bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment response of bevacizumab combination chemotherapy in recurrent glioblastoma
Authors: Huang Yu-Kai , Lieu Ann-Shung 
Published: February 2020

Abstract
Treatment options for recurrent glioblastoma are rare, with their response uncertain. This study aimed to determine the response of chemotherapy including bevacizumab in combination with vincristine and carboplatin for glioblastoma at first recurrence in a single-institution cohort.
Clinical data of patients who received chemotherapy including bevacizumab, vincristine, and low-dose carboplatin for recurrent glioblastoma between 2008 and 2014 were analyzed. Differences between those who received combination chemotherapy (chemotherapy-positive) and those who did not (chemotherapy-negative) were estimated by Fisher exact test or Wilcoxon rank-sum test, as appropriate. Survival curves were estimated using the Kaplan–Meier method, and differences between survival curves were estimated by the log-rank test. Univariate analysis of treatment response for all recurrent glioblastoma patients and secondary recurrence patients under different conditions were evaluated using Wilcoxon rank-sum test or the Kruskal–Wallis test.
Although mortality rates were similar between the chemotherapy-negative and chemotherapy-positive groups (26.7% vs 28.6%), median overall survival was significantly longer in the chemotherapy-positive group than the chemotherapy-negative group (P = .006). There were no chemotherapy-related serious complications such as gastrointestinal perforation, serious bleeding, or new-onset seizure during chemotherapy, whereas others side effects including proteinuria and hypertension were more common albeit well controlled by medication.
This study revealed combination regimen of bevacizumab, vincristine, and low-dose carboplatin as a potentially effective therapeutic approach in recurrent glioblastoma. More in-depth understanding of the mechanism underlying this combination treatment and potential contribution of alternative genetic therapeutic in recurrent glioblastoma is necessary.
Safety and efficacy of Jujadokseo-hwan for memory deficit (amnesia) in mild neurocognitive disorder
Authors: Jeong Jin-Hyung , Lee Ji-Yoon , Kim Ju-Yeon , Seo Young-Kyung , Kang Wee-Chang , Kang Hyung-Won , Park So-Jung , Jang Hye-Kyoung , Park Yang-Chun , Jung In Chul 
Published: February 2020

Abstract

Background:
Mild neurocognitive disorder (mNCD) is one of the degenerative diseases that results in memory deficit, and can progress to dementia. The effectiveness of drug therapy for mNCD is still debatable, but treatment of this disease has important implications for postponing or preventing dementia. Jujadokseo-hwan (JDH) is a traditional herbal medicine formulation that exhibits improvement in cognitive abilities and neuroprotective effects. In this study, we will evaluate the safety and efficacy of JDH compared to placebo in mNCD patients.

Methods and design:
This is a randomized, double-blind, placebo-controlled, parallel-group, multicenter clinical trial. After obtaining informed consent from all participants and performing the screening process, the participants will be equally divided into an experimental group and a control group. Each participant will visit the trial center 7 times during the 12 weeks of intervention. The follow up study will be conducted 12 weeks after the intervention ends. The primary outcome is the variance in Seoul verbal learning test-elderly's version (SVLT-E) score from baseline to 12 weeks. Secondary outcomes include scores/values for the following variables: SVLT-E, Rey complex figure test, Digit span test, Korean-Boston naming test, calculation ability, controlled oral word association test, Korean-color word stroop test, digit symbol coding, Korean-trail making test-elderly's version, Korean version of mini mental state examination for dementia screening, euro-qol-5 dimension, pattern identifications tool for cognitive disorders, Korean version of Montreal cognitive assessment, Korean quality of life-Alzheimer disease, computerized tongue image analysis system, blood pressure pulse analyzer, bioelectrical impedance analyzer, wearable electroencephalogram device, functional near-infrared spectroscopy system, and cost analysis.

Discussion:
This is the first trial evaluating the efficacy of JDH for mNCD. We expect this trial will provide strong support for wide use of JDH for mNCD and lead to further research on herbal medicine treatments for mNCD.

