bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and Safety of Ticagrelor in Diabetes Patients Undergoing Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials
Authors: Zhang Zeyi , Chen Ou 
Published: March 2021

Abstract:
Dual antiplatelet treatment, consisting of aspirin and P2Y12 inhibitors, is essential for diabetes mellitus (DM) patients who have undergone percutaneous coronary intervention (PCI). This meta-analysis investigated whether ticagrelor, a novel P2Y12 inhibitor, was superior to clopidogrel and prasugrel in efficacy and safety for DM patients undergoing PCI. PubMed, the Cochrane Library and Google Scholar were searched for randomized controlled trials in which ticagrelor was administered. Eligible studies were independently scrutinized to extract data and assess the trials' quality. Statistical analysis was performed by calculating odds ratios (OR) and 95% confidence intervals (CI). A total of 8 studies consisting of 1056 patients were included. Results showed that ticagrelor reduced the major adverse cardiac events incidence compared with clopidogrel and prasugrel in the overall (OR = 0.40; 95% CI, 0.20–0.79; P = 0.008) and subgroup analyses compared with clopidogrel (OR = 0.39; 95% CI, 0.19–0.80; P = 0.01). No difference was observed in mortality rates (OR = 0.58; 95% CI, 0.23–1.45; P = 0.25), myocardial infarction (OR = 0.67; 95% CI, 0.28–1.60; P = 0.37), stroke (OR = 0.54; 95% CI, 0.10–3.01; P = 0.49), and total bleeding (OR = 1.70; 95% CI, 0.91–3.17; P = 0.10) between the ticagrelor and control groups. In DM patients undergoing PCI, ticagrelor significantly reduced major adverse cardiac events compared with clopidogrel and prasugrel in the overall and in the subgroup of clopidogrel. There was no difference regarding mortality, myocardial infarction, stroke, and bleeding. More randomized controlled trials are required to further validate these results.
Adverse Cerebral Cardiovascular Events Associated With Checkpoint Kinase 1 Inhibitors: A Systemic Review
Authors: Yang Tongtong , Gu Jie , Du Chong , Shan Tiankai , Wei Tianwen , Li Yafei , Wang Liansheng 
Published: March 2021

Abstract:
Checkpoint kinase 1 (CHK1) plays a broad role in regulating the cell cycle process and is involved in the pathogenesis of various malignant tumors. Preclinical and animal studies have shown that CHK1 inhibitors can enhance the cytotoxic effects of radiotherapy and chemotherapy. Currently, CHK1 inhibitors are actively tested in clinical trials. Nonspecific adverse cerebral cardiovascular events were reported after CHK1 inhibitor use; these events need to be monitored and managed carefully during the clinical application of CHK1 inhibitors. To get a better understanding of these, noteworthy adverse cardiovascular events, we systemically searched the PubMed, Cochrane databases, and clinicaltrials.gov, for relevant clinical trials and case reports. A total of 19 studies were identified and included in this review. Among the reported cerebral cardiovascular events, the most common is incident abnormal blood pressure fluctuations (n = 35), followed by incident QTcF prolongation (n = 15), arrhythmia (n = 13, 3 atrial fibrillation and 10 bradycardia), thromboembolic events (n = 9, 6 pulmonary embolisms, 2 stroke, and 1 cerebrovascular event), cardiac troponin T elevation (n = 2), and ischemic chest pain (n = 2). Besides, the estimated incidence for overall cardiovascular events based on the available data is 0.292 (95% confidence interval: 0.096–0.488). CHK1 inhibitors administered in tumor patients on top of conventional therapies can not only enhance the antitumor effects, but also induce adverse cerebral cardiovascular events. It is, therefore, of importance to carefully monitor and manage the CHK1 inhibitor–induced adverse effects on the cerebral cardiovascular system while applying CHK1 inhibitors to tumor patients.
Quercetin Efficiently Alleviates TNF-α-Stimulated Injury by Signal Transducer and Activator of Transcription 1 and Mitogen-Activated Protein Kinase Pathway in H9c2 Cells: A Protective Role of Quercetin in Myocarditis
Authors: Yang Bin , Zheng Chun-Yan , Zhang Rui , Zhao Cong , Li Shan , An Yi 
Published: March 2021

