bluuebunny/crossref_metadata_2025_split huggingface dataset:
Meningitis following spinal anaesthesia in an obstetric patient
Authors: Celik Mine , Kizilkaya Mehmet , Dostbil Aysenur , Dogan Nazim , Parlak Mehmet , Can Fatma Kesmez , Bayar Meral 
Published: March 2014

Meningitis following lumbar puncture and spinal anaesthesia is a rare but serious complication. A 19-year-old woman was administered spinal anaesthesia at another centre prior to a Caesarean section. The following day she experienced headaches. On the fourth day, she started vomiting and having convulsions, and became agitated. Meningitis was diagnosed based on a clinical examination and analysis of a lumbar puncture sample. After 21 days of treatment, she was discharged. Meningitis should be considered in the differential diagnosis of a patient presenting with headaches following spinal anaesthesia. The causes of meningitis following spinal anaesthesia are debated, and it is difficult to distinguish between aseptic and bacterial meningitis. It should be compulsory to wear a face mask while performing a dural puncture.
Simulation of pollution transport in buildings: the importance of taking into account dynamic thermal effects
Authors: Taylor Jonathon , Shrubsole Clive , Biddulph Phillip , Jones Benjamin , Das Payel , Davies Michael 
Published: March 2014

The recent introduction of the Generic Contaminant Model in EnergyPlus allows for the integrated modelling of multizone contaminant and dynamic thermal behaviour within a single simulation package. This article demonstrates how dynamic thermal simulation can modify pollutant transport within a building. PM2.5 infiltration from the external to internal environment under dynamic thermal conditions is compared in CONTAM, EnergyPlus 8.0, and Polluto, an in-house pollutant transport model developed in EnergyPlus 3.1. The influence of internal temperature on indoor PM2.5 levels is investigated by comparing results from standard CONTAM simulations and dynamic thermal EnergyPlus 8 simulations. Circumstances where the predictions of such models can diverge are identified. Practical application:This technical note compares the performance of a new indoor air quality model in EnergyPlus, an EnergyPlus in-house model (Polluto), and an established model (CONTAM). The work then compares the results of indoor air quality models under static and dynamic internal temperature conditions, and demonstrates how predicted indoor pollution levels may deviate significantly if an inappropriate indoor temperature is used. Practically, the work provides confidence in the new models, as well as demonstrating the importance of having a good understanding of the thermal behaviour of a building when modelling indoor air quality.
Sensitivity Plots for Confounder Bias in the Single Mediator Model
Authors: Cox Matthew G. , Kisbu-Sakarya Yasemin , Miočević Milica , MacKinnon David P. 
Published: March 2014

Background: Causal inference continues to be a critical aspect of evaluation research. Recent research in causal inference for statistical mediation has focused on addressing the sequential ignorability assumption; specifically, that there is no confounding between the mediator and the outcome variable. Objectives: This article compares and contrasts three different methods for assessing sensitivity to confounding and describes the graphical depiction of these methods. Design: Two types of data were used to fully examine the plots for sensitivity analysis. The first type was generated data from a single mediator model with a confounder influencing both the mediator and the outcome variable. The second was data from an actual intervention study. With both types of data, situations are examined where confounding has a large effect and a small effect. Subjects: The nonsimulated data were from a large intervention study to decrease intentions to use steroids among high school football players. We demonstrate one situation where confounding is likely and another situation where confounding is unlikely. Conclusions: We discuss how these methods could be implemented in future mediation studies as well as the limitations and future directions for these methods.
Water Uptake Performance of Hygroscopic Heat and Moisture Exchangers after 24‐Hour Tracheostoma Application
Authors: van den Boer Cindy , Vas Nunes Jonathan H. , Muller Sara H. , van der Noort Vincent , van den Brekel Michiel W. M. , Hilgers Frans J. M. 
Published: March 2014

