bluuebunny/crossref_metadata_2025_split huggingface dataset:
COVID-19 lockdown impact on the physical activity of adults with progressive muscle diseases
Authors: Roberts-Lewis Sarah F , Ashworth Mark , White Claire M , Rose Michael R 
Published: March 2021

IntroductionThis short article summarises findings about reduced physical activity of adults with progressive muscle disease as a result of COVID-19 lockdown.MethodsAs part of an ongoing longitudinal cohort study, we prospectively and objectively measured physical activity using accelerometry at baseline in 2019 and follow-up in 2020. A subset of 85 participants incidentally had follow-up data collected during the first UK COVID-19 lockdown from 23 March to 4 July 2020. Thus, for this cohort we had activity data from before and during the COVID-19 pandemic and we were able to prospectively and accurately quantify the changes in their physical activity.ResultsOur data highlighted reduced overall activity intensity and reduced light activity time in particular.ConclusionsFrom our findings, we can infer specific evidence-based recommendations about how to redress inactivity secondary to COVID-19 restrictions for adults with progressive muscle diseases. These recommendations are likely to be generalisable to other groups who are vulnerable to functional decline secondary to prolonged inactivity.
Changes in central venous to arterial carbon dioxide gap (PCO2gap) in response to acute changes in ventilation
Authors: Shastri Lisha , Kjærgaard Benedict , Rees Stephen Edward , Thomsen Lars Pilegaard 
Published: March 2021

BackgroundEarly diagnosis of shock is a predetermining factor for a good prognosis in intensive care. An elevated central venous to arterial PCO2difference (∆PCO2) over 0.8 kPa (6 mm Hg) is indicative of low blood flow states. Disturbances around the time of blood sampling could result in inaccurate calculations of ∆PCO2, thereby misrepresenting the patient status. This study aimed to determine the influences of acute changes in ventilation on ∆PCO2and understand its clinical implications.MethodsTo investigate the isolated effects of changes in ventilation on ∆PCO2, eight pigs were studied in a prospective observational cohort. Arterial and central venous catheters were inserted following anaesthetisation. Baseline ventilator settings were titrated to achieve an EtCO2of 5±0.5 kPa (VT= 8 mL/kg, Freq = 14 ± 2/min). Blood was sampled simultaneously from both catheters at baseline and 30, 60, 90, 120, 180 and 240 s after a change in ventilation. Pigs were subjected to both hyperventilation and hypoventilation, wherein the respiratory frequency was doubled or halved from baseline. ∆PCO2changes from baseline were analysed using repeated measures ANOVA with post-hoc analysis using Bonferroni’s correction.Results∆PCO2at baseline for all pigs was 0.76±0.29 kPa (5.7±2.2 mm Hg). Following hyperventilation, there was a rapid increase in the ∆PCO2, increasing maximally to 1.35±0.29 kPa (10.1±2.2 mm Hg). A corresponding decrease in the ∆PCO2was seen following hypoventilation, decreasing maximally to 0.23±0.31 kPa (1.7±2.3 mm Hg). These changes were statistically significant from baseline 30 s after the change in ventilation.ConclusionDisturbances around the time of blood sampling can rapidly affect the PCO2, leading to inaccurate calculations of the ∆PCO2, resulting in misinterpretation of patient status. Care should be taken when interpreting blood gases, if there is doubt as to the presence of acute and transient changes in ventilation.
Disability, sexual and reproductive health: a scoping review of healthcare professionals’ views on their confidence and competence in care provision
Authors: Craig Lucy Emma , Chen Zhong Eric , Barrie Joanne 
Published: March 2021

