bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence of Sudden Cardiac Death and Life-Threatening Arrhythmias in Clinically Manifest Cardiac Sarcoidosis With and Without Current Indications for an Implantable Cardioverter Defibrillator
Authors: Nordenswan Hanna-Kaisa , Pöyhönen Pauli , Lehtonen Jukka , Ekström Kaj , Uusitalo Valtteri , Niemelä Meri , Vihinen Tapani , Kaikkonen Kari , Haataja Petri , Kerola Tuomas , Rissanen Tuomas T. , Alatalo Aleksi , Pietilä-Effati Päivi , Kupari Markku 
Published: September 2022

Background:
Cardiac sarcoidosis (CS) predisposes to sudden cardiac death (SCD). Guidelines for implantable cardioverter defibrillators (ICDs) in CS have been issued by the Heart Rhythm Society in 2014 and the American College of Cardiology/American Heart Association/Heart Rhythm Society consortium in 2017. How well they discriminate high from low risk remains unknown.

Methods:
We analyzed the data of 398 patients with CS detected in Finland from 1988 through 2017. All had clinical cardiac manifestations. Histological diagnosis was myocardial in 193 patients (definite CS) and extracardiac in 205 (probable CS). Patients with and without Class I or IIa ICD indications at presentation were identified, and subsequent occurrences of SCD (fatal or aborted) and sustained ventricular tachycardia were recorded, as were ICD indications emerging first on follow-up.

Results:

Over a median of 4.8 years, 41 patients (10.3%) had fatal (n=8) or aborted (n=33) SCD, and 98 (24.6%) experienced SCD or sustained ventricular tachycardia as the first event. By the Heart Rhythm Society guideline, Class I or IIa ICD indications were present in 339 patients (85%) and absent in 59 (15%), of whom 264 (78%) and 30 (51%), respectively, received an ICD. Cumulative 5-year incidence of SCD was 10.7% (95% CI, 7.4%–15.4%) in patients with ICD indications versus 4.8% (95% CI, 1.2%–19.1%) in those without (χ
2
=1.834,
P
=0.176). The corresponding rates of SCD were 13.8% (95% CI, 9.1%–21.0%) versus 6.3% (95% CI, 0.7%–54.0%; χ
2
=0.814,
P
=0.367) in definite CS and 7.6% (95% CI, 3.8%–15.1%) versus 3.3% (95% CI, 0.5%–22.9%; χ
2
=0.680,
P
=0.410) in probable CS. In multivariable regression analysis, SCD was predicted by definite histological diagnosis (
P
=0.033) but not by Class I or IIa ICD indications (
P
=0.210). In patients without ICD indications at presentation, 5-year incidence of SCD, sustained ventricular tachycardia, and emerging Class I or IIa indications was 53% (95% CI, 40%–71%). By the American College of Cardiology/American Heart Association/Heart Rhythm Society guideline, all patients with complete data (n=245) had Class I or IIa indications for ICD implantation.

Conclusions:
Current ICD guidelines fail to distinguish a truly low-risk group of patients with clinically manifest CS, the 5-year risk of SCD approaching 5% despite absent ICD indications. Further research is needed on prognostic factors, including the role of diagnostic histology. Meanwhile, all patients with CS presenting with clinical cardiac manifestations should be considered for an ICD implantation.
Regnase-1 Prevents Pulmonary Arterial Hypertension Through mRNA Degradation of Interleukin-6 and Platelet-Derived Growth Factor in Alveolar Macrophages
Authors: Yaku Ai , Inagaki Tadakatsu , Asano Ryotaro , Okazawa Makoto , Mori Hiroyoshi , Sato Ayuko , Hia Fabian , Masaki Takeshi , Manabe Yusuke , Ishibashi Tomohiko , Vandenbon Alexis , Nakatsuka Yoshinari , Akaki Kotaro , Yoshinaga Masanori , Uehata Takuya , Mino Takashi , Morita Satoshi , Ishibashi-Ueda Hatsue , Morinobu Akio , Tsujimura Tohru , Ogo Takeshi , Nakaoka Yoshikazu , Takeuchi Osamu 
Published: September 2022

Background:
Pulmonary arterial hypertension (PAH) is a type of pulmonary hypertension (PH) characterized by obliterative pulmonary vascular remodeling, resulting in right-sided heart failure. Although the pathogenesis of PAH is not fully understood, inflammatory responses and cytokines have been shown to be associated with PAH, in particular, with connective tissue disease-PAH. In this sense, Regnase-1, an RNase that regulates mRNAs encoding genes related to immune reactions, was investigated in relation to the pathogenesis of PH.

