bluuebunny/crossref_metadata_2025_split huggingface dataset:
Three Sessions of Radial Extracorporeal Shockwave Therapy Gives No Additional Benefit Over “Minimal-Dose” Radial Extracorporeal Shockwave Therapy for Patients With Chronic Greater Trochanteric Pain Syndrome: A Double-Blinded, Randomized, Controlled Trial
Authors: Wheeler Patrick C. , Dudson Chloe , Calver Rachel , Goodall Duncan , Gregory Kim M. , Singh Harjinder , Boyd Kevin T. 
Published: January 2021

Objective:
To investigate the outcomes following 3 weekly sessions of radial extracorporeal shockwave therapy (rESWT) in patients with chronic greater trochanteric pain syndrome (GTPS) presenting to an NHS Sports Medicine Clinic in the United Kingdom.

Design:
Double-blinded randomized controlled trial.

Setting:
A single NHS Sports Medicine Clinic, in the United Kingdom.

Patients:
One hundred twenty patients in an NHS Sports Medicine clinic presenting with symptoms of GTPS who had failed to improve with a minimum of 3 months of rehabilitation were enrolled in the study and randomized equally to the intervention and treatment groups. Mean age was 60.6 ± 11.5 years; 82% were female, and the mean duration of symptoms was 45.4 ± 33.4 months (range, 6 months to 30 years).

Interventions:
Participants were randomized to receive either 3 sessions of ESWT at either the “recommended”/“maximally comfortably tolerated” dose or at “minimal dose.” All patients received a structured home exercise program involving flexibility, strength, and balance exercises.

Main Outcome Measures:
Follow-up was at 6 weeks, 3 months, and 6 months. Outcome measures included local hip pain, validated hip PROMs (Oxford hip score, non-arthritic hip score, Victorian Institute of Sport assessment questionnaire), and wider measures of function including sleep (Pittsburgh sleep quality index) and mood (hospital anxiety and depression scale).

Results:
Results were available for 98% of patients at the 6-month period. There were statistically significant within-group improvements in pain, local function, and sleep seen in both groups. However, fewer benefits were seen in other outcome measures, including activity or mood.

Conclusion:
There were no time × group interaction effects seen between the groups at any time point, indicating that in the 3 sessions, the “recommended-dose” rESWT had no measurable benefit compared with “minimal dose” rESWT in this group of patients with GTPS. The underlying reason remains unclear; it may be that rESWT is ineffective in the treatment of patients with chronic GTPS, that “minimal dose” rESWT is sufficient for a therapeutic effect, or that a greater number of treatment sessions are required for maximal benefit. These issues need to be considered in further research.
Use of angiotensin II receptor blocker during pregnancy
Authors: Wei Qiang , Zhang Li , Duan Mei-fan , Wang Yue-mei , Huang Nan , Song Chun-rong 
Published: January 2021

Abstract

Background:
Drugs that affect the renin-angiotensin system, such as angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors are not typically recommended for pregnant women because of their potential fetal toxicity.

Case study:
A 32-year-old pregnant woman with nephrotic syndrome lasting more than 5 years became pregnant for the first time. She had been taking losartan tablets before and during pregnancy. Ultrasound at 24+2 weeks of pregnancy showed oligohydramnios, and the maximum vertical depth of amniotic fluid volume was 1.4 cm. Follow-up ultrasound examinations every 2 weeks showed persistent oligohydramnios [amniotic fluid volume: 1.1–3.4 cm, amniotic fluid index 1.9–6.9 cm]. B-ultrasound at 30+2 weeks showed slightly enhanced fetal renal cortex echo. The patient was treated at 32+2 weeks of pregnancy at our hospital.

Diagnoses:
Nephrotic syndrome and oligohydramnios.

Interventions:
Losartan was discontinued and replaced by nifedipine controlled-release tablets to lower blood pressure. The amount of amniotic fluid gradually increased to normal levels within 8 days. The patient was discharged at 33+2 weeks of pregnancy for follow-up. At 34+4 weeks, blood pressure had increased to 177/113 mm Hg and the patient was re-hospitalized with nephrotic syndrome complicated by preeclampsia. Due to progression of severe preeclampsia, elective cesarean section was performed at 35+3 weeks. After delivery, losartan and nifedipine were prescribed to continue lowering blood pressure. The patient was discharged 4 days after surgery.

