bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Retrospective Look at Patient, Procedural, and Follow-up Characteristics Associated With WATCHMAN Implantation
Authors: Fowler Susan B. , Sendin Mary Janette 
Published: October 2021

Background
Persons with atrial fibrillation (AF) are at risk for stroke. Atrial fibrillation–related strokes most often result for emboli arising from the left atrial appendage (LAA). Stroke prevention includes the use of anticoagulants and/or antiplatelets. These medications can result in bleeding complications. An alternative to anticoagulants is the WATCHMAN device, which is delivered in the left atria resulting in closure of LAA.

Objective
The aim of this study was to describe patient, procedural, and follow-up characteristics in patients who have undergone WATCHMAN implantation.

Methods
This study used a retrospective design to review data previously collected and entered into the National Cardiovascular Data Registry database.

Results
During a 2-year period, 41 patients underwent the WATCHMAN procedure at our facility. The most common indication for the procedure in this population of patients with nonvalvular AF on oral anticoagulants was bleeding in the gastrointestinal or genitourinary systems. (Gastrointestinal/genitourinary bleed does not limit candidacy for surgical closure of the LAA.) There was only 1 postprocedure adverse event that included a groin hematoma. A transesophageal echocardiogram at 45 days indicated that the LAA seal showed no leak or flow around the device or a leak less than 5 mm. At 1 year, 95% (n = 36) of patients were only taking a single antiplatelet drug with aspirin. Eight patients were on a single antiplatelet medication at the time of follow-up 2 years after the procedure.

Discussion
A skilled team including a designated AF clinical nurse specialist contributed to program success measured by efficient placement of the WATCHMAN device and discontinuation of anticoagulation.
Postoperative Rather Than Preoperative Neutropenia Is Associated With Early Catheter-related Bloodstream Infections in Newly Diagnosed Pediatric Cancer Patients
Authors: Cher Wen Qi , Lee Vanessa , Wang Rachel , Cheah Sue-Mei , Lee York Tien , Saffari Seyed Ehsan , Tan Chin-Bee , Chong Chia-Yin , Lam Joyce C. M. , Loh Amos H. P. 
Published: October 2021

Background:
The relationship of early catheter-related bloodstream infections (CRBSIs) with perioperative neutropenia and antibiotic prophylaxis is not well established. We sought to evaluate perioperative factors associated with early CRBSIs in newly diagnosed pediatric cancer patients, particularly hematologic indices and antibiotic use.

Methods:
We retrospectively reviewed national registry records of newly diagnosed pediatric cancer patients with port-a-caths inserted using standardized perioperative protocols where only antibiotic use was not regulated. Thirty-day postoperative CRBSI incidence was correlated with preoperative factors using logistic regression and with postoperative blood counts using linear trend analysis.

Results:
Among 243 patients, 17 CRBSIs (7.0%) occurred at median 14 (range, 8–28) postoperative days. Early CRBSIs were significantly associated with cancer type [acute myeloid leukemia and other leukemias (AML/OLs) vs. solid tumors and lymphomas (STLs): odds ratio (OR), 5.09; P = 0.0036; acute lymphoblastic leukemia vs. STL: OR 0.83; P = 0.0446] but not preoperative antibiotics, absolute neutrophil counts and white blood cell counts. Thirty-day postoperative absolute neutrophil counts and white blood cell trends differed significantly between patients with acute lymphoblastic leukemia and STLs (OR 0.83, P < 0.05) and between AML/OLs and STLs (OR 5.09, P < 0.005), with AML/OL patients having the most protracted neutropenia during this period.

Conclusions:
Contrary to common belief, low preoperative absolute neutrophil counts and lack of preoperative antibiotics were not associated with higher early CRBSI rates. Instead, AML/OL patients, particularly those with prolonged neutropenia during the first 30 postoperative days, were at increased risk. Our findings do not support the use of empirical preoperative antibiotics and instead identify prolonged postoperative neutropenia as a major contributing factor for early CRBSI.
Opioid Prescribing Patterns Among Orthopedic Hand Surgeons After Implementation of a Divisional Protocol
Authors: Pflug Emily M. , Huang Shengnan , Haquebord Jacques H. , Hutzler Lorraine , Paksima Nader 
Published: October 2021

ABSTRACT

Introduction:
Overprescribing contributes to the misuse and overuse of narcotics. We hypothesized that implementation of postoperative prescribing guidelines would consistently reduce the amount of opioids prescribed after ambulatory hand surgery.

