bluuebunny/crossref_metadata_2025_split huggingface dataset:
T-Cell Receptor–Based Immunotherapy for Hematologic Malignancies
Authors: Biernacki Melinda A. , Brault Michelle , Bleakley Marie 
Published: May 2019

AbstractAdoptive immunotherapy with engineered T cells is at the forefront of cancer treatment. T cells can be engineered to express T-cell receptors (TCRs) specific for tumor-associated antigens (TAAs) derived from intracellular or cell surface proteins. T cells engineered with TCRs (TCR-T) allow for targeting diverse types of TAAs, including proteins overexpressed in malignant cells, those with lineage-restricted expression, cancer-testis antigens, and neoantigens created from abnormal, malignancy-restricted proteins. Minor histocompatibility antigens can also serve as TAAs for TCR-T to treat relapsed hematologic malignancies after allogeneic hematopoietic cell transplantation. Moreover, TCR constructs can be modified to improve safety and enhance function and persistence of TCR-T. Transgenic T-cell receptor therapies targeting 3 different TAAs are in early-phase clinical trials for treatment of hematologic malignancies. Preclinical studies of TCR-T specific for many other TAAs are underway and offer great promise as safe and effective therapies for a wide range of cancers.
Escape From ALL-CARTaz
Authors: Zheng Sisi , Asnani Mukta , Thomas-Tikhonenko Andrei 
Published: May 2019

Abstract
Chimeric antigen receptor (CAR) T-cell therapy has been transformative for the treatment of B-cell malignancies, with CD19- and CD22-directed CARs being prime examples. However, immunoediting and ensuing antigen loss remain the major obstacles to curative therapy in up to 25% of patients. For example, to achieve the CD19-negative phenotype, malignant cells can pick from a broad array of mechanisms, including focal loss-of-function mutations, dysregulated trafficking to the cell surface, alternative splicing, and lineage switching. In other cases, where resistance is mediated by insufficient antigen density, trogocytosis has been proposed as a possible underlying mechanism. To overcome these barriers, compensatory strategies will be needed, which could include using combinatorial CARs, harnessing epitope spreading, and targeting tumor neoantigens.
Toward the Development of the Perfect Medical Team: Critical Components for Adaptation
Authors: Gregory Megan E. , Hughes Ashley M. , Benishek Lauren E. , Sonesh Shirley C. , Lazzara Elizabeth H. , Woodard LeChauncy D. , Salas Eduardo 
Published: May 2019

Objective
Medical teams play a vital role in the delivery of safe and effective patient care. Toward the goal of becoming a high-reliability health system, the authors posit that the “perfect” medical team is one that develops their attitudes, behaviors, and cognitions (ABCs) to facilitate adaptation.

Methods
The authors synthesized the literature (frameworks, measures, and conceptual models) on teamwork in healthcare (k = 161) to develop an evidence-based model of ABCs, which current evidence suggests, are requisite for medical team adaptation. Clinical vignettes were garnered from the media and other sources to illustrate how these ABCs—or failure in using these ABCs—can lead to positive or negative events in healthcare.

Results
The resulting model contains the most frequently included ABCs in healthcare teamwork models, measures, and frameworks: psychological safety (41, 25.5%), situation assessment (66, 41.0%), shared mental models (56, 34.8%), team leadership behaviors (78, 48.4%), role awareness (64, 39.7%), team decision-making (61, 37.9%) and planning (41, 25.5%), conflict management (51, 31.7%), task coordination (71, 44.1%), adaptation (46, 28.6%), and backup behavior (54, 33.5%). The authors posit that communication and organizational conditions—other highly cited components—(141, 87.6%, and 90, 55.9%, respectively) serve as moderators of these relationships.

Conclusions
The authors argue that each of these ABCs is critical for enhancing team adaptation and subsequently increasing patient safety. A list of practical tools and educational strategies that teams and organizations can use to improve their performance on each of these ABCs is provided.
Patients Own Safety Incidents Reports to the Danish Patient Safety Database Possess a Unique but Underused Learning Potential in Patient Safety
Authors: Christiansen Anders Bech , Simonsen Simon , Nielsen Gert Allan 
Published: May 2019

Objective
The aim of the study was to analyze how patients’ own reports of safety incidents to the Danish Patient Safety Database can contribute to patient safety.

