nils-herrmann/clean_scirepeval huggingface dataset:
“Low T3-syndrome” in acute myocardial infarction — Relationship to beta-adrenergic blockade and clinical course

Serum levels of T4, T3 rT3 and resin T3 uptake were followed for 5 days in 40 patients with acute myocardial infarction (AMI) allocated to early treatment either with alprenolol or placebo. There was a significant fall in T3 (P<0.05) and an increase in rT3 (P<0.05) without any significant difference between the alprenolol — (n=19) and placebo — (n=21) treated groups. The risk of missing a further 20% change in se-T3 and se-rT3 after alprenolol compared to placebo treatment (β) was <0.10 and <0.50, respectively. In patients with a severe clinical course, the fall in T3 and increase in rT3 was significantly greater than in patients without complications. No change in T4 was observed either with respect to the clinical course nor following alprenolol. The data suggest that alprenolol can be given in the acute phase of myocardial infarction without causing any additional disturbance in the serum levels of T3 and T4.
The EXCITE stroke trial: comparing early and delayed constraint-induced movement therapy.

Although constraint-induced movement therapy (CIMT) has been shown to improve upper extremity function in stroke survivors at both early and late stages after stroke, the comparison between participants within the same cohort but receiving the intervention at different time points has not been undertaken. Therefore, the purpose of this study was to compare functional improvements between stroke participants randomized to receive this intervention within 3 to 9 months (early group) to participants randomized on recruitment to receive the identical intervention 15 to 21 months after stroke (delayed group).



Two weeks of CIMT was delivered to participants immediately after randomization (early group) or 1 year later (delayed group). Evaluators blinded to group designation administered primary (Wolf Motor Function Test, Motor Activity Log) and secondary (Stroke Impact Scale) outcome measures among the 106 early participants and 86 delayed participants before delivery of CIMT, 2 weeks thereafter, and 4, 8, and 12 months later.



Although both groups showed significant improvements from pretreatment to 12 months after treatment, the earlier CIMT group showed greater improvement than the delayed CIMT group in Wolf Motor Function Test Performance Time and the Motor Activity Log (P<0.0001), as well as in Stroke Impact Scale Hand and Activities domains (P<0.0009 and 0.0214, respectively). Early and delayed group comparison of scores on these measures 24 months after enrollment showed no statistically significant differences between groups.



CIMT can be delivered to eligible patients 3 to 9 months or 15 to 21 months after stroke. Both patient groups achieved approximately the same level of significant arm motor function 24 months after enrollment.
Carpal tunnel syndrome in manual wheelchair users with spinal cord injury: a cross-sectional multicenter study.

To investigate relationships between carpal tunnel syndrome, functional status, subject demographics, physical examination findings, and median nerve conduction study findings in manual wheelchair users with paraplegia.



Multicenter cross-sectional study. One hundred twenty-six manual wheelchair-using individuals with chronic paraplegia answered self-administered questionnaires on demographics, symptoms, and functional status. They underwent physical examination specific for carpal tunnel syndrome and upper-limb nerve conduction studies.



Fifty-seven percent of subjects had symptoms (72.2% bilateral); hand numbness was most common. Sixty percent of subjects had carpal tunnel syndrome physical examination findings (59.2% bilateral). Those with physical examination findings were more likely to have longer duration of injury (P = 0.003). Seventy-eight percent of subjects had electrophysiologic evidence of median mononeuropathy. Symptomatic subjects had significantly greater median-ulnar motor latency difference in the dominant hand (P = 0.02) and smaller compound muscle action potential amplitudes bilaterally (dominant hand, P = 0.01; nondominant hand, P = 0.04). Persons with carpal tunnel syndrome symptoms and physical examination findings had significantly worse functional status (symptoms, P < 0.001; physical examination, P = 0.02) and symptom severity scores (symptoms, P < 0.001; physical examination, P = 0.01), but a similar difference between subjects with and without median mononeuropathy was not seen. Logistic regression analysis revealed that the presence of symptoms was predicted by median-ulnar motor latency difference in the dominant hand (odds ratio, 4.38; 95% confidence interval 1.72-11.14) and sensory nerve action potential amplitude in the nondominant hand (odds ratio, 0.97; 95% confidence interval, 0.94-0.99).



