bluuebunny/crossref_metadata_2025_split huggingface dataset:
Step‐Monitored Home Exercise Improves Ambulation, Vascular Function, and Inflammation in Symptomatic Patients With Peripheral Artery Disease: A Randomized Controlled Trial
Authors: Gardner Andrew W. , Parker Donald E. , Montgomery Polly S. , Blevins Steve M. 
Published: September 2014

Background

This prospective, randomized, controlled clinical trial compared changes in primary outcome measures of claudication onset time (
COT
) and peak walking time (
PWT
), and secondary outcomes of submaximal exercise performance, daily ambulatory activity, vascular function, inflammation, and calf muscle hemoglobin oxygen saturation (StO
2
) in patients with symptomatic peripheral artery disease (
PAD
) following new exercise training using a step watch (
NEXT
Step) home‐exercise program, a supervised exercise program, and an attention‐control group.

Methods and Results

One hundred eighty patients were randomized. The
NEXT
Step program and the supervised exercise program consisted of intermittent walking to mild‐to‐moderate claudication pain for 12 weeks, whereas the controls performed light resistance training. Change scores for
COT
(
P
<0.001),
PWT
(
P
<0.001), 6‐minute walk distance (
P
=0.028), daily average cadence (
P
=0.011), time to minimum calf muscle StO
2
during exercise (
P
=0.025), large‐artery elasticity index (
LAEI
) (
P
=0.012), and high‐sensitivity C‐reactive protein (hs
CRP
) (
P
=0.041) were significantly different among the 3 groups. Both the
NEXT
Step home program and the supervised exercise program demonstrated a significant increase from baseline in
COT
,
PWT
, 6‐minute walk distance, daily average cadence, and time to minimum calf StO
2
. Only the
NEXT
Step home group had improvements from baseline in
LAEI
, and hs
CRP
(
P
<0.05).

Conclusions

NEXT
Step home exercise utilizing minimal staff supervision has low attrition, high adherence, and is efficacious in improving
COT
and
PWT
, as well as secondary outcomes of submaximal exercise performance, daily ambulatory activity, vascular function, inflammation, and calf muscle StO
2
in symptomatic patients with
PAD
.

Clinical Trial Registration
URL: ClinicalTrials.gov. Unique Identifier: NCT00618670.
Prevalence of Brain Arteriovenous Malformations in First-Degree Relatives of Patients With a Brain Arteriovenous Malformation
Authors: van Beijnum Janneke , van der Worp H. Bart , Algra Ale , Vandertop W. Peter , van den Berg René , Brouwer Patrick A. , van der Sprenkel Jan Willem Berkelbach , Kappelle L. Jaap , Rinkel Gabriël J.E. , Klijn Catharina J.M. 
Published: September 2014

Background and Purpose—
It is uncertain whether familial occurrence of brain arteriovenous malformations (BAVMs) represents coincidental aggregation or a shared familial risk factor. We aimed to compare the prevalence of BAVMs in first-degree relatives (FDRs) of patients with BAVM and the prevalence in the general population.

Methods—
We sent a postal questionnaire to 682 patients diagnosed with a BAVM in 1 of 4 university hospitals to retrieve information about the occurrence of BAVMs among their FDRs. We calculated a prevalence ratio using the BAVM prevalence among FDRs and the prevalence from a Scottish population-based study (93 per 628 788 adults). A prevalence ratio of ≥9 with a lower limit of the 95% confidence interval of 3 was considered indicative of a shared familial risk factor.

Results—
Informed consent was given by 460 (67%) patients, who had 2992 FDRs. We identified 3 patients with a FDR with a BAVM, yielding a prevalence ratio of 6.8 (95% CI, 2.2–21).

Conclusions—
The prevalence of BAVMs in FDRs of patients with a BAVM was increased but did not meet our prespecified criterion for a shared familial risk factor. In combination with the low absolute risk of a BAVM in FDRs, our results do not support screening of FDRs for BAVMs.
Incidence, Trends, and Predictors of Ischemic Stroke 1 Year After an Acute Myocardial Infarction
Authors: Ulvenstam Anders , Kajermo Ulf , Modica Angelo , Jernberg Tomas , Söderström Lars , Mooe Thomas 
Published: September 2014

Background and Purpose—
Ischemic stroke after acute myocardial infarction is an important complication. It is unknown whether the risk has changed because the treatment of acute myocardial infarction has improved during the past decade. There is also conflicting data about predictors of stroke risk.

