bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Off-Pump Coronary Artery Bypass Grafting on Patient Outcome
Authors: Sohrabi Farrokh , Mispireta Luis A. , Fiocco Michael , Dibos Luis A. , Buescher Philip C. , Sloane Peter J. 
Published: August 2007

Background Cardiopulmonary bypass (CPB) is associated with postoperative myocardial stunning, hypothermia, formation of microemboli, and systemic inflammatory response syndrome, all of which may prolong recovery from coronary artery bypass grafting (CABG) surgery. This study sought to compare outcomes in patients undergoing CABG off pump versus on pump. Methods Outcomes, including mortality and several morbidities, were reviewed in 1,623 on-pump patients and 683 off-pump patients. Morbidities assessed included postoperative bleeding, incidence of multiorgan dysfunction, and neurologic complications. Chi-square and t-test analysis were used to determine statistical significance. Results Mortality was 42% lower in the off-pump group than the on-pump group. Both critical care and total hospital length of stay were significantly shorter in the off-pump group. The incidence of postoperative bleeding requiring transfusion or a return to the operating room was reduced by 29% in the off-pump group and the incidence of multiorgan dysfunction was reduced by 31%. The off-pump patients also presented a significantly lower incidence of cerebral vascular accidents and seizures than on-pump patients. Conclusions We conclude that there is an association between improved patient outcome and off-pump CABG surgery. The outcomes of this study show a statistically significant decrease in mortality, critical care length of stay, total hospital stay, incidence of bleeding requiring transfusion or return to the operating room, amount of blood transfused, incidence of multiorgan dysfunction, cerebral vascular accidents, and seizures in off-pump patients when compared with on-pump patients. Such results support the use of myocardial revascularization off pump as an alternative to CABG surgery on pump. CABG surgery off pump may allow a better postoperative clinical course in patients who are candidates for the procedure.
Radionuclide-Based Insights into the Pathophysiology of Ischemic Heart Disease: Beyond Diagnosis
Authors: Michelena Hector I. , Vecker William A. 
Published: August 2007

This review article discusses the historical origin of cardiac radionuclide-based methods, the physiologic background that justifies their existence, as well as the basic pathophysiologic concepts of coronary artery disease and their connection with the technologic design and application of these methods. Most importantly, this review discusses the important insights that these methods have provided to the understanding of the mechanisms of ischemia, risk stratification, and both treatment choice and treatment efficacy in ischemic heart disease. Nuclear cardiology originated as an attempt to provide complementary physiologic information to the anatomic information provided by coronary angiography. To comprehend the design and applications of nuclear cardiology methods, one must have a basic understanding of coronary artery disease as an inflammatory process that may manifest as acute or chronic states. Basic concepts on myocyte metabolic pathways, coronary blood flow, ischemic cascade, ventricular remodeling, and ejection fraction become critical for this purpose. Insights into risk stratification may permit patient-tailored therapy approaches. Insights into prognosis have made nuclear cardiology a robust tool for outcome predictions, with an exceptionally high negative predictive value. Evaluation of prognosis in special patient populations such as diabetics has originated important pathophysiologic concepts. Most insights into phenomena such as myocardial hibernation, myocardial stunning, and viability have been generated by nuclear cardiology techniques. Finally, new applications of radionuclide-based methods such as molecular identification of “vulnerable” atherosclerotic plaques, “ischemic memory” using fatty acid imaging, and myocardial innervation imaging provide new avenues for insightful research.
Insulin Therapy, Glycemic Control, and Cardiovascular Risk Factors in Young Latin Americans with Type 2 Diabetes Mellitus
Authors: Avilés-Santa Larissa , Salinas Karin , Adams-Huet Beverley , Raskin Philip 
Published: August 2007

