bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diamond–Forrester classification using echocardiography haemodynamic assessment in cardiac intensive care unit patients
Authors: Kim Kyung‐Hee , Jentzer Jacob C. , Wiley Brandon M. , Miranda William R. , Bennett Courtney , Barsness Gregory W. , Oh Jae K. 
Published: September 2021

AbstractAimsWe sought to determine whether the Diamond–Forrester classification using non‐invasive haemodynamic measurements by 2‐D and Doppler echocardiography would predict hospital mortality in cardiac intensive care unit (CICU) patients.Methods and resultsWe retrospectively analysed unique patients admitted to the CICU at Mayo Clinic Rochester from 2007 to 2018. Doppler‐derived cardiac index (CI) and ratio of mitral valve E velocity to medial mitral annulus e′ velocity (E/e′ ratio) were used to classify patients into four profiles: Profile I (warm/dry), Profile II (warm/wet), Profile III (cold/dry), and Profile IV (cold/wet). Logistic regression was used to determine predictors of hospital mortality, and Cox proportional‐hazards analysis was used to determine predictors of mortality during one year of follow‐up. We included 4563 patients with a mean age of 68.3 ± 14.3 years, including 36.2% female patients. The distribution of each profile was as follows: I, 47.4%; II, 36.2%; III, 7.9%; IV, 8.5%. A total of 5.8% patients died during hospitalization, and 18.1% died by 1 year. Patients with either low CI or elevated E/e′ ratio had higher in‐hospital and 1 year mortality. Patients with elevated E/e′ ratio (i.e. Profiles II and IV) had an increased risk of death during hospitalization and at 1 year after multivariate adjustment (adjusted hazard ratio 1.72 and 2.17 for 1 year mortality, respectively, compared with Profile I, P < 0.01).ConclusionsSimple Doppler echocardiographic assessment can be used to identify haemodynamic profiles defined by the Diamond–Forester classification in patients admitted in CICU. These profiles predict outcomes and may be used to guide therapy in critically ill patients.
Effects of mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction patients with chronic obstructive pulmonary disease in EMPHASIS‐HF and RALES
Authors: Yeoh Su E. , Dewan Pooja , Serenelli Matteo , Ferreira João Pedro , Pitt Bertram , Swedberg Karl , van Veldhuisen Dirk J. , Zannad Faiez , Jhund Pardeep S. , McMurray John J.V. 
Published: September 2021

AbstractAimsHeart failure with reduced ejection fraction (HFrEF) and chronic obstructive pulmonary disease (COPD) individually cause significant morbidity and mortality. Their coexistence is associated with even worse outcomes, partly due to suboptimal heart failure therapy, especially underutilisation of beta‐blockers. Our aim was to investigate outcomes in HFrEF patients with and without COPD, and the effects of mineralocorticoid receptor antagonists (MRAs) on outcomes.Methods and resultsWe studied the effect of MRA therapy in a post‐hoc pooled analysis of 4397 HFrEF patients in the RALES and EMPHASIS‐HF trials. The primary endpoint was the composite of heart failure hospitalisation or cardiovascular death. A total of 625 (14.2%) of the 4397 patients had COPD. Patients with COPD were older, more often male, and smokers, but less frequently treated with a beta‐blocker. In patients with COPD, event rates (per 100 person‐years) for the primary endpoint and for all‐cause mortality were 25.2 (95% confidence interval 22.1–28.7) and 17.2 (14.9–19.9), respectively, compared with 19.9 (18.8–21.1) and 12.8 (12.0–13.7) in participants without COPD. The risks of all‐cause hospitalisation and sudden death were also higher in patients with COPD. The benefit of MRA, compared with placebo, was consistent in patients with or without COPD for all outcomes, e.g. hazard ratio for the primary outcome 0.66 (0.50–0.85) for COPD and 0.65 (0.58–0.73) for no COPD (interaction p = 0.93). MRA‐induced hyperkalaemia was less frequent in patients with COPD.ConclusionsIn RALES and EMPHASIS‐HF, one‐in‐seven patients with HFrEF had coexisting COPD. HFrEF patients with COPD had worse outcomes than those without. The benefits of MRAs were consistent, regardless of COPD status.
Transition‐Metal‐Free Intermolecular Chlorodifluoromethylthiolation of Alkenes and Alkynes
Authors: Yuan Wan‐Qiang , Guo Li‐Yun , Liu Yu‐Tao , Li Qing , Shi Jie , Pan Fei 
Published: September 2021

