bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rituximab – A novel therapy for severe ITP in pregnancy: A case report
Authors: Donohoe Fionan , Higgins Mary , Higgins Shane , McAuliffe Fionnuala , Murphy Karen 
Published: June 2018

Background Rituximab is a novel second-line agent for the treatment of immune thrombocytopenic purpura. Minimal data exist on the use of rituximab in pregnancy. This case illustrates the successful treatment of severe immune thrombocytopenic purpura diagnosed in pregnancy, refractory to all other medical management. Case A 32-year-old nulliparous woman was diagnosed with severe immune thrombocytopenic purpura at the time of booking for antenatal care (platelet level of 13 × 109/L). Standard treatment failed to adequately increase her platelet count. Therapy with rituximab was instituted, and her platelet count rose to normal levels, without side effects, and remained at a normal level throughout the pregnancy. There were no maternal or neonatal ill-effects of rituximab therapy. Conclusion Rituximab is potentially a safe treatment option for the management of immune thrombocytopenic purpura in pregnancy with good maternal and neonatal outcome when conventional treatments have been unsuccessful. Research is limited to case reports, and therefore limited information currently exists to guide clinicians.
Autopsy Biosafety
Authors: Brooks Erin G. , Utley-Bobak Suzanne R. 
Published: June 2018

Introduction: As invasive meningococcal disease progresses rapidly, often affects youth, and has a fairly high mortality rate, such cases are likely to fall under medical examiner/coroner (ME/C) jurisdiction. Morgue personnel may be at risk of contracting secondary meningococcal disease. We review the current scientific literature regarding Neisseria meningitidis infection and provide recommendations for the prevention of meningococcal disease at autopsy. Methods: A PubMed search utilizing applicable medical subject heading terms was performed retrieving articles for review from the preceding two decades. Pertinent current guidelines from multiple national organizations were also retrieved. Results: Invasive meningococcal disease is transmitted by direct contact with large respiratory droplets or oral secretions. While a surgical mask would normally provide adequate protection from large droplet spread, it does not prevent inhalation of smaller aerosolized particles such as those generated at autopsy. Prosectors are advised to routinely wear N-95 respirator masks or powered respirator hoods. All published cases of secondary meningococcal disease transmission to healthcare workers invariably arose in scenarios in which face masks/respirators were not employed; none of these cases involved meningococcal disease transmission to ME/C or other morgue staff. Discussion: In the event that no mask—or inadequate coverage such as a surgical mask—is employed during autopsy of a decedent suspected/confirmed to have invasive meningococcal disease, antibiotic prophylaxis is advisable. Assuming appropriate personal protective equipment is utilized, chemoprophylaxis is unnecessary. Routine meningococcal vaccination is not recommended, except for ME/C with specified immunocompromising conditions or traveling to hyperendemic/endemic meningococcal regions. Acad Forensic Pathol. 2018 8(2): 328-339
Don’t stop at first glance: pulmonary artery angiosarcoma mimicking chronic thromboembolic pulmonary hypertension
Authors: Correale Michele , Tarantino Nicola , Ieva Riccardo , Gravina Matteo , Casavecchia Grazia , Strazzella Caterina , Di Biase Matteo , Brunetti Natale Daniele 
Published: June 2018

We report the case of an incomplete diagnosis of chronic thromboembolic pulmonary hypertension, with relevant prognostic implications, missing the presence of a primary pulmonary artery angiosarcoma. After the late neoplasm diagnosis, the patient, treated for months with riociguat, was considered inoperable and died soon after.This case highlights the need to manage patients with suspected pulmonary arterial hypertension by expert referral centers with specific and multi‐professional expertise (heart and thoracic imaging) in order to avoid incomplete or delayed diagnoses.
Clinical and genetic determinants of nevirapine plasma trough concentration
Authors: Giacomelli Andrea , Rusconi Stefano , Falvella Felicia Stefania , Oreni Maria Letizia , Cattaneo Dario , Cozzi Valeria , Renisi Giulia , Monge Elisa , Cheli Stefania , Clementi Emilio , Riva Agostino , Galli Massimo , Ridolfo Anna Lisa 
Published: June 2018

