bluuebunny/crossref_metadata_2025_split huggingface dataset:
Smoothing Things over: The Transition from Pediatric to Adult Care for Kidney Transplant Recipients
Authors: Remorino Rowena , Taylor Judy 
Published: January 2017

Background Transition is a planned movement of adolescents with chronic physical and medical conditions from child-centered to adult-oriented healthcare systems as opposed to a purely administrative event. Objective To evaluate the transition of pediatric kidney transplant recipients to the adult service at Guy's Hospital between 2000 and 2001 as compared with best practice from the literature, and to establish client satisfaction with the process. Design Data were collected by means of a retrospective review of case notes, clinician interview, and a patient satisfaction questionnaire, and analyzed by a single reviewer. Main Outcome Measures Sixteen cases were analyzed with respect to their progress over the period of 1 year before and 1 year after transfer by looking at markers of adherence; a clinician's subjective assessment of overall graft stability before, during, and after transfer; and whether subjects chose to attend the transitional clinic. Results There was no qualitative difference in adherence or control among the patients who experienced the transitional clinic and those who did not. Patients who were considered stable and adherent before transition were not necessarily the same following transfer and vice versa. Patients who experienced the transitional clinic were not more satisfied as a group, although 9 of 11 thought their transition was “OK” or better. Conclusion This is an extremely challenging area of pediatric nephrology; all patients need a high level of support. Services cannot be targeted to high-risk groups.
There to Here: Young Adult Patients' Perceptions of the Process of Transition from Pediatric to Adult Transplant Care
Authors: McCurdy Corinne , DiCenso Alba , Boblin Sheryl , Ludwin David , Bryant-Lukosius Denise , Bosompra Kwadwo 
Published: January 2017

Background An increased understanding of the transition process from pediatric to adult transplant care may inform strategies for facilitating the transfer of patients and ultimately improve outcomes of care. Objective To explore the transition process from pediatric to adult transplant care from the perspective of young adults. Study Design Using a qualitative case study approach, data were collected from transplant recipients through organ-specific focus groups, from transplant coordinators and nurse practitioners through interviews, and from electronic documents. Data were analyzed using an editorial format. Results The analysis identified 5 elements of transition: There to Here, Getting Ready, Frame of Mind, Making It Easier, and Giving Back. In addition, threaded throughout the elements were the themes People Are Important, Expectations of Us, and Information We Need. Conclusions The transition for young people from a pediatric to an adult transplant center can be difficult and often traumatic. Young adults who transfer to adult care need to be better prepared for the adult center, made aware of the differences, and introduced to team members before the transfer. Transition programs that aim to improve the transition process should be developed for these patients.
Update on Pharmacoeconomics in Transplantation
Authors: Cavanaugh Teresa M. , Martin Jill E. 
Published: January 2017

Purpose To provide current information on pharmacoeconomic outcomes in transplantation for the past 6 years. Methods An extensive literature search was undertaken using PubMed and other authenticated Internet sources. Key words used to elicit pertinent studies were “pharmacoeconomics,” “transplantation,” “cost-effectiveness,” “cost-benefit,” “cost-minimization” and “cost-utility” analyses. Studies included in the review contain updated pharmacoeconomic data generated during the past 6 years on economic, clinical, and humanistic outcomes. These data are used to describe and analyze the cost of drug therapy used in transplantation. Results Background information is included in the review to provide a context from which to evaluate new study material. Data extracted from the studies include significant findings and study limitations. Data were stratified into understanding pharmacoeconomic methods and their application to transplantation, maintenance and induction therapies, and management of and costs associated with adverse events and quality-of-life issues. Conclusions Continued evolution of pharmacoeconomic analysis is needed so that optimal care can be provided in the most cost-effective manner. Pharmacoeconomic study, done rationally and logically, is an indispensable tool in determining optimal transplantation regimens.
Quality of Life and Bronchiolitis Obliterans Syndrome in Patients after Lung Transplantation
Authors: Künsebeck Hans W. , Kugler Christiane , Fischer Stefan , Simon Andre R. , Gottlieb Jens , Welte Tobias , Haverich Axel , Strueber Martin 
Published: January 2017