ObjectiveAfter total laryngectomy, patients suffer from pulmonary complaints due to the shortcut of the upper airways that results in decreased warming and humidification of inspired air. Laryngectomized patients are advised to use a heat and moisture exchanger (HME) to optimize the inspired air. According to manufacturers’ guidelines, these medical devices should be replaced every 24 hours. The aim of this study is to determine whether HMEs still function after 24‐hour tracheostoma application.Study DesignAssessment of residual water uptake capacity of used HMEs by measuring the difference between wet and dry core weight.SettingTertiary comprehensive cancer center.Subjects and MethodsThree hygroscopic HME types were tested after use by laryngectomized patients in long‐term follow‐up. Water uptake of 41 used devices (including 10 prematurely replaced devices) was compared with that of control (unused) devices of the same type and with a control device with a relatively low performance.ResultsAfter 24 hours, the mean water uptake of the 3 device types had decreased compared with that of the control devices. For only one type was this difference significant. None of the used HMEs had a water uptake lower than that of the low‐performing control device.ConclusionThe water uptake capacity of hygroscopic HEMs is clinically acceptable although no longer optimal after 24‐hour tracheostoma application. From a functional point of view, the guideline for daily device replacement is therefore justified.
Effects of Endoscopic Sinus Surgery and Nasal Surgery in Patients with Obstructive Sleep Apnea
Authors: Yalamanchali Sreeya , Cipta Stephanie , Waxman Jonathan , Pott Thomas , Joseph Ninos , Friedman Michael 
Published: April 2014

ObjectivesTo evaluate the impact of combined nasal surgery and endoscopic sinus surgery on the objective measurements of obstructive sleep apnea (OSA) and sleep architecture by comparing polysomnographic data before and after combined surgery in patients with OSA.Study DesignCase series with chart review.SettingA single clinical site.Subjects and MethodsPatients with OSA and chronic rhinosinusitis who underwent combined nasal surgery and endoscopic sinus surgery and preoperative and postoperative polysomnography were identified. Patient charts were reviewed and preoperative and postoperative body mass index, apnea‐hypopnea index (AHI), mean and minimum oxygen saturation, sleep efficiency, and sleep staging were compared.ResultsFifty‐six patients were included in our study. Patients were divided into 3 groups on the basis of the severity of OSA: those with mild OSA (n = 9), those with moderate OSA (n = 23), and those with severe OSA (n = 24). After combined nasal and sinus surgery, the mean AHI significantly decreased from 33.5 ± 22.0 to 29.4 ± 20.8 (P =. 009) in our overall population. Specifically, AHI improved significantly in patients with moderate OSA (from 22.3 ± 4.8 to 20.7 ± 8.2, P =. 023) and severe OSA (from 52.3 ± 21.4 to 43.6 ± 23.9, P =. 034), while patients with mild OSA did not have significant changes in AHI. Successful surgical procedures were achieved in only 2 of 56 patients.ConclusionAlthough combined nasal and sinus surgery may slightly improve AHI in a certain group of patients, it does not cure OSA or have a significant clinical impact.
Tricuspid annuloplasty with the MC3 ring and septal plication technique
Authors: Isomura Tadashi , Hirota Masanori , Hoshino Joji , Fukada Yasuhisa , Kondo Taichi , Takahashi Yu 
Published: March 2014

Background Functional tricuspid regurgitation is caused by annular dilation mainly in the posterior annulus. However, ring annuloplasty does not always prevent the recurrence of tricuspid regurgitation due to dilation of the septal annulus. We developed a septal plication technique with a 3-dimensional MC3 ring. Methods Between 2006 and 2011, 76 patients (male/female 30/46; mean age 68 ± 11 years) with functional tricuspid regurgitation received tricuspid ring annuloplasty. After placement of the annular sutures, the 3 commissural ring portions were fixed on the equivalent commissures to plicate the anterior and posterior annulus. The end of the septal ring portion was fixed at the optimal annular position to obtain minimal tricuspid regurgitation. All patients were followed-up for a mean of 47 ± 18 months; the longest duration was 79 months. Results Although there was no operative death, one patient died of sepsis during hospitalization (hospital mortality 1.3%). After implantation of the MC3 ring (mean size 31.0 ± 3.3 mm), additional edge-to-edge sutures were required for minor leakage in 5 (7%) patients. The degree of tricuspid regurgitation was significantly reduced at discharge (0.5 ± 0.6) and midterm (0.6 ± 0.6) compared to 2.5 ± 0.7 before the operation ( p < 0.0001). Conclusions The surgical durability of the MC3 ring was satisfactory at early and midterm follow-up, suggesting that correct plication of the septal annulus is effective for tricuspid ring annuloplasty with a 3-dimensional MC3 ring.
The distribution and extent of reflux and obstruction in patients with active venous ulceration
Authors: Kanth Aditi M , Khan Sami U , Gasparis Antonis , Labropoulos Nicos 
Published: March 2014

