bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Experimental Model of Eosinophilic Chronic Rhinosinusitis Induced by Bacterial Toxins in Rabbits
Authors: Braga Andréa A. , Valera Fabiana C. P. , Faria Francesca M. , Rossato Maria , Murashima Adriana A. B. , Fantucci Marina Z. , Aragon Davi C. , Queiroz Danielle L. C. , Anselmo-Lima Wilma T. , Tamashiro Edwin 
Published: July 2019

Background The pathophysiology of chronic rhinosinusitis (CRS) is still not well known due to the multifactorial etiologies involved. Bacteria play a role in the pathogenesis of CRS by various means, including biofilm adhesion, intracellular persistence, or inducing inflammation secondary to toxins. Endotoxins and exotoxins, especially Staphylococcus aureus superantigens, can produce significant immune responses in the host and are implicated in patients with CRS. The majority of animal models described for CRS revalidates the pathophysiology of acute sinusitis, ostium occlusion, or foreign body associated infection. Objectives To evaluate an experimental model of eosinophilic CRS using prolonged exposure to bacterial toxins. The histological changes in rabbits exposed to S. aureus enterotoxin B (SEB), lipopolysaccharide (LPS), or lipoteichoic acid (LTA) were compared. Methods After induction with ovalbumin (OVA) sensitization with subcutaneous injection for 2 weeks, rabbits underwent surgery to insert an indwelling catheter into the maxillary sinus. The sinus was irrigated with OVA 3 times weekly for 2 weeks, followed by sinus irrigation with bacterial toxin (SEB: 1 µg/mL, LPS: 100 ng/mL, or LTA: 100 ng/mL) 3 times weekly for 4 weeks. The histological changes in the treated sinus were compared with control rabbits. Results Sinuses exposed to bacterial toxins (SEB, LPS, and LTA) produced significant mucosal thickening with infiltration of inflammatory cells, notably eosinophils. SEB was the only toxin that promoted a mixed pattern of inflammation, including eosinophilic and neutrophilic infiltration. Conclusion Our experimental model of eosinophilic CRS in rabbits produced significant mucosal thickening and inflammation in the sinuses exposed to bacterial toxins, with histological changes analogous to what is observed in patients with CRS with nasal polyps. This model may serve as a basis for future investigation of the pathogenesis of eosinophilic CRS in relation to bacterial toxins or as a model for testing new therapeutic modalities for this disease.
Clinical and Radiological Results After Minimally Invasive Transpsoas Lateral Access Surgery for Degenerative Lumbar Stenosis
Authors: Coutinho Thiago Pereira , Cristante Alexandre Fogaça , Marcon Raphael Martus , da Rocha Ivan Dias , Ono Allan Hiroshi , Meyer Guilherme Pereira Correa , Barros Filho Tarcísio Eloy de Pessoa 
Published: July 2019

Study Design: Prospective cohort study. Objective: The lateral transpsoas access is a retroperitoneal approach for the lumbar spine to perform the lateral lumbar interbody fusion (LLIF), an intersomatic arthrodesis performed with a cage placed on the lateral borders of the epiphyseal ring. The procedure can be used to provide indirect decompression of the nervous structures through the discectomy and restoration of the disc height. The objective of the present study was to evaluate the indirect decompression following LLIF both with radiological and clinical parameters. Methods: Prospective clinical and radiological study in a single center with 20 patients diagnosed with 1- or 2-level degenerative lumbar stenosis. Radiological analysis on magnetic resonance imaging included foramen height, canal area, canal diameter, and disc height. Clinical outcomes included visual analogue scale (VAS) and Oswestry Disability Index (ODI) collected up to 12 months. Complications and reoperations were recorded. Results: In total, 25 levels were treated. No reoperation was required. Disc height was increased by an average of 25% ( P < .001). The canal area increased from 109 to 149 mm2 ( P < .001) and from 9.3 to 12.2 mm ( P < .001) in anteroposterior diameter. The foramen area demonstrated the effect of indirect decompression on both sides ( P < .001). The height of the foramen showed significant average increase of 2.8 mm ( P < .001). The results from VAS and ODI questionnaires confirmed the clinical effect of indirect decompression. Conclusion: We observed that indirect decompression by the LLIF method is feasible both radiologically and clinically with a low rate of complications and reoperations.
Early Sports Specialization Is Associated With Upper Extremity Injuries in Throwers and Fewer Games Played in Major League Baseball
Authors: Confino Jamie , Irvine James N. , O’Connor Michaela , Ahmad Christopher S. , Lynch T. Sean 
Published: July 2019

