bluuebunny/crossref_metadata_2025_split huggingface dataset:
Compassionate de-escalation of life-sustaining treatments in pediatric oncology: An opportunity for palliative care and intensive care collaboration
Authors: Cuviello Andrea , Pasli Melisa , Hurley Caitlin , Bhatia Shalini , Anghelescu Doralina L. , Baker Justin N. 
Published: October 2022

ContextApproximately 40%-60% of deaths in the pediatric intensive care unit (PICU) are in the context of de-escalation of life-sustaining treatments (LSTs), including compassionate extubation, withdrawal of vasopressors, or other LSTs. Suffering at the end of life (EOL) is often undertreated and underrecognized. Pain and poor quality of life are common concerns amongst parents and providers at a child’s EOL. Integration of palliative care (PC) may decrease suffering and improve symptom management in many clinical situations; however, few studies have described medical management and symptom burden in children with cancer in the pediatric intensive care unit (PICU) undergoing de-escalation of LSTs.MethodsA retrospective chart review was completed for deceased pediatric oncology patients who experienced compassionate extubation and/or withdrawal of vasopressor support at EOL in the PICU. Demographics, EOL characteristics, and medication use for symptom management were abstracted. Descriptive analyses were applied.ResultsCharts of 43 patients treated over a 10-year period were reviewed. Most patients (69.8%) were white males who had undergone hematopoietic stem cell transplantation and experienced compassionate extubation (67.4%) and/or withdrawal of vasopressor support (44.2%). The majority (88.3%) had a physician order for scope of treatment (POST – DNaR) in place an average of 13.9 days before death. PC was consulted for all but one patient; however, in 18.6% of cases, consultations occurred on the day of death. During EOL, many patients received medications to treat or prevent respiratory distress, pain, and agitation/anxiety. Sedative medications were utilized, specifically propofol (14%), dexmedetomidine (12%), or both (44%), often with opioids and benzodiazepines.ConclusionsPediatric oncology patients undergoing de-escalation of LSTs experience symptoms of pain, anxiety, and respiratory distress during EOL. Dexmedetomidine and propofol may help prevent and/or relieve suffering during compassionate de-escalation of LSTs. Further efforts to optimize institutional policies, education, and collaborations between pediatric intensivists and PC teams are needed.
The staging performance of a modified tumor-node-metastasis staging system incorporated with lymphovascular invasion in patients with esophageal squamous cell carcinoma
Authors: Zhuang Weitao , Wu Hansheng , Chen Rixin , Ben Xiaosong , Huang Shujie , Zhou Zihao , Wu Junhan , Tang Yong , Qiao Guibin 
Published: October 2022

BackgroundLymphovascular invasion (LVI) is recognized as an unfavorable prognostic factor for many solid tumors. However, its staging value has not been adequately illustrated in esophageal squamous cell carcinoma (ESCC).MethodsThe clinicopathologic relevance and prognostic impact of LVI were retrospectively analyzed in 822 patients with surgically treated ESCC. Univariate and multivariate analyses were used to determine the independent prognostic factors. Subgroup analyses stratified by pathological stages, nodal status and invasive depth were conducted using Kaplan–Meier method and log-rank test. Multiple staging models based on overall survival (OS) were constructed using Cox regression and evaluated by Harrell’s concordance index (C-index), integrated discrimination improvement (IDI), and net reclassification index (NRI).ResultsLVI was detected in 24.6% of ESCC patients, and its prevalence increased with a higher pathological stage (p &lt; 0.001). In multivariate analysis, LVI was found to be an independent prognostic factor for OS [Hazard ratio (HR) = 1.545, 95% CI, 1.201–1.986), and was associated with unfavorable outcomes in stage I to III ESCC, regardless of nodal status and invasive depth. The staging model that incorporated LVI as an independent factor achieved the greatest improvement in accuracy (ΔC-index: 2.9%), and the greatest added value (IDI 2.8%, p &lt; 0.01; NRI 13.7%, p &lt; 0.05) for prediction of OS in ESCC patients.ConclusionsLVI can facilitate further survival stratification in ESCC patients. The adoption of LVI as an independent staging factor in the current cancer staging system should be considered and further validated.
Case report: Primary intracranial EWs/PNET in adults: Clinical experience and literature review
Authors: Hu Xianwen , Huang Qi , Wang Ju , Li Dandan , Wang Pan , Cai Jiong 
Published: October 2022