Methods—
To obtain the 1-year incidence of stroke after acute myocardial infarction, the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions database for the years 1998 to 2008 was merged with the Swedish National Patient Register (NPR). The time trend was studied by dividing the entire time period into 5 separate periods. Independent predictors were identified using a multivariable Cox proportional hazards regression model.

Results—

Between 1998 and 2008, 7185 of 173 233 patients with acute myocardial infarction had an ischemic stroke within 1 year (4.1%). There was a 20% relative risk reduction during the study period (1998–2000 versus 2007–2008) relative risk 0.80 (95% confidence interval, 0.75–0.86;
P
<0.001. Independent predictors of stroke were age, female sex, ST-segment–elevation myocardial infarction, previous stroke, previous diabetes mellitus, heart failure at admission, angiotensin-converting enzyme inhibitor treatment and atrial fibrillation. Reperfusion treatment with fibrinolysis and percutaneous coronary intervention and treatment with aspirin, P2Y12-inhibitors, and statins predicted a reduced risk of stroke.

Conclusions—
The risk of ischemic stroke within a year after myocardial infarction is substantial but has clearly been reduced during the studied time period. The major predictive factors found to correlate well with previous investigations. Reperfusion treatment, thrombocyte aggregation inhibition, and lipid lowering are the main contributors to the observed risk reduction.
Transient Receptor Potential Melastatin Subfamily Member 2 Cation Channel Regulates Detrimental Immune Cell Invasion in Ischemic Stroke
Authors: Gelderblom Mathias , Melzer Nico , Schattling Benjamin , Göb Eva , Hicking Gordon , Arunachalam Priyadharshini , Bittner Stefan , Ufer Friederike , Herrmann Alexander M. , Bernreuther Christian , Glatzel Markus , Gerloff Christian , Kleinschnitz Christoph , Meuth Sven G. , Friese Manuel A. , Magnus Tim 
Published: September 2014

Background and Purpose—

Brain injury during stroke results in oxidative stress and the release of factors that include extracellular Ca
2+
, hydrogen peroxide, adenosine diphosphate ribose, and nicotinic acid adenine dinucleotide phosphate. These alterations of the extracellular milieu change the activity of transient receptor potential melastatin subfamily member 2 (TRPM2), a nonselective cation channel expressed in the central nervous system and the immune system. Our goal was to evaluate the contribution of TRPM2 to the tissue damage after stroke.

Methods—
In accordance with current quality guidelines, we independently characterized Trpm2 in a murine ischemic stroke model in 2 different laboratories.

Results—

Gene deficiency of
Trpm2
resulted in significantly improved neurological outcome and decreased infarct size. Besides an already known moderate neuroprotective effect of
Trpm2
deficiency in vitro, ischemic brain invasion by neutrophils and macrophages was particularly reduced in
Trpm2
-deficient mice. Bone marrow chimeric mice revealed that
Trpm2
deficiency in the peripheral immune system is responsible for the protective phenotype. Furthermore, experiments with mixed bone marrow chimeras demonstrated that Trpm2 is essential for the migration of neutrophils and, to a lesser extent, also of macrophages into ischemic hemispheres. Notably, the pharmacological TRPM2 inhibitor, N-(p-amylcinnamoyl)anthranilic acid, was equally protective in the stroke model.

Conclusions—
Although a neuroprotective effect of TRPM2 in vitro is well known, we can show for the first time that the detrimental role of TRPM2 in stroke primarily depends on its role in activating peripheral immune cells. Targeting TRPM2 systemically represents a promising therapeutic approach for ischemic stroke.
Nontraditional Serum Lipid Variables and Recurrent Stroke Risk
Authors: Park Jong-Ho , Lee Juneyoung , Ovbiagele Bruce 
Published: September 2014

Background and Purpose—
Expert consensus guidelines recommend low-density lipoprotein cholesterol as the primary serum lipid target for recurrent stroke risk reduction. However, mounting evidence suggests that other lipid parameters might be additional therapeutic targets or at least also predict cardiovascular risk. Little is known about the effects of nontraditional lipid variables on recurrent stroke risk.

