bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1234SNF472 IMPROVES LIMB BLOOD PERFUSION AND WALKING ABILITY IN A PERIPHERAL ARTERY DISEASE VASCULAR CALCIFICATION RAT MODEL
Authors: Bassissi Firas , Ferrer Reynes Miguel David , Pérez M Mar , Perelló Joan , Salcedo Carolina 
Published: June 2020

Abstract

Background and Aims
Peripheral Artery disease (PAD) is a common vascular disease associated with functional impairment and increased risk of cardiovascular events in End Stage Kidney Disease (ESKD) patients undergoing dialysis. Poor limb salvage outcomes and high post-amputation mortality in hemodialysis (HD) patients highlight the need for earlier medical therapies. Cilostazol and pentoxifylline are approved for PAD. Their use in HD patients stays limited and cilostazol use requires caution in this population. Clinical studies demonstrate associations between arterial calcification and adverse outcomes in PAD patients. SNF472, a selective calcification inhibitor that interferes in the formation and growth of hydroxyapatite, is in Phase 3 for calciphylaxis treatment. This study aims to evaluate the effects of SNF472 on limb functional recovery and blood perfusion in a Vitamin D3 (VitD)-induced arterial calcification rat model.

Method
Arterial calcification was induced in 32 Sprague Dawley rats by 3 consecutive daily s.c. doses of 120 kIU/kg VitD. Rats were divided into four groups and treated during 12 days by: placebo s.c, placebo p.o, SNF472 (20 mg/kg/day, s.c.) or cilostazol (20 mg/kg/day, p.o.). An additional group of 8 rats without VitD received vehicle only (sham). Efficacy was evaluated at day 12 and 17 (5 days after treatment stop). Posterior limb blood perfusion was measured using Laser Doppler Imaging and limb walking ability was evaluated by measuring Maximum Walking Distance (MWD) and Maximum Walking Time (MWT) using a treadmill. Rats were sacrificed at day 26 (14 days after treatment stop), and aortas were collected for calcium analysis.

Results
VitD-induced arterial calcification was associated with decreased blood perfusion and impairment of limb walking ability (MWT and MWD) compared to sham. SNF472 reduced aorta calcification by 41% compared to placebo. No effects of cilostazol on vascular calcification were observed. The inhibition of calcification in SNF472-treated animals was associated with significant higher limb blood perfusion compared to placebo or Cilostazol (1.28 and 1.37-fold higher, respectively at day 12: p&lt; 0.001) and it was translated into a significant improvement in walking ability compared to placebo (515±114 meters vs 334±187 meters, respectively: p&lt;0.05).

Conclusion
SNF472 shows improvements in vascular calcification, blood perfusion and a functional parameter like walking distance in a PAD vascular calcification rat model. These results suggest that SNF472 may represent a new therapeutic approach for the treatment of PAD associated with high vascular calcification such as in renal disease.
P1235THE IMPACT OF SPIRONOLACTONE ON DIASTOLIC FUNCTION IN HEMODIALYSIS PATIENTS - THE MIRENDA RCT
Authors: Hauser Tobias Gregor , Dornberger Vivien , Malzahn Uwe , Liu Dan , Störk Stefan , Nauck Matthias , Friedrich Nele , Wanner Christoph , Krane Vera , Hammer Fabian 
Published: June 2020

Abstract

Background and Aims
Patients on maintenance hemodialysis (HD) treatment are particularly prone to develop cardiovascular disease. Heart failure with preserved ejection fraction (HFpEF) characterized by diastolic dysfunction (DD) is highly prevalent and lacks an effective treatment to date. We investigated the effect of the mineralocorticoid receptor antagonist spironolactone compared to placebo on diastolic function in maintenance HD patients.

Method
The MiREnDa trial was a multicenter randomized-controlled trial that recruited 97 HD patients without previous spironolactone treatment. Participants were randomized 1:1 to spironolactone 50 mg once daily (n=50) or placebo (n=47). Changes in parameters of diastolic function were secondary endpoints of the trial whereas the primary endpoint was change in left ventricular mass index (LVMi). At baseline and after 40 weeks, subjects underwent echocardiography and biomarker testing. DD was defined according to the American Society of Echocardiography 2016 guidelines.

