bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Time to Therapeutic Anticoagulation and Associated Outcomes in Critically Ill, Obese Patients With Pulmonary Embolism Receiving Unfractionated Heparin
Authors: Sutton Lauren H. , Tellor Bethany R. , Pope Hannah E. , Riney Jennifer N. , Weaver Katherine L. 
Published: September 2019

Background: Delays in time to therapeutic activated partial thromboplastin time (aPTT) have been associated with poor outcomes in patients with acute pulmonary embolism (PE). Objective: To investigate the relationship between time to therapeutic anticoagulation and in-hospital mortality in critically ill, obese patients with acute PE. Methods: This study examined 204 critically ill patients with a body mass index (BMI) ≥30 kg/m2 receiving unfractionated heparin (UFH) for PE treatment. Patients achieving therapeutic anticoagulation within 24 hours of UFH initiation (early) were compared to those in >24 hours (delayed). Additional end points included 30-day mortality, median time to therapeutic aPTT, proportion of therapeutic and supratherapeutic aPTT values, hemodynamic deterioration, thrombolytic therapy after UFH initiation, length of stay, and bleeding. Results: No difference in in-hospital or 30-day all-cause mortality was seen (odds ratio [OR]: 1.33, confidence interval [CI]: 0.647-2.72; OR: 1.003, CI: 0.514-1.96). Patients in the early group had a greater proportion of therapeutic aPTT values (66.7% vs 50%, P < .001) and higher percentage of supratherapeutic aPTT values (20.9% vs 11.3%, P < .001); however, no increase in clinically significant bleeding was evident (15.2% vs 10.9%, P = .366). Conclusion: In this population, a shorter time to therapeutic aPTT was not associated with improved survival.
Cabozantinib use in metastatic renal cell carcinoma patients in clinical practice: Evaluation of dosing patterns, tolerability, and outcomes compared to clinical trials
Authors: McElwee Jessica H , Gourdin Theodore S , Mikoll Jennifer , Weeda Erin , Sion Amy M 
Published: September 2019

Introduction Despite first-line approval in metastatic renal cell carcinoma (mRCC), the tyrosine kinase inhibitor cabozantinib is associated with frequent treatment-limiting side effects. Dose reductions in published trials of the drug and in clinical practice are commonplace. We analyzed our institution’s real-world experience with cabozantinib dosing in patients with mRCC to assess strategies to improve tolerability and patient outcomes. Objectives The purpose of our study is to retrospectively analyze dose intensity, tolerability, and duration of exposure in mRCC patients who received cabozantinib at our institution. Methods In this retrospective, single-center chart review, we identified 35 adult patients who received at least one cycle cabozantinib for mRCC during a two-year period. Dosing patterns were reviewed for each patient to allow calculation of median dose intensity and median duration of exposure. Results The median dose intensity for cabozantinib was 55.4% and the median actual daily dose was 33.2 mg. Median duration of cabozantinib exposure was 10.4 months. Several alternative dosing strategies were employed with 60% of patients requiring at least one dose intervention to manage toxicities. Conclusions Patients in this analysis received a median actual daily dose of 33.4 mg, less than the reported median doses in the METEOR and CABOSUN trials. However, our median duration of cabozantinib treatment was 10.4 months compared to 8.3 months and 6.5 months in these respective trials. Further investigation is warranted to determine if alternative dosing strategies and lower median actual daily doses produce survival results comparable to published clinical trials.
Kynurenines, Neuropsychiatric Symptoms, and Cognitive Prognosis in Patients with Mild Dementia
Authors: Hafstad Solvang Stein-Erik , Nordrehaug Jan Erik , Aarsland Dag , Lange Johannes , Ueland Per Magne , McCann Adrian , Midttun Øivind , Tell Grethe S , Giil Lasse Melvaer 
Published: September 2019

