bluuebunny/crossref_metadata_2025_split huggingface dataset:
New Releasable Nonabsorbable Polypropylene 8.0 Suturing Technique for Sclerotomy Sealing in 23-Gauge Vitrectomy
Authors: Savastano Alfonso , Crincoli Emanuele , Caporossi Tomaso , Rizzo Clara , Savastano Maria Cristina , De Vico Umberto , Rizzo Stanislao 
Published: May 2021

Purpose:
We propose a new releasable 8.0 polypropylene suture for leaking sclerotomies at the end of vitrectomy. Characteristic of this suture is that it can be easily removed the day after surgery at the slit-lamp examination.

Methods:
Patients undergoing 23-gauge pars plana vitrectomy with the need for at least 2 sclerotomy sutures and having a preoperative Ocular Surface Disease Index score <12 were consecutively allocated to sealing with either polyglactin 910 absorbable suture (VY GROUP) or nonabsorbable 8.0 polypropylene releasable suture (PR GROUP). Evaluation of adverse events, Ocular Surface Disease Index score, and conjunctival hyperemia (through the Efron scale) was performed at 1, 7, and 30 days postoperatively.

Results:
Both methods effectively sealed sclerotomies. PR GROUP showed a significantly lower Ocular Surface Disease Index score and lower degree of conjunctival hyperemia at both 7 and 30 days follow-up. The Ocular Surface Disease Index score decreased significantly after 7 days in PR GROUP while in VY GROUP improved at 30 days postoperatively. PR GROUP showed a lower degree of conjunctival hyperemia both at 7 and 30 days follow-up.

Conclusion:
Polypropylene 8-0 releasable sutures proved to be effective in 23-gauge pars plana vitrectomy wound sealing while inducing less ocular surface inflammation and patient discomfort compared with the standard polyglactin 910 suture.
Updated safety precautions and guidance on eye banking procedures during the coronavirus disease 2019 pandemic
Authors: Armenti Stephen T. , Ballouz Dena , Mian Shahzad I. 
Published: May 2021

Purpose of review
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly infectious coronavirus causing the COVID-19 pandemic. Although airborne spread through infectious respiratory droplets is the primary source of transmission, recent literature has suggested the ocular surface may be able to harbor viral particles. Here, we aim to discuss how SARS-CoV-2 affects the ocular surface and updated guidance on how SARS-CoV-2 transmission should be considered in the setting of eye banking and corneal transplantation procedures.

Recent findings
SARS-CoV-2 RNA can be found on the ocular surface, which may suggest the eye as a site of viral replication. However, there is poor correlation between PCR positivity on the ocular surface and ocular symptoms. To date, although viral particles can be found on the ocular surface, use of standard antiseptic procedures during corneal tissue procurement appears to sufficiently reduce viral load. In addition, preprocedure testing may further decrease the chances of transplanting an infected cornea without significantly impacting the overall accessibility to corneal tissue by decreasing the donor pool.

Summary
Corneal transplantation remains a well tolerated and highly successful procedure with no evidence of viral transmission with transplantation. Although the ocular surface has the required receptors to allow for viral replication, there is no clear evidence that the eye is a site for primary viral infection.
Relationship between impaired repolarization parameters and poor cardiovascular clinical outcomes in patients with potentially serious coronary artery anomalies
Authors: Kalkan Mehmet Emin , Güner Ahmet , Kalçik Macit , Turna Önder , Cansever Aysel Türkvatan , Uzun Fatih , Akgün Taylan , Aslan Serkan , Güner Ezgi Gültekin , Çörekçioğlu Büşra , Akman Cemalettin , Ulutaş Ahmet Emir , Ertürk Mehmet 
Published: May 2021

Background
Congenital coronary artery anomalies (CCAAs) have the potential for life-threatening complications, including malignant ventricular arrhythmias and sudden cardiac death (SCD). In this study, we aimed to evaluate the relationship between impaired repolarization parameters and poor cardiovascular clinical outcomes in patients with potentially serious CCAAs.

Methods
This retrospective study included 85 potentially serious CCAA patients (mean age: 54.7 ± 13.6 years; male:44) who were diagnosed with conventional and coronary computed tomography angiography (CCTA). All patients underwent transthoracic echocardiography and 12-lead surface electrocardiography. Cardiac events were defined as sustained ventricular tachycardia or fibrillation, syncope, cardiac arrest and SCD.

