bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Prediction of Cervical Cancer and Precancers by Type-Specific Human Papillomavirus: Evidence from a Population-Based Cohort Study in China
Authors: Dong Li , Hu Shang-Ying , Zhang Qian , Feng Rui-Mei , Zhang Li , Zhao Xue-Lian , Zhang Xun , Qiao You-Lin , Zhao Fang-Hui
Published: September 2017

Risk stratification of human papillomavirus (HPV)-positive women is needed to avoid excessive colposcopy and overtreatment in cervical cancer screening. We aimed to evaluate the predictive value of type-specific HPV in detecting cervical cancer and precancers in a Chinese population–based cohort and provide evidence of HPV genotyping to triage HPV-positive women. We typed all Hybrid Capture 2–positive cytologic samples of 1,742 women in Shanxi Province Cervical Cancer Screening Study cohort. Cumulative risks of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) among HPV-positive women and cumulative detection rates of CIN2+ among general women by type-specific HPV were estimated during the course of 10-year follow-up. HPV 16 and HPV 52 were most prevalent types among the screening population. Ten-year cumulative risk of CIN2+ was 47.5% [95% confidence interval (CI), 31.6–62.3] for HPV 16–positive women and 46.3% (95% CI, 15.3–75.4) for HPV 31–positive women. Ten-year cumulative risks of CIN2+ among HPV 58, 39, 33, 18, and 52 positive women ranged from 34.3% to 12.0% in a decreasing order. CIN2+ risks were found to be positively associated with infection times of the same genotypes of HPV 16, 31, 33, and 58 (all Ptrend < 0.001). Cumulative detection rates of CIN2+ within 10 years were predominantly contributed by HPV 16, 31, and 58. Our results support the risk-based management of HPV-positive women using HPV genotyping and also indicate the significance of including HPV 31 and 58 apart from commonly acknowledged HPV 16 and HPV 18 in achieving better risk stratification. Cancer Prev Res; 10(12); 745–51. ©2017 AACR.
Habitação em Superquadra avaliação Pós-Ocupação (APO)
Authors: Zapatel Juan Antonio
Published: September 2017

Este artigo é um estudo sobre a apropriação dos espaços habitáveis nas primeiras superquadras construídas no Plano Piloto de Brasília. Este modelo habitacional constitui aproximadamente 80% das áreas residenciais planejadas nesta cidade. A elaboração de um método para a avaliação pós-ocupação (APO) destas áreas, permitiu confrontar as diretrizes preliminares com a configuração atual da habitação e conhecer a natureza de transformações introduzidas, tanto no "bloco" seis pavimentos sob pilotis, como na extensão das áreas residenciais destes edifícios na superquadra
Os Primeiros cartazes geométricos brasileiros
Authors: Chypriades Heloisa Dallan
Published: September 2017

A forte industrialização ocorrida na cidade de São Paulo nos anos 50 ocasiona transformações no meio artístico-cultural - a fundação dos museus ( MASP e MAM), a introdução de uma exposição internacional de artes plásticas (Bienal) e a criação do primeiro curso de design do país (IAC) – acabando por determinar a adoção da abstração geométrica enquanto linguagem gráfica nos cartazes dos eventos renovadores
Tecnologia da arquitetura e a pós na FAUUSP: um quarto de século atuando no desenvolvimento das pesquisas em avaliação do desempenho ambiental
Authors: Ornstein Sheila Walbe , Del Cario Ualfrido
Published: September 2017

Este artigo pretende descrever o desenvolvimento das pesquisas em avaliação do desempenho ambiental, particularmente aquelas voltadas às temáticas como o conforto ambiental e a avaliação pós-ocupação, ocorrido no contexto da área de concentração “ Tecnologia da Arquitetura” do curso de pós-graduação da FAUUSP. A consolidação de campos de pesquisa, no último quarto do século 20, a formação de quadros docentes e de pesquisadores no país aqui serão apresentados e discutidos à luz das tendências futuras (e da importância) da “ Tecnologia da Arquitetura” para a formação do arquiteto e do urbanista
Periferia Paulistana da necessidade de inserção das habitações de interesse social na Malha Urbana
Authors: Omstein Sheila Walbe
Published: September 2017

Este artigo relata a pesquisa sobre a avaliação pós-ocupação (APO) de habitação autoconstrufda por populações de baixa renda, aplicada em loteamentos situados no Butantã - SP, no período 1985-1988. Enfatiza a necessidade de extrapolar esta avaliação, particularmente no que se refere aos estudos comportamentais, para o espaço público, a infra-estrutura urbana e o bairro, a fim de se procurar mecanismos para efetivamente inserir estes bolsões de probreza no contexto urbano
A Construção da Espacialidade Plástica Pesquisa Qualitativa/Abordagem Fenomenológica
Authors: Pallamin Vera M.
Published: September 2017

A estruturação da espacialidade plástica, construída no âmbito do plano e da voluminosidade, é tratada como uma experiência estética, sob o ponto de vista fenomenológico. Introduz-se uma crítica ao enfoque objetivista em relação à mesma questão, fundamentando-se-a na obra de Maurice Merleau-Ponty (França, 1908-61), priorizando-se “Fenomenologia da Percepção”. A pesquisa desenvolve-se em termos qualitativos, efetivando-se a partir de trabalhos realizados por um grupo de graduandos em Arquitetura
Outcomes of Telemedicine Video-Conferencing Clinic Versus In-Person Clinic Follow-Up for Implantable Cardioverter-Defibrillator Recipients
Authors: Dalouk Khidir , Gandhi Nainesh , Jessel Peter , MacMurdy Karen , Zarraga Ignatius Gerardo , Lasarev Michael , Raitt Merritt
Published: September 2017

Background:

Implantable cardioverter-defibrillator (ICD) recipients require close follow-up that can be difficult for patients who have to travel long distances for clinic follow-up. We aimed to compare clinical outcomes between ICD patients followed-up in a telemedicine video-conferencing clinic (TMVC) and a conventional in-person clinic (CIC). We hypothesized that outcomes of patients followed in the TMVC are noninferior to the CIC.

