bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical significance of intrapancreatic choledochal cyst excision in surgical management of type I choledochal cyst
Authors: Fan Fei , Xu Da-Peng , Xiong Zheng-Xiang , Li Hai-Jia , Xin Hai-Bei , Zhao Huan , Zhang Jin-Wei 
Published: January 2018

Objective To investigate the effectiveness of intrapancreatic choledochal cyst excision in treating type I choledochal cyst, and increase understanding of the need for thorough surgical management of the disease. Methods Primary and secondary (including multiple) surgical cases, treated between 2005 and 2015, were retrospectively analysed, and follow-up data of post-treatment effectiveness to date were reviewed. Differences in curative effects were compared between whole and partial excision of the choledochal cyst. Results Out of 350 cases, patients with whole excision of the choledochal cyst ( n = 272) experienced no associated symptoms in the long-term (3/272 [1.1%] experienced stomach ache or fever). Patients with partial resection of the choledochal cyst ( n = 78) developed associated symptoms, including new cyst, calculus of the bile duct (51/78 [65.4%]), and carcinogenesis (11/78 [14.1%]) in the residual intrapancreatic biliary duct. Post-treatment clinical manifestations were significantly different between patients with partial resection versus whole excision of the choledochal cyst ( P<0.05). Conclusion Surgical re-excision should be considered in patients with a residual intrapancreatic portion of the choledochal cyst due to prior incomplete surgery, regardless of clinical symptoms.
CD133 expression and MYCN amplification induce chemoresistance and reduce average survival time in pediatric neuroblastoma
Authors: Zhong Zhi-Yong , Shi Bao-Jun , Zhou Hui , Wang Wen-Bo 
Published: January 2018

Objectives Neuroblastoma (NB) is the most common pediatric solid tumor derived from the sympathetic nervous system. MYCN is amplified in nearly half of patients with NB, and its association with rapid disease progression and poor outcome is controversial. Characterization of cancer stem cells (CSCs) in NBs has been rarely studied. This study was performed to determine whether MYCN and CD133+ CSCs are associated with chemotherapy resistance and the survival time of patients with NB. Methods Fifty patients with an unequivocal pathological diagnosis of NB were recruited. MYCN expression levels were measured before therapy. CSCs were derived and their multipotency tested by directed differentiation. The patients’ responses to chemotherapy and average survival time were compared among the groups as follows: CD133+, CD133−, MYCN amplification ≥5 times (i.e. MYCN≥5), MYCN<5, CD133+ plus MYCN≥5, and CD133− plus MYCN<5. Results CD133+ CSCs differentiated into neuron-like cells. CD133+ patients had a significantly poorer response to chemotherapy than did CD133− patients. CD133+ plus MYCN≥5 patients had a significantly shorter average survival time than did CD133− plus MYCN<5 patients. Conclusions CD133+ CSCs are chemoresistance. CD133 expression and MYCN amplification can be used together as a prognostic indicator of disease outcome.
The Responsiveness of Patient- Reported Outcome Tools in Shoulder Surgery Is Dependent on the Underlying Pathological Condition
Authors: Unger R. Zackary , Burnham Jeremy M. , Gammon Lee , Malempati Chaitu S. , Jacobs Cale A. , Makhni Eric C. 
Published: January 2018

