nils-herrmann/clean_scirepeval huggingface dataset:
Radiofrequency ablation of atrial fibrillation: is the persistence of all intraprocedural targets necessary for long-term maintenance of sinus rhythm?

Several approaches have been developed for radiofrequency catheter ablation of atrial fibrillation, but the correct intraprocedural end point is still under debate, and few data exist about the destiny of ablation lesions over time. The aim of the present study was to evaluate the long-term maintenance of intraprocedural end points of ablation procedures.



Inclusion criteria were (1) a previous ablation procedure of pulmonary vein (PV) encircling performed for drug-refractory persistent atrial fibrillation; (2) a "complete" intraprocedural end point, which consisted of voltage abatement inside the lesions, PV disconnection, and exit-block pacing from inside the lesions, attained in all PVs; and (3) stable sinus rhythm documented during a minimum follow-up of 2.5 years after the procedure. Twenty volunteers were selected (12 males, mean age 59+/-7 years) and underwent a repeat electrophysiological study. After a follow-up of 36.4+/-4.7 months, complete voltage abatement was maintained around 32 PVs (40.0%), PV disconnection persisted in 12 (37.5%) of the previously isolated PVs, and exit block was present in 39 PVs (48.7%). Ten patients who underwent a redo ablation procedure because of recurrences of atrial fibrillation were used as the control group. Differences in intraprocedural end-point maintenance between the 2 groups were not statistically significant.



Common intraprocedural end points such as voltage abatement, PV disconnection, and exit block persist only in a limited number of patients, even when the outcome is favorable during follow-up. Further investigation will be required to determine whether such data will have implications for ablation strategies.
CHA₂DS₂-VASc scores predict mortality after hospitalization for atrial fibrillation.

The outcome of patients hospitalized for atrial fibrillation (AF) is relatively poor. We sought to determine the mortality rate and predictors of mortality following hospitalization for AF and to evaluate whether the CHA2DS2-VASc score was a predictor of mortality.



We examined the national database of Thailand residents who registered for government provided health insurance in 2005 and reviewed patient records from 2005 to 2010 to determine all-cause mortality. A total of 8981 patients (mean age, 65 years; 42% male) were admitted to the hospital with a diagnosis of AF. Data on demographics and comorbidities were retrieved from the database. The CHA2DS2-VASc score was calculated for each patient.



The hospitalization rate for AF was 15.5 per 100,000 person-years. The two most common comorbidities were hypertension (N=1638, 18.2%) and diabetes (N=1349, 15.0%). The average CHA2DS2-VASc score for all patients was 1.8. By the 72-month follow-up (average 46 months), 3948 patients (44.0%) had died. The CHA2DS2-VASc score was directly related to the mortality rate (P log-rank <0.0001). Multivariate analysis showed that a CHA2DS2-VASc score ≥ 6 (hazard ratio [HR] 2.2, 95% confidence interval [CI], 1.4-3.7, P=0.002) and the presence of chronic kidney disease (HR 2.0, 95% CI 1.7-2.4, P<0.0001) were the strongest predictors of death.



The outcome after hospitalization for AF is relatively poor. The CHA2DS2-VASc score is an independent prognostic marker of poor outcomes following hospitalization for AF.
Evaluation of hospital factors associated with hospital postoperative venous thromboembolism imaging utilisation practices.

Recent research suggests that hospital rates of postoperative venous thromboembolism (VTE) are subject to surveillance bias: the more hospitals 'look for' VTE, the more VTE they find. However, little is known about what drives variation in hospital VTE imaging rates. We conducted an observational study to examine hospital and market characteristics that were associated with hospital-level rates of postoperative VTE imaging, focusing on hospitals with particularly high rates.



For Medicare beneficiaries undergoing 11 major operations (2009-2010) at 2820 hospitals, hospital-level postoperative VTE imaging use rates were calculated. Hospital characteristics associated with hospital VTE imaging use rates were examined including case severity, size, ownership, VTE process measure adherence, accreditations, staffing, malpractice environment, and county market factors. Associations between explanatory variables and VTE imaging rates were assessed using quantile regressions at the 25th, median, 75th and 90th quantiles.



Mean postoperative VTE imaging rates ranged from 85.26 (SD=67.38) per 1000 discharges in the lowest quartile of hospitals ranked by VTE imaging rates to 168.86 (SD=76.70) in the highest quartile. Drivers of high imaging rates at the 90th quantile were high resident-to-bed ratio (coefficient=51.35, p<0.01), Joint Commission accreditation (coefficient=19.05, p<0.01), presence of other hospitals in the same market with high imaging rates (coefficient=15.29, p<0.01), average case severity (coefficient=11.97, p<0.01), local malpractice costs (coefficient=11.29, p<0.01), and market competition (coefficient=11.03, p<0.01).



