LLukas22/scidocs huggingface dataset:
Long-term benefit of early pre-reperfusion metoprolol administration in patients with acute myocardial infarction: results from the METOCARD-CNIC trial (Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction).

OBJECTIVES
The goal of this trial was to study the long-term effects of intravenous (IV) metoprolol administration before reperfusion on left ventricular (LV) function and clinical events.


BACKGROUND
Early IV metoprolol during ST-segment elevation myocardial infarction (STEMI) has been shown to reduce infarct size when used in conjunction with primary percutaneous coronary intervention (pPCI).


METHODS
The METOCARD-CNIC (Effect of Metoprolol in Cardioprotection During an Acute Myocardial Infarction) trial recruited 270 patients with Killip class ≤II anterior STEMI presenting early after symptom onset (<6 h) and randomized them to pre-reperfusion IV metoprolol or control group. Long-term magnetic resonance imaging (MRI) was performed on 202 patients (101 per group) 6 months after STEMI. Patients had a minimal 12-month clinical follow-up.


RESULTS
Left ventricular ejection fraction (LVEF) at the 6 months MRI was higher after IV metoprolol (48.7 ± 9.9% vs. 45.0 ± 11.7% in control subjects; adjusted treatment effect 3.49%; 95% confidence interval [CI]: 0.44% to 6.55%; p = 0.025). The occurrence of severely depressed LVEF (≤35%) at 6 months was significantly lower in patients treated with IV metoprolol (11% vs. 27%, p = 0.006). The proportion of patients fulfilling Class I indications for an implantable cardioverter-defibrillator (ICD) was significantly lower in the IV metoprolol group (7% vs. 20%, p = 0.012). At a median follow-up of 2 years, occurrence of the pre-specified composite of death, heart failure admission, reinfarction, and malignant arrhythmias was 10.8% in the IV metoprolol group versus 18.3% in the control group, adjusted hazard ratio (HR): 0.55; 95% CI: 0.26 to 1.04; p = 0.065. Heart failure admission was significantly lower in the IV metoprolol group (HR: 0.32; 95% CI: 0.015 to 0.95; p = 0.046).


CONCLUSIONS
In patients with anterior Killip class ≤II STEMI undergoing pPCI, early IV metoprolol before reperfusion resulted in higher long-term LVEF, reduced incidence of severe LV systolic dysfunction and ICD indications, and fewer heart failure admissions. (Effect of METOprolol in CARDioproteCtioN During an Acute Myocardial InfarCtion. The METOCARD-CNIC Trial; NCT01311700).
Computer assisted assessment and advice for "non-serious" 999 ambulance service callers: the potential impact on ambulance despatch.

OBJECTIVE
To investigate the potential impact for ambulance services of telephone assessment and triage for callers who present with non-serious problems (Category C calls) as classified by ambulance service call takers.


DESIGN
Pragmatic controlled trial. Calls identified using priority dispatch protocols as non-serious were allocated to intervention and control groups according to time of call. Ambulance dispatch occurred according to existing procedures. During intervention sessions, nurses or paramedics within the control room used a computerised decision support system to provide telephone assessment, triage and, if appropriate, offer advice to permit estimation of the potential impact on ambulance dispatch.


SETTING
Ambulance services in London and the West Midlands.


SUBJECTS
Patients for whom emergency calls were made to the ambulance services between April 1998 and May 1999 during four hour sessions sampled across all days of the week between 0700 and 2300.


MAIN OUTCOME MEASURES
Triage decision, ambulance cancellation, attendance at an emergency department.


