bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complement Activation in Patients With Heat-Related Illnesses: Soluble CD59 Is a Novel Biomarker Indicating Severity of Heat-Related Illnesses
Authors: Nakamura Yuki , Sueyoshi Koichiro , Miyoshi Yukari , Ishihara Tadashi , Hirano Yohei , Kondo Yutaka , Kuroda Yoko , Iwabuchi Kazuhisa , Okamoto Ken , Tanaka Hiroshi 
Published: April 2022

OBJECTIVES:
Although multiple organ dysfunction syndrome (MODS) is the main cause of death in patients with heat-related illnesses, its underlying pathophysiological mechanism remains elusive. Complement activation is considered one of the main causes of MODS in patients with sepsis and trauma. Considering the pathophysiological similarity of heat related-illnesses with sepsis and trauma, the complement system might be activated in patients with heat-related illnesses as well. Our aim was to investigate whether excessive complement activation occurs in patients with heat-related illnesses.

DESIGN:
Prospective observational study.

SETTING:
Emergency department in the university hospital.

PATIENTS:
Thirty-two patients with heat-related illnesses and 15 age-matched healthy controls were enrolled in this study.

INTERVENTIONS:
Blood samples were collected from the study subjects for the measurement of complement factors.

MEASUREMENTS AND MAIN RESULTS:
Complement component 3a (C3a), complement component 5a (C5a), C5b-9, complement factor B (Ba), Factor H, and soluble CD59 in plasma were measured. The levels of C3a, C5a, C5b-9, and Ba significantly increased in patients with heat-related illnesses on day 0 compared with those in the healthy controls. Soluble CD59 was significantly high in patients with heat-related illnesses on day 0 and showed a correlation with the severity of the condition (Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment, and staging scores), Japanese Association for Acute Medicine disseminated intravascular coagulation scores, and the coagulation system (prothrombin time and fibrin degradation products).

CONCLUSIONS:
The complement system was activated in patients with heat-related illnesses, suggesting that it is one of the causes of MODS. Soluble CD59 may be a potent biomarker for the severity of heat-related illnesses.
Short-term ADT and Dose-escalated IMRT in Patients With Intermediate-risk Prostate Cancer
Authors: Post Carl M. , Kahn Jenna M. , Turina Claire B. , Beer Tomasz M. , Hung Arthur Y. 
Published: April 2022

Objectives:
In the era of dose-escalated prostate radiation therapy (RT), the use of androgen deprivation therapy (ADT) is undefined for intermediate-risk (IR) prostate cancer. There is growing concern of the risk of ADT to be detrimental to quality of life. This single-institution retrospective analysis aimed to evaluate outcomes of IR patients treated with dose-escalated intensity modulated radiation therapy (IMRT) with or without concurrent/adjuvant short-term ADT.

Materials and Methods:
Data was collected from 260 consecutive patients treated with dose-escalated IMRT with daily image-guided RT for newly diagnosed IR prostate cancer. Biochemical recurrence-free survival (BCRFS), distant metastasis-free survival, prostate cancer-specific survival, and overall survival (OS) were calculated using Kaplan-Meier methodology.

Results:
Median follow-up was 93 months. A total of 181 patients had unfavorable IR disease, and 36.2% (N=94) received ADT, with median ADT duration of 6 months. Seven-year BCRFS was 94.1% vs. 86.2% (P=0.067), for ADT and no ADT, respectively, and no difference in distant metastasis-free survival or prostate cancer-specific survival was observed. ADT was associated with significantly worse 7-year OS (80.0% vs. 91.3%, P=0.010). Analysis of the unfavorable IR cohort alone, showed similar results; 7-year BCRFS and 7-year OS in patients who received ADT versus no ADT were 93.7% vs. 85.9% (P=0.093), and 79.0% vs. 90.6% (P=0.019), respectively.

Conclusions:
In our 15-year experience treating IR prostate cancer with dose-escalated IMRT with daily image-guided RT, short-term concurrent ADT was associated with a statistically significant worse OS. Additional studies are needed to determine if ADT is beneficial or detrimental for patients with IR prostate cancer treated with dose-escalated radiation.
Patients are Willing and Successful With Home Suture Removal After Mohs Surgical Procedures
Authors: Seger Edward W. , Neill Brett C. , Patel Soham , Siscos Spyros M. , Hocker Thomas L. H. 
Published: April 2022

BACKGROUND
Suture removal after surgery is low risk; however, it is often performed by a medical provider. The current SARS-CoV-2 pandemic has forced providers to assess means of reducing in-person contact.

