bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peak troponin predicts successful weaning from VA ECMO in patients with acute myocardial infarction complicated by cardiogenic shock
Authors: North Monique , Eckman Peter , Samara Michael , Chavez Ivan , Schmidt Christian , Garberich Ross , Hryniewicz Katarzyna 
Published: February 2021

Background: In patients treated for refractory cardiogenic shock (RCS) following acute myocardial infarction (AMI), predicting successful weaning from veno-arterial extracorporeal membrane oxygenation (VA ECMO) has important implications for decision-making and prognosis. Methods: We performed a retrospective review of adult VA ECMO patients with RCS complicating AMI at our institution from 2010 to 2019. We evaluated use of peak troponin I as a predictor of successful decannulation. Results: Sixty-two patients were analyzed; mean age 61.1 ± 9.8 years, 73% males, 62% presented with STEMI. Forty-five patients were successfully weaned (group I). Seventeen patients did not wean (group II); seven patients received a durable LVAD, 10 died. Patients from group I had significantly lower peak troponin I (89 vs 434 ng/mL, p = 0.0001). Receiver operating characteristic curves showed a peak troponin I cutoff of 400 ng/mL correctly classified patients by weaning status 90% of the time, with associated sensitivity of 71% and specificity of 98%. With each 50 ng/mL increase in troponin I, the likelihood of weaning decreased by 33%. Conclusions: Peak troponin I above 400 ng/mL may be helpful in predicting unsuccessful weaning from VA ECMO support for refractory cardiogenic shock following myocardial infarction and facilitate triage decisions regarding need for advanced therapies.
Analysis of chlamydia contacts and the look-back interval at a UK sexual health clinic
Authors: Turner Catherine , Howlett Sally E , Loftus Hannah 
Published: February 2021

Guidance on contact tracing in Chlamydia trachomatis (CT) is limited. CT contacts data over 12 months (1 December 2018–29 November 2019) at a UK sexual health clinic were analysed to determine the appropriateness of the currently recommended six-month ‘look-back’ interval. Age and sex of CT contacts were associated with clinical outcomes. Subgroups of 100 CT positive/negative contacts (each N = 100) were randomly selected. The relationship between time since sexual intercourse with the index case (Last Sexual Intercourse; LSI) and CT positivity was examined; suitability of varying look-back intervals was explored. Of 891 CT contacts (mean age = 25.0 years, 66.2% men), 66.9% tested positive for CT. Positive CT contacts were significantly younger (23.8 ± 6.8 years vs. 27.4 ± 9.1, p < 0.001) and more often women (36.4% vs. 28.5%, p = 0.018) than negative contacts. In the subgroups, the Mann–Whitney U test revealed no significant difference between the LSI of positive and negative contacts ( p = 0.081). 95% of positive CT contacts ( N = 82) were captured within a hypothetical three-month look-back interval. While most CT positive contacts were captured within three months, they appeared to remain proportionately represented beyond this point. Although this supports current guidelines, further research should investigate whether CT contacts involved in longer look-back intervals may require disproportionately greater resources to trace.
INR Response to Low-Dose Vitamin K in Warfarin Patients
Authors: Kulig Caitlin E. , Roberts A. Joshua , Rowe A. Shaun , Kim Hahyoon , Dager William E. 
Published: February 2021

Background Literature suggests that 2 mg of vitamin K intravenously (IV) provides a similar effect as 10 mg to reverse warfarin. Doses <5 mg haven’t been studied in depth. Objective The objective was to determine the international normalized ratio (INR) reduction effect of ultra low-dose (ULD) IV vitamin K. Methods This retrospective, observational cohort study compared IV vitamin K doses of 0.25-0.5 mg (ULD) versus 1-2 mg (standard low dose [SLD]). The primary outcome assessed ΔINR at 36 hours; secondary outcomes assessed ΔINR at 12 hours and 30-day venous thromboembolism (VTE) and mortality rates. Results Of 88 patients identified (median baseline INR [IQR], 5.1 [3.1, 7.3] vs 4.5 [2.8, 8.2], ULD vs SLD, respectively), 59 had an INR at 12 hours. The ULD had fewer 12-hour INR values <2, with no statistical difference in the ΔINR at 12 hours between the ULD and SLD cohorts (median ΔINR, 2.2 [1.1, 3.4] vs 2.2 [1.1, 6.3]; P = 0.54; median INR, 2.3 vs 1.8). A total of 41 patients had both a 12- and 36-hour INR. No significant difference in the ΔINR between the 12- and 36-hour values occurred (median ΔINR, 0.52 [0.2, 0.91] vs ΔINR, 0.46 [0.18, 0.55]; P = 0.61), suggesting no rebound or excessive reversal and no difference in 30-day rates of VTE ( P > 0.99) or death ( P = 0.38). Conclusion and Relevance ULD IV vitamin K reversed INR similarly to doses of 1-2 mg without rebound. A ULD strategy may be considered in patients requiring more cautious reversal.
Involving High-Grade Glioma Patients and Their Carers in Qualitative Research to Promote Structured Physical Activity: A Mixed-Methods Study Protocol
Authors: Islam Ishrat , Goss Silvia , Nelson Annmarie , Byrne Anthony 
Published: February 2021

