bluuebunny/crossref_metadata_2025_split huggingface dataset:
Meta-analysis of intracavitary electrocardiogram guidance for peripherally inserted central catheter placement
Authors: Liu Guang , Hou Wenbo , Zhou Chao , Yin Yuxia , Lu Shoutao , Duan Cuihai , Li Maoquan , Toft Egon Steen , Zhang Haijun 
Published: March 2019

Background: Recently, intracavitary electrocardiogram technology has been applied to peripherally inserted central catheter placement and demonstrates many potential advantages. However, the tip positioning accuracy of intracavitary electrocardiogram technology compared to conventional X-ray method is unknown. Objective: We did a meta-analysis to compare the tip positioning accuracy between intracavitary electrocardiogram technology and conventional X-ray method. Data sources: We searched several databases, including Cochrane Library, PubMed, Web of science, and Embase. Additional studies were identified through hand searches of bibliographies and Internet searches. All human studies published in full text, abstract, or poster form were eligible for inclusion. Search terms included peripherally inserted central catheter, PICC, intracavitary electrocardiogram, IC-ECG, EKG, ECG, and catheter tip location. Study eligibility criteria: Only randomized controlled trials of using intracavitary electrocardiogram technology versus X-ray method for peripherally inserted central catheter placement were included. All studies included adult patients aged at least 18 years. Study appraisal and synthesis methods: Independent extraction of articles by two authors using predefined data fields, including study quality indicators. Of the 178 citations identified, 5 studies that included 1672 patients met the eligibility criteria. It was found that statistical heterogeneity existed among the various studies (I2 = 16%, p < 0.00001); therefore, the fixed effect model was used in the meta-analysis (p < 0.05). The meta-analysis compared the tip positioning accuracy between intracavitary electrocardiogram technology and X-ray method and showed that intracavitary electrocardiogram technology had a better positioning accuracy (odds ratio: 2.88, 95% confidence interval: 2.15–3.87, p < 0.0001). Limitations: Only five randomized trial met inclusion criteria, and the lack of an incomplete search led to the publication bias seen in these results. Conclusion: The intracavitary electrocardiogram method had a more favorable positioning accuracy versus traditional X-ray method for peripherally inserted central catheter placement in adult patients. The intracavitary electrocardiogram can be a promising technique to guide tip positioning of peripherally inserted central catheter.
Downregulation of glucose-6-phosphate dehydrogenase contributes to diabetic neuropathic pain through upregulation of toll-like receptor 4 in rats
Authors: Sun Qian , Zhang Bing-Yu , Zhang Ping-An , Hu Ji , Zhang Hong-Hong , Xu Guang-Yin 
Published: March 2019

Background and aim Diabetic neuropathic pain is a refractory and disabling complication of diabetes mellitus. The pathogenesis of the diabetic neuropathic pain is still unclear, and treatment is insufficient. The aim of this study is to investigate the roles of glucose-6-phosphate dehydrogenase (G6PD) and toll-like receptor 4 (TLR4) in neuropathic pain in rats with diabetes. Methods Type 1 diabetes model was induced by intraperitoneal injection of streptozotocin (STZ, 75 mg/kg) in adult female Sprague-Dawley rats. Paw withdrawal threshold and paw withdrawal latency of rats were measured by von Frey filaments and thermal radiation, respectively. The expressions of G6PD and TLR4 in L4-L6 dorsal root ganglions (DRGs) were measured by western blotting and quantitative real-time polymerase chain reaction analysis. Fluorescent immunohistochemistry was employed to detect expressions of G6PD and TLR4 and co-location of G6PD with TLR4. Results The mRNA and protein expression levels of G6PD in DRGs were significantly decreased in diabetic rats when compared with age-matched control rats. Upregulation of G6PD by intrathecal injection of G6PD overexpression adenovirus markedly attenuated hindpaw pain hypersensitivity of diabetic rats. The mRNA and protein expression levels of TLR4 in DRGs of diabetic rats were significantly increased when compared with control rats. Intrathecal injection of TLR4-selective inhibitor CLI-095 attenuated diabetic pain in dose- and time-dependent manners. Furthermore, G6PD and TLR4 were co-localized in DRG neurons. Intrathecal injection of G6PD overexpression adenovirus greatly reduced TLR4 expression, while intrathecal injection of CLI-095 had no significant effect on G6PD expression in diabetic rats. Conclusions Our results suggest that decrease in G6PD expression was involved in diabetic peripheral neuropathic pain, which was most likely through upregulation of TLR4 expression in the DRGs of rats.
Unlocking intuition and expertise: using interpretative phenomenological analysis to explore clinical decision making
Authors: Anderson Natalie Elizabeth , Slark Julia , Gott Merryn 
Published: March 2019

