Miracle-dz/UniFAR-FTUs huggingface dataset:
Smoker's paradox in heart failure: might asymmetric dimethylarginine be the possible explanation?

We are grateful to Dr Yilmaz et al. 1 for their interest in our article on smoking and clinical outcomes in patients with heart failure. They raise several important issues, including an alternative explanation for the findings from OPTIMIZE-HF that smokers hospitalized with heart failure had lower risk adjusted in-hospital mortality, shorter length of stay, and similar early post discharge mortality compared with …
Culotte stenting technique in coronary bifurcation disease: angiographic follow-up using dedicated quantitative coronary angiographic analysis and 12-month clinical outcomes.

AIMS Percutaneous treatment of coronary bifurcation disease remains challenging. In patient subsets in which a two-stent strategy is necessary, the culotte technique is a widely used method. We sought to examine the clinical and angiographic outcomes of patients treated in this manner at our institution. As quantitative coronary angiographic analysis using standard measurement programmes is problematic, we used a dedicated bifurcation analysis system. METHODS AND RESULTS We prospectively enrolled patients undergoing culotte stenting with drug-eluting stents (Cypher, Endeavor, polymer-free rapamycin-eluting, Taxus) in two German centres. Lesions were classified according to the Medina classification. Angiographic follow-up was scheduled between 6 and 12 months post-index procedure. Clinical follow-up was available up to 12 months. Culotte technique was used in 134 lesions in 132 patients. Of these, 124 (92.5%) represented 'true bifurcation' lesion morphology. Kissing balloon inflation was used in 62% of patients. Procedural angiographic success was achieved in all lesions. Follow-up coronary angiography was performed in 108 (81.8%) patients. Median (IQR) late lumen loss was 0.10 (-0.04-0.38) mm in the proximal main vessel, 0.34 (0.03-0.66) mm in the distal main branch, and 0.30 (-0.01-0.72) mm in the side branch. The incidence of binary angiographic restenosis was 22% for the whole bifurcation lesion, 0% in the proximal main vessel, 9.1% in the distal main branch, and 16% in the side branch. At 12 months, 28 of 132 (21%) patients had undergone target lesion revascularization. The incidence of stent thrombosis (at 1 year) was 1.5%. Predictors of angiographic restenosis were older age, increasing bifurcation angle, more severe distal main branch stenosis, and smaller side branch reference diameter; kissing balloon post-dilatation tended to have a protective effect. CONCLUSION The culotte stenting technique is associated with high procedural success and a relatively low risk of angiographic restenosis. Safety results in our cohort were favourable in terms of a low risk of stent thrombosis.
Diagnostic accuracy of computed tomography coronary angiography and evaluation of stress-only single-photon emission computed tomography/computed tomography hybrid imaging: comparison of prospective electrocardiogram-triggering vs. retrospective gating.

AIMS To determine diagnostic accuracy, effective radiation dose, and potential value of computed tomography coronary angiography (CTCA) for hybrid imaging with single-photon emission computed tomography (SPECT) comparing prospective electrocardiogram (ECG)-triggering vs. retrospective ECG-gating. METHODS AND RESULTS Two hundred patients underwent standard myocardial stress/rest- SPECT perfusion imaging, which served as standard of reference. One hundred consecutive patients underwent 64-slice CTCA using prospective ECG-gating, and were compared with 100 patients who had previously undergone CTCA using retrospective ECG-gating. For predicting ischaemia, CTCA with prospective ECG-triggering and a stenosis cut-off >50% had a per-vessel sensitivity, specificity, negative, and positive predictive value of 100, 84, 100, and 30%; respective values for CTCA with retrospective ECG-gating were similar (P = n.s.): 86, 83, 98, and 33%. Combining CTCA with stress-only SPECT revealed 100% clinical agreement with regard to perfusion defects, and provided additional information in half the patients on preclinical coronary findings. Effective radiation dose was 2.2 +/- 0.7 mSv for CTCA with prospective ECG-triggering, and 19.7 +/- 4.2 mSv with retrospective ECG-gating (P < 0.001) (5.4 +/- 0.8 vs. 24.1 +/- 4.3 mSv for hybrid imaging). CONCLUSION Prospective ECG-triggering for CTCA reduces radiation dose by almost 90% without affecting diagnostic performance. Combined imaging with stress-only SPECT is an attractive alternative to standard stress/rest-SPECT for evaluation of coronary artery disease, offering additional information on preclinical atherosclerosis.
Aldosterone blockade and left ventricular dysfunction: a systematic review of randomized clinical trials.