AbstractA general and convenient method for the direct transition‐metal‐free intermolecular chlorodifluoromethylthiolation of a variety of unactivated alkenes and alkynes has been described. This methodology exhibits good functional group tolerance and is operationally simple. Mechanistic studies indicated an electrophilic substitution mechanism, and the strong electrophilic difluoromethylthiolating reagent HCF2SCl was generated in situ under standard reaction conditions. The developed protocol fulfils the requirements of sustainable and green chemistry.
Micelle‐Mediated Trimerization of Ynals to Orthogonally Substituted 4H‐Pyrans in Water: Downstream Rearrangement to Bioactive 2,8‐dioxabicyclo[3.3.1]nona‐3,6‐diene Frameworks
Authors: Rashid Showkat , Bhat Bilal A. , Mehta Goverdhan 
Published: September 2021

AbstractAn efficient trimerization of ynals to diversely substituted 4H‐pyran constructs has been executed in water, under ambient conditions employing micellar catalysis. The method is in agreement with the ideas of green and sustainable chemistry. The locus of the micellar reaction site has been probed through proton NMR studies. A general acid‐mediated downstream rearrangement of the derived 4H‐pyrans to interesting 2,8‐dioxabicyclo[3.3.1]nona‐3,6‐dienes has been observed.
S‐Adenosyl‐L‐Homocysteine Hydrolase Immobilized on Citric Acid‐capped Gallium Oxyhydroxide on SWCNTs Modified Electrode for AdoHcy Impedimetric Sensing
Authors: Knežević Sara , Ognjanović Miloš , Gavrović Jankulović Marija , Đurašinović Tatjana , Antić Bratislav , Djurić Sanja Vranješ , Stanković Dalibor M. 
Published: September 2021

AbstractS‐Adenosyl‐L‐Homocysteine (AdoHcy) is a crucial pathological factor in homocysteine‐associated disorders. We developed an impedimetric approach for single drop S‐Adenosyl‐L‐Homocysteine detection, based on S‐Adenosyl‐L‐Homocysteine hydrolase (SAH), produced in the prokaryotic expression system (E. coli) by recombinant DNA technology, immobilized on citrate acid‐coated gallium oxyhydroxide dispersed over single‐walled carbon nanotubes (CA/GaO(OH)@SWCNT). The proposed biosensor offers detection of AdoHcy, with a limit of detection (LOD) of 0.17 μM. with operating linear range from 1 to 44 μM. The remarkable stability of gallium oxyhydroxide crystal was further improved by citric acid coating and its optical, electrical and physical anisotropy was skipped using SWCNTs.
Associations of diarrhea episodes and seeking medical treatment among children under five years: Insights from the Zimbabwe Demographic Health Survey (2015–2016)
Authors: Musuka Godfrey , Dzinamarira Tafadzwa , Murewanhema Grant , Cuadros Diego , Chingombe Innocent , Herrera Helena , Takavarasha Felicia , Mapingure Munyaradzi 
Published: September 2021

AbstractDiarrhea is a significant pediatric public health concern globally and places a significant burden on healthcare systems. In resource‐limited settings, the problems of diarrhea could be worse than reported. Continuously monitoring and understanding the changing epidemiology of diarrhea, including risk factors, remain an important aspect necessary to design effective public health interventions to reduce the incidence, outcomes and strain on healthcare resources caused by diarrheal illness. We, therefore, undertook this study to understand the factors associated with diarrhea as well as describe determinants for seeking medical treatment in children under‐five in Zimbabwe using the Zimbabwe Demographic and Health Survey 2015–2016 Data. Children with recent diarrhea were on average younger (mean age 22 months), compared to those who did not have an episode of diarrhea (mean age 30 months) p = .001. Incidence of recent diarrhea was lower among female children compared to their male counterparts (16% vs. 19%), p = .013. Incidence of diarrhea decreased with increasing maternal education level and so was the same for increasing wealth quintile. Those with unimproved sources of drinking water had a higher incidence of diarrhea. The wealth quintile remained the only factor associated with seeking medical attention for a recent diarrhea episode among children less than 6 years, with those in the highest wealth quintile being 2.49 times likely to do so, p = .031. The results are useful in informing pediatric public health policies and strategies for them to be successful in significantly reducing the incidence, morbidity, mortality and significant healthcare costs and burden to society associated with caring for children with diarrheal illnesses.
Comparing the family characteristics, professional profile, and personality traits of COVID‐19 volunteer and nonvolunteer frontline healthcare workers at the epicenter in Nigeria
Authors: Olagundoye Olawunmi , Adewole Oluremi , Onafeso Esther Tolulope , Akinwumi Omobolanle , Amosun Folasade , Popoola Olalekan 
Published: September 2021