Methods:

We first examined the expression levels of
ZC3H12A
(encoding Regnase-1) in peripheral blood mononuclear cells from patients with PH classified under various types of PH, searching for an association between the
ZC3H12A
expression and clinical features. We then generated mice lacking Regnase-1 in myeloid cells, including alveolar macrophages, and examined right ventricular systolic pressures and histological changes in the lung. We further performed a comprehensive analysis of the transcriptome of alveolar macrophages and pulmonary arteries to identify genes regulated by Regnase-1 in alveolar macrophages.

Results:

ZC3H12A
expression in peripheral blood mononuclear cells was inversely correlated with the prognosis and severity of disease in patients with PH, in particular, in connective tissue disease-PAH. The critical role of Regnase-1 in controlling PAH was also reinforced by the analysis of mice lacking Regnase-1 in alveolar macrophages. These mice spontaneously developed severe PAH, characterized by the elevated right ventricular systolic pressures and irreversible pulmonary vascular remodeling, which recapitulated the pathology of patients with PAH. Transcriptomic analysis of alveolar macrophages and pulmonary arteries of these PAH mice revealed that
Il6, Il1b
, and
Pdgfa/b
are potential targets of Regnase-1 in alveolar macrophages in the regulation of PAH. The inhibition of IL-6 (interleukin-6) by an anti–IL-6 receptor antibody or platelet-derived growth factor by imatinib but not IL-1β (interleukin-1β) by anakinra, ameliorated the pathogenesis of PAH.

Conclusions:
Regnase-1 maintains lung innate immune homeostasis through the control of IL-6 and platelet-derived growth factor in alveolar macrophages, thereby suppressing the development of PAH in mice. Furthermore, the decreased expression of Regnase-1 in various types of PH implies its involvement in PH pathogenesis and may serve as a disease biomarker, and a therapeutic target for PH as well.
Assessing the cardiotoxicity of Epirubicin-based chemotherapy in patients with breast cancer using high-sensitivity cardiac troponin T, N-terminal pro b-type natriuretic peptide and soluble suppression of tumorigenicity-2
Authors: Isemede Daniel A , Sharma Aabha , Bailey Joseph 
Published: September 2022

Background Cardiac toxicity resulting in long-term complications are recognised side effect of anthracycline-based chemotherapy used in the treatment of breast cancer. Current management modality involves measurement of left ventricular ejection fraction which has inherent limitations due to its dependence on haemodynamic conditions, and inability to detect subclinical changes in left ventricular systolic function. This study aimed to evaluate changes in the concentration of cardiac biomarkers present in serum as indicators of cardiac toxicity in breast cancer patients undergoing Epirubicin-based chemotherapy. Methods Eighty-one breast cancer patients elected to undergo Epirubicin chemotherapy were recruited. Blood samples taken at baseline, mid-cycle and final cycle of chemotherapy were analysed for hs-cTnT, NT-proBNP and sST2. Longitudinal changes in biomarkers were compared to pre-treatment baseline values and between treatment groups. Results At mid-cycle, mean cumulative dose of 265 mg/m2 of FEC elicited a 270% change in hs-cTnT but with no significant change in NT-proBNP and sST2. At the final cycle, mean cumulative dose of 340 mg/m2 of FEC elicited a 565% change in hs-cTnT with no significant change in NT-proBNP and sST2. There was progressive increase in hs-cTnT from baseline with increasing cumulative dose of Epirubicin. At mid-cycle, median hs-cTnT was 7.4 ng/L (IQR: 5.6–9.3) vs. baseline of 2.0 ng/L (IQR: 2.0–4.7) p < 0.001. Final cycle median hs-cTnT versus baseline was 13.3 ng/L (IQR: 8.2–22.1) vs. 2.0 ng/L (IQR: 2.0–4.7) p < 0.001. Conclusion Serial measurement of hs-cTnT but not NT-proBNP or sST2 during Epirubicin chemotherapy has important value in the early determination cardiomyocytes damage.
Completing a soundscape questionnaire reduces the psychological distance of sound and hearing
Authors: Welch David , Rana Komal , Reddy Ravi 
Published: September 2022

