bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fostemsavir: A Novel Attachment Inhibitor for Patients With Multidrug-Resistant HIV-1 Infection
Authors: Hiryak Kayla , Koren David E. 
Published: September 2020

Objective To review the efficacy and safety of fostemsavir (FTR) for the treatment of multidrug-resistant HIV-1 infection in heavily treatment-experienced adults who are failing their current antiretroviral regimen. Data Sources Clinical trials and review articles were obtained through PubMed (2015 to July 2020) using the search terms fostemsavir, BMS-663068, and GSK3684934. Study Selection and Data Extraction All relevant articles, trials, and abstracts in the English language were included. Data Synthesis FTR demonstrates a novel mechanism of action, preventing virus attachment to the host CD4 receptor. FTR extended-release 600-mg tablets every 12 hours orally has proven beneficial in obtaining viral suppression for heavily treatment-experienced patients with multidrug-resistant infection refractory to other agents, as indicated in phase 3 trials. Treatment courses were evaluated to 96 weeks with significant viral load reductions noted within the first 24 weeks. Adverse events commonly reported include nausea, vomiting, diarrhea, fatigue, and headache. Serious events and fatality were not attributed to FTR and occurred because of advancement of HIV or other acute infection. Relevance to Patient Care and Clinical Practice FTR presents a new treatment option for patients with multidrug resistance and intolerability to other medications. The favorable adverse effect profile of FTR alongside the limited drug interaction profile makes it a viable option in a salvage regimen. Conclusions FTR provides an alternative agent when composing a regimen for patients with multidrug-resistant HIV-1 infection. It is generally well tolerated, with few significant interactions, and neither renal nor hepatic dose adjustments are required.
Effect of Dexamethasone in Peripheral Nerve Blocks on Recovery of Nerve Function
Authors: Gagne Oliver J. , Cheema Amar , Abuhantash Monther , Ree Ron , Penner Murray , Wing Kevin , Younger Alastair , Salat Peter , Veljkovic Andrea 
Published: September 2020

Background: Peripheral nerve blocks (PNBs) have revolutionized distal extremity surgery reducing pain and improving hospital efficiency. Perineural dexamethasone has been administered with PNBs to prolong their effects, although the safety of dexamethasone has not been established in the literature. This study aimed to determine if the addition of dexamethasone affected the postoperative neurological sensory status for foot and ankle surgeries and the recovery of nerve injuries. We hypothesized that the rate of persistent nerve injury would be higher in the dexamethasone group. Methods: This is a retrospective observational cohort study of prospectively collected data of all patients from a single foot and ankle surgeon’s practice. Perineural dexamethasone was routinely used as an adjunct by the regional anesthesia group until a clinical trend of increased paresthesia was found on short-term follow-up, which led to the discontinuation of its use. In this study, the cohort that received dexamethasone with ropivacaine was compared with the cohort that received ropivacaine alone. The primary outcome was a separate sensory nerve status sheet that was completed for every distal nerve territory for every patient at their follow-up visits at 2 weeks, 6 weeks, 3 months, and 6 months. Univariate analysis and a logistic regression model were used to determine the association between dexamethasone and delayed nerve recovery. A total of 250 patients were included in the study, with 117 patients in the dexamethasone group and 133 in the ropivacaine-only group. Results: The rates of nerve injuries were not different between the groups (72 [62%] in the dexamethasone group vs 79 [59%] in the ropivacaine-only group). However, nerve injury symptoms were more likely to persist and not fully recover in the dexamethasone group ( n = 47, 65%) compared with the ropivacaine-only group ( n = 32, 41%) (OR, 2.12; P = .006). Conclusion: Perineural dexamethasone added to PNBs may be associated with delayed nerve recovery after foot and ankle surgery. It may be prudent to avoid its use until its full safety profile is established in larger prospective trials. Level of Evidence: Level III, retrospective comparative study.
Significant Improvement of Somatic Symptom Disorder With Brief Psychoeducational Intervention by PMHNP in Primary Care
Authors: Johnson Kim K. , Bennett Carole , Rochani Haresh 
Published: September 2020

