bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survival Benefits of Therapeutic Plasma Exchange in Severe Sepsis and Septic Shock: A Systematic Review and Meta-analysis
Authors: Lee Olive P. E. , Kanesan Nalaayeni , Leow Esther H. , Sultana Rehena , Chor Yek K. , Gan Chin S. , Lee Jan H. 
Published: April 2023

Objectives To summarize the role of therapeutic plasma exchange (TPE) in critically ill adults and children with severe sepsis. Data collection A systematic search was performed using the following databases: Medline, EMBASE, CINAHL, and Cochrane from January 1990 till December 2022. Comparative studies of TPE in severe sepsis were selected. Adult and pediatric data were analyzed separately. Data synthesis Eight randomized control trials and 6 observational studies (n = 50,142 patients) were included. Centrifugal TPE was the most common modality (209/280, 74.6% adults and 952/1026, 92.7% children). Every TPE study utilized different volume exchanges. Most TPE sessions (1173/1306, 89.8%) employed fresh frozen plasma (FFP) as replacement fluid and heparin as anticoagulant. Adults with severe sepsis supported with TPE using FFP had lower mortality (risk ratio, RR: 0.64 [95% confidence interval, CI: 0.49, 0.84]) compared to those who did not. In contrast, TPE was associated with increased mortality in septic children without thrombocytopenia-associated multiorgan failure ( RR: 2.23, 95% CI: 1.93, 2.57). There was no difference in outcomes in patients supported with centrifugal and membrane TPE. In both populations, patients supported on TPE as a continuous regime had poorer outcome. Conclusion Current evidence indicates that TPE is a potential adjunct therapy in adults with severe sepsis but not in children.
Purpurin, a Natural Anthroquinone Ameliorates Streptozotocin-induced Diabetic Nephropathy via Attenuating Hyperglycemia, Dyslipidemia, and Inflammation in Rats
Authors: Shang Yan , Mohideen Abubucker Peer 
Published: April 2023

Background Throughout the world, diabetic nephropathy has been treated by managing hyperglycemia and hypertension with antidiabetic and antihypertensive drugs, but the potency of reversing the diabetic nephropathy-induced complications is still questionable. Materials and Methods This study was focused on elucidating the nephroprotective effect of purpurin, a natural anthraquinone, against diabetic nephropathy induced in an in vivo model. Diabetic nephropathy was induced in rats by injecting streptozotocin (STZ) and then treating them with purpurin. The rats were analyzed for food intake, body weight gain, fasting blood glucose (FBG), glycated hemoglobin (HbA1c), serum insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) to analyze the anti-glycemic effect of purpurin on diabetic nephropathy-induced rats. The lipid profile, blood urea nitrogen (BUN), serum creatinine, and lactate dehydrogenase (LDH), and kidney injury molecule-1 (KIM-1) levels were assessed. Proinflammatory cytokines, such as tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and interleukin 6 (IL-6), were quantified to determine the anti-inflammatory effect of purpurin on diabetic nephropathy-induced rats. Finally, histopathological analysis of kidney tissue was performed. Results Purpurin effectively decreased the body weight, FBG, HbA1c, HOMA-IR values, and increased insulin levels. It significantly decreased lipid profiles while increasing high-density lipoprotein (HDL) in diabetic nephropathy-induced rats. It also decreased the BUN, creatinine, LDH, and KIM-1 levels. The reduction in proinflammatory cytokine levels was observed in the purpurin-treated diabetic nephropathy rats. Finally, the histopathological analysis confirms the nephroprotective effect of purpurin. Conclusion Taken together, our results conclude that purpurin possesses therapeutic potency to ameliorate diabetic-induced nephropathy, and it can be a promising drug for diabetic nephropathy in the future.
Early versus standard management of chimeric antigen receptor therapy toxicities and management's impact on safety and efficacy
Authors: Gaffney Kelly J , Davis James A , McGann Mary , Edwards Kathy , Ahmed Zaheer , Butcher Colleen , Greenwell Brian , Hess Brian T , Hashmi Hamza 
Published: April 2023

