bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time course of coronary flow capacity impairment in ST-segment elevation myocardial infarction
Authors: van Lavieren Martijn A , Stegehuis Valérie E , Bax Matthijs , Echavarría-Pinto Mauro , Wijntjens Gilbert W M , de Winter Robbert J , Koch Karel T , Henriques José P , Escaned Javier , Meuwissen Martijn , van de Hoef Tim P , Piek Jan J 
Published: May 2020

Abstract

Background
Microvascular dysfunction in the setting of ST-elevated myocardial infarction (STEMI) plays an important role in long-term poor clinical outcome. Coronary flow reserve (CFR) is a well-established physiological parameter to interrogate the coronary microcirculation. Together with hyperaemic average peak flow velocity, CFR constitutes the coronary flow capacity (CFC), a validated risk stratification tool in ischaemic heart disease with significant prognostic value. This mechanistic study aims to elucidate the time course of the microcirculation as reflected by alterations in microcirculatory physiological parameters in the acute phase and during follow-up in STEMI patients.

Methods
We assessed CFR and CFC in the culprit and non-culprit vessel in consecutive STEMI patients at baseline (n = 98) and after one-week (n = 64) and six-month follow-up (n = 65).

Results
A significant trend for culprit CFC in infarct size as determined by peak troponin T (p = 0.004), time to reperfusion (p = 0.038), the incidence of final Thrombolysis In Myocardial Infarction 3 flow (p = 0.019) and systolic retrograde flow (p = 0.043) was observed. Non-culprit CFC linear contrast analysis revealed a significant trend in C-reactive protein (p = 0.027), peak troponin T (p &lt; 0.001) and heart rate (p = 0.049). CFC improved both in the culprit and the non-culprit vessel at one-week (both p &lt; 0.001) and six-month follow-up (p = 0.0013 and p &lt; 0.001) compared with baseline.

Conclusion
This study demonstrates the importance of microcirculatory disturbances in the setting of STEMI, which is relevant for the interpretation of intracoronary diagnostic techniques which are influenced by both culprit and non-culprit vascular territories. Assessment of non-culprit vessel CFC in the setting of STEMI might improve risk stratification of these patients following coronary reperfusion of the culprit vessel.
Integrating clinical features with genetic factors enhances survival prediction for adults with acute myeloid leukemia
Authors: Silveira Douglas R. A. , Quek Lynn , Santos Itamar S. , Corby Anna , Coelho-Silva Juan L. , Pereira-Martins Diego A. , Vallance Grant , Brown Benjamin , Nardinelli Luciana , Silva Wellington F. , Velloso Elvira D. R. P. , Lucena-Araujo Antonio R. , Traina Fabiola , Peniket Andy , Vyas Paresh , Rego Eduardo M. , Bendit Israel , Rocha Vanderson 
Published: May 2020

Abstract
The 2017 European LeukemiaNet 2017 acute myeloid leukemia (AML) risk stratification (ELN2017) is widely used for risk-stratifying patients with AML. However, its applicability in low- and middle-income countries is limited because of a lack of full cytogenetic and molecular information at diagnosis. Here, we propose an alternative for risk stratification (the Adapted Genetic Risk [AGR]), which permits cytogenetic or molecular missing data while retaining prognostic power. We first analyzed 167 intensively treated patients with nonacute promyelocytic leukemia AML enrolled in São Paulo, Brazil (Faculdade de Medicina da Universidade de São Paulo), as our training data set, using ELN2017 as the standard for comparison with our AGR. Next, we combined our AGR with clinical prognostic parameters found in a Cox proportional hazards model to create a novel scoring system (survival AML score, SAMLS) that stratifies patients with newly diagnosed AML. Finally, we have used 2 independent test cohorts, Faculdade de Medicina de Ribeirão Preto (FMRP; Brazil, n = 145) and Oxford University Hospitals (OUH; United Kingdom, n = 157) for validating our findings. AGR was statistically significant for overall survival (OS) in both test cohorts (FMRP, P = .037; OUH, P = .012) and disease-free survival in FMRP (P = .04). The clinical prognostic features in SAMLS were age (&gt;45 years), white blood cell count (&lt;1.5 or &gt;30.0 × 103/μL), and low albumin levels (&lt;3.8 g/dL), which were associated with worse OS in all 3 cohorts. SAMLS showed a significant difference in OS in the training cohort (P &lt; .001) and test cohorts (FMRP, P = .0018; OUH, P &lt; .001). Therefore, SAMLS, which incorporates the novel AGR evaluation with clinical parameters, is an accurate tool for AML risk assessment.
Efficacy and safety of anti-CD19 CAR T-cell therapy in 110 patients with B-cell acute lymphoblastic leukemia with high-risk features
Authors: Zhang Xian , Lu Xin-an , Yang Junfang , Zhang Gailing , Li Jingjing , Song Lisong , Su Yunchao , Shi Yanze , Zhang Min , He Jiujiang , Song Dan , Lv Fanyong , Li Wenqian , Wu Yan , Wang Hui , Liu Hongxing , Zhou Xiaosu , He Ting , Lu Peihua 
Published: May 2020