Objectives This study was performed to precisely define the underlying pathophysiology in patients with active venous ulcers. Methods A PubMed search was conducted from 1991 to 2013 to select papers reporting the anatomic and physiologic etiology of ulceration in CEAP Class 6 patients. Studies which did not decipher between active and healed ulcers, did not use clear definitions, or did not give detailed accounts on the distribution/extent of venous pathology were excluded. Using the PRISMA guidelines, 12 studies were selected for further analysis. Results Primary insufficiency was reportedly the most common etiology of ulcers. Reflux most frequently occurred in the superficial system, either isolated or in conjunction with perforating and/or deep systems. Combined superficial and deep disease was observed in a median of 11.6% of limbs (range of 0–48%). Triple system disease was seen in a median of 31.6% of limbs (range of 22–52%). Isolated deep reflux was infrequently reported (2.1–28.4% of limbs). Previous deep venous thrombosis, reported in a median of 33% of patients, is likely underreported as it may resolve without detectable damage. Conclusion There is a lack of data in the literature regarding the etiology of chronic active venous ulcers. Insufficiency of the superficial venous system from the micro- to the macro-vasculature has been frequently implicated in the development of venous ulceration. A prospective randomized controlled study is required for more conclusive results.
Interpretation of automated breast ultrasound (ABUS) with and without knowledge of mammography: a reader performance study
Authors: Skaane Per , Gullien Randi , Eben Ellen B. , Sandhaug Merete , Schulz-Wendtland Ruediger , Stoeblen Frank 
Published: March 2014

Background Automated breast ultrasonography (ABUS) has the potential to be an important adjunct to mammography in women with dense breasts. Purpose To compare reader performance and inter-observer variation of ABUS alone and in combination with mammography. Material and Methods This retrospective study had ethical committee approval. All women gave written informed consent. One hundred and fourteen breasts in 90 women examined by digital mammography and ABUS were interpreted by five radiologists using BI-RADS categories. The 114 breasts included 38 cancers and 76 normal or benign findings. In the first reading session ABUS only was interpreted, and in the second ABUS plus digital mammography. Image interpretations were done without knowledge of clinical or imaging results. A consensus panel analyzed false negative and false positive interpretations. Reading time was recorded for one radiologist. AUC was used for performance measurement, and kappa statistic for inter-observer variability. Results Mean size for cancers was 16.2 mm; area under the curve (AUC) values for ABUS alone and for combined reading were, respectively: reader A, 0.592–0.744; reader B, 0.740–0.947; reader, C 0.759–0.823; reader D, 0.670–0.688; reader E, 0.904–0.923; and all readers combined 0.730–0.823. The higher AUC for combined reading was statistically significant ( P < 0.05) for reader B and for all readers. There was a considerable inter-observer variability. Observer agreement revealed following kappa values for ABUS alone and combined reading, respectively: reader A, 0.22–0.30; reader B, 0.33–0.44; reader C, 0.32–0.39; reader D, 0.07–0.14; and reader E, 0.34–0.43. Shadowing from dense parenchyma was the most common cause of false positive ABUS interpretations. Mean interpretation time for a bilateral normal ABUS examination was 9 min. Conclusion Observer agreement was higher and all radiologists improved diagnostic performance using combined ABUS and mammography interpretation. Combined reading should be standard if ABUS is implemented in screening of women with dense breasts.
Primary renal synovial sarcoma: computed tomography imaging findings
Authors: Lv Xiao-Fei , Qiu Ying-Wei , Han Lu-Jun , Cao Jing , Zhang Chao , Liu Zhen-Yin , Zhang Xue-Lin , Cai Pei-Qiang , Li Li 
Published: March 2014

