bluuebunny/crossref_metadata_2025 huggingface dataset:
Endovascular treatment of the subclavian artery aneurysm in high-risk patient - a single-center experience
Authors: Marjanovic Ivan , Tomic Aleksandar , Maric Nebojsa , Pecarski Danijela , Sarac Momir , Paunovic Dragana , Rusovic Sinisa
Published: May 2016

We present our first experience with endovascular treatment of 6 subclavian
artery aneurysms (SAA) occurring in five male and one female patient. All
patients, in our studies, according to ASA classification were high risk for
open repair of SAA. The etiology of the all aneurysms was atherosclerosis
degeneration of the artery. Two aneurysms were of intrathoracic location,
then the other were extrathoracic. Symptoms related to subclavian artery
aneurysms were present in two patients, compression and chest pain in one,
and hemorrhage shock in second, while the remaining patients were
asymptomatic. We preferred the Viabhan endoprosthesis for endovascular repair
in 5 cases. In one patient with ruptured of subclavian artery aneurysm who
was high-risk for open repair we made combined endovascular procedure. First
at all, we covered the origin of left subclavian artery with thoracic stent
graft and after that we put two coils in proximal part of subclavian artery.
There was no operative mortality, and the early patency rate was 100%. The
follow-up period was from 3 months to 3 years. During this period, one
patient died of heart failure and one patient required endovascular
reoperation due to endoleak type I. Endovascular treatment is recommended for
all patients with subclavian artery aneurysm whenever this is possible due to
anatomical reasons especially in high-risk patient with intrathoracic
localization of aneurysm, to prevent potential complications.
Hereditary hemorrhagic telangiectasia with bilateral pulmonary vascular malformations: A case report
Authors: Loncarevic Olivera , Rusovic Sinisa , Stojisavljevic Marko , Vukovic Jelena , Plavec Goran , Acimovic Slobodan , Cvetkovic Gordana , Petrovic Marina
Published: May 2016

Introduction. Hereditary hemorrhagic telangiectasia (HHT) also known as Osler-Weber-Rendu syndrome is an autosomal dominant disease that occurs due to vascular dysplasia associated with the disorder in the signaling pathway of transforming growth factor ? (TGF-?). The clinical consequence is a disorder of blood vessels in multiple organ systems with the existence of telangiectasia which causes dilation of capillaries and veins, are present from birth and are localized on the skin and mucosa of the mouth, respiratory, gastrointestinal and urinary tract. They can make a rupture with consequent serious bleeding that can end up with fatal outcome. Since there is a disruption of blood vessels of more than one organic system, the diagnosis is very complex and requires a multidisciplinary approach. Case report. We reported a 40-year-old female patient with a long-time evolution of problems, who was diagnosed and treated at the Clinic for Lung Diseases of the Military Medical Academy in Belgrade, Serbia, because of bilaterally pulmonary arteriovenous malformations associated with HHT. Embolization was performed in two acts, followed with normalization of clinical, radiological and functional findings with the cessation of hemoptysis, effort intolerance with a significant improvement of the quality of life. Conclusion. HHT is a rare dominant inherited multisystem disease that requires multidisciplinary approach to diagnosis and treatment. Embolization is the method of choice in the treatment of arteriovenous malformations with minor adverse effects and very satisfying therapeutic effect.
Patient Characteristics and Participation in a Genetic Study: A Type 2 Diabetes Cohort
Authors: Amiri Loabat , Cassidy-Bushrow Andrea E. , Dakki Heather , Li Jia , Wells Karen , Oliveria Susan A. , Yood Marianne Ulcickas , Thomas Abraham , Lanfear David E.
Published: May 2016

Background

Recruitment of large, diverse populations into genetic studies remains challenging. Potential strategies to overcome limitations include leveraging electronic health data and minimizing patient burden. We sought to describe the overall participation rate and identify characteristics associated with participation in a genetic substudy of patients with type 2 diabetes mellitus, in which patients were identified via electronic hospital data and asked to participate by providing DNA samples by mail.

Methods

During a phone interview, participants (n = 455) were asked to take part in a genetic substudy. Subjects verbally consenting were mailed saliva collection kits and written consent forms. We examined demographic and clinical variables associated with verbal consent and DNA kit return using logistic regression.

Results

Overall, 90% (n = 410) verbally consented to the genetic substudy during interviews. However, of those consenting, only 70% returned the DNA kit (n = 287). Among those consenting, after covariate adjustment, male sex (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.09–2.65), African American race (OR, 0.61; 95% CI, 0.39–0.95), hemoglobin A1c (HbA1c) (OR, 0.87; 95% CI, 0.75–1.00), and physical activity (OR, 0.58; 95% CI, 0.37–0.91) were significantly associated with DNA kit return.

Conclusions

To our knowledge, we are the first to demonstrate an inverse association between HbA1c and participation in genetic research, potentially indicating a compliance-related trait needing further exploration. The DNA kit return rate being notably lower than the verbal consent rate suggests that the greater convenience of a telephone/mail-in process did not drastically enhance full participation. Direct comparison to in-person donation may be warranted.
Intensive Therapy in Newly Diagnosed Type 2 Diabetes: Results of a 6-Year Randomized Trial
Authors: Harrison Lindsay B. , Adams-Huet Beverley , Li Xilong , Raskin Philip , Lingvay Ildiko
Published: May 2016

Background

This study aimed to assess the efficacy of early intensive diabetes therapy with either insulin plus metformin (INS) or triple oral therapy (TOT) with metformin, glyburide, and pioglitazone on glycemic control and A-cell function.