Trial registration number:
KCT0003570 (Registered in Clinical Research Information Service of the Republic of Korea, https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=12669).
Clinicopathological characteristics and prognostic value of POLE mutations in endometrial cancer
Authors: He Ya , Wang Tian , Li Na , Yang Binkai , Hu Yuanjing 
Published: February 2020

Abstract

Background:
The aim of this meta-analysis was to assess the clinicopathological features and to confirm prognostic value of POLE exonuclease domain mutations (EDM) in endometrial carcinoma patients.

Methods:
The PubMed, Web of Science, the data of China National Knowledge Infrastructure, and Wan fang Medical Network were systematically searched for relevant articles without a cut-off date. The keywords for the search were “endometrial cancer,” “endometrial carcinoma,” “EC,” “POLE mutations,” “POLE exonuclease domain mutations,” “POLE-mutant,” “clinical characteristics” “prognostic.” Pooled hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by using Review manager 5.3 and Stata 14.0 statistical software.

Results:
Six cohort studies assessing 179 EC patients with POLE EDMs were included. The results indicated a favorable progression-free survival in POLE-mutant patients (HR = 0.32; 95% CI: = [0.09–1.18]). Furthermore, the overall survival was great in patients with POLE-mutant (HR = 0.68; 95% CI = [0.41–1.13]). It was shown that a significantly higher incidence of POLE mutations with Federation of International of Gynecologists and Obstetricians (FIGO) I group compared to FIGO II-IV group (pooled ORs: 0.34, 95% CI: [0.12–0.94], P = .04), POLE-mutant EC was not significantly associated with histology (OR = 0.56,95% CI: 0.29–1.23), tumor grade (OR = 1.22,95% CI:0.85–1.74), lymph-vascular space invasion (OR = 0.40,95% 0.06–2.42), depth of myometrial invasion (OR = 0.70,95% CI: 0.41–1.18), lymph node status (OR = 0.41, 95% 0.04–4.50), and European Society for Medical Oncology risk groups (OR = 0.68,95% CI: 0.37–1.26).

Conclusion:
This meta-analysis has confirmed POLE EDMs may serve as a predictive biomarker of favorable prognosis. Further studies are needed to explore the appropriate clinical utility of POLE EDMs in EC.
A retrospective cohort study comparing two treatments for active venous leg ulcers
Authors: Liu Xiaochun , Zheng Guofu , Ye Bo , Chen Weiqing , Xie Hailiang , Zhang Teng , Lin Jing 
Published: February 2020

Abstract
Endovenous laser ablation (EVLA) and ultrasound-guided foam sclerotherapy (UGFS) have largely replaced traditional surgery for treatment of varicose veins (VVs) with active venous leg ulcers (VLUs), and multiple combined modes have emerged. A retrospective cohort study was performed to compare the effect of traditional surgery (high ligation and stripping followed with compression [compression plus HL-S]) to high ligation-endovenous laser ablation-foam sclerotherapy followed with compression (compression plus HL-EVLA-FS) on the treatment of active VLUs.
Data of active VLUs treated in our center from 2008 to 2017 and followed up for 1 year were analyzed. The intervention measures in the first 5 years were compression plus HL-S, and in the following 5 years were compression plus HL-EVLA-FS. The primary outcome was ulcer healing time. The secondary outcomes were the VVs occlusion and clinical success as assessed by a change in venous clinical severity score (VCSS) and complications.
The study included 120 patients and 200 patients treated with HL-S and HL-EVLA-FS, respectively, during 2008 to 2017. The average ulcer healing time were 2.3 ± 2.4 and 1.7 ± 1.7 months, respectively. Significant difference was found in the cumulative ulcers healing rate between the two groups (Hazard ratio [HR] and 95% confidence interval [CI] was respectively 1.458 and 1.140–1.865, P = .0002), but no difference was found in the VVs occlusion (HR and 95% CI was respectively 1.005 and 0.774–1.3071, P = .967). Significant difference occurred in 6 months and 12 months post-operatively in the VCSS change and in the procedure data and some complications between the 2 groups.
In conclusion, the treatment of HL-EVLA-FS can accelerate the healing of VLUs, improve the VCSS and present superior procedure data. However, no advantage could be found in the VVs occlusion compared with control group.
A Lean Approach to Improve Medication Administration Safety by Reducing Distractions and Interruptions
Authors: Kavanagh Adam , Donnelly Jennifer 
Published: February 2020

Background:
Medication errors are potentially avoidable incidents that can lead to harm. Medications are often administered under challenging conditions, which creates opportunities for distractions and interruptions.

