bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopic versus open partial nephrectomy for the management of highly complex renal tumors with PADUA score ⩾10: A single center analysis.
Authors: Chiancone Francesco , Fabiano Marco , Meccariello Clemente , Fedelini Maurizio , Persico Francesco , Fedelini Paolo 
Published: March 2021

Introduction: The aim of this study was to compare laparoscopic and open partial nephrectomy (PN) for renal tumors of high surgical complexity (PADUA score ⩾10). Methods: We retrospectively evaluated 93 consecutive patients who underwent PN at our department from January 2015 to September 2019. 21 patients underwent open partial nephrectomy (OPN) (Group A) and 72 underwent laparoscopic partial nephrectomy (LPN) (Group B). All OPNs were performed with a retroperitoneal approach, while all LPNs were performed with a transperitoneal approach by a single surgical team. Post-operative complications were classified according to the Clavien-Dindo system. Results: The two groups showed no difference in terms of patients’ demographics as well as tumor characteristics in all variables. Group A was found to be similar to group B in terms of operation time ( p = 0.781), conversion to radical nephrectomy ( p = 0.3485), and positive surgical margins ( p = 0.338) while estimated blood loss ( p = 0.0205), intra-operative ( p = 0.0104), and post-operative ( p = 0.0081) transfusion rates, drainage time ( p = 0.0012), pain score at post-operative day 1 (<0.0001) were significantly lower in Group B. The rate of enucleation and enucleoresection/polar resection was similar ( p = 0.1821) among the groups. Logistic regression analysis indicated that preoperative factors were not independently associated with the surgical approach. There was a statistically significant difference in complication rate (<0.0001) between the two groups even if no significant difference in terms of grade ⩾3 post-operative complications ( p = 0.3382) was detected. Discussion: LPN represents a feasible and safe approach for high complex renal tumors if performed in highly experienced laparoscopic centers. This procedure offers good intraoperative outcomes and a low rate of post-operative complications.
Meaning of critical traumatic injury for a patient’s body and self
Authors: Tsai Yu-Lun , Chiang Hsien-Hsien , Chen Yu-Ju , Chiang Hui-Hsun , Chen Yuan-Hao , Liaw Jen-Jiuan 
Published: March 2021

Background: Patients with a traumatic injury often require intensive care for life-saving treatments. Physical suffering and emotional stress during critical care can be alleviated by ethical caring provided by nurses. The relationship between body and self are fundamentally inseparable. Nurses need to understand the impacts of traumatic injury on a patient’s body and self. Aim: To understand the meaning of traumatic injury for body and self for patients receiving intensive care. Research design: A qualitative descriptive study using Giorgi’s phenomenological approach. Participants and research context: Patients receiving intensive care for physical trauma were selected by purposive sampling (N = 15) from a medical center in Taiwan. Individual in-depth, face-to-face audiotaped interviews, guided by semi-structured questions, were used to collect data. Each interview lasted 30–60 min. Audiotaped interviews were transcribed and analyzed. Ethical considerations: This study was approved by the Institutional Review Board of the medical center. Findings: The impact of the experience of traumatic injury on participants’ body and self was described by three main themes: (1) Searching for the meaning of the injured body, (2) Feeling trapped in the bed, and (3) The carer and the cared-for. Discussion and conclusion: The implications of the three themes described in the findings are as follows: Trauma as a source of meaning; Body and self are mutually limiting or mutually enabling; and Ethical relationships. The experience of needing intensive care following a traumatic injury on the body and self was dynamic and mutual. The experience of the injury changed the relationship between body and self, and gave new meaning to life. Nurses play a crucial role in continuity of care by understanding the meaning of a traumatic injury for patient’s body and self that facilitates ethical care and recovery from injury.
Pediatric Ventricular Assist Device Implantation: An Anesthesia Perspective
Authors: Newington Dash F. T. , De Rita Fabrizio , McCheyne Alan , Barker Claire Louise 
Published: March 2021

