bluuebunny/crossref_metadata_2025_split huggingface dataset:
Study into the reversal of septic shock with landiolol (beta blockade): STRESS-L Study protocol for a randomised trial
Authors: Lall Ranjit , Mistry Dipesh , Skilton Emma , Boota Nafisa , Regan Scott , Bion Julian , Gates Simon , Gordon Anthony C , Lord Janet , McAuley Daniel Francis , Perkins Gavin , Singer Mervyn , Young Duncan , Whitehouse Tony 
Published: February 2021

IntroductionIn 2013, a single-centre study reported the safe use of esmolol in patients with septic shock and tachycardia who required vasopressor therapy for more than 24 hours. Although not powered to detect a change in mortality, marked improvements were seen in survival (adjusted HR, 0.39; 95% CI, 0.26 to 0.59; p<0.001). Beta blockers are one of the most studied groups of drugs but their effect in septic shock is poorly understood; proposed mechanisms include not only the modulation of cardiac function but also immunomodulation.Methods and analysisSTRESS-L is a randomised, open-label, non-blinded clinical trial which is enrolling a total of 340 patients with septic shock as defined by Sepsis-3 consensus definition and a tachycardia (heart rate ≥95 beats per minute (bpm)) after vasopressor treatment of at least 24 hours. Standard randomisation (1:1 ratio) allocates patients to receive usual care (according to international standards) versus usual care and a continuous landiolol infusion to reduce the heart rate between 80 and 94 bpm. The primary endpoint is the mean Sequential Organ Failure Assessment score over 14 days from entry into the trial and while in intensive care unit. Results will inform current clinical practice guidelines.Ethics and disseminationThis trial has clinical trial authorisation from the UK competent authority, the Medicines and Healthcare products Regulatory Agency, and has been approved by the East of England-Essex Research Ethics Committee (reference: 17/EE/0368).The results of the trial will be reported first to trial collaborators. The main report will be drafted by the trial coordinating team, and the final version will be agreed by the Trial Steering Committee before submission for publication, on behalf of the collaboration.RegistrationThe trial is funded by the National Institute for Health Research Efficacy and Mechanism Evaluation (EME) (Project Number: EME-14/150/85) and registeredISRCTN12600919and EudraCT: 2017-001785-14.
Protocol for a cluster randomised trial evaluating a multifaceted intervention starting preconceptionally—Early Interventions to Support Trajectories for Healthy Life in India (EINSTEIN): a Healthy Life Trajectories Initiative (HeLTI) Study
Authors: Kumaran Kalyanaraman , Krishnaveni Ghattu V , Suryanarayana Kumar Gavali , Prasad Manohar Prabhu , Belavendra Antonisamy , Atkinson Stephanie , Balasubramaniam Ramaswamy , Bandsma Robert H J , Bhutta Zulfiqar A , Chandak Giriraj Ratan , Comelli Elena M , Davidge Sandra T , Dennis Cindy-Lee , Hammond Geoffrey L , Jha Prabhat , Joseph K S , Joshi Sadhana R , Krishna Murali , Lee Kang , Lye Stephen , McGowan Patrick , Nepomnaschy Pablo , Padvetnaya Vivek , Pyne Saumyadipta , Sachdev Harshpal Singh , Sahariah Sirazul Ameen , Singhal Nalini , Trasler Jacquetta , Yajnik Chittaranjan S , Baird Janis , Barker Mary , Martin Marie-Claude , Husain Nusrat , Sellen Daniel , Fall Caroline H D , Shah Prakesh S , Matthews Stephen G 
Published: February 2021

