bluuebunny/crossref_metadata_2025_split huggingface dataset:
The acute and chronic effects of high-intensity exercise in hypoxia on blood pressure and post-exercise hypotension
Authors: Kleinnibbelink Geert , Stens Niels A. , Fornasiero Alessandro , Speretta Guilherme F. , Van Dijk Arie P.J. , Low David A. , Oxborough David L. , Thijssen Dick H.J. 
Published: September 2020

Abstract

Background:
Acute exercise leads to an immediate drop in blood pressure (BP), also called post-exercise hypotension (PEH). Exercise in hypoxia is related to additional vasodilation, potentially contributing to more profound PEH. Therefore, we investigated the impact of hypoxia versus normoxia on the magnitude of PEH. Second, we examined whether these changes in PEH relate to the BP-lowering effects of 12-week exercise training under hypoxia.

Methods:
In this prospective study, 21 healthy individuals (age 22.2 ± 3.0 years, 14 male) performed a 45-minute high-intensity running exercise on 2 different days in a random order, under hypoxia (fraction of inspired oxygen 14.5%) and normoxia (fraction of inspired oxygen 20.9%). BP was examined pre-exercise (t = 0) and at t = 15, t = 30, t = 45, and t = 60 minutes post-exercise. Afterward, subjects took part in a 12-week hypoxic running exercise training program. Resting BP was measured before and after the 12-week training program.

Results:
Acute exercise induced a significant decrease in systolic BP (systolic blood pressure [SBP], P = .001), but not in diastolic BP (diastolic blood pressure [DBP], P = .113). No significant differences were observed in post-exercise BP between hypoxic and normoxic conditions (SBP, P = .324 and DBP, P = .204). Post-exercise changes in SBP, DBP, and mean arterial pressure significantly correlated to the 12-week exercise training-induced changes in SBP (r = 0.557, P = .001), DBP (r = 0.615, P < .001), and mean arterial pressure (r = 0.458, P = .011).

Conclusion:
Our findings show that hypoxia does not alter the magnitude of PEH in healthy individuals, whilst PEH relates to the BP-lowering effects of exercise. These data highlight the strong link between acute and chronic changes in BP.
Admitted AIDS-associated Kaposi sarcoma patients
Authors: Vally Faheema , Selvaraj Wencilaus Margret Pious , Ngalamika Owen 
Published: September 2020

Abstract
Kaposi sarcoma (KS) is an AIDS-defining angioproliferative malignancy associated with high morbidity and mortality. Most KS patients in regions with high incidence such as sub-Saharan Africa present late with advanced stage disease. Admitted KS patients have high mortality rates. Factors associated with mortality of admitted KS patients are poorly defined.
We conducted a retrospective file review to ascertain reasons for admission and identify factors associated with mortality of admitted HIV-associated (epidemic) KS patients in Zambia. Baseline study variables were collected, and patients were retrospectively followed from admission to time of discharge or death.
Mortality rate for admitted epidemic KS patients was high at 20%. The most common reasons for admission included advanced KS disease, severe anemia, respiratory tract infections, and sepsis. The majority (48%) of admitted patients had advanced clinical stage with visceral involvement on admission. Clinical predictors of mortality on univariate analysis included visceral KS [odds ratio (OR) = 13.74; 95% confidence interval (95% CI) = 1.68–113; P = 0.02), fever (OR = 26; 95% CI = 4.85–139; P = .001), and sepsis (OR = 35.56; 95% CI = 6.05–209; P = .001). Baseline hemoglobin levels (5.6 vs 8.2 g/dL; P = .001) and baseline platelet counts (63 x 10^9/L vs 205 x 10^9/L; P = .01) were significantly lower in mortalities vs discharges. Baseline white cell counts were higher in mortalities vs discharges (13.78 x 10^9/L vs 5.58 x 10^9/L; P = .01), and HIV-1 viral loads at the time of admission were higher in mortalities vs discharges (47,607 vs 40 copies/μL; P = .02). However, only sepsis (or signs and symptoms of sepsis) were independently associated with mortality after controlling for confounders.
In conclusion, common reasons for admission of epidemic KS patients include advanced disease, severe anemia, respiratory tract infections, and signs and symptoms of sepsis. Signs and symptoms of sepsis are independent predictors of mortality in these patients.
Enhanced immune reaction resulting from co-vaccination of WT1 helper peptide assessed on PET-CT
Authors: Nakata Jun , Isohashi Kayako , Morimoto Soyoko , Itou Ryota , Kamiya Takashi , Matsuura Ai , Nakajima Hiroko , Fujiki Fumihiro , Nishida Sumiyuki , Hasii Yoshiko , Hasegawa Kana , Nakatsuka Shinichi , Hosen Naoki , Tsuboi Akihiro , Oka Yoshihiro , Kumanogoh Atsushi , Shibano Masaru , Munakata Satoru , Oji Yusuke , Hatazawa Jun , Sugiyama Haruo 
Published: September 2020

