bluuebunny/crossref_metadata_2025_split huggingface dataset:
Robot‐assisted partial nephrectomy with intracorporeal renal hypothermia using ice slush: step‐by‐step technique and matched comparison with warm ischaemia
Authors: Ramirez Daniel , Caputo Peter A. , Krishnan Jayram , Zargar Homayoun , Kaouk Jihad H. 
Published: October 2015

ObjectivesTo outline our step‐by‐step technique for intracorporeal renal cooling during robot‐assisted partial nephrectomy (RAPN).Patients and MethodsPatient selection was performed during a preoperative clinic visit. Cases where we estimated during preoperative assessment that warm ischaemia time would be >30 min, as determined by whether the patient had a complex renal mass, were selected. The special equipment required for this procedure includes an Ecolab Hush Slush machine (Microtek Medical Inc., Columbus, MS, USA) a Mon‐a‐therm needle thermocouple device (Covidien, Mansfield, MA, USA) and six modified 20‐mL syringes. Patients are arranged in a 60° modified flank position with the operating table flexed slightly at the level of the anterior superior iliac spine. For the introduction of a temperature probe and ice slush, an additional 12‐mm trocar is placed along the mid‐axillary line beneath the costal margin. Modified 10/20 mL syringes are prefilled with ice slush for instillation via an accessory trocar. Peri‐operative and 6‐month functional outcomes in the cold ischaemia group were compared with those of a cohort of patients who underwent RAPN with warm ischaemia in a 2:1 matched fashion. Matching was performed based on preoperative estimated glomerular filtration rate (GFR), ischaemia time and RENAL nephrometry score.ResultsStrategies for successful intracorporeal renal cooling include: (i) placement of accessory port directly over the kidney; (ii) uniform ice consistency and modified syringes; (iii) sequential clamping of renal artery and vein; (iv) protection of the neighbouring intestine with a laparoscopic sponge; and (v) complete mobilization of the kidney. Kidney temperature is monitored via a needle thermocoupler device, while core body temperature is concurrently monitored via an oesophageal probe in real time. Renal function was assessed by serum creatinine level, estimated GFR (eGFR) and mercaptoacetyltriglycine (MAG‐3) renal scan, peri‐operatively and at 6‐month follow‐up. In the separate matched analysis, cold ischaemia during RAPN was found to be associated with a 12.9% improvement in preservation of postoperative eGFR. No difference was seen in either group at 6‐month follow‐up.ConclusionsWe conclude that RAPN with intracorporeal renal hypothermia using ice slush is technically feasible and may improve postoperative renal function in the short term. Our technique for intracorporeal hypotheramia is cost‐effective, simple and highly reproducible.
Sleep Disturbance and Expressive Language Development in Preschool‐Age Children With Down Syndrome
Authors: Edgin Jamie O. , Tooley Ursula , Demara Bianca , Nyhuis Casandra , Anand Payal , Spanò Goffredina 
Published: October 2015

Recent evidence has suggested that sleep may facilitate language learning. This study examined variation in language ability in 29 toddlers with Down syndrome (DS) in relation to levels of sleep disruption. Toddlers withDSand poor sleep (66%,n = 19) showed greater deficits on parent‐reported and objective measures of language, including vocabulary and syntax. Correlations between sleep and language were found in groups with equivalent medical and social backgrounds and after control for relevant behavioral comorbidities, including autism symptoms. These results emphasize the important role of quality sleep in all children's expressive language development, and may help increase our understanding of the etiology of language deficits in developmental disorders, potentially leading to new treatment approaches.
Lipoprotein(a) and apolipoprotein(a) in polycystic ovary syndrome
Authors: Enkhmaa Byambaa , Anuurad Erdembileg , Zhang Wei , Abbuthalha Adnan , Kaur Parneet , Visla Jasmeen , Karakas Sidika , Berglund Lars 
Published: October 2015

