bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation of carotid corrected flow time and respirophasic variation in blood flow peak velocity with stroke volume variation in elderly patients under general anaesthesia
Authors: Chen Yu , Liu Ziyou , Fang Jun , Xie Yanhu , Zhang Min , Yang Jia 
Published: August 2022

Abstract
Background
Accurate assessment of volume responsiveness in elderly patients is important as it may reduce the risk of post-operative complications and enhance surgical recovery. This study evaluated the utility of two Doppler ultrasound-derived parameters, the carotid corrected flow time (FTc) and respirophasic variation in carotid artery blood flow peak velocity (ΔVpeak), to predict volume responsiveness in elderly patients under general anaesthesia.

Methods
A total of 97 elderly patients undergoing elective abdominal surgery under general anaesthesia were enrolled in this prospective observational study. After entering the operating room, all patients underwent radial artery puncture connected with a LiDCO device to measure stroke volume variation (SVV), and fluid therapy was performed after anaesthesia induction. Patients were classified as responders if SVV ≥ 13% before fluid challenge and nonresponders if SVV < 13%. The FTc, ΔVpeak, SVV and haemodynamic data were measured by ultrasound at baseline (T0) and before (T1) and after (T2) fluid challenge. The correlations between the Doppler ultrasound-derived parameters and SVV were analysed, and the receiver operating characteristic (ROC) curves was computed to characterize both FTc and ΔVpeak as measures of volume responsiveness in elderly patients.

Results
Forty-one (42.3%) patients were fluid responders. Carotid FTc before fluid challenge was negatively correlated with SVV before fluid challenge (r = -0.77; P < 0.01), and ΔVpeak was positively correlated with SVV (r = 0.72; P < 0.01). FTc and ΔVpeak predicted SVV ≥ 13% after general anaesthesia in elderly patients, with areas under the receiver operating characteristic curves (AUROCs) of 0.811 [95% confidence interval (CI), 0.721–0.900; P < 0.001] and 0.781 (95% CI, 0.686–0.875; P < 0.001), respectively. The optimal cut-off values of FTc and ΔVpeak to predict SVV ≥ 13% were 340.74 ms (sensitivity of 76.8%; specificity of 80.5%) and 11.69% (sensitivity of 78.0%; specificity of 67.9%), respectively.

Conclusions
There was a good correlation between carotid artery ultrasound parameters and SVV. FTc predicted fluid responsiveness better than ΔVpeak in elderly patients during general anaesthesia. Further study is needed before these parameters can be recommended for clinical application.

Trial registration
www.chictr.org.cn(ChiCTR2000031193); registered 23 March 2020.
Association of serum apoA-I with in-stent restenosis in coronary heart disease
Authors: Wang Xin , Zhang Min , Cheng Jie , Zhou Hua 
Published: August 2022

Abstract
Background
Despite use of drug-eluting stents (DES), in-stent restenosis (ISR) continues adversely affecting clinical outcomes of patients undergoing percutaneous coronary intervention (PCI). Apolipoprotein A-I (apoA-I) has athero-protective effects. However, there is a paucity of clinical data regarding the association between apoA-I and ISR. We sought to investigate whether serum apoA-I is related to ISR after DES-based PCI.

Methods
In this retrospective case control study, 604 consecutive patients who underwent DES implantation before were enrolled. Patients who underwent repeat angiography within 12 months were included in the early ISR study (n = 205), while those beyond 12 months were included in the late ISR study (n = 399). ISR was defined as the presence of > 50% diameter stenosis at the stent site or at its edges. Clinical characteristics were compared between ISR and non-ISR patients in the early and late ISR study, respectively, after adjusting for confounding factors by multivariate logistic regression, stratified analysis, and propensity score matching. The predictive value was assessed by univariate and multivariate logistic regression analysis, receiver operating characteristic (ROC) curve analysis, and quartile analysis.

