bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preventive infusion of donor-derived CAR-T cells after haploidentical transplantation
Authors: Zhang Cheng , Ma Ying-Ying , Liu Jun , Liu Yao , Gao Lei , Gao Li , Kong Pei-Yan , Xiong Qing-Hui , Mei Wei-Ling , Liu Jia , Jiang Peng-Fei , Ye Xun , Zhong Jiang F. , Cao Wei , Han De-Ping , Zhang Xi 
Published: July 2019

Abstract

Rationale:
Relapse is the main cause of death after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Unfortunately, there are no efficient methods to prevent relapse after allo-HSCT. Chimeric antigen receptor T (CAR-T) cells have achieved favorable outcomes in the treatment of refractory/relapsed acute lymphoblastic leukemia (ALL) because of their strong anti-leukemia activity. However, it is unclear whether the CAR-T cells constructed using viral systems can be used as preventive infusions to prevent relapse after haploidentical HSCT.

Patient concerns:
Two patients with ALL with high risk received haploidentical HSCT.

Diagnoses:
Two patients were diagnosed with ALL with high risk.

Interventions:
Patients received preventive infusion of donor-derived CAR-T cells constructed using viral systems on day 60 after haploidentical HSCT.

Outcomes:
The CAR-T cells were continually detected, and no graft versus host disease developed. The two patients survived with disease-free for 1 year and 6 months, respectively.

Lessons:
Preventive infusion of donor-derived CAR-T cells after haploidentical HSCT may be safe and that immunosuppressors may not affect the proliferation of CAR-T cells.
Impact of amyloid-PET in daily clinical management of patients with cognitive impairment fulfilling appropriate use criteria
Authors: Triviño-Ibáñez Eva María , Sánchez-Vañó Raquel , Sopena-Novales Pablo , Romero-Fábrega Juan Carlos , Rodríguez-Fernández Antonio , Carnero Pardo Cristóbal , Martínez Lozano María Dolores , Gómez-Río Manuel 
Published: July 2019

Abstract
To evaluate the use of amyloid-positron emission tomography (PET) in routine clinical practice, in a selected population with cognitive impairment that meets appropriate use criteria (AUC).
A multicenter, observational, prospective case-series study of 211patients from 2 level-3 hospitals who fulfilled clinical AUC for amyloid-PET scan in a naturalistic setting. Certainty degree was evaluated using a 5-point Likert scale: 0 (very low probability); 1 (low probability); 2 (intermediate probability); 3 (high probability); and 4 (practically sure), before and after amyloid PET. The treatment plan was considered as cognition-specific or noncognition-specific.
Amyloid-PET was positive in 118 patients (55.9%) and negative in 93 patients (44.1%). Diagnostic prescan confidence according amyloid-PET results showed that in both, negative and positive-PET subgroup, the most frequent category was intermediate probability (45.7% and 55.1%, respectively). After the amyloid-PET, the diagnostic confidence showed a very different distribution, that was, in the negative-PET group the most frequent categories are very unlikely (70.7%) and unlikely (29.3%), while in the positive-PET group were very probable (57.6%) and practically sure (39%). Only in 14/211 patients (6.6%) the result of the amyloid-PET did not influence the diagnostic confidence, while in 194 patients (93.4%), the diagnostic confidence improved significantly after amyloid-PET results. The therapeutic intention was modified in 93 patients (44.1%). Specific treatment for Alzheimer disease was started, before amyloid-PET, in 80 patients (37.9%).
This naturalistic study provides evidence that the implementation of amyloid-PET is associated with a significant improvement in diagnostic confidence and has a high impact on the therapeutic management of patients with mild cognitive impairment fulfilled clinical AUC.
Loss of guidewire and its sequelae after central venous catheterization
Authors: Zhao Shenyu , Wang Zhe , Zhao Yu 
Published: July 2019

Abstract

Rationale:
Central venous catheterization is a common tool used to monitor central venous pressure and administer fluid medications in patients undergoing surgery. The loss of a broken guide wire into the circulation is a rare and preventable complication. Here, we report a peculiar case of a missed guidewire puncturing the aortic arch and cerebrum.