Results
At baseline, mean age was 58.3 ± 13.0 years, 13 subjects were female and 28 presented with NYHA grade II or higher. Median serum level of NT-proBNP was 2,803 (quartiles: 1,060; 10,676) pg/ml, median previous time on dialysis was 45.0 (quartiles: 21.0; 79.0) months. 28 patients (45.9%) had normal diastolic function, 16 (26.2%) were diagnosed with grade 1 DD, 15 (24.6%) with grade 2 DD and 2 (3.3%) with grade 3 DD. In the remaining cases, the grade of DD was rated indeterminate. There were no significant disparities between the placebo and spironolactone group regarding baseline characteristics.
At follow-up, diastolic function improved in two and deteriorated in three subjects on spironolactone treatment, whereas in the placebo group, diastolic function improved in three and deteriorated in two patients. No change in diastolic function was observed in 14 individuals on spironolactone treatment and in 10 receiving placebo (Pearson’s Χ: p=0.87). According to the diagnostic algorithm proposed by the American society of Echocardiography 2016 guideline, 18 patients (11 on spironolactone; 7 on placebo) could no longer be allocated to a distinct group of DD. These patients needed to be classified as indeterminate, even though they only showed mild alterations in diastolic function parameters.

Conclusion
In this randomized, placebo-controlled trial, 40 weeks of spironolactone treatment did not change diastolic function in HD patients.
P1432THE PRE-DIALYSIS CARE TRAJECTORIES OF ESRD PATIENTS: WHAT TYPES AND WHAT FACTORS OF EMERGENCY DIALYSIS START?
Authors: Raffray Maxime , Pladys Adélaïde , Gao Fei , Couchoud Cécile , Vigneau Cécile , Bayat Sahar 
Published: June 2020

Abstract

Background and Aims
According to the REIN registry, in France in 2017, 30% of incident end-stage renal disease (ESRD) patients started dialysis in emergency. Emergency dialysis start (ES) is associated with higher risks of morbidity and mortality as well as a decreased quality of life for patients. The objectives were to describe groups of patients with similar care trajectories (or “types”) and identify the factors associated with ES.

Method
Data from the French REIN registry linked with the French national health insurance database (SNDS) were used. Patients aged 18 years old and older who started dialysis in 2015 in France were included. The 2 years pre-dialysis care trajectory was defined using 8 key components of ambulatory and hospital CKD care consumption. Multiple Correspondence Analysis (MCA) on these components was performed before a Hierarchical Clustering on Principal Components (HCPC) in order to identify types of care trajectories. Logistic regression models including both patients’ characteristics and the key CKD healthcare consumption were used to identify factors associated with ES.

Results
Among the 8856 patients included, 2681 (30.3%) started dialysis in emergency. The HCPC identified 6 types of pre-dialysis care trajectories. ES rate ranged from 11% to 62% depending on the type. Patient’s profiles were also different between types of trajectories, including age and comorbidities (diabetes prevalence ranged from 22% to 56%). For example, the 5th and 6th types of pre-dialysis care trajectories with high ES rates were characterized by low and absent CKD healthcare consumption respectively. They were shared by younger and less comorbid patients (26.7% and 25.7% aged &lt; 45 years old, 66.5% and 59.4% without any cardiovascular diseases respectively). Conversely to the absence of nephrologist follow-up, the absence of general practitioner follow-up was not significantly associated with ES (OR=1.83, CI 95% [1.58-2.13] and OR=0.79, CI 95% [0.61-1.04] respectively).

Conclusion
Exploiting the strength of the combined use of clinical and healthcare consumption data, our study shows the diversity of pre-dialysis care trajectories of CKD patients. While some of these types of trajectories can be explained by patients’ clinical and demographic characteristics, complementary qualitative approaches are required to fully understand ES. Some types, as well as ES associated factors, highlight the need for earlier CKD screening and nephrologist referral.
P1433VALIDATION OF A SERUM CALCIFICATION PROPENSITY TEST FOR THE PREDICTION OF ALL-CAUSE MORTALITY AMONG DIALYSIS PATIENTS
Authors: Ramos Sanchez Rosa , Zawada Adam , Wolf Melanie , Rincon Bello Abraham , Masso Jimenez Elisabet , Hurtado Munoz Sara , Ribera Tello Laura , Mora-Macia Josep , Stuard Stefano , Stauss-Grabo Manuela , Winter Anke , Canaud Bernard 
Published: June 2020

Abstract

Background and Aims
Vascular calcification as cause of vascular stiffness is a major contributor to the high cardiac burden among stage 5 chronic kidney disease dialysis (CKD5HD) patients. Early identification of patients with high calcification propensity is crucial for proper risk stratification and management of these patients. Recently, a novel in vitro test (T50-test) was developed which determines calcification propensity of human serum and predicts mortality among ND-CKD (non-dialysis chronic kidney disease) patients, kidney transplant recipients and CKD5HD patients suffering from secondary hyperparathyroidism. We now evaluated whether these results can be confirmed in an unselected cohort of CKD5HD patients and can be used in the future for improving care of these patients.

