bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of non-respect of SYNTAX score II recommendation for surgery in patients with left main coronary artery disease treated by percutaneous coronary intervention: an EXCEL substudy
Authors: Modolo Rodrigo , Chichareon Ply , van Klaveren David , Dressler Ovidiu , Zhang Yiran , Sabik Joseph F , Onuma Yoshinobu , Kappetein Arie Pieter , Stone Gregg W , Serruys Patrick W 
Published: October 2019

AbstractOBJECTIVESThe SYNTAX score II (SSII) was developed from the SYNTAX trial to predict the 4-year all-cause mortality after left main or multivessel disease revascularization and to facilitate the decision-making process. The SSII provides the following treatment recommendations: (i) coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) (equipoise risk), (ii) CABG preferred (excessive risk for PCI) or (iii) PCI preferred (excessive risk for CABG). We sought to externally validate SSII and to investigate the impact of not abiding by the SSII recommendations in the randomized EXCEL trial of PCI versus CABG for left main disease.METHODSThe calibration plot of predicted versus observed 4-year mortality was constructed from individual values of SSII in EXCEL. To assess overestimation versus underestimation of predicted mortality risk, an optimal fit regression line with slope and intercept was determined. Prospective treatment recommendations based on SSII were compared with actual treatments and all-cause mortality at 4 years.RESULTSSSII variables were available from EXCEL trial in 1807/1905 (95%) patients. For the entire cohort, discrimination was possibly helpful (C statistic = 0.670). SSII-predicted all-cause mortality at 4 years overestimated the observed mortality, particularly in the highest-risk percentiles, as confirmed by the fit regression line [intercept 2.37 (1.51–3.24), P = 0.003; slope 0.67 (0.61–0.74), P < 0.001]. When the SSII-recommended treatment was CABG, randomized EXCEL patients treated with PCI had a trend towards higher mortality compared with those treated with CABG (14.1% vs 5.3%, P = 0.07) in the as-treat population. In the intention-to-treat population, patients randomized to PCI had higher mortality compared with those randomized to CABG (15.1% vs 4.1%, P = 0.02), when SSII recommended CABG.CONCLUSIONSIn the EXCEL trial of patients with left main disease, the SSII-predicted 4-year mortality overestimated the 4-year observed mortality with a possibly helpful discrimination. Non-compliance with SSII CABG treatment recommendations (i.e. randomized to PCI) was associated with higher 4-year all-cause mortality.
Clinical outcomes of immunocompromised patients on extracorporeal membrane oxygenation support for severe acute respiratory failure
Authors: Na Soo Jin , Park So Hee , Hong Sang-Bum , Cho Woo Hyun , Lee Sang-Min , Cho Young-Jae , Park Sunghoon , Koo So-My , Park Seung Yong , Chang Youjin , Kang Byung Ju , Kim Jung-Hyun , Oh Jin Young , Jung Jae-Seung , Yoo Jung-Wan , Sim Yun Su , Jeon Kyeongman 
Published: October 2019

Abstract

OBJECTIVES
There are limited data regarding extracorporeal membrane oxygenation (ECMO) support in immunocompromised patients, despite an increase in ECMO use in patients with respiratory failure. The aim of this study was to investigate the clinical characteristics and outcomes of immunocompromised patients requiring ECMO support for severe acute respiratory failure.

METHODS
Between January 2012 and December 2015, all consecutive adult patients with severe acute respiratory failure who underwent ECMO for respiratory support at 16 tertiary or university-affiliated hospitals in South Korea were enrolled retrospectively. The patients were divided into 2 groups based on the immunocompromised status at the time of ECMO initiation. In-hospital and 6-month mortalities were compared between the 2 groups. In addition, association of immunocompromised status with 6-month mortality was evaluated with logistic regression analysis.

RESULTS
Among 461 patients, 118 (25.6%) were immunocompromised. Immunocompromised patients were younger and had lower haemoglobin and platelet counts than immunocompetent patients. Ventilatory parameters and the use of adjunctive/rescue therapies were similar between the 2 groups, but prone positioning was more commonly used in immunocompetent patients. Successful weaning rates from ECMO (46.6% vs 58.9%; P = 0.021) was lower and hospital mortality (66.1% vs 59.8%; P = 0.22) was higher in immunocompromised patients. In addition, immunocompromised status was associated with higher 6-month mortality (74.6% vs 64.7%, adjusted odds ratio 2.10, 95% confidence interval 1.02–4.35; P = 0.045).

