bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is Adjuvant Chemotherapy Efficient in Colon Cancer with High Microsatellite Instability? A Look Towards the Future
Authors: Schiappacasse Cocio Guido V. , Schiappacasse Enrico D. 
Published: January 2019

Abstract
The high microsatellite instability (MSI-H) is frequently observed in localized colorectal adenocarcinoma. MSI-H is a good prognostic factor in nonmetastatic colon adenocarcinoma. However, MSI-H is not a predictive factor because it is not related with better survival in patients with colon cancer with adjuvant chemotherapy. MSI-H should be a predictive factor because it is associated with a higher expression of enzymes, which are inhibited by cytotoxic agents. Here, we analyze this controversy. We conclude MSI-H is not a predictive factor because the adjuvant therapy based on traditional cytotoxic agents does not act on either immune signaling pathways or BRAF mutation.
Albuminuria Regression and All-Cause Mortality among Insulin-Treated Patients with Type 2 Diabetes: Analysis of a Large UK Primary Care Cohort
Authors: Anyanwagu Uchenna , Donnelly Richard , Idris Iskandar 
Published: January 2019

<b><i>Background:</i></b> Overt albuminuria (urinary albumin-creatinine ratio [ACR] &#x3e; 300 mg/g) is an established risk factor for progression of nephropathy and total mortality. However, whether a reduction in ACR translates into a reduction in mortality and/or cardiovascular (CV) events among insulin-treated patients with type 2 diabetes (T2D) in routine practice is currently not known. <b><i>Methods:</i></b> We obtained data on a large cohort of insulin users with T2D and nephropathy (baseline ACR ≥300 mg/g) from UK general practices between 2007 and 2014. Their corresponding ACR values after 1year of follow-up were thereafter categorized into: (1) &#x3c; 300 mg/g (i.e., albuminuria regression) or (2) &#x3e; 300 mg/g (i.e., nonregression of albuminuria), and the cohort was followed-up for 5 years for all-cause mortality and CV events. Cox proportional hazard models were fitted to estimate the risk of all-cause death. <b><i>Results:</i></b> A total of 11,074 patients with insulin-treated T2D met the inclusion criteria. Their mean age was 62.3 (13.6) years; mean HbA1c: 8.7 (1.8) and 53% were male. A total of 682 deaths occurred after a follow-up period of 43,393 person-years with a mortality rate of 16 per 1,000 person-years. Five-year survival was markedly reduced in the group whose proteinuria persisted or progressed (91 vs. 95%; log-rank <i>p</i> value &#x3c; 0.001). Compared to patients whose ACR levels remained above 300 mg/g, all-cause mortality and CV events were 31 and 27% lower in those whose albuminuria regressed to &#x3c; 300 mg/g (adjusted hazard ratio [aHR] 0.69; 95% CI 0.52–0.91; <i>p</i> = 0.008 and aHR 0. 73; 95% CI 0.54–0.98; <i>p</i> = 0.041), respectively. <b><i>Conclusion:</i></b> In patients with insulin-treated T2D and nephropathy in routine practice, a regression in albuminuria (e.g., via better BP or glycemic control) is associated with a significant reduction in all-cause mortality. Thus, albuminuria is not only simply a risk marker of renal and CV disease but also an independent target for therapy. Albuminuria reduction should be viewed as a goal for renal and CV protection.
Unexpected High Prevalence of Cardiovascular Disease Risk Factors and Psychiatric Disease Among Young People With Sudden Cardiac Arrest
Authors: Allan Katherine S. , Morrison Laurie J. , Pinter Arnold , Tu Jack V. , Dorian Paul ,   the Rescu Investigators, Nascimiento Barto , Scales Damon , Ko Dennis , Hutchison Jamie , Dainty Katie , Swartz Richard , Verbeek Richard , Rizoli Sandro , Cheskes Sheldon , Brooks Steven , Lin Steve , Chan Tim 
Published: January 2019

Background

It is believed that most sudden cardiac arrests (
SCA
s) in young people occur in previously healthy people with rare risk factors for sudden death. Few studies have investigated large populations with complete ascertainment. Our objective was to use multisource records to identify and classify all out‐of‐hospital cardiac arrests in the Greater Toronto Area (population 6.6 million) in people aged 2 to 45 years from 2009 to 2012.