Methods—
We analyzed the Vitamin Intervention for Stroke Prevention study database comprising 3680 recent (<120 days) noncardioembolic stroke patients followed up for 2 years. Independent associations of baseline serum lipid variables with recurrent ischemic stroke (primary outcome) and the composite end point of ischemic stroke/coronary heart disease/vascular death (secondary outcomes) were assessed.

Results—
Of all variables evaluated, only triglycerides/high-density lipoprotein cholesterol (HDL-C) ratio was consistently and independently related to both outcomes: compared with the lowest quintile, the highest triglycerides/HDL-C ratio quintile was associated with stroke (adjusted hazard ratio, 1.56; 95% confidence interval, 1.05−2.32) and stroke/coronary heart disease/vascular death (1.39; 1.05−1.83), including adjustment for lipid modifier use. Compared with the lowest quintile, the highest total cholesterol/HDL-C ratio quintile was associated with stroke/coronary heart disease/vascular death (1.45; 1.03−2.03). Low-density lipoprotein cholesterol/HDL-C ratio, non-HDL-C, elevated triglycerides alone, and low HDL-C alone were not independently linked to either outcome.

Conclusions—
Of various nontraditional lipid variables, elevated baseline triglycerides/HDL-C and total cholesterol/HDL-C ratios predict future vascular risk after a stroke, but only elevated triglycerides/HDL-C ratio is related to risk of recurrent stroke. Future studies should assess the role of triglycerides/HDL-C as a potential therapeutic target for global vascular risk reduction after stroke.
Platelet-rich plasma encapsulation in hyaluronic acid/gelatin-BCP hydrogel for growth factor delivery in BCP sponge scaffold for bone regeneration
Authors: Son So-Ra , Sarkar Swapan Kumar , Linh Nguyen-Thuy Ba , Padalhin Andrew R , Kim Bo Ram , Jung Hae Il , Lee Byong-Taek 
Published: September 2014

Microporous calcium phosphate based synthetic bone substitutes are used for bone defect healing. Different growth factor loading has been investigated for enhanced bone regeneration. The platelet is a cellular component of blood which naturally contains a pool of necessary growth factors that mediate initiation, continuation, and completion of cellular mechanism of healing. In this work, we have investigated the encapsulation and immobilization of platelet-rich plasma (PRP) with natural polymers like hyaluronic acid (HA) and gelatin (Gel) and loading them in a biphasic calcium phosphate (BCP) scaffold, for a synthetic-allologous hybrid scaffold. Effect of PRP addition in small doses was evaluated for osteogenic potential in vitro and in vivo. BCP (10%) mixed HA–Gel hydrogel with or without PRP, was loaded into a BCP sponge scaffold. We investigated the hydrogel-induced improvement in mechanical property and PRP-mediated enhancement in biocompatibility. In vitro studies for cytotoxicity, cell attachment, and proliferation were carried out using MC3T3-E1 pre-osteoblast cells. In in vitro studies, the cell count, cell proliferation, and cell survival were higher in the scaffold with PRP loading than without PRP. However, in the in vivo studies using a rat model, the PRP scaffold was not superior to the scaffold without PRP. This discrepancy was investigated in terms of the interaction of PRP in the in vivo environment.
The Sensitivity of Standard Radiographic Foot Measures to Misalignment
Authors: Willauer Patrick , Sangeorzan Bruce J. , Whittaker Eric C. , Shofer Jane B. , Ledoux William R. 
Published: September 2014