Methods:
A divisional protocol was instituted in November 2018. A retrospective cohort study was designed to examine the policy's effects on postoperative prescribing. Postoperative opioid prescriptions for patients undergoing ambulatory hand surgery were evaluated 1 year before and 1 year after policy initiation. All prescriptions were converted into the total oral morphine equivalent (OME) prescribed.

Results:
A total of 1,672 surgeries were included. Six hundred sixty-one cases were in preimplementation group, and 1,011 cases were in the postimplementation group. The median of total OME decreased significantly after distribution of prescribing guidelines from 75 in the preimplementation group to 45 in the postimplementation group (p < .001) with significant reductions seen for carpal tunnel release (p < .001), trigger finger release (p < .001), distal radius open reduction internal fixation (p < .001), and finger closed reduction and pinning (p < .001). When categorized by procedure type, the median of total OME decreased from 75 to 30 for soft tissue procedures (p < .001) and from 120 to 100 for bony procedures (p < .001).

Conclusion:
Divisional prescribing guidelines lead to consistent short-term to mid-term reductions in the amount of opioid medication prescribed postoperatively.
Exploring the Relationship Between Objective Pupillometry Metrics and Midline Shift
Authors: Giamarino Kathryn , Blessing Robert , Boelter Christopher , Thompson Julie A. , Reynolds Staci S. 
Published: October 2021

ABSTRACT

BACKGROUND: Pupillary examinations provide early subtle signs of worsening intracranial pathology. Objective pupillomtery assessment, although not yet the standard of care, is considered best practice. However, inconsistent findings from objective pupillometry studies have caused a lack of consensus among clinicians; as such, no clinical guidelines are available to guide clinical use of objective pupillometer devices. To add to the body of evidence, the purpose of this project was to explore the relationship between objective pupillometry metrics and midline shift (MLS). METHODS: A retrospective chart review of pupillometer data was conducted. Midline shift was correlated with objective pupillometry metrics including Neurological Pupil Index (NPi), pupil size, and anisocoria. Midline shift was measured for the patient's initial neuroimaging and with any defined neurological change. Spearman ρ was used for statistical analysis of correlations between pupillometer metrics and MLS measured at both the septum pellucidum and pineal gland. RESULTS: A total of 41 patients were included in the analysis; most were White (58.5%) and male (58.5%), with a mean (SD) age of 58.49 (16.92) years. Spearman ρ revealed statistically significant positive correlations between right pupil NPi and anisocoria with MLS, and significant negative correlations between left pupil NPi and pupil size with MLS. CONCLUSIONS: Results from this project are consistent with previous studies. Objective pupillometry continues to be a valuable component of a comprehensive neurological examination, because it has the ability to discern early and subtle changes in a patient's neurological status, leading to lifesaving interventions.
Novel approach towards antimicrobial chemotherapy optimization in lower respiratory tract infections in children
Authors: Abramavicius Silvijus , Stundziene Alina , Jankauskaite Lina , Vitkauskiene Astra , Kowalski Ireneusz M. , Wojtkiewicz Joanna , Stankevicius Edgaras 
Published: October 2021

Abstract
The use of local antibiogram in guiding clinical decisions is an integral part of the antimicrobial stewardship program. Conventional antibiograms are not disease-specific, ignore the distribution of microorganisms, obscure the in-vitro efficacy interrelationships, and have limited use in polymicrobial infections.
We aimed to develop an in-house empiric, disease-specific, antimicrobial prescription auxiliary for the treatment of hospitalized pediatric pneumonia patients and to present the methods which help to choose the first and the second line antimicrobial therapy, while accounting for cost and safety aspects.
A retrospective single center observational study was conducted on bronchoscopy obtained sputum culture. Analysis of probabilities, variance minimization, Boolean network modeling, and dominance analysis were applied to analyze antibiogram data. The Kirby–Bauer disk diffusion method was used to test the susceptibility of all isolates. Final optimization analysis included local drug acquisition cost (standardized to price per DDD) and safety profile.
Data of 145 pediatric patients hospitalized with pneumonia with 218 isolates over 5 years was collected. A combination of statistical methods such as probabilities of drug efficacy, variance minimization, Boolean network modeling, and dominance analysis can help to choose the optimal first-line and the second-line antimicrobial treatment and optimize patient care. This research reveals that ampicillin is the optimal choice as the first-line drug and piperacillin-tazobactam is the second-line antimicrobial drug if the first one is not effective, while accounting for cost and safety aspects.
The paper proposes a new methodology to adapt empiric antimicrobial therapy recommendations based on real world data and accout for costs and risk of adverse events.
Abdominal changes in patients with degenerative spinal deformity
Authors: Guo Chen , Xu Shuai , Liang Yan , Meng Fanqi , Zhu Zhenqi , Liu Haiying 
Published: October 2021

