bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors associated with red blood cell, platelet, and plasma transfusions among inpatient hospitalizations: a nationally representative study in the United States
Authors: Goel Ruchika , Patel Eshan U. , White Jodie L. , Chappidi Meera R. , Ness Paul M. , Cushing Melissa M. , Takemoto Clifford M. , Shaz Beth H. , Frank Steven M. , Tobian Aaron A. R. 
Published: December 2018

BACKGROUNDDemographic and hospital‐level factors associated with red blood cell (RBC), plasma, and platelet transfusions in hospitalized patients across the U.S. are not well characterized.METHODSWe conducted a retrospective analysis of the National Inpatient Sample (2014). The unit of analysis was a hospitalization; sampling weights were applied to generate nationally‐representative estimates. The primary outcome was having ≥ 1 RBC transfusion procedure; plasma and platelet transfusions were similarly assessed as secondary outcomes. For each component, factors associated with transfusion were measured using adjusted prevalence ratios (adjPR) and 95% confidence intervals (95% CI) estimated by multivariable Poisson regression.RESULTSThe prevalence of RBC, plasma, and platelet transfusion was 5.8%, 0.9%, and 0.7%, respectively. RBC transfusions were associated with older age (≥ 65 vs. < 18 years; adjPR = 1.80; 95% CI = 1.66–1.96), female sex (adjPR = 1.13; 95% CI = 1.12–1.14), minority race/ethnic status, and hospitalizations in rural hospitals compared to urban teaching hospitals. Prevalence of RBC transfusion was lower among hospitalizations in the Midwest compared to the Northeast (adjPR = 0.73; 95% CI = 0.67–0.80). All components were more likely to be transfused in patients with a primary hematologic diagnosis, patients with a higher number of total diagnoses, patients who experienced a higher number of other procedures, and patients who eventually died in the hospital. In contrast to RBC transfusions, prevalence of platelet transfusion was greater in urban teaching hospitals (vs. rural; adjPR = 1.71; 95% CI = 1.49–1.98) and lower in blacks (vs. whites; adjPR = 0.80; 95% CI = 0.76–0.85).CONCLUSIONSNationally, there is heterogeneity in factors associated with transfusion between each blood component, including by hospital type and location. This variability presents patient blood management programs with potential opportunities to reduce transfusions.
Maintenance rituximab for relapsing thrombotic thrombocytopenic purpura: a case report
Authors: Saleem Rabia , Rogers Zora R. , Neunert Cindy , George James N. 
Published: December 2018

BACKGROUNDAppropriate management to prevent relapses of acquired, autoimmune thrombotic thrombocytopenic purpura (TTP) is not clear. Rituximab (375 mg/m2/week × 4) is effective treatment for acute episodes but it is not consistently effective for prevention of relapses. Maintenance rituximab, 375 mg/m2/3 months for 2 years, is commonly used to prevent progression of follicular lymphoma, but the outcome of maintenance rituximab to prevent TTP relapses has been rarely reported.CASE REPORTAn 8‐year‐old girl was diagnosed with acquired TTP in 2008; her ADAMTS13 activity was less than 5%, with a functional inhibitor of greater than 8 Bethesda units/mL. She achieved remission with therapeutic plasma exchange, corticosteroids, and rituximab (375 mg/m2/week × 4). During the following 6 years she had seven additional episodes. Each episode responded to therapeutic plasma exchange, sometimes requiring additional treatments (corticosteroids, rituximab, and cyclophosphamide). However, these treatments, as well as splenectomy and trials of cyclophosphamide and mycophenolate mofetil during clinical remissions, failed to prevent relapses. Her ADAMTS13 activity remained 8% or less throughout all of her remissions. Maintenance rituximab was begun in 2013: 500 mg (313 mg/m2) every 2–3 months × 5, then 600 mg (375 mg/m2) every 6 months × 2. After 1 year, her ADAMTS13 was 26%; after 2 years, 51%. During the past 3 years since stopping rituximab, she has remained well, with normal ADAMTS13 activity (70%–78%).CONCLUSIONMaintenance rituximab treatment may be effective for prevention of relapses in patients with acquired, autoimmune TTP, even when splenectomy and intensive immunosuppression, including multiple conventional courses of rituximab, fail to prevent subsequent relapses.
Daytime variation of perioperative myocardial injury in non-cardiac surgery and effect on outcome
Authors: du Fay de Lavallaz Jeanne , Puelacher Christian , Lurati Buse Giovanna , Bolliger Daniel , Germanier Dominic , Hidvegi Reka , Walter Joan Elias , Twerenbold Raphael , Strebel Ivo , Badertscher Patrick , Sazgary Lorraine , Lampart Andreas , Espinola Jaqueline , Kindler Christoph , Hammerer-Lercher Angelika , Thambipillai Saranya , Guerke Lorenz , Rentsch Katharina , Buser Andreas , Gualandro Danielle , Jakob Marcel , Mueller Christian 
Published: December 2018

