bluuebunny/crossref_metadata_2025_split huggingface dataset:
CLIPPERS and its mimics: evaluation of new criteria for the diagnosis of CLIPPERS
Authors: Taieb Guillaume , Mulero Patricia , Psimaras Dimitri , van Oosten Bob W , Seebach Jörg D. , Marignier Romain , Pico Fernando , Rigau Valérie , Ueno Yuji , Duflos Claire , Fominykh Vera , Guiraud Vincent , Lebrun-Frénay Christine , Camdessanché Jean-Philippe , Kerschen Philippe , Ahle Guido , Téllez Nieves , Rovira Alex , Hoang-Xuan Khe , Pelletier Jean , Labauge Pierre 
Published: May 2019

ObjectiveTo evaluate the accuracy of the recently proposed diagnostic criteria for chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS).MethodsWe enrolled 42 patients with hindbrain punctate and/or linear enhancements (<3 mm in diameter) and tested the CLIPPERS criteria.ResultsAfter a median follow-up of 50 months (IQR 25–82), 13 out of 42 patients were CLIPPERS-mimics: systemic and central nervous system lymphomas (n=7), primary central nervous system angiitis (n=4) and autoimmune gliopathies (n=2). The sensitivity and specificity of the CLIPPERS criteria were 93% and 69%, respectively. Nodular enhancement (
≥
3 mm in diameter), considered as a red flag in CLIPPERS criteria, was present in 4 out of 13 CLIPPERS-mimics but also in 2 out of 29 patients with CLIPPERS, explaining the lack of sensitivity. Four out of 13 CLIPPERS-mimics who initially met the CLIPPERS criteria displayed red flags at the second attack with a median time of 5.5 months (min 3, max 18), explaining the lack of specificity. One of these four patients had antimyelin oligodendrocyte glycoprotein antibodies, and the three remaining patients relapsed despite a daily dose of prednisone/prednisolone
≥
30 mg and a biopsy targeting atypical enhancing lesions revealed a lymphoma.ConclusionsOur study highlights that (1) nodular enhancement should be considered more as an unusual finding than a red flag excluding the diagnosis of CLIPPERS; (2) red flags may occur up to 18 months after disease onset; (3) as opposed to CLIPPERS-mimics, no relapse occurs when the daily dose of prednisone/prednisolone is
≥
30 mg; and (4) brain biopsy should target an atypical enhancing lesion when non-invasive investigations remain inconclusive.
Management of perioperative myocardial ischaemia after isolated coronary artery bypass graft surgery
Authors: Sef Davorin , Szavits-Nossan Janko , Predrijevac Mladen , Golubic Rajna , Sipic Tomislav , Stambuk Kresimir , korda zvonimir , Meier Pascal , turina Marko Ivan 
Published: May 2019

ObjectivesUpdated knowledge about perioperative myocardial ischaemia (MI) after coronary artery bypass grafting (CABG) and treatment of acute graft failure is needed. We analysed main factors associated with perioperative MI and effects of immediate coronary angiography-based treatment strategy on patient outcome.MethodsAmong 1119 consecutive patients with coronary artery disease who underwent isolated CABG between January 2011 and December 2015, 43 (3.8%) patients underwent urgent coronary angiography due to suspected perioperative MI. All the data were prospectively collected and retrospectively analysed. The primary endpoint was 30-day mortality; postoperative left ventricular ejection fraction) and major adverse cardiac events were secondary endpoints.ResultsOverall, 30-day mortality in patients with CABG was 1.4% while in patients who developed perioperative MI was 9% (4 patients). Angiographic findings included incorrect graft anastomosis, graft spasm, dissection, acute coronary artery thrombotic occlusion and ischaemia due to incomplete revascularisation. Emergency reoperation (Redo) was performed in 14 (32%), acute percutaneous coronary intervention (PCI) in 15 (36%) and conservative treatment (Non-op) in 14 patients. Demographic and preoperative clinical characteristics between the groups were comparable. Postoperative LVEF was significantly reduced in the Redo group (45% post-op vs 53% pre-op) and did not change in groups PCI (56% post-op vs 57% pre-op) and Non-op (58% post-op vs 57% pre-op).ConclusionsUrgent angiography allows identification of the various underlying causes of perioperative MI and urgent treatment when this is needed. Urgent PCI may be associated with improved clinical outcome in patients with early graft failure.
Biological variation of cardiac markers in patients with aortic valve stenosis
Authors: Peeters Frederique E C M , Kietselaer Bas L J H , Hilderink Judith , van der Linden Noreen , Niens Marijke , Crijns Harry J G M , Meex Steven J R 
Published: May 2019

