bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pressure and Flow Characteristics of a Novel Bidirectional Cannula for Cardiopulmonary Bypass
Authors: Chen Yi , Tutungi Elli , McMillan James , Tayeh Sara M. , Underwood Jess K. , Wells Adam C. , Smith Julian A. , Moshinsky Randall A. 
Published: December 2017

Objective Femoral arterial cannulation is associated with a significant risk of lower limb ischemia. The aim of the study was to assess the pressure and flow in the femoral artery using a novel bidirectional femoral cannula in a sheep model of peripheral cardiopulmonary bypass. Methods Peripheral cardiopulmonary bypass was established using a multistage venous cannula inserted into the internal jugular vein and the bidirectional or a conventional arterial cannula into the femoral artery in seven adult ewes. Systemic and distal perfusion pressures and flow rates were measured during cardiopulmonary bypass with flow rates of 1, 2, 3, and 4 L/min. Lower limb venous oxygen saturation and lactate levels were also measured. Results A significantly higher blood flow in the lower limb using the bidirectional cannula was observed and compared with a conventional cannula at all flow rates (mean flow 115 mL/min vs 10 mL/min, P < 0.05). The mean distal perfusion pressure was also significantly higher in the bidirectional cannula group (86 mm Hg vs 45 mm Hg at 4 L/min of flow, P < 0.05). The bidirectional cannula was associated with higher venous oxygen saturations in the lower limb than in the conventional cannula group; however, lower limb lactate production was similar in the two groups. Conclusions This in vivo data demonstrates superior distal flow and pressure characteristics of a novel bidirectional cannula compared with a conventional femoral cannula during peripheral cardiopulmonary bypass.
Long-Term Success with Driveline Exit Site Relocation for Deep Driveline Infection in Left Ventricular Assist Device Patients
Authors: Balsam Leora B. , Jacoby Adam , Louie Eddie , Levine Jamie P. 
Published: December 2017

Objective Driveline infection is a common complication of durable left ventricular assist device support. The majority involve the driveline exit site and can be treated with antibiotics and local wound care. Less frequently, these infections extend into deeper tissues and surgical debridement is necessary. Few studies have described the surgical strategy for treatment of deep driveline infection or have reported long-term outcomes. With a growing population of patients being implanted as destination therapy, there is an obvious need to evaluate and optimize treatment for complex driveline infections. Methods Outcomes of patients undergoing durable left ventricular assist device implantation at a single center between 2011 and 2017 were reviewed retrospectively. Data including occurrence of driveline infection, pathogen, time to driveline infection, and treatment strategy were abstracted from the electronic medical record. Results Driveline infection occurred in 10 (16.4%) of 61 patients at a median of 362 days (Q1 = 99, Q3 = 694) after primary left ventricular assist device implantation. Three (30.0%) of 10 driveline infections were categorized as deep and did not resolve with intravenous antibiotic therapy. In these cases, a multistage approach that included initial debridement and exteriorization of the infected driveline, followed by delayed surgical relocation of the driveline in a clean vascularized soft tissue bed, was used. Long-term device salvage was achieved in all cases. Conclusions An aggressive surgical strategy, including debridement and formal relocation of the driveline exit site, can result in long-term device salvage after deep driveline infection. This approach is a less invasive alternative to device exchange for refractory driveline infections.
Totally Endoscopic Cardiac Surgery for Atrial Septal Defect Repair on Beating Heart without Robotic Assistance in 25 Patients
Authors: Dang Quang-Huy , Le Ngoc-Thanh , Nguyen Cong-Huu , Tran Dac-Dai , Nguyen Do-Hung , Nguyen Trung-Hieu , Ngo Thi-Hai-Linh 
Published: December 2017

