bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tocilizumab for the management of immune mediated adverse events secondary to PD-1 blockade
Authors: Stroud Chipman RG , Hegde Aparna , Cherry Cynthia , Naqash Abdul R , Sharma Nitika , Addepalli Srikala , Cherukuri Sulochana , Parent Teresa , Hardin Jessica , Walker Paul 
Published: December 2017

Background Immune checkpoint inhibitors are poised to revolutionize the management of a growing number of malignancies. Unfortunately, the management of steroid-refractory immune mediated adverse events is based on a paucity of randomized data and limited to single center experiences. Our initial experience with the IL-6 receptor antagonist tocilizumab showed clinical improvement in a wide variety of irAEs. As a result, we adopted the use of tocilizumab for the management of steroid refractory irAEs. Methods The character and clinical course of irAEs were abstracted from the medical record and analyzed. The dose of tocilizumab was 4 mg/kg given IV over one hour. C-reactive protein was drawn at first nivolumab infusion and at q two weeks (and with irAEs) thereafter. Clinical improvement was defined as either: documentation of resolution of symptoms or hospital discharge within seven days. Results Of the initial 87 patients that were treated with nivolumab, 34 required tocilizumab (39.1%). All patients were on corticosteroids. The majority (88.2%) were lung cancer patients. The index grade 3/4 irAE was pneumonitis in 35.3%, serum sickness/SIRS in 35.3%, cerebritis in 14.7% and one case each of hypophysitis, colitis, pancreatitis, hepatitis and immune mediated coagulopathy. Median time between first nivolumab and initiation of tocilizumab was 76 days (range 1–429). There was a statistically significant increase in C-reactive protein from a median of 23 mg/L (range 0.1–238.5) at baseline to 109.3 mg/L (21.5–350.4) at the time of index irAE, followed by a decrease to 19.2 mg/L (0.25–149) after tocilizumab ( p < 0.00001). Clinical improvement was noted in 27/34 patients (79.4%). Some patients (52.9%) required a single dose, while 38.2% required two, 8.8% required three and 1 patient required four doses. Twenty-seven doses were given in the inpatient setting (49.1%). Median time to discharge was four days (range 1–27). Seventy-four percent of patients were discharged home. For the 53 doses of tocilizumab that were delivered when infliximab was an option, there was a cost savings of $141,048.72 (WAC) during the 18 month study period. Conclusions Tocilizumab may be a therapeutic option for the management of steroid refractory irAEs secondary to immune checkpoint blockade. However, randomized trials are needed to better elucidate the relative efficacy and safety of these agents.
Characterization of collaborative practice agreements held by hematopoietic stem cell transplant pharmacists
Authors: Bryk Amy , Koontz Susannah , Mayor JoAl , Betcher Jeffrey , Tombleson Rebecca , Bookout Ryan , Saunders Ila M 
Published: December 2017

Background Current workforce shortages within the hematopoietic stem cell transplant field necessitate capitalizing on the role of oncology-trained pharmacists. Working within an agreed-upon protocol, pharmacists are able to expand patient care delivery through optimal medication therapy management. Methods An electronic survey was developed by the Advocacy & Policy Working Committee of the American Society for Blood and Marrow Transplantation Pharmacy Special Interest Group and distributed to pharmacists involved in the care of hematopoietic stem cell transplant patients. The primary objective was to assess the current state of collaborative practice agreements in the hematopoietic stem cell transplant setting. Results Forty-eight responses representing 41 institutions were returned. Respondents were mostly female (67%) and practiced in the adult setting (83%). Reponses represented a range of practice experience in hematopoietic stem cell transplant with the majority of the hematopoietic stem cell transplant positions (83%) funded by the department of pharmacy at an academic medical center. Of the 48 responses, 22 (46%) respondents reported having collaborative practice agreements in place; 10 (21%) respondents did not currently have collaborative practice agreements, but were planning to implement them; and 16 (33%) respondents did not have collaborative practice agreements at their institution. Clinical activities performed under a collaborative practice agreement included medication selection and dosing modifications, therapeutic drug monitoring, supportive care management, and management of comorbid conditions and chronic diseases. The most commonly cited barrier to establishing collaborative practice agreements was the inability to secure reimbursement for services provided. No respondents reported a negative impact on job satisfaction. Conclusions The results of this survey provide the pharmacy community with a robust understanding of the current landscape of hematopoietic stem cell transplant pharmacy collaborative practice agreements.
Demographic variation in the injury patterns of adult cyclists admitted to a large US healthcare network: A five-year review
Authors: Williams Shanna E , Nelson Rachel , Kashif Reema , Goff Tyler , Simon Laura , Janse Melissa 
Published: December 2017

