bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role Development of Nurse Practitioners and Physician Assistants in Liver Transplantation
Authors: Chaney Amanda J. , Harnois Denise M. , Musto Kaitlyn R. , Nguyen Justin H. 
Published: January 2017

Background: Nurse practitioners (NPs) and physician assistants (PAs) are increasingly utilized in health care. However, their roles in liver transplantation (LT) have not been investigated. Materials and Methods: In this study, we reviewed the employment and development of NPs and PAs and their impact on our deceased-donor LT (DDLT) program. Results: We found a safe and efficient way to utilize NPs and PAs in a DDLT program. Since the beginning of our program, Model of End-Stage Liver Disease (MELD) scores have increased significantly, suggesting patients are sicker at the time of transplant, and wait times of patients have become longer. With the incorporation of NPs and PAs, we found that length of stay (LOS) was not affected. The overall median warm ischemic time did not increase. Outcomes of LT for both patient and graft survival actually improved and remain at or above the expected values. These results collectively support the usefulness and validity of NPs and PAs in a DDLT program. Conclusion: We have determined that surgical and medical NPs and PAs are essential for optimal patient outcomes. They facilitate a better learning experience for residents and fellows on their transplant rotations. Further investigations to assess the roles of these providers and their impact on the education of residents and fellows in transplantation are warranted. Further transplant hepatology education programs and/or fellowships are recommended to assist in the education and professional development of transplant NPs and PAs.
A Website Intervention to Increase Knowledge About Living Kidney Donation and Transplantation Among Hispanic/Latino Dialysis Patients
Authors: Gordon Elisa J. , Feinglass Joe , Carney Paula , Vera Karina , Olivero Maria , Black Anne , O’Connor Kate Grubbs , Baumgart Jessica MacLean , Caicedo Juan Carlos 
Published: January 2017

Background: Hispanic dialysis patients often encounter barriers to learning about living kidney donation and transplantation. Effective culturally targeted interventions to increase knowledge are lacking. We developed a culturally targeted educational website to enhance informed treatment decision making for end-stage kidney disease. Methods: A pretest/posttest intervention study was conducted among adult Hispanic patients undergoing dialysis at 5 dialysis centers in Chicago, Illinois. Surveys included a 31-item, multiple-choice pretest/posttest of knowledge about kidney transplantation and living donation, attitudes about the website, Internet use, and demographics. The intervention entailed viewing 3 of 6 website sections for a total of 30 minutes. The pretest/posttest was administered immediately before and after the intervention. Participants completed a second posttest via telephone 3 weeks thereafter to assess knowledge retention, attitudes, and use of the website. Results: Sixty-three patients participated (96% participation rate). Website exposure was associated with a mean 17.1% same day knowledge score increase between pretest and posttest ( P < .001). At 3 weeks, participants’ knowledge scores remained 11.7% above pretest ( P < .001). The greatest knowledge gain from pretest to 3-week follow-up occurred in the Treatment Options ( P < .0001) and Cultural Beliefs and Myths ( P < .0001) website sections. Most participants (95%) “agreed” or “strongly agreed” that they would recommend the website to other Hispanics. Conclusions: Web-based education for patients undergoing dialysis can effectively increase Hispanics’ knowledge about transplantation and living kidney donation. Study limitations include small sample size and single geographic region study. Dialysis facilities could enable website access as a method of satisfying policy requirements to provide education about kidney transplantation.
New-Onset Diabetes After Kidney Transplantation and Pretransplant Hypomagnesemia
Authors: Sinangil Ayse , Celik Vedat , Barlas Soykan , Sakaci Tamer , Koc Yener , Basturk Taner , Akin Emin Baris , Ecder Tevfik 
Published: January 2017

