bluuebunny/crossref_metadata_2025_split huggingface dataset:
Application of 18F-fluorodeoxyglucose positron emission tomography/computerized tomography in mantle cell lymphoma
Authors: Yang Shaoxi , Fu Lilan , AbuduRxiti Meilinur , Wu Jianhua , Wang Qiaoyu , Qin Yongde , Zou Xiaoguang , Li Hongsheng 
Published: March 2020

Objective
The study is to investigate the application of 18F-fluorodeoxyglucose (18F-FDG) PET/computerized tomography (CT) for the evaluation of mantle cell lymphoma (MCL).

Methods
We retrospectively analyzed 39 patients who were pathologically diagnosed with MCL and underwent 18F-FDG PET/CT before treatment between August 2007 and August 2018. We compared the clinical information and PET/CT imaging characteristics in different groups based on bone marrow invasion, spleen invasion or International Prognostic Index (IPI) score. We also assessed the efficacy of PET/CT evaluation basing on the follow-up PET CT findings of 21 MCL patients and their biopsies.

Results
Thirty-five patients were stage IV according to the Revised Ann Arbor Staging System. Lymph node involvement was observed in all 39 cases. The maximum diameter of the affected lymph nodes (4.33 ± 3.09 cm) and maximum standardized uptake value (SUVmax) (8.38 ± 4.99) was positively correlated (r = 0.486, P = 0.002). Extranodal invasion was identified in 38 patients with MCL, and the SUVmax of extranodal invasion was 7.34 ± 3.31. Extranodal invasion was most common in the spleen (25/38) and bone marrow (18/38). The group with bone marrow invasion was more prone to nasopharyngeal, lung and renal invasions (all P < 0.05). The groups with bone marrow invasion or spleen invasion were more likely to have decreased hemoglobin (Hgb) and platelets (all P < 0.01). The IPI high-risk group was more prone to lung involvement, elevated LDH and CRP, and decreased Hgb (all P < 0.05). Among the follow-up of 30 MCL patients, the 2-year progression-free survival and overall survival rates were 73.33 and 87.50%, respectively. PET/CT reexaminations of 21 MCL patients after treatment showed that the sensitivity, specificity, negative predictive value, positive predictive value and accuracy of the efficacy evaluation were 80, 90.91, 88.89, 83.33 and 85.71%, respectively.

Conclusion

18F-FDG PET/CT imaging has important application value in the diagnosis, staging, treatment efficacy assessment and prognosis monitoring of MCL, especially in the systemic assessment of advanced MCL.
Platelet Inhibition With IV Glycoprotein IIb/IIIa Inhibitor to Prevent Thrombosis in Pediatric Patients Undergoing Aortopulmonary Shunting*
Authors: Emani Sirisha , Pereira Luis M. , Piekarski Breanna L. , Diallo Fatoumata , Chu Esther , Wesley Mark C. , Thiagarajan Ravi , Emani Sitaram M. 
Published: March 2020

Objectives:
Shunt thrombosis, a potential complication of aortopulmonary shunting, is associated with high mortality. Commonly used oral antiplatelet drugs such as aspirin demonstrate variable absorption and inconsistent antiplatelet effect in critically ill patients early after surgery. IV glycoprotein IIb/IIIa inhibitors are antiplatelet agents with rapid and reproducible effect that may be beneficial as a bridge to oral therapy.

Design:
Retrospective review of pediatric patients undergoing treatment with IV tirofiban. Discarded blood samples were used to determine pharmacokinetic parameters.

Setting:
Pediatric cardiac ICU at a single institution.

Patients:
Fifty-two pediatric patients (< 18 yr) undergoing surgical aortopulmonary shunt procedure who received tirofiban infusion as a bridge to oral aspirin.

Interventions:
None.