Methods

Fifty-eight treatment-naive newly diagnosed patients with type 2 diabetes underwent a 3-month lead-in treatment period with insulin and metformin, then were randomized to INS or TOT for 6 years. β-Cell function was measured using mixed-meal challenge test. β-Cell function remained stable throughout the 6-year study in both groups, as measured by the C-peptide area under the curve (AUC; P = 0.13), the AUC C-peptide/AUC glucose ( P = 0.9), and by the disposition index ( P = 0.8). Excellent glycemic control was maintained in both groups (end-of-study hemoglobinA1c, 7.3% [SD, 1.7%] INS vs 6.4% [1.4%] TOT; P = 0.4). There were 8 treatment failures (confirmed hemoglobinA1c, 98%) in INS and 6 in TOT ( P = 0.93). The predictors of treatment failure included higher fasting glucose ( P = 0.008), fasting C-peptide ( P = 0.008), systolic blood pressure ( P = 0.004), and lower insulin sensitivity ( P = 0.04) at randomization.

Conclusions

Early intensive treatment at the time of type 2 diabetes diagnosis—initial short-term insulin treatment followed by either insulin-based or intensive oral hypoglycemic–based therapy—stabilizes β-cell function for at least 6 years. Treatment failure was independent of intervention and was associated with worse disease pathology at baseline.
Effects of Low-Dose Corticosteroids on the Bone Mineral Density of Patients with Rheumatoid Arthritis
Authors: Lee Young Ho , Woo Jin-Hyun , Choi Seong Jae , Ji Jong Dae , Song Gwan Gyu
Published: May 2016

Background

The effects of long-term high-dose corticosteroids on bone mineral density (BMD) are clear, but the effects of low-dose corticosteroids in patients with rheumatoid arthritis (RA) remain controversial. The aim of this study was to assess the effects of low-dose corticosteroids on BMD in patients with RA.

Methods

The authors surveyed randomized controlled studies that examined the effects of low-dose corticosteroids on BMD in patients with RA using MEDLINE and the Cochrane Controlled Trials Register and by performing manual searches. Data were collected on BMD (end-of-period or change-from-baseline) after longest recorded treatment durations. Meta-analysis was performed using a random effects model; outcomes are presented as standardized mean differences (SMDs).

Results

Seven studies were included in this meta-analysis, which included 7 studies on lumbar BMD meta-analysis and 6 studies on femur BMD meta-analysis. Corticosteroids resulted in a moderate worsening in lumbar BMD compared with controls (SMD = −0.483; 95% confidence interval [CI], −0.815 to −0.151, P = 0.004), whereas the femoral BMD differences were not siginificant (SMD = −0.224; 95% CI, −0.663 to 0.215, P = 0.318). Subgroup analysis of BMD data performed on a change-from-baseline basis showed that corticosteroids had a clear effect on both lumbar and femoral BMDs (SMD = −0.354; 95% CI, −0.620 to −0.088, P = 0.009; SMD = −0.488; 95% CI, −0.911 to −0.065, P = 0.024, respectively).

Conclusions

This meta-analysis shows BMD loss after low-dose corticosteroid treatment in patients with RA. These findings have practical implications for the long-term management of patients with RA on low-dose corticosteroids.
Delineation of a Gene Network Underlying the Pulmonary Response to Oxidative Stress in Asthma
Authors: Freishtat Robert J. , Benton Angela S. , Watson Alan M. , Wang Zuyi , Rose Mary C. , Hoffman Eric P.
Published: May 2016

Cigarette smoke exposure induces a respiratory epithelial response that is mediated in part by oxidative stress. The contribution of oxidative stress to cigarette smoke-induced responses in asthmatic respiratory epithelium is not well understood. We sought to increase this understanding by employing data integration and systems biology approaches to publicly available microarray data deposited over the last several years. In this study, we analyzed 14 publicly available asthma- or tobacco-relevant data series and found 4 (2 mice and 2 human) that fulfilled adequate signal/noise thresholds using unsupervised clustering and F test statistics. Using significance filters and a 4-way Venn diagram approach, we identified 26 overlapping genes in the epithelial transcriptional stress response to cigarette smoke and asthma. This test set corresponded to a 26-member gene/protein network containing 18 members that were highly regulated in a fifth data series of direct lung oxidative stress. Of those network members, 2 stood out (ie, tissue inhibitor of metalloproteinase 1 and thrombospondin 1) owing to central location within the network and marked up-regulation sustained at later times in response to oxidative stress. These analyses identified key relationships and primary hypothetical targets for future studies of cigarette smoke-induced oxidative stress in asthma.
Cigarette Smoke Alters Tissue Inhibitor of Metalloproteinase 1 and Matrix Metalloproteinase 9 Levels in the Basolateral Secretions of Human Asthmatic Bronchial Epithelium in Vitro
Authors: Watson Alan M. , Benton Angela S. , Rose Mary C. , Freishtat Robert J.
Published: May 2016

Background

Asthma, a major cause of chronic lung disease worldwide, has increased in prevalence in all age and ethnic groups, particularly in urban areas where cigarette smoking is common. Cigarette smoke (CS) significantly impacts the development of asthma and is strongly associated with increased asthma-related morbidity.

Purpose

To evaluate bioinformatic analyses predicting that CS would alter expression of tissue inhibitor of metalloproteinase (TIMP) 1 and matrix metalloproteinase (MMP) 9 in asthmatic epithelium.

Methods

Primary differentiated normal (n = 4) and asthmatic (n = 4) human respiratory epithelia on collagen-coated Transwells at air-liquid interface were exposed for 1 hour to CS condensate (CSC) or hydrogen peroxide (H2O2). Tissue inhibitor of metalloproteinase 1 and MMP-9 protein levels were measured at 24 hours by enzyme-linked immunosorbent assay in cell lysates and in apical and basolateral secretions.