ObjectiveRecently, daytime variation in perioperative myocardial injury (PMI) has been observed in patients undergoing cardiac surgery. We aim at investigating whether daytime variation also occurs in patients undergoing non-cardiac surgery.MethodsIn a prospective diagnostic study, we evaluated the presence of daytime variation in PMI in patients at increased cardiovascular risk undergoing non-cardiac surgery, as well as its possible impact on the incidence of acute myocardial infarction (AMI), and death during 1-year follow-up in a propensity score–matched cohort. PMI was defined as an absolute increase in high-sensitivity cardiac troponin T (hs-cTnT) concentration of ≥14 ng/L from preoperative to postoperative measurements.ResultsOf 1641 patients, propensity score matching defined 630 with similar baseline characteristics, half undergoing non-cardiac surgery in the morning (starting from 8:00 to 11:00) and half in the afternoon (starting from 14:00 to 17:00). There was no difference in PMI incidence between both groups (morning: 50, 15.8% (95% CI 12.3 to 20.3); afternoon: 52, 16.4% (95% CI 12.7 to 20.9), p=0.94), nor if analysing hs-cTnT release as a quantitative variable (median morning group: 3 ng/L (95% CI 1 to 7 ng/L); median afternoon group: 2 ng/L (95% CI 0 to 7 ng/L; p=0.16). During 1-year follow-up, the incidence of AMI was 1.2% (95% CI 0.4% to 3.2%) among morning surgeries versus 4.1% (95% CI 2.3% to 6.9%) among the afternoon surgeries (corrected HR for afternoon surgery 3.44, bootstrapped 95% CI 1.33 to 10.49, p log-rank=0.03), whereas no difference in mortality emerged (p=0.70).ConclusionsAlthough there is no daytime variation in PMI in patients undergoing non-cardiac surgery, the incidence of AMI during follow-up is increased in afternoon surgeries and requires further study.Clinical trial registrationNCT02573532;Results.
Shoulder reflexes integrate elbow information at “long-latency” delay throughout a corrective action
Authors: Kurtzer Isaac L. 
Published: December 2018

Previous studies have demonstrated a progression of function when healthy subjects counter a sudden mechanical load. Short-latency reflexes are linked to local stretch of the particular muscle and its antagonist. Long-latency reflexes integrate stretch information from both local sources and muscles crossing remote joints appropriate for a limb’s mechanical interactions. Unresolved is how sensory information is processed throughout the corrective response, since capabilities at some time can be produced by circuits acting at that delay and at briefer delays. One possibility is that local abilities are always expressed at a short-latency delay and integrative abilities are always expressed at a long-latency delay. Alternatively, the neural circuits may be altered over time, leading to a temporal shift in expressing certain abilities; a refractory period could retard integrative responses to a second perturbation, whereas priming could enable integrative responses at short latency. We tested between these three hypotheses in a shoulder muscle by intermixing trials of step torque with either torque pulses ( experiment 1) or double steps of torque ( experiment 2). The second perturbation occurred at 35, 60, and 110 ms after the first perturbation to probe processing throughout the corrective action. The second perturbation reliably evoked short-latency responses in the shoulder muscle linked to only shoulder motion and long-latency responses linked to both shoulder and elbow motion. This pattern is best accounted by the continuous action of controllers with fixed functions. NEW & NOTEWORTHY Sudden displacement of the limb evokes a short-latency reflex, 20–50 ms, based on local muscle stretch and a long-latency reflex based on integrating muscle stretch at different joints. A novel double-perturbation paradigm tested if these abilities are temporally conserved throughout the corrective response or are shifted (retarded or delayed) due to functional changes in the responsible circuits. Multi-joint integration was reliably expressed at a long-latency delay consistent with the continuous operation of circuits with fixed abilities.
Natural Killer–Derived Exosomal miR-186 Inhibits Neuroblastoma Growth and Immune Escape Mechanisms
Authors: Neviani Paolo , Wise Petra M. , Murtadha Mariam , Liu Cathy W. , Wu Chun-Hua , Jong Ambrose Y. , Seeger Robert C. , Fabbri Muller 
Published: December 2018

