bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tumor secreted ANGPTL2 facilitates recruitment of neutrophils to the lung to promote lung pre-metastatic niche formation and targeting ANGPTL2 receptor signaling prevents metastatic disease.
Authors: Charan Manish , Dravid Piyush , Cam Maren , Setty Bhuvana , Roberts Ryan D , Houghton Peter J , Cam Hakan 
Published: October 2019

Abstract
The authors have withdrawn the journal submission associated with this preprint and requested that the preprint also be withdrawn.
Selenium, Copper, Zinc and Hypertension: An Analysis of the National Health and Nutrition Examination Survey (2011-2016)
Authors: Bastola Mrigendra Mani , Locatis Craig , Maisiak Richard , Fontelo Paul 
Published: October 2019

Abstract
Background: Hypertension is a major cardiovascular illness worldwide with many underlying causes. The role of trace elements selenium, copper, and zinc in hypertension is uncertain. The objective of this study was to evaluate the role of these trace elements in hypertension. Method: Data from 6683 National Health and Nutrition Examination Survey (NHANES) participants from 2011 to 2016 were analyzed using Statistical Analytical System (SAS, version 9.4) software for the role of trace elements in hypertension in age range 8 to 80 years, irrespective of the antihypertensive medication taken. Recent American Heart Association guidelines and pediatric practice guidelines for hypertension were used.Results: Findings showed a significant positive association between serum selenium levels and hypertension but not serum zinc and copper. At optimal levels for transport and distribution, serum selenium levels of 120 µg/L or higher (reference level 70 -150 µg/L) were significantly associated with hypertension (OR = 1.46, 95% CI= 1.29 – 1.66) after adjusting for confounding factors. At serum selenium level greater than 150 µg/L, the association with hypertension strengthened (OR= 1.69, 95% CI = 1.32-2.17). Conclusion: A positive association was found between serum selenium and hypertension, irrespective of age or anti-hypertensive medications intake. These findings also suggest that the reference levels of serum levels in healthy individuals may need to be re-determined, if supported by additional studies. If validated, patients with hypertension may also need to be cautioned about selenium intake.
The effect of antibiotics on post-adenotonsillectomy morbidity in tanzanian children: study protocol for a randomized double-blind placebo-controlled trial.
Authors: Katundu Denis Robert , Shija Peter Stephen , Nyombi Baltazari , Semvua Hadija , Oussoren Fieke K , Heerbeek Niels van 
Published: October 2019

Abstract
Background: Adenotonsillectomy is the most frequently performed operation in children worldwide. For decades prophylactic antibiotics have been prescribed to limit postoperative complications. In a Cochrane review the effect of this antibiotic use has been refuted. However, all reviewed studied were done in developed countries. In Tanzania, like many other developing countries with limited resources and a high burden of infectious diseases, postoperative antibiotic prescription is still very common to decrease the supposed higher postoperative morbidity. However, as a consequence of this widespread use of postoperative antibiotics cross-resistance and risk of allergic side effects rise. Well designed randomised controlled trials are needed to limit unnecessary antibiotic prescription and secondary antibiotic resistance.
Aim: The aim of this study is to analyse the prophylactic role of postoperative antibiotic on the morbidity following adenotonsillectomy in children in Tanzania.
Design: A double blinded randomised placebo controlled trial set in northern Tanzania. Participating centres are the department of otolaryngology at Kilimanjaro Christian Medical Centre (KCMC) in Moshi and the department of paediatric surgery at the Arusha Lutheran Medical Centre (ALMC) in Arusha.
Methods: Around 270 children aged 2 to 14 years, all scheduled for elective (adeno)tonsillectomy, will be included and assigned to receive either a standard regimen of 5 days antibiotic prophylaxis or placebo after surgery. The primary outcomes are postoperative haemorrhage, fever and pain. Secondary outcomes are the time until normal diet is resumed, the time until normal activities are resumed, occurrence of adverse events and microbial recolonization of the tonsillar beds.
Discussion: This study will enhance increase of proper antimicrobial prescription in Tanzanian institutions as well as other resource-limited countries where prescription of antibiotics is still very common. In addition, it might augment current knowledge about surface and core tonsillar micro-organisms and sensitivity patterns.
The Effect of TRX vs. Aquatic Exercises on Self-Reported Knee Instability and Affected Factors in Women with Knee Osteoarthritis: A Randomized Controlled Trial
Authors: Asar Shirin , Gandomi Farzaneh , Mozafari Mahsa , Sohaili Freshteh 
Published: October 2019

