bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left Atrial Septal Pouch—Is it Really a New Risk Factor for Ischemic Stroke?
Authors: Michałowska Ilona , Dudzińska Katarzyna , Kowalik Ilona , Kwiatek Paweł , Piotrowski Roman , Kułakowski Piotr , Baran Jakub 
Published: February 2021

Purpose:
The atrial septal pouch is an anatomic variant of the interatrial septum caused by incomplete fusion of the septum primum and secundum. It is debatable whether coexistence of septal pouch and atrial fibrillation (AF) increases the risk of stroke. Thus, the aim of the study was to evaluate the coexistence of left atrial septal pouch (LASP) and AF in patients with a history of stroke in comparison with those without an earlier history of stroke.

Materials and Methods:
We analyzed 145 patients with AF (68 in the study group, 77 in the control group). The study group consisted of patients with previous stroke and AF; control group consisted of patients scheduled for AF ablation. All patients underwent computed tomography with the assessment of atrial septum morphology and presence of LASP. The study was a subanalysis of the ASSAM (AssesSment of the left atrial appendage morphoLogy in patients aAfter ischaeMic Stroke) study.

Results:
The prevalence of LASP in the entire group was 38.6%. There were no significant differences in the prevalence of LASP between the study and control groups (33.8% vs. 42.9%, P=0.265). Mean longitudinal and transverse dimensions of LASP were 9.34±3.27 and 2.4±0.6 mm, respectively, and there was no significant difference between the study and controls. Patients from the stroke group were older (P<0.0001), had a higher CHA2DS2-VASc score (5.41±1.93 vs. 1.62±1.46, P<0.0001) compared with controls.

Conclusions:
Presence of LASP is not more prevalent in patients with a history of stroke. Additional information on the presence of LASP do not improve accuracy of risk stratification for stroke in patients with AF.
Recombinant Human Thrombomodulin Has Additive Effects in Septic Patients Undergoing Continuous Hemodiafiltration Due to Intestinal Perforation
Authors: Kono Hiroshi , Hosomura Naohiro , Amemiya Hidetake , Kawaida Hiromichi , Furuya Shinji , Akaike Hidenori , Kawaguchi Yoshihiko , Sudo Makoto , Ichikawa Daisuke 
Published: February 2021

ABSTRACT

Background:
Disseminated intravascular coagulation (DIC) is associated with high mortality in patients with severe sepsis. The purpose of this study was to investigate the effects of recombinant human thrombomodulin (rhTM) in septic patients undergoing continuous hemodiafiltration (CHDF). Furthermore, effects of rhTM in acute lung injury, the first target organ in sepsis, were investigated using a sepsis model in rats.

Methods:
Clinical laboratory data, and the DIC, Sequential Organ Failure Assessment (SOFA), and Acute Physiologic and Chronic Health Evaluation (APACHE) II scores were compared between patients undergoing CHDF alone (rhTM− group; n = 23 cases) and patients undergoing CHDF treated with rhTM (rhTM+ group; n = 21 cases). Rats underwent cecal ligation and puncture (CLP) treated with or without rhTM, and acute lung injury (ALI) was analyzed. Production of TNF-α by isolated tissue macrophages (Mfs) was assessed.

Results:
The numbers of leukocytes, and C-reactive protein and D-dimer levels were significantly suppressed, and platelet counts recovered significantly faster in the rhTM+ group compared with the rhTM− group. The DIC score was reduced in both groups. The SOFA and APACHE II scores gradually reduced in the rhTM+ group. The CHDF treatment and ICU admission periods were shortened in the rhTM+ group compared with the rhTM− group. Treatment of rhTM was an independent factor for CHDF treatment period by multivariate analyses. CLP-induced ALI was significantly improved by rhTM. Increased TNF-α production by tissue Mfs was significantly suppressed by rhTM in vivo and in vitro

Conclusion:
Additive effects of rhTM treatment were observed in septic patients undergoing CHDF.
Cost-effectiveness of Diagnostic Tools to Establish the Presence of Peripheral Arterial Disease in People With Diabetes
Authors: Normahani Pasha , Epstein David M. , Gaggero Alessio , Davies Alun H. , Sounderajah Viknesh , Jaffer Usman 
Published: February 2021

Objective:
To evaluate the cost-effectiveness of point-of-care duplex ultrasound (PAD-scan) and other bedside tests for the diagnosis of peripheral arterial disease (PAD) in people with diabetes.