Background: The purpose of this study was to identify the effects that X-ray source misalignment has on common measurements made from anterior-poster (AP) and medial-lateral (ML) view foot radiographs. Methods: A cadaveric foot model was used to obtain ML radiographs with ±25 degree transverse plane misalignment. From these images the calcaneal pitch angle (CPA) and lateral talometatarsal angle (LTMA) were measured. AP images were captured with up to 30 degree sagittal plane misalignment as well as ±15 degree misalignment in the transverse plane at each sagittal angle. From these images the talonavicular coverage angle (TNCA) and talometatarsal angle (TMA) were measured. Results: On the ML images, the CPA was sensitive to transverse plane misalignment from −10 to −25 degrees and from 15 to 25 degrees ( P < .005). The LTMA was a more reliable measurement than the CPA and did not demonstrate sensitivity to transverse plane misalignment. On the AP images, the TNCA and TMA were not sensitive to sagittal plane misalignment alone. However, at 0, 10, and 15 degrees sagittal misalignment the TNCA showed sensitivity to transverse plane misalignment ( P < .0083). Conclusion: Misalignment of an X-ray source can lead to errors in the measurement of foot radiographic parameters, especially the CPA when there is transverse plane misalignment and the TNCA when there is both sagittal and transverse plane misalignment. The LTMA and TMA can be measured reliably, even with significant misalignment present. Clinical Relevance: If a researcher or clinician is interested in measuring the CPA or TNCA, the current best practices guidelines for obtaining ML and AP images should be closely followed.
Prevalence of Metatarsus Adductus in Patients Undergoing Hallux Valgus Surgery
Authors: Aiyer Amiethab A. , Shariff Raheel , Ying Li , Shub Jeffrey , Myerson Mark S. 
Published: September 2014

Background: Metatarsus adductus (MA) is a congenital condition in which there is adduction of the metatarsals in conjunction with supination of the hindfoot through the subtalar joint. It is generally believed that MA precedes the development of hallux valgus. Historically, studies have demonstrated that patients with a history of MA were ~3.5 times more likely to develop hallux valgus. The purpose of this study was to identify the relative prevalence of MA in patients undergoing surgery for symptomatic hallux valgus. Methods: Between 2002 and 2012, 587 patients who underwent hallux valgus surgery were retrospectively identified following IRB approval and parameters including the hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the metatarsus adductus angle (MAA) were recorded. The MAA was considered abnormal if the value was greater than 20 degrees. Interobserver and intraobserver reliability studies for the measurement of the MAA were completed as well. Results: Using the modified Sgarlato technique for measurement of the MAA, there was a high interobserver and intraobserver reliability. The interclass and intraclass coefficients were greater than .90. The prevalence of MA in this patient population was found to be 29.5%. Of those patients with MA, 23 males and 150 females were identified. This gave a male to female ratio of 1:6.5 ( P < .00001). Lesser toe deformities (claw toes, hammertoes) were the most commonly associated diagnoses identified. When stratified by severity, 113 (65%) patients had an MAA between 21 and 25 degrees, 41 (23.7%) had an MAA between 26 and 30 degrees, 8 (4.6%) patients had an MAA between 31 and 35 degrees, and 11 (6.3%) patients had an MAA greater than 36 degrees. Conclusion: Historically the prevalence of MA in patients with hallux valgus has been reported to be 35%. The data in this study indicate a comparable prevalence at 29.4%. The presence of concomitant MA may portend different outcomes for operative treatment of hallux valgus. Further research needs to delineate rates of persistence of deformity in this patient population to guide operative management. Level of Evidence: Level IV, case series.
A Prospective Outcome and Cost-effectiveness Comparison Between Two Ligament Reattachment Techniques Using Suture Anchors for Chronic Ankle Instability
Authors: Cho Byung-Ki , Kim Yong-Min , Park Kyoung-Jin , Park Ji-Kang , Kim Do-Kyoon 
Published: September 2014

