bluuebunny/crossref_metadata_2025_split huggingface dataset:
Benefits of Cardiac Rehabilitation on Cardiovascular Outcomes in Patients With Diabetes Mellitus After Percutaneous Coronary Intervention
Authors: Jiménez‐Navarro Manuel F. , Lopez‐Jimenez Francisco , Pérez‐Belmonte Luis M. , Lennon Ryan J. , Diaz‐Melean Carlos , Rodriguez‐Escudero J. P. , Goel Kashish , Crusan Daniel , Prasad Abhiram , Squires Ray W. , Thomas Randal J. 
Published: October 2017

Background

Participation in cardiac rehabilitation (
CR
) is an essential component of care for patients with coronary artery disease. However, little is known about its benefit on cardiovascular outcomes in patients with diabetes mellitus (
DM
) who have undergone percutaneous coronary intervention. The aim of our study was to evaluate the impact of
CR
in this high‐risk group of patients.

Methods and Results

We performed a retrospective analysis of all patients with
DM
who underwent percutaneous coronary intervention in Olmsted County (Minnesota) between 1994 and 2010, assessing the impact of
CR
participation on clinical outcomes.
CR
participation was significantly lower in patients with
DM
(38%, 263/700) compared with those who did not have
DM
(45%, 1071/2379;
P
=0.004). Using propensity score adjustment, we found that in patients with
DM
,
CR
participation was associated with significantly reduced all‐cause mortality (hazard ratio, 0.56; 95% confidence interval, 0.39–0.80;
P
=0.002) and composite end point of mortality, myocardial infarction, or revascularization (hazard ratio, 0.77; 95% confidence interval, 0.60–0.98;
P
=0.037), during a median follow‐up of 8.1 years. In patients without
DM
,
CR
participation was associated with a significant reduction in all‐cause mortality (hazard ratio, 0.67; 95% confidence interval, 0.55–0.82;
P
<0.001) and cardiac mortality (hazard ratio, 0.67; 95% confidence interval, 0.47–0.95;
P
=0.024).

Conclusions

CR
participation after percutaneous coronary intervention is associated with lower all‐cause mortality rates in patients with
DM
, to a similar degree as for those without
DM
. However,
CR
participation was lower in patients with
DM
, suggesting the need to identify and correct the barriers to
CR
participation for this higher‐risk group of patients.
Lack of meaningful activity on acute physical hospital wards: Older people’s experiences
Authors: Clarke Channine , Stack Caroline , Martin Marion 
Published: October 2017

Introduction Research suggests that older people on acute physical hospital wards are at increased risk of physical and mental health decline due to inactivity during their stay. Whilst studies have highlighted potential causes of such inactivity, there exists a paucity of occupational therapy research that explores engagement in meaningful occupation from patients’ perspectives in hospital settings. Method Interpretative phenomenological analysis was used to gain a deeper understanding of how 18 older people spent their time on hospital wards and the impact this had on their feelings of wellbeing. Interviews were carried out and analysed using interpretive phenomenological analysis guidelines. Findings Patients experienced a lack of meaningful activity on the wards which resulted in feelings of passivity, boredom and a sense of alienation from their normal roles, routines and sense of self. Despite a willingness to engage in activity, barriers were suggested as limited resources, hospital routines and personal limitations. Suggestions of potential meaningful activities were made. Conclusion Occupational therapy services need to review service provision and provide an occupation-focused service, ensuring that patients’ engagement in meaningful activities is seen as an integral part of their role in order to maintain patients’ mental and physical wellbeing. Recommendations for further research are highlighted.
Recognizing the role of CGRP and CGRP receptors in migraine and its treatment
Authors: Edvinsson Lars , Warfvinge Karin 
Published: October 2017

