bluuebunny/crossref_metadata_2025_split huggingface dataset:
Applying the Health Belief Model to predict preference for surgical intervention versus medical therapy among patients with open-angle glaucoma
Authors: Awad Khaled , Awad Ramy , Elkazaz Hager , Saleh Marwa , Mehanna Azza 
Published: October 2022

ObjectiveTo determine the factors influencing patient preference of surgical intervention versus medical therapy for open-angle glaucoma based on the Health Belief Model.Methods and analysisThe study is a cross-sectional study. The study was conducted on 309 patients having open-angle glaucoma attending glaucoma clinic at Alexandria Ophthalmology Hospital, Alexandria, Egypt. The patients were subjected to an interview questionnaire comprising demographic data, patient knowledge and beliefs about glaucoma, glaucoma medications and treatment options, and patient preference of treatment modality, based on the Health Belief Model.ResultsAbout half of the patients (46%) were found to prefer surgical intervention. Patients were less knowledgeable about glaucoma, in general, but knowledge scores of patients preferring surgical intervention were significantly higher than those preferring medical therapy (Percentage Mean Score, PMS: 42.46%–37.37%, respectively). Male and female patients using more medications were significantly more likely to prefer surgical intervention (p=0.015 and p=0.003, respectively). Patients having preference for surgical intervention reported higher scores for perceived susceptibility and severity of long-term medical therapy (PMS=72.61% vs 54.62%–68.62% versus 52.83%, respectively), higher scores for perceived benefits of surgical intervention (PMS=92.90% vs 43.96%, respectively) and higher scores for self-efficacy (PMS=97.18% vs 50.37%, respectively). Meanwhile, they obtained lower scores for perceived barriers to surgical intervention (PMS=53.43% vs 86.07%, respectively).ConclusionsMale gender, increased number of used eye-drops and more knowledge about glaucoma were significantly associated with patient preference for surgical intervention. Perceived benefits and barriers and self-efficacy were the significant predictors for patient surgical interference preference.
Validity and reliability of CVI Range assessment for Clinical Research (CVI Range-CR): a longitudinal cohort study
Authors: Chang Melinda , Roman-Lantzy Christine , O’Neil Sharon H , Reid Mark W , Borchert Mark S 
Published: October 2022

IntroductionCortical visual impairment (CVI) is the leading cause of paediatric visual impairment in developed countries. Children with CVI exhibit visual behaviours that differ from those with ocular causes of visual impairment. Currently, there is no standard method of assessing these visual characteristics. We have developed a modified version of the CVI Range, a functional vision assessment, suitable for use in clinical research (CVI Range–Clinical Research (CVI Range-CR)). The purpose of this study is to assess the reliability and validity of this instrument in children with CVI.Methods and analysisThis is a prospective cohort study of 45 children with CVI. A neuro-ophthalmologist will grade visual acuity using the six-level Visual Behaviour Scale (VBS). A neuropsychologist will administer the CVI Range-CR, which will be recorded. The neuropsychologist and two external graders will review and score recorded assessments. These procedures will be performed at baseline and 12 months. We will calculate the intraclass correlation coefficient to assess inter-rater reliability at baseline and follow-up. Additionally, we will correlate CVI Range-CR scores to VBS scores.
Cervical spine movements during laryngoscopy and orotracheal intubation: a systematic review and meta-analysis
Authors: Correa Jaqueline Betina Broenstrup , Felice Vinicius Brenner , Sbruzzi Graciele , Friedman Gilberto 
Published: October 2022

