bluuebunny/crossref_metadata_2025_split huggingface dataset:
PB2440 CHARACTERISTICS OF PATIENTS WITH CANCER TREATED FOR VENOUS THROMBOEMBOLISM IN GENERAL HOSPITAL DR. JOSIP BENČEVIĆ DURING FIVE YEARS
Authors: Holik H. , Coha B. , Peić A. Kovač , Pulanić D. 
Published: June 2019

Background:In the Republic of Croatia cancer is the second cause of mortality after cardiovascular disease. Patients with cancer have a 4 to 7‐fold higher risk of developing venous thromboembolism (VTE) and those who developed VTE have poorer survival than those without VTE. The greatest risk of developing VTE is present in pancreatic, brain, stomach and ovarian cancer, while the lowest risk is with breast and prostate cancer.Aims:Analyze characteristics of patients with cancer who were treated for VTE in General Hospital Dr. Josip Benčević for a period of five years.Methods:In the General Hospital Dr Josip Benčević ‐ location of Slavonski Brod longitudinal observational analyzes of patients with cancer and newly diagnosed VTE treated in hospital during 2011‐2015.Results:A total of 546 cases of VTE were diagnosed in the period of 5 years, out of which 134 (25%) patients with cancer. In patients with cancer and VTE (134) 46% were female while the median age was 67 years, ranging from 38 to 89 years. 87 (65%) patients had deep vein thrombosis (DVT), pulmonary embolism (PE) had a 34 (25%) while 13 (10%) patients had PE and DVT simultaneously. Cancer was only risk factor for development of VTE in 44 (33%) patients, while others had one or more additional risk factors; 51 patients (38%) were treated with possible thrombogenic chemotherapy, 36 (27%) had surgery within 6 months of diagnosis, 15 (11%) patients had sepsis and 18 (13%) were immobilized. A total of 27 (20%) patients died, 16 out of pulmonary embolism, 10 from cancer and 1 from sepsis as a main cause of death. The most common primary cancer sites were: lung 17%, colon and rectum 16%, haematological malignancies 11%, pancreas 9%, ovary 8%, prostate 7%, breast 6%, liver and gallbladder 6%, urinary bladder 5 % and stomach 4%.Summary/Conclusion:The results of our analysis are consistent with data from the literature on VTE incidence and the percentage of VTE caused by cancer. Distrubution of patients with cancer and VTE according to primary cancer site is also like data from literature – most cases were with lung and colon cancer who are the most common cases of cancer in our population while the most thrombogenic cancer in our study was pancreas. VTE prevention in patients with high risk of developing VTE is a priority in today's treatment. Strong adherence of the appropriate thromboprophylaxis is required to reduce the incidence of VTE in the cancer patients.
PB2441 DIRECT ORAL ANTICOAGULATION IN PATIENTS WITH MYELOPROLIFERATIVE NEOPLASMS: A SINGLE‐CENTER REAL‐LIFE EXPERIENCE
Authors: Raso S. , santoro M. , Napolitano M. , Mancuso S. , Accurso V. , Carlisi M. , Tarantino G. , Siragusa S. 
Published: June 2019

Background:The risk of developing a venous thromboembolic event (VTE) in Myeloproliferative Neoplasms (MPNs) accounts from 5 to 10‐fold the general population risk. According to recommendations of European Leukemia Net, patients affected by MPNs already diagnosed with VTE have to be considered at high risk for VTE recurrence. To date the standard treatment adopted for prevention and treatment of VTE in this setting of patients is represented by low molecular weight heparin (LMWH) and vitamin K antagonists (AVK). Recent data have demonstrated the noninferiority of direct oral anticoagulant (DOAC) drugs, when compared to LMWH, in preventing VTE recurrences in patients affected by cancer with an acceptable toxic profile. However, there are only scarce evidences on the safety and efficacy of DOACs in patients with hematological malignancies.Aims:Our aim is to collect real‐life data on the use, efficacy and safety of DOACs in patients with diagnosis of MPNs.Methods:Data from 51 patients affected by MPNs on anticoagulant therapies were collected. Of them, 27 were on treatment with AVK, 4 on LMWH and 20 on DOAC. Data from the 20 MPNs patients taking DOACs for treatment/prevention of VTE or atrial fibrillation (AF) were retrospectively collected in a specific database. Data were analyzed with descriptive statistic tools. Adverse events were graded according to the “Common Terminology Criteria – Adverse Events” (CTC‐AE) scale.Results:14/20 (70%) of the patients on treatment with DOAC have the indication for prevention of VTE recurrences and 6/20 (30%) for AF. Of the 20 patients, 5 were taking dabigatran, 6 rivaroxaban, 3 apixaban and 4 edoxaban. Of the 14 patients on anticoagulation treatment for prevention of VTE, 2 (14.3%) patients failed prevention and showed VTE recurrence: in one case, because of drug failure a second line prophylaxis therapy with warfarin was started; in the second case, failure was due to inadequate cytoreduction for MPN and the DOAC was not dropped. Bleeding was registered in three cases: 2 graded as first and 1 as second grade as per CTC AE classification. Grade 2 bleeding was resolved with dose reduction of anticoagulation treatment. None of the patient was concomitantly under antiplatelet therapy.Summary/Conclusion:Real life data from a single center experience on the use of DOAC in patients with MPN suggest that also in these setting of patients DOACs are safe. More extensive data collection is needed to confirm these preliminary findings.
PB2442 BRONCHOSCOPIC TREATMENT WITH FRESH FROZEN PLASMA AND TISSUE PLASMINOGEN ACTIVATOR FOR A CHILD WITH TYPE 1 PLASMINOGEN DEFICIENCY
Authors: Hangul M. , Tuzuner A. B. , Somekh I. , Klein C. , Patıroglu T. , Unal E. , Kose M. 
Published: June 2019