Abstract
Anti-CD19 chimeric antigen receptor (CAR) T-cell therapy is effective in patients with advanced B-cell acute lymphoblastic leukemia (B-ALL). However, efficacy data is sparse in subgroups of patients with high-risk features such as BCR-ABL+, TP53 mutation, extramedullary disease (including central nervous system leukemia) or posttransplant relapse. It is also uncertain whether there is an added benefit of transplantation after anti-CD19 CAR T-cell therapy. We conducted a phase 1/2 study of 115 enrolled patients with CD19+ B-ALL. A total of 110 patients were successfully infused with anti-CD19 CAR T cells. In all, 93% of patients achieved a morphologic complete remission, and 87% became negative for minimal residual disease. Efficacy was seen across all subgroups. One-year leukemia-free survival (LFS) was 58%, and 1-year overall survival (OS) was 64% for the 110 patients. Seventy-five nonrandomly selected patients (73.5%) subsequently received an allogeneic hematopoietic stem cell transplant (allo-HSCT). LFS (76.9% vs 11.6%; P &lt; .0001; 95% confidence interval [CI], 11.6-108.4) and OS (79.1% vs 32.0%; P &lt; .0001; 95% CI, 0.02-0.22) were significantly better among patients who subsequently received allo-HSCT compared with those receiving CAR T-cell therapy alone. This was confirmed in multivariable analyses (hazard ratio, 16.546; 95% CI, 5.499-49.786). Another variate that correlated with worse outcomes was TP53 mutation (hazard ratio, 0.235; 95% CI, 0.089-0.619). There were no differences in complete remission rate, OS, or LFS between groups of patients age 2 to 14 years or age older than 14 years. Most patients had only mild cytokine release syndrome and neurotoxicity. Our data indicate that anti-CD19 CAR T-cell therapy is safe and effective in all B-ALL subgroups that have high-risk features. The benefit of a subsequent allo-HSCT requires confirmation because of nonrandom allocation. This trial was registered at www.clinicaltrials.gov as #NCT03173417.
Tissue mast cell counts may be associated with decreased severity of gastrointestinal acute GVHD and nonrelapse mortality
Authors: Ustun Celalettin , DeFor Todd E. , Karadag Fatma K. , Don Yun Hyun , Nathan Sunita , Brunstein Claudio G. , Blazar Bruce R. , Weisdorf Daniel J. , Holtan Shernan G. , Amin Khalid 
Published: May 2020

Abstract
The functions of mast cells in human graft-versus-host disease (GVHD) are unknown. We studied 56 patients who had an allogeneic hematopoietic cell transplantation (alloHCT) with a biopsy for diagnosis of gastrointestinal tract (GIT) GVHD before any treatment (including steroids): 35 with GIT GVHD, 21 HCT recipients whose biopsies did not confirm GVHD, and 9 with a new diagnosis of inflammatory bowel disease (IBD) as a comparison. The median number of mast cells (mean of CD117+ cells, counted in 3 selected spots under 40× magnification) was similar between patients with GVHD (59 cells) and those without GVHD (60 cells). However, the median number of mast cells was significantly associated with maximum clinical stage of GIT GVHD; the lowest counts of mast cells were observed in the highest clinical stage of GIT GVHD (stage 1, 80; stage 2, 69; stage 3, 54; stage 4, 26; P = .01). Moreover, every decrease by 10 mast cells was associated with increased nonrelapse mortality through 1 year (hazard ratio, 0.77; 95% confidence interval, 0.59-1.00; P = .05). AlloHCT recipients all had significantly fewer mast cells, even those without GVHD compared with those with IBD (median, 59 vs 119; P &lt; .01). The median number of GIT mast cells was also significantly lower in patients who received myeloablative conditioning (61.5 cells) than in those who received reduced intensity conditioning (78 cells) in the entire study population (P = .02). We conclude that GIT mast cells are depleted in all alloHCT patients, more prominently in those receiving myeloablative conditioning and those with severe GIT GVHD. Our novel findings warrant further investigation into the biological effects of mast cells in GIT GVHD.
High metabolic heterogeneity on baseline 18FDG-PET/CT scan as a poor prognostic factor for newly diagnosed diffuse large B-cell lymphoma
Authors: Senjo Hajime , Hirata Kenji , Izumiyama Koh , Minauchi Koichiro , Tsukamoto Eriko , Itoh Kazuo , Kanaya Minoru , Mori Akio , Ota Shuichi , Hashimoto Daigo , Teshima Takanori ,   North Japan Hematology Study Group
Published: May 2020