Background: Only few data are available on the influence of CYP2B6 and CYP3A4/A5 polymorphisms on nevirapine plasma concentrations in the Caucasian population. Our aim was to assess the impact of CYP2B6 and CYP3A4/A5 polymorphisms on nevirapine plasma concentrations consecutively collected. Methods: We retrospectively analyzed clinical data of all HIV-positive patients who were followed at the Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan between January 2000 and December 2015. All patients with at least one nevirapine plasma trough concentration (NVP Cmin) determination were tested for CYP2B6 c.516 G>T, CYP3A4*22C>T and CYP3A5*3 A>G polymorphisms. Univariate and multivariate regression analyses were carried out considering NVP Cmin as the dependent variable and genetic polymorphisms and clinical characteristics as independent variables. Results: A total of 143 patients were evaluated. Most of them were males (61.5%) and Caucasian (92.3%). Overall, NVP Cmin varied from 1571 to 14,189  ng/mL (median  =  5063  ng/mL, interquartile range  =  3915–6854). The median NVP Cmin significantly differed in patients with different CYP2B6 genotypes, but did not vary in those with different CYP3A phenotypes. In the final general linear model, factors significantly associated with a higher NVP Cmin were each extra unit of T alleles of CYP2B6 rs3745274 (β  =  0.328, 95% confidence interval  =  0.172–0.484; p  <  0.0001), older age (β  =  0.362, 95% confidence interval  =  0.193–0.532; p  <  0.0001) and hepatitis C virus coinfection (β  =  0.161, 95% confidence interval  =  0.006–0.315; p  <  0.041). Conclusion: Our study, conducted in a prevalent Caucasian population, highlighted the importance of CYP2B6 genetic variants in influencing nevirapine plasma trough concentration. Furthermore, older age and hepatitis C virus coinfection significantly increase exposure to nevirapine.
Mental health service users' and professionals' relationship with games and gaming
Authors: Hopia Hanna , Siitonen Marko , Raitio Katja 
Published: June 2018

Background Games and elements of gamification can be utilized in mental healthcare to provide customized interventions for the service users. However, very little evidence exists as to what kind of experiences service users and professionals have towards games and gaming, and what their perceptions of the phenomenon are. This sort of information is needed to help professionals put game-based interventions actively into practice in mental health services. Research objectives The objective is to describe the experiences and perceptions of digital games and gaming from the perspectives of mental health service users and mental health professionals. Methods In this qualitative study, data consisted of interviews of 23 mental health service users and professionals working in the mental health field. We conducted altogether 39 interviews. Sixteen of the participants were interviewed twice. Main categories and subcategories were identified using qualitative content analysis. Results The analysis revealed four distinct orientations towards games and gaming: (a) compulsive gaming; (b) closet gaming; (c) gaming as a hobby; and (d) late bloomers. Each group was characterized by different personal histories, experiences, conceptions and attitudes regarding gaming and digital games. Conclusion When attempting to implement a game-based intervention in mental health services, it is essential to recognize the different attitudes that both service users and staff exhibit concerning games and gaming. The attitudes of service users and professionals described in this study can be utilized in the implementation of game-based methods as part of care and rehabilitation in mental health services.
The BREATHE Project, a mobile application, video-monitoring system in family homes as an aid to the caring role: Needs, acceptability and concerns of informal carers
Authors: Comiskey Catherine M , Delaney Sarah , Galligan Karen , Dinsmore John , Keenan Mike , Cullen Kevin 
Published: June 2018

Introduction Family carers provide 80% of care to older people in Europe. Our aim was to explore the needs and acceptability among informal carers, of a live video home monitoring system. Methods A descriptive qualitative design was implemented with nine interviewees and a focus group of five informal carers in Ireland in 2014. A thematic analysis of the data was conducted. Results Ten hours of data were recorded. Three themes emerged: routine, risk, and acceptance. Although all assisted persons had a routine, carers not living in the home stated that cameras would assist with less tangible concerns such as nutrition and loneliness. Carers were interested in monitoring risks in specific situations rather than general monitoring. The majority of carers, while expressing concerns about privacy, accepted camera technology for monitoring emergencies and, in-spite of concerns, favoured a real video view. Acceptance in non-emergencies was mixed and concerns about the privacy of the assisted person were expressed. Discussion While video monitoring is contentious, informal carers did express a willingness for real video-footage monitoring under strict conditions that addressed specific needs. Conclusion The challenge for technology is to address these needs while maintaining personal dignity.
Concomitant Upper Extremity Fracture Worsens Outcomes in Elderly Patients With Hip Fracture
Authors: Thayer Mary Kate , Kleweno Conor P. , Lyons Vivian H. , Taitsman Lisa A. 
Published: June 2018

