bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of Stereotactic Radiosurgery in the Management of Brain Metastases From a Health-Economic Perspective: A Systematic Review
Authors: Warsi Nebras M , Karmur Brij S , Brar Karanbir , Moraes Fabio Y , Tsang Derek S , Laperriere Normand , Kondziolka Douglas , Mansouri Alireza 
Published: March 2020

Abstract

BACKGROUND
Stereotactic radiosurgery (SRS) is an effective option in the management of brain metastases, offering improved overall survival to whole-brain radiation therapy (WBRT). However, given the need for active surveillance and the possibility of repeated interventions for local/distant brain recurrences, the balance between clinical benefit and economic impact must be evaluated.

OBJECTIVE
To conduct a systematic review of health-economic analyses of SRS for brain metastases, compared with other existing intervention options, to determine the cost-effectiveness of this treatment across different clinical scenarios.

METHODS
The MEDLINE, EMBASE, Cochrane, CRD, and EconLit databases were searched for health-economic analyses, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using terms relevant to brain metastases and radiation-based therapies. Simple cost analysis studies were excluded. Quality analysis was based on BMJ Consolidated Health Economics Reporting Standards (CHEERS) checklist.

RESULTS
Eleven eligible studies were identified. For lesions with limited mass effect, SRS was more cost-effective than surgical resection (6 studies). In patients with Karnofsky performance scale (KPS) >70 and good predicted survival, SRS was cost-effective compared to WBRT (7 studies); WBRT became cost-effective with poor performance status or low anticipated life span. Following SRS, routine magnetic resonance imaging surveillance saved $1326/patient compared to symptomatic imaging due to reduced surgical salvage and hospital stay (1 study).

CONCLUSION
Based on our findings, SRS is cost-effective in the management of brain metastases, particularly in high-functioning patients with longer expected survival. However, before an optimal care pathway can be proposed, emerging factors such as tumor molecular subtype, diagnosis-specific graded prognostic assessment, neuroprognostic score, tailored surveillance imaging, and patient utilities need to be studied in greater detail.
Outcomes of presumed malignant glioma treated without pathological confirmation: a retrospective, single-center analysis
Authors: Climans Seth Andrew , Ramos Ronald Cepe , Laperriere Normand , Bernstein Mark , Mason Warren P 
Published: March 2020

Abstract

Background
Tissue diagnosis is essential in the usual management of high-grade glioma. In rare circumstances, due to patient preference, performance status, comorbidities, or tumor location, biopsy is not feasible. Sometimes a biopsy is nondiagnostic. Many neuro-oncology clinics have patients like this, but these patients’ outcomes and responses to treatment are not known.

Methods
We retrospectively reviewed records from adult patients diagnosed with presumed high-grade glioma of the brain without definitive pathology, diagnosed between 2004 and 2016. We recorded several clinical variables including date of first diagnostic imaging and date of death.

Results
We identified 61 patients and subclassified them to brainstem glioma (n = 32), supratentorial presumed glioblastoma (n = 24), presumed thalamic diffuse midline glioma (n = 2), gliomatosis cerebri (n = 2), and cerebellar glioma (n = 1). Most brainstem glioma patients had no biopsy because of tumor location. Supratentorial presumed glioblastoma patients had no biopsy predominantly because of comorbidities. Median survival, from first diagnostic imaging, was 3.2 months (95% CI: 2.9 to 6.3 months) in the supratentorial glioblastoma group and 18.5 months (95% CI: 13.0 to 44.1 months) in the brainstem group. Treatment with radiation or chemotherapy did not alter the median survival of the supratentorial glioblastoma group (hazard ratio 1.41, uncorrected P = .5).

Conclusions
Patients with imaging diagnoses of high-grade glioma have similar, if not worse, survival than those with pathological confirmation. Based on these uncontrolled data, it is unclear how effective radiation or chemotherapy is in this population.
Re-treatment of Hepatitis C Infection After Multiple Failures of Direct-Acting Antiviral Therapy
Authors: Fierer Daniel S , Wyles David L 
Published: March 2020

Abstract

Background
Direct-acting antiviral (DAA) therapies for hepatitis C virus (HCV) result in initial cure rates of 95% to 99% and re-treatment cure rates of 95%. Nevertheless, given the sheer magnitude of infected persons, some will ultimately fail multiple DAA therapies, and re-treatment of these persons has not been adequately studied.

