bluuebunny/crossref_metadata_2025_split huggingface dataset:
Duration of Respiratory Failure After Trauma Is Not Associated With Increased Long-Term Mortality
Authors: Cook Mackenzie R. , O’Connell Kathleen , Qiu Qian , Riggle Andrew J. , Shoultz Thomas H. , Maine Rebecca G. , Arbabi Saman , O’Keefe Grant E. , Cuschieri Joseph , Maier Ronald V. , Robinson Bryce R. H. 
Published: May 2018

Objectives:
Although 1-year survival in medically critically ill patients with prolonged mechanical ventilation is less than 50%, the relationship between respiratory failure after trauma and 1-year mortality is unknown. We hypothesize that respiratory failure duration in trauma patients is associated with decreased 1-year survival.

Design:
Retrospective cohort of trauma patients.

Setting:
Single center, level 1 trauma center.

Patients:
Trauma patients admitted from 2011 to 2014; respiratory failure is defined as mechanical ventilation greater than or equal to 48 hours, excluded head Abbreviated Injury Score greater than or equal to 4.

Interventions:
None.

Measurements and Main Results:
Mortality was calculated from the Washington state death registry. Cohort was divided into short (≤ 14 d) and long (> 14 d) ventilation groups. We compared survival with a Cox proportional hazard model and generated a receiver operator characteristic to describe the respiratory failure and mortality relationship. Data are presented as medians with interquartile ranges and hazard ratios with 95% CIs. We identified 1,503 patients with respiratory failure; median age was 51 years (33–65 yr) and Injury Severity Score was 19 (11–29). Median respiratory failure duration was 3 days (2–6 d) with 10% of patients in the long respiratory failure group. Cohort mortality at 1 year was 16%, and there was no difference in mortality between short and long duration of respiratory failure. Predictions for 1-year mortality based on respiratory failure duration demonstrated an area under the receiver operator characteristic curve of 0.57. We determined that respiratory failure patients greater than or equal to 75 years had an increased hazard of death at 1 year, hazard ratio, 6.7 (4.9–9.1), but that within age cohorts, respiratory failure duration did not influence 1-year mortality.

Conclusions:
Duration of mechanical ventilation in the critically injured is not associated with 1-year mortality. Duration of ventilation following injury should not be used to predict long-term survival.
Long-Term Survival of Young Patients Surviving ICU Admission With Severe Sepsis*
Authors: Abu-Kaf Heba , Mizrakli Yuval , Novack Victor , Dreiher Jacob 
Published: May 2018

Objectives:
Sepsis remains a disease with a high mortality rate. The study goal was to assess long-term survival of severe sepsis in young patients.

Design:
Retrospective cohort study.

Setting:
Patients admitted with sepsis to ICUs in seven tertiary hospitals between 2003 and 2011.

Patients:
A total of 409 patients less than 45 years who survived to hospital discharge were age and sex matched with 818 patients with infectious disease without sepsis selected from internal medicine or surgical department admissions.

Interventions:
None.

Measurements and Main Results:
The median age in sepsis patients and the comparison group was 31 and 32 years, respectively. The proportions of patients surviving after hospital discharge were significantly lower in the sepsis group compared with the control group; among survivors, 6-month, 1-year, and 3-year mortality rates were 0.7% versus 0%, 4.5% versus 0.7%, 7.9% versus 1.2%, and 10.8% versus 1.8%, respectively (p < 0.001 for all). In a multivariate Cox proportional hazards regression model, sepsis was associated with an increased risk of mortality (hazard ratio, 3.79; 95% CI, 2.27–6.32), while controlling for age, Charlson Comorbidity Index, history of stroke, and congestive heart failure. Past the 24-month landmark, sepsis was not found to be an independent risk for mortality (hazard ratio, 1.79; 95% CI, 0.67–4.79). Based on cause of death analysis, chronic underlying comorbidities might explain the excess mortality in patients with sepsis.

