bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subcutaneous Tocilizumab in Monotherapy or in Combination With Nonbiologic Disease-Modifying Antirheumatic Drugs in Latin American Patients With Moderate to Severe Active Rheumatoid Arthritis
Authors: Mysler Eduardo , Cardiel Mario H. , Xavier Ricardo M. , López Alejandra , Ramos-Esquivel Allan 
Published: April 2020

Objective
To assess the efficacy and safety of subcutaneous tocilizumab (TCZ) in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) in Latin American patients with rheumatoid arthritis (RA) and inadequate response to previous csDMARDs.

Methods
ML28700 was a multicenter, open-label, single-arm trial. Previously treated RA patients who had not received treatment with TCZ or any biological agent (n = 284) and with a baseline Disease Activity Score in 28 joints based on erythrocyte sedimentation rate (DAS28-ESR) of 3.2 or greater were assigned to receive subcutaneous TCZ (162 mg/wk) in association with csDMARD for 24 weeks. Patients who achieved remission (DAS28-ESR <2.6) at week 24 continued with TCZ as monotherapy until week 52; otherwise, they continued with their assigned treatment. The primary efficacy end point was remission rate (DAS28-ESR <2.6) at weeks 24 and 52. Secondary objectives included disease activity scores, safety, and quality of life.

Results
At week 24, a total of 169 patients (59.5%; 95% confidence interval, 53.5%–65.3%) achieved remission, 91 patients (32.0%) had low disease activity, and 46 patients (8.4%) were not responders. Sustained remission at week 52 was achieved by 80.8% (n = 126) of patients who continued with TCZ monotherapy versus 44.6% (n = 37) of those on combination therapy. A total of 241 patients (84.9%; 95% confidence interval, 80.2%–88.8%) had at least 1 adverse event during follow-up. Adverse events led to drug modification in 32 patients (11.3%) or discontinuation in 21 patients (7.4%).

Conclusions
Subcutaneous TCZ is an efficacious therapy with long-lasting results and tolerable adverse events in Latin American patients with RA.
Trial registration no.: NCT02011334 Tozura Study Program.
18F-PSMA 1007 in Suspected Renal Cell Carcinoma
Authors: Marafi Fahad , Sasikumar Arun , Al-Terki Abdullatif , Alfeeli Mahmoud 
Published: April 2020

Abstract
A 60-year-old man with suspected right renal cell carcinoma underwent 18F-FDG PET/CT and 18F prostate-specific membrane antigen (PSMA) 1007 PET/CT scan. Compared with the 18F-FDG PET/CT scan, 18F-PSMA 1007 PET/CT showed intense tracer concentration in the primary tumor in the right kidney and intense tracer concentration consistently in all lung nodules. Unlike noted in previous pilot studies with 68Ga-PSMA, we observed that the primary renal tumor also showed intense tracer avidity with 18F-PSMA 1007. 18F-PSMA 1007 PET/CT may provide preoperative insight into possible etiology, histopathological probability of tumor type, staging information, and theranostic potentials in evaluation of suspected renal cell carcinoma.
Mediastinal Epithelioid Hemangioendothelioma Revealed on 68Ga-DOTATATE PET/CT
Authors: Long Yu , Shao Fuqiang , Lan Xiaoli 
Published: April 2020

AbstractEpithelioid hemangioendothelioma is a rare vascular sarcoma, and it rarely leads abnormal serum calcium. Here we presented a 61-year-old woman with suspected tumor-induced osteomalacia who underwent68Ga-DOTATATE PET/CT to detect possible culprit tumor. The images showed a hypermetabolic paraspinal soft nodule in the right upper posterior mediastinum, which suggested a somatostatin receptor–positive tumor. The tumor was resected and pathologically confirmed as epithelioid hemangioendothelioma.
Parents’ Perception of Self-Management Behaviors for Their Children With Spina Bifida in South Korea: A Qualitative Study
Authors: Yun Hyun Jung , Choi Eun Kyoung , Han Sang Won 
Published: April 2020

Abstract

Purpose
This study aimed to explore parents’ perceptions of self-management behaviors for their children with spina bifida (SB).

Design
Qualitative method.

