bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Insulin Degludec/Insulin Aspart and Biphasic Insulin Aspart 30 in Uncontrolled, Insulin-Treated Type 2 Diabetes: A Phase 3a, Randomized, Treat-to-Target Trial
Authors: Fulcher Gregory R. , Christiansen Jens Sandahl , Bantwal Ganapathi , Polaszewska-Muszynska Miroslawa , Mersebach Henriette , Andersen Thomas H. , Niskanen Leo K. 
Published: May 2014

OBJECTIVE
Insulin degludec/insulin aspart (IDegAsp) is the first combination of a basal insulin with an ultralong duration of action, and a rapid-acting insulin in a single injection. This trial compared IDegAsp with biphasic insulin aspart 30 (BIAsp 30) in adults with type 2 diabetes inadequately controlled with once- or twice-daily (OD or BID) pre- or self-mixed insulin with or without oral antidiabetic drugs.

RESEARCH DESIGN AND METHODS
In this 26-week, randomized, open-label, multinational, treat-to-target trial, participants (mean age 58.7 years, duration of diabetes 13 years, BMI 29.3 kg/m2, and HbA1c 8.4% [68 mmol/mol]) were exposed (1:1) to BID injections of IDegAsp (n = 224) or BIAsp 30 (n = 222), administered with breakfast and the main evening meal and dose titrated to a self-measured premeal plasma glucose (PG) target of 4.0–5.0 mmol/L.

RESULTS
After 26 weeks, mean HbA1c was 7.1% (54 mmol/mol) for both groups, with IDegAsp achieving the prespecified noninferiority margin for mean change in HbA1c (estimated treatment difference [ETD] –0.03% points [95% CI –0.18 to 0.13]). Treatment with IDegAsp was superior in lowering fasting PG (ETD –1.14 mmol/L [95% CI –1.53 to –0.76], P &lt; 0.001) and had a significantly lower final mean daily insulin dose (estimated rate ratio 0.89 [95% CI 0.83–0.96], P = 0.002). Fewer confirmed, nocturnal confirmed, and severe hypoglycemia episodes were reported for IDegAsp compared with BIAsp 30.

CONCLUSIONS
IDegAsp BID effectively improves HbA1c and fasting PG levels with fewer hypoglycemia episodes versus BIAsp 30 in patients with uncontrolled type 2 diabetes previously treated with once- or twice-daily pre- or self-mixed insulin.
The Physical Function Intensive Care Test: Implementation in Survivors of Critical Illness
Authors: Nordon-Craft Amy , Schenkman Margaret , Edbrooke Lara , Malone Daniel J. , Moss Marc , Denehy Linda 
Published: May 2014

Background
Recent studies have demonstrated safety, feasibility, and decreased hospital length of stay for patients with weakness acquired in the intensive care unit (ICU) who receive early physical rehabilitation. The scored Physical Function in Intensive Care Test (PFIT-s) was specifically designed for this population and demonstrated excellent psychometrics in an Australian ICU population.

Objective
The purpose of this study was to determine the responsiveness and predictive capabilities of the PFIT-s in patients in the United States admitted to the ICU who required mechanical ventilation (MV) for 4 days or longer.

Methods
This nested study within a randomized trial administered the PFIT-s, Medical Research Council (MRC) sum score, and grip strength test at ICU recruitment and then weekly until hospital discharge, including at ICU discharge. Spearman rho was used to determine validity. The effect size index was used to calculate measurement responsiveness for the PFIT-s. The receiver operating characteristic curve was used in predicting participants' ability to perform functional components of the PFIT-s.

Results
From August 2009 to July 2012, 51 patients were recruited from 4 ICUs in the Denver, Colorado, metro area. At ICU discharge, PFIT-s scores were highly correlated to MRC sum scores (rho=.923) and grip strength (rho=.763) (P&lt;.0005). Using baseline test with ICU discharge (26 pairs), test responsiveness was large (1.14). At ICU discharge, an MRC sum score cut-point of 41.5 predicted participants' ability to perform the standing components of the PFIT-s.

Limitations
The small sample size was a limitation. However, the findings are consistent with those in a larger sample from Australia.

