bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence, Mortality, and Outcome-Predictors of Sudden Cardiac Arrest Complicating Myocardial Infarction Prior to Hospital Admission
Authors: Karam Nicole , Bataille Sophie , Marijon Eloi , Tafflet Muriel , Benamer Hakim , Caussin Christophe , Garot Philippe , Juliard Jean-Michel , Pires Virginie , Boche Thévy , Dupas François , Le Bail Gaelle , Lamhaut Lionel , Simon Benoît , Allonneau Alexandre , Mapouata Mireille , Loyeau Aurélie , Empana Jean-Philippe , Lapostolle Frederic , Spaulding Christian , Jouven Xavier , Lambert Yves ,   for the e-MUST Study Investigators
Published: January 2019

Background:
Mortality of ST-segment–elevation myocardial infarction (STEMI) decreased drastically, mainly through reduction in inhospital mortality. Prehospital sudden cardiac arrest (SCA) became one of the most feared complications. We assessed the incidence, outcome, and prognosis’ predictors of prehospital SCA occurring after emergency medical services (EMS) arrival.

Methods and Results:

Data were taken between 2006 and 2014 from the e-MUST study (Evaluation en Médecine d’Urgence des Strategies Thérapeutiques des infarctus du myocarde) that enrolls all STEMI managed by EMS in the Greater Paris Area, including those dead before hospital admission. Among 13 253 STEMI patients analyzed, 749 (5.6%) presented EMS-witnessed prehospital SCA. Younger age, absence of cardiovascular risk factors, symptoms of heart failure, extensive STEMI, and short pain onset-to-call and call-to-EMS arrival delays were independently associated with increased SCA risk. Mortality rate at hospital discharge was 4.0% in the nonSCA group versus 37.7% in the SCA group (
P
<0.001); 26.8% of deaths occurred before hospital admission. Factors associated with increased mortality after SCA were age, heart failure, and extensive STEMI, while male sex and cardiovascular risk factors were associated with decreased mortality. Among patients admitted alive, PCI was the most important mortality-reduction predictor (odds ratio, 0.40; 95% CI, 0.25–0.63;
P
<0.0001).

Conclusions:
More than 1 of 20 STEMI presents prehospital SCA after EMS arrival. SCA occurrence is associated with a 10-fold higher mortality at hospital discharge compared with STEMI without SCA. PCI is the strongest survival predictor, leading to a twice-lower mortality. This highlights the persistently dramatic impact of SCA on STEMI and the major importance of PCI in this setting.
Impact of Participation in a Telestroke Network on Clinical Outcomes
Authors: Zhang Donglan , Shi Lu , Ido Moges S. , Green Dale E. , Li Yan , Su Dejun , Hess David C. 
Published: January 2019

Background:
A telestroke program, known as the Remote Evaluation for Acute Ischemic Stroke program, has been implemented in Georgia since 2003. This study examined whether a hospital’s participation in a telestroke network was associated with improvement in clinical outcomes and quality indicators.

Methods and Results:
An observational study was conducted using data from the Georgia Coverdell Acute Stroke Registry between September 2005 and September 2016 for patients aged ≥18 years with ischemic stroke. We use a difference-in-differences approach to compare the following clinical outcomes and quality indicators among those admitted at hospitals within and outside of the Remote Evaluation for Acute Ischemic Stroke network: tPA (tissue-type plasminogen activator) use, complications related to tPA use, door-to-needle time, ambulation at discharge, discharge status, and destination. Logistic regression models and a propensity score weighting approach were performed to adjust for patients’ age, sex, race, insurance coverage, arrival mode, ambulatory status before the current stroke, stroke severity, medical history, admission time, and hospital bed size. A total of 25 494 patients with ischemic stroke admitted at 15 nonteaching hospitals located outside of the Atlanta metropolitan area were included in the analysis. After propensity score weighting, hospitals participated in a telestroke network was not associated with a significant increase in the rate of tPA use, while it was significantly associated with a modest decline in the rate of complications related to tPA (−5.9%; 95% CI, −9.2% to −2.6%). Telestroke participation showed no significant difference in other clinical outcomes and quality measures except for a marginally significant decrease in in-hospital mortality (−1.1%; 95% CI, −2.2% to −0.1%).

