bluuebunny/crossref_metadata_2025_split huggingface dataset:
Per-protocol repeat kidney biopsy portends relapse and long-term outcome in incident cases of proliferative lupus nephritis
Authors: Parodis Ioannis , Adamichou Christina , Aydin Selda , Gomez Alvaro , Demoulin Nathalie , Weinmann-Menke Julia , Houssiau Frédéric A , Tamirou Farah 
Published: March 2020

Abstract

Objectives
In patients with LN, clinical and histological responses to treatment have been shown to be discordant. We investigated whether per-protocol repeat kidney biopsies are predictive of LN relapses and long-term renal function impairment.

Methods
Forty-two patients with incident biopsy-proven active proliferative (class III/IV±V) LN from the database of the UCLouvain were included in this retrospective study. Per-protocol repeat biopsies were performed after a median [interquartile range (IQR)] time of 24.3 (21.3–26.2) months. The National Institutes of Health activity index (AI) and chronicity index (CI) scores were assessed in all biopsies.

Results
Despite a moderate correlation between urinary protein/creatinine ratios (UPCR) and AI scores at repeat biopsy (r = 0.48; P = 0.001), 10 patients (23.8%) with UPCR &lt; 1.0 g/g still had a high degree of histological activity (AI &gt; 3). High AI scores (continuous) in repeat biopsies were associated with an increased probability and/or shorter time to renal relapse (n = 11) following the repeat biopsy [hazard ratio (HR) = 1.2, 95% CI: 1.1, 1.3; P = 0.007], independently of proteinuria levels. High CI scores (continuous) in repeat biopsies were associated with a sustained increase in serum creatinine levels corresponding to ≥120% of the baseline value (HR = 1.8, 95% CI: 1.1, 2.9; P = 0.016) through a median (IQR) follow-up time of 131.5 (73.8–178.2) months, being also the case for acute tubulointerstitial inflammation and interstitial fibrosis/tubular atrophy in repeat but not baseline biopsies.

Conclusion
Our results highlight the usefulness of per-protocol repeat biopsies, herein performed after a median time of 24 months from baseline, as an integral part of the treatment evaluation, also in patients showing adequate clinical response.
Insomnia, hypnotic use, and road collisions: a population-based, 5-year cohort study
Authors: Morin Charles M , Altena Ellemarije , Ivers Hans , Mérette Chantal , LeBlanc Mélanie , Savard Josée , Philip Pierre 
Published: February 2020

Abstract

Study Objectives
The study objectives were to examine accidental risks associated with insomnia or hypnotic medications, and how these risk factors interact with sex and age.

Methods
A population-based sample of 3,413 adults (Mage = 49.0 years old; 61.5% female), with or without insomnia, were surveyed annually for five consecutive years about their sleep patterns, sleep medication usage, and road collisions.

Results
There was a significant risk of reporting road collisions associated with insomnia (hazard ratio [HR] = 1.20; 95% confidence interval [CI] = 1.00–1.45) and daytime fatigue (HR = 1.21; 95% CI = 1.01–1.47). Insomnia and its daytime consequences were perceived to have played some contributory role in 40% of the reported collisions. Both chronic (HR = 1.50; 95% CI = 1.17–1.91) and regular use of sleep medications (HR = 1.58; 95% CI = 1.16–2.14) were associated with higher accidental risks, as well as being young female with insomnia and reporting excessive daytime sleepiness.

Conclusions
Both insomnia and use of sleep medications are associated with significant risks of road collisions, possibly because of or in association with some of their residual daytime consequences (i.e. fatigue and poor concentration). The findings also highlight a new group of at-risk patients, i.e. young women reporting insomnia and excessive daytime sleepiness.
Estimates of Preterm Infants' Breastfeeding Transfer Volumes Are Not Reliably Accurate
Authors: Perrella Sharon L. , Nancarrow Kathryn , Rea Alethea , Murray Kevin , Geddes Donna T. , Simmer Karen N. 
Published: March 2020

Background:
Adequate human milk nutrition is critical for infant growth and neurodevelopment; however, low milk transfer volumes are common when establishing preterm breastfeeding. Despite clinical assessments of milk transfer volumes at the breast being inaccurate, measurement of feed volume via test weighing is rarely carried out either routinely or in cases where infant weight gain is inadequate.

