bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Exploratory Study of Neoadjuvant Cetuximab Followed by Cetuximab and Chemoradiotherapy in Women With Newly Diagnosed Locally Advanced Cervical Cancer
Authors: Fracasso Paula M. , Duska Linda R. , Thaker Premal H. , Gao Feng , Zoberi Imran , Dehdashti Farrokh , Siegel Barry A. , Uliel Livnat , Menias Christine O. , Rehm Patrice K. , Goodner Sherry A. , Creekmore Allison N. , Lothamer Heather L. , Rader Janet S. 
Published: June 2022

Objectives:
This study explored the feasibility of cetuximab with chemoradiation in women with cervical carcinoma and evaluated fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) to assess early response to cetuximab (NCT00292955).

Patients and Methods:
Eligible patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB-IVB invasive carcinoma of the uterine cervix were treated on 1 of 3 dose levels (DL). DL1 consisted of neoadjuvant cetuximab, then concurrent radiotherapy with cetuximab 250 mg/m2/cisplatin 40 mg/m2, followed by weekly cetuximab. DL2 consisted of radiotherapy with cetuximab 200 mg/m2 and cisplatin 30 mg/m2. DL3 consisted of radiotherapy with cetuximab 250 mg/m2 and cisplatin 30 mg/m2. Patients underwent 18F-FDG-PET/CT before treatment, after neoadjuvant cetuximab, and at the end of treatment.

Results:
Of the 21 patients enrolled, 9, 3, and 9 were treated in DL1, DL2, and DL3, respectively. DL1 required dose reductions due to gastrointestinal toxicities. DL2 and 3 were tolerated with 1 dose-limiting toxicity (grade 4 renal failure) at DL3. Following 3 weekly treatments of neoadjuvant cetuximab in DL1, 7 patients had maximum standardized uptake value changes on 18F-FDG-PET/CT consistent with response to cetuximab. Of the 12 patients with locally advanced disease, eleven evaluable patients had no evidence of disease on 18F-FDG-PET/CT at treatment end. Five-year progression-free survival and overall survival rates for all patients were 57.5% and 58.5%, respectively.

Conclusions:
Cetuximab with cisplatin 30 mg/m2 and radiotherapy was tolerated. 18F-FDG-PET/CT demonstrated early evidence of response to neoadjuvant cetuximab. With advances in precision oncology and the recent approval of pembrolizumab in metastatic cervical cancer, dual-target inhibition with an epidermal growth factor receptor inhibitor may be a promising treatment in the future.
Novel Colorectal Endoscopic Submucosal Dissection With Double-Endoscope and Snare-Based Traction
Authors: Chou Chu-Kuang , Tsai Kun-Feng , Tseng Cheng-Hao , Lee Ching-Tai , Yang Kuo-Hsin , Chang Min-Chi , Hsu Chao-Wen 
Published: June 2022

BACKGROUND:
Colorectal endoscopic submucosal dissection is technically demanding, and the traction offered by gravity, cap, or clip-with-line during conventional endoscopic submucosal dissection remains unsatisfactory. Robotic systems are still under development and are expensive. We proposed double-scope endoscopic submucosal dissection with strong and adjustable traction offered by snaring the lesion with additional scope.

OBJECTIVE:
This study aimed to test the novel double-scope endoscopic submucosal dissection with snare-based traction.

DESIGN:
This was a retrospective study that reviewed double-scope endoscopic submucosal dissection compared with matched conventional endoscopic submucosal dissection, and size, location, morphology, and pathology between groups were compared.

SETTINGS:
This study was conducted in a referral endoscopy center in a local hospital.

PATIENTS:
This study included patients with colorectal lesions receiving double-scope endoscopic submucosal dissection and matched conventional endoscopic submucosal dissection.

MAIN OUTCOME MEASURES:
The pathological completeness, procedure time, and complications were analyzed.

RESULTS:
Fifteen double-scope endoscopic submucosal dissection procedures, with 11 lesions located in the proximal colon with a median size of 40 mm, were performed. The median procedure time of double-scope endoscopic submucosal dissection was 32.45 (interquartile range, 16.03–38.20) minutes. The time required for second scope insertion was 2.57 (interquartile range, 0.95–6.75) minutes; for snaring, 3.03 (interquartile range, 2.12–6.62) minutes; and for actual endoscopic submucosal dissection, 28.23 (interquartile range, 7.90–37.00) minutes. All lesions were resected completely. No major complication was encountered. The procedure time was significantly shorter than that of 14 matched conventional endoscopic submucosal dissections (54.61 [interquartile range, 33.11–97.25] min; p = 0.021).

