bluuebunny/crossref_metadata_2025_split huggingface dataset:
The iterative lipid impact on inflammation in atherosclerosis
Authors: Kraaijenhof Jordan M. , Hovingh G. Kees , Stroes Erik S.G. , Kroon Jeffrey 
Published: August 2021

Purpose of review
Lipid-mediated atherogenesis is hallmarked by a chronic inflammatory state. Low-density lipoprotein cholesterol (LDL-C), triglyceride rich lipoproteins (TRLs), and lipoprotein(a) [Lp(a)] are causally related to atherosclerosis. Within the paradigm of endothelial activation and subendothelial lipid deposition, these lipoproteins induce numerous pro-inflammatory pathways. In this review, we will outline the effects of lipoproteins on systemic inflammatory pathways in atherosclerosis.

Recent findings
Apolipoprotein B-containing lipoproteins exert a variety of pro-inflammatory effects, ranging from the local artery to systemic immune cell activation. LDL-C, TRLs, and Lp(a) induce endothelial dysfunction with concomitant activation of circulating monocytes through enhanced lipid accumulation. The process of trained immunity of the innate immune system, predominantly induced by LDL-C particles, hallmarks the propagation of the low-grade inflammatory response. In concert, bone marrow activation induces myeloid skewing, further contributing to immune cell mobilization and plaque progression.

Summary
Lipoproteins and inflammation are intertwined in atherogenesis. Elucidating the inflammatory pathways will provide new opportunities for therapeutic agents.
Rapid Progression After 177Lu-DOTATATE in Patients With Neuroendocrine Tumors
Authors: Assi Hussein A. , Hornbacker Kathleen , Shaheen Shagufta , Wittenberg Theresa , Silberman Robyn , Kunz Pamela L. 
Published: August 2021

Abstract
Peptide receptor radionuclide therapy (PRRT) is a treatment option for somatostatin receptor–positive, unresectable or metastatic neuroendocrine tumors (NETs). Despite high disease control rates seen with PRRT, a subset of the NET population seems to have a short progression-free interval. We hypothesize that patients with NETs with rapid progression post-PRRT may have mixed low- and high-grade cell populations, and PRRT treats the lower-grade component, allowing the more aggressive high-grade component to progress.
We report 7 patients with biopsy-proven NET who received PRRT with 177Lu-DOTATATE at the Stanford Cancer Center who had evidence of progressive disease (PD) on or within 6 months of therapy.
All patients had primary pancreatic, metastatic, well-differentiated NET on diagnosis and were heavily pretreated before receiving PRRT. Two patients had PD while on PRRT; 5 had PD within 6 months of completing PRRT. The median time from the last cycle to PD was 3.2 months (range, 1.1–4.6 months). The median progression-free survival was 7.7 months (95% confidence interval, 5.7–9.8 months). Three patients had a repeat biopsy post-PRRT, 2 of which demonstrated higher disease grade compared with their initial pathology. Further evaluation in larger patient cohorts is warranted to elucidate predictive factors of PRRT response/nonresponse to enable better patient selection.
The Social Determinants of Mental Health
Authors: Fink-Samnick Ellen 
Published: August 2021

Purpose:
The social determinants of mental health (SDoMH) continue to exert their fierce presence around the globe. The factors known to influence health outcomes equally impact mental health. A global mental health chasm has widened courtesy of COVID-19's intersection with every psychosocial aspect of functioning, inclusive of how people are born, live, learn, work, socialize, worship, and die. Racial, ethnic, and cultural inequities across the diversity, equity, and inclusion space have led to rising morbidity and mortality across every population. Part 2 of this article series is dedicated to assessment and intervention tools for the workforce. A key fifth or Quintile Aim of wholistic health equity is also presented to advance the industry's seminal quality compass, the Triple Aim, for the future.

Learning Outcomes:

After reading this article, learners will be able to:

Finding/Conclusion:
Access to quality wholistic health care encompasses pathophysiology, psychopathology, and psychosocial circumstances and remains a challenge across populations. Mental health, along with health disparities, has been fueled by systematic racism that has facilitated inadequate funding, poor reimbursement, decreased treatment options, and pervasive stigma across the cultural divide (e.g., race, ethnicity, gender, sexual orientation, familial status, disability, socioeconomic status). The SDoMH mandate a fresh lens by health and behavioral health professionals, and particularly case management, to ensure a more proactive and comprehensive approach to care. To achieve the successful outcomes mandated by this approach, the industry's quality compass, the Triple/Quadruple Aim, must be expanded to include a Quintile Aim of wholistic health equity.