ObjectiveCardiac biomarkers hold promise for follow-up and management of aortic valve stenosis (AVS). When interpreting serial biomarker measurements of patients with AVS, it can be challenging to distinguish ‘real changes’ from ‘random fluctuation’. Hence, robust estimation of the biological variation of these biomarkers is essential. In the present study we assessed biological variation of B-type natriuretic peptide (BNP), N-terminus pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin-T and high-sensitivity troponin-I (hs-TnT and hs-TnI), and ST2 in subjects with stable AVS.MethodsSerial blood sampling was performed in 25 subjects with moderate AVS—confirmed by echocardiography—and all free from acute cardiovascular events in the past 6 months. Blood samples were taken on seven standardised occasions during 1 year. Analytical variation (CVA), within-subject biological variation (CVI), between-subject biological variation (CVG), index of individuality (II) and reference change values were calculated for all cardiac biomarkers.ResultsCVIwas highest for BNP (62.0%, 95% CI 52.5 to 75.4) and lowest for hs-TnI (9.2%, 95% CI 2.8 to 13.8). CVGexceeded the CVIfor all biomarkers except BNP, and ranged from 19.8% (95% CI 13.8 to 33.4) for ST2 to 57.2% (95% CI 40.4 to 97.3) for hs-TnT. NT-proBNP, hs-TnT and ST2 revealed CVA<5%, while BNP and hs-TnI showed a higher CVA(19.7 and 14.9, respectively). All biomarkers except BNP showed marked individuality, with II ranging from 0.21 to 0.67 (BNP 1.34).ConclusionThis study provides the first biological variation estimates of cardiac biomarkers in patients with stable AVS. These estimates allow a more evidence-based interpretation of biomarker changes in the follow-up and management of patients with AVS.Trial registration numberNCT02510482
Characterisation of HIV-1 molecular transmission clusters among newly diagnosed individuals infected with non-B subtypes in Italy
Authors: Fabeni Lavinia , Alteri Claudia , Berno Giulia , Scutari Rossana , Orchi Nicoletta , De Carli Gabriella , Bertoli Ada , Carioti Luca , Gori Caterina , Forbici Federica , Salpini Romina , Vergori Alessandra , Gagliardini Roberta , Cicalini Stefania , Mondi Annalisa , Pinnetti Carmela , Mazzuti Laura , Turriziani Ombretta , Colafigli Manuela , Borghi Vanni , Montella Francesco , Pennica Alfredo , Lichtner Miriam , Girardi Enrico , Andreoni Massimo , Mussini Cristina , Antinori Andrea , Ceccherini-Silberstein Francesca , Perno Carlo Federico , Santoro Maria Mercedes 
Published: May 2019

ObjectiveWe evaluated the characteristics of HIV-1 molecular transmission clusters (MTCs) in 1890 newly diagnosed individuals infected with non-B subtypes between 2005 and 2017 in Italy.MethodsPhylogenetic analyses were performed onpolsequences to characterise subtypes/circulating recombinant forms and identify MTCs. MTCs were divided into small (SMTCs, 2–3 sequences), medium (MMTCs, 4–9 sequences) and large (LMTCs, ≥10 sequences). Factors associated with MTCs were evaluated using logistic regression analysis.Results145 MTCs were identified and involved 666 individuals (35.2%); 319 of them (16.9%) were included in 13 LMTCs, 111 (5.9%) in 20 MMTCs and 236 (12.5%) in 112 SMTCs. Compared with individuals out of MTCs, individuals involved in MTCs were prevalently Italian (72.7% vs 30.9%, p<0.001), male (82.9% vs 62.3%, p<0.001) and men who have sex with men (MSM) (43.5% vs 14.5%, p<0.001). Individuals in MTCs were also younger (median (IQR) years: 41 (35–49) vs 43 (36–51), p<0.001) and had higher CD4 cell count in comparison with individuals out of MTCs (median (IQR): 109/L: 0.4 (0.265–0.587) vs 0.246 (0.082–0.417), p<0.001). The viral load remained stable between the two groups (median (IQR) log10copies/mL: 4.8 (4.2–5.5) vs 5.0 (4.3–5.5), p=0.87). Logistic regression confirmed that certain factors such as being MSM, of Italian origin, younger age and higher CD4 cell count were significantly associated with MTCs.ConclusionsOur findings show that HIV-1 newly diagnosed individuals infected with non-B subtypes are involved in several MTCs in Italy. These MTCs include mainly Italians and MSM and highlight the complex phenomenon characterising the HIV-1 spread. This is important especially in view of monitoring the HIV epidemic and guiding the public health response.
The FMS-like tyrosine kinase-3 ligand/lung dendritic cell axis contributes to regulation of pulmonary fibrosis
Authors: Tort Tarrés Meritxell , Aschenbrenner Franziska , Maus Regina , Stolper Jennifer , Schuette Lisanne , Knudsen Lars , Lopez Rodriguez Elena , Jonigk Danny , Kühnel Mark Philipp , DeLuca David , Prasse Antje , Welte Tobias , Gauldie Jack , Kolb Martin RJ , Maus Ulrich A 
Published: May 2019