Background Ventricular assist devices (VADs) are increasingly being implanted in children, yet there is little literature to guide anesthetic management for these procedures. Aims To describe the pediatric population presenting for VAD implantation and the anesthetic management these patients receive. To compare (a) children under and over 12 months of age and (b) children with and without congenital heart disease. Methods Retrospective review of patients aged 0 to 17 years who underwent VAD implantation at a single center between 2014 and 2019. Results Seventy-seven VADs were implanted in 68 patients (46 left VADs, 24 biventricular VADs, 6 right VADs, and 1 univentricular VAD). One procedure was abandoned. Preoperatively, 20 (26%) patients were supported with extracorporeal membrane oxygenation and 57 (73%) patients were ventilated. Intraoperative donor blood products were required in 74 (95%) cases. Postimplantation inotropic support was required in 66 (85%) cases overall and 46 (100%) patients receiving a left VAD. Infants under 12 months were more likely to require preoperative extracorporeal membrane oxygenation (42% vs 19%), have femoral venous access (54% vs 28%), receive an intraoperative vasoconstrictor (42% vs 24%), and have delayed sternal closure (63 vs 22%). Mortality was higher in patients under 12 months (25% vs 19%) and in patients with congenital heart disease (25% vs 20%). Conclusions Children undergoing VAD implantation require high levels of preoperative organ support, high-dose intraoperative inotropic support, and high-volume blood transfusion. Children under 12 months and those with congenital heart disease are particularly challenging for anesthesiologists and have worse overall outcomes.
‘You don’t look autistic’: A qualitative exploration of women’s experiences of being the ‘autistic other’
Authors: Seers Kate , Hogg Rachel C 
Published: March 2021

There is currently a paucity of literature exploring the experiences of women on the autism spectrum. It is imperative research is conducted to capture the experiences of women on the autism spectrum and ensure appropriate support is provided to this cohort. Drawing upon a social constructionist framework, this qualitative research study sought to understand how psychological and socio-cultural constructions of autism spectrum condition and gender influence the well-being of women on the autism spectrum. Eight participants engaged in a semi-structured interview, with thematic analysis conducted to demonstrate the impact of gender roles and social expectations on the women’s identity and autism spectrum condition expression. The research highlighted the changing understandings of autism spectrum condition across a woman’s lifespan and the process and impact of resisting hegemonic autism spectrum condition categorisation. The findings demonstrate that social constructions of gender and stereotypical understandings of autism spectrum condition, which prioritise a deficit, medical model, have significant consequences for women’s well-being and subjectivity. The women experienced challenging formative years, but with diagnosis and the evolution and acceptance of their identities, they were able to resist negative narratives of autism spectrum condition, embrace their strengths and develop adaptive coping strategies. It is hoped this article generates insights for societal and clinical recognition to better support women on the autism spectrum. Lay abstract Most autism spectrum condition research addresses the neurological and biological causes of autism spectrum condition, focusing upon deficits associated with autism spectrum condition and behavioural interventions designed to minimise these deficits. Little is known about the lived experiences of adult women on the autism spectrum and how they navigate social expectations around gender, autism spectrum condition and gendered understandings of autism spectrum condition. The lived experiences of eight women on the AS will be shared here, with attention to how gendered expectations influence women’s experiences of autism spectrum condition, their sense of self and well-being. Findings showed these women struggled to reconcile the expectations of others, particularly early in life. The women had difficultly conforming to stereotypical ideals of femininity, yet as they aged, they felt less need to conform, valuing their unique style and behaviours. The women also rejected deficit-oriented descriptions of autism spectrum condition generated by the medical community, preferring to focus on their strengths and unique characteristics. It is hoped this article helps psychologists and the wider community to understand and meet the needs of women on the AS.
A novel approach to assessing language proficiency in adults: A pre-pilot classification accuracy study
Authors: Schwarz Amy Louise , Resendiz Maria , Herrera Laura Catarina , Gonzales Maria Diana 
Published: March 2021

