bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rationalising requests for preoperative sleep studies and postoperative HDU beds: a quality improvement project in paediatric ENT patients undergoing elective surgery
Authors: Morris Simon , Jones Rhodri , Puttasiddaiah Paramesh Mankunda , Eales Michael , Whittet Heikki 
Published: November 2021

BackgroundSleep disordered breathing represents a spectrum of upper airway obstruction including snoring, increased respiratory effort and obstructive sleep apnoea. An increasing demand for paediatric preoperative sleep studies and postoperative high dependency unit (HDU) beds was having a significant impact on service delivery at this ear, nose and throat (ENT) unit.MethodsRetrospective and prospective review of all paediatric sleep study requests over a 30-month period in a single tertiary ENT department. Data were collected on indication for and result of sleep study, patient outcome, operative details and HDU bed occupancy. During the study period, a ‘Sleep Study’ proforma was introduced which incorporated the ‘I’m Sleepy Score’ (ISS) and ENT-UK national guidelines.ResultsRetrospective review included 198 sleep studies, of which 62% (n=118) showed no evidence of obstructive sleep apnoea (OSA). There was little consistency in patients’ sleep study results and need for monitoring on HDU following adenotonsillectomy. Prospective review following intervention included 60 patients, of which 62% (n=37) showed evidence of OSA. The mean ISS in this cohort was 4.7. Only those with moderate-to-severe OSA or with relevant risk factors underwent overnight HDU observation. The number of sleep study requests fell by >50%; from 11 per month to 5 per month. The total HDU bed occupancy was reduced by 50% following intervention (from n=18 to n=9).ConclusionThe use of the ISS and incorporation of ENTUK’s recommendations has reduced the number of negative sleep studies being requested and has rationalised the number of paediatric HDU bed requests being made. This has helped provide a prudent elective paediatric ENT service in this unit with corresponding cost benefits.
TIGIT/CD155 axis mediates resistance to immunotherapy in patients with melanoma with the inflamed tumor microenvironment
Authors: Kawashima Shusuke , Inozume Takashi , Kawazu Masahito , Ueno Toshihide , Nagasaki Joji , Tanji Etsuko , Honobe Akiko , Ohnuma Takehiro , Kawamura Tatsuyoshi , Umeda Yoshiyasu , Nakamura Yasuhiro , Kawasaki Tomonori , Kiniwa Yukiko , Yamasaki Osamu , Fukushima Satoshi , Ikehara Yuzuru , Mano Hiroyuki , Suzuki Yutaka , Nishikawa Hiroyoshi , Matsue Hiroyuki , Togashi Yosuke 
Published: November 2021

BackgroundPatients with cancer benefit from treatment with immune checkpoint inhibitors (ICIs), and those with an inflamed tumor microenvironment (TME) and/or high tumor mutation burden (TMB), particularly, tend to respond to ICIs; however, some patients fail, whereas others acquire resistance after initial response despite the inflamed TME and/or high TMB. We assessed the detailed biological mechanisms of resistance to ICIs such as programmed death 1 and/or cytotoxic T-lymphocyte-associated protein 4 blockade therapies using clinical samples.MethodsWe established four pairs of autologous tumor cell lines and tumor-infiltrating lymphocytes (TILs) from patients with melanoma treated with ICIs. These tumor cell lines and TILs were subjected to comprehensive analyses and in vitro functional assays. We assessed tumor volume and TILs in vivo mouse models to validate identified mechanism. Furthermore, we analyzed additional clinical samples from another large melanoma cohort.ResultsTwo patients were super-responders, and the others acquired resistance: the first patient had a non-inflamed TME and acquired resistance due to the loss of the beta-2 microglobulin gene, and the other acquired resistance despite having inflamed TME and extremely high TMB which are reportedly predictive biomarkers. Tumor cell line and paired TIL analyses showed high CD155, TIGIT ligand, and TIGIT expression in the tumor cell line and tumor-infiltrating T cells, respectively. TIGIT blockade or CD155-deletion activated T cells in a functional assay using an autologous cell line and paired TILs from this patient. CD155 expression increased in surviving tumor cells after coculturing with TILs from a responder, which suppressed TIGIT+T-cell activation. Consistently, TIGIT blockade or CD155-deletion could aid in overcoming resistance to ICIs in vivo mouse models. In clinical samples, CD155 was related to resistance to ICIs in patients with melanoma with an inflamed TME, including both primary and acquired resistance.ConclusionsThe TIGIT/CD155 axis mediates resistance to ICIs in patients with melanoma with an inflamed TME, promoting the development of TIGIT blockade therapies in such patients with cancer.
Ram Horn-Shaped Inspired Folded Compact Antenna for 4G LTE-A and WLAN Portable Mobile Applications
Authors: Abolade Jeremiah O. , Konditi Dominic B. O. 
Published: November 2021

