bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and effectiveness of large volume coils in the treatment of small aneurysms
Authors: Kulcsár Zsolt , Wanke Isabel , Rüfenacht Daniel , Wetzel Stephan G , Göricke Sophia , Kolia Kiriaki , Quarfordt Steven , Calvert Justin , Hawk Harris , Baxter Blaise 
Published: January 2016

Background and purposeLarge volume soft design coils facilitate quicker aneurysm filling and high packing density. Our purpose was to analyze the feasibility, safety, and effectiveness of the Penumbra Coil 400 (PC400) system in the treatment of small aneurysms.Materials and methodsA retrospective analysis of prospective data collected at three different centers was performed on consecutive aneurysms <10 mm treated with the PC400 system. A total of 92 aneurysms were included in the study. Feasibility, procedure safety, angiographic and clinical results, and follow-up results were evaluated.ResultsMean aneurysm size was 5.8±2.0 mm. An average of 2.5±1.3 coils with a mean length of 18±16 cm per aneurysm was used, resulting in a mean packing density of 45.6±14.4%. The thromboembolic event rate was 3.3% and no procedural aneurysm rupture was observed. Immediate adequate occlusion was achieved in 66% of aneurysms. During a mean follow-up period of 7.4 months the number of adequate occlusions increased to 91%.ConclusionsLarge volume PC 400 coils are safe and effective in the treatment of small aneurysms with a low thromboembolic complication rate and no hemorrhagic events. High packing densities are achieved with a low average number of coils used per aneurysm treated. The aneurysms demonstrated progressive occlusion over time, which probably suggests stability in the long term.
Influence of platelet reactivity on BARC classification in East Asian patients undergoing percutaneous coronary intervention
Authors: Kwon Tae Jung , Tantry Udaya S. , Park Yongwhi , Choi Young-Min , Ahn Jong-Hwa , Kim Kye Hwan , Koh Jin-Sin , Park Jeong-Rang , Hwang Seok-Jae , Kwak Choong Hwan , Hwang Jin-Yong , Gurbel Paul A. , Smith Sidney C. , Jeong Young-Hoon 
Published: January 2016

SummaryAn increasing body of data suggests that East Asian patients have differing risk profiles for both thrombophilia and bleeding compared with Western population. This study was designed to evaluate the relationship of bleeding to platelet function in East Asians undergoing percutaneous coronary intervention (PCI). Patients who had undergone uneventful PCI (n= 301) were prospectively enrolled and bleeding events were evaluated during dual antiplatelet therapy (DAPT) with aspirin and clopidogrel. Platelet function was measured during hospitalisation and at 30-day follow-up by light transmittance aggregometry (LTA) and vasodilator-stimulated phosphoprotein phosphorylation (VASP-P) assay. During 30-day follow-up, 29.2 % of patients (n=88) experienced post-discharge Bleeding Academic Research Consortium (BARC) complications (24.6 % and 7.0 % of BARC type 1 and 2, respectively). Patients presenting with acute myocardial infarction had fewer episodes of type 1 BARC bleeding (odds ratio: 0.41; 95 % confidence interval: 0.22 to 0.76; p= 0.005). The cut-off of low platelet reactivity (LPR) (20 μM ADP-induced platelet aggregation ≤ 46.1 %; platelet reactivity index ≤ 45.1 %) was the independent determinant of type 2 BARC bleeding (odds ratio: 3.55 and 4.44; p= 0.009 and 0.002, respectively). The first 30-day BARC bleeding episodes were associated with an increased rate of subsequent premature DAPT discontinuation during one-year follow-up (4.7 % vs 11.4 %; odds ratio: 2.60; 95 % confidence interval: 1.04 to 6.50; p= 0.035). In conclusion, among East Asians, mild bleeding episodes are common early after PCI and are associated with premature DAPT discontinuation. Type 2 BARC bleeding episodes are associated with LPR cut-offs measured at 30 days post-discharge.
Platelet inhibition with prasugrel in patients with acute myocardial infarction undergoing therapeutic hypothermia after cardiopulmonary resuscitation
Authors: Flierl Ulrike , Röntgen Philipp , Florian Zauner , Jörn Tongers , Dominik Berliner , Johann Bauersachs , Andreas Schäfer 
Published: January 2016

