bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Dapagliflozin on Urine Metabolome in Patients with Type 2 Diabetes
Authors: Bletsa Evdoxia , Filippas-Dekouan Sebastien , Kostara Christina , Dafopoulos Panagiotis , Dimou Aikaterini , Pappa Eleni , Chasapi Styliani , Spyroulias Georgios , Koutsovasilis Anastasios , Bairaktari Eleni , Ferrannini Ele , Tsimihodimos Vasilis 
Published: February 2021

Abstract

Context
Inhibitors of sodium-glucose cotransporters-2 have cardio- and renoprotective properties. However, the underlying mechanisms remain indeterminate.

Objective
To evaluate the effect of dapagliflozin on renal metabolism assessed by urine metabolome analysis in patients with type 2 diabetes.

Design
Prospective cohort study.

Setting
Outpatient diabetes clinic of a tertiary academic center.

Patients
Eighty patients with hemoglobin A1c &gt; 7% on metformin monotherapy were prospectively enrolled.

Intervention
Fifty patients were treated with dapagliflozin for 3 months. To exclude that the changes observed in urine metabolome were merely the result of the improvement in glycemia, 30 patients treated with insulin degludec were used for comparison.

Main Outcome Measure
Changes in urine metabolic profile before and after the administration of dapagliflozin and insulin degludec were assessed by proton-nuclear magnetic resonance spectroscopy.

Results
In multivariate analysis urine metabolome was significantly altered by dapagliflozin (R2X = 0.819, R2Y = 0.627, Q2Y = 0.362, and coefficient of variation analysis of variance, P &lt; 0.001) but not insulin. After dapagliflozin, the urine concentrations of ketone bodies, lactate, branched chain amino acids (P &lt; 0.001), betaine, myo-inositol (P &lt; 0001), and N-methylhydantoin (P &lt; 0.005) were significantly increased. Additionally, the urine levels of alanine, creatine, sarcosine, and citrate were also increased (P &lt; 0001, P &lt;0.0001, and P &lt;0.0005, respectively) whereas anserine decreased (P &lt; 0005).

Conclusions
Dapagliflozin significantly affects urine metabolome in patients with type 2 diabetes in a glucose lowering-independent way. Most of the observed changes can be considered beneficial and may contribute to the renoprotective properties of dapagliflozin.
Implementing a Telehospitalist Program Between Veterans Health Administration Hospitals: Outcomes, Acceptance, and Barriers to Implementation
Authors: Gutierrez Jeydith , Moeckli Jane , Holcombe Andrea , O'Shea Amy MJ , Bailey George , Rewerts Kelby , Hagiwara Mariko , Sullivan Steven , Simon Melissa , Kaboli Peter 
Published: February 2021

BACKGROUNDTelehospitalist services are an innovative alternative approach to address staffing issues in rural and small hospitals.OBJECTIVETo determine clinical outcomes and staff and patient satisfaction with a novel telehospitalist program among Veterans Health Administration (VHA) hospitals.DESIGN, SETTING, AND PARTICIPANTSWe conducted a mixed‐methods evaluation of a quality improvement program with pre‐ and postimplementation measures. The hub site was a tertiary (high‐complexity) VHA hospital, and the spoke site was a 10‐bed inpatient medical unit at a rural (low‐complexity) VHA hospital. All patients admitted during the study period were assigned to the spoke site.INTERVENTIONReal‐time videoconferencing was used to connect a remote hospitalist physician with an on‐site advanced practice provider and patients. Encounters were documented in the electronic health record.MAIN OUTCOMESProcess measures included workload, patient encounters, and daily census. Outcome measures included length of stay (LOS), readmission rate, mortality, and satisfaction of providers, staff, and patients. Surveys measured satisfaction. Qualitative analysis included unstructured and semi‐structured interviews with spoke‐site staff.RESULTSTelehospitalist program implementation led to a significant reduction in LOS (3.0 [SD, 0.7] days vs 2.3 [SD, 0.3] days). The readmission rate was slightly higher in the telehospitalist group, with no change in mortality rate. Satisfaction among teleproviders was very high. Hub staff perceived the service as valuable, though satisfaction with the program was mixed. Technology and communication challenges were identified, but patient satisfaction remained mostly unchanged.CONCLUSIONTelehospitalist programs are a feasible and safe way to provide inpatient coverage and address rural hospital staffing needs. Ensuring adequate technological quality and addressing staff concerns in a timely manner can enhance program performance.
A prospective study to evaluate the accuracy of rapid diagnostic tests for diagnosis of human leptospirosis: Result from THAI-LEPTO AKI study
Authors: Dinhuzen Janejira , Limothai Umaporn , Tachaboon Sasipha , Krairojananan Panadda , Laosatiankit Bangon , Boonprasong Sakarin , Lumlertgul Nuttha , Peerapornratana Sadudee , Srisawat Nattachai 
Published: February 2021