Aim: Hypomagnesemia is a frequent finding in kidney transplant patients and plays a causal role in insulin resistance and diabetes. The aim of this study was to investigate whether the pretransplant magnesium (Mg) level is a risk factor for the development of new-onset diabetes after kidney transplantation (NODAT) and the presence of relationship between pretransplant hypomagnesemia and the development period of NODAT. Methods: Four hundred and nineteen nondiabetic renal transplant recipients were evaluated retrospectively. The patients were divided into NODAT and non-NODAT groups. The time of diagnosis of patients with NODAT was divided into 0 to 3, 3 to 6, 6 to 12 months, and after 12 months. Patients’ characteristics and pretransplant Mg levels in NODAT were compared with non-NODAT, and it was investigated whether pretransplant hypomagnesemia was a risk factor for the development of NODAT. Results: Totally 70 (16.6%) patients (36 female [F], mean age 51.7 ± 8.2 years) were diagnosed with NODAT. Three hundred and forty-nine patients (115 F, mean age 43.2 ± 12.5 years) did not have NODAT. Pretransplant mean Mg level was 1.97 ± 0.40 mg/dL in patients with NODAT, while it was 2.5 ± 0.45 mg/dL in non-NODAT patients ( P < .001). Serum Mg level was found to be similar in subgroups according to the development period of NODAT ( P = .07). When patients were stratified according to quartiles of Mg level, the frequency of NODAT was significantly higher in patients in the lower quartile (Mg < 2.1 mg/dL; P < .001). Older age, high body mass index, and low pretransplant serum Mg levels were established as risk factors for developing NODAT. According to the quartile of Mg level, the risk of developing NODAT was highest in the lowest quartile. Conclusion: Pretransplant hypomagnesemia is an independent risk factor of NODAT. Therefore, it is necessary to closely monitor the Mg levels in the posttransplant period.
Self-Reported Employment Status and Social Participation After Successful Kidney Transplantation
Authors: Parajuli Sandesh , Singh Jagmeet , Sandal Shaifali , Liebman Scott E. , Demme Richard A. 
Published: January 2017

Introduction: Kidney transplantation (KTX) is considered the treatment of choice for most individuals with end-stage kidney disease. The purpose of this study was to assess the employment status and social participation after successful KTX. Methods: This was a retrospective cross-sectional study. Eligible participants were patients who received a transplant ≥1 year ago and who were previously on hemodialysis (HD) for ≥1 year. Two hundred individuals participated in this study. Results: A significant number (93.5%) of patients reported they were working prior to HD versus 35% while on HD. Only 14% reported receiving disability benefits prior to HD versus 75% receiving disability while on HD. Comparing transplant recipients with pre-HD patients, 35.5% versus 93.5% reported working, and 74.5% versus 14% reported receiving disability benefits, respectively. After transplant, patients were more likely to join recreational clubs, travel frequently, and participate in recreational/religious activities and social events than when they were on HD. Conclusion: Posttransplant, these individuals are more likely to participate in social and leisure activities, but the majority did not resume employment and continued to receive disability payments. Future studies could explore barriers to employment in patients who underwent successful transplantation and the causes and factors as to why these individuals continue to receive disability benefits.
3D Rotational Angiography: Recent Experience in the Evaluation of Cerebral Aneurysms for Treatment
Authors: Ishihara S. , Ross I.B. , Piotin M. , Weill A. , Aerts H. , Moret J. 
Published: January 2017

Three dimensional (3D) reconstruction techniques providing volume rendered 3D images from rotational angiography data now exist. We report the design and early experience with one such system. 237 aneurysms were studied. Information was obtained on the morphology of the aneurysm itself and the vascular architecture in and around the aneurysm. 218 (92%) aneurysms went on to have endovascular treatment. The 3D images provided valuable information on aneurysmal anatomy, including relationships with the parent and adjacent vessels. This technique allowed fast and safe decision-making regarding the feasibility of endovascular or surgical treatment and provided useful information for performing the chosen treatment.
Timing of ICAM-I Expression in a Canine Model of Post-Haemorrhagic Cerebral Vasospasm
Authors: Abruzzo T. , Shengelaia G.G. , Cloft H.J. , Thaxton G. , Dudley P. , Tong F. , Dion J.E. 
Published: January 2017

