bluuebunny/crossref_metadata_2025_split huggingface dataset:
‘We’re like a gang, we stick together’: experiences of ventricular assist device communities
Authors: Standing Holly C , Exley Catherine , MacGowan Guy A , Rapley Tim 
Published: January 2018

Background: Ventricular assist devices (VADs) are a relatively new development in the management of advanced heart failure. In the UK, VAD recipients comprise a unique group of less than 200 patients. This is the first paper to explore the experience of VAD communities, the extent to which communities are developed around the device, and how these influence the experience of living with the VAD. Methods: Qualitative interviews were conducted with 20 VAD recipients (implanted as a bridge to transplantation), 11 interviews also included the VAD recipients’ partners. Interpretive phenomenology was employed as the theoretical basis guiding the analysis of the interviews. Results: Four key themes emerged from the data: the existence of VAD communities; experiential knowledge and understanding; social comparisons; and the impacts of deaths within the VAD community. Many of the interviewees valued the VAD communities and the relationships they had formed with fellow recipients. The beneficial impacts of the VAD communities included offering recently implanted patients a realistic view of what to expect from life with a VAD; this could aid them in accepting and adapting to the changes imparted by the device. However, negative impacts of the VAD communities were also reported, in particular following deaths within the group, which were a source of distress for many of the interviewees. Conclusions: In general, the VAD communities appeared to be a beneficial source of support for the majority of interviewees. Consideration should be given to how these communities could be supported by clinicians.
Predictors of intracranial hemorrhage volume and distribution in brain arteriovenous malformation
Authors: Yu Jay F , Nicholson Andrew D , Nelson Jeffrey , Alexander Matthew D , Tse Stephanie H , Hetts Steven W , Hemphill J Claude , Kim Helen , Cooke Daniel L 
Published: January 2018

Background and purpose Despite evidence regarding risk factors for brain arteriovenous malformation (bAVM)-associated spontaneous intracranial hemorrhage (ICH), few data exist describing the spectrum of clinical outcomes that bAVM-associated ICH may manifest. This study aimed to identify the demographical, clinical, and bAVM anatomical variables associated with ICH volume and the presence of intraventricular hemorrhage (IVH) of ruptured bAVMs, two indicators of worse clinical outcome, to help better predict outcome for unruptured bAVMs. Methods Computed tomography images ( n = 169) of patients with ruptured bAVM in a prospectively maintained institutional database were retrospectively reviewed to calculate ICH volume and the presence or absence of IVH. Demographic, clinical, and bAVM characteristics information was summarized and analyzed with univariable and multivariable regression models to identify the associations of these features with ICH volume and the presence of IVH. Results Patient sex, exclusively deep venous drainage, and lobar location were associated with ICH volume in univariable analysis; exclusively deep venous drainage remained significant in multivariable analysis (PI = 0.33, 95% CI: 0.21–0.52, p < 0.001). Exclusively deep venous drainage, multiple feeding arteries, and venous stenosis were associated with IVH in univariable analysis; exclusively deep venous drainage (OR = 7.27, 95% CI: 1.94–27.29, p = 0.003) remained significant in multivariable analysis. Conclusions Variables associated with ICH volume and the presence of IVH in ruptured bAVMs were evaluated and identified. They impart information that may help predict the clinical outcome of unruptured bAVM, in turn aiding clinicians in treatment planning.
Value of Percent Free Prostate-Specific Antigen for the Prediction of Pathological Stage in Men with Clinically Localized Prostate Cancer
Authors: Morote J. , Trilla E. , Esquena S. , Serrallach F. , Abascal J.M. , Id H'Mammed Y. , de Torres I.M. 
Published: January 2018

