bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative effectiveness of second-line ipilimumab vs. nivolumab in combination with ipilimumab in patients with advanced melanoma who received frontline anti-PD-1 antibodies
Authors: Baron Kelsey , Moser Justin C , Patel Shiven , Grossmann Kenneth F , Colonna Sarah V , Hyngstrom John R 
Published: May 2020

Introduction Anti-PD-1 antibodies are commonly used as frontline therapy for patients with metastatic melanoma. Although these medications can cause long term responses, a significant number of patients will not respond or will lose response. Optimal second-line therapy after losing response to anti-PD-1 antibodies is not well established. Therefore, we retrospectively compared the overall survival of patients who lost response to anti-PD1 antibodies between patients treated with single agent ipilimumab or ipilimumab and nivolumab. Methods A de-identified U.S. nationwide electronic health record-derived database was reviewed for patients with advanced melanoma treated with single agent anti-PD1 antibodies in the frontline setting and who subsequently received second-line ipilimumab or combination ipilimumab and nivolumab. Overall survival from initiation of second-line therapy was compared using Kaplan Meier curves and log-rank analysis. Other known prognostic markers for melanoma were analyzed for correlation with survival in a similar fashion. Disease characteristics between the two groups were compared using chi-square analysis. Results A total of 842 patients with advanced melanoma who received frontline anti-PD-1 antibodies were included for analysis. Of these, 57 received either ipilimumab ( n = 22) or ipilimumab in combination with nivolumab ( n = 35) in the second-line setting. Median survival from second-line therapy initiation for those treated with ipilimumab alone was 6 months and was 5.6 months for those treated with combination ipilimumab and anti-PD-1 antibodies, p = 0.81. Conclusions In this small, retrospective analysis, for patients who lost response to frontline anti-PD-1 therapy, patients treated with ipilimumab had similar survival to those who received ipilimumab in combination with anti-PD-1 antibodies.
Platelet Electron Microscopy: Utilizing LEAN Methodology to Optimize Laboratory Workflow
Authors: Asher Lucas , Hata Jessica 
Published: May 2020

Background Platelet electron microscopy (PEM) is the gold standard methodology for diagnosing storage pool disorder, defined as a paucity of delta granules, alpha granules, or both. PEM literature is limited with few published resources and without well-developed interlaboratory standardization for the preparation and examination of platelet samples. Methods Whole mount (WM) dense body (DB) counts for 300 pediatric cases were reviewed to determine whether counting fewer platelets could yield the same results. For 6 cases, DB average was determined on the day of WM preparation and on 2 consecutive days. Both WM and thin section (TS) preparations were examined for all cases. Results Employing LEAN methodology, an algorithm was developed to markedly decrease the number of platelets counted and still ensure accurate results. WMs decay with time; a statistically significant difference in DB counts was noted between day 0 and day 1 ( p < .1). Twelve of 300 cases required both WM and TS preparations for a complete diagnosis. Conclusion It is possible to maintain accuracy and decrease 100 platelet DB counts by >75%. WMs must be counted on the day they are prepared to avoid false paucity of DB secondary to sample decay. An accurate evaluation of platelet morphology requires both the WM and TS techniques.
Morphological analysis of functional filtering blebs with anterior segment optical coherence tomography: A short-term prediction for success of trabeculectomy
Authors: Raj Anuradha , Bahadur Harsh 
Published: May 2020

