bluuebunny/crossref_metadata_2025_split huggingface dataset:
Veterans Specific Activity Questionnaire (VSAQ): a new and efficient method of assessing exercise capacity in patients with pulmonary arteriovenous malformations
Authors: Gawecki Filip , Myers Jonathan , Shovlin Claire L. 
Published: March 2019

IntroductionAssessment of performance status is an important component of clinical management of patients with pulmonary arteriovenous malformations (PAVMs). Usual methods are time-consuming and insensitive to variations within normal or supranormal exercise capacity.MethodsThe Veterans Specific Activity Questionnaire (VSAQ) was modified to facilitate completion by patients independently. Patient-reported activity limitations were converted to the Medical Research Council (MRC) Dyspnoea Scale, New York Heart Association (NYHA) classification and metabolic equivalents (METs) in which 1 MET equals the consumption of 3.5 mL O2per kilogram of body weight per minute.ResultsThe study population consisted of 71 patients with PAVMs aged 20–85 (median 52) years. Oxygen saturation (SaO2) was 80%–99.5 % (median 96%), and haemoglobin was 73–169 g/L in women and 123–197 g/L in men (p<0.0001). Arterial oxygen content (CaO2) (1.34 × [haemoglobin × SaO2]/100) was maintained unless iron deficiency was present. Most patients (49/71, 69%) did not need to stop until activities more energetic than walking briskly at 4 mph were achieved (6.4 km per hour, VSAQ >5, MRC Dyspnoea Scale 1 or 2, NYHA class I). SaO2was inversely associated with the MRC Dyspnoea Scale and NYHA class, but not the VSAQ. Raw VSAQ scores captured a marked difference between men and women. METs were also higher in men at 3.97–15.55 (median 8.84) kcal/kg/min, compared with 1.33–14.4 (median 8.25) kcal/kg/min (p=0.0039). There was only a modest association between METs and SaO2(p=0.044), but a stronger association between METs and haemoglobin (p =0.001). In crude and sex-adjusted regression, the CaO2was more strongly associated with METs than either SaO2or haemoglobin in isolation.ConclusionThe VSAQ, capturing patient-reported outcome measures, is an efficient and quantifiable measure of exercise capacity that can be readily employed in clinical services particularly where patients have normal to high exercise tolerance. In the PAVM population, exercise capacity reflects haemoglobin and CaO2more than SaO2, even where SaO2measurements are low.
Return to play following anterior cruciate ligament reconstruction: incorporating fatigue into a return to play functional battery. Part A: treadmill running
Authors: Connell Richard , Milne Ross , Paton Bruce 
Published: March 2019

BackgroundThe risk of reinjury and other sequelae following anterior cruciate ligament reconstruction (ACLR) remains high. Lack of knowledge regarding factors contributing to these risks limits our ability to develop sensitive return to play (RTP) tests. Using a running task, we evaluate whether fatigue induces alterations in foot progression angle (FPA), a proposed biomechanical risk factor and could be used to enhance RTP test sensitivity.MethodTransverse plane foot kinematics (FPA) were assessed for 18 post-ACLR subjects during a treadmill running task, before and after a generalised lower limb fatigue protocol. Subject’s contralateral limbs were used as a control group.ResultsA small but significant difference between FPA for ACLR and contralateral limbs was observed before but not after fatigue. When confounding variables were considered, there was a significant difference in FPA change between ACLR and contralateral limbs from the prefatigue to postfatigue state.ConclusionsFollowing ACLR athletes may develop a knee-protective movement strategy that delays the progression of osteoarthritis in the ACL-injured knee. This may, however, increase the risk of ACL reinjury. Following the onset of fatigue this proposed movement strategy, and thus osteoarthritis protection, is lost.
MSK30: a validated tool to assess clinical musculoskeletal knowledge
Authors: Cummings Danielle L , Smith Matthew , Merrigan Brian , Leggit Jeffrey 
Published: March 2019

