bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of one-year outcomes in chronic heart failure: the portrait of a middle income country
Authors: Gioli-Pereira Luciana , Marcondes-Braga Fabiana G. , Bernardez-Pereira Sabrina , Bacal Fernando , Fernandes Fábio , Mansur Alfredo J. , Pereira Alexandre C. , Krieger José E. 
Published: November 2019

Abstract

Background
Heart failure (HF) is a major public health problem with increasing prevalence worldwide. It is associated with high mortality and poor quality of life due to recurrent and costly hospital admissions. Several studies have been conducted to describe HF risk predictors in different races, countries and health systems. Nonetheless, understanding population-specific determinants of HF outcomes remains a great challenge.
We aim to evaluate predictors of 1-year survival of individuals with systolic heart failure from the GENIUS-HF cohort.

Methods
We enrolled 700 consecutive patients with systolic heart failure from the SPA outpatient clinic of the Heart Institute, a tertiary health-center in Sao Paulo, Brazil. Inclusion criteria were age between 18 and 80 years old with heart failure diagnosis of different etiologies and left ventricular ejection fraction ≤50% in the previous 2 years of enrollment on the cohort. We recorded baseline demographic and clinical characteristics and followed-up patients at 6 months intervals by telephone interview. Study data were collected and data quality assurance by the Research Electronic Data Capture tools. Time to death was studied using Cox proportional hazards models adjusted for demographic, clinical and socioeconomic variables and medication use.

Results
We screened 2314 consecutive patients for eligibility and enrolled 700 participants.
The overall mortality was 6.8% (47 patients); the composite outcome of death and hospitalization was 17.7% (123 patients) and 1% (7 patients) have been submitted to heart transplantation after one year of enrollment. After multivariate adjustment, baseline values of blood urea nitrogen (HR 1.017; CI 95% 1.008–1.027; p < 0.001), brain natriuretic peptide (HR 1.695; CI 95% 1.347–2.134; p < 0.001) and systolic blood pressure (HR 0.982;CI 95% 0.969–0.995; p = 0.008) were independently associated with death within 1 year. Kaplan Meier curves showed that ischemic patients have worse survival free of death and hospitalization compared to other etiologies.

Conclusions
High levels of BUN and BNP and low systolic blood pressure were independent predictors of one-year overall mortality in our sample.

Trial registration
Current Controlled Trials NTC02043431, retrospectively registered at in January 23, 2014.
Cascade screening for familial hypercholesterolemia-identification of the C308Y mutation in multiple family members and relatives for the first time in mainland China
Authors: Jin Weirong , Zhang Qiuwang , Wang Bei , Pan Lili , Qin Hongyou , Yang Daying , Zhou Xiangqun , Du Yongcai , Lin Ling , Kutryk Michael J. 
Published: November 2019

Abstract

Background
Familial hypercholesterolemia (FH), an autosomal dominant genetic disorder, is underdiagnosed and undertreated. The majority of FH cases are caused by low density lipoprotein receptor (LDL-R) gene mutations. The C308Y mutation in LDL-R results in approximately 70% loss of LDL-R activity, leading to the elevation of low density lipoprotein-cholesterol (LDL-C) and an increased risk of premature coronary heart disease (CHD). The aim of this study was to identify FH cases by cascade screening in family members and relatives of a 37-year old male with premature CHD and hypercholesterolemia.

Methods
Clinical exam, blood lipid profiling and genomic DNA sequencing of all exons of LDL-R were performed for the proband and his 14 family members and relatives. FH diagnosis was carried out using the Dutch Lipid Clinic Network (DLCN) criteria.

Results
Lipid profiling showed that 9 individuals, including the proband, had hypercholesterolemia. All these 9 subjects had a G > A substitution at nucleotide 986 in exon 7 resulting in the C308Y mutation as determined by DNA sequencing, and all those carrying the mutation were diagnosed as having definite FH under the DLCN criteria. However, most (7/9) did not have suggestive clinical manifestations of CHD.

