bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and efficacy of a single total dose infusion (1020 mg) of ferumoxytol
Authors: Khan Harris , May Paige , Kuo Elim , Pai Preetika , Boles Katherine , McGee Ashley , Dang Tanaka , Schmit Jessica 
Published: April 2021

Purpose: Iron deficiency anemia (IDA) is the most common type of anemia. A single dose infusion of intravenous (IV) iron is a convenient treatment option. Ferumoxytol is an IV formulation of iron that is typically given in two doses of 510 mg each. Utilizing a single dose of 1020 mg over 15 min has previously been described as safe and effective. In July 2018, we began to administer a single 1020 mg dose of ferumoxytol to patients needing IV iron replacement at the North Florida/South Georgia Veterans Health System. To evaluate the impact of this change, a utilization review was conducted. Methods: Outcomes of all patients who received ferumoxytol injections in the 6 months prior to and after the dosing strategy change were analyzed. A total of 140 patients, who received 270 separate IV ferumoxytol infusions, were included in the analysis. Results: No significant difference in safety was observed, with one infusion reaction occurring in each group ( p = 1.00). Efficacy also appeared equivalent with no significant difference between the change in hemoglobin for those who received a single 1020 mg dose versus those who received two 510 mg doses ( p = 0.764). As expected, those who received a single total dose infusion of 1020 mg had less clinic utilization ( p < 0.0001). Conclusion: In summary, ferumoxytol administered as a 1020 mg single dose infusion was more convenient and should be considered a safe and effective treatment option for IDA.
Clinicopathological parameters for predicting non-invasive follicular thyroid neoplasm with papillary features (NIFTP)
Authors: Jang Eunju , Kim Kwangsoon , Jung Chan Kwon , Bae Ja Seong , Kim Jeong Soo 
Published: April 2021

Background: Criteria for the preoperative diagnosis of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) have not yet been confirmed. This study aimed to analyze differences in clinicopathological characteristics between follicular variant of papillary thyroid carcinoma (FVPTC) subtypes to determine which parameters are relevant in differentiating NIFTP from other variants. Methods: We retrospectively analyzed the records of 199 patients with a preoperative diagnosis of FVPTC who underwent thyroid surgery at Seoul St. Mary’s Hospital (Seoul, Korea) from 2011 to 2015. Clinicopathological features were analyzed retrospectively via a complete review of medical charts and pathology reports of patients. Results: The NIFTP and invasive encapsulated FVPTC (EFVPTC) groups showed relatively benign features, with a majority of the patients categorized as Bethesda category III (25.8% and 25.6%, respectively) or IV (34.8% and 30.2%, respectively), while the infiltrative FVPTC group showed more malignant features, with more patients categorized as category V (28.6%) or VI (47.6%) ( p < 0.001). BRAF V600E mutations were significantly less prevalent in the NIFTP group (0%) and invasive EFVPTC group (4.7%) compared with the infiltrative FVPTC group (34.9%) ( p < 0.001). Multivariate analysis showed that absence of BRAF V600E mutation (OR 20.311, p = 0.004) and lymph node metastasis (odds ratio 10.237, p = 0.004) were significantly associated with NIFTP. Conclusion: Although Bethesda category was a statistically significant factor in distinguishing FVPTC subtypes, it was not effective in conclusively distinguishing NIFTP and invasive EFVPTC. Absence of BRAF V600E mutation and lymph node metastasis are important features in distinguishing NIFTP from other subtypes.
Significance of autoimmune disease in severe pulmonary hypertension complicating extensive pulmonary fibrosis: a prospective cohort study
Authors: Saggar Rajeev , Giri Paresh C. , Deng Chunqin , Johnson Dana , McCloy Mary K. , Liang Lloyd , Shaikh Faisal , Hong Jason , Channick Richard N. , Shapiro Shelley S. , Lynch Joseph P. , Belperio John A. , Weigt Samuel S. , Ramsey Allison L. , Ross David J. , Sayah David M. , Shino Michael Y. , Derhovanessian Ariss , Sherman Alexander E. , Saggar Rajan 
Published: April 2021