Introduction: Structured physical activity may improve physical, cognitive, and social functionality, as well as overall quality of life of people with high-grade glioma. Yet, engaging them in such activities remains highly challenging due to their unique disease burden and perceived “loss of control.” A greater understanding of patients’ interests, preferences, behavioral motivations, and perceived barriers around physical activity is needed to design tailored and patient-led physical activity interventions. This protocol describes the method and ethical considerations of a cross-sectional mixed-methods study that has been developed to collect such information from glioma patients and their carers. Methods and analysis: The International Physical Activity Questionnaire (IPAQ 7, short form) and semi-structured interviews will be used for data collection. IPAQ scoring protocol will be followed to examine objective data and Clarke and Braun’s thematic approach will be used to analyze the interview transcripts. Ethics: Ethical approval was obtained from Cardiff University’s Research Ethics Committee and from the regional NHS Research Ethics Committee. The main ethical concerns are to maintain patients’ safety and comfort and ensure that their consent remains informed and valid throughout the recruitment, data collection, management, and dissemination stage. Risks associated with their physical condition, emotional distress, and time commitment should be continuously assessed and necessary actions should be taken accordingly. Conclusion: The protocol will work as a step by step guide for future researchers for developing similar qualitative research and obtaining ethical approval when involving vulnerable individuals like high-grade glioma patients in studies.
Does the Laminar Airflow System Affect the Development of Perioperative Hypothermia? A Randomized Clinical Trial
Authors: Dagli Recai , Çelik Fatma , Özden Hüseyin , Şahin Serdar 
Published: February 2021

Objectives: We aimed to compare tympanic membrane temperature changes and the incidence of inadvertent perioperative hypothermia (IPH) in patients undergoing laparoscopic cholecystectomy under general anesthesia in laminar airflow systems (LAS-OR) and conventional turbulent airflow systems (CAS-OR). Background: Different heating, ventilation, and air-conditioning (HVAC) systems are used in the operating room (OR), such as LAS and CAS. Laminar airflow is directed directly to the patient in LAS-OR. Does laminar airflow in ORs cause faster heat loss by convection? Methods: This is a prospective, randomized study. We divided 200 patients with simple randomization (1:1), as group LAS and group CAS, and took the patients into the LAS-OR or CAS-OR for the operation. Clinical trial number: IRCT20180324039145N3. The tympanic membrane temperatures of patients were measured (°C) before anesthesia induction ( T 0) and then every 15 min during surgery ( Tn). Changes (Δ n) between T 0 and Tn were measured. Results: In the first 30 min, there was a temperature decrease of approximately 0.8 °C (1.44 °F) in both groups. Temperature decreases at 45 min were higher in group LAS than in group CAS but not statistically significant, Δ45, respectively, 0.89 (95% confidence interval [CI] [0.77, 1.02]) versus 0.77 (95% CI [0.69, 0.84]; p = .09). IPH occurred in a total of 60.9% (112 of 184) of patients in the entire surgical evaluation period in group LAS and group CAS (58.9% vs. 62.8%, p = . 59). Conclusions: IPH is seen frequently in both HVAC systems. Clinically, the advantage of HVAC systems relative to each other has not been demonstrated during laparoscopic cholecystectomy.
Early Sport Specialization Linked to Throwing Arm Function and Upper Extremity Injury History in College Baseball Players
Authors: Croci Jason , Nicknair Jim , Goetschius John 
Published: February 2021

