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"Improved Cell Survival and Paracrine Capacity of Human Embryonic Stem Cell-Derived Mesenchymal Stem Cells Promote Therapeutic Potential for Pulmonary Arterial Hypertension",
"Double-blind, placebo-controlled clinical trial with a rho-kinase inhibitor in pulmonary arterial hypertension.",
"Mesenchymal stem cell prevention of vascular remodeling in high flow-induced pulmonary hypertension through a paracrine mechanism.",
"Beraprost therapy for pulmonary arterial hypertension.",
"Exercise capacity and haemodynamics in patients with sickle cell disease with pulmonary hypertension treated with bosentan: results of the ASSET studies",
"Long-term research of stem cells in monocrotaline-induced pulmonary arterial hypertension",
"Adipose-derived stem cells attenuate pulmonary arterial hypertension and ameliorate pulmonary arterial remodeling in monocrotaline-induced pulmonary hypertensive rats",
"Effect of bone marrow mesenchymal stem cells on experimental pulmonary arterial hypertension",
"Predicting Survival in Pulmonary Arterial Hypertension: Insights From the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL)",
"Contribution of Impaired Parasympathetic Activity to Right Ventricular Dysfunction and Pulmonary Vascular Remodeling in Pulmonary Arterial Hypertension",
"Mesenchymal stem (stromal) cells for treatment of ARDS: a phase 1 clinical trial.",
"Bosentan treatment for pulmonary arterial hypertension related to connective tissue disease: a subgroup analysis of the pivotal clinical trials and their open-label extensions",
"Treatment of pulmonary arterial hypertension with the selective endothelin-A receptor antagonist sitaxsentan.",
"Ambrisentan therapy for pulmonary arterial hypertension.",
"Clinical efficacy of low dose recombinant tissue-type plasminogen activator for the treatment of acute intermediate-risk pulmonary embolism"
] | [
"Although transplantation of adult bone marrow mesenchymal stem cells ( BM-MSCs ) holds promise in the treatment for pulmonary arterial hypertension ( PAH ) , the poor survival and differentiation potential of adult BM-MSCs have limited their therapeutic efficiency . Here , we compared the therapeutic efficacy of human embryonic stem cell-derived MSCs ( hESC-MSCs ) with adult BM-MSCs for the treatment of PAH in an animal model . One week following monocrotaline (MCT)-induced PAH , mice were r and omly assigned to receive phosphate-buffered saline ( MCT group ) ; 3.0 × 106 human BM-derived MSCs ( BM-MSCs group ) or 3.0 × 106 hESC-derived MSCs ( hESC-MSCs group ) via tail vein injection . At 3 weeks posttransplantation , the right ventricular systolic pressure ( RVSP ) , degree of RV hypertrophy , and medial wall thickening of pulmonary arteries were lower= , and pulmonary capillary density was higher in the hESC-MSC group as compared with BM-MSC and MCT groups ( all p < 0.05 ) . At 1 week posttransplantation , the number of engrafted MSCs in the lungs was found significantly higher in the hESC-MSC group than in the BM-MSC group ( all p < 0.01 ) . At 3 weeks posttransplantation , implanted BM-MSCs were undetectable whereas hESC-MSCs were not only engrafted in injured pulmonary arteries but had also undergone endothelial differentiation . In addition , protein profiling of hESC-MSC- and BM-MSC-conditioned medium revealed a differential paracrine capacity . Classification of these factors into bioprocesses revealed that secreted factors from hESC-MSCs were preferentially involved in early embryonic development and tissue differentiation , especially blood vessel morphogenesis . We concluded that improved cell survival and paracrine capacity of hESC-MSCs provide better therapeutic efficacy than BM-MSCs in the treatment for PAH",
"BACKGROUND We have previously demonstrated that long-term inhibition of Rho-kinase ameliorates pulmonary arterial hypertension ( PAH ) in animal models . In the present study , we examined the clinical effects of mid-term oral treatment with an extended release formulation of AT-877 ( fasudil hydrochloride ) , a specific Rho-kinase inhibitor ( AT-877ER ) on PAH . METHODS AND RESULTS 23 PAH patients were treated with either placebo ( 10/2 females/males , 51 ± 16 years , idiopathic PAH ( IPAH ) in 6 , PAH associated with connective tissue disease ( CTD-PAH ) in 3 , PAH with congenital heart disease ( CHD-PAH ) in 2 , and portal PAH in 1 ) or AT-877ER ( 6/5 females/males , 47 ± 14 years , IPAH in 2 , CTD-PAH in 5 , and CHD-PAH in 4 ) ; 3 patients were excluded . We performed a 6-min walk test and right heart catheterization in the remaining 20 patients , before and 3 months after the treatment ( placebo n=11 , AT-877ER n=9 ) . Although there were no significant differences between the 2 groups for the 6-min walk distance , pulmonary hemodynamics tended to be improved in the AT-877ER group , especially the prevalence of improved cardiac index from baseline , which was significantly higher in the AT-877ER than in the placebo group . In the AT-877ER group , serum levels of hydroxyfasudil , an active metabolite of AT-877ER tended to correlate with improvements in the cardiac index and mean pulmonary artery pressure . CONCLUSIONS Mid-term treatment with oral AT-877ER showed additional improvement in pulmonary hemodynamics in patients with PAH",
"UNLABELLED Pulmonary arterial hypertension ( PAH ) is characterized by functional and structural changes in the pulmonary vasculature , and despite the drug treatment that made significant progress , the prognosis of patients with advanced PH remains extremely poor . In the present study , we investigated the early effect of bone marrow mesenchymal stem cells ( BMSCs ) on experimental high blood flow-induced PAH model rats and discussed the mechanism . BMSCs were isolated , cultured from bone marrow of Sprague-Dawley ( SD ) rat . The animal model of PAH was created by surgical methods to produce a left-to-right shunt . Following the successful establishment of the PAH model , rats were r and omly assigned to three groups ( n=20 in each group ) : sham group ( control ) , PAH group , and BMSC group ( received a sublingual vein injection of 1 - 5 × 10(6 ) BMSCs ) . Two weeks after the administration , BMSCs significantly reduced the vascular remodeling , improved the hemodynamic data , and deceased the right ventricle weight ratio to left ventricular plus septal weight ( RV/LV+S ) ( P<0.05 ) . Real-time reverse transcription-polymerase chain reaction ( RT-PCR ) and immunohistochemistry analysis results indicated that the inflammation factors such as interleukin-1β ( IL-1β ) , IL-6 , and tumor necrosis factor-α ( TNF-α ) were reduced ( P<0.05 ) ; the expression of matrix metallo proteinase-9 ( MMP-9 ) was lower ( P<0.05 ) ; vascular endothelial growth factor ( VEGF ) was higher in BMSC group than those in PAH group ( P<0.05 ) . CONCLUSION Sublingual vein injection of BMSCs for 2 weeks , significantly improved the lung and heart injury caused by left-to-right shunt-induced PAH ; decreased pulmonary vascular remodeling and inflammation ; and enhanced angiogenesis",
"OBJECTIVES The purpose of this study was to assess the safety and efficacy of the oral prostacyclin analogue beraprost sodium during a 12-month double-blind , r and omized , placebo-controlled trial in patients with pulmonary arterial hypertension ( PAH ) . BACKGROUND Pulmonary arterial hypertension is a progressive disease that ultimately causes right heart failure and death . Despite the risks from its delivery system , continuous intravenous epoprostenol remains the most efficacious treatment currently available . METHODS A total of 116 patients with World Health Organization ( WHO ) functional class II or III primary pulmonary hypertension or PAH related to either collagen vascular diseases or congenital systemic to pulmonary shunts were enrolled . Patients were r and omized to receive the maximal tolerated dose of beraprost sodium ( median dose 120 microg four times a day ) or placebo for 12 months . The primary end point was disease progression ; i.e. , death , transplantation , epoprostenol rescue , or > 25 % decrease in peak oxygen consumption ( VO(2 ) ) . Secondary end points included exercise capacity assessed by 6-min walk test and peak VO(2 ) , Borg dyspnea score , hemodynamics , symptoms of PAH , and quality of life . RESULTS Patients treated with beraprost exhibited less evidence of disease progression at six months ( p = 0.002 ) , but this effect was not evident at either shorter or longer follow-up intervals . Similarly , beraprost-treated patients had improved 6-min walk distance at 3 months by 22 m from baseline and at 6 months by 31 m ( p = 0.010 and 0.016 , respectively ) compared with placebo , but not at either 9 or 12 months . Drug-related adverse events were common and were related to the disease and /or expected prostacyclin adverse events . CONCLUSIONS These data suggest that beneficial effects may occur during early phases of treatment with beraprost in WHO functional class II or III patients but that this effect attenuates with time",
"Doppler‐defined pulmonary hypertension ( PH ) in sickle cell disease ( SCD ) is associated with 40 % mortality at 40 months . To assess the effect of bosentan in SCD‐PH , two r and omized , double‐blind , placebo‐controlled , 16‐week studies were initiated . Safety concerns are particularly relevant in SCD due to comorbid conditions . ASSET‐1 and ‐2 enrolled patients with pulmonary arterial hypertension ( PAH ) and pulmonary venous hypertension ( PH ) , respectively . Haemodynamics and 6‐min walk distance ( 6MWD ) were obtained at baseline and week 16 . The studies were terminated due to slow site initiation and patient enrolment ( n = 26 ) . Bosentan appeared to be well tolerated . Although sample sizes were limited , in ASSET‐1 at baseline , 6MWD correlated with cardiac output ( CO ; P = 0·006 ) with non‐significant inverse correlations between 6MWD and pulmonary vascular resistance ( PVR ; P = 0·07 ) and between 6MWD and right atrial pressure ( P = 0·08 ) . In ASSET‐2 at baseline , there was a non‐significant correlation between 6MWD and CO ( P = 0·06 ) . Due to limited sample sizes , efficacy endpoints were not analysed . However , in both studies , non‐significant increases in CO were observed with bosentan compared to placebo . Similarly , non‐significant decreases in PVR were observed with bosentan . Limited data in SCD‐PH suggest that a low 6MWD predicts a low CO . St and ard‐dose bosentan appears to be well tolerated . Further investigation is warranted . Clinical trials.gov registration numbers NCT00310830 , NCT00313196 , NCT00360087",
"Our previous studies have shown that bone marrow mesenchymal stem cells ( BMSCs ) can inhibit the progression of pulmonary artery hypertension ( PAH ) in the monocrotaline ( MCT ) model in the short term . The aim of this study was to further investigate the long-term effect of BMSCs on PAH and to explore the mechanism of the protective effect including the pulmonary vascular remodeling and cell differentiation . PAH model was established by subcutaneous injection of 50 mg/kg MCT as previously study . Postoperatively , the animals were r and omly divided into three groups ( n = 10 in each group ) : control , PAH group , and BMSCs implantation group . Six months after injection , immunology and immunohistochemistry analysis indicated the MCT-induced intima-media thickness in muscular arteries was reduced ( P < 0.05 ) ; the area of collagen fibers in lung tissue was lower ( P < 0.05 ) , and the proliferating cell nuclear antigen level in pulmonary artery smooth muscle cells was decreased ( P < 0.05 ) . Immunofluorescence showed that the cells have the ability to differentiate between von Willebr and factor and vascular endothelial growth factor . Six months after intravenous injection , BMSCs could significantly improve pulmonary function by inhibiting the ventricular remodeling and the effect of cell differentiation",
"Abstract We investigated the effect of adipose-derived stem cells ( ADSCs ) transplantation effects on structural remodeling and pulmonary artery pressure in monocrotaline (MCT)-induced pulmonary hypertensive rats . In the first experiment , 32 male Sprague-Dawley ( SD ) rats were r and omly divided into four groups ( n = 8/group ) : 3 ADSCs treated groups and normal control ( Ctrl ) . ADSCs were administered through the left jugular vein at 105 , 106 and 107 cells , respectively , and a cell density of 106cells/ml was shown to be optimal . The GFP-tagged ADSCs were identified in the lungs and differentiated into endothelial-like cells . In the second experiment , 96 male SD rats were r and omly divided into three groups ( n = 32/group ) : Ctrl , MCT-induced pulmonary arterial hypertension ( PAH ) , and PAH treated with ADSCs ( ADSCs ) . Two weeks post-MCT administration , the ADSCs group received 1 × 106 ADSCs via the external jugular vein . Compared to PAH rats , mean pulmonary arterial pressure was decreased in rats at 1 , 2 , and 3 weeks after ADSCs-treatment ( 18.63 ± 2.15 mmHg versus 24.53 ± 2.90 mmHg ; 23.07 ± 2.84 mmHg versus 33.18 ± 2.30 mmHg ; 22.98 ± 2.34 mmHg versus 36.38 ± 3.28 mmHg , p < 0.05 ) . Meanwhile , the right heart hypertrophy index ( 36.2 1 ± 4.27 % versus 41.01 ± 1.29 % ; 39.47 ± 4.02 % versus 48.75 ± 2 .13 % ; 41.02 ± 0.9 % versus 50.52 ± 1.49 % , p < 0.05 , respectively ) , ratio of wall/lumen thickness , as well as the wall/lumen area were significantly reduced in PAH rats at these time points following ADSCs-treatment , as compared with untreated PAH rats . In summary , ADSCs may colonize the pulmonary arteries , attenuate pulmonary arterial hypertension and ameliorate pulmonary arterial remodeling",
"The aim of the present study was to investigate the effect of bone marrow mesenchymal stem cell ( BMSC ) transp1antation on lung and heart damage in a rat model of monocrotaline (MCT)-induced pulmonary arterial hypertension ( PAH ) . The animals were r and omly divided into 3 groups : control , PAH and BMSC implantation groups . Structural changes in the pulmonary vascular wall , such as the pulmonary artery lumen area ( VA ) and vascular area ( TAA ) were measured by hematoxylin and eosin ( H&E ) staining , and the hemodynamics were detected by echocardiography . Two weeks post-operation , our results demonstrated that sublingual vein injection of BMSCs significantly attenuated the pulmonary vascular structural and hemodynamic changes caused by pulmonary arterial hypertension . The mechanism may be executed via paracrine effects",
