bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of internal fixation versus hemiarthroplasty for elderly patients with an undisplaced femoral neck fracture: a systematic review and meta-analysis
Authors: Ma Hsuan-Hsiao , Chou Te-Feng Arthur , Tsai Shang-Wen , Chen Cheng-Fong , Wu Po-Kuei , Chen Wei-Ming 
Published: October 2019

Abstract

Background
Although internal fixation has been the main treatment option for elderly patients with an undisplaced femoral neck fracture, it is associated with a high reoperation rate. Some surgeons have discussed the use of hemiarthroplasty, but there is limited literature comparing these two treatment modalities. In this study, we compared the perioperative results of hemiarthroplasty with internal fixation for undisplaced femoral neck fractures.

Methods
We performed a comprehensive review of literatures on PubMed, Web of Science, Embase, and the Cochrane Library for randomized controlled trials and comparative observational studies. Of the 441 studies initially identified, 3 met all inclusion criteria. Two reviewers independently graded study quality and abstracted relevant data including reoperation rate, mortality rate, Harris Hip Score (HHS), length of hospital stay, and operation duration.

Results
Our results revealed that hemiarthroplasty was associated with a lower reoperation rate than the internal fixation group (OR 4.489; 95% CI 2.030 to 9.927). Mortality rate at postoperative 1 month and 1 year and HHS at postoperative 1 year and 2 years were not different. Length of hospital stay (SMD − 0.800, 95% CI − 1.011 to − 0.589) and operation duration (SMD − 2.497, 95% CI − 2.801 to − 2.193) were shorter in the internal fixation group.

Conclusions
Compared with the internal fixation group, patients that underwent hemiarthroplasty had a lower reoperation rate and an equivalent overall mortality rate. Our meta-analysis suggests that hemiarthroplasty might be a better treatment choice than internal fixation in treating elderly patients with an undisplaced femoral neck fracture.
The use of a machine-learning algorithm that predicts hypotension during surgery in combination with personalized treatment guidance: study protocol for a randomized clinical trial
Authors: Wijnberge M. , Schenk J. , Terwindt L. E. , Mulder M. P. , Hollmann M. W. , Vlaar A. P. , Veelo D. P. , Geerts B. F. 
Published: October 2019

Abstract

Background
Intraoperative hypotension is associated with increased morbidity and mortality. Current treatment is mostly reactive. The Hypotension Prediction Index (HPI) algorithm is able to predict hypotension minutes before the blood pressure actually decreases. Internal and external validation of this algorithm has shown good sensitivity and specificity. We hypothesize that the use of this algorithm in combination with a personalized treatment protocol will reduce the time weighted average (TWA) in hypotension during surgery spent in hypotension intraoperatively.

Methods/design
We aim to include 100 adult patients undergoing non-cardiac surgery with an anticipated duration of more than 2 h, necessitating the use of an arterial line, and an intraoperatively targeted mean arterial pressure (MAP) of > 65 mmHg. This study is divided into two parts; in phase A baseline TWA data from 40 patients will be collected prospectively. A device (HemoSphere) with HPI software will be connected but fully covered. Phase B is designed as a single-center, randomized controlled trial were 60 patients will be randomized with computer-generated blocks of four, six or eight, with an allocation ratio of 1:1. In the intervention arm the HemoSphere with HPI will be used to guide treatment; in the control arm the HemoSphere with HPI software will be connected but fully covered. The primary outcome is the TWA in hypotension during surgery.

Discussion
The aim of this trial is to explore whether the use of a machine-learning algorithm intraoperatively can result in less hypotension. To test this, the treating anesthesiologist will need to change treatment behavior from reactive to proactive.