Background: Single-sport athletes who specialize in baseball at a young age may have a greater predisposition to overuse injury, burnout, and decreased career longevity when compared with multiple-sport athletes. The effect of sport specialization has not been studied in professional baseball players. Hypothesis: Major League Baseball (MLB) players who played multiple sports in high school would experience fewer injuries, spend less time on the disabled list, play more games, and have a longer career than athletes who played only baseball in high school. Study Design: Descriptive epidemiology study. Methods: First- and second-round MLB draft picks from 2008 to 2016 who played in at least 1 professional game were included in this study. Athletes who participated in 1 or more sports in addition to baseball during high school were considered multisport athletes, and athletes who participated in only baseball were considered single-sport athletes. For each athlete, participation in high school sports, injuries sustained in MLB and Minor League Baseball, number of days on the disabled list for each injury, number of games played in both leagues, and whether the athlete was still active were collected from publicly available records. Results: A total of 746 athletes were included in this study: 240 (32%) multisport and 506 (68%) single sport. Multisport athletes played in significantly more mean total games (362.8 vs 300.8; P < .01) as well as more mean MLB games (95.9 vs 71.6; P = .04) than single-sport athletes. There was no difference in the mean number of seasons played in the major leagues (1.8 vs 1.6; P = .15) or minor league (5.25 vs 5.20; P = .23) between multisport and single-sport athletes. Single-sport athletes had a significantly higher prevalence of upper extremity injuries compared with multisport athletes (136 [63%] vs 55 [50%]; P = .009). Single-sport pitchers also had a higher prevalence of shoulder and elbow injuries (86 vs 27; P = .008) and were more likely to have recurrent elbow injuries (33% vs 17% recurrence; P = .002) compared with multisport pitchers. Conclusion: Professional baseball players who participated in multiple sports in high school played in more major league games and experienced lower rates of upper and lower extremity injuries than players who played only baseball in high school.
A phase 2 study of brentuximab vedotin in patients with CD30-positive advanced systemic mastocytosis
Authors: Gotlib Jason , Baird John H. , George Tracy I. , Langford Cheryl , Reyes Isabel , Abuel Justin , Perkins Cecelia , Schroeder Kurt , Bose Prithviraj , Verstovsek Srdan 
Published: July 2019

Abstract
There is an unmet need for effective therapies for advanced systemic mastocytosis (advSM). CD30 is expressed on the surface of neoplastic mast cells (MC) in more than 50% of patients with advSM. Brentuximab vedotin (BV) is a CD30-directed antibody-drug conjugate with preclinical evidence supporting both an antineoplastic effect and an attenuation of immunoglobulin E-associated mediator release. These observations are the basis for this phase 2 trial of BV monotherapy (1.8 mg/kg IV every 3 weeks up to 8 cycles) in patients with CD30-positive advSM. The primary objective was to determine the efficacy of BV according to International Working Group-Myeloproliferative Neoplasms Research and Treatment-European Competence Network on Mastocytosis (IWG-MRT-ECNM) response criteria. Secondary objectives included evaluation of safety, changes in bone marrow (BM) MC burden, serum tryptase level, flow cytometric quantification of MC surface expression of CD30, and self-reported symptom burden. The trial enrolled 10 patients with a diagnosis of CD30+ advSM (aggressive SM, SM with an associated hematologic neoplasm [SM-AHN], or mast cell leukemia [MCL]) with 1 or more signs of SM-related organ damage. According to IWG-MRT-ECNM criteria, none of the patients demonstrated better than stable disease with BV. In addition, there were no significant reductions in BM MC burden, serum tryptase levels, or MC surface expression of CD30. Self-reported symptom scores showed no durable improvement with BV treatment. We conclude that BV is not active as a single agent in CD30+ advSM. This trial was registered at www.clinicaltrials.gov as #NCT01807598.
Tumor Mutational Burden Is Site Specific in Non–Small-Cell Lung Cancer and Is Highest in Lung Adenocarcinoma Brain Metastases
Authors: Stein Matthew K. , Pandey Manjari , Xiu Joanne , Tae Hongseok , Swensen Jeff , Mittal Sandeep , Brenner Andrew J. , Korn W. Michael , Heimberger Amy B. , Martin Mike G. 
Published: July 2019

