bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgery for Primary Cardiac Tumors in Children
Authors: Padalino Massimo A. , Vida Vladimiro L. , Boccuzzo Giovanna , Tonello Marco , Sarris George E. , Berggren Hakan , Comas Juan V. , Di Carlo Duccio , Di Donato Roberto M. , Ebels Tjark , Hraska Viktor , Jacobs Jeffrey P. , Gaynor J. William , Metras Dominique , Pretre Rene , Pozzi Marco , Rubay Jean , Sairanen Heikki , Schreiber Christian , Maruszewski Bohdan , Basso Cristina , Stellin Giovanni 
Published: May 2012

Background—
To evaluate indications and results of surgery for primary cardiac tumors in children.

Methods and Results—

Eighty-nine patients aged ≤18 years undergoing surgery for cardiac tumor between 1990 and 2005 from 16 centers were included retrospectively (M/F=41/48; median age 4.3 months, range 1 day to 18 years). Sixty-three patients (68.5%) presented with symptoms. Surgery consisted of complete resection in 62 (69.7%) patients, partial resection in 21 (23.6%), and cardiac transplant in 4 (4.5%). Most frequent histotypes (93.2%) were benign (rhabdomyoma, myxoma, teratoma, fibroma, and hemangioma). Postoperative complications occurred in 29.9%. Early and late mortality were 4.5% each (mean follow-up, 6.3±4.4 years); major adverse events occurred in 28.2% of the patients; 90.7% of patients are in New York Heart Association class I. There were no statistically significant differences in survival, postoperative complications, or adverse events after complete and partial resection in benign tumors other than myxomas. Cardiac transplant was associated significantly with higher mortality rate (
P=
0.006). Overall mortality was associated to malignancy (
P
=0.0008), and adverse events during follow-up (
P
=0.005).

Conclusions—
Surgery for primary cardiac tumors in children has good early and long-term outcomes, with low recurrence rate. Rhabdomyomas are the most frequent surgical histotypes. Malignant tumors negatively affect early and late survival. Heart transplant is indicated when conservative surgery is not feasible. Lack of recurrence after partial resection of benign cardiac tumors indicates that a less risky tumor debulking is effective for a subset of histotypes such as rhabdomyomas and fibromas.
Simple Score to Assess the Risk of Rejection After Orthotopic Heart Transplantation
Authors: Kilic Arman , Weiss Eric S. , Allen Jeremiah G. , Conte John V. , Shah Ashish S. , Baumgartner William A. , Yuh David D. 
Published: May 2012

Background—
The aim of this study was to derive and validate a risk score for rejection after orthotopic heart transplantation.

Methods and Results—

The United Network for Organ Sharing registry was used to identify patients undergoing orthotopic heart transplantation between 1998 and 2008. A total of 14 265 eligible patients were randomly divided into derivation (80%; n=11 412) and validation (20%; n=2853) cohorts. The primary outcome was drug-treated rejection within 1 year of orthotopic heart transplantation. Covariates found to be associated (exploratory univariate
P
<0.2) with rejection were entered into a multivariable logistic regression model. Inclusion of each variable in the model was assessed by improvement in the McFadden pseudo-
R
2
, likelihood ratio test, and c index. A risk score was then generated through the use of relative magnitudes of the odds ratios from the derivation cohort, and its ability to predict rejection was tested independently in the validation cohort. A 13-point risk score incorporating 4 variables (age, race, sex, HLA matching) was created. The mean scores in the derivation and validation cohorts were 8.3±2.2 and 8.4±2.1, respectively. Predicted 1-year rejection rates based on the derivation cohort ranged from 16.2% (score=0) to 50.7% (score=13;
P
<0.001). In weighted regression analysis, there was a strong correlation between these predicted rates of rejection and actual, observed rejection rates in the validation cohort (
r
2
=0.96,
P
<0.001). Logistic regression analysis also demonstrated a significant association (odds ratio, 1.13;
P
<0.001). The c index of the composite score was equivalent in both the derivation and validation cohorts (c=0.67).

