bluuebunny/crossref_metadata_2025_split huggingface dataset:
Childhood injuries in Oman: retrospective review of a multicentre trauma registry data
Authors: Mehmood Amber , Agrawal Priyanka , Allen Katharine A , Al-Kashmiri Ammar , Al-Busaidi Ali , Hyder Adnan Ali 
Published: November 2018

ObjectivesInjuries are among the top causes of hospital-based mortality for adults in Oman. However, little is known about the distribution and risk of injuries among children. This paper describes the epidemiology and risk factors for childhood injuries (0–15 years of age), in two hospitals of Oman.MethodsData were collected between November 2014 and April 2015 at Khoula and Nizwa Hospitals. All patients between 0 and 15 years with a diagnosis of injury/trauma admitted to the hospital, and those who had trauma team activation in the emergency department were included in the analysis. Descriptive and multivariable Poisson regression analyses were conducted to generate sociodemographic risk factor profiles associated with the need for surgical management of injuries.ResultsOut of 795 cases, 59% were under 5 years of age; 67% were males. Around 50% injuries were fall related, followed by exposure to inanimate mechanical forces and transport injuries. Burn injuries were more prevalent in females than males. Three-fourths of all injuries occurred in private residences. Almost 92% injuries were minor (Injury Severity Score <9). Of children with all types of injuries, 303 (40.9%) received surgical treatment. Patients suffering from head injuries (RR 8.8: 95% CI 4.9 to 15.3) or being involved in a burn injury (RR 1.5: 95% CI 0.3 to 7.5) were at increased risk of undergoing surgical treatment.ConclusionIn this study, >30% of injury admissions were children 0–15 years of age. The high incidence of falls, home injuries and burns highlight the need for age-targeted interventions and injury control programmes. Although infrequent, transport injuries and head injuries put children in need of surgical management and prolonged hospital care.
Extubation from high-frequency oscillatory ventilation in extremely low birth weight infants: a prospective observational study
Authors: Tana Milena , Lio Alessandra , Tirone Chiara , Aurilia Claudia , Tiberi Eloisa , Serrao Francesca , Purcaro Velia , Corsello Mirta , Catenazzi Piero , D’Andrea Vito , Barone Giovanni , Ricci Cinzia , Pastorino Roberta , Vento Giovanni 
Published: November 2018

ObjectiveTo evaluate if weaning from high-frequency oscillatory ventilation (HFOV) directly to a non-invasive mode of respiratory support is feasible and results in successful extubation in extremely low birth weight (ELBW) infants.DesignProspective observational study.SettingTertiary neonatal intensive care unit.PatientsOne hundred and eight ELBW infants of 26.2±1.4 weeks of gestational age (GA) directly extubated from HFOV.InterventionsAll infants were managed with elective HFOV and received surfactant after a recruitment HFOV manoeuvre. Extubation was attempted at mean airways pressure (MAP) ≤6 cm H2O with FiO2≤0.25. After extubation, all infants were supported by nasal continuous positive airway pressure (6–8 cm H2O).Main outcome measuresExtubation failure (clinical deterioration requiring reintubation) was defined as shorter than 7 days.ResultsNinety patients (83%) were successfully extubated and 18 (17%) required reintubation. No significant differences were found between the two groups in terms of birth weight, day of life and weight at the time of extubation. Multivariable analysis showed that GA (OR 1.71; 95% CI 1.04, 2.08) and higher MAP prior to surfactant (OR 1.51; 95% CI 1.06, 2.15) were associated with successful extubation.ConclusionsIn ELBW infants, direct extubation from HFOV at MAP ≤6 cm H2O with FiO2≤0.25 is feasible. Our extubation success rate (83%) is higher than conventional mechanical ventilation in this very vulnerable class of infants.
Ziprasidone, haloperidol and clonazepam intramuscular administration in the treatment of agitation symptoms in Chinese patients with schizophrenia: A network meta-analysis
Authors: Su Liang , Lu Zheng , Shi Shenxun , Xu Yifeng 
Published: November 2018