Outcomes:
Losartan use was terminated at 32+2 weeks of pregnancy. Amniotic fluid returned to normal after 8 days and the baby was delivered after 22 days. At last follow-up, the infant was 24 months old and healthy.

Conclusion:
Although ARBs are effective for treating hypertension, they should be replaced by other classes of anti-hypertensive drugs in pregnant women. Pregnant women who elect to continue using ARBs should be informed about risks, they should be carefully monitored during pregnancy, and their pregnancy should be allowed to proceed as long as clinically feasible in order to optimize maternal and infant outcomes.
Decision-Making in the Era of New Medical Technologies in Pediatric Hematology-Oncology: The Death of Palliative Care?
Authors: Fortin Sylvie , Le Gall Josiane , Richer Johanne , Payot Antoine , Duval Michel 
Published: January 2021

Background:
Recent advances in immunology, genomics, and cellular therapy have opened numerous therapeutic possibilities in pediatric hematology-oncology, generating new hope in poor prognosis situations. How decisions are made when it comes to treatments and aims needs to be explored in this new technologic context. In particular, their impact on the gold standard of early referral to palliative care must be assessed.

Materials and Methods:
Stemming from an ethnographic study combining semistructured interviews and observations carried out in a hematopoietic stem cell transplant unit in a Montréal Pediatric Hospital, we discuss the decision-making process when a patient faces poor prognosis.

Results and Discussion:
Although health care providers individually envisioned that palliative care may be the best course of action for patients receiving emergent therapy, they remained collectively in the curative mode. The intricate relationship between science, hope, caregiver, and care receiver sustains this perspective even when (near) death is the probable outcome. When proven treatment fails, emerging therapeutic possibilities offer new hope that can delay the referral to the palliative care team.
A Comparison Between the Effect of Combined Chain Exercises Plus Kinesio Taping With Combined Chain Exercises Alone in Knee Osteoarthritis
Authors: Danazumi Musa Sani , Ibrahim Shehu Usman , Yakasai Abdulsalam Mohammed , Dermody Gordana , Bello Bashir , Kaka Bashir 
Published: January 2021

Objective
This study aimed to examine the effect of Kinesio taping as an adjunct to combined chain exercises compared with combined chain exercises alone in the management of individuals with knee osteoarthritis.

Methods
A total of 60 (27 male, 33 female) individuals (age range = 50–71 yrs and mean age = 54.26 ± 8.83 yrs) diagnosed as having mild to moderate knee osteoarthritis (based on the Kellgren and Lawrence grade I―III classification) were randomly allocated into two groups with 30 participants each in the Kinesio taping + combined chain exercises and combined chain exercises groups. Participants in the Kinesio taping + combined chain exercises group received Kinesio taping plus combined chain exercises and those in the combined chain exercises group received only combined chain exercises. Each participant was assessed for pain, range of motion, functional mobility, and quality of life at baseline and after 8 wks of intervention. A mixed-design multivariate analysis of variance was used to analyze the treatment effect.

Results
No significant differences were observed in the baseline characteristics of participants in both groups. The result indicated that there was a significant time effect for all outcomes, with a significant interaction between time and intervention (P < 0.001). The Bonferroni post hoc analyses of time and intervention effects indicated that the Kinesio taping + combined chain exercises group improved significantly better than the combined chain exercises group in all outcomes, pain (mean = 2.01 [0.64] vs. 3.94 [1.12], F[df] = 5.466[1,58], P = 0.011), flexion range of motion (mean = 121.15 [2.07] vs. 104.28 [3.24], F[df] = 26.722[1,58], P < 0.001), functional mobility (mean = 19.47 [1.95] vs. 31.01 [2.39], F[df] = 29.436[1,58], P < 0.001), and quality of life (mean = 68.76 [3.19] vs. 45.62 [2.87], F[df] = 71.984[1,58], P < 0.001), after 8 wks of intervention.

Conclusions
The findings of this study concluded that Kinesio taping + combined chain exercises and combined chain exercises were both effective but Kinesio taping plus combined chain exercises was more effective in the management of individuals with knee osteoarthritis.

