bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of spontaneous hemopneumothorax: Indications for surgery
Authors: Inafuku Kenji , Maehara Takamitsu , Yamamoto Taketsugu , Masuda Munetaka 
Published: January 2015

Background Although spontaneous hemopneumothorax is rare, emergency surgery may be necessary if massive bleeding is present. Methods We examined therapeutic strategies and outcomes as well as background factors in 16 patients with spontaneous hemopneumothorax treated at our hospital between April 2002 and August 2013. Results Emergency surgery was performed in 3 patients, all of whom were hemodynamically unstable. Elective surgery was performed in 7 patients, all of whom showed continuous bleeding from a pleural cavity drain. The surgery consisted of intrapleural hematoma removal, hemostasis, and bullectomy; 3-port thoracoscopy was used in all of the surgical cases. Six patients, none of whom showed continuous bleeding, recovered with conservative therapy. Comparing the conservative therapy and surgery groups revealed the mean continuous bleeding volume and total blood loss to be significantly greater in the latter, but no significant difference was noted between the two groups in terms of the initial bleeding volume following tube thoracostomy. None of the cases required a blood transfusion. Conclusions Spontaneous hemopneumothorax is not necessarily an indication for surgery, and even when the initial volume of blood drained through the chest tube is large, some patients can still be treated conservatively with careful monitoring of vital signs and continuous bleeding volumes. However, it is important not to miss the optimal timing of surgery in order to avoid administering unnecessary blood transfusions to young patients.
Use of Inertial Sensors to Predict Pivot-Shift Grade and Diagnose an ACL Injury During Preoperative Testing
Authors: Borgstrom Per Henrik , Markolf Keith L. , Wang Yan , Xu Xiaoyu , Yang Paul R. , Joshi Nirav B. , Yeranosian Michael G. , Petrigliano Frank A. , Hame Sharon L. , Kaiser William J. , McAllister David R. 
Published: January 2015

Background: The pivot-shift (PS) examination is used to demonstrate knee instability and detect anterior cruciate ligament (ACL) injury. Prior studies using inertial sensors identified the ACL-deficient knee with reasonable accuracy, but none addressed the more difficult problem of using these sensors to determine whether a subject has an ACL deficiency and to correctly assign a PS grade to a patient’s knee. Hypothesis: Inertial sensor data recorded during a PS examination can accurately predict ACL deficiency and the PS score assigned by the examining physician. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 32 patients with unilateral ACL deficiency and 29 with intact ACLs in both knees had inertial sensor modules strapped to the tibia and femur of each limb for preoperative PS testing under anesthesia. Support vector machine (SVM) methods assessed PS grades on the basis of these data, with the examiner’s clinical grading shift used as ground truth. A fusion of regression and SVM classification techniques diagnosed ACL deficiency. Results: The clinically determined PS grades of all 122 knees were as follows: 0 (n = 69), +1 (n = 23), +2 (n = 27), and +3 (n = 3). The SVM classification analysis was 77% accurate in correctly classifying these grades, with 98% of computed PS grades falling within ±1 grade of the clinically determined value. The system fusion algorithm diagnosed ACL deficiency in an individual with an overall accuracy of 97%. This method yielded 6% false negatives and 0% false positives. Conclusion: This study used inertial sensor technology with SVM algorithms to accurately determine clinically assigned PS grades in ACL-intact and ACL-deficient knees. By extending the assessment to a separate group of patients without ACL injury, the inertial sensor data demonstrated highly accurate diagnosis of ACL deficiency.
Luminal Toxin-Binding Agents for Clostridium difficile Infection
Authors: McCoy Ryan M. , Klick Andrew , Hill Steven , Dull Ryan B. 
Published: January 2015