BackgroundAgitation is very common in patients with acute stage schizophrenia, and injection of antipsychotics and clonazepam is widely used. Network meta-analysis of these comparisons among three injection treatments has been seldom reported.AimTo compare the efficacy and safety of various injections for agitation symptoms in Chinese patients with schizophrenia.MethodsSearches were made in PubMed, Embase and Web of Knowledge, Cochrane Library, Wanfang data, CNKI, SinoMed and VIP databases up to 18 February 2018. Standard search strategies were performed by two reviewers according to the Cochrane Review Group. The Consolidated Standards of Reporting Trials statement was used to assess the methodological quality of the studies. STATA was used to perform meta-analysis. The Cochrane Grades of Recommendation, Assessment, Development and Evaluation (GRADE) was used to assess the strength of evidence.ResultsA total of 15 studies were included in the network meta-analysis. There were 11 studies comparing ziprasidone with haloperidol, and four studies comparing haloperidol with clonazepam. The results showed that ziprasidone is more effective than haloperidol and clonazepam (sucra: 77.2, 72.8 and 0) in the treatment of agitation symptoms. There was the effect size (standardised mean difference (SMD)) in the three groups: haloperidol: SMD=2.278, 95% CI 1.836 to 2.719; ziprasidone: SMD=2.536, 95% CI 2.082 to 2.990; and clonazepam: SMD=1.360, 95% CI 0.127 to 2.593. The acceptability was assessed by the incidence of excessive sedation, which showed that ziprasidone and haloperidol were similar with both being superior to clonazepam (sucra: 0.3, 0.7 and 99.0). Ziprasidone had significantly less adverse effects than haloperidol in effects of extrapyramidal system (EPS) (z=5.01, p<0.001). There were no statistically significant differences between haloperidol and ziprasidone in tachycardia and abnormal ECG (z=1.69, p=0.091; z=0.87, p=0.386; respectively). Based on GRADE, the strength of the evidence for primary outcome was ‘medium’.ConclusionOur results suggested that ziprasidone was more suitable than haloperidol and clonazepam in the treatment of agitation symptoms in Chinese patients with schizophrenia, according to the efficacy and acceptability of these three intramuscular injection medications.
Stromal protein βig-h3 reprogrammes tumour microenvironment in pancreatic cancer
Authors: Goehrig Delphine , Nigri Jérémy , Samain Rémi , Wu Zhichong , Cappello Paola , Gabiane Gaëlle , Zhang Xinyi , Zhao Yajie , Kim In-San , Chanal Marie , Curto Roberta , Hervieu Valerie , de La Fouchardière Christelle , Novelli Francesco , Milani Pascale , Tomasini Richard , Bousquet Corinne , Bertolino Philippe , Hennino Ana 
Published: November 2018

ObjectivePancreatic cancer is associated with an abundant stromal reaction leading to immune escape and tumour growth. This massive stroma drives the immune escape in the tumour. We aimed to study the impact of βig-h3 stromal protein in the modulation of the antitumoural immune response in pancreatic cancer.DesignWe performed studies withp48-Cre;KrasG12D,pdx1-Cre;KrasG12D;Ink4a/Arffl/fl,pdx1-Cre;KrasG12D; p53R172Hmice and tumour tissues from patients with pancreatic ductal adenocarcinoma (PDA). Some transgenic mice were given injections of anti-βig-h3, anti-CD8, anti-PD1 depleting antibodies. Tumour growth as well as modifications in the activation of local immune cells were analysed by flow cytometry, immunohistochemistry and immunofluorescence. Tissue stiffness was measured by atomic force microscopy.ResultsWe identified βig-h3 stromal-derived protein as a key actor of the immune paracrine interaction mechanism that drives pancreatic cancer. We found that βig-h3 is highly produced by cancer-associated fibroblasts in the stroma of human and mouse. This protein acts directly on tumour-specific CD8+T cells and F4/80 macrophages. Depleting βig-h3in vivoreduced tumour growth by enhancing the number of activated CD8+T cell within the tumour and subsequent apoptotic tumour cells. Furthermore, we found that targeting βig-h3 in established lesions released the tissue tension and functionally reprogrammed F4/80 macrophages in the tumour microenvironment.ConclusionsOur data indicate that targeting stromal extracellular matrix protein βig-h3 improves the antitumoural response and consequently reduces tumour weight. Our findings present βig-h3 as a novel immunological target in pancreatic cancer.
Reclassification of BRCA1 and BRCA2 variants of uncertain significance: a multifactorial analysis of multicentre prospective cohort
Authors: Lee Jee-Soo , Oh Sohee , Park Sue Kyung , Lee Min-Hyuk , Lee Jong Won , Kim Sung-Won , Son Byung Ho , Noh Dong-Young , Lee Jeong Eon , Park Hai-Lin , Kim Man Jin , Cho Sung Im , Lee Young Kyung , Park Sung Sup , Seong Moon-Woo 
Published: November 2018