Introduction: Circulating tryptophan (Trp) and its downstream metabolites, the kynurenines, are potentially neuroactive. Consequently, they could be associated with neuropsychiatric symptoms and cognitive prognosis in patients with dementia. Objective: The objective of this study was to assess associations between circulating kynurenines, cognitive prognosis, and neuropsychiatric symptoms. Methods: We measured baseline serum Trp, neopterin, pyridoxal 5′-phosphate (PLP), and 9 kynurenines in 155 patients with mild dementia (90 with Alzheimer’s disease, 65 with Lewy body dementia). The ratios between kynurenine and Trp and kynurenic acid (KA) to kynurenine (KKR) were calculated. The Mini-Mental State Examination (MMSE) and the Neuropsychiatric Inventory (NPI) were administered at baseline and annually over 5 years. Associations between baseline metabolite concentrations with MMSE and the NPI total score were assessed using a generalized structural equation model (mixed-effects multiprocess model), adjusted for age, sex, current smoking, glomerular filtration rate, and PLP. Post hoc associations between KKRs and individual NPI items were assessed using logistic mixed-effects models. False discovery rate (0.05)–adjusted P values ( Q values) are reported. Results: Kynurenine had a nonlinear quadratic relationship with the intercept of the MMSE scores over 5 years ( Q < 0.05), but not with the slope of MMSE decline. Kynurenine was associated with a higher NPI total score over time ( Q < 0.001). Post hoc, both KKR and KA were associated with more hallucinations ( Q < 0.05). Conclusions: Kynurenine has a complex relationship with cognition, where both low and high levels were associated with poor cognitive performance. A higher KKR indicated risk for neuropsychiatric symptoms, especially hallucinations.
Development of an Instrument for Measuring Self-Care Behaviors After Left Ventricular Assist Device Implantation
Authors: Kato Naoko P. , Jaarsma Tiny , Casida Jesus M. , Lee Christopher S. , Strömberg Anna , Gal Tuvia Ben 
Published: October 2019

Background: Successful long-term left ventricular assist device (LVAD) therapy necessitates a high degree of self-care. We aimed to develop an instrument that measures self-care behaviors in adult patients living with an LVAD. Methods: We used the method to develop patient-reported outcomes recommended by the US Food and Drug Administration. Prior to developing the instrument, a literature review was conducted to generate items using the middle-range theory of self-care of chronic illness as a guiding framework. A 2-round Delphi method, involving 17 clinicians with expertise in heart failure and assist devices from the Netherlands, Israel, United States, Canada, and Japan, was used to generate and select items. In the first Delphi survey, the levels of importance, relevance, and clarity of items in the instrument were evaluated. The second Delphi survey was performed to gain consensus on the final selection of items. We also examined face validity. Results: A preliminary 37-item version of the Self-Care Behavior Scale was produced. The first panel judged 33 items as important and relevant, taking out 4 items due to vague wording and duplication and adding in 4 items. In the final 33-item version, 19 items address self-care maintenance behaviors, 10 items address self-care monitoring behaviors, and 4 items address self-care management behaviors. Patients (N = 25) did not have any difficulties understanding items and report any missing items. Conclusion: The 33-item Self-Care Behavior Scale for patients with heart failure having an LVAD has been developed and is ready for further psychometric testing.
Radiogenomics in Clear Cell Renal Cell Carcinoma: Correlations Between Advanced CT Imaging (Texture Analysis) and MicroRNAs Expression
Authors: Marigliano Chiara , Badia Stefano , Bellini Davide , Rengo Marco , Caruso Damiano , Tito Claudia , Miglietta Selenia , Palleschi Giovanni , Pastore Antonio Luigi , Carbone Antonio , Fazi Francesco , Petrozza Vincenzo , Laghi Andrea 
Published: September 2019