Abstract:
This study aimed to evaluate the protective effect of quercetin and its in-depth mechanism in TNF-α-stimulated cardiomyocytes. The differential expression of TNF-alpha (TNF-α) and signal transducer and activator of transcription 1 (STAT1) was analyzed based on the GEO database. H9c2 cells were stimulated with TNF-α to simulate myocarditis. Cell counting kit-8 assay and flow cytometry assay were performed to detect the cell viability and apoptosis. ELISA was used to measure the levels of proinflammatory cytokines (IL-6 and IL-17A) and anti-inflammatory cytokine (IL-10). STAT1 expression was downregulated by transfection with si-STAT1, and its expression was detected using quantitative real-time polymerase chain reaction and Western blot. Western blot was also performed to assess the expression of the mitogen-activated protein kinase (MAPK) pathway–related factors. In this article, TNF-α was highly expressed in patients with myocarditis, and TNF-α (20 μg/mL) declined the viability of H9c2 cells. Quercetin pretreatment partially alleviated the decrease of cell viability, the increase of apoptosis, and the release of inflammatory cytokines (IL-10, IL-6, and IL-17A) induced by TNF-α. In addition, TNF-α increased STAT1 expression, but quercetin prevented the TNF-α-increased STAT1 level. Remarkably, knockdown of STAT1 enhanced the protective effect of quercetin on TNF-α-injured H9c2 cells. Moreover, quercetin restrained the TNF-α-induced activation of the MAPK pathway. Also, the inhibitory effect of quercetin on the pathway was aggravated by STAT1 lacking. In summing, quercetin plays a protective role in TNF-α-stimulated H9c2 cell injury, which may be related to the regulation of STAT1 and MAPK pathway.
An Inconvenient Truth of Clinical Assessment and Indocyanine Green Angiography Precise Marking for Indeterminate Burn Excision
Authors: Wongkietkachorn Apinut , Surakunprapha Palakorn , Jenwitheesuk Kamonwan , Eua-angkanakul Kant , Winaikosol Kengkart , Punyavong Pattama , Wongkietkachorn Nuttapone , Wongkietkachorn Supawich , Salyapongse A. Neil 
Published: March 2021

Background:
The clinical assessment of indeterminate burn wounds has relatively poor accuracy. Indocyanine green angiography (ICGA) has high accuracy and can be used to mark wounds precisely so as to guide burn excision. This study aimed to assess the differences between ICGA and clinical assessment marking and compare the marking result with the long-term wound outcome.

Methods:
This was a prospective, multicentered, triple-blinded, experimental study. Indeterminate burn wounds were clinically assessed, and the area to be excised was firstly marked by the attending surgeon. ICGA marking was then performed by a second surgeon. Measurement of the marked area was conducted by a third surgeon. Three surgeons were each blinded to the others' processes. The wounds were followed up to assess complete wound closures on day 21.

Results:
There were 20 burn sites included in the study. There was a significant difference in the marked areas between clinical assessment and ICGA (mean, 57.3 ± 44.1%; P = 0.001). The maximum difference found was as high as 160.9%. The correction rate of ICGA marking to complete wound closure on day 21 was 95.0%. Over 90% of the decreased areas of excision—which were assessed by ICGA to be superficial burns but evaluated by clinical assessment to be deep burns—were completely healed on day 21.

Conclusions:
ICGA contributes to a significant difference versus clinical assessment in the marking for excision of indeterminate burns and strongly associates with long-term wound outcomes. The burn wounds can be assessed precisely to reduce unnecessary excision and prevent inadequate excision.
Trends in Physical Activity Among US Adults With Heart Failure, 2007-2016
Authors: Ye Fan , Yale Steven , Zheng Yi , Hu Hui , Zhou Li , Fanning Jason , Yeboah Joseph , Brubaker Peter , Bertoni Alain G. 
Published: March 2021

Purpose:
Lack of physical activity (PA) is an important risk for heart failure (HF). The objective of this study was to examine PA trends in HF and non-HF participants from a nationally representative sample of US adults from 2007 to 2016.

Methods:
Work-related/recreational activities (min/wk) were calculated on the basis of the reported frequency, intensity, and duration, respectively. Multivariable analyses were performed using National Health and Nutrition Examination Survey data.

Results:
Among 28 824 participants, younger (aged 18-64 yr) HF participants reported less PA time than non-HF groups, especially vigorous PA. Differences were found to be smaller in older (≥ 65 yr) participants. Overall, the percentage of younger participants who met PA guidelines was significantly lower in the HF individuals in work-related PA and total PA from 2007 to 2016 than in the non-HF participants (OR = 0.55: 95% CI, 0.39-0.59 for total PA, 0.45, 0.28-0.75 for vigorous work-related PA, and 0.68, 0.47-0.97 for moderate work-related PA, respectively). In older participants, only when considering total PA, the prevalence of meeting PA guidelines was significantly different between HF and non-HF groups (0.78, 0.62-0.98).

