bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early metabolic response to acute myocardial ischaemia in patients undergoing elective coronary angioplasty
Authors: Di Marino Sara , Viceconte Nicola , Lembo Angelo , Summa Vincenzo , Tanzilli Gaetano , Raparelli Valeria , Truscelli Giovanni , Mangieri Enrico , Gaudio Carlo , Cicero Daniel Oscar 
Published: March 2018

ObjectiveBalloon-induced transient coronary ischaemia represents a model of myocardial ischaemia and reperfusion. We are interested in the very early systemic metabolic response to this event.MethodsBlood samples of patients with stable angina (SA) were collected before and after coronary angioplasty. Serum metabolic profiles were obtained using nuclear magnetic resonance spectroscopy. Univariate and multivariate analyses were used to investigate changes in metabolite concentrations.ResultsThirty-four consecutive patients with SA, undergoing elective coronary angioplasty at Policlinico Umberto I of Rome, were included in this study. Changes in metabolites concentration induced by balloon occlusion in venous and arterial sera were detected. In both serum types, a significant increase in ketone bodies, 2-hydroxybutyrate, glutamine and O-acetylcarnitine concentration is observed, while alanine, lactate, phenylalanine and tyrosine decreased after intervention. Most significant metabolic changes were detected in arterial serum.ConclusionsOur study points out two main global metabolic changes in peripheral blood after balloon-induced coronary ischaemia: ketone bodies increase and lactate decrease. Both could be related to compensation mechanisms finalised to fulfil heart’s needs after short period of myocardial ischaemia and probably after reperfusion.
Normative ultrasound references for the paediatric wrist; dorsal soft tissues
Authors: Rosendahl Karen , Bruserud Ingvild Sævold , Oehme Ninnie , Júlíusson Pétur Benedikt , Horatio Laura Tanturri de , Müller Lil-Sofie Ording , Magni-Manzoni Silvia 
Published: March 2018

ObjectiveTo report novel ultrasound (US) references for the healthy paediatric wrist.MethodsHealthy children and adolescents had an US examination including Doppler, of the right wrist, using a mid-sagittal image through the radiocarpal (RC)/midcarpal (MC) joints. These features were noted: appearances and depth of the recess, with an additional measurement in the flexed position and number of Doppler signals within the recess in close proximity to the joint. In a second, blinded session, all images were reassessed by the same observer.ResultsIn total, 116 subjects (59 girls) aged 6–16 years (mean 10 years and 11 months) were included. The RC recess was visible in 71, of which 60 were non-bulging and 11 were bulging. In flexion, the thickness decreased in 60 (84.5%), suggestive of joint fluid. Of the 54 visible MC recesses, 45 (83.3%) thinned in flexion. The mean depths of the RC and MC recesses were 0.4 mm (SD 0.5, range 0–2.9) and 0.5 mm (SD 0.6, range 0–2.4), respectively, with no differences according to sex, but with increasing depths by age.For the RC joints, at least one Doppler signal was seen in the recess in 9/116 joints (7.8%), whereas this was true for 3.5% of the MC recesses. There were no statistically significant association between the depth of the RC or MC recesses and number of hand active sport activities (P=0.733 and P=0.091, respectively).ConclusionThe appearances of the dorsal RC and MC recesses in healthy children may mimic pathology. Hence, findings should be interpreted carefully.
Canagliflozin and Heart Failure in Type 2 Diabetes Mellitus
Authors: Rådholm Karin , Figtree Gemma , Perkovic Vlado , Solomon Scott D. , Mahaffey Kenneth W. , de Zeeuw Dick , Fulcher Greg , Barrett Terrance D. , Shaw Wayne , Desai Mehul , Matthews David R. , Neal Bruce 
Published: March 2018

Background:
Canagliflozin is a sodium glucose cotransporter 2 inhibitor that reduces the risk of cardiovascular events. We report the effects on heart failure (HF) and cardiovascular death overall, in those with and without a baseline history of HF, and in other participant subgroups.