Purpose:
The aim of this study was to reduce the number of interruptions and distractions experienced by nurses during the medication administration process.

Methods:
A Lean approach was used to value stream map the process, devise solutions, and measure the impact of the change.

Results:
Sources of distraction and interruption were identified. Through collaboration the medication administration process was standardized, and a purpose-built medication administration room was developed. Frequency of interruptions and distractions from all sources was reduced.

Conclusions:
Value stream mapping the process enabled the identification of non–value-added activities that were threats to the integrity of the process. Standardizing the medication administration process and creating a safe space to facilitate the process successfully reduced interruptions and distractions from all sources.
Preeclampsia Among African American Pregnant Women: An Update on Prevalence, Complications, Etiology, and Biomarkers
Authors: Zhang Ming , Wan Philip , Ng Kenneth , Singh Kurnvir , Cheng Tzu Hsuan , Velickovic Ivan , Dalloul Mudar , Wlody David 
Published: February 2020

ABSTRACT

Importance
Preeclampsia is a devastating disease of pregnancy associated with increased risk of fetal and maternal complications. African American pregnant women have a high prevalence of preeclampsia, but there is a need of systemic analyses of this high-risk group regarding complications, etiology, and biomarkers.

Objective
The aim of this study was to provide a synopsis of current research of preeclampsia specifically related to African American women.

Evidence Acquisition
A comprehensive search was performed in the bibliographic database PubMed with keywords “preeclampsia” and “African American.”

Results
African American women with preeclampsia were at an increased risk of preterm birth, which resulted in low-birth-weight infants. Intrauterine fetal death among African American preeclamptic patients occurs at twice the rate as in other races. On the maternal side, African American mothers with preeclampsia have more severe hypertension, antepartum hemorrhage, and increased mortality. Those who survive preeclampsia have a high risk of postpartum cardiometabolic disease. Preexisting conditions (eg, systemic lupus erythematosus) and genetic mutations (eg, sickle cell disease in the mother, FVL or APOL1 mutations in the fetus) may contribute to the higher prevalence and worse outcomes in African American women. Many blood factors, for example, the ratio of proteins sFlt/PlGF, hormones, and inflammatory factors, have been studied as potential biomarkers for preeclampsia, but their specificity needs further investigation.

Conclusions
Further studies of preeclampsia among African American women addressing underlying risk factors and etiologies, coupled with identification of preeclampsia-specific biomarkers allowing early detection and intervention, will significantly improve the clinical management of this devastating disease.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this activity, the learner should be better able to describe the difference in prevalence of fetal and maternal complications among African American women with preeclampsia versus women of other races; explain updated genetic studies of preeclampsia specifically related to African American women; and analyze current research of biomarkers for prediction of status and progress of preeclampsia.
Ulipristal Acetate Before Hysteroscopic Myomectomy: A Systematic Review
Authors: Vitale Salvatore Giovanni , Ferrero Simone , Caruso Salvatore , Barra Fabio , Marín-Buck Alejandro , Vilos George Angelos , Vitagliano Amerigo , Török Péter , Ciebiera Michal , Cianci Antonio 
Published: February 2020

Importance
Uterine leiomyomas, also referred to as myomas or fibroids, are the most common benign tumors of the reproductive tract. Ulipristal acetate (UPA) is an active selective progesterone receptor modulator used as preoperative treatment for uterine myomas.

Purpose
The aim of this review is to provide an overview of the literature about the effects of UPA administration before hysteroscopic myomectomy. The clinical question in “PICO” format was in patients affected by uterine myomas undergoing operative hysteroscopic management, “Does UPA impact the surgical outcomes?”

Evidence Acquisition
We performed a systematic literature search in PubMed/MEDLINE and Embase for original studies written in English (registered in PROSPERO CRD42018092201), using the terms “hysteroscopy” AND “ulipristal acetate” published up to March 2019. Original articles about UPA treatment before hysteroscopic myomectomy (randomized, observational, retrospective studies) were considered eligible.

Results
Our literature search produced 32 records. After exclusions, 4 studies were considered eligible for analysis. Results show that UPA does not worsen the overall technical difficulty of hysteroscopic myomectomy. Moreover, it may increase the chance of complete primary myomectomy in complex hysteroscopic procedures.

