bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical Activity Measured by Implanted Devices Predicts Atrial Arrhythmias and Patient Outcome: Results of IMPLANTED (Italian Multicentre Observational Registry on Patients With Implantable Devices Remotely Monitored)
Authors: Palmisano Pietro , Guerra Federico , Ammendola Ernesto , Ziacchi Matteo , Luigi Pisanò Ennio Carmine , Dell'Era Gabriele , Aspromonte Vittorio , Zaccaria Maria , Di Ubaldo Francesco , Capucci Alessandro , Nigro Gerardo , Occhetta Eraldo , Maglia Giampiero , Ricci Renato Pietro , Boriani Giuseppe , Accogli Michele , Botto Gian Luca , Bertaglia Emanuele , Zoni Berisso Massimo , Nissardi Vincenzo , Santini Luca , Soldati Ezio , Stabile Giuseppe , Landolina Maurizio , Padeletti Luigi 
Published: February 2018

Background
To determine whether daily physical activity (PA), as measured by implanted devices (through accelerometer sensor), was related to the risk of developing atrial arrhythmias during long‐term follow‐up in a population of heart failure (HF) patients with an implantable cardioverter defibrillator (ICD).

Methods and Results

The study population was divided into 2 equally sized groups (PA cutoff point: 3.5 h/d) according to their mean daily PA recorded by the device during the 30‐ to 60‐day period post‐ICD implantation. Propensity score matching was used to compare 2 equally sized cohorts with similar characteristics between lower and higher activity patients. The primary end point was time free from the first atrial high‐rate episode (AHRE) of duration ≥6 minutes. Secondary end points were: first AHRE ≥6 hours, first AHRE ≥48 hours, and a combined end point of death or HF hospitalization. Data from 770 patients (65±15 years; 66% men; left ventricular ejection fraction 35±12%) remotely monitored for a median of 25 months were analyzed. A PA ≥3.5 h/d was associated with a 38% relative reduction in the risk of AHRE ≥6 minutes (72‐month cumulative survival: 75.0% versus 68.1%; log rank
P
=0.025), and with a reduction in the risk of AHRE ≥6 hours, AHRE ≥48 hours, and the combined end point of death or HF hospitalization (all
P
<0.05).

Conclusions
In HF patients with ICD, a low level of daily PA was associated with a higher risk of atrial arrhythmias, regardless of the patients' baseline characteristics. In addition, a lower daily PA predicted death or HF hospitalization.
The Deviated Nose and the Nasal Airway
Authors: Maran A G D 
Published: February 2018

The pathology of the deviated nose is discussed in relation to its bony and cartilaginous components. The importance of the interlocking stresses within the septal cartilage is pointed out especially with respect to continuing deformation after trauma. The methods of rhinometry are analysed and normal airflow through the nose is described. The effects on the nasal airway of a caudal dislocation of the septum, an angulation at the valve area, a high septal deflection and an excessively wide choana are discussed. In the treatment of a deviated bony segment the difficulties of medial and lateral osteotomies are described. The indications for a septoplasty are thought to be a dislocated caudal end, a tip deviation and an external lateral angulation. The submucous resection of the septum should be reserved for resolved haematoma and cartilage absorption. The importance of the patient's priorities in deciding what operation to do are pointed out. Finally the experimental work on the effect of cartilage and mucoperichondrium resection on nasal growth is reviewed. It is suggested that a child with a severe septal deflection and airway obstruction should be offered a septoplasty taking care not to damage the mucoperichondrium.
Integrating building modelling with future energy systems
Authors: Jenkins David 
Published: February 2018

The low-carbon building design process for a building engineer is often confined to construction, building services and occupancy. However, as we see coincident changes in climate, technologies, fuels and operation, it becomes important to extend this understanding to include wider energy systems, while clarifying the importance of the built environment within that system. With energy systems, such as the National Grid, involving multiple actors from different disciplines, a key challenge is to provide guidance and future projections that are translated into different discipline-specific vernaculars, but with a genesis of common assumptions. More generally, integration across the disciplines must be reflected by modelling approaches, policy-making frameworks and outputs. This article will demonstrate the initial stages of the energy demand research of the Centre of Energy Systems Integration project, where novel modelling techniques are being used to explore the effect of future buildings on national energy systems. Practical application: The tools and techniques described within this article are designed with future industry practice in mind. The driver is the increased importance of external factors outside the traditional building envelope in determining the energy and carbon performance of a building (or buildings). Building engineers, and others within building design teams, require a new portfolio of tools and resources to better account for the impact of buildings on wider energy systems and vice versa. The role of such practitioners is therefore likely to evolve.
Comparison of Pediatric Intracapsular Tonsillectomy and Extracapsular Tonsillectomy: A Cost and Utility Decision Analysis
Authors: Baik Grace , Brietzke Scott E. 
Published: February 2018