OBJECTIVE
To determine whether patients undergoing Mohs surgery are willing and successful with home suture removal.

MATERIALS AND METHODS
A prospective study was performed with patients undergoing Mohs surgery. Before their surgery, patients were assessed for their willingness to remove sutures before and after viewing educational material. Patients who were willing to attempt removal were contacted after expected suture removal date to verify success and assess their experience.

RESULTS
One hundred fifty patients were enrolled in the study. 90.1% were willing to attempt home suture removal. Patients were more willing (p = .003), more confident (p = .024), and had lower anxiety (p = .049) with removal after viewing educational resources. Patients with a history of suture removal were more likely to attempt removal after their procedure (p = .036). Ninety-seven percent of patients who were willing to attempt suture removal were successful. There were no major complications with removal.

CONCLUSION
Patients were overwhelmingly successful with suture removal after an educational intervention. Providers should consider providing this option after surgical procedures when clinically appropriate.
BARTONELLA HENSELAE–ASSOCIATED OPTIC NEUROPATHY PRESENTING AS A CENTRAL SCOTOMA IN THE ABSENCE OF OVERT PAPILLITIS: A MULTIMODAL IMAGING STUDY
Authors: Ng Caleb C. , McDonald H. Richard , Bern Bruce H. , Carson Michael D. , Cunningham Emmett T. 
Published: April 2022

Background/Purpose:
The purpose of this report was to describe the use of multimodal imaging to establish the diagnosis of Bartonella henselae–associated optic neuropathy in a patient who presented with a central scotoma without overt evidence of optic nerve involvement.

Methods:
This was a case report. Main outcome measures included clinical, optical coherence tomography, and fluorescein angiography findings.

Observations:
A 72-year-old woman presented with a 3-day history of central scotoma in the left eye. Her examination was remarkable for faint exudation in the nasal macula of the left eye but was otherwise normal for her age. Spectral domain optical coherence tomography of the macula revealed mild thickening of the papillomacular bundle with scattered small cystoid spaces and several intraretinal exudates, none of which were visible clinically. Fluorescein angiography revealed localized leakage of the inferotemporal optic disc. When prompted, the patient recalled being scratched multiple times by her two pet kittens. Serial testing showed rising anti–B. henselae (B. henselae) immunoglobulin G antibody titers to 1:1,280, confirming the suspected diagnosis of B. henselae–associated optic neuropathy.

Conclusion:

Bartonella-associated optic nerve involvement can occur without overt evidence of optic disc swelling. Multimodal imaging can be used to suggest the diagnosis and support appropriate serologic testing.
Psychometric Evaluation of the Korean Version of the Functional Assessment of Chronic Illness Therapy-Fatigue
Authors: LEE Won-Gyeom , KIM Hee-Ju 
Published: April 2022

ABSTRACT

Background
The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) instrument is a fatigue measure widely used on patients with cancer worldwide. The psychometric quality of the Korean version of the FACIT-Fatigue instrument has never been systematically evaluated.

Purpose
The purpose of this study was to assess the reliability and validity of the Korean version of the FACIT-Fatigue instrument.

Methods
This study used data collected from 170 patients with cancer and 120 healthy individuals. Internal consistency reliability was analyzed using Cronbach's α and item–total correlation. Construct validity was analyzed using confirmatory factor analysis, and known-group validity was tested using t tests. Convergent validity was analyzed using Pearson's correlation with pain and functional limitations. Predictive validity was analyzed using receiver operating characteristic curves.

Results
The Cronbach's α was .93 for the reliability evaluation, and the item–total correlation ranged from .27 to .84. In the construct validity evaluation, the bifactor model showed good fit (Q = 1.93, comparative fit index = .97, Tucker–Lewis index = .96, root mean square error of approximation = .05), indicating using the instrument's total score to be more appropriate than using the subscale scores (explained common variance = .76, ω = .95, ωH = .85, ωH/ω = .89). The group of patients with cancer showed significantly higher fatigue than the healthy subject group, showing known-group validity (t = −10.40, p < .05). Fatigue showed significant and strong correlations with functional limitations and pain (all ps < .001). The area under the curve was .81 (cutoff point = 40, Youden's index: 0.47, sensitivity: 77.60%, specificity: 73.04%), verifying that the instrument is predictive of higher fatigue severity in patients with cancer.