Background Lung transplantation has become an established and effective treatment for patients with end-stage pulmonary disease. Objective To investigate health-related quality of life in correlation with occurrence and degree of bronchiolitis obliterans syndrome after transplantation. Methods In a cross-sectional study design, 119 consecutive lung transplant recipients (63.9% bilateral and 36.1% single lung transplants) responded voluntarily to a set of standardized questionnaires (12-Item Short-Form Health Survey, Center for Epidemiologic Studies-Depression Scale, Coping With Everyday Life, Beck Anxiety Inventory, Zerssen list of complaints) that covered health-related quality of life and psychological well being. Also, we performed pulmonary function studies to clinically grade bronchiolitis obliterans syndrome in all patients. Results In this cohort, 41.2% of patients developed bronchiolitis obliterans syndrome at a mean interval of 5.6 years after lung transplantation. Actuarial freedom from bronchiolitis obliterans syndrome was 90.1%±2.3% at 1 year, 79.9%±3.7% at 3 years, and 59.5%±4.8% at 5 years after lung transplantation. Recipients with bronchiolitis obliterans syndrome reported significantly lower well being and quality of life than those without bronchiolitis obliterans syndrome, who scored similar to healthy volunteers. In a subanalysis, body functioning ( P<.001) and related areas of coping ( P<.001) were mostly affected by bronchiolitis obliterans syndrome. Conclusions Quality of life was negatively affected by the onset of bronchiolitis obliterans syndrome. However, even patients who develop bronchiolitis obliterans syndrome reported a temporary benefit from lung transplantation. In addition to optimal medical care and efforts in preventing bronchiolitis obliterans syndrome, psychological support of lung recipients seems to be essential, especially when bronchiolitis obliterans syndrome occurs.
Grieving over Complications Associated with Neuro-Endovascular Treatment
Authors: Goto K. , Noda M. 
Published: January 2017

Neuro-endovascular therapy is regarded as one of the greatest achievements of modern medicine because of its effectiveness and low-invasiveness in the treatment of difficult neurovascular diseases. On the other side of the coin however, occasionally complications may occur which not only have a profound neurological effect, but also have a severe effect on the vital prognosis. The nightmare of a neuro-endovascular therapist is a catastrophe resulting from a preventive treatment for an asymptomatic or minimally symptomatic patient with a potentially dangerous disease. Therefore, grave psychic distress tends to occur on both sides of the patient-doctor relationship. Once severe complications occur, we have simultaneously to take care of not only the psychic trauma of a patient and/or family but also our own psychic trauma. If treatment is not appropriate, we might invite malpractice suits or end up in occupational burnout. In order to study the adaptive mechanisms that allow our continued survival in this new specialty of medicine, we administered a questionnaire survey to members of the Japanese Society of Neuro-endovascular Treatment. 51% of 300 respondents stated that they had been the targets of severe recriminations by patients and/or families as a result of complications. 284 respondents had multiple (2.5 on average) signs and symptoms of psychic trauma. Also 23% of respondents were unable to continue the clinical practice of neuro-endovascular therapy or resorted to conservative treatment. Only 7% of respondents had medical curriculum or residency program training on the psychological problems of complications. There is no systematic approach to education regarding physician grief in clinical practice. Many respondents tend to focus their attention solely on the details of failed interventional procedures and repeatedly “undo” actions and relive past events. However, the study showed that intellectualization of the tragic experiences without accepting and working through grief only adds to the physician's grief. The correlation was evaluated between the respondents' initial response to grieving and their change of attitude regarding their ability or willingness to performing the procedure after they had experienced devastating complications. It may be said that by facing the emotional truths of responsibility and grief, physicians can develop the ability to empathize with patients and their families. Mention is also made of the patient-doctor relationship, medical education, and the relationship with fellow physicians and medical lawsuits.
MR Quantification of Flow in Children with Vascular Malformations
Authors: Poskitt K.J. , Marotta T. , Haw C. , Cochrane D. , Steinbok P. 
Published: January 2017