BackgroundAirway management is challenging in trauma patients because of the fear of worsening cervical spinal cord damage. Video-integrated and optic-integrated devices and intubation laryngeal mask airways have been proposed as alternatives to direct laryngoscopy with the Macintosh laryngoscope (MAC). We performed a meta-analysis to clarify which devices cause less cervical movement during airway management.MethodsWe searched MEDLINE, Cochrane Central, Embase and LILACS from inception to January 2022. We selected randomised controlled trials comparing alternative devices with the MAC for cervical movement from C0 to C5 in adult patients, evaluated by radiological examination. Additionally, cervical spine immobilisation (CSI) techniques were evaluated. We used the Cochrane Risk of Bias Tool to evaluate the risk of bias, and the principles of the Grading of Recommendations, Assessment, Development, and Evaluations system to assess the quality of the body of evidence.ResultsTwenty-one studies (530 patients) were included. Alternative devices caused statistically significantly less cervical movement than MAC during laryngoscopy with mean differences of −3.43 (95% CI −4.93 to –1.92) at C0–C1, −3.19 (–4.04 to –2.35) at C1–C2, −1.35 (−2.19 to −0.51) at C2–C3, and −2.61 (–3.62 to –1.60) at C3–C4; and during intubation: −3.60 (–5.08 to –2.12) at C0–C1, −2.38 (−3.17 to −1.58) at C1–C2, −1.20 (–2.09 to –0.31) at C2–C3. The Airtraq and the Intubation Laryngeal Mask Airway caused statistically significant less movement than MAC restricted to some cervical segments, as well as CSI. Heterogeneity was low to moderate in most results. The quality of the body of evidence was ‘low’ and ‘very low’.ConclusionsCompared with the MAC, alternative devices caused less movement during laryngoscopy (C0–C4) and intubation (C0–C3). Due to the high risk of bias and the very low grade of evidence of the studies, further research is necessary to clarify the benefit of each device and to determine the efficacy of cervical immobilisation during airway management.
Development of a specialist ileoanal pouch surgery pathway: a multidisciplinary patient-centred approach
Authors: Celentano Valerio , Rafique Henna , Jerome Melanie , Lee Yu Jin , Kontovounisious Christos , Warren Oliver , MacDonald Alexander , Wahed Mahmood , Mills Sarah , Tekkis Paris 
Published: October 2022

BackgroundRestorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) is the gold standard procedure for ulcerative colitis refractory to medical treatment, as an alternative to permanent end ileostomy. Gaining experience in pouch surgery is difficult as the procedure is performed infrequently. This study presents an institutional initiative to promote standardisation of multidisciplinary care in IPAA surgery.MethodsA dedicated pathway for patients who had an IPAA or are considering IPAA surgery was developed among colorectal surgeons, gastroenterologists, paediatric colorectal surgeons, inflammatory bowel disease (IBD) nurses, dietitians, stoma nurses, trainees in colorectal surgery. Pathway items were discussed and finalised via emails and videoconferences.The pathway included triaging of patients referred for IPAA surgery, preoperative IBD multidisciplinary team discussion and management plan for surgery, surgical review prior to surgery, peer to peer counselling, surgical technique, postoperative short-term and long-term follow-up, audit, research and training in IPAA surgery.ResultsA multidisciplinary preoperative pathway was developed and a stepwise approach to minimally invasive ileoanal pouch surgery was formalised. A dedicated one-stop ileoanal pouch clinic was established integrating endoscopy and imaging on the same day of the consultation with the surgical and gastroenterology team. The clinic reviewed 72 patients over 24 months, and during the same time 36 patients underwent IPAA surgery at our institution.ConclusionsWe have described our initial experience in establishing a specialist IPAA surgery pathway and have proposed outcome measures that we hope will support a subspecialty IPAA service.
Outcomes and drivers of inappropriate dosing of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation: a systematic review and meta-analysis
Authors: Caso Valeria , de Groot Joris R , Sanmartin Fernandez Marcelo , Segura Tomás , Blomström-Lundqvist Carina , Hargroves David , Antoniou Sotiris , Williams Helen , Worsley Alice , Harris James , Caleyachetty Amrit , Vardar Burcu , Field Paul , Ruff Christian T 
Published: October 2022

ObjectiveThere has been limited systematic evaluation of outcomes and drivers of inappropriate non-vitamin K antagonist oral anticoagulants (NOACs) dosing among patients with atrial fibrillation (AF). This review identified and systematically evaluated literature on clinical and economic outcomes of inappropriate NOAC dosing and associated patient characteristics.MethodsMEDLINE, Embase, Cochrane Library, International Pharmaceutical Abstracts, Econlit, PubMed and NHS EEDs databases were searched for English language observational studies from all geographies published between 2008 and 2020, examining outcomes of, or factors associated with, inappropriate NOAC dosing in adult patients with AF.ResultsOne hundred and six studies were included in the analysis. Meta-analysis showed that compared with recommended NOAC dosing, off-label underdosing was associated with a null effect on stroke outcomes (ischaemic stroke and stroke/transient ischaemic attack (TIA), stroke/systemic embolism (SE) and stroke/SE/TIA). Meta-analysis of 15 studies examining clinical outcomes of inappropriate NOAC dosing found a null effect of underdosing on bleeding outcomes (major bleeding HR=1.04, 95% CI 0.90 to 1.19; p=0.625) but an increased risk of all-cause mortality (HR=1.28, 95% CI 1.10 to 1.49; p=0.006). Overdosing was associated with an increased risk of major bleeding (HR=1.41, 95% CI 1.07 to 1.85; p=0.013). No studies were found examining economic outcomes of inappropriate NOAC dosing. Narrative synthesis of 12 studies examining drivers of inappropriate NOAC dosing found that increased age, history of minor bleeds, hypertension, congestive heart failure and low creatine clearance (CrCl) were associated with an increased risk of underdosing. There was insufficient evidence to assess drivers of overdosing.ConclusionsOur analysis suggests that off-label underdosing of NOACs does not reduce bleeding outcomes. Patients prescribed off-label NOAC doses are at an increased risk of all-cause mortality. These data underscore the importance of prescriber adherence to NOAC dosing guidelines to achieve optimal clinical outcomes for patients with AF.PROSPERO registration numberCRD42020219844.
Transition to rilonacept monotherapy from oral therapies in patients with recurrent pericarditis
Authors: Brucato Antonio , Wheeler Alistair , Luis Sushil Allen , Abbate Antonio , Cremer Paul C , Zou Liangxing , Insalaco Antonella , Lewinter Martin , Lewis Basil S , Lin David , Nicholls Stephen , Pancrazi Massimo , Klein Allan L , Imazio Massimo , Paolini John F 
Published: October 2022