Methods and Results:

This retrospective study compares time to first appropriate ICD therapy, time to first inappropriate ICD therapy, time to first shock, and overall survival in patients followed in TMVC compared with CIC between 2001 and 2016. Two hundred and eighty-seven patients were followed in the TMVC group and 236 patients in the CIC. The average age of the TMVC and CIC groups was 64.13±9.38 and 65.23±8.57 years, respectively (
P
=0.164). There was no difference in the modified Seattle heart failure model score between the 2 groups (−0.12±1.0 versus −0.21±0.99;
P
=0.287). The Charlson comorbidity index score was higher in the CIC group compared with the TMVC group (7.0 versus 6.0;
P
=0.01). Mean duration of follow-up was 4.8 years. Adjusted and unadjusted tests of noninferiority found TMVC was not inferior to in-person follow-up for the prespecified outcomes.

Conclusions:

Video-conferencing ICD follow-up for patients in areas where electrophysiology subspecialty care is not available leads to outcomes that are noninferior to CIC follow-up.
Failure to Treat Life-Threatening Ventricular Tachyarrhythmias in Contemporary Implantable Cardioverter–Defibrillators
Authors: Thøgersen Anna Margrethe , Larsen Jacob Moesgaard , Johansen Jens Brock , Abedin Moeen , Swerdlow Charles D.
Published: September 2017

Background:

In clinical trials, manufacturer-specific, strategic programming of implantable cardioverter–defibrillators (ICDs), including faster detection rates, reduces unnecessary therapy but permits therapy for ventricular tachycardia/ventricular fibrillation (VF). Present consensus recommends a generic rate threshold between 185 and 200 beats per minute, which exceeds the rate tested in clinical trials for some manufacturers. In a case series, we sought to determine the relationship between programmed parameters and failure of modern ICDs to treat VF.

Methods and Results:

We reviewed cases in which normally functioning ICDs failed to deliver timely therapy for VF from April 2015 to January 2017 at 4 institutions. Of 10 ambulatory patients, 5 died from untreated VF, 4 had cardiac arrests requiring external shocks, and 1 was rescued by a delayed ICD shock. VF did not satisfy programmed detection criteria in 9 patients (90%). Seven of these patients had slowest detection rates that were consistent with generic recommendations but not tested in a peer-reviewed trial for their manufacturer’s ICDs. Manufacturer-specific factors interacted with fast detection rates to withhold therapy, including strict VF episode termination rules, enhancements to minimize T-wave oversensing, and features that restrict therapy to regular rhythms in ventricular tachycardia zones. Untreated VF despite recommended programming accounted for 56% of sudden deaths and 11% of all deaths during the study period.

Conclusions:

Complex and unanticipated interactions between manufacturer-specific features and generic programming can prevent therapy for VF. More data are needed to assess the risks and benefits of translating evidence-based detection parameters from one manufacturer to another.
Directional Atherectomy Followed by a Paclitaxel-Coated Balloon to Inhibit Restenosis and Maintain Vessel Patency
Authors: Zeller Thomas , Langhoff Ralf , Rocha-Singh Krishna J. , Jaff Michael R. , Blessing Erwin , Amann-Vesti Beatrice , Krzanowski Marek , Peeters Patrick , Scheinert Dierk , Torsello Giovanni , Sixt Sebastian , Tepe Gunnar
Published: September 2017

Background—

Studies assessing drug-coated balloons (DCB) for the treatment of femoropopliteal artery disease are encouraging. However, challenging lesions, such as severely calcified, remain difficult to treat with DCB alone. Vessel preparation with directional atherectomy (DA) potentially improves outcomes of DCB.

Methods and Results—

DEFINITIVE AR study (Directional Atherectomy Followed by a Paclitaxel-Coated Balloon to Inhibit Restenosis and Maintain Vessel Patency—A Pilot Study of Anti-Restenosis Treatment) was a multicenter randomized trial designed to estimate the effect of DA before DCB to facilitate the development of future end point-driven randomized studies. One hundred two patients with claudication or rest pain were randomly assigned 1:1 to DA+DCB (n=48) or DCB alone (n=54), and 19 additional patients with severely calcified lesions were treated with DA+DCB. Mean lesion length was 11.2±4.0 cm for DA+DCB and 9.7±4.1 cm for DCB (
P
=0.05). Predilation rate was 16.7% for DA+DCB versus 74.1% for DCB; postdilation rate was 6.3% for DA+DCB versus 33.3% for DCB. Technical success was superior for DA+DCB (89.6% versus 64.2%;
P
=0.004). Overall bail-out stenting rate was 3.7%, and rate of flow-limiting dissections was 19% for DCB and 2% for DA+DCB (
P
=0.01). One-year primary outcome of angiographic percent diameter stenosis was 33.6±17.7% for DA+DCB versus 36.4±17.6% for DCB (
P
=0.48), and clinically driven target lesion revascularization was 7.3% for DA+DCB and 8.0% for DCB (
P
=0.90). Duplex ultrasound patency was 84.6% for DA+DCB, 81.3% for DCB (
P
=0.78), and 68.8% for calcified lesions. Freedom from major adverse events at 1 year was 89.3% for DA+DCB and 90.0% for DCB (
P
=0.86).

Conclusions—

DA+DCB treatment was effective and safe, but the study was not powered to show significant differences between the 2 methods of revascularization in 1-year follow-up. An adequately powered randomized trial is warranted.

