bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronically Elevating Circulating Ketones Can Reduce Cardiac Inflammation and Blunt the Development of Heart Failure
Authors: Byrne Nikole J. , Soni Shubham , Takahara Shingo , Ferdaoussi Mourad , Al Batran Rami , Darwesh Ahmed M. , Levasseur Jody L. , Beker Donna , Vos Dyonne Y. , Schmidt Mya A. , Alam Abrar S. , Maayah Zaid H. , Schertzer Jonathan D. , Seubert John M. , Ussher John R. , Dyck Jason R.B. 
Published: June 2020

Background:
Previous studies have shown beneficial effects of acute infusion of the primary ketone body, β-hydroxybutyrate, in heart failure (HF). However, whether chronic elevations in circulating ketones are beneficial remains unknown.

Methods:

To chronically elevate circulating ketones in mice, we deleted the expression of the ketolytic, rate-limiting-enzyme, SCOT (succinyl-CoA:3-ketoacid-CoA transferase 1; encoded by
Oxct1
), in skeletal muscle. Tamoxifen-inducible skeletal muscle-specific
Oxct1
Muscle−
/
−
knockout (n=32) mice and littermate controls (wild type; WT; n=35) were subjected to transverse aortic constriction (TAC) surgery to induce HF.

Results:

Deletion of SCOT in skeletal, but not cardiac muscle resulted in elevated concentrations of fasted circulating β-hydroxybutyrate in knockout mice compared with WT mice (
P
=0.030). Five weeks following TAC, WT mice progressed to HF, whereas knockout mice with elevated fasting circulating ketones were largely protected from the TAC-induced effects observed in WT mice (ejection fraction,
P
=0.011; mitral E/A,
P
=0.012). Furthermore, knockout mice with TAC had attenuated expression of markers of sterile inflammation and macrophage infiltration, which were otherwise elevated in WT mice subjected to TAC. Lastly, addition of β-hydroxybutyrate to isolated hearts was associated with reduced NLRP3 (nucleotide-binding domain-like receptor protein 3)-inflammasome activation, which has been previously shown to play a role in contributing to HF-induced cardiac inflammation.

Conclusions:
These data show that chronic elevation of circulating ketones protects against the development of HF that is associated with the ability of β-hydroxybutyrate to directly reduce inflammation. These beneficial effects of ketones were associated with reduced cardiac NLRP3 inflammasome activation, suggesting that ketones may modulate cardiac inflammation via this mechanism.
Association of Atrial Fibrillation Without Cardiovascular Comorbidities and Stroke Risk: From the REGARDS Study
Authors: Singleton Matthew J. , Imtiaz‐Ahmad Muhammad , Kamel Hooman , O'Neal Wesley T. , Judd Suzanne E. , Howard Virginia J. , Howard George , Soliman Elsayed Z. , Bhave Prashant D. 
Published: June 2020

Background

Atrial fibrillation (
AF
) is associated with a 5‐fold increased stroke risk. While most patients with
AF
warrant anticoagulation, optimal treatment remains uncertain for patients with
AF
without cardiovascular comorbidities because the risk of stroke in this population has not been well‐characterized.

Methods and Results

Participants (N=28 253; 55% women, mean age 64.6±9.4 years), from the
REGARDS
(Reasons for Geographic and Racial Differences in Stroke) study (2003–present) were classified into 1 of 4 groups based on the presence or absence of
AF
and the presence or absence of cardiovascular comorbidities. Cox proportional hazards analysis was used to compare the risk of stroke between groups. During 244 560 person‐years of follow‐up (median 8.7 years), 1206 strokes occurred. Compared with patients with neither
AF
nor cardiovascular comorbidities, we did not find an increased stroke risk (hazard ratio [HR], 1.23; 95%
CI
, 0.62–2.18 [
P
=0.511]) among participants with
AF
alone. Participants without
AF
but with cardiovascular comorbidities had both an elevated stroke risk (HR, 1.77; 95%
CI
, 1.48–2.18 [
P
<0.0001]) and an increased risk of cardioembolic stroke (HR, 2.34; 95%
CI
, 1.48–3.90 [
P
=0.0002]).