Methods:
The CANVAS Program (Canagliflozin Cardiovascular Assessment Study) enrolled 10 142 participants with type 2 diabetes mellitus and high cardiovascular risk. Participants were randomly assigned to canagliflozin or placebo and followed for a mean of 188 weeks. The primary end point for these analyses was adjudicated cardiovascular death or hospitalized HF.

Results:

Participants with a history of HF at baseline (14.4%) were more frequently women, white, and hypertensive and had a history of prior cardiovascular disease (all
P
<0.001). Greater proportions of these patients were using therapies such as blockers of the renin angiotensin aldosterone system, diuretics, and β-blockers at baseline (all
P
<0.001). Overall, cardiovascular death or hospitalized HF was reduced in those treated with canagliflozin compared with placebo (16.3 versus 20.8 per 1000 patient-years; hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.67–0.91), as was fatal or hospitalized HF (HR, 0.70; 95% CI, 0.55–0.89) and hospitalized HF alone (HR, 0.67; 95% CI, 0.52–0.87). The benefit on cardiovascular death or hospitalized HF may be greater in patients with a prior history of HF (HR, 0.61; 95% CI, 0.46–0.80) compared with those without HF at baseline (HR, 0.87; 95% CI, 0.72–1.06;
P
interaction =0.021). The effects of canagliflozin compared with placebo on other cardiovascular outcomes and key safety outcomes were similar in participants with and without HF at baseline (all interaction
P
values >0.130), except for a possibly reduced absolute rate of events attributable to osmotic diuresis among those with a prior history of HF (
P
=0.03).

Conclusions:
In patients with type 2 diabetes mellitus and an elevated risk of cardiovascular disease, canagliflozin reduced the risk of cardiovascular death or hospitalized HF across a broad range of different patient subgroups. Benefits may be greater in those with a history of HF at baseline.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifiers: NCT01032629 and NCT01989754.
Relations of Sex to Diagnosis and Outcomes in Acute Coronary Syndrome
Authors: Sörensen Nils Arne , Neumann Johannes Tobias , Ojeda Francisco , Schäfer Sarina , Magnussen Christina , Keller Till , Lackner Karl J. , Zeller Tanja , Karakas Mahir , Münzel Thomas , Blankenberg Stefan , Westermann Dirk , Schnabel Renate B. 
Published: March 2018

Background

The atypical presentation of women with acute coronary syndrome (
ACS
) has been related to delayed diagnosis and treatment, which may explain worse outcome compared with men.

Methods and Results

We analyzed pooled data of 2520 patients of 2 prospective cohorts in terms of differences in presentation and management of women and men suggestive of
ACS
. Using logistic regression, we established 2 diagnostic models and tested their diagnostic performance in both sexes separately. Sex‐specific differences in management of patients with
ACS
were ascertained and a 2‐year follow‐up was performed. Women were older than men (median 67 versus 61 years,
P
=0.001), had more often dyspnea (22% versus 18%,
P
=0.024), nausea or vomiting (26% versus 16%,
P
=0.001) and radiating chest pain (47% versus 40%,
P
=0.001). Classical risk factors (smoking, diabetes mellitus, dyslipidemia or known coronary artery disease) were less frequent in women. Diagnostic models showed no significant sex‐related differences in diagnostic performance in a “first contact” setting (medical history and symptoms) or after “complete triage” (including
ECG
and biomarkers). Women with
ACS
underwent coronary angiography (73.8% versus 84.3%,
P
<0.001) and revascularization (53.8% versus 70.1%,
P
<0.001) less frequently. Two‐year incidence of myocardial infarction and death was similar in both sexes, but revascularization and cardiac rehospitalization were more frequent in men.