A compact dual-band ram horn-like folded antenna is presented in this work. The antenna is based on a ram horn-like folded strip, asymmetric microstrip feeding (AMF) technique, partial ground, and protruding stub at the ground plane. The dimension of the proposed antenna is 0.11

λ

g

× 0.17

λ

g

at 2.3 GHz (10 × 15 mm2). The proposed shape is achieved through the combination of two circular arcs with different radii. The antenna operates at 2.3 GHz and 5.8 GHz with a measured bandwidth of 100 MHz and 820 MHz, a gain of 0.62 dBi and 2.2 dBi, and radiation efficiency of 93.67% and 99.87%, respectively. The prototype of the proposed antenna is fabricated and measured. The measured result shows a good agreement with the simulated result. The parametric study of the proposed antenna is performed and results are presented. Besides, a comparative study between the antennas proposed in this work and the state of the art is performed and presented. The proposed antenna is comparatively small in size than all the recently reported works in the literature while ensuring good radiation characteristics. Therefore, the antenna proposed in this work is a better candidate for future portable sub-6GHz fifth-generation (5G), Advance Long-term Evolution (LTE-A), Worldwide Interoperability for Microwave Access (WiMAX), and Wireless Local Area Network (WLAN) applications.
Macrophage-Targeted Therapy Unlocks Antitumoral Cross-talk between IFNγ-Secreting Lymphocytes and IL12-Producing Dendritic Cells
Authors: Pfirschke Christina , Zilionis Rapolas , Engblom Camilla , Messemaker Marius , Zou Angela E. , Rickelt Steffen , Gort-Freitas Nicolas A. , Lin Yunkang , Bill Ruben , Siwicki Marie , Gungabeesoon Jeremy , Sprachman Melissa M. , Marquard Angela N. , Rodell Christopher B. , Cuccarese Michael F. , Quintana Jeremy , Ahmed Maaz S. , Kohler Rainer H. , Savova Virginia , Weissleder Ralph , Klein Allon M. , Pittet Mikael J. 
Published: November 2021

Abstract

Macrophages often abound within tumors, express colony-stimulating factor 1 receptor (CSF1R), and are linked to adverse patient survival. Drugs blocking CSF1R signaling have been used to suppress tumor-promoting macrophage responses; however, their mechanisms of action remain incompletely understood. Here, we assessed the lung tumor immune microenvironment in mice treated with BLZ945, a prototypical small-molecule CSF1R inhibitor, using single-cell RNA sequencing and mechanistic validation approaches. We showed that tumor control was not caused by CSF1R+ cell depletion; instead, CSF1R targeting reshaped the CSF1R+ cell landscape, which unlocked cross-talk between antitumoral CSF1R− cells. These cells included IFNγ-producing natural killer and T cells, and an IL12-producing dendritic cell subset, denoted as DC3, which were all necessary for CSF1R inhibitor–mediated lung tumor control. These data indicate that CSF1R targeting can activate a cardinal cross-talk between cells that are not macrophages and that are essential to mediate the effects of T cell–targeted immunotherapies and promote antitumor immunity.
See related Spotlight by Burrello and de Visser, p. 4 .
Effect of COVID‐19 on Acute Ischemic Stroke Hospitalizations and Treatments: Population‐Level Experience
Authors: Kim Youngran , Sharrief Anjail , Khose Swapnil , Abdelkhaleq Rania , Salazar‐Marioni Sergio , Krause Trudy Millard , McCullough Louise D. , Zhang Guo‐Qiang , Sheth Sunil A. 
Published: November 2021

Background
Several studies have reported changes in the volume and type of acute ischemic stroke (AIS) hospitalizations during the early stage of the COVID‐19 pandemic. However, population‐based assessments, which include lower volume centers and more comprehensive geographic areas, are limited. Here, we evaluate an entire state‐level experience during the first peak COVID pandemic and compare against a 1‐year prior historical period.