IntroductionThe Healthy Life Trajectories Initiative is an international consortium comprising four harmonised but independently powered trials to evaluate whether an integrated intervention starting preconceptionally will reduce non-communicable disease risk in their children. This paper describes the protocol of the India study.Methods and analysisThe study set in rural Mysore will recruit ~6000 married women over the age of 18 years. The village-based cluster randomised design has three arms (preconception, pregnancy and control; 35 villages per arm). The longitudinal multifaceted intervention package will be delivered by community health workers and comprise: (1) measures to optimise nutrition; (2) a group parenting programme integrated with cognitive–behavioral therapy; (3) a lifestyle behaviour change intervention to support women to achieve a diverse diet, exclusive breast feeding for the first 6 months, timely introduction of diverse and nutritious infant weaning foods, and adopt appropriate hygiene measures; and (4) the reduction of environmental pollution focusing on indoor air pollution and toxin avoidance.The primary outcome is adiposity in children at age 5 years, measured by fat mass index. We will report on a host of intermediate and process outcomes. We will collect a range of biospecimens including blood, urine, stool and saliva from the mothers, as well as umbilical cord blood, placenta and specimens from the offspring.An intention-to-treat analysis will be adopted to assess the effect of interventions on outcomes. We will also undertake process and economic evaluations to determine scalability and public health translation.Ethics and disseminationThe study has been approved by the institutional ethics committee of the lead institute. Findings will be published in peer-reviewed journals. We will interact with policy makers at local, national and international agencies to enable translation. We will also share the findings with the participants and local community through community meetings, newsletters and local radio.Trial registration numberISRCTN20161479, CTRI/2020/12/030134; Pre-results.
Bundle approach used to achieve zero central line-associated bloodstream infections in an adult coronary intensive care unit
Authors: Gupta Poonam , Thomas Mincy , Patel Ashfaq , George Reeba , Mathews Leena , Alex Seenu , John Siji , Simbulan Cherlyn , Garcia Ma Leni , Al-Balushi Sara , El Hassan Mawahib 
Published: February 2021

BackgroundCentral venous catheterisation is commonly used in critical patients in intensive care units (ICU). It may cause complications and attribute to increase mortality and morbidity. At coronary ICU (CICU) of cardiac hospital, central line-associated bloodstream infection (CLABSI) rate was 2.82/1000 central line days in 2015 and 3.11/1000 central line days in 2016. Working in collaboration with Institute for Healthcare Improvement (IHI), we implemented evidence-based practices in the form of bundles in with the aim of eliminating CLABSI in CICU.MethodsIn collaboration with IHI, we worked on this initiative as multidisciplinary team and tested several changes. CLABSI prevention bundles were tested and implemented, single kit for line insertion, simulation-based training for line insertions, standardised and real-time bundle monitoring by direct observations are key interventions tested. We used model for improvement and changes were tested using small Plan-Do-Study-Act cycles. Surveillance methods and CLABSI definition used according to National Healthcare Safety Network.ResultsThe CLABSI rate per 1000 patient-days dropped from 3.1 per 1000 device-days to 0.4 per 1000 device-days. We achieved 757 days free of CLABSI in the unit till December 2018 when a single case happened. After that we achieved 602 free days till July 2020 and still counting.ConclusionsImplementation of evidence-based CLABSI prevention bundle and process monitoring by direct observation led to significant and subsequently sustained improvement in reducing CLABSI rate in adult CICU.
Body volume is the major determinant of worsening renal function in acutely decompensated heart failure with reduced left ventricular ejection fraction
Authors: Ho Mei Han , Huang Duo , Ho Chi-Wai , Zuo Ming-Liang , Luo An-Guo , Cheung Emmanuel , Zhou Mi , Cheng Yangyang , Liu Mingya , Yiu Kai-Hang , Lau Chu Pak , Yeung Pauline , Yue Wen Sheng , Yin Li-Xue , Tse Hung Fat , Jiang Wei , Lei Zhen , Li Xin-Li , Cowie M , Siu Chung Wah 
Published: February 2021

