bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency department management of early sepsis: a national survey of emergency medicine and intensive care consultants
Authors: Jiwaji Zoeb , Brady Shirin , McIntyre Lauralyn A , Gray Alasdair , Walsh Timothy S 
Published: September 2013

ObjectivesEarly goal-directed therapy (EGDT) is recommended for sepsis management in current guidelines, but the underpinning evidence is controversial. Clinician beliefs and the capacity to implement all recommended elements of EGDT in emergency departments (EDs) are uncertain. Our study aimed to explore self-reported management of early sepsis by Scottish emergency medicine (EM) and intensive care medicine (ICM) consultants, delineate important differences and determine the guideline recommendations rated most important and deliverable within the ED.MethodsA postal survey using a hypothetical patient with septic shock was sent to all EM and ICM consultants practising in Scotland.Results67% (76/114) EM and 61% (96/157) ICM consultants responded. Normal saline was preferred by EM respondents (‘always/often used’: EM 86%, ICM 23%, p<0.0001), whereas ICM respondents preferred Hartmann's solution (EM 42%, ICM 72%, p=0.0164), gelofusin (EM 10%, ICM 63%, p<0.0001) and starch (EM 0%, ICM 24%, p<0.0001). More ICM respondents indicated they used central venous pressure and invasive arterial pressure monitoring in the ED, and initiated vasopressors (EM 57%, ICM 90%, p<0.0001). More ICM consultants used specific haemoglobin transfusion triggers (48% EM, 77% ICM, p=0.0002), but marked variation in haemoglobin triggers and targets was reported. Lactate was rated the most important single resuscitation parameter by both specialties; no ED and only two ICM consultants rated ScVO2most important.ConclusionsDifferences in early fluid and vasopressor management of sepsis exist between Scottish ICM and EM consultants. Transfusion practice is highly variable, suggesting clinical uncertainty. Lactate is considered more important than ScVO2measurement.
Selective Targeting of Gain-of-Function KCNQ1 Mutations Predisposing to Atrial Fibrillation
Authors: Campbell Courtney M. , Campbell Jonathan D. , Thompson Christopher H. , Galimberti Eleonora Savio , Darbar Dawood , Vanoye Carlos G. , George Alfred L. 
Published: September 2013

Background
Atrial fibrillation is the most common sustained cardiac arrhythmia in adults. We hypothesized that gain-of-function KCNQ1 mutations previously associated with familial atrial fibrillation have distinct pharmacological properties that may enable targeted inhibition.

Methods and Results

Wild-type (WT) KCNQ1 or the familial atrial fibrillation mutation KCNQ1-S140G was heterologously coexpressed with KCNE1 to enable electrophysiological recording of the slow delayed rectifier current (
I
Ks
) and investigation of pharmacological effects of the
I
Ks
selective blocker HMR-1556. Coexpression of KCNQ1-S140G with KCNE1 generated potassium currents (S140G-
I
Ks
) that exhibited greater sensitivity to HMR-1556 than WT-
I
Ks
. Enhanced HMR-1556 sensitivity was also observed for another gain-of-function atrial fibrillation mutation, KCNQ1-V141M. Heteromeric expression of KCNE1 with both KCNQ1-WT and KCNQ1-S140G generated currents (HET-
I
Ks
) with gain-of-function features, including larger amplitude, a constitutively active component, hyperpolarized voltage dependence of activation, and extremely slow deactivation. A low concentration of HMR-1556, which had little effect on WT-
I
Ks
but was capable of inhibiting the mutant channel, reduced both instantaneous and steady state HET-
I
Ks
to levels that were not significantly different from WT-
I
Ks
and attenuated use-dependent accumulation of the current. In cultured adult rabbit left atrial myocytes, expression of S140G-
I
Ks
shortened action potential duration compared with WT-
I
Ks
. Application of HMR-1556 mitigated S140G-
I
Ks
–induced action potential duration shortening and did not alter action potential duration in cells expressing WT-
I
Ks
.