LIMITATIONS:
This was a single-center, single-operator, retrospective case-controlled study with limited cases.

CONCLUSIONS:
This study confirmed the feasibility of double-scope endoscopic submucosal dissection with snare-based traction to shorten procedure time and to simplify endoscopic submucosal dissection. Additional trials are required.
Prediction of intraoperative hypotension from the linear extrapolation of mean arterial pressure
Authors: Jacquet-Lagrèze Matthias , Larue Antoine , Guilherme Enrique , Schweizer Rémi , Portran Philippe , Ruste Martin , Gazon Mathieu , Aubrun Frédéric , Fellahi Jean-Luc 
Published: June 2022

BACKGROUND
Hypotension prediction index (HPI) software is a proprietary machine learning-based algorithm used to predict intraoperative hypotension (IOH). HPI has shown superiority in predicting IOH when compared to the predictive value of changes in mean arterial pressure (ΔMAP) alone. However, the predictive value of ΔMAP alone, with no reference to the absolute level of MAP, is counterintuitive and poor at predicting IOH. A simple linear extrapolation of mean arterial pressure (LepMAP) is closer to the clinical approach.

OBJECTIVES
Our primary objective was to investigate whether LepMAP better predicts IOH than ΔMAP alone.

DESIGN
Retrospective diagnostic accuracy study.

SETTING
Two tertiary University Hospitals between May 2019 and December 2019.

PATIENTS
A total of 83 adult patients undergoing high risk non-cardiac surgery.

DATA SOURCES
Arterial pressure data were automatically extracted from the anaesthesia data collection software (one value per minute). IOH was defined as MAP < 65 mmHg.

ANALYSIS
Correlations for repeated measurements and the area under the curve (AUC) from receiver operating characteristics (ROC) were determined for the ability of LepMAP and ΔMAP to predict IOH at 1, 2 and 5 min before its occurrence (A-analysis, using the whole dataset). Data were also analysed after exclusion of MAP values between 65 and 75 mmHg (B-analysis).

RESULTS
A total of 24 318 segments of ten minutes duration were analysed. In the A-analysis, ROC AUCs to predict IOH at 1, 2 and 5 min before its occurrence by LepMAP were 0.87 (95% confidence interval, CI, 0.86 to 0.88), 0.81 (95% CI, 0.79 to 0.83) and 0.69 (95% CI, 0.66 to 0.71) and for ΔMAP alone 0.59 (95% CI, 0.57 to 0.62), 0.61 (95% CI, 0.59 to 0.64), 0.57 (95% CI, 0.54 to 0.69), respectively. In the B analysis for LepMAP these were 0.97 (95% CI, 0.9 to 0.98), 0.93 (95% CI, 0.92 to 0.95) and 0.86 (95% CI, 0.84 to 0.88), respectively, and for ΔMAP alone 0.59 (95% CI, 0.53 to 0.58), 0.56 (95% CI, 0.54 to 0.59), 0.54 (95% CI, 0.51 to 0.57), respectively. LepMAP ROC AUCs were significantly higher than ΔMAP ROC AUCs in all cases.

CONCLUSIONS
LepMAP provides reliable real-time and continuous prediction of IOH 1 and 2 min before its occurrence. LepMAP offers better discrimination than ΔMAP at 1, 2 and 5 min before its occurrence. Future studies evaluating machine learning algorithms to predict IOH should be compared with LepMAP rather than ΔMAP.
Genome-wide DNA methylation profile of peripheral blood lymphocytes from subjects with nonsteroidal anti-inflammatory drug-induced respiratory diseases
Authors: Lee Jong-Uk , Soo Chang Hun , Kyung Kim Min , Park Seung-lee , Kim Jung Hyun , Park Jong-Sook , Park Choon-Sik 
Published: June 2022

Background
Significant changes in CpG methylation have been identified in nasal polyps, which are the main targets of nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (NERD); however, these polyps are composed of various cellular components. In the present study, whole-genome CpG methylation in peripheral blood lymphocytes (PBLs) was analyzed to define the epigenetic changes in lymphocytes, which are the primary immune cells involved in NERD.

Materials and methods
Genomic DNA from peripheral blood mononuclear cells from 27 NERD and 24 aspirin-tolerant asthma (ATA) was subjected to bisulfate conversion and a methylation array. Quantitative CpG methylation, the β-values as a quantitative measure of DNA methylation, in lymphocytes were calculated after adjustments for cellular composition.

