bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting poor compliance with follow-up and intrauterine contraception services after medical termination of pregnancy
Authors: Pohjoranta Elina , Mentula Maarit , Suhonen Satu P , Heikinheimo Oskari 
Published: September 2018

BackgroundAttendance at post-abortion follow-up visits is poor, but little is known about factors affecting it.ObjectiveTo assess the factors associated with non-compliance with post-abortion services and to evaluate differences in rates of attendance and intrauterine device (IUD) insertion according to the type of service provision.Methods605 women undergoing a first trimester medical termination of pregnancy (MTOP) and planning to use intrauterine contraception were randomised into two groups. Women in the intervention group (n=306) were booked to have IUD insertion 1–4 weeks after the MTOP at the hospital providing the abortion, while women in the control group (n=299) were advised to contact their primary healthcare (PHC) centre for follow-up and IUD insertion.ResultsIn the intervention group, 21 (6.9%) women failed to attend the follow-up visit, whereas in the control group 67 (22.4%) women did not contact the PHC to schedule a follow-up (p<0.001). In both groups, non-attendance was associated with history of previous pregnancy and abortion. Not having an IUD inserted within 3 months was significantly more common in the control group (73.6% (n=220)) than in the intervention group (9.2% (n=28), p<0.001). In the intervention group, predictive factors for not having an IUD inserted were anxiety, history of pregnancy and abortion. However, we identified no significant predictive factors in the control group.ConclusionsFactors predicting low compliance with post-MTOP follow-up are few. Comprehensive provision of abortion care and post-abortion services seems beneficial for minimising the loss to follow-up and delay in initiation of effective contraception.Trial registration numberNCT01223521; Results.
Electronic cigarette explosion and burn injuries, US Emergency Departments 2015–2017
Authors: Rossheim Matthew E , Livingston Melvin D , Soule Eric K , Zeraye Helen A , Thombs Dennis L 
Published: September 2018

BackgroundElectronic cigarette (e-cigarette) battery failure can result in explosions and burn injuries. Previous attempts to quantify these events has been limited to compilations of case studies, federal agency reports and media reports. Although e-cigarette explosions and burn injuries are thought to be rare, current surveillance methods likely underestimate actual occurrences.MethodsAnalyses were conducted on cross-sectional data from the US Consumer Product Safety Commission’s (CPSC) National Electronic Injury Surveillance System (NEISS). A keyword search of case narrative text was used to identify e-cigarette-related explosion and burn injuries presenting to US emergency departments from 2015 to 2017. Sampling weights were applied to make conservative national incidence estimates.ResultsFrom 2015 to 2017, there were an estimated 2035 e-cigarette explosion and burn injuries presenting to US hospital emergency departments (95% CI 1107 to 2964).ConclusionsThere are more e-cigarette explosion and burn injuries in the USA than estimated in the past reports. Improved surveillance of e-cigarette injuries and regulation of e-cigarette devices is urgently needed. NEISS could be a valuable resource for e-cigarette injury surveillance.
Impact of PI3Kα (Phosphoinositide 3-Kinase Alpha) Inhibition on Hemostasis and Thrombosis
Authors: Laurent Pierre-Alexandre , Hechler Béatrice , Solinhac Romain , Ragab Ashraf , Cabou Cendrine , Anquetil Typhaine , Severin Sonia , Denis Cécile V. , Mangin Pierre H. , Vanhaesebroeck Bart , Payrastre Bernard , Gratacap Marie-Pierre 
Published: September 2018

Objective—
PI3Kα (phosphoinositide 3-kinase alpha) is a therapeutic target in oncology, but its role in platelets and thrombosis remains ill characterized. In this study, we have analyzed the role of PI3Kα in vitro, ex vivo, and in vivo in 2 models of arterial thrombosis.

Approach and Results—

Using mice selectively deficient in p110α in the megakaryocyte lineage and isoform-selective inhibitors, we confirm that PI3Kα is not mandatory but participates to thrombus growth over a collagen matrix at arterial shear rate. Our data uncover a role for PI3Kα in low-level activation of the GP (glycoprotein) VI-collagen receptor by contributing to ADP secretion and in turn full activation of PI3Kβ and Akt/PKB (protein kinase B). This effect was no longer observed at high level of GP VI agonist concentration. Our study also reveals that over a vWF (von Willebrand factor) matrix, PI3Kα regulates platelet stationary adhesion contacts under arterial flow through its involvement in the outside-in signaling of vWF-engaged α
IIb
β
3
integrin. In vivo, absence or inhibition of PI3Kα resulted in a modest but significant decrease in thrombus size after superficial injuries of mouse mesenteric arteries and an increased time to arterial occlusion after carotid lesion, without modification in the tail bleeding time. Considering the more discrete and nonredundant role of PI3Kα compared with PI3Kβ, selective PI3Kα inhibitors are unlikely to increase the bleeding risk at least in the absence of combination with antiplatelet drugs or thrombopenia.