"Background — Factors that determine survival in pulmonary arterial hypertension ( PAH ) drive clinical management . A quantitative survival prediction tool has not been established for research or clinical use . Methods and Results — Data from 2716 patients with PAH enrolled consecutively in the US Registry to Evaluate Early and Long-Term PAH Disease Management ( REVEAL ) were analyzed to assess predictors of 1-year survival . We identified independent prognosticators of survival and derived a multivariable , weighted risk formula for clinical use . One-year survival from the date of enrollment was 91.0 % ( 95 % confidence interval [ CI ] , 89.9 to 92.1 ) . In a multivariable analysis with Cox proportional hazards , variables independently associated with increased mortality included pulmonary vascular resistance > 32 Wood units ( hazard ratio [ HR ] , 4.1 ; 95 % CI , 2.0 to 8.3 ) , PAH associated with portal hypertension ( HR , 3.6 ; 95 % CI , 2.4 to 5.4 ) , modified New York Heart Association/World Health Organization functional class IV ( HR , 3.1 ; 95 % CI , 2.2 to 4.4 ) , men > 60 years of age ( HR , 2.2 ; 95 % CI , 1.6 to 3.0 ) , and family history of PAH ( HR , 2.2 ; 95 % CI , 1.2 to 4.0 ) . Renal insufficiency , PAH associated with connective tissue disease , functional class III , mean right atrial pressure , resting systolic blood pressure and heart rate , 6-minute walk distance , brain natriuretic peptide , percent predicted carbon monoxide diffusing capacity , and pericardial effusion on echocardiogram all predicted mortality . Based on these multivariable analyses , a prognostic equation was derived and vali date d by bootstrapping technique . Conclusions — We identified key predictors of survival based on the patient 's most recent evaluation and formulated a contemporary prognostic equation . Use of this tool may allow the individualization and optimization of therapeutic strategies . Serial follow-up and re assessment are warranted . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00370214",
"Background : The beneficial effects of parasympathetic stimulation have been reported in left heart failure , but whether it would be beneficial for pulmonary arterial hypertension ( PAH ) remains to be explored . Here , we investigated the relationship between parasympathetic activity and right ventricular ( RV ) function in patients with PAH , and the potential therapeutic effects of pyridostigmine ( PYR ) , an oral drug stimulating the parasympathetic activity through acetylcholinesterase inhibition , in experimental pulmonary hypertension ( PH ) . Methods : Heart rate recovery after a maximal cardiopulmonary exercise test was used as a surrogate for parasympathetic activity . RV ejection fraction was assessed in 112 patients with PAH . Expression of nicotinic ( & agr;-7 nicotinic acetylcholine receptor ) and muscarinic ( muscarinic acetylcholine type 2 receptor ) receptors , and acetylcholinesterase activity were evaluated in RV ( n=11 ) and lungs ( n=7 ) from patients with PAH undergoing heart/lung transplantation and compared with tissue obtained from controls . In addition , we investigated the effects of PYR ( 40 mg/kg per day ) in experimental PH . PH was induced in male rats by SU5416 ( 25 mg/kg subcutaneously ) injection followed by 4 weeks of hypoxia . In a subgroup , sympathetic/parasympathetic modulation was assessed by power spectral analysis . At week 6 , PH status was confirmed by echocardiography , and rats were r and omly assigned to vehicle or treatment ( both n=12 ) . At the end of the study , echocardiography was repeated , with additional RV pressure-volume measurements , along with lung , RV histological , and protein analyses . Results : Patients with PAH with lower RV ejection fraction ( < 41 % ) had a significantly reduced heart rate recovery in comparison with patients with higher RV ejection fraction . In PAH RV sample s , & agr;-7 nicotinic acetylcholine receptor was increased and acetylcholinesterase activity was reduced versus controls . No difference in muscarinic acetylcholine type 2 receptor expression was observed . Chronic PYR treatment in PH rats normalized the cardiovascular autonomic function , demonstrated by an increase in parasympathetic activity and baroreflex sensitivity . PYR improved survival , increased RV contractility , and reduced RV stiffness , RV hypertrophy , RV fibrosis , RV inflammation , and RV & agr;-7 nicotinic acetylcholine receptor and muscarinic acetylcholine type 2 receptor expression , as well . Furthermore , PYR reduced pulmonary vascular resistance , RV afterload , and pulmonary vascular remodeling , which was associated with reduced local and systemic inflammation . Conclusions : RV dysfunction is associated with reduced systemic parasympathetic activity in patients with PAH , with an inadequate adaptive response of the cholinergic system in the RV . Enhancing parasympathetic activity by PYR improved survival , RV function , and pulmonary vascular remodeling in experimental PH",
"BACKGROUND No effective pharmacotherapy for acute respiratory distress syndrome ( ARDS ) exists , and mortality remains high . Pre clinical studies support the efficacy of mesenchymal stem ( stromal ) cells ( MSCs ) in the treatment of lung injury . We aim ed to test the safety of a single dose of allogeneic bone marrow-derived MSCs in patients with moderate-to-severe ARDS . METHODS The STem cells for ARDS Treatment ( START ) trial was a multicentre , open-label , dose-escalation , phase 1 clinical trial . Patients were enrolled in the intensive care units at University of California , San Francisco , CA , USA , Stanford University , Stanford , CA , USA , and Massachusetts General Hospital , Boston , MA , USA , between July 8 , 2013 , and Jan 13 , 2014 . Patients were included if they had moderate-to-severe ARDS as defined by the acute onset of the need for positive pressure ventilation by an endotracheal or tracheal tube , a PaO2:FiO2 less than 200 mm Hg with at least 8 cm H2O positive end-expiratory airway pressure ( PEEP ) , and bilateral infiltrates consistent with pulmonary oedema on frontal chest radiograph . The first three patients were treated with low dose MSCs ( 1 million cells/kg predicted bodyweight [ PBW ] ) , the next three patients received intermediate dose MSCs ( 5 million cells/kg PBW ) , and the final three patients received high dose MSCs ( 10 million cells/kg PBW ) . Primary outcomes included the incidence of prespecified infusion-associated events and serious adverse events . The trial is registered with Clinical Trials.gov , number NCT01775774 . FINDINGS No prespecified infusion-associated events or treatment-related adverse events were reported in any of the nine patients . Serious adverse events were subsequently noted in three patients during the weeks after the infusion : one patient died on study day 9 , one patient died on study day 31 , and one patient was discovered to have multiple embolic infa rcts of the spleen , kidneys , and brain that were age-indeterminate , but thought to have occurred before the MSC infusion based on MRI results . None of these severe adverse events were thought to be MSC-related . INTERPRETATION A single intravenous infusion of allogeneic , bone marrow-derived human MSCs was well tolerated in nine patients with moderate to severe ARDS . Based on this phase 1 experience , we have proceeded to phase 2 testing of MSCs for moderate to severe ARDS with a primary focus on safety and secondary outcomes including respiratory , systemic , and biological endpoints . FUNDING The National Heart , Lung , and Blood Institute",
"Background : Endothelin-1 is considered to be a central pathogenic factor in connective tissue diseases ( CTDs ) such as systemic sclerosis ( SSc ) , leading to vasoconstriction , fibrosis , hypertrophy and inflammation . A frequent complication of CTD is pulmonary arterial hypertension ( PAH ) , which has a major effect on functioning and quality of life , and is associated with a particularly poor prognosis . Objective : To present a subgroup analysis that summarises experiences from the pivotal studies and their open-label extensions with the oral dual endothelin-1 receptor antagonist bosentan in patients with PAH and CTD , mostly SSc and lupus erythematosus . Methods : 66 patients with PAH secondary to CTD , in World Health Organization functional class III or IV , were r and omised to two double-blind , placebo-controlled studies and followed up for 12 and 16 weeks , respectively . The primary end point was change in exercise capacity , assessed using the 6-min walk test . In both studies and their extensions , survival was assessed from start of treatment to death or data cut-off and analysed as Kaplan – Meier estimates . Results : 44 patients with PAH secondary to CTD who were treated with bosentan were stable in 6-min walk distance at the end of the study ( + 19.5 m , 95 % confidence interval ( CI ) −3.2 to 42.2 ) , whereas patients treated with placebo deteriorated ( −2.6 m , 95 % CI −54.0 to 48.7 ) . 64 patients subsequently received bosentan in an open-label long-term extension study . Mean ( st and ard deviation ( SD ) ) exposure to bosentan was 1.6 ( 0.9 ) years , and duration of observation was 1.8 ( 0.8 ) years . 8 ( 16 % ) patients received epoprostenol as add-on treatment and 7 ( 14 % ) after discontinuation of bosentan . Survival in those receiving bosentan was 85.9 % after 1 year and 73.4 % after 2 years . Conclusion : Short-term bosentan treatment in a subgroup of patients with PAH secondary to CTD seems to have a favourable effect compared with placebo . The long-term follow-up of these patients suggests that first-line bosentan , with the subsequent addition of other PAH treatments if required , is safe for long-term treatment and may have a positive effect on outcome",
"OBJECTIVES We sought to determine the optimal dose of the selective endothelin A ( ET(A ) ) receptor antagonist sitaxsentan for the treatment of pulmonary arterial hypertension ( PAH ) ; for observation only , an open-label ( OL ) bosentan arm was included . BACKGROUND Endothelin is a mediator of PAH . In a preliminary PAH study , the selective ET(A ) receptor antagonist sitaxsentan improved six-min walk ( 6MW ) distance , World Health Organization ( WHO ) functional class ( FC ) , and hemodynamics . METHODS In this double-blind , placebo-controlled 18-week study , 247 PAH patients ( idiopathic , or associated with connective tissue disease or congenital heart disease ) were r and omized ; 245 patients were treated : placebo ( n = 62 ) , sitaxsentan 50 mg ( n = 62 ) or 100 mg ( n = 61 ) , or OL ( 6MW tests , Borg dyspnea scores , and WHO FC assessment s third-party blind ) bosentan ( n = 60 ) . The primary end point was change in 6MW distance from baseline to week 18 . Secondary end points included change in WHO FC , time to clinical worsening , and change in Borg dyspnea score . RESULTS At week 18 , patients treated with sitaxsentan 100 mg had an increased 6MW distance compared with the placebo group ( 31.4 m , p = 0.03 ) , and an improved WHO FC ( p = 0.04 ) . The placebo-subtracted treatment effect for sitaxsentan 50 mg was 24.2 m ( p = 0.07 ) and for OL bosentan , 29.5 m ( p = 0.05 ) . The incidence of elevated hepatic transaminases ( > 3x the upper limit of normal ) was 6 % for placebo , 5 % for sitaxsentan 50 mg , 3 % for sitaxsentan 100 mg , and 11 % for bosentan . CONCLUSIONS Treatment with the selective ET(A ) receptor antagonist sitaxsentan , orally once daily at a dose of 100 mg , improves exercise capacity and WHO FC in PAH patients , with a low incidence of hepatic toxicity",
"OBJECTIVES The purpose of this study was to examine the efficacy and safety of four doses of ambrisentan , an oral endothelin type A receptor-selective antagonist , in patients with pulmonary arterial hypertension ( PAH ) . BACKGROUND Pulmonary arterial hypertension is a life-threatening and progressive disease with limited treatment options . Endothelin is a vasoconstrictor and smooth muscle cell mitogen that plays a critical role in the pathogenesis and progression of PAH . METHODS In this double-blind , dose-ranging study , 64 patients with idiopathic PAH or PAH associated with collagen vascular disease , anorexigen use , or human immunodeficiency virus infection were r and omized to receive 1 , 2.5 , 5 , or 10 mg of ambrisentan once daily for 12 weeks followed by 12 weeks of open-label ambrisentan . The primary end point was an improvement from baseline in 6-min walk distance ( 6MWD ) ; secondary end points included Borg dyspnea index , World Health Organization ( WHO ) functional class , a subject global assessment , and cardiopulmonary hemodynamics . RESULTS At 12 weeks , ambrisentan increased 6MWD ( + 36.1 m , p < 0.0001 ) with similar and statistically significant increases for each dose group ( range , + 33.9 to + 38.1 m ) . Improvements were also observed in Borg dyspnea index , WHO functional class , subject global assessment , mean pulmonary arterial pressure ( -5.2 mm Hg , p < 0.0001 ) , and cardiac index ( + 0.33 l/min/m2 , p < 0.0008 ) . Adverse events were mild and unrelated to dose , including the incidence of elevated serum aminotransferase concentrations > 3 times the upper limit of normal ( 3.1 % ) . CONCLUSIONS Ambrisentan appears to improve exercise capacity , symptoms , and hemodynamics in patients with PAH . The incidence and severity of liver enzyme abnormalities appear to be low",
"Objectives : To investigate the efficacy and safety of initial thrombolysis by recombinant tissue-type plasminogen activator ( rt-PA ) in compared with anticoagulant therapy in patients with acute intermediate-risk pulmonary embolism ( PE ) . Methods : Sixty-six patients with acute intermediate-risk PE were r and omly assigned to receive rt-PA or LMWH between June 2014 and June 2017 in our department . We obtained information regarding the difference in the right ventricle/left ventricle ( RV/LV ) ratio , pulmonary artery systolic pressure ( PASP ) , clinical symptoms improvement , PE-related mortality , hemodynamic decompensation , recurrent PE , and major and minor bleeding . Results : In the rt-PA group , the mean PASP was reduced from 52.0±12.2 at baseline to 34.8±9.4 ( p<0.001 ) and the mean RV/LV ratio was reduced from 1.26±0.22 at baseline to 0.96±0.18 ( p<0.001 ) at 24 hours . In the LMWH group , the mean PASP was 53.4±12.8 at baseline and 48.5±11.9 at 24 hours ( p=0.11 ) , and the mean RV/LV ratio was 1.22±0.19 at baseline and 1.17±0.21 at 24 hours ( p=0.31 ) . In comparison with the LMWH group , there was a significant reduction in PASP and an improvement in the symptom severity in the rt-PA group . At 90 days , there was no difference in mortality , recurrent venous thromboembolism and major bleeding as a safety outcome , but increased minor bleeding and decreased hemodynamic decompensation occurred in the rt-PA group . Conclusions : In patients with acute intermediate-risk PE , low dose thrombolytic therapy is considered safe and effective , it can be recommended as an alternative option in clinical treatment"
] | Conclusions SC therapy is effective for PAH in pre clinical studies .
These results may help to st and ardise pre clinical animal studies and provide a theoretical basis for clinical trial design in the future . | Background Despite significant progress in drug treatment , the prognosis of patients with advanced pulmonary arterial hypertension ( PAH ) remains extremely poor .
Many pre clinical studies have reported the efficacy of stem cell ( SC ) therapy for PAH ; however , this approach remains controversial .
