bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Study of TCPC-Stent Conjunction for Cavopulmonary Assist in Fontan Patients With Right Ventricular Dysfunction
Authors: Jagani Jakin , Untaroiu Alexandrina 
Published: February 2017

Mechanical circulatory support devices have gained significant importance in recent years as a viable therapeutic option to support paediatric population and children with single functional ventricle. The Fontan operation helps to reroute the deoxygenated blood to the lungs by bypassing the dysfunctional right ventricle. Total Cavopulmonary Connection (TCPC) is usually a method opted by the clinicians to connect the superior vena cava (SVC) and inferior vena cava (IVC) to the left and right pulmonary artery (LPA and RPA). However, the non-physiologic flow patterns created by the Fontan procedure leads to an increase in chances of platelet deposition and pressure loss which calls for heart transplantation to prevent early and late stage pathophysiology. This had led to modification of TCPC geometry to reduce the pressure and energy loss and thereby unload the single functional ventricle to ensure longer survival period. A study on mechanical circulatory device in conjunction with the modified TCPC geometry has seen little exposure and has opened new gates to develop a variety of state-of-art cavopulmonary assist devices. This study is focused on the selection of optimal TCPC to reduce energy loss and the effect of stent inside the modified TCPC on hemodynamics and flow structures.
Four TCPC connections, developed for a particular age group of children, were studied for the velocity field, overall pressure and energy loss. In addition, the four TCPC connection geometries were also studied for distribution of hepatic blood from the IVC to both pulmonary arteries, and hence the lungs, to prevent development of any arteriovenous malformations. The entire stent assembly mounted inside the two best performing TCPC connections was examined for the hemodynamic effects using a series of 3D-CFD simulations.
The curved-type connection for the TCPC proved to provide minimum pressure and energy loss along with reduced traces of vortex and recirculation. However, it was not efficient in terms of hepatic blood distribution. The flared geometry performed second best in terms of both minimum power loss and even hepatic blood distribution. There was a slight difference in power loss between the flared and the curved TCPC configuration with stent but the flared geometry had better hepatic blood distribution.
This study demonstrated that a stent in conjunction with a TCPC leads to development of a helical flow pattern which provides better mixing of blood and even distribution to both the pulmonary arteries. The design of a stent with the best performing flared TCPC configuration can be optimized to reduce the amount of power loss and vortex generation and can be used to design similar scaled models for paediatric population of various age groups.
Carbon Source-Dependent Inducible Metabolism of Veratryl Alcohol and Ferulic Acid in Pseudomonas putida CSV86
Authors: Mohan Karishma , Phale Prashant S. 
Published: February 2017

ABSTRACT

Pseudomonas putida
CSV86 degrades lignin-derived metabolic intermediates,
viz
., veratryl alcohol, ferulic acid, vanillin, and vanillic acid, as the sole sources of carbon and energy. Strain CSV86 also degraded lignin sulfonate. Cell respiration, enzyme activity, biotransformation, and high-pressure liquid chromatography (HPLC) analyses suggest that veratryl alcohol and ferulic acid are metabolized to vanillic acid by two distinct carbon source-dependent inducible pathways. Vanillic acid was further metabolized to protocatechuic acid and entered the central carbon pathway via the β-ketoadipate route after
ortho
ring cleavage. Genes encoding putative enzymes involved in the degradation were found to be present at
fer
,
ver
, and
van
loci. The transcriptional analysis suggests a carbon source-dependent cotranscription of these loci, substantiating the metabolic studies. Biochemical and quantitative real-time (qRT)-PCR studies revealed the presence of two distinct
O
-demethylases,
viz
., VerAB and VanAB, involved in the oxidative demethylation of veratric acid and vanillic acid, respectively. This report describes the various steps involved in metabolizing lignin-derived aromatic compounds at the biochemical level and identifies the genes involved in degrading veratric acid and the arrangement of phenylpropanoid metabolic genes as three distinct inducible transcription units/operons. This study provides insight into the bacterial degradation of lignin-derived aromatics and the potential of
P. putida
CSV86 as a suitable candidate for producing valuable products.