IntroductionAdult primary intracranial Ewing sarcomas (EWs)/primitive neuroectodermal tumors (PNETs) are extremely rare, with only 30 patients published before us. The imaging features and treatment strategies of primary intracranial EWs/PNETs are unclear due to its rarity. The aim of this study was to investigate the clinical features, imaging findings, treatment, survival analysis, and prognosis of adult EWs/PNETs, and a systematic review was conducted based on the patient we treated and published literature.Case descriptionA 19-year-old male patient suffered from head pain due to an accidental fall on a motorcycle that occurred more than 10 days before going to the hospital, and underwent computed tomography (CT) examination; it was found that the left temporo-occipital fossa was occupied. Magnetic resonance imaging (MRI) was recommended to understand the nature of the lesion, and the result showed that it has a high probability of being a meningioma. He underwent surgical removal of the mass under general anesthesia, and surprisingly, postoperative pathology revealed EWs/PNET. The disease has a high degree of malignancy, and the patient developed multiple metastases throughout the body 5 years after surgery.ConclusionPrimary intracranial EWs/PNETs in adult patients are rare, of which imaging findings should be considered as one of the differential diagnoses of meningioma, hemangiopericytoma, and malignant triton tumor. Larger solid-cystic masses with septum-like enhancement may be relatively specific imaging findings of intracranial EWs/PNETs. The prognosis of primary adult intracranial EWs/PNETs is poor. Radical tumor resection combined with radiotherapy and chemotherapy is currently the main and possibly the most effective treatment method.
Severe Staphylococcus aureus infections in children: Case reports and management of positive Panton-Valentine leucocidin cases
Authors: Goemanne Sophie , Tilmanne Anne , Biarent Dominique , Smeesters Pierre , Simoni Paolo , Mahadeb Bhavna Ansuya , Vicinanza Alfredo 
Published: October 2022

BackgroundStaphylococcus aureus is a well-known bacterium associated with carriage and responsible for different types of infections. The Panton-Valentine leucocidin (PVL) is a key virulence factor causing tissue necrosis. PVL can, however, be present in both benign and life-threatening infections.Case reports and managementWe present three pediatric severe infections occurring over a period of only three weeks, in February 2021, and caused by genetically unrelated methicillin-sensitive Staphylococcus aureus producing PVL in a tertiary children’s hospital in Belgium. The first one presented with necrotizing pneumonia, the second one with a neck abscess extended to the mediastinum, and the last one had sacral osteomyelitis complicated by endocarditis. The management of these infections is mostly based on expert opinions. The most appropriate treatment seems to be the combination of early surgical drainage of infected collections with an antibiotic regimen associating two antibiotics; beta-lactams and either clindamycin or linezolid. Human immunoglobulins also appear to be useful as adjunctive therapy.ConclusionPVL-producing Staphylococcus aureus is associated with life-threatening infections in children. Prompt management is needed including surgery and appropriate antibiotic regimens.
Trifluridine/tipiracil as a therapeutic option in real life setting of metastatic colorectal cancer: An efficacy and safety analysis
Authors: Sur Daniel , Lungulescu Cristina , Spînu Ștefan , Gorzo Alecsandra , Dumitrescu Elena-Adriana , Gheonea Dan Ionut , Lungulescu Cristian-Virgil 
Published: October 2022