Background Type 2 diabetes has been linked to an increased risk of cardiovascular (CV) disease, but this risk has not been well documented in young patients, especially of Latin American descent. Also, the potential CV benefits of insulin therapy have not been evaluated in young patients with type 2 diabetes. The objectives of this study were to determine any gender-related difference in the presence of CV risk factors in young Latin Americans with poorly controlled type 2 diabetes and the effect of intensive insulin therapy on these CV risk factors. Methods and Results Fifty-seven Latin American patients with type 2 diabetes between the ages 18 and 45 years were evaluated at baseline. All women were premenopausal and had regular menstrual periods. The mean body mass index (BMI) was > 30 kg/m2 in both genders. Percent body fat, percent hemoglobin A1c, and lipoprotein profiles were similar between genders. Highly sensitive C-reactive protein (CRP) levels were elevated and similar between genders (p = .4). Leukocyte adhesion molecules (intercellular adhesion molecule 1, vascular adhesion molecule 1, E-selectin) and monocyte chemoattractant protein 1 were elevated, whereas adiponectin levels were below normal in both gender groups. Urinary albumin excretion was similar between genders and did not show any relationship with any of the variables. In women, there was a direct relationship between waist circumference and high-sensitivity CRP levels (rho = .53, p = .01). No other significant relationships were observed. Eighteen Latin American patients with type 2 diabetes completed up to 104 weeks of postintervention with insulin monotherapy. In these patients, glycemic, lipoprotein, and anthropometric measurements were obtained every 12 weeks. Highly sensitive CRP, leukocyte adhesion molecules, and urinary albumin excretion, among other tests, were obtained every 52 weeks. At 52 and 104 weeks, body weight, BMI, waist circumference, and percent body fat increased in a parallel and significant manner. Despite a significant decrease in percent hemoglobin A1c (22.2%; p = < .0001), lipid and lipoprotein profiles, highly sensitive CRP, leukocyte adhesion molecules, and other nontraditional CV risk factors did not change significantly. Conclusions In young, obese, Latino type 2 diabetic patients, improvement in glycemic control with insulin monotherapy was not associated with a parallel improvement in markers of vascular inflammation. Premenopausal Latino women with uncontrolled type 2 diabetes have CV risks comparable to Latino diabetic men of the same age. Obesity and underlying insulin resistance may counteract the potential CV benefits associated with insulin therapy in lean diabetic patients. Weight loss could be a potential therapeutic modality to improve CV risk in Latino type 2 diabetic patients, especially women.
Attitudes toward Hormone Replacement Therapy in the New Millennium: University Physicians’ and Patients’ Perspectives
Authors: Ismail Hassan M. , Aleveritis Ellie , Guha Bhuvana , Olive Kenneth , Sloan Susan 
Published: August 2007

Background Recent studies are changing the way physicians and patients view hormone replacement therapy (HRT). This study was performed at the East Tennessee State University (ETSU) internal medicine clinic to evaluate the current behaviors of university physicians and patients with respect to HRT. Methods A retrospective chart review was conducted at the main internal medicine outpatient clinic at ETSU. Two hundred seventy-four postmenopausal female patients were randomly selected using a computerized systematic sampling technique of International Classification of Diseases, Ninth Revision (ICD-9) codes for menopause or postmenopause. The study period was from July 2002 until June 2004. Patients were postmenopausal women age 35 years or over who had been seen by their physicians at least twice a year during the study period. Patients who were noncompliant with HRT or physician's visits or had contraindications or side effects to HRT mandating discontinuation of the treatment were excluded. Data regarding physicians’ patterns in discussion and discontinuation of the therapy and patients’ responses were collected. Epi Info 2002 was used for statistical analysis. Results One hundred seventy-seven patients met all of the criteria, of whom 140 were 35 to 75 years of age. Of this age group, 49 patients (35%) had coronary artery disease (CAD), 101 (72.1%) were on HRT prior to July 2002, and 30 (21.4%) had osteoporosis. Seventy-five patients (53.6%) had documented discussions with their physicians about HRT after July 2002. Most patients who were on HRT had no CAD (p = .0008). Of the patients who were on HRT, only 36 (35.6%) continued treatments (23 continued the same dose, and 13 had the dose modified), whereas 65 (64.3%) had treatments discontinued. HRT discussions were carried on mostly when patients had treatments stopped or modified (p = .0032). Of these patients who had discussions, 60 (80%) were advised to stop or modify the dose and agreed, and only 15 (20%) disagreed or received unbiased discussions from their physicians about HRT. Thiry-seven patients were over 75 years of age. This older group had a higher rate of HRT discontinuation (82%) but a lower rate of documented discussion (22%) than the younger group. Conclusion Physicians should pay more attention to the importance of providing high-quality and well-balanced patient counseling when addressing uncertain treatments and adequately document discussions with patients in medical records.
Current Status of Integrating Information Technologies into the Clinical Research Enterprise within US Academic Health Centers: Strategic Value and Opportunities for Investment
Authors: Turisco Fran , Keogh Diane , Stubbs Connie , Glaser John , Crowley William F. 
Published: August 2007

