bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical outcomes of transcatheter aortic valve implantation: from learning curve to proficiency
Authors: Lunardi Mattia , Pesarini Gabriele , Zivelonghi Carlo , Piccoli Anna , Geremia Giulia , Ariotti Sara , Rossi Andrea , Gambaro Alessia , Gottin Leonardo , Faggian Giuseppe , Vassanelli Corrado , Ribichini Flavio 
Published: August 2016

ObjectiveThe use of transcatheter aortic valve implantation (TAVI) is growing rapidly in countries with a predominantly elderly population, posing a huge challenge to healthcare systems worldwide. The increment of human and economic resource consumption imposes a careful monitoring of clinical outcomes and cost-benefit balance, and this article is aimed at analysing clinical outcomes related to the TAVI learning curve.MethodsOutcomes of 177 consecutive transfemoral TAVI procedures performed in 5 years by a single team were analysed by the Cumulative Sum of failures method (CUSUM) according to the clinical events comprised in the Valve Academic Research Consortium (VARC-2) safety end point and the VARC-2 definition of device success. Margins for events acceptance were extrapolated from landmark trials that tested both balloon or self-expandable percutaneous valves.Results30-day and 1-year survival rates were 97.2% and 89.9%, respectively. Achievement of the primary end point (number of cases needed to provide the acceptable margin of the composite end point of any death, stroke, myocardial infarction, life-threatening bleeding, major vascular complications, stage 2–3 acute kidney injury and valve-related dysfunction requiring a repeat procedure) required the performance of 54 cases, while the learning curve to achieve ‘device success’ identified 32 cases to reach the expected proficiency. In this experience, the baseline clinical risk as assessed by the Society of Thoracic Surgeons (STS) score determined the long-term survival rather than the adverse events related to the learning curve.ConclusionsA relatively large number of cases are required to achieve clinical outcomes comparable to those reported in high-volume centres and controlled trials. According to our national workload standards, this represents more than 2 years of continuous activity.
Drivers of healthcare costs associated with the episode of care for surgical aortic valve replacement versus transcatheter aortic valve implantation
Authors: Wijeysundera Harindra C , Li Lindsay , Braga Vevien , Pazhaniappan Nandhaa , Pardhan Anar M , Lian Dana , Leeksma Aric , Peterson Ben , Cohen Eric A , Forsey Anne , Kingsbury Kori J 
Published: August 2016

ObjectiveTranscatheter aortic valve implantation (TAVI) is generally more expensive than surgical aortic valve replacement (SAVR) due to the high cost of the device. Our objective was to understand the patient and procedural drivers of cumulative healthcare costs during the index hospitalisation for these procedures.DesignAll patients undergoing TAVI, isolated SAVR or combined SAVR+coronary artery bypass grafting (CABG) at 7 hospitals in Ontario, Canada were identified during the fiscal year 2012–2013. Data were obtained from a prospective registry. Cumulative healthcare costs during the episode of care were determined using microcosting. To identify drivers of healthcare costs, multivariable hierarchical generalised linear models with a logarithmic link and γ distribution were developed for TAVI, SAVR and SAVR+CABG separately.ResultsOur cohort consisted of 1310 patients with aortic stenosis, of whom 585 underwent isolated SAVR, 518 had SAVR+CABG and 207 underwent TAVI. The median costs for the index hospitalisation for isolated SAVR were $21 811 (IQR $18 148–$30 498), while those for SAVR+CABG were $27 256 (IQR $21 741–$39 000), compared with $42 742 (IQR $37 295–$56 196) for TAVI. For SAVR, the major patient-level drivers of costs were age >75 years, renal dysfunction and active endocarditis. For TAVI, chronic lung disease was a major patient-level driver. Procedural drivers of cost for TAVI included a non-transfemoral approach. A prolonged intensive care unit stay was associated with increased costs for all procedures.ConclusionsWe found wide variation in healthcare costs for SAVR compared with TAVI, with different patient-level drivers as well as potentially modifiable procedural factors. These highlight areas of further study to optimise healthcare delivery.
Variation in the use of definitive treatment options in the management of Graves’ disease: a UK clinician survey
Authors: Hookham Jessica , Collins Emma E , Allahabadia Amit , Balasubramanian Sabapathy P 
Published: August 2016

