bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Relationship between Platelet Collagen Receptor Glycoprotein VI and No-Reflow Phenomenon in Patients with Acute ST-Segment Elevation Myocardial Infarction
Authors: Kobat Mehmet Ali , Balin Mehmet , Celik Ahmet , Baydas Adil , Dagli Mustafa Necati 
Published: May 2016

Objectives The purpose of this study was to determine whether admission soluble glycoprotein VI (sGP-VI) level is associated with no-reflow phenomenon (NRP) after primary percutaneous coronary intervention (P-PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 178 consecutive patients admitted to our hospital for a first STEMI and undergoing P-PCI within 12 hours of onset of symptoms were enrolled. The patients were divided into 2 groups (NRP group and reflow group). Admission sGP-VI plasma levels were measured by enzyme-linked immunosorbent assay. Results Of the 178 patients who underwent P-PCI, 41 patients (23%) developed NRP. The patients in the reflow group had higher levels of sGP-VI compared with the patients in the NRP group (38.5 ± 21.0 vs 21.9 ± 11.9 ng/mL, P < 0.001). The sensitivity and specificity values of the sGP-VI levels were 90% and 49%, respectively (cutoff value was ≤25). In the multivariate logistic regression analyses, sGP-VI levels of 25 ng/mL or lower, higher peak troponin T levels and body mass index value, amount of opaque of greater than 250 mL, and lesion length of greater than 13.5 mm were independent predictors of angiographic NRP. Conclusions Lower admission sGP-VI levels are associated with NRP in patients with STEMI undergoing P-PCI. This outcome may open new therapeutic facility in the setting of P-PCI.
Half-Dose Recombinant Tissue Plasminogen Activator Treatment in Venous Thromboembolism
Authors: Canan Hasanoğlu H. , Hezer Habibe , Karalezli Ayşegül , Argüder Emine , Kiliç Hatice , Şentürk Ayşegül , Er Mükremin , Soytürk Ayşe Nur 
Published: May 2016

Introduction Pulmonary embolism (VTE) comes in different degrees of severity from massive pulmonary embolism to nonmassive pulmonary embolism with no symptoms or hypoxia. Thrombolytic therapy is a lifesaver especially for patients who are in the high-risk group. In this study, we aimed at evaluating symptoms and clinical and laboratory findings in patients who had a diagnosis of massive or submassive VTE and treated with 50-mg recombinant tissue plasminogen activator (rt-PA) per hour for various problems as opposed to the standard dose, which is 100 mg every 2 hours. Materials and Methods Forty-six patients with a diagnosis of massive or submassive VTE who received thrombolytic therapy were evaluated retrospectively. Twenty-three patients who were treated with 50-mg rt-PA per hour were included in the study group. On the other hand, 23 patients who were treated with 100 mg of intravenous infusion of rt-PA every 2 hours were included in the control group. Echocardiographic assessment of the right ventricular size, systolic pulmonary artery pressure (sPAP), oxygen saturation, systemic arterial pressure, and heart rate before the thrombolytic therapy and in the first 24 hours after the administration of therapy were checked and noted in both of the groups. Results No significant difference was found between the 2 groups with regard to demographic data, Wells scores, type of embolism, average symptom duration, sPAP, and oxygen saturation. Differences in recovery, as inferred from vital symptoms and sPAP measurements, were not significant between the 2 groups. Conclusions Lower-dose thrombolytic therapy showed similar efficacy versus the standard dose in VTE. Thrombolytic therapy is a life-saving treatment in massive VTE. Furthermore, a harm/benefit analysis may lead to the administration of half-dose therapy in selected cases when it is contraindicated for various reasons.
A Cut-Point Value of Uncarboxylated to Carboxylated Index is Associated with Glycemic Status Markers in Type 2 Diabetes
Authors: Villafán-Bernal José Rafael , Llamas-Covarrubias Mara Anaís , Muñoz-Valle José Francisco , Rivera-León Edgar Alfonso , González-Hita Mercedes Elvira , Bastidas-Ramírez Blanca Estela , Gurrola-Díaz Carmen Magdalena , Armendáriz-Borunda Juan Socorro , Sánchez-Enríquez Sergio 
Published: May 2016

