bluuebunny/crossref_metadata_2025 huggingface dataset:
Improved Waterproofing With Duct Tape in Pediatric Hip Spica Casting
Authors: Wiznia Daniel H. , Sharfman Zachary T. , Mackey Catherine , Sharkey Melinda S.
Published: March 2021

While pediatric hip spica casting is an invaluable tool to treat hip and femur conditions, effectively waterproofing the cast has represented a persistent challenge for the orthopaedist. We describe a simple technique that uses duct tape to allow for better waterproofing in the hopes of limiting unnecessary cast changes and skin complications.
Structural Iliac Crest Autograft for Segmental Reconstruction After Metastatic Renal Cell Tumor Resection of the Radial Shaft
Authors: Ola David , Perez Diandra , Damron Timothy A.
Published: March 2021

Introduction:

Metastatic bone lesions are sometimes managed with en bloc resection that creates defects often requiring reconstruction. Reconstructive options for intercalary segmental bone defects are dependent on defect site and size. The radius is a rare site of metastatic disease and even rarer to require resection. While vascularized or nonvascularized fibular autografts have been used in this setting, there is no prior report detailing the use of a large autogenous iliac crest bone graft. We report structural iliac crest autograft reconstruction in a surgically resected radial diaphyseal solitary renal cell carcinoma metastasis.

Case Report:

A 62-year-old man presented with a solitary osseous metastatic bone lesion to the radial shaft. After nephrectomy, resection of the bone lesion followed by reconstruction with autogenous iliac crest bone graft was accomplished. Postoperative plain radiographs a year later showed integration at both graft-host junctions without hardware failure. The Musculoskeletal Tumor Society (MSTS)/Enneking score at 1 year was 22/30 points.

Discussion:

This article presents a case illustrating unique use of structural iliac crest autograft in segmental diaphyseal reconstruction of the radial shaft following metastatic renal cell carcinoma bone resection. This technique has the advantage of potentially increasing rate and decreasing time of healing when compared with allograft techniques and avoids increased operative time and potential donor site morbidity of vascularized fibular grafts.
Stereotactic Body Radiotherapy for Palliation of Hematuria Arising From Urothelial Carcinoma of the Kidney in Unfavorable Surgical Candidates
Authors: Aronowitz Jesse , Ding Linda , Yates Jennifer , Zong Yang , Zheng Larry , Jiang Zhong , Yancey Jessica , Mittal Kriti , Fitzgerald Thomas J.
Published: March 2021

Introduction:

Hematuria can be a distressing and debilitating complication of urothelial carcinoma (UC) of the kidney for patients who are not candidates for surgery or ureteroscopic ablation. We retrospectively assessed the efficacy, tolerability, and safety of stereotactic body radiotherapy (SBRT) for controlling gross hematuria in this patient population.

Materials and Methods:

Institutional Review Board (IRB)-approved review of the records, laboratory values, pathology, and imaging of 8 consecutive patients treated with SBRT over a 5-year period for uncontrolled gross hematuria caused by UC of the renal pelvis or calyces.

Results:

Therapy was delivered in 3 to 5 treatments over 1 to weeks. Individual treatments lasted an average of 17.2 minutes. No patient experienced treatment-related pain, vomiting, or diarrhea. All enjoyed cessation of bleeding within a week of completing therapy. Hematuria recurred in 2 patients in 4 and 22 months. Of the patients who have not re-bled, 3 expired of metastatic disease or co-morbidities, and 3 remain alive up to 6 years posttreatment. Of patients who have survived longer than a year, creatinine has changed by −0.05 to +0.35, and estimated glomerular filtration rate has fallen by an average of 22%. No patient has required dialysis.

Conclusions:

SBRT appears to be an effective and well-tolerated means of palliating gross hematuria secondary to UC of the renal pelvis or calyces in patients who are unfavorable candidates for nephrectomy or ureteroscopic ablation. Treatment was associated with a moderate decline in renal function.
Surveillance Only for High-risk FIGO Stage IA/IB Malignant Ovarian Germ Cell Tumors
Authors: Nasioudis Dimitrios , Frey Melissa K. , Chapman-Davis Eloise , Caputo Thomas A. , Holcomb Kevin M.
Published: March 2021

Objectives:

Investigate the use and outcomes of a surveillance only strategy for patients with high-risk stage I malignant ovarian germ cell tumors.

Methods:

Patients with International Federation of Gynecology and Obstetrics stage IA/IB grade 2 or 3 immature teratoma, yolk sac, or mixed germ cell tumor diagnosed between 2004 and 2014 who had at least 1 month of follow-up were drawn from the National Cancer Database. Overall survival (OS) was evaluated for each histologic subtype using Kaplan-Meier curves, and compared with the log-rank test.

Results:

A total of 497 patients were identified; 115 (23.1%) with grade 2 immature teratoma, 157 (31.6%) with grade 3 immature teratoma, 101 (20.3%) with yolk sac tumor, 124 (25%) with mixed germ cell tumor. Rate of adjuvant chemotherapy was 68.2% (655 patients), while rate of lymph node biopsy/dissection was 55.2%. A total of 19 (3.8%) deaths were observed at a median of 29.8 months. There was no difference in OS between patients who did and did not receive adjuvant chemotherapy with grade 2 (P=0.35) and grade 3 immature teratoma (P=0.47) or mixed germ cell tumors (P=0.55). Patients with yolk sac tumors those who received chemotherapy had better OS compared with those who did not, P=0.019; 5-year OS rates were 92.7% and 79.6%, respectively.

