bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endobronchial valves for bronchopleural fistula: pitfalls and principles
Authors: Gaspard Dany , Bartter Thaddeus , Boujaoude Ziad , Raja Haroon , Arya Rohan , Meena Nikhil , Abouzgheib Wissam 
Published: October 2016

Background: Placement of endobronchial valves for bronchopleural fistula (BPF) is not always straightforward. A simple guide to the steps for an uncomplicated procedure does not encompass pitfalls that need to be understood and overcome to maximize the efficacy of this modality. Objectives: The objective of this study was to discuss examples of difficult cases for which the placement of endobronchial valves was not straightforward and required alterations in the usual basic steps. Subsequently, we aimed to provide guiding principles for a successful procedure. Methods: Six illustrative cases were selected to demonstrate issues that can arise during endobronchial valve placement. Results: In each case, a real or apparent lack of decrease in airflow through a BPF was diagnosed and addressed. We have used the selected problem cases to illustrate principles, with the goal of helping to increase the success rate for endobronchial valve placement in the treatment of BPF. Conclusions: This series demonstrates issues that complicate effective placement of endobronchial valves for BPF. These issues form the basis for troubleshooting steps that complement the basic procedural steps.
On the Planning and Design of Hospital Circulation Zones
Authors: Jiang Shan , Verderber Stephen 
Published: October 2016

Objective: This present literature review explores current issues and research inconsistencies regarding the design of hospital circulation zones and the associated health-related outcomes. Background: Large general hospitals are immense, highly sophisticated institutions. Empirical studies have indicated excessively institutional environments in large medical centers are a cause of negative effects to occupants, including stress, anxiety, wayfinding difficulties and spatial disorientation, lack of cognitional control, and stress associated with inadequate access to nature. The rise of patient-centered and evidence-based movements in healthcare planning and design has resulted in a general rise in the quality of hospital physical environments. However, as a core component of any healthcare delivery system, hospital circulation zones have tended to remain neglected within the comparatively broad palette of research conducted and reported to date. Method: A systematic literature review was conducted based upon combinations of key words developed vis-à-vis a literature search in 11 major databases in the realm of the health sciences and the planning and design of built environments for healthcare. Results: Eleven peer-reviewed articles were included in the analysis. Six research themes were identified according to associated health-related outcomes, including wayfinding difficulties and spatial disorientation, communication and socialization patterns, measures and control of excessive noise, patient fall incidents, and occupants’ stress and satisfaction levels. Conclusions: Several knowledge gaps as well as commonalities in the pertinent research literature were identified. Perhaps the overriding finding is that occupants’ meaningful exposure to views of nature from within hospital circulation zones can potentially enhance wayfinding and spatial navigation. Future research priories on this subject are discussed.
Exercise Behaviors and Health Conditions of Runners After Childbirth
Authors: Blyholder Liga , Chumanov Elizabeth , Carr Kathleen , Heiderscheit Bryan 
Published: October 2016

Background: With a recent increase in running popularity, more women choose to run during and after pregnancy. Little research has examined exercise behaviors and postpartum health conditions of runners. Hypothesis: Antenatal and postpartum exercise is beneficial in reducing certain postpartum health conditions. Study Design: Cross-sectional study. Level of Evidence: Level 5. Methods: A self-administered, online survey was developed that consisted of questions regarding antenatal and postpartum exercise behaviors, maternal history, and postpartum health conditions. The survey was completed by 507 postpartum women who were running a minimum of once per week. Results: Seventy-two percent of participants ran regularly during pregnancy, with 38% reporting running in the third trimester. Women with musculoskeletal pain during pregnancy were more likely to experience pain on return to running postpartum (odds ratio [OR], 3.08; 95% confidence interval [CI], 1.64-5.88). A birth spacing of <2 years or a vaginal-assisted delivery increased the odds of postpartum stress urinary incontinence (OR, 1.71; 95% CI, 1.00-2.91 and OR, 2.08; 95% CI, 1.24-3.47, respectively), while Caesarean section delivery decreased the odds (OR, 0.58; 95% CI, 0.35-0.96). Multiparous women and those who reported a Caesarean section delivery were more likely to report abdominal separation (OR, 2.11; 95% CI, 1.08-4.26 and OR, 2.20; 95% CI, 1.05-4.70, respectively). Antenatal weight training decreased the odds of postpartum pain (OR, 0.52; 95% CI, 0.28-0.94), stress urinary incontinence (OR, 0.46; 95% CI, 0.21-0.98), and abdominal separation (OR, 0.51; 95% CI, 0.26-0.96). Conclusion: Musculoskeletal pain, stress urinary incontinence, and abdominal separation are prevalent conditions among postpartum runners and are more likely to occur with specific maternal history characteristics. Antenatal weight training may reduce the odds of each of these conditions. Clinical Relevance: Strengthening exercises during pregnancy may prevent weakening and dysfunction of the abdominal and pelvic floor muscles, decreasing the odds of pain, stress urinary incontinence, and abdominal separation after pregnancy.
A Novel Neuroscience Intermediate-Level Care Unit Model
Authors: Quimby Alexandra E. , Shamy Michel C. F. , Rothwell Deanna M. , Liu Erin Y. , Dowlatshahi Dar , Stotts Grant 
Published: October 2016

