bluuebunny/crossref_metadata_2025_split huggingface dataset:
Favourable effect of a ‘second hit’ after 13 weeks in early RA non-responders: the Amsterdam COBRA treat-to-target randomized trial
Authors: Hartman Linda , Rasch Linda A , Turk Samina A , ter Wee Marieke M , Kerstens Pit J S M , van der Laken Conny J , Nurmohamed Michael T , van Schaardenburg Dirkjan , van Tuyl Lilian H D , Voskuyl Alexandre E , Boers Maarten , Lems Willem F 
Published: October 2022

Abstract

Objective
The aim of this study was to investigate the effect of treat-to-target combination therapy with intensification at 13 weeks in early RA.

Methods
Early RA patients were classified as being at high or low risk of worsening RA based on disease activity and prognostic factors. High-risk patients received COBRA-light (prednisolone 30 mg/day tapered to 7.5 mg/day, MTX increasing to 25 mg/week), and low-risk patients received MTX monotherapy increasing to 25 mg/week. The primary outcome (target) was DAS44 &lt; 1.6 or EULAR good response at 26 weeks. At 13 weeks, non-responders were randomized to (open-label) intensification [high-risk patients: prednisolone 60 mg/day tapered to 7.5 mg/day, addition of SSZ (2 g/day) and HCQ (400 mg/day); low-risk patients: prednisolone 30 mg/day tapered to 7.5 mg/day] or continuation.

Results
In the high-risk group (n = 150), 110 patients (73%) reached the target at 13 weeks, and 9 dropped out. Non-responders were randomized to intensification (n = 15) or continuation (n = 16), and after 26 weeks, 12 (80%) vs 7 (44%) of these, respectively, reached the target [difference: 36%, (95% CI 2%, 71%); P = 0.04]. In the low-risk group (n = 40), 17 (43%) reached the target. Non-responders were randomized to intensification (n = 8) or continuation (n = 7); 4 vs 3, respectively, reached the target.
Adverse event rates were higher in the high-risk group, and higher in the intensification subgroup of that group. Serious adverse events were rare. Protocol violations were frequent and mostly led to mitigation of actual treatment intensification.

Conclusion
Initial combination therapy was very successful in high-risk RA, and early intensification was beneficial in patients not reaching the strict target. The low-risk group was too small for drawing conclusions. In routine practice, adherence to early intensification based on strict targets is difficult.

Trial registration
Netherlands Trial Register (NTR), NL4393, https://www.trialregister.nl/.
Fostering a research integrity culture: Actionable advice for institutions
Authors: De Peuter Steven , Conix Stijn 
Published: October 2022

AbstractResearch institutions’ research culture is increasingly recognized as a central driver of research integrity. Institutions are urged to develop research integrity promotion plans to foster a culture of research integrity. A host of guidelines and associated initiatives have been issued but specific, actionable recommendations for institutions are scattered across the scientific literature and generally not acknowledged and implemented (yet). Based on a broad literature review, in the current paper some practical advice for institutions is suggested, grouped into (1) policies, procedures, and processes; (2) dealing with breaches of research integrity; (3) education and training; and (4) monitoring and evaluation. With each section, we formulate specific recommendations.
Recent advances in the treatment of hemophagocytic lymphohistiocytosis and macrophage activation syndrome
Authors: Jesudas Rohith , Nichols Kim E. 
Published: October 2022

Purpose of review
The approach to treating patients with hemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS) has shifted in recent years with the aim to limit exposure to genotoxic agents, such as etoposide, yet dampen hyperinflammation by targeting the activity of specific HLH/MAS-associated cytokines. In this review, we discuss recent efforts to reduce the dose of etoposide and/or incorporate cytokine-targeted therapies for the treatment of HLH/MAS.

Recent findings
There is emerging evidence that reduced-dose etoposide and/or cytokine-targeted therapies, including agents that neutralize or inhibit signaling induced by interferon gamma, interleukin (IL)-1, IL-18, and IL-6, can effectively ameliorate the clinical and laboratory manifestations of HLH/MAS and improve overall outcomes.