Objective: Patients with somatic symptom disorders (SSD) are prevalent in primary care, urgent care, and emergency rooms and present with reduced quality of life, increased disability, and suicidality . Criteria for SSD include (1) somatic symptoms that cause distress and disrupt life; (2) concurrent physical illness with thoughts and feelings that are disproportionate to the seriousness of the illness; and (3) distress which is persistent and causes suffering. The frequency of SSD in the general population is 5% to 7%; however, in primary care, it is 5% to 35% . Because patients present with anxiety, depression, and/or pain, providers are flummoxed when diagnostic findings do not match symptom intensity. The purpose of this project was to provide an intervention for patients with SSD and measure its effectiveness on their somatic symptoms. Method: This study provided a single-session, 30-minute psychoeducational intervention for patients to explain brain pathways for pain and the body’s response to stress, including scientific benefits of exercise and healthy diet. Patients were asked questions using the motivational interviewing technique OARS (open-ended question, affirmation, reflection, summary) and were encouraged to talk about their concerns. The study used a pre- and post-intervention visual analogue scale and a self-reported Patient Health Questionnaire–15 both before and 3 weeks post-intervention. Results: Measurements showed significant symptom improvement immediately after the intervention with sustained improvement 3 weeks post-intervention. Conclusions: This intervention demonstrates an effective treatment for this insidious illness, which plagues up to 35% of patients in primary care.
Modified head inversion technique for pterygium and pseudopterygium surgery combined with keratopigmentation
Authors: Bafna Rahul Kumar , Kalra Nidhi , Sinha Rajesh 
Published: September 2020

Purpose: We describe a single sitting modified technique of pterygium surgery along with corneal tattooing for combined cosmetic rehabilitation in eyes with corneal opacity and pterygium or pseudopterygium. Method: Five patients with corneal opacity due to healed keratitis/optically failed therapeutic grafts along with pterygium or pseudopterygium underwent combined pterygium surgery by head inversion technique and corneal tattooing in the same sitting. All patients had no visual prognosis in that eye and surgery was indicated for cosmetic reasons only. Results: At 6 months follow up no complications of pterygium surgery like recurrence, thinning, dellen, infections were noted in any patient. The dye was retained in the cornea and the cosmetic rehabilitation was excellent in all patients. Discussion: Corneal tattooing combined with pterygium/pseudopterygium surgery can be performed in a single sitting with this novel technique in eyes with no visual potential. This is particularly suitable for eyes with limbal stem cell deficiency or large pterygia/pseudopterygia where conjunctival autograft is not advisable. These patients are often apprehensive for an allograft from their only seeing other eye
Unaccompanied minors’ needs and the child welfare response
Authors: Sanfelici Mara , Wellman Barry , Mordeglia Silvana 
Published: September 2020

Summary This study examines a sample of 1705 cases of unaccompanied and separated children (UASCs) included in a pilot project for early recovery child protection intervention. The project was started in two Southern Italian regions; multidisciplinary teams ensured an immediate intervention at the moment of disembarkation, working on children engagement and need assessment. Data were gathered about minors’ characteristics and services activated. Descriptive information was selected to develop a profile of cases and bivariate analysis was used to assess the relationship between case characteristics and outcomes. Findings The UASCs belong to 38 different nationalities, forming a very diverse group in terms of culture, reasons for leaving their country and past experiences, most of them traumatic. A high number of children were victims of torture, maltreatment, and human trafficking. The empirical evidence highlights that, at the end of the intervention, the majority of UASCs were still hosted in first-level facilities that could respond to basic needs only. Second-level centres were not always equipped to promote their integration process. Applications Findings suggest that even if an early child protection intervention to identify children’s strengths and vulnerabilities was crucial for the children engagement, a parallel action for advocacy at national and European level needs to be carried out to raise awareness about human rights violations, the complexity of these minors’ needs, and the necessity to promote adequate services in the reception system, giving voice to these children.
Risk Factors for Lateral Lymph Node Metastases in Patients With Sporadic Medullary Thyroid Carcinoma
Authors: Wu Xin , Li Binglu , Zheng Chaoji , Liu Wei , Hong Tao , He Xiaodong 
Published: September 2020