Conclusions

In a large cohort of patients with suspected
ACS
, sex differences in clinical presentation did not impair diagnostic accuracy. Two‐year outcomes were comparable. Our findings suggest a benefit of chest pain units to minimize sex differences in
ACS
management and prognosis.

Clinical Trial Registration

URL
:
https://www.clinicaltrials.gov
. Unique identifiers:
NCT
02355457 (
BACC
),
NCT
03227159 (stenoCardia).
Clinical Outcomes After Cardiac Stress Testing Among US Patients Younger Than 65 Years
Authors: Kini Vinay , Dayoub Elias J. , Hess Paul L. , Marzec Lucas N. , Masoudi Frederick A. , Ho P. Michael , Groeneveld Peter W. 
Published: March 2018

Background
Scientific statements have championed the measurement of clinical outcomes after cardiac stress testing to better define their value. Using contemporary national data, we sought to describe the characteristics of patients who experience outcomes after stress testing.

Methods and Results

Using administrative claims from a large national private insurer, we conducted an observational cohort study of patients without cardiovascular disease aged 25 to 64 years who underwent stress testing from 2006 to 2011 and had at least 1 year of membership in the insurance company before and after testing. We used Kaplan–Meier time‐to‐event analyses to determine rates of acute myocardial infarction (
AMI
), elective coronary revascularization, and coronary angiography without revascularization in the year following testing. We used logistic regression to determine factors associated with outcomes, and stratified the cohort into quintiles based on likelihood of experiencing
AMI
and/or revascularization to describe the characteristics of patients at highest and lowest risk. Among 553 027 patients who underwent stress testing (mean age 50 years, 49% women, 73% white), 0.8% were hospitalized for
AMI
, 1.8% underwent elective coronary revascularization, and 2.5% underwent coronary angiography without revascularization within 1 year. Patients who were older, male, and white were more likely to undergo subsequent revascularization. Patients in the lowest likelihood quintile were young (mean age 40 years), frequently women (84.7%), had a low incidence of coexisting conditions (5.2% with diabetes mellitus), and had a 0.5% rate of
AMI
and/or revascularization.

Conclusions

The proportion of US patients younger than 65 who had
AMI
and/or coronary revascularization after stress testing was low. Assessing risk of subsequent outcomes may be useful in improving patient referrals for stress testing.
Non–ST‐Segment–Elevation Myocardial Infarction Among Patients With Chronic Kidney Disease: A Propensity Score–Matched Comparison of Percutaneous Coronary Intervention Versus Conservative Management
Authors: Bhatia Subir , Arora Shilpkumar , Bhatia Sravya M. , Al‐Hijji Mohammed , Reddy Yogesh N. V. , Patel Parshva , Rihal Charanjit S. , Gersh Bernard J. , Deshmukh Abhishek 
Published: March 2018

Background

Chronic kidney disease (
CKD
) remains an independent predictor of cardiovascular morbidity and mortality.
CKD
complicates referral for percutaneous coronary intervention (
PCI
) in non–ST‐segment–elevation myocardial infarction (
NSTEMI
) patients because of the risk for acute kidney injury and the need for dialysis, with American College of Cardiology/American Heart Association guidelines underscoring the limited data on these patients.

Methods and Results

Using the National Inpatient Sample to analyze hospitalizations in the United States from 2004 to 2014, we sought to assess
PCI
utilization and in‐hospital outcomes in
NSTEMI
admissions with
CKD
.
NSTEMI
admissions were identified by
International Classification of Diseases, Ninth Edition, Clinical Modification (ICD‐9‐CM)
code 410.7.
CKD
admissions were identified by
ICD‐9‐CM
code 585. Propensity score–matched cohorts of patients with
NSTEMI
were matched for age, sex, comorbidities, race, median household income, primary payer status, and hospital characteristics. Of 4 488 795 hospitalizations for
NSTEMI
, 31% underwent
PCI
. Overall, 89% of admissions had no
CKD
. In addition, 32% of
NSTEMI
admissions with no
CKD
and 23%, 14%, and 22% with
CKD
stages 3, 4, and 5 underwent
PCI
, respectively. Hospitalized
NSTEMI
patients with
CKD
stages 4 and 5 had 41% and 20% less likelihood, respectively, of undergoing
PCI
compared with those with no
CKD
. Among hospitalized
NSTEMI
patients with no
CKD
or
CKD
stage 3, 4, or 5,
PCI
‐treated groups had 63%, 57%, 39%, and 59% lower likelihood, respectively, of all‐cause, in‐hospital mortality compared with propensity score–matched medically managed groups.

