bluuebunny/crossref_metadata_2025_split huggingface dataset:
Myocardial Lesion Size After Epicardial Electroporation Catheter Ablation After Subxiphoid Puncture
Authors: Neven Kars , van Driel Vincent , van Wessel Harry , van Es René , Doevendans Pieter A. , Wittkampf Fred 
Published: July 2014

Background—
Irreversible electroporation is a promising nonthermal ablation modality able to create deep myocardial lesions. We investigated lesion size after epicardial electroporation catheter ablation with various energy levels after subxiphoid pericardial puncture.

Methods and Results—
In six 6-month-old pigs (60–75 kg), a custom deflectable octopolar 12-mm circular catheter with 2-mm ring electrodes was introduced via a deflectable sheath after pericardial access by subxiphoid puncture. Nonarcing, nonbarotraumatic, cathodal 50, 100, and 200 J electroporation applications were delivered randomly on the basal, mid and lateral left ventricle. After 3-month survival, myocardial lesion size and degree of intimal hyperplasia of the coronary arteries were analyzed histologically. Five animals survived the follow-up without complications and 1 animal died of shock after the subxiphoid puncture. At autopsy, whitish circular scars with indentation of the epicardium could be identified. Average lesion depths of the 50-, 100-, and 200-J lesions were 5.0±2.1, 7.0±2.0, and 11.9±1.5 mm, respectively. Average lesion widths of the 50-, 100-, and 200-J lesions were 16.6±1.1, 16.2±4.3, and 19.8±1.8 mm, respectively. In the 100- and 200-J cross sections, transmural left ventricular lesions and significant tissue shrinkage were observed. No intimal hyperplasia of the coronary arteries was observed.

Conclusions—
Epicardial electroporation ablation after subxiphoid pericardial puncture can create deep, wide, and transmural ventricular myocardial lesions. There is a significant relationship between the amounts of electroporation energy delivered epicardially and lesion size in the absence of major adverse events.
Renal Function–Adjusted Contrast Volume Redefines the Baseline Estimation of Contrast-Induced Acute Kidney Injury Risk in Patients Undergoing Primary Percutaneous Coronary Intervention
Authors: Andò Giuseppe , de Gregorio Cesare , Morabito Gaetano , Trio Olimpia , Saporito Francesco , Oreto Giuseppe 
Published: July 2014

Background—
Age, estimated glomerular renal function (eGFR), and ejection fraction are preprocedural predictors of contrast-induced acute kidney injury (CI-AKI) after primary percutaneous coronary intervention. The effect of renal function–adjusted contrast volume (CV) remains not totally explored, and a threshold has not yet been established.

Methods and Results—

Logistic regression and receiver-operating characteristic curve analyses were used to assess whether CV/eGFR was an independent predictor of CI-AKI. The increased discriminative value of CV/eGFR over the preprocedural model based on age, eGFR, and ejection fraction was examined using the net reclassification improvement analysis. Of 470 patients enrolled, we observed 25 (5.3%) cases of CI-AKI. Patients with CI-AKI had received a higher renal function–adjusted CV (CV/eGFR 3.62 versus 1.96;
P
<0.001), and CI-AKI incidence was higher (15%;
P
<0.001) in patients in the highest quartile of CV/eGFR, corresponding to the cutoff indicated by the receiver-operating characteristic curve (>2.5; area under the curve, 0.77). At multivariable analysis, CV/eGFR above the cutoff (odds ratio, 5.57;
P
=0.002) remained an independent predictor of CI-AKI. The model with CV/eGFR demonstrated a statistically significantly net reclassification improvement of 0.23 (
P
=0.021) over the baseline preprocedural model, largely driven by a correct decrease in risk estimates for patients not experiencing CI-AKI, with a likelihood ratio χ
2
of 5.973 (
P
=0.029).

Conclusions—
CV remains a key risk factor for CI-AKI after primary percutaneous coronary intervention and our study supports the need for minimizing CV, independently from baseline preprocedural risk. A CV restricted to no more than twice and a half the baseline eGFR might be valuable in reducing the risk of CI-AKI.
Cost-Effectiveness of Follow-Up of Pulmonary Nodules Incidentally Detected on Cardiac Computed Tomographic Angiography in Patients With Suspected Coronary Artery Disease
Authors: Goehler Alexander , McMahon Pamela M. , Lumish Heidi S. , Wu Carol C. , Munshi Vidit , Gilmore Michael , Chung Jonathan H. , Ghoshhajra Brian B. , Mark Daniel , Truong Quynh A. , Gazelle G. Scott , Hoffmann Udo 
Published: July 2014

Background—
Pulmonary nodules (PNs) are often detected incidentally during coronary computed tomographic (CT) angiography, which is increasingly being used to evaluate patients with chest pain symptoms. However, the efficiency of following up on incidentally detected PN is unknown.