Summary
The application of novel regimens containing lower doses of etoposide and/or cytokine-directed agents to treat HLH/MAS holds potential to dampen inflammation while minimizing therapy-associated toxicities. Nevertheless, further research is needed to better understand, which patients represent the most appropriate candidates to receive cytokine-targeted therapies, elucidate the optimal timing and dose of these therapies, and decipher whether they should be administered alone or in combination with conventional HLH-directed therapies, such as dexamethasone and standard-dose or reduced-dose etoposide.
Enhancing American Indians’/Alaska Natives’ Knowledge, Confidence, and Community During the Medical School Application Process: Findings From the Northwest Native American Center of Excellence
Authors: Vasquez Guzman Cirila Estela , Taylor Cynthia , Harris Anna , Donald Caitlin , Carney Patricia A. , Rasmussen-Rehkopf Sarah , Bruegl Amanda , Empey Allison , Hoffmann Laurel Murphy , Brodt Erik 
Published: October 2022

Purpose
To describe a Medical School Applicant Workshop (MSAW); present lessons learned about its impact on American Indian/Alaska Native (AIAN) participants’ knowledge, confidence, and sense of community; and report on participants’ medical school application progress 1 year after workshop completion.

Method
The Northwest Native American Center of Excellence at Oregon Health & Science University developed and implemented an annual 1-day AIAN MSAW in 2018. The main objectives of the workshop are for participants to gain insights into the medical school application process; learn strategies to competitively apply; receive feedback on their personal statement and mock interviews; and discuss the medical school application process with AIAN faculty, admissions deans, and peer-mentors. Recruitment of AIAN participants occurred via email; social media; text messaging; medical association contacts; and AIAN and science, technology, engineering, and mathematics organizations. Two surveys were administered: one immediately after and another 1-year after the workshop.

Results
Forty AIAN MSAW participants were accepted in 2018–2020. Findings indicate statistically significant increases in participants’ self-reported knowledge of the medical school application process and in their self-reported confidence. Participants reported meeting other AIAN students was highly beneficial and feeling connected to a community of AIAN health professionals after attending the workshop. Among the 25 participants who completed the 1-year follow-up survey, 12 (48.0%) indicated applying to medical school; all 12 of these participants were invited to interview, and 11 were offered acceptance to at least one medical school.

Conclusions
Completing the MSAW increased participants’ knowledge, confidence, and sense of community. If other programs and institutions were to consider using the MSAW model to reduce barriers and provide supports specifically designed for AIANs before and during the medical school application process, medical schools may stand to further increase AIAN representation in the physician workforce and ultimately to decrease health inequities among AIANs.
Comparative Analysis of Early Outcomes and Complications of PSO Among Neurosurgeons and Orthopedic Surgeons
Authors: McNeill Ian T. , Neifert Sean N. , Deutsch Brian C. , Martini Michael L. , Shuman William H. , Chapman Emily , Price Gabrielle , Hwang Songhon , Steinberger Jeremy , Caridi John M. 
Published: October 2022

Study Design:
Retrospective comparative cohort study using the National Surgical Quality Improvement Program.

Objective:
The aim of this study was to evaluate trends in the annual number of PSOs performed, describe the patient populations associated with each cohort, and compare outcomes between specialties.
Summary of Background Data:
Pedicle subtraction osteotomies (PSO) are complex and advanced spine deformity surgical procedures performed by neurosurgeons and orthopedic surgeons. Though both sets of surgeons can be equally qualified and credentialed to perform a PSO, it is possible that differences in training and exposure could translate into differences in patient management and outcomes.

Methods:
Patients that underwent lumbar PSO from 2005 to 2014 in the American College of Surgeons-National Surgical Quality Improvement Program registry were identified. Relevant demographic, preoperative comorbidity, and postoperative 30-day complications were queried and analyzed. The data was divided into 2 cohorts consisting of those patients who were treated by neurosurgeons versus orthopedic surgeons. Additional data from the Scoliosis Research Society Morbidity and Mortality database was queried and analyzed for comparison.

Results:
Demographic and comorbidity factors were similar between the neurosurgery and orthopedic surgery cohorts, except there were higher rates of hypertension among orthopedic surgeon-performed PSOs (65.66% vs. 48.67%, P=0.004). Except for 2012, in every year queried, orthopedic surgeons reported more PSOs than neurosurgeons. In patients who underwent lumbar fusion surgery, there was a higher rate of PSOs if the surgery was performed by an orthopedic surgeon (OR 1.7824, 95% CI: 1.4017–2.2665). The incidence of deep vein thrombosis after PSOs was higher for neurosurgery compared with orthopedic surgery (8.85% vs. 1.20%, P=0.004). However, besides deep vein thrombosis, there were no salient differences in surgical complication rates between neurosurgeon-performed PSOs and orthopedic surgeon-performed PSOs.

