bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lymphocyte senescence in COPD is associated with decreased sirtuin 1 expression in steroid resistant pro-inflammatory lymphocytes
Authors: Hodge Greg , Tran Hai B. , Reynolds Paul N. , Jersmann Hubertus , Hodge Sandra 
Published: April 2020

Background: The class III NAD-dependent histone deacetylase (HDAC) sirtuin 1 (SIRT1) is an important regulator of senescence, aging, and inflammation. SIRT1de-acetylates chromatin histones, thereby silencing inflammatory gene transcription. We have reported increased steroid-resistant senescent pro-inflammatory CD28nullCD8+ T cells in patients with chronic obstructive pulmonary disease (COPD). We hypothesized that SIRT1 is reduced in these cells in COPD, and that treatment with SIRT1 activators (resveratrol, curcumin) and agents preventing NAD depletion (theophylline) would upregulate SIRT1 and reduce pro-inflammatory cytokine expression in these steroid-resistant cells. Methods: Blood was collected from n = 10 COPD and n = 10 aged-matched controls. Expression of CD28, SIRT1, and pro-inflammatory cytokines was determined in CD8+ and CD8– T and natural killer T (NKT)-like cells cultured in the presence of ±1 µM prednisolone, ±5 mg/L theophylline, ±1 µM curcumin, ±25 µM resveratrol, using flow cytometry and immunofluorescence. Results: There was an increase in the percentage of CD28nullCD8+ T and NKT-like cells in COPD patients compared with controls. Decreased SIRT1 expression was identified in CD28nullCD8+T and NKT-like cells compared with CD28+ counterparts from both patients and controls (e.g. CD28null 11 ± 3% versus CD28+ 57 ± 9%). Loss of SIRT1 was associated with increased production of IFNγ and TNFα, steroid resistance, and disease severity. SIRT1 expression was upregulated in the presence of all drugs and was associated with a decrease in steroid resistance and IFNγ and TNFα production by CD28nullCD8+T and NKT-like cells. The presence of the SIRT1 inhibitor, EX-527 negated [by 92 ± 12% (median ± SEM)] the effect of the SIRT1 activator SRT720 on the percentage of CD8+ T cells producing IFNγ and TNFα. Conclusions: Steroid resistance in pro-inflammatory CD28nullCD8+ T and NKT-like cells is associated with decreased SIRT1 expression. Treatment with prednisolone, in combination with theophylline, curcumin or resveratrol increases SIRT1 expression, restores steroid sensitivity, and inhibits pro-inflammatory cytokine production from these cells and may reduce systemic inflammation in COPD. The reviews of this paper are available via the supplemental material section.
Sternoclavicular joint injections and their predictive value for the outcome of surgery
Authors: Urbanschitz Lukas , Kriechling Philipp , Fritz Benjamin , Meyer Dominik C , Wieser Karl 
Published: April 2020

Background Sternoclavicular joint injections are one of the first-line treatment options for painful non-infectious pathologies of the sternoclavicular joint; however, their long-term effects and predictive value in decision-making for surgery are yet to be defined. Methods 27/32 Patients who received in total 36 computed tomography-guided sternoclavicular joint injections in 2012–2017 replied the questionnaire with a mean follow-up of 38 months after the first sternoclavicular joint injection. Of those patients, seven underwent subsequent surgery. We evaluated pain response after sternoclavicular joint injection and American Shoulder and Elbow Surgeons-score at later follow-up. Results Directly after sternoclavicular joint injection, pain decreased from Visual Analog Scale 5.3 ± 2.4 to 3.8 ± 3 (p = 0.001). In the seven patients who underwent surgery for degenerative changes, definitive outcome correlated with pain relief after the last infiltration (r = 0.86, p = 0.012). Also, the final American Shoulder and Elbow Surgeons-score was lower in patients with multiple injections compared to those who were satisfied after the first injection (p = 0.019). Discussion Sternoclavicular injections are a useful tool in the context of degenerative sternoclavicular joint disorders as the amount of pain reduction is, in case the short-term effect is not long-lasting, at least a strong indicator for the future success of operative treatment.
Nasal Function Changes at High Altitude
Authors: Ottaviano Giancarlo , Nardello Ennio , Pendolino Alfonso Luca , Pozza Martino Dalla , Russo Massimiliano , Savietto Enrico , Andrews Peter J. , Ermolao Andrea 
Published: April 2020