Results

Tissue inhibitor of metalloproteinase 1 and MMP-9 levels in the apical secretions of normal and asthmatic epithelia were unchanged after exposure to CSC and H2O2. However, CSC increased TIMP-1 levels in the basolateral secretions of both normal and asthmatic epithelia, but decreased MMP-9 levels only in asthmatic basolateral secretions, resulting in a 2.5-fold lower MMP-9/TIMP-1 ratio that corresponded to decreased MMP-9 activity in CS-exposed asthmatic basolateral secretions.

Conclusions

These data validate our prior bioinformatic analyses predicting that TIMP-1 plays a role in the stress response to CS and indicate that asthmatics exposed to CS may be more susceptible to MMP-9-mediated airway remodeling. This is in agreement with the current paradigm that a reduction in the MMP-9/TIMP-1 ratio is a milieu that favors subepithelial airway remodeling in chronic asthma.
Comparison of the Diagnostic Values of the 3 Different Stool Antigen Tests for the Noninvasive Diagnosis of Helicobacter pylori Infection
Authors: Kesli Recep , Gokturk Huseyin Savas , Erbayrak Mustafa , Karabaglı Pınar , Terzi Yuksel
Published: May 2016

The aim of the study was to compare 3 stool antigen tests for diagnosis of Helicobacter pylori infection in adult patients with dyspeptic complaints before eradication therapy. We compared 2 enzyme immunoassays (EIAs: Premier Platinum Helicobacter pylori Stool Antigen [HpSA] Plus and Helicobacter pylori Antigen [Hp Ag]) and one immunochromatographic assay ( H. pylori fecal antigen test-lateral-flow chromatography) in detecting H. pylori. All the investigated stool antigen tests were made of monoclonal antibodies. We evaluated 168 adult patients with H. pylori infection by using 2 criterion standard methods (histological and rapid urease tests) together. The sensitivity and specificity were 90% and 91%, respectively, for the Premier Platinum HpSA Plus, 77% and 91%, respectively, for the Hp Ag, and 81% and 92%, respectively, for the H. pylori fecal antigen test, respectively. The best agreement between the criterion standard tests and the stool antigen tests used in the study was with the Premier Platinum HpSA Plus. Immunochromatographic assay-based stool antigen test ( H. pylori fecal antigen test) was found to be more sensitive than the EIA-based test (Hp Ag). One of the 2 important conclusions obtained from the study was that the Premier Platinum HpSA Plus was found to be the most accurate test for the diagnosis of H. pylori infection in adult dyspeptic patients before eradication therapy, and the other was that monoclonal and high-quality, reliable immunochromatographic assay tests are a good option especially for small hospital laboratories that do not have appropriate equipment for performing the EIA and working on few samples.
Method of LDL Cholesterol Measurement Influences Classification of LDL Cholesterol Treatment Goals
Authors: Agrawal Mayank , Spencer Horace J. , Faas Fred H.
Published: May 2016

Background

Low-density lipoprotein cholesterol (LDL-C) has been clearly associated with the risk of developing coronary heart disease. The best and most convenient method for determining LDL-C has come under increased scrutiny in recent years. We present comparisons of the Friedewald calculated LDL-C (C-LDL-C) and direct LDL-C (D-LDL-C) using 3 different homogenous assays. This highlights differences between the 2 methods of LDL-C measurement and how this affects the classification of samples into different LDL-C treatment goals as determined by the National Cholesterol Education Program Adult Treatment Panel III guidelines thus potentially affecting treatment strategies.

Methods

Lipid profiles of a total of 2208 clinic patients were retrieved from the Central Arkansas VA Healthcare System clinical laboratory database. Samples studied were of 1-week period during the 3 periods studied: 2000 (period 1), 2002 (period 2), and 2005 (period 3). Different homogenous assays for D-LDL-C measurement were used for each of the 3 periods.

Results

There is a fundamental disagreement between D-LDL-C and C-LDL-C, although Pearson correlation coefficients are 0.93, 0.97, and 0.98 for periods 1, 2, and 3, respectively. Using the model for period 1, when C-LDL-C is 70 mg/dL, the predicted D-LDL-C is 95 mg/dL (36% higher). The differences between C-LDL-C and predicted D-LDL-C progressively decrease at higher LDL-C cut points. In the assay used in period 3, there are 290 samples with D-LDL-C values between 100 and 130 mg/dL. Of these, only 182 samples show agreement with C-LDL-C values, whereas 90 samples with a D-LDL-C in the 100- to 130-mg/dL range are in the 70- to 100-mg/dL range using the C-LDL-C assay. Although the κ statistics suggests the LDL-C measures have relatively high levels of agreement, the significant generalized McNemar tests ( P < 0.01) provide additional evidence of disagreement between C-LDL-C and D-LDL-C during all the 3 periods.

Conclusions

Our results highlight D-LDL-C measurements using 3 different assays during 3 different periods. In all assays, there is a substantial lack of agreement between D-LDL-C and C-LDL-C, which, in most cases, resulted in higher D-LDL-C values than C-LDL-C. This leads to clinically significant misclassification of patient's LDL-C to a different LDL-C treatment goal, which would potentially result in more drug usage, thus exposing patients to more potential adverse effects and at a much greater cost with little evidence of benefit.
“Getting from Here to There”-Mechanisms and Limitations to the Activation of the Androgen Receptor in Castration-Resistant Prostate Cancer
Authors: Sharifi Nima , McPhaul Michael J. , Auchus Richard J.
Published: May 2016

Despite the clinical regression that typifies the initial response of advanced prostate cancer to gonadal testosterone depletion, tumors eventually progress. However, evidence supports the concept that signaling via the androgen receptor (AR) is important in progression to castration-resistant prostate cancer (CRPC).