Aims and objectives/purpose/research questions: Speech–language pathologists who speak more than one language and who are members of the American Speech–Language–Hearing Association self-identify in one yes/no question whether they have the proficiency level to be bilingual service providers. This research note describes a preliminary attempt to address the very practical issue of whether and in what circumstances Spanish–English bilinguals can accurately judge their proficiency levels in both languages. The research question is: Will bilingual adults accurately identify their first language and second language proficiency levels using a self-assessment when compared to a commonly used standardized norm-referenced test (SNRT) in both formal and informal contexts across the following outcome measures: (a) overall proficiency; (b) listening; (c) speaking; (d) reading; and (e) writing? Design/methodology/approach: Classification accuracy studies require at least 34 participants. Thirty-nine participants completed the commonly used Language Use Questionnaire (LUQ) self-assessment and the commonly used Woodcock–Muñoz Language Survey SNRT (WMLS-III). For this pre-pilot study, participants were Spanish–English bilingual university students. Data and analysis: Forty likelihood ratios (LRs) were calculated. Benchmarks for interpreting LRs for classification accuracy studies were applied to identify the likelihood of an individual being proficient or non-proficient in two languages. Findings/conclusions: For the overall proficiency and formal speaking proficiency outcomes in Spanish, positive LRs met the benchmark for strong agreement. Originality: The current study is the first to show that Spanish–English bilingual adults can accurately judge their Spanish proficiency levels for two specific outcome measures. Significance/implications: These results are important for two reasons. First, they suggest that Spanish–English bilingual adults can accurately judge their overall proficiency levels in Spanish. Second, they identify which outcome measures from the LUQ and WMLS-III should be considered in a future classification accuracy study.
Dihydromyricetin Exhibits Antitumor Activity in Nasopharyngeal Cancer Cell Through Antagonizing Wnt/β-catenin Signaling
Authors: Ye Ling , Yin Gendi , Jiang Miaohua , Tu Bo , Li Zhicheng , Wang Yiming 
Published: March 2021

Background: Cancer stem cells (CSCs) have been demonstrated to play a vital role in a diversity of biological processes in cancers. With the emergence of new evidence, the important function of CSCs in the formation of multidrug resistance of nasopharyngeal cancer has been demonstrated. Dysregulated Wnt/β-catenin signaling pathway is an important contributor to chemoresistance and maintenance of CSCs-like characteristics. This research aims to investigate comprehensively the function of dihydromyricetin (DMY), a natural ﬂavonoid drug, on the cisplatin (cis) resistance and stem cell properties of nasopharyngeal cancer. Methods: In this study, the functional role of DMY in nasopharyngeal cancer progression was comprehensively investigated in vitro and in vivo, and then its relationship with CSCs-like phenotypes and multiple oncogenes was analyzed. Results: In parallel assays, the growth inhibitory action of cis was enhanced by the addition of DMY in cis-resistant nasopharyngeal cancer cell lines (Hone1/cis and CNE1/cis). Functional assays showed that DMY markedly diminished the stem cell properties of nasopharyngeal cells, such as colony and tumor-sphere formation. In vivo data showed that the growth of Hone1 CSCs formed tumor xenograft was inhibited significantly by the administration of DMY. Additionally, DMY could impair the Wnt/β-catenin signaling pathway and regulate the expression of downstream proteins in nasopharyngeal cancer cells. Conclusions: Our study clarified the anti-tumor activity of DMY through blocking the Wnt/β-catenin signaling pathway in nasopharyngeal cancer. Therefore, DMY could be a novel therapeutic agent for nasopharyngeal cancer treatment.
Physical Fitness Training in Patients with Subacute Stroke (PHYS-STROKE): Safety analyses of a randomized clinical trial
Authors: Rackoll Torsten , Nave Alexander H , Ebinger Martin , Endres Matthias , Grittner Ulrike , Flöel Agnes ,   ; for the PHYS-Stroke study group
Published: March 2021

