bluuebunny/crossref_metadata_2025_split huggingface dataset:
Computed Tomography Imaging Features in Acute Uncomplicated Stanford Type-B Aortic Dissection Predict Late Adverse Events
Authors: Sailer Anna M. , van Kuijk Sander M.J. , Nelemans Patricia J. , Chin Anne S. , Kino Aya , Huininga Mark , Schmidt Johanna , Mistelbauer Gabriel , Bäumler Kathrin , Chiu Peter , Fischbein Michael P. , Dake Michael D. , Miller D. Craig , Schurink Geert Willem H. , Fleischmann Dominik 
Published: March 2017

Background—
Medical treatment of initially uncomplicated acute Stanford type-B aortic dissection is associated with a high rate of late adverse events. Identification of individuals who potentially benefit from preventive endografting is highly desirable.

Methods and Results—

The association of computed tomography imaging features with late adverse events was retrospectively assessed in 83 patients with acute uncomplicated Stanford type-B aortic dissection, followed over a median of 850 (interquartile range 247–1824) days. Adverse events were defined as fatal or nonfatal aortic rupture, rapid aortic growth (>10 mm/y), aneurysm formation (≥6 cm), organ or limb ischemia, or new uncontrollable hypertension or pain. Five significant predictors were identified using multivariable Cox regression analysis: connective tissue disease (hazard ratio [HR] 2.94, 95% confidence interval [CI]: 1.29–6.72;
P
=0.01), circumferential extent of false lumen in angular degrees (HR 1.03 per degree, 95% CI: 1.01–1.04,
P
=0.003), maximum aortic diameter (HR 1.10 per mm, 95% CI: 1.02–1.18,
P
=0.015), false lumen outflow (HR 0.999 per mL/min, 95% CI: 0.998–1.000;
P
=0.055), and number of intercostal arteries (HR 0.89 per n, 95% CI: 0.80–0.98;
P
=0.024). A prediction model was constructed to calculate patient specific risk at 1, 2, and 5 years and to stratify patients into high-, intermediate-, and low-risk groups. The model was internally validated by bootstrapping and showed good discriminatory ability with an optimism-corrected C statistic of 70.1%.

Conclusions—
Computed tomography imaging-based morphological features combined into a prediction model may be able to identify patients at high risk for late adverse events after an initially uncomplicated type-B aortic dissection.
Increased Arterial Stiffness is an Independent Predictor of Renal Function Decline in Patients With Type 2 Diabetes Mellitus Younger Than 60 Years
Authors: Fountoulakis Nikolaos , Thakrar Chiraag , Patel Kishan , Viberti Giancarlo , Gnudi Luigi , Karalliedde Janaka 
Published: March 2017

Background

The objective of this study was to evaluate whether aortic pulse wave velocity (Ao‐
PWV
) predicts estimated glomerular filtration rate (
eGFR
) decline in patients with type 2 diabetes mellitus.

Methods and Results

This prospective single‐center cohort study investigated 211 type 2 diabetes mellitus patients with
eGFR
≥45 mL/min with a baseline mean age of 60.1 years (range, 30–82 years). The mean±
SD
baseline
eGFR
was 85±26.1 mL/min. We divided the cohort into 2 groups above (n=117, “older”) and below (n=94, “younger”) the mean age to evaluate whether Ao‐
PWV
predicted progression of kidney disease differentially in older and younger patients. The primary end point was reaching a final
eGFR
below the median for the age group and an
eGFR
fall ≥1 mL/min per year. Median follow‐up was 9 years (range, 3–11 years) and ≈50% of patients in both groups reached the primary end point. In older patients, Ao‐
PWV
was similar in those who did and did not reach the primary end point. By contrast, younger patients who reached the primary end point had a higher Ao‐
PWV
at baseline compared with those who did not (10.8 m/s versus 9.5 m/s, respectively; mean difference of 1.36 m/s [95%
CI,
0.38–2.33],
P
=0.007). Ao‐
PWV
was an independent predictor of the primary end point (incident risk ratio, 1.09; 95%
CI,
1.02–1.18) after adjustment for traditional risk factors only in younger patients (
P
=0.02). A 1m/s increase in Ao‐
PWV
was associated with a mean fall in
eGFR
of 2.1 mL/min per year (95%
CI,
0.09–4.1) independent of other risk factors in younger patients (
P
=0.04).