Results
Fifty-six hypermethylated and three hypomethylated differentially methylated CpGs (DMCs) in PBLs in the NERD compared with ATA. The top 10 CpG loci predicted the methylation risk score, with a positive predictive value of 91.3%, a negative predictive value of 81.5% and an accuracy of 84.3%. As demonstrated in the nasal polyps, 30 DMCs were predicted to bind to the following 10 transcription factors, ranked in descending order: AP-2alphaA, TFII-1, STAT4, FOXP3, GR, c-Est-1, E2F-1, XBP1, ENKTF-1 and NF-1. Gene ontology analysis identified 13 categories such as regulation of T-helper 17 cell differentiation, including SMAD7 and NFKBIZ. PBLs in NERD contained no DMCs in genes associated with the prostaglandin and leukotriene pathways, which were found in ATA.

Conclusion
PBLs in NERD form a unique pattern of DNA CpG methylation, and the combined analysis may provide predictive values for NERD.
Paliperidone Extended Release Versus Olanzapine in Treatment-Resistant Schizophrenia
Authors: Wang Dandan , Wei Ning , Hu Fangzhen , Li Jianhua , Wang Yucheng , Qian Zhiwei , Yang Miao , Yao Mingrong , Xia Yong , Yu Hong , Tu Wenzhen , Ye Minjie , Qian Cheng , Hu Jianbo , Chen Jingkai , Hu Chanchan , Huang Manli , Xu Yi , Hu Shaohua 
Published: June 2022

Abstract

Purpose
Paliperidone is an atypical antipsychotic as effective as other atypical antipsychotics for schizophrenia. However, few studies have explored the efficacy of paliperidone for treatment-resistant schizophrenia. This study aimed to compare the efficacy and safety of paliperidone extended release (ER) versus olanzapine in schizophrenia patients with either poor treatment response or intolerable adverse effects due to standardized antipsychotic therapy.

Methods
This 12-week randomized, double-blind, multicenter study compared the treatment efficacy on psychotic symptoms, cognitive functions, and tolerance between paliperidone ER (6–15 mg/d, n = 45) and olanzapine (10–30 mg/d, n = 41) in treatment-resistant or treatment-intolerant patients with schizophrenia. The severity of psychotic symptoms was evaluated by the Positive and Negative Syndrome Scale and the Clinical Global Impression Severity of Illness Scale. The cognitive functions were assessed by the MATRICS Consensus Cognitive Battery. In addition, the metabolic impacts were evaluated by weight gain and waist circumference.

Results
Patients with either paliperidone ER or olanzapine treatment showed apparent improvement in psychotic symptoms, without significant intergroup difference. Twelve-week paliperidone ER or olanzapine treatment did not improve the cognitive functions. Both paliperidone ER and olanzapine treatment caused significant increase in weight and waist circumference, and olanzapine had a greater impact on waist circumference than paliperidone ER. In addition, both drugs were well tolerated.

Conclusions
Paliperidone ER could be a safe alternative for treatment-resistant schizophrenia.
Assessing the Role of Operative Intervention in Elderly Patients With Nonfunctional Pancreatic Neuroendocrine Neoplasms
Authors: Hue Jonathan J. , Sugumar Kavin , Mohamed Amr , Selfridge J. Eva , Bajor David , Hardacre Jeffrey M. , Ammori John B. , Rothermel Luke D. , Winter Jordan M. , Ocuin Lee M. 
Published: June 2022

Objectives
Resection of locoregional pancreatic neuroendocrine neoplasms (PanNENs) is typically recommended, but there is a paucity of data on the management of elderly patients.

Methods
The National Cancer Database (2004–2016) was queried for patients 80 years or older with localized PanNENs. Patients were grouped as nonoperative or operative management. Postoperative outcomes and survival were compared.

Results
In total, 591 patients were included: 202 underwent resection, and 389 did not. Increasing age and pancreatic head tumors were associated with lower likelihood of resection. The overall 90-day mortality rate was 6.4%, which was higher for pancreatoduodenectomy than distal pancreatectomy (13.6% vs 5.1%, respectively). Operatively managed patients had longer median survival (80.8 vs 45.0 months, P < 0.001), and this association was independent of tumor location. On multivariable Cox regression, resection remained associated with longer survival (hazard ratio, 0.69; 95% confidence interval, 0.50–0.95). Among operatively managed patients, age and tumor location were not associated with survival; however, greater comorbidity and high-risk tumor-specific features were associated with worse survival.

