bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coprescribing of opioids and high-risk medications in the USA: a cross-sectional study with data from national ambulatory and emergency department settings
Authors: Suvada Kara , Zimmer Anna , Soodalter Jesse , Malik Jimi S , Kavalieratos Dio , Ali Mohammed K 
Published: June 2022

ObjectiveDescribe trends in opioid plus high-risk medication coprescribing in the USA.DesignAnalyses of serial, cross-sectional, nationally representative data of the National Ambulatory Medical Care Survey (NAMCS) over 2007–2016 and the National Hospital Ambulatory Medical Care Survey (NHAMCS) over 2007–2018.SettingUS ambulatory (NAMCS) and emergency department (ED, NHAMCS) settings.ParticipantsPatient visits in which the patient was 18 years and older with an opioid prescription in the NAMCS or NHAMCS databases.Primary and secondary outcome measuresFrequency of opioid plus high-risk medication coprescribing.ResultsFrom a combined sample of 700 499 visits over 2007–2018, there were 105 720 visits (15.1%) where opioids were prescribed. n=31 825 were from NAMCS and n=73 895 were from NHAMCS. The mean prevalence of coprescription of opioids and high-risk medications for the combined NAMCS and NHAMCS sample was 18.4% in 2007, peaked at 33.2% in 2014 and declined to 23.8% in 2016. Compared with adults receiving opioid prescriptions alone, those coprescribed opioids and high-risk medications were older, more likely female, white and using private or Medicare insurance (p<0.0001).ConclusionsCoprescribing is more common in ambulatory than ED settings and has been declining, yet one in four patient visits where opioids were prescribed resulted in coprescribed, high-risk medications in 2016. Efforts and research to help lower the rates of high-risk prescribing are needed.
Patient-reported outcome measures following surgeries in implant dentistry and associated factors: a cross-sectional study
Authors: Wu Xinyu , Ye Mengjie , Sun Jiahui , Yan Qi , Shi Bin , Xia Haibin 
Published: June 2022

ObjectivesWe aimed to evaluate the patient-reported outcome measures (PROMs) of dental implant surgeries and analyse the associated indicators.DesignA cross-sectional study design was used.SettingDepartment of Oral Implantology, Hospital of Stomatology, Wuhan University (May 2020–April 2021).ParticipantsParticipants with missing teeth in need of implant-supported rehabilitation.InterventionsDental implant placement and/or bone augmentation procedures.Primary and secondary outcome measuresThe primary outcome was discomfort on postoperative day 1, measured using a numerical rating scale (NRS). Secondary outcomes included pain and anxiety during surgery; discomfort on postoperative days 3, 7 and 14; and post-surgical complications.ResultsA total of 366 participants were included, of which 288 (78.7%) and 328 (89.7%) reported no to mild pain and anxiety (NRS 0–3) during surgery, respectively. The proportion of patients reporting discomfort decreased from postoperative day 1 (57.7%) to day 3 (36.1%) and day 7 (17.5%). The most frequent postoperative adverse events were pain and swelling. Patient-related factors (age, sex, smoking, alcohol consumption, history of periodontitis, and pain and anxiety during surgery) and surgery-related factors (type and extent of surgical procedure) were analysed. The factors associated with the severity of discomfort after surgery included alcohol consumption, pain perception during surgery, bone augmentation procedures and age (p<0.05). Similarly, the factors associated with the duration of discomfort included alcohol consumption, pain perception during surgery and age (p<0.05).ConclusionsPROMs related to dental implant surgeries can be predicted using certain risk indicators. Alcohol consumption, pain during surgery and age were associated with discomfort following dental implant surgery.
Safety and tumour-specific immunological responses of combined dendritic cell vaccination and anti-CD40 agonistic antibody treatment for patients with metastatic pancreatic cancer: protocol for a phase I, open-label, single-arm, dose-escalation study (REACtiVe-2 trial)
Authors: Lau Sai Ping , van ’t Land Freek R , van der Burg Sjoerd H , Homs Marjolein Y V , Lolkema Martijn P , Aerts Joachim G J V , van Eijck Casper H J 
Published: June 2022