Conclusions

Ao‐
PWV
predicts
eGFR
decline, before the onset of advanced renal dysfunction, and is a potential target for renoprotection in younger patients with type 2 diabetes mellitus.
Aortic Calcification Onset and Progression: Association With the Development of Coronary Atherosclerosis
Authors: Kälsch Hagen , Lehmann Nils , Moebus Susanne , Hoffmann Barbara , Stang Andreas , Jöckel Karl‐Heinz , Erbel Raimund , Mahabadi Amir A. 
Published: March 2017

Background

Thoracic aortic calcification (
TAC
) and coronary artery calcification (
CAC
) are markers of subclinical atherosclerosis and are associated with incident major cardiovascular events. We investigated major determinants for incidence and progression of
TAC
and the association between
TAC
and
CAC
incidence and progression.

Methods and Results

In a population‐based cohort study, 3270 participants (aged 45–74 years, 53.1% women) received cardiac computed tomography at baseline and after a mean follow‐up of 5.1±0.3 years for quantification of calcification of the ascending (ATAC) and descending thoracic aorta (DTAC) and CAC. Multivariable relative risk regression analysis was used to investigate associations of cardiovascular risk factors with incident
TAC
, of baseline
TAC
with incident
CAC,
and of baseline
CAC
with incident
TAC
. Of 1243 participants with baseline
TAC
of 0, 517 (41.6%) revealed incident TAC after 5 years. Incidence of descending
TAC
was higher (34.5%) than ascending
TAC
(23.3%). Incident
TAC
after 5 years was associated with age (relative risk 1.26 [95% CI 1.21–1.33], per 5 years), blood pressure (relative risk 1.06 [95% CI 1.03–1.10], per 10 mm Hg), low‐density lipoprotein cholesterol (relative risk 1.08 [95% CI 1.04–1.12], per 20 mg/dL), and smoking (relative risk 1.28 [95% CI 1.07–1.53]). Among the 1185 participants without
CAC
at baseline, the risk of developing
CAC
was 28.3% when baseline
TAC
was present compared with 22.2% among those without baseline
TAC
(excess risk 6.1% [95% CI 1.2–11.0%]). The point estimate of excess risk for incident
CAC
was higher for ascending
TAC
(10.8% [95% CI 4.8–16.7%]) and low for descending
TAC
(1.8% [95% CI −3.2% to 6.7%]). Excess risk for developing ascending and descending TAC with present baseline
CAC
was 16.4% (95% CI 12.7–20.0%) and 15.6% (95% CI 10.8–20.4%), respectively.

Conclusion

TAC and CAC share similar major determinants for incident calcification. Participants with
TAC
, especially ascending
TAC
, are at elevated risk for development of
CAC
.
Featured Article: Pyruvate preserves antiglycation defenses in porcine brain after cardiac arrest
Authors: Scott Gary F , Nguyen Anh Q , Cherry Brandon H , Hollrah Roger A , Salinas Isabella , Williams Arthur G , Ryou Myoung-Gwi , Mallet Robert T 
Published: March 2017

