bluuebunny/crossref_metadata_2025_split huggingface dataset:
International survey of neuromonitoring and neurodevelopmental outcome in children and adults supported on extracorporeal membrane oxygenation in Europe
Authors: Cvetkovic Mirjana , Chiarini Giovanni , Belliato Mirko , Delnoij Thijs , Zanatta Paolo , Taccone Fabio Silvio , Miranda Dinis dos Reis , Davidson Mark , Matta Nashwa , Davis Carl , IJsselstijn Hanneke , Schmidt Matthieu , Broman Lars Mikael , Donker Dirk W , Vlasselaers Dirk , David Piero , Di Nardo Matteo , Muellenbach Ralf M , Mueller Thomas , Barrett Nicholas A , Lorusso Roberto , Belohlavek Jan , Hoskote Aparna 
Published: September 2021

Background: Adverse neurological events during extracorporeal membrane oxygenation (ECMO) are common and may be associated with devastating consequences. Close monitoring, early identification and prompt intervention can mitigate early and late neurological morbidity. Neuromonitoring and neurocognitive/neurodevelopmental follow-up are critically important to optimize outcomes in both adults and children. Objective: To assess current practice of neuromonitoring during ECMO and neurocognitive/neurodevelopmental follow-up after ECMO across Europe and to inform the development of neuromonitoring and follow-up guidelines. Methods: The EuroELSO Neurological Monitoring and Outcome Working Group conducted an electronic, web-based, multi-institutional, multinational survey in Europe. Results: Of the 211 European ECMO centres (including non-ELSO centres) identified and approached in 23 countries, 133 (63%) responded. Of these, 43% reported routine neuromonitoring during ECMO for all patients, 35% indicated selective use, and 22% practiced bedside clinical examination alone. The reported neuromonitoring modalities were NIRS ( n = 88, 66.2%), electroencephalography ( n = 52, 39.1%), transcranial Doppler ( n = 38, 28.5%) and brain injury biomarkers ( n = 33, 24.8%). Paediatric centres (67%) reported using cranial ultrasound, though the frequency of monitoring varied widely. Before hospital discharge following ECMO, 50 (37.6%) reported routine neurological assessment and 22 (16.5%) routinely performed neuroimaging with more paediatric centres offering neurological assessment (65%) as compared to adult centres (20%). Only 15 (11.2%) had a structured longitudinal follow-up pathway (defined followup at regular intervals), while 99 (74.4%) had no follow-up programme. The majority ( n = 96, 72.2%) agreed that there should be a longitudinal structured follow-up for ECMO survivors. Conclusions: This survey demonstrated significant variability in the use of different neuromonitoring modalities during and after ECMO. The perceived importance of neuromonitoring and follow-up was noted to be very high with agreement for a longitudinal structured follow-up programme, particularly in paediatric patients. Scientific society endorsed guidelines and minimum standards should be developed to inform local protocols.
Understanding How Nursing Students Experience Becoming Relational Practitioners: A Narrative Inquiry
Authors: Manankil-Rankin Louela , Schwind Jasna K. , Aksenchuk Sophia 
Published: September 2021

Background Teaching nursing students to become relational practitioners requires theoretical approaches and strategies that engender personal and aesthetic knowing. These qualities closely parallel those that define relational practice. The use of creative self-expression in supporting the development of student capacity for relational practice offers a viable approach. Purpose To learn how nursing students’ engagement in creative self-expression activities may impact the construction of their professional identity and capacity for relational practice as novice nurses. Method Clandinin and Connelly's narrative inquiry approach was used to explore nursing students’ experiences of learning how to become relational practitioners. Four new nurse graduates engaged in a follow-up focus group using Schwind's narrative reflective process to discuss the impact of a relational practice workshop series. Findings Bronwyn's story became the composite of the four participants. Two key narrative patterns emerged: being in service of others and being knowledgeable collaborative leaders. These entailed an intentional engagement in relationships with patients, which required attention to the co-constructed relational space. The creative approaches used to facilitate students’ learning informed their awareness that led to their transformation. Implications Educating future nurses who are relational, person-centered practitioners requires a holistic approach to teaching/learning which also includes creative self-expression.
Rate of Leptomeningeal Enhancement in Pediatric Myelin Oligodendrocyte Glycoprotein Antibody–Associated Encephalomyelitis
Authors: Gadde Judith A. , Wolf David S. , Keller Stephanie , Gombolay Grace Y. 
Published: September 2021