Objective: To systematically search the literature for trials evaluating luminal toxin-binding agents (LTBAs) for Clostridium difficile infection (CDI). Methods: A systematic search was conducted utilizing PubMed and International Pharmaceutical Abstracts with the following terms: anion-exchange resins, C difficile, cholestyramine, tolevamer, and colestipol. Articles were included if published in the English language and reported clinical outcomes of more than 5 adult humans with CDI treated with LTBAs. Results: Nearly all clinical trials evaluated LTBA as monotherapy for CDI and LTBAs are inferior to standard therapy. In contemporary practice, LTBAs are employed as adjunctive or sequential therapy for which there is a paucity of data. Some data suggest potential efficacy for recurrent CDI. Current guidelines for CDI assert LTBAs are contraindicated due to drug–drug interactions with vancomycin. However, the impact of this interaction on clinical outcomes has not been evaluated, and it is unknown whether higher doses of vancomycin or separating the administration of LTBAs from vancomycin would mitigate this interaction. Conclusion: LTBA monotherapy is inferior to vancomycin and metronidazole for CDI. Some data indicate possible benefit in reducing recurrent CDI, but outcomes with adjunctive and/or sequential LTBAs are unavailable. Further studies are needed to investigate the role of LTBAs for CDI.
Incident syphilis infection among people who inject drugs in Tijuana, Mexico
Authors: Pines Heather A , Rusch Melanie L , Vera Alicia , Rangel Gudelia , Magis-Rodriguez Carlos , Strathdee Steffanie A 
Published: January 2015

Summary Given that syphilis is associated with HIV infection among people who inject drugs (PWID), we examined syphilis incidence among PWID in Tijuana, Mexico. From 2006 to 2007, 940 PWID (142 women and 798 men) were recruited via respondent-driven sampling and followed for 18 months. At semi-annual visits, participants were tested for syphilis and completed surveys, which collected information on socio-demographics, sexual behaviours, substance use and injection behaviours. Poisson regression was used to estimate syphilis incidence rates (IRs), incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Twenty-one participants acquired syphilis during follow-up (IR = 1.57 per 100 person-years, 95% CI: 1.02–2.41). In a multivariate analysis, syphilis incidence was higher among women (IRR = 3.90, 95% CI: 1.37–11.09), HIV-positive participants (IRR = 4.60, 95% CI: 1.58–13.39) and those who reported ever exchanging sex for drugs, money, or other goods (IRR = 2.74, 95% CI: 0.97–7.76), while syphilis incidence was lower among those living in Tijuana for a longer duration (IRR = 0.95 per year, 95% CI: 0.91–1.00) and those reporting at least daily injection drug use (past 6 months) (IRR = 0.22, 95% CI: 0.09–0.54). Our findings suggest interventions that address the destabilising conditions associated with migration and integrate sexual and drug-related risk reduction strategies may help reduce syphilis incidence among PWID along the Mexico–US border.
Surface Electromyography of the Forearm Musculature During the Windmill Softball Pitch
Authors: Remaley D. Trey , Fincham Bryce , McCullough Bryan , Davis Kirk , Nofsinger Charles , Armstrong Charles , Stausmire Julie M. 
Published: January 2015

Background: Previous studies investigating the windmill softball pitch have focused primarily on shoulder musculature and function, collecting limited data on elbow and forearm musculature. Little information is available in the literature regarding the forearm. This study documents forearm muscle electromyographic (EMG) activity that has not been previously published. Purpose: Elbow and upper extremity overuse injuries are on the rise in fast-pitch softball pitchers. This study attempts to describe forearm muscle activity in softball pitchers during the windmill softball pitch. Overuse injuries can be prevented if a better understanding of mechanics is defined. Study Design: Descriptive laboratory study. Methods: Surface EMG and high-speed videography was used to study forearm muscle activation patterns during the windmill softball pitch on 10 female collegiate-level pitchers. Maximum voluntary isometric contraction of each muscle was used as a normalizing value. Each subject was tested during a single laboratory session per pitcher. Data included peak muscle activation, average muscle activation, and time to peak activation for 6 pitch types: fastball, changeup, riseball, curveball, screwball, and dropball. Results: During the first 4 phases, muscle activity (seen as signal strength on the EMG recordings) was limited and static in nature. The greatest activation occurred in phases 5 and 6, with increased signal strength, evidence of stretch-shortening cycle, and different muscle characteristics with each pitch style. These 2 phases of the windmill pitch are where the arm is placed in the 6 o’clock position and then at release of the ball. The flexor carpi ulnaris signal strength was significantly greater than the other forearm flexors. Timing of phases 1 through 5 was successively shorter for each pitch. There was a secondary pattern of activation in the flexor carpi ulnaris in phase 4 for all pitches except the fastball and riseball. Conclusion: During the 6 pitches, the greatest muscular activity was in phases 5 and 6. Flexor carpi ulnaris activity was greatest among the muscles tested. The riseball had the highest peak activity, but the curveball and dropball had the highest average signal strength. This muscle activity correlates with increasing distraction in the elbow, suggesting that flexor muscles act to counterdistract the elbow as they do for the baseball pitch. Clinical Relevance: Windmill pitchers are unique among overhead athletes as they throw, on average, more pitches per overhead athlete. Understanding the mechanics and physiology of the elbow in windmill pitchers is crucial to prevention and treatment of these increasingly common elbow injuries. This study establishes baseline data that will be useful to further prevent windmill pitch elbow injury.
Riociguat for the treatment of pulmonary arterial hypertension: a long-term extension study (PATENT-2)
Authors: Rubin Lewis J. , Galiè Nazzareno , Grimminger Friedrich , Grünig Ekkehard , Humbert Marc , Jing Zhi-Cheng , Keogh Anne , Langleben David , Fritsch Arno , Menezes Flavia , Davie Neil , Ghofrani Hossein-Ardeschir 
Published: January 2015

