bluuebunny/crossref_metadata_2025_split huggingface dataset:
Echocardiographic Evaluation of the Response to Prazosin Treatment in Scorpion Sting
Authors: Abdel Baseer Khaled A , Aboelela Mohamed Gamil , Qubaisy Heba M 
Published: July 2020

Abstract

Background
Scorpion envenomation is a major public health problem in children that can induce lethal neurological, respiratory and cardiovascular complications. We aimed to evaluate cardiovascular complications with a follow-up of envenomed children for 1 month for possibility of incomplete recovery.

Methods
This was a prospective study conducted for children who presented with scorpion sting to Emergency and Intensive Care units. Demographic, clinical and laboratory findings of patients were recorded. Cases with suspected clinical and electrocardiographic manifestations of myocarditis were subjected to bedside echocardiography with follow-up at the end of the first week and the first month.

Results
Scorpion sting cases presented to our hospital were 81 cases during 1-year study; of them, 17 cases were stable without systemic manifestations after 12 h observation and discharged. Sixty-four cases suffered systemic organic complications and needed ICU admission; their mean age was 11.52 ± 3.74 and 64% of them were males. Twenty-eight of admitted cases showed manifestations of myocarditis and by echocardiography, all of them had evidence of left ventricular dysfunction. On follow-up, there was significant improvement at the end of first week and complete improvement at the end of first month except three cases who died due to pulmonary edema and cardiogenic shock.

Conclusion
Acute toxic myocarditis is a common and an important cause of morbidity and mortality following scorpion envenomation that necessitates early and aggressive management. High index of suspicion, serial electrocardiogram monitoring and echocardiography are three integrative lines required to recognize this serious complication.
Lay summary
Acute toxic myocarditis is a common cause of morbidity and mortality following scorpion envenomation that necessitates rapid medical treatment. We aimed to evaluate cardiovascular complications after scorpion sting with a follow-up of envenomed children for 1 month for possibility of incomplete recovery. Tachycardia was the most frequent observed cardiac sign followed by hypotension, while the least was bradycardia and hypertension. All cases with manifestations suggestive of myocarditis were evaluated by bedside two-dimensional echocardiography and showed evidence of left ventricular dysfunction, that begin to regress within 1 week of treatment unless progressive pulmonary edema and resistant cardiogenic shock occurred. On follow-up for survivors, complete improvement at the end of first month was noticed. Clinical suspicion, serial ECG monitoring and echocardiography are required for rapid and early diagnosis. Early use of prazosin therapy can prevent long-term residual damage as evidenced by echocardiographic evaluation.
Continuous Quality Improvement of Writing Assignments: A Process for Faculty Development
Authors: Singleterry Lisa R. , Caulfield Susan 
Published: July 2020

Abstract
This article describes a four-step instructional design framework to assist nursing faculty with development of writing assignments. The framework encourages faculty to design assignments with a purpose, objectives, directions, and evaluation (PODE). Use of the PODE framework may reduce faculty frustration with students’ writing assignments and allow for continuous quality improvement of assignments and students’ writing skills. Faculty who have used the framework found it useful to improve development, assessment, and revision of course assignments, resulting in better work from students.
Using Learning Curves to Identify and Explain Growth Patterns of Learners in Bronchoscopy Simulation: A Mixed-Methods Study
Authors: Mema Briseida , Mylopoulos Maria , Tekian Ara , Park Yoon Soo 
Published: July 2020

Purpose
Learning curves can illustrate how trainees acquire skills and the path to competence. This study examined the growth trajectories of novice trainees while practicing on a bronchoscopy virtual reality (VR) simulator compared with those of experts.

Method
This was a sequential explanatory mixed-methods design. Twenty pediatric subspecialty trainees and 7 faculty practiced with the VR simulator (October 2017 to March 2018) at the Hospital for Sick Children, Toronto, Canada. The authors examined the relationship between number of repetitions and VR outcomes and patterns of growth using a growth mixture modeling. Using an instrumental case study design, field notes and semistructured interviews with trainees and simulation instructor were examined to explain the patterns of growth. The authors used a constant comparative approach to identify themes iteratively. Team analysis continued until a stable thematic structure was developed and applied to the entire data.

