nils-herrmann/clean_scirepeval huggingface dataset:
Fast atrial activity predicts recurrence of atrial fibrillation after pulmonary vein isolation: results from a prospective randomized study

Recurrence of atrial fibrillation (AF) after ablative treatment is common. We hypothesized that AF recurrence is heralded by fast ectopic atrial activity occurring after electrical reconnection of previously isolated pulmonary veins. Patients with paroxysmal or persistent AF undergoing pulmonary vein isolation (PVI) were followed up by 24-h Holter monitoring every 3 months for the first year and every 6 months thereafter. Antiarrhythmic drugs were withdrawn after a blanking period of 4 weeks for paroxysmal and 3 months for persistent AF. Ectopic atrial activity was defined as a burden of atrial extrasystoles >5 % of the total QRS number. Fast atrial activity was present if mean cycle length of ectopic atrial activity was shorter than 50 % of the mean cycle length of sinus rhythm in the last ten heartbeats. Patients with symptomatic fast atrial activity but without AF recurrence were randomized to undergo a second PVI procedure or resume antiarrhythmic medication. During follow-up, a 24-h Holter recording was performed every 3 months. Additionally, a 7-day external loop recording was performed in every pt with palpitations and no AF or ectopic atrial activity in the 24-h Holter. One hundred twenty-four pts with AF (88 paroxysmal, 36 persistent) developed fast atrial activity 6 ± 3 months after PVI. Twenty-two pts were asymptomatic and eight pts refused randomization. Ninety-four pts (61 men, age 57 ± 12 years) were randomized to either receive a second PVI procedure (group I, 48 pts) or antiarrhythmic medication (group II, 46 pts). Re-PVI in group I was performed 10 ± 8 months after the first PVI. During a follow-up of 20 ± 6 months, 11 pts of group I (23 %) and 43 pts of group II (93 %) had recurrence of AF. The mean time of AF recurrence after appearance of fast atrial activity was 4 ± 2 in group I and 5 ± 3 months in group II. In patients with atrial fibrillation and after the first PVI procedure, appearance of symptomatic fast atrial activity is associated with a high risk of AF recurrence. Re-isolation of reconnected pulmonary veins in these pts significantly reduces the risk of AF recurrence.
Neurological development of 5-year-old children receiving a low-saturated fat, low-cholesterol diet since infancy: A randomized controlled trial.

Early childhood introduction of nutritional habits aimed at atherosclerosis prevention is compatible with normal growth, but its effect on neurological development is unknown.



To analyze how parental counseling aimed at keeping children's diets low in saturated fat and cholesterol influences neurodevelopment during the first 5 years of life.



Randomized controlled trial conducted between February 1990 and November 1996.



Outpatient clinic of a university department in Turku, Finland.



A total of 1062 seven-month-old infants and their parents, recruited at well-baby clinics between 1990 and 1992. At age 5 years, 496 children still living in the city of Turku were available to participate in neurodevelopmental testing.



Participants were randomly assigned to receive individualized counseling aimed at limiting the child's fat intake to 30% to 35% of daily energy, with a saturated:monounsaturated:polyunsaturated fatty acid ratio of 1:1:1 and a cholesterol intake of less than 200 mg/d (n = 540) or usual health education (control group, n = 522).



Nutrient intake, serum lipid concentrations, and neurological development at 5 years, among children in the intervention vs control groups.



Absolute and relative intakes of fat, saturated fatty acids, and cholesterol among children in the intervention group were markedly less than the respective values of control children. Mean (SD) percentages of daily energy at age 5 years for the intervention vs control groups were as follows: for total fat, 30.6% (4.5%) vs 33.4% (4.4%) (P<. 001); and for saturated fat, 11.7% (2.3%) vs 14.5% (2.4%) (P<.001). Mean intakes of cholesterol were 164.2 mg (60.1 mg) and 192.5 mg (71. 9 mg) (P<.001) for the intervention and control groups, respectively. Serum cholesterol concentrations were continuously 3% to 5% lower in children in the intervention group than in children in the control group. At age 5 years, mean (SD) serum cholesterol concentration of the intervention group was 4.27 (0.63) mmol/L (165 [24] mg/dL) and of the control group, 4.41 (0.74) mmol/L (170 [29] mg/dL) (P =.04). Neurological development of children in the intervention group was at least as good as that of children in the control group. Relative risks for children in the intervention group to fail tests of speech and language skills, gross motor functioning plus perception, and visual motor skills were 0.95 (90% confidence interval [CI], 0.60-1.49), 0.95 (90% CI, 0.58-1.55), and 0.65 (90% CI, 0.39-1.08), respectively (P =.85,.86, and.16, respectively, vs control children).



