bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Safety of Sumatriptan and Naratriptan in Pregnancy: What Have We Learned?
Authors: Cunnington Marianne , Ephross Sara , Churchill Paige 
Published: October 2009

Objectives.— To monitor for a signal of major teratogenicity by determining the risk of all major defects following in utero exposure to sumatriptan and naratriptan. To monitor for unusual patterns of birth defects that might suggest teratogenicity.Background.— The prevalence of migraine is highest in women of childbearing age. Coupled with the recurrent nature of migraine attacks and the high proportion of unplanned pregnancies, intentional and inadvertent exposure to these drugs in pregnancy is likely. The Sumatriptan and Naratriptan Pregnancy Registry captures data on women exposed to those drugs during pregnancy to monitor for evidence of major teratogenicity.Methods.— Healthcare professionals from anywhere in the world can enroll, on a voluntary basis, women exposed to sumatriptan or naratriptan during their pregnancies in this primarily prospective, observational study. Only pregnancies with unknown outcomes at the time of enrollment were included in the analysis. The percentage of infants or fetuses with major birth defects was calculated as the total number of infants/fetuses with major birth defects divided by the sum of the number of infants/fetuses with major birth defects + the number of live births without defects. The risk of major birth defects was further stratified by earliest trimester of pregnancy exposure.Results.— Data are available on pregnancy outcomes from 599 exposed women. Among 479 first‐trimester exposures to sumatriptan, 20 outcomes with major birth defects were reported (4.6%, 95% confidence interval [CI] 2.9‐7.2%). The risk of major birth defects following exposure to sumatriptan during any trimester was 4.7% (95% CI 3.1‐7.0%). No distinctive pattern of major birth defects among exposed infants was noted. There were 50 first‐trimester exposures to naratriptan with 1 reported birth defect in a fetus with exposure to both sumatriptan and naratriptan.Conclusions.— The risk of all major birth defects following first‐trimester exposure to sumatriptan was 4.6% (95% CI 2.9‐7.2%). This coupled with a consistent failure of additional epidemiological studies to observe a signal for major teratogenicity gives a level of reassurance concerning the safety of sumatriptan in pregnancy. There are too few data on naratriptan to draw definitive conclusions, and the sample size for sumatriptan remains too small to detect any but very large increases in specific birth defects.
Increased Dopamine Is Associated With the cGMP and Homocysteine Pathway in Female Migraineurs
Authors: Gruber Hans‐Jürgen , Bernecker Claudia , Pailer Sabine , Lechner Anita , Horejsi Renate , Möller Reinhard , Fazekas Franz , Truschnig‐Wilders Martie 
Published: October 2009

(Headache 2010;50:109‐116)Background.— The group of catecholamines, which include dopamine, adrenaline, and noradrenaline, are neurotransmitters which have been considered to play a role in the pathogenesis of migraine. However, the impact of catecholamines, especially dopamine on migraine as well as the exact mechanisms is not clear to date as previous studies have yielded in part conflicting results.Objective.— This study aimed to produce a comprehensive examination of dopamine in migraineurs.Methods.— Catecholamines and various parameters of the homocysteine, folate, and iron metabolism as well as cyclic guanosine monophosphate (cGMP) and inflammatory markers were determined in 135 subjects.Results.— We found increased dopamine levels in the headache free period in female migraineurs but not in male patients. Increased dopamine is associated with a 3.30‐fold higher risk for migraine in women. We found no significant effects of aura symptoms or menstrual cycle phases on dopamine levels. Dopamine is strongly correlated with cGMP and the homocysteine—folate pathway.Conclusion.— We show here that female migraineurs exhibit increased dopamine levels in the headache free period which are associated with a higher risk for migraine.
Effectiveness of Nonpharmacologic Treatment for Migraine in Young Children
Authors: Eidlitz‐Markus Tal , Haimi‐Cohen Yishai , Steier David , Zeharia Avraham 
Published: October 2009