Methods
In-depth interviews were conducted with nine Korean parents of children with SB. The data were analyzed using the content analysis method.

Findings
Parental perceptions of the experiences of self-management behaviors in children with SB were classified into risk factors that hinder self-management behaviors and protective factors that accelerate them. Each category of factors was then further classified into child-, parent-, and school-related factors.

Conclusions
To promote self-management behaviors in children with SB, reducing risk factors and promoting protective factors considering child, family, and school dimensions based on cultural differences are necessary.

Clinical Relevance
Rehabilitation nurses should be considered essential healthcare providers who can offer stepwise guidance to achieve self-management behaviors in children with SB according to their stage of development.
No news is good news? Three-year postdischarge mortality of octogenarian and nonagenarian patients following emergency general surgery
Authors: Narueponjirakul Natawat , Hwabejire John , Kongwibulwut Manasnun , Lee Jae Moo , Kongkaewpaisan Napaporn , Velmahos George , King David , Fagenholz Peter , Saillant Noelle , Mendoza April , Rosenthal Martin , Kaafarani Haytham M.A. 
Published: April 2020

BACKGROUND
Outcome data on the very elderly patients undergoing emergency general surgery (EGS) are sparse. We sought to examine short- and long-term mortality in the 80 plus years population following EGS.

METHODS
Using our institutional 2008–2018 EGS Database, all the 80 plus years patients undergoing EGS were identified. The data were linked to the Social Security Death Index to determine cumulative mortality rates up to 3 years after discharge. Univariate and multivariable logistic regression analyses were used to determine predictors of in-hospital and 1-year cumulative mortality.

RESULTS
A total of 385 patients were included with a mean age of 84 years; 54% were female. The two most common comorbidities were hypertension (76.1%) and cardiovascular disease (40.5%). The most common procedures performed were colectomy (20.0%), small bowel resection (18.2%), and exploratory laparotomy for other procedures (15.3%; e.g., internal hernia, perforated peptic ulcer). The overall in-hospital mortality was 18.7%. Cumulative mortality rates at 1, 2, and 3 years after discharge were 34.3%, 40.5%, and 43.4%, respectively. The EGS procedure associated with the highest 1-year mortality was colectomy (49.4%). Although hypertension, renal failure, hypoalbuminemia, hyperbilirubinemia, and elevated liver enzymes predicted in-hospital mortality, the only independent predictors of cumulative 1-year mortality were hypoalbuminemia (odds ratio, 2.17; 95% confidence interval, 1.10–4.27; p = 0.025) and elevated serum glutamic pyruvic transaminase (SGOT) level (odds ratio, 2.56; 95% confidence interval, 1.09–4.70; p = 0.029) at initial presentation. Patients with both factors had a cumulative 1-year mortality rate of 75.0%.

CONCLUSION
More than half of the very elderly patients undergoing major EGS were still alive at 3 years postdischarge. The combination of hypoalbuminemia and elevated liver enzymes predicted the highest 1-year mortality. Such information can prove useful for patient and family counseling preoperatively.

LEVEL OF EVIDENCE
Prognostic, Level III.
Blood-based biomarkers for prediction of intracranial hemorrhage and outcome in patients with moderate or severe traumatic brain injury
Authors: Anderson Taylor N. , Hwang Jun , Munar Myrna , Papa Linda , Hinson Holly E. , Vaughan Allison , Rowell Susan E. 
Published: April 2020

BACKGROUND
Early identification of traumatic intracranial hemorrhage (ICH) has implications for triage and intervention. Blood-based biomarkers were recently approved by the Food and Drug Administration (FDA) for prediction of ICH in patients with mild traumatic brain injury (TBI). We sought to determine if biomarkers measured early after injury improve prediction of mortality and clinical/radiologic outcomes compared with Glasgow Coma Scale (GCS) alone in patients with moderate or severe TBI (MS-TBI).