Results
The presence of interarterial course (IAC) was confirmed by CCTA in 37 (43.5%) patients. During a median follow-up time of 24 (18–50) months, a total of 11 (12.9%) patients experienced cardiac events. The presence of IAC was significantly more frequent and Tp–e interval, Tp–e/QTc ratio and frontal QRS/T angle (fQRSTa) were significantly greater in patients with poor clinical outcomes. Moreover, the presence of IAC, high Tp-e/QTc ratio and high fQRSTa were found to be independent predictors of poor clinical outcomes and decreased long-term cardiac event-free survival in these patients. A net reclassification index was +1.0 for the Tp-e/QTc ratio and +1.3 for fQRSTa which were confirmable for additional predictability of these repolarization abnormalities

Conclusion
Impaired repolarization parameters, including wider fQRSTa, prolonged Tp–e interval, and increased Tp–e/QTc ratio, and IAC may be associated with poor cardiovascular clinical outcomes in potentially serious CCAA patients.
Epidemiology and causes of cardiogenic shock
Authors: Berg David D. , Bohula Erin A. , Morrow David A. 
Published: May 2021

Purpose of review
Cardiogenic shock is a complex clinical syndrome of end-organ hypoperfusion due to impaired cardiac performance. Although cardiogenic shock has traditionally been viewed as a monolithic disorder predominantly caused by severe left ventricular dysfunction complicating acute myocardial infarction (AMI), there is increasing recognition of the diverse causes of cardiogenic shock and wide spectrum of clinical severity. The purpose of this review is to describe the contemporary epidemiology of cardiogenic shock, including trends in clinical outcomes and recent efforts to refine risk assessment.

Recent findings
The incidence of cardiogenic shock among patients with AMI has remained remarkably stable at 3–10%; however, the proportion of cardiogenic shock cases related to AMI has decreased over time to ∼30%, while the proportion of cardiogenic shock cases due to acute decompensated heart failure has steadily increased. Estimated in-hospital mortality from cardiogenic shock in contemporary registries is approximately 30–40%, suggesting modest improvement in cardiogenic shock outcomes over the last decade. There is a wide spectrum of clinical severity among patients presenting with cardiogenic shock, which is described by the Society for Cardiovascular Angiography and Interventions clinical staging criteria.

Summary
Improved clinical characterization and risk assessment of patients with cardiogenic shock may facilitate more effective clinical investigations of this morbid clinical syndrome.
An Alternative Method of Public Reporting of Comparative Hospital Quality and Performance Data for Transparency Initiatives
Authors: O’Mahen Patrick , Mehta Paras , Knox Melissa K. , Yang Christine , Kuebeler Mark , Rajan Suja S. , Hysong Sylvia J. , Petersen Laura A. 
Published: May 2021

Background:
Hospital performance comparisons for transparency initiatives may be inadequate if peer comparison groups are poorly defined.

Objective:
The objective of this study was to evaluate a new approach identifying hospital peers for comparison.

Design/Setting:
We used Mahalanobis distance as a new method of developing peer-specific groupings for hospitals to incorporate both external and internal complexity. We compared the overlap in groups with an existing method used by the Veterans’ Health Administration’s Office for Productivity, Efficiency, and Staffing (OPES).

Participants:
One hundred twenty-two acute-care Veterans’ Health Administration’s Medical Facilities as defined in the OPES fiscal year 2014 report.

Measures:
Using 15 variables in 9 categories developed from expert input, including both hospital internal measures and community-based external measures, we used principal components analysis and calculated Mahalanobis distance between each hospital pair. This method accounts for correlation between variables and allows for variables having different variances. We identified the 50 closest hospitals, then eliminated any potential peer whose score on the first component was >1 SD from the reference hospital. We compared overlap with OPES measures.

Results:
Of 15 variables, 12 have SDs exceeding 25% of their means. The first 2 components of our analysis explain 24.8% and 18.5% of variation among hospitals. Eight of 9 variables scaling positively on the first component measure internal complexity, aligning with OPES groups. Four of 5 variables scaling positively on the second component but not the first are factors from the policy environment; this component reflects a dimension not considered in OPES groups.