Background: Elderly patients with low-energy hip fractures have high rates of morbidity and mortality, but it is not well known how often concurrent upper extremity fractures occur and how this impacts outcomes. We used the National Trauma Databank (NTDB), the largest aggregation of US trauma registry data available, to determine whether patients with concurrent upper extremity and hip fractures have worse outcomes than patients with hip fractures alone. Methods: We accessed the NTDB to identify patients aged 65 to 100 who sustained a hip fracture. The cohort was then narrowed to include only patients who sustained their injury in a fall and had an injury severity score indicating hip fracture as the most severe injury. We then analyzed this group to assess the impact of a simultaneous upper extremity fracture on length of stay, in-hospital mortality, and discharge disposition. Results: From 2007 to 2014, a total of 231,299 patients aged 65 to 100 were identified as having a hip fracture. The narrowed cohort with fall as the mechanism and hip fracture as the most severe injury included 193,862 patients. Of these, 12,618 patients sustained a concomitant upper extremity fracture (6.5%). Compared to isolated hip fractures, patients with a concomitant upper extremity fracture had higher odds of death in the hospital (odds ratio [OR] = 1.3; 95% confidence interval = 1.2-1.4), were less likely to be discharged to home as compared to a skilled facility (OR = 0.73; 95% confidence interval = 0.68-0.78), and had a significantly longer average length of stay (7.1 vs 6.4 days, P < .001). Conclusions: We found a 6.5% prevalence of concomitant upper extremity fractures in patients aged 65 to 100 with a hip fracture sustained after a fall where the hip fracture was the most severe injury. These patients had a higher risk of in-hospital mortality, were less likely to be discharged to home, and had longer average length of stay.
Detection of early osteoarthritis in canine knee joints 3 weeks post ACL transection by microscopic MRI and biomechanical measurement
Authors: Mittelstaedt Daniel , Kahn David , Xia Yang 
Published: June 2018

Purpose: To detect early osteoarthritis (OA) in a canine Pond–Nuki model 3 weeks after anterior cruciate ligament (ACL) transection surgery, both topographically over the medial tibial surface and depth-dependently over the cartilage thickness. Methods: Four topographical locations on each OA and contralateral medial tibia were imaged individually by magnetic resonance imaging (MRI) at 17.6 µm transverse resolution. The quantitative MRI T2 relaxation data were correlated with the biomechanical stress-relaxation measurements from adjacent locations. Results: OA cartilage was thinner than the contralateral tissue and had a lower modulus compared to the contralateral cartilage for the exterior, interior, and central medial tibia locations. Depth-dependent and topographical variations were detected in OA cartilage by a number of parameters (compressive modulus, glycosaminoglycan concentration, bulk and zonal thicknesses, T2 at 0° and 55° specimen orientations in the magnet). T2 demonstrated significant differences at varying depths between OA and contralateral cartilage. Conclusion: ACL transection caused a number of changes in the tibial cartilage at 3 weeks after the surgery. The characteristics of these changes, which are topographic and depth-dependent, likely reflect the complex degradation in this canine model of OA at the early developmental stage.
Use of a distraction-to-stall lengthening procedure in magnetically controlled growing rods: A single-center cohort study
Authors: Dahl Benny , Dragsted Casper , Ohrt-Nissen Søren , Andersen Thomas , Gehrchen Martin 
Published: June 2018