METHODS
We measured glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1 (UCH-L1), and microtubule-associated protein-2 (MAP-2) on arrival to the emergency department (ED) in patients with blunt TBI enrolled in the placebo arm of the Prehospital TXA for TBI Trial (prehospital GCS score, 3–12; SPB, > 90). Biomarkers were modeled individually and together with prehospital predictor variables [PH] (GCS score, age, sex). Data were divided into a training data set and test data set for model derivation and evaluation. Models were evaluated for prediction of ICH, mass lesion, 48-hour and 28-day mortality, and 6-month Glasgow Outcome Scale-Extended (GOS-E) and Disability Rating Scale (DRS). Area under the curve (AUC) was evaluated in test data for PH alone, PH + individual biomarkers, and PH + three biomarkers.

RESULTS
Of 243 patients with baseline samples (obtained a median of 84 minutes after injury), prehospital GCS score was 8 (interquartile range, 5–10), 55% had ICH, and 48-hour and 28-day mortality were 7% and 13%, respectively. Poor neurologic outcome at 6 months was observed in 34% based on GOS-E of 4 or less, and 24% based on DRS greater than or equal to7. Addition of each biomarker to PH improved AUC in the majority of predictive models. GFAP+PH compared with PH alone significantly improved AUC in all models (ICH, 0.82 vs. 0.64; 48-hour mortality, 0.84 vs. 0.71; 28-day mortality, 0.84 vs. 0.66; GOS-E, 0.78 vs. 0.69; DRS, 0.84 vs. 0.81, all p < 0.001).

CONCLUSION
Circulating blood-based biomarkers may improve prediction of neurological outcomes and mortality in patients with MS-TBI over prehospital characteristics alone. Glial fibrillary acidic protein appears to be the most promising. Future evaluation in the prehospital setting is warranted.

LEVEL OF EVIDENCE
Prospective, Prognostic and Epidemiological, level II.
Chronic inflammation mediates brain injury in HIV infection: relevance for cure strategies
Authors: McArthur Justin C. , Johnson Tory P. 
Published: April 2020

Purpose of review
Chronic inflammation is a major component of HIV infection, the effects of which can be devastating in the central nervous system (CNS). Protecting the brain is, therefore, critical as efforts proceed to cure HIV infection by reactivating latent viral reservoirs and driving immune responses. We review the clinical presentation and pathology findings of inflammatory processes in the CNS in patients managed with ART and the drivers of these processes.

Recent findings
Chronic inflammation is associated with increased mortality and morbidity and HIV infection increases the risk for chronic diseases, especially cognitive impairment. Latent viral reservoirs, including microglia and tissue macrophages, contribute to inflammation in the CNS. Inflammation is generated and maintained through residual viral replication, dysregulation of infected cells, continuously produced viral proteins and positive feedback loops of chronic inflammation. Novel therapeutics and lifestyle changes may help to protect the CNS from immune-mediated damage.

Summary
As therapies are developed to cure HIV, it is important to protect the CNS from additional immune-mediated damage. Adjunctive therapies to restore glial function, reduce neuroinflammation and systemic inflammation, and inhibit expression of viral proteins are needed.
Widespread use of face masks in public may slow the spread of SARS CoV-2: an ecological study
Authors: Kenyon Chris 
Published: April 2020

AbstractBackgroundThe reasons for the large differences between countries in the sizes of their SARS CoV-2 epidemics is unknown. Individual level studies have found that the use of face masks was protective for the acquisition and transmission of a range of respiratory viruses including SARS CoV-1. We hypothesized that population level usage of face masks may be negatively associated SARS CoV-2 spread.MethodsAt a country level, linear regression was used to assess the association between COVID-19 diagnoses per inhabitant and the national promotion of face masks in public (coded as a binary variable), controlling for the age of the COVID-19 epidemic and testing intensity.ResultsEight of the 49 countries with available data advocated wearing face masks in public – China, Czechia, Hong Kong, Japan, Singapore, South Korea, Thailand and Malaysia. In multivariate analysis face mask use was negatively associated with number of COVID-19 cases/inhabitant (coef. −326, 95% CI −601- −51, P=0.021). Testing intensity was positively associated with COVID-19 cases (coef. 0.07, 95% CI 0.05-0.08, P<0.001).ConclusionWhilst these results are susceptible to residual confounding, they do provide ecological level support to the individual level studies that found face mask usage to reduce the transmission and acquisition of respiratory viral infections.
Association Between moleculars and Osteoporotic Fracture Risk:A systematical review
Authors: Liu Jie-Yu , Wang Jia-Xiang , Xu Li , Lei Shu-Feng , Deng Fei-Yan 
Published: April 2020