Riociguat is a soluble, guanylate cyclase stimulator, approved for pulmonary arterial hypertension. In the 12-week PATENT-1 study, riociguat was well tolerated and improved several clinically relevant end-points in patients with pulmonary arterial hypertension who were treatment naïve or had been pretreated with endothelin-receptor antagonists or prostanoids. The PATENT-2 open-label extension evaluated the long-term safety and efficacy of riociguat.Eligible patients from the PATENT-1 study received riociguat individually adjusted up to a maximum dose of 2.5 mg three times daily. The primary objective was to assess the safety and tolerability of riociguat; exploratory efficacy assessments included 6-min walking distance and World Health Organization (WHO) functional class.Overall, 396 patients entered the PATENT-2 study and 324 (82%) were ongoing at this interim analysis (March 2013). The safety profile of riociguat in PATENT-2 was similar to that observed in PATENT-1, with cases of haemoptysis and pulmonary haemorrhage also being observed in PATENT-2. Improvements in the patients', 6-min walking distance and WHO functional class observed in PATENT-1 persisted for up to 1 year in PATENT-2. In the observed population at the 1-year time point, mean±sd6-min walking distance had changed by 51±74 m and WHO functional class had improved in 33%, stabilised in 61% and worsened in 6% of the patientsversusthe PATENT-1 baseline.Long-term riociguat was well tolerated in patients with pulmonary arterial hypertension, and led to sustained improvements in exercise capacity and functional capacity for up to 1 year.
Bacteraemia and antibiotic-resistant pathogens in community acquired pneumonia: risk and prognosis
Authors: Torres Antoni , Cillóniz Catia , Ferrer Miquel , Gabarrús Albert , Polverino Eva , Villegas Santiago , Marco Francesc , Mensa Josep , Menéndez Rosario , Niederman Michael 
Published: January 2015

