bluuebunny/crossref_metadata_2025_split huggingface dataset:
Establishing an anaesthetist-delivered propofol sedation service for advanced endoscopic procedures: implementing the RCA/BSG guidelines
Authors: Smith Ian , Durkin Damien , Lau Kaw Wai , Hebbar Srisha 
Published: November 2017

BackgroundFollowing recommendations from the Royal College of Anaesthetists and the British Society of Gastroenterology, we report our results of propofol sedation for complex endoscopic procedures delivered by a single consultant anaesthetist over a 5-year period.MethodsA weekly session was provided in the endoscopy department for procedures that were complex or could previously not be completed successfully. Deep sedation was provided by intermittent propofol bolus doses, supplemented with fentanyl where necessary, titrated to clinical effect. Patients were usually in semiprone or lateral positions and spontaneously breathed air supplemented with nasal oxygen. Service evaluation included patient recall, endoscopist satisfaction with conditions, procedural success and airway-related adverse outcomes.ResultsWe completed 1000 procedures, 42.5% of which were endoscopic retrograde cholangiopancreatography, with the remainder comprising a diverse range of endoscopic procedures of 3–156 min duration. Procedural conditions were excellent in 79% of cases, 261 procedures were completed which had been previously abandoned, 246 patients (24.6%) had a better experience than previously and none recalled any part of their procedure. Three patients required transient bag and mask ventilation, and nasal airways were used in 12 patients, but none required tracheal intubation or vasopressor support.ConclusionsThese guidelines facilitated a propofol sedation service with considerable benefits for patients and endoscopists. Provision of deep propofol sedation by an anaesthetist, in patients with an unsecured airway, appears practical, effective and efficient. Small adjustments to the airway were fairly common, but the incidence of adverse events and requirement for airway instrumentation was low.
A 59-year-old woman with visible precordial pulsations
Authors: Moss Alastair J , Pessotto Renzo , Flapan Andrew D 
Published: November 2017

Clinical introductionA retired 59-year-old woman presented to the cardiology clinic concerned with cardiac pulsations that were visible on her chest wall. These were not associated with dyspnoea, syncope or chest discomfort.Of note, 8 years previously, she complained of recurrent nocturnal diaphoresis and 5 kg weight loss. Blood sampling at that time revealed a microcytic anaemia, reactive thrombocytosis and raised inflammatory markers (erythrocyte sedimentation rate 99 mm/hour, C-reactive protein 161 mg/L). Following an episode of transient diplopia, ophthalmoscopy demonstrated a cotton wool spot in the left inferotemporal retinal arcade. She commenced a 2-year tapering course of 1 mg/kg prednisolone.On examination, she had a lean physique with a supine blood pressure of 162/60 mm Hg and palpable Corrigan’s pulse. She had a prominent apical pulsation and a loud early diastolic murmur was present at the left sternal edge radiating to the apex. Echocardiography showed severe central aortic regurgitation and a dilated aortic root (see online supplementary figure 1). Cardiac CT was performed to clarify the diagnosis (figure 1).Supplementary file 1Figure 1Contrast-enhanced CT of the thorax at index presentation (A) and 6 months (B). Prospective ECG-gated cardiac CT angiogram (75% R-R interval) performed at 8 years from index presentation (C) with a stretched multiplanar reconstruction of the aortic annulus, aortic root and thoracic aorta (D).QuestionWhich of the following diagnoses best explains this presentation?Ankylosing spondylitisTakayasu arteritisSalmonellosisIgG4-related aortitisGiant cell aortitis
Imaging the pathoanatomy of amyotrophic lateral sclerosis in vivo: targeting a propagation-based biological marker
Authors: Kassubek Jan , Müller Hans-Peter , Del Tredici Kelly , Lulé Dorothée , Gorges Martin , Braak Heiko , Ludolph Albert C 
Published: November 2017