AbstractBackgroundEmergency volunteering becomes a necessity in the face of unprecedented disasters like the coronavirus disease 2019 (COVID‐19) pandemic. There is a paucity of empirical data on volunteerism not imported from the developed countries. It became necessary to evaluate the local‐bred volunteerism with its peculiarity, as it emerged within the public health sector of Nigeria's COVID‐19 epicenter.ObjectivesTo compare the family characteristics, professional profiles, and personality traits of volunteer and nonvolunteer COVID‐19 frontline healthcare workers (HCWs). To determine the significant predictors of volunteering as well as the deterrents to and motivation for volunteering.MethodA comparative cross‐sectional study was conducted between May and August 2020 among COVID‐19 volunteer and nonvolunteer HCWs serving at the six dedicated COVID‐19 isolation/treatment centers and the 27 general hospitals, respectively. Using a stratified sampling technique, three professional categories of HCWs (doctors, nurses, and medical laboratory scientists) were randomly selected from the nonvolunteers while total enumeration of volunteers was done. The survey employed pilot‐tested self‐administered questionnaires. The univariate, bivariate, and multivariate analyses were carried out with IBM Statistical Package for Social Sciences (SPSS) version 23.0. The level of statistical significance was determined by a P‐value of <.05.ResultsA total of 244 volunteers and 736 nonvolunteers HCWs participated in this survey. Sex, ethnicity, professional level, income level, number of years of practice, and traits of agreeableness and conscientiousness were significantly different between volunteers and nonvolunteers (P < .05). Inadequate personal protective equipment (PPE), lack of insurance, and inadequate hazard allowance deterred nonvolunteers. After regression analysis, the significant predictors of volunteerism included sex (odds ratio [OR] = 2.644; confidence interval [CI]: 1.725‐4.051), ethnicity (OR = 2.557; CI: 1.551‐4.214), and professional level (matrons: OR = 0.417; CI: 0.254‐0.684, consultants: OR = 0.171; CI: 0.038‐0.757).ConclusionHRH crisis in the face of high‐danger situations such as the COVID‐19 pandemic makes it urgent for health policymakers to address the identified barriers to volunteerism in order to optimize the health outcomes of the population.
Rainfall retention and runoff generation processes in tropical mature green roof ecosystems
Authors: Arellano‐Leyva Eréndira Alejandra , López‐Portillo Melissa , Muñoz‐Villers Lyssette Elena , Prado‐Pano Blanca Lucía 
Published: September 2021

AbstractRainfall retention and runoff detention are likely the most important ecosystem services provided by extensive green roofs (EGRs) that contribute to urban stormwater mitigation and management. However, the hydrological performance and runoff generation mechanisms of mature, well‐established EGRs in tropical regions remain poorly understood. This study evaluated the rainfall retention, discharge detention times and processes of runoff generation in two neighbouring 20‐year‐old EGRs with different slopes (2° and 14° for EGRns and EGRws, respectively) and management practices in Mexico City; results were compared with those obtained in a conventional roof (CR, 2° slope). Precipitation, substrate moisture and storm runoff were continuously measured during the 2017 and 2018 rainy seasons (May–November). Results showed spatial differences in substrate properties and moisture within and between green roofs. In general, higher bulk densities and a wide range of variation in water content characterized the bare substrate areas compared to those below vegetation. Greatest increases in substrate moisture and storm runoff were observed in the steeper green roof. Subsurface flow was the dominant process controlling the amount and timing of stormflow in the EGRs. The occurrence of saturation excess overland flow was small and detected when large rain events were preceded by high wetness conditions. The main factors influencing the hydrological responses of the green roofs were their substrate hydrophysical properties, related mostly to vegetation cover, management and age, and to much lesser extent to slope and substrate depth. On average, rainfall retention was ~60% in the EGRs with significantly longer delays and prolonged runoff times (100 and 340 min, respectively) compared to CR (3%, 20 min, and 258 min, respectively). Overall, these findings highlight the potential of EGRs in reducing stormflow and peak discharges for most rainfall in Mexico City, and thus mitigating the risk of saturation and overflow of urban drainages.
A hydrographic method to identify the groundwater net recharge, barometric effect and evapotranspiration from a complicated semidiurnal water table fluctuation
Authors: Cheng Donghui , Yuan Jing , Qi Lijun 
Published: September 2021