IntroductionThe prognosis of patients with advanced pancreatic ductal adenocarcinoma (PDAC) is dismal and conventional chemotherapy treatment delivers limited survival improvement. Immunotherapy may complement our current treatment strategies. We previously demonstrated that the combination of an allogeneic tumour-lysate dendritic cell (DC) vaccine with an anti-CD40 agonistic antibody resulted in robust antitumour responses with survival benefit in a murine PDAC model. In the Rotterdam PancrEAtic Cancer Vaccination-2 trial, we aim to translate our findings into patients. This study will determine the safety of DC/anti-CD40 agonistic antibody combination treatment, and treatment-induced tumour-specific immunological responses.Methods and analysisIn this open-label, single-centre (Erasmus Univsersity Medical Center, Rotterdam, Netherlands), single-arm, phase I dose finding study, adult patients with metastatic pancreatic cancer with progressive disease after FOLFIRINOX chemotherapy will receive monocyte-derived DCs loaded with an allogeneic tumour lysate in conjunction with a CD40 agonistic antibody. This combination-immunotherapy regimen will be administered three times every 2 weeks, and booster treatments will be given after 3 and 6 months following the third injection. A minimum of 12 and a maximum of 18 patients will be included. The primary endpoint is safety and tolerability of the combination immunotherapy. To determine the maximum tolerated dose, DCs will be given at a fixed dosage and anti-CD40 agonist in a traditional 3+3 dose-escalation design. Secondary endpoints include radiographic response according to the RECIST (V.1.1) and iRECIST criteria, and the detection of antitumour specific immune responses.Ethics and disseminationThe Central Committee on Research Involving Human Subjects (CCMO; NL76592.000.21) and the Medical Ethics Committee (METC; MEC-2021-0566) of the Erasmus M.C. University Medical Center Rotterdam approved the conduct of the trial. Written informed consent will be required for all participants. The results of the trial will be submitted for publication in a peer-reviewed scientific journal.Trial registration numberNL9723.
Factors influencing participation in physical activity for persons living with dementia in rural and northern communities in Canada: a qualitative study
Authors: Freeman Shannon , Pelletier Chelsea , Ward Kirsten , Bechard Lauren , Regan Kayla , Somani Salima , Middleton Laura Elizabeth 
Published: June 2022

ObjectiveIn recognition that engagement in physical activities for persons living with dementia can be challenging in rural and northern communities, the objective of this study was to explore the factors influencing physical activity participation among persons living with dementia in rural/northern communities and to identify the locally-driven mitigation strategies participants used to address barriers to physical activity.SettingInterviews and focus groups were conducted in two locations in northern British Columbia, Canada including a rural community (<10 000 persons) and a medium-sized geographically isolated city (<80 000 persons). Both communities are located at substantial distances (>700 km) from larger urban centres.ParticipantsTwenty-nine individuals participated including healthcare providers (n=8), community exercise professionals (n=12), persons living with dementia (n=4) and care partners (n=5).ResultsRural and northern contextual factors including aspects of the built and natural environment were the main drivers of physical activity for persons living with dementia. Limited capacity in the health system to support physical activity due to a lack of referrals, poor communication mechanisms and limited resources for programming created challenges for physical activity participation. At the community level, local champions filled gaps in physical activity programming by leveraging informal networks to organise opportunities. Programme-level factors included a lack of consistency in staff, and challenges defining programme scope given limited population size and the fear of stigma for persons living with dementia.ConclusionsEnvironmental context and limited access to specialised programming affect the opportunities for persons living with dementia to engage in physical activities. Rural and northern communities showed resiliency in providing physical activity opportunities yet remained fragile due to human resource challenges. Without reliable resources and sustained support from the health system, local champions remain vulnerable to burnout. Enhancing support for local champions may provide greater stability and support to physical activity promotion in rural and northern communities.
Characteristics and renal survival of patients with lupus nephritis with glomerular immunoglobulin G4deposition: a single-centre retrospective analysis
Authors: Jiang Xue , Lan Lan , Zhou Qin , Wang Huijing , Wang Huiping , Chen Jianghua , Han Fei 
Published: June 2022