Purpose: A relevant challenge for the improvement of clear cell renal cell carcinoma management could derive from the identification of novel molecular biomarkers that could greatly improve the diagnosis, prognosis, and treatment choice of these neoplasms. In this study, we investigate whether quantitative parameters obtained from computed tomography texture analysis may correlate with the expression of selected oncogenic microRNAs. Methods: In a retrospective single-center study, multiphasic computed tomography examination (with arterial, portal, and urographic phases) was performed on 20 patients with clear cell renal cell carcinoma and computed tomography texture analysis parameters such as entropy, kurtosis, skewness, mean, and standard deviation of pixel distribution were measured using multiple filter settings. These quantitative data were correlated with the expression of selected microRNAs (miR-21-5p, miR-210-3p, miR-185-5p, miR-221-3p, miR-145-5p). Both the evaluations (microRNAs and computed tomography texture analysis) were performed on matched tumor and normal corticomedullar tissues of the same patients cohort. Results: In this pilot study, we evidenced that computed tomography texture analysis has robust parameters (eg, entropy, mean, standard deviation) to distinguish normal from pathological tissues. Moreover, a higher coefficient of determination between entropy and miR-21-5p expression was evidenced in tumor versus normal tissue. Interestingly, entropy and miR-21-5p show promising correlation in clear cell renal cell carcinoma opening to a radiogenomic strategy to improve clear cell renal cell carcinoma management. Conclusion: In this pilot study, a promising correlation between microRNAs and computed tomography texture analysis has been found in clear cell renal cell carcinoma. A clear cell renal cell carcinoma can benefit from noninvasive evaluation of texture parameters in adjunction to biopsy results. In particular, a promising correlation between entropy and miR-21-5p was found.
Fifty Percent Reduction in Narcotic Use After Minimally Invasive Cardiac Surgery Using Liposomal Bupivacaine
Authors: Castillo-Sang Mario , Bartone Cheryl , Palmer Cassady , Truong Vien T. , Kelly Brian , Voeller Rochus K. , Griffin Jeffrey , Smith Timothy , Raidt Hilary , Answini Geoffrey A. 
Published: September 2019

Objective Minimally invasive cardiac surgery via a right minithoracotomy (RMT) is a common approach to different valve pathologies, tumor resection, and atrial septal defect (ASD) closure. We studied intraoperative field block using liposomal bupivacaine (LB) in these operations. Methods Consecutive 171 minimally invasive RMTs (fourth intercostal space) were studied, and patients in cardiogenic or septic shock, intravenous drug abuse, and those re-explored were excluded ( n = 12). An early cohort was treated with standard postoperative analgesia while another underwent intraoperative field block with LB immediately after incision. We compared postoperative pain level, narcotic utilization (morphine milligram equivalent), and intensive care unit (ICU) and hospital length of stay. Results The procedures included 48 isolated mitral valve replacements (MVR); 2 MVR with other procedures; 93 mitral valve repairs (MVRr); 9 MVRr with other procedures; 4 isolated tricuspid valve repairs; 2 myxoma resections; 1 ASD closure. There were 13 patients in the non-LB group and 146 patients in the LB group. Use of LB decreased mean postoperative narcotic utilization by 50% ( P = 0.003). The LB group had lower pain levels on postoperative day 1 ( P = 0.039), which continued through postoperative day 5 ( P = 0.030). We found no difference in ICU or hospital length of stay between groups. There were no complications from LB field block. Conclusions LB field block decreases postoperative pain and narcotic utilization after cardiac surgery via a RMT, but it does not reduce length of stay. The technique is safe and should be considered in all patients undergoing RMT cardiac surgery.
Assessing the feasibility of using the Dalhousie Computerized Attention Battery to measure postoperative cognitive dysfunction in older patients
Authors: Sardiwalla Yaeesh , Eskes Gail , Bernard Andre , George Ronald B. , Schmidt Michael 
Published: October 2019

Purpose Postoperative cognitive dysfunction is difficult to predict and diagnose, and can have severe consequences in the long term. The purpose of this study was to examine the feasibility of using a computerised test battery, the Dalhousie Computerized Assessment Battery in the perioperative clinic to detect cognitive changes after surgery. Methods Fifty patients were recruited for this study. Patients completed the Dalhousie Computerized Assessment Battery and tests of general cognition, mood and pain at baseline and at three months postoperatively. Results This pilot study had a screening rate (85.4%) and low attrition rate (12%). At baseline, patients exhibited no significant cognitive differences compared to a normative dataset. Postoperative cognitive dysfunction incidence was 2.7% on Montreal Cognitive Assessment, 13.6% with Dalhousie Computerized Assessment Battery and 36.3% based on subjective reports. Conclusion Computerised cognitive testing in the perioperative setting proved feasible. Deficits in spatial working memory and dual tasks may be most compromised by surgically related variables.
A validated novel preoperative index to predict the extent of intraperitoneal contamination in patients with acute abdominal pathology: A cohort study
Authors: Hajibandeh Shahab , Hajibandeh Shahin , Hobbs Nicholas , Shah Jigar , Harris Matthew , Watton Leo , Huq Zahirul , Dalmia Sanjay , Malik Sohail , Mansour Moustafa 
Published: October 2019