ObjectivePolypharmacy management of recurrent pericarditis (RP) often involves long-term therapies, often with negative effects. Slow tapering of oral therapies is often required to avoid recurrence. A post hoc analysis of the phase III trial Rilonacept inHibition of interleukin-1 Alpha and beta for recurrent Pericarditis: a pivotal Symptomatology and Outcomes Study (RHAPSODY) evaluated investigator approaches to transitioning to IL-1 blockade monotherapy with rilonacept, which was hypothesised to allow accelerated withdrawal of common multidrug pericarditis regimens.MethodsRHAPSODY was a multicentre (Australia, Israel, Italy, USA), double-blind, placebo-controlled, randomised-withdrawal trial in adults and adolescents with RP. Investigators initiated rilonacept at the labelled dose level and discontinued oral pericarditis therapies during the 12-week run-in; randomised patients received study drug as monotherapy. Time to rilonacept monotherapy was quantified in patients receiving multidrug regimens at baseline who achieved rilonacept monotherapy during run-in.ResultsIn 86 enrolled patients, mean time to rilonacept monotherapy was 7.9 weeks, with no recurrences. Of these, 64% (n=55) entered on multidrug regimens: non-steroidal anti-inflammatory drugs (NSAIDs) plus colchicine (44% (24/55)), colchicine plus glucocorticoids (24% (13/55)), or NSAIDs, colchicine, plus glucocorticoids (33% (18/55)). Investigators transitioned patients receiving colchicine and glucocorticoids at baseline to rilonacept monotherapy without recurrence regardless of taper approach: sequential (n=14; median, 7.7 weeks) or concurrent (n=17; median, 8.0 weeks). Median time to rilonacept monotherapy was similar regardless of glucocorticoid dose and duration: ≤15 mg/day (n=21): 7.3 weeks; >15 mg/day (n=18): 8.0 weeks; long-term (≥28 days): 7.6 weeks.ConclusionsRapid discontinuation of oral RP therapies while transitioning to rilonacept monotherapy was feasible without triggering pericarditis recurrence.Trial registration numberNCT03737110.
Leisure-time and occupational physical activity and health outcomes in cardiovascular disease
Authors: Bonekamp Nadia E , Visseren Frank L J , Ruigrok Ynte , Cramer Maarten J M , de Borst Gert Jan , May Anne M , Koopal Charlotte 
Published: October 2022