Abstract
Background

Knee Instability (KI) is described as a sense of the knee buckling, shifting, or giving way during the weight bearing activities. High prevalence (65%) has been reported for KI amongst the patients with knee osteoarthritis (KOA). So, we studied the effect of two interventions on self-reported KI and affected factors.Methods

In this single blind, randomized, and controlled trial, 36 patients with radiographic grading (Kellgren–Lawrence 1–4) of knee osteoarthritis were selected for participating. patients were allocated in three groups aquatic exercises (n=12), Total Resistance eXercises (TRX) exercises (n=12) and control (n=12) by random. 8-week TRX and aquatic exercises were carried out by experimental groups. Pain severity was assessed by visual analog scale (VAS), Balance was also evaluated by Berg Balance Scale (BBS), quadriceps strength by dynamometer, and knee range of motion (ROM) by inclinometer, Western Ontario and McMaster Universities Osteoarthritis (WOMAC), self-reported KI were also measured before and after interventions.Results

The results of One-way ANOVA showed that there was no significant difference between aquatic exercises and TRX (P>0.05) for KI, BBS, WOMAC, and pain. But there was significant difference between the aquatic exercises and the control for KI (P=0.0001), BBS (P=0.0001), WOMAC Stiffness (P=0.0001), and pain (P=0.006). Also, there was significant difference between the TRX and the control for KI (P=0.0001), BBS (P=0.0001), and pain (P=0.003) except WOMAC Stiffness (P=0.07).Conclusions

TRX and aquatic interventions had a similar effect on the patients’ KI, pain, function, and also balance variables, but TRX exercises had more effect on the knee stiffness improvement.
Smart Pumps Improve Medication Safety but Increase Alert Burden in Neonatal Care
Authors: Melton Kristin , Timmons Kristen , Walsh Kathleen E , Meinzen-Derr Jareen K , Kirkendall Eric 
Published: October 2019

Abstract
Background: Smart pumps have been widely adopted but there is limited evidence to understand and support their use in pediatric populations. Our objective was to assess whether smart pumps are effective at reducing medication errors in the neonatal population and determine whether they are a source of alert burden and alert fatigue in an intensive care environment. Methods: Using smart pump records, over 370,000 infusion starts for continuously infused medications used in neonates and infants hospitalized in a level IV NICU from 2014-2016 were evaluated. Attempts to exceed preset soft and hard maximum limits, percent variance from those limits, and pump alert frequency, patterns and salience were evaluated. Results: Smart pumps prevented 160 attempts to exceed the hard maximum limit for doses that were as high as 7-29 times the maximum dose and resulted in the reprogramming or cancellation of 2093 infusions after soft maximum alerts. While the overall alert burden from smart pumps for continuous infusions was not high, alerts clustered around specific patients and medications, and a small portion (17%) of infusions generated the majority of alerts. Soft maximum alerts were often overridden (79%), consistent with low alert salience. Conclusions: Smart pumps have the ability to improve neonatal medication safety when compliance with dose error reducing software is high. Numerous attempts to administer high doses were intercepted by dosing alerts. Clustered alerts may generate a high alert burden and limit safety benefit by desensitizing providers to alerts. Future efforts should address ways to improve alert salience.
Characteristics And Outcome Of Influenza-Associated Encephalopathy/Encephalitis Among Children In A Tertiary Pediatric Hospital In Italy, 2017-2019
Authors: Mastrolia Maria Vincenza , Rubino Chiara , Resti Massimo , Trapani Sandra , Galli Luisa 
Published: October 2019

