bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trimetazidine potentiates the effects of exercise training in patients with ischemic cardiomyopathy referred for cardiac rehabilitation
Authors: Belardinelli Romualdo , Lacalaprice Francesca , Faccenda Ernesto , Volpe Loretta 
Published: September 2008

Background Patients referred for cardiac rehabilitation may take advantage from combining trimetazidine (TMZ) with exercise training (ET), as both treatments produce similar effects in the cardiovascular system. It is, however, unknown whether the combination of TMZ with ET may determine greater improvements in functional capacity and endothelial function than ET alone. Design A randomized longitudinal controlled study. Methods We studied 116 patients (97 men and 19 women, mean age 58 ± 9 years) with ischemic heart disease and left ventricular dysfunction who were referred for cardiac rehabilitation. Coronary risk factors were present in 82 patients (diabetes in 28 patients). Patients were randomized into three matched groups. A group (TMZ+ training, TT, n = 30) received TMZ at doses of 20 mg three times daily orally for 8 weeks in addition to standard medications and underwent a supervised program of ET at 60% of oxygen uptake at peak, three times a week for 8 weeks. A group (exercise, E, n = 30) completed the ET program without receiving TMZ. A control group (C, n = 26) was neither exercised nor received TMZ. A fourth group (TMZ, n = 30) receiving TMZ 20 mg three times daily for 8 weeks was also studied. On study entry and at 8 weeks all patients underwent echocardiography, cardiopulmonary exercise testing, and vasomotor reactivity of the brachial artery. Results Oxygen uptake at peak was significantly increased in the TT (25%), TMZ (15.1%), and E group (15.3%) (P≤0.001 TT vs. C; P≤0.05 vs. TMZ and E). Left ventricular ejection fraction was also improved in TT (18.4%), TMZ (15.7%), and E (12.9%) (P≤0.001 TT vs. C; P≤0.05 vs. TMZ and E), as a result of reduction in end-systolic volume. The endothelium-dependent dilation was similarly improved (P< 0.001 TMZ vs. C; P<0.05 vs. TMZ and E). The most significant improvements were observed in the subgroup TT with multiple risk factors. Conclusion The addition of TMZ to ET determined greater improvements in functional capacity, left ventricular ejection fraction, and endothelium-dependent dilation than TMZ or ET given alone. No differences between improvements after TMZ and E as compared with controls were observed.
Estimation of cardiovascular risk: a comparison between the Framingham and the SCORE model in people under 60 years of age
Authors: Scheltens Tjarda , Verschuren W.M. Monique , Boshuizen Hendriek C. , Hoes Arno W. , Zuithoff Nicolaas P. , Bots Michiel L. , Grobbee Diederick E. 
Published: September 2008

Background The Framingham Heart Study risk model has been used in the majority of cardiovascular risk management guidelines. Recently, a new model based on the SCORE system has been proposed. We compared both risk models with regard to their ability to predict cardiovascular mortality in the Netherlands. Design Cohort study. Methods In a Dutch cohort study of 39 719 persons, three properties of the risk models were investigated: discriminating ability (ranking persons in order of risks, expressed in area under the curve); calibrating ability (prediction of events compared with actual events expressed in goodness of fit); and the number of persons assigned to treatment according to the guideline. Results The discriminative ability of both models was similar: the area under the curve of Framingham was 0.86 and of SCORE 0.85. Calibration of both functions was inadequate. The goodness of fit of the SCORE model was 35 and of the Framingham model 64, whereas a goodness of fit less than 20 is considered acceptable. Using the Dutch guideline treatment threshold of 10% mortality risk, the SCORE risk function assigned 0.4% of the population to drug treatment where the Framingham function assigned 0.7%. Conclusion The findings of this study show that both the SCORE and the Framingham model function have a good discriminative ability but are insufficient in predicting absolute risks. SCORE assigned fewer participants to treatment than Framingham. If a new risk model is implemented in treatment guidelines, comparison with the model in use and evaluation of calibrating features is needed.
Long-term prognostic factors of young patients (≤ 35 years) having acute myocardial infarction: the detrimental role of continuation of smoking
Authors: Rallidis Loukianos S. , Lekakis John , Panagiotakos Demosthenes , Fountoulaki Katerina , Komporozos Christoforos , Apostolou Thomas , Rizos loannis , Kremastinos Dimitrios T. 
Published: September 2008