ObjectiveNeuropathological studies in amyotrophic lateral sclerosis (ALS) have shown a dissemination in a regional sequence in four anatomically defined patterns. The aim of this retrospective study was to see whether longitudinal diffusion tensor imaging (DTI) data support the pathological findings.MethodsThe application of DTI analysis to fibre structures that are prone to be involved at each neuropathological pattern of ALS was performed in a monocentre sample of 67 patients with ALS and 31 controls that obtained at least one follow-up scan after a median of 6 months.ResultsAt the group level, longitudinal ALS data showed significant differences for the stage-related tract systems. At the individual level, 27% of the longitudinally scanned patients with ALS showed an increase in ALS stage, while the remaining were stable or were at the highest ALS stage. Longitudinal fractional anisotropy changes in the respective tract systems correlated significantly with the slope of the revised ALS functional rating scale.InterpretationThe DTI-based protocol was able to image the disease patterns of ALS in vivo cross-sectionally and longitudinally, in support of DTI as a technical marker to image ALS stages.
Effect of Fcγ-receptor 3a (FCGR3A) gene polymorphisms on rituximab therapy in Hungarian patients with rheumatoid arthritis
Authors: Pál Ildikó , Szamosi Szilvia , Hodosi Katalin , Szekanecz Zoltan , Váróczy László 
Published: November 2017

BackgroundRheumatoid arthritis (RA) treatment includes the use of the anti-CD20 monoclonal antibody rituximab (RTX). RTX acts through Fcγ-receptors (FCGR) on effector natural killer cells and macrophages and it can be administered effectively in RA and in lymphomas. Based on the results of in vitro experiments, its efficacy may depend ofFCGRgene polymorphisms in both diseases.AimAs genetic background of diseases and therapeutic efficacy (pharmacogenetics) may vary among different geographical regions, we wished to assess possible relationships betweenFCGR3Apolymorphism and the therapeutic outcome of RTX therapy in a Hungarian RA cohort.Patients and methodsAltogether, 52 patients, 6 men and 46 women, were included in the study. Peripheral blood samples were used to determineFCGR3Apolymorphism by genotyping using real-time PCR method.ResultsThe distribution ofFCGR3Agenotypes was 8 VV, 34 VF and 10 FF. Disease activity score 28 (DAS28) reductions in patients with VV, VF and FF genotypes were 1.98±0.54 (p=0.008 between DAS28 before and after treatment), 2.07±0.23 (p<0.001) and 1.59±0.52 (p=0.014), respectively. Significant differences in DAS28 reductions on treatment were found between VF heterozygotes and FF homozygotes (p=0.032), as well as between heterozygotes and all (VV+FF) homozygotes (p=0.017). Furthermore, significantly more VV (62.5%; p=0.030) and VF (64.7%; p=0.015) patients achieved low disease activity compared with FF subjects (30.0%).ConclusionOur results suggest thatFCGR3Apolymorphism may predict more effective disease activity reduction by RTX. Furthermore, carrying the V allele may also be associated with better therapeutic response in Hungarian patients with RA.
Impact of gender on the response and tolerance to abatacept in patients with rheumatoid arthritis: results from the ‘ORA’ registry
Authors: Nourisson Cynthia , Soubrier Martin , Mulliez Aurélien , Baillet Athan , Bardin Thomas , Cantagrel Alain , Combe Bernard , Dougados Maxime , Flipo René-Marc , Schaeverbeke Thierry , Sibilia Jean , Vittecoq Olivier , Ravaud Philippe , Gottenberg Jacques-Eric , Mariette Xavier , Tournadre Anne 
Published: November 2017

ObjectiveThe impact of gender on the response and tolerance to abatacept was assessed in a large prospective cohort during 2 years of follow-up.MethodsFrom the 1017 patients included in the Orencia and Rheumatoid Arthritis registry, disease activity was assessed at baseline, 6, 12 and 24 months. The relationship between the European League Against Rheumatism (EULAR) response, Disease Activity Score 28 (DAS28) remission, rate of adverse events and gender was explored in multivariate analysis.Results990 patients, 79.3%female, with at least one follow-up visit were analysed. At baseline, women had longer disease duration, higher disease activity and more often received antitumour necrosis factor (TNF) drugs. The remission was not different between men and women during the follow-up after adjustment on age, disease duration and activity, rheumatoid factor and anti-cyclic citrullinated pyeptide (CCP) positivity, and current disease-modifying antirheumatic drugs (DMARDs), previous TNF blockers and corticosteroids use. The proportion of men and women achieving EULAR good-or-moderate response at any endpoints was similar (52.4% vs 55.5%), as well as time to achieving EULAR response (5.4±4.9 vs 5.6±5.2 months). Moderate EULAR response was more frequent in women at 6 months (OR=1.80, p=0.02) but was no longer significant at 12 or 24 months. During the follow-up, the DAS28, the tender joint count score and the patient global assessment remained higher in women (p=0.001, 0.04 and 0.06, respectively). Drug retention and safety were comparable.ConclusionIn this large daily practice cohort of established rheumatoid arthritis treated with abatacept, women achieved similar remission and EULAR response than men despite higher disease activity and tender joint count during the treatment course.
Evaluation of the Mycoplasma genitalium Resistance Plus kit for the detection of M. genitalium and mutations associated with macrolide resistance
Authors: Pitt Rachel , Cole Michelle Jayne , Fifer Helen , Woodford Neil 
Published: November 2017

