bluuebunny/crossref_metadata_2025_split huggingface dataset:
THER-02. EVALUATION OF THE ONCOLYTIC VIRUS DELTA24-RGD AS AN ANTI-TUMOR AGENT IN PRECLINICAL MODELS OF LOCALIZED AND DISSEMINATED AT/RT
Authors: Garcia-Moure Marc , González-Huarriz Marisol , de la Nava Daniel , Marrodán Lucía , Gomez-Manzano Cande , Fueyo Juan , Patiño-García Ana , Alonso Marta M 
Published: December 2020

Abstract
Current therapies for atypical teratoid/rhabdoid tumors (AT/RTs) are suboptimal, resulting in a 2-year OS below 20% and the development of severe side effects. Therefore, we need to explore alternative therapeutic approaches for this disease. Since the virus Delta24-RGD has already demonstrated its efficacy and safety as a therapeutic agent for brain tumors, including pediatric patients, here we propose to evaluate the anti-tumor effect of Delta24-RGD in AT/RT. In vitro, Delta24-RGD infects and replicates in AT/RT cultures followed by oncolysis, obtaining IC50 values below 1 PFU/cell. In vivo, a single local injection of Delta-24-RGD in three infratentorial AT/RT models (BT-12, CHLA-06 and CHLA-266) extended significantly the median OS (50 to 78 days BT-12; 21 to 31 days CHLA-06; 64 to 110 days CHLA-266). Delta-24-RGD also increased the survival of mice bearing supratentorial CHLA-266 tumors (from 93 to 132 days). Next, we evaluated the efficacy of Delta24-RGD in a model mimicking metastatic disease through intraventricular injection of BT-12-luciferase cells. Administration of Delta24-RGD inhibited tumor growth and development of metastases, leading to an increased OS and nearly 70% of long-term survivors. The interaction between Delta24-RGD and the immune system was evaluated in humanized mice models bearing CHLA-06. In this model, Delta24-RGD treatment extended OS (from 23 to 34 days) and we characterized the anti-tumor immune landscape in control and Delta24-RGD treated mice by transcriptional and functional analyses. These results underscore the potential of Delta24-RGD as a promising therapeutic choice for patients affected by AT/RT.
Obturator Nerve Blockade vs. Neuromuscular Blockade for the Prevention of Adductor Spasm in Patients Undergoing Transurethral Resection of Bladder Tumors: A Randomized Controlled Trial
Authors: Soberón José R , Awoniyi Caleb A , Perez Melissa Alvarez , Vasilopoulos Terrie , Canales Benjamin K 
Published: December 2020

Abstract

Background
The obturator nerve runs along the posterolateral walls of the bladder and electrosurgical stimulation in this region can result in adductor spasm which can occur suddenly and unexpectedly with potentially catastrophic results.

Methods
Sixty patients were prospectively randomized to receive either a single-injection ultrasound-guided obturator nerve block (ONB) or intravenous rocuronium after induction of general anesthesia (i.e., neuromuscular block [NMB]). The primary objective was to compare the incidence of adductor spasm during posterolateral bladder tumor resection when ONB or NMB was used. Secondary objectives included assessment of fall risk and incidence of adverse events.

Results
Five patients in the ONB group and six in the NMB group had nonlateral wall lesions. One patient in the ONB group suffered a cardiac arrest after induction of general anesthesia. Of the remaining 48 patients, six (10.2%) experienced adductor spasm. Most of these patients were in the NMB group (5/24, 20.8%), with only one patient (1/24, 4.2%) experiencing obturator reflex in the ONB group; this difference was not statistically significant (P=0.19). Patients in the ONB group had a greater decrease in mean hip adductor strength. Our study population was found to be at high risk of falls before surgery. There were no statistically significant group differences in the Timed Up and Go test, with time to perform the test increasing in both groups.

Conclusions
Both techniques are safe and efficacious for preventing adductor spasm. Our data and experience suggest that the ONB is relatively easy to perform and should be considered in patients with posterolateral bladder tumors.
Antiphospholipid patterns predict risk of thrombosis in systemic lupus erythematosus
Authors: Demir Selcan , Li Jessica , Magder Laurence S , Petri Michelle 
Published: December 2020

Abstract

Objective
We evaluated which aPL combinations increase the risk of future thrombosis in patients with SLE.

