bluuebunny/crossref_metadata_2025_split huggingface dataset:
Helicopter-based in-water resuscitation with chest compressions: a pilot study
Authors: Winkler Bernd E , Hartig Frank , DuCanto James , Koch Andreas , Georgieff Michael , Lungwitz Yannick P , Muth Claus-Martin 
Published: September 2014

BackgroundDrowning is a relevant worldwide cause of severe disability and death. The delay of ventilations and chest compressions is a crucial problem in drowning victims. Hence, a novel helicopter-based ALS rescue concept with in-water ventilation and chest compressions was evaluated.MethodsCardio pulmonary resuscitation (CPR) and vascular access were performed in a self-inflating Heliboat platform in an indoor wave pool using the Fastrach intubating laryngeal mask, the Oxylator resuscitator, Lund University Cardiopulmonary Assist System (LUCAS) chest compression device and EZ-IO intraosseous power drill. The time requirement and physical exertion on a Visual Analogue Scale (VAS) were compared between a procedure without waves and with moderate swell.ResultsMeasurement of the elapsed time of the various stages of the procedure did not reveal significant differences between calm water and swell: Ventilation was initiated after 02:48 versus 03:02 and chest compression after 04:20 versus 04:18 min; the intraosseous cannulisation was completed after 05:59 versus 06:30 min after a simulated jump off the helicopter. The attachment of the LUCAS to the mannequin and the intraosseous cannulisation was rated significantly more demanding on the VAS during swell conditions.ConclusionsCPR appears to be possible when performed in a rescue platform with special equipment. The novel helicopter-based strategy appears to enable the rescuers to initiate CPR in an appropriate length of time and with an acceptable amount of physical exertion for the divers. The time for the helicopter to reach the patient will have to be very short to minimise neurological damage in the drowning victim.
Implementation of an intensified antibiotic stewardship programme targeting third-generation cephalosporin and fluoroquinolone use in an emergency medicine department
Authors: Borde Johannes P , Kern Winfried V , Hug Martin , Steib-Bauert Michaela , With Katja de , Busch Hans-Jörg , Kaier Klaus 
Published: September 2014

IntroductionEarly initiation of antimicrobial treatment for acute infection is an important task in the emergency department (ED) with a likely impact on the hospital-wide antibiotic use pattern. We implemented an antibiotic stewardship (ABS) programme focused on non-trauma emergency patients at a large university hospital centre targeting broad-spectrum cephalosporin and fluoroquinolone use.MethodsGuidelines and focused discussion groups emphasised reduced prescription of third-generation cephalosporins and fluoroquinolones and encouraged penicillins. Antibiotic consumption expressed as monthly drug density in WHO-Anatomical Therapeutic Chemical defined and locally recommended daily doses (DDD and RDD) per 100 patient days was analysed before (January 2008 to October 2011) and after starting the intervention (January 2012 to October 2013). We performed a before-and-after uncontrolled interventional study using interrupted time-series (ITS) analysis in one ED to investigate ABS intervention-related effects in a quasiexperimental research setting.ResultsThe mean monthly total antibiotic use density declined from 111 RDD (138 DDD) per 100 patient days before the intervention to 86 RDD (128 DDD) per 100 patient days after starting the intervention. Among the different antibacterial drug classes, the consumption of third-generation cephalosporins showed the largest reduction and dropped significantly by −68% between preintervention and postintervention periods. Using the RDD dataset, ITS confirmed a highly significant postintervention change in level of third-generation cephalosporins (−15.2, 95% CI (−24.08 to −6.311)) and a corresponding increase in the use of aminopenicillin/betalactamase inhibitor formulations (+6.6, 95% CI (4.169 to 9.069)). The drug use densities for fluoroquinolones and for overall antibiotics declined, however, the postinterventional level changes missed statistical significance—overall (95% CI (−39.99 to 0.466), fluoroquinolones 95% CI (−11.72 to 4.333)).ConclusionsAn intensified ABS programme using non-restrictive tools targeting third-generation cephalosporin and fluoroquinolone use in the setting of a large academic hospital emergency medicine department is feasible and effective. The intervention may serve as a model for other emergency medicine departments at hospitals with a similar structure and baseline situation.
Prevalence of supporting limb laminitis in a UK equine practice and referral hospital setting between 2005 and 2013: implications for future epidemiological studies
Authors: Wylie C. E. , Newton J. R. , Bathe A. P. , Payne R. J. 
Published: September 2014