ObjectivesTo compare performance of the ResistancePlus kit (SpeeDx, Australia) with in-house methods for the detection of Mycoplasma genitalium-specific DNA and mutations associated with resistance to macrolide antimicrobials, directly from clinical specimens.MethodsAssay specificity and sensitivity was analysed using DNA from 46 non-M. genitalium organisms and standard curve analysis, respectively. A panel of archived DNA extracted from 97 M. genitalium-positive clinical specimens, for which the macrolide susceptibility genotype had been previously determined, were tested on the assay and results compared.ResultsFinal analytical specificity was 100%. Sensitivity was detected to at least 140 genome copies/µL. The assay detected M. genitalium in 92/97 (94.9%, 95% CI 88.4% to 98.3%) previously positive specimens. The genetic macrolide susceptibility assigned was concordant with previous results in 85/92 (92.4%, 95% CI 85.0% to 96.9%) specimens or 85/97 (87.6%, 95% CI: 79.4% to 93.4%) when the false-negative specimens were included. On seven (7/92, 7.6%) occasions, resistant specimens were called susceptible. Further testing resolved discrepancies for all but five (5.2%) specimens.ConclusionsThe ResistancePlus assay generally performed well in comparison to methods currently employed at the reference laboratory. It detected a range of different mutations; however, a small number of specimens that were genotyped as macrolide resistant by Sanger sequencing were either not detected by the assay or were genotyped as susceptible. This could impact on treatment outcomes if assay results were used for patient management.
A population-based prospective cohort study examining the influence of early-life respiratory tract infections on school-age lung function and asthma
Authors: van Meel Evelien R , den Dekker Herman T , Elbert Niels J , Jansen Pauline W , Moll Henriëtte A , Reiss Irwin K , de Jongste Johan C , Jaddoe Vincent W V , Duijts Liesbeth 
Published: November 2017

BackgroundEarly-life respiratory tract infections could affect airway obstruction and increase asthma risk in later life. However, results from previous studies are inconsistent.ObjectiveWe examined the associations of early-life respiratory tract infections with lung function and asthma in school-aged children.MethodsThis study among 5197 children born between April 2002 and January 2006 was embedded in a population-based prospective cohort study. Information on physician-attended upper and lower respiratory tract infections until age 6 years (categorised into ≤ 3 and >3–6 years) was obtained by annual questionnaires. Spirometry measures and physician-diagnosed asthma were assessed at age 10 years.ResultsUpper respiratory tract infections were not associated with adverse respiratory outcomes. Compared with children without lower respiratory tract infections ≤3 years, children with lower respiratory tract infections ≤3 years had a lower FEV1, FVC, FEV1:FVC and forced expiratory flow at 75% of FVC (FEF75) (Z-score (95% CI): ranging from −0.22 (−0.31 to –0.12) to −0.12 (−0.21 to −0.03)) and an increased risk of asthma (OR (95% CI): 1.79 (1.19 to 2.59)). Children with lower respiratory tract infections >3–6 years had an increased risk of asthma (3.53 (2.37 to 5.17)) only. Results were not mediated by antibiotic or paracetamol use and not modified by inhalant allergic sensitisation. Cross-lagged modelling showed that results were not bidirectional and independent of preschool wheezing patterns.ConclusionEarly-life lower respiratory tract infections ≤3 years are most consistently associated with lower lung function and increased risk of asthma in school-aged children.
Mesoporous cellular-structured carbons derived from glucose–fructose syrup and their adsorption properties towards acetaminophen
Authors: Tzvetkov George , Spassov Tony , Kaneva Nina , Tsyntsarski Boyko 
Published: November 2017

