bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Month-Long Treatment with Oral N-Acetylcysteine on the Oxidative Stress and Proteinuria in Patients with Diabetic Nephropathy a Pilot Study
Authors: Saklayen Mohammad G. , Yap Jayson , Vallyathan Val 
Published: May 2016

Introduction Oxidative stress plays an important role in the pathogenesis of diabetic nephropathy (DN). This study examined if use of N-acetylcysteine for a month in moderate doses would reduce the oxidative stress in patients with DN and reduce the proteinuria. Methods Fifteen volunteers with DN participated in the study. Participants took capsule form of N-acetylcysteine 1 gm twice a day for a month. Spot urines were collected and tested for protein/creatinine on days 1 and 30. Sera were collected on days 1, 15, 30, and 60 and tested for several oxidative stress biomarkers. Results There was no significant change in proteinuria or any of the oxidant stress markers at any point: protein-creatinine ratio (day 1, 1.6 ± 1.8; day 30, 1.3 ± 1.3), 8-isoprostane (day 1, 5.9 ± 4.2 pg/mL; day 15, 4.67 ± 2.4 pg/mL; day 30, 5.1 ± 2.8 pg/mL; and day 60, 4.7 ± 1.9 pg/mL), total antioxidant status (day 1, 1.5 ± 0.1 mM; day 15, 1.6 ± 0.2 mM; day 30, 1.5 ± 0.1 mM; and day 60, 1.5 ± 0.2 mM), aconitase (day 1, 7.9 ± 5.9 mU/mL; day 15, 10.1 ± 5.9 mU/mL; day 30, 8.9 ± 6.2 mU/mL; and day 60, 7.8 ± 5.5 mU/mL), glutathione peroxidase (day 1, 261.4 ± 56.4 mU/mL; day 15, 263.9 ± 57.2 mU/mL; day 30, 269.2 ± 66.0 mU/mL; and day 60, 257.5 ± 48.2 mU/mL), and superoxide dismutase (day 1, 242.6 ± 79.3 mU/mL; day 15, 252.1 ± 68.1 mU/mL; day 30, 262.0 ± 73.3 mU/mL; and day 60, 255.7 ± 61.5). However, 4 patients with initial high isoprostane levels showed nonsignificant decline at each subsequent time point. Conclusions N-acetylcysteine in moderate doses given over a month did not have significant effect on the overall oxidative stress in patients with DN and did not reduce proteinuria.
Neutrophil Gelatinase-Associated Lipocalin Levels in Patients with Crohn Disease Undergoing Treatment with Infliximab
Authors: Bolignano Davide , Della Torre Anna , Lacquaniti Antonio , Costantino Giuseppe , Fries Walter , Buemi Michele 
Published: May 2016

Increased levels of neutrophil gelatinase-associated lipocalin (NGAL), a small 25-kd stress protein released by several injured cells, have been reported in different pathological conditions such as kidney and chronic inflammatory bowel diseases. As NGAL is also emerging as a biomarker for monitoring the response to different types of treatment, the aims of this pilot study were to analyze urinary NGAL levels in a small cohort of patients affected by Crohn disease and to evaluate the eventual impact of the intravenous administration of infliximab on these levels. Crohn disease patients presented increased NGAL values compared with controls (210.5 ng/mL [88.3-1100.0 ng/mL] vs 7.6 [4.4] ng/mL; P = 0.001); the infusion of a single high dose of infliximab induced an impressive reduction in these levels to 80.1 ng/mL (38.6-400.2 ng/mL; P = 0.006) with a mean reduction ratio of 62.1%. These findings suggest a pivotal role of NGAL in the systemic adaptations to Crohn disease, also confirming the potential usefulness of NGAL measurement in the evaluation of early responses to therapy or in predicting different clinical outcomes.
Adipokines in Patients with Cancer Anorexia and Cachexia
Authors: Smiechowska Joanna , Utech Anne , Taffet George , Hayes Teresa , Marcelli Marco , Garcia José M. 
Published: May 2016