Background:
PAD is a risk factor for cardiovascular disease, diabetic foot ulceration (DFU), and amputation in diabetic patients. Diagnosis enables optimization of therapies to manage these risks. PAD-scan can be performed by frontline staff and has been shown to be the most accurate bedside test. However, its cost-effectiveness has not been investigated.

Methods:
A Markov model was constructed to estimate the health outcomes and costs over 5 years of different testing strategies applied to a cohort of diabetic patients. Bedside tests investigated were PAD-scan, ankle-brachial pressure index, toe-brachial pressure index, audible and visual Doppler, transcutaneous pressure of oxygen, and pulse palpation. Health outcomes were incidence of new DFU, major cardiovascular events, amputation, death, and DFU healing rates. Sensitivity analyses were performed.

Results:
PAD-scan was the most cost-effective bedside test with an incremental cost-effectiveness ratio of £11,391/quality-adjusted life years. PADscan had the highest probability (78.7%) of having the greatest net benefit at a willingness to pay threshold of £20,000 per quality-adjusted life years. It reduced the number of amputations by 24% and the number of cardiovascular deaths by 10% over 5 years, compared to toe-brachial pressure index (next best alternative). PAD-scans superiority in incremental cost-effectiveness ratio occurred at a PAD prevalence threshold of 0.24.

Discussion:
PAD-scan is a cost-effective test for the detection of PAD in patients with diabetes.
Clinical and Polysomnographic Characteristics of Nonobese and Obese Chinese Patients With Obstructive Sleep Apnea
Authors: Zou Huili , Jia Qingge , Yang Weiyi , Zhang Zhuo , Miao Jianting 
Published: February 2021

Purpose:
Obesity is a risk factor associated with the onset and exacerbation of obstructive sleep apnea (OSA). However, the majority of OSA patients in Asian populations are nonobese. To date, there have been insufficient large-scale studies of the differences in the clinical and polysomnographic features of obese and nonobese OSA patients in this population, and few studies have sought to identify predictors of OSA severity in affected obese and nonobese patients.

Methods:
We conducted a case-matched retrospective study, including 652 consecutive Chinese OSA patients (326 nonobese and 326 obese) to assess differences in demographic, clinical, and polysomnographic data between these two groups. Independent predictors of OSA severity were identified through multivariate linear regression analysis.

Results:
The age and gender distributions of our obese and nonobese OSA patient cohorts did not differ significantly (P > 0.05), and rates of comorbidities were comparable in these two patient groups (P > 0.05). Nonobese patients were more likely to report atypical symptoms of OSA, including insomnia (P < 0.001), irritability (P < 0.05), and depressive symptoms (P < 0.01), whereas obese patients were more likely to report typical symptoms of OSA, such as habitual snoring (P < 0.001), witnessed apnea (P < 0.05), and daytime sleepiness (P < 0.001). Relative to nonobese patients, those who were obese exhibited significantly higher apnea–hypopnea index during total sleep time (P < 0.001), apnea–hypopnea index during nonrapid eye movement sleep (P < 0.001), and apnea–hypopnea index during rapid eye movement sleep (P < 0.001), in addition to lower average oxygen saturation (P < 0.001), minimal oxygen saturation (P < 0.001), and a higher oxygen desaturation index (P < 0.001) and arousal index (P < 0.001). Total sleep time was, on average, shorter for nonobese patients (P < 0.05), who also exhibited decreased sleep efficiency and more frequent awakening relative to obese patients (P < 0.05). A multivariate linear regression analysis revealed that neck circumference and waist circumference were independent predictors of OSA severity in obese patients (P < 0.05).

Conclusions:
On average, OSA was typically less severe in nonobese patients, who were also more likely to experience atypical OSA symptoms relative to obese patients. These results also suggest that the differential contributions of body fat accumulation and distribution to OSA severity may offer insights into the pathogenesis, clinical manifestations, and optimal management of this condition in nonobese and obese patient populations. It is vital that clinicians consider these differences to properly diagnose and treat this debilitating condition.
Impact of COVID-19 on Mental Health: A Longitudinal Study Using Penalized Logistic Regression
Authors: Cui Jingyu , Lu Jingwei , Weng Yijia , Yi Grace Y. , He Wenqing 
Published: February 2021

