bluuebunny/crossref_metadata_2025_split huggingface dataset:
Protocol of a single group prospective observational study on the diagnostic value of 3T susceptibility weighted MRI of nigrosome-1 in patients with parkinsonian symptoms: the N3iPD study (nigrosomalironimagingin Parkinson’s disease)
Authors: Schwarz Stefan T , Xing Yue , Naidu Saadnah , Birchall Jim , Skelly Rob , Perkins Alan , Evans Jonathan , Sare Gill , Martin-Bastida Antonio , Bajaj Nin , Gowland Penny , Piccini Paola , Auer Dorothee P 
Published: December 2017

IntroductionParkinson’s disease (PD) is the most common movement disorder in the elderly and is characterised clinically by bradykinesia, tremor and rigidity. Diagnosing Parkinson’s can be difficult especially in the early stages. High-resolution nigrosome MRI offers promising diagnostic accuracy of patients with established clinical symptoms; however, it is unclear whether this may help to establish the diagnosis in the early stages of PD, when there is diagnostic uncertainty. In this scenario, a single photon emission CT scan using a radioactive dopamine transporter ligand can help to establish the diagnosis, or clinical follow-up may eventually clarify the diagnosis. A non-invasive, cost-effective diagnostic test that could replace this would be desirable. We therefore aim to prospectively test whether nigrosome MRI is as useful as DaTSCAN to establish the correct diagnosis in people with minor or unclear symptoms suspicious for PD.Methods and analysisIn a prospective study we will recruit 145 patients with unclear symptoms possibly caused by Parkinson’s from three movement disorder centres in the UK to take part in the study. We will record the Movement Disorder Society - Unified Parkinson’s Disease Rating Scale, and participants will undergo DaTSCAN and high-resolution susceptibility weighted MRI at a field strength of 3T. DaTSCANs will be assessed visually and semiquantitatively; MRI scans will be visually assessed for signal loss in nigrosome-1 by blinded investigators. We will compare how the diagnosis suggested by MRI compares with the diagnosis based on DaTSCAN and will also validate the diagnosis based on the two tests with a clinical examination performed at least 1 year after the initial presentation as a surrogate gold standard diagnostic test.Ethics and disseminationThe local ethics commission (Health Research Authority East Midlands – Derby Research Ethics Committee) has approved this study (REC ref.: 16/EM/0229). The study is being carried out under the principles of the Declaration of Helsinki (64th, 2013) and Good Clinical Practice standards. We have included a number of 15 research-funded DaTSCAN in the research protocol. This is to compensate for study site-specific National Health Service funding for this investigation in affected patients. We therefore have also obtained approval from the Administration of Radioactive Substances Administration Committee (ARSAC Ref 253/3629/35864). All findings will be presented at relevant scientific meetings and published in peer-reviewed journals, on the study website, and disseminated in lay and social media where appropriate.Trial registration numberNCT03022357; Pre-results.
Accuracy of recall of musculoskeletal injuries in elite military personnel: a cross-sectional study
Authors: Lovalekar Mita , Abt John P , Sell Timothy C , Lephart Scott M , Pletcher Erin , Beals Kim 
Published: December 2017

BackgroundSelf-reported data are often used in research studies among military populations.ObjectiveThe accuracy of self-reported musculoskeletal injury data among elite military personnel was assessed for issues with recall.DesignCross-sectional study.SettingApplied research laboratory at a military installation.ParticipantsA total of 101 subjects participated (age 28.5±5.6 years). Study participants were active duty military personnel, with no conditions that precluded them from full duty.Primary and secondary outcome measuresSelf-reported and medical record reviewed injuries that occurred during a 1-year period were matched by anatomic location, injury side (for extremity injuries), and injury year and type. The accuracy of recall was estimated as the per cent of medical record reviewed injuries correctly recalled in the self-report. The effect of injury anatomic location, injury type and severity and time since injury, on recall, was also assessed. Injuries were classified as recent (≤4 years since injury) or old injuries (>4 years since injury). Recall proportions were compared using Fisher’s exact tests.ResultsA total of 374 injuries were extracted from the subjects’ medical records. Recall was generally low (12.0%) and was not different between recent and old injuries (P=0.206). Injury location did not affect recall (P=0.418). Recall was higher for traumatic fractures as compared with less severe non-fracture injuries (P values 0.001 to <0.001). Recall for non-fracture injuries was higher for recent as compared with old injuries (P=0.033). This effect of time since injury on recall was not observed for fractures (P=0.522).ConclusionsThe results of this study highlight the importance of weighing the advantages and disadvantages of self-reported injury data before their use in research studies in military populations and the need for future research to identify modifiable factors that influence recall.
Factors associated with high levels of glycated haemoglobin in patients with type 1 diabetes: a multicentre study in Brazil
Authors: Andrade Carine Sousa , Ribeiro Guilherme Sousa , Santos Carlos Antonio Souza Teles , Neves Raimundo Celestino Silva , Moreira Edson Duarte 
Published: December 2017