The electronic patient records of all equine patients of Rossdales Equine Practice between January 1, 2005 and November 1, 2013 were reviewed to determine the number of cases of supporting limb laminitis (SLL) in a large equine practice and referral hospital setting in the UK and to discuss the implications for future epidemiological studies. The clinical notes were searched electronically for a combination of ‘laminitis AND (contralateral OR supporting OR overload OR weight bearing)’. The prevalence of SLL within each identified denominator population and the corresponding 95% CI were calculated. SLL developed in nine horses, one donkey and one pony. Thoroughbreds were the most commonly affected breed (72.7 per cent, CI 46.4 to 99.1 per cent), aged 2–14 years (median six years), and only mares (n=9) and stallions (n=2) were represented. SLL was not restricted to horses that were non‐weightbearing lame, it developed within 4–100 days after injury (median 14.5 days) and occurred most commonly in a forelimb (54.6 per cent, CI 25.1 to 84.0 per cent). During the same time frame, a total of 65,327 horses were registered with Rossdales Equine Practice, resulting in an overall practice prevalence of SLL of 0.02 per cent (CI 0.01 to 0.03 per cent). Future epidemiological studies to investigate risk factors for SLL prevention will, therefore, be a logistical challenge.
In Vivo Localization of 90Y and 177Lu Radioimmunoconjugates Using Cerenkov Luminescence Imaging in a Disseminated Murine Leukemia Model
Authors: Balkin Ethan R. , Kenoyer Aimee , Orozco Johnnie J. , Hernandez Alexandra , Shadman Mazyar , Fisher Darrell R. , Green Damian J. , Hylarides Mark D. , Press Oliver W. , Wilbur D. Scott , Pagel John M. 
Published: September 2014

Abstract
Cerenkov radiation generated by positron-emitting radionuclides can be exploited for a molecular imaging technique known as Cerenkov luminescence imaging (CLI). Data have been limited, however, on the use of medium- to high-energy β-emitting radionuclides of interest for cancer imaging and treatment. We assessed the use of CLI as an adjunct to determine localization of radioimmunoconjugates to hematolymphoid tissues. Radiolabeled 177Lu- or 90Y-anti-CD45 antibody (Ab; DOTA-30F11) was administered by tail vein injection to athymic mice bearing disseminated murine myeloid leukemia, with CLI images acquired at times afterward. Gamma counting of individual organs showed preferential uptake in CD45+ tissues with significant retention of radiolabeled Ab in sites of leukemia (spleen and bone marrow). This result was confirmed in CLI images with 1.35 × 105 ± 2.2 × 104 p/s/cm2/sr and 3.45 × 103 ± 7.0 × 102 p/s/cm2/sr for 90Y-DOTA-30F11 and 177Lu-DOTA-30F11, respectively, compared with undetectable signal for both radionuclides using the nonbinding control Ab. Results showed that CLI allows for in vivo visualization of localized β-emissions. Pixel intensity variability resulted from differences in absorbed doses of the associated energies of the β-emitting radionuclide. Overall, our findings offer a preclinical proof of concept for the use of CLI techniques in tandem with currently available clinical diagnostic tools. Cancer Res; 74(20); 5846–54. ©2014 AACR.
Obstructive Sleep Apnea and Progression of Coronary Artery Calcium: The Multi‐Ethnic Study of Atherosclerosis Study
Authors: Kwon Younghoon , Duprez Daniel A. , Jacobs David R. , Nagayoshi Mako , McClelland Robyn L. , Shahar Eyal , Budoff Matthew , Redline Susan , Shea Steven , Carr J. Jeffrey , Lutsey Pamela L. 
Published: September 2014

Background

Obstructive sleep apnea (
OSA
) is a common condition associated with cardiovascular disease. Its potential effect on progression of subclinical atherosclerosis is not well understood. We tested the hypothesis that self‐reported
OSA
is associated with progression of coronary artery calcium (
CAC
). We also evaluated whether traditional cardiovascular risk factors accounted for the association.