Steroid hormones are synthesized from cholesterol in a series of tightly regulated steps involving the cleavage of carbon-carbon bonds, the introduction of functional groups derived from activated molecular oxygen, and the oxidation and reduction of carbon-carbon and carbon-oxygen bonds. In the adrenal cortex and gonads, steroidogenesis is tightly regulated, very efficient, and highly directional. In contrast, steroid metabolism in peripheral tissues is characterized by competing enzymes and pathways, low efficiency, and great variability. Many steps are mechanistically and functionally irreversible, but some are not, and the repertoire of specific enzymes, intracellular redox state, and access to hormone precursors all contribute to steroid flux and accumulation.

The investigation of steroid metabolizing enzymes in CRPC often assumes that the pathways and the patterns of metabolism mirror those defined in the adrenals and the gonads and validated by human deficiency syndromes. Unfortunately, several potential pathways using different enzymes might contribute substantially to androgen synthesis in CRPC. Finally, a number of mechanisms have been reported by which the AR is activated independent of ligand. Recent observations have suggested that AR forms with constitutive activity occur in CRPC, stimulating transcription without a requirement for ligand. This overview outlines a broad view of how the mechanisms by which the AR may be activated, whether by alternate pathways of androgen synthesis or the production of alternate forms of the AR, with an emphasis on what aspects must be accounted for when using model systems to explore the biology of human prostate cancer.
Molecular Mechanism of Vitamin D in the Cardiovascular System
Authors: Li Yan Chun
Published: May 2016

Vitamin D deficiency is a global health problem that has various adverse consequences. Vitamin D is mainly synthesized in the skin by sunlight (UV light) irradiation; therefore, vitamin D status is influenced by geographic locations, seasonal changes, and skin pigmentations. The kidney is involved in the biosynthesis of 1,25-dihydroxyvitamin D and the reuptake of filtered 25-hydroxyvitamin D from the proximal tubules, thus, vitamin D deficiency is highly prevalent in patients with kidney disease who have renal insufficiency. There is a growing body of epidemiological and clinical evidence in the literature that links vitamin D deficiency to cardiovascular disease. The discovery of the vitamin D hormone functioning as an endocrine inhibitor of the renin-angiotensin system provides an explanation for this association. This review will discuss the mechanism underlying the connection between vitamin D and cardiovascular disease and its physiological and therapeutic implications.
Efficacy, Tolerability, and Factors Affecting the Efficacy of the Sequential Therapy in Curing Helicobacter Pylori Infection in Clinical Setting
Authors: Tursi Antonio , Elisei Walter , Giorgetti GianMarco , Picchio Marcello , Brandimarte Giovanni
Published: May 2016

Background

Sequential therapy is currently suggested as first-line therapy in curing Helicobacter pylori infection, but results coming from its use in clinical practice are scarce. We evaluated the efficacy of this therapy regimen in our current clinical practice.

Methods

A retrospective study was conducted on 437 consecutive dyspeptic patients with proven H. pylori infection. Patients received a 10-day sequential therapy with proton pump inhibitor (PPI) plus amoxicillin 1 g for the first 5 days, followed by PPI, clarithromycin 500 mg, and tinidazole 500 mg for the remaining 5 days (all twice daily) plus PPI every day for further 4 weeks in case of active peptic ulcer or severe gastritis detected at endoscopy. One month after conclusion of therapy, endoscopy was performed in those patients for whom the examinations were clinically relevant. The remaining patients were checked by 13C-urea breath test.

Results

Three-hundred ninety-eight patients (91.08%; 95% confidence interval [CI], 87.91%-93.50%) were fully compliant, 19 patients (4.35%; 95% CI, 2.71%-6.83%) took less than 80% of the prescribed drugs, 11 patients (2.52%; 95% CI, 1.33%-4.60%) were withdrawn because of side effects, and 9 patients (2.06%; 95% CI, 1.01%-4.01%) were lost to follow-up. The H. pylori eradication was obtained in 395 (90.39%, 95% C.I. 87.14% to 92.91%) of 437 and in 362 of 437 (82.84%, 95% C.I. 78.90% to 86.19%) as per-protocol and intention-to-treat analyses, respectively.

Conclusions

Sequential regimen seems to be a valid therapeutic strategy for the management of H. pylori infection in clinical practice.
Health Coverage and Its Relation to the Prevalence and Intensity of Symptomatic Knee Osteoarthritis
Authors: Clearfield Jacob , Segal Neil A.
Published: May 2016

Objective

This study aimed to determine whether health coverage among older adults is associated with (1) the prevalence of symptomatic knee osteoarthritis (OA) and (2) disablement in those with symptomatic knee OA.

Methods

Data were collected from the Osteoarthritis Initiative data set 5.2.1, a cohort study of subjects with or at risk for knee OA. Prevalence of symptomatic knee OA (knee symptoms on most of the last 30 days and Kellgren-Lawrence grade >2 on knee radiograph) was compared between those with and without health coverage among subjects aged 45 to 65 years, adjusted for age and body mass index. For those with symptomatic knee OA, Physical Activity for the Elderly scores and Knee Osteoarthritis Outcomes Survey function, pain, and quality-of-life scores were compared between those with and without health coverage before and after adjustment for age and body mass index.

