bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endovascular Fenestration/Stenting First Followed by Delayed Open Aortic Repair for Acute Type A Aortic Dissection With Malperfusion Syndrome
Authors: Yang Bo , Rosati Carlo Maria , Norton Elizabeth L. , Kim Karen M. , Khaja Minhaj S. , Dasika Narasimham , Wu Xiaoting , Hornsby Whitney E. , Patel Himanshu J. , Deeb G. Michael , Williams David M. 
Published: January 2019

Background:
Immediate open repair of acute type A aortic dissection is traditionally recommended to prevent death from aortic rupture. However, organ failure because of malperfusion syndrome (MPS) might be the most imminent life-threatening problem for a subset of patients.

Methods:
From 1996 to 2017, among 597 patients with acute type A aortic dissection, 135 patients with MPS were treated with upfront endovascular reperfusion (fenestration/stenting) followed by delayed open repair (OR). We compared outcomes between the first and second decades and observed mortalities with those expected with an “upfront OR for every patient” approach, determined using prognostic models from the literature (Verona, Leipzig-Halifax, Stockholm, Penn, and GERAADA [German Registry for Acute Aortic Dissection Type A] models).

Results:

Overall, in-hospital mortality improved between the 2 decades (21.0% versus 10.7%,
P
<0.001). In the second decade, for patients with MPS initially treated with fenestration/stenting, mortality from aortic rupture decreased from 16% to 4% (
P
=0.05), the risk of dying from organ failure was 6.6 times higher than dying from aortic rupture (hazard ratio=6.63; 95% CI, 1.5–29;
P
=0.01), and 30-day mortality after OR for MPS patients was 3.7%. Compared to the expected mortalities with the upfront OR for every patient models, our observed 30-day and in-hospital mortalities (9% and 11%, respectively) of all patients with acute type A aortic dissection were significantly lower (
P
≤0.03).

Conclusions:
Immediate OR is the strategy to prevent death from aortic rupture for the majority of patients with acute type A aortic dissection. However, relatively stable (no rupture, no tamponade) patients with MPS benefit from a staged approach: upfront endovascular reperfusion followed by aortic OR at resolution of organ failure.
Components and Trends in Door to Treatment Times for Endovascular Therapy in Get With The Guidelines-Stroke Hospitals
Authors: Menon Bijoy K. , Xu Haolin , Cox Margueritte , Saver Jeffrey L. , Goyal Mayank , Peterson Eric , Xian Ying , Matsuoka Roland , Jehan Reza , Yavagal Dileep , Gupta Rishi , Mehta Brijesh , Bhatt Deepak L. , Fonarow Gregg C. , Schwamm Lee H. , Smith Eric E. 
Published: January 2019

Background:
Endovascular therapy (EVT) is standard of care in patients with acute disabling ischemic stroke attributable to large-vessel occlusion and is more effective when delivered quickly. It is currently unclear whether time targets achieved in clinical trials can be achieved in clinical practice. We describe interval times from patient arrival in the emergency department (door) to first pass (treatment initiation) in patients receiving EVT within Get With The Guidelines-Stroke hospitals and analyze patient- and hospital-level variables associated with these times.

Methods:
Data are from sites participating fully as Comprehensive Stroke Centers within Get With The Guidelines-Stroke hospitals from October 2014 to September 2016. Workflow times analyzed include door to imaging, imaging to arterial access, arterial access to first pass, and the composite door to first pass time. Data are described overall and by calendar-year quarters. Multivariable modeling was used to identify patient- and hospital-level variables associated with workflow times.

Results:

Among 2929 patients with EVT from 195 hospitals (median age, 71 years [interquartile range {IQR}, 60–81]; 50.7% female; median baseline National Institute of Health Stroke Score, 17 [IQR, 12–22]; median annual EVT administration number, 16 [IQR, 10–27]), median door to first pass time was 130 minutes (IQR, 101–170 minutes), door to imaging time was 12 minutes (IQR, 7–20 minutes), imaging to arterial puncture time was 93 minutes (IQR, 68–126 minutes), and arterial puncture to first pass time was 18 minutes (IQR, 4–31 minutes). Overall, 3% patients achieved a door to first pass time ≤60 minutes. A statistically significant linear time trend was noted for door to first pass time (quarter 4 year 2014 median time, 134.5 minutes to quarter 3 year 2016 median time, 128 minutes,
P
=0.002). In multivariable analysis, older age, arrival during nonregular hours, and history of diabetes mellitus were associated with longer door to first pass time. Hospitals achieving shorter door to intravenous alteplase administration (door to needle) times were more likely to achieve faster door to first pass time (
P
<0.001). Each 5 cases/y increase in EVT case volume was associated with a 3% shorter door to first pass time, up to a case volume of 40 per year (
P
<0.001).

