bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clusterin expression in nontumor tissue in patients with resectable hepatocellular carcinoma related with postresectional survival
Authors: Kuo Po-Chung , Chau Ivy Yenwen , Li Anna Fen-Yau , Chau Yat-Pang , Hsia Cheng-Yuan , Chau Gar-Yang 
Published: September 2019

Background:
Surgical resection offers an effective treatment for patients with hepatocellular carcinoma (HCC); however, it has high tumor recurrence rate. Clusterin is a highly conserved glycoprotein that enhances cell aggregation in vitro. It is upregulated in several types of cancers such as breast, ovarian, colon, prostate and kidney cancers, and HCC. Clusterin overexpression is correlated with tumor metastasis. We evaluated the significance of clusterin expression levels in serum and resected tissues of patients with HCC.

Methods:
Serum, resected tumor tissue, and nontumor tissue were collected from 140 patients with HCC undergoing hepatic resection. Serum clusterin levels were determined by enzyme-linked immunosorbent assay. Clusterin expression in resected tissue was evaluated by immunohistochemistry. Median follow-up time was 57.8 months.

Results:
Mean serum clusterin levels were found to be 130.0 ± 58.7 µg/mL (range, 10.1-366.6 µg/mL). Serum clusterin levels were independent of tumor stage and deterioration of liver function in patients. No significant difference was observed in the survival of patients with high (>130.0 ± 58.7 µg/mL) or low (≤130.0 ± 58.7 µg/mL) serum clusterin level. Clusterin was expressed in HCC tissues of 76 patients (54.3%) and nontumor liver tissues of 53 patients (37.9%). No significant difference was observed in the survival of patients with positive or negative clusterin expression in HCC tissues. In nontumor tissues, patients with positive clusterin expression were observed to have low postoperative disease-free survival rate (p = 0.001) compared to patients with negative clusterin expression. Multivariate analysis showed that tumor with macrovascular/microvascular invasion and clusterin expression in nontumor tissues are independent prognostic factors following hepatic resection.

Conclusion:
In HCC, clusterin expression in nontumor tissue shows worse prognosis after hepatic resection. Clusterin can be a prognostic marker for patients with postresection HCC.
Serum γ-globulin and albumin concentrations predict secondary loss of response to anti-TNFα in inflammatory bowel disease patients
Authors: Schoenefuss Fabian , Hoffmann Peter 
Published: September 2019

Background:
Loss of response to anti-TNFα treatment occurs frequently in IBD- patients. We evaluatedthe predictive value of serum albumin and γ-globulin concentrations for treatment failure.

Methods:
Prospectively, all patients treated for the first time with either infliximab or adalimumab for IBD between 2007 and 2018 were included. All patients were tested for serum albumin and γ-globulin concentrations and were followed up until June 2018.

Results:
128 patients (95 Crohn’s disease, 67 females, age 40.1 ± 13.7 years) were included in the study. 81patients (63.3%) received infliximab and 47 (36.7%) adalimumab first line. Eight patients (6.3%) were primary non-responders, 50 patients (39.0%) showed a sustained clinical remission and 70 patients (54.7%) developed a secondary loss of response. Meantime to develop secondary loss of response was 24.5 ± 20.5 months. Albumin serum concentrations in the clinical response group were significantly higher than in the secondary loss of response group (39.8 ± 5.7 g/L vs. 35.0 ± 5.4 g/L). γ-globulin serum concentrations in the sustained response group were significantly lower than in the secondary loss of response group (11.8 ± 2.8 g/L vs. 14.7 ± 4.5 g/L). Hypoalbuminemia and hypergammaglobulinemia were associated with the loss of response. Immunosuppressant co-medication in patients with high γ-globulin serum concentrations reduced the risk of secondary loss of response.

Conclusion:
Low albumin and increased γ-globulin serum concentrations are strongly associated with a higher risk for loss of response to an anti-TNFα treatment. Increased serum γ-globulin concentrations may have a higher risk to produce anti-drug antibodies or a different phenotype of disease less responsive to anti-TNFα treatment.
Isolated ileal blind loop inflammation after intestinal resection with ileocolonic anastomosis in Crohn’s disease: an often neglected endoscopic finding with an unfavorable outcome
Authors: Beelen Evelien M.J. , de Vries Annemarie C. , Bodelier Alexander G. , Moolenaar Jolyn , Schouten W. Rudolph , van der Woude C. Janneke 
Published: September 2019

Objective
Postoperative endoscopic recurrence in patients with Crohn’s disease (CD) is commonly classified using the Rutgeerts score. Ulcerations in the ileal blind loop are not taken into account in the Rutgeerts score, and the clinical relevance of these lesions is unknown. This study aimed to assess the outcome of isolated ileal blind loop inflammation (IBLI) in postoperative CD patients.