Purpose: The objective of this study was to assess the outcome of patients treated with magnetically controlled growing rods (MCGRs) using a standardized distraction procedure with intended distraction-to-stall and to compare the outcomes between idiopathic and nonidiopathic patients. Methods: This was a retrospective single-center cohort study. Conversion cases were excluded. Distractions were performed with 2- to 3-month intervals with the intention of distraction-to-stall on both rods. Distraction length was measured on X-rays every 6 months. Spinal height was assessed using T1-T12 and T1-S1 annual increase. Results: 19 patients (eight idiopathic and 11 nonidiopathic) were included. Mean age at surgery was 9.7 ± 1.9 years, and median follow-up was 1.9 years (interquartile range (IQR): 1.3–2.2). Major curve improved from median 76° (IQR: 64–83) preoperatively to 42° (IQR: 32–51) postoperatively ( p < 0.001) corresponding to a curve correction of 43% (IQR: 33–51). Correction was maintained at 1- and 2-year follow-up. Median annual T1-T12 and T1-S1 height increase were 10 mm (IQR: 6–16) and 11 mm (IQR: 7–33), respectively. A total of 159 distraction procedures were performed; 83.5% of these were distracted-to-stall, and 16.5% were stopped due to discomfort. Median rod distraction per procedure was 2.0 mm (IQR: 1.6–2.7) for the concave side and 1.7 mm (IQR: 1.4–2.5) for the convex side. Five patients had implant-related complications. Patients with nonidiopathic etiology were significantly younger and had lower flexibility compared with idiopathic patients ( p ≤ 0.040). However, we found no statistically significant difference in curve correction, spinal height increase, distraction length, or complications between the two groups ( p ≥ 0.109). Conclusion: MCGR effectively corrected the deformity and increased spinal height using a distraction procedure with intended distraction-to-stall. Five of 19 patients had implant-related complications, and we found no difference in the outcomes between idiopathic and nonidiopathic patients.
Use of Posterior Hamstring Harvest During Anterior Cruciate Ligament Reconstruction in the Pediatric and Adolescent Population
Authors: Khanna Krishn , Janghala Abhinav , Pandya Nirav K. 
Published: June 2018

Background: Posterior hamstring harvest has been described in the adult population in a limited fashion, but no study is available describing the use of posterior hamstring harvest in an active pediatric and adolescent cohort. At times, surgeons may be faced with a challenging anterior harvest due to patient anatomic characteristics, particularly the anatomic features and size of the pes tendons. Clinicians need to have multiple harvest approaches at their disposal. Complications with hamstring harvest such as premature graft transection are more problematic in this population due to higher failure rates with allograft tissue. The posterior harvest via its more proximal location may allow for easier tendon identification, visualization of the accessory attachments, and longer preserved tendon length if transection error occurs when the anterior approach is avoided based on surgical technique, patient anatomic characteristics, and surgeon and patient preference. Purpose: To describe the technique of a posterior hamstring harvest in pediatric and adolescent patients and to analyze complications. Study Design: Case series; Level of evidence, 4. Methods: This study was a retrospective review of a consecutive series of pediatric and adolescent patients who underwent posterior hamstring harvest. During surgery, the patient’s leg was abducted and externally rotated to expose the posteromedial aspect of the knee. A 2-cm incision was made overlying the palpable medial hamstring at the popliteal crease. The posterior hamstring tendons were first harvested proximally with an open tendon stripper and distally with a closed stripper. Preoperative, intraoperative, and postoperative findings and complications were analyzed. Results: A total of 214 patients (mean ± SD age, 15.7 ± 4.1 years; range, 8.0-19.8 years) underwent posterior harvest, with a mean ± SD follow-up of 1.83 ± 1.05 years. No complications occurred in our series related to graft harvest—no graft transections, neurovascular injuries, secondary procedures for wound healing or closure, cosmetic concerns, or limitations in return to activity due to the posterior incision. Conclusion: The posterior hamstring harvest is a safe and reliable technique to harvest autograft tendon in pediatric and adolescent anterior cruciate ligament reconstructions. The posterior technique entailed no complications related to harvest. No patients expressed any cosmetic concerns about their incision or had limitations in return to sport due to the posterior harvest.
Validation of Sonography findings of synovitis and tenosynovitis of hands and wrists in patients with systemic sclerosis
Authors: Scheiman-Elazary Anat , Ranganath Veena K , Ben-Artzi Ami , Kafaja Suzanne , Borazan Nabeel H , Woodworth Thasia , Duan Lewei , Elashoff David , Clements Philip , Furst Daniel E 
Published: June 2018