Background Anorexia, cachexia, and insulin resistance are commonly seen in patients with cancer. Adipocyte-derived hormones or adipokines play a role in the regulation of appetite, body weight, and insulin sensitivity. However, their role in cancer-induced cachexia has not been well-established. The objective of this study was to determine the levels of adipokines and their relation to appetite, weight loss, insulin resistance, and other hormones in cancer cachexia. Methods We measured adiponectin, resistin, and leptin plasma levels in 21 men with cancer cachexia, 24 noncachectic cancer subjects, and 25 noncancer controls matched by age, sex, and pre-illness body weight. Body weight change, appetite scores, insulin resistance assessed by homeostasis model assessment, and other cytokines and hormones were also measured. Differences between groups were measured by analysis of covariance. Relations between variables were examined by linear regression analyses. Results Adiponectin levels were similarly elevated in cachectic and noncachectic cancer patients compared with noncancer controls. Leptin levels were significantly decreased in cancer cachexia and were directly associated with appetite and insulin resistance, explaining 37% and 19% of the variance seen in cancer patients, respectively. Resistin levels were not different between groups. Conclusions Leptin may play a role in the increased insulin resistance seen in cancer patients. However, these patients are resistant to the orexigenic effects of hypoleptinemia. Other mechanisms besides weight loss are responsible for the increased adiponectin level seen in cancer patients. It is unlikely that resistin plays a major metabolic role in this setting.
Optimum Timing of Blood Tests for Monitoring Patients with Clostridium difficile-Associated Diarrhea
Authors: Bhangu Aneel , Czapran Adam , Bhangu Sonia , Pillay Devadas 
Published: May 2016

Objective This study aimed to identify optimum timing of blood tests and suitable cutoff values when managing patients with Clostridium difficile-associated diarrhea (CDAD), in relation to early mortality. Methods Review of 204 patients treated as inpatients for a first episode of CDAD from January to December 2008. Differences in values during the first 7 days of CDAD for white cell count (WCC), albumin, C-reactive protein, and creatinine between those who died and survivors to 30 days were compared using Mann-Whitney U tests. Cutoff values were assessed using receiver operating characteristic curves. Results Overall 30-day mortality was 27% (n = 56/204). White cell counts were significantly higher in those who died on the first 3 days ( P < 0.001, P = 0.015, and P = 0.001, respectively). Median WCC in those who died was 20 × 109/L or greater on both days 1 and 2. Albumin was significantly different on day 1 only ( P = 0.003); C-reactive protein, and creatinine did not differ significantly on any day. The highest WCC in the first 3 days produced an area under the curve of 0.718 ( P < 0.001). A WCC cutoff at 20 × 109/L or greater when compared with 15 × 109 or greater had a higher positive predictive value (0.46 vs 0.34) and specificity (0.82 vs 0.60) but a lower sensitivity (0.49 vs 0.65). Mortality rates in the 2 groups were 46% and 34%, respectively. Conclusions White cell count in the first 3 days is the strongest serum predictor of mortality and should be routinely monitored. A WCC of 20 × 109/L or greater may be the best cutoff value to objectively identify cases at higher risk of death.
Left Ventricular Diastolic Function in Patients on Hemodialysis
Authors: Raizada Veena , Skipper Betty , Taylor Robert A. , Luo Wentao , Harford Antonia A. , Zager Philip G. , Rohrscheib Mark , Spalding Charles T. 
Published: May 2016

