bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Reliable Marker of Endothelial Cell Dysfunction and Vascular Damage: Legend or Reality?
Authors: Corinaldesi Giorgio , Corinaldesi Christian 
Published: April 2020

Abstract
Endothelial dysfunction is considered to be a pre-clinical stage of atherosclerosis and represents an initial step of plaque progression. The aim of this study is to investigate whether the overproduction of biochemical markers is related to vascular damage. We studied 72 patients split into three groups:
20 patients had no vessels significant disease; 18 patients had multi-vessels disease; 34 patients had multi-vessels disease and stenosis &gt;50%.
Patients with known coronary artery disease, stroke, hypertension, diabetes and/or dyslipidemia were excluded from the study.
We measured plasma levels of vWF (a marker of endothelial stress), VEGF (a marker of neointimal proliferation), TF and E-selectin (a marker of endothelial activation), all were measured by ELISA, and we investigated if their increased levels are related to the endothelial damage (table 1).
Table 1.
No disease Multi vessels Multi vessels disease+stenosis vWF (IU/dl) 84–102 128–154 146–182 VEGF (pg/ml) 28–124 120–180 160–240 TF (pg/ml) 16–98 80–220 230–370 E-Selectin (ng/ml) 30–74 72–96 94–128
There is a significant relation between vWF, VEGF, TF and E-Selectin and vessels disease severity; patients with no vessels disease had an average thickness of 0.48 mm, (IMT: 0.6–1.18mm), patients with multi vessels disease had a median atheroma score of 1.12, (IMT:1.18–2.42mm), patients with multi vessels disease and stenosis had a mediam atheroma score of 2.40, (IMT:&gt;2.42mm), indeed we did not find any significant relation between increased arterial stiffness and laminar shear-stress. Healthy endothelium exerts a favourable and athero-protective effects by a numbers of factors.
Table 2. Favorable and Atheroprotective Effects of the Healthy Endothelium
Promotion of vasodilation Antioxidant effects Anti-inflammatory effects Inhibition of leukocyte adhesion and migration Inhibition of smooth muscle cell proliferation and migration Inhibition of platelet aggregation and adhesion Anticoagulant effects Profibrinolytic effects
Table 3. Risk factors and predictors of endothelium dysfunction
Recruiment of inflammatory cells SMC proliferation Neointimal formation Oxidative stress Activation of procoagulant activities Activation of plateolet adhesion and aggregation Stasis of blood flow
In conclusion, we demonstrated that high levels of vWF, VEGF, TF, E-Selectin may play a critical role as for the development and the progression of atherosclerosis, even if further and wider studies are needed to confirm this statement.
Peripartum Haemostatic Changes in Women in Labour
Authors: Lefkou Eleftheria , Parmar Kiran , Mamopoulos Apostolos , Masouridou Sevasti , Karagiannis Vassilios , Hunt Beverley J 
Published: April 2020