Abstract
The incidence of degenerative spinal deformity (DSD) is increasing with the age while the effect of DSD on the abdominal cavity parameters is unclear.
To identify the characteristics of abdominal change in DSD and to explore the correlation between the abdominal cavity volume (ACV) and various types of DSD.
The retrospective study included 95 patients with DSD and 100 subjects without deformity as control group. The Cobb angle, thoracic kyphosis angle, thoracolumbar kyphosis (TLK) angle, and lumbar kyphosis angle were obtained through full-length X-ray. The ACV was calculated by measuring the longitudinal, transversal, and coronal diameters of the abdominal cavity on magnetic resonance imaging (MRI). The rotation of the diaphragm (DR) were measured in the sagittal plane. DSD ones were divided into degenerative lumbar scoliosis (DLS group), degenerative kyphosis (DK group), and degenerative lumbar scoliokyphosis (DKS group).
Compared to control group, ACV of the DLS and DKS group was smaller. The distance between the xiphoid process and spine in DLS group was shorter and DR in DK group and DKS group was smaller. The inter-group analysis showed ACV and the shortest distance between xiphoid process and spine in DLS and DKS group were significantly lower than those in DK group. The degree of DR in DK group and DKS group was higher than that in the DLS group. Multiple linear regression analysis showed Cobb angle and weight were influencing factors of ACV with ACV = 0.67 × weight – 0.19 × Cobb angle + 2231.8. The DR was affected by TLK with DR = 25.82 – 0.42 × TLK.
DLS can cause the decrease of ACV. DK will not cause changes of ACV but is related to the degree of kyphosis. DKS will impact both ACV and DR.
Intensive competency-based training strategy in a National Hospital in times of Pandemic
Authors: Camputaro Luis A. , Bello Quezada Manuel E. , Hoyos Arango William A. , Bortoli Romina G. , Ruiz Zelaya Francisco A. , Diaz Moreno Mario M. , Delgado Delgado Josue M. , Márquez Magaña Mauricio S. , Vigne Cuellar Paolo A. , Sanchez Maximiliano I. 
Published: October 2021

Abstract
COVID-19 has revealed the lack of capacity to respond to a pandemic. This article aims to
Given the large group of professionals to train (Physicians and Paramedics), a compact course based on competencies was designed and executed. In order to optimize instruction times and the need for assistance care, the course was scheduled for a total duration of 4 hours and was imparted by selected instructors from August 17 to 21, August 24 to 28, and September 7 to 11, 2020 (15 working days in total). The Research Ethics Committee of Hospital Nacional El Salvador approved the study. The effectiveness of the educational intervention was evaluated by a pre–post-survey of knowledge perception on 4 domains with 10 areas of skills in intensive care.
100% (n: 981) of the participants were trained in hands-on care of COVID-19 patients; 66.3% female–33.7% male, with an average age of 29.92 ± 5.82 years. The course achieved an increased perception of knowledge in the 10 areas evaluated with a mean of 5.72 ± 0.59 to 8.60 ± 0.19 (P < .0001).
The short intensive training in competencies carried out at Hospital Nacional El Salvador proved to be effective in improving the knowledge of healthcare workers engaged in patient care.
Evaluation of dopamine transporter density in healthy Brazilians using Tc-99m TRODAT-1 SPECT
Authors: Reis Marilia Alves dos , Gadelha Ary , Felício André C. , Hoexter Marcelo Queiroz , Batista Ilza Rosa , Braga-Neto Pedro , Calzavara Mariana , Cavagnolli Daniel Alves , Higuchi Cinthia , Leite Melissa Furlaneto Lellis , Nogueira Solange Amorim , Wagner Jairo , Castiglioni Mario Luiz Vieira , Shih Ming Chi , Bressan Rodrigo Affonseca 
Published: October 2021