AbstractThe COVID-19 pandemic has posed significant influence on the public mental health in a stealthy manner. Current efforts focus on alleviating the impacts of the disease on public health and economy, with the psychological effects due to COVID-19 largely ignored. In this paper, we analyze a mental health related dataset from the US to enhance our understanding of human reactions to the pandemic. We are particularly interested in providingquantitativecharacterization of the pandemic impact on the public mental health, on top ofqualitativeexplorations. We employ the multiple imputation by chained equations (MICE) method to deal with missing values and take the logistic regression with least absolute shrinkage and selection operator (Lasso) method to identify risk factors for mental health. The analyses are conducted to a large scale of online survey data from 12 consecutive weeks, so that the longitudinal trend of the risk factors can be investigated. Our analysis results unveil evidence-based findings to identify the groups who are psychologically vulnerable to COVID-19. This study is useful to assist healthcare providers and policy makers to take steps for mitigating the pandemic effects on public mental health.
Hydroxychloroquine for SARS-CoV-2 positive patients quarantined at home: The first interim analysis of a remotely conducted randomized clinical trial
Authors: Amaravadi Ravi K. , Giles Lydia , Carberry Mary , Hyman Matthew C. , Frank Ian , Nasta Sunita D. , Walsh Jennifer , Wileyto E. Paul , Gimotty Phyllis , Milone Michael , Teng Edith M. , Vyas Niraj J. , Balian Steve , Kolansky Jonathan A. , Abdulhay Nabil M. , McGovern Shaun K. , Gamblin Sarah , Doran Olivia , Callahan Paul L. , Abella Benjamin S. 
Published: February 2021

ABSTRACTBackgroundOlder patients are at risk of increased morbidity and mortality from COVID-19 disease due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). There are few effective treatments for outpatients with COVID-19.ObjectiveTo evaluate the efficacy of hydroxychloroquine to reduce time in quarantine for symptomatic ≥40 years-old COVID-19 patients.DesignA randomized, double-blind, placebo-controlled clinical trial.SettingOutpatients with polymerase chain reaction confirmed COVID-19 at a University of Pennsylvania affiliated testing center between April 15, 2020 and, July 14, 2020.ParticipantsOut of 5511 SARS-CoV-2 positive patients, 1072 met initial eligibility criteria for telephone-based recruitment, but only 34 subjects were able to be randomized.InterventionsHydroxychloroquine 400 mg per twice daily (n=17) or matching placebo (n=17), taken orally for up to 14 days.MeasurementsThe primary outcome was the time to release from quarantine. Secondary outcomes included the participant-reported secondary infection of co-inhabitants, hospitalization, treatment-related adverse events, time to symptom improvement, and incidence of cardiac arrhythmia.ResultsThe median time to release from quarantine for HCQ-treated vs. placebo-treated participants was 8 days (range 4-19 days) vs. 11 days (4-18 days); z-score +0.58, p=n.s. This did not meet the pre-specified criteria for early termination, however, this study was terminated early due to lack of feasibility. There was no mortality in either study arm.LimitationSince this study was terminated early due to a lack of feasibility, no conclusion can be made about the efficacy of hydroxychloroquine as a treatment for COVID-19 patients 40 years of age or older quarantined at home.ConclusionThe design of this remotely conducted study could guide testing of other more promising agents during the COVID-19 pandemic.Trial registrationClinicaltrials.gov identifier: NCT04329923
Specific Thoracic Pain: Red flag screening pathway for Physiotherapists. A Systematic Review
Authors: Erbesato Monica , Mourad Firas , Brindisino Fabrizio , Salomon Mattia , Rossettini Giacomo , Margelli Michele , Barbari Valerio , Storari Lorenzo , Andreoletti Federico , Disarò Jacopo , Maselli Filippo 
Published: February 2021