Purpose: Medullary thyroid carcinoma is a rare endocrine malignancy; 75% of patients with this disease have sporadic medullary thyroid carcinoma. While surgery is the only curative treatment, the benefit of prophylactic lateral neck dissection is unclear. This study aimed to analyze the clinicopathological risk factors associated with lateral lymph node metastases and determine the indication for prophylactic lateral neck dissection in patients with sporadic medullary thyroid carcinoma. Methods: The medical records of patients with medullary thyroid carcinoma who were treated at our hospital between January 2002 and January 2020 were retrospectively reviewed; a database of their demographic characteristics, test results, and pathological information was constructed. The relationship between lateral lymph node metastases and clinicopathologic sporadic medullary thyroid carcinoma features were analyzed using univariate and multivariate analyses. Results: Overall, 125 patients with sporadic medullary thyroid carcinoma were included; 47.2% and 39.2% had confirmed central and lateral lymph node metastases, respectively. Univariate and multivariate analyses identified 2 independent factors associated with lateral lymph node metastases: positive central lymph node metastases (odds ratio = 9.764, 95% confidence interval: 2.610–36.523; p = 0.001) and positive lateral lymph nodes on ultrasonography (odds ratio = 101.747, 95% confidence interval: 14.666–705.869; p < 0.001). Conclusion: Medullary thyroid carcinoma is a rare endocrine malignancy. Lymph node metastases are common in patients with sporadic medullary thyroid carcinoma. Prophylactic lateral neck dissection is recommended for patients who exhibit positive central lymph node metastases and/or positive lateral lymph nodes on ultrasonography.
Up-regulated long non-coding RNA ILF3-AS1 indicates poor prognosis of nasopharyngeal carcinoma and promoted cell metastasis
Authors: Yang Xuewen , Lin Feng , Gao Feng 
Published: September 2020

Background: Long non-coding RNAs (lncRNAs) have been confirmed to participate in the regulation of nasopharyngeal carcinoma. Here, we endeavored to explore the character of lncRNA ILF3-AS1 in the nasopharyngeal carcinoma and its function. Methods: A total of 68 nasopharyngeal carcinoma tissues and adjacent normal nasopharyngeal tissues were collected. Expressions of lncRNA ILF3-AS1 in these tissues were detected using quantitative real-time polymerase chain reaction (qRT-PCR). The relationship between the expression level of lncRNA ILF3-AS1 and clinical pathological characteristics was analyzed. Inhibition of lncRNA ILF3-AS1 was done using small interference RNA. Results: lncRNA ILF3-AS1 expression was significantly up-regulated in the 68 nasopharyngeal carcinoma tissue samples compared to their adjacent normal tissue samples. Increased lncRNA ILF3-AS1 level was related to the advanced tumor node metastasis stage and the metastasis of nasopharyngeal carcinoma. Also, increased lncRNA ILF3-AS1 indicated poor prognosis of nasopharyngeal carcinoma patients. Inhibition of lncRNA ILF3-AS1 reduced proliferation, invasion and migration of nasopharyngeal carcinoma cells. MicroRNA-320a (miR-320a) was determined as a direct target for lncRNA ILF3-AS1 in nasopharyngeal carcinoma. Furthermore, lncRNA ILF3-AS1 could sponge miR-320a to promote BMI1 expression. The expression of BMI1 was significantly inhibited by the down-regulation of lncRNA ILF3-AS1. Conclusions: For the first time, we demonstrated that lncRNA ILF3-AS1 was markedly over-expressed in nasopharyngeal carcinoma tissues and cells. Elevated lncRNA ILF3-AS1 expression was correlated with severe cancer stage and poor prognosis. lncRNA ILF3-AS1 could promote proliferation, invasion, and migration of cells, which might indicate a novel target site for the future diagnosis and therapy of nasopharyngeal carcinoma.
Standardized algorithm for muscle selection and dosing of botulinum toxin for Parkinson tremor using kinematic analysis
Authors: Samotus Olivia , Lee Jack , Jog Mandar 
Published: September 2020

