bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short‐term ketone monoester supplementation improves cerebral blood flow and cognition in obesity: A randomized cross‐over trial
Authors: Walsh Jeremy J. , Caldwell Hannah G. , Neudorf Helena , Ainslie Philip N. , Little Jonathan P. 
Published: October 2021

AbstractAdults with obesity are at increased risk of neurocognitive impairments, partly as a result of reduced cerebral blood flow and brain‐derived neurotrophic factor (BDNF). Ketone supplements containing β‐hydroxybutyrate (β‐OHB) are a purported therapeutic strategy for improving brain health in at‐risk populations. We tested the hypothesis that short‐term β‐OHB supplementation will elevate cerebral blood flow and BDNF, as well as improve cognition in adults with obesity. In a placebo‐controlled double‐blind, cross‐over design, 14 adults with obesity (10 females; aged 56 ± 12 years; body mass index = 33.8 ± 6.9 kg m–2) consumed 30 mL (12 g) of β‐OHB or placebo thrice‐daily for 14 days. Blood flow (Q) and cerebrovascular conductance (CVC) were measured in the common carotid (CCA), internal carotid (ICA) and vertebral (VA) arteries by duplex ultrasound. BDNF was measured by an enzyme‐linked immunosorbent assay. Cognition was assessed by the digit‐symbol substitution (DSST), Stroop and task‐switching tests. Following 14 days of ketone supplementation, we observed significant improvements in cerebrovascular outcomes including QCCA (+12%), QVA (+11%), VACVC (+12%) and VA shear rate (+10%). DSST performance significantly improved following ketone supplementation (+2.7 correct responses) and improved DSST performance was positively associated improvements in cerebrovascular outcomes including QCCA, CCACVC, QVA and VACVC. By contrast to one hypothesis, β‐OHB did not impact fasting serum and plasma BDNF. β‐OHB supplementation improved cognition in adults with obesity, which may be partly facilitated by improvements in cerebral blood flow. β‐OHB supplementation was well‐tolerated and appears to be safe for cerebrovascular health, suggesting potential therapeutic benefits of β‐OHB in a population at risk of neurocognitive impairment.
imageKey points
People with obesity are at increased risk of neurocognitive dysfunction, partly as a result of ‐induced reductions in cerebral blood flow (CBF) and brain‐derived neurotrophic factor (BDNF).
Ketone supplements containing β‐hydroxybutyrate (β‐OHB) reduce postprandial hyperglycaemia, which may increase CBF and BDNF, thereby protecting against obesity‐related cognitive dysfunction.
We show for the first time that 14 days of thrice‐daily β‐OHB supplementation improves aspects of cognition and increases cerebrovascular flow, conductance and shear rate in the extracranial arteries of adults with obesity.
Our preliminary data indicate a significant positive relationship between elevated CBF and improved cognition following β‐OHB supplementation.
This trial provides a foundation for the potential non‐pharmacological therapeutic application of β‐OHB supplementation in patient groups at risk of hyperglycaemic cerebrovascular disease and cognitive dysfunction.
Astaxanthin Supplementation Increases Glutathione Concentrations but Does Not Impact Fat Oxidation During Exercise in Active Young Men
Authors: McAllister Matthew J. , Mettler Joni A. , Patek Kyle , Butawan Matthew , Bloomer Richard J. 
Published: October 2021

This study investigated the effects of 6 mg/day of astaxanthin supplementation on markers of oxidative stress and substrate metabolism during a graded exercise test in active young men. A double-blind, randomized, counterbalanced, cross-over design was used. Fourteen men (age = 23 ± 2 years) supplemented with 6 mg/day of astaxanthin and a placebo for 4 weeks, with a 1 week washout period between treatments. Following each supplementation period, a fasting blood sample was obtained to measure markers of oxidative stress: glutathione, hydrogen peroxide, advanced oxidation protein products, and malondialdehyde. Participants also completed a graded exercise test after each treatment to determine substrate utilization during exercise at increasing levels of intensity. Glutathione was ∼7% higher following astaxanthin compared with placebo (1,233 ± 133 vs. 1,156 ± 185 μM, respectively; p = .02, d = 0.48). Plasma hydrogen peroxide and malondialdehyde were not different between treatments (p > .05). Although not statistically significant (p = .45), advanced oxidation protein products were reduced by ∼28%. During the graded exercise test, mean fat oxidation rates were not different between treatments (p > .05); however, fat oxidation decreased from 50 to 120 W (p < .001) and from 85 to 120 W (p = .004) in both conditions. Astaxanthin supplementation of 6 mg/day for 4 weeks increased whole blood levels of the antioxidant glutathione in active young men but did not affect oxidative stress markers or substrate utilization during exercise. Astaxanthin appears to be an effective agent to increase endogenous antioxidant status.
Is it time we split bowel preparation for all colonoscopies? Outcomes from a national survey of bowel preparation practice in the UK
Authors: Archer Thomas , Shirazi-Nejad Ahmad Reza , Al-Rifaie Ammar , Corfe Bernard M , Riley Stuart , Thoufeeq Mo 
Published: October 2021