Objective The aim of the study was to investigate the effectivity and safety of totally endoscopic cardiac surgery without robotic assistance for atrial septal defect (ASD) closure on beating hearts. Methods Twenty-five patients (adults/children: 15/10) underwent ASD closure using nonrobotically assisted totally endoscopic approach on beating heart. Three 5-mm trocars and one 12-mm trocar were used only the superior vena cava is snared filling the pleural and pericardial cavities with CO2, and the heart was beating during the surgery. Twenty-three patients had isolated secundum ASD (2 of which had severe tricuspid regurgitation) and two patients had ASD combined with partial anomalous pulmonary venous connection. All ASDs were closed using artificial patch, continuous suture; tricuspid regurgitations were repaired and the anomalous pulmonary veins were drained to the left atrium. Results No postoperative complications or deaths occurred. Mean± SD operation time and mean cardiopulmonary bypass time were 267.2 ±44.6 and 156.1 ± 33.6 min, respectively. These patients were extubated within the first 5 hours, and the volume of blood drainage on the first day was less than 80 mL. Four days after surgery, patients did not need analgesics and were able to return to normal activities 1 week postoperatively. Conclusions Totally endoscopic operation for ASD closure on beating heart is safe, with short recovery period, and surgical scars are of high cosmetic value, especially in a woman and girl.
Robotic Mitral Valve Repair
Authors: Goodman Avi , Koprivanac Marijan , Kelava Marta , Mick Stephanie L. , Gillinov A. Marc , Rajeswaran Jeevanantham , Brzezinski Anna , Blackstone Eugene H. , Mihaljevic Tomislav 
Published: December 2017

Objective Adoption of robotic mitral valve surgery has been slow, likely in part because of its perceived technical complexity and a poorly understood learning curve. We sought to correlate changes in technical performance and outcome with surgeon experience in the “learning curve” part of our series. Methods From 2006 to 2011, two surgeons undertook robotically assisted mitral valve repair in 458 patients (intent-to-treat); 404 procedures were completed entirely robotically (as-treated). Learning curves were constructed by modeling surgical sequence number semiparametrically with flexible penalized spline smoothing best-fit curves. Results Operative efficiency, reflecting technical performance, improved for (1) operating room time for case 1 to cases 200 (early experience) and 400 (later experience), from 414 to 364 to 321 minutes (12% and 22% decrease, respectively), (2) cardiopulmonary bypass time, from 148 to 102 to 91 minutes (31% and 39% decrease), and (3) myocardial ischemic time, from 119 to 75 to 68 minutes (37% and 43% decrease). Composite postoperative complications, reflecting safety, decreased from 17% to 6% to 2% (63% and 85% decrease). Intensive care unit stay decreased from 32 to 28 to 24 hours (13% and 25% decrease). Postoperative stay fell from 5.2 to 4.5 to 3.8 days (13% and 27% decrease). There were no in-hospital deaths. Predischarge mitral regurgitation of less than 2+, reflecting effectiveness, was achieved in 395 (97.8%), without correlation to experience; return-to-work times did not change substantially with experience. Conclusions Technical efficiency of robotic mitral valve repair improves with experience and permits its safe and effective conduct.
Complex Decision-Making in Heart Failure
Authors: Hamel Aimee V. , Gaugler Joseph E. , Porta Carolyn M. , Hadidi Niloufar Niakosari 
Published: December 2017

Background:
Heart failure follows a highly variable and difficult course. Patients face complex decisions, including treatment with implantable cardiac defibrillators, mechanical circulatory support, and heart transplantation. The course of decision-making across multiple treatments is unclear yet integral to providing informed and shared decision-making. Recognizing commonalities across treatment decisions could help nurses and physicians to identify opportunities to introduce discussions and support shared decision-making.

Objective:
The specific aims of this review are to examine complex treatment decision-making, specifically implantable cardiac defibrillators, ventricular assist device, and cardiac transplantation, and to recognize commonalities and key points in the decisional process.

Methods:
MEDLINE, CINAHL, PsycINFO, and Web of Science were searched for English-language studies that included qualitative findings reflecting the complexity of heart failure decision-making. Using a 3-step process, findings were synthesized into themes and subthemes.

Results:
Twelve articles met criteria for inclusion. Participants included patients, caregivers, and clinicians and included decisions to undergo and decline treatment. Emergent themes were “processing the decision,” “timing and prognostication,” and “considering the future.” Subthemes described how participants received and understood information about the therapy, making and changing a treatment decision, timing their decision and gauging health status outcomes in the context of their decision, the influence of a life or death decision, and the future as a factor in their decisional process.