Background: In the phase III RECOURSE trial, the orally administered combination trifluridine/tipiracil (FTD/TPI) demonstrated a survival benefit and an acceptable safety profile, earning approval as a third-line therapy in metastatic colorectal cancer (mCRC). This study aimed to assess the efficacy and safety of FTD/TPI in daily clinical practice in Romanian population.Methods: A single-center, retrospective, and observational study analyzed patients with mCRC that received chemotherapy with trifluridine/tipiracil between May 2019 and May 2022 at the Oncology Institute Prof. Dr. Ion Chiricuță in Cluj-Napoca, Romania. Study endpoints included safety, and median progression-free survival (PFS).Results: In this Romanian cohort (n = 50) the most common treatment-emergent adverse event was haematological toxicity (76%): anemia (50%), leucopenia (38%), neutropenia (34%), and thrombocytopenia (30%), followed by fatigue (60%), and abdominal pain (18%). Overall, the median progression-free survival was 3.85 months (95% CI: 3.1–4.6 months). PFS was significantly correlated with the number of FTD/TPI administrations and prior surgery.Conclusion: Our study corroborated the previously described safety profile for FTD/TPI in the third-line setting, and demonstrated relatively superior mPFS.
Blood flow restriction training promotes functional recovery of knee joint in patients after arthroscopic partial meniscectomy: A randomized clinical trial
Authors: Ke Junjie , Zhou Xuchang , Yang Yajing , Shen Hai , Luo Xiaobing , Liu Hui , Gao Lu , He Xin , Zhang Xin 
Published: October 2022

Purpose: To explore the effect of blood flow restriction training (BFRT) on the recovery of knee function in patients after arthroscopic partial meniscectomy (APM).Methods: Forty patients undergoing APM surgery were included in this parallel group, two-arm, single-assessor blinded, randomized clinical trial. The subjects were randomly divided into two groups: routine rehabilitation group (RR Group, n = 20) and routine rehabilitation + blood flow restriction training group (RR + BFRT Group, n = 20). One subject in each group dropped out during the experiment. All patients received 8 weeks of routine rehabilitation starting from the second day after APM. In addition, patients in the RR + BFRT group required additional BFRT twice a week. Visual analogue scale (VAS) score, range of motion (ROM), one-leg standing test (OLST) score, Lysholm knee score, quadriceps muscle strength, quadriceps thickness, and thigh circumference were evaluated at preoperative, postoperative, 4 and 8 weeks after surgery. SPSS 25.0 software was used for statistical analysis of the data. Repeated measures ANOVA was used if the data were normally distributed and had homogeneity of variance. Generalized estimating equations were chosen if the data were not normally distributed or had homogeneity of variance.Results: There were no significant differences in VAS score, ROM, OLST score, Lysholm knee score, quadriceps muscle strength, quadriceps thickness, and thigh circumference between the two groups before surgery (p &gt; 0.05). Compared with postoperative, VAS score, ROM, OLST score, Lysholm knee score, and thigh circumference were significantly improved in the RR group (p &lt; 0.05), while quadriceps muscle strength and quadriceps thickness were not significantly enhanced at 8 weeks postoperatively (p &gt; 0.05). However, VAS score, ROM, OLST score, Lysholm knee score, quadriceps muscle strength, quadriceps thickness, and thigh circumference were all significantly improved in the RR + BFRT group at 8 weeks postoperatively (p &lt; 0.05). Furthermore, compared with the RR group, VAS score (50% vs. 86%), ROM (7.9% vs. 16.0%), OLST score (57.3% vs. 130.1%), Lysholm knee score (38.4% vs. 55.7%), relative peak torque (11.0% vs. 84.7%), mean power (20.6% vs. 88.1%), rectus femoris thickness (0.40% vs. 13.0%), vastus medialis (0.29% vs. 5.32%), vastus lateralis (0% vs. 6.2%), vastus internus (0% vs. 5.8%), and thigh circumference (2.7% vs. 5.8%) in the RR + BFRT group were significantly improved at 4 and 8 weeks postoperatively (p &lt; 0.05).Conclusion: BFRT combined with routine rehabilitation training can better promote the recovery of knee joint function in patients after APM, especially the improvement of quadriceps muscle strength and thickness.
Dynamics and correlations of chlorophyll and phytol content with silage bacterial of different growth heights Pennisetum sinese
Authors: Li Mao , Lv Renlong , Zhou Hanlin , Zi Xuejuan 
Published: October 2022

