bluuebunny/crossref_metadata_2025_split huggingface dataset:
Palliative care in the context of immune and targeted therapies: A qualitative study of bereaved carers’ experiences in metastatic melanoma
Authors: Fox Jennifer A , Rosenberg John , Ekberg Stuart , Langbecker Danette 
Published: April 2020

Background: Immune and targeted therapies continue to transform treatment outcomes for those with metastatic melanoma. However, the role of palliative care within this treatment paradigm is not well understood. Aim: To explore bereaved carers’ experiences of immune and targeted therapy treatment options towards end of life for patients with metastatic melanoma. Design: An interpretive, qualitative study using a social constructivist framework was utilised. Interviews were recorded, transcribed and analysed using grounded theory methods. Setting/participants: Participants ( n = 20) were bereaved carers of patients who had received some form of immune and/or targeted therapy at one of three Australian metropolitan melanoma treatment centres. Results: Carers struggled to reconcile the positive discourse around the success of immune and targeted therapies in achieving long-term disease control, and the underlying uncertainty in predicting individual responses to therapy. Expectations that immune and targeted therapies necessarily provide longer-term survival were evident. Difficulty in prognostication due to clinical uncertainty and a desire to maintain hope resulted in lack of preparedness for treatment failure and end of life. Conclusion: Immune and targeted therapies have resulted in increased prognostic challenges. There is a need to engage, educate and support patients and carers to prepare and plan amid these challenges. Educational initiatives must focus on improving communication between patients, carers and clinicians; the differences between palliative and end-of-life care; and increased competency of clinicians in having goals-of-care discussions. Clinicians must recognise and communicate the benefit of collaborative palliative care to meet patient and family needs holistically and comprehensively.
Cocaine-induced changes in behaviour and DNA methylation in rats are influenced by inter-individual differences in spontaneous exploratory activity
Authors: Vaher Kadi , Anier Kaili , Jürgenson Monika , Harro Jaanus , Kalda Anti 
Published: April 2020

Background: Individual differences in behavioural traits influence susceptibility to addictive disorders. Drug addiction involves changes in gene expression, proposed to occur via DNA methylation (DNAm). Aims: To investigate DNAm changes in reward-related brain structures (nucleus accumbens (NAc), lateral habenula (LHb)) in response to cocaine exposure in rats differing in spontaneous exploratory activity. Methods: Rats were observed in the exploration box and categorised as high- (HE) or low explorers (LE). Rats were administered vehicle or cocaine (12 mg/kg, i.p.) for 7 days, followed by a 14-day withdrawal period and cocaine challenge (7 mg/kg); horizontal locomotor activity was recorded. Brain tissue was dissected after 24 h; we analysed messenger RNA (mRNA) and activity levels of epigenetic DNA modifiers (DNMTs and TETs) as well as mRNA and promoter methylation levels at selected genes previously linked to addictive behaviours. Results: The cocaine challenge dose stimulated locomotor activity in both LE- and HE rats only when administered after a repeated cocaine schedule, suggesting development of behavioural sensitisation. Quantitative polymerase chain reaction analyses demonstrated higher basal expression of Dnmt3a, Tet2 and Tet3 in the LHb of HE- vs. LE rats, and we observed differential effects of cocaine exposure on the expression and activity of epigenetic DNA modifiers in the NAc and LHb of HE- and LE rats. Furthermore, cocaine exposure differentially altered promoter methylation levels of A2AR, Ppp1cc, and Taar7b in the NAc and LHb of HE- and LE rats. Conclusions: DNAm might play a role in the HE- and LE phenotypes as well as mediate behavioural effects of LE- and HE rats in response to drugs of abuse.
Decreased serum exosomal miR-320a expression is an unfavorable prognostic factor in patients with hepatocellular carcinoma
Authors: Hao Xinjie , Xin Ruopei , Dong Wenjing 
Published: April 2020