Abstract
It has become evident that positron emission tomography/computed tomography (PET-CT) using 2-deoxy-2-[F-18]fluoro-D-glucose (FDG) (FDG PET-CT) can detect anti-tumor immune response induced by various immunotherapies. To evaluate whether FDG PET-CT could detect anti-cancer immune response caused by cancer vaccine therapy, we performed a retrospective analysis of FDG PET-CT imaging of patients who were treated with Wilms Tumor 1 (WT1) vaccine therapy in Osaka University during July 2008 and June 2018. Increased FDG uptakes were detected in WT1-vaccinated skin and their draining lymph nodes during the repeated vaccination. While the FDG uptakes seemed to decrease with time after the cessation of WT1 peptide vaccinations, persistence of FDG uptakes for years in WT1-vaccinated skin were also observed in 2 cases who showed good clinical course. Moreover, the FDG uptakes of patients treated with the combination vaccine of WT1 specific cytotoxic T cell (CTL) and helper peptides were significantly stronger than of those treated with the WT1 CTL peptide alone. Since it is evident that the combination vaccine can induce a more robust anti-tumor immunity than can CTL peptide vaccine alone, the FDG uptakes in WT1-vaccinated skin might reflect the degree of immune response. These results suggest that PET-CT might be a good tool for prediction of anti-tumor immune response induced by WT1 vaccine therapy. Larger scale prospective studies therefore seem to be warranted.
Clinical significance and influencing factors of fibrinogen in ANCA-associated vasculitis
Authors: Zhang Naidan , Sun Jiaxiang , Ji Chaixia , Zhou Yusha , Bao Xiao , Yuan Chengliang 
Published: September 2020

Abstract
Hypercoagulable is an important pathological state in anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). Fibrinogen (FIB) is the main protein in coagulation process. In this study, we aimed to investigate the clinical significance and influencing factors of FIB in AAV from Southwest China.
A retrospective study was performed on AAV patients from Peoples Hospital of Deyang City from January 2007 to December 2018. Demographic and clinical characteristics were collected.
A total of 463 AAV patients were included. In Wilcoxon rank sum test, FIB was significantly higher in AAV active group than inactive group (P = .005). FIB was also higher in bacterial infection group than in non-infection group both in active group (P = .008) and inactive group (P = .017). In receiver operating characteristic (ROC) curve analysis, the critical value of FIB for diagnosis of bacterial infection between AAV active and inactive groups was 3.385 g/L (P = .030), with sensitivity of 70.2% and specificity of 52.9%. In the multivariate analysis of variance (MANOVA), estimated glomerular filtration rate (eGFR) was shown to be an independent factor for FIB (P = .001). Least-significant difference showed the concentration of FIB (P < .05) increased with renal impairment, especially in endstage kidney disease (ESKD).
FIB identified a certain reference value in distinguishing AAV activity from bacterial infection. ESKD had a statistical effect on it. Influencing factors of FIB should be evaluated based on the renal function impairment of patients.
Risk of primary liver cancer associated with gallstones and cholecystectomy
Authors: Liu Tong , Siyin Sarah Tan , Yao Nan , Xu Guoshuai , Chen Yi-Tsun , Duan Ning , Li Wenqiang , Qu Jun , Liu Siqing 
Published: September 2020