Methods and Results

In the Multi‐Ethnic Study of Atherosclerosis (
MESA
) prospective cohort, we studied 2603 participants who at baseline (2002–2004) completed a sleep questionnaire and underwent coronary computed tomography (
CT
) and, then 8 years later (2010–2011), a repeat coronary
CT
. Participants were categorized by symptoms of habitual snoring or reported physician diagnosis of
OSA
. At baseline, 102 (3.9%) reported diagnosed
OSA
; 666 (25.6%) reported diagnosed habitual snoring; and 1835 (70.5%) reported neither habitual snoring nor
OSA
(“normal”). At baseline,
CAC
prevalence was highest among those with
OSA
but similar for those with and without habitual snoring. During 8 years of follow‐up, greater progression of
CAC
was observed among those with
OSA
versus normal (mean increase of 204.2 versus 135.5 Agatston units;
P
=0.01), after accounting for demographics, behaviors, and body habitus. Modest attenuation was observed after adjustment for cardiovascular risk factors (188.7 versus 138.8;
P
=0.06).
CAC
progression among habitual snorers was similar to that observed in the normal group.

Conclusions

OSA
was associated with
CAC
score progression after adjustment for demographics, behaviors, and body mass index. However, the association was not significant after accounting for cardiovascular risk factors, which may mediate the association between
OSA
and
CAC
.
A prospective, multicenter study of a double stent system for palliative treatment of malignant extrahepatic biliary obstructions
Authors: Kim Jong Woo , Gwon Dong I l , Han Young-Min , Won Je Hwan , Hong Hyun Pyo , Ko Gi-Young , Yoon Hyun-Ki , Sung Kyu-Bo 
Published: September 2014

Background A double stent system (covered stent in uncovered stent) was designed to provide long-term patency without tumor ingrowth or stent-related complications, such as stent migration, cholecystitis, or pancreatitis. Purpose To investigate the safety and efficacy of double stents in patients with malignant extrahepatic biliary obstructions. Material and Methods This prospective, nonrandomized, multicenter study enrolled 160 consecutive patients (102 men; mean age, 64 years; range, 33–91 years) with malignant extrahepatic biliary obstructions treated with a double stent system from January 2010 to March 2012. Results The technical success rate of the double stent placement was 100%. No stent migration was observed. Procedure-related minor (self-limiting hemobilia [ n = 6] and cholangitis [ n = 2]) and major (pancreatitis [ n = 16], cholecystitis [ n = 3], and hepatic abscess [ n = 2]) complications occurred in a total of 29 patients. The mean serum bilirubin level, which was 8.9 ± 5.6 mg/dL before drainage, decreased to 2.2 ± 4.6 mg/dL 1 month after stent placement ( P < 0.001). Successful internal drainage was achieved in 148 patients (92.5%). During the mean follow-up period of 205 days, acute cholecystitis ( n = 3) and hepatic abscess ( n = 2) occurred in five patients. The median patient survival and stent patency time were 135 days (95% confidence interval [CI], 96–160 days) and 114 days (95% CI, 83–131 days), respectively. Of 153 patients, 22 (14.4%) presented with stent dysfunction due to sludge incrustation ( n = 17), tumor overgrowth ( n = 4), or blood clot ( n = 1), and required repeat intervention. Tumor ingrowth was not observed in any of these patients. Conclusion Percutaneous treatment of malignant extrahepatic biliary obstruction using a double stent safely and effectively achieves internal biliary drainage.
Biomechanical Comparison of Patellar Fixation Techniques in Medial Patellofemoral Ligament Reconstruction
Authors: Russ Samuel D. , Tompkins Marc , Nuckley David , Macalena Jeffrey 
Published: September 2014