Background
Rapid diagnostic tests (RDTs) have become widely used in low-resource settings for leptospirosis diagnostic. This study aims to evaluate the diagnostic performance of the five commercially available RDTs to detect human IgM against Leptospira spp. in Thai population.

Methodology/Principal findings
Ninety-nine serum samples from Leptospirosis suspicious patients were tested with five RDTs, including Medical Science Public Health, Leptocheck-WB, SD bioline, TRUSTline, and J.Mitra. The case definition was based on MAT, qPCR, and culture results. Diagnostic accuracy was determined based on the first day of enrollment in an overall analysis and stratified according to days post-onset of fever. The five RDTs had overall sensitivity ranging from 1.8% to 75% and specificity ranging from 52.3% to 97.7%. Leptocheck-WB had high sensitivity of 75.0%. The sensitivity of five RDTs increased on days 4–6 post-onset of fever, while the specificity of all tests remained relatively stable at different days post-onset of fever.

Conclusions/Significance
The tested RDTs showed low sensitivity. Therefore, based on the present study, five commercially available RDTs might not be an appropriate test for acute leptospirosis screening in the Thai population.
Serum 24,25-dihydroxyvitamin D level in general Korean population and its relationship with other vitamin D biomarkers
Authors: Kim Hyun-Ki , Chung Hye Jin , Lê Hương Giang , Na Byoung-Kuk , Cho Min-Chul 
Published: February 2021

Background
Vitamin D status is presently assessed by measuring total serum concentration of 25-hydroxyvitamin D [25(OH)D]. However, 25(OH)D concentration alone might not accurately reflect vitamin D status owing to its weak relationship with various clinical indices and inconsistency across races. Recently, 24,25-dihydroxyvitamin D [24,25(OH)2D] and vitamin D metabolite ratio [VMR; ratio of 24,25(OH)2D to 25(OH)D] have emerged as vitamin D biomarkers. The present study aimed to determine the values of 24,25(OH)2D and VMR in healthy Koreans and compare them with other vitamin D biomarkers, including 25(OH)D and bioavailable 25(OH)D.

Methods
Serum samples and medical information were collected from 200 individuals (100 females and 100 males) who underwent general health checks without self-reported symptoms. We measured 24,25(OH)2D concentration using liquid chromatography–tandem mass spectrometry, and concentrations of 25(OH)D and vitamin D binding protein using immunoassays. VMR and bioavailable 25(OH)D concentration were calculated using the above data. Serum parathyroid hormone level, and bone mineral density (BMD) data were collected as clinical outcomes, and the effects of the vitamin D markers on them were tested using multiple linear regression models.

Results
The mean values of 25(OH)D, 24,25(OH)2D, VMR, and bioavailable 25(OH)D were 24.3 ± 8.5 ng/mL, 1.9 ± 1.1 ng/mL, 7.6 ± 2.5, and 3.2 ± 1.2 ng/mL, respectively. The concentration of 25(OH)D closely correlated with 24,25(OH)2D (R = 0.868, P < 0.001) and bioavailable 25(OH)D (R = 0.862, P < 0.001). No significant effects of 24,25(OH)2D, VMR, and bioavailable 25(OH)D were observed on the prediction of PTH and BMD in the multiple linear regression models.