ABSTRACTBackgroundGraves’ disease can be treated with antithyroid drugs (ATDs), radioiodine or surgery. Use of definitive treatments (radioiodine or surgery) varies widely across centres. Specific clinical circumstances, local facilities, patient and clinician preferences and perceptions will affect the choice of treatment. Detailed understanding of UK clinicians’ views and their rationale for different treatments is lacking.AimsTo study the preferences and perceptions of UK clinicians on the role of surgery and radioiodine in the management of Graves’ disease.Methods‘British Thyroid Association’ (BTA), ‘Society for Endocrinology’ (SFE) and ‘British Association of Endocrine and Thyroid Surgeons’ (BAETS) members were invited to complete an online survey examining their management decisions in Graves’ disease and factors that influenced their decisions.Results158 responses from UK consultants were included. The ratio of physicians to surgeons was 11:5 and males to females was 12:4. Most clinicians would commence ATDs in uncomplicated first presentation of Graves’ disease. A wide range of risk estimates on the effectiveness and risks of treatment was given by clinicians. Radioiodine was used most frequently in relapsed Graves’ disease. However, severe eye disease and pregnancy strongly influenced choice in favour of surgery. Surgeons underestimated the success of radioiodine (p&lt;0.01) and were more likely to recommend thyroidectomy than physicians.ConclusionsThis survey demonstrates significant variation in clinicians’ perceptions of risks of treatment and their choice of management options for relapsed Graves’ disease. The variation appeared to be dependent on patient and disease-specific factors as well as physician experience, gender and specialty.
Cytotoxic Properties of a DEPTOR-mTOR Inhibitor in Multiple Myeloma Cells
Authors: Shi Yijiang , Daniels-Wells Tracy R. , Frost Patrick , Lee Jihye , Finn Richard S. , Bardeleben Carolyne , Penichet Manuel L. , Jung Michael E. , Gera Joseph , Lichtenstein Alan 
Published: August 2016

Abstract
DEPTOR is a 48 kDa protein that binds to mTOR and inhibits this kinase in TORC1 and TORC2 complexes. Overexpression of DEPTOR specifically occurs in a model of multiple myeloma. Its silencing in multiple myeloma cells is sufficient to induce cytotoxicity, suggesting that DEPTOR is a potential therapeutic target. mTORC1 paralysis protects multiple myeloma cells against DEPTOR silencing, implicating mTORC1 in the critical role of DEPTOR in multiple myeloma cell viability. Building on this foundation, we interrogated a small-molecule library for compounds that prevent DEPTOR binding to mTOR in a yeast-two-hybrid assay. One compound was identified that also prevented DEPTOR–mTOR binding in human myeloma cells, with subsequent activation of mTORC1 and mTORC2. In a surface plasmon resonance (SPR) assay, the compound bound to recombinant DEPTOR but not to mTOR. The drug also prevented binding of recombinant DEPTOR to mTOR in the SPR assay. Remarkably, although activating TORC1 and TORC2, the compound induced apoptosis and cell-cycle arrest in multiple myeloma cell lines and prevented outgrowth of human multiple myeloma cells in immunodeficient mice. In vitro cytotoxicity against multiple myeloma cell lines was directly correlated with DEPTOR protein expression and was mediated, in part, by the activation of TORC1 and induction of p21 expression. Additional cytotoxicity was seen against primary multiple myeloma cells, whereas normal hematopoietic colony formation was unaffected. These results further support DEPTOR as a viable therapeutic target in multiple myeloma and suggest an effective strategy of preventing binding of DEPTOR to mTOR. Cancer Res; 76(19); 5822–31. ©2016 AACR.
Water Concentration Analysis by Raman Spectroscopy to Determine the Location of the Tumor Border in Oral Cancer Surgery
Authors: Barroso Elisa M. , Smits Roeland W.H. , van Lanschot Cornelia G.F. , Caspers Peter J. , ten Hove Ivo , Mast Hetty , Sewnaik Aniel , Hardillo José A. , Meeuwis Cees A. , Verdijk Rob , Noordhoek Hegt Vincent , Baatenburg de Jong Robert J. , Wolvius Eppo B. , Bakker Schut Tom C. , Koljenović Senada , Puppels Gerwin J. 
Published: August 2016