Trial registration
This trial has been registered with the NIH, U.S. National Library of Medicine at ClinicalTrials.gov, ID: NCT03376347. The trial was submitted on 4 November 2017 and accepted for registration on 18 December 2017.
Comparison of the effect of three different protein content enteral diets on serum levels of proteins, nitrogen balance, and energy expenditure in critically ill infants: study protocol for a randomized controlled trial
Authors: Fernández Reyes , Urbano Javier , Carrillo Ángel , Vivanco Ana , Solana María José , Rey Corsino , López-Herce Jesús 
Published: October 2019

Abstract

Background
Nutritional support is essential in the care of critically ill children since malnutrition in this population is associated with increased morbidity and mortality. Injury in patients admitted to pediatric intensive care units (PICU) results in a catabolic state and augmented protein breakdown, leading to a negative protein balance. Current recommendations about protein prescription in the PICU are fundamentally based on expert opinions, and the minimum threshold is 1.5 g/kg per day of protein, although protein needs could be higher in certain subgroups of patients. The main objectives of the present study are to examine whether the administration of a protein-enriched infant formula increases the serum levels of total proteins, albumin, prealbumin, transferrin, and retinol and improves nitrogen balance and to analyze the effect of the high-protein diet on energy expenditure. A secondary objective is to register possible secondary effects of the protein-enriched diet.

Methods
A multicenter prospective randomized controlled trial (RCT) will be performed in three hospitals. Patients meeting inclusion criteria will be randomly allocated to one of three enteral feeding formulae with different protein contents. Blood and urine test, nitrogen balance assessment, and energy expenditure testing by indirect calorimetry will be performed at the beginning of the nutrition regimen and at 24 h, 72 h and 5–7 days after initiation. The sample size for this trial is estimated to be 90 participants (about 30 participants in each group). The data analysis will be by intention to treat.

Discussion
This RCT will provide new data about the amount of protein needed to improve levels of serum protein and nitrogen balance, a surrogate of protein balance, in critically ill infants receiving enteral nutrition.

Trial registration
ClinicalTrials.gov identifier: NCT03901742. Registered April 1, 2019 – Retrospectively registered.
The Salt Swap intervention to reduce salt intake in people with high blood pressure: protocol for a feasibility randomised controlled trial
Authors: Payne Riches Sarah , Piernas Carmen , Aveyard Paul , Sheppard James P. , Rayner Mike , Jebb Susan A. 
Published: October 2019

Abstract

Background
High salt intake is a risk factor for hypertension and cardiovascular disease. Reducing salt intake has been shown to reduce blood pressure. Despite population-level interventions, including product reformulation and public awareness campaigns, adult salt consumption in the UK still exceeds recommendations; this is primarily due to salt consumed in processed and pre-packaged foods. Moderate or high-intensity dietary advice to encourage individuals to reduce their salt intake has been shown to be effective at reducing blood pressure, but evidence of the effectiveness of interventions that are suitable for delivery at scale in routine primary care is scarce. This feasibility trial investigates a complex behavioural change intervention to reduce dietary salt intake and blood pressure by encouraging individuals to purchase lower-salt foods when grocery shopping.

Methods
This randomised controlled trial will test the feasibility of a novel intervention to reduce salt intake, and the trial procedures to assess its effectiveness. We will recruit participants through UK general practices and randomise 40 participants with high blood pressure, in a 2:1 allocation to receive either the Salt Swap intervention or a control information leaflet. The primary outcomes relate to the criteria for progression to a large-scale trial. These include follow-up rates at 6 weeks, fidelity of intervention delivery and use of the intervention mobile app. Secondary outcomes include the effect of the intervention on the salt content of purchased foods (grams per 100 g), urinary sodium excretion assessed through 24-hour urine samples and blood pressure. Trial process measures will be collected and qualitative assessment will provide insights into participant engagement with the intervention content and perceived barriers to and facilitators of salt reduction dietary behavioural change.

Discussion
If the outcomes indicate the trial is feasible and there is evidence that behavioural change may result in salt reduction, we will proceed to a definitive trial to test the effectiveness of the intervention to lower blood pressure. If successful, this intervention approach could be applied not only to people with high blood pressure, but also to the wider population with normal blood pressure in whom dietary salt intake exceeds recommendations.