Purpose To analyze if the percentage of free prostate-specific antigen (PSA) can provide additional information to the combination of local clinical stage, serum PSA and Gleason score in the prediction of final stage and pathological features of prostate cancer. Materials and Methods A group of 480 men with clinically localized prostate cancer underwent lymphadenectomy and radical prostatectomy. Total and free PSA were measured in preoperative serum. Clinical stage was T1 in 70.4% of patients and T2 in 29.6%. The biopsy Gleason score ranged between 2 and 4 in 5.6%, between 5 and 7 in 78.4%, and was higher than 7 in 16%. Total serum PSA was below 4.1 ng/mL in 4.3%, between 4.1 and 10 ng/mL in 66.4%, between 10.1 and 20 ng/mL in 22.5%, and higher than 20 in 6.7% of patients. The tumor was organ-confined in 49.8% and specimen-confined in 64.2%, and its pathological features were favorable in 35%. Results Multiple logistic regression analysis demonstrated that percent free PSA has independent predictive value for pathological stage only in the subset of patients with cT1 tumors and serum PSA between 4.1 and 10 ng/mL. In this group the probability of organ-confined cancer was 68.3% if the percent free PSA was above 15 and 56.3% if it was lower (p<0.001). The probability of specimen-confined disease was 86.6% and 71.3%, respectively (p<0.007), and the probability of favorable pathology was 59.8% and 39.6%, respectively (p<0.002). We also found higher rates of organ- and specimen-confined tumors and favorable pathology for every Gleason score when the percent free PSA was higher than 15. Conclusions Percent free PSA seems to provide additional information to the combination of clinical stage and Gleason score for the prediction of pathological features only in patients with clinical stage T1c and serum PSA between 4.1 and 10 ng/mL.
Serum Levels of Tartrate-Resistant Acid Phosphatase-5B in Breast Cancer Patients Treated with Pamidronate
Authors: Martinetti A. , Seregni E. , Ripamonti C. , Ferrari L. , De Conno F. , Miceli R. , Pallotti F. , Coliva A. , Biancolini D. , Bombardieri E. 
Published: January 2018

A novel immunoassay specific for the osteoclast-produced TRAP isoform 5b has been developed recently. By means of this assay we studied the usefulness of serum TRAP-5b in monitoring the response to palliative treatment with pamidronate in breast cancer patients with bone metastases. We correlated serum TRAP-5b levels with pain intensity and intake of analgesics to assess the possible utility of the marker in identifying patients who could benefit from pamidronate treatment. Twenty-eight advanced breast cancer patients with bone metastases entered the study. Patients were treated according to the following schedule: two two-week cycles of 60 mg/week pamidronate IV, with a three-week interval in between (six infusions over seven weeks), followed by one infusion every three weeks for a total of 24 infusions over a treatment period of 61 weeks. Blood samples were taken before the start of treatment and before each infusion during two treatment cycles. To measure serum TRAP levels we employed the new immunoassay kit BoneTRAP® produced by Suomen Bioanalytiikka Oy (SBA), Oulu, Finland. In order to assess the usefulness of this marker in evaluating the response to pamidronate treatment we divided patients into two groups (group A, worsened; group B, improved) with respect to pain trend and analgesic intake. Our results did not show any statistically significant difference in baseline serum TRAP levels in the two groups. However, one week after the first pamidronate infusion TRAP-5b serum levels decreased by 39% and 18% in groups A and B, respectively (p=0.01); these levels persisted throughout the treatment period. In conclusion, a decrease in TRAP-5b serum levels may reflect the pharmacological activity of pamidronate and seems to predict pain relief and a reduction in analgesic consumption.
SCCA1–IGM and SCCA2–IGM Compared with Total SCCA-IGM for Diagnosis of Hepatocellular Carcinoma
Authors: Biasiolo Alessandra , Tono Natascia , Quarta Santina , Beneduce Luca , Gatta Angelo , Fassina Giorgio , Pontisso Patrizia 
Published: January 2018

Introduction SCCA1 and SCCA2 belong to the family of serine protease inhibitors (SERPIN). Both SCCA isoforms have been found to be increased in patients with squamous cell carcinoma (SCC) of different organs. Recent findings have demonstrated that SCCA-IgM immune complexes are a novel class of biomarkers for primary liver cancer detection. An increase in SCCA-IgM levels in patients with cirrhosis is associated with the development of liver cancer. Aims and methods To evaluate the diagnostic accuracy of different isoforms of SCCA-IgM compared with a commercial assay for SCCA-IgM in patients with hepatocellular carcinoma (HCC). Twenty-six patients with HCC (M/F 1 9/7; mean age ± SD: 65 ± 13 years) were analyzed. Serum samples from 28 blood donors (M/F 17/11; mean age ± SD: 38 ± 9 years) were used as control. Two monoclonal antibodies, SCC 111 and SCC 1 04 (CanAg Diagnostics, Gothenburg, Sweden) were used as catcher antibodies to perform specific ELISA for SCCA1-lgM and SCCA2-lgM. SCCA-IgM immune complexes were also detected in serum by a commercial ELISA kit (Hepa-IC, Xeptagen, Marghera, Italy) according to the manufacturer's instructions. Results Circulating SCCA1-IgM was detectable in 6 out of 26 patients (sensitivity 23%), while SCCA2-lgM ELISA was positive in 9 of 26 patients (sensitivity 35%). When SCCA-IgM levels were measured using the commercial assay the diagnostic sensitivity increased to 58% (15/26). The SCCA1-IgM, SCCA2-lgM and SCCA-IgM tests had 100% specificity in healthy controls. Conclusions The commercial assay allowed the detection of both isoforms of SCCA forming the IgM immune complexes, providing a better diagnostic sensitivity score than that obtained with the SCCA1-IgM or SCCA2-lgM test.
Implementation and Evaluation of a Risk-Based Approach to Guide Chronic Kidney Disease Care: Protocol for a Multiphase Mixed-Methods Study
Authors: Hemmelgarn Brenda R. , Smekal Michelle D. , Weaver Robert G. , Thomas Chandra , Benterud Eleanor , Tam Kin , Manns Braden J. , Tonelli Marcello , Finlay Juli , Donald Maoliosa , Tam-Tham Helen , Bello Aminu , Tangri Navdeep , Quinn Robert R. 
Published: January 2018

