bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of supra-arch in situ fenestration and chimney techniques for aortic dissection involving the left subclavian artery
Authors: XiaoHui Ma , Li Wei , Wei Guo , XiaoPing Liu , Xin Jia , Hongpeng Zhang , Lijun Wang 
Published: October 2018

Introduction Endovascular intervention involving the aortic arch, particularly in thoracic aortic dissection, remains challenging and controversial at current time when there is no commercially suitable grafts on most of the international markets. This study compared two endovascular treatments that maintain left subclavian artery perfusion using two modified techniques for type-B aortic dissection patients. Methods Consecutive cases utilizing chimney or in situ fenestration techniques to preserve left subclavian artery in type B AD from 2006 to 2015 in our single institution were retrospectively reviewed. Statistical analyses were performed with Student t-test, Wilcoxon rank sum, and Fisher exact tests when appropriate. Significant statistical differences were determined with p < 0.05. Results A total of 85 cases, including 67 (79.8%) with chimney and 18 (21.2%) with in situ fenestration techniques were identified in this retrospective study. In chimney group, there were 18 (26.9%) acute, 29 (43.3%) sub-acute, and 20 (29.9%) chronic aortic dissections. We implanted 24 Zenith and 43 Talent aortic endografts along with 55 balloon-expandable bare stents and 12 self-expanding covered stents in chimney group. Whereas in in situ fenestration group, there were four (22.2%) acute, six (33.3%) subacute, and eight (44.5%) chronic aortic dissections, all of which received Zenith endografts with 11 balloon-expandable covered and seven self-expanding covered stents, respectively. Demographic variables were similarly distributed with 100% intraoperative technical overall success in both groups. Comparing to in situ fenestration group, chimney group has shorter procedural and fluoroscopy time, less blood loss, and contrast volume used. All patients were followed-up to 52 months (median 38, range 24–52). Overall group mortality is 3.6% (3/84). All deaths were from chimney group. There was no procedure-related stroke observed within the study series. Primary patency was maintained while aortic remodeling with complete false lumen was achieved in all patients except that there were three (4.55%) Type-I endoleak cases in early post-operative period and one (1.5%) stent compression at 3-months follow-up in chimney group. There were no stent-related complications observed in in situ fenestration group. Conclusion Although there were previous studies describing the similar techniques, this study appears to be the first study to compare in situ fenestration and chimney techniques for aortic dissection involving the left subclavian artery according to the MEDLINE search. Although we are unable to establish the superiority between two approaches due to small sample size and relative short period of follow-up, in situ fenestration may represent a more favorable option, especially among aortic dissections with short proximal landing zones in the study.
International Radiotherapy Referrals From Rural Rwanda: Implementation Processes and Early Clinical Outcomes
Authors: Hanappe Maud , Nicholson Lowell T. , Elmore Shekinah N.C. , Fehr Alexandra E. , Bigirimana Jean Bosco , Borg Ryan C. , Butonzi John , Shyirambere Cyprien , Mpanumusingo Egide , Benewe Marie O. , Kanyike Dan M. , Triedman Scott , Shulman Lawrence N. , Rusangwa Christian , Park Paul H. 
Published: October 2018