Trial registration
ISRCTN, 20910962. Registered on 5 April 2017.
Variable levels of drift in tunicate cardiopharyngeal gene regulatory elements
Authors: Colgan William , Leanza Alexis , Hwang Ariel , DeBiasse Melissa B. , Llosa Isabel , Rodrigues Daniel , Adhikari Hriju , Barreto Corona Guillermo , Bock Saskia , Carillo-Perez Amanda , Currie Meagan , Darkoa-Larbi Simone , Dellal Daniel , Gutow Hanna , Hokama Pascha , Kibby Emily , Linhart Noah , Moody Sophia , Naganuma Allison , Nguyen Diep , Stanton Ryan , Stark Sierra , Tumey Cameron , Velleca Anthony , Ryan Joseph F. , Davidson Brad 
Published: October 2019

AbstractBackgroundMutations in gene regulatory networks often lead to genetic divergence without impacting gene expression or developmental patterning. The rules governing this process of developmental systems drift, including the variable impact of selective constraints on different nodes in a gene regulatory network, remain poorly delineated.ResultsHere we examine developmental systems drift within the cardiopharyngeal gene regulatory networks of two tunicate species,Corella inflataandCiona robusta.Cross-species analysis of regulatory elements suggests thattrans-regulatory architecture is largely conserved between these highly divergent species. In contrast,cis-regulatory elements within this network exhibit distinct levels of conservation. In particular, while most of the regulatory elements we analyzed showed extensive rearrangements of functional binding sites, the enhancer for the cardiopharyngeal transcription factorFoxFis remarkably well-conserved. Even minor alterations in spacing between binding sites lead to loss ofFoxFenhancer function, suggesting that boundtrans-factors form position-dependent complexes.ConclusionsOur findings reveal heterogeneous levels of divergence across cardiopharyngealcis-regulatory elements. These distinct levels of divergence presumably reflect constraints that are not clearly associated with gene function or position within the regulatory network. Thus, levels ofcis-regulatory divergence or drift appear to be governed by distinct structural constraints that will be difficult to predict based on network architecture.
Development of a simple and high-yielding fed-batch process for the production of porcine circovirus type 2 virus-like particle subunit vaccine
Authors: Cao Wenlong , Cao Hui , Yi Xiaoping , Zhuang Yingping 
Published: October 2019

Abstract
The cap protein is encoded by the orf2 gene of porcine circovirus type 2 (PCV2) has the main antigen epitope of PCV2 and can form virus-like particles (VLPs), which are expressed in insect cells. PCV2-VLPs can effectively inhibit PCV2 replication as a subunit vaccine. In this study, a robust and reliable fed-batch process was successfully developed for the production of PCV2-VLPs by Sf9 cells. The feeding solution, feeding strategy, and cell density at infection were optimized to maximize the final PCV2-VLPs production yields. The cell density at infection and the volumetric PCV2-VLPs production reached 12 × 106 cells/mL and 110 mg/L, respectively, which yielded 3- and 3.6-fold enhancements compared to the batch culture. The PCV2-VLPs produced in fed-batch culture were not different from the PCV2-VLPs produced in a batch culture in an immunity test. A highly efficient production process was produced for PCV2-VLPs subunit vaccines, which could provide an effective means for the industrial production of PCV2 vaccines.
Evaluation of least significant changes of pulse contour analysis-derived parameters
Authors: de Courson Hugues , Ferrer Loic , Cane Grégoire , Verchère Eric , Sesay Musa , Nouette-Gaulain Karine , Biais Matthieu 
Published: October 2019

Abstract

Background
Many maneuvers assessing fluid responsiveness (minifluid challenge, lung recruitment maneuver, end-expiratory occlusion test, passive leg raising) are considered as positive when small variations in cardiac index, stroke volume index, stroke volume variation or pulse pressure variation occur. Pulse contour analysis allows continuous and real-time cardiac index, stroke volume, stroke volume variation and pulse pressure variation estimations. To use these maneuvers with pulse contour analysis, the knowledge of the minimal change that needs to be measured by a device to recognize a real change (least significant change) has to be studied. The aim of this study was to evaluate the least significant change of cardiac index, stroke volume index, stroke volume variation and pulse pressure variation obtained using pulse contour analysis (ProAQT®, Pulsion Medical System, Germany).