The interaction among symptoms, physical examination, and nerve conduction study findings is complex. Carpal tunnel syndrome and median mononeuropathy are highly prevalent and functionally significant. This study highlights the need for primary prevention and patient education for preserving upper-limb function.
Cognitive Behavioral Intervention for Trauma in Schools (CBITS): school-based treatment on a rural American Indian reservation.

This study examines a pilot school-based treatment program for American Indian adolescents residing on a reservation who presented with symptoms of Posttraumatic Stress Disorder (PTSD) and symptoms of depression. This is the first study directed at treating American Indian children with trauma; seven case studies demonstrate our findings that a manualized cognitive behavior therapy intervention delivered in group format for 10 weeks has potential for helping some children who experience PTSD symptoms and depression. The findings generally replicate previous research conducted with groups of non-Indian adolescents in urban settings. PTSD and depressive symptoms decreased for three of the four students who completed treatment. Directions for future research include the need to understand and control attrition and to address cultural influences, including making adaptations in the cognitive behavioral formulations and techniques regarding feelings as operant behaviors. Results contribute to knowledge of feasibility and acceptability of cultural adaptations of CBT for trauma in an under-served population.
Distinctive patterns on CT angiography characterize acute internal carotid artery occlusion subtypes

Noninvasive computed tomography angiography (CTA) is widely used in acute ischemic stroke, even for diagnosing various internal carotid artery (ICA) occlusion sites, which often need cerebral digital subtraction angiography (DSA) confirmation. We evaluated whether clinical outcomes vary depending on the DSA-based occlusion sites and explored correlating features on baseline CTA that predict DSA-based occlusion site.We analyzed consecutive patients with acute ICA occlusion who underwent DSA and CTA. Occlusion site was classified into cervical, cavernous, petrous, and carotid terminus segments by DSA confirmation. Clinical and radiological features associated with poor outcome at 3 months (3-6 of modified Rankin scale) were analyzed. Baseline CTA findings were categorized according to carotid occlusive shape (stump, spearhead, and streak), presence of cervical calcification, Willisian occlusive patterns (T-type, L-type, and I-type), and status of leptomeningeal collaterals (LMC).We identified 49 patients with occlusions in the cervical (n = 17), cavernous (n = 22), and carotid terminus (n = 10) portions: initial NIH Stroke Scale (11.4 ± 4.2 vs 16.1 ± 3.7 vs 18.2 ± 5.1; P < 0.001), stroke volume (27.9 ± 29.6 vs 127.4 ± 112.6 vs 260.3 ± 151.8 mL; P < 0.001), and poor outcome (23.5 vs 77.3 vs 90.0%; P < 0.001). Cervical portion occlusion was characterized as rounded stump (82.4%) with calcification (52.9%) and fair LMC (94.1%); cavernous as spearhead occlusion (68.2%) with fair LMC (86.3%) and no calcification (95.5%); and terminus as streak-like occlusive pattern (60.0%) with poor LMC (60.0%), and no calcification (100%) on CTA.Our study indicates that acute ICA occlusion can be subtyped into cervical, cavernous, and terminus. Distinctive findings on initial CTA can help differentiate ICA-occlusion subtypes with specific characteristics.
Impact of Malondialdehyde-Modified Low-Density Lipoprotein on Tissue Characteristics in Patients With Stable Coronary Artery Disease　- Integrated Backscatter-Intravascular Ultrasound Study.

Malondialdehyde-modified low-density lipoprotein (MDA-LDL) is considered to play an essential role in plaque destabilization. We aimed to investigate the association between the tissue characteristics of culprit plaque assessed by integrated backscatter (IB)-intravascular ultrasound (IVUS) and the serum MDA-LDL levels in patients with stable coronary artery disease.



The study group consisted of 179 patients undergoing IB-IVUS during elective percutaneous coronary intervention. Patients were classified into 2 groups based on serum MDA-LDL level: low MDA-LDL group (<102 U/L, n=88) and high MDA-LDL group (≥102 U/L, n=91). Plaques in the high MDA-LDL group had higher %lipid (45.2±12.5% vs. 54.9±14.5%, P<0.001) and lower %fibrosis (43.0±9.1% vs. 36.4±11.4%, P<0.001) than did plaques in the low MDA-LDL group. Lipid-rich plaque (%lipid >60% or %fibrosis <30%) was significantly more frequently found in the high MDA-LDL group than in the low MDA-LDL group (14.3% vs. 39.8%, P<0.001). The incidence of MACE (cardiac death, myocardial infarction and/or hospitalization for heart failure) during 3 years was significantly higher in the high MDA-LDL group than in the low MDA-LDL group (6.6% vs. 15.9%, P=0.02).