Here, a series of cellular-structured and predominantly mesoporous carbons were prepared via carbonization of glucose–fructose syrup (GFS) with sulfuric acid and subsequent calcination between 400[Formula: see text]C and 700[Formula: see text]C. Comparative results on the microstructure, chemical and textural properties of the newly produced carbons are presented. Furthermore, their adsorption performance for removal of acetaminophen from water was tested and it was found that the carbon calcined at 700[Formula: see text]C has a maximum adsorption capacity (98.7[Formula: see text]mg[Formula: see text]g[Formula: see text]) among all samples due to its suitable textural properties (BET surface area of 418[Formula: see text]m[Formula: see text]g[Formula: see text] and total pore volume of 0.2[Formula: see text]cm[Formula: see text]g[Formula: see text]). This study demonstrates the potential use of GFS as a precursor in the preparation of carbonaceous materials for removal of biologically-active micropollutants from water.
Neopterin as an Effect Modifier of the Cardiovascular Risk Predicted by Total Homocysteine: A Prospective 2‐Cohort Study
Authors: Bjørnestad Espen Ø. , Borsholm Robert A. , Svingen Gard F. T. , Pedersen Eva R. , Seifert Reinhard , Midttun Øivind , Ueland Per M. , Tell Grethe S. , Bønaa Kaare H. , Nygård Ottar 
Published: November 2017

Background

Plasma total homocysteine (
tH
cy) is related to plasma neopterin, an indicator of interferon‐γ‐mediated immune activation, and both biomarkers positively predict cardiovascular risk. We examined whether the association between
tH
cy and subsequent risk of acute myocardial infarction (
AMI
) was modified by systemic concentrations of neopterin and C‐reactive protein among patients with coronary heart disease.

Methods and Results

By Cox modeling, we explored the association between
tH
cy and risk of
AMI
in 4164 patients with suspected stable angina pectoris. Subgroup analyses were performed according to median levels of neopterin and C‐reactive protein. A replication study was performed among 3749 patients with
AMI
at baseline. Median follow‐up was 7.3 and 8.3 years among patients with stable angina pectoris and
AMI
, respectively.
tH
cy and neopterin correlated in both cohorts (
r
s
=0.34 and
r
s
=0.30 among stable angina pectoris and
AMI
patients, respectively, both
P
<0.001).
tH
cy predicted
AMI
in both cohorts, independent of B‐vitamin treatment. However, significant risk associations were confined to patients with plasma neopterin above the median (hazard ratios [95% confidence interval] per 1‐
SD
increment of log‐transformed
tH
cy 1.38 [1.26–1.50] and 1.18 [1.10–1.26] among stable angina pectoris and
AMI
patients, respectively) (
P
int
<0.005 in both cohorts). Further, adding information on the interaction between
tH
cy and neopterin improved model discrimination and reclassification.
tH
cy and C‐reactive protein were weakly related, and no effect modification was found by C‐reactive protein.

Conclusions

Among patients with coronary heart disease,
tH
cy predicted risk of
AMI
only in subjects with concomitantly elevated plasma neopterin. Our results motivate further research on the relationship between homocysteine metabolism, cellular immune activation, and atherothrombosis.
Duration of Reproductive Life Span, Age at Menarche, and Age at Menopause Are Associated With Risk of Cardiovascular Disease in Women
Authors: Ley Sylvia H. , Li Yanping , Tobias Deirdre K. , Manson JoAnn E. , Rosner Bernard , Hu Frank B. , Rexrode Kathryn M. 
Published: November 2017

Background

Although the timing of menarche and menopause may be associated with cardiovascular disease (CVD), the entire reproductive life span has not been considered comprehensively as risk for
CVD
. We investigate the associations of reproductive life span duration and ages at menarche and menopause, induced by natural means or surgical bilateral oophorectomy, with incident
CVD
in women.

Methods and Results

Prospective cohort study of 73 814 Nurses' Health Study following participants without
CVD
, defined as incident coronary heart disease or stroke, from 1980 through 2012. Duration of reproductive life span was generated by subtracting age at menarche from age at menopause. A shorter reproductive life span was associated with a higher risk of incident
CVD
after multivariable adjustment (relative risk, 1.32 [95% confidence interval, 1.16–1.49] comparing duration <30 with ≥42 years;
P
trend<0.0001). Early age at menopause was associated with higher multivariable‐adjusted
CVD
risk (1.32 [1.16–1.51] comparing age <40 with 50 to <55 years;
P
trend<0.0001), with excess risk for both natural and surgical menopause. Compared with women with menarche at 13 years, the multivariable‐adjusted
CVD
risk for early menarche at ≤10 years was 1.22 (1.09–1.36). The association between reproductive life span and
CVD
remained significant in sensitivity analyses excluding women who experienced extreme early age at menarche or who used hormone therapy.