Background:Congenital plasminogen deficiency is a genetic disease with autosomal recessive inheritance pattern. Fibrous plaques that accumulate in the mucosal surfaces of oral cavity, eye and respiratory tract.Aims:We aimed to report the first bronchoscopic usage of fresh frozen plasma (FFP) and tissue plasminogen activator (t‐PA) for respiratory complications of a child with plasminogen deficiency.Methods:A child with plasminogen deficiency treated with FFP, t‐PA is reported.Results:A one‐year‐old male patient was admitted to the hospital for 1 week with cough and increased respiratory distress. Antibiotic therapy was started for bronchopneumonia.From his medical history it was learned that he had lingous conjunctivitis, in addition a ventriculo‐peritoneal shunt was inserted due to hydrocephalus in the antenatal period. His parents were cousins. The patient had significant paracardiac infiltrations, linear infiltrations in the parenchyma of the chest x ray. The patient was thought to have plasminogen deficiency by clinical findings and his plasminogen level was found to be 14% (N: 70‐130%).Type 1 plasminogen deficiency and related pulmonary involvement were considered. Bronchoscopy was performed. There were fibrin deposits in the trachea and bronchi. Recurrent pulmonary lavage was performed with FFP and t‐PA. Fibrin plugs occluding the bronchial cuffs were decreased and some of them disappeared.The patient recovered from respiratory distress that required high flow oxygen therapy, and discharged. Homozygous frameshift mutation in the PLG gene was detected.Summary/Conclusion:In this case, it has been firstly reported that total pulmonary lavage treatment with FFP and t‐PA can be a useful treatment method for paitents with plasminogen deficiency in the English literature.
Development of the Diverse Standardized Patient Simulation Cultural Competence Education Strategy
Authors: Ozkara San Eda 
Published: June 2019

Abstract
This article describes the development of the diverse standardized patient simulation (DSPS) cultural competence education strategy, which is designed to improve students’ knowledge, skills, and attitudes with regard to providing culturally competent care. Development of the DSPS was guided by the Jeffreys’ Cultural Competence and Confidence model. As a carefully orchestrated educational intervention utilizing standardized patient pedagogy, the DSPS had content validity review and followed international guidelines and standards for design, implementation, evaluation, and standardized patient training. This strategy was integrated into a nine-credit, 15-week medical-surgical nursing course. A step-by-step description for the development of the DSPS is provided.
Effective Cerebral Perfusion Pressure: Does the Estimation Method Make a Difference?
Authors: Grüne Frank , Mik Egbert G. , Dieters Erik , Hoeks Sanne E. , Stolker Robert Jan , Weyland Andreas , Visser Gerhard H. 
Published: June 2019

