bluuebunny/crossref_metadata_2025_split huggingface dataset:
Haemodynamic changes with varying chest compression rates in asphyxiated piglets
Authors: Bruckner Marlies , Neset Mattias , O'Reilly Megan , Lee Tze-Fun , Cheung Po-Yin , Schmölzer Georg M 
Published: February 2022

BackgroundCurrent neonatal resuscitation guidelines recommend that chest compressions (CCs) be delivered at a rate of 90/min. The aim of the study was to investigate the haemodynamic effects of different CC rates in a neonatal piglet model.MethodsSix asphyxiated piglets were randomised to CC with rates of 60/min, 90/min, 120/min, 150/min and 180/min for 1 min at each rate. CCs superimposed with sustained inflations were performed with an automated CC machine.ResultsSix newborn piglets (age 0–3 days, weight 2.0–2.3 kg) were included in the study. Overall, there was a gradual increase in stroke volume, minimum and maximum rate of left ventricle pressure change (dp/dtminand dp/dtmax), and carotid blood flow until CC rate of 150/min, with a level-off effect at a CC rate of 180/min. However, cardiac output continued to increase with the highest being at a CC rate of 180/min.ConclusionRate of CC was associated with changes in haemodynamic parameters during cardiopulmonary resuscitation. CC rate of 150–180/min during CC resulted in the highest cardiac output and arterial blood pressure.Trial registration numberPreclincialtrials.eu PCTE0000249.
Effect of a multifaceted intervention on the utilisation of primary health for maternal and child health care in rural Nigeria: a quasi-experimental study
Authors: Okonofua Friday , Ntoimo Lorretta Favour , Yaya Sanni , Igboin Brian , Solanke Ojuolape , Ekwo Chioma , Johnson Ermel Ameswue Kpogbe , Sombie Issiaka , Imongan Wilson 
Published: February 2022

ObjectiveThe objective of this study was to determine the effectiveness of a set of multifaceted interventions designed to increase the access of rural women to antenatal, intrapartum, postpartum and childhood immunisation services offered in primary healthcare facilities.DesignThe study was a separate sample pretest–post-test quasi-experimental research.SettingThe research was conducted in 20 communities and primary health centres in Esan South East and Etsako East Local Government Areas in Edo State in southern NigeriaParticipantsRandomly selected sample of ever married women aged 15–45 years.InterventionsSeven community-led interventions implemented over 27 months, consisting of a community health fund, engagement of transport owners on emergency transport of pregnant women to primary health centres with the use of rapid short message service (SMS), drug revolving fund, community education, advocacy, retraining of health workers and provision of basic equipment.Primary and secondary outcome measuresThe outcome measures included the number of women who used the primary health centres for skilled pregnancy care and immunisation of children aged 0–23 months.ResultsAfter adjusting for clustering and confounding variables, the odds of using the project primary healthcare centres for the four outcomes were significantly higher at endline compared with baseline: antenatal care (OR 3.87, CI 2.84 to 5.26 p<0.001), delivery care (OR 3.88, CI 2.86 to 5.26), postnatal care (OR 3.66, CI 2.58 to 5.18) and childhood immunisation (OR 2.87, CI 1.90 to 4.33). However, a few women still reported that the cost of services and gender-related issues were reasons for non-use after the intervention.ConclusionWe conclude that community-led interventions that address the specific concerns of women related to the bottlenecks they experience in accessing care in primary health centres are effective in increasing demand for skilled pregnancy and childcare in rural Nigeria.
Clinical pneumonia in the hospitalised child in Malawi in the post-pneumococcal conjugate vaccine era: a prospective hospital-based observational study
Authors: Iroh Tam Pui-Ying , Chirombo James , Henrion Marc , Newberry Laura , Mambule Ivan , Everett Dean , Mwansambo Charles , Cunliffe Nigel , French Neil , Heyderman Robert S , Bar-Zeev Naor 
Published: February 2022

