bluuebunny/crossref_metadata_2025_split huggingface dataset:
Suture Tape Augmentation of Screw Fixation Reduces Fragment Migration in Tibial Tubercle Osteotomy: A Biomechanical Study
Authors: Frame Mark , Hauck Oliver , Newman Michael , Cirtautas Anna , Wijdicks Coen 
Published: October 2021

Background: Tibial tubercle osteotomy (TTO) is a complex surgical procedure with a significant risk of complications, which include nonunion and tibial fracture. Purpose: To determine whether an additional suture tape augmentation can provide better biomechanical stability compared with standard screw fixation. Study Design: Controlled laboratory study. Methods: Five matched pairs of human cadaveric knees were divided into 2 groups: the first group underwent standard TTO fixation with 2 parallel screws (standard group). The second group underwent a novel fixation technique, in which a nonabsorbable suture tape (FiberTape) in a figure-of-8 construct was added to the standard screw fixation for extra stabilization in the inferior-superior direction (augmented group). The specimens were biomechanically tested using a multistep cyclic loading protocol from 400 N up to 800 N to simulate the rehabilitation process. Tubercular fragment migration of >50% of the initial distalization length was defined as clinical failure. A pull-to-failure test was applied to the specimens that survived cyclic loading. Tubercular fragment displacement during cyclic loading and pull-to-failure force were recorded and compared between the 2 groups. Results: Two specimens of the standard group exhibited clinical failure during cyclic loading to 400 N. All other specimens survived cyclic loading to 800 N. The augmented group showed less cyclic tubercular fragment displacement after every load level compared with the standard group, with statistically significant differences starting from 500 N ( P < .05; power > 0.8). Mean ± standard deviation tubercular fragment displacement at the end of cyclic loading was 2.56 ± 0.82 mm for the augmented group and 5.21 ± 0.51 mm for the standard group. Mean ultimate failure load after the pull-to-failure test was 2475 ± 554 N for the augmented group and 1475 ± 280 N for the standard group. Conclusion: The specimens that underwent suture tape augmentation showed less tubercular fragment displacement during cyclic loading and higher ultimate failure forces compared with those that underwent standard screw fixation. Clinical Relevance: The augmentation technique could potentially increase the success of a TTO.
Experiences and Motivations of Male Nurses in a Tertiary Hospital in Ghana
Authors: Appiah Stella , Appiah Evans O. , Lamptey Valentina N.L. 
Published: October 2021

Introduction Nurses make up the largest portion of the health care system throughout the world, hence, making the profession the backbone of health care. The nursing workforce is made up of both males and females. However, the majority of nurses are predominately females with the number of male nurses reported to be unappreciable. Objective The study therefore aimed to explore the experiences and motivation of male nurses in a tertiary hospital in Ghana. Methods A qualitative descriptive research design was employed to explore the lived experiences of male nurses. A total of 20 male nurses were purposively selected, and in-depth interviews were conducted with a semi-structured interview guide. The interviews were tape-recorded, transcribed verbatim, and analyzed using content analysis. Results The findings revealed 2 major themes: motivation and experiences of male nurses. The subthemes were individual motivations, external influence, intersecting social reactions and public perceptions, mixed encounters with patients, and satisfaction with the profession. Conclusion Male nurses are motivated to a large extent to be part of the nursing profession but will be deeply involved in the profession if some factors affecting them are addressed. Future studies may address the roles of nurse managers in mentoring more males to be involved in the nursing profession.
Beyond trust: Amplifying unheard voices on concerns about harm resulting from health data-sharing
Authors: Mulrine Stephanie , Blell Mwenza , Murtagh Madeleine 
Published: October 2021

