bluuebunny/crossref_metadata_2025_split huggingface dataset:
Totally Implantable Port Management: Impact of Positive Pressure during Needle Withdrawal on Catheter Tip Occlusion (An Experimental Study)
Authors: Lapalu Jordane , Losser Marie-Reine , Albert Odile , Levert Hélène , Villiers Stéphane , Faure Pierre , Douard Marie-Cécile 
Published: January 2018

Background Totally implanted ports (TIP) have become a standard part of patient care, providing long-term central venous access for treatment administration and other procedures. Despite overall the safety and effectiveness of TIP, complications still occur. Negative pressure created during needle withdrawal induces blood reflux and subsequent catheter occlusion. Application of positive pressure during needle withdrawal is thought to largely prevent such reflux, but supporting data are limited. Purpose of Research To quantify the role of positive pressure, using a test model designed to simulate physiological conditions. Methods Reflux associated with needle withdrawal with and without applied positive pressure was tested using various TIP models from different manufacturers mounted on a specially designed test bench. In addition to the presence or absence of positive pressure during needle withdrawal, study variables comprised of needle type (safety and standard), needle gauge and port septum diameter. Results Application of positive pressure during needle withdrawal reduced the incidence of reflux during needle withdrawal by nearly 80% (22% vs. 99%, p<0.001). When reflux did occur, the mean residual volume was half that observed without positive pressure. In the absence of positive pressure, mean reflux increased with septum diameter and needle gauge to a statistically significant extent. None of these variables significantly affected reflux in the context of needle withdrawal under positive pressure. Conclusion The results of this study support the use of positive pressure during needle withdrawal to prevent blood reflux potentially leading to catheter tip occlusion.
Hemodynamic Impact of Anastomosis Size and Angle in Side-to-End Arteriovenous Fistulae: A Computer Analysis
Authors: Van Canneyt Koen , Pourchez Thierry , Eloot Sunny , Guillame Caroline , Bonnet Alexandre , Segers Patrick , Verdonck Pascal 
Published: January 2018

Purpose An arteriovenous fistula (AVF) is the first choice vascular access for hemodialysis. The AVF pathway can be seen as consisting of seven segments: proximal artery, distal artery, arterial collaterals, proximal vein, distal vein, venous collaterals, and the anastomosis. While most studies describe access complications without considering the impact of the anastomosis (7th segment), the present mathematical study investigated the hemodynamic impact of anastomosis size and angle on pressure drop and flow distribution. Methods A side-to-end AVF model was developed, consisting of an anastomosis with a given cross-sectional area (substudy 1) and angle (substudy 2). Starting from two reference cases (one for each substudy) with fixed flow distribution, pressure drop over the anastomosis was calculated for an arterial inflow in the range 600 to 1200 ml/min. The same reference cases, subsequently with fixed pressure boundary conditions, were further used to assess flow distribution over the proximal vein and distal artery. Results Pressure drop decreased with a larger anastomosis cross-sectional area and an angle wider than 43°, while it was almost stable for smaller angles. Although proximal arterial inflow increased for larger anastomosis areas, the overall flow distribution shifted almost totally to the proximal vein. When the anastomosis angle exceeded 58°, the proximal arterial inflow was not sufficient to deliver enough flow, leading to distal arterial flow reversal. Conclusion Despite the underestimation of the hemodynamic impact of the anastomosis size and angle in the literature, this study showed major influences on the pressure drop over the anastomosis and, with it, on flow distribution towards the arterial and venous outflow.
Snare Technique for the Placement of a Peripherally Inserted Central Catheter in the Neonatal and Pediatric Patient
Authors: Monsky Wayne L. , Garza Armando S. , Loh Shaun , Link Daniel P. 
Published: January 2018