Conclusions
The C308Y mutation was discovered in multiple family members and relatives for the first time in mainland China. Cascade screening is key for the confirmatory diagnosis of FH. Our hypothesis that the C308Y is a common variant in the population of Southern China origin warrants further validation by screening for the C308Y mutation in a large population.
Gothenburg Very Early Supported Discharge study (GOTVED): a randomised controlled trial investigating anxiety and overall disability in the first year after stroke
Authors: Rafsten Lena , Danielsson Anna , Nordin Asa , Björkdahl Ann , Lundgren-Nilsson Asa , Larsson Maria E. H. , Sunnerhagen Katharina S. 
Published: November 2019

Abstract

Background and purpose
Early supported discharge (ESD) has been shown to be efficient and safe as part of the stroke care pathway. The best results have been seen with a multidisciplinary team and after mild to moderate stroke. However, how very early supported discharge (VESD) works has not been studied.
The aim of this study was to investigate whether VESD for stroke patients in need of ongoing individualized rehabilitation affects the level of anxiety and overall disability for the patient compared with ordinary discharge routine.

Methods
A randomized controlled trial was performed with intention to treat analyses comparing VESD and ordinary discharge from hospital. All patients admitted at the stroke care unit at Sahlgrenska University Hospital of Gothenburg between August 2011 and April 2016 were screened. Inclusion occurred on day 4 using a block randomization of 20 and with a blinded assessor. Assessments were made 5 days post-stroke and 3 and 12 months post-stroke. Patients in the VESD group underwent continued rehabilitation in their homes with a multidisciplinary team from the stroke care unit for a maximum of 1 month. The patients in the control group had support as usual after discharge when needed such as home care service and outpatient rehabilitation.
The primary outcome was anxiety as assessed by the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A). The secondary outcome was the patients’ degree of overall disability, measured by the modified Rankin Scale (mRS).

Results
No significant differences were found between the groups regarding anxiety at three or 12 months post-stroke (p = 0.811). The overall disability was significantly lower in the VESD group 3 months post-stroke (p = 0.004), compared to the control group. However, there was no significant difference between the groups 1 year post-stroke.

Conclusions
The VESD does not affects the level of anxiety compared to ordinary rehabilitation. The VESD leads to a faster improvement of overall disability compared to ordinary rehabilitation. We suggest considering coordinated VESD for patients with mild to moderate stroke in addition to ordinary rehabilitation as part of the service from a stroke unit.

Trial registration
Clinical Trials.gov: NCT01622205. Registered 19 June 2012 (retrospectively registered).
RETRACTED ARTICLE: Bronchial blocker versus double-lumen endobronchial tube in minimally invasive cardiac surgery
Authors: Zhang Chuncheng , Yue Jing , Li Mingyue , Jiang Wei , Pan Yu , Song Zhimin , Shi Cailian , Fan Weixuan , Pan Zhenxiang 
Published: November 2019

Abstract
Background
To compare the therapeutic value of a bronchial blocker (BB) with a double-lumen tube (DLT) in minimally invasive cardiac surgery (MICS).

Methods
Sixty patients who underwent MICS were randomized to use either a DLT (Group D, n = 30) or a BB (Group B, n = 29; one failed was omitted). The following data were collected: time of intubation and tube localization; incidence of tube displacement; postoperative sore throat and hoarseness; time of cardiopulmonary bypass; maintenance time for SpO2 < 90% (PaCO2 < 60 mmHg); mean arterial pressure and heart rate; SpO2, PaO2, PaCO2, EtCO2, mean airway pressure, and airway peak pressure; surgeons’ satisfaction with anesthesia; and short-term complications.

Results
The times of intubation and tube localization were significantly longer in Group B than in Group D (P < 0.05). Patients in Group B exhibited significantly lower incidence of tube displacement, postoperative sore throat, and hoarseness when compared with patients in Group D (P < 0.05). Mean arterial pressure and heart rate were significantly lower in Group B than in Group D after tracheal intubation (P < 0.05). The mean airway pressure and airway peak pressure were significantly lower in Group B than in Group D after one-lung ventilation (P < 0.05). SpO2 and PaO2 in Group B were significantly higher than in group D after cardiopulmonary bypass (P < 0.05). No short-term postoperative complications were observed in patients of Groups B and D during 3 month follow-up.