Premise The brain and the sensory nervous system contain a rich supply of calcitonin gene-related peptide (CGRP) and CGRP receptor components. Clinical studies have demonstrated a correlation between CGRP release and acute migraine headache that led to the development of CGRP-specific drugs that either abort acute attacks of migraine (gepants) or are effective as prophylaxis (antibodies). However, there is still much discussion concerning the site of action of these drugs. Problem Here we describe the most recent data related to CGRP in the trigeminal ganglion and its connections to the CNS, putative key regions involved in migraine pathophysiology. Gepants are small molecules that have limited ability to cross the blood-brain barrier (BBB), whereas CGRP antibodies are 1500 times larger molecules, and are virtually excluded from the brain, with a BBB permeability of < 0.1%. Thus we propose that the primary site of action for the antimigraine drugs is outside the CNS in areas not limited by the BBB. Potential solution Therefore, it is reasonable to discuss the localization of CGRP and its receptor components in relation to the BBB. The trigeminovascular system, located outside the BBB, has a key role in migraine symptomatology, and it is likely targeted by the novel CGRP drugs that successfully terminate migraine headache.
Soluble guanylyl cyclase is a critical regulator of migraine-associated pain
Authors: Ben Aissa Manel , Tipton Alycia F , Bertels Zachariah , Gandhi Ronak , Moye Laura S , Novack Madeline , Bennett Brian M , Wang Yueting , Litosh Vladislav , Lee Sue H , Gaisina Irina N , Thatcher Gregory RJ , Pradhan Amynah A 
Published: October 2017

Background Nitric oxide (NO) has been heavily implicated in migraine. Nitroglycerin is a prototypic NO-donor, and triggers migraine in humans. However, nitroglycerin also induces oxidative/nitrosative stress and is a source of peroxynitrite – factors previously linked with migraine etiology. Soluble guanylyl cyclase (sGC) is the high affinity NO receptor in the body, and the aim of this study was to identify the precise role of sGC in acute and chronic migraine. Methods We developed a novel brain-bioavailable sGC stimulator (VL-102), and tested its hyperalgesic properties in mice. We also determined the effect of VL-102 on c-fos and calcitonin gene related peptide (CGRP) immunoreactivity within the trigeminovascular complex. In addition, we also tested the known sGC inhibitor, ODQ, within the chronic nitroglycerin migraine model. Results VL-102-evoked acute and chronic mechanical cephalic and hind-paw allodynia in a dose-dependent manner, which was blocked by the migraine medications sumatriptan, propranolol, and topiramate. In addition, VL-102 also increased c-fos and CGRP expressing cells within the trigeminovascular complex. Importantly, ODQ completely inhibited acute and chronic hyperalgesia induced by nitroglycerin. ODQ also blocked hyperalgesia already established by chronic nitroglycerin, implicating this pathway in migraine chronicity. Conclusions These results indicate that nitroglycerin causes migraine-related pain through stimulation of the sGC pathway, and that super-activation of this receptor may be an important component for the maintenance of chronic migraine. This work opens the possibility for negative sGC modulators as novel migraine therapies.
Hip and Ankle Kinematics in Noncontact Anterior Cruciate Ligament Injury Situations: Video Analysis Using Model-Based Image Matching
Authors: Koga Hideyuki , Nakamae Atsuo , Shima Yosuke , Bahr Roald , Krosshaug Tron 
Published: October 2017

Background: Detailed kinematic descriptions of real anterior cruciate ligament (ACL) injury situations are limited to the knee only. Purpose: To describe hip and ankle kinematics as well as foot position relative to the center of mass (COM) in ACL injury situations through use of a model-based image-matching (MBIM) technique. The distance between the projection of the COM on the ground and the base of support (BOS) (COM_BOS) normalized to the femur length was also evaluated. Study Design: Descriptive laboratory study. Methods: Ten ACL injury video sequences from women’s handball and basketball were analyzed. Hip and ankle joint kinematic values were obtained by use of MBIM. Results: The mean hip flexion angle was 51° (95% CI, 41° to 63°) at initial contact and remained constant over the next 40 milliseconds. The hip was internally rotated 29° (95% CI, 18° to 39°) at initial contact and remained unchanged for the next 40 milliseconds. All of the injured patients landed with a heel strike with a mean dorsiflexion angle of 2° (95% CI, –9° to 14°), before reaching a flatfooted position 20 milliseconds later. The foot position was anterior and lateral to the COM in all cases. However, none of the results showed larger COM_BOS than 1.2, which has been suggested as a criterion for ACL injury risk. Conclusions: Hip kinematic values were consistent among the 10 ACL injury situations analyzed; the hip joint remained unchanged in a flexed and internally rotated position in the phase leading up to injury, suggesting that limited energy absorption took place at the hip. In all cases, the foot contacted the ground with the heel strike. However, relatively small COM_BOS distances were found, indicating that the anterior and lateral foot placement in ACL injury situations was not different from what can be expected in noninjury game situations.
Behavior and pressure drop of an upwardly two-phase flow through multi-hole orifices
Authors: Zeghloul Ammar , Azzi Abdelwahid , Hasan Abbas , Azzopardi Barry James 
Published: October 2017