Background Previous studies have shown that the assessment of Doppler mitral flow velocity (DMFV) curves can be used to predict prognosis owing to left ventricular (LV) diastolic dysfunction in certain specific diseases. Our aim was to study whether the prognostic value of DMFV curves is affected by the many end-stage renal disease factors, such as chronic uremia and long-term hemodialysis (HD), which cause LV diastolic dysfunction and death. Methods Retrospective echo Doppler studies obtained 10 to 12 hours after HD in 90 patients (52 males; mean age, 56 years) were analyzed to determine changes in deceleration time (DT) of the early mitral filling wave ( E) and the ratio of E to the atrial velocity ( A). The study findings (n = 83) showed 2 groups of DT: long DT (DT > 240 milliseconds) and normal/short DT (DT ≤ 240 milliseconds). Continuous variables of LV size using internal dimensions, systolic function using ejection fraction, hypertrophy using wall thickness and mass, and pulmonary hypertension and E/ A were compared between the 2 groups. Results Patients with long DT versus normal/short DT had lower absolute and indexed LV mass ( P = 0.03 and P = 0.02, respectively) and pulmonary hypertension ( P ≤ 0.001), without a significant difference in LV systolic function or E/ A. The mortality rate, adjusted for age and sex, was lower with long DT versus normal/short DT, with a hazard ratio of death, 0.44 (95% confidence interval, 0.23-0.86, P = 0.02). Conclusions Our study identified characteristics of DMFV curves in patients on long-term HD, which are clearly of value in predicting outcomes and survival in these patients.
Faculty Involvement in Translational Research and Interdisciplinary Collaboration at a US Academic Medical Center
Authors: Weston Christine M. , Bass Eric B. , Ford Daniel E. , Segal Jodi B. 
Published: May 2016

Background Forty-six academic health centers have been awarded Clinical and Translational Science Awards by the National Institutes of Health to enhance health by advancing translational research. Objective As a recipient of a Clinical and Translational Science Award, we aimed to determine the prevalence of translational and interdisciplinary collaboration at our institution. Design, Setting, and Participants We surveyed all full-time faculty and postdoctoral fellows (n = 3870) in the Johns Hopkins Schools of Medicine, Public Health, Nursing and Engineering, in late 2008. Main Outcome Measures Outcomes included (1) the proportion of investigators involved in early (T1), late (T2), and reverse translational (RT) research; (2) barriers to translational research; (3) attitudes about translational research; (4) involvement in interdisciplinary collaboration; and (5) barriers to collaboration. Results With 1800 respondents, the response rate was 55% for faculty and 40% for postdoctoral fellows. Of the 1314 investigators with more than 30% of their time committed to research, 69% reported conducting 1 or more types of translational research (T1 = 79%, T2 = 36%, RT = 36%). Attitudes about translational research revealed both concern and uncertainty. Fifty-four percent of respondents described translational research as having complex regulatory requirements; 42% felt that an individual's contributions suffer from underrecognition, 39% described it as high risk, and 35% consider funding less secure for translational researchers. Collaboration across school and types of research was common. Forty-seven percent of basic scientists collaborated with a clinical investigator in the last year, and 56% of clinical investigators collaborated with a basic scientist. Conclusions Overall, investigators who did translational research reported a greater number of collaborators than those who did not.
Both Vascular Endothelial Growth Factor and Soluble Flt-1 are Increased in Type 2 Diabetes but not in Impaired Fasting Glucose
Authors: Nandy Debashis , Mukhopadhyay Debabrata , Basu Ananda 
Published: May 2016