SummaryAcute myocardial infarction (AMI) is the leading cause for out-of-hospital cardiac arrest. Therapeutic hypothermia improves neurological outcome in combination with early revascularisation, but seems to affect clopidogrel responsiveness. The more potent thienopyridine prasugrel has not yet been sufficiently evaluated during therapeutic hypothermia. We investigated 23 consecutive AMI patients (61 ± 11 years) following out-of-hospital resuscitation undergoing revascularisation and therapeutic hypothermia. Prasugrel efficacy was assessed by the platelet-reactivity-index (PRI) before and 2, 4, 6, 12, 24, 48, and 72 hours(h) following a loading dose of 60 mg via a gastric tube. Mean PRI (±SD) was 70 ± 12 % prior to loading and 60 ± 16 % (2 h, ns), 52 ± 21 % (4 h, p< 0.01), 42 ± 26 % (6 h, p< 0.01), 37 ± 21 % (12 h, p< 0.01), 27 ± 23 % (24 h, p< 0.01), 18 ± 14 % (48 h, p< 0.01), and 13 ± 10 % (72 h, p< 0.01) after loading. Sufficient platelet inhibition occurred later compared to stable AMI patients (6 h vs 2 h); however, high on-treatment platelet reactivity significantly decreased over time and was non-existent after 72 h (PRI> 50 %: 2 h: 72 %, 4 h: 52 %, 6 h: 43 %, 12 h: 29 %, 24 h: 17 %, 48 h: 5 %, 72 h: 0 %). There was no relation between 30-day mortality rate (26 %) and PRI values. Prasugrel significantly reduced platelet reactivity even during vasopressor use, analgosedation and therapeutic hypothermia. Despite a significant delay compared to stable AMI patients, sufficient platelet inhibition was reached in 83 % of patients within 24 h. Therefore, prasugrel administration via gastric tube might be a useful therapeutic strategy in these patients at high risk, providing potent and effective P2Y12 inhibition.
Climate System Responses to a Common Emission Budget of Carbon Dioxide
Authors: Tian Di , Dong Wenjie , Yan Xiaodong , Chou Jieming , Yang Shili , Wei Ting , Zhang Han , Guo Yan , Wen Xiaohang , Yang Zhiyong 
Published: January 2016

Abstract
Global warming as quantified by surface air temperature has been shown to be approximately linearly related to cumulative emissions of CO2. Here, a coupled state-of-the-art Earth system model with an interactive carbon cycle (BNU-ESM) was used to investigate whether this proportionality extends to the complex Earth system model and to examine the climate system responses to different emission pathways with a common emission budget of man-made CO2. These new simulations show that, relative to the lower emissions earlier and higher emissions later (LH) scenario, the amount of carbon sequestration by the land and the ocean will be larger and Earth will experience earlier warming of climate under the higher emissions earlier and lower emissions later (HL) scenario. The processes within the atmosphere, land, and cryosphere, which are highly sensitive to climate, show a relatively linear relationship to cumulative CO2 emissions and will attain similar states under both scenarios, mainly because of the negative feedback between the radiative forcing and ocean heat uptake. However, the processes with larger internal inertias depend on both the CO2 emissions scenarios and the emission budget, such as ocean warming and sea level rise.
Prevalence of hypothyroidism in rheumatoid arthritis and its correlation with disease activity
Authors: Joshi Prakash , Agarwal Abhishek , Vyas Sony , Kumar Ravindra 
Published: January 2016