Background: Evidence suggests that shoulder and elbow injuries account for 31% to 37% of all National Collegiate Athletic Association (NCAA) baseball injuries, and up to 69% of NCAA baseball injuries are the result of noncontact and overuse mechanisms. Early sport specialization may contribute to the high rates of upper extremity injuries in college baseball players. Hypothesis: Higher specialization by age 13 years would be associated with worse subjective throwing arm function and a greater history of shoulder and elbow injury. Study Design: Cohort study. Level of Evidence: Level 2. Methods: Survey data were collected from college baseball players (N = 129) during midseason of the spring 2019 baseball season. Participants were stratified in low, moderate, and high specialization groups based on a 3-criteria sports specialization questionnaire. Participants’ throwing arm function was measured using the Functional Arm Scale for Throwers and the Kerlan-Jobe Orthopaedic Clinic shoulder and elbow questionnaires. Participants’ history of a shoulder or elbow injury that resulted in missing ≥2 weeks of baseball activity at any point in their baseball career was also collected. Results: The high specialization group reported worse subjective throwing arm function on the Functional Arm Scale for Throwers questionnaire than the low ( P = 0.03) and moderate ( P = 0.01) specialization groups. The high specialization group was over 5 times more likely to report a history of shoulder injury than the moderate (odds ratio [OR] = 5.42; 95% CI [1.71, 17.2]; P = 0.004) and low (OR = 5.20; 95% CI [1.87, 14.5]; P = 0.002) specialization groups, and over 3 times more likely to report a history of elbow injury than the moderate specialization group (OR = 3.77; 95% CI [1.05, 13.6]; P = 0.04). Conclusion: College baseball players that were highly specialized by age 13 years reported worse subjective throwing arm function and were more likely to have a history of upper extremity injury than players that were moderate or low specialization. Clinical Relevance: Early specialization in baseball may be detrimental to long-term upper extremity health in college baseball players.
Recognizing Aphemia and How to Differentiate From Aphasia in the Era of Telemedicine
Authors: Kasturiarachi Brittany M. , Krishnaiah Balaji 
Published: February 2021

Background: Aphemia, or pure motor mutism, is a phenomenon that has been reported previously in the literature and typically is associated with small infarcts in the inferior dominant precentral gyrus, pars opercularis, or inferior perirolandic gyrus. Clinically, it is important to distinguish aphemia from aphasia syndromes. Telemedicine is becoming more prevalent and involving neurologists across the country. This is an important consideration when addressing aphemic patients as many mistakes can be made during a virtual exam clouding a patient’s clinical picture. Case Presentation: Our patient is a 61-year-old female with a past medical history of hypertension, diabetes, and an old right frontoparietal stroke without any residual deficits. She presented after her family stated that she “quit speaking” for about seven hours. Initial neurological evaluation was done via telemedicine due to the COVID-19 pandemic and was pertinent for decreased consciousness, inability to answer either orientation question, a right facial droop, and aphasia. Later it was found that the patient exhibited a pure motor mutism rather than aphasia and had an MRI lesion in the left inferior precentral gyrus. Conclusion: Differentiating aphemia from aphasia is an important clinical skill for a neurologist to foster especially in the era of telemedicine. An intimate knowledge of the parts of a speech exam are vital in directing emergency staff during stroke evaluation. Additionally, distinguishing these clinical syndromes has implications with respect to prognosis and long-term rehabilitation.
Management of extra-abdominal fibromatosis in a musculoskeletal tumour centre in Hong Kong
Authors: Yvette Lam Wei Sze , Tak Fong Sin , Lok Mak Ka 
Published: February 2021

Introduction: Fibromatosis is a benign disease yet prone to recurrence. The best treatment option remains controversial. The purpose of this study was to analyse the management approach in our musculoskeletal tumour centre. Materials and Methods: Thirty-four patients with extra-abdominal fibromatosis referred to our centre between 2000 to 2018 were included. Patients’ demographics, tumour location and size, year of diagnosis, treatment modalities, surgical margins, recurrence, and subsequent management were analysed. Results: Patients mostly presented in the second and third decade, with female predominance. Twenty-seven patients underwent excision. Other management options included ‘watchful waiting’, pharmacological treatment and radiotherapy. Recurrence rate was 51.9%. There was no statistically significant relationship between marginal status and recurrence. Conclusion: We report our experiences on management of fibromatosis, with strategy shifted from early excision to a conservative approach over the years. Surgical excision is still indicated in some situations. Tumour recurrence is not rare but second excision is not always necessary.
The Predictors of Hypertension in Children: Palestinian Perspective
Authors: Batran Ahmad , Fashafsheh Nawras , Ayed Ahmad , Salameh Basma 
Published: February 2021

