bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differential methylation and expression of genes in the hypoxia-inducible factor 1 signaling pathway are associated with paclitaxel-induced peripheral neuropathy in breast cancer survivors and with preclinical models of chemotherapy-induced neuropathic pain
Authors: Kober Kord M , Lee Man-Cheung , Olshen Adam , Conley Yvette P , Sirota Marina , Keiser Michael , Hammer Marilyn J , Abrams Gary , Schumacher Mark , Levine Jon D , Miaskowski Christine 
Published: June 2020

Background Paclitaxel is an important chemotherapeutic agent for the treatment of breast cancer. Paclitaxel-induced peripheral neuropathy (PIPN) is a major dose-limiting toxicity that can persist into survivorship. While not all survivors develop PIPN, for those who do, it has a substantial negative impact on their functional status and quality of life. No interventions are available to treat PIPN. In our previous studies, we identified that the HIF-1 signaling pathway (H1SP) was perturbed between breast cancer survivors with and without PIPN. Preclinical studies suggest that the H1SP is involved in the development of bortezomib-induced and diabetic peripheral neuropathy, and sciatic nerve injury. The purpose of this study was to identify H1SP genes that have both differential methylation and differential gene expression between breast cancer survivors with and without PIPN. Methods A multi-staged integrated analysis was performed. In peripheral blood, methylation was assayed using microarray and gene expression was assayed using RNA-seq. Candidate genes in the H1SP having both differentially methylation and differential expression were identified between survivors who received paclitaxel and did (n = 25) and did not (n = 25) develop PIPN. Then, candidate genes were evaluated for differential methylation and differential expression in public data sets of preclinical models of PIPN and sciatic nerve injury. Results Eight candidate genes were identified as both differential methylation and differential expression in survivors. Of the eight homologs identified, one was found to be differential expression in both PIPN and “normal” mice dorsal root ganglia; three were differential methylation in sciatic nerve injury versus sham rats in both pre-frontal cortex and T-cells; and two were differential methylation in sciatic nerve injury versus sham rats in the pre-frontal cortex. Conclusions This study is the first to evaluate for methylation in cancer survivors with chronic PIPN. The findings provide evidence that the expression of H1SP genes associated with chronic PIPN in cancer survivors may be regulated by epigenetic mechanisms and suggests genes for validation as potential therapeutic targets.
Calorie provision from citrate anticoagulation in continuous renal replacement therapy in critical care
Authors: Rogers Alice R , Jenkins Bethan 
Published: June 2020

Background Citrate is used as a regional anticoagulant for continuous veno-venous haemofiltration and provides 0.59 kcal/mmol. Previous studies hypothesised continuous veno-venous haemofiltration can provide 200–1300 kcal/day dependent on the anticoagulant and replacement solutions used. The aim of this study was to calculate the calorie load from citrate in our patient group. Methods An equation derived from a paper by Oudemans-van Straaten was used to estimate calorie provision from citrate. Citrate calorie load was defined as the difference between the citrate in the filter circuit and the removal by continuous veno-venous haemofiltration. Clinical data were recorded on 20 consecutive patients admitted to intensive care unit and commenced on citrate continuous veno-venous haemofiltration using prismacitrate 18/0 by Gambro, a tri-sodium citrate solution. Clinical data recorded included patient demographics, filter settings including blood flow, filtration factor, citrate dose and time on filtration daily. Results A total of 20 critically ill patients received continuous veno-venous haemofiltration for treatment of a new acute kidney injury, mean age 66 years, 65% male. Mean duration of continuous veno-venous haemofiltration was 3.7 days. Mean daily time on filtration was 20 h/day. Mean filtration fraction, citrate dose and blood flow were 30%, 3 mmol/L and 123 ml/min, respectively. Our calculation showed that a mean of 9.5 ± 1.7 cal/h were provided from citrate with a mean daily calorie load of 196 ± 69 kcal. Conclusions Continuous veno-venous haemofiltration with tri-sodium citrate provided an additional 196 ± 69 kcal/day. The calorie load from citrate continuous veno-venous haemofiltration should be calculated regularly as changes in filter settings, in particular citrate dose and blood flow can have a significant impact on calorie provision.
Improving documentation of side-effects discussions by doctors for newly initiated psychotropic medications in outpatient clinics: A single-centre quality-improvement project
Authors: Bharathi Balasundaram , June Phua , Ling Tan Lay , Huat Peh Lai , Ashvini Selvaraj , Zhan Bong Yii , Boon Ang Woo 
Published: June 2020