Conclusions
The PFIT-s is a feasible and valid measure of function for individuals who require MV for 4 days or longer and who are alert, able to follow commands, and have sufficient strength to participate.
Endoscopic endonasal transcavernous posterior clinoidectomy with interdural pituitary transposition
Authors: Fernandez-Miranda Juan C. , Gardner Paul A. , Rastelli Milton M. , Peris-Celda Maria , Koutourousiou Maria , Peace David , Snyderman Carl H. , Rhoton Albert L. 
Published: May 2014

Object
The object of this paper was to describe the surgical anatomy and technical nuances of the endonasal transcavernous posterior clinoidectomy approach with interdural pituitary transposition and to report the clinical outcome of this technical modification.

Methods
The surgical anatomy of the proposed approach was studied in 10 colored silicon-injected anatomical specimens. The medical records of 12 patients that underwent removal of the posterior clinoid(s) with this technique were reviewed.

Results
The natural anatomical corridor provided by the cavernous sinus is used to get access to the posterior clinoid by mobilizing the pituitary gland in an interdural fashion. The medial wall of the cavernous sinus is preserved intact and attached to the gland during its medial and superior mobilization. This provides protection to the gland, allowing for preservation of its venous drainage pathways. The inferior hypophyseal artery is transected to facilitate the manipulation of the medial wall of the cavernous sinus and pituitary gland. This approach was successfully performed in all patients, including 6 with chordomas, 5 with petroclival meningiomas, and 1 with an epidermoid tumor. No patient in this series had neurovascular injury related to the posterior clinoidectomy. There were no instances of permanent hypopituitarism or diabetes insipidus.

Conclusions
The authors introduce a surgical variant of the endoscopic endonasal posterior clinoidectomy approach that does not require intradural pituitary transposition and is more effective than the purely extradural approach. The endoscopic endonasal transcavernous approach facilitates the removal of prominent posterior clinoids increasing the working space at the lateral recess of the interpeduncular cistern, while preserving the pituitary function.
Management of intended durotomy in minimally invasive intradural spine surgery
Authors: Tan Lee A. , Takagi Ippei , Straus David , O'Toole John E. 
Published: May 2014

Object
Minimally invasive surgery (MIS) has been increasingly used for the treatment of various intradural spinal pathologies in recent years. Although MIS techniques allow for successful treatment of intradural pathology, primary dural closure in MIS can be technically challenging due to a limited surgical corridor through the tubular retractor system. The authors describe their experience with 23 consecutive patients from a single institution who underwent MIS for intradural pathologies, along with a review of pertinent literature.

Methods
A retrospective review of a prospectively collected surgical database was performed to identify patients who underwent MIS for intradural spinal pathologies between November 2006 and July 2013. Patient demographics, preoperative records, operative notes, and postoperative records were reviewed. Primary outcomes include operative duration, estimated blood loss, length of bed rest, length of hospital stay, and postoperative complications, which were recorded prospectively.

Results
Twenty-three patients who had undergone MIS for intradural spinal pathologies during the study period were identified. Fifteen patients (65.2%) were female and 8 (34.8%) were male. The mean age at surgery was 54.4 years (range 30–74 years). Surgical pathologies included neoplastic (17 patients), congenital (3 patients), vascular (2 patients), and degenerative (1 patient). The most common spinal region treated was lumbar (11 patients), followed by thoracic (9 patients), cervical (2 patients), and sacral (1 patient). The mean operative time was 161.1 minutes, and the mean estimated blood loss was 107.2 ml. All patients were allowed full activity less than 24 hours after surgery. The median length of stay was 78.2 hours. Primary sutured dural closure was achieved using specialized MIS instruments with adjuvant fibrin sealant in all cases. The rate of postoperative headache, nausea, vomiting, and diplopia was 0%. No case of cutaneous CSF fistula or symptomatic pseudomeningocele was identified at follow-up, and no patient required revision surgery.