Purpose The aim of the study was to analyze morphological parameters of apparently functional filtering blebs with anterior segment optical coherence tomography at 1 month post trabeculectomy and to correlate these parameters with intraocular pressure at 6 months of follow-up to predict the short-term success of trabeculectomy. Methods In this cross-sectional, descriptive study, apparently functional blebs were evaluated using anterior segment optical coherence tomography with crossline scans after 1 month of trabeculectomy. Results A total of 55 eyes of 55 cases with mean age 49.29 ± 13.72 years were included in the study. On anterior segment optical coherence tomography examination, the mean bleb height and mean bleb wall thickness, subconjunctival fluid space, and scleral flap thickness were 1.45 ± 0.39 mm, 0.63 ± 0.25 mm, 0.64 ± 0.26 mm, and 0.45 ± 0.068 mm, respectively. There was statistically significant negative correlation between intraocular pressure at 1 month and bleb height ( r = −0.25, p = 0.05). There was statistically significant negative correlation between extent of cavity and intraocular pressure at 6 months ( r = −0.318, p = 0.018). Bleb height showed significant negative correlation with supra-scleral space ( r = −0.31, p = 0.02). Multi reflective bleb walls showed statistically significant increased chances of successful functioning blebs at 6 months as compared to uniform wall reflectivity ( p = 0.00). Bleb function was successful in 37 (67.3%) and unsuccessful in 18 (32.7%) in short term of 6 months of follow-up. Conclusion Bleb walls with multiform wall reflectivity on anterior segment optical coherence tomography at 1 month post trabeculectomy show increased chances of success of functioning filtering bleb at 6 months. Bleb wall characteristics on anterior segment optical coherence tomography at 1 month can predict the short-term success of blebs at 6 months.
Contemporary best practice in the management of pulmonary embolism during pregnancy
Authors: Wiegers Hanke M. G. , Middeldorp Saskia 
Published: May 2020

Approximately 1–2 per 1000 pregnancies are complicated by venous thromboembolism (VTE). VTE includes deep vein thrombosis (DVT) and pulmonary embolism (PE) and the diagnostic management of pregnancy-related VTE is challenging. Current guidelines vary greatly in their approach to diagnosing PE in pregnancy as they base their recommendations on scarce and weak evidence. The pregnancy-adapted YEARS diagnostic algorithm is well tolerated and is the most efficient diagnostic algorithm for pregnant women with suspected PE, with 39% of women not requiring computed tomographic pulmonary angiography. Low-molecular-weight heparin is the first-choice anticoagulant treatment in pregnancy and should be continued until 6 weeks postpartum and for a minimum of 3 months. Direct oral anticoagulants should be avoided in women who want to breastfeed. Management of delivery needs a multidisciplinary approach in order to decide on an optimal delivery plan. Neuraxial analgesia can be given in most patients, provided time windows since last low-molecular-weight heparin dose are respected. Women with a history of VTE are at risk of recurrence during pregnancy and in the postpartum period. Therefore, in most women with a history of VTE, thromboprophylaxis in subsequent pregnancies is indicated. The reviews of this paper are available via the supplemental material section.
Dynamic monitoring of CD45-/CD31+/DAPI+ circulating endothelial cells aneuploid for chromosome 8 during neoadjuvant chemotherapy in locally advanced breast cancer
Authors: Ma Ge , Jiang Yi , Liang Mengdi , Li JiaYing , Wang Jingyi , Mao Xinrui , Veeramootoo Jordee Selvamanee , Xia Tiansong , Liu Xiaoan , Wang Shui 
Published: May 2020

Background: Neoadjuvant chemotherapy (NCT) is the standard treatment for patients with locally advanced breast cancer (LABC). The aim of this study was to verify this relationship, and to estimate the clinical value of aneuploid circulating endothelial cells (CECs) in LABC patients with different NCT responses. Methods: Breast cancer patients received an EC4-T4 NCT regimen. Peripheral blood mononuclear cells were obtained before NCT, and after the first and last NCT courses. A novel subtraction enrichment and immunostaining fluorescence in situ hybridization (SE-iFISH) strategy was applied for detection of circulating rare cells (CRCs). CECs (CD45–/CD31+/DAPI+) and circulating tumor cells (CTCs) with different cytogenetic abnormalities related to chromosome 8 aneuploidy were analyzed in LABC patients subjected to NCT. Results: A total of 41 patients were enrolled. Firstly, CD31+/EpCAM+ aneuploid endothelial-epithelial fusion cells were observed in LABC patients. Further, aneuploid CECs in the peripheral blood showed a biphasic response during NCT, as they initially increased and then decreased, whereas a strong positive correlation was observed between aneuploid CECs and CTC numbers. Conclusion: We determined that aneuploid CEC dynamics vary in patients with different response to chemotherapy. Elucidating the potential cross-talk between CTCs and aneuploid CECs may help characterize the process associated with the development of chemotherapy resistance and metastasis.
A Qualitative Identification of Gaps in Understanding About Brain Death Among Trainees, Health Care Personnel and Families at an Academic Medical Center
Authors: Chen Patrick M. , LaBuzetta Jamie Nicole 
Published: May 2020

