bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impacts of Renal Sympathetic Activation on Atrial Fibrillation: The Potential Role of the Autonomic Cross Talk Between Kidney and Heart
Authors: Yu Lilei , Huang Bing , Wang Zhuo , Wang Songyun , Wang Menglong , Li Xuefei , Zhou Liping , Meng Guannan , Yuan Shenxu , Zhou Xiaoya , Jiang Hong 
Published: March 2017

Background

Recent studies have demonstrated that there is a high variability of renal sympathetic nerve density distribution from proximal to distal renal artery segments. The aim of our study was to investigate the roles of renal sympathetic nerve stimulation (
RSS
) on atrial fibrillation and cardiac autonomic nervous activity.

Methods and Results

Twenty‐eight dogs were randomly assigned to the proximal
RSS
group (P‐
RSS
, N=7), middle
RSS
group (M‐
RSS
, N=7), distal
RSS
group (D‐
RSS
, N=7), and the control group (sham
RSS
, N=7).
RSS
was performed using electrical stimulation on the bilateral renal arteries for 3 hours. Effective refractory period and the window of vulnerability were measured at atrial and pulmonary veins sites. Superior left ganglionated plexi (
SLGP
) and left stellate ganglion (
LSG
) function and neural activity were determined. C‐fos and nerve growth factor protein expression in the
SLGP
and
LSG
were examined. Only P‐
RSS
(1) caused pronounced blood pressure rises, induced a significant decrease in effective refractory period, and generated a marked increase in cumulative window of vulnerability and effective refractory period dispersion; (2) increased the frequency and amplitude of the neural activity in the
SLGP
and
LSG
; (3) increased
SLGP
and
LSG
function; and (4) upregulated the level of c‐fos and nerve growth factor expression in the
SLGP
and
LSG
.

Conclusions

This study demonstrated that renal sympathetic nerve activation induced by 3 hours of P‐
RSS
facilitated atrial fibrillation inducibility by upregulating cardiac autonomic nervous activity, suggesting a potential autonomic cross talk between kidney and heart.
Frequency Gradient Within Coronary Sinus Predicts the Long‐Term Outcome of Persistent Atrial Fibrillation Catheter Ablation
Authors: Yin Xiaomeng , Zhao Ziming , Gao Lianjun , Chang Dong , Xiao Xianjie , Zhang Rongfeng , Chen Qi , Cheng Jie , Yang Yanzong , Xi Yutao , Xia Yunlong 
Published: March 2017

Background

The coronary sinus (
CS
), as a junction of the atria, contributes to atrial fibrillation (
AF
) by developing unstable reentry, and isolating the atria by ablation at the
CS
could terminate
AF
. The present study evaluated whether
AF
activities at the
CS
in a subset of patients contributed to
AF
maintenance and predicted clinical outcome of ablation.

Methods and Results

We studied 122 consecutive patients who had a first‐time radiofrequency ablation for persistent
AF
. Bipolar electrograms were obtained from multiple regions of the left atrium by a Lasso mapping catheter before ablation. Pulmonary vein isolation terminated
AF
in 12 patients (9.8%). Sequential stepwise ablation was conducted in pulmonary vein isolation nontermination patients and succeeded in 22 patients (18%). In the stepwise termination group,
AF
frequency in the proximal
CS
(
CS
p) was significantly higher (10.2±2.1 Hz versus 8.3±1.8 Hz,
P
<0.001), and the ratio of distal
CS
(
CS
d) to proximal
CS
(
CS
d/
CS
p ratio, 56.6%±10.11% versus 70.7%±9.8%,
P
<0.001) was significantly lower than that in the nontermination group. The stepwise logistic regression analysis indicated that the
CS
d/
CS
p ratio was an independent predictor with an odds ratio of 1.131 (95%
CI
1.053‐1.214;
P
=0.001). With a cutoff of 67%, the patients with lower
CS
d/
CS
p ratios had significantly better index and long‐term outcomes than those with higher ratios during a follow‐up of 46±18 months.