Implications for Case Management Practice:
Case management's unique transdisciplinary composition has the workforce well positioned to effect grand change in population health perspectives. Wider attention to clinical and fiscal outcomes for health and mental health inequities mandates innovative approaches to patient care, which encompasses a wholistic health triad of pathophysiology, psychopathology, and psychosocial circumstances.
Mothers' Experiences with Antenatal Milk Expression
Authors: Juntereal Nina A. , Spatz Diane L. 
Published: August 2021

Abstract

Background:
Antenatal milk expression is a milk expression intervention beginning at either 36 or 37 weeks of gestation for the purpose of potential colostrum collection and storage prior to birth for postnatal infant feeding. Research on antenatal milk expression is limited and originates outside the United States.

Methods:
Women who used antenatal milk expression were interviewed about their experiences. A conventional, inductive approach to qualitative content analysis was used to analyze participants' responses.

Results:
Three women participated in interviews. They reported learning and performing antenatal milk expression for various postpartum needs including avoidance of formula, milk available for potential infant hypoglycemia, and to support human milk feeding during surrogate mother–infant separation. These mothers obtained education and information on antenatal milk expression primarily on their own.

Clinical Implications:
Greater awareness and understanding of antenatal milk expression is needed in the professional community caring for childbearing women. Perinatal nurses need to be aware of all breastfeeding practices including antenatal milk expression. Knowledge of the practice and advocacy for more research on antenatal milk expression will improve lactation support and ensure expectant mothers reach their personal breastfeeding goals.
Understanding the Experience of Osteoporosis Risk in Bariatric Surgical Patients
Authors: Mori Candace , Sheehan Denice , Graor Christine Heifner , Petrinec Amy 
Published: August 2021

Despite what is known about risk factors, preventive treatment, and increased prevalence of fragility fractures in post-bariatric surgical patients, little is known about how patient perspectives of osteoporosis risk inform their commitment to bone health. The purpose of this study was to examine the lived experience of osteoporosis risk in people who have had bariatric surgery. Interpretive phenomenology was used to explore osteoporosis from the perspectives of patients who have had bariatric surgery. Eligibility criteria included female, age older than 18 years, and able to understand and speak English.
This research provided an understanding of the risk of osteoporosis from the constructed realities and experiences of those who have had bariatric surgery. Participants in this study incorrectly felt they had little to no risk for osteoporosis after bariatric surgery.
Patients need to be aware of an increased risk for osteoporosis leading to the potential for fragility fractures after bariatric surgery; nurses are well positioned to enhance osteoporosis prevention efforts in this population through pre- and postoperative education.
Application of the Convergence Insufficiency Symptom Survey in Oculomotor Dysfunction and Accommodative Insufficiency
Authors: Pang Yi , Tan Qing-Qing , Gabriel Helen , Block Sandra S. , Wang Jingyun 
Published: August 2021

SIGNIFICANCE
This study confirmed the application of the Convergence Insufficiency Symptom Survey (CISS) in distinguishing children with oculomotor dysfunction (OMD) from those with normal binocular vision (NBV) but not in distinguishing children with accommodative insufficiency (AI).

PURPOSE
The purpose of this study was to determine the application of the CISS for quantifying symptoms in children aged 9 to 18 years with AI or OMD.

METHODS
All participants (aged 9 to 18 years) underwent comprehensive binocular vision tests including visual acuity, cover test, near point of convergence, fusional vergence, accommodative amplitude, and the Developmental Eye Movement test to ascertain the presence of any vision conditions. According to the examination outcomes, participants were divided into four groups: NBV group, AI group, OMD group, and a group with both AI and OMD (AI-OMD). The CISS was individually administered to each participant. An ANOVA and a receiver operating characteristic curve were performed to evaluate the ability of the CISS to quantify symptoms in AI and OMD.