Cardiac arrest (CA) and cardiocerebral resuscitation (CCR)-induced ischemia–reperfusion imposes oxidative and carbonyl stress that injures the brain. The ischemic shift to anaerobic glycolysis, combined with oxyradical inactivation of glyceraldehyde 3-phosphate dehydrogenase (GAPDH), provokes excessive formation of the powerful glycating agent, methylglyoxal. The glyoxalase (GLO) system, comprising the enzymes glyoxalase 1 (GLO1) and GLO2, utilizes reduced glutathione (GSH) supplied by glutathione reductase (GR) to detoxify methylglyoxal resulting in reduced protein glycation. Pyruvate, a natural antioxidant that augments GSH redox status, could sustain the GLO system in the face of ischemia–reperfusion. This study assessed the impact of CA-CCR on the cerebral GLO system and pyruvate’s ability to preserve this neuroprotective system following CA. Domestic swine were subjected to 10 min CA, 4 min closed-chest CCR, defibrillation and 4 h recovery, or to a non-CA sham protocol. Sodium pyruvate or NaCl control was infused (0.1 mmol/kg/min, intravenous) throughout CCR and the first 60 min recovery. Protein glycation, GLO1 content, and activities of GLO1, GR, and GAPDH were analyzed in frontal cortex biopsied at 4 h recovery. CA-CCR produced marked protein glycation which was attenuated by pyruvate treatment. GLO1, GR, and GAPDH activities fell by 86, 55, and 30%, respectively, after CA-CCR with NaCl infusion. Pyruvate prevented inactivation of all three enzymes. CA-CCR sharply lowered GLO1 monomer content with commensurate formation of higher molecular weight immunoreactivity; pyruvate preserved GLO1 monomers. Thus, ischemia–reperfusion imposed by CA-CCR disabled the brain’s antiglycation defenses. Pyruvate preserved these enzyme systems that protect the brain from glycation stress.Impact statementRecent studies have demonstrated a pivotal role of protein glycation in brain injury. Methylglyoxal, a by-product of glycolysis and a powerful glycating agent in brain, is detoxified by the glutathione-catalyzed glyoxalase (GLO) system, but the impact of cardiac arrest (CA) and cardiocerebral resuscitation (CCR) on the brain’s antiglycation defenses is unknown. This study in a swine model of CA and CCR demonstrated for the first time that the intense cerebral ischemia–reperfusion imposed by CA-resuscitation disabled glyoxalase-1 and glutathione reductase (GR), the source of glutathione for methylglyoxal detoxification. Moreover, intravenous administration of pyruvate, a redox-active intermediary metabolite and antioxidant in brain, prevented inactivation of glyoxalase-1 and GR and blunted protein glycation in cerebral cortex. These findings in a large mammal are first evidence of GLO inactivation and the resultant cerebral protein glycation after CA-resuscitation, and identify novel actions of pyruvate to minimize protein glycation in postischemic brain.
HEART score performance in Asian and Caucasian patients presenting to the emergency department with suspected acute coronary syndrome
Authors: de Hoog Vince C , Lim Swee Han , Bank Ingrid EM , Gijsberts Crystel M , Ibrahim Irwani B , Kuan Win Sen , Ooi Shirley BS , Chua Terrance SJ , Tai E Shyong , Gao Fei , Pasterkamp Gerard , den Ruijter Hester M , Doevendans Pieter A , Wildbergh Thierry X , Mosterd Arend , Richards A Mark , de Kleijn Dominique PV , Timmers Leo 
Published: March 2017

Background:The HEART score is a simple and effective tool to predict short-term major adverse cardiovascular events in patients suspected of acute coronary syndrome. Patients are assigned to three risk categories using History, ECG, Age, Risk factors and Troponin (HEART). The purpose is early rule out and discharge is considered safe for patients in the low risk category. Its performance in patients of Asian ethnicity is unknown. We evaluated the performance of the HEART score in patients of Caucasian, Chinese, Indian and Malay ethnicity.Methods:The HEART score was assessed retrospectively in 3456 patients presenting to the emergency department with suspected acute coronary syndrome (1791 Caucasians, 1059 Chinese, 344 Indians, 262 Malays), assigning them into three risk categories.Results:The incidence of major adverse cardiovascular events within six weeks after presentation was similar between the ethnic groups. A smaller proportion of Caucasians was in the low risk category compared with Asians (Caucasians 35.8%, Chinese 43.5%, Indians 45.3%, Malays 44.7%, p<0.001). The negative predictive value of a low HEART score was comparable across the ethnic groups, but lower than previously reported (Caucasians 95.3%, Chinese 95.0%, Indians 96.2%, Malays 96.6%). Also the c-statistic for the HEART score was not significantly different between the groups.Conclusions:These results show that the overall performance of the HEART score is equal among Caucasian and Asian ethnic groups. The event rate in the low risk group, however, was higher than reported in previous studies, which queries the safety of early discharge of patients in the low risk category.
The Incidental Thyroid Lesion in Parathyroid Disease Management
Authors: Alamoudi Uthman , Levi Eric , Rigby Matthew H. , Taylor S. Mark , Trites Jonathan R. B. , Hart Robert D. 
Published: March 2017

