bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship between the shift of socioeconomic status and cardiovascular mortality
Authors: Sung Jidong , Song Yun-Mi , Hong Kyung Pyo 
Published: June 2019

Background The aim of this study is to investigate whether upward or downward shifts in socioeconomic status have an effect on cardiovascular mortality. Design A retrospective cohort study. Methods Among the Korean National Health Insurance Service National Sample Cohort, 178,812 subjects were selected who were over 20 years of age as of 2002, with available data on routine health check and free of a diagnosis of ischaemic heart disease, stroke, heart failure or cancer at baseline. Cause of death was identified by the death certificate. Stratification of socioeconomic status was done by income as low (lower 30th percentile), high (higher 30th percentile) and middle, which was reclassified annually. Shift in socioeconomic status was defined as any change in the income class from baseline. Results During the follow-up of a median 10 years, cardiovascular mortality was significantly higher among middle and low socioeconomic status groups (hazard ratio and 95% confidence interval for middle 1.92 (1.68–2.19) and low 1.73 (1.50–2.00)) compared to the high socioeconomic status group after adjustment for age, gender, residence, blood pressure, fasting glucose, smoking and medications (statins and antiplatelet agents). In the same regression model, an upward shift of socioeconomic status was associated with a lower risk of cardiovascular death (hazard ratio 0.46, 95% confidence interval 0.40–0.52), while a downward shift was not a significant predictor. Conclusion An upward shift of socioeconomic status was associated with a lower risk of cardiovascular mortality after adjustment for baseline socioeconomic status, conventional risk factors and risk-reducing pharmacological treatments.
Ambient air pollution and pulmonary vascular volume on computed tomography: the MESA Air Pollution and Lung cohort studies
Authors: Aaron Carrie P. , Hoffman Eric A. , Kawut Steven M. , Austin John H.M. , Budoff Matthew , Michos Erin D. , Hinckley Stukovsky Karen , Sack Coralynn , Szpiro Adam A. , Watson Karol D. , Kaufman Joel D. , Barr R. Graham 
Published: June 2019

BackgroundAir pollution alters small pulmonary vessels in animal models. We hypothesised that long-term ambient air pollution exposure would be associated with differences in pulmonary vascular volumes in a population-based study.MethodsThe Multi-Ethnic Study of Atherosclerosis recruited adults in six US cities. Personalised long-term exposures to ambient black carbon, nitrogen dioxide (NO2), oxides of nitrogen (NOx), particulate matter with a 50% cut-off aerodynamic diameter of <2.5 μm (PM2.5) and ozone were estimated using spatiotemporal models. In 2010–2012, total pulmonary vascular volume was measured as the volume of detectable pulmonary arteries and veins, including vessel walls and luminal blood volume, on noncontrast chest computed tomography (TPVVCT). Peripheral TPVVCTwas limited to the peripheral 2 cm to isolate smaller vessels. Linear regression adjusted for demographics, anthropometrics, smoking, second-hand smoke, renal function and scanner manufacturer.ResultsThe mean±sdage of the 3023 participants was 69.3±9.3 years; 46% were never-smokers. Mean exposures were 0.80 μg·m−3black carbon, 14.6 ppb NO2and 11.0 μg·m−3ambient PM2.5. Mean±sdperipheral TPVVCTwas 79.2±18.2 cm3and TPVVCTwas 129.3±35.1 cm3. Greater black carbon exposure was associated with a larger peripheral TPVVCT, including after adjustment for city (mean difference 0.41 (95% CI 0.03–0.79) cm3per interquartile range; p=0.036). Associations for peripheral TPVVCTwith NO2were similar but nonsignificant after city adjustment, while those for PM2.5were of similar magnitude but nonsignificant after full adjustment. There were no associations for NOxor ozone, or between any pollutant and TPVVCT.ConclusionsLong-term black carbon exposure was associated with a larger peripheral TPVVCT, suggesting diesel exhaust may contribute to remodelling of small pulmonary vessels in the general population.
A homogenized approach to classify advanced gastric cancer patients with limited and adequate number of pathologically examined lymph nodes
Authors: Seeruttun Sharvesh Raj , Xu Lipu , Wang Fangwei , Yi Xiaodong , Fang Cheng , Liu Zhimin , Wang Wei , Zhou Zhiwei 
Published: June 2019