RESULTS
A total of 82 participants were qualified for this study, with 18 in the NBV group, 21 in AI, 16 in OMD, and 27 in AI-OMD group. The mean CISS score was significantly different among the four groups (F = 4.19, P = .008). Post hoc tests showed significantly higher CISS scores in the OMD group than the NBV (P = .01) and the AI (P = .03) groups, but no differences were detected among other groups. Receiver operating characteristics curve showed a significant effect of the CISS score on predicting an OMD (area under curve = 0.78, P = .006). Using a CISS score of ≥15, good discrimination of OMD was obtained.

CONCLUSIONS
Children with OMD (Developmental Eye Movement type II or IV) had higher CISS scores than ones with NBV. Using the CISS, children with AI did not report worse symptoms than children with NBV.
Pharmacologic Management of Acute Agitation in Youth in the Emergency Department
Authors: Hoffmann Jennifer A. , Pergjika Alba , Konicek Claire E. , Reynolds Sally L. 
Published: August 2021

AbstractWhen youth in the emergency department become acutely agitated, it can be dangerous and distressing to patients, families, and clinicians. Timely, effective, and patient-centered management is key to reducing the potential for patient and staff injury while preserving patient dignity. We review the definition of agitation and pharmacologic management for youth with acute agitation, including common classes of medications, indications for use, and adverse effects. We also discuss the need to integrate the use of medications into a comprehensive strategy for agitation management that begins with proactive prevention of aggressive behavior, creation of a therapeutic treatment environment, and verbal de-escalation strategies.
Is There a Role for Cellular Therapy in Chronic Lymphocytic Leukemia?
Authors: Dreger Peter 
Published: August 2021

Abstract
Despite multiple advances in the treatment landscape of chronic lymphocytic leukemia (CLL) during recent years, cellular therapies, such as allogeneic hematopoietic cell transplantation and chimeric antigen-engineered T cells, represent valuable therapeutic options for patients with multiply relapsed or poor-risk disease. This brief overview will summarize current results of cellular therapies in CLL including Richter transformation, suggest an indication algorithm and strategies for performing cellular therapies in these conditions, and discuss the impact of COVID-19 (coronavirus disease 2019) on allogeneic hematopoietic cell transplantation and chimeric antigen-engineered T cells in CLL.
Management of Chronic Lymphocytic Leukemia in Less-Resourced Countries
Authors: Chiattone Carlos S. , Gabus Raul , Pavlovsky Miguel A. , Akinola Norah O. , Varghese Abraham M. , Arrais-Rodrigues Celso 
Published: August 2021

Abstract
Despite the practice-changing advances achieved in the prognostic stratification and treatment of chronic lymphocytic leukemia (CLL), a large fraction of the world population resides in countries where access to many of these advances remains unavailable or subject to severe constraints. Although some of these countries display incidence rates of CLL that are lower than those of developed Western countries, a large number of patients are expected to be diagnosed with CLL in these regions every year. In this article, we review issues regarding management of CLL in some less-resourced countries, with a focus on the evidence basis for epidemiological and clinical information on this disease, the availability of diagnostic and therapeutic resources, and participation in clinical trials. Going forward, challenges that still need to be addressed include the development of unified countrywide registries, guidelines for management applicable to each country, wider availability of prognostic tools, access to new drugs, and policies that ensure these drugs are affordable to all patients worldwide.
Autoimmune Cytopenia in CLL
Authors: Albiol Nil , Moreno Carol 
Published: August 2021

Abstract
Chronic lymphocytic leukemia (CLL) is frequently associated with autoimmune hemolytic anemia and immune thrombocytopenia and, less frequently, with pure red cell aplasia and immune neutropenia. The emergence of these complications is related to an intertwined and complex relationship between patient, disease, and treatment characteristics. The prognostic repercussion of autoimmune cytopenia (AIC) in patients with CLL mainly depends on its response to therapy. For patients with AIC and nonactive CLL, treatment is as in primary, uncomplicated AIC, keeping in mind that no response is an indication for CLL therapy. The success of treating active CLL-related AIC widely relies on a flexible strategy that should include initial therapy with corticosteroids and a rapid shift to effective CLL therapy in nonresponding patients. Targeted therapies (e.g., ibrutinib) that have already demonstrated to be effective in CLL-related AIC will likely offer a unique possibility of treating both AIC and CLL as a single target.
Can Breast Implants Induce Breast Cancer Immunosurveillance? An Analysis of Antibody Response to Breast Cancer Antigen following Implant Placement
Authors: Fracol Megan , Shah Nikita , Dolivo David , Hong Seok , Giragosian Lexa , Galiano Robert , Mustoe Thomas , Kim John Y. S. 
Published: August 2021

Background:
Women with cosmetic breast implants have significantly lower rates of subsequent breast cancer than the general population (relative risk, 0.63; 95 percent CI, 0.56 to 0.71). The authors hypothesize that breast implant-induced local inflammation stimulates immunosurveillance recognition of breast tumor antigen.