Conclusion
Our study presents the distribution of 24,25(OH)2D concentration and VMR in Korean population for the first time. Overall, our data reaffirm that 25(OH)D is the primary marker for determining vitamin D status in the general population.
Inhalational versus intravenous maintenance of anesthesia for quality of recovery in patients undergoing corrective lower limb osteotomy: A randomized controlled trial
Authors: Kim Seung Hyun , Ju Hyang Mi , Choi Chong-Hyuck , Park Hae Ri , Shin Seokyung 
Published: February 2021

Background
Inhalational anesthesia and propofol-based total intravenous anesthesia (TIVA) are the two most popular methods of general anesthesia with distinct characteristics that may affect quality of recovery (QOR) differently. This study compared QOR after corrective lower limb osteotomy between desflurane-based inhalational anesthesia and propofol-based TIVA.

Methods
Sixty-eight patients, ASA class I or II who underwent corrective lower limb osteotomy were randomized to receive either desflurane anesthesia or propofol TIVA. The primary outcome was quality of recovery 40 (QoR-40) questionnaire scores on postoperative day (POD) 1 and 2. Postoperative nausea scores, antiemetic requirements, and amount of opioid consumption via intravenous patient-controlled analgesia (IV PCA) were assessed as secondary outcomes.

Results
Global QoR-40 scores on POD 1 (153.5 (140.3, 171.3) vs. 140.0 (120.0, 173.0), P = 0.056, 95% CI; -22.5, 0.2) and POD 2 (155.5 (146.8, 175.5) vs. 152.0 (134.0, 179.0), P = 0.209, 95% CI; -17.5, 3.9) were comparable between the two groups. Among the five dimensions of QoR-40, physical independence scores were significantly higher in the TIVA group compared to the Desflurane group on POD both 1 and 2. Nausea scores (0.0 (0.0, 0.0) vs. 1.0 (0.0, 3.5), P < 0.001) and number of patients requiring rescue antiemetics (0% vs. 15.2%, P = 0.017) were significantly lower in the TIVA group at the post anesthesia care unit (PACU). Although the number of bolus attempts between 0–24 h and the morphine equivalent dose of analgesics administered via IV PCA between 12–24 h were significantly less in the TIVA group compared to the Desflurane group, there was no significant difference between groups for the overall 48 h postoperative period.

Conclusions
Propofol-based TIVA did not improve global QoR-40 scores compared with desflurane-based inhalational anesthesia. However, considering the better QoR-40 scores in the domain of physical independence and less nausea in the early postoperative period, propofol TIVA should be considered as a useful option in patients undergoing corrective lower limb osteotomy.
Patient perspectives on an intervention after suicide attempt: The need for patient centred and individualized care
Authors: Michaud Laurent , Dorogi Yves , Gilbert Sophie , Bourquin Céline 
Published: February 2021

Background
Many types of intervention exist for suicide attempters, but they tend not to sufficiently consider patient’s views.

Aim
To identify useful components of a previously evaluated intervention after a suicide attempt from the patient’s views and to better understand the process of recovery.

Method
Forty-one interviews with suicide attempters were qualitatively analysed. Views of participants (i) on the components of the intervention (nurse case-management, joint crisis plan, meetings with relatives/network and follow-up calls) and (ii) their recovery were explored. The material was analysed by means of thematic analysis with a deductive-inductive approach.

Results
Participants valued the human and professional qualities of the nurse case-manager, and appreciated follow-up calls and meetings. However, their views diverged regarding for instance frequency of phone calls, or disclosing information or lack thereof. Interpersonal relationship, suicide attempters’ own resources and life changes emerged as core recovery factors.