Methods
Adult CD patients who underwent intestinal surgery with ileocolonic anastomosis between 1997 and 2017 were included and postoperative endoscopy reports were retrospectively reviewed. IBLI was defined as isolated inflammation of the ileal blind loop with or without ulcera confined to the anastomosis. Outcome was assessed using endoscopic recurrence (Rutgeerts >i2) and surgical recurrence (re-resection).

Results
A total of 341 CD patients were included. In 125 out of 341 (37%) patients, the ileal blind loop was described in the endoscopy reports. IBLI was reported in 43 of 341 (13%) patients. Start or step-up drug therapy was initiated in 10 of 32 (31%) IBLI patients with abdominal symptoms within a median of 0.9 months [interquartile range (IQR) 0.7–1.4] after ileocolonoscopy. Endoscopic recurrence occurred in 4 out of 38 (11%) IBLI patients without re-resection, within a median of 12.4 months (IQR 6.8–13.3). Intestinal re-resection was performed in 5 out of 43 (16%) IBLI patients within a median of 3.7 months (IQR 3.5–10.8).

Conclusion
IBLI is associated with symptoms and an unfavorable outcome, with a high risk of endoscopic recurrence in the neoterminal ileum and intestinal re-resection during short-term follow-up. Therefore, the blind ileal loop needs to be assessed during endoscopy in postoperative CD patients.
Association of Duration of Hypotension With Survival After Pediatric Cardiac Arrest
Authors: Laverriere Elizabeth K. , Polansky Marcia , French Benjamin , Nadkarni Vinay M. , Berg Robert A. , Topjian Alexis A. 
Published: September 2019

Objectives:
To evaluate the association of a single episode of hypotension and burden of hypotension with survival to hospital discharge following resuscitation from pediatric cardiac arrest.

Design:
Retrospective cohort study.

Setting:
Single-center PICU.

Patients:
Patients between 1 day and 18 years old who had a cardiac arrest, received chest compressions for more than 2 minutes, had return of spontaneous circulation for more than 20 minutes, and survived to receive postresuscitation care in the ICU.

Interventions:
None.

Measurement and Main Results:
One-hundred sixteen patients were evaluable. Hypotension, defined as systolic blood pressure less than the fifth percentile for age and sex, occurred in 37 patients (32%) within the first 6 hours and 64 (55%) within 72 hours of postresuscitation ICU care. There was no significant difference in survival to discharge for patients who had a single episode of hypotension within 6 hours (51% vs 69%; p = 0.06) or within 72 hours (56% vs 73%; p = 0.06). Burden of hypotension was defined as the percentage of hypotension measurements that were below the fifth percentile. After controlling for patient and cardiac arrest event characteristics, a higher burden of hypotension within the first 72 hours of ICU postresuscitation care was associated with decreased discharge survival (adjusted odds ratio = 0.67 per 10% increase in hypotension burden; 95% CI, 0.48–0.86; p = 0.006).

Conclusions:
After successful resuscitation from pediatric cardiac arrest, systolic hypotension was common (55%). A higher burden of postresuscitation hypotension within the first 72 hours of ICU postresuscitation care was associated with significantly decreased discharge survival, after accounting for potential confounders including number of doses of epinephrine, arrest location, and arrest etiology due to airway obstruction or trauma.
Necrotizing Enterocolitis and Associated Mortality in Neonates With Congenital Heart Disease: A Multi-Institutional Study
Authors: Spinner Joseph A. , Morris Shaine A. , Nandi Deipanjan , Costarino Andrew T. , Marino Bradley S. , Rossano Joseph W. , Shamszad Pirouz 
Published: September 2019

Objective:
There are scarce data about the prevalence and mortality of necrotizing enterocolitis in neonates with congenital heart disease. The purpose of this study is to provide a multi-institutional description and comparison of the overall prevalence and mortality of necrotizing enterocolitis in neonates with congenital heart disease.

Design:
Retrospective multi-institutional study.

Setting:
The Pediatric Health Information System database.

Patients:
Neonates with congenital heart disease between 2004 and 2014.

Interventions:
None.

