bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of body mass index on survival of medical patients with sepsis: a prospective cohort study in a university hospital in China
Authors: Zhou Qingtao , Wang Meng , Li Shuo , Zhang Jing , Ma Qingbian , Ding Yanling , Ge Hongxia , Shen Ning , Zheng Yaan , Sun Yongchang 
Published: September 2018

ObjectiveTo evaluate the impact of body mass index (BMI) on survival of a Chinese cohort of medical patients with sepsis.DesignA single-centre prospective cohort study conducted from May 2015 to April 2017.SettingA tertiary care university hospital in China.ParticipantsA total of 178 patients with sepsis admitted to the medical intensive care unit (ICU) were included.Main outcome measuresThe primary outcome was 90-day mortality while the secondary outcomes were in-hospital mortality, length of ICU stay and length of hospital stay.ResultsThe median age (IQR) was 78 (66–84) years old, and 77.0% patients were older than 65 years. The 90-day mortality was 47.2%. The in-hospital mortality was 41.6%, and the length of ICU stay and hospital stay were 12 (5–22) and 15 (9–28) days, respectively. Cox proportional hazard regression analysis identified that Sequential Organ Failure Assessment score (HR=1.229, p<0.001), Acute Physiology and Chronic Health Evaluation II score (HR=1.050, p<0.001) and BMI (HR=0.940, p=0.029) were all independently associated with the 90-day mortality. Patients were divided into four groups based on BMI (underweight 33 (18.5%), normal 98 (55.1%), overweight 36 (20.2%) and obese 11 (6.2%)). The 90-day mortality (66.7%, 48.0%, 36.1% and 18.2%, p=0.015) and in-hospital mortality (60.6%, 41.8%, 30.6% and 18.2%, p=0.027) were statistically different among the four groups. Differences in survival among the four groups were demonstrated by Kaplan-Meier survival analysis (p=0.008), with the underweight patients showing a lower survival rate.ConclusionsBMI was an independent factor associated with 90-day survival in a Chinese cohort of medical patients with sepsis, with patients having a lower BMI at a higher risk of death.
Improving access to healthcare for women in Tanzania by addressing socioeconomic determinants and health insurance: a population-based cross-sectional survey
Authors: Bintabara Deogratius , Nakamura Keiko , Seino Kaoruko 
Published: September 2018

ObjectiveThis study was performed to explore the factors associated with accumulation of multiple problems in accessing healthcare among women in Tanzania as an example of a low-income country.DesignPopulation-based cross-sectional survey.SettingNationwide representative data for women of reproductive age obtained from the 2015–2016 Tanzania Demographic and Health Survey were analysed.Primary outcome measuresA composite variable, ‘problems in accessing healthcare’, with five (1-5) categories was created based on the number of problems reported: obtaining permission to go to the doctor, obtaining money to pay for advice or treatment, distance to a health facility and not wanting to go alone. Respondents who reported fewer or more problems placed in lower and higher categories, respectively.ResultsA total of 13 266 women aged 15–49 years, with a median age (IQR) of 27 (20–36) years were interviewed and included in the analysis. About two-thirds (65.53%) of the respondents reported at least one of the four major problems in accessing healthcare. Furthermore, after controlling for other variables included in the final model, women without any type of health insurance, those belonging to the poorest class according to the wealth index, those who had not attended any type of formal education, those who were not employed for cash, each year of increasing age and those who were divorced, separated or widowed were associated with greater problems in accessing healthcare.ConclusionThis study indicated the additive effects of barriers to healthcare in low-income countries such as Tanzania. Based on these results, improving uptake of health insurance and addressing social determinants of health are the first steps towards reducing women’s problems associated with accessing healthcare.
The TLR7/8/9 Antagonist IMO-8503 Inhibits Cancer-Induced Cachexia
Authors: Calore Federica , Londhe Priya , Fadda Paolo , Nigita Giovanni , Casadei Lucia , Marceca Gioacchino Paolo , Fassan Matteo , Lovat Francesca , Gasparini Pierluigi , Rizzotto Lara , Zanesi Nicola , Jackson Devine , Mehta Svasti , Nana-Sinkam Patrick , Sampath Deepa , Pollock Raphael E. , Guttridge Denis C. , Croce Carlo M. 
Published: September 2018