Aims To investigate whether an intraperitoneal contamination index (ICI) derived from combined preoperative levels of C-reactive protein, lactate, neutrophils, lymphocytes and albumin could predict the extent of intraperitoneal contamination in patients with acute abdominal pathology. Methods Patients aged over 18 who underwent emergency laparotomy for acute abdominal pathology between January 2014 and October 2018 were randomly divided into primary and validation cohorts. The proposed intraperitoneal contamination index was calculated for each patient in each cohort. Receiver operating characteristic curve analysis was performed to determine discrimination of the index and cut-off values of preoperative intraperitoneal contamination index that could predict the extent of intraperitoneal contamination. Results Overall, 468 patients were included in this study; 234 in the primary cohort and 234 in the validation cohort. The analyses identified intraperitoneal contamination index of 24.77 and 24.32 as cut-off values for purulent contamination in the primary cohort (area under the curve (AUC): 0.73, P < 0.0001; sensitivity: 84%, specificity: 60%) and validation cohort (AUC: 0.83, P < 0.0001; sensitivity: 91%, specificity: 69%), respectively. Receiver operating characteristic curve analysis also identified intraperitoneal contamination index of 33.70 and 33.41 as cut-off values for feculent contamination in the primary cohort (AUC: 0.78, P < 0.0001; sensitivity: 87%, specificity: 64%) and validation cohort (AUC: 0.79, P < 0.0001; sensitivity: 86%, specificity: 73%), respectively. Conclusions As a predictive measure which is derived purely from biomarkers, intraperitoneal contamination index may be accurate enough to predict the extent of intraperitoneal contamination in patients with acute abdominal pathology and to facilitate decision-making together with clinical and radiological findings.
Tailored combined cytomegalovirus management in lung transplantation: a retrospective analysis
Authors: Solidoro Paolo , Patrucco Filippo , Libertucci Daniela , Verri Giulia , Sidoti Francesca , Curtoni Antonio , Boffini Massimo , Simonato Erika , Rinaldi Mauro , Cavallo Rossana , Costa Cristina 
Published: October 2019

Background: There is no univocal prophylactic regimen to prevent cytomegalovirus (CMV) infection/disease in lung transplantation (LT) recipients. The aim of this study is to evaluate short-term clinical outcomes of a tailored combined CMV management approach. Methods: After 1-year follow up, 43 LT patients receiving combined CMV prophylaxis with antiviral agents and CMV-specific IgG were evaluated in a retrospective observational study. Systemic and lung viral infections were investigated by molecular methods on a total of 1134 whole blood and 167 bronchoalveolar lavage (BAL) and biopsy specimens. CMV immunity was assessed by ELISPOT assay. Clinical and therapeutic data were also evaluated. Results: We found 2/167 cases of CMV pneumonia (1.2%), both in the donor-positive/recipient-positive (D+/R+) population, and 51/167 cases of CMV pulmonary infection (BAL positivity 30.5%). However, only 32/167 patients (19.1%) were treated due to their weak immunological response at CMV ELISPOT assay. Viremia ⩾100,000 copies/mL occurred in 33/1134 specimens (2.9%). Regarding CMV-serological matching (D/R), the D+/R– population had more CMV viremia episodes ( p < 0.05) and fewer viremia-free days ( p < 0.001). Conclusions: Compared to previous findings, our study shows a lower incidence of CMV pneumonia and viremia despite the presence of a substantial CMV load. In addition, our findings further confirm the D+/R– group to be a high-risk population for CMV viremia. Overall, a good immunological response seems to protect patients from CMV viremia and pneumonia but not from CMV alveolar replication. The reviews of this paper are available via the supplemental material section.
The prevalence of obesity and overweight, associated demographic and lifestyle factors, and health status in the adult population of Jeddah, Saudi Arabia
Authors: Al-Raddadi Rajaa , Bahijri Suhad M. , Jambi Hanan A. , Ferns Gordon , Tuomilehto Jaakko 
Published: October 2019