Conclusions
Primary dural closure with early mobilization is an effective strategy with excellent clinical outcomes in the use of MIS techniques for intradural spinal pathology. Prolonged bed rest after successful primary dural closure appears unnecessary, and the need for watertight dural closure should not prevent the use of MIS techniques in this specific patient population.
The effect of stem cells in bridging peripheral nerve defects: a meta-analysis
Authors: Hundepool Caroline A. , Nijhuis Tim H. J. , Mohseny Behnam , Selles Ruud W. , Hovius Steven E. R. 
Published: May 2014

Object
For decades the gold standard for reconstructing a large peripheral nerve defect has been, and remains, the nerve autograft. Alternatives to the nerve autograft include biological conduits and vessels. Adding stem cells in the lumen of a nerve conduit has been the subject of multiple studies. The purpose of the present meta-analysis was to summarize animal experimental studies on the effect of stem cells as a luminal additive when reconstructing a peripheral nerve defect with a nerve graft.

Methods
A literature search of the MEDLINE and Embase databases was performed from inception to April 2012, searching for animal experiments on peripheral nerve reconstruction models in which a nerve conduit was used with and without the support of 3 different types of stem cells. Stem cells were analyzed according to their origin: bone marrow, adipose tissue, and other origins. Included studies had consistent outcome measurements: walking track analysis, muscle mass ratio, and electrophysiology.

Results
Forty-four studies were included in the final analysis. Forest plots of the 3 outcome measurements (walking track analysis, muscle mass ratio, and electrophysiology) showed positive effects of stem cells on the regeneration of peripheral nerves at different time points. Almost all comparisons showed significant differences for all 3 stem cells groups compared with a control group in which stem cells were not used.

Conclusions
The present report systematically analyzed the different studies that used stem cells as a luminal additive when bridging a large peripheral nerve defect. All 3 different stem cell groups showed a beneficial effect when used in the reconstruction compared with control groups in which stem cells were not used.
Progress towards an optically powered cryobot
Authors: Stone W.C. , Hogan B. , Siegel V. , Lelievre S. , Flesher C. 
Published: May 2014

AbstractVALKYRIE (Very-deep Autonomous Laser-powered Kilowatt-class Yo-yoing Robotic Ice Explorer) is a NASA-funded project to develop key technologies for an autonomous ice penetrator, or cryobot, capable of delivering science payloads through outer planet ice caps and terrestrial glaciers. This 4 year effort will produce a cylindrical cryobot prototype 280 cm in length and 25 cm in diameter. One novel element of VALKYRIE’s design is the use of a high-energy laser as the primary power source. 1070 nm laser light is transmitted at 5 kW from a surface-based laser and injected into a custom-designed optical waveguide that is spooled out from the descending cryobot. Light exits the downstream end of the fiber, travels through diverging optics, and strikes an anodized aluminum beam dump, which channels thermal power to hot-water jets that melt the descent hole. Some beam energy is converted to electricity via photovoltaic cells, for running on-board electronics and jet pumps. Since the vehicle can be sterilized prior to deployment, and forward contamination is minimized as the melt path refreezes behind the cryobot, expansions on VALKYRIE concepts may enable cleaner access to deep subglacial lakes. This paper focuses on laser delivery and beam dump thermal design.
An experimental approach to explain the southern Andes elevational treeline
Authors: Fajardo Alex , Piper Frida I. 
Published: May 2014

• Premise of the study: The growth limitation hypothesis (GLH) is the most accepted mechanistic explanation for treeline formation, although it is still uncertain whether it applies across taxa. The successful establishment of Pinus contorta––an exotic conifer species in the southern hemisphere––above the Nothofagus treeline in New Zealand may suggest a different mechanism. We tested the GLH in Nothofagus pumilio and Pinus contorta by comparing seedling performance and carbon (C) balance in response to low temperatures.• Methods: At a southern Chilean treeline, we grew seedlings of both species 2 m above ground level, to simulate coupling between temperatures at the meristem and in the air (colder), and at ground level, i.e., decoupling air temperature (relatively milder). We recorded soil and air temperatures as well. After 3 yr, we measured seedling survival and biomass (as a surrogate of growth) and determined nonstructural carbohydrates (NSC).• Key results: Nothofagus and Pinus did not differ in survival, which, as a whole, was higher at ground level than at the 2‐m height. The root‐zone temperature for the growing season was 6.6°C. While biomass and NSC decreased significantly for Nothofagus at the 2‐m height compared with ground level (C limitation), these trends were not significant for Pinus.• Conclusions: The treeline for Nothofagus pumilio is located at an isotherm that fully matches global patterns; however, its physiological responses to low temperatures differed from those of other treeline species. Support for C limitation in N. pumilio but not in P. contorta indicates that the physiological mechanism explaining their survival and growth at treeline may be taxon‐dependent.
A pilot study evaluating erect chest imaging in children, using the Lodox Statscan digital X-ray machine
Authors: Daya Rupesh Baloo , Kibel Maurice A , Pitcher Richard Denys , Workman Lesley , Douglas Tania S , Sanders Virginia 
Published: May 2014

