bluuebunny/crossref_metadata_2025_split huggingface dataset:
KTP Laser Treatment of Early Glottic Cancer: A Multi-Institutional Retrospective Study
Authors: Parker Noah P. , Weidenbecher Mark S. , Friedman Aaron D. , Walker Brian A. , Lott David G. 
Published: July 2020

Objectives: The primary objectives were to report oncologic outcomes of transoral laser microsurgery with potassium-titanyl-phosphate (KTP) laser (TLM-KTP) ablation of early glottic cancer (EGC). The secondary objectives were to report vocal outcomes and to analyze factors that might influence outcomes. Methods: A multi-institutional, retrospective analysis of consecutive patients treated for T1 or T2 glottic squamous cell carcinoma undergoing TLM-KTP ablation with at least 2 years of follow-up was performed. Patients with prior radiation or surgery for laryngeal disease were excluded. Primary outcome measures included: surgical failures requiring radiation or laryngectomy, disease-specific survival (DSS), and overall survival (OS). Secondary outcome measures included: pre- and postoperative Voice Handicap Index-10 (VHI-10) scores. The effects of smoking status, stage, and anterior commissure involvement on outcomes were analyzed. Results: Overall 88 patients met inclusion criteria (83% male, 79.5% current or former smokers). Mean age was 68 (standard deviation (SD): 12). Mean follow-up was 39.5 months (SD: 15.3). Staging included 50 T1a, 21 T1b, and 20 T2 tumors, including three metachronous second primaries. Radiation and/or laryngectomy avoidance was achieved in 87/88 (98.9%) of patients, inclusive of 24 patients requiring KTP re-treatments. Two patients had biopsy-proven recurrence (2.3%), but only 21 of 24 re-treated patients received a formal biopsy. No patients died from laryngeal cancer. DSS and OS were 100% and 92.3%, respectively. The mean VHI-10 scores were 19.3 preoperatively, 3.8 at 6-months postop, and 3.8 at 2-years postop. Smokers had a longer interval to re-treatment ( P = .03), patients with T2 lesions had a shorter interval to re-treatment (0.02), and patients with T2 lesions presented with worse initial VHI-10 scores (0.002). Conclusions: A multi-institutional, retrospective case series of TLM-KTP ablation of EGC demonstrated excellent oncologic outcomes when close surveillance and proactive re-treatments were utilized. Disease-specific survival, overall survival, and vocal function were excellent. Additional studies are necessary to further analyze the merits and risks of this treatment approach.
Redesigned community baby showers to promote infant safe sleep
Authors: Ahlers-Schmidt Carolyn R , Schunn Christy , Hervey Ashley M , Dempsey Millicent , Blackmon Sheila , Davis Brenda , Baker Trudy , Mayes Cheryl A , Torres Maria 
Published: July 2020

Objective: The purpose of this study was to evaluate whether participation in a community event developed using Health Belief Model constructs increased intention to follow the American Academy of Paediatrics Safe Sleep Guidelines for infants. Design: Observational cohort study. Setting: Safe Sleep Community Baby Showers held between Spring 2015 and Spring 2019. Method: Women attending the Safe Sleep Community Baby Showers completed pre- and post-assessments measuring intentions based on constructs derived from the Health Belief Model. Results: Following the Safe Sleep Community Baby Showers, significantly more of the 812 participants demonstrated positive changes in Health Belief Model constructs, including beliefs about severity and susceptibility (infant is at risk, sleeping with infant can cause death, loose blankets can cause death), benefits (putting infant alone, on back in crib will help protect), barriers (infant will [not] choke on back) and self-efficacy (know what to do). Two barriers did not result in significant change: room for crib (cot) in parents’ room and able to keep infant warm without blankets. Most reported intention to only place infant supine (99%), in safe sleep locations (97.8%) and to include only safe items (86.2%; all p < .001). Conclusion: Structuring a community event based on the Health Belief Model resulted in significant increases in participants intending to follow the AAP Safe Sleep Guidelines. Further work is needed to address barriers around blankets and room sharing without bed sharing. Safe Sleep Community Baby Showers can impact Health Belief Model constructs related to the AAP Safe Sleep Recommendations, which may in turn impact behaviour.
Patient-Driven Diabetes Technologies: Sentiment and Personas of the #WeAreNotWaiting and #OpenAPS Movements
Authors: Litchman Michelle L. , Walker Heather R. , Fitzgerald Caroline , Gomez Hoyos Mariana , Lewis Dana , Gee Perry M. 
Published: July 2020