Abstract
Introduction: Obstetric haemorrhage (OH) is a major cause of maternal mortality and morbidity worldwide. Appropriate management requires understanding of normal peripartum haemostatic changes during labour, and yet there are few studies.
Aim: In this pilot study we aimed to evaluate peripartum haemostatic changes in healthy women.
Methods: We collected blood samples from 20 women peripartum, into 0.102 M trisodium citrate tubes (ratio9:1) (Becton Dickinson) from the antecubital fossa using flawless venepuncture at the following time-points:
antepartum; after delivery of the placenta; 24hrs post-partum and 48hrs post-partum.
Plasma was aliquoted and stored in −70°C until the following ELIZA assays were performed: D-Dimer levels (Dade Behring, Sysmex UK), prothrombin fragments 1+ 2 (PF 1+2) (Dade Behring, Sysmex, UK) and tissue plasminogen activator antigen (t-PA:Ag) (Biopool, Trinity Biotech, UK). Prothrombin time (PT) (PT-Fib HS), activated partial thromboplastin time (APTT) (APTT micronized silica) and clauss fibrinogen (Fib-C), reagents were from Instrumentation Laboratories Ltd UK. Statistical analysis was performed using XLSTAT 2008.
Results: The median (range) age was 28 (19–36) years and the body mass index (BMI) 28.9 (21.7– 35.3).
Table 1: To show the median (range) for the haemostatic assays
Assay (normal ranges) D-dimers (4–52ug/l) PF1+2 (0.2–1.2 pmol/l) t-PA:Ag: 3–11 ng/ml) PT (12–16s) APTT (26–38s) Fibrinogen (1.52–4.12 g/l) * p&lt;0.05 using the Mann Whitney U test between the 1st and each of the other three samples Antepartum 231 (122–900) 570 (352–1533 12 (7.2–23) 12 (10–14) 31 (24–36) 5.2 (3.1–8.7) Post Labour 482 (117–1044) 968 (480–1858)* 18 (8.6–40.6)* 13 (10–15) 30 (24–36) 5.3 (2.2–9.8) 24h 309 (65–931) 568 (264–1080)* 7 (4–23)* 13 (10–16)* 33 (27–41)* 5.3 (4–11) 48hrs 235 (85–614) 648 (371–2287) 7 (3–18)* 12 (10–16) 31 (23–43) 5.7 (3.5–11)
Conclusion: These findings demonstrate that peripartum haemostasis is prothrombotic with shortened PT, APTT and prolonged fibrinogen. There is increased thrombin generation and fibrinolytic activity. t-PA antigen is most notably elevated immediately post delivery.
Inactivation of PUMA Protects Hematopoietic Stem Cells and Confers Long Term Survival in Response to High Dose γ-Irradiation
Authors: Yu Hui , Shen Hongmei , Xu Feng , Hu Xiaoxia , Li Yanxin , Ling Yun , Yu Jian , Zhang Lin , Zambetti Gerard P. , Cheng Tao 
Published: April 2020

Abstract
Radiation injury remains a significant health problem. New medical intervention to prevent or manage radiation damage is highly dependent on a deeper understanding of how radiation-induced cell death is accomplished in the irradiated tissue cells such as stem and progenitor cells. To date, relatively specific or untainted molecular mediators in apoptosis of tissue stem and progenitor cells upon radiation injury have not been clearly defined. The p53 pathway is known as a major molecular mechanism for cell apoptosis, upon the exposure of lethal radiation. Targeting p53 confers a radioprotective effect, but may increase tumorigenesis due to impaired cell cycle arrest for DNA repair. In our current study, we have examined the specific role of PUMA (p53 up-regulated mediator of apoptosis) in the radiosensitivity of hematopoietic stem cells (HSCs) and hematopoietic progenitor cells (HPCs). By quantitative RT PCR, we found that the level of PUMA mRNA was relatively low in the most primitive long-term repopulating hematopoietic stem cells (LT-HSC, isolated based on the immnunophenotype “CD34−LKS”) as compared to other hematopoietic cell populations from mice, but it was significantly elevated in response to γ-irradiation. In the mice lacking PUMA, while neither HSC number nor HSC function was altered under homeostatic conditions, the PUMA−/− HSCs appeared to be resistant to radiation damage in vivo as retrospectively quantified in a competitive HSC transplant model. Our further direct measurement with a single cell culture system for HSC growth in vitro, demonstrated that PUMA, but not p21 (the chief mediator of p53 in cell cycle arrest), is primarily responsible for the radiosensitivity of HSC in the p53 pathway (200 LT-HSCs analyzed for each cell type). Together, these data provide definitive evidence for PUMA as an essential mediator in radiation-induced apoptosis of tissue stem cells. We finally focused on the beneficial effects of targeting PUMA in HSCs and HPCs on the animal survival upon the exposure of lethal irradiation. Strikingly, the wild-type mice reconstituted with PUMA−/− hematopoietic cells exhibited a significant survival advantage after two rounds of 9-Gy γ-irradiation (18 Gy in total) as compared to the mice reconstituted with PUMA+/+ hematopoietic cells (95 % vs. 0 % survival in 20 days, n=21/each group; 50% vs. 0 % survival in 180 days, n=20 or 11/each group, respectively) as shown in the figure below. Moreover, unlike the p53−/− mice, those PUMA−/− reconstituted mice did not have an increased incidence of hematopoietic malignancies (n=20) within 180 days. Therefore, our current study establishes PUMA as an attractive molecular target for the development of therapeutic agents for the prevention and treatment of radiation injury.
An Ultrastructural Investigation of the Fibrin Clot Utilizing Ferritin-Labelled Anti-Human Fibrinogen Antibody
Authors: WHITE JAMES G. , KRIVIT WILLIAM , VERNIER ROBERT 
Published: April 2020