BackgroundBRCA1 and BRCA2 (BRCA1/2) variants classified ambiguously as variants of uncertain significance (VUS) are a major challenge for clinical genetic testing in breast cancer; their relevance to the cancer risk is unclear and the association with the response to specific BRCA1/2-targeted agents is uncertain. To minimise the proportion of VUS in BRCA1/2, we performed the multifactorial likelihood analysis and validated this method using an independent cohort of patients with breast cancer.MethodsWe used a data set of 2115 patients with breast cancer from the nationwide multicentre prospective Korean Hereditary Breast Cancer study. In total, 83 BRCA1/2 VUSs (BRCA1, n=26; BRCA2, n=57) were analysed. The multifactorial probability was estimated by combining the prior probability with the overall likelihood ratio derived from co-occurrence of each VUS with pathogenic variants, personal and family history, and tumour characteristics. The classification was compared with the interpretation according to the American College of Medical Genetics and Genomics–Association for Molecular Pathology (ACMG/AMP) guidelines. An external validation was conducted using independent data set of 810 patients.ResultsWe were able to redefine 38 VUSs (BRCA1, n=10; BRCA2, n=28). The revised classification was highly correlated with the ACMG/AMP guideline-based interpretation (BRCA1, p for trend=0.015; BRCA2, p=0.001). Our approach reduced the proportion of VUS from 19% (154/810) to 8.9% (72/810) in the retrospective validation data set.ConclusionThe classification in this study would minimise the ‘uncertainty’ in clinical interpretation, and this validated multifactorial model can be used for the reliable annotation of BRCA1/2 VUSs.
A systematic review and meta-analysis of observational evidence for the use of bailout self-expandable stents following failed anterior circulation stroke thrombectomy
Authors: Wareham James , Flood Richard , Phan Kevin , Crossley Robert , Mortimer Alex 
Published: November 2018

BackgroundThe crucial role of thrombectomy in the management of emergent large vessel occlusive stroke is not disputed but there is a technical failure rate in a significant minority of patients whose outcomes are often poor. Our objective was to perform a systematic review and meta-analysis to assess the safety and efficacy of permanent self-expandable stent deployment as a bailout procedure in cases of failed anterior circulation thrombectomy.MethodsTwo independent reviewers searched the Pubmed (Medline) database for studies reporting outcomes following failed endovascular thrombectomy with subsequent rescue therapy employing self-expandable stents.ResultsEight studies (one prospective, seven retrospective) originating from Europe, Asia, and America comprising 160 patients met the inclusion criteria. Estimated baseline National Institutes of Health Stroke Scale score was 17.1 (95% CI 15.7 to 18.4). Following failed thrombetcomy and stent deployment, the rate of favorable outcome (modified Rankin Scale score 0–2) was 43% (95% CI 34% to 53%). Pooled mortality was 21% (95% CI 13% to 33%). Successful recanalization (Thrombolysis in Cerebral Infarction (TICI) 2b–3 or Thrombolysis in Myocardial Infarction (TIMI) 2–3) was 71% (95% CI 63% to 77%). Symptomatic intracerebral hemorrhage was seen in 12% (95% CI 7% to 18%). The Solitaire stent (Medtronic) was the most commonly deployed stent following failed thrombectomy attempts (66%; 95% CI 31% to 89%). Pre- or post-stent angioplasty was performed in 39%of patients (95% CI 29% to 48%). Glycoprotein IIb/IIIa inhibitors were used in 89% (95% CI 71% to 97%). 95% of patients received postprocedural antiplatelet therapy.ConclusionA rescue stent procedure seems reasonable as a last resort following failed thrombectomy but currently the level of evidence is limited. Prospective registries may aid in guiding future recommendations.
Real-world presentation with heart failure in primary care: do patients selected to follow diagnostic and management guidelines have better outcomes?
Authors: Bottle Alex , Kim Dani , Aylin Paul P , Majeed F Azeem , Cowie Martin R , Hayhoe Benedict 
Published: November 2018