Background: Inadequate efficacy and significant side effect profile makes pharmacological treatment of Parkinson’s disease (PD) tremor challenging. Personalized dosing of botulinum toxin type A (BoNT-A) using tremor analysis has shown efficacy and safety for treating upper limb tremor. This study incorporated a novel, standardized treatment algorithm for determining injection pattern and BoNT-A dosing, customizable by the physician, in PD patients with disabling tremor in one or both arms. Methods: This open-label study included 47 PD participants (25 “De-novo” and 22 “L-dopa”) who received 4 serial BoNT-A treatments with follow-ups at 6 weeks post-treatment over 42 weeks. The treatment algorithm utilized kinematic tremor analysis of each participant’s whole arm tremor and determined the physician’s injection pattern of BoNT-A. Endpoints included changes in angular tremor amplitude, Fahn-Tolosa-Marin (FTM C) tremor scale, Movement Disorder Society-Unified Parkinson’s disease rating scale (MDS-UPDRS) tremor-related score, tremor-related quality of life questionnaire, Likert ratings of perceived weakness, and maximal grip strength. Results: BoNT-A significantly ( p < 0.05) improved tremor amplitude (41.6%), quality of life (23.0%), UPDRS tremor score (29.6%), and arm function (FTM C; 24.6%) for both treatment cohorts from weeks 6 to 42. Maximum grip strength was reduced between 7.4% and 23.0% at follow-up visits and did not impact activities of daily living. Efficacy was obtained with first injection and remained without adjustment over two serial injection in 45% of participants. Conclusions: This is the first study to use a fully standardized treatment algorithm for personalization of BoNT-A injection patterns for disabling PD tremor over serial treatments. A sustained alleviation of tremor severity and improved arm function and quality of life fulfills an important unmet need for the treatment of PD tremor. This study demonstrated that BoNT-A can be administered as a monotherapy in tremor-dominant PD or as an add-on therapy for refractory PD tremor.
COVID-19 Disease and Hypercoagulability Leading to Acute Ischemic Stroke
Authors: Mullaguri Naresh , Hepburn Madihah , Gebel James Matthew , Itrat Ahmed , George Pravin , Newey Christopher R. 
Published: September 2020

Introduction: SARS-Coronavirus-2 infection leading to COVID-19 disease presents most often with respiratory failure. The systemic inflammatory response of SARS-CoV-2 along with the hypercoagulable state that the infection elicits can lead to acute thrombotic complications including ischemic stroke. We present 3 cases of patients with COVID-19 disease who presented with varying degrees of vascular thrombosis. Cases: Cases 1 and 2 presented as cerebral ischemic strokes without respiratory failure. Given their exposure risks, they were both tested for COVID-19 disease. Case 2 ultimately developed respiratory failure and pulmonary embolism. Cases 2 and 3 were found to have simultaneous arterial and venous thromboembolism (ischemic stroke and pulmonary embolism) as well as positive antiphospholipid antibodies. Conclusion: Our case series highlight the presence of hypercoagulability as an important mechanism in patients with COVID-19 disease with and without respiratory failure. Despite arterial and venous thromboembolic events, antiphospholipid and hypercoagulable panels in the acute phase can be difficult to interpret in the context of acute phase response and utilization of thrombolytics. SARS-CoV-2 testing in patients presenting with stroke symptoms may be useful in communities with a high case burden or patients with a history of exposure.
Cannabinoid use among Americans with MS: Current trends and gaps in knowledge
Authors: Braley Tiffany J , Whibley Daniel , Alschuler Kevin N , Ehde Dawn M , Chervin Ronald D , Clauw Daniel J , Williams David , Kratz Anna L 
Published: September 2020

Background Up-to-date information regarding the scope and impact of cannabinoid use among persons with MS (PwMS) is necessary to guide clinical practice and cannabinoid research. Objectives To assess utilization patterns and perceived impact of cannabinoid use among a national cohort of PwMS. Methods Data collected were part of a nationwide survey to characterize pain in PwMS. Items included questions about current/recent cannabinoid use, reasons for use, preferred THC/CBD formulations, and perceived benefits/side effects. PROMIS short-forms assessed symptom severity. Pain phenotype was assessed with the painDETECT questionnaire and FMSurvey Criteria Questionnaires. Results Among n = 1,027 respondents, 42% endorsed recent cannabinoid use, of which 18% endorsed healthcare provider guidance regarding use. PROMIS scores (except cognitive abilities), and pain centralization and neuropathic pain scores, were higher among recent/current users (each p < 0.0001). Sleep and pain were the most frequently reported reasons for use. Benefit from cannabinoids for sleep and pain were strongly correlated (r = 0.65, p < 0.0001). For those who expressed a preference for specific THC/CBD ratios, CBD-predominant formulations were favored. Conclusion Cannabinoid use is common in PwMS, despite a paucity of provider guidance. The range of perceived benefits, and potential differential effects of THC and CBD, highlight the need for personalized, evidence-based guidelines regarding cannabinoid use.
Comparison study of different indoleamine-2,3 dioxygenase inhibitors from the perspective of pharmacodynamic effects
Authors: Jiang Xue , Li Xiaopeng , Zheng Shuang , Du Guangying , Ma Jinbo , Zhang Liming , Wang Hongbo , Tian Jingwei 
Published: September 2020

