bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of inspiratory muscle training associated with a cardiac rehabilitation program on sympathetic activity and functional capacity in patients with heart failure: a study protocol for a randomized controlled trial
Authors: Leite Jéssica Costa , Brandão Daniella Cunha , Brandão Simone Cristina Soares , Fuzari Helen Kerlen Bastos , Vidal Tainá Maria , Frutuoso Jasiel , Remígio Maria Inês , de Araújo Bruna Thays Santana , Campos Shirley Lima , Dornelas de Andrade Armele 
Published: June 2020

Abstract
Background
Individuals affected by heart failure (HF) may present fatigue, dyspnea, respiratory muscle weakness, and sympathetic activity hyperstimulation of the myocardium, among other symptoms. Conducting cardiac rehabilitation (CR) programs can be associated with inspiratory muscle training. The aim of this study was to evaluate the efficacy of inspiratory muscular training (IMT) associated with a CR program on modulating myocardial sympathetic activity and maximal functional capacity, submaximal functional capacity, thickness, and mobility of the diaphragm muscle in patients with HF.

Methods
We will conduct a clinical, controlled, randomized, double-blind trial that will include sedentary men and women who are 21–60 years old and who have diagnosed systolic HF and a left ventricular ejection fraction of less than 45%. Participants will be randomly assigned to one of two groups: experimental and control. The control group will follow the conventional CR protocol, and the experimental group will follow the conventional CR protocol associated with IMT 7 days a week. The two proposed exercise protocols will have a frequency of three times a week for a period of 12 weeks. The sympathetic innervation of the cardiac muscle, the maximum and submaximal functional capacity, diaphragm mobility and thickness, and the quality of life of the participants will be evaluated before and after the intervention protocol.

Discussion
This clinical trial will be the first study to investigate the additional effects of IMT on CR in sympathetic hyperstimulation in the myocardium. The results of this study will contribute to developing therapeutic strategies collaborating to elucidate whether the association of IMT with CR can induce clinical benefits for patients with HF.

Trial registration
ClinicalTrials.gov identifier: NCT02600000. Registered November 9, 2015. Retrospectively registered.
Achieving blood pressure control targets in hypertensive patients of rural China – a pilot randomized trial
Authors: Huang Xiao , Liu Lishun , Song Yun , Gao Lan , Zhao Min , Bao Huihui , Qin Xianhui , Wu Yanqing , Wu Qinghua , Bi Chonglei , Yue Aiping , Fang Chongqian , Ma Hai , Cui Yimin , Tang Genfu , Li Ping , Zhang Yan , Li Jianping , Wang Binyan , Xu Xiping , Wang Hong , Parati Gianfranco , Spence J. David , Wang Xiaobin , Huo Yong , Chen Guangliang , Cheng Xiaoshu ,   for the investigators of intensive BP control in China
Published: June 2020

Abstract
Background
This study aimed to test the feasibility and titration methods used to achieve specific blood pressure (BP) control targets in hypertensive patients of rural China.

Methods
A randomized, controlled, open-label trial was conducted in Rongcheng, China. We enrolled 105 hypertensive participants aged over 60 years, and who had no history of stroke or cardiovascular disease. The patients were randomly assigned to one of three systolic-BP target groups: standard: 140 to < 150 mmHg; moderately intensive: 130 to < 140 mmHg; and intensive: < 130 mmHg. The patients were followed for 6 months.

Discussion
The optimal target for systolic blood pressure (SBP) lowering is still uncertain worldwide and such information is critically needed, especially in China. However, in China the rates of awareness, treatment and control are only 46.9%, 40.7%, and 15.3%, respectively. It is challenging to achieve BP control in the real world and it is very important to develop population-specific BP-control protocols that fully consider the population’s characteristics, such as age, sex, socio-economic status, compliance with medication, education level, and lifestyle. This randomized trial showed the feasibility and safety of the titration protocol to achieve desirable SBP targets (< 150, < 140, and < 130 mmHg) in a sample of rural, Chinese hypertensive patients. The three BP target groups had similar baseline characteristics. After 6 months of treatment, the mean SBP measured at an office visit was 137.2 mmHg, 131.1 mmHg, and 124.2 mmHg, respectively, in the three groups. Home BP and central aortic BP measurements were also obtained. At 6 months, home BP measurements (2 h after drug administration) showed a mean SBP of 130.9 mmHg in the standard group, 124.9 mmHg in the moderately intensive group, and 119.7 mmHg in the intensive group. No serious adverse events were recorded over the 6-month study period. Rates of adverse events, including dry cough, palpitations, and arthralgia, were low and showed no significant differences between the three groups. This trial provided real-world experience and laid the foundation for a future, large-scale, BP target study.

