bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation between Prognostic Factors and the Histopathological Response to Neoadjuvant Chemotherapy in Osteosarcoma: A Retrospective Study
Authors: Prabowo Yogi , Setiawan Iwan , Kamal Achmad Fauzi , Kodrat Evelina , Labib Zufar Muhammad Luqman 
Published: April 2021

Background.Multimodality treatment, incorporating neoadjuvant chemotherapy and adjuvant chemotherapy, is the standard management plan for osteosarcoma that increases the overall survival (OS) rate. However, data regarding prognostic factors affecting the histopathological response following neoadjuvant chemotherapy is limited. Patients and Methods. We retrospectively reviewed patients diagnosed with osteosarcoma in our center between 2008 and 2018. We classified patient characteristics according to gender, age, tumor size, site and stage at diagnosis, site of metastasis, type of surgery, necrosis rate based on the Huvos grading system, and the number of neoadjuvant chemotherapy cycles. We divided response to neoadjuvant chemotherapy into poor responder for patients with Huvos grades 1 and 2 and good responder for patients with Huvos grades 3 and 4. We also documented patients’ survival and follow-up information. Results. We reviewed 64 patients within 5–65 years of age, dominated by men (62.5%). The distal femur (53.1%) was the most common site of osteosarcoma. Fifteen (23.4%) patients had a good response while 49 (76.6%) patients were poor responders to neoadjuvant chemotherapy based on the Huvos grading system. Based on multivariate analysis, gender (

p

= 0.012), age (

p

= 0.029), symptom duration (

p

= 0.004), and tumor enlargement after neoadjuvant chemotherapy (

p

< 0.001) were significantly associated with histopathological response. A scoring system was proposed integrating these significant variables (age > 20 years = 1 point, female gender = 1 point, symptom duration > 12 weeks = 1 point, and increased tumor size after neoadjuvant chemotherapy = 2 points). This scoring system divides patients into two groups with a total score of more than two predicting a poor responder to neoadjuvant chemotherapy. Conclusions. Age, gender, symptoms duration, and tumor size after neoadjuvant chemotherapy are the prognostic features that affect the histopathological response to neoadjuvant chemotherapy in patients with osteosarcoma.
STINGing Viral Tumors: What We Know from Head and Neck Cancers
Authors: Saulters Emma , Woolley John F. , Varadarajan Shankar , Jones Terence M. , Dahal Lekh N. 
Published: April 2021

Abstract
It has now become increasingly clear that viruses, which may not be directly oncogenic, can affect the biology of tumors as well as immune behavior against tumors. This has led to a fundamental question: Should tumors associated with viral infection be considered distinct from those without? Typically, viruses activate the host innate immune responses by stimulating pathogen recognition receptors and DNA-sensing pathways, including the stimulator of interferon genes (STING) pathway. However, regulation of the STING pathway in a virus-associated tumor microenvironment is poorly understood. Human papillomavirus (HPV) infection within a subset of head and neck squamous cell carcinomas (HNSCC) promotes a unique etiology and clinical outcome. For reasons currently not well understood, patients with HPV+ tumors have a better outcome in terms of both overall survival and reduced risk of recurrence compared with HPV− HNSCC. This observation may reflect a greater intrinsic immunogenicity associated with HPV infection, pertaining to innate immune system pathways activated following recognition of viral nucleotides. Here we discuss how HNSCC provides a unique model to study the STING pathway in the context of viral-induced tumor type as well as recent advances in our understanding of this pathway in HSNCC.
Sex Differences in Carotid Plaque Composition in Patients With Embolic Stroke of Undetermined Source
Authors: Song Jae W. , Cao Quy , Siegler James E. , Thon Jesse M. , Woo John H. , Cucchiara Brett L. 
Published: April 2021

Background
We examined sex differences in nonstenotic carotid plaque composition in patients with embolic stroke of undetermined source (ESUS).

