bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ventricular tachyarrhythmia after coronary bypass surgery: incidence and outcome
Authors: Sadr-Ameli Mohammad Ali , Alizadeh Abolfath , Ghasemi Valiollah , Heidarali Mona 
Published: July 2013

Background Ventricular tachyarrhythmia after coronary artery bypass graft is common and the occurrence has been described, but the incidence and risk factors are not well defined. Aim To evaluate the incidence of arrhythmias and to detect high-risk populations. Methods In this prospective study, 856 consecutive patients undergoing coronary artery bypass graft were monitored for new-onset ventricular tachyarrhythmias: non-sustained monomorphic ventricular tachyarrhythmia, sustained monomorphic ventricular tachyarrhythmia, sustained polymorphic ventricular tachyarrhythmia, and ventricular fibrillation. Detailed analyses of the clinical, demographic, echocardiographic, and surgical findings and arrhythmias occurrence was carried out during 6 months of follow-up. Results The incidence of ventricular tachyarrhythmia was 26.6% (17.6% non-sustained monomorphic ventricular tachycardia, 5.5% sustained monomorphic ventricular tachycardia, 0.8% sustained polymorphic ventricular tachycardia, and 2.7% ventricular fibrillation). The strongest degrees of statistical significance were for low ejection fraction ( p = 0.01) and ischemic heart disease ( p = 0.02). The incidence of ventricular fibrillation (61%) was greatest in the first 48 h after surgery. Postoperative myocardial infarction ( p = 0.03) and hemodynamic instability ( p = 0.05) were also predictors of arrhythmia occurrence. Recurrence of arrhythmia was highest in the ventricular fibrillation group (52%). The correlations between tachyarrhythmia, age, sex, electrolyte disorders, body mass index, and systemic or pulmonary hypertension were not significant. Conclusion In view of the strong relationship between ventricular arrhythmias and low ejection fraction, ischemic heart disease, coronary artery disease severity, postoperative myocardial infection, and hemodynamic impairment, continuous monitoring is necessary, especially in the first 48 h after coronary artery bypass surgery.
CardiaMed mechanical valve: mid-term results of a multicenter clinical trial
Authors: Nazarov Vladimir M , Zheleznev Sergey I , Bogachev-Prokophiev Alexandr V , Afanasyev Alexandr V , Nemchenko Eugene V , Jeltovskiy Yuri V , Lavinyukov Sergey O 
Published: July 2013

Background Prosthesis choice is a major concern in valvular surgery. Methods A multicenter clinical trial was performed to assess the efficacy and safety of the CardiaMed prosthetic heart valve. The study enrolled 420 patients who underwent mitral (209) or aortic (211) valve replacement from 2003 to 2004 at 7 institutions in Russia, and who were followed up from 2006 to 2011. The mean age was 52.2 ± 10.2 years (range, 12–78 years), 47.4% were female, and 99.05% completed the study. Results The maximum observation term was 7.5 years (2188.5 patient-years); 1081.6 patient-years for aortic and 1106.9 patient-years for mitral valve replacement. The overall 7-year survival rate was 85.1% ± 3.7%; 86.1% ± 4.8% and 84.4% ± 5.4% for aortic and mitral valve replacement, respectively. The 7-year freedom from valve-related death was 93.9% ± 3.7% and 94.5% ± 3.2% for aortic and mitral valve replacement, respectively. When early mortality (<30 days) was excluded, these rates were 94.8% ± 3.1% and 93.8% ± 3.82%, respectively. Linearized valve-dependent complication rates were determined for structural valve failure (0%/patient-year overall), thrombosis (0.63%/patient-year, all for mitral valve replacement), thromboembolic complications including transient neurologic deficits (0.13%/patient-year overall, 0.5%/patient-year for aortic valve replacement, 0.8%/patient-year for mitral valve replacement), hemorrhagic bleeding (0.64%/patient-year overall, 0.55%/patient-year for aortic valve replacement, 0.09%/patient-year for mitral valve replacement), prosthetic endocarditis (0.28%/patient-year overall, 0.28%/patient-year for aortic valve replacement, 0%/patient-year for mitral valve replacement), and hemolysis (0%/patient-year overall). Conclusion The CardiaMed mechanical heart valve prostheses meets world standards of safety and efficacy.
Acute renal dysfunction: time from coronary angiography to cardiac surgery
Authors: Baloria Kanwar A , Pillai Biju S , Goel Sanjay , Selot Nandini 
Published: July 2013

