bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhancing Care for Long-Term Care Residents Approaching End-of-Life: A Mixed-Methods Study Assessing a Palliative Care Transfer Form
Authors: Baetz-Dougan Madelaine , Reiter Leora , Quigley Laura , Grossman Daphna 
Published: December 2020

Background: Many barriers exist in providing quality end-of-life care in long-term care (LTC), including transitions of care between acute care and LTC. Transfer forms can be beneficial in ensuring resident’s end-of-life care needs are coordinated between different settings. The NYGH-LTC Transfer Form is a newly developed tool created to enhance care for residents transferred from acute care back to their LTC home for end-of-life. Study Aim: Assess the perceived ease of use, usefulness, and care-enhancing potential of the NYGH-LTC Transfer Form by interprofessional LTC staff. Methods: The study population included interprofessional staff members at 2 LTC homes in Toronto, Canada. Quantitative data was obtained through surveys and qualitative data was obtained through focus groups. Results: There were a total of 34 participants. 79.4% of participants agreed the form was easy to use and 82.4% agreed it would improve care. Subgroup analysis demonstrated that participants with greater than 20 years experience were less likely to agree that it would improve care (p = 0.01). Qualitative analysis generated 4 themes: 1) Strengths, 2) Areas of Improvement, 3) Information Sharing, and 4) Communication. Conclusions: The NYGH-LTC Transfer Form was overall well-evaluated. The form was seen as most useful for those with less experience or less confidence in palliative care. Communication was identified as a major barrier to successful transitions of care and increased bidirectional verbal communication is needed in addition to the form.
Efficacy of Staged Oronasal Fistula Reconstruction and Improved Bone Graft Survival in Cleft Patients Undergoing Secondary Reconstruction
Authors: Awad Amanda N. , Watman Olivia F. , Nguyen Brittany N. , Kanth Aditi M. , Adetayo Oluwaseun A. 
Published: December 2020

Objective: To evaluate the efficacy of the senior author’s technique of staged reconstruction in patients with recalcitrant oronasal fistulas. Design: A retrospective review of the Pediatric Plastic Surgery Cleft & Craniofacial Surgery Database of cases from September 2013 to December 2018 was conducted. Patients: A total of 31 patients who had previously undergone >1 surgical attempt to repair a fistula or patients who have failed >1 attempt at bone graft were included in this study. All patients were referrals from outside facilities. Main Outcome Measures: Primary outcomes examined included fistula recurrence, infection rates, ability to proceed with second stage bone grafting after first stage fistula takedown and reconstruction, and bone graft loss. Results: Charts of 1053 patients were reviewed and 31 (2.94%) cases met inclusion criteria for this study. Nineteen (61.3%) of these patients proceeded with the second stage of reconstruction and 100% did not experience any graft loss. Seven patients who completed the first stage are undergoing orthodontic optimization prior to bone grafting. The remaining 5 are adult patients not interested in pursuing bone grafting. All 31 patients with recurrent and recalcitrant fistulas had successful fistula reconstruction with our approach, despite multiple previous failed reconstructions. Conclusions: The 2-staged reconstructive approach described herein effectively resulted in resolution of prior recurrent recalcitrant fistulas and resulted in eventual bone grafting. By employing this technique, we report successful fistula repair and bone grafting in patients who had previously undergone multiple surgical reconstructions.
Late-onset double-seronegative myasthenia gravis syndrome and myasthenic crisis due to nivolumab use for Hodgkin’s lymphoma
Authors: Dang Thai , Macwan Samir , Dasanu Constantin A 
Published: December 2020

Introduction Insofar, use of programmed cell death-1 (PD-1) immune checkpoint inhibitors in oncology has been linked with several immune-mediated neurologic effects. However, grade 3 to 4 adverse events such as myasthenic crisis have been vanishingly rare. Case presentation: We present herein a unique patient with Hodgkin lymphoma who developed late-onset double-seronegative myasthenia gravis syndrome followed by myasthenic crisis after 16 weeks of therapy with nivolumab. One day prior to this event, she developed ptosis, diplopia, bulbar symptoms of dysphagia, dysarthria, orthopnea as well as extremity weakness. She required intubation, mechanical ventilation, plasmapheresis and steroid therapy. Management and outcome: She gradually achieved a near-complete resolution of neurologic symptoms over the next several weeks. On a follow-up visit eight weeks later, she only has some residual diplopia. Restaging scans showed a continued decrease in size of the mediastinal mass, without abnormal uptake. She remains on prednisone 10 mg orally daily. Discussion Prompt recognition of this rare phenomenon, immediate discontinuation of checkpoint inhibitor therapy and subsequent management with immunosuppressive therapy are necessary steps in order to minimize the considerable rates of morbidity and mortality.
Accurate determination of glomerular filtration rate in adults for carboplatin dosing: Moving beyond Cockcroft and Gault
Authors: Tsang Corey , Akbari Ayub , Frechette Dominque , Brown Pierre Antoine 
Published: December 2020