Background Despite considerable health and environmental benefits, cycling is also associated with a risk of injury. Yet, variation in the patterns of cycling trauma which manifests by gender, age, and race/ethnicity is ill-defined. This retrospective study aims to characterize injury patterns in different demographic groups of bicyclists admitted to the Greenville Health System in South Carolina. Patients and methods In this IRB-approved, retrospective study, five years of patient data (2010–2014) were gathered from seven emergency departments associated with the Greenville Health System. A total of 155 adult patients hospitalized for bicycle-related trauma were examined in terms of demographics (age, gender, and race) and injury. Injuries were categorized by type, region, and severity. Non-parametric tests were performed to study the effect of demographic characteristics on injury presentation. Results Spinal cord ( p = 0.003) and internal organ injuries ( p = 0.000) were significantly more common in men. External body injuries were also more prevalent and severe in men ( p = 0.05), while injury to the extremities and pelvic region was more common and severe in women ( p = 0.02). Herniations ( p = 0.028), internal organ injuries ( p = 0.000), and abrasions ( p = 0.04) occurred more often in White cyclists. This group was also more likely to be wearing a helmet at the time of accident ( p = 0.00). Finally, while hematomas were more prevalent in older adults (≥55 years) cyclists ( p = 0.01), this population was also more also likely to wear a helmet than young adults (18–34 years) cyclists ( p = 0.025). Conclusion Demographic differences exist in the types and severity of cycling trauma. These differences should be considered during the identification and management of bicycle-related trauma.
Focal MRI-Guided Salvage High-Dose-Rate Brachytherapy in Patients With Radiorecurrent Prostate Cancer
Authors: Maenhout Metha , Peters Max , van Vulpen Marco , Moerland Marinus A. , Meijer Richard P. , van den Bosch Maurice A. A. J. , Nguyen Paul L. , Frank Steven J. , van der Voort van Zyp Jochem R. N. 
Published: December 2017

Introduction: Whole-gland salvage treatment of radiorecurrent prostate cancer has a high rate of severe toxicity. The standard of care in case of a biochemical recurrence is androgen deprivation treatment, which is associated with morbidity and negative effects on quality of life. A salvage treatment with acceptable toxicity might postpone the start of androgen deprivation treatment, might have a positive influence on the patients’ quality of life, and might even be curative. Here, toxicity and biochemical outcome are described after magnetic resonance imaging–guided focal salvage high-dose-rate brachytherapy in patients with radiorecurrent prostate cancer. Materials and Methods: Seventeen patients with pathologically proven locally recurrent prostate cancer were treated with focal high-dose-rate brachytherapy in a single 19-Gy fraction using magnetic resonance imaging for treatment guidance. Primary radiotherapy consisted of external beam radiotherapy or low-dose-rate brachytherapy. Tumors were delineated with Ga-68–prostate-specific membrane antigen or F18-choline positron emission tomography in combination with multiparametric magnetic resonance imaging. All patients had a prostate-specific antigen level of less than 10 ng/mL at the time of recurrence and a prostate-specific antigen doubling time of ≥12 months. Toxicity was measured by using the Common Terminology Criteria for Adverse Events version 4. Results: Eight of 17 patients had follow-up interval of at least 1 year. At a median follow-up interval of 10 months (range 3-40 months), 1 patient experienced a biochemical recurrence according to the Phoenix criteria, and prostate-specific membrane antigen testing revealed that this was due to a distant nodal metastasis. One patient had a grade 3 urethral stricture at 2 years after treatment. Conclusion: Focal salvage high-dose-rate brachytherapy in patients with radiorecurrent prostate cancer showed grade 3 toxicity in 1 of 17 patients and a distant nodal metastasis in another patient. Whether this treatment option leads to cure in a subset of patients or whether it can successfully postpone androgen deprivation treatment needs further investigation.
Establishing and characterizing patient-derived xenografts using pre-chemotherapy percutaneous biopsy and post-chemotherapy surgical samples from a prospective neoadjuvant breast cancer study
Authors: Yu Jia , Qin Bo , Moyer Ann M. , Sinnwell Jason P. , Thompson Kevin J. , Copland John A. , Marlow Laura A. , Miller James L. , Yin Ping , Gao Bowen , Minter-Dykhouse Katherine , Tang Xiaojia , McLaughlin Sarah A. , Moreno-Aspitia Alvaro , Schweitzer Anthony , Lu Yan , Hubbard Jason , Northfelt Donald W. , Gray Richard J. , Hunt Katie , Conners Amy L. , Suman Vera J. , Kalari Krishna R. , Ingle James N. , Lou Zhenkun , Visscher Daniel W. , Weinshilboum Richard , Boughey Judy C. , Goetz Matthew P. , Wang Liewei 
Published: December 2017