ObjectiveAssess characteristics of clinical pneumonia after introduction of pneumococcal conjugate vaccine (PCV), by HIV exposure status, in children hospitalised in a governmental hospital in Malawi.Methods and findingsWe evaluated 1139 children ≤5 years old hospitalised with clinical pneumonia: 101 HIV-exposed, uninfected (HEU) and 1038 HIV-unexposed, uninfected (HUU). Median age was 11 months (IQR 6–20), 59% were male, median mid-upper arm circumference (MUAC) was 14 cm (IQR 13–15) and mean weight-for-height z score was −0.7 (±2.5). The highest Respiratory Index of Severity in Children (RISC) scores were allocated to 10.4% of the overall cohort. Only 45.7% had fever, and 37.2% had at least one danger sign at presentation. The most common clinical features were crackles (54.7%), nasal flaring (53.5%) and lower chest wall indrawing (53.2%). Compared with HUU, HEU children were significantly younger (9 months vs 11 months), with lower mean birth weight (2.8 kg vs 3.0 kg) and MUAC (13.6 cm vs 14.0 cm), had higher prevalence of vomiting (32.7% vs 22.0%), tachypnoea (68.4% vs 49.8%) and highest RISC scores (20.0% vs 9.4%). Five children died (0.4%). However, clinical outcomes were similar for both groups.ConclusionsIn this post-PCV setting where prevalence of HIV and malnutrition is high, children hospitalised fulfilling the WHO Integrated Management of Childhood Illness criteria for clinical pneumonia present with heterogeneous features. These vary by HIV exposure status but this does not influence either the frequency of danger signs or mortality. The poor performance of available severity scores in this population and the absence of more specific diagnostics hinder appropriate antimicrobial stewardship and the rational application of other interventions.
Influence of prehospital management on the outcome of spinal cord decompression sickness in scuba divers
Authors: Andre Sophie , Lehot Henri , Morin Jean , Louge Pierre , de Maistre Sébastien , Roffi Romain , Druelle Arnaud , Gempp Emmanuel , Vallée Nicolas , Vergne Muriel , Blatteau Jean-Eric 
Published: February 2022

BackgroundDecompression sickness (DCS) with spinal cord involvement has an unfortunately high rate of long-term sequelae. The objective of this study was to determine the association of prehospital variables on the outcome of spinal cord DCS, especially the influence of the initial clinical presentation and the time to recompression.MethodsThis was a retrospective study using prospectively collected data which included divers with spinal cord DCS seen at a single hyperbaric centre study from 2010 to 2018. Information regarding dive, latency of onset of symptoms, time to recompression and prehospital management, that is, use of oxygen, treatment and means of evacuation, were analysed as predictor variables. The initial clinical severity was estimated by the score of the French society of diving and hyperbaric medicine (MEDSUBHYP). The primary end point was the presence or absence of sequelae at discharge assessed by the modified score of the Japanese Orthopedic Association.Results195 divers (48±12 years, 42 women) were included. 34% had neurological sequelae at discharge. In multivariate analysis, a MEDSUBHYP score ≥6 and a time to recompression >194 min were significantly associated with incomplete neurological recovery (OR 9.5 (95% CI 4.6 to 19.8), p<0.0001 and OR 2.1 (95% CI 1.03 to 4.5), p=0.04, respectively). Time to recompression only appeared to be significant for patients with high initial clinical severity. As time to recompression increased, the level of sequelae also increased (p=0.014).ConclusionDetermining the initial clinical severity is critical in identifying patients who need to be evacuated for recompression as quickly as possible.
Sex-specific differences in adverse outcome events among patients with atrial fibrillation
Authors: Evers-Dörpfeld Simone , Aeschbacher Stefanie , Hennings Elisa , Eken Ceylan , Coslovsky Michael , Rodondi Nicolas , Beer Jürg H , Moschovitis Giorgio , Ammann Peter , Kobza Richard , Ceylan Selinda , Krempke Melina , Meyer-Zürn Christine S , Moutzouri Elisavet , Springer Anne , Sticherling Christian , Bonati Leo H , Osswald Stefan , Kuehne Michael , Conen David 
Published: February 2022