Background Cytokine release syndrome (CRS) and immune effector cell-associated neurologic syndrome (ICANS) are well-documented toxicities of CAR T-cell therapy. To mitigate excessive toxicity, our center has formulated treatment protocols (early vs. standard) for timely management of CRS and ICANS with tocilizumab and/or corticosteroids. Methods This retrospective, single-center analysis included patients treated with CAR T-cell therapy. The goal was to describe the association of two management protocols with toxicity and efficacy outcomes. Results Fifty-five percent of the 40 patients assigned to early management, out of which 5% and 9% developed grade 3+ CRS and ICANS, respectively. Seventy-seven percent and 41% of these patients received tocilizumab and corticosteroids, respectively. Forty-five percent of patients were stratified as standard management, out of which 0% and 11% developed grade 3+ CRS and ICANS, respectively. Seventeen percent and 28% of these patients received tocilizumab and corticosteroids, respectively. The day +90 overall response rate (ORR) for all patients was 63%, with an ORR of 89% for those managed per early management versus 50% for those managed per standard protocol. Conclusion Early use of tocilizumab and corticosteroids is effective in preventing excessive CAR-T-related toxicities with no negative impact on efficacy.
Updates in the use of targeted therapies for the treatment of cholangiocarcinoma
Authors: Lodl Emma , Ramnaraign Brian , Sahin Ilyas , Wheeler Sarah 
Published: April 2023

Objective Many patients with cholangiocarcinoma (CCA) are not surgical candidates, and the survival benefit of chemotherapy is less than 12 months. Several mutations and mutational clusters have recently been identified in CCA, some of which are pharmacologically targetable. The emergence of targeted therapies has significantly altered the treatment landscape of CCA and improved the prognosis for advanced or metastatic CCA. The purpose of this review is to describe past and current treatment strategies of CCA with a focus on FDA-approved targeted therapies. Data sources A systematic evaluation of all FDA-approved targeted treatments for CCA through October 2022 was conducted. Information related to pharmacology, clinical efficacy, and safety was gathered from the package insert, and clinical trial data. Data summary As of the writing of this review, four targeted agents are FDA approved for the treatment of locally advanced or metastatic CCA. These agents include the IDH1 inhibitor ivosidenib and the FGFR2 inhibitors pemigatinib, infigratinib, and futibatinib. Collectively, these agents have provided additional treatment options for select patients with previously treated locally advanced or unresectable CCA. These agents have also contributed to the development of other targeted therapies for the treatment of CCA and have opened the door for the exploration of novel treatment combinations such as chemotherapy and immunotherapy, which have recently become a front-line treatment option. Conclusions Four targeted small molecule agents have emerged as effective therapies in the second-line setting for CCA, which has immensely changed the treatment landscape and directly led to further investigation of targeted agents and immunotherapy as treatment for CCA.
Systemic lupus erythematosus purtscher like retinopathy: Optical coherence tomography angiography assessment implications
Authors: Garcia-Soler Enrique , Martinez-Rubio Clara , De Smet Marc D. , Udaondo Patricia , Salom-Alonso David 
Published: April 2023

Purpose to underline the importance of optical coherence tomography angiography (OCT-A) in the diagnosis, assessment of final visual outcome and better understanding of the Purtscher like retinopathy, as well as to emphasize on performing an ophthalmologic evaluation in all patients with systemic lupus erythematosus, as eye involvement is closely related with disease activity. Methods case report. Ophthalmologic multimodal imaging assessment of a patient short after experiencing a systemic lupus erythematosus severe outset. Results fundus examination revealed multiple cotton-wool exudates and sharp defined intraretinal white flecken lesions, concentrated in the posterior pole, which along macular edema and the context of lupus disease led to the diagnosis of Purtscher like retinopathy, raising concern about underlying disease activity. OCT-A evidenced ischemic affront in the superficial and deep vascular plexuses but also at choroidal level, preconizing a poor visual outcome. Precapillary retinal vascular stops and choroid lobular ischemic images, with a honey comb configuration in the latter, were of note. Six months after initial consultation, previously displayed ischemic images gave rise to retinal and choroidal atrophy translated into counting fingers best corrected visual acuity with the posterior ensue of retina neovascularization. Conclusions This case proves ophthalmologic evaluation mandatory for all patients suffering from lupus and reveals OCT-A as an imaging tool of great value in the assessment of Purtscher retinopathy. To our knowledge, this would be the first report of a SLE Purtscher-like retinopathy characterized by OCT-A, matching graphically and unprecedently vascular micro-embolism stops and ischemic areas, seen as void signals, with the pathognomonic Purtscher flecken, and Paracentral Acute Middle Maculopathy (PAMM) lesions.
Anatomical Feasibility of an Off-the-shelf Single-Renal Scalloped Stent-Graft for Hostile Neck Abdominal Aortic Aneurysm: A Preclinical Study
Authors: Gennai Stefano , Leone Nicola , Andreoli Francesco , Migliari Mattia , Silingardi Roberto 
Published: April 2023