Children with high blood pressure are much more likely than children with lower blood pressure to experience hypertension in adulthood. The purpose of this study was to determine the prevalence of hypertension and predictors of hypertension in Palestinian children. Method Cross-sectional study was performed on five hundred and nine (10–13) year old students from governmental schools in Jenin and Tubas. Anthropometric measures consist of body mass index, hip circumference (HC), waist circumference (WC), the ratio of waist to hip (WHR), and the ratio of waist to height (WHtR) were measured. Blood pressure was assessed including systolic (SBP) and diastolic (DBP) utilizing a (Dynamap) vital signs monitor. Results Approximately 38.7% of participants (38.8% females and 38.63% males) were considered pre-hypertensive and 7.3% of the participants (7.4% females and 7.1% males) were hypertensive. Also, there was a weak to moderate relationship between mean blood pressure (systolic and diastolic) and the anthropometric measurements. Additionally, most predictors with significant effects on early childhood hypertension were body mass index (OR 1.16, 95% CI 1.09–1.23). Conclusions Hypertension and prehypertension are present in Palestinian children. Waist hip ratio is the greatest predictor of BP, followed by body mass index. Hence, weight-reduction strategies to at-risk children are crucial to minimizing the prevalence of Palestinian childhood hypertension.
Emergency Physicians Performing Point-of-Care Lung Sonography to Diagnose Pneumonia: A Prospective Multicenter Study
Authors: Zare Mohammad Amin , Mizani Mahtab , Sameti Azadeh , Bahmani Alireza , Fathi Marzieh 
Published: February 2021

Objective: There has always been some issues in the accurate diagnosis of pneumonia, a common cause of emergency department (ED) visits and revisits, which is typically made based on the patient’s clinical syndrome. This is made more difficult due to the traditional chest radiography having limited accuracy. This prospective multicenter study was conducted to determine the diagnostic accuracy of a point-of-care lung sonography performed by emergency physicians for the diagnosis of pneumonia in an acute care setting. This was compared with chest computed tomography (CT), the diagnostic gold standard. Methods: ED patients who presented with signs and symptoms of pneumonia were eligible to enroll in the study. After enrollment, point-of-care lung sonography was performed on patients by emergency physicians who had passed a focused teaching course on lung sonographic findings of pneumonia. All enrolled patients were followed up. Patients who underwent a chest CT during their hospital admission course were finally included and analyzed. Results: Emergency physicians who performed a point-of-care lung sonography had a sensitivity of 100%, specificity of 75%, positive predictive value of 88.88%, negative predictive value of 100%, and an overall accuracy of 90% in the diagnosis of pneumonia. Conclusion: These emergency physicians could accurately diagnose pneumonia, with a point-of-care lung sonography, after completing a focused sonography course.
Determination of the Accuracy of Supine and Prone Approaches to Sonographically Measured Kidney Dimensions
Authors: Ohagwu Christopher C. , Amogu Friday I. , Abonyi Livinus C. , Ochie Kalu , Eze Cletus U. , Ezechukwu Uchenna N. 
Published: February 2021

Objective: To determine the accuracy of supine and prone approaches to sonographically measured kidney dimensions. Methods: The kidney dimensions of 109 participants were sonographically determined in supine and prone patient positions. The two measurements were compared with each other using the intra-class correlation, coefficient of variation for duplicate measurements and Bland-Altman plot. The two sets of measurements were each compared with measurements from computed tomography. Results: There was a very strong agreement between kidney dimensions in supine and prone positions. There was also an agreement between kidney dimensions in supine and prone positions and computed tomography measurements. Conclusion: The kidney dimensions obtained using patient-in-supine position and patient-in-prone position approaches may be equivalent and the two approaches may be used interchangeably.
Prognostic Value of Initial Blood Cell Counts in Acute Myeloid Leukemia
Authors: Kirby Eric , Markert Ronald , Marinella Mark 
Published: February 2021