IMPORTANCE
Pseudomonas putida
CSV86 metabolizes lignin and its metabolic intermediates as a carbon source. Strain CSV86 displays a unique property of preferential utilization of aromatics, including for phenylpropanoids over glucose. This report unravels veratryl alcohol metabolism and genes encoding veratric acid
O
-demethylase, hitherto unknown in pseudomonads, thereby providing new insight into the metabolic pathway and gene pool for lignin degradation in bacteria. The biochemical and genetic characterization of phenylpropanoid metabolism makes it a prospective system for its application in producing valuable products, such as vanillin and vanillic acid, from lignocellulose. This study supports the immense potential of
P. putida
CSV86 as a suitable candidate for bioremediation and biorefinery.
What are the decision-making preferences of patients in vascular surgery? A mixed-methods study
Authors: Santema T B Katrien , Stoffer E Anniek , Kunneman Marleen , Koelemay Mark J W , Ubbink Dirk T 
Published: February 2017

ObjectivesShared decision-making (SDM) has been advocated as the preferred method of choosing a suitable treatment option. However, patient involvement in treatment decision-making is not yet common practice in the field of vascular surgery. The aim of this mixed-methods study was to explore patients' decision-making preferences and to investigate which facilitators and barriers patients perceive as important for the application of SDM in vascular surgery.Design and settingPatients were invited to participate after visiting the vascular surgical outpatient clinic of an Academic Medical Center in the Netherlands. A treatment decision was made during the consultation for an abdominal aortic aneurysm or peripheral arterial occlusive disease. Patients filled in a number of questionnaires (quantitative part) and a random subgroup of patients participated in an in-depth interview (qualitative part).ResultsA total of 67 patients participated in this study. 58 per cent of them (n=39) indicated that they preferred a shared role in decision-making. In more than half of the patients (55%; n=37) their preferred role was in disagreement with what they had experienced. 31 per cent of the patients (n=21) preferred a more active role in the decision-making process than they had experienced. Patients indicated a good patient–doctor relationship as an important facilitator for the application of SDM.ConclusionsThe vast majority of vascular surgical patients preferred, but did not experience a shared role in the decision-making process, although the concept of SDM was insufficiently clear to some patients. This emphasises the importance of explaining the concept of SDM and implementing it in the clinical encounter.
Surveillance of paediatric exposures to liquid laundry detergent pods in Italy
Authors: Settimi Laura , Giordano Felice , Lauria Laura , Celentano Anna , Sesana Fabrizio , Davanzo Franca 
Published: February 2017

ObjectiveTo analyse paediatric exposures to pod and traditional laundry detergents in Italy and changes in exposure trends.MethodsAnalyses of a series of patients aged <5 years and exposed to laundry detergents between September 2010 and June 2015, identified by the National Poison Control in Milan.ResultsIn comparison with patients exposed to traditional laundry detergents (n=1150), a higher proportion of those exposed to pods (n=1649) were managed in hospital (68% vs 42%), had clinical effects (75% vs 22%) and moderate/high severity outcomes (13% vs <1%). Exposure rates were stable over time for traditional detergents (average 0.65 cases/day), but an abrupt decline in major company pods was seen in December 2012, 4 months after the introduction of opaque outer packaging (from 1.03 to 0.36 cases/day and from 1.88 to 0.86 cases/million units sold). The odds of clinical effects was higher for exposure to pods than for traditional detergents (OR=10.8; 95% CI 9.0 to 12.9). Among patients exposed to pods, the odds of moderate/high severity outcomes was four times higher for children aged <1 years than for the other age groups (OR=3.9; 95% CI 2.2 to 7.0). Ten children exposed to laundry detergent pods had high severity outcomes while no children exposed to traditional laundry detergents developed high severity effects.ConclusionsThe study confirms that exposure to laundry detergent pods is more dangerous than exposure to traditional detergents. In Italy, 4 months after the introduction of opaque outer packaging by a major company, product-specific exposure rates decreased sharply, suggesting that reducing visibility of laundry detergent pods may be an effective preventive measure. Further efforts are needed to improve safety.
Frailty, Physical Activity, and Mobility in Patients With Cardiac Implantable Electrical Devices
Authors: Kramer Daniel B. , Tsai Timothy , Natarajan Poorna , Tewksbury Elise , Mitchell Susan L. , Travison Thomas G. 
Published: February 2017

Background
This study aimed to demonstrate the feasibility of measuring frailty in patients with cardiac implantable electrical devices while validating the physiologic significance of device‐detected physical activity by evaluating its association with frailty and mobility.