Results

Among subjects with health coverage, 27.8% had symptomatic knee OA compared with 36.1% of those without health coverage ( P = 0.0204 before and P > 0.24 after adjustment). Among subjects with symptomatic knee OA with and without health coverage physical activity differed significantly ( P = 0.048), as did pain ( P < 0.0001), function ( P = 0.0001), and quality of life ( P < 0.0001).

Conclusions

Lack of health coverage was not associated with the prevalence of symptomatic knee OA after adjustment. However, those with symptomatic knee OA without health coverage reported reduced physical activity, greater pain, worse functional limitations, and decreased quality of life.
Levels of Soluble Advanced Glycation End Product-Receptors and Other Soluble Serum Markers as Indicators of Diabetic Neuropathy in the Foot
Authors: El-Mesallamy Hala O. , Hamdy Nadia M. , Ezzat Omnia A. , Reda Ahmed M.
Published: May 2016

Objective

Advanced glycation end products (AGEs) and the interaction with their receptors (RAGE) play an important role in the pathogenesis of diabetic foot (DF) associated with diabetic neuropathy. Our study examined the association between asymmetric dimethyl arginine (ADMA), fructosamine, nitric oxide (NO), and soluble (s) RAGE levels in serum of diabetic patients with and without neuropathy.

Methods

Circulating levels of ADMA, fructosamine, NO, and sRAGE, estimated either chemically or by enzyme-linked immunosorbent assay, were examined in 60 type 2 diabetes mellitus (T2DM) overweight/obese (body mass index, 30.5 ± 1.5 kg/m2) male patients and 20 age-matched (55 ± 3 years) obese healthy subjects as control group. The T2DM subjects were categorized as patients without DF (n = 30), and the remaining were patients with DF associated with neuropathy.

Results

First sRAGE levels were significantly increased in T2DM patients without DF in comparison to healthy controls (1656.6 [1198.8-2065.4] vs 1111.7 [909-1605.3] pg/mL, respectively; P < 0.05). However, in the DF group (1049.6 [783.7-1221.8] pg/mL), its level decreased significantly in comparison to both groups ( P < 0.05). However, ADMA and fructosamine were significantly higher in diabetic patients with DF than both T2DM without DF and healthy controls. Moreover, NO was significantly lower in DF than in diabetic patients without DF and controls (5 ± 0.4 and 8 ± 0.4 vs 42 ± 2.5 μmol/L, respectively; P < 0.05). Finally, sRAGE levels were significantly correlated with ADMA, fructosamine, and NO.

Conclusions

Soluble forms of the receptor for advanced glycation end product could be an endogenous protection factor against occurrence of DF, hence may be of therapeutic value in the treatment of DF.
Continuous Furosemide Infusion in the Management of Ascites
Authors: Rogers Nicholas A. , Gupta Samir , Cuthbert Jennifer A.
Published: May 2016

Background

The current therapy for patients hospitalized with ascites requires titration of oral diuretics and often needs several days. A faster method for predicting the response to a given dose of diuretic may allow this process to be completed more rapidly.

Aim

The objective of this study was to describe the short-term safety and efficacy of a diuretic infusion to predict net sodium excretion in patients with cirrhosis, ascites, and edema using a fractional excretion of sodium (FENa) of 1% or greater as the target.

Methods

We conducted a retrospective case series of patients admitted for management of ascites who received intravenous furosemide by continuous infusion in ascites management. Patients were stratified depending on whether they had edema or received an intravenous bolus of furosemide or a large-volume paracentesis. The primary outcome was the proportion of patients achieving a FENa of 1% or greater during the infusion. Secondary outcomes included development of electrolyte abnormalities or acute kidney injury during or immediately following the infusion and natriuresis on titrated oral furosemide.

Results

Forty-seven patients meeting criteria were identified from 721 patients seen in consultation. Ten of the patients had edema and received neither bolus intravenous diuretic therapy nor therapeutic paracentesis; all 10 achieved a FENa of 1% or greater. One patient had transient hypokalemia. Of 37 patients who either had no edema or received additional treatment options, all but 6 patients achieved a FENa of 1% or greater. Transient complications in 31 patients with natriuresis included hyponatremia (n = 1), hypokalemia (n = 5), and acute kidney injury (n = 3). Twenty-four-hour urine sodium averaged more than 4 g/d on the titrated oral furosemide regimen in 19 patients completing the collection.

Conclusions

Use of a short continuous furosemide infusion can achieve a FENa of 1% or greater in patients with cirrhotic ascites and may be safe and efficacious for diuresis, meriting further study.
Echocardiogram Done Early in Neonatal Sepsis: What Does it Add?
Authors: Tomerak Rania H. , El-Badawy Ayman A. , Hussein Gehan , Kamel Nermin R.M. , Razak Abdel Rahman A.
Published: May 2016

Background

One of the major organs affected in neonatal sepsis is the heart. Echocardiogram provides real-time information on the cardiovascular performance rather than dependence on the clinical signs alone, which might lead to misjudgment.

Aim of the Work

To assess left ventricular (LV) functions in septic neonates early after admission using transthoracic color Doppler Echocardiography.

Patients and Methods

Echocardiography was done to 30 septic and 30 nonseptic newborns who were divided among 4 groups (septic full-term, 14; septic preterm, 16; nonseptic full-term, 21; and nonseptic preterm, 9). Comparisons were made among the 4 groups using analysis of variance and post hoc test regarding the systolic function (using ejection fraction and fractional shortening), the diastolic function (using the early patrial peak/atrial peak flow velocity ratio), and the global LV function (using myocardial performance index).