Methods and Results

Patients with anterior circulation ischemic stroke imaged with neck computed tomographic angiography who met criteria for ESUS or had atrial fibrillation were identified. Patients with atrial fibrillation were included as a negative control. Semiautomated plaque quantification software analyzed carotid artery bifurcations. Plaque subcomponent (calcium, intraplaque hemorrhage [IPH], and lipid rich necrotic core) volumes were compared by sex and in paired analyses of plaque ipsilateral versus contralateral to stroke. Multivariate linear regressions tested for associations. Ninety‐four patients with ESUS (55% women) and 95 patients with atrial fibrillation (47% women) were identified. Men with ESUS showed significantly higher volumes of calcified plaque (63.9 versus 19.6 mm
3
,
P
<0.001), IPH (9.4 versus 3.3 mm
3
,
P
=0.008) and a IPH/lipid rich necrotic core ratio (0.17 versus 0.07,
P
=0.03) in carotid plaque ipsilateral to stroke side than women. The atrial fibrillation cohort showed no significant sex differences in plaque volumes ipsilateral to stroke. Multivariate analyses of the ESUS cohort showed male sex was associated with IPH
ipsi
(β=0.49; 95% CI, 0.11–0.87) and calcium
ipsi
(β=0.78; 95% CI, 0.33–1.23). Paired plaque analyses in men with ESUS showed significantly higher calcified plaque (63.9 versus 34.1 mm
3
,
P
=0.03) and a trend of higher IPH
ipsi
(9.4 versus 7.5 mm
3
,
P
=0.73) and lipid rich necrotic core
ipsi
(59.0 versus 48.4 mm
3
,
P
=0.94) volumes.

Conclusions
Sex differences in carotid plaque composition in ESUS suggest the possibility of a differential contribution of nonstenosing carotid plaque as a stroke mechanism in men versus women.
Dual Antiplatelet Therapy Versus Aspirin in Patients With Stroke or Transient Ischemic Attack: Meta-Analysis of Randomized Controlled Trials
Authors: Bhatia Kirtipal , Jain Vardhmaan , Aggarwal Devika , Vaduganathan Muthiah , Arora Sameer , Hussain Zeeshan , Uberoi Guneesh , Tafur Alfonso , Zhang Cen , Ricciardi Mark , Qamar Arman 
Published: April 2021

Background and Purpose:
Antiplatelet therapy is key for preventing thrombotic events after transient ischemic attack or ischemic stroke. Although the role of aspirin is well established, there is emerging evidence for the role of short-term dual antiplatelet therapy (DAPT) in preventing recurrent stroke.

Methods:
We conducted a systematic review and study-level meta-analyses of randomized controlled trials comparing outcomes of early initiation of short-term DAPT (aspirin+P2Y12 inhibitor for up to 3 months) versus aspirin alone in patients with acute stroke or transient ischemic attack. Primary efficacy outcome was risk of recurrent stroke and primary safety outcome was incidence of major bleeding. Secondary outcomes studied were risk of any ischemic stroke, hemorrhagic stroke, major adverse cardiovascular events, and all-cause death. Pooled risk ratios (RRs) and CIs were calculated using a random-effects model.

Results:

Four trials with a total of 21 459 patients were included. As compared to aspirin alone, DAPT had a lower risk of recurrent stroke (RR, 0.76 [95% CI, 0.68–0.83];
P
<0.001; I
2
=
0%) but a higher risk of major bleeding events (RR, 2.22 [95% CI, 1.14–4.34],
P
=0.02, I
2
=
46.5%). Patients receiving DAPT had a lower risk of major adverse cardiovascular events (RR, 0.76 [95% CI, 0.69–0.84],
P
<0.001, I
2
=
0%) and recurrent ischemic events (RR, 0.74 [95% CI, 0.67–0.82],
P
<0.001, I
2
=
0%).

Conclusions:
As compared to aspirin alone, short-term DAPT within 24 hours of high-risk transient ischemic attack or mild-moderate ischemic stroke reduces the risk of recurrent stroke at the expense of higher risk of major bleeding.
A comprehensive database of the optical properties of irregular aerosol particles for radiative transfer simulations
Authors: Saito Masanori , Yang Ping , Ding Jiachen , Liu Xu 
Published: April 2021