Background There are few and conflicting data regarding the prognostic role of continued smoking in very young survivors of acute myocardial infraction (AMI) after the event. Design We conducted a prospective study to evaluate the impact of smoking habits on long-term outcome in individuals who sustained AMI at the age of ≤ 35 years. Methods We recruited 147 consecutive patients who had survived their first AMI at the age of ≤ 35 years. Patients were followed up for up to 10 years. Clinical end points were: readmission for acute coronary syndrome, cardiac death or coronary revascularization because of clinical deterioration. Results The most prevalent risk factor at presentation was smoking (94.8%). Follow-up data were obtained by 135 patients (32 ± 3 yeas old, 115 men). During follow-up 75 (55.6%) patients reported continuation of smoking. Forty-four (32.6%) patients presented cardiac events (three cardiac deaths, 30 acute coronary syndromes, and 11 revascularizations). Multivariate data analysis showed that persistence of smoking (relative risk = 2.35, 95% confidence interval 1.5–5.25, P = 0.03) and ejection fraction at presentation (relative risk = 0.95, 95% confidence interval 0.91–0.98, P= 0.008) were the only significant predictors of cardiac events after adjusting for various confounding factors. In addition, continuation of smoking was the most significant predictor of cardiac events during follow-up in our sample (i.e. had the lowest log-likelihood ratio as compared with ejection fraction or other covariates). Conclusion Persistence of smoking is the most powerful predictor for the recurrence of cardiac events in patients with premature AMI.
Vital exhaustion in coronary heart disease: the impact of socioeconomic status
Authors: Skodova Zuzana , Nagyova Iveta , Rosenberger Jaroslav , van Dijk Jitse P. , Middel Berrie , Vargova Helena , Sudzinova Adriana , Studencan Martin , Reijneveld Sijmen A. 
Published: September 2008

Background Vital exhaustion has been shown to be a significant risk factor contributing to coronary heart disease, as well as a predictor of a worse prognosis among coronary patients. Socioeconomic differences in vital exhaustion may be part of the causal mechanism in the health and mortality inequalities connected with socioeconomic disadvantage. Our aim was to explore socioeconomic inequalities in vital exhaustion among coronary patients. Methods We included 362 patients (32% women, mean age 56 ± 7.3 years) who were referred for coronary angiography. The Maastricht interview for vital exhaustion was conducted with each patient. Level of income and education were used as indicators of socioeconomic status. Functional status was assessed with the NYHA (dyspnoe symptoms) and CCS (chest pain) scales. Results Logistic regression showed significant socioeconomic inequalities in vital exhaustion among patients. Participants with low and middle income and education had a higher probability of being exhausted in comparison with patients with high income and education [odds ratio (95% confidence interval): 13.31 (4.67–37.94) and 2.10 (1.19–3.64), respectively]. Associations remained statistically significant after controlling for the effect of functional status and seriousness of disease. Socioeconomic differences were more salient among men than among women. Conclusion Low education and income seem to be strongly associated with higher vital exhaustion among patients; a significant factor contributing to worse prognosis and lower quality of life among patients with coronary heart disease.
Marital status and risk of out-of-hospital sudden cardiac arrest in the population
Authors: Empana Jean-Philippe , Jouven Xavier , Lemaitre Rozen , Sotoodehnia Nona , Rea Tom , Raghunathan Tom , Simon Gregory , Siscovick David 
Published: September 2008