Conclusions

In this large cohort of participants with
AF
without cardiovascular comorbidities, we found that
AF
itself, without cardiovascular comorbidities, did not confer increased risk of stroke. Cardiovascular comorbidities, however, were associated with an increased risk of both stroke of any type and cardioembolic stroke, even in the absence of
AF
.
The larva of Hydropsyche doehleri Tobias 1972, based on Swiss material (Hydropsychidae, Trichoptera)
Authors: VICENTINI HEINRICH , WYLER SOFIA , WARINGER JOHANN 
Published: June 2020

This paper describes the previously unknown larva of Hydropsyche doehleri Tobias 1972. Species association was enabled by the fact that both larval and adult specimens were collected at the same location and that H. doehleri was the only Hydropsychidae collected at this site, based on light-trap samples of adults. In addition, association of larvae with adult males and females were performed using DNA sequence data from the mitochondrial cytochrome c oxidase region. Information on the morphology of the larva is given, and the most important diagnostic features separating H. doehleri from its sister taxon H. siltalai Döhler 1963 are discussed. In both species, gills are lacking on abdominal segment VII. In the context of the Hydropsychidae key of Waringer & Graf (2011), the two species can be separated by the morphology and coloration of the frontoclypeal apotome, and by their distribution patterns: whereas H. siltalai is widespread in Europe, H. doehleri has been reported from only France, Italy, and southern Switzerland (Tessin). #We dedicate this paper to Univ. Prof. Dr Hans Malicky on the occasion of his 85th birthday.
Do Medical Students Receive Adequate Otolaryngology Training? A Canadian Perspective
Authors: Rosvall Brandon R. , Singer Zachary , Fung Kevin , Chin Christopher J. 
Published: June 2020

Objectives: Otolaryngology—head and neck surgery (OHNS) training has been found to be underrepresented in medical school curricula. The study aimed to assess (i) students’ clinical OHNS exposure, (ii) their confidence managing OHNS conditions, and (iii) the correlation between OHNS exposure and confidence managing OHNS conditions. Methods: Fourth-year medical students at two Canadian Universities completed a survey assessing baseline characteristics, OHNS training, and confidence managing OHNS conditions. Results: Of 87 returned surveys, 46 students had no clinical OHNS exposure, while 29 felt there was adequate OHNS exposure. The majority of students lacked confidence recognizing conditions requiring emergent referral. Students with greater OHNS training had greater confidence managing OHNS conditions ( r = 0.267, P = .012). Conclusion: The majority of medical students have minimal OHNS exposure. Students with greater OHNS exposure have greater confidence managing OHNS conditions. A review of Canadian medical school curricula is warranted to ensure adequate OHNS exposure.
The Safety and Efficacy of Verapamil Versus Diltiazem Continuous Infusion for Acute Rate Control of Atrial Fibrillation at an Academic Medical Center
Authors: Forshay Charlotte M. , Michael Boyd J. , Rozycki Alan , Pilz Jeffrey 
Published: June 2020

Purpose Due to critical shortages of intravenous diltiazem in 2018, the Ohio State University Wexner Medical Center (OSUWMC) adopted intravenous verapamil as an alternative. However, there is a paucity of data supporting the use of intravenous verapamil infusions for rate control in the acute treatment of atrial arrhythmias. The purpose of this study was to determine the safety and efficacy of intravenous verapamil as compared with diltiazem for the acute treatment of atrial arrhythmias. Methods This retrospective, case-control study compared patients who received verapamil infusions between June 1 and September 30, 2018, with patients who received diltiazem infusions between June 1 and September 30, 2017, at OSUWMC. Patients were matched 1:1 based on age, sex, and the presence of comorbid heart failure with reduced ejection fraction (≤40%). Results A total of 73 patients who received at least 1 verapamil infusion and 73 patients who received at least 1 diltiazem infusion met inclusion criteria. The composite need for inotrope or vasopressor was similar for both groups (5% with verapamil versus 4% with diltiazem, P = .999). The rate of hypotension was similar between groups (37% versus 33% experiencing a systolic blood pressure <90 mm Hg, P = .603, and 27% versus 23% experiencing a mean arterial pressure <65 mm Hg, P = .704), as was the rate of bradycardia (19% versus 18%, P = .831). The efficacy outcomes of this study were similar for both groups, with 89% of patients in the verapamil group and 90% of patients in the diltiazem group achieving a heart rate less than 110 beats per minute ( P = .785). Conclusion Intravenous verapamil and diltiazem infusions had similar safety and efficacy outcomes when used for acute treatment of atrial arrhythmias in the institutional setting.
Gastroesophageal Reflux Disease: A Cause for Eustachian Tube Dysfunction in Obstructive Sleep Apnea
Authors: Yan Suying , Wei Yongxiang , Zhan Xiaojun , Yao Linyin , Li Xiping , Fang Fang , Xu Jie 
Published: June 2020

