bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations between antenatal prednisone exposure and long-term cortisol and cortisone concentrations in children born to women with rheumatoid arthritis: results from a nationwide prospective cohort study
Authors: Ince-Askan Hilal , van den Akker Erica L T , de Rijke Yolanda B , van Rossum Elisabeth F C , Hazes Johanna M W , Dolhain Radboud J E M 
Published: January 2019

ObjectivesTo identify whether children with antenatal prednisone exposure have chronically elevated cortisol and cortisone concentrations, an altered body composition or higher blood pressure. In addition, to identify whether maternal rheumatoid arthritis disease (RA) activity is associated with these alterations.MethodsIn this prospective study, 56 children (mean age=10.0 years) with and 61 children (mean age=9.6 years) without antenatal prednisone exposure, born to women with RA, were included. Hair cortisol and cortisone were analysed using liquid chromatography–tandem mass spectrometry. Linear regression models were built to analyse differences between the two groups, corrected for relevant covariates. Hair cortisol concentrations were also compared between the study population and an age-matched healthy reference group(n=150 children, mean age=9.8 years).ResultsHair cortisol and cortisone concentrations were similar in children with and without antenatal prednisone exposure (median cortisol 1.14 pg/mg (IQR 0.67–1.75) and 1.15 pg/mg (IQR 0.65–2.21) and median cortisone 6.76 pg/mg (IQR 5.42–8.86) and 7.40 pg/mg (IQR 5.39–10.73), respectively). Antenatal prednisone exposure and maternal RA disease activity were also not associated with body composition or blood pressure. Hair cortisol concentrations were not different in children born to mothers with RA compared with children from the reference group.ConclusionThis, in its kind, large and unique long-term prospective study demonstrates that low-dose antenatal prednisone exposure and maternal RA disease activity are not associated with negative consequences in prepubertal childhood. The findings of this study are reassuring and support the assumption that low-dose maternal prednisone use during pregnancy is safe for the offspring, at least until the age of approximately 10 years.
iKure Techsoft: Providing Technology Enabled Affordable Health Care in Rural India
Authors: Chaudhuri Atanu , Saddikutti Venkatramanaiah , Prætorius Thim 
Published: January 2019

iKure Techsoft was established in 2010 with the main objective to provide affordable and high quality primary health care to the rural population in India and to build a sustainable for-profit business model. To that end, iKure’s cloud based, and patent pending, Wireless Health Incident Monitoring System (WHIMS) technology along with their hub-and-spoke operating model are central, but also essential to exploit and explore further if iKure is to scale-up. iKure provides primary health care services through three hub clinics and 28 rural health centres (RHCs). Each hub clinic employs between one and up to six medical teams (each consisting of 1 doctor, 1 nurse, 1 paramedic and 2 health workers stationed at the hub) & 1 mobile medical team (1 doctor, 1 paramedic, 2 health workers) for catering to the RHCs). Each medical team manages six RHCs. Paramount in iKure’s health care delivery model is their self-developed software called WHIMS, which is a cloud-based award-winning application that runs on low internet bandwidths. WHIMS allow for (a) centralized monitoring of key metrics such as doctor’s attendance, treatment prescribed, patient record management, pharmacy stock management, and (b) supports effective communication, integration and contact that connects RHCs with hub clinics, but also city-based multi-specialty hospitals with whom iKure has formal tie-ups. iKure, moreover, also works extensively with Non-Governmental Organizations (NGOs). Collaboration with local NGOs in the target areas helps to build trust with the rural villagers and their local knowledge and access helps to assess service demand. NGOs also provide the necessary local logistical support and basic infrastructure in the rural areas where iKure works. Moreover, collaboration, for example, with corporate organizations are central as they contribute with part of their corporate social responsibility (CSR) funds to support iKure initiatives. At present, iKure is planning to add diagnostic services to its six hub clinics as well as expand its presence in other parts of West Bengal and other states across India. Expanding rural health care services even with the technology support of WHIMS is challenging because, for example, health is a very local issue (due to, among other things, local customs and languages) and it requires investing significant amount of time and resources to build relationship with the rural people as well as collaborators such as NGOs and corporates. The accompanying case describes iKure’s journey so far in terms of understanding: (a) the state of health care and government health care services provided in rural India, (b) the establishment and evolution of the iKure business and health care model, (c) iKure’s operations and health care delivery model including the WHIMS technology solution and hub-and-spoke set-up of operations, (d) the collaborative model which relies on NGOs and private corporates, and (e) finally iKure’s challenges related to scaling-up.
ДИНАМІКА ПІСЛЯІНФАРКТНОГО РЕМОДЕЛЮВАННЯ СЕРЦЯ ЗА ДАНИМИ ЕХОКАРДІОСКОПІЇ ПРИ ЗАСТОСУВАННІ РАМІПРИЛУ І ЗОФЕНОПРИЛУ
Authors: Bidovanets L. Yu. 
Published: January 2019