ABSTRACT

Background:
Chest radiography accounts for a significant proportion of ionising radiation in children. The radiation dose of radiographs performed on the Lodox Statscan system has been shown to be lower than that of a computed radiography (CR) system. The role of the Lodox Statscan (hereafter referred to as the Statscan) in routine erect chest radiography in children has not been evaluated.

Objective:
To evaluate the image quality and diagnostic accuracy of erect paediatric chest radiographs obtained with the Statscan and compare this with conventional erect chest images obtained with a CR system.

Materials and Methods:
Thirty three children with suspected chest pathology were enrolled randomly over a period of three months. Erect chest radiographs were obtained with the Statscan, and a Shimadzu R-20J X-ray machine coupled with a Fuji FCR 5000 CR system. Image quality and diagnostic accuracy and diagnostic capability were evaluated between the two modalities.

Results:
The erect Statscan allowed superior visualisation of the three major airways. Statscan images however, demonstrated exposure and movement artifacts with hemidiaphragms and ribs most prone to movement. Bronchovascular clarity was also considered unsatisfactory on the Statscan images.

Conclusion:
The Statscan has limitations in erect chest radiography in terms of movement artefacts, exposure fluctuations, and poor definition of lung markings. Despite this, the Statscan allows better visualisation of the major airways, equivalent to a ‘high KV’ film at a fraction of the radiation dose. This supports the finding of an earlier study evaluating Statscan images in trauma cases, where the images were taken supine. Statscan has great potential in assisting in the diagnosis of childhood tuberculosis where airway narrowing occurs as a result of nodal compression.
Chilaiditi's syndrome demonstrated by SPECT/CT
Authors: Perumal Nalini S , Vangu Mboyo-Di-Tamba H , Purbhoo Khushica , Dhoodhat Shireen 
Published: May 2014

Purpose: Chilaiditi’s syndrome is a rare condition commonly diagnosed as an incidental radiological finding. The aim of this report is to show the role of SPECT-CT in this syndrome and state the functional and anatomical role of this hybrid imaging modality.
Materials and Methods: A case report.
Results: A 49-year-old female patient was referred for gallium-67 citrate for a possible
granulomatous myositis and underwent SPECT-CT of the abdomen to assess the area of decreased gallium uptake on planar images of the liver. The combined SPECT and CT modality demonstrated findings consistent with the clinical evidence of Chilaiditi’s syndrome. The anatomical part of this hybrid modality made it easier to evaluate the area of gallium lack of uptake which was due to air in the colon.
Conclusion: This case does not only show the role of SPECT-CT in this syndrome but also suggest that the use of such modality should be considered whenever available in the evaluation of patients in whom the localization of active disease becomes imperative.
Cardiovascular magnetic resonance imaging - a pictorial review
Authors: Dahya Vijay , Spottiswoode Bruce S 
Published: May 2014

Cardiovascular magnetic resonance imaging (CMR) is a powerful problem-solving tool and arguably offers the most comprehensive assessment of cardiac morphology and function, as well as the opportunity of rebuilding the bridge between cardiologists and radiologists. The role of CMR-trained imaging physicists is also valuable, and many CMR centres harmoniously incorporate these three sub-specialty fields.
This paper comprises an overview of several CMR techniques, outlining both the strengths and limitations of the modality.
Establishing a quality assurance baseline for radiological protection of patients undergoing diagnostic radiology
Authors: Korir Geoffrey K , Wambani Jeska Sidika , Korir Ian K 
Published: May 2014