Discussion
The study highlights the figure of an engaged clinician, with both professional and human commitment, aware that some suicide attempters put more emphasis on their own resources than on delivered health care.

Conclusions
Interventions should consider the clinician as the cornerstone of the tailored care valued by suicide attempters.
Assessment of plasma BMP-2, BMP-7, BMP-10, vitamin D, and TGF β1 in simple fractures among Sudanese patients
Authors: Ali Amin Ahmed , Mukhtar Muawia Mohamed , Shaheen Samir , Mohamed Abdelrahim Osman 
Published: February 2021

Background
Bone morphogenetic proteins (BMP) are multifunctional proteins. They work as cytokines regulating osteogenesis during fracture healing process. The objectives of this study were to assess changes in BMPs during fracture and their correlations to Fracture’s healing.

Methods
Case-Control hospital–based study conducted from January 2018 to January 2019. Demographic data, anthropometric measurements, and blood samples were collected from patients and controls (18–65 years old). Plasma concentrations of selected BMPs and vitamin D were measured using quantitative enzyme linked immunosorbent assay (ELISA). SPSS version 25 was used to calculate frequencies, Pearson correlation tests, chi-square and unpaired t-test.

Results
Sixty-five patients with fractures and Sixty-five controls were studied. Means of plasma concentrations were (TGFβ1 = 21.07 ng/ml ±8.49 and 19.8 ng/ml ±7.2) (BMP-2 = 76.3 pg/ml ± 156.6 and 55.5 ng/ml ± 127.9) (BMP-7 = 13.02 pg/ml ±43.5 and 64.6pg/ml ±250) (BMP-10 = 8.14 pg/ml ±12.7 and 5.48 pg/ml ±11.3) (Vitamin D mean was 24.94 ng/ml ±13.2 and 26.2 ng/ml ±11.6) in patients and controls, respectively. Forty-five subjects were enrolled into follow up study: 30 males, 15 females. Healing time mean was 4.13± 2.6 months. No significant correlation between BMP-2/BMP-7 with healing time.

Conclusions
BMP-7 was significantly lowers in the plasma of patients that controls (P = 0.042). Low Vitamin D was observed among Sudanese participants.
Key Success Factors in Managing and Implementing Public Funded R&D Projects in Indonesia
Authors: Hermawati Wati 
Published: February 2021

<p>Public Research Centers (PRCs) in Indonesia are mostly operated by government funding. However, their role in supporting innovation and economic performance of MSMEs (micro, small and medium enterprises) is still very small. The objective of this research is to determine what are the success factors in managing R&amp;D projects at a PRC in Indonesia, particularly in providing solving problems of MSMEs. Two case studies of R&amp;D Projects from a PRC ‘X’ were selected, namely: organic fertilizer project and appropriate technology project. Both projects are quite different in terms of the research process. By using qualitative method, all R&amp;D process elements were investigated. Results of the study shows that in general both case studies have indicated success factors that make R&amp;D project success and effectively manage and grouped them into three common categories, namely project management process; project resources; and project environments. The two case studies show that each project have different success factors and the lessons learned of these projects can be very useful to improve R&amp;D project activities at PRCs.</p><p><em>Keywords</em> : R&amp;D Project, Public Research Center, Success Factors, R&amp;D Management</p>
Clinical manifestations, course variants and complications of Takayasu arteritis in Kyrgyz patients
Authors: Koilubaeva G. M. , Karimova E. R. , Solovyev S. K. , Aseeva E. A. , Dzhuzenova F. S. , Nasonov E. L. , Dzhishambaev E. Zh. , Usupbaeva D. A. , Turusbekova A. K. 
Published: February 2021

