bluuebunny/crossref_metadata_2025_split huggingface dataset:
Asymptomatic High Flow Subclavian Steal in a Patient with Hemodialysis Access
Authors: Bron Cédric , Hirt Lorenz , Halabi Georges , Saucy François , Qanadli Salah D. , Haesler Erik 
Published: January 2018

Introduction Subclavian steal phenomenon due to proximal subclavian artery stenosis or occlusion is not uncommon but often remains asymptomatic. Case Report We describe the case of a 66-year-old man with end-stage renal disease hemodialysed through a brachio-brachial loop graft of the left forearm. Echo-Doppler precerebral examination showed a high reversed flow of 570 ml/min in the ipsilateral vertebral artery. After successful endovascular recanalization of the subclavian artery, access blood flow increased and vertebral flow decreased to 30 ml/min. Complete neurological examination was normal both before and after endovascular treatment. Discussion This case demonstrates how high a subclavian steal can be without causing symptoms and how well precerebral and cerebral circulation can adapt to hemodynamic changes.
Long Thoracic Vein Embolization for the Treatment of Breast Edema Associated with Central Venous Occlusion and Venous Hypertension
Authors: Arthur Miller Gregg , Friedman Alexander , Khariton Aleksandr , Jotwani Manish C. , Savransky Yevgeny 
Published: January 2018

Purpose Breast edema is a rare complication in hemodialysis patients with central venous occlusions. The present study sought to determine whether coil embolization of the long thoracic vein is an effective long-term treatment for this pathology. Methods The study patients were 6 female hemodialysis patients whose primary clinical manifestation of central vein occlusion was breast edema. When conservative treatment (allowing collaterals to dilate over time), as well as recanalization of occlusions through angioplasty with or without stent placement, failed to alleviate symptoms, patients underwent coil embolization of the long (lateral) thoracic vein. Results In 4 of the 6 cases, the breast edema was completely resolved without recurrence, while the other 2 patients experienced durable symptomatic improvement with only mild residual swelling. Average follow-up was 22 months. There were no adverse sequelae and none of the patients experienced increased swelling elsewhere following the coil embolization procedure. Conclusions Coil embolization of the long thoracic vein effectively alleviates breast edema in hemodialysis patients with elevated venous hydrostatic pressure due to central venous occlusions.
Small dose Contrast Venography as Venous Mapping in Predialysis Patients
Authors: Dong Won Yoo , Young Lee Ja , Shin Shin Young , Soo Kim Young , Ae Yoon Sun , Soo Kim Yong , Tai Hahn Seong , Cheol Park Sun , Ok Kim Young 
Published: January 2018

Purpose This study was designed to evaluate radiocontrast-induced nephrotoxicity (RIN), and the image quality and findings of venography using small doses of radiocontrast as a venous mapping method in pre-dialysis patients. Methods Twenty-eight patients with stage 4 and 5 chronic kidney disease underwent arm venography with 10–15 ml of dilute contrast medium. Image quality, venographic findings and glomerular filtration rate (GFR) before and after the procedure were evaluated. Results Mean GFR was 19.3±5.8 ml/min/1.73 m2 (7–30 ml/min/1.73 m2). Image quality of venography in the forearm and upper arm veins was good in all patients. Central veins were visualized well in 26 (92.8%) patients. Eight (28.5%) patients showed cephalic veins inadequate for creation of radiocephalic arteriovenous fistula (AVF) because of occlusion or small diameter veins. There was no significant difference in GFR between the pre- and post-study (19.3±5.8 vs. 19.2±6.2 ml/min/1.73 m2, p=0.693). RIN developed (GFR: 17 to 13 ml/min/1.73 m2) in only one patient but without sequelae, and the GFR completely recovered to baseline level 7 days after the study. Conclusion Small dose venography is safe and effective for venous mapping in pre-dialysis patients.
High Brachial Artery Bifurcation is Associated with Failure of Brachio-Cephalic Autologous Arteriovenous Fistulae
Authors: Lioupis Christos , Mistry Hiren , Junghans Cornelia , Haughey Niamh , Freedman Ben , Tyrrell Mark , Valenti Domenico 
Published: January 2018