Conclusions—
This novel 13-point risk score is highly predictive of clinically significant rejection episodes within 1 year of orthotopic heart transplantation. It has potential utility in tailoring immunosuppressive regimens and in research stratification in orthotopic heart transplantation.
Remote Monitoring Reduces Healthcare Use and Improves Quality of Care in Heart Failure Patients With Implantable Defibrillators
Authors: Landolina Maurizio , Perego Giovanni B. , Lunati Maurizio , Curnis Antonio , Guenzati Giuseppe , Vicentini Alessandro , Parati Gianfranco , Borghi Gabriella , Zanaboni Paolo , Valsecchi Sergio , Marzegalli Maurizio 
Published: May 2012

Background—
Heart failure patients with implantable cardioverter-defibrillators (ICDs) or an ICD for resynchronization therapy often visit the hospital for unscheduled examinations, placing a great burden on healthcare providers. We hypothesized that Internet-based remote interrogation systems could reduce emergency healthcare visits.

Methods and Results—

This multicenter randomized trial involving 200 patients compared remote monitoring with standard patient management consisting of scheduled visits and patient response to audible ICD alerts. The primary end point was the rate of emergency department or urgent in-office visits for heart failure, arrhythmias, or ICD-related events. Over 16 months, such visits were 35% less frequent in the remote arm (75 versus 117; incidence density, 0.59 versus 0.93 events per year;
P
=0.005). A 21% difference was observed in the rates of total healthcare visits for heart failure, arrhythmias, or ICD-related events (4.40 versus 5.74 events per year;
P
<0.001). The time from an ICD alert condition to review of the data was reduced from 24.8 days in the standard arm to 1.4 days in the remote arm (
P
<0.001). The patients' clinical status, as measured by the Clinical Composite Score, was similar in the 2 groups, whereas a more favorable change in quality of life (Minnesota Living With Heart Failure Questionnaire) was observed from the baseline to the 16th month in the remote arm (
P
=0.026).

Conclusions—
Remote monitoring reduces emergency department/urgent in-office visits and, in general, total healthcare use in patients with ICD or defibrillators for resynchronization therapy. Compared with standard follow-up through in-office visits and audible ICD alerts, remote monitoring results in increased efficiency for healthcare providers and improved quality of care for patients.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00873899.
Maternal Use of Hydroxychloroquine Is Associated With a Reduced Risk of Recurrent Anti-SSA/Ro-Antibody–Associated Cardiac Manifestations of Neonatal Lupus
Authors: Izmirly Peter M. , Costedoat-Chalumeau Nathalie , Pisoni Cecilia N. , Khamashta Munther A. , Kim Mimi Y. , Saxena Amit , Friedman Deborah , Llanos Carolina , Piette Jean-Charles , Buyon Jill P. 
Published: May 2012

Background—
A recent case-control study suggested a benefit of hydroxychloroquine (HCQ) in lowering the risk of cardiac manifestations of neonatal lupus (cardiac-NL) in pregnancies of anti-SSA/Ro–positive patients with systemic lupus erythematosus. A historical cohort assembled from 3 international databases was used to evaluate whether HCQ reduces the nearly 10-fold increase in risk of recurrence of cardiac-NL independently of maternal health status.

Methods and Results—

Two hundred fifty-seven pregnancies of anti-SSA/Ro-positive mothers (40 exposed and 217 unexposed to HCQ) subsequent to the birth of a child with cardiac-NL were identified from 3 databases (United States, England, and France). Exposure was defined as the sustained use of HCQ throughout pregnancy with initiation before 10 weeks of gestation. The recurrence rate of cardiac-NL in fetuses exposed to HCQ was 7.5% (3 of 40) compared with 21.2% (46 of 217) in the unexposed group (
P
=0.050). Although there were no deaths in the exposed group, the overall case fatality rate of the cardiac-NL fetuses in the unexposed group was 21.7%. In a multivariable analysis that adjusted for database source, maternal race/ethnicity, and anti-SSB/La status, HCQ use remained significantly associated with a decreased risk of cardiac-NL (odds ratio, 0.23; 95% confidence interval, 0.06–0.92;
P
=0.037). Similar results were obtained with propensity score analysis, an alternative approach to adjust for possible confounding by indication.

