bluuebunny/crossref_metadata_2025_split huggingface dataset:
Asymmetric dimethylarginine and all-cause mortality: a systematic review and meta-analysis
Authors: Zhou Shaoli , Zhu Qianqian , Li Xiang , Chen Chaojin , Liu Jiping , Ye Yuping , Ruan Ying , Hei Ziqing 
Published: March 2017

AbstractAsymmetrical dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase (NOS), impairs the beneficial effect of NO. The predictive value of ADMA for all-cause mortality remains controversial, though it is important in the development of cardiovascular disease (CVD) and progression to dialysis in renal disease. This systematic review and meta-analysis was conducted to investigate the association between circulating ADMA and all-cause mortality. Studies with data pertinent to the association between circulating ADMA and all-cause mortality were reviewed and OR, HR or RR with 95% CI derived from multivariate Cox’s proportional-hazards analysis were extracted. A total of 34 studies reporting 39137 participants were included in final analysis. The results demonstrated that circulating ADMA was independently associated with all-cause mortality (RR = 1.27, 95% CI: 1.20–1.34). The association was still statistically significant in patients with pre-existing renal disease (RR = 1.30, 95% CI: 1.19–1.43) and pre-existing CVD (RR = 1.26, 95% CI: 1.16–1.37). In those without pre-existing renal or CVD, ADMA also predicted all-cause mortality (RR = 1.31, 95% CI: 1.13–1.53). The present study suggests a positive association of circulating ADMA with all-cause mortality. Further studies are needed to investigate the effects of interventions on ADMA, and the value of ADMA as a biomarker.
Does the Access to Sun Exposure Ensure Adequate Levels of 25-Hydroxyvitamin D?
Authors: Paula Francisco José Albuquerque de , Franceschini Silvio Antônio , Vieira Carolina Sales , Ferriani Rui Alberto , Silva de Sá Marcos Felipe , Lara Lucia Alves da Silva , Damaso Ênio Luis 
Published: March 2017

Objectives To assess the prevalence of hypovitaminosis D, altered arterial blood pressure, and serum levels of glucose and lipids in community-dwelling women in the city of Ribeirão Preto, in the southeast of Brazil.
Methods This was a cross-sectional study of women aged 40–70 years old. Calcium intake and level of sun exposure were assessed by means of a questionnaire. A blood sample was used to determine glucose, lipid profile and 25-hydroxyvitamin D (25[OH]D) concentration.
Results Ninety-one women were enrolled (age = 54.2 ± 7.1 years). The mean serum 25(OH)D concentration was 25.7 ± 8.9 ng/mL. A total of 24 (26.4%) women had 25(OH)D levels < 20 ng/mL. Seventy women (76.9%) had 25(OH)D levels < 30 ng/mL. Seventy-five women (90.4%) had inadequate calcium intake, and 61 women (67%) had appropriate sun exposure, 49 of whom (80.3%) had serum 25(OH)D levels < 30 ng/mL.
Conclusion This study indicates that even in community-dwelling women, living in a city with high sun exposure, serum levels of 25(OH)D > 30 ng/ml are hardly reached. Thus, it is probable that other intrinsic factors besides sun exposure may regulate the levels of vitamin D.
Outcomes of Carotid Endarterectomy with Primary Closure
Authors: Cheng Ivy , Vyas Krishna , Velaga Santhosh , Davenport Daniel , Saha Sibu 
Published: March 2017

AbstractCarotid endarterectomy (CEA) reduces the risk of stroke in patients with internal carotid artery stenosis, although the optimal surgical technique is debated. The literature suggests that patch angioplasty reduces complication risk, although primary closure shortens cross-clamp time and eliminates complications associated with grafts.The objective of this study was to assess the complication rate after CEA with primary closure.Retrospective review of 240 consecutive patients between 2002 and 2010. Of these patients, 70% returned for follow-up visits for at least 2 or more years.Primary closure was used in all patients. The average cross-clamp time was 18 minutes. Complications in the immediate postoperative period within 30 days were as follows: stroke (n = 3; 1.1%), transient ischemic attack (TIA; n = 4; 1.5%), myocardial infarction (MI; n = 3; 1.1%), and death (n = 1; 0.4%). Short-term follow-up revealed eight patients who were found to have significant restenosis (>80%) by carotid duplex imaging. Two to ten year postoperative complication rates were as follows: stroke (n = 7; 4.2%), TIA (n = 7; 4.2%), amaurosis fugax (n = 1; 0.6%), MI (n = 8; 4.8%), and death (n = 28; 17%). Mortality was due to stroke or heart attack (n = 2; 1.2%), cancer (n = 7; 4.2%), and unknown causes (n = 19; 11%).This study presents our experience with complications after primary closure after CEA. In our experience, CEA is a safe and effective surgical means of preventing stroke in the short term. Well-designed prospective studies are needed to confirm specific patient characteristics in which primary closure and patch angioplasty are indicated.
Evidence-Based Guidelines for the Pharmacological Management of Acute Methamphetamine-Related Disorders and Toxicity
Authors: Wodarz Norbert , Krampe-Scheidler Anne , Christ Michael , Fleischmann Heribert , Looser Winfried , Schoett Katharina , Vilsmeier Frank , Bothe Lydia , Schaefer Corinna , Gouzoulis-Mayfrank Euphrosyne 
Published: March 2017