Results
In the early ISR study, 8.8% (18 of 205) patients developed ISR. Serum apoA-I in the ISR group was lower than that in the non-ISR group (1.1 ± 0.26 vs. 1.24 ± 0.23, P < 0.05). On multivariate logistic regression analysis, apoA-I was an independent risk factor for early ISR. Incidence of early ISR showed negative correlation with apoA-I and could be predicted by the combined use of apoA-I and glycosylated hemoglobin (HbA1c) level. In the late ISR study, 21.8% (87 of 399) patients developed ISR. On subgroup analysis, late ISR showed negative correlation with apoA-I irrespective of intensive lipid lowering; on multivariate logistic regression analysis, apoA-I was also an independent risk factor for late ISR. In patients with intensive lipid lowering, combined use of apoA-I, stenting time, and diabetes predicted the incidence of late ISR.

Conclusions
ApoA-I was an independent risk factor for ISR, and showed a negative correlation with ISR after DES-based PCI. Combined use of apoA-I and clinical indicators may better predict the incidence of ISR under certain circumstances.
Repetitive application of remote ischemic conditioning (RIC) in patients with peripheral arterial occlusive disease (PAOD) as a non-invasive treatment option: study protocol for a randomised controlled clinical trial
Authors: Hummitzsch Lars , Voelckers Luisa , Rusch Melanie , Cremer Jochen , Albrecht Martin , Rusch René , Berndt Rouven 
Published: August 2022

Abstract
Background
The best medical treatment (BMT) for most patients with early stage of peripheral arterial occlusive disease (PAOD) is often limited to gait training and pharmacological therapy besides endovascular surgery. The application of remote ischemic conditioning (RIC) has been described as a promising experimental strategy for the improvement of therapeutic outcome in cardiovascular disease but has not proven beneficial effects in clinical practice and treatment of PAOD yet.

Methods
Here we describe a prospective, randomized trial for the evaluation of possible effects of repeated application of RIC in patients with PAOD. This monocentric study will enrol 200 participants distributed to an intervention group receiving RIC + BMT and a control group only receiving BMT for four weeks. Patients are at least 18 years of age and have diagnosed PAOD Fontaine stage II b. Pain-free and total walking distance will be measured via treadmill test (primary endpoints). In addition, ankle-brachial index (ABI) and quality of life (QoL) will be assessed using the SF-36 and VascuQoL-6 questionnaire. Moreover, evaluation of markers for atherosclerosis, angiogenic profiling and mononuclear cell characterization will be performed using biochemical assays, proteome profiling arrays and flow cytometry (secondary endpoints).

Discussion
Our prospective, randomized monocentric trial is the first of its kind to analyse the effects of chronic and repetitive treatment with RIC in patients with PAOD and might provide important novel information on the molecular mechanisms associated with RIC in PAOD patients.
Trial registration: Prospectively registered in the German Clinical Trials Register (Deutsche Register Klinischer Studien) Registration number: DRKS00025735; Date of registration: 01.07.2021.
Vibrio vulnificus necrotizing fasciitis with sepsis presenting with pain in the lower legs in winter: a case report
Authors: Di Weihua , Cui Jing , Yu Hui , Cui Xiao , Sa Huanlan , Fu Zhong , Fu Bingjin , Guan Guofeng , Du Rui , Shao Cuijie , Gao Yong 
Published: August 2022

Abstract
Background
Vibrio vulnificus infections develop rapidly and are associated with a high mortality rate. The rates of diagnosis and treatment are directly associated with mortality.

Case presentation
We describe an unusual case of a 61-year-old male patient with chronic liver disease and diabetes who presented with a chief complaint of pain in both lower legs due to V. vulnificus infection in winter. Within 12 h of arrival, typical skin lesions appeared, and the patient rapidly developed primary sepsis. Despite prompt appropriate antibiotic and surgical treatment, the patient died 16 days after admission.

