bluuebunny/crossref_metadata_2025_split huggingface dataset:
Size at birth, growth trajectory in early life, and cardiovascular and metabolic risks in early adulthood: EPICure study
Authors: Ni Yanyan , Beckmann Joanne , Hurst John R , Morris Joan K , Marlow Neil 
Published: August 2020

ObjectiveTo investigate whether size at birth and growth trajectories in infancy and childhood are associated with determinants of cardiovascular and metabolic risks in young adults born extremely preterm (EP, <26 weeks of gestation).MethodsWe used longitudinal data from the EPICure study of 129 EP survivors up to 19 years in the UK and Ireland in 1995. Determinants of cardiovascular and metabolic risks at 19 years included the presence of metabolic syndrome, body mass index (BMI) and systolic blood pressure (SBP). Predictors were birth weight for gestation and gain in weight z-scores in the following periods: birth–postmenstrual age of 40 weeks (term), infancy (term–2.5 years), early childhood (2.5–6.0 years) and late childhood (6–11 years).ResultsMetabolic syndrome was present in 8.7% of EP participants at 19 years. Compared with subjects without metabolic syndrome, those with metabolic syndrome tended to have a smaller size at birth (difference in means: −0.55 SD, 95% CI −1.10 to 0.01, p=0.053) and a greater increase in weight z-scores from term to 2.5 years (difference in means: 1.00 SD, 95% CI −0.17 to 2.17, p=0.094). BMI at 19 years was positively related to growth from 2.5 to 6.0 years (
β
: 1.03, 95% CI 0.31 to 1.75, p=0.006); an inverse association with birthweight z-scores was found in the lower socioeconomic status group (
β
: −1.79, 95% CI −3.41 to –0.17, p=0.031). Central SBP was positively related to growth from 2.5 to 6.0 years (
β
: 1.75, 95% CI 0.48 to 3.02, p=0.007).ConclusionSize at EP birth and increased catch-up in weight from 2.5 to 6.0 years were associated with BMI and central SBP in early adulthood.
Exploratory cost-effectiveness model of electromagnetic navigation bronchoscopy (ENB) compared with CT-guided biopsy (TTNA) for diagnosis of malignant indeterminate peripheral pulmonary nodules
Authors: Rickets William , Lau Kelvin Kar Wing , Pollit Vicki , Mealing Stuart , Leonard Catherine , Mallender Philip , Chaudhuri Nilanjan , Shah Pallav L , Naidu Umamamaheswar Babu 
Published: August 2020

IntroductionLung cancer is accountable for 35 000 deaths annually, and prognosis is improved when the cancer is diagnosed early. CT-guided biopsy (transthoracic needle aspiration, TTNA) and electromagnetic navigation bronchoscopy (ENB) can be used to investigate indeterminate pulmonary nodules if the patient is unfit for surgery. However, there is a paucity of clinical and health economic evidence that directly compares ENB with TTNA in this population group. This cost-effectiveness study aimed to explore potential scenarios whereby ENB may be considered cost-effective when compared with TTNA.MethodsA cohort decision analytic model was developed using a UK National Health Service perspective. ENB was assumed to have equal sensitivity to TTNA at 82%. Lifetime costs and quality-adjusted life-year (QALY) gain were calculated to estimate the net monetary benefit at a £20 000 per QALY threshold. Sensitivity analyses were used to explore scenarios where ENB could be considered a cost-effective intervention.ResultsUnder the assumption that ENB has equal efficacy to TTNA, ENB was found to be dominant (less costly and more effective) when compared with TTNA, due to having a reduced risk and cost of adverse events. This conclusion was most sensitive to changes in the cost of intervention, estimates of effectiveness and adverse event rates.DiscussionENB is expected to be cost-effective when the likelihood of an accurate diagnosis is equal to (or better than) TTNA, which may occur in certain subgroups of patients in whom TTNA is unlikely to accurately diagnose malignancy or when an experienced practitioner achieves a high accuracy with ENB.
Survey of trainee attitudes to skill development and simulation training in
trauma and orthopaedics
Authors: Jassim Shivan S , Varma Sundeep K , Ramachandran Manoj , Akhtar Kashif S N 
Published: August 2020

Background
Simulation training in surgery is widespread and allows surgeons to
practise novel operative techniques and acquaint themselves with unfamiliar
surgical procedures. The use of box or virtual reality simulators in many
surgical specialities is established; however, its use within trauma and
orthopaedics (T&O) in the UK and the attitudes of trainee towards it are
not known. The aim of this study is to explore the experiences and opinions of
T&O trainees towards simulation training.

