bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left Septal Atrial Tachycardia After Open-Heart Surgery
Authors: Adachi Toru , Yoshida Kentaro , Takeyasu Noriyuki , Masuda Keita , Sekiguchi Yukio , Sato Akira , Tada Hiroshi , Nogami Akihiko , Aonuma Kazutaka 
Published: November 2014

Background—
Septal atrial tachycardia (AT) can occur in patients without structural heart disease and in patients with previous catheter ablation of atrial fibrillation. We aimed to assess septal AT that occurs after open-heart surgery.

Methods and Results—

This study comprised 20 consecutive patients undergoing catheter ablation of macroreentrant AT after open-heart surgery. Relevance to surgical approach, mechanisms, anatomic and electrophysiological characteristics, and outcomes were assessed. Septal AT was identified in 7 patients who had all undergone mitral valve surgery. All septal ATs were localized in the left atrial septum, whereas 10 of 13 nonseptal ATs originated from the right atrium. Patients with left septal AT had a thicker fossa ovalis (median, 4.0; 25th–75th percentile, 3.6–4.2 versus 2.3; 1.6–2.6 mm;
P
=0.006) and broader area of low voltage (<0.3 mV) in the septum than patients with nonseptal AT (82; 76–89 versus 31; 28%–36%;
P
=0.02). Repeated gradual prolongations of the tachycardia cycle length without change of the septal circuit were observed in all patients with septal AT (70; 63–100 versus 15; 10–40 ms;
P
=0.0008). Although ablation terminated all ATs, recurrence of targeted ATs was more frequent in patients with left septal AT during 30-month follow-up (71 versus 0%;
P
=0.001).

Conclusions—
Left septal AT after open-heart surgery was characterized by a thicker septum, more scar burden in the septum, and repeated prolongations of the tachycardia cycle length during ablation. Such an arrhythmogenic substrate may interfere with transmural lesion formation by ablation and may account for higher likelihood of recurrence of left septal AT.
Components of Hemodynamic Load and Cardiovascular Events
Authors: Cooper Leroy L. , Rong Jian , Benjamin Emelia J. , Larson Martin G. , Levy Daniel , Vita Joseph A. , Hamburg Naomi M. , Vasan Ramachandran S. , Mitchell Gary F. 
Published: November 2014

Background—
Elevated blood pressure is the leading modifiable risk factor for cardiovascular disease (CVD) and premature death. The blood pressure waveform consists of discrete hemodynamic components, derived from measured central pressure and flow, which may contribute separately to risk for an adverse outcome. However, pressure-flow measures have not been studied in a large, community-based sample.

Methods and Results—

We used proportional hazards models to examine the association of incident CVD with forward pressure wave amplitude, mean arterial pressure, and global reflection coefficient derived from wave separation analysis and echocardiography in 2492 participants (mean age 66±9 years, 56% women) in the Framingham Heart Study. During follow-up (0.04–6.8 years), 149 participants (6%) had a CVD event. In multivariable models adjusting for age, sex, antihypertensive therapy, body mass index, heart rate, total and high-density lipoprotein cholesterol concentrations, smoking, and the presence of diabetes mellitus, forward pressure wave amplitude (hazard ratio, 1.40; 95% confidence interval, 1.16–1.67;
P
=0.0003) was associated with incident CVD, whereas mean arterial pressure (hazard ratio, 1.10; 95% confidence interval, 0.94–1.29;
P
=0.25) and global wave reflection (hazard ratio, 0.93; 95% confidence interval, 0.78–1.12;
P
=0.58) were not. After adding systolic blood pressure and carotid-femoral pulse wave velocity to the model, forward pressure wave amplitude persisted as a correlate of events (hazard ratio, 1.33; 95% confidence interval, 1.05–1.68;
P
=0.02).

Conclusions—
Higher forward pressure wave amplitude (a measure of proximal aortic geometry and stiffness) was associated with increased risk for incident CVD, whereas mean arterial pressure and relative wave reflection (correlates of resistance vessel structure and function) were not associated with increased risk for incident CVD.
Electrocardiographic Deep Terminal Negativity of the P Wave in V
1
and Risk of Sudden Cardiac Death: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Tereshchenko Larisa G. , Henrikson Charles A. , Sotoodehnia Nona , Arking Dan E. , Agarwal Sunil K. , Siscovick David S. , Post Wendy S. , Solomon Scott D. , Coresh Josef , Josephson Mark E. , Soliman Elsayed Z. 
Published: November 2014

Background

Identifying individuals at risk for sudden cardiac death (
SCD
) is of critical importance. Electrocardiographic (
ECG
) deep terminal negativity of P wave in V
1
(
DTNPV
1), a marker of left atrial abnormality, has been associated with increased risk of all‐cause and cardiovascular mortality. We hypothesized that
DTNPV
1 is associated with increased risk of sudden cardiac death (
SCD
).