CONCLUSIONS
Immunocompromised patients treated with ECMO support for severe acute respiratory failure had poorer short- and long-term prognoses than did immunocompetent patients.
Morbidity and mortality of lobectomy or pneumonectomy after neoadjuvant treatment: an analysis from the ESTS database
Authors: Brunelli Alessandro , Rocco Gaetano , Szanto Zalan , Thomas Pascal , Falcoz Pierre Emmanuel 
Published: October 2019

Abstract

OBJECTIVES
To evaluate the postoperative complications and 30-day mortality rates associated with neoadjuvant chemotherapy before major anatomic lung resections registered in the European Society of Thoracic Surgeons (ESTS) database.

METHODS
Retrospective analysis on 52 982 anatomic lung resections registered in the ESTS database (July 2007–31 December 2017) (6587 pneumonectomies and 46 395 lobectomies); 5143 patients received neoadjuvant treatment (9.7%) (3993 chemotherapy alone and 1150 chemoradiotherapy). To adjust for possible confounders, a propensity case-matched analysis was performed. The postoperative outcomes (morbidity and 30-day mortality) of matched patients with and without induction treatment were compared.

RESULTS
8.2% of all patients undergoing lobectomies and 20% of all patients undergoing pneumonectomies received induction treatment. Lobectomy analysis: propensity score analysis yielded 3824 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the neoadjuvant group (626 patients, 16% vs 446 patients, 12%, P &lt; 0.001), but 30-day mortality rates were similar (71 patients, 1.9% vs 75 patients, 2.0%, P = 0.73). The incidence of bronchopleural fistula and prolonged air leak &gt;5 days were similar between the 2 groups (neoadjuvant: 0.5% vs 0.4%, P = 0.87; 9.2% vs 9.9%, P = 0.27). Pneumonectomy analysis: propensity score analysis yielded 1312 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the treated patients compared to those without neoadjuvant treatment (neoadjuvant 275 cases, 21% vs 18%, P = 0.030). However, the 30-day mortality was similar between the matched groups (neoadjuvant 68 cases, 5.2% vs 5.3%, P = 0.86). Finally, the incidence of bronchopleural fistula was also similar between the 2 groups (neoadjuvant 1.8% vs 1.4%, P = 0.44).

CONCLUSIONS
Neoadjuvant chemotherapy is not associated with an increased perioperative risk after either lobectomy or pneumonectomy, warranting a more liberal use of this approach for patients with locally advanced operable lung cancer.
Combining left atrial appendage closure and catheter ablation for atrial fibrillation: 2-year outcomes from a multinational registry
Authors: Phillips Karen P , Romanov Aleksandr , Artemenko Sergey , Folkeringa Richard J , Szili-Torok Tamas , Senatore Gaetano , Stein Kenneth M , Razali Omar , Gordon Nicole , Boersma Lucas V A 
Published: October 2019

Abstract

Aims
Clinical practice guidelines do not recommend discontinuation of long-term oral anticoagulation in patients with a high stroke risk after catheter ablation for atrial fibrillation (AF). Left atrial appendage closure (LAAC) with Watchman has emerged as an alternative to long-term anticoagulation for patients accepting of the procedural risks. We report on the long-term outcomes of combining catheter ablation procedures for AF and LAAC from multicentre registries.

Methods and results
Data were pooled from two prospective, real-world Watchman LAAC registries running in parallel in Europe/Middle-East/Russia (EWOLUTION) and Asia/Australia (WASP) between 2013 and 2015. Of the 1140 patients, 142 subjects at 11 centres underwent a concomitant AF ablation and LAAC procedure. The mean CHA2DS2-VASc score was 3.4 ± 1.4 and HAS-BLED score 1.5 ± 0.9. Successful LAAC was achieved in 99.3% of patients. The 30-day device and/or procedure-related serious adverse event rate was 2.1%. After a mean follow-up time of 726 ± 91 days, 92% of patients remained off oral anticoagulation. The rates of the composite endpoint of ischaemic stroke/transient ischaemic attack/systemic thromboembolism were 1.09 per 100 patient-years (100-PY); and for non-procedural major bleeding were 1.09 per 100-PY. These represent relative reductions of 84% and 70% vs. expected rates per risk scores.

