bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient experiences of perioperative nutrition within an Enhanced Recovery After Surgery programme for colorectal surgery: a qualitative study
Authors: Short V. , Atkinson C. , Ness A. R. , Thomas S. , Burden S. , Sutton E. 
Published: December 2015

AbstractAimNutrition is an important element of the Enhanced Recovery After Surgery (ERAS) programme. Patients have previously indicated that nutrition is a key component of ERAS that requires improvement. Our aim was to explore the perioperative nutrition experiences of colorectal surgical patients to identify barriers and facilitators to the integration of nutrition within ERAS.MethodSixteen individuals undergoing colorectal surgery participated in a semi‐structured interview between postoperative day three and hospital discharge. The topic guide was developed iteratively throughout the study; topics included preoperative counselling, carbohydrate loading, fasting and postoperative nutrition. A constant comparison technique was employed during coding, and an inductive thematic analysis was used. Validity was ensured by double coding a sample of transcripts.ResultsFindings are presented in the context of the following clinical themes: preoperative information, preoperative fasting, carbohydrate loading and nutritional drinks, postoperative diet and discharge. Individuals received too much general information which was repetitive, contradictory and not disease specific; this formed a key barrier affecting nutrition. Other barriers were negative experiences of nutritional drinks, stoma management, nausea and vomiting, and challenges from the hospital environment. Facilitators included interactions with staff, food accessibility and choice, and motivation for discharge.ConclusionThe key barrier to adherence of perioperative nutrition protocols was poor provision of information. Targeted information regarding postoperative diet, stoma management and coping with nausea and vomiting would be beneficial for colorectal surgical patients. Easily accessible food provided by ward staff was considered a facilitator.
The successful treatment of refractory respiratory failure due to miliary tuberculosis: survival after prolonged extracorporeal membrane oxygenation support
Authors: Nam Sung‐Jin , Cho Young‐Jae 
Published: December 2015

AbstractAcute respiratory distress syndrome (ARDS) has high morbidity and mortality. Although uncommon, pulmonary tuberculosis (TB) can cause ARDS in patients with extensive pulmonary parenchymal involvement. Veno‐venous extracorporeal membrane oxygenation (VV‐ECMO) is an accepted alternative option in refractory hypoxemic respiratory failure. It may normalize gas exchange and allow lung rest, avoiding ventilator induced lung injury. We report the case of a 44‐year‐old woman who developed ARDS secondary to pulmonary TB. Despite anti‐TB treatment and mechanical ventilation, patient had persistent refractory hypoxemia. In order to prevent further lung injury, VV‐ECMO support was performed for 73 days. Although the patient experienced several complications, patient was successfully managed on VV‐ECMO. VV‐ECMO support, in combination with anti‐TB drugs, is a useful tool in the treatment of ARDS with refractory hypoxemia caused by miliary TB.
A modern approach to ERCP: maintaining efficacy while optimising safety
Authors: Nalankilli Kumanan , Kannuthurai Sutharshan , Moss Alan 
Published: December 2015

Background and AimEndoscopic retrograde cholangiopancreatography (ERCP) is technically challenging and complications such as post‐ERCP pancreatitis (PEP) remain a concern. Modern ERCP techniques aim to maintain efficacy and improve safety. There are limited data regarding efficacy and safety of ERCP carried out by a newly qualified practitioner using modern techniques. The aim of the present study was to conduct an ERCP practice audit and compare it with an Australian national survey in order to review the evidence base underlying modern ERCP practice.MethodsAll ERCP carried out by a newly qualified practitioner, using prospectively collected data, from September 2011 to May 2015, were audited. Outcomes were compared to an Australia‐wide survey of ERCP practice. A literature review was carried out regarding recent developments in ERCP practice.ResultsAudit results correlated well with national data. All 478 ERCP were therapeutic and had pre‐procedure imaging. Wire‐guided biliary cannulation was used. Success rate was 97%. Overall adverse‐event rate was 0.8%. Choledocholithiasis was the predominant indication (72%). Biliary cannulation was successful in 338 of 348 naiive papillae. Of these, there were 53 (16%) difficult cannulations but the needle‐knife sphincterotomy (NKS) rate was low compared to national data (13% vs 33%). Rate of dual‐wire cannulation technique was higher (87% vs 30%). Pancreatic duct stenting (done in 32 cases [70% of dual‐wire cannulation cases]) and rectal indomethacin (25%) were used to reduce PEP risk.ConclusionsA newly qualified ERCP proceduralist achieved high success rates with minimal adverse events using modern techniques. Practice was consistent with national data, although dual‐wire cannulation technique was preferred to NKS. Evidence base for modern ERCP techniques was reviewed. ERCP efficacy and safety should be monitored by practice audit.
HbA1c measurement and relationship to incident stroke
Authors: Robson R. , Lacey A. S. , Luzio S. D. , Van Woerden H. , Heaven M. L. , Wani M. , Halcox J. P. J. , Castilla‐Guerra L. , Dawson J. , Hewitt J. 
Published: December 2015