Clinical Trial Registration—

http://www.clinicaltrials.gov
. Unique Identifier: NCT01366482.
Validation Study of Image-Based Fractional Flow Reserve During Coronary Angiography
Authors: Pellicano Mariano , Lavi Ifat , De Bruyne Bernard , Vaknin-Assa Hana , Assali Abid , Valtzer Orna , Lotringer Yonit , Weisz Giora , Almagor Yaron , Xaplanteris Panagiotis , Kirtane Ajay J. , Codner Pablo , Leon Martin B. , Kornowski Ran
Published: September 2017

Background—

Fractional flow reserve (FFR), an index of the hemodynamic severity of coronary stenoses, is derived from invasive measurements and requires a pressure-monitoring guidewire and hyperemic stimulus. Angiography-derived FFR measurements (FFR
angio
) may have several advantages. The aim of this study is to assess the diagnostic performance and interobserver reproducibility of FFR
angio
in patients with stable coronary artery disease.

Methods and Results—

FFR
angio
is a computational method based on rapid flow analysis for the assessment of FFR. FFR
angio
uses the patient’s hemodynamic data and routine angiograms to generate a complete 3-dimensional coronary tree with color-coded FFR values at any epicardial location. Hyperemic flow ratio is derived from an automatic resistance-based lumped model of the entire coronary tree. A total of 203 lesions were analyzed in 184 patients from 4 centers. Values derived using FFR
angio
ranged from 0.5 to 0.97 (median 0.85) and correlated closely (Spearman ρ=0.90;
P
<0.001) with the invasive FFR measurements, which ranged from 0.5 to 1 (median 0.84). In Bland–Altman analyses, the 95% limits of agreement between these methods ranged from −0.096 to 0.112. Using an FFR cutoff value of 0.80, the sensitivity, specificity, and diagnostic accuracy of FFR
angio
were 88%, 95%, and 93%, respectively. The intraclass coefficient between 2 blinded operators was 0.962 with a 95% confidence interval from 0.950 to 0.971,
P
<0.001.

Conclusions—

There is a high concordance between FFR
angio
and invasive FFR. The color-coded display of FFR values during coronary angiography facilitates the integration of physiology and anatomy for decision making on revascularization in patients with stable coronary artery disease.

Clinical Trial Registration—

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT03005028.
White Blood Cell Count and Major Adverse Cardiovascular Events After Percutaneous Coronary Intervention in the Contemporary Era
Authors: Shah Binita , Baber Usman , Pocock Stuart J. , Krucoff Mitchell W. , Ariti Cono , Gibson C. Michael , Steg Philippe Gabriel , Weisz Giora , Witzenbichler Bernhard , Henry Timothy D. , Kini Annapoorna S. , Stuckey Thomas , Cohen David J. , Iakovou Ioannis , Dangas George , Aquino Melissa B. , Sartori Samantha , Chieffo Alaide , Moliterno David J. , Colombo Antonio , Mehran Roxana
Published: September 2017

Background—

Elevated white blood cell (WBC) count is associated with increased major adverse cardiovascular events (MACE) in the setting of acute coronary syndrome. The aim of this study was to evaluate whether similar associations persist in an all-comers population of patients undergoing percutaneous coronary intervention in the contemporary era.

Methods and Results—

In the multicenter, prospective, observational PARIS study (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients Registry), 4222 patients who underwent percutaneous coronary intervention in the United States and Europe between July 1, 2009, and December 2, 2010, were evaluated. The associations between baseline WBC and MACE (composite of cardiac death, stent thrombosis, spontaneous myocardial infarction, or target lesion revascularization) at 24-month follow-up were analyzed using multivariable Cox regression. Patients with higher WBC were more often younger, smokers, and with less comorbid risk factors compared with those with lower WBC. After adjustment for baseline and procedural characteristics, WBC remained independently associated with MACE (hazard ratio [HR] per 10
3
cells/μL increase, 1.05 [95% confidence intervals (CI), 1.02–1.09];
P
=0.001), cardiac death (HR, 1.10 [95% CI, 1.05–1.17];
P
<0.001), and clinically indicated target revascularization (HR, 1.04 [95% CI, 1.00–1.09];
P
=0.03) but not stent thrombosis (HR, 1.07 [95% CI, 0.99–1.16];
P
=0.10) or spontaneous myocardial infarction (HR, 1.03 [95% CI, 0.97–1.09];
P
=0.29). The association between WBC and MACE was consistent in acute coronary syndrome and non–acute coronary syndrome presentations (interaction
P
=0.15).

Conclusions—

Increased WBC is an independent predictor of MACE after percutaneous coronary intervention in a contemporary all-comers cohort. Further studies to delineate the underlying pathophysiologic role of elevated WBC across a spectrum of coronary artery disease presentations are warranted.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00998127.
Gait Speed Can Predict Advanced Clinical Outcomes in Patients Who Undergo Transcatheter Aortic Valve Replacement
Authors: Kano Seiji , Yamamoto Masanori , Shimura Tetsuro , Kagase Ai , Tsuzuki Masanao , Kodama Atsuko , Koyama Yutaka , Kobayashi Toshihiro , Shibata Kenichi , Tada Norio , Naganuma Toru , Araki Motoharu , Yamanaka Futoshi , Shirai Shinichi , Mizutani Kazuki , Tabata Minoru , Ueno Hiroshi , Takagi Kensuke , Higashimori Akihiro , Otsuka Toshiaki , Watanabe Yusuke , Hayashida Kentaro
Published: September 2017

Background—

Gait speed reflects an important factor of frailty and is associated with an increased risk of late mortality in patients with cardiac disease. This study sought to assess the prognostic value of gait speed in elderly patients who underwent transcatheter aortic valve replacement.

