bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Retrospective Comparison of the Effectiveness and Safety of Intravenous Olanzapine Versus Intravenous Haloperidol for Agitation in Adult Intensive Care Unit Patients
Authors: Wang Michelle , Yankama Tuyen T. , Abdallah George T. , Eche Ijeoma Julie , Knoph Kristen N. , Wong Adrian , Patel Parth , Hsu Douglas , Eche Ifeoma Mary 
Published: January 2021

Objective: Intravenous (IV) olanzapine could be an alternative to first-generation antipsychotics for the management of agitation in intensive care unit (ICU) patients. We compared the effectiveness and safety of IV olanzapine to IV haloperidol for agitation management in adult patients in the ICU at a tertiary academic medical center. Methods: A retrospective cohort study was conducted. The primary outcome was the proportion of patients who achieved a Richmond Agitation Sedation Scale (RASS) score of < +1 within 4 hours of IV olanzapine or IV haloperidol administration. Secondary outcomes included the proportion of patients who required rescue medications for agitation within 4 hours of initial IV olanzapine or IV haloperidol administration, incidence of adverse events and ICU length of stay. Results: In the 192 patient analytic cohort, there was no difference in the proportion of patients who achieved a RASS score of < +1 within 4 hours of receiving IV olanzapine or IV haloperidol (49% vs. 42%, p = 0.31). Patients in the IV haloperidol group were more likely to receive rescue medications (28% vs 55%, p < 0.01). There was no difference in the incidence of respiratory events or hypotension between IV olanzapine and IV haloperidol. Patients in the IV olanzapine group experienced more bradycardia (11% vs. 3%, p = 0.04) and somnolence (9% vs. 1%, p = 0.02) compared to the IV haloperidol group. Patients in the IV olanzapine group had a longer median ICU length of stay (7.5 days vs. 5 days, p = 0.04). Conclusion: In this retrospective cohort study, there was no difference in the effectiveness of IV olanzapine compared to IV haloperidol for the management of agitation. IV olanzapine was associated with an increased incidence of bradycardia and somnolence.
Infant-Driven Feeding Systems: Do They “Normalize” the Feeding Experience of Infants With Cleft Palate?
Authors: Madhoun Lauren L. , O’Brien Meghan , Baylis Adriane L. 
Published: January 2021

Objective: To examine feeding skills of infants with cleft palate with or without cleft lip (CP±L) using infant-driven feeding systems compared to healthy controls on standard bottles. Design: Cross-sectional cohort. Setting: Large pediatric academic medical center in the Midwestern United States. Participants: Infants with CP±L (n = 15) using the Dr. Brown’s Specialty Feeding System and typically developing infants without CP±L (n = 15) using the Dr. Brown’s Natural Flow Original or Options bottles. Main Outcome Measure(s): Bottle-feeding proficiency, duration, milk transfer, and signs of feeding difficulty. Results: Five-minute feeding proficiency differed significantly between groups with the control group taking 44% of the feed compared to 15% for the CP±L group on level 1 ( P < .001) and 21% on level 2 ( P < .001) nipples. Proportion of milk transfer was 96% ± 7% for controls and 75% ± 24% for the CP±L group ( P = .013). Feeding duration (minutes) differed between the control group (13 ± 3) and the CP±L groups on each nipple level (level 1: 29 ± 16; P = .003; level 2: 32 ± 11; P = .001). Milk transfer rate (mL/min) was 9 ± 3 for control infants compared to 3 ± 1 for infants with CP±L on level 1 ( P < .001) and 5 ± 1 on level 2 ( P = .007). Coughing occurred in 40% of infants with CP±L and 27% of controls. Conclusions: Even when using specialty bottles, infants with CP±L differ from noncleft infants in feeding proficiency, duration, and overall intake.
Does nutritional status affect treatment tolerability, chemotherapy response and survival in metastatic gastric cancer patients? Results of a prospective multicenter study in Turkey
Authors: Karabulut Senem , Dogan Izzet , Usul Afsar Cigdem , Karabulut Mehmet , Ak Naziye , Duran Ali , Tastekin Didem 
Published: January 2021

