bluuebunny/crossref_metadata_2025_split huggingface dataset:
Isavuconazole shortens the QTc interval
Authors: Mellinghoff Sibylle C. , Bassetti Matteo , Dörfel Daniela , Hagel Stefan , Lehners Nicola , Plis Andrzej , Schalk Enrico , Vena Antonio , Cornely Oliver A. 
Published: November 2017

SummaryIsavuconazole is a novel antifungal drug approved for the treatment of adults with invasive aspergillosis and mucormycosis. While azoles as a class effect are known to prolong QTc interval, clinical trials have shown that isavuconazole administration may cause shortening in a dose‐related manner. Here, we assessed the effects of isavuconazole on the length of QTc interval. The objective of the study was to describe changes in the QTc interval induced by isavuconazole treatment. A total of 26 adult patients from 7 hospitals were included. Patients received isavuconazole for the treatment of invasive fungal infection and, in 1 case, for prophylaxis due to QTc prolongation under fluconazole. Twelve‐channel electrocardiograms (ECGs) were performed before and during treatment. Out of 26 patients, 24 showed shortening of QTc interval. In patients with QTc shortening, QTc during isavuconazole treatment showed a mean decrease of 7.4 ± 5.8% (36.5 ± 38.8 ms, range 7‐202; P = .004), compared to pre‐isavuconazole ECG. One patient with available long‐term follow‐up showed further decrease in QTc on days 55 and 110. Apart from 1 case report, these are the first data outside controlled clinical trials showing QTc shortening. Knowledge about cardiac effects of isavuconazole will serve to better manage the use of concomitant medications.
Successful treatment of chromoblastomycosis of 10‐year duration due to Fonsecaea nubica
Authors: He Liya , Ma Jianchi , Mei Xin , Lu Sha , Li Xiqing , Xi Liyan 
Published: November 2017

SummaryWe report a case of chromoblastomycosis due to the presence of large plaque and verrucous hyperplasia lesions on the left upper limb, with elbow abnormal activities, in a 56‐year‐old male. The diagnosis of chromoblastomycosis was based on gross and microscopic morphologies, histopathological examination and clinical manifestation. Molecular tools were applied to identifying the causative agent Fonsecaea nubica, which is rarely reported to be associated with chromoblastomycosis. The patient was initially treated orally with terbinafine (250 mg/day) and itraconazole (200 mg/day), subsequently patient received thermotherapy (45‐50°C, 3 h/day) for 1 month. The patient was successfully cured. A literature review was performed to assess general features, treatment and outcome of chromoblastomycosis due to F. nubica. All the 5 reviewed patients were male, over 30 years old and their lesions occurred after traumatic inoculation.
Lifelong Maintenance of Oral Tolerance and Immunity Profiles in Mice Depends on Early Exposure to Antigen
Authors: Speziali E. F. , Menezes J. S. , Santiago A. F. , Vaz N. M. , Faria A. M. C. 
Published: November 2017

AbstractOral tolerance is defined as a state of systemic hyporesponsiveness to an antigen that has been previously administered by the oral route. Many factors affect oral tolerance induction; some of them related to antigen, and some related to the animal. The age of the animal is one of the most important factors that affect oral tolerance as ageing brings many alterations in immune responses. Herein, we demonstrated that both the oral tolerance and pattern of immune reactivity triggered in early life were kept up to 15 months regarding the magnitude of antibody production, cell proliferation and cytokine profile when compared to immune responses induced in old mice. Therefore, our results corroborate with a promising proposal for prevaccination during childhood and young age, and a booster in older age, to make sure that the primary immunization in early life is not lost in aged individuals.
Prevalence, predictors and challenges of gestational diabetes mellitus screening among pregnant women in northern Tanzania
Authors: Njete H. I. , John B. , Mlay P. , Mahande M. J. , Msuya S. E. 
Published: November 2017