Conclusions and Relevance
Despite the positive results presented in this systematic review, low-quality evidence exists yet on the impact of UPA treatment before hysteroscopic myomectomy. High-quality prospective randomized controlled trials are required to establish the impact of UPA on surgical outcomes of patients treated for uterine myomas by hysteroscopy. Moreover, long-term outcomes of myomectomies after UPA treatment (such as frequency of myoma recurrence, recovery time, and quality of life) should be determined.

Target Audience
Obstetricians and gynecologists, family physicians, nurse practitioners.

Learning Objectives
After completing this activity, the learner should be better able to (1) identify the main characteristics of uterine myomas; (2) discuss the advantages and disadvantages of the use of UPA before hysteroscopic myomectomy; and (3) select the most appropriate therapeutic strategy based on the characteristics of the myoma(s) and the patient.
Monitoring of Respiratory Muscle Function in Critically Ill Children
Authors: Mortamet Guillaume , Crulli Benjamin , Fauroux Brigitte , Emeriaud Guillaume 
Published: February 2020

Objectives:
This review discusses the different techniques used at the bedside to assess respiratory muscle function in critically ill children and their clinical applications.

Data Sources:
A scoping review of the medical literature on respiratory muscle function assessment in critically ill children was conducted using the PubMed search engine.

Study Selection:
We included all scientific, peer-reviewed studies about respiratory muscle function assessment in critically ill children, as well as some key adult studies.

Data Extraction:
Data extracted included findings or comments about techniques used to assess respiratory muscle function.

Data Synthesis:
Various promising physiologic techniques are available to assess respiratory muscle function at the bedside of critically ill children throughout the disease process. During the acute phase, this assessment allows a better understanding of the pathophysiological mechanisms of the disease and an optimization of the ventilatory support to increase its effectiveness and limit its potential complications. During the weaning process, these physiologic techniques may help predict extubation success and therefore optimize ventilator weaning.

Conclusions:
Physiologic techniques are useful to precisely assess respiratory muscle function and to individualize and optimize the management of mechanical ventilation in children. Among all the available techniques, the measurements of esophageal pressure and electrical activity of the diaphragm appear particularly helpful in the era of individualized ventilatory management.
Comparison of End-of-Life Care Practices Between Children With Complex Chronic Conditions and Neonates Dying in an ICU Versus Non-ICUs: A Substudy of the Pediatric End-of-LIfe CAre Needs in Switzerland (PELICAN) Project*
Authors: Ramelet Anne-Sylvie , Bergstraesser Eva , Grandjean Chantal , Dorsaz Anouk , Fahrni-Nater Patricia , Cignacco Eva , Zimmerman Karin 
Published: February 2020

Objectives:
To describe and compare characteristics of care provided at the end of life for children with chronic complex conditions and neonates who died in an ICU with those who died outside an ICU.

Design:
Substudy of a nation-wide retrospective chart review.

Setting:
Thirteen hospitals, including 14 pediatric and neonatal ICUs, two long-term institutions, and 10 community-based organizations in the three language regions of Switzerland.

Patients:
One hundred forty-nine children (0–18 yr) who died in the years 2011 or 2012. Causes of death were related to cardiac, neurologic, oncological, or neonatal conditions.

Interventions:
None.

Measurements and Main Results:
Demographic and clinical characteristics, therapeutic procedures, circumstances of death, and patterns of decisional processes were extracted from the medical charts. Ninety-three (62%) neonates (median age, 4 d) and children (median age, 23 mo) died in ICU, and 56 (38%) with a median age of 63 months outside ICU. Generally, ICU patients had more therapeutic and invasive procedures, compared with non-ICU patients. Changes in treatment plan in the last 4 weeks of life, such as do-not-resuscitate orders occurred in 40% of ICU patients and 25% of non-ICU patients (p < 0.001). In the ICU, when decision to withdraw life-sustaining treatment was made, time to death in children and newborns was 4:25 and 3:00, respectively. In institutions where it was available, involvement of specialized pediatric palliative care services was recorded in 15 ICU patients (43%) and in 18 non-ICU patients (78%) (p = 0.008).