Background: Robust clinical documentation of side-effects communication is an integral component of good patient care, endorsed by the Singapore Medical Council Ethical Code and Ethical Guidelines and further highlighted by the Modified Montgomery Test. In addition to ensuring quality of care, good clinical documentation can help mitigate potential medico-legal risks against doctors and health-care providers. Objectives: This audit-cum-quality-improvement project aimed to enhance clinical documentation of side-effects discussion of newly prescribed medication in psychiatry outpatient clinics to 100% in a 12-month period. Methods: A baseline measurement revealed that 40% of new cases seen in general and geriatric psychiatry outpatient clinics from March to June 2017 had evidenced clinical documentation of at least one or more side effects. PDSA methodology was employed to bring about improvements and test change interventions. Results: Through three audit cycles between January and December 2018 and a fourth round of data collection in April 2019, documentation rates showed marked improvement from a baseline of 40% to 91%. The IT document tool was the most effective intervention which was successfully adopted and implemented into the standard documentation template for new case assessments. Conclusions: The project was a success overall, with improvements in documentation rates rising to 91%. Through change interventions, systemic factors rooted in patient safety have been embodied in everyday clinical practice.
Getting back to basics: Reintroduction of pelvic anatomy concepts for obstetrics and gynaecology residents
Authors: Vallabhajosyula Ranganath , Mathur Manisha , Kathirvel Rajeswari , Madan Aggarwal Ieera , Kang Julian , Mogali Sreenivasulu Reddy 
Published: June 2020

Background: A sound understanding of pelvic anatomy is essential for training in obstetrics and gynaecology (OBGYN) and for practising in the field post-qualification. There is a growing concern that surgery residents have an inadequate knowledge of anatomy and little confidence in their approach to the subject. Objective: This study aims to explain the use of an anatomy workshop to deliver a unique and self-designed innovative instruction method that employs cutting-edge resources to enhance OBGYN residents’ comprehension of clinical anatomy and to discuss why this approach works. Methodology: The workshop emphasised the clinical and surgical anatomy of the female pelvis using 3-D virtual dissections, relevant plastinated specimens and also bony pelvic models that had been developed in house. Anatomists and OBGYN consultants facilitated the workshop. The students’ knowledge of anatomy and their perceptions of the subject were evaluated by pre- and post-tests and a five-point Likert scale, respectively. A mixed methods analysis was applied. Results: Of the 42 participants, 26 (61.9%) completed both the pre- and post-test. The overall difference (mean percentage) between the pre- and post-test performance was 25.41%. There was a significant difference in the residents’ knowledge of anatomy between the pre- and post-workshop ( p<0.05). Participants ( n=10) provided positive feedback on the workshop content, teaching tools, learning activities and educators. They recommended that the workshop should be held at least once a year (70%), and particularly during the first year of residency (90%). Conclusion: The active learning workshop enabled by multidisciplinary teaching and the innovative tools employed resulted in improved outcomes in knowledge of anatomy, confidence and learning satisfaction. Reintroduction of anatomy concepts during OBGYN residency training is needed to improve surgical training and patient care.
Aeroallergen sensitization profile in medically resistant chronic rhinosinusitis
Authors: Odat Haitham , Alali Maulla , Al-Qudah Mohannad 
Published: June 2020