Conclusions

PCI
use decreased among hospitalized
NSTEMI
patients as
CKD
severity increased, and all‐cause, in‐hospital mortality was greater for
NSTEMI
patients admitted with more severe
CKD
regardless of treatment strategy.
Provider Specialty, Anticoagulation Prescription Patterns, and Stroke Risk in Atrial Fibrillation
Authors: O'Neal Wesley T. , Sandesara Pratik B. , Claxton J'Neka S. , MacLehose Richard F. , Chen Lin Y. , Bengtson Lindsay G. S. , Chamberlain Alanna M. , Norby Faye L. , Lutsey Pamela L. , Alonso Alvaro 
Published: March 2018

Background

Differences in anticoagulation rates and direct oral anticoagulant use by provider specialty may identify an area of practice improvement to reduce future stroke events in patients with atrial fibrillation (
AF
).

Methods and Results

We examined anticoagulant prescription fills in 388 045 (mean age, 68±15 years; 59% male) patients with incident
AF
from the MarketScan databases between 2009 and 2014. Provider specialty and filled anticoagulant prescriptions around the time of
AF
diagnosis (3 months before through 6 months after) were obtained from outpatient services and pharmacy claims. We estimated the association of provider specialty (cardiology versus primary care) with filling oral anticoagulant prescriptions, adjusting for patient characteristics. The risk of stroke and bleeding events also was explored. A total of 235 739 patients (61%) had a cardiology provider claim, whereas 152 306 (39%) were exclusively managed by primary care. Patients seen by cardiology providers were more likely to fill anticoagulant prescriptions than those seen by primary care (39% versus 27%; relative risk, 1.39; 95% confidence interval [
CI
], 1.37–1.40). Differences were observed for direct oral anticoagulants (relative risk, 1.74; 95%
CI
, 1.71–1.78) and warfarin (relative risk, 1.24; 95%
CI
, 1.22–1.26). A reduced risk of stroke events was observed among those seen by cardiology providers (hazard ratio, 0.90; 95%
CI
, 0.86–0.94) compared with primary care, without an increased bleeding risk (hazard ratio, 1.03; 95%
CI
, 0.98–1.07).

Conclusions

Patients seen by an outpatient cardiology provider shortly after
AF
diagnosis were more likely to initiate oral anticoagulation and were at lower risk of future stroke events without a higher rate of bleeding. Early referral to cardiology specialists may increase initiation of anticoagulant therapies and improve outcomes in
AF
.
Cognitive Function Before and After Left Heart Catheterization
Authors: Scott David A. , Evered Lisbeth , Maruff Paul , MacIsaac Andrew , Maher Sarah , Silbert Brendan S. 
Published: March 2018

Background

Hospital procedures have been associated with cognitive change in older patients. This study aimed to document the prevalence of mild cognitive impairment in individuals undergoing left heart catheterization (
LHC
) before the procedure and the incidence of cognitive decline to 3 months afterwards.