Trial Registration
Pan African Clinical Trial Registry: PACTR201810603949411.
Clinical outcome assessment in clinical trials of chronic pain treatments
Authors: Patel Kushang V. , Amtmann Dagmar , Jensen Mark P. , Smith Shannon M. , Veasley Christin , Turk Dennis C. 
Published: January 2021

Abstract
Clinical outcome assessments (COAs) measure outcomes that are meaningful to patients in clinical trials and are critical for determining whether a treatment is effective. The objectives of this study are to (1) describe the different types of COAs and provide an overview of key considerations for evaluating COAs, (2) review COAs and other outcome measures for chronic pain treatments that are recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) or other expert groups, and (3) review advances in understanding pain-related COAs that are relevant to clinical trials. The authors reviewed relevant articles, chapters, and guidance documents from the European Medicines Agency and U.S. Food and Drug Administration. Since the original core set of outcome measures were recommended by IMMPACT 14 years ago, several new advancements and publications relevant to the measurement or interpretation of COAs for chronic pain trials have emerged, presenting new research opportunities. Despite progress in the quality of measurement of several outcome domains for clinical trials of chronic pain, there remain some measurement challenges that require further methodological investigation.
Children Treated for Nonsyndromic Craniosynostosis Exhibit Average Adaptive Behavior Skills with Only Minor Shortcomings
Authors: Kljajić Marizela , Maltese Giovanni , Tarnow Peter , Sand Peter , Kölby Lars 
Published: January 2021

Background:
Adaptive behavior skills are important when assessing cognitive functions related to daily life; however, few studies have assessed these skills in patients treated for nonsyndromic craniosynostosis. In this study, the authors assessed the adaptive behavior skills of children treated for craniosynostosis and examined whether their outcomes are related to surgical technique.

Methods:
The Adaptive Behavior Assessment System, 2nd Edition, parent report was used for children (age, 7 to 16 years) treated for sagittal (n = 41), metopic (n = 24), and other rare synostoses (n = 8). Background data, including intelligence quotient, were controlled for confounders.

Results:
All evaluated children treated for craniosynostosis were estimated as lower in all aspects of adaptive behavior skills (full-scale, conceptual, social, and practical composites; effect size, 0.36 to 0.44) as compared with norms. The sagittal group showed shortcomings in social composite (effect size, 0.48) and subscales measuring self-care and self-direction, although no difference was observed between spring-assisted surgery and pi-plasty regarding outcomes of adaptive behavior skills. In addition, children treated for metopic synostosis showed results indicating shortcomings with adaptive behavior according to the full-scale, conceptual, and social composites (effect size, 0.53 to 0.61) relative to norms. Furthermore, attrition analysis revealed no significant differences between responders (rate, 80.2 percent) and nonresponders.

Conclusion:
These results found that children treated for craniosynostosis display average adaptive behavior skills, and that the two surgical techniques used to treat sagittal synostosis did not differ in their behavioral outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
High Superficial Musculoaponeurotic System Lamellar Facelift Under Local Anesthesia
Authors: Ors Safvet 
Published: January 2021

Purpose:
Patients, nowadays, prefer easy, low-risk, day-case procedures under local anesthesia for facial rejuvenation. Therefore, they favor facelift operations applied under local anesthesia.

Materials and Methods:
A total of 160 patients who underwent high superficial musculoaponeurotic system (SMAS) lamellar facelift under local anesthesia between 2010 and 2020 were included in this study. Patients operated under general anesthesia were excluded from this study. High SMAS lamellar facelift under local anesthesia was performed in all patients, consisting of 145 women and 15 men without any additional disease aged between 38 and 65 years. About 140 of these patients underwent primary facelift, whereas 20 of them had undergone SMAS plication more than 10 years ago. Lidocaine was used as a local anesthetic and the patients were not sedated. The duration of the operation was 80 minutes on average. The patients were left to rest for 1 hour after the operation and then sent home until their follow-up every other day for the first week.

Results:
This study shows that high SMAS facelift operations for the mid-face can easily be performed under local anesthesia under operating room conditions without sedation. However, an important point to keep in mind is that although the results of this surgery satisfy the patients, the outcomes do not entirely match the expectations from total face and neck lift performed under general anesthesia. High SMAS facelift with local anesthesia should be considered as an alternative for patients who do not want to undergo general anesthesia or who are at risk of undergoing general anesthesia. Especially during the COVID-19 pandemic, local anesthesia was considered much safer for the patients.