Background
Patient involvement enhances patient safety; however, there is a shortage of tools capable of systematically capturing and usage of patients’ own reports. Since 2012, the Danish Patient Safety Database (DPSD) has comprised such a tool.

Methods
A total of 209,263 incident reports were compared across the following four reporting groups: patients, relatives, doctors, and nurses. Using thematic comparison, 300 narratives from each group were compared with respect to differences and similarities in the wording of the safety incident.

Results
Only a tiny proportion of safety incidents were reported by patients’ themselves (1.4%). Most of these (86%) were accepted for processing in the DPSD. Almost 90% of the accepted incidents were classified successfully. Patients’ own reports were longer, more often “less severe incidents,” and more often reported by female patients. Thematic content analyses revealed incident descriptions from health professionals as terse, unemotional, and extensively using medical terminology and abbreviations. In contrast patients’ reports were lengthy, emotional, and focused on relations to health personal, health consequences, and communication errors.

Conclusions
Despite the very low ratio of patients reporting an observed incident to DPSD, the finding that most patients own reports are accepted and classified makes the DPSD a promising, comprehensive tool to capture patients’ own reports. However, the rich, contextualized descriptions seem insufficiently captured by established nomenclature.
Association Between Bilirubin, Atazanavir, and Cardiovascular Disease Events Among People Living With HIV Across the United States
Authors: Crane Heidi M. , Nance Robin M. , Heckbert Susan R. , Ritchings Corey , Rosenblatt Lisa , Budoff Matthew , Wood Brian R. , Tirschwell David L. , Kim H. Nina , Mathews William C. , Geng Elvin , Moore Richard D. , Hunt Peter W. , Eron Joseph J. , Burkholder Greer A. , Drozd Daniel R. , Chow Felicia C. , Becker Kyra J. , Zunt Joseph R. , Ho Emily L. , Kalani Rizwan , Huffer Andrew , Whitney Bridget M. , Saag Michael S. , Kitahata Mari M. , Delaney Joseph A. C. 
Published: May 2019

Objective:
Bilirubin is an antioxidant that may suppress lipid oxidation. Elevated bilirubin is associated with decreased cardiovascular events in HIV-uninfected populations. We examined these associations in people living with HIV (PLWH).

Methods:
Potential myocardial infarctions (MIs) and strokes were centrally adjudicated. We examined MI types: type 1 MI (T1MI) from atherosclerotic plaque instability and type 2 MI (T2MI) in the setting of oxygen demand/supply mismatch such as sepsis. We used multivariable Cox regression analyses to determine associations between total bilirubin levels and outcomes adjusting for traditional and HIV-specific risk factors. To minimize confounding by hepatobiliary disease, we conducted analyses limited to bilirubin values <2.1 mg/dL; among those with fibrosis-4 values <3.25; and among everyone. We repeated analyses stratified by hepatitis C status and time-updated atazanavir use.

Results:
Among 25,816 PLWH, there were 392 T1MI and 356 T2MI during follow-up. Adjusted hazard ratios for the association of higher bilirubin levels with T1MI were not significant. Higher bilirubin levels were associated with T2MI. By contrast, among PLWH on atazanavir, higher bilirubin levels were associated with fewer T2MI (hazard ratio 0.56:0.33–1.00). Higher bilirubin levels among those on atazanavir were associated with fewer T1MI combined with ischemic stroke.

Limitations:
Analyses were conducted with total rather than unconjugated bilirubin.

Conclusions:
Among PLWH, higher bilirubin levels were associated with T2MI among some subgroups. However, among those on atazanavir, there was a protective association between bilirubin and T2MI. These findings demonstrate different associations between outcomes and elevated bilirubin due to diverse causes and the importance of distinguishing MI types.
Mortality After Cryptococcal Infection in the Modern Antiretroviral Therapy Era
Authors: Hevey Matthew A. , Presti Rachel M. , O'Halloran Jane A. , Larson Lindsey , Raval Krunal , Powderly William G. , Spec Andrej 
Published: May 2019

Background:
The prevalence of cryptococcosis in people living with HIV (PLWH) in the developed world has decreased considerably in the modern antiretroviral therapy (ART) era. Although early mortality of PLWH with opportunistic infections is well understood, overall mortality has not been previously evaluated.

