bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infertility In Toms: Clinical approach, experiences and challenges
Authors: Prochowska Sylwia , Niżański Wojciech 
Published: August 2022

Practical relevance: An infertile tom used to be a relatively rare presentation in feline practice. However, as a result of breeding strategies targeting specific morphological/behavioural traits, and the influence of inbreeding (especially practised in rare breeds), among other factors, feline infertility has become a genuine clinical problem. Furthermore, increased interest among cat breeders and pet owners in diagnosing and treating an ‘unsuccessful’ tom (including using assisted reproductive techniques [ARTs]), has made such patients more commonplace in veterinary practice. Clinical challenges: A definitive cause for male infertility is often difficult to identify. One of the biggest challenges is the lack of fertility-based reference values for semen quality and hormone levels. Moreover, the literature in this field is scant and many reproductive tract conditions described in other species have not been reported in cats. The establishment of diagnostic tools and algorithms is essential to facilitate a reliable assessment of fertility potential. Global importance: There is a growing demand for appropriate veterinary care relating to feline reproduction. There is an expectation among breeders, particularly of pedigree cats of high breeding value, that the same options widely used for dogs (including ARTs) should also be available for cats. Equipment and technical skills: Equipment required for investigating male infertility includes a microscope and ultrasound machine; a blood analyser may also be useful, but samples can instead be sent to a laboratory. The skills required are often already performed by veterinarians; for example, catheterising the urethra, performing ultrasonography and blood sampling. Evidence base: There are some reports of fertility problems in male cats in the literature, but this area of feline reproduction is still relatively undeveloped. This review draws on the comprehensive knowledge developed and shared by specialists in this field, and is supported by the authors’ own clinical experience.
Increasing the Amount and Intensity of Stepping Training During Inpatient Stroke Rehabilitation Improves Locomotor and Non-Locomotor Outcomes
Authors: Henderson Christopher E. , Plawecki Abbey , Lucas Emily , Lotter Jennifer K. , Scofield Molly , Carbone Angela , Jang Jeong H. , Hornby T. George 
Published: August 2022

Background The efficacy of traditional rehabilitation interventions to improve locomotion post-stroke, including providing multiple exercises targeting impairments and activity limitations, is uncertain. Emerging evidence rather suggests attempts to prioritize stepping practice at higher cardiovascular intensities may facilitate greater locomotor outcomes. Objective The present study was designed to evaluate the comparative effectiveness of high-intensity training (HIT) to usual care during inpatient rehabilitation post-stroke. Methods Changes in stepping activity and functional outcomes were compared over 9 months during usual-care (n = 131 patients < 2 months post-stroke), during an 18-month transition phase with attempts to implement HIT (n = 317), and over 12 months following HIT implementation (n = 208). The transition phase began with didactic and hands-on education, and continued with meetings, mentoring, and audit and feedback. Fidelity metrics included percentage of sessions prioritizing gait interventions and documenting intensity. Demographics, training measures, and outcomes were compared across phases using linear or logistic regression analysis, Kruskal-Wallis tests, or χ2 analysis. Results Across all phases, admission scores were similar except for balance (usual-care>HIT; P < .02). Efforts to prioritize stepping and achieve targeted intensities during HIT vs transition or usual-care phases led to increased steps/day ( P < .01). During HIT, gains in 10-m walk [HIT median = 0.13 m/s (interquartile range: 0-0.35) vs usual-care = 0.07 m/s (0-0.24), P = .01] and 6-min walk [50 (9.3-116) vs 2.1 (0-56) m, P < .01] were observed, with additional improvements in transfers and stair-climbing. Conclusions Greater efforts to prioritize walking and reach higher intensities during HIT led to increased steps/day, resulting in greater gains in locomotor and non-locomotor outcomes.
Balance Training Modulates Cortical Inhibition in Individuals with Parkinson’s Disease: A Randomized Controlled Trial
Authors: Liu Hsin-Hsuan , Wang Ray-Yau , Cheng Shih-Jung , Liao Kwong-Kum , Zhou Jun-Hong , Yang Yea-Ru 
Published: August 2022