Abstract
A study of fibrin ultrastrtucture utilizing ferritin-conjugated antihuman fibrinogen antibody is reported. The structure of fibrin strands in thin section, and the periodic banding of the fibrin by ferritin conjugated antibody permits conclusions regarding the structural formation of the clot. The observations are in accord with the model of fibrin strand formation suggested by Hall and Slayter. Further areas of investigation utilizing this technic are suggested.
Application of preoperative assessment of pain induced by venous cannulation in predicting postoperative pain in patients under laparoscopic nephrectomy: a prospective observational study
Authors: Peng Fei , Li Yanshuang , Ai Yanqiu , Yang Jianjun , Wang Yanping 
Published: April 2020

Abstract
Background
Postoperative pain is the most prominent concern among surgical patients. It has previously been reported that venous cannulation-induced pain (VCP) can be used to predict postoperative pain after laparoscopic cholecystectomy within 90 mins in the recovery room. Its potential in predicting postoperative pain in patients with patient-controlled intravenous analgesia (PCIA) is worth establishing. The purpose of this prospective observational study was to investigate the application of VCP in predicting postoperative pain in patients with PCIA during the first 24 h after laparoscopic nephrectomy.

Methods
One hundred twenty patients scheduled for laparoscopic nephrectomy were included in this study. A superficial vein on the back of the hand was cannulated with a standard-size peripheral venous catheter (1.1 × 3.2 mm) by a nurse in the preoperative areas. Then the nurse recorded the VAS score associated with this procedure estimated by patients, and dichotomized the patients into low response group (VAS scores < 2.0) or high response group (VAS scores ≥2.0). After general anesthesia and surgery, all the patients received the patient-controlled intravenous analgesia (PCIA) with sufentanil. The VAS scores at rest and on coughing at 2 h, 4 h, 8 h, 12 h, 24 h, the effective number of presses and the number of needed rescue analgesia within 24 h after surgery were recorded.

Results
Peripheral venous cannulation-induced pain score was significantly correlated with postoperative pain intensity at rest (rs = 0.64) and during coughing (rs = 0.65), effective times of pressing (rs = 0.59), additional consumption of sufentanil (rs = 0.58). Patients with venous cannulation-induced pain intensity ≥2.0 VAS units reported higher levels of postoperative pain intensity at rest (P < 0.0005) and during coughing (P < 0.0005), needed more effective times of pressing (P < 0.0005) and additional consumption of sufentanil (P < 0.0005), and also needed more rescue analgesia (P = 0.01) during the first 24 h. The odds of risk for moderate or severe postoperative pain (OR 3.5, 95% CI 1.3–9.3) was significantly higher in patients with venous cannulation-induced pain intensity ≥2.0 VAS units compared to those <2.0 VAS units.

Conclusions
Preoperative assessment of pain induced by venous cannulation can be used to predict postoperative pain intensity in patients with PCIA during the first 24 h after laparoscopic nephrectomy.

Trial registration
We registered this study in a Chinese Clinical Trial Registry (ChiCTR) center on July 6 2019 and received the registration number: ChiCTR1900024352.
Estimated oxygen extraction versus dynamic parameters of fluid-responsiveness for perioperative hemodynamic optimization of patients undergoing non-cardiac surgery: a non-inferiority randomized controlled trial
Authors: Carsetti Andrea , Amici Mirco , Bernacconi Tonino , Brancaleoni Paolo , Cerutti Elisabetta , Chiarello Marco , Cingolani Diego , Cola Luisanna , Corsi Daniela , Forlini Giorgio , Giampieri Marina , Iuorio Salvatore , Principi Tiziana , Tappatà Giuseppe , Tempesta Michele , Adrario Erica , Donati Abele 
Published: April 2020

Abstract
Background
Goal directed therapy (GDT) is able to improve mortality and reduce complications in selected high-risk patients undergoing major surgery. The aim of this study is to compare two different strategies of perioperative hemodynamic optimization: one based on optimization of preload using dynamic parameters of fluid-responsiveness and the other one based on estimated oxygen extraction rate (O2ER) as target of hemodynamic manipulation.