Objective: People are often resistant to hearing-health education messages such as those aimed at the prevention of noise-induced hearing loss. This resistance may be due to psychological distance: the perceived relevance of hearing and awareness of sound to daily life. The soundscape is the internal, perceptual, experience of a sound environment. The objective of this study was to explore people’s thought processes when completing a questionnaire designed to assess the soundscape and, in particular, to investigate whether the experience reduced psychological distance of sound and their hearing. Design: Semi-structured interviews and qualitative data analysis. Setting: Questionnaires were completed on personal phones in any environment participants wished. Interviews were conducted via online video connection. Method: A soundscape questionnaire was administered to a convenience sample of adult volunteers who were then interviewed about the experience of completing it, and how doing so had influenced their views of sound and their hearing. Results: Themes in three main areas were identified: the questions, which were found to be challenging but interesting; the soundscape, and the insights of participants about their own soundscape experience; and participants’ new awareness of sound and their own hearing. Conclusion: The findings provide interesting feedback about the meaning of responses to the questionnaire and on how people thought while using it. Furthermore, the findings imply that bringing the soundscape to a person’s conscious awareness may successfully reduce psychological distance for them about their hearing and may, therefore, be a useful preliminary to hearing-health education interventions.
IT'S REALLY NOT THE NOW—IT'S THE HOW!
Authors: Bisk Tsvi 
Published: September 2022

In this contribution to the World Affairs 2022 Special Issue, I engage Alon Ben‐Meir's proposal for an Israeli–Palestinian–Jordanian Confederation previously published in this journal and discussed in depth by scholars, diplomats, and policy practitioners in a panel at the March 2022 Policy Studies Organization Middle East Dialog conference in Washington, DC. Given that achieving such a confederation has been sabotaged over and again to date, a critical question is how do we get from here to there without upsetting the irrational passions of both sides? I suggest various practical steps and policies that might mitigate the conflict in ways that could inexorably lead to the final destination of Ben‐Meir's confederation.
‘Mum, I think we might ring the ambulance, okay?’ A qualitative exploration of bereaved family members’ experiences of emergency ambulance care at the end of life
Authors: Anderson Natalie Elizabeth , Robinson Jackie , Goodwin Hetty , Gott Merryn 
Published: September 2022

Background: In the context of a sudden or unexpected event, people with a life-limiting illness and their family caregivers may be dependent on emergency ambulance services Aim: To explore bereaved family members’ experiences of emergency ambulance care at the end of life. Design: A qualitative study using reflexive thematic analysis of data collected from semi-structured phone interviews. Setting/Participants: A purposive sample of 38 family caregivers identified from a database of deaths in Aotearoa, New Zealand. Results: Emergency ambulance personnel assist, inform and reassure patients and family caregivers managing distressing symptoms, falls, infections, unexpected events and death itself. Family members and patients are aware of the pressure on emergency services and sometimes hesitate to call an ambulance. Associating ambulances with unwanted transport to hospital is also a source of reluctance. Conclusions: The generalist palliative care provided by emergency ambulance personnel is a vital service for patients in the last year of life, and their caregivers. This must be acknowledged in palliative care policy and supported with training, specialist consultation and adequate resources.
Who Gets (and Who Should Get) a Serious Illness Conversation in the Hospital? An Analysis of Readmission Risk Score in an Electronic Health Record
Authors: Serna Myrna K. , Fiskio Julie , Yoon Catherine , Plombon Savanna , Lakin Joshua R. , Schnipper Jeffrey L. , Dalal Anuj K. 
Published: September 2022

