bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transesophageal Echocardiography in Cryptogenic Stroke and Patent Foramen Ovale
Authors: Wessler Benjamin S. , Thaler David E. , Ruthazer Robin , Weimar Christian , Di Tullio Marco R. , Elkind Mitchell S.V. , Homma Shunichi , Lutz Jennifer S. , Mas Jean-Louis , Mattle Heinrich P. , Meier Bernhard , Nedeltchev Krassen , Papetti Federica , Di Angelantonio Emanuele , Reisman Mark , Serena Joaquín , Kent David M. 
Published: November 2013

Background—
Patent foramen ovale (PFO) is associated with cryptogenic stroke (CS), although the pathogenicity of a discovered PFO in the setting of CS is typically unclear. Transesophageal echocardiography features such as PFO size, associated hypermobile septum, and presence of a right-to-left shunt at rest have all been proposed as markers of risk. The association of these transesophageal echocardiography features with other markers of pathogenicity has not been examined.

Methods and Results—

We used a recently derived score based on clinical and neuroimaging features to stratify patients with PFO and CS by the probability that their stroke is PFO-attributable. We examined whether high-risk transesophageal echocardiography features are seen more frequently in patients more likely to have had a PFO-attributable stroke (n=637) compared with those less likely to have a PFO-attributable stroke (n=657). Large physiologic shunt size was not more frequently seen among those with probable PFO-attributable strokes (odds ratio [OR], 0.92;
P
=0.53). The presence of neither a hypermobile septum nor a right-to-left shunt at rest was detected more often in those with a probable PFO-attributable stroke (OR, 0.80;
P
=0.45; OR, 1.15;
P
=0.11, respectively).

Conclusions—
We found no evidence that the proposed transesophageal echocardiography risk markers of large PFO size, hypermobile septum, and presence of right-to-left shunt at rest are associated with clinical features suggesting that a CS is PFO-attributable. Additional tools to describe PFOs may be useful in helping to determine whether an observed PFO is incidental or pathogenically related to CS.
Evaluation of Vegetation Size and Its Relationship With Embolism in Infective Endocarditis
Authors: Berdejo Javier , Shibayama Kentaro , Harada Kenji , Tanaka Jun , Mihara Hirotsugu , Gurudevan Swaminatha V. , Siegel Robert J. , Shiota Takahiro 
Published: November 2013

Background—
Two-dimensional (2D) echocardiography studies have shown that the maximum length of vegetation (MLV) ≥10 mm is a predictor of embolic events (EEs) in patients with infective endocarditis. However, 2D measurements probably underestimate the vegetation dimensions. In this study, we evaluated the feasibility of real-time 3-dimensional transesophageal echocardiography (RT3DTEE) in determining MLV and its accuracy in identifying the risk for EEs compared with 2D transesophageal echocardiography (2DTEE).

Methods and Results—
We analyzed 60 patients with vegetations. RT3DTEE measurement of MLV was obtained with Advanced QLAB Quantification Software by cropping the 3D volume with the appropriate 2D plane to obtain the largest value. The standard 2DTEE images were also evaluated to determine the MLV. Major EEs were registered from medical records, and a logistic regression analysis was performed to determine the association between MLV and EEs. The RT3DTEE MLV was larger than the 2DTEE value with a mean difference of 3.2 mm (95% confidence interval, 2.1–4.2 mm). The best cut-off value for prediction of EEs was MLV ≥20 mm with RT3DTEE and MLV ≥16 mm with 2DTEE. The positive predictive value increased from 59.1% to 65.2% when RT3DTEE was used. The accuracy of classification of patients with EEs increased from 65% to 70% with this new technique.

Conclusions—
RT3DTEE is a feasible technique for the analysis of vegetation morphology and size that may overcome the shortcoming of 2DTEE, leading to a better prediction of the embolism risk in patients with infective endocarditis.
Role of Hemostatic Factors on the Risk of Venous Thrombosis in People With Impaired Kidney Function
Authors: Ocak Gürbey , Vossen Carla Y. , Lijfering Willem M. , Verduijn Marion , Dekker Friedo W. , Rosendaal Frits R. , Cannegieter Suzanne C. 
Published: November 2013

Background—
Factors explaining the association between impaired kidney function and venous thrombosis have not been identified so far. The aim of our study was to determine whether the association between impaired kidney function and venous thrombosis can be explained by the concurrent presence of genetic or acquired venous thrombosis risk factors.