ObjectiveIn healthy populations, leisure-time physical activity (LTPA) improves health outcomes, while, paradoxically, occupational physical activity (OPA) is associated with detrimental health effects. This study aimed to investigate the associations of LTPA and OPA with mortality, cardiovascular events and type 2 diabetes (T2D) in patients with cardiovascular disease (CVD).MethodsIn 7058 outpatients with CVD (age 61±10 years, 75% male) from the prospective Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease cohort, Cox models were used to quantify the associations between self-reported LTPA and OPA and all-cause mortality, cardiovascular events and T2D.ResultsOver 8.6 years (IQR: 4.6–12.5) of follow-up, 1088 vascular events, 1254 deaths and 447 incident T2D cases occurred. The top LTPA quarter had a lower risk of all-cause mortality (HR 0.63, 95% CI 0.54 to 0.74), recurrent cardiovascular events (HR 0.72, 95% CI 0.60 to 0.84) and incident T2D (HR 0.71, 95% CI 0.55 to 0.93), compared with the lowest quarter. The continuous LTPA associations were reverse J-shaped for all-cause mortality and vascular events and linear for T2D. OPA (heavy manual vs sedentary) showed a trend towards an increased risk of all-cause mortality (HR 1.08, 95% CI 0.86 to 1.35), cardiovascular events (HR 1.15, 95% CI 0.91 to 1.45) and T2D (HR 1.04, 95% CI 0.72 to 1.50). The detrimental effects of higher OPA were more pronounced in men, never-smokers, people with higher education and active employment.ConclusionsIn patients with CVD, LTPA was associated with lower risk of all-cause mortality, recurrent cardiovascular events and incident T2D. In contrast, OPA seemed to increase the risk of these outcomes. These findings support the existence of a physical activity paradox in patients with CVD.
Cardiovascular disease and mortality sequelae of COVID-19 in the UK Biobank
Authors: Raisi-Estabragh Zahra , Cooper Jackie , Salih Ahmed , Raman Betty , Lee Aaron Mark , Neubauer Stefan , Harvey Nicholas C. , Petersen Steffen E. 
Published: October 2022

ObjectiveTo examine association of COVID-19 with incident cardiovascular events in 17 871 UK Biobank cases between March 2020 and 2021.MethodsCOVID-19 cases were defined using health record linkage. Each case was propensity score-matched to two uninfected controls on age, sex, deprivation, body mass index, ethnicity, diabetes, prevalent ischaemic heart disease (IHD), smoking, hypertension and high cholesterol. We included the following incident outcomes: myocardial infarction, stroke, heart failure, atrial fibrillation, venous thromboembolism (VTE), pericarditis, all-cause death, cardiovascular death, IHD death. Cox proportional hazards regression was used to estimate associations of COVID-19 with each outcome over an average of 141 days (range 32–395) of prospective follow-up.ResultsNon-hospitalised cases (n=14 304) had increased risk of incident VTE (HR 2.74 (95% CI 1.38 to 5.45), p=0.004) and death (HR 10.23 (95% CI 7.63 to 13.70), p<0.0001). Individuals with primary COVID-19 hospitalisation (n=2701) had increased risk of all outcomes considered. The largest effect sizes were with VTE (HR 27.6 (95% CI 14.5 to 52.3); p<0.0001), heart failure (HR 21.6 (95% CI 10.9 to 42.9); p<0.0001) and stroke (HR 17.5 (95% CI 5.26 to 57.9); p<0.0001). Those hospitalised with COVID-19 as a secondary diagnosis (n=866) had similarly increased cardiovascular risk. The associated risks were greatest in the first 30 days after infection but remained higher than controls even after this period.ConclusionsIndividuals hospitalised with COVID-19 have increased risk of incident cardiovascular events across a range of disease and mortality outcomes. The risk of most events is highest in the early postinfection period. Individuals not requiring hospitalisation have increased risk of VTE, but not of other cardiovascular-specific outcomes.
Prognostic impact of left ventricular global longitudinal strain in atrial mitral regurgitation
Authors: Meucci Maria Chiara , Stassen Jan , Tomsic Anton , Palmen Meindert , Crea Filippo , Bax Jeroen J , Ajmone Marsan Nina , Delgado Victoria 
Published: October 2022

ObjectiveLeft atrial (LA) and left ventricular (LV) mechanics are impaired in patients with atrial functional mitral regurgitation (AFMR), but their prognostic value in this subset of patients remains unknown. The present study aimed to evaluate the association between LA and LV longitudinal strain and clinical outcomes in patients with AFMR.MethodsA total of 197 patients (mean age 73±10 years, 44% men) with at least moderate AFMR were retrospectively identified. LV global longitudinal strain (GLS) and left atrial reservoir strain (LAS) were calculated by two-dimensional speckle tracking echocardiography. All-cause mortality was the primary endpoint of the study. The threshold value of LV GLS (≤16.3%) to identify impaired LV mechanics was defined based on the risk excess of the primary endpoint described with a spline curve analysis.ResultsImpaired LV GLS (≤16.3%) was found in 89 (45%) patients. During a median follow-up of 69 months, 45 (23%) subjects experienced the primary endpoint. Patients with impaired LV GLS (≤16.3%) had a significantly lower cumulative survival rate at 5 years, as compared with patients with LV GLS (>16.3%) (74% vs 93%, p<0.001). On multivariable Cox regression analysis, LV GLS expressed as continuous variable was independently associated with the occurrence of all-cause mortality (HR 0.856, 95% CI 0.763 to 0.960; p=0.008) after adjustment for age, LAS, pulmonary artery systolic pressure and severe tricuspid regurgitation. Conversely, LAS was not significantly associated with patients’ outcome.ConclusionsIn patients with significant AFMR, the impairment of LV GLS was independently associated with worse outcomes.
Preliminary evaluation of the impact of mandatory life jacket laws at declared high-risk rock platforms on unintentional rock fishing drowning deaths
Authors: Peden Amy E , Daw Shane , Lawes Jasmin C 
Published: October 2022