Background and Purpose: Death by whole brain criteria (brain death) is a clinical diagnosis. We sought to identify aspects of brain death that were unclear to both health care personnel and patient families. Methods: Institutional review board approved cross-sectional survey study of attendings, medical trainees (residents and fellows), senior medical students, advanced practice providers (APPs), and critical care nursing (registered nurses [RNs]) at a tertiary referral center over 6 months (March 2018 to September 2018). Surveys were completed on paper or electronically. Participants supplied the top 3 of (1) their own personal questions regarding brain death and (2) questions received from patient families about brain death from a prepared list of questions. Results: Two hundred twenty-nine individuals participated in the survey, with a response rate of 46%. Participation rates in brain death declaration among attendings (92%), RNs (84%), APPs (100%), and trainees of which included fellows (92%) and residents (85%) were high. Most frequently asked questions by trainees and health care personnel were “What are brain death mimics?” and “What is the gold standard testing?”. Questions received from patient families most commonly include “What is brain death?” and “Is brain death reversible?”. All medical students had questions about brain death. Greater than 75% of attendings endorsed having questions regarding brain death. Conclusion: Many health care personnel are involved with brain death declaration, but there are gaps in their understanding about fundamentals regarding brain death. We identify a need for early and targeted brain death education regarding brain death and family communication for various members of the health care profession.
Incorporation of frailty estimated by gait speed within MELD-Na and the predictive potential for mortality in cirrhosis
Authors: Deng You , Lin Lin , Fan Xiaofei , Cui Binxin , Hou Lijun , Zhao Tianming , Hou Junjie , Mao Lihong , Wang Xiaoyu , Zhao Wei , Wang Bangmao , Yu Qingxiang , Sun Chao 
Published: May 2020

Background: The 5 m gait speed (5MGS), a simple and reliable performance metric and surrogate indicator of frailty, consistently predicts adverse events in elders. Additionally, MELD-Na (model for end-stage liver disease-sodium) scores fail to capture nutritional and functional decline of cirrhotic patients that may confer excess mortality. We hypothesized that 5MGS might be associated with all-cause mortality, and that inclusion of frailty assessment within MELD-Na could improve the prediction of mortality in cirrhosis. Methods: 5MGS was measured at baseline in 113 hospitalized cirrhotic patients. Survival status over 2 years and cirrhosis-related complications were recorded. We evaluated the prognostic value of 5MGS (as a continuous variable and as a dichotomous variable). The definition of slow versus preserved 5MGS was 0.8 ms−1 based on previous publication. Using Cox proportional hazards regression, a novel MELDNa-5MGS score was derived. Receiver operating characteristics (ROC) curves estimated discrimination between the new score model and established prognostic indices. Results: The continuous 5MGS and slow 5MGS were independent predictors of all-cause mortality [5MGS: hazard ratio (HR) 0.133 (0.047–0.347), p < 0.001; slow 5MGS: HR 4.805 (1.536–15.026), p < 0.007]. The equation derived from Cox regression analysis was as follows: MELDNa-5MGS: MELD-Na score + 11 × slow 5MGS. The 2-year mortality in patients with high MELDNa-5MGS score was significantly higher ( p < 0.001). Discriminatory power was significantly better for MELDNa-5MGS than MELD-Na score (AUC: 0.802 versus 0.724, p = 0.014 for 1 year; 0.773 versus 0.709, p = 0.044 for 2 years). Conclusion: In cirrhotic patients, 5GMS is an independent risk factor of mortality. Modification of MELD-Na to include frailty estimated by low 5GMS is related to improved prognostication of mortality.
Post-exertional increase in first-phase ejection fraction in recreational marathon runners
Authors: Faconti Luca , Parsons Iain , Farukh Bushra , McNally Ryan , Nesti Lorenzo , Fang Lingyun , Stacey Michael , Hill Neil , Woods David , Chowienczyk Phil 
Published: May 2020