RESULTS
In total, there were 635 intervention calls and 611 controls. Of those in the intervention group, 330 (52.0%) were triaged as not requiring an emergency ambulance, and 119 (36.6%) of these did not attend an emergency department. This compares with 55 (18.1%) of those triaged by a nurse or paramedic as requiring an ambulance (odds ratio 2.62; 95% CI 1.78 to 3.85). Patients triaged as not requiring an emergency ambulance were less likely to be admitted to an inpatient bed (odds ratio 0.55; 95% CI 0.33 to 0.93), but even so 30 (9.2%) were admitted. Nurses were more likely than paramedics to triage calls into the groups classified as not requiring an ambulance. After controlling for age, case mix, time of day, day of week, season, and ambulance service, the results of a logistic regression analysis revealed that this difference was significant with an odds ratio for nurses:paramedics of 1.28 (95% CI 1.12 to 1.47).


CONCLUSIONS
The findings indicate that telephone assessment of Category C calls identifies patients who are less likely to require emergency department care and that this could have a significant impact on emergency ambulance dispatch rates. Nurses were more likely than paramedics to assess calls as requiring an alternative response to emergency ambulance despatch, but the extent to which this relates to aspects of training and professional perspective is unclear. However, consideration should be given to the acceptability, reliability, and cost consequences of this intervention before it can be recommended for full evaluation.
Parent and Provider Decision-Making for Infants with Hypoxic-Ischemic Encephalopathy

Background: Hypoxic ischemic encephalopathy (HIE) is one of the most serious complications of full term birth that can lead to long-term neurological consequences or death. Parents and providers are faced with making complex decisions about which therapies to pursue within hours of birth. Purpose: The purpose of this study was to describe the decisions made for infants with HIE, who participated in the decision-making process, and what factors influenced the decision-making process. Design: A longitudinal, prospective, multiple case study design was used to study infant illness trajectories and parental responses (parental distress and hope) associated with caring for infants with HIE. Results: Two groups of parent decision-making emerged: standard care and experimental care. The decisionmaking groups appear to be dictated by the treatment the infants received within hours of birth. Parents within each group shared specific responses including similar hope and distress, which continued over the first 2 postnatal months. Conclusions: The results indicate that the type of medical therapy the infant receives determines the level of parental participation in decision-making. In the group of parents, in which providers obtained consent for study interventions parents had less hope for their infant even though the infant had a lower severity of illness compared to the infants receiving standard therapies. The reverse was true for parents of infants receiving standard therapy, parents were more hopeful even though their infants had a higher severity of illness. Journal of Pregnancy and Child Health J o u r na l o f P reg nancy anChild He a l t h
Foundations of Quantum Field Theory and It's Particulates

We propose a solution to the Mass Gap and Yang Mills problem establish by the Clay Mathematics Institute.
Transcatheter Mitral-Valve Repair in Patients with Heart Failure.

BACKGROUND
Among patients with heart failure who have mitral regurgitation due to left ventricular dysfunction, the prognosis is poor. Transcatheter mitral-valve repair may improve their clinical outcomes.


METHODS
At 78 sites in the United States and Canada, we enrolled patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite the use of maximal doses of guideline-directed medical therapy. Patients were randomly assigned to transcatheter mitral-valve repair plus medical therapy (device group) or medical therapy alone (control group). The primary effectiveness end point was all hospitalizations for heart failure within 24 months of follow-up. The primary safety end point was freedom from device-related complications at 12 months; the rate for this end point was compared with a prespecified objective performance goal of 88.0%.


RESULTS
Of the 614 patients who were enrolled in the trial, 302 were assigned to the device group and 312 to the control group. The annualized rate of all hospitalizations for heart failure within 24 months was 35.8% per patient-year in the device group as compared with 67.9% per patient-year in the control group (hazard ratio, 0.53; 95% confidence interval [CI], 0.40 to 0.70; P<0.001). The rate of freedom from device-related complications at 12 months was 96.6% (lower 95% confidence limit, 94.8%; P<0.001 for comparison with the performance goal). Death from any cause within 24 months occurred in 29.1% of the patients in the device group as compared with 46.1% in the control group (hazard ratio, 0.62; 95% CI, 0.46 to 0.82; P<0.001).