Temporal alterations in endothelial intercellular adhesion molecule I (ICAM-I) expression during the course of post-haemorrhagic cerebral vasospasm (PHCV) are correlated with angiographic and histologic changes in the canine basilar artery. Angiography was performed in six dogs to obtain baseline measurements of basilar artery diameter. In three dogs subarachnoid haemorrhage (SAH) was created by performing percutaneous puncture of the cisterna magna, and replacing 7 ml of cerebrospinal fluid with 7 ml of arterial blood. The remaining three dogs were used as controls. Daily angiography was performed on all dogs to determine the percent reduction in basilar artery diameter (%RBAD). One dog from each group was sacrificed after 24 hours. The remaining two dogs in each group were sacrificed after 48 hours. Each basilar artery was perfusion fixed and subjected to histologic, and immunohistochemical analysis. In the SAH group, the average %RBAD was 4 (+/- 3) at 24 hours, and 36 (+/- 1) at 48 hours. In the control group, the average %RBAD was — 1 (+/- 1) at 24 hours, and 0 (+/- 2) at 48 hours. Endothelial edema and endothelial expression of ICAM-I were found at 24 hours. At 48 hours post-SAH there was widespread endothelial desquamation, but no evidence of ICAM-I expression. In the control group, histology was normal and no ICAM-I expression was found at 24 or 48 hours. The results suggest that a brief window of therapeutic efficacy exists during the first postictal 24 hours where ICAM-I antagonists may be useful in suppressing the pathogenesis of PHCV.
Palliative Embolisation of Brain Arteriovenous Malformations Presenting with Progressive Neurological Deficit
Authors: Al-Yamany M. , terBrugge K. G. , Willinsky R. , Montanera W. , Tymianski M. , Wallace M.C. 
Published: January 2017

Large arteriovenous malformations (AVMs) located in eloquent areas of the brain are generally considered incurable because of the high morbidity and mortality associated with their treatment. When these patients develop a progressive neurological deficit they in time often become severely disabled. This report presents the results of palliative embolisation in this subgroup of patients. Analysis of our data-base of 714 patients with known brain AVMs revealed 17 patients who presented with progressive neurological deficit and who underwent palliative embolisation as the therapeutic modality of choice for management of their AVM. One patient was excluded due to lack of follow-up and two were excluded because they later received radiation therapy. Following embolisation 43% had improvement of their neurological deficit, 50% stabilized and 7% continued to deteriorate and these clinical results persisted for an average of more than 2 years follow-up. Transient neurological morbidity associated with embolisation treatment was 7% and there was no permanent morbidity and no mortality. Palliative embolisation of brain AVMs presenting with progressive neurological deficits arrested deterioration in more than 90% of patients and was associated with low morbidity and no mortality.
The Accuracy of Plain Skull X-ray Examination as a Predictor of Recanalization following Guglielmi Detachable Coil Embolisation in the Treatment of Cerebral Aneurysms
Authors: Hwang G.J. , Berenstein A. , Niimi Y. , Setton A. , Pryor J. , Baltsavias G. , Albert R. , Hartman J. 
Published: January 2017

We evaluated the accuracy of plain skull x-ray series as an imaging modality for the follow-up of cerebral aneurysm recanalization after Guglielmi Detachable Coil (GDC) embolisation. We retrospectively reviewed of 100 consecutive follow-up angiograms and skull x-ray examinations in 78 patients harboring 82 aneurysms and in whom 85 procedures were performed. Angiography was performed between 1 and 54 months (mean: 10.8 months) after embolisation. The skull series (AP, lateral and Towne's projections) were taken at the time of follow-up angiography. Each follow-up angiogram and skull series were compared to the immediate post-coiling, correlating presence or absence of coil compaction on the skull series and recanalization of the aneurysm at angiography. In 97 (97%) examinations, skull x-ray findings correlated with the angiographic findings. In three cases, skull x-ray examination suggested compaction when no recanalization was seen angiographically; in these three cases, the aneurysms were small and found to be more thrombosed than baseline. In no case did angiographic recanalization occur in the absence of compaction on skull series. These findings yield 100% sensitivity, 95% specificity, 93% positive predictive value, 100% negative predictive value and 97% accuracy. The location, size, configuration and neck/dome ratio of the aneurysm were not related to the correlation between angiography and skull x-ray exam. Skull x-ray series is a safe, accurate, and cost-effective mode of follow-up for patients with GDC-treated aneurysms. The possibility of it replacing angiography still requires a more comparative skull x-ray modality in follow-up studies.
Endovascular Treatment of Berry Intracranial Aneurysms Using a New Detachable Coil System
Authors: Tournade A. , Riquelme C. , Musacchio M. , Mont'Alverne F. 
Published: January 2017