AbstractBackgroundPatient-derived xenografts (PDXs) are increasingly used in cancer research as a tool to inform cancer biology and drug response. Most available breast cancer PDXs have been generated in the metastatic setting. However, in the setting of operable breast cancer, PDX models both sensitive and resistant to chemotherapy are needed for drug development and prospective data are lacking regarding the clinical and molecular characteristics associated with PDX take rate in this setting.MethodsTheBreast Cancer Genome GuidedTherapy Study(BEAUTY) is a prospective neoadjuvant chemotherapy (NAC) trial of stage I-III breast cancer patients treated with neoadjuvant weekly taxane+/-trastuzumab followed by anthracycline-based chemotherapy. Using percutaneous tumor biopsies (PTB), we established and characterized PDXs from both primary (untreated) and residual (treated) tumors. Tumor take rate was defined as percent of patients with the development of at least one stably transplantable (passed at least for four generations) xenograft that was pathologically confirmed as breast cancer.ResultsBaseline PTB samples from 113 women were implanted with an overall take rate of 27.4% (31/113). By clinical subtype, the take rate was 51.3% (20/39) in triple negative (TN) breast cancer, 26.5% (9/34) in HER2+, 5.0% (2/40) in luminal B and 0% (0/3) in luminal A. The take rate for those with pCR did not differ from those with residual disease in TN (p = 0.999) and HER2+ (p = 0.2401) tumors. The xenografts from 28 of these 31 patients were such that at least one of the xenografts generated had the same molecular subtype as the patient. Among the 35 patients with residual tumor after NAC adequate for implantation, the take rate was 17.1%. PDX response to paclitaxel mirrored the patients’ clinical response in all eight PDX tested.ConclusionsThe generation of PDX models both sensitive and resistant to standard NAC is feasible and these models exhibit similar biological and drug response characteristics as the patients’ primary tumors. Taken together, these models may be useful for biomarker discovery and future drug development.
Customer satisfaction of Vietnam Airline domestic service quality
Authors: Ha Nam Khanh Giao 
Published: December 2017

AbstractThe paper examines the relation between Vietnam Airline domestic service quality and customer satisfaction by gathering opinions from 402 passengers employing the Skytrax scale with some modification along with Cronbach’s alpha, exploratory factor analysis, and multiple regression analysis. Results show that Vietnam Airline domestic service quality can be measured by the following six determinants in order of decreasing importance: (1) boarding/deplaning/baggage, (2) check-in, (3) in-flight services, (4) reservation, (5) aircraft, and (6) flight crew. All of them have directly proportional effects to customer satisfaction. The paper also offers some suggestions to improve the service quality, thereby enhancing the customer satisfaction.
Effects of stress or infection on rat behavior show robust reversals due to environmental disturbance
Authors: Abdulai-Saiku Samira , Hegde Akshaya , Vyas Ajai , Mitra Rupshi 
Published: December 2017