ObjectivesTo use decision analysis modeling to compare utility and cost outcomes of intracapsular tonsillectomy (ICT) and extracapsular tonsillectomy (ECT). To use sensitivity analysis to determine the most important factors influencing outcomes favoring one surgical method versus another.Study DesignDecision analysis model.SettingHypothetical cohort.Subjects and MethodsA decision analysis model was created with computer software comparing the results of ICT and ECT. The model featured complications with completion tonsillectomy, such as postsurgical bleed, dehydration, and tonsillar regrowth. Outcomes were quantified with a utility scale ranging from 0.95 (1 surgical procedure without complications) to 0.55 (ICT, regrowth requiring completion ECT, post‐ECT bleeding). Costs measured out‐of‐pocket costs for an insured patient and factored in different recovery times for ECT versus ICT.ResultsBased on baseline parameters, ECT had higher cumulative utility than ICT. Utility model results were highly dependent on the value of having a single uncomplicated surgery, as well as on the tonsillar regrowth rate. Utility was equal at a regrowth rate of 1.64%; rates above this value favored ECT. The base cost model showed that ICT ($4177.92) was less expensive than ECT ($4546.91), although ICT with regrowth had the highest outcome cost ($8393.91). ECT and ICT costs were equal at a tonsil regrowth rate of 17.8% and at a recovery period of 7.4 days.ConclusionUtility decision modeling based on best estimates for baseline parameters suggests that ECT may be slightly superior to ICT, but cost analysis suggests the opposite. However, the comparative results are highly dependent on subtle changes in the tonsil regrowth rate and the potential difference in recovery time.
Cancer patients’ experiences of living with venous thromboembolism: A systematic review and qualitative thematic synthesis
Authors: Benelhaj Naima B , Hutchinson Ann , Maraveyas Anthony M , Seymour Julie D , Ilyas Muhammad Waqas , Johnson Miriam J 
Published: February 2018

Background: Cancer-associated thrombosis is common. Recommended treatment is daily injected low-molecular-weight heparin for 6 months. Most studies focus on prophylaxis and treatment; few have explored the patients’ experience. Aims: To identify and synthesise the available literature concerning patients’ experience of cancer-associated thrombosis. Design: Systematic literature review and qualitative thematic synthesis. Data source: MEDLINE, Embase, CINAHL, PsycINFO (until 10/2016; limited to English) were searched. Eligible papers were qualitative studies of adult patients’ experience of cancer-associated thrombosis. Two researchers screened titles/abstracts/papers against inclusion criteria with recourse to a third for disagreements. Critical Appraisal Skills Programme qualitative checklist tool was used for quality appraisal. Results: A total of 1397 articles were identified. Five qualitative studies (total n = 92; age range 32–84 years) met the inclusion criteria. Participants had various cancer types. Most had advanced disease and were receiving palliative care. Four major themes emerged from the data: knowledge deficit (patients and clinicians), effects of cancer-associated thrombosis (physical and psychological), effects of anticoagulation and coping strategies. Conclusion: The cancer journey is difficult in itself, but thrombosis was an additional, frightening and unexpected burden. Although the association between cancer and thromboembolism is well-known, cancer patients are not routinely educated about the risk or warning symptoms/signs of thromboembolism which may otherwise be misattributed to the cancer by patient and clinician alike. This systematic review highlights the impact of cancer-associated thrombosis on the lives of cancer patients, and calls for education for patients and clinicians to be part of routine care and further work to address this patient priority.
20-HETE synthesis inhibition promotes cerebral protection after intracerebral hemorrhage without inhibiting angiogenesis
Authors: Han Xiaoning , Zhao Xiaochun , Lan Xi , Li Qian , Gao Yufeng , Liu Xi , Wan Jieru , Yang Zengjin , Chen Xuemei , Zang Weidong , Guo Austin M , Falck John R , Koehler Raymond C , Wang Jian 
Published: February 2018