Abstract

Muscle wasting is a feature of the cachexia syndrome, which contributes significantly to the mortality of patients with cancer. We have previously demonstrated that miR-21 is secreted through extracellular vesicles (EV) by lung and pancreatic cancer cells and promotes JNK-dependent cell death through its binding to the TLR7 receptor in murine myoblasts. Here, we evaluate the ability of IMO-8503, a TLR7, 8, and 9 antagonist, to inhibit cancer-induced cachexia. Using EVs isolated from lung and pancreatic cancer cells and from patient plasma samples, we demonstrate that IMO-8503 inhibits cell death induced by circulating miRNAs with no significant toxicity. Intraperitoneal administration of the antagonist in a murine model for Lewis lung carcinoma (LLC-induced cachexia) strongly impaired several cachexia-related features, such as the expression of Pax7 as well as caspase-3 and PARP cleavage in skeletal muscles, and significantly prevented the loss of lean mass in tumor-bearing mice. IMO-8503 also impaired circulating miRNA–induced cell death in human primary myoblasts. Taken together, our findings strongly indicate that IMO-8503 serves as a potential therapy for the treatment of cancer cachexia.

Significance:
Cancer-associated cachexia is a significant problem for patients with cancer that remain poorly understood, understudied, and inadequately treated; these findings report a potential new therapeutic for the treatment of TLR7-mediated cancer cachexia.
ALBI and P-ALBI grade in Child-Pugh A patients treated with drug eluting embolic chemoembolization for hepatocellular carcinoma
Authors: Carling Ulrik , Røsok Bård , Line Pål-Dag , Dorenberg Eric J 
Published: September 2018

Background Treatment outcome for hepatocellular carcinoma (HCC) is related to tumor burden and liver function. Grading systems assessing liver function need validation in different clinical settings. Purpose To evaluate drug-eluting embolic transarterial chemoembolization (DEE-TACE) in Child–Pugh A HCC with respect to albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (P-ALBI) grade. Material and Methods Forty-nine patients with Child–Pugh class A, diagnosed with HCC and allocated to DEE-TACE treatment, were retrospectively analyzed regarding tumor and treatment characteristics, radiological response (mRECIST) one month post treatment, overall survival (OS), and adverse events (AEs; CTCAE, grades ≥3) with respect to ALBI and P-ALBI grade. Results There were 21 ALBI 1 patients, 29 P-ALBI 1 patients, and 19 patients were both ALBI and P-ALBI 1. Objective response rate was 74% with no statistically significant difference for ALBI (1 vs. 2; P = 0.08), or P-ALBI (1 vs. 2; P = 0.49). OS was 14.8 months (range = 1.7–62.0; ALBI 1 vs. 2: P = 0.08; P-ALBI 1 vs. 2: P = 0.003). OS in responders with ALBI 1 and 2 was 28.9 vs.10.2 months ( P = 0.02), and P-ALBI 1 and 2 was 26.7 vs. 8.6 months ( P < 0.001). In multivariate analyses, both ALBI 2 (HR = 2.4, P = 0.02) and P-ALBI 2 (HR = 3.3, P < 0.01) were negative prognostic factors for survival. There were 15 AEs in 13 patients, with hepatic failure only occurring in ALBI 2 and P-ALBI 2 patients. Conclusion P-ALBI grade 1 and 2 differentiated survival in Child–Pugh A patients treated with DEE-TACE. Both grading systems can differentiate survival in patients responding to treatment.
Do Mound Height and Pitching Distance Affect Youth Baseball Pitching Biomechanics?
Authors: Fleisig Glenn S. , Diffendaffer Alek Z. , Ivey Brett , Oi Takanori 
Published: September 2018