Conclusion
BB can be a potential alternative to the conventional DLT for lung isolation in MICS. Trial registration: ChiCTR1900024250, July 2, 2019.
What do patients with unmet medical needs want? A qualitative study of patients’ views and experiences with expanded access to unapproved, investigational treatments in the Netherlands
Authors: Bunnik Eline M. , Aarts Nikkie 
Published: November 2019

Abstract

Background
Patients with unmet medical needs sometimes resort to non-standard treatment options, including the use of unapproved, investigational drugs in the context of clinical trials, compassionate use or named-patient programs. The views and experiences of patients with unmet medical needs regarding unapproved, investigational drugs have not yet been examined empirically.

Methods
In this qualitative study, exploratory interviews and focus groups were held with patients with chronic or life-threatening diseases (n = 39), about topics related to non-standard treatment options, such as the search for non-standard treatment options, patients’ views of the moral obligations of doctors, and the conditions under which they would or would not wish to use non-standard treatment options, including expanded access to unapproved, investigational drugs.

Results
Respondents had very little knowledge about and/or experience with existing opportunities for expanded access to investigational drugs, although some respondents were actively looking for non-standard treatment options. They had high expectations of their treating physicians, assuming them to be aware of non-standard treatment options, including clinical trials elsewhere and expanded access programs, and assuming that they would inform their patients about such options. Respondents carefully weighed the risks and potential benefits of pursuing expanded access, citing concerns related to the scientific evidence of the safety and efficacy of the drug, side effects, drug-drug interactions, and the maintaining of good quality of life. Respondents stressed the importance of education and assertiveness to obtain access to good-quality health care, and were willing to pay out of pocket for investigational drugs. Patients expressed concerns about equal access to new and/or non-standard treatment options.

Conclusion
When the end of a standard treatment trajectory comes into view, patients may prefer that treating physicians discuss non-standard treatment options with them, including opportunities for expanded access to unapproved, investigational drugs. Although our respondents had varying levels of understanding of expanded access programs, they seemed capable of making well-considered choices with regard to non-standard treatment options and had realistic expectations with regard to the safety and efficacy of such options. Dutch patients might be less likely to fall prey to false hope than often presumed.
Antiparasitic effect of synthetic aromathecins on Leishmania infantum
Authors: Reguera Rosa M. , Álvarez-Velilla Raquel , Domínguez-Asenjo Bárbara , Gutiérrez-Corbo Camino , Balaña-Fouce Rafael , Cushman Mark , Pérez-Pertejo Yolanda 
Published: November 2019

Abstract

Background
Canine leishmaniasis is a zoonotic disease caused by Leishmania infantum, being the dogs one of the major reservoirs of human visceral leishmaniasis. DNA topology is a consolidated target for drug discovery. In this regard, topoisomerase IB – one of the enzymes controlling DNA topology – has been poisoned by hundreds of compounds that increase DNA fragility and cell death. Aromathecins are novel molecules with a multiheterocyclic ring scaffold that have higher stability than camptothecins.

Results
Aromathecins showed strong activity against both forms of L. infantum parasites, free-living promastigotes and intra-macrophagic amastigotes harbored in ex vivo splenic explant cultures obtained from infected BALB/c mice. However, they prevented the relaxation activity of leishmanial topoisomerase IB weakly, which suggests that the inhibition of topoisomerase IB partially explains the antileishmanial effect of these compounds. The effect of aromathecins was also studied against a strain resistant to camptothecin, and results suggested that the trafficking of these compounds is not through the ABCG6 transporter.

Conclusions
Aromathecins are promising novel compounds against canine leishmaniasis that can circumvent potential resistances based on drug efflux pumps.
Determinants of malaria treatment delay in northwestern zone of Tigray region, Northern Ethiopia, 2018
Authors: Tesfahunegn Afewerki , Zenebe Dawit , Addisu Alefech 
Published: November 2019

Abstract

Background
Globally malaria affects 212 million people and causes 438,000 deaths each year. Ensuring early and timely treatment of malaria is important for preventing and controlling of life-threatening complications and further transmission. Even though malaria treatment is widely available in Ethiopia, 47–84% of patients present after 24 h of onset of first symptoms. This study assessed the determinants of delay for malaria treatment in Tigray, Ethiopia.