Methods and Results—
We determined demographic and clinical characteristics of stable symptomatic patients referred for coronary CT angiography in whom incidentally detected PNs warranted follow-up. A validated lung cancer simulation model was populated with data from these patients, and clinical and economic consequences of follow-up per Fleischner guidelines versus no follow-up were simulated. Of the 3665 patients referred for coronary CT angiography, 591 (16%) had PNs requiring follow-up. The mean age of patients with PNs was 59±10 years; 66% were male; 67% had ever smoked; and 21% had obstructive coronary artery disease. The projected overall lung cancer incidence was 5.8% in these patients, but the majority died of coronary artery disease (38%) and other causes (57%). Follow-up of PNs was associated with a 4.6% relative reduction in cumulative lung cancer mortality (absolute mortality: follow-up, 4.33% versus non–follow-up, 4.54%), more downstream testing (follow-up, 2.34 CTs per patient versus non–follow-up, 1.01 CTs per patient), and an average increase in quality-adjusted life of 7 days. Costs per quality-adjusted life-year gained were $154 700 to follow up the entire cohort and $129 800 per quality-adjusted life-year when only smokers were included.

Conclusions—
Follow-up of PNs incidentally detected in patients undergoing coronary CT angiography for chest pain evaluation is associated with a small reduction in lung cancer mortality. However, significant downstream testing contributes to limited efficiency, as demonstrated by a high cost per quality-adjusted life-year, especially in nonsmokers.
Prognostic Value of Fasting Versus Nonfasting Low-Density Lipoprotein Cholesterol Levels on Long-Term Mortality
Authors: Doran Bethany , Guo Yu , Xu Jinfeng , Weintraub Howard , Mora Samia , Maron David J. , Bangalore Sripal 
Published: July 2014

Background—
National and international guidelines recommend fasting lipid panel measurement for risk stratification of patients for prevention of cardiovascular events. However, the prognostic value of fasting versus nonfasting low-density lipoprotein cholesterol (LDL-C) is uncertain.

Methods and Results—

Patients enrolled in the National Health and Nutrition Examination Survey III (NHANES-III), a nationally representative cross-sectional survey performed from 1988 to 1994, were stratified on the basis of fasting status (≥8 or <8 hours) and followed for a mean of 14.0 (±0.22) years. Propensity score matching was used to assemble fasting and nonfasting cohorts with similar baseline characteristics. The risk of outcomes as a function of LDL-C and fasting status was assessed with the use of receiver operating characteristic curves and bootstrapping methods. The interaction between fasting status and LDL-C was assessed with Cox proportional hazards modeling. Primary outcome was all-cause mortality. Secondary outcome was cardiovascular mortality. One-to-one matching based on propensity score yielded 4299 pairs of fasting and nonfasting individuals. For the primary outcome, fasting LDL-C yielded prognostic value similar to that for nonfasting LDL-C (C statistic=0.59 [95% confidence interval, 0.57–0.61] versus 0.58 [95% confidence interval, 0.56–0.60];
P
=0.73), and LDL-C by fasting status interaction term in the Cox proportional hazards model was not significant (
P
interaction
=0.11). Similar results were seen for the secondary outcome (fasting versus nonfasting C statistic=0.62 [95% confidence interval, 0.60–0.66] versus 0.62 [95% confidence interval, 0.60–0.66];
P
=0.96;
P
interaction
=0.34).

Conclusions—
Nonfasting LDL-C has prognostic value similar to that of fasting LDL-C. National and international agencies should consider reevaluating the recommendation that patients fast before obtaining a lipid panel.
In‐Hospital Worsening Heart Failure and Associations With Mortality, Readmission, and Healthcare Utilization
Authors: DeVore Adam D. , Hammill Bradley G. , Sharma Puza P. , Qualls Laura G. , Mentz Robert J. , Waltman Johnson Katherine , Fonarow Gregg C. , Curtis Lesley H. , Hernandez Adrian F. 
Published: July 2014

Background
A subset of patients hospitalized with acute heart failure experiences worsening clinical status and requires escalation of therapy. Worsening heart failure is an end point in many clinical trials, but little is known about its prevalence in clinical practice and its associated outcomes.