Methods and Results—

We investigated the 5-m or 15-feet gait speed (m/sec) in 1256 patients who underwent transcatheter aortic valve implantation using data from the OCEAN-TAVI Japanese multicenter registry (Optimized Catheter Valvular Intervention–Transcatheter Aortic Valve Implantation). Baseline characteristics, procedural outcomes, and all-cause mortality were compared among groups defined by differential gait speed classification: model 1, normal (>0.83 m/sec; n=563; 44.8%), slow (0.5–0.83 m/sec; n=429; 34.2%), slowest (<0.83 m/sec; n=205; 16.3%), unable to walk (n=48; 3.8%); and model 2, classification and regression tree survival model indicating the threshold of gait speed as 0.385 m/sec (>0.385 m/sec; n=1080 versus ≤0.385 m/sec; n=117). The cumulative 1-year mortality rate showed significant differences in the classical gait speed groups in model 1 (7.6%, 6.6%, 18.2%, and 40.7%, respectively;
P
<0.001) and survival classification and regression tree group in model 2 (7.7% versus 21.9%;
P
<0.001). The slowest walkers and those unable to walk demonstrated independent associations with increased midterm mortality after adjustment for several confounding factors (hazard ratio, 1.83, 4.28; 95% confidence interval, 1.03–3.26, 2.22–8.72;
P
=0.039, <0.001, respectively). Gait speed <0.385 m/sec determined by classification and regression tree also independently associated with worse prognosis (hazard ratio, 2.40; 95% confidence interval, 1.75–5.88;
P
=0.001).

Conclusions—

Gait speed using both traditional and specific classification is useful as a potential marker for predicting vulnerable patients associated with adverse clinical outcomes after transcatheter aortic valve replacement.
Phase 2a Clinical Trial of Mitochondrial Protection (Elamipretide) During Stent Revascularization in Patients With Atherosclerotic Renal Artery Stenosis
Authors: Saad Ahmed , Herrmann Sandra M.S. , Eirin Alfonso , Ferguson Christopher M. , Glockner James F. , Bjarnason Haraldur , McKusick Michael A. , Misra Sanjay , Lerman Lilach O. , Textor Stephen C.
Published: September 2017

Background—

Atherosclerotic renal artery stenosis reduces renal blood flow (RBF) and amplifies stenotic kidney hypoxia. Revascularization with percutaneous transluminal renal angioplasty (PTRA) and stenting often fails to recover renal function, possibly because of ischemia/reperfusion injury developing after PTRA. Elamipretide is a mitochondrial-targeted peptide that binds to cardiolipin and stabilizes mitochondrial function. We tested the hypothesis that elamipretide plus PTRA would improve renal function, oxygenation, and RBF in patients with atherosclerotic renal artery stenosis undergoing PTRA.

Methods and Results—

Inpatient studies were performed in patients with severe atherosclerotic renal artery stenosis scheduled for PTRA. Patients were treated before and during PTRA with elamipretide (0.05 mg/kg per hour intravenous infusion, n=6) or placebo (n=8). Stenotic kidney cortical/medullary perfusion and RBF were measured using contrast-enhanced multidetector CT, and renal oxygenation by 3-T blood oxygen level−dependent magnetic resonance imaging before and 3 months after PTRA. Age and basal glomerular filtration rate did not differ between groups. Blood oxygen level−dependent imaging demonstrated increased fractional hypoxia 24 hours after angiography and stenting in placebo (+47%) versus elamipretide (−6%). These were reverted to baseline 3 months later. Stenotic kidney RBF rose (202±29–262±115 mL/min;
P
=0.04) 3 months after PTRA in the elamipretide-treated group only. Over 3 months, systolic blood pressure decreased, and estimated glomerular filtration rate increased (
P
=0.003) more in the elamipretide group than in the placebo group (
P
=0.11).

Conclusions—

Adjunctive elamipretide during PTRA was associated with attenuated postprocedural hypoxia, increased RBF, and improved kidney function in this pilot trial. These data support a role for targeted mitochondrial protection to minimize procedure-associated ischemic injury and to improve outcomes of revascularization for human atherosclerotic renal artery stenosis.

Clinical Trial Registration—

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01755858.
Coronary Perforation Complicating Percutaneous Coronary Intervention in Patients With a History of Coronary Artery Bypass Surgery
Authors: Kinnaird Tim , Anderson Richard , Ossei-Gerning Nick , Cockburn James , Sirker Alex , Ludman Peter , de Belder Mark , Johnson Thomas W. , Copt Samuel , Zaman Azfar , Mamas Mamas A.
Published: September 2017

Background—

The evidence base for coronary perforation (CP) occurring during percutaneous coronary intervention in patients with a history of coronary artery bypass surgery (PCI-CABG) is limited and the long-term effects unclear. Using a national PCI database, the incidence, predictors, and outcomes of CP during PCI-CABG were defined.

Methods and Results—

Data were analyzed on all PCI-CABG procedures performed in England and Wales between 2005 and 2013. Multivariate logistic regressions and propensity scores were used to identify predictors of CP and its association with outcomes. During the study period, 309 CPs were recorded during 59 644 PCI-CABG procedures with the incidence rising from 0.32% in 2005 to 0.68% in 2013 (
P
<0.001 for trend). Independent associates of perforation in native vessels included age, chronic occlusive disease intervention, rotational atherectomy use, number of stents, hypertension, and female sex. In graft PCI, predictors of perforation were history of stroke, New York Heart Association class, and number of stents used. In-hospital clinical complications including Q-wave myocardial infarction (2.9% versus 0.2%;
P
<0.001), major bleeding (14.0% versus 0.9%;
P
<0.001), blood transfusion (3.7% versus 0.2%;
P
<0.001), and death (10.0% versus 1.1%;
P
<0.001) were more frequent in patients with CP. A continued excess mortality occurred after perforation, with an odds ratio for 12-month mortality of 1.35 for perforation survivors compared with matched nonperforation survivors without a CP (
P
<0.0001).