Background: Given the high number of available patient-reported outcome (PRO) tools for patients undergoing shoulder surgery, comparative information is necessary to determine the most relevant forms to incorporate into clinical practice. Purpose: To determine the utilization and responsiveness of common PRO tools in studies involving patients undergoing arthroscopic rotator cuff repair or operative management of glenohumeral instability. Study Design: Systematic review. Methods: A systematic review of rotator cuff and instability studies from multiple databases was performed according to PRISMA guidelines. Means and SDs of each PRO tool utilized, study sample sizes, and follow-up durations were collected. The responsiveness of each PRO tool compared with other PRO tools was determined by calculating the effect size and relative efficiency (RE). Results: After a full-text review of 238 rotator cuff articles and 110 instability articles, 81 studies and 29 studies met the criteria for final inclusion, respectively. In the rotator cuff studies, 25 different PRO tools were utilized. The most commonly utilized PRO tools were the Constant (50 studies), visual analog scale (VAS) for pain (44 studies), American Shoulder and Elbow Surgeons (ASES; 39 studies), University of California, Los Angeles (UCLA; 20 studies), and Disabilities of the Arm, Shoulder and Hand (DASH; 13 studies) scores. The ASES score was found to be more responsive than all scores including the Constant (RE, 1.94), VAS for pain (RE, 1.54), UCLA (RE, 1.46), and DASH (RE, 1.35) scores. In the instability studies, 16 different PRO tools were utilized. The most commonly used PRO tools were the ASES (13 studies), Rowe (10 studies), Western Ontario Shoulder Instability Index (WOSI; 8 studies), VAS for pain (7 studies), UCLA (7 studies), and Constant (6 studies) scores. The Rowe score was much more responsive than both the ASES (RE, 22.84) and the Constant (RE, 33.17) scores; however, the ASES score remained more responsive than the Constant (RE, 1.93), VAS for pain (RE, 1.75), and WOSI (RE, 0.97) scores. Conclusion: Despite being frequently used in the research community, the Constant score may be less clinically useful as it was less responsive. Additionally, it is a greater burden on the provider because it requires objective strength and range of motion data to be gathered by the clinician. In contrast, the ASES score was highly responsive after rotator cuff repair and requires only subjective patient input. Furthermore, separate PRO scoring methods appear to be necessary for patients undergoing rotator cuff repair and surgery for instability as the instability-specific Rowe score was much more responsive than the ASES score.
Investigating Effects of Sex Differences and Prior Concussions on Symptom Reporting and Cognition Among Adolescent Soccer Players
Authors: Brooks Brian L. , Silverberg Noah , Maxwell Bruce , Mannix Rebekah , Zafonte Ross , Berkner Paul D. , Iverson Grant L. 
Published: January 2018

Background: There has been increasing concern regarding the possible effect of multiple concussions on the developing brain, especially for adolescent females. Hypothesis/Purpose: The objectives were to determine if there are differences in cognitive functioning, symptom reporting, and/or sex effects from prior concussions. In a very large sample of youth soccer players, it was hypothesized that (1) there would be no differences in cognitive test performance between those with and without prior concussions, (2) baseline preseason symptoms would be better predicted by noninjury factors than concussion history, and (3) males and females with prior concussions would not have differences in cognition or symptoms. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Participants included 9314 youth soccer players (mean = 14.8 years, SD = 1.2) who completed preseason baseline cognitive testing, symptom reporting, and a health/injury history questionnaire from the ImPACT battery (Immediate Post-concussion Assessment and Cognitive Testing). On the basis of injury history, athletes were grouped by number of prior concussions: 0 (boys, n = 4012; girls, n = 3963), 1 (boys, n = 527; girls, n = 457), 2 (boys, n = 130; girls, n = 97), or ≥3 (boys, n = 73; girls, n = 55). The primary measures were the 4 primary cognitive scores and the total symptom ratings from ImPACT. Primary outcomes were assessed across injury groups, controlling for age, sex, learning disability, attention-deficit/hyperactivity disorder (ADHD), treatment for headaches/migraines, substance abuse, and mental health problems. Results: Cognitive test performance was not associated with concussion history but was associated with sex, age, learning disability, ADHD, and prior mental health problems. Greater symptom reporting was more strongly associated with psychiatric problems, older age, learning disability, substance abuse, headaches, being female, and ADHD than with a history of multiple concussions. Boys and girls did not differ on cognitive scores or symptom reporting based on a history of concussion. Conclusion: In this very large sample of youth soccer players with prior concussion, there was no evidence of negative effects on cognition, very weak evidence of negative effects on symptom reporting, and no evidence of sex × concussion differences in cognition or symptom reporting.
Cytokine Removal during Continuous Renal Replacement Therapy: An Ex Vivo Comparison of Convection and Diffusion
Authors: Cole L. , Bellomo R. , Davenport P. , Tipping P. , Ronco C. 
Published: January 2018