IntroductionAdequate bowel preparation is a prerequisite for effective colonoscopy. Split bowel preparation results in optimal cleansing. This study assessed the bowel preparation regimes advised by endoscopy units across the UK, and correlated the differences with outcomes.MethodsTrusts in the UK were surveyed, with data requested between January 2018 and January 2019, including: the type and timing of preparation, pre-endoscopy diet, adequacy rates and polyp detection. Trusts were grouped according to the timing of bowel preparation. χ2test was used to assess for differences in bowel preparation adequacy.ResultsMoviprep was the first line bowel preparation in 79% of trusts. Only 7% of trusts advised splitting bowel preparation for all procedures, however, 91% used split bowel preparation for afternoon procedures. Trusts that split preparation for all procedures had an inadequacy rate of 6.7%, compared with 8.5% (p<0.001) for those that split preparation for PM procedures alone and 9.5% (p<0.001) for those that provided day before preparation for all procedures. Morning procedures with day-before preparation had a higher rate of inadequate cleansing than afternoon procedures that received split preparation (7.7% vs 6.5 %, p<0.001). The polyp detection rate for procedures with adequate preparation was 37.1%, compared with 26.4% for those that were inadequate.ConclusionMost trusts in the UK do not provide instructions optimising the timing of bowel preparation prior to colonoscopy. This correlated with an increased rate of inadequate cleansing. Splitting bowel preparation is likely to reduce the impacts of poor cleansing: missed lesions, repeat colonoscopies and significant costs.
A pilot randomised controlled trial of a structured, home-based exercise programme on cardiovascular structure and function in kidney transplant recipients: the ECSERT study design and methods
Authors: Billany Roseanne E , Vadaszy Noemi , Bishop Nicolette C , Wilkinson Thomas J , Adenwalla Sherna F , Robinson Katherine A , Croker Kathryn , Brady Emer M , Wormleighton Joanne V , Parke Kelly S , Cooper Nicola J , Webster Angela C , Barratt Jonathan , McCann Gerry P , Burton James O , Smith Alice C , Graham-Brown Matthew PM 
Published: October 2021

BackgroundCardiovascular disease (CVD) is a major cause of morbidity and mortality in kidney transplant recipients (KTRs). CVD risk scores underestimate risk in this population as CVD is driven by clustering of traditional and non-traditional risk factors, which lead to prognostic pathological changes in cardiovascular structure and function. While exercise may mitigate CVD in this population, evidence is limited, and physical activity levels and patient activation towards exercise and self-management are low. This pilot study will assess the feasibility of delivering a structured, home-based exercise intervention in a population of KTRs at increased cardiometabolic risk and evaluate the putative effects on cardiovascular structural and functional changes, cardiorespiratory fitness, quality of life, patient activation, healthcare utilisation and engagement with the prescribed exercise programme.Methods and analysisFifty KTRs will be randomised 1:1 to: (1) the intervention; a 12week, home-based combined resistance and aerobic exercise intervention; or (2) the control; usual care. Intervention participants will have one introductory session for instruction and practice of the recommended exercises prior to receiving an exercise diary, dumbbells, resistance bands and access to instructional videos. The study will evaluate the feasibility of recruitment, randomisation, retention, assessment procedures and the intervention implementation. Outcomes, to be assessed prior to randomisation and postintervention, include: cardiac structure and function with stress perfusion cardiac MRI, cardiorespiratory fitness, physical function, blood biomarkers of cardiometabolic health, quality of life and patient activation. These data will be used to inform the power calculations for future definitive trials.Ethics and disseminationThe protocol was reviewed and given favourable opinion by the East Midlands-Nottingham 2 Research Ethics Committee (reference: 19/EM/0209; 14 October 2019). Results will be published in peer-reviewed academic journals and will be disseminated to the patient and public community via social media, newsletter articles and presentations at conferences.Trial registration numberNCT04123951.
Prevalence of disposable pod use and consumer preference for e-cigarette product characteristics among vape shop customers in Southern California: a cross-sectional study
Authors: Galimov Artur , Leventhal Adam , Meza Leah , Unger Jennifer B. , Huh Jimi , Baezconde-Garbanati Lourdes , Sussman Steven Y 
Published: October 2021