Objectives To analyse the prevalence of hypothyroidism in rheumatoid arthritis (RA) patients and to elucidate its correlation with disease activity. Methods A total of 52 RA patients were enrolled in this study. All patients were assessed fully clinically and underwent routine laboratory investigation including thyroid function testing. Results Hypothyroidism (defined as having a TSH level >4.20 μIU/mL) was observed in 20/52 (38.4%). Erythrocyte sedimentation rates (ESR) were found significantly elevated in patients with hypothyroidism compared to those without (36.3 ± 24.2 vs. 24.6 ± 9.0 mm/h). Disease activity parameters such as DAS-28-ESR, tender joint count; VAS scores were also significantly higher in the former. A significant correlation with serum TSH levels was observed with ESR and DAS-28-ESR. Conclusion Thyroid function test should be included in clinical evaluation of RA patients.
Quantification Analysis of the Intraoperative Bacterial Contamination Rate and Level in Osteochondral Autografts
Authors: Alomar Abdulaziz Z. , Somily Ali Mohammed , Alraiyes Thamer M. , Bin Nasser Ahmad S. , Aljassir Fawzi F. 
Published: January 2016

Background: Inadvertent contamination of osteochondral (OC) autografts during harvesting and preparation can lead to significant complications and can cause the operating team to weigh the infection risk after reimplantation against discarding the OC fragment. The most commonly reported contamination mechanism is the accidental dropping of an OC fragment; however, associated contamination levels remain unclear. The rate and level of contamination during standard harvesting and preparation are also unknown. Purpose: To quantitatively evaluate the rate and level of bacterial contamination of OC autografts during harvesting and preparation compared with those of accidently dropped autografts. Study Design: Controlled laboratory study. Methods: Under sterile conditions, 138 fresh OC specimens were harvested and retrieved from 23 primary total knee arthroplasties (TKAs). Six OC fragments were retrieved from each TKA: 3 were used as controls, and 3 were dropped onto the operating room floor. Each specimen was incubated to allow for aerobic and anaerobic growth, and the number of colony-forming units (CFUs) per gram was calculated. Results: Contamination rates (positive cultures) for the control and dropped groups were 29% (n = 20/69) and 42% (n = 29/69), respectively. The difference in the contamination rate between groups was not statistically significant ( P = .109). The most common organisms identified were Staphylococcus aureus (40%) in the control group and Staphylococcus epidermidis (24.1%) and Bacillus species (20.7%) in the dropped group. The contamination level (CFUs/g) for both groups was low. The median (range) CFUs/g among the contaminated specimens in the dropped and control groups were 27 (1-120) and 3 (1-15), respectively ( P < .0001). Conclusion: A relatively high rate of OC autograft contamination can be expected during harvesting and preparation (29%) or after accidentally dropping a specimen (42%). Although the types of organisms isolated differed between specimens contaminated during harvesting and preparation and dropped specimens, the quantification of the autograft contamination level revealed a very low CFUs/g in both cases. Clinical Relevance: The intraoperative autograft contamination level is very low. Hence, in cases of grafts with a known contamination incident, saving and reimplanting them after proper decontamination is recommended over discarding them or using an allograft.
Risk Factors for Short-term Complications of Anterior Cruciate Ligament Reconstruction in the United States
Authors: Cvetanovich Gregory L. , Chalmers Peter N. , Verma Nikhil N. , Cole Brian J. , Bach Bernard R. 
Published: January 2016

Background: Anterior cruciate ligament reconstruction (ACLR) is a commonly performed procedure that is highly successful in restoring knee stability and function. The incidence of early ACLR complications and the risk factors for these complications are not well defined. Purpose: To determine the incidence of 30-day complications and patient and surgical risk factors for complications after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent ACLR between 2005 and 2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database using Current Procedural Terminology billing codes. Postoperative complications in the 30-day period after surgery were identified. Potential patient and surgical risk factors for 30-day complications after ACLR were analyzed using univariate and multivariate analyses. Results: A total of 4933 patients were identified. Major complications occurred in 27 patients (0.55%), and minor complications occurred in 43 patients (0.87%), with overall complications occurring in 66 patients (1.34%). The most common complications were symptomatic deep venous thrombosis requiring treatment (n = 27; 0.55%), return to the operating room (n = 18; 0.36%), superficial infections (n = 10; 0.20%), deep infections (n = 7; 0.14%), and pulmonary embolism (n = 6; 0.12%). A single mortality (0.02%) occurred. Multivariate analyses demonstrated that smoking, dyspnea, a history of chronic obstructive pulmonary disease, and recent weight loss were all risk factors for the development of overall complications, although in combination, these factors accounted for only 3% of the variance in the complication rate. Conclusion: ACLR has a low incidence of complications (1.34%) in the early postoperative period, with the most common being symptomatic venous thromboembolic disease requiring treatment, return to the operating room, and infections. Because ACLR is an elective procedure, surgeons should use this information to counsel patients on risks and to guide their decision making about patient selection.
Is Knee Pain During Adolescence a Self-limiting Condition?
Authors: Rathleff Michael S. , Rathleff Camilla R. , Olesen Jens L. , Rasmussen Sten , Roos Ewa M. 
Published: January 2016