Methods and Results

We conducted a prospective, observational, clinical investigation of elderly participants undergoing elective
LHC
. Cognition was assessed using a battery of written tests and a computerized cognitive battery before the
LHC
and then at 3 months afterwards. The computerized tests were also administered at 24 hours (or discharge) and 7 days after
LHC
. A control group of 51 community participants was recruited to calculate cognitive decline using the Reliable Change Index. Of 437 participants, mild cognitive impairment was identified in 226 (51.7%) before the procedure. Computerized tests detected an incidence of cognitive decline of 10.0% at 24 hours and 7.5% at 7 days. At 3 months, written tests detected an incidence of cognitive decline of 13.1% and computerized tests detected an incidence of 8.5%. Cognitive decline at 3 months using written tests was associated with increasing age, whereas computerized tests showed cognitive decline was associated with baseline amnestic mild cognitive impairment, diabetes mellitus, and prior coronary stenting.

Conclusions

More than half the patients aged >60 years presenting for
LHC
have mild cognitive impairment.
LHC
is followed by cognitive decline in 8% to 13% of individuals at 3 months after the procedure. Subtle cognitive decline both before and after
LHC
is common and may have important clinical implications.

Clinical Trial Registration Information

URL
:
www.anzctr.org.au
. Unique identifier:
ACTRN
12607000051448.
Safety and Effectiveness of Direct Oral Anticoagulants Versus Vitamin K Antagonists: Pilot Implementation of a Near‐Real‐Time Monitoring Program in Italy
Authors: Mayer Flavia , Kirchmayer Ursula , Coletta Paola , Agabiti Nera , Belleudi Valeria , Cappai Giovanna , Di Martino Mirko , Schneeweiss Sebastian , Davoli Marina , Patorno Elisabetta 
Published: March 2018

Background
Real‐time monitoring is used to the ends of postmarketing observational research on newly marketed drugs. We implemented a pilot near‐real‐time monitoring program on the test case of oral anticoagulants. Specifically, we evaluated the safety and effectiveness of direct oral anticoagulants compared to vitamin K antagonists in nonvalvular atrial fibrillation secondary prevention during 2013‐2015 in the Lazio Region, Italy.

Methods and Results

A cohort study was conducted using a sequential propensity‐score–matched new user parallel‐cohort design. Sequential analyses were performed using Cox models. Overall, 10 742 patients contributed to the analyses. Compared with vitamin K antagonists, direct oral anticoagulant use was associated with a reduction of all‐cause mortality (0.81; 95% confidence interval [
CI
] 0.66‐0.99), cardiovascular mortality (0.71; 95%
CI
0.54‐0.93), myocardial infarction (0.67; 95%
CI
0.43‐1.04), ischemic stroke (0.87; 95%
CI
0.52‐1.45), hemorrhagic stroke (0.25; 95%
CI
0.07‐0.88), and with a nonsignificant increase of gastrointestinal bleeding (1.26; 95%
CI
0.69‐2.30).

Conclusions
The present pilot study is a cornerstone to develop real‐time monitoring for new drugs in our region.
Predictive Value of the Sequential Organ Failure Assessment Score for Mortality in a Contemporary Cardiac Intensive Care Unit Population
Authors: Jentzer Jacob C. , Bennett Courtney , Wiley Brandon M. , Murphree Dennis H. , Keegan Mark T. , Gajic Ognjen , Wright R. Scott , Barsness Gregory W. 
Published: March 2018

Background

Optimal methods of mortality risk stratification in patients in the cardiac intensive care unit (
CICU
) remain uncertain. We evaluated the ability of the Sequential Organ Failure Assessment (
SOFA
) score to predict mortality in a large cohort of unselected patients in the CICU.