Conclusions—

CP is an infrequent event during PCI-CABG but is closely associated with adverse clinical outcomes. A legacy effect of perforation on 12-month mortality was observed.
Clinical Profile and Consequences of Atrial Fibrillation in Hypertrophic Cardiomyopathy
Authors: Rowin Ethan J. , Hausvater Anais , Link Mark S. , Abt Patrick , Gionfriddo William , Wang Wendy , Rastegar Hassan , Estes N. A. Mark , Maron Martin S. , Maron Barry J.
Published: September 2017

Background:

Atrial fibrillation (AF), the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM), is capable of producing symptoms that impact quality of life and is associated with risk for embolic stroke. However, the influence of AF on clinical course and outcome in HCM remains incompletely resolved.

Methods:

Records of 1558 consecutive patients followed at the Tufts Medical Center Hypertrophic Cardiomyopathy Institute for 4.8±3.4 years (from 2004 to 2014) were accessed.

Results:

Of the 1558 patients with HCM, 304 (20%) had episodes of AF, of which 226 (74%) were confined to symptomatic paroxysmal AF (average, 5±5; range, 1 to >20), whereas 78 (26%) developed permanent AF, preceded by 7±6 paroxysmal AF episodes. At last evaluation, 277 patients (91%) are alive at 62±13 years of age, including 89% in New York Heart Association class I or II. No difference was found in outcome measures for patients with AF and age- and sex-matched patients with HCM without AF. Four percent of patients with AF died of HCM-related causes (n=11), with annual mortality 0.7%; mortality directly attributable to AF (thromboembolism without prophylactic anticoagulation) was 0.1% per year (n=2 patients). Patients were treated with antiarrhythmic drugs (most commonly amiodarone [n=103] or sotalol [n=78]) and AF catheter ablation (n=49) or the Maze procedure at surgical myectomy (n=72). Freedom from AF recurrence at 1 year was 44% for ablation patients and 75% with the Maze procedure (
P
<0.001). Embolic events were less common with anticoagulation prophylaxis (4/233, 2%) than without (9/66, 14%) (
P
<0.001).

Conclusions:

Transient symptomatic episodes of AF, often responsible for impaired quality of life, are unpredictable in frequency and timing, but amenable to effective contemporary treatments, and infrequently progress to permanent AF. AF is not a major contributor to heart failure morbidity or a cause of arrhythmic sudden death; when treated, it is associated with low disease-related mortality, no different than for patients without AF. AF is an uncommon primary cause of death in HCM virtually limited to embolic stroke, supporting a low threshold for initiating anticoagulation therapy.
Radiographic and Clinical Brain Infarcts in Cardiac and Diagnostic Procedures
Authors: Cho Sung-Min , Deshpande Abhishek , Pasupuleti Vinay , Hernandez Adrian V. , Uchino Ken
Published: September 2017

Background and Purpose—

The incidence of periprocedural brain infarcts varies among cardiovascular procedures. In a systematic review, we compared the ratio of radiographic brain infarcts (RBI) to strokes and transient ischemic attacks across cardiac and vascular procedures.

Methods—

We searched MEDLINE and 5 other databases for brain infarcts in aortic valve replacement, coronary artery bypass grafting, cardiac catheterization, and cerebral angiogram through September 2015. We followed the PRISMA (preferred reporting items for systematic reviews and meta-analyses) recommendations. We defined symptomatic rate ratio (RR) as ratio of stroke plus transient ischemic attack rate to RBI rate.

Results—

Twenty-nine studies involving 2124 subjects met the inclusion criteria. In meta-analysis of aortic valve replacements with 494 people, 69.4% (95% confidence interval (CI), 57.6%–81.4%) had RBIs, whereas 3.6% (95% CI, 2.0%–5.2%) had clinical events (RR, 0.08; 95% CI, 0.05–0.12). Coronary artery bypass grafting among 204 patients had 27.4% (95% CI, 6.0%–48.8%) RBIs and 2.4% (95% CI, 0.3%–4.5%) clinical events (RR, 0.11; 95% CI, 0.05–0.26). Cardiac catheterization among 833 people had 8.0% (95% CI, 4.1%–12.0%) RBIs, and 0.6% (95% CI, 0.1%–1.1%) had clinical events (RR, 0.16; 95% CI, 0.08–0.31). Cerebral angiogram among 593 people had 12.8% (95% CI, 6.6–19.0) RBIs and 0.6% (95% CI, 0%–13%) clinical events (RR, 0.10; 95% CI, 0.04–0.27). The RR of all procedures was 0.10 (95% CI, 0.07–0.13) without differences in the RRs across procedures (
P
=0.29).

Conclusions—

One of 10 people with periprocedural RBIs during cardiac surgeries and invasive vascular diagnostic procedures resulted in strokes or transient ischemic attacks, which may serve as a potential surrogate marker of procedural proficiency and perhaps as a predictor of risk for periprocedural strokes.
Safety of Simultaneous Coronary Artery Bypass Grafting and Carotid Endarterectomy Versus Isolated Coronary Artery Bypass Grafting
Authors: Weimar Christian , Bilbilis Konstantinos , Rekowski Jan , Holst Torulv , Beyersdorf Friedhelm , Breuer Martin , Dahm Manfred , Diegeler Anno , Kowalski Arne , Martens Sven , Mohr Friedrich W. , Ondrášek Jiri , Reiter Beate , Roth Peter , Seipelt Ralf , Siggelkow Markus , Steinhoff Gustav , Moritz Anton , Wilhelmi Mathias , Wimmer-Greinecker Gerhard , Diener Hans-Christoph , Jakob Heinz , Ose Claudia , Scherag Andre , Knipp Stephan C.
Published: September 2017

Background and Purpose—

The optimal operative strategy in patients with severe carotid artery disease undergoing coronary artery bypass grafting (CABG) is unknown. We sought to investigate the safety and efficacy of synchronous combined carotid endarterectomy and CABG as compared with isolated CABG.