Background: Pitching injuries continue to be a serious problem, with adolescents now representing the group with the most injuries. Some have proposed that lowering or eliminating the pitching mound in youth baseball may reduce joint stress and subsequent injuries. Another potential risk factor is advancing from youth to adult pitching distance without an intermediate distance. Hypotheses: It was hypothesized that for a group of young pitchers, pitching kinetics and kinematics would change with mound height. It was also hypothesized that pitching kinetics and kinematics would change with pitching distance. Study Design: Controlled laboratory study. Methods: Twenty-one young (12.6 ± 0.5 years) baseball pitchers pitched 5 full-effort fastballs each from 5 different conditions, in random order: 14.02-, 16.46-, and 18.44-m distances from a 25 cm–high mound, 16.46-m distance from a 15 cm–high mound, and 16.46-m distance from flat ground. Pitching biomechanical values were collected with a 12-camera automated motion capture system. Ball velocity and 31 other parameters were computed for each pitch. Data were compared between the 3 mound heights at 16.46 m by use of repeated-measures analysis of variance and paired post hoc t tests ( P < .05). Similarly, data were compared between the 3 distances from the 25-cm mound via repeated-measures analysis of variance and paired post hoc t tests ( P < .05). Results: No differences were found in ball velocity, shoulder kinetics, or elbow kinetics associated with mound height. Ten kinematic parameters differed with mound height, including 8 parameters at lead foot contact. Maximum shoulder horizontal adduction torque and maximum shoulder anterior force increased with pitching distance. Only 3 kinematic parameters showed significant differences with pitching distance. Conclusion: The hypothesis that shoulder and elbow kinetics would change with mound height was not supported by the data. Several kinematic differences were found, but the majority were at lead foot contact before the rapid, dynamic phases of pitching. Change in pitching distance was associated with slight increase in shoulder kinetics as well as a few kinematic differences. Clinical Relevance: Lowering or eliminating pitching mounds in youth baseball would not significantly decrease joint stress and injury risk to young pitchers. However, when available, transition from 14.02-m to 16.46-m to 18.44-m pitching distance may reduce stress on the young throwing shoulder.
Thermal Degradation of Polyurethane Bicomponent Systems in Controlled Atmospheres
Authors: Ketata N. , Sanglar C. , Waton H. , Alamercery S. , Delolme F. , Raffin G. , Grenier-Loustalot M.F. 
Published: September 2018

Although the thermal degradation of polyurethanes has been extensively studied in the past, the use of a panoply of recent analytical techniques has provided more detailed data and enabled us to confirm prior findings on the thermal degradation of bicomponent polyurethanes. The thermal behaviour of bicomponent polyurethanes in conditions of controlled atmosphere and temperature was characterized by determining their heat stability by on-line TGA/FT-IR coupling and off-line TGA/TCT/GC/MS coupling in order to identify the volatile compounds released. Degradation residues were analyzed by FT-IR and MALDI-TOF (matrix assisted laser desorption/ionization coupled with time-of-flight) mass spectrometry. A major drawback of these thermoplastic elastomers is that one of the components, isocyanate, is toxic. Based on the data obtained with model urethane compounds ( p-TI-based) and bicomponent polyurethane polymer (MDI- and PEG-based), we show that the thermal degradations are different. The widespread application of these materials exposes them to extreme working conditions, which is why we propose reaction mechanisms for their degradation.
Modification of Wood Flour with Maleic Anhydride for Manufacture of Wood-Polymer Composites
Authors: Nenkova S. , Dobrilova Cv. , Natov M. , Vasileva St. , Velev P. 
Published: September 2018

Composites consisting of synthetic polymers and natural organic fillers have many applications. Plant-based materials, particularly wood, are used as fillers. Most frequently they are added to the polymer in the shape of wood flour or wood fibres. This type of polymer composite allows the possibility of modifying the components in accordance with the requirements of the application. Modifications to wood flour (WF) were carried out with a 10% solution of maleic anhydride (MA) in acetone in the presence of benzoyl peroxide and dicumene hydroperoxide. Lignin and cellulose were isolated from the WF and modified by the same method as the WF. They were characterized by Fourier Transform infrared spectroscopy and it was proved that there was a chemical reaction between the wood components and MA. This was confirmed by chemical analysis and by a determination of the hydroxyl groups in unmodified and modified WF. Composites of polypropylene and modified WF were obtained and studied by scanning electron microscopy, transmission electron microscopy, dynamic mechanical analysis and mechanical tests. They showed an improvement in adhesion between the polymer and the modified WF
Preparation and Properties of LLDPE/PMVS Blends
Authors: He Jihui , Ye Hua , Liu Shumei , Zhao Jianqing 
Published: September 2018