PURPOSE Tumor mutational burden (TMB) is a developing biomarker in non–small-cell lung cancer (NSCLC). Little is known regarding differences between TMB and sample location, histology, or other biomarkers. METHODS A total of 3,424 unmatched NSCLC samples, including 2,351 lung adenocarcinomas (LUADs) and 1,073 lung squamous cell carcinomas (LUSCs), underwent profiling, including next-generation sequencing of 592 cancer-related genes, programmed death ligand 1 immunohistochemistry, and TMB. The rate TMB of 10 mutations per megabase (Mb) or greater was compared between primary and metastatic LUAD and LUSC. Molecular alteration frequency was compared at a cutoff of 10 mutations/Mb. RESULTS LUAD metastases were more likely to have a TMB of 10 mutations/Mb or greater compared with primary LUADs (38% v 25%; P < .001), and this difference was most pronounced with brain metastases (61% v 35% for other metastases; P < .001). The median TMB for LUAD brain metastases was 13 mutations/Mb compared with six mutations/Mb for primary LUADs. Variability existed for other LUAD metastasis sites, with adrenal metastases most likely to meet the cutoff of 10 mutations/Mb (51%) and bone metastases least likely to meet the cutoff (19%). TMB was more commonly 10 mutations/Mb or greater for LUSC primary tumors than for LUAD primary tumors (35% v 25%, respectively; P < .001). LUSC metastases were more likely to have a TMB of 10 mutations/Mb or greater than LUSC primary tumors. Poorly differentiated disease was more likely have a TMB of 10 mutations/Mb or greater when stratified by histology and primary tumor or metastasis. Site-specific molecular differences existed at this TMB cutoff including programmed death ligand 1 positivity and STK11 and KRAS mutation rate. CONCLUSION TMB is a site-specific biomarker in NSCLC with important spatial and histologic differences. TMB is more frequently 10 mutations/Mb or greater in LUAD and LUSC metastases and highest in LUAD brain metastases. Along this TMB cutoff, clinically informative distinctions exist in other tumor profiling characteristics. Further investigation is needed to expand on these findings.
A Mixed-Method Design Evaluation of the SAFE Obstetric Anaesthesia Course at 4 and 12–18 Months After Training in the Republic of Congo and Madagascar
Authors: White Michelle C. , Rakotoarisoa Tsiferana , Cox Nicola H. , Close Kristin L. , Kotze Joan , Watrous Abigail 
Published: July 2019

BACKGROUND:Maternal mortality in low- and middle-income countries (LMICs) is higher than in high-income countries (HICs), and poor anesthesia care is a contributing factor. Many anesthesia complications are considered preventable with adequate training. The Safer Anaesthesia From Education Obstetric Anaesthesia (SAFE-OB) course was designed as a refresher course to upgrade the skills of anesthesia providers in low-income countries, but little is known about the long-term impact of the course on changes in practice. We report changes in practice at 4 and 12–18 months after SAFE-OB courses in Madagascar and the Republic of Congo.METHODS:We used a concurrent embedded mixed-methods design based on the Kirkpatrick model for evaluating educational training courses. The primary outcome was qualitative determination of personal and organizational change at 4 months and 12–18 months. Secondary outcomes were quantitative evaluations of knowledge and skill retention over time. From 2014 to 2016, 213 participants participated in 5 SAFE-OB courses in 2 countries. Semistructured interviews were conducted at 4 and 12–18 months using purposive sampling and analyzed using thematic content analysis. Participants underwent baseline knowledge and skill assessment, with 1 cohort reevaluated using repeat knowledge and skills tests at 4 months and another at 12–18 months.RESULTS:At 4 months, 2 themes of practice change (Kirkpatrick level 3) emerged that were not present at 12–18 months: neonatal resuscitation and airway management. At 12–18 months, 4 themes emerged: management of obstetric hemorrhage, management of eclampsia, using a structured approach to assessing a pregnant woman, and management of spinal anesthesia. With respect to organizational culture change (Kirkpatrick level 4), the same 3 themes emerged at both 4 and 12–18 months: improved teamwork, communication, and preparation. Resistance from peers, lack of senior support, and lack of resources were cited as barriers to change at 4 months, but at 12–18 months, very few interviewees mentioned lack of resources. Identified catalysts for change were self-motivation, credibility, peer support, and senior support. Knowledge and skills tests both showed an immediate improvement after the course that was sustained. This supports the qualitative responses suggesting personal and organizational change.CONCLUSIONS:Participation at a SAFE-OB course in the Republic of Congo and in Madagascar was associated with personal and organizational changes in practice and sustained improvements in knowledge and skill at 12–18 months.
Two-Week Multimodal Prehabilitation Program Improves Perioperative Functional Capability in Patients Undergoing Thoracoscopic Lobectomy for Lung Cancer: A Randomized Controlled Trial
Authors: Liu Zijia , Qiu Tian , Pei Lijian , Zhang Yuelun , Xu Li , Cui Yushang , Liang Naixin , Li Shanqing , Chen Wei , Huang Yuguang 
Published: July 2019

BACKGROUND:
Patients with lung cancer often experience reduced functional capacity and quality of life after surgery. The current study investigated the impact of a short-term, home-based, multimodal prehabilitation program on perioperative functional capacity in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for nonsmall cell lung cancer (NSCLC).