The aim of this systematic review and meta- analysis is to assess the potential efficacy of SC therapy for PAH . |
19588356 | [
"10869264",
"18448495",
"23984728",
"11907289",
"15358690"
] | [
"Acute endothelin A receptor blockade causes selective pulmonary vasodilation in patients with chronic heart failure.",
"A randomised, controlled trial of bosentan in severe COPD",
"Macitentan and morbidity and mortality in pulmonary arterial hypertension.",
"Bosentan therapy for pulmonary arterial hypertension.",
"Combination of bosentan with epoprostenol in pulmonary arterial hypertension: BREATHE-2"
] | [
"BACKGROUND Elevated plasma endothelin-1 ( ET-1 ) levels in patients with chronic heart failure correlate with pulmonary artery pressures and pulmonary vascular resistance . ET(A ) receptors on vascular smooth muscle cells mediate pulmonary vascular contraction and hypertrophy . We determined the acute hemodynamic effects of sitaxsentan , a selective ET(A ) receptor antagonist , in patients with chronic stable heart failure receiving conventional therapy . METHODS AND RESULTS This multicenter , double-blind , placebo-controlled trial enrolled 48 patients with chronic New York Heart Association functional class III or IV heart failure ( mean left ventricular ejection fraction 21+/-1 % ) treated with ACE inhibitors and diuretics . Patients with a baseline pulmonary capillary wedge pressure > /=15 mm Hg and a cardiac index < /=2.5 L. min(-1 ) . m(-2 ) were r and omized to 1 of 3 doses ( 1.5 , 3.0 , or 6.0 mg/kg ) of sitaxsentan or placebo as an intravenous infusion over 15 minutes . Hemodynamic responses were assessed by catheterization of the right side of the heart for 6 hours . Sitaxsentan decreased pulmonary artery systolic pressure , pulmonary vascular resistance , mean pulmonary artery pressure , and right atrial pressure ( P</=0.001 , 0.003 , 0.017 , and 0.031 , respectively ) but had no effect on heart rate , mean arterial pressure , pulmonary capillary wedge pressure , cardiac index , or systemic vascular resistance . Plasma ET-1 levels were elevated at baseline and decreased with sitaxsentan . CONCLUSIONS In patients with moderate to severe heart failure receiving conventional therapy , acute ET(A ) receptor blockade caused selective pulmonary vasodilation associated with a reduction in plasma ET-1 . Sitaxsentan may be of value in the treatment of patients with pulmonary hypertension secondary to chronic heart failure",
"Pulmonary hypertension during exercise is common in severe chronic obstructive pulmonary disease ( COPD ) . It was hypothesised that the use of the endothelin-receptor antagonist bosentan can improve cardiopulmonary haemodynamics during exercise , thus increasing exercise tolerance in patients with severe COPD . In the present double-blind , placebo-controlled study , 30 patients with severe or very severe COPD were r and omly assigned in a 2:1 ratio to receive either bosentan or placebo for 12 weeks . The primary end-point was change in the 6-min walking distance . Secondary end-points included changes in health-related quality of life , lung function , cardiac haemodynamics , maximal oxygen uptake and pulmonary perfusion patterns . Compared with placebo , patients treated with bosentan during 12 weeks showed no significant improvement in exercise capacity as measured by the 6-min walking distance ( mean±sd 331±123 versus 329±94 m ) . There was no change in lung function , pulmonary arterial pressure , maximal oxygen uptake or regional pulmonary perfusion pattern . In contrast , arterial oxygen pressure dropped , the alveolar – arterial gradient increased and quality of life deteriorated significantly in patients assigned bosentan . The oral administration of the endothelin receptor antagonist bosentan not only failed to improve exercise capacity but also deteriorated hypoxaemia and functional status in severe chronic obstructive pulmonary disease patients without severe pulmonary hypertension at rest",
"BACKGROUND Current therapies for pulmonary arterial hypertension have been adopted on the basis of short-term trials with exercise capacity as the primary end point . We assessed the efficacy of macitentan , a new dual endothelin-receptor antagonist , using a primary end point of morbidity and mortality in a long-term trial . METHODS We r and omly assigned patients with symptomatic pulmonary arterial hypertension to receive placebo once daily , macitentan at a once-daily dose of 3 mg , or macitentan at a once-daily dose of 10 mg . Stable use of oral or inhaled therapy for pulmonary arterial hypertension , other than endothelin-receptor antagonists , was allowed at study entry . The primary end point was the time from the initiation of treatment to the first occurrence of a composite end point of death , atrial septostomy , lung transplantation , initiation of treatment with intravenous or subcutaneous prostanoids , or worsening of pulmonary arterial hypertension . RESULTS A total of 250 patients were r and omly assigned to placebo , 250 to the 3-mg macitentan dose , and 242 to the 10-mg macitentan dose . The primary end point occurred in 46.4 % , 38.0 % , and 31.4 % of the patients in these groups , respectively . The hazard ratio for the 3-mg macitentan dose as compared with placebo was 0.70 ( 97.5 % confidence interval [ CI ] , 0.52 to 0.96 ; P=0.01 ) , and the hazard ratio for the 10-mg macitentan dose as compared with placebo was 0.55 ( 97.5 % CI , 0.39 to 0.76 ; P<0.001 ) . Worsening of pulmonary arterial hypertension was the most frequent primary end-point event . The effect of macitentan on this end point was observed regardless of whether the patient was receiving therapy for pulmonary arterial hypertension at baseline . Adverse events more frequently associated with macitentan than with placebo were headache , nasopharyngitis , and anemia . CONCLUSIONS Macitentan significantly reduced morbidity and mortality among patients with pulmonary arterial hypertension in this event-driven study . ( Funded by Actelion Pharmaceuticals ; SERAPHIN Clinical Trials.gov number , NCT00660179 . )",
"BACKGROUND Endothelin-1 is a potent vasoconstrictor and smooth-muscle mitogen . In a preliminary study , the orally administered dual endothelin-receptor antagonist bosentan improved exercise capacity and cardiopulmonary hemodynamics in patients with pulmonary arterial hypertension . The present trial investigated the effect of bosentan on exercise capacity in a larger number of patients and compared two doses . METHODS In this double-blind , placebo-controlled study , we r and omly assigned 213 patients with pulmonary arterial hypertension ( primary or associated with connective-tissue disease ) to receive placebo or to receive 62.5 mg of bosentan twice daily for 4 weeks followed by either of two doses of bosentan ( 125 or 250 mg twice daily ) for a minimum of 12 weeks . The primary end point was the degree of change in exercise capacity . Secondary end points included the change in the Borg dyspnea index , the change in the World Health Organization ( WHO ) functional class , and the time to clinical worsening . RESULTS At week 16 , patients treated with bosentan had an improved six-minute walking distance ; the mean difference between the placebo group and the combined bosentan groups was 44 m ( 95 percent confidence interval , 21 to 67 ; P<0.001 ) . Bosentan also improved the Borg dyspnea index and WHO functional class and increased the time to clinical worsening . CONCLUSIONS The endothelin-receptor antagonist bosentan is beneficial in patients with pulmonary arterial hypertension and is well tolerated at a dose of 125 mg twice daily . Endothelin-receptor antagonism with oral bosentan is an effective approach to therapy for pulmonary arterial hypertension",
"The efficacy and safety of combining bosentan , an orally active dual endothelin receptor antagonist and epoprostenol , a continuously infused prostagl and in , in the treatment of pulmonary arterial hypertension ( PAH ) was investigated . In this double-blind , placebo-controlled prospect i ve study , 33 patients with PAH started epoprostenol treatment ( 2 ng·kg−1min−1 starting dose , up to 14±2 ng·kg−1min−1 at week 16 ) and were r and omised for 16 weeks in a 2:1 ratio to bosentan ( 62.5 mg b.i.d for 4 weeks then 125 mg b.i.d ) or placebo . Haemodynamics , exercise capacity and functional class improved in both groups at week 16 . In the combination treatment group , there was a trend for a greater ( although nonsignificant ) improvement in all measured haemodynamic parameters . There were four withdrawals in the bosentan/epoprostenol group ( two deaths due to cardiopulmonary failure , one clinical worsening , and one adverse event ) and one withdrawal in the placebo/epoprostenol group ( adverse event ) . This study showed a trend but no statistical significance towards haemodynamics or clinical improvement due to the combination of bosentan and epoprostenol therapy in patients with pulmonary arterial hypertension . Several cases of early and late major complications were reported . Additional information is needed to evaluate the risk/benefit ratio of combined bosentan-epoprostenol therapy in pulmonary arterial hypertension"
] | There was a trend for endothelin receptor antagonists to reduce mortality ( OR 0.48 ; 95 % CI 0.21 to 1.09 ) , and limited data suggest that endothelin receptor antagonists improve Borg dyspnoea score and cardiopulmonary haemodynamics in symptomatic patients .
Hepatic toxicity was not common , and endothelin receptor antagonists were well tolerated in this population .
Endothelin receptor antagonists can increase exercise capacity , improve WHO/NYHA functional class , prevent WHO/NYHA functional class deterioration , reduce dyspnoea and improve cardiopulmonary haemodynamic variables in patients with pulmonary arterial hypertension with WHO/NYHA functional class II and III .
However , there was only a trend towards endothelin receptor antagonists reducing mortality in patients with pulmonary arterial hypertension .
Efficacy data are strongest in those with idiopathic pulmonary hypertension | BACKGROUND Pulmonary arterial hypertension is a devastating disease , which leads to right heart failure and premature death .
Recent evidence suggests that endothelin receptor antagonists may be promising drugs in the treatment of pulmonary arterial hypertension .
OBJECTIVES To evaluate the efficacy of endothelin receptor antagonists in pulmonary arterial hypertension . |
23893797 | [
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"Postconditioning during coronary angioplasty in acute myocardial infarction: the POST-AMI trial.",
"[The effect on myocardial perfusion and clinical outcome of intracoronary nicorandil injection prior to percutaneous coronary intervention in ST-segment elevation myocardial infarction].",
"Early abciximab administration before primary percutaneous coronary intervention improves infarct-related artery patency and left ventricular function in high-risk patients with anterior wall myocardial infarction: a randomized study.",
"Intracoronary Compared to Intravenous Abciximab in Patients with ST Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention Reduces Mortality, Target Vessel Revascularization and Reinfarction after 1 Year",
"Facilitated percutaneous coronary intervention for acute ST-segment elevation myocardial infarction: results from the prematurely terminated ADdressing the Value of facilitated ANgioplasty after Combination therapy or Eptifibatide monotherapy in acute Myocardial Infarction (ADVANCE MI) trial.",
"Intracoronary Nicorandil and the Prevention of the No-Reflow Phenomenon During Primary Percutaneous Coronary Intervention in Patients with Acute ST-Segment Elevation Myocardial Infarction",
"Routine use of the transradial approach in primary percutaneous coronary intervention: procedural aspects and outcomes in 2209 patients treated in a single high-volume centre",
"Prehospital Abciximab in ST-Segment Elevation Myocardial Infarction: Results of the Randomized, Double-Blind MISTRAL Study",
"Cardioprotective Effects of Ischemic Postconditioning in Patients Treated With Primary Percutaneous Coronary Intervention, Evaluated by Magnetic Resonance",
"Impact of chronic statin-pretreatment on myocardial damage as assessed by Cardiac Magnetic Resonance findings in patients with acute ST-elevation myocardial infarction"
] | [
"BACKGROUND Postconditioning ( PC ) has been suggested to reduce myocardial damage during primary percutaneous coronary intervention ( PPCI ) , nevertheless clinical experience is limited . We aim ed to explore the cardioprotective effect of PC using cardiac magnetic resonance ( CMR ) in ST-elevation myocardial infa rct ion ( STEMI ) patients treated by PPCI . METHODS A total of 78 patients with first STEMI ( aged 59±12 years ) referred for PPCI , were stratified for STEMI location and r and omly assigned to conventional PPCI or PPCI with PC . All patients , with occluded infa rct related artery and no collateral circulation , received abciximab intravenously before PPCI . After reperfusion by effective direct stenting , control subjects underwent no further intervention , while in treated patients PC was performed within 1 min of reflow by 4 cycles of 1-minute inflation and 1-minute deflation of the angioplasty balloon . Primary end-point was infa rct size ( IS ) reduction , expressed as percentage of left ventricle mass assessed by delayed enhancement on CMR at 30±10 days after index PPCI . RESULTS All baseline characteristics but diabetes ( p=0.06 ) were balanced between groups . Postconditioning patients trended toward a larger IS compared to those treated by st and ard PPCI ( 20±12 % vs 14±10 % , p=0.054 ) . After exclusion of diabetics , PC group still showed a trend to larger IS ( p=0.116 ) . Major adverse events seem to be more frequent in PC group irrespective to diabetic status ( p=0.053 and p=0.080 , respectively ) . CONCLUSIONS This prospect i ve , r and omized trial suggests that PC did not have the expected cardioprotective effect and on the contrary it might harm STEMI patients treated by PPCI plus abciximab . ( Clinical Trial Registration -unique identifier : NCT01004289 )",
"Objective : To investigate the effect of intracoronary administration of nicor and il prior to primary percutaneous coronary intervention ( PPCI ) on myocardial perfusion and short-term clinical outcomes in patients with ST-segment elevation myocardial infa rct ion ( STEMI ) . Methods : A total of 158 patients with STEMI undergoing PPCI from January 2014 to December 2015 in Fuzhou General Hospital were enrolled consecutively in this prospect i ve controlled r and omized trial . Patients were assigned into three groups with r and om number table : the nicor and il group ( patients received intracoronary administration of 6 mg nicor and il after guide wire or balloon successfully crossed the target lesion , n=53 ) , the nitroglycerin group ( patients received intracoronary administration of 300 μg nitroglycerin after after guide wire or balloon successfully crossed the target lesion , n=52 ) and the control group ( patients received routine treatment , n=53 ) . The primary outcomes were myocardial perfusion , including the levels of corrected TIMI frame count ( cTFC ) , and the incidence of no reflow or slow flow after PPCI . The secondary outcomes included the incidence of major adverse cardiovascular events ( MACE ) during hospitalization ( all-cause death , reperfusion arrhythmia within 2 hours after PPCI , angina within 24 hours after PPCI , new heart failure or worsening cardiac function , and repeat revascularization ) and within 3 months of follow-up ( all-cause death , nonfatal myocardial infa rct ion , repeat revascularization , post-infa rct ion angina , and re-hospitalization for congestive heart failure ) . Results : The age of enrolled patients was ( 62.9±11.3 ) years old , and 130 cases ( 82.3 % ) of them were male . The median time of symptom-onset to balloon was 4.50 ( 3.20 , 6.43 ) hours . There were significantly difference in cTFC immediately after PPCI((21.68±7.43)frames , (24.74±8.66)frames , and (27.06±10.40)frames ) , incidence of no reflow or slow flow after PPCI(5.7%(3/53 ) , 13.5%(7/52 ) , and 22.6%(12/53 ) ) , ST-segment resolution at 2 hours after procedure(90.6%(48/53 ) , 84.6%(44/52 ) , and 74.5%(38/53 ) ) , and reperfusion arrhythmia at 2 hours after procedure(15.1%(8/53 ) , 36.6%(19/52 ) , and 34.0%(18/53 ) ) among the 3 groups(P<0.01 or 0.05 ) . In the multivariate logistic regression models , intracoronary administration of nicor and il could lower the cTFC level ( OR=0.17 , 95%CI 0.10 - 0.41 , P=0.001 ) , acted as a protecting factor on lowering the incidence of no reflow or slow flow ( OR=0.13 , 95%CI 0.02 - 0.96 , P=0.045 ) and reperfusion arrhythmia ( OR=0.26 , 95%CI 0.09 - 0.74 , P=0.012 ) , as well as facilitating the ST-segment resolution at 2 hours after procedure ( OR=4.62 , 95%CI 1.14 - 18.82 , P=0.033 ) . However , observed parameters were similar between intracoronary administration of nitroglycerin group compared with control group ( all P>0.05 ) . MACE within 3 months of follow-up were similar among the 3 groups(all P>0.05 ) . Conclusion : Intracoronary administration of nicor and il prior to balloon dilation can significantly improve the myocardial perfusion and reduce the occurrence of reperfusion arrhythmia during PPCI for STEMI , but does not affect the short-term prognosis in STEMI patients",
