bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of rheumatoid arthritis and biologic and targeted synthetic disease modifying antirheumatic agents on cancer risk and recurrence
Authors: Singh Namrata , Li Christopher I. 
Published: March 2021

Purpose of review
Several new therapeutic drugs are now available for the management of rheumatoid arthritis (RA). Given that RA has been associated with an increased risk of certain cancers like lymphoma and lung cancer, concern remains about the safety of (newer) immunosuppressants used in RA management as it relates to the risk of cancer.

Recent findings
Most meta-analyses of randomized clinical trials of tumor necrosis factor inhibitors (TNFi) have not observed an association between TNFi and risk of incident cancer. Studies of non-TNFi biologic disease modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs and cancer are also reassuring but limited and of short-term follow-up. Regarding the use of DMARDs in patients with RA and a prior malignancy, retrospective studies have shown that TNFi use is not associated with recurrence.

Summary
There is a need for ongoing studies on the safety of non-TNFi bDMARDs and targeted synthetic disease modifying anti-rheumatic drugs and recurrent cancer. Further research is also needed to guide the patients, rheumatologists, and oncologists regarding the safest DMARDs to choose for patients with RA and a recent diagnosis of cancer.
The use of mycophenolate mofetil area under the curve
Authors: Chakrabarti Katherine , Frame David , Al Abbas Mousa , McCune W. Joseph 
Published: March 2021

Purpose of review
Although mycophenolate mofetil (MMF) has been used successfully to treat a myriad of autoimmune diseases, its complex pharmacokinetics make it difficult to determine the true drug exposure for an individual patient. This review summarizes the body of literature focused on the gold standard measurement of the area under the curve (AUC) of mycophenolic acid (MPA), the active metabolite of MMF.

Recent findings
Fixed dosing of MMF leads to highly variable drug exposure. Retrospective series have reported improved clinical outcomes when a minimum AUC value from 0 to 12 h (AUC0–12h) ≥30 mg h/l is achieved. MPA levels are affected by various drug interactions, hypoalbuminemia, and renal insufficiency and the measurement of free rather than total MPA levels is prudent in some situations. A limited number of studies employing prospective dose adjustment of MMF based on AUC0–12h measurements have yielded mixed results.

Summary
Given the wide range of MPA AUC encountered in autoimmune diseases, dose adjustments of MMF based on AUC rather than fixed dosing of MMF should be considered in both clinical practice and clinical trials. Limited sampling strategies have been proposed to improve clinical feasibility of measurements, but a standard is yet to be defined.
Arthrodesis of the Pubic Symphysis With Compression Plating and Femoral Strut Allograft for Pubic Instability and Osteitis Pubis: A Novel Surgical Technique
Authors: Catanzano Anthony A. , Kollmorgen Robert , Olson Steven A. 
Published: March 2021

Introduction:
Osteitis pubis and pubic instability represent an uncommon, yet a potentially debilitating problem for patients. While many cases are amendable to conservative measures, the few recalcitrant cases present a difficult challenge for surgical management with the risk of implant failure, nonunion, and potential complications.

Materials and Methods:
A retrospective review of 3 patients undergoing symphyseal arthrodesis with a strut allograft for osteitis pubis and/or pubic instability after failed conservative management was conducted at a single institution. Preoperative evaluation, surgical technique, and postoperative regimen are thoroughly described. Surgical complications, reoperation rate, pain, and Patient-Reported Outcomes Measurement Information System (PROMIS) scores, as well as radiographic outcomes were reported.

Results:
Three patients undergoing our symphyseal arthrodesis technique after failed conservative management were identified. All patients had an improvement from preoperative pain levels and the 2 patients with >12-month follow-up were able to return to full activity, including 1 patient returning to full active duty in the United States Army.

Discussion:
The unique technique presented here utilizes both implant fixation, as well as allograft supplementation to improve fusion rates. Although a limited sample with limited follow-up, the early results of this novel technique are encouraging and may represent a more reliable surgical option for patients with chronic, recalcitrant pubic instability.
Reconstruction of Complex Acromion Nonunions and Fractures With a Locking Mesh Plate
Authors: Ogunleye Temi D. , Dugarte Anthony J. , Gilbertson Jeffrey A. , Cole Peter A. 
Published: March 2021

Objectives:
To assess surgical and functional outcomes in a cohort of patients having surgically reconstructed acromion nonunions or severely comminuted acute fracture patterns treated with a variable angle, locking mesh plate with a matrix of screw options.