AbstractConsumption of methamphetamine (“crystal”) has spread dramatically over several European countries. The management of methamphetamine-induced acute disorders has become a growing challenge to the health system. Pharmacological treatment strategies for methamphetamine-induced intoxication syndromes, acute withdrawal symptoms, and methamphetamine-induced psychosis are particularly important.The development of interdisciplinary and evidence- and consensus-based (S3) German Guidelines was based on a systematic literature and guideline search on therapeutic interventions in methamphetamine-related disorders (April, June 2015). Consideration was given to 9 guidelines and 103 publications. Recommendations on pharmacological treatment strategies were drawn up using the nominal group technique.Overall, only limited evidence is available. Benzodiazepines are first-line medication for methamphetamine-induced intoxication syndromes, particularly when they present with acute agitation and aggressive behavior. There is no evidence-based medication for the treatment of methamphetamine-related withdrawal symptoms and cravings. When treating methamphetamine-induced psychosis, second-generation antipsychotics should be favored, given their more favorable side-effect profile. The indication for continuation of antipsychotic medication must be reviewed regularly. In most cases, the antipsychotic should be tapered off within 6 months.
Effects of Intramuscular Midazolam and Lorazepam on Acute Agitation in Non-Elderly Subjects – A Systematic Review
Authors: Kousgaard Sabrina , Licht Rasmus , Nielsen René 
Published: March 2017

Abstract
Benzodiazepines are commonly used for the treatment of acute agitation in a psychiatric setting.We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL) for relevant publications. Randomized trials evaluating intramuscular (IM) midazolam or lorazepam given as monotherapy or as add-on treatment, with more than 10 patients aged 18–65 years, conducted in a psychiatric setting, and published between January 1, 1980, and February 3, 2016, were included.
16 studies from a search result of 5 516 studies were included. In total, 577 patients were treated with lorazepam IM 2–4 mg, and 329 patients were treated with midazolam IM 5–15 mg.
It is unclear whether lorazepam IM or midazolam IM is as efficacious as an antipsychotic IM. It is a bit more certain that the combination of benzodiazepines IM and a low dose antipsychotic IM is more efficacious than the benzodiazepine and the antipsychotic alone. However, there is no doubt that benzodiazepines are less likely to be associated with treatment emergent side effects, as compared to antipsychotics.
Mucosal breaks show same circumferential distribution in majority of patients with recurrent reflux esophagitis
Authors: Fukuda Naoki , Ishimura Norihisa , Okada Mayumi , Izumi Daisuke , Mikami Hironobu , Okimoto Eiko , Aimi Masahito , Mishiro Tsuyoshi , Oshima Naoki , Ishihara Shunji , Kinoshita Yoshikazu 
Published: March 2017

Abstract
Background and study aims Esophageal mucosal breaks in patients with reflux esophagitis (RE) have a unique circumferential distribution. However, the specific location of mucosal breaks during recurrence of RE remains unclear. We investigated the circumferential distribution of mucosal breaks in patients with recurrent RE and compared their location to that noted at the initial diagnosis.
Patients and methods We retrospectively enrolled patients with recurrent RE with Los Angeles (LA) grade A-C who were treated at our University Hospital between July 1996 and June 2014. The circumferential distribution of esophageal mucosal breaks was evaluated at the time of the initial diagnosis and again at the time of recurrence. Information regarding clinical parameters, including proton pump inhibitor administration, presence of hiatal hernia, and mucosal atrophy, was also reviewed.
Results A total of 114 patients with recurrent RE were examined during the study period, with a mean duration to recurrence after initial diagnosis of 39.4 months. The majority (72.8 %) had the same LA grade at recurrence. In addition, recurrent mucosal breaks in 96 (84.2 %) patients were observed to have occurred in the same circumferential location as at the initial diagnosis, while those in 18 (15.8 %) were observed in a different location. When recurrent lesions had a different location, the LA grade also tended to be different (P = 0.02).
Conclusions We found that most patients with recurrent RE developed lesions in the same circumferential location as noted for the initial lesions. Those in different locations at recurrence were associated with a change in LA grade.
Gesundheitsökonomische Potenziale einer ganzheitlichen Nachsorge von Schlaganfallpatienten
Authors: Reichert Anika , Fröhlich J. , Himmler S. , Krauth C. , Amelung V. E. 
Published: March 2017