Objectives: To evaluate the feasibility of a standardized single-renal scallop stent-graft. Design: Preclinical, single-center, real-world, all-comers, retrospective cohort study. Methods: A total of 1347 abdominal aortic aneurysm (AAA) repairs (endovascular and open) performed between 2010 and 2020 were screened for elective treatment and retrievable preoperative high-quality computed tomography angiography (CTA) performed <6 months of the surgical procedure. Six hundred of the included CTAs involved prespecified measurements and a morphological assessment protocol (NCT05150873). The proximal sealing zones suitable for standard stent-graft implantations were further analyzed (N=547). The primary outcome assessed the feasibility of 2 single-renal scallop designs (10×10 mm and 15×10 mm, height × width). The feasibility was the inter-renal length ≥10 mm and ≥15 mm for prototypes #10 and #15, respectively. The secondary outcome quantified hypothetical length and surface improvements comparing those suitable for investigational devices implantation (study group) versus those not (control group). Results: Of the total, 24.7% (n=135) was feasible with prototype #10. The study versus control group sealing zones were shorter (p=0.008), with a smaller surface (p=0.009) and a higher alpha angle (p=0.039). The length and surface area increased by about 25% and 23%, respectively, (both p<0.001) within the study group and became significantly better versus the control group (standard stent-graft; both p<0.001). Of the total, 7.1% (n=39) was suitable for prototype #15. The study versus control group sealing zones were shorter (p=0.148), with a smaller surface (p=0.077) and a higher alpha angle (p=0.027). The length and surface area increased by about 34% and 31%, respectively, (both p<0.001) within the study group and became significantly higher versus the control group (standard stent-graft; both p<0.001). Conclusions: The use of single-renal scalloped stent-graft might be feasible in a considerable number of AAA patients. The breakthrough stands in treating hostile AAAs presenting in mismatched renal arteries, keeping the complexity of the repair as similar as possible to standard endovascular repair with a remarkable improvement in sealing. Clinical Impact The anatomic feasibility of a single renal stent graft for the treatment of “hostile” abdominal aortic aneurysm (AAA) with mismatched renal arteries was evaluated. The experimental device could be feasible in a considerable number of patients with AAA, approaching 25%, and demonstrate significant improvements in sealing. As far as we know, this is the first paper to report the prevalence of mismatched renal arteries in a large cohort of AAA patients in the real world, while proposing a dedicated device. The breakthrough is to keep the complexity of the repair as close as possible to standard endovascular repair
Assessing Endovascular Aneurysm Repair Suitability According to Graft-Specific Instructions for Use in Patients With a Ruptured Abdominal Aortic Aneurysm
Authors: Gjosha Bergin , Jan Boer Gert , Fioole Bram , Buimer M.G. , de Bruin Jorg L. , Suman Arnela , van der Laan Lijckle 
Published: April 2023

Purpose: The purpose of the study is to ascertain endovascular aneurysm repair (EVAR) suitability in relation to stent-graft-specific instructions for use (IFU) in patients with a ruptured abdominal aortic aneurysm (RAAA). Materials and Methods: Using the preoperative computed tomography angiography (CTA), the aortic morphology of patients undergoing surgical repair of a RAAA in 2 Dutch hospitals between January 2014 and December 2019 was retrospectively assessed. Three-dimensional and central luminal line reconstructions were used. Anatomical suitability was defined according to the IFU of the stent graft system used. Results: Of 128 included patients, 112 (88%) were men and the mean age was 74.1 (SD=7.6) years. Anatomy within IFU for EVAR was present in 31 patients (24%). Overall, 94 patients (73%) were treated with open surgical repair (OSR) and 34 patients (27%) were treated with EVAR. Anatomy within IFU was present in 15 OSR patients (16%) and 16 EVAR patients (47%). In patients with anatomy outside of IFU, 90% (87/97) had unsuitable neck anatomy and 64% (62/97) had insufficient neck length. An unsuitable distal iliac landing zone was observed in 35 patients. Perioperative mortality was 27% (34/128), with no difference between OSR and EVAR (25/94 vs 9/34; p=0.989). Conclusion: Most RAAA patients in this series did not have aortic anatomy within IFU for EVAR, mainly due to insufficient neck length. However, whether anatomy outside of IFU equates to unsuitability for EVAR in an emergency setting remains a matter of debate and warrants further research. Clinical Impact The treatment of a ruptured abdominal aortic aneurysm can consist of endovascular repair or open repair. Retrospective anatomical assessment shows that most patients do not have anatomy inside the instructions for use for endovascular aneurysm repair, mainly due to insufficient neck length. Whether anatomy outside the instructions for use equates unsuitability for endovascular aneurysm repair remains a matter of debate.
The Association Between the D-dimer Level at 1 Year After EVAR and Sac Diameter Change in Patients With Persistent Type 2 Endoleak
Authors: Sugimoto Masayuki , Sato Tomohiro , Ikeda Shuta , Kawai Yohei , Niimi Kiyoaki , Banno Hiroshi 
Published: April 2023