Methods and Results

Expert reviewers employed a systematic process, with emergency medical services, in‐hospital and coroner records, to adjudicate the cause of death as
SCA
from cardiac or noncardiac causes. We report the adjudicated etiologies, circumstances, triggers, and characteristics of the
SCA
cohort. Of 2937 eligible
out‐of‐hospital cardiac arrest
cases, 608 (20.7%)
SCA
s had an adjudicated etiology of cardiac cause (120 survivors and 488 nonsurvivors). Two thirds of these
SCA
patients had a history of cardiovascular disease, and over 50% had been diagnosed with ≥1 cardiovascular disease risk factor. Moreover, 20.1% of
SCA
s were diagnosed with psychiatric disease and 30% had central nervous system drugs prescribed. Over 30% of
SCA
patients had
central nervous system
active drugs, including drugs of abuse detected postmortem, with opioids and ethanol being detected most frequently. Potentially heritable structural cardiac diseases accounted for only 6.9% of
SCA
events, with acquired cardiac diseases comprising the rest.

Conclusions

The underlying causes of
SCA
, in people aged 2 to 45 years, often occur in those with previously diagnosed cardiovascular diseases, and are associated with contributory factors including prescribed medications, recreational drugs, and a concomitant psychiatric history.
Changing Epidemiology of Hypoplastic Left Heart Syndrome: Results of a National Swedish Cohort Study
Authors: Öhman Annika , El‐Segaier Milad , Bergman Gunnar , Hanséus Katarina , Malm Torsten , Nilsson Boris , Pivodic Aldina , Rydberg Annika , Sonesson Sven‐Erik , Mellander Mats 
Published: January 2019

Background
Norwood surgery provides a palliative surgical option for hypoplastic left heart syndrome and has been available in Sweden since 1993. The practice of prenatal ultrasound screening was gradually implemented in the same era, resulting in an increased prenatal detection rate. Our primary aims were to study changes in the incidence of live births, prenatal detection rate, and the termination of pregnancies over time. The secondary aims were to study the proportion of live‐borns undergoing surgery and to identify factors that influenced whether surgery was or was not performed.

Methods and Results
Neonates with hypoplastic left heart syndrome with aortic atresia born 1990‐2010 were identified through national databases, surgical files, and medical records. The fetal incidence was estimated from the period when prenatal screening was rudimentary. The study period was divided into the presurgical, early surgical, and late surgical periods. The incidence was calculated as the overall yearly incidence for each time period and sex separately. Factors influencing whether surgery was performed were analyzed using Cox‐logistic regression. The incidence at live birth decreased from 15.4 to 8.4 per 100 000. The prenatal detection rate increased from 27% to 63%, and terminations increased from 19% to 56%. The odds of having surgery was higher in the late period and higher in the group with prenatal diagnosis.

Conclusions
We observed a decrease in incidence of live‐borns with hypoplastic left heart syndrome aortic atresia. There was in increase in prenatal detection rate and an increase in termination of pregnancy. The proportion of live‐borns who underwent surgery increased between time periods.
Racial Differences in the Effect of Granulocyte Macrophage Colony‐Stimulating Factor on Improved Walking Distance in Peripheral Artery Disease: The PROPEL Randomized Clinical Trial
Authors: McDermott Mary M. , Polonsky Tamar S. , Guralnik Jack M. , Ferrucci Luigi , Tian Lu , Zhao Lihui , Stein James , Domanchuk Kathryn , Criqui Michael H. , Taylor Doris A. , Li Lingyu , Kibbe Melina R. 
Published: January 2019

Background

The effects of race on response to medical therapy in people with peripheral artery disease (
PAD
) are unknown.

Methods and Results

In the PROPEL (Progenitor Cell Release Plus Exercise to Improve Functional Performance in PAD) Trial,
PAD
participants were randomized to 1 of 4 groups for 6 months: supervised treadmill exercise+granulocyte‐macrophage colony‐stimulating factor (
GM
‐
CSF
) (Group 1), exercise+placebo (Group 2), attention control+
GM
‐
CSF
(Group 3), or attention control+placebo (Group 4). Change in 6‐minute walk distance was measured at 12‐ and 26‐week follow‐up. In these exploratory analyses, groups receiving
GM
‐
CSF
(Groups 1 and 3), placebo (Groups 2 and 4), exercise (Groups 1 and 2), and attention control (Groups 2 and 4) were combined, maximizing statistical power for studying the effects of race on response to interventions. Of 210
PAD
participants, 141 (67%) were black and 64 (30%) were white. Among whites,
GM
‐
CSF
improved 6‐minute walk distance by +22.0 m (95%
CI
: −4.5, +48.5,
P
=0.103) at 12 weeks and +44.4 m (95%
CI
: +6.9, +82.0,
P
=0.020) at 26 weeks, compared with placebo. Among black participants, there was no effect of
GM
‐
CSF
on 6‐minute walk distance at 12‐week (
P
=0.26) or 26‐week (−5.0 m [−27.5, +17.5,
P
=0.66]) follow‐up, compared with placebo. There was an interaction of race on the effect of
GM
‐
CSF
on 6‐minute walk change at 26‐week follow‐up (
P
=0.018). Exercise improved 6‐minute walk distance in black (
P
=0.006) and white (
P
=0.034) participants without interaction.