Conclusions—
This study provides mechanistic insight into the role of PI3Kα in platelet activation and arterial thrombosis.
Epicardial Substrate as a Target for Radiofrequency Ablation in an Experimental Model of Early Repolarization Syndrome
Authors: Yoon Namsik , Patocskai Bence , Antzelevitch Charles 
Published: September 2018

Background:
Early repolarization syndrome (ERS) is an inherited cardiac arrhythmia syndrome associated with sudden cardiac death. Approaches to therapy are currently very limited. This study probes the mechanisms underlying the electrocardiographic and arrhythmic manifestation of experimental models of ERS and of the ameliorative effect of radiofrequency ablation.

Methods:

Action potentials, bipolar electrograms, and transmural pseudo-ECGs were simultaneously recorded from coronary-perfused canine left ventricular wedge preparations (n=11). The
I
to
agonist NS5806 (7–10 μmol/L), calcium channel blocker verapamil (3 μmol/L), and acetylcholine (1–3 μmol/L) were used to pharmacologically mimic the effects of genetic defects associated with ERS.

Results:
The provocative agents induced prominent J waves in the ECG secondary to accentuation of the action potential notch in epicardium but not endocardium. Bipolar recordings displayed low-voltage fractionated potentials in epicardium because of temporal and spatial variability in appearance of the action potential dome. Concealed phase 2 reentry developed when action potential dome was lost at some epicardial sites but not others, appearing in the bipolar electrogram as discrete high-frequency spikes. Successful propagation of the phase 2 reentrant beat precipitated ventricular tachycardia/ventricular fibrillation. Radiofrequency ablation of the epicardium destroyed the cells displaying abnormal repolarization and thus suppressed the J waves and the development of ventricular tachycardia/ventricular fibrillation in 6/6 preparations.

Conclusions:
Our findings suggest that low-voltage fractionated electrical activity and high-frequency late potentials recorded from the epicardial surface of the left ventricle can identify regions of abnormal repolarization responsible for ventricular tachycardia/ventricular fibrillation in ERS and that radiofrequency ablation of these regions in left ventricular epicardium can suppress ventricular tachycardia/ventricular fibrillation by destroying regions of ER.
Length of Stay and Discharge Disposition After Transcatheter Versus Surgical Aortic Valve Replacement in the United States
Authors: Arora Sameer , Strassle Paula D. , Kolte Dhaval , Ramm Cassandra J. , Falk Kristine , Jack Godly , Caranasos Thomas G. , Cavender Matthew A. , Rossi Joseph S. , Vavalle John P. 
Published: September 2018

Background:
As transcatheter aortic valve replacement (TAVR) extends its reach to lower surgical risk patients, the differences between resource utilization for TAVR and surgical AVR (SAVR) will become increasingly important.

Methods and Results:

AVR procedures between January 2012 and September 2015 at hospitals performing TAVR were identified using the National Inpatient Sample databases. Adults aged ≥50 years with aortic stenosis who underwent isolated TAVR or SAVR were eligible for inclusion. Standardized morbidity ratio weights were calculated using patient demographics, comorbidities, and hospital characteristics. Weighted linear and generalized logistic regression models were used to estimate the effect of undergoing TAVR, compared with undergoing SAVR, on length of stay (LOS) and discharge disposition. In TAVR-performing hospitals, 7266 (40%) patients underwent TAVR (6107 endovascular approach and 1159 transapical approach), while 10 833 (60%) underwent isolated SAVR. Patients undergoing TAVR were older, more likely to be female, and had more comorbidities. From 2012 to 2015, average LOS declined for both TAVR (6.3 days to 4.6 days;
P
<0.0001) and SAVR (7.5 days to 6.8 days;
P
<0.0001), with greater reduction in the TAVR group (
P
<0.0001). An increase in home/home health discharge was noted with TAVR (67.7%–77.4%;
P
<0.0001) but not with SAVR (76.8%–79.5%;
P
=0.25). After standardizing, patients undergoing TAVR had significantly shorter LOS (change in estimate, −2.93, 95% CI, −3.26 to −2.60) and lower incidence of transfer to skilled nursing facility (odds ratio, 0.45; 95% CI, 0.40–0.51) but no difference in in-hospital mortality (odds ratio, 0.85; 95% CI, 0.61–1.20) compared with if they had undergone SAVR. As compared with SAVR, patients who had TAVR performed via an endovascular approach had shorter LOS and lower rates of skilled nursing facility transfer, whereas in the transapical cohort, LOS, and skilled nursing facility transfer were similar to SAVR.