ObjectiveTo describe associations between initial management of people presenting with heart failure (HF) symptoms in primary care, including compliance with the recommendations of the National Institute for Health and Care Excellence (NICE), and subsequent unplanned hospitalisation for HF and death.MethodsThis is a retrospective cohort study using data from general practices submitting records to the Clinical Practice Research Datalink. The cohort comprised patients diagnosed with HF during 2010–2013 and presenting to their general practitioners with breathlessness, fatigue or ankle swelling.Results13 897 patients were included in the study. Within the first 6 months, only 7% had completed the NICE-recommended pathway; another 18.6% had followed part of it (B-type natriuretic peptide testing and/or echocardiography, or specialist referral). Significant differences in hazards were seen in unadjusted analysis in favour of full or partial completion of the NICE-recommended pathway. Covariate adjustment attenuated the relations with death much more than those for HF admission. Compared with patients placed on the NICE pathway, treatment with HF medications had an HR of 1.16 (95% CI 1.05 to 1.28, p=0.003) for HF admission and 1.03 (95% CI 0.90 to 1.17, p= 0.674) for death. Patients who partially followed the NICE pathway had similar hazards to those who completed it. Patients on no pathway had the highest hazard for HF admission at 1.30 (95% 1.18 to 1.43, p<0.001) but similar hazard for death.ConclusionsPatients not put on at least some elements of the NICE-recommended pathway had significantly higher risk of HF admission but non-significant higher risk of death than other patients had.
Cancer Risk from Exposure to Particulate Matter and Ozone According to Obesity and Health-Related Behaviors: A Nationwide Population-Based Cross-Sectional Study
Authors: Kim Kyoung Jin , Shin Jinyoung , Choi Jaekyung 
Published: November 2018

Abstract

Background:
There is little evidence of an association between cancer risk and long-term exposure to ambient particulate matter &lt;10 μm (PM10) and ozone (O3), according to obesity and health-related behaviors.

Methods:
In the 2012 Korean Community Health Survey, survey data on socioeconomic characteristics, health-related behaviors, and previous cancer history were collected from 100,867 participants. Daily average concentrations of PM10 and O3 (2003–2012) were obtained from the Korean Air Pollutants Emission Service. The cancer risks for interquartile increases in PM10 and O3 were evaluated using multiple logistic regression and were stratified by age, sex, obesity, and health-related behaviors.

Results:
Increased cancer risk was found among obese subjects aged ≥50 years after adjusting for confounding factors [PM10: ≥60 years: OR 1.34, 95% confidence interval (CI) 1.03–1.74; 50–60 years: OR 1.40, CI 1.01–1.96; O3: ≥60 years: OR 1.12, CI 1.04–1.20; 50–60 years: OR 1.20, CI 1.08–1.33]. However, we did not observe similar trends in the nonobese subjects. Among obese subjects aged ≥50 who had been exposed to PM10, men, ever smokers, and inactive subjects were at increased cancer risk. Regarding O3, the cancer risk was significantly higher among obese adults &gt;50 years old, regardless of sex or health-related behaviors.

Conclusions:
Long-term exposure to PM10 and O3 was found to increase cancer risk. In particular, the risk differed according to obesity status, age, sex, and health-related behaviors.

Impact:
The effect of air pollution on cancer risk was compounded by obesity, smoking, and physical inactivity among subjects over 50 years old.
Scaling Up Diabetes Prevention Programs in North Carolina: Perceptions of Demand From Potential Program Recipients and Providers
Authors: Thomas Tainayah , Samuel-Hodge Carmen D. , Porterfield Deborah S. , Alva Maria L. , Leeman Jennifer 
Published: November 2018

Purpose The purpose of this study was to assess factors that influence demand for the Diabetes Prevention Program (DPP) from the perspectives of potential program participants and providers. Methods A qualitative study guided by a conceptual framework was conducted with potential DPP participants and potential DPP providers. Five focus groups with potential participants (n = 37) and key informant interviews with potential providers (n = 14) were conducted in community settings across North Carolina. Results Although providers considered prediabetes to be an important health problem, potential DPP participants expressed less urgency related to a diagnosis of prediabetes. Potential participants felt that they were more likely to adopt diabetes prevention programs if affordable and convenient. For potential program providers, funding, collaboration, and staff support were key considerations for DPP adoption. Providers were supportive of DPP features; however, there was concern from both stakeholders on retention in a 16-week program. Both groups cited transportation, cost, and health insurance reimbursement as existing barriers to the uptake of these programs. Conclusion This qualitative study highlights important considerations for scaling up diabetes prevention programs in community settings, including what constraints agencies face in adopting programs, the perceived demand and programmatic needs for these services by customers, and the need for improving patient education on prediabetes. This implementation science study allows us to increase the potential to scale up and sustain diabetes prevention programs that fit available resources and customer needs.
Invasive Respiratory or Vasopressor Support and/or Death as a Proposed Composite Outcome Measure for Perioperative Care Research
Authors: Mizota Toshiyuki , Dong Li , Takeda Chikashi , Shiraki Atsuko , Matsukawa Shino , Shimizu Satoshi , Kai Shinichi 
Published: November 2018

BACKGROUND:
There is a need for a clinically relevant and feasible outcome measure to facilitate clinical studies in perioperative care medicine. This large-scale retrospective cohort study proposed a novel composite outcome measure comprising invasive respiratory or vasopressor support (IRVS) and death. We described the prevalence of IRVS in patients undergoing major abdominal surgery and assessed the validity of combining IRVS and death to form a composite outcome measure.