20-HETE, an arachidonic acid metabolite synthesized by cytochrome P450 4A, plays an important role in acute brain damage from ischemic stroke or subarachnoid hemorrhage. We tested the hypothesis that 20-HETE inhibition has a protective effect after intracerebral hemorrhage (ICH) and then investigated its effect on angiogenesis. We exposed hippocampal slice cultures to hemoglobin and induced ICH in mouse brains by intrastriatal collagenase injection to investigate the protective effect of 20-HETE synthesis inhibitor N-hydroxy-N′-(4- n-butyl-2-methylphenyl)-formamidine (HET0016). Hemoglobin-induced neuronal death was assessed by propidium iodide after 18 h in vitro. Lesion volume, neurologic deficits, cell death, reactive oxygen species (ROS), neuroinflammation, and angiogenesis were evaluated at different time points after ICH. In cultured mouse hippocampal slices, HET0016 attenuated hemoglobin-induced neuronal death and decreased levels of proinflammatory cytokines and ROS. In vivo, HET0016 reduced brain lesion volume and neurologic deficits, and decreased neuronal death, ROS production, gelatinolytic activity, and the inflammatory response at three days after ICH. However, HET0016 did not inhibit angiogenesis, as levels of CD31, VEGF, and VEGFR2 were unchanged on day 28. We conclude that 20-HETE is involved in ICH-induced brain damage. Inhibition of 20-HETE synthesis may provide a viable means to mitigate ICH injury without inhibition of angiogenesis.
Comprehensive Geriatric Assessment in Elderly Cancer Patients: An Experience in an Outpatient Population
Authors: Arnoldi Ermenegildo , Dieli Maria , Mangia Marina , Minetti Bruno , Labianca Roberto 
Published: February 2018

Aims and background Cancer is an age-related disease, and the increase in life expectancy will lead to a progressive increase of cancer cases in the elderly (≥70 years of age). We have created a group called GONG (Gruppo Oncologico Geriatrico) to apply cancer geriatric assessment in elderly cancer patients, in order to select which of them are eligible for oncological treatment or supportive care only. Patients and methods We applied this model to evaluate 153 patients from March 2004 to August 2005. Our model included three categories of patients: frail (at least one of the following items: Activities of Daily Living scale <80, ≥3 comorbidities unrelated to the tumor according to the Charlson Index, performance status ≤60/≥3 according respectively to Karnofsky and the ECOG scale, ≥1 geriatric syndrome); borderline (patients with multiple comorbidities not affecting performance status or ability in daily activities); non-frail. Results Applying the aforementioned criteria, we found 30 borderline, 14 frail and 109 non-frail patients. Statistical analysis showed a significant difference in mortality between frail and non-frail patients (P <0.05), whereas there was no difference between borderline and non-frail patients. Conclusions Our model was thus able to identify patients at higher risk of death. These results confirm the importance of cancer geriatric assessment also for the clinical evaluation of oncological patients. Additional randomized studies with a larger number of patients, also in an adjuvant setting, should be performed to confirm the effectiveness of this approach.
Late Brain Metastases from Breast Cancer: Clinical Remarks on 11 Patients and Review of the Literature
Authors: Piccirilli Manolo , Sassun Tanya Enny , Brogna Christian , Giangaspero Felice , Salvati Maurizio 
Published: February 2018