Conclusions:
Young patients experiencing an episode of severe sepsis continue to be at higher risk of long-term mortality. The highest mortality rates were observed during the first 24 months following discharge.
Proton Pump Inhibition in Patients Treated With Novel Antithrombotic Drugs: Should We Worry About Thrombosis?
Authors: Bolek Tomáš , Samoš Matej , Škorňová Ingrid , Kovář Frantisek , Galajda Peter , Staško Ján , Kubisz Peter , Mokáň Marián 
Published: May 2018

Abstract:
Proton pump inhibition (PPI) administered together with antiplatelet and anticoagulant agents reduces the risk of gastrointestinal hemorrhage. Several novel antithrombotic agents have been recently introduced for patients with acute coronary syndrome (prasugrel and ticagrelor) or for patients requiring long-term anticoagulation (dabigatran, rivaroxaban, apixaban, edoxaban, and betrixaban). In fact, these agents might offer even stronger inhibition of platelets or coagulation compared with older agents; therefore, the need for gastroprotection might be even stronger when these new agents are used for long-term antithrombotic therapy. On the contrary, there are several reports regarding an adverse interaction between PPI and antithrombotic agents connected with a reduction in antithrombotic therapy on-treatment levels, implicating a higher risk of thrombosis. This interaction was demonstrated in clopidogrel-treated patients and more recently also in dabigatran-treated patients. This article discusses a possible novel antithrombotic therapy/PPI interaction leading to higher risk of thrombosis.
ApoA-1 Mimetic Peptide ELK-2A2K2E Decreases Inflammatory Factor Levels Through the ABCA1-JAK2-STAT3-TTP Axis in THP-1–Derived Macrophages
Authors: Wang Jia-Lin , Gong Duo , Hu Xin-Yan , Wu Su , Zheng Xi-Long , Wu Jie , Tang Xiao-Er , Zhang Da-Wei , Tang Chao-ke 
Published: May 2018

Objective:
The aim of this study was to determine whether the apolipoprotein A-1 (apoA-1) mimetic peptide ELK-2A2K2E regulates inflammatory cytokine expression through activating the adenosine triphosphate–binding cassette transporter A1 (ABCA1)-janus kinase 2 (JAK2)-signal transducer and activator of transcription 3 (STAT3)-tristetraprolin (TTP) signaling pathway in THP-1 macrophage-derived foam cells.

Methods and Results:
The cells were treated with the apoA-1 mimetic peptide ELK-2A2K2E at different concentrations (0, 20, 40, and 80 μg/mL) or incubated with ELK-2A2K2E (40 μg/mL) for different times (0, 6, 12, and 24 hours). Our results showed that the levels of the cytokines, such as tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and monocyte chemoattractant protein-1 (MCP-1), were decreased at both concentration- and time-dependent manners. When the cells were exposed to lipopolysaccharides and actinomycin D, ELK-2A2K2E significantly decreased the mRNA stability of inflammatory cytokines at different time points (0, 30, 60, and 120 minutes) by increasing TTP expression as analyzed by real-time quantitative polymerase chain reaction. The effect of ELK-2A2K2E on TTP was obviously blocked by the inhibition of the JAK-STAT3 pathway. Furthermore, we found that ELK-2A2K2E activated the JAK-STAT3-TTP pathway through the upregulation of ABCA1 and then decreased inflammatory cytokine expression.