Experimental results on hydrodynamic behavior and pressure drop of two-phase mixture flowing upwardly in a pipe containing single- and/or multi-hole orifice plate are presented. It was found from the measurement of the void fraction upstream and downstream the orifices that the flow behavior is significantly affected by the layout of the orifice plate used and the flow starts to recover after approximately 7 D downstream the orifice. Furthermore, increasing orifice holes number results in decreasing the slip ratio. The standard deviation of the void fraction was used to identify the flow pattern before and after the orifices and found that the critical threshold transition occurred at a standard deviation of 0.2. The flow homogenization necessitates a minimum value of the liquid superficial velocity to occur, and the position where it takes place depends on this velocity and on the orifice holes number. It was also inferred from the two-phase pressure drop data across the orifices that three different flow regimes, where the transition between bubbly-to-slug and slug-to-churn flow, can be identified. An assessment of the predicted two-phase flow multiplier using some previous models dedicated to single-hole orifice was achieved; and found that the model proposed by Simpson et al. is the most reliable one. Single-phase pressure drop was also measured and compared with correlations from literature.
Dosimetric Analysis of Microscopic Disease in SBRT for Lung Cancers
Authors: Mao Ronghu , Tian Lingling , Zhang You , Ren Lei , Gao Renqi , Yin Fang-Fang , Ge Hong 
Published: October 2017

Objective: The objective of this study is to theoretically and experimentally evaluate the dosimetry in the microscopic disease regions surrounding the tumor under stereotactic body radiation therapy of lung cancer. Methods: For simplicity, the tumor was considered moving along 1 dimension with a periodic function. The probability distribution function of the tumor position was generated according to the motion pattern and was used to estimate the delivered dose in the microscopic disease region. An experimental measurement was conducted to validate both the estimated dose with a probability function and the calculated dose from 4-dimensional computed tomography data using a dynamic thorax phantom. Four tumor motion patterns were simulated with cos4(x) and sin(x), each with 2 different amplitudes: 10 mm and 5 mm. A 7-field conformal plan was created for treatment delivery. Both films (EBT2) and optically stimulated luminescence detectors were inserted in and around the target of the phantom to measure the delivered doses. Dose differences were evaluated using gamma analysis with 3%/3 mm. Results: The average gamma index between measured doses using film and calculated doses using average intensity projection simulation computed tomography was 80.8% ± 0.9%. In contrast, between measured doses using film and calculated doses accumulated from 10 sets of 4-dimensional computed tomography data, it was 98.7% ± 0.6%. The measured doses using optically stimulated luminescence detectors matched very well (within 5% of the measurement uncertainty) with the theoretically calculated doses using probability distribution function at the corresponding position. Respiratory movement caused inadvertent irradiation exposure, with 70% to 80% of the dose line wrapped around the 10 mm region outside the target. Conclusion: The use of static dose calculation in the treatment planning system could substantially underestimate the actual delivered dose in the microscopic disease region for a moving target. The margin for microscopic disease may be substantially reduced or even eliminated for lung stereotactic body radiation therapy.
Quality of time spent without symptoms of disease or toxicity of treatment for transmetatarsal amputation versus digital amputation in diabetic patients with digital gangrene
Authors: Elsherif Mohamed , Tawfick Wael , Canning Patrick , Hynes Niamh , Sultan Sherif 
Published: October 2017