AbstractA database (TAMUdust2020) of the optical properties of irregular aerosol particles is developed for applications to radiative transfer simulations involving aerosols, particularly dust and volcanic ash particles. The particle shape model assumes an ensemble of irregular hexahedral geometries to mimic complex aerosol particle shapes in nature. State-of-the-art light scattering computational capabilities are employed to compute the single-scattering properties of these particles for wide ranges of values of the size parameter, the index of refraction, and the degree of sphericity. The database therefore is useful for various radiative transfer applications over a broad spectral region from ultraviolet to infrared. Overall, agreement between simulations and laboratory/in-situ measurements is achieved for the scattering phase matrix and backscattering of various dust aerosol and volcanic ash particles. Radiative transfer simulations of active and passive spaceborne sensor signals for dust plumes with various aerosol optical depths and the effective particle sizes clearly demonstrate the applicability of the database for aerosol studies. In particular, the present database includes, for the first time, robust backscattering of nonspherical particles spanning the entire range of aerosol particle sizes, which shall be useful to appropriately interpret lidar signals related to the physical properties of aerosol plumes. Furthermore, thermal infrared simulations based on in-situ measured refractive indices of dust aerosol particles manifest the effects of the regional variations of aerosol optical properties. This database includes a user-friendly interface to obtain user-customized aerosol single-scattering properties with respect to spectrally dependent complex refractive index, size, and the degree of sphericity.
Suicide deaths among medical students, residents and physicians in India spanning a decade (2010–2019): An exploratory study using on line news portals and Google database
Authors: Chahal Savita , Nadda Anuradha , Govil Nikhil , Gupta Nishu , Nadda Diviyanshu , Goel Kapil , Behra Priyamadhaba 
Published: April 2021

Background: Despite having one of the world’s largest medical education consortium, India lacks a comprehensive and nationally representative data on suicide deaths among medical students and physicians unlike the one found in most of the developed nations of the world. Aim: We aimed to explore the different characteristics of suicide deaths among medical students, residents and physicians in India over a decade (2010–2019). Methods: Content analysis of all suicide death reports among medical students, residents and physicians available from online news portals and other publicly available sites was done. Search was done retrospectively using pertinent search words individually or in combination with language restricted to Hindi and English and timed from January 2010 to December 2019. Reports on completed suicide by allopathic medical students, residents and physicians from India were included. Socio-demographic and suicidological variables were analysed using R software. Results: A total of 358 suicide deaths among medical students (125), residents (105) and physicians (128) were reported between 2010 and 2019. Around 7 out of 10 suicides happened before the age of 30 and had mean age 29.9 (±12.2) years. Female residents and physicians were younger than their male counterparts at the time of suicide. Overall maximum suicide deaths were concentrated in South India except the state of Kerala. The specialty of anesthesiology (22.4%) followed by obstetrics-gynaecology (16.0%) had the highest suicide deaths. Violent suicide methods were more commonly used by all, with hanging being the most common mean of suicide. Academic stress among medical students (45.2%) and residents (23.1%), and marital discord among physicians (26.7%) were the most noticeable reasons for suicide. Mental health problems were the next most common reason in medical students (24%) and physicians (20%) while harassment (20.5%) was in residents. Twenty six percent had exhibited suicide warning signs and only 13% had ever sought psychiatric help before ending their lives. A total of nine reports of suicide pact were found with the average deaths per pact being 2.4 and predominantly driven by financial reasons. Conclusion: Academic stress among medical students and residents, and marital discord in physicians emerged as the key reasons for suicide. However, this preventable domain should be further explored through focused research. This is the first of its kind study from India which attempted to explore this vital yet neglected public health issue using the most feasible and practical method of online news content-based analysis.
Family Size, Household Wealth and Socio-economic Status Across the Body Mass Index Distribution During US Economic Development
Authors: Carson Scott Alan 
Published: April 2021

Households behave systematically in family planning and intra-household resource allocation. A neglected area in historical health studies is the relationship between body mass index (BMI), health and family size. Using robust statistics and a large nineteenth-century BMI data set, this study uses an overlapping generations model to explain resource allocation within the household and illustrates that there is a positive relationship across the BMI distribution with family size. There is also a positive relationship between BMIs and average wealth, and an inverse relationship between BMI and inequality. After controlling for family size and wealth characteristics, there was a positive relationship between BMI and worker’s agricultural rural status. JEL: N3, D1, I1
A Mixed-Methods Study of Two Modes of the Circle of Security
Authors: Sadowski Christina , Goff Rachel , Sawyer Neroli 
Published: April 2021