Objective Circulating microRNAs (miRNAs) have promising potential as diagnostic or prognostic biomarkers for hepatocellular carcinoma (HCC). This study aimed to analyze the clinical significance of serum exosomal miR-320a expression in patients with HCC. Methods A total of 104 patients with HCC, 55 patients with chronic liver disease (CLD), and 50 healthy volunteers were enrolled. Serum exosomal miR-320a levels were measured by quantitative reverse-transcriptase polymerase chain reaction and compared among the groups. The relationships between exosomal miR-320a levels and clinicopathological factors in patients with HCC were also analyzed. Results Serum exosomal miR-320a levels were significantly lower in patients with HCC compared with patients with CLD and healthy controls. Receiver-operating characteristic curve analysis showed that serum exosomal miR-320a had good diagnostic value for distinguishing between HCC subjects and normal controls. Serum exosomal miR-320a levels were significantly elevated 1 month after surgery in patients with HCC. Moreover, serum exosomal miR-320a downregulation was strongly associated with positive lymph node metastasis, positive vein invasion, advanced TNM stage, and shorter survival. Serum exosomal miR-320a was confirmed as an independent prognostic marker for HCC. Conclusions Collectively, these results indicate that serum exosomal miR-320a might be a potential biomarker for the detection and prognosis of HCC.
Association between proteinuria and maternal and neonatal outcomes in pre-eclampsia pregnancy: a retrospective observational study
Authors: Xu Xiangxiang , Wang Yun , Xu Hui , Kang Yan , Zhu Qin 
Published: April 2020

Objectives To evaluate the association between proteinuria and maternal and neonatal outcomes in pregnant women with pre-eclampsia. Methods This retrospective study included patients beyond 20 weeks of gestation diagnosed with pre-eclampsia, who were admitted to Suzhou Municipal Hospital between December 2013 and December 2015. Demographic and clinical data were extracted from clinical records, including age, body mass index, newborn weight and Apgar score. Pre-eclampsia risk factors and perinatal outcomes were analysed. Results A total of 407 patients were enrolled, of whom, 402 with pre-eclampsia were included in the final analyses, divided into two groups: patients with proteinuria ( n = 364 [90.55%]) and patients without proteinuria ( n = 38 [9.45%]). Newborn 5-min Apgar scores were statistically lower in the proteinuria group versus the group without proteinuria (9.77 versus 9.95). Compared with patients without proteinuria, patients with proteinuria had a significantly higher rate of births before 37 weeks of gestation (50.80% versus 31.60%), but the incidence of preterm membrane rupture was significantly lower (3.8% versus 13.2%). Conclusion Proteinuria may be associated with adverse maternal and neonatal outcomes in cases of pre-eclampsia.
Hypochloremia is associated with increased risk of all-cause mortality in patients in the coronary care unit: A cohort study
Authors: Li Zongying , Xing Cheng , Li Tingting , Du Linxiang , Wang Na 
Published: April 2020

Objective Serum chloride disorders have been gaining increased attention. We aimed to assess the impact of serum chloride on all-cause mortality in critically ill patients in coronary care units (CCUs). Methods We extracted clinical data from the Multiparameter Intelligent Monitoring in Intensive Care III database. We used data for the first CCU admission of each patient; baseline data were extracted within 24 hours after CCU admission. Statistical methods included the Lowess smoothing technique, Cox proportional hazards model, and subgroup analyses. Results A total 5616 patients who met the inclusion criteria were included. We observed a U-shaped relationship between admission chloride levels and 30-day all-cause mortality. In multivariate analysis adjusted for age, ethnicity, and sex, both hyper- and hypochloremia were significant predictors of risk of 30-day, 90-day, and 365-day all-cause mortality. After adjusting additional clinical characteristics, hypochloremia remained a significant predictor of risk of 30-day all-cause mortality (hazard ratio, 1.47; 95% confidence interval, 1.19–1.83). For 90-day and 365-day all-cause mortality, similar significant robust associations were found. Conclusions We observed a U-shaped relationship between admission chloride levels and 30-day all-cause mortality among patients in the CCU. Hypochloremia was associated with increased risk of all-cause mortality in these patients.
Upregulation of matrix metalloproteinase 9 (MMP9)/tissue inhibitor of metalloproteinase 1 (TIMP1) and MMP2/TIMP2 ratios may be involved in lipopolysaccharide-induced acute lung injury
Authors: Chen Guobing , Ge Dandan , Zhu Bizhen , Shi Huixuan , Ma Qilin 
Published: April 2020