Abstract
Previous research has revealed a positive relationship between GSD, cholecystectomy and primary liver cancer (PLC). However, previous studies had several limitations including the retrospective design, narrow assessment of potential confounders and lack of competing risk models in time-to-event analyses. We conducted a large prospective cohort study to explore the relationship between GSD, cholecystectomy and PLC. A total of 95,021 participants who had not been diagnosed with PLC previously were enrolled from the Kailuan Cohort study. Demographic characteristics and biochemical parameters were recorded at baseline for all participants. We used Cox regression models and competing risk regression models to evaluate the association of GSD and cholecystectomy with the risk PLC. A total of 306 incidental PLC cases were identified during a median follow-up of 9.05 (8.75–9.22) years per participant. Compared with the normal group, the multivariable HRs (95%CI) for the association of GSD and cholecystectomy with PLC were 1.77 (1.05–2.94), 5.25 (1.95–14.17). In the CS model, the multivariable HRs (95%CI) was 1.76 (1.05–2.94) for the association of GSD and cholecystectomy with PLC and 5.25 (1.95–14.17) for GSD and cholecystectomy. Similar results were also obtained in the SD model with corresponding multivariate HRs (95%CI) of 1.75 (1.01–3.00), 5.22 (1.90–14.07) in the GSD group and cholecystectomy group, respectively. GSD and cholecystectomy were associated with an elevated risk of PLC.
Registration number: ChiCTR–TNRC–11001489.
Higher hypertension prevalence, lower incidence, and aggressive treatment with decreasing mortality, cardiovascular, and cerebrovascular incidence in Taiwan from 2005 to 2010
Authors: Liao Chia-Te , Wu Pei-Chih , Shih Jung-Chang , Cheng Tain-Junn , Wu Wen-Shiann 
Published: September 2020

Abstract
Hypertension continues to be an important public health concern because of its associated morbidity, mortality, and economic impact on society. The aims of this study are to compare the secular changes in age-stratified hypertension prevalence, incidence, co-morbidity, and 3 years of cardiovascular outcome in Taiwan in the years 2005 and 2010.
We enrolled hypertensive individuals from the datasets of the Longitudinal Health Insurance Database (LHID) in 2005 and 2010 in Taiwan separately. We analyzed the hypertension prevalence, incidence, medication treatment, and associated morbidities. The risks of cardiovascular and cerebrovascular events and all-causes mortalities among the hypertensive individuals were evaluated in 3 years of follow-up.
There was an increased prevalence of hypertension but decreased incidence of hypertension in those over 65 from 2005 to 2010. Dyslipidemia was the highest rate of co-morbidity in 2005 and 2010. The most frequent categories of anti-hypertensive agents prescribed was 1 or 2 for both 2005 and 2010. Calcium channel blockers were the most common anti-hypertensive agents prescribed, followed by Angiotensin converting enzyme inhibitors/Angiotensin receptor blockers. After 3 years of follow-up, the risks of coronary artery disease (CAD), cerebrovascular diseases (CVD) as well as death were less in 2010 than in 2005 in Taiwan.
Our study showed that hypertension individuals had an increased prevalence, younger age, decreased incidence, increased medication treatment associated with decreased the CAD, CVD, and mortalities in 2010 compared to 2005 in Taiwan.
Efficacy and safety of Chinese herbal compound in the treatment of functional constipation
Authors: Ji Lijiang , Fan Yihua , Li Linhui , Bai Huiwen , Weng Liping , Zhao Ping 
Published: September 2020

Abstract

Background:
Functional constipation refers to constipation without organic lesions caused by dietary factors, mood depression, changes in life rules, and poor bowel habits. Clinically, constipation is mainly manifested by changes of stool texture, difficulty or lack of bowel movement, and dry stool. Sometimes, it can be accompanied by abdominal distension and abdominal discomfort. Chinese herbal compound is a prescription which is composed of 2 or more medicinal flavors and is designed for relatively certain diseases and syndromes. Clinical studies have shown that TCM compounds have a good therapeutic effect on functional constipation, but there is no evidence of evidence-based medicine. The purpose of this study is to systematically evaluate the efficacy and safety of TCM compounds in the treatment of functional constipation, and to provide evidence-based basis for the clinical application of TCM compounds in the treatment of constipation.