Objective: to study clinical presentation, course variants and complications of Takayasu arteritis (AT) in Kyrgyz patients.Patients and methods. 75 Kyrgyz patients with a definite diagnosis of AT were included in the study, most of them were women (93.3%). The median age was 33 [23; 40] years, the median duration of the disease was 7 [3.0; 13.0] years. The anatomical type of vascular lesions was determined using the angiographic classification of R. Moriwaki et al., the AT activity – according to the BVAS index, the clinical stage of AT – using the R. Jefferson classification, the severity and prognosis of the disease – according to the K. Ishikawa classification. Highly sensitivity CRP (hsCRP) was assessed in 44 (58.67%) patients, interleukin 6 (IL6) – in 26 (34.7%). Instrumental procedures included duplex Doppler ultrasonography of peripheral arteries and contrast-enhanced computed pan aortography.Results and discussion. The mean age of AT onset was 24.4±9.4 years. The majority of patients had V anatomical type of vascular lesions (61.3%), vascular stage (89.3%), severe stenosis (54.7%) with predominant affection of the brachiocephalic trunk (68%), common carotid arteries (53.7 %) and renal (52%) arteries. Most patients (82.7%) at the time of inclusion in the study had a severe exacerbation of AT according to the BVAS index. An increase in hsCRP level was seen in 66% of cases, IL6 – in 31%. At the onset of AT, 20% of patients had fever, general weakness, weight loss, myalgia and/or arthralgia. 43% of patients had ≥2 complications. The clinical manifestations of AT were mainly characterized by cardiovascular pathology (77.3%) with the formation of relative aortic valve insufficiency (AVI) (93.1%) and kidney damage (57.3%) with the development of renovascular arterial hypertension (91%). At the first visit, more than one third of patients (37.3%) had irreversible damage, accompanied in half of them by AVI degree II or III.Conclusion. Young women predominated among Kyrgyz patients with AT. Most of the patients had anatomical type V AT (61.3%), vascular stage (89.3%), severe stenosis (54.7%), affection of the brachiocephalic trunk (68%), common carotid (57.3%) and renal (52%) arteries. Severe exacerbation of the disease was observed in 82.7% of patients. The presence of ≥2 complications worsened the prognosis of AT. The clinical manifestations of AT were characterized mainly by cardiovascular pathology (77.3%) and kidney damage (57.3%). In more than one third of patients (37.3%) AT was diagnosed late.
Time course of radiographic hip joint changes in patients with early axial spondyloarthritis
Authors: Agafonova E. M. , Rumyantseva D. G. , Smirnov A. V. , Erdes Sh. 
Published: February 2021

The diagnosis of coxitis remains one of the most difficult problems in the management of patients with axial spondyloarthritis (axSpA). In Russia, almost every two patients with axSpA were found to have hip joint (HJ) damage. However, until a certain time, there have been no methods to estimate the rate of progression of radiographic HJ changes in clinical practice. We have previously developed a formula for calculating the rate of coxitis progression, which simplifies the assessment of radiographic HJ changes and allows a physician to make a timely decision about changing therapy if rapidly progressing coxitis is detected.Objective: to estimate the rate of radiological progression of coxitis during a 24-month follow-up of patients with early axSpA.Patients and methods. Examinations were made in 38 patients (20 women and 18 men) who had been followed up for at least 2 years without radiographic and ultrasound signs of HJ joint involvement. The patients' mean age was 28.8±5.5 years; the disease duration was 22.7±15.7 months. HLA-B27 was positive in 35 (92%) patients. The summary stage of radiographic coxitis (ssRC) was used to assess HJ damage; the previously developed formula was applied to estimate the rate of radiological progression of coxitis (R-rpC).Results and discussion. The median cervical-capsular distance (CCD) was 5.2 mm at baseline and 4.9 mm at 2 years (p7 mm increase in the CCD. The mean ssRC was 0.34±0.75 scores at base line, 0.86±0.78 scores at 1 year; and this indicator increased up to 1.24±1.36 scores at 2 years (p=0.004). During 2 years of follow-up, there was no coxitis progression (the difference between ssRC2 and ssRC1 was 0) in 24 (63%) patients; ΔssRC increased by 1 score in 5 (13%); by 2 scores in 6 (16%), and by 4 scores in 3 (8%). On patient inclusion to the investigation, R-rpC averaged 0.5 (it was conventionally assumed that patients had no signs of HJ damage at the disease onset (ssRC=0). During therapy for the underlying disease, the mean R-rpC was 0.3 and 0.2 score/year within the first and second years, respectively. The mean R-rpC in the ΔssRC >0 group was as many as 0.85 score/year at one-year follow-up and 0.53 score/year at two-year follow-up.Conclusion. The developed procedure for estimating the progression of coxitis using ssRC is easy to use and can identify patients at high risk for coxitis progression.
Evaluation of the efficacy and safety of bioactive concentrate from small sea fish in elderly patients with knee osteoarthritis
Authors: Usova E. V. , Averkieva Yu. V. , Letaeva M. V. , Malyshenko O. S. , Koroleva M. V. , Raskina T. A. 
Published: February 2021

