bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations between demographic characteristics and unmet supportive care needs in adults with cystic fibrosis
Authors: Obregon Laura Liliana , Jeong Kwonho , Hoydich Zachariah P , Yabes Jonathan , Pilewski Joseph , Richless Connie , Moreines Laura T , Dellon Elisabeth P , Goss Christopher H , Arnold Robert M , Kavalieratos Dio 
Published: August 2019

ContextPatients living with cystic fibrosis (CF) report impaired quality of life. Little is known about unmet supportive care needs among adults living with CF and how they are associated with demographic characteristics.ObjectivesThe primary objective of this study was to identify associations between demographic variables and unmet supportive care needs regarding anxiety, sadness, pain and uncertainty about the future of living with CF.MethodsWe recruited 165 adults with CF from a single academic medical centre to complete a brief demographic survey and the Supportive Care Needs Survey (SCNS-34), a validated self-reported needs assessment that measures the prevalence of and preferences for support for 34 needs that commonly occur in patients with serious illness.ResultsApproximately half of the participant sample was male, with a median age of 29 years, varying income levels and a range of lung disease severity. We found statistically significant associations between insufficient income and increased odds of reporting need for support regarding anxiety (OR: 6.48; 95% CI 2.08 to 20.2), sadness (OR: 6.15; 95% CI 2.04 to 18.5), pain (OR: 7.06; 95% CI 2.22 to 22.4) and worries surrounding uncertainty about the future (OR: 3.43; 95% CI 1.18 to 9.99).ConclusionAdults with CF report significant unmet needs for support in several physical and emotional domains. Many of these domains were associated with demographic characteristics, most notably, income. Our findings underscore the importance of developing treatment approaches that are sensitive to patient demographics when addressing unmet supportive care needs among adults with CF.
Differential disruption of autoinhibition and defect in assembly of cytoskeleton during cell division decide the fate of humanDIAPH1-related cytoskeletopathy
Authors: Kim Bong Jik , Ueyama Takehiko , Miyoshi Takushi , Lee Seungmin , Han Jin Hee , Park Hye-Rim , Kim Ah Reum , Oh Jayoung , Kim Min Young , Kang Yong Seok , Oh Doo Yi , Yun Jiwon , Hwang Sang Mee , Kim Nayoung K D , Park Woong-Yang , Kitajiri Shin-ichiro , Choi Byung Yoon 
Published: August 2019

BackgroundDiaphanous-related formin 1 (DIA1), which assembles the unbranched actin microfilament and microtubule cytoskeleton, is encoded byDIAPH1. Constitutive activation by the disruption of autoinhibitory interactions between the N-terminal diaphanous inhibitory domain (DID) and C-terminal diaphanous autoregulatory domain (DAD) dysregulates DIA1, resulting in both hearing loss and blood cell abnormalities.Methods and resultsHere, we report the first constitutively active mutant in the DID (p.A265S) of humans with only hearing loss and not blood cell abnormality through whole exome sequencing. The previously reported DAD mutants and our DID mutant (p.A265S) shared the finding of diminished autoinhibitory interaction, abnormally upregulated actin polymerisation activity and increased localisations at the plasma membrane. However, the obvious defect in the DIA1-driven assembly of cytoskeleton ‘during cell division’ was only from the DAD mutants, not from p.A265S, which did not show any blood cell abnormality. We also evaluated the five DID mutants in the hydrophobic pocket since four of these five additional mutants were predicted to critically disrupt interaction between the DID and DAD. These additional pathogenic DID mutants revealed varying degrees of defect in the DIA1-driven cytoskeleton assembly, including nearly normal phenotype during cell division as well as obvious impaired autoinhibition, again coinciding with our key observation in DIA1 mutant (p.A265S) in the DID.ConclusionHere, we report the first mutant in the DID of humans with only hearing loss. The differential cell biological phenotypes of DIA1 during cell division appear to be potential determinants of the clinical severity ofDIAPH1-related cytoskeletopathy in humans.
Blind exchange with mini-pinning technique for distal occlusion thrombectomy
Authors: Haussen Diogo C , Al-Bayati Alhamza R , Eby Brendan , Ravindran Krishnan , Rodrigues Gabriel Martins , Frankel Michael R , Nogueira Raul G 
Published: August 2019