Background: The point of care in many health systems is increasingly a point of health data generation, data which may be shared and used in a variety of ways by a range of different actors. Aim: We set out to gather data about the perspectives on health data-sharing of people living in North East England who have been underrepresented within other public engagement activities and who are marginalized in society. Methods: Multi-site ethnographic fieldwork was carried out in the Teesside region of England over a 6-month period in 2019 as part of a large-scale health data innovation program called Connected Health Cities. Organizations working with marginalized groups were contacted to recruit staff, volunteers, and beneficiaries for participation in qualitative research. The data gathered were analyzed thematically and vignettes constructed to illustrate findings. Results: Previous encounters with health and social care professionals and the broader socio-political contexts of people’s lives shape the perspectives of people from marginalized groups about sharing of data from their health records. While many would welcome improved care, the risks to people with socially produced vulnerabilities must be appreciated by those advocating systems that share data for personalized medicine or other forms of data-driven care. Conclusion: Forms of innovation in medicine which rely on greater data-sharing may present risks to groups and individuals with existing vulnerabilities, and advocates of these innovations should address the lack of trustworthiness of those receiving data before asking that people trust new systems to provide health benefits.
Avoiding immunogenic drugs is key to preserve renal function in patients receiving immune checkpoint inhibitors: Lessons learned from three illustrative cases
Authors: Martínez Valenzuela Laura , Antón Paula , Tango Ariel , Gómez Francisco , Fulladosa Xavier , De Carvalho Alejandra , Gomà Montserrat , Cruzado Josep Maria , Draibe Juliana , Torras Juan 
Published: October 2021

Background: In the recent years, new immunotherapy agents are showing promising results in the treatment of cancer. Immune checkpoint inhibitors (ICI), which block neoplasm-induced lymphocyte inhibition and enhance cancer immunosurveillance mechanisms, are associated to acute tubulointerstitial nephritis (ATIN). The mechanisms of this adverse effect are debated. Methods: We present a three-case series of ATIN in the setting of ICI therapy managed in our Nephrology department. We detail the clinical course of the episodes, emphasizing on the concomitant medications administered. We also conducted a literature review of the altered drug immunogenicity in patients under immunotherapy drugs. Results: The three reported ATIN cases illustrate closer temporal association with the concomitant medication rather than the ICI itself. This suggests a scenario where the tolerance to previously accepted drugs seems to be lost. Moreover, one of the patients presented an ATIN flare after ICI discontinuation, suggesting an state of leukocyte hyperactivation. Conclusions: Unraveling the exact patho-mechanisms by which ICI-related ATIN occurs will allow the prevention of the development of this side effect and determine whether ICI re-challenge in patients previously affected by ICI-ATIN is safe.
Bleeding assessment tools in the diagnosis of VWD in adults and children: a systematic review and meta-analysis of test accuracy
Authors: Kalot Mohamad A. , Husainat Nedaa , Tayiem Sammy , El Alayli Abdallah , Dimassi Ahmad B. , Diab Osama , Abughanimeh Omar , Madoukh Bader , Qureini Aref , Ameer Barbara , Di Paola Jorge , Eikenboom Jeroen C.J. , Jacobs-Pratt Vicky , McLintock Claire , Montgomery Robert , O’Donnell James S. , Sidonio Robert , Brignardello-Petersen Romina , Flood Veronica , Connell Nathan T. , James Paula D. , Mustafa Reem A. 
Published: October 2021

Abstract
Von Willebrand disease (VWD) can be associated with significant morbidity. Patients with VWD can experience bruising, mucocutaneous bleeding, and bleeding after dental and surgical procedures. Early diagnosis and treatment are important to minimize the risk of these complications. Several bleeding assessment tools (BATs) have been used to quantify bleeding symptoms as a screening tool for VWD. We systematically reviewed diagnostic test accuracy results of BATs to screen patients for VWD. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. Two investigators screened and abstracted data. Risk of bias was assessed using the revised tool for the quality assessment of diagnostic accuracy studies and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We pooled estimates of sensitivity and specificity. The review included 7 cohort studies that evaluated the use of BATs to screen adult and pediatric patients for VWD. The pooled estimates for sensitivity and specificity were 75% (95% confidence interval, 66-83) and 54% (29-77), respectively. Certainty of evidence varied from moderate to high. This systematic review provides accuracy estimates for validated BATs as a screening modality for VWD. A BAT is a useful initial screening test to determine who needs specific blood testing. The pretest probability of VWD (often determined by the clinical setting/patient population), along with sensitivity and specificity estimates, will influence patient management.
Transcription factor MEF2D is required for the maintenance of MLL-rearranged acute myeloid leukemia
Authors: Zhao Lianzhong , Zhang Pengcheng , Galbo Phillip M. , Zhou Xinyue , Aryal Sajesan , Qiu Shaowei , Zhang Hao , Zhou Yang , Li Chunliang , Zheng Deyou , Bhatia Ravi , Lu Rui 
Published: October 2021