AbstractObjectivesTo determine the prevalence and predictors of gestational diabetes mellitus (GDM) as well as acceptability of returning for glucose tolerance testing among pregnant women in Moshi municipality, northern Tanzania.MethodsCross‐sectional study from October 2015 to April 2016 among women with gestation age of 24–28 weeks of pregnancy attending at Kilimanjaro Christian Medical Centre (KCMC) referral hospital, Majengo and Pasua Health Centres. Women were interviewed and requested to return the next day (window within a month, depending on gestational age) for fasting plasma glucose (FPG) testing, followed immediately by a 75 g oral glucose tolerance test (OGTT). GDM was diagnosed using the 2013 WHO criteria. Logistic regression was conducted to reveal independent predictors for GDM.ResultsOf 433 interviewed women, 100 (23%) did not return for FPG and OGTT testing. The prevalence of GDM among the 333 screened women was 19.5%, and 3% had diabetes in pregnancy (DIP). GDM was significantly associated with age ≥35 years (adjusted OR 6.75), pre‐pregnancy obesity (AOR 2.22) and history of abortion (AOR 2.36).ConclusionPrevalence of GDM is high in Moshi. We recommend introduction of routine screening for hyperglycaemia during pregnancy along with strategies for follow‐up to prevent long‐term effects of GDM and DIP in women and their children.
Daily inspiratory muscle training lowers blood pressure and vascular resistance in healthy men and women
Authors: DeLucia Claire M. , De Asis Roxanne M. , Bailey E. Fiona 
Published: November 2017

New Findings
What is the central question of this study?
What impact does inspiratory muscle training have on systemic vascular resistance, cardiac output and baroreflex sensitivity in adult men and women?

What is the main finding and its importance?
Inspiratory muscle training exerts favorable effects on blood pressure, vascular resistance and perception of stress. This exercise format is well‐tolerated and equally effective whether implemented in men or women.

AbstractPrevious work has shown that inspiratory muscle training (IMT) lowers blood pressure after a mere 6 weeks, identifying IMT as a potential therapeutic intervention to prevent or treat hypertension. Here, we explore the effects of IMT on respiratory muscle strength and select cardiovascular parameters in recreationally active men and women. Subjects were randomly assigned to IMT (n = 12, 75% maximal inspiratory pressure) or sham training (n = 13, 15% maximal inspiratory pressure) groups and underwent a 6‐week intervention comprising 30 breaths day−1, 5 days week−1. Pre‐ and post‐training measures included maximal inspiratory pressure and resting measures of blood pressure, cardiac output, heart rate, spontaneous cardiac baroreflex sensitivity and systemic vascular resistance. We evaluated psychological and sleep status via administration of the Cohen–Hoberman inventory of physical symptoms and the Epworth sleepiness scale. Male and female subjects in the IMT group showed declines in systolic/diastolic blood pressures (−4.3/−3.9 mmHg, P < 0.025) and systemic vascular resistance (−3.5 mmHg min l−1, P = 0.008) at week 6. There was no effect of IMT on cardiac output (P = 0.722), heart rate (P = 0.795) or spontaneous cardiac baroreflex sensitivity (P = 0.776). The IMT subjects also reported fewer stress‐related symptoms (pre‐ versus post‐training, 12.5 ± 8.5 versus 7.2 ± 9.7, P = 0.025). Based on these results, we suggest that a short course of IMT confers significant respiratory and cardiovascular improvements and parallel (modest) psychological benefits in healthy men and women.
The Spirochete Brachyspira pilosicoli, Enteric Pathogen of Animals and Humans
Authors: Hampson David J. 
Published: November 2017