AbstractIn neuroblastoma, the interplay between immune cells of the tumor microenvironment and cancer cells contributes to immune escape mechanisms and drug resistance. In this study, we show that natural killer (NK) cell–derived exosomes carrying the tumor suppressor microRNA (miR)-186 exhibit cytotoxicity against MYCN-amplified neuroblastoma cell lines. The cytotoxic potential of these exosomes was partly dependent upon expression of miR-186. miR-186 was downregulated in high-risk neuroblastoma patients, and its low expression represented a poor prognostic factor that directly correlated with NK activation markers (i.e., NKG2D and DNAM-1). Expression of MYCN, AURKA, TGFBR1, and TGFBR2 was directly inhibited by miR-186. Targeted delivery of miR-186 to MYCN-amplified neuroblastoma or NK cells resulted in inhibition of neuroblastoma tumorigenic potential and prevented the TGFβ1-dependent inhibition of NK cells. Altogether, these data support the investigation of a miR-186–containing nanoparticle formulation to prevent tumor growth and TGFβ1-dependent immune escape in high-risk neuroblastoma patients as well as the inclusion of ex vivo–derived NK exosomes as a potential therapeutic option alongside NK cell–based immunotherapy.Significance: These findings highlight the therapeutic potential of NK cell–derived exosomes containing the tumor suppressor miR-186 that inhibits growth, spreading, and TGFβ-dependent immune escape mechanisms in neuroblastoma.
Effects of Enteral Immunonutrition in Patients Undergoing Pancreaticoduodenectomy: A Meta-Analysis of Randomized Controlled Trials
Authors: Guan Haonan , Chen Sanwei , Huang Qiang 
Published: December 2018

<b><i>Background:</i></b> The effect of enteral immunonutrition (EIN) in patients undergoing pancreaticoduodenectomy (PD) is still doubtful. This meta-analysis aimed to assess the impact of EIN on postoperative clinical outcomes for patients undergoing PD. <b><i>Methods:</i></b> A literature search was carried out to identify all of the randomized controlled trials (RCTs) concerning the use of EIN for PD. Data collection ended on April 1, 2018. Pooled risk ratios (RRs) and the mean difference (MD) with a 95% CI were calculated using fixed effects or random effects models. The analyses were performed with RevMan 5.3.5. <b><i>Results:</i></b> Four RCTs with a total of 299 patients were included. Immunonutrition reduced the incidence of postoperative infectious complications (RR 0.58, 95% CI 0.37–0.92; <i>p</i> = 0.02) and shortened the length of hospital stay (MD –1.79, 95% CI –3.40 to 0.18; <i>p</i> = 0.03). Conversely, there were no significant differences in the incidence of overall postoperative complications (RR 0.81, 95% CI 0.62–1.05; <i>p</i> = 0.11), non-infectious complications (RR 0.94, 95% CI 0.69–1.28; <i>p</i> = 0.70) and postoperative mortality (RR 2.43, 95% CI 0.37–16.10; <i>p</i> = 0.36). <b><i>Conclusions:</i></b> EIN reduced postoperative infectious complications and shortened the length of the hospital stay; immunonutrition should be encouraged in patients undergoing PD.
The immediate influence of implicit motor learning strategies on spatiotemporal gait parameters in stroke patients: a randomized within-subjects design
Authors: Kleynen Melanie , Jie Li-Juan , Theunissen Kyra , Rasquin Sascha MC , Masters Rich SW , Meijer Kenneth , Beurskens Anna J , Braun Susy M 
Published: December 2018