AbstractObjectiveLevels of lipoprotein(a), Lp(a), an independent risk factor for cardiovascular disease (CVD), are affected by sex hormones. Women with polycystic ovary syndrome (PCOS) have elevated androgen levels and are at increased CVD risk. We investigated the impact of PCOS‐related hormonal imbalance on Lp(a) levels in relation to apo(a) gene size polymorphism, a major regulator of Lp(a) level.DesignCross‐sectional.PatientsForty‐one Caucasian women with PCOS based on the NIH criteria.Measurements(1) Apo(a) gene size polymorphism measured as Kringle (K) 4 repeat number; (2) total plasma Lp(a) level; (3) allele‐specific apo(a) level assessing the amount of Lp(a) carried by an individual apo(a) allele/isoform; and (4) sex hormone levels.ResultsThe mean age was 32 ± 6 years, and the mean BMI was 35 ± 8 with 66% of women classified as obese (BMI >30 kg/m2). LDL cholesterol was borderline high (3·37 mmol/l), and HDL cholesterol was low (1·06 mmol/l). The distribution of Lp(a) level was skewed towards lower levels with a median level of 22·1 nmol/l (IQR: 6·2–66·5 nmol/l). Lp(a) levels were not correlated with age, body weight or BMI. The median allele‐specific apo(a) level was 10·6 nmol/l (IQR: 3·1–31·2 nmol/l), and the median apo(a) size was 27 (IQR: 23–30) K4 repeats. Allele‐specific apo(a) levels were significantly and inversely correlated with K4 repeats (r = −0·298, P = 0·007). Neither Lp(a) nor allele‐specific apo(a) levels were significantly associated with testosterone or dehydroepiandrosterone sulphate levels.ConclusionsThe apo(a) genetic variability remains the major regulator of plasma Lp(a) levels in women with PCOS.
Gamma knife radiosurgery in patients with persistent acromegaly or Cushing's disease: long‐term risk of hypopituitarism
Authors: Cohen‐Inbar Or , Ramesh Arjun , Xu Zhiyuan , Vance Mary Lee , Schlesinger David , Sheehan Jason P. 
Published: October 2015

SummaryIntroductionFor patient with a recurrent or residual acromegaly or Cushing's disease (CD) after resection, gamma knife radiosurgery (GKRS) is often used. Hypopituitarism is the most common adverse effect after GKRS treatment. The paucity of studies with long‐term follow‐up has hampered understanding of the latent risks of hypopituitarism in patients with acromegaly or CD. We report the long‐term risks of hypopituitarism for patients treated with GKRS for acromegaly or CD.MethodsFrom a prospectively created, IRB‐approved database, we identified all patients with acromegaly or CD treated with GKRS at the University of Virginia from 1989 to 2008. Only patients with a minimum endocrine follow‐up of 60 months were included. The median follow‐up is 159·5 months (60·1–278). Thorough radiological and endocrine assessments were performed immediately before GKRS and at regular follow‐up intervals. New onset of hypopituitarism was defined as pituitary hormone deficits after GKRS requiring corresponding hormone replacement.ResultsSixty patients with either acromegaly or CD were included. Median tumour volume at time of GKRS was 1·3 cm3 (0·3–13·4), and median margin dose was 25 Gy (6–30). GKRS‐induced new pituitary deficiency occurred in 58·3% (n = 35) of patients. Growth hormone deficiency was most common (28·3%, n = 17). The actuarial overall rates of hypopituitarism at 3, 5 and 10 years were 10%, 21·7% and 53·3%, respectively. The median time to hypopituitarism was 61 months after GKRS (range, 12–160). Cavernous sinus invasion of the tumour was found to correlate with the occurrence of a new or progressive hypopituitarism after GKRS (P = 0·018).ConclusionsDelayed hypopituitarism increases as a function of time after radiosurgery. Hormone axes appear to vary in terms of radiosensitivity. Patients with adenoma in the cavernous sinus are more prone to develop loss of pituitary function after GKRS.
Maternal morbid obesity: financial implications of weight management
Authors: Caldas M. C. , Serrette J. M. , Jain S. K. , Makhlouf M. , Olson G. L. , McCormick D. P. 
Published: October 2015

SummaryThe objective of this study was to evaluate health outcomes and costs of pregnancies complicated by extreme maternal obesity (class III obesity, body mass index ≥ 40). We conducted a retrospective case‐control descriptive study comparing extremely obese women (cases) and their infants with randomly selected controls. Health outcomes were obtained from the medical records and costs from billing data. Total costs for each mother–infant dyad were calculated. Compared with 85 controls, the 82 cases experienced higher morbidity, higher costs and prolonged hospital stay. However, 26% of cases maintained or lost weight during pregnancy, whereas none of the controls maintained or lost weight during pregnancy. When mother/infant dyads were compared on costs, case subjects who maintained or lost weight experienced lower costs than those who gained weight. Neonatal intensive care consumed 78% of total hospital costs for infants of the obese women who gained weight, but only 48% of costs for infants of obese women who maintained or lost weight. For extremely obese women, weight management during pregnancy was achievable, resulted in healthier neonatal outcomes and reduced perinatal healthcare costs.
Impact of insulin initiation on glycaemic variability and glucose profiles in a primary healthcare Type 2 diabetes cohort: analysis of continuous glucose monitoring data from the INITIATION study
Authors: Manski‐Nankervis J. , Yates C. J. , Blackberry I. , Furler J. , Ginnivan L. , Cohen N. , Jenkins A. , Vasanthakumar S. , Gorelik A. , Young D. , Best J. , O'Neal D. 
Published: October 2015

