bluuebunny/crossref_metadata_2025_split huggingface dataset:
Developing a patient information leaflet to improve information offered to patients undergoing appendicectomy
Authors: Smith Radford , cross Katie 
Published: April 2016

An appendicectomy is one of the most common operations performed in North Devon District Hospital (NDDH) with over 200 carried out between 2013 to 2014. Despite this, a patient information leaflet (PIL) about appendicectomy is unavailable, which is compromising standards of care and uncompliant with Trust policy.This project aimed to establish levels of written information offered to patients undergoing an appendicectomy, develop a PIL, and assess its impact on the provision of written information using Plan-Do-Study-Act (PDSA) methodology. Case notes of patients operated on between January 2013 to October 2014 were randomly sampled at baseline. The primary outcome measure was whether written information was offered, retrospectively determined by reviewing the medical record. A PIL was then designed following a standard protocol, published on NDDH's website and distributed onto surgical wards. Posters were displayed in staff rooms to encourage use of the PIL for PDSA cycle 1. An article further promoting the PIL was written for the wards monthly newsletter and a local presentation was delivered for PDSA cycle 2. Patients views about the PIL were assessed prospectively using a questionnaire. The primary outcome was measured at 10 weeks following PDSA cycle 1 and at 5 months following PDSA cycle 2.17% (5/30) of patients were offered written information at baseline. Following PDSA cycle 1, this rose substantially to 53% (8/15) but rates fell to 46% (7/15) following PDSA cycle 2. 89% of patients (8/9) surveyed agreed or strongly agreed that the PIL was helpful.This project indicates that provision of written information is poor despite it being highly valued by patients. The first ever Trust appendicectomy PIL has been established which substantially improved provision of written information after 10 weeks. However, continued education of staff is essential to embed good practice over the long term.
MED12 protein expression in breast fibroepithelial lesions: correlation with mutation status and oestrogen receptor expression
Authors: Tan Wai Jin , Chan Jason Yongsheng , Thike Aye Aye , Lim Jeffrey Chun Tatt , Md Nasir Nur Diyana , Tan Jane Sie Yong , Koh Valerie Cui Yun , Lim Weng Khong , Tan Jing , Ng Cedric Chuan Yong , Rajasegaran Vikneswari , Nagarajan Sanjanaa , Bay Boon Huat , Teh Bin Tean , Tan Puay Hoon 
Published: April 2016

AimsRecent reports have identified recurrentMED12somatic mutations in fibroadenomas and phyllodes tumours. The frequency and type of somatic mutations were noted to be similar to those of uterine leiomyomas. We aimed to investigate protein expression of MED12, correlating it toMED12mutational status and expression of oestrogen receptors (ER).MethodsImmunohistochemistry was performed on a total of 232 fibroepithelial lesions (100 fibroadenomas, 132 phyllodes tumours) diagnosed at the Department of Pathology, Singapore General Hospital using MED12, ERα and ERβ antibodies. Expressions were evaluated in both stroma and epithelium, and correlated withMED12mutational status.ResultsMED12mutation was significantly associated with high MED12 protein expression (H-score >150) in the stroma (p=0.029), but not in the epithelium. It was not associated with ERα and ERβ protein expression in both stroma and epithelium. MED12 protein expression was significantly correlated with ERα in epithelial (p=0.007) and ERβ in stromal (p=0.049) components. MED12 was not significantly different between fibroadenomas and phyllodes tumours. Epithelial expression of ERα was significantly higher in fibroadenomas (p<0.001) than in phyllodes tumours. Conversely, both epithelial and stromal expression of ERβ was significantly higher in phyllodes tumours (p<0.001).ConclusionsPositive associations observed between MED12 and ERα, ERβ immunohistochemical expression suggest a biological interplay between the proteins. The lack of significant association ofMED12mutation with ER protein expression indicates a need to further explore the functional impact ofMED12mutations on the ER signalling pathway in breast fibroepithelial lesions.
Analysis of radiation doses incurred during diagnostic cerebral angiography after the implementation of dose reduction strategies
Authors: Schneider Tanja , Wyse Emily , Pearl Monica S 
Published: April 2016