Background Clinical decision making is a complex, but important, research area. Decision-making theories have evolved to recognise that, although heuristics and biases can lead to error, expert clinician decision makers can also use intuition to good effect. More research is needed to understand how nurses and other clinicians make sense of complexity and uncertainty. Aim This paper discusses the utility of interpretative phenomenological analysis to elucidate clinical decision making, expertise and intuition. Methods A narrative review of published interpretative phenomenological analysis studies exploring clinical decision-making, and discussion of an exemplar study. Results A limited number of interpretative phenomenological analysis studies have been published in this area. By seeking out descriptions of real-world decision making, interpretative phenomenological analysis research provides ecologically valid insights into what it is like to make time-critical, high-stakes decisions with limited information. Conclusion Contributing to the study of complex clinical decision making in combination with other research approaches, interpretative phenomenological analysis research has significant unrealised potential to inform education, assessment and support interventions and the development of clinical guidelines. Future applications could enhance understanding of multi-disciplinary decision-making and the development of expertise and intuition, over time.
Sexuality as taboo: using interpretative phenomenological analysis and a Foucauldian lens to explore fathers’ practices in talking to their children about puberty, relationships and reproduction
Authors: Bennett Clare , Harden Jane 
Published: March 2019

Background Fathers can play an important role in their children’s learning about relationships and sexuality but we know very little about the father’s lived experience in this regard. Aim To explore eight fathers’ perceptions and experiences of discussing puberty, relationships and reproduction with their 10-year-old children. Methods The paper commences with a genealogical analysis of the history of sex education in England from the Public Health Act of 1848 to the present day. Interpretative phenomenological analysis (IPA) was used as both a methodology and a method. Face-to-face interviews were conducted with each father and results were analysed ideographically, followed by analysis across the group. Interpretations were developed using a Foucauldian lens of governmentality and biopower. Findings The paper explores how synthesis of IPA with a Foucauldian lens revealed significant tensions between the fathers’ cognitions, accounts and behaviours, which were underpinned by an enduring perception of sexuality as taboo. Conclusion By providing a contextualised understanding of the fathers’ practices, this study demonstrates that a more informed approach to health promotion strategy can be achieved and the implications for nursing are explored.
An interpretative phenomenological analysis of young men’s experiences of addressing their sexual health and the importance of researcher reflexivity
Authors: Sydor Anna 
Published: March 2019

Background Incidence of sexually transmitted infections has increased in both young men and young women. Young men do not access sexual health services in the same numbers as young women, this study sought to discover young men’s experiences. Aims This paper reports one overarching theme from an interpretative phenomenological study that sought to discover the experiences of young males (aged 20–24) addressing or failing to address their sexual health. Owing to the sensitive subject under investigation, these participants were hard to reach for research purposes. Methods This study used interpretative phenomenological analysis and the researcher was a young female (aged 20–30), in contrast with participants. This affected data collection and analysis so the importance of reflexivity in interpretative phenomenological analysis is discussed here. Results Six superordinate themes were identified: sexual health knowledge and attitudes; feelings about masculinities; communication; feelings about healthcare; feelings about working; and keeping fit. From these, three overarching themes were developed, these reflect the depth of data analysis undertaken. One of these themes, the ‘hidden moral code’, and the importance of researcher reflexivity in its identification are discussed here. Conclusions It is suggested that interpretative phenomenological analysis is a particularly suitable method for nursing research, which allows and embraces the influence and attributes of the researcher. This paper considers one superordinate theme in depth, chosen because the researcher’s attributes are a significant factor in its recognition.
Sex differences in stroke metrics among Southeast Asian countries: Results from the Global Burden of Disease Study 2015
Authors: Hwong Wen Yea , Bots Michiel L , Selvarajah Sharmini , Sivasampu Sheamini , Reidpath Daniel D , Law Wan Chung , Musa Kamarul Imran , Vaartjes Ilonca 
Published: March 2019