Мета: оцінити динаміку післяінфарктного ремоделювання серця у хворих на гострий інфаркт міокарда на тлі приймання препаратів групи інгібіторів ангіотензинперетворювального ферменту раміприлу і зофеноприлу.
Матеріали і методи. Обстежено 54 хворих на гострий інфаркт міокарда, до складу комплексної терапії яких включено раміприл і зофеноприл. Оцінювали та порівнювали розміри серця за результатами ехокардіоскопії, рівень артеріального тиску, частоту серцевих скорочень та величину подвійного добутку.
Результати. Включення у комплексну терапію хворих на гострий інфаркт міокарда раміприлу і зофеноприлу супроводжується практично однаковим ефектом щодо зниження артеріального тиску та його стабільного утримання в межах фізіологічної норми протягом 3 місяців післяінфарктного періоду.
Застосування зофеноприлу, порівняно з раміприлом, у хворих, які перенесли гострий інфаркт міокарда, через 3 місяці супроводжується істотним зниженням частоти серцевих скорочень, подвійного добутку, кінцево-систолічного обʼєму (на 18,7 %), збільшенням фракції викиду (на 16,8 %), що свідчить про позитивний вплив препарату не тільки на величину артеріального тиску, але й на стан міокарда та його відновлення в післяінфарктний період.
Висновки. Включення у комплексну терапію хворих на гострий інфаркт міокарда раміприлу і зофеноприлу створює передумови для зниження тяжкості ушкодження міокарда та його відновлення в післяінфарктний період.
ОРГАНІЗАЦІЙНО-МЕТОДИЧНІ ВКАЗІВКИ ВЕДЕННЯ ПАЦІЄНТІВ З ВІРУСНИМ ГЕПАТИТОМ С
Authors: Komar O. M. , Kizlova N. M. 
Published: January 2019

Мета: удосконалити організацію основних складових надання медичної допомоги пацієнтам з вірусним гепатитом С; зменшити ризик інфікування вірусом дорослого населення.
Матеріали і методи. Системному аналізу підлягали існуючі міжнародні й вітчизняні стандарти, протоколи і вказівки надання медичної допомоги хворим з вірусним гепатитом С. використання контент-аналізу дозволило вивчити нормативно-правове поле на теренах України організації системи охорони здоров’я за видами та рівнями надання медичної допомоги цій категорії пацієнтів, а бібліосемантичний метод дослідження окреслив коло невирішених питань щодо організаційно-методичного ведення пацієнтів з вірусним гепатитом С.
Результати. Запропоновано комплексний підхід до функціонально-структурної організації надання медичної допомоги пацієнтам з вірусним гепатитом С за рівнями (первинний, вторинний, третинний). Наведено методологію ранньої діагностики вірусного гепатиту С у вигляді алгоритму дій для лікаря первинної ланки та спеціаліста (інфекціоніста, гастроентеролога). Розкрито профілактичні технології попередження інфікування й розповсюдження вірусного гепатиту С.
Висновки. Виконання організаційно-методичних вказівок ведення пацієнтів з вірусним гепатитом С дасть змогу забезпечити проведення консультацій і тестування громадян за клінічними, епідеміологічними показниками та з профілактичною метою, а також з метою виявлення інфікованих вірусним гепатитом С.
Mouse Model of Tracheal Replacement With Electrospun Nanofiber Scaffolds
Authors: Dharmadhikari Sayali , Best Cameron A. , King Nakesha , Henderson Michaela , Johnson Jed , Breuer Christopher K. , Chiang Tendy 
Published: January 2019

