bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantifying the Economic Impact of Depression for Spine Patients in the United States
Authors: Ren Bryan O. , Khambete Pranav , Rasendran Chandruganesh , O’Donnell Jeffrey A. , Ahn Nicholas U. 
Published: June 2021

Study Design:
This was a retrospective cross-sectional analysis.

Objective:
The objective of this study was to estimate the incremental health care costs of depression in patients with spine pathology and offer insight into the drivers behind the increased cost burden.

Summary of Background Data:
Low back pain is estimated to cost over $100 billion per year in the United States. Depression has been shown to negatively impact clinical outcomes in patients with low back pain and those undergoing spine surgery.

Materials and Methods:
Data was collected from the Medical Expenditure Panel Survey from 2007 to 2015. Spine patients were identified and stratified based on concurrent depression International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Health care utilization and expenditures were analyzed between patients with and without depression using a multivariate 2-part logistic regression with adjustments for sociodemographic characteristics and Charlson Comorbidity Index.

Results:
A total of 37,094 patients over 18 years old with a spine condition were included (mean expenditure: $7829±241.67). Of these patients, 7986 had depression (mean expenditure: $11,455.41±651.25) and 29,108 did not have depression (mean expenditure: $6837.89±244.51). The cost of care for spine patients with depression was 1.42 times higher (95% confidence interval, 1.34–1.52; P<0.001) than patients without depression. The incremental expenditure of spine patients with depression was $3388.22 (95% confidence interval, 2906.60–3918.96; P<0.001). Comorbid depression was associated with greater inpatient, outpatient, emergency room, home health, and prescription medication utilization and expenditures compared with the nondepressed cohort.

Conclusions:
Spine patients with depression had significantly increased incremental economic cost of nearly $3500 more annually than those without depression. When extrapolated nationally, this translates to an additional $27.5 billion annually in incremental expenditures that can be attributed directly to depression among spine patients, which equates to roughly 10% of the total estimated spending on depression nationally. Strategies focused on optimizing the treatment of depression have the potential for dramatically reducing health care costs in spine surgery patients.
Novel Use of Extracorporeal Blood Purification for Treatment of Severe, Refractory Neurotoxicity After Chimeric Antigen Receptor T-Cell Therapy—A Case Report
Authors: Singbartl Kai , Rosenthal Allison , Leis Jose , Patel Bhavesh , Sen Ayan 
Published: June 2021

BACKGROUND:
Chimeric antigen receptor T-cell therapies (CAR-T) are transforming the treatment of B-cell leukemias and lymphomas. Cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome represent common, potentially life-threatening toxicities from chimeric antigen receptor T-cell therapy treatment.

CASE SUMMARY:
We present a 53-year-old patient with primary refractory high-grade B-cell lymphoma who developed severe, refractory neurotoxicity following chimeric antigen receptor T-cell therapy but exhibited complete recovery after extracorporeal blood purification with CytoSorb (CytoSorbents, Monmouth Junction, NJ).
Six days after chimeric antigen receptor T-cell therapy infusion, the patient developed cytokine release syndrome grade 3, prompting administration of dexamethasone and tocilizumab, a monoclonal antibody against the interleukin-6 receptor. His C-reactive protein levels started to decrease with tocilizumab and dexamethasone treatments. However, his ferritin levels continued to rise, and his interleukin-6 levels were above the upper detection threshold. Thirty-six hours later, the patient showed improved cytokine release syndrome but developed severe immune effector cell-associated neurotoxicity syndrome with predominant encephalopathy (grade 3) despite treatment with dexamethasone/methylprednisolone, tocilizumab, and anakinra. We therefore sought a rescue strategy to remove inflammatory mediators. Following emergency use authorization, we initiated extracorporeal blood purification with CytoSorb (CytoSorbents).
Four-day extracorporeal blood purification resulted in complete resolution of immune effector cell-associated neurotoxicity syndrome and greater than 95% reduction in interleukin-6 levels without side effects. The patient was discharged home 10 days later with no signs of neurotoxicity or other secondary end-organ dysfunction.