BackgroundOne goal of increasing awareness of radiation dose is to encourage personal and technical modifications in order to reduce the radiation exposure of patients and staff.ObjectiveTo analyze the radiation doses incurred during diagnostic cerebral angiography and the angiographic techniques practiced over a 4-year period, in order to demonstrate the effectiveness of implementing radiation dose reduction strategies.MethodsA retrospective review of the first 50 consecutive adult and pediatric patients undergoing diagnostic cerebral angiography each year from 2010 to 2013 was performed. Angiograms and procedure examination protocols were reviewed for patient age, gender, diagnosis, angiography techniques, fluoroscopy time, reference point air kerma (Ka,rin mGy), and kerma-area product (PKA in μGym2).ResultsFrom January 2010 to June 2013, a total of 231 diagnostic cerebral angiograms were reviewed (200 adults, 31 children). Adult patients were aged from 19 to 94 years and included 77 men and 123 women. Pediatric patients were aged from 2 to 18 years and comprised 11 boys and 20 girls. Median Ka,rand PKA significantly decreased from 2010 to 2013 in adults (1867 mGy; 21 231 µGym2vs 653 mGy; 7860 µGym2) and children (644 mGy; 6495 µGym2vs138 mGy; 1465 µGym2), (p<0.001).ConclusionsIncreased awareness and implementation of dose reduction strategies resulted in decreased radiation doses for diagnostic cerebral angiography both in adult and pediatric patients. The use of lower and variable digital subtraction angiography frame rates and tailored examinations contributed significantly to the reduced radiation doses observed during diagnostic cerebral angiography.
Combined proximal balloon occlusion and distal aspiration: a new approach to prevent distal embolization during neurothrombectomy
Authors: Stampfl Sibylle , Pfaff Johannes , Herweh Christian , Pham Mirko , Schieber Simon , Ringleb Peter A , Bendszus Martin , Möhlenbruch Markus A 
Published: April 2016

Background and purposeEmbolization of thrombus fragments in a new vascular territory is a potential adverse event in neurothrombectomy. This study was performed to evaluate the safety and feasibility of a novel approach combining proximal balloon occlusion and distal aspiration to prevent distal thrombembolic complications.MethodsPatients with ischemic stroke meeting the following inclusion criteria were eligible: occlusion in the anterior circulation, neurothrombectomy using a balloon catheter for proximal flow arrest, and an intermediate catheter for distal aspiration. Pre- and post-interventional Thrombolysis In Cerebral Infarction (TICI) scores were assessed. Clinical presentation at admission and discharge and after 3 months was also evaluated and complications (particularly new thrombembolic events) were recorded.ResultsWe retrospectively identified 31 patients from our prospectively collected stroke database who met the inclusion criteria. In all patients the initial TICI was 0. A TICI score of ≥2b was achieved in 96.8%. No new thrombembolic complications occurred. The median NIH Stroke Scale score was 19 at admission and 4.5 at discharge. After 3 months, 51.6% of the patients had a favorable clinical outcome (modified Rankin Scale score 0–2) and 19.3% had died.ConclusionsA combination of proximal internal carotid artery occlusion using a balloon catheter and distal aspiration through an intermediate catheter represents a safe and efficient adjunct to mechanical thrombectomy with stent retrievers. In our patient cohort, no new thrombembolic complications were detected.
Use of the 2.8 French Progreat microcatheter in diagnostic cerebral angiography
Authors: Griauzde Julius , Gemmete Joseph J , Shastri Ravi , Pandey Aditya S , Chaudhary Neeraj 
Published: April 2016