CONTEXT Aldosterone blockade has been used to treat acute myocardial infarction (MI) and chronic heart failure. OBJECTIVE The aim of this study is to summarize the evidence on the efficacy of spironolactone (SP), eplerenone (EP), or canrenoate (CAN) in patients with left ventricular dysfunction. DATA SOURCES A search of multiple electronic databases until June 2008 was supplemented by hand searches of reference lists of included studies and review articles, meeting abstracts, FDA reports, and contact with study authors and drug manufacturers. STUDY SELECTION AND DATA EXTRACTION Studies were eligible for inclusion if they included patients with left ventricular systolic or diastolic dysfunction, treatment with SP, EP, or CAN vs. control, and reported clinical outcomes. Nineteen randomized controlled trials (four in acute MI and 15 in heart failure, n = 10 807 patients) were included -- 14 of SP, three of EP, and three of CAN. Analysis was performed using relative risks (RRs) with 95% confidence intervals (CIs) and a random effects model with statistical heterogeneity assessed by I(2). DATA SYNTHESIS Aldosterone blockade reduced all-cause mortality by 20% (RR 0.80, 95% CI 0.74-0.87). All-cause mortality was reduced in both heart failure (RR = 0.75, 95% CI 0.67-0.84) and post-MI (RR 0.85, 95% CI 0.76-0.95) patients. Only nine trials reported hospitalizations, and the RR reduction was 23% (RR 0.77, 95% CI 0.68-0.87), although 98% of the outcomes came from two trials. Ejection fraction (EF) improved in the seven heart failure trials, which assessed this outcome (weighted mean difference 3.1%, 95% CI 1.6-4.5). CONCLUSION We demonstrated a 20% reduction in all-cause mortality with the use of aldosterone blockade in a clinically heterogeneous group of clinical trial participants with heart failure and post-MI. In addition, we found a 3.1% improvement in EF. Further study in those with less severe symptoms or preserved systolic function is warranted.
Intrinsic Motivation of Physicians

By incorporating the concept of intrinsic motivation of physicians into a theoretical framework, this paper examines the possible existence of multiple equilibria in which hospitals differ only in terms of the work attitude of physicians, who are homogenous in all other aspects, including benevolence in their concern for their patients. Our results offer a theoretical understanding of a phenomenon observed frequently in any society, namely that of the existence of hospitals with more or less similar management environment, but with significant differences in the work attitude of physicians and therefore medical treatments provided to patients.
Doctors and Their Workshops

Doctors are obviously influential in determining the costs of their services. But even more important, many believe, is the influence physicians have over the use and cost of nonphysician health-care resources and services. Doctors and Their Workshops is the first comprehensive attempt to use economic analysis to understand some of the physician effects on nonphysician aspects of health care.
Influence of age and gender in the normal values of Sino Nasal Outcome Test–22

Sino Nasal Outcome Test (SNOT)‐22 is a disease‐specific outcomes measure questionnaire that combines rhinologic issues with general health issues. These issues may have variable weight on quality of life perception, and the influence of several factors such as gender, ethnicity, age, socio‐cultural status and co‐morbidities is unknown. The aim of this study was to evaluate the influence of gender and age on normal values of SNOT‐22.
Intravenous administration of nicorandil immediately before percutaneous coronary intervention can prevent slow coronary flow phenomenon.

AIMS To determine the effect of intravenous administration of nicorandil on slow coronary flow (SCF) phenomenon in patients undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS In a preliminary study, 6 mg of nicorandil showed optimal efficacy for vasodilatation without causing significant haemodynamic instability. In the main study, a total of 408 patients were randomly assigned to receive intravenous administration of 6 mg of nicorandil immediately before PCI. The number of patients in the nicorandil group was 206 [acute coronary syndrome (ACS): 47, non-ACS: 159] and that in the control group was 202 (ACS: 61, non-ACS: 141). Nicorandil significantly decreased the incidence of post-procedural SCF phenomenon in both the ACS and non-ACS groups. The rate of target vessel revascularization (TVR) was significantly lower in the nicorandil group than in the control group in ACS patients. CONCLUSION Our simple procedure prevented SCF phenomenon not only in patients with ACS but also in patients with non-ACS without any adverse effect. Additionally our procedure reduced the rate of TVR in patients with ACS.
Treatment Protocol for Controlling Bone Metabolism Parameters in Hemodialysis Patients