Methods and Results

Adult patients admitted to the
CICU
from January 1, 2007, to December 31, 2015, at a single tertiary care hospital were retrospectively reviewed.
SOFA
scores were calculated daily, and Acute Physiology and Chronic Health Evaluation (
APACHE
)‐
III
and
APACHE
‐
IV
scores were calculated on
CICU
day 1. Discrimination of hospital mortality was assessed using area under the receiver‐operator characteristic curve values. We included 9961 patients, with a mean age of 67.5±15.2 years; all‐cause hospital mortality was 9.0%. Day 1
SOFA
score predicted hospital mortality, with an area under the receiver‐operator characteristic curve value of 0.83; area under the receiver‐operator characteristic curve values were similar for the
APACHE
‐
III
score, and
APACHE
‐
IV
predicted mortality (
P
>0.05). Mean and maximum
SOFA
scores over multiple
CICU
days had greater discrimination for hospital mortality (
P
<0.01). Patients with an increasing
SOFA
score from day 1 and day 2 had higher mortality. Patients with day 1
SOFA
score <2 were at low risk of mortality. Increasing tertiles of day 1
SOFA
score predicted higher long‐term mortality (
P
<0.001 by log‐rank test).

Conclusions

The day 1
SOFA
score has good discrimination for short‐term mortality in unselected patients in the CICU, which is comparable to
APACHE
‐
III
and
APACHE
‐
IV
. Advantages of the
SOFA
score over
APACHE
include simplicity, improved discrimination using serial scores, and prediction of long‐term mortality.
Interventions to enhance coping after traumatic brain injury: A systematic review
Authors: Mueller Christoph , Wesenberg Sandra , Nestmann Frank , Stubbs Brendon , Bebbington Paul , Raymont Vanessa 
Published: March 2018

Background/Aims: The aim of this study was to identify effective psychosocial interventions to enhance coping in people who have experienced a traumatic brain injury, in order to inform clinical practice and articulate future research directions. Methods: Five electronic databases (CINAHL, Medline, EMBASE, PsycINFO, and Cochrane Library) were searched. Titles and abstracts were independently screened by two of the authors and selected for inclusion. The full text of all potentially relevant studies were retrieved and assessed for eligibility, reporting and methodological quality, and risk of bias. Findings: Eight included studies were very heterogeneous in terms of study design, type of intervention, the population studied and instruments used to evaluate coping. All studies were judged to have a moderately high risk of bias. Six studies used cognitive behavioural therapy-based interventions. Two interventions (a peer-mentoring programme and cognitive behavioural therapy combined with motivational interviewing) showed significant treatment effects on maladaptive coping. Two cognitive behavioural therapy-based group programmes improved adaptive coping, but increases were either not sustained over time or no longer significant when compared to an active control. Conclusions: There is insufficient evidence to support practice recommendations strongly. Targeting specific subgroups of people who have experienced traumatic brain injury might allow the development of more effective coping interventions. Further, a more unified concept of coping in traumatic brain injury needs to be articulated allowing larger scale evaluations.
Ahola (aloha backwards): Social practice fashion Honolulu style
Authors: Navarro Delgado Henry 
Published: March 2018

Abstract
To non-residents, Hawaii embodies the archetypical tourist destination – erupting volcanoes, magnificent beaches, surfing lifestyle and hula dancers; a year-around place of adventure, romance and relaxation; and the perfect setting for advertisements and movie fantasies. However, the realities of contemporary life in Hawaii are quite different from those idyllic visions. The site-specific public fashion project Ahola (Aloha Backwards) mined these dichotomies by integrating fashion design, public art and collaborative teaching methodologies to engage the local community. In so doing, Ahola adapted a Social Practice Fashion framework to the cultural context of Hawaii while providing informal, community-centred professional training for aspiring local fashion entrepreneurs. Through its use of Collaborative Learning methods, this participatory fashion project expanded teaching beyond traditional academic settings, while simultaneously empowering Honolulu residents by allowing their direct input at every stage of the project. This article analyses how Ahola took advantage of standard methodologies from the fashion industry as tools for social activism and integrated them with collaborative teaching to enable informal learning opportunities. In addition to discussing the implications of the project’s methodology, as a viable approach for socially conscious fashion design practitioners. The article also examines the pedagogic significance of Collaborative Learning for both traditional high learning institutions and community-centred educational initiatives.