Background: There are various ligament reattachment techniques for the modified Brostrom procedure. There have been few comparative studies on recently developed techniques. This prospective study was performed to compare the functional outcomes of 2 different ligament reattachment techniques using suture anchors. We furthermore evaluated the cost-effectiveness of the suture bridge technique. Methods: Forty-five amateur athletes under 30 years of age were followed for more than 2 years. Twenty-four procedures with the suture anchor technique and 21 procedures with the suture bridge technique were performed by one surgeon. The functional evaluation consisted of the American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), Karlsson score, Sefton grading system, and the period to return to various forms of exercise (jogging, spurt running, jumping, one leg standing for >1 minute, walking on uneven ground, and going down stairs). Measurement of talar tilt angle and anterior talar translation was obtained from stress radiographs to evaluate mechanical stability. Results: There were no significant differences on AOFAS score, FAOS, Karlsson score, Sefton grade, and stress radiographs. There were no significant differences on the return to exercises, except for jumping. As the most common complication, there were 3 cases of skin irritation by suture materials in the suture anchor group and 2 cases of intraoperative breakage of the suture anchor in suture bridge group. Conclusions: Both ligament reattachment techniques using suture anchors showed similar functional outcomes. Considering the additional medical expenses incurred by more suture anchors, the modified Brostrom procedure using the suture bridge technique had low cost-effectiveness. Proper indication and clinical usefulness of suture bridge technique for chronic ankle instability will be addressed in further studies. Level of Evidence: Level II, prospective comparative study.
Novel findings: Expression of angiotensin-converting enzyme and angiotensin-converting enzyme 2 in thoracic aortic dissection and aneurysm
Authors: Li Yang , Hu Jia , Qian Hong , Gu Jun , Meng Wei , Zhang Er-yong 
Published: September 2014

Introduction: Angiotensin-converting enzyme (ACE) and ACE2 are key regulators of the renin–angiotensin system, which has been shown to participate in a series of cardiovascular diseases. We hypothesized that dysregulated gene expression of ACE and ACE2 contribute to the formation of thoracic aortic dissection and aneurysm. Materials and methods: We assessed ACE plasma concentration in 73 patients with acute thoracic aortic dissection ( n=34), aneurysm ( n=18), coronary heart disease ( n=21) and 13 healthy volunteers. ACE and ACE2 gene expression in available aortic tissues was also examined by using quantitative real-time polymerase chain reaction. Results: In patients with acute aortic dissection, ACE plasma concentration and its mRNA level in aortic tissue were markedly reduced compared with those in patients with aneurysm, coronary heart disease and healthy controls. The level of ACE2 gene expression in dissection samples was also significantly lower than that in aneurysm (8.01±7.44, p<0.01) and coronary heart disease groups (9.61±11.54, p<0.01). A strong correlation was observed between the gene expressions of ACE and those of ACE2, and ACE to ACE2 ratio was significantly elevated in dissection tissues. Conclusions: Imbalanced down-regulation of ACE and ACE2 mRNA expression levels may play an important role in the development and progression of thoracic aortic aneurysmal dilatation and subsequently dissection.
The association between angiotensin-converting enzyme 2 polymorphisms and essential hypertension risk: A meta-analysis involving 14,122 patients
Authors: Yang Mei , Zhao Jing , Xing Lin , Shi Li 
Published: September 2014

Background: Some studies have evaluated the associations between the angiotensin-converting enzyme 2 (ACE2) gene polymorphisms and essential hypertension (EH) risk. However, the results remain uncertain. We carried out a meta-analysis to derive a more comprehensive estimation of these associations. Methods: Case-control studies were identified by searching PubMed, EMBASE, Chinese National Knowledge Infrastructure (CNKI) and Wangfang databases. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of the associations. Results: Significant associations were found between the ACE2 G8790A polymorphism and EH risk in males (OR = 1.27; 95% CI, 1.11–1.44; p = 0.0004; I2 = 34%) and females (OR = 1.21; 95% CI, 1.09–1.34; p = 0.0003; I2 = 31%), respectively. Significant associations were also observed between the ACE2 rs2106809 polymorphism and EH risk in males (OR = 1.24; 95% CI, 1.10–1.39; p = 0.0004; I2 = 18%) and females (OR = 1.39; 95% CI, 1.27–1.51; p < 0.00001; I2 = 0%), respectively. However, there was no significant association between the ACE2 A1075G polymorphism and EH risk in males (OR = 1.27; 95% CI, 0.77–2.10; p = 0.35; I2 = 69%) and females (OR = 1.02; 95% CI, 0.83–1.26; p = 0.84; I2 = 33%), respectively. Conclusions: These results suggest that the ACE2 G8790A and rs2106809 polymorphisms may be associated with EH risk.