Results
The growth mixture model identified 2 patterns of growth. A slower growth included learners that had inherent difficulty with the skill, did not integrate the knowledge of anatomy in simulation practice, and used the simulator for simple repetitive practice with no strategy for improvement in between trials. The faster growth included learners who used an adaptive expertise approach: integrating knowledge of anatomy, finding flexible solutions, and creating a deeper conceptual understanding.

Conclusions
The authors provide validity evidence for use of growth models in education and explain patterns of growth such as a “slow growth” with a mechanistic repetitive practice and a “fast growth” with adaptive expertise.
Update on noninfectious uveitis in children and its treatment
Authors: Maccora Ilaria , Sen Ethan S. , Ramanan Athimalaipet V. 
Published: July 2020

Purpose of review
To give an overview of recently published articles covering risk factors, novel biomarkers and treatment for noninfectious uveitis in children.

Recent findings
In the last few years, several genetic markers, serum biomarkers, aqueous humor markers, tear biomarkers and clinical factors have been identified, which are associated with childhood noninfectious uveitis. We describe the most important reports in this field that may help to tailor the screening and monitoring of this population in the future and might become the target of novel therapies. The advances in the biologic therapy of paediatric uveitis, thanks to evidence provided by the SYCAMORE, ADJUVITE and APTITUDE trials, offer new possibilities for the treatment of patients who fail methotrexate with adalimumab and tocilizumab. We discuss the importance of comprehensive outcome measures as proposed by the Multinational Interdisciplinary Working Group for Uveitis in Childhood (MIWGUC).

Summary
Paediatric noninfectious uveitis is a sight-threatening condition and the identification of risk factors and novel biomarkers is critical for tailored management. Biologic therapies are revolutionizing the outcomes of patients resistant to conventional therapy. Increasing our knowledge of disease pathogenesis is crucial to improve targeting of screening to those at highest risk and stratification of treatments.
Epidemiology and outcomes of novel coronavirus 2019 in patients with immune-mediated inflammatory diseases
Authors: Gianfrancesco Milena , Yazdany Jinoos , Robinson Philip C. 
Published: July 2020

Purpose of review
The novel coronavirus 2019 (COVID-19) pandemic is of special concern for patients with immune-mediated inflammatory disease (IMID) and those who care for them because of the potential for worse outcomes. This article analyzes peer-reviewed research on the epidemiology and outcomes of COVID-19 in those with IMID.

Recent findings
Published literature on approximately 1400 patients was included from rheumatology, gastroenterology, and dermatology. Data suggest that those who are older and have comorbidities have poorer outcomes. This is consistent with the reports from the general population of patients with COVID-19. Adjusted analyses from the largest published studies demonstrate independent effects of systemic glucocorticoids, as well as age and comorbidities with poorer COVID-19 outcomes (SECURE-IBD registry, n = 525; COVID-19 Global Rheumatology Alliance registry, n = 600); biologic or targeted synthetic disease-modifying antirheumatic drug therapy has not been associated with more severe outcomes. These early results will require validation in population-based studies as more data becomes available.

Summary
Current data suggest that similar to the general population, age, and comorbidities are risk factors for poorer COVID-19 outcomes in patients with IMID. Additional research is needed to quantify outcomes and risk across rheumatic disease types, comorbidities, and immunosuppressive drugs.
Does Main Curve Flexibility Affect Screw Insertion Accuracy Using a CT-based Navigation System in Adolescent Idiopathic Scoliosis Surgery?
Authors: Uehara Masashi , Takahashi Jun , Shimizu Masayuki , Ikegami Shota , Kuraishi Shugo , Oba Hiroki , Takizawa Takashi , Munakata Ryo , Hatakenaka Terue , Koseki Michihiko , Kato Hiroyuki 
Published: July 2020

Study Design:
A retrospective single-center and single-surgeon study.

Objective:
This study investigated the screw perforation rate according to main curve flexibility in pedicle screw fixation using a computed tomography (CT) guidance for adolescent idiopathic scoliosis (AIS).

Summary of Background:
The authors have been using a CT-based navigation system during pedicle screw insertion for AIS to avoid serious neurovascular or visceral structure injury but suspect that high main curve flexibility may account for some breaches.

Data:
Seventy-two consecutive patients with AIS Lenke type 1 or 2 who had undergone pedicle screw fixation using a CT-based navigation system between February 2008 and April 2018 were retrospectively reviewed.