Objectives: To explore the effect of gastroesophageal reflux disease (GERD) on Eustachian tube function in patients with obstructive sleep apnea (OSA). Methods: This was a cross-sectional study. The patients were divided into 4 groups according to OSA and GERD: OSA+GERD group; OSA-only group; GERD-only group; and normal control group. Results: There were no differences among the 4 groups regarding age, sex, smoking history, and alcohol history (all P > .05). The patients in the OSA and OSA+GERD groups had a significantly larger body mass index than those in the control and GERD-only groups (all P < .05). The proportions of patients with abnormal ETS-7 and ETD-Q results were higher in the GERD and OSA+GERD groups compared to the control group ( P < .008). There were no significant differences in ETS-7 and ETD-Q between the control and the OSA-only groups ( P > .008). The multivariable analysis showed that only GERD was independently associated with abnormal ETS-7 results (odds ratio = 3.090, 95% CI: 1.332-7.169, P = .009). Conclusion: Given the high concomitance rate in patients with OSA, GERD might be an important association factor of Eustachian tube dysfunction in patients with OSA.
Characteristics of ST-elevation myocardial infarction with failed thrombolysis
Authors: Mishra Ashish , Prajapati Jayesh , Dubey Gajendra , Patel Iva , Mahla Mukesh , Bishnoi Suresh , Pandey Vimlesh 
Published: June 2020

Background Fibrinolytic therapy is an important reperfusion strategy, especially when primary percutaneous coronary interventions cannot be offered to ST-elevation myocardial infarction patients. Given that failed reperfusion after fibrinolytic therapy is common, it is pragmatic that the predictors, outcomes, and angiographic profiles of patients with failed thrombolysis are carefully scrutinized. Methods We prospectively studied clinical variables and outcomes over 30 months in 243 ST-elevation myocardial infarction patients who received fibrinolytics as primary treatment. Logistic regression analysis was used to identify predictors of failed thrombolysis. Results Failed thrombolysis occurred in 38.68% of patients with a mean window period of 6.58 ± 1.42 h, and 55.32% of patients with failed thrombolysis had Killip class >I on presentation. Risk factors such as diabetes mellitus (55.32%), dyslipidemia (60.64%) and obesity (77.66%) were frequently associated with failed thrombolysis; 73.40% of patients with failed thrombolysis had Thrombolysis in Myocardial Infarction flow grade 0/1 in the infarct-related artery, and 58.51% of such patients needed a rescue percutaneous coronary intervention. The mean Thrombolysis in Myocardial Infarction risk score was 5.46 ± 2.77 in failed thrombolysis patients, with mortality of 4.25% at the 6-month follow-up. Conclusion Non-resolution of presenting symptoms and ST changes on electrocardiography at 90 min served as the earliest indicators of failed thrombolysis, with a significant angiographic correlation. Clinical variables such as delayed presentation (>6 h), dyspnea, Killip class >I, cardiogenic shock, Thrombolysis in Myocardial Infarction score, and conventional risk factors including diabetes mellitus, dyslipidemia, and obesity represented cluster of predictors of failed thrombolysis.
Will high-dose heparin affect blood loss and inflammatory response in patients undergoing cardiopulmonary bypass?
Authors: Braatz Erik , Sesartic Vanja , Liska Jan 
Published: June 2020

Introduction: We performed a randomized study to investigate if a high versus a standard dose of heparin dose during cardiopulmonary bypass could affect intra- and post-operative bleeding and reduce the inflammatory response. Methods: A total of 30 patients undergoing elective coronary artery bypass grafting were randomized into high or standard dose of heparin during cardiopulmonary bypass. Blood loss was documented peri- and post-operatively, and interleukin-6, tumor necrosis factor-α, and C3 were measured in conjunction with cardiopulmonary bypass. Results: Data from 29 patients were analyzed after exclusion of one patient. The mean initial bolus and total heparin doses were 43,000 ± 5,800 IU versus 35,000 ± 4,100 IU, (p < 0.001), and 58,000 ± 9,500 IU versus 45,000 ± 7,900 IU, (p < 0.001) in the intervention and the control group, respectively. The median intra-operative bleeding was 150 mL (interquartile range 100-325) in the control versus 225 mL (IQR 200-350) in the intervention group, p = 0.15. The median chest tube blood loss 12 hour post-operatively was 300 mL (interquartile range 250-385) in the control versus 450 mL (IQR 315-505) in the intervention group, p = 0.029. There was no significant difference between the control group and the intervention group during cardiopulmonary bypass for the measured inflammatory markers interleukin-6 (p = 0.98), tumor necrosis factor-α (p = 0.72), or C3 (p = 0.13). Conclusion: This small study showed a small increase of post-operative bleeding associated with higher heparin dosage in conjunction with cardiopulmonary bypass but did not demonstrate an effect of heparin on the inflammatory response to cardiopulmonary bypass.
Ultrasonographic characteristics of medullary thyroid carcinoma according to nodule size: application of the Korean Thyroid Imaging Reporting and Data System and American Thyroid Association guidelines
Authors: Hahn Soo Yeon , Shin Jung Hee , Oh Young Lyun , Park Ko Woon 
Published: June 2020