Purpose: This study compared the impact, challenges, and benefits of the Circle of Security-Parenting (COS-P) intervention across two delivery modes: group center-based (GCCOS-P) and individual home-based (IHCOS-P). Methods: This mixed-methods study compared the impact of the COS-P on parental reflective functioning and parental stress across two delivery modes: GCCOS-P ( n = 7) and IHCOS-P ( n = 7). It compared the challenges and benefits of each, from the qualitative perspectives of participants ( n = 2 IHCOS-P; n = 3 GCCOS-P) and facilitators ( n = 4). Results: Quantitative statistical analysis comparing pre- and postintervention measures suggest that each delivery mode was equally effective in reducing parental stress and generally noneffective with respect to parental reflective functioning. Challenges and benefits of each mode, inherent in the peer/shared learning environment of the GCOS-P and the individualized, flexible delivery of the IHCOS-P, were identified. Discussion: This study adds to knowledge about the widely utilized COS-P, highlighting challenges and benefits of two modes of delivery.
Effects of upper limb exercise programs on the arteriovenous fistula in patients on hemodialysis: A systematic review and meta-analysis
Authors: Andrade Francini Porcher , Benvenutti Heloíse , da Silva Kacylen Costa , Rovedder Paula Maria Eidt 
Published: April 2021

Background: The arteriovenous fistula (AVF) is a commonly used vascular access for chronic kidney disease (CKD) patients; exercise interventions may boost its maturation and help in its maintenance. A systematic review and meta-analysis of clinical trials on the effects of upper limb exercise programs on the AVF was conducted. Methods: The primary outcomes were draining vein diameter (DVD) and draining vein blood flow rate (DVBFR), and secondary outcomes were handgrip strength (HGS) and brachial artery flow rate (BAFR). Quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results: Four studies met the inclusion criteria. When compared to usual care groups, the experimental groups did not improve DVD (mean difference [MD] 0.23, confidence interval [CI] −0.20–0.65). There were significant differences in DVBFR (mL/min) according to the fixed-effect model (MD 141.13, CI 36.84–245.42). HGS (kg) was significantly different between groups (MD 2.95, CI 0.55–5.35), but BAFR (mL/min) was not (MD 91.65, CI −94.72–278.01). Conclusions: Although exercise programs did not improve DVD and BAFR, they increased muscle strength and DVBFR. Therefore, experimental exercise programs should be emphasized for AVF maturation and maintenance. Research Registry number: reviewregistry924.
Treatment with eltrombopag of severe immune thrombocytopenia and hemolytic anemia associated with COVID-19 pneumonia: a case report
Authors: Gruden Gabriella , Beggiato Eloise , Camerino Enrica , Capriotti Serena , Canepa Silvia , Scandella Michela , Avolio Maria , Pittalunga Fabrizia , Barutta Federica , Durazzo Marilena 
Published: April 2021

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). Whether SARS-CoV-2 can trigger an autoimmune reaction against platelets and red blood cells remains unclear. Herein, we report a case of COVID-19 pneumonia associated with severe immune thrombocytopenia and hemolytic anemia. An 83-year-old woman was admitted to the hospital because of both dyspnea and diffuse mucocutaneous bleeding. Exams revealed hemolytic anemia (HA), severe immune thrombocytopenia (ITP), and bilateral pneumonia. Molecular testing confirmed a diagnosis of COVID-19 pneumonia. Thrombocytopenia did not respond to first-line treatment with immunoglobulin, corticosteroids, and platelet transfusions. Addition to therapy of the thrombopoietin receptor agonist, eltrombopag, resulted in full recovery. COVID-19 can be associated with ITP and HA. There are neither guidelines nor clinical experience on the treatment of COVID-19-associated ITP and our case, showing complete response to eltrombopag, may help clinicians in their practice during the COVID-19 pandemic. Plain language summary The case of an 83-year-old woman with COVID-19 pneumonia associated with two severe blood diseases that cause platelet and red cell destruction Coronavirus disease 2019 (COVID-19) is caused by a virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We do not know exactly whether this virus can stimulate our immune system to react against platelets and red blood cells. Herein, we report a case of COVID-19 pneumonia associated with two severe blood diseases, immune thrombocytopenia, which causes platelet destruction, and hemolytic anemia, which causes red cell destruction. An 83-year-old woman was admitted to the hospital because of both difficulty in breathing and diffuse bleeding in mucosae and skin. Exams revealed hemolytic anemia, severe immune thrombocytopenia, and pneumonia in both lungs. Molecular testing confirmed a diagnosis of COVID-19 pneumonia. The first treatment with immunoglobulin, corticosteroids, and platelet transfusions was not enough to cure thrombocytopenia; the addition of eltrombopag which acts on the thrombopoietin receptor agonist resulted in full recovery. COVID-19 can be present together with immune thrombocytopenia and hemolytic anemia. As there are no guidelines on the treatment of immune thrombocytopenia in patients with COVID-19 and the clinical experience is limited, the complete response achieved with eltrombopag may help clinicians in their practice during the COVID-19 pandemic.
Ulnar Collateral Ligament Reconstruction With the Modified Jobe Technique in Baseball Pitchers
Authors: Yoshida Masahito , Takenaga Tetsuya , Takeuchi Satoshi , Takaba Keishi , Tsuchiya Atsushi , Fukuyoshi Masaki , Nakagawa Hiroki , Matsumoto Yuji , Saito Masayoshi , Futamura Hidenori , Futamura Ryo , Murakami Hideki , Sugimoto Katsumasa 
Published: April 2021