Abstract
BACKGROUND: Influenza is the most frequent cause of acute upper respiratory tract infections during winter season. Although rare, neurological manifestations are known to occur during influenza infection and approximatively three-quarters of cases are in children. In this study, we aimed to characterize the burden and clinical spectrum of influenza-associated encephalopathy and encephalitis in children admitted at a tertiary pediatric hospital in Italy over two influenza seasons (2017-2019).
METHODS: We retrospectively analyzed clinical, laboratory, instrumental data and outcome of patients discharged with ICD9-CM 487.0 code
RESULTS: Fifteen children (13.1% of those discharged with a diagnosis of influenza infection in the study period), had influenza-associated central nervous system (CNS) manifestations. Eight patients (53.3%) were diagnosed as influenza encephalitis, 7 (46.7%) as influenza encephalopathy. Median age was 27 months. In children under 2 years of age (40% of all cases) altered consciousness was the most frequent neurological manifestation while respiratory symptoms were present at admission in all cases. Younger children also required intensive care support more frequently. Five subjects (33.3%) presented comorbidity. None of the patients had received seasonal influenza vaccination. The median time from onset of respiratory signs to onset of neurological manifestations was 24 hours. Cerebrospinal fluid (CSF) analysis was normal in most patients and polymerase chain reaction for influenza virus RNA on CSF, when performed, was negative in all samples. Neuroradiological investigations, performed in 5 children, reported cortical and subcortical white matter signal alterations. Oseltamivir was administered only in 2 cases. Fourteen patients recovered without sequelae, and only a 2-year-old girl had minimal impairment in fine motor skills at discharge.
CONCLUSIONS: All children presenting acute neurological features during influenza season should be evaluated for influenza-associated CNS complications even if the respiratory involvement is mild. Absence of underlying diseases or other risk factors are not protective factors against CNS influenza-associated complications. The lack of CSF pleocytosis does not exclude CNS involvement. Children under 2 years of age are at higher risk of requiring intensive care support.
Total resuscitative endovascular balloon occlusion of the aorta causes inflammatory activation and organ damage within 30 minutes of occlusion in normovolemic pigs
Authors: Sadeghi Mitra , Dogan Emanuel M. , Karlsson Christina , Jansson Kjell , Seilitz Jenny , Skoog Per , Hörer Tal M. , Nilsson Kristofer F. 
Published: October 2019

Abstract
Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) causes physiological, metabolic, end-organ and inflammatory changes that need to be addressed for better management of severely injured patients. The aim of this study was to investigate occlusion time-dependent metabolic, end-organ and inflammatory effects of total REBOA in Zone I in a normovolemic animal model. Methods: Twenty-four pigs (25-35kg) were randomized to total occlusion REBOA in Zone I for either 15, 30, 60 minutes (REBOA15, REBOA30, and REBOA60, respectively) or to a control group, followed by 3-hour reperfusion. Hemodynamic variables, metabolic and inflammatory response, intraperitoneal and intrahepatic microdialysis, and plasma markers of end-organ injuries were measured during intervention and reperfusion. Intestinal histopathology was performed. Results: Mean arterial pressure and cardiac output increased significantly in all REBOA groups during occlusion and blood flow in the superior mesenteric artery and urinary production subsided during intervention. Metabolic acidosis with increased intraperitoneal and intrahepatic concentrations of lactate and glycerol was most pronounced in REBOA30 and REBOA60 during reperfusion and did not normalize at the end of reperfusion in REBOA60. Inflammatory response showed a significant and persistent increase of pro- and anti-inflammatory cytokines during reperfusion in REBOA30 and was most pronounced in REBOA60. Plasma concentrations of liver, kidney, pancreatic and skeletal muscle enzymes were significantly increased at the end of reperfusion in REBOA30 and REBOA60. Significant intestinal mucosal damage was present in REBOA30 and REBOA60. Conclusion: Total REBOA caused severe systemic and intra-abdominal metabolic disturbances, organ damage and inflammatory activation already at 30 minutes of occlusion.
Resilient Health Care: a systematic review of conceptualisations, study methods and factors that develop resilience.
Authors: Iflaifel Mais HM , Lim Rosemary , Ryan Kath M , Crowley Clare 
Published: October 2019