Purpose The placement of a peripherally inserted central catheter (PICC) for neonatal or pediatric patients may at times be technically challenging. We describe an alternate method of placing a PICC in neonatal and pediatric patients with difficult venous access. Methods An Amplatz gooseneck snare is advanced from the femoral vein to the basilic vein, as a target for puncture and guidewire positioning, allowing PIcc placement. Between 1999 and 2006, 44 PICCs were placed in the manner described. The medical records were reviewed allowing for up to 7 yrs of patient follow-up. Results Ninety-five percent of PICCs were successfully placed using the snare technique. Two placements were aborted and two procedural complications occurred. The review revealed no evidence of osteomyelitis, nerve injury, deep venous thrombosis or leg length discrepancy. Conclusion this technique offers an alternate method for PICC placement in neonatal and pediatric patients when conventional methods are unsuccessful. The technique avoids the need for intermediate to long-term jugular, subclavian or femoral vein access.
Placement of Central Venous Catheters in Patients Undergoing Major Maxillofacial Surgery - A Retrospective Clinical Audit
Authors: Zochios Vasileios , Gilhooly Michael , Fenner Simon 
Published: January 2018

Purpose The subclavian vein is thought to be the most appropriate route for central venous access in major maxillofacial surgery. Evidence suggests that left-sided central venous catheters should lie below the carina and be angulated at less than 40° to superior vena cava wall. This reduces perforation risk. With this in mind we audited our current practice for placement of central venous catheters for major maxillofacial surgery. The criteria against which we compared our practice were: 1) all catheter tips should lie below the carina and 2) the angle of the distal 1 cm of the catheter should be no more than 40° to the superior vena cava wall. Methods Left subclavian central venous catheters placed on a weekly operating list between September 2005 and August 2008 were identified retrospectively: 83 patients were identified; 22 were excluded. The angle of the central venous catheter tip and distance from the carina were measured on the first post-procedure chest-X ray. All central venous catheters used were 16 cm long. Results 82% of the catheter tips were located above the carina while 61% were angulated at greater than 40°; 11% of central venous catheters met both standards; 14% of central venous catheters placed by a consultant and 12% of catheters placed by a trainee met both standards. Conclusions 89% of the central venous catheters were not correctly placed. The majority of central venous catheter tips above the carina were at an adverse angle to the superior vena cava wall. We suggest that for left subclavian central lines, 20 cm catheters be used.
The Role of a Vascular Access Surgeon in Ventriculo-Venous Shunts in Difficult Hydrocephalus
Authors: Ayaz Hossain Mohammad , Enver Frampton Adam , Choo Melissa , Morsy Mohamed , Thomas Marsh Henry , Martin Andrew James , Solomon Chemla Eric 
Published: January 2018

Introduction Cerebrospinal fluid (CSF) diversion into the right atrium or peritoneal cavity is the mainstay of treatment for normotensive hydrocephalus. Unfortunately multiple shunt failures can lead to patients returning for repeat interventions, leaving drainage options limited. We present a case series of five patients requiring venous access for shunt placement. Methods Using the St Georges technique of axillary vein dissection, a suitable vein draining into the axillary vein was found and a shunt inserted under direct vision into the vein. Results Four females and one male were retrospectively followed up from first venous shunt employment in February 2003 to May 2008. Of the 34 revised shunts performed (ventriculo-peritoneal, ventriculo-pleural or ventriculo-venous) in the group, 13 procedures included the use of the axillary vein for CSF diversion. All shunts had a cumulative primary and secondary patency of 50% and 80% at 1 yr, respectively. There was no significant difference in the primary or secondary patency between the three types. Conclusions We have presented a series of 35 primary and secondary shunts in five patients with hydrocephalus. All patients had exhausted all CSF diversion options prior to the use of the axillary vein. With comparable survival of the axillary shunts with ventriculo-pleural and peritoneal shunts, we therefore present a favorable outcome in the use of the axillary vein for CSF diversion.
Infection of Hemodialysis Arteriovenous Grafts
Authors: Akoh Jacob A. , Patel Neil 
Published: January 2018