Measurements and Main Results:
The primary study measure is the prevalence of necrotizing enterocolitis. Secondary measures include in-hospital mortality, hospital charges, ICU length of stay, hospital length of stay, and 30-day readmission. The prevalence of necrotizing enterocolitis was 3.7% (1,448/38,770) and varied significantly among different congenital heart disease diagnoses. The lowest prevalence of necrotizing enterocolitis was in transposition of the great arteries (n = 104, 2.1%). Compared with transposition of the great arteries, necrotizing enterocolitis occurred more frequently in neonates with hypoplastic left heart syndrome (odds ratio, 2.7; 95% CI, 2.1–3.3), truncus arteriosus (odds ratio, 2.6; 95% CI, 1.9–3.5), common ventricle (odds ratio, 2.1; 95% CI, 1.5–2.8), and aortic arch obstruction (odds ratio, 1.4; 95% CI, 1.1–1.7). Prematurity is a significant risk factor for necrotizing enterocolitis and for mortality in neonates with necrotizing enterocolitis, conferring varying risk by cardiac diagnosis. Unadjusted mortality associated with necrotizing enterocolitis was 24.4% (vs 11.8% in neonates without necrotizing enterocolitis; p < 0.001), and necrotizing enterocolitis increased the adjusted mortality in neonates with transposition of the great arteries (odds ratio, 2.5; 95% CI, 1.5–4.4), aortic arch obstruction (odds ratio, 1.8; 95% CI, 1.3–2.6), and tetralogy of Fallot (odds ratio, 1.6; 95% CI, 1.1–2.4). Necrotizing enterocolitis was associated with increased hospital charges (p < 0.0001), ICU length of stay (p = 0.001), and length of stay (p = 0.001).

Conclusions:
The prevalence of necrotizing enterocolitis among neonates with congenital heart disease is 3.7% and is associated with increased in-hospital mortality, length of stay, and hospital charges. The prevalence and associated mortality of necrotizing enterocolitis in congenital heart disease vary among different heart defects.
Differential Influence of Donor Age Depending on the Indication for Liver Transplantation—A Collaborative Transplant Study Report
Authors: Houben Philipp , Döhler Bernd , Weiß Karl H. , Mieth Markus , Mehrabi Arianeb , Süsal Caner 
Published: September 2019

Background.
Despite steadily increasing donor age, there are no general guidelines for the use of organs from elderly donors in liver transplantation. This study focuses on identifying the recipients who are less affected from an old-donor organ graft and conversely in whom a rather unfavorable outcome is expected because of high donor age.

Methods.
Forty-eight thousand two hundred sixty-one adult liver transplantations, performed between 2000 and 2017 and reported to the Collaborative Transplant Study, were analyzed.

Results.
The proportion of ≥65-year-old donors has risen to >33% in recent years. The donor age has an approximately linear influence on graft survival. On average, each year’s rise in the donor age was associated with a 0.9% increase in the risk of graft loss (hazard ratio [HR], 1.009; P < 0.001). The impact of donor age was strong in patients with hepatitis C–related cirrhosis (HR, 1.013; P < 0.001), substantial in patients with alcoholic cirrhosis (HR, 1.007; P < 0.001) and rather weak in patients with hepatocellular carcinoma (HR, 1.003; P = 0.038). The increase in the risk of graft loss per year rise in donor age was 1.4% for 18 to 49 year olds, 1.0% for middle-aged, and only 0.4% for ≥60-year-old recipients (all P < 0.001).

Conclusions.
Consequently, older recipients and especially patients with hepatocellular carcinoma seem to be less affected by an increased donor age, whereas the donor age is an important factor in all other patient groups.
Outcomes of Conversion From Calcineurin Inhibitor to Belatacept-based Immunosuppression in HLA-sensitized Kidney Transplant Recipients
Authors: Sethi Supreet , Najjar Reiad , Peng Alice , Choi Jua , Lim Kathlyn , Vo Ashley , Jordan Stanley C. , Huang Edmund 
Published: September 2019

Background.
The efficacy and safety of belatacept when converted from calcineurin inhibitors (CNI) in HLA-sensitized (HS) kidney transplant recipients has not been established.

Methods.
The study included 108 kidney transplant recipients converted from CNI to belatacept between July 1, 2012, and September 30, 2017. Rejection-free, patient, and graft survival over 5 years follow-up were compared between HS and non-HLA-sensitized (non-HS) recipients using the Kaplan-Meier product-limit method. The estimated glomerular filtration rate slope postconversion was compared using linear mixed effects models.