Patient concerns:
A 53-year-old man with complaints of an intermittent headache and right swollen ankle following central venous catheterization.

Diagnoses:
Using computed tomography; the patient was diagnosed with the loss of a guide wire in his body. The guide wire had migrated to the brain and punctured the vascular wall of the aortic arch.

Interventions:
Due to the risks of surgery, the patient was advised to have a follow-up visit once every 3 months.

Outcomes:
At present, the patient could live like a normal person, although he suffers from intermittent headaches.

Lessons:
The loss of a guide wire is a completely preventable complication, provided that a hold on the tip of the wire is maintained during placement, and the correct safety measurements and protocols are followed.
High pretreatment plasma D-dimer levels predict poor prognosis in gastrointestinal cancers
Authors: Rong Guoyi , Fan Wenxin , Shen Jian 
Published: July 2019

Abstract

Background:
High pretreatment plasma D-dimer levels can predict poor prognosis in various types of gastrointestinal carcinomas. Our meta-analysis explored the correlation between plasma D-dimer levels and prognosis in gastrointestinal malignancies.

Methods:
Two independent reviewers conducted a comprehensive search from PubMed, ScienceDirect, Embase, Web of Science and the Cochrane Library. All articles evaluating the correlation between pretreatment plasma D-dimer levels and prognosis in gastrointestinal malignancies were searched. We chose overall survival (OS) as the primary survival outcome measure and progression-free survival (PFS), disease-free survival (DFS) and cancer-specific survival (CSS) as the secondary survival outcome measures. We extracted hazard ratios (HRs) and 95% confidence intervals (CIs) from the eligible publications.

Results:
We included 30 studies involving 5928 gastrointestinal cancer patients. There was an obvious correlation between high D-dimer levels and poor OS (HR = 2.01, 95% CI = 1.72–2.36, P < .01). High plasma D-dimer levels were correlated with shorter PFS (HR = 1.34, 95% CI = 1.05–1.70, P = .32), DFS (HR =  1.67, 95% CI = 1.12–2.50, P < .01) and CSS rates (HR = 1.93, 95% CI = 1.49–2.49, P = .66).

Conclusions:
Elevated pretreatment plasma D-dimer levels might help predict poor prognosis in patients with gastrointestinal malignancies.
Efficacy and safety of Hou Gu Mi Xi for peptic ulcer diseases
Authors: Chen Xiaofan , Yan Dongmei , Fang Jianhe , Liu Wenjun , Nie Heyun , Lv Nonghua , Fang Nian , Gong Jinhua , Yu Jianwei , Jiang Yiping , Liu Zhijun , Gan Huihu , Fu Ying , Yang Deping , Xiong Yan , Liu Dunju , Chen Ming , Wang Yanping , Wang Yang , Sun Xin , Zhou Xu , Zhu Weifeng 
Published: July 2019

Abstract

Background:
Peptic ulcer disease (PUD) is a major burden worldwide. Several challenges remain with standard Western treatment of PUD, such as persistent weakness, fatigue, and relapse. A dietary traditional Chinese medicine (TCM) formula, Hou Gu Mi Xi (HGMX), has been developed as a complementary treatment for PUD.

Aims:
This multicenter, double-blind, randomized controlled trial will assess efficacy and safety of HGMX in patients with PUD.

Methods:
Three hundred sixty eligible patients will be assigned to receive HGMX, placebo, HGMX + rabeprazole or placebo + rabeprazole for 4 weeks after 2 weeks of standard Western treatment. This first step, with a 2 × 2 factorial design, will focus on assessing the main and interaction effects of HGMX and rabeprazole on ulcer healing. Then, rabeprazole will be stopped, and HGMX will be continued for up to 1 year. The second step, with a placebo-controlled design, will compare the long-term effects of HGMX and placebo. Extended follow-up with no treatment will continue for up to 2 years. Independent and paired t tests, Pearson χ
2 test and the rank-sum test will be used to compare between-group differences. The P value will be adjusted using the O’Brien & Fleming method for multiple comparisons.