ObjectiveThe incidental thyroid lesion is a common finding during general imaging studies. Their management has been the subject of numerous studies and recommendations. Parathyroid disease workup necessitates imaging investigation of the adjacent thyroid gland and therefore provides a unique window to the perioperative management of thyroid incidentaloma. The specific prevalence of incidental thyroid lesions in the context of parathyroid disease is unknown. We seek to investigate its prevalence during parathyroid workup and surgery and to ascertain if there was a change in management of these patients.Study DesignFive‐year retrospective database review.SettingTertiary care medical center.Subjects and MethodsThe source and indication for referral, preoperative investigation findings, and management of the incidental thyroid lesions were examined. The actual procedure performed and final pathology results were assessed.ResultsA total of 98 patients and 106 operations, including revision surgeries, were identified. There were 21 incidental thyroid lesions (21.4%) detected, whereby 15 patients underwent fine‐needle aspirations and 12 subsequently had diagnostic hemithyroidectomies. This decision was made preoperatively in 5 patients and intraoperatively in 7 patients at the time of parathyroid surgery. Along with other pathologies, there were 7 patients with micropapillary thyroid carcinoma identified.ConclusionsIn our series, the prevalence of incidental thyroid lesion and thyroid malignancy is comparable to the general population. The management of the initial parathyroid disease in our patients was altered by the imaging and cytological findings of these thyroid lesions. This has implications on perioperative counseling of the thyroid and parathyroid disease.
Effect of Combined Hormonal Replacement Therapy on the Aldosterone/Renin Ratio in Postmenopausal Women
Authors: Ahmed Ashraf H. , Gordon Richard D. , Ward Gregory , Wolley Martin , McWhinney Brett C. , Ungerer Jacobus P. , Stowasser Michael 
Published: March 2017

Abstract

Background:
Plasma aldosterone/renin ratio (ARR) is the most popular screening test for primary aldosteronism (PA). Because both estrogen and progesterone (including in oral contraceptive agents) affect aldosterone and renin levels, we studied the effects of combined hormonal replacement therapy (HRT) on ARR; renin was measured as both direct renin concentration (DRC) and plasma renin activity (PRA).

Methods:
Fifteen normotensive, healthy postmenopausal women underwent measurement (seated, midmorning) of plasma aldosterone, DRC, PRA, electrolytes, and creatinine and urinary aldosterone, cortisol, electrolytes, and creatinine at baseline and after 2 weeks and 6 weeks of treatment with combined HRT (conjugated estrogens 0.625 mg and medroxyprogesterone 2.5 mg daily).

Results:
Combined HRT was associated with statistically significant increases in aldosterone [median (range): baseline, 150 (85 to 600); 2 weeks, 230 (129 to 790); 6 weeks, 434 (200 to 1200) pmol/L; P &lt; 0.001 (Friedman test)] and PRA [2.3 (1.2 to 4.3), 3.8 (1.4 to 7.0), 5.1 (1.4 to 10.8) ng/mL/h, respectively; P &lt; 0.001] but decreases in DRC [21 (10 to 31), 21 (10 to 39), and 14 (8.0 to 30) mU/L, respectively; P &lt; 0.01], leading to increases in ARR calculated by DRC [7.8 (3.6 to 34.8), 11.4 (5.4 to 48.5), and 30.4 (10.5 to 90.2), respectively; P &lt; 0.001]. The ARR calculated by DRC exceeded the cutoff value (70) in three patients after 6 weeks. There were no significant changes in ARR calculated by PRA [79 (26 to 184), 91 (23 to 166), and 88 (50 to 230), respectively; P = 0.282], plasma electrolytes and creatinine, or any urinary measurements.

Conclusion:
The combined oral HRT used in this study is capable of significantly increasing ARR with a risk of false-positive results during screening for PA but only if DRC (and not PRA) is used to calculate the ratio.
Genetic mutations linked to Parkinson's disease differentially control nucleolar activity in pre-symptomatic mouse models
Authors: Evsyukov V. , Domanskyi A. , Bierhoff H. , Gispert S. , Mustafa R. , Schlaudraff F. , Liss B. , Parlato R. 
Published: March 2017