Conclusion:
Individualized peers that incorporate external complexity generate more nuanced comparators to evaluate quality.
Pain Reported by Chinese Children During Cancer Treatment
Authors: Cheng Lei , Yuan Changrong , Wang Jiashu , Stinson Jennifer 
Published: May 2021

Background
Pain is a frequently reported and distressing symptoms during cancer treatment. However, there is limited evidence on pain reported by Chinese children with cancer.

Objectives
This study aimed to investigate the prevalence, intensity, interference, and management of pain reported by Chinese children during cancer treatment and explore the predictors of pain interference.

Methods
We conducted a cross-sectional survey to investigate the pain intensity, pain interference, co-occurring symptoms (anger, anxiety, depression, fatigue), and pain management strategies reported by children 8 years and older undergoing active cancer treatment in 4 Chinese hospitals.

Results
Data were analyzed for 187 children. The prevalence of moderate to severe pain (≥4/10) was 38.50%, with an average pain interference score of 52.97 out of 100. Approximately 24% of children were prescribed pain medicine. Pain interference and pain intensity were marginally correlated (r = 0.047, P < .01) and were both positively correlated with pain duration and co-occurring symptoms and negatively correlated with perceived pain alleviation (all P < .01). Multiple regression analyses suggested that severe pain intensity (B = 2.028, P = .003) and fatigue (B = 0.440, P < .001) significantly predicted higher levels of pain interference (R
2 = 0.547, F = 23.102, P < .001).

Conclusion
Chinese children with cancer reported a low pain intensity score but a relatively high level of pain interference. According to the children’s reports, pain has not been sufficiently addressed through Chinese pediatric oncology supportive care.

Implications for Practice
There is an urgent requirement for comprehensive pain assessment and standardized, targeted interventions in Chinese pediatric oncology pain management.
Characteristics of Environmental influences on Child Health Outcomes (ECHO) Cohorts Recruited During Pregnancy
Authors: Faro Elissa Z. , Sauder Katherine A. , Anderson Amber L. , Dunlop Anne L. , Kerver Jean M. , McGrath Monica , Roary Mary , Roman Carolyn W. , Weidinger Cara , Huddleston Kathi C. 
Published: May 2021

Abstract

Purpose:
The objective of this study was to characterize the study designs, recruitment strategies, and other study characteristics among cohorts that initiated during pregnancy as part of the Environmental influences on Child Health Outcomes (ECHO) program.

Methods:
ECHO research programs (cohorts) were reviewed. Only those who had or were currently recruiting during pregnancy were surveyed in 2018 about research recruitment strategies (participant incentives, study burden, community collaboration, and cultural adaptations). Data are presented with cohort characteristics (location, inclusion and exclusion criteria, sociodemographics, medical information, behavioral factors, and biospecimens).

Results:
Forty-seven of the 84 ECHO pediatric cohorts recruited during pregnancy. Findings demonstrate various recruitment strategies, domains of data collection, and biospecimen collection are all characteristics of successful cohorts.

Clinical Implications:
These data that include over 50,000 children from families across the country, many in underserved areas, will be used for research with the potential to lead to profound policy changes. Prenatal conditions such as maternal age, obesity, depression, and drug use can be examined using study data, including biological markers, from pregnancy through childbirth and into childhood and will inform national policies on the role of early life exposures and underlying mechanisms of disease progression.
Decline in Physical Restraint Use Following Implementation of Institutional Guidelines
Authors: Shields Lisa B. E. , Edelen Avalena , Daniels Michael W. , Flanders Kimberly 
Published: May 2021

OBJECTIVE
To investigate the strategies implemented at our institution to reduce medical restraint use.

BACKGROUND
Restraints have been utilized to prevent agitation, self-extubations, and falls, although they are often associated with negative repercussions for nurses and patients.

METHODS
The restraint data at our institution were compared with the National Database of Nursing Quality Indicators (NDNQI) benchmark. We also described the measures taken to improve restraint documentation.

RESULTS
The number of patients in medical restraints, medical restraint hours, medical restraints/patient-days, and deaths in restraints at our institution all significantly decreased (P < 0.00001). There were 27 self-extubations of restrained patients compared with 11 self-extubations of nonrestrained patients. The percentage of inpatients with restraints in critical care and step-down areas declined and remained below the NDNQI benchmark.