Conclusions:
Commonalities were present across therapies, which involved the timing of discussions, the delivery of information, and considerations of the future. Exploring this further could help support patient-centered care and optimize shared decision-making interventions.
An Online Intervention to Enhance Nurse Practitioners’ Skin Cancer Knowledge, Attitudes, and Counseling Behaviors
Authors: Goodman Hope Ann , Pacheco Christy L. , Loescher Lois J. 
Published: December 2017

ABSTRACT
The purpose of this pilot study was to determine whether a brief educational video administered online improved nurse practitioners’ knowledge, attitudes, and behaviors regarding skin cancer and skin cancer prevention counseling. Participants completed an online test assessing knowledge, attitudes, and behaviors, before and after viewing an online video. Thirty Arizona nurse practitioners completed the pilot study. There were statistically significant increases from the pretest to the posttest for all main variables. This pilot study found that the online intervention was highly effective for improving nurse practitioners’ knowledge, attitudes, and behaviors regarding skin cancer and skin cancer prevention counseling.
Selected Food/Herb–Drug Interactions: Mechanisms and Clinical Relevance
Authors: Amadi Cecilia N. , Mgbahurike Amaka A. 
Published: December 2017

Background:
Food/Herb–drug interactions have become a major problem in health care. These interactions can lead to loss of therapeutic efficacy or toxic effects of drugs.

Areas of Uncertainty:
To probe the clinical relevance of such interactions, the impact of food/herb intake on the clinical effects of drug administration has to be evaluated. Failure to identify and efficiently manage food–drug interactions can lead to serious consequences. A comprehensive knowledge of the mechanisms that underpin variability in disposition will help optimize therapy.

Data Sources:
Electronic search of literatures from relevant databases were conducted. A total of 58 original scientific reports/review articles were obtained with the search strategy; of which 25 were found eligible to be included in the present review. Required data were extracted from these studies, and their methodologies were assessed.

Results and Conclusions:
This review updates our knowledge on clinical food–drug interactions with emphasis on mechanism and clinical implications. Results obtained from literature search identified interactions with selected foods/herbs generated from in vivo and in vitro studies. For example, interaction studies in humans revealed a reduction in the bioavailability of mercaptopurine when taken concurrently with substances containing xanthine oxidase (eg, cow milk); a reduction in the bioavailability of quinine with Garcinia kola; increased bioavailability/toxicity of felodipine, nifedipine, saquinavir, sildenafil with grape juice; increased bioavailability of felodipine, cisapride with red wine and diminished bioavailability of fexofenadine with apple. Pharmacokinetic and/or pharmacodynamic mechanisms are implicated in many of these interactions. By evaluating the dietary patterns of patients and use of prescribed medications, health professionals will be well informed of potential interactions and associated adverse effects.
Complete Versus Staged Repair for Neonates With Tetralogy of Fallot
Authors: Savla Jill J. , Fisher Brian T. , Faerber Jennifer A. , Huang Yuan-Shung V. , Mercer-Rosa Laura 
Published: December 2017

Background:
The surgical strategy for neonates with tetralogy of Fallot (TOF) consists of complete or staged repair. Assessing the comparative effectiveness of these approaches is facilitated by a large multicenter cohort. We propose a novel process for cohort assembly using the Pediatric Health Information System (PHIS), an administrative database that contains clinical and billing data for inpatient and emergency department stays from tertiary children’s hospitals.

Methods:
A 4-step process was used to identify neonates with TOF: (1) screen neonates in PHIS with International Classification of Diseases-9 (ICD-9) diagnosis or procedure codes for TOF; (2) include patients with TOF procedures before 30 days of age; (3) exclude patients with missing 2-year follow-up data; (4) analyze patients’ 2-year surgery sequence patterns, exclude patients inconsistent with a treatment strategy for TOF, and designate patients as complete or staged repair. Manual chart review at 1 PHIS center was performed to validate this process.

Results:
Between January 2004 and March 2015, 5862 patients were identified in step 1. Step 2 of cohort assembly excluded 3425 patients (58%); step 3 excluded 148 patients (3%); and step 4 excluded 54 patients (1%). The final cohort consisted of 2235 neonates with TOF from 45 hospitals. Manual chart review of 336 patients showed a positive predictive value for accurate PHIS identification of 44% after step 1 and 97% after step 4.