AbstractAdequate resection of oral cavity squamous cell carcinoma (OCSCC) means complete tumor removal with a clear margin of more than 5 mm. For OCSCC, 85% of the surgical resections appear inadequate. Raman spectroscopy is an objective and fast tool that can provide real-time information about the molecular composition of tissue and has the potential to provide an objective and fast intraoperative assessment of the entire resection surface. A previous study demonstrated that OCSCC can be discriminated from healthy surrounding tissue based on the higher water concentration in tumor. In this study, we investigated how the water concentration changes across the tumor border toward the healthy surrounding tissue on freshly excised specimens from the oral cavity. Experiments were performed on tissue sections from 20 patients undergoing surgery for OCSCC. A transition from a high to a lower water concentration, from tumor (76% ± 8% of water) toward healthy surrounding tissue (54% ± 24% of water), takes place over a distance of about 4 to 6 mm across the tumor border. This was accompanied by an increase of the heterogeneity of the water concentration in the surrounding healthy tissue. The water concentration distributions between the regions were significantly different (P &lt; 0.0001). This new finding highlights the potential of Raman spectroscopy for objective intraoperative assessment of the resection margins. Cancer Res; 76(20); 5945–53. ©2016 AACR.
Contribuições da análise da atividade do trabalho no processo de retorno do trabalhador afastado por LER/DORT
Authors: Silva Elaine Cristina , Camarotto João Alberto 
Published: August 2016

O aumento do número de trabalhadores afastados por LER/DORT tem constrangido a sociedade brasileira a lidar com esse problema, visto que a importância de suasmanifestações pode ser considerada um grave problema de saúde pública. Os trabalhadores afastados têm encontrado várias dificuldades ao retornar ao trabalho, uma vez que, além das limitações funcionais, também enfrentam obstáculos no trabalho. Além disso, a reabilitação profissional do INSS, não garante as melhorias necessárias para um efetivo retorno às atividades laborais. Frente a esta realidade, o objetivo deste artigo é proporcionar o entendimento de como a análise da atividade de trabalho contribui para o processo de retorno de trabalhadores afastados por LER/DORT. O modelo proposto no fluxograma para a análise do processo de retorno ao trabalho, após afastamento por LER/DORT, é explicado e associado aos pressupostos da Ergonomia da Atividade. A análise da atividade de trabalho permite a compreensão dos aspectos intrínsecos das ações dos trabalhadores e os respectivos constrangimentos, o que permite aproximar a necessidade da empresa com as potencialidades dos trabalhadores.
Validade e reprodutibilidade do Questionário de Hábitos relacionados ao Trabalho (QHT) para trabalhadores do SAMU 192
Authors: Chaise Fabiana Oliveira , Kasten Ana Paula , Furlanetto Tássia Silveira , Pasa Jorge , Candotti Cláudia Tarragô 
Published: August 2016

O estudo teve objetivo de desenvolver um questionário sobre hábitos relacionados ao trabalho (QHT) e verificar sua validade e reprodutibilidade. As etapas do QHT foram: observação de campo e revisão teórica sobre hábitos relacionados ao trabalho de profissionais da área da saúde; descrição e conteúdo; validade de conteúdo e reprodutibilidade. Para análise dos dados foi utilizado estatística descritiva (validade de conteúdo) e percentual de concordância(%C) e a medida de concordância Kappa (reprodutibilidade). Seis especialistas avaliaram a maior parte do instrumento como excelente, considerando-o válido em seu conteúdo. Os valores de Kappa mostraram concordância moderadas a excelentes entre as respostas(%C>80%), indicando ser o QHT um instrumento reprodutível. Apesar das limitações do QHT tais como ausência de questões sobre etilismo e desequilíbrio entre demanda de trabalho e disponibilidade de recursos humanos, o alcance prático do instrumento está na suafacilidade em obtenção de informações para conhecer o perfil e alguns importantes aspectos de rotina de trabalho dos trabalhadores da saúde, útil para avaliação na área da Terapia Ocupacional.
Une défense de la langue arabe dialev ctale dans un journal de l’Association des Oulémas algériens en 1936 : démontrer l’unicité de la langue arabe par la richesse de ses parlers
Authors: Courreye Charlotte 
Published: August 2016

