bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of circulating Progesterone Receptor Membrane Component-1 (PGRMC1) with breast tumor characteristics and comparison with known tumor markers
Authors: Ruan Xiangyan , Cai Guiju , Wei Yun , Gu Muqing , Zhang Ying , Zhao Yue , Mueck Alfred O. 
Published: December 2019

Abstract

Objectives:
Progesterone receptor membrane component-1 (PGRMC1) expressed in breast cancer tissue has been suggested to predict a worse prognosis. The aim of this study was to assess for the first time if blood concentrations of PGRMC1 are also associated with receptor status, tumor diameter, grading, and lymphatic status. The second aim was comparison with known tumor markers.

Methods:
A total of 372 women, including 278 patients with invasive breast cancer, 65 with benign breast disease, and 29 healthy women (control), were recruited. PGRMC1 blood concentrations were measured by a recently developed enzyme-linked immunosorbant assay, and were correlated to predictive tumor characteristics and compared with serum carcinoembryonic antigen (CEA), CA125, and CA153.

Results:
PGRMC1 levels in the cancer group were significantly higher than in the control and benign group and increased with higher cancer stages (P < 0.05). PGRMC1 concentrations in the estrogen receptor (ER)+/progesterone receptor (PR)+ group were higher than in the ER−/PR− group, related to larger tumor diameter and the presence of lymph node metastasis (P < 0.05). Multivariable linear regression analysis was used to control the confounding factors. Tumor diameter, lymphatic metastasis, and ER (but not PR) were positively associated with PGRMC1 (P < 0.05). The receiver-operating characteristic curve (ROC) analysis was used to assess area under the curve (AUC). AUC was 87.9% for stages III+IV and 80.8% for stages I+II (P < 0.01). ROC did not find significant effects on AUC for CA125, only significant for CEA and CA153 for stages III+IV.

Conclusion:
As PGRMC1 levels are positively associated with breast tumor characteristics known to predict a worse diagnosis, PGRMC1 may be valuable as a new tumor marker, and superior to CEA, C125, and CA153. Because of the positive association with ER-expression, PGRMC1 may interact with this receptor.
MANAGEMENT OF REFRACTORY LARGE MACULAR HOLE WITH AUTOLOGOUS NEUROSENSORY RETINAL FREE FLAP TRANSPLANTATION
Authors: Chang Yo-Chen , Liu Pei-Kang , Kao Tzu-En , Chen Kuo-Jen , Chen Yi-Hsien , Chiu Wei-Jun , Wu Kwou-Yeung , Wu Wen-Chuan 
Published: December 2019

Purpose:
To investigate the morphological and functional outcome of refractory large macular hole (MH) with autologous neurosensory retinal free flap transplantation.

Methods:
This case series enrolled 10 patients suffering from refractory large MH at Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. All eyes underwent pars plana vitrectomy, a neurosensory retinal free flap with a 1.5 to 2-MH diameter was harvested. We used an adhesive agent such as whole blood or Viscoat to assist the stabilization of the retinal free flap and then use tamponade silicone oil to tamponade the vitreous cavity. Silicone oil was removed 6 months postoperatively. Main outcome measures including closure of MH and change in best-corrected visual acuity change were recorded.

Results:
The mean age was 64.9 ± 11.5 years. Before presentation, all cases had received at least two vitreoretinal procedures including vitrectomy, internal limiting membrane peeling, and fluid–gas exchange. At last visit, closure of the MH was achieved in 9 of 10 (90%) cases. The mean preoperative best-corrected visual acuity and that after 12 months of surgery improved from 1.65 ± 0.43 logarithm of minimum angle of resolution to 0.88 ± 0.49 logarithm of minimum angle of resolution (P < 0.001).

Conclusion:
For eyes with refractory or large MH, autologous neurosensory retinal free flap under silicone oil tamponade may provide a new option to improve the anatomical and function outcome, especially in cases where insufficient internal limiting membrane is left.
Double-Session Micropulse Transscleral Laser (CYCLO G6) as a Primary Surgical Procedure for Glaucoma
Authors: Magacho Leopoldo , Lima Francisco E. , Ávila Marcos P. 
Published: December 2019

Précis:
Double-session micropulse transscleral laser was an effective and safe treatment strategy for eyes that have not undergone glaucoma surgery previously.

Purpose:
To evaluate the safety and effectiveness of double-session micropulse transscleral laser (MP3) as a primary treatment modality for glaucoma.