Methods and Results

This analysis included 15 375 participants (54.1±5.8 years, 45% men, 73% whites) from the Atherosclerosis Risk in Communities (
ARIC
) study.
DTNPV
1 was defined from the resting 12‐lead
ECG
as presence of biphasic P wave (positive/negative) in V
1
with the amplitude of the terminal negative phase >100 μV, or one small box on
ECG
scale. After a median of 14 years of follow‐up, 311 cases of
SCD
occurred. In unadjusted Cox regression,
DTNPV
1 was associated with an 8‐fold increased risk of
SCD
(
HR
8.21; [95%
CI
5.27 to 12.79]). Stratified by race and study center, and adjusted for age, sex, coronary heart disease (
CHD
), and
ECG
risk factors, as well as atrial fibrillation (
AF
), stroke,
CHD
, and heart failure (
HF
) as time‐updated variables, the risk of
SCD
associated with
DTNPV
1 remained significant (2.49, [1.51–4.10]).
DTNPV
1 improved reclassification: additional 3.4% of individuals were appropriately reclassified into a higher
SCD
risk group, as compared with traditional
CHD
risk factors alone. In fully adjusted models
DTNPV
1 was associated with increased risk of non‐fatal events:
AF
(5.02[3.23–7.80]),
CHD
(2.24[1.43–3.53]),
HF
(1.90[1.19–3.04]), and trended towards increased risk of stroke (1.88[0.99–3.57]).

Conclusion

DTNPV
1 is predictive of
SCD
suggesting its potential utility in risk stratification in the general population.
Prevertebral Space Invasion in Head and Neck Cancer
Authors: Imre Abdulkadir , Pinar Ercan , Erdoğan Nezahat , Ece Ahmet Ata , Olgun Yuksel , Aladag Ibrahim , Ozturkcan Sedat 
Published: November 2014

Objective: This study evaluated the diagnostic value of magnetic resonance imaging (MRI) and computed tomography (CT) in prevertebral space invasion in patients with head and neck squamous cell carcinomas (HNSCC). Subjects and Methods: This study retrospectively reviewed 197 patients with advanced primary laryngeal or hypopharyngeal carcinoma who underwent laryngectomy and neck dissection at our institution. The MRI and CT findings were compared with the surgical findings and postoperative pathology. Results: In 191 patients, the macro- and microscopic margins of the surgical specimens were tumor-free. In the remaining 6 patients, prevertebral space involvement was observed intraoperatively. MRI predicted the absence of prevertebral fascia invasion in 40 of 42 patients with a negative predictive value of 100% and specificity of 95.2%, while the negative predictive value and specificity of CT were 99.2% and 88.2%, respectively. Conclusion: Preservation of the retropharyngeal fat plane on MRI reliably predicts the absence of prevertebral space fixation in patients with advanced HNSCC.
The Effect of Voice Rest on the Outcome of Phonosurgery for Benign Laryngeal Lesions
Authors: Kiagiadaki Devora , Remacle Marc , Lawson George , Bachy Vincent , Van der Vorst Sebastien 
Published: November 2014

Objectives: According to the literature, voice rest following phonosurgery, as recommended in clinical practice, varies between 3 and 7 days. However, up until now, no randomized trials have been published comparing voice rest of short versus long duration. Methods: This is an ongoing prospective randomized study, comparing strict voice rest of 5 versus 10 days on the voice following phonosurgery. Thirty-one elective patients operated on for benign laryngeal lesions were randomized. They completed pre- and postoperative assessments, including perceptual voice quality (Grade, Roughness, Breathiness, Asthenia, Strain, Instability scale), Voice Handicap Index total score, and voice analysis with both acoustic and aerodynamic measurements. Additional factors such as smoking, vocal abuse, reflux, and preoperative speech therapy were also taken into account. Results: Sixteen patients were randomized to follow 5 days’ voice rest and 15 patients were randomized to 10 days’ voice rest. Statistical analysis showed no significant differences in pre- or postoperative measurements between the 2 groups. However, multilinear regression analysis for the effect of voice rest duration on postoperative values showed a significant improvement in maximum phonation time (MPT) with 10 days’ voice rest. Conclusions: Preliminary results show a benefit of prolonged voice rest (10 days’ duration) on MPT.
Diurnal variation and short-term pre-analytical stability of serum soluble α-klotho in healthy volunteers: a pilot study
Authors: Tan Sven-Jean , Smith Edward R , Hewitson Tim D , Holt Stephen G , Toussaint Nigel D 
Published: November 2014