Trial registration
Feasibility Study of the Intensive Systolic Blood Pressure Control; ClinicalTrials.gov, ID: NCT02817503. Registered retrospectively on 29 June 2016.
Determination of efficacy and toxicity of diclofenac microemulsion formulation for musculoskeletal pain: an observational study
Authors: Banh Hoan Linh , Cave Andrew 
Published: June 2020

Abstract
Objective
Musculoskeletal pain is often caused by injury to the bones, muscles, tendons, ligaments or nerves. Symptoms can be localized or generalized. Mild-moderate symptoms are treated with topical/oral over the counter drugs. Microemulsion delivery formulations are thermodynamically stable, have superior bioavailability and better penetration of lipophilic and hydrophilic drug into the dermis. A prospective observational study in patients: 18 years or older, with mild-moderate musculoskeletal pain; with severe pain without adequate pain control; with severe pain and could not tolerate oral agents; with renal impairment were invited to try diclofenac 2% in microemulsion foam. They were followed up at 2 and 4 weeks. A 50% reduction on a visual analog pain scale was considered success. Adverse events were defined as irritation, gastrointestinal upset/bleed, rectal bleed, and hematemesis. The objective was to determine the efficacy and toxicity of diclofenac 2% in microemulsion foam.

Results
Thirteen consecutive patients with musculoskeletal pain consented to participate. Two patients were lost to follow up. Two of the 11 patients reported minimal improvement, while nine patients reported minimum 50% reduction. No adverse effects were reported. Diclofenac 2% in microemulsion foam is effective in the treatment of mild to moderate musculoskeletal pain and well tolerated.
Voxel-based comparison of [68Ga]Ga-RM2-PET/CT and [68Ga]Ga-PSMA-11-PET/CT with histopathology for diagnosis of primary prostate cancer
Authors: Fassbender Thomas Franz , Schiller Florian , Zamboglou Constantinos , Drendel Vanessa , Kiefer Selina , Jilg Cordula A. , Grosu Anca-Ligia , Mix Michael 
Published: June 2020

AbstractBackgroundFocal therapies or focally escalated therapies of primary prostate cancer are becoming more and more important. This increases the need to identify the exact extension of the intraprostatic tumor and possible dominant intraprostatic lesions by imaging techniques. While the prostate-specific membrane antigen (PSMA) is already a well-established target for imaging of prostate cancer cells, the gastrin-releasing peptide receptor (GRPR) seems to provide interesting additional information. Histopathology was used to examine the extent to which the single and combined image information of PET scans targeting GRPR and PSMA might lead to better tumor delineation.MethodsEight patients with histologically proven primary prostate cancer underwent two positron emission tomography with computer tomography scans, [68Ga]Ga-RM2-PET/CT (RM2-PET) and [68Ga]Ga-PSMA-11-PET/CT (PSMA-PET), prior to radical prostatectomy. RM2-PET data were correlated voxel-wise to a voxel-based model of the histopathologic tumor volume information. The results were compared to, correlated to, and combined with the correlation of PSMA-PET data analyzed analogously.ResultsIn 4/8 patients, RM2-PET showed a higher signal in histologically proven tumor regions compared to PSMA. There were also tumor regions where PSMA-PET showed a higher signal than GRPR in 4/8 patients. A voxel-wise correlation of RM2-PET against histopathology yielded similar results compared to the correlation of PSMA-PET against histopathology, while PSMA-PET is the slightly better performing imaging technique. The combined information of both tracers yielded the best overall result, although this effect was not statistically significant compared to RM2-PET alone.ConclusionsQualitative and quantitative findings in this preliminary study with 8 patients indicate that RM2-PET and PSMA-PET partially show not only the same, but also distinct regions of prostate cancer. Patients with pPCa might profit from information given by tracers targeting GRPR and PSMA simultaneously, in terms of a better delineation of the gross tumor volume.
Healthcare consumption after a change in health insurance coverage: a French quasi-natural experiment
Authors: Sevilla-Dedieu Christine , Billaudeau Nathalie , Paraponaris Alain 
Published: June 2020

Abstract
Background
Compared with the number of studies performed in the United States, few studies have been conducted on the link between health insurance and healthcare consumption in Europe, likely because most European countries have compulsory national health insurance (NHI) or a national health service (NHS). Recently, a major French private insurer, offering voluntary complementary coverage in addition to the compulsory NHI, replaced its single standard package with a range of offers from basic coverage (BC) to extended coverage (EC), providing a quasi-natural experiment to test theoretical assumptions about consumption patterns.