ObjectiveTo assess whether women with atrial fibrillation (AF) have a higher risk of adverse events than men during long-term follow-up since controversial data have been published.MethodsIn the context of two very similar observational multicentre cohort studies, we prospectively followed 3894 patients (28% women) with previously documented AF for a median of 4.02 (3.00–5.83) years. The primary outcome was a composite of ischaemic stroke, myocardial infarction and cardiovascular death. Secondary outcomes included the individual components of the composite outcome, hospitalisation for heart failure, major and clinically relevant non-major bleeding, stroke or systemic embolism and non-cardiovascular death.ResultsMean age was 73.1 years in women vs 70.8 years in men. The incidence of the primary endpoint in women versus men was 2.46 vs 3.24 per 100 patient-years, respectively (adjusted HR (aHR) 0.74, 95% CI 0.58 to 0.94; p=0.01). Women died less frequently from cardiovascular (aHR 0.57, 95% CI 0.41 to 0.78; p<0.001) and non-cardiovascular causes (aHR 0.68, 95% CI 0.47 to 0.98; p=0.04). There were no significant sex-specific differences in stroke (incidence 1.05 vs 1.00; aHR 1.02, 95% CI 0.70 to 1.49, p=0.93), myocardial infarction (incidence 0.67 vs 0.72; aHR 0.98, 95% CI 0.61 to 1.57, p=0.94), major and clinically relevant non-major bleeding (incidence 4.51 vs 4.34; aHR 0.95, 95% CI 0.79 to 1.15, p=0.63) or heart failure hospitalisation (incidence 3.28 vs 3.07; aHR 1.06, 95% CI 0.85 to 1.32, p=0.60).ConclusionIn this large study of patients with established AF, women had a lower risk of death than men, but there were no sex-specific differences in other adverse outcomes.
Agreement between L1 and E6/E7-based assays for detection of high-risk HPV in cervical, oropharyngeal and penile cancers
Authors: Alcaniz Boada Elia , Cuschieri Kate , Graham Catriona , Moncur Sharon , Bhatia Ramya 
Published: February 2022

AimsHuman papillomavirus (HPV) molecular testing targets either the late gene L1 or early genes E6 and/or E7. Loss of L1 during integration is suggested to compromise sensitivity in samples associated with cancer, however, clear evidence for this is lacking. Our aim is to address this by performing a head-to-head comparison between assays targeting L1 vs E6/E7, using a series of high-grade and invasive disease samples within different biological matrices and anatomical sites.MethodsWe obtained 298 samples comprising of liquid-based cytology and biopsies of cervical cancer and cervical intraepithelial neoplasia grade 3, in addition to biopsies of penile and oropharyngeal cancers. Two commercially available HPV primary screening assays and two assays with extended genotyping were applied to the sample set targeting L1 (Abbott RealTime HR HPV Assay and Optiplex HPV Genotyping Test) and E6/E7 genes (Xpert HPV Test and EuroArray HPV Test).ResultsAgreement for high-risk HPV (hrHPV) for all samples types between the screening assays is over 88% and over 96% for the two genotyping assays. For HPV 16 agreement is over 90% for both screening and genotyping assays. Kappa statistics show good to very good agreement between the screening and genotyping assays for hrHPV and HPV 16.ConclusionsAnalysis of the valid results from our data indicates that L1 and E6/E7 targeting assays show similar performance for detection of hrHPV in high grade cervical lesions and cancers of cervix, penis and oropharynx.
Work incapacity among family caregivers: a record linkage study
Authors: Mikkola Tuija M , Mänty Minna , Kautiainen Hannu , von Bonsdorff Mikaela B , Haanpää Maija , Koponen Hannu , Kröger Teppo , Eriksson Johan G 
Published: February 2022

