bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of a Pharmacist-Led Intensive Care Unit Sleep Improvement Protocol on Sleep Duration and Quality
Authors: Andrews Jessica L. , Louzon Patricia R. , Torres Xavier , Pyles Eric , Ali Mahmood H. , Du Yuan , Devlin John W. 
Published: November 2020

Background: Sleep improvement protocols are recommended for use in the intensive care unit (ICU) despite questions regarding which interventions to include, whether sleep quality or duration will improve, and the role of pharmacists in their development and implementation. Objective: To characterize the impact of a pharmacist-led, ICU sleep improvement protocol on sleep duration and quality as evaluated by a commercially available activity tracker and patient perception. Methods: Critical care pharmacists from a 40-bed, mixed ICU at a large community hospital led the development and implementation of an interprofessional sleep improvement protocol. It included daily pharmacist medication review to reduce use of medications known to disrupt sleep or increase delirium and guideline-based recommendations on both environmental and nonpharmacological sleep-focused interventions. Sleep duration and quality were compared before (December 2018 to December 2019) and after (January to June 2019) protocol implementation in non–mechanically ventilated adults using both objective (total nocturnal sleep time [TST] measured by an activity tracker (Fitbit Charge 2) and subjective (patient-perceived sleep quality using the Richards-Campbell Sleep Questionnaire [RCSQ]) measures. Results: Groups before (n = 48) and after (n = 29) sleep protocol implementation were well matched. After protocol implementation, patients had a longer TST (389 ± 123 vs 310 ± 147 minutes; P = 0.02) and better RCSQ-perceived sleep quality (63 ± 18 vs 42 ± 24 mm; P = 0.0003) compared with before implementation. Conclusion and Relevance: A sleep protocol that incorporated novel elements led to objective and subjective improvements in ICU sleep duration and quality. Application of this study may result in increased utilization of sleep protocols and pharmacist involvement.
Biomechanical Comparison of 2 Common Techniques of Minimally Invasive Hallux Valgus Correction
Authors: Aiyer Amiethab , Massel Dustin H. , Siddiqui Noman , Acevedo Jorge I. 
Published: November 2020

Background: Hallux valgus is one of the most common surgically corrected forefoot deformities. Compared to open procedures, minimally invasive (MIS) treatment of hallux valgus has resulted in decreased operative time, reduced complication rates, and greater patient satisfaction. Historically, distal chevron osteotomies are the standard for moderate hallux valgus correction. To our knowledge, no studies have evaluated biomechanical strength of transverse and chevron distal first metatarsal osteotomy (DMO) constructs. The purpose of this study was to evaluate the biomechanical strength of these techniques. Methods: Eighteen cadaveric specimens (9 matched pairs) were randomized to transverse or chevron DMO. Each technique was performed by a separate fellowship-trained orthopedic foot and ankle surgeon. Radiographic images were analyzed. Biomechanical testing was performed using Instron Mechanical System. Ultimate load to failure, yield load, and stiffness were assessed. A 10-N preload was applied to the sesamoid bones for stability. A coaxial compression rate (10 mm/min) was applied until failure was observed. Mean and standard deviations were compared. All cadaveric specimens were male. Results: There was no significant difference in percent metadiaphyseal shift between osteotomies ( P = .453). The most common mode of failure was fracture at screw insertion site (55.6%), followed by failure at osteotomy site (44.4%). A trend toward increased ultimate load to failure ( P = .480), yield load ( P = .054), and stiffness ( P = .438) among transverse compared to chevron osteotomy was observed, but this difference was not statistically significant. Conclusion: Biomechanical testing demonstrated no significant difference in ultimate load, yield load, and stiffness between MIS transverse and chevron osteotomy constructs; a trend toward increased strength in the transverse osteotomy cohort was observed. Chevron osteotomies may result in early failure by relative ease of cutout through cancellous bone compared to transverse osteotomies in which failure requires cortical cutout. Clinical Relevance: Use of MIS techniques for hallux valgus correction is gaining clinical traction. Although various clinical studies have evaluated outcomes of these MIS techniques, biomechanical studies have been minimal. Specifically, the potential biomechanical benefits of various MIS hallux valgus osteotomy techniques have not been delineated to date. The content of this manuscript is quite timely, given the rise in use of these MIS techniques.
Incidence of ifosfamide induced encephalopathy in patients receiving concomitant fosaprepitant
Authors: Modi Jill N , Cimino Sarah K 
Published: November 2020