Introduction:The effective cerebral perfusion pressure (CPPe), zero-flow pressure (ZFP), and resistance area product (RAP) are important determinants of cerebral blood flow. ZFP and RAP are usually estimated by linear regression analysis of pressure-velocity relationships of the middle cerebral artery. The aim of this study was to validate 4 other estimation methods against the standard linear regression method.Methods:In a previous study, electroencephalography, arterial blood pressure, and middle cerebral artery flow velocity were measured in patients during internal cardioverter defibrillator implantation procedures to determine the electroencephalography frequency ranges that represent ischemic changes during periods of circulatory arrest. In this secondary analysis, arterial blood pressure and middle cerebral artery flow velocity were used to estimate CPPe, ZFP, and RAP by 4 different methods—the 3-point intercept calculation (LR3, systolic/mean/diastolic) and methods described by Czosnyka (systolic/diastolic), Belford (mean/diastolic), and Schmidt (systolic/diastolic)—and compare them with the reference linear regression method. CPPe was calculated as the difference between mean arterial pressure and ZFP. The primary endpoint was the difference, correlation, and agreement of these differently estimated CPPe measurements.Results:In total, 174 measurements in 35 patients were collected under steady-state conditions before the first circulatory arrest phase during internal cardioverter defibrillator testing. CPPe, ZFP, and RAP measurements based on the 3-point intercept and Czosnyka calculation methods showed small mean differences, good agreement, low percentage errors, and excellent correlation when compared with the reference method. Agreement and correlation were moderate for the Belford method and unsatisfactory for the Schmidt method.Conclusions:CPPe, ZFP, and RAP measurements based on 2 alternative calculation methods are comparable to the linear regression reference method.
Cervical Laminectomy With or Without Lateral Mass Instrumentation
Authors: Kim Boaz Sungwhan , Dhillon Rana Singh 
Published: June 2019

Study design:
Narrative review.

Background:
Cervical decompressive laminectomy is a common posterior approach for addressing multilevel cervical spondylotic myelopathy. However, there is a concern that cervical laminectomy can lead to kyphotic deformity with subsequent neurological decline. In this context, cervical laminectomy with fusion using lateral mass instrumentation has become increasingly utilized with the aim of reducing the risk of developing postoperative kyphotic deformity, which is thought to predispose to poorer neurological outcomes in the long term.

Objective:
To compare the evidence for stand-alone cervical laminectomy with laminectomy with posterior fusion in terms of clinical outcomes and the incidence of adverse events, particularly the development of postoperative cervical kyphosis.

Material and Methods:
Initial Medline search using MeSH terms yielded 226 articles, 23 of which were selected. An additional PubMed search and the reference list of individual papers were utilized to identify the remaining papers of relevance.

Results:
Cervical laminectomy both with and without fusion offers effective decompression for symptomatic multilevel cervical spondylotic myelopathy. The incidence of postlaminectomy kyphosis is lower following posterior fusion; however, there seems to be no clinical-radiologic correlation given that patients who develop postoperative kyphosis often do not progress to clinical myelopathy. Furthermore, there are specific additional risks of posterior instrumentation that need to be considered.

Conclusion:
In carefully selected patients with normal preoperative cervical sagittal alignment, stand-alone cervical laminectomy may offer acceptably low rates of postoperative kyphosis. In patients with preoperative loss of cervical lordosis and/or kyphosis, posterior fusion is recommended to reduce the risk of progression to postoperative kyphotic deformity, bearing in mind that radiologic evidence of kyphosis may not necessarily correlate with poorer clinical outcomes. Furthermore, the specific risks associated with posterior fusion (instrumentation failure, pseudarthrosis, infection, C5 nerve root palsy, and vertebral artery injury) need to be considered and weighed up against potential benefits.
Association of Elevated Plasma Interleukin-18 Level With Increased Mortality in a Clinical Trial of Statin Treatment for Acute Respiratory Distress Syndrome*
Authors: Rogers Angela J. , Guan Jiazhen , Trtchounian Anna , Hunninghake Gary M. , Kaimal Rajani , Desai Manisha , Kozikowski Lori-Ann , DeSouza Lesley , Mogan Susan , Liu Kathleen D. , Matthay Michael A. , Steingrub Jay , Wheeler Art , Yoon Joo Heon , Nakahira Kiichi , Choi Augustine M. , Baron Rebecca M. 
Published: June 2019

Objective:
A high plasma level of inflammasome mediator interleukin-18 was associated with mortality in observational acute respiratory distress syndrome cohorts. Statin exposure increases both inflammasome activation and lung injury in mouse models. We tested whether randomization to statin therapy correlated with increased interleukin-18 in the ARDS Network Statins for Acutely Injured Lungs from Sepsis trial.

Design:
Retrospective analysis of randomized controlled clinical trial.

Setting:
Multicenter North American clinical trial, the ARDS Network Statins for Acutely Injured Lungs from Sepsis.

Patients:
Six hundred eighty-three subjects with infection-related acute respiratory distress syndrome, representing 92% of the original trial population.

Interventions:
Random assignment of rosuvastatin or placebo for up to 28 days or 3 days after ICU discharge.