Methods
Reimbursement claim data from 85,541 insurees were analysed from 2009 to 2018. Insurees who opted for EC were matched to those still covered by BC with similar characteristics. Difference-in-differences (DiD) models were used to compare both the monetary value and physical quantities of healthcare consumption before and after the change in coverage.

Results
As expected, the DiD models revealed a strongly significant, though transitory (mainly during the first year), increase after the change in coverage for EC insurees, particularly for costly care such as dental prostheses and spectacles. Surprisingly, consumption seemed to precede the change in coverage, suggesting that one possible determinant of opting for more coverage may be previous unplanned expenses.

Conclusion
Both catching-up behaviour and moral hazard are likely to play a role in the observed increase in healthcare consumption.
Effects of endotoxin adsorber hemoperfusion on sublingual microcirculation in patients with septic shock: a randomized controlled trial
Authors: Chen Shih-Hong , Chan Wing-Sum , Liu Chih-Min , Chiu Ching-Tang , Chao Anne , Wu Vin-Cent , Sheng Wang-Huei , Lai Chien-Heng , Wang Ming-Jiuh , Yeh Yu-Chang 
Published: June 2020

Abstract
Background
Endotoxins can induce an excessive inflammatory response and result in microcirculatory dysfunction. Polymyxin-B hemoperfusion (PMX-HP) has been recognized to effectively remove endotoxins in patients with sepsis and septic shock, and a rat sepsis model revealed that PMX-HP treatment can maintain a better microcirculation. The primary aim of this study was to investigate the effect of PMX-HP on microcirculation in patients with septic shock.

Methods
Patients with septic shock were enrolled and randomized to control and PMX-HP groups. In the PMX-HP group, patients received the first session of PMX-HP in addition to conventional septic shock management within 24 h after the onset of septic shock; the second session of PMX-HP was provided after another 24 h as needed.

Results
Overall, 28 patients finished the trial and were analyzed. The mean arterial pressure and norepinephrine infusion dose did not differ significantly between the control and PMX-HP groups after PMX-HP treatment. At 48 h after enrollment, total vessel density (TVD) and perfused vessel density (PVD) were higher in the PMX-HP group than in the control group [TVD 24.2 (22.1–24.9) vs. 21.1 (19.9–22.9) mm/mm2; p = 0.007; PVD 22.9 (20.9–24.9) vs. 20.0 (18.9–21.6) mm/mm2, p = 0.008].

Conclusions
This preliminary study observed that PMX-HP treatment improved microcirculation but not clinical outcomes in patients with septic shock at a low risk of mortality. Nevertheless, larger multicenter trials are needed to confirm the effect of PMX-HP treatment on microcirculation in patients with septic shock at intermediate- and high-risk of mortality.
Trial registration ClinicalTrials.gov protocol registration ID: NCT01756755. Date of registration: December 27, 2012. First enrollment: October 6, 2013. https://clinicaltrials.gov/ct2/show/NCT01756755
Assessment of interprofessional competence in undergraduate health professions education: protocol for a systematic review of self-report instruments
Authors: Allvin Renée , Thompson Carl , Edelbring Samuel 
Published: June 2020

Abstract
Background
Health practitioners from different professions, and with differing competencies, need to collaborate to provide quality care. Competencies in interprofessional working need developing in undergraduate educational preparation. This paper reports the protocol for a systematic review of self-report instruments to assess interprofessional learning in undergraduate health professionals’ education.