Conclusions:
As compared with if they undergo SAVR, patients undergoing TAVR (by a nontransapical approach) had a shorter LOS and higher likelihood of home discharge, as opposed to skilled nursing facility. From 2012 to 2015, there was a greater trend towards a reduction of LOS and more home discharges among TAVR, as opposed to SAVR. These data have important implications in the era of constrained resources with a growing emphasis on reducing health care costs.
The Effect of Medicare Accountable Care Organizations on Early and Late Payments for Cardiovascular Disease Episodes
Authors: Sinha Shashank S. , Moloci Nicholas M. , Ryan Andrew M. , Markovitz Adam A. , Colla Carrie H. , Lewis Valerie A. , Hollenbeck Brent K. , Nallamothu Brahmajee K. , Hollingsworth John M. 
Published: September 2018

Background:
Initial evaluations of the Pioneer and Shared Savings Programs have shown modest savings associated with care receipt in a Medicare accountable care organization (ACO). Whether these savings are affected by disease chronicity and the mechanisms through which they occur are unclear. In this context, we examined the association between Medicare ACO implementation and episode spending for 2 different cardiovascular conditions.

Methods and Results:
We analyzed a 20% sample of national Medicare data, identifying fee-for-service beneficiaries aged ≥65 years admitted for acute myocardial infarction (AMI) or congestive heart failure (CHF) between January 2010 and October 2014. We distinguished admissions to hospitals participating in a Medicare ACO from those to hospitals that were not. We calculated 365-day, price-standardized episode spending made on behalf of these beneficiaries, differentiating between early (index admission to 90 days postdischarge) and late payments (91-365 days postdischarge). Using an interrupted time series design, we fit longitudinal multivariable models to estimate the association between hospital ACO participation and episode spending. Our study included 153 476 beneficiaries admitted for AMI to 401 ACO participating hospitals and 2597 nonparticipating hospitals and 260 420 beneficiaries admitted for CHF to 412 ACO participating hospitals and 2796 nonparticipating hospitals. On multivariable analysis, admission to an ACO participating hospital was not associated with changes in early episode spending (AMI, $95 per beneficiary; 95% CI, −$481 to $671; CHF, $158; 95% CI, −$290 to $605). However, it was associated with significant reductions in late episode spending for both cohorts (AMI, −$680; 95% CI, −$1348 to −$11; CHF, −$889; 95% CI, −$1465 to −$313).

Conclusions:
For beneficiaries with AMI or CHF, admission to ACO participating hospitals was not associated with changes in early episode spending, but it was associated with significant savings during the late episode. ACO effects on late episode spending may complement other value-based payment reforms that target the early episode.
Population-Based Assessment of the Incidence of Aortic Dissection, Intramural Hematoma, and Penetrating Ulcer, and Its Associated Mortality From 1995 to 2015
Authors: DeMartino Randall R. , Sen Indrani , Huang Ying , Bower Thomas C. , Oderich Gustavo S. , Pochettino Alberto , Greason Kevin , Kalra Manju , Johnstone Jill , Shuja Fahad , Harmsen W. Scott , Macedo Thanila , Mandrekar Jay , Chamberlain Alanna M. , Weiss Salome , Goodney Philip P. , Roger Veronique 
Published: September 2018

Background
Aortic syndromes (ASs), including aortic dissection, intramural hematoma, and penetrating aortic ulcer, carry significant acute and long-term morbidity and mortality. However, the contemporary incidence and outcomes of AS are unknown.

Methods and Results

We used the Rochester Epidemiology Project record linkage system to identify all Olmsted County, MN, residents with AS (1995–2015). Diagnostic imaging, medical records, and death certificates were reviewed to confirm the diagnosis and AS subtype. Age- and sex-adjusted incidence rates were estimated using annual county-level census data. Survival for patients with AS was compared with age- and sex-matched controls using Cox regression to adjust for comorbid conditions. We identified 133 patients with AS (77, aortic dissection; 21, intramural hematoma; and 35, penetrating aortic ulcer). Average age was 71.8 years (SD=14.1), and 57% were men. The age- and sex-adjusted incidence was 7.7 per 100 000 person-years, was higher for men than women (10.2 versus 5.7 per 100 000 person-years), and increased with age. Among subtypes, the incidence of aortic dissection was highest (4.4 per 100 000 person-years), whereas the incidence of penetrating aortic ulcer and intramural hematoma was lower (2.1 and 1.2 per 100 000 person-years). Overall, the incidence of AS was stable over time (
P
trend=0.33), although the incidence of penetrating aortic ulcer seemed to increase from 0.6 to 2.6 per 100 000 person-years (
P
=0.008) with variability over the study interval. Patients with AS had more than twice the mortality rate at 5, 10, and 20 years when compared with population-based controls (5-, 10-, and 20-year mortality 39%, 57%, and 91% versus 18%, 41%, and 66%; overall adjusted mortality hazards ratio=2.1;
P
<0.001). Survival was lower than expected up to 90 days after AS diagnosis and did not differ significantly by subtype or by 5-year strata of diagnosis.