Conclusions:
The number of PSO procedures performed by neurosurgeons and orthopedic surgeons has increased annually. Differences in outcomes between neurosurgeons and orthopedic surgeons suggest an opportunity for wider assessment and alignment of adult spinal deformity surgery exposure and training across specialties.
Trends in percutaneous coronary intervention in China: analysis of China PCI Registry Data from 2010 to 2018
Authors: Liu Zhaoping , Li Jianping , Zhang Yan , Yu Bo , Ma Yitong , Ma Genshan , Wang Jianan , Liu Bin , Su Xi , Li Bao , Zhang Zheng , Chen Yuguo , Chen Jiyan , Chen Lianglong , Chen Yundai , Yuan Zuyi , Jia Shaobin , Gao Chuanyu , Tang Yida , Fu Xianghua , Han Yaling , Ge Junbo , Ma Xudong , Huo Yong 
Published: October 2022

Background and purpose:
In the past 30 to 40 years, percutaneous coronary intervention (PCI) in China has greatly improved. The State Ministry of Health established a quality control (QC) system in 2009, and all medical centers were required to report their PCI cases. We analyzed the data from the QC system to describe the current status and development of PCI in China.

Methods:
PCI case data during a period from 2010 to 2018 were extracted from the online QC system. Data quality was audited by QC centers at the provincial level. Statistical analysis was mainly descriptive. Trend analysis was conducted by recoding the year as a continuous variable in linear regression or logistic regression.

Results:
The number of medical centers reporting PCI cases was 941 in 2010, and increased to 1,788 in 2018. Total number of PCI cases reported online to the QC system was 236,717 in 2010, and increased to 705,970 in 2018. Estimate of the actual case number that included those reported offline only (based on offline audit by provincial QC centers) was 284,936 in 2010, and increased to 915,256 in 2018. The most common indication for PCI was unstable angina (52.9%–59.1%), followed by ST elevation myocardial infarction (STEMI; 25.0%–27.4%). Majority of the PCI procedures were performed via the radial artery (65.4% in 2010 and 90.7% in 2018). Angiography detected a left main lesion in 5%, single-vessel disease in 38.7% to 44.4%, two-vessel disease in 22.3% to 27.5%, and three-vessel disease in 27.0% to 28.7% of the patients. The rate of primary PCI for STEMI in all STEMI cases was 28.0% in 2010, and increased to 45.9% in 2018. The average number of stents implanted per case was 1.63 in 2010, and decreased to 1.46 in 2018. There was a trend for decreasing mortality (0.31% in 2010; 0.26% in 2018).

Conclusions:
The number of PCI cases in China increased steadily during a period from 2010 to 2018, with stable mortality rate. Transradial access is the dominant PCI route. The rate of primary PCI for STEMI increased substantially, but remained relatively low.
Baseline platelet count independently predicts long-term adverse outcomes in patients undergoing percutaneous coronary intervention: a single-center retrospective cohort study
Authors: Hou Xiangeng , Zheng Yingying , Wu Tingting , Chen You , Yang Yi , Ma Yitong , Xie Xiang 
Published: October 2022

Background
and purpose: The association between platelet counts (PC) with clinical outcomes after percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD) has been reported by some but not all previous studies. The present study aims to investigate the association of PC with the outcomes of CAD patients who underwent PCI.

Methods:
We conducted a retrospective cohort study to examine the potential impact of baseline PC with long-term outcomes in patients receiving at least one stent. The final analysis included a total of 6,046 patients. The median follow-up was 32 (1–120) months

Results:
All-cause mortality did not differ significantly among the four groups based on baseline PC (lowest 25%, Quartile 1 [Q1], PC < 173, n = 1,473; 25%–50%, Quartile 2 [Q2], 173 ≤ PC < 208, n = 1,529; 50%–75%, Quartile 3 [Q3], 208 ≤ PC < 250, n = 1,507; and 75%–100%, Quartile 4 [Q4], PC ≥ 250, n = 1,537). The rate of major adverse cardiovascular and cerebrovascular events was 12.8% (188/1,473) in the Q1 group, 12.8% (196/1,529) in the Q2 group, 15.1% (228/1,507) in the Q3 group, and 16.3% (150/1,537) in the Q4 group (P = 0.010). The rate of major adverse cardiovascular events was 11.3% (167/1,473) in the Q1 group, 11.6% (177/1,529) in the Q2 group, 13.9% (210/1,507) in the Q3 group, and 15.0% (231/1,537) in the Q4 group (P = 0.004). Using Q1 as reference, the adjusted hazard ratio (aHR) for major adverse cardiovascular and cerebrovascular events in multivariate Cox regression was 1.212 (95% confidence interval [CI]: 1.004–1.455, P < 0.001) in Q2, 1.455 (95% CI: 1.200–1.766, P < 0.001) in Q3, and 1.754 (95% CI: 1.426–2.118, P < 0.001) in Q4. Using Q1 as reference, the aHR for major adverse cardiovascular events was 1.201(95% CI: 0.968–1.492, P = 0.096) in Q2, 1.489 (95% CI: 1.206–1.837, P < 0.001) in Q3, and 1.847 (95% CI: 1.500–2.275, P < 0.001) in Q4.