Methods
This is a multicenter randomized controlled trial. Adult patients undergoing elective major open abdominal surgery will be allocated to receive a protocol based on dynamic parameters of fluid-responsiveness or a protocol based on estimated O2ER. The hemodynamic optimization will be continued for 6 h postoperatively. The primary outcome is difference in overall postoperative complications rate between the two protocol groups. Fluids administered, fluid balance, utilization of vasoactive drugs, hospital length of stay and mortality at 28 day will also be assessed.

Discussion
As a predefined target of cardiac output (CO) or oxygen delivery (DO2) seems to be not adequate for every patient, a personalized therapy is likely more appropriate. Following this concept, dynamic parameters of fluid-responsiveness allow to titrate fluid administration aiming CO increase but avoiding fluid overload. This approach has the advantage of personalized fluid therapy, but it does not consider if CO is adequate or not. A protocol based on O2ER considers this second important aspect. Although positive effects of perioperative GDT have been clearly demonstrated, currently studies comparing different strategies of hemodynamic optimization are lacking.

Trial registration
ClinicalTrials.gov, NCT04053595. Registered on 12/08/2019.
When is referral from primary care to specialist services appropriate for survivors of stroke? A modified RAND-appropriateness consensus study
Authors: Lim Lisa , Mant Jonathan , Mullis Ricky , Roland Martin 
Published: April 2020

Abstract
Background
There is guidance in the United Kingdom about what long-term care stroke survivors should receive, but a lack of guidance about who should deliver it and where this care should take place. This is a key issue given the evidence that current needs are not well addressed. The purpose of this study was to explore when a referral from generalist to specialist services is appropriate in the long-term management of stroke survivors.

Methods
A modified RAND-Appropriateness method was used to gain consensus from a range of stroke specialist and generalist clinicians. Ten panelists rated fictional patient scenarios based on long-term post-stroke needs. Round 1 was an online survey in which panelists rated the scenarios for a) need for referral to specialist care and b) if referral was deemed necessary, need for this to be specifically to a stroke specialist. Round 2 was a face-to-face meeting in which panelists were presented with aggregate scores from round 1, and invited to discuss and then re-rate the scenarios.

Results
Seventeen scenarios comprising 69 referral decisions were discussed. Consensus on whether the patient needed to be referred to a specialist was achieved for 59 (86%) decisions. Of the 44 deemed needing referral to specialists, 18 were judged to need referral to a stroke-specialist and 14 to a different specialist. However, for 12 decisions there was no consensus about which specialist the patient should be referred to. For some scenarios (spasticity; incontinence; physical disability; communication; cognition), referral was deemed to be indicated regardless of severity, whereas indications for referral for topics such as risk factor management and pain depended on complexity and/or severity.

Conclusions
There was broad agreement about when a stroke survivor requires referral to specialist care, but less agreement about destination of referral. Nevertheless, there was agreement that some of the longer-term issues facing stroke survivors are best addressed by stroke specialists, some by other specialists, and some by primary care. This has implications for models of longer-term stroke care, which need to reflect that optimal care requires access to, and better co-ordination between, both generalist and specialist healthcare.
Cumulative incidence of hepatocellular carcinoma and hepatitis B surface antigen Seroclearance after Nucleos(t) ide analogue-induced hepatitis B e antigen Seroclearance
Authors: Lee Hyun Woong , Lee Jung Il , Kim Saein , Kim Sora , Chang Hye Young , Lee Kwan Sik 
Published: April 2020

Abstract
Background
Hepatitis B e antigen (HBeAg) seroclearance has been considered as the treatment endpoint in HBeAg-positive patients with chronic hepatitis B (CHB). Although HBeAg seroclearance has been accomplished, some aspects are yet unclear. We investigated the cumulative incidence of hepatocellular carcinoma (HCC) and evaluated hepatitis B surface antigen (HBsAg) seroclearance in patients undergoing nucleos(t) ide analogue (NA)-induced HBeAg seroclearance.