Expected outcomes:
The primary outcomes are total efficacy rate of PUD treatment, quality of ulcer healing, and changes in spleen qi deficiency symptoms. The secondary outcomes include ulcer area, PUD recurrence, Helicobacter pylori eradication rate, gastric function, body weight, and body mass index. Adverse events (AEs), severe AEs, treatment-related AEs, and withdrawal owing to AEs will be recorded to assess treatment safety.

Discussion:
The trial results will provide high-quality evidence for HGMX, as a complementary therapy, for the long-term management of PUD and will be valuable for the development of related guidelines and regulations.

Trial registration:
The protocol of this trial was approved in all research hospitals and was registered in ClinicalTrials.gov at October 25, 2017(No. NCT03320538).
Palliative care in pediatric heart failure and transplantation
Authors: Kaufman Beth D. , Cohen Harvey J. 
Published: July 2019

Purpose of review
Advanced heart failure in children is characterized by dynamic clinical trajectories, uncertainty of prognosis, and intermittent need for difficult decision-making, often related to novel therapeutic interventions with uncertain impact on quality of life. This review will examine the current role of palliative care to support this unique population.

Recent findings
Pediatric heart failure patients commonly die in ICUs with high burden of invasive therapies together with end of life care needs. In addition, several studies advocate for integration of palliative care early in disease trajectory, not only focused on end of life care. Many advocate for the core tenets of palliative care (symptom management, communication of prognosis, and advanced care planning) to be provided by the primary cardiology team, with consultation by pediatric palliative care specialists. There is also a consensus that palliative care training should be incorporated into pediatric advanced heart disease training programs.

Summary
Palliative care is an important component of pediatric heart failure care. Research and quality improvement efforts are needed to determine the most effective palliative care interventions for children with advanced heart disease. Provision of palliative care is an essential component of training for pediatric heart failure and transplant specialists.
Shortened 8‐Week Course of Sofosbuvir/Ledipasvir Therapy in Adolescents With Chronic Hepatitis C Infection
Authors: Serranti Daniele , Dodi Icilio , Nicastro Emanuele , Cangelosi Antonina M. , Riva Silvia , Ricci Silvia , Bartolini Elisa , Trapani Sandra , Mastrangelo Greta , Vajro Pietro , D'Antiga Lorenzo , Resti Massimo , Indolfi Giuseppe 
Published: July 2019

ABSTRACTTreatment‐naïve, noncirrhotic adults with chronic hepatitis C virus genotype 1 infection and with viremia levels <6 million IU/mL could be effectively treated with sofosbuvir/ledipasvir for 8 weeks. The aim of this pilot, prospective, open‐label, multicenter study was to evaluate the efficacy and safety of this shortened treatment course in adolescents (≥12 years). The efficacy endpoint was sustained virological response 12 weeks after the end of treatment. Safety was assessed by adverse events and clinical/laboratory data. Fourteen consecutive adolescents (median age 16.5 years, Q1 14.1–Q3 17.4; female 57.1%), vertically infected, were enrolled and treated (June 2018–January 2019). Overall, the end of treatment response and sustained virological response 12 weeks after the end of treatment were 100%. No grade 3 to 4 adverse event or a serious adverse event was observed. Further studies are needed to confirm the optimal efficacy of the shortened 8‐week treatment with sofosbuvir/ledipasvir for treatment‐naïve, noncirrhotic adolescents with chronic hepatitis C virus genotype 1 infection and pretreatment viremia level < 6 million IU/mL.
Diagnosis and Management of Vasa Previa: A Comparison of 4 National Guidelines
Authors: Tsakiridis Ioannis , Mamopoulos Apostolos , Athanasiadis Apostolos , Dagklis Themistoklis 
Published: July 2019