(Headache 2010;50:219‐223)Objective.— To evaluate the effectiveness of nonpharmacologic treatment for migraine in children younger than age 6 years.Background.— The mean age of onset of migraine in children is 7.2 years for boys and 10.9 years for girls. Treatment consists of individually tailored pharmacologic and nonpharmacologic interventions. However, data on migraine management in preschoolers are very sparse.Methods.— Demographic, clinical, and outcome data were collected from the files of patients with migraine who attended a pediatric headache clinic. Only those treated by nonpharmacologic measures, namely, good sleep hygiene, diet free of food additives, and limited sun exposure, were included. Clinical factors and response to treatment were compared between children younger than 6 years and older children.Results.— Of the 92 children identified, 32 were younger than 6 years and 60 were older. There was no difference between the age groups in most of the demographic and clinical parameters. The younger group was characterized by a significantly lower frequency of migraine attacks and shorter disease duration (in months). Mean age of the patients with no response to treatment (grade 1) was 10.588 ± 3.254 years; partial response (grade 2), 9.11 ± 4.6 years; and complete response (grade 3), 8.11 ± 3.93 years (P = .02). The percentage of patients with complete to partial response as opposed to no response was significantly higher in the younger group (P = .00075).Conclusion.— As the primary option, conservative therapy for migraine appears to be more effective in children younger than 6 years than in older children, perhaps because of their shorter duration of disease until treatment and lower frequency of attacks.
Ankle‐Brachial Index, a Screening for Peripheral Obstructive Arterial Disease, and Migraine – A Controlled Study
Authors: Jurno Mauro Eduardo , Chevtchouk Liliana , Nunes Aida Aguilar , De Rezende Dilermando Fazito , Da Cunha Jevoux Carla , De Souza Jano Alves , Moreira Filho Pedro Ferreira 
Published: October 2009

(Headache 2010;50:626‐630)Background.— Epidemiological studies support the association between migraine, especially migraine with aura, and vascular disorders. The ankle‐brachial index (ABI) is largely used as a surrogate of peripheral obstructive arterial disorders (POAD). Accordingly, in this study we contrasted the ABI in individuals with migraine and in controls.Methods.— We investigated 50 migraineurs and 38 controls and obtained the ABI (ratio between the systolic arterial pressure obtained in the legs and in the arms) using digital sphygmomanometry. As per validation studies, we used the cut‐off of 0.9 as the normal limit for the ABI. We adjusted for gender, use of contraceptive hormones, tabagism, and other cardiovascular risk factors.Results.— We found abnormal values of ABI, suggestive of mild or moderate POAD, in 31 individuals (35.2%). Mean value was 0.96 (standard deviation = 0.10). None of our patients had ABI < 0.4, which would suggest severe POAD. Mean ABI for migraineurs was 0.94 (0.11), and for controls it was 0.99 (0.09). Difference was significant (t = 2.21 and P = .022).After adjustments, ABI remained significantly associated with migraine status (P = .024). Adjustments were reasonably effective (X2 of Hosmer‐Lemeshow = 1.06, P = .590).Conclusion.— Our findings suggest that decreased values of ABI are more common in migraineurs than in controls. Although causality was not assessed by us, the relationship is of importance per se. Doctors should measure the ABI in individuals with migraine as an easy way to screen for cardiovascular risk.
Mediterranean Diet and High Dietary Acid Load Associated with Mixed Nuts: Effect on Bone Metabolism in Elderly Subjects
Authors: Bulló Mònica , Amigó‐Correig Pilar , Márquez‐Sandoval Fabiola , Babio Nancy , Martínez‐González Miquel A. , Estruch Ramon , Basora Joseph , Solà Rosa , Salas‐Salvadó Jordi 
Published: October 2009

OBJECTIVES: To analyze the effect of differing diet on the acid load content on bone metabolism.DESIGN: Multicentric, randomized, single‐blind, parallel‐group clinical trial.SETTING: Outpatient clinics.PARTICIPANTS: Two hundred thirty‐eight elderly men and women aged 60 to 80 at high risk for cardiovascular disease were randomly assigned to three interventional groups: a recommended low‐fat diet (control diet group), a Mediterranean diet supplemented with virgin olive oil, or a Mediterranean diet supplemented with mixed nuts.MEASUREMENTS: Main outcomes were 12‐month changes from baseline in bone formation and resorption markers and bone mass measured according to quantitative ultrasound scanning.RESULTS: The baseline data on the anthropometric, bone densitometry, and biochemical variables did not differ between the three groups. Dietary potential renal acid load (PRAL) and daily net endogenous acid production (NEAP) at baseline did not differ between groups. After intervention, subjects allocated to the Mediterranean diet with mixed nuts had a significant increase of PRAL and NEAP. In comparison, subjects in the Mediterranean diet with nuts group had higher parathyroid hormone (PTH) levels (2.63, 95% confidence interval (CI)=−1.01–6.35, P=.02) and a nonsignificantly higher (0.31, 95% CI=−0.13–0.74, P=.14) urine free deoxypyridoxine:creatinine ratio, a marker of bone resorption, than the control group and the Mediterranean diet with virgin olive oil group.CONCLUSION: A Mediterranean dietary pattern associated with a high dietary acid load derived from consumption of mixed nuts does not seem to have a much greater effect on bone metabolism biomarkers, with the exception of PTH levels, than a Mediterranean diet without mixed nuts or a control diet in elderly subjects.
A single assay for multiple storage‐sensitive red blood cell characteristics by means of infrared spectroscopy
Authors: Pistorius Arthur M.A. , Luten Marleen , Bosman Giel J.C.G.M. , DeGrip Willem J. 
Published: October 2009