CONCLUSIONS
Among patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite the use of maximal doses of guideline-directed medical therapy, transcatheter mitral-valve repair resulted in a lower rate of hospitalization for heart failure and lower all-cause mortality within 24 months of follow-up than medical therapy alone. The rate of freedom from device-related complications exceeded a prespecified safety threshold. (Funded by Abbott; COAPT ClinicalTrials.gov number, NCT01626079 .).
Angiographic and electrocardiographic parameters of myocardial reperfusion in angioplasty of patients with ST elevation acute myocardial infarction loaded with ticagrelor or clopidogrel (MICAMI-TICLO trial).

INTRODUCTION
Ticagrelor has been shown to improve outcomes in patients with ACS. However, the effects of this drug on parameters of microvascular flow in patients presenting with ST-segment elevation myocardial infarction (STEMI) have not been completely evaluated.


METHODS
Ninety-two patients presenting with STEMI where randomized to a loading dose of clopidogrel (600 mg) or ticagrelor (180 mg) before undergoing primary angioplasty. We assessed angiographic and electrocardiographic parameters of myocardial reperfusion. Blinded operators calculated angiographic corrected TIMI Frame count (cTFC) and myocardial blush grade (MBG) before and after stent implantation. ST segment resolution was also measured in all patients. Primary endpoint was cTFC after PCI. Secondary endpoints were cTFC prior to PCI, TIMI flow grade, MBG and the percentage of ST resolution.


RESULTS
Of the 92 randomized patients, 70 patients were analyzed. Mean age of patients was 58.8±10 years. Patients presented with a mean ischemic time of 4.4±2.6 hours. There were no significant differences in the time between loading dose and stent deployment (35.2±36.4 in ticagrelor and 42.7±29.5 min in clopidogrel, p=0.36). cTFC before angioplasty was significantly lower in ticagrelor than in clopidogrel (81.1±29.4 vs. 95.1±17.5 frames respectively, p=0.01). After angioplasty there were no differences between ticagrelor and clopidogrel in cTFC (24.6±9.3 vs. 27.0±13.4 frames respectively, p=0.62); MBG grade 3 was present in 76.4 vs. 69.4% of patients, respectively (p=0.41). The percentage of ST resolution did not show any differences between groups (84.8±23.4 in ticagrelor vs. 70.8±33.7 in clopidogrel, p=0.36).


CONCLUSION
Compared with clopidogrel, ticagrelor loading in patients presenting with STEMI is not associated with an improvement of angiographic and electrocardiographic parameters of myocardial reperfusion after angioplasty.
Depression but not anxiety is associated with metabolic syndrome in primary care based community sample

INTRODUCTION
Metabolic syndrome (MetS) and depression are considered important risk factors for diabetes and cardiovascular disease. Recent evidence suggests that depression can be an important predictor of MetS. Data on the association between anxiety and MetS remain mixed. In a large primary care based community sample we investigated an association of depressive and anxiety disorders and symptoms with MetS.


METHODS
A total of 1115 (51% men, mean age 62.0 ± 9.6 years) randomly selected individuals of 45 years and older were evaluated for: (i) MetS using the World Health Organization (WHO), National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) and International Diabetes Federation (IDF) criteria; (ii) current major depressive episode (MDE) and current generalized anxiety disorder (GAD), the Mini International Neuropsychiatric interview; (iii) lifetime MDE; and (iv) symptoms of depression and anxiety, the Hospital Anxiety and Depression scale (HADS). Socio-demographic characteristics (education, residence, marital status and social status) and medical histories (physical activity, smoking status, alcohol consumption and histories of myocardial infarction and stroke) were also evaluated.


RESULTS
After adjusting for socio-demographic status, medical histories and current GAD, current MDE and lifetime MDE were associated with greater prevalence of MetS according to the WHO criteria (OR=1.7, 95%CI [1.1-2.7] and OR=3.7, 95%CI [2.4-5.7], respectively, p ≤ 0.001). Lifetime MDE was also associated with MetS according to the IDF and NCEP/ATP III criteria. On the other hand, current GAD was not associated with MetS in multivariate regression models when adjusted for current MDE. Similar results were obtained when evaluating an association between depression/anxiety symptoms and MetS, since elevated depressive, but not anxiety, symptoms were independently associated with MetS.