CONCLUSIONS:
Our case represents the first reported, successful application of extracorporeal blood purification with CytoSorb (CytoSorbents) to treat severe, refractory neurotoxicity following chimeric antigen receptor T-cell therapy.
Systemic therapy for early breast cancer in older adults: current status and prospects
Authors: Battisti Nicolò Matteo Luca , Biganzoli Laura 
Published: June 2021

Purpose of review
In this review, we describe the evidence on the efficacy and the safety of systemic treatments for the management of early breast cancer (EBC) in older individuals

Recent findings
Chemotherapy has a temporary impact on quality of life (QoL) for older EBC patients and improves survival outcomes for those with oestrogen receptor (ER)-negative disease. Benefits were seen also in the context of comorbidities, although these may be influenced by selection bias. The Cancer and Aging Research Group-Breast Cancer tool can predict the risk of severe toxicities on chemotherapy in older patients. Gene expression profiling is less frequently used in older adults although it holds promise to better inform patient selection also in this age group.
Postneoadjuvant systemic therapy and novel agents remain poorly described in older patients with EBC. No disease-free survival benefits were seen in older patients receiving abemaciclib plus adjuvant endocrine therapy.

Summary
Chemotherapy is beneficial for selected older patients with high-risk, ER-negative EBC. Although its impact on QoL is temporary, preferences, higher risk of toxicity and competing risks need to be carefully considered. Open questions remain on novel therapeutic approaches and gene expression profile in older EBC patients and more real-world evidence is warranted.
Looking at cancer health disparities in gynecologic oncology in 2020
Authors: Clair Kiran , Bristow Robert E. 
Published: June 2021

Purpose of review
To summarize the most recent evidence on gynecologic cancer disparities and to describe studies investigating the social determinants of health and receipt of evidence-based care and potential interventions to address inequities in care.

Recent findings
Significant disparities in disease-specific survival by race/ethnicity, socioeconomic status, and payer status have persisted in women with gynecologic cancers. Compared with white women, black women have an increased likelihood of disease-specific mortality for endometrial cancer and are less likely to receive guideline-adherent care for ovarian cancer. The Covid-19 pandemic has brought significant attention to the structural barriers that contribute to persistent health disparities and how community-based partnerships with a focus on policy interventions are needed for equitable gynecologic cancer outcomes.

Summary
In this review, we discuss structural barriers contributing to racial inequities, the role of Medicaid payer status and receipt of quality cancer care, gender, and racial workforce diversity, and community-based partnerships to create evidence-based interventions to address disparities.
Cleft Lip and Palate Surgery during COVID-19 Pandemic
Authors: Rossell-Perry Percy , Gavino-Gutierrez Arquimedes 
Published: June 2021

Background:
The COVID-19 pandemic has caused a negative impact in every sector of life, especially in the health sector. Patients with different medical conditions are suffering delays in their surgical treatments. Cleft lip and palate is a common congenital disease that requires early interdisciplinary attention, and there is uncertainty about the safety of performing its surgical treatment during the COVID-19 pandemic. The objective of this study was to evaluate the safety of a surgical cleft protocol for cleft lip and palate used during the COVID-19 pandemic at a high volume cleft center in Lima, Peru.

Methods:
This is a comparative study between two groups of patients with nonsyndromic cleft lip and palate who were operated on before and during the COVID-19 pandemic. Data collection was done by evaluation of presurgical condition, and surgical and nonsurgical postoperative outcomes and complications.

Results:
Significant differences were observed regarding both the age of the patients at the time of the primary surgeries, and surgical times between the two groups. Nonstatistical significant differences were observed between the two groups regarding the presurgical conditions, postoperative outcomes, and complications. Rate of COVID-19 infection was 1.25%.