Methods:
A systematic search was performed on English database (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese database (CNKI, Wanfang, Weipu (VIP), CBM), in addition to the manual retrieval of Baidu and Google academic for randomized controlled trials (RCTs) on the treatment of functional constipation with Chinese herbal compound. The retrieval time limit was from the establishment of the database to August 2020. Two researchers independently screened the literature, extracted the data and evaluated the quality of the included studies. A meta-analysis was performed using RevMan5.3 software.

Results:
In this study, the efficacy and safety of TCM herbal compounds in the treatment of functional constipation were evaluated by the overall effective rate, recovery rate, colonic transmission function, and other indicators.

Conclusions:
This study will provide reliable evidence-based evidence for the clinical application of Chinese herbal compound in the treatment of functional constipation.

OSF Registration number:
DOI 10.17605/OSF.IO/D5ECF.
Imaging features of periostitis as a manifestation of IgA vasculitis
Authors: Noh Ji Hoon , Chung Bo Mi , Kim Wan Tae 
Published: September 2020

Abstract

Introduction:
Periostitis in systemic vasculitis is very rare with only a few previously reported cases. The reported cases were seen in polyarteritis nodosa or Takayasu arteritis. We report the first case of periostitis associated with IgA vasculitis with demonstration of computed tomography (CT), magnetic resonance imaging (MRI) features, and serial changes of radiographs.

Patient concerns:
A 74-year-old man visited an orthopedic outpatient clinic for pain in both lower legs and left ankle pain. He underwent a total ankle arthroplasty of the left ankle 3 years ago. His medical history disclosed IgA vasculitis/nephropathy caused by cephalosporin antibiotic class 5 months earlier. Plain radiography, MRI of the right lower leg, CT scan of the left ankle showed single lamellar to spiculated periosteal reactions at both tibia, fibula and left calcaneus. There was no evidence of bone or soft tissue mass lesions or cortical destruction.

Diagnosis:
We concluded that this was a case of periosteal reactions associated with IgA vasculitis for the following reasons: (1) periosteal biopsy was negative for tumor. (2) there was no pulmonary lesion on chest radiography and CT, no history of trauma, inflammatory arthritis, metabolic disease, or genetic disease that could cause periostitis at multiple bones, (3) the initial MRI showed predominant signal changes around the tibial and fibular shafts, possibly explaining subsequent periosteal reactions, and (4) symptoms subsided with conservative treatment and follow-up radiographs showed remodeling of periosteal reactions.

Interventions:
The patient took conservative management.

Outcomes:
His calf pain improved, and a radiograph 7 months later showed remodeling to the solid or single lamellar periosteal reaction along the both tibia and left fibula.

Conclusion:
Awareness of this uncommon manifestation would help differential diagnosis of periostitis and could help decrease the patient's anxiety. It should also be noted that periosteal reactions by benign entities could cause aggressive-looking periosteal reactions in post-operative regions.
Complementing Root Cause Analysis With Improvement Strategies to Optimize Venous Thromboembolism Prophylaxis in Patients With Epidural Catheters
Authors: Slade Justin J. , Wrzesniewski Carolyn E. , Hunter Oluwatobi O. , Allaudeen Nazima 
Published: September 2020