Design:
Retrospective case series.

Setting:
Level I trauma center.

Patients:
Between 2012 and 2017, 10 patients, 4 patients with acromion nonunions and 6 patients with severely comminuted acromion fractures presented to a single institution and underwent surgical treatment.

Intervention:
Surgical repair of complex acromion fractures and nonunions utilizing a 2.4/2.7 locking mesh plate (Depuy-Synthes) with bone grafting (nonunions).

Main Outcome Measurements:
Primary outcome measures include range of motion; strength; Disabilities of the Arm, Shoulder, and Hand; and Short Form 36 Health Survey.

Results:
Seven of 10 patients (70%) achieved 1 year follow-up, mean 23.3 months (range, 12 to 46 mo). Nine of 10 patients achieved union following the index reconstruction procedure and 1 patient achieved union after revision of failed mesh plate fixation. At final follow-up, the mean Disabilities of the Arm, Shoulder, and Hand score was 20.0 (11.2 in fracture group and 31.6 in nonunion group) and mean mental and physical component Short Form 36 scores were 51.4 and 42.9, respectively.

Conclusions:
A variable angle, locking mesh plate may be a useful implant choice for complex nonunions and severely comminuted fracture patterns of the acromion process. In this series, union rate and perioperative complications were acceptable in extreme fracture variants.
A Unified Platelet-rich Plasma Preparation Protocol Using a Customizable Concentration System for Knee Osteoarthritis
Authors: Baria Michael R. , Magnussen Robert A. , Lau Melissa , Miller Meghan Maume , Vasileff William Kelton , Borchers James R. 
Published: March 2021

Introduction:
Platelet-rich plasma (PRP) is an autologous solution of platelets, concentrated over baseline, that delivers a high dose of anti-inflammatory and anabolic proteins. High-quality data support its use for pathology like knee osteoarthritis (OA), but vast heterogeneity among PRP processing methods and product content make synthesizing clinical data very challenging. Most processing techniques rely upon centrifugation and often involve manual processing steps, such as resuspension or extraction of platelets, which can introduce further heterogeneity in the final product. The Angel cPRP device is a fully automated device that uses both centrifugation and principles of flow cytometry in its PRP processing. However, the system has a wide range of preprocessing settings that alter PRP composition and there are no recommendations or standards on which settings should be used for OA. The aims of this manuscript are to (1) describe a unified PRP processing technique using this system and (2) report preliminary outcomes using that unified protocol when treating knee OA.

Methods:
For the processing of PRP, all patients had whole blood drawn under aseptic conditions (104 cc whole blood for unilateral OA, 156 cc whole blood for bilateral OA) that was then processed at the unified setting of 0% hematocrit, first spin performed at 4000 rpm for 11 minutes and the second spin at 3000 rpm for 2 minutes. The device automatically separated the resulting PRP that was then injected. For the second aim of this work, 90 knees (63 patients) met the criteria for inclusion. International Knee Documentation Committee (IKDC) subjective scores completed at baseline and 3 months were collected and analyzed.

Results:
Overall, IKDC score improved from 42.3±14.1 preinjection to 59.7±17.5 at 3 months postinjection (P<0.001). Of the 90 knees injected with PRP, 57% met the criteria for a positive response at 3 months with an average final IKDC score of 66.5±15.0 (Δ 24.7±10.9). Increased patient age (P=0.008) and body mass index (P=0.008) were associated with lower 3-month subjective IKDC scores.

Discussion:
A single PRP injection created with the unified preparation protocol described here resulted in significant improvement in preliminary patient-reported outcomes. There was a positive response in 57% of patients. Higher age and body mass index were associated with worse outcomes. Given the wide range of preprocessing settings available on this device, the protocol described here can serve as an initial guide for clinical and research implementation.
Developmental Status of Young Children in Foster Care
Authors: McLeigh Jill D. , Tunnell Karlyn , Lazcano Cecilia 
Published: March 2021

ABSTRACT:

Objective:
Children in foster care (CFC) may be at higher risk for developmental problems. This study sought to determine (1) the percentage of CFC with developmental problems seen at an integrated primary care clinic and (2) whether the presence of various risk factors was associated with increased odds of developmental problems in general and across developmental domains.