AbstractBackgroundThe prognosis of gastric cancer patients with a limited number of pathologically examined lymph nodes (eLN, < 16) is dismal compared to those with adequately eLN (≥ 16), yet they are still classified within the same subgroups using the American Joint Committee on Cancer (AJCC) staging system. We aimed at formulating an easy‐to‐adopt and clinically reliable stratification approach to homogenize the classification for these two categories of patients.MethodsPatients staged according to the 8th AJCC pathological nodal (N) and tumor‐node‐metastasis (TNM) classification were stratified into a Limited and Adequate eLN cohort based on their number of pathologically examined LNs. The statistical differences between the 5‐year overall survival (OS) rates of both cohorts were determined and based on which, patients from the Limited eLN cohort were re‐classified to a proposed modified nodal (N′) and TNM (TN′M) classification, by matching their survival rates with those of the Adequate eLN cohort. The prognostic performance of the N′ and TN′M classification was then compared to a formulated lymph‐node‐ratio‐based nodal classification, in addition to the 8th AJCC N and TNM classification.ResultsSignificant heterogeneous differences in 5‐year OS between patients from the Limited and Adequate eLN cohort of the same nodal subgroups were identified (all P < 0.001). However, no significant differences in 5‐year OS were observed between the subgroups N0, N1, N2, and N3a of the Limited eLN cohort when compared with N1, N2, N3a, and N3b from the Adequate eLN cohort, respectively (P = 0.853, 0.476, 0.114, and 0.230, respectively). A novel approach was formulated in which only patients from the Limited eLN cohort were re‐classified to one higher nodal subgroup, denoted as the N′ classification. This re‐classification demonstrated superior stratifying and prognostic ability as compared to the 8th AJCC N and lymph‐node‐ratio classification (Akaike information criterion values [AIC]: 12,276 vs. 12,358 vs. 12,283, respectively). The TN′M classification also demonstrated superior prognostic ability as compared to the 8th AJCC TNM classification (AIC value: 12,252 vs. 12,312).ConclusionThe proposed lymph node classification approach provides a clinically practical and reliable technique to homogeneously classify cohorts of gastric cancer patients with limited and adequate number of pathologically examined lymph nodes.
Maternal High-Fat Diet Consumption and Chronic Hyperandrogenemia Are Associated With Placental Dysfunction in Female Rhesus Macaques
Authors: Kuo Kelly , Roberts Victoria H J , Gaffney Jessica , Takahashi Diana L , Morgan Terry , Lo Jamie O , Stouffer Richard L , Frias Antonio E 
Published: June 2019

Abstract
The risk of adverse perinatal outcomes with maternal polycystic ovary syndrome may differ among hyperandrogenic and nonhyperandrogenic phenotypes and is likely modulated by maternal obesity and diet. The relative contribution of maternal hyperandrogenism and nutritional status to placental dysfunction is unknown. Female rhesus macaques (N = 39) were assigned at puberty to one of four treatment groups: subcutaneous cholesterol implants and a standard chow diet (controls); testosterone (T) implants and a normal diet; cholesterol implants and a high-fat, Western-style diet (WSD); and testosterone implants in combination with a high-fat diet. After 3.5 years of treatment, contrast-enhanced and Doppler ultrasound analyses of placental blood flow were performed for a representative subset of animals from each treatment group during pregnancy, and placental architecture assessed with stereological analysis. Placental growth factors, cellular nutrient sensors, and angiogenic markers were measured with ELISA and Western blotting. WSD consumption was associated with a 30% increase in placental flux rate relative to that in animals receiving a normal diet. T and WSD treatments were each independently associated with increased villous volume, and T also was associated with an ∼ 40% decrease fetal capillary volume on stereological analysis. T treatment was associated with significantly increased mTOR and SOCS3 expression. WSD consumption was associated with decreased GLUT1 expression and microvillous membrane localization. Hyperandrogenemic and nonhyperandrogenemic phenotypes are associated with altered placental angiogenesis, nutrient sensing, and glucose transport. WSD and T appear to have distinct effects on vascular impedance and capillary angiogenesis.
Testosterone Supplementation and Cognitive Functioning in Men—A Systematic Review and Meta-Analysis
Authors: Buskbjerg Cecilie R , Gravholt Claus H , Dalby Helene R , Amidi Ali , Zachariae Robert 
Published: June 2019