Conclusions:
Although a slight decrease in tPA complication was observed among hospitals participating in the telestroke network, overall the impact of telestroke participation on a hospital’s stroke care quality was not statistically significant based on our observational study.
The Impact of Head-Worn Displays on Strategic Alarm Management and Situation Awareness
Authors: Pascale Michael T. , Sanderson Penelope , Liu David , Mohamed Ismail , Brecknell Birgit , Loeb Robert G. 
Published: January 2019

Objective: To investigate whether head-worn displays (HWDs) help mobile participants make better alarm management decisions and achieve better situation awareness than alarms alone. Background: Patient alarms occur frequently in hospitals but often do not require clinical intervention. Clinicians may become desensitized to alarms and fail to respond to clinically relevant alarms. HWDs could make patient information continuously accessible, support situation awareness, and help clinicians prioritize alarms. Method: Experiment 1 ( n = 76) tested whether nonclinicians monitoring simulated patients benefited from vital sign information continuously displayed on an HWD while they performed a secondary calculation task. Experiment 2 ( n = 13) tested, across three separate experimental sessions, how effectively nursing trainees monitored simulated patients’ vital signs under three different display conditions while they assessed a simulated patient. Results: In Experiment 1, participants who had access to continuous patient information on an HWD responded to clinically important alarms 25.9% faster and were 6.7 times less likely to miss alarms compared to participants who only heard alarms. In Experiment 2, participants using an HWD answered situation awareness questions 18.9% more accurately overall than when they used alarms only. However, the effect was significant in only two of the three experimental sessions. Conclusion: HWDs may help users maintain continuous awareness of multiple remote processes without affecting their performance on ongoing tasks. Application: The outcomes may apply to contexts where access to continuous streams of information from remote locations is useful, such as patient monitoring or clinical supervision.
Drainage and sewage system performance – Consequences of reductions in toilet flush volume
Authors: Valencio Isabella P , Gonçalves Orestes M 
Published: January 2019

This study aims to evaluate impacts of reducing toilet flush volume from 6.8 to 4.8 Lpf with laboratory and field studies. In laboratory, 260 tests were performed including water consumption, waste removal and solid transport tests, in 20 different toilets produced by national and international manufacturers. These tests demonstrated that a simple reduction in flush tank water level was not a viable solution for reducing flush volume, due to flush energy loss. Toilets are designed to work with certain water volume, and reducing this volume without studying the consequences that this could cause, can make with the toilet fail. Toilets approved according the standards ABNT NBR15097, ABNT NBR15491 and ASMEA112.19.2 were installed in 10 houses. The monitoring of water consumption and sewage system videos were conducted during eight months. When 6.8-Lpf toilets were installed, the average toilet water consumption was 16.6L/inhabitant/day. For 4.8-Lpf toilets, this value increased to 17.6. The number of flushes/person/day increased after toilets replacement, indicating that users applied successive flushes. Videos showed blockages in sewage system horizontal pipes. Findings from this study suggest that low-flush toilets do not decrease total water use, and may result in increased water use. In addition, they can cause clogging and solid deposit on sewage system. Practical application: Many management failures have affected the world water availability. Water demand has increased with population growth, and unless the equilibrium between water demand and supply is restored, the world will face increasing water shortage. However, it is essential to study the way of reducing water consumption. Without an effective analysis, instead of bringing benefits to population, water consumption reduction can lead to clogging and negative consequences on sewage system performance, causing disorder to them. It is recommended that manufacturers did not reduce the toilet water consumption without a study on the impact caused on the sewage systems, as well as designers should be careful when specifying sanitary appliances.
Effects of quadriceps muscle neuromuscular electrical stimulation in living donor liver transplant recipients: phase-II single-blinded randomized controlled trial
Authors: Hanada Masatoshi , Soyama Akihiko , Hidaka Masaaki , Nagura Hiroki , Oikawa Masato , Tsuji Ayumi , Kasawara Karina Tamy , Mathur Sunita , Reid W Darlene , Takatsuki Mitsuhisa , Eguchi Susumu , Kozu Ryo 
Published: January 2019