AbstractAimsTo determine the proportion of people with diabetes who have HbA1c measured, what proportion achieve an HbA1c level of < 58 mmol/mol (7.5%), the frequency of testing and if there was any change in HbA1c level in the year before and the year after an incident stroke.MethodsThis study used the Secure Anonymised Information Linkage (SAIL) databank, which stores hospital data for the whole of Wales and ~ 65% of Welsh general practice records, to identify cases of stroke in patients with diabetes between 2000 and 2010. These were matched against patients with diabetes but without stroke disease. We assessed the frequency of HbA1c testing and change in HbA1c in the first year after stroke. Estimation was made of the proportion of patients achieving an HbA1c measurement ≤ 58 mmol/mol (7.5%).ResultsThere were 1741 patients with diabetes and stroke. Of these, 1173 (67.4%) had their HbA1c checked before their stroke and 1137 (65.3%) after their stroke. In the control group of 16 838 patients with diabetes but no stroke, 8413 (49.9%) and 9288 (55.1%) had their HbA1c checked before and after the case‐matched stroke date, respectively. In patients with diabetes and stroke, HbA1c fell from 61–56 mmol/mol (7.7–7.3%) after their stroke (P < 0.001). Before the study, 55.0% of patients with stroke had an HbA1c ≥ 58 mmol/mol compared with 65.2% of control patients, these figures were 62.5% and 65.3% after the stroke.ConclusionsThe frequency of diabetes testing was higher in patients who had experienced a stroke before and after their incident stroke compared with control patients but did not increase after their stroke. Glucose control improved significantly in the year after a stroke.
The cholecystokinin‐1 receptor antagonist devazepide increases cholesterol cholelithogenesis in mice
Authors: Wang Helen H. , Portincasa Piero , Wang David Q.‐H. 
Published: December 2015

AbstractBackgroundA defect in gallbladder contraction function plays a key role in the pathogenesis of gallstones. The cholecystokinin‐1 receptor (CCK‐1R) antagonists have been extensively investigated for their therapeutic effects on gastrointestinal and metabolic diseases in animal studies and clinical trials. However, it is still unknown whether they have a potential effect on gallstone formation.DesignTo study whether the CCK‐1R antagonists enhance cholelithogenesis, we investigated cholesterol crystallization, gallstone formation, hepatic lipid secretion, gallbladder emptying function and intestinal cholesterol absorption in male C57BL/6J mice treated by gavage with devazepide (4 mg/day/kg) or vehicle (as controls) twice per day and fed the lithogenic diet for 21 days.ResultsDuring 21 days of feeding, oral administration of devazepide significantly accelerated cholesterol crystallization and crystal growth to microlithiasis, with 40% of mice forming gallstones, whereas only agglomerated cholesterol monohydrate crystals were found in mice receiving vehicle. Compared to the vehicle group, fasting and postprandial residual gallbladder volumes in response to the high‐fat meal were significantly larger in the devazepide group during cholelithogenesis, showing reduced gallbladder emptying and bile stasis. Moreover, devazepide significantly increased hepatic secretion of biliary cholesterol, but not phospholipids or bile salts. The percentage of intestinal cholesterol absorption was higher in devazepide‐treated mice, increasing the bioavailability of chylomicron‐derived cholesterol in the liver for biliary hypersecretion into bile. These abnormalities induced supersaturated bile and rapid cholesterol crystallization.ConclusionsThe potent CCK‐1R antagonist devazepide increases susceptibility to gallstone formation by impairing gallbladder emptying function, disrupting biliary cholesterol metabolism and enhancing intestinal cholesterol absorption in mice.
Serum high‐molecular‐weight adiponectin level and incident dementia in patients with vascular risk factors
Authors: Kitagawa K. , Miwa K. , Okazaki S. , Sakaguchi M. , Mochizuki H. 
Published: December 2015