Conclusions:
Although EVT treatment times are modestly improving, additional efforts are needed to streamline workflow so that the true potential of this treatment is realized. These data may inform benchmark goals for EVT workflow times.
High-Phosphate Diet Induces Exercise Intolerance and Impairs Fatty Acid Metabolism in Mice
Authors: Peri-Okonny Poghni , Baskin Kedryn K. , Iwamoto Gary , Mitchell Jere H. , Smith Scott A. , Kim Han Kyul , Szweda Luke I. , Bassel-Duby Rhonda , Fujikawa Teppei , Castorena Carlos M. , Richardson James , Shelton John M. , Ayers Colby , Berry Jarett D. , Malladi Venkat S. , Hu Ming-Chang , Moe Orson W. , Scherer Philipp E. , Vongpatanasin Wanpen 
Published: January 2019

Background:
Inorganic phosphate (Pi) is used extensively as a preservative and a flavor enhancer in the Western diet. Physical inactivity, a common feature of Western societies, is associated with increased cardiovascular morbidity and mortality. It is unknown whether dietary Pi excess contributes to exercise intolerance and physical inactivity.

Methods:
To determine an association between Pi excess and physical activity in humans, we assessed the relationship between serum Pi and actigraphy-determined physical activity level, as well as left ventricular function by cardiac magnetic resonance imaging, in DHS-2 (Dallas Heart Study phase 2) participants after adjusting for relevant variables. To determine direct effects of dietary Pi on exercise capacity, oxygen uptake, serum nonesterified fatty acid, and glucose were measured during exercise treadmill test in C57/BL6 mice fed either a high-Pi (2%) or normal-Pi (0.6%) diet for 12 weeks. To determine the direct effect of Pi on muscle metabolism and expression of genes involved in fatty acid metabolism, additional studies in differentiated C2C12 myotubes were conducted after subjecting to media containing 1 to 3 mmol/L Pi (pH 7.0) to simulate in vivo phosphate conditions.

Results:

In participants of the DHS-2 (n=1603), higher serum Pi was independently associated with reduced time spent in moderate to vigorous physical activity (
P
=0.01) and increased sedentary time (
P
=0.004). There was no association between serum Pi and left ventricular ejection fraction or volumes. In animal studies, compared with the control diet, consumption of high-Pi diet for 12 weeks did not alter body weight or left ventricular function but reduced maximal oxygen uptake, treadmill duration, spontaneous locomotor activity, fat oxidation, and fatty acid levels and led to downregulation of genes involved in fatty acid synthesis, release, and oxidation, including
Fabp4
,
Hsl
,
Fasn
, and
Pparγ
, in muscle. Similar results were recapitulated in vitro by incubating C2C12 myotubes with high-Pi media.

Conclusions:
Our data demonstrate a detrimental effect of dietary Pi excess on skeletal muscle fatty acid metabolism and exercise capacity that is independent of obesity and cardiac contractile function. Dietary Pi may represent a novel and modifiable target to reduce physical inactivity associated with the Western diet.
Community‐Wide Dissemination of Bystander Cardiopulmonary Resuscitation and Automated External Defibrillator Use Using a 45‐Minute Chest Compression–Only Cardiopulmonary Resuscitation Training
Authors: Nishiyama Chika , Kitamura Tetsuhisa , Sakai Tomohiko , Murakami Yukiko , Shimamoto Tomonari , Kawamura Takashi , Yonezawa Takahiro , Nakai Shohei , Marukawa Seishiro , Sakamoto Tetsuya , Iwami Taku 
Published: January 2019

Background

Little is known about whether cardiopulmonary resuscitation (
CPR
) training can increase bystander
CPR
in the community or the appropriate target number of
CPR
trainings. Herein, we aimed to demonstrate community‐wide aggressive dissemination of
CPR
training and evaluate temporal trends in bystander
CPR
.