Background An ever-increasing number of people are involved in sport activities at high altitude. Objective This study aimed to evaluate the pulmonary and nasal functions, including nasal cytology, in healthy volunteers moving for 1 week from an altitude of 2000 m to another of 3400 m. Methods Peak nasal inspiratory flow (PNIF), pulmonary function, including peak expiratory flow (PEF), mucociliary transport time (MCTt), nasal cytology, and oxygen saturation (O2 sat) were studied in 5 different occasions—T1: at base camp (2000 m); T2: at the mountain refuge (3400 m); T3: after 7 days at 3400 m; T4: after the return at the base camp (2000 m); and T5: at the base camp (2000 m) after 15 days. Results With respect to T1, PEF values decreased at T2 ( P = .004), T3 ( P = .004), T4 ( P = .000), and T5 ( P = .001). Forced expiratory volume in the first second and forced vital capacity did not differ among the 5 different times of measurements. In regard to T1, PNIF values increased at T2 ( P = .003) and T3 ( P = .001). MCTt and O2 sat showed similar but opposite changes with MCTt increased at T2 and T3 in respect to T1 ( P = .000 for both), while O2 sat decreased at T2 and T3 in respect to T1 ( P = .000 for both). At nasal cytology, the number of neutrophils increased at T2 in respect to T1 ( P = .008). At multivariate analysis, PNIF changed with altitude from T1 to T4 even accounting for the effect of all the other variables (T1 vs T2 PNIF, P = .009; T1 vs T3 PNIF, P = .007; T1 vs T4 PNIF, P = .021). Conclusions Although the study has some limitations, being conducted on a small cohort and at no controlled environmental conditions, data seem to support the utility of MCTt for studying nasal mucosa damage induced by high altitude. Nasal cytology seems to be able to identify the inflammation of the nasal mucosa exposed to hypoxia. Further investigations on larger series and possibly conducted in hypobaric chamber at controlled standardized conditions are necessary in order to confirm these results and, most importantly, the improvement of PNIF at high altitude.
New advances in mechanomyography sensor technology and signal processing: Validity and intrarater reliability of recordings from muscle
Authors: Meagher Claire , Franco Enrico , Turk Ruth , Wilson Samuel , Steadman Nathan , McNicholas Lauren , Vaidyanathan Ravi , Burridge Jane , Stokes Maria 
Published: April 2020

Introduction The Mechanical Muscle Activity with Real-time Kinematics project aims to develop a device incorporating wearable sensors for arm rehabilitation following stroke. These will record kinematic activity using inertial measurement units and mechanical muscle activity. The gold standard for measuring muscle activity is electromyography; however, mechanomyography offers an appropriate alterative for our home-based rehabilitation device. We have patent filed a new laboratory-tested device that combines an inertial measurement unit with mechanomyography. We report on the validity and reliability of the mechanomyography against electromyography sensors. Methods In 18 healthy adults (27–82 years), mechanomyography and electromyography recordings were taken from the forearm flexor and extensor muscles during voluntary contractions. Isometric contractions were performed at different percentages of maximal force to examine the validity of mechanomyography. Root-mean-square of mechanomyography and electromyography was measured during 1 s epocs of isometric flexion and extension. Dynamic contractions were recorded during a tracking task on two days, one week apart, to examine reliability of muscle onset timing. Results Reliability of mechanomyography onset was high (intraclass correlation coefficient = 0.78) and was comparable with electromyography (intraclass correlation coefficient = 0.79). The correlation between force and mechanomyography was high (R2 = 0.94). Conclusion The mechanomyography device records valid and reliable signals of mechanical muscle activity on different days.
People living in nursing care facilities who are ambulant and fracture their hips: description of usual care and an alternative rehabilitation pathway
Authors: Killington Maggie , Davies Owen , Crotty Maria , Crane Rhiannon , Pratt Naomi , Mills Kylie , McInnes Arabella , Kurrle Susan , Cameron Ian D. 
Published: April 2020

Abstract
Background
Little is known about treatment provided to people living in nursing care facilities (NCFs) after hospital admission for hip fracture. In addition, there are no clinical guidelines for rehabilitation and recovery following hip fracture for nursing home residents.