Methods:
We conducted a retrospective cohort study of cryptococcosis in PLWH from January 1, 2002, to July 1, 2017. Data were also evaluated before and after 2008 to evaluate the possible effect of modern ART on outcomes. Death date was obtained from the hospital's medical informatics database and the Social Security Death Index. Participants were grouped as survivors, early-mortality (death <90 days), and late-mortality (death ≥90 days) individuals.

Results:
We reviewed 105 PLWH with cryptococcosis, with 55 survivors (52.4%), 17 early-mortality (16.2%), and 33 late-mortality individuals (31.4%). Overall, mortality was 47.6% (n = 50) with a median follow-up of 3.7 years (interquartile range 1.1, 8.1 years). Late-mortality individuals were less likely to be virally suppressed at the last observation compared with survivors (24% vs 62%, P < 0.001). Individuals diagnosed in the modern ART era had significantly lower mortality (hazard ratio 0.5, confidence interval: 0.2 to 0.8) and were more likely to be virally suppressed at the last observation (57% vs 29%, P = 0.003). Individuals with government-provided insurance had a higher mortality compared to those with private insurance (hazard ratio 2.8, confidence interval: 1.1 to 7.2, P = 0.013).

Conclusions:
Despite improvements in ART, PLWH have high mortality after cryptococcal infection that persists beyond their initial hospitalization. Lower mortality was associated with increased HIV viral suppression and private insurance in the modern ART era.
New and novel rapid diagnostics that are impacting infection prevention and antimicrobial stewardship
Authors: Sullivan Kaede V. , Dien Bard Jennifer 
Published: May 2019

Purpose of review
The current review summarizes advances in rapid diagnostic testing that impacts infection prevention and antimicrobial stewardship programs.

Recent findings
A variety of rapid diagnostic technologies to identify organisms in cultured blood are now available. When coupled with antimicrobial stewardship (ASP), these rapid technologies can optimize antimicrobial utilization and patient outcomes. Two rapid molecular panels that detect organisms related to pneumonia are available and may impact infection prevention surveillance definitions. Three molecular tests are available for the detection of meningitis and encephalitis pathogens. Still, the clinical impact of these broad, multiplexed panels need additional clarification. For Clostridioides difficile infections, ultrasensitive toxin A/B assays may provide enhanced sensitivity and specificity compared with enzyme immunoassay and molecular testing respectively. Finally, the adoption of Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI TOF MS) for rapid organism identification is growing. Recent US Food and Drug Administration-clearance of a MALDI TOF MS platform for identification of Nocardia, Mycobacteria, and molds may expedite antimicrobial decisions for infections that traditionally required days to weeks for an identification.

Summary
Tests with broad diagnostic scope and swift turnaround time are rapidly entering the market. Many impact infection prevention and ASP programs. Collaboration with the microbiology laboratory is crucial to ensure that new tests successfully optimize patient care.
Hepatic Angiomyolipoma Having FDG Uptake at the Similar Level of the Normal Liver Parenchyma
Authors: Wang Xuezhu , Wang Jingnan , Cheng Xin , Li Fang , Huo Li 
Published: May 2019

AbstractA middle-aged woman underwent a contrast CT to evaluate a palpable upper abdominal mass. The images showed large lesion in the left lobe of the liver, and malignancy was among differential diagnoses. For this reason, FDG PET/CT was performed. Surprisingly, the level of FDG uptake by the large hepatic lesion was similar to the normal part of the liver. Pathological examination demonstrated hepatic angiomyolipoma.
18F-FDG PET/CT Imaging of Trichoblastic Carcinoma With Nodal Metastasis
Authors: Nguyen Ba Duong , Seetharam Mahesh , Ocal Tolgay I. 
Published: May 2019

Abstract
Trichoblastic carcinoma is an uncommon malignant neoplasm arising from follicular germinative cells. The high-grade trichoblastic carcinoma has been reported with lymphatic and hematogenous dissemination. The authors present a 59-year-old man with gluteal cleft trichoblastic carcinoma and highlight the useful role of serial 18F-FDG PET/CT examinations in the demonstration of initial and subsequent nodal metastasis in the inguina and pelvis.
The Finding of the “Mini Brain” May Not Be a Unique Anatomic Appearance of Spinal Plasmacytoma
Authors: Zhong Xiao , Jia Zhiyun , Su Minggang 
Published: May 2019