Background The incidence of acute renal dysfunction has not changed much over the years, despite improvements in perioperative care. Our objectives were to evaluate the impact of timing of cardiac surgery after coronary angiography on acute renal dysfunction, to identify risk factors associated with development of acute renal dysfunction, and to measure the association between acute renal dysfunction and mortality. Patients and methods The patients were divided into 3 groups: group A (cardiac surgery 0–3 days after angiography), group B (surgery 4–6 days after angiography), and group C (surgery > 6 days after angiography). Endpoints were acute renal dysfunction, defined as serum creatinine > 25% of baseline on the 3rd postoperative day, and mortality. Results In 749 patients, the incidence of acute renal dysfunction was 15%; 5% required dialysis. Hypertension, congestive heart failure, chronic obstructive pulmonary disease, ejection fraction < 40%, prolonged cardiopulmonary bypass time, intraaortic balloon pump use, and urgent surgery were risk factors for acute renal dysfunction after cardiac surgery. Patients in group C had a lower risk of acute renal dysfunction. Conclusion Acute renal dysfunction has a definite relationship with the time period between angiography and cardiac surgery. The causative factors for this condition are multiple and also show a consistent association with mortality.
Evaluation of myocardial fat deposition by multislice computed tomography
Authors: Durmaz Mehmet Sedat , Demirtaş Hakan , Aralaşmak Ayşe , Özkaynak Can 
Published: July 2013

Aim To investigate correlations between myocardial fat deposition of unknown etiology and myocardial infarction, coronary artery stenosis, time after the infarction, aneurysmatic dilatation of arteries, and stenting or bypass operation. Patients and methods We evaluated coronary computed tomography angiographies of 266 patients presenting with history of myocardial infarction or having risk factors for coronary artery disease, analyzed the characteristics of myocardial fat, and compared the clinical parameters of patients with and without myocardial fat. Results 34 of the 266 patients had myocardial fat deposits. Of the 34 with myocardial fat, 47% had a history of myocardial infarction. Myocardial fat occurrence after myocardial infarction was statistically significant. Myocardial fat was more frequently associated with longer time after infarction and fewer coronary arteries involved, but without statistical significance. A bypass operation and myocardial fat deposition correlated with aneurysmatic dilatation of the coronary arteries and myocardial fat deposition within the area supplied by this artery. Conclusion Myocardial fat was detected in 34% of patients with myocardial infarction. Myocardial fat was significantly more frequent in patients who underwent a bypass operation and those who had aneurysmatic dilatation of the coronary arteries. The frequency of myocardial fat deposition increased with the involvement of fewer coronary arteries and longer time after infarction.
Bilateral internal thoracic artery grafting in insulin-treated diabetes
Authors: Lev-Ran Oren , Matsa Menachem , Ishay Yaron , Abod Moataz Abo , Vodonos Alina , Sahar Gideon 
Published: July 2013

Background We sought to assess the risk and late outcome of bilateral internal thoracic artery grafting in eligible insulin-treated diabetic subsets. Methods 147 insulin-treated diabetic patients undergoing arterial revascularization were grouped as: skeletonized bilateral internal thoracic artery ( n = 83) or internal thoracic artery-radial artery ( n = 64). Chronic lung disease or overweight and female constituted exclusion criteria for bilateral internal thoracic artery grafts. Results Patients who had bilateral internal thoracic artery grafts were younger and comprised fewer females. Left-sided bilateral internal thoracic artery configurations were predominantly applied. Despite mean hemoglobin A1c of 8.0% ± 1% (range, 7%–13.5%) respective rates of deep sternal infection in bilateral internal thoracic artery and radial artery patients were 1.2% and 0%; superficial wound infection occurred in 3.1% and 3.6%, respectively. One sternoplasty was performed. Bilateral internal thoracic artery grafting did not correlate with sternal complications (odds ratio = 2.24, 95%CI: 0.56–8.95, p = 0.256). Of the radial artery conduits, 98% were adequate, and procurement-site complications occurred in 3.1%. Follow-up was 2–58 months (median, 25 months). Five-year survival was comparable in the 2 groups ( p = 0.360). Bilateral internal thoracic artery grafting did not reduce late major adverse cardiac events ( p = 0.729) or late mortality ( p = 0.384). Conclusions Skeletonized bilateral internal thoracic artery grafts can be used with acceptable risk in a substantial portion of insulin-treated diabetic patients, so it should not be automatically denied, but the choice of such grafts is not associated with midterm cardiac benefits.
Low dose tranexamic acid effect on post-coronary artery bypass grafting bleeding
Authors: Esfandiari Bakhtiari Rostam , Bistgani Mohammad Moazeni , Kabiri Majid 
Published: July 2013