Background The possible impact of malnutrition on the efficacy and tolerability of modern chemotherapy for metastatic gastic adenocarcinoma (mGC) patients is unclear. With this study, we aimed to represent the possible impact of malnutrition on the efficacy and tolerability of chemotherapy, and also on the overall survival of mGC patients. Methods In this prospective multicenter study, we collected demographic, oncological and nutritional data of our mGC patients. The nutritional status of patients were assessed with the Nutritional Risk Index (NRI), Body Mass Index (BMI) and weight loss percentage within 21-day period, between the chemotherapy cycles. All of these parameters along with toxicity assessment were evaluated after each courses of chemotherapy in order to determine inter-treatment weight loss. NRIs were calculated with a formula as follows; [1.519 × serum albumin level(g/L) + 41.7 × current weight/basic weight]. Patients were classified as having ‘no malnutrition’ (NRI > 97.5), ‘moderate malnutrition’ (97.5 ≥ NRI ≥ 83.5) or ‘severe malnutrition’ (NRI < 83.5). Drug-induced toxicities and treatment responses were evaluated via National Cancer Institute CTCAE version 4.0 and RECIST Criteria 1.1, respectively. Results One hundred and sixteen mGC patients were enrolled into the study. Median age was 60 years with range 32–83. Primary location of the tumor was antrum in 40% of the patients and of which 24% had undergone primary tumor resection. Ninety-eight percent of the patients had WHO performance status 0 or 1. Malnutrition was diagnosed in 67% of the patients and was severe in 31% of them. All patients received chemotherapy as first-line setting. Severe malnutrition was not associated with chemotherapy responses (p = 0.57). Moderate/severe malnutrition was associated with more cytopenia, nausea/vomiting, diarrhea, neuropathy, (p < 0.05 for all parameters). Moderate/severe malnutrition is associated with worser non-hematological toxicities (p = 0.038). Forty-one percent of patients died during the follow up period (Median: 138 days, range: 21–378). Malnutritional level was associated with significantly reduced overall survival. Severe malnutrition was associated with shorter median overall survival (74 days (95% CI, 20.7–111.0) vs. 237 (95% CI, 148.4-325.6) in none/moderate groups, p = 0.007). Conclusions In mGC patients, moderate/severe malnutrition is associated with worse non-hematological toxicities. Severe malnutrition is also associated with reduced overall survival.
Autoimmune hemolytic anemia in a patient with myelodysplastic syndrome: Responding to 5-azacitidine therapy
Authors: Kaur Jaspreet , Tuler Shahaf , Dasanu Constantin A 
Published: January 2021

Introduction Autoimmune disorders, including autoimmune cytopenias, are more common in patients with myelodysplastic syndrome (MDS) and may share with MDS the same steps of pathogenesis. Some patients with MDS have antibodies against red cells. Case report We describe herein a 79-year-old patient who presented with fatigue, jaundice and pancytopenia. She was diagnosed with warm-antibody autoimmune hemolytic anemia (AIHA) and synchronous MDS. Management and outcome: In our patient, AIHA responded to the hypomethylating agent 5-azacitidine used for the treatment of MDS. Six months later, the patient remains in clinico-laboratory remission for both MDS and AIHA. Discussion/conclusions Our case indirectly suggests that 5-azacitidine led to a decrease in autoantibody production by the auto-reactive B-cell clone in MDS leading in turn to a diminished rate of autoimmune hemolysis. If our observation is accurate, we believe that similar reports will populate the scientific literature in the future years.
Effect of Distractors on Sustained Attention and Hyperactivity in Youth With Attention Deficit Hyperactivity Disorder Using a Mobile Virtual Reality School Program
Authors: Hong Narae , Kim Jae-jin , Kwon Joon-Hee , Eom Hyojung , Kim Eunjoo 
Published: January 2021

Objective: This study examined whether distractors in virtual reality (VR) environment affected the attention and hyperactivity in children and adolescents with ADHD. Method: A total of 40 students (21 ADHD, 19 controls) aged between 9 and 17 years participated in this study. A rapid visual information processing task utilizing VR (VR-RVP) was performed under two conditions (no-distractor and distractor condition). Task performance and head movement during each condition were compared, and additional analyses were conducted after grouping participants into two developmental stages. Results: Children with ADHD performed comparably to the controls under the distractor condition, but had poorer performance under the no-distractor condition. They displayed more head movement under the distractor condition than in the no-distractor condition. Conclusion: VR is possibly a useful tool for investigating the effect of distractors on individuals with ADHD, and children with ADHD are more vulnerable to a low-level stimulation situation than normal children in VR.
Evaluation of the difficulty of peripheral venous cannulation during anesthesia induction in children: Is DIVA score sufficient?
Authors: Keskin Gulsen , Akin Mine , Senayli Yesim , Saydam Sibel , Kurt Devrim Tanil 
Published: January 2021