ObjectiveRenal injury is common in SLE. Immune complex deposition plays an important role in the development of lupus nephritis (LN), while little is known about glomerular IgG4deposition in patients with LN. This study aimed to investigate the characteristics and renal outcome of patients with LN with glomerular IgG4deposition.MethodsThis is a single-centre retrospective study enrolling 89 patients with biopsy-proven LN. Clinicopathological features, treatment responses and renal outcomes were collected and compared between patients with and without glomerular IgG4deposition. Renal outcome events include progression of renal dysfunction and end-stage renal disease.ResultsThirty (33.7%) patients had glomerular IgG4deposition. Patients with glomerular IgG4deposition had lower serum albumin level (25.06±8.61 g/L vs 28.29±6.31 g/L, p=0.05), more class V LN (60.0% vs 35.6%, p=0.03), more positive phospholipase A2 receptor (PLA2R) staining (43.3% vs 18.6%, p=0.01), more IgG1deposits (96.7% vs 64.4%, p=0.01) and less C3 deposits (46.7% vs 72.9%, p=0.02) than those without glomerular IgG4deposition. They also had better renal survival than those without glomerular IgG4deposition (96.7% vs 79.7%, p=0.03). Multivariate Cox regression showed that high serum creatinine level (relative risk (RR)=1.005, 95% CI 1.002 to 1.008, p=0.01) and high Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores (RR=1.078, 95% CI 1.004 to 1.157, p=0.04) independently correlated with poor renal outcome, while glomerular IgG4deposition tended to correlate with good renal outcome (RR=5.95, 95% CI 0.759 to 45.97, p=0.09). Further, patients with both glomerular IgG4and PLA2R positivity (n=13) had higher levels of serum C3 and C4 and less glomerular C3 deposits compared with those with positive IgG4but negative PLA2R in the glomerulus (n=17), and had a tendency of low SLEDAI score (p=0.07).ConclusionsPatients with LN with glomerular IgG4deposits may have better renal survival, and patients with LN with simultaneous glomerular IgG4and PLA2R deposits may have low disease activity.
Disease monitoring using lung function trajectory in lymphangioleiomyomatosis: assessment in two national cohorts
Authors: Johnson Jan , Stewart Iain , Johnson Simon R 
Published: June 2022

Study questionIn lymphangioleiomyomatosis, airflow obstruction and impairment of gas transfer progress at variable rates and serial lung function is recommended for disease monitoring. As these measurements are variable, recognising subjects needing treatment can be difficult. We used two prospective national cohorts to study change over time and variation in FEV1to inform clinical decision making.Patients and methodsClinical and lung function data for 141 UK and 148 American subjects were studied. Multilevel mixed effects modelling, route mean square analysis of errors and Bland-Altman analysis were used to analyse variability in lung function over time.ResultsAt baseline assessment, DLCOwas reduced to a greater degree than FEV1. In untreated patients, FEV1and DLCOdeclined at proportionately similar rates independent of initial lung function. In mechanistic target of rapamycin (mTOR) inhibitor treated patients, FEV1stabilised but DLCOcontinued to decline. FEV1/DLCOper cent predicted ratio was 1.37 (0.43) at baseline and increased to 1.41 (0.50) after 42 (24) months (p=0.0002). At least five measurements were required before >70% of individuals had estimates of rate of FEV1loss within 50 mL/year and DLCOloss within 0.1 mmol/min/kPa/year of the final values.ConclusionsWhile FEV1and DLCOfall proportionately in most, in early disease and during mTOR inhibitor treatment, DLCOshould also be monitored as it may fall independent of FEV1. Since at least five observations over many months are required to make confident estimates of FEV1and DLCOtrajectories, new strategies are needed to measure disease activity and target early treatment appropriately.
Environmental risks and sphingolipid signatures in adult asthma and its phenotypic clusters: a multicentre study
Authors: Wu Chao-Chien , Wang Chin-Chou , Chung Wen-Yu , Sheu Chau-Chyun , Yang Yi-Hsin , Cheng Ming-Yen , Lai Ruay-Sheng , Leung Sum-Yee , Lin Chi-Cheng , Wei Yu-Feng , Lin Ching-Hsiung , Lin Sheng-Hao , Hsu Jeng-Yuan , Huang Wei-Chang , Tseng Chia-Cheng , Lai Yung-Fa , Cheng Meng-Hsuan , Chen Huang-Chi , Yang Chih-Jen , Hsu Shih-Chang , Su Chian-Heng , Wang Chien-Jen , Liu Huei-Ju , Chen Hua-Ling , Hsu Yuan-Ting , Hung Chih-Hsing , Lee Chon-Lin , Huang Ming-Shyan , Huang Shau-Ku 
Published: June 2022