Methods
We conducted a retrospective population‐based study using the Texas Inpatient Public Use Data File, capturing all discharges from hospitals in the State of Texas, except federal hospitals. AIS admission volumes, patient characteristics, proportions of large vessel occlusion (LVO), admission rates to comprehensive stroke centers, use of intravenous tissue plasminogen activator and endovascular treatment, and patient outcomes were compared between April 1, 2019 and June 30, 2019 (historical control period) and April 1, 2020 and June 30, 2020 (pandemic period).

Results

A total of 9277 hospitalized AIS cases were identified during the pandemic period, a decrease of 12% (10 524) compared with the control period. Cases without LVO dropped by 15%, whereas LVO cases dropped by only 5%. There were no significant differences in age or race and ethnicity of patients. While admission rates to comprehensive stroke centers (39.6% versus 39.4%,
P
=0.81) and endovascular treatment use in LVO (17.0% versus 16.3%,
P
=0.45) were not different between the 2 periods, the use of intravenous tissue plasminogen activator (15.0% versus 13.6%, relative risk [RR], 0.90; 95% CI, 0.84–0.97;
P
=0.004) decreased. The percentage of patients who died or were discharged to hospice increased from 7.2% to 8.25% (RR, 1.17; 95% CI. 1.06–1.29;
P
=0.001).

Conclusions
This study from a statewide population‐level analysis confirms smaller hospital‐based cohorts observing decreasing numbers of milder AIS admissions, and lower use of thrombolysis. Although LVO admissions and endovascular treatment use were largely unchanged, these findings suggest missed treatment opportunities for patients with AIS in the pandemic.
Trauma exposure and factors associated with ICD-11 PTSD and complex PTSD in the Lithuanian general population
Authors: Kvedaraite Monika , Gelezelyte Odeta , Kairyte Agniete , Roberts Neil P , Kazlauskas Evaldas 
Published: November 2021

Background: After the inclusion of a novel diagnosis of Complex Posttraumatic Stress Disorder (CPTSD) in the 11th edition of the International Classification of Diseases (ICD-11), there is a growing need for research focused on not only studying the underlying risk factors of this disorder but also differentiating the risk factors of Posttraumatic Stress Disorder (PTSD) and CPTSD to understand better the factors leading to CPTSD onset and symptom maintenance. Aims: This study aimed to explore the prevalence of traumatic experiences, trauma-related disorders and risk factors associated with ICD-11 PTSD and CPTSD in a population-based Lithuanian sample using the International Trauma Questionnaire (ITQ). Methods: The study sample included 885 participants (age M[ SD] = 37.96 [14.67], 63.4% female). The Life Events Checklist was used to measure trauma exposure, PTSD and CPTSD symptoms were measured by the Lithuanian ITQ version. The Disclosure of Trauma Questionnaire (DTQ) was used to measure the urge or reluctance to talk about trauma. Results: The prevalence of at least one traumatic experience in the study sample was 81.4%. The prevalence of PTSD and CPTSD among the general population in Lithuania was 5.8% and 1.8%, respectively. Accumulative lifetime trauma exposure, sexual assault and assault with a weapon were significant predictors for both PTSD and CPTSD. Participants from the CPTSD group reported greater reluctance to disclose trauma and stronger emotional reactions than no diagnosis and PTSD groups. Results also indicate that the Lithuanian ITQ version is a valid measure for screening PTSD and CPTSD in the general population. Conclusion: Previous history of trauma and interpersonal trauma were associated with posttraumatic stress disorders but did not differentiate between PTSD and CPTSD in our study. However, social trauma-related factors, such as trauma disclosure, were associated with stronger CPTSD symptoms.
Wellbeing and mental health amongst medical students in Canada
Authors: Wilkes Thomas Christopher , Lewis Thomas , Paget Mike , Holm Johanna , Brager Nancy , Bulloch Andy , Macmaster Frank , Molodynski Andrew , Bhugra Dinesh 
Published: November 2021