PurposeLow- and middle-income countries disproportionately comprise 65% of cancer deaths. Cancer care delivery in resource-limited settings, especially low-income countries in sub-Saharan Africa, is exceedingly complex, requiring multiple modalities of diagnosis and treatment. Given the vast human, technical, and financial resources required, access to radiotherapy remains limited in sub-Saharan Africa. Through 2017, Rwanda has not had in-country radiotherapy services. The aim of this study was to describe the implementation and early outcomes of the radiotherapy referral program at the Butaro Cancer Centre of Excellence and to identify both successful pathways and barriers to care.MethodsButaro District Hospital is located in a rural area of the Northern Province and is home to the Butaro Cancer Centre of Excellence. We performed a retrospective study from routinely collected data of all patients with a diagnosis of cervical, head and neck, or rectal cancer between July 2012 and June 2015.ResultsBetween 2012 and 2015, 580 patients were identified with these diagnoses and were potential candidates for radiation. Two hundred eight (36%) were referred for radiotherapy treatment in Uganda. Of those referred, 160 (77%) had cervical cancer, 31 (15%) had head and neck cancer, and 17 (8%) had rectal cancer. At the time of data collection, 101 radiotherapy patients (49%) were alive and had completed treatment with no evidence of recurrence, 11 (5%) were alive and continuing treatment, and 12 (6%) were alive and had completed treatment with evidence of recurrence.ConclusionThis study demonstrates the feasibility of a rural cancer facility to successfully conduct out-of-country radiotherapy referrals with promising early outcomes. The results of this study also highlight the many challenges and lessons learned in providing comprehensive cancer care in resource-limited settings.
Delivering Survivorship Care to Women in Low-Resource Settings: A Report From India
Authors: Kaur Navneet , Jain Asmita 
Published: October 2018

Purpose The concept of cancer survivorship care as a distinct phase of cancer treatment is relatively new in the developing world. India has a growing population of survivors of breast cancer, but the resources to meet their needs are limited; therefore, to be cost effective, it is important to identify areas that cause the most disruption in their quality of life (QOL). This study was conducted with the following objectives: to estimate the prevalence of various survivorship issues, identify most important issues that limit QOL, and collect information about patients’ perspectives of their supportive care needs to design a plan of follow-up and supportive care. Methods This descriptive, hospital-based, cross-sectional study was conducted in 230 survivors of breast cancer in an academic health care setting in northern India. A checklist of 14 commonly reported survivorship issues as well as questionnaires for QOL assessment—FACT-B and SF-36 —were administered to participants. A semistructured interview was conducted to identify supportive care needs from the patient’s perspective. Main outcome measures were frequencies of survivorship issues and QOL scores among three groups divided on the basis of time elapsed since treatment (< 2 years of follow-up, 2 to 5 years of follow-up, and > 5 years follow-up), stepwise regression analysis to identify issues that have the most significant impact on QOL, and a theme-based analysis of survivors’ interviews to identify supportive care needs. Results The most prevalent survivorship issues were fatigue (60%), restriction of shoulder movement (59.6%), body and joint pain (63.5%), chemotherapy-induced cessation of menstruation (73.3%), and loss of sexual desire (60%). Issues that had a maximum impact on QOL scores were emotional distress (r = −11.375), fatigue (r = −9.27), and premature menopause and its related symptoms (r = −2.085). An analysis of interviews demonstrated maximum unmet needs in the area related to health care information, psychosocial support to cope with breast cancer diagnosis and treatment, relief of physical symptoms, and access to follow-up and supportive care. Conclusion Supportive care services should be designed to address the above-mentioned areas on a priority basis so as to make effective use of limited available resources. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.
The Max Access Solution: A 'No Patient Left Behind' Model for Treatment Access
Authors: Novakowski Ann K. , Garcia-Gonzalez Pat 
Published: October 2018