Background: Patients with diabetes have developed innovative do-it-yourself (DIY) methods for adapting existing medical devices to better fit individual needs. Method: A multiple method study used Symplur Analytics to analyze aggregated Twitter data of #WeAreNotWaiting and #OpenAPS tweets between 2014 and 2017 to examine DIY patient-led innovation. Conversation sentiment was examined between diabetes stakeholders to determine changes over time. Two hundred of the most shared photos were analyzed to understand visual representations of DIY patient-led innovations. Finally, discourse analysis was used to identify the personas who engage in DIY patient-led diabetes technologies activities and conversations on Twitter. Results: A total of 7886 participants who generated 46 578 tweets were included. Sentiment analysis showed that 82%-85% of interactions around DIY patient-led innovation was positive among patient/caregiver and physician groups. Through photo analysis, five content themes emerged: (1) disseminating media and conference coverage, (2) showcasing devices, (3) celebrating connections, (4) providing instructions, and (5) celebrating accomplishments. Six personas emerged across the overlapping userbase: (1) fearless leaders, (2) loopers living it up, (3) parents on a mission, (4) the tech titans, (5) movement supporters, and (6) healthcare provider advocates. Personas had varying goals and behaviors within the community. Conclusions: #WeAreNotWaiting and #OpenAPS on Twitter reveal a fast-moving patient-led movement focused on DIY patient innovation that is further mobilized by an expanding and diverse userbase. Further research is indicated to bring technology savvy persons with diabetes into conversation with healthcare providers and researchers alike.
Effect of diuretic infusion clinic in preventing hospitalization for patients with decompensating heart failure
Authors: Alghalayini Kamal Waheeb 
Published: July 2020

Introduction: It is proposed that access to administering intravenous furosemide outside the hospital can contribute to lowering hospital admissions for heart failure. This study aims to evaluate the effect of outpatient furosemide infusion protocol in preventing hospitalization for patients with decompensating heart failure. This constitutes designing a viable clinical pathway in hospitals using a multidisciplinary heart failure program. Methods: A prospective interventional study testing the effect of diuretic infusion clinic in preventing hospitalization for patients with decompensating heart failure was conducted on 150 decompensating heart failure patients requiring hospital admission. Only 105 patients met the criteria and subsequently enrolled in the study. Each patient was administered intravenous furosemide infusion one or more times according to the protocol and depending on their symptoms of decompensation. Patients were referred for admission at any point once there is no improvement of their medical condition, or referred to heart failure clinic when clinical picture improved as observed by the treating team. Results: In total, 14 of 105 patients who received intravenous furosemide infusion did not respond to diuretic infusion protocol and required hospital admission while 91 patients responded to same protocol and did not require admission, P value was statistically significant in three laboratory test measures of potassium (<0.001), urea (0.004), and creatinine (0.008). Heart failure with reduced ejection fraction was observed in 70 (76.9%) responders with a mean ejection fraction of 23% and in 9 (64.3%) non-responders with mean ejection fraction of 19.9%. Conclusion: Outpatient intravenous furosemide infusion protocol is effective in preventing hospitalization for decompensating heart failure and a viable clinical pathway for heart failure programs.
Anesthesia management of atrial myxoma resection with multiple cerebral aneurysms: a case report and review of the literature
Authors: Zhang Ran , Tang Zhiyu , Qiao Qing , Mahmood Feroze , Feng Yi 
Published: July 2020

AbstractBackgroundEmbolic stroke is a common complication of atrial myxoma, whereas multiple cerebral aneurysms associated with atrial myxoma is rare. The pathogenesis of the cerebral vascular disease related to an atrial myxoma is still not well known, and there are no guidelines to guide treatment and anesthesia management in such patients.Case presentationIn this report, we present a 38-year-old woman with occasional dizziness and headache diagnosed as multiple cerebral fusiform aneurysms, in whom transthoracic echocardiography revealed a mass attached to the interatrial septum in the left atrium. Myxoma resection was performed in fast track cardiac surgery pathway without neurological complications, and no intervention was carried out on the cerebral aneurysms. She was discharged home 6 days after the procedure for followed-up. Furthermore, we reviewed and analyzed the literature in the PubMed and Google Scholar databases in order to conclude the optimal treatment in such cases.ConclusionsAtrial myxoma-related cerebral aneurysms are always multiple and in a fusiform shape in most occasions. Early resection of myxoma and conservative therapy of aneurysm is an optimal treatment. TEE and PbtO2monitoring play an essential role in anesthesia management. Fast track cardiac anesthesia is safe and effective to early evaluate neurological function. Long term follow-up for “myxomatous aneurysms” is recommended. And outcome of most patients is excellent.
Alterations of kinematics in knees after single versus multiple radius femoral prostheses total knee arthroplasty: a retrospective study
Authors: Li Mengyuan , Fu Guangtao , Huang Wenhan , Lin Bofu , Zhang Ruiying , Zhang Yu , Ma Yuanchen , Zheng Qiujian 
Published: July 2020