AbstractAimsLittle is known about the relative importance of body volume and haemodynamic parameters in the development of worsening of renal function in acutely decompensated heart failure (ADHF). To study the relationship between haemodynamic parameters, body water content and worsening of renal function in patients with heart failure with reduced ejection fraction (HFrEF) hospitalised for ADHF.Methods and resultsThis prospective observational study involved 51 consecutive patients with HFrEF (age: 73±14 years, male: 60%, left ventricular ejection fraction: 33.3%±9.9%) hospitalised for ADHF. Echocardiographic-determined haemodynamic parameters and body volume determined using a bioelectric impedance analyser were serially obtained. All patients received intravenous furosemide 160 mg/day for 3 days. There was a mean weight loss of 3.95±2.82 kg (p&lt;0.01), and brain natriuretic peptide (BNP) reduced from 1380±901 pg/mL to 797±738 pg/mL (p&lt;0.01). Nonetheless serum creatinine (SCr) increased from 134±46 μmol/L to 151±53 μmol/L (p&lt;0.01), and 35% of patients developed worsening of renal function. The change in SCr was positively correlated with age (r=0.34, p=0.017); and negatively with the ratio of extracellular water to total body water, a parameter of body volume status (r=−0.58, p&lt;0.001); E:E’ ratio (r=−0.36, p=0.01); right ventricular systolic pressure (r=−0.40, p=0.009); and BNP (r=−0.40, p=0.004). Counterintuitively, no correlation was observed between SCr and cardiac output, or total peripheral vascular resistance. Regression analysis revealed that normal body volume and lower BNP independently predicted worsening of renal function.ConclusionsNormal body volume and lower serum BNP on admission were associated with worsening of renal function in patients with HFrEF hospitalised for ADHF.
Effectiveness and safety of secukinumab in 608 patients with psoriatic arthritis in real life: a 24-month prospective, multicentre study
Authors: Ramonda Roberta , Lorenzin Mariagrazia , Carriero Antonio , Chimenti Maria Sole , Scarpa Raffaele , Marchesoni Antonio , Lubrano Ennio , Salvarani Carlo , Cauli Alberto , Semeraro Angelo , Santo Leonardo , Ortolan Augusta , Doria Andrea , Fracassi Elena , Virelli Giulia , Masia Marco , Fanizzi Rosalinda , Visalli Elisa , Amato Giorgio , Carletto Antonio , Foti Rosario 
Published: February 2021

ObjectivesTo evaluate in a multicentric Italian cohort of patients with psoriatic arthritis (PsA) on secukinumab followed for 24 months: (1) the long-term effectiveness and safety of secukinumab, (2) the drug retention rate and minimal disease activity (MDA), (3) diﬀerences in the outcomes according to the biological treatment line: biologic-naïve patients (group A) versus multifailure (group B) patients.MethodsConsecutive patients with PsA receiving secukinumab were evaluated prospectively. Disease characteristics, previous/ongoing treatments, comorbidities and follow-up duration were collected. Disease activity/functional/clinimetric scores and biochemical values were recorded at baseline (T0), 6(T6), 12(T12) and 24(T24) months. Effectiveness was evaluated overtime with descriptive statistics; multivariate Cox and logistic regression models were used to evaluate predictors of drug-discontinuation and MDA at T6. Infections and adverse events were recorded.Results608 patients (41.28% men; mean (SD) age 52.78 (11.33)) were enrolled; secukinumab was prescribed as first-line biological treatment in 227 (37.34%) patients, as second (or more)-line biological treatment in 381 (62.66%). Effectiveness of secukinumab was shown with an improvement in several outcomes, such as Ankylosing Spondylitis Disease Activity Score (T0=3.26 (0.88) vs T24=1.60 (0.69) ;p=0.02) and Disease Activity Index for Psoriatic Arthritis (T0=25.29 (11.14) vs T24=7.69 (4.51); p<0.01). At T24,group Ashowed lower Psoriasis Area Severity Index (p=0.04), erythrocyte sedimentation rate and C reactive protein (p=0.03 ;p=0.05) and joint count (p=0.03) compared withgroup B. At T24, MDA was achieved in 75.71% ofgroup Aand 70.37% ofgroup B. Treatment was discontinued in 123 (20.23%) patients, mainly due to primary/secondary loss of effectiveness, and in 22 due to adverse events. Retention rate at T24 was 71% in the whole population, with some difference depending on secukinumab dosage (p=0.004) and gender (p=0.05).ConclusionsIn a real-life clinical setting, secukimumab proved safe and effective in all PsA domains, with notable drug retention rate.
Association between lung function of school age children and short-term exposure to air pollution and pollen: the PARIS cohort
Authors: Amazouz Hélène , Bougas Nicolas , Thibaudon Michel , Lezmi Guillaume , Beydon Nicole , Bourgoin-Heck Mélisande , Just Jocelyne , Momas Isabelle , Rancière Fanny 
Published: February 2021

Background
Daily levels of ambient air pollution and pollen may affect lung function but have rarely been studied together. We investigated short-term exposure to pollen and air pollution in relation to lung function in school-age children from a French population-based birth cohort.