Conclusion
The long-term outcomes from these international, multicentre registries show efficacy for all-cause stroke prevention and a significant reduction in late bleeding events in a population of high stroke risk post-ablation patients who have been withdrawn from oral anticoagulation.
Clinical characteristics and long-term clinical course of patients with Brugada syndrome without previous cardiac arrest: a multiparametric risk stratification approach
Authors: Letsas Konstantinos P , Bazoukis George , Efremidis Michael , Georgopoulos Stamatis , Korantzopoulos Panagiotis , Fragakis Nikolaos , Asvestas Dimitrios , Vlachos Konstantinos , Saplaouras Athanasios , Sakellaropoulou Antigoni , Mililis Panagiotis , Strempelas Panagiotis , Giannopoulos Georgios , Gavrielatos Gerasimos , Tzeis Stylianos , Kardamis Christoforos , Katsivas Apostolos , Deftereos Spyridon , Stavrakis Stavros , Sideris Antonios 
Published: October 2019

Abstract

Aims
Risk stratification in Brugada syndrome (BrS) still represents an unsettled issue. In this multicentre study, we aimed to evaluate the clinical characteristics and the long-term clinical course of patients with BrS.

Methods and results
A total of 111 consecutive patients (86 males; aged 45.3 ± 13.3 years) diagnosed with BrS were included and followed-up in a prospective fashion. Thirty-seven patients (33.3%) were symptomatic at enrolment (arrhythmic syncope). An electrophysiological study (EPS) was performed in 59 patients (53.2%), and ventricular arrhythmias were induced in 32 (54.2%). A cardioverter defibrillator was implanted in 34 cases (30.6%). During a mean follow-up period of 4.6 ± 3.5 years, appropriate device therapies occurred in seven patients. Event-free survival analysis (log-rank test) showed that spontaneous type-1 electrocardiogram pattern (P = 0.008), symptoms at presentation (syncope) (P = 0.012), family history of sudden cardiac death (P < 0.001), positive EPS (P = 0.024), fragmented QRS (P = 0.004), and QRS duration in lead V2 > 113 ms (P < 0.001) are predictors of future arrhythmic events. Event rates were 0%, 4%, and 60% among patients with 0–1 risk factor, 2–3 risk factors, and 4–5 risk factors, respectively (P < 0.001). Current multiparametric score models exhibit an excellent negative predictive value and perform well in risk stratification of BrS patients.

Conclusions
Multiparametric models including common risk factors appear to provide better risk stratification of BrS patients than single factors alone.
Social inequalities in health: duration of unemployment unevenly effects on the health of men and women
Authors: Acevedo Paula , Mora-Urda Ana I , Montero Pilar 
Published: October 2019

AbstractBackgroundEmployment status is an important determinant of health inequalities. The aim of this article is to analyze the association between duration of unemployment and the presence of cardiovascular risk factors, self-perception of health and presence of depression and anxiety, assessing differences in the effects of unemployment by sex and age.MethodsThe sample was composed of 12 123 people (52.4% men), 18 to 74 years old (mean age= 43.5 years, SD = 10.4). Logistic regression analyses were used to study the influence of duration of unemployment on health (‘0 days’, ‘≤11 months’ and ‘≥12 months’). Sex, age, level of education, employment status and time spent unemployed, as well as tobacco and alcohol use and physical activity, were considered. Morbidity variables were hypertension, hypercholesterolemia, diabetes, obesity, depression and anxiety, and a subjective health assessment.ResultsThe results showed both unemployed men and women had worse outcome in health compared with their active counterparts. The risk of hypertension was presented in long-term unemployed men, which had 1.3 times more likely to suffer from hypertension. The risk of obesity was presented only in unemployed women, which had 1.5 times more risk of obesity, doubling the risk (OR= 2.2) among women under age 40. The unemployment had a protective effect against anxiety among younger women (OR = 0.53)ConclusionIt has been observed a different influence of unemployment time on men and women’s health. The employment status should be considered in public health policy agendas with the purpose of reducing inequalities in health.
Multiscale Dynamics of Spontaneous Brain Activity Is Associated With Walking Speed in Older Adults
Authors: Zhou Junhong , Poole Victoria , Wooten Thomas , Lo On-Yee , Iloputaife Ikechukwu , Manor Brad , Esterman Michael , Lipsitz Lewis A 
Published: October 2019

Abstract

Background
In older adults, compromised white matter tract integrity within the brain has been linked to impairments in mobility. We contend that poorer integrity disrupts mobility by altering the processing of sensorimotor and cognitive and attentional resources in neural networks. The richness of information processing in a given network can be quantified by calculating the complexity of resting-state functional MRI time series. We hypothesized that (i) older adults with lower brain complexity, specifically within sensorimotor, executive, and attention networks, would exhibit slower walking speed and greater dual-task costs (ie, dual-task cost) and (ii) such complexity would mediate the effect of white matter integrity on these metrics of mobility.

