bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mobile health and implantable cardiac devices: Patients' expectations
Authors: Villani Giovanni Q , Villani Andrea , Zanni Alessia , Sticozzi Concetta , Maceda Diego Penela , Rossi Luca , Pisati Maria Sole , Piepoli Massimo F 
Published: March 2019

Background Mobile computing and communication technologies in health services and information (so-called mHealth) have modified the traditional approach in the follow-up of patients with implantable cardiac devices, increased patient engagement and empowerment, reduced healthcare costs and improved patients' outcome. Recent developments in mobile technology, with the introduction of smartphone-compatible devices that can measure various health parameters and transfer automatically generated data, have increased the potential application of remote monitoring and the interest towards mHealth. However, little is known about the patients' interest and expectations of this new technology. Objective The patients' interest in the possibility of receiving data from their implantable cardiac device, clinical and health advice via remote monitoring on their smartphones were investigated. Methods A questionnaire entitled ‘Expectations for future possibility of self-management of device data’ (Likert scale scored) was submitted to 300 consecutive implantable cardiac device outpatients. The questionnaire was focused on collecting patients’ expectations in receiving direct information regarding their implantable cardiac device status (item 1, five questions), their own clinical status (item 2, seven questions) and advice on healthy lifestyle promotion (item 3, nine questions). Patient characteristics associated with greater interest towards mHealth were also investigated. Results Questionnaires were completed by 268 patients (221 men, aged 69 ± 14 years). The Cronbach test reported an alpha value of 0.98 for item 1, 0.94 for item 2 and 0.97 for item 3. Patients declared to be mainly interested in the device interventions (62%) and in severe arrhythmia occurrence (61%), followed by data on heart failure severity (54%) and their performed physical activity (48%). Patients showed very little interest in ECG tracing (37%), but the lowest interest was expressed towards healthy lifestyle promotion advice (<40%). A higher education degree and the presence of the caregiver positively affected the interest towards remote monitoring information ( P < 0.001). Conclusions The patients' interests were mainly directed at receiving information related to technical data of the implantable cardiac device and not to the overall management of the disease, underlying the insufficient awareness of patients towards the key role of self-control health status and the promotion of a healthy lifestyle.
Identification of genetic alterations associated with primary resistance to EGFR‐TKIs in advanced non‐small‐cell lung cancer patients with EGFR sensitive mutations
Authors: Wang Fang , Diao Xia‐Yao , Zhang Xiao , Shao Qiong , Feng Yan‐Fen , An Xin , Wang Hai‐Yun 
Published: March 2019

AbstractBackgroundIdentification of activated epidermal growth factor receptor (EGFR) mutations and application of EGFR‐tyrosine kinase inhibitors (EGFR‐TKIs) have greatly changed the therapeutic strategies of non‐small‐cell lung cancer (NSCLC). However, the long‐term efficacy of EGFR‐TKI therapy is limited due to the development of drug resistance. The aim of this study was to investigate the correlation between the aberrant alterations of 8 driver genes and the primary resistance to EGFR‐TKIs in advanced NSCLC patients with activated EGFR mutations.MethodsWe retrospectively reviewed the clinical data from 416 patients with stage III/IV or recurrent NSCLC who received an initial EGFR‐TKI treatment, from April 2004 and March 2011, at the Sun Yat‐sen University Cancer Center. Several genetic alterations associated with the efficacy of EGFR‐TKIs, including the alterations in BIM, ALK, KRAS, PIK3CA, PTEN, MET, IGF1R, and ROS1, were detected by the routine clinical technologies. The progression‐free survival (PFS) and overall survival (OS) were compared between different groups using Kaplan–Meier survival analysis with the log‐rank test. A Cox regression model was used to estimate multivariable‐adjusted hazard ratios (HRs) and their 95% confidence intervals (95% CIs) associated with the PFS and OS.ResultsAmong the investigated patients, 169 NSCLC patients harbored EGFR‐sensitive mutations. EGFR‐mutant patients having PTEN deletion had a shorter PFS and OS than those with intact PTEN (P = 0.003 for PFS, and P = 0.034 for OS). In the combined molecular analysis of EGFR signaling pathway and resistance genes, we found that EGFR‐mutant patients coexisted with aberrant alterations in EGFR signaling pathway and those having resistant genes had a statistically poorer PFS than those without such alterations (P < 0.001). A Cox proportional regression model determined that PTEN deletion (HR = 4.29,95% CI = 1.72–10.70) and low PTEN expression (HR = 1.96, 95% CI = 1.22–3.13), MET FISH + (HR = 2.83,95% CI = 1.37–5.86) were independent predictors for PFS in patients with EGFR‐TKI treatment after adjustment for multiple factor.ConclusionsWe determined that the coexistence of genetic alterations in cancer genes may explain primary resistance to EGFR‐TKIs.
Long Intravascular Persistence of 20% Albumin in Postoperative Patients
Authors: Hasselgren Emma , Zdolsek Markus , Zdolsek Joachim H. , Björne Håkan , Krizhanovskii Camilla , Ntika Stelia , Hahn Robert G. 
Published: March 2019