Purpose:
To assess the accuracy of the Preterm Breastfeeding Assessment Tool (PBAT) in determining transfer volumes and examine factors associated with PBAT accuracy.

Methods:
Pre/postfeed weights were performed using electronic scales and PBAT scores recorded for 1186 breastfeeds in 60 preterm infants born less than 33/40 and 33 to 39/40 postmenstrual age. Measured milk intake volumes were converted to percent prescribed feed volume and compared with PBAT estimates of milk transfer.

Results:
The PBAT is accurate in identifying when no milk is transferred at the breast but not in estimating transfer of half or the full prescribed volume (accuracy 26% and 47%, respectively). Wide ranges of transfer volumes (11-75 mL) were observed within and between infants, and for 20% of breastfeeds, no milk was transferred. Preterm Breastfeeding Assessment Tool accuracy decreased with each 1-week increase in birth gestation (odds ratio = 0.82; 95% confidence interval, 0.71-0.94; P = .004).

Implications for Practice:
When establishing breastfeeding, test weighing facilitates adequate nutrition by guiding appropriate complementary feeding. For mothers breastfeeding several times per day in preparation for discharge home, test weighing may offer a useful tool for developing maternal confidence in assessing milk transfer. Preterm Breastfeeding Assessment Tool is inaccurate in assessing preterm infants' milk transfer volumes when breastfeeding.

Implications for Research:
While studies have typically focused on medically stable infants, test weighing offers a useful tool to examine breastfeeding efficacy and inform nutritional management of preterm infants with complications such as chronic lung and cardiac disease.
Association Between Radiographic Spinopelvic Parameters and Health-related Quality of Life in De Novo Degenerative Lumbar Scoliosis and Concomitant Lumbar Spinal Stenosis
Authors: Gao Ang , Wang Yongqiang , Yu Miao , Wei Feng , Jiang Liang , Liu Zhongjun , Liu Xiaoguang 
Published: March 2020

Study Design...
A retrospective clinical study of patients who were treated from January 2011 to December 2018 and met our criteria.

Objective...
The aim of this study is to investigate the relationship between radiographic spinopelvic parameters and the health-related quality of life (HRQOL) in pretreatment de novo degenerative lumbar scoliosis (DNDLS) patients with concomitant lumbar spinal stenosis (LSS).

Summary of Background Data...
DNDLS has garnered attention because of the increasing aged population. Unlike other types of spine deformities, DNDLS may occur with concomitant LSS. Radiographic spinopelvic parameters are important for evaluating spine alignment in these patients; however, the association between these parameters and the HRQOL is unknown.

Methods...
Data from 204 patients diagnosed with DNDLS and concomitant LSS were reviewed. HRQOL was assessed using the visual analog scale (VAS) scores (for the back and leg), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, and Scoliosis Research Society (SRS)-22 questionnaire (SRS-22). Radiographic spinopelvic parameters were obtained from anteroposterior and lateral x-rays. The relationship between spinopelvic parameters and HRQOL was analyzed by correlation analysis in the overall population.

Results...
Lumbar lordosis (LL) showed clinical relevance to JOA (r = 0.290), ODI (r = –0.269), SRS-22 pain domain (r = 0.134), SRS-22 function domain (r = 0.257), and VAS for back pain (r = −0.196). There was clinical relevance between T1 pelvic angle (T1PA) and JOA (r = −0.212) and ODI (r = 0.251), sagittal vertical axis (SVA) and JOA (r = −0.211) and SRS-22 function domain (r = −0.229) and ODI (r = 0.215), and L1 pelvic angle (L1PA) and ODI (r = 0.200). HRQOL differences were validated in the SVA and PI-LL groups by SRS-Schwab classification. A significant difference was validated by setting a sagittal balance threshold for SVA, T1PA, T1 sagittal tilt, and L1PA.

Conclusion...
The sagittal radiographic parameters showed a weak correlation with preoperative HRQOL in patients with concomitant DNDLS and LSS. T1PA, T1ST, and L1PA can effectively assess pretreatment HRQOL.