Reactive blending has been carried out by the melt mixing of linear low density polyethylene (LLDPE) and silicone rubber containing vinyl group (PMVS) to obtain grafted and crosslinked blends. Two methods involving the use of free radicals generated from (a) thermomechanical shear and (b) peroxide decomposition were used to prepare the LLDPE/PMVS blends. The occurrence of grafting and crosslinking of the PMVS molecular chains was deduced by considering the mixing torque, solvent extraction data and evidence from the Fourier transform infrared spectra (FTIR), as well as differential scanning calorimetry (DSC) and scanning electron microscopy (SEM). The experimental results indicated that reactive blending significantly improved the interfacial adhesion between the two phases and that peroxide decomposition had a higher initiation efficiency in respect of grafting and crosslinking than thermomechanical shear. Thermogravimetric analysis (TGA) showed that reactive blending with PMVS improved the thermal stability of LLDPE. Dynamic rheological behaviour and melt flow rate (MFR) results suggested that grafting and crosslinking between the two components increased the viscoelasticity of the blends and the addition of PMVS improved the processability of the LLDPE. Crosslinking by peroxides gave a higher tensile strength than thermomechanical shear but a lower elongation at break. The limiting oxygen index (LOI) test indicated that the flame retardancy of the LLDPE/PMVS blend increased with increasing amounts of PMVS.
Numerical Modelling of Design Parameters for Manufacturing Polyester/Glass Composites by Resin Injection Pultrusion
Authors: Jeswani A.L. , Roux J.A. 
Published: September 2018

Resin Injection Pultrusion (RIP) is an automated, continuous process and is one of the most cost-effective methods for manufacturing composite materials with constant cross sections (such as rod stock, beams, channels and tubing). In the present work, a 3-D finite volume technique was developed to advance the liquid resin flow front through the fibre reinforcement in the injection pultrusion process. The objective of this study was to improve fibre reinforcement wet-out and thus the quality of the pultruded part in an injection pultrusion process. The complete wet-out of the dry reinforcement by the liquid resin depends on various design and process parameters. The design parameters explored in this study were the aspect ratio of the final composite, injection slot width, injection slot location from inlet of injection chamber, and location of the multiple injection ports. The numerical model simulates the flow of polyester resin through glass rovings and predicts the impact of the design (geometric) parameters on wet-out, resin pressure field, and resin velocity field. The location of the liquid resin flow front has been predicted for an injection slot, as well as for five discrete injection ports.
Mechanical and Thermal Properties of Nano-Composites of Poly(Vinyl Chloride) and Co-Poly(Vinyl Chloride-Vinyl Alcohol-Vinyl Acetate) with Montmorillonite
Authors: Bibi Navida , Sarwar Muhammad Ilyas , Ishaq Muhammad , Ahmad Zahoor 
Published: September 2018

Nano-composites of poly(vinyl chloride) and co-poly(vinyl chloride-vinyl alcohol-vinyl acetate) with clay were prepared by the solution intercalation method. Montmorillonite, a three-layered clay mineral consisting of silicate sheets, was employed as reinforcing phase. Compatibilisation between the two phases was achieved by intercalation of montmorillonite with dodecylamine to increase the organophilicity of the clay. Thin films of pure polymers and their composite materials containing various proportions of clay were obtained by evaporation of the solvent. After further drying under vacuum, these films were characterised for their mechanical and thermal properties. The results have shown that the modulus and the tensile strength of the composite films increased initially compared to the pure polymers and then decreased upon further addition of the clay. The glass transition temperature of the films, measured from the maxima of the tanδ curves using dynamic mechanical thermal analysis, showed a greater shift towards higher temperatures in copolymer-clay than in PVC-clay films. This is indicative of a higher degree of interaction between the two phases of copolymer-clay composites than PVC-clay composites. The microhardness values and the decomposition temperatures also increased in both systems with the addition of an appropriate amount of the clay.
Service Life Prediction of Gfrp Rebars in an Alkaline Environment
Authors: Won Jong-Pil , Lee Su-Jin , Jang Chang-Il , Won Cheol 
Published: September 2018