Conclusions

GM
‐
CSF
improved 6‐minute walk distance in whites with
PAD
but had no effect in black participants. Further study is needed to confirm racial differences in
GM
‐
CSF
efficacy in
PAD
.

Clinical Trial Registration

URL
:
http://www.clinicaltrials.gov
. Unique identifier:
NCT
01408901.
In‐Hospital Outcomes After Transcatheter Versus Surgical Aortic Valve Replacement in Octogenarians
Authors: Sheng Siyuan P. , Strassle Paula D. , Arora Sameer , Kolte Dhaval , Ramm Cassandra J. , Sitammagari Kranthi , Guha Avirup , Paladugu Madhu B. , Cavender Matthew A. , Vavalle John P. 
Published: January 2019

Background

Octogenarians have low physiologic reserve and may benefit more from transcatheter aortic valve replacement (
TAVR
) than surgical aortic valve replacement (
SAVR
).

Methods and Results

This retrospective cohort study based on the National Inpatient Sample included octogenarians who underwent
TAVR
or
SAVR
from 2012 to 2015. Crude and standardized‐morbidity‐ratio‐weighted regression models were used to compare in‐hospital outcomes. Among 19 145
TAVR
and 9815
SAVR
hospitalizations,
TAVR
patients had higher Charlson Comorbidity Index (
CCI
) scores (2.0 versus 0.8,
P
<0.0001) than
SAVR
patients. Before weighting,
TAVR
was associated with significantly shorter length of stay, more home discharges, and lower incidences of acute kidney injury, bleeding, and cardiogenic shock. Associations were consistent across Charlson Comorbidity Index, except for
TAVR
being associated with greater length of stay reductions among patients with Charlson Comorbidity Index ≥2, compared with Charlson Comorbidity Index <2 (change in estimate −3.56 versus −2.61 days,
P
=0.004). After weighting,
TAVR
patients had significantly shorter length of stay (change in estimate −3.29 days, 95%
CI
−3.82, −2.75) and lower odds of transfer to skilled nursing facility (odds ratio 0.34, 95%
CI
0.29, 0.41), acute kidney injury (odds ratio 0.55, 95%
CI
0.45, 0.68), bleeding (odds ratio 0.44, 95%
CI
0.37, 0.53), and cardiogenic shock (odds ratio 0.55, 95%
CI
0.33, 0.92), compared with
SAVR
patients. Odds of permanent pacemaker implantation, transient ischemic attack/stroke, vascular complications, and in‐hospital mortality were not significantly different.

Conclusions

TAVR
may be preferred over
SAVR
in high‐risk octogenarians because of shorter length of stay, better discharge disposition, and less acute kidney injury, and bleeding. All octogenarians may benefit more from
TAVR
, irrespective of comorbidity burden, but additional research is needed to confirm our findings.
Psychotic versus non-psychotic bipolar disorder: Socio-demographic and clinical profiles in an Italian nationwide study
Authors: Altamura Alfredo Carlo , Buoli Massimiliano , Cesana Bruno Mario , Fagiolini Andrea , de Bartolomeis Andrea , Maina Giuseppe , Bellomo Antonello , Dell’Osso Bernardo ,   ISBD Italian Chapter Epidemiological Group
Published: January 2019