Abnormal mineral metabolism and severe secondary hyperparathyroidism play a key role in the pathophysiology of skeletal and extraskeletal calcification and are associated with increased morbidity and mortality among hemodialysis (HD) patients (Block GA et al., 1998, 2004; Ganesh et al., 2001; London GM et al., 2003). As a result of these findings, the National Kidney Foundation introduced guidelines in 2003 on controlling parathyroid hormone (PTH), calcium (Ca), phosphorous (P) and calcium-phosphorous ion product (CaxP) in these patients (National Kidney Foundation-Kidney Disease Outcomes and Quality Initiative, 2003). However, in spite of the publication of the K/DOQI guidelines, most HD patients remained outside the recommended targets (Al Aly et al., 2004; Arenas et al., 2006; Lorenzo et al., 2006; Maduell et al., 2005). Historically, Ca-containing phosphate binders and vitamin D have provided the main strategies for reducing P and PTH levels (Slatopolsky et al., 1986). However, the overuse of Ca-containing phosphate binders and active vitamin D can result in hypercalcemia, high CaxP level and Ca overload, which may accelerate vascular disease and hasten death. These side effects potentially require temporary cessation of vitamin D and a reduction in Ca-containing binder administration. This cycle results in a temporary worsening of secondary hyperparathyroidism, allowing bone disease progression (Block et al., 1998, 2000; Johnson et al., 2002; Moe et al., 2003). Hence, new treatment strategies are required (Jindal et al., 2006; Moe et al., 2009;). Since 2006, two new drugs, paricalcitol and cinacalcet, have been available in daily clinical practice for secondary hyperparathyroidism treatment. Paricalcitol is a vitamin D metabolite that has some advantages over calcitriol, the standard form of vitamin D used worldwide. Paricalcitol suppresses PTH faster than calcitriol (Sprague et al., 2001), and may have a lesser Ca and P intestinal absorption capacity, with smaller increases in Ca and P serum (Llach et al., 2001). Patients who receive paricalcitol may also have a significant survival advantage over those who receive calcitriol (Teng et al., 2003). Despite these advantages, the occurrence of hypercalcemia and high CaxP, when high doses of paricalcitol are used, is not unusual (Goodman, 2001; Martin & Gonzalez, 2001).
Fish consumption, marine omega-3 fatty acids, and incidence of heart failure: a population-based prospective study of middle-aged and elderly men.

AIMS Fatty fish and marine omega-3 fatty acids were associated with lower rates of heart failure (HF) among US elderly, but this has not been confirmed in broader age ranges or other populations where source and type of fish may differ. We therefore conducted a population-based, prospective study of 39 367 middle-aged and older Swedish men. METHODS AND RESULTS Diet was measured using food-frequency questionnaires. Men were followed for HF through Swedish inpatient and cause-of-death registers from 1 January 1998 to 31 December 2004. We used proportional hazards models adjusted for age and other covariates to estimate hazard ratios (HR). Compared with no consumption, men who ate fatty fish once per week had an HR of 0.88 (95% CI 0.68-1.13). Hazard ratios for consumption two times per week and > or =3 times per week were 0.99 and 0.97, respectively. Hazard ratios across quintiles of marine omega-3 were 1, 0.94 (95% CI 0.74-1.20), 0.67 (95% CI 0.50-0.90), 0.89 (95% CI 0.68-1.16), 1.00 (95% CI 0.77-1.29). CONCLUSION In this population, moderate intake of fatty fish and marine omega-3 fatty acids was associated with lower rates of HF, though the association for fish intake was not statistically significant; higher intake was not associated with additional benefit.
HEPATITIS B MARKERS IN ISFAHAN, CENTRAL IRAN: A POPULATION-BASED STUDY

H B virus (HBV) infection is one of the major global health problems with two billion people infected worldwide, 75% of whom are Asians (1). The main route of HBV transmission is via blood and blood products. Needle-stick injuries in health personnel, hemodialysis, shared needles in drug abusers, dental surgery, receiving blood or blood products, cupping, ear and nose piercing practices, tattooing, sexual contact and contact with body fluid Hepatitis Monthly 2009; 9(1): 12-16
Quantitative assessment of homograft function 1 year after insertion into the pulmonary position: impact of in situ homograft geometry on valve competence.