METHODS:
A randomized controlled trial was conducted with 73 patients. Patients in the prehabilitation group (n = 37) received a 2-week multimodal intervention program before surgery, including aerobic and resistance exercises, respiratory training, nutrition counseling with whey protein supplementation, and psychological guidance. Patients in the control group (n = 36) received the usual clinical care. The assessors were blinded to the patient allocation. The primary outcome was perioperative functional capacity measured as the 6-minute walk distance (6MWD), which was assessed at 1 day before and 30 days after surgery. A linear mixed-effects model was built to analyze the perioperative 6MWD. Other outcomes included lung function, disability and psychometric evaluations, length of stay (LOS), short-term recovery quality, postoperative complications, and mortality.

RESULTS:
The median duration of prehabilitation was 15 days. The average 6MWD was 60.9 m higher perioperatively in the prehabilitation group compared to the control group (95% confidence interval [CI], 32.4–89.5; P < .001). There were no differences in lung function, disability and psychological assessment, LOS, short-term recovery quality, postoperative complications, and mortality, except for forced vital capacity (FVC; 0.35 L higher in the prehabilitation group, 95% CI, 0.05–0.66; P = .021).

CONCLUSIONS:
A 2-week, home-based, multimodal prehabilitation program could produce clinically relevant improvements in perioperative functional capacity in patients undergoing VATS lobectomy for lung cancer.
Next-generation sequencing of microbial cell-free DNA for rapid noninvasive diagnosis of infectious diseases in immunocompromised hosts
Authors: Camargo Jose F. , Ahmed Asim A. , Lindner Martin S. , Morris Michele I. , Anjan Shweta , Anderson Anthony D. , Prado Clara E. , Dalai Sudeb C. , Martinez Octavio V. , Komanduri Krishna V. 
Published: July 2019

Background: Cell-free DNA (cfDNA) sequencing has emerged as an effective laboratory method for rapid and noninvasive diagnosis in prenatal screening testing, organ transplant rejection screening, and oncology liquid biopsies. Methods: Here we report our experience using next-generation sequencing (NGS) for detection of microbial cfDNA in a cohort of ten immunocompromised patients with febrile neutropenia or deep-seated infection. Results: Among five hematological malignancy patients, for whom a microbiological diagnosis was established, pathogen identification by cfDNA NGS demonstrated 100% positive agreement with conventional diagnostic laboratory methods. Further, cfDNA identified the etiological agent in two patients with culture negative sepsis who had undergone hematopoietic stem cell transplant. Conclusion: These data support the clinical utility of measurement of microbial cfDNA sequencing from peripheral blood for rapid noninvasive diagnosis of infections in immunocompromised hosts. Larger studies are needed.
Postoperative pain of patients with necrotic teeth with apical periodontitis following single visit endodontic treatment versus multiple visit endodontic treatment using triple antibiotic paste: a randomized clinical trial
Authors: AbdurRahman Safeya , Abdel Aziz Saied M. , Gawdat Shaimaa I. , AbdalSamad Ahmed M. 
Published: July 2019

Background: A randomized clinical trial was conducted to compare the postoperative pain following endodontic treatment of necrotic teeth with apical periodontitis. Treatments were performed in multiple visits with application of triple antibiotic paste interappointment dressing or single visit without interappointment dressing. Methods: In total 44 participants were assigned randomly into two groups. Group A: multiple visit endodontic treatment with triple antibiotic paste interappointment dressing; group B: single visit endodontic treatment without interappointment dressing. Postoperative pain of participants was assessed after 24, 48, 72 hours and one week using numerical rating scale. Results: No statistically significant difference was found in postoperative pain after 24, 48, 72 hours and one week between the two groups. Conclusion: Triple antibiotic paste as an interappointment dressing in multiple visits endodontic treatment was not proved to reduce the postoperative pain compared to a single visit in patients with necrotic teeth with apical periodontitis who did not have an interappointment dressing. Trial registration: clinicaltrials.gov, NCT02947763. Date: 28th October 2016.
Limites e possibilidades do Sistema Único de Saúde utilizando a imagem pendular da relação entre o Estado e o Mercado
Authors: Tenório Danielle de Melo 
Published: July 2019