Methods and Results

We analyzed inpatient data from the Acute Decompensated Heart Failure National Registry linked to Medicare claims to examine the prevalence and outcomes of patients with worsening heart failure, defined as the need for escalation of therapy at least 12 hours after hospital presentation. We compared patients with worsening heart failure to patients with an uncomplicated hospital course and patients with a complicated presentation. Of 63 727 patients hospitalized with acute heart failure, 11% developed worsening heart failure. These patients had the highest observed rates of mortality, all‐cause readmission, and Medicare payments at 30 days and 1 year after hospitalization (
P
< 0.001 for all comparisons). The adjusted hazards of 30‐day mortality were 2.56 (99%
CI
, 2.34 to 2.80) compared with an uncomplicated course and 1.29 (99%
CI
, 1.17 to 1.42) compared with a complicated presentation. The adjusted cost ratios for postdischarge Medicare payments at 30 days were 1.35 (99%
CI
, 1.24 to 1.46) compared with an uncomplicated course and 1.11 (99%
CI
, 1.02 to 1.22) compared with a complicated presentation.

Conclusions
In‐hospital worsening heart failure was common and was associated with higher rates of mortality, all‐cause readmission, and postdischarge Medicare payments. Prevention and treatment of in‐hospital worsening heart failure represents an important goal for patients hospitalized with acute heart failure.
Von Willebrand Factor Drives the Association Between Elevated Factor VIII and Poor Outcomes in Patients With Ischemic Stroke
Authors: Samai Alyana , Monlezun Dominique , Shaban Amir , George Alexander , Dowell Lauren , Kruse-Jarres Rebecca , Schluter Laurie , El Khoury Ramy , Martin-Schild Sheryl 
Published: July 2014

Background and Purpose—
Despite clear roles of factor VIII (FVIII) and von Willebrand factor (vWF) in thrombosis, few studies have examined the relationship of these factors with acute ischemic stroke (AIS). We sought to determine whether concurrent elevation in FVIII and vWF was associated with adverse events and outcomes.

Methods—
From our prospective stroke registry, patients consecutively admitted with AIS between July 2008 and October 2013 were included if both FVIII and vWF were measured during admission. The primary outcome was the modified Rankin Scale score on discharge.

Results—

Among 1453 cases in our stroke registry, 148 patients with AIS met inclusion criteria; 62 patients (41.9%) had FVIII−/vWF−, 16 patients (10.8%) had FVIII+/vWF−, and 51 patients (34.5%) had FVIII+/vWF+. In the fully adjusted model, patients with FVIII+/vWF+ had increased odds of inpatient complications (odds ratio, 8.6; 95% confidence interval, 1.58–46.85;
P
=0.013) and neuroworsening (odds ratio, 3.2; 95% confidence interval, 1.18–8.73;
P
=0.022) than patients with FVIII−/vWF−. Adjusted for age, baseline stroke severity, and glucose, patients with FVIII+/vWF+ had increased odds of poor functional outcome (modified Rankin Scale>2; odds ratio, 2.87; 95% confidence interval, 1.16–7.06;
P
=0.021) than patients with FVIII−/vWF−.

Conclusions—
Concurrent FVIII/vWF elevation predicts higher odds of inpatient complications, neuroworsening, and worse functional outcomes for patients with AIS compared with patients with normal levels. Our findings suggest that FVIII and vWF levels may serve as clinically useful stroke biomarkers by providing risk profiles for patients with AIS.
The Construction of the Post-War Consensus of the Soviet Governing Elite
Authors: Stotland Daniel 
Published: July 2014

wwii led to the creation of a more technocrat-oriented Soviet elite, whose managing ethos is still visible in the Russian leadership paradigm. The war filled the party with a vast number of the new Communists whose political and general, education level, remained low, forcing the party focus toward pragmatic rather than ideological aims and forcing the center to devolve a considerable degree of autonomy to the provincial party leaders.
This situation led to the rise of G. M. Malenkov and the pragmatist faction, tasked to reaffirm the political authority of the party as the central feature of the Soviet system. Malenkov’s approach consisted of embracing rather than limiting the role of the party as the governing, managing institution, encouraging the ties between the governmental and the party apparatus. The Kremlin would acquiesce in the party direct management of the economic matters, in effect legitimizing the wartime compromises.
Yet the change in course required a fundamental shift in party identity. By making economic growth the central priority, the party reoriented away from the role of the guardian of the ideological purity and toward a more conventional governmental structure, in many ways laying the foundation of party-state’s destruction.
High-Order Finite-Volume Transport on the Cubed Sphere: Comparison between 1D and 2D Reconstruction Schemes
Authors: Katta Kiran K. , Nair Ramachandran D. , Kumar Vinod 
Published: July 2014