Methods
We evaluated treated an HIV-infected man with cirrhosis from genotype 1b HCV who had failed 3 DAA regimens.

Results
We treated and cured our “particularly difficult-to-cure” patient with sofosbuvir plus glecaprevir/pibrentasvir plus ribavirin for 24 weeks. We discuss the literature on potential biological factors behind his treatment failures such as lack of HCV seroconversion during his infection course, and multiple failures of hepatitis B seroconversion after vaccination, and the rationale for choosing his curative salvage regimen.

Discussion
There are no clinical trials-proven re-treatment regimens for “particularly difficult-to-cure” patients. Multiple patient- and virus-related factors that do not affect cure rates in treatment-naive patients may need to be considered in choosing a re-treatment regimen for these patients. These regimens may need to include combinations drugs that are not available in single-tablet form, addition of ribavirin, and longer durations of treatment than standard.
Changes and Associations of Genomic Transcription and Histone Methylation with Salt Stress in Castor Bean
Authors: Han Bing , Xu Wei , Ahmed Naeem , Yu Anmin , Wang Zaiqing , Liu Aizhong 
Published: March 2020

AbstractSoil salinity is a major source of abiotic plant stress, adversely affecting plant growth, development and productivity. Although the physiological and molecular mechanisms that underlie plant responses to salt stress are becoming increasingly understood, epigenetic modifications, such as histone methylations and their potential regulation of the transcription of masked genes at the genome level in response to salt stress, remain largely unclear. Castor bean, an important nonedible oil crop, has evolved the capacity to grow under salt stress. Here, based on high-throughput RNA-seq and ChIP-seq data, we systematically investigated changes in genomic transcription and histone methylation using typical histone H3 lysine 4 trimethylation (H3K4me3) and histone H3 tri-methylated lysine 27 (H3K27me3) markers in castor bean leaves subjected to salt stress. The results showed that gain or loss of histone methylation was closely associated with activated or repressed gene expression, though variations in both transcriptome and histone methylation modifications were relatively narrow in response to salt stress. Diverse salt responsive genes and switched histone methylation sites were identified in this study. In particular, we found for the first time that the transcription of the key salt-response regulator RADIALIS-LIKE SANT (RSM1), a MYB-related transcription factor involved in ABA(abscisic acid)-mediated salt stress signaling, was potentially regulated by bivalent H3K4me3-H3K27me3 modifications. Combining phenotypic variations with transcriptional and epigenetic changes, we provide a comprehensive profile for understanding histone modification, genomic transcription and their associations in response to salt stress in plants.
Eclogite and Garnet Pyroxenite Xenoliths from Kimberlites Emplaced Along the Southern Margin of the Kaapvaal Craton, Southern Africa: Mantle or Lower Crustal Fragments?
Authors: Le Roex Anton , Tinguely Christel , Gregoire Michel 
Published: March 2020