ObjectivesIn February 2020, the US Food and Drug Administration issued a guidance restricting the sales and distribution of cartridge-based e-cigarettes with flavours other than tobacco and menthol. Disposable devices were exempt from this guidance. This study examined the prevalence of disposable pod use and flavour preference compared with refillable pod and other e-cigarette users among vape shop customers.DesignCross-sectional study.SettingIn July 2019–March 2020, trained data collectors visited 44 vape shops in California with permission to recruit customers from shop owners.ParticipantsIntercept interviews with 276 customers were conducted.Outcomes and proceduresCustomers were grouped based on self-reported device type used most often (disposable pod, refillable pod and other e-cigarettes). Groups were compared on self-reported demographics, flavours preferred, daily e-cigarette use, preferred nicotine concentration levels and cigarette use.ResultsOf the 276 customers surveyed, 11.2% used disposable pods in the past 30 days. Among disposable pod users, fruit/candy (80.7%), mint (77.4%) and menthol (67.7%) were common preferred flavours, while tobacco flavours were less commonly preferred (19.4%). When compared with refillable pod and other non-pod e-cigarette device users, disposable pod users were younger, used higher nicotine concentration levels, were more likely to prefer mint and menthol flavours and use e-cigarettes as their first product, while less likely to ever use cigarettes and use e-cigarettes daily.DiscussionDespite using higher nicotine levels and preferred menthol/mint flavours more often than users of other devices, disposable pod users reported lower prevalence of lifetime smoking and daily vaping and were younger. Given the current findings, regulations addressing non-tobacco flavours and nicotine concentration in disposable pod devices merit consideration in efforts to reduce vaping in younger adult never smokers.
Development and validation of risk-adjusted outcomes for systems of emergency care: the DAVROS study
Authors: Goodacre Steve 
Published: October 2021

BackgroundThe (Development and validation of risk-adjusted outcomes for systems of emergency care) DAVROS study aims to develop a method to predict the probability of mortality for patients admitted to hospital as a medical emergency. This would facilitate evaluation of the performance of emergency care systems through comparison of actual to predicted mortality.MethodsWe collected data on presenting physiology, demographic data, co-morbidities, blood tests and mortality from the ambulance patient report form, emergency department notes and hospital computer records of 11 528 emergency medical admissions to three hospitals in South Yorkshire. These data are used to develop risk-adjustment models to predict 7-day and 30-day mortality.ResultsMortality was 630/11 528 (5.5%) at 7 days and 1068/11 528 (9.3%) at 30 days. Univariate analysis has identified predictor variables associated with 7 and 30-day mortality and multivariable analysis has identified independent predictor variables. Preliminary analysis suggests a model based on demographics, co-morbidities and International Classification of Diseases code has a c-statistic of 0.766 for 7-day mortality and 0.776 for 30-day mortality. The addition of physiological parameters increases these values to 0.852 and 0.835, respectively. We will present the DAVROS risk-prediction model for 7 and 30-day mortality, derived on half the cohort and validated on the other half, with estimates of discriminant value (c-statistic) and calibration (Hosmer-Lemeshow).ConclusionA risk-adjustment model based on demographic data, co-morbidities and baseline physiology can predict 7 and 30-day mortality in emergency medical admissions with acceptable discriminatory power.
Systemic inflammation at 24 h predicts outcome in patients after out-of-hospital cardiac arrest treated with therapeutic hypothermia
Authors: Clegg Gareth 
Published: October 2021