RationaleDendritic cells (DC) accumulate in the lungs of patients with idiopathic lung fibrosis, but their pathogenetic relevance is poorly defined.ObjectivesTo assess the role of the FMS-like tyrosine kinase-3 ligand (Flt3L)-lung dendritic cell axis in lung fibrosis.Measurements and main resultsWe demonstrate in a model of adenoviral gene transfer of active TGF-β1 that established lung fibrosis was accompanied by elevated serum Flt3L levels and subsequent accumulation of CD11bposDC in the lungs of mice. Patients with idiopathic pulmonary fibrosis also demonstrated increased levels of Flt3L protein in serum and lung tissue and accumulation of lung DC in explant subpleural lung tissue specimen. Mice lacking Flt3L showed significantly reduced lung DC along with worsened lung fibrosis and reduced lung function relative to wild-type (WT) mice, which could be inhibited by administration of recombinant Flt3L. Moreover, therapeutic Flt3L increased numbers of CD11bposDC and improved lung fibrosis in WT mice exposed to AdTGF-β1. In this line, RNA-sequencing analysis of CD11bposDC revealed significantly enriched differentially expressed genes within extracellular matrix degrading enzyme and matrix metalloprotease gene clusters. In contrast, the CD103posDC subset did not appear to be involved in pulmonary fibrogenesis.ConclusionsWe show that Flt3L protein and numbers of lung DC are upregulated in mice and humans during pulmonary fibrogenesis, and increased mobilisation of lung CD11bposDC limits the severity of lung fibrosis in mice. The current study helps to inform the development of DC-based immunotherapy as a novel intervention against lung fibrosis in humans.
Animal model of left atrial thrombus in congestive heart failure in rats
Authors: Chen Jiqiu , Strauss Benjamin , Liang Lifan , Hajjar Roger J. 
Published: May 2019

The aim of the present study was to develop and study a new model of left atrial thrombus (LAT) in rat with congestive heart failure (CHF). CHF was induced by aortic banding for 2 mo, followed by ischemia-reperfusion (I/R) and subsequent aortic debanding for 1 mo. Cardiac function and the presence of LAT were assessed by echocardiography. Masson’s staining was performed for histological analysis. All CHF rats presented with significantly decreased cardiac function, fibrosis in remote myocardium, and pulmonary edema. The incidence rate of LAT was 18.8% in the rats. LAT was associated with severity of aortic constriction, aortic pressure gradient, aortic blood flow velocity, and pulmonary edema but not myocardial infarction or a degree of left ventricular depression. The progressive process of thrombogenesis was characterized by myocyte hypertrophy, fibrosis, and inflammation in the left atrial wall. Fibrin adhesion and clot formation were observed, whereas most LAT presented as a relatively hard “mass,” likely attributable to significant fibrosis in the middle and outer layers. Some LAT mass showed focal necrosis as well as fibrin bulging. Most LAT occurred at the upper anterior wall of the left atrial appendage. Aortic debanding had no significant impact on large LATs (>5 mm2) that had formed, whereas small LATs (<5 mm2) regressed 1 mo after aortic release. LAT is found in a rat model of aortic banding plus I/R followed by aortic debanding. The model provides a platform to study molecular mechanisms and potential new pathways for LAT treatment. NEW & NOTEWORTHY It is critically important to have a rodent model to study the molecular mechanism of thrombogenesis in the left atrium. Left atrial thrombus (LAT) is not a simple fibrin clot like those seen in peripheral veins or arteries. Rather, LAT is a cellular mass that likely develops in conjunction with blood clotting. Studying this phenomenon will help us understand congestive heart failure and promote new therapies for LAT.
Safety of Dual‐Antiplatelet Therapy After Myocardial Infarction Among Patients With Chronic Kidney Disease
Authors: Rymer Jennifer A. , Kaltenbach Lisa A. , Doll Jacob A. , Messenger John C. , Peterson Eric D. , Wang Tracy Y. 
Published: May 2019

Background

Although recommended in the guidelines, the safety of chronic P2Y
12
inhibitor therapy in patients with chronic kidney disease (
CKD
) after an acute myocardial infarction (
MI
) is not well studied.