Zusammenfassung
Zielsetzung Diese Studie analysiert die gesundheitsökonomischen Potenziale eines Versorgungsansatzes, der eine ganzheitliche
Nachsorge und Betreuung von Schlaganfallpatienten nach ihrer Rückkehr in die eigene Häuslichkeit umfasst.
Methodik In einem Entscheidungsbaummodell werden auf Basis von Inputdaten aus der Literatur und Expertenmeinungen 4
Patientenpfade bis zu 36 Monate nach dem Schlaganfallereignis verglichen: Versorgungmanagement und Regelversorgung bei
bedarfsgerechter Versorgung und Fehlversorgung.
Ergebnisse Eine bedarfsgerechte Nachsorge führt kurzfristig zu Mehrkosten bei der Hilfsmittel-Erstausstattung. Diese können
jedoch potenziell durch eine Vermeidung adverser Ereignisse sowie durch positive Effekte auf das Risiko stationärer Pflege und die
Mortalität nach etwa fünf Monaten ausgeglichen werden.
Schlussfolgerung Eine umfassende Bedarfserfassung, die Auswahl effektiver Hilfsmittel sowie die Einbindung des Patienten in
Entscheidungen tragen nachweislich zu einer Verbesserung des funktionellen Zustandes und damit assoziierten Kosten bei.
New Knowledge About Old Drugs: The Anti-Inflammatory Properties of Cardiac Glycosides
Authors: Fürst Robert , Zündorf Ilse , Dingermann Theo 
Published: March 2017

AbstractIn the 19th century, cardio-active steroid glycosides, shortly cardiac glycosides, were scientifically established as drugs against heart failure. Their in vivo, cellular, and molecular actions as well as their predominant target, Na+-K+-ATPase, have been comprehensively investigated in the 20th century and the discovery of endogenous cardiac glycosides has fostered this research field. In the last years, however, results from clinical trials and meta-analyses have questioned their therapeutic value due to efficacy and safety issues. This has led to a considerable decline of their usage. Beyond the cardiovascular system, cardiac glycosides have been increasingly recognized as antitumor compounds and Na+-K+-ATPase has evolved into a promising drug target in oncology. A wealth of review articles exists that intensively discuss these topics. Surprisingly, the anti-inflammatory actions of cardiac glycosides, which were discovered in the 1960s, have so far hardly been perceived and have not yet been summarized. This review provides an overview of the in vivo and in vitro actions of cardiac glycosides on inflammatory processes and of the signaling mechanisms responsible for these effects: cardiac glycosides have been found to decrease inflammatory symptoms in different animal models of acute and chronic inflammation. Regarding the underlying mechanisms most research has focused on leukocytes. In these cells, cardiac glycosides primarily inhibit cell proliferation and the secretion of proinflammatory cytokines.
Opioid-type Respiratory Depressant Side Effects of Cebranopadol in Rats Are Limited by Its Nociceptin/Orphanin FQ Peptide Receptor Agonist Activity
Authors: Linz Klaus , Schröder Wolfgang , Frosch Stefanie , Christoph Thomas 
Published: March 2017

Abstract

Background
Cebranopadol is a first-in-class analgesic with agonist activity at classic opioid peptide receptors and the nociceptin/orphanin FQ peptide receptor. The authors compared the antinociceptive and respiratory depressant effects of cebranopadol and the classic opioid fentanyl and used selective antagonists to provide the first mechanistic evidence of the contributions of the nociceptin/orphanin FQ peptide and μ-opioid peptide receptors to cebranopadol’s respiratory side-effect profile.

Methods
Antinociception was assessed in male Sprague–Dawley rats using the low-intensity tail-flick model (n = 10 per group). Arterial blood gas tensions (Paco
2 and Pao
2) were measured over time in samples from unrestrained, conscious rats after intravenous administration of cebranopadol or fentanyl (n = 6 per group).