Methods and Results—
The glomerular filtration rate was estimated (eGFR) in 2473 venous thrombosis patients and 2936 controls from a population-based case–control study. Kidney function was grouped into 6 categories based on percentiles of the eGFR in the controls (>50th [reference], 10th–50th, 5th–10th, 2.5th–5th, 1st–2.5th, and <1st percentile). Several hemostatic factors showed a procoagulant shift with decreasing kidney function in controls, most notably factor VIII and von Willebrand factor. Compared with eGFR >50th percentile, factor VIII levels (adjusted mean difference, 60 IU/dL for the <1st eGFR percentile category) and von Willebrand factor levels (adjusted mean difference, 60 IU/dL for the <1st eGFR percentile category) increased with each percentile category. The odds ratios for venous thrombosis similarly increased across the categories from 1.1 (95% confidence interval, 0.9–1.3) for the 10th to 50th percentile to 3.7 (95% confidence interval, 2.4–5.7) for the <1st percentile category. Adjustment for factor VIII or von Willebrand factor attenuated these odds ratios, indicating an effect of eGFR on thrombosis through these factors. Adjustments for other risk factors for venous thrombosis did not affect the odds ratios.

Conclusion—
Impaired kidney function affects venous thrombosis risk via concurrently raised factor VIII and von Willebrand factor levels.
Outcomes in Catheter Ablation of Ventricular Tachycardia in Dilated Nonischemic Cardiomyopathy Compared With Ischemic Cardiomyopathy
Authors: Dinov Borislav , Fiedler Lukas , Schönbauer Robert , Bollmann Andreas , Rolf Sascha , Piorkowski Christopher , Hindricks Gerhard , Arya Arash 
Published: November 2013

Background—
Data on the outcomes of ventricular tachycardia (VT) ablation in nonischemic dilated cardiomyopathy (NIDCM) are insufficient. The Heart Center of Leipzig VT (HELP-VT) study was conducted prospectively to compare outcomes after radiofrequency catheter ablation of VT in patients with NIDCM compared with ischemic cardiomyopathy (ICM).

Methods and Results—

Two hundred twenty-seven patients, 63 with NIDCM and 164 with ICM, presenting with sustained VT were ablated with radiofrequency catheter ablation. Noninducibility of any clinical and nonclinical VT was achieved in 66.7% of NIDCM and in 77.4% of ICM patients. Ablation of the clinical VT only was achieved in 18.3% of ICM and in 22.2% of NIDCM patients. There was no statistically significant difference in short-term outcomes between the 2 groups. At the 1-year follow-up, VT-free survival in NIDCM was 40.5% compared with 57% in ICM. In univariate analysis, the hazard ratio for VT recurrence was significantly higher for NIDCM (1.62; 95% confidence interval, 1.12– 2.34;
P
=0.01). In both the ICM and NIDCM subgroups, procedure failure and incomplete procedural success were independent predictors of VT recurrence.

Conclusions—
Although the short-term success rates after VT ablation in NIDCM and ICM patients were similar, the long-term outcomes in NIDCM patients were significantly worse. Complete VT noninducibility at the end of the ablation is associated with beneficial long-term outcome in NIDCM. Pursuing compete elimination of all inducible VTs is desirable and may improve the long-term success in NIDCM.
Biomechanical and Performance Implications of Weapon Design
Authors: Stone Richard T. , Moeller Brandon F. , Mayer Robert R. , Rosenquist Bryce , Van Ryswyk Darin , Eichorn Drew 
Published: November 2013

Objective: Shooter accuracy and stability were monitored while firing two bullpup and two conventional configuration rifles of the same caliber in order to determine if one style of weapon results in superior performance. Background: Considerable debate exists among police and military professionals regarding the differences between conventional configuration weapons, where the magazine and action are located ahead of the trigger, and bullpup configuration, where they are located behind the trigger (closer to the user). To date, no published research has attempted to evaluate this question from a physical ergonomics standpoint, and the knowledge that one style might improve stability or result in superior performance is of interest to countless military, law enforcement, and industry experts. Method: A live-fire evaluation of both weapon styles was performed using a total of 48 participants. Shooting accuracy and fluctuations in biomechanical stability (center of pressure) were monitored while subjects used the weapons to perform standard drills. Results: The bullpup weapon designs were found to provide a significant advantage in accuracy and shooter stability, while subjects showed considerable preference toward the conventional weapons. Conclusion: Although many mechanical and maintenance issues must be considered before committing to a bullpup or conventional weapon system, it is clear in terms of basic human stability that the bullpup is the more advantageous configuration. Application: Results can be used by competitive shooter, military, law enforcement, and industry experts while outfitting personnel with a weapon system that leads to superior performance.
Effect of body mass index on early clinical outcomes after cardiac surgery
Authors: Allama Amr , Ibrahim Islam , Abdallah Ayat , Ashraf Saeed , Youhana Aprim , Kumar Pankaj , Bhatti Farah , Zaidi Afzal 
Published: November 2013