CONCLUSIONS
Depressive, but not anxiety, disorders and symptoms are associated with greater prevalence rate of MetS. Assessment and management of MetS risk factors should be considered in depressed individuals.
Systematicity in the Lexicon : On Having Your Cake and Eating It Too

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Phytochemical, anti-oxidant and Anthelmintic activities of various leaf extracts of Flacourtia sepiaria Roxb.

OBJECTIVE
The present study was carried out to investigate the phytochemical constituents, In vitro antioxidant potential and anthelmintic activities of Flacourtia sepiaria Roxb leaves.


METHODS
The dried powdered leaves of Flacourtia sepiaria were extracted using petroleum ether, chloroform, ethyl acetate and methanol by a soxhlet extractor and preliminary phytochemical screening was performed using standard protocols. All the extract was evaluated for their potential antioxidant activities using test such as DPPH, superoxide anion radical, hydroxyl radical, nitric oxide radical scavenging abilities, ferrous chelating ability and total phenolic and flavanoid content. Anthelmintic activity of extract was screened in adult Indian earthworm model.


RESULTS
Preliminary screening revealed the presence of bioactive compounds especially phenolics, tannins and terpenoids in all extracts. The phenolic and flavanoid content was highest in methanolic extract and lowest in petroleum ether extract. The paralytic (9.46±0.212) and death time (31.43±0.148) of methanolic extract was found to be significant (P<0.05) when compared with paralytic (7.33±0.206) and death time (18.60±0.229) of standard piperazine citrate at 100 mg/mL concentration.


CONCLUSIONS
The results of the present study indicate that the leaf extracts of Flacourtia sepiaria exhibited strong antioxidant activity and possess significant anthelmintic activity and thus it is a good source of antioxidant and anthelmintic constituents.
Effectiveness of two intensive treatment methods for smoking cessation and relapse prevention in patients with coronary heart disease: study protocol and baseline description

BACKGROUND
There is no more effective intervention for secondary prevention of coronary heart disease than smoking cessation. Yet, evidence about the (cost-)effectiveness of smoking cessation treatment methods for cardiac inpatients that also suit nursing practice is scarce. This protocol describes the design of a study on the (cost-)effectiveness of two intensive smoking cessation interventions for hospitalised cardiac patients as well as first results on the inclusion rates and the characteristics of the study population.


METHODS/DESIGN
An experimental study design is used in eight cardiac wards of hospitals throughout the Netherlands to assess the (cost-)effectiveness of two intensive smoking cessation counselling methods both combined with nicotine replacement therapy. Randomization is conducted at the ward level (cross-over). Baseline and follow-up measurements after six and 12 months are obtained. Upon admission to the cardiac ward, nurses assess patients' smoking behaviour, ensure a quit advice and subsequently refer patients for either telephone counselling or face-to-face counselling. The counselling interventions have a comparable structure and content but differ in provider and delivery method, and in duration. Both counselling interventions are compared with a control group receiving no additional treatment beyond the usual care. Between December 2009 and June 2011, 245 cardiac patients who smoked prior to hospitalisation were included in the usual care group, 223 in the telephone counselling group and 157 in the face-to-face counselling group. Patients are predominantly male and have a mean age of 57 years. Acute coronary syndrome is the most frequently reported admission diagnosis. The ultimate goal of the study is to assess the effects of the interventions on smoking abstinence and their cost-effectiveness. Telephone counselling is expected to be more (cost-)effective in highly motivated patients and patients with high SES, whereas face-to-face counselling is expected to be more (cost-)effective in less motivated patients and patients with low SES.