Objective Although European Best Practice Guidelines on vascular access recommend universal pre-operative duplex scan in patients receiving brachio-cephalic (BC) arteriovenous fistulae (AVF), this is not widespread practice. Furthermore, cadaveric and angiographic studies suggest that variation in upper limb arterial anatomy is common. Our aim was to investigate the prevalence of high brachial artery bifurcation (HB) and its impact on BC AVF patency. Methods A retrospective analysis of consecutive autologous BC AVF created over an 18-month period (January 2008 to June 2009). Patients with high bifurcations identified at duplex scan were compared with a control group who had normal bifurcations. All patients were followed up at 1, 6 and 12 weeks post-operatively. The study endpoint was AVF patency. Results One hundred and five autologous BC AVF procedures were performed in our institution, of which 29 (27.6%) were identified as having a high brachial bifurcation on pre-operative duplex scan. The bifurcation was axillary in six patients and located at the proximal, middle and distal third of the humerus in nine, seven and seven patients, respectively. The actuarial functional patency rate was 53.2% (standard error = 9.6%) in the HB group and 76.2% (standard error = 4.9%) in the control group (log-rank test, p=0.027). Conclusions These data show that aberrant brachial artery anatomy is both common (12%) and a predictor of autologous BC AVF failure. These data support the universal use of pre-AVF duplex scanning.
Insertion of Tunneled Hemodialysis Catheters without Fluoroscopy
Authors: Motta Elias Rosilene , Cristina da Silva Makida Sonia , Abensur Hugo , Carlos Martins Castro Manuel , Maria Affonso Moysés Rosa , Jorge Pereira Benedito , Bueno de Oliveira Rodrigo , Luders Cláudio , João Egidio Romão 
Published: January 2018

Background The tunneled cuffed catheter (TCC) is used as a bridge access for hemodialysis. Few prospective studies have been designed to evaluate conversion from non-tunneled to TCC without the use of fluoroscopy when performed by nephrologists. Methods We performed an observational prospective cohort in incident patients receiving hemodialysis through a non-tunneled right jugular vein catheter. Results 130 procedures were performed in 122 patients (51±18 years). The success rate was 100%. There was a total of 26,546 catheter days. Ninety-one of the 130 catheters were removed during the study period. Life table analysis revealed primary patency rates of 92%, 82%, and 68% at 30, 60, and 120 days, respectively. Infection requiring catheter removal occurred at a frequency of 0.09 per 100 catheter days. Catheter malfunction requiring intervention occurred at a rate of 0.03 per 100 catheter days. Hypertension and duration of existing non-tunneled catheter of less than 2 weeks were independently associated with better TCC survival. Conclusion The conversion from non-tunneled to TCC performed by nephrologists and without fluoroscopy may be safe by using the internal right jugular vein. The ideal time to do this procedure is within less than 2 weeks of existing non-tunneled catheter.
Proximalization of the Arterial Inflow (PAI) in Patients with Dialysis Access-Induced Ischemic Syndrome: First Report on Long-Term Clinical Results
Authors: Thermann Florian , Wollert Ulrich , Ukkat Jörg , Dralle Henning 
Published: January 2018

Purpose Proximalization of the arterial inflow (PAI) is a promising technique which was introduced several years ago as a treatment option for patients with dialysis access-induced ischemic syndrome (DAIIS). In our institutions we have been performing PAI since 2003 and have seen positive clinical results. The aim of this prospective survey is to present the long-term results of PAI. Methods Between 2003 and 2008, forty PAI operations were performed in our institutions: 4 patients had acute pain and sensorimotor dysfunction with no lesions, 33 had small acral lesions, and 3 had extended lesions following the creation of autogenous fistulas. In 22 cases a heparinized graft was used and in 18 cases a regular PTFE-graft. Criteria for successful treeatment of the disease course were evaluated by clinical and ultrasound examinations. Results In 36 cases (90%), PAI led to clinical success which was permanent in 33 patients (82%) seen in the follow-up period of 9 to 40 months. Primary patency was 62% after 12 months and secondary patency was 75% after 18 months. Heparinized grafts led to better patency rates. In 3 out of the 4 patients with large acral lesions, graft explantation was necessary due to infection or failing success. Conclusions Based on our experience, clinical long-term results are successful in certain patients with DAIIS. The aim for the near future should be a better patency rate to minimize the need for reoperations. In cases of extended limb necrosis/gangrene results were poor. In such patients primary closure of the access must be discussed.
Web-Based Education Prior to Outpatient Orthopaedic Surgery Enhances Early Patient Satisfaction Scores: A Prospective Randomized Controlled Study
Authors: van Eck Carola F. , Toor Aneet , Banffy Michael B. , Gambardella Ralph A. 
Published: January 2018