ObjectiveLong-term complications of type 1 diabetes mellitus (DM1) can be prevented with adequate glycaemic control. However, high levels of glycated haemoglobin (HbA1c) occur in 60%–90% of the patients with DM1. Thus, we aimed to investigate the role of sociodemographic, behavioural and clinical factors on the HbA1c levels of patients with DM1 in Brazil.Design, setting and participantsA cross-sectional study was conducted in ambulatory patients with DM1 aged ≥18 years from 10 Brazilian cities. Sociodemographic, behavioural and clinical data were obtained through interviews.Main outcome measuresHbA1c level was measured by liquid chromatography. Hierarchical multiple variable linear regression models were used to identify factors correlated with high levels of HbA1c.ResultsOf 979 patients with DM1, 63.8% were women, and the mean age was 40 (SD 14.6) years. The mean HbA1c level was 9.4% (SD 2.2%), and 89.6% of the patients had HbA1c ≥7.0%. Factors independently correlated with increased HbA1c levels included: lower education, non-participation in diabetes classes/lecture during the year before, having a self-perception of poor adherence to diet and insulin, not having private medical care and not measuring the HbA1c levels in the prior year. Of note, poor adherence to diet and insulin were the independent factors most strongly associated with high levels of HbA1c (mean increment in HbA1c levels of 0.88% and 1.25%, respectively).ConclusionPoor glycaemic control, which is common among Brazilian patients with DM1, is associated with lower education, self-perception of insufficient adherence to diet and insulin and inadequate monitoring of HbA1c levels. Specific actions, particularly those targeting improving adherence to diet and insulin, may contribute to successful management of patients with DM1.
Cross-sectional surveys of the amount of sugar, energy and caffeine in sugar-sweetened drinks marketed and consumed as energy drinks in the UK between 2015 and 2017: monitoring reformulation progress
Authors: Hashem Kawther M , He Feng J , MacGregor Graham A 
Published: December 2017

ObjectivesTo investigate the sugar, energy and caffeine content of sugar-sweetened drinks marketed and consumed as energy drinks available in the UK.Study designWe carried out a cross-sectional survey in 2015 and 2017 of energy drinks available in the main UK retailers.MethodsThe sugar (sugars g/100 mL), energy (kcal/100 mL), caffeine (mg/100 mL) and serving size were collected from product packaging and nutrition information panels of energy drinks available in the nine main UK grocery retailers, three health and beauty retailers and one convenience store.ResultsThe number of formulations (per 100 mL) and number of products (per serving) have fallen (from 75 to 49 and from 90 to 59) between 2015 and 2017, respectively. Energy drinks surveyed showed a 10% reduction in sugar, from 10.6 to 9.5 g/100 mL (P=0.011) and a 6% reduction in energy content (P=0.005) per 100 mL between 2015 and 2017. The average caffeine content of energy drinks, with a warning label, has remained high at 31.5±0.9 in 2015 and 31.3±1.0 mg/100 mL in 2017. Despite there being reductions, sugar, energy and caffeine content remain at concerning levels in 2017.ConclusionsTo reduce the harmful impact of energy drinks, further reduction in sugar and a reduction in caffeine by reformulation are urgently needed. Other measures such as ban on the sale of energy drinks to children and smaller product sizes should also be explored, while warning labels should be kept. A reduction in sugar, energy and caffeine content and overall energy drinks consumption could be beneficial in reducing sugar, energy and caffeine intake of consumers of energy drinks.
Systematic review of the implementation of audience response systems and their impact on participation and engagement in the education of healthcare professionals
Authors: Iskander Morkos 
Published: December 2017