Hospital teaching status, resident-to-bed ratio, malpractice environment and local market factors drive hospital postoperative VTE imaging use, suggesting that non-clinical forces predominantly drive hospital VTE imaging practices.
Comparison of 2 Orthotic Approaches in Children With Cerebral Palsy.

To compare dynamic ankle-foot orthoses (DAFOs) and adjustable dynamic response (ADR) ankle-foot orthoses (AFOs) in children with cerebral palsy.



A total of 10 children with cerebral palsy (4-12 years; 6 at Gross Motor Function Classification System level I, 4 at Gross Motor Function Classification System level III) and crouch and/or equinus gait wore DAFOs and ADR-AFOs, each for 4 weeks, in randomized order. Laboratory-based gait analysis, walking activity monitor, and parent-reported questionnaire outcomes were compared among braces and barefoot conditions.



Children demonstrated better stride length (11-12 cm), hip extension (2°-4°), and swing-phase dorsiflexion (9°-17°) in both braces versus barefoot. Push-off power (0.3 W/kg) and knee extension (5°) were better in ADR-AFOs than in DAFOs. Parent satisfaction and walking activity (742 steps per day, 43 minutes per day) were higher for DAFOs.



ADR-AFOs produce better knee extension and push-off power; DAFOs produce more normal ankle motion, greater parent satisfaction, and walking activity. Both braces provide improvements over barefoot.
The Coping with Asthma Study: a randomised controlled trial of a home based, nurse led psychoeducational intervention for adults at risk of adverse asthma outcomes.

Morbidity and mortality associated with severe asthma might be reduced by interventions that address psychosocial factors contributing to adverse outcomes. A study was undertaken to assess the effectiveness of a 6 month home based psychoeducational intervention delivered by a respiratory nurse specialist for adults at risk of adverse asthma outcomes.



A pragmatic randomised controlled trial was performed in 92 adults registered with hospital or primary care asthma clinics. All had previous hospital admissions and/or were on British Thoracic Society step 4-5 treatment and had failed to attend clinic appointments or were considered to have poor adherence to other aspects of their agreed management. Patients were visited in their homes for assessment and, where appropriate, intervention. The main outcomes measured were symptom control, asthma specific quality of life, and generic health status.



At the 6 month primary time point there were no significant differences between usual care and intervention groups in mean symptom control, physical functioning, or mental health scores (differences (with 95% CI) -0.35 (-1.83 to 1.13), 3.10 (-11.42 to 17.63), 0.42 (-10.22 to 11.07), respectively). Small effects on asthma specific quality of life up to 12 months (e.g. adjusted difference at 12 months 0.13 (95% CI 0.02 to 0.25)) and short term effects on generic health status, which mirrored improvements in aspects of self-care observed at the end of the intensive phase of the intervention, were apparent only from fully adjusted analyses.



A home based intervention provided by a nurse receiving psychological supervision may have effects on quality of life but is overall of limited long term benefit to adults at risk of adverse asthma outcomes.
[Relationship between obstructive sleep apnea/hypopnea syndrome and insulin resistance].

To investigate whether obstructive sleep apnea/hypopnea syndrome (OSAHS) is independently associated with insulin resistance (IR).



We recruited 60 male obese patients with OSAHS [OSAHS group, age (42.3 +/- 2.6) years, body mass index (BMI) (28.3 +/- 2.1) kg/m2, waist/hip ratio (WHR) 0.95 +/- 0.05], 60 male weight-matched obese patients without OSAHS [OB group, age (41.5 +/- 3.1) years, BMI (27.7 +/- 1.5) kg/m2, WHR 0.94 +/- 0.04] and 60 male normal weight subjects [NW group, age (41.8 +/- 2.4) years, BMI (22.6 +/- 1.9) kg/m2, WHR 0.86 +/- 0.05]. The subjects underwent polysomnography and OSAHS was defined as an apnea-hypopnea index (AHI) > or = 5. The systolic blood pressure and diastolic blood pressure were measured. IR was evaluated by fasting serum true insulin (TI) level and IR index based on the homeostasis model assessment method (HOMA-IR). In the OSAHS group, multiple linear regression was used with either TI or HOMA-IR as the dependent variable, and the corresponding set of independent variables included age, BMI, WHR, AHI and minimum oxygen saturation (MSpO2).