Objectives: The clinical experience with tissue-engineered tracheal grafts (TETGs) has been fraught with graft stenosis and delayed epithelialization. A mouse model of orthotopic replacement that recapitulates the clinical findings would facilitate the study of the cellular and molecular mechanisms underlying graft stenosis. Methods: Electrospun nanofiber tracheal scaffolds were created using nonresorbable (polyethylene terephthalate + polyurethane) and co-electrospun resorbable (polylactide-co-caprolactone/polyglycolic acid) polymers (n = 10/group). Biomechanical testing was performed to compare load displacement of nanofiber scaffolds to native mouse tracheas. Mice underwent orthotopic tracheal replacement with syngeneic grafts (n = 5) and nonresorbable (n = 10) and resorbable (n = 10) scaffolds. Tissue at the anastomosis was evaluated using hematoxylin and eosin (H&E), K5+ basal cells were evaluated with the help of immunofluorescence testing, and cellular infiltration of the scaffold was quantified. Micro computed tomography was performed to assess graft patency and correlate radiographic and histologic findings with respiratory symptoms. Results: Synthetic scaffolds were supraphysiologic in compression tests compared to native mouse trachea ( P < .0001). Nonresorbable scaffolds were stiffer than resorbable scaffolds ( P = .0004). Eighty percent of syngeneic recipients survived to the study endpoint of 60 days postoperatively. Mean survival with nonresorbable scaffolds was 11.40 ± 7.31 days and 6.70 ± 3.95 days with resorbable scaffolds ( P = .095). Stenosis manifested with tissue overgrowth in nonresorbable scaffolds and malacia in resorbable scaffolds. Quantification of scaffold cellular infiltration correlated with length of survival in resorbable scaffolds (R2 = 0.95, P = .0051). Micro computed tomography demonstrated the development of graft stenosis at the distal anastomosis on day 5 and progressed until euthanasia was performed on day 11. Conclusion: Graft stenosis seen in orthotopic tracheal replacement with synthetic tracheal scaffolds can be modeled in mice. The wide array of lineage tracing and transgenic mouse models available will permit future investigation of the cellular and molecular mechanisms underlying TETG stenosis.
Factors predictive of long-term mortality in lupus nephritis: a multicenter retrospective study of a Japanese cohort
Authors: Ichinose K , Kitamura M , Sato S , Fujikawa K , Horai Y , Matsuoka N , Tsuboi M , Nonaka F , Shimizu T , Fukui S , Umeda M , Koga T , Kawashiri S , Iwamoto N , Tamai M , Nakamura H , Origuchi T , Nishino T , Kawakami A 
Published: January 2019

Background Lupus nephritis (LN) is a major determinant of mortality in systemic lupus erythematosus (SLE). Here we evaluated the association between complete renal response (CR) and mortality in LN. Methods We retrospectively analyzed the cases of 172 of 201 patients with LN for whom data on the therapeutic response at 6 and 12 months after induction therapy were available. The patients underwent a renal biopsy at Nagasaki University Hospital and community hospitals in Nagasaki between the years 1990 and 2016. We determined the CR rates at 6 and 12 months after induction therapy initiation and evaluated the predictive factors for CR and their relationship with mortality. We performed univariate and multivariable competing risks regression analyses to determine the factors predictive of CR. The patients' survival data were analyzed by the Kaplan–Meier method with a log-rank test. Results The median follow-up duration after renal biopsy was 120 months (interquartile range: 60.3–191.8 months). The 5-, 10-, 15- and 20-year survival rates of our cohort were 99.3, 94.6, 92.0 and 85.4%, respectively. During follow-up, nine patients (5.2%) died from cardiovascular events, infection, malignancy and other causes. The multivariate analysis revealed that the following factors were predictive of CR. At 6 months: male gender (odds ratio (OR) 0.23, 95% confidence interval (CI) 0.08–0.65, p = 0.0028), proteinuria (g/gCr) (OR 0.83, 95% CI 0.71–0.97, p = 0.0098) and index of activity (0–24) (OR 0.84, 95% CI 0.71–0.99, p = 0.0382). At 12 months: male gender (OR 0.25, 95% CI 0.09–0.67, p = 0.0043) and index of activity (0–24) (OR 0.82, 95% CI 0.69–0.98, p = 0.0236). The Kaplan–Meier analysis showed that compared to not achieving CR at 12 months, achieving CR at 12 months was significantly correlated with the survival rate (OR 0.18, 95% CI 0.04–0.92, p = 0.0339). Conclusions Our results suggest that the survival rate of patients with LN is associated with the achievement of CR at 12 months after induction therapy, and that male gender and a higher index of activity (0–24) are the common predictive factors for failure to achieve CR at 6 and 12 months.
No clear relationship between antihypertensive class and cognitive function over 12 months in a cohort study of community-dwelling adults aged 80 and over
Authors: Peters Ruth 
Published: January 2019

