bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics of the nonpulmonary vein foci induced after second‐generation cryoballoon ablation for paroxysmal atrial fibrillation
Authors: Kato Nobutaka , Nitta Junichi , Sato Akira , Inamura Yukihiro , Takamiya Tomomasa , Inaba Osamu , Negi Ken , Takahashi Yoshihide , Goya Masahiko , Sasano Tetuo 
Published: December 2019

AbstractIntroductionPulmonary vein isolation (PVI) using cryoballoon is effective for patients with paroxysmal atrial fibrillation (PAF); however, few reports have evaluated the non‐pulmonary vein (PV) foci after cryoballoon ablation. We aimed to evaluate the characteristics of non‐PV foci and predictors of atrial fibrillation (AF) recurrence after cryoballoon ablation.Methods and ResultsThis was a single‐center retrospective study of 647 patients with PAF who underwent initial PVI using a second‐generation cryoballoon. After PVI, all patients underwent high‐dose isoproterenol infusion to assess the existence of non‐PV foci. Non‐PV foci were observed in 211 patients (32.6%), which were most frequently observed in the superior vena cava. Higher age (odds ratio [OR] = 1.02; 95% confidence interval [CI] = 1.00‐1.04; P = .025), female sex (OR = 1.65; 95% CI = 1.13‐2.41; P = .009), and lower body mass index (OR = 0.95; 95% CI = 0.89‐1.00; P = .049) were significantly associated with non‐PV foci. The existence of non‐PV foci was an independent predictor of AF recurrence (Hazard's ratio = 1.70; 95% CI = 1.12‐2.60; P = .014). When non‐PV foci were mappable and successfully ablated, patients with non‐PV foci showed similar outcomes with those without non‐PV foci (1‐year AF‐free survival rates of 88.5% vs 91.5%; P = .338). Conversely, when we failed to detect and eliminate non‐PV foci because they had multiple origins and were not consistently inducible (multichanging non‐PV foci), the 1‐year AF‐free survival rate was 56.4% even after substrate modification.ConclusionNon‐PV foci were observed in one‐third of patients with PAF after cryoballoon ablation and were associated with AF recurrence. Catheter ablation for non‐PV foci was effective when they were mappable; however, multichanging non‐PV foci were associated with worse prognosis.
Krüppel‐like factor 4 regulates stemness and mesenchymal properties of colorectal cancer stem cells through the TGF‐β1/Smad/snail pathway
Authors: Leng Zhengwei , Li Yong , Zhou Guojun , Lv Xiaojiang , Ai Walden , Li Jianshui , Hou Lingmi 
Published: December 2019

AbstractKrüppel‐like factor 4 (KLF4) was closely associated with epithelial‐mesenchymal transition and stemness in colorectal cancer stem cells (CSCs)‐enriched spheroid cells. Nonetheless, the underlying molecular mechanism is unclear. This study showed that KLF4 overexpression was accompanied with stemness and mesenchymal features in Lgr5+CD44+EpCAM+ colorectal CSCs. KLF4 knockdown suppressed stemness, mesenchymal features and activation of the TGF‐β1 pathway, whereas enforced KLF4 overexpression activated TGF‐β1, phosphorylation of Smad 2/3 and Snail expression, and restored stemness and mesenchymal phenotypes. Furthermore, TGF‐β1 pathway inhibition invalidated KLF4‐facilitated stemness and mesenchymal features without affecting KLF4 expression. The data from the current study are the first to demonstrate that KLF4 maintains stemness and mesenchymal properties through the TGF‐β1/Smad/Snail pathway in Lgr5+CD44+EpCAM+ colorectal CSCs.
Formulation and evaluation of the topical ethosomal gel of melatonin to prevent UV radiation
Authors: Shukla Richa , Tiwari Gaurav , Tiwari Ruchi , Rai Awani K. 
Published: December 2019