Results

The E-wave and the early peak flow velocity/atrial peak flow velocity ratio were significantly lower in the septic neonates, whether full-term or premature, compared to their corresponding age groups in the nonseptic newborns, suggesting LV diastolic dysfunction ( P < 0.001 and P < 0.014, respectively). No difference was found in the diastolic function between the full-term and the preterm neonates whether lying within the septic group or in the nonseptic group. Myocardial performance index was significantly higher in the septic neonates who died than in the survivors ( P < 0.001).

Conclusion

Neonatal sepsis is associated with LV diastolic dysfunction.
Cystatin C Levels in Patients with Dipper and Nondipper Hypertension
Authors: Ordu Serkan , Ozhan Hakan , Alemdar Recai , Yildirim Hayriye , Gungor Adem , Caglar Sabri Onur , Aydin Mesut , Bulur Serkan
Published: May 2016

Objective

Subjects with nondipper hypertension carry a higher risk of cardiovascular events than their normotensive counterparts. The present study was designed to investigate cystatin C levels in patients with dipper and nondipper hypertension.

Methods

Eighty-eight consecutive patients who had been treated with antihypertensive drugs for at least 6 months were included in the study. Dipping and nondipping patterns were detected with ambulatory blood pressure monitoring. Clinical, laboratory, and ambulatory blood pressure monitoring data of patient groups with nondipper and dipper hypertension were compared.

Results

Patients in the nondipper group were older than those in the dipper group. Serum cystatin C level was higher in the patients in the nondipper group. Cystatin C was negatively correlated with the rate of systolic blood pressure fall at night ( r = −0.41; P < 0.001). Linear regression analyses revealed that only cystatin C level was a significant correlate of nocturnal systolic blood pressure decrease. Logistic regression analyses also showed that cystatin C was an independent predictor of nondipping pattern (odds ratio, 3.586; 95% confidence interval, 1.432–8.98; P = 0.006]).

Conclusion

The present study showed that cystatin C is higher in patients with nondipper hypertension patients.
Translational Research Challenges: Finding the Right Animal Models
Authors: Prabhakar Sharma
Published: May 2016

Translation of scientific discoveries into meaningful human applications, particularly novel therapies of human diseases, requires development of suitable animal models. Experimental approaches to test new drugs in preclinical phases often necessitated animal models that not only replicate human disease in etiopathogenesis and pathobiology but also biomarkers development and toxicity prediction. Whereas the transgenic and knockout techniques have revolutionized manipulation of rodents and other species to get greater insights into human disease pathogenesis, we are far from generating ideal animal models of most human disease states. The challenges in using the currently available animal models for translational research, particularly for developing potentially new drugs for human disease, coupled with the difficulties in toxicity prediction have led some researchers to develop a scoring system for translatability. These aspects and the challenges in selecting an animal model among those that are available to study human disease pathobiology and drug development are the topics covered in this detailed review.
Serum Gamma-Glutamyltransferase as a Risk Factor for General Cardiovascular Disease Prediction in Koreans
Authors: Kim Kwang-Min , Kim Bom-Taeck , Lee Duck-Joo , Park Sat-Byul , Joo Nam-Seok , Kim Kyu-Nam
Published: May 2016

Objective

Gamma-glutamyltransferase (GGT) is a novel cardiovascular disease (CVD) risk factor, but its use as an independent factor for general CVD risk prediction remains unclear in general population. This study examined the association between serum GGT concentration and 10-year CVD risk in Koreans.

Methods

This cross-sectional study was performed on 27,270 Koreans. Besides individual components of 10-year CVD risk, body mass index, fasting blood glucose, liver enzymes, lipid profile, uric acid and high sensitive C-reactive protein data were used. The study subjects were grouped into quartiles according to the levels of GGT. Analyses relating GGT to 10-year CVD risk greater than 20% used multiple confounders-adjusted logistic regression.

Results

Positive correlations were established between log-transformed GGT concentration and 10-year CVD risk (Spearman's rho = 0.51; P < 0.001). Compared to the lowest baseline GGT category, unadjusted odds ratios for 10-year CVD risk greater than 20% were significantly increased from the lowest to the highest GGT quartiles; these results remained significant after adjustments for multiple confounders.

Conclusion

Increased GGT concentration is associated with the increase in 10-year CVD risk. Serum GGT may be helpful to predict the future risk of general CVD.
Insulin Signaling and Insulin Resistance
Authors: Beale Elmus G.
Published: May 2016

Insulin resistance or its sequelae may be the common etiology of maladies associated with metabolic syndrome (eg, hypertension, type 2 diabetes, atherosclerosis, heart attack, stroke, and kidney failure). It is thus important to understand those factors that affect insulin sensitivity. This review stems from the surprising discovery that interference with angiotensin signaling improves insulin sensitivity, and it provides a general overview of insulin action and factors that control insulin sensitivity.
Hypothalamic-Pituitary-Thyroid Axis in Patients with Alzheimer Disease (AD)
Authors: Yong-Hong Li , Xiao-Dong Peng , Chang-Quan Huang , Bo Yang , Qing-Xiu Liu
Published: May 2016

Objective

We observed the function of hypothalamic-pituitary-thyroid axis in patients with Alzheimer disease (AD) using a case-control study.

Methods

The case was a cohort that included 50 patients with AD. For each case subject, 1 control who was of similar age, sex, daily activities (scale of Lawton), sleep quality (Pittsburgh Sleep Quality Index), and depression (15-item Geriatrics Depression Scale) was recruited. Thyrotropin-releasing hormone (TRH), thyroid-stimulating hormone (TSH), total triiodothyronine (TT3), total tetraiodothyronine (TT4), free triiodothyronine (FT3), and free tetraiodothyronine (FT4) were detected using radioimmunity.