Background and objectives It is unknown whether cytokine adsorption to the membrane during continuous renal replacement therapy is affected by the technique. Such knowledge might affect the choice of technique in vivo. Accordingly, we conducted an ex vivo study to test whether continuous veno-venous hemofiltration (CVVH) or continuous veno-venous hemodialysis (CVVHD) affect cytokine adsorption differently. Setting Laboratory attached to the Intensive Care Unit of a tertiary hospital Design Six healthy human volunteers donated blood, which was incubated with endotoxin. Control blood was left at room temperature, and treatment blood was recirculated for eight hours through closed circuits using polyacrylonitrile membranes (AN69). The effect of CVVH and CVVHD on cytokine removal from the circuits was compared. Measurements The concentrations of interleukins (IL)-1ß, 6, 8, 10 and TNF were measured in the control samples, pre-and post-filter and in the effluent at baseline and hourly thereafter. The clearances by adsorption, and filtration were calculated. Results Control cytokine concentrations remained the same or increased slightly. Adsorption was the major mechanism of removal for all cytokines with the exception of IL-1ß, but the effect was short-lived. Peak adsorption generally occurred at baseline before the start of CVVH and CVVHD, with clearances ranging from 43.7ml/min (for IL-8) to 7.6ml/min (for IL-10). The time-weighted average total clearances during CVVH were 23.3, 4.3, 3.8, –2.0, and 15ml/min for IL-8, IL-1ß, TNF, IL-6, and IL-10 respectively. The corresponding clearances during CVVHD were 19.0, 10.7, 2.7, 2.4, and 0.3ml/min. IL-10 clearances were greater during CVVH than CVVHD (p=0.03). Non adsorptive CVVH clearance of IL-1ß was greater than CVVHD clearance, but this advantage was outweighed by an increased tendency of the membrane to release IL-1ß into the circuit during HF. Conclusions The technique of solute removal had only a minor effect on the magnitude of cytokine adsorption, and neither technique had the advantage for all the measured cytokines.
First Clinical Trial for a New Crrt Machine: The Prismaflex
Authors: Salvatori G. , Ricci Z. , Bonello M. , Ratanarat R. , D'intini V. , Brendolan A. , Dan M. , Piccinni P. , Bellomo R. , Ronco C. 
Published: January 2018

A new CRRT machine has been designed to fulfill the expectations of nephrologists and intensivists operating in the common ground of critical care nephrology. The new equipment is called “Prismaflex” (Gambro-Dasco, Mirandola, Modena) and it is the natural evolution of the Prisma machine that has been utilized worldwide for CRRT in the last decade. We performed a preliminary “alfa trial” to establish usability, flexibility and realiability of the new device. Accuracy was also tested by recording various operational parameters during different intermittent and continuous renal replacement modalities. Forty-one runs were conducted on 13 patients and the difference between delivered and prescribed parameters was always lower than 2%. We concluded that the new Prismaflex is a well designed new machine for CRRT and can be safely and effectively utilized in the critical care nephrology setting.
An Easy Technique to Digest and Isolate UHMWPE Wear Particles from a Hip Joint Simulator
Authors: Affatato S. , Emiliani D. , Bersaglia G. , Traina F. , Toni A. 
Published: January 2018

The size and morphology of polyethylene wear particles isolated from in vitro tests were analysed in this study. There are some major controversies emerging in the literature that will only be resolved by careful particles analysis. Since it is difficult to identify the factors that affect size and morphology of the wear particles, the goal of this study was to compare four different polymer wear debris isolation techniques (base method and acid treatment) under identical conditions in a hip joint simulator to obtain polyethylene wear particles. We investigated achieving particulate isolation by using a different approach to the one reported in the literature that involved an easier and streamline method of particle debris isolation. The new method, compared to the previous one, used a strong base, normal centrifugation, and filtration to digest the serum constituents thus isolating the polyethylene particle debris from lubricant. In all four methods the isolation involved some or all of the following steps: density gradient separation, centrifugation or ultracentrifugation, and washing. However, a requirement for all these techniques was that the lubricant had to be devoid of organic compounds in order to effectively image and count the particle debris. The results from these studies clearly show that this new method of particle isolation is easier and more streamlined than the three methods analysed and reported in literature because it did not involve ultracentrifugation and is quicker.
Biomedical Coatings to Improve the Tissue-Biomaterial Interface
Authors: Rizzi G. , Scrivani A. , Fini M. , Giardino R. 
Published: January 2018