The sensitivity of blood cultures in the diagnosis of bacteraemia for community-acquired pneumonia is low. Recommendations, by guidelines, to perform blood cultures are discordant. We aimed to determine the incidence, microbial aetiology, risk factors and outcomes of bacteraemic patients with community-acquired pneumonia, including cases with antibiotic-resistant pathogens (ARP).A prospective, observational study was undertaken on consecutive adult patients admitted to the Hospital Clinic of Barcelona (Barcelona, Spain) with community-acquired pneumonia and blood cultures were obtained.Of the 2892 patients included, bacteraemia was present in 297 (10%) patients; 30 (10%) of whom had ARP (multidrug-resistantStreptococcus pneumoniae, methicillin-resistantStaphylococcus aureus,Pseudomonas aeruginosa, and an extended spectrum of beta-lactamase producingEnterobacteriaceae). In multivariate analyses, pleuritic pain, C-reactive protein ≥21.6 mg·dL−1and intensive care unit admissions were independently associated with bacteraemia, while prior antibiotic treatment and pneumococcal vaccine were protective factors. The risk factors for ARP bacteraemia were previous antibiotics and C-reactive protein <22.2 mg·dL−1, while pleuritic pain was the only protective factor in the multivariate analysis. Bacteraemia (excluding ARP), appropriate empiric treatment, neurological disease, arterial oxygen tension/inspiratory oxygen fraction <250, pneumonia severity index risk classes IV and V, and intensive care unit admission were independently associated with a 30-day hospital mortality in the multivariate analysis. Inappropriate therapy was more frequent in ARP bacteraemia, compared with other bacteraemias (27%versus3%, respectively, p<0.001).Antibiotic therapy protected against bacteraemia, but increased specifically the risk of bacteraemia from ARP due to the inappropriate coverage of these pathogens. Identifying patients at risk of ARP bacteraemia would help in deciding appropriate empiric antimicrobial therapy. The results from this study provide evidence concerning community-acquired pneumonia patients in whom blood cultures should not be performed.
Age-adjusted high-sensitivity troponin T cut-off value for risk stratification of pulmonary embolism
Authors: Kaeberich Anja , Seeber Valerie , Jiménez David , Kostrubiec Maciej , Dellas Claudia , Hasenfuß Gerd , Giannitsis Evangelos , Pruszczyk Piotr , Konstantinides Stavros , Lankeit Mareike 
Published: January 2015

High-sensitivity troponin T (hsTnT) helps in identifying pulmonary embolism patients at low risk of an adverse outcome. In 682 normotensive pulmonary embolism patients we investigate whether an optimised hsTnT cut-off value and adjustment for age improve the identification of patients at elevated risk.Overall, 25 (3.7%) patients had an adverse 30-day outcome. The established hsTnT cut-off value of 14 pg·mL−1retained its high prognostic value (OR (95% CI) 16.64 (2.24–123.74); p=0.006) compared with the cut-off value of 33 pg·mL−1calculated by receiver operating characteristic analysis (7.14 (2.64–19.26); p<0.001). In elderly (aged ≥75 years) patients, an age-optimised hsTnT cut-off value of 45 pg·mL−1but not the established cut-off value of 14 pg·mL−1predicted an adverse outcome. An age-adjusted hsTnT cut-off value (≥14 pg·mL−1for patients aged <75 years and ≥45 pg·mL−1for patients aged ≥75 years) provided additive and independent prognostic information on top of the simplified pulmonary embolism severity index (sPESI) and echocardiography (OR 4.56 (1.30–16.01); p=0.018, C-index=0.77). A three-step approach based on the sPESI, hsTnT and echocardiography identified 16.6% of all patients as being at higher risk (12.4% adverse outcome).Risk assessment of normotensive pulmonary embolism patients was improved by the introduction of an age-adjusted hsTnT cut-off value. A three-step approach helped identify patients at higher risk of an adverse outcome who might benefit from advanced therapy.
Gastric tonometry guided therapy in critical care patients: a systematic review and meta-analysis
Authors: Zhang Xin , Xuan Wei , Yin Ping , Wang Linlin , Wu Xiaodan , Wu Qingping 
Published: January 2015

Abstract
Introduction
The value of gastric intramucosal pH (pHi) can be calculated from the tonometrically measured partial pressure of carbon dioxide ($$ {P}_{C{O}_2} $$

P

C

O
2

) in the stomach and the arterial bicarbonate content. Low pHi and increase of the difference between gastric mucosal and arterial $$ {P}_{C{O}_2} $$

P

C

O
2

($$ {P}_{C{O}_2} $$

P

C

O
2

gap) reflect splanchnic hypoperfusion and are good indicators of poor prognosis. Some randomized controlled trials (RCTs) were performed based on the theory that normalizing the low pHi or $$ {P}_{C{O}_2} $$

P

C

O
2

gap could improve the outcomes of critical care patients. However, the conclusions of these RCTs were divergent. Therefore, we performed a systematic review and meta-analysis to assess the effects of this goal directed therapy on patient outcome in Intensive Care Units (ICUs).

Methods
We searched PubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov for randomized controlled trials comparing gastric tonometry guided therapy with control groups. Baseline characteristics of each included RCT were extracted and displayed in a table. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous outcomes. Another measure of effect (risk difference, RD) was used to reassess the effects of gastric tonometry on total mortality. We performed sensitivity analysis for total mortality. Continuous outcomes were presented as standardised mean differences (SMDs) together with 95% CIs.