Conclusions:

A surveillance only strategy for patients with stage I malignant ovarian germ cell tumors is associated with excellent survival outcomes for patients with grade 2 or 3 immature teratoma or mixed germ cell tumors.
Pancreatic Cancer Clinical Treatment Trials Accrual
Authors: Guerra Carmen E. , Kelly Sheila , Redlinger Colleen , Hernández Patricia , Glanz Karen
Published: March 2021

Objectives:

Low rates of participation in cancer clinical trials are commonly reported, raising concerns about missed opportunities to engage patients in treatment trials. We reviewed eligibility for and enrollment in pancreatic cancer clinical trials for patients seen at a National Cancer Institute (NCI)-designated cancer center during 1 year, to calculate participation rates with detailed information to determine the best-case participation rate.

Materials and Methods:

This retrospective cohort study used the Abramson Cancer Center Cancer Registry, clinical trial protocols, and electronic medical records (EMRs) to determine eligibility for all available pancreatic cancer clinical trials. Patient characteristics and reasons for ineligibility were abstracted from EMRs. We then computed participation rates based on enrollment in trials using EMR and clinical trials monitoring data.

Results:

Of 233 new pancreatic cancer patients in 2014, 47 or 20% enrolled in a clinical trial (enrollment fraction). According to the EMR, of the 66 patients who were eligible for a trial, 54 (82% of eligible) accepted and 47 (71% of eligible) ultimately enrolled in a trial, 8 (12% of eligible) declined, and 4 (6% of eligible) had no record of patient decision. Enrollment in a trial by both the EMR and clinical trials database was confirmed for 71% of eligible patients.

Conclusions:

This study reveals that 71% of newly diagnosed pancreatic cancer patients who were eligible for a trial were enrolled in a treatment trial. We contend that in-depth analysis, rather than enrollment fraction, should be used to inform the gap between actual participation and optimal clinical trial participation for cancer patients.
Trends and Factors Associated With Receipt of Upfront Surgery for Stage II to III Rectal Adenocarcinoma in the United States, 2006 to 2016
Authors: Hein David M. , Ahn Chul , Aguilera Todd A. , Folkert Michael R. , Sanford Nina N.
Published: March 2021

Introduction:

The German rectal study published in 2004 established neoadjuvant chemoradiation as a standard of care for locally advanced rectal cancer and current National Comprehensive Cancer Network guidelines endorse several preoperative regimens. Upfront surgery, however, is considered substandard care. In the era of evolving treatment paradigms for locally advanced rectal cancer, we sought to assess trends and predictors of receipt of upfront surgery for stage II to III rectal cancer.

Methods:

The National Cancer Database was used to identify patients diagnosed with clinical stage II to III rectal adenocarcinoma between 2006 and 2016. Multivariable logistic regression defined adjusted odds ratios and associated 95% confidence intervals of receipt of upfront definitive surgery. The timing of upfront surgery relative to day of diagnosis and rate of receipt of adjuvant therapy were also estimated.

Results:

Among 51,562 patients, 6411 (12.4%) were treated with upfront surgery, which decreased from 16.7% in 2006 to 7.1% in 2016 (P<0.001). The majority of patients (5737 [89.5%]) had definitive surgery after initial diagnostic biopsy. Variables associated with receipt of upfront surgery included female sex, older age, higher comorbidity score, and treatment at a community cancer center (P<0.001). Among those receiving upfront surgery, 2904 (45.3%) received adjuvant radiation therapy, 3218 (50.2%) received adjuvant chemotherapy, and 2559 (39.9%) received no further treatment.

Conclusions:

The proportion of patients with clinical stage II to III rectal cancer treated with upfront surgery has steadily declined since 2006, however, certain subgroups appear to remain at greater risk. Further research is needed to better elucidate patient and systems-level factors contributing to these disparities in care.
Opposite genotype-specific effects of serotoninergic treatments on Pavlovian Conditioned Approach in mice of two inbred strains C57 BL/6J and DBA/2J
Authors: Maiolati Marzia , Tarmati Valeria , Latagliata Claudio , Cabib Simona , Orsini Cristina
Published: March 2021

Individual variability in the response to pharmacological therapies is a major problem in the treatment of psychiatric disorders. Comparative studies of phenotypes expressed by mice of the C57BL/6J (C57) and DBA/2J (DBA) inbred strains can help identify neurobiological determinants of this variability at preclinical levels. We have recently demonstrated that whereas young adult mice of both strains develop sign-tracking in a Pavlovian Conditioned Approach (PCA), a trait associated with dysfunctional behavior in rat models, in full adult C57 mice acquisition of this phenotype is inhibited by pre-frontal cortical (PFC) serotonin (5HT) transmission. These findings suggest a different role of 5HT transmission on sign-tracking development in mice of the two genotypes. In the present experiments, we tested the effects of the 5-HT synthesis booster 5-hydroxytryptophan (5-HTP) and of the selective 5HT reuptake inhibitor (SSRI) fluoxetine on the development and expression of sign-tracking in young adult mice from both inbred strains. In mice of the C57 strain, administration of 5-HTP before each training session blocked the training-induced shift to positive PCA scores which indicates the development of sign-tracking, whereas the same treatment was ineffective in mice of DBA strain. On the other hand, a single administration of fluoxetine was ineffective in unhandled saline- and 5-HTP-treated C57 mice, whereas it enhanced the expression of positive PCA scores by mice of DBA strain treated with 5-HTP during training. These findings confirm the strain-specific inhibitory role of PFC 5-HT transmission on sign-tracking development by mice of the C57 strain and support the hypothesis that different genotype-specific neurobiological substrates of dysfunctional phenotypes contribute to variable effects of pharmacotherapies.
Personalized Therapy for Mycophenolate: Consensus Report by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology
Authors: Bergan Stein , Brunet Mercè , Hesselink Dennis A. , Johnson-Davis Kamisha L. , Kunicki Paweł K. , Lemaitre Florian , Marquet Pierre , Molinaro Mariadelfina , Noceti Ofelia , Pattanaik Smita , Pawinski Tomasz , Seger Christoph , Shipkova Maria , Swen Jesse J. , van Gelder Teun , Venkataramanan Raman , Wieland Eberhard , Woillard Jean-Baptiste , Zwart Tom C. , Barten Markus J. , Budde Klemens , Dieterlen Maja-Theresa , Elens Laure , Haufroid Vincent , Masuda Satohiro , Millan Olga , Mizuno Tomoyuki , Moes Dirk J. A. R. , Oellerich Michael , Picard Nicolas , Salzmann Linda , Tönshoff Burkhard , van Schaik Ron H. N. , Vethe Nils Tore , Vinks Alexander A. , Wallemacq Pierre , Åsberg Anders , Langman Loralie J.
Published: March 2021