Conclusions
Resection of nonfunctional PanNENs in elderly patients is associated with improved survival compared with nonoperative management. Resection could be considered in appropriate operative candidates, regardless of tumor location, but the perioperative mortality rate must be considered.
Splanchnic Vein Thrombosis
Authors: Mandal Meenakshi , Rana Surinder Singh , Kang Mandeep , Chakrabarti Arunaloke , Gupta Vikas , Kumar-M Praveen , Gupta Rajesh 
Published: June 2022

Objective
Infected pancreatic necrosis (IPN) is associated with poor outcomes. The present study looked at incidence of infection and predictors, if any, in these collections.

Methods
This prospective observational study was done between July 2019 and October 2020. Symptomatic patients of acute necrotic collections and walled-off necrosis of pancreas requiring drainage were included. Necrotic fluid and blood were analyzed for growth of organisms.

Results
Sixty-two patients were included. The mean age was 36.8 years (standard deviation, 11.5 years). Male-female ratio was 4:1. Alcohol was the most common etiology. Infection was noted in 44 of the 62 patients (70.9%) and bacteremia noted in 23 of the 62 patients (37%). Escherichia coli was the most common organism in necrotic collections and Staphylococcus was the most common organism isolated from blood culture. The patients with Modified Computed Tomography–Severity Index of 8 of higher (P < 0.001) had significant association with IPN but not with bacteremia. However, splanchnic vein thrombosis (P = 0.022) was significantly associated with development of IPN as well as bacteremia on both univariate and multivariate analysis.

Conclusions

Escherichia coli and Staphylococcus were the most common organisms grown from necrotic collections and blood respectively. Presence of splanchnic vein thrombosis was a significant factor for development of IPN and bacteremia on univariate as well as multivariate analysis.
Class III β-Tubulin Expression Is of Value in Selecting nab-Paclitaxel and Gemcitabine as First-Line Therapy in Unresectable Pancreatic Cancer
Authors: Kato Akihisa , Naitoh Itaru , Naiki-Ito Aya , Hayashi Kazuki , Okumura Fumihiro , Fujita Yasuaki , Sano Hitoshi , Nishi Yuji , Miyabe Katsuyuki , Inoue Tadahisa , Hirano Atsuyuki , Takada Hiroki , Yoshida Michihiro , Hori Yasuki , Natsume Makoto , Kato Hiroyuki , Takahashi Satoru , Kataoka Hiromi 
Published: June 2022

Objectives

Nab-paclitaxel and gemcitabine (GnP) or FOLFIRINOX (a combination of leucovorin, fluorouracil, irinotecan, and oxaliplatin [FFX]) is currently recognized as the standard first-line regimen for unresectable pancreatic ductal adenocarcinoma (PDAC). Class III β-tubulin (TUBB3) has the potential to predict resistance to taxane in various tumors; therefore, this study aimed to clarify whether TUBB3 is a predictive marker for GnP response.

Methods
We retrospectively reviewed 113 patients with PDAC who received GnP or FFX as first-line chemotherapy and examined immunohistochemically the TUBB3 expression in specimens obtained by endoscopic ultrasound-guided fine-needle aspiration.

Results
High TUBB3 expression was associated with a significantly lower disease control rate (P = 0.017) and shorter progression-free survival (PFS) (P = 0.019), and multivariate analysis revealed that TUBB3 expression was an independent variable for PFS in the GnP first-line group (P = 0.045). In addition, in the FFX first-line group, TUBB3 expression was not correlated with PFS or overall survival (OS). In all 113 patients, TUBB3 expression was not also associated with OS.

Conclusions
Class III β-tubulin might be a predictive factor for the response of GnP, but not a prognostic factor for OS, helping the selection of an optimized first-line chemotherapy regimen for unresectable PDAC.
Preclinical Pediatric Care by Emergency Physicians
Authors: Vetschera Anna , Beliveau Vincent , Esswein Katharina , Linzmeier Klaus , Gozzi Roland , Hohlrieder Matthias , Simma Burkhard 
Published: June 2022

Objectives
Fewer than 10% of emergency medical system (EMS) calls concern children and adolescents younger than 18 years. Studies have shown that the preclinical care of children differs from that of adults regarding assessment, interventions, and monitoring. The aims of this study were to describe the preclinical care and emergency transport of pediatric patients in Vorarlberg, Austria and to compare trauma and nontrauma cases.

Methods
This is a population-based study, analyzing medical records of EMS calls to children and adolescents. We received all patient records of EMS calls to children and adolescents younger than 18 years (n = 4390 in total) from the 2 local EMS providers, the Red Cross Vorarlberg and the Austrian Mountain Rescue Service (Christophorus 8 and Gallus 1) covering a study period of 7 years, from 2013 to 2019. The record data were extracted by automation with an in-house program and subsequently anonymized. Statistical analyses were performed with SPSS Statistics.