Methods
In this retrospective cohort study, 203 patients with CHB were HBsAg and HBeAg seropositive before NA (entecavir or tenofovir) treatment. All patient who experienced NA -induced HBeAg seroclearance were recruited. Patients with documented HBeAg seroclearance were followed-up every 6 months. Baseline characteristics and laboratory results were recorded.

Results
The mean age at HBeAg seroclearance was 40 years (range, 20–84), and the mean follow-up duration was 5 years (range, 2–11). The cumulative incidence of HCC was 1.5 to 11.5% at 1 to 8 years after HBeAg seroclearance. Cirrhosis was the only significant factor for HCC development (hazard ratio [HR], 24.651; confidence interval [CI], 3.018 to 201.365; P = 0.003). The cumulative incidence of HBsAg seroclearance was 3.5 to 18.7% after 1 to 8 years from HBeAg seroclearance.

Conclusions
A significant proportion of patients developed HCC after NA-induced HBeAg seroclearance. The presence of liver cirrhosis at the time of HBeAg seroclearance serves as an independent factor for HCC development. Some patients with NA-induced HBeAg seroclearance achieved HBsAg seroclearance.
Patient and family experience with chronic transfusion therapy for sickle cell disease: A qualitative study
Authors: Hawkins Lauren M. , Sinha Cynthia B. , Ross Diana , Yee Marianne E. M. , Quarmyne Maa-Ohui , Krishnamurti Lakshmanan , Bakshi Nitya 
Published: April 2020

Abstract
Background
There is a limited understanding of the patient and family experience of Chronic Transfusion Therapy (CTT) for prevention of complications of Sickle Cell Disease (SCD). We sought to understand patient and family experience with CTT using qualitative methods.

Methods
Fifteen parents of children < 18 years old and nine children 12–18 years old with SCD who were receiving CTT for > 1 year were interviewed using a semi-structured interview format, and interviews were analyzed using open coding methods.

Results
Four themes created a narrative of the patient and family experience of CTT: 1) Burden of CTT, 2) Coping with CTT, 3) Perceived benefits and risks of CTT, and 4) Decision making regarding CTT. Participants reported substantial burden of CTT, including the impact of CTT on daily life and family, distress about venous access, burden of chelation therapy, and anxiety about CTT complications. Participants described how they coped with CTT. Participants reported increased energy, decreased pain, fewer hospitalizations, and stroke prevention with CTT, but also recognized complications of CTT, though awareness was limited in adolescents. Parents described sharing in the informed decision-making process with their healthcare provider about CTT, but adolescent patient participants reported that they were not involved in this process.

Conclusions
CTT is associated with significant patient and family burden. Support from family, healthcare providers and school may help individuals cope with some of this burden. These findings provide the basis for future studies to identify strategies to mitigate the burden of CTT and improve the patient experience with this therapy. Future studies should also systematically assess patient knowledge about the key components of CTT and chelation using quantitative assessments.
Sustainable livelihood alternatives among Nile perch (Lates niloticus) fishers in Lake Victoria Tanzania: analytical hierarchy process (AHP) approach
Authors: Mkuna Eliaza , Baiyegunhi Lloyd , Adamus Wiktor 
Published: April 2020

AbstractSustainable livelihood has been a focal point in many development initiatives by private and public sectors in most African countries. However artisanal fishers in the main lakes of Africa are faced with several alternative decisions to improve their livelihood sustainably. Several studies which have been conducted in Africa offered various options using different models such as sustainable livelihood approach/framework (SLA). This study provides different decision-making alternatives using multi-criteria decision model known as analytical hierarchy process (AHP) to assess the most economical and sustainable livelihood options for Nile perch fishers in Lake Victoria Tanzania. Using structured questionnaires and key informant interviews, different strategic criteria such as environment, economic, social and technology were analyzed and the study found that, important factor in the strategic criteria is environment. Moreover, different livelihood alternatives which include livelihood diversification, fisheries co-management and promotion of aquaculture were analyzed. The study found that livelihood diversification which implies diversifying income-generating activities was identified as the best alternative model for sustainable livelihood development. The study recommends proper income diversification interventions and environment management for the sustainability of Nile perch fishers’ livelihood and fishery resources in Lake Victoria.