Background: Obesity is a risk factor for many chronic diseases, and its prevalence and trends vary among populations. Saudi Arabia shows a greater rise in prevalence than many other countries. We aimed to study the association between several chronic disorders, demographic, and lifestyle factors with increased body mass index (BMI) in the adult population of Jeddah. Methods: Data were obtained from a door-to-door cross sectional study. A three-stage stratified cluster sampling technique was adopted. Individuals in selected households agreeing to participate were interviewed to complete a predesigned questionnaire covering demographic and lifestyle variables, medical history, and family history of chronic diseases. This was followed by anthropometric and blood pressure measurements. A random capillary plasma glucose (RPG) was measured, followed by further testing using fasting plasma glucose and glycated hemoglobin (HbA1c) to verify whether participants were normal, diabetic, or prediabetic. Multiple logistic regression analyses were used to adjust for confounding factors. Results: A total of 1419 individuals were included in the study: 667 men and 752 women. The prevalence of overweight and obesity was 35.1 and 34.8%, respectively, in men, and 30.1% and 35.6%, respectively, in women. Both overweight and obesity increased in prevalence to 60 years of age, and decreased in the oldest age group in both sexes. After adjusting for age, risk of obesity in men was increased with having a postgraduate degree [odds ratio (OR), 95%CI = 2.48, 1.1–5.61] and decreased with increased physical activity (OR, 95%CI = 0.49, 0.26–0.91). Risk of prediabetes and diabetes was increased in obese women (OR, 95%CI = 2.94, 1.34–6.44, and 3.61, 1.58–8.26 respectively), that of hypertension in obese men (OR, 95%CI =2.62, 1.41–4.87), and that of dyslipidemia in both sexes (OR, 95%CI = 2.60, 1.40–4.83 in men, and 2.0, 1.01–3.85 in women). A family history of dyslipidemia was associated with reduced risk of obesity among women (OR, 95%CI = 0.33, 0.12–0.92), whereas, in people with above normal weight (BMI ⩾25), there was increased risks of prediabetes, diabetes, and dyslipidemia among women (OR, 95%CI = 2.50, 1.21–5.17; 3.20, 1.45–7.03, and 1.88, 1.02–3.49, respectively ), and of hypertension among men (OR, 95%CI = 1.80, 1.00–3.23). Conclusions: The prevalence of overweight and obesity in the Saudi population remain high, indicating ineffectiveness or lack of preventive measures. Risk of prediabetes, diabetes, dyslipidemia, and hypertension increased with increasing BMI, with some sex differences in these associations.
Optimizing imaging of the rat pulmonary microvasculature by micro‐computed tomography
Authors: Deng Yupu , Rowe Katelynn J. , Chaudhary Ketul R. , Yang Anli , Mei Shirley H.J. , Stewart Duncan J. 
Published: October 2019

Micro‐computed tomography (micro‐CT) is used in pre‐clinical research to generate high‐resolution three‐dimensional (3D) images of organs and tissues. When combined with intravascular contrast agents, micro‐CT can provide 3D visualization and quantification of vascular networks in many different organs. However, the lungs present a particular challenge for contrast perfusion due to the complexity and fragile nature of the lung microcirculation. The protocol described here has been optimized to achieve consistent lung perfusion of the microvasculature to vessels < 20 microns in both normal and pulmonary arterial hypertension rats. High‐resolution 3D micro‐CT imaging can be used to better visualize changes in 3D architecture of the lung microcirculation in pulmonary vascular disease and to assess the impact of therapeutic strategies on microvascular structure in animal models of pulmonary arterial hypertension.
Tackling the Wicked Problem of Measuring What Matters: Framing the Questions
Authors: Zhao Yong , Wehmeyer Michael , Basham James , Hansen David 
Published: October 2019

Purpose: Making policy makers, researcher, education leaders, and assessment developers aware that what matters in education assessment is a wicked problem that cannot be easily solved following traditional approaches. Design/Approach/Methods: Starting from the questions that what matters in education assessment, this article presented such questions as a wicked problem because there is no consensus, not right or wrong answer, and certain solutions may lead to side effects on students and society. Therefore, a new approach of ecology should be involved, and different education outcomes or intended qualities of learners are presented in complex relationships. Findings: Deciding what matters in education assessment is a wicked question. It is not a tame or technology problem and can be resolved by any conventional approaches. What is pivotal now is to decipher what matters in education and then what should be measured and ultimately how to measure. The ecology and collaborate approach deliberated in this article could expedite such a process. Originality/Value: This article advocates paradigm change in understanding and resolving one of the most urgent problems in education. It provides an ecology explanation of the relationships that exist among the different education outcomes and students’ qualities. By guiding through the dissecting of the problem step by step, this article has demonstrated a unique angle of understanding the wicked problem.