Methods
In this observational study, we included 50 mechanically ventilated patients undergoing neurosurgery in the operating room. Cardiac index, stroke volume index, pulse pressure variation and stroke volume variation obtained using ProAQT® (Pulsion Medical System, Germany) were recorded every 12 s during 15-min steady-state periods. Least significant changes were calculated every minute.

Results
Least significant changes statistically differed over time for cardiac index, stroke volume index, pulse pressure variation and stroke volume variation (p < 0.001). Least significant changes ranged from 1.3 to 0.7% for cardiac index, from 1.3 to 0.8% for stroke volume index, from 10 to 4.9% for pulse pressure variation and from 10.8 to 4.3% for stroke volume variation.

Conclusion
To conclude, the present study suggests that pulse contour analysis is able to detect rapid and small changes in cardiac index and stroke volume index, but the interpretation of rapid and small changes of pulse pressure variation and stroke volume variation must be done with caution.
Modeling the spread of porcine reproductive and respiratory syndrome virus (PRRSV) in a swine population: transmission dynamics, immunity information, and optimal control strategies
Authors: Phoo-ngurn Phithakdet , Kiataramkul Chanakarn , Chamchod Farida 
Published: October 2019

Abstract
Porcine reproductive and respiratory syndrome (PRRS) is an important swine disease that affects many swine industries worldwide. The disease can cause reproductive failure and respiratory problems in a swine population. As vaccination is an important tool to control the spread of PRRS virus (PRRSV), we employ a mathematical model to investigate the transmission dynamics of PRRSV and the effects of immunity information, as well as vaccination control strategies. We also explore optimal vaccination coverage and vaccination rate to minimize the number of infected swines and vaccination efforts. Our results suggest that: (i) higher vaccination coverage and vaccination rate together with prior knowledge about immunity may help reduce the prevalence of PRRSV, and (ii) longer maximum vaccination efforts are required when swines stay longer in a population and it takes them longer time to recover from PRRS infections.
Before Consent: Qualitative Analysis of Deliberations of Patients With Advanced Cancer About Early-Phase Clinical Trials
Authors: Garrett Sarah B. , Matthews Thea M. , Abramson Corey M. , Koenig Christopher J. , Hlubocky Fay J. , Daugherty Christopher K. , Munster Pamela N. , Dohan Daniel 
Published: October 2019

PURPOSE: Patients with advanced cancer and oncologists deliberate about early-phase (EP) trials as they consider whether to pursue EP trial enrollment. We have limited information about those deliberations and how they may facilitate or impede trial initiation. This study describes these deliberations and their relationship to trial initiation. PATIENTS AND METHODS: We collected longitudinal, ethnographic data on deliberations of patients with advanced cancer at two academic medical centers. We used constant comparative and framework analyses to characterize the deliberative process and its relationship to trial initiation. RESULTS: Of 96 patients with advanced cancer, 26% initiated EP enrollment and 19% joined a trial. Constant comparative analysis revealed two foci of deliberation. Setting the stage focused on patient and physician support for EP trial involvement, including patients’ interest in research and oncologists’ awareness of trials and assessment of patient fit. Securing a seat focused on eligibility for and entrance to a specific trial and involved trial availability, treatment history, disease progression, and enrollment timing. Patients enrolled in a trial only when both stages could be successfully navigated. CONCLUSION: Ethnographic data revealed two foci of deliberation about EP trial enrollment among patients with advanced cancer. Physician support played a consequential role in both stages, but enrollment also reflected factors beyond the control of any specific individual. Insights from this study, combined with other recent studies of trial enrollment, advance our understanding of the complex process of EP trial accrual and may help identify strategies to improve rates of participation.
Molecular and mechanical signals determine morphogenesis of the cerebral hemispheres in the chicken embryo
Authors: Garcia Kara E. , Stewart Wade G. , Espinosa M. Gabriela , Gleghorn Jason P. , Taber Larry A. 
Published: October 2019