Method:
This cross-sectional study used the Ages and Stages Questionnaire, Third Edition, demographic, and health-related data retrieved from electronic health records. The study included 796 children aged 1 to 66 months seen at an integrated primary care clinic exclusively serving CFC. Frequencies and percentages of children with developmental problems were calculated, and relationships between developmental status and potential risk factors were accessed using χ2 and bivariate logistic regression analyses.

Results:
Overall, 68.5% had scores indicative of developmental concern (DC), and 39.8% had scores indicating developmental delay (DD). After adjusting for other risk factors, analysis suggested that being male (odds ratio [OR] 2.169, 95% confidence interval [CI] 1.595–2.950) and exhibiting trauma symptoms (OR 1.51, 95% CI 0.993–2.295) were associated with higher odds of exhibiting DC, whereas being in a kinship placement (OR 0.55, 95% CI 0.359–0.842) was associated with lower odds. Odds were higher for exhibiting DD for children who were male (OR 1.716, 95% CI 1.278–2.303), born prematurely (OR 2.165, 95% CI 1.438–3.259), experienced physical abuse (OR 1.541, 95% CI 1.040–2.283), and presented trauma symptoms (OR 1.441, 95% CI 0.975–2.130).

Conclusion:
The findings suggest that early screening is vital for CFC to identify developmental impairment so that appropriate education and interventions can be offered.
Child Psychological Functioning During the COVID-19 Lockdown: An Ecological, Family-Centered Approach
Authors: Dubois-Comtois Karine , Suffren Sabrina , St-Laurent Diane , Milot Tristan , Lemelin Jean-Pascal 
Published: March 2021

ABSTRACT:

Objective:
To evaluate how sociodemographic characteristics and various aspects of parent well-being, family functioning, parent-child relationship, and child characteristics are related to psychological functioning in children aged 9 to 12 years during the COVID-19 lockdown.

Method:
Participants included 144 children aged 9 to 12 years and their parents who lived in the province of Quebec, Canada, during the COVID-19 mandatory lockdown. Parents and children were administered a phone-based survey in which various child, parent, parent-child, and family characteristics were assessed.

Results:
Results showed that higher internalizing problems in children were related to greater depressive symptoms in parents, lower attachment security to parents, and greater aversion to aloneness in children. Results on externalizing behavior problems showed that more problems were associated with more family dysfunction and chaos and lower attachment security to parents. Finally, results on children's anxiety toward COVID-19 showed that more anxiety was associated with greater parental anxiety toward COVID-19 and more child aversion to aloneness.

Conclusion:
Our findings showed that even during an unusual and stressful context such as a pandemic, proximal variables such as the attachment relationship that have been known to be closely associated with adaptation are significantly related to child psychological functioning. Such observations are important because they highlight factors that may accentuate child vulnerability in times of a pandemic and shed light on potential intervention targets.
Validation of Hypertensive Disorders During Pregnancy: ICD-10 Codes in a High-burden Southeastern United States Hospital
Authors: Labgold Katie , Stanhope Kaitlyn K. , Joseph Naima T. , Platner Marissa , Jamieson Denise J. , Boulet Sheree L. 
Published: March 2021

Background:
Identification of hypertensive disorders in pregnancy research often uses hospital International Classification of Diseases v. 10 (ICD-10) codes meant for billing purposes, which may introduce misclassification error relative to medical records. We estimated the validity of ICD-10 codes for hypertensive disorders during pregnancy overall and by subdiagnosis, compared with medical record diagnosis, in a Southeastern United States high disease burden hospital.

Methods:
We linked medical record data with hospital discharge records for deliveries between 1 July 2016, and 30 June 2018, in an Atlanta, Georgia, public hospital. For any hypertensive disorder (with and without unspecified codes) and each subdiagnosis (hemolysis, elevated liver enzymes, and low platelet count [HELLP] syndrome, eclampsia, preeclampsia with and without severe features, chronic hypertension, superimposed preeclampsia, and gestational hypertension), we calculated positive predictive value (PPV), negative predictive value (NPV) sensitivity, and specificity for ICD-10 codes compared with medical record diagnoses (gold standard).