IntroductionTechnical improvements to enhance distal occlusion thrombectomy are desirable. We describe the blind catheter exchange technique and report the pinning technique with small devices (‘mini-pinning’) for distal occlusions.MethodsA retrospective review of a prospective database from January 2015 to August 2018 was performed for cases of distal occlusion in which the ‘blind exchange/mini-pinning’ (BEMP) techniques were used. The technique involves the deployment of a 3 mm Trevo retriever followed by microcatheter removal and blind advancement of a 3MAX aspiration catheter over the bare retriever delivery wire (‘blind exchange’) until clot contact under aspiration. The retriever is subsequently partially recaptured in order to ‘cork’ the thrombus (‘mini-pinning’) and the system pulled as a unit. Patients with distal occlusions treated with BEMP and standard techniques (either 3 mm Trevo or 3MAX) were compared.ResultsTwenty-five vessels were treated in 22 patients. The majority of patients had isolated distal occlusions predominantly in the distal middle cerebral artery (MCA) segments, half of which involved the superior division. The comparison between BEMP (n=25 vessels) and standard techniques (n=144 vessels) revealed balanced groups. One of the highlighted differences was the more distal MCA occlusions among those who underwent BEMP (M3 occlusions 52% vs 22%; p=0.001). Otherwise, the vessel, segments, divisions and luminal diameter were comparable. There was a higher rate of first-pass modified Thrombolysis in Cerebral Infarction 2b–3 (80% vs 56%; p=0.03) and a trend towards higher rates of first-pass full reperfusion (60% vs 40%; p=0.07) with BEMP compared with standard techniques. Final reperfusion and clinical outcomes were comparable.ConclusionBEMP appears to be a safe and effective technique for the treatment of distal occlusions. Additional studies are warranted.
A descriptive study of venous sinus pressures and gradients in patients with idiopathic intracranial hypertension
Authors: Fargen Kyle M , Garner Rebecca M , Kittel Carol , Wolfe Stacey Q 
Published: August 2019

ObjectiveTo determine the relationship between normal physiologic and pathologic venous sinus pressures in patients with idiopathic intracranial hypertension (IIH), which is poorly understood.MethodsRetrospective analysis was performed to identify patients with medically refractory IIH who were evaluated by angiography and retrograde venography with venous manometry. Patients were further subdivided into groups based on anatomic factors.Results104 patients met inclusion criteria for the study. In the absence of non-invasive venographic screening, 58% of patients in this series were found to have pressure gradients of ≥8 mm Hg; 93% were located near the transverse-sigmoid sinus junction. Opening pressure (OP) is strongly predictive of superior sagittal sinus (SSS) pressures (p<0.001) and also of the presence of a pressure gradient ≥8 mm Hg (p<0.001). Twenty-three percent of patients with an OP <25 had a pressure gradient ≥8 mm Hg compared with 77% of patients with an OP ≥35. Analysis of patients with OP ≤20 suggests that SSS pressures in patients without IIH should be less than 16–18 mm Hg with total cranial gradients <5 mm Hg. Across all patients, a pressure decrement of approximately 1 mm Hg occurs with progressively more caudal transition across anatomic points of measurement.ConclusionsThis study describes intracranial and extracranial venous pressure measurements and gradients in different subgroups of patients with IIH. OP is highly predictive of intracranial venous pressures and significant venous pressure gradients.
Heart Failure Risk Stratification and Efficacy of Sodium-Glucose Cotransporter-2 Inhibitors in Patients With Type 2 Diabetes Mellitus
Authors: Berg David D. , Wiviott Stephen D. , Scirica Benjamin M. , Gurmu Yared , Mosenzon Ofri , Murphy Sabina A. , Bhatt Deepak L. , Leiter Lawrence A. , McGuire Darren K. , Wilding John P.H. , Johanson Per , Johansson Peter A. , Langkilde Anna Maria , Raz Itamar , Braunwald Eugene , Sabatine Marc S. 
Published: August 2019

Background:
Patients with type 2 diabetes mellitus (T2DM) are at increased risk of developing heart failure. Sodium-glucose cotransporter-2 inhibitors reduce the risk of hospitalization for heart failure (HHF) in patients with T2DM. We aimed to develop and validate a practical clinical risk score for HHF in patients with T2DM and assess whether this score can identify high-risk patients with T2DM who have the greatest reduction in risk for HHF with a sodium-glucose cotransporter-2 inhibitor.

