bluuebunny/crossref_metadata_2025_split huggingface dataset:
AORTIC STIFFNESS ASSESSED BY HIGH-RESOLUTION PHOTOPLETHYSMOGRAPHY AND SINGLE-LEAD ECG
Authors: Hellqvist Henrik , Karlsson Mikael , Kahan Thomas , Spaak Jonas 
Published: June 2022

Objective:
Aortic stiffness is an independent predictor of cardiovascular risk and plays an important role for the development of cardiovascular disease. However, it is rarely measured in clinical practice as it requires complicated methodology and expensive equipment. We assessed whether high-resolution photoplethysmography (PPG) and single-lead ECG, two methods available in current consumer devices, could be used to measure aortic stiffness.

Design and method:
Simultaneous recordings of infrared PPG (earlobe and index finger), single lead ECG (PowerLab, ADInstruments) and continuous blood pressure (BP) by the volume-clamp method (Ohmeda 2300, Finapres) at 1000 Hz were made in 33 subjects and repeated after 1–3 wks. Carotid-femoral pulse wave velocity (cfPWV, SphygmoCor, AtCor Medical) and aortic pulse wave velocity (aoPWV, Arteriograph, Tensiomed) were measured as reference.
PPG fiducial point identification was refined using pulse wave shapes and the blood pressure signal. Pulse wave analysis extracted 23 features previously associated with arterial stiffness, which were ranked according to univariate strength of correlations with cfPWV and aoPWV. The feature with highest rank was used in a multiple linear regression model with heart rate, body height, mean arterial BP and PAT (ECG R-peak to PPG foot) as covariates.

Results:
Mean age was 44 (range 21–66) ys, 19 were men, and 5 had hypertension; office BP was 119 ± 12/72 ± 9 mm Hg. PWV was similar at visit 1 and 2 (cfPWV 6.74 ± 1.17 vs 6.80 ± 1.18; aoPWV 7.66 ± 1.80 vs 7.55 ± 1.52).
Finger-PPG showed stronger relations with PWV than earlobe-PPG, and 17 of the 23 extracted features showed correlations (P < 0.05) with cfPWV and aoPWV.
The ratio of acceleration features (b-c-d-e)/a showed highest correlations with cfPWV and aoPWV (r2 = 0.58 and 0.64, respectively), that improved in multiple regression (r2 = 0.72 and 0.71, respectively; both P < 0.001).

Conclusions:
High-resolution finger-PPG combined with advanced feature extraction can be used to assess aortic stiffness. Adding body height, BP and single-lead ECG improve the strength of the correlation. Easily available PPG based aortic stiffness may facilitate cardiovascular risk prevention, evaluation, and improve treatment.
ON THE PRESENCE OF EVA SYNDROME IN YOUNG PEOPLE WITHOUT ELEVATED BLOOD PRESSURE
Authors: Evsevyeva Maria , Sergeeva Oksana , Kudryavtseva Victoria , Gachkova Irina , Penzova Violetta , Ovchinnikova Olga 
Published: June 2022

Objective:
The problem of early vascular aging or EVA syndrome is intensively studied. While it remains unclear what is primary - an increase in blood pressure (BP) or an increase in vascular stiffness (VS) due to the primary pathology of the arterial wall? The Objective is to assess the possibility of the presence of cases of isolated EVA syndrome against the background of normotension among young people (YP).

Design and method:
275 YP (95 boys and 180 girls) aged from 18 to 25 years were examined on basis of the StSMU Health Center as part of the National Preventive Project University - Health Territory. Angiological screening was performed using the VaSera VS-1500 device (Fukuda Denshi, Japan), which allows us to evaluate such an VS indicator as cardio-ankle vascular index (CAVI). The examined patients were divided into terciles according to this indicator, taking into account gender, which made it possible to distinguish carriers of elevated (upper CAVI-tercile), normal (middle CAVI-tercile) and favorable (lower CAVI-tercile) VS. The upper tercile is correlated with EVA syndrome. 4 groups were formed: 1gr. - increased VS; 2gr. - increased VS and arterial hypertension -prehypertension (AH-PH); 3gr. - AH-PH; 4gr. - favorable VS and normotension. Carriers of hereditary connective tissue disorders were excluded from the study for a reason an increase in their VS due to genetically determined angiopathy with an imbalance of elastin and collagen fibers in arterial wall.