Our data indicate that repeated child-targeted dietary counseling of parents during the first 5 years of a child's life lessens age-associated increases in children's serum cholesterol and is compatible with normal neurological development. JAMA.
Impact of Compound Hypertonic Saline Solution on Decompensated Heart Failure.

The aim of the present study was to evaluate the effects of hypertonic saline solution (C-HSS) with high dose furosemide on hospitalization time, readmission, and mortality in patients with New York Heart Association (NYHA) class III heart failure.Decompensated heart failure patients (NYHA III) with chronic ischemic or nonischemic cardiomyopathy and ejection fraction < 40% were divided into 2 groups in an open-label random manner: the first group received a 1-hour intravenous infusion of furosemide (100 mg) plus compound C-HSS (100 mL) twice daily and underwent serious water restriction (500 mL/day); the second group received furosemide intravenous bolus (100 mg) twice a day and water restriction (500 mL/day), without C-HSS. Both groups had normal sodium (120 mmol sodium) intake. After discharge, the two groups continued to receive 120 mmol Na/day and 500-1000 mL water/day.The first group (132 C-HSS patients) had an increase in urination, a reduction in hospitalization time (4 ± 2 versus 7 ± 2 days, P < 0.01), and a reduction in hospitalization costs (2210 RMB versus 3506 RMB, P < 0.01) compared with the second group (132 without C-HSS patients). During the follow-up period (36 ± 12 months), the first group had a significantly higher average readmission time (31.84 ± 7.58 months versus 15.60 ± 6.25 months, P < 0.01) and lower mortality rate (16.5% versus 31.9%, P < 0.01).The results suggest that periodical C-HSS administration, combined with serious water restriction and a normal sodium diet, significantly reduces the hospitalization time, readmission rate, and mortality in patients with NYHA class III HF.
Prevalence of atrial fibrillation and association of previous antithrombotic treatment in patients with cerebral microbleeds.

Cerebral microbleeds (CMBs) are associated with an increased risk of intracerebral hemorrhage. The impact of oral anticoagulation (OAC) on CMBs is not well characterized. Our aim was to assess the prevalence of CMBs in stroke and transient ischaemic attack (TIA) patients with atrial fibrillation (AF) and to analyze the implications of previous treatment with OAC.



In this retrospective analysis on data from a prospectively recruiting stroke registry, patients with ischaemic stroke or TIA with brain magnetic resonance imaging including susceptibility weighted imaging were consecutively enrolled during a 3-year period. For each patient cardiovascular risk factors, AF history and recent diagnosis of AF, present use of OAC and antiplatelets, the National Institute of Health Stroke Scale and the premorbid modified Rankin Scale score were recorded. Two independent raters identified CMBs according to consensus criteria. CMB location was classified as lobar, deep or in the posterior fossa.



In all, 785 patients (mean age 63.9 ± 14.2 years) were included. At least one CMB was detected in 186 (23.7%) patients. CMBs were significantly more frequent in patients with AF (30.5% vs. 22.4%). Patients with previous OAC treatment were more likely to have CMBs (36.7% vs. 22.8%, P = 0.03) and abundant CMBs (n > 10) were more frequent in anticoagulated patients even after adjustment for age. However, age was the only independent factor predicting CMBs (P = 0.001).



Cerebral microbleeds are common in elderly AF patients with acute ischaemic stroke. Previous OAC is associated with a higher number of CMBs predominantly in the lobar location. Establishing a causal relationship requires prospective longitudinal investigation.
Effect of Exenatide, Sitagliptin, or Glimepiride on β-Cell Secretory Capacity in Early Type 2 Diabetes

Agents that augment GLP-1 effects enhance glucose-dependent β-cell insulin production and secretion and thus are hoped to prevent progressive impairment in insulin secretion characteristic of type 2 diabetes (T2D). The purpose of this study was to evaluate GLP-1 effects on β-cell secretory capacity, an in vivo measure of functional β-cell mass, early in the course of T2D.