Objective Inadequate vascular remodeling is contributory to increased cardiovascular events in people with type 2 diabetes mellitus (DM) and impaired fasting glucose (IFG). Vascular endothelial growth factor (VEGF) and its regulatory molecule soluble Flt-1(sFlt-1) play important roles in atherogenesis. Research Design We measured fasting plasma concentrations of VEGF and sFlt-1 in 11 nondiabetic (ND) (aged 46.1 ± 2.1 years; body mass index [BMI], 26.1 ± 0.9 kg/m2; glucose, 5.0 ± 0.1 mM), 15 IFG (aged 52.9 ± 1.8 years; BMI, 32.7 ± 1.3 kg/m2; glucose, 6.4 ± 0.1 mM), and 8 DM (aged 55.8 ± 3.2 years; BMI, 30.0 ± 1.0 kg/m2; glucose, 9.3 ± 0.5 mM) subjects. Results Plasma VEGF (42.1 ± 4.0 vs 24.2 ± 0.9 vs 29.4 ± 3.8 pg/mL, respectively) and sFlt-1 (119.4 ± 4.9 vs 58.9 ± 3.2 vs 56.7 ± 1.2 pg/mL, respectively) concentrations were higher ( P < 0.04) in DM than IFG and ND subjects. Whereas VEGF concentrations were significantly lower ( P < 0.05) in IFG than in ND subjects, sFlt-1 concentrations did not differ between the IFG and ND subjects. Conclusions Although plasma VEGF concentrations were higher (35%) in DM than in ND subjects, VEGF action on vascular remodeling was likely attenuated by higher sFlt-1 concentrations in DM. In contrast, IFG subjects did not have major perturbations in either VEGF or sFlt-1 levels. Further studies defining the roles of these mediators in DM and IFG are necessary to extend these observations.
7-Year Survey after Percutaneous Dilatational Tracheotomy on a Medical Intensive Care Unit
Authors: Lebiedz Pia , Suca Annemarie , Gümüs Emel , Radke Robert M. , Kaya Elif , Hilker Ekkehard , Reinecke Holger 
Published: May 2016

Purpose Percutaneous dilatational tracheotomy (PDT) is a well-established procedure in intensive care medicine. Several reports confirm a low acute and long-term complication rate. However, dilatational tracheotomy is still often postponed even in patients that are under ventilator support for more than 2 weeks. We present a retrospective study analyzing the subjective long-term results after percutaneous tracheotomy performed at our medical intensive care unit between 2002 and 2008. Methods We used a modified method described by Ciaglia for tracheotomy. We selected 649 patients eligible for the survey among those who had received PDT between 2002 and 2008 and had been dismissed from hospital alive. Results The return rate was 38.5% with 29.8% of the questionnaires being completed by the patients; in 32 cases, relatives reported of the patients' death. No patient experienced wound infection; none needed surgical wound revision. Dysarthria was reversible in all 16 cases; 2 patients reported a persistent hoarseness that was preexisting in both cases. One patient experienced a tracheal stenosis and received a tracheal stent; one other required a permanent tracheotomy because of a nonresectable granulation tissue. The overall rate of long-term complications associated with the long-term ventilation and the PDT was 1.8%. Conclusions Percutaneous dilatational tracheotomy is an easily performed, cost-saving method for long-term ventilated patients with a low rate of acute and long-term complications even in old and multimorbid internal medicine patients.
Effective Antihypertensive Strategies for High-Risk Patients with Diabetic Nephropathy
Authors: Van Buren Peter Noel , Adams-Huet Beverley , Toto Robert Daniel 
Published: May 2016

Aim Clinical guidelines recommend blood pressure (BP) lowering and renin-angiotensin-aldosterone system inhibition to slow kidney disease progression in patients with diabetic nephropathy. This study's purpose was to determine whether an antihypertensive regimen including a maximally dosed angiotensin-converting enzyme inhibitor could safely achieve target BP in indigent, predominantly minority patients with this disease. Methods We studied 81 hypertensive adults (52% Hispanic and 31% African American) with nephropathy attributed to type 1 or 2 diabetes during the run-in period of a randomized controlled trial. The subjects received lisinopril titrated to 80 mg daily and additional antihypertensives to target a systolic BP (SBP) lower than 130 mm Hg. Blood pressure and serum potassium level were measured weekly, and a 4-gram sodium diet was prescribed. The primary outcome variable was SBP change from screening to randomization. Success in achieving SBP goal, change in urine albumin-creatinine ratio, hyperkalemia (serum potassium ≥5.5 mmol/L) and hypotension (SBP < 100 mm Hg) were also analyzed. Results The median SBP decreased from 144 to 133 mm Hg (median change, −9.6%.) Fifty-eight (71%) achieved goal SBP during run-in. The median UACR decreased from 206.8 to 112.7 mg/mmol (median change, −42.7%). The UACR reduction correlated with SBP reduction. Seventeen subjects experienced hyperkalemia responsive to dietary/medical management. Two subjects experienced hypotension responsive to medication adjustments. Conclusion A regimen using a maximally dosed angiotensin-converting enzyme inhibitor is safe and effective for achieving BP goal in high-risk, predominantly minority patients with diabetic nephropathy. Implementing this regimen necessitates close monitoring of serum potassium level.
Screening for the Metabolic Syndrome in a Public Care Hospital Clinic Population a Simple Measurement of Waist Circumference
Authors: Parish Roy C. , Huang Jian , Mansi Ishak 
Published: May 2016