Methods
An electronic survey consisting of 11 questions on the experiences of
simulation training and attitudes towards it was sent to all T&O speciality
trainees in London.

Results
Fewer than 10% of the responders had used or had ready access to
simulators to prepare for unfamiliar operations, with almost 90% preferring to
read about them in a journal or watch them on an online video site. Over half
had only seen simulators on courses or been aware of them. Over 75% of the
responders believed that simulators should be available for trainees, but most
did not feel that they should be used as part of formal assessments.

Conclusions
Methods for preparing for new operations have expanded over the past
20 years, yet the use of simulator machines is not widespread. Many trainees
believe current machines are not widely available nor realistic enough to be
useful, with most preferring online videos and operative technique books for
preparing for an unfamiliar operation.
Mass eradication ofHelicobacter pylorito reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands
Authors: Chiang Tsung-Hsien , Chang Wei-Jung , Chen Sam Li-Sheng , Yen Amy Ming-Fang , Fann Jean Ching-Yuan , Chiu Sherry Yueh-Hsia , Chen Yi-Ru , Chuang Shu-Ling , Shieh Chun-Fu , Liu Cheng-Ying , Chiu Han-Mo , Chiang Hung , Shun Chia-Tung , Lin Ming-Wei , Wu Ming-Shiang , Lin Jaw-Town , Chan Chang-Chuan , Graham David Y , Chen Hsiu-Hsi , Lee Yi-Chia 
Published: August 2020

ObjectiveAlthough mass eradication ofHelicobacter pylorihas been proposed as a means to eliminate gastric cancer, its long-term effects remain unclear.DesignMass eradication ofH. pyloriinfection was launched in 2004 and continued until 2018 for a high-risk Taiwanese population aged 30 years or older dwelling on Matsu Islands with prevalentH. pyloriinfection. Test positives for the13C-urea breath test underwent eradication therapy. We evaluated the effectiveness of the mass eradication in reducing two main outcomes, incidence and mortality rates of gastric cancer, until the end of 2016 and 2018, respectively.ResultsAfter six rounds of mass screening and eradication, the coverage rate reached 85.5% (6512/7616). The referral rate for treatment was 93.5% (4286/4584). The prevalence rates ofH. pylorifell from 64.2% to 15.0% with reinfection rates of less than 1% per person-year. The presence and severity of atrophic gastritis and intestinal metaplasia also decreased with time. Compared with the historical control period from 1995 to 2003, the effectiveness in reducing gastric cancer incidence and mortality during the chemoprevention period was 53% (95% CI 30% to 69%, p<0.001) and 25% (95% CI −14% to 51%, p=0.18), respectively. No significant changes were noted in the incidence rates of other digestive tract cancers or the antibiotic resistance rate ofH. pylori.ConclusionPopulation-based eradication ofH. pylorihas significantly reduced gastric cancer incidence with no increase in the likelihood of adverse consequences. A significant reduction in mortality is likely to be achieved with a longer follow-up period.Trial registration numberNCT00155389
Continuous PENG block for hip fracture: a case series
Authors: Del Buono Romualdo , Padua Eleonora , Pascarella Giuseppe , Soare Corina Gabriela , Barbara Enrico 
Published: August 2020

Introduction
The pericapsular nerve group (PENG) block is a novel regional technique indicated for analgesia for hip joint pain. We administered PENG blocks and performed catheter insertion for continuous infusions in patients with femur fractures on hospital admission. In this case series, we describe our initial experience of pain management in 10 patients with continuous infusion and its associated adverse events.

Case series
The PENG block was administered with an introducer needle. The catheter was then inserted 3 cm beyond the needle tip. In three patients, blood aspiration through the catheter occurred. In each patient, the catheter was repositioned 0.5–1.0 cm more medially. No blood aspiration or visible hematoma occurred subsequently. The presence of any vascular structure deep to the iliopsoas muscle was excluded postoperatively based on a Doppler color flow scan.

