bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systematic Review and Meta-Analysis of Immunosuppressant Therapy Clinical Trials in Membranous Lupus Nephritis
Authors: Swan Joshua T. , Riche Daniel M. , Riche Krista D. , Majithia Vikas 
Published: May 2016

Purpose We performed a systematic review and meta-analysis to compare response rates (complete remission plus partial remission) for nonsteroid immunosuppressant therapy to steroid-only immunosuppressant therapy in patients with membranous lupus nephritis. Methods A literature review was conducted from June 25, 2010 by querying PubMed, MEDLINE, and EMBASE databases. Inclusion criteria were trials containing remission data on patients with confirmed pure class V (Va and Vb) membranous lupus nephritis. The primary analysis evaluates response rates for regimens that contain at least one nonsteroid immunosuppressant therapy and steroid-only immunosuppressant therapy. A proportion meta-analysis using a DerSimonian-Laird random-effects model was performed. Data are reported as pooled proportions in percentages with 95% confidence intervals. Significant heterogeneity and/or bias were compensated for by trial exclusion. Results Twenty-four studies met inclusion criteria for meta-analysis, which yielded 34 groups of patients' data. Upon meta-analysis, the response rate for nonsteroid immunosuppressant therapy is higher than for steroids alone (81% [74%-87%] vs 60% [39%-79%]), even when compensating for significant heterogeneity and bias (76% [71%-81%] versus 60% [39%-79%]). Conclusion Nonsteroid immunosuppressant therapies in combination with steroids seem to be more effective than steroids alone for inducing partial or complete remission in patients with membranous lupus nephritis who have nephrotic proteinuria at baseline. This trial was not able to analyze adverse events, flares, relapses, or patient survival because of underreporting.
Assessment of Atrial Conduction Time in Patients with Systemic Lupus Erythematosus
Authors: Dogdu Orhan , Yarlioglues Mikail , Kaya Mehmet Gungor , Ardic Idris , Kilinc Yusuf , Elcik Deniz , Kelesoglu Saban , Akpek Mahmut , Sahin Omer , Cosgun Said , Oguzhan Nilufer , Oguzhan Abdurrahman 
Published: May 2016

Objectives Systemic lupus erythematosus (SLE) is an autoimmune disorder resulting in multisystemic inflammatory damage. Recent articles report that 20% to 30% of deaths in patients with SLE have cardiovascular origin. The aim of this study was to investigate the atrial conduction time in patients with SLE by using high-usefulness tissue Doppler echocardiography (TDI). Methods The study population included 56 patients with SLE (49 women; mean [SD] age, 46.2 [12.2] years, and mean [SD] disease duration, 30.7 [10.9] months) and 45 healthy subjects as control group (39 women; mean [SD] age, 45.8 [12.3] years). P-wave dispersion (PWD) was calculated by using 12-lead electrocardiogram. The timing of atrial contractions (PA) was measured as the interval between the onset of P wave on electrocardiogram and the beginning of A wave on TDI. Atrial electromechanical delay (EMD) was calculated from the lateral (PA lateral), septal (PA septal) mitral annulus, and lateral tricuspid annulus (PA tricuspid). Results Lateral mitral annulus and PA septal were significantly longer in the patients with SLE than in the control subjects (66.7 [15.9] vs 56.5 [13.7], P = 0.001, and 53.5 [15.0] vs 45.0 [15.1] milliseconds, P = 0.006, respectively). Interatrial (PA lateral − PA tricuspid) and intra-atrial (PA septal − PA tricuspid) EMD were significantly higher in SLE groups (25.5 [9.7] vs 19.9 [8.3], P = 0.003 and 13.3 [7.7] vs 8.4 [8.0] milliseconds, P = 0.002, respectively). Similarly, maximum P-wave duration and PWD were significantly longer in the patients with SLE than in the control subjects (104.9 [13.5] vs 98.1 [15.1], P = 0.021 and 24.6 [7.4] vs 20.0 [8.1] milliseconds, P = 0.004, respectively). There were significant positive correlations between the disease duration and interatrial EMD ( r = 0.611, P < 0.001) and intra-atrial EMD ( r = 0.565, P < 0.001). Positive correlation was also present between the disease duration and PWD ( r = 0.457, P < 0.001). Conclusion Atrial EMD is prolonged in patients with SLE. We have also shown that PWD, intra-atrial EMD, and interatrial EMD were significantly correlated with disease duration. This study calls attention to the following: the measurement of atrial conduction time may be clinically helpful in the definition of cardiac involvement.
Crossing the Chasm: Information Technology to Biomedical Informatics
Authors: Fahy Brenda G. , Balke C. William , Umberger Gloria H. , Talbert Jeffery , Canales Denise Niles , Steltenkamp Carol L. , Conigliaro Joseph 
Published: May 2016