Background Most individuals with Parkinson’s disease (PD) develop balance dysfunction. Previous studies showed that individuals with PD have abnormal corticomotor changes related to severity of motor symptoms and disease progression. Cortical disinhibition was observed in PD and this alteration can be an early sign of PD. Balance training seems to be an effective intervention to improve balance in individuals with PD. However, it is not much known about the effect of balance training on cortical neuroplasticity in PD population. Objective To investigate the effects of balance training on corticomotor excitability in individuals with PD. Methods Twenty-eight PD participants were recruited and randomly assigned to either the balance training (BT) or the control (CON) group. Both groups underwent 16 training sessions over 8 weeks. Outcome measures for corticomotor inhibition included the cortical silent period (CSP) and short-interval intracortical inhibition (SICI) on transcranial magnetic stimulation. Balance performance was measured using the Mini-Balance Evaluation Systems Test (Mini-BEST) and the Timed Up and Go (TUG) test. Results Participants in the BT group showed a significant increase in corticomotor inhibition (CSP: P = .028, SICI: P = .04) and a significant improvement in balance performance (Mini-BEST: P = .001, TUG: P = .04) after training. Compared to the CON group, the BT group showed a greater increase in corticomotor inhibition (CSP: P = .017, SICI: P = .046) and better improvement in balance (Mini-BEST: P = .046). Conclusion Balance training could modulate corticomotor inhibition in the primary motor cortex and improve balance performance in individuals with PD.
Lenvatinib in patients with unresectable hepatocellular carcinoma who progressed to Child-Pugh B liver function
Authors: Huynh Jasmine , Cho May Thet , Kim Edward Jae-Hoon , Ren Min , Ramji Zahra , Vogel Arndt 
Published: August 2022

Background: Lenvatinib is an approved first-line treatment for unresectable hepatocellular carcinoma (uHCC). We evaluated the safety and efficacy of lenvatinib versus sorafenib in patients with uHCC who deteriorated to Child-Pugh class B (CP-B) on treatment. Methods: We retrospectively evaluated patients from REFLECT who deteriorated to CP-B versus those who remained Child-Pugh class A (CP-A) within 8 weeks after randomization. Best overall response and objective response rate (ORR) per modified Response Evaluation Criteria In Solid Tumors (mRECIST) were assessed from baseline. Progression-free survival (PFS) per mRECIST and overall survival (OS) were assessed beginning at week 8. Results: Patients with CP-B versus CP-A classification receiving lenvatinib had ORRs of 28.3 and 42.9%, respectively; patients with CP-B versus CP-A classification receiving sorafenib had ORRs of 8.5 and 12.9%, respectively. Median PFS and OS (landmark analyses beginning at week 8) in patients receiving lenvatinib were 3.7 months [95% confidence interval (CI): 1.8–7.4] and 6.8 months (95% CI: 2.6–10.3) in the CP-B subgroup versus 6.5 months (95% CI: 5.6–7.4) and 13.3 months (95% CI: 11.6–16.1) in the CP-A subgroup, respectively. Median PFS and OS in patients receiving sorafenib were 0.5 months (95% CI: 0.1–3.6) and 4.5 months (95% CI: 2.9–6.1) in the CP-B subgroup versus 3.6 months (95% CI: 2.7–3.7) and 12.0 months (95% CI: 10.2–14.0) in the CP-A subgroup, respectively. The most common treatment-emergent adverse events in the lenvatinib cohort were hypertension (both subgroups) and decreased appetite (CP-B subgroup). Conclusion: Results suggest that patients with uHCC whose liver function deteriorates to CP-B after initiation of therapy may continue to receive lenvatinib. Trial registration: ClinicalTrials.gov, NCT01761266, https://clinicaltrials.gov/ct2/show/NCT01761266 .
MRI lesions in SpA: a comparison with noninflammatory back pain using propensity score adjustment method
Authors: Chung Ho Yin , Huang Jin Xian , Lee Kam Ho , Tsang Helen Hoi Lun , Lau Chak Sing , Chan Shirley Chiu Wai 
Published: August 2022