The evaluation of treatments such as embolization, stereotactic radiation, and even surgery would be enhanced by an objective method of measuring flow in feeding arteries or draining veins. We developed a non-invasive method of measuring vascular flow using cardiac gated phase contrast MR angiography (MR Q flow). The purpose of this work was to employ the same technique in a series of patients with vascular malformations of the head and neck. We selected a series of vascular malformations with simple arterial and venous architecture and significantly smaller vessel diameters than that encountered with Vein of Galen Malformations. Our aim was to determine the reproducibility of the derived flow values by using multiple velocity encoded sequences (VENC) and compare the values derived from the arterial feeders to the venous outflow data. There are inherent technical difficulties with assessing flow through multiple arterial feeders or draining veins, so the technique is most easily applied to AVMs with simple, easily defined feeding arteries or draining veins. Nonetheless, this technique is relatively straightforward to learn, rapid, cost-effective and may provide an objective means to assess therapeutic maneuvers when applied to head and neck vascular malformations.
Recanalization Rates after Endovascular Coil Embolization in a Cohort of Matched Ruptured and Unruptured Cerebral Aneurysms
Authors: Tan I.Y.L. , Agid R.F. , Willinsky R.A. 
Published: January 2017

The aim of this study was to retrospectively assess the recanalization rate, factors associated with and time taken for recanalization to occur in a matched ruptured and unruptured aneurysm population that were treated with endovascular coiling. Ruptured and unruptured aneurysms treated between 2002 and 2007 were matched for aneurysm location, diameter and neck size. Recanalization rate, time to recanalize, re-treatment rate and clinical outcome were analysed. Ninety-eight matched ruptured and unruptured aneurysms (49 aneurysms in each group) were studied. 46.8% of aneurysms in the ruptured group achieved complete obliteration on the initial post treatment angiogram versus 34.7% in the unruptured group. The ruptured group had a higher rate of recanalization (40.4% versus 20.4%). 25.5% of aneurysms had significant recanalization in the ruptured group versus 6.1% in the unruptured group (p=0.009). The retreatment rate was higher in the ruptured group (21.3% versus 6%). Ruptured aneurysms took a shorter time to recanalize with a mean time of 5.3±3.8 months versus 12.4±7.7months (p=0.003). Multivariate logistic regression analysis found neck size (p=0.0098), wide neck morphology (p=0.0174), aneurysm diameter (p< 0.0001) and ruptured aneurysms (p=0.0372) were significant predictors of recanalization. The majority of patients in both groups had a good outcome with GOS=5 (85.7% and 83.7%) but two deaths occurred in the ruptured group. Ruptured and unruptured aneurysms showed significant differences in rate, degree and timing of recanalization, thus requiring different protocols for imaging follow-up post endovascular treatment. Earlier and more frequent imaging follow-up is recommended for ruptured aneurysms.
Outcomes Analysis of Ruptured Distal Anterior Cerebral Artery Aneurysms Treated by Endosaccular Embolization and Surgical Clipping
Authors: Suzuki S. , Kurata A. , Yamada M. , Iwamoto K. , Nakahara K. , Sato K. , Niki J. , Sasaki M. , Kitahara T. , Fujii K. , Kan S. 
Published: January 2017