Conclusion—
Aggregate data from a multinational effort show that in mothers at high risk of having a child with cardiac-NL, the use of HCQ may protect against recurrence of disease in a subsequent pregnancy.
Echocardiography Screening for Rheumatic Heart Disease in Ugandan Schoolchildren
Authors: Beaton Andrea , Okello Emmy , Lwabi Peter , Mondo Charles , McCarter Robert , Sable Craig 
Published: May 2012

Background—
Historically, sub-Saharan Africa has had the highest prevalence rates of clinically detected rheumatic heart disease (RHD). Echocardiography-based screening improves detection of RHD in endemic regions. The newest screening guidelines (2006 World Health Organization/National Institutes of Health) have been tested across India and the Pacific Islands, but application in sub-Saharan Africa has, thus far, been limited to Mozambique. We used these guidelines to determine RHD prevalence in a large cohort of Ugandan school children, to identify risk factors for occult disease, and to assess the value of laboratory testing.

Methods and Results—

Auscultation and portable echocardiography were used to screen randomly selected schoolchildren, 5 to 16 years of age, in Kampala, Uganda. Disease likelihood was defined as definite, probable, or possible in accordance with the 2006 National Institutes of Health/World Health Organization guidelines. Ninety-seven percent of eligible students received screening (4869 of 5006). Among them, 130 children (2.7%) had abnormal screening echocardiograms. Of those 130, secondary evaluation showed 72 (55.4%) with possible, probable, or definite RHD; 18 (13.8%) with congenital heart disease; and 40 (30.8%) with no disease. Echocardiography detected 3 times as many cases of RHD as auscultation: 72 (1.5%) versus 23 (0.5%;
P
<0.001). Children with RHD were older (10.1 versus 9.3 years;
P
=0.002). Most cases (98%) involved only the mitral valve. Lower socioeconomic groups had more RHD (2.7% versus 1.4%;
P
=0.036) and more advanced disease (64% versus 26%;
P
<0.001). Antistreptolysin O titers were elevated in children with definite RHD.

Conclusions—
This is one of the largest single-country childhood RHD prevalence studies and the first to be conducted in sub-Saharan Africa. Our data support inclusion of echocardiography in screening protocols, even in the most resource-constrained settings, and identify lower socioeconomic groups as most vulnerable. Longitudinal follow-up of children with echocardiographically diagnosed subclinical RHD is needed.
Implementation process and acceptance of a setting based prevention programme to promote healthy lifestyle in preschool children
Authors: Herbert Birgit , Strauß Angelika , Mayer Andrea , Duvinage Kristin , Mitschek Christine , Koletzko Berthold 
Published: May 2012

Objective: Evaluation of the implementation process of a kindergarten-based intervention (‘TigerKids’) to promote a healthy lifestyle. Design: Questionnaire survey among kindergarten teachers about programme implementation and acceptance. Setting: Kindergartens in Bavaria, Germany. Methods: Two hundred and fifteen kindergartens were included; 96.3 % returned informative questionnaires. ‘TigerKids’ is a multi-approach behavioural intervention programme to increase physical activity level and to promote healthy eating in preschool children. Project elements and materials are designed for kindergarten teachers, children, and their parents. The main outcome measures of the study are implementation, acceptance, and estimated effectiveness of the intervention programme. Results: The elements for promoting healthy lifestyle were implemented regularly in the participating kindergartens: 94.2 % used the drinking station daily, 75.8 % prepared the magic fruit plate daily, and 63.3 % carried out the activity programme at least two times per week. The educators reported that the children ate more fruits and vegetables, drank more non-sugared beverages, and were more active. The designed materials and elements for the children, the educators, and the parents were also evaluated positively by the kindergarten teachers. Conclusion: The ‘TigerKids’ programme is a suitable instrument for health promotion in the kindergarten setting.
Stroke-related knowledge, lifestyle behaviours and health beliefs in Singaporean Chinese: Implications for health education
Authors: Wong Wai Pong , Yeung Meredith , Loh Susan , Lee Mina , Ghazali F , Chan CJ , Feng S , Liew YV , Seah PF , Wee J , Wang J , Huang X , Dean Elizabeth 
Published: May 2012

