bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between plasma B-type natriuretic peptide and anaemia in heart failure with or without ischaemic heart disease: a retrospective study
Authors: Tominaga Mitsutoshi , Kawai Makoto , Minai Kosuke , Ogawa Kazuo , Inoue Yasunori , Morimoto Satoshi , Tanaka Toshikazu , Nagoshi Tomohisa , Ogawa Takayuki , Yoshimura Michihiro 
Published: March 2019

ObjectivesAnaemia is a risk of worsening heart failure. However, anaemia sometimes remains undetected because the superficial cardiac function does not precisely reflect the adverse impact of anaemia. Plasma B-type natriuretic peptide (BNP) could be helpful in these cases. However, the direct anaemic effects on BNP remain unknown. Herein, we compared the direct effect of anaemia on BNP and left ventricular ejection fraction (LVEF) using an advanced statistical procedure.DesignA retrospective study.SettingSecondary care (cardiology), single-centre study.ParticipantsThe study consisted of 3756 inpatients, including 684 without ischaemic heart disease (IHD) and 3072 with IHD.Primary and secondary outcome measuresRelationship between plasma BNP levels and LVEF values.ResultsA path model was constructed to simultaneously examine the adverse impact of anaemia on LVEF and plasma BNP, allowing for renal function. The path model revealed that LVEF increased in response to low haemoglobin (Hb), and the phenomenon was prominent in non-IHD (standardised regression coefficients (St.β): −0.264, p<0.001) rather than in IHD (St.β: 0.015, p=0.531). However, the response of BNP was commonly observed in both groups (non-IHD St.β: −0.238, IHD St.β: −0.398, p<0.001, respectively). Additionally, this study showed a direct link between low estimated glomerular filtration rate and high BNP independently of LVEF. Incrementally, Bayesian structural equation modelling in covariance structure analysis clearly supported this result. The scatter plots and simple regression analysis revealed that an adequate blood supply was approximately Hb 110 g/L and over in the non-IHD patients, whereas blood was not supplied in sufficient quantities even by Hb 130 g/L in patients with IHD.ConclusionThe current study demonstrated that anaemia was a substantial risk for worsening cardiac overload as estimated by plasma BNP. The anaemic response of LVEF likely changed depending on underlying cardiac disorders (IHD or not). However, the response of BNP was robustly observed.
Paraplegia prevention in aortic aneurysm repair by thoracoabdominal staging with ‘minimally invasive staged segmental artery coil embolisation’ (MIS²ACE): trial protocol for a randomised controlled multicentre trial
Authors: Petroff David , Czerny Martin , Kölbel Tilo , Melissano Germano , Lonn Lars , Haunschild Josephina , von Aspern Konstantin , Neuhaus Petra , Pelz Johann , Epstein David Mark , Romo-Avilés Nuria , Piotrowski Katja , Etz Christian D 
Published: March 2019

IntroductionSpinal cord injury (SCI) including permanent paraplegia constitutes a common complication after repair of thoracoabdominal aortic aneurysms. The staged-repair concept promises to provide protection by inducing arteriogenesis so that the collateral network can provide a robust blood supply to the spinal cord after intervention. Minimally invasive staged segmental artery coil embolisation (MIS2ACE) has been proved recently to be a feasible enhanced approach to staged repair.Methods and analysisThis randomised controlled trial uses a multicentre, multinational, parallel group design, where 500 patients will be randomised in a 1:1 ratio to standard aneurysm repair or to MIS2ACE in 1–3 sessions followed by repair. Before randomisation, physicians document whether open or endovascular repair is planned. The primary endpoint is successful aneurysm repair without substantial SCI 30 days after aneurysm repair. Secondary endpoints include any form of SCI, mortality (up to 1 year), length of stay in the intensive care unit, costs and quality-adjusted life years. A generalised linear mixed model will be used with the logit link function and randomisation arm, mode of repair (open or endovascular repair), the Crawford type and the European System for Cardiac Operative Risk Evaluation (euroSCORE) II as fixed effects and the centre as a random effect. Safety endpoints include kidney failure, respiratory failure and embolic events (also from debris). A qualitative study will explore patient perceptions.Ethics and disseminationThis trial has been approved by the lead Ethics Committee from the University of Leipzig (435/17-ek) and will be reviewed by each of the Ethics Committees at the trial sites. A dedicated project is coordinating communication and dissemination of the trial.Trial registration numberNCT03434314.
Protocol for prospective randomised assessor-blinded pilot study comparing hyperbaric oxygen therapy with PENtoxifylline+TOcopherol± CLOdronate for the management of early osteoradionecrosis of the mandible
Authors: Bulsara Vishal M , Bulsara Max K , Lewis Emma 
Published: March 2019