ImportanceVasa previa represents an uncommon and life-threatening condition for the fetus. The prenatal identification of the condition may improve the outcome.ObjectiveThe aim of this study was to synthesize and compare published evidence of 4 national guidelines on diagnosis and management of vasa previa.Evidence AcquisitionA descriptive review of 4 recently published national guidelines on vasa previa was conducted: Royal College of Obstetricians and Gynaecologists on “Vasa Praevia: Diagnosis and Management,” Society for Maternal-Fetal Medicine on “Diagnosis and Management of Vasa Previa,” Society of Obstetricians and Gynaecologists of Canada on “Guidelines for the Management of Vasa Previa,” and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists on “Vasa Praevia.” These guidelines were compared regarding recommendations on diagnosis and management, while the quality of evidence was also reviewed based on each method of reporting.ResultsThere were many similar recommendations in the compared guidelines regarding the diagnosis and management of vasa previa. Early prenatal diagnosis using ultrasound and color Doppler imaging, hospitalization or management as outpatients, and cesarean delivery in a tertiary center with experienced clinicians are the main recommendations.ConclusionsEvidence-based guidelines may increase the awareness of the diagnosis and management of vasa previa among health care professionals and lead to more favorable perinatal outcomes.Target AudienceObstetricians and gynecologists, family physicians.Learning ObjectivesAfter participating in this activity, the learner should be better able to identify possible risk factors associated with vasa previa in pregnant women; describe the best diagnostic methods in pregnant women with vasa previa; and propose the appropriate management in cases of vasa previa.
Dual-Task Cost of Discrimination Tasks During Gait in People With Multiple Sclerosis
Authors: Gutiérrez-Cruz Carmen , Rojas Ruiz Francisco Javier , De La Cruz Marquez Juan Carlos , Gutiérrez-Davila Marcos 
Published: July 2019

Purpose
The aim of the study was to assess dual-task cost to spatio-temporal gait parameters in people with multiple sclerosis and a matched control group.

Method
The multiple sclerosis group was composed of 17 participants with a diagnosis of multiple sclerosis and an Expanded Disability Status Scale score of less than 6. A total of 17 healthy participants were allocated to the control group by stratification. Controls were matched on the basis of age, sex, sociocultural habits, and body structure. Dual-task cost was determined by within-group repeated-measures analysis of variance. Participants were instructed to ambulate under normal conditions and perform a discrimination and decision-making task concurrently. Then, between-group analysis of variance was used to assess differences in mean dual-task cost between groups and determine dual-task cost differential. Testing was performed using three-dimensional photogrammetry and an electronic walkway.

Results
Based on dual-task cost differential, gait cycle time increase (−5.8%) and gait speed decrease (6.3%) because of multiple sclerosis–induced impairment.

Conclusions
During single- and dual-task conditions, gait speed was lower in multiple sclerosis participants, because of a shorter step length and increased swing time. Increased gait time might be the result of compensatory mechanisms adopted to maintain stability while walking specially during the double-support phases.
Anti-Inflammatory and Healing Effects of Pulsed Ultrasound Therapy on Fibroblasts
Authors: de Oliveira Perrucini Priscila Daniele , Poli-Frederico Regina Célia , de Almeida Pires-Oliveira Deise Aparecida , Dragonetti Bertin Larissa , Beltrão Pires Flavia , Shimoya-Bittencourt Walkiria , Martins Santos Viviane , Medeiros Coelho Julice , Franco de Oliveira Rodrigo 
Published: July 2019

Objective
The aim of this study was to analyze the effects of low-intensity pulsed ultrasound therapy under different pulse regimes on cultures of semiconfluent L929 fibroblasts, evaluating cell viability, anatomical structural alterations, modulation of vascular endothelial growth factor, interleukin 6, collagen type 1 alpha 1, collagen type 1 alpha 2, and fibroblast growth factor 7, as well as the amount of inflammatory mediators interleukin 2, interleukin 4, interleukin 6, interferon γ, tumor necrosis factor, interleukin 17A, and interleukin 10 at 24, 48, and 72 hrs.

Design
The design was experimental study.

Methods
The treatments consisted of 0.2 W/cm2 doses at a frequency of 1 MHz, with a pulse rate of 10% and 20%. Viability was assessed by the MTT assay (3-(4,5-dimethylthiazole)-2,5-diphenyltetrazolium bromide), gene expression by real-time quantitative polymerase chain reaction, and cytokine quantification by flow cytometry.

Results
At 48 hrs, ultrasound enhanced cell viability and affected interleukin 6 cytokine production, vascular endothelial growth factor, interleukin 6, type 1 alpha 1 and alpha 2 collagens, and fibroblast growth factor 7 gene modulation.