Background: The behavior of animals is intricately linked to the environment; a relationship that is often studied in laboratory conditions by using environmental perturbations to study biological mechanisms underlying the behavioral change. Methods: This study pertains to two such well-studied and well-replicated perturbations, i.e., stress-induced anxiogenesis and Toxoplasma-induced loss of innate fear. Here, we demonstrate that behavioral outcomes of these experimental manipulations are contingent upon the ambient quality of the wider environment where animal facilities are situated. Results: During late 2014 and early 2015, a building construction project started adjacent to our animal facility. During this phase, we observed that maternal separation stress caused anxiolysis, rather than historically observed anxiogenesis, in laboratory rats. We also found that Toxoplasma infection caused an increase, rather than historically observed decrease, in innate aversion to predator odors in rats. Conclusion: These observations suggest that effects of stress and Toxoplasma are dependent on variables in the environment that often go unreported in the published literature.
Quantification of polysaccharides fixed to Gram stained slides using lactophenol cotton blue and digital image processing
Authors: Ericksen Bryan 
Published: December 2017

Dark blue rings and circles emerged when the non-specific polysaccharide stain lactophenol cotton blue was added to Gram stained slides. The dark blue staining is attributable to the presence of capsular polysaccharides and bacterial slime associated with clumps of Gram-negative bacteria. Since all bacterial cells are glycosylated and concentrate polysaccharides from the media, the majority of cells stain light blue. The contrast between dark and light staining is sufficient to enable a digital image processing thresholding technique to be quantitative with little background noise. Prior to the addition of lactophenol cotton blue, the Gram-stained slides appeared unremarkable, lacking ubiquitous clumps or stained polysaccharides. Adding lactophenol cotton blue to Gram stained slides is a quick and inexpensive way to screen cell cultures for bacterial slime, clumps and biofilms that are invisible using the Gram stain alone.
Living with heart failure: Karachi exploratory study
Authors: Gowani Ambreen , Gul Raisa , Dhakam Sajid , Kurji Nadia 
Published: December 2017

Background:Heart failure (HF) is the leading cause of hospitalisation among older people. It is one of the most debilitating chronic illnesses that severely affect patients' quality of life (QoL) by reducing their physiological as well as psychological capacities. The experiences of patients with HF from Western countries are well-highlighted in the literature, while there is a gap regarding the lived experiences of patients with HF in developing countries. Therefore, the current study aimed to explore the experiences of patients living with heart failure in developing countries such as Pakistan.Methods:Using the phenomenological approach, in-depth interviews were conducted with eight patients living with HF, encompassing variation in their age, gender, income, educational status and level of self-care. The content of the interview was analysed using steps from Morse and Niehaus.Results:The analysis of patients' narratives revealed four major themes: being restrained by the illness; fear of uncertainty; challenging adaptation to health-deviated needs; and role of the healthcare system in self-care.Conclusion:HF imposes limitations upon all dimensions of life owing to its worsening nature. However, in a developing country, the problem is further intensified by the constraints of the healthcare system. Therefore, ways to support patients with HF in developing countries need to be developed to improve their QOL.
Classical music in cardiac prevention and rehabilitation
Authors: Cheng Max A , Grove Tim 
Published: December 2017

Objective: The objective of the current service evaluation was to assess whether classical music positively impacts upon exercise intensity in patients undergoing a cardiovascular prevention and rehabilitation programme. Design: A crossover study design was used, in which patients were exposed to both classical music and no music over 2 consecutive weeks, determined through a random order. Setting: This took place in cardiovascular prevention and rehabilitation exercise sessions at two Imperial College NHS Healthcare sites. Patients: The sample consisted of 30 cardiac rehabilitation patients undergoing secondary prevention. Main outcome measures: Comparison of heart rate (average and peak) and Borg Rating of Perceived Exertion (RPE) recorded in each patient under both music and non-music conditions. Results: Average heart rate, Borg RPE, and energy expenditure showed minimal differences between exercise modes. However, peak heart rate increased on average by 7 beats per minute when comparing exercising under classical to no music. Conclusions: The study found that classical music significantly increased an individual's peak heart rate during a cardiac exercise session, thereby increasing physical activity intensity.
What is the most appropriate out-of-hospital opioid for adults with traumatic pain?
Authors: Ellis Pierre 
Published: December 2017