Abstract
This paper presents two finite-volume (FV) schemes for solving linear transport problems on the cubed-sphere grid system. The schemes are based on the central-upwind finite-volume (CUFV) method, which is a class of Godunov-type method for solving hyperbolic conservation laws, and combines the attractive features of the classical upwind and central FV methods. One of the CUFV schemes is based on a dimension-by-dimension approach and employs a fifth-order one-dimensional (1D) Weighted Essentially Nonoscillatory (WENO5) reconstruction method. The other scheme employs a fully two-dimensional (2D) fourth-order accurate reconstruction method. The cubed-sphere grid system imposes several computational challenges due to its patched-domain topology and nonorthogonal curvilinear grid structure. A high-order 1D interpolation procedure combining cubic and quadratic interpolations is developed for the FV schemes to handle the discontinuous edges of the cubed-sphere grid. The WENO5 scheme is compared against the fourth-order Kurganov–Levy (KL) scheme formulated in the CUFV framework. The performance of the schemes is compared using several benchmark problems such as the solid-body rotation and deformational-flow tests, and empirical convergence rates are reported. In addition, a bound-preserving filter combined with an optional positivity-preserving filter is tested for nonsmooth problems. The filtering techniques considered are local, inexpensive, and effective. A fourth-order strong stability preserving explicit Runge–Kutta time-stepping scheme is used for integration. The results show that schemes are competitive to other published FV schemes in the same category.
A Compensatory Approach of the Fixed Localization in EnKF
Authors: Wu Xinrong , Li Wei , Han Guijun , Zhang Shaoqing , Wang Xidong 
Published: July 2014

Abstract
While fixed covariance localization can greatly increase the reliability of the background error covariance in filtering by suppressing the long-distance spurious correlations evaluated by a finite ensemble, it may degrade the assimilation quality in an ensemble Kalman filter (EnKF) as a result of restricted longwave information. Tuning an optimal cutoff distance is usually very expensive and time consuming, especially for a general circulation model (GCM). Here the authors present an approach to compensate the demerit in fixed localization. At each analysis step, after the standard EnKF is done, a multiple-scale analysis technique is used to extract longwave information from the observational residual (referred to the EnKF ensemble mean). Within a biased twin-experiment framework consisting of a global barotropical spectral model and an idealized observing system, the performance of the new method is examined. Compared to a standard EnKF, the hybrid method is superior when an overly small/large cutoff distance is used, and it has less dependence on cutoff distance. The new scheme is also able to improve short-term weather forecasts, especially when an overly large cutoff distance is used. Sensitivity studies show that caution should be taken when the new scheme is applied to a dense observing system with an overly small cutoff distance in filtering. In addition, the new scheme has a nearly equivalent computational cost to the standard EnKF; thus, it is particularly suitable for GCM applications.
Headache During a Cluster of Benign Paroxysmal Positional Vertigo Attacks
Authors: Pollak Lea , Pollak Eitan 
Published: July 2014

Objective: In view of patients’ recurrent complaints, we were interested in investigating the frequency and headache characteristics in patients during a benign paroxysmal positional vertigo (BPPV) cluster. Methods: Patients with BPPV treated at an outpatient dizziness clinic were interviewed about the presence of headache; its quality, localization, severity, time course, and aggravating and alleviating factors; and headache-related disability during their present vertigo cluster. Results: Among 152 patients with BPPV, 53 (34.8%) reported headache associated with vertigo. According to The International Classification of Headache Disorders, 8 (15%) patients could be classified as migraine without aura (1.1), 14 (26%) were classified as infrequent episodic tension-type headache associated with pericranial tenderness (2.1.1), 23 (43%) were classified as infrequent episodic tension-type headache without pericranial tenderness (2.1.2), 6 (11%) had cervicogenic headache (11.2.1), and in 2 (4%) patients, the headache could not be specified (14.2). Fifty-two age-matched BPPV patients without headache did not differ in history of headaches, BPPV history, or background diseases. The distribution of canal involvement and number of treatment maneuvers was also similar in both groups. Conclusion: Headache is frequent in BPPV. The most common is tension-type headache, followed by migraine and cervicogenic headache. Head pain seems to be an independently associated epiphenomenon of BPPV that can worsen patients’ distress.
Facial Cutaneous Necrosis Associated With Suspected Levamisole Toxicity From Tainted Cocaine Abuse
Authors: Formeister Eric J. , Falcone Michael T. , Mair Eric A. 
Published: July 2014