Methods:

We developed a clinical risk score for HHF in 8212 patients with T2DM in the placebo arm of SAVOR-TIMI 53 (Saxagliptin Assessment of Vascular Outcomes Recorded in Patients With Diabetes Mellitus–Thrombolysis in Myocardial Infarction 53). Candidate variables were assessed using multivariable Cox regression, and independent clinical risk indicators achieving statistical significance of
P
<0.001 were included in the risk score. We externally validated the score in 8578 patients with T2DM in the placebo arm of DECLARE-TIMI 58 (Dapagliflozin Effect on Cardiovascular Events–Thrombolysis in Myocardial Infarction 58). The relative and absolute risk reductions in HHF with the sodium-glucose cotransporter-2 inhibitor dapagliflozin were assessed by baseline HHF risk.

Results:

Five clinical variables were independent risk predictors of HHF: prior heart failure, history of atrial fibrillation, coronary artery disease, estimated glomerular filtration rate, and urine albumin-to-creatinine ratio. A simple integer-based score (0–7 points) using these predictors identified a >20-fold gradient of HHF risk (
P
for trend <0.001) in both the derivation and validation cohorts, with C indices of 0.81 and 0.78, respectively. Although relative risk reductions with dapagliflozin were similar for patients across the risk scores (25%–34%), absolute risk reductions were greater in those at higher baseline risk (1-sided
P
for trend=0.04), with high-risk (2 points) and very-high-risk (≥3 points) patients having 1.5% and 2.7% absolute reductions in Kaplan-Meier estimates of HHF risk at 4 years, respectively.

Conclusions:
Risk stratification using a novel clinical risk score for HHF in patients with T2DM identifies patients at higher risk for HHF who derive greater absolute benefit from sodium-glucose cotransporter-2 inhibition.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifiers: NCT01107886 and NCT01730534.
Echocardiographic Detection of Occult Diastolic Dysfunction in Pulmonary Hypertension After Fluid Challenge
Authors: Agrawal Vineet , D'Alto Michele , Naeije Robert , Romeo Emanuele , Xu Meng , Assad Tufik R. , Robbins Ivan M. , Newman John H. , Pugh Meredith E. , Hemnes Anna R. , Brittain Evan L. 
Published: August 2019

BackgroundIdentification of occult diastolic dysfunction often requires invasive right heart catheterization with provocative maneuvers such as fluid challenge. Non‐invasive predictors of occult diastolic dysfunction have not been identified. We hypothesized that echocardiographic measures of diastolic function are associated with occult diastolic dysfunction identified at catheterization.Methods and ResultsWe retrospectively examined hemodynamic and echocardiographic data from consecutive patients referred for right heart catheterization with fluid challenge from 2009 to 2017. A replication cohort of 52 patients who prospectively underwent simultaneous echocardiography and right heart catheterization before and after fluid challenge at Monaldi Hospital, Naples, Italy. In the retrospective cohort of 126 patients (83% female, 56+14 years), 27/126 (21%) had occult diastolic dysfunction. After adjusting for tricuspid regurgitant velocity and left atrial volume index, E velocity (odds ratio 1.8, 95% CI 1.1–2.9,P=0.01) and E/e′ (odds ratio 1.9, 95% CI 1.1–3,P=0.005) were associated with occult diastolic dysfunction with an optimal threshold of E/e′ >8.6 for occult diastolic dysfunction (sensitivity 70%, specificity 64%). In the prospective cohort, 5/52 (10%) patients had diastolic dysfunction after fluid challenge. Resting E/e′ (odds ratio 8.75, 95% CI 2.3–33,P=0.001) and E velocity (odds ratio 7.7, 95% CI 2–29,P=0.003) remained associated with occult diastolic dysfunction with optimal threshold of E/e′ >8 (sensitivity 73%, specificity 90%).ConclusionsAmong patients referred for right heart catheterization with fluid challenge, E velocity and E/e′ are associated with occult diastolic dysfunction after fluid challenge. These findings suggest that routine echocardiographic measurements may help identify patients like to have occult diastolic dysfunction non‐invasively.
Tissue‐Specific Metabolic Profiles After Prolonged Cardiac Arrest Reveal Brain Metabolome Dysfunction Predominantly After Resuscitation
Authors: Choi Jaewoo , Shoaib Muhammad , Yin Tai , Nayyar Gautam , Shinozaki Koichiro , Stevens Jan F. , Becker Lance B. , Kim Junhwan 
Published: August 2019

Background
Cardiac arrest (CA) has been a leading cause of death for many decades. Despite years of research, we still do not understand how each organ responds to the reintroduction of blood flow after prolonged CA. Following changes in metabolites of individual organs after CA and resuscitation gives context to the efficiency and limitations of current resuscitation protocols.