Discussion
Overall, eight patients had femoral neck fractures, and two patients had intertrochanteric fractures. All 10 patients reported good pain relief. The median (IQR) Numerical Rating Scale (NRS) score decreased from 7 (6–7) before the block to 2 (2–2.75) 20 min after PENG catheter placement. The median (IQR) NRS score after 12, 24 and 48 hours were 2 (2–3), 2 (2–3), and 2 (0.25–2), respectively. Patients underwent surgery 24–48 hours following catheter placement. Catheters were removed by an Acute Pain Service nurse 72 hours postinsertion. We want to highlight the potential for intravascular catheter placement in this anatomical region. Further studies are required to confirm if this is a technical error or an associated complication of continuous PENG blocks.
Association between asthma, corticosteroids and allostatic load biomarkers: a cross-sectional study
Authors: Barry Luke Evan , O’Neill Ciaran , Heaney Liam G 
Published: August 2020

BackgroundAllostatic load, a measure of early ageing or ‘wear and tear’ from adapting to environmental challenges, has been suggested as a framework with which to understand the stress-related disruption of multiple biological systems which may be linked to asthma. Considering the socioeconomic context is also critical given asthma and allostatic overload are more common in lower socioeconomic groups.AimsEstimate the relationship between allostatic load and its constituent biomarkers, asthma and corticosteroid prescribing while controlling for socioeconomic status.MethodsData from Understanding Society (a nationally representative survey of UK community-dwelling adults) waves 1–3 (2009–2012) allowed the identification of a sex-specific risk profile across 12 biomarkers used to construct an Allostatic Load Index for a sample of 9816 adults. Regression analyses were used to examine the association of asthma status and corticosteroid prescriptions with allostatic load and its constituent biomarkers while controlling for socioeconomic status (n=9805).ResultsSubjects with currently treated asthma and no corticosteroid prescription have an allostatic load 1.21 times higher than those without asthma (p<0.001). Asthmatic subjects in receipt of inhaled corticosteroids had an allostatic load, approximately 1.12 times higher than those without asthma (p<0.001). This association persisted in sensitivity analyses and appeared to be driven by an association with specific biomarkers (dehydroepiandrosterone-sulfate, waist-to-height ratio and C-reactive protein).ConclusionEarly ageing, in the form of a higher allostatic load, was present even in the mildest asthma group not receiving inhaled corticosteroids. Allostatic load is helpful in understanding the increased all-cause mortality and multimorbidity observed in asthma.
Night-to-night variability of respiratory events in obstructive sleep apnoea: a systematic review and meta-analysis
Authors: Roeder Maurice , Bradicich Matteo , Schwarz Esther Irene , Thiel Sira , Gaisl Thomas , Held Ulrike , Kohler Malcolm 
Published: August 2020

BackgroundIt is current practice to use a single diagnostic sleep study in the diagnostic workup of obstructive sleep apnoea (OSA). However, a relevant night-to-night variability (NtNV) of respiratory events has been reported.MethodsWe evaluated the NtNV of respiratory events in adults with suspected or already diagnosed OSA who underwent more than one diagnostic sleep study. Data sources were PubMed, Cochrane and Embase up to 23 January 2019. Random-effects models were used for evidence synthesis. For moderator analysis, mixed-effects regression analysis was performed. The study was registered with PROSPERO (CRD42019135277).ResultsOf 2143 identified papers, 24 studies, comprising 3250 participants, were included. The mean Apnoea-Hypopnoea Index (AHI) difference between the first and second night was −1.70/hour (95% CI −3.61 to 0.02). REM time differences (first to second night) were significantly positive associated with differences in mean AHI (β coefficient 0.262 (95% CI 0.096 to 0.428). On average, 41% (95% CI 27% to 57%) of all participants showed changes of respiratory events >10/hour from night to night. Furthermore, 49% (95% CI 32% to 65%) of participants changed OSA severity class (severity thresholds at 5/hour, 15/hour and 30/hour) at least once in sequential sleep studies. Depending on the diagnostic threshold (5/hour, 10/hour or 15/hour), on average 12% (95% CI 9% to 15%), 12% (95% CI 8% to 19%) and 10% (95% CI 8% to 13%) of patients would have been missed during the first night due to single night testing.ConclusionWhile there was no significant difference between mean AHI in two sequential study nights on a group level, there was a remarkable intraindividual NtNV of respiratory events, leading to misdiagnosis and misclassification of patients with suspected OSA.
Prospective evaluation of the “Stop the Bleed” program in Japanese participants
Authors: Ito Kaori , Morishita Koji , Tsunoyama Taichiro , Nagao Tsuyoshi , Tomonaga Ayumi , Hondo Kenichi , Yagi Masayuki , Kato Nagisa , Miyake Yasufumi , Sakamoto Tetsuya 
Published: August 2020