Background: Multiple techniques for reconstruction of the medial patellofemoral ligament (MPFL) have been described; however, little is known about the biomechanical properties of these techniques. Fixation of the graft to the patella has not been studied in a human cadaveric model. Hypothesis/Purpose: The purpose of this study was to compare the ultimate failure load and stiffness of 2 different MPFL patellar fixation techniques: suture anchor fixation and interference screw fixation. The null hypothesis was that the suture anchor group would show no difference in the ultimate failure load and stiffness compared with the interference screw group. Study Design: Controlled laboratory study. Methods: Reconstruction of the MPFL with semitendinosus autografts was performed in 8 pairs of fresh-frozen cadaveric knees (16 knees total; mean age, 55.8 ± 7.7 years). The specimens were randomly assigned to 2 groups of 8 specimens each based on the method used to fix the graft to the medial patella: suture anchor or interference screw fixation. Each reconstruction technique was performed on 1 knee from the same cadaveric specimen. Suture anchor reconstruction was completed with 2 parallel 3.0-mm biocomposite suture anchors. Interference screw fixation was accomplished with two 4.75-mm biocomposite interference screws docked in parallel tunnels. The reconstructions were cyclically loaded for 10 cycles to 30 N and then tested to failure at a constant displacement rate of 6 mm/s with a line of pull parallel to the anchors or interference screws. Ultimate failure load (N), stiffness (N/mm), and mode of failure were recorded for each specimen. Results: The suture anchor group had a significantly lower mean failure load (201.54 ± 63.14 N) than the interference screw group (299.25 ± 99.87 N) ( P = .007). The suture anchor group also had significantly lower mean stiffness (20.60 ± 6.78 N/mm) compared with the interference screw group (34.66 ± 10.74 N/mm) ( P = .007). The most common mode of failure in the suture anchor group was failure at the graft-suture interface. In the interference screw group, the most common mode of failure was the tendon graft pulling out of the tunnel. Conclusion: Interference screw fixation to the medial patella was found to be significantly stronger than suture anchor fixation when comparing the ultimate failure load and stiffness. Clinical Relevance: This study compares the biomechanical properties of 2 commonly used methods for patellar graft fixation in MPFL reconstruction surgery. It supports the use of interference screw fixation based on the ultimate load and stiffness, although suture anchor fixation may be sufficient when compared with the native MPFL based on previously published data.
Adrenal insufficiency predicts early mortality in patients with cirrhosis
Authors: Chawlani Romesh , Arora Anil , Ranjan Piyush , Sharma Praveen , Tyagi Pankaj , Bansal Naresh , Singla Vikas , Arora Veronica , Kotecha Hardik L , Kirnake Vijendra , Toshniwal Jay , Kumar Ashish 
Published: September 2014

BackgroundAdrenal insufficiency (AI), also known as hepato‐adrenal syndrome, is a well‐known entity in cirrhotic patients. However, factors associated with AI and its effect on survival are still not clear. We determined the prevalence of AI in patients with cirrhosis who had no hemodynamic instability or any acute deterioration, and studied its influence on short‐term survival.Patients and methodsIn consecutive cirrhotic patients, presence of AI was determined either by total serum cortisol <18 µg/dl, 60 minutes after 250 µg synacthen injection, or when the delta‐fraction (post‐synacthen serum cortisol minus basal serum cortisol) was <9 µg/dl.ResultsA total of 120 patients were included in the study (median age 50 years (range 27–73), males 87%). The median CTP and MELD scores were 10 (range 6–13) and 20 (range 6–40). The etiology of cirrhosis was alcohol (51%), cryptogenic (28%), viral (19%) and autoimmune (2%). Sixty‐nine patients (58%) had AI and the remaining 51 (42%) had normal adrenal function. Serum bilirubin was significantly higher (p  < 0.05) in the AI group, and total cholesterol, HDL, LDL and hemoglobin were significantly lower (p  < 0.05) in the AI group. CTP score, MELD score, and basal cortisol levels were not different between those with and without AI (p  = NS). By 120 days of follow‐up, 41 patients had died. Thus, the 120‐day survival was 66%, and this was higher in patients without AI than in patients with AI (78% vs 56%; p  = 0.019). On multivariate analysis absence of AI, low WBC and low CTP score independently predicted 120‐day survival.ConclusionsAI is present in more than half of cirrhotic patients but does not parallel the severity scores of cirrhosis. Its presence predicts early mortality in these patients, and this prediction is independent of CTP or MELD scores.
Defective endomitosis during megakaryopoiesis leads to thrombocytopenia in Fanca−/− mice
Authors: Pawlikowska Patrycja , Fouchet Pierre , Vainchenker William , Rosselli Filippo , Naim Valeria 
Published: September 2014

Key Points
Fanca −/− megakaryocytes accumulate genomic instability through endomitotic cycles. Defective endomitosis induces senescence of Fanca−/− megakaryocytes.
Positron emission tomography in the diagnostic work-up of screening-detected lung nodules
Authors: Veronesi Giulia , Travaini Laura L. , Maisonneuve Patrick , Rampinelli Cristiano , Bertolotti Raffaella , Spaggiari Lorenzo , Bellomi Massimo , Paganelli Giovanni 
Published: September 2014