Abstract
Background Traditional approaches to safety management in health care have focused primarily on counting errors and understanding how things go wrong. Resilient Health Care (RHC) provides an alternative complementary perspective of learning from incidents and understanding how, most of the time, work is safe. The aim of this review was to identify how RHC was conceptualised, described and interpreted, to describe the methods used to study, and to identify factors that develop RHC. Methods Electronic searches of PubMed, Scopus and Cochrane databases were performed to identify relevant peer-reviewed studies, and a hand search for studies published in books that explained how RHC as a concept was interpreted, methods used to study, and factors to develop RHC. Studies were evaluated independently by two researchers. Data was synthesised using a deductive thematic approach. Results Twenty-seven studies were included; they shared similar descriptions of RHC which was the ability to adjust its functioning prior to, during, or following events and thereby sustain required operations under both expected and unexpected conditions. Qualitative methods such as observations and interviews were used to study RHC. Models for studying RHC currently exist and were in the early stages of implementation. Effective team relationships, trade-offs and healthcare ‘resilience’ training of health care professionals were factors used to develop RHC. Conclusions Although there was consistency in the conceptualisation of RHC, methods used to study and factors to develop RHC, further research should focus on operationalising RHC assessment methods and developing, testing and evaluating interventions for developing RHC.
Explaining the Dimensions of Social Support for Breakfast and Healthy Snacks in Students: A Qualitative Study
Authors: Bastami Fatemeh , Ardalan Arash , Zamani-Alavijeh Fereshteh , Mostafavi Firoozeh 
Published: October 2019

Abstract
Background: breakfast elimination as well as consumption of low-value snacks is ever increasing among adolescents. This study sought to explain the dimensions of social support for breakfast and healthy snacks among students. Methods : A qualitative research was conducted in Isfahan, Tehran, and Khorramabad high schools in 2017--18. Data were obtained from five focus group discussions and 35 in-depth interviews as well as semi-structured interviews with students of both sex, parents and school authorities. The data simultaneously analyzed using conventional content analysis in three stages including preparation, organization, and reporting. Prolonged engagement, maximum variation of sampling and member check were the enrichment factors of the research. Results : Three main categories emerged. First, family supports with sub- categories of family in the school programs as well as mother-sponsored support and family life patterns. Second, school supports with sub- categories of instrumental and informational support. And third, support of other community organizations with sub- categories of intra-department coordination and mass media. Conclusion : By providing exciting advocacy opportunities such as holding an exhibition and building families' confidence in the safety of school nutrition, school can attract family partnerships. In addition, promoting healthy eating needs multi-level supports such as mass media, municipalities, police, and the school's renovation office as well as the coordination of these organizations with health sector.
Postpartum moderate to severe anemia in a low-income country, Burkina Faso
Authors: ZAMANE Hyacinthe , Coulibaly Abou , Ouédraogo Issa , Coulibaly-Diallo Guémilatou , Ouedraogo Ali , Bonané-Thieba Blandine 
Published: October 2019

Abstract
Background In Burkina Faso, Sahelian country with limited resources, the maternal mortality ratio is still high and anemia is one of the major contributing factors. To identify epidemiological aspects of postpartum anemia in order to better guide public policy in its prevention and management.Methods This was a secondary analysis of data from the 2010 Demographic and Health Survey in Burkina Faso. The classification of anemia in women according to the World Health Organization was considered. For the research of associated factors, moderate or severe anemia was considered.Results A total of 1616 women were included. Hemoglobin levels were less than 12 g/dl in 839 women (51.9%). It was less than 10 g/dl in 251 cases (15.5%). There has been a significant increase in the risk of postpartum anemia for women in the Sahel region (OR=2.9; IC [1.2-7.4]; p=0.024). The adjusted effect of the woman's status about postpartum amenorrhea also showed an increased risk in women still having no return from menstruation.Conclusion Anemia is common during postpartum. It is of multifactorial origin. Further studies are needed to better adapt its current prevention strategies and investigate the relationship between Sahel region and anemia.
Low back pain caused by Iliopsoas tendinopathy treated with ultrasound-guided local injection of anesthetic and steroid: a retrospective study
Authors: Zhu Zhaochen , Zhang Jieyuan , Sheng Jiagen , Zhang Changqing , Xie Zongping 
Published: October 2019