AIMS To prospectively evaluate homograft function with cardiac magnetic resonance (CMR) imaging 1 year after insertion into the pulmonary position, and to assess the impact of in situ homograft geometry, surgical factors, and 'intrinsic' homograft properties on early valve incompetence. METHODS AND RESULTS A total of 60 patients (mean age 21 +/- 10 years; 35 females) with congenital heart disease underwent pulmonary valve replacement with homograft insertion and were prospectively enrolled into a study protocol that included serial echocardiography and CMR 1 year after surgery. None of the patients had homograft stenosis but 10 (17%) had significant homograft incompetence (i.e. pulmonary regurgitation fraction >20% on CMR). A higher incidence of 'eccentric' pulmonary forward flow pattern (P < 0.001, Fisher's exact test), more acute 'homograft distortion angle' (P < 0.001), larger relative 'annular' size (P < 0.01), and greater pre-homograft right ventricular outflow tract (RVOT) diameters (P = 0.01) at CMR was seen in those with worse homograft function. In a backward multivariate linear regression model, 'eccentric' pulmonary forward flow pattern (r(part) = 0.36, P < 0.001), 'homograft distortion angle' (r(part) = 0.31, P = 0.001), and pre-homograft RVOT diameter (r(part) = 0.19, P = 0.03) were independently associated with the degree of pulmonary regurgitation (in %) at 1 year. CONCLUSION Using CMR, in this prospective cohort study, we have shown that significant valve incompetence is present in one-sixth of patients after homograft insertion into the pulmonary position, and that alterations in the in situ homograft geometry were associated with the likelihood of developing valve incompetence. These findings imply that mechanical factors may have an important impact on homograft performance.
Recurrence of ventricular arrhythmias in ischaemic secondary prevention implantable cardioverter defibrillator recipients: long-term follow-up of the Leiden out-of-hospital cardiac arrest study (LOHCAT).

AIMS To assess the long-term rate of mortality and the recurrence of potentially life-threatening ventricular arrhythmias in secondary prevention implantable cardioverter defibrillator (ICD) patients and to construct a model for baseline risk stratification. METHODS AND RESULTS Since 1996, all patients with ischaemic heart disease, receiving ICD therapy for secondary prevention of sudden death, were included in the current study. Patients were evaluated at implantation and during long-term follow-up. A total of 456 patients were included in the analysis and followed for 54 +/- 35 months. During follow-up, 100 (22%) patients died and ICD therapy was noted in 216 (47%) patients, of which 138 (30%) for fast, potentially life-threatening ventricular arrhythmia. Multivariate analysis revealed a history of atrial fibrillation or flutter (AF), ventricular tachycardia as presenting arrhythmia, and wide QRS and poor left ventricular ejection fraction as independent predictors of life-threatening ventricular arrhythmias. The strongest predictor was AF with a hazard ratio of 2.1 (95% confidence interval 1.3-3.2). On the basis of the available clinical data, it was not possible to identify a group which exhibited no risk on recurrence of potentially life-threatening ventricular arrhythmias. CONCLUSION Ischaemic secondary prevention ICD recipients exhibit a high recurrence rate of potentially life-threatening ventricular arrhythmias. Factors that increase risk can be identified but, even with these factors, it was not possible to distinguish a recurrence-free group.
INDOOR ALLERGEN LEVELS IN DAY NURSERIES

The level of indoor allergens were lower in day nurseries than in most houses. Most samples contain allergen levels below threshold levels for sensitization. The risk of sensitization to indoor allergens in day nurseries for infants appears to be less than in their own homes. It also appears that the efficacy of avoidance measures such as the use of synthetic protective mattress covers and frequent washing of sheets and toys is effective.
HUBUNGAN TINGKAT PARTISIPASI IBU DALAM KEGIATAN POSYANDU DENGAN STATUS GIZI ANAK BALITA (STUDI DI KELURAHAN CANGKIRAN KECAMATAN MIJEN KOTA SEMARANG)