The association of autoimmune disease (AI) with transplant‐free survival in the setting of severe Group 3 pulmonary hypertension and extensive pulmonary fibrosis remains unclear. We report cases of severe pulmonary hypertension (mean pulmonary artery pressure ≥35 mmHg and right ventricular dysfunction) and extensive pulmonary fibrosis after pulmonary arterial hypertension‐specific therapy. We used multivariate regression to determine the clinical variables associated with transplant‐free survival. Of 286 screened patients, 55 demonstrated severe pulmonary hypertension and extensive pulmonary fibrosis and were treated with parenteral prostacyclin therapy. The (+)AI subgroup (n = 34), when compared to the (–)AI subgroup (n = 21), was more likely to be female (77% versus 19%) and younger (58.7 ± 12.1 versus 66.0 ± 10.7 years), and revealed lower forced vital capacity (absolute) (1.9 ± 0.7 versus 2.9 ± 1.1 L), higher DLCO (% predicted) (31.1 ± 15.2 versus 23.2 ± 8.0), and increased unadjusted transplant‐free survival (1 year (84.6 ± 6.3% versus 45 ± 11.1%)), 3 years (71 ± 8.2% versus 28.6 ± 11.9%), and 5 years (47.6 ± 9.6% versus 6.4 ± 8.2%); (p = 0.01)). Transplant‐free survival was unchanged after adjusting for age and gender. The pulmonary hemodynamic profiles improved after parenteral prostacyclin therapy, independent of AI status. The baseline variables associated with mortality included age at pulmonary hypertension diagnosis (heart rate (HR) 1.23 (confidence interval (CI) 1.03–1.47); p = 0.02) and presence of AI (HR 0.26 (confidence interval (CI) 0.10–0.70); p < 0.01). Gas exchange was not adversely affected by parenteral prostacyclin therapy. In the setting of severe Group 3 pulmonary hypertension and extensive pulmonary fibrosis treated with pulmonary arterial hypertension‐specific therapy, AI is independently associated with increased transplant‐free survival. Pulmonary hypertension/pulmonary fibrosis associated with AI should be considered in future clinical trials of pulmonary arterial hypertension‐specific therapy in Group 3 pulmonary hypertension.
Work Engagement and the Validity of Job Demands–Resources Model Among Nurses in Japan: A Literature Review
Authors: Kato Yuichi , Chiba Rie , Shimazu Akihito 
Published: April 2021

Background: Work engagement (WE) is defined as a positive, fulfilling, and work-related state of mind. Enhancing WE leads to positive outcomes in both individuals and organizations. Although cultural factors may influence the antecedents and outcomes of WE, no reviews summarized these factors among nurses, mainly in Asia. This review aimed to identify the antecedents and outcomes of WE among nurses in Japan. This may offer novel insights into the influencing factors on WE. Methods: A literature search was conducted using six data sources: PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycINFO, Business Source Premier, Ichushi-Web, and CiNii. A total of 38 studies met the inclusion criteria. Studies that included registered nurses and/or midwives at hospitals or facilities were included in this review. The antecedents and outcomes were classified into four themes based on the job demands–resources model (JD-R model). Findings: Many variables in three components of the JD-R model (i.e., job resources, personal resources, and favorable outcomes) exhibited positive relationships with WE as theorized. Many other variables in job demands demonstrated negative relationships with WE as hypothesized. Many factors that were identified in this review were consistent with the JD-R model. The model in turn was found to be applicable among nurses. The antecedents and outcomes in this review were similar to those in previous studies in Western countries, while this review also revealed teamwork nursing as a possible antecedent of WE, which has not previously been reported. Conclusion/Application to Practice: Improving job resources (e.g., teamwork nursing) and personal resources may effectively enhance WE among Japanese nurses.
Exploring the Effect of Mindfulness on Burnout in a Pediatric Emergency Department
Authors: Wong Kei U. , Palladino Lauren , Langhan Melissa L. 
Published: April 2021