"BACKGROUND Early abciximab administration before primary percutaneous coronary intervention ( PPCI ) for ST-segment elevation myocardial infa rct ion ( STEMI ) is recommended in practice guidelines . However , the evidence supporting abciximab use before and during transfer for PPCI is limited . We investigated the effect of early abciximab administration on early reperfusion , ST-segment resolution , enzymatic infa rct size , and left ventricular function in patients with first anterior wall STEMI . METHODS A total of 59 nonshock patients with STEMI admitted < 12 hours to remote hospitals with anticipated delay to PPCI of < 90 minutes were r and omly assigned to 2 study groups : 27 patients received abciximab before transfer to catheterization laboratory ( Early group ) , and 32 patients received abciximab immediately before PPCI ( Late group ) . RESULTS Angiography revealed more frequent infa rct -related artery patency in the Early group than in the Late group ( TIMI 2 + 3 : 48 % vs 20 % , P = .04 ) . Better ST-segment resolution of > 50 % 60 minutes after PPCI was found in Early group than in the Late group ( 84 % vs 56.7 % , P = .04 ) . The area under the curve for creatine kinase-MB indicated a significantly greater extent of myocardial injury in the Late group versus the Early group ( 8324 + /- 4185 vs 5938 + /- 3949 U/L . h , P = .04 ) . There was a significant difference in the 30-day left ventricular end-systolic volume index ( P = .02 ) and end-diastolic volume index ( P = .05 ) in the echocardiography favoring the Early group . CONCLUSIONS Early abciximab administration before transfer for PPCI in patients with first anterior wall STEMI results in more frequent infa rct -related artery patency before PPCI , better myocardial tissue perfusion after PPCI , with lower enzymatic infa rct size and lower degree of left ventricular remodeling during 30-day follow-up",
"Objectives : Administration of the glycoprotein IIb/IIIa inhibitor abciximab to patients with ST segment elevation myocardial infa rct ion ( STEMI ) undergoing primary percutaneous coronary intervention ( pPCI ) improves outcome . Data have suggested that an intracoronary ( IC ) bolus might be superior to the st and ard intravenous ( IV ) administration . We have previously reported reduced short-term mortality and need for target vessel revascularization ( TVR ) with the IC route . We now present long-term data from our r and omized trial on IC versus IV abciximab in pPCI-treated STEMI patients . Methods : A total of 355 pPCI-treated STEMI patients were r and omized to either IC or IV bolus abciximab followed by a 12-hour IV infusion . Patients were followed for 1 year to observe mortality , TVR or myocardial infa rct ion ( MI ) and the combination of these . Results : The two treatment arms ( IV , n = 170 ; IC , n = 185 ) were similar with regard to baseline characteristics . Mortality was reduced from 10 % in the IV group to 2.7 % in the IC group ( p = 0.004 ) . TVR and MI were also reduced with IC administration ( TVR : 14.1 vs. 7.6 % , p = 0.04 ; MI : 11.8 vs. 5.4 % , p = 0.03 ) . Consequently , patients in the IC treatment arm had a relative risk reduction of 55 % for the combined endpoint after 1 year ( p = 0.002 ) compared to the IV treatment arm . Conclusions : In pPCI-treated STEMI patients treated with abciximab , IC bolus administration result ed in a significant reduction in mortality , TVR and MI compared to IV bolus administration",
"BACKGROUND Facilitated percutaneous coronary intervention (PCI)--simultaneous administration of glycoprotein IIb/IIIa inhibitors and reduced-dose fibrinolytics before primary PCI for ST-segment elevation myocardial infa rct ion (STEMI)--may be a promising reperfusion strategy . METHODS The ADVANCE MI trial was intended to evaluate facilitated PCI in 5640 STEMI patients but was prematurely terminated as a result of slow recruitment over 12 months at 30 centers in the United States . Patients with STEMI with planned primary PCI were r and omly assigned to receive eptifibatide + 50 % of st and ard-dose tenecteplase ( which equated to 0.25 mg/kg intravenous bolus ) or eptifibatide + placebo before PCI and r and omized in a 2 x 2 factorial design to unfractionated heparin or enoxaparin . RESULTS A total of 148 patients were r and omized ( 74 patients in each treatment arm ) and formed the \" as-r and omized \" intention-to-treat population . However , only 69 patients actually received eptifibatide + tenecteplase , and 77 actually received eptifibatide + placebo ( 2 patients did not receive eptifibatide and 4 patients r and omized to tenecteplase did not receive this therapy)--these 146 patients formed the \" as-treated \" population . Among both population s , epicardial infa rct artery patency and myocardial tissue perfusion on pre-PCI angiography were improved in the tenecteplase group , but ST-segment resolution at 60 minutes was similar . The frequency of the primary end point of death or new/worsening severe heart failure at 30 days was higher among patients treated with eptifibatide + tenecteplase in the \" as-treated \" ( 10 % vs 3 % , P = .09 ) and the \" as-r and omized \" ( 11 % vs 1 % , P = .02 ) population s. Bleeding complications were 2-fold higher with eptifibatide + tenecteplase . Analysis of the results by treatment with unfractionated heparin versus enoxaparin demonstrated similar findings . CONCLUSIONS Although definitive conclusions can not be made as a result of the small sample size and premature study termination , facilitated PCI with eptifibatide + reduced-dose tenecteplase was associated with improved angiographic flow patterns , increases in adverse clinical outcomes , and higher bleeding rates compared with eptifibatide + placebo administered before primary PCI for STEMI",
"Background This study aim ed to investigate intracoronary nicor and il treatment on the no-reflow phenomenon ( NRP ) during primary percutaneous coronary intervention ( PCI ) in patients with acute ST-segment elevation myocardial infa rct ion ( STEMI ) and to compare nicor and il with sodium nitroprusside . Material / Methods Patients with sustained acute STEMI who underwent primary PCI ( N=120 ) were r and omly assigned to three groups : the nicor and il-treated group ( N=40 ) had 2 mg of nicor and il injected into the coronary artery at 2 mm beyond the occlusion with balloon pre-dilation ; the sodium nitroprusside-treated group ( N=40 ) underwent the same procedure , but with 200 μg of sodium nitroprusside ; the control group ( N=40 ) received PCI and balloon pre-dilation only . Coronary angiography , incidence of NRP , hypotensive episodes , ST-segment resolution ( STR ) rate , levels of N-terminal pro-brain natriuretic peptide ( NT-proBNP ) , creatine kinase-MB ( CK-MB ) , cardiac troponin I ( cTnI ) , wall motion score index ( WMSI ) , and left ventricular ejection fraction ( LVEF ) were measured before and after primary PCI . Major adverse cardiovascular events ( MACEs ) post-PCI and at three-month follow-up were recorded . Results Patients in the sodium nitroprusside and nicor and il groups had significantly improved thrombolysis in myocardial infa rct ion ( TIMI ) scores , TIMI myocardial perfusion grade ( TMPG ) , and ST-segment elevation resolution ( STR ) ( P<0.05 ) , and a significantly lower incidence of NRP ( P=0.013 ) . The incidence of intraoperative hypotension in the sodium nitroprusside group was significantly greater than the nicor and il and control groups ( P=0.035 ) . Conclusions Patients with sustained acute STEMI undergoing primary PCI , treated with intracoronary nicor and il had a reduced incidence of the NRP , improved myocardial perfusion and cardiac function",
"Objective To examine the feasibility of a routine transradial approach ( TRA ) in primary percutaneous coronary intervention ( PPCI ) for acute ST-segment elevation myocardial infa rct ion ( STEMI ) . Design A single-centre observational study with prospect i ve data collection . Setting A high-volume interventional centre in Amsterdam , The Netherl and s. Patients Procedural data were analysed for 2209 consecutive patients presenting with STEMI without cardiogenic shock , between January 2001 and December 2008 . Interventions PPCI routinely performed by the TRA . Main Outcome Measures The primary outcomes of interest were the need for crossover to another vascular access site , the achievement of procedural success and their trends over time . Secondary outcome measures were trends in total procedural duration , fluoroscopy times and use of equipment . Results In a total of 2209 procedures the radial artery was the primary access site , comprising 96.1 % of all procedures performed during the study period . In 84 cases ( 3.8 % ) access site crossover was needed . Crossover rates decreased from 5.9 % in 2001–2 to 1.5 % in 2007–8 ( p=0.001 ) . The procedural success rate was 94.1 % , which remained stable over the years . Despite an increased complexity of PPCI ( more non-left anterior descending infa rct -related arteries , thrombus aspiration and multivessel PPCI ) , total procedural duration decreased from 38 min ( IQR 28–50 ) in 2001–2 to 24 min ( 18–33 ) in 2007–8 , p<0.001 for trend . Conclusions Systematic use of the TRA in PPCI yields low access site crossover , high procedural success rates and excellent procedural performances . It can therefore represent the primary access site in the vast majority of STEMI patients",
"Background — The value of prehospital initiation of glycoprotein IIb/IIIa inhibitors remains a controversial issue . We sought to investigate whether in-ambulance initiation of abciximab in patients with ST-segment elevation myocardial infa rct ion ( STEMI ) improves ST-segment elevation resolution ( STR ) after primary percutaneous coronary intervention ( PCI ) . Methods and Results — MISTRAL ( Myocardial Infa rct ion with ST-elevation Treated by Primary Percutaneous Intervention Facilitated by Early Reopro Administration in Alsace ) is a prospect i ve , r and omized , double-blind study . Two hundred and fifty-six patients with acute STEMI were allocated to receive abciximab either in the ambulance ( ambulance group , n=127 ) or in the catheterization laboratory ( hospital group , n=129 ) . The primary end point was complete ( > 70 % ) STR after PCI . Complete STR was not significantly different between the 2 groups ( before PCI , 21.6 % versus 15.5 % , P=0.28 ; after PCI , 70.3 % versus 65.8 % , P=0.49 ) . Thrombolysis In Myocardial Infa rct ion ( TIMI ) 2 to 3 flow rates before PCI tended to be higher in the ambulance group ( 46.8 % versus 35 % , P=0.08 ) but not after PCI ( 70.3 % versus 65.8 % , P=0.49 ) . Slow flow tended to be lower ( 5.6 % versus 13.4 % , P=0.07 ) , and distal embolization occurred significantly less often in the ambulance group ( 8.1 % versus 21.1 % , P=0.008 ) . One- and 6-month major adverse cardiac event rates were low and similar in both groups . Conclusions — Early ambulance administration of abciximab in STEMI did not improve either STR or TIMI flow rate after PCI . However , it tended to improve TIMI flow pre-PCI and decreased distal embolization during procedure . Larger studies are needed to confirm these results . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00638638",
"Background —Postconditioning has been suggested to reduce myocardial damage during primary percutaneous coronary intervention ( PPCI ) in patients with ST-segment – elevation myocardial infa rct ion . However , because clinical experience is limited , we examined the cardioprotective effects of postconditioning , using cardiac MRI in patients treated with PPCI . Methods and Results —One hundred eighteen patients with ST-segment – elevation myocardial infa rct ion referred for PPCI were r and omly assigned to have either conventional PPCI or PPCI with postconditioning . Postconditioning was performed immediately after obtained reperfusion with 4 balloon occlusions , each lasting 30 seconds , followed by 30 seconds of reperfusion . The primary end point was myocardial salvage after 3 months as judged by delayed enhancement cardiac MRI . We found a 19 % relative reduction of infa rct size in the postconditioning group ( 51±16 % of total area at risk versus 63±17 % , P<0.01 ) , corresponding to a 31 % increase in salvage ratio . The number of patients developing heart failure was significantly fewer in the postconditioning group ( 27 % versus 46 % , P=0.048 ) . No significant evidence of interaction between the impact of postconditioning and the location of the culprit lesion or size of the myocardium at risk was detected ( P=0.21 and P=0.71 ) . Conclusions —Mechanical postconditioning reduces infa rct size in patients with ST-segment – elevation myocardial infa rct ion treated with PPCI . The impact of mechanical postconditioning seems to be independent of the size of myocardium at risk . Clinical Trial Registration —URL : http://www . clinical trials.gov . Unique Identifier : NCT00507156",
"Background Recent data have demonstrated a lower mortality in acute ST-elevation myocardial infa rct ion ( STEMI ) patients with previous treatment with statins , especially in patients with high risk profiles . Moreover , a significant reduction in enzymatic infa rct size in non-STEMI patients could be observed . However , systematic data of the impact of chronic statin pre-treatment on myocardial damage and reperfusion injury assessed with the gold st and ard cardiac magnetic resonance imaging ( CMR ) are lacking . The aim of our prospect i ve study was therefore to assess the effects of a chronic statin pre-treatment on myocardial damage as assessed by CMR in patients with acute reperfused STEMI ."
] | This present meta- analysis suggests that statin pretreatment might be effective in improving myocardial perfusion in STEMI patients | BACKGROUND To achieve sufficient myocardial perfusion in ST-segment elevation myocardial infa rct ion ( STEMI ) patients receiving primary percutaneous coronary intervention ( PPCI ) , many adjunctive therapies have been proposed .
Previous trials have reported variances in myocardial perfusion improvement for statin pretreatment , which made it inconvincible to confirm the beneficial effects of statins .
Therefore , we performed a systematic review and meta- analysis to determine whether statin pretreatment was effective in improving myocardial perfusion .
HYPOTHESIS Statin pretreatment could improve myocardial perfusion in STEMI patients undergoing PPCI . |
27167891 | [
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"Prevalence of and Associations with Waterpipe Tobacco Smoking among U.S. University Students",
"Waterpipe tobacco smoking: knowledge, attitudes, beliefs, and behavior in two U.S. samples.",
"Waterpipe Tobacco Smoking Prevalence and Correlates in 25 Eastern Mediterranean and Eastern European Countries: Cross-Sectional Analysis of the Global Youth Tobacco Survey.",
"Beliefs and perceptions toward quitting waterpipe smoking among cafe waterpipe tobacco smokers in Bahrain.",
"Are waterpipe users interested in quitting?",
"Waterpipe smoking in Kuwait.",
"Cigarettes and waterpipe smoking among medical students in Syria: a cross-sectional study.",
"Patterns of water-pipe and cigarette smoking initiation in schoolchildren: Irbid longitudinal smoking study.",
"Waterpipe tobacco use among Iranian university students: correlates and perceived reasons for use.",
"Knowledge, attitudes and practice of university students regarding waterpipe smoking in Pakistan."