Conclusions:
This systematic cohort identification algorithm resulted in a high positive predictive value to appropriately categorize patients. This carefully assembled cohort offers a unique opportunity for future studies in neonatal TOF outcomes.
Ablative Therapies for Locally Advanced Pancreatic Cancer
Authors: Shah Rupen , Ostapoff Katherine T. , Kuvshinoff Boris , Hochwald Steven N. 
Published: December 2017

Abstract
The vast majority of patients who present with pancreatic adenocarcinoma have locally advanced or metastatic disease at the time of presentation without possibility of cure. Although in recent years there have been some new promising chemotherapy regimens that improve overall survival by a few months, the prognosis remains dismal. There is, however, a subset of patients who experience durable stable disease or partial responses after initial courses of chemotherapy with locally advanced disease. In these select patients, there remains interest in local ablative therapy with or without resection as a means for local control, palliation of symptoms, and possible improved survival. This review describes the techniques, complications, and expected benefits of several ablative techniques as a treatment modality for locally advanced pancreatic cancer.
Cortisol and Subjective Stress Responses to Acute Psychosocial Stress in Fibromyalgia Patients and Control Participants
Authors: Coppens Eline , Kempke Stefan , Van Wambeke Peter , Claes Stephan , Morlion Bart , Luyten Patrick , Van Oudenhove Lukas 
Published: December 2017

ABSTRACT

Objective
Hypothalamic-pituitary-adrenal axis dysfunction may play a role in fibromyalgia (FM) pathogenesis but it remains understudied in this disorder. Furthermore, early childhood adversities (ECA) are common in FM, but whether they moderate stress reactivity is unknown. Hence, we investigated cortisol and subjective responses to acute psychosocial stress in FM and controls, while adjusting for ECA.

Methods
Twenty-seven female FM patients and 24 age-matched female controls were recruited in a tertiary care center and through advertisements, respectively. The Childhood Trauma Questionnaire was used to measure ECA history. Salivary cortisol levels and subjective stress ratings were measured at multiple time points before and after the Trier Social Stress Test (TSST) was administered.

Results
Significant main effects of group [F(1,43) = 7.04, p = .011, lower in FM] and ECA [F(1,43) = 5.18, p = .028, higher in participants with ECA] were found for cortisol responses. When excluding controls with ECA (n = 5), a significant group-by-time interaction was found [F(6,39) = 2.60, p = .032], driven by a blunted response to the stressor in FM compared with controls (p = .037). For subjective stress responses, a significant main effect of group [F(1,45) = 10.69, p = .002, higher in FM] and a trend toward a group-by-time interaction effect [F(6,45) = 2.05, p = .078, higher in FM 30 minutes before and 30 and 75 minutes after the TSST, and impaired recovery (difference immediately after – 30 minutes after the TSST) in FM] were found.

Conclusions
Blunted cortisol responsivity to the TSST was observed in FM patients compared with controls without ECA. FM patients had higher subjective stress levels compared with controls, particularly at baseline and during recovery from the TSST. In FM patients, ECA history was not associated with cortisol or subjective stress levels or with responsivity to the TSST. Future research should investigate the mechanisms underlying hypothalamic-pituitary-adrenal axis dysregulation in FM.
High-Alert Medication Stratification Tool-Revised: An Exploratory Study of an Objective, Standardized Medication Safety Tool
Authors: Washburn Natalie C. , Dossett Heather A. , Fritschle Andrew C. , Degenkolb Kerri E. , Macik Monica R. , Walroth Todd A. 
Published: December 2017

Objective
To develop an objective tool designed to standardize the identification of high-alert medications (HAMs) according to patient safety risk.

Methods
Medications were evaluated using the High-Alert Medication Stratification Tool (HAMST). Tool revision occurred through assessing medications on an organization-approved HAM list and comparing scores with control medications not included on the list. Because of variations in HAMST interpretation by end users in interdisciplinary committees, a revision of the scoring tool was completed to create the High-Alert Medication Stratification Tool–Revised (HAMST-R), and the assessment was repeated. Both tools range from 0 to 10, with 10 describing agents with highest risk.

Results
The median (interquartile range [IQR]) initial HAM (n = 44) score using HAMST was 6 (5–7). The median (IQR) control (n = 45) score was 1 (0-2). Using the modified tool, HAMST-R, the median (IQR) HAM score was 4 (4–6) versus 1 (0–1) for controls. Scores for HAMs were significantly higher than controls using both tools (P < 0.001). A HAMST-R score of 4 or higher defines medications as high alert, as this score includes 75% of HAMs and no controls.