We aimed to assess and to demonstrate the efficiency of a new mechanical system in the endovascular treatment of berry intracranial aneurysms. From September 1999 to October 2000, 38 patients with 40 aneurysms experienced selective embolization using Detach Coils (DCS® — Cook). They were 12 men and 26 women, aged 26 to 77 years, mean age 53.4. The clinical status of patients was graded by Hunt and Hess scale: Stage 0:8 — stage I:3 — Stage II: 11 — Stage III: 11 — Stage IV: 2 — Stage V: 3. The localization of aneurysms was as follows: internal carotid artery: 11; sylvian artery: 10; anterior communicating artery: 5; anterior cerebral artery A1-A2: 5; intra-cavernous carotid artery: 1; basilar trunk: 5; PICA: 2; posterior cerebral artery: 1. The size of the aneurysms ranged from 2 to 40 mm. For embolization of aneurysms, we utilized 242 coils (mean number 6.05). The shape and size of coils varied as follows: longest J 6.25 — shortest J 4–3 — longest S 10–20 — shortest S 2–2. The mean time of procedure was 43 minutes (max 180 minutes — min 7 minutes). We did not have any technical complications during the procedure and no immediate rebleeding occurred. Initial follow-up of the patients showed angiographic full occlusion. Detach Coils appear to be a very precise, reliable and rapid system, with high stability during coil detachment (in very small or very giant aneurysms) in the embolization of intracranial aneurysms, with an interesting aspect concerning the low cost of this new mechanical device.
Growth and Spontaneous Regression of a Middle Cerebral Artery Aneurysm after Surgical Clipping
Authors: Tan C.B. , Rodesh G. , Lasjaunias P. 
Published: January 2017

We present a case of growth and spontaneous regression of a middle cerebral artery aneurysm after surgical clipping. A 36-year-old woman who presented with grade II subarachnoid haemorrhage was found to have a right middle cerebral artery aneurysm. The aneurysm was surgically clipped in view of the morphology of the aneurysm. Second clipping was performed four months later as there was re-growth of the neck of the aneurysm. Again re-growth of the aneurysm was noted five months after the second clipping. As further clipping of the aneurysm would be difficult, external and internal carotid arteries bypass was the treatment option but unfortunately, the by-pass operation was unsuccessful. Interestingly, angiogram performed after the bypass surgery revealed partial thrombosis and decreasing size of the aneurysm. Complete obliteration of the aneurysm was noted without further intervention one month after the failed by-pass surgery.
Endovascular and Surgical Management of Multiple Intradural Aneurysms
Authors: Porter P.J. , Mazighi M. , Rodesch G. , Alvarez H. , Aghakhani N. , David Ph , Lasjaunias P. 
Published: January 2017

Patients with multiple intradural aneurysms present unique clinical challenges, particularly when presenting with subarachnoid haemorrhage. This study was undertaken to retrospectively review the management of such patients treated at a single institution. Consecutive patients with multiple intradural aneurysms managed at our institution between 1993 and 1999 were studied. The 122 patients had a total of 305 aneurysms. In most patients presenting with subarachnoid haemorrhage, the aneurysm responsible for the bleed could be identified with a fair degree of certainty, as confirmed by subsequent surgical and autopsy findings. Irregularity of the aneurysm (false sac or polylobulation) was the most useful criterion for making this determination. Failure to recognize all aneurysms on the original angiogram remained an uncommon but clinically important problem. Posterior inferior cerebellar and anterior communicating artery aneurysm locations were disproportionately more likely, and para-ophthalmic less likely, to be responsible for the subarachnoid haemorrhage. There was a trend for patients with uncertainty regarding the site of bleeding to have all aneurysms treated, and for cure to be obtained in a shorter time. Surgical and endovascular complication rates and patient outcomes were not dissimilar from what one would expect for single aneurysm patients. During follow-up, we observed a haemorrhage rate from unruptured aneurysms of 1.1% per patient-year of observation, and a de novo aneurysm formation rate of 0.76% of patients per year. In conclusion, we feel that although patients with multiple intradural aneurysms have more complex management issues than those with single aneurysms, good outcomes can be achieved with appropriate use of endovascular and/or surgical therapy. The goal in the acute setting following subarachnoid haemorrhage is recognition of all aneurysms and urgent treatment of the one responsible for the haemorrhage. When there is uncertainty, more than one aneurysm may need to be treated. Decisions on subsequent treatment of remaining unruptured aneurysms must be individualized.
Revascularization Using an Extracorporeal Pump for the Treatment of Cerebral Embolism in the Acute Stage
Authors: Sonobe M. , Nakai Y. , Matsumaru Y. , Sugita K. 
Published: January 2017