BackgroundAudience response system provides a mechanism to engage larger groups as active participants in teaching sessions. However, they are traditionally based on ‘fixed’ closed loop system, which limits their functionality to a single geographical location, thus has the effect of confining their use to universities and other larger institutions, with a primary focus on education. Conversely, in the healthcare education context, the majority of formal education is undertaken through postgraduate training programmes, largely conducted in smaller cohorts in clinical settings.ObjectiveThe purpose of this review is to evaluate audience response systems in terms of feasibility of implementation and the impact on participation within the field of education of healthcare professionals, in comparison to the non-healthcare education.Study selectionTherefore, systematic structured searches of PubMed and Medline databases for healthcare education were conducted, and Scopus, Education Resources Information Center, British Education Index, Education Abstracts, Education Administration Abstracts and PsycINFO databases for non-healthcare education databases.Findings and conclusionsConsistent and fundamental differences were found in the studies evaluating healthcare education compared with other fields, with more difficulties encountered in implementation and a less significant impact on engagement seen. Here we discuss the consequences of these findings on the use of audience response systems and beyond.
Study on the Landscape Pattern of Dalian Jinshitan National Holiday Resort in the Context of Tourism Urbanization
Authors: ZHANG Ruiying , XI Jianchao , ZHANG Nan 
Published: December 2017

Resort-based urbanization is an important form of tourism urbanization. The paper analyzes the basic characteristics and diversity of landscape elements under the influence of the tourist development of Jinshitan National Holiday Resort (JNHR), discusses the changes in the spatial distribution of landscapes, and reveals how landscapes have changed under the influence of the tourism development of JNHR. The study shows that the whole landscape at Jinshitan has undergone a process from fragmentation to integration in the context of manmade tourism development and interference. As more tourism projects are developed, supporting infrastructures and facilities are continuously improved. Landscapes in Jinshitan have been vigorously developed in depth and extended from coastal area to inland area. As shown by the changing spatial distribution of relocated and commercial housing estates since 1992, there have been differences in the location, living environment and available landscapes between the housing estates, indicating the heterogeneity of social space and inequality in the living environment.
Homologous Recombination Deficiency and Platinum-Based Therapy Outcomes in Advanced Breast Cancer
Authors: Zhao Eric Y. , Shen Yaoqing , Pleasance Erin , Kasaian Katayoon , Leelakumari Sreeja , Jones Martin , Bose Pinaki , Ch'ng Carolyn , Reisle Caralyn , Eirew Peter , Corbett Richard , Mungall Karen L. , Thiessen Nina , Ma Yussanne , Schein Jacqueline E. , Mungall Andrew J. , Zhao Yongjun , Moore Richard A. , Den Brok Wendie , Wilson Sheridan , Villa Diego , Shenkier Tamara , Lohrisch Caroline , Chia Stephen , Yip Stephen , Gelmon Karen , Lim Howard , Renouf Daniel , Sun Sophie , Schrader Kasmintan A. , Young Sean , Bosdet Ian , Karsan Aly , Laskin Janessa , Marra Marco A. , Jones Steven J.M. 
Published: December 2017