Materials and Methods:
Patients who underwent MP3 therapy with double sessions in each hemifield, with a follow-up period of at least 6 months, were retrospectively considered. Patients were categorized into 2 groups: GI (no previous glaucoma surgery) and GII (with previous glaucoma surgery). Success was defined by either achieving a final intraocular pressure (IOP) between 6 and 18 mm Hg and an IOP reduction of >20%, or a minimum 50% reduction in the number of glaucoma medications, at the last visit, without any serious complications.

Results:
Eighty-four eyes were included in the GI group and 101 in the GII group, with the latter demonstrating relatively higher preoperative IOP (31.1±5.4 vs. 26.2±6.9 mm Hg, P<0.001). Final IOP (14.9±5.2 vs. 13.6±4.1 mm Hg, P=0.06), average MP3 treatment time (358.0±50.7 vs. 362.7±67.8 s, P=0.5), and follow-up duration (10.8±5.1 vs. 12.3±5.4 mo, P=0.06) were similar between the groups. The percentage reduction with regard to glaucoma medication was higher in GI than in GII (49.1±28.8 vs. 38.8±30.1%, P=0.02). GI underwent fewer MP3 procedures than GII (1.2±0.5 vs. 1.5±0.8, P=0.002). No hypotony or phthisis bulbi was observed in GI (1 and 2 in GII, respectively). Procedural success was noted in 92.9% of the cases in GI and 87.1% in GII.

Conclusions:
Double-session MP3 therapy could be considered as a safe and effective procedure to treat glaucoma in eyes that have not undergone any previous glaucoma surgery. Primary eyes achieved a success-rate similar to those with refractory glaucoma with fewer MP3 procedures and fewer glaucoma medications.
Albumin supplementation may have limited effects on prolonged hypoalbuminemia in major burn patients: An outcome and prognostic factor analysis
Authors: Chen Yi-Fan , Ma Hsu , Perng Cherng-Kang , Liao Wen-Chieh , Shih Yu-Chung , Lin Chih-Hsun , Chen Mei-Chun , Hsiao Fu-Yin , Wang Tien-Hsiang 
Published: December 2019

Background:
Burns that affect ≥20% of the total body surface area (TBSA) trigger a major inflammatory response in addition to capillary leakage and loss of serum proteins including albumin. Persistent hypoalbuminemia is therefore common in major burn patients. The purpose of this study was to determine whether human albumin solutions can benefit major burn patients with persistent hypoalbuminemia.

Methods:
We conducted a retrospective review of major burn patients with ≥20% of TBSA involved at Taipei Veterans General Hospital between January 2007 and December 2018. Thirty-eight patients were enrolled. Patient demographics, burn characteristics, fluid balance, laboratory results, and outcomes were recorded through chart review.

Result:
No significant differences were found in the baseline characteristics of patients who received <25 mg/kg/%TBSA/day of human albumin solutions and those who received more than this amount. Renal replacement therapy, duration of mechanical ventilation, length of stay in the burn unit, and in-hospital mortality rate were not statistically different between the two groups. The serum C-reactive protein/albumin ratio was associated with in-hospital mortality (p = 0.036).

Conclusion:
The administration of large amounts of albumin supplements for the correction of prolonged hypoalbuminemia in major burn patients had no significant benefits on mortality.
Fiberoptic bronchoesophagoscopy-assisted evaluation and prognostic factor analysis in children with congenital esophageal atresia and tracheoesophageal fistula
Authors: Chou Chia-Sui , Soong Wen-Jue , Lee Yu-Sheng , Tsao Pei-Chen , Chen Wei-Yu , Chen Szu-Jung , Liu Chin-Su , Jeng Mei-Jy 
Published: December 2019

Background:
Esophageal atresia (EA) and tracheoesophageal fistula (TEF) are serious congenital anomalies with high morbidity and mortality. Diagnostic and therapeutic fiberoptic endoscopy has been used in children to evaluate and manage trachea-esophageal anomalies. This study aimed to evaluate the prognostic factors and the role of fiberoptic bronchoesophagoscopy (FB) in managing children with EA and TEF.

Methods:
From 2000 to 2017, hospitalized children with suspected EA and TEF were enrolled in the study. All associated medical records were retrospectively reviewed. Basic characteristics, diagnoses, age of surgical reconstruction, FB findings, associated anomalies, and survival durations were reviewed. Prognostic factors associated with the patients’ mortality were analyzed.