Abstract
Testosterone supplementation (TS) is assumed important for cognitive functioning in men, but conflicting results have prevented firm conclusions. The current study systematically reviewed available randomized controlled trials (RCTs) on effects of TS on cognitive functioning in men, subjected the findings to meta-analysis, and explored between-study differences as possible moderators of the effects. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two authors independently searched for eligible records in the electronic databases of PubMed, PsycINFO, Web of Science, the Cochrane Library, Cumulative Index of Nursing and Allied Health, and Embase and determined eligibility using the following (population, intervention, comparison, outcome) criteria: population, male adults (>18 years); intervention, TS; comparison, placebo; and outcome, results of standardized neuropsychological tests. Following duplicate removal, 3873 records were screened with 92 remaining for full-text screening. Twenty-one papers reporting results of 23 independent RCTs were included, of which none treated samples of clinically hypogonadal men. The small improvement found in overall cognitive functioning (Hedges g = 0.09; CI 95%: −0.02 to 0.19) failed to reach statistical significance (P = 0.108) and approached zero when adjusting for possible publication bias (g = 0.04). The effects for the 11 individual cognitive domains did not reach statistical significance (g: −0.04 to 0.19, P: 0.061 to 0.989). Small statistically significant (P < 0.05) effects were found for five study subsets but failed to meet the fail-safe criterion. The available evidence indicates that effects of TS on cognitive functioning in men with testosterone levels within normal ranges are less robust and of insufficient magnitude to be of clinical relevance. The effects in clinically hypogonadal men remain to be investigated.
Establishment and phenotyping of neurosphere cultures from primary neuroblastoma samples
Authors: Barton Jack , Pacey Katherine , Jain Neha , Kasia Tessa , Edwards Darren , Thevanesan Christine , Straathof Karin , Barone Giuseppe , Anderson John 
Published: June 2019

Background: Primary cell culture using serum free media supplemented with growth factors has been used in a number of cancers to propagate primary cells with stem like properties, which form as spherical cellular aggregates. Methods: We systematically evaluated the capacity of freshly disaggregated neuroblastoma tumors to become established as neurospheres in stem cell media using a uniform protocol. 67 primary neuroblastoma samples from patients treated at a single institution were prospectively evaluated for their ability to become established in culture. Samples, either solid tissue or cells from surgical transit fluid both post chemotherapy and chemotherapy naïve, were evaluated from diagnostic needle biopsies or surgical resections. Results: Overall 37 neurosphere cultures were successfully established from 67 samples. In 11 out of 14 cases investigated by flow cytometry, uniform staining for neuroblastoma markers CD56 and GD2 was demonstrated in CD45 negative non-hemopoietic cells, confirming neuroblastoma origin. Conclusion: We present a simple and reproducible approach for producing primary neurospheres from neuroblastoma samples, which provides a reliable resource for future work including genetic analysis, stem cell research and models for therapeutics.
Prevalence of impaired renal function among rural and urban populations: findings of a cross-sectional study in Malawi
Authors: Nakanga Wisdom P , Prynn Josephine E , Banda Louis , Kalyesubula Robert , Tomlinson Laurie A , Nyirenda Moffat , Crampin Amelia C 
Published: June 2019