Background: Hypertension is prevalent in older adults. Hypertension has also been associated with an increased risk of cognitive decline. However, evidence relating to the impact of antihypertensive use is mixed. Calcium-channel blockers (CCB) have been suggested as the most beneficial class of antihypertensive for protection of cognition in older adults, however, to date, there have been no cohort studies designed to examine this. Methods: Community-dwelling treated hypertensive adults aged 80 and over were recruited from general practice sites and followed for 1 year. Cognitive function was assessed at baseline and 12 months using the modified Mini-Mental State Exam (3MS). Regression was used to examine the association between 12-month exposure to antihypertensive class and change in cognitive function. Results: A total of 292 participants completed the study. Mean change in 3MS score was a rise of 0.53 [standard deviation (SD) 4.7] 3MS points in those taking CCBs ( n = 135) compared with a drop of 0.09 (SD 5.1) in those without ( n = 157) p = 0.28. There was no relationship between CCBs or between any antihypertensive class and change in cognitive function over 1 year. Additional analyses using a clinically meaningful fall of 5 or more 3MS points showed similar results. Conclusion: In a hypertensive community-dwelling older adult population treated with antihypertensives, there was no evidence that CCBs were protective of cognitive function over a 12-month exposure. If a protective effect is present, it may be small or require a longer treatment period. Larger longer studies are required for confirmation.
Patients transitioning from non-pegylated to pegylated interferon beta-1a have a low risk of new flu-like symptoms: ALLOW phase 3b trial results
Authors: Naismith Robert T , Hendin Barry , Wray Sibyl , Huang DeRen , Gaudenzi Fiorenza , Dong Qunming , Sperling Bjørn , Mann Monica , Werneburg Brian 
Published: January 2019

Background Flu-like symptoms are common adverse events associated with interferon beta relapsing multiple sclerosis therapies. Objectives To evaluate the incidence and severity of flu-like symptoms after transitioning from non-pegylated interferons to peginterferon beta-1a and assess flu-like symptom mitigation using naproxen. Methods ALLOW was a phase 3b open-label study in relapsing multiple sclerosis patients. Patients had received non-pegylated interferon for 4 or more months immediately before beginning a 4-week screening period. At baseline, patients switched to peginterferon beta-1a and were randomly assigned (1:1) to continue their current flu-like symptoms management regimen or start twice-daily naproxen 500 mg for 8 weeks. Patients then switched to their preferred regimen and were followed for 48 weeks in total. Results Of 201 patients, 89.6% did not experience new/worsening flu-like symptoms during their first 8 weeks on peginterferon beta-1a. Flu-like symptom severity remained low in current-regimen and naproxen patients, with no significant between-group differences. Median flu-like symptom duration per injection was 3.2 hours longer with peginterferon beta-1a versus prior interferon, but the 4-week cumulative duration was reduced 49–78%. No new safety signals were identified. Conclusion Most patients who switched from non-pegylated interferon to peginterferon beta-1a did not experience new/worsening flu-like symptoms. Flu-like symptom duration per injection increased, but the cumulative duration significantly decreased. These data may inform flu-like symptom management guidance.
Contact Sports as a Risk Factor for Amyotrophic Lateral Sclerosis: A Systematic Review
Authors: Blecher Ronen , Elliott Michael A. , Yilmaz Emre , Dettori Joseph R. , Oskouian Rod J. , Patel Akil , Clarke Andrew , Hutton Mike , McGuire Robert , Dunn Robert , DeVine John , Twaddle Bruce , Chapman Jens R. 
Published: January 2019