Methods
Fifty-three older adults completed a walking assessment and a neuroimaging protocol. Brain complexity was quantified by calculating the multiscale entropy of the resting-state functional MRI signal within seven previously defined functional networks. The white matter integrity across structures of the corpus callosum was quantified using fractional anisotropy.

Results
Participants with lower resting-state complexity within the sensorimotor, executive, and attention networks walked more slowly under single- and dual-task (ie, walking while performing a serial-subtraction task) conditions (β &gt; 0.28, p ≤ .01) and had a greater dual-task cost (β &lt; −0.28, p &lt; .04). Complexity in these networks mediated the influence of the corpus callosum genu on both single- (indirect effects &gt; 0.15, 95% confidence intervals = 0.02–0.32) and dual-task walking speeds (indirect effects &gt; 0.13, 95% confidence intervals = 0.02–0.33).

Conclusion
These results suggest that the multiscale dynamics of resting-state brain activity correlate with mobility and mediate the effect of the microstructural integrity in the corpus callosum genu on walking speed in older adults.
ApoE Genotype, Lipid Profile, Exercise, and the Associations With Cardiovascular Morbidity and 18-Year Mortality
Authors: Dankner Rachel , Ben Avraham Sivan , Harats Dror , Chetrit Angela 
Published: October 2019

AbstractBackgroundStudies of longevity examined apolipoprotein E (ApoE), a gene involved in lipoprotein metabolism, which interacts with susceptibility to age-related diseases, and with mortality. We evaluated the association of ApoE isoforms with cardiovascular disease (CVD) and all-cause mortality.MethodsA prospective cohort of 949 survivors of the Israel Study of Glucose Intolerance, Obesity, and Hypertension, examined during 1999–2004, mean age 72 years, was followed for mortality until 2017. Participants were interviewed for lifestyle habits and medical history. Anthropometrics and biochemical markers were taken. Logistic regression was used to assess CVD morbidity and Cox proportional hazard model for mortality.ResultsThe most common genotype in the cohort was ApoE E3 (76.3%), with the other two almost equally distributed (ApoE E2 11.2% and ApoE E4 12.5%). In men only, ApoE E4 associated with CVD (adjusted odds ratio = 1.46, 95% confidence interval [CI] 0.76, 2.80) and with 18-year mortality (adjusted hazard ratio = 1.47, 95% CI 0.95, 2.26), adjusting for age, ethnicity, physical activity, hypertension, diabetes, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, triglycerides and lipid-lowering medications. Low levels of HDL cholesterol, adjusted for ApoE and the above-mentioned variables, associated with higher prevalence of CVD (adjusted odds ratio = 1.35, 95% CI 1.00, 1.83) and all-cause mortality (adjusted hazard ratio = 1.42, 95% CI 1.14, 1.78). ApoE E3 and E2 conferred a lower 18-year mortality risk in the physically active individuals, compared to the sedentary (adjusted hazard ratio = 0.57, 95% CI 0.44, 0.74, and adjusted hazard ratio = 0.53, 95% CI 0.78, 1.02, respectively).ConclusionsIn community-dwelling older adults, sociodemographic characteristics and physical activity, blood pressure and HDL-cholesterol levels, may outweigh the impact of ApoE polymorphisms on CVD morbidity and all-cause mortality.
DUX4-induced bidirectional HSATII satellite repeat transcripts form intranuclear double-stranded RNA foci in human cell models of FSHD
Authors: Shadle Sean C , Bennett Sean R , Wong Chao-Jen , Karreman Nancy A , Campbell Amy E , van der Maarel Silvère M , Bass Brenda L , Tapscott Stephen J 
Published: October 2019