AbstractPurpose: Recent studies have identified mutation signatures of homologous recombination deficiency (HRD) in over 20% of breast cancers, as well as pancreatic, ovarian, and gastric cancers. There is an urgent need to understand the clinical implications of HRD signatures. Whereas BRCA1/2 mutations confer sensitivity to platinum-based chemotherapies, it is not yet clear whether mutation signatures can independently predict platinum response.Experimental Design: In this observational study, we sequenced tumor whole genomes (100× depth) and matched normals (60×) of 93 advanced-stage breast cancers (33 platinum-treated). We computed a published metric called HRDetect, independently trained to predict BRCA1/2 status, and assessed its capacity to predict outcomes on platinum-based chemotherapies. Clinical endpoints were overall survival (OS), total duration on platinum-based therapy (TDT), and radiographic evidence of clinical improvement (CI).Results: HRDetect predicted BRCA1/2 status with an area under the curve (AUC) of 0.94 and optimal threshold of 0.7. Elevated HRDetect was also significantly associated with CI on platinum-based therapy (AUC = 0.89; P = 0.006) with the same optimal threshold, even after adjusting for BRCA1/2 mutation status and treatment timing. HRDetect scores over 0.7 were associated with a 3-month extended median TDT (P = 0.0003) and 1.3-year extended median OS (P = 0.04).Conclusions: Our findings not only independently validate HRDetect, but also provide the first evidence of its association with platinum response in advanced breast cancer. We demonstrate that HRD mutation signatures may offer clinically relevant information independently of BRCA1/2 mutation status and hope this work will guide the development of clinical trials. Clin Cancer Res; 23(24); 7521–30. ©2017 AACR.
Thromboembolic Risks of the Procedural Process in Second-Generation Cryoballoon Ablation Procedures
Authors: Miyazaki Shinsuke , Watanabe Tomonori , Kajiyama Takatsugu , Iwasawa Jin , Ichijo Sadamitsu , Nakamura Hiroaki , Taniguchi Hiroshi , Hirao Kenzo , Iesaka Yoshito 
Published: December 2017

Background
Atrial fibrillation ablation is associated with substantial risks of silent cerebral events (SCEs) or silent cerebral lesions. We investigated which procedural processes during cryoballoon procedures carried a risk.

Methods and Results
Forty paroxysmal atrial fibrillation patients underwent pulmonary vein isolation using second-generation cryoballoons with single 28-mm balloon 3-minute freeze techniques. Microembolic signals (MESs) were monitored by transcranial Doppler throughout all procedures. Brain magnetic resonance imaging was obtained pre- and post-procedure in 34 patients (85.0%). Of 158 pulmonary veins, 152 (96.2%) were isolated using cryoablation, and 6 required touch-up radiofrequency ablation. A mean of 5.0±1.2 cryoballoon applications was applied, and the left atrial dwell time was 76.7±22.4 minutes. The total MES counts/procedures were 522 (426–626). Left atrial access and Flexcath sheath insertion generated 25 (11–44) and 34 (24–53) MESs. Using radiofrequency ablation for transseptal access increased the MES count during transseptal punctures. During cryoapplications, MES counts were greatest during first applications (117 [81–157]), especially after balloon stretch/deflations (43 [21–81]). Pre– and post–pulmonary vein potential mapping with Lasso catheters generated 57 (21–88) and 61 (36–88) MESs. Reinsertion of once withdrawn cryoballoons and subsequent applications produced 205 (156–310) MESs. Touch-up ablation generated 32 (19–62) MESs, whereas electric cardioversion generated no MESs. SCEs and silent cerebral lesions were detected in 11 (32.3%) and 4 (11.7%) patients, respectively. The patients with SCEs were older than those without; however, there were no significant factors associated with SCEs.

Conclusions
A significant number of MESs and SCE/silent cerebral lesion occurrences were observed during second-generation cryoballoon ablation procedures. MESs were recorded during a variety of steps throughout the procedure; however, the majority occurred during phases with a high probability of gaseous emboli.
Predicting Risk in Patients Hospitalized for Acute Decompensated Heart Failure and Preserved Ejection Fraction
Authors: Thorvaldsen Tonje , Claggett Brian L. , Shah Amil , Cheng Susan , Agarwal Sunil K. , Wruck Lisa M. , Chang Patricia P. , Rosamond Wayne D. , Lewis Eldrin F. , Desai Akshay S. , Lund Lars H. , Solomon Scott D. 
Published: December 2017

Background
Risk-prediction models specifically for hospitalized heart failure with preserved ejection fraction are lacking.