Introduction The incidence of Ifosfamide-induced encephalopathy (IIE) ranges from 5-30%. Aprepitant and fosaprepitant may increase the risk of IIE; however, data is limited. The objective of this study was to characterize the incidence of IIE in patients receiving concomitant fosaprepitant. Methods This single-center, retrospective chart review included adult patients diagnosed with sarcoma who received at least one administration of high dose ifosfamide (≥1800mg/m2) and fosaprepitant between January 2017 and June 2018. The primary endpoint was the percentage of patient cycles in which IIE was experienced. Secondary endpoints included characterization of IIE management strategies, time to IIE resolution, and the incidence of IIE upon ifosfamide re-challenge. Subgroup analyses were performed to assess whether the following variables predisposed a patient to neurotoxicity: elevated serum creatinine, hypoalbuminemia, metabolic acidosis, hyperbilirubinemia, shorter infusion time, and higher body mass index. The role of CYP2B6 inhibitors and prior cisplatin use were also examined. Results Fifty-one patients who received 215 total cycles of ifosfamide were included. Twenty (9.3%) patient cycles included documented evidence of IIE. The most common management strategies were to prolong the infusion time and administer methylene blue. The mean time to resolution of IIE was 2.58 days. The incidence of secondary IIE upon re-challenge was 26.3%. Baseline albumin <3.5 g/dL (p<0.001) was statistically associated with the development of IIE. Conclusion Co-administration of fosaprepitant and ifosfamide in sarcoma appears to be safe. Hypoalbuminemia was a notable risk factor confirmed in this study. Further research is needed to delineate IIE risk factors.
The p48 flow diverter: First clinical results in 25 aneurysms in three centers
Authors: den Bergh FRA Van , De Beule T , van Rooij WJ , Voormolen MH , Van der Zijden T , Stockx L , van Zwam WH , Fransen H 
Published: November 2020

Background The novel low-profile p48 flow diverter has been designed to treat aneurysms on small vessels of 1.75–3mm. We report our first clinical experiences. Methods Between March 2018–January 2020, 22 patients with 25 aneurysms were treated with the p48 in 3 centers. One patient had 3 aneurysms covered by one p48 and one patient had 2 aneurysms. There were 5 men, 17 women, with a mean age of 55 years (median 59, range 29–73 years). Results In 25 aneurysms, 24 p48 flow diverters were placed. In 1 patient additional coils were placed in the aneurysm. Procedural vessel rupture by the micro guidewire occurred in 2 patients and vessel rupture during p48 balloon dilatation occurred in 1 patient. Overall, the permanent morbidity rate was 13.6% (3 of 22, 95%CI 3.9–34.2%) and mortality was 4.5% (1 of 22, 95%CI <0.01–23.5%). Most complications were procedure-related and not device-specific. Of 22 patients with 25 aneurysms treated with p48, 18 patients with 20 aneurysms had angiographic follow-up after 5–18 months. Of 19 aneurysms, 10 were occluded and 7 showed a remnant. Two aneurysms were open after 6 months. Three aneurysms were still not occluded after 12, 14, and 18 months and these 3 were retreated. Retreatment rate was 16% (3 of 19) and the adequate occlusion rate was 90% (17 of 19). Conclusions Treatment of aneurysms in small-caliber vessels with the p48 is feasible and effective but is not without complications. More data is needed to establish indications, safety, and efficacy more accurately.
The next step in balloon assisted endovascular neurosurgical procedures: A case series of initial experience with the Scepter Mini balloon microcatheter
Authors: Mehta Tapan , Hassan Ameer , Masood Kamran , Tekle Wondwossen , Grande Andrew , Tummala Ramachandra , Jagadeesan Bharathi D 
Published: November 2020

