bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rapid Early Tumor Progression is Prognostic in Glioblastoma Patients
Authors: Palmer Joshua D. , Bhamidipati Deepak , Shukla Gaurav , Sharma Dinesh , Glass Jon , Kim Lyndon , Evans James J. , Judy Kevin , Farrell Christopher , Andrews David W. , Wang Zi-Wuan , Peiper Stephen C. , Werner-Wasik Maria , Shi Wenyin 
Published: April 2019

Objectives:
Determine the prognostic significance of rapid early tumor progression before radiation and chemotherapy for glioblastoma patients.

Methods:
A retrospective review of glioblastoma patients was performed. Rapid early progression (REP) was defined as new enhancing tumor or >25% increase in enhancement before radiotherapy. The pre/postoperative magnetic resonance imaging was compared with the preradiation magnetic resonance imaging to determine REP. A blinded review of imaging was performed. Kaplan-Meier curves were generated to compare progression-free and overall survival (OS). Univariate analysis was performed using the log-rank test for categorical variables and Cox proportional hazards for continuous variables. Multivariable logistic regression was performed to assess factors related to early progression and Cox proportional hazards model was used for multivariate analysis of OS.

Results:
Eighty-seven patients met entry criteria. A total of 52% of patients developed REP. The OS in the REP group was 11.5 months (95% confidence interval [CI]: 7.4-17.6) and 20.1 months (95% CI: 17.8-26.1) without REP (P=0.013). On multivariate analysis including significant prognostic factors, presence of REP was found to increase the risk of death (hazard ratio: 2.104, 95% CI: 1.235-3.583, P=0.006). A total of 74% of patients recurred in the site of REP.

Conclusions:
REP was common and independently predicted for a worse OS. Integrating REP with MGMT promotor methylation improved prognostic assessment. The site of REP was a common site of tumor progression. Our findings are hypothesis generating and may indicate a particular subset of glioblastoma patients who are resistant to current standard of care therapy. Further study to determine other molecular features of this group are underway.
Combined environmental and social exposures during pregnancy and associations with neonatal size and body composition
Authors: Martenies Sheena E. , Allshouse William B. , Starling Anne P. , Ringham Brandy M. , Glueck Deborah H. , Adgate John L. , Dabelea Dana , Magzamen Sheryl 
Published: April 2019

Background:
Prenatal environmental and social exposures have been associated with decreased birth weight. However, the effects of combined exposures (CEs) in these domains are not fully understood. Here we assessed multi-domain exposures for participants in the Healthy Start study (Denver, CO) and tested associations with neonatal size and body composition.

Methods:
In separate linear regression models, we tested associations between neonatal outcomes and three indices for exposures. Two indices were developed to describe exposures to environmental hazards (ENV) and social determinants of health (SOC). A third index CEs in both domains (CE = ENV/10 × SOC/10). Index scores were assigned to mothers based on address at enrollment. Birth weight and length were measured at delivery, and weight-for-length z-scores were calculated using a reference distribution. Percent fat mass was obtained by air displacement plethysmography.

Results:
Complete data were available for 897 (64%) participants. Median (range) ENV, SOC, and CE values were 31.9 (7.1–63.2), 36.0 (2.8–75.0), and 10.9 (0.4–45.7), respectively. After adjusting for potential confounders, 10-point increases in SOC and CE were associated with 27.7 g (95% confidence interval [CI] = 12.4, 42.9 g) and 56.3 g (19.4 – 93.2 g) decreases in birth weight, respectively. SOC and CE were also associated with decreases in percent fat mass.

Conclusions:
CEs during pregnancy were associated with lower birth weight and percent fat mass. Evidence of a potential synergistic effect between ENV and SOC suggests a need to more fully consider neighborhood exposures when assessing neonatal outcomes.
Nonhuman leukocyte antigen antibodies that have impact in the heart transplant patient
Authors: Reddy Yogesh N.V. , Pereira Naveen L. 
Published: April 2019

Purpose of review
Despite human leukocyte antigen (HLA) matching and monitoring for donor-specific HLA antibodies, antibody-mediated rejection and chronic rejection in the form of allograft vasculopathy and chronic graft dysfunction continue to occur. There has been increasing interest in non-HLA antibodies as mediators of these changes.