Objective: to evaluate the efficacy and safety of Alflutop (the bioactive concentrate from small sea fish) in patients aged 75 years and older with knee osteoarthritis (OA). Patients and methods. The investigation enrolled 38 patients aged 75 years and older with knee OA (according to the American College of Rheumatology (ACR) criteria, 1986), Kellgren–Lawrence grades II–III, ≥40 mm pain visual analogue scale (VAS), who required continuous non-steroidal anti-inflammatory drug (NSAID) use. All the patients received Alflutop in the standard regimen: a 1-ml intramuscular injection daily for 20 days. The dynamics of pain during movement was assessed using the VAS scale, the WOMAC, and the EQ-5D questionnaire. Comorbidity was determined according to the Charlson comorbidity index, polypharmacy, and the safety of therapy in all the patients. The investigation duration was 8 weeks.Results and discussion. On day 21 of Alflutop therapy, there was a statistically significant reduction in pain, stiffness, and functional insufficiency according to the WOMAC index (p< 0.001) and improvements in quality of life as shown by the EQ-5D questionnaire (p< 0.001); on day 56, the number of NSAID intake days decreased (p=0.005). The findings suggest that there is a high level of comorbidity in the majority (94.7%) of patients. The mean number of drugs taken was 5.0±1.5, which indicates the presence of polypharmacy. No serious or severe adverse events were recorded.Conclusion. The results of the investigation showed the statistically significant efficacy and safety of Alflutop in patients with knee OA in the elderly group.
Assessment of pollution and sources of heavy metals in the sediments of the Shitalakhya river, Bangladesh
Authors: Rahman Kalimur , Barua Saurav , Ahammad Fahim , Akramul Alam Md. 
Published: February 2021

The Shitalakya River, located near Dhaka City of Bangladesh, supplies water to the city dwellers and hence it is essential to determine pollu-tion condition, ecological risk and sources of heavy metals in the river sediments. Sediment works as the sink and source of heavy metals in the riverine ecosystem. The samples collected from the ten sites of the Shitalakhya River were investigated in the study. Average concentra-tion of different heavy metals in the sediments are Cu>Zn>Ni>Pb>Cr>Cd. Geo-accumulation index reveals moderately pollute Cu concen-tration, unpolluted to moderately pollute Ni concentration and unpolluted for the rest of the heavy metals. The order of geo-accumulation index are Cu>Ni>Pb>Cd>Zn>Cr. Overall, the heavy metals render low potential ecological risk and the order of potential ecological risk index are Cd>Cu>Ni>Pb>Cr>Zn. Though the concentration of Cd is low in sediment, it poses higher ecological risk. Positive matrix factor-ization (PMF) identifies two sources of pollution, S1 and S2. Where, S1 consists with Cu, Ni, Pb, Zn; which come from industrial wastewater. S2 consists with Cr, Cd, Pb, Zn; which originate from natural sources. The outcomes of the study provide as a reference to plan, control and manage heavy metal pollution and protect the water source of the Shitalakhya River.Â Â Â Â