Aim We aim to compare the outcome of diabetic patients with gangrenous toes who were managed initially either by digital amputation or by transmetatarsal amputation. The null hypothesis is that transmetatarsal amputation had less theatre trips and better healing. Materials and Methods A parallel observational comparative study of all diabetic patients who underwent either digital or transmetatarsal amputation in a tertiary referral center from 2002 through 2015. Comorbid conditions, subsequent amputations, hospital stay, and readmission were noted. Results A total of 223 patients underwent minor amputation during the study period, of which 147 patients were diabetic and 76 patients were non-diabetic. Seventy-seven patients had digital amputation and 70 transmetatarsal amputation in diabetic patients. Demographics were similar in both groups. The median time to major amputation was (400 ± IQR 1205 days) in the digital amputation group, compared to 690 ± IQR 891 days in the transmetatarsal amputation group ( P = 0.974). 29.9% of digital amputations and 15.7% of transmetatarsal amputations in diabetic patients, required minor amputations or revision procedures ( P = 0.04). Median length of hospital stay was (20 days, IQR 27) in the digital group and (17 days, IQR17) in the transmetatarsal amputation group ( P = 0.17). Need for re-admission was 48.1% in digital patients compared to 50% in transmetatarsal amputation patients ( P = 0.81). Quality of time spent without symptoms of disease or toxicity of treatment (Q-TWiST) was (315 days, IQR 45) in digital group and (346 days, IQR 48) in the transmetatarsal amputation patients ( P = 0.099). Conclusion Despite the lack of statistical significance, transmetatarsal amputation offered better outcome in the diabetic patients, with less re-intervention rate, shorter hospital stays, less theatre trips, and longer time without toxicity (TWiST).
Arthroscopic versus open excision of dorsal ganglion cysts: a systematic review
Authors: Crawford Catherine , Keswani Aakash , Lovy Andrew J. , Levy Isaiah , Lutz Kristina , Kim Jaehon , Hausman Michael 
Published: October 2017

We conducted a systematic review comparing recurrence and complication rate following open versus arthroscopic excision of ganglion cysts. Sixteen full-text articles were included. The pooled recurrence rate of open excision was 20% (range: 5.6–40.7%) with Q value of 27 and I2 of 82%. The pooled recurrence rate of arthroscopic excision was 9% (range: 0–17%) with Q value of 10 and I2 of 2%. Eleven of 16 studies were low quality or had a high risk of bias; however, excluding low quality studies or those with high risk of bias produced similar recurrence rates in arthroscopic and open excision (7.9% versus 9.8%). For the subset of studies with complete reporting of complications, rates were similar in open and arthroscopic excision (6% versus 4%). Our review suggests that arthroscopic and open approaches have comparable outcome profiles. Nevertheless, standardized study methods with adequate powering are required to collect high quality data, allowing for greater confidence in conclusions regarding these two approaches for existing ganglion cysts. Level of Evidence: II
The management of chronic non-arthritic scapholunate dissociation: a systematic review
Authors: Naqui Zafar , Khor Wee Sim , Mishra Anuj , Lees Vivien , Muir Lindsay 
Published: October 2017

A systematic review was conducted to identify the best management for chronic scapholunate dissociation. EMBASE, MEDLINE, and CENTRAL were searched from 1965–2016. A narrative synthesis was performed. One thousand, one hundred and ninety-one citations were identified, of which 17 had final analysis. In all interventions, the pain score at 2 years reduced from 6.0 to 2.8 with similar effect from capsulodesis and tenodesis techniques. Overall there was an 18% loss of flexion arc. Radial to ulnar arc improved in capsulodesis (+19%; n = 45) and worsened in tenodesis (−6%; n = 45). Grip strength was better in capsulodesis (+31%; n = 64 versus + 11%; n = 56). There was insufficient evidence to link radiological outcome with clinical outcome. Rates of complications (20%) and CRPS (3.8%) were high, with implications for patient consent. Due to heterogeneity in data collection, the lack of comparative studies and short-term follow-up, no conclusion regarding the superiority of a single technique was possible. Longer term comparative studies are required, as are natural history studies. A minimum data set has been advised. Level of evidence: II
Psychosocially Supportive Design: The Case for Greater Attention to Social Space Within the Pediatric Hospital
Authors: McLaughlan Rebecca 
Published: October 2017