Research: There is abundant data revealing that there is significant rate of rates of Psychiatric morbidity, psychological stress, and burnout in the medical student population. A core study group in the UK collaborated with 12 countries around the world to review medical student wellness. In this context we surveyed 101 medical students at the Cummings medical school, Calgary, Canada during the height of the COVID pandemic regarding their wellbeing and mental health. Results/main findings: Prior to medical school 27% reported a diagnosis with a mental disorder. Whilst at medical school 21% reported a mental health condition, most commonly an anxiety disorder and or depressive disorder. The most commonly reported source of stress was study at 81%, the second being relationships at 62%, money stress was a significant source of stress for 35%, and finally 10% reported accommodation or housing as stressful. Interestingly only 14% tested CAGE positive but 20% of students reported having taken a non-prescription substance to feel better or regulate their mood. Seventy-five percent of medical students met specific case criteria for exhaustion on the Oldenburg Burnout inventory 74% met criteria for the GHQ questionnaire. Conclusions: These findings confirm that medical students are facing significant stressors during their training. These stressors include, in order of frequency, study, relational, financial, and accommodation issues. Nonprescription Substance use was a common finding as well as exhaustion and psychiatric morbidity. Future interventions pursued will have to address cultural issues as well as the organizational and individual determinates of stress.
Repertoires of conflict-related sexual violence: Introducing the RSVAC data package
Authors: Dumaine Logan , Nordås Ragnhild , Gargiulo Maria , Wood Elisabeth Jean 
Published: November 2021

Scholars increasingly call for documentation and analysis of specific forms of conflict-related sexual violence. Moreover, accountability for crimes is stronger when specific patterns of victimization are documented. This article introduces the Repertoires of Sexual Violence in Armed Conflict (RSVAC) data package, which assembles reports from 1989 to 2015 of forms of sexual violence by government/states forces, insurgent/rebel organizations, and pro-government militias for each conflict and year. RSVAC compiles the reported prevalence of eight forms of sexual violence – rape, sexual slavery and forced marriage, forced prostitution, sexual mutilation, forced pregnancy, forced sterilization and abortion, non-penetrative sexual torture, and sexual abuse (as well as that of multiple-perpetrator reports of each form). It includes extensive qualitative notes on reported incidents, as well as ‘conflict manuscripts’ that include the relevant portions of source documents. Disaggregating ‘sexual violence’ into its distinct forms enables analysis of the reported presence of forms of sexual violence across time, conflicts, and organizations. We illustrate its usefulness by highlighting hitherto neglected global patterns it suggests, and also discuss limitations, potential biases and underreporting that users need to take into account. We outline several research questions that the data can help answer and suggest how the data package could inform policy efforts to address sexual violence and its consequences.
Correlation of heart rate recovery and heart rate variability with atrial fibrillation progression
Authors: Yoon Gwang-Seok , Choi Seong-Huan , Kwon Sung Woo , Park Sang-Don , Shin Sung-Hee , Woo Seong-Ill , Kwan Jun , Kim Dae-Hyeok , Baek Yong-Soo 
Published: November 2021

Objective To examine the combination of heart rate recovery (HRR) and heart rate variability (HRV) in predicting atrial fibrillation (AF) progression. Methods Data from patients with a first detected episode of AF who underwent treadmill exercise testing and 24-h Holter electrocardiography were retrospectively analysed. Autonomic dysfunction was verified using HRR values. Sympathetic and parasympathetic modulation was analysed by HRV. AF progression was defined as transition from the first detected paroxysmal episode to persistent/permanent AF. Results Of 306 patients, mean LF/HF ratio and HRR did not differ significantly by AF progression regardless of age (< or ≥65 years). However, when the LF/HF ratio was divided into tertiles, in patients aged <65 years, the mid LF/HF (1.60–2.40) ratio was significantly associated with lower AF progression rates and longer maintenance of normal sinus rhythm. For patients aged <65 years, less metabolic equivalents were related to higher AF progression rates. For patients aged ≥65 years, a low HRR was associated with high AF progression rates. Conclusion In relatively younger age, high physical capacity and balanced autonomic nervous system regulation are important predictors of AF progression. Evaluation of autonomic function assessed by age could predict AF progression.
Addressing Hispanic Obesity Disparities Using a Community Health Worker Model Grounded in Motivational Interviewing
Authors: Brown Louis D. , Vasquez Denise , Lopez Diane I. , Portillo Erin M. 
Published: November 2021