When mycophenolic acid (MPA) was originally marketed for immunosuppressive therapy, fixed doses were recommended by the manufacturer. Awareness of the potential for a more personalized dosing has led to development of methods to estimate MPA area under the curve based on the measurement of drug concentrations in only a few samples. This approach is feasible in the clinical routine and has proven successful in terms of correlation with outcome. However, the search for superior correlates has continued, and numerous studies in search of biomarkers that could better predict the perfect dosage for the individual patient have been published. As it was considered timely for an updated and comprehensive presentation of consensus on the status for personalized treatment with MPA, this report was prepared following an initiative from members of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT). Topics included are the criteria for analytics, methods to estimate exposure including pharmacometrics, the potential influence of pharmacogenetics, development of biomarkers, and the practical aspects of implementation of target concentration intervention. For selected topics with sufficient evidence, such as the application of limited sampling strategies for MPA area under the curve, graded recommendations on target ranges are presented. To provide a comprehensive review, this report also includes updates on the status of potential biomarkers including those which may be promising but with a low level of evidence. In view of the fact that there are very few new immunosuppressive drugs under development for the transplant field, it is likely that MPA will continue to be prescribed on a large scale in the upcoming years. Discontinuation of therapy due to adverse effects is relatively common, increasing the risk for late rejections, which may contribute to graft loss. Therefore, the continued search for innovative methods to better personalize MPA dosage is warranted.
Multimodal imaging in infectious and noninfectious intermediate, posterior and panuveitis
Authors: Thomas Akshay S. , Lin Phoebe
Published: March 2021

Purpose of review

Given the heterogeneity of uveitis, markers of inflammation vary from patient to patient. Multimodal imaging has proven itself to be critical for accurate evaluation for disease activity and treatment response in uveitis.

Recent findings

Ultra-widefield (UWF) fluorescein angiography and autofluorescence (AF) as well as optical coherence tomography angiography (OCTA) have provided insights into disease pathogenesis and monitoring not previously appreciated. In addition to structural retinal imaging, OCT can be used to assess the choroid, the posterior cortical vitreous and the retinal vasculature in eyes with uveitis.

Multimodal ocular imaging in eyes with uveitis is critical for disease diagnosis and assessing response to treatment. UWF fluorescein angiography can detect retinal vasculitis even in the absence of overt vascular sheathing. UWF AF can help detect more chorioretinal lesions than clinically visible. OCT can be used to assess the posterior cortical vitreous, retina, large retinal vessels and choroid in uveitis. The use of multimodal imaging will likely be needed to determine clinical trial endpoints in studies evaluating therapeutics for uveitis.
Detection of Primary Angle Closure Glaucoma Progression by Optical Coherence Tomography
Authors: Kurysheva Natalia I. , Lepeshkina Lyudmila V.
Published: March 2021

Purpose:

To compare the role of spectral-domain optical coherence tomography (SD-OCT) in regard to retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) assessment in the detection of primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) progression.

Materials and Methods:

In the prospective study, 131 subjects with PACG and POAG were examined during 72 months with follow-up visits every 6 months. Visual field (VF) progression was detected using the Guided Progression Analysis (GPA) of the Humphrey visual field analyzer and structural change using SD-OCT while a significant negative trend for the RNFL and GCC was gauged. The diagnostic accuracy of RNFL and GCC thinning in the detection of glaucoma progression was compared between PACG and POAG eyes using the Kaplan-Meier method with the calculation of the log-rank test.

Results:

Progression was detected in 57% of eyes with POAG and 59% of eyes with PACG. The rate of thinning of RNFL (−2.95±1.85 μm/y) and GCC (−3.22±2.96 μm/y) was significantly higher in PACG progression eyes compared with POAG [−1.64±2.00 μm/y (P=0.018) and −1.74±2.05 μm/y (P=0.046), respectively]. The progression was associated with initial pattern standard deviation in both glaucoma subtypes, while only in PACG—with long-term intraocular pressure fluctuations (cutoff >5.2 mm Hg) and lens thickness (cutoff >4.92 mm), and only in POAG—with initial focal loss volume of GCC (cutoff >1.5%).