] | [
"Background Although waterpipe tobacco smoking seems to be increasing on U.S. university campuses , these data have come from convenience sample s. Purpose We aim ed to determine the prevalence of and associations with waterpipe tobacco smoking among a r and om sample of students . Methods We surveyed a r and om sample of graduate and undergraduate students at a large , urban university . We used multivariate modeling to determine independent associations between belief-related predictors and waterpipe tobacco smoking . Results Of the 647 respondents , waterpipe smoking was reported in 40.5 % , over the past year in 30.6 % , and over the past 30 days in 9.5 % . Over half of the sample ( 52.1 % ) perceived that tobacco smoking from a waterpipe was less addictive than cigarette smoking . In fully adjusted multivariate models , 1-year waterpipe smoking was associated with low perceived harm ( OR = 2.54 , 95 % CI = 1.68 , 3.83 ) , low perceived addictiveness ( OR = 4.64 , 95 % CI = 3.03 , 7.10 ) , perception of high social acceptability ( OR = 20.00 , 95 % CI = 6.03 , 66.30 ) , and high perception of popularity ( OR = 4.72 , 95 % CI = 2.85 , 7.82 ) . Conclusions In this sample , lifetime waterpipe use was as common as lifetime cigarette use . Perception of harm , perception of addictiveness , social acceptability , and popularity were all strongly related to waterpipe smoking",
"Despite evidence of increasing waterpipe tobacco smoking prevalence among U.S. young adults , little is known about the knowledge , attitudes , beliefs , and smoking patterns of waterpipe users in this population . To address this lack of knowledge , two convenience sample s of U.S. waterpipe users were surveyed -- one from a Richmond , Virginia , waterpipe café ( n=101 ) , the other from an Internet forum called HookahForum.com ( n=100 ) . Sixty percent reported first-time waterpipe use at or before age 18 . Daily waterpipe use was reported by 19 % , weekly use by 41 % , and monthly use by 29 % . Waterpipe use was more common during the weekend ( 75 % ) than during weekdays ( 43 % ) . Forty-four percent reported spending > or=60 min smoking tobacco during a waterpipe session . The majority of waterpipe users owned a waterpipe ( 57 % ) and purchased it on the Internet ( 71 % ) . Many waterpipe users smoked the sweetened and flavored tobacco ( i.e. , maassel ) , and fruit flavors were the most popular ( 54 % ) . Past month use of cigarettes , tobacco products other than cigarettes or waterpipe , and alcohol was 54 % , 33 % , and 80 % respectively , and 36 % reported past-month marijuana use . Most waterpipe users were confident about their ability to quit ( 96 % ) , but only a minority ( 32 % ) intended to quit . Most waterpipe users believed waterpipe tobacco smoking was less harmful and addictive than cigarettes . These results are from small convenience sample s ; more detailed study of a larger group of r and omly sample d U.S. waterpipe tobacco smokers will be valuable in underst and ing this behavior and developing effective strategies to prevent it",
"INTRODUCTION Waterpipe tobacco smoking is highly prevalent among young people in some setting s. There is an absence of nationally representative prevalence studies of waterpipe tobacco use and dual use with other tobacco products in young people . METHODS We conducted a secondary analysis of the Global Youth Tobacco Survey , a nationally representative cross-sectional study of students aged 13 - 15 years . Of 180 participating countries , 25 included optional waterpipe tobacco smoking questions : 15 Eastern Mediterranean and 10 Eastern European countries . We calculated the prevalence of current ( past 30-day ) waterpipe tobacco use , including dual waterpipe and other tobacco use , and used logistic regression models to identify sociodemographic correlates of waterpipe tobacco smoking . Individual country results were combined in a r and om effects meta- analysis . RESULTS Waterpipe tobacco smoking prevalence was highest in Lebanon ( 36.9 % ) , the West Bank ( 32.7 % ) and parts of Eastern Europe ( Latvia 22.7 % , the Czech Republic 22.1 % , Estonia 21.9 % ) . These countries also recorded greater than 10 % prevalence of dual waterpipe and cigarette use . In a meta- analysis , higher odds of waterpipe tobacco smoking were found among males ( Adjusted odds ratio [ AOR ] = 1.37 , 95 % confidence interval [ CI ] = 1.18 % to 1.59 % ) , cigarette users ( AOR = 6.95 , 95 % CI = 5.74 % to 8.42 % ) , those whose parents ( AOR = 1.54 , 95 % CI = 1.31 % to 1.82 % ) or peers smoked ( AOR = 3.53 , 95 % CI = 2.97 % to 4.20 % ) and those whose parents had higher educational attainment ( Father , AOR = 1.47 , 95 % CI = 1.14 % to 1.89 % ; Mother , AOR = 1.62 , 95 % CI = 1.07 % to 2.46 % ) . We report on regional- and country income-level differences . CONCLUSIONS Waterpipe tobacco smoking , including dual waterpipe and cigarette use , is alarmingly high in several Eastern Mediterranean and Eastern European countries . Ongoing waterpipe tobacco smoking surveillance is warranted",
"INTRODUCTION There is a rising prevalence of waterpipe smoking worldwide , but still a paucity of information on perceptions toward quitting waterpipe use . We set out to establish the beliefs and perceptions of café waterpipe smokers toward quitting waterpipe smoking in the Kingdom of Bahrain . METHODS A cross-sectional study . A r and om sample of 20 of 91 cafés serving waterpipe tobacco in Bahrain was taken . A question naire was administered in each café to 20 participants aged 18 and above . RESULTS Three hundred eighty participants completed question naires from waterpipe smokers . Eighty-four percent of participants were Bahraini and 71 % had a university degree . Mean age was 28.9 years . Average age of waterpipe smoking initiation was 20.3 years . The majority of waterpipe users chose flavored tobacco . Sixty-one percent smoked waterpipe tobacco daily with a mean smoking time of 2.6hr/day . Seventy-two percent considered waterpipe tobacco as harmful as or more harmful than cigarettes , but 67 % considered cigarettes as more addictive . Eighty-two percent stated that they could quit waterpipe at any time , but only 40 % were interested in quitting . Interest in quitting smoking was related to 4 variables : a physician mentioning the need to quit smoking , being non-Bahraini , having a family with a hostile attitude toward waterpipe smoking , and not considering oneself \" hooked \" on waterpipe tobacco . CONCLUSIONS Waterpipe smokers in Bahrain cafés are frequent and high users . Health professionals must consider waterpipe smoking in all consultations and health promotion messages . A partnership between health professionals and disapproving members of families may be an effective strategy in encouraging waterpipe smokers to quit",
"Waterpipe smoking has increased dramatically worldwide in recent years , with an estimated 100 million daily users . Research on this traditional Middle Eastern tobacco use method is in its infancy , and little is known about users ' cessation-related attitudes and experiences . A r and om sample of 268 narghile ( waterpipe ) smokers ( 40 % female ; mean age = 30 years ; range = 18 - 68 ) was obtained from cafes and restaurants in Aleppo , Syria . The majority of users ( 86.5 % ) believed they could quit using waterpipes at any time , but that belief was inversely related to perceived dependence , with only 48.7 % of those who thought they were \" very hooked \" believing they could quit . Interest in quitting was expressed by 28.4 % of subjects , with the majority ( 89.2 % ) reporting health concerns as a primary reason , and 59.2 % having made an unsuccessful quit attempt in the past year . In a logistic regression model , independent predictors of interest in quitting included being married , having smoked for fewer years , not increasing the frequency of smoking over time , and having family members who do not smoke a waterpipe and disapprove of its use . Results indicate that a sizable percentage of waterpipe users express interest in quitting and have tried unsuccessfully in the past to quit . Waterpipe use needs to be considered in developing effective tobacco use cessation programs in the Middle East",
"A nonr and om sampIe of 2972 Kuwaitis answered a question naire about smoking behaviour and beliefs . More than one-third ( 35 % ) were nonsmokers , 45 % smoked only the waterpipe , 12 % only cigarettes and 8 % both waterpipe and cigarettes . Compared with cigarette smokers , waterpipe smokers were more likely to be female and to be unskilled manual workers than professionals or students . Waterpipe smokers started the habit at an older age on average than cigarette smokers . Most waterpipe smokers smoked only 1 bowl per day , and smoked mostly at coffee houses . Factor analysis of beliefs about waterpipe smoking result ed in 4 groups of beliefs which explained 50 % of the variance . The results are discussed in terms of public health policy and possible risk reduction strategies",
"OBJECTIVES To investigate tobacco use , beliefs and attitudes among medical students in Syria . METHODS A cross-sectional study of a r and om sample of 570 medical students ( first and fifth year ) registered at the Damascus University Faculty of Medicine in 2006 - 2007 . We used a self-administered question naire for demo-graphic information , smoking behaviour ( cigarette , waterpipe ) , family and peer smoking , attitudes and beliefs about smoking and future role in advising patients to quit smoking . RESULTS The overall prevalence of tobacco use was 10.9 % for cigarettes ( 15.8 % men , 3.3 % women ) , 23.5 % for waterpipe ( 30.3 % men , 13.4 % women ) and 7.3 % for both ( 10.1 % men , 3.1 % women ) . Both smoking methods were more popular among the fifth year students ( 15.4 % and 27 % ) compared to their younger counterparts ( 6.6 % and 19.7 % ) . Regular smoking patterns predominated for cigarettes ( 62 % ) , while occasional use patterns predominated for waterpipes ( 83 % ) . More than two thirds of students ( 69 % ) thought they might not address or would have difficulty addressing smoking in their future patients . CONCLUSION The level of tobacco use among Syrian medical students is alarming and highlights the rapidly changing patterns of waterpipe use , especially among female students . Medical schools should work harder to tackle this phenomenon and address it more efficiently in their curricula",
"INTRODUCTION Tobacco use remains a major public health problem worldwide . Water-pipe smoking is spreading rapidly and threatening to undermine the successes achieved in tobacco control . METHODS A school-based longitudinal study in the city of Irbid , Jordan , was performed from 2008 to 2010 . All seventh- grade students in 19 r and omly selected schools , out of a total of 60 schools in the city , were enrolled at baseline and surveyed annually . RESULTS Of the 1781 students enrolled at baseline 1,701 ( 95.5 % ) were still in the study at the end of the second year of follow-up ( 869 boys , median age at baseline 13 years ) . Ever and current water-pipe smoking were higher than those of cigarette smoking at baseline ( ever smoking : 25.9 % vs. 17.6 % and current smoking : 13.3 % vs. 5.3 % for water-pipe and cigarette smoking , respectively ; p < .01 for both ) but cigarette smoking caught up by the second year of follow-up ( ever smoking : 46.4 % vs. 44.7 % ; p = .32 and current smoking : 18.9 % vs. 14.9 % ; p < .01 ) . Water pipe-only smokers at baseline were twice as likely to become current cigarette smokers after 2 years compared with never smokers ( relative risk ( RR ) = 2.1 ; 95 % CI = 1.2 , 3.4 ) . A similar pattern was observed for cigarette-only smokers at baseline ( RR = 2.0 ; 95 % CI = 0.9 , 4.8 ) . CONCLUSIONS Prevalence of water-pipe and cigarette smoking increased dramatically over the 2-year follow-up period with similar patterns in boys and girls , although girls had lower prevalence in all categories . Water-pipe smoking at baseline predicted the progress to cigarette smoking in the future and vice versa",
"SETTING Waterpipe smoking is becoming a global health crisis among youth . OBJECTIVE To identify the prevalence of waterpipe use among Iranian university students and to explore perceived reasons for use . METHODS A r and om sample of 1024 university students at two major universities in South Iran was enrolled in the study . A three-part question naire ( baseline data , tobacco smoking status and perceived reasons for waterpipe use ) was used . Students filled out the self-administered question naire in their classrooms . RESULTS The prevalence of waterpipe smoking in the respondents ' lifetime and in the last 30 days was 42.5 % and 18.7 % , respectively . The mean age at initiation of waterpipe smoking was 16.3 ± 3.2 years . Ever smoking was positively associated with age and male sex , whereas no association was found regarding marital status . The highest odds of lifetime waterpipe smoking were observed in students with close friends who smoked the waterpipe ( 5.94 , 95%CI 4.26 - 8.30 ) . The most important perceived reason for waterpipe smoking as stated by students was enjoyment ( 55.8 % ) . CONCLUSION Given the alarming prevalence of waterpipe smoking , preventive measures should be adopted among university students taking into account the influence of peers , siblings and parents in the lessening social tolerance of waterpipe smoking",
"OBJECTIVES To study the awareness , perceptions and practice of university students in Karachi , Pakistan , with regard to shisha ( waterpipe ) smoking . DESIGN Cross-sectional survey conducted among students at four different universities of Karachi , selected through r and om cluster sampling . RESULTS A total of 450 participants , 59.6 % males ( n=268 ) and 40.4 % females ( n=182 ) , were included in the study . About half of the participants reported having ever smoked shisha ( n=241 , 53.6 % ) . On examining factors associated with starting shisha smoking , curiosity was found to be the most common reason ( n=148 , 61.4 % ) , followed by pleasure-seeking ( n=113 , 46.9 % ) , peer pressure ( n=55 , 22.8 % ) , boredom ( n=43 , 17.8 % ) and stress ( n=26 , 10.8 % ) . Of 241 participants who had ever smoked waterpipes , the majority ( n=149 , 61.8 % ) were current smokers . A vast majority of participants ( n=269 , 60 % ) considered waterpipe smoking to be less unhealthy than cigarette smoking . Boredom in youth , use of waterpipe in leisure activities and peer pressure were identified as the most common reasons for the escalating popularity of waterpipe smoking in Pakistan . CONCLUSIONS Waterpipe smoking is very popular among Pakistani university students , and knowledge among university students about the dangers of waterpipe smoking is alarmingly low"
] | In conclusion , there is a lack of evidence of effectiveness for most waterpipe interventions . | Waterpipe tobacco smoking is growing in popularity despite adverse health effects among users .
We systematic ally review ed the literature , search ing MEDLINE , EMBASE and Web of Science , for interventions targeting prevention and cessation of waterpipe tobacco smoking . |
28753768 | [
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"How do doctors refer to patient-reported outcome measures (PROMS) in oncology consultations?",
"Sexual Therapy for Women with Multiple Sclerosis and Its Impact on Quality of Life",
"Sex life and sexual function in men and women before and after total disc replacement compared with posterior lumbar fusion.",
"Patient-Reported Outcomes Measurement Information System (PROMIS) instruments among individuals with symptomatic knee osteoarthritis: a cross-sectional study of floor/ceiling effects and construct validity",
"Performance of a Patient Reported Outcomes Measurement Information System (PROMIS) Short Form in Older Adults with Chronic Musculoskeletal Pain."
] | [
"Purpose We conducted a secondary qualitative analysis of consultations between oncologists and their patients to explore how patient-reported outcome measures ( PROMs ) data were referred to in the process of ( 1 ) eliciting and exploring patients ’ concerns ; ( 2 ) making decisions about supportive treatment and ( 3 ) making decisions about chemotherapy and other systemic treatments . Methods We purposively sample d audio recordings of 18 consultations from the intervention arm and 4 from the attention control arm of a previous UK r and omised controlled trial of the feedback of PROMs data to doctors ( Velikova et al. in J Clin Oncol 22(4):714–724 [ 1 ] ) . We used a combination of content and conversation analysis to examine how opportunities for discussion of health-related quality of life issues are opened up or closed down within the consultation and explore why this may or may not lead to changes in patient management . Findings Explicit reference to the PROMs data provided an opportunity for the patient to clarify and further elaborate on the side effects of chemotherapy . High scores on the PROMs data were not explored further if the patient indicated they were not a problem or were not related to the cancer or chemotherapy . Symptomatic treatment was more often offered for problems like nausea , constipation , pain and depression but much less so for fatigue . Doctors discussed fatigue by providing a cause for the fatigue ( e.g. the chemotherapy ) , presenting this as ‘ something to be expected ’ , minimising its impact or moving on to another topic . Chemotherapy regimens were not changed on the basis of the PROMs data alone , but PROMs data were sometimes used to legitimise changes . Conclusions Explicit mention of PROMs data in the consultation may strengthen opportunities for patients to elaborate on their problems , but doctors may not always know how to do this . Our findings have informed the development of a training package to enable doctors to optimise their use of PROMs data within the consultation",
"Objective : Multiple Sclerosis ( MS ) is a disease with a detrimental effect on functional status . The present study investigated the effect of a sexual therapy program on the quality of life ( QOL ) of women with multiple sclerosis . Method : Women with multiple sclerosis and sexual dysfunction ( n = 30 ) were selected , and were r and omly assigned into the treatment ( n = 15 ) , or the control groups ( n = 15 ) . Participants of the treatment group ( n = 15 ) received 12 weekly sessions of sexual therapy . Participants in both groups completed the Female Sexual Function Inventory ( FSFI ) and the MS Quality of Life- 54 ( MSQOL-54 ) in the onset of the program and at the end of the program . Results : ANCOVA(s ) using pre-test scores as covariate(s ) revealed that in comparison to the control condition , MS patients within the treatment group showed a significant improvement in their sexual desire ( 0.0001 ) , arousal ( 0.022 ) , lubrication ( 0.001 ) , orgasm ( 0.001 ) , satisfaction ( 0.0001 ) , overall quality of life ( 0.001 ) , energy ( 0.023 ) , cognitive function ( 0.005 ) , and social function ( 0.001 ) at the end of the program . In addition , they were less limited in their roles due to the emotional and health problems . Conclusion : The present study revealed that addressing sexual dysfunction in MS patients could improve their quality of life . In the future , this research can extend its results , and apply the same method to men with MS to find whether sexual therapy enhances their quality of life",
