bluuebunny/crossref_metadata_2025_split huggingface dataset:
Protective Roles of Interferon‐γ in Cardiac Hypertrophy Induced by Sustained Pressure Overload
Authors: Kimura Akihiko , Ishida Yuko , Furuta Machi , Nosaka Mizuho , Kuninaka Yumi , Taruya Akira , Mukaida Naofumi , Kondo Toshikazu 
Published: March 2018

Background

A clear understanding of the molecular mechanisms underlying hemodynamic stress‐initiated cardiac hypertrophy is important for preventing heart failure. Interferon‐γ (
IFN
‐γ) has been suggested to play crucial roles in various diseases other than immunological disorders by modulating the expression of myriad genes. However, the involvement of
IFN
‐γ in the pathogenesis of cardiac hypertrophy still remains unclear.

Methods and Results

In order to elucidate the roles of
IFN
‐γ in pressure overload–induced cardiac pathology, we subjected Balb/c wild‐type (
WT
) or
IFN
‐γ‐deficient (
Ifng
−/−
) mice to transverse aortic constriction (
TAC
). Three weeks after
TAC
,
Ifng
−/−
mice developed more severe cardiac hypertrophy, fibrosis, and dysfunction than
WT
mice. Bone marrow–derived immune cells including macrophages were a source of
IFN
‐γ in hearts after
TAC
. The activation of
PI
3K/Akt signaling, a key signaling pathway in compensatory hypertrophy, was detected 3 days after
TAC
in the left ventricles of
WT
mice and was markedly attenuated in
Ifng
−/−
mice. The administration of a neutralizing anti‐
IFN
‐γ antibody abrogated
PI
3K/Akt signal activation in
WT
mice during compensatory hypertrophy, while that of
IFN
‐γ activated
PI
3K/Akt signaling in
Ifng
−/−
mice.
TAC
also induced the phosphorylation of Stat5, but not Stat1 in the left ventricles of
WT
mice 3 days after
TAC
. Furthermore,
IFN
‐γ induced Stat5 and Akt phosphorylation in rat cardiomyocytes cultured under stretch conditions. A Stat5 inhibitor significantly suppressed
PI
3K/Akt signaling activation in the left ventricles of
WT
mice, and aggravated pressure overload–induced cardiac hypertrophy.

Conclusions

The
IFN
‐γ/Stat5 axis may be protective against persistent pressure overload–induced cardiac hypertrophy by activating the
PI
3K/Akt pathway.
The Impact of Opening a Medical Step-Down Unit on Medically Critically Ill Patient Outcomes and Throughput: A Difference-in-Differences Analysis
Authors: Gershengorn Hayley B. , Chan Carri W. , Xu Yunchao , Sun Hanxi , Levy Ronni , Armony Mor , Gong Michelle N. 
Published: March 2018

Objective: To understand the impact of adding a medical step-down unit (SDU) on patient outcomes and throughput in a medical intensive care unit (ICU). Design: Retrospective cohort study. Setting: Two academic tertiary care hospitals within the same health-care system. Patients: Adults admitted to the medical ICU at either the control or intervention hospital from October 2013 to March 2014 (preintervention) and October 2014 to March 2015 (postintervention). Interventions: Opening a 4-bed medical SDU at the intervention hospital on April 1, 2014. Measurements and Main Results: Using standard summary statistics, we compared patients across hospitals. Using a difference-in-differences approach, we quantified the association of opening an SDU and outcomes (hospital mortality, hospital and ICU length of stay [LOS], and time to transfer to the ICU) after adjustment for secular trends in patient case-mix and patient-level covariates which might impact outcome. We analyzed 500 (245 pre- and 255 postintervention) patients in the intervention hospital and 678 (323 pre- and 355 postintervention) in the control hospital. Patients at the control hospital were younger (60.5-60.6 vs 64.0-65.4 years, P < .001) with a higher severity of acute illness at the time of evaluation for ICU admission (Sequential Organ Failure Assessment score: 4.9-4.0 vs 3.9-3.9, P < .001). Using the difference-in-differences methodology, we identified no association of hospital mortality (odds ratio [95% confidence interval]: 0.81 [0.42 to 1.55], P = .52) or hospital LOS (% change [95% confidence interval]: −8.7% [−28.6% to 11.2%], P = .39) with admission to the intervention hospital after SDU opening. The ICU LOS overall was not associated with admission to the intervention hospital in the postintervention period (−23.7% [−47.9% to 0.5%], P = .06); ICU LOS among survivors was significantly reduced (−27.5% [−50.5% to −4.6%], P = .019). Time to transfer to ICU was also significantly reduced (−26.7% [−44.7% to −8.8%], P = .004). Conclusions: Opening our medical SDU improved medical ICU throughput but did not affect more patient-centered outcomes of hospital mortality and LOS.
Extended Mortality and Chronic Kidney Disease After Septic Acute Kidney Injury
Authors: Chua Horng-Ruey , Wong Weng-Kin , Ong Venetia Huiling , Agrawal Dipika , Vathsala Anantharaman , Tay Hui-Ming , Mukhopadhyay Amartya 
Published: March 2018