Methods and Results

We provided
CPR
training (45‐minute chest compression–only
CPR
plus automated external defibrillator use training or the conventional
CPR
training), targeting 16% of residents. All emergency medical service–treated out‐of‐hospital cardiac arrests of medical origin were included. Data on patients experiencing out‐of‐hospital cardiac arrest and bystander
CPR
quality were prospectively collected from September 2010 to December 2015. The primary outcome was the proportion of high‐quality bystander
CPR
. During the study period, 57 173 residents (14.7%) completed the chest compression–only
CPR
training and 32 423 (8.3%) completed conventional
CPR
training. The proportion of bystander
CPR
performed did not change (from 43.3% in 2010 to 42.0% in 2015;
P
for trend=0.915), but the proportion of high‐quality bystander
CPR
delivery increased from 11.7% in 2010 to 20.7% in 2015 (
P
for trend=0.015). The 1‐year increment was associated with high‐quality bystander
CPR
(adjusted odds ratio, 1.461; 95% CI, 1.055–2.024). Bystanders who previously experienced
CPR
training were 3.432 times (95% CI, 1.170–10.071) more likely to perform high‐quality
CPR
than those who did not.

Conclusions

We trained 23.0% of the residents in the medium‐sized city of Osaka, Japan, and demonstrated that the proportion of high‐quality
CPR
performed on the scene increased gradually, whereas that of bystander
CPR
delivered overall remained stable.
Public Awareness of Stroke and the Appropriate Responses in China
Authors: Li Shengde , Cui Li-Ying , Anderson Craig , Zhu Suiqiang , Xu Ping , Wei Tiemin , Luo Yun , Chen Shengli , Jiang Nan , Hong Yuehui , Liu Weidong , Li Jian , Gao Chunpeng , Yu Chengdong , Shan Guangliang , Wang Longde , Peng Bin , Liu Dan , Xie Dongmei , Wei Fei , Wu Guanghui , Li Hongyan , Luo Hua , Min Jie , Tang Jinhai , Sun Jun , Li Luoqing , Yao Qi , Liu Shilin , Shi Wei , Yan Wei , Yu Xiaofei , Luo Xiaopeng , Peng Xiaoxiang , Zhang Ya , Gao Yang , Peng Ye , Xue Yongling , Lin Zhi ,   on behalf of the FAST-RIGHT study group
Published: January 2019

Background and Purpose—
Early presentation is critical for receiving effective reperfusion therapy for acute ischemic stroke, therefore, we undertook a national survey of awareness and responses to acute stroke symptoms in China.

Methods—
We undertook a cross-sectional community-based study of 187 723 adults (age ≥40 years) presenting to 69 administrative areas across China between January 2017 and May 2017 to determine the national stroke recognition rate and the correct action rate. Multivariable logistic regression models were used to identify factors associated with stroke recognition and intention-to-avail emergency medical services.

Results—

Estimates of stroke recognition rate and correct action rate were 81.9% (153 675/187 723) and 60.9% (114 380/187 723), respectively, but these rates varied widely by sociodemographic status, region, and stroke risk. Approximately one-third of participants who recognized a stroke failed to call emergency medical service. Low likelihood of emergency medical service use was associated with younger age (40–59 years), being male, rural location, (regions of east, south, and northwest China), high body mass index (≥24), low education (primary school or below), low personal income (<US $731 per annum), living with immediate family, having multiple children (≥2), having a friend with stroke, exposure to less avenues to learn about stroke, nonsmoking, regular exercise, unknown family history, and no history of cardiovascular disease. Intention of calling emergency medical service was strongly related to awareness of stroke (odds ratio 2.05; 95% CI, 2.00–2.10;
P
<0.001).