Study Design: Systematic review. Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease, ultimately resulting in paralysis and death. The condition is considered to be caused by a complex interaction between environmental and genetic factors. Although vast genetic research has deciphered many of the molecular factors in ALS pathogenesis, the environmental factors have remained largely unknown. Recent evidence suggests that participation in certain types of sporting activities are associated with increased risk for ALS. Objective: To test the hypothesis that competitive sports at the highest level that involve repetitive concussive head and cervical spinal trauma result in an increased risk of ALS compared with the general population or nonsport controls. Methods: Electronic databases from inception to November 22, 2017 and reference lists of key articles were searched to identify studies meeting inclusion criteria. Results: Sixteen studies met the inclusion criteria. Sports assessed (professional or nonprofessional) included soccer (n = 5), American football (n = 2), basketball (n = 1), cycling (n = 1), marathon or triathlon (n = 1), skating (n = 1), and general sports not specified (n = 11). Soccer and American football were considered sports involving repetitive concussive head and cervical spinal trauma. Professional sports prone to repetitive concussive head and cervical spinal trauma were associated with substantially greater effects (pooled rate ratio [RR] 8.52, 95% CI 5.18-14.0) compared with ( a) nonprofessional sports prone to repetitive concussive head and cervical spinal trauma (pooled RR 0.60, 95% CI 0.12-3.06); ( b) professional sports not prone to repetitive head and neck trauma (pooled RR 1.35, 95% CI 0.67-2.71); or ( c) nonprofessional sports not prone to repetitive concussive head and cervical spinal trauma (pooled RR 1.17, 95% CI 0.79-1.71). Conclusions: Our review suggests that increased susceptibility to ALS is significantly and independently associated with 2 factors: professional sports and sports prone to repetitive concussive head and cervical spinal trauma. Their combination resulted in an additive effect, further increasing this association to ALS.
Serum levels of hyaluronic acid are associated with COPD severity and predict survival
Authors: Papakonstantinou Eleni , Bonovolias Ioannis , Roth Michael , Tamm Michael , Schumann Desiree , Baty Florent , Louis Renaud , Milenkovic Branislava , Boersma Wim , Stieltjes Bram , Kostikas Konstantinos , Blasi Francesco , Aerts Joachim G. , Rohde Gernot G.U. , Lacoma Alicia , Torres Antoni , Welte Tobias , Stolz Daiana 
Published: January 2019

Hyaluronic acid (HA) and its degradation products play an important role in lung pathophysiology and airway remodelling in chronic obstructive pulmonary disease (COPD).We investigated if HA and its degrading enzyme hyaluronidase (HYAL)-1 are associated with COPD severity and outcome.Serum HA was assessed in a discovery cohort of 80 COPD patients at stable state and exacerbations. HA, HYAL-1 and HYAL-1 enzymatic activity were evaluated at stable state, exacerbations and 4 weeks after exacerbations in 638 COPD patients from the PROMISE validation cohort.In the discovery cohort, serum HA was higher at exacerbations compared with the stable state (p=0.015). In the validation cohort, HA was higher at moderate and severe exacerbations than at baseline (p<0.001), and remained higher after 4 weeks (p<0.001). HA was strongly predictive for overall survival since it was associated with time to death (p<0.001) independently of adjusted Charlson score, annual exacerbation rate and BODE (body mass, airflow obstruction, dyspnoea, exercise capacity) index. Serum HYAL-1 was increased at moderate (p=0.004) and severe (p=0.003) exacerbations, but decreased after 4 weeks (p<0.001). HYAL-1 enzymatic activity at stable state was inversely correlated with FEV1% pred (p=0.034) and survival time (p=0.017).Serum HA is associated with COPD severity and predicts overall survival. Degradation of HA is associated with airflow limitation and impairment of lung function.
Exhaled air dispersion during high-flow nasal cannula therapyversusCPAPviadifferent masks
Authors: Hui David S. , Chow Benny K. , Lo Thomas , Tsang Owen T.Y. , Ko Fanny W. , Ng Susanna S. , Gin Tony , Chan Matthew T.V. 
Published: January 2019

BackgroundHigh-flow nasal cannula (HFNC) is an emerging therapy for respiratory failure but the extent of exhaled air dispersion during treatment is unknown. We examined exhaled air dispersion during HFNC therapyversuscontinuous positive airway pressure (CPAP) on a human patient simulator (HPS) in an isolation room with 16 air changes·h−1.MethodsThe HPS was programmed to represent different severity of lung injury. CPAP was delivered at 5–20 cmH2Ovianasal pillows (Respironics Nuance Pro Gel or ResMed Swift FX) or an oronasal mask (ResMed Quattro Air). HFNC, humidified to 37°C, was delivered at 10–60 L·min−1to the HPS. Exhaled airflow was marked with intrapulmonary smoke for visualisation and revealed by laser light-sheet. Normalised exhaled air concentration was estimated from the light scattered by the smoke particles. Significant exposure was defined when there was ≥20% normalised smoke concentration.ResultsIn the normal lung condition, mean±sdexhaled air dispersion, along the sagittal plane, increased from 186±34 to 264±27 mm and from 207±11 to 332±34 mm when CPAP was increased from 5 to 20 cmH2OviaRespironics and ResMed nasal pillows, respectively. Leakage from the oronasal mask was negligible. Mean±sdexhaled air distances increased from 65±15 to 172±33 mm when HFNC was increased from 10 to 60 L·min−1. Air leakage to 620 mm occurred laterally when HFNC and the interface tube became loose.ConclusionExhaled air dispersion during HFNC and CPAPviadifferent interfaces is limited provided there is good mask interface fitting.