Background Few studies have categorized ultrasound (US) findings of various sized medullary thyroid carcinomas (MTCs) according to updated guidelines. Purpose To evaluate and compare the differences in US findings of MTC according to nodule size, using the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and American Thyroid Association (ATA) guidelines. Material and Methods The study included 119 patients with 129 MTC nodules, which were surgically confirmed at our institution between March 1999 and September 2017. Nodules were divided into large (≥1.0 cm) and small (<1.0 cm) groups. US images were analyzed according to the K-TIRADS and ATA guidelines. The differences in US characteristics between small and large nodules were compared using Fisher’s exact or Chi-square tests. Results Of 129 MTC nodules, 84 (65.1%) were large nodules and 45 (34.9%) were small nodules. According to the nodule size, small MTC nodules were classified more commonly as high suspicion by K-TIRADS and ATA (95.6% and 93.3%, respectively) ( P < 0.001), but presented neither cystic change, isoechogenicity, nor low suspicion category by K-TIRADS and ATA. In contrast, large MTC nodules showed more frequently cystic change (15.5%), isoechogenicity (16.7%), smooth margins (50%), or low or intermediate suspicion US features by K-TIRADS and ATA (59.6% and 36.0%, respectively) (all P values < 0.001). Conclusion Most small MTC nodules are classified as high suspicion on US, whereas large MTC nodules are diagnosed more frequently as low or intermediate suspicion by K-TIRADS and ATA.
Preliminary analysis of serum electrolytes and body mass index in patients with and without urolithiasis
Authors: Zhang Zaixian , Xu Qingquan , Huang Xiaobo , Liu Shihe , Zhang Chuanyu 
Published: June 2020

Objectives To compare body mass index (BMI); serum parameters; and urine parameters between patients with and without urolithiasis. Methods Data from 1164 patients admitted to our Department of Urology from January 2011 to July 2013 were retrospectively reviewed; 714 patients (age, 5–87 years; male:female ratio, 1.8:1) exhibited urolithiasis, and 450 patients (age, 12–94 years; male:female ratio, 3.8:1) did not. Blood and urine were collected from patients the morning after hospital admission. Serum and urine parameters were checked by an automatic biochemistry analyzer. Statistical analysis included the Mann–Whitney U test and binary logistic regression. Results Serum sodium, potassium, chloride, calcium, phosphorus, and carbon dioxide combining power significantly differed between groups. In male patients, serum sodium, calcium, and phosphorus levels were higher in the urolithiasis group, whereas serum potassium and urine pH levels were lower. In female patients, serum sodium was higher in the urolithiasis group. BMI was higher in the urolithiasis group in all patients, male and female. Respective β-values of serum sodium and BMI in male patients were 0.077 and 0.084; in female patients, these values were 0.119 and 0.102. Conclusions Changes in serum sodium and BMI may be involved in the pathogenesis and treatment of urolithiasis.
Meta-analysis of 5-hydroxytryptamine transporter gene promoter region polymorphism and post-stroke depression
Authors: Wang Yukai , Liu HongYu , Jiang Yan , Shi Xinxiu , Shao Yankun , Xu Zhong Xin 
Published: June 2020