ObjectivesTo explore the impact of mandatory lifejacket wear legislation on unintentional rock fishing-related drowning fatalities at declared high-risk rock platforms in New South Wales (NSW; Australia).MethodsRock fishing-related drownings for the five years pre-legislation enactment (23 November 2011 to 22 November 2016) and five years post-legislation enactment (23 November 2016 to 22 November 2021) were compared. Google Earth was used to assess if drowning deaths occurred at declared areas under legislation. Binary logistic regression was used to analyse change in the number of deaths in declared areas pre-legislation/post-legislation.ResultsOver the 10 years, 80 rock fishing drowning deaths occurred in New South Wales; 23 in declared areas pre-legislation and 13 post-legislation (−43.5%). The odds of a rock fishing drowning death occurring in a declared area pre-legislation was 2.3 times higher (95% CI 0.942 to 5.752; p=0.067).ConclusionReductions in rock fishing deaths at declared areas were observed since the legislation’s introduction, but were not significant. Greater enforcement and extension to other high-risk platforms may reduce deaths further.
Arginase-2-specific cytotoxic T cells specifically recognize functional regulatory T cells
Authors: Weis-Banke Stine Emilie , Lisle Thomas Landkildehus , Perez-Penco Maria , Schina Aimilia , Hübbe Mie Linder , Siersbæk Majken , Holmström Morten Orebo , Jørgensen Mia Aaboe , Marie Svane Inge , Met Özcan , Ødum Niels , Madsen Daniel Hargbøl , Donia Marco , Grøntved Lars , Andersen Mads Hald 
Published: October 2022

BackgroundHigh expression of the metabolic enzyme arginase-2 (ARG2) by cancer cells, regulatory immune cells, or cells of the tumor stroma can reduce the availability of arginine (L-Arg) in the tumor microenvironment (TME). Depletion of L-Arg has detrimental consequences for T cells and leads to T-cell dysfunction and suppression of anticancer immune responses. Previous work from our group has demonstrated the presence of proinflammatory ARG2-specific CD4 T cells that inhibited tumor growth in murine models on activation with ARG2-derived peptides. In this study, we investigated the natural occurrence of ARG2-specific CD8 T cells in both healthy donors (HDs) and patients with cancer, along with their immunomodulatory capabilities in the context of the TME.Materials and methodsA library of 15 major histocompatibility complex (MHC) class I-restricted ARG2-derived peptides were screened in HD peripheral blood mononuclear cells using interferon gamma (IFN-γ) ELISPOT. ARG2-specific CD8 T-cell responses were identified using intracellular cytokine staining and ARG2-specific CD8 T-cell cultures were established by enrichment and rapid expansion following in vitro peptide stimulation. The reactivity of the cultures toward ARG2-expressing cells, including cancer cell lines and activated regulatory T cells (Tregs), was assessed using IFN-γ ELISPOT and a chromium release assay. The Treg signature was validated based on proliferation suppression assays, flow cytometry and quantitative reverse transcription PCR (RT-qPCR). In addition, vaccinations with ARG2-derived epitopes were performed in the murine Pan02 tumor model, and induction of ARG2-specific T-cell responses was evaluated with IFN-γ ELISPOT. RNAseq and subsequent GO-term and ImmuCC analysis was performed on the tumor tissue.ResultsWe describe the existence of ARG2-specific CD8+T cells and demonstrate these CD8+T-cell responses in both HDs and patients with cancer. ARG2-specific T cells recognize and react to an ARG2-derived peptide presented in the context of HLA-B8 and exert their cytotoxic function against cancer cells with endogenous ARG2 expression. We demonstrate that ARG2-specific T cells can specifically recognize and react to activated Tregs with high ARG2 expression. Finally, we observe tumor growth suppression and antitumorigenic immunomodulation following ARG2 vaccination in an in vivo setting.ConclusionThese findings highlight the ability of ARG2-specific T cells to modulate the immunosuppressive TME and suggest that ARG2-based immunomodulatory vaccines may be an interesting option for cancer immunotherapy.