Conclusions
Through this exploratory study, clarification of the tool was required to increase its concurrent validity, interrater reliability, and implementation among other health systems. The revised tool, HAMST-R, is a newly developed, objective tool for standardized identification of HAMs. The tool may also be used for prospective identification of medications as high risk to patient safety during formulary review.
“Occipital Tunnel” Sign on FDG PET for Differentiating Dementias
Authors: Sawyer David M. , Kuo Phillip H. 
Published: December 2017

Abstract
PET using FDG is a critical tool for evaluation of dementias, with characteristic patterns of hypometabolism suggesting specific diagnoses. Hypometabolism in the occipital region is recognized as an important finding associated with dementia with Lewy bodies and posterior cortical atrophy. We describe here the novel “occipital tunnel” sign, which results from relative sparing of FDG uptake in the medial occipital (primary visual) cortex compared with more severe loss in the surrounding lateral occipital (visual association) cortex. This sign is useful for recognizing the occipital findings of dementia with Lewy bodies and posterior cortical atrophy, especially when viewing sagittal projections.
Salivary Gland Activity Obscures Mandibular Metastasis of Prostate Carcinoma on 68Ga–Prostate-Specific Membrane Antigen PET
Authors: Lengana Thabo , Lawal Ismaheel , Boshomane Tebatso , Ololade Kehinde , Reyneke Florette , Kaoma Chimbabantiu , Mokgoro Neo , Vorster Mariza , Sathekge Mike 
Published: December 2017

Abstract
We report a case of a 65-year-old man with prostate cancer; his treatment history included radical prostatectomy followed by radiation therapy and subsequent androgen deprivation therapy for more than 5 years. He currently presented with a history of rising prostate-specific antigen and complained of jaw aches. 68Ga–prostate-specific membrane antigen PET/CT study performed for suspected biochemical recurrence demonstrated vertebral lesions and lesion in his jaw. Subsequent biopsy of jaw lesion demonstrated prostate cancer metastases.
The Role of FDG PET in Diabetic Myonecrosis
Authors: Chaussé Guillaume , Abikhzer Gad 
Published: December 2017

Abstract
A 66-year-old man with poorly controlled type 2 diabetes was admitted for acute bilateral calf pain in the context of coronary artery disease, chronic renal failure, and peripheral neuropathy. Lower-extremity Doppler ultrasound excluded deep vein thrombosis. FDG-PET was performed to exclude a suspected infection because of elevated white blood cells and inflammatory markers but normal creatinine kinase levels. PET scan demonstrated intense bilateral calf muscle and left thigh muscle uptake, which in combination with the patient's history was consistent with diabetic myonecrosis, a rare end-stage complication of diabetes. The patient was managed conservatively, and pain resolved following a typical self-limited course.
Recent advances on the global regularity for irrotational water waves
Authors: Ionescu A. D. , Pusateri F. 
Published: December 2017

We review recent progress on the long-time regularity of solutions of the Cauchy problem for the water waves equations, in two and three dimensions. We begin by introducing the free boundary Euler equations and discussing the local existence of solutions using the paradifferential approach. We then describe in a unified framework, using the Eulerian formulation, global existence results for three- and two-dimensional gravity waves, and our joint result (with Deng and Pausader) on global regularity for the gravity–capillary model in three dimensions. We conclude this review with a short discussion about the formation of singularities and give a few additional references to other interesting topics in the theory.This article is part of the theme issue ‘Nonlinear water waves’.
On the short-wavelength stabilities of some geophysical flows
Authors: Ionescu-Kruse Delia 
Published: December 2017

This paper is a survey of the short-wavelength stability method for rotating flows. Additional complications such as stratification in the flow or the presence of non-conservative body forces are considered too. This method is applied to the specific study of some exact geophysical flows. For Gerstner-like geophysical flows one can identify perturbations in certain directions as a source of instabilities with an exponentially growing amplitude, the growth rate of the instabilities depending on the steepness of the travelling wave profile. On the other hand, for certain physically realistic velocity profiles, steady flows moving only in the azimuthal direction, with no variation in this direction, are locally stable to the short-wavelength perturbations.This article is part of the theme issue ‘Nonlinear water waves’.