Results
The ED50 for peak antinociceptive effect in the tail-flick model was 7.4 μg/kg for cebranopadol (95% CI, 6.6 to 8.2 μg/kg) and 10.7 μg/kg for fentanyl citrate (9 to 12.7 μg/kg). Fentanyl citrate increased Paco
2 levels to 45 mmHg (upper limit of normal range) at 17.6 μg/kg (95% CI, 7.6 to 40.8 μg/kg) and to greater than 50 mmHg at doses producing maximal antinociception. In contrast, with cebranopadol, Paco
2 levels remained less than 35 mmHg up to doses producing maximal antinociception. The nociceptin/orphanin FQ peptide receptor antagonist J-113397 potentiated the respiratory depressant effects of cebranopadol; these changes in Paco
2 and Pao
2 were fully reversible with the μ-opioid peptide receptor antagonist naloxone.

Conclusions
The therapeutic window between antinociception and respiratory depression in rats is larger for cebranopadol than that for fentanyl because the nociceptin/orphanin FQ peptide receptor agonist action of cebranopadol counteracts side effects resulting from its μ-opioid peptide receptor agonist action.
Causes and Characteristics of Death in Intensive Care Units
Authors: Orban Jean-Christophe , Walrave Yannick , Mongardon Nicolas , Allaouchiche Bernard , Argaud Laurent , Aubrun Frédéric , Barjon Geneviève , Constantin Jean-Michel , Dhonneur Gilles , Durand-Gasselin Jacques , Dupont Hervé , Genestal Michèle , Goguey Chloé , Goutorbe Philippe , Guidet Bertrand , Hyvernat Hervé , Jaber Samir , Lefrant Jean-Yves , Mallédant Yannick , Morel Jerôme , Ouattara Alexandre , Pichon Nicolas , Guérin Robardey Anne-Marie , Sirodot Michel , Theissen Alexandre , Wiramus Sandrine , Zieleskiewicz Laurent , Leone Marc , Ichai Carole ,   for the AzuRéa Network
Published: March 2017

Abstract

Background
Different modes of death are described in selected populations, but few data report the characteristics of death in a general intensive care unit population. This study analyzed the causes and characteristics of death of critically ill patients and compared anticipated death patients to unexpected death counterparts.

Methods
An observational multicenter cohort study was performed in 96 intensive care units. During 1 yr, each intensive care unit was randomized to participate during a 1-month period. Demographic data, characteristics of organ failures (Sequential Organ Failure Assessment subscore greater than or equal to 3), and organ supports were collected on all patients who died in the intensive care unit. Modes of death were defined as anticipated (after withdrawal or withholding of treatment or brain death) or unexpected (despite engagement of full-level care or sudden refractory cardiac arrest).

Results
A total of 698 patients were included during the study period. At the time of death, 84% had one or more organ failures (mainly hemodynamic) and 89% required at least one organ support (mainly mechanical ventilation). Deaths were considered unexpected and anticipated in 225 and 473 cases, respectively. Compared to its anticipated counterpart, unexpected death occurred earlier (1 day vs. 5 days; P< 0.001) and had fewer organ failures (1 [1 to 2] vs. 1 [1 to 3]; P< 0.01) and more organ supports (2 [2 to 3] vs. 1 [1 to 2]; P< 0.01). Withdrawal or withholding of treatments accounted for half of the deaths.

Conclusions
In a general intensive care unit population, the majority of patients present with at least one organ failure at the time of death. Anticipated and unexpected deaths represent two different modes of dying and exhibit profiles reflecting the different pathophysiologic underlying mechanisms.
Frequency of Subungual Melanoma in Longitudinal Melanonychia: A Single-Center Experience
Authors: Decker Ashley , Connolly Karen L. , Lee Erica H. , Busam Klaus J. , Nehal Kishwer S. 
Published: March 2017

BACKGROUND
Clinical and dermatoscopic guidelines are used to differentiate between benign longitudinal melanonychia (LM) and subungual melanoma; however, the frequency of malignancy among patients undergoing a biopsy for LM is not well defined.

OBJECTIVE
To describe the histologic diagnoses and malignancy among patients undergoing a biopsy for clinical LM.

METHODS
Retrospective cohort study of consecutive patients who underwent a nail biopsy for LM at a single cancer center between 2000 and 2014. Clinical features, biopsy techniques, and histopathologic results were reviewed.