Introduction:
Acute myeloid leukemia (AML) is an aggressive hematologic malignancy that has a poor prognosis. Not only does AML lead to mortality, but toxicity from chemotherapy can result in life-threatening complications. While the goal of treatment for some AML patients is cure, if the risks of chemotherapy are substantial, then less aggressive treatment regimens, including no treatment, should be pursued. The goal of this study was to identify risk factors for early mortality among patients with AML who receive chemotherapy.
Methods:
This study was a retrospective chart review. From January 2015 to August 2019, patients who received chemotherapy for AML were included. Demographic and clinical characteristics were gathered from when the patient was first suspected to have AML: age, sex, race, body surface area (BSA), white blood cell count (WBC), hemoglobin, platelet count, lactate dehydrogenase (LDH), and uric acid. The outcome was weeks of survival from the first day of treatment. The independent samples Mann-Whitney Test was used for dichotomous comparisons.
Results:
Forty-nine patients were included in the study. Patients aged ≤65 years old had greater median survival than those &gt;65 years old (40.36 weeks vs. 11.50 weeks, p=0.045). Patients with a hemoglobin &gt;8 g/dL had greater median survival than those ≤8g/dL (45.43 weeks vs. 6.57 weeks, p&lt;0.001). Patients with a platelet count &gt;50,000/mm3 had greater median survival than those ≤50,000/mm3 (47.72 weeks vs. 8.29 weeks, p&lt;0.001). Sex and race were not related to survival time nor were cutoffs for BSA, WBC, LDH, and uric acid.
For the 23 of 49 patients who survived less than six months from the time they started chemotherapy, patients with a platelet count &gt;50,000/mm3 had greater median survival than those ≤50,000/mm3 (11.29 weeks vs. 4.43 weeks, p=0.016). Also, for patients surviving less than six months, those with BSA &gt;1.95 m2 had median survival of 10 weeks versus median survival of 4.5 weeks for BSA ≤1.95 m2 (p=0.07).
Conclusion:
For patients receiving chemotherapy for AML, we found that in addition to older age, lower hemoglobin and lower platelet count were risk factors for survival time and should be considered before embarking on an aggressive treatment regimen, as the risks may outweigh the benefits.
Figure

Disclosures
No relevant conflicts of interest to declare.
Level of Evidence for FDA Drug Approvals in Pivotal Clinical Trials of Hematological Malignancies
Authors: Al Hadidi Samer , Ramos Carlos A. 
Published: February 2021

BACKGROUND
Clinical trials are integral to improve treatment outcomes for patients with hematological malignancies. Although early phase (I/II) clinical trials may provide evidence of clinical efficacy, the main goal for early phase trials is to assess safety signal. Results of phase III clinical trials provide the strongest evidence to support the use of new cancer medications. The Food and Drug Administration (FDA) is responsible to ensure appropriate control and supervision of pharmaceutical drugs.
METHODS
On the basis of publicly available study protocols and FDA reviews, the authors reviewed the level of evidence in 52 clinical trials supporting 49 drug approvals from 2016 to 2020. Data cut point was May 2020. These trials resulted in approval of medications to treat leukemia, non-Hodgkin lymphoma, Hodgkin lymphoma, myelodysplastic syndrome, myeloproliferative neoplasms and multiple myeloma.
RESULTS
A total of 52 clinical trials were assessed in the 5 years period. Phase III trials supported 61.5% while earlier phase trials supported 36.5% of subsequent FDA hematological malignancies approvals. The level of evidence to support FDA approvals improved with time with 50% of approvals in 2016 and 2017 supported by phase III clinical trials compared to 69% in 2019. Approvals were based on early phase trials in mantle cell lymphoma (100%), chronic myeloid leukemia (100%), diffuse large B cell lymphoma (100%), classic Hodgkin's lymphoma (67%) and acute myeloid leukemia (56%). Phase III trials enrolled 87% of the patients (14238 from16429 patients). Eighteen drug approvals (37% of all approvals) were based on 13% of the total number of patients in the studied period.
CONCLUSIONS
Level of evidence to support drug approvals in hematological malignancies was based on early phase trials in more than a third of the times. Although early phase studies are appropriate for safety signals, further clinical activity assessment should be done to support the use of new drugs to treat hematological malignancies. Previous successful early phase studies failed to show clinical activity in phase III studies. Despite the fact that use of new approved drugs based on early phase studies evidence may be needed, patients and healthcare providers should be aware of such possibility when using newly approved medications.
Figure

Disclosures
Ramos: Novartis: Membership on an entity's Board of Directors or advisory committees; Tessa Therapeutics: Research Funding; Kuur Therapeutics: Research Funding.