Background: Risk prediction tools are used in a variety of clinical settings to guide patient care, although their use in chronic kidney disease (CKD) care is limited. Objectives: To assess the association of a risk-based model of CKD care on patient care, satisfaction, outcomes, and cost. Design: Mixed-methods with a pre-post design. Setting: We will use mixed-methods and a pre-post design to evaluate use of the Kidney Failure Risk Equation (KFRE) to guide CKD care. The KFRE will be applied to patients currently followed in nephrology multidisciplinary CKD clinics in Alberta, as well as to new patients being considered for multidisciplinary care. Patients: Patients with a 2-year risk of kidney failure ≥10% or estimated glomerular filtration rate (eGFR) ≤15 mL/min/1.73 m2 will be recommended care by a multidisciplinary team coordinated by a nurse clinician and nephrologist, with access to other multidisciplinary resources including dietitians, pharmacists, and social workers as required. Measurements/Methods: Focus groups and interviews will be conducted to qualitatively describe patient and provider perspectives of potential barriers and facilitators to implementation of the risk-based approach to CKD care. Patient and provider surveys will also be used to quantify patient and provider satisfaction before and after the intervention. Finally, administrative data will be used to evaluate the association between the risk-based approach to care and outcomes including health care resource use, frequency of testing, modality choice, and death. Conclusions: Use of a risk-based model of care has the potential to increase use of optimal treatments such as the use of home dialysis and preemptive kidney transplantation, while reducing costs and poor outcomes related to processes of care such as unnecessary laboratory testing; however, there is also potential for unintended consequences. Our mixed-methods approach will integrate perceptions and needs from key stakeholders (including patients with CKD, their families, and their providers) to guide implementation and ensure appropriate modifications.
Characterisation of the Clothespin Relocation Test as a functional assessment tool
Authors: Kyberd Peter , Hussaini Ali , Maillet Ghislain 
Published: January 2018

Method The Clothespin Relocation Test has been adapted from an arm training tool to create an instrument to measure hand function. It is based on the time to move three clothespins from a horizontal to a vertical bar, and back. To be generally useful, the measures need to have their psychometric properties investigated. This paper measures the characteristics of an able-bodied population to gain an understanding of the underlying statistical properties of the test, in order that it can then be used to compare with different subject groups. Fifty adults (29 males, 21 females, mean age 31) were tested with five runs of three clothespins moved up and then down. Ten subjects returned twice more to observe repeatability. Results There was a non-Gaussian range of times, from 2.5 to 7.37 s. Mean time for Up was 4.1 s, and was 4.0 s for Down, with a skew towards the faster times of 0.57 for Up and 0.97 for Down. Over the three sessions there was a small (not significant) increase in speed 4.1 ± 0.5 s first run Down to 3.5 ± 0.4 s for third. Conclusion These initial tests confirm that it has potential to be used as a measurement of the performance of arm movement.
Carboxymethyl chitosan–zinc coating for prevention of pin tract infection: An animal model
Authors: Martin Vidmi Taolam , Wang Lei , Zeng Rong , You DeQiang , Zhang XianRong , Elodie Welera Haissou , Yu Bin 
Published: January 2018