Aims: The aims of the current research were to investigate the most appropriate out-of-hospital opioid for adults with traumatic pain. Providing adequate analgesia has multiple benefits both during and post injury. Methods: The literature search was carried out using multiple databases to identify relevant out-of-hospital research with additional grey literature to support. The main themes encountered were intravenous morphine compared to intravenous fentanyl, and the contrast between them. Discussion: There were no significant differences in effectiveness or adverse effects. Intranasal application was thought to be favoured where intravenous access was unobtainable. Conclusions: Further research is required to establish which is the most appropriate opioid. This could include a greater focus on the onset time, duration and optimal dose. Increased education and organisational focus would need to be addressed alongside a change in drug formulary for the out-of-hospital clinician.
Clinical, functional and radiological outcomes of extracorporeal irradiation in limb salvage surgery for bone tumours
Authors: Jones C. W. , Shatrov J. , Jagiello J. M. , Millington S. , Hong A. , Boyle R. , Stalley P. D. 
Published: December 2017

AimsWe present a retrospective review of patients treated with extracorporeally irradiated allografts for primary and secondary bone tumours with the mid- and long-term survivorship and the functional and radiographic outcomes.Patients and MethodsA total of 113 of 116 (97.4%) patients who were treated with extracorporeally irradiated allografts between 1996 and 2014 were followed up. Forms of treatment included reconstructions, prostheses and composite reconstructions, both with and without vascularised grafts. Survivorship was determined by the Kaplan-Meier method. Clinical outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) scoring system, the Toronto Extremity Salvage Score (TESS) and Quality of Life-C30 (QLQ-30) measures. Radiographic outcomes were assessed using the International Society of Limb Salvage (ISOLS) radiographic scoring system.ResultsThere were 61 (54%) men with a mean age of 22 years (6 to 70) and 52 (46%) women with a mean age of 26 years (3 to 85). There were 23 deaths. The five-year patient survivorship was 82.3% and the ten-year patient survivorship was 79.6%. The mean follow-up of the 90 surviving patients was 80.3 months (2 to 207). At the last follow-up, 105 allografts (92.9%) were still in place or had been at the time of death; eight (7%) had failed due to infection, local recurrence or fracture. Outcome scores were comparable with or superior to those in previous studies. The mean outcome scores were: MSTS 79% (sd 8); TESS 83% (sd 19); QLQ 82% (sd 16); ISOLS 80.5% (sd 19). Pearson correlation analysis showed a strong relationship between the MSTS and ISOLS scores (r = 0.71, p < 0.001).ConclusionThis study shows that extracorporeal irradiation is a versatile reconstructive technique for dealing with large defects after the resection of bone tumours with good functional and radiographic outcomes. Functional outcomes as measured by MSTS, TESS and QLQ-30 were strongly correlated to radiographic outcomes. Cite this article: Bone Joint J 2017;99-B:1681–8
Complications following arthroscopic surgery of the hip
Authors: Nakano N. , Lisenda L. , Jones T. L. , Loveday D. T. , Khanduja V. 
Published: December 2017

Aims The number of patients undergoing arthroscopic surgery of the hip has increased significantly during the past decade. It has now become an established technique for the treatment of many intra- and extra-articular conditions affecting the hip. However, it has a steep learning curve and is not without the risk of complications. The purpose of this systematic review was to determine the prevalence of complications during and following this procedure. Materials and Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in designing this study. Two reviewers systematically searched the literature for complications related to arthroscopy of the hip. The research question and eligibility criteria were established a priori. Pertinent data were abstracted and analysed. Results We found 276 relevant studies with a total of 36 761 arthroscopies that met the inclusion criteria. The mean age of the patients was 36.7 years (1.7 to 70) and the mean body mass index was 25.7 kg/m2 (20.2 to 29.2). Femoroacetabular impingement and labral tears were the most common indications for the procedure. The total number of complications was 1222 (3.3%). Nerve injury (0.9%), mainly involving the pudendal and lateral femoral cutaneous nerves, and iatrogenic chondral and labral injury (0.7%), were the two most common complications. There were 58 major complications (0.2%), the most common being intra-abdominal extravasation of fluid, which was found in 13 cases (0.04%). There were three deaths (0.008%). Conclusion Arthroscopic surgery of the hip is a procedure with a relatively low rate of complications, although some may be significant in this young cohort of patients. This study relied on the reported complications only and the results should be interpreted with caution. Cite this article: Bone Joint J 2017;99-B:1577–83.