Measurements and Main Results:
Primary outcome measures were shunt thrombosis and bleeding events, whereas secondary outcomes included measurement of platelet inhibition by thromboelastography with platelet mapping and pharmacokinetic analysis (performed in a subset of 15 patients). Shunt thrombosis occurred in two of 52 patients (3.9%) after prophylaxis treatment with tirofiban; both thrombosis events occurred after discontinuation of the drug. One patient (1.9%) experienced bleeding complication during the infusion. A tirofiban bolus of 10 µg/kg and infusion of 0.15 µg/kg/min resulted in significantly increased platelet inhibition via adenosine diphosphate pathway (median 66% [43–96] pre-tirofiban compared with 97% [92–99%] at 2 hr; p < 0.05). Half-life of tirofiban in plasma was 142 ± 1.5 minutes, and the average steady-state concentration was 112 ± 62 ng/mL. Age and serum creatinine were significant covariates associated with systemic clearance. Dosing simulations were generated based upon one compartment model.

Conclusions:
IV glycoprotein IIb/IIIa inhibitor as a bridge to oral antiplatelet therapy is safe in pediatric patients after aortopulmonary shunting. Dosing considerations should include both age and renal function. Randomized trials are warranted to establish efficacy compared with current anticoagulation practices.
Outcomes of Pediatric Patients Treated With Extracorporeal Membrane Oxygenation for Intractable Supraventricular Arrhythmias
Authors: Ghaleb Stephanie , Thiagarajan Ravi R. , Cooper David S. , Czosek Richard J. 
Published: March 2020

Objectives:
Extracorporeal membrane oxygenation is used to support refractory cardiorespiratory failure. Outcomes and complications when extracorporeal membrane oxygenation is used to support cardiorespiratory failure secondary to arrhythmia in pediatric patients remain poorly defined. Our purpose is to describe pediatric patients requiring extracorporeal membrane oxygenation support for supraventricular arrhythmias in the context of normal cardiac anatomy and congenital heart disease and identify patient/peri-extracorporeal membrane oxygenation variables associated with extracorporeal membrane oxygenation–related complications and survival.

Design:
Retrospective multicenter review from 1993 to 2016.

Setting:
Extracorporeal Life Support Organization registry.

Subjects:
Patients younger than 21 years old requiring extracorporeal membrane oxygenation support for supraventricular arrhythmias.

Interventions:
None.

Measurements and Main Results:
A total of 342 patients were identified (weight, 3.8 kg [3.2–7.5 kg]; age at extracorporeal membrane oxygenation initiation, 24 d [6–222]; 61% male). Sixty-five percentage survived to hospital discharge. Complications were frequent (85%) and most commonly cardiac related (31%). In multivariable modeling, mortality was associated with congenital heart disease, time from intubation to extracorporeal membrane oxygenation initiation, use of bicarbonate prior to extracorporeal membrane oxygenation, extracorporeal membrane oxygenation duration, and the presence of a complication. The presence of any complication was associated with a three-fold increase in the odds of death. In subgroup analysis of isolated supraventricular arrhythmias patients, similar patient and extracorporeal membrane oxygenation characteristics were associated with outcome. A lower pre-extracorporeal membrane oxygenation pH and Pco
2 and site of venous cannulation were associated with complications (p < 0.02).

Conclusions:
Extracorporeal membrane oxygenation use for medically refractory supraventricular arrhythmias was associated with a 65% survival to hospital discharge. However, there was a high rate of complications, the presence of which was associated with decreased survival. Complications appeared to be related to pre-extracorporeal membrane oxygenation clinical status and whether earlier extracorporeal membrane oxygenation cannulation prior to patient deterioration would improve outcomes needs additional evaluation.
A Respiratory Therapist-Driven Pathway Improves Timeliness of Extubation Readiness Assessment in a Single PICU
Authors: Loberger Jeremy M. , Jones Ryan M. , Prabhakaran Priya 
Published: March 2020

Objectives:
Our smart aim was to decrease the time between when a mechanically ventilated patient was eligible for and when they underwent their first extubation readiness test (delta time) by 50% within 3 months through the development and implementation of a respiratory therapist-driven extubation readiness test pathway.

Design:
Quality improvement project.

Setting:
Single, tertiary care, 24-bed, academic PICU.

Patients:
Pediatric patients admitted to the PICU and requiring mechanical ventilation for a primary pulmonary process.

Interventions:
We developed an extubation readiness test pathway that consisted of an eligibility screen and a standard testing process. Patients were screened every 3 hours. Upon passing the screen and being cleared by a prescriber, a test was initiated. No clinical management was dictated to prescribers.