Higher MDA-LDL might be associated with greater lipid and lower fibrous content, contributing to coronary plaque vulnerability.
Treatment of diastolic dysfunction in hypertensive patients without left ventricular hypertrophy

The aim of this study was to evaluate the influence of verapamil SR 240 mg (V) and the combination amiloride 5 mg + hydrochlorothiazide 50 mg (AH) on diastolic dysfunction of hypertensive patients without left ventricular hypertrophy (LVH). Twenty-six hypertensive patients with diastolic dysfunction, normal systolic function and without LVH were included into a 2-week washout period and then randomised to a 6-month V or AH treatment. One blinded-to-treatment echocardiographist at baseline and at weeks 4, 12 and 24 assessed Doppler-echocardiography. Both V and AH, satisfactorily controlled blood pressure, but only V improved diastolic function shown by a tendency to reduce peak A and to increase peak E/A ratio, and by a significant reduction in deceleration time. After 24 weeks, V significantly reduced wall thickness in comparison with AH. These results need to be confirmed in a larger scale study.
Vitamin-E diffused highly cross-linked polyethylene liner compared to standard liners in total hip arthroplasty. A randomized, controlled trial

We hypothesized that a vitamin E-treated polyethylene articulating liner had lower femoral head penetration than a conventional liner. Fifty-one patients with primary hip osteoarthritis were randomized to an uncemented cup with either vitamin E-treated highly cross-linked polyethylene (HXLPE) (vitamin-e group, n = 25) or a standard HXLPE liner (control group, n = 26) and followed for two years after surgery. The outcome variable was polyethylene (PE) linear head penetration, measured with radiostereometry (RSA). The head penetration in x- (medial/lateral) and y- (vertical) axes was significantly lower for the vitamin E-treated liner up to two years with a mean difference between the groups of 0.10 mm (95 % CI 0.04–0.18) and 0.08 mm (95 % CI 0.01–0.15), respectively. The initial total penetration was lower for the vitamin-E group but did not reach statistical significance at two years with a mean difference between the groups of 0.07 mm (95 % CI −0.001 to 0.15, p = 0.09). We found no differences in clinical outcome between the groups. In this prospective, randomized, controlled trial on a new vitamin-E diffused HXLPE liner we found, compared to a conventional HXLPE liner, lower initial head penetration and lower superior and medial wear. A longer follow-up than two years is necessary to demonstrate lower overall head penetration in vitamin-E liners compared to contemporary highly cross-linked PE.
Adjuvant hormonal treatment for prostate cancer: the bicalutamide early prostate cancer program.

Adjuvant hormonal therapy has been demonstrated to be able to delay disease progression in nonmetastatic prostate cancer. To date, however, a favorable impact on survival has only been demonstrated in lymph-node-positive disease and in external-beam radiotherapy series with locally advanced and probably mainly micrometastatic tumors. The Bicalutamide Early Prostate Cancer Program is the largest study under way to define the role of adjuvant treatment in early prostate cancer and identify subgroups of patients likely to benefit from immediate hormonal therapy. At the time of the most recently published analysis, the risk of objective clinical progression was significantly reduced in the bicalutamide arm (hazards ratio 0.58, 95% confidence interval 0.51-0.66, p < 0.0001). However, further maturation of data is needed to see whether this difference will lead to a survival advantage.
Novel four-drug salvage treatment regimens after failure of a human immunodeficiency virus type 1 protease inhibitor-containing regimen: antiviral activity and correlation of baseline phenotypic drug susceptibility with virologic outcome.

