bluuebunny/crossref_metadata_2025_split huggingface dataset:
Examining the translational success of an initiative to accelerate the assessment of chest pain for patients in an Australian emergency department: a pre-post study
Authors: Greenslade Jaimi H. , Ho Ariel , Hawkins Tracey , Parsonage William , Crilly Julia , Cullen Louise 
Published: May 2020

Abstract
Background
The Improved assessment of chest pain trial (IMPACT) protocol is an accelerated strategy for the risk stratification and management of patients presenting to the emergency department (ED) with chest pain. This study sought to describe the adoption, sustainability and health services implications of implementing the IMPACT protocol.

Methods
This was a study of adult patients in a large Australian tertiary hospital who had serial troponin testing commenced within the ED. Data from two periods were utilized; the pre-implementation period (8th April 2012 to 5th April 2014) and the post-implementation period (6th April 2014 to 2nd April 2016). The primary outcome was the proportion of patients undergoing accelerated care. Secondary endpoints were ED assessment time, hospital length of stay, and costs. Data were compared in the pre- and post-implementation periods.

Results
The proportion of patients receiving accelerated care increased from 3% in the pre- to 34% in the post-intervention period. This increase occurred rapidly after implementation of IMPACT and was sustained over a 2-year period. For patients with troponin concentrations <99th percentile, the mean ED assessment time reduced from 12.3 h in the pre- to 10.1 h in the post-implementation period. Mean hospital length of stay was similar in the pre- and post-implementation periods (82.4 and 80.9 h). The average cost of chest pain assessment reduced from $3520 pre implementation to $3204 post implementation; a $316 reduction per patient.

Conclusions
The IMPACT protocol was rapidly adopted and utilised after implementation into standard care. The initial increase in the proportion of patients undergoing accelerated assessment, followed by a plateau towards the end of the study period indicate adoption and sustainability of the IMPACT protocol over a two-year period. Modest reductions in length of stay and cost were seen after implementation. Given the large number of patients investigated for chest pain, such reductions may have substantial impact on the overall healthcare system.
“Current dementia care: what are the difficulties and how can we advance care globally?”
Authors: Giebel Clarissa 
Published: May 2020

Abstract
Background
Dementia is a growing global public health concern, with post-diagnostic care often very limited. Depending on where people live, both within a country and depending on high-, middle-, and low-income countries, they might also face barriers in accessing the right care at the right time. Therefore, it is important to highlight recent evidence on the facilitators and barriers to dementia care, but also evidence on how to move dementia care forward.

Main text
Current dementia care is subject to several inequalities, including living in rural regions and being from a minority ethnic background. Evidence in this collection highlights the issues that both people living with dementia and unpaid carers are facing in accessing the right care, with evidence from Australia, Canada, Uganda, to the Netherlands, and further afield. Providing improved dementia-specific training to health care professionals and supporting medication and reablement interventions have been identified as possible ways to improve dementia care for all.

Conclusions
This special issue focuses on recent evidence on inequalities in dementia care across the globe and how dementia care can be advanced in various areas.
A retrospective review of 10-year trends in general anesthesia for cesarean delivery at a university hospital: the impact of a newly launched team on obstetric anesthesia practice
Authors: Ikeda Takamitsu , Kato Atsuko , Bougaki Masahiko , Araki Yuko , Ohata Takuya , Kawashima Seiichiro , Imai Yousuke , Ninagawa Jun , Oba Koji , Chang Kyungho , Uchida Kanji , Yamada Yoshitsugu 
Published: May 2020

Abstract
Background
The indications for general anesthesia (GA) in obstetric settings, which are determined in consideration of maternal and fetal outcome, could be affected by local patterns of clinical practice grounded in unique situations and circumstances that vary among medical institutions. Although the use of GA for cesarean delivery has become less common with more frequent adoption of neuraxial anesthesia, GA was previously chosen for pregnancy with placenta previa at our institution in case of unexpected massive hemorrhage. However, the situation has been gradually changing since formation of a team dedicated to obstetric anesthesia practice. Here, we report the results of a review of all cesarean deliveries performed under GA, and assess the impact of our newly launched team on trends in clinical obstetric anesthesia practice at our institution.