Recent findings
In this review, we discuss the recent literature describing the importance of non-HLA antibodies in organ transplantation and summarize the literature evaluating such antibodies in heart transplantation.

Summary
Monitoring of non-HLA antibodies requires additional measurement standardization and correlation of specific antibodies with outcomes. However, there is promise that identification with newer immunoproteomic techniques and therapy toward such antibodies may improve long-term graft outcomes and decrease acute rejection and allograft vasculopathy.
Stability studies in oncology
Authors: Vigneron Jean , D’Huart Elise , Demoré Béatrice 
Published: April 2019

Abstract

Introduction:
Hospital pharmacists, physicians, and nurses need stability information on the drugs used in their daily practice. The objectives of this work were to evaluate if the information given by pharmaceutical companies about the stability of reconstituted and diluted solutions in the field of oncology were sufficient in the daily practice of hospitals.

Methods:
The first step was to establish a list of the main needs about stability data on the basis of the daily practice of hospital pharmacists. The second step was to search through information given by pharmaceutical companies and then to compare to hospital pharmacists’ needs. The third step was to find information in the cases, in which pharmaceutical companies’ information was not sufficient.

Results:
The situation is different depending on the product. For originators, stability data given by pharmaceutical companies are often very limited, the goal being to obtain the marketing authorization. For generics or biosimilars, extended stability studies are carried out to conquer the market and are part of the marketing strategy.
A list of studies to fill the gap of companies’ information was presented. Examples including bortezomib, rituximab, azacitidine, nivolumab, and some mixtures were presented. The importance of stability studies conducted in hospitals is emphasized.

Conclusion:
Pharmaceutical companies perform stability studies for their products and for their own interest. In many cases, the results of these studies are insufficient and do not meet the need for information that hospital pharmacists are looking for. Conducting stability studies by hospital pharmacy teams should be encouraged.
Early Ultrasound Follow-Up of Extension-Type Supracondylar Fractures Treated by the Collar-and-Cuff (Blount) Technique
Authors: Choufani Camille , Blondiaux Eléonore , Pietton Raphaël , Bachy Manon , Leroy Antonin , Vialle Raphaël 
Published: April 2019

Background
Extension-type supracondylar fractures can be treated with external immobilization, with the elbow flexed 100°. However, this technique requires early evaluation by true lateral x-ray of the elbow to detect secondary fracture displacement.

Questions/Purpose
The purpose of this work is to evaluate whether ultrasound imaging is suitable for demonstrating initial reduction of supracondylar fractures and early secondary displacement of the fracture.

Methods
Fourteen patients aged 3 to 7 years (mean, 4.8 years) were treated by closed reduction under general anesthesia and immobilization with a collar and cuff. All patients had early postoperative x-rays and ultrasonography on day 1, as well as day 8 x-rays and ultrasonography. Ultrasonograms were performed by an experienced senior radiologist.

Results
In all cases, a complete reduction was confirmed at initial follow-up on both sonogram and intraoperative fluoroscopy. In 13 of 14 cases, no secondary displacement of the fracture was noted at day 8 on either ultrasonography or x-ray images. In 1 case, a secondary displacement was noted at day 8 on ultrasonography and confirmed by the lateral x-ray.

Conclusions
Our study found a complete agreement assessing the quality of intraoperative reduction of supracondylar fractures by radiographs and ultrasonography. These results confirm that ultrasound imaging is suitable for demonstrating secondary displacements of supracondylar fractures in children. We postulate that in Gartland types II and III fractures treated by Blount procedure, a negative ultrasound result at day 8 follow-up may reduce the need for further radiographs. However, in any doubtful situation, the need for conventional radiographs remains.