BACKGROUND: To maintain a high quality of red blood cells (RBCs), RBC characteristics must be followed during storage under blood bank conditions. By means of infrared (IR) spectroscopy, several characteristics can be measured simultaneously.STUDY DESIGN AND METHODS: IR spectra were acquired for samples from RBCs that were collected and stored according to Dutch blood bank procedures for a period of up to 50 days. Spectra of the soluble cell components were acquired separately after hypotonic lysis of the cells, followed by centrifugation. Characteristic vibrational bands were analyzed with respect to storage time–dependent changes in peak position and in intensity.RESULTS: A decrease in corresponding peak intensities indicates that RBCs lose protein and lipid during storage. Changes in protein secondary structure during storage are largely confined to integral membrane proteins and membrane‐associated proteins. A concurrent decrease in lipid packing density probably reflects the gradual change in cellular shape from discoidal to globular. By integration over a narrow range, storage‐dependent changes in intracellular adenosine triphosphate (ATP) and glucose levels could be estimated. ATP levels decrease during storage, but stay above the required 75% of the initial level after 35 days of storage. Glucose concentrations stay well above 5 mmol/L over the entire storage period.CONCLUSION: IR spectroscopy is a promising technique to follow structural and metabolic changes in RBCs during storage under blood bank conditions. Several variables can be determined rapidly in a single measurement.
The practice of reporting transfusion‐related acute lung injury: a national survey among clinical and preclinical disciplines
Authors: Vlaar Alexander P. , Wortel Kim , Binnekade Jan M. , Van Oers Marinus H.J. , Beckers Erik , Gajic Ognjen , Schultz Marcus J. , Juffermans Nicole P. 
Published: October 2009

BACKGROUND: Transfusion‐related acute lung injury (TRALI) is hypothesized to be a “two‐hit” entity, in which an inflammatory condition (e.g., sepsis) predisposes to TRALI. TRALI is a clinical diagnosis. Disciplines involved in managing TRALI may differ in decision‐making on the reporting of TRALI.STUDY DESIGN AND METHODS: A survey was conducted among critical care physicians, hematologists, hemovigilance workers, and transfusion medicine physicians, using case vignettes and a questionnaire. The vignettes varied in patient‐ and blood product–related factors that may influence the decision to report a TRALI case. Multiple linear regression analysis was performed. A positive β‐coefficient is in favor of reporting.RESULTS: Ninety‐two questionnaires were returned (response rate, 68%). For all disciplines, preferences in favor of reporting TRALI were onset of symptoms within 1 hour (β = 0.4), after transfusion of a single unit of FFP (β = 0.5), and in the absence of acute lung injury before transfusion (β = 1.3). An admission diagnosis of sepsis was a negative preference (β = −0.3). Massive transfusion (6 RBC plus 4 FFP units) was a negative preference for transfusion medicine physicians (β = −0.3), but a positive preference for the other disciplines. The questionnaire revealed that massive transfusion and the age of blood products were considered relatively more important reasons to report TRALI by critical care physicians compared to the other disciplines (p < 0.05).CONCLUSION: A pretransfusion inflammatory condition is a reason to withhold from reporting of a suspected TRALI case. Disciplines involved in managing TRALI differ in decision‐making of reporting TRALI, which may contribute to variance in incidence.
Permanent Pacemaker Implantation Following Aortic Valve Replacement: Current Prevalence and Clinical Predictors
Authors: HUYNH HIEU , DALLOUL GHASSAN , GHANBARI HAMID , BURKE PETER , DAVID MARIAM , DACCARETT MARCOS , MACHADO CHRISTIAN , DAVID SHUKRI 
Published: October 2009