Results:
It was found that 14.7% (14) fell into the first group among boys, and 20.6% (37) of their total number among girls (P = 0.098). In the second and third groups there were 11.6% (11) and 47.4% (45) boys, and 5.0% (9) and 16.1% (29) girls with P = 0.041 and P = 0.028. Cases with favorable VS in combination with normotension (control) were revealed among boys and girls 11.8% (10) and 21.1% (38), respectively (P = 0.037).

Conclusions:
Our data indicate possibility of the development of isolated EVA syndrome in YP without presence of elevated office BP. Such results are useful to use when conducting screening activities among YP to perform more individualized preventive interventions among them.
HIGHER PREVALENCE OF MASKED UNCONTROLLED HYPERTENSION WITH NEW EUROPEAN BLOOD PRESSURE TARGETS IN AN ELDERLY PRIMARY CARE POPULATION
Authors: Berglund John , Wijkman Magnus O. , Nilsson Staffan 
Published: June 2022

Objective:
The aim of this study was to examine the distribution and clinical characteristics of hypertension phenotypes among patients aged 65 years or older, in a primary care setting, applying the new lower blood pressure targets, of 140/80 mmHg for office blood pressure measurement and 130/75 for ambulatory measurement, proposed by the European Society of Hypertension in 2018.

Design and method:
This is a cross-sectional analysis of 77 subjects previously diagnosed with hypertension who used at least one antihypertensive drug in a primary care setting in south-east Sweden. Data was collected between May 2012 and May 2016. All subjects were examined regarding general clinical characteristics, office blood pressure and ambulatory blood pressure (Spacelabs ABP monitor 90217). The participants were grouped based on office blood pressure target achievement. Furthermore, subjects were categorized in four groups based on hypertension phenotype. These groups were defined based on office- and ambulatory blood pressure target achievement; Sustained controlled hypertension i.e. concordant goal achievement, Sustained uncontrolled hypertension i.e. non-achievement, Masked uncontrolled hypertension i.e. controlled office blood pressure with uncontrolled ambulatory blood pressure and White coat uncontrolled hypertension i.e. uncontrolled office blood pressure with controlled ambulatory blood pressure. Lastly, shifts in the distribution of hypertension phenotypes using current and previous blood pressure targets respectively were examined.

Results:
Obesity related parameters (i.e. BMI and waist circumference) were significantly lower in the group with controlled hypertension based solely on current office blood pressure targets, with BMI (kg/m2) of 25.5 ± 3.9 vs. 28.8 ± 4.9 (p < 0.01) and waist circumference (cm) of 91.0 ± 12.1 vs. 100.3 ± 12.7 (p < 0.01).
Among subjects with controlled office blood pressure, the prevalence of masked uncontrolled hypertension was higher (14/29 or 48%) when new office- and ambulatory blood pressure targets were applied than when older targets were applied (14/43 or 33%).

Conclusions:
The main finding of this observational study was that the prevalence of masked uncontrolled hypertension among subjects with controlled office blood pressure was higher applying new instead of old blood pressure targets. We believe that regular ambulatory blood pressure monitoring can facilitate optimized antihypertensive treatment.
Evaluation of the Processes and Outcomes of a Physician Leadership Program: The Continuous Feedback Loop Design
Authors: Gascon Gregg M. , Chen Huey T. , Morosanu Liliana , Chen Victor H. , Cass Phil , Falcone Robert 
Published: June 2022

Introduction:
Physicians assume leadership roles in their health care organizations and practices often without support or training. The Physicians Leadership Academy provides integrated leadership seminars, mindfulness training, and executive coaching in a 10-month curriculum to physicians across area organizations.

Methods:
Program evaluators responded to stakeholders' need for continuous program improvement by developing a continuous feedback loop evaluation design incorporating a program monitoring system and a theory-driven program evaluation. Given the size of the 2019 to 20 cohort (n = 19), a one-group pretest/posttest design was used to assess the mechanisms of the program (mindfulness and wellbeing) along with knowledge development, emotional intelligence, and personal and professional growth. The assessments used a combination of published and administrator-developed assessments to address the unique aspects of the program. Doing such ensured continuous improvement and sustainability for the program.