Methods:
Sera were collected from two cohorts of healthy women: women with long-term breast implants (i.e., breast implants for >6 months) and breast implant-naive women. Antibody responses to breast tumor antigens were tested by enzyme-linked immunosorbent assay and compared between cohorts by unpaired t test. Of the implant-naive cohort, nine women underwent breast augmentation, and antibody responses before and after implant placement were compared by paired t test.

Results:
Sera were collected from 104 women: 36 (34.6 percent) long-term breast implants and 68 (65.4 percent) implant-naive women. Women with long-term breast implants had higher antibody responses than implant-naive women to mammaglobin-A (optical density at 450 nm, 0.33 versus 0.22; p = 0.003) and mucin-1 (optical density at 450 nm, 0.42 versus 0.34; p = 0.02). There was no difference in antibody responses to breast cancer susceptibility gene 2, carcinoembryonic antigen, human epidermal growth factor receptor-2, or tetanus. Nine women with longitudinal samples preoperatively and 1 month postoperatively demonstrated significantly elevated antibody responses following implant placement to mammaglobin-A (mean difference, 0.13; p = 0.0002) and mucin-1 (mean difference 0.08; p = 0.02). There was no difference in postimplant responses to other breast tumor antigens, or tetanus.

Conclusions:
Women with long-term breast implants have higher antibody recognition of mammaglobin-A and mucin-1. This study provides the first evidence of implant-related immune responses to breast cancer antigens.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Maximizing the Flap Inflow in a Foot Reconstruction: Ultrasonographic Evaluation of Artery Flow in Accordance with the Angle of the Ankle
Authors: Suh Young Chul , Kim Hyung Bae , Brown Erin , Hong Joon Pio , Suh Hyunsuk Peter 
Published: August 2021

Summary:
Adequate arterial inflow is mandatory for a successful free tissue transfer. Maximizing this inflow appears to be especially important during distal lower extremity reconstruction, where perfusion pressures can be significantly lower than in the trunk or head and neck. In the current study, the authors used color and pulsed-wave Doppler ultrasonography to analyze blood flow volumes in the foot in accordance with the ankle position. Twenty feet of 10 healthy subjects were included in the analyses. All subjects were examined by Doppler ultrasonography at three different ankle angles (dorsiflexion at 90 degrees, relaxed position, and complete plantar flexion). The average flow volumes of the dorsalis pedis artery varied dramatically at the different ankle positions, as follows: dorsiflexion, 19.81 ± 3.88 ml/minute; relaxed position, 11.71 ± 4.72 ml/minute; and plantar flexion, 3.47 ± 1.41 ml/minute. The average flow volume of the posterior tibial artery also varied dramatically at these different ankle positions: dorsiflexion, 9.08 ± 8.25 ml/minute; relaxed position, 14.78 ± 2.45 ml/minute; and plantar flexion, 19.03 ± 5.03 ml/minute. The ankle position dramatically affects the flow velocity in the anterior and posterior tibial vessels, which is an important consideration when performing free tissue transfer reconstruction of the foot. Ankle dorsiflexion would be recommended when using the anterior tibial artery as a recipient vessel, whereas plantar flexion of the ankle would be advised when the posterior tibial artery is used as a recipient vessel.
Rates of Revision and Obstructive Sleep Apnea after Surgery for Velopharyngeal Insufficiency: A Longitudinal Comparative Analysis of More Than 1000 Operations
Authors: Rochlin Danielle H. , Sheckter Clifford C. , Khosla Rohit K. , Lorenz H. Peter 
Published: August 2021

Background:
The purpose of this study was to evaluate the comparative incidence of obstructive sleep apnea following velopharyngeal insufficiency surgery in the United States.

Methods:
A retrospective analysis of cleft and noncleft pediatric patients who underwent velopharyngeal insufficiency surgery was performed using the IBM MarketScan Commercial Database. Patients were tracked longitudinally from 2007 to 2016 to evaluate the incidence of obstructive sleep apnea. Multivariable regression was used to evaluate predictors of postoperative obstructive sleep apnea and surgical revision.