Results.
There were 29 HS and 79 non-HS recipients included. Rejections after conversion were mostly cell-mediated. There was no difference in rejection-free survival (log-rank P = 0.30; at 5 y, HS: 82%; non-HS: 84.6%); however, rejection-free survival was lower among HS recipients converted within the first-year posttransplant compared to non-HS recipients (log-rank P = 0.03; at 5 y, HS: 55.6%; non-HS: 75.0%). There was no difference in patient survival (log-rank P = 0.75; at 5 y, HS: 85.7%, non-HS: 83.7%) or graft survival (log-rank P = 0.17; at 5 y, HS: 78.5%, non-HS: 89.8%) in the 2 groups. On average, estimated glomerular filtration rate slope improved postconversion in non-HS (0.28 mL/min/1.73 m2/y [0.03 to 0.53]) but declined in HS recipients (-0.44 mL/min/1.73 m2/y [-0.85 to -0.03]).

Conclusions.
There was no difference in rejection-free, patient, or graft survival after conversion to belatacept over 5 years among HS and non-HS recipients. However, rejection-free survival was lower in HS recipients converted to belatacept within the first-year posttransplant. Conversion from CNI to belatacept should be done cautiously in high immunologic risk patients.
Doesin uteroHIV-exposure and the early nutritional environment influence infant development and immune outcomes? Findings from a pilot study in Pretoria, South Africa
Authors: White Marina , Feucht Ute D , Duffley Eleanor , Molokoane Felicia , Durandt Chrisna , Cassol Edana , Rossouw Theresa , Connor Kristin L 
Published: September 2019

AbstractBackgroundAs mother-to-child-transmission of HIV decreases, and the population of infants who are born HIV-exposed, but uninfected (HEU) continues to rise, there is growing need to understand the development and health outcomes of infants who are HEU to ensure that they have the healthiest start to life.MethodsIn a prospective cohort pilot study at Kalafong Hospital, Pretoria, South Africa, we aimed to determine if we could recruit new mothers living with HIV on antiretrovirals (ART; n=20) and not on ART (n=20), and new mothers without HIV (n=20) through our clinics to study the effects of HEU on growth, immune- and neuro-development in infants in early life, and test the hypothesis that infants who were HEU would have poorer health outcomes compared to infants who were HIV-unexposed, uninfected (HUU). We also undertook exploratory analyses to investigate relationships between the early nutritional environment, food insecurity, and infant development. Infant growth, neurodevelopment (Guide for Monitoring Child Development [GMCD]) and levels of monocyte subsets (CD14, CD16, and CCR2 expression [flow cytometry]) were measured in infants at birth and 12 weeks (range 8-16 weeks).ResultsWe recruited 33 women living with HIV on ART, and 22 women living without HIV within four days of delivery from June-December 2016. 21 women living with HIV and 10 without HIV returned for a follow-up appointment at 12 weeks postpartum. The high mobility of this population presented major challenges to participant retention. Preliminary analyses revealed lower head circumference and elevated CCR2+ (% and median fluorescence intensity) on monocytes at birth among infants who were HEU compared to HUU. Maternal reports of food insecurity were associated with lower maternal nutrient intakes at 12 weeks postpartum and increased risk of stunting at birth for infants who were HEU, but not infants who were HUU.ConclusionsOur small feasibility pilot study suggests that HEU may adversely affect infant development, and further, infants who are HEU may be even more vulnerable to the programming effects suboptimal nutritionin uteroand postnatally. This pilot and preliminary analyses have been used to inform our research questions and protocol in our ongoing, full-scale study.
Zika Virus Infection: Review Of Neuroimage Studies And The Relationship Between Findings And Time Of Infection
Authors: Radaelli Graciane , Lahorgue Nunes Magda , Bernardi Soder Ricardo , Monteiro de Oliveira Júlia , Konat Bruzzo Fernanda Thays , Neto Felipe Kalil , Leal Conceição Eduardo , Portuguez Mirna Wetters , da Costa Jaderson Costa 
Published: September 2019