Level of Evidence
Diagnostic study, level II.
A Novel Pharyngeal Clearance Maneuver for Initial Tracheostomy Tube Cuff Deflation in High Cervical Tetraplegia
Authors: Ehsanian Reza , Klein Christina , Mohole Jyodi , Colaci Joshua , Pence Benjamin T. , Crew James , McKenna Stephen 
Published: April 2019

Abstract
Mechanical insufflation-exsufflation, or “cough assist,” is a commonly used method of clearing tracheal and pulmonary secretions in patients with respiratory insufficiency secondary to spinal cord injury. This report presents a novel technique termed the pharyngeal clearance maneuver, which uses a modified application of the mechanical insufflation-exsufflation device to mobilize “secretion burden” at the portion of the trachea above the tracheostomy cuff during cuff deflation. Utilization of this strategy may reduce the risk of aspiration, infection, and respiratory compromise for patients with high cervical spinal cord injury in the acute rehabilitation setting. It is of particular benefit for those whose cuffs are being deflated for the first time and who may have large secretion volumes above the cuff. It can be further used as needed before speaking trials and swallow therapies. We anticipate that the pharyngeal clearance maneuver may be used in other populations with impaired cough and need for invasive ventilator support because of ventilator pump failure (eg, spinal muscular atrophy, congenital myopathies, obesity hypoventilation, amyotrophic lateral sclerosis, muscular dystrophy, and acute inflammatory demyelinating polyneuropathy).
Sustained Effect of a Community-based Behavioral and Nutrition Intervention on HIV-related Outcomes Among Women Living With HIV in Rural India: A Quasi-experimental Trial
Authors: Nyamathi Adeline M. , Shin Sanghyuk S. , Sinha Sanjeev , Carpenter Catherine L. , Garfin Dana Rose , Ramakrishnan Padma , Yadav Kartik , Ekstrand Maria L. 
Published: April 2019

Background:
Women living with HIV (WLH) in rural communities face challenges to obtaining treatment and accurate disease-related information. Nutritional deficits exacerbate disease progression.

Setting:
WLH were recruited from primary health centers in rural India.

Method:
A quasi-experimental trial of a comprehensive Accredited Social Health Activist (Asha)-supported intervention compared 4 distinct Asha-based programs [(1) standard education (SE) alone; (2) nutrition education (+NE); (3) nutrition supplements (+NS); or (4) nutrition education and nutrition supplements (+NENS)] on key disease and nutrition-related outcomes [CD4 count, body mass index (BMI), serum albumin, and hemoglobin]. Assessments occurred at baseline, and months 6 (immediately after intervention), 12, and 18. Multilevel modeling examined effects of program (group) over time.

Findings:
Among 600 WLH enrolled (n = 150 per arm), mean age, CD4 count, and BMI (kg/m2) were 34.31, 447.42, and 20.09, respectively, at baseline. At 18-month follow-up, program 4 (+NENS) experienced greatest improvements in CD4 counts compared with program 1 (+SE) [adjusted difference = 223.81, 95% confidence interval (CI): 170.29 to 277.32]. For BMI, programs 3 (+NS; adjusted difference = 2.33, 95% CI: 1.39 to 3.26) and 4 (+NENS; adjusted difference = 2.14, 95% CI: 1.17 to 3.12) exhibited greater gains compared with program 1 (+SE). Programs 3 and 4 were not significantly different from each other (adjusted difference = −0.18, 95% CI: −1.12 to 0.76). Hemoglobin and serum albumin also improved over time; program 4 (+NENS) exhibited the greatest gains.

Conclusions:
A low-cost Asha-supported behavioral and nutritional intervention improved outcomes for WLH. Gains were sustained at 18-month follow-up. Similar approaches may help improve HIV and other infectious disease-related outcomes in vulnerable populations.
Advances in molecular diagnostic testing for central nervous system infections
Authors: Houlihan Catherine F. , Bharucha Tehmina , Breuer Judith 
Published: April 2019

Purpose of review
Central nervous system (CNS) infections present an ongoing diagnostic challenge for clinicians, with an aetiological agent remaining unidentified in the majority of cases even in high-income settings. This review summarizes developments in a range of diagnostic methods published in the past 18 months.

Recent findings
Several commercial assays exist for the detection of viral, bacterial and fungal pathogens using single multiplex PCR. Multicentre validation of the Biofire FilmArray panel illustrated high sensitivity for bacterial and fungal pathogens, but poor results for Cryptococcus species detection. The development of microarray cards for bacterial CNS pathogens shows promise but requires further validation. Few developments have been made in proteomics and transcriptomics, contrasted with significant increase in the use of metagenomic (or unbiased) sequencing. Novel viruses causing CNS infection have been described using this technique but contamination, cost, expertise and turnaround time requirements remain restrictive. Finally, the development of Gene Xpert and Ultra has revolutionized tuberculosis meningitis diagnostics with newly released recommendations for their use from the WHO.