Results:
The cohort of physicians demonstrated significant engagement and learning across the curriculum, improved mindfulness, and improved capacity of the providers to affect their health care system and communities.

Conclusions:
The utility of the program was demonstrated through quantitative and qualitative analyses. Implications of the methodology for future evaluations of program developments are discussed.
Consensus-Based Development of an Assessment Tool: A Methodology for Patient Engagement in Primary Care and CPD Research
Authors: Lin Ethan , Gobraeil Jeanne , Johnston Sharon , Venables Maddie J. , Archibald Douglas 
Published: June 2022

Abstract
With cardiovascular disease (CVD) posing a significant disease burden in Canada and more broadly, preventative efforts which incorporate best evidence, patient preference, and physician expertise must continue to take place. Primary care providers play a pivotal role in this effort, and a greater understanding of patient perspectives is needed to guide management and inform training. We used a validated consensus method, the nominal group technique (NGT), to identify patient-reported experience measures (PREM) related to CVD prevention deemed most important by both patients and providers. The NGT was used by using structured discussions between patients and providers to bring ideas about PREM CVD outcomes to a consensus. Four patient partners and four primary care providers were selected to participate in an NGT session. Each participant wrote down items/questions they believed important in CVD preventative care. After discussions, all items underwent anonymous ranking on a 5-point scale. Items were included/excluded based on 75% agreement a priori. The panel produced 10 items from a total of 26 after 2 rounds of ranking. The top two items were as follows: “Is your treatment plan tailored to you” and “Was your physician good at giving information about your risk factors?” These results are significantly different compared with existing quality measures because they highlight aspects of patient experience and therapeutic relationship. A questionnaire consisting of prioritized PREM items is valuable in quality improvement and continuous professional development (CPD).
First Episodes of Norovirus and Sapovirus Gastroenteritis Protect Against Subsequent Episodes in a Nicaraguan Birth Cohort
Authors: Vielot Nadja A. , Reyes Yaoska , Blette Bryan , González Fredman , Toval-Ruiz Christian , Gutiérrez Lester , Vilchez Samuel , Diez-Valcarce Marta , Vinjé Jan , Becker-Dreps Sylvia , Bucardo Filemón 
Published: June 2022

Background:
Norovirus and sapovirus cause a large burden of acute gastroenteritis (AGE) in young children. We assessed protection conferred by norovirus and sapovirus AGE episodes against future episodes.

Methods:
Between June 2017 and July 2018, we recruited 444 newborns in León, Nicaragua. Weekly household surveys identified AGE episodes over 36 months, and AGE stools were tested by reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR) for norovirus genogroup (G)I/GII and sapovirus. We used recurrent-event Cox models and negative control methods to estimate protection conferred by first episodes, controlling for observed and unobserved risk factors, respectively.

Results:
Sapovirus episodes conferred a 69% reduced hazard of subsequent episodes using the negative control method. Norovirus GI (hazard ratio [HR] = 0.67; 95% confidence interval [CI] = 0.31, 1.3) and GII (HR = 0.20; 95% CI = 0.04, 0.44) episodes also appeared highly protective. Protection against norovirus GII was enhanced following two episodes.

Conclusions:
Evidence of natural immunity in early childhood provides optimism for the future success of pediatric norovirus and sapovirus vaccines.
Pregnancy Exposure to Phenols and Anthropometric Measures in Gestation and at Birth
Authors: Jedynak Paulina , Rolland Matthieu , Pin Isabelle , Thomsen Cathrine , Sakhi Amrit K. , Sabaredzovic Azemira , Philippat Claire , Slama Rémy ,   the SEPAGES Study Group
Published: June 2022

Background:
Some synthetic phenols alter pathways involved in fetal development. Despite their high within-subject temporal variability, earlier studies relied on spot urine samples to assess pregnancy exposure. In this study, we examined associations between prenatal phenol exposure and fetal growth.

Methods:
We measured concentrations of two bisphenols, four parabens, benzophenone-3, and triclosan in 478 pregnant women in two weekly pools of 21 samples each, collected at 18 and 34 gestational weeks. We used adjusted linear regressions to study associations between phenol concentrations and growth outcomes assessed twice during pregnancy and at birth.