We conducted a randomized controlled trial in 40 subjects with early T2D who received the GLP-1 analog exenatide (n = 14), the dipeptidyl peptidase IV inhibitor sitagliptin (n = 12), or the sulfonylurea glimepiride (n = 14) as an active comparator insulin secretagogue for 6 months. Acute insulin responses to arginine (AIRarg) were measured at baseline and after 6 months of treatment with 5 days of drug washout under fasting, 230 mg/dL (glucose potentiation of arginine-induced insulin release [AIRpot]), and 340 mg/dL (maximum arginine-induced insulin release [AIRmax]) hyperglycemic clamp conditions, in which AIRmax provides the β-cell secretory capacity.



The change in AIRpot was significantly greater with glimepiride versus exenatide treatment (P < 0.05), and a similar trend was notable for the change in AIRmax (P = 0.1). Within each group, the primary outcome measure, AIRmax, was unchanged after 6 months of treatment with exenatide or sitagliptin compared with baseline but was increased with glimepiride (P < 0.05). α-Cell glucagon secretion (AGRmin) was also increased with glimepiride treatment (P < 0.05), and the change in AGRmin trended higher with glimepiride than with exenatide (P = 0.06).



After 6 months of treatment, exenatide or sitagliptin had no significant effect on functional β-cell mass as measured by β-cell secretory capacity, whereas glimepiride appeared to enhance β- and α-cell secretion.
Comparison of the clinical hypnotic effects of Zopiclone and Triazolam

In a double blind crossover therapeutic trial the hypnotic effect of Zopiclone 7.5 mg and Triazolam 0.5 mg given orally at bedtime for 7 consecutive days have been compared. 5 of the items in Spiegel's questionnaire and 12 of the 18 items in Norris' visual analogue scale were significantly more improved by Zopiclone than by Triazolam. Both drugs caused few side-effects.
Availability of data when heart failure patients are admitted to hospice.

Guidelines recommend hospice care for patients with advanced heart failure (HF) who are approaching end of life. However, little is known about the data available when HF patients are admitted to hospice. This pilot study surveyed the staff from 100 hospices in the United States and Canada about how frequently data were provided to or obtained by the hospice when admitting HF patients and how important they perceived the data. The survey response rate was 66%. Overall, data were less often provided or obtained than rated important (aggregate mean difference, P<.001, r=.75). Data important to prognostication or ongoing care were provided to or readily obtained by the hospices for blood pressure (50.0%), left ventricular ejection fraction (EF) (50.0%), edema (58.3%), HF medications, symptoms of dyspnea (63.2%), chest pain (57.2%), common comorbidities, and pacemaker (69.6%) or other devices (60.0%). Approximately half of the time, hospices reported that they rarely or never received information about medication intolerance. Significant amounts of clinically valid data are not provided to or obtained by hospice providers when admitting HF patients. Investigations are needed to corroborate these findings, understand information transfer at transitions in care, and to determine the impact of admission data on hospice care for HF patients. Congest Heart Fail.
Differences in routine esophagogastroduodenoscopy between Japanese and international facilities: A questionnaire survey.

The mortality rate of gastric cancer (GC) is close to the incidence rate worldwide. However, in Korea and Japan, the mortality rate of GC is less than half of the incidence rate. We hypothesized that good-quality routine esophagogastroduodenoscopy (EGD) contributes to a high detection rate for early GC (EGC) and improves mortality in these countries.



To clarify the differences in routine EGD, a questionnaire survey was conducted in 98 Japanese and 53 international institutions.



Prevalence of screening examination among routine EGD was higher in Japanese than in international institutions. Japanese endoscopists noted that endoscopic mucosal atrophy was the most significant risk factor for GC, whereas international endoscopists paid more attention to clinical information such as age, symptoms and family history. Antispasmodics, mucolytics and defoaming agents were used more frequently in Japanese institutions. The examination time was similar (mostly 5-10 min) between Japanese and international institutions. Japanese endoscopists took more pictures (>20 in almost all institutions) than international endoscopists (≤20 in two-thirds of institutions). In Japanese institutions, biopsy specimens were more frequently taken from areas of mucosal discoloration, unevenness or spontaneous bleeding rather than from obvious endoscopic lesions such as ulceration or polyps. In most Japanese institutions, one or two biopsy specimens were taken per lesion, compared with ≥three in international institutions.