AbstractThe lifetime prevalence of isolated pain in the thoracic spine is relatively low, approximately 13-17%, compared to neck and low back pain, 40% and 57% respectively. However a patient with thoracic or chest pain is more likely to mask a serious pathology, such as spinal fracture, spinal tumor or metastasis, myocardial ischemia, pneumonia, etc.. A physical therapist is a primary healthcare professional and it is his responsibility to screen and identify serious pathologies outside the scope of practice. That is, differential diagnosis may help in excluding medical pain sources and, most importantly, recognize emergencys scenarios. An in-depth subjective and objective examination are the two pillars for the clinical evaluation that may help clinicians to determine if the pain is of musculoskeletal origin or not. In the literature, there is a lack of knowledge about the red flags (i.e. warning symptoms and signs) that can be useful for the screening for referral, not medical diagnosis, in the thoracic and chest wall pain. The aim of our systematic review is to investigate which findings form the subjective (symptoms and red flags) and objective examination (signs and tests) are valid tools for the differential diagnosis for thoracic pain or chest pain suspected to be caused by a serious pathology.
OBESITY MAY HAMPER SARS-CoV-2 VACCINE IMMUNOGENICITY
Authors: Pellini Raul , Venuti Aldo , Pimpinelli Fulvia , Abril Elva , Blandino Giovanni , Campo Flaminia , Conti Laura , De Virgilio Armando , De Marco Federico , Di Domenico Enea Gino , Di Bella Ornella , Di Martino Simona , Ensoli Fabrizio , Giannarelli Diana , Mandoj Chiara , Manciocco Valentina , Marchesi Paolo , Mazzola Francesco , Moretto Silvia , Petruzzi Gerardo , Petrone Fabrizio , Pichi Barbara , Pontone Martina , Zocchi Jacopo , Vidiri Antonello , Vujovic Branka , Piaggio Giulia , Morrone Aldo , Ciliberto Gennaro 
Published: February 2021

ABSTRACTBackgroundThe first goal of the study was to analyse the antibody titre 7 days after the second dose of BNT162b2 vaccine in a group of 248 healthcare workers (HCW). The second goal was to analyse how the antibody titre changes in correlation with age, gender and BMI.MethodsParticipants were assigned to receive the priming dose at baseline and booster dose at day 21. Blood and nasopharyngeal swabs were collected at baseline and 7 days after second dose of vaccine.Findings248 HWCs were analysed, 158 women (63.7%) and 90 men (36.3%). After the second dose of BNT162b2 vaccine, 99.5% of participants developed a humoral immune response.The geometric mean concentration of antibodies among the vaccinated subjects after booster dose (285.9 AU/mL 95% CI: 249.5-327.7); was higher than that of human convalescent sera (39.4 AU/mL, 95% CI: 33.1-46.9), with p<0.0001. The antibody titre was found to be higher in young and female participants. A strong correlation of BMI classes with antibody titres was noticed: humoral response was more efficient in the group with under- and normal-weight vs the group with pre- and obesity participants (p<0.0001 at T1).InterpretationThese findings imply that females, lean and young people have an increased capacity to mount humoral immune responses compared to males, overweight and the older population. Although further studies are needed, this data may have important implications for the development of vaccination strategies for COVID-19, particularly in obese people.FundingNone
Development of web-based quality-assurance tool for radiotherapy target delineation for head and neck cancer: quality evaluation of nasopharyngeal carcinoma
Authors: Kim Jun Won , Marsilla Joseph , Kazmierski Michal , Tkachuk Denis , Huang Shao Hui , Xu Wei , Cho John , Ringash Jolie , Bratman Scott , Haibe-Kains Benjamin , Hope Andrew 
Published: February 2021

AbstractPurposeWe developed QUANNOTATE, a new web-application for rapid review of radiotherapy (RT) target volumes, and used it to evaluate the relationship between target delineation compliance with the international guidelines and treatment outcomes in nasopharyngeal carcinoma (NPC) patients undergoing definitive RT.Methods and MaterialsThe dataset used for this study consists of anonymized CT simulation scans, RT structures, and clinical data of 332 pathologically confirmed NPC patients treated with intensity-modulated RT between July 2005 and August 2017. We imported the contours of intermediate risk clinical target volumes of the primary tumor (IR-CTVp) receiving 56 Gy into QUANNOTATE. We determined inclusion of anatomic sites within IR-CTVp in accordance with 2018 International guideline for CTV delineation for NPC and correlated the results with time to local failure (TTLF) using Cox-regression.ResultsAt a median follow-up of 5.6 years, 5-year TTLF and overall survival rates were 93.1% and 85.9% respectively. The most frequently non-guideline compliant anatomic sites were sphenoid sinus (n = 69, 20.8%), followed by cavernous sinus (n = 38, 19.3%), left and right petrous apices (n = 37 and 32, 11.1% and 9.6%), clivus (n = 14, 4.2%), and right and left foramen rotundum (n = 14 and 12, 4.2% and 3.6%). Among 23 patients with a local failure (6.9%), the number of non-compliant cases were 8 for sphenoid sinus, 7 cavernous sinus, 4 left and 3 right petrous apices, and 2 clivus. Compared to conforming cases, cases which did not contour the cavernous sinus had a higher local failure (LF) rate (89.1% vs 93.6%, p= 0.013). Multivariable analysis confirmed that lack of cavernous sinus contouring was prognostic for LF.ConclusionsQUANNOTATE allowed rapid review of target volumes in a large patient cohort. Despite an overall high compliance with the international guidelines, undercoverage of the cavernous sinus was correlated with LF.
Genetic Variations in Evolutionary Accelerated Regions Disrupt Cognition in Schizophrenia
Authors: Bhattacharyya Upasana , Kukshal Prachi , Bhatia Triptish , Deshpande Smita N , Thelma B.K 
Published: February 2021