Methods and Results
Adult male Sprague–Dawley rats were arbitrarily assigned into 3 groups: control, 20 minutes of CA, or 20 minutes of CA followed by 30 minutes of cardiopulmonary bypass resuscitation. The rats were euthanized by decapitation to harvest brain, heart, kidney, and liver tissues. The obtained tissue samples were analyzed by ultra‐high‐performance liquid chromatography–high‐accuracy mass spectrometry for comprehensive metabolomics evaluation. After resuscitation, the brain showed decreased glycolysis metabolites and fatty acids and increased amino acids compared with control. Similarly, the heart displayed alterations mostly in amino acids. The kidney showed decreased amino acid and fatty acid pools with severely increased tricarboxylic acid cycle metabolites following resuscitation, while the liver showed minimal alterations with slight changes in the lipid pool. Each tissue has a distinct pattern of metabolite changes after ischemia/reperfusion. Furthermore, resuscitation worsens the metabolic dysregulation in the brain and kidney, while it normalizes metabolism in the heart.

Conclusions
Developing metabolic profiles using a global metabolome analysis identifies the variable nature of metabolites in individual organs after CA and reperfusion, establishing a stark contrast between the normalized heart and liver and the exacerbated brain and kidney, only after the reestablishment of blood circulation.
Five‐Year Change in the Renal Function After Catheter Ablation of Atrial Fibrillation
Authors: Park Je‐Wook , Yang Pil‐Sung , Bae Han‐Joon , Yang Song‐Yi , Yu Hee Tae , Kim Tae‐Hoon , Uhm Jae‐Sun , Joung Boyoung , Lee Moon‐Hyoung , Pak Hui‐Nam 
Published: August 2019

Background

Although it has been reported that renal function can improve after catheter ablation of atrial fibrillation (
AF
), long‐term changes in renal function and its relationship to rhythm outcomes have not yet been evaluated. We explored the 5‐year change in estimated glomerular filtration rate (
eGFR
) in
AF
patients depending on medical therapy and catheter ablation.

Methods and Results

Among 1963 patients who underwent
AF
catheter ablation and 14 056 with
AF
under medical therapy in the National Health Insurance Service database, we compared 571 with
AF
catheter ablation (59±10 years old, 72.3% male, and 66.5% paroxysmal
AF
) and 1713 with medical therapy after 1:3 propensity‐score matching. All participants had 5 years of serial
eGFR
data (Chronic Kidney Disease‐Epidemiology Collaboration [
CKD
‐
EPI
] method). Catheter ablation improved
eGFR
5 yrs
(
P
<0.001), but medical therapy did not. In 2284 matched patients, age (adjusted odds ratio [
OR
], 0.98 [0.97–0.99];
P
<0.001) and
AF
catheter ablation (adjusted
OR
, 2.02 [1.67–2.46];
P
<0.001) were independently associated with an improved
eGFR
5 yrs
. Among 571 patients who underwent
AF
ablation, freedom from
AF
/atrial tachycardia recurrence after the last
AF
ablation procedure was independently associated with an improved
eGFR
5 yrs
(adjusted
OR
, 1.44 [1.01–2.04];
P
=0.043), especially in patients without diabetes mellitus (adjusted
OR
, 1.78 [1.21–2.63];
P
=0.003,
P
for interaction=0.012). Although underlying renal dysfunction (<60 mL/min/1.73m
2
) was associated with atrial structural remodeling (adjusted
OR
, 1.05 [1.00–1.11];
P
=0.046), it did not affect the
AF
ablation rhythm outcome.

Conclusions

AF
catheter ablation significantly improved renal function over a 5‐year follow‐up, especially in patients maintaining sinus rhythm without preexisting diabetes mellitus.
Frailty Among Older Adults With Acute Myocardial Infarction and Outcomes From Percutaneous Coronary Interventions
Authors: Damluji Abdulla A. , Huang Jin , Bandeen‐Roche Karen , Forman Daniel E. , Gerstenblith Gary , Moscucci Mauro , Resar Jon R. , Varadhan Ravi , Walston Jeremy D. , Segal Jodi B. 
Published: August 2019

Background

Frailty is a predictor of adverse outcomes after acute myocardial infarction (
AMI
).