Little information exists about the incorporation of information technologies (ITs) into clinical research processes within US academic health centers (AHCs). Therefore, we queried a group of 37 leading AHCs regarding their current status and future plans in clinical research IT. The survey specifically inquired about the presence or absence of basic infrastructure and IT support requirements; individual applications needed to support study preparation, study conduct, and its administrative support; and integration of data from basic research, clinical trials, and the clinical information systems increasingly used in health care delivery. Of the 37 AHCs, 78% responded. All strongly agreed that a “state-of-the-art” clinical research IT program would be ideal today and will be essential tomorrow. Nonetheless, no AHC currently has an IT solution that even approached this ideal. No AHC reported having all of the essential management foundations (ie, a coherent vision, an overall strategy, a governance structure, and a dedicated budget) necessary to launch and sustain a truly successful implementation of a cohesive clinical research IT platform. Many had achieved breakthroughs in individual aspects of clinical research IT, for example, adverse event reporting systems or consent form templates. However, overall implementation of IT to support clinical research is uneven and insufficient. These data document a substantial gap in clinical research IT investments in leading US AHCs. Linking the clinical research IT enterprise with its clinical operations in a meaningful fashion remains a crucial strategic goal of AHCs. If they are to continue to serve as the “translational research engines” that our society expects, AHCs must recognize this gap and allocate substantial resource deployment to remedying this situation.
Does Diabetes Mellitus Explain the Higher Hospital Mortality of Women with Acute Myocardial Infarction? Results from the Berlin Myocardial Infarction Registry
Authors: Maier Birga , Thimme Walter , Kallischnigg Gerd , Graf-Bothe Claudia , Röhnisch Jens-Uwe , Hegenbarth Claire , Theres Heinz 
Published: August 2007

Background Women with acute myocardial infarction (AMI) exhibit greater hospital mortality than do men. In general, diabetes mellitus is one of the major factors influencing the outcome of patients with AMI. The aim of this study was to analyze the interaction between diabetes and gender, specifically with regard to the higher hospital mortality of female AMI patients aged ≤ 75 years. Methods We prospectively collected data from 3,715 patients aged ≤ 75 (2,794 men, 921 women) with acute myocardial infarction who were treated in 25 hospitals in Berlin, Germany, from 1999 to 2002. In a multivariate analysis, we specifically studied the interaction between the factors diabetes mellitus and gender in their effects on hospital mortality. Results After adjustment in multivariate analysis, the interaction between gender and diabetes was statistically significant, and the estimated odds ratios were as follows: female diabetic patients compared with male diabetic patients, odds ratio (OR) = 2.28 (95% confidence interval [CI] 1.42-3.68); female diabetic patients compared with male nondiabetic patients, OR = 2.90 (95% CI 1.90-4.42); and female diabetic patients compared with female nondiabetic patients, OR = 2.92 (95% CI 1.75-4.87). There was no statistically significant difference between the risk of dying for female nondiabetic patients or for male diabetic patients when compared with male nondiabetic patients. Conclusions In AMI patients aged ≤ 75 years, female gender alone is not an independent predictor of hospital mortality. Detailed, multivariate analysis reveals that specifically diabetic women demonstrate higher hospital mortality than do men. Special attention should be provided to these female diabetic patients.
Why is Orthostatic Tolerance Lower in Women than in Men? Renal and Cardiovascular Responses to Simulated Microgravity and the Role of Midodrine
Authors: Grenon Marlene S. , Xiao Xinshu , Hurwitz Shelley , Sheynberg Natalie , Kim Christine , Seely Ellen W. , Cohen Richard J. , Williams Gordon H. 
Published: August 2007