BackgroundMusculoskeletal (MSK) complaints comprise a large proportion of outpatient visits. However, multiple studies show that medical school curriculum often fails to adequately prepare graduates to diagnose and manage common MSK problems. Current standardised exams inadequately assess trainees’ MSK knowledge and other MSK-specific exams such as Freedman and Bernstein’s (1998) exam have limitations in implementation. We propose a new 30-question multiple choice exam for graduating medical students and primary care residents. Results highlight individual deficiencies and identify areas for curriculum improvement.Methods/ResultsWe developed a bank of multiple choice questions based on 10 critical topics in MSK medicine. The questions were validated with subject-matter experts (SMEs) using a modified Delphi method to obtain consensus on the importance of each question. Based on the SME input, we compiled 30 questions in the assessment. Results of the large-scale pilot test (167 post-clerkship medical students) were an average score of 74 % (range 53% – 90 %, SD 7.8%). In addition, the tool contains detailed explanations and references were created for each question to allow an individual or group to review and enhance learning.SummaryThe proposed MSK30 exam evaluates clinically important topics and offers an assessment tool for clinical MSK knowledge of medical students and residents. It fills a gap in current curriculum and improves on previous MSK-specific assessments through better clinical relevance and consistent grading. Educators can use the results of the exam to guide curriculum development and individual education.
Calculated plasma volume status and outcomes in patients undergoing coronary bypass graft surgery
Authors: Maznyczka Annette Marie , Barakat Mohamad Fahed , Ussen Bassey , Kaura Amit , Abu-Own Huda , Jouhra Fadi , Jaumdally Hannah , Amin-Youssef George , Nicou Niki , Baghai Max , Deshpande Ranjit , Wendler Olaf , Kolvekar Shyam , Okonko Darlington O 
Published: March 2019

ObjectivesCongestion is associated with worse outcomes in critically ill surgical patients but can be difficult to quantify noninvasively. We hypothesised that plasma volume status (PVS), estimated preoperatively using a validated formula that enumerates percentage change from ideal plasma volume (PV), would provide incremental prognostic utility after coronary artery bypass graft (CABG) surgery.MethodsIn this retrospective cohort study, patients who underwent CABG surgery (1999–2010) were identified from a prospectively collected database. Actual ([1-haematocrit] x [a+(b x weight [kg])]) and ideal (c x weight [kg]) PV were obtained from equations where a, b and c are sex-dependent constants. Calculated PVS was then derived (100% x [(actual−ideal)/ideal]).ResultsIn 1887 patients (mean age 67±10 years; 79% male; median European System for Cardiac Operative Risk Evaluation [EuroSCORE] 4), mean PVS was −8.2±9%. While 8% of subjects had clinical evidence of congestion, a relatively increased PV (PVS >0%) was estimated in 17% and correlated with lower serum sodium, higher EuroSCORE and a diagnosis of diabetes mellitus. A PVS≥5.6% was optimally prognostic and associated with greater mortality (HR: 2.31, p=0.009), independently of, and incremental to, EuroSCORE, New York Heart Association class and serum sodium. A PVS≥5.6% also independently predicted longer intensive care (β: 0.65, p=0.007) and hospital (β: 2.01, p=0.006) stays, and greater postoperative renal (OR: 1.61, p=0.008) and arrhythmic (OR: 1.29, p=0.03) complications.ConclusionsHigher PVS values, calculated simply from weight and haematocrit, are associated with worse inpatient outcomes after CABG. PVS could help refine risk stratification and further investigations are warranted to evaluate the potential clinical utility of PVS-guided management in patients undergoing CABG.
Diagnostic accuracies of screening for atrial fibrillation by cardiac nurses versus radiographers
Authors: Kvist Lærke Marius , Vinter Nicklas , Urbonaviciene Grazina , Lindholt Jes Sanddal , Diederichsen Axel Cosmus Pyndt , Frost Lars 
Published: March 2019