There were some discrepancies between Japanese and international institutions for routine EGD. Thus, standardization is required for adequate risk assessment, proper techniques, and knowledge of endoscopic diagnosis of EGC.
Low bearing wear in explanted HeartMate II left ventricular assist devices after chronic clinical support.

The primary objective of this study was to evaluate bearing wear during clinical use of the HeartMate II (HMII) left ventricular assist device. Bearings obtained from HMII pumps explanted after clinical use in the Destination Therapy and Bridge to Transplantation clinical trials were analyzed for wear using surface profilometry. Geometric profile variations measured on the inlet bearing ball were used to calculate the wear. Bearing wear was normalized to the total pump support duration to obtain an annualized bearing wear rate. Bearing life was estimated assuming a linear wear rate, as the time to reach a wear limit of 25 µm, which includes a 3× safety factor, to ensure that there is no contact between the rotor blades and the blood bore housing. One hundred and eighty-three bearings from left ventricular assist devices implanted in 181 patients were analyzed. Average age of the patients was 56.3 ± 14.6 years, 76% were male, 46% had an ischemic etiology of heart failure. Mean support duration for the pumps was 363 ± 349 days (median: 238, range: 1-1,621 days). Sixty pumps (33%) were explanted at heart transplantation, 20 (11%) after device replacement, 6 (3%) for ventricular recovery, 94 (51%) after patient death, and 3 (2%) were explanted for other reasons. Mean bearing wear was 0.59 ± 0.37 µm (median: 0.46 µm [5-95% interval: 0.25-1.48]). The median bearing wear rate for patients supported for at least 1 year was 0.30 [5-95% interval: 0.09-0.94] µm/yr. The 5-95% limits of the bearing wear rate corresponded to an estimated bearing life between 27 and 269 years. The pump having the highest bearing wear rate (1.46 µm/yr) had an estimated bearing life of at least 17 years. HMII bearing wear is extremely small, with an estimated bearing life well in excess of 17 years; it is not a limiting factor for long-term support with the HMII left ventricular assistive system.
Sleep apnea prevalence in acute myocardial infarction--the Sleep Apnea in Post-acute Myocardial Infarction Patients (SAPAMI) Study.

While sleep apnea (SA) might be a modifiable cardiovascular risk factor, recent data suggest that SA is severely underdiagnosed in patients after acute myocardial infarction (MI). There is limited evidence about day-night variation of onset of MI on dependence of having SA. We therefore investigated the prevalence of SA and examined the day-night variation of onset of MI in acute MI patients.



We prospectively studied 782 consecutive patients admitted to the hospital with the diagnosis of acute MI. All subjects underwent sleep evaluations using a portable device after at least 48 h post-admission. Using the apnea-hypopnea index (AHI), groups were defined as patients without SA (<5 events/h), mild SA (5-15 events/h), moderate SA (15-30 events/h), and severe SA (≥ 30 events/h).



Almost all patients (98%) underwent urgent coronary angiography and 91% of patients underwent primary PCI. Using a threshold of AHI ≥ 5 events/h, SA was present in 65.7% of patients after acute MI. Mild SA was present in 32.6%, moderate in 20.4% and severe in 12.7%. The day-night variation in the onset of MI in all groups of SA patients was similar to that observed in non-SA patients. From 6 AM to 12 PM, the frequency of MI was higher in both SA and non-SA patients, as compared to the interval from 12 AM to 6 AM (all p<0.05).



There is a high prevalence of SA in patients presenting with acute MI. Peak time of MI onset in SA patients was between 6 AM and noon, similar to that in the general population. Whether diagnosis and treatment of SA after MI will significantly improve outcomes in these patients remains to be determined.
Disruption of macrophage pro-inflammatory cytokine release in Crohn's disease is associated with reduced optineurin expression in a subset of patients