BackgroundAdult asthma is phenotypically heterogeneous with unclear aetiology. We aimed to evaluate the potential contribution of environmental exposure and its ensuing response to asthma and its heterogeneity.MethodsEnvironmental risk was evaluated by assessing the records of National Health Insurance Research Database (NHIRD) and residence-based air pollution (particulate matter with diameter less than 2.5 micrometers (PM2.5) and PM2.5-bound polycyclic aromatic hydrocarbons (PAHs)), integrating biomonitoring analysis of environmental pollutants, inflammatory markers and sphingolipid metabolites in case–control populations with mass spectrometry and ELISA. Phenotypic clustering was evaluated by t-distributed stochastic neighbor embedding (t-SNE) integrating 18 clinical and demographic variables.FindingsIn the NHIRD dataset, modest increase in the relative risk with time-lag effect for emergency (N=209 837) and outpatient visits (N=638 538) was observed with increasing levels of PM2.5and PAHs. Biomonitoring analysis revealed a panel of metals and organic pollutants, particularly metal Ni and PAH, posing a significant risk for current asthma (ORs=1.28–3.48) and its severity, correlating with the level of oxidative stress markers, notably Nε-(hexanoyl)-lysine (r=0.108–0.311, p<0.05), but not with the accumulated levels of PM2.5exposure. Further, levels of circulating sphingosine-1-phosphate and ceramide-1-phosphate were found to discriminate asthma (p<0.001 and p<0.05, respectively), correlating with the levels of PAH (r=0.196, p<0.01) and metal exposure (r=0.202–0.323, p<0.05), respectively, and both correlating with circulating inflammatory markers (r=0.186–0.427, p<0.01). Analysis of six phenotypic clusters and those cases with comorbid type 2 diabetes mellitus (T2DM) revealed cluster-selective environmental risks and biosignatures.InterpretationThese results suggest the potential contribution of environmental factors from multiple sources, their ensuing oxidative stress and sphingolipid remodeling to adult asthma and its phenotypic heterogeneity.
Effect of hydrogenated fat-embedded calcium gluconate on lactation performance in dairy cows
Authors: Seymour D.J. , McKnight L.L. , Carson M. , Sanz-Fernandez M.V. , Daniel J.B. , Metcalf J.A. , Martín-Tereso J. , Doelman J. 
Published: June 2022

Hydrogenated fat-embedded calcium gluconate (HFCG), a prebiotic mixture designed to target the hindgut, has improved milk and component yields when supplemented in mid-lactation cows, likely due to improved hindgut health. The objective of this study was to evaluate production responses to HFCG when fed to dairy cattle over a full lactation. Seventy-four Holstein cows (21 primiparous, 53 multiparous) were used in a randomized complete block design comparing supplementation with HFCG (approximately 16 g/day supplement delivering approximately 6.4 g active ingredient) to a negative control from approximately 21 days prior to calving until end of lactation. In multiparous cattle supplemented with HFCG, average daily milk protein yield ( P = 0.037) was increased during the first 8 weeks of lactation, while average daily yields of milk fat, and fat- and energy-corrected milk tended ( P ≤ 0.075) to increase over the same period of time. Increased yields were likely supported by the concurrent increase in dry matter intake ( P = 0.036). Future work is needed to characterize the mode of action of this product within both the hindgut lumen and host, as well as investigate the potential differential responses between primiparous and multiparous animals over the course of lactation.
Use of mobile app to enhance functional outcomes and adherence of home-based rehabilitation program for elderly with hip fracture: A randomized controlled trial
Authors: Cheng Kui Ching , Lau Kin Ming Ken , Cheng Andy S. K. , Lau Tin Sing Keith , Lau Fuk On Titanic , Lau Mun Cheung Herman , Law Sheung Wai 
Published: June 2022

Background: Mobile app has been used to improve exercise adherence and outcomes in populations with different health conditions. However, the effectiveness of mobile app in delivering home-based rehabilitation program to elderly patients with hip fracture is unclear. Objective: The aim of this study was to test the effectiveness of mobile app in delivering home-based rehabilitation program for improving functional outcomes and reducing caregiver stress with enhancing adherence among the elderly patients with hip fracture. Methods: A randomized controlled trial with an intervention period of two months was performed. Eligible participants were randomized into either experimental group with home-based rehabilitation program using a mobile app or control group with home-based rehabilitation program using an exercise pamphlet. Primary outcomes were Modified Functional Ambulatory Category (MFAC), Elderly Mobility Scale (EMS) and Lower Extremity Functional Scale (LEFS). Secondary outcomes were exercise adherence and Modified Caregiver Strain Index (M-CSI). The outcomes were collected at pre-discharge training session, one month and two months after hospital discharge. Results: A total of 50 participants were enrolled, with 19 participants in the experimental group and 20 participants in the control group. Eleven participants had withdrawn from the study. The experimental group showed higher exercise adherence than the control group in first month ([Formula: see text]). There were no between-group differences in MFAC, EMS, LEFS and M-CSI at the first month and second month. Conclusion: Use of the mobile app improved exercise adherence, yet it did not improve physical performance, self-efficacy and reduce caregiver stress when compared to a standard home rehabilitation program for elderly patients with hip fracture. Further studies to investigate the benefits of mobile apps are required. (ClinicalTrials.gov ID: NCT04053348.)
Impact of the COVID-19 Pandemic on Trends in Cardiothoracic Imaging
Authors: Capaccione Kathleen M. , Huang Sophia , Leb Jay S. , D’souza Belinda , Goldstein Jonathan , Salvatore Mary M. 
Published: June 2022