AbstractOsteoporosis is a systemic chronic skeletal disease, which is characterized by low bone mineral density (BMD) and increased risk to osteoporotic fractures (OFs). OFs are associated with high mortality and morbidity, and seriously affect the life quality of patients. Osteoporosis is prevalent in the middle-aged and elderly population, especially the postmenopausal women. With population aging, osteoporosis becomes a world-wide serious public health problem. Early recognition of the high-risk population followed by timely and efficient intervention and/or treatment is important for preventing OFs. In light of the high heritability and complex pathogenesis of OP, comprehensive consideration of significant biological/biochemical factors is necessary for accurate risk evaluation. For this purpose, we reviewed recent research progress on moleculars which are diagnostic and/or predictive of OFs risk. Future integrative analyses and systematic evaluation of these moleculars may facilitate developing novel methodologies and/or test strategies, i.e., biochips, for early recognition of osteoporosis, hence to contribute to preventing OFs in the world.Graphical AbstractOsteoporosis, which is characterized by low bone mineral density (BMD) and increased risk to osteoporotic fractures (OFs), is prevalent in the middle-aged and elderly population, especially in the postmenopausal women. We focused on several types of important molecules, including proteins/peptides, RNAs, lipids, to gain comprehensive understanding and to generate novel perspectives in predicting and diagnosing OFs.
Frequency of testing for COVID 19 infection and the presence of higher number of available beds per country predict outcomes with the infection, not GDP of the country – A descriptive statistical analysis
Authors: Sinha Binayak , Sengupta Sumit , Ghosal Samit 
Published: April 2020

ABSTRACTIntroductionThe novel coronavirus epidemic which originated in late 2019 from China has wreaked havoc on millions across the world with illness, death and socioeconomic recession. As of now no valid treatment or preventative strategy has evolved worldwide and governments across the world have been forced to take the draconian step of social isolation in communities by enforcing “lockdowns”.Aim of this StudyThis study aims to correlate the rates of infection with the novel coronavirus and total deaths as the primary output variable. In addition the strength of association between infection rates and total death in comparison to GDP share of the respective countries, physicians, hospital beds and rates of testing for COVID 19 infection per thousand patients, is being assessed, in a bid to develop a model which would help to develop tools to reduce the impact of this disease.Material & MethodsData relating to number of cases, severity, cases recovered and deaths worldwide and specifically for the top six countries affected was collected from the WHO COVID-19 situation report which is being updated on a daily basis till 22nd March 2020, the date of analysis. Additional data related to GDP, physician and hospital bed per 1000 patients were procured from the World Bank database. All data were collected in a file in CSV format. Analysis was conducted in Jupyter notebook with Python 3.8.2 software and also with XL-Stat statistical software for excel. The analytical strategy was descriptive with no inferential overtones.ResultsCOVID 19 infection strongly correlates with total deaths (r : 0.89), with a predicted death rate of 25 patients per 1000 affected. There was no correlation between the GDP growth of the country and number of treating physicians/1000 patient population with any COVID 19 related outcome. However there was a negative correlation between COVID 19-related deaths and the number of beds available per 1000 population [r=-0.34]. Importantly there is an inverse correlation between the number of tests conducted per million population with the rates of active infections [r=-0.12], new cases [r=-0.38] and new deaths [r=-0.28] in COVID 19.ConclusionThis is the first study to assess parameters other than age and sex and sets out a robust dataset which indicates an increased risk of worsening outcomes with lesser number of beds and testing, suggesting that the need of the hour is to increase available bed numbers and to increase rates of testing.
Facemasks and similar barriers to prevent respiratory illness such as COVID-19: A rapid systematic review
Authors: Brainard Julii , Jones Natalia , Lake Iain , Hooper Lee , Hunter Paul R 
Published: April 2020