Methods
As part of a randomised trial (SACRED trial), which investigated the efficacy of a four week in-reach rehabilitation program, data were collected which described routine care for 240 people living in 76 nursing care facilities in South Australia who fractured their hips. The in-reach rehabilitation provided to 119 intervention participants is described, including intensity, type and methods used to encourage participation in rehabilitation. Adverse events that occurred, in particular falls, are also reported.

Results
NCF records indicated that, over the four weeks following discharge from hospital after hip fracture, 76% of patients receiving usual care had a consultation with their general practitioner. Physiotherapy was provided to 79% of patients in usual care (median of 1.96 h over the 4 weeks, which is less than 30 min each week of physiotherapy). In-reach rehabilitation was provided by the hospital team for 13 h over the 4 weeks with almost full attendance at physiotherapy sessions (median of 1 missed session, range 0–7 with a median of 14 physiotherapy sessions attended by participants, range 1–18). Experienced therapists provided a flexible approach to the rehabilitation to account for patients’ dementia and associated neuropsychiatric symptoms while providing dietetic support, mobility training and education to nursing home staff. The number of falls experienced by those in the intervention group was higher compared to those in usual care (Relative Risk 1.38 (95%CI 1.04–1.84, p = 0.03).

Conclusions
Rehabilitation can be provided to people living in NCFs following hip fracture, even when they have moderate to severe dementia but the model needs to be flexible. Provision of rehabilitation may increase the rate of falls in this population. Further studies are required to establish the feasibility of the intervention in other long term care settings. (327 words).

Trial registration
ACTRN12612000112864 registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR).
Adequate access to healthcare and added life expectancy among older adults in China
Authors: Hao Lisha , Xu Xin , Dupre Matthew E. , Guo Aimei , Zhang Xufan , Qiu Li , Zhao Yuan , Gu Danan 
Published: April 2020

Abstract
Background
Adequate access to healthcare is associated with lower risks of mortality at older ages. However, it is largely unknown how many more years of life can be attributed to having adequate access to healthcare compared with having inadequate access to healthcare.

Method
A nationwide longitudinal survey of 27,794 older adults aged 65+ in mainland China from 2002 to 2014 was used for analysis. Multivariate hazard models and life table techniques were used to estimate differences in life expectancy associated with self-reported access to healthcare (adequate vs. inadequate). The findings were assessed after adjusting for a wide range of demographic factors, socioeconomic status, family/social support, health practices, and health conditions.

Results
At age 65, adequate access to healthcare increased life expectancy by approximately 2.0–2.5 years in men and women and across urban-rural areas compared with those who reported inadequate access to healthcare. At age 85, the corresponding increase in life expectancy was 1.0–1.2 years. After adjustment for multiple confounding factors, the increase in life expectancy was reduced to approximately 1.1–1.5 years at age 65 and 0.6–0.8 years at age 85. In women, the net increase in life expectancy attributable to adequate access to healthcare was 6 and 8% at ages 65 and 85, respectively. In men, the net increases in life expectancy were generally greater (10 and 14%) and consistent after covariate adjustments. In contrast, the increase in life expectancy was slightly lower in rural areas (2.0 years at age 65 and 1.0 years at age 85) than in urban areas (2.1 years at age 65 and 1.1 years age 85) when no confounding factors were taken into account. However, the increase in life expectancy was greater in rural areas (1.0 years at age 65 and 0.6 years at age 85) than in urban areas (0.4 years at age 65 and 0.2 years at age 85) after accounting for socioeconomic and other factors.