Twenty human immunodeficiency virus-infected patients experiencing virologic failure of an indinavir- or ritonavir-containing treatment regimen were evaluated in a prospective, open-label study. Subjects received nelfinavir, saquinavir, abacavir, and either another nucleoside analog (n=10) or nevirapine (n=10). Patients treated with the nevirapine-containing regimen experienced significantly greater virologic suppression at week 24 than those not treated with nevirapine (P=.04). Baseline phenotypic drug susceptibility was strongly correlated with outcome in both treatment arms. Subjects with baseline virus phenotypically sensitive to 2 or 3 drugs in the salvage regimen experienced significantly greater virus load suppression than those with baseline virus sensitive to 0 or 1 drug (median week-24 change=-2.24 log and -0.35 log, respectively; P=.01). In conclusion, non-nucleoside reverse transcriptase inhibitors may represent a potent drug in salvage therapy regimens after failure of an indinavir or ritonavir regimen. Phenotypic resistance testing may provide a useful tool for selecting more effective salvage regimens.
A randomized controlled pilot trial of valacyclovir for attenuating inflammation and immune activation in HIV/herpes simplex virus 2-coinfected adults on suppressive antiretroviral therapy.

Human immunodeficiency virus (HIV) is associated with increased systemic inflammation and immune activation that persist despite suppressive antiretroviral therapy (ART). Herpes simplex virus type 2 (HSV-2) is a common coinfection that may contribute to this inflammation.



Sixty HIV type 1 (HIV-1)/HSV-2-coinfected adults on suppressive ART were randomized 1:1:1 to 12 weeks of placebo, low-dose valacyclovir (500 mg twice daily), or high-dose valacyclovir (1 g twice daily) in this 18-week trial. Co-primary outcome measures were the percentage of activated (CD38(+)HLA-DR(+)) CD8 T cells in blood, and highly sensitive C-reactive protein, interleukin 6, and soluble intercellular adhesion molecule 1 in plasma. Secondary outcomes included additional immune, inflammatory cytokine, and endothelial activation markers. The impact of valacyclovir (both groups combined) on each outcome was estimated using treatment × time interaction terms in generalized estimating equation regression models.



Participants were mostly white (75%) men who have sex with men (80%). Median age was 51 (interquartile range [IQR], 47-56) years, median duration of HIV infection was 15 (IQR, 8-21) years, median CD4 count at enrollment was 520 (IQR, 392-719) cells/µL, and median nadir CD4 count was 142 (IQR, 42-240) cells/µL. Valacyclovir was not associated with significant changes in any primary or secondary immunological outcomes in bivariate or multivariable models. Medication adherence was 97% by self-report, 96% by pill count, and 84% by urine monitoring. Eight patients had adverse events deemed possibly related to the study drug (5 placebo, 1 low-dose, 2 high-dose), and 6 patients reported at least 1 HSV outbreak (3 placebo, 3 low-dose, 0 high-dose).



Valacyclovir did not decrease systemic immune activation or inflammatory biomarkers in HIV-1/HSV-2-coinfected adults on suppressive ART.
ATLANTIS trial: results for patients treated within 3 hours of stroke onset. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke.

Only a single study has demonstrated beneficial effects of intravenous tissue plasminogen activator (tPA) in stroke patients.



We evaluated the clinical outcomes of the 61 patients enrolled in the Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) study who were randomized to receive intravenous tPA or placebo within 3 hours of symptom onset.



Despite a significant increase in the rate of symptomatic intracranial hemorrhage, tPA-treated patients were more likely to have a very favorable outcome (score of < or = 1) on the National Institutes of Health Stroke Scale at 90 days (P=0.01).



These data support current recommendations to administer intravenous tPA to eligible ischemic stroke patients who can be treated within 3 hours of symptom onset.
Prefrontal cortical hypometabolism during low-dose interferon alpha treatment

To evaluate prospectively interferon alpha (IFN-α) associated effects on cerebral glucose metabolism and its correlation to neuropsychiatric symptoms during low-dose IFN-α-treatment.  Eleven patients treated with low-dose IFN-α for chronic hepatitis C were prospectively evaluated by neuropsychiatric tests and cerebral [18F]deoxyglucose positron emission tomography (FDG-PET) before and in the 12th week of treatment. PET images were spatially normalized, corrected for variance in global activity and pixel-based t-statistics were calculated for each set of PET scans using SPM96 software. Pixel-cluster with P<0.001 for hypo- or hypermetabolism were displayed in parametric images. Covariance analysis with neuropsychiatric tests was calculated for each cluster.  In week 12 of IFN-α treatment, significant hypometabolism with a decrease of local activity ranging from 8 to 12% was found in all patients bilaterally in the prefrontal cortex (BA 9), which correlated in a covariate analysis with changes in depression score as measured by Beck's Depression Inventory. Additionally, hypermetabolism with a maximum increase in local activity of 6–8% was seen in all patients in putamina as well as the left occipital region (BA 18). Before IFN-α treatment, only 1/11 patient showed depressive symptomatology. After 3 months of treatment, 6/11 patients were classified as having mild to moderate depressive symptoms (P<0.1; Wilcoxon test).  Low-dose IFN-α therapy is associated with significant prefrontal hypometabolism. This hypometabolism covaried with depression score, but was even found in clinically non-depressed patients. These findings may reflect a possible predisposing factor for IFN-α associated neuropsychiatric syndromes and might contribute to a pathophysiological model of affective disorders, as endogenous IFN-α levels are elevated in a subset of psychotic patients during acute disease.
Mechanical vs intrinsic components in the improvement of brachial arterial compliance. Comparison of the effects of atenolol versus ramipril in hypertensive patients.