Conclusions

Rapid repetitive activities in the musculature of the proximal
CS
may contribute to maintenance of
AF
after pulmonary vein isolation alone in persistent
AF
. A cutoff at 67%, of the
CS
d/
CS
p frequency ratio might be an indicator to stratify the subset of patients who might benefit from
CS
ablation.
Chronic pain care
Authors: Dezutter Jessie , Offenbaecher Martin , Vallejo Miguel A. , Vanhooren Siebrecht , Thauvoye Evalyne , Toussaint Loren 
Published: March 2017

Objective Experiencing pain not only affects patients’ biopsychosocial functioning but also the existential domain. Attention to the existential, in addition to the biopsychosocial domains, might thus be important in chronic pain care. Therefore, we investigated: (a) how satisfied patients were with the attention of their practitioners to the impact of pain on biological, psychological, social, and existential life domains, and (b) how satisfaction with each domain was related to patient functioning. Method Pain patients ( N = 163) were questioned on their satisfaction with the attention of their practitioners to biological, psychological, social, and existential life domains, and on pain intensity, pain disability, life satisfaction, and depressive symptoms. Results Patients reported low satisfaction with the attention of their practitioners to the social and existential domains. Satisfaction with each domain was negatively related with pain intensity, pain disability, and depressive symptoms and positively related with life satisfaction. Only satisfaction with the existential domain was able to predict all functional outcomes above and beyond all other satisfaction variables modeled simultaneously. Conclusions Patients reported not feeling satisfied with the attention to the social and existential life domains. Furthermore, practitioners’ attention to the existential domain seems highly important for patient functioning. Openness to existential concerns of pain patients might thus be an important aspect of chronic pain care.
Hypotension of ⩽110 mmHg is Associated with Increased Mortality in South African Patients After Trauma
Authors: Clarke D.L. , Brysiewicz P. , Sartorius B. , Bruce J.L. , Laing G.L. 
Published: March 2017

Introduction: This study used data from a prospectively maintained trauma database to assess the level of systolic blood pressure at which mortality rates for trauma begin to increase and to compare systolic blood pressure with base deficit as a predictor of outcome. Methodology: The Pietermaritzburg Metropolitan Trauma Service maintains a prospective digital trauma registry. All trauma patients admitted to the service for the period January 2012–January 2015 were included. Analysis was performed on systolic blood pressure relative to a number of selected markers of outcome and a variety of physiological parameters. Results: Out of an original data set of 2974 trauma patients, a total of 169 elective patients, 799 patients with isolated traumatic brain injury, and 27 patients with incomplete data were excluded to leave a sample size of 2148 patients. Of these, 1830 (85.2%) were males and 318 (14.8%) were females. The mean age (standard deviation) was 31.8 (12.0) years. The median age (interquartile range) was 29 (23–37) years. There were 89 deaths in this cohort (4.1%). The median systolic blood pressure (interquartile range) was 123 (112–136) mmHg. The median base deficit was −1.4 (interquartile range: −4.5 to 1). The inflection curves below with fitted non-linear curve clearly show the upward change in mortality frequency around a systolic blood pressure of ⩽110 mmHg as well for a base deficit below −5. A cutoff of <110 for systolic blood pressure yields a high sensitivity and very high positive predictive value of 82% (95% confidence interval: 81–84) and 98% (95% confidence interval: 97–98), but low specificity (56%) and negative predictive value (12%), respectively. Similar optimal cutoff analysis for base deficit versus mortality suggests base deficit >4.8 as a good predictor area under the curve (0.82; 95% confidence interval: 0.75–0.88). This cutoff yields a high sensitivity of 80% (95% confidence interval: 78–82), moderate specificity of 75% (95% confidence interval: 62–85), very high positive predictive value of 98% (95% confidence interval: 97–99) but low negative predictive value of 17% (15–28). Conclusion: The data suggest that traumatic shock starts to become manifest at a systolic blood pressure of 110 mmHg and that a systolic blood pressure reading of 90 mmHg represents an advanced state of shock. Systolic blood pressure by itself is a poor predictor of mortality and outcome. Base deficit appears to be a far better predictor of mortality than systolic blood pressure. Future models to categorize shock will have to combine vital signs with biochemical markers of hypoperfusion.
Systematic Screening of Adverse Reactions to Metal Debris after Recap-M2A-Magnum Metal-on-Metal Total Hip Arthroplasty
Authors: Mäntymäki H. , Junnila M. , Lankinen P. , Seppänen M. , Vahlberg T. , Mäkelä K. T. 
Published: March 2017