Results:
Thirty-seven percent of 3,654 eligible pregnancies had a clinical diagnosis of any hypertensive disorder during pregnancy. Overall, ICD-10 codes identified medical record diagnoses well (PPV, NPV, specificity >90%; sensitivity >80%). PPV, NPV, and specificity were high for all subindicators (>80%). Sensitivity estimates were high for superimposed preeclampsia, chronic hypertension, and gestational hypertension (>80%); moderate for eclampsia (66.7%; 95% confidence interval [CI] = 22.3%, 95.7%), HELLP (75.0%; 95% CI = 50.9%, 91.3%), and preeclampsia with severe features (58.3%; 95% CI = 52.6%, 63.8%); and low for preeclampsia without severe features (3.2%; 95% CI, 1.4%, 6.2%).

Conclusions:
We provide bias parameters for future US-based studies of hypertensive outcomes during pregnancy in high-burden populations using hospital ICD-10 codes.
Effects of pupillary reflex dilation-guided opioid administration on remifentanil and morphine consumption during laparoscopic surgery
Authors: Guerci Philippe , Jay Guillaume , Arnout Chloé , Herbain Delphine , Baka Noureddine , Poirel Olivier , Novy Emmanuel , Bouaziz Hervé , Vial Florence 
Published: March 2021

BACKGROUND
Analysis of pupillary reflex dilation (PRD) assesses the balance of nociception--antinociception. Laparoscopic surgery induces haemodynamic variations that are misleading. During laparoscopy, PRD guidance helps differentiate haemodynamic changes because of excess nociception from secondary changes related to the reflex release of endocrine factors.

OBJECTIVE
The present study evaluated the effect of PRD-guided antinociception on the administration of intra-operative remifentanil and immediate postoperative morphine consumption in patients undergoing elective laparoscopic surgery.

DESIGN
The study was a single-blind, randomised controlled trial.

SETTING
The study took place at two sites at the University Hospital of Nancy from March 2014 to November 2017.

PATIENTS
A total of 100 patients who underwent scheduled laparoscopic surgery were included.

INTERVENTIONS
Patients were randomly given remifentanil guided by PRD (PRD-guided) or standard anaesthesia care (control).

MAIN OUTCOME MEASURES
The primary outcome was intra-operative remifentanil consumption. Secondary outcomes included morphine consumption in the immediate postoperative period and the number of intra-operative haemodynamic events.

RESULTS
Data from 95 patients were analysed. Intraoperative remifentanil consumption was lower in the PRD-guided group than in the control group: median [IQR], 0.09 [0.07 to 0.11] vs. 0.14 [0.12 to 0.16] μg kg−1 min−1, with a mean difference (95% confidence Interval, CI) of 0.048 (0.035 to 0.060) μg kg−1 min−1; P < 0.0001. Morphine consumption was 0.13 [0.1 to 0.5] vs. 0.15 [0.11 to 0.4] mg kg−1 (P
= 0.52) in the PRD-guided and control groups, respectively. The number of hypertensive and tachycardia events was greater in the PRD-guided group than in the control group: Hypertensive events 60.4% vs. 32.6%, relative risk 1.85 (95% CI, 1.24 to 2.84), P = 0.004; tachycardia events 31.6% vs. 4.3%, relative risk 2.09 (95% CI, 1.45 to 2.84), P < 0.001.

CONCLUSIONS
When PRD is used to differentiate between haemodynamic events arising from noxious stimuli and those events because of other nonsurgical stimuli, then intra-operative remifentanil administration is reduced intra-operatively during laparoscopic surgery but there was no change in postoperative morphine consumption.

TRIAL REGISTRATION
Clinicaltrials.gov NCT02116868.
Evaluation of glomerular filtration rate using iohexol plasma clearance in critically ill patients with augmented renal creatinine clearance
Authors: Collet Magalie , Hijazi Dany , Sevrain Pauline , Barthélémy Romain , Labeyrie Marc-Antoine , Prié Dominique , Tabibzadeh Nahid , Mebazaa Alexandre , Chousterman Benjamin G. 
Published: March 2021

BACKGROUND
Augmented renal creatinine clearance (ARC) (≥130 ml min−1 1.73 m−2) is frequent in intensive care unit (ICU) patients and may impact patient outcome.

OBJECTIVES
To compare glomerular filtration rate (GFR) measured with iohexol plasma clearance and creatinine clearance in critically ill patients with augmented renal clearance.

DESIGN
Single-centre, retrospective study.

SETTING
French University Hospital ICU from November 2016 to May 2019.

PATIENTS
Adult patients with augmented renal clearance who had a measurement of iohexol plasma clearance.