Abstract
Eclogite xenoliths, together with garnet pyroxenites and some mafic garnet granulites, found in kimberlites located along the southern margin of the Kaapvaal craton in southern Africa have been analysed by electron microprobe and mass spectrometry techniques to determine their geochemical characteristics. The majority of eclogites are bimineralic with garnet and omphacitic clinopyroxene in subequal proportions, with rutile as the main accessory phase; a few contain kyanite. Based on K2O in clinopyroxene and Na2O in garnet, the eclogites can be classified as Group II eclogites, and the majority are high-Ca in character. Garnet pyroxenites comprise garnet clinopyroxenites and garnet websterites. Major and trace element concentrations and isotope ratios of reconstituted bulk rock compositions of the eclogites and garnet pyroxenites allow constraints to be placed on depth of origin and likely protolith history. Calculated Fe–Mg exchange equilibration temperatures for the eclogites range from 815 to 1000 °C, at pressures of 1·7 ± 0·4 GPa as determined by REE partitioning, indicating that they were sampled from depths of 50–55 km; i.e. within the lower crust of the Namaqua–Natal Belt. The garnet pyroxenites show slightly lower temperatures (686–835 °C) at similar pressures of equilibration. Initial 143Nd/144Nd and 87Sr/86Sr ratios (calculated to time of kimberlite emplacement) of both lithologies overlap the field for lower crustal samples from the Namaqua–Natal Belt. Further evidence for a crustal origin is found in the similar REE patterns shown by many of the associated garnet granulite xenoliths. Garnet pyroxenites are interpreted to have a similar origin as the associated eclogites but with the mafic protolith having insufficient Na (i.e. low modal plagioclase) to allow for development of omphacitic pyroxene. Metamorphism of the mafic protoliths to these eclogites and garnet pyroxenites is inferred to have occurred during crustal shortening and thickening associated with the collision of the Namaqua–Natal Belt with the Kaapvaal craton at 1–1·2 Ga.
A review of Ehlers-Danlos syndrome
Authors: Miller Erin , Grosel John M. 
Published: March 2020

ABSTRACT
Ehlers-Danlos syndrome (EDS) describes a group of heritable disorders of connective tissue comprising mutations in the genes involved in the structure and/or biosynthesis of collagen. Thirteen EDS subtypes are recognized, with a wide degree of symptom overlap among subtypes and with other connective tissue disorders. The clinical hallmarks of EDS are tissue fragility, joint hypermobility, and skin hyperextensibility. Appropriate diagnosis of EDS is important for correct multidisciplinary management and is associated with better clinical outcomes for patients.
The emerging data on choice of optimal therapy for locally advanced nasopharyngeal carcinoma
Authors: Hui Edwin Pun , Ma Brigette B.Y. , Chan Anthony T.C. 
Published: March 2020

Purpose of review
We focus on the emerging data from randomized clinical trials for optimal integration of induction, concurrent, and/or adjuvant chemotherapy with intensity-modulated radiotherapy in locally advanced nasopharyngeal carcinoma (NPC), and the use of plasma Epstein–Barr virus (EBV) DNA for risk stratification.

Recent findings
Several phase 3 trials have shown that induction chemotherapy followed by concurrent chemoradiation (CRT) improved overall survival or disease-free survival when compared to CRT alone in stage III/IV NPC who is at high risk of distant metastases. The benefit of adjuvant chemotherapy following CRT when compared to CRT alone is uncertain. There are increasing clinical data supporting the use of plasma EBV DNA for risk stratification. There are growing clinical data supporting the integration of immune checkpoint inhibitors into the induction, concurrent, and/or adjuvant/maintenance phase of treatment in locally advanced NPC.

Summary
Concurrent chemoradiation remains the standard treatment backbone in locally advanced NPC. There is level 1 evidence for induction chemotherapy followed by CRT in stage III/IV NPC. There is increasing evidence against the indiscriminate use of adjuvant chemotherapy following CRT. With the increasing treatment intensification, future treatment algorithm in NPC should incorporate plasma EBV DNA and other biomarkers for risk stratification and treatment selection.
A Decade of Dementia Care Training: Learning Needs of Primary Care Clinicians
Authors: Lee Linda , Hillier Loretta M. , Patel Tejal , Weston W. Wayne 
Published: March 2020

Introduction:
Limited knowledge of dementia among health professionals is a well-documented barrier to optimal care. This study examined the self-perceived challenges with dementia care and learning needs among primary care clinicians and assessed whether these were associated with years of practice and perceived preparedness for dementia care.

Methods:
Participants were multi-disciplinary clinicians attending a 5-day team-based dementia education program and physicians attending a similar condensed continuing medical education workshop. Pre-education, they completed an online survey in which they rated (5-point scales): interest in learning about various dementia-related topics, perceived challenges with various dementia-related practice activities and preparedness for dementia care, provided additional dementia-related topics of interest, number of years in clinical practice, and discipline.