Objective: Psychotic versus non-psychotic patients with bipolar disorder have been traditionally associated with different unfavorable clinical features. In this study on bipolar Italian patients, we aimed to compare clinical and demographic differences between psychotic and non-psychotic individuals, exploring clinical factors that may favor early diagnosis and personalized treatment. Methods: A total of 1671 patients (males: n = 712 and females: n = 959; bipolar type 1: n = 1038 and bipolar type 2: n = 633) from different psychiatric departments were compared according to the lifetime presence of psychotic symptoms in terms of socio-demographic and clinical variables. Chi-square tests for qualitative variables and Student’s t-tests for quantitative variables were performed for group comparison, and a multivariable logistic regression was performed, considering the lifetime psychotic symptoms as dependent variables and socio-demographic/clinical characteristics as independent variables. Results: Psychotic versus non-psychotic bipolar subjects resulted to: be more frequently unemployed ( p < 0.01) and never married/partnered ( p < 0.01); have an earlier age at onset ( p < 0.01); more frequently receive a first diagnosis different from a mood disorder ( p < 0.01); have a shorter duration of untreated illness ( p < 0.01); have a more frequently hypomanic/manic prevalent polarity ( p < 0.01) and a prevalent manic–depressive type of cycling ( p < 0.01); present a lower lifetime number of depressive episodes ( p < 0.01), but have more manic episodes ( p < 0.01); and less insight ( p < 0.01) and more hospitalizations in the last year ( p < 0.01). Multivariable regression analysis showed that psychotic versus non-psychotic bipolar patients received more frequently a first diagnosis different from bipolar disorder (odds ratio = 0.64, 95% confidence interval = [0.46, 0.90], p = 0.02) or major depressive disorder (odds ratio = 0.66, 95% confidence interval = [0.48, 0.91], p = 0.02), had more frequently a prevalent manic polarity (odds ratio = 1.84, 95% confidence interval = [1.14, 2.98], p < 0.01) and had a higher number of lifetime manic episodes (more than six) (odds ratio = 8.79, 95% confidence interval = [5.93, 13.05], p < 0.01). Conclusion: Lifetime psychotic symptoms in bipolar disorder are associated with unfavorable socio-demographic and clinical features as well as with a more frequent initial misdiagnosis.
Physical activity, physical function and quality of life in community-based maintenance cardiac rehabilitation
Authors: Hately Garrick , Mandic Sandra 
Published: January 2019

Objective: This study compared physical activity (PA), physical function and quality of life in elderly individuals with coronary artery disease (CAD) and their non-CAD peers participating in community-based, maintenance cardiac rehabilitation (CR). Design: Cross-sectional study. Setting: Community-based maintenance CR programme. Methods: A total of 39 individuals (71.8% women; age 70.5 ± 5.5 years; 13 CAD, 26 non-CAD) wore an accelerometer for 7 days and completed anthropometry, chair stands, handgrip strength, a Short Physical Performance Battery, a PA questionnaire (IPAQ- SF), a quality of life questionnaire (SF-36), a 10-m shuttle walk test and two 6-minute walk tests. Results: Compared with the non-CAD group, the CAD group accumulated more objectively measured moderate-to-vigorous PA per week (329.7 ± 233.3 vs 160.6 ± 149.5 minutes, p = .013), achieved PA guidelines on more days per week (3.8 ± 2.2 vs 2.1 ± 2.6 days/week, p = .042), had a lower proportion of body fat (27.5 ± 8.4% vs 36.5 ± 8.7%, p = .004) and a higher proportion of muscle mass (72.5 ± 8.4% vs 63.0 ± 9.8%, p = .022). Physical function and quality of life were not different between the groups. Conclusion: Elderly CAD patients participating in community-based maintenance CR performed more PA and had more favourable body composition but similar physical function and quality of life compared with their non-CAD peers. Long-term participation in community-based maintenance CR may promote PA in elderly CAD patients and help maintain physical function and quality of life at a level similar to that of their non-CAD peers. However, due to a small sample size, these findings should be interpreted with caution and examined in future larger studies.
Demographics, A1C Testing, and Medication Use of Mexican Americans and Mexicans With Diabetes
Authors: Aponte Judith 
Published: January 2019

Purpose The purpose of this study is to investigate diabetes rates among Mexicans 20 years and older living in the United States and Mexico in 2012 and 2016. Methods The national sample was the National Health and Nutrition Examination Survey (NHANES) 2011-2012, NHANES 2015-2016, Mexican National Health and Nutrition Survey 2012 (ie, Encuesta Nacional de Salud y Nutrición 2012 [ENSANUT 2012]), and ENSANUT de Medio Camino 2016 (ENSANUT-MC 2016). Sex, age, A1C testing, and medication use (insulin, oral hypoglycemic agents, and both) were examined among participants. Results Most participants in study were female (50.7%, 53.9%, and 57.2%) and were younger (61 years, 57 years, and 60 years). A1C testing was conducted more in the United States (69.6% and 82.6%) than in Mexico (9.5% and 15.1%). More Mexicans (73.1% and 67.8% vs 54.9% and 54.9%) were using oral hypoglycemic agents, while more Mexican Americans used insulin (12.6% and 11.6% vs 6.3% and 11.1%) and used both insulin and oral hypoglycemic agents (17.1% and 15.8% vs 6.6% and 8.7%). Conclusions By examining and highlighting the diabetes mellitus practices and standardization of A1C testing, providers will be able to better understand and address the rising rates of diabetes in the United States and Mexico while driving practice and policy changes.
Diabetes Educators Beliefs About Patient Self-Management and Strategies Used to Support Persons With Diabetes
Authors: Gee Julie Peila , Scarbrough John , Bowker Dawn , Keller Teresa 
Published: January 2019