Conclusions
Overall, the incidence of aortic dissection and intramural hematoma has remained stable since 1995, despite the decline noted for other cardiovascular disease. AS confers increased early and long-term mortality that has not changed. These data highlight the need to improve long-term care to impact the prognosis of this patient group.
Cardiovascular and Mortality Outcomes in the Elderly With Impaired Cardiac and Pulmonary Function: The Cardiovascular Health Study (CHS)
Authors: Waheed Salman , Chaves Paulo H. M. , Gardin Julius M. , Cao Jie Jane 
Published: September 2018

Background

Impaired pulmonary function (
IPF
) and left ventricular systolic dysfunction (
LVSD
) are prevalent in the elderly and are associated with significant morbidity and mortality. The main objectives of this study were to examine the relative impact and joint association of
IPF
and
LVSD
with heart failure, cardiovascular mortality and all‐cause mortality, and their impact on risk classification using a continuous net reclassification index.

Methods and Results

We followed 2342 adults without prevalent cardiovascular disease (mean age, 76 years) from the Cardiovascular Health Study for a median of 12.6 years.
LVSD
was defined as
LV
ejection fraction <55%.
IPF
was defined as: forced expiratory volume in 1 second:forced vital capacity <70%, and predicted forced expiratory volume in 1 second <80%. Outcomes included heart failure hospitalization, cardiovascular mortality, all‐cause mortality, and composite outcome.
LVSD
was detected in 128 subjects (6%),
IPF
in 441 (19%) and both in 38 (2%). Compared to those without
LVSD
or
IPF
, there was a significantly increased cardiovascular risk for groups of
LVSD
only,
IPF
only, and
LVSD
plus
IPF
, adjusted hazard ratio (95%
CI
) 2.1 (1.5–3.0), 1.7 (1.4–2.1), and 3.2 (2.0–5.1) for
HF
; 1.8 (1.2–2.6), 1.4 (1.1–1.8), and 2.8 (1.7–4.7) for cardiovascular mortality; 1.3 (1.0–1.8), 1.7 (1.4–1.9), and 2.1 (1.5–3.0) for all‐cause mortality, and 1.6 (1.3–2.1), 1.7 (1.5–1.9), and 2.4 (1.7–3.3) for composite outcome, respectively. Risk classification improved significantly for all outcomes when
IPF
was added to the adjusted model with
LVSD
or
LVSD
to
IPF
.

Conclusions

While risk of cardiovascular outcomes was the highest among elderly with both
LVSD
and
IPF
, risk was comparable between subjects with
IPF
alone and those with
LVSD
alone. This observation, combined with improved risk classification by adding
IPF
to
LVSD
or
LVSD
to
IPF
, underscore the importance of comprehensive heart and lung evaluation in cardiovascular outcome assessment.
Disruption of VEGF Mediated Flk‐1 Signaling Leads to a Gradual Loss of Vessel Health and Cardiac Function During Myocardial Infarction: Potential Therapy With Pellino‐1
Authors: Thirunavukkarasu Mahesh , Selvaraju Vaithinathan , Joshi Mandip , Coca‐Soliz Vladimir , Tapias Leonidas , Saad IbnalWalid , Fournier Craig , Husain Aaftab , Campbell Jacob , Yee Siu‐Pok , Sanchez Juan A. , Palesty J. Alexander , McFadden David W. , Maulik Nilanjana 
Published: September 2018

Background

The present study demonstrates that the ubiquitin E3 ligase, Pellino‐1 (Peli1), is an important angiogenic molecule under the control of vascular endothelial growth factor (VEGF) receptor 2/Flk‐1. We have previously reported increased survivability of ischemic skin flap tissue by adenovirus carrying Peli1 (Ad‐Peli1) gene therapy in Flk‐1
+/−
mice.