Methods
Our original database for obstetric GA during the period of 2010 to 2019 was analyzed. The medical records of all parturients who received GA for cesarean delivery were reviewed to collect detailed information. Interrupted time series analysis was used to evaluate the impact of the launch of our obstetric anesthesia team.

Results
As recently as 2014, more than 10% of cesarean deliveries were performed under GA, with placenta previa accounting for the main indication in elective and emergent cases. Our obstetric anesthesia team was formed in 2015 to serve as a communication bridge between the department of anesthesiology and the department of obstetrics. Since then, there has been a steady decline in the percentage of cesarean deliveries performed under GA, decreasing to a low of less than 5% in the latest 2 years. Interrupted time series analysis revealed a significant reduction in obstetric GA after 2015 (P = 0.04), which was associated with decreased use of GA for pregnancy with placenta previa. On the other hand, every year has seen a number of urgent cesarean deliveries requiring GA.

Conclusions
There has been a trend towards fewer obstetric GA since 2015. The optimized use of GA for cesarean delivery was made possible mainly through strengthened partnerships between anesthesiologists and obstetricians with the support of our obstetric anesthesia team.
Does fine particulate matter (PM2.5) affect the benefits of habitual physical activity on lung function in adults: a longitudinal cohort study
Authors: Guo Cui , Bo Yacong , Chan Ta-Chien , Zhang Zilong , Lin Changqing , Tam Tony , Lau Alexis K. H. , Chang Ly-yun , Hoek Gerard , Lao Xiang Qian 
Published: May 2020

Abstract
Background
Physical activity (PA) increases a person’s inhalation of air pollutants due to greater ventilation, possibly leading to larger adverse health effects. This study aims to investigate the combined effects of long-term exposure to fine particulate matter (PM2.5) and habitual PA on lung function in adults.

Methods
This was a longitudinal cohort study that included 278,065 Taiwan residents with an age of 20 years old or above who joined a standard medical screening programme between 2001 and 2014. Each participant received at least one medical examination (including spirometric, blood, and urinary tests and a standard self-administered questionnaire survey) during the study period. We estimated the 2-year average PM2.5 concentrations at each participant’s address using a new physical model based on observational data. Information on the participants’ PA was collected using the standard self-administrated questionnaire. Generalised linear mixed models were used to investigate the combined effects of PM2.5 and PA on pulmonary function. We also performed stratified analyses by different levels of PM2.5 exposure and habitual PA.

Results
Each 10 MET-h increase in PA was associated with a higher level of 0.20%, 0.16%, and 0.19% in forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and maximum mid-expiratory flow (MMEF), respectively, after adjusting for PM2.5 exposure and a wide range of covariates including age, sex education, body mass index, lifestyles, and health conditions. Each 10 μg/m3 increase in PM2.5 was associated with a lower FVC, FEV1, and MMEF (2.43%, 2.78% and 3.10%, respectively). Negative interactions were observed, and PM2.5 exposure was associated with a greater reduction in lung function among the participants with higher PA levels.

Conclusions
We found significant negative interaction effects between long-term exposure to PM2.5 and habitual PA, suggesting that the increased intake of PM2.5 due to PA may attenuate the benefits of habitual PA on lung function. However, the PA benefits generally remained stable at different stratum of PM2.5 in the stratified analyses, and habitual PA may still be recommended to people residing in relatively polluted regions.
Association of sleep disturbance with risk of cardiovascular disease and all-cause mortality in patients with new-onset type 2 diabetes: data from the Korean NHIS-HEALS
Authors: Choi Young , Choi Jae Woo 
Published: May 2020

Abstract
Background
Sleep disturbance has been significantly associated with the incidence of cardiovascular disease (CVD) in the general population. However, despite the common prevalence of sleep disturbance in patients with type 2 diabetes, its relationship with the risk of CVD remains unclear. Here, we have examined the association of sleep disturbance with the incidence of all CVD and all-cause mortality in patients with newly-diagnosed type 2 diabetes.