Purpose: To evaluate 1-year mortality in patients with septic acute kidney injury (AKI) and to determine association between initial AKI recovery patterns ( reversal within 5 days, beyond 5 days but recovery, or nonrecovery) and chronic kidney disease (CKD) progression. Methods: Prospective observational study, with retrospective evaluation of initial nonconsenters, of critically ill patients with septic AKI. Results: We studied 207 patients (age, mean [SD]: 64 [16] years, 39% males), of which 56 (27%), 18 (9%), and 9 (4%) died in intensive care unit (ICU), post-ICU in hospital, and posthospitalization, respectively. Infections (including pneumonia) and major adverse cardiac events accounted for 64% and 12% of deaths, respectively. Factors independently associated with 1-year mortality include older age, ischemic heart disease, higher Simplified Acute Physiology Score II, central nervous system or musculoskeletal primary infections, higher daily fluid balance (FB), and frusemide administration during ICU stay (all P < .05). Among 63 patients receiving renal replacement therapy (RRT), hospital mortality was higher with cumulative median FB >8 L versus ≤8 L at RRT initiation (57% vs 24%; P = .009); there was trend for less ICU- and RRT-free days at day 28 in patients with higher FB pre-RRT ( P = NS). Chronic kidney disease progression over 1 year developed in 21%, 30%, and 79% of 105 initial survivors with AKI reversal, recovery, and nonrecovery, respectively ( P < .001). Acute kidney injury nonrecovery during hospitalization independently predicted CKD progression ( P = .001). Conclusions: Patients with septic AKI had 40% 1-year mortality, mainly associated with infections. High FB and frusemide administration were modifiable risk factors. Risk of CKD progression is high especially with initial AKI nonrecovery.
Evaluating Palliative Care Resources Available to the Public Using the Internet and Social Media
Authors: Claudio Celeste H. , Dizon Zoelle B. , October Tessie W. 
Published: March 2018

Background: Accessible information about palliative care available to the public on the Internet is growing. We do not know whether this information is consistent with the current accepted definition of palliative care. Aim: To identify resources on the Internet and social media regarding palliative care and evaluate the information conveyed. Design: A cross-sectional study of “palliative care” search results. Setting: Top 10 Google websites, top 10 most viewed YouTube videos, and social media platforms, Facebook and Twitter, were searched. Results: The most popular Google websites were mostly from national organizations promoting palliative care, whose definitions of palliative care consistently mention “quality of life” and “relief from symptoms and stress.” None of the websites mentioned children, and 77% cited palliative care as treatment for cancer with less focus on other diseases. No personal stories were included in Google websites, while 60% of YouTube videos included personal stories. Five main themes were generated from 266 YouTube video comments analyzed. The most common theme was emotionality, of which 91% were positive statements. Facebook and Twitter were mostly used by health-care professionals and not the public. Conclusions: Palliative care resources are mostly positive and consistent with the current definition of palliative care. Major Internet search engines such as Google and YouTube provide valuable insight into information the public receives about palliative care. Future development of Internet resources on palliative care should consider including children and emphasizing palliative care for all life-limiting illnesses.
Development of a Risk Tool to Support Discussions of Care for Older Adults Admitted to the ICU With Pneumonia
Authors: Satchidanand Nikhil , Servoss Timothy J. , Singh Ranjit , Bosinski Angela M. , Tirpak Penny , Horton Linda L. , Naughton Bruce J. 
Published: March 2018