Purpose Prosthetic arteriovenous grafts (AVG) are bedeviled by significant infectious complications. This study was to determine the infectious complications of prosthetic AVG and review the relevant literature. Methods All prosthetic AVG inserted between January 2000 to December 2007 were studied. Data on age, sex, date of graft insertion, indication for aVG, site of graft insertion, date of graft related infection, treatment and outcome for graft and patients were analyzed. Results There were 84 AVG inserted into 58 patients. Thigh AVG accounted for 55% of cases whereas upper arm AVG was inserted in 39%. Thirteen (17.3%) AVG were associated with one or more episodes of infection. The infection rate for SynerGraft (50%) was statistically significantly different from that of PTFE (12%) - Yates′ x2=6.164; df=1; p=0.013. The rate of infection was higher for thigh grafts (9/37) compared to other sites (4/34), but the difference was not statistically significant (Yates′ x2=1.123; df=1; p=0.289). Only one death was directly related to AVG infection in this series. Conclusion Infectious complications of AVG require prompt surgical or radiological intervention to save life or access. The need to excise an infected graft completely is sometimes counterbalanced by the compelling need to provide vascular access for hemodialysis in a patient with limited access options.
Detection of glucose metabolism disorders in coronary patients enrolled in cardiac rehabilitation: Is glycated haemoglobin useful? Data from the prospective REHABDIAB study
Authors: Tatulashvili Sopio , Patois-Vergès Bénédicte , Nguyen Amandine , Blonde Marie-Cécile , Vergès Bruno 
Published: January 2018

Introduction Diabetes and pre-diabetes are highly prevalent in patients with a history of acute coronary syndrome. This is why screening for glucose metabolism disorders is recommended in patients following an acute coronary syndrome. The aim of our study was to determine whether glycated haemoglobin alone compared with the oral glucose tolerance test could allow effective screening for glucose metabolism disorders in acute coronary syndrome patients undergoing cardiac rehabilitation. Patients and methods Among 347 patients with a recent history of acute coronary syndrome enrolled in our cardiac rehabilitation centre, 267 patients without previously known diabetes were recruited for this prospective study with performance of both oral glucose tolerance test and glycated haemoglobin measurement. The patients were divided into three groups: newly diagnosed diabetes mellitus, pre-diabetes and normoglycaemia according to the oral glucose tolerance test and glycated haemoglobin results. The results obtained with glycated haemoglobin were compared with those obtained with the oral glucose tolerance test, considered as the reference. Results For the diagnosis of diabetes, glycated haemoglobin had a sensitivity of 72% and a specificity of 100%. Positive and negative predictive values were high at 100% and 96%, respectively. However, for the diagnosis of pre-diabetes the sensitivity of glycated haemoglobin was low at 64% as were the specificity (53%) and the positive predictive values (37%). Glycated haemoglobin overdiagnosed pre-diabetes (52% vs 30%, p < 0.0001). For the diagnosis of normoglycaemia, the sensitivity of glycated haemoglobin was also low (48%). Conclusion According to our study, glycated haemoglobin has low sensitivity and specificity for the detection of pre-diabetes in patients with coronary disease enrolled in cardiac rehabilitation, and glycated haemoglobin over-diagnoses pre-diabetes in comparison with the oral glucose tolerance test.
Sodium-glucose co-transporter 2 inhibitors and cardiovascular outcomes: A systematic review and meta-analysis
Authors: Usman Muhammad Shariq , Siddiqi Tariq Jamal , Memon Muhammad Mustafa , Khan Muhammad Shahzeb , Rawasia Wasiq Faraz , Talha Ayub Muhammad , Sreenivasan Jayakumar , Golzar Yasmeen 
Published: January 2018