Methods—

Patients with asymptomatic high-grade carotid artery stenosis ≥80% according to ECST (European Carotid Surgery Trial) ultrasound criteria (corresponding to ≥70% NASCET [North American Symptomatic Carotid Endarterectomy Trial]) who required CABG surgery were randomly assigned to synchronous carotid endarterectomy+CABG or isolated CABG. To avoid unbalanced prognostic factor distributions, randomization was stratified by center, age, sex, and modified Rankin Scale. The primary composite end point was the rate of stroke or death at 30 days.

Results—

From 2010 to 2014, a total of 129 patients were enrolled at 17 centers in Germany and the Czech Republic. Because of withdrawal of funding after insufficient recruitment, enrolment was terminated early. At 30 days, the rate of any stroke or death in the intention-to-treat population was 12/65 (18.5%) in patients receiving synchronous carotid endarterectomy+CABG as compared with 6/62 (9.7%) in patients receiving isolated CABG (absolute risk reduction, 8.8%; 95% confidence interval, −3.2% to 20.8%;
P
WALD
=0.12). Also for all secondary end points at 30 days and 1 year, there was no evidence for a significant treatment-group effect although patients undergoing isolated CABG tended to have better outcomes.

Conclusions—

Although our results cannot rule out a treatment-group effect because of lack of power, a superiority of the synchronous combined carotid endarterectomy+CABG approach seems unlikely. Five-year follow-up of patients is still ongoing.

Clinical Trial Registration—

URL:
https://www.controlled-trials.com
. Unique identifier: ISRCTN13486906.
Integrin α4 Overexpression on Rat Mesenchymal Stem Cells Enhances Transmigration and Reduces Cerebral Embolism After Intracarotid Injection
Authors: Cui Li-li , Nitzsche Franziska , Pryazhnikov Evgeny , Tibeykina Marina , Tolppanen Laura , Rytkönen Jussi , Huhtala Tuulia , Mu Jing-wei , Khiroug Leonard , Boltze Johannes , Jolkkonen Jukka
Published: September 2017

Background and Purpose—

Very late antigen-4 (integrin α4β1)/vascular cell adhesion molecule-1 mediates leukocyte trafficking and transendothelial migration after stroke. Mesenchymal stem cells (MSCs) typically express integrin β1 but insufficient ITGA4 (integrin α4), which limits their homing after intravascular transplantation. We tested whether ITGA4 overexpression on MSCs increases cerebral homing after intracarotid transplantation and reduces MSC-borne cerebral embolism.

Methods—

Rat MSCs were lentivirally transduced to overexpress ITGA4. In vitro transendothelial migration was assessed using a Boyden chamber assay. Male Wistar rats intracarotidly received 0.5×10
6
control or modified MSCs 24 hours after sham or stroke surgery. In vivo behavior of MSCs in the cerebral vasculature was observed by intravital microscopy and single-photon emission computed tomography for up to 72 hours.

Results—

Transendothelial migration of ITGA4-overexpressing MSCs was increased in vitro. MSCs were passively entrapped in microvessels in vivo and occasionally formed large cell aggregates causing local blood flow interruptions. MSCs were rarely found in perivascular niches or parenchyma at 72 hours post-transplantation, but ITGA4 overexpression significantly decreased cell aggregation and ameliorated the evoked cerebral embolism in stroke rats.

Conclusions—

ITGA4 overexpression on MSCs enhances transendothelial migration in vitro, but not in vivo, although it improves safety after intracarotid transplantation into stroke rats.
Cost-Effectiveness of Thrombectomy in Patients With Acute Ischemic Stroke
Authors: Achit Hamza , Soudant Marc , Hosseini Kossar , Bannay Aurélie , Epstein Jonathan , Bracard Serge , Guillemin Francis
Published: September 2017

Background and Purpose—

The benefit of mechanical thrombectomy added to intravenous thrombolysis (IVT) in patients with acute ischemic stroke has been largely demonstrated. However, evidence of the economic incentive of this strategy is still limited, especially in the context of a randomized controlled trial. We aimed to analyze whether mechanical thrombectomy combined with IVT (IVMT) is cost-effective when compared with IVT alone.

Methods—

Individual-level cost and outcome data were collected in the THRACE randomized controlled trial (Thrombectomie des Artères Cerébrales) including patients with acute ischemic stroke. Patients were assigned to receive IVT or IVMT. The primary outcomes were modified Rankin Scale score of functional independence at 90 days (score 0–2) and the EuroQol-5D quality-of-life score at 1 year.

Results—

Treating acute ischemic stroke with IVMT (n=200) versus IVT (n=202) increased the rate of functional independence by 10.9% (53.0% versus 42.1%;
P
=0.028), at an increased cost of $2116 (€1909), with no significant difference in mortality (12% versus 13%;
P
=0.70) or symptomatic intracranial hemorrhage (2% versus 2%;
P
=0.71). The cost per one averted case of disability was estimated at $19 379 (€17 480). The incremental cost per one quality-adjusted life year gained was $14 881 (€13 423). On sensitivity analysis, the probability of cost-effectiveness with IVMT was 84.1% in terms of cases of averted disability and 92.2% in terms of quality-adjusted life years.

Conclusions—

Based on randomized trial data, this study demonstrates that IVMT used to treat acute ischemic stroke is cost-effective when compared with IVT alone.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01062698.
Regional Evaluation of the Severity-Based Stroke Triage Algorithm for Emergency Medical Services Using Discrete Event Simulation
Authors: Bogle Brittany M. , Asimos Andrew W. , Rosamond Wayne D.
Published: September 2017

Background and Purpose—

The Severity-Based Stroke Triage Algorithm for Emergency Medical Services endorses routing patients with suspected large vessel occlusion acute ischemic strokes directly to endovascular stroke centers (ESCs). We sought to evaluate different specifications of this algorithm within a region.