Background Sex differences in cardiovascular diseases generally disadvantage women, particularly within developing regions. Aims This study aims to examine sex-related differences in stroke metrics across Southeast Asia in 2015. Furthermore, relative changes between sexes are compared from 1990 to 2015. Methods Data were sourced from the Global Burden of Disease Study. Incidence and mortality from ischemic and hemorrhagic strokes were explored with the following statistics derived: (1) women-to-men incidence/mortality ratio and (2) relative percentage change in rate. Results Women had lower incidence and mortality from stroke compared to men. Notable findings include higher ischemic stroke incidence for women at 30–34 years in high-income countries (women-to-men ratio: 1.3, 95% CI: 0.1, 16.2 in Brunei and 1.3, 95% CI: 0.5, 3.2 in Singapore) and the largest difference between sexes for ischemic stroke mortality in Vietnam and Myanmar across most ages. Within the last 25 years, greater reductions for ischemic stroke metrics were observed among women compared to men. Nevertheless, women below 40 years in some countries showed an increase in ischemic stroke incidence between 0.5% and 11.4%, whereas in men, a decline from −4.2% to −44.2%. Indonesia reported the largest difference between sexes for ischemic stroke mortality; a reduction for women whereas an increase in men. For hemorrhagic stroke, findings were similar: higher incidence among young women in high-income countries and greater reductions for stroke metrics in women than men over the last 25 years. Conclusions Distinct sex-specific differences observed across Southeast Asia should be accounted in future stroke preventive guidelines.
Reducing Radiation and Lowering Costs With a Standardized Care Pathway for Nonoperative Thoracolumbar Fractures
Authors: Hanson Gregory , Lyons Keith W. , Fournier Debra A. , Lollis S. Scott , Martin Eric D. , Rhynhart Kurt K. , Handel Wanda J. , McGuire Kevin J. , Abdu William A. , Pearson Adam M. 
Published: March 2019

Study Design: Retrospective observational study. Objective: There is marked variation in the management of nonoperative thoracolumbar (TL) compression and burst fractures. This was a quality improvement study designed to establish a standardized care pathway for TL fractures treated with bracing, and to then evaluate differences in radiographs, length of stay (LOS), and cost before and after the pathway. Methods: A standardized pathway was established for management of nonoperative TL burst and compression fractures (AOSpine classification type A1-A4 fractures). Bracing, radiographs, costs, complications, and LOS before and after pathway adoption were analyzed. Differences between the neurosurgery and orthopedic spine services were compared. Results: Between 2012 and 2015, 406 nonoperative burst and compression TL fractures were identified. A total of 183 (45.1%) were braced, 60.6% with a custom-made thoracolumbosacral orthosis (TLSO) and 39.4% with an off-the-shelf TLSO. The number of radiographs significantly reduced after initiation of the pathway (3.23 vs 2.63, P = .010). A total of 98.6% of braces were custom-made before the pathway; 69.6% were off-the-shelf after the pathway. The total cost for braced patients after pathway adoption decreased from $10 462.36 to $8928.58 ( P = .078). Brace-associated costs were significantly less for off-the-shelf TSLO versus custom TLSO ($1352.41 vs $3719.53, respectively, P < .001). The mean LOS and complication rate did not change significantly following pathway adoption. The orthopedic spine service braced less frequently than the neurosurgery service (40.7% vs 52.2%, P = .023). Conclusions: Standardized care pathways can reduce cost and radiation exposure without increasing complication rates in nonoperative management of thoracolumbar compression and burst fractures.
Sex Differences in Statin Prescribing in Diabetic and Heart Disease Patients in FQHCs: A Comparison of the ATPIII and 2013 ACC/AHA Cholesterol Guidelines
Authors: Khan Nazia Naz S. , Kelly-Blake Karen , Luo Zhehui , Olomu Adesuwa 
Published: March 2019