AbstractA hydrographic method was proposed to separate out the hourly scaled groundwater level changes caused by net recharge, barometric effects and evapotranspiration from a semidiurnal water table fluctuation. A characteristic midnight time, with a turning point of the barometric pressure change and high relative air humidity, which meant that neither the barometric effect nor groundwater evapotranspiration occurred, was proposed for determining the net recharge rate rnet. Then, the barometric efficiency fbar was estimated using the other time period without evapotranspiration, and the evapotranspiration rate rETG was finally obtained using the remainder of the water level changes. A case example illustrated that estimation of fbar using the proposed method was more accurate than that using the traditional error analysis method, which may result in a significant underestimation under the condition of the present water level changes. Additionally, the abnormal semidiurnal fluctuations, more specifically, two step‐down fluctuations, which may be a common pattern when the groundwater level is controlled by net recharge, barometric effects and evapotranspiration, can be well understood using the three components separated out. The results also showed that nighttime groundwater evapotranspiration, accounting for an average of 23% of that during the daytime, cannot be ignored.
A quantitative polymerase chain reaction based method for molecular subtype classification of urinary bladder cancer—Stromal gene expressions show higher prognostic values than intrinsic tumor genes
Authors: Olah Csilla , Hahnen Christina , Nagy Nikolett , Musial Joanna , Varadi Melinda , Nyiro Gabor , Gyorffy Balazs , Hadaschik Boris , Rawitzer Josefine , Ting Saskia , Sjödahl Gottfrid , Hoffmann Michéle J. , Reis Henning , Szarvas Tibor 
Published: September 2021

AbstractTranscriptome‐based molecular subtypes of muscle‐invasive bladder cancer (MIBC) have been shown to be both prognostic and predictive, but are not used in routine clinical practice. We aimed to develop a feasible, reverse transcription quantitative polymerase chain reaction (RT‐qPCR)‐based method for molecular subtyping. First, we defined a 68‐gene set covering tumor intrinsic (luminal, basal, squamous, neuronal, epithelial‐to‐mesenchymal, in situ carcinoma) and stromal (immune, extracellular matrix, p53‐like) signatures. Then, classifier methods with this 68‐gene panel were developed in silico and validated on public data sets with available subtype class information (MD Anderson [MDA], The Cancer Genome Atlas [TCGA], Lund, Consensus). Finally, expression of the selected 68 genes was determined in 104 frozen tissue samples of our MIBC cohort by RT‐qPCR using the TaqMan Array Card platform and samples were classified by our newly developed classifiers. The prognostic value of each subtype classification system and molecular signature scores were assessed. We found that the reduced marker set combined with the developed classifiers were able to reproduce the TCGA II, MDA, Lund and Consensus subtype classification systems with an overlap of 79%, 76%, 69% and 64%, respectively. Importantly, we could successfully classify 96% (100/104) of our MIBC samples by using RT‐qPCR. Neuronal and luminal subtypes and low stromal gene expressions were associated with poor survival. In conclusion, we developed a robust and feasible method for the molecular subtyping according to the TCGA II, MDA, Lund and Consensus classifications. Our results suggest that stromal signatures have a superior prognostic value compared to tumor intrinsic signatures and therefore underline the importance of tumor‐stroma interaction during the progression of MIBC.
Clinical validation of p16/Ki‐67 dual‐stained cytology triage of HPV‐positive women: Results from the IMPACT trial
Authors: Wright Thomas C. , Stoler Mark H. , Ranger‐Moore Jim , Fang Qijun , Volkir Patrick , Safaeian Mahboobeh , Ridder Ruediger 
Published: September 2021