Objectives: To investigate immediate changes in walking performance associated with three implicit motor learning strategies and to explore patient experiences of each strategy. Design: Participants were randomly allocated to one of three implicit motor learning strategies. Within-group comparisons of spatiotemporal parameters at baseline and post strategy were performed. Setting: Laboratory setting. Subjects: A total of 56 community-dwelling post-stroke individuals. Interventions: Implicit learning strategies were analogy instructions, environmental constraints and action observation. Different analogy instructions and environmental constraints were used to facilitate specific gait parameters. Within action observation, only videotaped gait was shown. Main measures: Spatiotemporal measures (speed, step length, step width, step height) were recorded using Vicon 3D motion analysis. Patient experiences were assessed by questionnaire. Results: At a group level, three of the four analogy instructions ( n = 19) led to small but significant changes in speed ( d = 0.088 m/s), step height (affected side d = 0.006 m) and step width ( d = –0.019 m), and one environmental constraint ( n = 17) led to significant changes in step width ( d = –0.040 m). At an individual level, results showed wide variation in the magnitude of changes. Within action observation ( n = 20), no significant changes were found. Overall, participants found it easy to use the different strategies and experienced some changes in their walking performance. Conclusion: Analogy instructions and environmental constraints can lead to specific, immediate changes in the walking performance and were in general experienced as feasible by the participants. However, the response of an individual patient may vary quite considerably.
Specialized pediatric palliative care services for children dying from cancer: A repeated cohort study on the developments of symptom management and quality of care over a 10-year period
Authors: Zernikow Boris , Szybalski Katharina , Hübner-Möhler Bettina , Wager Julia , Paulussen Michael , Lassay Lisa , Jorch Norbert , Weber Carola , Schneider Dominik T , Janßen Gisela , Oommen Prasad T , Kuhlen Michaela , Brune Thomas , Wieland Regina , Schündeln Michael , Kremens Bernhard , Längler Alfred , Prokop Aram , Kiener Rita , Niehues Tim , Rose Martina , Baumann-Köhler Margit , Pöppelmann Monika , Thorer Heike , Irnich Martin , Sinha Kumar , Wolfe Joanne , Schmidt Pia 
Published: December 2018

Background: About one quarter of children affected with cancer die. For children and their families, the end-of-life period is highly distressing. Aim: This study focused on how end-of-life care in pediatric cancer patients changed over a period of 10 years and if changes in pediatric palliative care structures were associated with quality of care. Design: Over a 10-year period, all pediatric oncology departments in one German federal state were invited to participate in a repeated cross-sectional cohort study at three time-points (2005, 2010, 2015). Departments invited parents whose children died due to cancer 5 years earlier to participate. Identical semi-structured interviews were conducted with each cohort by the Survey of Caring for Children with Cancer. In addition, departments provided information on their pediatric palliative care infrastructure. Participants: In total, 124 families participated; 73% of interviews were conducted with mothers, 18% with fathers, and 9% with both parents. Results: Parents’ perception of symptom occurrence, symptom burden, and effectiveness of symptom-related treatment remained stable over the 10-year period. Over time, the availability of pediatric palliative care ( p < 0.001) as well as quality and satisfaction ratings of care ( p < 0.001) increased significantly. A growing number of children received specialized pediatric palliative care at home during the end-of-life period ( p = 0.009). Along with this development, more families had the chance to plan the location of death ( p = 0.003), and more children died at the preferred location ( p = 0.001). Conclusion: Advances in the availability of pediatric palliative care were associated with improvement in some aspects of quality of care (e.g. location of death) while other aspects, such as effectiveness of symptom management, remained unchanged. Further research is required to determine whether additional improvement in structural quality may increase the effectiveness of symptom management.
Body composition and mortality in the general population: A review of epidemiologic studies
Authors: Lee Dong Hoon , Giovannucci Edward L 
Published: December 2018