Background: Magnetic resonance imaging (MRI) is important in the management of axial spondyloarthritis (SpA). However, many MRI lesions are not exclusive to axial SpA. Further characterization of these lesions may lead to better clinical decisions. Objective: The objective of this study was to compare the frequency of individual spinal MRI lesions between axial SpA and noninflammatory back pain. The factors associated with individual lesions in participants with axial SpA were also determined. Design: This was a cross-sectional observational study. Methods: MRI lesions in 447 participants with axial SpA and 122 participants with noninflammatory back pain were compared using the propensity score adjustment method. Individual lesions included discovertebral lesions (DVL), Modic type 1 lesions, DVL without Modic type 1 lesions, facet joint lesions, costovertebral joint lesions, corner inflammatory lesions (CIL), and fatty corner lesions (FCL). The factors associated with the lesions were determined using regression analyses. Results: Among participants with axial SpA, 81.9% were HLA-B27-positive, 55.0% had radiographic axial SpA, and 60.5% had radiographic features of spinal damage (mSASSS >2). Almost half (48.6% in axial SpA versus 31.1% in noninflammatory back pain) had inflammatory lesions on spinal MRI. In propensity score matching with noninflammatory back pain, axial SpA had an increased occurrence of DVL without Modic type 1 lesion (OR = 3.43, p = 0.01), costovertebral lesion (OR = 11.89, p = 0.02), number of CIL ( B = 1.19, p < 0.001), and number of FCL ( B = 3.33, p < 0.001). Similar associations were found in the regression models in the radiographic axial SpA subgroup: DVL without Modic type 1 lesion (OR = 2.46, p = 0.001), costovertebral lesion (OR = 3.86, p < 0.001), number of CIL ( B = 1.13, p < 0.001), and FCL ( B = 2.29, p < 0.01). Conclusion: MRI lesions including DVL without Modic type 1, costovertebral joint lesions, CIL, and FCL were more specific in axial SpA.
Global safety monitoring of COVID-19 vaccines: how pharmacovigilance rose to the challenge
Authors: Rudolph Annette , Mitchell Joseph , Barrett Jim , Sköld Helena , Taavola Henric , Erlanson Nils , Melgarejo-González Carlos , Yue Qun-Ying 
Published: August 2022

Pharmacovigilance (PV) came suddenly into the spotlight when several new vaccines, developed as a response to the COVID-19 pandemic, received emergency authorisation and were rolled out on a large scale in late 2020. The vaccines underwent stringent clinical trials and evaluation from regulatory authorities, but with the use of novel technology and an anticipated rapid and vast deployment of the vaccines, the importance of a well-functioning international post marketing safety surveillance system was stressed. International PV stakeholders were faced with several challenges due to the extent of the global vaccination campaign. The unprecedented volume of reports of suspected adverse events following immunization has led to the development and use of new tools. Furthermore, the collaboration between various PV stakeholders was encouraged and strengthened. PV rose to the challenges posed by the currently ongoing global COVID-19 vaccination campaign and successful adaptations were made in a short period of time. However, the pandemic has not ended yet, the vaccination campaign is far from being completed, and further challenges are anticipated. Advances made during the pandemic will be important to strengthen PV in future and ensure to advance medicines’ safety together. Plain Language Summary Global safety monitoring of the COVID-19 vaccines: challenges, preparations, and outlooks Pharmacovigilance (PV) is the umbrella term for all sciences and activities relating to the detection, assessment, understanding, and prevention of adverse effects relating to medicines or vaccines. PV came into the spotlight when several new vaccines were authorised and rolled out as a response to the COVID-19 pandemic. The anticipated extent of the global vaccine rollout stressed the importance of a well-functioning safety surveillance system and international collaborations between patients, health care workers, vaccine producers, regulatory authorities, and PV centres. The identification and communication of potential safety concerns showed that adaptations to PV processes made in a short period of time as well as international collaborations were successful. However, it is important to learn from experiences made so far and to make sure the positive advances are maintained in the future to advance medicines’ safety together.
Characteristics of patients with xanthogranulomatous pyelonephritis undergoing nephrectomy: Identifying ways to optimise outcomes
Authors: Pfeifer Jacob , Wang Luke , Fu David , Stormont Gavin , Hill Brett , LaGrange Chad 
Published: August 2022

Objective: This study is conducted to investigate characteristics of patients with xanthogranulomatous pyelonephritis (XGP) who undergo nephrectomy and to identify ways to optimise outcomes for these patients. Materials and methods: 1587 patients were queried from our institutional electronic medical records. 12 patients who underwent nephrectomy with preoperative diagnoses of XGP in the operative note were identified. Associations were analysed with Kendall’s τb. p < 0.05 was statistically significant. Results: All patients were hemodynamically stable on day of surgery. Two patients died on postoperative days 1 and 3 from septic shock. Both had surgery during inpatient admission rather than electively, received relatively short duration of preoperative antibiotics (8 and 10 days), and both were on hemodialysis preoperatively. There was possible association between decreased glomerular filtration rate (τb = −0.550, p = 0.032) and death postoperatively. Among patients who lived, there was no significant association between duration of antibiotic therapy after intervention and duration of postoperative hospitalisation. Conclusion: These findings could suggest a possible association between declining renal function and mortality in our case series; and performing nephrectomy electively after a longer course of antibiotics may be associated with improved outcomes compared to nephrectomy performed during hospitalisation with a shorter course of antibiotics. Level of evidence: Level 4
A Novel Clinical Tool to Predict Cancer-specific Survival in Postoperative Patients With Primary Spinal and Pelvic Sarcomas: A Large Population-Based Retrospective Cohort Study
Authors: Huang Chao , Huang Zhangheng , Ding Zichuan , Zhou Zongke 
Published: August 2022

