bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome in elderly patients with aortic stenosis undergoing hip fracture surgery. Results may suggest a different postoperative strategy?
Authors: Rostagno Carlo , Ranalli Claudia , Polidori Gianluca , Cartei Alessandro , Boccaccini Alberto , Peris Adriano 
Published: January 2019

BackgroundFive to ten percent of patients with hip fracture have severe aortic valve stenosis (AS). The aim of the present investigation was to evaluate the impact of AS on early and long-term outcome after surgery for hip fracture.Methods145 patients with AS and 283 consecutive patients without AS (control group) aged >70 years referred to Azienda Ospadaliera Universitaria (AOU) Careggi for hip fracture were included in the study. The endpoints were incidence of postoperative myocardial infarction, 30-day and 1-year mortality, and a composite endpoint (30-day mortality + myocardial infarction).Results66 patients had mild, 47 moderate and 32 severe AS according to the European Society of Cardiology guidelines. 30-day mortality was 6.2% in AS and 3.1% in controls. Postoperative non-fatal myocardial infarction and composite endpoint were more frequent in AS than in the control group (8.3% vs 1.1%, p<0.001 and 14.5% vs 4.2%, p<0.001, respectively). The risk was significantly higher for patients with severe AS (28.1%). 1-year mortality in patients with moderate/severe AS was 46% in comparison with 16% in mild AS or in the control group (p<0.001). Coronary disease, atrial fibrillation, age, and aortic gradient were independent predictors of mortality in AS.DiscussionAS significantly affects postoperative outcome after surgery for hip fracture. Since not infrequently AS is incidentally diagnosed during hospitalization after trauma, which should be the management in these patients after hip surgery? How many might benefit from surgical valve replacement or transcatheter aortic valve replacement? A heart team evaluation may be suggested before discharge for most of these patients.Level of evidenceIV.
Introduction and evaluation of the ACS BCon basic course in Zaragoza, Spain
Authors: Yanez Carlos , Güemes Antonio , Navarro Ana , Vazquez Jacqueline , Moreno Alberto 
Published: January 2019

BackgroundThe American College of Surgeons Bleeding Control Basic (BCon) course aimed at teaching hemorrhage control techniques in the USA had not yet been taught in Spain. The purpose of this study is to assess its implementation among students and healthcare employees in the Lozano Blesa University Hospital of Zaragoza, a middle-sized Spanish city.MethodsThe study was conducted in a University Hospital and at the University of Zaragoza, scheduling four free B-Con sessions from 2017 to 2018. Two groups were identified as forming the population: healthcare employees and medical students. An anonymous questionnaire was completed at the end of the course regarding content, applicability, usefulness, relevance, and satisfaction. Study variables were ranked from 0 to 10: poor (when graded from 0 to 3), fair (4 to 6) and good (7 to 10). Results were compared between the groups, expressed in percentages and χ2 tested to analyze significant differences if any.ResultsAmong the 83 individuals who completed the course, 46 were medical students and 37 healthcare employees; 61% women and 39% men; aged 21 years to 52 years. Attendees evaluated satisfaction with the highest grade (84%), followed by usefulness (73%), applicability (70%), and relevance (66%). There was no variable graded as poor. The comparison of perceptions between groups did not reveal statistical differences based on a 0.05 significance level.ConclusionWe concluded that the B-Con course was valued as good for relevance, usefulness, applicability, and satisfaction by the majority of the studied population.Level of evidenceLevel III.
Community Need Index (CNI): a simple tool to predict emergency department utilization after hospital discharge from the trauma service
Authors: Huang Dih-Dih , Shehada Mahmoud Z , Chapple Kristina M , Rubalcava Nathaniel S , Dameworth Jonathan L , Goslar Pamela W , Israr Sharjeel , Petersen Scott R , Weinberg Jordan A 
Published: January 2019