Background and aim To report the six-month safety analyses among patients enrolled in the “Physical Fitness Training in Subacute Stroke—PHYS-STROKE” trial and identify underlying risk factors associated with serious adverse events. Methods We performed a pre-specified safety analysis of a multicenter, randomized controlled, endpoint-blinded trial comprising 200 patients with moderate to severe subacute stroke (days 5–45 after stroke) that were randomly assigned (1:1) to receive either aerobic, bodyweight supported, treadmill-based training (n = 105), or relaxation sessions (n = 95, control group). Each intervention session lasted for 25 min, five times weekly for four weeks, in addition to standard rehabilitation therapy. Serious adverse events defined as cerebro- and cardiovascular events, readmission to hospital, and death were assessed during six months of follow-up. Incident rate ratios (IRR) were calculated, and Poisson regression analyses were conducted to identify risk factors for serious adverse events and to test the association with aerobic training. Results Six months after stroke, 50 serious adverse events occurred in the trial with a higher incidence rate (per 100 patient-months) in the training group compared to the relaxation group (6.31 vs. 3.22; IRR 1.70, 95% CI 0.96 to 3.12). The association of aerobic training with serious adverse events incidence rates were modified by diabetes mellitus (IRR for interaction: 7.10, 95% CI 1.56 to 51.24) and by atrial fibrillation (IRR for interaction: 4.37, 95% CI 0.97 to 31.81). Conclusions Safety analysis of the PHYS-STROKE trial found a higher rate of serious adverse events in patients randomized to aerobic training compared to control within six months after stroke. Exploratory analyses found an association between serious adverse events occurrence in the aerobic training group with pre-existing diabetes mellitus and atrial fibrillation which should be further investigated in future trials. Data access statement The raw data and analyses scripts are provided by the authors on a secure online repository for reproduction of reported findings.
Malignant infarction after endovascular treatment: Incidence and prediction
Authors: Bernsen Marie Louise E , Kauw Frans , Martens Jasper M , van der Lugt Aad , Yo Lonneke SF , van Walderveen Marianne AA , Roos Yvo BWEM , van der Worp H Bart , Dankbaar Jan W , Hofmeijer Jeannette 
Published: March 2021

Background Early prediction of malignant infarction may guide treatment decisions. For patients who received endovascular treatment, the risk of malignant infarction is unknown and risk factors are unrevealed. Aims The objective of this study is to estimate the incidence of malignant infarction after endovascular treatment in patients with an occlusion of the anterior circulation, to identify independent risk factors, and to establish a model for prediction. Methods We analyzed patients who received endovascular treatment for a large vessel occlusion in the anterior circulation within 6.5 h after symptom onset, included in the Dutch MR CLEAN Registry between March 2014 and June 2016. We compared patients with and without malignant infarction. Candidate predictors were incorporated in a multivariable binary logistic regression model. The final prediction model was established using backward elimination. Discrimination and calibration were evaluated with the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow test. Results Of 1445 patients, 82 (6%) developed malignant infarction. Independent predictors were lower age, higher National Institutes of Health Stroke Scale (NIHSS), lower alberta stroke program early CT score (ASPECTS), internal carotid artery occlusion, lower collateral score, longer times from onset to groin puncture, and unsuccessful reperfusion. The AUROC of a prediction model combining these features was 0.83 (95% confidence interval (CI): 0.79–0.88) and the Hosmer-Lemeshow test indicated appropriate calibration (P = 0.937). Conclusion The risk of malignant infarction after endovascular treatment started within 6.5 h of stroke onset is approximately 6%. Successful reperfusion decreases the risk. A prediction model combining easily retrievable measures of age, ASPECTS, collateral status, and reperfusion shows good discrimination between patients who will develop malignant infarction and those who will not.
Recanalization after cerebral venous thrombosis. A randomized controlled trial of the safety and efficacy of dabigatran etexilate versus dose-adjusted warfarin in patients with cerebral venous and dural sinus thrombosis
Authors: Ferro José M , Bendszus Martin , Jansen Olav , Coutinho Jonathan M , Dentali Francesco , Kobayashi Adam , Aguiar de Sousa Diana , Neto Lia L , Miede Corinna , Caria Jorge , Huisman Holger , Diener Hans-Christoph ,   on behalf of the RE-SPECT CVT Study Group
Published: March 2021