Conclusions

A shorter duration of reproductive life span is associated with a higher risk of
CVD
, which is likely driven by the timing of menopause induced either naturally or surgically. Extremely early age at menarche is also associated with a higher risk of
CVD
.
Differential Impact of Serial Measurement of Nonplatelet Thromboxane Generation on Long‐Term Outcome After Cardiac Surgery
Authors: Kakouros Nikolaos , Gluckman Tyler J. , Conte John V. , Kickler Thomas S. , Laws Katherine , Barton Bruce A. , Rade Jeffrey J. 
Published: November 2017

Background
Systemic thromboxane generation, not suppressible by standard aspirin therapy and likely arising from nonplatelet sources, increases the risk of atherothrombosis and death in patients with cardiovascular disease. In the RIGOR (Reduction in Graft Occlusion Rates) study, greater nonplatelet thromboxane generation occurred early compared with late after coronary artery bypass graft surgery, although only the latter correlated with graft failure. We hypothesize that a similar differential association exists between nonplatelet thromboxane generation and long‐term clinical outcome.

Methods and Results

Five‐year outcome data were analyzed for 290 RIGOR subjects taking aspirin with suppressed platelet thromboxane generation. Multivariable modeling was performed to define the relative predictive value of the urine thromboxane metabolite, 11‐dehydrothromboxane B
2
(11‐dhTXB
2
), measured 3 days versus 6 months after surgery on the composite end point of death, myocardial infarction, revascularization or stroke, and death alone. 11‐dhTXB
2
measured 3 days after surgery did not independently predict outcome, whereas 11‐dhTXB
2
>450 pg/mg creatinine measured 6 months after surgery predicted the composite end point (adjusted hazard ratio, 1.79;
P
=0.02) and death (adjusted hazard ratio, 2.90;
P
=0.01) at 5 years compared with lower values. Additional modeling revealed 11‐dhTXB
2
measured early after surgery associated with several markers of inflammation, in contrast to 11‐dhTXB
2
measured 6 months later, which highly associated with oxidative stress.

Conclusions
Long‐term nonplatelet thromboxane generation after coronary artery bypass graft surgery is a novel risk factor for 5‐year adverse outcome, including death. In contrast, nonplatelet thromboxane generation in the early postoperative period appears to be driven predominantly by inflammation and did not independently predict long‐term clinical outcome.
Impact on Prehospital Delay of a Stroke Preparedness Campaign
Authors: Denti Licia , Caminiti Caterina , Scoditti Umberto , Zini Andrea , Malferrari Giovanni , Zedde Maria Luisa , Guidetti Donata , Baratti Mario , Vaghi Luca , Montanari Enrico , Marcomini Barbara , Riva Silvia , Iezzi Elisa , Castellini Paola , Olivato Silvia , Barbi Filippo , Perticaroli Eva , Monaco Daniela , Iafelice Ilaria , Bigliardi Guido , Vandelli Laura , Guareschi Angelica , Artoni Andrea , Zanferrari Carla , Schulz Peter J. 
Published: November 2017

Background and Purpose—
Public campaigns to increase stroke preparedness have been tested in different contexts, showing contradictory results. We evaluated the effectiveness of a stroke campaign, designed specifically for the Italian population in reducing prehospital delay.

Methods—
According to an SW-RCT (Stepped-Wedge Cluster Randomized Controlled Trial) design, the campaign was launched in 4 provinces in the northern part of the region Emilia Romagna at 3-month intervals in randomized sequence. The units of analysis were the patients admitted to hospital, with stroke and transient ischemic attack, over a time period of 15 months, beginning 3 months before the intervention was launched in the first province to allow for baseline data collection. The proportion of early arrivals (within 2 hours of symptom onset) was the primary outcome. Thrombolysis rate and some behavioral end points were the secondary outcomes. Data were analyzed using a fixed-effect model, adjusting for cluster and time trends.

Results—

We enrolled 1622 patients, 912 exposed and 710 nonexposed to the campaign. The proportion of early access was nonsignificantly lower in exposed patients (354 [38.8%] versus 315 [44.4%]; adjusted odds ratio, 0.81; 95% confidence interval, 0.60–1.08;
P
=0.15). As for secondary end points, an increase was found for stroke recognition, which approximated but did not reach statistical significance (
P
=0.07).

Conclusions—
Our campaign was not effective in reducing prehospital delay. Even if some limitations of the intervention, mainly in terms of duration, are taken into account, our study demonstrates that new communication strategies should be tested before large-scale implementation.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01881152.