Abstract
Acute myeloid leukemia (AML) with MLL-rearrangement (MLL-r) comprises ∼10% of all AML cases and portends poor outcomes. Much remains uncovered on how MLL-r AML drives leukemia development while preventing cells from normal myeloid differentiation. Here, we identified that transcription factor MEF2D is a super-enhancer-associated, highly expressed gene in MLL-r AML. Knockout of MEF2D profoundly impaired leukemia growth, induced myeloid differentiation, and delayed oncogenic progression in vivo. Mechanistically, MEF2D loss led to robust activation of a CEBPE-centered myeloid differentiation program in AML cells. Chromatin profiling revealed that MEF2D binds to and suppresses the chromatin accessibility of CEBPE cis-regulatory regions. In human acute leukemia samples, MEF2D expression showed a strong negative correlation with the expression of CEBPE. Depletion of CEBPE partially rescued the cell growth defect and myeloid cell differentiation induced by the loss of MEF2D. Lastly, we show that MEF2D is positively regulated by HOXA9, and downregulation of MEF2D is an important mechanism for DOT1L inhibitor-induced antileukemia effects. Collectively, our findings suggest that MEF2D plays a critical role in human MLL-r AML and uncover the MEF2D-CEBPE axis as a crucial transcriptional mechanism regulating leukemia cell self-renewal and differentiation block.
CNS involvement in AML at diagnosis is rare and does not affect response or survival: data from 11 ECOG-ACRIN trials
Authors: Ganzel Chezi , Lee Ju-Whei , Fernandez Hugo F. , Paietta Elisabeth M. , Luger Selina M. , Lazarus Hillard M. , Cripe Larry D. , Douer Dan , Wiernik Peter H. , Rowe Jacob M. , Tallman Martin S. , Litzow Mark R. 
Published: October 2021

Abstract
Central nervous system (CNS) involvement in patients with newly diagnosed acute myeloid leukemia (AML) is rare, and systematic data regarding outcome are scarce. This retrospective study summarized data from 11 consecutive Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (ECOG-ACRIN) clinical trials for patients with newly diagnosed AML. In all, 3240 patients with AML were analyzed, and 36 (1.11%) were found to have CNS involvement at diagnosis. The incidence of CNS disease among the 5 studies with per protocol mandatory lumbar puncture (LP) was similar to the incidence among studies in which LP was performed at the discretion of the investigator (0.86% vs 1.41%; P = .18). There was no significant difference in the rate of complete remission (CR) among patients with CNS involvement and those with other extramedullary disease (EMD) sites or those with no EMD (52.8% vs 59.3%-60%). The median overall survival (OS) for patients who were CNS positive, who had other EMD, or who had no EMD was 11.4, 11.3, and 12.7 months, respectively. There was no difference in OS among patients with CNS involvement, those with other EMD (hazard ratio [HR], 0.96; adjusted P = .84), and those with no EMD (HR, 1.19; adjusted P = .44). In conclusion, the reported incidence of CNS involvement in patients with newly diagnosed AML is low (1.1%), irrespective of whether an LP is mandatory or not. The presence of CNS disease at diagnosis in and of itself does not seem to portend a poor prognosis for achieving an initial CR or for OS.
Randomized evaluation of quizartinib and low-dose ara-C vs low-dose ara-C in older acute myeloid leukemia patients
Authors: Dennis Mike , Thomas Ian F. , Ariti Cono , Upton Laura , Burnett Alan K. , Gilkes Amanda , Radia Rohini , Hemmaway Claire , Mehta Priyanka , Knapper Steven , Clark Richard E. , Copland Mhairi , Russell Nigel , Hills Robert K. 
Published: October 2021