BackgroundThe Stop the Bleed (STB) program was developed to bring military bleeding control techniques into wider use among American civilians. It was introduced in Japan in case of mass casualty events during the Tokyo Olympic/Paralympic Games in 2021, and its effectiveness was prospectively evaluated.MethodsJapanese physicians certified as STB instructors held bleeding control basic training courses from April to July 2019. Participants’ knowledge was assessed using pre-training and post-training tests comprising five questions. One point was awarded for each correct answer, giving a maximum total score of 5. (Q1) What is the most common preventable trauma death?; (Q2) Which actions should be prioritized for bleeding victims?; (Q3) Which patients should be transferred to hospital first?; (Q4) How should a tourniquet be applied?; (Q5) How should pain associated with a tourniquet be managed?ResultsThe study involved 157 participants (20 physicians/nurses, 82 medical students, 33 emergency services personnel, 22 police officers/security personnel). The mean±SD scores were 2.1±1.1 before training and 3.2±1.0 after training (p<0.01). The respective percentages of correct answers before and after training were 58% and 75% for Q1, 10% and 13% for Q2, 38% and 55% for Q3, 73% and 89% for Q4, and 33% and 91% for Q5. Q2 had the lowest percentage of correct answers and the poorest improvement.DiscussionThe STB program improved tourniquet knowledge. However, it was less effective in improving knowledge about which actions to prioritize for bleeding victims. This may be because the participants were well trained in basic life support and therefore expected to immediately commence cardiopulmonary resuscitation for patients in shock. The STB program is valuable in preparing Japanese people for mass casualty events during the Tokyo Olympic/Paralympic Games in 2021.Level of evidenceIV.Study typeTherapeutic.
Body Composition, Metabolic Health, and Functional Impairment among Adults Treated for Abdominal and Pelvic Tumors during Childhood
Authors: Wilson Carmen L. , Liu Wei , Chemaitilly Wassim , Howell Carrie R. , Srivastava Deo Kumar , Howell Rebecca M. , Hudson Melissa M. , Robison Leslie L. , Ness Kirsten K. 
Published: August 2020

Abstract

Background:
We aimed to characterize body composition, metabolic impairments, and physical performance among survivors of pediatric abdominal and pelvic solid tumors.

Methods:
Participants included 431 survivors of abdominal or pelvic tumors [median attained age = 29.9 (range: 18.7–55.1) years]. Relative lean mass and fat mass were assessed with dual X-ray absorptiometry. Metabolic outcomes [insulin resistance (IR), high-density lipoprotein (HDL), low-density lipoprotein, and triglycerides] were based on laboratory values and medication usage. General linear regression evaluated associations between treatment and lifestyle with body composition; binomial regression evaluated associations between body composition and metabolic outcomes and physical performance.

Results:
Lean mass was lower than values from the National Health and Nutrition Examination Survey (NHANES) in males (Z-score = −0.67 ± 1.27; P &lt; 0.001) and females (Z-score = −0.72 ± 1.28; P &lt; 0.001). Higher cumulative abdominal and pelvic radiation doses were associated with lower lean mass among males [abdominal: β = −0.22 (SE) ± 0.07; P = 0.002 and pelvic: β = −0.23 ± 0.07; P = 0.002] and females (abdominal: β = −0.30 ± 0.09; P = 0.001 and pelvic: β = −0.16 ± 0.08; P = 0.037). Prevalence of IR (40.6% vs. 33.8%; P = 0.006), low HDL (28.9% vs. 33.5%; P = 0.046), and high triglycerides (18.4% vs. 10.0%; P &lt; 0.001) was increased among survivors relative to NHANES. Compared with survivors with normal/high lean mass and normal/low fat mass, survivors with normal/high lean mass and high fat mass had an increased risk of IR (P &lt; 0.001), low HDL (P &lt; 0.001), reduced quadriceps strength at 60°/second (P &lt; 0.001) and 300°/second (P &lt; 0.001), and reduced distance covered in the 6-minute walk (P &lt; 0.01).

Conclusions:
Abdominal/pelvic radiotherapy is associated with body composition changes that can adversely influence metabolic outcomes and performance status among survivors.