Background and Purpose: Neurointensive care units have been shown to improve patient outcomes across a variety of neurological and neurosurgical conditions. However, the efficacy of less resource-intensive intermediate-level care units to deliver similar care has not been well studied. The purpose of this study is to evaluate the impact of neurocritical specialist comanagement on patient flow and safety in a neuroscience intermediate-level care unit. Methods: Our intervention consisted of the addition of a physician with critical care experience as well as training in neurology, anesthesiology, or intensive care to a neuroscience intermediate-level care unit to comanage patients alongside neurology and neurosurgery staff during weekday daytime hours. A retrospective analysis was performed on prospectively collected data pertaining to all patients admitted to the unit over a 3-year period, 1 year before our intervention and 2 years after. Patient statistics including wait times to admission, length of stay (LOS), and mortality were reviewed. Results: Following the intervention, there were significant reductions in wait times to unit admission from both the emergency department and postanesthetic care unit, as well as reductions in the average LOS. No significant safety concerns were identified. Conclusion: This study has demonstrated that the optimization of a neuroscience intermediate-level care unit involving comanagement of patients by a neurocritical specialist can reduce wait times to admission and lengths of stay, with preserved safety outcomes.
Percutaneous balloon atrial septostomy on top of venoarterial extracorporeal membrane oxygenation results in safe and effective left heart decompression
Authors: Baruteau Alban-Elouen , Barnetche Thomas , Morin Luc , Jalal Zakaria , Boscamp Nicholas S , Le Bret Emmanuel , Thambo Jean-Benoit , Vincent Julie A , Fraisse Alain , Torres Alejandro J 
Published: October 2016

Background: Transcatheter techniques are emerging for left atrial (LA) decompression under venoarterial extracorporeal membrane oxygenation (VA-ECMO). We aimed to assess whether balloon atrioseptostomy (BAS) is a safe and efficient strategy. Methods: All patients who underwent percutaneous static BAS under VA-ECMO at four tertiary institutions were retrospectively reviewed. Results: From 2000 to 2014, BAS was performed in 64 patients (32 adults and 32 children). Indications for ECMO support included acute myocarditis (31.3%) and non-myocarditis cardiac disease, mostly end-stage dilated cardiomyopathy (32.8%). BAS was required because of pulmonary oedema/haemorrhage and left ventricular (LV) distension. The mean balloon diameter was 21.8 ± 8.4mm. Adequate LA decompression was achieved in all patients. Mean LA pressure fell from 24.2 ± 6.9 mmHg to 7.8 ± 2.6 mmHg ( p < 0.001). The left-to-right atrial pressure gradient fell from 17.2 ± 7.1 mmHg to 0.09 ± 0.5 mmHg ( p < 0.001). Echocardiography showed an unrestrictive left-to-right atrial shunting in all patients. Improvement of day 1 chest X-ray was observed in 76.6% of patients, clinical status in 98.4% of patients and pulmonary haemorrhage in 14 out of 14 patients. Complications occurred in 9.4% of patients, representing pericardial effusion, fast atrial fibrillation, ventricular fibrillation requiring defibrillation, transient complete heart block and femoral venous dissection requiring covered stent placement. In the 37 (57.8%) patients who were successfully decannulated, the median ECMO duration was 9 (range: 4–24) days. After a median follow-up of 12.3 (range: 0.1–142) months, 35.9% patients died, 17.2% received a LV assist device as a bridge to transplantation, 31.2% were transplanted and 56.2% were home discharged and alive. Conclusions: Percutaneous BAS may be a safe and efficient strategy for discharging the LA in both adults and children supported by VA-ECMO.
Acute Ultrasonography Investigation to Predict Reruptures and Outcomes in Patients With an Achilles Tendon Rupture
Authors: Westin Olof , Nilsson Helander Katarina , Grävare Silbernagel Karin , Möller Michael , Kälebo Peter , Karlsson Jón 
Published: October 2016