Methods
A health facility-based case–control study design in northwestern zone of Tigray was conducted from September 2018 to January 2019. All the study participants enrolled were confirmed malaria patients (by microscopy or rapid diagnostic test) and who sought treatment. Cases were defined as malaria patients who sought treatment after 24 h of the onset of the first symptom and control were those who sought treatment within 24 h onset of symptom. A structured questionnaire was used to collect data on the determinants of malaria treatment delay. Data were entered into EpiInfo 7.0 and exported to SPSS 20.0 for analysis. Binary logistic regression was computed to identify predictors of delay for malaria treatment.

Results
In total 161 cases and 161 controls were identified. Being residents of Tahtay Adyabo district (AOR = 2.84, 95% CI 1.29–6.27), having no formal education (AOR = 2.39, 95% CI 1.09–5.22), the decisions to seek health care being taken by the patient (AOR = 2.38 95% CI 1.09–5.2), the decisions to seek health care being taken by their fathers (AOR = 2.52, 95% CI 1.13–5.62), and having good knowledge about malaria symptoms (AOR = 2.02, 95% CI 1.21–3.39) were found determinants of delay for malaria treatment.

Conclusion
In this study, delays in obtaining treatment for malaria were associated with having no formal education, knowing about the signs and symptoms of malaria, living in Tahtay Adyabo district, and decision-making on seeking malaria treatment. The results suggests having treatment commenced at sites closer to the community and strengthened awareness-raising activity about the importance of early seeking for all with malaria-like symptoms, especially for household heads would contribute to improved treatment and reduced complications from malaria.
Comparing the cost of essential nutrients from different food sources in the American diet using NHANES 2011–2014
Authors: Hess Julie M. , Cifelli Christopher J. , Agarwal Sanjiv , Fulgoni Victor L. 
Published: November 2019

Abstract

Background
One reason that some Americans do not meet nutrient needs from healthy eating patterns is cost. Food cost affects how people eat, and healthy diets tend to be more expensive. Cost is also important for diet sustainability. Sustainable eating patterns must be both nutritionally adequate and affordable. The objective of this study was to compare the cost of obtaining shortfall nutrients from different food groups to help identify cost-effective ways Americans can move towards healthy and sustainable eating patterns.

Methods
This analysis used dietary intake data from the National Health and Nutrition Examination Survey from 2011 to 2012 and 2013–2014 (n = 5876 children 2–18 years and n = 9953 adults 19–99 years). Americans’ nutrient intake from food categories in “What We Eat in America” and the 2015–2020 Dietary Guidelines for Americans was determined using the Food and Nutrient Database for Dietary Studies. Food cost and the cost of nutrients were obtained from Center for Nutrition Promotion and Policy food cost database 2001–2002 and 2003–2004 (adjusted for inflation).

Results
The daily mean cost of food was $4.74 ± 0.06 for children and $6.43 ± 0.06 for adults. “Protein foods” and “mixed dishes” were the two most expensive food categories (43–45% of daily food costs), while “grains,” “fruits,” and “vegetables” combined accounted for ~ 18% of the daily cost, and “milk and dairy” accounted for 6–12% of total daily food costs in both adults and children. “Milk and dairy” were the least expensive dietary sources of calcium and vitamin D in the American diet, while “grains” were the least expensive sources of iron and magnesium, and “protein foods” were the least expensive sources of choline. “Fruits” and “vegetables” were the least expensive sources of potassium and vitamin C, respectively, and “snacks and sweets” were the least expensive sources of vitamin E.

Conclusion
“Milk and dairy” were inexpensive sources of three of the four nutrients of public health concern (calcium, vitamin D, and potassium), while “grains” were the least expensive source of fiber. The results of this work reinforce the importance of consuming a variety of nutrient-rich foods for cost-effective, sustainable eating patterns.
A new combination rule for Spatial Decision Support Systems for epidemiology
Authors: de Lima Luciana Moura Mendes , de Sá Laísa Ribeiro , dos Santos Macambira Ana Flávia Uzeda , de Almeida Nogueira Jordana , de Toledo Vianna Rodrigo Pinheiro , de Moraes Ronei Marcos 
Published: November 2019