DISCUSSION
This study examines two intensive smoking cessation interventions for cardiac patients using a multi-centre trial with eight cardiac wards. Although not all eligible patients could be included and the distribution of patients is skewed in the different groups, the results will be able to provide valuable insight into effects and costs of counselling interventions varying in delivery mode and intensity, also concerning subgroups.


TRIAL REGISTRATION
Dutch Trial Register NTR2144.
Robust and efficient detection of DDoS attacks for large-scale internet

In recent years, distributed denial of service (DDoS) attacks have become a major security threat to Internet services. How to detect and defend against DDoS attacks is currently a hot topic in both industry and academia. In this paper, we propose a novel framework to robustly and efficiently detect DDoS attacks and identify attack packets. The key idea of our framework is to exploit spatial and temporal correlation of DDoS attack traffic. In this framework, we design a perimeter-based antiDDoS system, in which traffic is analyzed only at the edge routers of an internet service provider (ISP) network. The novelties of our framework are 1) temporal-correlation based feature extraction and 2) spatial-correlation based detection. With these techniques, our scheme can accurately detect DDoS attacks and identify attack packets without modifying existing IP forwarding mechanisms at routers. Our simulation results show that the proposed framework can detect DDoS attacks even if the volume of attack traffic on each link is extremely small. Especially, for the same false alarm probability, our scheme has a detection probability of 0.97, while the existing scheme has a detection probability of 0.17, which demonstrates the superior performance of our scheme.
Experimental demonstration of a single layer tri-band circularly polarized reflectarray

The reflectarray antenna is a substitution of reflector antennas by making use of planar phased array techniques [1]. The array elements are specially designed, providing proper phase compensations to the spatial feed through various techniques [2–4]. The bandwidth limitation due to microstrip structures has led to various multi-band designs [5–6]. In these designs, the multi-band performance is realized through multi-layer structures, causing additional volume requirement and fabrication cost. An alternative approach is provided in [7–8], where single-layer structures are adopted. The former [7] implements a dual-band linearly polarized reflectarray whereas the latter [8] establishes a single-layer tri-band concept with circular polarization (CP). In this paper, a prototype based on the conceptual structure in [8] is designed, fabricated, and measured. The prototype is composed of three sub-arrays on a single layer. They have pencil beam patterns at 32 GHz (Ka-band), 8.4 GHz (X-band), and 7.1 GHz (C-band), respectively. Considering the limited area, two phase compensation techniques are adopted by these sub-arrays. The varied element size (VES) technique is applied to the C-band, whereas the element rotation (ER) technique is used in both X-band and Ka-band.
Conceptual Graphs and Formal Concept Analysis

It is shown how Conceptual Graphs and Formal Concept Analysis may be combined to obtain a formalization of Elementary Logic which is useful for knowledge representation and processing. For this, a translation of conceptual graphs to formal contexts and concept lattices is described through an example. Using a suitable mathematization of conceptual graphs, basics of a uniied mathematical theory for Elementary Logic are proposed.
Hyaluronic Acid in Drug Delivery Systems

− Hyaluronic acid (HA) is a biodegradable, biocompatible, non-toxic, non-immunogenic and non-inflammatory linear polysaccharide, which has been used for various medical applications including arthritis treatment, wound healing, ocular surgery, and tissue augmentation. Because of its mucoadhesive property and safety, HA has received much attention as a tool for drug delivery system development. It has been used as a drug delivery carrier in both nonparenteral and parenteral routes. The nonparenteral application includes the ocular and nasal delivery systems. On the other hand, its use in parenteral systems has been considered important as in the case of sustained release formulation of protein drugs through subcutaneous injection. Particles and hydrogels by various methods using HA and HA derivatives as well as by conjugation with other polymer have been the focus of many studies. Furthermore, the affinity of HA to the CD44 receptor which is overexpressed in various tumor cells makes HA an important means of cancer targeted drug delivery. Current trends and development of HA as a tool for drug delivery will be outlined in this review.