Background there are several reports on the outcomes of cardiac surgery in relation to body mass index. Some concluded that obesity did not increase morbidity or mortality after cardiac surgery, whereas others demonstrated that obesity was a predictor of both morbidity and mortality. Methods this was a retrospective study of 3370 adult patients undergoing cardiac surgery. The patients were divided into 4 groups according to body mass index. The 4 groups were compared in terms of preoperative, operative, and postoperative characteristics. Results obese patients had a significantly younger mean age. Diabetes, hypertension, and hyperlipidemia were significantly more common in obese patients. The crossclamp time was significantly longer in the underweight group. Reoperation for bleeding, and pulmonary, gastrointestinal, and renal complications were significantly more common in the underweight group. Wound complications were significantly more frequent in the obese group. Mortality was inversely proportional to body mass index. The adjusted odds ratios of the early clinical outcomes demonstrated a higher risk of wound complications in overweight and obese patients Conclusion body mass index has no effect on early clinical outcomes after cardiac surgery, except for a higher risk of wound complications in overweight and obese patients.
Treatment outcomes of pneumothorax with chronic obstructive pulmonary disease
Authors: Ota Hideki , Kawai Hideki , Matsuo Tsubasa 
Published: November 2013

Background Coexisting pulmonary fibrosis and emphysema in the same individual has received increased attention. We retrospectively investigated treatment outcomes of secondary spontaneous pneumothorax in chronic obstructive pulmonary disease patients with both pulmonary fibrosis and emphysema. Methods Among 362 consecutive secondary spontaneous pneumothorax patients treated at our hospital from 2003 to 2012, 58 with emphysema-dominant chronic obstructive pulmonary disease (all elderly men with a smoking history) were enrolled and divided into 2 groups based on computed tomography images: emphysema alone ( n = 51) and coexisting emphysema and pulmonary fibrosis ( n = 7). The clinical characteristics and mortality were compared between the 2 groups. Results There was no significant difference in the recurrence rate after nonsurgical treatment. No patient died of pneumothorax-related complications, but one of 2 with pulmonary fibrosis who underwent surgery died of a postoperative respiratory complication. The mortality rate from respiratory failure during follow-up was significantly higher in the group with pulmonary fibrosis (6/7) than in the group without pulmonary fibrosis (11/51, p = 0.002). The median survival was 0.8 years in the group with pulmonary fibrosis vs. and 5.4 years in the group without pulmonary fibrosis. Conclusions The coexistence of pulmonary fibrosis and emphysema on computed tomography images may represent a predictor of respiratory mortality in elderly chronic obstructive pulmonary disease patients with secondary spontaneous pneumothorax. Because of the potential risk of respiratory failure, we recommend nonsurgical treatment for secondary spontaneous pneumothorax in chronic obstructive pulmonary disease patients with these radiological features.
Minimal extracorporeal circulation (MECC) does not result in less hypertrophic scar formation as compared to conventional extracorporeal circulation (CECC) with dexamethasone
Authors: Soykan EA , Butzelaar L , de Kroon TL , Beelen RHJ , Ulrich MMW , Mink van der Molen AB , Niessen FB 
Published: November 2013