Introduction. Here, we evaluate the effect of the COVID-19 pandemic on utilization of cardiothoracic imaging studies. Methods. We queried our radiology record system to retrospectively identify numbers of specific key cardiothoracic imaging studies for five years prior and during the COVID-19 pandemic. Statistical analysis was performed to evaluate changes in the number of exams in 2020 and 2021 compared to 2019. Results. Five-year retrospective analysis demonstrated progressive increases in nearly all cross-sectional studies. In 2020, daily chest radiograph utilization decreased with an overall number of daily radiographs of 406 (SD = 73.1) compared to 480 per day in 2019 (SD = 82.6) (

p

< 0.0001). Portable radiograph utilization was increased in 2020 averaging 320 (SD = 68.2) films daily in 2020 compared to 266 (SD = 29.1) in 2019 (

p

< 0.0001). Utilization of thoracic CT was decreased during the pandemic, with 21.8 (SD = 12.9) studies daily compared to 52.0 (SD = 21.4) (

p

< 0.0001) studies daily in 2019. Cardiac imaging utilization was also substantially decreased in 2020 compared to 2019, averaging a total of 3.8 (SD = 3.2) versus 10.8 (SD = 6.6) studies daily and 0.88 (SD = 1.7) versus 2.5 (SD = 2.3) studies daily for CT and MRI, respectively. Evaluation of cardiothoracic imaging for the subsequent 18 months after New York’s entry to phase I recovery in June 2020 demonstrated that by one year after the emergence of COVID-19 imaging utilization had recovered to prepandemic levels. Cardiac imaging continued to increase throughout the chronic phase of the COVID-19 pandemic, reaching almost twice the prepandemic levels by the end of 2021. Conclusion. COVID-19 has had far-reaching effects on medicine and public health. Here, we demonstrate decreases in all cross-sectional cardiothoracic imaging studies, closely mirroring findings in other fields during the height of the pandemic, which have since rebounded.
Down-Regulation of Overexpressed Sp1 Protein in Human Fibrosarcoma Cell Lines Inhibits Tumor Formation
Authors: Lou Zhenjun , O'Reilly Sandra , Liang Hongyan , Maher Veronica M. , Sleight Stuart D. , McCormick J. Justin 
Published: June 2022

AbstractSp1 is a transcription factor for many genes, including genes involved in tumorigenesis. We found that human fibroblast cells malignantly transformed in culture by a carcinogen or by stable transfection of an oncogene express Sp1 at 8-fold to 18-fold higher levels than their parental cells. These cell lines form fibrosarcomas in athymic mice with a very short latency, and the cells from the tumors express the same high levels of Sp1. Similar high levels of Sp1 were found in the patient-derived fibrosarcoma cell lines tested, and in the tumors formed in athymic mice by these cell lines. To investigate the role of overexpression of Sp1 in malignant transformation of human fibroblasts, we transfected an Sp1 U1snRNA/Ribozyme into two human cell lines, malignantly transformed in culture by a carcinogen or overexpression of an oncogene, and into a patient-derived fibrosarcoma cell line. The level of expression of Sp1 in these transfected cell lines was reduced to near normal. The cells regained the spindle-shaped morphology and exhibited increased apoptosis and decreased expression of several genes linked to cancer, i.e., epithelial growth factor receptor, urokinase plasminogen activator, urokinase plasminogen activator receptor, and vascular endothelial growth factor. When injected into athymic mice, these cell lines with near normal levels of Sp1 failed to form tumors or did so only at a greatly reduced frequency and with a much longer latency. These data indicate that overexpression of Sp1 plays a causal role in malignant transformation of human fibroblasts and suggest that for cancers in which it is overexpressed, Sp1 constitutes a target for therapy.