Background: The optimal treatment for acute Achilles tendon ruptures is still an ongoing debate. Acute ultrasonography (US) investigation to measure the diastasis between the tendon ends has previously been used to classify acute Achilles tendon ruptures; however, no study has used US to predict reruptures and functional outcomes. Purpose: To investigate whether acute US can be used to predict the risk of reruptures and outcomes after treatment of an acute Achilles tendon rupture. Study Design: Cohort study; Level of evidence, 2. Methods: Forty-five patients (37 men, 8 women) with a mean age of 39 ± 9.2 years (range, 23-59 years) from a cohort of 97 patients participating in a randomized controlled study comparing surgical and nonsurgical treatment were included. US was performed within 72 hours from the index injury. Diastasis between the tendon ends was documented. Reruptures were documented, and the patients’ functional outcomes were measured 12 months after injury. Results: Patients with a diastasis of >10 mm treated nonsurgically had a higher degree of rerupture. In the nonsurgically treated group, 3 of 4 patients with a diastasis of >10 mm suffered from rerupture ( P < .001). Moreover, in the nonsurgical group, there was significantly worse outcomes in patients with a diastasis of >5 mm in terms of patient-reported outcomes using the Achilles tendon Total Rupture Score (ATRS) ( P = .004) and heel-rise height at 12 months ( P = .048) compared with the group with a lesser degree of tendon separation. Conclusion: US may be a useful tool to predict the risk of rerupture and greater degree of functional deficit. It may be an important measure in a clinical treatment algorithm for deciding whether a patient will benefit from surgical intervention after an acute Achilles tendon rupture.
Capnography Prevents Hypoxia during Sedation for Dental Treatment: A Randomized Controlled Trial
Authors: Takaya K. , Higuchi H. , Ishii-Maruhama M. , Yabuki-Kawase A. , Honda Y. , Tomoyasu Y. , Maeda S. , Miyawaki T. 
Published: October 2016

Intravenous sedation is useful for dental treatment in patients with intellectual disabilities. However, it is often necessary to manage such patients with deep sedation because their cooperation cannot be obtained. During deep sedation, undetected hypoventilation can lead to severe complications, such as hypoxia. Recently, capnographic monitoring has been advocated as a useful technique for preventing hypoxia during sedation. This randomized control trial evaluated whether the use of capnography reduces the incidence of hypoxia during the deep sedation of patients for dental treatment. This study involved patients with intellectual disabilities who underwent dental treatment under sedation. The subjects were randomized to the intervention group (I-group) or control group (C-group). All of the patients underwent routine monitoring, as well as bispectral index (BIS) and capnographic monitoring; however, only an independent observer had access to the patients’ capnographic data during the dental procedures. Sedation was maintained at a BIS of 50 to 70 by administration of propofol. In the I-group, the independent observer signaled to the dental anesthesiologist if the capnogram indicated that the patient had been suffering from alveolar hypoventilation or apnea for >15 s. In the C-group, the observer signaled to the dental anesthesiologist if the capnogram indicated that the patient had been suffering from alveolar hypoventilation or apnea for >60 s. In both groups, the dental anesthesiologists responded to the signals using appropriate airway management strategies. The primary endpoint of this study was the incidence of hypoxia during dental treatment, which was defined as oxygen saturation of <95%. Hypoxemic episodes occurred in 13.4% and 34.8% of cases in the I-group and C-group, respectively. The incidence of hypoxia was significantly lower in the I-group. These results suggest that capnographic monitoring during deep sedation for dental treatment prevents hypoxemic episodes by allowing the early detection of hypoventilation. Knowledge Transfer Statement: This is the first randomized controlled trial to examine whether the use of capnography reduces the incidence of hypoxia during deep sedation for dental treatment. The findings of this study can be used by clinicians to aid decision-making regarding dental sedation standards at individual clinics. Moreover, they can be used as high-level evidence during the production or updating of clinical guidelines for dental sedation by leading associations.
The very long-term risk and predictors of recurrent ischaemic events after a stroke at a young age: The FUTURE study
Authors: Arntz Renate M , van Alebeek Mayte E , Synhaeve Nathalie E , van Pamelen Jeske , Maaijwee Noortje AMM , Schoonderwaldt Hennie , van der Vlugt Maureen J , van Dijk Ewoud J , Rutten-Jacobs Loes CA , de Leeuw Frank-Erik 
Published: October 2016