BACKGROUND:
Albumin may persist intravascularly for a shorter time in patients after major surgery than in healthy volunteers due to a surgery-induced breakdown (shedding) of the endothelial glycocalyx layer.

METHODS:
In this nonrandomized clinical trial, an IV infusion of 3 mL/kg of 20% albumin was given at a constant rate during 30 minutes to 15 patients on the first day after major open abdominal surgery (mean operating time 5.9 h) and to 15 conscious volunteers. Blood samples and urine were collected during 5 h and mass balance calculations used to estimate the half-lives of the administered albumin molecules and the induced plasma volume expansion, based on measurements of hemodilution and the plasma albumin concentration.

RESULTS:
At the end of the infusions, albumin had diluted the plasma volume by 13.3% ± 4.9% (mean ± SD) in the postoperative patients and by 14.2% ± 4.8% in the volunteers (mean difference −0.9, 95% CI, −4.7 to 2.9; 1-way ANOVA P = .61), which amounted to twice the infused volume. The intravascular half-life of the infused albumin molecules was 9.1 (5.7–11.2) h in the surgical patients and 6.0 (5.1–9.0) h in the volunteers (Mann-Whitney U test, P = .26; geometric mean difference 1.2, 95% CI, 0.8–2.0). The half-life of the plasma volume expansion was 10.3 (5.3–17.6; median and interquartile range) h in the surgical patients and 7.6 (3.5–9.0) h in the volunteers (P = .10; geometric mean difference 1.5, 95% CI, 0.8–2.8). All of these parameters correlated positively with the body mass index (correlation coefficients being 0.42–0.47) while age and sex did not affect the results.

CONCLUSIONS:
Twenty percent albumin caused a long-lasting plasma volume expansion of similar magnitude in postoperative patients and volunteers.
Transient Tachypnea of Newborns Is Associated With Maternal Spinal Hypotension During Elective Cesarean Delivery: A Retrospective Cohort Study
Authors: Singh Shubhangi , Lumbreras-Marquez Mario Isaac , Farber Michaela K. , Xu Xinling , Singh Prashant , Gorman Terri , Palanisamy Arvind 
Published: March 2019

BACKGROUND:
The risk for transient tachypnea of newborns, a common cause of respiratory distress in the neonatal period, is 2- to 6-fold higher during elective cesarean delivery compared to vaginal delivery. Here, we evaluated the association between transient tachypnea of newborns and the degree and duration of predelivery maternal hypotension during spinal anesthesia for elective cesarean delivery.

METHODS:
Demographic data, details of anesthetic management, blood pressure measurements, and vasopressor requirement preceding delivery were compared between transient tachypnea newborns (n = 30) and healthy neonates (n = 151) with normal respiratory function born via elective cesarean delivery between July 2015 and February 2016. The degree and duration of hypotension were assessed using area under the curve for systolic blood pressure (SBP) ≤90 mm Hg and area under the curve for mean arterial pressure ≤65 mm Hg. After adjusting for confounders, multivariable logistic regression was used to evaluate the association between area under the curve for SBP and transient tachypnea of newborns.