METHODS:
We retrospectively collected perioperative data for 2776 patients undergoing major abdominal surgery (liver, colorectal, gastric, pancreatic, or esophageal resection) at Kyoto University Hospital. We defined IRVS as requirement for mechanical ventilation for ≥24 hours postoperatively, postoperative reintubation, or postoperative vasopressor administration. We evaluated the prevalence of IRVS within 30 postoperative days and examined the association between IRVS and subsequent clinical outcomes. The primary outcome of interest was long-term survival. Multivariable Cox proportional regression analysis was performed to adjust for the baseline patient and operative characteristics. The secondary outcomes were length of hospital stay and hospital mortality.

RESULTS:
In total, 85 patients (3.1%) received IRVS within 30 postoperative days, 15 of whom died by day 30. Patients with IRVS had a lower long-term survival rate (1- and 3-year survival probabilities, 66.1% and 48.5% vs 95.2% and 84.0%, respectively; P < .001, log-rank test) compared to those without IRVS. IRVS was significantly associated with lower long-term survival after adjustment for the baseline patient and operative characteristics (adjusted hazard ratio, 2.72; 95% confidence interval, 1.97–3.77; P < .001). IRVS was associated with a longer hospital stay (median [interquartile range], 65 [39–326] vs 15 [12–24] days; adjusted P < .001) and a higher hospital mortality (24.7% vs 0.5%; adjusted P < .001). Moreover, IRVS was adversely associated with subsequent clinical outcomes including lower long-term survival (adjusted hazard ratio, 1.78; 95% confidence interval, 1.21–2.63; P = .004) when the analyses were restricted to 30-day survivors.

CONCLUSIONS:
Patients with IRVS can experience ongoing risk of serious morbidity and less long-term survival even if alive at postoperative day 30. Our findings support the validity of using IRVS and/or death as a composite outcome measure for clinical studies in perioperative care medicine.
Ευρωπαϊκή Ολοκλήρωση και Ελληνική Οικονομία: Η Ελλάδα στον Πυρήνα ή στην Περιφέρεια της Ευρώπης;
Authors: Χρυσομαλλίδης Χαράλαμπος , Μαραβέγιας Ναπολέων 
Published: November 2018

A decade has passed since the outbreak of the global fi nancial crisis and the defi cit crisis in Greece. The question that arises is whether the Greek economy has been stabilized, reaching a new equilibrium, as the Greek economy seems to have overcome severe crisis conditions; however, returning to high and sustainable growth remains under question. The analysis lays emphasis on the fact that the country historically belonged to the EU periphery, which is considered a critical parameter for the operation of the Greek economy within the Eurozone. For this analysis we take into account the structure of the Greek economy and the existing architecture of the Eurozone. The article examines also the economy’s prospects, in relation to the European integration process.
Hospitalisations for suicidal behaviour: clinical characteristics and nursing care
Authors: Vanzela Amanda Sarah , Vedana Kelly Graziani Giacchero , Costa Juliana dos Santos , Zanetti Ana Carolina Guidorizzi 
Published: November 2018

Introduction: The care given to people with suicidal behaviour is an important predictor of future death by suicide; however, there is a lack of research on the issue in Brazil. Objective: This study investigated hospitalisations for suicidal behaviour (sociodemographic and clinic characteristics, nursing care and associated factors). Method: Data were collected through manual consultation of medical records of patients admitted in 2015 to a psychiatric emergency unit of a hospital, and analysed using descriptive statistics, Chi-square test and Fisher's exact test. Results: Adult women without a partner, with mood disorder, comorbidities, history of previous suicide attempts and who returned to their own homes predominated among the 127 study cases. The most frequent nursing diagnosis was ‘impaired social interaction’. Age and gender were associated with medical diagnoses. Marital status was associated with medical and nursing diagnoses. Changes in psychosocial assessment were associated with current suicidal ideation, number of attempts, and medical diagnoses. The nursing diagnosis ‘risk of self-directed violence’ was associated with thought disorders and self-harm history. Conclusion: This study contributes to the mapping of factors associated with suicidal behaviour, vulnerabilities and associated factors. It also reflects on the potential of nursing interventions in the care and prevention of suicidal behaviour.