Objective To investigate the relationship between 5-hydroxytryptamine transporter gene promoter region ( 5-HTTLPR) gene polymorphism and post-stroke depression (PSD). Methods We searched the CNKI, China Science and Technology Journal, China WanFang, PubMed, Embase, and Web of Science databases for studies of the relationship between 5-HTTLPR polymorphism and PSD. Data were evaluated using Stata software. Results The L allele was significantly related to the S allele (OR = 0.57, 95% confidence interval (CI) 0.49–0.65). The dominant genotype LL + LS was related to SS (OR = 0.48, 95%CI 0.39–0.59), the recessive genotype LL was related to LS + SS (OR = 0.39, 95%CI: 0.30–0.51), the homozygous genotype LL was related to SS (OR = 0.24, 95%CI 0.18–0.33), and the heterozygous genotype LS was related to SS (OR = 0.55, 95 CI 0.44–0.68). All the differences were significant. Ethnicity subgroup analysis showed significant differences among the five genotypes in both Asians and Caucasians. Hardy–Weinberg equilibrium (HWE) subgroup analysis showed that, after removal of a non-HWE-conforming control group, all five genotypes were significant and genotypes LL, LS + LL, and LS and L allele had beneficial effects on recovery from PSD. Conclusion 5-HTTLPR gene polymorphism is strongly associated with PSD, and the LL, LS + LL, and LS genotypes and L allele may protect against this condition.
Association of sirtuin-1 and vascular endothelial growth factor expression with tumor progression and poor prognosis in liposarcoma
Authors: Wu Hongzeng , Zhang Qianqian , Zhao Yi , Xu Fengzhou , Zhang Jinming , He Hongyan , Wang Xu , Feng Helin 
Published: June 2020

Objectives A relationship exists between sirtuin-1 expression and growth and survival of malignant tumors. This study aimed to investigate the prognostic value of sirtuin-1 and vascular endothelial growth factor (VEGF) expression in patients with liposarcoma by examining associations between their expression levels and clinical outcomes. Methods Clinical and histopathological characteristics and follow-up and survival information were retrospectively reviewed for 42 liposarcoma cases. Sirtuin-1 and VEGF protein expression levels were evaluated by immunohistochemistry and their associations with clinical parameters were analyzed using the Spearman-rho test. Univariate and multivariate Cox regression analyses were performed to identify potential prognostic factors. Kaplan–Meier analysis was performed to analyze overall survival. Results Sirtuin-1 and VEGF protein expression levels were significantly associated with histological grade, metastasis, and American Joint Committee on Cancer stage. A significant positive correlation was observed between sirtuin-1 and VEGF expression levels (R = 0.677). In univariate analysis, sirtuin-1 and VEGF expression were correlated with shorter overall survival, but the association was significant only for sirtuin-1 (hazard ratio = 3.752, 95% confidence interval 1.553–9.062) in multivariate analysis. Conclusion Sirtuin-1 and VEGF expression levels are significantly correlated with progression of liposarcoma, and sirtuin-1 expression significantly predicts a poor prognosis in patients with liposarcoma.
Drug therapy problems identified among older adults placed in a nursing home: the Croatian experience
Authors: Šola Katarina Fehir , Mucalo Iva , Brajković Andrea , Jukić Ivona , Verbanac Donatella , Vladimir Knežević Sanda 
Published: June 2020

Objective The aim of this study was to determine the frequency and type of drug therapy problems (DTPs) in older institutionalized adults. Method We conducted a cross-sectional observational study from February to June 2016 at a 150-bed public nursing home in Croatia, where comprehensive medication management (CMM) services were provided. A rational decision-making process, referred to as the Pharmacotherapy Workup method, was used to classify DTPs. Results Data were prospectively collected from 73 residents, among which 71% were age 75 years or older. The median number of prescribed medications per patient was 7 (2–16) and polypharmacy (> 4) was recorded for 54 (74.0%) patients. A total 313 DTPs were identified, with an average of 4.3 ± 2 DTPs per patient. The most frequent DTP was needing additional drug therapy (n = 118; 37.7%), followed by adverse drug reaction (n = 55; 17.6%). Lactulose (14.4%), tramadol (6.7%), and potassium (6.4%) were the medications most frequently related to DTPs. Conclusion The high prevalence of DTPs identified among older institutionalized adults strongly suggests the need to incorporate new pharmacist-led CMM services within existing institutional care facilities, to improve the care provided to nursing home residents.
Pregnancy Termination in the Case of an Orofacial Cleft: An Investigation of the Concept of Reproductive Autonomy
Authors: Hens Kristien , Hens Greet 
Published: June 2020

Objective: To describe ethical approaches to the issue of pregnancy termination after prenatal detection of cleft lip ± palate. Results: Gynecologists and cleft surgeons are sometimes confronted with the demand for a pregnancy termination after ultrasound detection of an isolated cleft lip/cleft palate. In this article, we discuss different ethical theories and principles that can be applied to the dilemma at hand. We formulate recommendations that will respect the right to autonomy of the pregnant woman and at the same time acknowledge that a termination of pregnancy for a cleft lip may in most cases not be the best option. Conclusion: The recognition of each person’s right to reproductive autonomy also entails that clinicians should make sure that prospective parents are provided with up-to-date and relevant clinical information.