Results:
Thirteen hundred surveys were completed across both education programs. Mean ratings of preparedness for dementia care across all respondents reflected that they felt somewhat prepared for dementia care. Challenge ratings varied from low to very challenging and mean ratings reflected a high level of interest in learning more about all of the dementia-related topics; significant differences between disciplines in these ratings were identified. In most cases, perceived challenges and learning needs were not correlated with number of years in clinical practice, but in some cases lower ratings of preparedness for dementia care were associated with higher ratings of the challenges of dementia care.

Discussion:
Clinicians perceived that their formal education had not prepared them well for managing dementia and desired more knowledge in all topic areas, regardless of years in practice. Implications for education are discussed.
Idarucizumab for dabigatran reversal in daily clinical practice
Authors: Vene Nina , Mavri Alenka , Božič-Mijovski Mojca , Gregorič Minja , Uštar Katja K. , Žerjav Urša , Gradišek Primož , Stecher Adela , Frol Senta , Nedog Viljenka , Detkova Nataliya , Kosi Iwona E. 
Published: March 2020

BACKGROUND
Real-life experience with idarucizumab, which reverses the anticoagulant effect of dabigatran, is currently limited.

OBJECTIVE
To evaluate efficacy and safety of the clinical use of idarucizumab after its availability in Slovenia.

METHODS
We analysed consecutive cases treated with idarucizumab in Slovenia from January to October 2016. The decision to reverse dabigatran with idarucizumab was made by the treating clinicians, as was the assessment of clinical outcomes and blood sampling/monitoring (activated partial thromboplastin time, thrombin time and diluted thrombin time) before and after use.

RESULTS
Idarucizumab was used in 17 cases. One patient was treated with the antidote twice with an interval of 2 months between treatments. The indications for idarucizumab use were: emergency surgery (4/17), severe bleeding (11/17; seven with intracranial bleeding) and ischaemic stroke (2/17). During surgery, no excessive bleeding was reported. Five patients died due to cardiogenic, haemorrhagic or septic shock, intracranial bleeding or multiple organ failure. Among cases with laboratory data available, baseline coagulation tests were prolonged in 12/13 cases with bleeding or emergency surgery. After idarucizumab administration, normal coagulation parameters were confirmed in 10/11. However, re-occurrence of dabigatran effect was noted later in four patients with creatinine clearance less than 30 ml min−1, and one patient with persistent bleeding required retreatment with idarucizumab.

CONCLUSION
Our first experiences with idarucizumab use in daily-care settings support a rapid and efficient decrease in the anticoagulant effect of dabigatran in emergency situations. Late re-occurrence of dabigatran effect was noted in a subset of patients with severe renal failure.
Transversus abdominis plane block versus quadratus lumborum block type 2 for analgesia in renal transplantation
Authors: Kolacz Marcin , Mieszkowski Marcin , Janiak Marek , Zagorski Krzysztof , Byszewska Beata , Weryk-Dysko Malgorzata , Onichimowski Dariusz , Trzebicki Janusz 
Published: March 2020

BACKGROUND
Several studies have shown an analgesic efficacy of a transversus abdominis plane block (TAPB) in reducing opioid requirements during and after cadaveric renal transplantation surgery, but the effect of a quadratus lumborum block (QLB) in this type of surgery is unclear.

OBJECTIVES
The main objective of this prospective, randomised, double-centre clinical study was to compare the analgesic efficacy of a one-sided lateral approach TAPB with a unilateral QLB type 2 in cadaveric renal transplantation surgery.

DESIGN
Randomised, single-blinded trial.

SETTING
Two University-affiliated tertiary care hospitals between April 2016 and May 2017.

PATIENTS
A total of 101 patients aged more than 18 years, scheduled for cadaveric renal transplantation.

INTERVENTIONS
On receiving ethical board approval and individual informed consent, consecutive patients were allocated randomly to receive either an ultrasound-guided single-shot lateral TAPB or an ultrasound-guided single-shot QLB type 2 on the surgical side using 20 ml of bupivacaine 0.25% with adrenaline after a standardised induction of general anaesthesia. All patients on surgical completion and recovery from general anaesthesia were admitted to the postanaesthesia care unit for 24 h. They received standardised intravenous patient-controlled analgesia with fentanyl, and their pain scores were noted at regular intervals.