Measurements and Main Results:
The preintervention and intervention cohorts included 109 and 43 mechanical ventilation courses, respectively. The mean delta time decreased from 33.77 hours to 2.92 hours after pathway implementation (p = 0.000). The medical length of stay decreased from 196.6 to 177.2 hours (p = 0.05). There were no statistically significant changes in duration of mechanical ventilation until first extubation (112.9 vs 122.3 hr; p = 0.651) and 48-hour extubation failure rate (16.5% vs 4.8%; p = 0.056). The sensitivity and positive predictive value for the extubation readiness test were 89.5% and 94.4%, respectively. The mean for all process compliance measures was 91.5%.

Conclusions:
A respiratory therapist-driven extubation readiness test pathway can be safely implemented in a large, academic PICU. The pathway resulted in earlier extubation readiness testing without increasing key balancing measures—the duration of mechanical ventilation, PICU length of stay, or the extubation failure rate.
Closing the Gap: Optimizing Performance to Reduce Interruptions in Cardiopulmonary Resuscitation*
Authors: Jones Sara I. , Jeffers Justin M. , Perretta Julie , Stella Andrew , Sorcher Jill L. , Hunt Elizabeth A. , Duval-Arnould Jordan M. 
Published: March 2020

Objectives:
The American Heart Association recommends minimizing pauses of chest compressions and defines high performance resuscitation as achieving a chest compression fraction greater than 80%. We hypothesize that interruption times are excessively long, leading to an unnecessarily large impact on chest compression fraction.

Design:
A retrospective study using video review of a convenience sample of clinically realistic in situ simulated pulseless electrical activity cardiopulmonary arrests.

Setting:
Johns Hopkins Children’s Center; September 2013 to June 2017.

Patients:
Twenty-two simulated patients.

Interventions:
A framework was developed to characterize interruptions. Two new metrics were defined as follows: interruption time excess (the difference between actual and guideline-indicated allowable duration of interruption from compressions), and chest compression fraction potential (chest compression fraction with all interruption time excess excluded).

Measurements and Main Results:
Descriptive statistics were generated for interruption-level and event-level variables. Differences between median chest compression fraction and chest compression fraction potential were assessed using Wilcoxon rank-sum test. Comparisons of interruption proportion before and after the first 5 minutes were assessed using the X
2 test statistic. Seven-hundred sixty-six interruptions occurred over 22 events. Median event duration was 463.0 seconds (interquartile range, 397.5–557.8 s), with a mean 34.8 interruptions per event. Auscultation and intubation had the longest median interruption time excess of 13.0 and 7.5 seconds, respectively. Median chest compression fraction was 76.0% (interquartile range, 67.7–80.7 s), and median chest compression fraction potential was 83.4% (interquartile range, 80.4–87.4%). Comparing median chest compression fraction to median chest compression fraction potential found an absolute percent difference of 7.6% (chest compression fraction: 76.0% vs chest compression fraction potential: 83.4%; p < 0.001).

Conclusions:
This lays the groundwork for studying inefficiency during cardiopulmonary resuscitation associated with chest compression interruptions. The framework we created allows for the determination of significant avoidable interruption time. By further elucidating the nature of interruptions, we can design and implement targeted interventions to improve patient outcomes.
Hypothermia Plus Melatonin in Asphyctic Newborns: A Randomized-Controlled Pilot Study
Authors: Jerez-Calero Antonio , Salvatierra-Cuenca Maria Teresa , Benitez-Feliponi Ángela , Fernández-Marín Carmen Elisabeth , Narbona-López Eduardo , Uberos-Fernández José , Muñoz-Hoyos Antonio 
Published: March 2020