Objective: The objective of the present study was to describe stroke-related knowledge (risk factors, warning signs and emergency response), lifestyle behaviours and health beliefs among Singaporean Chinese, and to identify any factors associated with such knowledge, behaviours and beliefs. Design: This was a cross-sectional study design employing a non-probability sampling method. Setting: Participants were recruited from the community. Method: Singaporean Chinese aged 40–74 years completed an interviewer-administered questionnaire seeking demographic information, knowledge of stroke risk factors, warning signs and emergency response, lifestyle behaviours such as physical activity participation and dietary habits, and health beliefs. Results: A total of 411 questionnaires (42% men, average age 52.4 years ± 7.3) were analyzed. Most respondents were able to identify at least one correct risk factor and warning sign (88% and 78% respectively). But only 38% stated the correct emergency response. Mass media was the main source of their knowledge. Most respondents reported healthy lifestyle and have positive health beliefs, many of which were associated with age, gender, education, income, religion and whether having relatives suffering from a chronic illness. Conclusion: In conclusion, this survey identified areas for health education programmes to improve stroke-related knowledge and lifestyle behaviour change in different target groups.
Race and Drug Formulation Influence on Mycophenolic Acid Pharmacokinetics in Stable Renal Transplant Recipients
Authors: Tornatore Kathleen M. , Sudchada Patcharaporn , Attwood Kris , Wilding Gregory E. , Gundroo Aijaz C. , DiFrancesco Robin , Gray Vanessa , Venuto Rocco C. 
Published: May 2012

AbstractBackgroundLimited mycophenolic acid (MPA) data are available comparing racial influence on mycophenolate mofetil (MMF) and enteric‐coated mycophenolate sodium (EC‐MPS) pharmacokinetics.MethodsIntrapatient MPA pharmacokinetics of MMF versus EC‐MPS were compared in 13 male African American (AA) and 14 Caucasian (C) renal transplant recipients (RTRs). RTRs were switched to equivalent doses of the alternate formulation for at least 10 days prior to the second study. Mycophenolic acid clearance and dose‐normalized area under the concentration‐time curve0‐12 (AUC*) were determined. Mixed model statistics evaluated the main effects of race, drug formulation, and interaction of race and drug formulation (R × D) with albumin, cyclosporine trough, renal function, and diabetes and enterhepatic recirculation.ResultsSignificant R × D was identified for MPA AUC* for EC‐MPS (AA, 0.056 ± 0.029 [mg·h/L]/mg; C, 0.080 ± 0.044 [mg·h/L]/mg) compared with MMF (AA, 0.053 ± 0.019 [mg·h/L]/mg; C, 0.060 ± 0.025 [mg·h/L]/mg), P = .022. Significant R × D was identified with albumin in the model for MPA clearance for MMF (AA, 21.7 ± 8.9 L/h; C, 20.5 ± 10.8 L/h) compared with EC‐MPS (AA, 22.2 ± 10.1 L/h; C, 16.2 ± 9.1 L/h), P = .032.ConclusionsRace influences MPA exposure between MMF and EC‐MPS and may warrant therapeutic monitoring during formulation conversion.
Population Pharmacokinetic Analysis of a Nevirapine‐Based HIV‐1 Prevention of Mother‐to‐Child Transmission Program in Uganda to Assess the Impact of Different Dosing Regimens for Newborns
Authors: Frank Monika , Harms Gundel , Kunz Andrea , Kloft Charlotte 
Published: May 2012

AbstractSingle‐dose nevirapine for mothers and newborns at delivery is the simplest prevention strategy for vertical HIV‐1 transmission and hence widely used in resource‐constrained settings. HIV‐1‐positive mothers and newborns received single‐dose nevirapine in a prevention of mother‐to‐child HIV‐1 transmission (PMTCT) program in Uganda. In a pharmacokinetic investigation, breast milk and plasma samples of mothers and newborns were collected. The nonlinear mixed‐effects modeling approach was suitable for analysis (average: 1.8 samples/matrix/individual). For describing the nevirapine pharmacokinetics in mothers and newborns, a 1‐compartment model was demonstrated to be sufficient. The plasma‐placenta transfer could be quantified, revealing a transfer fraction of 11% to 25% (with a significant influence of time span between maternal nevirapine intake and birth) and a high transfer rate constant from maternal drug administration. Interindividual variability was moderate between mothers and high between newborns. Simulations revealed that newborns born early (<1 hour) after maternal nevirapine intake would benefit from a 3‐fold higher nevirapine dosage (6 mg/kg) after birth for analogous protective plasma concentrations over the first 2 weeks. In contrast, postnatal nevirapine dosage seemed to be dispensable for newborns born late (>24 hours) after maternal nevirapine intake. These dosing recommendations should be evaluated in prospective studies, including additional antiretroviral drugs in accordance with current PMTCT guidelines.
Optimal Duration of Dual‐Antiplatelet Therapy Following Drug‐Eluting Stent Implantation: A Meta‐Analysis
Authors: Zhang Tuo , Shen Linghong , Hu Liuhua , He Ben 
Published: May 2012