Methods and Results
We analyzed data from the ARIC (Atherosclerosis Risk in Communities) Study Heart Failure Community Surveillance to create and validate a risk score predicting mortality in patients ≥55 years of age admitted with acute decompensated heart failure with preserved ejection fraction (ejection fraction ≥50%). A modified version of the risk-prediction model for acute heart failure developed from patients in the EFFECT (Enhanced Feedback for Effective Cardiac Treatment) study was used as a composite predictor of 28-day and 1-year mortalities and evaluated together with other potential predictors in a stepwise logistic regression. The derivation sample consisted of 1852 hospitalizations from 2005 to 2011 (mean age, 77 years; 65% women; 74% white). Risk scores were created from the identified predictors and validated in hospitalizations from 2012 to 2013 (n=821). Mortality in the derivation and validation sample was 11% and 8% at 28 days and 34% and 31% at 1 year. The modified EFFECT score, including age, systolic blood pressure, blood urea nitrogen, sodium, cerebrovascular disease, chronic obstructive pulmonary disease, and hemoglobin, was a powerful predictor of mortality. Another important predictor for both 28-day and 1-year mortalities was hypoxia. The risk scores were well calibrated and had good discrimination in the derivation sample (area under the curve: 0.76 for 28-day and 0.72 for 1-year mortalities) and validation sample (area under the curve: 0.73 and 0.71, respectively).

Conclusions
Mortality after acute decompensation in patients with heart failure with preserved ejection fraction is high, with one third of patients dying within a year. A prediction tool may allow for greater discrimination of the highest risk patients.

Clinical Trial Registration: URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT00005131
miR-22 Is a Novel Mediator of Vascular Smooth Muscle Cell Phenotypic Modulation and Neointima Formation
Authors: Yang Feng , Chen Qishan , He Shiping , Yang Mei , Maguire Eithne Margaret , An Weiwei , Afzal Tayyab Adeel , Luong Le Anh , Zhang Li , Xiao Qingzhong 
Published: December 2017

Background:
MicroRNA-22 (miR-22) has recently been reported to play a regulatory role during vascular smooth muscle cell (VSMC) differentiation from stem cells, but little is known about its target genes and related pathways in mature VSMC phenotypic modulation or its clinical implication in neointima formation following vascular injury.

Methods:
We applied a wire-injury mouse model, and local delivery of AgomiR-22 or miR-22 inhibitor, as well, to explore the therapeutic potential of miR-22 in vascular diseases. Furthermore, normal and diseased human femoral arteries were harvested, and various in vivo, ex vivo, and in vitro models of VSMC phenotype switching were conducted to examine miR-22 expression during VSMC phenotype switching.

Results:
Expression of miR-22 was closely regulated during VSMC phenotypic modulation. miR-22 overexpression significantly increased expression of VSMC marker genes and inhibited VSMC proliferation and migration, whereas the opposite effect was observed when endogenous miR-22 was knocked down. As expected, 2 previously reported miR-22 target genes, MECP2 (methyl-CpG binding protein 2) and histone deacetylase 4, exhibited a regulatory role in VSMC phenotypic modulation. A transcriptional regulator and oncoprotein, EVI1 (ecotropic virus integration site 1 protein homolog), has been identified as a novel miR-22 target gene in VSMC phenotypic modulation. It is noteworthy that overexpression of miR-22 in the injured vessels significantly reduced the expression of its target genes, decreased VSMC proliferation, and inhibited neointima formation in wire-injured femoral arteries, whereas the opposite effect was observed with local application of a miR-22 inhibitor to injured arteries. We next examined the clinical relevance of miR-22 expression and its target genes in human femoral arteries. We found that miR-22 expression was significantly reduced, whereas MECP2 and EVI1 expression levels were dramatically increased, in diseased in comparison with healthy femoral human arteries. This inverse relationship between miR-22 and MECP2 and EVI1 was evident in both healthy and diseased human femoral arteries.

Conclusions:
Our data demonstrate that miR-22 and EVI1 are novel regulators of VSMC function, specifically during neointima hyperplasia, offering a novel therapeutic opportunity for treating vascular diseases.