One of the most important factors determining the degree of tissue interaction of an implanted device is the property of its surface. Thus, great importance is given to chemical and morphological characteristics of biomaterial surfaces to improve biocompatibility, cell migration, proliferation and differentiation, mechanical stability and endogenous tissue ingrowth. In order to obtain new and healing stimulating properties, it is possible to apply a coating or more generally a surface treatment to the surface of a prosthetic device. One of the most versatile methods for coating is thermal spray technology. This paper considers the principle of thermal spray processes and their application in the biomedical field, namely the coatings used for orthopedic prostheses and dental implants. Among thermal spray processes, plasma spray as well as High Velocity Oxygen Fuel (HVOF) processes will be particularly considered and their most important aspects will be illustrated.
Robust Motor Speed Control under Time Varying Loads in Moving Actuator Type artificial Heart (AnyHeart)
Authors: Lee J.J. , Kim W.E. , Choi J. , Park J.W. , Chung J. , Nam K. , Park S.K. , Son H.S. , Sun K. , Min B.G. 
Published: January 2018

The Moving Actuator type artificial heart(AnyHeart) as well as many other artificial hearts uses a motor as its power source. For controllability of control parameters such as pump rate, pump output, blood pressure profile and flow form, the precise motor speed control is important. However, because the implantable device has limited carrying capacity of hardware components in size and number, applying diverse motor control methods are not possible. In addition, the existing PI (Proportional-Integral) motor controller does not show satisfactory performance. A new controller that is sufficiently robust for the changes of load and physical system parameters has been designed and tested. The robust speed controller is based on the sliding mode control method that is applicable to a system of which the ranges of uncertainty in physical parameters are known. In a mock circulation system test, the actual speed showed good tracking characteristics in respect to the reference speed. Fast follow-up characteristics were also observed under high afterload and speed conditions. The speed error, current and power consumption were reduced by about 40%. The proposed control technique overcomes the limitations of the PI controller, and makes important improvements in both performance and stability.
Extracorporeal Blood Treatment (EBT) Methods in SIRS/Sepsis
Authors: Bellomo R. , Honoré P. , Matson J. , Ronco C. , Winchester J. 
Published: January 2018

Background Extracorporeal blood purification treatment (EBT) methods have been used in the treatment of experimental and human SIRS/Sepsis in a variety of settings and with variable reports of efficacy and safety. Their role in the management of SIRS/Sepsis remains controversial. Objectives To develop consensus statements regarding important aspects of research, practice and technical management concerning EBT. Methods Systematic review of published study. Evidence-based grading of information available. Consensus development regarding fundamental questions about EBT. Results Consensus was achieved on all questions posed during the conference. It was agreed that there is currently a clear biological rational for EBT in SIRS and Sepsis. It was agreed that conventional CVVH has sufficiently been shown not to be effective in SIRS/Sepsis in the absence of concomitant ARF and that other therapies such as plasmapheresis or high-volume hemofiltration or coupled plasma filtration adsorption appear more promising and should be tested in multicentre randomized controlled trials. Patients with ARF and SIRS/Sepsis should be treated differently from those with ARF alone even though current practice in this field is not well known. Patients with refractory septic shock should be considered for EBT. Appropriate end points for clinical trials can be defined and chosen according to the goals of the trial. Different technologies exist for EBT and better understanding of the merits and safety of each is needed as well as better standardization of methodology and dose. Conclusions Broad consensus can be achieved on several aspects of EBT and can be used to inform clinical practice and to help guide the establishment of a future research agenda.
Plasma Therapies in Thrombotic Syndromes
Authors: Nguyen T.C. , Stegmayr B.G. , Busund R. , Bunchman T.E. , Carcillo J.A. 
Published: January 2018