Objective Carboplatin is a cytotoxic chemotherapy drug developed in the 1980s which is still widely used today across various tumour types. Despite its common application, there remains a significant controversy and practice variation on its unique method of dosing by area under the curve (AUC). One potential reason for this variability stems from the reliance of using an estimated glomerular filtration rate (eGFR) as an extrapolation of the measured GFR (mGFR) which the commonly used Calvert equation was originally validated for. This review takes a novel and collaborative nephro-oncology approach to highlight the historical evolution of carboplatin dosing, methods for estimating GFR and its relative performance in the application of carboplatin dosing for adult patients. Data sources We reviewed all pertinent publications comparing carboplatin AUC-based dosing in adult patients based on the various methods of GFR measurements or estimations in order to provide a comprehensive description of each method’s advantages and risks. Data summary and conclusions The Cockcroft-Gault equation has been widely studied but newer eGFR equations, such as the CKD-Epidemiology Collaboration (CKD-EPI) or Janowitz-Williams equation have outperformed the Cockcroft-Gault in recent studies.
Nursing Leadership Roles and Its Influence on the Millennial Psychiatric Nurses’ Job Satisfaction and Intent to Leave
Authors: Perkins Rhanee T. , Bamgbade Sarah , Bourdeanu Laura 
Published: December 2020

BACKGROUND: There is an increasing need for millennial psychiatric nurses in health care. Nurses’ levels of satisfaction with their manager’s leadership styles are critical to their remaining in the profession. AIM: To explore the relationship between the roles of nursing leadership and their influence on the millennial psychiatric nurse’s level of job satisfaction and intent to leave. METHOD: Eighty-three psychiatric registered nurses between the ages of 22 and 37 with 6 months or more experience completed a Managerial Skills and Job Satisfaction Survey questionnaire. RESULTS: The millennial psychiatric nurse who perceived their managers to display the roles in being a mentor ( M = 24.95, SD = 2.81), director ( M = 23.08, SD = 2.55), and monitor ( M = 22.71, SD = 2.51) had higher job satisfaction and would be less likely to leave the specialty, current position, and organization. CONCLUSION: The study revealed that nursing leaders need to focus on strengthening the monitor and mentor roles and work on changing from having a coordinator role to the director role.
Protease activated receptor 2 and matriptase expression in the joints of cats with and without osteoarthritis
Authors: Ariffin Siti M Zainal , Bennett David , Ferrell William R , Lockhart John C , Dunning Lynette , Clements Dylan N , Lascelles B Duncan X , Ibrahim Tengku A Tengku , Johnston Pamela 
Published: December 2020