Background: Sub-Saharan Africa faces region-specific risk factors for chronic kidney disease (CKD), such as nephrotoxic herbal medicines, antiretroviral therapy and infections, in addition to hypertension and diabetes. However, large epidemiological studies from this area are scarce. Methods: In a cross-sectional survey of non-communicable diseases, we conducted a prevalence sub-study of CKD in two Malawian populations. Study participants (N=5264) of 18 years of age and above were recruited and data on demographics and CKD risk factors were collected. Glomerular filtration rate was estimated (eGFR) using the CKD-EPI equation. Results: The prevalence of eGFR<60ml/min/1.73m2 was 1.4% (95% CI 1.1 – 1.7%) and eGFR<90ml/min/1.73m2 was 20.6% (95% CI 19.5 – 21.7%). The rural area had higher age-standardized prevalence of both eGFR<60ml/min/1.73m2, at 1.8% (95% CI 1.4 – 2.3) and eGFR <90 ml/min/1.73m², at 21.1% (95% CI 19.9 – 22.3), than urban location, which had a prevalence of 1.5%, (95% CI 1.0 – 2.2) and 19.4% (95% CI 18.0 – 20.8), respectively, with overlapping confidence intervals. The prevalence of CKD was lower in females than in males in both rural and urban areas. Older age (p < 0.001), a higher level of education (p = 0.03) and hypertension (p < 0.001) were associated with a higher adjusted odds ratio (aOR) of low eGFR. Diabetes was associated with a reduced aOR of eGFR<90ml/min/1.73m2 of 0.69 (95% CI 0.49–0.96; p=0.03). Of participants with eGFR<60ml/min/1.73m2, 14 (19.4%) had no history of hypertension, diabetes or HIV, while 36 (50%) had a single risk factor of being hypertensive. Conclusions: Impaired renal function is prevalent, but lower than expected, in rural and urban Malawi. Further research is needed to increase understanding of CKD incidence, survival and validation of eGFR calculations in this population.
Preditores sociodemográficos, laborais e psicossociais da Síndrome de Burnout em docentes de educação a distância
Authors: Kruel Goebel Daniele , Carlotto Mary Sandra 
Published: June 2019

O presente estudo teve o objetivo de identificar o poder preditivo das variáveis sociodemográficas, laborais e psicossociais (estressores ocupacionais, estressores contextuais e dimensões do tecnoestresse) para as dimensões da Síndrome de Burnout (sb) em docentes de educação a distância (EaD). A amostra do tipo não probabilística constituiu-se de 310 participantes. Os dados foram coletados por meio de plataforma on-line, tendo como instrumentos de pesquisa um questionário de dados sociodemográficos e laborais, o Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo, a escala Avaliação de Estressores Psicossociais no Contexto Laboral, o Questionário de Estressores Ocupacionais EaD e a Escala de Tecnoestresse. Os resultados obtidos, mediante a análise de regressão linear múltipla, identificaram modelos preditores para as dimensões da sb. Na dimensão Ilusão pelo Trabalho, a variável de maior poder explicativo foi o tecnoestresse/ descrença; na dimensão Desgaste Psíquico, foi o conflito trabalho-família; na Indolência, foi o estressor forma como o trabalho é organizado; e, para a dimensão Culpa, a variável foi a sobrecarga de papéis. Os resultados sugerem a necessidade de ações interventivas, principalmente na organização do trabalho docente e quanto aos estressores ocupacionais. Adicionalmente, também sugere ações preventivas voltadas para a capacitação técnica, relacional e importância do equilíbrio entre trabalho e vida familiar. Sugere-se que novos estudos sejam realizados em relação à sb e a seus preditores mediante delineamentos longitudinais com o intuito de avaliar o comportamento e a estabilidade do modelo preditivo. Palavras-chave: burnout, docentes de EaD, psicologia da saúde ocupacional.
Inter-operator variability in pPOSSUM scores: a note of caution
Authors: van Boxel Gijsbert I , McLure Stewart , Jones Keaton , Jones Gregory ,   On behalf of The OxSCAR Collaborative
Published: June 2019

Purpose: Predicting perioperative morbidity and mortality can be achieved by several risk predicting algorithms. In the UK, the National Emergency Laparotomy Audit, mandated for all patients undergoing emergency laparotomy, uses pPOSSUM as its risk prediction tool. However, there is no literature reporting the inter-operator variability in calculating the score. Inter-rater variability was assessed based on 10 real general surgical cases that went on to have an emergency laparotomy. Methods: Forty clinicians, 10 each of registrars and consultants in anaesthetics and general surgery, were asked to calculate the pPOSSUM based on the clinical information typically available at the time of making the decision to proceed to emergency laparotomy for the same 10 National Emergency Laparotomy Audit cases. All participants were surveyed to assess their understanding and use of the pPOSSUM score. Results: More than 80% of respondents stated that they use pPOSSUM in daily clinical practice. There was variability in the calculated scores between the groups analysed. Two subgroups were evident: one in which the calculated mean pPOSSUM was similar between participants but did not reflect the true value, and the other which was accurate, but demonstrated high inter-rater variability. Conclusions: This is the first study to investigate inter-operator variability in pPOSSUM scores. Previous reports on the validity of the tool fail to account for subjective variation. At a time where pPOSSUM has become a routine part of clinical practice, this variability needs to be accounted for and taken into consideration in the decision-making process.
When does the exquisite become excessive in lip augmentation?
Authors: MILLER AMY , DETTERMAN MEAGHAN 
Published: June 2019