Background We have recently reported on the association between clinical depression and out-of-hospital sudden cardiac arrest (SCA). In this study, we extend our research on the contribution of psychosocial characteristics to SCA, by examining the association between marital status and out-of-hospital SCA. Design A large case-control study of risk factors for incident SCA including 2119 cases and 4042-matched controls. Methods Participants were enrollees of a health maintenance organization (USA). Cases experienced SCA between 1980 and 1994 (mean age of 67 years). Controls were a stratified random sample of enrollees, with the strata defined by age, sex, earlier heart disease, and calendar year. The marital status at the time of the SCA or a comparable index date for controls was assessed using ambulatory care medical records. Conditional logistic regression was used to estimate odds ratio and its 95% confidence interval. Results Cases were more likely to be unmarried than the controls (30.2% vs. 21.0%), defined as being separated or divorced (10.0% vs. 7.0%), single (5.0% vs. 3.6%) or widowed (15.2% vs. 10.4%). Unmarried participants had a higher risk of SCA (odds ratio: 1.53; 95% confidence interval: 1.33–1.76), after adjustment for SCA risk factors. Consistent findings were observed according to sex, older age (>70 years), earlier coronary heart disease and the presence of clinical depression. Those who were both unmarried and clinically depressed had the highest risk of SCA. Conclusion These data support an association between marital status and SCA.
Symptoms of fatigue and depression in ischemic heart disease are driven by personality characteristics rather than disease stage: a comparison of CAD and CHF patients
Authors: Smith Otto R.F. , Pedersen Susanne S. , Van Domburg Ron T. , Denollet Johan 
Published: September 2008

Background Symptoms of fatigue and depression are prevalent across stages of ischemic heart disease (IHD). We examined (i) the effect of both the IHD stage and type-D personality on fatigue and depressive symptoms at 12-month follow-up, and (ii) whether the effect of type-D personality on these symptoms is moderated by IHD stage. Methods Two different samples of patients were included to represent IHD stage: 401 percutaneous coronary intervention patients (early-stage IHD) and 105 ischemic chronic heart failure patients (end-stage IHD) completed the DS14 Type-D Scale at baseline. Logistic regression analysis was used to examine the impact of IHD stage and type-D personality on fatigue and depression at follow-up. Results Disease stage was neither associated with symptoms of fatigue ( P = 0.99) nor depression ( P = 0.29) at 12 months. In contrast, type-D personality was shown to predict both symptoms of fatigue [odds ratio (OR) = 2.96; 95% confidence interval (CI): 1.92–4.58, P < 0.001] and depression (OR = 4.91; 95% CI: 3.16–7.65, P < 0.001) at follow-up; the effect of type-D personality on these symptoms was not moderated by disease stage. In multivariable analysis, type-D remained a significant predictor of symptoms of fatigue (OR = 3.14; 95% CI: 1.98–4.99, P < 0.001) and depression (OR = 5.90; 95% CI: 3.60–9.67, P < 0.001), also after controlling for symptom levels at baseline. Conclusion Type-D personality but not disease stage predicted symptoms of fatigue and depression at 12-month follow-up.
The Need for Standardization of Methods for Worldwide Infant Hearing Screening: A Systematic Review
Authors: Olusanya Bolajoko O. , Somefun Abayomi O. , Swanepoel De Wet 
Published: September 2008

AbstractNo uniform case definition presently exists for infant hearing screening programs worldwide especially for minimal hearing loss (HL). This article systematically reviewed the current practices in developing countries for programs aimed at early detection of “disabling” congenital and early‐onset HL and found significant variations which undermine comparability of key findings in the reported studies. Implications for the exclusion of minimal HL are explored within the context of the International Classification of Functioning, Disability and Health (ICF) of the World Health Organization and its adapted version for children and youth (ICF‐CY). A revised World Health Organization classification that accounts for all categories of HL based on ICF‐CY may provide a suitable framework for improved uniformity in reporting standards.
Investigation of Pharyngeal Swallowing Function Using High‐Resolution Manometry
Authors: Takasaki Kenji , Umeki Hiroshi , Enatsu Kaori , Tanaka Fujinobu , Sakihama Noriyuki , Kumagami Hidetaka , Takahashi Haruo 
Published: September 2008