IntroductionOnly mild therapeutic hypothermia (MTH) is shown to improve outcome after return of spontaneous circulation, post out of hospital cardiac arrest (OHCA), though its mechanism remains unknown. We hypothesise that the benefit of MTH is mediated through modulation of the inflammatory response.MethodsDuring our prospective observational study from Aug 2008 to October 2009, 196 OHCA patients were enrolled. 173 were eligible for inclusion; 115 died in Emergency Department (ED), 38 died in intensive care unit (ICU) and 20 survived to discharge. Patients had blood sampled on arrival in the ED and at 24 h, 72 h and 5 days. A small subgroup of patients had blood sampled prehospital during the initial resuscitation phase. Serum levels of cytokines important in the regulation of inflammation (interleukin 6 (IL-6), IL-8, IL-10) were measured along with markers of neutrophil activation (elastase and CD 11b). All patients who reached the ICU had MTH induced and were maintained at 32–34° for 24 h.ResultsLevels of the pro-inflammatory cytokine IL-8 were significantly higher at 24 h after return of spontaneous circulation in patients who died in ICU, compared to those who survived to discharge (478.1 pg/ml (CI 171.1 to 831.1) cf 108.0 pg/ml (CI 44.8 to 171.1) p=0.03). Serum levels of the ‘anti’-inflammatory cytokine IL-10 were also much higher in non-survivors (CI 80.9 pg/ml (22.3 to 139.4) cf CI 10.2pg/ml (3.6 to 16.8) p=0.002). IL-10 predicted survival 24 h with an area under the Receiver Operating Characteristic of 0.91 (CI 0.77 to 1.0, p<0.001), and a sensitivity of 100%, specificity 75% at a cut off of 32 pg/ml, LR 4.0. Indicators of neutrophil activation, were markedly elevated in all patients on arrival in the ED.DiscussionOHCA is associated with massive systemic inflammation. We have shown that this begins much earlier than previously described, and that levels of both the classically pro-inflammatory and counterregulatory chemokines predict survival. Our findings are consistent with the hypothesis that MTH works, at least in part, by modulating the inflammation.
Unscheduled re-attendances to a paediatric Emergency Department: an audit
Authors: Black Lisa 
Published: October 2021

IntroductionUnscheduled re-attendances (UR) continue to pose a problem to the Paediatric Emergency Department (PED) and there is paucity of research on this topic. 5% of PED attendances are UR.1 Although some are inevitable, it is important to identify strategies to minimise such attendances.ObjectivesTo estimate the size of the problem, identify high risk patient groups and determine other factors (system or doctor) related to UR within an inner city PED.MethodsAll patients under the age of 17, who reattended within 72 h, over a 28-day period, were identified and their Emergency Department notes reviewed.Results91 children were identified, which represented an UR rate of 3.88%, of which 69 (76%) were under 5 years old. Gastroenteritis (GE) and upper respiratory tract infection (URTI) were the predominant causes of UR. 67% of children were assessed by a junior doctor (JD {< ST2}) on initial presentation. On re-attendance, 74% were again assessed by a JD contrary to department policy and on both occasions less than half were discussed with a senior doctor. Only 70% were discharged with a documented safety net advising appropriate re-attendance. Four children had a revised diagnosis on re-attendance and 22% were ultimately admitted.ConclusionsUR is an important performance indicator and a periodic review should be a part of clinical governance activity. High risk groups for UR were <5 s, GE and URTI. We suggest that improved discharge information for parents with expected disease course, better supervision of JD / initial senior review and better collaboration with primary care providers may decrease such UR.
The effectiveness of patient self-assessment forms at increasing emergency department efficiency
Authors: Middleton Scott 
Published: October 2021