Background: A synovial sarcoma arising from the kidney is extremely rare. To date, few data are available on their radiological features. Purpose: To identify the computer tomography (CT) imaging findings of primary renal synovial sarcomas (PRSSs). Material and Methods: Five cases of PRSS confirmed by histopathological and cytogenetic studies were retrospectively analyzed. All patients had undergone unenhanced and multiphase enhanced CT examinations (one patient underwent CT twice). The CT characteristics, including shape, size, margin, attenuation, and enhancement pattern after intravenous contrast medium injection, were analyzed. Results: The study involved two female and three male patients (mean age, 27.4 years; range, 15–43 years). Unenhanced CT showed completely or partly well-defined masses, with heterogeneous ( n = 5) or homogeneous ( n = 1) patchy low density. On multiphase contrast-enhanced CT, in five of the six CT examinations, the tumors appeared as solid-cystic masses with cyst walls or pseudo-capsules, and demonstrated moderately heterogeneous ( n = 5) and/or septate enhancement ( n = 2), with a “rapid wash-in and slow wash-out” pattern of enhancement in the solid component. Only one tumor showed a simple cyst appearance and developed an irregular, intratumoral, septate soft density 8 months later. A renal vein and inferior vena cava thrombus was noticed in one patient, while lymphadenopathy was not observed in any patient. Conclusion: PRSS should be included in the differential diagnosis when an adolescent or young adult presents with a renal neoplasm appearing as a solid-cystic mass with well-defined borders, a cystic wall or pseudo-capsule, heterogeneous or septate enhancement, a “rapid wash-in and slow wash-out” pattern of enhancement in the solid component, and no sign of lymphadenopathy.
Respiratory gated and prolonged acquisition 18F-FDG PET improve preoperative assessment of colorectal liver metastases
Authors: Revheim Mona-Elisabeth , Haugvik Sven-Petter , Johnsrud Kjersti , Mathisen Øystein , Fjeld Jan Gunnar , Skretting Arne 
Published: March 2014

Background Detection of small liver metastases from colorectal cancer by 18F-FDG PET/CT is hampered by high physiologic uptake in the liver parenchyma and respiratory movements during image acquisition. Purpose To investigate whether two tailored 18F-FDG PET liver acquisitions (prolonged liver acquisition time [PL-PET] and repeated breath-hold respiratory gated liver acquisition [RGL-PET]) would improve detection of colorectal liver metastases, when added to a standard whole body PET (WB-PET). Material and Methods Twenty consecutive patients referred to our hospital for surgical treatment of colorectal liver metastases diagnosed with contrast-enhanced CT underwent preoperative 18F-FDG PET/CT tailored for detection of liver metastases. Concordance between preoperative imaging results and true findings (histology and/or follow-up imaging) as well as changes in clinical management, based on 18F-FDG PET/CT findings, were documented. Background noise, defined as the standard deviation measured in a reference region within the normal liver parenchyma, was compared between the three 18F-FDG PET/CT protocols. Results WB-PET, PL-PET, and RGL-PET showed suspicious liver lesions in 18 out of 20 patients. Compared to WB-PET alone, the combination of PL-PET and RGL-PET showed additional lesions in the liver in seven out of the 18 patients. The combination of all three PET acquisitions changed clinical management in four patients. Two patients with negative PET results were later found to have benign liver lesions. Conclusion The addition of tailored liver-specific 18F-FDG PET/CT protocols (PL-PET and RGL-PET) to a WB-PET, improved the detection of intrahepatic colorectal metastases, compared to WB-PET alone. Such add-ons can change clinical patient management of potentially resectable colorectal liver metastases.
Phenotype of migraine headache and migraine aura of Richard Wagner
Authors: Göbel Anna , Göbel Carl H , Göbel Hartmut 
Published: March 2014

Background The headache phenotype and neurological symptoms of the German composer Richard Wagner (1813–1883), whose music dramas count towards the most frequently performed operas across the world, are previously undocumented. Methods Richard Wagner’s own descriptions of his headache symptoms in his original writings and letters are investigated, as well as the complete diary records of his second wife, Cosima Wagner. Results There are manifold indications that Richard Wagner suffered from a severe headache disorder, which fulfils most likely the diagnostic criteria of migraine without aura and migraine with aura of ICHD-3 beta. Conclusions Richard Wagner’s life and opus can help to better understand the burden and suffering caused by migraine with its severe effects on the individual, familial and social life, the culture and community.
Measurement of the Glenoid Track In Vivo as Investigated by 3-Dimensional Motion Analysis Using Open MRI
Authors: Omori Yasushi , Yamamoto Nobuyuki , Koishi Hayato , Futai Kazuma , Goto Akira , Sugamoto Kazuomi , Itoi Eiji 
Published: March 2014