Results

Compared with the healthy controls, the patients with AD had significantly lower levels of TRH (67.72 ± 18.44 vs 78.64 ± 14.31 pmol/L; t = 2.078; P = 0.036), TSH (3.89 ± 1.22 vs 4.31 ± 1.07 mIU/L; t = 2.331; P = 0.024), TT3 (1.44 ± 0.21 vs 1.63 ± 0.19 nmol/L; t = 3.761; P = 0.018), TT4 (119.71 ± 18.64 nmol/L vs 129.54 ± 23.17 nmol/L; t = 1.328; P = 0.044), FT3 (4.01 ± 1.27 vs 5.41 ± 0.99 pmol/L; t = 4.976; P = 0.008), and FT4 (9.84 ± 1.56 vs 12.96 ± 2.20 pmol/L; t = 5.381; P = 0.006). In the AD cases, none of the correlations between TRH and TSH, TT3, TT4, FT3, and FT4, and between TSH and TT3, TT4, FT3, FT4 was significant. However, in the healthy controls, TRH was significantly correlated with TSH ( R = 0.020; P = 0.042) and FT4 ( R = 0.015; P = 0.018), and TSH was significantly correlated with TT4 ( R = 0.209; P = 0.017) and FT4 ( R = 0.215; P = 0.009).

Conclusion

Alzheimer disease was associated with abnormal function of the hypothalamic-pituitary-thyroid axis.
Design of “Neuropsychological and Mental Health Outcomes of Operation Iraqi Freedom
Authors: Aslan Mihaela , Concato John , Peduzzi Peter N. , Proctor Susan P. , Schnurr Paula P. , Marx Brian P. , McFall Miles , Gleason Theresa , Huang Grant D. , Vasterling Jennifer J.
Published: May 2016

Objective

This study aimed to describe methodological challenges encountered in designing a follow-up assessment of US Army Soldiers who served in Operation Iraqi Freedom.

Study Design and Setting

The Neurocognition Deployment Health Study (NDHS) enrolled 1595 soldiers at 2 military installations, starting in 2003. Prior work compared predeployment and postdeployment assessments among Iraq-deployed and nondeployed soldiers. The current phase, as VA Cooperative Studies Program #566, is collecting follow-up data on participants who were deployed to Iraq or Afghanistan. Specific aims include evaluating the prevalence and course of posttraumatic stress disorder (PTSD), the persistence of previously observed neuropsychological changes, and the relationship of these changes—and traumatic brain injury—to subsequent PTSD. The target sample size is 817 participants, with 200 participants also receiving performance-based neuropsychological assessments.

Results

We describe 6 methodological challenges and their implications for longitudinal research among a “closed,” young, mobile study population: transitioning from cluster-based (battalion) sampling to individual-level sampling; overcoming practical barriers (such as location searches); selecting exposure and outcome measures that combine previously collected and current study data; accounting for loss of an exposed (deployed) versus (nonexposed) nondeployed comparison; determining timing of assessments; and developing a complex statistical analysis plan. Enrollment is ongoing.

Conclusions

The study provides unique insights regarding elements of study design and analysis that are relevant to longitudinal research. In particular, the dynamic “real-life” context of military deployment provides a basis for applying observational methodology to characterize mental health disorders associated with exposure to war-zone deployment and other contexts associated with exposure to extreme stress.
Neuronal Deletion of Ghrelin Receptor Almost Completely Prevents Diet-Induced Obesity
Authors: Lee Jong Han , Lin Ligen , Xu Pingwen , Saito Kenji , Wei Qiong , Meadows Adelina G. , Bongmba Odelia Y.N. , Pradhan Geetali , Zheng Hui , Xu Yong , Sun Yuxiang
Published: May 2016

Ghrelin signaling has major effects on energy and glucose homeostasis, but it is unknown whether ghrelin’s functions are centrally and/or peripherally mediated. The ghrelin receptor, growth hormone secretagogue receptor (GHS-R), is highly expressed in the brain and detectable in some peripheral tissues. To understand the roles of neuronal GHS-R, we generated a mouse line where Ghsr gene is deleted in all neurons using synapsin 1 (Syn1)-Cre driver. Our data showed that neuronal Ghsr deletion abolishes ghrelin-induced spontaneous food intake but has no effect on total energy intake. Remarkably, neuronal Ghsr deletion almost completely prevented diet-induced obesity (DIO) and significantly improved insulin sensitivity. The neuronal Ghsr-deleted mice also showed improved metabolic flexibility, indicative of better adaption to different fuels. In addition, gene expression analysis suggested that hypothalamus and/or midbrain might be the sites that mediate the effects of GHS-R in thermogenesis and physical activity, respectively. Collectively, our results indicate that neuronal GHS-R is a crucial regulator of energy metabolism and a key mediator of DIO. Neuronal Ghsr deletion protects against DIO by regulating energy expenditure, not by energy intake. These novel findings suggest that suppressing central ghrelin signaling may serve as a unique antiobesity strategy.
Insulin-Dependent Regulation of mTORC2-Akt-FoxO Suppresses TLR4 Signaling in Human Leukocytes: Relevance to Type 2 Diabetes
Authors: Zhang Zhiyong , Amorosa Louis F. , Coyle Susette M. , Macor Marie A. , Birnbaum Morris J. , Lee Leonard Y. , Haimovich Beatrice
Published: May 2016