Background: Pin tract infection is a common problem in orthopedic and traumatology surgery. The aim of this study was to investigate the efficacy of an implant coated with carboxymethyl chitosan–zinc (CMC-Zn2+) in prevention of pin tract infection. Materials and Methods: Twenty-four male New Zealand White rabbits were randomized into two equal groups ( n = 12, uncoated and CMC-Zn2+). The implants were colonized with 1 × 106 colony forming units of Staphylococcus aureus and inserted into the lateral right proximal tibia in each rabbit. In each group, at 2 and 4 weeks post-surgery, five and seven rabbits were killed, respectively, to harvest the soft tissues around the implant as well as the hard tissue for histological analysis. The bone cross-sectional view, X-ray, and micro-computed tomography (μCT) were performed. Results: The surgical sites in each animal were evaluated individually at both time points. No evident signs of infections were found in the CMC-Zn2+ group, while a high rate of infection was observed in the uncoated group where minor infections were 85.71% ( n = 12) and major infections 14.29% ( n = 12). The radiography, μCT, and histological analysis showed no evident signs of infection in both groups at 2 weeks post-surgery. However, at 4 weeks, signs of infection were found in all the animals in the uncoated group, whereas in the CMC-Zn2+ group, no infections were observed. The difference between the two groups was highly significant ( p = 0.00). Conclusions: Our study showed that CMC-Zn2+-coated implants were effective in preventing pin tract infection.
Rivaroxaban dose adjustment using thrombin generation in severe congenital protein C deficiency and warfarin-induced skin necrosis
Authors: Menon Neethu , Sarode Ravi , Zia Ayesha 
Published: January 2018

Key Points
Rivaroxaban was efficacious and safe in a child with protein C deficiency to prevent the recurrence of skin necrosis or venous thrombosis. The dosage of direct oral anticoagulants in children with thrombophilia is unclear; a thrombin generation assay may be useful to adjust it.
Homologous Recombination Deficiency in Patients With Pancreatic Ductal Adenocarcinoma and Response to Chemotherapy
Authors: Shahda Safi , Timms Kirsten M. , Ibrahim Ashley A. , Reid Julia E. , Cramer Harvey M. , Radovich Milan , Ibrahim Sulfikar , Allen Brian , O’Neil Bert H. 
Published: January 2018

Purpose Mutations or copy number abnormalities of genes involved in homologous recombination (HR) occur in pancreatic ductal adenocarcinoma (PDAC). DNA-based measures of HR deficiency (HRD) have been developed and may help identify tumors with better response to DNA-damaging agents. This study aimed to describe the HR pathway mutations and HRD status and determine their association with treatment response and outcome in patients with PDAC. Patients and Methods We performed a retrospective analysis of tumor samples from patients treated at Indiana University for locally advanced or metastatic PDAC. Patients were included if they received gemcitabine plus nanoparticle albumin-bound paclitaxel (control) or fluorouracil, oxaliplatin, leucovorin, and irinotecan (FOLFIRINOX) and had adequate follow-up to assess survival and response to therapy. Tumor analysis generated a three-biomarker HRD score and mutation data for 44 genes. Results Ninety-one samples met inclusion criteria, and 78 samples (formalin-fixed paraffin-embedded, n = 15; fine-needle aspiration, n = 63) generated mutation data. HRD analysis was successful for 57 samples (HRD score: median, 18; range, 5 to 61); the primary cause of failure was low tumor cellularity. Six BRCA1/ 2 mutations were detected, four with HRD scores in the top decile ( P = .011). There was no statistically significant correlation between HRD score and radiographic response (odds ratio per interquartile range, 1.40; P = .32 adjusted for treatment) in either treatment group. In patients treated with FOLFIRINOX, HRD score dichotomized at the median was not associated with progression-free survival (median, 5.3 v 9.4 months for low v high HRD score, respectively; P = .083) or overall survival (median, 11.9 v 10.7 months for low v high HRD score, respectively; P = .76). Conclusion Mutations in DNA repair genes occur in PDAC, and HRD scores can be generated in the majority of patients. The HRD score was not significantly associated with higher response rate or prolonged survival in patients treated with FOLFIRINOX.
Runx1 is sufficient for blood cell formation from non-hemogenic endothelial cells in vivo only during early embryogenesis
Authors: Yzaguirre Amanda D. , Howell Elizabeth D. , Li Yan , Liu Zijing , Speck Nancy A. 
Published: January 2018