Background and Aims: An adverse reaction to metal debris is a known complication after large diameter head metal-on-metal total hip arthroplasty. However, the failure rate varies depending on the implant design. Therefore, we investigated the prevalence of adverse reaction to metal debris, as well as the symptoms and risk factors after undergoing a ReCap-M2a-Magnum large diameter head metal-on-metal total hip arthroplasty. Materials and Methods: Between 2005 and 2012, 1188 patients (1329 hips) underwent ReCap-M2a-Magnum total hip arthroplasty at our institution. Systematic screening for adverse reaction to metal debris was arranged using the Oxford Hip Score questionnaire, hip and pelvic radiographs, and assessments of the serum chromium and cobalt ion levels. Clinical evaluation and magnetic resonance imaging were performed for the symptomatic patients, as well as those with either chromium or cobalt ion levels ⩾5 µg/L. The prevalence of adverse reaction to metal debris after ReCap-M2a-Magnum total hip arthroplasty was assessed, and the risk factors for adverse reaction to metal debris were evaluated using logistic regression. The mean follow-up time was 5.2 (0.003–9.1) years. This study was an extension of a previous study conducted at our institution with 80 patients. Results: In total, 33 patients (33 hips, 2.5% of all hips) required a revision operation due to adverse reaction to metal debris. Moreover, 157 hips exhibited definitive adverse reaction to metal debris, but a revision operation was not performed (157 of 1329 hips, 11.8% of all hips). Overall, 190 out of 1329 (14.3%) hips had definitive adverse reaction to metal debris. Pain, subluxation sensation, clicking, swelling, a small head size, and a fair/poor Oxford Hip Score were associated with definitive adverse reaction to metal debris. Conclusion: We found a high prevalence of adverse reaction to metal debris in the ReCap-M2a-Magnum total hip arthroplasty patients in this study; however, most of the patients did not require revision operations.
Preoperative Aspartate Aminotransferase-to-Platelet Ratio Index Predicts Perioperative Liver-Related Complications Following Liver Resection for Colorectal Cancer Metastases
Authors: Amptoulach S. , Gross G. , Sturesson C. , Rissler P. , Kalaitzakis E. 
Published: March 2017

Background and Aims: There are limited data on the potential role of preoperative non-invasive markers, specifically the aspartate-to-alanine aminotransferase ratio and the aspartate aminotransferase-to-platelet ratio index, in predicting perioperative liver-related complications after hepatectomy for colorectal cancer metastases. Methods: Patients undergoing liver resection for colorectal cancer metastases in a European institution during 2003–2010 were retrospectively enrolled. Relevant data, such as neoadjuvant chemotherapy, preoperative liver function tests, and perioperative complications, were collected from medical records. The nontumorous liver parenchyma in the surgical specimens of 31 patients was re-evaluated. Results: Overall, 215 patients were included. In total, 40% underwent neoadjuvant chemotherapy and 47% major resection, while 47% had perioperative complications (6% liver-related). In multivariate regression analysis, the aspartate aminotransferase-to-platelet ratio index was independently associated with liver-related complications (odds ratio: 1.149, p = 0.003) and perioperative liver failure (odds ratio: 1.155, p = 0.012). The latter was also true in the subcohort of patients with neoadjuvant chemotherapy (odds ratio: 1.157, p = 0.004) but not in those without such therapy (p = 0.062). The aspartate-to-alanine aminotransferase ratio was not related to liver-related complications (p = 0.929). The area under the receiver operating characteristics curve for the aspartate aminotransferase-to-platelet ratio index as a predictor of liver-related complications was 0.857 (p = 0.008) in patients with neoadjuvant chemotherapy. Increasing aspartate aminotransferase-to-platelet ratio index was observed with an increase in degrees of sinusoidal obstruction syndrome (p = 0.01) but not for fibrosis (p = 0.175) or steatosis (p = 0.173) in the nontumorous liver in surgical specimens. Conclusion: The preoperative aspartate aminotransferase-to-platelet ratio index, but not the aspartate-to-alanine aminotransferase ratio, predicts perioperative liver-related complications following hepatectomy due to colorectal cancer metastases, in particular after neoadjuvant chemotherapy. The aspartate aminotransferase-to-platelet ratio index is related to sinusoidal obstruction syndrome in the nontumorous liver.
A quality improvement project to reduce waiting time for pediatric outpatient referral clinics in Singapore
Authors: Tan Justin Hung Tiong , Rajendra Barathi , Shahdadpuri Raveen , Loke Chui Yee , Ng Selena Su-Ling , Jaafar Nooraini , Lau Gek Muay , Tan May Chui Suan , Ng Kee Chong , Arkachaisri Thaschawee 
Published: March 2017