Objectives The aim of this study was to determine the presence of protease-activated receptor 2 (PAR2) and matriptase proteins and quantify PAR2 and matriptase mRNA expression in the articular cartilage and synovial membrane of cats with and without osteoarthritis (OA). Methods A total of 28 articular cartilage samples from adult cats (14 OA and 14 normal), 10 synovial membranes from adult cats (five OA and five normal) and three cartilage samples from 9-week-old fetal cats were used. The presence of PAR2 and matriptase in the cartilage and synovial membrane of the adult samples was detected by immunohistochemical (IHC) staining, while real-time PCR was used for mRNA expression analyses in all samples. Results PAR2 was detected in all OA and normal articular cartilage and synovial membrane samples but confined to only a few superficial chondrocytes in the normal samples. Matriptase was only detected in OA articular cartilage and synovial membrane samples. PAR2 and matriptase mRNA expression were, however, detected in all cartilage and synovial membrane samples. PAR2 and matriptase mRNA expression levels in OA articular cartilage were five ( P <0.001) and 3.3 ( P <0.001) times higher than that of the healthy group, respectively. There was no significant difference ( P = 0.05) in the OA synovial membrane PAR2 and matriptase mRNA expression compared with the normal samples. Conclusions and relevance Detection of PAR2 and matriptase proteins and gene expression in feline articular tissues is a novel and important finding, and supports the hypothesis that serine proteases are involved in the pathogenesis of feline OA. The consistent presence of PAR2 and matriptase protein in the cytoplasm of OA chondrocytes suggests a possible involvement of proteases in cartilage degradation. Further investigations into the PAR2 and matriptase pathobiology could enhance our understanding of the proteolytic cascades in feline OA, which might lead to the development of novel therapeutic strategies.
Isolated retro-orbital granulocytic sarcoma relapse of Acute Myeloid Leukemia after allogeneic hematopoietic stem cell transplantation: a case report
Authors: Sun Xiaona , Rong Xin , Nie Hongping , Yan Xiaoming 
Published: December 2020

Background: Granulocytic sarcoma (GS) is rare as an isolated presentation of relapse after allogeneic hematopoietic stem-cell transplantation (allo-HSCT), particularly in adult patients with acute myelogenous leukemia (AML). We report here the case of a 37-year-old man who developed a GS of the retro-orbital as an isolated manifestation of AML relapse 27 months after allo-HSCT. Case report: A 37-year-old man was diagnosed with AML and subsequently received allo-HSCT after clinical chemical remission. The patient suddenly presented with painless exophthalmos of the left eye twenty-seven months after allo-HSCT. Orbital magnetic resonance imaging (MRI) revealed left retro-orbital masses. Histopathology revealed diffused infiltration of leukemic blasts. Further systemic investigation showed no leukemic involvement of his other organs. Isolated retro-orbital relapse of AML was diagnosed. Despite treatment using retro-orbital irradiation, the patient died 6 months after presentation. Conclusion: Our patient had a poor survival prognosis, even with timely diagnosis and proper treatment. Although the ophthalmologist has a secondary role in the diagnosis and treatment of leukemia, a prompt recognition of the ocular manifestations and their significance as a sign of possible extramedullary lesion is crucial.
Effects on Mental Health After the COVID-19 Lockdown Period: Results From a Population Survey Study in Lima, Peru
Authors: Krüger-Malpartida Hever , Pedraz-Petrozzi Bruno , Arevalo-Flores Martin , Samalvides-Cuba Frine , Anculle-Arauco Victor , Dancuart-Mendoza Mauricio 
Published: December 2020

Background: COVID-19 has created a rapid onset health crisis severely affecting different countries, such as Peru. This pandemic also involved social changes, such as the COVID-19 lockdown, which has had negative effects on different aspects of peoples’ mental health. For this reason, the main objective of this work is to establish a model that explains the effects of the COVID-19-lockdown period on the mental health of a population sample in Peru. Methods: In this sense, online questionnaires were carried out using the PHQ-9, GAD-7, and CPDI in 400 participants. To better explain the data, an ordinal logistic regression was carried out. Results: The model showed that the severity of stress due to COVID-19 is positively associated with the variables age (OR = 1.02; CI95 [1.01; 1.04]), depression (OR = 1.29; CI95 [1.14; 1.31]) and anxiety (OR = 1.49; CI95 [1.35; 1.66]), as well as with the presence of a deceased relative due to COVID-19 (OR = 3.53; CI95 [1.43; 8.82]). On the contrary, the presence of a family member who was hospitalized for COVID-19 is negatively correlated with COVID-19 related stress (OR = 0.30; CI95 [0.13; 0.69]). Conclusion: In conclusion, elderly people, having high levels of anxiety or depression, as well as having a deceased relative due to COVID-19 show higher levels of COVID-19 related stress. These factors play an important role in the intervention of future studies that plan to intervene in the mental health of the population affected by the COVID-19 lockdown.
The Significance and Impact of Screening Preservation Fluid Cultures in Renal Transplant Recipients
Authors: Reticker Anesia , Lichvar Alicia , Walsh Meghan , Gross Alan E. , Patel Shree 
Published: December 2020