Study Design Retrospective cohort study. Objective Primary osseous sarcomas originating from the spine and pelvis are rare and usually portend inferior prognoses. Currently, the standard treatment for spinal and pelvic sarcomas is surgical resection, but the poor prognosis limits the benefits to postoperative patients. This study aims to identify the independent prognostic factors of cancer-specific survival (CSS) in postoperative patients with primary spinal and pelvic sarcomas and construct a nomogram for predicting these patients’ 3-, 5-, and 10-year CSS probability. Methods A total of 452 patients were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. They were divided into a training cohort and a validation cohort. Univariate and multivariate Cox regression analyses were used to identify these patients’ CSS-related independent prognostic factors. Then, those factors were used to construct a prognostic nomogram for predicting the 3-, 5-, and 10-year CSS probability, whose predictive performance and clinical value were verified by the calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA). Finally, a mortality risk stratification system was constructed. Results Sex, histological type, tumor stage, and tumor grade were identified as CSS-related independent prognostic factors. A nomogram with high predictive performance and good clinical value to predict the 3-, 5-, and 10-year CSS probability was constructed, on which a mortality risk stratification system was constructed based to divide these patients into 3 mortality risk subgroups effectively. Conclusions This study constructed and validated a clinical nomogram to predict CSS in postoperative patients with primary spinal and pelvic sarcomas. It could assist clinicians in classifying these patients into different mortality risk subgroups and realize sarcoma-specific management.
Neuropsychological Performance and Engagement in Estate Planning and Advance Care Planning Preparation of Patients With Neurocognitive Disorders and Healthy Older Adults: Is the Situation Alarming or Reassuring in Greece?
Authors: Giannouli Vaitsa , Tsolaki Magda 
Published: August 2022

Background/Objective: This study examined for the first time in Greece, the estate planning and advance care planning (ACP) of healthy older adults and older patients diagnosed with different types of neurocognitive disorders for the presence of a valid will, a durable power of attorney for healthcare, and a living will, while the associations between general cognition, education, depression, actual financial capacity, and demographic and socioeconomic characteristics were examined. Methods: A total of 543 participants were examined with neuropsychological tests including Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). Along with the neuropsychological examination, all participants responded to relevant ACP questions. Results: Surprisingly, the majority of the participants regardless of their diagnostic group did not have a valid will, had not assigned a durable power of attorney for healthcare, and had not a written living will. Logistic regression revealed that biological sex, age, education, marital status, diagnostic group, MMSE, GDS, and actual financial capacity as measured with LCPLTAS did not predict the existence of a valid will, durable power of attorney, and written living will. Conclusions: A diagnosis of AD is not associated with more engagement in ACP as supported by research in USA. Concerns are raised about possible exploitation and abuse of older patients.
Utility of No-Charge Panel Genetic Testing for Inherited Retinal Diseases in a Real-World Clinical Setting
Authors: McClard Cynthia K. , Pollalis Dimitrios , Jamshidi Farzad , Kingsley Ronald , Lee Sun Young 
Published: August 2022