Conclusions:
The surgical protocol used for cleft lip and palate repair during the COVID-19 pandemic is a safe method based on the observed postoperative outcomes. However, the COVID-19 pandemic caused delays of the time of the primary cleft lip and palate repair, and its long-term impact should be well evaluated.
Deep proteogenomic investigations elucidate the NRF2 antioxidant mechanism as a major driving mechanism of lung adenocarcinoma in Asia
Authors: Liang Kung-Hao , Wang Mong-Lien 
Published: June 2021

Background:
Lung adenocarcinoma is a global leading cause of death. Despite modern therapeutic interventions, undesirable outcomes such as drug resistances and disease recurrence still occur. Therefore, continued investigations of disease driving mechanisms and counteracting strategies are urgently needed.

Methods:
We re-visited two deep-proteogenomic resources of lung adenocarcinoma published recently. These resources were derived from patient cohorts with decent sizes in Taiwan and China. The gene set enrichment analysis (GSEA) was performed. A heatmap was produced by the generalized association plot (GAP).

Results:
Among 189 common oncogenic pathways investigated, the nuclear factor erythroid 2-related factor 2 (NRF2) downstream antioxidant mechanism was uncovered for the first time the leading oncogenic mechanism of lung adenocarcinoma in Taiwan. The gene levels of NRF2 (also known as NFE2L2) is negatively correlated with those of KEAP1 (Pearson’s correlation = −0.275, p = 0.009) in patients’ tumor tissues. Furthermore, the protein levels of EIF2S2 and PGD are higher in patients with more advanced stages in the Taiwan cohort (p = 0.001 and 0.05, respectively), and are indicative of poorer progression-free survival (PFS) and overall survival (OS) in the China cohort (all Cox-regression p < 0.05). On the other hand, EPHX1 is higher in patients with earlier stages in Taiwan (p = 0.003), and are indicative of better PFS and OS in China (both Cox-regression p < 0.05). When the patients were stratified using the median protein abundances for Kaplan–Meier visualizations, patient strata with higher EIF2S2, PGD, and EPHX1 have significantly poorer PFS (log-rank p = 0.041); poorer OS (p = 0.006), and better PFS and OS (p = 0.001 and 0.030), respectively.

Conclusion:
The NRF2 downstream antioxidant mechanism is one major driving mechanism of lung adenocarcinoma in Asia, and represents important directions for future therapeutic interventions. Major downstream proteins such as EIF2S2, PGD, and EPHX1 are indicative of cancer stages and prognosis.
Quality of Life Evaluation Through a Single-Item “Daily Prosthesis Usage Time” in Individuals with Lower-Limb Amputation
Authors: Topuz Semra , Ülger Özlem , Yakut Yavuz , Yazıcıoğlu Gül 
Published: June 2021

ABSTRACT

Introduction
The purpose of this study was to identify the relation of daily prosthesis usage time (DPUT) of individuals with amputation with quality of life (QoL) questionnaires.

Methods
The research was carried out on 125 individuals with amputation. Prosthetic-related parameters were searched, as well as demographic data. A generic (Nottingham Health Profile [NHP]) questionnaire and a questionnaire specific to individuals with amputation (Trinity Amputation and Prosthesis Experience Scales [TAPES]) QoL measurements were used.

Results
Ninety-one males and 28 females with a mean age of 42.4 ± 14.7 years participated in the study. The average DPUT was 11.1 ± 4.4 hrs/d. Study results showed that there was significant correlation between both of the QoL questionnaires (NHP and TAPES) and DPUT. High correlation was determined between DPUT and NHP total score and NHP-Pain, and very high correlation was found between DPUT and NHP–Physical Activity subscale. A moderate negative correlation was found between DPUT and NHP–Energy Level, NHP–Emotional Reaction, NHP–Social Isolation, and NHP–Sleep. A moderate negative correlation was found between DPUT and TAPES–Activity Restriction. A high correlation was found between DPUT and residual limb pain, prosthetic satisfaction, time interval after amputation, and number of prosthetic fittings. A moderate correlation was found between DPUT and walking aids, whereas a poor relationship was shown between phantom pain and DPUT.