Low-dose computed tomography (CT) screening for lung cancer can reduce lung cancer mortality, but overdiagnosis, false positives and invasive procedures for benign nodules are worrying. We evaluated the utility of positron emission tomography (PET)-CT in characterising indeterminate screening-detected lung nodules.383 nodules, examined by PET-CT over the first 6 years of the COSMOS (Continuous Observation of Smoking Subjects) study to diagnose primary lung cancer, were reviewed and compared with pathological findings (surgically-treated patients) or follow-up (negative CT for ⩾2 years, considered negative); 196 nodules were malignant.The sensitivity, specificity and accuracy of PET-CT for differentially diagnosing malignant nodules were, respectively, 64%, 89% and 76% overall, and 82%, 92% and 88% for baseline-detected nodules. Performance was lower for nodules found at repeat annual scans, with sensitivity ranging from 22% for nonsolid to 79% for solid nodules (p=0.0001). Sensitivity (87%) and specificity (73%) were high for nodules ⩾15 mm, better (sensitivity 98%) for solid nodules ⩾15 mm.PET-CT was highly sensitive for the differential diagnosis of indeterminate nodules detected at baseline, nodules ⩾15 mm and solid nodules. Sensitivity was low for sub-solid nodules and nodules discovered after baseline for which other methods,e.g.volume doubling time, should be used.
Nasopharyngeal gene expression, a novel approach to study the course of respiratory syncytial virus infection
Authors: van den Kieboom Corné H. , Ahout Inge M.L. , Zomer Aldert , Brand Kim H. , de Groot Ronald , Ferwerda Gerben , de Jonge Marien I. 
Published: September 2014

Respiratory syncytial virus (RSV) causes mild infections in the vast majority of children. However, in some cases, it causes severe disease, such as bronchiolitis and pneumonia. Development of severe RSV infection is determined by the host response. Therefore, the main aim of this study was to identify biomarkers associated with severe RSV infection.To identify biomarkers, nasopharyngeal gene expression was profiled by microarray studies, resulting in the selection of five genes:ubiquitin D,tetraspanin 8,mucin 13,β-microseminoproteinandchemokine ligand 7.These genes were validated by real-time quantitative PCR in an independent validation cohort, which confirmed significant differences in gene expression between mildly and severely infected and between recovery and acute patients.Nasopharyngeal aspirate samples are regularly taken when a viral respiratory tract infection is suspected. In this article, we describe a method to discriminate between mild and severe RSV infection based on differential host gene expression. The combination of pathogen detection and host gene expression analysis in nasopharyngeal aspirates will significantly improve the diagnosis and prognosis of respiratory tract infections.
Characteristics of diabetic foot ulcers in Western Sydney, Australia
Authors: Haji Zaine Norafizah , Burns Joshua , Vicaretti Mauro , Fletcher John P , Begg Lindy , Hitos Kerry 
Published: September 2014

AbstractBackgroundAustralia is ranked ninth of 39 countries in the Western Pacific region most affected by diabetes. Patients with diabetes are at high risk of developing foot ulcerations that can develop into non‐healing wounds. Recent studies suggest that the lifetime risk of developing a diabetic foot ulcer is as high as 25%. Few studies have reported the prevalence of, risk factors and socioeconomic status associated with, diabetic foot ulcers in Australia. The aim of this study was to evaluate the characteristics of diabetic foot ulcers in a tertiary referral outpatient hospital setting in Western Sydney, Australia.MethodsFrom January‐December 2011, a total of 195 outpatients with diabetes were retrospectively extracted for analysis from the Westmead Hospital's Foot Wound Clinic Registry. Data on demographics, socioeconomic status, co‐morbidities, foot ulcer characteristics and treatment were recorded on a standardised form.ResultsDemographics and physical characteristics were: 66.2% male, median age 67 years (IQR: 56‐76), median body mass index (BMI) of 28 kg/m2 (IQR: 25.2‐34.1), 75.4% had peripheral neuropathy and the median postcode score for socioeconomic status was 996 (IQR: 897‐1022). Diabetic foot ulcer characteristics were: median cross sectional area of 1.5 cm2 (IQR: 0.5‐7.0), median volume of 0.4 cm3 (IQR: 0.11‐3.0), 45.1% on the plantar aspect of the foot, 16.6% UT Wound Grade of 0C to 3C (with ischaemia) and 11.8% with a Grade 0D to 3D (with infection and ischaemia) and 25.6% with osteomyelitis. Five patients required an amputation: 1 major and 4 minor amputations.ConclusionsIn accordance with other international studies, foot ulcers are more likely to present on the plantar surface of the foot and largely affect overweight older males with a long standing history diabetes in our outpatient hospital in Western Sydney.