Materials and Methods:
The authors evaluated the perforation rate of pedicle screws inserted into the main thoracic curve between the upper-end and lower-end vertebrae for factors associated with screw violations using multivariate logistic regression mixed models.

Results:
A total of 723 pedicle screws were inserted into the T4–T12 vertebrae with the aid of CT-based navigation. The respective grade 3 perforation rates according to main curve flexibility were 0%–30%: 3.2%; 30%–55%: 1.1%; 55%–75%: 5.2%; and 75%–100%: 5.5%. Main curve flexibility of ≥55% was significantly associated with grade 3 screw perforations (P=0.02).

Conclusions:
Main curve flexibility of ≥55% was significantly related to screw violation in AIS surgery. Greater care is thus advised for screw insertion using CT navigation in AIS with main curve flexibility ≥55%.
Targeting defective DNA repair in prostate cancer
Authors: Carmichael Juliet , Maza Maria de los Dolores Fenor de la , Rescigno Pasquale , Chandran Khobe , de Bono Johann 
Published: July 2020

Purpose of review
Prostate cancer is the second leading cause of cancer death in men. Characterization of the genomic landscape of prostate cancer has demonstrated frequent aberrations in DNA repair pathways, identifiable in up to 25% patients with metastatic disease, which may sensitize to novel therapies, including PARP inhibitors and immunotherapy. Here, we summarize the current clinical landscape and future horizons for targeting defective DNA repair pathways in PC.

Recent findings
Several clinical trials have demonstrated efficacy of different PARP inhibitors in metastatic castration-resistant prostate cancer (mCRPC), most pronounced in those with BRCA mutations. The PROfound trial is the first positive phase 3 biomarker-selected trial to demonstrate improved outcomes with a targeted treatment, Olaparib, in mCRPC. Whilst the Keynote-199 trial failed to demonstrate efficacy of immune-checkpoint inhibitor pembrolizumab in unselected mCRPC patients, there was evidence of response in those harbouring DNA repair defects.

Summary
These landmark trials represent a significant advance towards personalization of PC therapy. However, resistance remains inevitable and there is a lack of reliable predictive biomarkers to select patients for treatment. Characterization of resistance mechanisms, and validation of novel biomarkers is critical to maximize clinical benefit and inform novel treatment combinations to improve outcomes.
The role of myeloid-derived suppressor cells in hematologic malignancies
Authors: Gunes Emine Gulsen , Rosen Steven T. , Querfeld Christiane 
Published: July 2020

Purpose of reviewThis article focuses on the immunosuppressive impact of myeloid-derived suppressor cells (MDSCs) and the potential clinical implications in hematological malignancies.Recent findingsMDSCs play a critical role in the regulation of the immune response in cancer. They inhibit activation of adaptive immune response and as a result foster the growth of the malignancy. Recent studies have shown that MDSCs serve as prognostic biomarkers and as targets for cancer immunotherapy. Preclinical and clinical studies have identified new approaches to deplete MDSC populations and inhibit MDSC function with combination immunomodulatory therapies including chemotherapeutic agents with immune checkpoint-directed treatment.SummaryA broad spectrum of publications indicate that direct targeting of MDSCs may abrogate their protumorigenic impact within the tumor microenvironment through activation of the adaptive immune response.
Penile Necrosis as a Presenting Sign of Purpura Fulminans Mimicking Fournier's Gangrene
Authors: Caputo Valentina , Bonoldi Emanuela , Rongioletti Franco 
Published: July 2020

Abstract:
We report the case of a 63-year-old white man who, 3 days after stent removal of endoscopic drainage of pancreatic cysts, developed a penile necrosis due to purpura fulminans (PF) that has been misdiagnosed as Fournier's gangrene. Penile necrosis was rapidly followed by a lethal multiorgan failure due to disseminated intravascular coagulopathy (DIC), triggered by the subsequent development of a severe acute pancreatitis. PF describes a rare syndrome involving intravascular thrombosis and hemorrhagic infarction of the skin. Although reports of penile necrosis secondary to various causes are documented in the literature, penile necrosis secondary to PF in the setting of acute pancreatitis is a rare event. Histopathologic studies of the skin showing an occlusive nonvasculitic vasculopathy are the first step to achieve an accurate diagnosis.
The Association of Febuxostat Compared With Allopurinol on Blood Pressure and Major Adverse Cardiac Events Among Adult Patients With Hyperuricemia: A Meta-analysis
Authors: Barrientos-Regala Marie , Macabeo Renelene A. , Ramirez-Ragasa Rosemarie , Pestaño Noemi S. , Punzalan Felix E. R. , Tumanan-Mendoza Bernadette , Castillo Rafael R. 
Published: July 2020