Results:
Benzophenone-3 was positively associated with all ultrasound growth parameters in at least one time point, in males but not females. In females, butylparaben was negatively associated with third-trimester abdominal circumference and weight at birth. We observed isolated associations for triclosan (negative) and for methylparaben and bisphenol S (positive) and late pregnancy fetal growth.

Conclusions:
Our results suggest associations between prenatal exposure to phenols and fetal growth. Benzophenone-3 was the exposure most consistently (positively) associated across all growth parameters.
Necrotic Granulomatous Inflammation after Use of Small Intestine Submucosa Matrix for Recurrent Compression Neuropathy
Authors: Koenig Zachary A. , Burns Jack C. , Hayes John D. 
Published: June 2022

Summary:
Various techniques exist for treating recurrent carpal and ulnar tunnel syndrome, but AxoGuard nerve wrap has shown promising results for treatment of compression neuropathies when used in conjunction with neurolysis and tenosynovectomy. Prior results demonstrate no safety concerns, and there have not been any reported cases of infection, persistent inflammation, or recurrent perineural fibrosis. A 41-year-old, right-hand-dominant woman experienced repeated bouts of carpal and ulnar tunnel syndromes, which were treated with a small intestine submucosa matrix wrap around the median and ulnar nerves in the wrist. Here, we report a case of necrotic granulomatous inflammation 2.5 months after AxoGuard xenograft nerve wrap was placed around the median and ulnar nerves. As a salvage, NuShield placental allograft was wrapped around the median nerve, which has shown promising results at several months follow-up. Placental allograft nerve wraps represent a useful tool in compression neuropathy resistant to autografts, xenografts, and revision decompression operations.
Effect of Optic Disc Tilt on the Measurement of Peripapillary Vessel Density Using Optical Coherence Tomography Angiography
Authors: Han Ye Eun , Sung Kyung Rim 
Published: June 2022

Précis:
Eyes with tilted disc (TD) had significantly lower peripapillary vessel density (pVD) and lower long-term measurement reproducibility in optical coherence tomography angiography (OCTA). After adjusting for confounding factors, disc tilt still contributed to the reduction of pVD in most sectors.

Purpose:
The purpose of this study was to investigate the effect of optic disc tilt on the measurement of sectoral pVD by OCTA and on the long-term measurement reproducibility.

Materials and Methods:
This retrospective observational case-control study included 70 healthy eyes. Average and 8-sector pVDs and peripapillary retinal nerve fiber layer (pRNFL) thicknesses were obtained from OCTA at 2 visits at 1-year intervals. The disc tilt was quantified by ovality ratio (the longest/shortest disc diameter) on fundus photography, with a TD defined as an ovality ratio ≥1.3. pVD and pRNFL thickness of each sector were compared in the TD and nontilted disc (NTD) groups. Long-term reproducibility was assessed by the intraclass correlation coefficients (ICCs) for both groups. Factors associated with pVD were evaluated by univariable and multivariable linear regression analyses.

Results:
Thirty-five eyes each had TD and NTD. Average pVD was lower in the TD than in the NTD group (47.0%±3.5% vs. 51.7%±2.8%, P<0.001), as were pVDs in all 8 sectors. The long-term reproducibilities of average and sectoral pVD measurements were lower in the TD (ICC: 0.46–0.83) than in the NTD (ICC: 0.67–0.96) group. Disc tilt was significantly associated with pVD in average and all sectors except for nasal inferior sector after adjusting for axial length, pRNFL thickness, and signal strength index of OCTA image.

Conclusion:
OCTA-measured pVD and the long-term reproducibility were lower in eyes with TD than NTD. These findings should be considered when interpreting OCTA-measured pVD.
Role of Transbronchial Lung Cryobiopsy in the Diagnosis of Interstitial Lung Disease
Authors: Zayed Yazan , Alzghoul Bashar N. , Hyde Ryan , Wadood Zerka , Banifadel Momen , Khasawneh Majd , Maharrey Phillip Brandon , Saker Haneen , Harden Christopher , Barnes Gabrielle , Gomez-Manjarres Diana , Patel Divya , Faruqi Ibrahim , Mehrad Borna , Mehta Hiren J. 
Published: June 2022

Background:
Diagnosis of interstitial lung disease (ILD) is based on multidisciplinary team discussion (MDD) with the incorporation of clinical, radiographical, and histopathologic information if available. We aim to evaluate the diagnostic yield and safety outcomes of transbronchial lung cryobiopsy (TBLC) in the diagnosis of ILD.