IntroductionOsteoradionecrosis (ORN) of the mandible is a painful and debilitating condition occurring after radiotherapy to the head and neck to treat cancer. For decades, hyperbaric oxygen (HBO) has formed the mainstay of the early management of ORN. Literature about the efficacy of HBO is contentious. Recently, Oral and Maxillofacial surgical units in France and UK have trialled a combination of medications to treat ORN, also known as PENTOCLO (PENtoxifylline+TOcopherol±CLOdronate). This regime has shown promising results to date however randomised controlled trials in the area comparing HBO against PENTOCLO are lacking and there are no current trials registered in Europe, UK, Australia and the USA. The purpose of this pilot study is to generate a hypothesis that can be tested in large multi-centre controlled trials.Methods and analysisFor this pilot study we will recruit 16 patients who will be randomly allocated to one of either HBO or PENTOCLO. After a 4 week period of uniform ‘pre-treatment’ medication patients will be commenced on their allocated treatment. Standard follow-up examination, imaging and photographs will be taken and de-identified and then presented to two Oral and Maxillofacial surgeons for allocation of a Notani & Lyons classification score. Data for each patient will be tracked over the 18 months of treatment and follow-up. The results will then be analysed using descriptive statistics and all patients included in an intention to treat analysis.Ethics and disseminationEthical approval for this study has been granted by the South Metropolitan Health Service HREC (PRN RGS0000001193). Data generated by conducting this study will be uploaded to an open access repository in a de-identified form. Results from this study will be disseminated at national and international conferences as well as peer reviewed medical publications.Trial registration numberACTRN12618001099213; Pre-results.
The Daily Mile: teachers’ perspectives of the barriers and facilitators to the delivery of a school-based physical activity intervention
Authors: Malden Stephen , Doi Lawrence 
Published: March 2019

ObjectivesChildren spend a significant amount of their time in a school environment, often engaged in sedentary activities. The Daily Mile is a physical activity intervention which aims to increase physical activity and fitness in children through the completion of an outdoor teacher-led walk or run during the school day. This study aimed to explore the barriers, facilitators and perceived benefits of the Daily Mile from the perspectives of teachers through the use of qualitative semi-structured interviews. It also aimed to identify important context-specific factors, which might require consideration for those who intend to adopt the Daily Mile.SettingEight Local Authority primary schools in the City of Edinburgh and East Lothian, UK.ParticipantsThirteen teachers (eleven women) who teach children in primaries one to seven in a school which delivered the Daily Mile.ResultsData were analysed using an interpretative thematic analysis. Teachers were positive and enthusiastic about the Daily Mile and perceived it to be beneficial to children’s health and fitness. A number of barriers to participation were identified including inadequate all-weather running surfaces and time constraints in an already full school curriculum. The perceived impact on learning time was identified as a concern for teachers, while other benefits were also identified including increased teacher–child rapport and perceived enhanced classroom concentration levels.ConclusionThe Daily Mile appears to be a valuable addition to the school day, however important context-specific barriers to delivery of the Daily Mile exist, which should be considered when implementing the Daily Mile in schools.
Water intake after dehydration makes muscles more susceptible to cramp but electrolytes reverse that effect
Authors: Lau Wing Yin , Kato Haruyasu , Nosaka Kazunori 
Published: March 2019