Abstract:
Increased uric acid levels have been known to be associated with different cardiovascular and renal diseases. Over the past few years, several studies have examined the role of urate-lowering therapy (ULT) in hypertension and major adverse cardiac events (MACE) and suggest a potential role of elevated serum uric acid as an independent cardiovascular risk factor. This meta-analysis was done to determine the association of 2 ULTs commonly used in clinical practice (febuxostat vs. allopurinol) on hypertension and MACE and resolve the conflicting results of the outcomes of earlier studies. Randomized controlled trials comparing febuxostat versus allopurinol published with outcomes on blood pressure, all-cause mortality, myocardial infarction (MI), and stroke were searched through PubMed, Google Scholar, and Cochrane database. A total of 10 studies were subsequently included in the meta-analysis. Pooled analysis of the mean differences (MD) were done for the outcomes on blood pressure (systolic and diastolic) and risk ratios (RRs) for the outcomes on MACE with corresponding 95% confidence intervals (CIs). Pooled analysis of studies on hyperuricemic patients showed that febuxostat 40 mg has no significant difference compared with allopurinol 100/300 mg with respect to diastolic (MD, −0.56 with 95% CI of −4.28 to 3.15) and systolic blood pressure (MD, 0.30 with 95% CI of −3.33 to 3.93). No significant differences were also noted on all-cause mortality (RR, 1.18 with 95% CI of 0.99–1.41), MI (RR, 0.92 with 95% CI of 0.72–1.18), and stroke (RR, 1.05 with 95% CI of 0.77–1.43). The results of this meta-analysis showed that the 2 ULTs (febuxostat vs. allopurinol) have no significant association with respect to blood pressure among adult patients with hyperuricemia. No significant association was also noted of either ULT with all-cause mortality, MI, and stroke.
Diabetes and CYP2C19 Polymorphism Synergistically Impair the Antiplatelet Activity of Clopidogrel Compared With Ticagrelor in Percutaneous Coronary Intervention–treated Acute Coronary Syndrome Patients
Authors: Mohareb Mina W. , AbdElghany Mohamed , Zaki Hala F. , El-Abhar Hanan S. 
Published: July 2020

Abstract:
Diabetes and CYP2C19 loss of function (LOF) alleles are associated with the variable antiplatelet activity of the prodrug clopidogrel. We conducted a randomized trial (NCT03613857) to compare the combined and individualized effects of diabetes and CYP2C19 polymorphisms on the antiplatelet reactivity of clopidogrel versus ticagrelor in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Patients (948, 1 year follow-up 943) were randomly allocated in a 1:1 ratio to receive either clopidogrel or ticagrelor, after PCI; patients were subdivided into 8 subgroups according to the diabetes and/or CYP2C19 allele status. The study outcomes were recurrent ACS, maximum platelet aggregation (MPA), high platelet reactivity index (PRI), and incidence of major bleeding events. Diabetic patients with LOF alleles taking clopidogrel had the highest recurrent ACS rate (6 of 33 patients) versus all other study groups (P < 0.05). However, both drugs had similar proportions of recurrent ACS in all other subgroups. Similarly, both PRI and MPA were significantly higher in the diabetic patients having LOF alleles and receiving clopidogrel versus all their study groups (P < 0.05). Nevertheless, ticagrelor caused higher rates of major bleeding versus clopidogrel (P < 0.001). PCI-treated ACS patients with diabetes and CYP2C19 LOF alleles are at a higher risk of recurrent ACS and high PRI/MPA, when treated with clopidogrel versus ticagrelor, but almost comparable outcomes are recorded in the absence of 1 or the 2 risk factors.
Cochlear Implantation in Patients With Menière's Disease: Does Disease Activity Affect the Outcome?
Authors: Kocharyan Armine , Mark Michelle E. , Ascha Mustafa S. , Murray Gail S. , Manzoor Nauman F. , Megerian Cliff , Mowry Sarah E. , Semaan Maroun T. 
Published: July 2020