Conclusions:
Self-reported PA, especially vigorous activities, is much lower in older HF participants. However, the disparity in meeting PA guidelines between those with HF and without HF is remarkable in younger individuals. Future research should focus on better understanding the psychological and physical barriers to engaging in PA among HF patients.
Area Deprivation Index and Cardiovascular Events
Authors: Guhl Emily N. , Zhu Jianhui , Johnson Amber , Essien Utibe , Thoma Floyd , Mulukutla Suresh R. , Magnani Jared W. 
Published: March 2021

Introduction:
Neighborhood socioeconomic status is associated with health outcomes. Cardiac rehabilitation (CR) provides a cost-effective, multidisciplinary approach to improve outcomes in cardiovascular disease. We aimed to evaluate the association of the Area Deprivation Index (ADI), a marker of neighborhood social composition, with risk of recurrent cardiovascular outcomes and assessed the modifying effect of CR.

Methods:
We identified patients with a primary diagnosis of (1) myocardial infarction or (2) incident heart failure (HF) admitted to a large-sized regional health center during 2010-2018. We derived the ADI from home addresses and categorized it into quartiles (higher quartiles indicating increased deprivation). We obtained number of CR visits and covariates from the health record. We compared rehospitalization (cardiovascular, acute coronary syndrome [ACS], and HF) and mortality rates across ADI quartiles.

Results:
We included 6957 patients (age 69.2 ± 13.4 yr, 38% women, 89% White race). After covariate adjustment, the ADI was significantly associated with higher incidence rates (IRs)/100 person-yr of cardiovascular rehospitalization (quartile 1, IR 34.6 [95% CI, 31.2-38.2]; quartile 4, 41.5 [95% CI, 39.1-44.1], P < .001). In addition, the ADI was significantly associated with higher rates of rehospitalization for HF (P < .001), ACS (P < .012), and all-cause mortality (P < .04). These differences in rehospitalization and mortality rates by the ADI were no longer significant in those who attended CR.

Conclusions:
We found the increased ADI was adversely associated with rehospitalizations and mortality. However, in individuals with CR, outcomes were significantly improved compared with those with no CR. Our findings suggest that CR participation has the potential to improve outcomes in disadvantaged neighborhoods.
The Effectiveness of Cardiopulmonary Rehabilitation Programs on Psychosocial Factors in Patients With Pulmonary and Cardiac Disease
Authors: Alqahtani Mohammed M. , Alanazi Abdulla M. M. , Yohannes Abebaw Mengistu , Smith Caitlin E. , Goodfellow Lynda T. 
Published: March 2021

Purpose:
Those with chronic cardiac and pulmonary diseases are predisposed to several psychosocial disorders. Tailored rehabilitation programs have been shown to improve physiological and psychosocial well-being. The purpose of this study was, first, to assess the psychosocial improvements among patients with cardiac and pulmonary diseases who have finished cardiac rehabilitation (CR) and pulmonary rehabilitation (PR) programs; second, to assess the differences in psychosocial factors among those patients based on smoking status at the beginning and end of these programs.

Methods:
The CR and PR programs in hospital settings were retrospectively analyzed from 2013-2018. Before and after, all patients completed the sociodemographic characteristics along with the Psychosocial Risk Factor Survey that measures total distress, depression, anxiety, hostility, and social isolation.

Results:
There were 355 patients with cardiac and 244 patients with pulmonary disease who completed 6- to 12-wk CR or PR programs. There were significant improvements in all psychosocial symptoms among cardiac patients. Patients with pulmonary disease exhibited significant improvements in all psychosocial factors except for social isolation. Moreover, current smokers in the CR group reported elevated symptoms of several psychosocial scores.