The aim of this study was to compare the mechanical and intrinsic effects of an angiotensin converting enzyme inhibitor, vs a beta-blocker, on brachial arterial compliance. In a double blind study, 34 essential hypertensive patients were treated for 3 months with either ramipril 2.5-5.0 mg daily (n = 17, age 57 +/- 7 y, 11 males) or atenolol 50-100 mg daily (n = 17, age 53 +/- 8 y, 11 males). Blood pressure (BP), brachial artery diameter (D), brachial-radial pulse wave velocity (PWV) and effective compliance (Ceff), were measured before and at the end of the study. Isobaric evaluation (Ciso) was performed in the entire population studied at an average mean BP of 110 mmHg. Ramipril significantly reduced BP from 155 +/- 16/94 +/- 6 mmHg to 140 +/- 15/85 +/- 7 mmHg (p < 0.001) without affecting heart rate (HR; 74 +/- 10 vs. 75 +/- 12 bpm). In addition, it significantly improved both PWV (18%; p < 0.001) and arterial compliance (45%; p < 0.001), from which 35% was related to a pressure independent effect (p < 0.01). Atenolol also induced a reduction in both BP (159 +/- 17/96 +/- 10 to 133 +/- 13/81 +/- 8 mmHg; p < 0.001) and HR (76 +/- 10 to 57 +/- 7 bpm; p < 0.001). In a similar way, PWV (11%; p < 0.05) and Ceff (30%; p < 0.05) were significantly improved without significant change in Ciso. This suggests that blood pressure reduction was responsible for compliance improvement. In conclusion, it is suggested that atenolol induces only hemodynamic changes, mediated mainly by BP reduction. In contrast, the improved brachial buffering function observed after ramipril involves not only hemodynamic changes, but also changes mediated by other mechanisms, such as modification of wall structures.
Response of angina and ischemia to long-term treatment in patients with chronic stable angina: a double-blind randomized individualized dosing trial of nifedipine, propranolol and their combination.

Seventy-four patients with chronic stable mild angina, mild coronary artery disease (83% had one- or two-vessel disease) and normal left ventricular function were studied to measure the response of treadmill exercise performance and painful and silent ischemia in the ambulatory setting to randomly assigned treatment with nifedipine or propranolol and their combination; titration to maximal tolerated dosages was performed in double-blind manner. At 3 months both nifedipine and propranolol reduced the weekly angina rate (p less than 0.05); during treadmill exercise testing, increases (p less than 0.05) were noted in time to angina and total exercise time and decreases in maximal ST depression at the end of exercise. There were no differences between the responses to nifedipine and propranolol and no significant additional changes were seen after another 3 months of therapy. The combination of nifedipine and propranolol reduced the number of patients with angina on exercise treadmill testing from 64% to 38% (p less than 0.05). During ambulatory electrocardiographic monitoring before treatment, there were 1.4 +/- 2.4 (mean +/- SD) episodes/24 h of painful ischemia and a very low silent ischemia frequency: mean 1.1 +/- 2.7 episodes/24 h, mean duration 16 +/- 25 min/24 h. Treatment with propranolol and nifedipine resulted in reduction of episodes and duration of painful and painless ischemia; approximately 77% of patients were free of all ischemic episodes. It is concluded that patients with chronic stable mild angina have a low incidence of silent ischemia. Nifedipine or propranolol alone, titrated to individualized maximally tolerated dosages, are equally effective in long-term control of painful and painless ischemia, anginal episodes and exercise-induced ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)