After adjustment for age, BMI, and WHR, the OSAHS group was more insulin resistant, as indicated by the higher levels of TI and HOMA-IR. Multiple linear regression showed that the central obesity parameter (WHR) was the major determinant of IR of the OSAHS group, while sleep-disordered breathing parameters (AHI and MSpO2) were also independent determinants of IR of the group ( P = 0.003).



OSAHS may be independently associated with IR.
Possible site of bronchodilation due to inhaled procaterol aerosol in asthmatic patients

We studied the effective site of an inhaled aerosol of procaterol, a β2-selective adrenergic bronchodilator, in 8 asthmatic patients whose basal lung functions are almost within the normal range in both slow vital capacity (VC) and forced expiratory volume in one second (FEV1.0), and are free from asthmatic attack. In patients who had received procaterol 30 min after inhalation of aerosol, there was no significant change in VC, although FEV1.0, maximal expiratory flow at 50% VC $$(\dot V_{50} )$$ , maximal expiratory flow at 25% VC $$(\dot V_{25} )$$ and maximal expiratory flow at 30% VC of partial maximal expiratory flow volume curve $$(\dot V_{30p} )$$ improved significantly. On the other hand, in those who had received placebo, none of the parameters changed. Furthermore, Rl decreased and C0.5 increased significantly during the first 5 min after inhalation of procaterol aerosol. After an interval of 5 min, Rl did not change any further, while C0.5 continued to improve until 30 min after inhalation of procaterol. These results suggest that procaterol may first dilate the large airway and then may gradually dilate the small airway in bronchial asthma.
Prospective multicenter study of pathogen distributions in early-onset and late-onset hospital-acquired pneumonia in china.

Tiemei Zhao, Youning Liu, Bin Cao, Hui Wang, Liangan Chen, Danyang She, Zhixin Liang, Tieying Sun, Yanming Li, Zhaohui Tong, Zhen Wang, Bei He, Wei Yang, Jieming Qu, Xiangyang Li, Rongchang Chen, Feng Ye, Jian Kang, Erran Li, Ping Chen, Yan Zheng, Zhongsen Ma, Jin Ren, Yi Shi, Wenkui Sun, Yulin Feng, Hong Fan, Shujuan Jiang, Song Zhang, Shengdao Xiong, Peng Zuo, Zhanwei Wang Department of Respiratory Diseases, Chinese PLA General Hospital, Beijing, People’s Republic of China; Department of Infectious Diseases & Clinical Microbiology, Beijing Chao-Yang Hospital, Beijing, People’s Republic of China; Clinical Laboratory, Peking University People’s Hospital, Beijing, People’s Republic of China; Department of Respiratory Diseases and Critical Care Medicine, Beijing Hospital, Beijing, People’s Republic of China; Department of Respiratory Diseases, Beijing Chao-Yang Hospital, Beijing, People’s Republic of China; Department of Respiratory Diseases, Peking University Third Hospital, Beijing, People’s Republic of China; Department of Respiratory Diseases, Huadong Hospital Affiliated to Fudan University, Shanghai, People’s Republic of China; Guangzhou Institute of Respiratory Disease, Guangzhou, People’s Republic of China; Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, People’s Republic of China; Department of General Hospital of Shenyang Military Region, Shenyang, People’s Republic of China; Department of Respiratory Diseases, The Second Hospital of Jilin University, Jilin, People’s Republic of China; Department of Respiratory Diseases, Nanjing General Hospital of Nanjing Military Command, Nanjing, People’s Republic of China; Department of Respiratory Diseases, West China Hospital, Sichuan University, Sichuan, People’s Republic of China; Department of Respiratory Diseases, Shandong Provincial Hospital, Shandong, People’s Republic of China; Department of Respiratory Diseases, Tongji Hospital, Wuhan, People’s Republic of China
Effectiveness of mirtazapine in the treatment of depression with associated somatic symptoms