Objective This study aimed to examine the changes and significance of matrix metalloproteinase 9 (MMP9), MMP2, tissue inhibitor of metalloproteinase 1 (TIMP1), and TIMP2 in rats with lipopolysaccharide (LPS)-induced acute lung injury (ALI). Methods Wistar rats were randomly divided into a control group (injected with saline) and an ALI group (injected with LPS), then subdivided into four time points (2, 6, 12, and 24 hours). Serum tumor necrosis factor alpha and interleukin-6 levels were detected by ELISA to investigate the inflammatory reaction after LPS injection. The degree of ALI was determined by hematoxylin–eosin staining of lung tissue, the lung wet/dry weight ratio, and pulmonary permeability index. Changes in lung MMP and TIMP protein and mRNA levels were detected by western blotting and quantitative real-time polymerase chain reaction. Results Changes in the ratios of MMP9/TIMP1 and MMP2/TIMP2 were consistent with and strongly positively associated with the lung wet/dry weight ratio, the pulmonary permeability index, and serum tumor necrosis factor alpha and interleukin-6 levels in the ALI group. Conclusion ALI induced by LPS may be related to upregulation of MMP9/TIMP1 and MMP2/TIMP2 ratios.
Radiologic predictor of intraoperative lateral wall fractures in treatment of pertrochanteric fractures with cephalomedullary nailing
Authors: Dai Jun-qi , Jin Dongxu , Zhang Changqing , Huang Yi-Gang 
Published: April 2020

Objective This study was performed to investigate the reliability of the height of pertrochanteric fractures as a predictor of lateral wall fractures after cephalomedullary nailing and provide a simple way to determine the threshold value. Methods We performed a prospective randomized clinical study of 50 consecutive patients who underwent measurement of the height of the pertrochanteric fracture and the tangent line to the superior margin of the contralateral femoral neck. The preoperative and postoperative integrity of the lateral wall was evaluated by computed tomography. Results The pertrochanteric fracture height was significantly lower in patients with than without intraoperative lateral wall fractures (15.6 vs. 28.5 mm, respectively). The threshold value of the fracture height was 20.445 mm, which was not significantly different from the mean height of the tangent line of the superior margin of the contralateral femoral neck (19.4 mm). Conclusions Pertrochanteric fractures with the proximal starting point lower than the mirror position of the tangent line to the superior margin of the contralateral femoral neck have a higher risk of intraoperative lateral wall fractures during cephalomedullary nailing.
Electronic cigarette use among Italian smokers: patterns, settings, and adverse events
Authors: Gallus Silvano , Borroni Elisa , Liu Xiaoqiu , Carrozzi Laura , Dalla Pietra Gianfranco , Eslami Varzaneh Shokoofe , Harari Sergio , Inciso Giovanni , Martucci Paola , Papale Maria , Pistelli Francesco , Polla Biagio , Polo Maria Francesca , Principe Rosastella , Pulerà Nolita , Raschi Stefania , Sarzani Riccardo , Serafini Antonella , Odone Anna , van den Brandt Piet , Lugo Alessandra 
Published: April 2020

Objective: Information is scanty on the patterns and settings of electronic cigarette use and on its possible adverse events. To fill the knowledge gap on these issues, we conducted a survey among ever-smokers attending smoking cessation services (SCS) in Italy. Methods: In 2016–2018, we enrolled 395 ever-smokers aged ⩾18 years who were current or former electronic cigarette users in 12 SCS from northern, central, and southern Italy. Results: In all, 12.4% of ever smokers were regular, 9.4% occasional, and 78.2% past users of electronic cigarettes. Of all users, 93.8% consumed electronic cigarettes with nicotine, 95.9% used refillable devices, and 76.6% purchased electronic cigarette devices or liquids in vape shops. The mean duration of use was 3.7 months and the mean number of puffs per day was 86. Among users, 71.5% used electronic cigarettes in at least 1 smoke-free indoor environment, 53.7% in workplaces, 49.5% in restaurants and bars, 33.5% in train/metro stations or airports, and 18.4% in public transports. The use of electronic cigarettes in smoke-free environments significantly decreased with age and increased with duration of use and nicotine dependence. In our sample, 47.1% reported at least 1 adverse event attributable to electronic cigarette use: 19.5% dry cough, 12.0% dry mouth, 7.6% throat or mouth irritation, and 6.8% sore throat. Conclusion: In Italy, most conventional cigarette smokers use electronic cigarettes where smoking conventional cigarettes is prohibited. About half of users reported 1 or more symptoms attributable to electronic cigarettes, despite the relatively short duration of use.
External Debt and Economic Growth Nexus: Empirical Evidence From Nigeria
Authors: Ohiomu Sylvester 
Published: April 2020