BackgroundThe sexual and reproductive needs of people with disabilities are often unmet. Healthcare professionals play an important role in meeting these needs.ObjectiveTo explore the views of healthcare professionals on their confidence and competence in providing sexual and reproductive healthcare to people with disabilities.MethodologyTwo databases were searched yielding 14 studies included in the review. Studies detailing healthcare professionals’ experiences working in the subject area were included alongside results and evaluations of staff training/workshops within the area. Search results were screened for eligibility by the first and second authors and any discrepancies were resolved by the third author. All subsequent stages were carried out by the first author and reviewed by the second and third authors.ResultsThe study's findings indicate that there is a lack of training, guidelines, patient contact, time, teamwork and collaboration between staff, and a lack of awareness/access to resources within this area. Evaluations of training programmes/workshops showed an increase in knowledge, comfort and skills surrounding the subject. Continuous training would be beneficial to ensure these are maintained at a high level.ConclusionsOverall healthcare professionals felt they lack confidence and competence in providing sexual and reproductive healthcare to people with disabilities. Further research in this area is recommended to assess this in more depth. Development of guidelines, multidisciplinary training programmes and further resources for both staff and patients are recommended.
Access to sexual healthcare during New Zealand’s COVID-19 lockdown: cross-sectional online survey of 15–24-year-olds in a high deprivation region
Authors: Rose Sally B , Garrett Susan M , McKinlay Eileen M , Morgan Sonya J 
Published: March 2021

BackgroundNew Zealand’s response to the COVID-19 pandemic involved a nationwide stay-at-home lockdown in March–April 2020 that restricted access to primary healthcare services.MethodsAn online survey of 15–24-year-olds in a high deprivation region of New Zealand asked about the need for, and receipt of, sexual healthcare during lockdown. Experience of telehealth and preferences for future receipt of sexual healthcare were also explored. Social media advertising was used to recruit participants over five weeks in August and October 2020.ResultsThe survey sample included 500 respondents comprising 58.8% females, 25.4% Māori (indigenous) ethnicity and 21.4% LGBTQI+ (lesbian, gay, bisexual, transgender, queer, intersex +) young people. During lockdown, 22.2% of respondents reported sexual health needs (111/500), but fewer than half this group got help (45%, 50/111), believing their issue could wait, or due to barriers contacting services and lack of information about service availability. Experience of telehealth consultations (by 28/50 participants) was mostly favourable though only 46% agreed it was easier than going to the clinic. Telehealth methods were the preferred option by some participants for future receipt of sexual healthcare; but for most scenarios suggested, respondents favoured in-person clinic visits.ConclusionsYoung people experienced unmet need for sexual healthcare during lockdown in New Zealand, but not because services were unavailable. Findings point to the need for targeted information dissemination to young people about available services and the importance of seeking help during lockdown. More research is needed to understand the advantages and disadvantages of sexual healthcare delivered via telehealth to inform future service provision.
Breathing training improves exercise capacity in patients with tetralogy of Fallot: a randomised trial
Authors: Hock Julia , Remmele Julia , Oberhoffer Renate , Ewert Peter , Hager Alfred 
Published: March 2021

ObjectivePatients with tetralogy of Fallot (ToF) have limited pulmonary blood flow before corrective surgery and ongoing dysfunction of the pulmonary valve and right ventricle throughout life leading to lower exercise capacity and lung volumes in many patients. Inhalation training can increase lung volumes, improve pulmonary blood flow and consequently exercise capacity. This study tests whether home-based daily breathing training improves exercise capacity and lung volumes.MethodsFrom February 2017 to November 2018, 60 patients (14.7±4.8 years, 39% female) underwent spirometry (forced vital capacity (FVC); forced expiratory volume in 1 s (FEV1)), cardiopulmonary exercise testing (peak oxygen uptake (peakV˙O2)) and breathing excursion measurement. They were randomised into immediate breathing exercise or control group (CG) and re-examined after 6 months. The CG started their training afterwards and were re-examined after further 6 months. Patients trained with an inspiratory volume-oriented breathing device and were encouraged to exercise daily. The primary endpoint of this study was the change in peakV˙O2. Results are expressed as mean±SEM (multiple imputations).ResultsIn the first 6 months (intention to treat analysis), the training group showed a more favourable change in peakV˙O2(Δ0.5±0.6 vs −2.3±0.9 mL/min/kg, p=0.011), FVC (Δ0.18±0.03 vs 0.08±0.03 L, p=0.036) and FEV1(Δ0.14±0.03 vs −0.00±0.04 L, p=0.007). Including the delayed training data from the CG (n=54), this change in peakV˙O2correlated with self-reported weekly training days (r=0.282, p=0.039).ConclusionsDaily inspiratory volume-oriented breathing training increases dynamic lung volumes and slows down deconditioning in peakV˙O2in young patients with repaired ToF.
Anti-interleukin 1 agents for the treatment of recurrent pericarditis: a systematic review and meta-analysis
Authors: Imazio Massimo , Andreis Alessandro , Piroli Francesco , Lazaros George , Gattorno Marco , Lewinter Martin , Klein Allan L , Brucato Antonio 
Published: March 2021