Conclusions
The enhanced sensitivity of KCNQ1 gain-of-function mutations for HMR-1556 suggests the possibility of selective therapeutic targeting, and, therefore, our data illustrate a potential proof of principle for genotype-specific treatment of this heritable arrhythmia.
Trends in Storm-Triggered Landslides over Southern California
Authors: Ren Diandong , Leslie Lance M. , Lynch Mervyn J. 
Published: September 2013

AbstractChanges in storm-triggered landslide activity for Southern California in a future warming climate are estimated using an advanced, fully three-dimensional, process-based landslide model, the Scalable and Extensible Geofluid Modeling System for landslides (SEGMENT-Landslide). SEGMENT-Landslide is driven by extreme rainfall projections from the Geophysical Fluid Dynamics Laboratory High Resolution Atmospheric Model (GFDL-HIRAM). Landslide changes are derived from GFDL-HIRAM forcing for two periods: 1) the twentieth century (CNTRL) and 2) the twenty-first century under the moderate Intergovernmental Panel on Climate Change Special Report on Emissions Scenarios A1B enhanced greenhouse gas emissions scenario (EGHG). Here, differences are calculated in landslide frequency and magnitude between the CNTRL and EGHG projections; kernel density estimation (KDE) is used to determine differences in projected landslide locations. This study also reveals that extreme precipitation events in Southern California are strongly correlated with several climate drivers and that GFDL-HIRAM simulates well the southern (relative to Aleutian synoptic systems) storm tracks in El Niño years and the rare (~27-yr recurrence period) hurricane-landfalling events. GFDL-HIRAM therefore can provide satisfactory projections of the geographical distribution, seasonal cycle, and interannual variability of future extreme precipitation events (>50 mm) that have possible landslide consequences for Southern California. Although relatively infrequent, extreme precipitation events contribute most of the annual total precipitation in Southern California. Two findings of this study have major implications for Southern California. First is a possible increase in landslide frequency and areal distribution during the twenty-first century. Second, the KDE reveals three clusters in both the CNTRL and EGHG model mean scarp positions, with a future eastward (inland) shift of ~0.5° and a northward shift of ~1°. These findings suggest that previously stable areas might become susceptible to storm-triggered landslides in the twenty-first century.
Influence of Assimilating Satellite-Derived Atmospheric Motion Vector Observations on Numerical Analyses and Forecasts of Tropical Cyclone Track and Intensity
Authors: Wu Ting-Chi , Liu Hui , Majumdar Sharanya J. , Velden Christopher S. , Anderson Jeffrey L. 
Published: September 2013

Abstract
The influence of assimilating enhanced atmospheric motion vectors (AMVs) on mesoscale analyses and forecasts of tropical cyclones (TC) is investigated. AMVs from the geostationary Multifunctional Transport Satellite (MTSAT) are processed by the Cooperative Institute for Meteorological Satellite Studies (CIMSS, University of Wisconsin–Madison) for the duration of Typhoon Sinlaku (2008), which included a rapid intensification phase and a slow, meandering track. The ensemble Kalman filter and the Weather Research and Forecasting Model are utilized within the Data Assimilation Research Testbed. In addition to conventional observations, three different groups of AMVs are assimilated in parallel experiments: CTL, the same dataset assimilated in the NCEP operational analysis; CIMSS(h), hourly datasets processed by CIMSS; and CIMSS(h+RS), the dataset including AMVs from the rapid-scan mode. With an order of magnitude more AMV data assimilated, the CIMSS(h) analyses exhibit a superior track, intensity, and structure to CTL analyses. The corresponding 3-day ensemble forecasts initialized with CIMSS(h) yield smaller track and intensity errors than those initialized with CTL. During the period when rapid-scan AMVs are available, the CIMSS(h+RS) analyses offer additional modifications to the TC and its environment. In contrast to many members in the ensemble forecasts initialized from the CTL and CIMSS(h) analyses that predict an erroneous landfall in China, the CIMSS(h+RS) members capture recurvature, albeit prematurely. The results demonstrate the promise of assimilating enhanced AMV data into regional TC models. Further studies to identify optimal strategies for assimilating integrated full-resolution multivariate data from satellites are under way.
Predictability Characteristics of Landfalling Cyclones along the North American West Coast
Authors: McMurdie Lynn A. , Ancell Brian 
Published: September 2013