Methods—

We developed a discrete event simulation environment to model patients with suspected stroke transported according to algorithm specifications, which varied by stroke severity screen and permissible additional transport time for routing patients to ESCs. We simulated King County, Washington, and Mecklenburg County, North Carolina, distributing patients geographically into census tracts. Transport time to the nearest hospital and ESC was estimated using traffic-based travel times. We assessed undertriage, overtriage, transport time, and the number-needed-to-route, defined as the number of patients enduring additional transport to route one large vessel occlusion patient to an ESC.

Results—

Undertriage was higher and overtriage was lower in King County compared with Mecklenburg County for each specification. Overtriage variation was primarily driven by screen (eg, 13%–55% in Mecklenburg County and 10%–40% in King County). Transportation time specifications beyond 20 minutes increased overtriage and decreased undertriage in King County but not Mecklenburg County. A low- versus high-specificity screen routed 3.7× more patients to ESCs. Emergency medical services spent nearly twice the time routing patients to ESCs in King County compared with Mecklenburg County.

Conclusions—

Our results demonstrate how discrete event simulation can facilitate informed decision making to optimize emergency medical services stroke severity-based triage algorithms. This is the first step toward developing a mature simulation to predict patient outcomes.
Effects of Statin Intensity and Adherence on the Long-Term Prognosis After Acute Ischemic Stroke
Authors: Kim Jinkwon , Lee Hye Sun , Nam Chung Mo , Heo Ji Hoe
Published: September 2017

Background and Purpose—

Statin is an established treatment for secondary prevention after ischemic stroke. However, the effects of statin intensity and adherence on the long-term prognosis after acute stroke are not well known.

Methods—

This retrospective cohort study using a nationwide health insurance claim data in South Korea included patients admitted with acute ischemic stroke between 2002 and 2012. Statin adherence and intensity were determined from the prescription data for a period of 1 year after the index stroke. The primary outcome was a composite of recurrent stroke, myocardial infarction, and all-cause mortality. We performed multivariate Cox proportional regression analyses.

Results—

We included 8001 patients with acute ischemic stroke. During the mean follow-up period of 4.69±2.72 years, 2284 patients developed a primary outcome. Compared with patients with no statin, adjusted hazard ratios (95% confidence interval) were 0.74 (0.64–0.84) for good adherence, 0.93 (0.79–1.09) for intermediate adherence, and 1.07 (0.95–1.20) for poor adherence to statin. Among the 1712 patients with good adherence, risk of adverse events was lower in patients with high-intensity statin (adjusted hazard ratio [95% confidence interval], 0.48 [0.24–0.96]) compared with those with low-intensity statin. Neither good adherence nor high intensity of statin was associated with an increased risk of hemorrhagic stroke.

Conclusions—

After acute ischemic stroke, high-intensity statin therapy with good adherence was significantly associated with a lower risk of adverse events.
Anti-IgE and Anti-IL5 Biologic Therapy in the Treatment of Nasal Polyposis: A Systematic Review and Meta-analysis
Authors: Rivero Alexander , Liang Jonathan
Published: September 2017

Objective:

To determine the role of biologic therapy on sinonasal symptoms and objective outcomes in chronic rhinosinusitis with nasal polyposis (CRSwNP).

Methods:

PubMed, OVID MEDLINE, and Cochrane Central were reviewed from 2000 to 2015. Inclusion criteria included English-language studies containing original data on biologic therapy in CRSwNP patients with reported outcome measures. Two investigators independently reviewed all manuscripts and performed quality assessment and quantitative meta-analysis using validated tools.

Results:

Of 495 abstracts identified, 7 studies fulfilled eligibility: 4 randomized control trials (RCT), 1 case-control, and 2 case series. Outcome measures included nasal polyp score (NPS,6), computer tomography score (5), and symptom scores (5). Meta-analysis was performed on 5 studies: Anti-IL5 therapy (mepolizumab/reslizumab) and anti-IgE therapy (omalizumab) demonstrated a standard mean difference of NPS improvement of −0.66 (95% CI, −1.24 to −0.08) and −0.75 (95% CI, −1.93 to 0.44), respectively, between biologic therapy and placebo. Quality assessment indicated a low to moderate risk of bias for the RCTs.

Conclusion:

Biologic therapies may prove beneficial in the treatment of recalcitrant nasal polyposis in select populations. In meta-analysis, anti-IL5 therapy demonstrates a reduction in nasal polyp score. Anti-IgE therapy reduces nasal polyp score in patients with severe comorbid asthma. Additional high-level evidence is needed to assess clinical efficacy.
Exploring Race/Racism Past and Present: A Forum at Union Presbyterian Seminary
Authors: Blount Brian K. , Cannon Katie G. , Thompson Jamie , Adams Samuel L.
Published: September 2017

This article is based on the transcript of a forum on race and racism held April 6, 2016, at Union Presbyterian Seminary, in Richmond, Virginia. Participants Dr. Brian K. Blount, Dr. Katie G. Cannon, the Rev. Jamie Thompson, and Dr. Samuel L. Adams (moderator) discussed memories of growing up in a segregated America, the Civil Rights movement, and their observations of and experiences with racism today. Questions were generated by the panelists before the forum, and panelists had the opportunity to edit and add to their discussion points for publication.
Stop the Violence: Breaking the Cycle of Anti-Black Violence
Authors: Douglas Kelly Brown
Published: September 2017

This article examines narratives of anti-blackness and the myth of white superiority to clarify why violence against black bodies is part of American identity and to discern how that cycle of violence might be broken. Churches are vital in the process of opening white minds to the realities and consequences of American myths of anti-blackness and white supremacy. Until such a time as churches become literate in all facets of systemic racism, the cry to “stop the violence” will be meaningless.
A Colonized Christmas Story
Authors: De La Torre Miguel A.
Published: September 2017