AbstractBackgroundDesign modifications in prostheses may cause alterations in gait kinematics, thus influencing functional restoration of knees after total knee arthroplasty (TKA). The aim of the study was to investigate the differences in gait kinematics and clinical outcomes after single radius (SR) versus multiple radius (MR) TKA.MethodThe present retrospective study included 38 unilateral TKA involving 20 knees using MR design implant and 18 knees using SR design implant. Thirty-six healthy volunteers were also recruited. The mean follow-up time was 16 ± 3 months. At the end of follow-up, the 6 degrees of freedom (DOF) kinematics of knees and range of motion (ROM) were measured with a portable optical tracking system. Knee society score (KSS) and knee injury, and osteoarthritis outcome score (KOOS) were also collected.ResultsPatients in the SR group had significantly higher scores in activities of daily living (84.7 ± 15.9) and sports and recreation (67.5 ± 25.2) KOOS sub-score than MR group (69.9 ± 17.6,P = 0.012; 50.0 ± 20.8,P = 0.027, respectively). Significant differences were detected between MR knees and SR knees (1.82° ± 3.11° vs 4.93° ± 3.58°,P = 0.009), and MR knees and healthy knees (1.82° ± 3.11° vs 3.62° ± 3.52°,P = 0.032) in adduction/abduction ROM. The proximal/distal translation was significantly smaller in MR knees (0.58 ± 0.54 cm) compared with SR knees (1.03 ± 0.53 cm,P = 0.003) or healthy knees (0.84 ± 0.45 cm,P = 0.039). SR knees (0.24 ± 0.40 cm) had smaller translation compared with the MR group (0.54 ± 0.33 cm,P = 0.017) and control group (0.67 ± 0.36 cm,P = 0.028). No significant difference was detected in the other DOFs during the gait cycle. Significant difference was detected in extension/flexion, internal/external rotation, adduction/abduction, proximal/distal and medial/lateral among MR, SR and healthy knees.ConclusionAfter TKA, patients have altered gait kinematics compared with the control group. MR and SR design showed varied characteristics in 6 DOF gait kinematics, which could be the cause of the difference in functional outcome.
Gallbladder cancer with EGFR mutation and its response to GemOx with erlotinib: a case report and review of literature
Authors: Soni Kishan , Kumar Tarun , Pandey Manoj 
Published: July 2020

Abstract
Background
Gallbladder cancer (GBC) is the most common and aggressive extra hepatic biliary tree cancer (BTC) with dismal outcome. Complete surgical resection is the treatment of choice. Chemotherapy is used for palliation in advanced GBC where surgery is not possible, and the most commonly used agent is gemcitabine in combination with cisplatin or oxaliplatin or with capecitabine regimens. Complete remissions are hardly encountered in these cases; therefore, it is important to combine standard therapies with molecular targeting.

Case presentation
A 60-year-old woman presented with pain in abdomen and loss of appetite for 1 month, and imaging showed locally advanced gallbladder carcinoma with liver metastasis. After biopsy confirmation, patient was initially started on gemcitabine and oxaliplatin combination followed by gene sequencing, which showed Tp53 (exon 7—c.713 G > A and exon 5—c.376-2A > G) and EGFR (exon 20—T790M) mutation, and erlotinib was added to chemotherapy, after 6 cycles of chemotherapy patient showed a 90% partial radiological response as per RECIST criteria.