Method
This prospective clinical study included 776 incident and prevalent hemodialysis patients from 8 Fresenius Medical Care NephroCare centers in Cataluña (Spain). T50 was determined at Calciscon AG, all other clinical data were retrieved from the European Clinical Database (EuCliD®). After their baseline T50 measurement, patients were followed for two years for the occurrence of the primary endpoint all-cause mortality. The association between T50 and all-cause mortality was examined by using proportional subdistribution hazards regression modelling accounting for kidney transplantation as competing event. In sensitivity analyses we adjusted for age, sex, vascular access (fistula/graft, catheter), treatment modality (HD, HDF), Charlson comorbidity index and dialysis vintage.

Results
Mean age of the study population was 72.2 years and 63.8% were male. 42.5% had diabetes and 55.0% past history of cardiovascular disease. Mean T50 was 283.4 min among the total cohort. During follow-up, 185 (23.8%) patients died. Patients who reached the endpoint had a significantly lower T50 at baseline as compared to those who survived during follow-up (269.6 vs 287.7 min, p = 0.001). A cross-validated model (mean c statistic: 0.5767) identified T50 as a linear predictor of all-cause-mortality (subdistribution hazard ratio (per min): 0.9957, 95% CI [0.9933;0.9981]). T50 remained a significant predictor of all-cause mortality after adjusting for relevant confounding in sensitivity analyses.

Conclusion
In this prospective study, we confirmed that T50 is an independent predictor of all-cause mortality among a large unselected cohort of hemodialysis patients. T50 may be used to identify patients with high vascular calcification propensity and mortality risks and may help physicians to implement a personalized and more precise renal replacement therapy option.
Association between health insurance status and malignant glioma
Authors: Fischer Igor , Mijderwijk Hendrik-Jan , Kahlert Ulf D , Rapp Marion , Sabel Michael , Hänggi Daniel , Steiger Hans-Jakob , Forster Marie-Therese , Kamp Marcel A 
Published: June 2020

Abstract

Background
Prior studies have suggested an association between patient socioeconomic status and brain tumors. In the present study we attempt to indirectly validate the findings, using health insurance status as a proxy for socioeconomic status.

Methods
There are 2 types of health insurance in Germany: statutory and private. Owing to regulations, low- and middle-income residents are typically statutory insured, whereas high-income residents have the option of choosing a private insurance. We compared the frequencies of privately insured patients suffering from malignant neoplasms of the brain with the corresponding frequencies among other neurosurgical patients at our hospital and among the German population. To correct for age, sex, and distance from the hospital, we included these variables as predictors in logistic and binomial regression.

Results
A significant association (odds ratio [OR] = 1.59, CI = 1.45-1.74, P &lt; .001) between health insurance status and brain tumors was found. The association is independent of patients’ sex or age. Whereas privately insured patients generally tend to come from farther away, such a relationship was not observed for patients suffering from brain tumors. Comparing the out of house and in-house brain tumor patients showed no selection bias on our side.

Conclusion
Previous studies have found that people with a higher income, level of education, or socioeconomic status are more likely to suffer from malignant brain tumors. Our findings are in line with these studies. Although the reason behind the association remains unclear, the probability that our results are due to some random effect in the data is extremely low.
Class Status and Social Mobility on Tobacco Smoking in Post-Reform China Between 1991 and 2011
Authors: Yang Xiaozhao Yousef 
Published: June 2020

Abstract

Introduction
There is growing attention to social mobility’s impact on tobacco use, but few studies have differentiated the two conceptually distinct mechanisms through which changes in social class can affect tobacco smoking: the class status effect and the mobility effect.

Aims and Methods
I applied Diagonal Reference Modeling to smoking and heavy smoking among respondents of the 1991 China Health and Nutrition Survey who were revisited two decades later in 2011 (n = 3841, 49% male, baseline mean age was 38 years). I divided the sample into six social classes (non-employment, self-employed, owners, workers, farmers, and retirees) and measured social mobility by changes in income and occupational prestige.