Although endovascular surgery is now widely used to treat intracranial aneurysms, no comparative studies of clipping versus endovascular surgery to address distal ACA aneurysms at the same institution are available. We compared the results of these treatment modalities to address distal ACA aneurysms at our institution. We treated 68 patients with ruptured distal ACA aneurysms (endovascular surgery, n=13; clipping surgery, n=55). We performed a retrospective comparison of the treatment outcomes. To study the efficacy of endovascular surgery we classified all our cases into three types: type A were small-necked aneurysms, type B were wide-necked aneurysms on the parent artery, and type C were aneurysms in which the A3 portion of the ACA arose from the aneurysmal dome near the neck. Intraoperative hemorrhage occurred in 7.7% of aneurysms treated by endovascular surgery and in 34.5% treated by clipping surgery. In 7.7% of the endovascularly-treated aneurysms we noted coil migration during embolization surgery; venous infarction due to cortical vein injury occurred in 7.3% of clipped aneurysms. Of the endovascularly-treated aneurysms, 7.7% manifested post-embolization hemorrhage; 23.1% manifested coil compaction. In clipping surgery, postoperative rerupture occurred in 1.8% of the aneurysms; one patient presented with postoperative acute epidural hematoma. Clip dislocation was noted in 1.8% of aneurysms. Angiography was indicative of post-treatment vasospasm in 7.7% of aneurysms treated endovascularly and in 50.9% of the clipped aneurysms. The clinical outcome showed no significant difference between endovascular surgery and clipping surgery.
Simultaneous Combined Intravenous Recombinant Tissue Plasminogen Activator and Endovascular Therapy for Hyperacute Middle Cerebral Artery M1 Occlusion
Authors: Toyota S. , Sugiura S. , Iwaisako K. 
Published: January 2017

We investigated the efficacy and safety of combined intravenous (IV) recombinant tissue plasminogen activator (rtPA) and simultaneous endovascular therapy (ET) for hyperacute middle cerebral artery (MCA) M1 occlusion. Between October 2005 and April 2007, in the combined group, 22 patients eligible for IV rtPA, who were diagnosed as having MCA M1 occlusion, were treated with IV rtPA and simultaneous ET was initiated as soon as possible. The other patients were treated with IV rtPA alone (IV group A: n = 11). Between May 2007 and November 2008, all patients eligible for IV rtPA, who were diagnosed as having MCA M1 occlusion, underwent thrombolysis by IV rtPA alone (IV group B: n = 24). The improvement of the National Institutes of Health Stroke Scale score at 24 hours was highest in the combined group (10 ± 4.1). In contrast, it was 5.1 ± 4.7 in the IV group A (P = 0.017) and 5.6 ± 5.6 in IV group B (P = 0.006). In the combined group, successful recanalization was observed in 18 of 22 patients with one symptomatic intracranial hemorrhage. The rate of mRS0–2 at three months was highest in the combined group, 36% in the IV group A and 33% in the IV group B (P = 0.008). Simultaneous treatment with IV rtPA and ET improved the clinical outcome of MCA M1 occlusion without a significant increase of adverse effects in our study.
Stenting of the cervical internal carotid artery in acute stroke management: The Karolinska experience
Authors: Mpotsaris Anastasios , Kabbasch Christoph , Borggrefe Jan , Gontu Vamsi , Soderman Michael 
Published: January 2017

Background Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is a routine procedure. Yet, precise indications and clinical safety in this setting remains controversial. Present data for mechanical thrombectomy include few studies with acute stenting of tandem occlusions. We evaluated the feasibility, safety and clinical outcome of this endovascular treatment in a retrospective analysis of all consecutive cases at a comprehensive stroke centre. Methods This was a retrospective analysis of all consecutive patients with acute extracranial carotid artery occlusion including acute dissection or high-grade stenosis and concomitant intracranial large-vessel occlusion treated with emergency carotid stenting and intracranial mechanical thrombectomy between November 2007 and May 2015. Results A total of 63 patients with a median age of 67 years (range 33–84 years) were treated. Of these, 33 (52%) patients had concomitant intravenous thrombolysis with recombinant tissue-type plasminogen activator initially. Median admission National Institutes of Health Stroke Scale was 14 (range 1–29). Median time from stroke onset to recanalization was 408 minutes (range 165–1846 minutes). Procedure time was significantly shorter after intravenous thrombolysis (110 minutes [range 15–202 minutes] vs. 130 minutes [range 60–280 minutes]; p = 0.02). Three (5%) patients experienced post-procedural symptomatic intracerebral haemorrhage. In 55/63 (87%) patients, a score of ≥2b on the Thrombolysis in Cerebral Infarction scale could be achieved. Eight (13%) patients died, five (8%) during the acute phase. A total of 29/63 (46%) patients showed a favourable outcome (modified Rankin Scale score of 0–2) after three months. Conclusions Our single-centre retrospective analysis of emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy demonstrated high technical success, reasonable clinical outcomes and acceptable rates of symptomatic intracranial haemorrhage in carefully chosen patients which are triaged interdisciplinary based on clinical and computed tomography imaging criteria. This warrants further study in a randomised prospective trial.
Gamma Knife radiosurgery for the treatment of intracranial dural arteriovenous fistulas
Authors: Dmytriw Adam A , Schwartz Michael L , Cusimano Michael D , Mendes Pereira Vitor , Krings Timo , Tymianski Michael , Radovanovic Ivan , Agid Ronit 
Published: January 2017