Se evalúa la evolución clínica de la depresión con síntomas somáticos durante los primeros 3 meses de tratamiento con mirtazapina.  711 pacientes seleccionados por 98 psiquiatras de todo el territorio español que trabajaban en consultas externas de psiquiatría. Instrumentos: se utilizó la Escala de Depresión de Hamilton de 17 ítems (HAMD-17) y la Entrevista Psiquiátrica Estandarizada Polivalente (EPEP), sección síntomas somáticos. Los pacientes fueron evaluados pretratamiento y a los 15, a los 30 y a los 90 días postratamiento. Resultados. La intensidad de la depresión medida con la HAMD-17 disminuye significativamente (p < 0,0001) desde 23,27 pretratamiento hasta 6,75 a los 3 meses. La intensidad de la sintomatología somática medida con la EPEP disminuye significativamente (p < 0,0001) desde 7,68 pretratamiento hasta 2,28 a los 3 meses. Mirtazapina modifica la atribución de los síntomas somáticos en somatizadores: en la visita basal el 41,37% de la muestra pensaba que la causa de los síntomas era psicológica, mientras que a los 3 meses el porcentaje se había incrementado significativamente (p<0,05) a un 63,94%. La mitad de la muestra (48,52%) tomaba benzodiazepinas al inicio del estudio; mientras que tras 90 días de tratamiento, sólo precisaron asociar benzodiazepinas un 6,71% de los pacientes. La incidencia de efectos adversos fue del 13,36% de los pacientes. Del total de los abandonos del estudio, solamente un 4 % fueron debidos a acontecimientos adversos. Conclusiones. Mirtazapina es un antidepresivo eficaz y seguro para el tratamiento de los pacientes depresivos con síntomas somáticos asociados y es capaz de modificar la atribución de los síntomas en pacientes somatizadores.
Tryptophan depletion in SSRI-recovered depressed outpatients

Recently, a number of studies have challenged the finding that acute tryptophan depletion (TD) increases depressive symptoms in medicated, formerly depressed patients. The present study examined the effects of acute nutritional TD on remitted depressed patients currently treated with selective serotonin reuptake inhibitors. In an attempt to clarify conflicting earlier findings, the effects of a number of clinical variables on outcome were also investigated.  Ten patients underwent TD in a double-blind, controlled, balanced crossover fashion. The control session followed the procedure of Krahn et al. (1996 Neuropsychopharmacology 15:325–328). Sessions were 5–8 days apart.  TD was significantly related to increased scores on clinician-rated depression and anxiety scales, and on self-rated depression, anxiety, and somatic symptoms. The control challenge had no effect, despite the fact that the reductions in plasma tryptophan during the control session were unexpectedly high. Some evidence was found for a threshold in the relationship between reduction of plasma tryptophan and mood response.  The mood effect of TD in medicated, formerly depressed patients was confirmed. A threshold may exist for mood effects following TD, implying that recent negative findings may have been caused by insufficient depletion. No other predicting or mediating factors were identified, although the variable "history of response pattern to medication" deserves further study.
Brain networks underlying the clinical effects of long-term subthalamic stimulation for Parkinson's disease: a 4-year follow-up study with rCBF SPECT.

The motor improvement derived from high-frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD) is maintained over time after surgery. The aim of the present prospective follow-up study was to assess regional cerebral blood flow (rCBF) changes related to such improvement in the long term.



Ten PD patients with STN-DBS underwent 3 rCBF SPECT studies at rest-once preoperatively in the off-drug condition and the other 2 postoperatively in the off-drug/on-stimulation conditions at 5 +/- 2 and 42 +/- 7 mo. Patients were administered with Unified Parkinson Disease Rating Scale (UPDRS), Hoehn and Yahr (H&Y) scale, and Schwab and England (S&E) scale. Statistical parametric mapping was used to investigate rCBF changes during long-term STN stimulation in comparison with preoperative rCBF and the relationship between rCBF and UPDRS scores was used as a covariate of interest.



All patients showed a maximum clinical improvement during the first months after surgery and remained rather stable during further follow-up. The effect of STN-DBS from the pre- to the postoperative condition at 5 mo was to produce rCBF increases in the presupplementary motor area (pre-SMA), premotor (PMC), and dorsolateral prefrontal cortices. From the postoperative condition at 5 mo to that at 42 mo, the STN stimulation produced further rCBF increases in these frontal areas, and also in the primary motor/sensory cortices, globus pallidi, ventral lateral thalamic nuclei, cerebellum, pons, and midbrain entailing the substantia nigra (P < 0.0001). A correlation was detected between the improvement in motor scores and the rCBF increase in the pre-SMA and PMC (P < 0.0001). No correlation was present between the daily consumption of levodopa and the rCBF.