Abstract
Metabolic heterogeneity (MH) can be measured using 18F-fluorodeoxyglucose (18FDG) positron emission tomography/computed tomography (PET/CT), and it indicates an inhomogeneous tumor microenvironment. High MH has been shown to predict a worse prognosis for primary mediastinal B-cell lymphoma, whereas its prognostic value in diffuse large B-cell lymphoma (DLBCL) remains to be determined. In the current study, we investigated the prognostic values of MH evaluated in newly diagnosed DLBCL. In the training cohort, 86 patients treated with cyclophosphamide, doxorubicin, vincristine, and prednisone–like chemotherapies were divided into low-MH and high-MH groups using receiver operating characteristic analysis. MH was not correlated with metabolic tumor volume of the corresponding lesion, indicating that MH was independent of tumor burden. At 5 years, overall survivals were 89.5% vs 61.2% (P = .0122) and event-free survivals were 73.1% vs 51.1% (P = .0327) in the low- and high-MH groups, respectively. A multivariate Cox-regression analysis showed that MH was an independent predictive factor for overall survival. The adverse prognostic impacts of high MH were confirmed in an independent validation cohort with 64 patients. In conclusion, MH on baseline 18FDG-PET/CT scan predicts treatment outcomes for patients with newly diagnosed DLBCL.
Acute exacerbation of idiopathic interstitial pneumonias related to chemotherapy for lung cancer: nationwide surveillance in Japan
Authors: Minegishi Yuji , Gemma Akihiko , Homma Sakae , Kishi Kazuma , Azuma Arata , Ogura Takashi , Hamada Naoki , Taniguchi Hiroyuki , Hattori Noboru , Nishioka Yasuhiko , Tanizawa Kiminobu , Johkoh Takeshi , Yokoyama Takuma , Mori Kazutaka , Taguchi Yoshio , Ebina Masahito , Inase Naohiko , Hagiwara Koichi , Ohnishi Hiroshi , Mukae Hiroshi , Inoue Yoshikazu , Kuwano Kazuyoshi , Chiba Hirofumi , Ohta Ken , Tanino Yoshinori , Sakai Fumikazu , Sugiyama Yukihiko 
Published: May 2020

BackgroundChemotherapy-induced acute exacerbation (AEx) of idiopathic interstitial pneumonias (IIPs) seriously compromises the success of treatment of Japanese lung cancer patients. Here, we conducted a nationwide surveillance to clarify the risk of AEx and compare it with the survival benefit of chemotherapy for this population.MethodsAdvanced nonsmall cell lung cancer (NSCLC) or small cell lung cancer (SCLC) patients with IIPs were retrospectively analysed. For the surveillance of first-line chemotherapy in 2009, we gathered clinical data from 396 patients who received chemotherapy at 19 institutions between January 1990 and July 2009. In a consecutive retrospective study in 2012, we analysed data from 278 patients from 17 institutions who received second-line chemotherapy between April 2002 and March 2012.ResultsOf the 396 patients analysed, 13.1% developed chemotherapy-related AEx. Combination chemotherapies of carboplatin plus paclitaxel (CP) or carboplatin plus etoposide (CE) were frequently used as first-line treatments. The lowest incidence of AEx was 3.7% in CE, followed by 8.6% in CP. In the retrospective study, 16.2% of the 278 patients developed a second-line chemotherapy-related AEx. The overall response rate by second-line chemotherapy was 7.4% in NSCLC and 25.7% in SCLC. The median overall survival from second-line and first-line chemotherapy was 8.0 and 14.3 months in NSCLC, and 8.7 and 16.0 months in SCLC, respectively.ConclusionCombination chemotherapies consisting of CP or CE are candidates for standard first-line treatments for patients with advanced lung cancer accompanied by IIP. Second-line chemotherapy should be considered for patients remaining fit enough to receive it.
Repeat assessment of examination signs among children in Malawi with fast-breathing pneumonia
Authors: Lenahan Jennifer L. , Nkwopara Evangelyn , Phiri Melda , Mvalo Tisungane , Couasnon Mari T. , Turner Kali , Ndamala Chifundo , McCollum Eric D. , May Susanne , Ginsburg Amy Sarah 
Published: May 2020