Abstract
MRI and 18F-FDG PET/CT were performed on a 37-year-old man who was suspected with malignant spinal tumor on x-ray examination. An FDG-avid expansile lytic lesion was found in his T12 vertebra. The lesion showed a characteristic “mini-brain” appearance on MRI and CT. This extremely high specificity sign and consistent manifestation on PET image indicated plasmacytoma as the most optimal diagnosis. But finally, a giant cell tumor was confirmed after surgery. The case cautions that the specificity of the diagnostic characteristics of “mini-brain” sign for plasmacytoma or multiple myeloma may not be as high as previously reported.
State Tested Nursing Assistants’ Workplace Experiences That Threaten or Support Intent to Stay
Authors: Senecal Megan Benner , McBride Kimberly , Steiner Victoria , Pierce Linda , Saltzman Barbara 
Published: May 2019

Abstract

Purpose
Over 1 million Americans utilize skilled nursing facilities (SNFs) annually. Within SNFs, State Tested Nursing Assistants (STNAs) are primary caregivers; however, low retention rates are notable and threaten patient care.

Design
A phenomenological, qualitative study was conducted to explore intrinsic factors that influence STNAs’ intent to stay in their positions.

Methods
Ten STNAs employed at for-profit SNFs participated in semistructured face-to-face interviews. Data were analyzed to identify broad concepts and recurrent themes.

Findings
Findings suggest that intrinsic factors supporting and threatening intent to stay included the fulfillment of basic psychological needs. Supporting themes included self-confidence, appreciation, positive relationships, and a willingness to go beyond required duties. Threatening themes included frustration, lack of support, and career advancement opportunities.

Conclusions
Findings provide an understanding of factors that influence STNAs' intent to stay.

Clinical Relevance
The results may help guide the development of responsive strategies that improve quality and continuity of care in SNFs.
Prospective Evaluation of Health After Breast Reduction Surgery Using the Breast-Q, Short-Form 36, Breast-Related Symptoms Questionnaire, and Modified Breast Evaluation Questionnaire
Authors: Lewin Richard , Lidén Mattias , Lundberg Jonas , Hansson Emma , Selvaggi Gennaro , Thorarinsson Andri , Elander Anna 
Published: May 2019

Introduction
Breast hypertrophy is a condition associated with physical, psychological, and psychosocial problems. The primary aims of this study were to determine the impact of breast hypertrophy and the effects of breast reduction, performed on the basis of well-described inclusion criteria, on general and breast-related health, using both general and diagnosis-specific validated questionnaires. We used a prospective, longitudinal paired study design. A secondary aim was to analyze the relationship between preoperative breast volume, body mass index, sternal notch-to-nipple distance and the weight of resected tissue on the one hand and improvements in health on the other.

Methods
Three hundred forty-eight consecutive patients undergoing breast reduction were included and the Short-Form 36 (SF-36), Breast-Related Symptoms Questionnaire (BRSQ), Modified Breast Evaluation Questionnaire (mBEQ) and BREAST-Q were distributed preoperatively and 1 year postoperatively.

Results
A total of 284 (83%) patients answered the questionnaires either preoperatively or postoperatively, or both, and 159 (46%) patients answered both. The breast hypertrophy patients had significantly lower scores preoperatively than the matched normal population when it came to all dimensions of the SF-36 and mBEQ. The preoperative scores for both the BRSQ and BREAST-Q were low.
After breast reduction, there were significant improvements in all dimensions of the BRSQ, mBEQ, and Breast-Q and in several dimensions of the SF-36.

Conclusions
Breast reduction reduces or removes disease-associated pain. It improves or normalizes perceived health and psychosocial self-esteem in slightly obese women or women of normal weight with preoperative breast volumes around 1000 mL. Women with higher preoperative breast volumes and longer sternal notch-to-nipple distances appear to be more satisfied with the cosmetic result postoperatively.
A Systematic Review of Outcomes After Genital Lymphedema Surgery
Authors: Guiotto Martino , Bramhall Russell J. , Campisi Corrado , Raffoul Wassim , di Summa Pietro Giovanni 
Published: May 2019

Introduction
Genital lymphedema (GL) surgery can be either palliative or functional. Palliative procedures involve excision of the affected tissue and reconstruction by either local flaps or skin grafts. Reconstructive procedures aim to restore lymphatic flow through microsurgical lymphaticovenous anastomoses (LVAs). This systematic analysis of outcomes and complication rates aims to compare outcomes between these surgical treatment options for GL.