The dynamics and correlations of chlorophyll and phytol content with silage bacterial of different growth heights Pennisetum sinese were investigated. The results demonstrated that the chlorophyll and phytol content of P. sinese before and after ensiled decreased with the increase of growth height. Ensiling significantly reduced pigment content but had no significant effect on phytol. In addition, P. sinese pigment yield before and after ensiled increased with growth heights increasing, and the yield at 150 or 180 cm was obviously higher. Moreover, the higher silage quality V-Score were at 150 or 180 cm growth heights. Furthermore, the silage microbial diversity were varied by growth heights, and some specific undesirable microorganisms (Acinetobacter, Cellvibrio, Sphingobacterium, etc.) were negatively correlated with pigment and phytol content. Therefore, with comprehensive consideration of pigment, phytol yield, and silage quality, the optimum harvest growth height of P. sinese was 150 cm. Furthermore, precise reduction of particular undesirable microorganisms maybe helps to preserve pigments and phytol.
Psychometric properties of the Collective Efficacy Scale Short-Form in Chilean teachers
Authors: Herrera Camilo , Torres-Vallejos Javier , Martínez-Libano Jonathan 
Published: October 2022

BackgroundThe Collective Efficacy Scale Short-Form (CES-SF) is a short and reliable instrument that assesses collective efficacy in schools at a group level. Previous research has shown a two-factor structure considering the perception of the group competence about their teaching capabilities and task analysis that refers to the opportunities inherent to a specific task. However, there is no conclusive evidence that collective efficacy corresponds to a two-factor model or single-factor structure.MethodsA cross-sectional research was conducted on a 693 sample of teachers (Mage = 39.4; SD = 11.8) from schools in the 16 regions of Chile. They were assessed using the CES-SF, Personal Well-being Index, Social Well-Being Scale, and satisfaction with the school. Exploratory and confirmatory factor analyses were used to assess the construct validity of the CES-SF.ResultsThe CES-SF showed mixed results about its construct validity. Best fit has been found to retain two new factors (opportunities and challenges for collective efficacy) with eight items each, yielding a McDonald’s ω of 0.803. Convergent validity was also established.ConclusionThe psychometric results suggest that a two-factor structure for the CES-SF is a valid and reliable measure for this construct for Chilean teachers. However, collective efficacy might not strongly relate to subjective wellbeing but to school-context variables.
Profiles and factors associated with schizophrenia in eastern Ethiopia: A matched case-control study
Authors: Mohammed Fethia , Geda Biftu , Yadeta Tesfaye Assebe , Dessie Yadeta 
Published: October 2022

BackgroundDespite its strong hereditary and genetic connections, there are other factors reported to be linked to schizophrenia, but not well studied in eastern Ethiopia.ObjectiveThis study was aimed to investigating the potential profiles and factors associated with schizophrenia in eastern Ethiopia.Materials and methodsA matched case-control study was conducted in two public hospitals from December 1, 2021, to January 30, 2022. Cases were patients with schizophrenia who visited the hospitals, and controls were healthy individuals without any mental illness who visited the same hospitals. A questionnaire was used to collect the data. Cases and controls were matched using age and sex. STATA-14 was used for analysis. A conditional logistic regression with an adjusted odds ratio (AOR) and a 95% confidence interval (CI) was applied to identify the determinants. P-values of &lt;0.05 were used to build the final model as a measure of statistical significance.ResultsThe mean age of the study participants group was 28.6 (±8.44) years, mean age for cases was 28.7(±8.5) ranging from 18 to 56 years and the mean age for the controls was 28.4 (±8.5), ranging from 18 to 60 years. About 181 (83.03%) of the participants were male. The odds of having schizophrenia was about 12.2 times higher among participants with family history of mental illness (AOR: 12.21; 95% CI: 4.83–30.00). The odds of having schizophrenia was 4.5 times higher among polysubstance users (AOR: 4.45; 95% CI: 1.28–5.45) and 2.8 times higher among khat consumers (AOR: 2.82; 95% CI: 1.23–6.45) compared to their counterparts.ConclusionOur findings show that genetic risk factors as well as some modifiable behaviors are associated to schizophrenia in eastern Ethiopia. At all levels, special attention should be given to those who are at risk.
Distinct alterations of functional connectivity of the basal forebrain subregions in insomnia disorder
Authors: Jiang Guihua , Feng Ying , Li Meng , Wen Hua , Wang Tianyue , Shen Yanan , Chen Ziwei , Li Shumei 
Published: October 2022