Purpose: To show the utility of genetic testing in inherited retinal disease (IRD) patients. Methods: This retrospective cohort study was performed at a single academic center and comprised 59 patients clinically diagnosed with IRD who had testing via the Invitae IRD Panel (Invitae Corp). Samples were collected from August 2019 to April 2021. The rates of genetic diagnosis and disease-category specific results (ie, positive, undetermined, negative) were assessed. Results: Testing results were returned a mean of 20 days (range, 14-28 days) after submission. Of the samples, 50.8% (30/59) had a diagnostic yield. By disease category, the yield was 46.4% (13/28) nonsyndromic retinitis pigmentosa (RP), 50.0% (4/8) syndromic RP, 46.2% (6/13) macular dystrophies, 75.0% (3/4) cone or cone-rod dystrophies, and 80.0% (4/5) other retinopathies; there were no cases of rod dystrophies. The results were undetermined in 47.5% of patients (28/59) because of identification of only 1 recessive mutation (5.1%; 3/59), 1 recessive mutation and at least 1 variant of uncertain significance (VUS) (13.6%; 8/59), or VUS only (28.8%; 17/59). One patient (1.7%) received negative testing results with no mutations or VUS identified. Conclusions: Open-access, no-charge panel testing offers a reasonable diagnostic yield. Accurate clinical diagnosis of IRD before testing and acknowledgment of the limitations of panel testing are critical. The results add to the current estimates of the value of genetic testing for retina specialists in the management of IRD.
Haptoglobin 1 allele predicts higher serum haptoglobin concentration and lower multiorgan failure risk in sickle cell disease
Authors: Ruiz Maria A. , Shah Binal N. , Ren Guohui , Hussain Faiz , Njoku Franklin , Machado Roberto F. , Gordeuk Victor R. , Saraf Santosh L. 
Published: August 2022

Abstract
Haptoglobin (HP) is an acute-phase protein and the main scavenger of cell-free hemoglobin. When HP is depleted, as observed in hemolytic conditions such as sickle cell disease (SCD), cell-free hemoglobin can lead to acute organ damage. The impact of the HP 1-1, 2-1, and 2-2 isoforms on HP and cell-free hemoglobin concentrations and SCD-related complications is unclear. In a longitudinal cohort of patients with SCD, the HP 1 allele was associated with higher HP and lower cell-free hemoglobin concentrations at a routine clinic visit as well as during hospitalization for a vaso-occlusive episode or acute chest syndrome. With a median follow-up of 6.8 years, acute chest syndrome occurred in 42% (n = 163) and multiorgan failure in 14% (n = 53) of 391 patients with SCD with a minimum follow-up of 6 months. The HP 1 allele was independently associated with lower risk of developing multiorgan failure during acute chest syndrome (additive model hazard ratio, 0.5; P &lt; .001). Future studies assessing the regulation of HP concentrations and ability to bind cell-free hemoglobin according to the HP genotype may help to identify patients with SCD at high risk for multiorgan failure and to guide interventions, such as rapid initiation of exchange transfusion or HP replacement therapy.
GFAP and NfL increase during neurotoxicity from high baseline levels in pediatric CD19-CAR T-cell patients
Authors: Gust Juliane , Rawlings-Rhea Stephanie D. , Wilson Ashley L. , Tulberg Niklas M. , Sherman Amber L. , Seidel Kristy D. , Wu Qian “Vicky” , Park Julie R. , Gardner Rebecca A. , Annesley Colleen E. 
Published: August 2022

AbstractThere is a need for biomarkers to predict and measure the severity of immune effector cell–associated neurotoxicity syndrome (ICANS). Glial fibrillary acidic protein (GFAP) and neurofilament light chain (NfL) are well-validated biomarkers of astroglial and neuronal injury, respectively. We hypothesized that pretreatment GFAP and NfL levels can predict the risk of subsequent ICANS and that increases in GFAP and NfL levels during treatment reflect ICANS severity. We measured cerebrospinal fluid GFAP (cGFAP) and NfL (cNfL) along with serum NfL (sNfL) levels at pretreatment and day 7 to 10 after chimeric antigen receptor (CAR) T-cell infusion in 3 pediatric cohorts treated with CD19- or CD19/CD22-directed CAR T cells. cGFAP and cNfL levels increased during grade ≥1 ICANS in patients treated with CD19-directed CAR T cells but not in those who received CD19/CD22-directed CAR T cells. The sNfL levels did not increase during ICANS. Prelymphodepletion cGFAP, cNfL, and sNfL levels were not predictive of subsequent ICANS. Elevated baseline cGFAP levels were associated with a history of transplantation. Patients with prior central nervous system (CNS) radiation had higher cNfL levels, and elevated baseline sNfL levels were associated with a history of peripheral neuropathy. Thus, cGFAP and cNfL may be useful biomarkers for measuring the severity of CNS injury during ICANS in children. Elevated baseline levels of cGFAP, cNfL, and sNfL likely reflect the cumulative injury to the central and peripheral nervous systems from prior treatment. However, levels of any of the 3 biomarkers before CAR T-cell infusion did not predict the risk of ICANS.