Results
During the study period, 7.9% of all EMS calls concerned children and adolescents younger than 18 years. For our study, 3761 records were analyzed and 1270 trauma cases (33.8%) were identified. The most common injuries were injuries of the extremities and traumatic brain injury. The frequency of National Advisory Committee of Aeronautics Scores of 4 or higher was 17.7%, similar for all age groups and for trauma as well as nontrauma patients. Mean Glasgow Coma Scale scores were higher in the trauma group than in the nontrauma group (14.2 vs 11.2). In 62.9% of all patients, 1 or more vital parameters were documented. A majority of these values was in the pathologic range for the respective age group. The rate of pulsoxymetry monitoring during transport was low (42.1% in trauma and 30.3% in nontrauma patients) and decreased significantly with patient age. Moreover, while the placing of intravenous lines and monitoring during transport were significantly more frequent in trauma patients, the administration of medication or oxygen was significantly more frequent in nontrauma patients.

Conclusions
The pediatric population lacks assessments and monitoring in preclinical care, especially the youngest children and nontrauma patients, although emergency severity scores are similar.
Improving Adherence to AAP Acute Otitis Media Guidelines in an Academic Pediatrics Practice through a Quality Improvement Project
Authors: Wolf Ryan M. , Langford Kyle T. , Patterson Barron L. 
Published: June 2022

Introduction:
Acute otitis media (AOM) is the most common reason for antibiotic use in children. The American Academy of Pediatrics (AAP) published its latest AOM guidelines in 2013. A safety-net antibiotic prescription (SNAP) is recommended for some patients based on age, severity, and duration of symptoms. At baseline, 78% of patients diagnosed with AOM in our general pediatrics practice met AAP guidelines, and 20% of eligible patients received a SNAP according to guidelines. We aimed to increase adherence to AAP AOM guidelines in an academic general pediatrics clinic from 78% to 90% by January 2020.

Methods:
A quality improvement team determined key drivers and developed interventions. Patients included were 6 months to 12 years old with AOM. Encounters were reviewed for adherence to AAP AOM guidelines. During the project, interventions included an ear pain note template, which generated guideline-based recommendations, note template education in clinic orientation sessions, a didactic session on AOM management, and reminders on workstations. Data were analyzed using P-charts.

Results:
Percent of AOM encounters (n = 1266) adhering to AAP AOM guidelines increased from 78% to 92%. We also reviewed two process measures. First, the use of the ear pain note template increased from 0% to 44%. Second, the percent of AOM encounters where an eligible patient received a SNAP increased from 21% to 78% (encounters n = 421).

Conclusion:
We demonstrate increased adherence to AAP AOM guidelines, including improved use of SNAPs after introducing a note template with clinical decision support and provider educational sessions.
Therapeutic Hypothermia on Transport: The Quest for Efficiency: Results of a Quality Improvement Project
Authors: Redpath Stephanie , Moore Heather , Sucha Ewa , Agarwal Amisha , Barrowman Nicholas , Lemyre Brigitte , St. Germain Louise 
Published: June 2022

Introduction:
Therapeutic hypothermia (TH) within 6 hours after birth is known to improve both survival and neurodevelopmental outcomes in neonates with hypoxic ischemic encephalopathy (HIE). Meeting this recommended target temperature for neonates who require transport for TH treatment can be complex for various reasons. This study aimed to reduce the time from birth to the initiation of TH and target temperature, thereby increasing the proportion of transported neonates reaching target temperature within 6 hours to >50%.

Methods:
We evaluated the effect of three quality improvement interventions, including revised transport team processes, outreach education/resources, and the use of a servo-controlled cooling device on land transports. We compared key outcome TH metrics for cohorts before and after implementation.

Results:
The study team compared baseline data for 77 to 102 neonates born between 2009 and April 2015 (preintervention) and September 2015 and September 2020 (postintervention(s)). We observed reductions in both the time from birth to the initiation of passive cooling (38%) and time to reach target TH temperature (23%), with an increase in the proportion of neonates reaching target temperature by 6 hours of age from 50% to 71%.

Conclusions:
We used quality improvement methodology to identify key areas for intervention(s) and improvement. Targeted interventions have successfully and consistently improved the timing and delivery of TH to neonates with hypoxic ischemic encephalopathy within the transport environment, with a 20% increase in neonates reaching target temperature by 6 hours of age.