Abstract
Background

Low back pain is a prevalent symptom that occur in all age of people, whereas the pathogenesis is unknown. Iliopsoas tendinopathy is an increasingly recognized hip disorder that may contribute to low back pain. Our purpose is to reveal the relationship of iliopsoas tendinopathy with low back pain and to evaluate the effect of ultrasound-guided local injection of anesthetic and steroid into iliopsoas tendon in treating low back pain.

Methods

This retrospective study reviewed 45 patients diagnosed with iliopsoas tendinopathy treated by B-ultrasound guided injection of lidocaine and triamcinolone into the iliopsoas tendon from March 2016 to June 2016. Medical records were collected to analyze the clinical presentation. Visual Analogue scale (VAS) and Harris Hip score (HHS) were administered to determine patient outcomes. Telephone follow-up was conducted, and the mean follow-up was 11 months.

Results

We observed that most patients with iliopsoas tendinopathy also complain chronic low back pain except for groin pain. After injection of anesthetic and corticosteroid into the iliopsoas tendon, the VAS fell from 7.82±1.35 to 2.73±1.24 immediately after the injection, and 0.8±0.75 at follow-up. The HHS improved from 41.09±17.67 to 97.89±2.79 at follow-up. Statistically significant difference (P<0.001) was observed. All patients returned to their original level of function and only seven patients (15%) presented with mild pain at the follow-up.

Conclusions

Low back pain is a prevalent presentation for iliopsoas tendinopathy. Diagnosis of iliopsoas tendinopathy should be considered in patients with low back pain with tenderness over the iliopsoas tendon. Ultrasound-guided local injection of anesthetic and steroid lead to satisfactory effect in relieving low back and groin pain and improving joint function.
Orthopaedic Implant Labeling – how small is too small? Preventing a Never Event
Authors: Kapur Ben , Kumar Gunesakaren 
Published: October 2019

Abstract
Background There are currently no guidelines for the standards of legibility, dimensions and presentation on implant labels. There have been recommendations that text height on implant boxes should be at least 4mm. Orthopaedic implants are packaged individually and checked intraoperatively once the correct size has been identified. During this process there are many factors that could lead to error. Dimensions of laminar flow canopies fixes the distance at which the implant label can be read from. Never events are multifactorial. Small text, poor vision due to liquid on a surgeons visor and the seam of the plastic packaging can obscure vital information and contribute to a never event. Methods We reviewed elective and trauma implants. Using the National Joint Registry 15th Annual Report we identified the most commonly used total hip and knee arthroplasty implants (4 hip and 3 knee). We also reviewed the femoral nail and plate implants of 3 commonly used implant companies. Implant box text size was compared to a theoretical minimum standard of 4mm for text on implant labels derived from Snellen Chart Formula. Results 20 implants were reviewed (hip – 8, knee 6, trauma-6). Across all implants, the average implant size text height was 2.8mm. The average for trauma and elective implants was the same. The average expiry date is 2mm in height. On 65% (13/20) of implant boxes, the plastic wrapping seam obscured vital text. 15% (3/20) of boxes had a text height of 4mm.Conclusion The recommended text height is 4mm. This was observed in only 15% of implants. Never events are usually multifactorial however, occur in part due to poor legibility of implant labels leading to incorrect implants being inserted. To further progress these recommendations, manufacturers can consider and adopt these suggestions to reduce risk and improve patients’ safety when their implants are being used.