Introduction: Myelin oligodendrocyte glycoprotein antibodies (MOG-abs) are associated with demyelinating diseases. Leptomeningeal enhancement occurs in 6% of adult MOG-abs patients but rates in pediatric MOG-abs patients are unknown. Methods: Retrospective review of pediatric MOG-abs patients was performed. Results: Twenty-one patients (7 boys, 14 girls) were included with an average age of 8.6 years (range 2-15 years). Seven of 21 (33%) pediatric MOG-abs patients had leptomeningeal enhancement. Two patients’ relapses were manifested by leptomeningeal enhancement alone and another patient presented with seizures, encephalopathy, and aseptic meningitis without demyelinating lesions. Cerebrospinal fluid pleocytosis was seen in both leptomeningeal (4/7 patients) and nonleptomeningeal enhancement (10/14 patients). Interestingly, 3 patients with leptomeningeal enhancement had normal cerebrospinal fluid white blood cell count. Cortical edema was more likely in patients with leptomeningeal enhancement ( P = .0263). Conclusion: We expand the clinical spectrum of anti-MOG antibody–associated disorder. Patients with recurrent leptomeningeal enhancement without demyelinating lesions should be tested for MOG antibodies.
Psychiatrist workforce planning: contexts, considerations and recommendations
Authors: Looi Jeffrey CL , Bastiampillai Tarun , Allison Stephen 
Published: September 2021

Objective: To provide a clinical update for psychiatrists and trainees on psychiatric workforce-planning in the Australasian context. Conclusions: There is a lack of detailed evidence regarding effective psychiatric workforce planning. Planning may be based on a foundation of psychiatrist-to-population ratios. This would be modified by needs assessment, understanding of service models and existing service demand. Given that it has recently expressed significant concerns about workforce shortages, the RANZCP should lead development of an independent Australasian psychiatric workforce planning model to inform policy advice to governments.
Short-Term Complications and Outcomes of the Cadence Total Ankle Arthroplasty
Authors: Fram Brianna , Corr Daniel O. , Rogero Ryan G. , Pedowitz David I. , Tsai Justin 
Published: September 2021

Background: Total ankle arthroplasty (TAA) is an increasingly popular option for the operative treatment of ankle arthritis. The Cadence TAA entered clinical use in 2016 and was designed to address common failure modes of prior systems. We report early complications and radiographic and clinical outcomes of this total ankle system at a minimum of 2 years of follow-up. Methods: We performed a retrospective review of a consecutive cohort of patients undergoing primary Cadence TAA by a single surgeon from 2016 to 2017. Complications and reoperations were documented using the American Orthopaedic Foot & Ankle Society (AOFAS) TAA reoperation coding system. Patients completed the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sport subscales, SF-12 Mental (MCS) and Physical (PCS) Component Summaries, and visual analog scale (VAS) pain rating (0-100). Radiographic evaluation was performed to assess postoperative range of motion (ROM) of the sole of the foot relative to the long axis of the tibia, alignment, and implant complications. Results: Fifty-eight patients with a mean age of 63.3 years and mean body mass index of 31.9 kg/m2 were included. Twelve of 58 patients (20.7%) underwent an additional procedure(s) within 2 years, including 3 (5.2%) who required removal of one or both components, 2 for infection and 1 for osteolysis. Forty-three patients were followed for a minimum of 2 years with radiographic imaging; 1 patient’s (2.3%) radiographs had signs of peri-implant osteolysis, with no cases demonstrating loosening or subsidence. FAAM-ADL, FAAM-Sport, SF-12 PCS, and VAS pain scores all improved at a mean of 27.4 months postoperatively, with mean score changes (± SD) of 16.3 (± 22.0), 25.3 (± 24.5), 6.0 (± 11.1), and −32.3 (± 39.8), respectively. Radiographic analysis revealed that average coronal alignment improved from 6.9 degrees from neutral preoperatively to 2.3 degrees postoperatively. The average ROM of the foot relative to the tibia was 36.5 degrees total arc of motion based on lateral radiographs. Conclusion: Early experience with this 2-component total ankle replacement was associated with a high component retention rate, improved coronal plane alignment, good postoperative ROM, radiographically stable implants, and improved patient function. Level of Evidence: Level IV, case series.
Treatment with doxorubicin-based protocol in cardiac involvement diffuse large B-cell lymphoma: A case report
Authors: Tekinalp Atakan , Kars Taha U , Dikici Hatice Z , Yılmaz Pınar D , Demircioğlu Sinan , Çeneli Özcan 
Published: September 2021