Measurements and Main Results:
We measured plasma interleukin-18 levels in all Statins for Acutely Injured Lungs from Sepsis patients with sample available at day 0 (baseline, n = 683) and day 3 (after randomization, n = 588). We tested the association among interleukin-18 level at baseline, rising interleukin-18, and the impact of statin therapy on 60-day mortality, adjusting for severity of illness. Baseline plasma interleukin-18 level greater than or equal to 800 pg/mL was highly associated with 60-day mortality, with a hazard of death of 2.3 (95% CI, 1.7–3.1). Rising plasma interleukin-18 was also associated with increased mortality. For each unit increase in log2 (interleukin-18) at day 3 compared with baseline, the hazard of death increased by 2.3 (95% CI, 1.5–3.5). Subjects randomized to statin were significantly more likely to experience a rise in plasma interleukin-18 levels. Subjects with acute kidney injury, shock, low baseline interleukin-18, and those not receiving systemic corticosteroids were more likely to experience rising interleukin-18. Randomization to statin therapy was associated with rising in interleukin-18 in all of those subsets, however.

Conclusions:
Elevated baseline plasma interleukin-18 was associated with higher mortality in sepsis-induced acute respiratory distress syndrome. A rise in plasma interleukin-18 was also associated with increased mortality and was more common in subjects randomized to statin therapy in this clinical trial.
Predictive Value of Preoperative Periocular Skin Cancer Measurements for Final Mohs Defect Size
Authors: Scofield-Kaplan Stacy M. , Jackson Colette , Gurney Troy , McDonnell Emma , Mancini Ronald 
Published: June 2019

The preoperative periocular skin cancer measurements can assist in determining the post-Mohs defect size.

Purpose:
To evaluate the relationship between pre-Mohs skin cancer lesion measurements with the post-Mohs defect size in order to most accurately estimate post-Mohs defect size.

Methods:
This is a retrospective analysis of patients who underwent Mohs excision by one of 3 Mohs surgeons followed by reconstruction for basal cell carcinoma or squamous cell carcinoma of the eyelid. The study included all patients from January 2011 to May 2018 operated on by a single oculoplastic surgeon (R.M.) at the University of Texas Southwestern Medical Center. Maximum horizontal and vertical (H/V) dimensions were determined clinically by Mohs surgeons at the time of excision and photographs of the lesion and defect size were analyzed in order to determine the total area of the lesion preoperatively and the defect postoperatively with Image J using H/V dimensions and the area tracing function.

Results:
Forty-two patients with periocular skin cancers underwent Mohs resection followed by reconstruction. The Mohs defect was overall 4.88 times the size of the preoperative skin cancer measurement using maximum H/V dimensions by Mohs surgeons (p < 0.0001). When using Image J, the area of the Mohs defect was 6.5 times the size of the preoperative lesion (p < 0.0001) using both the maximum H/V dimensions and the area tracing function. There was a statistically significant difference between the Image J area tracing and area determined with H/V dimensions by both the Mohs surgeon and Image J.

Conclusions:
Postoperative Mohs defect size can be estimated based on maximum H/V dimensions clinically or with Image J technology. Image J digital photograph analysis using the area tracing function more accurately determines the pre-Mohs lesion size and the post-Mohs defect area when compared with standard maximum H/V measurements and digital photographic analysis of maximum H/V measurements with Image J.
Next-Generation Sequencing in Pancreatic Cancer
Authors: Shen Gong-Qing , Aleassa Essa M. , Walsh R. Matthew , Morris-Stiff Gareth 
Published: June 2019

Abstract
Pancreatic ductal adenocarcinoma (PDAC) is lethal, and the majority of patients present with locally advanced or metastatic disease that is not amenable to cure. Thus, with surgical resection being the only curative modality, it is critical that disease is identified at an earlier stage to allow the appropriate therapy to be applied. Unfortunately, a specific biomarker for early diagnosis has not yet been identified; hence, no screening process exists. Recently, high-throughput screening and next-generation sequencing (NGS) have led to the identification of novel biomarkers for many disease processes, and work has commenced in PDAC. Genomic data generated by NGS not only have the potential to assist clinicians in early diagnosis and screening, especially in high-risk populations, but also may eventually allow the development of personalized treatment programs with targeted therapies, given the large number of gene mutations seen in PDAC. This review introduces the basic concepts of NGS and provides a comprehensive review of the current understanding of genetics in PDAC as related to discoveries made using NGS.
KRAS in Cyst Fluid Obtained by Endoscopic Ultrasound–Fine-Needle Aspiration in Pancreatic Cystic Lesions
Authors: Faias Sandra , Pereira Luisa , Luís Ângelo , Cravo Marília , Dias Pereira António , Torres Joana 
Published: June 2019