Level of Evidence: 4
Fallout from Nuclear Weapons Tests: Environmental, Health, Political, and Sociological Considerations
Authors: Bouville André 
Published: March 2020

Abstract
The process of nuclear fission, which was discovered in 1938, opened the door to the production of nuclear weapons, which were used in 1945 by the United States against Japan in World War II, and to the detonation of >500 nuclear weapons tests in the atmosphere by the United States, the former Soviet Union, the United Kingdom, China, and France from 1946–1980. Hundreds of radionuclides, most of them short-lived, were produced in the atmospheric tests. The radioactive clouds produced by the explosions were usually partitioned between the troposphere and the stratosphere: the activity that remained in the troposphere resulted in local and regional fallout, consisting mainly of short-lived radionuclides and in relatively high doses for the populations residing in the vicinity of the test site, whereas the activity that reached the stratosphere returned to the ground with a half-life of ~1 y and was composed of long-lived radionuclides that contaminated all uncovered materials on Earth to a small extent and led to low-level irradiation of the world population for decades or more. The health effects resulting from exposure to radioactive fallout constitute, in most cases, small excesses over baseline rates for thyroid cancer and leukemia. An extra 49,000 cases of thyroid cancer would be expected to occur among the US population from exposure to radioactive fallout from the atmospheric nuclear weapons tests that were conducted at the Nevada Test Site in the 1950s. In addition, there could be as many as 11,000 deaths from non-thyroid cancers related to fallout from all atmospheric tests that were conducted at all sites in the world, with leukemia making up 10% of the total. Public concern arose in part from the secrecy that surrounded the nuclear testing programs and, for a long time, the poor communication regarding the consequences of the tests, both in terms of radiation doses and of health effects. Sociological and political pressures contributed to the establishment of programs of compensation for radiation exposures and evidence of radiation-induced diseases in countries that incurred significant fallout from nuclear weapons testing.
Systemic Infection Caused by Malassezia pachydermatis in Infants: Case Series and Review of the Literature
Authors: Huang Ching-Ying , Peng Chun-Chih , Hsu Chyong-Hsin , Chang Jui-Hsing , Chiu Nan-Chang , Chi Hsin 
Published: March 2020

Background:

Malassezia pachydermatis is a rare cause of systemic infection in infants.

Methods:
A total of 4 cases of M. pachydermatis fungemia that occurred in our neonatal intensive care unit over a 21-month period were reviewed, as well as 27 cases reported in the literature since 1988.

Results:
The patients were preterm with multiple complications and had birth weights ranging from 490 to 810 g and gestational age between 23 and 26 weeks. All patients had received prophylactic fluconazole, broad-spectrum antibiotics and parenteral lipid supplements before fungemia onset, which occurred between the age of 7 and 28 days. Symptoms were nonspecific and thrombocytopenia was the primary laboratory finding. All patients received intravenous antifungal treatment and recovered from their infection. The 27 cases from review of the literature also indicated that the infected infants were extremely low birth weight (77.8%), with multiple underlying diseases (94.7%), receiving lipid-supplementation (100%) from a central vascular catheter. Most infants received antifungal treatment (73.1%) and catheter removal (73.1%) as the management.

Conclusions:

M. pachydermatis is a pathogenic agent that causes late onset sepsis in critically ill low birth weight infants with generally good outcomes. Targeted antifungal treatment as well as catheter removal appear to be key factors for infection management.
Home blood pressure monitoring and e-Health: investigation of patients’ experience with the Hy-Result system
Authors: Postel-Vinay Nicolas , Steichen Olivier , Pébelier Emmanuelle , Persu Alexandre , Berra Elena , Bobrie Guillaume , Savard Sébastien , Nogueria José , Azizi Michel 
Published: March 2020

Background:
Hy-Result is a validated system designed to help patients complying with the home blood pressure monitoring (HBPM) protocol and understanding their blood pressure (BP) readings. It is available as a standalone web application or within a wireless BP monitor app.

Objective:
The aim of the study was to explore patients’ experience with Hy-Result.

Methods:
Online survey completed by 512 users of the Hy-Result web application or monitor app, and three focus groups with 24 hypertensive patients who monitor their BP at home and use the Hy-Result web application to record their data. We assessed the experience of patients with the functionalities and medical content of Hy-Result, their feelings and expectations, and the impact of Hy-Result on the physician–patient relationship.