BackgroundFamily caregiving-related physical and mental health problems may lead to work incapacity in employed caregivers. The aim of this study was to quantify sickness absences and disability pensions (SADP) among high-intensity family caregivers available to the labour market compared with a control population.MethodsThe study sample included all individuals in Finland, who had received caregiver’s allowance and were available to the labour market in 2012 (n=16 982) and their controls (n=35 371). Information on the number of sickness absence (spells >10 days) and disability pension (SADP) days and related diagnoses according to ICD-10 were obtained from national registers for the years 2012–2017. The analyses were adjusted for age, sex, occupational status, education, income and degree of urbanisation.ResultsDuring the follow-up, 40.9% of caregivers and 39.5% of controls had at least one sickness absence spell and 6.1% and 4.7%, respectively, received disability pension. The mean annual number of SADP days was 23.2 (95% CI 22.3 to 24.1) for caregivers and 18.5 (95% CI 18.0 to 19.0) for controls (adjusted incidence rate ratio (IRR)=1.16, 95% CI 1.10 to 1.22). The number of annual SADP days due to mental disorders was higher in caregivers (7.2, 95% CI 6.7 to 7.8) than controls (4.0, 95% CI 3.8 to 4.3; adjusted IRR 1.58, 95% CI 1.42 to 1.75). There were no differences in SADP days due to cancer, neurological, cardiovascular, respiratory, or musculoskeletal diseases, or external causes.DiscussionHigher number of SADP days due to mental disorders in caregivers suggests that family caregiving has an adverse effect on work capacity and that caregivers are at increased risk for mental disorders.
High-affinity CD16 integration into a CRISPR/Cas9-edited CD38 locus augments CD38-directed antitumor activity of primary human natural killer cells
Authors: Clara Joseph Andrew , Levy Emily R , Reger Robert , Barisic Stefan , Chen Long , Cherkasova Elena , Chakraborty Mala , Allan David S J , Childs Richard 
Published: February 2022

BackgroundAdoptive transfer of natural killer (NK) cells with augmented antibody-dependent cellular cytotoxicity (ADCC) capabilities and resistance to CD38 targeting has the potential to enhance the clinical anti-myeloma activity of daratumumab (DARA). Therefore, we sought to develop an efficient CRISPR/Cas9-based gene editing platform to disrupt CD38 expression (CD38 knockout (KO)) in ex vivo expanded NK cells and simultaneously arm CD38KONK cells with a high-affinity CD16 (CD16-158V) receptor.MethodsCD38KOhuman NK cells were generated using Cas9 ribonucleoprotein complexes. The platform was expanded by incorporating messenger RNA (mRNA) transfection of CD38KONK cells and targeted gene insertion at theCD38locus to mediate gene knockin (KI). The capacity of these gene-edited NK cells to persist and mediate ADCC in the presence of DARA was tested in vitro and in a MM.1S xenograft mouse model.ResultsHighly efficient CD38 gene disruption was achieved in ex vivo expanded NK cells without affecting their proliferative or functional capacity. CD38 KO conferred resistance to DARA-induced NK cell fratricide, enabling persistence and augmented ADCC against myeloma cell lines in the presence of DARA in vitro and in a MM.1S xenograft mouse model. CD38KONK cells could be further modified by transfection with mRNA encoding a CD16-158V receptor, resulting in augmented DARA-mediated ADCC. Finally, we observed that a homology-directed repair template targeted to theCD38locus facilitated an efficient 2-in-1 CD38 KO coupled with KI of a truncated CD34 reporter and CD16-158V receptor, with CD38KO/CD16KINK cells demonstrating a further enhancement of DARA-mediated ADCC both in vitro and in vivo.ConclusionsAdoptive immunotherapy using ex vivo expanded CD38KO/CD16KINK cells has the potential to boost the clinical efficacy of DARA. By incorporating complementary genetic engineering strategies into a CD38 KO manufacturing platform, we generated NK cells with substantially augmented CD38-directed antitumor activity, establishing a strong rationale for exploring this immunotherapy strategy in the clinic.
How to perform intra-aneurysmal coil embolization after Pipeline deployment: a study from a hemodynamic viewpoint
Authors: Zhang Mingqi , Tian Zhongbin , Zhang Yisen , Zhang Ying , Wang Kun , Leng Xiaochang , Yang Xinjian , Xiang Jianping , Liu Jian 
Published: February 2022