Aim To investigate the diurnal variability and pre-analytical stability of soluble α-klotho in serum. Background Recent evidence suggests that the cleaved extracellular domain of the α-klotho receptor, soluble α-klotho, affects phosphate homeostasis, ion channel regulation and antifibrotic/antioxidant pathways. However, soluble α-klotho measurements have yielded inconsistent results when related to renal function, markers of mineral metabolism and patient outcomes. Pre-analytical factors such as biological variation and analyte stability may affect the interpretation of soluble α-klotho results but are yet to be formally assessed. Methods Clotted blood samples were collected from 10 healthy adult volunteers at three time-points during the day to assess diurnal change. Additional samples were collected and allowed to stand at room temperature for 30, 60 and 120 min, prior to centrifugation and analysis to evaluate analyte stability. Serum soluble α-klotho was measured using a validated commercial enzyme-linked immunosorbent assay. Results Delayed processing of samples had no significant effect on serum soluble α-klotho concentrations over a 2-h period. Serum soluble α-klotho concentrations remained stable over morning, midday and afternoon time-points in this pilot study. Conclusion Serum soluble α-klotho demonstrates short-term pre-analytical stability and minimal diurnal variability in this pilot study. Larger studies are warranted to confirm these findings.
Ruptured abdominal aortic aneurysms: decreasing incidence may reduce the impact of a Scottish screening programme
Authors: Dreyer Stephan B , Burns Paul 
Published: November 2014

Objectives The aim of this study was to determine whether there has been a change in annual ruptured abdominal aortic aneurysm admissions and elective abdominal aortic aneurysm repairs in a tertiary vascular surgery department. Methods All patients admitted with ruptured abdominal aortic aneurysm from 1987 to 2009 and all undergoing elective abdominal aortic aneurysm repair from 1995 to 2009 were identified from the local surgical audit database. Annual ruptured abdominal aortic aneurysm admissions were calculated and compared in the first and second halves of the study period. Results During a 23-year period, 888 patients (male 728, female 158, gender was not documented for two patients) were identified with a ruptured abdominal aortic aneurysm. The annual number of admissions remained relatively constant from 1987 to 1997, with a mean of 44 (95% CI 39.91–48.09). There was a significant decrease to a mean of 33.67 per annum (95% CI 28.53–38.8) in the period 1998–2009, p = 0.006. The mean mortality was 39.8% and showed no significant decrease. There was no increase in the number of elective abdominal aortic aneurysm repairs during the study period. Conclusions This study suggests that the incidence of ruptured abdominal aortic aneurysms is decreasing, mirroring the trend seen in other cardiovascular disease. As such, further analysis as to the cost-effectiveness of a Scottish screening programme is merited.
How to prevent venous cannula orifice obstruction during extracorporeal circulation
Authors: Abdel-Sayed S , Favre J , von Segesser LK 
Published: November 2014