BackgroundTortuous vascular anatomy poses a significant challenge to performing diagnostic cerebral angiography.ObjectiveTo report a new cerebral angiography technique for overcoming tortuous aortic and supra-aortic anatomy using a 2.8 French (F) Progreat microcatheter (0.028 inch (internal diameter) (Terumo; Somerset, New Jersey, USA) to obtain a diagnostic cerebral angiogram.Materials and methodsA retrospective analysis of consecutive cases undergoing diagnostic cerebral angiography at our institution between 1 January 2013 and 30 November 2015 in which a 2.8F Progreat microcatheter was used. Clinical and operative notes were reviewed and correlated with imaging. Radiologic imaging, including CT, MRI, and digital subtraction angiography, was reviewed. Neurologic, systemic, and local complications were recorded on the basis of clinical follow-up results after each angiographic examination. Events that occurred within 24 h of the angiography were considered to be complications of the procedure.ResultsInitial attempts at catheterization of the target vessel with various 4F and 5F catheters were unsuccessful owing to tortuosity, atherosclerotic disease, or occlusion of the catheter in the target vessel. Microcatheterization of the target vessel was successful in 59/62 (95%) target vessels. A diagnostic cerebral angiogram with a power injection was obtained in 59 (100%) of the successfully catheterized vessels. In one case, angiography proceeded to aneurysm coiling after over-the-wire exchange. In two cases, angiography proceeded to mechanical thrombectomy after over-the-wire exchange. No procedural complications were seen.ConclusionsThe 2.8F Progreat microcatheter can be used to obtain a diagnostic cerebral angiogram in patients with anatomic challenges limiting catheterization by standard techniques.
New data on the tectonic evolution of the Khoy region, NW Iran
Authors: Avagyan Ara , Shahidi Alireza , Sosson Marc , Sahakyan Lilit , Galoyan Ghazar , Muller Carla , Vardanyan Sargis , Firouzi Khalil Bahar , Bosch Delphine , Danelian Taniel , Asatryan Gayane , Mkrtchyan Mushegh , Shokri Mohammad Ali 
Published: April 2016

Abstract
The Khoy region (NW Iran) is important in the clarification of the structural framework of the alpine belt between the Taurides, the Lesser Caucasus and the NW Iran belt. The area is well-known for these ophiolitic units. We present here new stratigraphic and structural data that can be used to reconstruct the tectonic evolution of this region and then try to establish connections between these belts. According to new dates from nannoplankton assemblages, the obducted ophiolite of the Khoy complex was thrust over a sheared Campanian olistostrome and lenses of amphibolite are included within the contact. The obduction event is also marked by erosion of the ophiolitic unit and the deposition of conglomerates, shales, sandstones and siltstones. Poorly extended Paleocene detrital deposits cover the Campanian–Maastrichtian rocks. The Eocene formations characterize a basin filled with volcanogenic and sedimentary layers. The Middle and Upper Eocene series unconformably overlie the ophiolites and their cover of Campanian–Maastrichtian and Paleocene deposits. This corresponds to a syn-orogenic basin formed after the collision between Eurasia and the Taurides–Anatolides–South Armenian microplate. The Oligocene–Miocene Qom Formation with basal conglomerates unconformably covers all the earlier formations, including the Palaeozoic formations, indicating intense shortening before its deposition. Compressional deformation continued and is manifested by numerous folds, mainly west-dipping thrusts and reverse faults cutting the Qom Formation, and by recent NW–SE dextral strike-slip faults. This illustrates the continuous shortening and uplift (with intense erosion) resulting from the advanced stage of the collision between Arabia and Eurasia. The structural location of the tectonic units suggests that the Khoy Gondwana-related basement was part of the South Armenian Block and that the Khoy allochthonous ophiolites were obducted on it from the Amasia–Stepanavan–Sevan–Hakari suture zone.
Distinct Longitudinal Associations of MBL, MASP-1, MASP-2, MASP-3, and MAp44 With Endothelial Dysfunction and Intima–Media Thickness
Authors: Hertle Elisabeth , Arts Ilja C.W. , van der Kallen Carla J.H. , Feskens Edith J.M. , Schalkwijk Casper G. , Hoffmann-Petersen Ingeborg T. , Thiel Steffen , Stehouwer Coen D.A. , van Greevenbroek Marleen M.J. 
Published: April 2016

Objective—
Previous studies suggested that the lectin-complement pathway plays a complex role in cardiovascular disease (CVD). To date, no prospective human studies have investigated the relationship between the initiating factor of the lectin pathway, that is, mannose-binding lectin (MBL), and low-grade inflammation, endothelial dysfunction, or carotid intima–media thickness (cIMT). Moreover, MBL-associated proteases (MASPs) and MBL-associated proteins (MAps), which mediate downstream complement activation, have not been studied in the development of CVD.