Methods
We used the Korean National Health Insurance Service–Health Screening Cohort data and included 36,058 patients with new-onset type 2 diabetes aged ≥ 40 years between 2004 and 2007, along with follow-up examinations to 2013. We used the ICD-10 code to measure sleep disturbance as a primary diagnosis and the multivariable Cox proportional hazards regression models to estimate the adjusted hazard ratio (AHR) and 95% confidence interval (CI) of all CVD, coronary heart disease (CHD), stroke, and all-cause mortality.

Results
We identified 6897 cases of all CVD (CHD, n = 4138; stroke, n = 2759) and 2890 events of all-cause mortality during a mean follow-up period of 7.0 years. Sleep disturbance was associated with an increased risk of All CVD (AHR, 1.24; 95% CI, 1.06–1.46), CHD events (AHR, 1.24; 95% CI, 1.00–1.53), and all-cause mortality (AHR, 1.47; 95% CI, 1.15–1.87) in patients with new-onset type 2 diabetes. Furthermore, women (AHR, 1.33; 95% CI, 1.06–1.67) and middle-aged adults (AHR, 1.29; 95% CI, 1.02–1.64) with sleep disturbance had a significantly increased risk of CVD than those without; contrarily, men (AHR, 1.45; 95% CI, 1.09–1.95) and older adults (AHR, 1.51; 95% CI, 1.15–1.99) with sleep disturbance were associated with a significantly increased risk of all-cause mortality than those without.

Conclusions
Our findings suggest that sleep disturbance is significantly associated with an increased risk of CVD and all-cause mortality in patients with new-onset type 2 diabetes.
Autophagy-dependent and -independent modulation of oxidative and organellar stress in the diabetic heart by glucose-lowering drugs
Authors: Packer Milton 
Published: May 2020

AbstractAutophagy is a lysosome-dependent intracellular degradative pathway, which mediates the cellular adaptation to nutrient and oxygen depletion as well as to oxidative and endoplasmic reticulum stress. The molecular mechanisms that stimulate autophagy include the activation of energy deprivation sensors, sirtuin-1 (SIRT1) and adenosine monophosphate-activated protein kinase (AMPK). These enzymes not only promote organellar integrity directly, but they also enhance autophagic flux, which leads to the removal of dysfunctional mitochondria and peroxisomes. Type 2 diabetes is characterized by suppression of SIRT1 and AMPK signaling as well as an impairment of autophagy; these derangements contribute to an increase in oxidative stress and the development of cardiomyopathy. Antihyperglycemic drugs that signal through insulin may further suppress autophagy and worsen heart failure. In contrast, metformin and SGLT2 inhibitors activate SIRT1 and/or AMPK and promote autophagic flux to varying degrees in cardiomyocytes, which may explain their benefits in experimental cardiomyopathy. However, metformin and SGLT2 inhibitors differ meaningfully in the molecular mechanisms that underlie their effects on the heart. Whereas metformin primarily acts as an agonist of AMPK, SGLT2 inhibitors induce a fasting-like state that is accompanied by ketogenesis, a biomarker of enhanced SIRT1 signaling. Preferential SIRT1 activation may also explain the ability of SGLT2 inhibitors to stimulate erythropoiesis and reduce uric acid (a biomarker of oxidative stress)—effects that are not seen with metformin. Changes in both hematocrit and serum urate are the most important predictors of the ability of SGLT2 inhibitors to reduce the risk of cardiovascular death and hospitalization for heart failure in large-scale trials. Metformin and SGLT2 inhibitors may also differ in their ability to mitigate diabetes-related increases in intracellular sodium concentration and its adverse effects on mitochondrial functional integrity. Differences in the actions of SGLT2 inhibitors and metformin may reflect the distinctive molecular pathways that explain differences in the cardioprotective effects of these drugs.
Association of human XPA rs1800975 polymorphism and cancer susceptibility: an integrative analysis of 71 case–control studies
Authors: Yuan Maoxi , Yu Chunmei , Yu Kuiying 
Published: May 2020

