bluuebunny/crossref_metadata_2025_split huggingface dataset:
Closure of Large Percutaneous Access Sites Using the Prostar XL Percutaneous Vascular Surgery Device
Authors: Haas P. Clay , Krajcer Zvonimir , Diethrich Edward B. 
Published: March 2015

Purpose: To report early experience using a vascular closure device following endovascular aortic aneurysmal repair in which large-bore sheaths are used. Technique: A 10F Prostar XL Percutaneous Vascular Surgery device is used to deploy sutures around sheath entry sites up to 16F. At the completion of the procedure, the sutures are tied with a sliding knot to ensure adequate hemostasis. Conclusions: Maintaining the minimal invasiveness of the percutaneous approach to aortic endografting reduces patient discomfort and permits earlier ambulation and hospital discharge. Initial success seems to be maintained at 1 month, however, longer follow-up will be required.
Endotension: An Explanation for Continued AAA Growth after Successful Endoluminal Repair
Authors: White Geoffrey H. , May James , Petrasek Paul , Waugh Richard , Stephen Michael , Harris John 
Published: March 2015

Purpose: To present and analyze several cases that illustrate persistent sac pressurization following endovascular abdominal aortic aneurysm (AAA) repair. Methods and Results: Four patients with successful endovascular AAA exclusion presented in follow-up with an expanding aneurysm. Two had initial sac diameter decrease, but by 18 and 24 months, respectively, the AAA had enlarged and become pulsatile. There was no endoleak evident, but the proximal attachment stents had migrated distally in both cases. One patient developed endoleak with aneurysm expansion at 6 months; contained rupture occurred at 12 months. The last case had slowly evolving aneurysm expansion over 36 months but no endoleak. All endografts were removed and successfully replaced with conventional grafts. Intrasac thrombus was implicated as the means of pressure transmission that precipitated AAA expansion in these cases. Conclusions: Excluded AAAs can increase in size owing to persistent or recurrent pressurization (endotension) of the sac even when there is no evidence of endoleak. One proposed mechanism is pressure transmission via thrombus that lines the attachment site. Endotension may also represent an indiscernible, very low flow endoleak that allows blood to clot at the source of leakage.
Outpatient Carotid Artery Stenting: A Case Report
Authors: New Gishel , Roubin Gary S. , Iyer Sriram S. , Lawrence Emily J. , Oetgen Matthew , Al-Mubarek Nadim , Moussa Issam , Moses Jeffrey W. , Vitek Jiri J. 
Published: March 2015

Purpose: To report a case of carotid artery stenting for asymptomatic carotid restenosis performed in an outpatient setting. Methods and Results: A 68-year-old man with right carotid restenosis after repeat carotid endarterectomy underwent carotid angioplasty and stenting on an ambulatory basis. The procedure to implant a Smart stent required 45 minutes; the femoral access site was closed with a puncture closure device. The patient experienced no sequelae to this procedure and is well 6 months after treatment. Conclusions: Outpatient delivery of percutaneous carotid stenting may be feasible in appropriately selected patients.
Endovascular AAA Repair: Prevention of Side Branch Endoleaks with Thrombogenic Sponge
Authors: Walker Stuart R. , Macierewicz Jan , Hopkinson Brian R. 
Published: March 2015

Purpose: To report a technique that might decrease the incidence of lumbar artery endoleaks following endovascular repair (EVR) of abdominal aortic aneurysms (AAAs). Methods: Ninety-three patients (86 males, median age 72 years, range 56 to 88) undergoing EVR with the aortomonoiliac technique were entered into a study to detect and then occlude patent side branches before completion of the endografting procedure. Prior to deploying the iliac occluder, an aneurysmogram was performed to detect patent aortic side branches. If these side branches were found, an absorbable gelatin sponge was inserted into the aneurysm sac via the occluder introducer sheath. The patients were followed with contrast-enhanced spiral computed tomography (CT) at 1 week and 3, 6, and 12 months to detect the presence of endoleaks. Results: Forty-eight (52%) patients demonstrated patent side branches that were occluded by the insertion of gelatin sponges into the aneurysm sac. The remaining 45 patients without evidence of side branch flow were untreated. Ten (10.7%) patients died in the perioperative period, and 15 (16.1%) primary endoleaks (13 proximal, 2 distal) were detected. This left 68 (73.1%) patients for follow-up, 33 (48.5%) of whom had patent branch vessels treated with the thrombogenic sponge. The median follow-up was 4 months (range 1 to 17), during which time no side branch endoleak was detected on surveillance CT scans in any of the 68 patients, which included all patients treated with the thrombogenic sponge technique and those in whom no patent side branches had been identified. Conclusions: We have demonstrated a safe and reliable method of preventing lumbar artery endoleaks following endovascular AAA repair.
Response of Renal and Femoropopliteal Arteries to Palmaz Stent Implantation Assessed with Intravascular Ultrasound
Authors: Leertouwer Trude C. , Gussenhoven Elma J. , van Lankeren Winnifred , van Overhagen Hans 
Published: March 2015