Introduction: Cardiopulmonary bypass surgery is associated with a systemic inflammatory response through the interaction of air, blood and synthetic components in the bypass system and the physical trauma of surgery. An alternative cardiopulmonary bypass system, minimal extracorporeal circulation (MECC), has shown promising results in terms of reducing the inflammatory response. We hypothesized that this system may reduce pathological excessive scarring. To study this assumption, the effects of MECC and the effects of conventional extracorporeal circulation (CECC) with dexamethasone on skin scarring were compared in a standardized wound-healing model. Methods and Results: Pre-sternal scars were evaluated prospectively at four and 12 months postoperatively. The height and width of the scars were measured, using a slide caliper and sonography. The scars were scored using the validated Patient and Observer Scar Assessment Scale. Additional risk factors for hypertrophic scar formation were identified by means of a questionnaire. During surgery, MECC was used in 45 patients and CECC/dexamethasone in 42 patients. Four months postoperatively, 22 patients of the MECC group (49%) and 18 patients in the CECC/dexamethasone group (43%) had developed hypertrophic scars. Twelve months postoperatively, the hypertrophic scars in four patients of the MECC group and in two patients of the CECC/dexamethasone group had become normotrophic. In 18 patients of the MECC group (38%) and 16 patients of the CECC group (41%) the scars remained hypertrophic at 12 months. These differences between the two groups were not statistically significant. Conclusion: MECC does not reduce hypertrophic scar formation compared with CECC with dexamethasone, but its use is more beneficial than the use of CECC/dexamethasone because of the circulatory and immunological advantages and because treatment with dexamethasone can be omitted.
Ultra-Low Velocity Knee Dislocations
Authors: Werner Brian C. , Gwathmey F. Winston , Higgins Sean T. , Hart Joseph M. , Miller Mark D. 
Published: November 2013

Background: Knee dislocations resulting in multiligament knee injuries (MLIs) are usually associated with high-energy mechanisms such as motor vehicle accidents or sports injuries; however, obese patients are at risk of MLIs from simple falls. Termed “ultra-low velocity” (ULV) dislocations, these injuries occur in obese patients during activities of daily living and may be associated with higher associated risks and complications. Hypothesis: Ultra-low velocity knee dislocations occur more commonly in obese female patients, are associated with higher risks of neurovascular injuries, and have more significant perioperative complications compared with other MLIs. Study Design: Case series; Level of evidence, 4. Methods: The records of 215 consecutive patients with MLIs were identified over a 12-year period. Their charts were reviewed to identify a cohort of patients with mechanisms consistent with ULV dislocations (n = 23). This cohort was compared with all patients with MLIs. Additionally, ULV patients with neurovascular injuries were compared with those without neurovascular injuries. Results: The average body mass index (BMI) was significantly higher in the ULV cohort (49.1 kg/m2) compared with all patients with MLIs (34.1 kg/m2). Injuries occurred more commonly in female patients in the ULV cohort (69.6%) compared with all patients with MLIs (24.3%). Peroneal nerve injuries occurred more commonly in the ULV cohort (39.1%) compared with all patients with MLIs (8.4%), as did vascular injuries (28.1% vs 4.7%, respectively). Postoperative complications were common among all ULV-MLI patients regardless of neurovascular injury status. Seventeen patients (6/12 in the intact group and 11/11 in the neurovascular injury group) had significant complications postoperatively. A significantly higher overall complication rate was noted in the ULV-MLI group (73.9%) compared with the entire MLI cohort (21.4%). Additionally, the ULV-MLI cohort had a higher reoperation rate, wound infection rate, deep venous thrombosis rate, and presence of vascular claudication. Conclusion: Ultra-low velocity knee injuries occur in patients with a greater BMI, more frequently in female patients, and with higher rates of concomitant neurovascular injuries compared with other MLIs. Additionally, a significantly greater incidence of postoperative complications can be expected after ligament reconstruction in this population compared with other MLIs.
Volume of Milk Obtained in Relation to Location and Circumstances of Expression in Mothers of Very Low Birth Weight Infants
Authors: Acuña-Muga Juliana , Ureta-Velasco Noelia , de la Cruz-Bértolo Javier , Ballesteros-López Rosa , Sánchez-Martínez Rocío , Miranda-Casabona Eugenia , Miguel-Trigoso Almudena , García-San José Lidia , Pallás-Alonso Carmen 
Published: November 2013