Objective: To evaluate the efficacy of neuromuscular electrical stimulation on quadriceps muscle strength and thickness in liver transplantation patients. Design: Phase-II, randomized, parallel-group, allocation-concealed, assessor-blinded, single-center controlled trial. Setting: Inpatient rehabilitation sector. Subjects: Patients following living donor liver transplantation. Interventions: The quadriceps muscle stimulation and the control groups received bilateral muscle electrical stimulation on the quadriceps and tibialis anterior muscles, respectively. Neuromuscular electrical stimulation sessions in both groups were conducted for 30 minutes per session, once per day for five weekdays over four weeks by a physical therapist. Main measures: Quadriceps muscle strength and quadriceps muscle thickness. Results: Neuromuscular electrical stimulation was applied to the quadriceps muscles group ( n = 23) or the tibialis anterior muscle in the control group ( n = 22). The decrease in quadriceps muscle thickness differed significantly between both groups on postoperative day 30 (median −3 vs −8, P < 0.01). The changes in predicted quadriceps strength and 6 minutes walking distance were not significantly different between groups (quadriceps strength median −12% vs −5%, P = 0.40; 6 minutes walking distance median −18 vs −21 m, P = 0.74). Conclusion: Neuromuscular electrical stimulation of the quadriceps muscle for liver transplantation recipients was able to maintain the quadriceps muscle thickness after surgery. Future larger scale studies are needed to consider the effectiveness of neuromuscular electrical stimulation and how to incorporate this intervention in the overall strategy of the physical therapy program.
PET Imaging of Hepatocellular Carcinomas: 18F-Fluoropropionic Acid as a Complementary Radiotracer for 18F-Fluorodeoxyglucose
Authors: Zhao Jing , Zhang Zhanwen , Nie Dahong , Ma Hui , Yuan Gongjun , Su Shu , Liu Shaoyu , Liu Sheng , Tang Ganghua 
Published: January 2019

Objective: To evaluate the preclinical value of 18F-fluoropropionic acid (18F-FPA) and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) for imaging HCCs. Methods: The 18F-FPA and 18F-FDG uptake patterns in 3 HCC cell lines (Hep3B, HepG2, and SK-Hep1) were assessed in vitro and in vivo. The 18F-FPA uptake mechanism was investigated using inhibition experiments with orlistat and 5-tetradecyloxy-2-furoic acid. The 18F-FPA PET imaging was performed in different tumor animal models and compared with 18F-FDG. We also evaluated the expressions of glucose transporter-1 (GLUT1), fatty acid synthase (FASN), and matrix metalloproteinase-2 (MMP2) in these cell lines. Results: In vitro experiments showed that the radiotracer uptake patterns were complementary in the HCC cell lines. Orlistat and 5-tetradecyloxy-2-furoic acid decreased the uptake of 18F-FPA. The tumor-to-liver ratio of 18F-FPA was superior to that of 18F-FDG in the SK-Hep1 and HepG2 tumors ( P < .05). However, in the Hep3B tumors, the tumor-to-liver normalized uptake of 18F-FDG was higher than 18F-FPA ( P < .01). FASN was highly expressed in cell lines with high 18F-FPA uptake, whereas GLUT1 was highly expressed in cell lines with high 18F-FDG uptake. The 18F-FPA uptake correlated with FASN ( r = 0.89, P = .014) and MMP2 ( r = 0.77, P = .002) expressions. Conclusions: PET imaging with 18F-FPA combined with 18F-FDG can be an alternative for detecting HCC.
Trainer and support staff’s experiences of engaging with the Who’s Challenging Who? challenging behaviour training course
Authors: Flynn Samantha , Hastings Richard P , Gillespie David , McNamara Rachel , Randell Elizabeth 
Published: January 2019

Background: The Who’s Challenging Who? (WCW) training is coproduced and delivered by people with intellectual disabilities (IDs), and it aims to improve staff empathy for people with challenging behaviour (CB). This study qualitatively describes trainees’ and trainers’ experiences of the WCW. Methods: Semi-structured interviews were undertaken with managers ( n = 7), support staff ( n = 6) and the WCW trainers ( n = 4; three had IDs). Interviews were transcribed verbatim and analysed using thematic analysis. Results: Two cross-cutting themes were drawn from the data: (1) valued roles of the trainers, whereby trainers and trainees benefited from the training being coproduced and delivered by people with IDs, and (2) beyond the training, within which trainees reported that they were engaging in increased reflection about their past and current practice. Conclusions: Being trained by people with IDs and CB appears to be a useful method, which can lead to perspective taking and reflection about supporting people with IDs and CB.
Estimation of stochastic behaviour in cardiac myocytes: I. Ca2+ movements inside the cytosol and sarcoplasmic reticulum on curvilinear domains
Authors: Arif Serife , Lai Choi-Hong , Ramesh Nadarajah I 
Published: January 2019