Results
The gastric tonometry guided therapy significantly reduced total mortality (OR, 0.732; 95% CI, 0.536 to 0.999, P = 0.049; I2 = 0%; RD, −0.056; 95% CI, −0.109 to −0.003, P = 0.038; I2 = 0%) when compared with control groups. However, after excluding the patients with normal pHi on admission, the beneficial effects of this therapy did not exist (OR, 0.736; 95% CI 0.506 to 1.071, P = 0.109; I2 = 0%). ICU length of stay, hospital length of stay and days intubated were not significantly improved by this therapy.

Conclusions
In critical care patients, gastric tonometry guided therapy can reduce total mortality. Patients with normal pHi on admission contributed to the ultimate result of this outcome; it may indicate that these patients may be more sensitive to this therapy.
Rapid reprogramming of epigenetic and transcriptional profiles in mammalian culture systems
Authors: Nestor Colm E , Ottaviano Raffaele , Reinhardt Diana , Cruickshanks Hazel A , Mjoseng Heidi K , McPherson Rhoanne C , Lentini Antonio , Thomson John P , Dunican Donncha S , Pennings Sari , Anderton Stephen M , Benson Mikael , Meehan Richard R 
Published: January 2015

Abstract
Background
The DNA methylation profiles of mammalian cell lines differ from those of the primary tissues from which they were derived, exhibiting increasing divergence from the in vivo methylation profile with extended time in culture. Few studies have directly examined the initial epigenetic and transcriptional consequences of adaptation of primary mammalian cells to culture, and the potential mechanisms through which this epigenetic dysregulation occurs is unknown.

Results
We demonstrate that adaptation of mouse embryonic fibroblasts to cell culture results in a rapid reprogramming of epigenetic and transcriptional states. We observed global 5-hydroxymethylcytosine (5hmC) erasure within three days of culture initiation. Loss of genic 5hmC was independent of global 5-methylcytosine (5mC) levels and could be partially rescued by addition of vitamin C. Significantly, 5hmC loss was not linked to concomitant changes in transcription. Discrete promoter-specific gains of 5mC were also observed within seven days of culture initiation. Against this background of global 5hmC loss we identified a handful of developmentally important genes that maintained their 5hmC profile in culture, including the imprinted loci Gnas and H19. Similar outcomes were identified in the adaption of CD4+ T cells to culture.

Conclusions
We report a dramatic and novel consequence of adaptation of mammalian cells to culture in which global loss of 5hmC occurs, suggesting rapid concomitant loss of methylcytosine dioxygenase activity. The observed epigenetic and transcriptional re-programming occurs much earlier than previously assumed, and has significant implications for the use of cell lines as faithful mimics of in vivo epigenetic and physiological processes.
Update to recommended best practice for verification and validation of ICME methods and models for aerospace applications
Authors: Cowles Bradford A , Backman Daniel G , Dutton Roland E 
Published: January 2015

Abstract
Background
Rigorous verification and validation practices are regarded essential for successful implementation of Integrated Computational Materials Engineering (ICME) for aerospace applications. Guidelines and a recommended best practice for ICME verification and validation were developed in 2011 under Air Force Research Laboratory sponsorship and were published in 2012. These included general guidelines for ICME verification and validation, a recommended best practice, practitioner aides in the form of checklists for planning and status assessment, a Tool Maturity Level assessment guide, and a recommended approach for risk vs. consequence assessment for specific ICME applications. ICME development programs and expert practitioners have since reviewed and used the guidelines and provided constructive feedback for improvements.

Findings
This feedback was used to generate a comprehensive revision to the original guidelines and recommended best practice, as well as to the corresponding practitioner aides. The System-Level and Model-Level Checklists were simplified and improved, as was the Tool Maturity Level assessment guide. A template for a one-page summary chart was also generated to facilitate communication of status.

Conclusions
Experience with several ICME-related programs and expert practitioners reinforced the conclusion that guidelines and a recommended best practice are important tools to ensure that rigorous, comprehensive verification and validation practices are employed during ICME development and implementation efforts.