bluuebunny/crossref_metadata_2025_split huggingface dataset:
Granulocyte transfusions could benefit patients with severe oral mucositis after allogeneic hematopoietic stem cell transplantation
Authors: Berglund Sofia , Watz Emma , Remberger Mats , Garming Legert Karin , Axdorph‐Nygell Ulla , Sundin Mikael , Uhlin Michael , Mattsson Jonas 
Published: August 2019

AbstractBackground and objectivesMucositis is a common complication after allogeneic hematopoietic stem cell transplantation (HSCT), and is caused by a combination of conditioning‐induced mucosal damage and severe neutropenia. The symptoms include oral and abdominal pain, inability to swallow food and fluids, and severe diarrhoea. Severe mucositis is associated with increased risk of Graft‐versus‐Host disease and infection. Granulocyte transfusions (GCX) could be a treatment option, and our objective was to study its feasibility and potential benefits.Material and methodsThis retrospective, single‐centre study included 30 patients receiving GCX because of severe oral mucositis after HSCT during 2005–2017. Clinical outcome, response to GCX, change in opiate administration and adverse events were studied.ResultsTwenty‐seven patients received GCX from donors pre‐treated with steroids and G‐CSF, and three from donors pre‐treated with steroids only. Overall response was 83% (24/29 evaluable patients). Fifteen patients reached a complete response. In 14 of 24 responders, a reduction of the administration of opiate pain relief was seen. In eight patients this reduction was ≥50% of the dose. Adverse events (AEs) were reported in 14 cases, and were mild to moderate, and well manageable with symptomatic treatment. No life‐threatening or fatal AEs were recorded.ConclusionsThese results indicate that GCX could be a safe and effective treatment for oral mucositis after HSCT with the potential to reduce the necessity of opiate analgesic treatment in this disorder. No severe AEs were seen in this study, but the risk for severe pulmonary AEs after GCX needs to be considered.
A review of the impact of increased whole blood collections on the blood system
Authors: Beckman Neil , Yazer Mark H. 
Published: August 2019

Background and ObjectivesIt is likely that there will be an increased emphasis on production of whole blood as evidence for efficacy in massively transfused patients increases. Depending on the magnitude of the increase, this has the potential to impact many blood collectors’ practices and to influence the whole supply chain.MethodsThe review uses current knowledge of practices and discusses the impacts on blood collectors, suppliers and the implications for blood donation, manufacturing, inventory and distribution.ResultsIncreased whole blood utilisation will influence the production, supply and distribution of blood donation consumables with suppliers further influenced by likely equipment redundancy in the event of a significant increase. New blood components or consumables require regulatory approval and registration, a complex and resource‐consuming area.Wastage would increase directly as a result of the need to have whole blood constantly available at the right location despite stochastic demand. Efficiency and yield would be influenced due to the reduced number of separated blood components and plasma for fractionation volumes. To ameliorate this, whole blood may need to be returned later in shelf life so that plasma can be recovered. A high uptake of whole blood requires a review of the blood donation and manufacturing infrastructure with the possibility of amendments to fixed assets such as blood processing centres.ConclusionThe impacts are across the whole supply chain, and whilst the topics discussed are not directly applicable to any specific blood collector, the general principles will apply to many.
Association of high amounts of physical activity with mortality risk: a systematic review and meta-analysis
Authors: Blond Kim , Brinkløv Cecilie Fau , Ried-Larsen Mathias , Crippa Alessio , Grøntved Anders 
Published: August 2019

Objectives
To systematically review and analyse studies of high amounts of physical activity and mortality risk in the general population.

Eligibility criteria
Inclusion criteria related to follow-up (minimum 2 years), outcome (mortality from all causes, cancer, cardiovascular disease (CVD) or coronary heart disease), exposure (eg, a category of >1000 metabolic equivalent of task (MET) min/week), study design (prospective cohort, nested case control or case-cohort) and reports of cases and person years of exposure categories.

Information sources
Systematic searches were conducted in Embase and Pubmed from database inception to 2 March 2019.

Risk of bias
The quality of the studies was assessed with the Newcastle–Ottawa scale.

Included studies
From 31 368 studies identified, 48 were included. Two authors independently extracted outcome estimates and assessed study quality.