Background: A good patient-surgeon relationship relies on adequate preoperative education and counseling. Several multimedia resources, such as web-based education tools, have become available to enhance aspects of perioperative care. Purpose/Hypothesis: The purpose of this study was to evaluate the effect of an interactive web-based education tool on perioperative patient satisfaction scores after outpatient orthopaedic surgery. It was hypothesized that web-based education prior to outpatient orthopaedic surgery enhances patient satisfaction scores. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: All patients undergoing knee arthroscopy with meniscectomy, chondroplasty, or anterior cruciate ligament reconstruction or shoulder arthroscopy with rotator cuff repair were eligible for inclusion and were randomized to the study or control group. The control group received routine education by the surgeon, whereas the study group received additional web-based education. At the first postoperative visit, all patients completed the OAS CAHPS (Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems) survey. Differences in patient satisfaction scores between the study and control groups were determined with an independent t test. Results: A total of 177 patients were included (104 [59%] males; mean age, 42 ± 14 years); 87 (49%) patients were randomized to receive additional web-based education. Total patient satisfaction score was significantly higher in the study group (97 ± 5) as compared with the control group (94 ± 8; P = .019), specifically for the OAS CAHPS core measure “recovery” (92 ± 13 vs 82 ± 23; P = .001). Age, sex, race, workers’ compensation status, education level, overall health, emotional health, procedure type and complexity, and addition of a video did not influence patient satisfaction scores. Conclusion: Supplemental web-based patient education prior to outpatient orthopaedic surgery enhances patient satisfaction scores.
The association between air pollution and the incidence of idiopathic pulmonary fibrosis in Northern Italy
Authors: Conti Sara , Harari Sergio , Caminati Antonella , Zanobetti Antonella , Schwartz Joel D. , Bertazzi Pietro A. , Cesana Giancarlo , Madotto Fabiana 
Published: January 2018

Acute exacerbations and worsening of idiopathic pulmonary fibrosis (IPF) have been associated with exposure to ozone (O3), nitrogen dioxide (NO2) and particulate matter, but chronic exposure to air pollution might also affect the incidence of IPF. We investigated the association between chronic exposure to NO2, O3and particulate matter with an aerodynamic diameter <10 μm (PM10) and IPF incidence in Northern Italy between 2005 and 2010.Daily predictions of PM10concentrations were obtained from spatiotemporal models, and NO2and O3hourly concentrations from fixed monitoring stations. We identified areas with homogenous exposure to each pollutant. We built negative binomial models to assess the association between area-specific IPF incidence rate, estimated through administrative databases, and average overall and seasonal PM10, NO2, and 8-hour maximum O3concentrations.Using unadjusted models, an increment of 10 µg·m−3in NO2concentration was associated with an increase between 7.93% (95% CI 0.36–16.08%) and 8.41% (95% CI −0.23–17.80%) in IPF incidence rate, depending on the season. After adjustment for potential confounders, estimated effects were similar in magnitude, but with larger confidence intervals.Although confirmatory studies are needed, our results trace a potential association between exposure to traffic pollution and the development of IPF.
The inflammatory cell landscape in the lungs of patients with idiopathic pulmonary arterial hypertension
Authors: Marsh Leigh M. , Jandl Katharina , Grünig Gabriele , Foris Vasile , Bashir Mina , Ghanim Bahil , Klepetko Walter , Olschewski Horst , Olschewski Andrea , Kwapiszewska Grazyna 
Published: January 2018

Increasing evidence points towards an inflammatory component underlying pulmonary hypertension. However, the conclusive characterisation of multiple inflammatory cell populations in the lung is challenging due to the complexity of marker specificity and tissue inaccessibility. We used an unbiased computational flow cytometry approach to delineate the inflammatory landscape of idiopathic pulmonary arterial hypertension (IPAH) and healthy donor lungs.Donor and IPAH samples were discriminated clearly using principal component analysis to reduce the multidimensional data obtained from single-cell flow cytometry analysis. In IPAH lungs, the predominant CD45+cell type switched from neutrophils to CD3+T-cells, with increases in CD4+, CD8+and γδT-cell subsets. Additionally, diversely activated classical myeloid-derived dendritic cells (CD14−HLA-DR+CD11c+CD1a+/−) and nonclassical plasmacytoid dendritic cells (pDCs; CD14−CD11c−CD123+HLA-DR+), together with mast cells and basophils, were more abundant in IPAH samples. We describe, for the first time, the presence and regulation of two cell types in IPAH, γδT-cells and pDCs, which link innate and adaptive immunity.With our high-throughput flow cytometry with multidimensional dataset analysis, we have revealed the interactive interplay between multiple inflammatory cells is a crucial part of their integrative network. The identification of γδT-cells and pDCs in this disease potentially provides a missing link between IPAH, autoimmunity and inflammation.
Inhaled diesel exhaust alters the allergen-induced bronchial secretome in humans
Authors: Mookherjee Neeloffer , Piyadasa Hadeesha , Ryu Min Hyung , Rider Christopher Francis , Ezzati Peyman , Spicer Victor , Carlsten Christopher 
Published: January 2018