Approach and Results—

In a prospective cohort (n=574; age 60±7 years; 7-year follow-up), we investigated longitudinal associations of plasma MBL, MASP-1, MASP-2, MASP-3, and MAp44 with biomarker scores that reflect low-grade inflammation and endothelial dysfunction, respectively, and with cIMT. We also investigated their associations with incident CVD (n=73). In adjusted analyses, low-grade inflammation was lowest in the middle tertile (T
Middle
) of MBL, that is, T
Middle
was 0.19 SD (0.03 to 0.34) lower than T
Low
, and 0.15 SD (−0.02 to 0.31) lower than T
High
. cIMT was 28 μm (−50 to −5) lower in the highest MBL tertile (T
High
) than in T
Middle
and did not differ between T
Low
and T
Middle
. MBL was not associated with endothelial dysfunction or CVD. MASP-1 and MASP-2 were not associated with any cardiovascular outcomes. MASP-3 and MAp44 were, independently of MBL levels, associated with endothelial dysfunction (per 1 SD higher MASP-3: β=0.10 SD [0.02 to 0.18]; per 1 SD higher MAp44 β=0.12 SD [0.04 to 0.20]) but not with low-grade inflammation, cIMT, or CVD.

Conclusions—
High MBL may contribute to low cIMT, whereas the association of MBL with low-grade inflammation was nonlinear. MASP-1 and MASP-2 were not associated with adverse cardiovascular outcomes. MASP-3 and MAp44 may play a role in endothelial dysfunction, potentially independent of lectin-pathway activation.
Prognostic Relevance of Left Atrial Dysfunction in Heart Failure With Preserved Ejection Fraction
Authors: Santos Angela B.S. , Roca Gabriela Querejeta , Claggett Brian , Sweitzer Nancy K. , Shah Sanjiv J. , Anand Inder S. , Fang James C. , Zile Michael R. , Pitt Bertram , Solomon Scott D. , Shah Amil M. 
Published: April 2016

Background—
Left atrial (LA) size is an established marker of risk for adverse outcomes in heart failure with preserved ejection fraction (HFpEF). However, the independent prognostic importance of LA function in HFpEF is not known.

Methods and Results—

We assessed LA function measured by speckle-tracking echocardiography in 357 patients with HFpEF enrolled in the Treatment Of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial who were in sinus rhythm at the time of echocardiography. Lower peak LA strain, indicating LA dysfunction, was associated with older age, higher prevalence of atrial fibrillation and left ventricular (LV) hypertrophy, worse LV and right ventricular systolic function, and worse LV diastolic function. At a mean follow-up of 31 months (interquartile range, 18–43months), 91 patients (25.5%) experienced the primary composite end point of cardiovascular death, HF hospitalization, and aborted sudden death. Lower peak LA strain was associated with a higher risk of the composite end point (hazard ratio, 0.96 per unit of reduction in strain; 95% confidence interval, 0.94–0.99;
P
=0.009) and of HF hospitalization alone (hazard ratio, 0.95 per unit of reduction in strain; 95% confidence interval, 0.92–0.98;
P
=0.003). The association of LA strain with incident HF hospitalization remained significant after adjustment for clinical confounders, but not after further adjustment for LV global longitudinal strain and the E/E′ ratio, parameters of LV systolic and diastolic function, respectively.

Conclusions—
LA dysfunction in HFpEF is associated with a higher risk of HF hospitalization independent of potential clinical confounders, but not independent of LV strain and filling pressure. Impairment in LV systolic and diastolic function largely explains the association between impaired LA function and higher risk of HF hospitalization in HFpEF.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00094302.
Cannabis Use and Outcomes in Patients With Aneurysmal Subarachnoid Hemorrhage
Authors: Behrouz Réza , Birnbaum Lee , Grandhi Ramesh , Johnson Jeremiah , Misra Vivek , Palacio Santiago , Seifi Ali , Topel Christopher , Garvin Rachel , Caron Jean-Louis 
Published: April 2016

Background and Purpose—
The incidence of cannabis use in patients with aneurysmal subarachnoid hemorrhage (aSAH) and its impact on morbidity, mortality, and outcomes are unknown. Our objective was to evaluate the relationship between cannabis use and outcomes in patients with aSAH.