Accelerating the translation of new scientific discoveries to improve human health and disease management is the overall goal of a series of initiatives integrated in the National Institutes of Health (NIH) “Roadmap for Medical Research.” The Clinical and Translational Science Award (CTSA) program is, arguably, the most visible component of the NIH Roadmap providing resources to institutions to transform their clinical and translational research enterprises along the goals of the Roadmap. The CTSA program emphasizes biomedical informatics as a critical component for the accomplishment of the NIH's translational objectives. To be optimally effective, emerging biomedical informatics programs must link with the information technology platforms of the enterprise clinical operations within academic health centers. This report details one academic health center's transdisciplinary initiative to create an integrated academic discipline of biomedical informatics through the development of its infrastructure for clinical and translational science infrastructure and response to the CTSA mechanism. This approach required a detailed informatics strategy to accomplish these goals. This transdisciplinary initiative was the impetus for creation of a specialized biomedical informatics core, the Center for Biomedical Informatics (CBI). Development of the CBI codified the need to incorporate medical informatics including quality and safety informatics and enterprise clinical information systems within the CBI. This article describes the steps taken to develop the biomedical informatics infrastructure, its integration with clinical systems at one academic health center, successes achieved, and barriers encountered during these efforts.
Lower Fetuin-A Predicts Angiographic Impaired Reperfusion and Mortality in ST-Elevation Myocardial Infarction
Authors: Basar Nurcan , Sen Nihat , Kanat Selcuk , Ozlu Mehmet Fatih , Ozcan Firat , Cay Serkan , Erden Gonul , Cagli Kumral Ergun , Yildirimkaya Metin , Maden Orhan , Covic Adrian , Kanbay Mehmet 
Published: May 2016

Aims Fetuin-A is an anti-inflammatory negative acute-phase glycoprotein, synthesized by the liver. In this study, we aimed to investigate the effects of admission fetuin-A levels on coronary and myocardial blood flow and short- and long-term prognosis in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention. Methods and Results One hundred eighty consecutive patients admitted with diagnosis of STEMI and 55 healthy age- and sex-matched volunteer controls were enrolled in the study. Patients with STEMI were divided into 2 groups in respect to thrombolysis in myocardial infarction myocardial perfusion grade after primary PCI: with thrombolysis in myocardial infarction myocardial perfusion grade 0-1-2 and thrombolysis in myocardial infarction myocardial perfusion grade 3. Serum levels of fetuin-A were lower in patients with STEMI than in the healthy group subjects. In-hospital and 1-year deaths were significantly higher in patients from the abnormal perfusion group. In-hospital major adverse cardiac event (MACE) and 1-year follow-up MACE also were significantly higher in patients from the abnormal perfusion group. The receiver-operating characteristic analysis indicated an optimal cut point of less than 200 μg/mL, which detects 1-year mortality with a negative predictive value of 95%. The 1-year mortality rate and 1-year MACE were significantly higher in patients with low fetuin-A level as compared with those with high fetuin-A level. Conclusions Because low-admission fetuin-A levels are associated with impaired coronary flow in STEMI patients undergoing primary percutaneous coronary intervention, admission fetuin-A level detection may be helpful in identifying the patients at a greater risk of poor coronary blood flow and worse short- and long-term prognosis.
Blockage of TNF-α by Infliximab Reduces CCL2 and CCR2 Levels in Patients with Rheumatoid Arthritis
Authors: Xia Liping , Lu Jing , Xiao Weiguo 
Published: May 2016

Objectives To investigate the mechanism in vivo for the regulation of inflammation of patients with RA by infliximab, we measured serum levels of chemokine ligand (CCL) 2, CCL3, CXCL8, and expression of CCL2 receptor chemokine receptor (CCR) 2 on CD4+ T cells from patients with rheumatoid arthritis (RA). Methods Forty-four patients with were enrolled in our study. Twenty-four patients received infliximab combined with methotrexate. Twenty patients received methotrexate alone. Serum levels of the chemokines CCL2, CCL3, and CXCL8 were quantified using commercial enzyme-linked immunosorbent assay kits. Flow cytometry was used to analyze the expression of CCR2 on CD4+ T cells. Results The mean CCL2 levels in the infliximab-treated patients decreased significantly from 885.20 ± 323.52 pg/mL at pretreatment to 454.65 ± 185.03 pg/mL ( P < 0.05) at 30 weeks after the initial treatment. Fluorescence density of CCR2 expression on CD4+ T cells were significantly reduced after infliximab treatment. Conclusions CCL2/CCR2 system in patients with active RA may be sensitive to anti-tumor necrosis factor-α therapy and suggest that CCL2 plays a crucial role in the pathogenesis of RA. CCR2 may be an important target for therapy in RA.
APOA4 Polymorphism as a Risk Factor for Unfavorable Lipid Serum Profile and Depression: A Cross-Sectional Study
Authors: Ota Vanessa Kiyomi , Chen Elizabeth Suchi , Ejchel Tatiana Flank , Furuya Tatiane Katsue , Mazzotti Diego Robles , Cendoroglo Maysa Seabra , Ramos Luiz Roberto , Araujo Lara Quirino , Burbano Rommel Rodriguez , de Arruda Cardoso Smith Marília 
Published: May 2016