Abstract
Survival for older patients with acute myeloid leukemia (AML) unsuitable for intensive chemotherapy is unsatisfactory. Standard nonintensive therapies have low response rates and only extend life by a few months. Quizartinib is an oral Fms-like tyrosine kinase 3 (FLT3) inhibitor with reported activity in wild-type patients. As part of the AML LI trial, we undertook a randomized evaluation of low-dose ara-C (LDAC) with or without quizartinib in patients not fit for intensive chemotherapy. Overall, survival was not improved (202 patients), but in the 27 FLT3-ITD patients, the addition of quizartinib to LDAC improved response (P = .05) with complete remission/complete remission with incomplete haematological recovery for quizartinib + LDAC in 5/13 (38%) vs 0/14 (0%) in patients receiving LDAC alone. Overall survival (OS) in these FLT3-ITD+ patients was also significantly improved at 2 years for quizartinib + LDAC (hazard ratio 0.36; 95% confidence intervals: 0.16, 0.85, P = .04). Median OS was 13.7 months compared with 4.2 months with LDAC alone. This is the first report of an FLT3-targeted therapy added to standard nonintensive chemotherapy that has improved survival in this population. Quizartinib merits consideration for future triplet-based treatment approaches. This trial was registered at www.clinicaltrials.gov as ISRCTN #ISRCTN40571019 and EUDRACT @2011-000749-19.
Evans syndrome in adults: an observational multicenter study
Authors: Fattizzo Bruno , Michel Marc , Giannotta Juri Alessandro , Hansen Dennis Lund , Arguello Maria , Sutto Emanuele , Bianchetti Nicola , Patriarca Andrea , Cantoni Silvia , Mingot-Castellano María Eva , McDonald Vickie , Capecchi Marco , Zaninoni Anna , Consonni Dario , Vos Josephine Mathilde , Vianelli Nicola , Chen Frederick , Glenthøj Andreas , Frederiksen Henrik , González-López Tomás José , Barcellini Wilma 
Published: October 2021

Abstract
Evans syndrome (ES) is a rare condition, defined as the presence of 2 autoimmune cytopenias, most frequently autoimmune hemolytic anemia and immune thrombocytopenia (ITP) and rarely autoimmune neutropenia. ES can be classified as primary or secondary to various conditions, including lymphoproliferative disorders, other systemic autoimmune diseases, and primary immunodeficiencies, particularly in children. In adult ES, little is known about clinical features, disease associations, and outcomes. In this retrospective international study, we analyzed 116 adult patients followed at 13 European tertiary centers, focusing on treatment requirements, occurrence of complications, and death. ES was secondary to or associated with underlying conditions in 24 cases (21%), mainly other autoimmune diseases and hematologic neoplasms. Bleeding occurred in 42% of patients, mainly low grade and at ITP onset. Almost all patients received first-line treatment (steroids with or without intravenous immunoglobulin), and 23% needed early additional therapy for primary refractoriness. Additional therapy lines included rituximab, splenectomy, immunosuppressants, thrombopoietin receptor agonists, and others, with response rates &gt;80%. However, a remarkable number of relapses occurred, requiring ≥3 therapy lines in 54% of cases. Infections and thrombotic complications occurred in 33% and 21% of patients, respectively, mainly grade ≥3, and correlated with the number of therapy lines. In addition to age, other factors negatively affecting survival were severe anemia at onset and occurrence of relapse, infection, and thrombosis. These data show that adult ES is often severe and marked by a relapsing clinical course and potentially fatal complications, pinpointing the need for high clinical awareness, prompt therapy, and anti-infectious/anti-thrombotic prophylaxis.
Overexpression of γ-glutamylcysteine synthetase gene from Caragana korshinskii decreases stomatal density and enhances drought tolerance
Authors: Lu Baiyan , Luo Xinjuan , Gong Chunmei , Bai Juan 
Published: October 2021

Abstract
Background
Gamma-glutamylcysteine synthetase (γ-ECS) is a rate-limiting enzyme in glutathione biosynthesis and plays a key role in plant stress responses. In this study, the endogenous expression of the Caragana korshinskiiγ-ECS (Ckγ-ECS) gene was induced by PEG 6000-mediated drought stress in the leaves of C. korshinskii. and the Ckγ-ECS overexpressing transgenic Arabidopsis thaliana plants was constructed using the C. korshinskii. isolated γ-ECS.

Results
Compared with the wildtype, the Ckγ-ECS overexpressing plants enhanced the γ-ECS activity, reduced the stomatal density and aperture sizes; they also had higher relative water content, lower water loss, and lower malondialdehyde content. At the same time, the mRNA expression of stomatal development-related gene EPF1 was increased and FAMA and STOMAGEN were decreased. Besides, the expression of auxin-relative signaling genes AXR3 and ARF5 were upregulated.