Objective:Menière's disease (MD) is characterized by episodes of vertigo, tinnitus, and sensorineural hearing loss. In the setting of bilateral deafness due to MD alone or contralateral pathology, cochlear implantation (CI) improves hearing. Active MD is characterized by fluctuating auditory symptoms and vertigo; whereas remittance of vertiginous symptoms and severe, permanent sensorineural hearing loss characterizes the inactive disease state. This study evaluates outcomes for MD patients compared with the general CI population and assesses if disease activity affects implant outcomes.Study Design:Retrospective chart review.Setting:Tertiary referral center.Patients:Twenty-four patients with MD that received CI (7 active, 16 inactive, and 1 Probable Menière's), and 24 age-matched controls.Interventions:Cochlear implantation.Main Outcome Measures:Word Recognition Score, Sentence Recognition Score (SRS), and Speech Reception Threshold.Results:Best-aided preoperative and postoperative audiometric data were compared per ear between MD patients and controls and stratified by disease status using descriptive statistics with mixed-effects modeling. Patients with MD derived significantly more benefit from CI than controls when comparing differences between preoperative and postoperative levels for Word Recognition Score (12.2%,p = 0.0236), SRS (12.8%,p = 0.0375), and Speech Reception Threshold (−14.4 dB,p = 0.0188). Active disease status does not negatively impact CI outcomes and patients with active MD may benefit from greater gains in SRS (23.5%,p = 0.0107).Conclusions:CI provides greater gains in functional hearing for patients with MD compared with age-matched controls. Patients with active MD seem to perform better with respect to SRS following CI than patients with inactive status.
Natural Adhesion Blepharoplasty Technique
Authors: Jung Gyu Sik 
Published: July 2020

Abstract
Nonincisional blepharoplasty is widely practiced to make natural double eyelids. However, this method has the disadvantage of the double fold loosening compared to incisional blepharoplasty. Many researchers have proposed a method of nonincisional blepharoplasty with lower risk of loosening. The authors innovated the method to induce spontaneous adhesion in a nonincisional blepharoplasty with induction of partial linear adhesions, and, therefore, lowering the risk of suture loosening. While performing this procedure, the orbicularis oculi muscle and the levator palpebrae muscle were partially incised through eight tiny incisions to induce adhesion, and the double eyelid was made with the nonincisional continuous suture technique. This study included 99 patients who underwent natural adhesion blepharoplasty technique between January and December 2018. After 1 year of follow-up, no double eyelid loosening was observed. Natural adhesion blepharoplasty is simple technique to create natural-looking results and a durable double fold with satisfactory aesthetic results.
Long-term Outcomes Following Primary Closure of Common Bile Duct Following Laparoscopic Common Bile Duct (CBD) Exploration: Experience of 355 Cases at a Tertiary Care Center
Authors: Asuri Krishna , Bansal Virinder K. , Bagaria Vivek , Prajapati Omprakash , Kumar Subodh , Ramachandran Rashmi , Garg Pramod , Misra Mahesh C. 
Published: July 2020

Introduction:
Primary closure of common bile duct (CBD) after laparoscopic common bile duct exploration (LCBDE) is now becoming the preferred technique for closure of choledochotomy. Primary CBD closure not only circumvents the disadvantages of an external biliary drainage but also adds to the advantage of LCBDE. Here, we describe our experience of primary CBD closure following 355 cases of LCBDE in a single surgical unit at a tertiary care hospital.

Materials and Methods:
All patients undergoing LCBDE in a single surgical unit were included in the study. Preoperative and intraoperative parameters including the technique of CBD closure were recorded prospectively. The postoperative recovery, complications, hospital stay, antibiotic usage, and postoperative intervention, if any, were also recorded.

Results:
Three hundred fifty-five LCBDEs were performed from April 2007 to December 2018, and 143 were post-endoscopic retrograde cholangiopancreatography failures. The overall success rate was 91.8%. The mean operative time was 98±26.8 minutes (range, 70 to 250 min). Transient bile leak was seen in 10% of patients and retained stones in 3 patients. Two patients required re-exploration and 2 patients died in the postoperative period. Follow-up ranged from 6 months to 10 years, with a median follow-up of 72 months. No long-term complications such as CBD stricture or recurrent stones were noted.

Conclusions:
Primary closure of CBD after LCBDE is safe and associated with minimal complications and no long-term problems. The routine use of primary CBD closure after LCBDE is recommended based on our experience.