Conclusion
This case reports the possible efficacy of erlotinib in combination with gemcitabine and oxaliplatin in treating an EGFR-mutated GBC with liver metastasis. To our knowledge, this is the first article reporting the response to erlotinib combination therapy with this particular solitary mutation.
Lipocalin 2 induces neuroinflammation and blood-brain barrier dysfunction through liver-brain axis in murine model of nonalcoholic steatohepatitis
Authors: Mondal Ayan , Bose Dipro , Saha Punnag , Sarkar Sutapa , Seth Ratanesh , Kimono Diana , Albadrani Muayad , Nagarkatti Mitzi , Nagarkatti Prakash , Chatterjee Saurabh 
Published: July 2020

AbstractBackgroundRecent clinical and basic research implicated a strong correlation between NAFLD/NASH phenotypes with ectopic manifestations including neuroinflammation and neurodegeneration, but the mediators and critical pathways involved are not well understood. Lipocalin 2 (Lcn2) is one of the important mediators exclusively produced in the liver and circulation during NASH pathology.MethodsUsing murine model of NASH, we studied the role of Lcn2 as a potent mediator of neuroinflammation and neurodegeneration in NASH pathology via the liver-brain axis.ResultsResults showed that high circulatory Lcn2 activated 24p3R (Lipocalin2 receptor) in the brain and induced the release of high mobility group box 1 (HMGB1) preferably from brain cells. Released HMGB1 acted as a preferential ligand to toll-like receptor 4 (TLR4) and induced oxidative stress by activation of NOX-2 signaling involving activated p65 protein of the NF-κB complex. Further, the HMGB1-derived downstream signaling cascade activated NLRP3 inflammasome and release of proinflammatory cytokines IL-6 and IL-1β from brain cells. In addition, to advance our present understanding, in vitro studies were performed in primary brain endothelial cells where results showed high circulatory Lcn2 influenced HMGB1 secretion. Mechanistically, we also showed that elevated Lcn2 level in underlying NASH might be a likely cause for induction of blood-brain barrier dysfunction since the adipokine decreased the expression of tight junction protein Claudin 5 and caused subsequent elevation of pro-inflammatory cytokines IL-6 and IL-1β.ConclusionIn conclusion, the NASH-induced brain pathology might be because of increased Lcn2-induced release of HMGB1 and accompanying neuroinflammation.
Accuracy and efficiency of an artificial intelligence tool when counting breast mitoses
Authors: Pantanowitz Liron , Hartman Douglas , Qi Yan , Cho Eun Yoon , Suh Beomseok , Paeng Kyunghyun , Dhir Rajiv , Michelow Pamela , Hazelhurst Scott , Song Sang Yong , Cho Soo Youn 
Published: July 2020

AbstractBackgroundThe mitotic count in breast carcinoma is an important prognostic marker. Unfortunately substantial inter- and intra-laboratory variation exists when pathologists manually count mitotic figures. Artificial intelligence (AI) coupled with whole slide imaging offers a potential solution to this problem. The aim of this study was to accordingly critique an AI tool developed to quantify mitotic figures in whole slide images of invasive breast ductal carcinoma.MethodsA representative H&E slide from 320 breast invasive ductal carcinoma cases was scanned at 40x magnification. Ten expert pathologists from two academic medical centers labeled mitotic figures in whole slide images to train and validate an AI algorithm to detect and count mitoses. Thereafter, 24 readers of varying expertise were asked to count mitotic figures with and without AI support in 140 high-power fields derived from a separate dataset. Their accuracy and efficiency of performing these tasks were calculated and statistical comparisons performed.ResultsFor each experience level the accuracy, precision and sensitivity of counting mitoses by users improved with AI support. There were 21 readers (87.5%) that identified more mitoses using AI support and 13 reviewers (54.2%) that decreased the quantity of falsely flagged mitoses with AI. More time was spent on this task for most participants when not provided with AI support. AI assistance resulted in an overall time savings of 27.8%.ConclusionsThis study demonstrates that pathology end-users were more accurate and efficient at quantifying mitotic figures in digital images of invasive breast carcinoma with the aid of AI. Higher inter-pathologist agreement with AI assistance suggests that such algorithms can also help standardize practice. Not surprisingly, there is much enthusiasm in pathology regarding the prospect of using AI in routine practice to perform mundane tasks such as counting mitoses.
Teprotumumab: a disease modifying treatment for graves’ orbitopathy
Authors: Ting Michelle , Ezra Daniel G. 
Published: July 2020

Abstract
Background
On 21st January 2020, the FDA approved Tepezza (teprotumumab-trbw) for the treatment of active Graves’ orbitopathy (GO) in adults. This approval was based on positive results from two multinational randomised double-blind placebo-controlled clinical trials.