Objective This study investigated the effects of low-dose tranexamic acid on post-coronary artery bypass surgery bleeding . Background Diffuse microvascular bleeding is still a common problem after cardiac procedures. This study was designed to evaluate the hemostatic effects of low-dose tranexamic acid in on-pump coronary artery bypass graft surgery. Methods In this prospective randomized placebo-controlled study, 150 patients who were candidates for coronary artery bypass were enrolled and randomly assigned to 1 of 2 groups (tranexamic acid or placebo). Total drainage volume and the need for transfusion as well as surgical complications were recorded and compared in the 2 groups. Results There was significantly less mediastinal chest tube drainage up to 48 h in the tranexamic acid group (432 ± 210 mL) compared to the placebo group (649 ± 235 mL, p = 0.006). In the placebo group, 43 (58%) patients were given allogeneic blood during hospital stay compared to 22 (25%) in the tranexamic acid group ( p < 0.001). No significant difference in postoperative complications was seen. Conclusion The use of low-dose tranexamic acid can significantly reduce blood loss and need for transfusion, with no increase in complications.
Symmetrical excessive pectus excavatum in children
Authors: Balci Akin Eraslan , Eren Sevval , Ozyurtkan Mehmet Oguzhan 
Published: July 2013

Objectives The indications for repair of pectus excavatum are controversial. We present our surgical results in children with severe pectus excavatum. Methods 27 children aged 6–15-years were included in the study. Pulmonary function tests and chest measurements were performed pre- and postoperatively. Deformed cartilages were resected subperichondrially, and a Kirchner wire was used to support the chest cage; it was removed 5 days after the operation. Fourteen children with restricted pulmonary function were considered to have excessive pectus excavatum. Results 3 patients had asthma-like symptoms that resolved postoperatively. None suffered chest pain postoperatively. Postoperative hospital stay was 7.1 days. Only minor complications occurred postoperatively. The mean pectus severity index was 0.27 ± 0.2 preoperatively and 0.41 ± 0.1 postoperatively ( p < 0.05). For children with restricted pulmonary function, it was 0.17 ± 0.3 preoperatively and 0.38 ± 0.2 postoperatively ( p < 0.05). Mean percentage of predicted forced expiratory volume in 1 s changed significantly from 79.2% ± 17.8% preoperatively to 83.6% ± 12.2% by the 3rd postoperative month. For children with a pectus severity index <0.2, it changed from 68.5% ± 13.2% preoperatively to 82.3% ± 13.4%. Pulmonary restriction correlated with a worse pectus severity index ( r = 0.8). After 6 and 13 months, a minor decrease in pulmonary function was noted. Significant increases in right and left ventricular function occurred in cases of severe deformity. Conclusions Surgery is recommended not only for cosmetic reasons but also to increase cardiorespiratory functional capacity and alleviate symptoms. Kirchner wires can be used safely.
Evidence on the cost and cost-effectiveness of palliative care: A literature review
Authors: Smith Samantha , Brick Aoife , O’Hara Sinéad , Normand Charles 
Published: July 2013