RESULTS:
The median area under the curve for SBP was higher in cases of transient tachypnea of newborns (0.94; interquartile range, 0–28.7 mm Hg*min) compared to healthy controls (0; interquartile range, 0–3.30 mm Hg*min; P = .001). Similarly, median area under the curve for mean arterial pressure was also higher in cases of transient tachypnea of newborns (0; interquartile range, 0–18.6 mm Hg*min) compared to controls (0; interquartile range, 0–1.1 mm Hg*min; P = .01). Mothers of transient tachypnea newborns received significantly higher amounts of phenylephrine and ephedrine compared to controls (P = .001 and 0.01, respectively). Hence, the total vasopressor dose given to mothers in the transient tachypnea of newborn group was much higher than for the control group (P = .001). In the multivariable logistic regression, area under the curve for SBP was significantly associated with transient tachypnea of newborns (odds ratio, 1.02; 95% CI, 1.01–1.04, P = .005) after adjusting for gravidity and the type of anesthetic (spinal versus combined spinal epidural).

CONCLUSIONS:
Our results suggest that the degree and duration of maternal SBP <90 mm Hg after neuraxial anesthesia during elective cesarean delivery are associated with transient tachypnea of newborns. Future prospective studies should further explore the effects of maternal hypotension, its prevention, and treatment for transient tachypnea of newborns.
Culture-Negative and Culture-Positive Sepsis: A Comparison of Characteristics and Outcomes
Authors: Sigakis Matthew J. G. , Jewell Elizabeth , Maile Michael D. , Cinti Sandro K. , Bateman Brian T. , Engoren Milo 
Published: March 2019

BACKGROUND:
The primary objective of this study was to compare the characteristics of culture-positive and culture-negative status in septic patients. We also determined whether culture status is associated with mortality and whether unique variables are associated with mortality in culture-positive and culture-negative patients separately.

METHODS:
Utilizing patient records from intensive care units, emergency department, and general care wards in a large academic medical center, we identified adult patients with suspected infection and ≥2 systemic inflammatory response syndrome criteria between January 1, 2007, and May 31, 2014. We compared the characteristics between culture-positive and culture-negative patients and used binary logistic regression to identify variables independently associated with culture status and mortality. We also did sensitivity analyses using patients with Sequential Organ Failure Assessment and quick Sequential Organ Failure Assessment criteria for sepsis.

RESULTS:
The study population included 9288 culture-negative patients (89%) and 1105 culture-positive patients (11%). Culture-negative patients received more antibiotics during the 48 hours preceding diagnosis but otherwise demonstrated similar characteristics as culture-positive patients. After adjusting for illness severity, a positive culture was not independently associated with mortality (odds ratio = 1.01 [95% CI, 0.81–1.26]; P = .945). The models predicting mortality separately in culture-negative and culture-positive patients demonstrated very good and excellent discrimination (C-statistic ± SD, 0.87 ± 0.01 and 0.92 ± 0.01), respectively. In the sensitivity analyses using patients with sepsis by Sequential Organ Failure Assessment and quick Sequential Organ Failure Assessment criteria, after adjustments for illness severity, positive cultures were still not associated with mortality (odds ratio = 1.13 [95% CI, 0.86–1.43]; P = .303; and odds ratio = 1.05 [95% CI, 0.83–1.33]; P = .665), respectively. In all models, physiological derangements were associated with mortality.

CONCLUSIONS:
While culture status is important for tailoring antibiotics, culture-negative and culture-positive patients with sepsis demonstrate similar characteristics and, after adjusting for severity of illness, similar mortality. The most important factor associated with negative cultures is receipt of antibiotics during the preceding 48 hours. The risk of death in patients suspected of having an infection is most associated with severity of illness. This is aligned with the Sepsis-3 definition using Sequential Organ Failure Assessment score to better identify those suspected of infection at highest risk of a poor outcome.
A Statistical Timetable for the Sub–2-Hour Marathon
Authors: ANGUS SIMON D. 
Published: March 2019