Results
About 61.7% of men were smokers and those from the classes of workers, owners, and self-employees consumed more cigarettes compared to the unemployed, but women smokers (3.7%) tend to be from the lower classes (unemployed and farmers). Controlling for social class, each 1000 Yuan increase in annual income led to smoking 0.03 more cigarettes (p &lt; .05) and 1% increase (p &lt; .05) in the likelihood of heavy smoking among men, but the income effect is null for women. Upwardly mobile men (a 10-points surge in occupational prestige) smoked like their destination class (weight = 78%), whereas men with downward mobility were more similar to peers in the original class (weight = 60%).

Conclusions
Contrary to the social gradient in smoking in other industrial countries, higher class status and upward mobility are each associated with more smoking among Chinese men, but not among women.

Implications
Tobacco control policies should prioritize male smoking at workplaces and the instrumental purposes of using tobacco as gifts and social lubricant. Taxation may counter the surge in smoking brought by individuals’ income increase after upward mobility. Caution should be paid to women joining the similar social gradient in smoking as they gain foothold in the labor market.
Utilizing Behavioral Science to Improve Antibiotic Prescribing in Rural Urgent Care Settings
Authors: Cummings Patricia L , Alajajian Rita , May Larissa S , Grant Russel , Greer Hailey , Sontz Jordan , Dezfuli Massoud 
Published: June 2020

Abstract

Background
Antibiotic-inappropriate prescribing for acute respiratory tract infections (ARTI) is 45% among urgent care centers (UCCs) in the United States. Locally in our UCCs, antibiotic-inappropriate prescribing for ARTI is higher—over 70%.

Methods
We used a quasi-experimental design to implement 3 behavioral interventions targeting antibiotic-inappropriate/non-guideline-concordant prescribing for ARTI at 3 high-volume rural UCCs and analyzed prescribing rates pre- and post-intervention. The 3 interventions were (1) staff/patient education, (2) public commitment, and (3) peer comparison. For peer comparison, providers were sent feedback emails with their prescribing data during the intervention period and a blinded ranking email comparing them with their peers. Providers were categorized as “low prescribers” (ie,  ≤23% antibiotic-inappropriate prescriptions based off the US National Action Plan for Combating Antibiotic Resistant Bacteria 2020 goal) or “high prescribers” (ie,  ≥45%—the national average of antibiotic-inappropriate prescribing for ARTI). An interrupted time series (ITS) analysis compared prescribing for ARTI (the primary outcome) over a 16-month period before the intervention and during the 6-month intervention period, for a total of 22 months, across the 3 UCCs.

Results
Fewer antibiotic-inappropriate prescriptions were written during the intervention period (57.7%) compared with the pre-intervention period (72.6%) in the 3 UCCs, resulting in a 14.9% absolute decrease in percentage of antibiotic-inappropriate prescriptions. The ITS analysis revealed that the rate of antibiotic-inappropriate prescribing was statistically significantly different pre-intervention compared with the intervention period (95% confidence interval, –4.59 to –0.59; P = .014).

Conclusions
In this sample of rural UCCs, we reduced antibiotic-inappropriate prescribing for ARTI using 3 behavioral interventions.
HIV Testing in Adults Presenting With Central Nervous System Infections
Authors: Ma Bert , Vigil Karen J , Hasbun Rodrigo 
Published: June 2020

Abstract

Background
Universal HIV testing in adults presenting to a health care setting was recommended by the Centers for Disease Control and Prevention (CDC) in 2006, but compliance in central nervous system (CNS) infections is unknown.

Methods
A multicenter study of adults presenting with CNS infections to 18 hospitals in Houston and New Orleans between 2000 and 2015 was done to characterize HIV testing and explore factors associated with a positive HIV test.

Results
A total of 1478 patients with a diagnosis of meningitis or encephalitis were identified; 180 were excluded because of known HIV diagnosis (n = 100) or were &lt;17 years old (n = 80). Out of 1292 patients, 642 (49.7%) had HIV testing, and testing did not differ significantly before or after the CDC recommendations in 2006 (53% vs 48%; P = .068). An HIV test was more commonly done in patients who were non-Caucasian, had fever &gt;38°C, or had seizures on presentation, and of those tested, non-Caucasian patients and those with photophobia were more likely to have a positive HIV test (P &lt; .05). HIV testing also varied by type of CNS infection: community-acquired bacterial meningitis (98/130, 75.4%), encephalitis (174/255, 68.2%), aseptic meningitis (285/619, 46.0%), and health care–associated meningitis (85/288, 29.5%; P &lt; .001).