As part of our #EthicsinAesthetics campaign, we are considering the enhancements we see in this sector and promoting the natural enhancement of patients' features, rather than drastically changing their appearance. In this article, Amy Miller and Meaghan Detterman consider the enhancement of the lips, and ask: when does the exquisite become excessive? It is said that beauty is in the eye of the beholder, and it is certainly true that there is no single definition of what ‘beauty’ is. Lip enhancement treatments continue to rise in popularity, and much of the time this procedure is able to naturally enhance the patient's own beauty and bring balance to the face. However, in the aesthetics sector, we sometimes see trends towards a ‘false’ appearance emerging, and many practitioners will receive requests from patients who are actively seeking an unnatural or ‘false’ look. This article explores the issue of dealing with a patient who is requesting unnatural augmentation of the lips, and provides some advice on how to deal with this difficult situation.
Preventing complications and managing symptoms of CKD
Authors: Rainey Helen 
Published: June 2019

A common long-term condition, chronic kidney disease can appear with many different symptoms and may require different management strategies. Helen Rainey outlines what these can be and what practice nurses need to know to help their patients Chronic kidney disease (CKD) is a common long-term condition frequently seen in people with diabetes, hypertension and in the elderly population. It rarely causes symptoms in its early stages and practice nurses have a key role in monitoring patients for signs of complications and supporting their treatment. It is important to discuss potential symptoms with patients and encourage lifestyle measures, as well as considering medication to treat them. Close working between primary care and renal services is essential to allow patients with worsening CKD to make timely decisions about their treatment and receive coordinated care closer to home.
Electronic cigarettes: weighing up the evidence
Authors: Cope Graham 
Published: June 2019

Electronic cigarettes have been evaluated and assessed as a smoking cessation tool; however, as Graham Cope explains, a more cautious approach may be needed and users should be made aware of the potential harm of these devices Electronic cigarettes (e-cigarettes) have been evaluated to assess their safety and value as a smoking cessation tool. They were deemed to be a safer alternative to tobacco smoking. The vapour emitted was regarded as harmless and that society's attitudes should change to encourage these devices into everyday use, and therefore the regulations should be relaxed to assist the decline of tobacco smoking. However, a more cautious approach argues that nicotine replacement therapy should be used first, and only after that fails should smoking e-cigarettes, known as vaping, be done at low strength and for a limited period. Users should be made aware that nicotine from e-cigarettes could be harmful and the increasing use of attractive forms of vaping by young people is a worrying trend.
A INFLUÊNCIA DOS MEIOS DE COMUNICAÇÃO EM MASSA NA TEORIA DA DECISÃO: UMA ANÁLISE DO DISCURSO LINGUÍSTICO NO NÍVEL PERLOCUCIONÁRIO
Authors: De Souza Artur Cesar , Santiago Mariana Ribeiro 
Published: June 2019

O presente artigo analisa, pelo prisma do discurso linguístico, no nívelperlocucionário, a influência exercida pelos meios de comunicação de massa na teoria da decisão. A escolha do tema se justifica tendo em vista que os meios de comunicação de massa, por meio do seu próprio sistema linguístico, participam ativamente de uma rede de comunicação e de informação, visando não somente comunicar e informar, mas igualmente influir diretamente para a construção de umanova ordem de ideias e de resultados de decisões. O estudo tem como objetivo analisar a influência do nível perlocucionário do discurso linguístico produzido pelos meios de comunicação em massa em relação à teoria da decisão judicial. Para tanto, num primeiro momento, visa-se demonstrar como os meios de comunicação de massa se apropriam do discurso linguístico para fins de manipulação da realidade social, e, na sequência, demonstra-se o efeito do discurso perlocucionário nadelimitação do conteúdo hermenêutico da decisão judicial. O método de abordagem utilizado é o dialético jurídico, acompanhado do método de pesquisa bibliográfico. Em conclusão, entende-se que é preciso neutralizar a ingerência psicológica do discurso midiático, uma vez que a ilegitimidade dessa influência põe em risco o conteúdo hermenêutico da decisão judicial.