Background: The long waiting time in our General Pediatric Clinic results in the delay in diagnosis and treatment leading to increase in morbidity and dissatisfaction rate among sick children who seek treatment at KK Women’s and Children’s Hospital, Singapore. The mean ± SD waiting time in our General Pediatric Clinic increased from 40 ± 4 days in 2008 and 45 ± 7 days in 2009 to 50 ± 5 days in 2010. Objectives: To reduce long waiting times in our General Pediatric Clinic by 20%. Methods: The Reducing Waiting Time Working Group was formed to tackle the waiting time problem in the General Pediatric Clinic. Extensive literature was searched and reviewed, brainstorming and discussions were carried out and strategies were developed. A series of implementations were carried out sequentially including clearing of the backlog of cases, development of general and fast track referral guidelines, triaging system and ‘5 Days SMS and 48 Hours Call’ system. Results: By clearing the backlog cases, waiting time was reduced from 57 days to 44 days. Through effective triaging system and ‘5 Days SMS and 48 Hours Call’ system, the mean ± SD waiting time was further reduced by 30% from 50 ± 5 days to 35 ± 7 days. By June 2012, the mean waiting time was 27 days. Conclusions: Waiting time is one of the important indicators of healthcare quality provided by any healthcare institution. Through these implementations, waiting time was successfully reduced by 30%. These methods may serve as viable options to improve waiting time in other healthcare settings.
Total Kidney Volume as a Biomarker of Disease Progression in Autosomal Dominant Polycystic Kidney Disease
Authors: Tangri Navdeep , Hougen Ingrid , Alam Ahsan , Perrone Ronald , McFarlane Phil , Pei York 
Published: March 2017

Purpose of review: Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder characterized by the formation of kidney cysts and kidney enlargement, which progresses to kidney failure by the fifth to seventh decade of life in a majority of patients. Disease progression is evaluated primarily through serum creatinine and estimated glomerular filtration rate (eGFR) measurements; however, it is known that serum creatinine and eGFR values typically do not change until the fourth or fifth decade of life. Until recently, therapy only existed to target complications of ADPKD. As therapeutic agents continue to be investigated for use in ADPKD, a suitable biomarker of disease progression in place of serum creatinine is needed. Sources of information: This review summarizes recent research regarding the use of total kidney volume as a biomarker in ADPKD, as presented at the Canadian Society of Nephrology symposium held in April 2015. Findings: Measurement of patients’ total kidney volume made using ultrasound (US) or magnetic resonance imaging (MRI) has been shown by the Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease (CRISP) study to be directly correlated with both increases in cyst volume and change in glomerular filtration rate (GFR). Additional studies have shown total kidney volume to have an association with complications of ADPKD as well. Limitations: Areas for further study continue to exist in comparison of methods of measuring total kidney volume. Implications: We believe that the evidence suggests that total kidney volume may be an appropriate surrogate marker for ADPKD disease progression.
Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours
Authors: Arcangeli Stefano , Falcinelli Lorenzo , Bracci Stefano , Greco Alessandro , Monaco Alessia , Dognini Jessica , Chiostrini Cinzia , Bellavita Rita , Aristei Cynthia , Donato Vittorio 
Published: March 2017

Objective:
To evaluate treatment outcomes and patterns of CT lung injury after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) in a series of inoperable lung lesions.