BackgroundCholinergic basal forebrain (BF) plays an important role in sleep-wake regulation and is implicated in cortical arousal and activation. However, less is known currently regarding the abnormal BF-related neuronal circuit in human patients with insomnia disorder (ID). In this study, we aimed to explore alterations of functional connectivity (FC) in subregions of the BF and the relationships between FC alterations and sleep and mood measures in ID.Materials and methodsOne hundred and two ID patients and ninety-six healthy controls (HC) were included in this study. Each subject underwent both resting-state fMRI and high-resolution anatomical scanning. All participants completed the sleep and mood questionnaires in ID patients. Voxel-based resting-state FC in each BF subregion (Ch_123 and Ch_4) were computed. For the voxel-wise FC differences between groups, a two-sample t-test was performed on the individual maps in a voxel-by-voxel manner. To examine linear relationships with sleep and mood measures, Pearson correlations were calculated between FC alterations and sleep and mood measures, respectively.ResultsThe ID group showed significantly decreased FC between the medial superior frontal gyrus and Ch_123 compared to HC. However, increased FC between the midbrain and Ch_4 was found in ID based on the voxel-wise analysis. The correlation analysis only revealed that the altered FC between the midbrain with Ch_4 was significantly negatively correlated with the self-rating anxiety scale.ConclusionOur findings of decreased FC between Ch_123 and medial superior frontal gyrus and increased FC between midbrain and Ch4 suggest distinct roles of subregions of BF underlying the neurobiology of ID.
Effect of grand multiparity on adverse maternal outcomes: A prospective cohort study
Authors: Dasa Tamirat Tesfaye , Okunlola Michael A. , Dessie Yadeta 
Published: October 2022

BackgroundGrand multiparity remains a risk factor for a wide range of obstetric complications, especially in developing countries. Grand multiparity has been shown to increase the risks of medical and obstetric complications during pregnancies. However, in a research setting, the risk factors associated with adverse maternal outcomes have yet to be adequately investigated among grand multiparity. Furthermore, there is limited information that examines the effect of grand multiparity on pregnancy outcomes in Ethiopia through prospective follow-up design.ObjectiveThis study aimed to investigate the effect of grand multiparity on pregnancy outcomes in selected public hospitals in the Sidama Region State of Ethiopia.MethodsA prospective cohort study design was employed on 837 pregnant women who were admitted for delivery in selected public hospitals from January 1 to August 31, 2021. The study subjects were recruited during admission for labor and delivery. Every woman who was admitted to labor wards was screened for eligibility. The exposed group in this cohort was grand multiparity, and the non-exposed group was multiparity. Data collection was started from the first contact after admission and follow-up to discharge for adverse maternal outcomes. The risk factors for adverse maternal outcomes in grand multiparity were investigated using multivariable Poisson regression analysis. The risk factor was reported as an adjusted risk ratio (ARR) with a 95% confidence interval (CI). When theP-value was &lt;0.05, statistical significance was declared.ResultsThe cohort's overall cumulative incidence of adverse maternal outcomes were 39.9% (95%CI: 36.6, 43.4%). Among exposed groups, the incidence of adverse maternal outcomes were 47.1% (95%CI: 41.0–53.2) and 36.3% (95% CI: 32.3–40.6) the multiparity. When compared to multiparous women, grand multiparity was associated with a greater risk of postpartum hemorrhage (ARR = 2.1; 95%CI:1.6–2.7) and malpresentation (ARR = 1.3; 95% CI: 1.01–1.7).ConclusionsPregnant women with grand multiparity have a higher incidence of adverse maternal outcomes. Grand multiparity increased the risk of adverse maternal outcomes such as postpartum bleeding and malpresentation. In low-resource settings, we recommend that community health education, the provision of accessible and effective contraceptive services, and increased awareness of the adverse maternal outcome among grand multiparity during pregnancy on obstetric performance should be prioritized. Also, trained health providers can effectively decrease the risk factor with good antenatal care and delivery.