Methods and Results

Outpatients with cardiac implantable electrical devices compatible with physical activity analysis with at least 7 days of data were eligible. Office testing included frailty status (Study of Osteoporotic Fractures instrument), gait speed (m/s), mobility according to the Timed Up and Go (
TUG
) test (seconds), and daily physical activity (h/d) as measured by cardiac implantable electrical device. Among 219 patients, Study of Osteoporotic Fractures testing found 39.7% to be robust, 47.5% prefrail, and 12.8% frail. The mean gait speed for the cohort was 0.8±0.3 m/s, mean
TUG
time was 10.9±4.4 seconds, and mean activity was 2.8±1.9 h/d. Frail patients were markedly more likely to have gait speeds <0.8 m/s (
OR
6.25, 95%
CI
1.79‐33.3). In unadjusted analyses each 1‐hour increase in mean daily activity was associated with a 46% reduction of frail phenotype (
OR
0.54, 95%
CI
0.40‐0.74) versus robust and with a 27% reduction in the odds of having the prefrail phenotype (
OR
0.73, 95%
CI
0.62‐0.86). After adjustment this association per hour of activity persisted, with an adjusted
OR
for frailty of 0.71 (95%
CI
0.51‐0.99) and adjusted
OR
for prefrailty of 0.81 (95%
CI
0.67‐0.99).

Conclusions
Frailty and mobility limitation are common among cardiac implantable electrical device patients and are correlated to device‐detected physical activity.
Declining Incidence of Ischemic Stroke
Authors: Vangen-Lønne Anne M. , Wilsgaard Tom , Johnsen Stein Harald , Løchen Maja-Lisa , Njølstad Inger , Mathiesen Ellisiv B. 
Published: February 2017

Background and Purpose—
It is proposed that 20% to 40% of the decline in first-ever stroke incidence is attributed to the improvement of risk factor control. We estimated the impact of modifiable cardiovascular risk factors on the changing incidence of ischemic stroke (IS) between 1995 and 2012, using individual person data from repeated surveys in a general population.

Methods—
The proportion of the IS incidence decline explained by change in each risk factor over time was estimated from 1995 to 2012 by Poisson regression among 26 329 participants who attended the fourth Tromsø survey in 1994 to 1995. Hazard ratios for IS were estimated with Cox proportional hazards regression among 27 936 participants who attended at least 1 of the Tromsø surveys in 1994 to 1995, 2001, or 2007 to 2008. Age- and sex-adjusted means or prevalences of risk factors over time were estimated by generalized estimating equations.

Results—
There were 1226 first-ever IS during 367 636 person-years of follow-up. Changes in cardiovascular risk factors accounted for 57% of the decrease in IS incidence from 1995 to 2012. The most important contributors were decreasing mean systolic blood pressure and smoking prevalence, accounting for 26% and 17% of the observed decline, respectively. Conversely, increasing diabetes mellitus prevalence contributed negatively to the declining IS incidence.

Conclusions—
Changes in cardiovascular risk factors explained 57% of the decrease in IS incidence from 1995 to 2012. Reduction in systolic blood pressure and prevalence of smoking were the most important contributors.
Applying Fuzzy Clustering to a Multimodel Ensemble for U.S. East Coast Winter Storms: Scenario Identification and Forecast Verification
Authors: Zheng Minghua , Chang Edmund K. M. , Colle Brian A. , Luo Yan , Zhu YueJian 
Published: February 2017

Abstract
This article introduces a method for objectively separating and validating forecast scenarios within a large multimodel ensemble for the medium-range (3–7 day) forecasts of extratropical cyclones impacting the U.S. East Coast. The method applies fuzzy clustering to the principal components (PCs) of empirical orthogonal function (EOF) analysis on mean sea level pressure (MSLP) from a 90-member combination of the global ensembles from the National Centers for Environmental Prediction, the Canadian Meteorological Center, and the European Centre for Medium-Range Weather Forecasts. Two representative cases are presented to illustrate the applications of this method. Application to the 26–28 January 2015 event demonstrates that the forecast scenarios determined by the fuzzy clustering method are well separated and consistent in different state variables (i.e., MSLP, 500-hPa geopotential height, and total precipitation). The fuzzy clustering method and an existing ensemble sensitivity method are applied to the 26–28 December 2010 event to investigate forecast uncertainty, which demonstrates that these two methods are complementary to each other and can be used in the operations together to track the evolution of forecast uncertainty. For past cases one can define a cluster close to the analysis based on the projection of the analysis onto the PC base of clustering. This analysis group is validated using conventional validation metrics for both cases examined, and this analysis group has fewer errors than the other groups as well as the multimodel ensemble mean and individual model means.
The Association Between Vestibular Physical Examination, Vertigo Questionnaires, and the Electronystagmography in Patients With Vestibular Symptoms
Authors: Gofrit Shany G. , Mayler Yulia , Eliashar Ron , Bdolah-Abram Tali , Ilan Ophir , Gross Menachem 
Published: February 2017