Leukocyte signaling in patients with systemic insulin resistance is largely unexplored. We recently discovered the presence of multiple Toll-like receptor 4 (TLR4) signaling intermediates in leukocytes from patients with type 2 diabetes or acute insulin resistance associated with cardiopulmonary bypass surgery. We extend this work to show that in addition to matrix metalloproteinase 9, hypoxia-inducible factor 1α, and cleaved AMPKα, patient leukocytes also express IRS-1 phosphorylated on Ser312, Akt phosphorylated on Thr308, and elevated TLR4 expression. Similar signaling intermediates were detected in leukocytes and neutrophils treated with lipopolysaccharide (LPS), a ligand of TLR4, in vitro. In contrast, insulin, but not LPS, induced mammalian target of rapamycin complex 2 (mTORC2)–dependent phosphorylation of Akt on Ser473 and FoxO1/O3a on Thr24/32 in leukocytes and neutrophils. Insulin suppressed LPS-induced responses in a dose- and time-dependent manner. AS1842856, a FoxO1 inhibitor, also suppressed TLR4 signaling. We propose that insulin is a homeostatic regulator of leukocyte responses to LPS/TLR4 and that the signaling intermediates expressed in leukocytes of patients with type 2 diabetes indicate TLR4 signaling dominance and deficient insulin signaling. The data suggest that insulin suppresses LPS/TLR4 signals in leukocytes through the mTORC2-Akt-FoxO signaling axis. Better understanding of leukocyte signaling in patients with type 2 diabetes may shed new light on disease causation and progression.
An Analysis of Religious Tourist Growth in Nepal
Authors: Sutihar Deo Narayan
Published: May 2016

This article attempts to estimate annual growth rate of religious tourist to total tourist arrival ratio in Nepal, test the significance of annual growth rate of this ratio and evaluate the presence of auto-correlation among error terms using time series data of the ratio of religious tourist to total tourist arrival in Nepal from 1992 to 2010. The calculation of t-statistic exhibits that the growth rate of religious tourist to total tourist arrival ratio is significant. The D-W test shows that there is existence of positive auto- correlation among error terms. To remove the auto-correlation, the transformed variables have been used to estimate transformed equation of straight line and then it is found that there is no existence of auto-correlation among error terms after transforming the original data. 

Economic Literature, Vol. XI (20-25), June 2013 
Recreational Demand for Fewa Lake: An Application of Travel Cost Method
Authors: Thapa Arjun K
Published: May 2016

Economic valuation of non-market commodities like the recreational amenities provided by national parks, lakes, zoos and sanctuaries is complex and new in Nepal. In this study it is intended to analyze the recreational demand of Fewa Lake by using individual travel cost method. Fifty Nepali visitors were interviewed by administering close ended questionnaire schedule. Most of the respondents were urban unmarried males with secondary and above qualifications, earning a monthly income of around rupees ten thousand. The regression result shows cost of travelling, income, age, * education and location as the major determinants of demand for Fewa Lake’s recreational amenities. The consumer surplus was estimated to be Rs. 18.5 per Nepali visitor per trip. It can be inferred that a provision of entry fee along with quality enhancement would attract more visitors and generate revenue for this Lake.  

Economic Literature, Vol. XI (54-59), June 2013 
Knowledge, Attitude and their Effect on the Recently Graduated Employees’ Financial Management Practices and Satisfaction
Authors: Subarna Bir JBR
Published: May 2016

Researches on financial management practices still seems to be in its embryonic stage, particularly in the context of Nepal where studies taking Nepalese sample are in trivial number though this issue has received an increased attention internationally. This study carries in its womb the objectives of determining the effect of financial knowledge and attitude on the financial management practices and satisfaction with the financial status by taking a total of 110 recently graduated employees as sample respondent. The Family Resource management model originally conceptualized by Deacon and Firebaugh (1988)has been the inspiration for the conceptual framework so constructed for this study. The more positive financial attitudes, longer the job experience and stronger the family’s financial background, the better was the financial management practices among the recently graduated employees. Likewise, wealthy financial background of the respondent’s family, their longer job experience and sound financial management practices adopted by them were related to higher satisfaction with financial status. However, financial knowledge possessed by them was found to be insignificant in predicting their financial management practices as well as satisfaction with their financial status.

Economic Literature Vol.12 2014: 69-81
Surgical outcome of strabismus
Authors: Shrestha Sabina
Published: May 2016

Introduction:

Strabismus is encountered daily by paediatric ophthalmologists and orthoptists in their practice. Strabismus and amblyopia affect 5% of the population. The aim of the study was to determine the surgical outcome of strabismus.

Methods:

It was a prospective study conducted at Nepal Eye Hospital from 2010 to 2011 with the sample size of 40. Patients undergoing strabismus surgery either for esotropia or exotropia were included in the study. Detailed preoperative and postoperative orthoptic evaluation of all the patients was done apart from the anterior and posterior segment examination and the surgical outcome was assessed.

Results:

Forty patients of which 52.5% males and 47.5% females with mean age of 21.025 years underwent strabismus surgery. Manifest divergent squint was present in 61%, manifest convergent squint in 38% and intermittent squint in 5% of patients. 87.5% underwent 2 muscle surgery, 10% underwent 3 muscle surgery and 2.5% underwent single muscle surgery. Postoperative deviation for near was 0 ? in 10%, 2-8 ? in 37.5% and 10-15? in 27.5%. Similarly, postoperative deviation for distance was 0? in 22%, 2-8? in 27% and 10-15? in 22%. Binocular single vision was present in 50% patients preoperatively and 53% patients postoperatively.  

Conclusion:

Though cosmesis has been improved in most of the patients after strabismus surgery, binocular single vision and stereopsis improved in very minimal percentage of patients as the surgery was done after the age of visual maturation in most of the cases. This accentuates the need for strabismus surgery within the years of cortical plasticity.