Conclusions:
This nation-wide study demonstrated that patients with a complex chronic condition who die in ICU, compared with those who die outside ICU, are characterized by fast changing care situations, including when to withdraw life-sustaining treatment. This highlights the importance of early effective communication and shared decision making among clinicians and families.
Brain Connectivity Modulation After Exoskeleton-Assisted Gait in Chronic Hemiplegic Stroke Survivors
Authors: Molteni Franco , Formaggio Emanuela , Bosco Anna , Guanziroli Eleonora , Piccione Francesco , Masiero Stefano , Del Felice Alessandra 
Published: February 2020

Objective
The aim of this study was to investigate electroencephalographic (EEG) connectivity short-term changes, quantified by node strength and betweenness centrality, induced by a single trial of exoskeleton-assisted gait in chronic stroke survivors.

Design
Study design was randomized crossover. Electroencephalographic data (64-channel system) were recorded before gait (baseline) and after unassisted overground walking and overground exoskeleton-assisted walking. Coherence was estimated for alpha1, alpha2, and beta frequency ranges. Graph analysis assessed network model properties: node strength and betweenness centrality.

Results
Nine participants were included in the final analysis. In the group (four participants) with a left-hemisphere stroke lesion (dominant hemisphere), over the vertex, node strength increased in alpha1, alpha2, and beta bands, and betweenness centrality decreased in alpha2 both after unassisted overground walking and exoskeleton-assisted walking. In the group (five participants) with a right-hemisphere lesion (nondominant hemisphere), node strength increased in alpha1 and alpha2 over the contralesional sensorimotor area and ipsilesional prefrontal area after overground exoskeleton-assisted walking, compared with baseline and unassisted overground walking.

Conclusion
A single session of exoskeleton training provides short-term neuroplastic modulation in chronic stroke. In participants with a nondominant hemisphere lesion, exoskeleton training induces activations similar to those observed in able-bodied participants, suggesting a role of lesion lateralization in networks’ reorganization.
Utilizing Artificial Intelligence to Determine Bone Mineral Density Via Chest Computed Tomography
Authors: Savage Rock H. , van Assen Marly , Martin Simon S. , Sahbaee Pooyan , Griffith Lewis P. , Giovagnoli Dante , Sperl Jonathan I. , Hopfgartner Christian , Kärgel Rainer , Schoepf U. Joseph 
Published: February 2020

Purpose:
The purpose of this study was to validate the accuracy of an artificial intelligence (AI) prototype application in determining bone mineral density (BMD) from chest computed tomography (CT), as compared with dual-energy x-ray absorptiometry (DEXA).

Materials and Methods:
In this Institutional Review Board–approved study, we analyzed the data of 65 patients (57 female, mean age: 67.4 y) who underwent both DEXA and chest CT (mean time between scans: 1.31 y). From the DEXA studies, T-scores for L1-L4 (lumbar vertebrae 1 to 4) were recorded. Patients were then divided on the basis of their T-scores into normal control, osteopenic, or osteoporotic groups. An AI algorithm based on wavelet features, AdaBoost, and local geometry constraints independently localized thoracic vertebrae from chest CT studies and automatically computed average Hounsfield Unit (HU) values with kVp-dependent spectral correction. The Pearson correlation evaluated the correlation between the T-scores and HU values. Mann-Whitney U test was implemented to compare the HU values of normal control versus osteoporotic patients.

Results:
Overall, the DEXA-determined T-scores and AI-derived HU values showed a moderate correlation (r=0.55; P<0.001). This 65-patient population was divided into 3 subgroups on the basis of their T-scores. The mean T-scores for the 3 subgroups (normal control, osteopenic, osteoporotic) were 0.77±1.50, −1.51±0.04, and −3.26±0.59, respectively. The mean DEXA-determined L1-L4 BMD measures were 1.13±0.16, 0.88±0.06, and 0.68±0.06 g/cm2, respectively. The mean AI-derived attenuation values were 145±42.5, 136±31.82, and 103±16.28 HU, respectively. Using these AI-derived HU values, a significant difference was found between the normal control patients and osteoporotic group (P=0.045).

Conclusion:
Our results show that this AI prototype can successfully determine BMD in moderate correlation with DEXA. Combined with other AI algorithms directed at evaluating cardiac and lung diseases, this prototype may contribute to future comprehensive preventative care based on a single chest CT.