Introduction Cardiac involvement in diffuse large B-cell lymphoma is a rare entity in non-Hodgkin lymphomas. Symptoms are usually related to heart failure. Patients who are severely symptomatic due to cardiac mass could be considered treatment as soon as possible. In this report, we present a patient diagnosed with diffuse large B-cell lymphoma with cardiac involvement. Case Report A 61-year-old female patient was admitted to our unit with gastric biopsy diffuse large B-cell lymphoma. Computerized tomography of the chest and positron emission tomography/computed tomography demonstrated a neoplastic mass in the intra-atrial septum extended to inferior vena cava (5 × 4 cm in size and standardized uptake value maximum 24.6). She was in stage III and in the high-risk group. Because of pronounced heart failure findings associated with the mass-specific chemotherapy was planned early. Management & Outcome Although a fraction of ejection was 60% by echocardiography before the treatment, she had a cardiac risk for doxorubicin due to being over 60 years old and hypertension. Complete remission was achieved after three cycles of rituximab–cyclophosphamide–doxorubicin–vincristine and methylprednisolone protocol including doxorubicin. Treatment was completed with six cycles and she was followed up for three months. Discussion Because of the cardiotoxicity of doxorubicin-based protocols, patients should be evaluated according to cardiac functions before and during the chemotherapy.
Neonatal Myocardial Ischemia-Reperfusion Injury: A Proposed Pathogenic Sequence in the Context of Maternal/Fetal Vascular Malperfusion and Paradoxical Embolism
Authors: Manci Elizabeth A. , Dolma Kalsang , Manjunath Chaitra , Liu Shou-Shawn , Galliani Carlos A. , Bhat Ramachandra 
Published: September 2021

Background Neonatal myocardial infarction (MI) in a structurally normal heart is frequently an obscure event that remains undiagnosed until autopsy. Causal attributions usually cite underlying maternal or fetal conditions. Refinement in understanding of pathogenic mechanisms underlying neonatal MI is key to advancements in diagnosis, prevention, treatments and prognosis. Objective This study presents a 36-week gestational age female with perinatal asphyxia, congenital hemolytic anemia and umbilical vein thrombosis who sustained catastrophic MI with reperfusion injury; and it reviews pertinent literature. Results We propose a pathogenic sequence that links maternal vascular malperfusion, fetal vascular malperfusion, hemolytic anemia, umbilical venous thrombosis, and paradoxical thromboemboli. Conclusion This case highlights the importance of placental examination in connecting complex neonatal events with adverse maternal/placental conditions. A high index of suspicion is essential for early diagnosis of neonatal MI.
Pipeline leak detection and corrosion monitoring based on a novel FBG pipe-fixture sensor
Authors: Wang Jiajian , Ren Liang , Jia Ziguang , Jiang Tao , Wang Guo-xin 
Published: September 2021

Pipeline leakage and pipeline internal corrosion are two serious threats to pipeline safety operation. In this study, based on the measurement theory of pipeline internal diameter variation and a numerical simulation analysis of existing sensor shortcomings, a novel FBG pipe-fixture sensor is designed and developed to detect pipeline leakage and monitor pipeline internal corrosion simultaneously. A calibration test is conducted, and the test results indicate that the FBG pipe-fixture sensor solves the problem of a large difference between the test values and the theoretical values and eliminates the limitation of measurement range. To validate the actual performance of the sensor, a pipeline leak detection test and a pipeline internal corrosion monitoring test are, respectively, conducted on a steel pipe leak test platform and a steel pipe with different simulated corrosion levels. The test results demonstrate that the FBG pipe-fixture sensor can effectively detect pipe leakage and decrease the localization error of the leakage point to within 1 m. The sensor can also effectively monitor pipe internal corrosion and evaluate the internal corrosion degree with a measurement accuracy of 0.1 mm. The novel FBG pipe-fixture sensor may be a potential sensor for pipeline leak detection and pipeline internal corrosion monitoring.
Feasibility of Aerobic Exercise and Tai-Chi Interventions in Advanced Lung Cancer Patients: A Randomized Controlled Trial
Authors: Cheung Denise Shuk Ting , Takemura Naomi , Lam Tai Chung , Ho James Chung Man , Deng Wen , Smith Robert , Yan Yinxia , Lee Anne Wing Mui , Lin Chia Chin 
Published: September 2021