Purpose: To establish the processes responsible for late lumen loss in renal and femoropopliteal Palmaz stents using intravascular ultrasound (IVUS). Methods: The first 7 consecutive patients treated with stents for renal (n = 4) and femoropopliteal (n = 3) arterial occlusive disease were studied with IVUS immediately after angiographically successful stent placement (< 10% residual stenosis) and periodically during follow-up. Images of both stent edges and the most stenotic site inside the stent at follow-up were matched to the same cross sections captured immediately after stent placement for quantitative analysis. Results: Late lumen loss in renal artery stents at 5 to 34 months was considerably less than in femoropopliteal stents (17% versus 62%, respectively). In the renal location, late lumen loss (3.0 ± 1.3 mm2) was due to neointimal hyperplasia, whereas stent area remained unchanged (3% decrease). Late lumen loss (7.4 ± 8.2 mm2) in femoropopliteal stents was due to neointimal hyperplasia and stent area reduction (26%). Overall, in both types of arteries, neointimal development and stent area reduction were larger at the most stenotic site than at the stent edges. Conclusions: These data suggest that there may be differences between renal and femoropopliteal arteries in the extent of hyperplastic response to stents.
Clinical Experience with Superior Vena Caval Greenfield Filters
Authors: Ascher Enrico , Hingorani Anil , Mazzariol Fernanda , Jacob Theresa , Yorkovich William , Gade Prasad 
Published: March 2015

Purpose: To evaluate the results of superior vena caval (SVC) Greenfield filters in patients at risk for pulmonary embolism (PE) secondary to upper extremity deep venous thrombosis (UEDVT). Methods: Over a 46-month period, 26 patients (10 men, mean age 67 years, range 25 to 89) with UEDVT in whom anticoagulation was contraindicated (n = 22) or ineffective in preventing recurrent PE or extension of the thrombus (n = 4) were treated with placement of SVC Greenfield filters. Results: One SVC filter was misplaced into the innominate vein but left in place; this vein remains patent after 2 months without evidence of filter migration. Follow-up ranged from 10 days to 46 months (mean 7.8 months). Fifteen (58%) patients died inhospital of causes unrelated to the SVC filter or recurrent thromboembolism (mean time to death 36 days). Of the 11 survivors, follow-up ranged from 1 to 38 months (mean 22). Sequential chest roentgenograms in 9 (82%) patients revealed no filter migration or displacement. No evidence of PE was found in any of the survivors over the course of follow-up. Conclusions: Insertion of SVC Greenfield filters is a safe and feasible therapy to prevent recurrent thromboembolism in patients with UEDVT who are refractory to or inappropriate for anticoagulation therapy.
Aorto—Left Renal Vein Fistula: Is There a Place for Endovascular Management?
Authors: Sultan Sherif , Madhavan Prakash , Colgan Mary Paula , Hughes Neil , Doyle Meave , Malloy Martin , Moore Dermot , Shanik Gregor 
Published: March 2015

Purpose: To describe the endovascular treatment of an aorto-left renal vein fistula. Methods and Results: A 77-year-old man with multiple comorbidities presented with low back pain, hematuria, cyanosis, and a pulsatile abdominal mass. Imaging confirmed a 7-cm abdominal aortic aneurysm with a contained rupture into the left renal vein. Owing to the patient's high surgical risk, a Talent Endoluminal Stent-Graft was implanted to satisfactorily exclude the aneurysm. Hemodynamic stability and normal renal function were restored; however, continued perfusion of the sac prompted an attempt to percutaneously repair the renal vein defect. This effort failed, so open laparotomy was necessary. Conclusions: Although total endovascular management was not successful in this case, the initial use of a minimally invasive approach allowed the patient's clinical status to improve and lower the risk of subsequent surgery.
A discourse analysis of hand hygiene policy in NHS Trusts
Authors: Cole Mark 
Published: March 2015