Synthesis of results
We estimated hazard ratios (HRs) using random effect restricted cubic spline dose–response meta-analyses. Compared with the recommended level of physical activity (750 MET min/week), mortality risk was lower at physical activity levels exceeding the recommendations, at least until 5000 MET min/week for all cause mortality (HR=0.86, 95% CI 0.78 to 0.94) and for CVD mortality (HR=0.73, 95% CI 0.56 to 0.95).

Strengths and limitations of evidence
The strengths of this study include the detailed dose–response analyses, inclusion of 48 studies and examination of sources of heterogeneity. The limitations include the observational nature of the included studies and the inaccurate estimations of amount of physical activity.

Interpretation
Compared with the recommended level, mortality risk was lower at physical activity levels well above the recommended target range. Further, there was no threshold beyond which lifespan was compromised.

Registration
PROSPERO CRD42017055727.
Missing female patients: an observational analysis of sex ratio among outpatients in a referral tertiary care public hospital in India
Authors: Kapoor Mudit , Agrawal Deepak , Ravi Shamika , Roy Ambuj , Subramanian S V , Guleria Randeep 
Published: August 2019

ObjectiveTo investigate gender discrimination in access to healthcare and its relationship with the patient’s age and distance from the healthcare facility.Design and settingAn observational study based on outpatient data from a large referral public hospital in Delhi, India.ParticipantsConfirmed clinical appointments.Primary and secondary outcome measuresEstimates from the logistic regression are used to compute sex ratios (male/female) of patient visits with respect to distance from the hospital and age. Missing female patients for each state—a measure of the extent of gender discrimination—is computed as the difference in the actual number of female patients who came from each state and the number of female patients that should have visited the hospital had male and female patients come in the same proportion as the sex ratio of the overall population from the 2011 census.ResultsOf 2377028 outpatient visits, excluding obstetrics and gynaecology patients, the overall sex ratio was 1.69 male to one female visit. Sex ratios, adjusted for age and hospital department, increased with distance. The ratio was 1.41 for Delhi, where the facility is located; 1.70 for Haryana, an adjoining state; 1.98 for Uttar Pradesh, a state further away; and 2.37 for Bihar, the state furthest from Delhi. The sex ratios had a U-shaped relationship with age: 1.93 for 0–18 years, 2.01 for 19–30 years, and 1.75 for 60 years or over compared with 1.43 and 1.40 for the age groups 31–44 and 45–59 years, respectively. We estimate there were 402 722 missing female outpatient visits from these four states, which is 49% of the total female outpatient visits for these four states.ConclusionWe found gender discrimination in access to healthcare, which was worse for female patients who were in the younger and older age groups, and for those who lived at increasing distances from the hospital.
Framing of clinical information affects physicians’ diagnostic accuracy
Authors: Popovich Ivor , Szecket Nicolas , Nahill Art 
Published: August 2019

BackgroundFraming bias occurs when people make a decision based on the way the information is presented, as opposed to just on the facts themselves. How the diagnostician sees a problem may be strongly influenced by the way it is framed. Does framing bias result in clinically meaningful diagnostic error?MethodsWe created three hypothetical cases and asked consultants and registrars in Emergency Medicine and Internal Medicine to provide their differential diagnoses and investigations list. Two of the presentations were written two ways to frame the case towards or away from a particular diagnosis (Presentation 2 – pulmonary embolus (PE) and Presentation 3 – interstitial lung disease (ILD)) and these were randomly assigned to the participants. Both versions were however entirely identical in terms of the objective facts. Physician impressions and diagnostic plan were compared. A third presentation was identical for all and served as a control for clinician baseline ‘risk-averseness’.ResultsThere were significant differences in the differential diagnoses generated depending on the presentation’s framing. PE and ILD were considered and investigated for the majority of the time when the presentation was framed towards these diagnoses, and the minority of the time when it was not. This finding was most striking in Presentation 2, where 100%versus50% of clinicians considered PE in their diagnosis when the presentation was framed towards PE. This result remained robust when undertaking stratified analysis and logistic regression to account for differences in seniority and baseline risk-averseness— neither of the latter variables had any effect on the result.ConclusionWe demonstrate a clinically meaningful effect of framing bias on diagnostic error. The strength of our study is focus on clinically meaningful outcomes: investigations ordered. This finding has implications for the way we conduct handovers and teach juniors to communicate clinical information.
Associations between adult height and type 2 diabetes mellitus: a systematic review and meta-analysis of observational studies
Authors: Shrestha Sarita , Rasmussen Sara H , Pottegård Anton , Ängquist Lars H , Jess Tine , Allin Kristine H , Bjerregaard Lise G , Baker Jennifer L 
Published: August 2019