Background The uncarboxylated osteocalcin (ucOC) has been described as a regulator of glucose metabolism in mice, and it is decreased in human type 2 diabetes mellitus (T2D). Although inversely correlated with serum glucose, insulin, and glycated hemoglobin, it is unclear if ucOC decrement is caused by diabetes or plays a role in the pathogenesis and/or progression of the disease. Whatever the case may be, diabetes affects osteoblast gene expression, and possibly the proportion of ucOC over carboxylated OC (cOC). The association of ucOC/cOC index with glycemic status markers in patients with T2D has not been described before. Objective The objective of this study was to assess the ucOC/cOC index and its relationship with glycemic status markers in patients with T2D. Methods The ucOC/cOC index was determined by the quotient of ucOC and cOC serum levels in 80 T2D patients and 160 healthy subjects. The relationship between the ucOC/cOC index and glycemic status markers was evaluated. Results The ucOC/cOC index was low and negatively correlated to fasting plasma glucose and homeostasis assessment-insulin resistance model in T2D patients. The odds ratio for T2D patients with an ucOC/cOC index below the cut-point obtained by receiver operating characteristic analysis was 12.64 (confidence interval, 5.75–27.77; P < 0.001). Conclusions A value of ucOC/cOC index less than 0.3 is associated with markers of poor metabolic control in patients with T2D.
Pediatric Nephrologists’ Beliefs regarding Randomized Controlled Trials
Authors: Wightman Aaron G. , Oron Assaf P. , Symons Jordan M. , Flynn Joseph T. 
Published: May 2016

Background Pediatrics and pediatric nephrology lag behind adult medicine in producing randomized controlled trials (RCTs). Physician attitudes have been shown to play a significant role in RCT enrollment. Methods We surveyed members of the American Society of Pediatric Nephrology regarding beliefs about RCTs and factors influencing decisions to recommend RCT enrollment. Regression analyses were used to identify the effects of variables on an aggregate score summarizing attitudes toward RCTs. Results One hundred thirty replies were received. Sixty-six percent had enrolled patients in RCTs. Respondents in practice for more than 15 years were more likely to have recruited a patient to an RCT than those in practice for less than 5 years. Respondents were more willing to recommend RCT enrollment if the study was multicenter, patients were sicker or had a poorer prognosis, or if the parent or participant received a financial incentive versus the provider. In multiple regression analysis, history of enrolling patients in an RCT was the only significant predictor of higher aggregate RCT-friendly attitude. Conclusions Many pediatric nephrologists have never enrolled a patient in an RCT, particularly those in practice for less than 5 years. Respondents who have not enrolled patients in RCTs have a less RCT-friendly attitude. Provision of improved training and resources might increase participation of junior providers in RCTs.
The Positive Effect of Moderate Walking Exercise on Chemerin Levels in Portuguese Patients with Type 2 Diabetes Mellitus
Authors: Neuparth Maria João , Proença Jorge Brandão , Santos-Silva Alice , Coimbra Susana 
Published: May 2016

Background Physical exercise intervention is known to be crucial in the management of type 2 diabetes mellitus (T2DM). We aimed to evaluate, in patients with T2DM, the effect of regular moderate walking exercise on markers of oxidative stress, lipid metabolism, and inflammation. Methods We studied 30 patients with T2DM who walked regularly during the last year and 53 patients with T2DM who did not perform any type of exercise. The patients were evaluated for chemerin, adiponectin, leptin, oxidized low-density lipoprotein, and C-reactive protein (CRP) levels. Results The active T2DM patients showed significantly lower body mass index, as compared with the inactive patients. The active T2DM patients showed significantly lower levels of chemerin and CRP than those of the inactive T2DM patients (CRP lost significance after adjustment for body mass index). The active patients, compared with the inactive, presented a trend toward higher levels of adiponectin and lower values of oxidized low-density lipoprotein. Leptin differed significantly between sexes, and the active women presented a trend toward lower levels as compared with the inactive women. Conclusions In the patients with T2DM, the practice of moderate walking in a regular basis was sufficient to reduce chemerin levels, which suggests that practice of regular physical exercise should be encouraged.
Triglyceride Glucose Index and Common Carotid Wall Shear Stress
Authors: Tripolino Cesare , Irace Concetta , Scavelli Faustina B. , de Franceschi Maria S. , Esposito Teresa , Carallo Claudio , Gnasso Agostino 
Published: May 2016