IntroductionEmergency department ergonomics is an under researched topic. To our knowledge, this is the only study investigating the effectiveness of a patient self-assessment form in managing patient flow through an emergency department in a busy teaching hospital.MethodsSelf-reported information contained on the forms included patient demographics, presenting complaint, past medical, surgical and drug history, and the option to consent for the emergency care summary, which provides an up-to-date drug history from the general practitioner. This form followed the patient through the department and was utilised by the triage nurse and care providers. 200 patients in Manchester triage categories three to five were recruited, half of whom were given self-assessment forms. Time spent in triage, time taken for first assessment and total time in the department were recorded for all patients.ResultsPatients without a self-assessment form had a mean time spent in triage of 6.0± 3.6 SD min and mean time taken for first assessment of 11.0±6.0 SD min. Patients managed with a self-assessment form had a mean time spent in triage of 4.9 ±3.5 SD min and mean time taken for first assessment of 9.0±5.0 SD min. Patients without a self-assessment form had a median total time spent in the department of 201 min (range 33–301), whereas patients managed with the self-assessment form had a median time of 121 min (range 19–240). The differences in triage, first assessment and total department times between groups were significant (p<0.05).ConclusionThis pilot study showed the effectiveness of a self-assessment form at increasing patient flow through the department, reducing triage, first assessment and total department times. The reasons for this are complex and merit further investigation.
The ARTISSE intrasaccular device for intracranial aneurysm treatment: short-term, mid-term and long-term clinical and angiographic results
Authors: Piotin Michel , Fahed Robert , Redjem Hocine , Smajda Stanislas , Desilles Jean Philippe , Escalard Simon , Maïer Benjamin , Hebert Solène , Delvoye François , Mazighi Mikael , Blanc Raphaël 
Published: October 2021

BackgroundThe concept of intra-aneurysmal flow disruption has emerged as a new paradigm for the treatment of primarily bifurcation aneurysms. The purpose of this study was to determine the clinical and angiographic outcomes of patients treated with the new ARTISSE intrasaccular device (ISD).MethodsSelected patients with bifurcation aneurysms that matched the indications of the ARTISSE ISD defined by the manufacturer were treated in a single center. Clinical and angiographic follow-up was conducted at 6 and 36 months. Aneurysm occlusion was assessed using the Raymond–Roy classification scale.ResultsNine subjects with nine unruptured bifurcation aneurysms were enrolled. Mean aneurysm size was 7.2±1.2 mm (range 5.5–9.7 mm). An adequate aneurysm occlusion (defined as a complete occlusion or a neck remnant) was achieved in 6/9 patients (66.7%) at 6 months and 4/7 patients (57.1%) at 36 months follow-up. Two of the nine subjects experienced a major stroke (22.2%), including one on postoperative day 1 due to a procedure-related parent vessel occlusion and subsequent ischemic stroke. The other major stroke occurred within the 36-month follow-up period during treatment of a separate aneurysm with coils, leading to perforation with hemorrhagic stroke causing a permanent neurological deficit.ConclusionThe ARTISSE ISD was successfully deployed in all nine cases. There were, however, several procedure-related complications and results in terms of angiographic aneurysm occlusion were modest.
Intracranial aneurysm treatment with intrasaccular flow disruption: comparison of WEB-21 and WEB-17 systems
Authors: Pagano Paolo , Paiusan Laurentiu , Soize Sebastien , Pierot Laurent 
Published: October 2021

BackgroundNew generations of Woven EndoBridge (WEB) devices (WEB-21 and WEB-17) are available to treat aneurysms with a width <6.5 mm. Limited comparisons between both systems exist in the literature, but mid-term efficacy has not been compared. Our study aimed to compare the indications, feasibility, and safety of both systems and to evaluate their efficacy at mid-term follow-up (12 months).MethodsAneurysms treated with WEB-21 and WEB-17 were extracted from a prospective database. Patient and aneurysm characteristics, complications, and anatomical results were analyzed by an interventional neuroradiologist, independent of the procedures.ResultsFrom June 2015 to November 2019, 87 patients with 92 aneurysms were treated with WEB-21 (38/92, 41.3%) and WEB-17 (54/92, 58.7%). WEB-21 and WEB-17 had high treatment feasibility (97.4% and 94.4%, respectively). A higher percentage of ruptured aneurysms were treated with WEB-17 (9.3%) than with WEB-21 (2.6%; p=0.03). Morbidity and mortality at 1 month were similar in both groups (no morbidity in either group, and mortality 2.7% in the WEB-21 group and 2.0% in the WEB-17 group). The rate of complete and adequate aneurysm occlusion was not significantly higher with the WEB-17 system (59.2% and 95.9%, respectively) compared with the WEB-21 (52.9% and 85.3%, respectively).ConclusionsThis study showed the high feasibility of aneurysm treatment with both the WEB-21 and WEB-17 systems. Indications were relatively similar with both devices except for ruptured aneurysms, which were more frequently treated with the WEB-17 device. Efficacy at 12 months (complete and adequate occlusions) was slightly, but not significantly, better with the WEB-17 device.