AbstractObjectives/Hypothesis: This study aimed to demonstrate the feasibility of a novel high‐resolution manometry system, and to establish normal values of swallowing pressures along the velopharynx and upper esophagus.Study Design: Prospective study.Methods: Thirty‐three asymptomatic adult Japanese controls were studied. A solid‐state high‐resolution manometry assembly with 36 circumferential sensors spaced 1 cm apart was positioned to record pressures during swallowing from the velopharynx to the upper esophagus. The maximum values of the swallowing (dry and 5 mL of water) pressures at velopharynx, meso‐hypopharynx, and at the upper esophageal sphincter (UES) were measured. The resting UES pressure, the length of the part in the cervical esophagus showing the resting UES pressure, and the distances from the nostril to the above‐mentioned points of pressure measurement were also measured.Results: The maximum value of dry and water swallowing pressures at the velopharynx, meso‐hypopharynx and UES, and the distances from the nasal vestibulum to each point in men were 141.1 ± 73.5 (mm Hg, mean ± standard deviation) and 162.7 ± 94.9, 175.3 ± 59.7 and 182.9 ± 83.6, 172.7 ± 73.8 and 236.1 ± 78.9, and 10.0 ± 1.3 (cm) and 10.1 ± 1.4, 14.1 ± 1.5 and 14.4 ± 1.3, 17.9 ± 1.7 and 18.0 ± 1.4, respectively. Those in women were 118.9 ± 38.0 (mm Hg) and 124.7 ± 43.4, 165.9 ± 41.5 and 167.3 ± 65.0, 149.2 ± 68.7 and 243.7 ± 87.4, and 9.5 ± 1.2 (cm) and 9.4 ± 1.2, 13.0 ± 1.5 and 12.8 ± 1.4, 15.8 ± 1.5 and 16.0 ± 1.3, respectively. The maximum value of resting UES pressure, the length of the part in the cervical esophagus showing the resting UES pressure and the distance from the nostril to the mid‐point of the width of the resting UES pressure in men and in women were 70.2 ± 30.0 mm Hg, 4.0 ± 0.7 cm, 19.1 ± 1.3 cm, and 61.8 ± 26.7 mm Hg, 3.6 ± 0.6 cm, 17.0 ± 1.2 cm, respectively.Conclusion: The present study provides anatomical and physiological information about normal swallowing along the velopharynx and upper esophagus, which will be an aid to the future clinical and investigative studies.
Acoustic Trauma Augments the Cochlear Immune Response to Antigen
Authors: Miyao Masumichi , Firestein Gary S. , Keithley Elizabeth M. 
Published: September 2008

AbstractObjectives/Hypothesis: To test whether noise‐exposure, which activates a cochlear immune response with cytokine expression and infiltration of circulating leukocytes could augment the response to antigen (Ag).Study Design: Randomized, prospective, mice.Methods: We sensitized mice to an Ag, injected it intrathecally, and subsequently exposed the mice to noise (8–16 kHz, 90, 100, or 118 dB for 2 hours). Control mice received either noise exposure alone (100 or 118 dB), Ag challenge alone, intrathecal surgery and phosphate‐buffered saline injection or no treatment. Four hours or 7 days later the mice were killed and cochlear sections were evaluated immunohistochemically for CD45, ICAM‐1, and phospho‐nuclear transcription factor‐κB expression.Results: Intrathecal Ag injection caused no hearing loss, but did result in a small immune response. Loud noise (118 dB) caused severe hearing loss and slight inflammation. The number of CD45‐positive cells was significantly greater in the Ag plus‐118 dB noise group relative to the Ag‐alone group or 118 dB noise‐exposure group. ICAM expression was seen in the lower part of the spiral ligament and small vessels within the normal cochlea. The amount of expression increased after Ag injection and acoustic trauma. Activated nuclear transcription factor‐κB occurred in the nuclei of hair cells, supporting cells, spiral ligament fibrocytes, and neurons 4 hours after noise exposure.Conclusions: It seems that noise exposure can activate a cochlear immune response, which in the presence of Ag, allows for greater recruitment of inflammatory cells than occurred in response to Ag alone.
Minimally Invasive Pituitary Surgery
Authors: Senior Brent A. , Ebert Charles S. , Bednarski Karen K. , Bassim Marc K. , Younes Mahar , Sigounas Dimitri , Ewend Mathew G. 
Published: September 2008