BackgroundEmergency department (ED) visits after hospital discharge may reflect failure of transition of care to the outpatient setting. Reduction of postdischarge ED utilization represents an opportunity for quality improvement and cost reduction. The Community Need Index (CNI) is a Zip code-based score that accounts for a community’s unmet needs with respect to healthcare and is publicly accessible via the internet. The purpose of this study was to determine if patient CNI score is associated with postdischarge ED utilization among hospitalized trauma patients.MethodsLevel 1 trauma patient admitted between January 2014 and June 2016 were stratified by 30-day postdischarge ED utilization (yes/no). CNI is a nationwide Zip code-based score (1.0–5.0) and was determined per patient from the CNI website. Higher scores indicate greater barriers to healthcare per aggregate socioeconomic factors. Patients with 30-day postdischarge ED visits were compared with those without, evaluating for differences in CNI score and clinical and demographic characteristics.Results309 of 3245 patients (9.5%) used the ED. The ED utilization group was older (38.3±15.7 vs. 36.3±16.4 years, p=0.034), more injured (Injury Severity Score 10.4±8.7 vs. 7.7±8.0, p<0.001), and more likely to have had in-hospital complications (17.5% vs. 5.4%, p<0.001). Adjusted for patient age, injury severity, gender, race/ethnicity, penetrating versus blunt injury, alcohol above the legal limit, illicit drug use, the presence of one or more complications and comorbidities, hospital length of stay, and insurance category, CNI score ≥4 was associated with increased utilization (OR 2.0 [95% CI 1.4 to 2.9, p<0.001]).DiscussionCNI is an easily accessible score that independently predicts postdischarge ED utilization in trauma patients. Patients with CNI score ≥4 are at significantly increased risk. Targeted intervention concerning discharge planning for these patients represents an opportunity to decrease postdischarge ED utilization.Level of evidenceIII, Prognostic and Epidemiological.
Towards formalization of the soliton counting technique for the Khovanov–Rozansky invariants in the deformed ℛ-matrix approach
Authors: Anokhina A. 
Published: January 2019

We consider recently developed Cohomological Field Theory (CohFT) soliton counting diagram technique for Khovanov (Kh) and Khovanov–Rozansky (KhR) invariants.[Formula: see text] Although, the expectation to obtain a new way for computing the invariants has not yet come true, we demonstrate that soliton counting technique can be totally formalized at an intermediate stage, at least in particular cases. We present the corresponding algorithm, based on the approach involving deformed [Formula: see text]-matrix and minimal positive division, developed previously in Ref. 3. We start from a detailed review of the minimal positive division approach, comparing it with other methods, including the rigorous mathematical treatment.4 Pieces of data obtained within our approach are presented in the Appendices.
A Process Engineering Approach to Improve Production of P(3HB) byCupriavidus necatorfrom Used Cooking Oil
Authors: Cruz Madalena V. , Gouveia Ana Rosa , Dionísio Madalena , Freitas Filomena , Reis Maria A. M. 
Published: January 2019

Different feeding strategies, namely, exponential feeding and DO-stat mode, were implemented for the production of poly(3-hydroxybutyrate), P(3HB), byCupriavidus necatorDSM 428 with used cooking oil (UCO) as the sole carbon source. With the exponential feeding strategy, a cell dry mass of 21.3 ± 0.9 g L−1was obtained, with a polymer content of 84.0 ± 4.5 wt.%, giving an overall volumetric productivity of 4.5 ± 0.2 g L−1 day−1. However, the highest P(3HB) volumetric productivity, 12.6 ± 0.8 g L−1 day−1, was obtained when the DO-stat mode was implemented together with the use of ammonium hydroxide for pH control, which served as an additional nitrogen source and allowed to reach higher cell dry mass (7.8 ± 0.6 g L−1). The P(3HB) obtained in all experiments had a high molecular mass, ranging from 0.6 × 105to 2.6 × 105 g mol−1, with low polydispersity indexes of 1.2-1.6. Melting and glass transition temperatures were also similar for the polymer produced with both cultivation strategy, 174°C and 3.0-4.0°C, respectively. The polymer exhibited a crystallinity ranging from 52 to 65%. The DO-stat strategy to feed oil containing substrates as the sole carbon sources was reported for the first time in this study, and the preliminary results obtained show that it is a promising strategy to improve P(3HB) production. Nevertheless, the process requires further optimization in order to make it economically viable.
Validation of Melanoma Immune Profile (MIP), a Prognostic Immune Gene Prediction Score for Stage II–III Melanoma
Authors: Gartrell Robyn D. , Marks Douglas K. , Rizk Emanuelle M. , Bogardus Margaret , Gérard Camille L. , Barker Luke W. , Fu Yichun , Esancy Camden L. , Li Gen , Ji Jiayi , Rui Shumin , Ernstoff Marc S. , Taback Bret , Pabla Sarabjot , Chang Rui , Lee Sandra J. , Krolewski John J. , Morrison Carl , Horst Basil A. , Saenger Yvonne M. 
Published: January 2019

Abstract

Purpose:
Biomarkers are needed to stratify patients with stage II–III melanoma for clinical trials of adjuvant therapy because, while immunotherapy is protective, it also confers the risk of severe toxicity. We previously defined and validated a 53-immune gene melanoma immune profile (MIP) predictive both of distant metastatic recurrence and of disease-specific survival (DSS). Here, we test MIP on a third independent population.