Objectives: The aim of this study is to report the aeroallergen sensitization profile in medically resistant chronic rhinosinusitis with or without nasal polyps and its relationship to asthma. Methods: Retrospective charts review of 402 chronic rhinosinusitis patients who failed to respond to medical treatment and scheduled for surgery at a tertiary academic center was performed. One hundred and fifty-five patients had chronic rhinosinusitis with nasal polyps and 247 patients had chronic rhinosinusitis without nasal polyps, furthermore; the two phenotypes were subdivided according to the presence or absence of asthma. Allergen-specific immunoglobulin E to 24 inhalant allergens was measured to all patients by the enzyme allergo-sorbent test. Results: The average age was 35 years ( SD ± 13) with 236 males and 166 females. Two hundred and fifty-three patients (63%) were tested positive for at least one allergen with no significant difference between patients with or without polyp (in chronic rhinosinusitis with nasal polyps, 103 patients (66%) were positive compared with 150 patients (61%) in chronic rhinosinusitis without nasal polyps). There were no significant differences in the prevalence, type, and number of positive allergens between the two phenotypes. The prevalence of asthma was found to be 19% in patients with chronic rhinosinusitis without nasal polyps versus 46% in those with chronic rhinosinusitis with nasal polyps ( p = 0.001), and the prevalence of high eosinophils was 27%, and 47% in both phenotypes, respectively ( p = 0.0001). Conclusions: The prevalence of inhalational allergy in medically resistant chronic rhinosinusitis is high, however, this profile does not differ based on the presence of polyp. Patients with chronic rhinosinusitis with nasal polyps had a higher prevalence of asthma and blood eosinophils as compared with chronic rhinosinusitis without nasal polyps. Our results showed a little role of inhalant allergens in nasal polyps or asthma comorbidity in refractory sinusitis patients.
Characterization of envelope sequence of HIV virus in children infected with HIV in Vietnam
Authors: Dang Linh Vu Phuong , Pham Hung Viet , Dinh Thanh Thi , Nguyen Thu Hoai , Vu Quyen Thi Huyen , Vu Nhung Thi Phuong , Le Phuong Thi Bich , Nguyen Lam Van , Le Hai Thanh , Vu Phuong Thi , Olson Linus 
Published: June 2020

Background: HIV is characterized by high levels of genetic variability, including increased numbers of heterogeneous sequences of the envelope region. Therefore, studying genetic variability of HIV in relation to viral replication might facilitate prognosis of disease progression. Methods: The study was designed as cross-sectional; data and samples of participants collected and analyzed env genes were obtained from 23 children enrolled by Vietnam National Children’s Hospital. Results: Substantial mutations in the C2 region were found in patients with high levels of viral replication while changes in the C3 region were mostly found in patients with low viral load. In the V1 region, we found profound amino acid modifications in patients with low HIV viral loads in contrast to the V2 sequence, where we identified single point mutations in patients with increased HIV viral load. The V3 region was relatively homogeneous, while profound deletions in the V4 region were detected in patients with increased viral replication. Conclusion: Our results suggest that genetic variations in different regions of the HIV envelope sequence, including both conserved C2 and C3 and variable V1/V2 and V4 regions, might be involved in increased viral infectivity and replication capacity. Such knowledge might help improve prediction of HIV progress and treatment in patients.
Transjugular intrahepatic portosystemic shunt and alfapump® system for refractory ascites in liver cirrhosis: Outcomes and complications
Authors: Will Valerie , Rodrigues Susana G , Stirnimann Guido , De Gottardi Andrea , Bosch Jaime , Berzigotti Annalisa 
Published: June 2020