Introduction Patients who suffer a stroke at a young age, remain at a substantial risk of developing recurrent vascular events and information on very long-term prognosis and its risk factors is indispensable. Our aim is to investigate this very long-term risk and associated risk factors up to 35 years after stroke. Patients and methods Prospective cohort study among 656 patients with a first-ever ischaemic stroke or transient ischaemic stroke (TIA), aged 18–50, who visited our hospital (1980–2010). Outcomes assessed at follow-up (2014–2015) included TIA or ischaemic stroke and other arterial events, whichever occurred first. Kaplan–Meier analysis quantified cumulative risks. A prediction model was constructed to assess risk factors independently associated with any ischaemic event using Cox proportional hazard analyses followed by bootstrap validation procedure to avoid overestimation. Results Mean follow-up was 12.4 (SD 8.2) years (8105 person-years). Twenty-five years cumulative risk was 45.4% (95%CI: 39.4–51.5) for any ischaemic event, 30.1% (95%CI: 24.8–35.4) for cerebral ischaemia and 27.0% (95%CI: 21.1–33.0) for other arterial events. Risk factors retained in the prediction model were smoking (HR 1.35, 95%CI: 1.04–1.74), poor kidney function (HR 2.10, 95%CI: 1.32–3.35), history of peripheral arterial disease (HR 2.10, 95%CI: 1.08–3.76) and cardiac disease (HR 1.84, 95%CI: 1.06–3.18) (C-statistic 0.59 (95%CI: 0.55–0.64)). Discussion and conclusion Young stroke patients remain at a substantial risk for recurrent events; almost 1 of 2 develops a recurrent ischaemic event and 1 of 3 develops a recurrent stroke or TIA during 25 years of follow-up. Risk factors independently associated with recurrent events were poor kidney function, smoking, history of peripheral arterial disease and cardiac disease.
Theophylline as an add-on to thrombolytic therapy in acute ischaemic stroke (TEA-Stroke): A randomized, double-blinded, placebo-controlled, two-centre phase II study
Authors: Modrau Boris , Hjort Niels , Østergaard Leif , Mouridsen Kim , Andersen Grethe , Bach Flemming Winther 
Published: October 2016

Introduction Early reperfusion of brain tissue at risk of injury (penumbra salvage) is crucial in treating acute ischaemic stroke. Neuroprotective agents may extend the time window for the reperfusion. The vasoactive agent theophylline redistributes the perfusion to ischaemic brain tissue and thus reduces brain damage, brain tissue oedema and mortality in animal stroke models. Furthermore, treatment with theophylline has been shown to result in considerable and rapid clinical improvement, albeit only temporary, in some stroke patients. We hypothesize that treatment with theophylline will improve the collateral supply in acute ischaemic brain tissue and thus facilitate reperfusion despite proximal vessel occlusion. The primary study objective is to evaluate whether theophylline is safe and efficient in acute ischaemic stroke patients as an add-on to thrombolytic therapy. Methods The TEA-Stroke Trial is a two-centre, proof of concept phase II clinical study with a randomized, double-blinded, placebo-controlled design. One hundred and twenty patients with acute ischaemic stroke and significant perfusion–diffusion mismatch, as determined by magnetic resonance imaging, are randomized 1:1 to either theophylline or placebo as an add-on to standard thrombolytic therapy. Study outcome The dual primary outcome measures include penumbra salvage (penumbral tissue not developing into infarcted tissue) and clinical improvement at the 24-h follow-up. Discussion Results from studies of theophylline in stroke animal models, clinical case series and randomized clinical trials are controversial. A Cochrane analysis from 2004 concluded that there was not enough evidence to assess whether theophylline is safe and improves outcomes in patients with acute ischaemic stroke. The TEA-Stroke Trial will clarify whether theophylline as an add-on to standard thrombolytic therapy improves penumbra salvage with a reduced risk of reperfusion damage, reduced final infarct size, and improved clinical outcome.
A novel mutation in the N-terminal domain of Drosophila BubR1 affects the spindle assembly checkpoint function of BubR1
Authors: Duranteau Marie , Montagne Jean-Jacques , Rahmani Zohra 
Published: October 2016