AimWe examined the diagnostic accuracy of single-lead ECG as assessed by radiographers and 12-lead ECG as assessed by cardiac nurses for the diagnosis of atrial fibrillation (AF).MethodsBased on the Danish Cardiovascular Screening Trial, we conducted a population-based, cross-sectional study of 1338 randomly selected Danish men aged 65–74 years with no exclusion criteria. The participants were screened with single-lead ECG during a CT scan assessed by radiographers and 12-lead ECG assessed by cardiac nurses. The diagnostic accuracy was evaluated compared with that produced by a 12-lead ECG assessed by two consenting cardiologists.ResultsThe study identified 68 participants with ongoing AF, of whom 60 had self-reported AF and 8 had AF detected in the screening. Single-lead ECG assessed for AF by radiographers had a sensitivity of 60.3% (95% CI 47.7 to 72.0), specificity of 97.2% (95% CI 96.2 to 98.1), positive predictive value (PPV) of 53.9% (95% CI 42.1 to 65.5) and negative predictive value (NPV) of 97.9% (95% CI 96.9 to 98.6). 12-lead ECG assessed by cardiac nurses had a sensitivity of 97.1% (95% CI 89.8 to 99.6), specificity of 100% (95% CI 99.7 to 100), PPV of 100% (95% CI 94.6 to 100) and NPV of 99.8% (95% CI 99.4 to 100).ConclusionsSingle-lead ECG assessed by radiographers had a moderate sensitivity and PPV but a very high specificity and NPV. Using radiographers may be acceptable for opportunistic screening, in particular if radiographers are thoroughly trained. Thus, 12-lead ECG assessed by cardiac nurses is a potential diagnostic method for the detection of AF.
Stereotactic aspiration for hypertensive intracerebral haemorrhage in a Chinese population: a retrospective cohort study
Authors: Zhang Xuyang , Zhou Shaolong , Zhang Qiang , Fu Xudong , Wu Yuehui , Liu Jiasheng , Liang Bo , Yang Zhuo , Wang Xinjun 
Published: March 2019

ObjectiveWe aimed to compare the therapeutic effects of stereotactic aspiration and best medical management in patients who developed supratentorial hypertensive intracerebral haemorrhage (HICH) with a volume of haemorrhage between 20 and 40 mL.MethodsThe clinical data of 220 patients with supratentorial HICH with a volume between 20 and 40 mL were retrospectively analysed. Among them, 142 received stereotactic aspiration surgery (stereotactic aspiration group) and 78 received best medical management (conservative group). All were followed up for 6 months. Multivariate logistic regression and Kaplan-Meier survival curves were used to compare the outcome between the two groups.ResultsThe rebleeding rate was lower in the group that had stereotactic aspiration when compared with the group with medical treatment (6 [4.2%] vs 9 [11.5%], χ2=4.364, p=0.037). After 6 months, although the mortality rate did not differ significantly between the two groups (8 cases [5.6%] vs 10 cases [12.8%], χ2=3.461, p=0.063), the rate of a favourable outcome was higher in the group who received stereotactic aspiration (χ2=15.870, p=0.000). Logistic regression identified that medical treatment (OR=1.64, p=0.000) was an independent risk factor for an unfavourable outcome. The Kaplan-Meier curves indicated that the median favourable outcome time in the stereotactic aspiration group was 59.5 days compared with that in the medically treated group (87.0 days). The log-rank test indicated that the prognosis at 6 months was better for those treated with stereotactic haematoma aspiration (χ2=29.866, p=0.000). However, the 6-month survival rate was similar between the two groups (χ2=3.253, p=0.068).ConclusionsStereotactic haematoma aspiration significantly improved the quality of life, although did not effectively reduce the rate of mortality. When selected appropriately, patients with HICH may benefit from this type of surgical intervention.
Detection of Left Ventricular Hypertrophy Using Bayesian Additive Regression Trees: The MESA (Multi‐Ethnic Study of Atherosclerosis)
Authors: Sparapani Rodney , Dabbouseh Noura M. , Gutterman David , Zhang Jun , Chen Haiying , Bluemke David A. , Lima Joao A. C. , Burke Gregory L. , Soliman Elsayed Z. 
Published: March 2019