BackgroundAlthough short adult height is generally associated with increased risks of type 2 diabetes mellitus (T2DM), there are large inconsistencies across studies. The aims of this study were to describe and quantify currently available evidence on the association between adult height and T2DM, to examine whether the reported associations differ by sex, and to examine the shapes of the height and T2DM associations.MethodsRelevant literature was identified using PubMed (1966–May 2018), EMBASE (1947–May 2018) and Google Scholar (May 2018). We identified cross-sectional and cohort studies with original publications on human subjects, which were included in a random-effects meta-analysis.ResultsFrom 15 971 identified sources, 25 studies met the inclusion criteria for the systematic review (N=401 562 individuals). From these 25 studies, 16 (9 cross-sectional studies and 7 cohort studies) were included in the meta-analysis (n=261 496 individuals). The overall random-effects meta-analysis indicated an inverse association between adult height and T2DM (effect estimate=0.88, 95% CI 0.81 to 0.95). No sex differences in the associations between adult height and T2DM were found (effect estimate for men: 0.86, 95% CI 0.75 to 0.99; effect estimate for women: 0.90; 95% CI 0.80 to 1.01; p value for sex interaction=0.80). Due to lack of data, results on the shape of the association between height and T2DM were inconclusive.ConclusionsShorter height is associated with an increased risk of T2DM and the association does not significantly differ by sex. The currently available data are insufficient to support conclusions regarding the shape of the association between height and T2DM.Trial registration numberCRD42017062446.
AvDR-Based Wireless Secure Key Generation with Colored Noise for IoT
Authors: Soni Ankit , Upadhyay Raksha , Kumar Abhay 
Published: August 2019

Physical layer key generation exploiting inherent channel randomness is an open research area in securing the networks with resource constraint nodes; therefore reduction of numerical computation is desirable to save battery power. However, the correlated components due to colored noise also affect the system performance. In this work, we consider the correlated colored noise components along with the additive white Gaussian noise (AWGN) in the wireless channel and analyze the effect of these correlated components on the system performance. We further propose a hybrid averaging and dimensionality reduction (AvDR), based received signal strength (RSS) preprocessing which is the combination of moving window averaging (Av) and principal component analysis (PCA) as dimensionality reduction technique (DR) to improve the system performance. Further, the system performance was evaluated by numerical simulations, and it is observed that the same improvement in system performance is achieved by generating keys from a fewer number of points selected after PCA as compared to processing all the points. Picking a few of the points in the data sequence instead of all reduces the total number of numerical calculations and saves system power, which is the primary requirement of resource constraint networks like the IoT.
Medial gastrocnemius muscle remodeling correlates with reduced plantarflexor kinetics 14 weeks following Achilles tendon rupture
Authors: Hullfish Todd J. , O’Connor Kathryn M. , Baxter Josh R. 
Published: August 2019

Deficits in plantarflexor kinetics are associated with poor outcomes in patients following Achilles tendon rupture. In this longitudinal study, we analyzed the fascicle length and pennation angle of the medial gastrocnemius muscle and the length of the Achilles tendon using ultrasound imaging. To determine the relationship between muscle remodeling and deficits in plantarflexor kinetics measured at 14 wk after injury, we correlated the reduction in fascicle length and increase in pennation angle with peak torque measured during isometric and isokinetic plantarflexor contractions. We found that the medial gastrocnemius underwent an immediate change in structure, characterized by decreased length and increased pennation of the muscle fascicles. This decrease in fascicle length was coupled with an increase in tendon length. These changes in muscle-tendon structure persisted throughout the first 14 wk following rupture. Deficits in peak plantarflexor torque were moderately correlated with decreased fascicle length at 120 degrees per second ( R2 = 0.424, P = 0.057) and strongly correlated with decreased fascicle length at 210 degrees per second ( R2 = 0.737, P = 0.003). However, increases in pennation angle did not explain functional deficits. These findings suggest that muscle-tendon structure is detrimentally affected following Achilles tendon rupture. Plantarflexor power deficits are positively correlated with the magnitude of reductions in fascicle length. Preserving muscle structure following Achilles tendon rupture should be a clinical priority to maintain plantarflexor kinetics. NEW & NOTEWORTHY In our study, we found that when the Achilles tendon ruptures due to excessive biomechanical loading, the neighboring skeletal muscle undergoes rapid changes in its configuration. The magnitude of this muscle remodeling explains the amount of ankle power loss demonstrated by these patients once their Achilles tendons are fully healed. These findings highlight the interconnected relationship between muscle and tendon. Isolated injuries to the tendon stimulate detrimental changes to the muscle, thereby limiting joint-level function.
In Vivo Modeling of Chemoresistant Neuroblastoma Provides New Insights into Chemorefractory Disease and Metastasis
Authors: Yogev Orli , Almeida Gilberto S. , Barker Karen T. , George Sally L. , Kwok Colin , Campbell James , Zarowiecki Magdalena , Kleftogiannis Dimitrios , Smith Laura M. , Hallsworth Albert , Berry Philip , Möcklinghoff Till , Webber Hannah T. , Danielson Laura S. , Buttery Bliss , Calton Elizabeth A. , da Costa Barbara M. , Poon Evon , Jamin Yann , Lise Stefano , Veal Gareth J. , Sebire Neil , Robinson Simon P. , Anderson John , Chesler Louis 
Published: August 2019