Background The use of compliant dual lumen balloon microcatheters (CDLB) for the endovascular treatment of vascular malformations, wide neck aneurysms, and intracranial angioplasty (for vasospasm) is well documented. Navigation of 4 mm or larger CDLB within tortuous and small distal intracranial vessels can be challenging. Recently, the lower profile Scepter Mini balloon microcatheter (SMB) has been approved for use, with potential for improved intracranial navigation. Objective Discuss operative experience of Scepter Mini (Microvention, Aliso Viejo, CA). Methods We describe our initial experience with the SMB in a series of nine patients. Results The balloon microcatheter was used for delivery of liquid embolic in six patients (Case 1, 2, 6–9), adjunct support for delivery or positioning of the Woven Endobridge (WEB) device in two (Case 3,4), and gentle post-deployment repositioning of a WEB device in the last one (Case 5). We were able to successfully navigate the SMB over a 0.008 “micro wire to the target lesion in all the patients. We experienced initial difficulty with injecting liquid embolic in Case 2. We postulate that the SMB was in a tortuous segment of a dural vessel in this patient, and that it kinked on inflation with occlusion of the liquid embolic delivery lumen; this was overcome with slightly proximal repositioning and reinflation of the SMB. Conclusion Our initial experience shows that the SMB has potential to be useful in endovascular neurosurgical procedures requiring balloon assistance within smaller diameter blood vessels.
A Novel Technique of Arthroscopic Ankle Lateral Ligament Repair Using a Knotless Suture Anchor
Authors: Kanzaki Noriyuki , Chinzei Nobuaki , Yamashita Takahiro , Kumai Tsukasa , Kuroda Ryosuke 
Published: November 2020

Background: Although arthroscopic lateral ligament repair (ALLR) with suture anchors for chronic lateral ankle instability has become widely accepted, some complications have been reported as well. Establishment of a new technique is essential for better clinical outcomes after ALLR. Purpose To report a novel technique and good clinical results of ALLR using a knotless suture anchor. Study Design: Case series; Level of evidence, 4. Methods: We examined 30 patients (16 men and 14 women) who underwent ALLR. The mean age of the patients was 30.0 years, and the average period of postoperative monitoring was 21 months. The Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale was used for clinical evaluation postoperatively, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) for patient-reported results. Surgical complications were also examined. Results: The JSSF ankle-hindfoot scale showed a significant improvement from preoperatively to follow-up (from 72.1 to 96.1; P < 0.001), and the SAFE-Q was significantly improved in all subscales (pain and pain-related, physical function and daily living, social function, shoe-related, and general health and well-being; P < 0.004 for all). Complications included residual joint pain due to remaining osteophytes in 1 case, scar pain of the accessory anterolateral portal in 2 cases, and positive Tinel sign indicative of superficial peroneal nerve irritation at the anterolateral portal in 1 case. Conclusion: The clinical results of the novel ALLR technique were overall satisfactory. Knot-related complications, one of the main reasons for postoperative complications, were reduced by using a knotless suture anchor.
Outcomes of Arthroscopic Surgical Treatment of Osteochondral Lesions of the Elbow in Pediatric and Adolescent Athletes
Authors: Allahabadi Sachin , Bryant Jessica K. , Mittal Ashish , Pandya Nirav K. 
Published: November 2020