Methods
We will search PubMed, Web of Science, CINAHL and ERIC from January 2010 onwards. A combination of search terms for interprofessional learning, health professions, psychometric properties, assessment of learning and assessment tools will be used. Two reviewers will independently screen all titles, abstracts and full-texts. Potential conflicts will be resolved through discussion. Quantitative and mixed-methods studies evaluating interprofessional learning in undergraduate health professions education (e.g. medicine, nursing, occupational and physical therapy, pharmacy and psychology) will be included. Methodological quality of each reported instrument, underpinning theoretical frameworks, and the effects of reported interventions will be assessed. The overall outcome will be the effectiveness of instruments used to assess interprofessional competence. Primary outcomes will be the psychometric properties (e.g. reliability, discriminant and internal validity) of instruments used. Secondary outcomes will include time from intervention to assessment, how items relate to specific performance/competencies (or general abstract constructs) and how scores are used (e.g. to grade students, to improve courses or research purposes). Quantitative summaries in tabular format and a narrative synthesis will allow recommendations to be made on the use of self-report instruments in practice.

Discussion
Many studies use self-report questionnaires as tools for developing meaningful interprofessional education activities and assessing students’ interprofessional competence. This systematic review will evaluate both the benefits and limitations of reported instruments and help educators and researchers (i) choose the most appropriate existing self-report instruments to assess interprofessional competence and (ii) inform the design and conduct of interprofessional competency assessment using self-report instruments.

Systematic review registration
Open Science Framework [https://osf.io/vrfjn].
Some approximation properties of new Kantorovich type q-analogue of Balázs–Szabados operators
Authors: Hamal Hayatem , Sabancigil Pembe 
Published: June 2020

AbstractIn this paper, we define a new Kantorovich type q-analogue of the Balázs–Szabados operators, we give some local approximation properties of these operators and prove a Voronovskaja type theorem.
Development of human prostate cancer stem cells involves epigenomic alteration and PI3K/AKT pathway activation
Authors: Wu Jingjing , Cang Shundong , Liu Christina , Ochiai Whitman , Chiao Jen Wei 
Published: June 2020

Abstract
Background
Human prostate cancer spheres endowed with stem cell properties have been obtained from androgen-dependent cell line LNCaP after exposure to an epigenomic modulator phenethyl isothiocynate (PEITC). Sphere cells can self-renew and grow with androgen, and also without androgen. Little is known about the signaling pathway and mechanism in the development of the stem cells in the spheres.

Methods
Expression of phosphoinositol-3 kinase (PI3K) pathway members and histone acetylation were quantified in the tumor spheres and LNCaP cells by western immunoblotting.

Results
The level of phosphorylated AKT was significantly increased in the sphere stem cells than the LNCaP cells at an average of 7.4 folds (range 5.8–10.7 folds), whereas the P27 level was elevated 5.4 folds (range 4.8–6.3 folds) (P < 0.05). The acetylation level on histone H3 lysine 9 was decreased.

Conclusions
PEITC appears to regulate the epigenome through histone acetylation and activate the PI3K/AKT pathway in the LNCaP cells. This mechanism may be responsible in part for the development of the prostate cancer stem cells.
SICE: an improved missing data imputation technique
Authors: Khan Shahidul Islam , Hoque Abu Sayed Md Latiful 
Published: June 2020

AbstractIn data analytics, missing data is a factor that degrades performance. Incorrect imputation of missing values could lead to a wrong prediction. In this era of big data, when a massive volume of data is generated in every second, and utilization of these data is a major concern to the stakeholders, efficiently handling missing values becomes more important. In this paper, we have proposed a new technique for missing data imputation, which is a hybrid approach of single and multiple imputation techniques. We have proposed an extension of popular Multivariate Imputation by Chained Equation (MICE) algorithm in two variations to impute categorical and numeric data. We have also implemented twelve existing algorithms to impute binary, ordinal, and numeric missing values. We have collected sixty-five thousand real health records from different hospitals and diagnostic centers of Bangladesh, maintaining the privacy of data. We have also collected three public datasets from the UCI Machine Learning Repository, ETH Zurich, and Kaggle. We have compared the performance of our proposed algorithms with existing algorithms using these datasets. Experimental results show that our proposed algorithm achieves 20% higher F-measure for binary data imputation and 11% less error for numeric data imputations than its competitors with similar execution time.
Hybrid medical simulation – a systematic literature review
Authors: Brown Wayne J. , Tortorella Richard A. W. 
Published: June 2020