Conclusions/Implications for Practice
The Korean version of the FACIT-Fatigue instrument was shown to be reliable and valid. Its construct validity supports the use of the total scale score rather than the subscale scores.
Investigation of the Experience of Immigrant Nurses in a Diverse Cultural Setting
Authors: AL-NUSAIR Hussam , ALNJADAT Rafi 
Published: April 2022

ABSTRACT

Background
Work-related stress (WRS) is one of the most common stressors in healthcare workplace settings.

Purpose
This research study was designed to examine and discuss perceived WRS, job performance, social support, and the desire of immigrant nurses to work in a multicultural workplace.

Methods
A case research mixed-methodology approach, a quantitative survey, and semistructured qualitative interviews were used in this research study. Three hundred twenty-one respondents were invited, of which 246 (76.6%) returned valid questionnaires. A purposeful sampling technique was used in the qualitative portion of the study. A semistructured interviewing system was used on 20 nurses.

Results
“Workload” was the most common traumatic occurrence, whereas “treatment” and “death and dying” were the least common traumatic occurrences. Similarly, the mean of the social support scale, as defined using the McCain and Marklin Social Integration Scale, was moderate to high, suggesting that most of the participants received strong social support from their colleagues. The qualitative research found that the participants faced high pressures related to work and have struggled to acquire cultural skills, while having difficulties meeting their patients' cultural and spiritual needs and sustaining high-quality nursing care.

Conclusions
The findings of this study support that immigrant nurses working in the Kingdom of Saudi Arabia are stressed. A significant difference between the qualitative and quantitative results was found. The findings further contribute to our understanding of WRS, social support, job performance, and intention to stay among immigrant nurses in the Kingdom of Saudi Arabia.
Comparative study on treatment of acute cerebral infarction between mechanical thrombectomy by micro catheter and thrombectomy by Solitaire AB stent
Authors: Dong Xiaoli , Xu Guodong , Song Yaxue , Ma Liang , Huo Tiantian , Yin Nan , Meng Nan 
Published: April 2022

Abstract

Background:
Acute cerebral artery occlusion is a common disease with high morbidity and mortality. At present, the commonly used mechanical thrombectomy schemes are mechanical thrombectomy and stent thrombectomy. However, the clinical differences between the two methods is not fully understood. The present study aimed to evaluate the clinical effectiveness of Solitaire AB stent thrombectomy for acute cerebral infarction (ACI).

Methods:
A retrospective study was carried out in 96 ACI patients admitted to our department from January 2017 to January 2020. According to the treatment they received, they were divided into group A (conventional microcatheter mechanical thrombectomy, n = 48) and group B (Solitaire AB stent thrombectomy, n = 48). All patients were followed up for 3 months. Their pre- and post-operative nerve function indices were compared between the 2 groups. The therapeutic effects were evaluated by thrombolysis in cerebral infarction scale system, Glasgow coma scale (GCS), National Institutes of Health Stroke Scale (NIHSS), and modified Rankin scale statistics.

Results:
Two groups of patients with NIHSS scores postoperative 3 and 30 days decreased significantly compared with preoperation. NIHSS score of group A 3 and 30 days postoperation was significantly higher than group B (P < .05). Two groups of patients with GCS scores postoperative 3 and 30 days increased significantly compared with preoperation. GCS score of group A 3 and 30 days postoperation was significantly lower than group B (P < .05). Group B with vascular recanalization ratio postoperative 30 days was higher than group A, however with no significant differences (P > .05). Moreover, group B with outcomes (modified Rankin scale score ≤2 points) postoperative 3 months was better than group A, however with no significant differences (P > .05).

Conclusion:
Solitaire AB stent embolectomy shows similar efficacy as mechanical thrombectomy in the treatment of ACI patients.
Development and External Validation of a Machine Learning Model for Prediction of Potential Transfer to the PICU
Authors: Mayampurath Anoop , Sanchez-Pinto L. Nelson , Hegermiller Emma , Erondu Amarachi , Carey Kyle , Jani Priti , Gibbons Robert , Edelson Dana , Churpek Matthew M. 
Published: April 2022

OBJECTIVES:
Unrecognized clinical deterioration during illness requiring hospitalization is associated with high risk of mortality and long-term morbidity among children. Our objective was to develop and externally validate machine learning algorithms using electronic health records for identifying ICU transfer within 12 hours indicative of a child’s condition.

DESIGN:
Observational cohort study.

SETTING:
Two urban, tertiary-care, academic hospitals (sites 1 and 2).

PATIENTS:
Pediatric inpatients (age <18 yr).