ABSTRACT Background: Children under five years of age are included in group of nutrition’s susceptible. They are on growth and development cycle which need a huge nutrient. The aim of this study is to understand the relationship between mother’s participation levels in posyandu and nutritional status of children under five years of age. Method: Study of analitical observation with cross sectional was used. Subject was a mother in Cangkiran, having children aged between 12-59 month. Subject was taken with proportional stratified random sampling technique. Mother’s participation in posyandu was taken from health care staff’s data, protein and energy intake were taken from food recall 3x24 hours, and nutritional status of children under five years of age was compared with Z-score of WHO 2005. Data was analyzed using Rank-Spearman and partial correlation used SPSS for Windows 19.0 software. Result: Approximately 56,4% of subjects have active participation’s levels in posyandu. Much of the children under five years of age from those have 80,6% good nutritional status (WAZ), 67,7% normal (WHZ), 61,3% normal (HAZ), and 61,3% normal (BMIAZ). There is a relationship mother’s participation levels in posyandu with nutritional status children under five years of age based on WAZ (p = 0,030 ; r = 0,651) but not for WHZ (p = 0,998 ; r = 0,000), HAZ (p = 0,163 ; r = 0,191), and BMIAZ (p = 0,689 ; r = -0,055). This realtionship is also controlled by sufficient levels of energy (p = 0,047 ; r = 0,639) and protein (p = 0,003 ; r = 0,823). Conclusion: Increased participation levels of mother’s in posyandu enhances nutritional status of children under five years of age (based on WAZ). This case is also influenced by sufficient levels of energy and protein. Keyword: mother’s participation levels, posyandu, nutritional status, children under five years of age
Developmental Stress and Survival among the Mid Upper Paleolithic Sunghir Children: Dental Enamel Hypoplasias of Sunghir 2 and 3

The Sunghir 2 and 3 late juvenile to early adolescent immature skeletons, from the Mid Upper Paleolithic (Eastern Gravettian) of northern Russia, exhibit several episodes of dental enamel hypoplasias. Those of the older male Sunghir 2 relate principally to a stress episode in the third year post-natal, although subsequent minor stress episodes may be indicated. They are not accompanied by other marked developmental abnormalities. The younger female Sunghir 3 exhibits at least three episodes of pronounced post-natal stress through the third to fifth years post-natal, followed by femoral and tibial growth arrest lines that formed shortly before her death at 9–11 years. These first decade post-natal stress episodes of Sunghir 3 may be related to the same developmental condition that produced her abnormally bowed femora pre-natally and/or to continued frailty related to that condition. Surviving these stress episodes for different lengths of time, both Sunghir 2 and 3 were awarded the most elaborate Paleolithic burial known. Copyright © 2011 John Wiley & Sons, Ltd.
Rising autism rates still pose a mystery.

A NEW STUDY SUGGESTS THAT THE prevalence of autism spectrum disorders (ASDs) has surged in recent years, but questions remain as to whether the rise reflects an actual increase in the number of individuals with the condition, changing definitions of diagnosis or awareness, or a combination of such factors. Thestudy,releasedinDecemberbythe US Centers for Disease Control and Prevention (CDC), found that 1 8-year-old in110wasclassified in2006ashavingan ASD vs 1 in 153 estimated in 2002 (http: / /www.cdc .gov/mmwr/prev iew /mmwrhtml/ss5810a1.htm). The study was a systematic retrospective review of evaluation records from 11 sites participating in the Autism and Developmental Disabilities Monitoring Network. It compared results with those from its 2002 analysis, which involved 10 of the same sites; for these sites, prevalence increased 57% from 2002 to 2006 (http: / /www.cdc .gov/mmwr/prev iew /mmwrhtml/ss5601a2.htm). The researchers selected 8 years of age as a reasonable index age for monitoring peak prevalence. A further breakdown of the numbers reveals that ASD prevalence increased across all sex, racial, ethnic, and cognitive functioning subgroups. ASD prevalence was much higher for boys than for girls, with 1 in 70 boys and 1 in 315 girls identified with an ASD. ASD prevalence rose on average 55% for white children, 41% for black children, and 90% for Hispanic children. At a December 18 press conference, Catherine Rice, PhD, a behavioral scientist with the CDC and a coauthor of the report, said the new numbers are concerning. “No single factor explains the changes identified in ASD prevalence over the time period studied,” Rice said. “Some of the increase is due to better detection, particularly among children who may not have come to attention in the past, including girls, Hispanic children, and children without cognitive impairment. ” Getting an answer to the “why” question of the rise in ASD prevalence remains difficult, said Thomas R. Insel, MD, director of the National Institute of Mental Health, who praised the CDC