AbstractAimTo use continuous glucose monitoring to examine the effects of insulin initiation with glargine, with or without glulisine, on glycaemic variability and glycaemia in a cohort of people with Type 2 diabetes receiving maximum oral hypoglycaemic agents in primary healthcare.MethodsWe conducted a post hoc analysis of continuous glucose monitoring data from 89 participants at baseline and at 24 weeks after insulin commencement. Indicators of glycaemic variability (standard deviation, J‐index and mean amplitude of glycaemic excursion) and glycaemia (HbA1c, mean glucose, area under the glucose–time curve) were assessed. Multi‐level regression analysis was used to identify the predictors of change.ResultsComplete glycaemic variability data were available for 78 participants. Of these participants, 41% were women, their mean (sd) age was 59.2 (10.4) years, the median (interquartile range) diabetes duration was 10.4 (6.5, 13.3) years and the median (interquartile range) baseline HbA1c was 82.5 (71.6, 96.7) mmol/mol [9.7 (8.7, 11.0)%]. At baseline, BMI correlated negatively with standard deviation (r = −0.30) and mean amplitude of glycaemic excursion (r = −0.26), but not with J‐index; HbA1c correlated with J‐index (r = 0.61) but not with mean amplitude of glycaemic excursion and standard deviation. After insulin initiation the mean (sd) glucose level decreased [from 12.0 (3.0) to 8.5 (1.6) mmol/l; P < 0.001], as did the median (interquartile range) J‐index [from 66.9 (47.7, 95.1) to 36.9 (27.6, 49.8) mmol/l; P < 0.001]. Baseline HbA1c correlated with a greater J‐index reduction (r = −0.45; P < 0.001). The mean amplitude of glycaemic excursion and standard deviation values were unchanged. The baseline temporal profile, showing elevated postprandial morning glucose levels, was unchanged after insulin initiation, despite an overall reduction in glycaemia.ConclusionInsulin initiation reduced hyperglycaemia but did not alter glycaemic variability in adults with Type 2 diabetes receiving maximum oral hypoglycaemic agents. The most significant postprandial excursions were seen in the morning, which identifies prebreakfast as the most effective target for short‐acting insulin therapy.
Effect of high‐dose atorvastatin on the cardiovascular risk associated with individual components of metabolic syndrome: a subanalysis of the Treating to New Targets (TNT) study
Authors: Deedwania P. C. , Shepherd J. , Breazna A. , DeMicco D. A. ,   on Behalf of the Treating to New Targets (TNT) Steering Committee Investigators
Published: October 2015

AimsTo investigate the impact of intensive lipid‐lowering with high‐dose atorvastatin on the cardiovascular risk associated with individual metabolic syndrome components [high body mass index (BMI), elevated triglycerides, low high‐density lipoprotein (HDL) cholesterol, hypertension and elevated fasting glucose] in patients with coronary heart disease (CHD).MethodsPatients with clinically evident, stable CHD and low‐density lipoprotein (LDL) cholesterol <3.4 mmol/l (130 mg/dl) were randomized to double‐blind therapy with atorvastatin 10 mg/day (n = 5006) or 80 mg/day (n = 4995) after an 8‐week open‐label run‐in with atorvastatin 10 mg. The median follow‐up was 4.9 years. The impact of individual metabolic syndrome risk factors was tested on the primary endpoint, which was the occurrence of a first major cardiovascular event.ResultsOn‐treatment LDL cholesterol was 2.6 mmol/l (101 mg/dl) with atorvastatin 10 mg and 2.0 mmol/l (77 mg/dl) with atorvastatin 80 mg. Among patients receiving atorvastatin 10 mg, the presence of each individual metabolic syndrome component significantly increased the risk of major cardiovascular events compared with the absence of each (BMI, p = 0.014; triglycerides, p = 0.006; HDL cholesterol, p = 0.0006; hypertension, p < 0.0001; and fasting glucose p < 0.0001). In patients receiving atorvastatin 80 mg, elevated triglycerides and fasting glucose were no longer significant predictors of major cardiovascular events. The predictive power of hypertension on the risk of major cardiovascular events was reduced in patients treated with atorvastatin 80 mg, although it remained a significant predictor.ConclusionsTreatment with high‐dose atorvastatin to a mean LDL cholesterol level of 2.0 mmol/l (77 mg/dl) considerably attenuated the predictive power associated with three metabolic syndrome components.
Early renin‐angiotensin system intervention is more beneficial than late intervention in delaying end‐stage renal disease in patients with type 2 diabetes
Authors: Schievink B. , Kröpelin T. , Mulder S. , Parving H.‐H. , Remuzzi G. , Dwyer J. , Vemer P. , de Zeeuw D. , Lambers Heerspink H. J. 
Published: October 2015