Methods
A systematic review of the PubMed database was performed with the following search algorithm: (lymphorrhea or lymphedema) and (genital or scrotal or vulvar) and (microsurgery or “surgical treatment”), evaluating outcomes, and complications after surgical treatment of GL.

Results
Twenty studies published between 1980 and 2016 met the inclusion criteria (total, 151 patients). Three main surgical treatments for GL were identified. Surgical resection and primary closure or skin graft was the most common procedure (46.4%) with a total complication rate of 10%. Surgical resection and flap reconstruction accounted for 39.1% of the procedures with an overall complication rate of 54.2%. Lympho venous shunt (LVA) procedures (14.5%) had a total complication rate of 9%.

Conclusions
This review demonstrates a lack of consensus in both the preoperative assessment and surgical management of GL. Patients receiving excisional procedures tended to be later stage lymphedema. Patients in the excision and flap reconstruction group seemed to have the highest complication rates. Microsurgical LVAs may represent an alternative approach to GL, either alone or in combination with traditional procedures.
The Economic Impact of Flexor Tendon Lacerations of the Hand in the United States
Authors: Mehrzad Raman , Mookerjee Vikram , Schmidt Scott , Jehle Charles C. , Kiwanuka Elizabeth , Liu Paul Y. 
Published: May 2019

Purpose
Flexor tendon lacerations are a common and debilitating injury for thousands of Americans annually. Despite this, no study has attempted to estimate the economic impact of these injuries. The objective of this study was to estimate the economic impact of flexor tendon lacerations in America.

Methods
The cost of flexor tendon lacerations to society was estimated using a validated prevalence-based cost of illness model. The primary cohort was defined as all patients in the United States presenting with complete flexor tendon lacerations who underwent surgical repair. The secondary cohort was defined by all patients who required reoperation within 1 year of their initial operation. For these groups, both direct and indirect costs (lost income, missed workdays, and disability payments) were measured.

Results
Flexor tendon lacerations incur an estimated cost of between US $240.8 and US $409.1 million annually to the American medical system. The total direct cost per injury is estimated to be US $13,725, whereas estimates to the indirect costs range from US $60,786 to US $112,888.

Conclusions
Flexor tendon lacerations represent an important economic burden to our health care system, even when compared with other common hand conditions. Specifically, indirect costs, such as missed workdays, are the major contributor toward the total cost these injuries incur on society, accounting for upward of 89% of the total cost. This suggests that we should focus our efforts to improve treatments and rehabilitation protocols which decrease these indirect costs.
Risk Factors for Adult Postintubation Tracheal Stenosis
Authors: Songu Murat , Ozkul Yilmaz 
Published: May 2019

Background:
To identify risk factors for developing adult postintubation tracheal stenosis (TS) and determine if there were patient characteristics that could serve as prognostic indicators of clinical outcomes in this patient population.

Methods:
A total of 55 patients with postintubation TS admitted to our institution between February 2009 and March 2017 (TS group) and randomly selected 86 patients admitted to the intensive care unit and intubated over the same period in whom TS was ruled out (control group) were compared. Causal factors of intubation were noted. Patient-, treatment-, and procedure/cuff site-related risk factors of TS were compared.

Results:
Both groups did not differ from each other by means of age and gender (P = 0.640, and P = 0.724, respectively). Compared to controls, patients with TS had a significantly higher BMI (32.8 ± 7.64 kg/m2 versus 25.9 ± 6.68 kg/m2; p = 0.002) and were more likely to have diabetes (28.4% vs 9.82%; p = 0.0011). Patients who were previously intubated for more than 48 hours (P = 0.016) and patients treated with irradiation (P = 0.028) were significantly more likely to develop TS than control patients.

Conclusion:
Patients with TS had a significantly higher BMI, and were more likely to have diabetes compared to controls. Patients who were previously intubated for more than 48 hours and patients treated with irradiation were more likely to develop TS than control patients.