Abstract
The presynaptic dopamine transporter (DAT) modulates the uptake of dopamine by regulating its concentration in the central nervous system. We aimed to evaluate the DAT binding potential (DAT-BP) in a sample of healthy Brazilians through technetium-99 metastable TRODAT-1 single-photon emission computed tomography imaging.
We selected 126 healthy individuals comprising 72 men and 54 women, aged 18 to 80 years. We conducted semi-quantitative evaluation in transaxial slices, following which we identified the regions of interest in the striatal region using the occipital lobe as a region of non-specific DAT-BP.
We found a decrease in DAT-BP in healthy individuals aged over 30 years, culminating in a 42% mean reduction after 80 years. There was no difference in the decrease by age group between the right (linear regression test [R
2] linear = 0.466) and left striatum (R
2 linear = 0.510). Women presented a higher DAT-BP than men (women: R
2 linear = 0.431; men: R
2 linear = 0.457); nonetheless, their decrease by age group was equal to that in men.
Our study sheds light on important DAT-BP findings in healthy Brazilian subjects. Our results will facilitate understanding of brain illnesses that involve the dopamine system, such as neuropsychiatric disorders.
Serum CD5L predicts acute lung parenchymal injury and acute respiratory distress syndrome in trauma patients
Authors: Cheng Qian , Lai Xiaofei , Yang Liping , Yang Huiqing , Luo Yan 
Published: October 2021

Abstract
Cluster of differentiation 5 antigen-like (CD5L), derived from alveolar epithelial cells partly, is a secreted protein. It is shown that CD5L is associated with lung inflammation and systemic inflammatory diseases, but the relationship between CD5L and trauma-related acute lung parenchymal injury (PLI), acute lung injury or acute respiratory distress syndrome (ARDS) is unclear. This study aims to explore the value of serum CD5L levels in predicting trauma-associated PLI/ARDS and its potential clinical significance.
This is a prospective observational study, and a total of 127 trauma patients were recruited from the emergency department (ED), and among them, 81 suffered from PLI/ARDS within 24 hours after trauma, and 46 suffered from trauma without PLI/ARDS. Fifty healthy subjects from the medical examination center were also recruited as controls for comparison. The serum CD5L level was measured within 24 hours of admission. The receiver operating characteristic analysis and logistic regression analysis were used to identify the correlation between high CD5L and trauma associated-PLI/ARDS within 24 hours following trauma.
The trauma associated-PLI/ARDS subjects showed a significantly higher level of serum CD5L on emergency department admission within 24 hours after trauma compared with its level in non-trauma associated-PLI/ARDS subjects and healthy subjects. The initial CD5L concentration higher than 150.3 ng/mL was identified as indicating a high risk of PLI/ARDS within 24 hours following trauma (95% confidence interval: 0.674–0.878; P < .001). Moreover, CD5L was an independent risk factor for trauma associated-PLI/ARDS within 24 hours following trauma.
CD5L could predict PLI/ARDS within 24 hours following trauma.
Construction and comprehensive analysis of a competitive endogenous RNA network to reveal potential biomarkers for the malignant differentiation of glioma
Authors: Li Xin , Zhang Jingwen , Zhang Min , Qi Xianghua , Wang Shiyuan , Teng Jing 
Published: October 2021

Abstract

Background:
Long noncoding RNAs (lncRNAs) can act as microRNA (miRNA) sponges to regulate protein-coding gene expression; therefore, lncRNAs are considered major components of the competitive endogenous RNA (ceRNA) network and have attracted growing attention. This study explored the regulatory mechanisms and functional roles of lncRNAs as ceRNAs in the malignant differentiation of low-grade glioma (LGG) to glioblastoma (GBM) and their potential impact on the prognosis of patients with GBM.

Methods:
LncRNA and messenger RNA (mRNA) data were extracted from the Cancer Genome Atlas (TCGA) database from 156 GBM samples and 529 LGG samples. Separately, the miRNA expression data were downloaded from the Gene Expression Omnibus database, with the GSE112009 dataset containing miRNA expression data from 10 GBM samples and 15 LGG samples. Weighted gene coexpression network analysis was performed to screen the glioma grade-related lncRNAs. Then, a ceRNA network was established. The database for annotation, visualization, and integrated discovery was adopted to conduct functional enrichment analysis based on 57 upregulated differentially expressed mRNAs in the ceRNA network. Finally, Kaplan–Meier curves were created for the survival analysis of 13 hub lncRNA by combining the clinical data of GBM patients in TCGA.