AimsTo develop and validate a model to simulate progression of diabetic kidney disease (DKD) from early onset until end‐stage renal disease (ESRD), and to assess the effect of renin‐angiotensin system (RAS) intervention in early, intermediate and advanced stages of DKD.MethodsWe used data from the BENEDICT, IRMA‐2, RENAAL and IDNT trials that assessed effects of RAS intervention in patients with type 2 diabetes. We built a model with discrete disease stages based on albuminuria and estimated glomerular filtration rate (eGFR). Using survival analyses, we assessed the effect of RAS intervention on delaying ESRD in early [eGFR>60 ml/min/1.73 m2 and albumin:creatinine ratio (ACR) <30 mg/g], intermediate (eGFR 30–60 ml/min/1.73 m2 or ACR 30–300 mg/g) and advanced (eGFR <30 ml/min/1.73 m2 or ACR >300 mg/g) stages of DKD for patients in different age groups.ResultsFor patients at early, intermediate and advanced stage of disease, whose mean age was 60 years and who received placebo, the median time to ESRD was 21.4, 10.8 and 4.7 years, respectively. RAS intervention delayed the predicted time to ESRD by 4.2, 3.6 and 1.4 years, respectively. The benefit of early RAS intervention was more pronounced in younger patients; for example, for patients with a mean age of 45 years, RAS intervention at early, intermediate or advanced stage delayed ESRD by 5.9, 4.0 and 1.1 years versus placebo.ConclusionsRAS intervention early in the course of proteinuric DKD is more beneficial than late intervention in delaying ESRD.
Genotypic differences in embryonic life history traits ofFolsomia quadrioculata(Collembola: Isotomidae) across a wide geographical range
Authors: SENGUPTA SAGNIK , ERGON TORBJØRN , LEINAAS HANS PETTER 
Published: October 2015

1. Life history traits play a central role in adaptation to specific environmental conditions. Egg development time, hatchling, and egg batch size in 10 populations of the soil‐dwelling collembolan speciesFolsomia quadrioculata(Tullberg, 1871) from diverse habitats across arctic and temperate regions, ranging in latitude from 43 to 81°N were studied.2. For all traits, 15 °C was used as the reference temperature. Phenotypic plasticity was studied by changing temperature to 10 and 20 °C in hatchling size, and to 20 °C in egg development time. The effect of latitude, climatic zone, and summer temperature at their sites of sampling was tested to address the hypotheses that populations from cooler areas would have (i) a faster temperature‐dependent egg development, (ii) a larger hatchling size, (iii) smaller egg batches and (iv) higher phenotypic plasticity3. The first and fourth hypothesis were not supported, whereas the second and third were partly supported when including the whole latitudinal gradient, but not within regions. Plasticity showed a complex pattern, including large differences between populations from similar macroclimates and considerable similarity between some populations from contrasting climates. Small effects of latitude and macroclimatic variables emphasised that local climate and microhabitat should be taken into account when evaluating thermal conditions as possible drivers of population‐specific differences in soil‐dwelling ectotherms.4. There was a trade‐off between egg batch and hatchling sizes. A weak correlation between the population mean egg development time and the mean hatchling size suggested that the populations are, or have been, exposed to differential selection.
Otolith elemental characteristics of whitefish (Coregonus lavaretus) from brackish waters of the Gulf of Bothnia, Baltic Sea
Authors: Hägerstrand Henry , Himberg Mikael , Jokikokko Erkki , von Numers Mikael , Mrówczyńska Lucyna , Vasemägi Anti , Wiklund Tom , Lill Jan‐Olof 
Published: October 2015