Conclusions
Even though HIV testing should be done in all adults presenting with a CNS infection, testing remains ~50% and did not improve after the recommendation for universal testing by the CDC in 2006.
The Impact of Influenza Vaccination on Antibiotic Use in the United States, 2010–2017
Authors: Klein Eili Y , Schueller Emily , Tseng Katie K , Morgan Daniel J , Laxminarayan Ramanan , Nandi Arindam 
Published: June 2020

Abstract

Background
Influenza, which peaks seasonally, is an important driver for antibiotic prescribing. Although influenza vaccination has been shown to reduce severe illness, evidence of the population-level effects of vaccination coverage on rates of antibiotic prescribing in the United States is lacking.

Methods
We conducted a retrospective analysis of influenza vaccination coverage and antibiotic prescribing rates from 2010 to 2017 across states in the United States, controlling for differences in health infrastructure and yearly vaccine effectiveness. Using data from IQVIA’s Xponent database and the US Centers for Disease Control and Prevention’s FluVaxView, we employed fixed-effects regression analysis to analyze the relationship between influenza vaccine coverage rates and the number of antibiotic prescriptions per 1000 residents from January to March of each year.

Results
We observed that, controlling for socioeconomic differences, access to health care, childcare centers, climate, vaccine effectiveness, and state-level differences, a 10–percentage point increase in the influenza vaccination rate was associated with a 6.5% decrease in antibiotic use, equivalent to 14.2 (95% CI, 6.0–22.4; P = .001) fewer antibiotic prescriptions per 1000 individuals. Increased vaccination coverage reduced prescribing rates the most in the pediatric population (0–18 years), by 15.2 (95% CI, 9.0–21.3; P &lt; .001) or 6.0%, and the elderly (aged 65+), by 12.8 (95% CI, 6.5–19.2; P &lt; .001) or 5.2%.

Conclusions
Increased influenza vaccination uptake at the population level is associated with state-level reductions in antibiotic use. Expanding influenza vaccination could be an important intervention to reduce unnecessary antibiotic prescribing.
Analysis of Ganciclovir-Resistant Cytomegalovirus Infection Caused by the UL97 Gene Mutation in Codons 460 and 520 in Pediatric Patients: A Case Series
Authors: Boonsathorn Sophida , Pasomsub Ekawat , Techasaensiri Chonnamet , Apiwattanakul Nopporn 
Published: June 2020

Abstract

Background
Drug-resistant cytomegalovirus (CMV) infection has been increasingly recognized. However, there are limited data in pediatric patients. In this study, the prevalence and factors associated with CMV infection with UL97 mutations in pediatric patients treated with ganciclovir but not responding to treatment were evaluated.

Methods
This retrospective study was conducted from January 2013 to December 2017. All patients who were suspected of having ganciclovir-resistant CMV infection and had never had ganciclovir prophylaxis were included. Genotypic assay for UL97 mutations in codons 460 and 520 conferring ganciclovir resistance was performed. Factors associated with the presence of UL97 mutations were analyzed.

Results
Of 34 patients included, 10 patients (29.4%) had a genotypically confirmed UL97 mutation. The median age (interquartile range [IQR]) was 3 (0.85–8.68) years. Ganciclovir resistance was tested at a median time (IQR) of 22.5 (14.3–31) days after initiation of ganciclovir. All resistant isolates harbored a UL97 mutation in codon 460. Compared with patients infected with CMV without UL97 mutation, those infected with UL97 mutation strains were younger (median age [IQR], 3.02 [0.85–8.68] vs 10.45 [2.7–16.4] years) and had a higher maximum viral load (median [IQR], 5.06 [4.74–6.05] vs 4.42 [4.03–4.87] copies/mL). Six of 10 (60%) patients were successfully treated with high-dose ganciclovir (7.5 mg/kg twice daily).

Conclusions
UL97 mutation ganciclovir-resistant CMV infection was not uncommon in the pediatric population. Screening for this mutation should be considered in patients experiencing virological worsening while ganciclovir is given, even if patients have not previously received ganciclovir prophylaxis.