Purpose: Recent studies suggested that continuous clotting renewal in thrombi plays a central role in sac enlargement after endovascular aneurysm repair (EVAR). We reviewed patients with persistent type 2 endoleak (T2EL) to estimate the impact of D-dimer level on sac enlargement. Methods: A retrospective review of elective EVAR for infrarenal abdominal aortic aneurysm performed between June 2007 and February 2020. Persistent T2EL was defined as T2EL confirmed at both the 6 and 12 month contrast-enhanced computed tomography (CECT) follow-ups. “Isolated” T2EL was defined as T2EL without other types of endoleak within 12 months. Patients with >2 year follow-up, persistent isolated T2ELs, and D-dimer level data at 1 year (DD1Y) were included. Patients with any reintervention within 12 months were excluded. The association between DD1Y and aneurysm enlargement (AnE), defined as a ≥5 mm diameter increase, within 5 years was analyzed. Among 761 conventional EVAR, 515 patients had >2 years of follow-up. Thirty-three patients with any reintervention within 12 months and 127 patients without CECT at either 6 or 12 months were excluded. Among 131 patients with persistent isolated T2ELs, 74 patients with DD1Y data were enrolled. During a 37 month median follow-up [25–60, IQR], 24 AnEs were observed. In the AnE patients, the median DD1Y was significantly higher than that in the other patients (12.30 [6.88–21.90] vs 7.62 [4.41–13.00], P=0.024). ROC curve analysis indicated that the optimal cutoff point of DD1Y for AnE was 5.5 µg/mL (AUC=0.681). In univariate analysis, angulated neck, occlusion of the inferior mesenteric artery, and DD1Y≥5.5 µg/mL were significantly associated with AnE (P= 0.037, 0.038, and 0.010). Cox regression analysis revealed that DD1Y≥5.5 µg/mL was correlated with AnE (P=0.042, HR [95% CI] 4.520 [1.056–19.349]). Conclusion: A 1 year higher D-dimer level can potentially predict AnE within 5 years in persistent T2EL patients. AnE was considered improbable when the D-dimer level was low enough. Clinical Impact The present study suggests that a 1-year higher D-dimer level could potentially predict aneurysm expansion within 5 years in patients with persistent type 2 endoleak (T2EL). On the other hand, aneurysm expansion was considered unlikely if the D-dimer level was low enough. As there are many patients with T2EL who require regular follow-up, any predictor of future aneurysm expansion could be of great help in conserving medical resources. In patients with a low likelihood of future expansion, we might consider delaying follow-up, similar to patients with sac shrinkage.
Four cases of localized plaque psoriasis successfully treated by intense pulsed light: A case series
Authors: Hu Cai-Xia , Cui Yu , Cheng Yi , Gao Shun-Qiang , Wang Wen-Qing , Jiang Shao-Qian , Zhang Yan 
Published: April 2023

Four patients with localized plaque psoriasis had used various systemic drugs along with topical cream. However, their skin lesions recurred, and the disease was refractory. After 2 weeks of discontinuation of oral and external medication, they were given three consecutive irradiation treatments with intense pulsed light once every 2 weeks for a 6-week period. After treating for 6 weeks, the erythema colors of the patients were evidently darkened, the scales were evidently reduced, and the skin lesions were significantly thinner or even flattened. The treatment was satisfactory, without occurrence of severe adverse reactions.
Dynamic data-enabled stratified sampling for trial invitations with application in NHS-Galleri
Authors: Brentnall Adam R , Mathews Chris , Beare Sandy , Ching Jennifer , Sleeth Michelle , Sasieni Peter 
Published: April 2023