Background: Burnout is a common phenomenon among health care providers known to adversely affect their mental health and clinical acumen. As mindfulness has been shown to diminish burnout with large-scale interventions, our aim was to assess whether smaller, on-shift activities aimed at increasing mindfulness could decrease burnout among staff in a pediatric emergency department (PED). Methods: Prior to the implementation of a series of mindfulness-based activities, a diverse cohort of PED staff including nurses, physicians, nurse practitioners, technicians, and administrative personnel completed electronic preintervention surveys about their demographics, personal mindfulness engagement, and individual baseline burnout level using the Maslach Burnout Inventory (MBI). Trained nurses and physicians served as champions who coordinated on-shift mindfulness activities, and burnout levels were subsequently reassessed using a postintervention survey. Findings: Among 83 eligible staff, 75 completed the preintervention and 69 completed the postintervention survey. For the MBI, the majority of staff had moderate to high burnout levels at baseline. Few staff engaged in personal mindfulness activities outside of work. Although 82% of staff participated in the on-shift interventions, no significant differences were found in scores before and after the intervention for emotional exhaustion (20.1 vs. 20, p = .93), depersonalization (7.6 vs. 7.3, p = .97), and personal accomplishment (36.1 vs. 34.8, p = .11). Conclusion/Application to Practice: While mindfulness effectively combats burnout, few PED providers regularly practice mindfulness activities. Brief, on-shift mindfulness activities were insufficient to significantly reduce burnout levels. Hospital leadership should consider dedicating resources to more intensive mindfulness activities to combat amplified burnout levels among emergency department staff.
Influence of Achilles tendon rupture site on surgical repair outcomes
Authors: Cao Shengxuan , Teng Zhaolin , Wang Chen , Zhou Qian , Wang Xu , Ma Xin 
Published: April 2021

Purpose: This study aims to measure the distance between the common site of Achilles tendon rupture and calcaneal insertion through ultrasound and to compare the outcomes between proximal and distal rupture groups. Methods: We investigated the electronic medical records of 117 patients and preoperative ultrasound describing the rupture site. Among 88 patients, we compared the patient-reported outcome and re-rupture rate of proximal and distal rupture groups. Results: The mean rupture site of the 117 included subjects was 4.5 ± 1.3 cm. The rupture site had a weak negative correlation with body mass index ( ρ = −0.230, P = 0.013). Furthermore, 77% of the patients with distal rupture reported good outcome (Achilles Tendon Rupture Score > 80) compared to 56% of the patients with proximal rupture ( P = 0.041). Conclusion: Patients with proximal rupture had less satisfactory postoperative outcomes than those with distal rupture.
Multimodal Ultrasound Versus MRI for the Diagnosis and Monitoring of Achilles Tendinopathy: A Prospective Longitudinal Study
Authors: Gatz Matthias , Bode Daniela , Betsch Marcel , Quack Valentin , Tingart Markus , Kuhl Christiane , Schrading Simone , Dirrichs Timm 
Published: April 2021

Background: The diagnosis and monitoring of Achilles tendinopathy with imaging are challenging. There is a lack of studies comparing the diagnostic accuracy of magnetic resonance imaging (MRI), brightness mode ultrasound (B-mode), and power Doppler ultrasound with recent technologies such as ultrasound tissue characterization (UTC) and shear wave elastography (SWE). Purpose: To assess whether SWE and UTC, which offer quantitative values, show a superior diagnostic accuracy and capacity to detect structural improvement in Achilles tendinopathy compared with MRI, B-mode, or power Doppler. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients with insertional (n = 28) and midportion (n = 38) Achilles tendinopathy were evaluated at baseline and 6-month follow-up using MRI, B-mode, power Doppler, SWE, and UTC. Asymptomatic controls (n = 37) were evaluated at T 0. Diagnostic accuracy was analyzed based on a quantitative receiver operating characteristic (ROC) analysis with quantitative cutoff values (anteroposterior diameter, Öhberg score, UTC echo type, Young modulus) and by semiquantitative Likert scale–based assessment of experienced physicians. Results: For diagnosing insertional Achilles tendinopathy, semiquantitative MRI and power Doppler were most favorable (diagnostic accuracy, 95%), while the cross-sectional area of MRI revealed 89% accuracy in the ROC analyses (area under the curve [AUC], 0.911; P < .001). For diagnosing midportion Achilles tendinopathy, semiquantitative MRI and B-mode were most favorable (diagnostic accuracy, 87%), while UTC echo types 3 and 4 revealed 86% and 87% accuracy, respectively, in the ROC analyses (AUC, 0.911 and 0.941, respectively; P < .001). However, for quantitative and semiquantitative evaluation of diagnostic accuracy in both insertional and midportion Achilles tendinopathy, there was no significant difference in favor of one imaging modality over the others. Compared with baseline, only SWE showed a significant change at the 6-month follow-up ( P = .003-.035), but there were only fair to poor monitoring accuracies of 71% (insertion) and 60% (midportion). However, compared with the other modalities, the monitoring accuracy of SWE was significantly higher ( P = .002-.039). Conclusion: There was no statistically significant difference in favor of one imaging modality over the others, but MRI revealed the highest overall diagnostic accuracy for the diagnosis of both insertional and midportion Achilles tendinopathy.
Transition to Telehealth Physical Therapy After Hip Arthroscopy for Femoroacetabular Impingement: A Pilot Study With Retrospective Matched-Cohort Analysis
Authors: Horton Brandy S. , Marland Jennifer D. , West Hugh S. , Wylie James D. 
Published: April 2021