Summary
Progress has been made in the clinical validation and international recommendation of PCR-based tests for CNS infections. Sequencing techniques present the most dynamic field, although significant ongoing challenges persist.
Accessory Palmaris Longus
Authors: Yuan Jing , Dhanaraj Ian Dominic , Ng Hannah Jia Hui , Rajaratnam Vaikunthan 
Published: April 2019

Abstract
Current medical literature has described many variations of the palmaris longus. One variation that is rarely seen is that of the accessory palmaris longus, which is better known in literature as the “palmaris profundus.” This brief review will describe the anatomy and the developmental origins of the palmaris longus, as well as the clinical relevance of an accessory palmaris longus. We will also present a case on the accessory palmaris longus and discuss whether the accessory palmaris longus, if encountered during a routine carpal tunnel surgery, should be resected intraoperatively.
Merkel Cell Carcinoma of the Digit
Authors: Persitz Jonathan , Atzmon Ran , Keren Timoret , Avisar Erez 
Published: April 2019

Abstract
Merkel cell carcinoma (MCC) is a biologically aggressive neuroendocrine tumor of the skin. There are roughly 1500 new cases of MCC diagnosed every year in the United States, with an increased incidence over the past 15 years reaching up to 8%. Epidemiological studies show that the highest MCC incidence is seen in men older than 65 years, with a ratio of 0.23 per 10,000 among whites. Merkel cell carcinoma of the skin most commonly presents as a single, rapidly growing, flesh-colored, painless mass. Because MCC is uncommon, histopathological examination is usually delayed. Because of the high mortality rate associated with this aggressive tumor, a multidisciplinary panel is recommended to ensure high-quality coordinated care. The choice of treatment option depends on disease characteristics, staging at presentation, regional lymph node involvement, comorbidities, and performance status of the patient. We report a case of MCC to alert medical professionals of this potentially fatal tumor, as early diagnosis and treatment may improve morbidity and mortality rates.
Hematoma Risks of Nonsteroidal Anti-inflammatory Drugs Used in Plastic Surgery Procedures
Authors: Walker Nicholas J. , Jones Veronica M. , Kratky Lauren , Chen Haiying , Runyan Christopher M. 
Published: April 2019

Background
The opioid crisis in America has sparked a shift toward a multimodality perioperative pain regimen. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the perioperative period decreases opioid consumption and increases efficacy. However, many plastic surgeons avoid their use because of antiplatelet effects. The purpose of this article is to systematically review the plastic surgery literature to assess the risk of intraoperative or postoperative bleeding and hematoma formation.

Methods
A systematic review of articles published in PubMed was performed in September 2018 to investigate the incidence of increased bleeding and hematoma formation with use of NSAIDs in the perioperative period in plastic surgery. All articles were reviewed for primary outcome measures, and a selective literature review was performed to examine perioperative NSAID use in other surgical subspecialties. Random-effect meta-analysis was performed.

Results
Our search yielded 806 total articles, with 15 meeting inclusion criteria, and this included 3064 patients (1679 with perioperative NSAIDs, 1385 with no NSAIDs). There was no significant difference in overall incidence of bleeding/hematoma in the treatment group versus control (no NSAIDs). The overall pooled odds ratio (OR) and corresponding 95% confidence interval were 1.20 and 0.73 to 1.97 (P = 0.48). When separated by drug administered across all plastic surgery procedures, there were no statistically significant differences in incidences of hematoma or increased bleeding with use of ketorolac (OR, 1.48 [0.86–2.56]; P = 0.57), ibuprofen (OR, 0.55 [0.14–2.14]; P = 0.87), or celecoxib (OR, 0.22 [0.02–2.52]; P = 0.39). When examining NSAID use in breast surgery, there was no statistically significant difference in incidence of hematoma or increased bleeding when combining all 3 drug types (OR, 1.39 [0.82–2.37]; P = 0.60). Some individual studies demonstrated trends toward increased bleeding/hematoma in reduction mammoplasties.