AbstractBackgroundDecision making in the health area usually involves several factors, options and data. In addition, it should take into account technological, social and spatial aspects, among others. Decision making methodologies need to address this set of information , and there is a small group of them with focus on epidemiological purposes, in particular Spatial Decision Support Systems (SDSS).MethodsMakes uses a Multiple Criteria Decision Making (MCDM) method as a combining rule of results from a set of SDSS, where each one of them analyzes specific aspects of a complex problem. Specifically, each geo-object of the geographic region is processed, according to its own spatial information, by an SDSS using spatial and non-spatial data, inferential statistics and spatial and spatio-temporal analysis, which are then grouped together by a fuzzy rule-based system that will produce a georeferenced map. This means that, each SDSS provides an initial evaluation for each variable of the problem. The results are combined by the weighted linear combination (WLC) as a criterion in a MCDM problem, producing a final decision map about the priority levels for fight against a disease. In fact, the WLC works as a combining rule for those initial evaluations in a weighted manner, more than a MCDM, i.e., it combines those initial evaluations in order to build the final decision map.ResultsAn example of using this new approach with real epidemiological data of tuberculosis in a Brazilian municipality is provided. As a result, the new approach provides a final map with four priority levels: “non-priority”, “non-priority tendency”, “priority tendency” and “priority”, for the fight against diseases.ConclusionThe new approach may help public managers in the planning and direction of health actions, in the reorganization of public services, especially with regard to their levels of priorities.
Monostotic fibrous dysplasia at C7 treated with vertebroplasty: a case report and review of the literature
Authors: Xin Xin , Feng Jianhong , Yue Chen , Jin Tao , Liu Xinxin 
Published: November 2019

Abstract

Background
Monostotic fibrous dysplasia (MFD) involving the spine is rare, and the treatment options are controversial. Surgery is needed when patients suffer from persistent pain, spinal cord compression/injury, and vertebral collapse/instability. Treatment methods include biopsy/observation, corpectomy with instrumented fusion, posterior fusion, vertebroplasty (VP), curettage and bone graft, and complete removal of the vertebra with a combined anterior and posterior fusion procedure.

Case presentation
The patient was a 56-year-old woman with a 2-year history of neck pain. No obvious abnormalities were detected on neurological or physical examination, and laboratory findings were all within normal limits. An imaging examination suggested a C7 vertebral bone tumor. The patient refused to continue conservative observation treatment and requested surgery. Open VP of the C7 vertebral body was carried out, and her postoperative neck pain was completely relieved. The postoperative pathological results supported the diagnosis of fibrous dysplasia, and the patient was ultimately diagnosed with MFD. At the 12-month follow-up visit, the patient reported no clinical symptoms, and no signs of tumor recurrence were detected.

Conclusion
VP can relieve pain while stabilizing the spine. Thus, the surgical treatment of MFD vertebral lesions by VP is a valuable option.
Successful use of the left portal vein as graft for middle hepatic vein reconstruction in left hemihepatectomy: preliminary experience on six cases
Authors: Lv Tao , Kong Ling Xiang , Yang Jiayin , Wu Hong , Wen Tianfu , Jiang Li , Yang Jian 
Published: November 2019

Abstract

Background
The purpose of this research was to assess the feasibility of reconstructing the middle hepatic vein (MHV) with resected left portal vein during left hemihepatectomy.

Methods
From January 2014 to January 2018, six patients received left hemihepatectomy combined with MHV reconstruction using the resected left portal vein in West China Hospital. We reviewed the clinical data including patient details, surgical technique, graft patency, and operative results.

Results
All six patients underwent left hemihepatectomy for liver tumors located at left hepatocaval confluence. In these patients, MHV was resected due to tumor invading and reconstructed using the resected left portal vein as graft. The mean operating time was 316 min. Two patients developed complications: one experienced bile leakage and one experienced pleural effusion. No patient developed vascular graft complications. All the grafts remained unobstructed, and no local tumor recurrence occurred during the observation period of 13–41 months.

Conclusions
Our results indicated that the left portal vein was a safe graft for hepatic vein reconstruction. In addition, left hemihepatectomy combined with middle hepatic vein resection and reconstruction using the left portal vein can be performed safely to treat liver tumors located at hepatocaval confluence.