ObjectiveNo previous study has compared water and oral rehydration solution (ORS) intake after dehydration induced by exercise in the heat for the effect on muscle cramps. The present study tested the hypothesis that water ingestion after dehydration would increase muscle cramp susceptibility, but this would be prevented by ORS ingestion.MethodsTen men performed two bouts of downhill running (DHR; −5%) in the heat (35°C–36 °C) until their body mass was reduced by 2%. Ten minutes after DHR, either spring water or electrolyte water similar to ORS (OS-1®) was ingested in a counter-balanced order on two different days separated by a week. Muscle cramp susceptibility was assessed by a threshold frequency (TF) of electrical train stimulation to induce cramp before, immediately after (0), and 30 and 60 min after the ingestion. Blood samples were taken before, immediately and 80 min after DHR to measure serum electrolyte concentrations.ResultsMuscle cramp susceptibility assessed by TF did not change from baseline to immediately after DHR for both conditions (water: 24.6 ± 2.1 Hz, OS-1®: 24.7 ± 1.4 Hz). TF decreased after water intake by 4.3 Hz (30 min) and 5.1 Hz (60 min post-ingestion), but increased after OS-1®intake by 3.7 and 5.4 Hz, respectively. Serum sodium and chloride concentrations decreased after water intake but maintained after OS-1®intake.ConclusionThese results suggest that water intake after dehydration makes muscles more susceptible to electrical simulation-induced muscle cramp, probably due to dilution of electrolytes, and when OS-1®is consumed, the susceptibility to muscle cramp decreases.
Delirium management by palliative medicine specialists: a survey from the association for palliative medicine of Great Britain and Ireland
Authors: Boland Jason W , Kabir Monisha , Bush Shirley H , Spiller Juliet Anne , Johnson Miriam J , Agar Meera , Lawlor Peter 
Published: March 2019

ObjectivesDelirium is common in palliative care settings. Management includes detection, treatment of cause(s), non-pharmacological interventions and family support; strategies which are supported with varying levels of evidence. Emerging evidence suggests that antipsychotic use should be minimised in managing mild to moderate severity delirium, but the integration of this evidence into clinical practice is unknown.MethodsA 21-question online anonymous survey was emailed to Association for Palliative Medicine members in current clinical practice (n=859), asking about delirium assessment, management and research priorities.ResultsResponse rate was 39%: 70% of respondents were palliative medicine consultants. Delirium guidelines were used by some: 42% used local guidelines but 38% used none. On inpatient admission, 59% never use a delirium screening tool. Respondents would use non-pharmacological interventions to manage delirium, either alone (39%) or with an antipsychotic (58%). Most respondents (91%) would prescribe an antipsychotic and 6% a benzodiazepine, for distressing hallucinations unresponsive to non-pharmacological measures. Inpatient (57%) and community teams (60%) do not formally support family carers. Research priorities were delirium prevention, management and prediction of reversibility.ConclusionThis survey of UK and Irish Palliative Medicine specialists shows that delirium screening at inpatient admission is suboptimal. Most specialists continue to use antipsychotics in combination with non-pharmacological interventions to manage delirium. More support for family carers should be routinely provided by clinical teams. Further rigorously designed clinical trials are urgently needed in view of management variability, emerging evidence and perceived priorities for research.
Sociodemographic and behavioural correlates of lifetime number of sexual partners: findings from the English Longitudinal Study of Ageing
Authors: Jackson Sarah E , Yang Lin , Veronese Nicola , Koyanagi Ai , López Sánchez Guillermo Felipe , Grabovac Igor , Soysal Pinar , Smith Lee 
Published: March 2019

BackgroundNo current data are available on correlates of lifetime sexual partners at older ages. This study aimed to explore correlates of the lifetime number of sexual partners in a sample of older adults.MethodData were from 3054 men and 3867 women aged ≥50 years participating in the English Longitudinal Study of Ageing. Participants reported their lifetime number of sexual partners and a range of sociodemographic characteristics and health behaviours. Multivariable multinomial logistic regression was used to examine correlates of lifetime number of sexual partners, with analyses performed separately for men and women and weighted for non-response.ResultsYounger age, being separated/divorced or single/never married, being a current or former smoker, and drinking alcohol regularly or frequently were independently associated with a higher number of sexual partners in both men and women. Homosexuality in men and bisexuality in women were also associated with a higher number of sexual partners. White ethnicity, regular moderate and vigorous physical activity, and the absence of limiting long-standing illness were independently associated with a higher number of sexual partners in women only, and being in the highest and lowest quintiles of wealth was independently associated with a higher number of sexual partners in men only.ConclusionsA higher lifetime number of sexual partners is associated with a number of sociodemographic and behavioural factors. An understanding of who is more likely to have had more sexual partners may help health practitioners to identify individuals who are at greatest risk of sexually transmitted infection and their associated health complications across the life course.
Road user behaviour, attitudes and crashes: a survey of Aboriginal and Torres Strait Islander people in Australia
Authors: Cullen Patricia , Hunter Kate , Clapham Kathleen , Senserrick Teresa , Rogers Kris , Harrison James E , Ivers Rebecca Q 
Published: March 2019