Introduction Healthcare-associated infection is a major patient safety concern. Hand hygiene is widely thought to be the single most important measure to affect reductions but compliance is problematic. Producing policies that clearly outline the responsibilities of staff is seen as a key way to instil accountability and improve performance. Objectives: The purpose of this study is to examine the discourse of hand hygiene policies across 359 NHS Trusts in England and consider the implications for practice. Method: The data were examined by combining the techniques of corpus linguistics with critical discourse analysis to generate keywords and concordance lines and then to make an interpretation what this may mean for the healthcare worker. Results: High frequency words such as ‘must’, ‘should’, ‘will’, ‘responsible’, ‘compliance’ and ‘audit’ suggest a tone that is authoritative and unyielding. This creates a fractured relationship between those who produce policies and the healthcare workers who need to comply with them. Conclusion: In their intentions to advance patient care policy, producers take little account of the messy, contextual factors that make the recommendations challenging to implement in daily practice. Firstly, Trusts should consider the use language that acknowledges the dynamic nature of practice and, secondly, cease using audit data as an indicator of performance as the conditions under which information is collected lacks reliability.
When ignorance is not bliss – a study of poor awareness of radiation exposure
Authors: Poullis Chris , Mackay Alice , Ahmed Munir 
Published: March 2015

Introduction and objective: Patient safety is at the forefront of quality of care. Radiation exposure secondary to diagnostic imaging is increasing rapidly. Coupled with clinicians’ lack of awareness concerning radiation, doses incurred during these common procedures mean patients are being exposed to substantial cumulative radiation. Recent publications have indicated a significant minority of cancers are secondary to medical ionising radiation. The purpose of this study was to establish physician knowledge of radiation dosages. Methods: Clinician knowledge of radiation doses was determined by a questionnaire distributed to 40 doctors across all specialties in a District General Hospital in England. Clinicians were asked to estimate the radiation dose incurred during common diagnostic investigations, environmental exposure and the relation to increased cancer risk. The results were correlated against seniority and previous formal education on ionising radiation. Results: Clinician knowledge of radiation doses was poor with a mean score of 17% (range 0–44%). There was, on average, more than a 12-fold underestimation of radiation exposure levels across all grades and specialties of doctors. Those with previous formal education outperformed those without, but not significantly ( p > 0.05). Conclusions: Clinician awareness surrounding radiation doses of common diagnostic modalities is poor, grossly underestimating the true values. Increasing seniority or prior formal radiology training did not significantly alter the outcome. There is a need to educate clinicians, raise radiation dose awareness and avoid the financial, medico-legal and health delivery implications of unnecessary patient exposure to radiation.
Autophagy is required for stem cell mobilization by G-CSF
Authors: Leveque-El Mouttie Lucie , Vu Therese , Lineburg Katie E. , Kuns Rachel D. , Bagger Frederik O. , Teal Bianca E. , Lor Mary , Boyle Glen M. , Bruedigam Claudia , Mintern Justine D. , Hill Geoffrey R. , MacDonald Kelli P. A. , Lane Steven W. 
Published: March 2015

Key PointsG-CSF activates autophagy in HSCs and neutrophils. The response and survival of HSCs mobilized by G-CSF in vivo require autophagy.
N-Acetyl-Cysteine, a Drug that Enhances the Endogenous Activation of Group-II Metabotropic Glutamate Receptors, Inhibits Nociceptive Transmission in Humans
Authors: Truini Andrea , Piroso Serena , Pasquale Erica , Notartomaso Serena , Stefano Giulia Di , Lattanzi Roberta , Battaglia Giuseppe , Nicoletti Ferdinando , Cruccu Giorgio 
Published: March 2015

Background Emerging research seeking novel analgesic drugs focuses on agents targeting group-II metabotropic glutamate receptors (mGlu2 and mGlu3 receptors). N-Acetylcysteine (NAC) enhances the endogenous activation of mGlu2/3 receptors by activating the glial glutamate:cystine membrane exchanger. Here, we examined whether NAC inhibits nociceptive responses in humans and animals. We tested the effect of oral NAC (1.2 g) on thermal-pain thresholds and laser-evoked potentials in 10 healthy volunteers, according to a crossover, double-blind, placebo-controlled design, and the effect of NAC (100 mg/kg, i.p.) on the tail-flick response evoked by radiant heat stimulation in mice. Results In healthy subjects, NAC treatment left thermal-pain thresholds unchanged, but significantly reduced pain ratings to laser stimuli and amplitudes of laser-evoked potentials. NAC induced significantly greater changes in these measures than placebo. In the tail-flick test, NAC strongly reduced the nocifensive reflex response to radiant heat. The action of NAC was abolished by the preferential mGlu2/3 receptor antagonist, LY341495 (1 mg/kg, i.p.). Conclusions Our findings show for the first time that NAC inhibits nociceptive transmission in humans, and does the same in mice by activating mGlu2/3 receptors. These data lay the groundwork for investigating the therapeutic potential of NAC in patients with chronic pain.
Critical care capacity in Canada: results of a national cross-sectional study
Authors: Fowler Robert A , Abdelmalik Philip , Wood Gordon , Foster Denise , Gibney Noel , Bandrauk Natalie , Turgeon Alexis F , Lamontagne François , Kumar Anand , Zarychanski Ryan , Green Rob , Bagshaw Sean M , Stelfox Henry T , Foster Ryan , Dodek Peter , Shaw Susan , Granton John , Lawless Bernard , Hill Andrea , Rose Louise , Adhikari Neill K , Scales Damon C , Cook Deborah J , Marshall John C , Martin Claudio , Jouvet Philippe ,   on behalf of the Canadian Critical Care Trials Group and The Canadian ICU Capacity Group
Published: March 2015