Methods and Results

Two separate experimental groups of mice were subjected to myocardial infarction (
MI
) followed by the immediate intramyocardial injection of adenovirus carrying LacZ (Ad‐LacZ) (1×10
9
pfu) or Ad‐Peli1 (1×10
9
pfu). Heart tissues were collected for analyses. Compared with wild‐type (
WTMI
) mice, analysis revealed decreased expressions of Peli1, phosphorylated (p‐)Flk‐1, p‐Akt, p‐
eNOS
, p‐
MK
2, p‐IκBα, and
NF
‐κB and decreased vessel densities in Flk‐1
+/−
mice subjected to
MI
(Flk‐1
+/−
MI
). Mice (
CD
1) treated with Ad‐Peli1 after the induction of
MI
showed increased β‐catenin translocation to the nucleus, connexin 43 expression, and phosphorylation of Akt,
eNOS
,
MK
2, and IκBα, that was followed by increased vessel densities compared with the Ad‐LacZ–treated group. Echocardiography conducted 30 days after surgery showed decreased function in the Flk1
+/−
MI
group compared with
WTMI
, which was restored by Ad‐Peli1 gene therapy. In addition, therapy with Ad‐Peli1 stimulated angiogenic and arteriogenic responses in both
CD
1 and Flk‐1
+/−
mice following
MI
. Ad‐Peli1 treatment attenuated cardiac fibrosis in Flk‐1
+/−
MI
mice. Similar positive results were observed in
CD
1 mice subjected to
MI
after Ad‐Peli1 therapy.

Conclusion

Our results show for the first time that Peli1 plays a unique role in salvaging impaired collateral blood vessel formation, diminishes fibrosis, and improves myocardial function, thereby offering clinical potential for therapies in humans to mend a damaged heart following
MI
.
Incidence of Long‐Term Structural Valve Dysfunction and Bioprosthetic Valve Failure After Transcatheter Aortic Valve Replacement
Authors: Barbanti Marco , Costa Giuliano , Zappulla Paolo , Todaro Denise , Picci Andrea , Rapisarda Giulia , Di Simone Emanuela , Sicuso Rita , Buccheri Sergio , Gulino Simona , Pilato Gerlando , La Spina Ketty , D'Arrigo Paolo , Valvo Roberto , Indelicato Antonino , Giannazzo Daniela , Immè Sebastiano , Tamburino Claudia , Patanè Martina , Sgroi Carmelo , Giuffrida Angelo , Trovato Danilo , Monte Ines Paola , Deste Wanda , Capranzano Piera , Capodanno Davide , Tamburino Corrado 
Published: September 2018

Background

Long‐term data on durability of currently available transcatheter heart valves are sparse. We sought to assess the incidence of long‐term (8‐year) structural valve dysfunction and bioprosthetic valve failure in a cohort of patients with transcatheter aortic valve replacement (
TAVR
) who reached at least 5‐year follow‐up.

Methods and Results

Consecutive patients with at least 5‐year follow‐up available undergoing
TAVR
from June 4, 2007 to March 30, 2012 were included.
Structural valve dysfunction
and bioprosthetic valve failure were defined according to newly standardized European Association of Percutaneous Cardiovascular Interventions/
European Society of Cardiology/European Association for Cardio‐Thoracic Surgery
criteria and reported as cumulative incidence function to account for the competing risk of death. A total of 288 consecutive patients with a mean age of 80.7±5.3 years and with a mean
Society of Thoracic Surgery
mortality score of 8.1±5.1% were analyzed. Survival rate at 8 years was 29.8%. Mean pressure gradients decreased from 53.3±15.9 mm Hg (pre‐
TAVR
) to 10.5±4.5 mm Hg (in‐hospital post‐
TAVR
) (
P
<0.001). There was a small, not significant, increase in the transaortic gradient throughout follow‐up.
Bioprosthetic valve failure
was observed in a total of 11 patients (8‐year cumulative incidence function: 4.51%; 95% confidence interval
,
1.95%–8.76%). Severe and moderate
structural valve dysfunctions
were reported in 7 patients (8‐year
cumulative incidence function:
2.39%; 95%
confidence interval,
0.77%–5.71%) and 13 patients (8‐year
cumulative incidence function:
5.87%; 95%
confidence interval
, 3.06%–9.96%), respectively. Aortic valve reintervention (redo
TAVR
) was successfully performed in 2 patients (0.7%) presenting with symptomatic severe restenosis and intraprosthetic regurgitation subsequent to endocarditis.

Conclusions

In an aged population of patients with symptomatic severe
aortic stenosis
treated with first‐generation bioprostheses,
TAVR
was associated with a survival rate of 30% but low rates of bioprosthetic valve failure and structural valve dysfunction at 8 years.