Background The effect of different anticoagulants on recanalization after cerebral venous thrombosis has not been studied in a randomized controlled trial. Methods RE-SPECT CVT (ClinicalTrials.gov number: NCT02913326) was a Phase III, prospective, randomized, parallel-group, open-label, multicenter, exploratory trial with blinded endpoint adjudication. Acute cerebral venous thrombosis patients were allocated to dabigatran 150 mg twice daily, or dose-adjusted warfarin, for 24 weeks, after 5–15 days’ treatment with unfractionated or low-molecular-weight heparin. A standardized magnetic resonance protocol including arterial spin labeling, three-dimensional time-of-flight venography, and three-dimensional contrast-enhanced magnetic resonance angiography was obtained at the end of the treatment period. Cerebral venous recanalization at six months was assessed by two blinded adjudicators, using the difference in a score of occluded sinuses and veins (predefined secondary efficacy endpoint) and in the modified Qureshi scale (additional endpoint), between baseline and the end of the treatment. Results Of 120 cerebral venous thrombosis patients randomized, venous recanalization could be evaluated in 108 (55 allocated to dabigatran and 53 to warfarin, 1 patient had a missing occlusion score at baseline). No patient worsened in the score of occluded cerebral veins and sinuses, while 33 (60%) on dabigatran and 35 (67%) on warfarin improved. The mean score change from baseline in the occlusion score was similar in the two treatment groups (dabigatran −0.8, SD 0.78; warfarin −1.0, SD 0.92). In the modified Qureshi score, full recanalization was adjudicated in 24 (44%) and 19 (36%), and partial recanalization in 23 (42%) and 26 (49%) patients in the dabigatran and warfarin arms, respectively. No statistically significant treatment difference in the modified Qureshi score could be detected ( p = 0.44). Conclusion The majority of patients with cerebral venous thrombosis, anticoagulated with either dabigatran or warfarin for six months, showed partial or complete recanalization of occluded sinuses and veins at the end of the treatment. Clinical trial registration: Trial registry name: ClinicalTrials.gov URL: https://clinicaltrials.gov Registration number: NCT02913326
Non-contrast head CT-based thrombolysis for wake-up/unknown onset stroke is safe: A single-center study and meta-analysis
Authors: Zha Alicia M , Kamal Haris , Jeevarajan Jerome A , Arevalo Octavio , Zhu Liang , Ankrom Christy M , Bonfante-Mejia Eliana E , Cossey Tiffany D , Wu Tzu Ching , Barreto Andrew D , Grotta James C , Jagolino-Cole Amanda L 
Published: March 2021

Background Recent studies have shown that tPA can be safely administered past the standard 4.5 h window with good outcomes when selected with multi-model imaging, which is often lacking outside of comprehensive stroke centers. Aim We aim to analyze the safety and outcomes of wake up/unknown onset (WUS/UNK) patients treated based on non-contrast head CT (NCCT) at our institution and in the literature. Methods Suspected stroke patients from January 2015 to December 2018 receiving tPA within 4.5 h (standard window-SW) and with WUS/UNK based on NCCT and clinical-imaging mismatch were identified. We compared baseline characteristics, tPA metrics, and outcome data, with primary outcome as symptomatic intracerebral hemorrhage (sICH). A meta-analysis was performed evaluating NCCT-based treatment of WUS/UNK patients. Results Of 1827 patients treated at our hub or through telestroke, 93 underwent WUS/UNK-based treatment. There was no statistical difference in sICH between WUS/UNK and SW: 1% vs. 4% (OR 0.3; 95% confidence interval 0.0–1.9). 90-day modified Rankin scale outcomes were similar between SW and WUS/UNK-treated patients. Seven studies encompassing 485 WUS/UNK patients were included in a pooled analysis with a 2.1% incidence of sICH. In our meta-analysis, three studies compared NCCT-based treated WUS/UNK patients with SW patients with no difference in rate of hemorrhage: 2.1% vs 3.4% (OR 1.01; 95% confidence interval 0.45–2.28). Interpretation Our single-center analysis and meta-analysis suggest that tPA can be safely administered based on NCCT with comparable rates of sICH for select WUS/UNK stroke patients.