Background: The prevalence of adolescent knee pain is 33%, and patellofemoral pain (PFP) is the most common diagnosis with a nontraumatic onset. The 2-year prognosis of adolescent PFP compared with other types of knee pain is unknown. Purpose: To investigate the 2-year prognosis of knee pain among adolescents with and without a diagnosis of PFP. Study Design: Cohort study; Level of evidence, 2. Methods: In 2011, a cohort of 2200 adolescents aged 15 to 19 years answered an online questionnaire on musculoskeletal pain. Of these, 504 reported knee pain, and 153 of these were clinically diagnosed with PFP. After 2 years, the 504 adolescents, as well as 252 randomly selected adolescents who did not report knee pain in 2011, were contacted again. Primary outcome at follow-up was the proportion of adolescents with knee pain during the last week prior to follow-up. Results: Overall, 55.9% (95% CI, 50.8%-60.9%) of those reporting knee pain at baseline also reported pain 2 years later. Adolescents diagnosed with PFP had a 1.26 (95% CI, 1.05-1.50) higher relative risk (RR) of knee pain at follow-up compared with other types of knee pain. Adolescents with PFP were significantly more likely to reduce or stop sports participation compared with adolescents with other types of knee pain. Of those without knee pain at baseline, 12.8% (95% CI, 8.4%-17.2%) reported knee pain at follow-up in 2013. Adolescents with knee pain at baseline had a 4.51 (95% CI, 3.15-6.45) higher RR of knee pain at follow-up compared with adolescents without knee pain at baseline. Conclusion: Knee pain during adolescence, and PFP in particular, is in most cases present after 2 years and thus may not be self-limiting. A greater focus on early detection and prevention of knee pain during adolescence is needed.
Antenatal reflex DNA screening for trisomy 18 and trisomy 13 in addition to Down’s syndrome
Authors: Bestwick Jonathan P , Wald Nicholas J 
Published: January 2016

Objective Antenatal reflex DNA screening for Down’s syndrome has a high screening performance. We aimed to determine the performance of trisomy 18 and trisomy 13 reflex DNA screening when added to Down’s syndrome screening. Methods In our modelled screening protocol, women provide two samples: a serum sample for a Combined test and a plasma sample for a possible DNA test. Women with Down’s syndrome, trisomy 18, or trisomy 13 Combined test risks above a single cut-off have a reflex DNA test using the plasma sample, without the need to recall them to collect another sample and provide counselling. Women with a failed DNA test (after a second attempt using a fresh plasma sample) have an Integrated test, and are classified as positive if any of the Down’s syndrome, trisomy 18, or trisomy 13 Integrated test risks are greater than 1 in 25. Results At 1 in 800 term risk cut-offs for Down’s syndrome, trisomy 18, and trisomy 13, an estimated 10% of women are reflexed to DNA screening, yielding a 91% Down’s syndrome detection rate, an 89% trisomy 18 detection rate, and a 79% trisomy 13 detection rate for a 0.05% false-positive rate. At a 1 in 1900 term risk cut-off for Down’s syndrome, trisomy 18, or trisomy 13, an estimated 20% of women are reflexed to DNA screening, and this yields a 94% Down’s syndrome detection rate, a 92% trisomy 18 detection rate, and an 84% trisomy 13 detection rate for a 0.10% false-positive rate. Conclusion Reflex DNA screening for trisomies 18 and 13 can be usefully added to reflex DNA screening for Down’s syndrome.
Implementation of a visceral surgery clinical pathway: Evaluating patient satisfaction with information, safety and involvement in care
Authors: Cudré Léon , Mabire Cédric , Pellet Joanie , Demartines Nicolas 
Published: January 2016