ABSTRACTIntroductionBreaking the sub–2-h marathon in an official event has attracted growing interest in recent times with commercial and international momentum building. Here it is shown that predictinghow likelyandwhenthe sub–2-h barrier will be broken are statistically coupled considerations.MethodsUsing a nonlinear limiting exponential model and calculating prediction intervals, a statistical timetable for the sub–2-h event is produced over a range of likelihoods.ResultsAt the benchmark odds level (1 in 10, or 10% likely), the expected sub–2-h arrival time is found to be May 2032. By estimating the model for male and female world record progressions, I find that limiting marathon times for males and females (at 1 in 10) are 1 h 58 min 5 s and 2 h 5 min 31 s, respectively. These times equate to a performance gap of 2.9% and 8.6%, respectively. The male estimate has remarkable similarity (~7 s) to Joyner’s 1991 limiting human physiological estimate. Finally, I provide an estimate of the equivalent “sub–2-h” threshold for females and argue that a threshold of 130 min (“sub-130”) could be an appropriate choice.ConclusionThe study is the first to address all three related aspects of world record marathon performance (sub–2 h, limits, gender equivalence) in a single, unified modeling framework and provides many avenues for further exploration and insight.
Physical Activity and Cerebral Small Vein Integrity in Older Adults
Authors: SHAABAN C. ELIZABETH , AIZENSTEIN HOWARD JAY , JORGENSEN DANA R. , MAHBUBANI REBECCA L. M. , MECKES NICOLE A. , ERICKSON KIRK I. , GLYNN NANCY W. , METTENBURG JOSEPH , GURALNIK JACK , NEWMAN ANNE B. , IBRAHIM TAMER S. , LAURIENTI PAUL J. , VALLEJO ABBE N. , ROSANO CATERINA 
Published: March 2019

ABSTRACT
Identifying promoters of cerebral small vein integrity is important to counter vascular contributions to cognitive impairment and dementia.

Purpose
In this preliminary investigation, the effects of a randomized 24-month physical activity (PA) intervention on changes in cerebral small vein integrity were compared to those of a health education (HE) control.

Methods
Cerebral small vein integrity was measured in 24 older adults (n = 8, PA; n = 16, HE) using ultra-high field MRI before and at the end of the 24-month intervention. Deep medullary veins were defined as straight or tortuous; percent change in straight length, tortuous length, and tortuosity ratio were computed. Microbleed count and white matter hyperintensities were also rated.

Results
Accelerometry-based values of PA increased by 17.2% in the PA group but declined by 28.0% in the HE group. The PA group, but not the HE group, had a significant increase in straight vein length from baseline to 24-month follow-up (P = 0.02 and P = 0.21, respectively); the between-group difference in percent change in straight length was significant (increase: median, 93.6%; interquartile range, 112.9 for PA; median, 28.4%; interquartile range, 90.6 for HE; P = 0.07). Between group differences in other markers were nonsignificant.

Conclusions
Increasing PA in late-life may promote cerebral small vein integrity. This should be confirmed in larger studies.
Sedentary Time and White Matter Hyperintensity Volume in Older Adults
Authors: BRONAS ULF G. , STEFFEN ALANA , DION CATHERINE , BOOTS ELIZABETH A. , ARFANAKIS KONSTANTINOS , MARQUEZ DAVID X. , LAMAR MELISSA 
Published: March 2019

ABSTRACTPurposeCerebrovascular disease in the form of white matter hyperintensities (WMH) increases with age and is associated separately with sedentary time and reduced kidney function. A better understanding of the relationships among these variables would help clarify whether sedentary time should be considered more closely in older adults at particular levels of kidney function to reduce the risk of WMH.MethodsWe analyzed information from 94 healthy community-dwelling older adults to determine the association of sedentary time and WMH in nondemented, nondepressed older adults, and whether level of kidney function was an effect modifier of the relationship between sedentary time and WMH. Sedentary behavior was measured using the Sedentary Behavior Questionnaire. White matter hyperintensity was assessed using whole-brain 3T magnetic resonance imaging T1- and T2-weighted images. Kidney function was calculated by the epi-chronic kidney disease formula for estimated glomerular filtration rate (eGFR). Exposures or predictors were sedentary time, age, sex, education in years, Framingham stroke risk 10-yr prediction score, and eGFR. The analytical approach was multiple linear regression.ResultsAdjusting for age, sex, education in years, Framingham stroke risk 10-yr prediction score, greater sedentary time was associated with greater WMH but this effect was dependent on level of eGFR (sedentary time–eGFR interactionb= −0.0005,P= 0.022). At eGFR values of 69, 81, and 93 mL·min−1per 1.73 m2(the 25th, 50th, and 75th percentiles), sedentary timebcoefficients wereb= 0.021 (95% confidence interval [CI], 0.011–0.031),b= 0.015 (95% CI, 0.008–0.022), andb= 0.009 (95% CI, 0.003–0.016). The effect weakened linearly as eGFR increased, with no significant association at eGFR ≥97 mL·min−1per 1.73 m2.ConclusionsFindings suggest that sedentary time is associated with WMH in persons with an eGFR ≤96 mL·min−1per 1.73 m2and that this association is stronger with lower levels of kidney function.
Effects of Aerobic Exercise during Pregnancy on 1-Month Infant Neuromotor Skills
Authors: MCMILLAN AMY GROSS , MAY LINDA E. , GAINES GEORGEANNA GOWER , ISLER CHRISTY , KUEHN DEVON 
Published: March 2019