Background Metabolic syndrome is a collection of anthropomorphic and metabolic derangements that, taken together, constitute a strong predictor of stroke, cardiovascular disease, type 2 diabetes, and perhaps other disorders. Diagnosing the metabolic syndrome according to presently accepted definitions requires a mixture of anthropomorphic and laboratory measurements. In indigent patient populations or locations that lack adequate laboratory facilities, a noninvasive low-cost or cost-free alternative would be beneficial as a preliminary screening measure. Methods To identify potential means for the diagnosis, we evaluated anthropomorphic measures individually and in combination for their predictive value against the standard classification. Receiver operator characteristic curves identified optimal cutoff values for the variables tested, and consideration of sensitivity and specificity were considered concerning the consequences of false negatives and positives. Results Receiver operator characteristic curves showed that only waist circumference in men gave acceptable specificity and sensitivity. Combinations of measurements did not improve on a simple measurement of waist circumference. Conclusions Waist circumference was a potentially useful single indicator in men but not in women. Other values and combinations were evaluated as well. Waist measurement alone may serve as sufficient screening in men in locations where laboratory facilities are lacking or funds are severely limited, as in developing countries.
Evidence that Androgens Modulate Human Thymic T Cell Output
Authors: Olsen Nancy J. , Kovacs William J. 
Published: May 2016

Background The thymus has long been recognized as a target for the actions of androgenic hormones, but it has only been recently recognized that alterations in circulating levels of gonadal steroids might affect thymic output of T cells. We had the opportunity to examine parameters of thymic cellular output in several hypogonadal men undergoing androgen replacement therapy. Methods Circulating naive (CD4+CD45RA+) T cells were quantitated by flow cytometric analysis of peripheral blood mononuclear cells. Cells bearing T-cell receptor excision circles were quantitated using real-time polymerase chain reaction amplification of DNA isolated from peripheral blood mononuclear cells from healthy men and from hypogonadal men before and after testosterone replacement therapy. Results CD4+CD45+ (naive) T cells comprised 10.5% of lymphocytes in healthy males; this proportion was greatly increased in 2 hypogonadal men (35.5% and 44.4%). One man was studied sequentially during treatment with physiologic doses of testosterone. CD4+CD45RA+ cells fell from 37.36% to 20.05% after 1 month and to 12.51% after 7 months of normalized androgen levels. In 2 hypogonadal patients, T-cell receptor excision circle levels fell by 83% and 78% after androgen replacement therapy. Conclusions Our observations indicate that the hypogonadal state is associated with increased thymic output of T cells and that this increase in recent thymic emigrants in peripheral blood is reversed by androgen replacement.
Familial Pycnodysostosis: Identification of a Novel Mutation in the CTSK Gene (Cathepsin K)
Authors: Toral-López Jaime , Gonzalez-Huerta Luz Maria , Sosa Blanca , Orozco Sócrates , González Hugo Peláez , Cuevas-Covarrubias Sergio A. 
Published: May 2016