Background: Telehealth use has increased significantly of late. However, outside of total hip and knee arthroplasty, there is minimal evidence regarding its efficacy in orthopaedics and postoperative rehabilitation. Purpose: To determine the efficacy and cost-effectiveness of a transition to postoperative telehealth physical therapy in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI). Study Design: Cohort study; Level of evidence, 3. Methods: Included were 51 patients undergoing postoperative physical therapy after hip arthroscopy for FAI. The intervention group consisted of patients undergoing initial in-person visits followed by a transition to telehealth physical therapy for 3 months postoperatively (group 1; n = 17). Comparison groups included patients undergoing in-person physical therapy with the same physical therapy team as the telehealth group (group 2; n = 17) and patients undergoing in-person therapy with a different therapy team at the same facility (group 3; n = 17). All groups were matched 1-to-1 by patient age and sex. All patients completed the short version of the International Hip Outcome Tool (iHOT-12) both preoperatively and at 3 months postoperatively. At 3 months postoperatively, it was determined whether patients met the minimally clinically important difference (MCID; ≥13 points) or substantial clinical benefit (SCB; ≥28 points) or whether they reached a Patient Acceptable Symptomatic State (PASS; ≥64 points). Billed charges were recorded as a measure of cost. Results: The overall mean age of the study patients ranged from 33 to 34 years. Among the 3 groups, there was no significant difference in the preoperative, postoperative, or pre- to postoperative change in iHOT-12 scores or in the percentage of patients meeting MCID, SCB, or PASS at 3 months. Group 1 had significantly lower mean costs ($1015.67) compared with group 2 ($1555.62; P = .011) or group 3 ($1896.38; P < .001). Conclusion: In this pilot study, telehealth physical therapy after hip arthroscopy was found to lead to similar short-term outcomes and was cost-effective compared with in-person physical therapy.
Impact of the COVID-19 pandemic on acute surgical patients’ discharge summaries – Experience of Wales worst-hit COVID-19 hospital
Authors: Ooi Rucira , Stimson Imogen Bambrough , Williams Gethin 
Published: April 2021

Background The emergence of the COVID-19 pandemic has placed increased demands on the NHS workforce, especially in medical and intensive care units. The subsequent redistribution of surgical house officers to accommodate this in a single-centre NHS hospital has possibly negatively impacted on the effective discharge notification of acute surgical patients. Methods Discharge summaries of all patients directly discharged from a Surgical Assessment Unit were collected on the day of discharge and analysed to identify the date of completion and staff grade of the responsible clinician. Data collection was carried out before the initiation of lockdown measures and continued for a further three weeks during the peak of the COVID-19 pandemic with an interventional period in between. A poster was created and displayed in areas where discharge software could be accessed. Results In the initial audit, 36.2% of the 246 patients had delayed discharge summaries with an average of 7 days to complete. On re-evaluation, 45.3% of the 223 patients had delayed discharge summaries, taking an average of 12 days to complete. A survey conducted post-re-audit identified that the most common reason for delayed discharge summaries was due to time constraints associated with the increased workload. Conclusion The reallocation of surgical staff in response to the COVID-19 pandemic has affected communication between primary and secondary care, with a rise in delayed discharge letters of acute surgical patients. Given the potential repercussions of these delays, healthcare systems should be aware of this consequence of the pandemic, especially in preparation for any resurgences.
Everolimus regulates the activity of gemcitabine-resistant pancreatic cancer cells by targeting the Warburg effect via PI3K/AKT/mTOR signaling
Authors: Cui Jing , Guo Yao , Wu Heshui , Xiong Jiongxin , Peng Tao 
Published: April 2021