Objectives Alterations in wall shear stress contribute to both clinical and subclinical atherosclerosis. Several conditions such as hypertension, diabetes, and obesity can impair shear stress, but the role of insulin resistance has never been investigated. The present study was designed to investigate whether insulin resistance assessed by TyG Index associates with wall shear stress in the common carotid artery. Methods One hundred six individuals were enrolled. Blood pressure, lipids, glucose, and cigarette smoking were evaluated. TyG Index was calculated as log[fasting triglycerides × fasting glucose / 2]. Subjects underwent blood viscosity measurement and echo-Doppler evaluation of carotid arteries to calculate wall shear stress. The association between TyG Index and carotid wall shear stress was assessed by simple and multiple regression analyses. Results TyG Index was significantly and inversely associated with carotid wall shear stress both in simple ( r = −0.44, P < 0.001) and multiple regression analyses accounting for age, sex, and major cardiovascular risk factors. The association was further confirmed after exclusion of subjects with diabetes, dyslipidemia, fasting blood glucose greater than 100 mg/dL, and triglycerides greater than 150 mg/dL. Conclusions The present findings suggest that increasing insulin resistance, as assessed by TyG Index, associates with atherosclerosis-prone shear stress reduction in the common carotid artery.
Triglyceride–to–High-Density-Lipoprotein-Cholesterol Ratio is an Index of Heart Disease Mortality and of Incidence of Type 2 Diabetes Mellitus in Men
Authors: Vega Gloria Lena , Barlow Carolyn E. , Grundy Scott M. , Leonard David , DeFina Laura F. 
Published: May 2016

Background High triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) impart risk for heart disease. This study examines the relationships of TG/HDL-C ratio to mortality from all causes, coronary heart disease (CHD), or cardiovascular disease (CVD). Subjects and Methods Survival analysis was done in 39,447 men grouped by TG/HDL-C ratio cut point of 3.5 and for metabolic syndrome. National Death Index International Classification of Diseases ( ICD-9 and ICD-10) codes were used for CVD and CHD deaths occurring from 1970 to 2008. Incidence of type 2 diabetes mellitus (DM) according to ratio was estimated in 22,215 men. Triglyceride/HDL-C ratio and cross-product of TG and fasting blood glucose (TyG index) were used in analysis. Results Men were followed up for 581,194 person-years. Triglyceride/HDL-C ratio predicted CHD, CVD, and all-cause mortality after adjustment for established risk factors and non–HDL-C. Mortality rates were higher in individuals with a high ratio than in those with a low ratio. Fifty-five percent of men had metabolic syndrome that was also predictive of CHD, CVD, and all-cause mortality. Annual incidence of DM was 2 times higher in men with high TG/HDL-C ratio than in those with a low ratio. Individuals with high TG/HDL-C ratio had a higher incidence of DM than those with a low ratio. The TyG index was not equally predictive of causes of mortality to TG/HDL-C, but both were equally predictive of diabetes incidence. Conclusions Triglyceride/HDL-C ratio predicts CHD and CVD mortality as well as or better than do metabolic syndrome in men. Also, a high ratio predisposes to DM. The TyG index does not predict CHD, CVD, or all-cause mortality equally well, but like TG/HDL-C ratio, it predicts DM incidence.
Clinical Implications of the Interleukin 27 Serum Level in Breast Cancer
Authors: Lu Dapeng , Zhou Xiangyu , Yao Lutian , Liu Caigang , Jin Feng , Wu Yunfei 
Published: May 2016

Introduction Interleukin 27 (IL-27), belonging to the IL-12 family, exerts a critical role in immune regulation of infection, autoimmunity, and tumor. In this study, we aimed to investigate the roles of IL-27 and vascular endothelial growth factor (VEGF) in breast cancer. Methods The serum levels of IL-27 and VEGF in 150 patients with breast cancer and 90 control subjects were measured by an enzyme-linked immunosorbent assay. Estrogen receptor, progesterone receptor, and human epithelial growth factor receptor 2 were measured by immunohistochemistry. Clinical stage, tumor size, lymph node metastasis, grade, and histological type were also recorded. Results The serum levels of IL-27 and VEGF were significantly greater in breast cancer patients than in the control group. In addition, there was a significant correlation between IL-27 and VEGF, and serum IL-27 and VEGF levels were associated with the clinical stage of breast cancer. Moreover, the serum levels of IL-27 were especially elevated in breast cancer patients who were estrogen receptor–positive and progesterone receptor–positive. Furthermore, the serum levels of IL-27 and VEGF decreased after patients with breast cancer had modified radical mastectomy. Conclusion Interleukin 27 may be a new prognostic biomarker of breast cancer and a promising target to limit both angiogenesis and tumor growth.
Evaluation of Feasible Timing of Elective Noncardiac Procedure after Antiplatelet Discontinuation in Patients Treated with Antiplatelet Agents
Authors: Joo Min Sun , Ahn Byung Moo , Kim Hee Jun , Mun Hee-Sun , Kang Min Kyung , Choi Seong Hoon , Park Min Jeong , Song Won Keun , Lee Nam Ho , Cho Jung Rae 
Published: May 2016