Methods
This prospective cohort study consisted of SLE patients who had been tested for all seven aPL (LA, aCL isotypes IgM, IgG and IgA, and anti-β2-glycoprotein I isotypes IgM, IgG and IgA). Pooled logistic regression was used to assess the relationship between aPL and thrombosis.

Results
There were 821 SLE patients with a total of 75 048 person-months of follow-up. During the follow-up we observed 88 incident cases of thrombosis: 48 patients with arterial, 37 with venous and 3 with both arterial and venous thrombosis. In individual models, LA was the most predictive of any [age-adjusted rate ratio 3.56 (95% CI 2.01, 6.30), P &lt; 0.0001], venous [4.89 (2.25, 10.64), P &lt; 0.0001] and arterial [3.14 (1.41, 6.97), P = 0.005] thrombosis. Anti-β2-glycoprotein I IgA positivity was a significant risk factor for any [2.00 (1.22, 3.3), P = 0.0065] and venous [2.8 (1.42, 5.51), P = 0.0029] thrombosis. Only anti-β2-glycoprotein I IgA appeared to add significant risk to any [1.73 (1.04, 2.88), P = 0.0362] and venous [2.27 (1.13, 4.59), P = 0.0218] thrombosis among those with LA. We created an interaction model with four categories based on combinations of LA and other aPL to look at the relationships between combinations and the risk of thrombosis. In this model LA remained the best predictor of thrombosis.

Conclusion
Our study demonstrated that in SLE, LA remained the best predictor of thrombosis and adding additional aPL did not add to the risk, with the exception of anti-β2-glycoprotein I IgA.
Assessing Unperceived Learning Needs in Continuing Medical Education for Primary Care Physicians: A Scoping Review
Authors: Armson Heather , Perrier Laure , Roder Stefanie , Shommu Nusrat S. , Wakefield Jacqueline , Shaw Elizabeth , Zahorka Stephanie , Elmslie Tom , Lofft Meghan 
Published: December 2020

Introduction:
Assessing needs before developing continuing medical education/continuing professional development (CME/CPD) programs is a crucial step in the education process. A previous systematic literature review described a lack of objective evaluation for learning needs assessments in primary care physicians. This scoping review updates the literature on uses of objective evaluations to assess physicians' unperceived learning needs in CME/CPD. Identifying and understanding these approaches can inform the development of educational programs that are relevant to clinical practice and patient care. The study objectives were to (1) scope the literature since the last systematic review published in 1999; (2) conduct a comprehensive search for studies and reports that explore innovative tools and approaches to identify physicians' unperceived learning needs; (3) summarize, compare, and classify the identified approaches; and (4) map any gaps in the literature to identify future areas of research.

Methods:
A scoping review was used to “map” the literature on current knowledge regarding approaches to unperceived needs assessment using conceptual frameworks for planning and assessing CME/CPD activities.

Results:
Two prominent gaps were identified: (1) performance-based assessment strategies are highly recommended in nonresearch articles yet have low levels of implementation in published studies and (2) analysis of secondary data through patient input or environmental scanning is emphasized in grey literature implementation strategies more so than in peer-reviewed theoretical and research articles.

Discussion:
Future evaluations should continue to incorporate multiple strategies and focus on making unperceived needs assessments actionable by describing strategies for resource management.
Opioid Misuse and Overdose: Changes in Pharmacist Practices and Outcomes
Authors: Eukel Heidi , Steig Jayme , Frenzel Oliver , Skoy Elizabeth , Werremeyer Amy , Strand Mark 
Published: December 2020

Background:
Continuing education (CE) provides educational opportunities for health professionals to adequately respond to issues in practice but infrequently evaluate sustained practice change. The opioid epidemic has risen to the forefront of health priorities in our nation. The Opioid and Naloxone Education (ONE Rx) CE program provides pharmacists the opportunity to expand their abilities and impact in the opioid crisis.

Methods:
ONE Rx CE included risk assessment for opioid misuse/overdose, role of naloxone, disease of addiction, and communication strategies for patients and providers. Pharmacists who completed the CE screened patients and provided interventions over 12 months. CE participants were provided presurveys, postsurveys, and delayed postsurveys coordinated with the educational program. The Kirkpatrick Model was used to evaluate the effectiveness of the program by examining the four levels of assessment: reaction, commitment, behavior, and results.