Abstract
Background
Gemcitabine (GEM) resistance remains a significant clinical challenge in pancreatic cancer treatment. Here, we investigated the therapeutic utility of everolimus (Evr), an inhibitor of mammalian target of rapamycin (mTOR), in targeting the Warburg effect to overcome GEM resistance in pancreatic cancer.

Methods
The effect of Evr and/or mTOR overexpression or GEM on cell viability, migration, apoptosis, and glucose metabolism (Warburg effect) was evaluated in GEM-sensitive (GEMsen) and GEM-resistant (GEMres) pancreatic cancer cells.

Results
We demonstrated that the upregulation of mTOR enhanced cell viability and favored the Warburg effect in pancreatic cancer cells via the regulation of PI3K/AKT/mTOR signaling. However, this effect was counteracted by Evr, which inhibited aerobic glycolysis by reducing the levels of glucose, lactic acid, and adenosine triphosphate and suppressing the expression of glucose transporter 1, lactate dehydrogenase-B, hexokinase 2, and pyruvate kinase M2 in GEMsen and GEMres cells. Evr also promoted apoptosis by upregulating the pro-apoptotic proteins Bax and cytochrome-c and downregulating the anti-apoptotic protein Bcl-2. GEM was minimally effective in suppressing GEMres cell activity, but the therapeutic effectiveness of Evr against pancreatic cancer growth was greater in GEMres cells than that in GEMsen cells. In vivo studies confirmed that while GEM failed to inhibit the progression of GEMres tumors, Evr significantly decreased the volume of GEMres tumors while suppressing tumor cell proliferation and enhancing tumor apoptosis in the presence of GEM.

Conclusions
Evr treatment may be a promising strategy to target the growth and activity of GEM-resistant pancreatic cancer cells by regulating glucose metabolism via inactivation of PI3K/AKT/mTOR signaling.
Normal contact performance of mortise and tenon joint: theoretical analysis and numerical simulation
Authors: Xie Qifang , Zhang Baozhuang , Zhang Lipeng , Guo Tiantian , Wu Yajie 
Published: April 2021

AbstractThis article aims to investigate the contact characteristics of mortise and tenon (M&T) joints in the traditional timber structures. In particular, the normal embedded compressive contact between contact surfaces of M&T joint was investigated. Based on basic contact theory and contact characteristics between mortise and tenon, a normal elasto-plastic contact model, which can reflect the real normal contact behavior of M&T joints in traditional wooden structures, was proposed. Coulomb friction contact was utilized to describe the tangential slipping characteristics of the contact surfaces. Micro-morphology scanning tests of wood samples with different roughness were carried out to determine the parameters involved in the normal contact model. The normal contact model subroutine of M&T joint was compiled by FORTRAN language, implemented into ABAQUS through user-defined interface (UINTER). Then the proposed model was verified by shear tests of wood contact surfaces considering different normal pressures. Finally, a finite element model (FEM) of straight tenon joint subjected to cyclic reversed loading, based on the proposed normal elasto-plastic contact model, was developed, and a FEM considering normal “hard contact” between the contact surfaces, was also performed. The simulation results were validated by the experimental results. Results showed that the user-defined normal elasto-plastic contact FEM was more in line with the actual force state and mechanical behavior of M&T joints, which can more accurately predict the failure modes and simulate the hysteretic behavior of M&T joints, compared to the FEM considering normal “hard contact” of the contact surfaces.