In PACG, the rate of the visual function deterioration correlated with GCC thinning rate (r=0.330, P=0.027), but not with the RNFL thinning rate (r=−0.010, P=0.79), while in POAG, it was significant for both RNFL thinning (r=0.296, P=0.039) and GCC thinning (r=0.359, P=0.011). In PACG patients with progressive GCC thinning, functional progression was detected earlier (log-rank test P≤0.001) than in patients with progressive RNFL thinning (log-rank test P=0.457), while for POAG, these results were P=0.012 and ≤0.001 for GCC and RNFL thinning, respectively.

Conclusions:

SD-OCT plays an important role in detecting PACG progression. In contrast to POAG, GCC thinning predicted functional loss better than RNFL thinning in PACG.
New-Onset of Inflammatory Bowel Disease in a Patient Treated With Teprotumumab for Thyroid Associated Ophthalmopathy
Authors: Ashraf Davin C. , Jankovic Ivana , El-Nachef Najwa , Winn Bryan J. , Kim Grace E. , Kersten Robert C.
Published: March 2021

A patient with thyroid-associated ophthalmopathy was treated with teprotumumab and developed symptoms concerning for inflammatory bowel disease after her sixth infusion. Colonoscopy was performed, and mucosal biopsies identified evidence of active colitis consistent with a diagnosis of ulcerative colitis. Despite treatment with budesonide and mesalamine, the patient continued to be symptomatic one and a half months after cessation of teprotumumab and required infliximab to achieve good control of her inflammatory bowel disease. This case represents the first report of new-onset inflammatory bowel disease arising during treatment with teprotumumab.
Carcinoma Expleomorphic Adenoma of the Lacrimal Gland
Authors: Vahdani Kaveh , Rose Geoffrey E.
Published: March 2021

Aims:

To report the characteristics and long-term outcomes of patients presenting with carcinoma ex-pleomorphic adenoma (CXPA) or malignant mixed tumor of the lacrimal gland.

Methods:

A retrospective case-note review for patients with CXPA, seen at Moorfields Eye Hospital between 1985 and 2018, was performed for demographics, presentation, imaging, histopathology, management, and outcome.

Results:

Twenty-six patients (11 male; 42%) presented at a mean age of 46 years (median 46.4; range 24–81), with average symptom(s) duration of 67 months (median 24 months; range 6 weeks–53 years). The commonest symptoms were proptosis (13 patients; 50%), orbital ache or pain (11/26, 42%), having noted a lump in the upper eyelid (8/26, 31%), and diplopia (7/26, 27%). About 90% of patients had nonaxial globe displacement, over a half had a palpable mass and 3-quarters had reduced motility. Adenocarcinoma was the commonest malignant component of the tumor, occurring in 16 (62%) of the patients, followed by adenoid cystic carcinoma in 5 patients (19%); 10/26 (28%) tumors showed significant invasion on histological examination. A quarter of the patients had tumor-related death at an average of 2.8 years after diagnosis (median 2.5; range 1.5–4.4 years), and the overall probability of survival for the whole cohort was 63% at both 5 years and 10 years after treatment. The prognosis for CXPA was significantly worse with a history of prior incompletely excised pleomorphic adenoma (p < 0.001), a markedly invasive malignant component (p = 0.001), evidence of perineural invasion (p = 0.042), and an American Joint Committee on Cancer tumor size of T3 or greater (p = 0.024).

Conclusion:

Intact excision of CXPAs that do not display histological evidence of extension beyond the tumor pseudocapsule have a good outcome, similar to that for intact excision of benign pleomorphic adenomas. In contrast, our patients with markedly invasive CXPA had a tendency to local recurrence or distant metastasis, and tumor-related death occurred in about two-thirds.
Early Experience With the Clinical Use of Teprotumumab in a Heterogenous Thyroid Eye Disease Population
Authors: Diniz Stefania B. , Cohen Liza M. , Roelofs Kelsey A. , Rootman Daniel B.
Published: March 2021

Purpose:

To describe the clinical course in a heterogeneous series of subjects with thyroid eye disease (TED) treated with teprotumumab.

Methods:

Cross-sectional cohort study including patients with clinical diagnosis of TED who was treated with teprotumumab. The entire cohort was analyzed together and subsequently in clinical subgroups based on stage and grade of disease. Primary outcome measure was change in proptosis ≥2 mm. Secondary outcome measures included change in clinical activity score (CAS), ductions, strabismic deviation, MRD1, and MRD2. Bivariate and multivariate statistics were performed.

Results:

The study included 21 patients. Mean ± SD age was 61.5 ± 12.6 years and 71.4% were female. Reduction in proptosis ≥2 mm was achieved in 71.4% of the sample. Stage and grade were not significant predictors of outcome. Treatment with teprotumumab resulted in a 2.5 ± 1.8 mm reduction of proptosis (P < 0.001), 2.2 ± 1.4 reduction in CAS (P < 0.001), and 16.9 ± 19.3 degree improvement in extraocular motility (P < 0.001). There were no significant differences for change in CAS, proptosis, ductions, or MRD2 between different grades and stages of disease. Total strabismus and MRD1 improvement were greater in the active stage of disease (P < 0.05). Three cases of dysthyroid optic neuropathy, refractory to methylprednisolone therapy improved after initiation of teprotumumab.