Genetic mutations underlying neurodegenerative disorders impair ribosomal DNA (rDNA) transcription suggesting nucleolar dysfunction as a novel pathomechanism in polyglutamine diseases and in certain forms of amyotrophic lateral sclerosis/frontotemporal dementia. Here, we investigated nucleolar activity in pre-symptomatic digenic models of Parkinson's disease (PD) modeling the multifactorial etiology of this disease.
To this end, we analyzed a novel mouse model mildly overexpressing the mutant human-A53T-alpha-synuclein (hA53T-SNCA/PARK1) in a PTEN-induced kinase 1 (PINK1/PARK6) knock-out background and mutant mice lacking both DJ-1/PARK7 and PINK1/PARK6. We showed that overexpressed human-A53T-alpha-synuclein localizes in the nucleolus. Moreover, these mutants show a progressive reduction of rDNA transcription linked to a reduced mouse lifespan. On the contrary in DJ-1/PINK1 double knock-out (DKO) mice rDNA transcription is preserved. mRNA levels of the nucleolar transcription initiation factor-IA (TIF-IA) decrease in substantia nigra of PD patients. Because loss of TIF-IA, as a tool to mimic nucleolar stress, increases oxidative stress and because DJ-1 and PINK1 mutations result in higher vulnerability to oxidative stress, we further explored the synergism between these PD-associated genes and impaired nucleolar function. By the conditional ablation of TIF-IA gene, we blocked ribosomal RNA (rRNA) synthesis in adult dopaminergic neurons in a DJ-1/PINK1 DKO background. However, the early phenotype of these triple knock-out mice was similar to those mice exclusively lacking TIF-IA. These data sustain a model in which DJ-1/PINK1 loss does not impair nucleolar activity in a pre-symptomatic stage. This is the first study that analyzes nucleolar function in digenic PD models. We can conclude that at least in these models the nucleolus is not as severely disrupted as previously shown in DA neurons from PD patients and neurotoxin-based PD mouse models. The results also show that early increase in rDNA transcription and nucleolar integrity may represent specific homeostatic responses in these digenic pre-symptomatic PD models.
Add-on Policies Under Vertical Differentiation: Why Do Luxury Hotels Charge for Internet While Economy Hotels Do Not?
Authors: Lin Song 
Published: March 2017

This paper examines firms’ product policies when they sell an add-on (e.g., Internet service) in addition to a base product (e.g., hotel rooms) under vertical differentiation (e.g., four- versus three-star hotels). I show that the role of an add-on differs; higher-quality firms prefer to sell it as optional to discriminate consumers, and lower-quality firms trade off discrimination and differentiation, trying to lure consumers from higher-quality rivals with a lower-price add-on. Equilibrium policies of lower-quality firms are more sensitive to the cost-to-value ratio of an add-on. If the ratio is sufficiently small, then they sell it to all consumers, potentially explaining why lower-end hotels are more likely than higher-end ones to offer free Internet service. Contrary to consensus in the literature, optional add-ons can intensify price competition over consumers who trade off a higher-quality base product versus a lower-quality base including an add-on. Hence, higher-quality firms are incentivized to commit to bundling, while lower-quality firms prefer to commit to not selling it. Add-ons can further reduce lower-quality firms’ profits if consumers cannot observe the prices, because holding up consumers ex post encourages them to switch to higher-quality rivals, which then become better off. Therefore, lower-quality firms are incentivized to advertise add-on prices, and higher-quality firms are not. The online appendix is available at https://doi.org/10.1287/mksc.2017.1028 .
Cement-in-cement revision of the femoral stem
Authors: Cnudde P. H. J. , Kärrholm J. , Rolfson O. , Timperley A. J. , Mohaddes M. 
Published: March 2017

Aims Compared with primary total hip arthroplasty (THA), revision surgery can be challenging. The cement-in-cement femoral revision technique involves removing a femoral component from a well-fixed femoral cement mantle and cementing a new stem into the original mantle. This technique is widely used and when carried out for the correct indications, is fast, relatively inexpensive and carries a reduced short-term risk for the patient compared with the alternative of removing well-fixed cement. We report the outcomes of this procedure when two commonly used femoral stems are used. Patients and Methods We identified 1179 cement-in-cement stem revisions involving an Exeter or a Lubinus stem reported to the Swedish Hip Arthroplasty Register (SHAR) between January 1999 and December 2015. Kaplan-Meier survival analysis was performed. Results Survivorship is reported up to six years and was better in the Exeter group (91% standard deviation (sd) 2.8% versus 85% sd 5.0%) (p = 0.02). There was, however, no significant difference in the survival of the stem and risk of re-revision for any reason (p = 0.58) and for aseptic loosening (p = 0.97), between revisions in which the Exeter stem (94% sd 2.2%; 98% sd 1.6%) was used compared with those in which the Lubinus stem (95% sd 3.2%; 98% sd 2.2%) was used. The database did not allow identification of whether a further revision was indicated for loosening of the acetabular or femoral component or both. Conclusion The cement-in-cement technique for revision of the femoral component gave promising results using both designs of stem, six years post-operatively. Cite this article: Bone Joint J 2017;99-B(4 Supple B):27–32.