MAIN OUTCOME MEASURES
The primary endpoint was total cumulative fentanyl dose used per kg body mass in the first 24 h after surgery. Secondary outcomes were the need to start a continuous infusion of fentanyl in addition to patient-controlled analgesia boluses during the stay in post-anaesthesia care unit, postoperative pain severity measured using a numerical rating scale, patient satisfaction with analgesic treatment, evidence of postoperative nausea and vomiting, pruritus and sedation level.

RESULTS
The 49 patients allocated to the QLB type 2 group used significantly less fentanyl per kg in the first 24 h after surgery than the 52 patients who received a TAPB (median [IQR] 4.2 [2.3 to 8.0] μg kg−1 versus 6.7 [3.5 to 10.7] μg kg−1, P = 0.042). No statistically significant differences were noted in the secondary endpoints within the study, including the frequency of adverse effects of opioids.

CONCLUSION
The reduction of fentanyl consumption in the first 24 h after renal transplantation with no difference in pain intensity and patient satisfaction shows a beneficial effect of one-sided QLB type 2 over a one-sided TAPB in regards to postoperative analgesia. However, the reduction in opioid consumption did not affect the frequency of opioid-related adverse effects.

TRIAL REGISTRATION
ClinicalTrials.gov ID: NCT02783586.
The vaginal microbiome as a tool to predict IVF success
Authors: Schoenmakers Sam , Laven Joop 
Published: March 2020

Purpose of review
Herein, we present an overview of the recent microbiome research and findings within the field of reproductive medicine and its relation with the outcome of Assisted reproductive technology (ART). Analyses of the microbiome composition all throughout the female reproductive trace during the process of assisted reproductive techniques are discussed.

Recent findings
Only the vaginal microbiome can be sampled without possible risks of contamination. Although this also seems to apply to the cervical microbiome, collection has to be performed with extreme caution. Because of the high risk of cross contamination, results of microbial composition of all other sites of the female reproductive tract have to be interpreted with caution. The vaginal composition prior to the start of hormonal treatment for ART seems to be predictive of in vitro fertilization/in vitro fertilization-intracytoplasmic sperm injection (IVF/IVF-ICSI) outcome, with mainly a highly negative predictive value.

Summary
The local microbiota, especially the absence or presence of specific microbes, within parts of the female reproductive tract seem to be associated with the outcome of ART.
Ventricular arrhythmias in heart failure with reduced ejection fraction
Authors: Voskoboinik Aleksandr , Moss Joshua D. 
Published: March 2020

Purpose of review
To provide a framework for approaching ventricular arrhythmias in the setting of cardiomyopathy, outline the latest evidence-based recommendations for catheter ablation and device therapy, and discuss novel treatment strategies.

Recent findings
Risk stratification of ventricular arrhythmias in systolic heart failure has evolved, with an increasing role for cardiac magnetic resonance imaging to identify underlying substrate and scar burden. Medical therapy for heart failure has greatly improved, and the role of primary prevention defibrillators in nonischemic cardiomyopathy has become more ambiguous. Catheter ablation is superior to medical therapy for arrhythmia control and should be considered early, particularly for premature ventricular complex mediated cardiomyopathy. Novel technologies to deliver energy to previously inaccessible sites include high-impedance catheter irrigants, multicatheter bipolar ablation, specialized catheters with extendable needles, transcoronary ethanol infusion, and stereotactic body radiation therapy.

Summary
Assessment and management of ventricular arrhythmias in systolic heart failure requires a systematic, multimodality approach aimed at identifying the underlying cause and reversible causes, optimizing medical therapy, assessing need for an implantable cardioverter defibrillator, and considering catheter ablation. Further research will focus on prevention of disease progression, improved risk stratification, and ablation technologies that minimize procedure duration and enable delivery of durable lesions.