Conclusions:

Treatment of TED with teprotumumab in a heterogeneous patient population is associated with improvement in proptosis, extraocular motility, and CAS. Patients beyond those defined in the clinical trials, including those affected by stable stage, milder grade, and vision-threatening TED may benefit from this therapy. There are, however, limits on the overall efficacy of this medication in the management of certain physical characteristics in TED including eyelid position and strabismus.
Factors affecting the quantity and quality of platelet-rich plasma and platelet-derived growth factor-BB: an observational study
Authors: Verma Rahul , Kandwal Abhishek , Negi Gita , Chandra Harish
Published: March 2021

Objective:

Platelet-rich plasma (PRP) releases growth factors upon activation, which in turn accelerates healing and regeneration of the target tissue. However, PRP composition may vary according to the patient’s demographics, and wider applications of PRP warrant product standardization. The current study aimed to examine variables influencing the platelet-derived growth factor BB (PDGF-BB) concentration in PRP.

Methods:

This observational study was conducted in the Department of Pathology and Dentistry at Swami Rama Himalayan University, a tertiary care hospital in northern India from December 2016 to November 2017. PRP was prepared from 40 mL of whole blood from 35 individuals (22 women, 13 men). Platelet counts, platelet indices (platelet distribution width, mean platelet volume) and PDGF-BB levels were measured, and platelet yield, platelet dose, and growth factor dose in PRP were also calculated. All parameters were analyzed using Pearson’s correlation coefficient. The association between PDGF-BB and PRP platelet count was evaluated using logistic regression. This study was approved by the Ethics Committee of Swami Rama Himalayan University (SRHU/HIMS/ETHICS/2016/103) on September 7, 2016.

Results:

The mean platelet count, PDGF-BB concentration, platelet yield, platelet dose, and growth factor dose in PRP were 1317×10
9
/L, 30±9.89ng/mL, 71.62±28.34%, 6.5±3.5×10
9
, and 159.62±52.39ng/mL, respectively. Linear regression analysis indicated that PRP platelet counts were a good predictor for PGDF-BB (
P
<0.05; adjusted
R
2
=0.96. PRP platelet count was significantly positively correlated with PDGF-BB concentration (
r
=0.74,
P
<0.001), platelet yield (
r
=0.80,
P
<0.001), platelet dose (
r
=1,
P
<0.001), and growth factor dose (
r
=0.74,
P
<0.001).

Conclusions:

PRP has wide clinical applications associated with its healing and regenerative properties, and both the quality and quantity of PRP thus need to be standardized as per the requirements. Evaluating variables affecting PRP will thus aid pathologists and clinical practitioners.
Characteristics of Successful Health Alliance Strategies: Evidence From Rural Healthcare Experiences
Authors: Sarcone David M. , Kimmel Chad M.
Published: March 2021

EXECUTIVE SUMMARY

The formation of regional strategic alliances continues to be a well-evidenced response to a varying array of market forces that are challenging the ability of healthcare institutions to realize their missions. Organizations that serve rural communities especially feel pressure to initiate the formation of these collaborative arrangements.

In response to concerns of Pennsylvania legislators regarding the impact of these alliances on rural healthcare entities, the Center for Rural Pennsylvania funded a study of outcomes of regional strategic alliances involving rural healthcare institutions. Although the research focused on outcomes, the data also revealed organizational characteristics and patterns of decisions and actions that separated rural healthcare institutions with greater alliance outcome success from their peers serving other rural communities. Strategic leadership and interorganizational management expertise serve as the foundation for decisions and actions beginning before an active search for an alliance and culminating with the achievement of alliance goals. Commitments to collaborative leadership, purposeful partnership, coordination, and progress thematically represent the series of critical decisions and actions collectively required to achieve strategic alliance success. The case of the Laurel Health System illustrates these commitments.

Although the findings are based on an intensive review of regional strategic alliances involving rural healthcare institutions, the lessons presented here are transferable to community healthcare organizations regardless of location.
Applications of Bacterial Cellulose as a Natural Polymer in Tissue Engineering
Authors: Bouhlouli Mahboubeh , Pourhadi Masoumeh , Karami Farshid , Talebi Zahra , Ranjbari Javad , Khojasteh Arash
Published: March 2021

Choosing the material with the best regeneration potential and properties closest to that of the extracellular matrix is one of the main challenges in tissue engineering and regenerative medicine. Natural polymers, such as collagen, elastin, and cellulose, are widely used for this purpose in tissue engineering. Cellulose derived from bacteria has excellent mechanical properties, high hydrophilicity, crystallinity, and a high degree of polymerization and, therefore, can be used as scaffold/membrane for tissue engineering. In the current study, we reviewed the latest trends in the application of bacterial cellulose (BC) polymers as a scaffold in different types of tissue, including bone, vascular, skin, and cartilage. Also, we mentioned the biological and mechanical advantages and disadvantages of BC polymers. Given the data presented in this study, BC polymer could be suggested as a favorable natural polymer in the design of tissue scaffolds. Implementing novel composites that combine this polymer with other materials through modern or rapid prototyping methods can open up a great prospect in the future of tissue engineering and regenerative medicine.
Concept and Design of a Novel Pulsatile Left Heart Assist Device—The PERKAT Left Ventricle System
Authors: Kretzschmar Daniel , Möbius-Winkler Sven , Schulze P. Christian , Ferrari Markus W.
Published: March 2021