This study models external debt and economic growth nexus for policy analysis on public finance and public debt management. The work uses the methodology of group unit root test, auto-regressive distributed lag (ARDL) bounds testing, and co-integrating long-run tests for robust policy recommendations. The results showed that the debt overhang variable (D_Y) and crowding-out effect variable (DS_X) depress the level of investment. This adversely affects economic growth in Nigeria. The study recommends that Nigeria should embark on strict debt management policy, pursue effective debt reduction strategies, and improve investment drives for economic expansion and sustainable development. JEL Classification: C22, C51, E27, H63, H81
Would Chuck Norris Certainly Win the Hunger Games? Simulating the Result Reliability of Battle Royale Games Through Agent-Based Models
Authors: Rosenbusch Hannes , Röttger Jonas , Rosenbusch David 
Published: April 2020

Background. The amount of random chance involved in multiplayer competitions varies depending on the structure of the competition. A hugely popular mode of competition is the Battle Royale, in which a group of participants semi-randomly encounters and battles each other until only one player is left. We utilized computer simulations to investigate how strongly the outcomes of different Battle Royale formats reflect the actual distribution of skill among the players. Further, we investigated which game features affect the congruency between skills and results. Method. We build agent-based models in NETLOGO to simulate the outcomes of different Battle Royale formats. Results. Our results consistently forwarded that outcomes from Battle Royale are only weakly aligned with actual player skills. Conclusion. Our findings suggest that many forms of Battle Royale involve substantially more luck than other sports or e-sports competitions. Further, game developers should note that introducing new game features can entail both higher and lower involvement of skill over luck, and that these features can be tuned to obtain a desired level of uncertainty.
Perceptions of Facilitators and Barriers to Measuring and Improving Quality in Palliative Care Programs
Authors: Kuchinad Kamini , Sharma Ritu , Isenberg Sarina R. , Hamayel Nebras Abu Al , Weaver Sallie J. , Zhu Junya , Hannum Susan M. , Kamal Arif H. , Walling Anne M. , Lorenz Karl A. , Ailon Jonathan , Dy Sydney M. 
Published: April 2020

Objective: To examine perceptions of facilitators and barriers to quality measurement and improvement in palliative care programs and differences by professional and leadership roles. Methods: We surveyed team members in diverse US and Canadian palliative care programs using a validated survey addressing teamwork and communication and constructs for educational support and training, leadership, infrastructure, and prioritization for quality measurement and improvement. We defined key facilitators as constructs rated ≥4 (agree) and key barriers as those ≤3 (disagree) on 1 to 5 scales. We conducted multivariable linear regressions for associations between key facilitators and barriers and (1) professional and (2) leadership roles, controlling for key program and respondent factors and clustering by program. Results: We surveyed 103 respondents in 11 programs; 45.6% were physicians and 50% had leadership roles. Key facilitators across sites included teamwork, communication, the implementation climate (or environment), and program focus on quality improvement. Key barriers included educational support and incentives, particularly for quality measurement, and quality improvement infrastructure such as strategies, systems, and skilled staff. In multivariable analyses, perceptions did not differ by leadership role, but physicians and nurse practitioners/nurses/physician assistants rated most constructs statistically significantly more negatively than other team members, especially for quality improvement (6 of the 7 key constructs). Conclusions: Although participants rated quality improvement focus and environment highly, key barriers included lack of infrastructure, especially for quality measurement. Building on these facilitators and measuring and addressing these barriers might help programs enhance palliative care quality initiatives’ acceptability, particularly for physicians and nurses.
Disparities in the Use of Guideline-Based Pharmacotherapy Exist for Atherosclerotic Cardiovascular Disease and Heart Failure Patients Who Have Intellectual/Developmental Disabilities in a Commercially Insured Database
Authors: Erickson Steven R. , Basu Tanima , Dorsch Michael P. , Kamdar Neil 
Published: April 2020