Purpose The Max Foundation has led the development and implementation of the widely recognized model for patient assistance programs by which manufacturers make available some of their innovative products to patients in low- and middle-income countries. Recognizing that a limitation of a pharmaceutical patient assistance program is the focus on a particular product while a patient’s cancer need is company agnostic, the Max Access Solution borrows from all the lessons learned from developing and managing access programs while shifting the focus from the drug to the patient. This innovative long-term access approach provides a bridge to treatment to individually identified patients in countries where the treatment is not otherwise locally available. Methods The initiative focuses on the patient and his or her needs across the disease spectrum, harnessing the power of multisector collaborations, including drug manufacturers, international distributors, diagnostics companies, ministries of health, ministries of health hospitals, cancer centers and other public institutions in recipient countries, and local nongovernmental organizations and patient organizations, as well as cancer research centers in the United States. We established the following measurable objectives: identify all treatments approved for a particular cancer, identify the supportive care needed to successfully treat the disease, identify local and international stakeholders for the success of the initiative, develop collaborative agreements with each of them, and establish an end-to-end validated supply chain into each country/cancer institution. Results In the first year of implementation, The Max Foundation delivered more than 700,000 required daily doses of oral cancer medication for CML to more than 10,000 patients in 65 countries, made 2,500 molecular tests available to patients, executed more than 220 collaboration agreements, and established a gross domestic product–validated supply chain into 90 cancer-treating institutions. Conclusion The Max Access Solution is a unique and innovative approach to cancer care access. An aim of The Max Foundation in developing the Max Access Solution for CML was as a proof of concept as well as to develop systems and impact measurements, with the long-term vision of expanding the model to other cancers. This model may be replicated in a variety of noncommunicable disease areas, including breast cancer and other cancers, to reduce health disparities globally. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.
Treatment Information and Navigation Program for New Patients With Breast Cancer in Malaysia
Authors: Taib Nur Aishah , Islam Tania , Kaur Ranjit , Mushtaffa Suhaida 
Published: October 2018

Purpose Advancements in medical treatment with wider treatment options have made breast cancer (BC) care more complex. Short consultation time with physicians, patient fears, and poor coping skills at the time of diagnosis may affect a patient’s decision, causing treatment delays and nonadherence. The main reasons for advanced BC presentation in Malaysia are a delay in making a treatment decision and poor breast health literacy on the disease and its treatment outcomes. To address this gap, we developed an audio-visual tool on multimodal treatments; adverse effects; navigating admission, discharge, and follow-up; and advice on diet and exercise to maintain a healthy lifestyle during the survivorship period in layperson language in Malay, Mandarin, and English. This study aims to assess its effectiveness in improving patient knowledge and satisfaction. Methods A pilot study of 50 patients found that patients needed face-to-face interaction to watch the video. Hence, a breast care nurse–led orientation was developed. A self-administered pre- and postsurvey in 246 patients with newly diagnosed breast cancer in University Malaya Medical Centre was performed to evaluate expectations, satisfactions, and knowledge. We scored the results with the following Likert scale terms: 0 means no knowledge and 4 means a great degree of knowledge. Scoring was done pre- and postintervention. A Wilcoxon matched paired signed rank test was used in the analysis. Results Among 246 patients who received the intervention, 79.3% (n = 197) found that the video met or exceeded their expectations, and 80.2% found the video effective in broadening their perspective on BC treatments. One hundred seventy-one patients (69.2%) rated the video as highly meeting their expectations. There were significant improvements in knowledge of treatment options for BC (mean scores 0.93 v 2.97 for pre- and postintervention; P < .001). Similar findings were found in different types of operations for BC; admission procedures; and information on chemotherapy, radiotherapy, hormone therapy, and alternative medicine. Knowledge scores for healthy diet, physical activity after treatment, and care of the arm were observed ( P < .001). Conclusion Video-based information on treatments and navigating care through a breast care nurse–led service effectively improved patients’ knowledge and satisfaction. This approach can be used to educate patients with cancer in a middle-resource setting. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.
Clinical Use of the Pictorial Baxter Retching Faces Scale for the Measurement of Postoperative Nausea in Children
Authors: Watcha Mehernoor F. , Lee Andrew D. , Medellin Eduardo , Felberg M. Toni , Bidani Sudha A. 
Published: October 2018

BACKGROUND:
Because nausea is difficult to evaluate in children, vomiting is used as the objective clinical end point in managing pediatric postoperative nausea and vomiting and postdischarge nausea and vomiting (PDNV). The recently developed pictorial Baxter Retching Faces (BARF) scale has content, construct, and convergent validity in quantifying pediatric nausea intensity. We determined its clinical usefulness in assessing pediatric postoperative nausea and vomiting and PDNV, establishing the lowest age associated with consistently reliable use, the score at which patients identify a need for therapy, and the minimum clinically relevant change in scores, and examined its test–retest reliability.