Objective: Models of patient and family-centered care advocate catering to psychosocial needs when designing healthcare facilities yet there is little evidence available to determine how the built environment can cater to psychosocial needs. This article highlights the obstacles to overcoming this knowledge deficit in the pursuit of evidence-based guidelines to inform social provisions within the pediatric hospital setting. It will propose a working definition for psychosocial space and identify new research directions to enhance understandings of the relationship between social space and well-being. Background: While traditional multibed ward configurations afforded opportunities for peer support relationships to develop, both for patients and caregivers, the contemporary preference for single-occupancy rooms intensifies the need to critically examine social spaces within the pediatric hospital. Methods: Research suggests a correlation between social support and well-being. This article reviews the research underpinning contemporary understandings of this relationship; it positions literature from sociology, environmental psychology, and evidence-based design to highlight the limitations of this knowledge and identify where additional research is required to inform evidence-based design guidelines for psychosocially supportive spaces within pediatric healthcare settings. Conclusions: Evidence regarding the therapeutic value of social support within the pediatric hospital is not sufficiently sophisticated or conclusive to inform guidelines for the provision of social space with pediatric hospitals. There is an urgent need for targeted research to inform evidence-based design guidelines; this will demand a broad disciplinary approach.
Factors That Drive Youth Specialization
Authors: Padaki Ajay S. , Popkin Charles A. , Hodgins Justin L. , Kovacevic David , Lynch Thomas Sean , Ahmad Christopher S. 
Published: October 2017

Background: Specialization in young athletes has been linked to overuse injuries, burnout, and decreased satisfaction. Despite continued opposition from the medical community, epidemiological studies suggest the frequency is increasing. Hypothesis: Extrinsic pressures in addition to individual aspirations drive this national trend in sports specialization. Study Design: Descriptive epidemiology study. Level of Evidence: Level 3. Methods: A novel instrument assessing the driving factors behind youth specialization was generated by an interdisciplinary team of medical professionals. Surveys were administered to patients and athletes in the department’s sports medicine clinic. Results: The survey was completed by 235 athletes between 7 and 18 years of age, with a mean age of 13.8 ± 3.0 years. Athletes specialized at a mean age of 8.1 years, and 31% of athletes played a single sport while 58% played multiple sports but had a preferred sport. More than 70% of athletes had collegiate or professional ambitions, and 60% played their primary sport for 9 or more months per year, with players who had an injury history more likely to play year-round ( P < 0.01). Approximately one-third of players reported being told by a coach not to participate in other sports, with specialized athletes reporting this significantly more often ( P = 0.04). Half of the athletes reported that sports interfered with their academic performance, with older players stating this more frequently ( P < 0.01). Conclusion: Young athletes are increasingly specializing in a single sport before starting high school. While intrinsic drive may identify healthy aspirations, extrinsic influences are prevalent in specialized athletes. Clinical Relevance: Extrinsic factors contributing to youth specialization were identified and compounded the deleterious sequelae of youth athlete specialization.
Citrulline as a marker of intestinal function and absorption in clinical settings: A systematic review and meta‐analysis
Authors: Fragkos Konstantinos C. , Forbes Alastair 
Published: October 2017

BackgroundCitrulline has been described as a marker of intestinal function or absorption but evidence varies according to clinical settings.ObjectiveThe objective of this article is to examine the evidence of plasma citrulline as a marker of intestinal function and absorption in various clinical settings.MethodsStudies were examined for p values, means and standard deviations, correlation coefficients or other metrics depicting the association of citrulline with intestinal function. A random effects model was used to produce a pooled estimate. A hierarchical summary receiver operating curve model was fitted for diagnostic accuracy measures.ResultsCitrulline levels are correlated strongly with small bowel length in short bowel syndrome patients (r  = 0.67). Citrulline is strongly negatively correlated (r  = –0.56) with intestinal disease severity with regards to enteropathies (coeliac disease, tropical enteropathy, Crohn’s disease, mucositis, acute rejection in intestinal transplantation). Citrulline cut‐off levels have an overall sensitivity and specificity of 80% and 84% respectively. Citrulline levels in untreated coeliac patients compared to controls were reduced by 10 µmol/l. Citrulline levels increase with gluten‐free diet and with improvement of enteropathy. Citrulline is decreased in critical illness and sepsis.ConclusionThese findings allow us to advocate quite reasonably that citrulline is a marker of acute and chronic intestinal insufficiency.