Conclusions
Adequate access to healthcare was associated with longer life expectancy among older adults in China. These findings have important implications for efforts to improve access to healthcare among older populations in China.
Effect of internal limiting membrane peeling on normal retinal function evaluated by microperimetry-3
Authors: Qi Yue , Wang Zengyi , Li Shi-Ming , You Qisheng , Liang Xida , Yu Yanping , Liu Wu 
Published: April 2020

Abstract
Background
To evaluate the effect of internal limiting membrane (ILM) peeling surrounding macular holes (MH) for the function of retina by microperimetry-3(MP-3).

Methods
This is a prospective, cohort study which included patients with MHs who were treated by 23-gauge 3-port pars plana vitrectomy and ILM peeling with air tamponade. Color fundus photography, retinal optical coherence tomography and MP-3 were performed 1 week before, 1 and 4 months after the operation. In MP-3 examination, a customized follow-up pattern with 45 spots in the central 8° visual field was used. The spots corresponding to the retina surrounding macular holes were selected for comparison of pre- and post-operative function.

Results
We incuded 44 eyes of 44 patients with best corrected visual acuity (BCVA) of 1.06 ± 0.40 (logMAR). All eyes achieved an anatomical success at 4 months. BCVA significantly improved at 1 month (0.53 ± 0.30, P < 0.01) and 4 months (0.31 ± 0.24, P < 0.01), respectively. Mean retinal sensitivity (MRS, dB) of the retina surrounding macular hole was 23.46 ± 3.01 dB at baseline, and significantly increased at 1 month (26.25 ± 2.31 dB, u = − 4.88, P < 0.01) and 4 months (27.14 ± 2.45 dB, t = − 6.29, P < 0.01). Patients with increased MRS are significantly younger than those with deceased MRS (59.72 ± 3.22 years vs. 65.60 ± 8.19 years, P < 0.01). After ILM peeling, the increasing extent of MRS was significantly higher in inferior and nasal retina than in superior and temporal retina at 1 and 4 months (P < 0.05).

Conclusion
ILM peeling in normal retina will not decrease the retinal function in a short-term after surgery.
Thailand medical mobile application for patients triage base on criteria based dispatch protocol
Authors: Sutham Krongkarn , Khuwuthyakorn Pattaraporn , Thinnukool Orawit 
Published: April 2020

Abstract
Background
Before patients are admitted into the emergency department, it is important to undertake a pre-hospital process, both in terms of treatment performance and a request for resources from an emergency unit. The existing system to triage patients in Thailand is not functioning to its full capacity in either the primary medical system or pre-hospital treatment with shortcomings in the areas of speed, features, and appropriate systems. There is a high possibility of issuing a false Initial Dispatch Code (IDC), which will cause the over or underutilisation of emergency resources, such as rescue teams, community hospitals and emergency medical volunteers.

Methods
A usability system design, together with a reliability test, was applied to develop an application to optimise the pre-hospital process, specifically to sort patients, using an IDC to improve the request for emergency resources. The triage mobile application was developed on both iOS and Android operating systems to support patient triage based on Criteria Based Dispatch (CBD). The 25 main symptom categories covered by CBD were used to design and develop the application, and 12 emergency medical staff, including doctors and nurses, were asked to test the system in the aspects of triage protocol correction, triage reliability, usability and user satisfaction.

Results
The results of testing the proposed triage application were compared with the time used to triage by experienced staff and it was found that, in non-trauma cases, it was faster and more effective to use the application for emergency operations and to correct the IDC code representation.

Conclusions
The triage application will be utilised to support the pre-hospital process and to classify patients’ conditions before they are admitted to the Emergency Department (ED). The application is suitable for users who are not medical emergency staff. Patients with non-trauma symptoms may be a suitable group to use the application in terms of time used to identify IDC for their own symptoms. The use of the application can be beneficial for those who wish to self-identify their symptoms before requesting medical services.
Valuing the cost of improving Chilean primary vaccination: a cost minimization analysis of a hexavalent vaccine
Authors: Olivera Ignacio , Grau Carlos , Dibarboure Hugo , Torres Juan Pablo , Mieres Gustavo , Lazarov Luis , Alvarez Fabián P. , Yescas Juan Guillermo López 
Published: April 2020