Background The current standard of care is to delay noncardiac procedure (NCP) 5 to 7 days after discontinuation of antiplatelet agents (APAs) in patients with coronary stents. However, it is often difficult to follow because of concerns over stent thrombosis. The point-of-care aspirin/P2Y12 assay (VerifyNow; Accumetrics Inc, San Diego, CA) is useful to evaluate platelet reactivity in conjunction with APAs. In this study, we evaluated the feasible timing after discontinuation of APAs. Methods and Results Sixty-two patients taking APAs, who were scheduled to undergo elective NCP, were enrolled. All patients took either aspirin 100 mg or aspirin 100 mg plus clopidogrel 75 mg daily. The aspirin-reactivity unit (ARU) and P2Y12-reactivity unit (PRU) were measured from 0 days (day 0, no discontinuation) to as long as 5 days (day 5, 5 days after discontinuation) depending on each procedure schedule. For 15 patients, baseline ARU and PRU (592 and 288) before aspirin/clopidogrel loading at index percutaneous coronary intervention were collected as control. For ARU after discontinuation of APA, days 0 to 5 values progressively increased over time (489.4 ± 85.3, 512.6 ± 77.0, 589.9 ± 58.8, 613.6 ± 47.3, 632.6 ± 49.2, 662.0 ± 4.2). Likewise, for PRUs, days 0 to 5 values also increased over time (245.0 ± 96.9, 253.9 ± 80.9, 270.9 ± 45.8, 289.0 ± 68.6, 306.5 ± 29.2, 351.0 ± 8.5). The ARU and PRU well correlated with days after APA discontinuation by linear regression analysis ( y = 490.897 + 39.238 * x, R2 = 0.43, P < 0.001; y = 241.739 + 16.701 * x, R2 = 0.092, P = 0.018, respectively). Assuming baseline ARU and PRU as 592 and 288, the mean days after complete reversal of platelet reactivity by APAs are 2.6 and 2.8, respectively. Conclusions The feasible timing of NCP after discontinuation of APAs showed less than 5 days. VerifyNow is useful in the evaluation of antiplatelet reversal after discontinuation of APAs.
The Effect of a Disease Management Algorithm and Dedicated Postacute Coronary Syndrome Clinic on Achievement of Guideline Compliance: Results from the Parkland Acute Coronary Event Treatment Study
Authors: Yorio Jeff , Viswanathan Sundeep , See Raphael , Uchal Linda , McWhorter Jo Ann , Spencer Nali , Murphy Sabina , Khera Amit , de Lemos James A. , McGuire Darren K. 
Published: May 2016

Background The application of disease management algorithms by physician extenders has been shown to improve therapeutic adherence in selected populations. It is unknown whether this strategy would improve adherence to secondary prevention goals after acute coronary syndromes (ACSs) in a largely indigent county hospital setting. Methods Patients admitted for ACS were randomized at the time of discharge to usual follow-up care versus the same care with the addition of a physician extender visit. Physician extender visits were conducted according to a treatment algorithm based on contemporary practice guidelines. Groups were compared using the primary end point of achievement of low-density lipoprotein treatment goals at 3 months after discharge and achievement of additional evidence-based practice goals. Results One hundred forty consecutive patients were randomized. A similar proportion of patients returned for study follow-up in both groups at 3 months (54 [79%]/68 in the usual care group vs 57 [79%]/72 in the intervention group; P = 0.97). Among those completing the 3-month visit, a low-density lipoprotein cholesterol level less than 100 mg/dL was achieved in 37 (69%) of the usual care patients compared with 35 (57%) of those in the intervention group ( P = 0.43). There was no statistical difference in implementation of therapeutic lifestyle changes (smoking cessation, cardiac rehabilitation, or exercise) between groups. Prescription rates of evidence-based therapeutics at 3 months were similar in both groups. Conclusion The implementation of a post-ACS clinic run by a physician extender applying a disease management algorithm did not measurably improve adherence to evidence-based secondary prevention treatment goals. Despite initially high rates of evidence-based treatment at discharge, adherence with follow-up appointments and sustained implementation of evidence-based therapies remains a significant challenge in this high-risk cohort.
Serum Ghrelin Concentrations are Increased in Children with Growth Hormone Insensitivity and Decrease during Long-Term Insulinlike Growth Factor-I Treatment
Authors: Uckun-Kitapci Aysin , Haqq Andrea M. , Purnell Jonathan Q. , Newcomb Kenneth , Gulkesen Hakan , Underwood Louis E. 
Published: May 2016