AbstractTo investigate whether European whitefish (Coregonus lavaretus) groups in the brackish (≤7%) Gulf of Bothnia (Baltic Sea) express specific otolith elemental characteristics, concentrations of elements (Ca, Ba, Sr, Zn, Mn, Fe) in whole otoliths were studied by inductively coupled plasma‐optical emission spectrometry. Whitefish (N = 67) were sampled from six different latitudinal sites; four in the sea and two in rivers along the west coast of Finland, and from a fresh water lake for comparison. The concentration of several elements showed significant differences among sampling sites. Otolith Ba concentrations were higher at the northern sampling sites compared to the southern ones, thereby showing negative association to capture‐habitat salinity. In contrast, otolith Sr and Zn concentrations were lower at the northern sampling sites, thereby associating positively to capture‐habitat salinity. Otolith Mn concentrations did not associate with latitude or salinity but markedly varied between sampling sites. Elevated Fe concentrations occurred in fish otoliths from the two northernmost sites. Ca concentrations were at the same levels in otoliths from all whitefish samples. Otoliths of whitefish from the lake had very high Ba and low Sr concentrations compared to concentrations in otoliths from whitefish in the sea and rivers. Our results show that otolith elemental characteristics of whitefish vary considerably at various geographic scales showing high potential for population identification using elemental fingerprints. Analysis of otolith elemental characteristics may therefore provide an efficient tool for the identification of main areas of residence, spawning locations, and migration routes, thus contributing towards the sustainable management of whitefish stocks.
Prevalence of migraine in persons with the 3243A>G mutation in mitochondrial DNA
Authors: Guo S. , Esserlind A.‐L. , Andersson Z. , Frederiksen A. L. , Olesen J. , Vissing J. , Ashina M. 
Published: October 2015

Background and purposeOver the last three decades mitochondrial dysfunction has been postulated to be a potential mechanism in migraine pathogenesis. The lifetime prevalence of migraine in persons carrying the 3243A>G mutation in mitochondrial DNA was investigated.MethodsIn this cross‐sectional study, 57 mDNA 3243A>G mutation carriers between May 2012 and October 2014 were included. As a control group, a population‐based cohort from our epidemiological studies on migraine in Danes was used. History of headache and migraine was obtained by telephone interview, based on a validated semi‐structured questionnaire, performed by trained physicians.ResultsThe prevalence of migraine is significantly higher in persons carrying the 3243A>G mutation than in controls (58% vs. 18%; P < 0.001). This applies for both subforms of migraine, migraine without aura (47% vs. 12%; P < 0.001) and migraine with aura (18% vs. 6%; P < 0.001), and in females (58% vs. 24%; P < 0.001) and males (58% vs. 12%; P < 0.001) for any migraine.ConclusionsA high prevalence of migraine in persons with the mDNA 3243A>G mutation was found. This finding suggests a clinical association between a monogenetically inherited disorder of mitochondrial dysfunction and susceptibility to migraine. Mitochondrial DNA aberrations may contribute to the pathogenesis of migraine.
Physicochemical and sensory characteristics of soya protein isolate hydrolysates with added substrate‐like amino acids
Authors: Zhang Jianan , Xu Jucai , Liu Lei , Liu Yang , Zhao Tiantian , Wu Changping , Sun‐Waterhouse Dongxiao , Zhao Mouming , Su Guowan 
Published: October 2015

SummarySoya protein isolate (SPI) with or without added substrate‐like amino acid was subject to enzymatic hydrolysis catalysed by commercial proteases (Alcalase 2.4 L, flavourzyme and pancreatin). Addition of a small amount of amino acids (amino acid: SPI = 1: 2500, mol g−1) during hydrolysis would cause a significantly (P < 0.05) reduced protein recovery, increased degree of hydrolysis, and altered amino acid composition and antioxidant activities of SPI hydrolysates. The SPI hydrolysates prepared with added Asp, Arg or Lys exhibited a higher antioxidant activity than the control. The bitterness of SPI hydrolysates was largely reduced upon addition of Met, Asp or Glu during hydrolysis, whilst the umami taste and mouthfeel‐liking were remarkably increased. Therefore, adding amino acid during hydrolysis is a feasible and beneficial approach to improve both the functional and sensory properties of SPI hydrolysate.