AimsCorticosteroid-dependent and colchicine-resistant recurrent pericarditis (RP) is a challenging management problem, in which conventional anti-inflammatory therapy (nonsteroidal anti-inflammatory drugs, colchicine, corticosteroids) is unable to control the disease. Recent data suggest a potential role for anti-interleukin-1 (IL-1) agents for this condition. This study was designed to assess the safety and efficacy of anti-IL-1 agents in this setting.MethodsWe performed a systematic review and meta-analysis of randomised controlled trials and observational studies assessing pericarditis recurrences and drug-related adverse events in patients receiving anti-IL-1 drugs for pericarditis.ResultsThe meta-analysis assessed 7 studies including 397 pooled patients with RP. The median age was 42 years, 60% were women and the aetiology was idiopathic in 87%. After a median follow-up of 14 months (IQR,12–39), patients receiving anti-IL-1 agents (anakinra or rilonacept) had a significantly reduction in pericarditis recurrences (incidence rate ratio 0.06, 95% CI 0.03 to 0.14), compared with placebo and/or standard medical therapy. Anti-IL-1 agents were associated with increased risk of adverse events compared with placebo (risk ratio (RR) 5.38, 95% CI 2.08 to 13.92): injection-site reactions occurred in 15/41 (36.6%) vs none (RR 14.98, 95% CI 2.09 to 107.09), infections occurred in 13/51 (25.5%) vs 3/41 (7.3%; RR 3.65, 95% CI 1.23 to 10.85). Anti-IL-1 agents were not associated with increased risk of severe adverse events.ConclusionsIn patients with RP, anti-IL-1 agents (anakinra and rilonacept) are efficacious for prevention of recurrences, without severe adverse events.
Primary results from TAIL: a global single-arm safety study of atezolizumab monotherapy in a diverse population of patients with previously treated advanced non-small cell lung cancer
Authors: Ardizzoni Andrea , Azevedo Sergio , Rubio-Viqueira Belen , Rodríguez-Abreu Delvys , Alatorre-Alexander Jorge , Smit Hans J M , Yu Jinming , Syrigos Konstantinos , Trunzer Kerstin , Patel Hina , Tolson Jonathan , Cardona Andres , Perez-Moreno Pablo D , Newsom-Davis Tom 
Published: March 2021