Conclusion:
A higher baseline PC was independently associated with an increased risk of major adverse cardiovascular and cerebrovascular events and major adverse cardiovascular events, but not all-cause-mortality in CAD patients after PCI.
Pre-operative distraction using electric ride-on cars for children undergoing elective ambulatory surgery
Authors: Pastene Bruno , Piclet Jules , Praud Camille , Garcia Karine , Louis Katia , Schmidt Claire , Boyadjiev Ioanna , Boucekine Mohamed , Baumstarck Karine , Bezulier Karine , Bouvet Lionel , Zieleskiewicz Laurent , Leone Marc 
Published: October 2022

BACKGROUND
Pre-operative anxiety occurs in 18 to 60% of children undergoing surgery and results in poor outcomes. Nonpharmacological methods of distraction are effective in alleviating peri-operative anxiety. In our institution, ride-on electric cars (ride-on e-cars) are routinely used by children undergoing ambulatory surgery as a mean of nonpharmacological distraction.

OBJECTIVES
The aim of this study is to assess the effect of pre-operative distraction with ride-on e-cars on children's pre-operative anxiety when undergoing elective ambulatory surgery.

DESIGN
This was a prospective, randomised, controlled, open-label study.

SETTING
The study was carried out from September 2019 to September 2021 in the ambulatory paediatric surgery unit of our teaching hospital, in Marseille, France.

PATIENTS
Children aged 2 to 10 years and weighing less than 35 kg undergoing elective ambulatory surgery were eligible. One hundred and fifteen children were included, 56 in the control group and 59 in the intervention group.

INTERVENTION
Children in the control group were transported from the operating room (OR) waiting area to the OR using a trolley, while children in the intervention group used the ride-on e-cars, without pharmacological premedication or parental presence.

MAIN OUTCOME MEASURES
The primary outcome was pre-operative anxiety at the end of the transport (prior going into the OR assessed by the modified Yale Preoperative Anxiety Score Short Form (mYPAS-SF). Secondary outcomes were the anxiety levels in children over time, as well as postoperative pain and agitation assessed with the Face Legs Activity Cry Consolability (FLACC) and Paediatric Anaesthesia Emergence Delirium (PAED) scales, respectively.

RESULTS
The mYPAS-SF anxiety scores did not differ between the control group and the intervention group (39 ± 19 vs. 37 ± 21, P = 0.574). The secondary outcomes were similar between the two groups.

CONCLUSIONS
Our randomised controlled trial showed that the use of ride-on e-cars did not alter pre-operative anxiety as compared with standard transport in children undergoing elective ambulatory surgery.

TRIAL REGISTRATION
Clinicaltrials.gov identifier: NCT03961581
Selection of percutaneous mechanical circulatory support in cardiogenic shock: patient-specific considerations and insights from contemporary clinical data
Authors: Acosta Mary E. , Belkin Mark N. , Nathan Sandeep 
Published: October 2022

Purpose of review
Cardiogenic shock remains a complex and variable disease process requiring early recognition and prompt, multidisciplinary treatment. Available data link usage of high-dose and/or multiple vasopressors in cardiogenic shock to increased mortality. This review proposes a structured approach to escalation of percutaneous mechanical circulatory support (pMCS) in cardiogenic shock, based on the hemodynamic and metabolic parameters highlighted in the revised SCAI Shock Classification, and supported by the available clinical data.

Recent findings
Intra-aortic balloon pumps (IABP) may improve hemodynamics in early cardiogenic shock (stage B) but offer little benefit in stage C–E shock where percutaneous ventricular assist devices (pVAD) improve cardiac power/index and may improve survival in certain subsets. In stage D–E shock, escalation from standalone pVADs to devices in combination is often appropriate. Left ventricular venting, with IABP or Impella, in conjunction with VA ECMO, appears to be beneficial.