This study proposes a model that predicts the degradation of a GFRP rebar exposed to an alkaline environment, and based on this estimate, predicts the service life of the GFRP rebar. The alkaline environment was a pH 12.6 solution of 0.16% calcium hydroxide, 1% sodium hydroxide, and 1.4% potassium hydroxide, and the GFRP rebar was immersed for 300 days. We performed a tensile test to measure the degradation. The measured tensile strength for each time period was the remaining residual tensile strength (as a percentage) of the reinforcing GFRP rebar under a controlled state. The time shift factor was taken as the time at which the residual tensile strength was 80% of the control strength. A rebar immersed in an alkaline solution for 300 days at 80 °C was calculated to have a TSF of 13,125 days, or about 36 years, under normal South Korean regional conditions, based on the statistics of Korea's mean annual temperature. This study provides a more appropriate model for the environment of Korea than the one suggested by Dejke.
Silicon-Organic Polyepoxides with Epoxy Side Groups Modified with Chelates
Authors: Lekishvili Nodar , Samakashvili Shorena , Lekishvili Giorgi 
Published: September 2018

New silicon-organic polyepoxides containing epoxy side groups attached to their main chains have been synthesised by hydride addition (hydrosilylation) of dihydrosiloxanes with the diallyl ether of an epoxidised glycerol group situated at the tertiary carbon atom. General features of the reaction were studied and its kinetic rate constants and reaction order determined. The relative reactivities of various dihydridesiloxanes in the hydrosilylation reaction were determined. The modification of the polyepoxides introduced chelates containing Cu, Ni, Mn and Co atoms into the main chain. The composition and structure of the synthesised polymers were established from elemental, IR and NMR spectral analyses and from DSC, DTA and TGA data. It was established that the glass transition temperature (Tg) and thermo-oxidative stability of the chelate-containing polymers considerably exceeded those of the unmodified polyepoxides.
Clinical practice guidelines for older people with multimorbidity and life-limiting illness: what are the implications for deprescribing?
Authors: Okeowo Daniel , Patterson Alastair , Boyd Cynthia , Reeve Emily , Gnjidic Danijela , Todd Adam 
Published: September 2018

Background: The aim of this study was (1) to apply the current United Kingdom (UK) National Institute for Health and Care Excellence (NICE) clinical practice guidelines to a hypothetical older patient with multimorbidity and life-limiting illness; (2) consider how treatment choices could be influenced by NICE guidance specifically related to multimorbidity; and, (3) ascertain if such clinical practice guidelines describe how and when medication should be reviewed, reduced and stopped. Methods: Based upon common long-term conditions in older people, a hypothetical older patient was constructed. Relevant NICE guidelines were applied to the hypothetical patient to determine what medication should be initiated in three treatment models: a new patient model, a treatment-resistant model, and a last-line model. Medication complexity for each model was assessed according to the medication regimen complexity index (MRCI). Results: The majority of the guidelines recommended the initiation of medication in the hypothetical patient; if the initial treatment approach was unsuccessful, each guideline advocated the use of more medication, with the regimen becoming increasingly complex. In the new patient model, 4 separate medications (9 dosage units) would be initiated per day; for the treatment-resistant model, 6 separate medications (15 dosage units); and, for the last-line model, 11 separate medications (20 dosage units). None of the guidelines used for the hypothetical patient discussed approaches to stopping medication. Conclusions: In a UK context, disease-specific clinical practice guidelines routinely advocate the initiation of medication to manage long-term conditions, with medication regimens becoming increasingly complex through the different steps of care. There is often a lack of information regarding specific treatment recommendations for older people with life-limiting illness and multimorbidity. While guidelines frequently explain how and when a medication should be initiated, there is often no information concerning when and how the medications should be reduced or stopped.