Methods

This study included 1063 children from the PARIS (Pollution and Asthma Risk: an Infant Study) cohort whose lung function and FeNO measurements were performed at age 8 years old. Exposure data were collected up to 4 days before testing. We estimated daily total pollen concentration, daily allergenic risk indices for nine pollen taxa, as well as daily concentrations of three air pollutants (particulate matter less than 10 µm (PM
10
), nitrogen dioxide (NO
2
), ozone (O
3
)). Children with similar pollen and air pollution exposure were grouped using multidimensional longitudinal cluster analysis. Associations between clusters of pollen and air pollution exposure and respiratory indices (FEV
1
, FVC, FeNO) were studied using multivariable linear and logistic regression models adjusted for potential confounders.

Results

Four clusters of exposure were identified: no pollen and low air pollution (Cluster 1), grass pollen (Cluster 2), PM
10
(Cluster 3) and birch/plane-tree pollen with high total pollen count (Cluster 4). Compared with children in Cluster 1, children in Cluster 2 had significantly lower FEV
1
and FVC levels, and children from Cluster 3 had higher FeNO levels. For FEV
1
and FVC, the associations appeared stronger in children with current asthma. Additional analysis suggested a joint effect of grass pollen and air pollution on lung function.

Conclusion
Daily ambient chemical and biological air quality could adversely influence lung function in children.
Risk of in-hospital mortality in severe acute kidney injury after traumatic injuries: a national trauma quality program study
Authors: Ahmed Nasim , Mathew Roy O , Kuo Yenhong , Asif Arif 
Published: February 2021

BackgroundThe development of acute kidney injury (AKI) in trauma patients has been associated with an almost threefold increase in overall mortality. Many risk factors of mortality in severe AKI have been reported, but majority of the studies have been performed using a single-center data or have a small sample size. The purpose of this study was to identify the risk factors of mortality in severe AKI trauma patients.MethodsThe study was performed using 2012-2016 American College of Surgeon Trauma Quality Improvement Program data, a national database of trauma patients in the USA.All adult trauma patients aged 16 to 89 years old, admitted to the hospital and who developed a severe AKI were included in the study. A p value of <0.05 was considered statistically significant.ResultsOut of 9309 trauma patients who developed severe AKI, 2641 (28.08%) died. There were significant differences found in bivariate analysis between the groups who died and who survived after developing a severe AKI. Multivariable analysis showed male sex, older age, higher Injury Severity Score, lower Glasgow Coma Scale, presence of hypotension (systolic blood pressure<90 mm Hg) and coagulopathy were all significantly associated with in-hospital mortality. The area under the curve value was 0.706 and the 95% CI was 0.68 to 0.727.DiscussionCurrent analysis showed certain patients’ characteristics are associated with higher mortality in patients with severe AKI. Prompt identification and aggressive monitoring and management in high-risk patients may result in reduced mortality.Level of evidenceIV.Study typeObservational cohort study.
Origins and chromosome differentiation of Thinopyrum elongatum revealed by PepC and Pgk1 genes and ND-FISH
Authors: Dai Yi , Huang Shuai , Sun Genlou , Li Haifeng , Chen Shiqiang , Gao Yong , Chen Jianmin 
Published: February 2021

Thinopyrum elongatum is an important gene pool for wheat genetic improvement. However, the origins of the Thinopyrum genomes and the nature of the genus’ intraspecific relationships are still controversial. In this study, we used single-copy nuclear genes and non-denaturing fluorescence in situ hybridization (ND-FISH) to characterize genome constitution and chromosome differentiation in Th. elongatum. According to phylogenetic analyses based on PepC and Pgk1 genes, there was an E genome with three versions (Ee, Eb, Ex) and St genomes in the polyploid Th. elongatum. The ND-FISH results of pSc119.2 and pAs1 revealed that the karyotypes of diploid Th. elongatum and Th. bessarabicum were different, and the chromosome differentiation occurred among accessions of the diploid Th. elongatum. In addition, the tetraploid Th. elongatum has two groups of ND-FISH karyotype, indicating that the tetraploid Th. elongatum might be a segmental allotetraploid. In summary, our results suggested that the diploid Th. elongatum, Th. Bessarabicum, and Pseudoroegneria were the donors of the Ee, Eb, and St genomes to the polyploid Th. elongatum, respectively.
Chapter 3.1b Antarctic Peninsula and South Shetland Islands: petrology
Authors: Leat Philip T. , Riley Teal R. 
Published: February 2021