Background: Patients who have intellectual/developmental disabilities (IDDs) develop atherosclerotic cardiovascular disease (ASCVD) or heart failure (HF) at rates similar to or higher than the general population. They also face disparities accessing and using health care services. Objective: To determine if disparities exist in the use of guideline-based pharmacotherapy (GBP) for ASCVD or HF for adults with IDD. Methods: Using the 2014 Clinformatics Data Mart Database, adults with ASCVD or HF were divided into IDD or non-IDD groups. Patients with contraindications for GBP medications were excluded. Use of GBP between IDD and non-IDD groups was examined. Subgroup analysis included comparisons between IDD groups. Results: For HF, 1011 patients with IDD and 236,638 non-IDD patients were identified. For ASCVD, 2190 IDD and 790,343 non-IDD patients were identified. We found that 47.9%, 35.8%, and 13.1% of IDD and 58.7%, 48.4%, and 18.9% of non-IDD patients had pharmacy claims for statins ( P < 0.001), β-blockers ( P < 0.001), or antiplatelet therapy ( P < 0.001), respectively. For HF, 46.8% and 50.3% of IDD and 59.8% and 55.4% of non-IDD patients had pharmacy claims for β-blockers (P < 0.001) and angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs; P = 0.003), respectively. In all but one multivariate regression models patients with IDD were less likely to use GBP than patients in the non-IDD group. Subgroup analysis revealed that patients who had Down syndrome had lower GBP use in 4 of the 5 measures. Conclusion and Relevance: Disparities exist in the use of GBP for patients with IDD with ASCVD or HF. Patients who have an IDD should be examined by clinicians to ensure appropriate access to and use of GBP.
Influences of Smoking Status on Effectiveness of Cytochrome P450 Enzyme System Metabolized Medications in Reducing In-Hospital Death in 14 658 Patients With Acute Myocardial Infarction: Data From CPACS-3 Study
Authors: Li Min , Feng Lin , Li Xian , Gao Runlin , Wu Yangfeng 
Published: April 2020

Background: The benefit of cytochrome P450 (CYP450) enzyme system metabolized medications, especially clopidogrel, was reported more pronounced in smoking than nonsmoking patients, but limited evidence was available from Asian patients. We analyzed data from a large registry-based study of Chinese patients with acute myocardial infarction (AMI) to understand if the above finding could be reproduced. Methods: A total of 14 658 patients with AMI were prospectively recruited from 101 hospitals across China. Generalized estimating equation was applied to assess the association between CYP450 enzyme system metabolized medications (clopidogrel, statins, calcium channel blockers) and in-hospital death in smoking and nonsmoking patients, separately, adjusting for hospital clustering effects and propensity score of using the medication in question. Results: There were 86%, 93%, and 10% of study patients who received clopidogrel, statins, and calcium channel blockers during the hospitalization. Compared with patients not receiving clopidogrel, patients receiving the drug had a significantly lower risk of in-hospital death (adjusted relative risk [RR] = 0.61, 95% confidence interval [CI]: 0.40-0.91) in current smokers but an insignificant lower risk (adjusted RR = 0.85, 95% CI: 0.71-1.01) in nonsmokers, and the P for interaction was <.01. The corresponding adjusted RR was 0.45 (95% CI: 0.24-0.86) in current smokers and 0.94 (95% CI: 0.68-1.29) in nonsmokers ( P for interaction <.01) for statins use and 1.00 (95% CI: 0.53-1.89) in current smokers and 0.66 (95% CI: 0.48-0.90) in nonsmokers ( P for interaction = .23) for calcium channel blockers use. Conclusions: Our study in a large cohort of Chinese patients with AMI found that the treatment effect in reducing risk of in-hospital death was significantly larger in smokers than in nonsmokers as for clopidogrel and statins but not for calcium channel blockers.