Objectives Running a marathon has been equivocally associated with acute changes in cardiac performance. First-phase ejection fraction is a novel integrated echocardiographic measure of left ventricular contractility and systo-diastolic coupling which has never been studied in the context of physical activity. The aim of this study was to assess first-phase ejection fraction following recreational marathon running along with standard echocardiographic indices of systolic and diastolic function. Design and participants: Runners (n = 25, 17 males), age (mean ± standard deviation) 39 ± 9 years, were assessed before and immediately after a marathon race which was completed in 4 h, 10 min ± 47 min. Main outcome measures Central hemodynamics were estimated with applanation tonometry; cardiac performance was assessed using standard M-mode two-dimensional Doppler, tissue-doppler imaging and speckle-tracking echocardiography. First-phase ejection fraction was calculated as the percentage change in left ventricular volume from end-diastole to the time of peak aortic blood flow. Results Conventional indices of systolic function and cardiac performance were similar pre- and post-race while aortic systolic blood pressure decreased by 9 ± 8 mmHg ( P < 0.001) and first-phase ejection fraction increased by approximately 48% from 16.3 ± 3.9% to 22.9 ± 2.5% ( P < 0.001). The ratio of left ventricular transmitral Doppler early velocity (E) to tissue-doppler imaging early annular velocity (e′) increased from 5.1 ± 1.8 to 6.2 ± 1.3 ( P < 0.01). Conclusion In recreational marathon runners, there is a marked increase in first-phase ejection fraction after the race despite no other significant change in cardiac performance or conventional measure of systolic function. More detailed physiological studies are required to elucidate the mechanism of this increase.
Cycling and men’s health: A worldwide survey in association the Global Cycling Network
Authors: Koupparis Anthony , Mehmi Ashley , Rava Matteo , Kearley Sam , Aning Jon , Rowe Edward , Richardson Simon 
Published: May 2020

Objectives: This study aimed to examine the association between cycling and men’s health issues, including prostate cancer (CaP), erectile dysfunction (ED), chronic pelvic pain syndrome (CPPS) and lower urinary tract symptoms (LUTs). Methods: Information regarding CaP, ED, CPPS and LUTs were collected from 8074 male cyclists via a unique online men’s health and cycling video produced in conjunction with the Global Cycling Network (GCN) using validated questionnaires. Logistic regression analyses were used to evaluate any relationship between cycling and men’s health issues, including the effect of risk factors. Results: The GCN video received 619,105 views, and completed data were collected on 8074 male cyclists. Of these, 0.57% had a diagnosis of CaP, 14.5% described ED, 8.82 reported symptoms of CPPS and 12.5% reported LUTs. All reported symptoms were mild, and no correlation was found between cycling and CaP or ED on statistical analyses. Conclusions: This is the largest worldwide cross-section observational study on the association between cycling and men’s health. It demonstrates no negative association between cycling and CaP, ED, CPPS or LUTs. Level of evidence: Not applicable for this multicentre audit.
Comparison of Functional Outcomes Between Lumbar Interbody Fusion Surgery and Discectomy in Massive Lumbar Disc Herniation: A Retrospective Analysis
Authors: Gupta Anuj , Chhabra H. S. , Nagarjuna D. , Arora Mohit 
Published: May 2020

Study Design: Retrospective analysis. Objective: Lumbar disc herniation is one the most common condition responsible for low back and radicular pain. Although the symptoms are not proportional to the size of disc prolapse but massive disc herniation frequently needs surgical management. According to literature, the incidence of low back pain, recurrent disc herniation and segmental instability are more in discectomy whereas incidence of adjacent segment degeneration (ASD) is more after fusion surgery. There are very few studies that directly compare long-term functional outcome of both these procedures. We compared the functional outcome of both the procedures in this study. Methods: All patients of massive disc prolapse, operated at our center between 2011 to 2017, were contacted. All the patients underwent either discectomy or transforaminal lumbar interbody fusion (TLIF). Functional outcomes of all the patients were collected using visual analogue scale (VAS) (back), VAS (leg), modified Oswestry Disability Index (mODI), Sciatica Bothersomeness Index (SBI), and McNab’s criterion. Various complications were also analyzed. Results: There were 144 patients in the discectomy group and 123 patients in the TLIF group. Mean duration of follow-up was 55.07 months and 51.86 months, respectively. Both the groups show no significant difference in VAS. Significant difference was seen in mODI and SBI favoring discectomy. McNab’s criterion showed excellent result in 80% of patients of discectomy compared with 68% patients of TLIF. Overall complication rate in discectomy group was 11% whereas 13% in TLIF group. Conclusion: Both show good functional outcome but better in discectomy. Recurrent herniation and instability were noticed more with discectomy and ASD was more common after fusion surgeries. The choice of procedure should be individualized, and it also depends on surgical expertise, but in developing countries where resources are constrained, discectomy should be preferred.
SuperShip: Journey of a Successful Entrepreneur
Authors: Cao Viet Quoc 
Published: May 2020