Results:
A total of 33 children were enrolled, and 91% of them were type C. The median age at the time of hospitalization was 26 days (range, birth to 9 years), including 20 (61%) low-birth-weight infants and 26 (79 %) referred patients. FB was performed in patients preoperatively (39%) and postoperatively (96.8%). Among them, 28 patients (85%) had associated anomalies, including 17 (52%) cardiac and 23 (70%) airway anomalies. The median age of 31 patients who underwent surgical reconstruction was 3 (range, 0–39) days. Esophageal anastomotic stricture (21/31, 67.7%) was the most common postsurgical complication. Twenty-three patients (74.2%) received postoperative FB-guided interventions, including balloon dilatation, laser therapy, and stent implantation. Among the 9 mortality cases, the median age at death was 270 (range, 4–3246) days. Significant factor associated with mortality was delayed (> 48 h old) or no surgical reconstruction (p = 0.030).

Conclusion:
Delayed (>48-hour old) or no surgical reconstruction was significantly related to mortality in children with congenital EA and TEF. Preoperative and postoperative FB evaluations helped to facilitate diagnoses and nonsurgical managements and resolve the patients’ tracheoesophageal problems.
Experiences of First Insulin-Treated Patients (1922–1923)
Authors: de Leiva-Hidalgo Alberto , de Leiva-Pérez Alejandra 
Published: December 2019

Background:
Historical description of first insulin trials just after its discovery.

Areas of Uncertainty:
The review includes first initiatives of insulin treatment. The probability of other trials, not reported to the Insulin Committee of the University of Toronto and conducted in the years 1922 and 1923, is quite low.

Data Sources:
(1) Archival Collections, University of Toronto: Insulin Discovery and Early Developments of Insulin (University of Toronto Libraries digital special collection, with a particular section entitled “From a Patient's Point of View” containing letters, patient charts, newspaper clippings, and photographs). (2) Thomas Fisher Rare Book Library: Academy of Medicine Collection, F. G. Banting Papers, C. H. Best Papers, J. B.Collip Papers, W. R. Feasby Papers, E. Hugues Papers, J. J. R. Macleod Papers. (3) National Library of Medicine: PubMed search for the topic of history of insulin, History of Medicine-on syllabus archive. (4) Selected Journals for History of Medicine: Bulletin of the History of Medicine, Journal of the History of Medicine and Allied Sciences, Medical History. (5) Selected books: The Discovery of Insulin (M. Bliss); Diabetes, Its Medical and Cultural History (D. von Engelhardt); H. C. Hagedorn and Danish Insulin (T.Deckert), Continuing Quest (W. A. Tomkins).

Therapeutic Advances:
This historical review shows the quick progress from impure pancreatic extract to the selective isoelectric precipitation of the hormone, which made possible the introduction of insulin in the clinic.

Conclusions:
The coordination between the Departments of Physiology (Connaught Laboratories) and Medicine (Toronto General Hospital) was essential for the discovery and implementation of insulin therapy. The Insulin Committee was decisive for the negotiation with the pharmaceutical industry, the purification, grand-scale production, patents' achievement, and provision of licenses to expert clinicians and prestigious health centers. At the end of the year 1923, insulin treatment was already extended to Europe (mainly Scandinavia, Great Britain, and Spain). Insulin discovery and treatment changed the clinical spectrum of diabetes.
Drivers of High-cost Medical Complexity in a Medicaid Population
Authors: Labby David , Wright Bill , Broffman Lauren , Holtorf Megan 
Published: December 2019

Background:Efforts to improve outcomes for the 10% of patients using two thirds of health care expenditures increasingly include addressing social determinants. Empiric evidence is needed to identify the highest impact nonmedical drivers of medical complexity and cost.Objectives:This study examines whether complex, highest cost patients have different patterns of critical life adversity than those with better health and lower utilization.Research Design:Using a validated algorithm we constructed a complexity/cost risk patient profile. We developed and fielded a life experience survey (Supplemental Digital Content 1, http://links.lww.com/MLR/B920) to a representative sample, then examined how the prevalence of specific adversities varied between complex, high-cost individuals, and others.Subjects:Surveys were sent to 9176 adult Medicaid members in Portland, Oregon.Measures:Our primary variable was high medical complexity health cost risk; an alternative specification combined health cost risk and actual utilization/cost. Our survey instrument measured exposure to early and later-life adversities.Results:Compared with healthy individuals in our population, medically complex individuals had significantly higher rates of adversity. The greatest risk of medical complexity and cost was associated with substance use [odds ratio (OR), 4.1], homelessness (OR, 3.0), childhood maltreatment (OR, 2.8), and incarceration (OR 2.4). Those with the highest prior year acute care utilization and cost had the highest rates of these same factors: substance use (62.5%), homelessness (61.7%), childhood maltreatment (55.5%), and incarceration (52.1%).Conclusion:Clinical and policy strategies that mitigate high-impact social drivers of poor outcomes are likely critical for improving both health and costs for complex, high-needs patients.
What’s Happening at Home
Authors: Harrison Krista L. , Leff Bruce , Altan Aylin , Dunning Stephan , Patterson Casey R. , Ritchie Christine S. 
Published: December 2019

Background:
Home clinical care (HCC) includes home-based medical care (HBMC—medical visits in the home) and skilled home health care (skilled nursing or therapy visits). Over 7 million older adults would benefit from HCC; however, we know surprisingly little about homebound older adults and HCC.