Purpose: The purpose of this study was to determine the difference in the rate of statin prescribing based on the Adult Treatment Panel (ATP) III and 2013 American College of Cardiology (ACC)/American Heart Association cholesterol guidelines across sex in Federally Qualified Health Centers (FQHCs), and to determine the proportion of patients on recommended statin dosage based on the 2013 cholesterol guideline. Methods: The Office Guidelines Applied to Practice (Office-GAP) study is a quasi-experimental, 2 FQHCs center study that enrolled patients with coronary heart disease and diabetes mellitus (DM). We computed 10-year atherosclerotic cardiovascular disease (ASCVD) risks scores based on ACC guidelines and determined the rate of statin prescribing across sex in FQHCs using both guidelines. Main outcomes measures were (1) rate of statin prescribing based on ATPIII and 2013 cholesterol guidelines across sex and (2) proportion of patients on recommended statin dosage based on the 2013 cholesterol guideline. Results: The 2013 cholesterol guideline did not increase the rate of eligibility of statin for men and women compared to ATPIII guideline. No significant difference between men and women in statin prescribing under ATPIII (67% vs 57%, P = .13) and 2013 cholesterol guidelines (66% vs 63%, P = .69) and in the recommended dosage of statin per the 2013 cholesterol guidelines between men and women in FQHCs (12% vs 22%, P = .22). Conclusions: We found statin underprescribing for both men and women with ASCVD and DM in FQHCs. Utilizing both the ATPIII and the 2013 cholesterol guidelines, men with ASCVD and DM were prescribed statin more than women. However, fewer men were found to be on the recommended dosage of statin based on the 2013 cholesterol guideline. Our findings suggest that Office-GAP may have improved the prescription/use of statin in both men and women.
Long-term follow-up of the RESONATE phase 3 trial of ibrutinib vs ofatumumab
Authors: Byrd John C. , Hillmen Peter , O’Brien Susan , Barrientos Jacqueline C. , Reddy Nishitha M. , Coutre Steven , Tam Constantine S. , Mulligan Stephen P. , Jaeger Ulrich , Barr Paul M. , Furman Richard R. , Kipps Thomas J. , Thornton Patrick , Moreno Carol , Montillo Marco , Pagel John M. , Burger Jan A. , Woyach Jennifer A. , Dai Sandra , Vezan Remus , James Danelle F. , Brown Jennifer R. 
Published: March 2019

Abstract
Ibrutinib, a once-daily oral inhibitor of Bruton tyrosine kinase, has greatly improved outcomes for patients with chronic lymphocytic leukemia (CLL). The phase 3 RESONATE trial, which compared single-agent ibrutinib to ofatumumab in high-risk, relapsed patients with CLL, provided support for approval of ibrutinib in the United States and Europe. We describe long-term follow-up of patients treated in RESONATE, where continued superiority of progression-free survival (PFS) (hazard ratio [HR], 0.133; 95% confidence interval [CI], 0.099-0.178) was observed. Overall survival benefit continues (HR, 0.591; 95% CI, 0.378-0.926), although with decreased magnitude relative to that seen before crossover to ibrutinib was implemented for patients on ofatumumab (HR, 0.426; 95% CI, 0.220-0.823). Notably, overall response to ibrutinib increased over time, with 91% of patients attaining a response. The PFS benefit with ibrutinib was independent of baseline risk factors, although patients with ≥2 prior therapies had shorter PFS than those with &lt;2 prior therapies, and the presence of TP53 or SF3B1 mutations showed a trend toward shorter PFS vs without these factors. Median duration of ibrutinib was 41 months, with 46% remaining on treatment at a median follow-up of 44 months. Grade ≥3 adverse events generally decreased over time, causing only a small proportion of patients to cease therapy. Ibrutinib was discontinued due to progressive disease in 27% of patients. This long-term study provides support for sustained efficacy and safety of ibrutinib in relapsed/refractory CLL and consideration of study provisions that allow crossover to investigational therapy when benefit has been clearly demonstrated. This trial was registered at www.clinicaltrials.gov as #NCT01578707.
Upregulation of MUC5AC production and deposition of LEWIS determinants by HELICOBACTER PYLORI facilitate gastric tissue colonization and the maintenance of infection
Authors: Gonciarz Weronika , Walencka Maria , Moran Anthony P. , Hinc Krzysztof , Obuchowski Michał , Chmiela Magdalena 
Published: March 2019