Object. For patients with cerebral embolism, we are using an extracorporeal pump to revascularize the more peripheral brain tissues far from the thrombus, proceeding the microcatheter beyond the thrombus, and dissolving the thrombus during a satisfactory time as required. Methods. As the critical cerebral blood flow is thought to be below 30 ml/100g/min, in the case of middle cerebral artery occlusion at the M1 portion, over 15ml/min. of arterial blood is necessary to protect the brain tissue from irreversible change. One thousand and eight hundred mmHg (about 2 atoms) of pump pressure is necessary to send 15ml/min. of blood through the microcatheter (110 cm, FastTrucker 18, Boston). It was confirmed by laboratory and clinical data that hemolysis of the pump action is not sufficient to aggravate kidney function. Conclusion. This method enables the protection of brain tissues from irreversible change after cerebral embolism, and extends the time sufficiently for thrombolysis.
Natural History and Treatment Modalities of Symptomatic Bilateral Middle Cerebral Artery Stenosis
Authors: Zhongrong M. , Feng L. , Shengmao L. , Fengshui Z. , Hongqi Z. , Moli W. , Yang H. 
Published: January 2017

To assess the natural history, pathogenesis, and treatment modalities of symptomatic bilateral middle cerebral artery stenosis, we retrospectively evaluated a consecutive series of patients for their medical history, anamnesis, and our treatment protocol. Treatment included transluminal angioplasty, bypass surgery and/or conservative antiplatelet therapy for prevention of the stroke attack and vessel reconstruction. Indications, feasibility, effectiveness, and complications of treatment are also discussed. A series of 19 patients with symptomatic bilateral middle cerebral artery (MCA) stenosis were treated consecutively from 1998 to 2002. Medical history, anamnesis, and treatment protocol were reviewed and evaluated retrospectively, Of these 19 patients, six (six vessels, 31.57%) were treated by balloon (two vessels) or stent-assistant angioplasty (four vessels), four (four vessels, 21.05%) were treated by bypass surgery, 18 vessels plus ten vessels occluded before treatment (47.37%) were conservatively treated by antiplatelet agents. 24 vessels (12 patients) were followed from three months to four years by angiography (nine cases), TCD (12 cases), or MRA (five cases). A total of 38 vessels were involved (19 vessels), of which ten vessels (10/38, 26.31%) had occluded before coming to our hospital. Three patients (3/19, 15.78%) had a history of hypertension, five had a history of smoking. The mean age of these 19 patients was 33 yrs (24 ∼ 42 yrs), with a slight male preponderance (males/females = 13/6). Initial clinical presentations were TIAs (14/19, 73.68%) and minor stroke (5/19, 26.32%), symptoms attacked alternatively for five patients (5/38, 13.16%). Seven vessels (7/28, 25%) occluded within one to three years, of which three occluded asymptomatically, four acutely occluded vessels accompanied acute stroke. Nine vessels (9/28, 32.14%) were treated by conservative antiplatelet agents and one treated by bypass surgery had related recurrent TIAs. Vessels treated by angioplasty (balloon or stent) remained patent and free of symptoms. The stenosed bilateral MCA may occlude within one to three years without intervention. The pathogenesis of this special disease is unclear, it may be genetic or due to asymptomatic infection. The results showed that earlier appropriate treatment can resolve the clinical symptoms and somehow change the natural history of this disease. Conservative medical therapy cannot prevent further stroke attack. Collaterals are very important for these special patients.
3D Micrus Coil “Cage” in Wide-Necked Aneurysms
Authors: Leonardi M. , Simonetti L. , Cenni P. , Raffi L. 
Published: January 2017

We aimed to verify that Micrus 3D microcoils can be used as first coils in the treatment of saccular wide-necked aneurysms to provide stable protection to the neck by keeping the coil mesh inside the aneurysm. We selected 22 wide-necked aneurysms and calculated the ratio between sac diameter and neck width which was close to unity. The aneurysms were treated by endovascular approach using Micrus 3D (Spherical) microcoils as first coils. The coils proved stable during placement and detachment and compatible with both GDC and Micrus coils used for filling and packing. The endovascular procedure was suspended in only two out of 22 aneurysms selected for treatment. Aneurysm bleeding occurred in two endovascular procedures but was controlled. No complications were encountered in the remaining 18 patients treated. The percentage of technical failures has been reduced since the adoption of 3D Micrus microcoils in our practice.