AbstractBackgroundThe objective of the present study is to comprehensively evaluate the impact of the rs1800975 A/G polymorphism within the human xeroderma pigmentosum group A (XPA) gene on susceptibility to overall cancer by performing an integrative analysis of the current evidence.MethodsWe retrieved possible relevant publications from a total of six electronic databases (updated to April 2020) and selected eligible case–control studies for pooled assessment.P-values of association and odds ratio (OR) were calculated for the assessment of association effect. We also performed Begg’s test and Egger’s test, sensitivity analysis, false-positive report probability (FPRP) analysis, trial sequential analysis (TSA), and expression/splicing quantitative trait loci (eQTL/sQTL) analyses.ResultsIn total, 71 case–control studies with 19,257 cases and 30,208 controls from 52 publications were included for pooling analysis. We observed an enhanced overall cancer susceptibility in cancer cases compared with negative controls in the Caucasian subgroup analysis for the genetic models of allelic G vs. A, carrier G vs. A, homozygotic GG vs AA, heterozygotic AG vs. AA, dominant AG + GG vs. AA and recessive GG vs. AA + AG (P < 0.05, OR > 1). A similar positive conclusion was also detected in the “skin cancer” or “skin basal cell carcinoma (BCC)” subgroup analysis of the Caucasian population. Our FPRP analysis and TSA results further confirmed the robustness of the conclusion. However, our eQTL/sQTL data did not support the strong links of rs1800975 with the gene expression or splicing changes ofXPAin the skin tissue. In addition, even though we observed a decreased risk of lung cancer under the homozygotic, heterozygotic and dominant models (P < 0.05, OR < 1) and an enhanced risk of colorectal cancer under the allelic, homozygotic, heterozygotic, dominant (P < 0.05, OR > 1), our data from FPRP analysis and another pooling analysis with only the population-based controls in the Caucasian population did not support the strong links between theXPArs1800975 A/G polymorphism and the risk of lung or colorectal cancer.ConclusionsOur findings provide evidence of the close relationship between theXPArs1800975 A/G polymorphism and susceptibility to skin cancer in the Caucasian population. The potential effect ofXPArs1800975 on the risk of developing lung or colorectal cancer still merits the enrollment of larger well-scaled studies.
Item analysis of the Eating Assessment Tool (EAT-10) by the Rasch model: a secondary analysis of cross-sectional survey data obtained among community-dwelling elders
Authors: Hansen Tina , Kjaersgaard Annette 
Published: May 2020

AbstractBackgroundThe Eating Assessment Tool (EAT-10) is increasingly used to screen for self-perceived oropharyngeal dysphagia (OD) in community-dwelling elders. A summated EAT-10 total score ranges from 0 to 40, with a score ≥ 3 indicative of OD. When using cut-points of a summated score, important requirements for the measurements are specific objectivity, validity, and reliability. Analysis by the Rasch model allows investigation of whether scales like EAT-10 satisfy these requirements. Currently, a few studies have found that EAT-10 responses from clinical populations with OD do not adequately fit the Rasch model.PurposeThe aim of this study was to determine whether measurements by EAT-10 fit the Rasch model when applied in screening self-perceived OD in non-clinical populations.MethodsSecondary analysis was conducted on data from a cross-sectional survey of community-dwelling elders living in a municipal district of Tokyo, Japan, in which 1875 respondents completed the Japanese version of EAT-10 (J-EAT-10). Data were cleaned and recoded for the purpose of the analysis in this study, which resulted in inclusion of J-EAT-10 responses from 1144 respondents. Data were analyzed using RUMM2030 and included overall model fit, reliability, unidimensionality, threshold ordering, individual item and person fits, differential item functioning, local item dependency, and targeting.ResultsThe analysis identified that the response categories from zero to four were not used as intended and did not display monotonicity, which necessitated reducing the five categories to three. Considerable floor effect was demonstrated and there was an inappropriate match between items’ and respondents’ estimates. The person separation reliability (PSI = 0.65) was inadequate, indicating that it is not possible to differentiate between different levels of OD. Several items displayed misfit with the Rasch model, and there were local item dependency and several redundant items.ConclusionsJ-EAT-10 performed less than optimally and exhibited substantial floor effect, low reliability, a rating scale not working as intended, and several redundant items. Different improvement strategies failed to resolve the identified problems. Use of J-EAT-10 in population-based surveys cannot therefore be recommended. For such purpose, alternative screening tools of self-perceived OD should be chosen or a new one should be developed and validated.
A systematic review of metabolomic dysregulation in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis/Systemic Exertion Intolerance Disease (CFS/ME/SEID)
Authors: Huth Teilah Kathryn , Eaton-Fitch Natalie , Staines Donald , Marshall-Gradisnik Sonya 
Published: May 2020