AbstractObjectives/Hypothesis: Surgical approaches to the pituitary have undergone numerous refinements over the last 100 years. The introduction of the endoscope and the advent of minimally invasive pituitary surgery (MIPS) have revolutionized pituitary surgery. This study aims to compile and evaluate outcomes of all of the MIPS performed at our institution.Study Design: Retrospective, cases series of 176 consecutive patients undergoing MIPS.Methods: Patient demographics, tumor characteristics, and intraoperative or postoperative complications for of 176 consecutive patients undergoing MIPS were complied. Statistical analysis for categorical variables and incidence across series were conducted using Pearson's χ2 test and Fisher's exact tests. Odd ratios were calculated to relate the discrete variables to outcomes and designing clinical prediction of risk.Results: One hundred seventy‐six patients who underwent 193 procedures. Pathologic evaluation revealed 147 of the tumors to be pituitary adenomas. Only one death occurred (mortality rate of 0.5%). The rate of diabetes insipidus occurred in 20.2% of the procedures. Vascular complications occurred in 5.2% of the procedures. Intraoperative cerebrospinal fluid (CSF) leaks were identified in 19.7% whereas postoperative CSF leak was noted in 10.3%. Resection of Rathke's cleft cyst correlated higher risk of both intraoperative and postoperative CSF leak (OR = 2.6, P <.001). Resection of tumors other than adenomata correlated with significantly higher risk of CSF leak (OR = 9.0, P = <.001). Sinusitis occurred after eleven resections (5.7%). Meningitis occurred in 2 of 193 resections (1.0%) in our series. Two neurologic complications occurred in our series, pneumocephalus and cranial neuropathy (1.0%). No other complications occurred.Conclusions: MIPS is a safe and efficacious marriage of the endoscope to the transsphenoidal approach. Thus, a brightness and clarity of vision is combined with the unique ability to explore the tumor bed with angled views and hydroscopy. Outcomes and complication rates comparable to traditional transsphenoidal approaches have resulted but with less dissection and tissue manipulation, reduced need for packing, and greater patient comfort and acceptance.
Quality of Life Measures and Predictors for Adults With Unilateral Vocal Cord Paralysis
Authors: Fang Tuan‐Jen , Li Hsueh‐Yu , Gliklich Richard E. , Chen Ya‐Hui , Wang Pa‐Chun , Chuang Hsiu‐Feng 
Published: September 2008

AbstractObjective/Hypothesis: To investigate the quality of life (QoLF) status of Taiwanese adults with unilateral vocal cord paralysis (UVCP).Study Design: A prospective, QoLF survey in a tertiary referral voice center.Methods: Fifty‐five consecutive UVCP patients were evaluated with Medical Outcome Study Short Form‐36 (SF‐36) Health Survey and the voice outcome survey at entry.Results: UVCP patients have significantly lower scores in all eight SF‐36 subscales (P < .05) than do normative Taiwan adult population, particularly in role functioning‐physical problems, social functioning, and role functioning‐emotional problems. Shimmer parameter is a robust and consistent predictor for bodily pain (β = −20.8), role functioning‐emotional problems (β = −27.9), and social functioning (β = −20) general health dimensions. Shimmer is also predictive of UVCP‐related total voice outcome survey score (β = −8.6, P < .05).Conclusions: UVCP can seriously compromise phonation, swallowing, and social functions; thus significantly impacting a patient's general health status. Voice physiological function is also a QoLF outcome indicator.
Imaging of the Calf Vocal Fold With High‐Frequency Ultrasound
Authors: Walsh Conor J. , Heaton James T. , Kobler James B. , Szabo Thomas L. , Zeitels Steven M. 
Published: September 2008

AbstractObjectives/Hypothesis: High‐frequency ultrasound imaging offers the potential for assisting in the diagnosis and treatment of vocal fold pathology if it allows aspects of vocal fold microstructure to be visualized noninvasively. The objective of this study was to assess the ability of high‐frequency ultrasound to image vocal fold anatomy and injected biomaterials.Study Design: The vocal folds of two excised calf larynges were imaged ex vivo and compared with corresponding histological sections.Methods: High‐frequency ultrasound imaging was performed under saline submersion using 40 and 50 MHz transducers, and corresponding cryostat cross‐sections were stained with H&E, Trichome, and Verhoeff's Van Gieson stains.Results: The epithelial surface, lamina propria, and underlying muscle were easily identified with the high‐frequency ultrasound as verified with histological sections representing each imaged region. The arytenoid cartilage vocal process can also be clearly distinguished from the surrounding tissue, as can the full extent of injected biomaterials within the superficial lamina propria. Useful ultrasound resolution was obtained to depths of at least 10 mm within the tissue with the 40 MHz transducer.Conclusions: This preliminary study demonstrates the capability of high‐frequency ultrasound to image the layered anatomy of the calf vocal fold and to discern materials injected into the superficial lamina propria, indicating that this technology holds a strong potential for use in phonosurgery.