Background Since the discovery of Ca2+ sparks and their stochastic behaviour in cardiac myocytes, models have focused on the inclusion of stochasticity in their studies. While most models pay much attention to the stochastic modelling of cytosolic Ca2+ concentration the coupling of Ca2+ sparks and blinks in a stochastic model has not been explored fully. The cell morphology in in silico studies in the past is assumed to be Cartesian, spherical or cylindrical. The application on curvilinear grids can easily address certain restrictions posed by such grid set up and provide more realistic cell morphology. In this paper, we present a stochastic reaction–diffusion model that couples Ca2+ sparks and blinks in realistic shapes of cells in curvilinear domains. Methodology: Transformation of the model was performed to the curvilinear coordinate system. The set of equations is used to produce Ca2+ waves initiated from sparks and blinks. A non-buffered and non-dyed version as well as a buffered and dyed version of these equations were studied in light of observing the dynamics on the two different systems. For comparison, results for both the Cartesian and curvilinear grids are provided. Results and conclusions: A successful demonstration of the application of curvilinear grids serving as basis for future developments.
The relation of novel cardiovascular risk parameters in patients with familial Mediterranean fever
Authors: Kozan Mustafa , Ozan Zeynep Tugba , Demir Vahit , Ede Hüseyin 
Published: January 2019

Objective In this study, we aimed at correlating the thickness of epicardial adipose tissue and levels of Vitamin D with cardiac risk in patients with familial Mediterranean fever. Methods Sixty-five patients with familial Mediterranean fever and 38 healthy controls with matching age and sex were included in the study. The patients with a history of familial Mediterranean fever attacks within the previous two weeks or with any history of inflammatory or cardiovascular disease were excluded. Data regarding age, gender, weight, height, waist circumference, body mass index (calculated as weight/height2), pulse wave velocity, serum Vitamin D levels from fasting blood samples, and Homeostatic Model Assessment for insulin resistance were obtained for the patients and controls. The epicardial adipose tissue was visualized as an echo-free space between the outer surface of myocardium and visceral pericardium using two-dimensional echocardiography, and the thickness of epicardial adipose tissue was measured in parasternal long-axis view at the end of diastole. Results The patients with familial Mediterranean fever had significantly higher levels of C-reactive protein, epicardial adipose tissue, and pulse wave velocity (p < 0.001, <0.05, <0.005, respectively) as compared with the control group. However, the serum Vitamin D levels in the two groups were observed to be similar (p = 0.486). Weak but significant positive correlations were observed between epicardial adipose tissue thickness and C-reactive protein (r = 0.302, p < 0.005), epicardial adipose tissue thickness and pulse wave velocity (r = 0.263, p < 0.01), and C-reactive protein and pulse wave velocity (r = 0.235, p < 0.05). Conclusion Thickness of epicardial adipose tissue and pulse wave velocity were observed to increase in patients with familial Mediterranean fever.
Alterations in Protein Kinase A Substrate Specificity as a Potential Cause of Cushing Syndrome
Authors: Bathon Kerstin , Weigand Isabel , Vanselow Jens T , Ronchi Cristina L , Sbiera Silviu , Schlosser Andreas , Fassnacht Martin , Calebiro Davide 
Published: January 2019