ABSTRACTAIMTo conduct a systematic literature review on neuroimage findings in children with microcephaly by Zika virus (ZIKV).METHODWe performed a literature search in PubMed, Cochrane Library and Web of Science for full-text articles reporting neuroimage exam of computed tomography scan or magnetic resonance imaging.RESULTSWere identified 2,214 publications. Of these 2,170 were excluded by the analysis of titles and abstracts, resulting in 7 articles included. The abnormalities presented in neuroimage showed the highest occurrence in the first trimester: decreased brain volume + increased extra-axial CSF space (100%), subcortical calcifications (89.1%), microcephaly (89.1%), ventriculomegaly (72.9%), malformation of cortical development (40.5%), basal ganglia calcifications (40.5%), megacisterna magna (39.1%). In relation to the second trimester of ZIKV infection, the most common were as follows: decreased brain volume + increased extra-axial CSF space (100%), subcortical calcifications (100%), microcephaly (85.7%), ventriculomegaly (71.4%), malformation of cortical development (71.4%), basal ganglia calcifications (19%), megacisterna magna (4.7%). In relation to the neuroimage abnormalities detected in the 3rd trimester 2 cases were found.INTERPRETATIONThis systematic review is the first that evaluates brain changes in newborns with different neuroimage techniques (CT and MRI exams) and related findings with the gestational period of ZIKV infection.
Nothing About Us Without Us: A Scoping Review and Priority-Setting Partnership in Type 1 Diabetes and Exercise
Authors: Klaprat Nika M.D. , Askin Nicole , MacIntosh Andrea , Brunton Nicole , Hay Jacqueline L. , Yardley Jane E. , Marks Seth D. , Sibley Kathryn M. , Duhamel Todd A. , McGavock Jonathan M. 
Published: September 2019

AbstractObjectivesExamine the characteristics of patient engagement (PE) practices in exercise-based randomized trials in type 1 diabetes (T1D), and facilitate T1D stakeholders in determining the top ten list of priorities for exercise research.DesignTwo methodological approaches were employed: a scoping review and a modified James Lind Alliance priority-setting partnership.MethodsPublished (Medline, Embase, CINAHL, and Central databases) and grey literature (www.clinicaltrials.gov) were searched to identify randomized controlled trials of exercise interventions lasting minimum four weeks and available in English. We extracted information on PE and patient-reported outcomes (PROMs) to identify if patient perspectives had been implemented. Based on results, we set out to determine exercise research priorities as a first step towards a patient-engaged research agenda. An online survey was distributed across Canada to collect research questions from patients, caregivers and healthcare providers. We qualitatively analyzed submitted questions and compiled a long-list that a twelve-person stakeholder steering committee used to identify the top ten priority research questions.ResultsOf 9,962 identified sources, 19 published trials and 4 trial registrations fulfilled inclusion criteria. No evidence of PE existed in any included study. Most commonly measured PROMs were frequency of hypoglycemia (n=7) and quality of life (n=4). The priority-setting survey yielded 194 submitted research questions. Steering committee rankings identified 10 priorities focused on lifestyle factors and exercise modifications to maintain short-term glycemic control.ConclusionRecent exercise-based randomized trials in T1D have not included PE and PROMs. Patient priorities for exercise research have yet to be addressed with adequately designed clinical trials.
Machine learning based prediction of antibiotic sensitivity in patients with critical illness
Authors: Ghosh Debabrata , Sharma Shivam , Hasan Eeshan , Ashraf Shabina , Singh Vaibhav , Tewari Dinesh , Singh Seema , Kapoor Mudit , Sengupta Debarka 
Published: September 2019

ABSTRACTRising antibiotic resistance inflicts a heavy burden on healthcare, both clinically and economically. Owing to the time required to obtain culture and sensitivity test results, quite often the clinicians rely on their experience and static clinical guidelines to prescribe antibiotics. Such empirical treatment often fails to account for patient-specific attributes and changes in the antibiotic resistance patterns with time and location. The aim of this study was to analyze the patient and hospital specific features regarding their prognostic relevance to treat bacterial infections of patients in the intensive care units (ICUs). We performed a single-center retrospective cohort analysis across 25526 positive cultures recorded in MIMIC-III critical care database. We retrieved a number of clinically relevant relationships from association analysis between patient factors and bacterial strains. For instance, higher elapsed time from patient admission to sample collection for culture showed strong association with blood stream infection caused by Enterococcus faecium, Pseudomonas aeruginosa, and Staphylococcus, indicating that these infections are possibly hospital acquired. To predict antibiotic sensitivity at the level of individual patients we developed an ensemble of machine learning algorithms. The model provided superior prediction accuracy (about 87%) and area under the ROC curve (around 0.91 on an average) for the four most common sample types as compared to a number of off-the-shelf techniques. We demonstrate the predictive power of commonly recorded patient attributes in personalised prediction of antibiotic efficacy.