BackgroundAs part of a randomised controlled trial of treatment with placeboversus3 days of amoxicillin for nonsevere fast-breathing pneumonia among Malawian children aged 2–59 months, a subset of children was hospitalised for observation. We sought to characterise the progression of fast-breathing pneumonia among children undergoing repeat assessments to better understand which children do and do not deteriorate.MethodsVital signs and physical examination findings, including respiratory rate, arterial oxygen saturation measured by pulse oximetry (SpO2), chest indrawing and temperature were assessed every 3 h for the duration of hospitalisation. Children were assessed for treatment failure during study visits on days 1, 2, 3 and 4.ResultsHospital monitoring data from 436 children were included. While no children hadSpO290–93% at baseline, 7.4% (16 of 215) of children receiving amoxicillin and 9.5% (21 of 221) receiving placebo developedSpO290–93% during monitoring. Similarly, no children had chest indrawing at enrolment, but 6.6% (14 of 215) in the amoxicillin group and 7.2% (16 of 221) in the placebo group went on to develop chest indrawing during hospitalisation.ConclusionRepeat monitoring of children with fast-breathing pneumonia identified vital and physical examination signs not present at baseline, includingSpO290–93% and chest indrawing. This information may support providers and policymakers in developing guidance for care of children with nonsevere pneumonia.
Variation of performance, of self-reported alertness and effort as a function of low doses of alcohol and of driving experience
Authors: Berthelon Catherine , Galy Edith 
Published: May 2020

AbstractPurposeAlcohol is the most frequent detected substance in the automobile fatal crashes but its precise mode of action on mental state is not always clear, notably when combined with lack of driving experience. The aim of this work is thus to evaluate performance and self-reported alertness and effort as a function of low doses of Blood Alcohol Concentration (BAC) and of drivers’ experience.MethodsA single blind counterbalanced experiment was conducted on a driving simulator. Fifteen young novice drivers (18 years old, less of 2 months of driving licence) and fifteen young experienced drivers (21 years old, 3 years of driving licence) were tested with 0.0 g/l, 0.2 g/l and 0.5 g/l of alcohol at early afternoon. Driving scenarios was road tracking during 45 min at a constant speed of 110 km/h while maintaining a steady trajectory. Participants responded to the Thayer’s scale before and after each driving session, and to an adaptation of the NASA-TLX after each driving session. Statistical analyses were performed on driving parameters, self-reported alertness and effort as a function of alcohol level and driving experience.ResultsAlcohol deteriorated lateral and longitudinal stability of the trajectories. Notably with BAC 0.5 g/l, effort and speed increased but the increase in speed was particularly high for young experienced drivers. When young novice drivers felt that they were low alert, they also felt that they exerted more effort, their performance decreased, but they reduced their speed.ConclusionsAlcohol thus degrades driving performance, and especially when the effort is high and alertness is low. The decrease of inhibitory process noted in presence of alcohol seems thus higher for young experienced than for young novice drivers. Results are in line with a drop in the blood alcohol level tolerated while driving.
Effectiveness of a therapeutic multiple-lifestyle intervention taking into account the periconceptional environment in the management of infertile couples: study design of a randomized controlled trial – the PEPCI study
Authors: Dupont Charlotte , Aegerter Philippe , Foucaut Aude-Marie , Reyre Aymeric , Lhuissier François J. , Bourgain Marie , Chabbert-Buffet Nathalie , Cédrin-Durnerin Isabelle , Selleret Lise , Cosson Emmanuel , Lévy Rachel 
Published: May 2020

Abstract
Background
Infertility is defined as the inability to conceive after 12 months of unprotected intercourse. It affects approximately one in six couples seeking pregnancy in France or western countries. Many lifestyle factors of the couples’ pre and peri-conceptional environment (weight, diet, alcohol, tobacco, coffee, drugs, physical activity, stress, sleep…) have been identified as risk factors for infertility in both males and females. The high prevalence rates of unhealthy diets and lifestyles in the reproductive population of industrialized countries are worrisome. Nevertheless, adoption of a healthy lifestyle may improve fertility but lifestyle changes are difficult to achieve and to maintain due notably to behavioral factors.