SuperShip Vietnam, a Joint Stock Company, founded in 2015, specializes in freight forwarding and express delivery services for e-commerce transactions in Vietnam. In 4 years, it has come a long way from a start-up with only five members and VNĐ 40 million (~US$1,800) as the capital. Difficulties and challenges faced by the firm were incredibly huge. Nevertheless, with slow but steady growth, the company utilized the quality of services as the foundation to build customer satisfaction and loyalty rather than taking the route of price-based competition. SuperShip has grown steadily to become a prestigious and well-established enterprise in the fast-moving freight forwarding market. SuperShip is not yet satisfied with its multiple accomplishments as there are still many peaks to conquer to achieve the company’s vision. The case highlights as to how through participation in union-association and volunteering activities; implementing small business plans to earn extra money during college days can help in developing leadership, negotiation and interpersonal skills and hone the entrepreneurship trait. Dilemma For steady growth, should the company utilize the quality of services as the foundation to build customer satisfaction and loyalty or take the route of price-based competition. Theory: Sustainability of a business in goods delivery sector Type of the case: Experience-based applied single case study Protagonist: The owner of the firm Options Copy the business model of the two large players in the existing market and offer similar services. Raise the benchmark of customer satisfaction and loyalty by designing and delivering superior quality of service with the help of well trained and empowered employees. Discussions and Case Questions For a training firm is it better to focus on a single service and performing it with excellence than offering many courses. How did SuperShip created its point of difference? How the firm can grow further while raising funds at a low cost? What is the next level of quality of service that the firm should target?
National Multidisciplinary Survey of Regional Anesthesia Preferences in Breast Reconstruction
Authors: Head Linden K. , Lui Anne , Cordeiro Erin , Boyd Kirsty U. 
Published: May 2020

Background: The purpose of this work was to determine the regional anesthesia preferences of plastic surgeons (PS) and anesthesiologists (A) involved in breast reconstruction in Canada. Methods: Online surveys were sent to members of the Canadian Society of Plastic Surgeons (CSPS) and the Canadian Anesthesiologists Society (CAS). The primary outcome was regional anesthesia preferences in breast reconstruction (delayed, immediate, alloplastic, autologous). Secondary outcomes included the availability and the influence of specialty and academic status on preferences. Statistical analysis used descriptive statistics and Pearson χ2 test. Results: Responses from CSPS and CAS totaled 141 (response rate = 30%) and 217 (response rate = 14%), respectively. Compared with non-academic centres (NAC), academic centres (AC) had significantly greater access to (AC = 60%, NAC = 39%, P = .001) and preferred to use regional anesthesia more often (AC = 36%, NAC = 10%, P < .001). The following proportions of physicians preferred to use regional anesthesia: 40% (PS = 32%, A = 44%, P = .081) for immediate alloplastic reconstruction, 23% (PS = 24%, A = 22%, P = .821) for delayed alloplastic reconstruction, 34% (PS = 18%, A = 41%, P < .001) for immediate autologous reconstruction, and 19% (PS = 13%, A = 21%, P = .195) for delayed autologous reconstruction. Regional anesthesia preferences were significantly different between plastic surgeons and anesthesiologists ( P < .001)—anesthesiologists favoured paravertebral blocks for all reconstructions, while plastic surgeons favoured pectoral nerve blocks for immediate alloplastic reconstruction and intercostal nerve blocks for all other reconstructions. Conclusions: Plastic surgeons and anesthesiologists prefer not to use regional anesthesia in the majority breast reconstructions. Among those who deploy regional anesthesia, plastic surgeons and anesthesiologist have divergent preferences with respect to modality. There is a need for a prospective study comparing paravertebral blocks and intercostal nerve blocks.