Background: Early, data-driven discussion surrounding palliative care can improve care delivery and patient experience. Objective: To develop a 30-day mortality prediction tool for older patients in intensive care unit (ICU) with pneumonia that will initiate palliative care earlier in hospital course. Design: Retrospective Electronic Health Record (EHR) review. Setting: Four urban and suburban hospitals in a Western New York hospital system. Participants: A total of 1237 consecutive patients (>75 years) admitted to the ICU with pneumonia from July 2011 to December 2014. Measurements: Data abstracted included demographics, insurance type, comorbidities, and clinical factors. Thirty-day mortality was also determined. Logistic regression identified predictors of 30-day mortality. Area under the receiver operating curve (ROC) was calculated to quantify the degree to which the model accurately classified participants. Using the coordinates of the ROC, a predicted probability was identified to indicate high risk. Results: A total of 1237 patients were included with 30-day mortality data available for 100% of patients. The mortality rate equaled 14.3%. Age >85 years, having active cancer, Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), sepsis, and being on a vasopressor all predicted mortality. Using the derived index, with a predicted probability of mortality >0.146 as a cutoff, sensitivity equaled 70.6% and specificity equaled 65.6%. The area under the ROC was 0.735. Conclusion: Our risk tool can help care teams make more informed decisions among care options by identifying a patient group for whom a careful review of goals of care is indicated both during and after hospitalization. External validation and further refinement of the index with a larger sample will improve prognostic value.
Photometric Evaluation in Adolescence of Patients With Bilateral Cleft Lip and Palate Treated With Nasoalveolar Molding and Primary Columella Lengthening
Authors: Meazzini Maria Costanza , Chiavenna Carlo , Autelitano Luca , Garattini Giovanna , Brusati Roberto 
Published: March 2018

Objective: Nasal stigma in patients with bilateral cleft lip and palate (BCLP) are a short columella and a flattened nasal tip. Design: The aim of this study was to evaluate the aesthetics of adolescents with BCLP, operated with a modified Cutting primary columella lengthening technique, associated to a modified Grayson orthopedic nasoalveolar molding (NAM). Setting and Patients: 72 BCLP patients were operated with this approach. Standardized photographic records were taken every 2 years. A group of 23 patients between 12 and 13 years of age was compared through normalized photogrammetry to a matched control of 23 noncleft adolescents. Results: Nasal protrusion and length of the columella were very close to normal. On the other hand, nasolabial angle and interalar width were still excessively wide compared to the noncleft sample. Conclusions: NAM and primary columella lengthening in BCLP has allowed to avoid traditional secondary columella lengthening at 5 to 6 years of age and given the patients a more pleasing, near-normal nasolabial appearance until adolescence. Some of the patients will require correction of the nasal width at a later stage.
Can Dynamic MRI Be Used to Accurately Identify Velopharyngeal Closure Patterns?
Authors: Perry Jamie L. , Mason Kazlin , Sutton Bradley P. , Kuehn David P. 
Published: March 2018