Results:
(1) Functionalities: Over 90% of survey respondents and all focus group participants found Hy-Result easy to use. The main drawback of the web application is the need to manually enter all BP values at once. (2) Medical content: Hy-Result offers information on arterial hypertension and HBPM that most patients found useful. Users found that Hy-Result triggers appropriate reactions to BP readings, including adequately timed general practitioner visits. (3) Feelings and expectations: Over 90% of survey respondents trust Hy-Result and focus group participants understood that text messages are suggestions, not diagnoses. Hy-Result did not cause anxiety or excessive BP measurements. (4) Physician–patient relationship: Three-quarter of survey respondents agreed that Hy-Result may help when talking with their doctor about their BP values but only one-third of those have shown the report to their physician. For focus group participants, using Hy-Result should ideally be a physician prescription. They were aware that Hy-Result does not replace clinical judgment and that physicians still have a decisive role in BP management.

Conclusion:
Most of the users described Hy-Result as an easy-to-use and useful tool. Patients are willing to use it on physician request.
Is the blood pressure of right arm measured with synchronous four-limb method is equal to that with single arm method?
Authors: Yang Tao , Wu Qinghua , Hu Weitong , Su Hai 
Published: March 2020

Objective:
Synchronous four-limb blood pressure (BP) measurement (four-limb method) is widely used for diagnosing peripheral artery diseases in clinical practise, but it is unclear whether the BP of right arm measured with this method is similar to that measured with single arm method.

Methods:
This study included 198 in-patients (aged 18–89, mean age 60.1± 13.9 years old, 109 males). They were divided into four groups on the therapy as renin-angiotensin system inhibitor (46 patients), calcium channel blocker (43 patients), beta receptor blocker (27 patients), and combination (Com, 82 patients) groups. The patients were randomly instructed to follow one of two BP measurement proposals designed to avoid the bias induced by BP measurement order. The result with single arm method was recorded as RA-1 and that with four-limb method as RA-4. The difference between RA-4 and RA-1 was calculated as Dif-RA. The percentage increase (PI) was also calculated on the formula: (RA-4 − RA-1)/RA-1.

Results:
The mean Dif-RA on SBP and DBP were 1.9/1.5 mmHg. Although the levels of SBP, DBP and pulse pressure of RA-1 were different, the PI of these parameters were comparable among four treatment groups. Multivariate regression analyses showed that age and SBP of RA-1 were positive independent factors for Dif-RA on SBP.

Conclusion:
The SBP and DBP of right arm measured with synchronous four-limb method are 1.9/1.5 mmHg higher against the single arm method in treated hypertensives, and the increase extent of BP is not associated with the used drugs.
The prognostic role of Ki-67/MIB-1 in meningioma
Authors: Liu Ning , Song Si-Ying , Jiang Jia-Bao , Wang Ting-Jian , Yan Chang-Xiang 
Published: March 2020

Abstract

Background:
Ki-67 is a typical immunohistochemical marker for cell proliferation. Higher expression of Ki-67 is correlated with poor clinical outcomes in several cancers. However, the prognostic value of Ki-67 on the prognosis of meningiomas is still controversial. The purpose of this meta-analysis was to evaluate the prognostic value of Ki-67 in meningiomas.

Methods and materials:
We searched Medline and EMBASE from inception to December 31, 2018, to identify relevant articles. Using a fixed or random effects model, pooled hazard ratios (HRs) for overall survival (OS) and disease/progression/recurrence-free survival (D/P/RFS) were estimated.

Results:
A total of 43 studies, comprising 5012 patients, were included in this analysis. Higher Ki-67 expression levels were significantly associated with worse OS (HR = 1.565; 95% CI: 1.217–2.013) and D/P/RFS (HR = 2.644; 95% CI: 2.264–3.087) in meningiomas. Subgroup analysis revealed that all the included factors (ethnicity, tumor grade, HR sources, definition of cutoffs, cutoff values) for heterogeneity investigation can affect the pooled results. Among them, the definitions of cutoffs and cutoff values factor are the two main contributors toward heterogeneity. Multivariable meta-regression analysis also showed that methodologies used for cutoff value definition contributed to the high inner-study heterogeneity.