ABSTRACTThe current pandemic of COVID-19 has lead to conflicting opinions on whether wearing facemasks outside of health care facilities protects against the infection. To better understand the value of wearing facemasks we undertook a rapid systematic review of existing scientific evidence about development of respiratory illness, linked to use of facemasks in community settings.MethodsWe included all study designs. There were 31 eligible studies (including 12 RCTs). Narrative synthesis and random-effects meta-analysis of attack rates for primary and secondary prevention in 28 studies were performed. Results were reported by design, setting and type of face barrier in primary prevention, and by who wore the facemask (index patient or well contacts) in secondary prevention trials. The preferred outcome was influenza-like illness (ILI) but similar outcomes were pooled with ILI when ILI was unavailable. GRADE quality assessment was based on RCTs with support from observational studies.ResultsWhere specific information was available, most studies reported about use of medical grade (surgical paper masks). In 3 RCTs, wearing a facemask may very slightly reduce the odds of developing ILI/respiratory symptoms, by around 6% (OR 0.94, 95% CI 0.75 to 1.19, I 29%, low-certainty evidence). Greater effectiveness was suggested by observational studies. When both house-mates and an infected household member wore facemasks the odds of further household members becoming ill may be modestly reduced by around 19% (OR 0.81, 95%CI 0.48 to 1.37, I 45%, 5 RCTs, low certainty evidence). The protective effect was very small if only the well person (OR 0.93, 95% CI 0.68 to 1.28, I 11%, 2 RCTs, low uncertainty evidence) or the infected person wore the facemask (very low certainty evidence).DiscussionBased on the RCTs we would conclude that wearing facemasks can be very slightly protective against primary infection from casual community contact, and modestly protective against household infections when both infected and uninfected members wear facemasks. However, the RCTs often suffered from poor compliance and controls using facemasks. Across observational studies the evidence in favour of wearing facemasks was stronger. We expect RCTs to under-estimate the protective effect and observational studies to exaggerate it. The evidence is not sufficiently strong to support widespread use of facemasks as a protective measure against COVID-19. However, there is enough evidence to support the use of facemasks for short periods of time by particularly vulnerable individuals when in transient higher risk situations. Further high quality trials are needed to assess when wearing a facemask in the community is most likely to be protective.
A prospective observational cohort study considering the feasibility and tolerability of high intensity interval training as a novel treatment therapy for patients with intermittent claudication
Authors: Pymer Sean , Ibeggazene Said , Palmer Joanne , Smith George E. , Harwood Amy E. , Carroll Sean , Ingle Lee , Chetter Ian C. 
Published: April 2020

AbstractBackgroundUptake and completion rates for supervised exercise programmes (SEP) for patients with intermittent claudication (IC) are low. Current exercise prescription is aone size fits all approach, based on claudication pain thresholds, potentially limiting individual benefits. High-intensity interval training (HIIT) has the potential to overcome these barriers as it is a more time-efficient, objectively prescribed exercise programme. This study aimed to assess a novel HIIT programme for patients with IC in terms of safety, feasibility, tolerability and indicators of efficacy.Design/MethodsPatients referred to a usual-care SEP were invited to undertake an alternative HIIT programme. All recruited patients performed a baseline cardiopulmonary exercise test (CPET), to inform their exercise prescription. HIIT involved ten, one-minute high-intensity intervals on a stationary cycle ergometer interspersed with one-minute recovery intervals, performed three times per week for six-weeks. Outcomes included safety, feasibility, tolerability, walking distance and quality of life (QoL).Results144 patients with IC were referred, 95 met initial eligibility criteria (66%) and 30 (32%) were recruited for HIIT, of which 15 (50%) completed. Of the recruited patients, 90% were on optimal medical therapy and 40% had concomitant cardiac, cerebrovascular and/or respiratory disease.One serious adverse event was recorded and patients who completed the programme attended 100% of the sessions. Improvements in walking distances and quality of life were observed. Following recruitment of the first 20 patients, the inclusion criteria was refined on the basis of CPET, leading to improved completion rates.ConclusionThe study provides preliminary findings indicating that patients with IC can complete a short-term HIIT programme. HIIT also appears safe, well-tolerated and although not formally powered, walking distances and QoL appear to improve following HIIT. Further research to evaluate the role of HIIT in patients with IC seems warranted.