Our study suggests that the long-term STN stimulation leads to improvement in neural activity in the frontal motor/associative areas. After an rCBF increase during the first months of stimulation, these regions showed a further increment in the later phase, which was accompanied by an increased activity in subcortical structures. The correlation between motor improvement and rCBF increase in higher order motor cortical areas suggests that even in the long term, as well as in the short term, the STN-DBS achieves its therapeutic benefit by restoring the activity within these cortical regions.
Pain Control Program improves family caregivers ’ knowledge of cancer pain management

The majority of cancer treatment is provided in outpatient settings. Family caregivers' (FCs') knowledge and beliefs about pain and its management are critical components of effective care.  This study's aim was to evaluate the efficacy of a psychoeducational intervention, compared to control, to increase FCs' knowledge of cancer pain management.  FCs of oncology outpatients were randomized together with the patients into the PROSELF  FCs completed a demographic questionnaire and the Family Pain Questionnaire (FPQ) at the beginning and end of the study to assess their knowledge about pain and its management. The intervention consisted of nurse coaching, home visits, and phone calls that occurred over 6 weeks.  One hundred and twelve FCs (60% female) with a mean age of 63 years (SD 10.7) participated. Compared to FCs in the control group, FCs in the PRO-SELF© group had significantly higher knowledge scores on all of the single items on the FPQ, except for the item "cancer pain can be relieved", as well as for the total FPQ score.  The use of a knowledge and attitude survey like the FPQ, as part of a psychoeducational intervention provides an effective foundation for FC education about cancer pain management.  Oncology nurses can use FCs' responses to the FPQ to individualize teaching and spend more time on identified knowledge deficits. This individualized approach to FC education may save staff time and improve patient outcomes.
Pulmonary vein ostium geometry: analysis by magnetic resonance angiography.

During a catheter ablation procedure for selective electrical isolation of pulmonary vein (PV) ostia, the size of these ostia is usually estimated using fluoroscopic angiography. This measurement may be misleading, however, because only the projected supero/inferior ostium diameters can be measured. In this study, we analyzed 3-dimensional magnetic resonance angiographic (MRA) images to measure the minimal and maximal cross-sectional diameter of PV ostia in relation to the diameter that would have been projected on fluoroscopic angiograms during a catheter ablation procedure.



In 42 patients with idiopathic atrial fibrillation who were scheduled for selective electrical isolation of PV ostia, the minimal and maximal diameters of these ostia were measured from 3-dimensional MRA images. Thereafter, these images were oriented in a 45 degrees right or left anterior oblique direction and the projected diameter of the PV ostia were measured again. The average ratio between maximal and minimal diameter was 1.5+/-0.4 for the left and 1.2+/-0.1 for the right pulmonary vein ostia. Because of the orientation and oval shape of especially the left pulmonary vein ostia, their minimal diameters were significantly smaller than the projected diameters.



Pulmonary vein ostia, especially those at the left, are oval with the short axis oriented approximately in the antero/posterior direction. Consequently, PV ostia may sometimes be very narrow despite a rather normal appearance on angiographic images obtained during a catheter ablation procedure.
Pain in young people aged 13 to 17 years with cerebral palsy: cross-sectional, multicentre European study

To determine the prevalence and associations of self- and parent-reported pain in young people with cerebral palsy (CP).



Cross-sectional questionnaire survey conducted at home visits in nine regions in seven European countries. Participants were 13 to 17-year-olds (n=667) drawn from population CP registers in eight regions and from multiple sources in one region. 429 could self-report; parent-reports were obtained for 657. Data were collected on: severity, frequency, site and circumstances of pain in previous week; severity of pain associated with therapy in previous year.



The estimated population prevalence of any pain in previous week was 74% (95% CI 69% to 79%) for self-reported pain and 77% (95% CI 73% to 81%) for parent-reported pain. 40% experienced leg pains, 34% reported headaches and 45% of those who received physiotherapy experienced pain during therapy. Girls reported more pain than boys (OR=2.1, 95% CI 1.5 to 3.0) and young people reported more pain if they had emotional difficulties (comparing highest and lowest quartiles: OR=3.1, 95% CI 1.7 to 5.6). Parents reported more pain in children with emotional difficulties (OR=4.2, 95% CI 2.7 to 6.6), or with more impaired walking ability.



Pain in young people with CP is highly prevalent. Because pain causes immediate distress and is associated with lower subjective well-being and reduced participation, clinicians should routinely assess pain. Clinical interventions to reduce pain should be implemented and evaluated. The efficacy of medical and therapeutic interventions causing pain should be re-examined to establish if their benefit justifies the pain and fear of pain that accompany them.