Background. The wide use of ionising radiation in medical care has resulted in the largest man-made cause of radiation exposure. In recent years, diagnostic departments in Kenya have adapted the high-speed film/screen combination without well-established quality control, objective image quality criteria, and assessment of patient dose. The safety of patients in terms of justification and the as-low-as-reasonably-achievable (ALARA) principle is inadequate without quality assurance measures.
Aim. This study assessed the level of film rejects, device performance, image quality and patient dose in 4 representative hospitals using high-speed film/screen combination.
Results. The X-ray equipment quality control tests performance range was 67% to 90%, and 63% of the radiographs were of good diagnostic value. The measured prevalent chest examination entrance surface dose (ESD) showed levels above the international diagnostic reference levels (DRLs), while lumbar spine and pelvis examination was the largest source of radiation exposure to patients.
Conclusion. The optimisation of patient protection can be achieved with optimally performing X-ray equipment, the application of good radiographic technique, and continuous assessment of radiographic image quality.
FAST as a predictor of clinical outcome in blunt abdominal trauma
Authors: Terry Benjamin M , Blehar David , Gaspari Romolo , Maydell Arthur Thomas , Bezuidenhout Fourie Abraham , Andronikou Savvas 
Published: May 2014

Background. Peer-reviewed literature demonstrates increasing support for the use of focused abdominal sonography in trauma (FAST) in the setting of blunt trauma, one study demonstrating the sensitivity and specificity of FAST for the detection of free fluid to be 0.64 - 0.98 and 0.86 - 1.00, respectively, compared with abdominal CT. Utilising ultrasound in trauma triage increases efficiency and cost-effectiveness and reduces reliance on CT, compared with using CT alone. There is little evidence to support relying solely on a negative FAST and physical examination for patient management.
Method. A retrospective descriptive study of 172 adult patients who received FAST for the evaluation of blunt abdominal trauma between 22 July 2007 and 21 January 2008 at Tygerberg Hospital was performed. Ultrasound findings were correlated with CT scan findings, operative findings if managed surgically, clinical outcomes whether managed surgically or conservatively, as well as postmortem findings in deceased patients.
Results. FAST was negative in 147 (85.5%) patients. Twenty-four (16.3%) of these patients died from all-cause mortality, none of which was due to intra-abdominal injury.
Seven patients with negative FAST underwent CT scan owing to change in clinical course, and 3 patients with negative FAST underwent laparotomy owing to change in clinical course, with positive findings in 2 patients – a bowel injury requiring resection (not seen on CT) and a diaphragmatic rupture seen on CXR. A negative FAST was shown to be an excellent predictor for the absence of significant intra-abdominal trauma.
The mortality rate among 25 FAST positive patients was 24% (N=6). Only one of these patients (with a splenic rupture) was suspected to have died from abdominal pathology.
Radiological findings at a South African forensic pathology laboratory in cases of sudden unexpected death in infants
Authors: Fenton-Muir Naomi , Kewana Kgahlego , Ngema Yenziwe , Liebenberg Linda , Douglas Tania S. 
Published: May 2014

Objectives
The work serves as a preliminary evaluation of the utility of the full-body radiography in examining cases of SUDI.

Setting
This paper reviews findings from full-body digital radiography in cases of sudden unexpected death in infants (SUDI) in 2008 at the Salt River Forensic Pathology Laboratory in Cape Town.

Subjects
Cases of SUDI referred to the mortuary and undergoing full-body digital radiography were reviewed (192 cases).

Design
Imaging reports were cross-referenced with death registry data. Manner of death, cause of death, whether an autopsy had taken place, and radiological findings, were recorded and analysed.

Results
The absence of bony fractures was recorded as an imaging finding in 40% of cases. The most common type of imaging pathology was lung disease. In cases where autopsies were performed and pathology was found on imaging, the findings of the two methods of examination were consistent.

Conclusions
Imaging may have served to assist CoD determination based on case history, and therefore full-body radiography may improve the workflow in busy forensic pathology laboratories.
More detailed and consistent recording of imaging findings is required before stronger conclusions may be drawn regarding the utility of full body digital imaging of paediatric cases in forensic pathology laboratories.
Imaging findings in an infant with congenital pulmonary venolobar syndrome (scimitar syndrome)
Authors: Westgarth-Taylor Tracy , Kilborn Tracy 
Published: May 2014

Congenital venolobar syndrome (CVLS) is a rare complex malformation that includes hypoplasia of the lung, partial anomalous pulmonary venous drainage and in a quarter of patients, associated cardiac anomalies.
We present the chest radiograph and multidetector CT findings in a case of congenital venolobar syndrome in an infant.