Summary
Graded escalation of pMCS support should be considered in SCAI stage B shock patients onwards, with the choice of support allowable by local expertise, matched to the degree and anticipated trajectory of hemodynamic and metabolic compromise. Additional clinical data are required before timing, and escalation of pMCS initiation may be integrated into a single treatment algorithm.
RATE OF AND TIME TO COMPLETE RETINAL VASCULARIZATION IN PREMATURE INFANTS AND ASSOCIATED FACTORS
Authors: Lai Tso-Ting , Yang Chung-May , Hsieh Yi-Ting , Yeh Po-Ting , Huang Ching-Wen , Tsai Chia-Ying 
Published: October 2022

Purpose:
To evaluate the rate of and time to complete vascularization in premature infants and to explore associated factors.

Methods:
A monocentric, retrospective cohort study including 541 premature infants who underwent screening for retinopathy of prematurity (ROP) between July 2016 and June 2019. Patients underwent regular dilated fundus examinations with indirect ophthalmoscopy until complete vascularization. The worse eye of each patient was included for analyses. The proportion of infants with complete retinal vascularization at the last visit and the time to full vascularization was analyzed.

Results:
Among all infants (average gestational age 31.29 ± 3.12 weeks), 490 (90.57%) had complete records of retinal vascularization outcomes, of whom 439 (89.59%) achieved complete vascularization. The average postmenstrual age for complete vascularization was 45.39 ± 11.04 weeks, and 95.22% achieved completion before 64 weeks of postmenstrual age. Retinopathy of prematurity developed in 118 (22.56%) infants; 33 (6.10%) received antivascular endothelial growth factor treatment. For all infants screened for ROP, lower birth weight, presence of ROP, and antivascular endothelial growth factor therapy predicted delayed complete vascularization; for infants diagnosed with ROP, only lower birth weight predicted delayed complete vascularization. Subgroup analysis showed significant differences between patients without ROP, with untreated ROP, and with treated ROP in time to complete vascularization and its rate (99.7%, 66.2%, and 16.7%, respectively).

Conclusion:
Lower birth weight predicted delayed complete vascularization. Antivascular endothelial growth factor therapy and the presence of ROP, including ROP severity, may also affect time to complete vascularization. These findings should help improve the understanding and management of persistent avascular retina in preterm infants.
Corneal ectasia detection by epithelial pattern standard deviation from OCT
Authors: Salomão Marcella Q. , Hofling-Lima Ana Luisa , Gomes Esporcatte Louise Pellegrino , Correa Fernando Faria , Meneses Erica Ferreira , Li Yan , Huang David , Lopes Bernardo , Sena Nelson , Machado Aydano P. , Ambrósio Renato 
Published: October 2022

Purpose:
To test the ability of the corneal epithelial pattern standard deviation (PSD) to distinguish between normal and cases with corneal ectatic condition.

Setting:
Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil.

Design:
Cross-sectional retrospective study.

Methods:
Patients were stratified into 4 groups based on clinical data and corneal tomography. Groups 1 and 2 comprised 1 eye randomly selected from 105 patients with normal corneas (N) and 86 patients with bilateral keratoconus (KC). Groups 3 and 4, respectively, comprised 11 ectatic eyes with no surgical treatment for KC (very asymmetric ectasia [VAE]-E) from patients whose fellow eyes (61) presented with normal topographic patterns (VAE-NT). Corneas were scanned using an OCT system (RT Vue) and Scheimpflug corneal tomography (Pentacam) and also had biomechanical assessment through the Corvis ST. Corneal epithelial thickness maps were analyzed, and the PSD value was calculated. The area under the receiver operating characteristic curve analysis was used to evaluate the diagnostic accuracy of the indices.

Results:
A total of 105 normal eyes, 86 keratoconic eyes, and 11 ectatic eyes whose fellow eyes (61) presented normal topographic patterns were evaluated. Epithelial PSD was significantly different across the 4 groups (P < .0001). The pairwise comparison revealed that the normal group presented significantly lower values than both ectasia groups (KC and VAE-E, P < .0001) and the VAE-NT group (P = .0008). There was no statistical significant difference between KC and VAE-E (P = .4284), while they were significantly higher than the VAE-NT group (P < .0001 and P = .0004).

Conclusions:
Epithelial PSD can be used to detect abnormal epithelial thickness patterns. Corneal epithelial thickness changes could be detected accurately in patients with KC, even in the form fruste of the disease.