Conclusion:
These findings provide critical information about the effects of tailored rehabilitation programs among patients with chronic cardiac and pulmonary diseases on psychosocial levels. By using the Psychosocial Risk Factor Survey, we have found that total distress, depression, anxiety, and hostility were reduced among patients who completed the CR or PR programs. Current smokers exhibited the elevated mean scores on psychosocial symptoms in the cardiac group that may be a target for smoking cessation program. The advantages of tailored rehabilitation programs are significant, which may be of benefit for physical, social, behavioral, and psychological well-being.
Short-Term Outcomes of Pediatric Keratoprosthesis With the Near-Complete Conjunctival Flap
Authors: Bawany Mohammad H. , Kudla Callais , Khan Faraaz A. , Chung Mina M. , Aquavella James V. 
Published: March 2021

Purpose:
The Boston keratoprosthesis (KPro) has been used for certain indications in pediatric patients with congenital corneal opacities. Here, we describe the use of a near-complete conjunctival flap at the time of Boston type 1 KPro surgery in pediatric patients, with the goal of improving pediatric KPro outcomes.

Methods:
We performed a retrospective chart review of 21 eyes from 16 patients who received their first KPro before the age of 18 years at a tertiary care center in Rochester, NY. Surgeries were performed between 2011 and 2017 (3 years before and after the incorporation of a conjunctival flap, which began in 2014 as part of the pediatric KPro procedure). Patients who had a minimum 1-year postoperative follow-up, or had corneal melts within 1 year of KPro implantation, were included in our study. The main outcome measure in this study was a comparison of the number of complications that required surgical intervention, including retroprosthetic membrane, corneal melt, retinal detachment, and endophthalmitis, in eyes that received KPro implantation without a conjunctival flap compared with eyes that received KPro implantation with a conjunctival flap. Change in the visual acuity up to 1 year postoperatively was also measured.

Results:
Ten eyes received KPro with no conjunctival flap, and 11 eyes received KPro with a near-complete conjunctival flap. After 1-year postoperative follow-up, eyes receiving a KPro with a conjunctival flap had fewer KPro-related complications requiring surgical intervention (5 vs. 16, P = 0.0002). Corneal melt was seen in 2 of 11 (18%) eyes in the conjunctival flap group and 5 of 10 (50%) eyes in the nonflap group (P = 0.12). No eyes developed endophthalmitis in the flap group, whereas 1 of 10 (10%) eyes developed endophthalmitis in the nonflap group. Visual acuity at 1-year follow-up improved in 9 of 11 (82%) eyes in the flap group compared with 5 of 10 (50%) eyes in the nonflap group (P = 0.3).

Conclusions:
Implementation of a conjunctival flap in pediatric KPro may help decrease the short-term postoperative complications requiring surgical procedures and may lead to improved visual acuity after 1 year. Further investigation, including longer-term follow-up, is needed to better understand how the described technique affects surgical outcomes in children.
Comparison of Pterygium Recurrence Rates Between Attending Physicians and Supervised Trainee Residents
Authors: Thompson John P. , Harbin Zach , Das Hrishikesh , Deschner Lauren A. , Seale Stephanie A. , Kheirkhah Ahmad 
Published: March 2021

Purpose:
To compare the recurrence rates after pterygium surgery performed by supervised trainee residents and attending physicians.

Methods:
This retrospective study included pterygium surgeries performed by trainee residents and attending physicians in an academic institution in South Texas in the years 2008 to 2019. All residents performed surgeries under direct supervision of an attending physician. Only primary pterygium cases with a minimum postoperative follow-up of 6 months were included. Patients' demographics, primary surgeon, use of conjunctival autograft (CAU) or amniotic membrane graft (AMG), recurrence of pterygium, follow-up length, and complications were recorded.

Results:
This study included 240 eyes of 229 patients with a mean age of 55.6 ± 12.3 years (range, 28–91 years). Of these eyes, 100 surgeries were performed by attending physicians (including 87 with CAU and 13 with AMG) and 140 surgeries by trainee residents (including 119 with CAU and 21 with AMG). There were no significant differences between the 2 groups of patients regarding age, sex, and surgical technique (CAU vs. AMG). Patients were followed up for an average of 19.8 ± 15.2 months. No statistically significant differences were found in comparing the rate of pterygium recurrence between attending physicians and residents when using CAU (6.8% vs. 10.0%, respectively; P = 0.42) and AMG (69.2% vs. 47.6%, respectively; P = 0.22). Moreover, there were no significant differences in other postoperative complications between the groups.