Conclusions
This study showed that “the average DPUT” may be used in terms of short assessment of QoL of individuals with amputation. The outcomes of this study pointed out that especially prosthetic-related parameters affected the QoL in individuals with amputation. In problems resulting from routine assessment and questionnaires having so many items, a single-item question, “the average DPUT,” may be used effectively in a shorter period and is helpful for organizing a rehabilitation program.

Clinical Relevance
A single-item question, “The average daily prosthesis usage time (DPUT),” be used effectively in a shorter assessment of quality of life of individuals with amputation and is helpful for organizing a rehabilitation program.
Thrombosis in myeloproliferative neoplasms: update in pathophysiology
Authors: Reeves Brandi N. , Moliterno Alison R. 
Published: June 2021

Purpose of review
This review summarizes high-impact research in myeloproliferative neoplasms (MPN) from the last 18 months, with a particular focus on basic science findings.

Recent findings
A pseudo-hypoxia state with stabilization of hypoxia-inducible factor (HIFα exists that is central to cell growth, cell renewal, inflammation, and thrombotic potential in MPN hematopoietic cells.

Summary
HIFα and inflammatory pathways are new therapeutic targets in MPN, with the potential to ameliorate thrombotic risk and perhaps eradicate mutant progenitor cells.
Brothers in arms: platelets and neutrophils in ischemic stroke
Authors: Denorme Frederik , Rustad John L. , Campbell Robert A. 
Published: June 2021

Purpose of review
In this review, we will describe how the combined ability of platelets and neutrophils to interact with each other drives ischemic stroke brain injury.

Recent findings
Neutrophils are one of the first cells to respond during ischemic stroke. Although animals stroke models have indicated targeting neutrophils improves outcomes, clinical trials have failed to yield successful strategies. Platelets play a critical role in recruiting neutrophils to sites of injury by acting as a bridge to the injured endothelium. After initial platelet adhesion, neutrophils can rapidly bind platelets through P-selectin and glycoprotein Ibα. In addition, recent data implicated platelet phosphatidylserine as a novel key regulator of platelet-neutrophil interactions in the setting of ischemic stroke. Inhibition of procoagulant platelets decreases circulating platelet-neutrophil aggregates and thereby reduces infarct size. Platelet binding alters neutrophil function, which contributes to the injury associated with ischemic stroke. This includes inducing the release of neutrophil extracellular traps, which are neurotoxic and pro-thrombotic, leading to impaired stroke outcomes.

Summary
Platelet-neutrophil interactions significantly contribute to the pathophysiology of ischemic stroke brain injury. Better understanding the mechanisms behind their formation and the downstream consequences of their interactions will lead to improved therapies for stroke patients.
Distraction osteogenesis in craniosynostosis
Authors: Sandhaus Henya , Johnson Matthew D. 
Published: June 2021

Purpose of review
Craniosynostosis, a condition of premature cranial suture fusion, can have significantly detrimental effects on development and growth due to sequelae of increased intracranial hypertension (ICP), exophthalmos, and upper airway obstruction. Evolving surgical treatments now include distraction osteogenesis (DO) due to its many benefits relative to standard cranial vault remodeling procedures. This article provides an overview and update of different surgical applications of DO for patients with craniosynostosis.

Recent findings
DO has been utilized successfully for single and multisuture craniosynostosis with or without midface hypoplasia to increase intracranial volume, decrease ICP and improve aesthetics. It has been applied in single suture synostosis, posterior vault DO, fronto-orbital advancement, monobloc DO and Le Fort III DO. DO has been applied through modification of traditional surgical procedures with success in maintaining goals of surgery while reducing risk.

Summary
DO is still a relatively new and evolving surgical technique for patients with syndromic and nonsyndromic craniosynostosis. With promising benefits, consideration for each procedure should be weighed until longer-term data is available.
Management of noncleft velopharyngeal insufficiency
Authors: Jefferson Niall David , Willging Jay Paul 
Published: June 2021

Purpose of review
Velopharyngeal insufficiency in the absence of an overt cleft-palate is a less common and often missed cause of a resonance disorder. The purpose of this manuscript is to provide the reader with an overview of the clinical assessment. Highlight the need for multidisciplinary involvement. Discuss the process of decision-making related to a repair and finally comment on the preoperative, intra-operative, and postoperative considerations.