Results:
A total of 1098 patients underwent a pharyngeal flap (61.0 percent), sphincter pharyngoplasty (22.2 percent), or palatal lengthening with or without island flaps (16.8 percent). Diagnoses were predominantly cleft lip and/or palate (52.8 percent) and congenital oropharyngeal anomalies (42.6 percent). Eighty patients (7.3 percent) developed obstructive sleep apnea at an average of 10.2 months postoperatively. Predictors of obstructive sleep apnea included older age (p = 0.014) and head and neck neoplasm (p = 0.011). The obstructive sleep apnea rate following sphincter pharyngoplasty was 11.1 percent, compared to 7.2 percent after pharyngeal flap surgery. Compared to sphincter pharyngoplasty, pharyngeal flap surgery was associated with a lower risk of further surgery (OR, 0.43; p = 0.010). Of patients with cleft lip and/or palate, 35 developed obstructive sleep apnea (6.0 percent) without a significant association with procedure type.

Conclusions:
In this national claims database analysis of cleft and noncleft pediatric patients, the rate of obstructive sleep apnea following velopharyngeal insufficiency surgery was not significantly different for pharyngeal flap compared to sphincter pharyngoplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
The Role of the Buccal Fat Pad in Facial Aesthetic Surgery
Authors: Rohrich Rod J. , Stuzin James M. , Savetsky Ira L. , Avashia Yash J. , Agrawal Nikhil A. , Prada Margarita 
Published: August 2021

Summary:
Social media have triggered a buccal fat pad excision frenzy. Not surprisingly, there is tremendous appeal of having a slimmer lower face and more defined jawline after undergoing a small intraoral procedure under local anesthesia. Although this procedure is great for social media and seemingly beneficial for jawline aesthetics, the evidence remains limited as to whether or not this is an effective long-term solution. How much the buccal fat pad persists or diminishes as we age is an area of debate. However, the possibility of causing premature aging and midface distortion in the long run is disconcerting.
MR Perfusion in the Evaluation of Mechanical Thrombectomy Candidacy
Authors: Muddasani Varsha , de Havenon Adam , McNally J. Scott , Baradaran Hediyeh , Alexander Matthew D. 
Published: August 2021

Abstract
Stroke is a leading cause of disability and mortality, and the incidence of ischemic stroke is projected to continue to rise in coming decades. These projections emphasize the need for improved imaging techniques for accurate diagnosis allowing effective treatments for ischemic stroke. Ischemic stroke is commonly evaluated with computed tomography (CT) or magnetic resonance imaging (MRI). Noncontrast CT is typically used within 4.5 hours of symptom onset to identify candidates for thrombolysis. Beyond this time window, thrombolytic therapy may lead to poor outcomes if patients are not optimally selected using appropriate imaging. MRI provides an accurate method for the earliest identification of core infarct, and MR perfusion can identify salvageable hypoperfused penumbra. The prognostic value for a better outcome in these patients lies in the ability to distinguish between core infarct and salvageable brain at risk—the ischemic penumbra—which is a function of the degree of ischemia and time. Many centers underutilize MRI for acute evaluation of ischemic stroke. This review will illustrate how perfusion-diffusion mismatch calculated from diffusion-weighted MRI and MR perfusion is a reliable approach for patient selection for stroke therapy and can be performed in timeframes that are comparable to CT-based algorithms while providing potentially superior diagnostic information.
Endovascular Thrombectomy Treatment
Authors: Lavie Jayson , Vellimana Ananth K. , Chatterjee Arindam Rano 
Published: August 2021

Abstract
Tremendous advancements in the treatment of acute ischemic stroke in the last 25 years have been based on the principle of reperfusion in early time windows and identification of small core infarct for intravenous thrombolysis and mechanical thrombectomy. Advances in neuroimaging have made possible the safe treatment of patients with acute ischemic stroke in longer time windows and with more specific selection of patients with salvageable brain tissue. In this review, we discuss the history of endovascular stroke thrombectomy trials and highlight the neuroimaging-based trials that validated mechanical thrombectomy techniques in the extended time window with assessment of penumbral tissue. We conclude with a survey of currently open trials that seek to safely expand eligibility for this highly efficacious treatment.