ObjectiveThis study aimed to describe road user behaviour, attitudes and crashes in Aboriginal and Torres Strait Islander people in four urban, regional and remote communities located in New South Wales (NSW) and South Australia (SA).MethodsFace-to-face surveys were administered to clients (n=625) in Aboriginal Community Controlled Health Services (ACCHS). All Aboriginal and Torres Strait Islander clients attending the ACCHS for any reason were approached to participate over a 2-week period. Surveys included questions on sociodemographic factors, crash involvement, road behaviours and road safety attitudes drawn from tools used in national surveys.ResultsThe participation rate was high (69%–75%). Seat belt wearing rates were very high, particularly in the front of a car, although rear seat belt wearing rates in SA (77%) were substantially lower than in NSW (93%). Among drivers, 11% reported always or mostly driving 10 km/hour over the speed limit, and this was higher among drivers in SA (13.4%). Drivers aged 55 years and over and/or women were more likely to report that they do not drink at any time or restricted what they drank when driving. These results enable comparison with the Community Attitude to Road Safety survey conducted Australia-wide in 2013.ConclusionsThis study confirms that Aboriginal and Torres Strait Islander people are inclined to report attitudes or road safety behaviours similar to the rest of the population; however, rear restraint use was lower and self-reported speeding was higher. These issues are likely attributable to transport options and geography in remote communities, which can contribute to overcrowding and unsafe driving practices.
A randomised double-blind placebo-controlled feasibility trial of flavonoid-rich cocoa for fatigue in people with relapsing and remitting multiple sclerosis
Authors: Coe Shelly , Cossington Jo , Collett Johnny , Soundy Andrew , Izadi Hooshang , Ovington Martin , Durkin Luke , Kirsten Maja , Clegg Miriam , Cavey Ana , Wade Derick T , Palace Jacqueline , DeLuca Gabriele C , Chapman Kim , Harrison Jane-Marie , Buckingham Elizabeth , Dawes Helen 
Published: March 2019

The impact of flavonoids on fatigue has not been investigated in relapsing and remitting multiple sclerosis (RRMS).ObjectiveTo determine the feasibility and estimate the potential effect of flavonoid-rich cocoa on fatigue and fatigability in RRMS.MethodsA randomised double-blind placebo-controlled feasibility study in people recently diagnosed with RRMS and fatigue, throughout the Thames Valley, UK (ISRCTN69897291). During a 6-week intervention participants consumed a high or low flavonoid cocoa beverage daily. Fatigue and fatigability were measured at three visits (weeks 0, 3 and 6). Feasibility and fidelity were assessed through recruitment and retention, adherence and a process evaluation.Results40 people with multiple sclerosis (10 men, 30 women, age 44±10 years) were randomised and allocated to high (n=19) or low (n=21) flavonoid groups and included in analysis. Missing data were <20% and adherence to intervention of allocated individuals was >75%. There was a small effect on fatigue (Neuro-QoL: effect size (ES) 0.04, 95% CI −0.40 to 0.48) and a moderate effect on fatigability (6 min walk test: ES 0.45, 95% CI −0.18 to 1.07). There were seven adverse events (four control, three intervention), only one of which was possibly related and it was resolved.ConclusionA flavonoid beverage demonstrates the potential to improve fatigue and fatigability in RRMS.
Impact of Metastatic Lymph Node to Total Lymph Node Ratio on Survival of Endometrial Cancer Patients
Authors: Tangjitgamol Siriwan , Kittisiam Thannaporn , Sriraumpuch Jittrind 
Published: March 2019