Conclusions:
ApoA-I mimetic peptide ELK-2A2K2E increases the degradation of TNF-α, IL-6, and MCP-1 mRNA and reduces the levels of inflammatory cytokines through activating the JAK2-STAT3-TTP signaling pathway that is dependent on the upregulation of ABCA1.
Antiapoptotic Effect of β1 Blockers in Ascending Thoracic Aortic Smooth Muscle Cells: The Role of HSP70 Expression
Authors: Rizos Ioannis K. , Tsoporis James N. , Toumpoulis Ioannis K. , Salpeas Vasileios , Izhar Shehla , Rigopoulos Angelos G. , Sakadakis Eleftherios A. , Parker Thomas G. 
Published: May 2018

Abstract:
Heat shock proteins (HSPs) play an important role in the cellular adaptation to stress, a requisite for cell survival. The aortic wall appears to be a target for increased expression of HSPs during surgical stress. We aimed to define the expression and function of aortic HSP70 in 31 patients with normal ascending thoracic aortic diameter who underwent aortic valve replacement due to aortic valve stenosis and in 35 patients with dilated ascending thoracic aorta who underwent replacement of an ascending thoracic aortic aneurysm. To elucidate responsible signaling mechanisms we used an in vitro model of rat hypoxic aortic vascular smooth muscle cell (AVSMC) cultures. We demonstrated an increase in AVSMC HSP70 and an attenuation of the apoptotic markers (TUNEL-positive nuclei, caspase-3 activity, Bax/Bcl2 ratio) in aortic wall tissue specimens from both aortic valve stenosis and ascending thoracic aortic aneurysm patients on β1 blockade with metoprolol. In vitro, metoprolol treatment of hypoxic rat AVSMCs increased nitric oxide (NO) production, induced heat shock factor 1 transport to the nucleus, upregulated HSP70, decreased p53 phosphorylation and attenuated apoptosis. Blockade of NO production, resulted in decreased HSP70 and prevented the metoprolol-induced anti-apoptotic response of hypoxic AVSMCs. We demonstrate an anti-apoptotic effect of metoprolol dependent on NO-induced HSP70 expression, and thus augmentation of HSP70 expression should be considered as a therapeutic approach to limit apoptosis in the human ascending thoracic aorta of patients undergoing cardiac surgery.
Isolated vitamin D supplementation improves the immune-inflammatory biomarkers in younger postmenopausal women: a randomized, double-blind, placebo-controlled trial
Authors: Bueloni-Dias Flavia Neves , Orsatti Claudio Lera , Cangussu Luciana Mendes , Poloni Priscila Ferreira , Spadoto-Dias Daniel , Nahas-Neto Jorge , Nahas Eliana A.P. 
Published: May 2018

Abstract

Objective:
The aim of this study was to evaluate the effect of vitamin D (VitD) supplementation on immune-inflammatory biomarkers in younger postmenopausal women.

Methods:
In this double-blind, placebo-controlled trial, 160 postmenopausal women aged 50 to 65 years with amenorrhea ≥12 months were randomized into two groups: VitD group, oral supplementation with 1000 IU VitD3/day (n = 80) or placebo group (n = 80). The intervention time was 9 months, and the women were assessed at baseline and endpoint. Serum levels of interleukins (ILs)-1β, IL-5, IL-6, IL-10, IL-12ρ70, IL-17α, tumor necrosis factor-alpha, and interferon-gamma were determined by immunoassay. Plasma concentrations of 25-hydroxyvitamin D [25(OH)D] were measured by high-performance liquid chromatography. Per-protocol analysis was adopted as the statistical method using a gamma distribution and repeated measures design, followed by Wald's multiple comparisons test.

Results:
The two groups were similar at baseline in terms of clinical and laboratory parameters. After 9 months, there was a significant increase of 25(OH)D levels in the VitD group (+45.4%, P < 0.001) and a decrease (−18.5%, P = 0.049) in the placebo group. A significant decrease in IL-5, IL-12p70, IL-17α, tumor necrosis factor-alpha, and interferon-gamma levels was observed in the VitD group (P < 0.05). IL-5 and IL-6 levels were significantly lower in the VitD group compared to the placebo group (P < 0.05). There were no significant intervention effects on serum IL-1β or IL-10 levels in either group (P > 0.05).