PurposeTo determine whether Hispanic residents receiving the Healthy Fit intervention enhanced with Motivational Interviewing (MI) experienced greater improvements in body composition, relative to participants receiving the initial intervention.DesignQuasi-experimental evaluation.SettingEl Paso, Texas.SampleAmong 656 baseline participants, 374 (54%) completed the 12-month assessment.InterventionIn Healthy Fit, community health workers (CHWs) promote nutrition and exercise. To strengthen intrinsic motivation and help participants overcome barriers to change, we incorporated a 30-minute motivational interview into the baseline assessment. Follow-up phone calls at 1, 3, and 6 months were identical across conditions.MeasuresCHWs assessed body mass index (BMI) and body fat percentage (BFP) using a bioelectrical impedance scale.AnalysisRegression models estimated differences between intervention conditions on change in BMI and BFP from baseline to the 12-month assessment.ResultsParticipants receiving MI had 2.13 times higher odds of losing weight (OR = 2.14, 95% CI [1.30, 3.53], P = .003) and 2.59 times higher odds of reduced BFP (OR = 2.59, 95% CI [1.51, 4.41], P < .001), relative to initial intervention participants. MI participants lost an average of 1.23 kg (2.71 lbs.) and their BFP declined 2% over 12 months.ConclusionFindings suggest CHW use of MI is a promising approach for promoting incremental changes in diet and exercise, which Healthy Fit integrates into a low-cost intervention.
Capecitabine-induced leukoencephalopathy in a patient with triple-negative breast cancer: A case report and review of the literature
Authors: Liu Li , Brown Erika N , Abu-Shahin Fadi I 
Published: November 2021

Introduction Capecitabine is an orally administered prodrug that converts preferentially to 5-fluorouracil within tumors, resulting in enhanced concentrations of 5-fluorouracil in tumor tissue. The use of capecitabine has shown efficacy in the metastatic setting for breast cancer, and more recently, efficacy as adjuvant therapy for triple-negative breast cancer (TNBC). Capecitabine has been shown to be well tolerated with minimal side effects, but the incidence of leukoencephalopathy is rare with a risk of less than one percent. Case report We report on a 34-year-old female patient with left TNBC, moderately differentiated, stage IIB that experienced symptoms of neurotoxicity following initiation of adjuvant chemotherapy with capecitabine. Management and outcome Naranjo Algorithm Assessment score of nine indicated patient had drug-induced leukoencephalopathy leading to discontinuation of capecitabine and resolution of the neurotoxicity symptoms. Discussion Early detection of capecitabine-induced neurotoxicity by magnetic resonance imaging is crucial as symptoms may be reversible to the condition that capecitabine is immediately discontinued.
Brachial artery aneurysm as a late complication of arteriovenous fistula
Authors: Janeckova Jana , Bachleda Petr , Koleckova Marketa , Utikal Petr 
Published: November 2021

Introduction: Brachial artery aneurysm (BAA) is a rare late complication of arteriovenous fistula (AVF). It brings the risk of peripheral embolism and hand ischemia and is defined by brachial artery diameter above 10 mm or by regional dilatation by >50%. BAA is described in the literature in closed radiocephalic arteriovenous fistulas after kidney transplantation. The aim of the study was to analyze the prevalence of BAA and of their more dangerous forms. Method: A observational one center study performed on patients after kidney transplantation with AVF or arteriovenous graft (AVG). We invited all patients followed up for kidney transplantation in our center. Arterial diameter greater than 10 mm was considered as a brachial artery aneurysm to simplify the detection and evaluation of aneurysms. Results: About 162 patients with AVF after kidney transplantation were examined between 4/2018 and 4/2020. Brachial artery aneurysm was detected in 34 patients (21%) with AVF or AVG, of them 7 had confirmed wall thrombi. AVF flow volume of more than 1500 ml/min increased the risk of BAA development by 4.54x. Eight aneurysms were treated surgically. After this surgery, the primary patency was 87.5% in 12 months. Conclusion: Brachial artery aneurysm was relatively frequent in our study compare to the literature. Aneurysm or dilatation of the brachial artery is more frequent in functional AVFs. Surgical correction is necessary in cases of complicated aneurysms to prevent distal embolization.