Conclusions
These changes suggest that transgenic Arabidopsis improved drought tolerance, and Ckγ-ECS may act as a negative regulator in stomatal development by regulating the mRNA expression of EPF1 and STOMAGEN through auxin signaling.
Trimetazidine offers myocardial protection in elderly coronary artery disease patients undergoing non-cardiac surgery: a randomized, double-blind, placebo-controlled trial
Authors: Dai Zhong-Liang , Song Yi-Feng , Tian Ya , Li Yin , Lin Miao , Lin Juan , Wang Qi , Wang Ping , Gao Wen-Li 
Published: October 2021

Abstract
Background
Trimetazidine (TMZ) pretreatment protects cardiomyocytes during cardiac surgery. TMZ may protect elderly patients with ischaemic heart disease (IHD) undergoing non-cardiac surgery.

Methods
This was a randomized, double-blind, placebo-controlled trial (registration #ChiCTR1900025018) of patients with IHD scheduled to undergo non-cardiac surgery at Shenzhen People’s Hospital (Shenzhen, Guangdong Province, China) between June 2014 and September 2015, randomized to 60 mg TMZ or placebo 12 h before surgery. The primary endpoint was the occurrence of in-hospital cardiovascular events. The secondary endpoints were myocardial ischaemia on five-lead electrocardiogram (cECG), cardiac troponin I (cTnI) elevation, cardiac death, acute coronary events, heart failure, and arrhythmia requiring treatments.

Results
Compared with the placebo group, the TMZ group showed a lower occurrence of in-hospital cardiovascular events (primary endpoint, 20.0% vs. 37.5%, P = 0.02), myocardial ischaemia (15.0% vs. 32.5%, P < 0.01), cTnI elevation (2.5% vs. 10%, P < 0.01), acute coronary events (10.0% vs. 20.0%, P < 0.05), heart failure (0% vs. 2.5%, P < 0.05), and arrhythmia requiring treatment (17.5% vs. 35.0%, P < 0.05). There was no acute myocardial infarction during the 30-day postoperative period.

Conclusions
In elderly patients with IHD undergoing non-cardiac surgery, TMZ pretreatment was associated with myocardial protective effects.
Trial registration The trial was prospectively registered at http://www.chictr.org.cn/showproj.aspx?proj=41909 with registration number [ChiCTR1900025018] (7/8/2019).
Impact of the HOP-UP-PT program on older adults at risk to fall: a randomized controlled trial
Authors: Arena Sara K. , Wilson Christopher M. , Boright Lori , Peterson Edward 
Published: October 2021

Abstract
Background
Reduced falls and fall risks have been observed among older adults referred to the HOP-UP-PT (Home-based Older Persons Upstreaming Prevention-Physical Therapy) program. The purpose of this study was to describe outcomes of HOP-UP-PT program participants and then to compare these outcomes to non-participants.

Methods
Six Michigan senior centers referred adults ≥65 years who were at-risk for functional decline or falls. 144 participants (n = 72 per group) were randomized to either the experimental group (EG) or the control group (CG). Physical therapists (PTs) delivered physical, environmental, and health interventions to the EG over nine encounters (six in-person, three telerehabilitation) spanning seven months. The CG participants were told to continue their usual physical activity routines during the same time frame. Baseline and re-assessments were conducted at 0-, 3-, and 7-months in both groups. Descriptions and comparisons from each assessment encounter were analyzed.

Results
Participants ages were: EG = 76.6 (7.0) years and CG = 77.2 (8.2). Baseline measures were not significantly different apart from the Short Physical Performance Battery (SPPB) which favored the EG (P = 0.02). While no significant differences were identified in the survey outcomes or home environment assessments, significant differences in favor of the EG were identified in common fall risk indicators including the Timed Up and Go (P = 0.04), Four Test Balance Scale (P = 0.01), and the modified SPPB (P = 0.02) at the 3-month assessment visit. However, these differences were not sustained at the 7-month assessment as, notably, both groups demonstrated positive improvements in the Four Test Balance Score and SPPB. For individuals at a moderate/high fall risk at baseline, 47.8% of CG reported falling at seven months; whereas, only 6.3% of EG participants meeting the same criteria reported a fall after HOP-UP-PT participation.

Conclusions
A prevention-focused multimodal program provided by PTs in older adults’ homes proved beneficial and those with the highest fall risk demonstrated a significant decrease in falls. A collaboration between PTs and community senior centers resulted in upstreaming care delivery that may reduce both the financial and personal burdens associated with falls in an older adult population.

Trial registration
This study was retrospective registered at Clinical Trials.gov, TRN: NCT04814459 on 24/03/2021.