Background: The primary objective of the present study was to determine the rate and the independent predictors of the difficult peripheral intravascular access (PIVA) in the operating room (OR). The secondary objective was to validate the ability of the difficult intravenous access (DIVA) scoring system in the detection of difficult PIVA in the operating room. Methods: In this prospective observational study, patients between 0 and 18 years old who were operated in the pediatric hospital were evaluated. Peripheral intravenous cannulation performed during inhalation induction in 1008 patients were recorded. The following data were collected: demographic characteristics, the presence of a chronic disease, the DIVA score, operating room temperature, the area of PIVA application, the duration of PIVA and the number of PIVA attempts. The independent determinants of the difficult PIVA were determined with multivariate logistic regression. Results: A total of 1008 patients (82% boys) with a median age of 4 (range 0.04–17 years) were included in the study. The median number of PIVA attempts was 1 whereas the median duration for successful PIVA was 15 s (range 4–2100). PIVA was successful at the first attempt in 75.3% of patients. Among patients who required more than two PIVA attempts, the most common adjunctive method was to seek help from another operator (80.8%). In the multivariable logistic regression model, only the presence of chronic disease, being underweight, and DIVA score ⩾4 (OR 6.355, CI 4.57–9.486) remained to be the significant determinants of difficult PIVA. Conclusion: The success rate of anesthesiologist-performed PIVA at the first attempt in the OR was 75.3%. Having a chronic disease, a DIVA score ⩾4 and being underweight appeared as the independent predictors for difficult PIVA.
Core experiences of parents of children with autism during the COVID-19 pandemic lockdown
Authors: Tokatly Latzer Itay , Leitner Yael , Karnieli-Miller Orit 
Published: January 2021

The lockdown that was imposed by governments as part of the attempt to contain the COVID-19 pandemic included extreme measures, such as home confinement and the shutting down of special education systems. Our aim was to learn about the core experiences of parents of children with autism during this significant life disturbance. Thirty-one parents of 25 children with autism participated in semi-structured telephone interviews which were transcribed verbatim and underwent a qualitative, immersion/crystallization analysis. The analysis was conducted in an iterative consensus-building process to identify parents’ experiences, concerns, challenges, coping strategies, and perceived needs during the lockdown. The main themes that emerged related to the various parental concerns; the major difficulties encountered during this unique time, the functional, social, and behavioral implications the lockdown had on these children; and the manner in which the parents coped as an indication of their resourcefulness and outlook. Our findings broaden the insight into the underlying elements of the hardships and gains experienced by children with autism and their parents in times of significant life adversity. Programs in such times should be directed at supporting and guiding parents on how to better accommodate to the situation, thereby optimizing their coping strategies and resilience. Lay abstract The lockdown and home isolation due to the COVID-19 pandemic led to significant transformation in lifestyles. Being a parent in this situation was not easy for anyone, much less for parents of children with special needs. The shutting down of special education systems meant that parents lost a vital support network and had to be the sole full-time caregivers despite often lacking the skills to cope with this new and daunting situation. We interviewed parents and learned that the main difficulties faced by homebound autistic children stemmed from the change in routine, lack of special education services, limited physical space, and food- and sleep-related issues. Some children experienced worsening in behavioral, social, and developmental domains, yet others seemed to not only overcome the challenges of changing conditions but even benefit from them. The children’s success or failure was directly related to how their parents coped. The key factors that enabled successful coping were the parents’ ability to accommodate to the child’s needs, their own creativeness and resourcefulness, and a generally positive outlook. The results of this analysis revealed that the best way to benefit autistic children caught up in drastic changes in their routine lifestyle is to invest in a strong support system for their parents.
Research Attitudes Questionnaire scores predict Alzheimer’s disease clinical trial dropout
Authors: Stites Shana D , Turner R Scott , Gill Jeanine , Gurian Anna , Karlawish Jason , Grill Joshua D ,   for the Alzheimer’s Disease Cooperative Study
Published: January 2021