Results:
The Kirkpatrick Model was used to evaluate the impact of the CE. Reaction: 97% of respondents recommended the ONE Rx program. Commitment: 77% of respondents indicated commitment to provide ONE Rx opioid risk screening and interventions to patients. Behavior: Twelve months after training, pharmacists registered to prescribe naloxone increased by 67% and the number of pharmacists reporting naloxone dispensing doubled from 23% to 46%. Outcomes: Pharmacist interventions included medication take back programs explained (88.4%), naloxone dispensing to high-risk patients (10.9%), and discussion of opioid use disorder with patients with risk factors (49%).

Conclusion:
By using the Kirkpatrick Model, the ONE Rx CE program demonstrated high-quality opioid and naloxone education to pharmacists. Survey results and opioid harm reduction interventions indicate the CE resulted in sustained pharmacy practice behavior change.
Journal Club Using Virtual Breakout Rooms: Interactive Continuing Education with No Learner Preparation During COVID-19
Authors: Cadieux Magalie , Campos-Zamora Melissa , Zagury-Orly Ivry , Dzara Kristina 
Published: December 2020

Introduction:
As a result of the COVID-19 pandemic, the authors rapidly transitioned an in-person, learner-led medical education journal club (MEJC) to the virtual environment. The “interactive, no-prep” approach, using breakout rooms within a videoconferencing system, required no prior learner preparation.

Methods:
From March to May 2020, learners were invited to participate in a monthly 60-minute virtual MEJC. A needs assessment survey informed article selection. Facilitators developed a presentation to provide background and describe the article's research question(s). In breakout groups, learners generated study designs to answer the research question(s). After the actual study methodology and results were revealed, learners engaged in facilitated open discussion. After the session, learners completed an electronic survey to rate perceived usefulness and suggest improvement areas.

Results:
A total of 15 learners participated; most completed the survey (13/15; 87%). The MEJC was rated as very or extremely useful. Qualitative feedback indicated that it was convenient, allowed creativity, and enabled rich discussion without prior preparation. When possible, improvement suggestions were implemented.

Discussion:
The authors offer an evidence-based MEJC approach that is free, interactive with virtual breakout rooms and requires no prior learner preparation. Early indicators suggest that others navigating the COVID-19 crisis may want to implement this approach.
Pregnancy outcomes of the first thawing cycle in “freeze-all” strategy of infertility patients with fever during oocyte recruitment: a matched-pair study
Authors: Lin Ming-Mei , Niu Zi-Ru , Zhang Hua , Li Rong 
Published: December 2020

Abstract

Background:
It is currently unknown whether patients with a fever after controlled ovulation during egg retrieval could increase the risk of pelvic infection or not, and fever itself may affect endometrial receptivity or embryo quality with poor pregnancy outcomes. The aim of this study was to analyze the outcomes of patients with fever during oocyte retrieval after the first frozen-thawed embryo transfer (FET) cycle.

Methods:
This was a 1:3 retrospective paired study matched for age. In this study, 58 infertility patients (Group 1) had a fever during the control ovulation, and the time of the oocyte retrieval was within 72 hours, they underwent ovum pick up and whole embryo freezing (“freeze-all” strategy). The control subjects (Group 2) are 174 patients matched for age who underwent whole embryo freezing for other reasons. The baseline characteristics, clinical data of ovarian stimulation, and outcomes, such as the clinical pregnancy rate, ongoing clinical pregnancy rate were compared between the two groups in the subsequent FET cycle.

Results:
All patients had no pelvic inflammatory disease after oocyte retrieval. Anti-Mullerian hormone (AMH) levels (4.2 vs. 2.2, P <0.001) were higher in group 2, and the number of oocytes retrieved, and fertilization rate were lower in group 1 (P < 0.001), but the endometrial thickness, the number of embryo transfers, and the type of luteal support supplementation were similar between the two groups. Regarding pregnancy outcomes in the subsequent FET cycle, the implantation rate, clinical pregnancy rate, early spontaneous rate, ectopic pregnancy rate, and ongoing pregnancy rate were all not significantly different. Further regression analyses showed that the clinical pregnancy rate and ongoing pregnancy rate were also not significantly different.