Impact:
Interventions targeting body composition may facilitate management of cardiovascular disease risk in this population.
Abstract A09: Photoimmunotherapy (PIT) for treatment of bladder cancer
Authors: Railkar Reema , Siddiqui Mohammad Rashid , Sanford Thomas , Kobayashi Hisataka , Choyke Peter L. , Agarwal Piyush K. 
Published: August 2020

Abstract
Introduction: The use of light as a means of therapy for bladder cancer (BC) has a long history but has been hampered by a lack of tumor specificity and therefore, damage to the normal bladder mucosa. Here, we describe a targeted form of phototherapy called photoimmunotherapy (PIT). To begin with, anti-EGFR antibody panitumumab (pan) was labeled with the photo-absorber (PA), IRDye 700Dx (IR700), to create pan IR700, an antibody-PA conjugate that is activated by near-infrared radiation (NIR). However, PIT may be less effective when a tumor lacks “overwhelming” expression of a single target such as EGFR. Hence, a combinatorial PIT approach for targeting BC expressing EGFR and HER2, using PA-labeled pan and trastuzumab (tra), respectively.
Methods: Human BC tissue microarray (TMAs) and BC cell lines were analyzed for expression of EGFR and HER2. Mechanism of PIT-induced cell death was studied using proliferation assays, transmission electron microscopy (TEM), and production of reactive and singlet oxygen species (ROS/SOS). Finally, efficacy of PA-labeled antibodies singly and in combination was analyzed in vitro and in vivo.
Results: Most BC tissues have some expression of EGFR, but squamous cell carcinoma (SCC) of bladder has maximum EGFR expression. About 45% of BC tissues stain for both EGFR and HER2. Pan IR700 activated by NIR light rapidly killed UMUC-5 cells, a bladder SCC line. Pan alone, pan IR700 without NIR, or NIR alone had no effect on cells. TEM demonstrated that cell death is due to necrosis. Singlet oxygen species (SOS) had a substantially larger contribution towards cell death than reactive oxygen species (ROS). NIR-PIT with pan IR700 demonstrated reduced growth compared to only pan IR700-treated UMUC-5 xenograft tumors. In non-SCC BCs we used a combinatorial PIT approach using pan IR700 and tra IR700 to target EGFR and HER2, respectively. In vitro, PIT in the presence of combination pan IR700 and tra IR700 was more efficacious than either agent alone with lethal dose 50 (LD50) of 28.66 J/cm2 for combination PIT compared to 71.55 J/cm2 for the PanIR700 alone. In vivo, tumor xenografts treated with combination PIT showed significant tumor growth retardation compared to single-agent therapy.
Conclusion: PIT is a new targeted treatment for BC. Our data demonstrate that pan IR700-induced PIT selectively kills EGFR-expressing bladder cancer. Combination PIT is a promising approach for treating BC by selectively inducing death in BC cells with low/moderate expression of surface receptors.
Citation Format: Reema Railkar, Mohammad Rashid Siddiqui, Thomas Sanford, Hisataka Kobayashi, Peter L. Choyke, Piyush K. Agarwal. Photoimmunotherapy (PIT) for treatment of bladder cancer [abstract]. In: Proceedings of the AACR Special Conference on Bladder Cancer: Transforming the Field; 2019 May 18-21; Denver, CO. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(15_Suppl):Abstract nr A09.
Abstract IA20: Intravesical versus systemic therapy: Win, lose, or draw—the future is now for multidisciplinary NMIBC drug development
Authors: Hahn Noah M. 
Published: August 2020

Abstract
In recent years, we have witnessed an explosion in both therapeutic drug development and our understanding of the key biologic drivers and targets in bladder cancer. While new drug approvals have thus far been confined to metastatic patients, several promising agents have fully accrued key FDA registration studies in the BCG-unresponsive non-muscle invasive bladder cancer (NMIBC) population. Initial early-response data in the carcinoma in situ (CIS) populations demonstrate clear signals of activity with long-term follow-up ongoing to assess response durability. Agents administered by either intravesical or systemic routes are among those being assessed. While urologists, medical oncologists, and radiation oncologists have long worked together in the care of muscle-invasive bladder cancer (MIBC) and metastatic bladder cancer patients, an established template of multidisciplinary collaboration in the care of NMIBC patients is lacking. This unknown frontier creates both challenges and immense opportunities. True lasting, impactful progress rarely happens in isolation. This session will utilize data and example cases to illustrate specialty-specific skills and perceptions that define us, must be acknowledged for the biases they create, and ultimately should be embraced as a vehicle to establish functional and collaborative multidisciplinary drug development and clinical care models for NIMIBC patients.
Citation Format: Noah M. Hahn. Intravesical versus systemic therapy: Win, lose, or draw—the future is now for multidisciplinary NMIBC drug development [abstract]. In: Proceedings of the AACR Special Conference on Bladder Cancer: Transforming the Field; 2019 May 18-21; Denver, CO. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(15_Suppl):Abstract nr IA20.