AbstractBackgroundThe phased withdrawal of oral polio vaccine (OPV) and the introduction of inactivated poliovirus vaccine (IPV) is central to the polio ‘end-game’ strategy.MethodsWe analyzed the cost implications in Chile of a switch from the vaccination scheme consisting of a pentavalent vaccine with whole-cell pertussis component (wP) plus IPV/OPV vaccines to a scheme with a hexavalent vaccine with acellular pertussis component (aP) and IPV (Hexaxim®) from a societal perspective. Cost data were collected from a variety of sources including national estimates and previous vaccine studies. All costs were expressed in 2017 prices (US$ 1.00 = $Ch 666.26).ResultsThe overall costs associated with the vaccination scheme (4 doses of pentavalent vaccine plus 1 dose IPV and 3 doses OPV) from a societal perspective was estimated to be US$ 12.70 million, of which US$ 8.84 million were associated with the management of adverse events related to wP. In comparison, the cost associated with the 4-dose scheme with a hexavalent vaccine (based upon the PAHO reference price) was US$ 19.76 million. The cost of switching to the hexavalent vaccine would be an additional US$ 6.45 million. Overall, depending on the scenario, the costs of switching to the hexavalent scheme would range from an additional US$ 2.62 million to US$ 6.45 million compared with the current vaccination scheme.ConclusionsThe switch to the hexavalent vaccine schedule in Chile would lead to additional acquisition costs, which would be partially offset by improved logistics, and a reduction in adverse events associated with the current vaccines.
Clinical and cost-effectiveness of oral sodium bicarbonate therapy for older patients with chronic kidney disease and low-grade acidosis (BiCARB): a pragmatic randomised, double-blind, placebo-controlled trial
Authors:   The BiCARB study group
Published: April 2020

Abstract
Background
Chronic kidney disease with metabolic acidosis is common in older people, but the effectiveness of oral sodium bicarbonate therapy in this group is unclear. We tested whether oral sodium bicarbonate provides net health benefit for older people with advanced chronic kidney disease and serum bicarbonate concentrations < 22 mmol/L.

Methods
Pragmatic multicentre, parallel group, double-blind, placebo-controlled randomised trial. We recruited adults aged ≥ 60 years with estimated glomerular filtration rate of < 30 mL/min/1.73 m2, not receiving dialysis, with serum bicarbonate concentration < 22 mmol/L, from 27 nephrology and geriatric medicine departments in the UK. Participants received oral sodium bicarbonate (up to 3 g/day) or matching placebo given for up to 2 years, randomised in a 1:1 ratio. The primary outcome was between-group difference in the Short Physical Performance Battery (SPPB) at 12 months, adjusted for baseline values, analysed by intention to treat. Secondary outcomes included generic and disease-specific quality of life (EQ-5D and KDQoL tools), anthropometry, renal function, walk distance, blood pressure, bone and vascular health markers, and incremental cost per quality-adjusted life year gained.

Results
We randomised 300 participants between May 2013 and February 2017, mean age 74 years, 86 (29%) female. At 12 months, 116/152 (76%) participants allocated to bicarbonate and 104/148 (70%) allocated to placebo were assessed; primary outcome data were available for 187 participants. We found no significant treatment effect for the SPPB: bicarbonate arm 8.3 (SD 2.5) points, placebo arm 8.8 (SD 2.2) and adjusted treatment effect − 0.4 (95% CI − 0.9 to 0.1, p = 0.15). We found no significant treatment effect for glomerular filtration rate (0.6 mL/min/1.73 m2, 95% CI − 0.8 to 2.0, p = 0.39). The bicarbonate arm showed higher costs and lower quality of life as measured by the EQ-5D-3L tool over 1 year (£564 [95% CI £88 to £1154]); placebo dominated bicarbonate under all sensitivity analyses. Adverse events were more frequent in those randomised to bicarbonate (457 versus 400).

Conclusions
Oral sodium bicarbonate did not improve physical function or renal function, increased adverse events and is unlikely to be cost-effective for use by the UK NHS for this patient group.

Trial registration
European Clinical Trials Database (2011-005271-16) and ISRCTN09486651; registered 17 February 2012.