Whereas the Algerian Ulama are usually perceived as an elite, giving value only to fuṣḥā Arabic and despising the local dialects, an article promoting the vernacular Arabic language (ʿāmmiyya) and enhancing its use was published in one of their newspapers in February 1936. This original argumentation leads us to question their link to the Arabic language, conceived as a comprehensive entity composed by a founding language and its various branches. In colonial context, the priority was in fact to preserve this language from foreign influences to struggle against acculturation.
Alors qu’il est communément admis que les Oulémas algériens, par élitisme, ne prêtaient de valeur qu’à l’arabe éloquent (fuṣḥā) et méprisaient les parlers locaux, un journal de l’Association des Oulémas Musulmans Algériens publia en février 1936 un article qui défendait l’usage et l’intérêt de la langue arabe dialectale (ʿāmmiyya). Cette argumentation originale nous permet d’interroger leur rapport à la langue arabe, conçue comme un tout cohérent composé d’une langue-mère aux différentes branches. En contexte colonial, la priorité était en fait de préserver cette langue des influences étrangères, pour lutter contre l’acculturation.
This article is in French.
A Coding System for Reoperations Following Total Ankle Replacement and Ankle Arthrodesis
Authors: Younger Alastair S. E. , Glazebrook Mark , Veljkovic Andrea , Goplen Gordon , Daniels Timothy R. , Penner Murray , Wing Kevin J. , Dryden Peter J. , Wong Hubert , Lalonde Karl-André 
Published: August 2016

Background: Repeated surgery can be a measure of failure of the primary surgery. Future reoperations might be avoided if the cause is recognized and procedures or devices modified accordingly. Reoperations result in costs to both patient and the health care system. This paper proposes a new classification system for reoperations in end-stage ankle arthritis, and analyzes reoperation rates for ankle joint replacement and arthrodesis surgeries from a multicenter database. Methods: A total of 213 ankle arthrodeses and 474 total ankle replacements were prospectively followed from 2002 to 2010. Reoperations were identified as part of the prospective cohort study. Operating reports were reviewed, and each reoperation was coded. To verify inter- and intraobserver reliability of this new coding system, 6 surgeons experienced in foot and ankle surgery were asked to assign a specific code to 62 blinded reoperations, on 2 separate occasions. Reliability was determined using intraclass correlation coefficients (ICCs) and proportions of agreement. Results: Of a total of 687 procedures, 74.8% (514/687) required no reoperation (Code 1). By surgery type, 14.1% (30/213) of ankle arthrodesis procedures and 30.2% (143/474) of ankle replacement procedures required reoperation. The rate for reoperations surrounding the ankle joint (ie, Codes 2 and 3) was 9.9% (21/213) for ankle arthrodesis versus 5.9% for ankle replacement (28/474). Reoperation rates within the ankle joint (ie, Codes 4 to 10) were 4.7% (10/213) for ankle arthrodesis and 26.1% (124/474) for ankle replacement. Overall, 0.9% (2/213) of arthrodesis procedures required reoperation outside the initial operative site (Code 3), versus 4.6% (22/474) for total ankle replacement. The rate of reoperation due to deep infection (Code 7) was 0.9% (2/213) for arthrodesis versus 2.3% (11/474) for ankle replacement. Interobserver reliability testing produced a mean ICC of 0.89 on the first read. The mean ICC for intraobserver reliability was 0.92. For interobserver, there was 87.9% agreement (804/915) on the first read, and 87.5% agreement (801/915) on the second. For the intra observer readings, 88.5% (324/366) were in agreement. Conclusions: The new coding system presented here was reliable and may provide a more standardized, clinically useful framework for assessing reoperation rates and resource utilization than prior complication- and diagnosis-based classification systems, such as modifications of the Clavien Dindo System. Analyzing reoperations at the primary site may enable a better understanding of reasons for failure, and may therefore improve the outcomes of surgery in the future. Level of Evidence: Level III, retrospective comparative cohort study based on prospectively collected data.
Value of 3D Reconstructions of CT Scans for Calcaneal Fracture Assessment
Authors: Roll Christina , Schirmbeck Johanna , Müller Franz , Neumann Carsten , Kinner Bernd 
Published: August 2016

Background: The interpretation of CT scans for the evaluation of calcaneal fractures is difficult. Three-dimensional (3D) reconstruction (volume rendering technique [VRT]) has been valuable in the evaluation of irregularly shaped bones. However, their value for the analysis of calcaneal fractures is still debated. Therefore, the objective of this study was to assess the effect of additional use of 3D CTs in calcaneal fractures. Methods: In a prospective multicenter study, the CT data set of 5 different fractures was presented to 57 evaluators. First, the participating surgeons were asked to assess the fractures on the basis of axial, coronal, and sagittal reconstructions using a multiple-choice questionnaire. Second, 3D reconstructions (VRT) were presented. The CT scans were validated by the intraoperative findings and the results were compared to the model solution of 3 foot and ankle surgeons. Intra- and interrater reliabilities were calculated. Results: The proportion of intraobserver agreement was 82%, with Cohen kappa of κ = 0.748 ( P < .001). Interrater agreement varied between 0.772 ( P = .006) for the assessment of concomitant fractures and 0.987 ( P < .001) for the suggested approach. The evaluation of several items improved after presentation of the 3D CTs (Cochrane Q test, P < .001). The benefit of 3D imaging was higher in inexperienced surgeons and complex fractures (Friedman test P < .001). Conclusion: The evaluation of CT scans of calcaneal fractures was improved by the additional use of 3D images (VRT). Level of Evidence: Level II, prospective comparative study.
Drug–drug interactions of cytostatics with regular medicines in lung cancer patients
Authors: Rompelman Florentine MV , Smit Adrianus AJ , Franssen Eric JF , Crul Mirjam 
Published: August 2016