Background The risks and benefits of sodium-glucose co-transporter 2 (SGLT2) inhibitors on cardiovascular outcomes have not been well established. We pooled evidence from all available clinical trials to assess the cardiovascular effects of this drug. Design A systematic review and meta-analysis of randomised controlled trials. Methods We queried electronic databases (MEDLINE, Scopus, CENTRAL and clinicaltrials.gov) from their inception to July 2017 for published and unpublished placebo controlled trials of SGLT2 inhibitors. Only studies with a follow-up period of at least 24 weeks and reporting at least one cardiovascular outcome were included. Results from trials were presented as odds ratios (ORs) with 95% confidence intervals (CIs) and were pooled using a random-effects model. Results Thirty-five eligible studies (canagliflozin, nine; empagliflozin, eight; dapagliflozin, 18), consisting of 34,987 patients with type 2 diabetes mellitus were included. Pooled results show that SGLT2 inhibitors, when compared to placebo, significantly reduce all-cause mortality (OR 0.79, 95% CI 0.70–0.89; P < 0.001), major adverse cardiac events (OR 0.8, 95% CI 0.76–0.92; P < 0.001), non-fatal myocardial infarction (OR 0.85, 95% CI 0.73–0.98; P = 0.03) and heart failure/hospitalisation for heart failure (OR 0.67, 95% CI 0.59–0.76; P < 0.001) in patients with type 2 diabetes mellitus. No significant difference was noted in the occurrence of stroke (OR 1.02, 95% CI 0.85–1.21; P = 0.87), atrial fibrillation (OR 0.61, 95% CI 0.31–1.19; P = 0.15) or unstable angina (OR 0.95, 95% CI 0.73–1.25; P = 0.73). In addition, there was no heterogeneity between different drugs in the SGLT2 inhibitor class for all of the clinical outcomes studied ( I2 = 0). Conclusions SGLT2 inhibitors significantly reduce the incidence of mortality, major adverse cardiac events, non-fatal myocardial infarction and heart failure in patients with type 2 diabetes mellitus. Subtypes of SGLT2 inhibitors appear to have similar cardiovascular effects.
Phenotypes of organ involvement in sarcoidosis
Authors: Schupp Jonas Christian , Freitag-Wolf Sandra , Bargagli Elena , Mihailović-Vučinić Violeta , Rottoli Paola , Grubanovic Aleksandar , Müller Annegret , Jochens Arne , Tittmann Lukas , Schnerch Jasmin , Olivieri Carmela , Fischer Annegret , Jovanovic Dragana , Filipovic Snežana , Videnovic-Ivanovic Jelica , Bresser Paul , Jonkers René , O'Reilly Kate , Ho Ling-Pei , Gaede Karoline I. , Zabel Peter , Dubaniewicz Anna , Marshall Ben , Kieszko Robert , Milanowski Janusz , Günther Andreas , Weihrich Anette , Petrek Martin , Kolek Vitezslav , Keane Michael P. , O'Beirne Sarah , Donnelly Seamas , Haraldsdottir Sigridur Olina , Jorundsdottir Kristin B. , Costabel Ulrich , Bonella Francesco , Wallaert Benoît , Grah Christian , Peroš-Golubičić Tatjana , Luisetti Mauritio , Kadija Zamir , Pabst Stefan , Grohé Christian , Strausz János , Vašáková Martina , Sterclova Martina , Millar Ann , Homolka Jiří , Slováková Alena , Kendrick Yvonne , Crawshaw Anjali , Wuyts Wim , Spencer Lisa , Pfeifer Michael , Valeyre Dominique , Poletti Venerino , Wirtz Hubertus , Prasse Antje , Schreiber Stefan , Krawczak Michael , Müller-Quernheim Joachim 
Published: January 2018

Sarcoidosis is a highly variable, systemic granulomatous disease of hitherto unknown aetiology. The GenPhenReSa (Genotype–Phenotype Relationship in Sarcoidosis) project represents a European multicentre study to investigate the influence of genotype on disease phenotypes in sarcoidosis.The baseline phenotype module of GenPhenReSa comprised 2163 Caucasian patients with sarcoidosis who were phenotyped at 31 study centres according to a standardised protocol.From this module, we found that patients with acute onset were mainly female, young and of Scadding type I or II. Female patients showed a significantly higher frequency of eye and skin involvement, and complained more of fatigue. Based on multidimensional correspondence analysis and subsequent cluster analysis, patients could be clearly stratified into five distinct, yet undescribed, subgroups according to predominant organ involvement: 1) abdominal organ involvement, 2) ocular–cardiac–cutaneous–central nervous system disease involvement, 3) musculoskeletal–cutaneous involvement, 4) pulmonary and intrathoracic lymph node involvement, and 5) extrapulmonary involvement.These five new clinical phenotypes will be useful to recruit homogenous cohorts in future biomedical studies.
Effects of inspiratory muscle training on dyspnoea in severe COPD patients during pulmonary rehabilitation: controlled randomised trial
Authors: Beaumont Marc , Mialon Philippe , Le Ber Catherine , Le Mevel Patricia , Péran Loïc , Meurisse Olivier , Morelot-Panzini Capucine , Dion Angelina , Couturaud Francis 
Published: January 2018