CONCLUSIONS
This study reports the processes implemented to reduce restraint use through enhanced communication and increased documentation. Further exploration into factors that may attain a restraint-free environment is warranted.
Is a Surrogate Pregnancy a High-Risk Pregnancy?
Authors: Amorado Patricia , Magann Everett F. , Phillips Amy M. , Moutos Dean M. , Whittington Julie R. , Hughes Dawn S. , Klausen Jack H. 
Published: May 2021

Importance
As assisted reproductive technology has advanced, there has been an increase in gestational carriers/surrogate pregnancies. Information is needed to determine if these pregnancies are high-risk pregnancies and should be managed by maternal fetal medicine or if they are not high risk and should be cared for by residency-trained obstetricians and gynecologists.

Objective
In this review of the literature, we explore whether surrogate pregnancies should be classified as high-risk pregnancies and managed by subspecialists.

Evidence Acquisition, Results
Our literature search discovered 28 relevant studies that evaluated surrogate pregnancy and pregnancy complications/outcomes. We learned that the overall risk by using artificial reproductive technology and risks for hypertension, preterm delivery, cesarean delivery, low birth weight neonate, fetal anomalies, and stillbirth did not seem to increase maternal/perinatal risk to the level where a subspecialist was required for the inclusive management of a gestational surrogate. Given that the ideal gestational carrier is healthy, has previously had a term pregnancy, has a single embryo implanted, and has had no more than 3 prior cesarean deliveries, these pregnancies should be lower-risk pregnancies.

Conclusions
We recommend that close monitoring and high index of suspicion should be maintained for complications, but care for the surrogate pregnancy can be accomplished by a residency-trained obstetrician-gynecologist.

Relevance
An uncomplicated surrogate pregnancy can be managed by a residency-trained obstetrician-gynecologist and does not need to be managed by high-risk obstetric subspecialists.

Target Audience
Obstetricians and gynecologists, family physicians

Learning Objectives
After completing this activity, the learner should be better able to counsel patients on the risks of surrogate pregnancy; identify outcomes associated with assisted reproductive technology; and conduct risk-based stratification of surrogate pregnancy.
Clinical Significance and Prognostic Value of SOX2 Protein Expression in Patients With Oral Squamous Cell Carcinoma
Authors: Ghazaghi Faezeh , Saffar Hana , Yazdani Farzad , Etebarian Arghavan 
Published: May 2021

Objectives:
Cancer stem cells are a small group of highly tumorigenic cells with the trend of self-renewal, tumor progression, metastasis, recurrence, and therapeutic resistance. SOX2 is an important cancer stem cell marker that is involved in tumorigenesis and correlated with aggressive features in various types of malignancies. The present study was aimed to investigate the expression of this biomarker in neoplastic tissues of oral squamous cell carcinoma (OSCC) to determine whether it has the potential to predict the outcomes and survival of the affected patients.

Materials and Methods:
The medical records of 73 patients diagnosed with OSCC were retrospectively studied. Clinical and pathologic features included age, sex, tumor size, histologic grade, lymph node involvement, recurrence, metastasis, and follow up. Immunohistochemical analysis for SOX2 protein expression was performed, and its correlations with clinicopathologic features were evaluated.

Results:
SOX2 was significantly associated with tumor size, lymph node metastasis, and patients’ survival. We found no apparent correlation between SOX2 and tumor recurrence, distant metastasis, or differentiation. The multivariate analysis identifies patients’ age, sex, and SOX2 expression as independent prognostic factors for overall survival.

Conclusion:
SOX2 may worsen the prognosis and be a progressive malignant factor, which can help clinicians investigate OSCC patients’ survival and plan the appropriate treatment accordingly.
Minimal Residual Disease in Multiple Myeloma
Authors: Mina Roberto , Bonello Francesca , Oliva Stefania 
Published: May 2021

Abstract
Minimal residual disease (MRD) techniques are essential to identify the small clonal fraction within and outside the bone marrow. In the last years, evidence regarding their prognostic role for the evaluation of the depth of response of current treatment strategies has grown rapidly. Consequently, MRD was incorporated in an increasing number of clinical trials for multiple myeloma patients, also as primary endpoint, and even to guide therapeutic choices. A robust correlation between MRD negativity and survival was established. Yet, several issues regarding MRD evaluation remain to be addressed: from the optimal and more cost-effective techniques for its assessment and its harmonization worldwide to its use in clinical practice to its impact on treatment modulation. This review focuses on the available evidence supporting the use of MRD status for the management of multiple myeloma patients and on open issues that still need an answer.
From Bench to Bedside
Authors: Morgan Gareth J. , Boyle Eileen M. , Davies Faith E. 
Published: May 2021