The Christmas story has been retold so often, through sermons, church plays, popular literature, and movies, that a false memory has been constructed. This memory romanticizes the birth of Jesus, thus masking the radical political implications of the event. All too often, we read the Gospels with privileged eyes, thus transforming the Christmas story into a hopeful salvific tale, if not legend. But the Jesús narratives can be read as anti-colonial literature about a native resident living under an invading colonial foreign power. This article reads the familiar story through the eyes of marginalized Latinxs (Latinos/as), who live under the consequences of colonization.
Developmental Trajectories of Cocaine/Crack Use Among Juvenile Offenders: PTSD as a Risk Factor
Authors: Wojciechowski Thomas W.
Published: September 2017

Cocaine and crack are illicit drugs linked to numerous health issues. Despite the public health issues which these drugs present, there has yet to be an examination of the heterogeneity which exists in the developmental course of use of these drugs among a group at-risk for substance abuse: juvenile offenders. Furthermore, the role that posttraumatic stress disorder plays for predicting developmental patterns of use of these drugs has yet to be investigated either. The present research analyzed data from a sample of 1,354 juvenile offenders using group-based trajectory modeling and multinomial logistic regression to examine these phenomena. Results indicated that a five-group trajectory model best fit the data. Meeting criteria for a lifetime diagnosis of posttraumatic stress disorder at baseline predicted assignment to the Accelerating and Moderate Chronic groups. These results indicate that juvenile offenders are at-risk for participation in cocaine/crack use and patterns of use which extend into adulthood.
Teaching Metacognition Experientially
Authors: Richmond Aaron S. , Bacca Anastasia M. , Becknell Jared S. , Coyle Ryan P.
Published: September 2017

We investigated the effects of using experiential learning and direct instruction to teach metacognitive theory and to determine whether instructional type differentially affected higher vs. lower level learning. We randomly assigned 87 introductory psychology students to either experiential learning or direct instruction conditions. We pretested participant’s knowledge of metacognitive theory, and then participants received either experiential or direct instruction, after which they completed a posttest of knowledge of metacognitive theory. After covarying prior knowledge, data suggested that experiential learning may be more effective than direct instruction for teaching metacognitive theory, particularly for higher level recall and recognition assessments. Our results suggest that when taught using experiential learning, students may process information at a deeper level and recall more information because they may have related new information to their past experiences, engaged in the course material, and may have increased self-efficacy for the learned material.
Increasing Availability of Exposure Therapy Through Intensive Group Treatment for Childhood Anxiety and OCD
Authors: Whiteside Stephen P. H. , Dammann Julie E. , Tiede Michael S. , Biggs Bridget K. , Hillson Jensen Andrea
Published: September 2017

Archival data were used to examine the feasibility of a 5-day, clinic-based, intensive exposure–based cognitive-behavioral group therapy for childhood anxiety disorders (CADs) and obsessive-compulsive disorder (OCD). Participants were 143 children (82 girls) aged 6 to 19 years ( M = 13.93 years, SD = 2.9 years) with CADs or OCD (or both) in 28 consecutive groups. Repeated-measures ANOVA in the subsample ( n = 57) with complete treatment data indicated positive change on all variables from pretreatment to posttreatment with few differences between CADs and OCD patients. Effect sizes were moderate to large for anxiety symptoms (parent reported = 0.74, child reported = 0.65) and impairment (parent reported = 1.02, child reported = 0.69). The intensive group protocol required fewer sessions and 36% fewer therapist-hours per patient than the individually administered protocol. The program increased treatment availability for families from diverse geographic areas ( M distance traveled to clinic = 407 miles, SD = 786.4 miles). These findings support further, well-controlled examination of the 5-day intensive group treatment protocol’s efficacy and potential to increase availability of evidence-based exposure therapy.
I-Through-We: How Supportive Social Relationships Facilitate Personal Growth
Authors: Lee David S. , Ybarra Oscar , Gonzalez Richard , Ellsworth Phoebe
Published: September 2017

Personal growth is usually considered an outcome of intrapersonal processes—personal resources residing within the person. Comparatively, little research has examined the interpersonal processes underlying personal growth. We investigated how one interpersonal factor—people’s relationships with others—influences personal growth. Study 1 showed that brief reminders of a supportive (vs. nonsupportive) other led people to choose a job that promoted personal growth over one that offered a higher salary. Moreover, feelings of self-confidence from thinking about a supportive (vs. nonsupportive) other mediated personal growth. Extending these results, Studies 2 and 3 demonstrated that people’s perceptions of how supportive their close others are predicted personal growth in two distinct cultures with varying emphasis on individual (vs. collective) growth. Consistent with Study 1’s findings, the results were also mediated by feelings of self-confidence. These findings suggest that the link between supportive relationships and personal growth may reflect a general process.
On the Performance of the Marginal Homogeneity Test to Detect Rater Drift
Authors: Sgammato Adrienne , Donoghue John R.
Published: September 2017

When constructed response items are administered repeatedly, “trend scoring” can be used to test for rater drift. In trend scoring, raters rescore responses from the previous administration. Two simulation studies evaluated the utility of Stuart’s Q measure of marginal homogeneity as a way of evaluating rater drift when monitoring trend scoring. In the first study, data were generated based on trend scoring tables obtained from an operational assessment. The second study tightly controlled table margins to disentangle certain features present in the empirical data. In addition to Q, the paired t test was included as a comparison, because of its widespread use in monitoring trend scoring. Sample size, number of score categories, interrater agreement, and symmetry/asymmetry of the margins were manipulated. For identical margins, both statistics had good Type I error control. For a unidirectional shift in margins, both statistics had good power. As expected, when shifts in the margins were balanced across categories, the t test had little power. Q demonstrated good power for all conditions and identified almost all items identified by the t test. Q shows substantial promise for monitoring of trend scoring.