BackgroundAtezolizumab treatment improves survival, with manageable safety, in patients with previously treated advanced/metastatic non-small cell lung cancer. The global phase III/IV study TAIL (NCT03285763) was conducted to evaluate the safety and efficacy of atezolizumab monotherapy in a clinically diverse population of patients with previously treated non-small cell lung cancer, including those not eligible for pivotal trials.MethodsPatients with stage IIIB/IV non-small cell lung cancer whose disease progressed after 1–2 lines of chemotherapy were eligible for this open-label, single-arm, multicenter study, including those with severe renal impairment, an Eastern Cooperative Oncology Group performance status of 2, prior anti-programmed death 1 (PD-1) therapy, and autoimmune disease. Atezolizumab was administered intravenously (1200 mg every 3 weeks). Coprimary endpoints were treatment-related serious adverse events and immune-related adverse events.Results619 patients enrolled and 615 received atezolizumab. At data cutoff, the median follow-up was 12.6 months (95% CI 11.9 to 13.1). Treatment-related serious adverse events occurred in 7.8% and immune-related adverse events in 8.3% of all patients and as follows, respectively, in these subgroups: renal impairment (n=78), 11.5% and 12.8%; Eastern Cooperative Oncology Group performance status of 2 (n=61), 14.8% and 8.2%; prior anti–PD-1 therapy (n=39), 5.1% and 7.7%; and autoimmune disease (n=30), 6.7% and 10.0%. No new safety signals were reported. In the overall population, the median overall survival was 11.1 months (95% CI 8.9 to 12.9), the median progression-free survival was 2.7 months (95% CI 2.1 to 2.8) and the objective response rate was 11%.ConclusionsThis study confirmed the benefit–risk profile of atezolizumab monotherapy in a clinically diverse population of patients with previously treated non-small cell lung cancer. These safety and efficacy outcomes may inform treatment decisions for patients generally excluded from checkpoint inhibitor trials.
T cell infiltration on local CpG-B delivery in early-stage melanoma is predominantly related to CLEC9A+CD141+cDC1 and CD14+antigen-presenting cell recruitment
Authors: Koster Bas D , López González Marta , van den Hout Mari FCM , Turksma Annelies W , Sluijter Berbel JR , Molenkamp Barbara G , van Leeuwen Paul AM , Vosslamber Saskia , Scheper Rik J , van den Eertwegh Alfons JM , van den Tol M Petrousjka , Jordanova Ekaterina J , de Gruijl Tanja D 
Published: March 2021

BackgroundWe previously reported CpG-B injection at the primary tumor excision site prior to re-excision and sentinel node biopsy to result in immune activation of the sentinel lymph node (SLN), increased melanoma-specific CD8+T cell rates in peripheral blood, and prolonged recurrence-free survival. Here, we assessed recruitment and activation of antigen-presenting cell (APC) subsets in the SLN and at the injection site in relation to T cell infiltration.MethodsRe-excision skin specimens from patients with clinical stage I-II melanoma, collected 7 days after intradermal injection of either saline (n=10) or 8 mg CpG-B (CPG7909, n=12), were examined by immunohistochemistry, quantifying immune subsets in the epidermis, papillary, and reticular dermis. Counts were related to flow cytometric data from matched SLN samples. Additional in vitro cultures and transcriptional analyses on peripheral blood mononuclear cells (PBMCs) were performed to ascertain CpG-induced APC activation and chemokine profiles.ResultsSignificant increases in CD83+, CD14+, CD68+, and CD123+APC were observed in the reticular dermis of CpG-B-injected skin samples. Fluorescent double/triple staining revealed recruitment of both CD123+BDCA2+plasmacytoid dendritic cells (DCs) and BDCA3/CD141+CLEC9A+type-1 conventional DC (cDC1), of which only the cDC1 showed considerable levels of CD83 expression. Simultaneous CpG-B-induced increases in T cell infiltration were strongly correlated with both cDC1 and CD14 counts. Moreover, cDC1 and CD14+APC rates in the reticular dermis and matched SLN suspensions were positively correlated. Flow cytometric, transcriptional, and chemokine release analyses of PBMC, on in vitro or in vivo exposure to CpG-B, indicate a role for the activation and recruitment of both cDC1 and CD14+monocyte-derived APCs in the release of CXCL10 and subsequent T cell infiltration.ConclusionThe CpG-B-induced concerted recruitment of cDC1 and CD14+APC to the injection site and its draining lymph nodes may allow for both the (cross-)priming of T cells and their subsequent homing to effector sites.
Copy number loss in granzyme genes confers resistance to immune checkpoint inhibitor in nasopharyngeal carcinoma
Authors: Ma Yuxiang , Chen Xi , Wang Ao , Zhao Hongyun , Lin Qingguang , Bao Hua , Zhang Yang , Hong Shaodong , Tang Wanxiangfu , Huang Yan , Yang Yunpeng , Wu Xue , Shao Yang , Fang Wenfeng , Zhang Li 
Published: March 2021