Background Missing data are a notable problem in Alzheimer’s disease clinical trials. One cause of missing data is participant dropout. The Research Attitudes Questionnaire is a 7-item instrument that measures an individual’s attitudes toward biomedical research, with higher scores indicating more favorable attitudes. The objective of this study was to describe the performance of the Research Attitudes Questionnaire over time and to examine whether Research Attitudes Questionnaire scores predict study dropout and other participant behaviors that affect trial integrity. Methods The Research Attitudes Questionnaire was collected at baseline and weeks 26 and 52 from each member of 119 participant/study partner dyads enrolled in a Phase 2, randomized, double-blind, placebo-controlled mild-to-moderate Alzheimer’s disease clinical trial. Within-subject longitudinal analyses examined change in Research Attitudes Questionnaire scores over time in each population. Logistic regression analyses that controlled for trial arm and clustering in trial sites were used to assess whether baseline Research Attitudes Questionnaire scores predicted trial completion, study medication compliance, and enrollment in optional substudies. Results Participants and study partners endorsed statistically similar ratings on the Research Attitudes Questionnaire that were stable over time. Participants with baseline Research Attitudes Questionnaire scores above 28.5 were 4.7 (95% confidence interval = 1.01 to 21.95) times as likely to complete the trial compared to those with lower scores. Applying the same cutoff, baseline study partner Research Attitudes Questionnaire scores were similarly able to predict study completion (odds ratio = 4.2, 95% confidence interval = 1.71 to 10.32). Using a score cutoff of 27.5, higher participant Research Attitudes Questionnaire scores predicted study medication compliance (odds ratio = 5.85, 95% confidence interval = 1.34 to 25.54). No relationship was observed between Research Attitudes Questionnaire score and participation in optional substudies. Conclusion This brief instrument that measures research attitudes may identify participants at risk for behaviors that cause missing data.
Primary lung tumour invading the chest wall
Authors: Charnock Mark 
Published: January 2021

Introduction This case study describes a primary lung tumour invading the chest wall, that clinically was thought likely to be a lipoma, and was imaged first using ultrasound. Case Report A 67 year old male presented to his GP with a six month history of a lump increasing in size on the left upper chest wall. The ultrasound scan demonstrated a hypoechoic and hypervascular soft tissue mass, extending out of the chest into the subcutaneous tissue and starting to erode the overlying rib. The appearances were highly suspicious for a chest malignancy. Further imaging and an ultrasound guided biopsy confirmed the diagnosis of a squamous cell carcinoma. Discussion The majority of patients who present to their general practitioner with a soft tissue mass commonly have benign abnormalities such as a lipoma or epidermoid cyst. Tumours of the chest wall are varied and are divided into benign and malignant tumours, and those that arise from the rib cage. Primary lung tumours are uncommonly seen on ultrasound. Lung cancers account for around 20% of all cancer deaths and the chest wall is involved in around 5% of primary lung tumours. Conclusion This case highlights the need for prompt investigation of enlarging superficial masses. Ultrasound imaging offers excellent detail for superficial structures and in this case, due to the location of the mass, identified a primary lung tumour.
Clinical impact of the tumor immune microenvironment in completely resected stage IIIA(N2) non-small cell lung cancer based on an immunological score approach
Authors: Feng Wen , Li Yuan , Shen Lei , Zhang Qin , Cai Xu-Wei , Zhu Zheng-Fei , Sun Meng-Hong , Chen Hai-Quan , Fu Xiao-Long 
Published: January 2021