Abstract
The predictability of North Pacific cyclones can vary widely, from highly accurate prediction of storm intensity and location to forecast position errors of hundreds of kilometers and central pressure errors of tens of hectopascals. In this study, a Weather Research and Forecasting Model (WRF) ensemble Kalman filter is used to investigate predictability of landfalling cyclones on the west coast of North America over two winter seasons (2008/09 and 2009/10). Predictability is defined as the ensemble spread of cyclone central pressure at the final forecast time (24 h) where large spread means low predictability. Both ensemble spread and ensemble initial-condition sensitivity are examined for a wide variety of cyclones that occurred during the two seasons. Storms that are deepening and track from the southwest exhibit the largest ensemble initial-condition sensitivity and highest ensemble spread compared to decaying storms and storms that track from other directions. Storms that end south of 40°N, typically slow moving storms from the northwest, exhibit higher predictability regardless of whether or not they are deepening or decaying. Cyclones with large ensemble spread and low sensitivity are mature cyclones whose low predictability likely results from large initial-condition spread instead of large perturbation growth. These results highlight particular synoptic situations and cyclone characteristics that are associated with low predictability and can potentially be used to improve forecasts through improved observational coverage.
Assessment of aggressiveness of rectal cancer using 3-T MRI: correlation between the apparent diffusion coefficient as a potential imaging biomarker and histologic prognostic factors
Authors: Akashi Michiaki , Nakahusa Yuji , Yakabe Tomomi , Egashira Yoshiyuki , Koga Yasuo , Sumi Kenji , Noshiro Hirokazu , Irie Hiroyuki , Tokunaga Osamu , Miyazaki Kohji 
Published: September 2013

Background Diffusion-weighted magnetic resonance imaging (DW-MRI) permits non-invasive assessment of tumor characteristics. Purpose To assess the value of DW-MRI as a potential non-invasive marker of tumor aggressiveness in rectal cancer by analyzing the relationship between tumoral apparent diffusion coefficient (ADC) values of MRI and histopathologic prognostic parameters that are not affected by preoperative chemoradiation therapy. Material and Methods Forty patients with rectal cancer were assessed with primary staging 3-T MRI, including DWI, before undergoing surgical therapy. In all patients, surgery was performed without neoadjuvant therapy. Mean tumor ADC was measured and compared between subgroups based on pretreatment carcinoembryonic antigen (CEA) levels, MRI parameters (e.g. postoperative local recurrence), and histopathologic parameters, including A (invasive distance: A1, T-stage; A2, mesorectal fascia [MRF] status), B (differentiation grade: B1, poorly differentiated; B2, moderately differentiated; B3, well differentiated), C (others: C1, N-stage; C2, lymphangiovascular invasion). Results Mean tumor ADCs were different when comparing groups stratified by histologic differentiation grades ( P = 0.0192). There was no significant difference in mean ADCs when stratifying patients according to CEA levels, T-stage, N-stage, MRF status, presence of lymphangiovascular invasion, or the presence of local recurrence. Conclusion Significant correlations were found between mean ADC values and differentiation grade. ADC may be useful as an imaging biomarker of tumor aggressiveness, but it cannot serve as an independent biomarker of advanced rectal cancer.
Digital breast tomosynthesis versus full-field digital mammography: comparison of the accuracy of lesion measurement and characterization using specimens
Authors: Seo Nieun , Kim Hak Hee , Shin Hee Jung , Cha Joo Hee , Kim Hyunji , Moon Jin Hee , Gong Gyungyub , Ahn Sei-Hyun , Son Byung Ho 
Published: September 2013

Background Digital breast tomosynthesis (DBT) is one of the new techniques being developed to overcome the inherent limitations of mammography caused by superimposed structures in a 2D projection. Purpose To compare the diagnostic performances of digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) for lesion characterization and size measurement using breast specimens. Material and Methods Out of 156 women scheduled for surgery, we included in our study 114 women, each of whom had a single, breast lesion. Three breast radiologists independently evaluated the DBT and FFDM performance regarding the breast specimens obtained during surgery. Each reader measured the lesion size, and then categorized the probability of malignancy using the American College of Radiology Breast Imaging Reporting and Data system (BI-RADS). After both reading sessions, the readers selected the preferred modality of either FFDM or DBT in lesion characterization. We also analyzed the radiologists’ evaluation performance in patients with dense versus fatty breasts when using DBT and FFDM. Results The imaging findings of 84 cancers and 30 benign lesions, all of which had been pathologically proven, were reviewed. The size evaluation determined by DBT was more accurately correlated with that found by pathology ( P = 0.001 for fatty breasts and <0.001 for dense breasts) than that determined by FFDM. The correlation coefficients of DBT and FFDM to the pathologically determined lesion size were 0.90 and 0.89, respectively ( P < 0.001). Compared with the pathologically determined lesion size, the size determined by both imaging modalities was overestimated. Overall, assessment of the probability of malignancy by DBT and FFDM did not differ significantly ( P = 0.07); however, in dense breast, DBT was more strongly correlated with the pathology determination than FFDM ( P = 0.03). Conclusion DBT may be superior to FFDM for determining the preoperative size measurement of breast lesions irregardless of their parenchymal density. Particularly in dense breasts, DBT was more useful for differentiating the lesion malignancy rate.
Sport-Specific Injury Pattern Recorded During Anterior Cruciate Ligament Reconstruction
Authors: Granan Lars-Petter , Inacio Maria C.S. , Maletis Gregory B. , Funahashi Tadashi T. , Engebretsen Lars 
Published: September 2013