BackgroundAnti-programmed death (PD)-1 therapy has recently been used in recurrent or metastatic (R/M) nasopharyngeal carcinoma (NPC). The long-term survival and its biomarkers responding to anti-PD-1 treatment in patients with R/M NPC remain unclear.MethodsPatients with R/M NPC were enrolled between March 2016 and January 2018 from two phase I clinical trials. The median follow-up period was 24.7 months. Eligible patients progressed on standard chemotherapy had measurable disease by Response Evaluation Criteria in Solid Tumor V.1.1. Non-obligatory contemporaneous tumor samples were collected for whole-exome sequencing. The primary outcome was objective response rate (ORR). Duration of response (DOR), progression-free survival (PFS), and overall survival (OS) were secondary outcomes assessed in all patients.ResultsAmong 124 evaluable patients, anti-PD-1 therapy achieved an ORR of 29.8% and a durable clinical benefit rate of 60.5%. The median OS (mOS) was 17.1 months (95% CI 14.2 to 24.7), median PFS (mPFS) was 3.8 months (95% CI 3.4 to 6.0), and median DOR was 9.5 months. Significant OS benefit from treatment was observed in patients without liver metastasis (23.8 vs 13.3 months, p=0.006). Copy number deletion in genes encoding granzyme B or granzyme H (GZMB/H) was associated with poor treatment outcome (mPFS altered vs wildtype: 1.7 vs 3.6 months, p=0.03; mOS altered vs wildtype: 10.1 vs 18 months, p=0.012).ConclusionsAnti-PD-1 treatment provided promising clinical benefit in pretreated patients with R/M NPC. Copy number loss in eitherGZMBorGZMHgenes was associated with reduced survival.
Temporal trends of the association between extreme temperatures and hospitalisations for schizophrenia in Hefei, China from 2005 to 2014
Authors: Pan Rubing , Wang Qizhi , Yi Weizhuo , Wei Qiannan , Cheng Jian , Su Hong 
Published: March 2021

ObjectiveWe aimed to examine the temporal trends of the association between extreme temperature and schizophrenia (SCZ) hospitalisations in Hefei, China.MethodsWe collected time-series data on SCZ hospitalisations for 10 years (2005–2014), with a total of 36 607 cases registered. We used quasi-Poisson regression and distributed lag non-linear model (DLNM) to assess the association between extreme temperature (cold and heat) and SCZ hospitalisations. A time-varying DLNM was then used to explore the temporal trends of the association between extreme temperature and SCZ hospitalisations in different periods. Subgroup analyses were conducted by age (0–39 and 40+ years) and gender, respectively.ResultsWe found that extreme cold and heat significantly increased the risk of SCZ hospitalisations (cold: 1st percentile of temperature 1.19 (95% CI 1.04 to 1.37) and 2.5th percentile of temperature 1.16 (95% CI 1.03 to 1.31); heat: 97.5th percentile of temperature 1.37 (95% CI 1.13 to 1.66) and 99th percentile of temperature 1.38 (95% CI 1.13 to 1.69)). We found a slightly decreasing trend in heat-related SCZ hospitalisations and a sharp increasing trend in cold effects from 2005 to 2014. However, the risk of heat-related hospitalisation has been rising since 2008. Stratified analyses showed that age and gender had different modification effects on temporal trends.ConclusionsThe findings highlight that as temperatures rise the body’s adaptability to high temperatures may be accompanied by more threats from extreme cold. The burden of cold-related SCZ hospitalisations may increase in the future.
Emergency general surgery utilization and disparities during COVID-19: an interrupted time-series analysis
Authors: Greenberg Anya L , Schwartz Hope , Collins Caitlin R , Kelly Yvonne M , Mackersie Robert , Mourad Michelle , Roberts John P , Bongiovanni Tasce 
Published: March 2021