BackgroundPipeline embolization device (PED) deployment combined with coil therapy for large complex intracranial aneurysms is effective and considered superior to PED deployment alone. However, the optimal strategy for use of coils remains unclear. We used patient-specific aneurysm models and finite element analysis to determine the ideal packing density of coils after PED placement.MethodsFinite element analysis was used to provide a higher-fidelity model for accurate post-treatment computational fluid dynamics analysis to simulate the real therapeutic process of PED and all coils. We then calculated and analyzed the reduction ratio of velocity to identify the hemodynamic change during PED deployment and each coil embolization.ResultsSixteen consecutive patients underwent PED plus coil procedures to treat internal carotid artery intracranial aneurysms. After PED deployment, the intra-aneurysmal flow velocity significantly decreased (15.3 vs 10.0 cm/s; p<0.001). When the first coil was inserted, the flow velocity in the aneurysm further decreased and the reduction was significant (10.0 vs 5.3 cm/s; p<0.001). Analysis of covariance showed that the effect of the reduction ratio of velocity of the second coil was significantly lower than that of the first coil (p<0.001)—that is, when the packing density increased to 7.06%, the addition of coils produced no further hemodynamic effect.ConclusionAdjunct coiling could improve the post-PED hemodynamic environment in treated intracranial aneurysms. However, dense packing is not necessary because the intra-aneurysmal hemodynamics tend to stabilize as the packing density reaches an average of 7.06% or after insertion of the second coil.
Systematic review of the use of CRP in clinical trials for psoriatic arthritis: a concern for clinical practice?
Authors: Houttekiet Charlotte , de Vlam Kurt , Neerinckx Barbara , Lories Rik 
Published: February 2022

BackgroundC reactive protein (CRP) levels are suggested as serum biomarkers in the diagnosis and prognosis of psoriatic arthritis (PsA). However, increased CRP levels are found in less than 50% of PsA patients even in the presence of active disease.ObjectivesTo evaluate the role of CRP levels in interventional clinical trials in PsA patients to better understand the trial generalisability, relationship with disease activity and predictive value for treatment response and decision making.MethodsA systematic review was conducted via PubMed, Cochrane and Embase. We focused on phase III trials in PsA.ResultsEight of 22 studies applied minimum baseline CRP levels for inclusion. Baseline CRP levels were wide-ranging (0.1–238 mg/L) and lower in studies without CRP in the enrolment criteria. All 22 studies used the American College of Rheumatology (ACR20) response and other endpoints that integrated CRP levels. One of seven studies that evaluated individual ACR-score components revealed a decrease in CRP levels along with improvement of other endpoints. Subanalyses show conflicting evidence on CRP levels as predictor of disease course.ConclusionCRP levels were inconsistently used as inclusion criterion in clinical trials, often limiting generalisability of the data. The use of composite scores such as ACR20 or Disease Activity Score-28-CRP is also limited since baseline levels of CRP affects their sensitivity to change. High CRP levels may be an individual predictor for disease progression and response to treatment, but the current conflicting findings and selective patient trial inclusions, do not allow CRP to play a very prominent role in treatment decision making.
Effectiveness of e-cigarettes as aids for smoking cessation: evidence from the PATH Study cohort, 2017–2019
Authors: Chen Ruifeng , Pierce John P , Leas Eric C , Benmarhnia Tarik , Strong David R , White Martha M , Stone Matthew , Trinidad Dennis R , McMenamin Sara B , Messer Karen 
Published: February 2022