Background Intracranial dural arteriovenous fistulae (DAVF) may present a treatment challenge. Endovascular embolization is in most cases the first line of treatment but does not always achieve cure. Gamma Knife (GK) radiosurgery represents an alternative treatment option, and the purpose of this study was to further evaluate its utility. Methods We reviewed all cases of DAVF treated between 2009 and 2016 at our institution with GK radiosurgery independently, or following failed/refused endovascular or surgical management. Patients’ clinical files, radiological images, catheter angiograms, and surgical DAVF disconnection reports were retrospectively reviewed. Results Sixteen DAVF (14 patients) treated by GK radiosurgery were identified. Eleven fistulae were aggressive and five were benign. Marginal doses ranged from 15 to 25 Gy. Target volumes ranged from 0.04 to 4.47 cm3. In all symptomatic patients, GK treatment resulted in symptom palliation. In 13/15 lesions, cure of symptoms (86.0%) was reported. One lesion was asymptomatic. Angiographic cure was achieved in eight cases (50%), small residual DAVF occurred in four, and four were unchanged. One patient developed headache that resolved at one year. No hemorrhage occurred during the follow-up period. There was no significant association between Borden type and cure rate. Prior failed endovascular treatment and small target volume were associated with lower rates of cure. Conclusions Stereotactic radiosurgery is viable treatment for DAVF. It is very effective in palliating symptoms as a de novo approach or adjunctive to endovascular therapy. In our experience it is only somewhat effective in achieving complete angiographic cure.
Minimum absolute lymphocyte counts during radiation are associated with a worse prognosis in patients with unresectable hepatocellular carcinoma
Authors: Zhao Qianqian , Xu Xiaoqing , Yue Jinbo , Zhu Kunli , Feng Rui , Jiang Shumei , Qi Zhonghua , Wang Renben 
Published: January 2017

Background: Peripheral blood lymphocytes play an important role in antitumour immunity. We examined the relationship between the minimum absolute lymphocyte counts (Min ALCs) during radiotherapy (RT) and clinical outcomes in patients with hepatocellular carcinoma (HCC). Methods: Data from a total of 69 HCC patients who had received RT were retrospectively analysed. Peripheral blood lymphocytes were measured before RT, weekly during RT and after RT. Regression and mixed-effect models were used to assess the relationships with and potential predictors of overall survival (OS). Receiver-operating characteristic (ROC) curve analysis was used to define optimal cut-off points of continuous variables for outcomes. Results: The median follow up was 30 months (range, 4–68 months). The median survival time (MST), 1-year OS rate and 2-year OS rate of the whole group were 25 months, 51% and 39%, respectively. The average circulating lymphocyte counts declined during RT (1493.19 versus 503.48 cells/µl, p < 0.001). A lower Min ALC was associated with worse OS ( p = 0.001), with a cut-off value of 450 cells/µl (sensitivity and specificity, 50% and 70.6%, respectively). The MSTs, 1-year OS rates and 2-year OS rates were 15 months versus 47 months, 27% versus 78% and 4% versus 71% for patients with relatively lower (⩽450 cells/µl) and higher Min ALCs (>450 cells/µl), respectively ( p < 0.001). After adjusting for potential confounders, multivariate Cox regression analysis demonstrated that Min ALC independently predicted patients’ OS (HR, 0.32; 95% CI, 0.15–0.69). Conclusions: Lower Min ALCs during RT may act as a worse prognostic factor for HCC after RT.