Conclusions
Low-intensity pulsed ultrasound therapy had a biostimulatory effect on semiconfluent in vitro L929 fibroblast cells, where the group with a dose of 0.2 W/cm2-10% (G2) presented higher responses, in all the analyzed aspects, toward the dose pulsed to 20%, confirming its therapeutic properties related to the initial phases of tissue healing.
Weekend Admission to Inpatient Rehabilitation Facilities Is Associated With Transfer to Acute Care in a Nationwide Sample of Patients With Stroke
Authors: Shih Shirley L. , Flavin Marisa , Goldstein Richard , Slocum Chloe , Ryan Colleen M. , Singhal Aneesh , Frankel Jason , Zafonte Ross , Schneider Jeffrey C. 
Published: July 2019

Objective
The aim of the study was to determine the impact of weekend versus weekday admission to an inpatient rehabilitation facility on the risk of acute care transfer in patients with stroke.

Design
This was a retrospective analysis using the Uniform Data System for Medical Rehabilitation, a national database comprising data from 70% of US inpatient rehabilitation facilities. A total of 1,051,436 adult (age ≥18 yrs) stroke cases were identified between 2002 and 2014 that met inclusion criteria. Logistic regression models were developed to test for associations between weekend (Friday–Sunday) versus weekday (Monday–Thursday) inpatient rehabilitation facility admission and transfer to acute care (primary outcome) and inpatient rehabilitation facility length of stay (secondary outcome), adjusting for relevant patient, medical, and facility variables. A secondary analysis examined acute care transfer from 2002 to 2009 before passage of the Affordable Care Act (ACA), 2010 to 2012 post–Affordable Care Act, and 2013 to 2014 after implementation of the Hospital Readmissions Reduction Program.

Results
Weekend inpatient rehabilitation facility admission was associated with increased odds of acute care transfer (odds ratio = 1.06, 95% confidence interval = 1.04–1.08) and slightly shorter inpatient rehabilitation facility length of stay (P < 0.001). Overall, the risk of acute care transfer decreased after the ACA and Hospital Readmissions Reduction Program.

Conclusions
Weekend admission to inpatient rehabilitation facility may pose a modest increase in the risk of transfer to acute care in patients with stroke.

To Claim CME Credits
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives
Upon completion of this article, the reader should be able to: (1) Understand disparities in obesity rates among adolescents with mobility disabilities; (2) Describe limitations of current clinical screening methods of obesity in children with mobility disabilities; and (3) Identify potential alternatives for obesity screening in children with mobility disabilities.

Level
Advanced

Accreditation
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0
AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Projecting Cost Containment in the Operating Room Utilizing Incentivized Strategies to Reduce Healthcare Cost
Authors: Koppert Tanner , Tumin Dmitry , Tobias Joseph D. , Raman Vidya T. 
Published: July 2019

Introduction:
Streamlining healthcare in United States is of paramount concern while maintaining standards of quality and safety. Incentivizing change may be even more effective in driving such measures. At Nationwide Children’s Hospital, we incentivize cost savings directly to the healthcare team member. In this project, we evaluated a simple substitution of a buretrol for Y-type tubing based on weight rather than age cutoffs.

Methods:
This was deemed a quality improvement project and therefore exempt from Institutional Review Board approval. We obtained costs of Y-type tubing versus buretrols. We interrogated the electronic medical record to quantify case volume in the main operating room according to age and weight. We calculated our costs to compare our current practice of using buretrol fo age ≤ 12 years and the planned practice of using buretrol for weight < 20 kg.

Results:
We identified 28,875 children ages 0-12 (60% weight <20kg) and 6,301 children ages 13-18 (0.1% weight <20kg) undergoing procedures in the main operating rooms over a 1-year period.. A unit cost savings of $4.40 substituting Y-type tubing for a buretrol was determined. Transitioning from age-based to weight-based criteria for buretrol use was determined to potentially save $51,260 over the period reviewed.

Conclusions:
Simple changes can impact efficiency and cost in healthcare. It is important to consider incentivizing such measures to help drive these changes. In the future, with more incentivized measures, hopefully we can successfully make an impact of efficiency and cost of healthcare in United States without compromising safety or quality.