Abstract
To evaluate the diagnostic accuracy of KRAS mutation in pancreatic cystic fluid and compare it with carcinoembryonic antigen and cytology, we identified studies with cyst fluid obtained by endoscopic ultrasound prior to surgery. We classified cysts as malignant, premalignant, and benign. A random-effects model was used for quantitative meta-analysis. Pooled sensitivities, specificities, and summary receiver operating characteristic curve analysis were conducted. We analyzed 16 studies, with 3429 patients, including 731 referred for surgery. Carcinoembryonic antigen was better for clinically significant cysts (premalignant and malignant) with sensitivity = 0.58 (95% confidence interval [CI], 0.53–0.65), specificity = 0.9 (95% CI, 0.76–0.97), and area under the curve (AUC) = 0.69. Cytology performed better in malignant cysts, with sensitivity = 0.37 (95% CI, 0.27–0.48), specificity = 0.96 (95% CI, 0.93–0.98), and AUC = 0.78. Isolated, KRAS mutation failed the diagnosis of malignant and significant cysts, with sensitivities = 0.43 (95% CI, 0.34–0.43) and 0.46 (95% CI, 0.42–0.51), specificities = 0.62 (95% CI, 0.56–0.68) and 0.97 (95% CI, 0.92–0.99), and AUCs = 0.56 and 0.53, respectively. Carcinoembryonic antigen and cytology are more accurate than KRAS. Additional studies are lacking to recommend KRAS as a single diagnostic test.
Imaging-guided Percutaneous Biopsy of Nodules ≤1 cm
Authors: Portela de Oliveira Eduardo , Souza Carolina A. , Inacio Joao R. , Abdelzarek Mohamed , Dennie Carole , Gupta Ashish , Bayanati Hamid 
Published: June 2019

Objective:
Percutaneous biopsy of lung nodules is established as a safe procedure with high diagnostic yield and accuracy. Its role in the diagnosis of subcentimeter nodules is, however, less clear. The goal of this study was to evaluate diagnostic yield, accuracy, and safety of computed tomography (CT)-guided needle biopsy in the diagnosis of subcentimeter lung nodules.

Material and Methods:
A retrospective review of a prospectively maintained database over a 12-year period identified 133 eligible CT-guided needle biopsies of lesions ≤1 cm. Diagnostic yield and accuracy for the diagnosis of malignancy were calculated. Lesion features and procedure characteristics were assessed using univariate and multivariate logistic regression analysis to identify risk factors associated with biopsy failure and complications.

Results:
Biopsy specimens were adequate for diagnosis in 116/133(87%) cases; the diagnostic yield for malignant and benign lesions was 93% and 65%, respectively. Final benign diagnosis was the strongest independent risk factor for biopsy failure. In multivariate logistic regression, fine-needle aspiration was an independent risk factor for diagnostic failure. Core needle biopsy was an independent risk factor for pneumothorax, and core needle biopsy, number of passes, and age were independent risk factors for pneumothorax requiring tube drainage.

Conclusions:
CT-guided percutaneous needle biopsy had high diagnostic yield for the diagnosis of subcentimeter lung nodules with a similar complication rate to biopsy of larger lesions. Fine-needle aspiration may be an independent factor for diagnostic failure even for malignant lesions.
A yeast optogenetic toolkit (yOTK) for gene expression control in Saccharomyces cerevisiae
Authors: An-adirekkun Jidapas (My) , Stewart Cameron J. , Geller Stephanie H. , Patel Michael T. , Melendez Justin , Oakes Benjamin L. , Noyes Marcus B. , McClean Megan N. 
Published: June 2019

AbstractOptogenetic tools for controlling gene expression are ideal for tuning synthetic biological networks due to the exquisite spatiotemporal control available with light. Here we develop an optogenetic system for gene expression control and integrate it with an existing yeast toolkit allowing for rapid, modular assembly of light-controlled circuits in the important chassis organism Saccharomyces cerevisiae. We reconstitute activity of a split synthetic zinc-finger transcription factor (TF) using light-induced dimerization. We optimize function of this split TF and demonstrate the utility of the toolkit workflow by assembling cassettes expressing the TF activation domain and DNA-binding domain at different levels. Utilizing this TF and a synthetic promoter we demonstrate that light-intensity and duty-cycle can be used to modulate gene expression over the range currently available from natural yeast promoters. This work allows for rapid generation and prototyping of optogenetic circuits to control gene expression in Saccharomyces cerevisiae.