Background A majority of lung cancer patients are diagnosed at advanced stages. Although there is considerable evidence of the benefits of aerobic exercise and tai-chi for lung cancer patients, little is known about the comparative effectiveness of the 2 exercise modes in advanced lung cancer patients. Objectives To explore the feasibility and preliminary effects of aerobic exercise and tai-chi interventions on survival and well-being among advanced lung cancer patients. Methods In an assessor-blinded, exploratory randomized controlled trial, 30 advanced lung cancer patients were randomized to an aerobic exercise group, a tai-chi group (both attending 12-week, twice-weekly supervised sessions), or a self-management control group (receiving written exercise guidelines). The primary outcomes focused on feasibility including intervention completion, exercise adherence, and adverse events, while the secondary outcomes addressed preliminary effects and included 1-year survival, cancer symptoms (Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Score, Brief Fatigue Inventory), quality of life (EORTC QLQ-C30, QLQ-LC13), physical performance (6-minute walk test, up-and-go, sit-to-stand, 1-leg standing), activity levels (actigraph), and circadian rhythms (salivary cortisol). Results Intervention feasibility was established with a satisfactory completion rate at post-intervention for the aerobic exercise group (80%) and the tai-chi group (78%). The tai-chi group attained higher adherence than the exercise group in terms of attendance in supervised sessions (89% vs 75% of scheduled classes) and self-practice (225% vs 87% of the prescribed amount). Higher adherence to self-practice in the tai-chi group remained at the 6-month follow-up (81% vs 38% of the prescribed amount). No adverse event as a result of the intervention was reported. Effect-related outcomes did not show statistically significant changes in any group, except an improvement post-intervention in the up-and-go (−2.26, 95% CI: −4.04, −0.48) and sit-to-stand tests (4.52, 95% CI: 2.19, 6.85) in the aerobic exercise group. Conclusions The findings support the feasibility of aerobic exercise and tai-chi interventions in advanced lung cancer patients. A future study with a larger sample from multiple sites is recommended to confirm the comparative effects of the 2 exercise interventions relative to the self-management group and to enhance the generalizability of the findings.
Effect of renal impairment on the efficacy and safety of intra-arterial treatment: A post-hoc analysis of DIRECT-MT study
Authors: Hu Wei , Shen Hongjian , Tao Chunrong , Zhu Yuyou , Xu Pengfei , Li Rui , Yang Pengfei , Zhang Yongwei , Li Zifu , Zhang Yongxin , Peng Ya , Liu Sheng , Zhang Liyong , Hong Bo , Wang Guoping , Liu Jianming ,   for the DIRECT-MT Investigators
Published: September 2021

Objective To determine the influence of renal impairment on clinical outcomes in patients presenting emergent anterior circulation occlusion treated with mechanical thrombectomy. Methods Consecutive patients with anterior circulation stroke treated with mechanical thrombectomy at 41 academic tertiary care centers were included. renal impairment was defined as glomerular filtration rate <60 mL/min/1.73 m2 at the time of admission. The primary outcome was the distribution of scores on the modified Rankin scale, and safety outcomes were mortality within 90 days and hemorrhagic complications. Binary and ordinal logistic regression was used to evaluate the associations between renal impairment and categorical outcomes. Linear regression was used to assess continuous outcomes. Results A total of 607 patients (47 renal impairment and 600 non-renal impairment) who underwent mechanical thrombectomy were included in this study. Multivariate regression analysis showed that renal impairment was independently associated with the increase of the modified Rankin scale at 90 days. The proportion of patients with successful reperfusion was 71.7% in the renal impairment group and 83.3% in the non-renal impairment group. Renal impairment was an independent predictor of 90-day mortality. No significant treatment for the ordinal modified Rankin scale or 90-day mortality was observed by renal impairment interaction. The risk of asymptomatic intracranial hemorrhage was higher in the mechanical thrombectomy plus IVT group (53.6%) than in the mechanical thrombectomy alone group (15.8%) for renal impairment, but was similar between the mechanical thrombectomy plus IVT group (34.6%) and the mechanical thrombectomy alone group (36.4%) for non-renal impairment ( p = 0.01). Conclusion These results demonstrated that the outcomes of mechanical thrombectomy alone and mechanical thrombectomy plus IVT group did not differ significantly in acute stroke patients with and without renal impairment. Also, renal impairment was an independent predictor of worse functional independence and higher mortality at 90 days.
Evaluation of a New Neural Network Classifier for Diabetic Retinopathy
Authors: Katz Or , Presil Dan , Cohen Liz , Nachmani Roi , Kirshner Naomi , Hoch Yaacov , Lev Tsvi , Hadad Aviel , Hewitt Richard John , Owens David R 
Published: September 2021