Objectives:To investigate the effect of adding melatonin to hypothermia treatment on neurodevelopmental outcomes in asphyctic newborns.Design:Pilot multicenter, randomized, controlled, double-blind clinical trial. Statistical comparison of results obtained in two intervention arms: hypothermia plus placebo and hypothermia plus melatonin.Setting:Level 3 neonatal ICU.Patients:Twenty-five newborns were recruited.Interventions:The hypothermia plus melatonin patients received a daily dose of IV melatonin, 5 mg per kg body weight, for 3 days. General laboratory variables were measured both at neonatal ICU admission and after intervention. All infants were studied with amplitude-integrated electroencephalography and brain MRI within the first week of life. The neurodevelopmental Bayley III test, the Gross Motor Function Classification System, and the Tardieu scale were applied at the ages of 6 and 18 months.Measurements and Main Results:Clinical characteristics, laboratory evaluations, MRI findings, and amplitude-integrated electroencephalography background did not differ between the treatment groups. The newborns in the hypothermia plus melatonin group achieved a significantly higher composite score for the cognitive section of the Bayley III test at 18 months old, with respect to the hypothermia plus placebo group (p= 0.05). There were no differences between the groups according to the Gross Motor Function Classification System and Tardieu motor assessment scales.Conclusions:The early addition of IV melatonin to asphyctic neonates is feasible and may improve long-term neurodevelopment. To our knowledge, this is the first clinical trial to analyze the administration of IV melatonin as an adjuvant therapy to therapeutic hypothermia.
Nondaily Use of HIV Preexposure Prophylaxis in a Large Online Survey of Primarily Men Who Have Sex With Men in the United States
Authors: Sewell Whitney C. , Powell Victoria E. , Mayer Kenneth H. , Ochoa Aileen , Krakower Douglas S. , Marcus Julia L. 
Published: March 2020

Background:
Event-driven dosing of HIV preexposure prophylaxis (PrEP) using a 2-1-1 regimen is efficacious for men who have sex with men (MSM). However, data are limited on the prevalence, correlates, and patterns of nondaily PrEP use in the United States.

Setting:
Nationwide online survey.

Methods:
We distributed a survey to assess experiences with PrEP, including nondaily use, in May 2019 on geosocial networking sites commonly used by MSM.

Results:
Among 9697 respondents, the mean age was 43 years, 67% were non-Hispanic white, and 90% were MSM. Nearly all (91.0%) had heard of PrEP, 40.1% ever used PrEP, and 33.3% used PrEP in the past 6 months. Most (60.6%) were interested in nondaily PrEP. Those without health insurance and those with higher incomes were more likely to be interested in nondaily PrEP. Of the 3232 who used PrEP in the past 6 months, 176 (5.4%) reported nondaily use. Fewer sexual partners, frequent sex planning, and substance use were associated with nondaily use. Common reasons for nondaily use were inconsistent sexual activity (59%) and cost (49%). The most prevalent regimen was event driven (48.3%); of those, 64.7% used 2-1-1. Of nondaily users, 24.0% used PrEP on a regular schedule but not every day, including only on weekends or days starting with T or S.

Conclusions:
Given substantial interest in nondaily PrEP, and use of nondaily strategies that have not been evaluated in clinical studies, there is a need for US public health authorities to provide guidance on safe and effective nondaily dosing for MSM.
HIV Oral Self-Testing for Male Partners of Women Attending Antenatal Care in Central Uganda: Uptake of Testing and Linkage to Care in a Randomized Trial
Authors: Korte Jeffrey E. , Kisa Rose , Vrana-Diaz Caroline J. , Malek Angela M. , Buregyeya Esther , Matovu Joseph K.B. , Kagaayi Joseph , Musoke William , Chemusto Harriet , Mukama Semei C. , Ndyanabo Anthony , Mugerwa Shaban , Wanyenze Rhoda K. 
Published: March 2020

Background:
In Uganda, HIV testing rates are approximately 90% among women in antenatal care, with male rates much lower. The World Health Organization has recommended HIV self-testing (HIVST), and one promising model is for women in antenatal care to deliver HIVST kits to their male partners. We investigated the impact of this model on male partner testing rates.

Setting:
Three high-volume antenatal clinics in central Uganda.

Methods:
We implemented a cluster-randomized controlled trial comparing standard of care to intervention, with the primary outcome of self-reported male partner HIV testing. Women and male partners were followed at 1 and 3 months. We used unadjusted analyses and log-linear models with an intent-to-treat approach accounting for clustering.

Results:
Study coordinators randomized 1514 women (777 intervention and 737 control). Baseline characteristics were balanced across arms with mean age (SD) of 25.2 (5.5) years and >44% with secondary education or higher. More male partners tested for HIV in intervention [576/746 (77.2%)] versus control [264/709 (37.2%)], P < 0.01. We identified 34 HIV-positive men in intervention versus 10 in control, with 6/26 (23%) and 4/6 (67%), respectively, reporting linking to care.