Numerous studies have examined the association between body mass index and mortality and often observed that risk of mortality was higher in those with lower body mass index than those who were overweight or even obese (“obesity paradox”). One potential explanation of the obesity paradox is the limitation of body mass index as an imperfect measure of adiposity. However, relatively few studies have examined the association between body composition and mortality due to practical issues of assessing body composition in large-scale epidemiological settings. The available epidemiologic studies on this topic were heterogenous with regard to study design, analyses, results, and interpretations. The majority of studies using direct body composition measures such as dual-energy x-ray absorptiometry or computed tomography had relatively small sample size, short follow-up period and restricted study population. Studies have also used other approaches to indirectly estimate body composition to examine the association with mortality in a larger and more representative population. Overall findings were not consistent but suggested that fat mass and lean body mass may play an independent role on mortality in the general population. Various shapes of the associations were observed, but studies generally suggested that high fat mass was associated with increased risk of mortality (especially higher range of fat mass) and low lean body mass was associated with increased risk of mortality (especially lower range of lean body mass). On the other hand, fat mass and lean body mass tended to show either null or inverse association with mortality in elderly populations. Given the complex relationship of two body components as well as with other factors (e.g., age, smoking, disease, etc.), future studies should be conducted and interpreted after careful consideration of potential biases. In summary, the available data suggest independent associations of fat mass and lean body mass on mortality in the general population. Impact statement Current understanding of the association of body composition on mortality in the general population is limited. This review evaluated the available epidemiologic studies on body composition and mortality that leveraged diverse approaches to estimate body composition. Although studies showed inconsistent results, there was evidence suggesting that high fat mass and low lean body mass may be independently associated with mortality in the general population. This review may help partially explain the “obesity paradox” phenomenon and facilitate further studies to advance the understanding of the association of body composition on health in the general and patient populations.
Anti-platelet and anti-coagulant therapy in peripheral arterial disease prior to surgical intervention
Authors: Harky Amer , Maskell Perry , Burgess Mika 
Published: December 2018

Objective Peripheral artery disease is a major clinical co-morbidity that can significantly affect quality of life, especially in the presence of diabetes mellitus and older age. The focus of this literature review is on medical management, through anti-platelet and anti-coagulation, of peripheral artery disease prior to undergoing surgical or endovascular management. Method Extensive electronic literature search performed in four major databases (PubMed, SCOPUD, Embase and Ovid) to identify the published randomized and non-randomized studies that compared and discussed the management of peripheral artery disease with different anti-thrombotic agents. Results A total of 17 studies were identified to meet the inclusion criteria of this review. Among them, 4 were systematic review and meta-analyses, 1 was observational study and 12 were randomized controlled trials. The reported outcomes in each study are summarized and reported separately within this review. Conclusion Peripheral artery disease is a complex and multifactorial clinical condition. The use of dual anti-platelets, such as aspirin and clopidogrel, are the key in preventing major cardiovascular events as well as stroke and death. Utilization of anti-coagulation such as direct oral anti-coagulants’ as additional parameters for the prevention of disease progression, is paramount. Eventually, the choice of either dual-antiplatelet therapy or combined anti-coagulation with anti-platelets should be carefully considered, particularly following the most recent published debatable studies.
Life goes on… Patient perspectives on having a cancer diagnosis and other comorbid diseases: A qualitative study
Authors: Arreskov Anne B , Graungaard Anette H , Kristensen Mads T , Søndergaard Jens , Davidsen Annette S 
Published: December 2018

Objectives Due to a growing population with both cancer and chronic diseases, we explored patients’ experiences of living with a cancer diagnosis and comorbidities, the possible effects on everyday living and management of comorbidities. Methods Semi-structured interviews were conducted during 2016 with 15 patients in Denmark, with finished cancer treatment and preexisting comorbidities. Analysis was performed by Systematic Text Condensation. Results Symptoms which disrupted everyday function were given attention, regardless of the disease from which the symptoms originated. The awareness of cancer and comorbidities constituted an inverse process over time. Most patients perceived cancer as being transient, whereas experiences of comorbidities varied from ignorance to worry. Most patients reported maintaining their chronic illness consultations with their general practitioner as before cancer. Conclusion Patients prioritized an everyday life with normal chores highly in contrast to paying attention to diseases. Disruptive symptoms, rather than specific diseases, took up patients’ attention. Cancer did not change the patients’ attendance at chronic care consultations. General practitioners should focus on maintaining the patient’s functional level in everyday life. Further, they should continue to prioritize the chronic care management, as this might increase the patients’ own view of the importance of self-management.