Methods:
68 patients who were medically inoperable (69 lesions) without evidence of viable extrathoracic disease were included. Dose prescription was driven by tumour location (hilar/pericentral vs peripheral) and/or target volume. 52% of the lesions received a biological equivalent dose (BED10) ≥100 Gy. Assessment of tumour response was based on the Response Evaluation Criteria in Solid Tumours 1.1 criteria coupled with fluorine-18 fludeoxyglucose/positron emission tomography-CT. Toxicity monitoring was focused on treatment-related pulmonary adverse events according to the Common Terminology Criteria for Adverse Events v. 4.0. Acute and late events were classified as radiation pneumonitis (RP) and radiation fibrosis (RF), respectively. Survival curves were calculated using the Kaplan–Meier method. Univariate and multivariate analyses of survival were performed using the Cox proportional hazards model.

Results:
After a median follow-up of 12 months (range, 3–31 months), no instances of ≥Grade 4 RP was documented, and clinically severe (Grade 3) RP occurred in 5.8% of the patients. 2 (3%) patients developed a late severe (≥Grade 3) symptomatic RF. No specific pattern of CT lung injury was demonstrated, in both acute and late settings. Median overall survival (OS) and progression-free survival (PFS) for the entire population were 30.8 and 14.1 months, respectively. At multivariate analysis (MVA), BED10 ≥ 100 Gy and KPS ≥ 90 emerged as significant prognostic factors for OS (p = 0.01 and p = 0.001, respectively), and BED10 ≥ 100 Gy for PFS (p = 0.02).

Conclusion:
Our findings show that HHT adjusted for tumour location and/or target volume is an effective treatment with an acceptable toxicity profile in patients who are medically inoperable with lung tumours and is not associated with a specific pattern of lung injury. Therefore, it can represent a viable option when conventional stereotactic ablative radiotherapy facilities are not available.

Advances in knowledge:
The present study is among the largest series addressing the role of HHT for inoperable lung tumours. This technique is safe and effective and is not associated with a specific pattern of lung injury, at least at early and average time points.
ENERGETIC REGULARITIES OF PULSE LOADING BY SYSTEMS WITH INTERMEDIATE LINK
Authors: Яшин Александр , Yashin Aleksandr , Баринов Сергей , Barinov Sergey , Киричек Алексей , Kirichek Alexey , Зайцев Алексей , Zaytsev Aleksey 
Published: March 2017

The investigations carried out deal with the re-gularity study in the distribution of shock pulse energy at multiple procedures of loading. The experimental researches were carried out on the specially developed test bench in which under all waveguides (or tools) of the shock system there were situated independently (separately) sensors connected with an oscilloscope registering parameters of a shock pulse (a form, amplitude, duration).
As a result it was determined that the increase of the eccentricity in the symmetry axis location of a head and a waveguide (or a tool) and their number in the shock system contributes to the reduction of an energy portion sent to the deformation source. The application of multi-contact schemes of loading allows sending large total energy of a shock pulse to the deformation source to accept conditions of experiment fulfillment.
At that the energy portion of a shock pulse fall-ing to each waveguide (or a tool) in the multicontact scheme as compared with the singlecontact one decreases (for rod-formed waveguides by 20%, and for spherical tools – by 15%) at the installation of each subsequent waveguide (or a tool) in the shock system.
INTEGRAL LAW OF CHANGES IN SYNERGISTIC SYSTEMS
Authors: Титенок Александр , Titenok Aleksandr 
Published: March 2017

On the basis of longterm researches carried out by the author, the law deduced and formulated by him in the paper there is presented a theoretical concept on changes in a state of synergetic systems.
The sense of the law consists in the comprehension and reveal of the sources of creation and system development. The scientific problem is formulated. The model of the integral law of evolution in system changes is presented. A historical engineering aspect of the obtained model and its value from the positions of mathematics is substantiated. A theoretical significance and actual value of the integral law summarized the paper.
Comparative study of the dynamics of Mimas-Tethys system at different resonances
Authors: Jha Sarita , Jha Goind Kumar 
Published: March 2017

Here we have done the comparative study on the dynamics of Mimas-Tethys system at Â and Â resonances along with secular resonance of all inner satellites and Saturnâ€™s oblateness. We have drawn Poincare surface of sections and Time-series graph to compare their effect.