Diesel exhaust (DE) is a paradigm for traffic-related air pollution. Human adaptation to DE is poorly understood and currently based on oversimplified models. DE promotes allergic responses, but protein expression changes mediated by this interaction have not been systematically investigated. The aim of this study was to define the effect of inhaled DE on allergen-induced proteins in the lung.We performed a randomised and blinded controlled human crossover exposure study. Participants inhaled filtered air or DE; thereafter, contralateral lung segments were challenged with allergen or saline. Using label-free quantitative proteomics, we comprehensively defined DE-mediated alteration of allergen-driven secreted proteins (secretome) in bronchoalveolar lavage. We further examined expression of proteins selected from the secretome data in independent validation experiments using Western blots, ELISA and immunohistochemistry.We identified protein changes unique to co-exposure (DE+allergen), undetected with mono-exposures (DE or allergen alone). Validation studies confirmed that specific proteins (e.g.the antimicrobial peptide cystatin-SA) were significantly enhanced with DE+allergen compared to either mono-exposure.This study demonstrates that common environmental co-exposures can uniquely alter protein responses in the lungs, illuminating biology that mono-exposures cannot. This study highlights the value of complex humanin vivomodels in detailing airway responses to inhaled pollution.
RESPIRE 2: a phase III placebo-controlled randomised trial of ciprofloxacin dry powder for inhalation in non-cystic fibrosis bronchiectasis
Authors: Aksamit Timothy , De Soyza Anthony , Bandel Tiemo-Joerg , Criollo Margarita , Elborn J. Stuart , Operschall Elisabeth , Polverino Eva , Roth Katrin , Winthrop Kevin L. , Wilson Robert 
Published: January 2018

We evaluated the efficacy and safety of ciprofloxacin dry powder for inhalation (DPI) in patients with non-cystic fibrosis bronchiectasis, two or more exacerbations in the previous year and predefined sputum bacteria.Patients were randomised 2:1 to twice-daily ciprofloxacin DPI 32.5 mg or placebo in 14- or 28-day on/off treatment cycles for 48 weeks. Primary end-points were time to first exacerbation and frequency of exacerbations. Enrolling countries and α level split (0.049 and 0.001 for 14- and 28-day cycles, respectively) differed from RESPIRE 1.Patients were randomised to ciprofloxacin DPI (14 days on/off (n=176) or 28 days on/off (n=171)) or placebo (14 days on/off (n=88) or 28 days on/off (n=86)). The exacerbation rate was low across treatment arms (mean±sd0.6±0.9). Active treatment showed trends to prolonged time to first exacerbation (ciprofloxacin DPI 14 days on/off: hazard ratio 0.87, 95.1% CI 0.62–1.21; p=0.3965; ciprofloxacin DPI 28 days on/off: hazard ratio 0.71, 99.9% CI 0.39–1.27; p=0.0511) and reduced frequency of exacerbations (ciprofloxacin DPI 14 days on/off: incidence rate ratio 0.83, 95.1% CI 0.59–1.17; p=0.2862; ciprofloxacin DPI 28 days on/off: incidence rate ratio 0.55, 99.9% CI 0.30–1.02; p=0.0014), although neither achieved statistical significance. Ciprofloxacin DPI was well tolerated.Trends towards clinical benefit were seen with ciprofloxacin DPI, but primary end-points were not met.
Bioaerosol concentrations generated from toilet flushing in a hospital-based patient care setting
Authors: Knowlton Samantha D. , Boles Corey L. , Perencevich Eli N. , Diekema Daniel J. , Nonnenmann Matthew W. ,   CDC Epicenters Program
Published: January 2018

Abstract
Background
In the United States, 1.7 million immunocompromised patients contract a healthcare-associated infection, annually. These infections increase morbidity, mortality and costs of care. A relatively unexplored route of transmission is the generation of bioaerosols during patient care. Transmission of pathogenic microorganisms may result from inhalation or surface contamination of bioaerosols. The toilet flushing of patient fecal waste may be a source of bioaerosols. To date, no study has investigated bioaerosol concentrations from flushing fecal wastes during patient care.