Background and purposeThe involvement of metabolic factors in the development of dementia has received much attention. However, previous studies have yielded conflicting results regarding how blood adipocytokine level impacts cognitive decline and dementia. This study aimed to clarify whether serum high‐molecular‐weight (HMW) adiponectin level is related to incident dementia.MethodsData were from 466 patients (mean age 67.8 years, male 57%) – who had normal cognitive function and received brain magnetic resonance imaging – from amongst the 1106 patients in the Osaka Follow‐up Study for Carotid Atherosclerosis, Part 2, a prospective cohort study of cardiovascular events and dementia amongst patients with vascular risk factors enrolled between 2001 and 2009. Baseline HMW adiponectin levels were measured using frozen serum. Dementia occurrence was examined in June 2013.ResultsSerum HMW adiponectin level was 4.33 ± 2.95 μg/ml; the levels were lower in men than in women and negatively correlated with body mass index. During the follow‐up period (median 6.9 years), 47 patients had incident dementia including Alzheimer's disease dementia (27), vascular dementia (13), mixed dementia (four), other dementia (three). Risks of dementia in patients with high versus low HMW adiponectin levels were almost identical (P = 0.689). No association was found between adiponectin levels and Alzheimer's disease dementia or vascular dementia in the whole group or amongst men and women separately.ConclusionsThis study demonstrated that serum HMW adiponectin level has little association with future dementia. Determination of metabolic factors involved in dementia requires evaluation of other biomarkers or parameters.
Epilepsy with temporal encephalocele: Characteristics of electrocorticography and surgical outcome
Authors: Panov Fedor , Li Yi , Chang Edward F. , Knowlton Robert , Cornes Susannah B. 
Published: December 2015

SummaryTemporal lobe encephaloceles (TEs) are increasingly identified in patients with epilepsy due to advances in neuroimaging. Select patients become seizure‐free with lesionectomy. In practice, however, many of these patients will undergo standard anterior temporal lobectomy. Herein we report on the first series of patients with refractory temporal lobe epilepsy (TLE) with encephalocele to undergo chronic or intraoperative electrocorticography (ECoG) in order to characterize the putative epileptogenic nature of these lesions and help guide surgical planning. This retrospective study includes nine adult patients with magnetic resonance imaging/computed tomography (MRI/CT)–defined temporal encephalocele treated between 2007 and 2014 at University of California San Francisco (UCSF). Clinical features, ECoG, imaging, and surgical outcomes are reviewed. Six patients underwent resective epilepsy surgery. Each case demonstrated abnormal epileptiform discharges around the cortical area of the encephalocele. Two underwent tailored lesionectomy and four underwent lesionectomy plus anterior medial temporal resection. Postoperatively, five patients, including both with lesionectomy only, had Engel class Ia surgical outcome, and one had a class IIb surgical outcome. The role of TE in the pathogenesis of epilepsy is uncertain. ECoG can confirm the presence of interictal epileptiform discharges and seizures arising from these lesions. Patients overall had a very good surgical prognosis, even with selective surgical approaches.
Cortical interneuron dysfunction in epilepsy associated with autism spectrum disorders
Authors: Jacob John 
Published: December 2015

SummaryAutism and epilepsy are two associated disorders that are highly prevalent, share common developmental origins, and demonstrate substantial heritability. In this review, cross‐disciplinary data in a rapidly evolving field that bridges neurology and psychiatry are synthesized to identify shared biologic mechanisms. The relationship between these debilitating, lifelong conditions is examined at the clinical, genetic, and neurophysiologic levels in humans and in animal models. Scopus and PubMed searches were used to identify relevant literature. Clinical observations have prompted speculation about the interdependence of autism and epilepsy, but causal relationships have proved difficult to determine. Despite their heritability, the genetic basis of autism spectrum disorder (ASD) and epilepsy has remained largely elusive until the advent of next‐generation sequencing. This approach has revealed that mutations that are either causal or confer an increased disease risk are found in numerous different genes, any one of which accounts for only a small percentage of cases. Conversely, even cases with identical clinical phenotypes can be genetically heterogeneous. Candidate gene identification has facilitated the development of mouse genetic models, which in parallel with human studies have implicated shared brain regions and circuits that mediate disease expression. Diverse genetic causes of ASD and epilepsy converge on cortical interneuron circuits as one important mediator of both disorders. Cortical interneurons are among the most diverse cell types in the brain and their unique chemical and electrical coupling exert a powerful inhibitory influence on excitatory neurons via the release of the neurotransmitter, γ‐aminobutyric acid (GABA). These multifaceted approaches have validated theories derived from the field of developmental neurobiology, which propose that the neurologic and neuropsychiatric manifestations are caused by an altered ratio of excitation to inhibition in the cortex.
Septic tendonitis of the deep digital flexor tendon in a Thoroughbred horse referred for weight loss and intermittent fever
Authors: Santinelli I. , Beccati F. , Passamonti F. , Pepe M. 
Published: December 2015