Discussion
This article discusses the outcomes of those trials and the potential role of teprotumumab in altering current treatment paradigms in Graves’ orbitopathy. Future challenges are explored, including the need to confirm its disease-modifying effect, to establish its optimal position in the treatment pathway, and to define the appropriate subset of patients who would benefit from its use.

Conclusions
The results from these two large clinical trials have shown teprotumumab to have remarkable effects on multiple clinical outcomes in GO, particularly in its ability to reverse proptosis. It may herald a new era in the treatment of thyroid eye disease and could offer an alternative to surgery and its associated complications. Additional studies will continue to shape the treatment of GO and define the role of teprotumumab within the treatment paradigm.
Early clinical management of severe burn patients using telemedicine: a pilot study protocol
Authors: Moreau Maxim , Paré Guy 
Published: July 2020

AbstractBackgroundEmergency physicians are responsible for assessing the severity of a patient’s burns, which determines whether the patient needs to be transferred to a burn center. Such a proper assessment represents a daunting task because severe burn injuries are rare. Inaccurate estimates often result in unjustified and costly transfers and unneeded fluid resuscitation and assisted ventilation procedures. Telemedicine offers a solution to these challenges. The present pilot study aims to investigate the feasibility, acceptability, and potential value of a large telemedicine initiative at the University of Montreal Health Center’s burn center and its network of referring hospitals.MethodsA three-stage study protocol is proposed to achieve this objective. First, a proof of concept phase will assess the technical feasibility of telemedicine at one referring hospital with a high volume of patient transfers. Second, the organizational and human feasibility of the project will be evaluated in four referring medical centers. All teleconsultation sessions will be analyzed using the WHO’s telemedicine implementation model. The third phase will consist of evaluating the potential impacts of telemedicine in a subset of 10 referring hospitals. The quality of communications between referring physicians and specialists will be assessed using semi-structured interviews. A pre-test/post-test with a comparison group design will be used to assess the effects of telemedicine on patient transfers, ventilation procedures, patient complications, mortality, length of ICU stay, and additional surgical procedures. The economic viability of telemedicine will be assessed using a cost-minimization approach.DiscussionThe telemedicine initiative is expected to yield positive and significant outcomes that are relevant to a wide range of medical centers that already use or are considering using a similar technology. The contribution of this pilot study lies in its ability to reveal technological, organizational, and human barriers and provide a preliminary assessment of the clinical and economic value of a large-scale telemedicine initiative in the context of burn medicine.
Apolipoprotein M and Risk of Type 2 Diabetes
Authors: Hajny Stefan , Christoffersen Mette , Dalila Nawar , Nielsen Lars B , Tybjærg-Hansen Anne , Christoffersen Christina 
Published: July 2020

Abstract

Context
Recent studies have discovered a role of apolipoprotein M (apoM) in energy metabolism, and observational analyses in humans suggest an association with type 2 diabetes. The causal relationship remains however elusive.

Objective
To investigate whether reduced plasma apoM concentrations are causally linked to increased risk of type 2 diabetes.

Design
Prospective study design analyzed by Mendelian randomization.

Setting and participants
Two cohorts reflecting the Danish general population: the Copenhagen City Heart Study (CCHS, n = 8589) and the Copenhagen General Population Study (CGPS; n = 93 857). Observational analyses included a subset of participants from the CCHS with available plasma apoM (n = 725). Genetic analyses included the complete cohorts (n = 102 446). During a median follow-up of 16 years (CCHS) and 8 years (CGPS), 563 and 2132 participants developed type 2 diabetes.

Main outcome measures
Plasma apoM concentration, genetic variants in APOM, and type 2 diabetes.

Results
First, we identified an inverse correlation between plasma apoM and risk of type 2 diabetes in a subset of participants from the CCHS (hazard ratio between highest vs lowest quartile (reference) = 0.32; 95% confidence interval = 0.1-1.01; P for trend = .02). Second, genotyping of specific single nucleotide polymorphisms in APOM further revealed a 10.8% (P = 6.2 × 10–5) reduced plasma apoM concentration in participants with variant rs1266078. Third, a meta-analysis including data from 599 451 individuals showed no association between rs1266078 and risk of type 2 diabetes.

Conclusions
The present study does not appear to support a causal association between plasma apoM and risk of type 2 diabetes.