Methods and Results

We estimated the prevalence of frailty among adults age ≥75 years admitted with
AMI
and examined the relationship between frailty, interventions, and mortality. We used the Premier Healthcare Database to identify older adults with primary diagnoses of
AMI
. We classified individuals as frail or not using the validated Claims‐based Frailty Index. We described patients’ characteristics and receipt of percutaneous coronary intervention stratified by frailty status. The primary outcome was hospital mortality. From 2000 to 2016, we identified 469 390 encounters for older patients admitted with
AMI
. The median age was 82 years, 53% were women, and 75% were white. The prevalence of frailty was 19%. Frail patients were less likely to receive percutaneous coronary intervention than nonfrail (15% versus 33%,
P
<0.001) and much less likely to receive coronary artery bypass surgery (1% versus 9%,
P
<0.001). There were far fewer interventions in individuals over age 85 years. Frailty was associated with higher mortality during
AMI
admission (unadjusted odds ratio [
OR
] 1.43,
CI
1.39–1.46). While there was a differential benefit of the interventions because of frailty, frail patients had reduced hospital mortality with percutaneous coronary intervention (frail:
OR
0.59,
CI
0.55–0.63; nonfrail:
OR
0.49,
CI
0.47–0.50,
P
for interaction <0.001) and with coronary artery bypass surgery (frail:
OR
0.77,
CI
0.65–0.93; nonfrail:
OR
0.74,
CI
0.71–0.77,
P
for interaction <0.001) relative to no intervention.

Conclusions

In the United States, frailty is common among older patients admitted with
AMI
. While these vulnerable patients are at an increased risk for mortality, judicial use of revascularization with percutaneous coronary intervention in frail older patients still confers immediate survival benefit.
The diet of a forest-dependent frog species, Odorrana morafkai (Anura: Ranidae), in relation to habitat disturbance
Authors: Le Duong Thi Thuy , Rowley Jodi J.L. , Tran Dao Thi Anh , Hoang Huy Duc 
Published: August 2019

Abstract
While deforestation is one of the greatest drivers of biodiversity loss, our understanding of the effects of habitat modification on species is limited. We investigated the diet of a forest-dwelling frog species, Morafka’s frog (Odorrana morafkai), in a highland forest in Vietnam in relation to habitat disturbance, sex and season. We surveyed the species at 45 sites in forest of varying disturbance and examined its diet using stomach flushing, estimating prey availability via trapping. We detected significantly fewer O. morafkai in highly disturbed habitats compared to moderately disturbed or non-disturbed habitats. We revealed that O. morafkai is a dietary generalist, identifying 28 prey types, primarily invertebrates. Prey composition, the number of prey items per stomach and prey volume per stomach did not vary between disturbance levels. Diet did not vary significantly between sexes, except that females had a higher prey volume. Prey composition in the species varied between seasons, with Coleoptera and Orthoptera dominating the diet in the rainy season and Lepidoptera in the dry season. The number of prey items per stomach and prey volume were significantly higher in the rainy season. There was a significant correlation between prey availability and diet composition. The low number of O. morafkai detected in highly disturbed habitats suggests that this habitat may not be optimal for the species, despite having a generalist feeding strategy and presumed high mobility. This study provides a window into the impact of an increasing threat, habitat disturbance, on forest-dependent amphibian species.
It’s Not mana, It’s High Gods!
Authors: Larsson Göran 
Published: August 2019

Abstract
In this short review and debate article I use Nicolas Meylan’s Mana: A History of a Western Category as a starting point for discussing the Swedish historian of religions Geo Widengren (1907-1996) and his theory of the so-called High God. Resembling mana, the High God theory is a second-order concept that is used to explain the origin of religion in the history of humankind.
Optimal Design of Cluster- and Multisite-Randomized Studies Using Fallible Outcome Measures
Authors: Cox Kyle , Kelcey Benjamin 
Published: August 2019

Background: Evaluation studies frequently draw on fallible outcomes that contain significant measurement error. Ignoring outcome measurement error in the planning stages can undermine the sufficiency and efficiency of an otherwise well-designed study and can further constrain the evidence studies bring to bear on the effectiveness of programs. Objectives: We develop simple formulas to adjust statistical power, minimum detectable effect (MDE), and optimal sample allocation formulas for two-level cluster- and multisite-randomized designs when the outcome is subject to measurement error. Results: The resulting adjusted formulas suggest that outcome measurement error typically amplifies treatment effect uncertainty, reduces power, increases the MDE, and undermines the efficiency of conventional optimal sampling schemes. Therefore, achieving adequate power for a given effect size will typically demand increased sample sizes when considering fallible outcomes, while maintaining design efficiency will require increasing portions of a budget be applied toward sampling a larger number of individuals within clusters. We illustrate evaluation planning with the new formulas while comparing them to conventional formulas using hypothetical examples based on recent empirical studies. To encourage adoption of the new formulas, we implement them in the R package PowerUpR and in the PowerUp software.