Conclusions—
Substantial discrepancies exist between stroke recognition and correct action and not all stroke patients know the appropriate responses. Further, national stroke educational programs with specific plans targeting different groups are needed, which do not solely focus on stroke recognition, but also on the appropriate responses at the time of a stroke.
CHOCO-JEX: A Research Experiment Focused on the Chocó Low-Level Jet over the Far Eastern Pacific and Western Colombia
Authors: Yepes Johanna , Poveda Germán , Mejía John F. , Moreno Leonardo , Rueda Carolina 
Published: January 2019

AbstractThe ChocoJet Experiment (CHOCO-JEX) is an interinstitutional research program developed by the Universidad Nacional de Colombia, the General Maritime Directorate of the Ministry of National Defense of Colombia, the Colombian Air Force, and the Desert Research Institute. The main goal of CHOCO-JEX is to characterize the vertical structure of the low-level Chocó jet (ChocoJet) through observations and modeling. Thus, four 7-day intensive observation periods (IOPs) took place during different seasons in 2016, two over land and two over the far eastern Pacific off the coast of Colombia, including the deployment of upper-air soundings four times per day to monitor the predominant diurnal cycle and the synoptic and seasonal variability. Preliminary results show deeper westerly moisture flow and a stronger diurnal cycle over land than over ocean. IOP4 provides the first observational evidence of the southwesterly ChocoJet with mean winds of 5 m s–1. Diurnal cycles of zonal wind are coherent with mountain–valley and sea–land breezes at low levels and the easterly flow is predominant at midlevels. Potential temperature anomalies appear to be related to gravity waves that modulate the diurnal cycle of precipitation in the region.
Improving Visual Communication of Weather Forecasts with Rhetoric
Authors: Lambrecht K. M. , Hatchett B. J. , Walsh L. C. , Collins M. , Tolby Z. 
Published: January 2019

Abstract
Communicating weather-related hazards to the public can be a challenge for meteorologists, particularly given the nature of confidence levels in forecasting science. Despite these challenges, communicating high-impact weather remains extremely important because it has implications for the safety, health, and resilience of impacted communities. Because the dynamics of this issue are complex, solutions to weather hazard communication benefit from interdisciplinary solutions and multiple types of expertise. Our work demonstrates how rhetoric, a foundational communication discipline, can be applied to improving weather forecast communication. Applying a rhetorical framework allows the identification of communication strategies that not only invite public involvement but encourage users to act as conduits for weather information distribution. As a result, trust can be developed between the National Weather Service (NWS) and public audiences. The initial results support the hypothesis that effective public communication from NWS messaging can be improved by incorporating the concept of “commonplaces,” which are the expressions of beliefs, values, and norms that construct community attitudes toward weather or natural hazard forecasts, into visual communication techniques such as NWS Weather Stories.
Texture in the monitoring of regorafenib therapy in patients with colorectal liver metastases
Authors: Andersen Iben R , Thorup Kennet , Andersen Michael B , Olesen Rene , Mortensen Frank V , Nielsen Dennis T , Rasmussen Finn 
Published: January 2019

Background The morphological changes seen during treatment with regorafenib represent challenges when evaluating treatment response using RECIST. Computed tomography texture analysis (CTTA) has potential as a non-invasive functional imaging biomarker during treatment with anti-angiogenetic therapies. Purpose To explore changes in three-dimensional tumor CTTA in colorectal liver metastases (CRLM) in a cohort of patients with metastatic colorectal cancer during treatment with regorafenib. Material and Methods Twenty-seven patients with CRLM were treated with regorafenib and evaluated using CTTA. Texture analysis was applied in the standard contrast-enhanced CT performed in the portal-venous phase (PVP-CT) and in two selected scan series derived from a dynamic contrast-enhanced CT (DCE-CT). A total of 269 scan series were analyzed. Results In the unfiltered dataset of the PVP-CT, all texture parameters, except for kurtosis, changed significantly during treatment. In the filtered PVP-CT dataset, the CTTA parameters entropy, uniformity, and standard deviation were markedly associated with overall survival (OS) at spatial scaling factors (SSF) of 1.0– 2.0, but did not change significantly during treatment. Skewness increased significantly during treatment and was evaluated at SSF ≥1.0. In general, the same trends in texture parameter changes were seen when analyzing DCE-CT datasets. However, these changes did not reach the same level of significance. Conclusions In this exploratory study, we demonstrated substantial changes in the texture parameters during treatment with regorafenib, most evident in the unfiltered dataset of the PVP-CT. Some texture parameters showed prognostic association with OS. Texture may potentially help evaluate the treatment response in patients treated with regorafenib.
Paroxysmal pressing headache: A new short-lasting headache
Authors: Pareja Juan A , Álvarez Mónica , Cárcamo Alba , Liaño Talía , Rodríguez-Caravaca Gil , Cuadrado María-Luz 
Published: January 2019