Methods and Results

The
TRANSLATE
‐ACS (Treatment with ADP Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study included 11 108
MI
patients treated with percutaneous coronary intervention and discharged alive on a P2Y
12
inhibitor from 233
US
hospitals. We compared rates of GUSTO (Global Use of Strategies to Open Occluded Arteries) severe/moderate bleeding and premature discontinuation of P2Y
12
inhibitor by 1 year after
MI
among patients with varying
CKD
severity. The majority of
MI
patients treated with percutaneous coronary intervention had
CKD
: 42% had stage 2 (mild), 27% had stage 3 (moderate), and 4% had stage ≥4 (severe/end stage). Higher potency P2Y
12
inhibitors (prasugrel or ticagrelor) were prescribed at discharge in 39%, 35%, 23%, and 15% (
P
<0.01) of patients with stages 1, 2, 3, and ≥4, respectively. One‐year
GUSTO
severe/moderate bleeding rates were higher with each stage of
CKD
: 1% in patients with
CKD
stage 1 or no
CKD
, 2% with an adjusted hazard ratio of 1.61 (95% CI, 1.05–2.35) for
CKD
stage 2, 4% with an adjusted hazard ratio of 1.92 (95% CI, 1.21–3.02) for
CKD
stage 3, and 10% with an adjusted hazard ratio of 2.44 (95% CI, 1.40–4.23) for patients with
CKD
stage ≥4. By 1 year after
MI
, 16% of patients overall had prematurely discontinued P2Y
12
inhibitor therapy; however, this rate was not largely affected by
CKD
stage. Premature P2Y
12
inhibitor–discontinuation rates were higher for patients discharged on higher potency P2Y
12
inhibitors in patients with
CKD
stage ≥2 (
P
<0.01).

Conclusions

CKD
severity was associated with a higher bleeding risk among those with acute
MI
treated with a P2Y
12
inhibitor. Patients with more advanced
CKD
were not significantly more likely than those with less advance CKD to prematurely discontinue P2Y
12
inhibitor therapy.
Intensification Variability of Tropical Cyclones in Directional Shear Flows: Vortex Tilt–Convection Coupling
Authors: Gu Jian-Feng , Tan Zhe-Min , Qiu Xin 
Published: May 2019

AbstractThe coupling of vortex tilt and convection, and their effects on the intensification variability of tropical cyclones (TCs) in directional shear flows, is investigated in this study. The height-dependent vortex tilt controls TC structural differences in clockwise (CW) and counterclockwise (CC) hodographs during their initial stage of development. Moist convection may enhance the coupling between displaced vortices at different levels and thus reduce the vortex tilt amplitude and enhance precession of the overall vortex tilt during the early stage of development. However, differences in the overall vortex tilt between CW and CC hodographs are further amplified by a feedback from convective heating and therefore result in much higher intensification rates for TCs in CW hodographs than those in CC hodographs. In CW hodographs, convection organization in the left-of-shear region is favored because the low-level vortex tilt is ahead of the overall vortex tilt and the TC moves to the left side of the deep-layer shear. This results in a more humid midtroposphere and stronger surface heat flux on the left side (azimuthally downwind) of the overall vortex tilt, thus providing a positive feedback and supporting continuous precession of the vortex tilt into the upshear-left region. In CC hodographs, convection tends to organize on the right side (azimuthally upwind) of the overall vortex tilt because the low-level vortex tilt is behind the overall vortex tilt and the TC moves to the right side of the deep-layer shear. In addition, convection organizes radially outward near the downshear-right region, which weakens convection within the inner region. These configurations lead to a drier midtroposphere and weaker surface heat flux in the downwind region of the overall vortex tilt and also a broader potential vorticity skirt. As a result, a negative feedback is established that prevents continuous precession of the overall vortex tilt.
Shifting Spatial and Temporal Patterns in the Onset of Seasonally Snow-Dominated Conditions in the Northern Hemisphere, 1972–2017
Authors: Allchin Michael I. , Déry Stephen J. 
Published: May 2019