Methods:
We conducted a meta-analysis by comprehensive literature search to include all studies that evaluated the diagnostic yields and/or adverse events with TBLC in patients with ILD. We calculated the pooled event rates and their 95% confidence intervals (CIs) for the diagnostic yield by MDD, histopathologic diagnostic yield, and various clinical adverse events.

Results:
We included 68 articles (44 full texts and 24 abstracts) totaling 6386 patients with a mean age of 60.7±14.1 years and 56% men. The overall diagnostic yield of TBLC to achieve a definite or high-confidence diagnosis based on MDD was 82.3% (95% CI: 78.9%-85.2%) and histopathologic diagnosis of 72.5% (95% CI: 67.7%-76.9%). The overall rate of pneumothorax was 9.6% (95% CI: 7.9%-11%), while the rate of pneumothorax requiring drainage by a thoracostomy tube was 5.3% (95% CI: 4.1%-6.9%). The rate of moderate bleeding was 11.7% (95% CI: 9.1%-14.9%), while the rate of severe bleeding was 1.9% (95% CI: 1.4%-2.6%). The risk of mortality attributed to the procedure was 0.9% (95% CI: 0.7%-1.3%).

Conclusion:
Among patients with undiagnosed or unclassified ILD requiring tissue biopsy for diagnosis, transbronchial cryobiopsy represents a reliable alternative to surgical lung biopsy with decreased incidence of various clinical adverse events.
Protocol for a Randomized Multiple Center Trial of Conservative Versus Liberal Oxygenation Targets in Critically Ill Children (Oxy-PICU): Oxygen in Pediatric Intensive Care
Authors: Chang Irene , Thomas Karen , O'Neill Gutierrez Lauran , Peters Sam , Agbeko Rachel , Au Carly , Draper Elizabeth , Jones Gareth A. L. , Major Lee Elliot , Orzol Marzena , Pappachan John , Ramnarayan Padmanabhan , Ray Samiran , Sadique Zia , Gould Doug W. , Harrison David A. , Rowan Kathryn M. , Mouncey Paul R. , Peters Mark J. 
Published: June 2022

OBJECTIVES:
Oxygen administration is a fundamental part of pediatric critical care, with supplemental oxygen offered to nearly every acutely unwell child. However, optimal targets for systemic oxygenation are unknown. Oxy-PICU aims to evaluate the clinical effectiveness and cost-effectiveness of a conservative peripheral oxygen saturation (Spo
2) target of 88–92% compared with a liberal target of more than 94%.

DESIGN:
Pragmatic, open, multiple-center, parallel group randomized control trial with integrated economic evaluation.

SETTING:
Fifteen PICUs across England, Wales, and Scotland.

PATIENTS:
Infants and children age more than 38 week-corrected gestational age to 16 years who are accepted to a participating PICU as an unplanned admission and receiving invasive mechanical ventilation with supplemental oxygen for abnormal gas exchange.

INTERVENTION:
Adjustment of ventilation and inspired oxygen settings to achieve an Spo
2 target of 88–92% during invasive mechanical ventilation.

MEASUREMENTS and MAIN RESULTS:
Randomization is 1:1 to a liberal Spo
2 target of more than 94% or a conservative Spo
2 target of 88–92% (inclusive), using minimization with a random component. Minimization will be performed on: age, site, primary reason for admission, and severity of abnormality of gas exchange. Due to the emergency nature of the treatment, approaching patients for written informed consent will be deferred to after randomization. The primary clinical outcome is a composite of death and days of organ support at 30 days. Baseline demographics and clinical status will be recorded as well as daily measures of oxygenation and organ support, and discharge outcomes. This trial received Health Research Authority approval on December 23, 2019 (reference: 272768), including a favorable ethical opinion from the East of England—Cambridge South Research Ethics Committee (reference number: 19/EE/0362). Trial findings will be disseminated in national and international conferences and peer-reviewed journals.