Conclusions:
In younger postmenopausal women, isolated supplementation with 1000 IU of VitD3 for 9 months was associated with a reduction in proinflammatory biomarkers.
SLCO1B1 genetic variation and hormone therapy in menopausal women
Authors: Moyer Ann M. , de Andrade Mariza , Faubion Stephanie S. , Kapoor Ekta , Dudenkov Tanda , Weinshilboum Richard M. , Miller Virginia M. 
Published: May 2018

Abstract

Objective:
Response to menopausal hormone therapy (MHT) shows individual variation. SLCO1B1 encodes the OATP1B1 transporter expressed in the liver that transports many endogenous substances, including estrone sulfate, from the blood into hepatocytes. This study evaluated the relationship between genetic variation in SLCO1B1 and response to MHT in women enrolled in the Kronos Early Estrogen Prevention Study (KEEPS) at Mayo Clinic, Rochester, MN.

Methods:
KEEPS participants were randomized to oral conjugated equine estrogen (n = 33, oCEE), transdermal 17β-estradiol (n = 33, tE2), or placebo (n = 34) for 48 months. Menopausal symptoms (hot flashes, night sweats, insomnia, palpitations) were self-reported before treatment and at 48 months. Estrone (E1), E2, and sulfated conjugates (E1S, E2S) were measured using high-performance liquid chromatography-tandem mass spectrometry. SLCO1B1 rs4149056 (c.521T>C, p.Val174Ala) was genotyped using a TaqMan assay.

Results:
After adjusting for treatment, there was a significant association between the SLCO1B1 rs4149056 TT genotype (encoding normal function transporter) and lower E1S, E1S/E1, and E2S (P = 0.032, 0.010, and 0.008, respectively) compared with women who were heterozygous (TC) or homozygous (CC) for the reduced function allele. The interactions between genotype, treatment, and E2S concentration were stronger in women assigned to tE2 (P = 0.013) than the women taking oCEE (P = 0.056). Among women assigned to active treatment, women with the CT genotype showed a significantly greater decrease in night sweats (P = 0.041) than those with the TT genotype.

Conclusions:
Individual variation in sulfated estrogens is explained, in part, by genetic variation in SLCO1B1. Bioavailability of sulfated estrogens may contribute to relief of night sweats.
Design and protocol of Estrogenic Regulation of Muscle Apoptosis (ERMA) study with 47 to 55-year-old women's cohort: novel results show menopause-related differences in blood count
Authors: Kovanen Vuokko , Aukee Pauliina , Kokko Katja , Finni Taija , Tarkka Ina M. , Tammelin Tuija , Kujala Urho M. , Sipilä Sarianna , Laakkonen Eija K. 
Published: May 2018

Abstract

Objective:
The multidisciplinary Estrogenic Regulation of Muscle Apoptosis (ERMA) study was designed to reveal how hormonal differences over the menopausal stages affect the physiological and psychological functioning of middle-aged women. This paper describes the protocol and nonrespondent analysis of ERMA and novel findings on menopausal differences in blood count variables and their association with female sex hormones.

Methods:
Women aged 47 to 55 years were assigned to pre, early peri, late peri, and postmenopausal groups based on follicle-stimulating hormone (FSH) and bleeding diary. Multivariate linear regression models were constructed to estimate the association of 17β-estradiol (E2) and FSH with the blood count variables.

Results:
In all, 3,064 women returned the prequestionnaire (ERMA phase one), 1,393 donated blood samples and were assigned to the relevant menopausal group (phase two), and 914 completed phase three, which included physiological and psychological measurements. Nonrespondents were more likely than respondents to be obese, whereas the menopausal groups showed no mean differences in body mass index. Blood count variables, while being within clinical reference values, showed significant differences between groups. E2 and FSH were associated with the white blood cell (WBC) count and neutrophil-to-lymphocyte ratio.