Conclusion
Our case findings suggest that V. vulnificus infection should be suspected in patients with an unclear infection status experiencing pain of unknown origin in the lower legs, particularly in patients with liver disease or diabetes, immunocompromised status, and alcoholism.
Performances of birthweight charts to predict adverse perinatal outcomes related to SGA in a cohort of nulliparas
Authors: Galvão Rafael B. , Souza Renato T. , Vieira Matias C. , Pasupathy Dharmintra , Mayrink Jussara , Feitosa Francisco E. , Rocha Filho Edilberto A , Leite Débora F. , Vettorazzi Janete , Calderon Iracema M. , Sousa Maria H. , Cecatti Jose G. ,   for the Preterm SAMBA study group
Published: August 2022

Abstract
Background
Small-for-gestational-age neonates (SGA) are at increased risk of neonatal morbidity. Nulliparity represents a risk factor for SGA; birthweight charts may perform differently for the detection of SGA among nulliparas. This study aimed at describing the prevalence of SGA in nulliparas according to different birthweight charts and evaluating the diagnostic performance of these charts to maternal and perinatal outcomes.

Methods
This is a secondary analysis of a Brazilian cohort of nulliparas named Preterm SAMBA study. Birthweight centiles were calculated using the Intergrowth-21st, WHO-Fetal Growth Charts, Birth in Brazil population chart and GROW-customised chart. The risks of outcomes among SGA neonates and their mothers in comparison to neonates with birthweights between the 40th-60th centiles were calculated, according to each chart. ROC curves were used to detect neonatal morbidity in neonates with birth weights below different cutoff centiles for each chart.

Results
A sample of 997 nulliparas was assessed. The rate of SGA infants varied between 7.0–11.6%. All charts showed a significantly lower risk of caesarean sections in women delivering SGA neonates compared to those delivering adequate-for-gestational-age neonates (OR 0.55–0.64, p < .05). The charts had poor performance (AUC 0.492 – 0.522) for the detection of neonatal morbidity related to SGA born at term.

Conclusion
The populational and customised birthweight charts detected different prevalence of small-for-gestational-age neonates and showed similar and poor performance to identify related neonatal adverse outcomes in this population.
Impact of the COVID-19 pandemic on emergency hospital cancer admissions in a UK region
Authors: Mitchell Helen , Alford Ben S. , O’Hare Simon , O’Callaghan Eamon , Fox Colin , Gavin Anna T. 
Published: August 2022

Abstract
Background
The pandemic disrupted society and health services through lockdowns and resource reallocation to care for COVID-19 patients. Reductions in numbers of cancer patients having surgery, being diagnosed pathologically or via 2-week wait, and screening programs pauses have been described. The effect on emergency presentation, which represents an acute episode with poor outcomes, has not been investigated. This study explored the pandemic’s impact on emergency hospital admissions for cancer patients in a UK region.

Methods
Hospital discharge data for cancer patients in Northern Ireland, which included route to admission, were analysed for the pandemic era in 2020 compared to averages for March to December 2017–2019, focusing on volume and route of emergency admissions by demography and tumour site.

Findings
Compared with the pre-pandemic era, the number of cancer emergency admissions fell by 12·3% in 2020. Emergency admissions for cancer were significantly reduced when COVID-19 levels were highest (− 18·5% in April and − 16.8% in October). Females (− 15·8%), urban residents (− 13·2%), and age groups 0 to 49 and 65–74 years old (− 17%) experienced the largest decreases as did those with haematological (− 14·7%), brain and CNS (− 27·9%), and lung cancers(− 14·3%). Significant reductions in referrals from outpatient departments (− 51%) and primary care (− 43%) (p < 0·001) were counterbalanced by admissions from other routes including confirmed or suspected COVID-19 infection (increase 83·6%).

Interpretation
Reductions in emergency admissions, and pathologically diagnosed cancers, as reported by the Northern Ireland Cancer Registry (NICR), indicate undiagnosed patients in the community which has implications for future workloads and survival. Data suggest undiagnosed cases may be higher for haematological, brain and CNS, and lung cancers and among females. Efforts should be made to encourage people with symptoms to present for diagnosis or reassurance.