Introduction In this report we describe a series of patients with a previously undescribed headache. Methods Over a 4-year period, we recruited 14 patients with a distinctive type of head pain of unknown cause that did not meet diagnostic criteria for other primary headaches. Results Nine women and five men with a mean age of 49.6 years (standard deviation, 17.8) presented with spontaneous headache attacks lasting 2–15 minutes. In each attack, the pain was localized to a region of one side of the head. Pain location varied between episodes in 12 patients. Pain quality was pressing, and pain intensity was mild to severe. There were no accompanying symptoms. Physical examination and all ancillary tests were unremarkable. Among seven patients who tried pharmacological treatments, one responded to antidepressants, another to indomethacin and three to other nonsteroidal anti-inflammatory drugs or simple analgesics. Conclusions Paroxysmal pressing headache may be a new headache syndrome marked by short duration of the pain and shifting location.
Trauma Surgeon and Palliative Care Physician Attitudes Regarding Goals-of-Care Delineation for Injured Geriatric Patients
Authors: Cunningham Holly B. , Scielzo Shannon A. , Nakonezny Paul A. , Bruns Brandon R. , Brasel Karen J. , Inaba Kenji , Brakenridge Scott C. , Kerby Jeffrey D. , Joseph Bellal A. , Mohler M. J. , Cuschieri Joseph , Paulk Mary E. , Ekeh Akpofure P. , Madni Tarik D. , Taveras Luis R. , Imran Jonathan B. , Wolf Steven E. , Phelan Herb A. 
Published: January 2019

Background: The value of defining goals of care (GoC) for geriatric patients is well known to the palliative care community but is a newer concept for many trauma surgeons. Palliative care specialists and trauma surgeons were surveyed to elicit the specialties’ attitudes regarding (1) importance of GoC conversations for injured seniors; (2) confidence in their own specialty’s ability to conduct these conversations; and (3) confidence in the ability of the other specialty to do so. Methods: A 13-item survey was developed by the steering committee of a multicenter, palliative care-focused consortium and beta-tested by trauma surgeons and palliative care specialists unaffiliated with the consortium. The finalized instrument was electronically circulated to active physician members of the American Association for the Surgery of Trauma and American Academy for Hospice and Palliative Medicine. Results: Respondents included 118 trauma surgeons (8.8%) and 244 palliative care specialists (5.7%). Palliative physicians rated being more familiar with GoC, were more likely to report high-quality training in performing conversations, believed more palliative specialists were needed in intensive care units, and had more interest in conducting conversations relative to trauma surgeons. Both groups believed themselves to perform GoC discussions better than the other specialty perceived them to do so and favored their own specialty leading team discussions. Conclusions: Both groups believe themselves to conduct GoC discussions for injured seniors better than the other specialty perceived them to do so, which led to disparate views on the optimal leadership of these discussions.
Trends in Breast Cancer Incidence and Stage Distribution Before and During the Introduction of the Mammography Screening Program in Lithuania
Authors: Steponaviciene Laura , Briediene Ruta , Vanseviciute Rasa , Smailyte Giedre 
Published: January 2019

Background: The aim of this study was to analyze the incidence trends of localized and advanced breast cancer (BC) before and during the implementation of the mammography screening program (MSP) in Lithuania. Methods: The study period was divided into 2 intervals: the prescreening period (1998-2005) and implementation period (2006-2012). Analysis was performed for 3 age-groups: 0 to 49 years, 50 to 69 (target population), and older than 70. Results: In all age-groups, the incidence of localized BC has shown a steady increase, while the incidence of advanced stage BC has decreased. In the target population, during the study period, the stage I BC incidence increased statistically significantly by 10.3% per year (from 3.3 per 100 000 in 1998 to 12.2 per 100 000 in 2012). The increase in localized BC was faster in the period before the implementation of the MSP than during the implementation in 2006 to 2012 (10.3% and 5.7%). A slightly statistically significant decrease was observed for advanced BC during the study period (−1.1% per year), while during the implementation of the MSP, significant changes were not seen. Conclusions: The results of our study indicate that the implementation of the MSP in Lithuania did not significantly influence trends of localized and advanced BC. Changes observed during the study period, including the prescreening and screening introduction periods, may reflect the general trends in the awareness of BC and improvements in diagnostics.