Serious Illness Conversations (SICs) explore patients’ prognostic awareness, hopes, and worries, and can help establish priorities for their care during and after hospitalization. While identifying patients who benefit from an SIC remains a challenge, this task may be facilitated by use of validated prediction scores available in most commercial electronic health records (EHRs), such as Epic’s Readmission Risk Score (RRS). We identified the RRS on admission for all hospital encounters from October 2018 to August 2019 and measured the area under the receiver operating characteristic (AUROC) curve to determine whether RRS could accurately discriminate post discharge 6-month mortality. For encounters with standardized SIC documentation matched in a 1:3 ratio to controls by sex and age (±5 years), we constructed a multivariable, paired logistic regression model and measured the odds of SIC documentation per every 10% absolute increase in RRS. RRS was predictive of 6-month mortality with acceptable discrimination (AUROC .71) and was significantly associated with SIC documentation (adjusted OR 1.42, 95% CI 1.24-1.63). An RRS >28% used to identify patients with post discharge 6-month mortality had a high specificity (89.0%) and negative predictive value (NPV) (97.0%), but low sensitivity (25.2%) and positive predictive value (PPV) (7.9%). RRS may serve as a practical EHR-based screen to exclude patients not requiring an SIC, thereby leaving a smaller cohort to be further evaluated for SIC needs using other validated tools and clinical assessment.
Impact of Piperacillin-Tazobactam Dosing in Septic Shock Patients Using Real-World Evidence: An Observational, Retrospective Cohort Study
Authors: Allen John M. , Surajbali Devi , Q. Nguyen Dalena , Kuczek Jolanta , Tran Maithi , Hachey Brianna , Feild Carinda , Shoulders Bethany R. , Smith Steven M. , Voils Stacy A. 
Published: September 2022

Background: Sepsis and septic shock are associated with significant morbidity and mortality. Rapid initiation of appropriate antibiotic therapy is essential, as inadequate therapy early during septic shock has been shown to increase the risk of mortality. However, despite the importance of appropriate antibiotic initiation, in clinical practice, concerns for renal dysfunction frequently lead to antibiotic dose reduction, with scant evidence on the impact of this practice in septic shock patients. Objective: The purpose if this article is to investigate the rate and impact of piperacillin-tazobactam dose adjustment in early phase septic shock patients using real-world electronic health record (EHR) data. Methods: A multicenter, observational, retrospective cohort study was conducted of septic shock patients who received at least 48 hours of piperacillin-tazobactam therapy and concomitant receipt of norepinephrine. Subjects were stratified into 2 groups according to their cumulative 48-hour piperacillin-tazobactam dose: low piperacillin-tazobactam dosing (LOW; <27 g) group and normal piperacillin-tazobactam dosing (NORM; ≥27 g) group. To account for potential confounding variables, propensity score matching was used. The primary study outcome was 28-day norepinephrine-free days (NFD). Results: In all, 1279 patients met study criteria. After propensity score matching (n = 608), the NORM group had more median NFD (23.9 days [interquartile range, IQR: 0-27] vs 13.6 days [IQR: 0-27], P = 0.021). The NORM group also had lower rates of in-hospital mortality/hospice disposition (25.9% [n = 79] vs 35.5% [n = 108]), P = 0.014). Other secondary outcomes were similar between the treatment groups. Conclusions and Relevance: In the propensity score–matched cohort, the NORM group had significantly more 28-day NFD. Piperacillin-tazobactam dose reduction in early phase septic shock is associated with worsened clinical outcomes. Clinicians should be vigilant to avoid piperacillin-tazobactam dose reduction in early phase septic shock.
Assessment of Water, Sanitation and Hygiene Practices Among Households, 2019 − Sierra Leone: A Community-based Cluster Survey
Authors: Sesay Bockarie Pompay , Hakizimana Jean Leonard , Elduma Adel Hussein , Gebru Gebrekrstos Negash 
Published: September 2022