Background: Medical image segmentation is a well-studied subject within the field of image processing. The goal of this research is to create an AI retinal screening grading system that is both accurate and fast. We introduce a new segmentation network which achieves state-of-the-art results on semantic segmentation of color fundus photographs. By applying the net-work to identify anatomical markers of diabetic retinopathy (DR) and diabetic macular edema (DME), we collect sufficient information to classify patients by grades R0 and R1 or above, M0 and M1. Methods: The AI grading system was trained on screening data to evaluate the presence of DR and DME. The core algorithm of the system is a deep learning network that segments relevant anatomical features in a retinal image. Patients were graded according to the standard NHS Diabetic Eye Screening Program feature-based grading protocol. Results: The algorithm performance was evaluated with a series of 6,981 patient retinal images from routine diabetic eye screenings. It correctly predicted 98.9% of retinopathy events and 95.5% of maculopathy events. Non-disease events prediction rate was 68.6% for retinopathy and 81.2% for maculopathy. Conclusion: This novel deep learning model was trained and tested on patient data from annual diabetic retinopathy screenings can classify with high accuracy the DR and DME status of a person with diabetes. The system can be easily reconfigured according to any grading protocol, without running a long AI training procedure. The incorporation of the AI grading system can increase the graders’ productivity and improve the final outcome accuracy of the screening process.
Increased serum PCSK9 in patients with idiopathic pulmonary arterial hypertension: insights from inflammatory cytokines
Authors: Zhong Dong‐Xiang , Zhang Yuan , Jin Qi , Zhang Xiao‐Chun , Zhang Feng , Chen Dan‐Dan , Guan Li‐Hua , Zhou Da‐Xin , Ge Jun‐Bo 
Published: September 2021

Proprotein convertase subtilisin/kexin type 9 (PCSK9) is an important and major player in the pathophysiology of hypercholesterolemia and atherosclerosis. Recently, PCSK9 has been implicated in the pathogenesis of inflammatory diseases. Whether PCSK9 is involved in idiopathic pulmonary arterial hypertension (IPAH) remains unclear. This study aimed to investigate the relationship between PCSK9 and IPAH. Serum PCSK9, interleukin‐6 (IL‐6), tumor necrosis factor‐α (TNF‐α), interleukin‐1 β (IL‐1β), and monocyte chemotactic protein‐1 (MCP‐1) were measured by enzyme linked immunosorbent assay. Transthoracic echocardiography was performed among 40 IPAH patients and 20 control subjects. Hemodynamic data were collected via right heart catheterization in patients with IPAH. Serum PCSK9, TNF‐α, IL‐6, IL‐1β, and MCP‐1 levels were significantly higher in IPAH patients than in control subjects (p < 0.001). Among enrolled IPAH patients, PCSK9 levels were higher in WHO‐FC III/IV patients compared with those in WHO‐FC I/II (p < 0.05), and were positively correlated with TNF‐α, IL‐6, MCP‐1, N‐Terminal pro‐brain natriuretic peptide, pulmonary arterial systolic pressure (r = 0.653, p < 0.001), pulmonary arterial diastolic pressure (r = 0.466, p = 0.002), mean pulmonary arterial pressure (mPAP, r = 0.730, <0.001), pulmonary vascular resistance (r = 0.488, p = 0.001), and right ventricle diameter (r = 0.563, p < 0.001). In multiple regression analysis, mPAP was strongly associated with serum PCSK9 (β = 0.694, p < 0.001), independent of other variables. Receiver operating characteristic curve analysis showed the optimal cutoff value of serum PCSK9 concentration for predicting IPAH was 90.67 ng/ml, with a sensitivity of 90.0% and a specificity of 85.0%. In conclusion, IPAH patients had elevated serum PCSK9 levels which correlated the presence and severity of pulmonary hypertension. PCSK9 may be a novel potential therapeutic target.