Introduction APOA1/C3/A4/A5 gene cluster is closely involved in lipid metabolism, and its polymorphisms have been associated with coronary heart disease and lipid plasma levels. Here, we aimed to investigate associations of APOC3 (3238C>G, −482C>T, 1100C>T) and APOA4 (Gln360His, Thr347Ser) polymorphisms in 382 individuals from a cohort of a Longitudinal Brazilian Elderly Study with major age-related morbidities and with lipid and protein serum levels. Materials and Methods The whole sample was genotyped by polymerase chain reaction-restriction fragment length polymorphism. Descriptive statistics, logistic regression analysis, Student t test, deviation from Hardy-Weinberg, Bonferroni correction for multiple testing, and haplotype analyses were performed. Results Although APOC3 1100T allele carriers presented lower triglyceride and very low density lipoprotein levels than non-T carriers, these associations disappeared after Bonferroni correction ( P > 0.05). Moreover, APOA4 360His allele was associated with depression ( P = 0.03), increased triglyceride ( P = 0.035) and very low density lipoprotein ( P = 0.035) levels, and reduced HDL levels ( P = 0.0005). Haplotype analyses found an association between His/C/C haplotype (Gln360His/−482C>T/1100C>T) with depression, but this result was due to Gln360His polymorphism. Conclusions Our data suggest that 360His allele might be a risk factor for depression and unfavorable lipid profile and depression for elderly people in the Brazilian population.
Prostaglandin I2 Analogs Suppress Tumor Necrosis Factor α Production and the Maturation of Human Monocyte-Derived Dendritic Cells
Authors: Yeh Ching-Hui , Kuo Chang-Hung , Yang San-Nan , Huang Ming-Yii , Wu Hsaing-Chi , Wang Hsing-Pi , Kuo Thai-Hung , Hung Chih-Hsing 
Published: May 2016

Background Dendritic cells (DCs) are professional antigen-presenting cells and have critical roles in regulating immune responses. Prostaglandin I2 (PGI2) analogs are considered to be potential treatments for asthma. However, the effect of PGI2 analogs on human monocyte-derived DCs (MDDCs) is still not clearly understood. Methods Human MDDCs were pretreated with iloprost and treprostinil (2 PGI2 analogs) or forskolin (an adenyl cyclase activator) before lipopolysaccharide (LPS) stimulation. In some cases, I prostanoid (IP) receptor and E prostanoid receptor antagonists were added before the PGI2 analog treatment. tumor necrosis factor α (TNF-α) was measured by enzyme-linked immunosorbent assay. The expression of costimulatory molecules was assessed by flow cytometry. T-cell polarization function was investigated by measuring interferon γ, interleukin 13 (IL-13), and IL-17A production by T cells cocultured with iloprost-treated MDDCs. Results Iloprost and treprostinil suppressed LPS-induced TNF-α expression in MDDCs. This effect could be reversed by an IP receptor antagonist, CAY10449, but not by E prostanoid receptor antagonists. Forskolin conferred a similar effect. Iloprost suppressed the LPS-induced expression of costimulatory molecules, including CD80, CD86, CD40, and HLA-DR. Iloprost-treated MDDCs increased IL-17A production by T cells. Conclusions Prostaglandin I2 analogs may exert anti-inflammatory effects by suppressing TNF-α expression via the IP receptor-cyclic adenosine monophosphate pathways and by inhibiting the expression of costimulatory molecules in human MDDCs.
Quantitative Assessment of Wilms Tumor 1 (WT1) Gene Transcripts in Egyptian Acute Lymphoblastic Leukemia Patients
Authors: Ali Sadek Hoda , El-Metnawey Wafaa Hassan , Shaheen Iman Abdel-Mohsen , Korshied Mervat Mamdouh , Mohamed Azza Sobieh 
Published: May 2016