AbstractCushing syndrome is a severe endocrine disorder of cortisol excess associated with major metabolic and cardiovascular sequelae. We recently identified somatic mutations in PRKACA, the gene encoding the catalytic (C) α subunit of protein kinase A (PKA), as being responsible for cortisol-producing adrenocortical adenomas (CPAs), which are a major cause of Cushing syndrome. In spite of previous studies on the two initially identified mutations (L206R, 199_200insW), the mechanisms of action of the clinically highly relevant PRKACA mutations remain poorly understood. Here, by investigating a large panel of PRKACA mutations, including all those identified so far in Cushing syndrome, we unexpectedly found that not all mutations interfere with the binding of regulatory (R) subunits as previously hypothesized. Because several mutations lie in a region of PKA Cα involved in substrate recognition, we investigated their consequences on substrate specificity by quantitative phosphoproteomics. We found that all three mutations analyzed (L206R, 200_201insV, and d244−248+E249Q) cause major changes in the preference of PKA for its targets, leading to hyperphosphorylation of several PKA substrates, most notably including histone H1.4 at Ser36, which is required for and promotes mitosis. This is reflected by a ninefold hyperphosphorylation of H1.4 in CPAs carrying the L206R mutation. Thus, our findings suggest that in addition to hampering binding to R subunits, PRKACA mutations act by altering PKA substrate specificity. These findings shed light on the molecular events leading to Cushing syndrome and illustrate how mutations altering substrate specificity of a protein kinase may cause human disease.
Sigmoid volvulus: Comorbidity with sigmoid gangrene
Authors: Atamanalp Sabri Selcuk , Disci Esra , Atamanalp Refik Selim 
Published: January 2019

Sigmoid volvulus (SV) is the wrapping of the sigmoid colon around its mesentery, and sigmoid gangrene is a catastrophic complication of SV. Although the diagnosis of SV is generally not difficult, unfortunately, most of the clinical, laboratory and radiological signs are not pathognomonic in demonstrating sigmoid gangrene. The treatment of gangrenous SV requires emergency surgery. Sigmoid gangrene worsens the prognosis of SV by doubling the mortality rate.
How to cite this:Atamanalp SS, Disci E, Atamanalp RS. Sigmoid volvulus: Comorbidity with sigmoid gangrene. Pak J Med Sci. 2019;35(1):288-290. doi: https://doi.org/10.12669/pjms.35.1.295
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Biochemical and clinical characterization of metabolic phenotypes: a cross-sectional study from Maracaibo city, Venezuela
Authors: Bermudez Valmore , Rojas Joselyn , Salazar Juan , Martinez Maria Sofia , Olivar Luis Carlos , Calvo Maria Jose , Mindiola Andres , Añez Roberto , Wilches-Duran Sandra , Cerda Marcos , Graterol Modesto , Graterol Rosemily , Hernandez Juan Diego , Garicano Carlos , Velasco Manuel 
Published: January 2019

Background: In 1980, Reuben Andresen observed that in certain individuals, obesity did not increase mortality, introducing an atypical phenotype called “healthy obese”. Other studies reported that 10-15 % of lean individuals presented insulin resistance, hyperglycemia and dyslipidemia. The objective of this study was to evaluate biochemical and clinical characteristics of metabolic phenotypes in Maracaibo city. Methods: A descriptive, cross-sectional sub-analysis of The Maracaibo City Metabolic Syndrome Prevalence Study, with a randomized multistage sampling was performed including 1226 non diabetic individuals from both sexes. For phenotype definition, the subjects were first classified according to their BMI into Normal-Weight, Overweight and Obese; then divided in metabolically healthy and unhealthy using a two-step analysis cluster being predictive variables: HOMA2-IR, HOMA2-βcell, triglycerides. To evaluate the relationship with coronary risk, a multiple logistic regression model was performed. Results: In the studied population, 43.9% (n=538) were healthy normal weight, 5.2% (n=64) unhealthy normal weight, 17.4% (n=217) healthy obese and 33.5% (n=411) unhealthy obese subjects. Atypical phenotypes, Metabolically Unhealthy Normal-Weight (MUNW) was more frequent in males (56.3%), whereas Metabolically Unhealthy Obese (MUO) was more frequent in females (51.3%). This phenotypes had a higher coronary event risk, especially for obese individuals (MHO: OR=1.85 CI95%: 1.11-3.09; p=0.02 and MUO: OR=2.09 CI95%: 1.34-3.28; p<0.01). Conclusion: Individuals with atypical metabolic phenotypes are common in Maracaibo city. Related factors may include insulin resistance, basal glucose, and triglycerides levels. Lastly, obese subjects show a higher coronary event risk even those with normal metabolic status.