Level of evidence: Level V
SAVE 2.0: Identifying and strengthening resident leadership skills through simulation based team training
Authors: Onufer Emily Jean , Andrade Erin , Caldwell Katharine E. , Cullinan Darren , Vallar Kelly , Turnbull Isaiah R. , Schuerer Douglas , Wise Paul E. , Klingensmith Mary E. , Punch LJ 
Published: January 2021

BACKGROUND
The “Surgery for Abdomino-thoracic ViolencE (SAVE)” animate lab engages surgical residents in the management of penetrating injuries in a team setting. Senior residents, representing postgraduate year (PGY) 3–5, assume the role of team leader and facilitate the junior residents, PGY1–2, in operative management of simulated penetrating wounds. Residents completed five scenarios with increasing level of difficulty within set time limits. Senior residents were evaluated on their team’s ability to “SAVE” their patient within the time allotted, as well as their communication and leadership skills.

METHODS
General, vascular, urology, and plastic surgery residents (n = 79) were divided into 25 teams of three to four residents by “resident scores” (R scores, the sum of the team members’ PGY) to create balanced teams with comparable years of clinical experience. Residents completed assessments of their senior resident’s leadership ability and style.

RESULTS
Evaluation of a resident’s desired learning style changed across PGY with junior residents preferring more hands-on guidance compared with senior residents preferring only verbal correction. Resident leadership evaluations demonstrated that team leaders of varied resident years achieved the highest scores. Greater differences in the mismatch between autonomy provided to and desired by junior residents correlated to greater junior resident discomfort in expressing their opinion, confidence, and leadership ratings of senior residents. However, greater autonomy mismatch also correlated to more rapid time to task completion.

CONCLUSION
Different from our expectations, clinical experience alone did not define team leader success. Leadership is a powerful influence on the outcome of team performance and may be a skill, which can transcend overall clinical experience. A match between desired and provided resident autonomy and team cohesion may demonstrate a stronger effect on team success in stressful operative situations, such as trauma resuscitation. Enhancement of leadership skills early in residency training may represent an important focus for trauma surgery education.
Circulating Donor Heart Exosome Profiling Enables Noninvasive Detection of Antibody-mediated Rejection
Authors: Hu Robert W. , Korutla Laxminarayana , Reddy Sanjana , Harmon Joey , Zielinski Patrick D. , Bueker Alex , Molina Maria , Romano Connie , Margulies Ken , McLean Rhondalyn , Lal Priti , Vallabhajosyula Prashanth 
Published: January 2021

Background.
Endomyocardial biopsy remains the gold standard for distinguishing types of immunologic injury—acute versus antibody-mediated rejection (AMR). Exosomes are tissue-specific extracellular microvesicles released by many cell types, including transplanted heart. Circulating transplant heart exosomes express donor-specific human leukocyte antigen (HLA) I molecules. As AMR is mediated by antibodies to donor HLAs, we proposed that complement deposition that occurs with AMR at tissue level would also occur on circulating donor heart exosomes.

Methods.
Plasma exosomes in 4 patients were isolated by column chromatography and ultracentrifugation. Donor heart exosomes were purified using anti-donor HLA I antibody beads and complement C4d protein expression was assessed in this subset as marker for AMR.

Results.
Three patients had no rejection episodes. Circulating donor heart exosomes showed troponin protein and mRNA expression at all follow-up time points. One patient developed AMR on day 14 endomyocardial biopsy that was treated with rituximab, IVIG/plasmapheresis. Time-specific detection of C4d protein was seen in donor heart exosome subset in this patient, which resolved with treatment. C4d was not seen in other 3 patients’ donor exosomes.