<b><i>Objective:</i></b> To evaluate the prognostic role of metastatic lymph node (MLN), total lymph nodes (TLN) and MLN to TLN ratio in advanced-stage endometrial cancer (EMC). ­<b><i>Methods:</i></b> EMC patients who had complete surgical staging between January 1995 and May 2017 and were in stage IIIC–IVB with pelvic and/or para-aortic nodal metastasis were identified. Data collected were age, stage, histopathology, TLN and MLN numbers, adjuvant treatment, disease status, and living status. The association of lymph node ratio (LNR), presented as a percentage of MLN to TLN, and other clinicopathologic factors with progression-free survival (PFS) and cancer-specific survival (CSS) was studied. <b><i>Results:</i></b> Among 82 patients identified, mean age was 59.5 ± 10.7 years. Majority had stage IIIC1 (45.1%) and endometrioid histopathology (65.9%). After surgery, 71 patients (86.6%) had adjuvant treatment. After a median follow-up of 29.8 months (range 0.40–257.5 months), 43 patients (52.4%) had progression or recurrences. Total of 40 patients (48.8%) were dead from cancer. By univariable analyses, significant poor prognostic factors for PFS and CSS (hazard ratios [HRs]) were age ≥50 years (2.43), stage IV (3.26), nonendometrioid histopathology (2.87), ovarian involvement (2.40), TLN (2.07), LNR (2.82), and adjuvant treatment (3.58). Only adjuvant radiation with or without chemotherapy, but none of LN features, remained significant by multivariable analyses with HR of 2.27 for PFS and 3.04 for CSS. <b><i>Conclusion:</i></b> This study found that TLN, LNR, age, stage, histopathology, ovarian involvement, and adjuvant treatment were prognostic factors for survival in advanced-stage EMC. Only the adjuvant treatment of radiation with or without chemotherapy was the only independent significant prognostic factor.
Relationship of Neighborhood Greenness to Heart Disease in 249 405 US Medicare Beneficiaries
Authors: Wang Kefeng , Lombard Joanna , Rundek Tatjana , Dong Chuanhui , Gutierrez Carolina Marinovic , Byrne Margaret M. , Toro Matthew , Nardi Maria I. , Kardys Jack , Yi Li , Szapocznik José , Brown Scott C. 
Published: March 2019

Background
Nature exposures may be associated with reduced risk of heart disease. The present study examines the relationship between objective measures of neighborhood greenness (vegetative presence) and 4 heart disease diagnoses (acute myocardial infarction, ischemic heart disease, heart failure, and atrial fibrillation) in a population‐based sample of Medicare beneficiaries.

Methods and Results

The sample included 249 405 Medicare beneficiaries aged 65 years and older whose location (
ZIP
+4) in Miami‐Dade County, Florida, did not change from 2010 to 2011. Analyses examined relationships between greenness, measured by mean block‐level normalized difference vegetation index from satellite imagery, and 4 heart disease diagnoses. Hierarchical regression analyses, in a multilevel framework, assessed the relationship of greenness to each heart disease diagnosis, adjusting successively for individual sociodemographics, neighborhood income, and biological risk factors (diabetes mellitus, hypertension, and hyperlipidemia). Higher greenness was associated with reduced heart disease risk, adjusting for individual sociodemographics and neighborhood income. Compared with the lowest tertile of greenness, the highest tertile of greenness was associated with reduced odds of acute myocardial infarction by 25% (odds ratio, 0.75; 95%
CI
, 0.63–0.90), ischemic heart disease by 20% (odds ratio, 0.80; 95%
CI
, 0.77–0.83), heart failure by 16% (odds ratio, 0.84; 95%
CI
, 0.80–0.88), and atrial fibrillation by 6% (odds ratio, 0.94; 95%
CI
, 0.87–1.00). Associations were attenuated after adjusting for biological risk factors, suggesting that cardiometabolic risk factors may partly mediate the greenness to heart disease relationships.

Conclusions
Neighborhood greenness may be associated with reduced heart disease risk. Strategies to increase area greenness may be a future means of reducing heart disease at the population level.