ABSTRACT
The spindle assembly checkpoint (SAC) is a surveillance mechanism that ensures accurate segregation of chromosomes into two daughter cells. BubR1, a key component of the SAC, also plays a role in the mitotic timing since depletion of BubR1 leads to accelerated mitosis. We previously found that mutation of the KEN1-box domain of Drosophila BubR1 (bubR1-KEN1 mutant) affects the binding of BubR1 to Cdc20, the activating co-factor of the APC/C, and does not accelerate the mitotic timing despite resulting in a defective SAC, which was unlike what was reported in mammalian cells. Here, we show that a mutation in a novel Drosophila short sequence (bubR1-KAN mutant) leads to an accelerated mitotic timing as well as SAC failure. Moreover, our data indicate that the level of Fzy, the Drosophila homolog of Cdc20, recruited to kinetochores is diminished in bubR1-KEN1 mutant cells and further diminished in bubR1-KAN mutant cells. Altogether, our data show that this newly identified Drosophila BubR1 KAN motif is required for a functional SAC and suggest that it may play an important role on Cdc20/Fzy kinetochore recruitment.
DUX4 induces a transcriptome more characteristic of a less-differentiated cell state and inhibits myogenesis
Authors: Knopp Paul , Krom Yvonne D. , Banerji Christopher R. S. , Panamarova Maryna , Moyle Louise A. , den Hamer Bianca , van der Maarel Silvère M. , Zammit Peter S. 
Published: October 2016

ABSTRACT
Skeletal muscle wasting in facioscapulohumeral muscular dystrophy (FSHD) results in substantial morbidity. On a disease-permissive chromosome 4qA haplotype, genomic and/or epigenetic changes at the D4Z4 macrosatellite repeat allows transcription of the DUX4 retrogene. Analysing transgenic mice carrying a human D4Z4 genomic locus from an FSHD-affected individual showed that DUX4 was transiently induced in myoblasts during skeletal muscle regeneration. Centromeric to the D4Z4 repeats is an inverted D4Z4 unit encoding DUX4c. Expression of DUX4, DUX4c and DUX4 constructs, including constitutively active, dominant-negative and truncated versions, revealed that DUX4 activates target genes to inhibit proliferation and differentiation of satellite cells, but that it also downregulates target genes to suppress myogenic differentiation. These transcriptional changes elicited by DUX4 in mouse have significant overlap with genes regulated by DUX4 in man. Comparison of DUX4 and DUX4c transcriptional perturbations revealed that DUX4 regulates genes involved in cell proliferation, whereas DUX4c regulates genes engaged in angiogenesis and muscle development, with both DUX4 and DUX4c modifing genes involved in urogenital development. Transcriptomic analysis showed that DUX4 operates through both target gene activation and repression to orchestrate a transcriptome characteristic of a less-differentiated cell state.
Essential role of the Dishevelled DEP domain in a Wnt-dependent human-cell-based complementation assay
Authors: Gammons Melissa V. , Rutherford Trevor J. , Steinhart Zachary , Angers Stephane , Bienz Mariann 
Published: October 2016

ABSTRACT
Dishevelled (DVL) assembles Wnt signalosomes through dynamic head-to-tail polymerisation by means of its DIX domain. It thus transduces Wnt signals to cytoplasmic effectors including β-catenin, to control cell fates during normal development, tissue homeostasis and also in cancer. To date, most functional studies of Dishevelled relied on its Wnt-independent signalling activity resulting from overexpression, which is sufficient to trigger polymerisation, bypassing the requirement for Wnt signals. Here, we generate a human cell line devoid of endogenous Dishevelled (DVL1– DVL3), which lacks Wnt signal transduction to β-catenin. However, Wnt responses can be restored by DVL2 stably re-expressed at near-endogenous levels. Using this assay to test mutant DVL2, we show that its DEP domain is essential, whereas its PDZ domain is dispensable, for signalling to β-catenin. Our results imply two mutually exclusive functions of the DEP domain in Wnt signal transduction – binding to Frizzled to recruit Dishevelled to the receptor complex, and dimerising to cross-link DIX domain polymers for signalosome assembly. Our assay avoids the caveats associated with overexpressing Dishevelled, and provides a powerful tool for rigorous functional tests of this pivotal human signalling protein.