Experimental Design:
A retrospective cohort of 78 patients with stage II–III primary melanoma was analyzed using the NanoString assay to measure expression of 53 target genes, and MIP score was calculated. Statistical analysis correlating MIP with DSS, overall survival, distant metastatic recurrence, and distant metastasis-free interval was performed using ROC curves, Kaplan–Meier curves, and standard univariable and multivariable Cox proportional hazards models.

Results:
MIP significantly distinguished patients with distant metastatic recurrence from those without distant metastatic recurrence using ROC curve analysis (AUC = 0.695; P = 0.008). We defined high- and low-risk groups based on the cutoff defined by this ROC curve and find that MIP correlates with both DSS and overall survival by ROC curve analysis (AUC = 0.719; P = 0.004 and AUC = 0.698; P = 0.004, respectively). Univariable Cox regression reveals that a high-risk MIP score correlates with DSS (P = 0.015; HR = 3.2).

Conclusions:
MIP identifies patients with low risk of death from melanoma and may constitute a clinical tool to stratify patients with stage II–III melanoma for enrollment in clinical trials.
Intra-Plaque Vessels on Contrast-Enhanced Ultrasound Sonography Predict Carotid Plaque Histology
Authors: Amamoto Takaaki , Sakata Noriyuki , Ogata Toshiyasu , Shimada Hirofumi , Inoue Tooru 
Published: January 2019

<b><i>Background and Purpose:</i></b> Although the echogenicity of carotid plaques on carotid enhanced ultrasound (CEUS) was reported to correlate with the historological density of intra-plaque neovessels, it is unclear whether the intra-plaque vessel size is associated with carotid plaque vulnerability. We evaluated the relationship of size of intra-plaque vessels on CEUS with carotid plaque histology. <b><i>Methods:</i></b> We prospectively registered patients with carotid stenosis who were hospitalized to receive carotid endarterectomy between 2012 and 2016. CEUS was performed by ultrasound specialists using a 7-MHz linear transducer (GE LOGIQ7; GE Healthcare, Milwaukee, WN, USA). Sonazoid® was used for conducting CEUS. The sizes of microbubbles inside the plaques were scored at 0, 1, 3, and 5 min after the injection of contrast agent, and were categorized according to our defined vascular score (Vas-S; 0: the effect of contrast was not recognized; 1: the microbubbles were visible, but so blurred and vague that their shape could not be recognized; 2: dot or string-like microbubbles with movement, localized in part or the whole site of the plaque). At histological examination, we simplified the modified American Heart Association classification and defined as an atherosclerotic category (Ath-cat; 1: unruptured plaque; 2: ruptured plaque; 3: healed plaque). We then assessed the correlation of Vas-S with Ath-cat, which describes the process of rupture and restoration of carotid plaques. <b><i>Results:</i></b> A total of 97 patients were included in this study. A higher Ath-cat was significantly associated with higher Vas-S at any time. Spearman signed-rank test indicated that Vas-S at 1 min was most strongly correlated with Ath-cat (ρ = 0.43, <i>p</i> = 0.001). Receiver operating curve analysis indicated that a Vas-S of 0 at 1 min was significantly associated with an unruptured plaque (area under curve [AUC] 0.72, <i>p</i> = 0.006), while a Vas-S of 2 at 1 min was significantly associated with a healed plaque (AUC 0.72, <i>p</i> = 0.001). <b><i>Conclusion:</i></b> Vas-S values of 0 and 2 at 1 min indicated unruptured and healed plaques respectively. Thus, a Vas-S of 1 at 1 min is an indicator of a ruptured plaque. The intra-plaque vessel size on CEUS was significantly associated with carotid plaque histology, and may predict the process of plaque rupture and restoration.
The Relationship between Blood Pressure Variability, Recanalization Degree, and Clinical Outcome in Large Vessel Occlusive Stroke after an Intra-Arterial Thrombectomy
Authors: Chang Jun Young , Jeon Sang Beom , Lee Jung Hwa , Kwon O-Ki , Han Moon-Ku 
Published: January 2019