Aims and Background Late brain metastases from breast cancer are a rare event. Only a few cases have been reported in the English literature. The authors describe the clinical and pathological remarks, together with treatment modalities, removal extent and overall survival, of 11 patients in whom brain metastases were detected more than 10 years from the primary tumor. Patients and Methods Between January 1997 and April 2001, we hospitalized 11 patients, all females, with a histologically proven diagnosis of brain metastasis from breast invasive ductal carcinoma. We defined ‘late metastasis’ as those metastases that appeared at least 10 years after the breast cancer diagnosis. The median age at the moment of brain metastasis diagnosis was 59 years (range, 47-70), with a median latency time from breast cancer diagnosis of 16 years (range, 11-30). Results Ten patients underwent surgery followed by adjuvant radiotherapy (whole brain radiotherapy). Two of them received, after whole brain radiotherapy, stereotaxic radio surgery treatment. One patient had stereotaxic brain biopsy, performed by neuronavigator, followed by palliative corticosteroid therapy. Median survival after brain metastasis diagnosis was 28 months (range, 3 months-4 years). Conclusions Although late brain metastases are a rare event, specific neurologic symptoms and neuroradiological evidence of a cerebral neoplasm should be correlated to the presence of a cerebral metastasis, in a patient with a previous history of breast cancer. The longer latency time from breast cancer to brain metastasis could be explained by the “clonal dominance” theory and by different genetic alterations of the metastatic cell, which could influence the clinical history of the disease.
Utility of the Clinical Practice of Admnistering Thrombophilic Screening and Antithrombotic Prophylaxis with Low-Molecular-Weight Heparin to Healthy Donors Treated with G-Csf for Mobilization of Peripheral Blood Stem Cells
Authors: Martino Massimo , Luise Francesca , Oriana Vincenzo , Console Giuseppe , Moscato Tiziana , Mammì Corrado , Messina Giuseppe , Massara Elisabetta , Irrera Giuseppe , Piromalli Angela , Lombardo Vincenzo Trapani , Laganà Carmelo , Lacopino Pasquale 
Published: February 2018

The aim of the study was to verify the utility of the clinical practice of administering thrombophilic screening and antithrombotic prophylaxis with low-molecular-weight heparin to healthy donors receiving granulocyte colony-stimulating factor to mobilize peripheral blood stem cells. Thrombophilia screening comprised of testing for factor V Leiden G1691A, prothrombin G20210A, the thermolabile variant (C677T) of the methylene tetrahydrofolate reductase gene, protein C, protein S, factor VIII and homocysteine plasmatic levels, antithrombin III activity, and acquired activated protein C resistance. We investigated prospectively 72 white Italian healthy donors, 39 men and 33 women, with a median age of 42 years (range, 18-65). Five donors (6.9%) were heterozygous carriers of Factor V Leiden G1691A; two healthy donors had the heterozygous prothrombin G20210A gene mutation; C677T mutation in the methylene tetrahydrofolate reductase gene was present in 34 (47.2%) donors in heterozygous and in 7 donors (9.7%) in homozygous. Acquired activated protein C resistance was revealed in 8 donors of the study (11.1%). The protein C plasmatic level was decreased in 3 donors (4.2%); the protein S level was decreased in 7 donors (9.7%). An elevated factor VIII dosage was shown in 10 donors (13.9%) and hyperhomocysteinemia in 9 donors (12.5%). Concentration of antithrombin III was in the normal range for all study group donors. The factor V Leiden mutation was combined with the heterozygous prothrombin G20210A in 2 cases and with protein S deficiency in one case; 2 healthy donors presented an associated deficiency of protein C and protein S. Although none of these healthy subjects had a previous history of thrombosis, low-molecular-weight heparin was administered to all donors during granulocyte colony-stimulating factor administration to prevent thrombotic events. No donor experienced short or long-term thrombotic diseases after a median follow-up of 29.2 months. Our data do not support this clinical practice because there is no evidence that the combination of granulocyte colony-stimulating factor to previous hypercoagulable conditions results in thrombotic events.
Sphincter Preservation in Four Consecutive Phase II Studies of Preoperative Chemoradiation: Analysis of 247 T3 Rectal Cancer Patients
Authors: Gambacorta Maria Antonietta , Valentini Vincenzo , Coco Claudio , Manno Alberto , Doglietto Giovanni B , Ratto Carlo , Cosimelli Maurizio , Miccichè Francesco , Maurizi Francesca , Tagliaferri Luca , Mantini Giovanna , Balducci Mario , La Torre Giuseppe , Barbaro Brunella , Picciocchi Aurelio 
Published: February 2018