AbstractBackgroundClinically, melatonin (MLT) has variable oral absorption and extensive first‐pass effect, making its oral mode less preferable. Ethosomes are able to permeate intact through the human skin due to its high deformability.AimPresent study assessed topical potential of ethosomes loaded with MLT for the prevention of UV radiation.MethodsMelatonin was encapsulated using different ratios of ethanol, soya lecithin, and cholesterol. Prepared ethosomes were characterized for scanning electron microscopy (SEM), zeta potential, % entrapment efficiency (%EE), in vitro drug release kinetics. Then, optimized formulation was incorporated in gel and evaluated for viscosity, pH, extrudability, homogeneity, skin irritation study, spreadability, in vitro skin permeation study, flux, and stability.ResultsEthosomes were spherical in structure as confirmed by SEM, and zeta potential was in range of −12.4 mV to −27.4 mV. %EE of the vesicles was in the range of 49.61%‐78.047%. Cumulative percentage drug release from various ethosomal formulations was ranged from 64.82%‐81.01%. F3 was selected as optimized formulation on the basis of highest %EE, zeta potential, and in vitro drug release. An ethosomal gel of optimized formulation F3 was prepared by using carbopol 934 and compared with plain gel formulation. G3 formulation showed pseudoplastic rheological behavior, optimum pH, spreadability and also showed maximum % in vitro drug permeation with flux 13.85 μg/cm2/hr and followed zero‐order release kinetics which was good for topical drug delivery system.ConclusionThis research suggested that MLT loaded ethosomes can be potentially used as a topically drug delivery system.
Higher expression levels of aquaporin (AQP)1 and AQP5 in the lungs of arid‐desert living Lepus yarkandensis
Authors: Zhang Jianping , Li Shuwei , Liu Jie , Li Lexing , Deng Fang , Baikeli Buheliqihan , Li Linrui , Ma Xuanye , Liu Guoquan 
Published: December 2019

AbstractWater transport across epithelial cells that line the airways and alveoli is a crucial component of lung physiology. Aquaporins (AQPs) facilitate water transport across the air space–capillary barrier in the distal lung. However, the roles of lung AQPs in desert animal adaptation to dry airstream environments are still unclear. A hare (Lepus yarkandensis) only lives in the Tarim Basin, and its living environment is an arid climate with rare precipitation. We studied cellular localization and expression levels of AQP1, AQP3, AQP4 and AQP5 in L. yarkandensis lungs by immunohistochemistry, quantitative real‐time polymerase chain reaction and Western blot. The lung of rabbits (Oryctolagus cuniculus) that inhabit in mesic environment was similarly studied. Obtained results in two species of animals were compared to investigate whether AQPs in the lung altered expression in the animal living in arid region. AQP1 was localized to the endothelial cells in capillaries and venules surrounding terminal bronchioles and alveoli. AQP5 was localized to the ciliated columnar cells in terminal bronchioles and the alveolar type I cells in the alveolus. Quantitative real‐time PCR analysis showed higher AQP1 and AQP5 mRNA levels in L. yarkandensis compared to O. cuniculus. Similar results were obtained by Western blot. These results revealed that the higher expression levels of AQP1 and AQP5 played a significant role in water transport in the lungs of arid‐desert living L. yarkandensis and might accelerate water transport from capillary compartments to the airspace.
The impact of driver sleepiness on fixation‐related brain potentials
Authors: Ahlström Christer , Solis‐Marcos Ignacio , Nilsson Emma , Åkerstedt Torbjörn 
Published: December 2019

AbstractThe effects of driver sleepiness are often quantified as deteriorated driving performance, increased blink durations and high levels of subjective sleepiness. Driver sleepiness has also been associated with increasing levels of electroencephalogram (EEG) power, especially in the alpha range. The present exploratory study investigated a new measure of driver sleepiness, the EEG fixation‐related lambda response. Thirty young male drivers (23.6 ± 1.7 years old) participated in a driving simulator experiment in which they drove on rural and suburban roads in simulated daylight versus darkness during both the daytime (full sleep) and night‐time (sleep deprived). The results show lower lambda responses during night driving and with longer time on task, indicating that sleep deprivation and time on task cause a general decrement in cortical responsiveness to incoming visual stimuli. Levels of subjective sleepiness and line crossings were higher under the same conditions. Furthermore, results of a linear mixed‐effects model showed that low lambda responses are associated with high subjective sleepiness and more line crossings. We suggest that the fixation‐related lambda response can be used to investigate driving impairment induced by sleep deprivation while driving and that, after further refinement, it may be useful as an objective measure of driver sleepiness.
Assessment of fasted and fed gastrointestinal contraction frequencies in healthy subjects using continuously tagged MRI
Authors: de Jonge Catharina S. , Sprengers André M. J. , van Rijn Kyra L. , Nederveen Aart J. , Stoker Jaap 
Published: December 2019