The benefit of inspiratory muscle training (IMT) combined with a pulmonary rehabilitation programme (PRP) is uncertain. We aimed to demonstrate that, in severe and very severe chronic obstructive pulmonary disease (COPD) patients, IMT performed during a PRP is associated with an improvement of dyspnoea.In a single-blind randomised controlled trial, 150 severe or very severe COPD patients were allocated to follow PRP+IMTversusPRP alone. The evaluations were performed at inclusion and after 4 weeks. The primary outcome was the change in dyspnoea using the Multidimensional Dyspnoea Profile questionnaire at the end of a 6-min walk test (6MWT) at 4 weeks. Secondary outcomes were changes in dyspnoea using the Borg (end of the 6MWT) and modified Medical Research Council scales and in functional parameters (maximal inspiratory pressure (PImax), inspiratory capacity, 6MWT and quality of life). All analyses were performed on an intention-to-treat basis.Dyspnoea decreased significantly in both groups; however, the improvement of dyspnoea was not statistically different between the two groups. We only found a statistically significant greater increase ofPImaxafter IMT+PRP than after PRP alone.In this trial including severe or very severe COPD patients, we did not find a significant benefit of IMT during PRP+IMT as compared to PRP alone on dyspnoea, despite a significantly higher improvement ofPImaxin the IMT group.
Inspiratory muscle training does not improve clinical outcomes in 3-week COPD rehabilitation: results from a randomised controlled trial
Authors: Schultz Konrad , Jelusic Danijel , Wittmann Michael , Krämer Benjamin , Huber Veronika , Fuchs Sebastian , Lehbert Nicola , Wingart Silke , Stojanovic Dragan , Göhl Oliver , Alma Harma J. , de Jong Corina , van der Molen Thys , Faller Hermann , Schuler Michael 
Published: January 2018

The value of inspiratory muscle training (IMT) in pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) is unclear. The RIMTCORE (Routine Inspiratory Muscle Training within COPD Rehabilitation) randomised controlled trial examined the effectiveness of IMT added to pulmonary rehabilitation.In total, 611 COPD patients (Global Initiative for Chronic Obstructive Lung Disease stage II–IV) received a 3-week inpatient pulmonary rehabilitation, of which 602 patients were included in the intention-to-treat analyses. The intervention group (n=300) received highly intensive IMT and the control group (n=302) received sham IMT. The primary outcome was maximal inspiratory pressure (PImax). The secondary outcomes were 6-min walk distance, dyspnoea, quality of life and lung function. Outcomes were assessed pre- and post-pulmonary rehabilitation. ANCOVA was used.The intervention group showed higher effects inPImax(p<0.001) and forced inspiratory volume in 1 s (p=0.013). All other outcomes in both study groups improved significantly, but without further between-group differences. Sex and pulmonary rehabilitation admission shortly after hospitalisation modified quality of life effects.IMT as an add-on to a 3-week pulmonary rehabilitation improves inspiratory muscle strength, but does not provide additional benefits in terms of exercise capacity, quality of life or dyspnoea. A general recommendation for COPD patients to add IMT to a 3-week pulmonary rehabilitation cannot be made.
RESPIRE 1: a phase III placebo-controlled randomised trial of ciprofloxacin dry powder for inhalation in non-cystic fibrosis bronchiectasis
Authors: De Soyza Anthony , Aksamit Timothy , 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 pre-defined bacteria in sputum.In this phase III, double-blind, placebo-controlled trial, patients were randomised 2:1 to twice-daily ciprofloxacin DPI 32.5 mg or placebo in two treatment regimens consisting of on/off treatment cycles of 14 or 28 days for 48 weeks. The primary end-points were time to first exacerbation and frequency of exacerbations.A total of 416 patients were randomised to the 14-day on/off regimen (ciprofloxacin DPI (n=137) and placebo (n=68)) or the 28-day on/off regimen (ciprofloxacin DPI (n=141) and placebo (n=70)). Ciprofloxacin DPI 14 days on/off significantly prolonged time to first exacerbationversuspooled placebo (median time >336versus186 days; hazard ratio 0.53, 97.5% CI 0.36–0.80; p=0.0005) and reduced the frequency of exacerbations compared with matching placebo by 39% (mean number of exacerbations 0.6versus1.0; incidence rate ratio 0.61, 97.5% CI 0.40–0.91; p=0.0061). Outcomes for ciprofloxacin DPI 28 days on/off were not statistically significantly different from placebo. The safety profile of ciprofloxacin DPI was favourable.Ciprofloxacin DPI was well tolerated and has the potential to be an effective treatment option in non-cystic fibrosis bronchiectasis.