Introduction: In Sierra Leone, diseases related to water, sanitation, and hygiene remain among the leading cause of morbidity and account for 20% of all death. This study assessed the water, sanitation, and hygiene services and practices at household level in Sierra Leone. Methods: A cluster survey was conducted among 1002 households in 4 districts of Sierra Leone. Data was collected on water, sanitation, and hygiene indicators, occurrence of diarrhoeal diseases at household level within 14-day prior to the survey. Chi-square test at 95% significant level was computed to compare the difference in accessing improved water sources, sanitation, and hygiene in urban and rural areas. Result: Of the 1002 households surveyed, 650 (65%) had access to improved drinking water sources. In the urban areas, 432 (88%) out of 486 households had improved drinking water source, which is higher as compared to rural areas. Only 218 (42%) out of 516 households had improved drinking water ( P < .001). Of the total households surveyed, 167 (17%) had improved sanitation with 45 (5%) having a handwashing facility. There were 173 households reporting diarrhoeal disease within 2 weeks prior to the survey, with prevalence of 17%. Conclusion: Majority of households in rural areas do not have access to improved water sources, sanitation, and handwashing facilities. This study found a high prevalence of diarrhoeal disease at the household level. It is recommended that The Ministry of Health and Sanitation work with relevant sectors to increase access to improved drinking water, sanitation, and handwashing facilities in rural areas.
Characteristics of House-Tree-Person Drawing Test in Junior High School Students with Depressive Symptoms
Authors: Guo Qianting , Yu Guilin , Wang Jun , Qin Yang , Zhang Liyuan 
Published: September 2022

Objective This study aims to explore the drawing characteristics of the house-tree-person drawing test (HTP) in junior high school students with depressive symptoms. Methods A total of 167 junior high school students were recruited and completed HTP and questionnaires. 12 drawing characteristics of HTP were extracted and compared to explore the potential drawing characteristics of depressive symptoms. Results Among 12 drawing characteristics, eight drawing characteristics appeared more frequently in the depressed group (CES-D ≥ 20) than in the non-depressed group (CES-D < 20), while one drawing characteristic appeared with a lower frequency. Further, controlling for the risk perception of COVID-19, seven drawing characteristics, not suggestive of movement, lacking details, blackening the paper, drawing in an only dark color, drawing a detailed crown, hands behind the back, and omitting expression, emerged as predictors of depressive symptoms (CES-D ≥ 20) in junior high school students. Conclusion Seven drawing characteristics of HTP are significantly associated with depressive symptoms in junior high school students. HTP is insightful for early screening for junior high school students with depressive symptoms.
Therapeutic Efficacy of Traditional Chinese Medicine Syndrome-Based Formulae to Neuropathic Pain Caused by Chemotherapy
Authors: Liu Yan-Wen , Chen Ying-Jung , Chen Yen-Hao , Tsai Ming-Yen 
Published: September 2022

Objective: Chemotherapy-induced neuropathic pain (CINP) is a troublesome complication of anti-cancer treatment. The aim of this retrospective study was to investigate the effectiveness of classic Chinese herbal formulae (CHF) Huang Qi Gui Zhi Wu Wu Tang (HQGZWWT) and Dang Gui Si Ni Tang (DGSNT) in the treatment of CINP. Materials and Methods: Douleur Neuropathique 4 (DN4) and Functional Assessment of Cancer Therapy-General (FACT-G) questionnaires were rated at baseline and after 3-monthly CHF treatment. Results: By searching through our medical records of all the CIPN patients from 2018 to 2019, we identified and enrolled 37 patients with Deficiency-Cold syndrome in the study, for whom the treatment of neuropathic pain by regular pharmacotherapies had failed or intolerable. At the third month evaluation with the DN4 questionnaire, 13 patients had symptomatic remission, 15 patients remained stable, and 9 patients had no response to CHF. The 3-month mean DN4 score was significantly higher than that at the baseline ( P < .001). After CHF treatment, significant differences in quality of life were noted in the physical, social, emotional, and functional well-being subscales, and in the total score, of the FACT-G ( P < .001). No adverse events or instances of disease progression were observed. Conclusions: The results of our small study are the first in the literature to show the clinical effectiveness of CHF for CINP. Combination of HQGZWWT and DGSNT is well tolerated and may offer the possibility to ameliorate CINP more than conventional care can. It merits further investigation.