Objective: This study aimed to illustrate the otorhinolaryngologic manifestations of levamisole toxicity and illuminate the features of this diagnosis. Methods: We describe a case of a known cocaine abuser with suspected levamisole toxicity who developed cutaneous necrosis of the cheeks, earlobes, nose, upper and lower lip, and the midline hard palate. We also review the existing clinical literature about this emerging phenomenon. Results: Levamisole is a common adulterant in cocaine distributed in the United States and has been reported to cause microvascular thrombosis and vasculitis with resultant skin necrosis in cocaine abusers. The distribution of skin findings characteristically involves the cheeks, earlobes, nose, lips, and hard palate and responds variably to cessation of cocaine use. In its most severe cases, immune suppression and/or surgical debridement may be required. Conclusion: Levamisole toxicity can frequently involve the ears, nose, and throat tissues. Otorhinolaryngologists should recognize these manifestations to expeditiously diagnose and manage this condition. Failure to do so promptly can lead to complications that may necessitate reconstructive or amputation surgery.
Predictors of Adverse Events After Parotidectomy
Authors: Kim Bobby D. , Lim Seokchun , Wood Josh , Samant Sandeep , Ver Halen Jon P. , Kim John Y. S. 
Published: July 2014

Objective: There is a current paucity of large-scale, multi-institutional studies that explore the risk factors for major complications following parotidectomy. Methods: The American College of Surgeons National Surgical Quality Improvement Program participant use file was reviewed to identify all patients who had undergone parotidectomy between 2006 and 2011. Risk factors that predicted adverse events were estimated by using multivariate logistic regression. Results: Of 2919 included patients, 202 patients experienced adverse outcomes within the first 30 days of surgery. These included surgical complications in 76 (2.6%) patients; medical complications in 90 (3.1%) patients; death in 7 (0.2%) patients; and reoperation in 77 (2.6%) patients. Predictors of any complication included disseminated cancer (odds ratio [OR] = 2.28; 95% confidence interval [CI], 1.05-4.95; P = .036) and increasing total relative value units (OR = 1.01; 95% CI, 1.00-1.02; P = .027). Active smoking was a major risk factor for surgical complications (OR = 1.81; 95% CI, 1.08-3.05; P = .025). Dyspnea (OR = 2.93; 95% CI, 1.37-6.27; P = .006) significantly predicted medical complications. Conclusion: Although complication rates after parotidectomy are generally low, avoidance of specific and nonspecific postoperative complications still remains an area for improvement. Future outcomes databases should include procedure-specific complications, including facial nerve injury.
Mechanical Regulation of Human Vocal Fold Stellate Cells
Authors: Sato Kiminori , Kurita Takashi , Chitose Shun-ichi , Umeno Hirohito , Nakashima Tadashi 
Published: July 2014

Objective: It is generally accepted that tensile and compressive strains have direct effects on cell morphology and structure, including changes in cytoskeletal structure and organization. Cytoskeletons play the role of mechanoreceptor of the cells. Vocal fold stellate cells (VFSCs) in the human maculae flavae (MFe) are inferred to be involved in the metabolism of extracellular matrices essential for the viscoelasticity of the vocal fold mucosa. Our previous studies have supported the hypothesis that the tension caused by phonation (vocal fold vibration) regulates the behavior of the VFSCs. The microstructure of the intermediate filaments and the expression of their proteins were investigated in VFSCs in the MFe, which had remained unphonated since birth. Methods: Three adult vocal fold mucosae that had remained unphonated since birth were investigated by immunohistochemistry and electron microscopy. Results: The intermediate filaments of the VFSCs were fewer in number. The expression of their characteristic proteins (vimentin, desmin, and glial fibrillary acidic protein) was also reduced. Conclusion: Vocal fold vibration seems to affect VFSC morphology and structure, such as cytoskeletal structure and organization. This supports the hypothesis that vocal fold vibration regulates VFSC behavior in the human MFe. In addition to chemical factors, mechanical factors also appear to modulate VFSC behavior.