Conclusions:
Pterygium recurrence rates were similar between attending physicians and supervised trainee residents. Thus, acceptable outcomes can be expected when pterygium surgery is performed by a supervised ophthalmology resident.
The Impact of Gender on the Effectiveness of an Auricular Acupressure Intervention Administered to Community-Dwelling Poor Sleepers: A Cluster Randomized Controlled Trial
Authors: HUNG Hsuan-Man , CHIANG Hsiao-Ching , WANG Hui-Ling 
Published: March 2021

ABSTRACT

Background
Women report a higher incidence of sleep problems than men. Few studies addressing the effect of gender on the efficacy of administering auricular acupressure (AA) at shenmen points (heart meridian 7 [HT7]) on sleep quality have been published.

Purpose
The primary aim of this study was to investigate the effects of a 4-week AA intervention applied at the HT7 points on sleep quality, perceived physical health, and perceived mental health in community-dwelling individuals with poor self-reported sleep quality. Additional analyses were used to evaluate the gender-specific effects of this intervention.

Methods
A cluster randomized controlled trial with repeated-measures design was used. One hundred seventy-nine eligible participants were randomly assigned to either the AA group (n = 88; 47 women, 41 men) or the sleep hygiene instruction (SHI) group (n = 91; 52 women, 39 men). The AA group self-administered acupressure at HT7 on both ears for a 4-week period, whereas the SHI group received an SHI information sheet. Outcome measures included the Pittsburgh Sleep Quality Index (PSQI) and the Short-Form Health Survey-12 Version 2, with data collected at baseline and at 2, 4, and 8 weeks posttest.

Results
Linear mixed-model analysis revealed that the participants in the AA group experienced significantly greater reductions in mean PSQI global score and the three indices of sleep latency, subjective sleep quality, and daytime dysfunction than the SHI group at 2 and 4 weeks posttest. The improvements in subjective sleep quality and daytime dysfunction remained at 4 weeks posttest in the AA group, but not in the SHI group. The PSQI global score decreased significantly more in men than women in the AA group between baseline and 4 weeks posttest.

Conclusions/Implications for Practice:
Four weeks of self-administered acupressure at HT7 on both ears is an effective intervention for community-dwelling poor sleepers who are over 45 years old. Moreover, the improvements in subjective sleep quality and daytime dysfunction persist for up to 4 weeks after the end of the intervention. This self-administered acupressure intervention is more effective in men than in women in terms of improving sleep quality. Gender bias is known to influence research results and may lead to inappropriate generalizations. Thus, future studies that are performed to build basic scientific evidence should include considerations of the effects of gender in the study design.
Introducing a Radiography-based Score in Children With Acute Respiratory Failure
Authors: Raissaki Maria , Ilia Stavroula , Katsoula Vasiliki , Kotziamanis Alexandros , Theotokatou Despoina , Briassoulis George 
Published: March 2021

Purpose:
Respiratory failure (RF) is one of the most common reasons for hospitalization in pediatric intensive care units (PICU). We propose a radiography-based severity score for the assessment of children with RF and investigate the possible associations with severity indices and outcome.

Materials and Methods:
Children with acute RF admitted in PICU were enrolled. Disease severity scores [Pediatric Risk of Mortality (PRISM) and Pediatric Logistic Organ Dysfunction (PELOD)], the ratio of partial pressure arterial oxygen and fraction of inspired oxygen (PaO2/FiO2) ratios, duration of ventilator support (DVS), length of PICU and hospital stay (LOS), and outcome were recorded. A 5-point radiography score that considered potential radiographic findings was derived through stepwise multivariable logistic regression analysis, and validated. Radiographs upon PICU admission and on the worst RF day (maximum respiratory support and worst oxygenation/ventilation parameters) were blindly reviewed and independently scored by 2 radiologists and 2 clinicians, following training.

Results:
We enrolled 104 children [median age 2.7 (interquartile range, 0.5 to 9.6) y, 65.4% boys]. Overall, 163 radiographs (PICU admission: 86, worst RF day: 77) were assessed. Radiography scores correlated positively with predicted mortality (PELOD, PRISM), DVS, LOS (all P<0.001) and inversely with PaO2/FiO2 (P<0.001). Scores differed among diagnostic categories (P<0.05); patients with acute respiratory distress syndrome, air-leaks, drowning, and pneumonia scored the highest (P<0.005). Radiography scoring trends indicating deterioration were associated with prolonged DVS, PICU, and hospital LOS (P<0.001). Agreement between all raters was good (κ=0.7, P<0.001).

Conclusions:
This novel radiography score for children with RF, associated with clinical severity scores, mortality risk, duration of ventilatory support, and hospitalization, follows a simple structured approach and can be readily utilized by radiologists and pediatricians as a bedside tool for stratification of disease severity and prognosis.