SummaryThis case report describes the history, clinical and diagnostic findings, treatment and outcome of a 3‐year‐old Thoroughbred gelding. The horse was examined for chronic weight loss, intermittent fever of 4 months' duration and acute lameness of 2 weeks' duration, and was finally diagnosed with septic tendonitis of the deep digital flexor tendon and digital flexor tendon sheath caused byStreptococcus equissp.zooepidemicus. Investigation of the lower respiratory tract also allowed isolation ofS. equissp.zooepidemicus. Although surgical treatment was recommended, because of the severity of the lesion and the guarded prognosis for a return to full athletic function, the owner declined surgery. The horse was therefore treated aggressively with antimicrobials using systemic, local and regional approaches, and with anti‐inflammatory drugs. At 20 months after discharge, the horse was able to race, and he is now in full work with 20 races finished successfully.
Ordinal regression by a gravitational model in the field of educational data mining
Authors: Gómez‐Rey Pilar , Fernández‐Navarro Francisco , Barberà Elena 
Published: December 2015

AbstractEducational data mining (EDM) is a research area where the goal is to develop data mining methods to examine data critically from educational environments. Traditionally, EDM has addressed the following problems: clustering, classification, regression, anomaly detection and association rule mining. In this paper, the ordinal regression (OR) paradigm, is introduced in the field of EDM. The goal of OR problems is the classification of items in an ordinal scale. For instance, the prediction of students' performance in categories (where the different grades could be ordered according to A ≻ B ≻ C ≻ D) is a classical example of an OR problem. The EDM community has not yet explored this paradigm (despite the importance of these problems in the field of EDM). Furthermore, an amenable and interpretable OR model based on the concept of gravitation is proposed. The model is an extension of a recently proposed gravitational model that tackles imbalanced nominal classification problems. The model is carefully adapted to the ordinal scenario and validated with four EDM datasets. The results obtained were compared with state‐of‐the‐art OR algorithms and nominal classification ones. The proposed models can be used to better understand the learning–teaching process in higher education environments.
Predicting performance in ASEAN banks: an integrated fuzzy MCDM–neural network approach
Authors: Wanke Peter , Kalam Azad Md. Abul , Barros C. P. , Hadi‐Vencheh Abdollah 
Published: December 2015

AbstractThis paper presents a performance assessment of 88 Association of Southeast Asian Nations banks from 2010 to 2013, using an integrated three‐stage approach on financial criteria that emulates the CAMELS rating system. More precisely, fuzzy analytic hierarchy process is used first to assess the relative weights of a number of criteria related to capital adequacy (C), asset quality (A), management quality (M), earnings (E), liquidity (L), and sensitivity to market risk (S) based on the opinion of 88 Association of Southeast Asian Nations experts. Then, these weights are used as technique for order of preference by similarity to ideal solution inputs to assess their relative efficiency. Lastly, neural networks are combined with technique for order of preference by similarity to ideal solution results to produce a model for banking performance with effective predictive ability. The results reveal that contextual variables have a prominent impact on efficiency. Specifically, parsimony in equity leveraging derived from Islamic finance principles may be the underlying cause in explaining higher efficiency levels.
Why is the South Orkney Island shelf (the world's first high seas marine protected area) a carbon immobilization hotspot?
Authors: Barnes David K. A. , Ireland Louise , Hogg Oliver T. , Morley Simon , Enderlein Peter , Sands Chester J. 
Published: December 2015

AbstractThe Southern Ocean archipelago, the South Orkney Islands (SOI), became the world's first entirely high seas marine protected area (MPA) in 2010. The SOI continental shelf (~44 000 km2), was less than half covered by grounded ice sheet during glaciations, is biologically rich and a key area of both sea surface warming and sea‐ice losses. Little was known of the carbon cycle there, but recent work showed it was a very important site of carbon immobilization (net annual carbon accumulation) by benthos, one of the few demonstrable negative feedbacks to climate change. Carbon immobilization by SOI bryozoans was higher, per species, unit area and ice‐free day, than anywhere‐else polar. Here, we investigate why carbon immobilization has been so high at SOI, and whether this is due to high density, longevity or high annual production in six study species of bryozoans (benthic suspension feeders). We compared benthic carbon immobilization across major regions around West Antarctica with sea‐ice and primary production, from remotely sensed and directly sampled sources. Lowest carbon immobilization was at the northernmost study regions (South Georgia) and southernmost Amundsen Sea. However, data standardized for age and density showed that only SOI was anomalous (high). High immobilization at SOI was due to very high annual production of bryozoans (rather than high densities or longevity), which were 2x, 3x and 5x higher than on the Bellingshausen, South Georgia and Amundsen shelves, respectively. We found that carbon immobilization correlated to the duration (but not peak or integrated biomass) of phytoplankton blooms, both in directly sampled, local scale data and across regions using remote‐sensed data. The long bloom at SOI seems to drive considerable carbon immobilization, but sea‐ice losses across West Antarctica mean that significant carbon sinks and negative feedbacks to climate change could also develop in the Bellingshausen and Amundsen seas.