"BACKGROUND CONTEXT Sex life and sexual function may be affected by low back pain ( LBP ) . Sexual dysfunction after anterior lumbar fusion is reported in both men and women , but focus is mainly on impaired male biological function ( retro grade ejaculation ) as this may cause infertility . This has led to concern as to whether anterior surgery should be employed in men , at least in younger age groups . PURPOSE To investigate how chronic low back pain ( CLBP ) of assumed discogenic origin affects sex life and sexual function in patients considered for surgical treatment , whether this is affected by surgical treatment ( total disc replacement [ TDR ] or posterolateral fusion [PLF]/posterior lumbar interbody fusion [ PLIF ] ) , and if so , are there differences between the surgical procedures undertaken . STUDY DESIGN A r and omized controlled trial comparing TDR and instrumented lumbar spine fusion , performed either as a PLF or PLIF . PATIENT SAMPLE One hundred fifty-two patients were included in this r and omized controlled trial to compare the effect on CLBP of either TDR via an anterior retroperitoneal approach or instrumented posterior lumbar fusion , PLF or PLIF . OUTCOME MEASURES Global assessment of back pain , back pain ( visual analog scale [ VAS ] 0 - 100 ) , function ( Oswestry Disability Index [ ODI ] 0 - 100 ) , quality of life ( EQ5D [ EuroQol ] 0 - 1 ) , and answers on specific sexual function . METHODS Outcome was assessed using data from the Swedish Spine Register ( SweSpine ) . In ODI , one question , ODI 8 , reflects the impact of back pain on sex life . This question was analyzed separately . Patients also answered a gender-specific question naire preoperatively and at the 2-year follow-up to determine any sexual dysfunction regarding erection , orgasm , and ejaculation . Follow-up was at 1 and 2 years . RESULTS Before surgery , 34 % reported that their sex life caused some extra LBP , and an additional 30 % that their sex life was severely restricted by LBP . After surgery , sex life improved in both groups , with a strong correlation to a reduction of LBP . The gender-specific question naire used to measure sexual function after 2 years revealed no negative effect of TDR or Fusion in men regarding erection or retro grade ejaculation . However , 26 % of all men in the Fusion group , compared with 3 % in the TDR group , reported postoperative deterioration in the ability to achieve orgasm , despite a reduction of LBP . CONCLUSIONS Impairment of sex life appears to be related to CLBP . An improvement in sex life after TDR or lumbar fusion was positively correlated to a reduction in LBP . Total disc replacement in this study , performed through an anterior retroperitoneal approach , was not associated with greater sexual dysfunction compared with instrumented lumbar fusion performed either as a PLF or as a PLIF . Sexual function , expressed as orgasm , deteriorated in men in the Fusion group postoperatively , in spite of this group reporting less LBP after 2 years",
"Background The psychometric properties of Patient Reported Outcomes Measurement Information System ( PROMIS ) instruments have been explored in a number of general and clinical sample s. No study , however , has evaluated the psychometric function of these measures in individuals with symptomatic knee osteoarthritis ( KOA ) . The aim of this project was to evaluate the construct ( structural ) validity and floor/ceiling effects of four PROMIS measures in this population . Methods We conducted a secondary analysis of baseline data from a r and omized trial comparing Tai Chi and physical therapy . Participants completed four PROMIS static short-form instruments ( i.e. , Anxiety , Depression , Physical Function , and Pain Interference ) as well as six well-vali date d ( legacy ) measures that assess pain , function , and psychological health . We calculated descriptive statistics and percentages of participants scoring the minimum ( floor ) and maximum ( ceiling ) possible scores for PROMIS and legacy measures . We also estimated the association between PROMIS scores and scores on legacy measures using Spearman ’s rank correlations coefficients . Results Data from 204 participants were analyzed . Mean age of the sample was 60 years ; 70 % were female . The PROMIS Anxiety and Depression had floor effects with 17 and 24 % of participants scoring the minimum , respectively . PROMIS Anxiety and Depression scores had strongest associations with general mental health , including stress ( Perceived Stress Scale , r ≥ 0.65 ) and depression ( Beck Depression Index-II , r = 0.70 ) . PROMIS Pain Interference scores correlated most strongly with measures of whole body pain ( Short-Form 36 Bodily Pain , r = −0.73 ) and physical health ( Short-Form 36 Physical-Component Summary , r = −0.73 ) ; their correlations were lower with other legacy measures , including with the WOMAC knee-specific pain ( r = 0.47 ) . PROMIS Physical Function scores had stronger associations with scores on the Short-Form 36 Physical Function ( r = 0.79 ) than with scores on other legacy measures . Conclusion The four PROMIS static-short forms performed well among individuals with symptomatic knee osteoarthritis as evidence d in correlations with legacy measures . PROMIS Anxiety and Depression target general mental health ( e.g. , stress , depression ) , and PROMIS Pain Interference and Physical Function static-short forms target whole-body outcomes among participants with symptomatic knee osteoarthritis . Floor effects in the PROMIS Anxiety and Depression scores should be considered if needing to distinguish among patients with very low levels of these outcomes .Trial registration Clinical trials.gov NCT01258985 . Registered 10 December",
"OBJECTIVE To assess reliability , validity , and responsiveness of a 29-item short-form version of the Patient Reported Outcomes Measurement Information System ( PROMIS ) and a novel “ impact score ” calculated from those measures . DESIGN Prospect i ve cohort study . SETTING Rural primary care practice s. SUBJECTS Adults aged ≥ 55 years with chronic musculoskeletal pain , not currently receiving prescription opioids . METHODS Subjects completed the PROMIS short form at baseline and after 3 months . Patient subsets were compared to assess reliability and responsiveness . Construct validity was tested by comparing baseline scores among patients who were or were not applying for Worker 's Compensation ; those with higher or lower catastrophizing scores ; and those with or without recent falls . Responsiveness was assessed with mean score changes , effect sizes , and st and ardized response means . RESULTS Internal consistency was good to excellent , with Cronbach 's alpha between 0.81 and 0.95 for all scales . Among patients who rated their pain as stable , test-retest scores at 3 months were around 0.70 for most scales . PROMIS scores were worse among patients seeking or receiving worker 's compensation , those with high catastrophizing scores , and those with recent falls . Among patients rating pain as “ much less ” at 3 months , absolute effect sizes for the various scales ranged from 0.24 ( Depression ) to 1.93 ( Pain Intensity ) . CONCLUSIONS Results indicate that the PROMIS short 29-item form may be useful for the study of patients with chronic musculoskeletal pain . Our findings also support use of the novel “ impact score ” recommended by the National Institutes of Health ( NIH ) Task Force on Research St and ards for Chronic Low Back Pain"
] | Several PROMs have been identified to evaluate sexual function in neurologic patients .
Strong evidence was found only for the Multiple Sclerosis Intimacy and Sexuality Question naire-15 and Multiple Sclerosis Intimacy and Sexuality Question naire-19 for patients with MS , although evidence was lacking for certain measurement properties as well . | CONTEXT Impaired sexual function has a significant effect on quality of life .
Various patient-reported outcome measures ( PROMs ) are available to evaluate sexual function .
The quality of the PROMs to be used for neurologic patients remains unknown .
OBJECTIVE To systematic ally review which vali date d PROMs are available to evaluate sexual function in neurologic patients and to critically assess the quality of the validation studies and measurement properties for each identified PROM . |
24417824 | [
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"A Carbohydrate-Rich Beverage Prior to Surgery Prevents Surgery-Induced Immunodepression: A Randomized, Controlled, Clinical Trial.",
"Preoperative oral carbohydrate administration reduces postoperative insulin resistance.",
"Effects of preoperative oral carbohydrates and peptides on postoperative endocrine response, mobilization, nutrition and muscle function in abdominal surgery",
"Preoperative Gastric Emptying Effects of Anxiety and Oral Carbohydrate Administration",
"Effect of preoperative intravenous carbohydrate loading on preoperative discomfort in elective surgery patients",
"Preoperative oral feeding reduces stress response after laparoscopic cholecystectomy.",
"Effects of preoperative feeding with a whey protein plus carbohydrate drink on the acute phase response and insulin resistance. A randomized trial",
"Fast-track surgery improves postoperative clinical recovery and reduces postoperative insulin resistance after esophagectomy for esophageal cancer",
"Influence of preoperative oral feeding on stress response after resection for colon cancer.",
"Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance.",
"Oral nutrition or water loading before hip replacement surgery; a randomized clinical trial",
"Randomized clinical trial comparing an oral carbohydrate beverage with placebo before laparoscopic cholecystectomy",
"Effect of \"preoperative\" oral carbohydrate treatment on insulin action--a randomised cross-over unblinded study in healthy subjects.",
"Preoperative oral carbohydrates and postoperative insulin resistance.",
"Preoperative Carbohydrate Loading in Patients Undergoing Coronary Artery Bypass or Spinal Surgery",
"Strategies to attenuate the catabolic response to surgery and improve perioperative outcomes",
"Preoperative oral supplementation with carbohydrate and branched-chain amino acid-enriched nutrient improves insulin resistance in patients undergoing a hepatectomy: a randomized clinical trial using an artificial pancreas",
"Preoperative Fasting of 2 Hours Minimizes Insulin Resistance and Organic Response to Trauma After Video-Cholecystectomy: A Randomized, Controlled, Clinical Trial"
] | [
"BACKGROUND Fasting before surgery is still common care in a lot of western hospitals . Overnight fasting can induce postoperative insulin resistance . Insulin resistance has been shown to be related to infectious morbidity . It was shown that postoperative insulin resistance can be attenuated by preoperative intake of a clear carbohydrate-rich beverage . The aim of this study was to investigate whether preoperative intake of carbohydrate-rich beverages could postoperatively influence the immune system . METHODS In this r and omized , controlled study , we investigated the effect of surgery on the postoperative immune response in 10 preoperatively fasted patients ( control ) and 2 groups of 10 patients receiving 2 different carbohydrate-rich beverages preoperatively , by measuring human leukocyte antigen (HLA)-DR expression on monocytes on the day before and on the day after surgery . Furthermore , we studied perioperative fluid homeostasis and preoperative well-being of the patients . RESULTS HLA-DR expression decreased significantly after surgery in the control group . Patients receiving any of the 2 carbohydrate-rich beverages did not show this postoperative decrease . Fluid homeostasis was not affected in any of the groups , and well-being tended to be better in patients receiving carbohydrate-rich beverages compared with controls . CONCLUSION This study suggests that preoperative intake of a carbohydrate-rich beverage can prevent surgery-induced immunodepression and thus might reduce the risk of infectious complications",
"UNLABELLED Infusions of carbohydrates before surgery reduce postoperative insulin resistance . We in-vestigated the effects of a carbohydrate drink , given shortly before surgery , on postoperative metabolism . METHOD Insulin sensitivity , glucose turnover ( [ 6,6 , 2H2]-D-glucose ) and substrate utilization were measured using hyperinsulinemic normoglycemic clamps and indirect calorimetry in two matched groups of patients before and after elective colorectal surgery . The drink group ( n = 7 ) received 800 ml of an isoosmolar carbohydrate rich beverage the evening before the operation ( 100 g carbohydrates ) , as well as another 400 ml ( 50 g carbohydrates ) 2 h before the initiation of anesthesia . The fasted group ( n = 7 ) was operated after an overnight fast . RESULTS After surgery , energy expenditure increased in both groups . Endogenous glucose production was higher after surgery and the difference was significant during low insulin infusion rates in both groups ( P < 0.05 ) . The supressibility of endogenous glucose production by the two step insulin infusion was similar pre- and postoperatively in both groups . At the high insulin infusion rate postoperatively , whole body glucose disposal was more reduced in the fasted group ( -49 + /- 6 % vs -26 + /- 8 % , P < 0.05 vs drink ) . Furthermore , during high insulin infusion rates , glucose oxidation decreased postoperatively only in the fasted group ( P < 0 . 05 ) and postoperative levels of fat oxidation were greater in the fasted group ( P < 0.05 vs drink ) . Only minor postoperative changes in cortisol and glucagon were found and no differences were found between the treatment groups . CONCLUSIONS Patients given a carbohydrate drink shortly before elective colorectal surgery displayed less reduced insulin sensitivity after surgery as compared to patients who were operated after an overnight fast",
"Background : Surgery is succeeded by long‐lasting state of relative peripheral insulin resistance , which is reduced by giving glucose infusion or oral carbohydrate‐rich drinks immediate before operating instead of fasting . The aim of the present study was to investigate whether oral carbohydrate or carbohydrate with peptide drinks preoperatively instead of fasting would improve postoperative voluntary muscle strength , nutritional intake and ambulation , decrease postoperative fatigue , anxiety and discomfort , and reduce the endocrine response to surgery",
"Background Overnight fasting is routine before elective surgery . This may not be the optimal way to prepare for surgical stress , however , because intravenous carbohydrate supplementation instead of fasting has recently been shown to reduce postoperative insulin resistance . In the current study , gastric emptying of a carbohydrate-rich drink was investigated before elective surgery and in a control situation . Methods Twelve patients scheduled for elective surgery were r and omly given 400 mL of either a carbohydrate-rich drink ( 285 mOsm/kg , 12.0 % carbohydrates , n = 6 ) or water 4 hours before being anesthetized . Gastric emptying was measured ( gamma camera , 99Tcm ) . Each patient repeated the protocol postoperatively as a control . All values were presented as the mean ± SEM by means of a nonparametric statistical evaluation . Results Despite the increased anxiety experienced by patients before surgery ( p < 0.005 ) , gastric emptying did not differ between the experimental and control situations . Initially , water emptied more rapidly than carbohydrate . However , after 90 minutes , the stomach was emptied regardless of the solution administered ( 3.2 ± 1.1 % [ mean ± SEM ] remaining in the stomach in the carbohydrate group versus 2.3 ± 1.2 % remaining in the stomach in the water group ) . Conclusions Preoperative anxiety does not prolong gastric emptying . The stomach had been emptied 90 minutes after Ingestion of both the carbohydrate-rich drink and water , thereby indicating the possibility of allowing an intake of iso-osmolar carbohydrate-rich fluids before surgery",
"Background and objective We studied the effect of three different fasting protocol s on preoperative discomfort and glucose and insulin levels . Methods Two hundred and ten ASA I – III patients undergoing general or gastrointestinal surgery were r and omly assigned to three groups : overnight intravenous 5 % glucose infusion ( 1000 ml ) , carbohydrate-rich drink ( 400 ml ) at 6–7 a.m. , or overnight fasting . The subjective feelings of thirst , hunger , mouth dryness , weakness , tiredness , anxiety , headache and pain of each patient were question ed preoperatively using a visual analogue scale . Serum glucose and insulin levels were measured at predetermined time points preoperatively . Results During the waiting period before surgery , the carbohydrate-rich drink group was less hungry than the fasting group ( P = 0.011 ) . No other differences were seen in visual analogue scale scores among the study groups . Trend analysis showed increasing thirst , mouth dryness and anxiety in the intravenous glucose group ( P < 0.05 ) . The carbohydrate-rich drink group experienced decreasing thirst but increasing hunger and mouth dryness ( P < 0.05 ) . In the fasting group , thirst , hunger , mouth dryness , weakness , tiredness and anxiety increased ( P < 0.05 ) . Both intravenous and oral carbohydrate caused a significant increase in glucose and insulin levels . Conclusion Intravenous glucose infusion does not decrease the sense of thirst and hunger as effectively as a carbohydrate-rich drink but does alleviate the feelings of weakness and tiredness compared with fasting",
"BACKGROUND / AIMS Fasting period before surgery may change metabolic status of the patient and have influence on perioperative stress response . The aim of the study was to investigate effects of preoperative carbohydrate-rich beverage on stress response after laparoscopic cholecystectomy . METHODOLOGY Patients admitted for laparoscopic cholecystectomy were included into study and they were r and omized into a group that was fed prior to surgery and in a group that was in the regime of nothing by mouth from the evening one day before surgery . Concentrations of C-reactive protein and cortisol , were measured before and subsequently up to 48 h postoperatively . RESULTS Postoperative serum C-reactive protein increased significantly in both groups , but the increase was more evident in the group with fasting protocol both 24 and 48 hours postoperatively . In fed patients cortisol concentration measured in the afternoon immediately after the operation showed physiological decline . In patients with fasting protocol postoperative cortisol values rise above the values measured in the morning . CONCLUSIONS Preoperative feeding has advantage over overnight fasting by reducing preoperative discomfort in patients after laparoscopic cholecystectomy . In fed patients , smaller increase in C-reactive protein and better regulation of cortisol levels are an indicator of decreased perioperative stress response",