A dinâmica pendular busca o ponto de equilíbrio entre o Mercado e Estado, cabendo ao Estado a missão de intervenção, observando a sociedade. Ela consiste em duas referências ordenadoras: Estado e Mercado. O Estado está do lado esquerdo e o mercado do lado direito e o pêndulo se configura na sociedade oscilando de acordo com seus princípios e necessidade de cada sociedade em determinada época. Quando esse pêndulo se direciona a direita para o Mercado os mecanismos da sociedade estão direcionados para o lucro, a disputa econômica e todas as ações e serviços prestado tem como finalidade o retorno econômico, ou seja, somente quem pode pagar por tais serviços é quem pode desfrutá-los, inversamente do que ocorre quando o pêndulo se inclina para a esquerda (o Estado), pois é Estado que assume a responsabilidade e o dever de oferecer os serviços e assistência a sociedade não visando lucratividade. Este ensaio vislumbra refletir sobre os aspectos em que a visão pendular pode servir para análise da saúde e do Sistema Único de Saúde como produto de uma conformação social e econômica no Brasil contemporâneo.
Dengue: reflexões sobre a incidência da doença no município de Palmares, Pernambuco no pós-enchente (2010, 2011)
Authors: Da Silva Elany Bezerra , Da Cunha Nóbrega Pedro Ricardo 
Published: July 2019

O artigo em tela revela a importância de um ambiente equilibrado no tocante à saúde ambiental e consequentemente trata de questões relacionadas à saúde pública. Os eventos desencadeados através de desequilíbrios ambientais afetam diretamente à saúde da população, propiciando um ambiente suscetível a diversas doenças vetoriais. Tem-se como objetivo analisar a incidência de casos de dengue na cidade dos Palmares, refletindo sobre o surgimento dos possíveis criadouros do mosquito Aedes aegypti, catalizados no contexto pós-enchentes. Foram realizadas pesquisas, a partir da coleta de dados dos casos de dengue nos últimos dois anos e entrevistas com a comunidade dos bairros mais afetados pelas enchentes no município. A partir dos dados levantados, constatou-se que devido à situação calamitosa que a cidade se encontra, com casas, prédios e locais públicos abandonados sem manutenção agregados ao montante de lixo espalhado pela cidade, surgiram novos criadouros potenciais do mosquito Aedes aegypti, dessa forma a comunidade se tornou vulnerável às doenças de circulação hídrica, em especial a dengue, que vem causando transtornos à saúde coletiva da população.
Conhecimento dos pacientes do programa HIPERDIA sobre a Doença Renal Crônica
Authors: Nunes Simony Fabíola Lopes 
Published: July 2019

Estudo descritivo, com abordagem qualitativa e quantitativa sobre o conhecimento de pacientes do programa Hiperdia sobre a Doença Renal Crônica (DRC). Objetivou-se verificar o conhecimento que diabéticos e hipertensos acompanhados pela Estratégia de Saúde da Família possuem sobre a DRC. Este estudo contou com 110 pacientes inscritos e acompanhados pela ESF do bairro da Nova Imperatriz estando os participantes cientes sobre a pesquisa e assinado o termo de consentimento livre e esclarecido de acordo com a Resolução do Ministério da Saúde 196/96 e aprovada pelo Comitê de Ética em Pesquisa sob nº 004316/2011.30. Os resultados demonstraram que dos 110 participantes 70 (63,6%) não possuíam qualquer conhecimento sobre a DRC, 90 (81%) não souberam quais eram os grupos de risco para o desenvolvimento da DRC e 64 (58,1%) não sabiam que a realização do tratamento adequado para DM e HAS constituiu medida eficaz para a prevenção da progressão do DRC, desta forma, concluiu-se que os pacientes do programa Hiperdia possuem conhecimento insatisfatório em relação a DRC. Sugere-se, portanto, que a educação em saúde com foco na prevenção da DRC integre as medidas de enfermagem na ESF.
A educação permanente no serviço de enfermagem em emergência
Authors: Nunes Simony Fabíola Lopes 
Published: July 2019

A educação permanente em saúde tem por base a atuação e a reflexão da realidade vivenciada no cotidiano da assistência dos profissionais da saúde de modo a transformar a realidade por meio da problematização. Revisão integrativa que objetivou analisar as publicações científicas acerca da educação permanente para os trabalhadores de enfermagem no serviço de emergência, indexados em bancos de dados no período de 2005 a 2010. Após análise os resultados dos estudos apontaram que a Educação Permanente cria espaços de reflexão para que os profissionais procurem novas estratégias de intervenção e caminhos para a superação de dificuldades individuais e coletivas no serviço.