Objects: Dizziness makes up a diagnostic and treatment challenge. The diagnostic accuracy of the medical history and vestibular physical examination in cases of vestibular symptoms is not clear. The aim of this study is to determine the association between vestibular physical examination, vestibular questionnaires, and electronystagmography (ENG) test in patients with vestibular symptoms. Methods: This is a prospective study of 135 adults with vestibular symptoms. The subjects underwent targeted physical examination and filled vestibular questionnaires, including the Dizziness Handicap Inventory (DHI), before ENG testing. The results of the physical examination and questionnaires were compared with the final ENG findings. Results: Of patients who had normal ENG results, 32.1% (17/52) showed abnormal physical examination, and 48.8% (40/82) of the patient who had normal physical examination showed abnormal ENG results ( P = .46). Among patients with severe disability by DHI, 46.4% (13/28) had an abnormal ENG, and 42.9% (12/28) had a normal ENG ( P = .39). Conclusions: This study did not demonstrate association between vestibular physical examination, vestibular questionnaires, and ENG results. Although history (augmented by questionnaires) and physical examination are the initial steps in the evaluation of vertigo, the current study suggests that they should be complemented by objective testing for evaluation of inner ear origin of vertigo.
The use of Quality-Adjusted Life Years in cost-effectiveness analyses in palliative care: Mapping the debate through an integrative review
Authors: Wichmann Anne B , Adang Eddy MM , Stalmeier Peep FM , Kristanti Sinta , Van den Block Lieve , Vernooij-Dassen Myrra JFJ , Engels Yvonne ,   On behalf of PACE
Published: February 2017

Background: In cost-effectiveness analyses in healthcare, Quality-Adjusted Life Years are often used as outcome measure of effectiveness. However, there is an ongoing debate concerning the appropriateness of its use for decision-making in palliative care. Aim: To systematically map pros and cons of using the Quality-Adjusted Life Year to inform decisions on resource allocation among palliative care interventions, as brought forward in the debate, and to discuss the Quality-Adjusted Life Year’s value for palliative care. Design: The integrative review method of Whittemore and Knafl was followed. Theoretical arguments and empirical findings were mapped. Data sources: A literature search was conducted in PubMed, EMBASE, and CINAHL, in which MeSH (Medical Subject Headings) terms were Palliative Care, Cost-Benefit Analysis, Quality of Life, and Quality-Adjusted Life Years. Findings: Three themes regarding the pros and cons were identified: (1) restrictions in life years gained, (2) conceptualization of quality of life and its measurement, including suggestions to adapt this, and (3) valuation and additivity of time, referring to changing valuation of time. The debate is recognized in empirical studies, but alternatives not yet applied. Conclusion: The Quality-Adjusted Life Year might be more valuable for palliative care if specific issues are taken into account. Despite restrictions in life years gained, Quality-Adjusted Life Years can be achieved in palliative care. However, in measuring quality of life, we recommend to—in addition to the EQ-5D— make use of quality of life or capability instruments specifically for palliative care. Also, we suggest exploring the possibility of integrating valuation of time in a non-linear way in the Quality-Adjusted Life Year.
Association of osteopontin with specific prognostic factors and survival in adjuvant breast cancer trials of the Hellenic Cooperative Oncology Group
Authors: Psyrri Amanda , Kalogeras Konstantine T. , Wirtz Ralph M. , Kouvatseas George , Karayannopoulou Georgia , Goussia Anna , Zagouri Flora , Veltrup Elke , Timotheadou Eleni , Gogas Helen , Koutras Angelos , Lazaridis Georgios , Christodoulou Christos , Pentheroudakis George , Economopoulou Panagiota , Laskarakis Apostolos , Arapantoni-Dadioti Petroula , Batistatou Anna , Sotiropoulou Maria , Aravantinos Gerasimos , Papakostas Pavlos , Kosmidis Paris , Pectasides Dimitrios , Fountzilas George 
Published: February 2017

Abstract
Background
The shift towards an earlier diagnosis of breast cancer (BC) highlights the need for biomarkers that would identify patients at risk for relapse and metastatic spread and indicate the potential value of additional treatment strategies. Osteopontin (OPN) is a matricellular protein that has been suggested to be a potential biomarker in BC. In the present study, we used archived BC patient samples to assess the clinical utility of OPN.