Aims and Background To evaluate the impact of preoperative chemoradiation on sphincter preservation in patients with low- medium locally advanced resectable rectal cancer treated by four chemoradiation schedules. Materials and Methods Between 1990 and 2002, 247 patients were treated according to four schedules of chemoradiotherapy: FUMIR (5-fluorouracil, mitomycin, external beam radiotherapy 37.8 Gy), PLAFUR (cisplatinum, 5-fluorouracil, external beam radiotherapy 50.4 Gy), TOMRT (raltitrexed, external beam radiotherapy 50.4 Gy), and TOMOXRT (raltitrexed, oxaliplatin, external beam radiotherapy 50.4 Gy). Four to five weeks after chemoradiation, patients were restaged and surgery was performed 2-3 weeks later. Results Overall, the sphincter-saving surgery was performed in 82.5% of patients. In patients candidate to an abdominoperineal resection before chemoradiaton (distance tumor-anorectal ring, <30 mm) a sphincter-saving surgery was possible in 58% of cases: 44% (FUMIR), 52% (PLAFUR), 63% (TOMRT), 76% (TOMOXRT) (P <0.017). The involved surgeons kept the same surgical criteria in performing sphincter-saving surgery. After chemoradiation, patients with tumor location still between 0 and 30 mm received sphincter-saving surgery according to the protocols: 33% (FUMIR), 42% (PLAFUR), 50% (TOMRT), 64% (TOMOXRT) (P = 0.066) Conclusions Even though the surgeons’ skill in performing sphincter-saving surgery could be improved with time, the high rate of this procedure in the latest schedules suggests an impact of the new drugs in promoting tumor downsizing and therefore sphincter-saving surgery.
In Vivo Evaluation of Melanoma Thickness by Multispectral Imaging and An Artificial Neural Network. A Retrospective Study on 250 Cases of Cutaneous Melanoma
Authors: Marchesini Renato , Bono Aldo , Tomatis Stefano , Bartoli Cesare , Colombo Ambrogio , Lualdi Manuela , Carrara Mauro 
Published: February 2018

Aims and Background Noninvasive diagnostic methods such as dermoscopy, sonography, palpation or combined approaches have been developed in an attempt to preoperatively estimate melanoma thickness. However, the clinical presentation is often complex and the evaluation subjective. Multispectral image analysis of melanomas allows selection of features related to the content and distribution of absorbers, mainly melanin and hemoglobin, present within the lesion. Hence, it is reasonable to assume that the same features might be useful to predict melanoma thickness. Methods A multispectral image system was used to analyze in vivo 1939 pigmented skin lesions. The lesion selection was based on clinical and/or dermoscopic features that supported a suspicion for melanoma. All the lesions were then subjected to surgery for the histopathological diagnosis, and 250 were melanomas. From the multispectral images of the melanomas, we selected 12 features, seven of which were used to train and test an artificial neural network on 155 and 95 melanomas, respectively. Results Sensitivity (i.e., melanoma ≥0.75 mm thick correctly classified) and specificity (i.e., melanoma <0.75 mm thick correctly classified) evaluated from the receiving operating characteristic curves ranged from 76 to 90% and from 91 to 74%, respectively. Conclusions Our approach provides results similar to those obtained with other methods and has the advantage that it is not related to the expertise of the clinician. In addition, the physical interpretation of the selected features suggests a possible role of spectrophotometry as an objective method to study the natural history of the early phases of the disease.
P53 Gene Mutations in Surgical Margins and Primary Tumor Tissues of Patients with Squamous Cell Carcinoma of the Head and Neck
Authors: Tunca Berrin , Erisen Levent , Coskun Hakan , Cecener Gulsah , Ozuysal Sema , Egeli Unal 
Published: February 2018

Aims and Background The frequency of p53 mutations in primary tumors, the effect of the mutations on some clinical and pathological features of head and neck squamous cell carcinoma, and the impact of p53 mutations in the surgical margins on local recurrence were determined. Material and Methods We investigated the presence of p53 mutations in primary tumor samples and in the surgical margins of 34 patients with head and neck cancer using single strand conformational polymorphism and sequencing analysis. Results The p53 mutations (codons 175addAT, 175delGC, 206G→A, and 248delC) were found in the primary tumor samples of 15 of 34 patients (44.12%) and in the surgical margins of 5 of the 15 tumors (33.33%) with p53 mutations. Conclusions We found no statistically significant association between the presence of p53 mutations in the primary tumor, the clinical and pathological features, or outcome of head and neck squamous cell carcinoma in this study. Furthermore, the presence of p53 mutations in the surgical margins may not increase the risk of local-regional recurrence, but probably increases the risk of developing distant metastases or second primary tumors.