INTERVENTIONS:
None.

MEASUREMENT AND MAIN RESULTS:
Our primary outcome was direct ward to ICU transfer. Using age, vital signs, and laboratory results, we derived logistic regression with regularization, restricted cubic spline regression, random forest, and gradient boosted machine learning models. Among 50,830 admissions at site 1 and 88,970 admissions at site 2, 1,993 (3.92%) and 2,317 (2.60%) experienced the primary outcome, respectively. Site 1 data were split longitudinally into derivation (2009–2017) and validation (2018–2019), whereas site 2 constituted the external test cohort. Across both sites, the gradient boosted machine was the most accurate model and outperformed a modified version of the Bedside Pediatric Early Warning Score that only used physiologic variables in terms of discrimination (C-statistic site 1: 0.84 vs 0.71, p < 0.001; site 2: 0.80 vs 0.74, p < 0.001), sensitivity, specificity, and number needed to alert.

CONCLUSIONS:
We developed and externally validated a novel machine learning model that identifies ICU transfers in hospitalized children more accurately than current tools. Our model enables early detection of children at risk for deterioration, thereby creating opportunities for intervention and improvement in outcomes.
Resuscitative endovascular balloon occlusion of the aorta for life-threatening postpartum hemorrhage: A nationwide observational study in Japan
Authors: Kamijo Kyosuke , Nakajima Mikio , Shigemi Daisuke , Kaszynski Richard H. , Ohbe Hiroyuki , Goto Tadahiro , Sasabuchi Yusuke , Fushimi Kiyohide , Matsui Hiroki , Yasunaga Hideo 
Published: April 2022

BACKGROUND
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used for postpartum hemorrhage (PPH), which is one of the leading causes of maternal mortality worldwide; however, its utility in the obstetrics setting remains unclear. Thus, this study aimed to describe the characteristics, demographics, and mortality of patients with PPH who underwent REBOA.

METHODS
We used the Japanese Diagnosis Procedure Combination inpatient database to identify patients with PPH who underwent REBOA from April 2012 to March 2020. We examined the patients' characteristics, interventions administered, and in-hospital mortality.

RESULTS
We identified 143 patients with PPH who underwent REBOA. The most common cause of PPH was atonic postpartum hemorrhage (52.4%), followed by disseminated intravascular coagulation (29.4%) and amniotic fluid embolism documented (11.2%). Among patients who delivered at hospitals in which REBOA was performed (n = 55), 38.2% of patients experienced preterm births, and 70.9% delivered via cesarean delivery. The proportion of patients who underwent transcatheter arterial embolization and hysterectomy was 53.8% and 16.1%, respectively. In-hospital mortality was 7.0%.

CONCLUSION
The results of the present study could be helpful in clinical decision making and providing patients and families with additional treatment options for PPH.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
Beyond Graft Survivl: A National Cohort Study Quantifying the Impact of Increasing Kidney Donor Profile Index on Recipient Outcomes 1 Year Post-transplantation
Authors: Tully Emma K. , Hayes Ian P. , Hughes Peter D. , Sypek Matthew P. 
Published: April 2022

Background.
The reporting of a locally validated kidney donor profile index (KDPI) began in Australia in 2016. Across diverse populations, KDPI has demonstrated utility in predicting allograft survival and function. A metric that incorporates both elements may provide a more comprehensive picture of suboptimal recipient outcomes.

Methods.
A retrospective cohort study of adult kidney transplant recipients in Australia (January 2009 to December 2014) was conducted. Conventional recipient outcomes and a composite measure of suboptimal outcome (1-y allograft failure or estimated glomerular filtration rate [eGFR] <30 mL/min) were evaluated across KDPI intervals (KDPI quintiles and 5-point increments in the KDPI 81–100 cohort). The impact of increasing KDPI on allograft function (1-y eGFR) and a suboptimal outcome was explored using multivariable regression models, adjusting for potential confounding factors.

Results.
In 2923 donor kidneys eligible for analysis, median KDPI was 54 (interquartile range [IQR], 31–77), and Kidney Donor Risk Index was 1.39 (IQR, 1.03–1.67). The median 1-y eGFR was 52.74 mL/min (IQR, 40.79–66.41 mL/min). Compared with the first quintile reference group, progressive reductions in eGFR were observed with increasing KDPI and were maximal in the fifth quintile (adjusted β-coefficient: −27.43 mL/min; 95% confidence interval, –29.44 to –25.42; P < 0.001). A suboptimal outcome was observed in 359 recipients (12.3%). The adjusted odds for this outcome increased across quintiles from a baseline of odds ratio of 1.00 (first quintile) to odds ratio of 11.68 (95% confidence interval, 6.33-21.54, P < 0.001) in the fifth quintile cohort.