Abstract
Introduction
Intensive Care Units (ICUs) provide life-supporting treatment; however, resources are limited, so demand may exceed supply in the event of pandemics, environmental disasters, or in the context of an aging population. We hypothesized that comprehensive national data on ICU resources would permit a better understanding of regional differences in system capacity.

Methods
After the 2009–2010 Influenza A (H1N1) pandemic, the Canadian Critical Care Trials Group surveyed all acute care hospitals in Canada to assess ICU capacity. Using a structured survey tool administered to physicians, respiratory therapists and nurses, we determined the number of ICU beds, ventilators, and the ability to provide specialized support for respiratory failure.

Results
We identified 286 hospitals with 3170 ICU beds and 4982 mechanical ventilators for critically ill patients. Twenty-two hospitals had an ICU that routinely cared for children; 15 had dedicated pediatric ICUs. Per 100,000 population, there was substantial variability in provincial capacity, with a mean of 0.9 hospitals with ICUs (provincial range 0.4-2.8), 10 ICU beds capable of providing mechanical ventilation (provincial range 6–19), and 15 invasive mechanical ventilators (provincial range 10–24). There was only moderate correlation between ventilation capacity and population size (coefficient of determination (R2) = 0.771).

Conclusion
ICU resources vary widely across Canadian provinces, and during times of increased demand, may result in geographic differences in the ability to care for critically ill patients. These results highlight the need to evolve inter-jurisdictional resource sharing during periods of substantial increase in demand, and provide background data for the development of appropriate critical care capacity benchmarks.
Resting energy expenditure and substrate oxidation rates correlate to temperature and outcome after cardiac arrest - a prospective observational cohort study
Authors: Holzinger Ulrike , Brunner Richard , Losert Heidrun , Fuhrmann Valentin , Herkner Harald , Madl Christian , Sterz Fritz , Schneeweiß Bruno 
Published: March 2015

Abstract
Introduction
Targeted temperature management improves outcome after cardiopulmonary resuscitation. Reduction of resting energy expenditure might be one mode of action. The aim of this study was to correlate resting energy expenditure and substrate oxidation rates with targeted temperature management at 33°C and outcome in patients after cardiac arrest.

Methods
This prospective, observational cohort study was performed at the department of emergency medicine and a medical intensive care unit of a university hospital. Patients after successful cardiopulmonary resuscitation undergoing targeted temperature management at 33°C for 24 hours with subsequent rewarming to 36°C and standardized sedation, analgesic and paralytic medication were included. Indirect calorimetry was performed five times within 48 h after cardiac arrest. Measurements were correlated to outcome with repeated measures ANOVA, linear and logistic regression analysis.

Results
In 25 patients resting energy expenditure decreased 20 (18 to 27) % at 33°C compared to 36°C without differences between outcome groups (favourable vs. unfavourable: 25 (21 to 26) vs. 21 (16 to 26); P = 0.5). In contrast to protein oxidation rate (favourable vs. unfavourable: 35 (11 to 68) g/day vs. 39 (7 to 75) g/day, P = 0.8) patients with favourable outcome had a significantly higher fat oxidation rate (139 (104 to 171) g/day vs. 117 (70 to 139) g/day, P <0.05) and a significantly lower glucose oxidation rate (30 (−34 to 88) g/day vs. 77 (19 to 138) g/day; P < 0.05) as compared to patients with unfavourable neurological outcome.

Conclusions
Targeted temperature management at 33°C after cardiac arrest reduces resting energy expenditure by 20% compared to 36°C. Glucose and fat oxidation rates differ significantly between patients with favourable and unfavourable neurological outcome.