Background:

The incidence of conduction disease requiring permanent pacemaker (PPM) implantation following aortic valve replacement (AVR) ranges from 3% to 6%. Data concerning the potential risks for PPM requirement associated with certain valve types have been conflicting and controversial. We sought to evaluate the prevalence, predictors for PPM implantation, and PPM dependency during follow‐up in patients undergoing AVR.
Methods:

A total of 214 consecutive patients undergoing AVR were studied retrospectively. A total of 207 patients were included in the statistical analysis. Clinical variables including valve size and types were catalogued and the incidence of PPM evaluated. Cardiac rhythm device clinic records were examined and PPM dependency status was catalogued. Multivariate analyses were performed to determine predictors of PPM implantation and PPM dependency during follow‐up.
Results:

Fifteen patients (7.2%) required PPM postoperatively. After controlling for clinical and surgical characteristics, predictors for PPM included preoperative first‐degree atrioventricular block with and without left anterior fascicular block or intraventricular conduction delay [odd ratios (OR) = 12.5, P = 0.001], cardiac arrest postoperatively (OR = 9.4, P = 0.012), and combined aortic and mitral valve surgery (OR = 11.5, P = 0.027). Aortic valve types did not predict complete heart block (CHB) and PPM implantation. Of those patients who underwent PPM implantation, 70% were classified as PPM dependent during long‐term follow‐up.
Conclusion:

CHB and PPM implantation continue to be common complications of AVR. Preexisting atrioventricular with intrafascicular or intraventricular conduction disease along with cardiac arrest and dual valve surgery are the most important significant predictors of PPM implantation and PPM dependency during follow‐up. The selection of valve types did not predict conduction disease requiring PPM implantation.
Idiopathic Left Ventricular Arrhythmias Originating Adjacent to the Left Aortic Sinus of Valsalva: Electrophysiological Rationale for the Surface Electrocardiogram
Authors: YAMADA TAKUMI , MCELDERRY H. THOMAS , OKADA TARO , MURAKAMI YOSHIMASA , DOPPALAPUDI HARISH , YOSHIDA NAOKI , YOSHIDA YUKIHIKO , INDEN YASUYA , MUROHARA TOYOAKI , EPSTEIN ANDREW E. , PLUMB VANCE J. , KAY G. NEAL 
Published: October 2009

IVT Arising Adjacent to the Left Sinus of Valsalva.

Background:
Idiopathic ventricular arrhythmias (VAs) may be amenable to catheter ablation within or adjacent to the left sinus of Valsalva (LSOV). However, features that discriminate these sites have not been defined. The purpose of this study was to determine the electrocardiographic and electrophysiological features of VAs originating within or adjacent to the LSOV.
Methods and Results:
We studied 48 consecutive patients undergoing successful catheter ablation of idiopathic VAs originating from the left coronary cusp (LCC, n = 29), aortomitral continuity (AMC, n = 10) and great cardiac vein or anterior interventricular cardiac vein (Epi, n = 9). A small r wave, or rarely an R wave, was typically observed in lead I during the VAs and pacing in these regions. An S wave in lead V5 or V6 occurred significantly more often during both the VAs and pacing from the AMC than during that from the LCC and Epi (p < 0.05 to 0.0001). For discriminating whether VA origins can be ablated endocardially or epicardially, the maximum deflection index (MDI = the shortest time to the maximum deflection in any precordial lead/QRS duration) was reliable for VAs arising from the AMC (100%), but was less reliable for LCC (73%) and Epi (67%) VAs. In 3 (33%) of the Epi VAs, the site of an excellent pace map was located transmurally opposite to the successful ablation site (LCC = 1 and AMC = 2).
Conclusions:
The MDI has limited value for discriminating endocardial from epicardial VA origins in sites adjacent to the LSOV probably due to preferential conduction, intramural VA origins or myocardium in contact with the LCC. (J Cardiovasc Electrophysiol, Vol. 21, pp. 170‐176, February 2010)
Magnetic Resonance Imaging‐Confirmed Ablative Debulking of the Left Atrial Posterior Wall and Septum for Treatment of Persistent Atrial Fibrillation: Rationale and Initial Experience
Authors: SEGERSON NATHAN M. , DACCARETT MARCOS , BADGER TROY J. , SHABAAN AKRAM , AKOUM NAZEM , FISH ERIC N. , RAO SWATI , BURGON NATHAN S. , ADJEI‐POKU YAW , KHOLMOVSKI EUGENE , VIJAYAKUMAR SATHYA , DIBELLA EDWARD V.R. , MACLEOD ROB S. , MARROUCHE NASSIR F. 
Published: October 2009

LA Debulking for Atrial Fibrillation.