Background: Completely resected stage IIIA(N2) non-small cell lung cancer (NSCLC) comprises a heterogeneous population according to discrepancies in survival prognosis. Accumulating evidence suggests that tumor-infiltrating lymphocytes (TILs) are clinically significant, despite a lack of consensus regarding the immunological score (IS) in NSCLC. Here, we determined the prognostic value of the immune microenvironment as an IS in a uniform cohort of patients with completely resected stage IIIA(N2) NSCLC. Methods: Consecutive patients with pathologically confirmed stage IIIA(N2) NSCLC and who underwent complete resection (2005–2012) were retrospectively reviewed. Tissue microarrays (TMAs) were constructed from surgical paraffin-embedded primary lung tumor specimen. For each case, two representative regions from the tumor center (CT) and two from the invasive margin (IM) containing the highest density of lymphocytes were selected. Densities of CD3+, CD45RO+, and CD8+ lymphocytes were assessed using immunohistochemistry (IHC) by specialized pathologists according to predefined scoring scales. Patients were classified according to IS definition based on TIL type, density, and distribution, and relationships between IS and prognosis were evaluated. Results: Patients ( N = 288) with complete IHC-based TMA spots were included. Univariate analyses showed that CD3+ T cell density was associated with neither overall survival (OS) nor distant metastasis-free survival (DMFS), whereas CD45RO+ T cell density in the IM was a significant prognostic factor for DMFS ( p = 0.02) and was predictive of OS ( p = 0.05). Combined CD45RO+ and CD8+ cell infiltration in tumor regions (CT and IM) significantly improved IS prognostic impact. Multivariate analyses revealed IS as an independent prognostic predictor for both DMFS ( p = 0.001) and OS ( p = 0.002). Conclusion: The proposed IS might provide valuable prognostic information, including prediction of DMFS and OS in stage IIIA(N2) NSCLC patients. Larger patient cohorts are needed to validate this IS classification, which might assist with accurate risk stratification and treatment decisions.
Real-World Efficacy of the Hybrid Closed-Loop System
Authors: Usoh Chinenye O. , Johnson Crystal Paige , Speiser Jaime L. , Bundy Richa , Dharod Ajay , Aloi Joseph A. 
Published: January 2021

Background: Hybrid closed-loop (HCL) insulin pump therapy (Medtronic 670G) is an emerging technology that is growing in use worldwide. Initial clinical trials demonstrated the effectiveness of HCL in reducing hypoglycemia and improving glucose control; however, these subjects were intensely monitored and supervised. There has been concern regarding the ability of patients to remain in auto mode. We aimed to assess HCL when used in a typical outpatient endocrine clinic. Methods: We initially analyzed data from 80 individuals with type 1 diabetes managed in an endocrine clinic by a single certified diabetes educator (CDE). We then included our other providers and had 230 subjects by the end of the study. Patients were either transitioned from traditional insulin pump or multiple daily insulin injection therapy (MDI) to HCL. Patients initiated to HCL pump therapy from July 2017 through February 2020 were studied. Endpoints of change in time in hypoglycemic/hyperglycemic range and time in target range were analyzed. The primary outcome was a change in percent time in the target range during manual mode compared with auto mode. Results: There was an 18.2% increase in average time in target range when comparing manual mode to auto mode (59.3% vs 70.1%, P < .0001). Average time in hyperglycemic range was significantly reduced by 26.7% (39.0% vs 28.6%, P < .0001) but without increasing average time in hypoglycemic range (1.7% vs 1.3%, P = 0.95). Conclusions: HCL was effective in reducing hyperglycemia and increasing time in the target range but did not increase hypoglycemia. These data suggest HCL will improve the metrics of glucose control.
The fibula and talus position difference in functional and mechanical ankle instability: MRI findings
Authors: Yuan Chengjie , Zhu Genrui , Wang Zhifeng , Wang Chen , Wang Xu , Ma Xin 
Published: January 2021

Purpose: This study aimed to use MRI to evaluate the fibula and talus position difference in functional and mechanical ankle stability patients. Methods: 61 and 68 patients with functional and mechanical instability, and 60 healthy volunteers were involved. Based on the axial MRI images, the rotation of the talus was identified through the Malleolar Talus Index (MTI). The position relative to the talus (Axial Malleolar Index, AMI) and medial malleolus (Intermalleolar Index, IMI) were used to evaluated the displacement of the fibula. Results: Post hoc analysis showed that the values of malleolar talus index was significantly larger among mechanical instability (89.18° ± 2.31°) than that in functional instability patients (86.55° ±61.65°, P < 0.001) and healthy volunteers (85.59° ± 2.42°, P < 0.001). The axial malleolar index of the mechanical instability patients (11.39° ± 1.41°) were significantly larger than healthy volunteers (7.91° ± 0.83°) (P < 0.0001). There were no statistically significant differences in the above three indexes between the functional instability patients and healthy volunteers. Conclusion: The functional instability patients didn’t have a posteriorly positioned fibula and an internally rotated talus. The malleolar talus index was significantly larger among mechanical instability patients than that in functional instability patients. Increased malleolar talus index may become a new indirect MRI sign for identifying functional and mechanical instability patients.