SUMMARYBrachyspira pilosicoliis a slow-growing anaerobic spirochete that colonizes the large intestine. Colonization occurs commonly in pigs and adult chickens, causing colitis/typhlitis, diarrhea, poor growth rates, and reduced production. Colonization of humans also is common in some populations (individuals living in village and peri-urban settings in developing countries, recent immigrants from developing countries, homosexual males, and HIV-positive patients), but the spirochete rarely is investigated as a potential human enteric pathogen. In part this is due to its slow growth and specialized growth requirements, meaning that it is not detectable in human fecal samples using routine diagnostic methods. Nevertheless, it has been identified histologically attached to the colon and rectum in patients with conditions such as chronic diarrhea, rectal bleeding, and/or nonspecific abdominal discomfort, and one survey of Australian Aboriginal children showed that colonization was significantly associated with failure to thrive.B. pilosicolihas been detected in the bloodstream of elderly patients or individuals with chronic conditions such as alcoholism and malignancies. This review describes the spirochete and associated diseases. It aims to encourage clinicians and clinical microbiologists to considerB. pilosicoliin their differential diagnoses and to develop and use appropriate diagnostic protocols to identify the spirochete in clinical specimens.
Patterns of pain over time among children with juvenile idiopathic arthritis
Authors: Rashid Amir , Cordingley Lis , Carrasco Roberto , Foster Helen E , Baildam Eileen M , Chieng Alice , Davidson Joyce E , Wedderburn Lucy R , Ioannou Yiannis , McErlane Flora , Verstappen Suzanne M M , Hyrich Kimme L , Thomson Wendy 
Published: November 2017

ObjectivesPain is a very common symptom of juvenile idiopathic arthritis (JIA). Disease activity alone cannot explain symptoms of pain in all children, suggesting other factors may be relevant. The objectives of this study were to describe the different patterns of pain experienced over time in children with JIA and to identify predictors of which children are likely to experience ongoing pain.MethodsThis study used longitudinal-data from patients (aged 1–16 years) with new-onset JIA. Baseline and up to 5-year follow-up pain data from the Childhood Arthritis Prospective Study (CAPS) were used. A two-step approach was adopted. First, pain trajectories were modelled using a discrete mixture model. Second, multinomial logistic regression was used to determine the association between variables and trajectories.ResultsData from 851 individuals were included (4 years, median follow-up). A three-group trajectory model was identified: consistently low pain (n=453), improved pain (n=254) and consistently high pain (n=144). Children with improved pain or consistently high pain differed on average at baseline from consistently low pain. Older age at onset, poor function/disability and longer disease duration at baseline were associated with consistently high pain compared with consistently low pain. Early increases in pain and poor function/disability were also associated with consistently high pain compared with consistently low pain.ConclusionsThis study has identified routinely collected clinical factors, which may indicate those individuals with JIA at risk of poor pain outcomes earlier in disease. Identifying those at highest risk of poor pain outcomes at disease onset may enable targeted pain management strategies to be implemented early in disease thus reducing the risk of poor pain outcomes.
Care bundles to reduce central line-associated bloodstream infections in the neonatal unit: a systematic review and meta-analysis
Authors: Payne Victoria , Hall Mike , Prieto Jacqui , Johnson Mark 
Published: November 2017

BackgroundCentral line-associated bloodstream infections (CLABSIs) are associated with increased mortality, prolonged hospitalisation and increased healthcare costs. Care bundles have reduced CLABSIs in adult intensive care units (ICUs) but replication in paediatric ICUs has had inconsistent outcomes. A systematic review was performed to assess the evidence for the efficacy of care bundles in reducing CLABSIs in the neonatal unit (NNU).MethodsMEDLINE, CINAHL and EMBASE were searched from January 2010 up to January 2017. The Cochrane Library, Web of Science, Zetoc and Ethos were searched for additional studies. Randomised controlled trials (RCTs), quasi-experimental and observational studies were eligible. The primary outcome measure was CLABSI rates per 1000 central line, or patient, days. A meta-analysis was performed using random effects modelling.ResultsTwenty-four studies were eligible for inclusion: six were performed in Europe, 12 were in North America, two in Australia and four were in low/middle-income countries. Five were observational studies and 19 were before and after quality improvement studies. No RCTs were found. Meta-analysis revealed a statistically significant reduction in CLABSIs following the introduction of care bundles (rate ratio=0.40 (CI 0.31 to 0.51), p<0.00001), which equates to a 60% reduction in CLABSI rate.ConclusionThere is a substantial body of quasi-experimental evidence to suggest that care bundles may reduce CLABSI rates in the NNU, though it is not clear which bundle elements are effective in specific settings. Future research should focus on determining what processes promote the effective implementation of infection prevention recommendations, and which elements represent essential components of such care bundles.
Post-traumatic stress after PICU and corticosteroid use
Authors: Corbet Burcher Georgina , Picouto Maria D , Als Lorraine C , Cooper Mehrengise , Pierce Christine M , Nadel Simon , Garralda M Elena 
Published: November 2017