Background Plasma therapies are being applied to thombotic syndromes, but there are limited controlled studies. Objective To review the evidence and the current practices for plasma therapies in thrombotic syndromes. Methods Expert-enhanced evidence-based analysis. Evidence obtained as of Dec 31, 2002 using Pub Med electronic reference library and expert-obtained library for a total of > 3,000 references obtained using the terms plasma therapy or plasma exchange or plasmapheresis or plasmafiltration or sorbents each combined with the words thrombotic syndrome or sepsis or septic shock. The authors screened the abstracts, reviewed the agreed set of papers, and compiled the recommendations. Results Plasma therapies, which alter the plasma components in patients, have been applied in thrombotic syndromes worldwide. In these patients, there is a biologic plausibility for plasma therapies since they have molecules that are prothrombotic and/or antifibrinolytic which would put them at risk for microvascular thrombosis and end-organ damage. There are respectively one randomized controlled trial (RCT) in primary thrombotic syndrome, and secondary thrombotic syndrome, which showed an improvement in mortality in applying plasma therapies (plasma exchange by centrifugation). However, there are numerous non-randomized and case series. Plasma exchange is accepted as the standard therapy for primary thrombotic syndrome as in thrombotic thrombocytopenic purpura (TTP). However, no consensus has been reached for plasma exchange in secondary thrombotic syndromes such as in sepsis, hemolytic uremic syndrome (HUS), thrombocytopenia associated multiple organ failure, TTP/HUS, s/p bone marrow or solid organ transplant, HELLP syndrome, immunologic disorders, drug exposure, or pancreatitis. Conclusions As we understand more about the pathophysiology of thrombotic syndromes, specific plasma therapies can be applied for the specific need of a particular patient population. There are sufficient preliminary data to recommend a definitive RCT to evaluate the efficacy of the different types of plasma therapies in secondary thrombotic syndromes.
New Generation Ceramic Membranes have the Potential of Removing Endotoxins from Dialysis Water and Dialysate
Authors: Czermak P. , Ebrahimi M. , Catapano G. 
Published: January 2018

Poor water properties, use of concentrated bicarbonate, and biofilm growth in pipes and storage tanks often cause dialysis water and dialysate contamination with bacteria and endotoxins. High-flux dialysis with bicarbonate may favor endotoxin transfer from the dialysate into the blood exposing patients to serious short - and long-term side effects. Ultrafiltration across hydrophobic synthetic membranes effectively removes endotoxins from dialysis water by combined filtration and adsorption. However, repeated sterilization worsens the membrane separation properties, and limits their use. Ceramic membranes are generally more resistant to harsh operating conditions than polymeric membranes, and may represent an alternative for endotoxin removal. Previously, we proved that the ceramic membranes commercially available at that time were not retentive enough to ensure production of endotoxin-free dialysis water. In this paper, we investigated the endotoxin removal capacity of new generation commercial ceramic membranes with nominal molecular weight cut-off down to 1,000. In dead-end filtration, all investigated membranes produced water meeting, the European standards, or close to, when challenged with low endotoxin concentrations, but only one membrane type succeeded at high endotoxin concentrations. In cross-flow filtration, none produced water meeting the European standard. Moreover, sterilization and rinsing procedures altered the separation properties of two out of three membrane types.
New Methods for Hemoglobin Detection in a Microparticle-Plasma Suspension
Authors: Brandl M. , Hartmann J. , Falkenhagen D. 
Published: January 2018

In the extracorporeal adsorption system, MDS (Microspheres based Detoxification System), micro-adsorbent particles measuring 1–25 micrometers circulate in a filtrate circuit for highly specific blood purification/adsorption. The MDS circuit containing the adsorbent microparticles is linked to the patient's blood line by a hollow fiber plasma filter. When the transmembrane pressure or the shear forces due to the red blood cells in the hollow fiber filter are too high, they can be damaged and hemoglobin will be released. In order to detect free hemoglobin (fHb) by optical means, we have designed a new flow-dynamic filter system, placed in the microadsorbent circuit for continuous separation of microparticles from the filtrate. In the flow dynamic filter, we use a high velocity liquid vortex to remove sedimentation and particle plugs on the filter membrane. In our investigations, 3 and 8 μm cellulose nitrate filter membranes for particle separation are used. The obtained particle free bypass filtrate flow rates are typically 0.5 and 0.8 ml/min respectively. The typical sensitivity for fHb detection by the applied noninvasive optical method is 0.15 g/dL. Medical safety regulations require a fail-safe mechanism for fHb detection which monitors the bypass filtrate flow in the flowdynamic filter and shuts down the system in case of membrane occlusion. The bypass filtrate flow is monitored by periodically occluding and releasing the bypass line by means of a clamp. The resulting back pressure profile gives information about the actual filtration rate. This safety principle was proven by statistical analysis and shows its clear functionality. (Int J Artif Organs 2006; 29: 1092–100)