Abstract

Neuroblastoma is a pediatric cancer that is frequently metastatic and resistant to conventional treatment. In part, a lack of natively metastatic, chemoresistant in vivo models has limited our insight into the development of aggressive disease. The Th-MYCN genetically engineered mouse model develops rapidly progressive chemosensitive neuroblastoma and lacks clinically relevant metastases. To study tumor progression in a context more reflective of clinical therapy, we delivered multicycle treatment with cyclophosphamide to Th-MYCN mice, individualizing therapy using MRI, to generate the Th-MYCNCPM32 model. These mice developed chemoresistance and spontaneous bone marrow metastases. Tumors exhibited an altered immune microenvironment with increased stroma and tumor-associated fibroblasts. Analysis of copy number aberrations revealed genomic changes characteristic of human MYCN-amplified neuroblastoma, specifically copy number gains at mouse chromosome 11, syntenic with gains on human chromosome 17q. RNA sequencing revealed enriched expression of genes associated with 17q gain and upregulation of genes associated with high-risk neuroblastoma, such as the cell-cycle regulator cyclin B1-interacting protein 1 (Ccnb1ip1) and thymidine kinase (TK1). The antiapoptotic, prometastatic JAK–STAT3 pathway was activated in chemoresistant tumors, and treatment with the JAK1/JAK2 inhibitor CYT387 reduced progression of chemoresistant tumors and increased survival. Our results highlight that under treatment conditions that mimic chemotherapy in human patients, Th-MYCN mice develop genomic, microenvironmental, and clinical features reminiscent of human chemorefractory disease. The Th-MYCNCPM32 model therefore is a useful tool to dissect in detail mechanisms that drive metastasis and chemoresistance, and highlights dysregulation of signaling pathways such as JAK–STAT3 that could be targeted to improve treatment of aggressive disease.

Significance:
An in vivo mouse model of high-risk treatment-resistant neuroblastoma exhibits changes in the tumor microenvironment, widespread metastases, and sensitivity to JAK1/2 inhibition.
ОСОБЛИВОСТІ ПЕРЕБІГУ ГОСТРОГО КОРОНАРНОГО СИНДРОМУ, ЗУМОВЛЕНОГО ФЕНОМЕНОМ “SLOW-FLOW” (ОГЛЯД ЛІТЕРАТУРИ ТА ОПИС КЛІНІЧНОГО ВИПАДКУ)
Authors: Shved M. I. , Prokopovych O. A. , Gurskyi V. T. , Masliy B. Ya. , Vivchar V. P. 
Published: August 2019