Background and Objectives:High reliability organizations in health care must identify defects and systematically approach causal factors with subsequent process redesign to achieve goals important to patients, families, and staff. Root cause analysis (RCA) is a commonly leveraged strategy for reviewing adverse events and can yield immense benefits toward patient safety when applied alongside complementary change management strategies such as Lean and Six Sigma. We performed an RCA in response to a hospital-acquired venous thromboembolism (VTE) event in a postoperative patient for which pharmacologic VTE prophylaxis was not appropriately resumed following removal of an epidural catheter.Methods:A multidisciplinary stakeholder team was assembled to further understand the details of the event. A current process map was created and non-value-added steps were identified. Causal analysis revealed that frequent staff turnover, variable methods of communication between stakeholders, inconsistent responsibilities with respect to ordering and administering pharmacologic VTE prophylaxis, and lack of an established standard work process were key contributors toward the defect of concern. Several countermeasures were introduced to combat these identified root causes, including shifting responsibility for managing VTE prophylaxis orders periepidural catheter removal from the surgical house staff to our regional anesthesia service, and creation of an epidural catheter heparin restart order set, which in one step places an order to resume prophylaxis following catheter removal at a specific time. Recommendations from this session were disseminated to staff through previously established huddles that are a component of our daily management system.Results:Postintervention, review of our updated process demonstrated a reduction in variability through establishment of standard work that is primarily owned by a constant factor in this care pathway (our regional anesthesia team). On review of the subsequent 10 cases of patients with epidural catheters, all patients receiving pharmacologic VTE prophylaxis had a maximum of 1 dose stopped for epidural catheter removal, therefore minimizing time without VTE prophylaxis.Conclusions:RCA can be utilized in the aftermath of an adverse event to establish causal factors and identify countermeasures to prevent recurrence of such an event. It can be further augmented with additional change management strategies including Lean, Six Sigma, the Model for Improvement, and failure modes and effects analysis. These strategies allowed us to design effective error-reducing strategies to achieve a more reliable process, which yielded reduced VTE prophylaxis administration defects that in turn has prevented recurrence of hospital-acquired VTE in patients with epidural catheters.
Risk factors for mortality among hospitalized patients with COVID-19
Authors: Incerti Devin , Rizzo Shemra , Li Xiao , Lindsay Lisa , Yau Vince , Keebler Dan , Chia Jenny , Tsai Larry 
Published: September 2020

AbstractObjectivesTo develop a prognostic model to identify and quantify risk factors for mortality among patients admitted to the hospital with COVID-19.DesignRetrospective cohort study. Patients were randomly assigned to either training (80%) or test (20%) sets. The training set was used to fit a multivariable logistic regression. Predictors were ranked using variable importance metrics. Models were assessed by C-indices, Brier scores, and calibration plots in the test set.SettingOptum® de-identified COVID-19 Electronic Health Record dataset.Participants17,086 patients hospitalized with COVID-19 between February 20, 2020 and June 5, 2020.Main outcome measureAll-cause mortality during hospital stay.ResultsThe full model that included information on demographics, comorbidities, laboratory results and vital signs had good discrimination (C-index = 0.87) and was well calibrated, with some overpredictions for the most at-risk patients. Results were generally similar on the training and test sets, suggesting that there was little overfitting.Age was the most important risk factor. The performance of models that included all demographics and comorbidities (C-index = 0.79) was only slightly better than a model that only included age (C-index = 0.76). Across the study period, predicted mortality was 1.2% for 18-year olds, 8.4% for 55-year olds, and 28.6% for 85-year olds. Predicted mortality across all ages declined over the study period from 21.7% by March to 13.3% by May.ConclusionAge was the most important predictor of all-cause mortality although vital signs and laboratory results added considerable prognostic information with oxygen saturation, temperature, respiratory rate, lactate dehydrogenase, and white blood cell count being among the most important predictors. Demographic and comorbidity factors did not improve model performance appreciably. The model had good discrimination and was reasonably well calibrated, suggesting that it may be useful for assessment of prognosis.
Instrumented individuals are not representative of the population. Survival of wolverines with and without GPS collars
Authors: Milleret Cyril , Bischof Richard , Dupont Pierre , Brøseth Henrik , Odden John , Mattisson Jenny 
Published: September 2020

AbstractResults from biologging studies are often scaled up to population-level inferences and this begs the question: Are instrumented animals representative of the population given the potential bias in individual selectivity, the influence of capture, handling and wearing bio-loggers? The answer is elusive due to the challenges of obtaining comparable data from individuals without bio-loggers. Using non-invasive genetic data of a large carnivore, the wolverine (Gulo gulo) in Scandinavia, and an open-population spatial capture-recapture model, we were able to estimate and compare survival rates of individuals fitted with GPS collars versus individuals that had never been captured and collared. We found that mortality of GPS collared individuals was 47% lower compared to individuals without GPS collars. While instrumented and non-instrumented wolverines had similar risks of dying from legal culling, GPS collared individuals displayed lower mortality rates due to causes other than legal culling. Reports of positive effects of biologging on the fitness of individuals are rather uncommon and we argue that the most likely explanation is that GPS-collars could shield animals from poaching. Our results highlight the challenges of drawing population level inferences for large carnivores when using data from an instrumented sample of the population.