Background: A Hill-Sachs lesion is a common injury associated with anterior glenohumeral instability, and a Hill-Sachs lesion that engages with the anterior glenoid rim is 1 factor related to recurrent instability. In a cadaveric study in 2007, a new concept, the “glenoid track,” was proposed to evaluate the risk of engagement of Hill-Sachs lesions with the glenoid. Purpose: To investigate the glenoid track in vivo using a custom-developed noninvasive motion analysis system. Study Design: Descriptive laboratory study. Methods: Using a wide-gantry magnetic resonance imaging (MRI) scanner, the right shoulders of 30 healthy volunteers were examined. The MRI scans were taken of the right arm in 7 static supine positions from 0° to maximum abduction, keeping maximum external rotation and horizontal extension. Using the custom motion analysis system, 3-dimensional models of the scapula and humerus were created from the MRI data. Then, the movement of the humerus and scapula was calculated using voxel-based registration of each model, and the motion of the glenoid on the humeral head was analyzed. Results: The models demonstrated that glenoid contact shifted from the inferomedial to the superolateral portion of the humeral head. The mean widths of the glenoid track with the arm at 60°, 90°, 120°, and 150° of abduction were 20.7 ± 4.5 mm, 19.4 ± 3.9 mm, 18.9 ± 2.7 mm, and 18.7 ± 2.5 mm (89%, 83%, 82%, and 81% of the glenoid width), respectively. The width of the glenoid track at 60° of abduction was significantly greater than those at 90°, 120°, and 150° of abduction ( P = .0472, .0148, and .0083, respectively). There were no significant differences among widths measured at 90°, 120°, and 150° of abduction. Conclusion: The existence and widths of the glenoid track were confirmed in vivo.
A Review of Current Evidence of Olmesartan Medoxomil Mimicking Symptoms of Celiac Disease
Authors: Sanford Michele L. , Nagel Angela K. 
Published: March 2014

Objective: To review the evidence of an association between olmesartan medoxomil and symptoms mimicking celiac disease. Data Sources: Literature was searched in PubMed (1965-November 2013) using the key words or MeSH terms olmesartan, enteropathy, celiac disease, sprue, and diarrhea. References from the Food and Drug Administration (FDA) and Dipiro’s Pharmacotherapy eighth edition textbook were also reviewed. Data Synthesis: There have been recent implications of olmesartan medoxomil being linked to symptoms mimicking celiac disease. Investigators first identified the association in 22 patients who presented with presumed refractory celiac disease. Upon further evaluation, it was discovered that these symptoms improved when olmesartan was discontinued. In response to this report, additional case studies have been published. DeGaetani et al also further analyzed patients with seronegative villous atrophy from the Celiac Disease Center and found that olmesartan accounted for 22% of previously unclassified sprue cases. Conversely, the authors of the ROADMAP trial, which compared olmesartan to placebo, found no significant differences in the incidence of gastrointestinal adverse effects. Conclusions: There is growing evidence supporting the association between olmesartan and sprue-like symptoms; however, further research is warranted. These symptoms can be life threatening and clinicians should be aware of the potential association.
Clinical features of macrophage activation syndrome in the adult northern Chinese population
Authors: Li X , Qu B , Nie Y , Zhu G , Li W , Mu F 
Published: March 2014

Objective Macrophage activation syndrome (MAS) is a relatively rare but potentially fatal complication of childhood rheumatic illnesses. We sought to provide insight for the timely recognition and diagnosis of MAS and efficacious disease management in adults with rheumatic diseases. Methods Clinical files for eight adult MAS patients treated at the Second Affiliated Hospital of Harbin Medical University were analyzed for clinical manifestations, laboratory investigations, therapeutic measurements and clinical outcomes. Results The study included male and female patients with ages ranging from 16 to 59 years old. All patients were diagnosed with underlying rheumatic diseases with five patients having adult-onset Still’s disease (AOSD), two patients having systemic lupus erythematosus (SLE) and one patient having Sjögren’s syndrome (SS). The interval from fever onset to MAS diagnosis varied from seven days to 40 days. The most common clinical presentations were prolonged high fever, respiratory symptoms and jaundice. No patients had symptoms involving the central nervous system (CNS). Laboratory findings showed peripheral cytopenias, elevated liver enzymes, elevated triglycerides, hypofibrinogenemia and bone marrow hemophagocytosis. Potential effective treatments for MAS include glucocorticoid plus immunoglobulin therapy, but delays in diagnosis and treatment may lead to a fatal disease course. Conclusion MAS in adults may not be as rare as was once thought, although the clinical features of MAS in adults often differ from those seen in children. The MAS mortality in adults is far higher than that for children. A diagnosis of MAS should be considered when a patient with rheumatic disease presents with prolonged high fever, peripheral cytopenia and liver failure. Collection of bone marrow aspirates is critical for accurate diagnosis and MAS therapy should begin as early as possible.