AbstractCognition is believed to be a product of human evolution, while schizophrenia is ascribed as the by-product with cognitive impairment as it’s genetically mediated endophenotype. Genomic loci associated with these traits are enriched with recent evolutionary markers such as Human accelerated regions (HARs). HARs are markedly different in humans since their divergence with chimpanzees and mostly regulate gene expression by binding to transcription factors and/or modulating chromatin interactions. We hypothesize that variants within HARs may alter such functions and thus contribute to disease pathogenesis. 49 systematically prioritized variants from 2737 genome-wide HARs were genotyped in a north-Indian schizophrenia cohort (331 cases, 235 controls). Six variants were significantly associated with cognitive impairment in schizophrenia, thirteen with general cognition in healthy individuals. These variants were mapped to 122 genes; predicted to alter 70 transcription factors binding sites and overlapped with promoters, enhancers and/or repressors. These genes and TFs are implicated in neurocognitive phenotypes, autism, schizophrenia and bipolar disorders; a few are targets of common or repurposable antipsychotics suggesting their draggability; and enriched for immune response and brain developmental pathways. Immune response has been more strongly targeted by natural selection during human evolution and has a prominent role in neurodevelopment. Thus, its disruption may have deleterious consequences for neuronal and cognitive functions. Importantly, among the 15 associated SNPs, 12 showed association in several independent GWASs of different neurocognitive functions. Further analysis of HARs may be valuable to understand their role in cognition biology and identify improved therapeutics for schizophrenia.
Knowledge, Attitude, and Practices towards SARS-COV-2 Infection in the United Arab Emirates Population: a Cross-sectional Survey-based Study
Authors: Alremeithi Hamda Musabbah , Alghefli Aljazia Khalfan , Almadhani Rouqyah , AlKetbi Latifa Baynouna 
Published: February 2021

AbstractIn the current situation involving the novel coronavirus disease (COVID-19), the disease containment depends mainly on the population’s preventive practices and self-isolation. In this study, we explored the adult population’s approach towards COVID-19 in UAE between the 4th and 14th of April 2020. We used a community-based, cross-sectional study using a self-administered electronic questionnaire covering five different aspects: demographics, knowledge, practice, attitude, source and trust of information, and a patient health questionnaire (PHQ-2) for depression screening. A total of 1,867 people responded to the survey. Knowledge results were better in people with higher education levels, non-UAE nationals, those with a higher PHQ-2 score, or with a positive contact history with a SARS-COV-2 infected patient. The best practice scores were shown by participants with high knowledge scores and education levels. Depression risk was significantly higher in men, non-UAE nationals, in those with lower knowledge scores, and younger ages. The most followed practices were staying home, handwashing, avoiding social gatherings, limiting three people per vehicle, and avoiding public transportation. The least practiced measures were covering the face while sneezing or coughing and wearing masks. Although staying home was reported by 92.5% of participants, 22.6% mentioned that they were visited by more than 2 people and visited others in 18.4% during the last week. Social media was the source of information for 82.1% of the participants, and most trusted doctors and healthcare providers. A depression risk was present in 18.9% of the participants and the majority of respondents agreed that SARS-COV-2 infection will finally be successfully controlled. The obtained results on knowledge and practices, although satisfactory, could be insufficient to prevent this pandemic from being contained. We recommend the intensification of awareness programs and good practices. Mental health is an area worth further studies.