Methods
Formalin-fixed paraffin-embedded tumor tissue samples from 975 patients were collected from two large phase III randomized adjuvant chemotherapy trials (HE10/97 and HE10/00) that included patients with high risk BC. All tissue samples were assessed for ER, PgR, Ki67 and HER2 protein expression. OPN protein and mRNA expression was evaluated using immunohistochemistry and quantitative reverse transcription-polymerase chain reaction, respectively.

Results
OPN mRNA expression data were available for 814 patients, whereas OPN protein expression data were available for 546 patients. The majority of patients were ER/PgR-positive (78.3%), HER2-negative (76.5%) and Ki67-positive (55.2%) and had received adjuvant radiation therapy (76.8%) and hormonal therapy (81.1%). OPN mRNA expression was significantly associated with age (60.9% in high OPN tumors vs. 54.1% in low OPN tumors, p = 0.047), ER/PgR-negative status (25.7 vs. 17.2%, p = 0.004) and BC subtypes (p = 0.021). In addition, high OPN mRNA expression was significantly associated with reduced DFS (HR 1.26, 95% CI 1.00–1.59, Wald’s p = 0.050) and OS (HR 1.37, 95% CI 1.05–1.78, p = 0.019), while it retained its prognostic significance for both DFS (HR 1.39, 95% CI 1.10–1.77, p = 0.007) and OS (HR 1.54, 95% CI 1.61–2.05, p = 0.003) in the multivariate analysis.

Conclusions
We showed that high OPN mRNA expression is associated with decreased DFS and OS in a large cohort of BC patients treated with adjuvant chemotherapy in a clinical trial setting. Our results suggest that OPN may serve as a prognostic factor and a potential target for therapy.
Trial registration Australian New Zealand Clinical Trials Registry; HE10/97 ACTRN12611000506998; HE10/00 ACTRN12609001036202
Prophylactic Plasma Transfusion Is Not Associated With Decreased Red Blood Cell Requirements in Critically Ill Patients
Authors: Warner Matthew A. , Chandran Arun , Jenkins Gregory , Kor Daryl J. 
Published: February 2017

BACKGROUND:
Critically ill patients frequently receive plasma transfusion under the assumptions that abnormal coagulation test results confer increased risk of bleeding and that plasma transfusion will decrease this risk. However, the effect of prophylactic plasma transfusion remains poorly understood. The objective of this study was to determine the relationship between prophylactic plasma transfusion and bleeding complications in critically ill patients.

METHODS:
This is a retrospective cohort study of adults admitted to the intensive care unit (ICU) at a single academic institution between January 1, 2009 and December 31, 2013. Inclusion criteria included age ≥18 years and an international normalized ratio measured during ICU admission. Multivariable propensity-matched analyses were used to evaluate associations between prophylactic plasma transfusion and outcomes of interest with a primary outcome of red blood cell transfusion in the ensuing 24 hours and secondary outcomes of hospital- and ICU-free days and mortality within 30 days of ICU discharge.

RESULTS:
A total of 27,561 patients were included in the investigation with 2472 (9.0%) receiving plasma therapy and 1105 (44.7%) for which plasma transfusion was prophylactic in nature. In multivariable propensity-matched analyses, patients receiving plasma had higher rates of red blood cell transfusion (odds ratio: 4.3 [95% confidence interval: 3.3–5.7], P < .001) and fewer hospital-free days (estimated % increase: −11.0% [95% confidence interval: −11.4, −10.6%], P < .001). There were no significant differences in ICU-free days or mortality. These findings appeared robust, persisting in multiple predefined sensitivity analyses.

CONCLUSIONS:
Prophylactic administration of plasma in the critically ill was not associated with improved clinical outcomes. Further investigation examining the utility of plasma transfusion in this population is warranted.