Conclusions:
Our results demonstrate an enormous increase in self-reported partner HIV testing when HIVST is available at home. However, men testing positive through HIVST appeared less likely to link to care than men testing positive at a clinic. These results highlight the potential of HIVST in increasing HIV testing rates, while underscoring the importance of developing effective approaches to maximizing linkage to care among those testing positive through HIVST.
Early, low-dose and short-term application of corticosteroid treatment in patients with severe COVID-19 pneumonia: single-center experience from Wuhan, China
Authors: Wang Yin , Jiang Weiwei , He Qi , Wang Cheng , Liu Baoju , Zhou Pan , Dong Nianguo , Tong Qiaoxia 
Published: March 2020

AbstractBackgroundSevere patients with 2019 novel coronavirus (2019-nCoV) pneumonia progressed rapidly to acute respiratory failure. We aimed to evaluate the definite efficacy and safety of corticosteroid in the treatment of severe COVID-19 pneumonia.MethodsForty-six hospitalized patients with severe COVID-19 pneumonia hospitalized at Wuhan Union Hospital from January 20 to February 25, 2020, were retrospectively reviewed. The patients were divided into two groups based on whether they received corticosteroid treatment. The clinical symptoms and chest computed tomography(CT) results were compared.ResultsA total of 26 patients received intravenous administration of methylprednisolone with a dosage of 1-2mg/kg/d for 5-7 days, while the remaining patients not. There was no significant difference in age, sex, comorbidities, clinical or laboratory parameters between the two groups on admission. The average number of days for body temperature back to the normal range was significantly shorter in patients with administration of methylprednisolone when compared to those without administration of methylprednisolone (2.06±0.28 vs. 5.29±0.70, P=0.010). The patients with administration of methylprednisolone had a faster improvement of SpO2, while patients without administration of methylprednisolone had a significantly longer interval of using supplemental oxygen therapy (8.2days[IQR 7.0-10.3] vs. 13.5days(IQR 10.3-16); P<0.001). In terms of chest CT, the absorption degree of the focus was significantly better in patients with administration of methylprednisolone.ConclusionOur data indicate that in patients with severe COVID-19 pneumonia, early, low-dose and short-term application of corticosteroid was associated with a faster improvement of clinical symptoms and absorption of lung focus.
Forensic genomics of a novel Klebsiella quasipneumoniae type from an NICU in China reveals patterns of genetic diversity, evolution and epidemiology
Authors: Perlaza-Jiménez Laura , Wu Qing , Torres Von Vergel L. , Zhang Xiaoxiao , Li Jiahui , Rocker Andrea , Lithgow Trevor , Zhou Tieli , Vijaykrishna Dhanasekaran 
Published: March 2020

ABSTRACTDuring March of 2017 a neonate patient suffered severe diarrhea and subsequently developed septicemia and died, with Klebsiella isolated as the causative microorganism. Coincident illness of an attending staff member and three other neonates with Klebsiella triggered a response, leading to a detailed microbiological and genomics investigation of isolates collected from the staff member and all 21 co-housed neonates. Multilocus sequence typing and genomic sequencing identified that the Klebsiella from all 21 neonates was a new MLST ST2727, and belonged to a less frequently detected subspecies K. quasipneumoniae subsp. similipneumoniae (KpIIB). Genomic characterization showed that the isolated ST2727 strains had diverged from other KpIIB strains at least >90 years ago, whereas the neonate samples were highly similar with a genomic divergence of 3.6 months and not related to the staff member, indicating that transmission did not occur from staff to patient or between patient to patient, but were acquired from a common hospital source. The genomes revealed that the isolates contained the ubiquitous ampH gene responsible for resistance to penicillin G, cefoxitin and cephalosporin C, and all Kp-IIB strains were competent for host cell adhesion. Our results highlight the clinical significance and genomic properties of relatively mild, but persistent MLST types such as ST2727, and urges for genomic surveillance and eradication within hospital environments.Data summaryGenome sequences generated in this study are available in NCBI under BioProject ID PRJNA610124. All bioinformatic protocols used to process the genomic data are available at https://github.com/vjlab/KpIIB_ST2727.