Background: Osteochondral injuries of the elbow are limiting and affect the ability of pediatric and adolescent athletes to participate in sports. Purpose: To report short- and midterm outcomes on athletes undergoing microfracture or fragment fixation of osteochondral elbow lesions and evaluate the effects thereof on sporting activity. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective study analyzing patients who underwent surgical treatment via microfracture or fragment fixation for osteochondral elbow lesions. Patients were treated at a single institution by a single surgeon between 2012 and 2019. Diagnosis was confirmed with magnetic resonance imaging, and patients were indicated for surgery after having persistent symptoms despite trialing rest, immobilization, and/or activity restriction for at least 3 months. Demographic data including sports of choice were collected preoperatively. Imaging and intraoperative findings were documented, and any complications were noted. Range of motion (ROM) was compared pre- to postoperatively. Return-to-sport evaluation included the ability to play the preoperative sport of choice. Results: In total, 23 patients (25 elbows) were included with a mean follow-up of 23.5 months (range, 6-60.3 months) and a mean age of 13.8 years. Of 25 lesions, 20 (80%) were on the athlete’s dominant side. There was significant improvement from pre- to postoperative ROM, including extension (mean ± SD, 6.4° ± 5.3° to 0.04° ± 0.2°; P < .00001), flexion (129.2° ± 10.6° to 138.6° ± 4.4°; P = .00013), and arc of ROM (122.6° ± 13.2° to 138.6° ± 4.4°; P < .00001). Mean lesion size was 81.9 ± 59.3 mm2 (range, 15-225 mm2). All elbows demonstrated radiographic healing postoperatively. Mean time to release to sport was 4.48 ± 1.38 months (range, 2.5-8 months). Six (26.1%) patients changed or stopped their preoperative sporting activity, including 2 of 4 gymnasts and 4 of 11 baseball players. Conclusion: Arthroscopic technique with lesion debridement and microfracture or fixation appears safe and results in radiographic healing; however, with these techniques, there remains a high rate of inability to return to sport in patients involved in higher-demand upper extremity activity, such as baseball and gymnastics. Further treatment strategies, including cartilage restoration procedures, may be warranted in this population.
A fixed-duration, measurable residual disease–guided approach in CLL: follow-up data from the phase 2 ICLL-07 FILO trial
Authors: Michallet Anne-Sophie , Letestu Rémi , Le Garff-Tavernier Magali , Aanei Carmen , Ticchioni Michel , Dilhuydy Marie-Sarah , Subtil Fabien , Rouille Valerie , Mahe Beatrice , Laribi Kamel , Villemagne Bruno , Salles Gilles , Tournilhac Olivier , Delmer Alain , Portois Christelle , Pegourie Brigitte , Leblond Veronique , Tomowiak Cecile , De Guibert Sophie , Orsini Piocelle Frederique , Banos Anne , Carassou Philippe , Cartron Guillaume , Fornecker Luc-Matthieu , Ysebaert Loic , Dartigeas Caroline , Truchan-Graczyk Malgorzata , Vilque Jean-Pierre , Aurran Thérèse , Cymbalista Florence , Lepretre Stéphane , Levy Vincent , Nguyen-Khac Florence , Feugier Pierre 
Published: November 2020

Abstract
Trials assessing first-line, fixed-duration approaches in chronic lymphocytic leukemia (CLL) are yielding promising activity, but few long-term data are available. We report follow-up data from a phase 2 trial (ICLL07 FILO) in previously untreated, medically fit patients (N = 135). Patients underwent obinutuzumab-ibrutinib induction for 9 months; then, following evaluation (N = 130 evaluable), those in complete remission and with bone marrow measurable residual disease (BM MRD) &lt;0.01% (n = 10) received ibrutinib for 6 additional months; those in partial remission and/or with BM MRD ≥0.01%, the majority (n = 120), also received 4 cycles of immunochemotherapy (fludarabine/cyclophosphamide-obinutuzumab). Beyond end of treatment, responses were assessed every 3 month and peripheral blood MRD every 6 months. At median follow-up 36.7 months from treatment start, progression-free and overall survival rates (95% confidence interval) at 3 years were 95.7% (92.0% to 99.5%) and 98% (95.1% to 100%), respectively. Peripheral blood MRD &lt;0.01% rates were 97%, 96%, 90%, 84%, and 89% at months 16, 22, 28, 34, and 40, respectively. No new treatment-related or serious adverse event occurred beyond end of treatment. Thus, in previously untreated, medically fit patients with CLL, a fixed-duration (15 months), MRD-guided approach achieved high survival rates, a persistent MRD benefit beyond the end of treatment, and low long-term toxicity. This trial was registered at www.clinicaltrials.gov as #NCT02666898.
Optimizing genomic reference populations to improve crossbred performance
Authors: Wientjes Yvonne C. J. , Bijma Piter , Calus Mario P. L. 
Published: November 2020