Background: Participants of health research studies such as cancer screening trials usually have better health than the target population. Data-enabled recruitment strategies might be used to help minimise healthy volunteer effects on study power and improve equity. Methods: A computer algorithm was developed to help target trial invitations. It assumes participants are recruited from distinct sites (such as different physical locations or periods in time) that are served by clusters (such as general practitioners in England, or geographical areas), and the population may be split into defined groups (such as age and sex bands). The problem is to decide the number of people to invite from each group, such that all recruitment slots are filled, healthy volunteer effects are accounted for, and equity is achieved through representation in sufficient numbers of all major societal and ethnic groups. A linear programme was formulated for this problem. Results: The optimisation problem was solved dynamically for invitations to the NHS-Galleri trial (ISRCTN91431511). This multi-cancer screening trial aimed to recruit 140,000 participants from areas in England over 10 months. Public data sources were used for objective function weights, and constraints. Invitations were sent by sampling according to lists generated by the algorithm. To help achieve equity the algorithm tilts the invitation sampling distribution towards groups that are less likely to join. To mitigate healthy volunteer effects, it requires a minimum expected event rate of the primary outcome in the trial. Conclusion: Our invitation algorithm is a novel data-enabled approach to recruitment that is designed to address healthy volunteer effects and inequity in health research studies. It could be adapted for use in other trials or research studies.
Ultrasound-Guided Glenohumeral Corticosteroid Injection for the Treatment of Adhesive Capsulitis of the Shoulder: The Role of Clinical Stage in Response to Treatment
Authors: Ammerman Brittany M. , Dennis Elizabeth R. , Ling Daphne , Hannafin Jo A. 
Published: April 2023

Background: Treatment for idiopathic adhesive capsulitis of the shoulder remains controversial. Stages 1 to 2 reflect an inflammatory process supporting a rationale for intra-articular glenohumeral joint corticosteroid injection to treat synovial inflammation and prevent progression to capsular fibrosis. Hypothesis: We hypothesize that an intra-articular ultrasound-guided glenohumeral injection (USGI) of corticosteroid in patients diagnosed with Stage 1 or 2 idiopathic adhesive capsulitis will result in timely functional recovery and resolution of pain and stiffness. Study Design: Case series. Level of Evidence: Level 4. Methods: Patients with Stage 1 or 2 idiopathic adhesive capsulitis treated with an intra-articular corticosteroid injection were included. Patients were seen by a single physician and diagnosed using history and physical examination with careful attention to measurement of glenohumeral range of motion (ROM). A total of 61 patients met inclusion criteria. ROM measurements documented in the patient charts were recorded in forward flexion, abduction, internal rotation, and external rotation in neutral abduction. All ROM measurements were performed pre- and postinjection. All patients were treated with an USGI of local anesthetic and depomedrol. Recovery criteria were defined as forward flexion, abduction, and external rotation within 15° of the contralateral side and internal rotation within 3 spinous process levels of the contralateral side. Results: A total of 11 patients with Stage 1 and 50 patients with Stage 2 adhesive capsulitis comprised the final study cohort. Within the Stage 1 cohort, all 11 patients met recovery criteria for forward flexion and internal rotation (100%), 10 met recovery criteria for abduction (91%), and 8 met recovery criteria for external rotation (73%). Within the Stage 2 cohort, 31 patients met recovery criteria for forward flexion (62%), 30 met recovery criteria for abduction (60%), 36 met recovery criteria for internal rotation (72%), and 25 met recovery criteria for external rotation (50%). The difference in time to recovery in days was statistically significant in all ROM planes and was within 2 to 6 weeks for patients in Stage 1 and 7 to 10 weeks for Stage 2. Conclusion: USGI for early adhesive capsulitis allows patients to recover ROM more rapidly if performed early after onset of pain and stiffness. Clinical Relevance: These results stress the importance of recognition of idiopathic adhesive capsulitis in its early stages and subsequent intervention with an intra-articular glenohumeral corticosteroid injection.