Introduction: Infectious complications can be a major cause of morbidity and mortality in solid organ transplant recipients. Preservation fluid is necessary to maintain organ viability but may serve as a vector or infection. The utility of screening preservation fluid routinely for microbial growth and the impact of culture-positive preservation fluid is controversial. Research Question: What is the clinical impact of a culture positive preservation fluid in a kidney transplant recipient? Design: This retrospective study was performed to define the incidence of post-operative infection related to PF and examine the negative sequelae of culture-positive PF. One hundred and fifty-two deceased donor renal transplant recipients from January 2015 to December 2017 were included for analysis. Results: Overall, 67% of patients (102/152) received an allograft from a culture-positive PF. Nearly 80% of microbial growth was consistent with skin flora, and coagulase-negative staphylococci was the most frequently isolated organism (56%). Sixty-seven percent of patients (68/102) with culture-positive PF received antimicrobial treatment for an average duration of 5 days. There was no difference in the incidence of infection between patients with culture positive PF compared to culture-negative PF. Furthermore, there were no cases of infection related to PF regardless of whether culture-positive PF was treated or untreated. The incidence of subsequent C. difficile infection and multidrug-resistant organisms was similar. Discussion: This study suggests antimicrobial treatment for culture positive PF may not be necessary with pathogens that are common contaminants and of low virulence. Interventional studies are needed to validate this strategy.
MFAP2 Promotes the Proliferation of Cancer Cells and Is Associated With a Poor Prognosis in Hepatocellular Carcinoma
Authors: Zhu Xiang , Cheng Ye , Wu Fan , Sun Haoyao , Zheng Wubin , Jiang Wei , Shi Junfeng , Ma Shijie , Cao Hongyong 
Published: December 2020

Backgrounds: Microfibril-associated protein 2 (MFAP2) is an extracellular matrix protein that regulates the function of microfibrils by interacting with fibrillin. MFAP2 has been reported to play an important role in metabolic diseases and has been shown to be significantly overexpressed in head and neck squamous cell carcinoma and Hepatocellular carcinoma (HCC). However, the molecular function and prognostic value of MFAP2 have never been reported in HCC or other tumors. Methods: In the present study, expression characteristics of MFAP2 in HCC, its influence on the development of HCC, as well as its function and potential mechanism in HCC were verified by Quantitative reverse transcription-polymerase chain reaction, bioinformatics data mining and in vitro cell experiments. Results: MFAP2 was prominently high-expressed in HCC and associated with cancer stages. HCC patients with higher MFAP2 expression displayed lower overall survival (OS) and disease-specific survival(DSS), while there was no significant difference in recurrence-free survival (RFS). In vitro experiments showed that downregulation of MFAP2 inhibited proliferation, migration level of HCC cells. Transcription factors, DNA methyltransferases, immune factors may interact with MFAP2 mRNA to promote tumor progression in HCC. Conclusion: These findings suggest that MFAP2 may play a key role in the development of HCC. Therefore, MFAP2 may be a valuable prognostic marker and an effective anticancer target in HCC.
Prognostic and Predictive Value of Circulating and Disseminated Tumor Cells in Breast Cancer: A National Cancer Database (NCDB) Analysis
Authors: Bilani Nadeem , Elson Leah , Liang Hong , Elimimian Elizabeth Blessing , Arteta-Bulos Rafael , Nahleh Zeina 
Published: December 2020