Background: Anterior cruciate ligament (ACL) injuries are more commonly seen with certain cutting and pivoting sports. However, injury patterns associated with these sports have not been well described. Purpose: (1) To describe the patient demographics and injury pattern at the time of ACL reconstruction (ACLR) by activities that lead to ACL injuries and (2) to estimate the association of activities at the time of injury with the odds of isolated ACL injuries as well as with meniscus, cartilage, and multiligament injuries diagnosed at the time of ACLR. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study combined 2 ACLR registry cohorts, from Norway and the United States, from 2004 to 2011. A cohort of 10,958 primary ACLRs was included. The most prevalent sports activities at the time of injury were the following: soccer, skiing, American football, basketball, and team handball. The end points were the concurrent injury patterns at the time of ACLR: isolated ACL, meniscus, cartilage, and multiligament injuries. Results: All sports were compared with the most prevalent injury mechanism: soccer. Skiing injuries were 1.13 (95% confidence interval [CI], 1.01-1.27) times more likely to result in isolated ACL tears, 2.05 (95% CI, 1.01-4.16) times more likely to result in posterior cruciate ligament tears, 1.94 (95% CI, 1.51-2.49) times more likely to result in medial collateral ligament (MCL) tears, and 1.73 (95% CI, 1.38-2.17) times more likely to result in multiligament injuries. Athletes playing American football were 2.72 (95% CI, 1.32-5.62) times more likely to have MCL tears. Those injured playing basketball were 1.28 (95% CI, 1.06-1.54) times more likely to have lateral meniscus tears, 1.23 (95% CI, 1.01-1.51) times more likely to have cartilage damage, and 1.38 (95% CI, 1.11-1.72) times more likely to have meniscus and cartilage injuries. Athletes injured playing team handball were less likely to have MCL tears (odds ratio [OR], 0.68; 95% CI, 0.46-0.99) and more likely to have lateral meniscus injuries (OR, 1.27; 95% CI, 1.10-1.48). Conclusion: Injury patterns were associated with certain sports. Compared with soccer, American football has a higher likelihood of resulting in multiligament injuries, whereas basketball has a higher likelihood of resulting in cartilage and lateral meniscus injuries. Injury patterns seen at the time of surgery may reflect the forces applied to the knee by the specific sports performed.
Cognitive functions in multiple sclerosis: impact of gray matter integrity
Authors: Llufriu Sara , Martinez-Heras Eloy , Fortea Juan , Blanco Yolanda , Berenguer Joan , Gabilondo Iñigo , Ibarretxe-Bilbao Naroa , Falcon Carles , Sepulveda Maria , Sola-Valls Nuria , Bargallo Nuria , Graus Francesc , Villoslada Pablo , Saiz Albert 
Published: September 2013