RESULTS
Forty-two patients with 43 biopsied lesions were included. Three of the 43 biopsies revealed melanoma (mean depth 2.1 mm). The mean age among patients with malignant lesions was 60 years compared with 58.1 years for benign lesions. The mean width of all biopsied lesions was 4.2 mm, with a mean of 10.7 mm for malignant and 3.4 mm for benign. The first digit was the most commonly involved nail in both malignant and benign lesions.

CONCLUSION
Most nail biopsies performed for LM revealed benign pathology; however, melanoma was diagnosed in a small subgroup. Although clinical and dermatoscopic guidelines help guide biopsies, they should not replace clinical judgment as malignant lesions can deviate from these guidelines.
Acute Decompensation in Pediatric Cardiac Patients: Outcomes After Rapid Response Events
Authors: Bavare Aarti C. , Rafie Kimia S. , Bastero Patricia X. , Hagan Joseph L. , Checchia Paul A. 
Published: March 2017

Objective:
We studied rapid response events after acute clinical instability outside ICU settings in pediatric cardiac patients. Our objective was to describe the characteristics and outcomes after rapid response events in this high-risk cohort and elucidate the cardiac conditions and risk factors associated with worse outcomes.

Design:
A retrospective single-center study was carried out over a 3-year period from July 2011 to June 2014.

Setting:
Referral high-volume pediatric cardiac center located within a tertiary academic pediatric hospital.

Patients:
All rapid response events that occurred during the study period were reviewed to identify rapid response events in cardiac patients.

Interventions:
None.

Measurements and Main Results:
We reviewed 1,906 rapid response events to identify 152 rapid response events that occurred in 127 pediatric cardiac patients. Congenital heart disease was the baseline diagnosis in 74% events (single ventricle, 28%; biventricle physiology, 46%). Seventy-four percent had a cardiac surgery before rapid response, 37% had ICU stay within previous 7 days, and acute kidney injury was noted in 41% post rapid response. Cardiac and/or pulmonary arrest occurred during rapid response in 8.5%. Overall, 81% were transferred to ICU, 22% had critical deterioration (ventilation or vasopressors within 12 hr of transfer), and 56% received such support and/or invasive procedures within 72 hours. Mortality within 30 days post event was 14%. Significant outcome associations included: single ventricle physiology—increased need for invasive procedures and mortality (adjusted odds ratio, 2.58; p = 0.02); multiple rapid response triggers—increased ICU transfer and interventions at 72 hours; critical deterioration—cardiopulmonary arrest and mortality; and acute kidney injury—cardiopulmonary arrest and need for hemodynamic support.

Conclusions:
Congenital heart disease, previous cardiac surgery, and recent discharge from ICU were common among pediatric cardiac rapid responses. Progression to cardiopulmonary arrest during rapid response, need for ICU care, kidney injury after rapid response, and mortality were high. Single ventricle physiology was independently associated with increased mortality.
Effect size and statistical power in the rodent fear conditioning literature – a systematic review
Authors: Carneiro Clarissa F. D. , Moulin Thiago C. , Macleod Malcolm R. , Amaral Olavo B. 
Published: March 2017

AbstractProposals to increase research reproducibility frequently call for focusing on effect sizes instead of p values, as well as for increasing the statistical power of experiments. However, it is unclear to what extent these two concepts are indeed taken into account in basic biomedical science. To study this in a real-case scenario, we performed a systematic review of effect sizes and statistical power in studies on learning of rodent fear conditioning, a widely used behavioral task to evaluate memory. Our search criteria yielded 410 experiments comparing control and treated groups in 122 articles. Interventions had a mean effect size of 29.5%, and amnesia caused by memory-impairing interventions was nearly always partial. Mean statistical power to detect the average effect size observed in well-powered experiments with significant differences (37.2%) was 65%, and was lower among studies with non-significant results. Only one article reported a sample size calculation, and our estimated sample size to achieve 80% power considering typical effect sizes and variances (15 animals per group) was reached in only 12.2% of experiments. Actual effect sizes correlated with effect size inferences made by readers on the basis of textual descriptions of results only when findings were non-significant, and neither effect size nor power correlated with study quality indicators, number of citations or impact factor of the publishing journal. In summary, effect sizes and statistical power have a wide distribution in the rodent fear conditioning literature, but do not seem to have a large influence on how results are described or cited. Failure to take these concepts into consideration might limit attempts to improve reproducibility in this field of science.