Abstract
The DUX4 transcription factor is normally expressed in the cleavage-stage embryo and regulates genes involved in embryonic genome activation. Misexpression of DUX4 in skeletal muscle, however, is toxic and causes facioscapulohumeral muscular dystrophy (FSHD). We recently showed DUX4-induced toxicity is due, in part, to the activation of the double-stranded RNA (dsRNA) response pathway and the accumulation of intranuclear dsRNA foci. Here, we determined the composition of DUX4-induced dsRNAs. We found that a subset of DUX4-induced dsRNAs originate from inverted Alu repeats embedded within the introns of DUX4-induced transcripts and from DUX4-induced dsRNA-forming intergenic transcripts enriched for endogenous retroviruses, Alu and LINE-1 elements. However, these repeat classes were also represented in dsRNAs from cells not expressing DUX4. In contrast, pericentric human satellite II (HSATII) repeats formed a class of dsRNA specific to the DUX4 expressing cells. Further investigation revealed that DUX4 can initiate the bidirectional transcription of normally heterochromatin-silenced HSATII repeats. DUX4-induced HSATII RNAs co-localized with DUX4-induced nuclear dsRNA foci and with intranuclear aggregation of EIF4A3 and ADAR1. Finally, gapmer-mediated knockdown of HSATII transcripts depleted DUX4-induced intranuclear ribonucleoprotein aggregates and decreased DUX4-induced cell death, suggesting that HSATII-formed dsRNAs contribute to DUX4 toxicity.
Endoscopic closure of a bronchopleural fistula after pneumonectomy with the Amplatzer occluder: a step forward?
Authors: Motus Igor Ya , Bazhenov Alexander V , Basyrov Rauf T , Tsvirenko Anna S 
Published: October 2019

Abstract

OBJECTIVES
A bronchopleural fistula after pneumonectomy is a relatively rare but very serious complication. The development of endoscopic methods of treatment opens a new page in treating this condition. The goal of this paper was to confirm that the atrial septal defect Amplatzer device can be used for bronchopleural fistula closure in properly selected patients.

METHODS
A retrospective study of 13 patients with bronchopleural fistula after pneumonectomy was performed. There were 11 men and 2 women aged 26–70 years. Right-sided fistulas occurred in 10 patients and left-sided fistulas occurred in 3. The underlying disease was lung cancer in 7 patients and pulmonary tuberculosis in 6. Video-assisted thoracoscopic surgery (N = 7) and open-window thoracostomy (N = 6) were used to treat the empyema. To treat occlusion of the bronchial fistulas, we used Amplatzer atrial septal defect occluders originally intended for closure of ventricular and interatrial septal defects. The occluder was inserted from the bronchus by flexible bronchoscopy with the patient under local anaesthesia, with the help of video-assisted thoracoscopy or through a window thoracostomy from the pleural cavity.

RESULTS
We noted 3 complications after the procedure. In 2 patients, displacement of the occluders required re-installation in 1 patient and latissimus dorsi muscle coverage in the other. In the third patient, the occluder became dislodged during severe exacerbation of tuberculosis that occurred after the patient violated the treatment regimen. She died of tuberculosis 6 months after the occluder was inserted. The course in the remaining 10 patients was uneventful.

CONCLUSIONS
Our experience suggests that the use of an atrial septal defect occluder for the treatment of a bronchial fistula after pneumonectomy is a reliable option.
Hot Rocks and Not-So-Hot Rocks on the Seashore: Patterns and Body-Size Dependent Consequences of Microclimatic Variation in Intertidal Zone Boulder Habitat
Authors: Gunderson A R , Abegaz M , Ceja A Y , Lam E K , Souther B F , Boyer K , King E E , You Mak K T , Tsukimura B , Stillman J H 
Published: October 2019

SynopsisMicroclimatic variation has emerged as an important driver of many ecological and evolutionary processes. Nonetheless, fine-scale temperature data are still rare in most habitats, limiting our ability to understand the consequences of microclimatic variation under current and future conditions. We measured fine-scale thermal variation in a common, species-rich, but rarely studied habitat with respect to temperature: the airspaces under rocks on intertidal zone boulder shores. The effects of thermal variation were investigated using physiological, behavioral, and demographic responses of the porcelain crab Petrolisthes cinctipes. Habitat temperatures were measured at fine spatial and temporal resolution over 18 months, producing 424,426 temperature records. Microclimatic variation increased with increasing intertidal elevation, particularly with respect to heat extremes. However, mean temperatures were similar across the entire intertidal zone. Overheating risk for P. cinctipes increases with intertidal elevation but is size dependent, as large animals are more heat sensitive than small animals. Still, microclimatic variation high in the intertidal zone provided thermal refugia even under the warmest conditions. Size-dependent thermal responses predicted that large crabs should be rare high in the intertidal zone, which was supported by demographic data. Furthermore, simulations parameterized by our microclimate and organismal data recapitulated demographic patterns. Therefore, interactions between microclimatic variation and size-dependent thermal responses may have significant ecological repercussions that warrant greater attention.