Background: In the context of limited resources, evidence on costs and cost-effectiveness of alternative methods of delivering health-care services is increasingly important to facilitate appropriate resource allocation. Palliative care services have been expanding worldwide with the aim of improving the experience of patients with terminal illness at the end of life through better symptom control, coordination of care and improved communication between professionals and the patient and family. Aim: To present results from a comprehensive literature review of available international evidence on the costs and cost-effectiveness of palliative care interventions in any setting (e.g. hospital-based, home-based and hospice care) over the period 2002–2011. Design: Key bibliographic and review databases were searched. Quality of retrieved papers was assessed against a set of 31 indicators developed for this review. Data Sources: PubMed, EURONHEED, the Applied Social Sciences Index and the Cochrane library of databases. Results: A total of 46 papers met the criteria for inclusion in the review, examining the cost and/or utilisation implications of a palliative care intervention with some form of comparator. The main focus of these studies was on direct costs with little focus on informal care or out-of-pocket costs. The overall quality of the studies is mixed, although a number of cohort studies do undertake multivariate regression analysis. Conclusion: Despite wide variation in study type, characteristic and study quality, there are consistent patterns in the results. Palliative care is most frequently found to be less costly relative to comparator groups, and in most cases, the difference in cost is statistically significant.
Palliative care for people with non-malignant lung disease: Summary of current evidence and future direction
Authors: Boland Jason , Martin Jonathan , Wells Athol U , Ross Joy R 
Published: July 2013

Background: The physical and psychosocial needs of patients with chronic non-malignant lung disease are comparable to those with lung cancer. This article will focus on chronic obstructive pulmonary disease, interstitial lung disease and cystic fibrosis as examples of life-limiting, non-curable and non-malignant lung diseases. The need for supportive and palliative care: Recent national guidance has demanded that palliative care is inclusive of all patients with life-limiting disease, irrespective of diagnosis, and that specialist palliative care teams are involved in the management of patients on a basis of need rather than prognosis. What is known: Despite medical therapy, most patients with moderate to severe chronic obstructive pulmonary disease, interstitial lung disease and cystic fibrosis experience pain, fatigue and dyspnoea, with the majority not getting relief from dyspnoea towards the end of life. Furthermore, dyspnoea causes social isolation and difficulty performing activities of daily living and impairs quality of life. There is an increasing evidence base for the assessment of supportive and palliative care needs, symptom interventions, prognostication, models of service delivery and implications of these for clinical practice and research in non-malignant lung diseases. What is unknown: Despite advances, much still remains unknown regarding assessment, management and prognostication in individual chronic non-malignant lung diseases. Although different service models are being used in clinical practice, the optimal model(s) of service delivery remain unknown. Implication for future research, policy and practice: We describe key areas for further research, which include the need for large, high-quality trials of pharmacological and non-pharmacological interventions and their combinations as well as evaluation of the efficacy and cost-effectiveness of models of care. As access to palliative care is poor for these patients, the barriers to referral need to be understood and reduced, which along with effective working between palliative care teams, with respiratory services backup, should optimise delivery of care in patients with life-limiting non-malignant lung disease.
False-positive prostate cancer markers in a man with symptomatic urethral Chlamydia trachomatis infection
Authors: Smelov V , Novikov A , Brown L J , Eklund C , Strokova L , Ouburg S , Morre S A , Dillner J 
Published: July 2013

Summary Symptomatic male urethral Chlamydia trachomatis infection resulted in inflammation of the prostate, with associated increases in both prostate-specific (PSA) and prostate cancer-specific (PCA3) markers with prostate biopsies showing no evidence of malignancy.
Primary cervical lymphoma: a rare presentation to a genitourinary medicine clinic
Authors: Bull L , Knowles A , Ogden S , Boag F , Naresh K N , Bower M 
Published: July 2013

Summary Primary non-Hodgkin's lymphoma of uterine cervix is a rare diagnosis. We present the case of a 47-year-old woman who presented to our genitourinary (GU) medicine service complaining of a malodorous discharge. Speculum examination revealed a necrotic mass on the cervix. She was referred urgently to gynaecology and subsequent histology revealed a diffuse large B-cell lymphoma. She received six cycles of RCHOP chemotherapy and is now in clinical remission. This case highlights the need for GU medicine physicians to remain vigilant with regard to possible gynaecological malignancies in all of our patients, the need for medical backup within GU medicine clinics and for clear pathways of referral to other specialists to exist.
Seroprevalence of hepatitis B in a cohort of HIV-infected children and adults in Swaziland
Authors: Dziuban E J , Marton S A , Hughey A B , Mbingo T L , Draper H R , Schutze G E 
Published: July 2013