Background: Given the importance of mother’s milk for very low birth weight (VLBW) infants, it would be helpful to know which circumstances are most favorable for milk expression. Objective: This study aimed to estimate the volume of milk obtained by mothers of VLBW infants as a function of proximity to the infant and use of the kangaroo position during the actual expression. Methods: In this prospective cohort study, when the infant was stable and the mother had established a breastfeeding routine, she was given a notebook in which to record the location of expression and the amount of milk expressed for 10 consecutive days. Breast milk expression volumes were recorded and analyzed. Results: Data were collected on 26 mother-VLBW infant dyads and 1642 milk expressions. The first early morning expressions (n = 276, 17%) were conducted at home. Thereafter, 743 (45%) expressions were conducted far from the infant, either in a different room within the hospital or at home, and 623 (38%) were performed in proximity to the infant (beside the incubator, during kangaroo mother care [KMC], after KMC, or during kangaroo father care). The mean milk volume was significantly higher when expression was conducted in proximity to the infant. When only milk expressions conducted in proximity to the infant were considered, volumes obtained during KMC (107.7 mL, 91.8-123.5) and after KMC (117.7 mL, 99.0-136.5) were significantly higher than those obtained beside the incubator (96.9 mL, 79.9-113.9), respectively, P = .0030 and P = .0024. Conclusion: Milk expression conducted in proximity to the infant, particularly during and immediately after KMC, is associated with higher milk volume.
Extended follow-up of the CYCLOFA-LUNE trial comparing two sequential induction and maintenance treatment regimens for proliferative lupus nephritis based either on cyclophosphamide or on cyclosporine A
Authors: Závada J , Pešičková S Sinikka , Ryšavá R , Horák P , Hrnčíř Z , Lukáč J , Rovenský J , Vítová J , Havrda M , Rychlík I , Böhmova J , Vlasáková V , Slatinská J , Zadražil J , Olejárová M , Tegzova D , Tesar V 
Published: November 2013

Objective To evaluate the extended follow-up of the CYCLOFA-LUNE trial, a randomized prospective trial comparing two sequential induction and maintenance treatment regimens for proliferative lupus nephritis based either on cyclophosphamide (CPH) or cyclosporine A (CyA). Patients and methods Data for kidney function and adverse events were collected by a cross-sectional survey for 38 of 40 patients initially randomized in the CYCLOFA-LUNE trial. Results The median follow-up time was 7.7 years (range 5.0–10.3). Rates of renal impairment and end-stage renal disease, adverse events (death, cardiovascular event, tumor, premature menopause) did not differ between the CPH and CyA group, nor did mean serum creatinine, 24 h proteinuria and SLICC damage score at last follow-up. Most patients in both groups were still treated with glucocorticoids, other immunosuppressant agents and blood pressure lowering drugs. Conclusion An immunosuppressive regimen based on CyA achieved similar clinical results to that based on CPH in the very long term.
Safety and Efficacy Outcomes of Preoperative Aspirin in Patients Undergoing Coronary Artery Bypass Grafting
Authors: Ma Xiaochun , Ma Chi , Yun Yan , Zhang Qian , Zheng Xia 
Published: November 2013

Background: The administration of aspirin is traditionally discontinued prior to coronary artery bypass grafting (CABG), given a potential risk of excessive postoperative bleeding. Few studies have previously suggested the benefits of continuing aspirin until the time of surgery. The primary aim of this review is to evaluate the effects of preoperative aspirin therapy on several clinically important outcomes in patients undergoing CABG. Methods: A meta-analysis of eligible studies of patients undergoing CABG, reporting preoperative aspirin in comparison with no aspirin/placebo and our outcomes, was carried out. The safety outcomes included postoperative bleeding, packed red blood cell (PRBC) transfusion requirements, and reoperation for bleeding. The efficacy outcomes included perioperative myocardial infarction (MI), cerebrovascular accidents (CVAs), and mortality. Results: In 8 randomized controlled trials (RCTs; n = 1538), preoperative aspirin increased postoperative bleeding (difference in means = 132.30 mL; 95 % confidence interval [CI] 47.10-217.51; P = .002), PRBC transfusion requirements (difference in means = 0.67 units; 95% CI 0.10-1.24; P = .02), and reoperation for bleeding (odds ratio [OR] = 1.76; 95% CI 1.05-2.93; P = .03). In 19 observational studies (n = 19551), preoperative aspirin increased postoperative bleeding (difference in means = 132.74 mL; 95% CI 45.77-219.72; P = .003) and PRBC transfusion requirements (difference in means = 0.19 units; 95% CI 0.02-0.35; P = .02) but not reoperation for bleeding (OR = 1.13; 95% CI 0.91-1.42; P = .27). Subgroup analyses for RCTs demonstrated that aspirin given at doses ≤ 100 mg/d might not increase the postoperative bleeding, and the dose of 325 mg/d might not be a cutoff value that has clinical and statistical significance. No statistically significant differences in the rate of perioperative MI, CVAs, or mortality were seen between the 2 groups. Conclusions: Preoperative aspirin therapy is associated with increased postoperative bleeding, PRBC transfusion requirements, and reoperation for bleeding in patients undergoing CABG. Doses lower than 100 mg/d may minimize the risk of bleeding. Additional RCTs are needed to assess the effects of preoperative aspirin on the safety and efficacy outcomes in patients undergoing CABG.