BackgroundWe developed a new left ventricular hypertrophy (LVH) criterion using a machine‐learning technique called Bayesian Additive Regression Trees (BART).Methods and ResultsThis analysis included 4714 participants from MESA (Multi‐Ethnic Study of Atherosclerosis) free of clinically apparent cardiovascular disease at enrollment. We usedBARTto predictLVmass fromECGand participant characteristics using cardiac magnetic resonance imaging as the standard. Participants were randomly divided into a training set (n=3774) and a validation set (n=940). We compared the diagnostic/prognostic performance of our newBART‐LVHcriteria with traditionalECG‐LVHcriteria and cardiac magnetic resonance imaging–LVH. In the validation set,BART‐LVHshowed the highest sensitivity (29.0%; 95%CI, 18.3%–39.7%), followed by Sokolow‐Lyon‐LVH(21.7%; 95%CI, 12.0%–31.5%), Peguero–Lo Presti (14.5%; 95%CI, 6.2%–22.8%), Cornell voltage product (10.1%; 95%CI, 3.0%–17.3%), and Cornell voltage (5.8%; 95%CI, 0.3%–11.3%). The specificity was >93% for all criteria. During a median follow‐up of 12.3 years, 591 deaths, 492 cardiovascular disease events, and 332 coronary heart disease events were observed. In adjusted Cox models, bothBART‐LVHand cardiac magnetic resonance imaging–LVHwere associated with mortality (hazard ratio [95%CI], 1.88 [1.45–2.44] and 2.21 [1.74–2.81], respectively), cardiovascular disease events (hazard ratio [95%CI], 1.46 [1.08–1.98] and 1.91 [1.46–2.51], respectively), and coronary heart disease events (hazard ratio [95%CI], 1.72 [1.20–2.47] and 1.96 [1.41–2.73], respectively). These associations were stronger than associations observed with traditionalECG‐LVHcriteria.ConclusionsOur newBART‐LVHcriteria have superior diagnostic/prognostic ability to traditionalECG‐LVHcriteria and similar performance to cardiac magnetic resonance imaging–LVHfor predicting events.
Nocturia as an Unrecognized Symptom of Uncontrolled Hypertension in Black Men Aged 35 to 49 Years
Authors: Victor Ronald G. , Li Ning , Blyler Ciantel A. , Mason O'Neil R. , Chang L. Cindy , Moy Norma Priscilla B. , Rashid Mohammad A. , Weiss Jeffrey P. , Handler Joel , Brettler Jeffrey W. , Sagisi Michael B. , Rader Florian , Elashoff Robert M. 
Published: March 2019

Background

Hypertension is assumed to be asymptomatic. Yet, clinically significant nocturia (≥2 nightly voids) constitutes a putative symptom of uncontrolled hypertension. Black men with hypertension may be prone to nocturia because of blunted nocturnal blood pressure (
BP
) dipping, diuretic drug use for hypertension, and comorbidity that predisposes to nocturia. Here, we test the hypothesis that nocturia is a common and potentially reversible symptom of uncontrolled hypertension in black men.

Methods and Results

We determined the strength of association between nocturia (≥2 nightly voids) and high
BP
(≥135/85 mm Hg) by conducting in‐person health interviews and measuring
BP
with an automated monitor in a large community‐based sample of black men in their barbershops. Because nocturia is prevalent and steeply age‐dependent after age 50 years, we studied men aged 35 to 49 years. Among 1673 black men (mean age, 43±4 years [
SD
]), those with hypertension were 56% more likely than men with normotension to have nocturia after adjustment for diabetes mellitus and sleep apnea (adjusted odds ratio, 1.56; 95%
CI
, 1.25–1.94 [
P
<0.0001]). Nocturia prevalence varied by hypertension status, ranging from 24% in men with normotension to 49% in men whose hypertension was medically treated but uncontrolled. Men with untreated hypertension were 39% more likely than men with normotension to report nocturia (
P
=0.02), whereas men whose hypertension was treated and controlled were no more likely than men with normotension to report nocturia (
P
=0.69).

Conclusions
Uncontrolled hypertension was an independent determinant of clinically important nocturia in a large cross‐sectional community‐based study of non‐Hispanic black men aged 35 to 49 years.

Clinical Trial Registration

URL
:
http://www.clinicaltrials.gov
. Unqiue identifier:
NCT
02321618.
OTO-201 for the Treatment of Acute Otitis Externa: Results from a Phase 3 Randomized Clinical Study
Authors: Ansley John , Mair Eric A. , Namini Hamid , Lu Chung H. , LeBel Carl 
Published: March 2019