Methods
Consequently, we decided to propose an interventional study aimed at improving the quality of life of infertile couples before the start of assisted reproductive technology treatment. It is a randomized controlled multicentre trial. Both members of the couples are involved in an integrated global care program (PEPCI for “Parcours Environnement PériConceptionnel en Infertilité”) vs. usual care. This global intervention not only considers diet and/or physical activity but follows a holistic approach, including a multidisciplinary assessment to address complete physical, psychological and social well-being. According to patient needs, this includes interventions on weight, exercise, diet, alcohol and drugs, mental and social health.

Discussion
The main objective of trial is to demonstrate that periconceptional multidisciplinary care has a positive impact on reproductive functions. We will also focus on feasibility, acceptance, compliance and conditions of success of a multifaceted lifestyle intervention.

Trial registration
The trial was registered at ClinicalTrials.gov, Identifier: NCT02961907 on November 11, 2016.
Elderly women’s experiences of self-sampling for HPV testing
Authors: Hermansson Ruth S. , Olovsson Matts , Gustavsson Catharina , Lindström Annika Kristina 
Published: May 2020

Abstract
Background
Self-sampling for HPV testing, as an alternative to the conventional speculum based sampling, is highly acceptable to women of screening ages. The aim of this study was to describe older women’s (60 to 75 years) experiences of self-sampling.

Methods
In Sweden a descriptive study with quantitative and qualitative methods was designed to collect data from a survey of women who participated in self-sampling for HPV testing. Individual interviews were done with women who tested positive in the first self-sampling, and were either negative in their second HPV test or were positive in their second HPV test, but without precancerous lesions or cancer.

Results
Of 893 eligible women, 868 (97.2%) answered the survey. Among the surveyed women, 49.2% reported it was very easy to perform self-sampling, 46.8% answered it was easy and 2.0% answered it was not easy. A majority (58.9%) answered that they prefer self-sampling, 16.5% that they prefer sample collection by a healthcare provider, 23.7% did not have any preference and 0.9% did not answer the question. In the interviews, 13 of 16 invited women participated. Most of them reported that they prefer self-sampling because it was easy to perform, less embarrassing and less time consuming than a visit to a clinic. The majority of women reported that they were not worried when informed about having an HPV positive test. Overall, participating women with better knowledge about the significance of an HPV infection were more worried about having a positive HPV test.

Conclusion
Cervical cancer remains a highly preventable disease through screening and early treatment. Our results indicated that vaginal self-sampling for HPV testing was a well-accepted method for cervical cancer prevention in this group of older women.

Trial registration
https://www.researchweb.org/is/en/fouckfuu/project/272587. Registered 24 June 2019-retrospectively registered. www.researchweb.org
Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross-sectional study
Authors: Ghimire Umesh , Aryal Binod Kumar , Gupta Ankush Kumar , Sapkota Suman 
Published: May 2020

Abstract
Background
Despite consistent efforts to enhance child nutrition, poor nutritional status of children continues to be a major public health problem in Nepal. This study identified the predictors of severe acute malnutrition (SAM) among children aged 6 to 59 months in the two districts of Nepal.

Methods
We used data from a cross-sectional study conducted among 6 to 59 months children admitted to the Outpatient Therapeutic Care Centers (OTCC). The nutritional status of children was assessed using mid-upper arm circumference (MUAC) measurement. To determine which variables predict the occurrence of SAM, adjusted odds ratio was computed using multivariate logistic regression and p-value < 0.05 was considered as significant.

Results
Out of 398 children, 5.8% were severely malnourished and the higher percentage of female children were malnourished. Multivariate analysis showed that severe acute malnutrition was significantly associated with family size (five or more members) (Adjusted Odds Ratio [AOR]: 3.96; 95% Confidence Interval [CI]: 1.23–12.71). Children from severely food insecure households (AOR: 4.04; 95% CI: 1.88–10.53) were four times more likely to be severely malnourished. Higher odds of SAM were found among younger age-group (AOR: 12.10; 95% CI: 2.06–71.09) children (0–12 vs. 24–59 months).

Conclusions
The findings of this study indicated that household size, household food access, and the child’s age were the major predictors of severe acute malnutrition. Engaging poor families in kitchen gardening to ensure household food access and nutritious diet to the children, along with health education and promotion to the mothers of young children are therefore recommended to reduce child undernutrition.