Background Exposure to microgravity induces cardiovascular deconditioning, manifested by orthostatic intolerance (OI). We assessed the renal, cardioendocrine, and cardiovascular responses of women and men to simulated microgravity to examine the impact of gender on OI. Methods Fifteen healthy female and 14 healthy male subjects were given a constant diet for 3 to 5 days, after which they underwent a tilt-stand test (pre-TST) and began 14 to 16 days of head-down tilt bed rest (HDTB), followed by a repeat tilt-stand test (post-TST). Female subjects began HDTB so that the post-TST was at the same time in their menstrual cycle as their pre-TST. Twenty-four-hour urine collections (daily), hormonal measurements, plethysmography, and cardiovascular system identification were performed. Results The times to presyncope were significantly different for men and women before ( p = .005) and after HDTB ( p = .001), with all of the women but only 50% of the men experiencing presyncope during the pre-TST ( p = .002) and all of the women but only 64% of the men experiencing presyncope during the post-TST. At baseline, the following differences between women and men were observed: women had higher serum aldosterone levels ( p = .02), higher parasympathetic responsiveness ( p = .01), lower sympathetic responsiveness ( p = .05), and lower venous compliance ( p = .05). Several parameters changed with HDTB in both men and women. In a double-blinded randomized trial, midodrine (5 mg orally) or placebo given to female subjects 1 hour before post-TST was ineffective in preventing OI. Conclusion In conclusion, the frequency of OI is higher in women than in men and is not modified by midodrine at the dose used. This increased susceptibility is likely secondary to intrinsic basal differences in the activity of volume-mediated parasympathetic and adrenergic systems and in venous tone. Thus, approaches to reduce OI in women are likely to differ from those effective in men.
Focal Segmental Glomerulosclerosis in Patients with Mandibuloacral Dysplasia Owing to ZMPSTE24 Deficiency
Authors: Agarwal Anil K. , Zhou Xin J. , Hall Roger K. , Nicholls Kathy , Bankier Agnes , Van Esch Hilde , Fryns Jean-Pierre , Garg Abhimanyu 
Published: August 2007

Background Mandibuloacral dysplasia (MAD) is a rare autosomal recessive disorder characterized by skeletal abnormalities such as hypoplasia of the mandible and clavicles and acro-osteolysis. Other features include cutaneous atrophy and lipodystrophy. Two genetic loci are known for MAD: lamin A/C ( LMNA), encoding structural nuclear lamina proteins, and zinc metalloproteinase ( ZMPSTE24), a membrane-bound endoprotease involved in post-translational proteolytic cleavage of carboxy terminal residues of prelamin A to form mature lamin A. Methods Mutational analysis of ZMPSTE24 in an additional patient with MAD and determination of functional activity of mutant ZMPSTE24 in a yeast growth arrest pheromone diffusion (halo) assay. Results We previously reported a Belgian woman with MAD who had ZMPSTE24 mutations and died of complications of chronic renal failure at the age of 27.5 years. We now report a 37-year-old Australian man with MAD who also had compound heterozygous mutations in the ZMPSTE24 gene, a null mutation, Phe361fsX379, and a missense mutation, Asn265Ser, which is partially active in the yeast complementation assay. He also developed end-stage renal disease and, despite receiving a cadaveric renal transplantation, died prematurely at the age of 37 years. Renal biopsies of both patients revealed focal segmental glomerulosclerosis, and the female patient had the collapsing variant. Conclusion These observations suggest focal segmental glomerulosclerosis as a phenotypic manifestation in patients with ZMPSTE24 deficiency.
Uric Acid Homeostasis in the Evaluation of Diuretic-Induced Hyponatremia
Authors: Liamis George , Christidis Dimitrios , Alexandridis George , Bairaktari Eleni , Madias Nicolaos E. , Elisaf Moses 
Published: August 2007

Background Diuretics are one of the most common causes of severe hyponatremia. The responsible pathogenetic mechanisms remain unclear. Serum uric acid concentration has been proposed as an index of differentiating between two pathophysiologic constructs of diuretic-induced hyponatremia-extracellular volume depletion and syndrome of inappropriate antidiuretic hormone secretion (SIADH)-like state-but its discriminating value has not been verified in large series of patients. Here we attempt to illuminate the pathophysiology of diuretic-induced hyponatremia by focusing on uric acid homeostasis. Additionally, we analyze the epidemiology and clinical characteristics of the disorder. Methods We studied prospectively 158 adult patients with hyponatremia on admission to our internal medicine clinic. Here we report on those with diuretic-induced hyponatremia. Results Forty patients (13 male and 27 female) had diuretic-induced hyponatremia, rendering it the most common cause of the disorder (25.3%). These patients had lower mean ([Na+]) (121.2 ± 7.2 vs 126.4 ± 4.1 mEq/L, p = .0001) than the remaining hyponatremic patients. Patients with serum uric acid levels < 4 mg/dL ( n = 14) exhibited a biochemical profile consistent with a SIADH-like state, whereas patients with serum uric acid levels ≥ 4 mg/d ( n = 26) were consistent with extracellular volume depletion. Conclusions Diuretics are the most common cause of community-developed hyponatremia. The serum uric acid level effectively discriminates between two biochemical profiles of diuretic-induced hyponatremia, one consistent with extracellular volume depletion and another that simulates SIADH.
Cellular Immunity and Inflammatory Mediator Responses to Intense Exercise in Overweight Children and Adolescents
Authors: McMurray Robert G. , Zaldivar Frank , Galassetti Pietro , Larson Jennifer , Eliakim Alon , Nemet Dan , Cooper Dan M. 
Published: August 2007