Introduction: Indoleamine 2,3-dioxygenase (IDO) was a potential tumor immunotherapy target. IDO inhibitors showed inconsistent results in clinical trials, but no preclinical comparative study was reported. The purpose of this study was to evaluate the differences of representative IDO inhibitors (PCC0208009, INCB024360, NLG919) from the pharmacological perspective. Methods: In vitro experiments included: inhibition effects on IDO activity in cell and enzyme-based assay, effects on IDO expression in HeLa cells, and enhancement of proliferation and activation of peripheral blood mononuclear cell (PBMC). In vivo experiments included: pharmacokinetics and tumor distribution in CT26-bearing mice, effects on Kyn/Trp and anti-tumor effect and immunological mechanism in CT26 and B16F10 tumor-bearing mice. Results: Compared with INCB024360 and NLG919, PCC0208009 effectively inhibited IDO activity at lower dose 2 nM and longer duration more than 72 h, had higher enhancements on PBMC proliferation and activation, and could inhibit the IDO expression in Hela cells. The pharmacokinetics characteristics of three IDO inhibitors were similar in CT26-bearing mice. In CT26 and B16F10 tumor-bearing mice, PCC0208009 and INCB024360 had similar effects in Kyn/Trp reduction, and more potent than NLG919; three IDO inhibitors had similar effects in tumor suppression, changes of the percentages of CD3+CD8+ and CD3+CD4+ T cells, and activation of tumor infiltrating lymphocytes, while PCC0208009 had a better tendency than INCB024360 and NLG919. Conclusion: PCC0208009, INCB024360, and NLG919 were all effective IDO inhibitors, but the comprehensive pharmacological activity of PCC0208009 was better than INCB024360 and NLG919, which was basically consistent with the results or progresses of clinical trials.
Autologous Stem Cells in Cervical Spine Fusion
Authors: Hsieh Patrick C. , Chung Andrew S. , Brodke Darrel , Park Jong-Beom , Skelly Andrea C. , Brodt Erika D. , Chang Ki , Buser Zorica , Meisel Hans Joerg , Yoon S. Timothy , Wang Jeffrey C. ,   The AO Spine Knowledge Forum Degenerative
Published: September 2020

Study Design: Systematic review. Objectives: To systematically review, critically appraise and synthesize evidence on use of stem cells from autologous stem cells from bone marrow aspirate, adipose, or any other autologous sources for fusion in the cervical spine compared with other graft materials. Methods: A systematic search of PubMed/MEDLINE was conducted for literature published through October 31, 2018 and through February 20, 2020 for EMBASE and ClinicalTrials.gov comparing autologous cell sources for cervical spine fusion to other graft options. Results: From 36 potentially relevant citations identified, 10 studies on cervical fusion met the inclusion criteria set a priori. Two retrospective cohort studies, one comparing cancellous bone marrow (CBM) versus hydroxyapatite (HA) and the other bone marrow aspirate (BMA) combined with autograft and HA versus autograft and HA alone, were identified. No statistical differences were seen between groups in either study for improvement in function, symptoms, or fusion; however, in the study evaluating BMA, the authors reported a statistically greater fusion rate and probability of fusion over time in the BMA versus the non-BMA group. Across case series evaluating BMA, authors reported improved function and pain and fusion ranged from 84% to 100% across the studies. In general, complications were poorly reported. Conclusions: The overall quality (strength) of evidence of effectiveness and safety of autologous BMA for cervical arthrodesis in the current available literature was very low. Based on currently available data, firm conclusions regarding the effectiveness or safety of BMA in cervical fusions cannot be made.