ABSTRACT
Hematopoietic cells differentiate during embryogenesis from a population of endothelial cells called hemogenic endothelium (HE) in a process called the endothelial-to-hematopoietic transition (EHT). The transcription factor Runx1 is required for EHT, but for how long and which endothelial cells are competent to respond to Runx1 are not known. Here, we show that the ability of Runx1 to induce EHT in non-hemogenic endothelial cells depends on the anatomical location of the cell and the developmental age of the conceptus. Ectopic expression of Runx1 in non-hemogenic endothelial cells between embryonic day (E) 7.5 and E8.5 promoted the formation of erythro-myeloid progenitors (EMPs) specifically in the yolk sac, the dorsal aorta and the heart. The increase in EMPs was accompanied by a higher frequency of HE cells able to differentiate into EMPs in vitro. Expression of Runx1 just 1 day later (E8.5-E9.5) failed to induce the ectopic formation of EMPs. Therefore, endothelial cells, located in specific sites in the conceptus, have a short developmental window of competency during which they can respond to Runx1 and differentiate into blood cells.
Use of helical tomotherapy in locally advanced and/or metastatic breast cancer for locoregional treatment
Authors: Thery Laura , Arsene-Henry Alexandre , Carroll Susan , Peurien Dominique , Bazire Louis , Robilliard Magalie , Fourquet Alain , Kirova Youlia M 
Published: January 2018

Objective:
Helical tomotherapy (HT) is a new promising tool whose use remains to be studied. This work assesses its impact for local irradiation in terms of side effects, as well as tumour control in locally advanced (LABC) and metastatic breast cancer (MBC).

Methods:
We retrospectively reviewed data of 66 patients with LABC and MBC. Patients received standard fractionated radiotherapy by HT, with or without concurrent systemic treatment.

Results:
The median age was 60 years (28–77). The median follow-up of the population was 35.9 months (10.6–95.8). For 91% of patients, HT was concomitant with systemic treatments. Three patients experienced grade 3 skin toxicity and all had concurrent 5FU-vinorelbine. One patient who was receiving concurrent treatment with trastuzumab–pertuzumab had a decreased left ventricular ejection fraction by 14%. No late cardiac or lung toxicity was observed. A clinical benefit was observed in 75% of cases. At 2 months after HT, we observed tumour regression in 7/8 patients, as following: 1 complete, 4 partial responses, and 2 stable disease. The median survival for MBC group was 64.4 months (42.6–65.8) and 21.1 (6.1–36.1) months for LABC.

Conclusion:
This study suggests that the use of HT is well tolerated and feasible with a multimodal strategy that includes concurrent systemic treatments for patients with LABC and MBC.

Advances in knowledge:
The survival of LABC and MBC increases and new safe tools are needed to determine optimal strategies of treatment. To our knowledge, this is the first paper describing the use of HT for this population.
What Is Career Success for Academic Hospitalists? A Qualitative Analysis of Early‐Career Faculty Perspectives
Authors: Cumbler Ethan , Yirdaw Essey , Kneeland Patrick , Pierce Read , Rendon Patrick , Herzke Carrie , Jones Christine D. 
Published: January 2018

BACKGROUNDUnderstanding the concept of career success is critical for hospital medicine groups seeking to create sustainably rewarding faculty positions. Conceptual models of career success describe both extrinsic (compensation and advancement) and intrinsic (career satisfaction and job satisfaction) domains. How hospitalists define career success for themselves is not well understood. In this study, we qualitatively explore perspectives on how early‐career clinician‐educators define career success.METHODSWe developed a semistructured interview tool of open‐ended questions validated by using cognitive interviewing. Transcribed interviews were conducted with 17 early‐career academic hospitalists from 3 medical centers to thematic saturation. A mixed deductive‐inductive, qualitative, analytic approach was used to code and map themes to the theoretical framework.RESULTSThe single most dominant theme participants described was “excitement about daily work,” which mapped to the job satisfaction organizing theme. Participants frequently expressed the importance of “being respected and recognized” and “dissemination of work,” which were within the career satisfaction organizing theme. The extrinsic organizing themes of advancement and compensation were described as less important contributors to an individual's sense of career success. Ambivalence toward the “academic value of clinical work,” “scholarship,” and especially “promotion” represented unexpected themes.CONCLUSIONSThe future of academic hospital medicine is predicated upon faculty finding career success. Clinician‐educator hospitalists view some traditional markers of career advancement as relevant to success. However, early‐career faculty question the importance of some traditional external markers to their personal definitions of success. This work suggests that the self‐concept of career success is complex and may not be captured by traditional academic metrics and milestones.