"Background Prolonged preoperative fasting increases insulin resistance and current evidence recommends carbohydrate ( CHO ) drinks 2 hours before surgery . Our hypothesis is that the addition of whey protein to a CHO-based drink not only reduces the inflammatory response but also diminish insulin resistance . Methods Seventeen patients scheduled to cholecystectomy or inguinal herniorraphy were r and omized and given 474 ml and 237 ml of water ( CO group ) or a drink containing CHO and milk whey protein ( CHO-P group ) respectively , 6 and 3 hours before operation . Blood sample s were collected before surgery and 24 hours afterwards for biochemical assays . The endpoints of the study were the insulin resistance ( IR ) , the prognostic inflammatory and nutritional index ( PINI ) and the C-reactive protein (CRP)/albumin ratio . A 5 % level for significance was established . Results There were no anesthetic or postoperative complications . The post-operative IR was lower in the CHO-P group when compared with the CO group ( 2.75 ± 0.72 vs 5.74 ± 1.16 ; p = 0.03 ) . There was no difference between the two groups in relation to the PINI . The CHO-P group showed a decrease in the both CRP elevation and CRP/albumin ratio ( p < 0.05 ) . The proportion of patients who showed CRP/albumin ratio considered normal was significantly greater ( p < 0.05 ) in the CHO-P group ( 87.5 % ) than in the CO group ( 33.3 % ) . Conclusions Shortening the pre-operative fasting using CHO and whey protein is safe and reduces insulin resistance and postoperative acute phase response in elective moderate operations . Trial registration Clinical Trail.gov",
"Purpose This study aims to investigate the influence of fast-track surgery ( FTS ) on insulin resistance indicators in a prospect i ve r and omized , controlled clinical trial in esophageal cancer patients . Methods Between November 2009 and March 2011 , 34 patients underwent the FTS pathway , and 34 patients underwent the conventional pathway after esophagectomy in our department . The times to postoperative flatus and defecation , duration of postoperative hospital stay , hospitalization expenditures , and postoperative complications were recorded . Insulin resistance indicators were measured before operation as well as on the 1st , 3rd , and 7th postoperative days ( PODs ) , including serum levels of fasting blood glucose ( FBG ) , fasting insulin ( FINS ) , interleukin-6 ( IL-6 ) , and C-reactive protein ( CRP ) in patients of both groups . The insulin resistance index ( homeostasis model assessment of insulin resistance ( HOMA-IR ) ) was calculated at each time point . Results We found a significantly shorter postoperative hospital stay and faster return of gastrointestinal function in patients who underwent FTS ( P < 0.01 ) . In addition , the total hospitalization expenditure was significantly lower in the FTS group ( P < 0.01 ) . The preoperative insulin resistance indicators showed no significant differences between the two groups . On PODs 1 and 3 , the levels of log-HOMA-IR , FINS , IL-6 , and CRP in the FTS group were significantly lower than those in the control group ( all P < 0.05 ) . On POD 7 , the CRP level in the FTS group was significantly lower than that in the control group ( P < 0.05 ) . Conclusions FTS promotes early recovery of gastrointestinal function and reduces stress reaction and postoperative insulin resistance after esophagectomy for esophageal cancer",
"BACKGROUND / AIMS Preoperative management involves patients fasting from midnight on the evening prior to surgery . Fasting period is often long enough to change the metabolic condition of the patient which increases perioperative stress response . That could have a detrimental effect on clinical outcome . The aim of the present study was to investigate the possible effects of carbohydrate-rich beverage on stress response after colon resection . METHODOLOGY R and omized and double blinded study included 40 patients with colon , upper rectal or rectosigmoid cancer . Investigated group received a carbohydrate-rich beverage the day before and two hours before surgery . In the control group patients were in the st and ard preoperative regime : nothing by mouth from the evening prior to operation . Peripheral blood was sample d 24h before surgery , at the day of the surgery , and 6 , 24 and 48h postoperatively . RESULTS Colonic resection in both groups caused a significant increase in serum interleukin 6 ( IL-6 ) levels 6 , 24 and 48h after the operation . Increase was more evident and statistically significant in the group with fasting protocol . More significant increase of interleukin 10 ( IL-10 ) occurred in patients who received preoperative nutrition . CONCLUSIONS Smaller increase in IL-6 and higher in IL- 10 are indicators of reduced perioperative stress",
"Postoperative insulin resistance is a well-characterized metabolic state that has been shown to correlate with the length of postoperative stay in hospital . Preoperative intravenous or oral carbohydrate treatment has been shown to attenuate the development of postoperative insulin resistance measured 1 day after surgery . To study the effects of preoperative oral carbohydrate treatment on postoperative changes in insulin resistance and substrate utilization , in the absence of postoperative confounding factors , 15 patients were double-blindly treated with either a carbohydrate-rich beverage ( 12.5 % ) ( n = 8) or placebo ( n = 7 ) before undergoing total hip replacement surgery . Insulin sensitivity , endogenous glucose release , and substrate oxidation rates were measured before and immediately after surgery . Whole body insulin sensitivity decreased by 18 % in the treatment group vs. 43 % in the placebo group ( P < 0.05 , Student 's t-test for unpaired data ) . In both groups , the major mechanism of insulin resistance was an inhibition of insulin-induced nonoxidative glucose disposal after surgery . The better preservation of insulin sensitivity in the treatment group was attributable to a less reduced glucose disposal in peripheral tissues and increased glucose oxidation rates",
"Background Surgery induces insulin resistance that might be alleviated by a nutritional drink given preoperatively . The authors hypothesized that some of the beneficial effects of the drink could be attributed to the volume component ( approximately 1 L ) rather than to the nutrients . Methods Sixty patients scheduled for elective total hip replacement under spinal anesthesia were recruited to a clinical trial , and r and omly allocated to preoperative fasting , to oral ingestion of tap water , or to oral ingestion of a carbohydrate drink . An intravenous glucose tolerance test calculated glucose clearance and insulin sensitivity on the day before surgery , in the postoperative ward , and on the day after surgery . Other parameters were stress ( cortisol in plasma and urine ) , muscle catabolism ( urinary 3-methylhistidine ) , and wellbeing . Results Fifty-seven patients completed the study . In the postoperative ward , the glucose clearance and the insulin response had decreased from the previous day by 23 % and 36 % , respectively . Insulin sensitivity did not decrease until the next morning ( −48 % ) and was due to an increased insulin response ( + 51 % ) . Cortisol excretion was highest on the day of surgery , while 3-methylhistidine increased 1 day later . Follow-up on the third postoperative day showed an average of 1.5 complications per patient . Wellbeing was better 2 weeks after than before the surgery . None of the measured parameters differed significantly between the study groups . Conclusions Preoperative ingestion of tap water or a nutritional drink had no statistically significant effect on glucose clearance , insulin sensitivity , postoperative complications , or wellbeing in patients undergoing elective hip surgery . Trial registration Registration number : NCT 01211184 ( http://www . clinical trials.gov",
"Preoperative oral carbohydrate can attenuate postoperative insulin resistance and catabolism , and may have the potential to improve postoperative recovery . There are no data from r and omized studies on postoperative clinical outcome after specific surgical procedures . This study evaluated the clinical effects of a preoperative carbohydrate beverage in patients undergoing laparoscopic cholecystectomy",
"BACKGROUND AND AIMS Preoperative intake of a clear carbohydrate-rich drink reduces insulin resistance after surgery . In this study , we evaluated whether this could be related to increased insulin sensitivity at the onset of surgery . Furthermore , we aim ed to establish the optimal dose-regimen . METHODS Six healthy volunteers underwent hyperinsulinaemic ( 0.8 mU/kg/min ) , normoglycaemic ( 4.5 mmol/l ) clamps and indirect calorimetry on four occasions in a crossover-r and omised order ; after overnight fasting ( CC ) , after a single evening dose ( 800 ml ) of the drink ( LC ) , after a single morning dose ( 400 ml , CL ) and after intake of the drink in the evening and in the morning before the clamp ( LL ) . Data are presented as mean+/-SD . Statistical analysis was performed using the Student 's t-test and ANOVA . RESULTS Insulin sensitivity was higher in CL and LL ( 9.2+/-1.5 and 9.3+/-1.9 mg/kg/min , respectively ) compared to CC and LC ( 6.1+/-1.6 and 6.6+/-1.9 mg/kg/min , P<0.01 vs. CL and LL ) . CONCLUSIONS A carbohydrate-rich drink enhances insulin action 3 h later by approximately 50 % . Enhanced insulin action to normal postpr and ial day-time level at the time of onset of anaesthesia or surgery is likely to , at least partly , explain the effects on postoperative insulin resistance",
"UNLABELLED Infusions of carbohydrates before surgery have been shown to reduce postoperative insulin resistance . Presently , we investigated the effects of a carbohydrate drink , given shortly before surgery , on postoperative insulin sensitivity . METHODS Insulin sensitivity and glucose turnover ( [ 6 , 6,(2)H(2)]-D-glucose ) were measured using hyper-insulinemic , normoglycemic clamps before and after elective surgery . Sixteen patients undergoing total hip replacement were r and omly assigned to preoperative oral carbohydrate administration ( CHO-H , n = 8) or the same amount of a placebo drink ( placebo , n = 8) before surgery . Insulin sensitivity was measured before and immediately after surgery . Patients undergoing elective colorectal surgery were studied before surgery and 24 h postoperatively ( CHO-C ( n = 7 ) , and fasted ( n = 7 ) , groups ) . The fasted group underwent surgery after an overnight fast . In both studies , the CHO groups received 800 ml of an isoosmolar carbohydrate rich beverage the evening before the operation ( 100 g carbohydrates ) , as well as another 400 ml ( 50 g carbohydrates ) 2 h before the initiation of anesthesia . RESULTS Immediately after surgery , insulin sensitivity was reduced 37 % in the placebo group ( P < 0.05 vs. preoperatively ) while no significant change was found in the CHO-H group ( -16 % , p = NS ) . During clamps performed 24h postoperatively , insulin sensitivity and whole-body glucose disposal was reduced in both groups , but the reduction was greater compared to that in the CHO-C group ( -49 + /- 6 % vs. -26 + /- 8 % , P > > 0.05 fasted vs. CHO-C ) . CONCLUSIONS Patients given a carbohydrate drink shortly before elective surgery displayed less reduced insulin sensitivity after surgery as compared to patients undergoing surgery after an overnight fast",
"BACKGROUND : Surgical stress creates a state of insulin resistance which may contribute to the development of hyperglycemia and , subsequently , postoperative complications . Consumption of an oral carbohydrate supplement before surgery may improve insulin sensitivity and reduce hyperglycemia . In this trial , we investigated the effects of carbohydrate supplementation on insulin resistance in coronary artery bypass graft and spinal decompression and fusion surgical patients . METHODS : Twenty-six patients undergoing coronary artery bypass graft and 12 undergoing spine surgery were r and omized to receive 800 mL of an oral carbohydrate supplement the evening before and 400 mL 2 hours before surgery ( CHO ) or to fasting per st and ard hospital protocol ( FAST ) . Baseline and postoperative measurements of insulin sensitivity were assessed using the short insulin tolerance test and homeostasis model assessment ( HOMA ) . Interleukin-6 , C-reactive protein , and free fatty acid levels were determined at baseline , postoperatively , and 24 , 48 , and 72 hours after surgery . Adiponectin was measured at baseline . Subjective feelings of well-being were measured immediately before surgery , and intra- and postoperative outcomes were documented . RESULTS : Postoperative insulin sensitivity did not differ significantly between the FAST and CHO groups whether measured by the short insulin tolerance test ( rate of disappearance of blood glucose : 0.29%/min vs 0.38%/min ; 99 % confidence interval [ CI ] for difference , −0.17 to 0.32 , P = 0.41 ) or HOMA ( insulin resistance at values > 1 : 2.3 vs 3.3 ; 99 % CI for difference , −0.8 to 2.8 , P = 0.14 ) . Circulating blood glucose levels after surgery in the CHO group , 6.2 mmol/L , tended to be lower than the FAST group , 6.9 mmol/L ( 99 % CI for difference , −1.7 to 0.25 , P = 0.05 ) and postoperative & bgr;-cell function , measured by HOMA-&bgr ; ( impaired & bgr;-cell function at values < 100 % ) , tended to be higher in the CHO group , 87 % , vs 47.5 % in the FAST group ( 99 % CI for difference , −9.4 to 88.4 ) , but these differences were not significant . Adiponectin levels were not different between groups at baseline , and levels of free fatty acid , interleukin-6 and C-reactive protein were not affected by treatment . CONCLUSIONS : Preoperative carbohydrate loading did not improve postoperative insulin sensitivity . However , the observed postoperative blood glucose levels and & bgr;-cell function as well as secondary outcomes warrant further study to reevaluate traditional fasting practice s in surgical patients",
"ATIENTS undergoing major surgery encounter stereotypical alterations in carbohydrate and protein metabolism often referred to as the catabolic response . Characteristic features of impaired carbohydrate homeostasis are increased production of glucose combined with decreased glucose utilization result ing in hyperglycemia . The magnitude of hyperglycemia depends on the severity of surgical tissue trauma . In fasting non-diabetic patients undergoing elective intra-abdominal operations , blood glucose levels increase to 7–10 mmol·L –1 . During cardiac surgery , blood glucose values frequently exceed 15 mmol·L –1 in non-diabetic patients and 20 mmol·L –1 in diabetic subjects . Protein catabolism is characterized by a net loss of body protein . In metabolically healthy patients cumulative nitrogen losses , after elective abdominal operations , range between 40 and 80 g , equivalent to 1.2 to 2.4 kg lean tissue . Postoperative protein loss in patients with type 2 diabetes is 50 % greater than in their non-diabetic counterparts . 1 Much of the catabolic profile can be explained by specific neuroendocrine changes , including increased circulating concentrations of cortisol , glucagon , and catecholamines . These hormones exert catabolic effects , either directly or indirectly , by inhibiting insulin secretion and /or counteracting its peripheral action leading to the impairment of tissue insulin sensitivity . The extent of insulin resistance depends on the intensity of trauma , suggesting that insulin resistance is a marker of surgical stress . Clinical significance of the catabolic response to surgery Evidence is mounting that even moderate increases in blood glucose are associated with adverse outcomes . Patients with fasting glucose levels > 7 mmol·L –1 or r and om blood glucose levels > 11.1 mmol·L –1 on general surgical wards showed an 18-fold increase in in-hospital mortality , a longer length of stay , and a greater risk of infection . 2 In critically ill patients , mortality was directly correlated with increasing glucose levels above 5 mmol·L –1 . 3 In patients undergoing cardiovascular procedures , hyperglycemia was associated with increased mortality and organ dysfunction . 4 Furthermore , detrimental effects of acute hyperglycemia were documented in patients with cerebrovascular disease , myocardial ischemia , and trauma . Erosion of lean tissue protein delays wound healing , compromises immune function , and diminishes muscle strength after surgery . The result ing muscle weakness prolongs mechanical ventilation , inhibits effective coughing , and impedes mobilization . The length of time for return of normal physiologic function after discharge from the hospital is related to the extent of loss of lean body mass during hospitalization .",
"Glucose metabolism is adversely affected in patients following major surgery . Patients may develop hyperglycemia due to a combination of surgical stress and postoperative insulin resistance . A r and omized trial was conducted to eluci date the effect of preoperative supplementation with carbohydrates and branched-chain amino acids on postoperative insulin resistance in patients undergoing hepatic resection . A total of 26 patients undergoing a hepatectomy for the treatment of a hepatic neoplasm were r and omly assigned to receive a preoperative supplement of carbohydrate and branched-chain amino acid-enriched nutrient mixture or not . The postoperative blood glucose level and the total insulin requirement for normoglycemic control during the 16 h following hepatic resection were determined using the artificial pancreas STG-22 . Postoperative insulin requirements for normoglycemic control in the group with preoperative nutritional support was significantly lower than that in the control group ( P = 0.039 ) . There was no incidence of hypoglycemia ( < 40 mg/dL ) observed in patients , including those with diabetes mellitus , when the STG-22 was used to control blood glucose levels . STG-22 is a safe and reliable tool to control postoperative glucose metabolism and evaluate insulin resistance . The preoperative oral administration of carbohydrate and branched-chain amino acid-enriched nutrient is of clinical benefit and reduces postoperative insulin resistance in patients undergoing hepatic resection",
"Background Studies showing the improvement of insulin sensitivity by reducing the term of preoperative fasting are mostly done in patients undergoing major operations . More information about the role of shortened preoperative fasting in perioperative metabolism is needed for such elective minor/moderate abdominal procedures as laparoscopic cholecystectomy . We investigated the influence of a carbohydrate-rich drink given 2 h before laparoscopic cholecystectomy on insulin resistance and the metabolic response to trauma . Methods A group of 21 female c and i date s ( 18–65 years old ) for elective laparoscopic cholecystectomy were r and omized to either an 8 h fasting group ( control group : n = 10 ) or to a group receiving 200 ml of a carbohydrate beverage containing 12.5 % ( 25 g , 50 kcal per 100 ml and approximately 285 mOsm ) of maltodextrine 2 h before operation ( CHO group : n = 11 ) . Blood sample s for various biochemical assays were collected both at induction of anesthesia and after the 10th postoperative hour . Insulin resistance was assessed by the HOMA-IR equation ( Insulin ( μU/ml ) × blood glucose (mg/dl)/405 ) . Results There were no postoperative complications . Seventy percent ( 7/10 ) of the controls and 27.3 % ( 3/11 ) of the CHO group experienced at least one episode of vomiting ( RR = 2.42 , 95 % Confidence Interval [ CI ] = 0.88–6.68 ; P = 0.08 ) . Biochemical analysis showed that serum glucose ( P < 0.01 ) , insulin ( P < 0.01 ) , lactate/pyruvate ratio ( P = 0.03 ) , and triglycerides ( P < 0.01 ) for the control group were higher than for the CHO group . The value of HOMA-IR was significantly greater ( P = 0.03 ) in the conventionally fasted patients than in the CHO group . Conclusions Abbreviation of the period of preoperative fasting and administration of a carbohydrate beverage diminishes insulin resistance and the organic response to trauma"
] | Preoperative carbohydrate drinks significantly improved insulin resistance and indices of patient comfort following surgery , especially hunger , thirst , malaise , anxiety and nausea .