AbstractBackgroundContinuously tagged MRI during free breathing can assess bowel motility at frequencies as low as the slow wave, motility pattern range. This study aimed to evaluate noninvasive gastrointestinal‐tagged MRI for small bowel motility assessment and to observe the physiological response to a 300‐kcal meal challenge in healthy, overnight‐fasted volunteers.MethodsAfter overnight fasting, 16 healthy subjects (7 women, mean age 25.5, range 19‐37 years) underwent a free breathing, tagged MRI scan to capture small bowel motility. Each subject underwent a (a) baseline motility scan, (b) food challenge, (c) postchallenge scan, and (d) second postchallenge scan (after 20 minutes). Motility was quantified using a frequency analysis technique for measuring the spectral power of the strain, referred to as motility score. Motility score was assessed in 20 frequency intervals between 1 and 20 contractions per minute (cpm), and the data were analyzed with linear mixed‐effect models.Key ResultThe stimulation protocol demonstrated an immediate, food‐induced, motility response in the low‐frequency range (2‐10 cpm), which is consistent with the stomach and small bowel frequency range (3‐12 cpm).Conclusions and InferencesThis study shows that this MRI tagging technique is able to quantify the fasted‐to‐fed response to a 300‐kcal meal challenge within the specific small bowel motility frequency range in healthy subjects. The food provocation MRI protocol provides a tool to explore the gut's response to a stimulus in specific motility frequency ranges in patients with gastrointestinal dysmotility and functional disorders.
Description and function of a difficult airway service
Authors: Murray David J. , Massy‐Westropp Collette , Narayana‐Reddy Kavya , Marsh Jennifer 
Published: December 2019

AbstractThe goal of the Pediatric Difficult Airway Service (DAS) is to improve the care of children with airway abnormalities primarily through identification of children at risk for failed airway management. The airway service encourages early recognition and provides consultation, a plan for airway management, expertise in airway management, and follow‐up care for children who have a difficult airway. The service has improved the education of healthcare professionals and heightened awareness about the consequences of failed airway management.
Transcriptome and binding data indicate that citral inhibits single strand DNA‐binding proteins
Authors: Graña Elisa , Díaz‐Tielas Carla , Sánchez‐Moreiras Adela M. , Reigosa Manuel J. , Celeiro María , Abagyan Ruben , Teijeira Marta , Duke Mary V. , Clerk Tracy , Pan Zhiqiang , Duke Stephen O. 
Published: December 2019

The mechanism of phytotoxicity of citral was probed in Arabidopsis thaliana using RNA‐Seq and in silico binding analyses. Inhibition of growth by 50% by citral downregulated transcription of 9156 and 5541 genes in roots and shoots, respectively, after 1 h. Only 56 and 62 genes in roots and shoots, respectively, were upregulated. In the shoots, the downregulation increased at 3 h (6239 genes downregulated, vs 66 upregulated). Of all genes affected in roots at 1 h (time of greatest effect), 7.69% of affected genes were for nucleic acid binding functions. Genes for single strand DNA binding proteins (SSBP) WHY1, WHY 2 and WHY3 were strongly downregulated in the shoot up until 12 h after citral exposure. Effects were strong in the root at just 1 h after the treatment and then at 12 and 24 h. Similar effects occurred with the transcription factors MYC‐2, ANAC and SCR‐SHR, which were also significantly downregulated for the first hour of treatment, and downregulation occurred again after 12 and 24 h treatment. Downregulation of ANAC in the first hour of treatment was significantly (P < 0.0001) decreased more than eight times compared to the control. In silico molecular docking analysis suggests binding of citral isomers to the SSBPs WHY1, WHY2, and WHY3, as well as with other transcription factors such as MYC‐2, ANAC and SCR‐SHR. Such effects could account for the profound and unusual effects of citral on downregulation of gene transcription.
Fibromyalgia impact and depressive symptoms: Can perceiving a silver lining make a difference?
Authors: Hirsch Jameson K. , Treaster Morgan K. , Kaniuka Andrea R. , Brooks Byron D. , Sirois Fuschia M. , Kohls Niko , Nöfer Eberhard , Toussaint Loren L. , Offenbächer Martin 
Published: December 2019