Cardiogenic shock is associated with high mortality. Patients often require temporary mechanical circulatory support. We aimed to develop a percutaneously implantable, assist device that unloads the left ventricle (LV) in a pulsatile way. The PERkutane KATheter pump technologie (PERKAT LV) device consists of a nitinol pump chamber, which is covered by foils carrying outflow valves. A flexible tube with a pigtail-shaped tip and inflow holes represents the distal part of the pump. The system is designed for 16F percutaneous implantation. The nitinol chamber is placed in the descending aorta while the flexible tube bypasses aortic arch and ascending aorta with its tip in the LV. An intra-aortic balloon pump is placed into the chamber and connected to a console. Balloon deflation generates a blood flow from the LV into the pump chamber. During balloon inflation, blood leaves the system through the outflow foil valves in the descending aorta. Under different afterload settings using a 30 cc intra-aortic balloon pump and varying inflation/deflations rates, we recorded flow rates up to 3.0 L/min. Based on this, we believe that PERKAT LV is a promising approach for temporary LV support. The proposed design and its excellent performance give basis for in vivo tests in an animal model.
Can probiotic supplements improve the symptoms of autism spectrum disorder in children?
Authors: Feng Kai , Zhao Ying , Yu Qingyang , Deng Jialin , Wu Jingjing , Liu Lingjia
Published: March 2021

Introduction:

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with increasing incidence. The externalizing and internalizing problems among children with ASD often persistent and highly impair functioning of both the child and the family. Children with ASD often develop gut-related comorbidities and dysbiosis can have negative effects on not only the gastrointestinal (GI) tract, but also psychological symptoms. Dietary exclusions and probiotic supplements also have been investigated in the management of ASD symptoms. Especially, there is some anecdotal evidence that probiotics supplements are able to alleviate GI symptoms as well as improve behaviors in children with ASD.

Method and analysis:

This review will report on overall studies that include randomized control trials, randomized cross-over studies and cluster-randomized trials designs that consider curative effect in children with ASD by probiotic supplements. We will search 6 databases: MEDLINE, Embase, Scopus, PubMed, The Cochrane Library, and Web of Science and we will perform a manual search the journal Autism and information of ongoing or unpublished studies. The Mixed Methods Appraisal Tool (MMAT) will be used to assess quality of articles and the Jadad scale will be used to assess for bias. Assessment of publication bias will be performed using funnel plots generated by Comprehensive Meta-Analysis (CMA) 3.0 software. Clarifying the evidence in this area will be important for future research directions when reformulating and promoting the therapeutic regime in the field.

Ethics and dissemination:

There are no human participants, data, or tissue being directly studied for the purposes of the review; therefore, ethics approval and consent to participate are not applicable. The results of this study will be presented at conferences and published in peer-reviewed journals.

Registration and status:

PROSPERO 2019 CRD42019132754.
Higher red blood cell distribution width at diagnose is a simple negative prognostic factor in chronic phase-chronic myeloid leukemia patients treated with tyrosine kinase inhibitors
Authors: Mao Xia-Li , Xi Ya-Ming , Li Zi-Jian , Jia Ming-Feng , Li Ming , Wang Li-Na , Zhao Long , Zhang Hao
Published: March 2021

The aim of this study was to evaluate the ability of the red blood cell distribution width (RDW) to predict prognosis and treatment response in chronic myeloid leukemia (CML)-chronic phase (CP) patients treated with tyrosine kinase inhibitor (TKIs).

We retrospectively enrolled 93 newly diagnosed CML-CP patients treated with TKIs from 2009 to 2018 at the First Hospital of Lanzhou University. Patients were divided into 2 groups using an RDW of 18.65% determined by receiver operating characteristic curve analysis. We analyzed the correlation of treatment responses and the RDW compared to common scoring systems, as well as the correlation of the RDW with disease outcome, including overall survival (OS) and progression-free survival (PFS), and demographic and laboratory factors affecting outcome. Univariate analysis and Cox regression analysis were used.

The median age of patients was 40 years, and 51 patients (54.8%) were men. A high RDW could predict treatment response at 3 months (P = .03) and 6 months (P = .02). The RDW was significantly lower in patients who achieved molecular response by 3 months (P < .001) and complete cytogenetic response by 6 months (P = .001) than in those who did not respond. Patients with a high RDW (>18.65%, n = 35) had significantly worse 5-year OS (77.1% vs 96.6%; P = .008) and PFS (80.0% vs 98.3%; P = .002) than those with a low RDW (≤18.65%, n = 58). Multivariate analysis demonstrated that a high RDW was an adverse predictor of OS (P = .005, HR (hazard ratio) = 9.741) and PFS (P = .009, HR = 16.735).

The RDW is a readily available prognostic marker of outcome in patients with CML-CP and can predict treatment response to TKIs. Further larger and prospective studies are required.
Is it safe and effective to correct congenital scoliosis associated with multiple intraspinal anomalies without preliminary neurosurgical intervention?
Authors: Yang Ningning , Luo Ming , Zhao Shixin , Xia Lei , Wang Wengang
Published: March 2021

The aim of the study was to determine if multiple intraspinal anomalies increase the risk of scoliosis correction compared to the normal intraspinal condition or 1 or 2 intraspinal anomalies in congenital scoliosis (CS) and whether correction for multiple intraspinal anomalies need to be performed with preliminary neurosurgical intervention before scoliosis correction.

A total of 318 consecutive CS patients who underwent corrective surgery without preliminary neurosurgical intervention at a single institution from 2008 to 2016 were retrospectively reviewed, with a minimum of 2 years of follow-up. The patients were divided into 3 groups according to different intraspinal conditions. In the normal group (N group; n = 196), patients did not have intraspinal anomalies. In the abnormal group (A group; n = 93), patients had 1 or 2 intraspinal anomalies. In the multiple anomaly group (M group; n = 29), patients had 3 or more intraspinal anomalies including syringomyelia, split cord malformation [SCM], tethered cord, low conus, intraspinal mass, Chiari malformation or/and arachnoid cyst. The occurrence of complications as well as perioperative and radiographic data were analyzed.