Background: Dynamic magnetic resonance imaging (MRI) has been proposed as a non-invasive, child-friendly, reproducible, and repeatable imaging method providing a 3-dimensional view of the velopharyngeal structures and function during speech. However, the value of dynamic MRI as compared to imaging methods such as nasopharyngoscopy is not well understood. The aim of this study was to compare the ability of nasopharyngoscopy and dynamic MRI to accurately identify velopharyngeal closure patterns among adults without cleft palate. Methods: Participants included 34 healthy adults with normal anatomy between 19 and 33 years of age (mean = 23 years; SD = 4.1 years). Participants underwent dynamic MRI and nasopharyngoscopy studies and comparisons were performed to determine the intra- and inter-rater reliability for accurately determining closure pattern. The MRI acquisition was a dynamic acquisition of a 2D plane. Results: Strong inter- (κ = .824; P < .001) and intra-rater (Rater 1: κ = 0.879, P < .001, 94% agreement between ratings; Rater 2 with 100% agreement) agreement was observed for the identification of closure pattern using nasopharyngoscopy. Inter-rater agreement for ratings using MRI demonstrated moderate agreement (κ = .489; P < .004). Examining point agreement revealed only 27 of the 33 ratings of MRI showed agreement (80%). Conclusion: This demonstrates that inter-rater reliability for determining closure patterns from nasopharyngoscopy is good; however, ratings using MRI was less reliable at determining closure patterns. It is likely that future improvements in dynamic imaging with MRI to enable 3D visualizations are needed for improved diagnostic accuracy for assessing velopharyngeal closure patterns.
Utility of Hematological Parameters in Predicting No-Reflow Phenomenon After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction
Authors: Wang Zuoyan , Ren Lihui , Liu Na , Peng Jianjun 
Published: March 2018

Objective: Because the no-reflow phenomenon in patients with ST- segment elevation myocardial infarction can lead to poor outcomes and early identification of patients at high risk may alter the clinical outcome, we aimed to study possible differences in the predictive utility among hematological parameters for early identification of patients at high risk of the no-reflow phenomenon during the primary percutaneous coronary intervention. Methods: A total of 612 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were enrolled. The patients were divided into 2 groups: no-reflow and normal reflow. Hematological parameters were measured on admission. Sensitivity, specificity, positive and negative predictive values, and receiver–operating characteristic areas under the curve were determined to evaluate the predictive values of these parameters. Results: The patients in the no-reflow group had a significantly higher neutrophil count, neutrophil–lymphocyte ratio, platelet–lymphocyte ratio, and mean platelet volume-to-lymphocyte ratio when compared to the normal reflow patients. We identified mean platelet volume-to-lymphocyte ratio to have a moderate predictive value and high specificity (66.8%) for the no-reflow phenomenon. Neutrophil–lymphocyte ratio provided the largest area under the curve for predicting no reflow. Regarding the predictive utility for no reflow, the comparison showed no statically significant differences among evaluated hematological parameters. Conclusion: For the prediction of no reflow, mean platelet volume-to-lymphocyte ratio yielded moderate performance. No hematological parameter on admission had persuasive superior capacities to predict no-reflow in patients receiving the primary percutaneous coronary intervention.
Comparing the 12-month patency of low- versus high-pressure dilation in failing arteriovenous fistulae: A prospective multicenter trial (YOROI study)
Authors: Wakamoto Koki , Doi Shigehiro , Nakashima Ayumu , Kawai Toru , Kyuden Yasufumi , Naito Takayuki , Asai Mariko , Takahashi Shunsuke , Murakami Masaaki , Masaki Takao 
Published: March 2018

Purpose: This study was performed to investigate the effect of the balloon dilation pressure on the 12-month patency rate in patients with failed arteriovenous fistulas undergoing hemodialysis. Materials and methods: In this multicenter, prospective, randomized trial, the 4-mm-diameter YOROI balloon was used for dilation of stenotic lesions. The balloons were inflated to a pressure of 8 atm (low-pressure group) or 30 atm to achieve complete expansion (high-pressure group). The 12-month patency rate after balloon angioplasty was analyzed by the Kaplan–Meier method and log-rank test and/or a Cox proportional hazard model. We also investigated the dilation pressure required to achieve complete expansion in the high-pressure group. Results: In total, 71 patients were enrolled and allocated to either the low-pressure group (n = 34) or the high-pressure group (n = 37). The 12-month patency rates showed no significant difference between the low- and high-pressure groups (47% and 49%, respectively; p = 0.87). In the low-pressure group, the patency rate was not different between patients with complete dilation and residual stenosis (44% and 50%, respectively; p = 0.87). The Cox proportional hazard model revealed that the 12-month patency rate was associated with the stenosis diameter (hazard ratio 0.36; p = 0.001) and the presence of diabetes (hazard ratio 0.33; p = 0.018). Finally, the pressure required to achieve complete dilation was ≤20 atm in 76% of patients and ≤30 atm in 97% of patients. One patient required a dilation pressure of >30 atm. Conclusion: The patency rate does not differ between low-pressure dilation and high-pressure dilation.
Individual and school-class correlates of youth cannabis use in Sweden
Authors: Karlsson Patrik , Ekendahl Mats , Gripe Isabella , Raninen Jonas 
Published: March 2018