Background Accurate assessment of minimal residual disease (MRD) in acute lymphoblastic leukemia (ALL) patients after initial chemotherapy is essential to evaluate the efficacy of therapeutic regimens. Wilms tumor 1 ( WT1) is a pan-leukemic marker used for identification of the leukemic clone rather than the use of individual specific molecular aberration of ALL. Methods Using a real-time quantitative polymerase chain reaction, bone marrow samples from 41 newly diagnosed Egyptian ALL patients; 22 adults and 19 children were examined for WT1 expression. After induction therapy, WT1 expression was reestimated in 20 ALL patients. Results WT1 was overexpressed in adult and pediatric ALL patients (95.4% and 89.4%, respectively). WT1 expression at diagnosis had no statistically significant impact on disease-free survival of patients ( P = 0.054). However, WT1 expression increased after induction chemotherapy in the 3 pediatric patients who had relapse. Conclusions WT1 is a leukemia-associated molecular marker that may be used for the diagnosis and for monitoring clinical progress in ALL; it also can be used as a molecular target for adoptive immunotherapy.
Effects of Coronary Angiography and Femoral Arterial Access on Endothelial Functions
Authors: Tulmaç Murat , Özer Nurtaç , Şimşek Vedat , Doğru Mehmet Tolga , Ebinç Haksun 
Published: May 2016

Background Impairment of endothelial function is an independent predictor of coronary events. The aim of this study was to clarify the influence of arterial access and coronary angiography on endothelial function. Methods Eighteen patients with stable angina pectoris who underwent coronary angiography were included in this study. Brachial artery flow-mediated dilatation of patients was measured before angiography, after femoral arterial sheath insertion, and after coronary angiography. Results Of 18 patients, 11 had angiographically apparent atherosclerosis. Flow-mediated dilatation after femoral arterial sheath insertion (mean ± SD, 6.62% ± 3.87%) was found to be significantly lower than either before (10.62% ± 5.18%) or after coronary angiography (11.66% ± 5.30%; P = 0.007 and P = 0.001, respectively). Basal and postangiographic flow-mediated dilatation values were similar. Flow-mediated dilatation significantly decreased after sheath insertion in the group with angiographically normal coronary arteries (14.47% ± 4.34% vs 5.98 ± 4.00%, respectively; P = 0.006), whereas the difference was not significant in patients with CAD (8.17% ± 4.16% vs 7.03% ± 3.92%, respectively). Conclusions Coronary angiography did not result in endothelial vasomotor dysfunction. Femoral arterial sheath insertion during coronary angiography was associated with a short-lived endothelial dysfunction. Larger studies are needed to interpret the effect of coronary atherosclerosis on attenuation of endothelial response against arterial wall injury.
Respiratory Impairment and Mortality in Older Persons: A Novel Spirometric Approach
Authors: Vaz Fragoso Carlos A. , Gill Thomas M. , McAvay Gail , Yaggi Henry Klar , Van Ness Peter H. , Concato John 
Published: May 2016

Background The Lambda-Mu-Sigma (LMS) method calculates the lower limit of normal for spirometric measures of pulmonary function as the fifth percentile of the distribution of z scores, suitably accounting for age-related changes in pulmonary function. Extending prior work, and to assess whether the LMS method is clinically valid when evaluating respiratory impairment in the elderly, our current objective was to evaluate the association of LMS-defined respiratory impairment (airflow limitation and restrictive pattern) with all-cause mortality and respiratory symptoms (chronic bronchitis, dyspnea, or wheezing) in older persons. Methods Spirometric data and outcome data on white participants aged 65 to 80 years were obtained from the Third National Health and Nutrition Examination Survey (NHANES-III, n = 1497) and the Cardiovascular Health Study (CHS, n = 3583). Multivariable analyses determined the corresponding associations, adjusting for important covariates. Results In the NHANES-III and CHS populations, respectively, LMS-defined airflow limitation had adjusted hazard ratios (95% confidence interval) of 1.64 (1.28-2.11) and 1.69 (1.48-1.92) for mortality; adjusted odds ratios for respiratory symptoms were 2.71 (1.92-3.83) and 2.63 (2.11-3.27). The LMS-defined restrictive pattern was also significantly associated with mortality (adjusted hazard ratios of 1.98 [1.54-2.53] and 1.68 [1.44-1.95]), as well as with respiratory symptoms (adjusted odds ratios of 1.55 [1.03-2.34] and 1.37 [1.07-1.75]) in NHANES-III and CHS, respectively. Conclusions The LMS-defined airflow limitation and restrictive pattern confers a significantly increased risk of death and likelihood of having respiratory symptoms. These results support the use of LMS-derived spirometric z scores as a basis for evaluating respiratory impairment in older persons.
Relationship of Blood Pressure to Heart Rate in Isolated Systolic Hypertension
Authors: Goldberger Jeffrey J. , Jacobson Jason T. 
Published: May 2016