AbstractBackgroundIn pig and poultry breeding, the objective is to improve the performance of crossbred production animals, while selection takes place in the purebred parent lines. One way to achieve this is to use genomic prediction with a crossbred reference population. A crossbred reference population benefits from expressing the breeding goal trait but suffers from a lower genetic relatedness with the purebred selection candidates than a purebred reference population. Our aim was to investigate the benefit of using a crossbred reference population for genomic prediction of crossbred performance for: (1) different levels of relatedness between the crossbred reference population and purebred selection candidates, (2) different levels of the purebred-crossbred correlation, and (3) different reference population sizes. We simulated a crossbred breeding program with 0, 1 or 2 multiplication steps to generate the crossbreds, and compared the accuracy of genomic prediction of crossbred performance in one generation using either a purebred or a crossbred reference population. For each scenario, we investigated the empirical accuracy based on simulation and the predicted accuracy based on the estimated effective number of independent chromosome segments between the reference animals and selection candidates.ResultsWhen the purebred-crossbred correlation was 0.75, the accuracy was highest for a two-way crossbred reference population but similar for purebred and four-way crossbred reference populations, for all reference population sizes. When the purebred-crossbred correlation was 0.5, a purebred reference population always resulted in the lowest accuracy. Among the different crossbred reference populations, the accuracy was slightly lower when more multiplication steps were used to create the crossbreds. In general, the benefit of crossbred reference populations increased when the size of the reference population increased. All predicted accuracies overestimated their corresponding empirical accuracies, but the different scenarios were ranked accurately when the reference population was large.ConclusionsThe benefit of a crossbred reference population becomes larger when the crossbred population is more related to the purebred selection candidates, when the purebred-crossbred correlation is lower, and when the reference population is larger. The purebred-crossbred correlation and reference population size interact with each other with respect to their impact on the accuracy of genomic estimated breeding values.
Genetic diversity and population structure of the endangered species Paeonia decomposita endemic to China and implications for its conservation
Authors: Wang Shi-Quan 
Published: November 2020

AbstractBackgroundPaeonia decomposita, endemic to China, has important ornamental, medicinal, and economic value and is regarded as an endangered plant. The genetic diversity and population structure have seldom been described. A conservation management plan is not currently available.ResultsIn the present study, 16 pairs of simple sequence repeat (SSR) primers were used to evaluate the genetic diversity and population structure. A total of 122 alleles were obtained with a mean of 7.625 alleles per locus. The expected heterozygosity (He) varied from 0.043 to 0.901 (mean 0.492) in 16 primers. Moderate genetic diversity (He = 0.405) among populations was revealed, with Danba identified as the center of genetic diversity. Mantel tests revealed a positive correlation between geographic and genetic distance among populations (r = 0.592,P = 0.0001), demonstrating consistency with the isolation by distance model. Analysis of molecular variance (AMOVA) indicated that the principal molecular variance existed within populations (73.48%) rather than among populations (26.52%). Bayesian structure analysis and principal coordinate analysis (PCoA) supported the classification of the populations into three clusters.ConclusionsThis is the first study of the genetic diversity and population structure ofP. decompositausing SSR. Three management units were proposed as conservation measures. The results will be beneficial for the conservation and exploitation of the species, providing a theoretical basis for further research of its evolution and phylogeography.
Fine mapping of the QTL cqSPDA2 for chlorophyll content in Brassica napus L.
Authors: Ye Jingxiu , Liu Haidong , Zhao Zhi , Xu Liang , Li Kaixiang , Du Dezhi 
Published: November 2020

Abstract

Background
Chlorophyll is the most important factor enabling plants to absorb, transfer and transform light energy and plays an important role in yield formation. Brassica napus is one of the most important oil crops. Breeding Brassica napus for high light efficiency by improving photosynthetic efficiency has considerable social and economic value. In Brassica napus, there have been studies of the initial location of chlorophyll in seed embryos and pericarps, but there are few reports on the fine mapping of chlorophyll QTLs. We constructed near-isogenic lines (NIL), fine-mapped a chlorophyll locus, and evaluated the effect of this dominant locus on agronomic traits.

Results
The cqSPDA2 locus was mapped to an interval of 21.87–22.91 Mb on the chromosome A02 of Brassica napus using doubled haploid (DH) lines. To fine-map cqSPDA2, we built NIL and designed Indel primers covering the mapping interval. The 469 individuals in the BC3F2 population were analyzed using these indel primers. Among these indel primers, 15 could narrow the mapping interval to 188 kb between Indel3 and Indel15. Next, 16 indel primers and 19 SSR primers were designed within the new narrower mapping interval, and 5 of the primer-amplified fragments were found to be polymorphic and tightly linked to the cqSPDA2 locus in the BC4F2 population. The mapping interval was narrowed to 152 kb on A02 between SSR2 and Indel15. By gene expression analysis, we found three annotated genes in the mapping interval, including BnaA02g30260D, BnaA02g30290D and BnaA02g30310D, which may be responsible for chlorophyll synthesis.

Conclusions
The locus cqSPDA2, a dominant QTL for chlorophyll content in Brassica napus, was fine-mapped to a 21.89–22.04 Mb interval on A02. Three annotated genes (BnaA02g30260D, BnaA02g30290D and BnaA02g30310D) that may be responsible for chlorophyll synthesis were found.