Conclusions.
Anti-donor HLA I specificity enables characterization of circulating donor heart exosomes in the clinical setting. Further characterization may open the window to noninvasively diagnose rejection type, such as AMR.
Rejection-associated Mitochondrial Impairment After Heart Transplantation
Authors: Romero Erick , Chang Eleanor , Tabak Esteban , Pinheiro Diego , Tallaj Jose , Litovsky Silvio , Keating Brendan , Deng Mario , Cadeiras Martin 
Published: January 2021

Background.
Mitochondrial dysfunction is associated with poor allograft prognosis. Mitochondrial-related gene expression (GE) in endomyocardial biopsies (EMBs) could be useful as a nonimmune functional marker of rejection. We hypothesize that acute cardiac allograft rejection is associated with decreased mitochondrial-related GE in EMBs.

Methods.
We collected 64 routines or clinically indicated EMB from 47 patients after heart transplant. The EMBs were subjected to mRNA sequencing. We conducted weighted gene coexpression network analysis to construct module-derived eigengenes. The modules were assessed by gene ontology enrichment and hub gene analysis. Modules were correlated with the EMBs following the International Society of Heart and Lung Transplantation histology-based criteria and a classification based on GE alone; we also correlated with clinical parameters.

Results.
The modules enriched with mitochondria-related and immune-response genes showed the strongest correlation to the clinical traits. Compared with the no-rejection samples, rejection samples had a decreased activity of mitochondrial-related genes and an increased activity of immune-response genes. Biologic processes and hub genes in the mitochondria-related modules were primarily involved with energy generation, substrate metabolism, and regulation of oxidative stress. Compared with International Society of Heart and Lung Transplantation criteria, GE-based classification had stronger correlation to the weighted gene coexpression network analysis–derived functional modules. The brain natriuretic peptide level, ImmuKnow, and Allomap scores had negative relationships with the expression of mitochondria-related modules and positive relationships with immune-response modules.

Conclusions.
During acute cardiac allograft rejection, there was a decreased activity of mitochondrial-related genes, related to an increased activity of immune-response genes, and depressed allograft function manifested by brain natriuretic peptide elevation. This suggests a rejection-associated mitochondrial impairment.
Prevalence of Mild Cognitive Impairment in the Lothian Birth Cohort 1936
Authors: Welstead Miles , Luciano Michelle , Muniz-Terrera Graciela , Taylor Adele M. , Russ Tom C. 
Published: January 2021

Background:
The Lothian Birth Cohort 1936 (LBC1936) is a highly phenotyped longitudinal study of cognitive and brain ageing. Given its substantial clinical importance, we derived an indicator of mild cognitive impairment (MCI) and amnestic and nonamnestic subtypes at 3 time points.

Methods:
MCI status was derived at 3 waves of the LBC1936 at ages 76 (n=567), 79 (n=441), and 82 years (n=341). A general MCI category was derived as well as amnestic MCI (aMCI) and nonamnestic MCI (naMCI). A comparison was made between MCI derivations using normative data from the LBC1936 cohort versus the general UK population.

Results:
MCI rates showed a proportional increase at each wave between 76 and 82 years from 15% to 18%. Rates of MCI subtypes also showed a proportional increase over time: aMCI 4% to 6%; naMCI 12% to 16%. Higher rates of MCI were found when using the LBC1936 normative data to derive MCI classification rather than UK-wide norms.

Conclusions:
We found that MCI and aMCI rates in the LBC1936 were consistent with previous research. However, naMCI rates were higher than expected. Future LBC1936 research should assess the predictive factors associated with MCI prevalence to validate previous findings and identify novel risk factors.
Rule of thumb in human intelligence for assessing the COVID-19 outbreak in Japan
Authors: Kurita Junko , Sugawara Tamie , Ohkusa Yasushi 
Published: January 2021

AbstractBackgroundThe COVID-19 outbreak in Japan exhibited its third peak at the end of 2020. Mathematical modelling and developed AI cannot explain several peaks in a single year.ObjectThis study was conducted to evaluate a rule of thumb for prediction from past wave experiences.MethodWe rescaled the number of newly infected patients as 100% at the peak and checked similarities among waves. Then we extrapolated the courses of the third and later waves.ResultsResults show some similarity around the second and the third waves. Based on this similarity, we expected the bottom of the third wave will show 2131 newly positive patients including asymptomatic patients at around the end of February, 2021.Discussion and ConclusionWe can infer the course of the third wave from similarity with the second wave. Mathematical modelling has been unable to do it, even when AI was used for prediction. Performance of the rule of thumb used with human intelligence might be superior to that of AI under these circumstances.