Conclusions.
Increases in donor KDPI were associated with higher probabilities of a suboptimal outcome and poorer baseline allograft function, particularly in the KDPI > 80 cohort. These findings may inform pretransplant discussions with potential recipients of high-KDPI allografts.
SARS-CoV-2 evolution and immune escape in immunocompromised patients treated with exogenous antibodies
Authors: Scherer Erin M. , Babiker Ahmed , Adelman Max W. , Allman Brent , Key Autum , Kleinhenz Jennifer M. , Langsjoen Rose M. , Nguyen Phuong-Vi , Onyechi Ivy , Sherman Jacob D. , Simon Trevor W. , Soloff Hannah , Tarabay Jessica , Varkey Jay , Webster Andrew S. , Weiskopf Daniela , Weissman Daniel B. , Xu Yongxian , Waggoner Jesse J. , Koelle Katia , Rouphael Nadine , Pouch Stephanie M. , Piantadosi Anne 
Published: April 2022

AbstractBackgroundSARS-CoV-2 mutations conferring escape from neutralizing antibodies can arise in immunocompromised patients with prolonged infection, but the conditions that facilitate immune escape are still not fully understood.MethodsWe characterized endogenous immune responses, within-host SARS-CoV-2 evolution, and autologous neutralization of the viral variants that arose in five immunocompromised patients with prolonged infection and B cell deficiencies.ResultsIn two patients treated with the monoclonal antibody bamlanivimab, viral resistance to autologous serum arose early and persisted for several months, accompanied by ongoing evolution in the spike protein. These patients exhibited deficiencies in both T and B cell arms, and one patient succumbed to disease. In contrast, we did not observe spike mutations in immunologically important regions in patients who did not receive exogenous antibodies or who received convalescent plasma and had intact T cell responses to SARS-CoV-2.ConclusionsOur results underscore the potential importance of multiple factors – the absence of an effective endogenous immune response, persistent virus replication, and selective pressure such as single-agent bamlanivimab – in promoting the emergence of SARS-CoV-2 mutations associated with immune evasion. These findings highlight the need for larger clinical studies in immunocompromised populations to better understand the ramifications of different therapies. Our results also confirm that patients with B cell deficiencies can elicit effector T cells and may suggest an important role for T cells in controlling infection, which is relevant to vaccines and therapeutics.
Global reports of takotsubo (stress) cardiomyopathy following COVID-19 vaccination: a systematic review and meta-analysis
Authors: Ahmed Sirwan Khalid , Mohamed Mona Gamal , Essa Rawand Abdulrahman , Ahmed Rashad Dabou Eman Abdelaziz , Abdulqadir Salar Omar , Omar Rukhsar Muhammad 
Published: April 2022

AbstractConcerns have been raised recently about takotsubo cardiomyopathy (TCM) after receiving COVID-19 vaccines, particularly the messenger RNA (mRNA) vaccines. The goal of this study was to compile case reports to provide a comprehensive overview of takotsubo cardiomyopathy (TCM) associated with COVID-19 vaccines. A systematic literature search was conducted in PubMed, Scopus, Embase, Web of Science, and Google Scholar between 2020 and June 1, 2022. The study included individuals who developed cardiac takotsubo cardiomyopathy from receiving COVID-19 vaccinations. Ten studies, including 10 cases, participated in the current systematic review. The mean age was 61.8 years; 90% were female, while 10% were male. 80% of the patients received the mRNA COVID-19 vaccine, while 20% received other types. In addition, takotsubo cardiomyopathy (TCM) occurred in 50% of patients receiving the first dose and another 40% after the second dose of COVID-19 vaccines. Moreover, the mean number of days to the onset of symptoms was 2.62 days. All cases had an elevated troponin test and abnormal ECG findings. The left ventricular ejection fraction (LVEF) was lower than 50% in 90% of patients. In terms of the average length of hospital stay, 50% stayed for 10.2 days, and all cases recovered from their symptoms. In conclusion, takotsubo (stress) cardiomyopathy (TCM) complications associated with COVID-19 vaccination are rare but can be life-threatening. Chest pain should be considered an alarming symptom, especially in those who have received the first and second doses of the COVID-19 vaccine.