Funding
The NICR is funded by the Public Health Agency of Northern Ireland. This work was supported by Macmillan Cancer Support and uses data collected by health services as part of their care and support functions.
The pillars of health: influence of multiple lifestyle behaviors on body mass index and depressive symptoms in adult twins
Authors: Duncan Glen E. , Avery Ally R. , Tsang Siny , Watson Nathaniel F. , Williams Bethany D. , Turkheimer Eric 
Published: August 2022

Abstract
Background
Guidelines promoting healthy lifestyles are cornerstones of chronic disease prevention and treatment. The purpose of this study is to investigate independent and joint associations of five key health behaviors with health outcomes (body mass index (BMI kg/m2) and depressive symptoms) in adult twins.

Methods
We included 6,048 twin pairs from a community-based registry. Five key health behaviors were: (1) ≥ 8 h of sleep per night, (2) ≥ 5 servings of fruits and vegetables daily, (3) ≤ 2 h sedentary time per day, (4) ≥ 150 min of moderate-to-vigorous physical activity (MVPA) per week, and (5) no smoking. We analyzed phenotypic associations between behaviors and outcomes; whether phenotypic associations were confounded by additive genetic and shared environmental factors within twin pairs (“quasi-causal” associations); and which behaviors, considered simultaneously, had the largest associations with outcomes.

Results
We found negative phenotypic associations between number of behaviors achieved with BMI and depressive symptoms score (ps < 0.05). Associations remained significant, though attenuated, when controlling for genetic and shared environmental factors, and demographics, for depressive symptoms score but not BMI (p < 0.05). Quantitative variable importance measures derived from regression tree models showed sedentary time and MVPA were the most important variables in partitioning twins with different BMI, and smoking and sedentary time for partitioning twins with different depressive symptoms score.

Conclusions
Achievement of commonly endorsed health behaviors is associated with lower BMI (especially sedentary and MVPA targets) and depressive symptoms score (especially sedentary and smoking targets). This provides further support of health behavior promotion to improve health outcomes.
A structural equation model-based study on the status and influencing factors of acute exacerbation readmission of elderly patients with chronic obstructive pulmonary disease within 30 days
Authors: Lu Hong-Yan , Zhang Rui , Chang Yan , Zhang Xiao-Na , Zhao Jie , Li Xin-Dan , Feng Xiang-Kai 
Published: August 2022

Abstract
Objective
To investigate the circumstances that lead to acute exacerbation readmission of elderly patients with chronic obstructive pulmonary disease (COPD) within 30 days and to explore the influencing factors of readmission using a structural equation model to provide evidence for medical staff so that effective intervention measures can be taken.

Methods
The convenience sampling method was used to select 1120 elderly patients with COPD from the respiratory departments of thirteen general hospitals in the Ningxia region, China, from April 2019 to August 2020, who then completed a survey questionnaire. The survey questionnaire contained a general data questionnaire and the modified Medical Research Council, activities of daily living, geriatric depression scale and COPD assessment test scales.

Results
The readmission rate of patients with COPD presenting with acute exacerbation within 30 days was determined to be 21.52%. Therefore, the modified model measures data accurately. The results showed that seasonal factors, family rehabilitation, age factors and overall health status were direct factors in the acute exacerbation readmission of patients with COPD within 30 days of hospital discharge. Smoking is not only a direct factor for acute exacerbation readmission within 30 days but also an indirect factor through disease status; disease status and chronic disease are not only direct factors for acute exacerbation readmission within 30 days but also indirect factors through the patient’s overall health status.