Objectives: OTO-201 is a ciprofloxacin otic suspension previously approved by the US Food and Drug Administration to treat children with bilateral otitis media with effusion requiring tympanostomy tube placement. In this phase 3, double-blind, randomized, prospective, sham-controlled, multicenter study, a single dose of OTO-201 was administered to the external auditory canal in subjects with unilateral or bilateral acute otitis externa. Methods: Two hundred sixty-two subjects, 3 to 83 years of age, were randomized, and 260 subjects were included in the intent-to-treat analysis population: OTO-201 (0.2 mL, 12 mg, n = 130) or sham (air injection, n = 130). The primary efficacy measure was clinical cure (CC) on day 8, judged by blinded assessor for erythema, edema, otorrhea, and tenderness. Subjects were monitored over 28 days for efficacy and safety. Results: OTO-201 demonstrated a significant increase in CC compared with sham at day 8 (69.2% vs 46.1%, P < .001). Higher CC was also noted on day 4 ( P = .028), day 15 ( P < .001), and day 29 ( P < .001). A similar effect was observed in the pathogen-positive population. Single OTO-201 administration in the office setting was well tolerated by subjects. Conclusions: In this study in subjects with acute otitis externa, a single administration of 12 mg OTO-201 to the external auditory canal demonstrated a significantly higher proportion of subjects with CC and bacterial eradication compared with sham starting on day 4 and on all other observation days through day 29, with no safety or tolerability concerns identified. OTO-201 is the first agent in a randomized phase 3 study to demonstrate the efficacy and safety of a single-dose, health care professional–administered topical antibiotic for the treatment of acute otitis externa.
Needs management in families affected by childhood-onset dystrophinopathies
Authors: Conway Kristin M , Eichinger Katy , Trout Christina , Romitti Paul A , Mathews Katherine D , Pandya Shree K ,   Muscular Dystrophy Surveillance, Tracking and Research Network (MD STARnet)
Published: March 2019

Purpose: To collect information about the needs of families affected by childhood-onset dystrophinopathies residing in the United States. Methods: Individuals with an eligible dystrophinopathy were identified by the Muscular Dystrophy Surveillance, Tracking, and Research network. Between September 2008 and December 2012, 272 caregivers completed a 48-item survey about needs related to information, healthcare services, psychosocial issues, finances, caregiver demographics, and the individual’s functioning. Results: Overall, at least 80% of the survey items were identified as needs for more than one-half of caregivers. Among the needs identified, physical health and access to information were currently managed for most caregivers. Items identified as needed but managed less consistently were funding for needs not covered by insurance and psychosocial support. Conclusions: Healthcare providers, public health practitioners, and policymakers should be aware of the many needs reported by caregivers, and focus on addressing gaps in provision of needed financial and psychosocial services.
Long non-coding RNA PVT1 promotes tumor progression by regulating the miR-143/HK2 axis in gallbladder cancer
Authors: Chen Jianan , Yu Yan , Li Hua , Hu Qiuyue , Chen Xiaolong , He Yuting , Xue Chen , Ren Fang , Ren Zhigang , Li Juan , Liu Liwen , Duan Zhenfeng , Cui Guangying , Sun Ranran 
Published: March 2019

Abstract
Background
The long non-coding RNA PVT1 (lncRNA PVT1) has been reported to act as an oncogenic regulator of several cancers. However, its expression and function in gallbladder cancer (GBC) remain largely unknown.

Methods
In situ hybridization (ISH) and quantitative real-time PCR (qPCR) were performed to detect the expression of PVT1 and miR-143 in GBC tissues and cell lines. Immunohistochemistry (IHC) assays were performed to assess the expression of the hexokinase 2 (HK2) protein. The relationships among PVT1, miR-143 and HK2 were evaluated using dual-luciferase reporter, RNA immunoprecipitation (RIP) and biotin pull-down assays. The biological functions of PVT1, miR-143 and HK2 in GBC cells were explored with cell counting kit 8 (CCK-8), 5-ethynyl-20-deoxyuridine (EdU), colony formation, transwell, wound healing and glucose metabolism assays in vitro. For in vivo experiments, a xenograft model was used to investigate the effects of PVT1 and HK2 on GBC.

Results
PVT1 was upregulated in GBC tissues and cells and was positively associated with malignancies and worse overall survival. PVT1 knockdown inhibited cell proliferation, migration, and invasion in vitro and restrained tumor growth in vivo. Further studies demonstrated that PVT1 positively regulated HK2 expression via its competing endogenous RNA (ceRNA) activity on miR-143. Additionally, HK2 expression and function were positively correlated with PVT1. Furthermore, we observed that the PVT1/miR-143/HK2 axis promoted cell proliferation and metastasis by regulating aerobic glucose metabolism in GBC cells.

Conclusions
The results of our study reveal a potential ceRNA regulatory pathway in which PVT1 modulates HK2 expression by competitively binding to endogenous miR-143 in GBC cells, which may provide new insights into novel molecular therapeutic targets for GBC.