ABSTRACTThe potential for anthropogenic climate change to impact patterns of seasonal snow cover has motivated numerous studies seeking trends in its extent and duration. Many have been based on the NOAA-Rutgers record of Northern Hemisphere snow cover. Several studies have found augmented early-season snow identified from this archive to be anomalous, and related it to the introduction of higher-resolution imagery and a more automated interpretation process in 1999. This study contributes to the discussion by describing in greater detail the spatial and temporal distributions of trends in the onset of seasonally snow-dominated conditions between 1972 and 2017, and relationships to their physiographic and climatological contexts. It also identifies changepoints between negative and positive onset-date anomalies, and relates these to corresponding meteorological patterns. Most trends identified indicated earlier onset, and were associated with midlatitudes, low to moderate elevations, and colder, drier climates. These were situated largely northeast of major topographic chains, southwest of increasingly ice-free Arctic waters, and to the east of areas associated with blocking systems. Onset-date anomalies switched from positive to negative in approximately 70% of the affected points before 1997. These changepoints generally occurred earlier at higher elevations to the south and west, and later at lower elevations to the north and east. Overall temporal trajectories correspond broadly to shifts in temperature and precipitation over the same areas. In contrast, positive (later) onset trends were found over much smaller areas, associated with warmer, wetter climates and higher elevations, particularly on west-facing slopes; temporal variations in anomalies of their onset dates and associated meteorological conditions were distinct from those having negative trends.
The changing pattern of synthetic cannabinoid use within England, April 2014 to March 2018
Authors: Sharp Phoebe , Hudson Simon , Hikin Laura , Smith Paul R , Morley Stephen R 
Published: May 2019

Introduction Synthetic cannabinoids (SC), designed to mimic delta-9-tetrahydrocannabinol, the natural component of cannabis, have seen a rapid increase in popularity since 2008. Nearly 200 SC have been detected to date. However, there are limited data available reporting the changing trend in their use. Here, we report the temporal changes in SC use, as well as the demographic profile of users. Method In this retrospective study, case background and toxicology findings were collected from forensic toxicology reports dated between 1 April 2014 and 31 March 2018 that included a positive result for the presence of one or more SC and/or metabolites. Results A total of 113 cases were positive for SC; 103 (91.2%) of the individuals were male, with a median age of 40 years (range 15–80 years). Over the four-year time period, a total of 12 different SC were detected; seven of these SC were detected in more than six cases each. The most commonly detected SC had a lifetime of one to two years before being replaced. Discussion and conclusion: Our data show that SC were being used for approximately one to two years before they were superseded by newer structures. It is therefore extremely difficult to predict future patterns of SC use and is consequently not advisable to offer limited screening.
Long-term care Legionella prevention and control strategies: Experiences of nursing homes in Florida and Georgia
Authors: Blake Sarah C , Hawley Jonathan N 
Published: May 2019

Background: Over the past several years, there have been more than 100 confirmed cases in US healthcare facilities of Legionnaires’ disease, a severe and potentially fatal pneumonia caused by the Legionella bacterium found in contaminated water systems. Older people and those with weakened immune systems are particularly vulnerable to Legionella, putting long-term care patients at greater risk of infection. Past efforts to address this growing environmental health crisis have been limited to local surveillance programs for testing water systems in multi-family housing units. In June 2017, the Centers for Medicare and Medicaid Services (CMS) required Medicare-certified healthcare facilities to establish water management programs to reduce the risk of Legionella. Methods: We conducted a mixed methods study (surveys, interviews) to examine the adoption and implementation of these guidelines as well as existing Legionella prevention and control strategies in nursing homes in Florida and Georgia. Results: Findings reveal that most nursing homes in these states do not test their water systems for Legionella because either they have never experienced an outbreak of Legionnaires’ disease or do not have a large water system for testing. Conclusion: Nursing home administrators know of the new CMS Legionella testing requirements and are currently developing water management plans.
Walking and running to benefit breast cancer: descriptive characteristics of participants in the 2017 Walk for Life events
Authors: Bernhart JA , O’Neill JR 
Published: May 2019

Aims: The prevalence of charities and other non-profit organisations sponsoring for-cause physical activity (PA) events has continued to rise. Few studies have examined for-cause events through a public health perspective to determine the reach and potential for public health and PA promotion. This study described participants in a for-cause event supporting breast cancer to determine the reach of the event and identified possible leverage points of for-cause events for public health promotion. Methods: Participants registered online for the Walk for Life events in Columbia, SC (Half marathon, 10k, 5k, and Walk-a-thon), were included in this study. Data were analyzed using Microsoft Excel. Results: Over 6,000 people participated in the event and 4,942 registered online. Of online registrants, most participants were women ( n = 3,800, 78.95%) and most participants, completed the walk-a-thon ( n = 3,539), followed by the 5k ( n = 829), half-marathon ( n = 236), and 10k ( n = 209). The average age of participants was 39.79 years (SD = 1.35). Conclusions: For-cause PA events often recruit high numbers of participants, particularly high-priority populations in PA interventions. Therefore, these events bear innovative implications for PA researchers and practitioners to leverage these events to promote health and PA while simultaneously supporting charity and non-profit organisations.