AbstractOptimal duration of dual‐antiplatelet therapy (DAPT) following drug‐eluting stent (DES) implantation remains uncertain. The aim of this study was to perform a meta‐analysis of trials evaluating the effect of DAPT duration on long‐term clinical outcomes after DES implantation. The authors searched OvidMEDLINE, EMBASE, and the Cochrane Library for both randomized controlled trials and nonrandomized studies that evaluated DAPT duration on long‐term clinical outcomes after DES implantation. The end point was the cumulative incidence of the composite of all‐cause death and nonfatal myocardial infarction (MI) at maximum follow‐up. Quantitative analysis was performed to estimate the pooled hazard ratios (HRs) for the effect of DAPT duration. The pooled effect of DAPT discontinuation before 6 months significantly increased risk of death and nonfatal MI (HR, 1.46; 95% confidence interval, 1.18‐1.80), but DAPT beyond 12 months did not reduce the incidence of the composite end point compared with drug discontinuation at 12 months (HR, 0.91; 95% confidence interval, 0.75‐1.10). In conclusion, the current evidence suggests that 6 to 12 months of DAPT may be optimal after DES implantation.
Pre-filling of the extracorporeal circuit with autologous blood is safe, but not effective in optimizing biocompatibility in high-risk patients
Authors: Kiessling A-H , Wedde S , Keller H , Reyher C , Stock U , Beiras-Fernandez A , Moritz A 
Published: May 2012

Objectives: Haemodilution resulting from crystalloid priming of the cardiopulmonary bypass circuit represents a major risk factor for blood transfusions in high-risk cardiac surgery patients. We designed this study to evaluate the effects of antegrade autologous priming (AAP) on reducing perioperative blood transfusion and markers of the inflammatory response in older patients (>75 years). Methods: Seventy-two patients undergoing first-time coronary bypass and/or aortic valve replacement were prospectively randomised to a cardiopulmonary bypass (CPB) with or without AAP. AAP was performed by adding the patient’s own blood to the prime solution (mean 280ml). Perfusion and anaesthetic techniques were as usual. The haematocrit was maintained at a minimum of 21% during CPB. Patients were well matched for all preoperative variables, including established transfusion risk factors. The primary endpoint was the requirement of red cell transfusion. The surrogate endpoints were renal function, inflammatory response and ischaemic parameters. Blood samples were drawn pre- and intraoperatively and at intervals of 6 hours till POD 6. Results: Current analysis shows no differences in patients receiving homologous packed red cell transfusions. Also, markers of the inflammatory response (IL6, IL8), renal function (cystatin C, creatinine) and myocardial ischaemia (troponin T, CK-MB) were comparable in both groups (p>0.05). Clinical outcomes were similar with respect to pulmonary, renal and hepatic function, length of ICU stay and hospital stay. Conclusion: These data suggest that antegrade autologous priming is a safe procedure, but an ineffective way for improving biocompatibility and reducing the need for blood transfusion in older patients.
The validation of a new comprehensive headache-specific quality of life questionnaire
Authors: Manhalter Nóra , Bozsik György , Palásti Ágnes , Csépány Éva , Ertsey Csaba 
Published: May 2012

Background: Measuring quality of life (QOL) is an important means of assessing the impact of headache. The currently used QOL questionnaires are usually geared toward migraine and focus on a limited number of factors, thus they are not necessarily informative in other headache types. We report the psychometric properties of a new questionnaire, the Comprehensive Headache-related Quality of life Questionnaire (CHQQ) that may be more sensitive to the burden of headache. Patients and methods: A total of 202 patients suffering from migraine ( n = 168) or tension-type headache (TTH) ( n = 34) completed the CHQQ and SF-36, a generic QOL questionnaire. We assessed the reliability and validity of the CHQQ and its physical, mental and social dimensions. Results: The questionnaire was easy to administer. Reliability was excellent with Cronbach’s alpha being 0.913 for the whole instrument (0.814–0.832 for its dimensions). The dimensions and total score showed significant correlations with the patients’ headache characteristics (criterion validity), and were also significantly correlated with the SF-36 domains (convergent validity). The total score and dimensions were significantly ( p < 0.005) lower in the migraine group than in the TTH group (discriminative validity). Conclusion: In this study the new headache-specific QOL instrument showed adequate psychometric properties.