ABSTRACTPurposeTo determine the effects of exercise during pregnancy on the neuromotor development of 1-month-old offspring. We hypothesized that aerobic exercise during pregnancy would be associated with higher neuromotor scores in infants at 1 month of age, based on standard pediatric assessment of neuromotor skills.MethodsSeventy-one healthy, pregnant women between 18 and 35 yr were randomly assigned to either aerobic exercise intervention or no exercise (control) group. Women in the exercise group performed 50 min of moderate-intensity, supervised aerobic exercise, three times per week; those in control group maintained usual activity. Neuromotor skills were measured at 1 month of age using the Peabody Developmental Motor Scales, 2nd Edition (PDMS-2). Unpairedt-tests were used to compare infants’ PDMS-2 subtest percentiles, Gross Motor Quotients, and Gross Motor Quotient percentile between groups.ResultsInfants of women in the exercise group had higher PDMS-2 scores on four of the five variables analyzed relative to infants of nonexercisers. Female infants tended to have improved scores relative to male infants of controls; this difference was attenuated in infants of exercisers.ConclusionsExercise during pregnancy can positively influence developing systems allowing for improved neuromotor development, thus leading to infants who are more adept at movement, and presumably more likely to be active. Because physical activity is a modifiable risk factor of childhood obesity, these findings suggest that exercise during pregnancy may potentially reduce childhood risk of obesity.
Neuromuscular Fatigue and Metabolism during High-Intensity Intermittent Exercise
Authors: FIORENZA MATTEO , HOSTRUP MORTEN , GUNNARSSON THOMAS P. , SHIRAI YUSUKE , SCHENA FEDERICO , IAIA F. MARCELLO , BANGSBO JENS 
Published: March 2019

ABSTRACTPurposeTo examine the degree of neuromuscular fatigue development along with changes in muscle metabolism during two work-matched high-intensity intermittent exercise protocols in trained individuals.MethodsIn a randomized, counter-balanced, crossover design, 11 endurance-trained men performed high-intensity intermittent cycle exercise protocols matched for total work and including either multiple short-duration (18 × 5 s; SS) or long-duration (6 × 20 s; LS) sprints. Neuromuscular fatigue was determined by preexercise to postexercise changes in maximal voluntary contraction force, voluntary activation level and contractile properties of the quadriceps muscle. Metabolites and pH were measured in vastus lateralis muscle biopsies taken before and after the first and last sprint of each exercise protocol.ResultsPeak power output (11% ± 2% vs 16% ± 8%,P< 0.01), maximal voluntary contraction (10% ± 5% vs 25% ± 6%,P< 0.05), and peak twitch force (34% ± 5% vs 67% ± 5%,P< 0.01) declined to a lesser extent in SS than LS, whereas voluntary activation level decreased similarly in SS and LS (10% ± 2% vs 11% ± 4%). Muscle [phosphocreatine] before the last sprint was 1.5-fold lower in SS than LS (P< 0.001). Preexercise to postexercise intramuscular accumulation of lactate and H+was twofold and threefold lower, respectively, in SS than LS (P< 0.001), whereas muscle glycogen depletion was similar in SS and LS. Rate of muscle glycolysis was similar in SS and LS during the first sprint, but twofold higher in SS than LS during the last sprint (P< 0.05).ConclusionsThese findings indicate that, in endurance-trained individuals, multiple long-sprints induce larger impairments in performance along with greater degrees of peripheral fatigue compared to work-matched multiple short-sprints, with these differences being possibly attributed to more extensive intramuscular accumulation of lactate/H+and to lower rates of glycolysis during multiple long-sprint exercise.