Феномен сповільненого коронарного кровотоку (CSFP) – це мікросудинне ураження, що полягає в сповільненні кровотоку (руху контрастних речовин) у коронарних артеріях без значного їх стенозування. Основними причинами CSFP вважають структурні й функціональні порушення в системі коронарної мікроциркуляції за рахунок ендотеліальної дисфункції, дифузної кальцифікації чи необструктивного атеросклерозу, оглушення гіпоксичної ділянки міокарда тощо. Відсутність чітких критеріїв у діагностиці та адекватних програм його лікування обґрунтовують доцільність збільшення клінічного матеріалу та дослідження механізмів його розвитку.
Мета дослідження – проаналізувати клінічний випадок розвитку гострого коронарного синдрому в пацієнтки з ангіографічно діагностованим феноменом “slow-flow”, дослідити особливості клінічного перебігу коронарного синдрому Y та оптимізувати його лікування і профілактику розвитку ускладнень.
Матеріали і методи. Застосовували методи системного аналізу, бібліосемантичного та описового моделювання на прикладі рідкісного випадку розвитку гострого коронарного синдрому в пацієнтки з ангіографічно дігностованим CSFP. Проведено огляд літератури в доступних науково-статистичних базах даних медичної інформації.
Результати досліджень та їх обговорення. Упровадження діагностичної коронарної ангіографії дає змогу провести диференційну діагностику мікроциркуляторних порушень коронарного кровотоку, а також дозволяє оцінити адекватність запропонованого лікування. Наведений клінічний випадок характеризується типовою клінічною симптоматикою гострого коронарного синдрому (ГКС) за відсутності ангіографічних атеросклеротичних змін вінцевих судин у жінки 66 років. Запропоноване лікування засобами “Небіволол”, “Розувастатин” і комбінованими метаболічними препаратами “Левокарнітин” та “Аргінін” дало швидкий клінічний ефект, який проявився зникненням ознак ішемії та відсутністю ангінозного болю за грудниною.
Висновки. У патогенезі розвитку ГКС вагому роль відіграють мікроциркуляторні порушення, зокрема феномен сповільненого коронарного кровотоку, що необхідно враховувати в діагностичному алгоритмі ведення таких пацієнтів. Основним диференційно-діагностичним критерієм у таких випадках є коронароангіографія, а в комплексне лікування доцільно включати бета-2-адреноблокатори, статин та метаболічно активні засоби – “Левокарнітин” і “Аргінін”, які мають ендотелійнормалізуючі, енерго- і кардіоцитопротекторні властивості.
ФУНКЦІОНАЛЬНИЙ СТАН АВТОНОМНОЇ НЕРВОВОЇ СИСТЕМИ У ЖІНОК МОЛОДОГО ВІКУ
Authors: Sheiko N. I. 
Published: August 2019

Визначення варіабельності серцевого ритму на сьогодні вважають доступним, неінвазивним, достатньо простим і відносно дешевим методом оцінки автономної нервової системи. Більшість дослідників розглядає його як інтегральний маркер, який відображає стан усіх регуляторних систем організму. Зміни вегетативного балансу у вигляді активації симпатичної ланки розглядають як неспецифічний компонент адаптаційної реакції у відповідь на різні стресорні дії. За останні роки збільшилася кількість осіб зі зниженими пристосувальними можливостями організму – з дизадаптацією регуляції функціональних систем, що призводить до зриву відповідних механізмів. Мета дослідження – оцінити стан автономної нервової системи у студентів-іноземців жіночої статі молодших курсів медичного факультету. Матеріали і методи. У дослідження було залучено 20 студентів-іноземців жіночої статі ІІ–ІІІ курcів медичного факультету віком 18–22 роки. Реєстрацію варіабельності серцевого ритму проводили в умовах фізіологічного спокою, після 10-хвилинного відпочинку, та в умовах активної ортостатичної проби за загальновідомою методикою зa допомогою комп’ютерного діагностичного комплексу “КардіоЛаб” (“ХАІ-Медіка”, Україна). Результати досліджень та їх обговорення. Результати аналізу варіабельності серцевого ритму в стані фізіологічного спокою свідчать про те, що обстежувані характеризуються належними для здорових осіб показниками варіабельності серцевого ритму, а у відповідь на ортостатичну пробу демонструють вірогідне зростання активності симпатичної ланки автономної нервової системи LF на (261±187) мс, LF % на (12,6±0,6) % (p<0,05) та зниження парасимпатичних впливів: RMSSD на (9,4±12,7) мс, pNN50 % на (21,1±5,1) %, HF на (481±83) мс (p<0,01) та HF % на (14,2±2) % (p<0,05) на серцевий ритм. Показник симпато-вагального балансу вірогідно зріс на 3,04±2,5. Висновки. Функціональний стан автономної нервової системи у молодих студентів-іноземців жіночої статі характеризується збалансованою діяльністю усіх її ланок. Використання ортостатичної проби при дослідженні варіабельності серцевого ритму дозволяє краще проаналізувати стан вегетативного тонусу та виявити приховані розлади функції автономної нервової системи.