ABSTRACT
During embryonic development, the telecephalon undergoes extensive growth and cleaves into right and left cerebral hemispheres. Although molecular signals have been implicated in this process and linked to congenital abnormalities, few studies have examined the role of mechanical forces. In this study, we quantified morphology, cell proliferation and tissue growth in the forebrain of chicken embryos during Hamburger-Hamilton stages 17-21. By altering embryonic cerebrospinal fluid pressure during development, we found that neuroepithelial growth depends on not only chemical morphogen gradients but also mechanical feedback. Using these data, as well as published information on morphogen activity, we developed a chemomechanical growth law to mathematically describe growth of the neuroepithelium. Finally, we constructed a three-dimensional computational model based on these laws, with all parameters based on experimental data. The resulting model predicts forebrain shapes consistent with observations in normal embryos, as well as observations under chemical or mechanical perturbation. These results suggest that molecular and mechanical signals play important roles in early forebrain morphogenesis and may contribute to the development of congenital malformations.
Exercise Thermoregulation with a Simulated Burn Injury: Impact of Air Temperature
Authors: CRAMER MATTHEW N. , MORALEZ GILBERT , HUANG MU , KOUDA KEN , POH PAULA Y. S. , CRANDALL CRAIG G. 
Published: October 2019

ABSTRACT
The U.S. Army’s Standards of Medical Fitness (AR 40-501) states: “Prior burn injury (to include donor sites) involving a total body surface area of 40% or more does not meet the standard.” However, the standard does not account for the interactive effect of burn injury size and air temperature on exercise thermoregulation.

Purpose
To evaluate whether the detrimental effect of a simulated burn injury on exercise thermoregulation is dependent on air temperature.

Methods
On eight occasions, nine males cycled for 60 min at a fixed metabolic heat production (6 W·kg−1) in air temperatures of 40°C or 25°C with simulated burn injuries of 0% (Control), 20%, 40%, or 60% of total body surface area (TBSA). Burn injuries were simulated by covering the skin with an absorbent, vapor-impermeable material to impede evaporation from the covered areas. Core temperature was measured in the gastrointestinal tract via telemetric pill.

Results
In 40°C conditions, greater elevations in core temperature were observed with 40% and 60% TBSA simulated burn injuries versus Control (P < 0.01). However, at 25°C, core temperature responses were not different versus Control with 20%, 40%, and 60% TBSA simulated injuries (P = 0.97). The elevation in core temperature at the end of exercise was greater in the 40°C environment with 20%, 40%, and 60% TBSA simulated burn injuries (P ≤ 0.04).

Conclusions
Simulated burn injuries ≥20% TBSA exacerbate core temperature responses in hot, but not temperate, air temperatures. These findings suggest that the U.S. Army’s standard for inclusion of burned soldiers is appropriate for hot conditions, but could lead to the needless discharge of soldiers who could safely perform their duties in cooler training/operational settings.
OS SENTIDOS DE BULLYING NAS VOZES DAS CRIANÇAS DO ENSINO FUNDAMENTAL: APRENDENDO E CRESCENDO COM OS CONFLITOS NA ESCOLA
Authors: Freitas Maíra De Oliveira , Borges Luís Paulo Cruz , Carvalho Julia Tavares de 
Published: October 2019

O presente trabalho tem como objetivo apresentar análises e reflexões sobre os sentidos do bullying a partir das vozes das crianças. As atividades foram desenvolvidas no projeto de Iniciação à Docência, que ocorre em turmas dos Anos Iniciais do Ensino Fundamental do CAp-UERJ e tem como título “Aprendendo e crescendo com os conflitos na escola: o respeito ao outro a serviço do desenvolvimento no ensino”. Nas rodas de discussão em sala de aula, focalizamos temas como tolerância, respeito e justiça. Para a elaboração e desenvolvimento do projeto, apoiamo-nos nos estudos de autores que discutem autonomia moral. Como pressupostos metodológicos, operamos a partir da pesquisa-ação em que produzimos informações e conhecimentos sobre a ação pedagógica cotidiana. Além da observação, também trabalhamos com o diário de campo como forma de registro das atividades, escrita e imagens. Como análises e reflexões iniciais, temos: i) O diálogo deve ser entendido como uma prática pedagógica; ii) A construção de um debate que envolva autonomia moral e ética requer o entendimento de que a criança é sujeito ativo no processo de dialogicidade e reflexão sobre o mundo.