Venous cannula orifice obstruction is an underestimated problem during augmented cardiopulmonary bypass (CPB), which can potentially be reduced with redesigned, virtually wall-less cannula designs versus traditional percutaneous control venous cannulas. A bench model, allowing for simulation of the vena cava with various affluent orifices, venous collapse and a worst case scenario with regard to cannula position, was developed. Flow (Q) was measured sequentially for right atrial + hepatic + renal + iliac drainage scenarios, using a centrifugal pump and an experimental bench set-up (afterload 60 mmHg). At 1500, 2000 and 2500 RPM and atrial position, the Q values were 3.4, 6.03 and 8.01 versus 0.77*, 0.43* and 0.58* l/min: p<0.05* for wall-less and the Biomedicus® cannula, respectively. The corresponding pressure values were -15.18, -31.62 and -74.53 versus -46.0*, -119.94* and -228.13* mmHg. At the hepatic position, the Q values were 3.34, 6.67 and 9.26 versus 2.3*, 0.42* and 0.18* l/min; and the pressure values were -10.32, -20.25 and -42.83 versus -23.35*, -119.09* and -239.38* mmHg. At the renal position, the Q values were 3.43, 6.56 and 8.64 versus 2.48*, 0.41* and 0.22* l/min and the pressure values were -9.64, -20.98 and -63.41 versus -20.87 -127.68* and -239* mmHg, respectively. At the iliac position, the Q values were 3.43, 6.01 and 9.25 versus 1.62*, 0.55* and 0.58* l/min; the pressure values were -9.36, -33.57 and -44.18 versus -30.6*, -120.27* and -228* mmHg, respectivly. Our experimental evaluation demonstrates that the redesigned, virtually wall-less cannulas, allowing for direct venous drainage at practically all intra-venous orifices, outperform the commercially available control cannula, with superior flow at reduced suction levels for all scenarios tested.
A study of whether video scoring is a reliable option for blinded scoring of the Gross Motor Function Measure-88
Authors: Franki Inge , Van den Broeck Chris , De Cat Josse , Molenaers Guy , Vanderstraeten Guy , Desloovere Kaat 
Published: November 2014

Objective: To investigate the agreement between live and video scores of the Gross Motor Function Measure-88. Design: Reliability study. Subjects: Forty children with bilateral spastic cerebral palsy. Interventions: Fifty evaluations were administered according to the test guidelines, and were videotaped. After a minimum interval of one month, the video recordings were again rated by the same assessor. Two physical therapy students also each scored the recordings twice, with a minimal interval of one month. Main measures: Agreement between live and video scores as well as inter-rater and intra-rater agreement of the video scores were assessed using intra-class correlation coefficients (ICC), standard error of measurements (SEM), and smallest detectable changes (SDC). Weighted kappa coefficients were used to analyse individual items. Results: The live and video scores from the same assessor showed good to very good agreement for the total score (ICC, 0.973; SEM, 2.28; SDC, 6.32) and dimensions B (ICC, 0.938), D (ICC, 0.965), and E (ICC, 0.992) but lower agreement for A (ICC, 0.720) and C (ICC, 0.667). Live-versus-video agreement for the total score was higher than inter-rater agreement by video (ICC, 0.949; SEM, 3.15; SDC, 8.73) but lower than intra-rater agreement by video (ICC, 0.989; SEM, 1.42; SDC, 3.96). Conclusion: The Gross Motor Function Measure-88 can be reliably scored using video recordings. The agreement between live and video scores is lower than the intra-rater reliability using video recordings only. Future clinical trial results should be interpreted using the appropriate SEM and SDC values.
Hiccups as a migraine aura
Authors: Chaudhry Priyanka , Friedman Deborah I 
Published: November 2014

Objective To report a case series of hiccup as a migraine aura. Background Hiccup is a syndrome of inappropriate muscle contraction. To our knowledge, hiccup as a migraine aura has not been reported. Case series We describe series of patients who presented with hiccups as their migraine aura symptom. Conclusion Hiccups can present as a primary aura symptom in patients with migraine.
Eltrombopag as steroid sparing therapy for immune thrombocytopenic purpura in systemic lupus erythematosus
Authors: Maroun M-C , Ososki R , Andersen J C , Dhar J P 
Published: November 2014

Background Eltrombopag activates the thrombopoietin (TPO) surface receptor on the megakaryocyte, which increases the production of platelets, and rapidly improves circulating platelet numbers in patients with immune thrombocytopenic purpura (ITP). This allows for rapid tapering and/or cessation of corticosteroid therapy. Less is known about the platelet response to this drug in ITP associated with systemic lupus erythematosus (SLE). Methods A retrospective review was performed of the clinical course of three consecutive patients, each with SLE-associated ITP who were initially treated with corticosteroids or other immunomodulatory therapy. These patients were treated with eltrombopag at the DMC Center for Bleeding Disorders and Thrombosis. Eltrombopag was administered according the package insert, with an initial dose of 50 mg daily, with weekly, then monthly monitoring of platelet counts and dose adjustments. Some immunomodulatory agents (e.g. hydroxychloroquine) were continued to control non hematologic SLE manifestations. Results All three patients maintained acceptable platelet counts (>50,000/mm3 for >3 years) following tapering and cessation of corticosteroids. The drug was well-tolerated and there were no adverse events, and specifically no thrombotic events. Conclusion Eltrombopag is effective as a rapidly acting corticosteroid sparing therapy for patients with ITP associated with SLE. This is important in reducing corticosteroid related side effects and morbidities in treating SLE patients with ITP. Larger studies are needed to ascertain safety and efficacy of eltrombopag in SLE patients with ITP, particularly those with coexisting antiphospholipid antibodies.
The significance of small things for dignity in psychiatric care
Authors: Skorpen Frode , Rehnsfeldt Arne , Thorsen Arlene Arstad 
Published: November 2014