ObjectiveWe aimed to compare general surgery emergency (GSE) volume, demographics and disease severity before and during COVID-19.BackgroundPresentations to the emergency department (ED) for GSEs fell during the early COVID-19 pandemic. Barriers to accessing care may be heightened, especially for vulnerable populations, and patients delaying care raises public health concerns.MethodsWe included adult patients with ED presentations for potential GSEs at a single quaternary-care hospital from January 2018 to August 2020. To compare GSE volumes in total and by subgroup, an interrupted time-series analysis was performed using the March shelter-in-place order as the start of the COVID-19 period. Bivariate analysis was used to compare demographics and disease severity.Results3255 patients (28/week) presented with potential GSEs before COVID-19, while 546 (23/week) presented during COVID-19. When shelter-in-place started, presentations fell by 8.7/week (31%) from the previous week (p<0.001), driven by decreases in peritonitis (β=−2.76, p=0.017) and gallbladder disease (β=−2.91, p=0.016). During COVID-19, patients were younger (54 vs 57, p=0.001), more often privately insured (44% vs 38%, p=0.044), and fewer required interpreters (12% vs 15%, p<0.001). Fewer patients presented with sepsis during the pandemic (15% vs 20%, p=0.009) and the average severity of illness decreased (p<0.001). Length of stay was shorter during the COVID-19 period (3.91 vs 5.50 days, p<0.001).ConclusionsGSE volumes and severity fell during the pandemic. Patients presenting during the pandemic were less likely to be elderly, publicly insured and have limited English proficiency, potentially exacerbating underlying health disparities and highlighting the need to improve care access for these patients.Level of evidenceIII.
Comparison of Survival between Single-Access and Conventional Laparoscopic Surgery in Rectal Cancer
Authors: Sirikurnpiboon Siripong 
Published: March 2021

Introduction. Innovative laparoscopic surgery for rectal cancer can be classified into 2 types: firstly, new instruments such as robotic surgery and secondly, new technique such as single-access laparoscopic surgery (SALS) and transanal total mesorectal excision (TaTME). Most reports of SALS for rectal cancer have shown pathologic outcomes comparable to those of conventional laparoscopic surgery (CLS); however, SALS is considered to be superior to CLS in terms of lower levels of discomfort and faster recovery rates. This study aimed to compare the survival outcomes of the two approaches. Methods. From 2011 to 2014, 84 cases of adenocarcinoma of the rectum and anal canal were enrolled. The operations were anterior, low anterior, intersphincteric, and abdominoperineal resections. Data collected included postoperative outcomes. The oncological outcomes recorded included 3-year and 5-year survival, local recurrence, and metastasis. Results. SALS was performed on 41 patients, and CLS was utilized in 43 cases. The demographic data of the two groups were similar. Intraoperative volumes of blood loss and conversion rates were similar, but operative time was longer in the SALS group. There were no significant differences in postoperative complications or pathological outcomes. The oncologic results were similar in terms of 3-year survival (100% and 97.7%;

p

= 1.00), 5-year survival (78.0% and 86.0%;

p

= 0.401), local recurrence rates (19.5% vs 11.6%,

p

= 0.376), and metastasis rates (19.5% vs 11.6%;

p

= 0.376) for SALS and CLS, respectively. Conclusion. SALS and CLS for rectal and anal cancer had comparable pathological and survival results, but SALS showed some superior benefits in the early postoperative period.