AimTo examine the association between corticosteroid use in paediatric intensive care units (PICU) and subsequent symptoms of post-traumatic stress disorder (PTSD).MethodsThe subjects were children aged 8–16 years admitted to PICU with sepsis, meningoencephalitis (ME) and other disorders. Illness information was extracted from case notes; 3–6 months post discharge children completed a PTSD symptom questionnaire (eight-item Impact of Events Scale (IES-8)) assessing intrusion and avoidance symptoms. Saliva samples were also collected for cortisol profile analysis.Results53 children completed the IES-8 questionnaires. 33 provided saliva samples. 19 (36%) received corticosteroids. In children with sepsis (n=15), corticosteroid use was associated with significantly lower PTSD intrusion symptom scores. There was a trend towards an association between corticosteroid use and lower evening cortisol levels. There was a comparable but weaker trend in children with ME.DiscussionCorticosteroid use may be associated with fewer PTSD symptoms and lower evening cortisol levels following PICU admission in children with sepsis.
Cluster analysis of novel isometric strength measures produces a valid and evidence-based classification structure for wheelchair track racing
Authors: Connick Mark J , Beckman Emma , Vanlandewijck Yves , Malone Laurie A , Blomqvist Sven , Tweedy Sean M 
Published: November 2017

BackgroundThe Para athletics wheelchair-racing classification system employs best practice to ensure that classes comprise athletes whose impairments cause a comparable degree of activity limitation. However, decision-making is largely subjective and scientific evidence which reduces this subjectivity is required.AimTo evaluate whether isometric strength tests were valid for the purposes of classifying wheelchair racers and whether cluster analysis of the strength measures produced a valid classification structure.MethodsThirty-two international level, male wheelchair racers from classes T51–54 completed six isometric strength tests evaluating elbow extensors, shoulder flexors, trunk flexors and forearm pronators and two wheelchair performance tests–Top-Speed (0–15 m) and Top-Speed (absolute). Strength tests significantly correlated with wheelchair performance were included in a cluster analysis and the validity of the resulting clusters was assessed.ResultsAll six strength tests correlated with performance (r=0.54–0.88). Cluster analysis yielded four clusters with reasonable overall structure (mean silhouette coefficient=0.58) and large intercluster strength differences. Six athletes (19%) were allocated to clusters that did not align with their current class. While the mean wheelchair racing performance of the resulting clusters was unequivocally hierarchical, the mean performance of current classes was not, with no difference between current classes T53 and T54.ConclusionsCluster analysis of isometric strength tests produced classes comprising athletes who experienced a similar degree of activity limitation. The strength tests reported can provide the basis for a new, more transparent, less subjective wheelchair racing classification system, pending replication of these findings in a larger, representative sample. This paper also provides guidance for development of evidence-based systems in other Para sports.
Reconstruction of head impacts in FIS World Cup alpine skiing
Authors: Steenstrup Sophie Elspeth , Mok Kam-Ming , McIntosh Andrew S , Bahr Roald , Krosshaug Tron 
Published: November 2017