<b><i>Background:</i></b> Blood pressure variability (BPV) is associated with target organ damage progression and increased cardiovascular events, including stroke. The aim of this study was to evaluate the associations between short-term BPV during acute periods and recanalization degree, early neurological deterioration (END) occurrence, and functional outcomes in acute ischemic stroke patients who had undergone intra-arterial thrombectomy (IAT). <b><i>Methods:</i></b> We retrospectively analyzed 303 patients with large vessel occlusive stroke who underwent IAT. The following BPV parameters, measured over 24 and 48 h after IAT, were compared: the mean, SD, coefficient of variation (CV), variation independent of the mean (VIM) for both the systolic BP (SBP) and diastolic BP, and the proportion of nocturnal SBP risers. <b><i>Results:</i></b> BPV parameters decreased with higher recanalization degree. The mean SBP (SBP<sub>mean</sub>) over 24 and 48 h after IAT, and the SD of SBP (SBP<sub>SD</sub>), CV of SBP (SBP<sub>CV</sub>), and VIM of SBP (SBP<sub>VIM</sub>) during the 48 h following the procedure had significant associations with recanalization degree. Patients with END had higher BPV than that of those without END, and the difference was more evident for incomplete recanalization. Increased BPV was associated with a shift toward poor functional outcome at 3 months after adjustment, including recanalization degree (OR range for significant parameters, 1.26–1.64, <i>p</i> = 0.006 for 48 h SBP<sub>mean</sub>, <i>p</i> = 0.003 for 48 h SBP<sub>CV</sub>, otherwise <i>p</i> &#x3c; 0.002). <b><i>Conclusions:</i></b> Short-term BPV over 24 and 48 h after IAT in acute ischemic stroke patients was related to recanalization degree, and END occurrence, and may be an independent predictor of clinical outcome.
Epicardial Fat Volume Improves the Prediction of Obstructive Coronary Artery Disease Above Traditional Risk Factors and Coronary Calcium Score
Authors: Zhou Jia , Chen Yundai , Zhang Ying , Wang Hao , Tan Yahang , Liu Yujie , Huang Lingyu , Zhang Hong , Ma Yanhe , Cong Hongliang 
Published: January 2019

Background:
Recent studies have demonstrated the tremendous potential of epicardial fat volume (EFV) to predict obstructive coronary artery disease. We aimed to develop a new model to estimate pretest probability of obstructive coronary artery disease using traditional risk factors with coronary calcium score and EFV and compare it with proposed models in Chinese patients who underwent coronary computed tomography angiography.

Methods:
The new models were derived from 5743 consecutive patients using multivariate logistic regression and validated in an internal cohort using invasive coronary angiography as the outcome and an external cohort with clinical outcome data. Hosmer-Lemeshow goodness-of-fit test, area under the receiver operating characteristic curve, integrated discrimination improvement and net reclassification improvement were calculated to validate and compare the performance of models.

Results:

EFV improved prediction above conventional risk factors and coronary calcium score (area under the receiver operating characteristic curve increased from 0.856 to 0.874, integrated discrimination improvement 0.0487, net reclassification improvement 0.1181,
P
<0.0001 for all). The final model included 5 predictors: age, sex, symptom, coronary calcium score, and EFV. Good internal validation and external validation of the new model were achieved, with positive net reclassification improvement and integrated discrimination improvement, excellent area under the receiver operating characteristic curve and favorable calibration. Further, the new model demonstrated a better prediction of clinical outcome, resulting in a more cost-effective risk stratification to optimize decision-making of downstream diagnosis and treatment.