Background Lung cancer patients have a high risk for drug–drug interactions, as they use numerous types of concomitant medicines including antineoplastic agents, cancer treatment co-medication, and medicines aimed at several types of comorbidities. Objective The primary objective of this study is to determine the incidence and the clinical relevance of the drug–drug interactions between antineoplastic agents and regular medication used by lung cancer patients. Secondary objectives are (i) to determine the effectiveness of the medication review by the hospital pharmacists concerned, (ii) to establish which patients are most at risk of drug–drug interactions and (iii) to determine whether physicians comply with advice given by hospital pharmacists. Setting This prospective study was undertaken in a Dutch hospital pharmacy, at Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam. Methods All lung cancer patients receiving one or more cytotoxic agents during the period 21 June 2010 till 2 December 2014 at OLVG were included. The medication list of the patients was obtained electronically from the community pharmacy and checked for interactions by a hospital pharmacist. Interactions that required intervention according to the national database were the only ones taken into account. Interventions were recorded in the patients’ electronic charts. All medication reviews were cross-checked and analyzed by an independent pharmacist at the end of the study period. Main outcome measure Prevalence and clinical relevance of drug–drug interactions between antineoplastic agents and other types of medication in lung cancer patients. Results A total of 298 lung cancer patients were included in this study. In 53 patients (18%), a total of 73 interactions with potential clinical relevance were found. The most frequent interaction was between cytostatics and coumarins while the most relevant one was between cisplatin and furosemide. According to statistical analysis, gender as well as the number of drugs prescribed were significant predictors for drug–drug interactions. Eighty-four percent of the interactions were discovered by pharmacists during daily routine. In 92% of the cases, the pulmonary physicians complied with the advice of the pharmacist. Conclusion Eighteen percent of lung cancer patients treated with cytotoxic therapy had one or more relevant drug–drug interactions. This study shows that medication surveillance by a hospital pharmacist is necessary to prevent possible negative drug–drug interactions. Further research should focus on the clinical outcome of the interactions as well as on interactions between cytostatics and alternative medicines and/or over-the-counter medicines.
Transarterial venous sinus occlusion of dural arteriovenous fistulas using ONYX
Authors: Torok Collin M , Nogueira Raul G , Yoo Albert J , Leslie-Mazwi Thabele M , Hirsch Joshua A , Stapleton Christopher J , Patel Aman B , Rabinov James D 
Published: August 2016

Purpose The purpose of this article is to present a case series of transarterial venous sinus occlusion for dural arteriovenous fistulas (DAVFs) of the transverse and sigmoid sinuses. Materials and methods From 2006 to 2012, 11 patients with DAVF of the transverse and sigmoid sinuses were treated with transarterial closure of the affected venous sinus using ethylene vinyl alcohol copolymer (ONYX). The consecutive retrospective cohort included six female and five male patients with an age range of 30–79. Patients presented with stroke, intracranial hemorrhage, seizure, headache, focal neurologic deficit or cognitive change. Lesions were categorized as Cognard II a + b ( n = 5) or Cognard II b ( n = 6). Four of this latter group consisted of isolated sinus segments. Selection criteria for dural sinus occlusion included direct multi-hole fistulas involving a broad surface in length or circumference of the sinus wall. External carotid artery (ECA) branches were directly embolized when considered safe. High-risk arterial supply from ICA, PICA, AICA or ECA cranial nerve branches were closed via retrograde approach during sinus occlusion. Results DAVF closure was accomplished in all 11 patients with a total of 17 embolization procedures using ONYX. High-risk arterial collaterals were closed via artery-artery or artery-sinus-artery embolization. The vein of Labbe was spared in the four cases with initial antegrade flow. No neurologic complications occurred, and DAVF closures were durable on three-month angiography. Conclusion Transarterial closure of the transverse and sigmoid sinuses.