ObjectiveTo assess the effectiveness of e-cigarettes in smoking cessation in the USA from 2017 to 2019, given the 2017 increase in high nicotine e-cigarette sales.MethodsIn 2017, the PATH Cohort Study included data on 3578 previous year smokers with a recent quit attempt and 1323 recent former smokers. Respondents reported e-cigarettes or other products used to quit cigarettes and many covariates associated with e-cigarette use. Study outcomes were 12+ months of cigarette abstinence and tobacco abstinence in 2019. We report weighted unadjusted estimates and use propensity score matched analyses with 1500 bootstrap samples to estimate adjusted risk differences (aRD).ResultsIn 2017, 12.6% (95% CI 11.3% to 13.9%) of recent quit attempters used e-cigarettes to help with their quit attempt, a decline from previous years. Cigarette abstinence for e-cigarette users (9.9%, 95% CI 6.6% to 13.2%) was lower than for no product use (18.6%, 95% CI 16.0% to 21.2%), and the aRD for e-cigarettes versus pharmaceutical aids was −7.3% (95% CI −14.4 to –0.4) and for e-cigarettes versus any other method was −7.7% (95% CI −12.2 to –3.2). Only 2.2% (95% CI 0.0% to 4.4%) of recent former smokers switched to a high nicotine e-cigarette. Subjects who switched to e-cigarettes appeared to have a higher relapse rate than those who did not switch to e-cigarettes or other tobacco, although the difference was not statistically significant.ConclusionsSales increases in high nicotine e-cigarettes in 2017 did not translate to more smokers using these e-cigarettes to quit smoking. On average, using e-cigarettes for cessation in 2017 did not improve successful quitting or prevent relapse.
Validation of the Japan Coma Scale for the prediction of mortality in children: analysis of a nationwide trauma database
Authors: Enomoto Yuki , Tsutsumi Yusuke , Tsuchiya Asuka , Kido Takahiro , Ishigami Koji , Togo Masahito , Yasuda Susumu , Inoue Yoshiaki 
Published: February 2022

ObjectiveThe Japan Coma Scale (JCS) is widely used in clinical practice to evaluate levels of consciousness in Japan. There have been several studies on the usefulness of JCS in adults. However, its usefulness in evaluating children has not been reported. Therefore, this study aimed to assess the usefulness of the JCS for the prediction of mortality in children.MethodsThis is a multicenter cohort study which used data from a national trauma registry (Japan Trauma Data Bank). This study included patients under 16 years of age who were treated between 2004 and 2015.The primary outcome measure was in-hospital mortality. Two models were used to examine each item of the Glasgow Coma Scale (GCS) and the JCS. Model A included the discrete levels of each index. In model B, data regarding age, sex, vital signs on arrival to hospital, the Injury Severity Score, and blunt trauma were added to each index. The effectivity of the JCS score was then evaluated using the area under the curve (AUC) for discrimination, a calibration plot, and the Hosmer-Lemeshow test for calibration.ResultsA total of 9045 patients were identified. The AUCs of the GCS and JCS were 0.929 (95% confidence interval (CI) 0.904 to 0.954) and 0.930 (95% CI 0.906 to 0.954) in model A and 0.975 (95% CI 0.963 to 0.987) and 0.974 (95% CI 0.963 to 0.985) in model B, respectively. The results of the Hosmer-Lemeshow test were 0.00 (p=1.00) and 0.00 (p=1.00) in model A and 4.14 (p=0.84) and 8.55 (p=0.38) in model B for the GCS and JCS, respectively.ConclusionsWe demonstrated that the JCS is as valid as the GCS for predicting mortality. The findings of this study indicate that the JCS is a useful and relevant tool for pediatric trauma care and future research.