Introduction:
Though pulmonary vein (PV) isolation has been widely adopted for treatment of atrial fibrillation (AF), recurrence rates remain unacceptably high with persistent and longstanding AF. As evidence emerges for non‐PV substrate changes in the pathogenesis of AF, more extensive ablation strategies need further study.
Methods:
We modified our PV antrum isolation procedure to include abatement of posterior and septal wall potentials. We also employed recently described image‐processing techniques using delayed‐enhancement (DE) MRI to characterize tissue injury patterns 3 months after ablation, to assess whether each PV was encircled with scar, and to assess the impact of these parameters on procedural success.
Results:
118 consecutive patients underwent debulking procedure and completed follow‐up, of which 86 underwent DE‐MRI. The total left atrial (LA) radiofrequency delivery correlated with percent LA scarring by DE‐MRI (r = 0.6, P < 0.001). Based on DE patterns, complete encirclement was seen in only 131 of 335 PVs (39.1%). As expected, Cox regression analysis showed a significant relationship between the number of veins encircled by delayed enhancement and clinical success (hazard ratio of 0.62, P = 0.015). Also, progressive quartile increases in postablation posterior and septal wall scarring reduced recurrences rates with a HR of 0.65, P = 0.022 and 0.66, P = 0.026, respectively.
Conclusion:
Pathologic remodeling in the septal and posterior walls of the LA helps form the pathogenic substrate for AF, and these early results suggest that more aggressive treatment of these regions appears to correlate with improved ablation outcomes. Noninvasive imaging to characterize tissue changes after ablation may prove essential to stratifying recurrence risk. (J Cardiovasc Electrophysiol, Vol. 21, pp. 126‐132, February 2010)
Septal Dyskinesia and Global Left Ventricular Dysfunction in Pediatric Wolff‐Parkinson‐White Syndrome with Septal Accessory Pathway
Authors: KWON BO SANG , BAE EUN JUNG , KIM GI BEOM , NOH CHUNG IL , CHOI JUNG YUN , YUN YONG SOO 
Published: October 2009

LV Dysfunction in WPW Syndrome. Introduction: Echocardiographic studies have shown that some patients with Wolff‐Parkinson‐White (WPW) syndrome have myocardial dyskinesia in the segments precociously activated by an accessory pathway (AP). The aim of the present study was to determine the extent to which the AP contributes to global left ventricular (LV) dysfunction.
Methods:
Electrophysiological and echocardiographic data from 62 children with WPW (age at diagnosis = 5.9 ± 4.2 years) were retrospectively analyzed.
Results:
The left ventricular ejection fraction (LVEF) of patients with septal APs (53 ± 11%) was significantly lower than that of patients with right (62 ± 5%) or left (61 ± 4%) APs (P = 0.001). Compared to patients with normal septal motion (n = 56), patients with septal dyskinesia (n = 6) had a reduced LVEF (61 ± 4% and 42 ± 5%, respectively) and an increased LV end diastolic dimension (P < 0.001 for both comparisons). Multivariate analysis identified septal dyskinesia as the only significant risk factor for reduced LVEF. All 6 patients with septal dyskinesia had right septal APs, and a preexcited QRS duration that was longer than that of patients with normal septal motion (140 ± 18 ms and 113 ± 32 ms, respectively; P = 0.045). After RFA there were improvements in both intraventricular dyssynchrony (septal‐to‐posterior wall motion delay, from 154 ± 91 ms to 33 ± 17 ms) and interventricular septal thinning (from 3.0 ± 0.5 mm to 5.3 ± 2.6 mm), and a significant increase in LVEF (from 42 ± 5% to 67 ± 8%; P = 0.001).
Conclusion:
The dyskinetic segment activated by a right septal AP in WPW syndrome may lead to ventricular dilation and dysfunction. RFA produced mechanical resynchronization, reverse remodeling, and improvements in LV function. (J Cardiovasc Electrophysiol, Vol. 21, pp. 290–295, March 2010)