Recent findings
With the advent of small calibre videonasendoscopes, evaluation of the size, location, and closure pattern of the velopharyngeal gap has improved the surgeons’ ability to provide a tailored repair. Evolutions in technique including posterior pharyngeal wall augmentation and buccal flap advancement in palatal lengthening have all increased the options available to the patient and treating team.

Summary
Multidisciplinary assessment by trained specialist from speech and language pathology and surgery remain the cornerstone in the evaluation and management of this patient cohort. Many have a chromosomal anomaly that should be tested for and managed accordingly. These patients are often diagnosed late and have developed additional compensatory speech disorders that often need to be addressed following repair of the palate. Targeted thoughtful assessment will allow for a greater likelihood of successful repair.
The Relationship of Comorbid Overweight-Obesity With Cold Executive Functions, Verbal Short-Term Memory, and Learning in Attention Deficit Hyperactivity Disorder
Authors: Guler Hasan Ali , Turkoglu Serhat 
Published: June 2021

Abstract
The aim of this study was to investigate the relationship between comorbid obesity/overweight and cold executive functions, verbal short-term memory, and learning in children with attention deficit and hyperactivity disorder (ADHD). Our study was conducted on 100 drug-naive participants, including 70 patients with ADHD and 30 healthy controls. In our study, patients diagnosed with ADHD were divided into two groups according to body mass index as above the 85th percentile and at or below the 85th percentile. Cold executive functions were evaluated by the Stroop Test (ST) and Cancellation Test (CT). Serial Digit Learning Test (SDLT) was administered to measure verbal short-term memory and learning capacity. To evaluate the severity of ADHD objectively, the parents completed the Conners' Parents Rating Scale–Revised Short Version (CPRS-RS). There was no statistically significant difference in ST, SDLT, CT scores, and CPRS-RS subscale scores between the two groups with ADHD. This study show that overweight/obesity comorbid with ADHD may not be associated with cold executive functions, verbal short-term memory, learning, or ADHD symptom severity.
Dry needling has lasting analgesic effect in shoulder pain: a double-blind, sham-controlled trial
Authors: Pai Marcus Yu Bin , Toma Juliana Takiguti , Kaziyama Helena Hideko Seguchi , Listik Clarice , Galhardoni Ricardo , Yeng Lin Tchia , Teixeira Manoel Jacobsen , Ciampi de Andrade Daniel 
Published: June 2021

Abstract

Introduction:
Myofascial pain syndrome (MPS) affects most patients with chronic shoulder pain. Dry needling (DN) is a common treatment for MPS, but its temporal pattern and sensory effects remain unknown.

Objectives:
We evaluated in a randomized, sham-controlled study the pattern of analgesic efficacy and local sensory changes of a single session of DN for MPS in patients with chronic shoulder pain.

Methods:
Patients with chronic shoulder pain were randomized into active (n = 20) or sham (n = 21) groups. A single DN was performed by a researcher blinded to group assignment and pain outcomes. Pain intensity was assessed by the numeric rating score, and sensory thresholds were evaluated with a quantitative sensory testing protocol, including the area of tactile sensory abnormalities 7 days before needling, right before, and 7 days after the intervention.

Results:
Dry needling led to significant larger pain intensity reduction (from 6.30 ± 2.05 to 2.40 ± 2.45 in the active group; P = 0.02, effect size = −1.3 (95% CI [−2.0 to −0.68]); (number necessary to treat = 2.1). Pain reduction scores were significantly different on the second day after needling and persisted so until the seventh day and were accompanied by improvement in other dimensions of pain and a decrease in the area of mechanical hyperalgesia in the active DN group alone (P < 0.05).

Conclusion:
Active trigger points DN provided analgesic effects compared with sham and decreased the area of local mechanical hyperalgesia. These findings have practical clinical implications and may provide mechanistic insights behind MPS.