AbstractTriage strategies are needed for primary human papillomavirus (HPV)‐based cervical cancer screening to identify women requiring colposcopy/biopsy. We assessed the performance of p16/Ki‐67 dual‐stained (DS) immunocytochemistry to triage HPV‐positive women and compared it to cytology, with or without HPV16/18 genotyping. A prospective observational screening study enrolled 35 263 women aged 25 to 65 years at 32 U.S. sites. Cervical samples had HPV and cytology testing, with colposcopy/biopsy for women with positive tests. Women without cervical intraepithelial neoplasia Grade 2 or worse (≥CIN2) at baseline (n = 3876) were retested after 1 year. In all, 4927 HPV‐positive women with valid DS results were included in this analysis. DS sensitivity for ≥CIN2 and ≥CIN3 at baseline was 91.2% (95% confidence interval [CI]: 86.8%‐94.2%) and 91.9% (95% CI: 86.1%‐95.4%), respectively, in HPV16/18‐positive women and 83.0% (95% CI: 78.4%‐86.8%) and 86.0% (95% CI: 77.5%‐91.6%) in women with 12 “other” genotypes. Using DS alone to triage HPV‐positive women showed significantly higher sensitivity and specificity than HPV16/18 genotyping with cytology triage of 12 “other” genotypes, and substantially higher sensitivity but lower specificity than using cytology alone. The risk of ≥CIN2 was significantly lower in HPV‐positive, DS‐negative women (3.6%; 95% CI: 2.9%‐4.4%), compared to triage‐negative women using HPV16/18 genotyping with cytology for 12 “other” genotypes (7.4%; 95% CI: 6.4%‐8.5%; P < .0001) or cytology alone (7.5%; 95% CI: 6.7%‐8.4%; P < .0001). DS showed better risk stratification than cytology‐based strategies and provided high reassurance against pre‐cancers both at baseline and at 1‐year follow‐up, irrespective of the HPV genotype. DS allows for the safe triage of primary screening HPV‐positive women.
Hypothyroidism is a predictive factor of superior antitumour efficacy of programmed death 1 inhibitors in hepatocellular carcinoma
Authors: Xu Lei , Leng Chao , Chen Lin , Dong Hanhua , Chen Yifa , Chen Xiaoping 
Published: September 2021

AbstractProgrammed death 1 (PD‐1) inhibitors are widely used for treatment of hepatocellular carcinoma (HCC). Hypothyroidism is commonly associated with this therapy, although the mechanism underlying this complication and effects on patient prognosis remain unclear. We retrospectively analysed the data of patients with HCC who received anti‐PD‐1 therapy at Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology between January 2018 and May 2020. Based on thyroid function evaluation, patients were categorised into hypothyroidism group and nonhypothyroidism group. Follow‐up was completed on February 28, 2021. The primary endpoint of our study was progression free survival (PFS). The study included 74 patients, and the disease control rate was higher in hypothyroidism group (62.7%, 27/43) than in nonhypothyroidism group (36.4%, 11/31) (P = .020). The PFS was longer in hypothyroidism group (7.44 months) than in nonhypothyroidism group (5.68 months) (P = .006). Additionally, the PFS of patients with hypothyroidism before immunotherapy (6.27 months) was also longer than that in nonhypothyroidism group (5.68 months), although the difference was statistically nonsignificant (P = .527). Cox regression analysis showed that the hazard ratios of hypothyroidism, Child‐Pugh grade B at initial admission and serum gamma‐glutamyl transferase levels >71 U/L before immunotherapy were 0.404 (95% confidence interval [CI]: 0.207‐0.791, P = .008), 2.753 (95%CI: 1.127‐6.455, P = .026) and 2.469 (95%CI: 1.155‐5.277, P = .020), respectively. Hypothyroidism was associated with prognosis in patients with HCC treated with PD‐1 inhibitors, and prognosis was more favourable in patients with hypothyroidism than in those without hypothyroidism. Hypothyroidism and the Child‐Pugh grade at initial admission were independently associated with patient prognosis.
Conservative stepwise surgical approach for management of placenta previa accreta: A prospective case series study
Authors: Ghaleb Mahmoud M. , Safwat Sarah , Purohit Ramkrishna , Samy Mohammed 
Published: September 2021

AbstractObjectiveTo describe a stepwise surgical approach for conservative management of placenta previa accreta to preserve the uterus and to evaluate the efficacy and safety of this approach in controlling postpartum hemorrhage including intrapartum hemorrhage.MethodsA prospective case series study conducted on 62 pregnant women with one or more cesarean deliveries diagnosed with placenta previa accreta between January 2018 and June 2019 at Ain Shams University Maternity Hospital. All participants underwent a conservative stepwise surgical approach through Pfannenstiel skin incision with fetal delivery through a uterine incision just above the upper border of the placenta, followed by bilateral uterine artery ligation with myometrial excision of the remaining adherent placenta and cervico‐isthmic sutures by MMG (the main surgeon) and MS.ResultsAmong 62 women, the surgical approach was successful in controlling postpartum hemorrhage and preserving the uterus in 50 (80.64%) participants. Three women (4.83%) had urinary bladder injuries, all were managed intraoperatively during the cesarean section. Five women (8%) had postpartum pyrexia and five women (8%) had postpartum endometritis, all were managed conservatively with broad‐spectrum antibiotics.ConclusionThe stepwise surgical approach can be applied to the conservative management of placenta previa accreta to avoid unnecessary cesarean hysterectomy.