Importance: Our understanding of the utility of circulating tumor cells (CTCs) and disseminated tumor cells (DTCs) as clinical biomarkers continues to evolve. Objective: This study evaluated (1) clinicopathologic factors associated with the presence of CTCs or DTCs, (2) the prognostic value of CTCs or DTCs by disease stage, 3), the value of these biomarkers in predicting the benefit of chemotherapy. Design: This is a retrospective analysis of patients with breast cancer (BC) diagnosed between 2004 and 2016 using the National Cancer Database (NCDB). To evaluate variables associated with the presence of CTCs or DTCs at the univariate level, we used chi-squared and Wilcoxon rank-sum tests. Multivariate logistic regression models were then constructed using significant variables. Consequently, we included CTC or DTC status (i.e. positive or negative) in multivariate, stage-by-stage Cox regression analyses for overall survival (OS). After stratifying by receptor status and staging, we used the Kaplan-Meier method to explore chemotherapy efficacy in CTC- or DTC-positive vs. CTC- or DTC-negative subsets. Results: Factors significantly associated with CTCs were race, progesterone receptor status, HER2 status, histology and AJCC N- and M-staging. Factors associated with DTCs were race, HER2 status, histology and AJCC N-staging. CTCs were associated with poor OS in late-stage (III and IV) but not early-stage (0-II) BC. DTCs were not significantly associated with OS in either context. In hormone receptor (HR)-positive disease, chemotherapy was associated with better OS when CTC status was positive, both in early-stage and late-stage disease. In a subset of patients without CTCs, however, chemotherapy conferred no survival benefit. DTC status was not a significant predictor of chemotherapy efficacy in early or late-stage, HR+ disease. Conclusions: This study suggests that CTC-status is a significant prognostic factor at later stages of BC; yet it can also help guide management of early-stage disease as it appears predictive for chemotherapy benefit.
Quantitative EEG During Critical Illness Correlates with Patterns of Long-Term Cognitive Impairment
Authors: Williams Roberson Shawniqua , Azeez Naureen Abdul , Taneja Randip , Pun Brenda T. , Pandharipande Pratik P. , Jackson James C. , Ely E. Wesley 
Published: December 2020

Objective Many intensive care unit (ICU) survivors suffer disabling long-term cognitive impairment (LTCI) after critical illness. We compared EEG characteristics during critical illness with patients’ 1-year neuropsychological outcomes. Methods We performed a post hoc analysis of patients in the BRAIN-ICU study who had undergone EEG for clinical purposes during admission (n = 10). All survivors underwent formal cognitive assessments at 12-month follow-up. We evaluated EEGs by conventional visual inspection and computed 10 quantitative features. We explored associations between EEG and patterns of LTCI using Wilcoxon rank-sum tests and Spearman’s rank correlations. Results Of 521 Vanderbilt patients enrolled in the parent study, 24 had EEG recordings during admission. Ten survivors had EEG tracings available and completed follow-up cognitive testing. All but one inpatient EEG showed generalized background slowing. All patients demonstrated cognitive impairment in at least one domain at follow-up. The most common deficits occurred in delayed memory (DM—median index 62) and visuospatial/constructional (VC—median index 69) domains. Relative alpha power correlated with VC score (ρ = 0.78, P = .008). Peak interhemispheric coherence correlated negatively with DM (ρ = −0.81, P = .018). Conclusions Quantitative EEG features during critical illness correlated with domain-specific cognitive performance in our small cohort of ICU survivors. Further study in larger prospective cohorts is required to determine whether these relationships hold. Significance EEG may serve as a prognostic biomarker predicting patterns of long-term cognitive impairment.
Short-term outcomes of inner branches for endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms
Authors: Silverberg Daniel , Bar-Dayan Avner , Hater Haitam , Khaitovich Boris , Halak Moshe 
Published: December 2020

Objectives To report our early experience using endografts with inner branches for the treatment of complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms (TAAAs). Methods A retrospective analysis of all patients treated in our institution for complex abdominal aortic aneurysms and TAAAs with custom-made stent grafts consisting of one or more inner branches. Data collected included patients demographics, aortic aneurysm morphology, stent grafts features, perioperative morbidity and mortality and short-term reintervention and mortality rates. Results Twenty-seven patients (18 males, mean age 70 ± 7.1) were included. Indications for surgery included TAAAs (12, 41%) juxtarenal abdominal aortic aneurysms (10, 37%), type 1A endoleaks (4, 15%) and paraanastamotic aneurysms (1, 4%). A total of 90 inner branches were used. Twenty-one (78%) of the stent grafts consisted only of inner branches and six (22%) had a combination of inner branches with either fenestrations or outer branches. Technical success was achieved in 26/27 (96%) of the patients. There was one perioperative mortality. Six patients suffered from major perioperative adverse events. Mean follow-up was seven months (range 1–23). During the follow-up period, four patients (15%) required reinterventions. Branch-related reinterventions were performed in two (7%) patients. No occlusions of inner branches occurred during the follow-up. Conclusions Inner branches in branched endovascular aneurysm repairs offer a feasible option for the treatment of complex abdominal aortic aneurysms and TAAAs. The procedures can be completed with high technical success and with acceptable short-term branch-related reintervention rates. Further follow-up is required to determine the long-term durability of this technology.