The incidence rate of multiple intraspinal anomalies in CS patients was 9.1% (29/318). No significant difference was observed in the perioperative outcomes or radiographic parameters at the final follow-up. There were no significant differences among the 3 groups in the total, major or neurological complication rates (all P > .05). Two patients (1 in the N group and 1 in the A group) experienced transient neurological complications, whereas no patient experienced permanent neurological deficits during surgery or follow-up.

To our knowledge, the current study reported the largest cohort of intraspinal anomalies in patients with CS that has been reported in the literature. The results of our study demonstrated that patients with congenital scoliosis associated with intraspinal anomalies, even multiple intraspinal anomalies that coexist with more complex intraspinal pathologies, may safely and effectively achieve scoliosis correction without preliminary neurological intervention. More complex intraspinal pathologies do not seem to increase the risk of neurosurgical complications during corrective surgery.
Sustained remission of multi-line relapsed extranodal NK/T-cell lymphoma, nasal type, following sintilimab and chidamide
Authors: Xu Jingyan , Xu Xihui , Chen Jieyu , Wang Jing , Jiang Chong , Lv Chenglan , Chen Bing
Published: March 2021

Introduction:

There is currently no optimal treatment modality for refractory or relapsed Extranodal NK/T-cell lymphoma, nasal type (ENKTL). In recent years, programmed cell death protein 1 (PD-1)/programmed cell – ligand 1 pathway blockade and histone deacetylase inhibitors have emerged as promising strategies for refractory or relapsed ENKTL. Accumulating evidence has shown that therapeutic effects of anti-PD-1 antibody could be enhanced by histone deacetylase inhibitors.

Patient Concerns:

A 52-year-old male patient was diagnosed with stage I ENKTL by biopsy on February 2010.

Diagnosis:

positron emission tomography–computed tomography (PET-CT) and biopsy were used to diagnose relapsed ENKTL in 2014.

Interventions:

The patient was treated with radiotherapy and six cycles of etoposide, prednisone, vincristine (Oncovin), cyclophosphamide and doxorubicin hydrochloride and achieved complete remission (CR) by PET-CT in August 2010. In November 2014, the patient was diagnosed with relapsed stage IV ENKTL and was treated with six cycles of alternative chemotherapy with the regimen of steroid (dexamethasone), methotrexate, ifosfamide, L-asparaginase, and etoposide and pegaspargase plus Gemcitabine, Oxaliplatin along with radiotherapy. The patient achieved remission and was placed on thalidomide maintenance treatment. Upon suspicion of relapse suggested by PET-CT, Autologous stem cell transplant was performed after BCNU, etoposide, Ara-C, and melphalan preconditioning on February 2016. Following relapse again in December 2016, the lesions of left femur were treated with radiotherapy and he received anti-PD-1 antibody. He was treated with 4 cycles of pegaspargase plus Gemcitabine, Oxaliplatin on August 2017. The patient's condition improved. He received maintenance and consolidation therapy including lenalidomide, radiotherapy of the right nasal cavity and paranasal sinuses and antigen-specific reactive T cell infusions. PET-CT imaging showed there was high metabolic activity signal in the distal end of right femoral on August 2018 and the treatment regimen was adjusted to radiotherapy of the distal end of right femoral and systemic treatment of PD-1 antibody Sintilimab and chidamide 30 mg. After 5 months post-treatment, biopsy of nasopharynx showed no lymphoma cells. The patient continued the treatment of Sintilimab and chidamide 20 mg.

Outcomes:

PET-CT imaging showed his lesions obtained remission after 8 months post-treatment.

Conclusion:

Thus, combination of sintilimab and chidamide can be used to treat relapsed ENKTL following treatment failure from chemo-, radio-, and immuno-therapy. A clinical trial has been launched.
Effect of rituximab dose on induction therapy in ABO-incompatible living kidney transplantation
Authors: Lee Hee Ryong , Kim Kipyo , Lee Seoung Woo , Song Joon Ho , Lee Jin Ho , Hwang Seun Deuk
Published: March 2021

Background:

Rituximab is an induction immunosuppressant essential for ABO-incompatible kidney transplantation (ABOi KT). However, studies on its dosing, which differs among countries and transplant centers, are lacking. Therefore, we retrospectively investigated the effectiveness of the induction dose of rituximab against patient mortality, graft failure, and adverse events.

Methods:

We included the studies referring to at least 2 of eligible induction doses (200 mg, 200–500 mg, or 500 mg) of rituximab during ABOi KT and relevant outcomes such as patient survival, graft failure, and bacterial and viral infections. We performed direct and indirect network meta-analyses using Bayesian models and ranked different rituximab doses using generation mixed treatment comparison. Publications were retrieved using CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded databases from 1970 to February 2020 and analyzed. The GRADE of network meta-analysis approach specified 4 levels of certainty for a given result: high, moderate, low, and very low.

Results:

Among the 4256 patients from 21 trials, glomerular filtration rate, graft loss, antibody-mediated rejection, T-cell mediated rejection, fungal infection, bacterial infection, and CMV infection did not differ among ABOi groups treated with different rituximab doses. The effect on mortality was significantly higher in rituximab 200 to 500 mg, and rituximab 500 mg groups (odds ratios [OR] 3.5, 95% CrI: 1.3–9.8, and OR 3.0, 95% CrI 1.1–9.8), but not in rituximab 20 mg group (OR 0.45, 95% CrI 0.036–2.5). The incidence of BK virus was significantly lower in the rituximab 200-mg group than in the other groups.