Background Care pathways are essential to ensure continuity, quality, efficient use of resources and positive patient outcomes. Although patient satisfaction is widely considered a major indicator of care quality, it remains largely unexamined in the context of care pathway implementation. The aim of this study was to assess patient satisfaction during implementation of a care pathway for recurrent surgeries. Method A newly designed questionnaire was utilized to examine patient satisfaction among adult patients hospitalized for visceral surgery at the University Hospital of Lausanne (CHUV). Analysis was conducted through nine care pathways frequently performed in visceral surgeries. Results Of the 280 patients surveyed, 258/280 (92%) of patients were satisfied with information received, 255/280 (91%) with the safety and 210/280 (75%) with their involvement in decision-making and care. Conclusion Patient satisfaction ratings of the care received during the care pathway were high. Complete and personalized information seems to be the key element for patients’ sense of safety and involvement in decision making and care.
Endobronchial ultrasound: morphological predictors of benign disease
Authors: Gogia Pratibha , Insaf Tabassum Z. , McNulty William , Boutou Afroditi , Nicholson Andrew G. , Zoumot Zaid , Shah Pallav L. 
Published: January 2016

The objective of this study was to assess the utility of endobronchial ultrasound (EBUS) morphology of lymph nodes in predicting benign cytology of transbronchial needle aspirates in a prospective observational study.Five ultrasonic morphological characteristics of mediastinal and hilar lymph nodes were recorded: size, shape, margins, echogenic appearance and the presence of a central blood vessel. These characteristics were correlated with the final diagnosis. A total of 402 consecutive patients (237 males and 165 females) undergoing EBUS were studied.The final diagnosis was malignant disease in 244 (60.6%) and benign disease in 153 (38.05%) subjects. Out of 740 sampled nodes, in 463 (62.6%) malignant cells were identified, whereas in 270 (36.5%) nodes, no malignant cells were identified. On univariate analysis small size, triangular shape and the presence of a central vessel were predictive of a benign aetiology. In the final multivariate model, a predictive probability of 0.811 (95% CI 0.72–0.91) for benign disease was found if lymph node size was <10 mm and a central vessel was present.Sonographic appearances of lymph nodes improve the predictive probability of EBUS for benign aetiologies, and may reduce the number of nodes requiring sampling and the need for further invasive investigations.
Electrical impedance tomography (EIT) for quantification of pulmonary edema in acute lung injury
Authors: Trepte Constantin J. C. , Phillips Charles R. , Solà Josep , Adler Andy , Haas Sebastian A. , Rapin Michael , Böhm Stephan H. , Reuter Daniel A. 
Published: January 2016

Abstract
Background
Assessment of pulmonary edema is a key factor in monitoring and guidance of therapy in critically ill patients. To date, methods available at the bedside for estimating the physiologic correlate of pulmonary edema, extravascular lung water, often are unreliable or require invasive measurements. The aim of the present study was to develop a novel approach to reliably assess extravascular lung water by making use of the functional imaging capabilities of electrical impedance tomography.

Methods
Thirty domestic pigs were anesthetized and randomized to three different groups. Group 1 was a sham group with no lung injury. Group 2 had acute lung injury induced by saline lavage. Group 3 had vascular lung injury induced by intravenous injection of oleic acid. A novel, noninvasive technique using changes in thoracic electrical impedance with lateral body rotation was used to measure a new metric, the lung water ratioEIT, which reflects total extravascular lung water. The lung water ratioEIT was compared with postmortem gravimetric lung water analysis and transcardiopulmonary thermodilution measurements.

Results
A significant correlation was found between extravascular lung water as measured by postmortem gravimetric analysis and electrical impedance tomography (r = 0.80; p < 0.05). Significant changes after lung injury were found in groups 2 and 3 in extravascular lung water derived from transcardiopulmonary thermodilution as well as in measurements derived by lung water ratioEIT.

Conclusions
Extravascular lung water could be determined noninvasively by assessing characteristic changes observed on electrical impedance tomograms during lateral body rotation. The novel lung water ratioEIT holds promise to become a noninvasive bedside measure of pulmonary edema.