Background and aims: The school-class context is a crucial social environment for young people but substance use researchers have largely overlooked potential influences operating at this level. This study explores associations between school-class and individual-level factors and cannabis use in Swedish youth. Data and methods: Data comprised four waves (2012–2015) of the Swedish Council for Information on Alcohol and Other Drugs’ (CAN) nationally representative school surveys among individuals in 9th and 11th grade. For the present analyses, we had data on totally 28,729 individuals from 2377 unique school classes. Multilevel logistic regressions predicted lifetime and 10+ times use of cannabis from both individual-level predictors and school-class-level measures derived from the individual-level variables. Results: There were individual-level associations between most predictor variables and cannabis use. An early debut of tobacco use and binge drinking as well as low cannabis related risk perceptions had strong associations with cannabis use. Conversely, several school-class-level variables had aggregate relationships with cannabis use, most notably the overall level of risk perceptions in the school class. Some of the school-class factors predicted cannabis use over and above the individual-level covariates, suggesting the presence of contextual effects. Surprisingly, while female gender was negatively related with cannabis use at the individual level, a higher proportion of females in the classroom increased the odds for lifetime cannabis use even after controlling for individual and other contextual-level covariates. Conclusions: Youth cannabis use is related to various factors at both the individual and school-class level in Sweden. Truancy and perceived risk related to cannabis use had contextual associations with cannabis use. The positive contextual association between a higher proportion of females in the classroom and lifetime use should be explored further.
The Feasibility of Classifying Breast Masses Using a Computer-Assisted Diagnosis (CAD) System Based on Ultrasound Elastography and BI-RADS Lexicon
Authors: Fleury Eduardo F. C. , Gianini Ana Claudia , Marcomini Karem , Oliveira Vilmar 
Published: March 2018

Objectives: To determine the applicability of a computer-aided diagnostic system strain elastography system for the classification of breast masses diagnosed by ultrasound and scored using the criteria proposed by the breast imaging and reporting data system ultrasound lexicon and to determine the diagnostic accuracy and interobserver variability. Methods: This prospective study was conducted between March 1, 2016, and May 30, 2016. A total of 83 breast masses subjected to percutaneous biopsy were included. Ultrasound elastography images before biopsy were interpreted by 3 radiologists with and without the aid of computer-aided diagnostic system for strain elastography. The parameters evaluated by each radiologist results were sensitivity, specificity, and diagnostic accuracy, with and without computer-aided diagnostic system for strain elastography. Interobserver variability was assessed using a weighted κ test and an intraclass correlation coefficient. The areas under the receiver operating characteristic curves were also calculated. Results: The areas under the receiver operating characteristic curve were 0.835, 0.801, and 0.765 for readers 1, 2, and 3, respectively, without computer-aided diagnostic system for strain elastography, and 0.900, 0.926, and 0.868, respectively, with computer-aided diagnostic system for strain elastography. The intraclass correlation coefficient between the 3 readers was 0.6713 without computer-aided diagnostic system for strain elastography and 0.811 with computer-aided diagnostic system for strain elastography. Conclusion: The proposed computer-aided diagnostic system for strain elastography system has the potential to improve the diagnostic performance of radiologists in breast examination using ultrasound associated with elastography.