Background Obesity modifies inflammatory mediators, but little is known about how obesity modifies the inflammatory responses of exercising children. This study assessed the acute effect of exercise on inflammatory mediators in overweight children. Methods Twenty-eight overweight (OW) youth (body mass index > 85%) and 30 normal-weight (NW) controls of the same proportions of age and gender performed 10 2-minute bouts of cycle ergometry exercise above the anaerobic threshold, with 1-minute rest intervals between bouts. Pre- and postexercise blood samples were collected for white blood cell subpopulation and inflammatory cytokines. Results Baseline leukocyte populations were higher in OW youth ( p < .05). Exercise increased most leukocyte subtypes for both groups ( p < .05). Granulocytes remained elevated 2 hours postexercise ( p < .05) for both groups, whereas monocytes remained elevated 2 hours postexercise for the OW children. Natural killer (NK) cells dropped below baseline 2 hours postexercise. Exercise significantly decreased CD4 and CD8 cells, which remained depressed 2 hours postexercise in the OW children. Baseline levels of interleukin (IL)-6 were ≈64% higher in OW children ( p < .001). Exercise increased IL-6 in both groups ( p < .001), which further increased 2 hours postexercise ( p < .05). Tumor necrosis factor α, IL-1β, and IL-1 receptor antagonist did not change with exercise. Conclusions Elevated baseline leukocyte subtypes and IL-6 levels in OW children suggest that childhood obesity is associated with a chronic low-grade inflammatory state. The acute inflammatory response to intense exercise appears to be similar between NW and OW children for most markers, but the depression of NK, CD4, and CD8 cells 2 hours postexercise suggests that an acute risk of mitogen-induced inflammation may exist in OW children after high-intensity exercise.
Variability in Postheparin Hepatic Lipase Activity is Associated with Plasma Adiponectin Levels in African Americans
Authors: Clarenbach Jacob J. , Vega Gloria Lena , Adams-Huet Beverley , Considine Robert V. , Ricks Madia , Sumner Anne E. 
Published: August 2007

Background African Americans commonly have normal high-density lipoprotein cholesterol (HDL-C) and low triglyceride levels despite having insulin resistance and obesity. The higher than expected HDL-C levels are usually attributed to low levels of hepatic triglyceride lipase (HTGL) activity. Factors that regulate HTGL in African Americans are not well delineated. Methods In the current study, HTGL activity was examined in relation to indices of body fat (body mass index [BMI] and waist circumference [WC]), insulin resistance (fasting plasma insulin and homeostasis model assessment of insulin resistance [HOMA-IR] index), and adipokines (adiponectin and leptin). Sixty-three African Americans (33 men, 30 women; median age 31 years, range 20-50 years; median BMI 28.6 kg/m2, range 19.7-54.7 kg/m2) had anthropometry and measurement of postheparin lipase activities (HTGL), plasma HDL-C, triglycerides, and plasma adiponectin. Results HTGL correlated strongly with HDL-C ( r = −.52, p < .0001) and adiponectin ( r = −.49, p < .001). HTGL increased with BMI and WC ( r = .297, p = .018 and r = .301, p = .016, respectively). Adiponectin correlated strongly with HDL-C ( r = .50, p < .0001) and triglycerides ( r = −.493, p < .001). From multiple regression models, 28% of HTGL variability among African Americans can be explained by adiponectin levels in combination with gender and 35% of HTGL is explained with HDL-C included in the model. Conclusion The data suggest that adiponectin is a significant metabolic concomitant of HTGL activity in African Americans.