Conclusions
Nonsteroidal anti-inflammatory drugs significantly improve pain control and decrease opioid use when used in plastic surgery. The majority of evidence in plastic surgery does not support an increased incidence of bleeding/hematoma with the use of perioperative NSAIDs.
County-level Variation in Use of Surgery and Cancer-specific Survival for Stage I-II Pancreatic Adenocarcinoma
Authors: Swords Douglas S. , Mulvihill Sean J. , Brooke Benjamin S. , Stoddard Gregory J. , Firpo Matthew A. , Scaife Courtney L. 
Published: April 2019

Objective:
The aim of the study was to describe county-level variation in use of surgery for stage I-II pancreatic ductal adenocarcinoma (PDAC) and the association between county surgery rates and cancer-specific survival (CSS).

Background:
The degree of small geographic area variation in use of surgery for stage I-II PDAC and the association between area surgery rates and CSS remain incompletely defined.

Methods:
This is a retrospective cohort study of patients aged 18 to 80 years in the 2007 to 2015 Surveillance, Epidemiology, and End Results database with stage I-II PDAC without contraindications to surgery or refusal. Multilevel models were used to characterize county-level variation in use of surgery and CSS. County-specific risk- and reliability-adjusted surgery rates and CSS rates were calculated.

Results:
Of 18,100 patients living in 581 counties, 10,944 (60.5%) underwent surgery. Adjusted county-specific surgery rates varied 1.5-fold from 49.9% to 74.6%. Median CSS increased in a graded fashion from 13 months [interquartile range (IQR) 13–14] in counties with surgery rates of 49.9% to 56.9% to 18 months (IQR 17–19) in counties with surgery rates of 68.0% to 74.6%. Results were similar in multivariable analyses. Adjusted county 18-month CSS rates varied 1.6-fold from 32.7% to 53.7%. Adjusted county surgery and 18-month CSS rates were correlated (r = 0.54; P < 0.001) and county surgery rates explained approximately half of county-level variation in CSS. Only 18 (3.1%) counties had adjusted surgery rates of 68.0% to 74.6%, which was associated with the longest CSS.

Conclusions:
County-specific rates of surgery varied substantially, and patients living in areas with higher surgery rates lived longer. These data suggest that increasing use of surgery in stage I-II PDAC could lead to improvements in survival.
Association ‘Between Gabapentinoids on the Day of Colorectal Surgery and Adverse Postoperative Respiratory Outcomes
Authors: Ohnuma Tetsu , Krishnamoorthy Vijay , Ellis Alan R. , Yan Rosalie , Ray Neil D. , Hsia Hung-Lun , Pyati Srinivas , Stefan Mihaela , Bryan William E. , Pepin Marc J. , Lindenauer Peter K. , Bartz Raquel R. , Raghunathan Karthik 
Published: April 2019

Objective:
The aim of this study was to determine the association between gabapentinoids on the day of surgery and adverse postoperative outcomes in patients undergoing colorectal surgery in the United States.

Background:
Gabapentinoids, gabapentin and pregabalin, are recommended in multimodal analgesia protocols for acute postoperative pain management after colorectal surgery. However, current literature focuses on the efficacy in reducing opioid consumption, but provides limited information about adverse risks.

Methods:
This was a retrospective study including 175,787 patients undergoing elective colorectal surgery using the Premier database between 2009 and 2014. Multilevel regression models measured associations of receipt of gabapentinoids with naloxone use after surgery, non-invasive ventilation (NIV), invasive ventilation (IMV), hospital length of stay (LOS), and parental morphine equivalents (PMEs) on the day of surgery and on the day before discharge.

Results:
Overall, 4677 (2.7%) patients received gabapentinoids on the day of surgery, with use doubling (1.7% in 2009 to 4.3% in 2014). Compared with patients who were unexposed to ganapentinoids, gabapentinoid exposure was associated with lower PMEs on the day of surgery [−2.7 mg; 95% confidence interval (CI), −5.2 to −0.0 mg], and with higher odds of NIV [odds ratio (OR) 1.22, 95% CI, 1.00–1.49] and receipt of naloxone (OR 1.58, 95% CI, 1.11–2.26). There was no difference between the groups with respect to IMV or PMEs on the day before discharge.

Conclusions:
Although use of gabapentinoids on the day of surgery was associated with slightly lower PMEs on the day of surgery, it was associated with higher odds of NIV and naloxone use after surgery.