Trial registration
Clinicaltrials.gov NCT00500825. Registered 11 July 2007.
Central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference is associated with lactate evolution in the hemodynamic resuscitation process in early septic shock
Authors: Mesquida Jaume , Saludes Paula , Gruartmoner Guillem , Espinal Cristina , Torrents Eva , Baigorri Francisco , Artigas Antonio 
Published: March 2015

Abstract
Introduction
Since normal or high central venous oxygen saturation (ScvO2) values cannot discriminate if tissue perfusion is adequate, integrating other markers of tissue hypoxia, such as central venous-to-arterial carbon dioxide difference (PcvaCO2 gap) has been proposed. In the present study, we aimed to evaluate the ability of the PcvaCO2 gap and the PcvaCO2/arterial-venous oxygen content difference ratio (PcvaCO2/CavO2) to predict lactate evolution in septic shock.

Methods
Observational study. Septic shock patients within the first 24 hours of ICU admission. After restoration of mean arterial pressure, and central venous oxygen saturation, the PcvaCO2 gap and the PcvaCO2/CavO2 ratio were calculated. Consecutive arterial and central venous blood samples were obtained for each patient within 24 hours. Lactate improvement was defined as the decrease ≥ 10% of the previous lactate value.

Results
Thirty-five septic shock patients were studied. At inclusion, the PcvaCO2 gap was 5.6 ± 2.1 mmHg, and the PcvaCO2/CavO2 ratio was 1.6 ± 0.7 mmHg · dL/mL O2. Those patients whose lactate values did not decrease had higher PcvaCO2/CavO2 ratio values at inclusion (1.8 ± 0.8vs. 1.4 ± 0.5, p 0.02). During the follow-up, 97 paired blood samples were obtained. No-improvement in lactate values was associated to higher PcvaCO2/CavO2 ratio values in the previous control. The ROC analysis showed an AUC 0.82 (p < 0.001), and a PcvaCO2/CavO2 ratio cut-off value of 1.4 mmHg · dL/mL O2 showed sensitivity 0.80 and specificity 0.75 for lactate improvement prediction. The odds ratio of an adequate lactate clearance was 0.10 (p < 0.001) in those patients with an elevated PcvaCO2/CavO2 ratio (≥1.4).

Conclusion
In a population of septic shock patients with normalized MAP and ScvO2, the presence of elevated PcvaCO2/CavO2 ratio significantly reduced the odds of adequate lactate clearance during the following hours.
A high mean arterial pressure target is associated with improved microcirculation in septic shock patients with previous hypertension: a prospective open label study
Authors: Xu Jing-Yuan , Ma Si-Qing , Pan Chun , He Hong-Li , Cai Shi-Xia , Hu Shu-Ling , Liu Ai-Ran , Liu Ling , Huang Ying-Zi , Guo Feng-Mei , Yang Yi , Qiu Hai-Bo 
Published: March 2015

Abstract
Introduction
The effect of mean arterial pressure titration to a higher level on microcirculation in septic shock patients with previous hypertension remains unknown. Our goal is to assess the effect of mean arterial pressure titration to a higher level on microcirculation in hypertensive septic shock patients.

Methods
This is a single-center, open-label study. Hypertensive patients with septic shock for less than 24 hours after adequate fluid resuscitation and requiring norepinephrine to maintain a mean arterial pressure of 65 mmHg were enrolled. Mean arterial pressure was then titrated by norepinephrine from 65 mmHg to the normal level of the patient. In addition to hemodynamic variables, sublingual microcirculation was evaluated by sidestream dark field imaging.

Results
Nineteen patients were enrolled in the study. Increasing mean arterial pressure from 65 mmHg to normal levels was associated with increased central venous pressure (from 11 ± 4 to 13 ± 4 mmHg, P = 0.002), cardiac output (from 5.4 ± 1.4 to 6.4 ± 2.1 l/minute, P = 0.001), and central venous oxygen saturation (from 81 ± 7 to 83 ± 7%, P = 0.001). There were significant increases in small perfused vessel density (from 10.96 ± 2.98 to 11.99 ± 2.55 vessels/mm2, P = 0.009), proportion of small perfused vessels (from 85 ± 18 to 92 ± 14%, P = 0.002), and small microvascular flow index (from 2.45 ± 0.61 to 2.80 ± 0.68, P = 0.009) when compared with a mean arterial pressure of 65 mmHg.

Conclusions
Increasing mean arterial pressure from 65 mmHg to normal levels is associated with improved microcirculation in hypertensive septic shock patients.

Trial registration
Clinicaltrials.gov: NCT01443494; registered 28 September 2011.