Objective:
To describe HCC received by older adults using claims data within the OptumLabs Data Warehouse.

Research Design:
Using administrative claims data for commercial and Medicare Advantage enrollees, we describe morbidity profiles, health service use, and care coordination (operationalized as care plan oversight [CPO]) for people receiving HCC and the subgroup receiving HBMC.

Participants:
Three million adults (3,027,247) age ≥65 with 12 months of continuous enrollment 2013–2014.

Measures:
CPT or HCPCS codes delineated HCC, HBMC, and CPO recipients and care site, frequency, and provider type. Other measures included demographic characteristics, clinical characteristics, and health care utilization.

Results:
Overall, 5% of the study population (n=161,801) received 2+ months of HCC visits; of these, 46% also received 2+ HBMC visits (n=73,638) while 54% received only skilled home health (n=88,163 HCC but no HBMC). HBMC-recipients had high comorbidity burden (Charlson score 4.3), dementia (35%), and ambulance trips (58%), but few nursing facility admissions (4.9%). Evidence of care coordination (CPO claims) occurred in 30% of the HCC population, 46% of HBMC, and 17% of the skilled home health care only.

Conclusions:
Approximately 1 of 20 older adults in this study received HCC; 30% or less have a claim for care coordination by their primary care provider.
Neutropenia and Life-threatening Agranulocytosis Among Children With β-Thalassemia Treated With Oral Iron Chelators in a Community With Background of Ethnic Neutropenia
Authors: Nazir Hanan F. , Alshizawi Maryam 
Published: December 2019

Introduction:
Neutropenia and agranulocytosis are rare side effects of deferiprone (DFP) in patients treated for iron overload. Unfortunately, no study directly addressed special risks in countries with a background of ethnic neutropenia, such as Oman.

Aim:
The aim of this study was to report the incidence of neutropenia in Omani children with β-thalassemia treated with different iron chelators.

Methods/Design:
This was a retrospective study that included 179 Omani pediatric patients. For patients who developed neutropenia, demographic data, iron-chelating agent, clinical presentation, management, and outcome were recorded. Detailed clinical, laboratory±radiologic information was added for patients with agranulocytosis.

Results:
Neutropenia was encountered in 43.6% of patients: severe neutropenia in 10 patients, moderate in 29, and mild in 69 patients. Severe and moderate neutropenia had similar incidence among DFP-exposed and DFP-naive patients (P=0.515 and 0.421, respectively), while mild neutropenia was common among DFP-naive patients (P=0.0001). A higher incidence of DFP-related agranulocytosis (4.1%) was noted compared with previous reports, but none had a fatal outcome.

Conclusions:
In a community with ethnic neutropenia, mild to moderate neutropenia is common. Higher incidence of severe neutropenia and agranulocytosis mandates careful monitoring and rational modification of iron-chelating agents to avoid life-threatening complications.
Antibacterial effects of local analgesics and anesthetics
Authors: Imani Farnad , Mubarak Shaden M.H. , Mostafavi Seyyed Khalil Shokouhi , Khoda-Bakhshi Marjan , Bojary Mohammad R. , Ghasemian Abdolmajid 
Published: December 2019

Objective:
The findings of a multitude of both animal and human studies could substantiate an additive role of both local and general anesthetic agents in inhibiting bacterial growth. The present study attempted to assess antimicrobial effects of local analgesics and general anesthetics including lidocaine, bupivacaine, pethidine, midazolam, and sufentanyl citrate.

Methods:
A bacterial suspension with opacity equal to the half Mac Farland containing of studied nine bacterial species [Escherichia coli ATCC25922, Staphylococcus aureus ATCC25923, Pseudomonas aeruginosa ATCC27853, Staphylococcus epidermidis ATCC12228, Streptococcus pneumoniae ATCC49619, group A Streptococcus (clinical), Bacillus cereus ATCC11778, Acinetobacter baumannii (clinical), and Enterococcus faecalis ATCC29212] was prepared. The bacterial growth was assessed via culturing each solution (containing bacterial suspension and anesthetic drug) on culture media. Antibacterial characteristics of anesthetics were evaluated at various time points of culturing the bacterial solution (exposure to anesthetics) and countering the bacterial colonies and compared with the controls.