Summary Hepatitis B virus (HBV) is an important co-morbidity in the HIV epidemic. A retrospective chart review was performed of HIV-infected patients with no previous antiretroviral history enrolled in a Swaziland clinic from January 2009 to May 2011. The seroprevalence of HBV surface antigen (HBsAg) was calculated and the data were analyzed using Mann-Whitney U and Fisher's exact tests. A total of 1282 patients were included in analysis. Five hundred were children aged <15 years. Overall HBsAg seroprevalence was 3.7% (1.4% of children and 5.1% of adults). Prevalence in under-5s was low (0.4%). Among adult women and men, prevalence was 4.2% and 9.8%, respectively ( P = 0.022). Median alanine aminotransferase level was 19 U/L in the HBsAg-negative adults and 25 U/L in the HBsAg-positive adults ( P = 0.005). Given the number of patients found to be HBsAg-positive, especially among adults, it is important for antiretroviral programmes to consider universal screening and strategically utilize medications that have been found effective in treating both HBV and HIV.
Involvement of mitochondrial pathway in benzo[a]pyrene-induced neuron apoptosis
Authors: Nie J-S , Zhang H-M , Zhao J , Liu H-J , Niu Q 
Published: July 2013

Benzo[a]pyrene (B[a]P), a well-known carcinogen, is widespread in the environment. Although the neurotoxic effect of B[a]P has not drawn much attention, toxic effects of B[a]P on learning and memory have been reported. Since it is well known that neuronal apoptosis plays a major role in impairment of learning and memory triggered by many stimuli, an effort has been made to examine whether the B[a]P-induced neurotoxicity occurs through mitochondria-mediated apoptosis. Cultured newborn rat cerebral neurons were used to clarify the apoptosis induced by B[a]P in the study. After incubating with different doses of B[a]P in presence of S9 for 40 h, the apoptotic rates of B[a]P-treated neurons increased in a dose-dependent manner. Further analysis showed that B[a]P-induced apoptosis was accompanied by loss of mitochondrial membrane potential, release of cytochrome c from mitochondria to the cytosol, downregulation of antiapoptotic protein B-cell lymphoma-2 (Bcl-2) levels with concurrent upregulation in proapoptotic Bcl-2-associated X protein (Bax) levels, and increase in the levels and activities of caspases-9 and -3. However, there was no difference in the activity of caspase-8 between B[a]P-exposed neurons and controls. Collectively, these results showed that B[a]P upregulates Bax and downregulates Bcl-2 expression in cultured cerebral neurons, which leads to mitochondrial release of cytochrome c, caspase-3 activation and neuronal apoptotic death.
Treatment of Postherpetic Pain With Scrambler Therapy, a Patient-Specific Neurocutaneous Electrical Stimulation Device
Authors: Smith Thomas J. , Marineo Giuseppe 
Published: July 2013

Objectives: Postherpetic neuropathy (PHN) is common, severe, and often refractory to treatment. We treated 10 patients with refractory PHN using Scrambler therapy, a neurocutaneous stimulation device that delivers “nonpain” information with surface electrodes. Methods: Scrambler therapy was given as 30-minute sessions daily for 10 days. Pain was recorded before and after treatment. Two centers. Result: The average pain score rapidly diminished from 7.64 ± 1.46 at baseline to 0.42 ± 0.89 at 1 month, a 95% reduction, with continued relief at 2 and 3 months. Patients achieved maximum pain relief with less than 5 treatments. Discussion: Scrambler therapy appears to have a promising effect on PHN, with prompt and continued relief and no side effects. Further research is warranted.
Antiretroviral Therapy at the End of Life
Authors: Ruiz Marco , Armstrong Megan , Reske Tom , Cefalu Charles , Anwar Dominique 
Published: July 2013

Introduction: There are no guidelines regarding the discontinuation of antiretroviral therapy at the end of life. Methods: We retrospectively reviewed our databases and identified patients with HIV/AIDS who died over the last 12 months in our HIV clinic. Results: A total of 41 patients from our HIV clinic died in a period of 12 months. Seventy-three percent of the patients were on antiretroviral therapy during the last clinic visit. During the last 3 months of life, 32% (13 of 41) were off antiretroviral therapy, with 77% (10 of 13) of them having intermittent therapy due to noncompliance. The remaining 23% (3 of 13) decided to stop antiretroviral therapy after discussion among families, patients, and providers. Conclusion: Discussions among providers, patients, and families are encouraged to establish goals of care and role of antiretrovirals during the last months of life.