Abstract
The Antarctic Peninsula contains a record of continental-margin volcanism extending from Jurassic to Recent times. Subduction of the Pacific oceanic lithosphere beneath the continental margin developed after Late Jurassic volcanism in Alexander Island that was related to extension of the continental margin. Mesozoic ocean-floor basalts emplaced within the Alexander Island accretionary complex have compositions derived from Pacific mantle. The Antarctic Peninsula volcanic arc was active from about Early Cretaceous times until the Early Miocene. It was affected by hydrothermal alteration, and by regional and contact metamorphism generally of zeolite to prehnite–pumpellyite facies. Distinct geochemical groups recognized within the volcanic rocks suggest varied magma generation processes related to changes in subduction dynamics. The four groups are: calc-alkaline, high-Mg andesitic, adakitic and high-Zr, the last two being described in this arc for the first time. The dominant calc-alkaline group ranges from primitive mafic magmas to rhyolite, and from low- to high-K in composition, and was generated from a mantle wedge with variable depletion. The high-Mg and adakitic rocks indicate periods of melting of the subducting slab and variable equilibration of the melts with mantle. The high-Zr group is interpreted as peralkaline and may have been related to extension of the arc.
Characterization of modern and historical seismic–tsunamic events and their global–societal impacts
Authors: Dilek Yildirim , Ogawa Yujiro , Okubo Yasukuni 
Published: February 2021

Abstract
Earthquakes and tsunamis are high-impact geohazard events that can be extremely destructive when they occur at large magnitudes and intensities, although their causes and potential locations are, for the most part, predictable within the framework of plate tectonics. Amongst the main reasons for their high impact include enormous numbers of casualties, extensive property damage in vast areas and significant social and economic disruption in urban settings where populous residential areas, global banking centres, industrial factories and critical facilities (nuclear power plants, dams) may be located. In order to reduce the impact of these geohazards, nations, societies, professional organizations and governments need to collaborate to prepare more effective seismic and tsunami risk assessments, disaster management plans, educational and training programmes for increased preparedness of the public, and strategic plans and objectives for capacity building, skill and knowledge transfer, and building of societal resilience. Improved building design and construction codes and emergency preparedness and evacuation plans should be part of disaster management plans in countries where destructive earthquakes and tsunamis have occurred. The rapid increases in population along coastal corridors in developing and developed countries is likely to escalate the social and economic impacts of these geohazards exponentially in the future. The chapters in this book present case studies of some of the most salient earthquake and tsunami events in historical and modern times, their origins and manifestations, and efforts and the most effective practices of risk assessment and disaster management implemented by various governments, international organizations and inter-governmental agencies following these events. New methods of computing probabilistic seismic hazard risks, delineating respect distance and damage zones along and across seismically active faults and recognizing tsunamigenic and submarine landslides on the seafloor are introduced. The conclusions presented in the chapters show that: (1) scientific understanding of the characteristics of seismically active faults is paramount; (2) increased local (community), national and global resilience is necessary to empower societal preparedness for earthquake and tsunami events; and, (3) all stakeholders, including policy-makers, scientists, local, state and national governments, media and world organizations (UNESCO, IUGS, GeoHazards International, Global Geodetic Observing System, National Earthquake Hazards Reduction Program) must work together to disseminate accurate and timely information on geohazards, to develop effective legislation for risk reduction and to prepare realistic and practical hazard mitigation and management measures.
Nonclassical monocytes in cardiovascular physiology and disease
Authors: Tahir Sibgha , Steffens Sabine 
Published: February 2021

Monocytes are a heterogeneous cell population of innate immune cells with distinct cell surface markers that help them in carrying out different functions. In humans, there are three well-characterized subsets, namely, classical (CD14++CD16−), intermediate (CD14++CD16+), and nonclassical (CD14+ CD16++) monocytes. There is an emerging focus on the not yet well explored nonclassical monocytes that maintain vascular integrity by slowly patrolling on the endothelium, reacting to inflammatory signals, and clearing cell debris. In this manner, they are not only crucial for vascular homeostasis but also play a vital role in wound healing and resolution of inflammation by linking innate to adaptive immune response. Although they have been shown to be protective, yet they are also associated with inflammatory disease progression. This short review will give an insight about the emerging role of nonclassical monocytes in vascular homeostasis, inflammation, and protection in the context of cardiovascular disease.