Results:
We observed high efficacy of Sufentanil Citrate (50 μg/ml) on reducing colony count of Staph. aureus and also Strep. pneumoniae with high response rate within 24 h of exposure to antibiotic. Also, midazolam (1 mg/ml) could effectively reduce colony count of Staph. aureus and Strep. pneumoniae. Moreover, by exposing pethidine with the dose of 50 mg/ml, the count of P. aeruginosa and E. faecalis was successfully reduced in media. Bacterial viability in various time points after exposure to lidocaine 1% and also bupivacaine 0.5% showed inhibited growth of all bacterial species viable cells with high response rate.

Conclusion:
Sufentanil Citrate, midazolam, and pethidine exerted efficient inhibitory effect on Staph. aureus, Strep. pneumoniae, P. aeruginosa and E. faecalis. Lidocaine and bupivacaine had a strong inhibitory effect on growth of nine standard bacterial species in our survey.
USP General Chapter <800> and Its Impact on Nursing Practice
Authors: Kleppin Susan 
Published: December 2019

EDITOR'S NOTE
The Infusion Nurses Society (INS) and the Journal of Infusion Nursing (JIN) editors are pleased to debut Pharmacology Report, a recurring bimonthly column authored by Susan Kleppin, RPh, FASHP. Susan is an accomplished pharmacist in health-system pharmacy with significant experience in infusion therapy. Her column will discuss relevant pharmacology topics, including medications new to market, safe handling for hazardous drugs, and managing drug shortages. INS and JIN extend Susan a warm welcome.
Myasthenia Gravis Crisis and Atrial Fibrillation
Authors: Jacobs Daniel H. 
Published: December 2019

Introduction:
Myasthenia gravis (MG) crisis has no specific reported correlation with atrial fibrillation (AF). We present a series of patients observed from a single general neurologist’s outpatient and inpatient practice over a 9-year period who experienced the combination of MG crisis and AF.

Case Report:
Retrospective chart review of patients within 1 neurologist’s inpatient and outpatient practice was done. Charts were selected based on the occurrence of newly diagnosed AF during MG crisis over a 9-year period. Most patients were diagnosed in the hospital and then followed as outpatients. Charts were reviewed to determine factors that may have played a role in the co-occurrence of these 2 conditions. Eight patients were identified that had co-occurring MG crisis and AF. All patients had very active MG, and were in or had recently been in MG crisis at the time their AF was discovered. Patients tended to have late-onset MG to be male, to be acetylcholinesterase receptor antibody positive, and to have improvement or remission of their AF once the MG achieved better clinical control.

Conclusion:
New-onset AF can occur during MG crisis. The cardiac outcome improves with treatment of the underlying disease, after initial cardiac stabilization.
Clinical Usefulness of Cell-Free DNA as a Prognostic Marker in Acute Ischemic Stroke
Authors: Vajpeyee Atulabh , Wijatmiko Teddy , Vajpeyee Manisha , Taywade Onjal , Pandey Swapnil , Chauhan Puneet S. 
Published: December 2019

Objective:
Stroke has become the second most common cause of death. Several biomarkers have been detected in the peripheral blood from stroke patients, but none has found a place in clinical practice. Cell-free DNA (cf-DNA) liberated into the blood soon after the onset of stroke might be useful for assessing disease severity and prognosis.

Study Design and Methods:
A total of 54 patients presenting with ischemic stroke were recruited consecutively with the exclusion of patients having trauma, tumor, infections, and organ failure. The cf-DNA was extracted by circulating nucleic acid kit from Qiagen and measured by real-time quantitative polymerase chain reaction assay for β-globin gene. The primary outcome measure was poststroke modified Rankin scale Score at 3 months after the onset of symptoms.

Results:
Higher cf-DNA levels were associated with severity at the time of admission measured by National Institutes of Health Stroke Scale (P=0.003) and poor outcome as measured by modified Rankin scale 3-month scores (P=0.001). Therapeutic intervention in the form of a mechanical thrombectomy or IV thrombolysis was associated with improved outcome in patients with cf-DNA<10,000 kilogenome-equivalents/L (P≤0.01).

Conclusions:
cf-DNA level correlates well with the severity of stroke at admission and long-term prognosis. It can be used as an additional marker to predict the outcome of therapeutic intervention.