No definite conclusions could be made regarding preservation of muscle mass .
Following ingestion of carbohydrate drinks , no adverse events such as apparent or proven aspiration during or after surgery were reported .
Administration of oral carbohydrate drinks before surgery is probably safe and may have a positive influence on a wide range of perioperative markers of clinical outcome . | INTRODUCTION Surgical stress in the presence of fasting worsens the catabolic state , causes insulin resistance and may delay recovery .
Carbohydrate rich drinks given preoperatively may ameliorate these deleterious effects .
A systematic review was undertaken to analyse the effect of preoperative carbohydrate loading on insulin resistance , gastric emptying , gastric acidity , patient wellbeing , immunity and nutrition following surgery . |
28416626 | [
"11692018",
"25082804",
"23920426",
"4501739",
"19066101"
] | [
"Management and Prognostic Features of Intracerebral Hemorrhage During Anticoagulant Therapy: A Swedish Multicenter Study",
"Variation in Restarting Antithrombotic Drugs at Hospital Discharge After Intracerebral Hemorrhage",
"Long-Term Outcome after Anticoagulation-Associated Intracerebral Haemorrhage with or without Restarting Antithrombotic Therapy",
"Characteristics of Symptomatic Intracranial Hemorrhage in Patients Receiving Non-Vitamin K Antagonist Oral Anticoagulant Therapy",
"Preliminary findings of the minimally-invasive surgery plus rtPA for intracerebral hemorrhage evacuation (MISTIE) clinical trial."
] | [
"Background and Purpose — Patients treated with oral anticoagulants ( ACs ) have an increased risk of intracerebral hemorrhage ( ICH ) , which is more often fatal than spontaneous ICH . Options to reverse the AC effect include intravenous administration of vitamin K , plasma , and coagulation factor concentrate . However , the optimal management of AC-related ICH has not been determined in any r and omized trial . In this study , the present management of AC-related ICH was surveyed , and determinants of survival were assessed . Methods — We retrospectively review ed the medical records of all AC-related ICHs at 10 Swedish hospitals during a 4-year period , 1993 to 1996 . Survival status after the ICH was determined from the Swedish National population register . Results — We identified 151 patients with AC-related ICH . Death rates were 53.6 % at 30 days , 63.6 % at 6 months , and 77.5 % at follow-up ( mean 3.5 years ) . The case fatality ratio at 30 days was 96 % among patients unconscious on admission ( n=27 ) , 80 % among patients who became unconscious before active treatment was started ( n=15 ) , 55 % among patients in whom no special action was taken except withdrawal of AC treatment ( n=42 ) , and 28 % among patients given active anti-coumarin treatment while they were still conscious ( n=64 ) . The case fatality ratio at 30 days was 11 % in the group treated with plasma ( n=18 ) , 30 % in the group treated with vitamin K ( n=23 ) , and 39 % in the group treated with coagulation factor concentrate ( n=23 ) . Within the first 24 to 48 hours after admission , 47 % of the patients deteriorated . Choice of therapy to reverse the AC effect differed substantially between the hospitals ( P < 0.0001 ) , as did the time interval from symptom onset to start of treatment . Multiple logistic regression analysis showed only 2 factors ( intraventricular extension of bleeding and ICH volume ) that were independently related to case fatality at both 30 days and 6 months . The results were similar when the analysis was restricted to patients who were conscious on admission . Conclusions — In AC-related ICH , a progressive neurological deterioration during the first 24 to 48 hours after admission is frequent , and the mortality is high . Choice of therapy to reverse the AC effect differed considerably between the hospitals . There was no evidence that any treatment strategy was superior to the others . A r and omized controlled trial is needed to determine the best choice of treatment",
"Background and Purpose — Whether intracerebral hemorrhage ( ICH ) survivors should restart antithrombotic drugs is unknown . We analyzed the frequency of restarting antithrombotic drugs in ICH survivors who had taken prophylactic antithrombotic drugs in atrial fibrillation or after thromboembolic disease in 5 cohorts and explored factors associated with doing so . Methods — We compared the characteristics and proportions of patients taking antithrombotic drugs at ICH onset and discharge in 4 hospital-based cohorts ( Lille , France , n=542 ; Utrecht , The Netherl and s , n=389 ; multicenter Clinical Relevance of Microbleeds in Stroke-2 ( CROMIS-2 ) ICH , United Kingdom , n=667 ; and Amsterdam , The Netherl and s , n=403 ) and 1 community-based study ( Lothian , Scotl and , n=137 ) , using bivariate analyses . We sought characteristics associated with restarting using bivariate and multivariable logistic regression analyses . Results — A total of 942 ( 44 % ) patients with ICH took antithrombotic drugs at hospital admission ( no difference between cohorts ) . Antithrombotic drugs were restarted in 96 ( 20 % ) of the 469 survivors who had taken antithrombotic drugs for secondary prevention or atrial fibrillation , but this proportion differed when stratified by the cohort of origin ( Lille , 18 % ; Utrecht , 45 % ; Lothian , 15 % ; CROMIS-2 ICH , 11 % ; Amsterdam , 20 % ; P<0.001 ) and by type of antithrombotic drug pre-ICH ( 14 % in patients with previous antiplatelet drugs versus 26 % in patients with previous vitamin K antagonists and 41 % in patients with both drugs ; P<0.001 ) . We did not find other consistent , independent associations with restarting antithrombotic drugs . Conclusions — The variation in clinical practice and lack of consistent associations with restarting antithrombotic drugs after ICH reflect current knowledge and support the need for r and omized controlled trials to resolve this dilemma",
"Background : For patients who survive intracerebral haemorrhage ( ICH ) during treatment with oral anticoagulation ( OAC ) , the balance between the benefits and risks of restarting OAC is unclear . The decision to restart OAC or to start antiplatelet therapy in these patients therefore poses a dilemma for all physicians involved . We assessed the long-term outcome of patients who did or did not restart antithrombotic therapy after OAC-associated ICH . Methods : We conducted a retrospective follow-up study of all patients discharged from our institution after OAC-associated ICH over a 10-year period . Data on the use of OAC or platelet inhibitors and the occurrence of vascular events during follow-up were assessed through question naires and patient files . The primary outcome was recurrent fatal or non-fatal stroke . Secondary outcomes were the occurrence of other haemorrhagic , thrombotic or thromboembolic events . With patients without antithrombotic treatment as reference , we calculated incidence ratios with corresponding 95 % confidence intervals ( CI ) for treatment with OAC and for treatment with antiplatelet therapy . Results : We included 38 patients , of whom 21 ( 55 % ) died during a mean follow-up of 3.5 years . The medication regime changed frequently during follow-up , illustrated by the fact that two thirds of the patients who had resumed OAC within 2 months of ICH terminated this at later points in time . Two recurrent strokes occurred during 35.4 patient-years without antithrombotic medication , 7 during 63.8 patient-years on antiplatelet medication ( incidence ratio 1.9 ; 95 % CI , 0.4 - 9.4 ) , and 3 during 19.5 patient-years on OAC ( incidence ratio 2.7 ; 95 % CI , 0.5 - 16.3 ) . There was only 1 recurrent ICH , which occurred during treatment with OAC . Conclusion : In this observational study , no significant difference in the primary outcome measure was found between the treatment groups , but there was a tendency towards a higher long-term risk of any stroke in patients who resumed OAC or started antiplatelet therapy . However , based on these results it is difficult to draw any concrete conclusions or make any strong recommendations . A r and omized trial to assess the optimal long-term strategy after OAC-related ICH is warranted . Based on the point estimates of our study , such a trial should involve at least 300 patient-years of follow-up",
"Objectives The first non-vitamin K antagonist oral anticoagulant ( NOAC ) introduced to the market in Japan was dabigatran in March 2011 , and three more NOACs , rivaroxaban , apixaban , and edoxaban , have since become available . R and omized controlled trials of NOACs have revealed that intracranial hemorrhage ( ICH ) occurs less frequently with NOACs compared with warfarin . However , the absolute incidence of ICH associated with NOACs has increased with greater use of these anticoagulants , and we wanted to explore the incidence , clinical characteristics , and treatment course of patients with NOACs-associated ICH . Methods We retrospectively analyzed the characteristics of symptomatic ICH patients receiving NOACs between March 2011 and September 2014 . Results ICH occurred in 6 patients ( 5 men , 1 woman ; mean ± SD age , 72.8 ± 3.2 years ) . Mean time to onset was 146.2 ± 111.5 days after starting NOACs . Five patients received rivaroxaban and 1 patient received apixaban . None received dabigatran or edoxaban . Notably , no hematoma expansion was observed within 24 h of onset in the absence of infusion of fresh frozen plasma , activated prothrombin complex concentrate , recombinant activated factor VIIa or hemodialysis . When NOAC therapy was initiated , mean HAS-BLED and PANWARDS scores were 1.5 ± 0.5 and 39.5 ± 7.7 , respectively . Mean systolic blood pressure was 137.8 ± 15.9 mmHg within 1 month before spontaneous ICH onset . Conclusion Six symptomatic ICHs occurred early in NOAC therapy but hematoma volume was small and did not exp and in the absence of infusion of reversal agents or hemodialysis . The occurrence of ICH during NOAC therapy is possible even when there is acceptable mean systolic blood pressure control ( 137.8 ± 15.9 mmHg ) and HAS-BLED score ≤ 2 . Even stricter blood pressure lowering and control within the acceptable range may be advisable to prevent ICH during NOAC therapy",
"INTRODUCTION Compared to ischemic stroke , intracerebral hemorrhage ( ICH ) is easily and rapidly identified , occurs in younger patients , and produces relatively small initial injury to cerebral tissues -- all factors suggesting that interventional amelioration is possible . Investigations from the last decade established that extent of ICH-mediated brain injury relates directly to blood clot volume and duration of blood exposure to brain tissue . Using minimally-invasive surgery plus recombinant tissue plasminogen activator ( rtPA ) , MISTIE investigators explored aggressive avenues to treat ICH . METHODS We investigated the difference between surgical intervention plus rtPA and st and ard medical management for ICH . Subjects in both groups were medically managed according to st and ard ICU protocol s. Subjects r and omized to surgery underwent stereotactic catheter placement and clot aspiration . Injections of rtPA were then given through hematoma catheter every 8 h , up to 9 doses , or until a clot-reduction endpoint . After each injection the system was flushed with sterile saline and closed for 60 min before opening to spontaneous drainage . RESULTS Average aspiration of clots for all patients r and omized to surgery plus rtPA was 20 % of mean initial clot size . After acute treatment phase ( aspiration plus rtPA ) , clot was reduced an average of 46 % . Recorded adverse events were within safety limits , including 30-day mortality , 8 % ; symptomatic re-bleeding , 8 % ; and bacterial ventriculitis , 0 % . Patients r and omized to medical management showed 4 % clot resolution in a similar time window . Preliminary analysis indicates that clot resolution rates are greatly dependent on catheter placement . Location of ICH also affects efficacy of aggressive treatment of ICH . CONCLUSION There is tentative indication that minimally-invasive surgery plus rtPA shows greater clot resolution than traditional medical management"
] | Conclusions — In observational studies , reinstitution of anticoagulation after ICH was associated with a lower risk of thromboembolic complications and a similar risk of ICH recurrence . | Background and Purpose — The safety and efficacy of restarting anticoagulation therapy after intracranial hemorrhage ( ICH ) remain unclear .
We performed a systematic review and meta- analysis to summarize the associations of anticoagulation resumption with the subsequent risk of ICH recurrence and thromboembolism . |
25767129 | ["24030388","22048460","27116918","21830838","21295286","23536105","22697191","22888309","21810630",(...TRUNCATED) | ["Varenicline, smoking cessation, and neuropsychiatric adverse events.","Adjunctive Varenicline Trea(...TRUNCATED) | ["OBJECTIVE In 2009 , the U.S. Food and Drug Administration issued a black box warning for varenicli(...TRUNCATED) | "This meta- analysis found no evidence of an increased risk of suicide or attempted suicide , suicid(...TRUNCATED) | "OBJECTIVE To determine the risk of neuropsychiatric adverse events associated with use of varenicli(...TRUNCATED) |
26949760 | ["15202752","26086947","11951800","15732546","25010879","20608298","19544814","26428908","8803392","(...TRUNCATED) | ["Clinical performance of large, all-ceramic CAD/CAM-generated restorations after three years: a pil(...TRUNCATED) | ["BACKGROUND Adhesively luted all-ceramic restorations preserve and stabilize weakened tooth structu(...TRUNCATED) | "Overall , the 5-year complication rates were low .\nThe most frequent complications were secondary (...TRUNCATED) | "OBJECTIVE The purpose of this systematic review was to compare the survival and complication rates (...TRUNCATED) |
21474812 | ["12411652","26121986","15618441","17060137","4673522","24153026","9684063","12735531","15753416","1(...TRUNCATED) | ["Trunk Control as an Early Predictor of Comprehensive Activities of Daily Living Function in Stroke(...TRUNCATED) | ["Background and Purpose — Prediction of activities of daily living ( ADL ) functions at an early (...TRUNCATED) | "Because of insufficient method ological quality of most prognostic studies , the predictive value o(...TRUNCATED) | "BACKGROUND AND PURPOSE Knowledge about robust and unbiased factors that predict outcome of activiti(...TRUNCATED) |
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in Dataset Viewer.
This is a copy of the MS^2 dataset, except the input source documents of the train, validation, and test splits have been replaced by a dense retriever.
- query: The
backgroundfield of each example - corpus: The union of all documents in the
train,validationandtestsplits. A document is the concatenation of thetitleandabstract. - retriever:
facebook/contriever-msmarcovia PyTerrier with default settings - top-k strategy:
"oracle", i.e. the number of documents retrieved,k, is set as the original number of input documents for each example
Retrieval results on the validation set:
| Recall@100 | Rprec | Precision@k | Recall@k |
|---|---|---|---|
| 0.4764 | 0.2395 | 0.2395 | 0.2395 |
Retrieval results on the validation set:
| Recall@100 | Rprec | Precision@k | Recall@k |
|---|---|---|---|
| 0.4364 | 0.2125 | 0.2125 | 0.2125 |
Retrieval results on the test set:
| Recall@100 | Rprec | Precision@k | Recall@k |
|---|---|---|---|
| 0.4481 | 0.2224 | 0.2224 | 0.2224 |
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