Conclusions:
The ERMA study was successful in recruiting and characterizing the menopausal status of a cohort sample of middle-aged women. The significant group differences found in the blood count variables and their associations with E2 and FSH verifies menopause-associated changes in WBC composition potentially being an early sign of low-grade inflammation that may develop later in life.
Efficacy of injecting platelet concentrate combined with hyaluronic acid for the treatment of vulvovaginal atrophy in postmenopausal women with history of breast cancer: a phase 2 pilot study
Authors: Hersant Barbara , SidAhmed-Mezi Mounia , Belkacemi Yazid , Darmon Franklin , Bastuji-Garin Sylvie , Werkoff Gabrielle , Bosc Romain , Niddam Jeremy , Hermeziu Oana , La Padula Simone , Meningaud Jean Paul 
Published: May 2018

Abstract

Objective:
Approximately 50% to 70% of breast cancer survivors are affected by one or more symptoms of vulvovaginal atrophy (VVA). For those who cannot take hormone therapy, autologous platelet-rich plasma combined with hyaluronic acid (A-PRP-HA) may provide a new alternative therapy for the treatment of VVA in postmenopausal women with history of breast cancer.

Methods:
We enrolled 20 postmenopausal breast cancers survivors with VVA and a score of <15 on the Gloria Bachman Vaginal Health Index (VHI) comprised of five items including: vaginal pH, elasticity, fluid volume (secretions), epithelial integrity, and moisture.
We administered intramucosal injections of A-PRP combined with HA (Regenkit) and performed clinical evaluations at 0, 1, 3, and 6 months. Primary endpoint: evaluation of vulvovaginal mucosa changes using the VHI; secondary endpoint: evaluation of dyspareunia and sexual dysfunction based on the Female Sexual Distress (FSD) score.

Results:
All participants (20 women) showed improvement in the clinical symptoms of vaginal dryness and dyspareunia. The VHI score showed a significant increase at 6 months, going from a total baseline score (pretreatment) of 10.7 ± 2.12 to 20.75 ± 4.8 (P < 0.0001) at 6 months. Improvement in hydration and vaginal epithelial integrity was reported. A VHI score of > 15 showed a successful treatment outcome. The FSD score decreased significantly during the study, from a baseline score of 36.35 ± 2.53 pretreatment to 30.15 ± 2.47 6 months after treatment, representing improvement of 17% (P < 0.0001, respectively). No adverse events were reported.

Conclusions:
The injection of A-PRP-HA appeared to be a promising method to improve the trophicity and hydration of vaginal mucosa for the treatment of VVA in postmenopausal breast cancer survivors with contraindications to hormone therapy.
Invasive Pneumococcal Disease in Neonates Prior to Pneumococcal Conjugate Vaccine Use in South Africa: 2003–2008
Authors: Moodley Krishnee , Coovadia Yacoob Mahomed , Cohen Cheryl , Meiring Susan , Lengana Sarona , De Gouveia Linda , von Mollendorf Claire , Crowther-Gibson Penny , Quan Vanessa , Eley Brian , Reubenson Gary , Nana Trusha , von Gottberg Anne 
Published: May 2018

Background:
Neonatal invasive pneumococcal disease (IPD) in developing countries is poorly described. We provide a baseline description of neonatal IPD in South Africa, before implementation of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2009.

Methods:
Data from children (age ≤ 2 years) with IPD (pneumococcus identified from a normally sterile specimen) from January 2003 to December 2008 were extracted from a national laboratory-based surveillance database. Clinical and laboratory characteristics of IPD among neonates (0–27 days old) was compared with IPD among young children (≥ 28 days ≤ 2 years). Early-onset IPD (0–6 days old) was compared with late-onset IPD (≥ 7–27 days old). Isolates were serotyped using the Quellung reaction.