Conclusions:
Higher Ki-67 expression levels negatively influenced survival in meningiomas. A higher cutoff value (>4%) is more appropriate for prognosis prediction. It is highly recommended that Ki-67 expression profile could be assessed in meningiomas treatment for predicting survival. And patients with elevated expression of Ki-67 need to have close follow-ups.
Aspirin and the risk of hepatocellular carcinoma development in patients with alcoholic cirrhosis
Authors: Shin Sangdeok , Lee Sang Hoon , Lee Minjong , Kim Ji Hyun , Lee Wongu , Lee Hyun Woo , Park Min Soo , Park Seungwoo , Kim Tae Suk , Choi Dae Hee 
Published: March 2020

Abstract
Aspirin therapy has shown protective effects against hepatocellular carcinoma (HCC) in preclinical studies. However, it is unclear whether aspirin therapy lowers the risk of HCC in patients with alcoholic cirrhosis.
A retrospective analysis of data from 949 consecutive patients with alcoholic cirrhosis who abstained from alcoholic drinking was performed. The primary and secondary outcomes were development of HCC and gastrointestinal bleeding events, respectively. Risk was compared between patients with aspirin treatment and patients who were not treated (non-aspirin group) using a time-varying Cox proportional hazards model for total population and propensity score-matching analysis.
The aspirin group included 224 patients and the non-aspirin group had 725 patients. During the study period of median duration of 3.1 years, 133 patients (13.6%) developed HCC. In time-varying Cox proportional analyses, the aspirin group showed a significantly lower risk of HCC (adjusted hazard ratio [aHR]: 0.13; 95% confidence interval [CI]: 0.08–0.21; P < .001). In propensity score-matched pairs, aspirin therapy significantly reduced the risk of HCC (aHR: 0.14; 95% CI: 0.09–0.22; P < .001). In bleeding risk, treatment with aspirin alone was not significantly associated with a higher bleeding risk (aHR: 0.81; 95% CI: 0.45–1.44; P = .46).
Aspirin therapy was associated with the lower risk of HCC in patients with alcoholic cirrhosis.
Clinical effects of hemoperfusion combined with pulse high-volume hemofiltration on septic shock
Authors: Chu Laping , Li Guangyao , Yu Yafen , Bao Xiaoyan , Wei Hongyi , Hu Minhong 
Published: March 2020

Abstract
Sepsis can cause septic shock, multiple organ dysfunction and even death. The combination of different blood purification would be the certain trend in the treatment of sepsis.
This study was to evaluate the clinical effects of hemoperfusion (HP) combined with pulse high volume hemofiltration (PHVHF) on septic shock.
Thirty cases were involved in this study and were randomly divided into two groups: HP and PHVHF group (n = 15) and CVVH (continuous veno-venous hemofiltration) group (n = 15). Acute physiology and chronic health evaluation (APACHE) II scores, sequential organ failure assessment (SOFA) scores as well as biochemical changes were measured before and after the treatment. The levels of IL-6, IL-10, and TNF-α in plasma were assessed by ELISA before and after treatment for 2 and 24 h. The norepinephrine doses were also analyzed. The 28-day mortalities in both groups were also compared.
In both groups, body temperature (BT), respiratory rate (RR), white blood cells (WBC), C-reactive protein (CRP), Procalcitonin (PCT), lactic acid, serum creatinine, APACHE II scores and SOFA scores decreased after hemofiltration (P < .05). The HP&PHVHF group was superior to the CVVH group in CRP, APACHE II score (P < .01), and heart rate (HR), WBC, PCT, SOFA (P < .05). The doses of norepinephrine were also decreased after treatment (P < .01), with more reduction in the HP&PHVHF group (P < .05). After 24 h of treatment, the levels of IL-6, IL-10, and TNF-α decreased in both groups (P < .05), and the decrease was more significant in HP&PHVHF group (P < .05). In combined group, after 2 h of hemoperfison, there was a significant reduction in these inflammatory factors (P < .01). Combined therapy group's mortality was 26.7%, while CVVH group's was 40%.
HP combined with PHVHF has a significant effect on septic shock and can be an important therapy for septic shock.