Methods
Particle and bioaerosol concentrations were measured in hospital bathrooms across three sampling conditions; no waste no flush, no waste with flush, and fecal waste with flush. Particle and bioaerosol concentrations were measured with a particle counter bioaerosol sampler both before after a toilet flushing event at distances of 0.15, 0.5, and 1 m from the toilet for 5, 10, 15 min.

Results
Particle concentrations measured before and after the flush were found to be significantly different (0.3–10 μm). Bioaerosol concentrations when flushing fecal waste were found to be significantly greater than background concentrations (p-value = 0.005). However, the bioaerosol concentrations were not different across time (p-value = 0.977) or distance (p-value = 0.911) from the toilet, suggesting that aerosols generated may remain for longer than 30 min post flush. Toilets produce aerosol particles when flushed, with the majority of the particles being 0.3 μm in diameter. The particles aerosolized include microorganisms remaining from previous use or from fecal wastes. Differences in bioaerosol concentrations across conditions also suggest that toilet flushing is a source of bioaerosols that may result in transmission of pathogenic microorganisms.

Conclusions
This study is the first to quantify particles and bioaerosols produced from flushing a hospital toilet during routine patient care. Future studies are needed targeting pathogens associated with gastrointestinal illness and evaluating aerosol exposure reduction interventions.
Lipidomics unveils the complexity of the lipidome in metabolic diseases
Authors: Lydic Todd A. , Goo Young‐Hwa 
Published: January 2018

AbstractDysregulation of lipid metabolism is responsible for pathologies of human diseases including metabolic diseases. Recent advances in lipidomics analysis allow for the targeted and untargeted identification of lipid species and for their quantification in normal and diseased conditions. Herein, this review provides a brief introduction to lipidomics, highlights its application to characterize the lipidome at the cellular and physiological levels under different biological conditions, and discusses the potential for the use of lipidomics in the discovery of biomarkers.
Enzalutamide for the Treatment of Androgen Receptor–Expressing Triple-Negative Breast Cancer
Authors: Traina Tiffany A. , Miller Kathy , Yardley Denise A. , Eakle Janice , Schwartzberg Lee S. , O’Shaughnessy Joyce , Gradishar William , Schmid Peter , Winer Eric , Kelly Catherine , Nanda Rita , Gucalp Ayca , Awada Ahmad , Garcia-Estevez Laura , Trudeau Maureen E. , Steinberg Joyce , Uppal Hirdesh , Tudor Iulia Cristina , Peterson Amy , Cortes Javier 
Published: January 2018

PurposeStudies suggest that a subset of patients with triple-negative breast cancer (TNBC) have tumors that express the androgen receptor (AR) and may benefit from an AR inhibitor. This phase II study evaluated the antitumor activity and safety of enzalutamide in patients with locally advanced or metastatic AR-positive TNBC.Patients and MethodsTumors were tested for AR with an immunohistochemistry assay optimized for breast cancer; nuclear AR staining > 0% was considered positive. Patients received enzalutamide 160 mg once per day until disease progression. The primary end point was clinical benefit rate (CBR) at 16 weeks. Secondary end points included CBR at 24 weeks, progression-free survival, and safety. End points were analyzed in all enrolled patients (the intent-to-treat [ITT] population) and in patients with one or more postbaseline assessment whose tumor expressed ≥ 10% nuclear AR (the evaluable subgroup).ResultsOf 118 patients enrolled, 78 were evaluable. CBR at 16 weeks was 25% (95% CI, 17% to 33%) in the ITT population and 33% (95% CI, 23% to 45%) in the evaluable subgroup. Median progression-free survival was 2.9 months (95% CI, 1.9 to 3.7 months) in the ITT population and 3.3 months (95% CI, 1.9 to 4.1 months) in the evaluable subgroup. Median overall survival was 12.7 months (95% CI, 8.5 months to not yet reached) in the ITT population and 17.6 months (95% CI, 11.6 months to not yet reached) in the evaluable subgroup. Fatigue was the only treatment-related grade 3 or higher adverse event with an incidence of > 2%.ConclusionEnzalutamide demonstrated clinical activity and was well tolerated in patients with advanced AR-positive TNBC. Adverse events related to enzalutamide were consistent with its known safety profile. This study supports additional development of enzalutamide in advanced TNBC.