Conclusions:
Transvaginal ultrasound-guided follicular puncture for oocyte retrieval is a safe and minimally invasive method for patients with fever. Moreover, the fever had almost no effect on embryo quality.
Student Nurses' Perceptions of Mercy
Authors: Thiel Linda M. , Razmus Ivy , Nauta Becky , Keep Suzanne , Thomas Roberta , Moran Katherine 
Published: December 2020

ABSTRACT:
Mercy is a valued nursing attribute. It often identifies faith-based educational institutions, clinics, and hospitals and has been a quality valued and taught by the Catholic Sisters of Mercy through nursing's history. This qualitative study explored the meaning of mercy as expressed by undergraduate nursing students attending a faith-based nursing school. This article presents the findings of a question posed to students: What does mercy mean to me? Nursing practice and education implications are also presented.
Hand or foot train-of-four tests and surgical site muscle relaxation assessed with multiple motor evoked potentials
Authors: Betz Michael , Aguirre José , Schubert Martin , Götschi Tobias , Huber Barbara , Schüpbach Regula , Brada Muriel , Spirig José M. , Farshad Mazda 
Published: December 2020

BACKGROUND
Intra-operative muscle relaxation is often required in orthopaedic surgery and the hand train-of-four (TOF) test is usually used for its quantification. However, even though full muscle relaxation is claimed by anaesthesiologists based on a TOF count of zero, surgeons observe residual muscle activity.

OBJECTIVE
The aim of the study was to assess if hand or foot TOF adequately represents intra-operative muscle relaxation compared with multiple motor evoked potentials.

DESIGN
Prospective observational study.

SETTING
A single-centre study performed between February 2016 and December 2018 at the Balgrist University Hospital, Zurich, Switzerland.

PATIENTS
Twenty patients scheduled for elective lumbar spinal fusion were prospectively enrolled in this study after giving written informed consent.

INTERVENTIONS
To assess neuromuscular blockade (NMB) with the intermediate duration nondepolarising neuromuscular blocking agent rocuronium, hand TOF (adductor pollicis) and foot TOF (flexor hallucis brevis) monitoring, and muscle motor evoked potentials (MMEPs) from the upper and lower extremities were assessed prior to surgery under general anaesthesia. Following baseline measurements, muscle relaxation was performed with rocuronium until the spinal surgeon observed sufficient relaxation for surgical intervention. At this timepoint, NMB was assessed by TOF and MMEP.

MAIN OUTCOME MEASURES
The primary outcome was to determine the different effect of rocuronium on muscle relaxation comparing hand and foot TOF with the paraspinal musculature assessed by MMEP.

RESULTS
Hand TOF was more resistant to NMB and had a shorter recovery time than foot TOF. When comparing MMEPs, muscle relaxation occurred first in the hip abductors, and the paraspinal and deltoid muscles. The most resistant muscle to NMB was the abductor digiti minimi. Direct comparison showed that repetitive MMEPs simultaneously recorded from various muscles at the upper and lower extremities and from paraspinal muscles reflect muscle relaxation similar to TOF testing.

CONCLUSION
Hand TOF is superior to foot TOF in assessing muscle relaxation during spinal surgery. Hand TOF adequately represents the degree of muscle relaxation not only for the paraspinal muscles but also for all orthopaedic surgical sites where NMB is crucial for good surgical conditions.

TRIAL REGISTRATION
ClinicalTrials.gov (NCT03318718).
BMI and malignant hyperthermia pathogenic ryanodine receptor type 1 sequence variants in Switzerland
Authors: Gonzalez Asensio , Girard Thierry , Dell-Kuster Salome , Urwyler Albert , Bandschapp Oliver 
Published: December 2020

BACKGROUND
Ryanodine receptor type 1 (RYR1) sequence variants are pathogenic for malignant hyperthermia. Variant carriers have a subtle increase in resting myoplasmic calcium concentration compared with nonaffected individuals, but whether this has metabolic effects in daily life is unknown.

OBJECTIVES
We analysed the potential effect of malignant hyperthermia-pathogenic RYR1 sequence variants on BMI as a single factor. Due to the heterogeneity of genetic variants predisposing to malignant hyperthermia, and to incomplete information about their regional distribution, we describe the prevalence of RYR1 variants in our population.