BackgroundTreatment of refractory ascites in liver cirrhosis is challenging. Transjugular intrahepatic portosystemic shunt and alfapump® have been proposed for the management, but few data comparing both exist.AimsThe aim of this study was to evaluate the characteristics and outcomes of patients treated with transjugular intrahepatic portosystemic shunt and alfapump® for refractory ascites at our centre.MethodsAll consecutive patients were retrospectively reviewed for baseline characteristics, efficacy of treatment, complications and survival.ResultsIn total, 19 patients with transjugular intrahepatic portosystemic shunt and 40 patients with alfapump® were included. Patients with transjugular intrahepatic portosystemic shunt had better liver function and less hepatic encephalopathy at baseline. Fifty‐eight per cent of patients developed hepatic encephalopathy in the first six months after transjugular intrahepatic portosystemic shunt. In patients with alfapump®, renal function decreased and 58% developed prerenal impairment and 43% hepatorenal syndrome in the first six months. Alfapump® patients with new catheters required less reinterventions (26% versus 57% with old catheters, p  = 0.049). Transplant‐free survival at 1 year was 25% in alfapump® and 65% in transjugular intrahepatic portosystemic shunt. Hepatic encephalopathy predicted transplant‐free survival in patients with alfapump® (hazard ratio 2.00, 95% confidence interval 0.99–4.02, p  = 0.05). In a sensitivity analysis comparing patients with similar liver function, the rate of hepatorenal syndrome and prerenal impairment was higher in patients with alfapump® and these patients were hospitalised more frequently, whereas the rate of hepatic encephalopathy was similar in both treatment groups.ConclusionsBoth transjugular intrahepatic portosystemic shunt and alfapump® were effective treatments for refractory ascites in cirrhosis. Patients treated with transjugular intrahepatic portosystemic shunt had a better one‐year transplant‐free survival but had less negative prognostic factors at baseline. Selecting patients without hepatic encephalopathy prior to implantation of an alfapump® might improve transplant‐free survival.
Outcomes of Hemospray therapy in the treatment of intraprocedural upper gastrointestinal bleeding post‐endoscopic therapy
Authors: Hussein Mohamed , Alzoubaidi Durayd , de la Serna Alvaro , Weaver Michael , Fernandez‐Sordo Jacobo O , Rey Johannes W , Hayee Bu’Hussain , Despott Edward , Murino Alberto , Moreea Sulleman , Boger Phil , Dunn Jason , Mainie Inder , Graham David , Mullady Dan , Early Dayna , Ragunath Krish , Anderson John , Bhandari Pradeep , Goetz Martin , Kiesslich Ralf , Coron Emmanuel , de Santiago Enrique R , Gonda Tamas , Lovat Laurence B , Haidry Rehan 
Published: June 2020

IntroductionWith increasing advances in minimally invasive endoscopic therapies and endoscopic resection techniques for luminal disease, there is an increased risk of post‐procedure bleeding. This can contribute to significant burden on patient’s quality of life and health resources when reintervention is required. Hemospray (Cook Medical, North Carolina, USA) is a novel haemostatic powder licensed for gastrointestinal bleeding. The aim of this single‐arm, prospective, non‐randomised multicentre international study is to look at outcomes in patients with upper gastrointestinal bleeds following elective endoscopic therapy treated with Hemospray to achieve haemostasis.MethodsData was prospectively collected on the use of Hemospray from 16 centres (January 2016–November 2019). Hemospray was used during the presence of progressive intraprocedural bleeding post‐endoscopic therapy as a monotherapy, dual therapy with standard haemostatic techniques or rescue therapy once standard methods had failed. Haemostasis was defined as the cessation of bleeding within 5 min of the application of Hemospray. Re‐bleeding was defined as a sustained drop in haemoglobin (>2 g/l), haematemesis or melaena with haemodynamic instability after the index endoscopy.ResultsA total of 73 patients were analysed with bleeding post‐endoscopic therapy. The median Blatchford score at baseline was five (interquartile range 0–9). The median Rockall score was six (interquartile range 5–7). Immediate haemostasis following the application of Hemospray was achieved in 73/73 (100%) of patients. Two out of 57 (4%) had a re‐bleed post‐Hemospray, one was following oesophageal endoscopic mucosal resection and the other post‐duodenal endoscopic mucosal resection. Both patients had a repeat endoscopy and therapy within 24 h. Re‐bleeding data was missing for 16 patients, and mortality data was missing for 14 patients. There were no adverse events recorded in association with the use of Hemospray.ConclusionHemospray is safe and effective in achieving immediate haemostasis following uncontrolled and progressive intraprocedural blood loss post‐endoscopic therapy, with a low re‐bleed rate.
Preoperative Anemia Treatment With Intravenous Iron in Patients Undergoing Major Orthopedic Surgery: A Systematic Review
Authors: Smith Aaron , Moon Tiffany , Pak Taylor , Park Brian , Urman Richard D. 
Published: June 2020