Background: Tearing and insufficiency of the ulnar collateral ligament (UCL) of the elbow result in valgus instability, which can lead to pain while throwing and decline in performance in overhead athletes. Purpose: To assess the clinical results of a modified UCL reconstruction technique using 1 bone hole in the ulna and 1 bone tunnel in the humerus in baseball players. Study Design: Case series; Level of evidence, 4. Methods: The inclusion criteria were medial elbow pain preventing effective playing, clinically medial elbow laxity, and magnetic resonance imaging results consistent with UCL injury. Patients who were engaged in other sports and in other positions in baseball except pitchers were excluded from this study. Our modified Tommy John procedure was performed via a muscle-splitting approach and an original single-bone-tunnel technique, using a suture anchor. After a minimum of 24 months, patients were evaluated using the Conway scale and the Timmerman-Andrews score. Results: Of 31 patients, 20 baseball pitchers (20 male: 5 high school, 5 collegiate, 8 nonprofessional, and 2 professional pitchers) were reviewed. The mean patient age at the time of operation was 21.9 years, and the mean postoperative follow-up period was 35.1 months (range, 24-66 months). The mean Timmerman-Andrews subjective score improved significantly from pre- to postoperatively (from 68.3 to 98.3; P < .05); the objective score also improved significantly (from 81.1 to 96.4; P = .01). No complications were detected at the latest follow-up. Overall, 19 patients were able to return to their preinjury level of sports or higher. Conclusion: UCL reconstruction with 1 bone hole in the ulna and 1 bone tunnel in the humerus demonstrated satisfactory results in baseball pitchers. Our modified technique was safe and achieved satisfactory clinical results, with a 95% rate of return to sports.
Medical Student Leadership Development through a Business School Partnership Model: A Case Study and Implementation Strategy
Authors: Daaleman Timothy P , Storrie Mindy , Beck Dallaghan Gary , Smithson Sarah , Gilliland Kurt O , Byerley Julie S 
Published: April 2021

Background: There is an ongoing call for leadership development in academic health care and medical students desire more training in this area. Although many schools offer combined MD/MBA programs or leadership training in targeted areas, these programs do not often align with medical school leadership competencies and are limited in reaching a large number of students. Methods: The Leadership Initiative (LI) was a program created by a partnership between a School of Medicine (SOM) and Business School with a learning model that emphasized the progression from principles to practice, and the competencies of self-awareness, communication, and collaboration/teamwork. Through offerings across a medical school curriculum, the LI introduced leadership principles and provided an opportunity to apply them in an interactive activity or simulation. We utilized the existing SOM evaluation platform to collect data on program outcomes that included satisfaction, fidelity to the learning model, and impact. Results: From 2017 to 2020, over 70% of first-year medical students participated in LI course offerings while a smaller percentage of fourth-year students engaged in the curriculum. Most students had no prior awareness of LI course material and were equivocal about their ability to apply lessons learned to their medical school experience. Students reported that the LI offerings provided opportunities to practice the skills and competencies of self-awareness, communication, and collaboration/teamwork. Discussion: Adding new activities to an already crowded medical curriculum was the greatest logistical challenge. The LI was successful in introducing leadership principles but faced obstacles in having participants apply and practice these principles. Most students reported that the LI offerings were aligned with the foundational competencies.