METHODS:
We obtained subject ratings of the severity of their nausea using the BARF and visual analog scales in the preoperative, postanesthesia care unit and postdischarge phases. Changes in nausea were rated on a 5-point Likert scale, along with responses to queries of a need for rescue antiemetics at these time points.

RESULTS:
Children ≥6 years of age had a consistently reliable ability to use the BARF scale (132/132 [100%] vs 59/76 [77.6%] for children ≥6 and <6 years of age, respectively, Fisher exact test, P < .001). The BARF scale had excellent performance in predicting patient-perceived need for antiemetics, with a score of 4 having 80.0% sensitivity and 85.6% specificity. The minimum clinically relevant difference in BARF scores was 1.47 (95% confidence interval, 0.84–2.1). The intraclass correlation coefficient was 0.56 (95% confidence interval, 0.34–0.73).
The BARF scale identified 60 of 192 (31.3%) children as having postoperative nausea in the postanesthesia care unit, with severe nausea (score >6) in 13 (6.7%). Emesis occurred in 8 (4.1%). Rescue antiemetics were administered to 16 (8.3%), including 2 with severe emesis (≥3 episodes) but in only 2 of 11 (18.2%) with severe nausea without vomiting. PDNV was reported in 39 of the 99 who returned diaries (39.4%), with nausea in 34 (34.3%), severe nausea in 15 (15.2 %), and emesis in 16 (16.2%).

CONCLUSIONS:
The pictorial BARF scale is easy to use in the clinical setting by children ≥6 years of age, has a minimum clinically relevant difference of 1.47, with scores of 4 or higher associated with a patient-identified need for rescue antiemetics. Assessment of postoperative nausea by the BARF scale has shown that clinically significant nausea occurs frequently in children but is not always treated unless accompanied by vomiting.
Prohemostatic Activity of Factor X in Combination With Activated Factor VII in Dilutional Coagulopathy
Authors: Takeshita Shusuke , Ogawa Satoru , Nakayama Yoshinobu , Mukai Nobuhiro , Nakajima Yasufumi , Mizobe Toshiki , Sawa Teiji , Tanaka Kenichi A. 
Published: October 2018

BACKGROUND:
Recombinant activated factor VII (rFVIIa) concentrate reduces allogeneic blood transfusions, but it may increase thromboembolic complications in complex cardiac surgery. The mixture of activated factor VII (FVIIa) and factor X (FX) (FVIIa/FX) (FVIIa:FX = 1:10) is a novel bypassing agent for hemophilia patients. We hypothesized that the combination of FX and FVIIa could improve thrombin generation (TG) in acquired multifactorial coagulation defects such as seen in cardiac surgery and conducted in vitro evaluation of FVIIa/FX in parallel with other coagulation factor concentrates using in vitro and in vivo diluted plasma samples.

METHODS:
Plasma samples were collected from 9 healthy volunteers and 12 cardiac surgical patients. We measured TG (Thrombinoscope) using in vitro 50% dilution plasma and in vivo dilution plasma after cardiopulmonary bypass, in parallel with thromboelastometry (ROTEM) and standard coagulation assays. In vitro additions of FVIIa/FX (0.35, 0.7, and 1.4 μg/mL, based on the FVIIa level), rFVIIa (1.4, 2.8, and 6.4 μg/mL), prothrombin complex concentrate (0.3 international unit), and 20% plasma replacement were evaluated.