Abstract
Background
Chronic Fatigue Syndrome/Myalgic Encephalomyelitis/Systemic Exertion Intolerance Disease (CFS/ME/SEID) is a complex illness that has an unknown aetiology. It has been proposed that metabolomics may contribute to the illness pathogenesis of CFS/ME/SEID. In metabolomics, the systematic identification of measurable changes in small molecule metabolite products have been identified in cases of both monogenic and heterogenic diseases. Therefore, the aim of this systematic review was to evaluate if there is any evidence of metabolomics contributing to the pathogenesis of CFS/ME/SEID.

Methods
PubMed, Scopus, EBSCOHost (Medline) and EMBASE were searched using medical subject headings terms for Chronic Fatigue Syndrome, metabolomics and metabolome to source papers published from 1994 to 2020. Inclusion and exclusion criteria were used to identify studies reporting on metabolites measured in blood and urine samples from CFS/ME/SEID patients compared with healthy controls. The Joanna Briggs Institute Checklist was used to complete a quality assessment for all the studies included in this review.

Results
11 observational case control studies met the inclusion criteria for this review. The primary outcome of metabolite measurement in blood samples of CFS/ME/SEID patients was reported in ten studies. The secondary outcome of urine metabolites was measured in three of the included studies. No studies were excluded from this review based on a low-quality assessment score, however there was inconsistency in the scientific research design of the included studies. Metabolites associated with the amino acid pathway were the most commonly impaired with significant results in seven out of the 10 studies. However, no specific metabolite was consistently impaired across all of the studies. Urine metabolite results were also inconsistent.

Conclusion
The findings of this systematic review reports that a lack of consistency with scientific research design provides little evidence for metabolomics to be clearly defined as a contributing factor to the pathogenesis of CFS/ME/SEID. Further research using the same CFS/ME/SEID diagnostic criteria, metabolite analysis method and control of the confounding factors that influence metabolite levels are required.
Dysregulation of miR-3607 predicts prognosis of hepatocellular carcinoma and regulates tumor cell proliferation, migration and invasion
Authors: Dou Wenwen , Yang Min , Su Yan , Xie Ruizhu 
Published: May 2020

Abstract
Background
Hepatocellular carcinoma (HCC) is one of the most common global malignancies with increasing morbidity and mortality. The purpose of this study was to investigate the expression levels and prognostic value of microRNA-3607 (miR-3607) in patients with HCC.

Methods
The expression of miR-3607 was estimated by quantitative real-time RT-PCR. Survival analysis using the Kaplan-Meier method and Cox regression analysis was conducted to evaluate the prognostic value of miR-3607. The functional role of miR-3607 in HCC progression was further assessed using gain- and loss-of-function experiments. Bioinformatics analysis and a dual-luciferase reporter assay were used to explore the direct targets of miR-3607.

Results
miR-3607 expression was found to be significantly decreased in HCC tissues and cells compared with the matched tissues and cells (P < 0.001). The decreased expression of miR-3607 was associated with the patients’ tumor size and TNM stage (all P < 0.05). According to the survival curves, patients with low miR-3607 expression had poorer overall survival than those with high levels (log-rank P = 0.012). Moreover, the Cox analysis results indicated that miR-3607 expression was an independent prognostic factor for HCC. The results of cell experiments revealed that the overexpression of miR-3607 in HCC cells led to the inhibited cell proliferation, migration, and invasion. TGFBR1 was identified as a direct target of miR-3607.

Conclusion
The data of this study indicated that the decreased expression of miR-3607 in HCC predicts poor prognosis and the overexpression of miR-3607 in HCC cells can suppress the tumor progression by targeting TGFBR1. This study provides a novel insight into the prognosis and treatment of HCC, and miR-3607 serves as a candidate prognostic biomarker and therapeutic target of HCC.