Conclusions:
Addition of EFV to conventional risk factors and coronary calcium score offered a more accurate and effective estimation for pretest probability of obstructive coronary artery disease, which may help to improve initial management of stable chest pain.
Elevated Sera sST2 Is Associated With Heart Failure in Men ≤50 Years Old With Myocarditis
Authors: Coronado Michael J. , Bruno Katelyn A. , Blauwet Lori A. , Tschöpe Carsten , Cunningham Madeleine W. , Pankuweit Sabine , van Linthout Sophie , Jeon Eun‐Seok , McNamara Dennis M. , Krejčí Jan , Bienertová‐Vašků Julie , Douglass Erika J. , Abston Eric D. , Bucek Adriana , Frisancho J. Augusto , Greenaway Merci S. , Hill Anneliese R. , Schultheiss Heinz‐Peter , Cooper Leslie T. , Fairweather DeLisa 
Published: January 2019

Background

Myocarditis is an important cause of acute and chronic heart failure. Men with myocarditis have worse recovery and an increased need for transplantation compared with women, but the reason for the sex difference remains unclear. Elevated sera soluble (s)
ST
2 predicts mortality from acute and chronic heart failure, but has not been studied in myocarditis patients.

Methods and Results

Adults with a diagnosis of clinically suspected myocarditis (n=303, 78% male) were identified according to the 2013 European Society of Cardiology position statement. Sera
sST
2 levels were examined by
ELISA
in humans and mice and correlated with heart function according to sex and age. Sera
sST
2 levels were higher in healthy men (
P
=8×10
−6
) and men with myocarditis (
P
=0.004) compared with women.
sST
2 levels were elevated in patients with myocarditis and New York Heart Association class
III
‐
IV
heart failure (
P
=0.002), predominantly in men (
P
=0.0003). Sera
sST
2 levels were associated with New York Heart Association class in men with myocarditis who were ≤50 years old (
r
=0.231,
P
=0.0006), but not in women (
r
=0.172,
P
=0.57). Sera
sST
2 levels were also significantly higher in male mice with myocarditis (
P
=0.005) where levels were associated with cardiac inflammation. Gonadectomy with hormone replacement showed that testosterone (
P
<0.001), but not estradiol (
P
=0.32), increased sera
sST
2 levels in male mice with myocarditis.

Conclusions

We show in a well‐characterized subset of heart failure patients with clinically suspected and biopsy‐confirmed myocarditis that elevated sera
sST
2 is associated with an increased risk of heart failure based on New York Heart Association class in men ≤50 years old.
The MOVEMENT Trial
Authors: Holm Manne , Tornvall Per , Henareh Loghman , Jensen Ulf , Golster Nanna , Alström Patrik , Santos‐Pardo Irene , Witt Nils , Fedchenko Nikolai , Venetsanos Dimitrios , Beck Olof , van der Linden Jan 
Published: January 2019

Background
Morphine administration is a strong predictor of delayed onset of action of orally administered ticagrelor in patients with ST‐segment–elevation myocardial infarction, likely because of impaired gastrointestinal motility. The aim of this study was to evaluate whether the peripheral opioid antagonist methylnaltrexone could improve pharmacodynamics and pharmacokinetics of orally administered ticagrelor in patients with ST‐segment–elevation myocardial infarction receiving morphine.

Methods and Results

The MOVEMENT (Methylnaltrexone to Improve Platelet Inhibition of Ticagrelor in Morphine‐Treated Patients With ST‐Segment Elevation Myocardial Infarction) trial was a multicenter, prospective, randomized, controlled trial in patients with ST‐segment–elevation myocardial infarction treated with morphine and ticagrelor. Upon arrival to the catheterization laboratory, patients were randomized to a blinded intravenous injection of either methylnaltrexone (8 or 12 mg according to weight) or 0.9% sodium chloride. The proportion of patients with high on‐treatment platelet reactivity and plasma concentrations of ticagrelor and
AR
‐C124910XX were assessed at baseline (arrival in the catheterization laboratory) and 1 and 2 hours later. A total of 82 patients received either methylnaltrexone (n=43) or placebo (n=39). Median (interquartile range) time from ticagrelor administration to randomization was 41 (31–50) versus 45.5 (37–60) minutes (
P
=0.16). Intravenous methylnaltrexone administration did not significantly affect prevalence of high on‐treatment platelet reactivity at 2 hours after inclusion, the primary end point, when compared with placebo (54% versus 51%,
P
=0.84). Plasma concentrations of ticagrelor and its active metabolite, the prespecified secondary end points, did not differ significantly between the groups over time. There was no significant difference in patient self‐estimated pain between the groups.

Conclusions
Methylnaltrexone did not significantly improve platelet reactivity or plasma concentrations of orally administered ticagrelor in patients with ST‐segment–elevation myocardial infarction receiving morphine.

Clinical Trial Registration

URL
:
http://www.clinicaltrials.gov
. Unique identifier:
NCT
02942550.