Abstract
The summation of 20 years of biological studies and the comprehensive analysis of more than 1000 multiple myeloma genomes with data linked to clinical outcome has enabled an increased understanding of the pathogenesis of multiple myeloma in the context of normal plasma cell biology. This novel data have facilitated the identification of prognostic markers and targets suitable for therapeutic manipulation. The challenge moving forward is to translate this genetic and biological information into the clinic to improve patient care. This review discusses the key data required to achieve this and provides a framework within which to explore the use of response-adapted, biologically targeted, molecularly targeted, and risk-stratified therapeutic approaches to improve the management of patients with multiple myeloma.
An Overview of Organoid and 3-Dimensional Models in Multiple Myeloma
Authors: Rodriguez Cesar 
Published: May 2021

Abstract
Multiple myeloma is a hematological malignancy of differentiated B cells that resides primarily in bone marrow niches. Its interaction with the microenvironment is known to provide a survival advantage and plays an important role in drug resistance. Despite the increased efficacy of new treatment drugs, clinical results oftentimes fall short of in vitro observations, and this disease remains incurable. Conventional 2-dimensional cultures used to perform chemosensitivity assays and the established multiple myeloma cells lines commonly used do not replicate the conditions seen in vivo. This review presents various 3-dimensional culture platforms for myeloma that attempt to overcome this obstacle by incorporating aspects of the tumor microenvironment. The unique features of each model and contributions they have provided in personalized medicine, tumor physiology, and chemosensitivity assays will be summarized.
Clinical Importance of Incidentally Detected Hyperenhancing Liver Observations on Portal Venous Phase Computed Tomography in Patients Without Known Malignancy or Liver Disease
Authors: Corwin Michael T. , DiGeronimo Ryan T. , Navarro Shannon M. , Fananapazir Ghaneh , Wilson Machelle , Loehfelm Thomas W. 
Published: May 2021

Objective
The aim of the study was to determine the prevalence of clinically important masses among incidental hyperenhancing liver observations on portal venous phase computed tomography (CT) in patients without known malignancy or liver disease.

Methods
Retrospective search of portal venous phase CTs was performed to identify hyperenhancing liver observations in patients without cancer or liver disease. Observations were assigned a morphology of homogeneous, hemangioma, or heterogeneous. The reference standard was pathology (n = 2), liver protocol CT/magnetic resonance imaging (n = 40), follow-up portal venous phase CT for 2 years or more (n = 81), or clinical follow-up for 5 years or more (n = 107).

Results
There were no clinically important masses among 83 observations with homogeneous morphology or 110 with hemangioma morphology. There were 2 clinically important masses (1 hepatocellular carcinoma and 1 hepatic adenoma) among 37 (5.4%) heterogeneous morphology observations.

Conclusions
Incidental hyperenhancing liver observations on portal venous phase CT with homogeneous or typical hemangioma morphology in patients without known cancer or liver disease are highly likely benign.
High-Resolution Diffusion-Weighted Imaging for Evaluation of Extramural Tumor Invasion in Primary Rectal Cancer
Authors: Park Eun Joo , Kim Seung Ho , Jo Sung Jae , Nam Kyung Han , Lim Yun-jung , Jung Hyun Kyung 
Published: May 2021

Objective
The aim of this study was to determine the added value of high-resolution diffusion-weighted imaging (DWI) to T2-weighted imaging (T2WI) for evaluation of extramural tumor invasion (EMTI) in patients with primary rectal cancer.

Methods
Seventy-eight patients who had undergone 3.0-T magnetic resonance imaging including DWI (b = 0, 1000 s/mm2, 2 mm iso-voxel) and subsequent surgery were included. Two blinded radiologists independently read the T2WI first and then the combined DWI set. They recorded their confidence level using a 5-point scale. The diagnostic accuracy was calculated by receiver operating characteristic curve analysis based on the histopathological results as the reference.

Results
The study population consisted of EMTI positive (n = 44) and negative (n = 34). The area under the curve was not significantly increased after adding DWI to T2WI (reader 1, 0.868–0.856, P = 0.5618; reader 2, 0.848–0.865, P = 0.4539).

Conclusion
Adding DWI to T2WI showed no additional diagnostic value for the evaluation of EMTI in patients with primary rectal cancer.