Background Patients with isolated systolic hypertension (ISH) have been noted to be less responsive to β-blockers than patients with essential hypertension (HTN). The purpose of this study was to determine the relationship between blood pressure (BP) and heart rate in ISH. Methods A total of 619 patients underwent 24-hour ambulatory BP monitoring. Patients were grouped as normal, HTN, or ISH. Clinical characteristics, mean BPs, and mean heart rate were compared between the groups. Results Two hundred seventy-one patients had normal BP, 98 had HTN, and 90 had ISH. Antihypertensives were used in 37% with normal BP, 51% with HTN, and 58% with ISH. The pulse pressure was highest for ISH (67 [10] mm Hg), followed by HTN (59 [12] mm Hg) and normal BP (49 [7] mm Hg; P < 0.0001). Heart rate in ISH was 71 [10] beats per minute; slower than that for normal BP (73 [11] beats per minute; P = 0.0464) and HTN (78 [12] beats per minute; P < 0.0001). There was a positive relationship between diastolic BP and heart rate. In ISH, there was a negative relationship between systolic BP and heart rate (slope = −0.18; r = 0.24; P = 0.0209) and a positive relationship between diastolic BP and heart rate (slope = 0.19; r = 0.33; P = 0.0015). Conclusions The noted relationship of heart rate to systolic BP and pulse pressure may in part explain the lower efficacy of β-blockers in patients with ISH. The rate-lowering effects of these medications may result in an increase in systolic and pulse pressures.
Implementation and Impact of a Consensus Diagnostic and Management Algorithm for Complicated Pneumonia in Children
Authors: Pillai Dinesh , Song Xiaoyan , Pastor William , Ottolini Mary , Powell David , Wiedermann Bernhard L. , DeBiasi Roberta L. 
Published: May 2016

Introduction Variable treatment exists for children with bacterial pneumonia complications such as pleural effusion and empyema. Subspecialists at an urban academic tertiary children's hospital created a literature-based diagnosis and management algorithm for complicated pneumonia in children. We proposed that algorithm implementation would reduce use of computed tomography (CT) for diagnosis of pleural infection, thereby decreasing radiation exposure, without increased adverse outcomes. Materials and Methods A cross-sectional study was undertaken in children (3 months to 20 years old) with principal or secondary diagnosis codes for empyema and/or pleural effusion in conjunction with bacterial pneumonia. Study cohorts consisted of subjects admitted 15 months before (cohort 1, n = 83) and after (cohort 2, n = 87) algorithm implementation. Data were collected using clinical and financial data systems. Imaging studies and procedures were identified using Current Procedural Terminology codes. Statistical analysis included χ2 test, linear and ordinal regression, and analysis of variance. Results Age ( P = 0.56), sex ( P = 0.30), diagnoses ( P = 0.12), and severity level ( P = 0.84) were similar between cohorts. There was a significant decrease in CT use in cohort 2 (cohort 1, 60% vs cohort 2, 17.2%; P = 0.001) and reduction in readmission rate (7.7% vs 0%; P = 0.01) and video-assisted thoracoscopic surgery procedures (44.6% vs 28.7; P = 0.03), without concomitant increases in vancomycin use (34.9% vs 34.5%; P = 0.95) or hospital length of stay (6.4 vs 7.6 days; P = 0.4). Among patients who received video-assisted thoracoscopic surgery drainage (n = 57), there were no significant differences between cohorts in median time from admission to video-assisted thoracoscopic surgery (2 days; P = 0.29) or median duration of chest tube drainage (3 vs 4 days; P = 0.10). There was a statistically nonsignificant trend for higher rate of pathogen identification in cohort 2 (cohort 1, 33% vs cohort 2, 54.1%; P = 0.12); Streptococcus pneumonia was the most commonly identified pathogen in both cohorts (37.5% vs 27%; P = 0.23). Discussion Implementation of an institutional complicated pneumonia management algorithm reduced CT scan use/radiation exposure, VATS procedures, and readmission rate in children with a diagnosis of pleural infection, without associated increases in length of stay or vancomycin use. This algorithm provides the framework for future prospective quality improvement studies in pediatric patients with complicated pneumonia.