Results:
Overall 27,630 IPD cases were reported. Of the 26,277 (95%) with known ages, 6583 (25%) were ≤ 2 years of age, of which 4.5% (294/6583) were neonates. The estimated annual incidence of neonatal IPD in 2008 was 5 per 100,000 live births. Fifty-one percent of neonates with IPD presented with early-onset IPD. Case fatality ratios (CFRs) were high in both groups, 31% (28/89) in neonatal IPD versus 26% (614/2383) in non-neonatal IPD (P = 0.18). Among neonates, the meningitis cases (15/37, 41%) were associated with the highest CFR. The 13-valent pneumococcal conjugate vaccine (PCV13) serotypes accounted for 69% (134/194) of neonatal IPD isolates.

Conclusions:
Pneumococcal neonatal disease in South Africa was not uncommon before PCV introduction and is associated with a high CFR. The indirect effect on neonatal IPD of PCV rollout requires further evaluation.
Purposeful Recruitment Strategies to Increase Diversity in Physical Therapist Education
Authors: Moerchen Victoria , Williams-York Bernadette , Ross Libby J. , Wise Denise , Dominguez Jesus , Kapasi Zoher , Brooks Salome 
Published: May 2018

Background and Purpose.
A more diverse physical therapist (PT) workforce is needed to meet the rapidly changing demographic of the United States. To achieve this increased representation within the profession, PT education must recruit, admit, and retain a more diverse student body. A comprehensive definition of underrepresented minorities (URMs) in professional physical therapy education was recently expanded to include educational, economic, and geographic disadvantage in addition to race and ethnicity.

Position and Rationale.
The PT profession has not examined the disadvantaged profile of its applicant pool or student demographic, but this expanded URM definition now supports this effort. This position paper reports on a survey conducted by the American Council of Academic Physical Therapy's Diversity Task Force designed to examine recruitment into PT education through the lens of the new URM definition, with a focus on how students from underrepresented and disadvantaged backgrounds decide to pursue a PT career. The position taken was that identifying potential differences in how URM students achieve this decision will support the development of purposeful recruitment strategies for students from URM groups.

Discussion and Conclusion.
Students from URM backgrounds reported different critical decision ages, as well as different use of or preference for resources to learn about the PT career and to prepare for application to DPT programs. Although personal experience with physical therapy was the primary influence on white students' decision to pursue a PT career, values and interests were equally impactful on this decision for disadvantaged students. Both nonwhite and disadvantaged students were also more influenced by exposure to the patient–therapist relationship and by inclusion and diversity than white students. This paper uses these data to support the need for different strategies and tailored recruitment of URM students into physical therapy education programs.
Outcomes of Flipped Classroom Instruction in an Entry-Level Physical Therapy Course
Authors: Deprey Sara M. 
Published: May 2018

Background and Purpose.
Instead of relying exclusively on traditional lecture classes, instruction known as “flipped classrooms” provides students a more interactive learning environment. In a flipped classroom, students are required to listen to prepared prerecorded course content before they come to class. Rather than homework following a lecture, students complete assignments in the classroom on concepts specifically drawn from the lecture. Flipped classrooms are gaining more popularity; however, quantitative studies on their ability to improve learning are lacking.

Case Description.
This is a retrospective review over 3 consecutive years that describe outcomes of three teaching methods within one unit of an entry-level physical therapy course. Examination scores from a traditional lecture (TRAD) classroom (n = 44), a partially flipped (pFLIP) (n = 49), and a fully integrated flipped (full FLIP) classroom (n = 50) were compared.

Outcomes.
Students receiving instruction in a full FLIP classroom demonstrated the greatest improvements from examination 1 to examination 2. The pFLIP cohort demonstrated statistically significant lower scores compared to full FLIP cohort on examination 2.

Discussion and Conclusion.
The TRAD class received in-class lectures with homework, whereas the pFLIP cohort received in-class question and discussion of content, while the full FLIP cohort received intentional in-class work. A full FLIP classroom requires active participation by students, and in doing so, it simultaneously provides an enhanced opportunity to apply new content to contextualize new information with prior knowledge to solve problems. This opportunity to apply content along with the availability of the instructor to provide feedback in real time may have led to greater understanding of the course material.