Objectives: Validating musculoskeletal ultrasound features of the joints and tendons of the hands in a large scleroderma cohort. Methods: A total of 81 scleroderma patients participated in this prospective, cross-sectional study. Grayscale and power Doppler musculoskeletal ultrasound images of 13 joints and 5 tendons of the wrist and hand were obtained. Clinical assessment included modified Rodnan skin thickness score, joint count, and Scleroderma Health Assessment Questionnaire. Face validity, content validity, construct validity, and feasibility were assessed. Results: Mean age was 53.8 years (range 22–80), 76.5% were females, and disease duration ranged from 0.25 to 29 years. Mean length of the examination was 36 min. Scleroderma Health Assessment Questionnaire–Disability Index correlated with musculoskeletal ultrasound erosions (r = 0.5, p = 0.0003). Skin score correlated with tendinitis grayscale (r = 0.26, p = 0.02). Intra-reader correlation coefficient for musculoskeletal ultrasound was 0.96 for the joints and could not be calculated for tendons because there were too few positive findings. When tendon changes existed, percent of agreement was 77.7%–83.3%. Conclusion: Musculoskeletal ultrasound of 13 joints and 5 tendons of the hands and wrist has face and content validity. Construct validity was shown for the tendons and erosion scores. Feasibility and reliability were partially validated.
Phase 2b study of 2 dosing regimens of quizartinib monotherapy in FLT3-ITD–mutated, relapsed or refractory AML
Authors: Cortes Jorge E. , Tallman Martin S. , Schiller Gary J. , Trone Denise , Gammon Guy , Goldberg Stuart L. , Perl Alexander E. , Marie Jean-Pierre , Martinelli Giovanni , Kantarjian Hagop M. , Levis Mark J. 
Published: June 2018

Key Points
Quizartinib at 60 mg/day (vs 30 mg/day) was associated with higher overall response, survival, and bridge to transplant. The benefit-risk profile of quizartinib in relapsed or refractory FLT3-ITD–mutated AML warrants further evaluation of 60-mg once-daily dose.
Remission of depression in patients with schizophrenia and comorbid major depressive disorder: results from the FACE-SZ cohort
Authors: Fond Guillaume , Boyer Laurent , Berna Fabrice , Godin Ophélia , Bulzacka Ewa , Andrianarisoa Méja , Brunel Lore , Aouizerate Bruno , Capdevielle Delphine , Chereau Isabelle , Coulon Nathalie , D'Amato Thierry , Dubertret Caroline , Dubreucq Julien , Faget Catherine , Leignier Sylvain , Lançon Christophe , Mallet Jasmina , Misdrahi David , Passerieux Christine , Rey Romain , Schandrin Aurélie , Urbach Mathieu , Vidailhet Pierre , Leboyer Marion , Schürhoff Franck , Llorca Pierre-Michel ,   the FACE-SZ (FondaMental Academic Centers of Expertise for Schizophrenia) group
Published: June 2018

BackgroundMajor depressive disorder (MDD) is underdiagnosed and undertreated in schizophrenia, and has been strongly associated with impaired quality of life.AimsTo determine the prevalence and associated factors of MDD and unremitted MDD in schizophrenia, to compare treated and non-treated MDD.MethodParticipants were included in the FondaMental Expert Centers for Schizophrenia and received a thorough clinical assessment. MDD was defined by a Calgary score ≥6. Non-remitted MDD was defined by current antidepressant treatment (unchanged for >8 weeks) and current Calgary score ≥6.Results613 patients were included and 175 (28.5%) were identified with current MDD. MDD has been significantly associated with respectively paranoid delusion (odds ratio 1.8; P = 0.01), avolition (odds ratio 1.8; P = 0.02), blunted affect (odds ratio 1.7; P = 0.04) and benzodiazepine consumption (odds ratio 1.8; P = 0.02). Antidepressants were associated with lower depressive symptoms score (5.4 v. 9.5; P < 0.0001); however, 44.1% of treated patients remained in non-remittance MDD. Nonremitters were found to have more paranoid delusion (odds ratio 2.3; P = 0.009) and more current alcohol misuse disorder (odds ratio 4.8; P = 0.04). No antidepressant class or specific antipsychotic were associated with higher or lower response to antidepressant treatment. MDD was associated with Metabolic syndrome (31.4 v. 20.2%; P = 0.006) but not with increased C-reactive protein.ConclusionsAntidepressant administration is associated with lower depressive symptom level in patients with schizophrenia and MDD. Paranoid delusions and alcohol misuse disorder should be specifically explored and treated in cases of non-remission under treatment. MetS may play a role in MDD onset and/or maintenance in patients with schizophrenia.Declaration of interestNone.