Background Pycnodysostosis, an autosomal recessive skeletal dysplasia, is characterized by short stature, osteosclerosis, delayed cranial suture closure, hypoplastic mandible, acro-osteolysis, hypoplastic clavicle, and dental anomalies. The disorder is caused by CTSK gene defects, a gene localized on 1q21. Purpose To describe the clinical, radiological, and molecular findings in a family with pycnodysostosis. Methods The CTSK gene was analyzed from genomic DNA in a nonconsanguinity Mexican family with 3 affected members with pycnodysostosis and 100 healthy controls. Results and Interpretation We identified the novel homozygous mutation c.908G>A within exon 8 of the CTSK gene. This missense mutation leads to the substitution of the amino acid glycine at position 303 by glutamic acid (G303E) in cathepsin K protease. No genotype/phenotype correlation was present in affected members of the family with pycnodysostosis.
Lack of Association between the IL-10 Gene Polymorphisms and Features of the Metabolic Syndrome
Authors: Lu Ming-Ying , Lakkakula Bhaskar V.K.S. , Liao Yi-Chu , Tsai Pei-Chien , Yang Yi-Hsin , Juo Suh-Hang Hank 
Published: May 2016

Backgrounds Insulin resistance plays a major role in the pathogenesis of the metabolic syndrome. Inflammation is the leading cause of insulin resistance, and interleukin 10 (IL-10) is one of the anti-inflammatory cytokines. We conducted a case-control study to investigate the association between the IL-10 polymorphisms and the metabolic syndrome. Methods One thousand two hundred two unrelated subjects residing in southern Taiwan were retrospectively recruited from a community-based health screening program. Two hundred sixty subjects were defined as the metabolic syndrome (3-5 risk components) and 549 subjects as controls (0-1 risk component) on the basis of the Asian version of the Adult Treatment Panel III criteria. A functional IL-10 single nucleotide polymorphism (SNP; rs1800871) and 2 tagging SNPs (rs3790622, rs3021094) were genotyped by TaqMan method. Results We analyzed the association between the genotypes and the presence of the metabolic syndrome or metabolic traits by χ2 test and multivariant logistic regression. None of the IL-10 SNPs were found to be significantly related with the metabolic syndrome or its risk components. All the 3 SNPs were in single linkage disequilibrium block. Haplotype analysis did not yield significant association between IL-10 gene and the metabolic syndrome (global P = 0.88). Conclusions Because we used tagging SNPs and a modest clinical cohort, we concluded that the IL-10 gene polymorphisms may be unlikely to play an important role for the metabolic syndrome.
Vascular Endothelial Growth Factor Gene Polymorphisms and Rheumatoid Arthritis
Authors: Lv Hao-zhe , Lin Tao , Xia Li-ping , Shen Hui , Zhu Xiang-yang , Zhang Jin-tao , Xiao Wei-guo , Lu Jing 
Published: May 2016

Objective To investigate polymorphisms of the vascular endothelial growth factor (VEGF) gene in patients with rheumatoid arthritis (RA) and their relationship to clinical features. Method A total of 198 unrelated Chinese individuals were enrolled in this study, including 98 patients with RA and 100 healthy controls. Eight different polymorphisms of the VEGF gene were analyzed using Sequenom MassArray platform. Result All 8 polymorphisms were in Hardy-Weinberg equilibrium in controls. The frequencies of rs833070 A allele and rs325010 C allele were elevated in the patients with RA compared with the controls. There were increased genotype frequencies in GA of rs833070, GC of rs3025030, CT of rs3025039 and decreased genotype frequencies in GG of rs833070, GG of rs3025030, CC of rs3025039 in the patients with RA compared with the controls. The frequencies of haplotype GA in rs2010963 and rs833070 were higher in the patients with RA than in the controls. There was no significant difference in the genotype or allele frequencies in the RA group sorted by complications, serum markers, or age of onset. Conclusion Our data suggested a trend of association between VEGF gene polymorphisms and RA, and patients who carried the haplotype GA of rs2010963 and rs833070 were more susceptible to RA. Our study was performed in a small population, and further studies in other populations are needed to confirm these results.