Crohn's disease (CD) is a complex and highly heterogeneous chronic inflammatory disorder, primarily affecting the gastrointestinal tract. Genetic and functional studies have highlighted a key role for innate immunity in its pathogenesis. Profound systemic defects in innate immunity and acute inflammation are understood to result in markedly delayed clearance of bacteria from the tissues, leading to local chronic granulomatous inflammation and compensatory adaptive immunological changes. Macrophages, key orchestrators of acute inflammation, are likely to play an important role in the initial impaired innate immune response. Monocyte-derived macrophages from CD patients stimulated with Escherichia coli were shown to release attenuated levels of tumour necrosis factor and interferon-γ with normal secretion of interleukin-8 (IL-8), IL-10 and IL-6. In controls, the secretion of these cytokines was strongly positively correlated, which was not seen with CD macrophages. The transcriptomes of CD and control macrophages were examined in an attempt to understand the molecular basis of this defect. There were no differentially expressed genes identified between the two groups, consistent with genetic heterogeneity; however, a number of molecules were found to be under-expressed in subgroups of CD patients. The most common of these was optineurin (OPTN) which was under-expressed in approximately 10% of the CD patients. Reduced OPTN expression coincided with lower intracellular protein levels and diminished cytokine secretion after bacterial stimulation both in the patients and with small interfering RNA knockdown in THP-1 cells. Identifying and studying subgroups of patients with shared defective gene expression could aid our understanding of the mechanisms underlying highly heterogeneous diseases such as CD.
Perioperative stroke and associated mortality after noncardiac, nonneurologic surgery.

Stroke is a leading cause of morbidity and mortality in the United States and occurs in the perioperative period. The authors studied the incidence, predictors, and outcomes of perioperative stroke using the American College of Surgeons National Surgical Quality Improvement Program.



Data on 523,059 noncardiac, nonneurologic patients in the American College of Surgeons National Surgical Quality Improvement Program database were analyzed for the current study. The incidence of perioperative stroke was identified. Logistic regression was applied to a derivation cohort of 350,031 patients to generate independent predictors of stroke and develop a risk model. The risk model was subsequently applied to a validation cohort of 173,028 patients. The role of perioperative stroke in 30-day mortality was also assessed.



The incidence of perioperative stroke in both the derivation and validation cohorts was 0.1%. Multivariate analysis revealed the following independent predictors of stroke in the derivation cohort: age ≥ 62 yr, history of myocardial infarction within 6 months before surgery, acute renal failure, history of stroke, dialysis, hypertension, history of transient ischemic attack, chronic obstructive pulmonary disease, current tobacco use, and body mass index 35-40 kg/m² (protective). These risk factors were confirmed in the validation cohort. Surgical procedure also influenced the incidence of stroke. Perioperative stroke was associated with an 8-fold increase in perioperative mortality within 30 days (95% CI, 4.6-12.6).



Noncardiac, nonneurologic surgery carries a risk of perioperative stroke, which is associated with higher mortality. The models developed in this study may be informative for clinicians and patients regarding risk and prevention of this complication.
Aerosol pentamidine-induced bronchoconstriction. Predictive factors and preventive therapy.

To describe the frequency of aerosol pentamidine-induced bronchoconstriction, its relationship to non-specific airway responsiveness, and its response to preventive therapy using salbutamol, ipratropium bromide, or sodium cromoglycate.



Consecutive HIV-infected individuals starting prophylactic AP were eligible if they had not been previously treated with this agent. Simple spirometry was performed before and 10 min after a single 60-mg dose given through an ultrasonic nebulizer. Methacholine challenge was performed in all subjects 24 h to four days after the initial AP dose. Subjects with a change in FEV1 (delta FEV1) greater than or equal to 10 percent decrease after the initial AP dose were restudied on three separate occasions (greater than 24 hours apart) after premedication with two puffs of salbutamol (200 micrograms), ipratropium bromide (40 micrograms), or sodium cromoglycate (2 mg), in random order.



Fifty-three subjects were studied. The median delta FEV1 after a single dose of AP was -7.0 percent (range: -47 percent, 1.8 percent). The delta FEV1 following AP was only partially predicted by the degree of nonspecific bronchial responsiveness as measured by a standard methacholine challenge. Age, current smoking, history of asthma, baseline FEV1, or a prior episode of PCP failed to predict the delta FEV1 following AP. Eighteen subjects (34 percent) had a delta FEV1 greater than or equal to 10 percent decrease (median: -17.0 percent). In these subjects, after premedication with salbutamol, ipratropium bromide, and sodium cromoglycate, the median delta FEV1 was 1.0, 0.8, and -9.6 percent, respectively.



Aerosol pentamidine produced a decrease in FEV1 greater than or equal to 10 percent in 34 percent of subjects. This was not accurately predicted by the methacholine response. The bronchoconstriction induced by AP was effectively prevented by either salbutamol or ipratropium, whereas cromoglycate was only partially effective.