Methods—
Records of consecutive patients admitted with aSAH between 2010 and 2015 were reviewed. Clinical features and outcomes of aSAH patients with negative urine drug screen and cannabinoids-positive (CB+) were compared. Regression analyses were used to assess for associations.

Results—

The study group consisted of 108 patients; 25.9% with CB+. Delayed cerebral ischemia was diagnosed in 50% of CB+ and 23.8% of urine drug screen negative patients (
P
=0.01). CB+ was independently associated with development of delayed cerebral ischemia (odds ratio, 2.68; 95% confidence interval, 1.03–6.99;
P
=0.01). A significantly higher number of CB+ than urine drug screen negative patients had poor outcome (35.7% versus 13.8%;
P
=0.01). In univariate analysis, CB+ was associated with the composite end point of hospital mortality/severe disability (odds ratio, 2.93; 95% confidence interval, 1.07–8.01;
P
=0.04). However, after adjusting for other predictors, this effect was no longer significant.

Conclusions—
We offer preliminary data that CB+ is independently associated with delayed cerebral ischemia and possibly poor outcome in patients with aSAH. Our findings add to the growing evidence on the association of cannabis with cerebrovascular risk.
Understanding political participation in West Africa: the relationship between good governance and local citizen engagement
Authors: Krawczyk Kelly Ann , Sweet-Cushman Jennie 
Published: April 2016

Strengthening citizen participation in West Africa is an increasingly important aspect of democratic development – especially in mitigating setbacks arising from poor governance. This article uses Round 4 Afrobarometer data to explore what stimulates local-level participation by examining determinants against the backdrop of eight West African nations: Benin, Burkina Faso, Cape Verde, Ghana, Liberia, Mali, Nigeria, and Senegal. Using a negative binomial regression model, our results are evaluated within the framework of good governance, and show that local context, specifically relative to citizens’ perceptions of and attitudes about the performance of local government, matters when it comes to local political participation. Points for practitioners This study provides public administrators with a framework for understanding what drives local-level, non-electoral citizen participation in West Africa, and helps them understand how to increase local citizen engagement and build a more democratic society through the pursuit of good governance principles. In addition, this study highlights the critical importance of local government performance, and the role of citizens’ attitudes and evaluations, in local civic engagement.
Autologous adipose-derived stem cells: Basic science, technique, and rationale for application in ulcer and wound healing
Authors: Zollino Ilaria , Zuolo Michele , Gianesini Sergio , Pedriali Massimo , Sibilla Maria Grazia , Tessari Mirko , Carinci Francesco , Occhionorelli Savino , Zamboni Paolo 
Published: April 2016

Objectives The present review represents a translational boundary between basic research and surgery, particularly focusing on the promising application of adipose-derived stem cells harvested intra-operatively during debridement of venous leg ulcers. Methods We reviewed 830 out of 5578 articles on MEDLINE starting from 1997 and sorted by the relevance option. Results The technique currently used for adipose-derived stem cells intra-operative harvesting is presented, including a safety evaluation on a cohort of 5089 revised patients who underwent plastic surgery and maxillo-facial surgical procedures. Complications were reported in 169 cases (3.3%). One hundred and forty-one (2.77%) patients were classified as having minor complications, specifically: nodularity/induration 93 (1.83%), dysesthesia 14 (0.26%), hematoma 12 (0.23%), superficial infection 11 (0.21%), pain 7 (0.13%), poor cosmesis 3 (0.06%), and abnormal breast secretion 1 (0.02%), while 28 patients (0.55%) were classified as having major complications, specifically: deep infection 22 (0.43%), sepsis 3 (0.06%), abdominal hematoma 2 (0.04%), and pneumothorax 1 (0.02%). Application of cell therapy in venous leg ulcer is currently used only for patients not responding to the standard treatment. The review shows the lack of randomized clinical trials for application of adipose-derived stem cells among treatments for venous leg ulcer. Finally, adipose-derived stem cells implantation at the wound site promotes a new tissue formation rich in vascular structures and remodeling collagen. Conclusion Adipose-derived stem cells strategy represents a great opportunity for the treatment of chronic wounds, due to the simplicity of the technique and the application of cell treatment in the operating room immediately following debridement. However, clinical studies and data from randomized trials are currently lacking.