AbstractHealth-care education based upon technology enabled mannequins (high-fidelity simulators) is a costly investment for colleges and universities. However, a hybrid model using wearable technology integrated with human actors (standardized patients) may present a cost-effective alternative to high fidelity simulation training scenarios. A systematic literature review of papers published from 1960 to 2019 illustrates that hybrid simulation can be as effective as high fidelity simulators in certain training scenarios while at the same time providing a superior training context to enhance learners patient to care-giver interactions and to better immerse the trainee in the feelings and emotion of the scenario.
Recreational off-highway vehicle crashes resulting in victims being treated at a regional trauma center: mechanisms and contributing factors
Authors: Jennissen Charles A. , Reaney Meaghan T. , Denning Gerene M. 
Published: June 2020

Abstract
Background
Recreational off-highway vehicles (ROVs) have become increasingly popular in recent years; however, crash epidemiology is not well described. ROVs travel at least 30 mph, and unlike all-terrain vehicles, have a rollover protective structure (ROPS) and seat belts or a harness system for occupants. This study’s objective was to evaluate the demographics, mechanisms, injuries, and associated risk factors of ROV crashes.

Methods
A retrospective chart review was performed for patients of all ages with ROV-related injuries presenting to a Level 1 trauma center from 2004 to 2017. Cases were identified by ICD-9/10 codes and narrative searches. Person- and crash-related variables were examined in relation to injury outcomes including body area injured, injury severity score, and disposition (e.g. hospitalization, intensive care unit admission). Descriptive, bivariate (chi-square, Fishers exact test), and linear regression analyses were performed.

Results
Seventy-two patients with ROV-related injuries were identified. The number of injured patients increased over the study period (p < 0.01). Patients were 49% youth < 16 years old, 63% males, and 99% Caucasian. Half of the injured (51%) were passengers, with a higher proportion of youth being passengers (70%) as compared to adults (35%) (p < 0.01). Nearly one-third (30%) of crash victims < 16 years old were ROV drivers. Twenty-nine percent of all crashes occurred on roadways. Almost 40% of injured adults crashed at night, while all youth were injured during the day (p < 0.01). The primary crash mechanism was a rollover (67%). Only one patient was documented as being helmeted, and approximately one-fourth (24%) sustained head injuries and/or loss of consciousness. Other documented injuries included those to the face (20%), chest (22%), abdomen (11%), extremities (58%), and skin (51%). Over 90% of narratives were consistent with victims being unrestrained. Nearly three-fourths (74%) of victims were hospitalized and 26% required ICU care, one-half (53%) of these being children.

Conclusions
Although ROVs have ROPs, lack of helmet and safety belt use are reducing their benefit. Youth are a large proportion of those injured in ROV crashes, often while driving despite vehicle operation recommended only for those ≥16 years old. Increased public education is needed regarding proper safety measures while operating and riding ROVs.
5-year efficacy of all surface laser ablation with cross-linking (ASLA-XTRA) for the treatment of myopia
Authors: Aslanides Ioannis M. , Hafezi Farhad , Chen Shihao , Mukherjee Hatch , Selimis Vasileios , Maragkos Ilias , Lu Nanji , Kymionis George 
Published: June 2020

Abstract
Background
The purpose of our study is to examine the long (5-year) efficacy of the all surface laser ablation (ASLA) combined with accelerated cross-linking (CXL) for the treatment of myopia without the use of mitomycin-C (MMC).

Methods
This retrospective study consisted of 202 eyes of 118 myopic (SD: 2.41, range: − 1.50 to − 12.75 D) patients (44 males, 74 females). Mean age was 28.50 years (SD: 6.45, range: 18 to 51 years) that underwent ASLA with accelerated CXL for the treatment of their myopia.

Results
The patients underwent routine postoperative assessment on the 1st, 3rd, 7th day and in the 1st, 3rd, 6th and 12th month, 30th month (±6 months), 4th and 5th year. The mean spherical equivalent (SEq) refractive error changed from − 6.41 ± 2.41 D preoperatively to − 0.02 ± 0.53 D at 5 years postoperatively. The haze score was 0.18, 0.25 and 0.28 at 1, 3 and 6 months postoperatively. At 12 months after the treatment, no eyes had significant corneal haze and in all the following postoperative time intervals the haze traces were gone.

Conclusion
ASLA combined with accelerated CXL (ASLA-XTRA) appears to be safe, efficacious and offering very good refractive results. The potential additional benefits of this modality are the stabilizing effect of the refraction and its sterilization effect on the treated cornea without the potential side effects of MMC.