DESIGN
A retrospective cohort study.

SETTING
A single University hospital.

PATIENTS
Patients from malignant hyperthermia families with pathogenic RYR1 sequence variants were selected if BMI was available.

OUTCOME MEASURES
BMI values were compared amongst malignant hyperthermia susceptible (MHS) and malignant hyperthermia-negative individuals using hierarchical multivariable analyses adjusted for age and sex and considering family clustering. Variant prevalence was calculated.

RESULTS
The study included 281 individuals from 42 unrelated malignant hyperthermia families, 109 of whom were MHS and carriers of the familial RYR1 sequence variants. Median [IQR] BMI in MHS individuals with pathogenic RYR1 variants was 22.5 kg m−2 [21.3 to 25.6 kg m−2]. In malignant hyperthermia-negative individuals without variants, median BMI was 23.4 kg m−2 [21.0 to 26.3 kg m−2]. Using multivariable regression adjusted for age and sex, the mean difference was −0.73 (95% CI −1.51 to 0.05). No carrier of a pathogenic RYR1 sequence variant was found to have BMI higher than 30 kg m−2. Only 10 RYR1 variants from the list of the European MH Group were found in our cohort, the most common being p.Val2168Met (39% of families), p.Arg2336His (24%) and p.Arg614Cys (12%).

CONCLUSION
The observed tendency towards lower BMI values in carriers of malignant hyperthermia-pathogenic RYR1 sequence variants points to a possible protective effect on obesity. This study confirms regional differences of the prevalence of malignant hyperthermia-pathogenic RYR1 sequence variants, with just three variants covering 75% of Swiss MHS families.

TRIAL REGISTRATION
This manuscript is based on a retrospective analysis.
Effect of positive end-expiratory pressure during anaesthesia induction on non-hypoxic apnoea time in infants
Authors: Kim Eun-Hee , Lee Ji-Hyun , Jang Young-Eun , Ji Sang-Hwan , Cho Sung-Ae , Kim Jin-Tae , Kim Hee-Soo 
Published: December 2020

BACKGROUND
Hypoxaemia occurs frequently in infants during anaesthetic induction.

OBJECTIVE
We evaluated the effect of positive end-expiratory pressure during anaesthesia induction on nonhypoxic apnoea time in infants.

DESIGN
Randomised controlled trial.

SETTING
Tertiary care children's hospital, single centre, from November 2018 to October 2019.

PATIENTS
We included patients under 1 year of age receiving general anaesthesia.

INTERVENTION
We assigned infants to a 7 cmH2O or 0 cmH2O positive end-expiratory pressure group. Anaesthesia was induced with 0.02 mg kg−1 atropine, 5 mg kg−1 thiopental sodium and 3 to 5% sevoflurane, and neuromuscular blockade with 0.6 mg kg−1 rocuronium. Thereafter, 100% oxygen was provided via face mask with volume-controlled ventilation of 6 ml kg−1 tidal volume, and either 7 cmH2O or no positive end-expiratory pressure. After 3 min of ventilation, the infants’ trachea was intubated but disconnected from the breathing circuit, and ventilation resumed when pulse oximetry reached 95%.

MAIN OUTCOME MEASURE
The primary outcome was nonhypoxic apnoea time defined as the time from cessation of ventilation to a pulse oximeter reading of 95%, whereas the secondary outcome was the incidence of significant atelectasis (consolidation score ≥2) assessed by lung ultrasound.

RESULTS
Sixty patients were included in the final analysis. Apnoea time in the 7 cmH2O positive end-expiratory pressure group (105.2 s) increased compared with that in the control group (92.1 s) (P = 0.011, mean difference 13.0 s, 95% CI, 3.1 to 22.9 s). Significant atelectasis was observed in all patients without positive end-expiratory pressure and 66.7% of those with 7 cmH2O positive end-expiratory pressure (P = 0.019, 95% CI, 1.7 to 563.1, odds ratio 31.2).

CONCLUSION
Positive end-expiratory pressure during anaesthesia induction with face mask ventilation increased nonhypoxic apnoea time in infants.

CLINICAL TRIAL REGISTRATION

www.clinicaltrials.gov, NCT03540940.