IntroductionPrior to the 2013/2014 season, the International Ski Federation (FIS) increased the helmet testing speed from 5.4 to 6.8 m/s for alpine downhill, super-G and giant slalom. Whether this increased testing speed reflects head impact velocities in real head injury situations on snow is unclear. We therefore investigated the injury mechanisms and gross head impact biomechanics in seven real head injury situations among World Cup (WC) alpine skiers.MethodsWe analysed nine head impacts from seven head injury videos from the FIS Injury Surveillance System, throughout nine WC seasons (2006–2015) in detail. We used commercial video-based motion analysis software to estimate head impact kinematics in two dimensions, including directly preimpact and postimpact, from broadcast video. The sagittal plane angular movement of the head was also measured using angle measurement software.ResultsIn seven of nine head impacts, the estimated normal to slope preimpact velocity was higher than the current FIS helmet rule of 6.8 m/s (mean 8.1 (±SD 0.6) m/s, range 1.9±0.8 to 12.1±0.4 m/s). The nine head impacts had a mean normal to slope velocity change of 9.3±1.0 m/s, range 5.2±1.1 to 13.5±1.3 m/s. There was a large change in sagittal plane angular velocity (mean 43.3±2.9 rad/s (range 21.2±1.5 to 64.2±3.0 rad/s)) during impact.ConclusionThe estimated normal to slope preimpact velocity was higher than the current FIS helmet rule of 6.8 m/s in seven of nine head impacts.
Poor overall quality of clinical practice guidelines for musculoskeletal pain: a systematic review
Authors: Lin Ivan , Wiles Louise K , Waller Robert , Goucke Roger , Nagree Yusuf , Gibberd Michael , Straker Leon , Maher Christopher G , O’Sullivan Peter P B 
Published: November 2017

ObjectivesUndertake a systematic critical appraisal of contemporary clinical practice guidelines (CPGs) for common musculoskeletal (MSK) pain conditions: spinal (lumbar, thoracic and cervical), hip/knee (including osteoarthritis) and shoulder.DesignSystematic review of CPGs (PROSPERO number: CRD42016051653).Included CPGs were written in English, developed within the last 5 years, focused on adults and described development processes. Excluded CPGs were for: traumatic MSK pain, single modalities (eg, surgery), traditional healing/medicine, specific disease processes (eg, inflammatory arthropathies) or those that required payment.Data sources and method of appraisalFour scientific databases (MEDLINE, Embase, CINAHL and Physiotherapy Evidence Database) and four guideline repositories. The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was used for critical appraisal.Results4664 records were identified, and 34 CPGs were included. Most were for osteoarthritis (n=12) or low back pain (n=11), most commonly from the USA (n=12). The mean overall AGREE II score was 45% (SD=19.7). Lowest mean domain scores were forapplicability(26%, SD=19.5) andeditorial independence(33%, SD=27.5). The highest score was forscopeandpurpose(72%, SD=14.3). Only 8 of 34 CPGS were high quality: for osteoarthritis (n=4), low back pain (n=2), neck (n=1) and shoulder pain (n=1).
Smoking prevalence and attitudes towards smoking among Estonian physicians: results from cross-sectional studies in 2002 and 2014
Authors: Põld Mariliis , Pärna Kersti 
Published: November 2017

ObjectivesTo explore smoking prevalence and attitudes towards smoking among Estonian physicians in 2002 and 2014.DesignTwo self-administered cross-sectional postal surveys were conducted among practising physicians in Estonia.ParticipantsInitial sample consisted of all practising physicians in Estonia. The corrected response rate was 67.8% in 2002 and 53.1% in 2014. Present study sample was restricted to physicians younger than 65 years (n=2549 in 2002, n=2339 in 2014).MethodsAge-standardised prevalence of smoking and prevalence of agreement with seven statements concerning attitudes towards smoking was determined. To analyse association of physicians’ attitudes towards smoking with study year and smoking status, logistic regression analysis was used. Adjusted ORs of agreement with the seven statements were determined. Corresponding 95% CIs were calculated.ResultsThe age-standardised prevalence of current smoking among men was 26.8% in 2002 and 15.3% in 2014, among women 10.4% and 5.8%, respectively. Compared with the year 2002, in 2014, prevalence of agreement with statements declaring harmfulness of smoking was higher and prevalence of agreement with statements approving smoking was lower. Adjusted ORs showed that compared with 2002, physicians’ attitudes towards smoking were less favourable in 2014, and physicians’ attitudes towards smoking were associated with their smoking status.ConclusionsCompared with 2002, the age-standardised smoking prevalence among male and female physicians was lower, and attitudes towards smoking were less approving in 2014. The smoking physicians had more approving attitudes towards smoking than their non-smoking colleagues.