Introduction: Based upon the Third National Health and Nutrition Examination Survey data, iron deficiency anemia is the cause of at least 20% of cases of anemia in adults over the age of 65. This is especially relevant in patients undergoing major orthopedic surgery as substantial perioperative blood loss is possible, leading to a high rate of allogeneic blood transfusion in total hip replacements, total knee replacements, and hip fracture repairs. Significance: The results of this systematic review may be of interest to clinicians and hospital administrators evaluating the clinical efficacy and cost effectiveness of intravenous (IV) iron administration prior to major orthopedic surgery. Materials and Methods: The original studies considered for this review included patients who were over 18 years of age, undergoing major orthopedic surgery, and who received an IV iron treatment in the preoperative setting. A total of 1083 articles were identified and reviewed. After removing duplicates, 1031 publications were screened, and 105 full-text studies were assessed for eligibility. A total of 98 were excluded and 7 articles remained which met the criteria for this review. The primary outcome examined in the included studies was the allogeneic blood transfusion rate. The secondary areas of interest were changes in serum hemoglobin, morbidity and mortality, length of stay, and cost effectiveness. Results: This systematic review found little evidence that IV iron therapy is effective at reducing transfusion in patients undergoing major orthopedic surgery. Conclusions: We do not recommend preoperative IV iron therapy for all patients scheduled for major orthopedic surgery.
Introduction to the Online Nursing Education Best Practices Guide
Authors: Authement Renae S. , Dormire Sharon L. 
Published: June 2020

Introduction As online nursing education programs continue to increase to meet the demands of the growing market, nursing faculty are challenged to develop and deliver courses based on best practice principles. The Online Nursing Education Best Practices Guide (ONE Guide) builds on and extends the nationally recognized Quality Matters® program and serves as a roadmap guiding course development and delivery. The fundamental principle for success in online teaching is instructor presence; the teacher as a facilitator of learning is illustrated throughout the guide. An Online Instructor Checklist facilitates systematic implementation of best practice principles. Methods This article is based on a focused literature review and concept analysis resulting in a comprehensive guide for delivery of effective, quality nursing education through best practices in the online learning environment. A broad search of databases focused on articles during 2014 to 2019 was completed. The literature review included articles that examined over 1200 student perceptions of instructor presence in the online setting. Conclusion Nurses carry a direct responsibility for the health and well-being of patients. Nursing quality education proves fundamental to the profession’s long-term outcomes. The ONE Guide and Online Instructor Checklist apply comprehensive, evidence-based teaching strategies to give a roadmap for success in the online teaching environment.
Configuration Synthesis and Performance Analysis of 9-Speed Automatic Transmissions
Authors: Ding Huafeng , Cai Changwang , Chen Ziming , Ke Tao , Mao Bowen 
Published: June 2020

AbstractCurrent research of automatic transmission (AT) mainly focuses on the improvement of driving performance, and configuration innovation is one of the main research directions. However, finding new configurations of ATs is one of the main limitations of configuration innovation. In the present study, epicyclic gear trains (EGTs) are applied to investigate mechanisms of 9-speed ATs. Then four kinematic configurations are proposed for automatic transitions. In order to evaluate the performance of proposed mechanisms, the lever analogy method is applied to conduct kinematic and mechanical analyses. The power flow analysis is conducted, and then transmission efficiencies are calculated based on the torque method. The comparative analysis between the proposed and existing mechanisms is carried out where obtained results show that proposed mechanisms have reasonable performance and can be used in ATs. The prototype of an AT is manufactured and the speed test is conducted, which proves the accuracy of analysis and the feasibility of proposed mechanisms.
Emergency department utilization of case-managed patients following benign gynecologic surgery
Authors: Kelly Elizabeth A. , Keller Cara C. , Sax Megan R. , Rossi Rocco A. 
Published: June 2020

Abstract
Background
Case management has been shown to reduce the amount of unnecessary emergency department visits among Medicaid or uninsured patients. This study aims to determine whether case management is associated with decreased unnecessary emergency department visits among benign gynecology surgical patients in the first 30 days following surgery.

Results
Out of 875 patients, there were a total of 58 return visits to the emergency department within 30 days and only 6 readmissions. Twenty-four emergency department visits occurred in the case-managed group, and thirty-eight emergency department visits occurred in the non-case-managed group. The two factors that were statistically significant for increase odds of return to the emergency department were the type of surgery (inpatient versus outpatient) and case management. The odds for returning to the emergency department for those not receiving case management was found to be 4.53 to that of the case-managed group when controlling for BMI, age, marital status, and type of surgery.

Conclusion
In an effort to reduce healthcare costs, case management is a promising intervention to help postoperative patients manage their care while minimizing emergency department visits.