RESULTS:
In diluted plasma, the addition of either FVIIa/FX or rFVIIa shortened the lag time and increased the peak TG, but the effect in lag time of FVIIa/FX at 0.35 μg/mL was more extensive than rFVIIa at 6.4 μg/mL. Prothrombin complex concentrate increased peak TG by increasing the prothrombin level but failed to shorten the lag time. No improvement in any of the TG variables was observed after 20% volume replacement with plasma. The addition of factor concentrates normalized prothrombin time/international normalized ratio but not with plasma replacement. In cardiac patients, similar patterns were observed on TG in post–cardiopulmonary bypass samples. FVIIa/FX shortened clotting time (CT) in a concentration-dependent manner on CT on thromboelastometry. Plasma replacement did not improve CT, but a combination of plasma and FVIIa/FX (0.35 μg/mL) more effectively shortened CT than FVIIa/FX alone.

CONCLUSIONS:
The combination of FVIIa and FX improved TG more efficiently than rFVIIa alone or plasma in dilutional coagulopathy models. The required FVIIa dose in FVIIa/FX was considerably lower than those reported during bypassing therapy in hemophilia patients (1.4–2.8 μg/mL). The combination of plasma could restore coagulation more efficiently compared to FVIIa/FX alone. Lesser FVIIa requirement to exert procoagulant activity may be favorable in terms of reducing systemic thromboembolic complications.
Health or Politics? Organizational Maintenance in the AAFP
Authors: Brophy Sorcha A. 
Published: October 2018

Abstract
In recent years, the American Academy of Family Physicians (AAFP) has debated and developed organizational stances on issues as varied as nuclear disarmament, gay marriage, policing, and climate change. This article considers the relationship of “political” policies to the ongoing maintenance of this professional association over time. The author describes transitions in the organization's policies from broad, neutral statements to more explicitly politicized social policy statements and then discusses debates around the establishment of an organizational policy on same-gender marriage, the term for gay marriage that is used within the AAFP. Results indicate that members use concerns about the maintenance of the organization over time as a lingua franca during debates. However, while members routinely interpret policy in terms of its relationship to the maintenance of the organization, they articulate conflicting visions of maintenance, with those in favor of the policies describing maintenance primarily in terms of external legitimacy and those in opposition describing maintenance primarily in terms of internal cohesion.
Targeting ulcerative colitis by suppressing glucose uptake with ritonavir
Authors: Jodeleit Henrika , Al-Amodi Omar , Caesar Janina , Villarroel Aguilera Christina , Holdt Lesca , Gropp Roswitha , Beigel Florian , Siebeck Matthias 
Published: October 2018

ABSTRACT
Glucose is the preferred source of energy in activated inflammatory cells. Glucose uptake into the cell is ensured by a family of glucose uptake transporters (GLUTs), which have been identified as off-target molecules of the HIV protease inhibitor ritonavir. In this study, we examined the effect of ritonavir on inflammation in vitro and in vivo. Peripheral blood mononuclear cells (PBMCs) were activated with anti-CD3 in the presence or absence of ritonavir and analyzed by flow cytometric analysis. Frequencies of CD4+ cells were significantly affected by ritonavir (CD69+ P=3E-05; CD134 P=4E-06; CD25+ P=E-07; central memory P=0.02; effector P=6E-03; effector memory P=6E-05). To corroborate that inflammation has a metabolic effect in vivo, a mouse model was used that is based on immunocompromised NOD-scid IL-2Rγ null mice reconstituted with PBMCs from patients with ulcerative colitis (UC). Inflammation had a significant effect on amino acid (AA) levels (Glu P=1E-07, Asp P=1E-04). Principal component analysis (PCA) discriminated between unchallenged and challenged groups. Finally, the efficacy of ritonavir was tested in the same mouse model. Dependent variables were clinical and histological scores, frequencies of human leukocytes isolated from spleen and colon, and levels of AA in sera of mice. Mice benefited from treatment with ritonavir as indicated by significantly decreased colon (P=7E-04) and histological (P=1E-04) scores, frequencies of M2 monocytes (CD14+ CD163; P=0.02), and Glu levels (P=2E-05). PCA discriminated between control and challenged groups (P=0.026). Thus, inhibition of glucose uptake might be a promising therapeutic intervention point for active UC.