Discussion:

In ABO-incompatible kidney transplantation, low-dose rituximab is more efficacious than higher doses and reduces serious infection risks. Additional randomized controlled trials might be needed to confirm these findings due to small sample size.
The element of family medicine in the mega journal of the family medicine specialty
Authors: Weng Tzu-Ling , Chu Feng-Yuan , Cheng Bo-Ren , Chen Tzeng-Ji
Published: March 2021

Background:

With the evolving specialization of modern medicine, family medicine (FM), also known as general practice, is relatively late in being recognized as a formal specialty in most countries of the world. Because many non-FM specialists were recruited into the new specialty in the early stages of FM specialization, the contents of FM specialty journals might, to an extent, reflect the development of the FM specialization.

Methods:

In this study, the voluminous journal, Chinese General Practice, which is regarded as the most representative specialty journal, was chosen and analyzed to illustrate the current situation of FM in China. A total of 878 articles, relating to the journal, Chinese General Practice in 2018, were retrieved from the publisher's web site and the original articles were categorized into FM- and non-FM- related articles by 3 board-certified FM doctors. Furthermore, the first authors, as well as the institutions and regions where the first authors worked, and their related specialties, were also analyzed.

Results:

Of the 634 original articles, 252 (39.7%) articles were FM related. Only 41 FM-related articles were written by authors working at FM departments: 3 at community health service centers, 29 at hospitals, and 9 at universities. Of the 382 non-FM related articles, 159 articles dealt with the topic of internal medicine, followed by traditional Chinese medicine (36), obstetrics and gynecology (28), neurology (27), pediatrics (27), and surgery (21).

Conclusion:

In conclusion, FM publications in China in the study year, as exemplified by Chinese General Practice, were mostly contributed by non-FM authors dealing with non-FM topics. A transition to more FM-oriented development might be anticipated in the near future.
C-reactive protein/abumin ratio is a useful biomarker for predicting the mucosal healing in the Crohn disease
Authors: Zhou Fu-Sheng , Gao Nan , Sun Xu , Jiang Xiao-Yun , Chen Jia-Jie , Mao Qi-Qi , Zhong Liang
Published: March 2021

Ileocolonoscopy is currently recognized as the gold standard for evaluating mucosal healing in patients with Crohn disease (CD). However, the ideal noninvasive marker to assess mucosal healing instead of invasive ileocolonoscopy is not available. This study aimed to determine the correlations between the mucosal healing and serological optimizing markers in CD.

This retrospective study consecutively included 62 CD patients with 137 hospitalizations between March 2014 and March 2020. On the basis of the Simple Endoscopic Score for Crohn's disease (SES-CD), the CD patients were divided into mucosal healing group (SES-CD ≤ 2) and nonmucosal healing group (SES-CD > 2). We collected the results of ileocolonoscopy examination and inflammatory markers and then serological optimizing markers, including C-reactive protein/albumin ratio (CRP/ALB), platelet/albumin ratio (PLT/ALB), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were calculated. The control group consisted of 50 healthy volunteers in the corresponding period.

We found that CRP/ALB, PLT/ALB, NLR, and PLR were correlated with the mucosal healing of CD, and the correlation of CRP/ALB with the mucosal healing was the highest (r = -0.64). Receiver operating characteristic (ROC) analysis showed that the area under the curve (AUC) of CRP/ALB (0.87) was higher than NLR (0.69), PLR (0.72), and PLT/ALB (0.81). In the efficacy of assessing the mucosal healing in CD, the sensitivity of CRP/ALB, NLR, PLR, and PLT/ALB were 91.1%, 83.9%, 73.2%, and 73.2%, respectively, and the specificity was 76.5%, 46.9%, 64.2%, and 75.3%, respectively.

CRP/ALB was the most appropriate marker to assess CD mucosal healing among the serological optimizing markers.
Antiemetics improve the tolerance of polyethylene glycol for colonoscopy preparation
Authors: Yan Xiu-Juan , Xu Ping , Qiu Hong-Yi , Wang Bo , Luo Qing-Qing , Chen Sheng-Liang
Published: March 2021

Background:

Bowel preparation is essential to the success of colonoscopy. However, many patients cannot finish the preparation due to nausea and vomiting when taking polyethylene glycol (PEG). Dopamine-2 receptor antagonists, such as domperidone and sulpiride, are classical antiemetic drugs. This study aimed to explore the effect of domperidone and sulpiride on reducing the discomforts associated with PEG.

Methods:

Patients scheduled for colonoscopy were enrolled and randomly allocated into 3 groups. Patients in the domperidone group (Dom group) or sulpiride group (Sul group) took 2 doses of domperidone or sulpiride before PEG. Patients in the control group (Con group) followed the regular routine of PEG. Discomforts during bowel preparation and the quality of bowel preparation were assessed.

Results:

A total of 306 patients were enrolled. The participants in the Dom group and Sul group completed PEG better and had fewer abdominal discomforts than those in the Con group. The severity of nausea and abdominal fullness was lower in the Dom group and Sul group. The quality of bowel preparation was better in the Dom group and Sul group than Con group.

Conclusions:

Domperidone and sulpiride could reduce the PEG-related discomfort and improve the quality of bowel preparation. This method may be a promising way to improve the satisfaction of bowel preparation for both patients and endoscopists.