Objectives: Our aim was to investigate the impact of gray matter (GM) integrity on cognitive performance in multiple sclerosis (MS), and its relationship with white matter (WM) integrity and presence of lesions. Methods: Sixty-seven patients with MS and 26 healthy controls underwent voxel-based analysis of diffusion tensor images (DTI) in GM and tract-based spatial statistics (TBSS) from WM to identify the regional correlations between cognitive functions and integrity. Lesion probability mapping (LPM) was generated for correlation analysis with cognition. Multiple linear regression analyses were used to identify the imaging measures associated with cognitive scores. Results: Compared with controls, patients showed abnormal DTI indices in several GM regions and in most WM tracts. Impairment in DTI indices in specific GM regions was associated with worse performance of distinct cognitive functions. Those regions showed anatomical correspondence with cognitively relevant tracts in TBSS and LPM. The combination of regional GM and WM DTI and lesion volume accounted for 36–51% of the variance of memory and attention scores. Regional GM DTI explained less than 5% of that variance. Conclusion: GM and WM integrity of specific networks influences cognitive performance in MS. However, GM damage assessed by DTI only adds a small increment to the explained variance by WM in predicting cognitive functioning.
Changes in Drop-Jump Landing Biomechanics During Prolonged Intermittent Exercise
Authors: Schmitz Randy J. , Cone John C. , Tritsch Amanda J. , Pye Michele L. , Montgomery Melissa M. , Henson Robert A. , Shultz Sandra J. 
Published: September 2013

Background: As injury rates rise in the later stages of sporting activities, a better understanding of lower extremity biomechanics in the later phases of gamelike situations may improve training and injury prevention programs. Hypothesis: Lower extremity biomechanics of a drop-jump task (extracted from a principal components analysis) would reveal factors associated with risk of anterior cruciate ligament injury during a 90-minute individualized intermittent exercise protocol (IEP) and for 1 hour following the IEP. Study Design: Controlled laboratory study. Level of Evidence: Level 4. Methods: Fifty-nine athletes (29 women, 30 men) completed 3 sessions. The first session assessed fitness for an IEP designed to simulate the demands of a soccer match. An experimental session assessed drop-jump biomechanics, after a dynamic warm-up, every 15 minutes during the 90-minute IEP, and for 1 hour following the IEP. A control session with no exercise assessed drop-jump performance at the same intervals. Results: Two biomechanical factors early in the first half (hip flexion at initial contact and hip loading; ankle loading and knee shear force) decreased at the end of the IEP and into the 60-minute recovery period, while a third factor (knee loading) decreased only during the recovery period ( P ≤ 0.05). Conclusion: The individualized sport-specific IEP may have more subtle effects on landing biomechanics when compared with short-term, exhaustive fatigue protocols. Clinical Relevance: Potentially injurious landing biomechanics may not occur until the later stages of soccer activity.
Selective serotonin reuptake inhibitors and torsade de pointes: new concepts and new directions derived from a systematic review of case reports
Authors: Kogut Christopher , Crouse Ericka Breden , Vieweg W. Victor R. , Hasnain Mehrul , Baranchuk Adrian , Digby Geneviève C. , Koneru Jayanthi N. , Fernandez Antony , Deshmukh Anand , Hancox Jules C. , Pandurangi Ananda K. 
Published: September 2013

Objective: In the light of the recent United States Food and Drug Administration (FDA) warning to clinicians on using previously approved doses of citalopram because of the purported higher risk of torsade de pointes (TdP), we pursued the broader question: are selective serotonin reuptake inhibitor (SSRI) antidepressant agents as a group unsafe because they might induce QTc interval prolongation and TdP? Method: We reviewed the literature and found only 15 case reports (6 of fluoxetine, 1 of sertraline and 8 of citalopram) of SSRI-associated QTc interval prolongation linking to TdP. Results: A total of 13 cases contained sufficient information for analysis. In the setting of TdP, QTc interval prolongation does not clearly relate to SSRI dose. Conclusion: Applying conventional statistics as the FDA does may not be the best tool to study this phenomenon because SSRI-associated TdP is a very rare event and hence best understood as an ‘extreme outlier’. Despite the limitations inherent in case report material, case reports on drug-associated QTc interval prolongation and TdP provide valuable information that should be considered along with other sources of information for clinical guidance.
Indolent T-cell lymphoproliferative disease of the gastrointestinal tract
Authors: Perry Anamarija M. , Warnke Roger A. , Hu Qinglong , Gaulard Philippe , Copie-Bergman Christiane , Alkan Serhan , Wang Huan-You , Cheng Jason X. , Bacon Chris M. , Delabie Jan , Ranheim Erik , Kucuk Can , Hu XiaoZhou , Weisenburger Dennis D. , Jaffe Elaine S. , Chan Wing C. 
Published: September 2013

Key Points
Ten cases of an indolent T-cell lymphoproliferative disease of the gastrointestinal tract are reported. It is important to recognize this condition because it can be mistaken for aggressive T-cell lymphoma, which may lead to unnecessary therapy.