MAIN OUTCOME MEASURE
Agreement between 6 h creatinine clearance (6 h CrCl) and iohexol plasma clearance (GFRio).

RESULTS
Twenty-nine patients were included. The median 6 h creatinine clearance was 195 [interquartile range (IQR) 162 to 251] ml min−1 1.73 m−2 and iohexol clearance was 133 [117 to 153] ml min−1 1.73 m−2. Sixteen patients (55%) had hyperfiltration (clearance >130 ml min−1 1.73 m−2) measured with iohexol clearance. Mean bias between iohexol and creatinine clearance was −80 [limits of agreement (LoA) −216 to 56 ml min−1 1.73 m−2]. For Cockcroft and Gault Modification of Diet in Renal Disease equation (MDRD), Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) formulae, mean biases were, respectively −27 (LoA −99 to 45), −14 (LoA −86 to 59) and 15 (LoA −33 to 64) ml min−1 1.73 m−2.

CONCLUSION
In the present study, we found that in patients with augmented renal creatinine clearance, half of the patients do not have hyperfiltration using iohexol clearance measurements. We observed an important bias between 6 h CrCl and GFRio with large LoA. In critically patients with ARC, 6 h CrCl does not reliably estimate GFR and 6 h CrCl nearly systematically overestimates renal function. Comparison of creatinine-based GFR estimations and GFRio show acceptable bias but wide LoA.
Contemporary perspectives on the genetics and clinical use of lipoprotein(a) in preventive cardiology
Authors: Page Michael M. , Watts Gerald F. 
Published: March 2021

Purpose of review
The pathogenicity of lipoprotein(a) [Lp(a)] as a risk factor for atherosclerotic cardiovascular disease (ASCVD) is well evidenced and recognized by international consensus-based guidelines. However, the measurement of Lp(a) is not routine clinical practice. Therapeutic agents targeting Lp(a) are now progressing through randomised clinical trials, and it is timely for clinicians to familiarize themselves with this complex and enigmatic lipoprotein particle.

Recent findings
Recent developments in the understanding of genetic influences on the structure, plasma concentration and atherogenicity of Lp(a) have contextualized its clinical relevance. Mendelian randomization studies have enabled estimation of the contribution of Lp(a) to ASCVD risk. Genotyping individual patients with respect to Lp(a)-raising single nucleotide polymorphisms predicts ASCVD, but has not yet been shown to add value beyond the measurement of Lp(a) plasma concentrations, which should be done by Lp(a) isoform-independent assays capable of reporting in molar concentrations. Contemporary gene-silencing technology underpins small interfering RNA and antisense oligonucleotides, which are emerging as the leading Lp(a)-lowering therapeutic agents. The degree of Lp(a)-lowering required to achieve meaningful reductions in ASCVD risk has been estimated by Mendelian randomization, providing conceptual support.

Summary
Measurement of Lp(a) in the clinical setting contributes to the assessment of ASCVD risk, and will become more important with the advent of specific Lp(a)-lowering therapies. Knowledge of an individual patient's genetic predisposition to increased Lp(a) appears to impart little or not additional clinical value beyond Lp(a) particle concentration.
Racial and ethnic disparities in heart failure: current state and future directions
Authors: Lewsey Sabra C. , Breathett Khadijah 
Published: March 2021

Purpose of review
This review discusses the current state of racial and ethnic inequities in heart failure burden, outcomes, and management. This review also frames considerations for bridging disparities to optimize quality heart failure care across diverse communities.

Recent findings
Treatment options for heart failure have diversified and overall heart failure survival has improved with the advent of effective pharmacologic and nonpharmacologic therapies. With increased recognition, some racial/ethnic disparity gaps have narrowed whereas others in heart failure outcomes, utilization of therapies, and advanced therapy access persist or worsen.

Summary
Racial and ethnic minorities have the highest incidence, prevalence, and hospitalization rates from heart failure. In spite of improved therapies and overall survival, the mortality disparity gap in African American patients has widened over time. Racial/ethnic inequities in access to cardiovascular care, utilization of efficacious guideline-directed heart failure therapies, and allocation of advanced therapies may contribute to disparate outcomes. Strategic and earnest interventions considering social and structural determinants of health are critically needed to bridge racial/ethnic disparities, increase dissemination, and implementation of preventive and therapeutic measures, and collectively improve the health and longevity of patients with heart failure.