Results:
A ceRNA network including 16 lncRNAs, 18 miRNAs, and 78 mRNAs specific to the malignant differentiation of LGG to GBM was established. The 57 upregulated differentially expressed mRNAs in the ceRNA network were significantly enriched in 35 gene ontology terms and 5 pathways. The survival analysis showed that 2 lncRNAs (LINC00261 and HOXA10-AS) were prognostic biomarkers for patients with GBM in TCGA.

Conclusion:
The proposed ceRNA network may help elucidate the regulatory mechanism by which lncRNAs function as ceRNAs and contribute to the malignant differentiation of LGG to GBM. Importantly, the candidate lncRNAs, miRNAs, and mRNAs involved in the ceRNA network can be further evaluated as potential therapeutic targets and prognostic biomarkers for GBM.
The effect of Pilates exercise training for scoliosis on improving spinal deformity and quality of life
Authors: Gou Yanyun , Lei Huangwei , Zeng Yi , Tao Jing , Kong Weicheng , Wu Jingsong 
Published: October 2021

Abstract

Background:
It remains unclear if Pilates is conducive to reducing spinal deformity and improving patients’ quality of life (QOL) with scoliosis. The aim of this study was to systematically review the published evidence to determine whether Pilates exercise training is an efficacious therapy for scoliosis.

Methods:
Searches was conducted in Medline, Embase, PubMed, Scopus, CINAHL, Physiotherapy Evidence Database (PEDro), Cochrane library, Baidu Scholar, and Green Medical to identify randomized studies that tested the effect of Pilates exercise training on Cobb angle, pain level, trunk range of motion (ROM), angle of trunk rotation, and QOL in idiopathic scoliosis. Separate meta-analyses were performed on the endpoints of these outcome measures. The PEDro scale was used to assess the methodological quality of the included studies.

Results:
This review included 10 randomized controlled trials (n = 359). PEDro scores ranged from 3 to 10, with the mean score across all articles being 5.3/10 and judged to be of fair quality. The results indicated that Pilates exercises was effective in reducing Cobb angle (standardized mean difference [SMD] = 1.23, 95% confidence interval [CI] = 0.11–2.35), angle of trunk rotation (SMD = 1.37, 95% CI = 1.01–1.73), and pain level (SMD = 2.78, 95% CI = 1.55–4.01), as well as improving trunk ROM (SMD = 1.23, 95% CI = 0.45–2.00), and QOL (SMD = 3.05, 95% CI = 2.59–3.51) in patients with scoliosis.

Conclusion:
Pilates exercise training may reduce the Cobb angle and trunk rotation, relieve pain, increase trunk ROM, and improve QOL for patients with scoliosis. Due to the poor quality of the evidence, however, these results should be interpreted with caution.
Gastric metastasis and transformation of primary lung adenocarcinoma to small cell cancer after acquired resistance to epidermal growth factor receptor tyrosine kinase inhibitors
Authors: Liu Jing , Xia Lei , Peng Yuan , Huang Yu Sheng , Yang Zhen Zhou 
Published: October 2021

Abstract

Rationale:
Transformation to small cell lung cancer (SCLC) is one of the mechanisms of resistance to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). However, no standard treatment is available after the transformation. In addition, gastric metastasis of primary lung cancer is rarely observed; thus, little is known about its metastatic characteristics.

Patient concerns:
A 58-year-old male patient was treated with gefitinib (0.25 g /day) as the 1st line treatment due of recurrence after surgical resection for EGFR exon 19 mutation pulmonary adenocarcinoma. However, he experienced recurrence with positive T790 M, and osimertinib (80 mg/day) was administered as the 2nd line therapy.

Diagnosis:
One year and 6 months after osimertinib initiation, he complained of stomachache, and a diagnostic gastroscopy biopsy confirmed small cell lung cancer in the gastric body, indicating osimertinib-induced phenotypic transformation.

Interventions and outcomes:
The patient was treated with etoposide and platinum chemotherapy and maintenance therapy with osimertinib. Finally, the patient achieved a partial response after 4 cycles.

Lessons:
Timely second biopsies should be considered in the diagnosis of phenotypic transformation. After transformation, chemotherapeutic treatment with etoposide and platinum and maintenance therapy with osimertinib inhibited the progression of the disease.