Individuals with fibromyalgia are at greater risk for depressive symptoms than the general population, and this may be partially attributable to physical symptoms that impair day‐to‐day functioning. However, individual‐level protective characteristics may buffer risk for psychopathology. For instance, the ability to perceive a “silver lining” in one’s illness may be related to better mental and physical health. We examined perceived silver lining as a potential moderator of the relation between fibromyalgia impact and depressive symptoms. Our sample of persons with fibromyalgia (N = 401) completed self‐report measures including the Fibromyalgia Impact Questionnaire‐Revised, Depression Anxiety Stress Scales, and the Silver Lining Questionnaire. Moderation analyses covaried age, sex, and ethnicity. Supporting hypotheses, increasing impact of disease was related to greater depressive symptoms, and perceptions of a silver lining attenuated that association. Despite the linkage between impairment and depressive symptoms, identifying positive aspects or outcomes of illness may reduce risk for psychopathology. Therapeutically promoting perception of a silver lining, perhaps via signature strengths exercises or a blessings journal, and encouraging cognitive reframing of the illness experience, perhaps via Motivational Interviewing or Cognitive Behavioral Therapy, may reduce depressive symptoms in persons with fibromyalgia.
After coming out: Parental acceptance of young lesbian and gay people
Authors: Ghosh Apoorva 
Published: December 2019

AbstractThis study examines extant scholarly knowledge on parental acceptance of young lesbian and gay people in traditional heteronormative families. Recent literature shows that parents generally accept their lesbian and gay children. However, parents do not always accept them immediately after they come out. Acceptance takes time, and transitioning to acceptance is often a complex process that depends on parents' access to the necessary resources for coping with the stresses of knowing that their child identifies as lesbian or gay. These resources include counseling or therapy, supportive friends and extended family, and a network of other parents with lesbian and gay children. This study also highlights the need for further research on parental acceptance in nontraditional families and of children with other nonheterosexual identities, such as asexuality, gray ace, bisexuality, or pansexuality. It also calls for an exploration of the complexities of parental acceptance as an ongoing process rather than as a singular event.
Understanding and taking stock of positive emotion disturbance
Authors: Gruber June , Villanueva Cynthia , Burr Emily , Purcell John R. , Karoly Hollis 
Published: December 2019

AbstractThe prevailing view on positive emotions is that they correlate with and confer psychological health benefits for the individual, including improved social, physical and cognitive functioning. Yet an emerging wave of scientific work suggests that positive emotions are also related to a range of suboptimal psychological health outcomes, especially when the intensity, duration, or context do not optimize the individual's goals or meet current environmental demands. This paper provides an overview of the “other side” of positive emotion, by describing and reviewing evidence supporting the emerging field of positive emotion disturbance (PED). We review relevant emotion processes and key themes of PED and apply this framework to example emotional disorders, and discuss implications for psychological change and future research agendas.
Variation in competent and respectful delivery care in Kenya and Malawi: a retrospective analysis of national facility surveys
Authors: Arsenault Catherine , English Mike , Gathara David , Malata Address , Mandala Wilson , Kruk Margaret E. 
Published: December 2019