Abstract
Background
Helicobacter pylori bacteria colonize human gastric mucosa, cause chronic inflammation, peptic ulcers and gastric cancer. Colonization is mediated by H. pylori adhesins, which preferentially bind mucin 5 (MUC5AC) and Lewis (Le) determinants. The aim of this study was to evaluate the influence of H. pylori and their components on MUC5AC production and deposition of LeX/LeY in gastric epithelial cells in relation to bacterial adhesion using Caviae porcellus primary gastric epithelial cells and an in vivo model of experimental H. pylori infection in these animals.

Methods
MUCA5C and LeX/LeY were induced in vitro by live H. pylori reference strain CCUG 17874 (2 × 107 CFU/ml), H. pylori glycine acid extract (GE), 10 μg/ml; cytotoxin associated gene A (CagA) protein, 1 μl/ml; UreA urease subunit, 5 μg/ml; lipopolysaccharide (LPS) 25 ng/ml and imaged by fluorescence microscopy after anti-MUC5AC or anti-LeX/LeY FITC antibody staining. Bacterial adhesion was imaged by using anti-H. pylori FITC antibodies. The animals were inoculated per os with H. pylori (3 times in 2 days intervals, 1 × 1010 CFU/ml). After 7 or 28 days an infection and inflammation were assessed by histological, serological and molecular methods. Gastric tissue sections of infected and control animals were screend for MUCA5C and LeX, and H. pylori adhesion as above.

Results
MUC5AC production and deposition of Lewis determinants, especially LeX were upregulated in the milieu of live H. pylori as well as GE, CagA, UreA or LPS in vitro and in vivo during infection, more effectively in the acute (7 days) than in the chronic (28 days) phase of infection. This was related to enhanced adhesion of H. pylori, which was abrogated by anti-MUC5AC and anti-LeX or anti-LeY antibody treatment.

Conclusions
Modulation of MUCA5C production and LeX/LeY deposition in the gastric mucosa by H. pylori can significantly increase gastric tissue colonization during H. pylori infection.
Differences in degree of lesion enhancement on CEM between ILC and IDC
Authors: van Nijnatten Thiemo JA , Jochelson Maxine S , Pinker Katja , Keating Delia M , Sung Janice S , Morrow Monica , Smidt Marjolein L , Lobbes Marc BI 
Published: March 2019

Objective: To investigate differences in the degree of enhancement on contrast-enhanced mammography (CEM) between patients with invasive lobular (ILC) and infiltrating ductal carcinoma (IDC) not otherwise specified. Methods and materials: Between 2010 and 2017, all patients diagnosed with ILC and who underwent CEM were included for this dual center study. Twenty-two patients with IDC, matched by size, were identified for comparison. Three independent readers, blinded for histopathology results, re-evaluated all CEM exams to determine degree of lesion enhancement according to a previously defined scoring scale ranging from minimal to strong enhancement. Interobserver agreement among the three readers was calculated by quadratic weighted κ coefficient. Results: 44 patients were included: 22 patients with ILC and 22 patients with IDC. There were no significant differences in age, mean tumor size, tumor grade or receptor status between the two subgroups. Degree of lesion enhancement on CEM was more often considered weak in case of ILC compared to IDC according to two out of three readers (31.8% vs 4.5 %, p = 0.045 and 22.7 vs 4.5 %, p = 0.185). All other lesions showed moderate or strong enhancement. Interobserver agreement between the three independent readers was good (κ = 0.72). Conclusion: In patients with ILC, degree of lesion enhancement on CEM appears to be more often weak than in infiltrating ductal carcinoma not otherwise specified. Radiologists should be aware that weakly enhancing lesions may in fact be malignant and particularly invasive lobular cancers. Advances in knowledge: Three independent readers evaluated 44 CEM cases with ILC or IDC. Degree of lesion enhancement seems more often weak in case of ILC. Radiologists should be aware of ILC in case of weak CEM enhancement.