Conclusions
The rate of patients with COPD presenting with acute exacerbation within 30 days is high; while taking measures to prevent readmission based on influencing factors that directly impact admission rates, attention should also be paid to the interaction between these factors.
Routine data-based quality indicators for the treatment of gonarthrosis and coxarthrosis patients in the ambulatory care sector – A study protocol for a cluster-randomised pilot trial to evaluate the MobilE-ARTH study
Authors: Bock Tobias , Flemming Ronja , Schüttig Wiebke , Schramm Anja , Weigl Martin B. , Sundmacher Leonie 
Published: August 2022

Abstract
Background
In 2019, Germany had the highest rate of hip replacement surgery and the fourth highest rate of knee replacement surgery among more than 30 OECD countries. The age-standardised rates were estimated at 174 hip joint and 137 knee joint replacements per 100,000 population. Against this background, the contrast between financial incentives for surgery and missing incentives for non-surgical treatment options is repeatedly discussed. Quality indicators (QIs) can serve to measure and transparently present the quality of evidence-based care. Comparing results in the form of audit and feedback has been shown to improve e.g. guideline-compliant ambulatory care. Existing QIs targeting the care of gon- and coxarthrosis mainly focus on discharge management after joint replacement surgery and/or require additional data collection. Therefore, as part of the MobilE-ARTH project, a set of QIs for ambulatory care prior to joint replacement surgery calculable based on routine data is being developed. The present study’s aim is to evaluate the impact of this QI set in terms of providing feedback on the quality of care.

Methods
The MobilE-ARTH project comprises (Phase 1) developing a QI set following the RAND/UCLA Appropriateness Method, (Phase 2) implementing the QIs in established physician networks of a German statutory health insurance (SHI) within a prospective, non-blinded, cluster-randomised pilot study, and (Phase 3) evaluating the QI set’s effectiveness. The physicians in the intervention networks will (a) receive feedback reports providing information about the routine data-based QIs of their gon- and/or coxarthrosis patients and aggregated results for their network, and (b) be invited to two voluntary, facilitated network meetings. In these network meetings, the physicians can use the information provided on the feedback reports to discuss multiprofessional care pathways for patients with gon- and/or coxarthrosis. Selected indicators of the QI set will serve as primary and secondary outcome measures. Routine data will be analysed within multi-level models using an intention-to-treat approach.

Discussion
Feedback reports help maintaining clinical standards and closing the gap between evidence and medical practice, thus enabling an overall improvement in health care. Providing physicians with QI-based information on quality of care promotes identifying strengths and weaknesses in medical treatments.

Trial registration
German Clinical Trials Register, number DRKS00027516, Registered 25th January 2022 – Prospectively registered.
ICU nurses´ lived experience of caring for adult patients with a tracheostomy in ICU: a phenomenological-hermeneutic study
Authors: Akroute Abder Rahim , Brinchmann Berit Støre , Hovland Anders , Fredriksen Sven-Tore Dreyer 
Published: August 2022

Abstract
Background
The care of adult patients with a tracheostomy in intensive care unit is complex, challenging and requires skilled intensive care unit nurses. ICU nurses’ live experience is scarcely known. This study aimed to describe the lived experience of intensive care unit nurses of caring for adult patients with a tracheostomy in intensive care unit.

Methods
This study employs a qualitative design. In-depth interviews were conducted with a purposive sampling of 6 intensive care unit nurses from a medical-surgical ICU of a university hospital in Norway who were interviewed. Data was analyzed and interpreted using a phenomenological-hermeneutic approach. This study was reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Results
The interpretation yielded the following themes and subthemes: 1) theme: ‘challenges of caring for patients with a tracheostomy’ consisted of the sub-themes: ‘difficult to communicate/interpret and understand the patient’s different forms of expression’, ‘complicated professional assessments’, ‘caring with patience’, and ‘collaborating with patient regarding challenges. 2) theme: ‘the satisfaction from providing care to patients with a tracheostomy’ consisted of the sub-themes: ‘working with intensive care patients is instructive’ and ‘importance to motivate’.

Conclusions
ICU nurses experienced ambivalent feelings while caring for adult patients with a tracheostomy in ICU. They perceived caring as demanding owing to communication and collaboration at the same time, they experienced satisfaction while they strived to provide proper care and motivation. The identified challenges would lead to further improvement in nurses’ experiences and, in turn, the quality-of-care for patients with a tracheostomy. Awareness of these challenges is crucial to understand the need for an effective communication strategy to improve the quality and safety of adult patients with tracheostomy in ICU.