Background Ghrelin increases food intake, body weight, and growth hormone (GH) secretion. Serum concentrations of ghrelin are low in obese hyperinsulinemic persons, are reduced by infusion of insulin into normal-weight subjects, and are increased in underweight hypoinsulinemic patients with anorexia nervosa. Laron syndrome is an autosomal recessive disorder of GH insensitivity that results in decreased insulinlike growth factor-I (IGF-I) synthesis and growth failure. These patients have elevated GH levels, excess adipose tissue, and are insulin resistant. Because IGF-I has insulinlike actions and patients with GH insensitivity syndrome (GHIS) exhibit excess adiposity, we sought to determine whether ghrelin levels were elevated in these patients and potentially regulated by IGF-I replacement. Methods Thirteen children with GHIS and 20 normal control children matched for age, sex, and body mass index underwent complete physical examination and a fasting blood draw at baseline. The GHIS subjects then underwent follow-up fasting blood draws during therapy with human recombinant IGF-I (80-120 μg/kg, given subcutaneously twice daily). Fasting glucose, insulin, and IGF-I concentrations were measured at the time of collection. Fasting total ghrelin levels were measured on stored serum samples. Results The GHIS subjects had 2-fold higher fasting ghrelin levels (2926 ± 1869 pg/mL) compared with the normal control children (1492 ± 493 pg/mL; P = 0.009), and mean ghrelin values were reduced 56% during 6.4 ± 0.2 years of IGF-I replacement ( P < 0.05). Conclusions Growth hormone resistance and low IGF-I levels are associated with elevated ghrelin levels, which may potentiate GH secretion and adiposity in these children. Suppression of ghrelin during IGF-I treatment suggests a novel mechanism potentially regulating ghrelin levels.
Elevated Gluconeogenesis and Lack of Suppression by Insulin Contribute to Cystic Fibrosis-Related Diabetes
Authors: Hardin Dana S. , Ahn Chul , Rice Julie , Rice Mark , Rosenblatt Randall 
Published: May 2016

The incidence of diabetes is high in cystic fibrosis (CF) and is an important cause of morbidity and mortality. Understanding the pathophysiology is imperative. Studies have documented increased endogenous (mostly hepatic) glucose production (HGP) but have not distinguished the relative contribution of gluconeogenesis (GNG). The purpose of this study was to quantitate GNG, to determine its contribution to high HGP, and to measure insulin's suppression of GNG. We recruited 31 adult CF subjects (age, 26.2 ± 7.9 years; 12 female subjects) and quantified GNG by measuring the incorporation of 2H into the second and fifth carbons of glucose. Hepatic glucose production was measured using [6,6-2H2]glucose. Protein breakdown was measured using [1-13C]leucine. Data were compared with that from 11 healthy volunteers (age, 27.5 ± 7.0 years) who underwent both GNG and clamp studies. Thirteen CF subjects and all controls had a hyperinsulinemic euglycemic clamp during measures of GNG. Other measures included glucose tolerance and glucagon and cortisol levels. Rate of GNG was higher in CF subjects than controls and comprised a greater percentage of fasting HGP (GNG as percent of HGP: CF = 68%; controls = 44%; P = 0.034). Suppression of GNG by insulin was significantly lower in CF than in controls and was lower in CF subjects with abnormal glucose tolerance than in those with normal glucose tolerance. Gluconeogenesis correlated with protein breakdown. These studies suggest that high HGP in CF is mostly from elevated rates of GNG and that resistance to insulin's suppression of GNG may contribute to abnormal glucose tolerance in CF.