Purpose The purpose of this study was to examine diabetes educators’ beliefs about the importance of patients’ role in self-management and the relationship between educator-reported strategies used to support patients with diabetes. Methods Using a descriptive, cross-sectional study design, diabetes educators’ (n = 225) beliefs toward self-management were assessed using the Clinician Support–Patient Activation Measure 13 (CS-PAM). Support strategies were assessed using the Clinician Self-Management Scale (SMS). Results The CS-PAM score for diabetes educators ranged from 56.1 to 100.0. The SMS scores ranged from 2.44 to 5.00. Educators’ beliefs and support strategies used in clinical encounters were significantly correlated. Bivariate analysis and multiple linear regression demonstrated no statistically significant differences in the beliefs of and support strategies used by educators and their characteristics. Conclusions Findings suggest that the majority of diabetes educators highly support and embrace patients’ participation in their own care. Educators who are more supportive of patients in self-managing are more likely to use effective support strategies, as measured by the SMS, thereby fostering a sense of patient ownership in their own care and promoting behavioral change that may lead to improved health outcomes. The lack of statistical significance between the educators’ beliefs and support strategies used and personal characteristics points to clinical implications in that diabetes educators are well aligned in the care of persons with diabetes.
Emergency surgery for left main disease: with and without cardioplegic arrest
Authors: Tsutsumi Koji , Ishida Osamu , Hashizume Kenichi , Inoue Yoshito 
Published: January 2019

Background The aims of this study were to evaluate the on-pump beating-heart technique of coronary artery bypass in patients with acute myocardial infarction and left main disease, and to retrospectively compare the early postoperative results with those of conventional on-pump arrested-heart coronary surgery. Methods Eighty-five patients with acute myocardial infarction caused by left main disease, who underwent emergency surgery between January 1998 and April 2017 at Saiseikai Utsunomiya Hospital, were enrolled in this study. Of these patients, 56 were evaluated using propensity-matched analysis. The patients were divided into two groups according to the surgical procedure: group A ( n = 28) had on-pump surgery on the arrested heart, and group B ( n = 28) had on-pump surgery on the beating heart. Early postoperative results were compared between the two groups. Results Preoperative and intraoperative characteristics showed no significant differences between the two groups. The peak creatine kinase myocardial band level was significantly lower in group B (group A 151 vs. group B 91 IU·L−1, p = 0.01). The early mortality rate was higher in group A than group B, but the difference was not significant (group A 28.6% vs. group B 17.9%, p = 0.53). Conclusions There was no significant advantage based on surgical procedure between on-pump beating-heart surgery and on-pump surgery on the arrested heart. On-pump beating-heart coronary artery bypass grafting significantly reduced the peak creatine kinase myocardial band level, but there were no significant differences in the early postoperative data, including the mortality rate and left ventricular function.
Advance care planning in the context of clinical deterioration: a systematic review of the literature
Authors: Pearse Wendy , Oprescu Florin , Endacott John , Goodman Sarah , Hyde Mervyn , O’Neill Maureen 
Published: January 2019

Background: A Rapid Response Team can respond to critically ill patients in hospital to prevent further deterioration and unexpected deaths. However, approximately one-third of reviews involve a patient approaching the end-of-life. It is not well understood whether patients have pre-existing advance care plans at the time of significant clinical deterioration requiring Rapid Response Team review. Nor is it understood whether such critical events prompt patients, their families and treating teams to discuss advance care planning and consider referral to specialist palliative care services. Aim and design: This systematic review examined advance care planning with patients who experience significant clinical deterioration in hospital and require Rapid Response Team review. The prevalence of pre-existing advance directives, whether this event prompts end-of-life discussions, the provision of broader advance care planning and referral to specialist palliative care services was examined. Data sources: Three electronic databases up to August 2017 were searched, and a manual review of article reference lists conducted. Quality of studies was appraised by the first and fourth authors. Results: Of the 324 articles identified through database searching, 31 met the inclusion criteria, generating data from 47,850 patients. There was a low prevalence of resuscitation orders and formal advance directives prior to Rapid Response Team review, with subsequent increases in resuscitation and limitations of medical treatment orders, but not advance directives. There was high short- and long-term mortality following review, and low rates of palliative care referral. Conclusions: The failure of patients, their families and medical teams to engage in advance care planning may result in inappropriate Rapid Response Team review that is not in line with patient and family priorities and preferences. Earlier engagement in advance care planning may result in improved person-centred care and referral to specialist palliative care services for ongoing management.