Background: This study is based on the ontological assumption about human interdependence, and also on earlier research, which has shown that patients in psychiatric hospitals and their relatives experience suffering and indignity. Aim: The aim of this study is to explore the experience of patients and relatives regarding respect for dignity following admission to a psychiatric unit. Research design: The methodological approach is a phenomenological hermeneutic method. Participants and research context: This study is based on qualitative interviews conducted with six patients at a psychiatric hospital and five relatives of patients who experienced psychosis. Ethical consideration: Permission was given by the Regional Committee for Medical Research Ethics in Western Norway, the Norwegian Data Protection Agency and all wards within the hospital in which the patients were interviewed. Findings: The analysis revealed one main theme: ‘The significance of small things for experiencing dignity’ and four subthemes described as follows - ‘to be conscious of small things’, ‘being conscious of what one says’, ‘being met’ and ‘to be aware of personal chemistry’. Discussion and conclusion: Staff members seem not to give enough attention to the importance of these small things. Staff members need to explore this phenomenon systematically and expand their own understanding of it.
Destructive Pseudo-neuroarthropathy Associated With Calcium Pyrophosphate Deposition
Authors: Lomax Adam , Ferrero Andrea , Cullen Nick , Goldberg Andy , Singh Dishan 
Published: November 2014

Background: Calcium pyrophosphate deposition (CPPD) disease is a metabolic disorder characterized by soft tissue calcific deposits formed primarily in articular cartilage. What can result is a crystal-induced arthropathy often referred to as pseudogout, which is variable in both presentation and severity. A particularly destructive and deforming arthritis is an uncommon but well-recognized subtype of this disease. Radiologically resembling the neuroarthropathy described by Charcot, a pattern of joint fragmentation and structural collapse occurs in the absence of peripheral neuropathy. This pseudo-neuroarthropathy is rarely reported in the foot and ankle. Methods: A total of 15 cases of pseudo-neuroarthropathy involving some previously unreported joints within the foot and ankle are described in this case series of 9 patients. Results: All patients presented with disease involving multiple joints. Clinical deformity was apparent in each case, and extensive joint destruction was seen on plain radiographs. In 6 patients, histopathological CPPD disease was confirmed on tissue biopsy of the affected joints. In the remaining 3 patients a clinical diagnosis was made on the basis of the classic appearance of pseudo-neuroarthropathy in the foot, with additional recognized features of CPPD. Operative management with deformity correction using joint arthrodesis produced satisfactory clinical and radiological results. Conclusions: In the absence of peripheral neuropathy and systemic disease, the pseudo-neuroarthropathy of CPPD should be considered when a progressively deforming and destructive arthritis is seen in the foot and ankle. Level of Evidence: Level IV, case series.
The fragile site WWOX gene and the developing brain
Authors: Tabarki Brahim , Al Mutairi Fuad , Al Hashem Amal 
Published: November 2014

WWOX was cloned as a tumor suppressor gene mapping to chromosomal fragile site FRA16D. Loss of WWOX is closely related to tumorigenesis, cancer progression, and therapy resistance. Recent studies demonstrate the growing role of WWOX gene in other human pathologies such as metabolic and nervous system-related conditions. The neurologic phenotype of WWOX mutation includes seizures, ataxia, developmental delay, and spasticity of variable severity. WWOX is a ubiquitous protein with high expression in many tissues including brain, cerebellum, brain stem, and spinal cord. WWOX is highly expressed in different brain regions during murine fetal development and remained unchanged in the cortex and the corpus callosum in adult mice. The mechanism or the putative role of WWOX in the nervous system is still unclear but may include abnormal signaling protein, disruption of neuronal pathways, neuronal differentiation, mitochondrial dysfunction, or apoptosis. Homozygous mutations affecting WWOX in humans are likely to be more described in the future using exome sequencing. The described findings highlight that WWOX plays a critical role in normal central nervous system development and disease. The aim of this review is to summarize the roles of WWOX in the developing brain.