AbstractObjectiveAlthough substantial progress has been made in increasing access to care during childbirth, reductions in maternal and neonatal mortality have been slower. Poor‐quality care may be to blame. In this study, we measure the quality of labour and delivery services in Kenya and Malawi using data from observations of deliveries and explore factors associated with levels of competent and respectful care.MethodsWe used data from nationally representative health facility assessment surveys. A total of 1100 deliveries in 392 facilities across Kenya and Malawi were observed and quality was assessed using two indices: the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) index and a previously validated index of respectful maternity care. Data from standardised observations of care were analysed using descriptive statistics and multivariable random‐intercept regression models to examine factors associated with variation in quality of care. We also quantified the variance in quality explained by each domain of covariates (patient‐, provider‐ and facility‐level and subnational divisions).ResultsOnly 61–66% of basic elements of competent and respectful care were performed. In adjusted models, better‐staffed facilities, private hospitals and morning deliveries were associated with higher levels of competent and respectful care. In Malawi, younger, primipara and HIV‐positive women received higher‐quality care. Quality also differed substantially across regions in Kenya, with a 25 percentage‐point gap between Nairobi and the Coast region. Quality was also higher in higher‐volume facilities and those with caesarean section capacity. Most of the explained variance in quality was due to regions in Kenya and to facility, and patient‐level characteristics in Malawi.ConclusionsOur findings suggest considerable scope for improvement in quality. Increasing staffing and shifting births to higher‐volume facilities – along with promotion of respectful care in these facilities – should be considered in sub‐Saharan Africa to improve outcomes for mothers and newborns.
Effects of implementing evidence-based appropriateness guidelines for epidural steroid injection in chronic low back pain: the EAGER (Esi Appropriateness GuidElines pRotocol) study
Authors: Johnson Scott M , Hutchins Troy , Peckham Miriam , Anzai Yoshimi , Ryals Elizabeth , Davidson H Christian , Shah Lubdha 
Published: December 2019

ObjectiveChronic low back pain is very common and often treated with epidural steroid injections (ESIs). As ESI referrals had been rapidly increasing at our Veterans’ Administration hospital, we were concerned that they were supplanting more comprehensive care. The objective was to determine how referral patterns and multidisciplinary care might change with the implementation of evidence-based guidelines.MethodsIn this retrospective observational study, multidisciplinary evidence-based guidelines were implemented in 2014 (EAGER: Esi Appropriateness GuidElines pRotocol) as part of the ordering process for an ESI. Time series analysis was performed to assess the primary outcome of subspecialty referral pattern, that is, the number of patients receiving referrals to ancillary services which might serve to provide a more comprehensive approach to their back pain. Secondary outcomes included patient-level changes (ie, body mass index, number of injections, opioid use), which were compared before and after protocol implementation.ResultsComparing preimplementation and postimplementation protocol periods, referrals to physical medicine/rehabilitation increased 11.7% (p=0.003) per year and integrative health increased 2.1% (p<0.001) per year among the 2294 individual patients who received ESI through the neurointerventional radiology service. Of 100 randomly selected patients for patient-level analysis, the median body mass index decreased from 31.57 to 30.22 (p=<0.001) and the mean number of injections decreased from 1.76 to 0.73 (p<0.001). The percentage of patients using oral opioid analgesics decreased from 72% to 49% (p=<0.001).ConclusionImplementation of evidence-based guidelines for ESI referral helps guide patients into a more comprehensive care pathway for chronic low back pain and is correlated with patient-level changes such as decreased body mass index and decreased opioid usage.
How can pain management in the emergency department be improved? Findings from multiple case study analysis of pain management in three UK emergency departments
Authors: Sampson Fiona C , O’Cathain Alicia , Goodacre Steve 
Published: December 2019

IntroductionInadequate pain management in EDs is a worldwide problem, yet there has been little progress in understanding how pain management can be improved. There is only weak evidence and limited rationale to support interventions to improve pain management. We used naturalistic, qualitative methods to understand the factors that influence how pain is managed within the adult ED.MethodsWe used a multiple case study design incorporating 143-hour non-participant observation, documentary analysis and semistructured interviews with 37 staff and 19 patients at three EDs in the North of England between 2014 and 2016. We analysed data using thematic analysis.ResultsOur analysis demonstrated that pain management was not well aligned with the core priorities of the ED and was overlooked when other works took priority. We identified that (1) pain management was not perceived to be a key organisational priority for which staff were held accountable and staff had limited awareness of their performance, (2) pain management was not a core component of ED education and training, (3) ED processes and structures were not aligned with pain management and pain reassessment was overlooked unless staff escalated pain management outside of normal processes and (4) staff held embedded beliefs that conceptualised pain management as distinct from core priorities and limited their capacity to improve. However, EDs were able to improve pain management by aligning processes of pain management with other core works, particularly patient flow (eg, nurse-initiated analgesia at triage).ImplicationsEDs may be able to improve pain management by ensuring pain management processes align with key ED priorities. Undertaking multifaceted changes to structures and processes may enable staff to improve pain management and develop a culture in which pain management can be prioritised more easily. Future interventions need to be compatible with the wider work of the ED and enable patient flow in order to be adopted and maintained.