bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real-world evaluation of the impact of radiotherapy and chemotherapy in elderly patients with glioblastoma based on age and performance status
Authors: Al Feghali Karine A , Buszek Samantha M , Elhalawani Hesham , Chevli Neil , Allen Pamela K , Chung Caroline 
Published: October 2020

Abstract

Background
This retrospective study investigated the impact of, in addition to age, the management and outcomes of elderly patients with glioblastoma (GBM).

Methods
The National Cancer Database was queried between 2004 and 2015 for GBM patients age 60 years and older. Three age groups were created: 60 to 69, 70 to 79, and 80 years and older, and 4 age/KPS groups: “age ≥ 60/ KPS &lt; 70” (group 1), “age 60 to 69/KPS ≥ 70” (group 2), “age 70 to 79/KPS ≥ 70” (group 3), and “age ≥ 80/KPS ≥ 70” (group 4). Multivariable (MVA) modeling with Cox regression determined predictors of survival (OS), and estimated average treatment effects analysis was performed.

Results
A total of 48 540 patients with a median age of 70 years (range, 60-90 years) at diagnosis, and a median follow-up of 6.8 months (range, 0-151 months) were included. Median survival was 5.0, 15.2, 9.6, and 6.8 months in groups 1, 2, 3, and 4, respectively (P &lt; .001). On treatment effects analysis, all groups survived longer with combined chemotherapy (ChT) and radiation therapy (RT), except group 1, which survived longer with ChT alone (P &lt; .001). RT alone was associated with the worst OS in all groups (P &lt; .01). Across all groups, predictors of worse OS on MVA were older age, lower KPS, White, higher comorbidity score, worse socioeconomic status, community treatment, tumor multifocality, subtotal resection, and no adjuvant treatment (all P &lt; .01).

Conclusions
In elderly patients with newly diagnosed GBM, those with good KPS fared best with combined ChT and RT across all age groups. Performance status is a key prognostic factor that should be considered for management decisions in these patients.
Maximizing the use of batch production of 18F-FDOPA for imaging of brain tumors to increase availability of hybrid PET/MR imaging in clinical setting
Authors: Aboian Mariam , Barajas Ramon , Shatalov Julia , Ravanfar Vahid , Bahroos Emma , Tong Elizabeth , Taylor Jennie W , Bush N Oberheim , Sneed Patricia , Seo Youngho , Cha Soonmee , Hernandez-Pampaloni Miguel 
Published: October 2020

Abstract

Background
Amino acid PET imaging of brain tumors has been shown to play an important role in predicting tumor grade, delineation of tumor margins, and differentiating tumor recurrence from the background of postradiation changes, but is not commonly used in clinical practice because of high cost. We propose that PET/MRI imaging of patients grouped to the day of tracer radiosynthesis will significantly decrease the cost of PET imaging, which will improve patient access to PET.

Methods
Seventeen patients with either primary brain tumors or metastatic brain tumors were recruited for imaging on 3T PET/MRI and were scanned on 4 separate days in groups of 3 to 5 patients. The first group of consecutively imaged patients contained 3 patients, followed by 2 groups of 5 patients, and a last group of 4 patients.

Results
For each of the patients, standard of care gadolinium-enhanced MRI and dynamic PET imaging with 18F-FDOPA amino acid tracer was obtained. The total cost savings of scanning 17 patients in batches of 4 as opposed to individual radiosynthesis was 48.5% ($28 321). Semiquantitative analysis of tracer uptake in normal brain were performed with appropriate accumulation and expected subsequent washout.

Conclusion
Amino acid PET tracers have been shown to play a critical role in the characterization of brain tumors but their adaptation to clinical practice has been limited because of the high cost of PET. Scheduling patient imaging to maximally use the radiosynthesis of imaging tracer significantly reduces the cost of PET and results in increased availability of PET tracer use in neuro-oncology.
Clostridioides (Clostridium) difficile Pacemaker Infection
Authors: Berkefeld Anna , Berger Fabian K , Gärtner Barbara C , Wantia Nina , Prinzing Anatol , Laugwitz Karl-Ludwig , Busch Dirk H , Rothe Kathrin 
Published: October 2020

Abstract
Clostridioides difficile is the leading cause of antibiotic-associated nosocomial diarrhea, but extra-intestinal manifestations are rare. We describe the first documented case of bacteraemia with pacemaker pocket and lead infection with the toxigenic C. difficile ribotype 014 with a lack of abdominal symptoms. The patient underwent pacemaker extraction and treatment with intravenous and oral vancomycin. Genotyping and molecular subtyping revealed clonality between pacemaker and intestinal isolates. This case illustrates the risk of intravascular device infections due to C. difficile. Even asymptomatic C. difficile colonization might pose a risk for prosthetic material infection.
Contesting Commemorative Landscapes: Confederate Monuments and Trajectories of Change
Authors: Simko Christina , Cunningham David , Fox Nicole 
Published: October 2020

Abstract
Following the racially motivated shootings at an African American church in Charleston, South Carolina, in 2015, a wave of contentious campaigns around Confederate statuary emerged, or at least intensified, in communities across the country. Yet local struggles have culminated in vastly different alterations to the built environment. This paper develops a framework for differentiating distinct “modes of recontextualization” rooted in the relocation and/or modification of commemorative objects. Building on models of memory as an iterative, path-dependent process, we track recontextualization efforts in three communities—St. Louis, Missouri; Oxford, Mississippi; and Austin, Texas—documenting how each mode alters the meaning of contested symbols. An analysis of local news sources in the year following recontextualization shows how each mode exerts identifiable proximate effects on broader political debates and, through that process, structures the horizon of possibility for longer-range outcomes.
Examination of the relationship between lapses and weight loss in a smartphone-based just-in time adaptive intervention
Authors: Goldstein Stephanie P , Brick Leslie A , Thomas J Graham , Forman Evan M 
Published: October 2020

AbstractWe developed a smartphone-based just-in-time adaptive intervention (JITAI), called OnTrack, that provides personalized intervention to prevent dietary lapses (i.e., nonadherence from the behavioral weight loss intervention diet). OnTrack utilizes ecological momentary assessment (EMA; repeated electronic surveys) for self-reporting lapse triggers, predicts lapses using machine learning, and provides brief intervention to prevent lapse. We have established preliminary feasibility, acceptability, and efficacy of OnTrack, but no study has examined our hypothesized mechanism of action: reduced lapse frequency will be associated with greater weight loss while using OnTrack. This secondary analysis investigated the association between lapse frequency and the weekly percentage of weight loss. Post hoc analyses evaluated the moderating effect of OnTrack engagement on this association. Participants (N = 121) with overweight/obesity (MBMI = 34.51; 84.3% female; 69.4% White) used OnTrack with a digital weight loss program for 10 weeks. Engagement with OnTrack (i.e., EMA completed and interventions accessed) was recorded automatically, participants self-reported dietary lapses via EMA, and weighed weekly using Bluetooth scales. Linear mixed models with a random effect of subject and fixed effect of time revealed a nonsignificant association between weekly lapses and the percentage of weight loss. Post hoc analyses revealed a statistically significant moderation effect of OnTrack engagement such that fewer EMA and interventions completed conferred the expected associations between lapses and weight loss. Lapses were not associated with weight loss in this study and one explanation may be the influence of engagement levels on this relationship. Future research should investigate the role of engagement in evaluating JITAIs.
Cognitive Improvement After Cochlear Implantation in Older Adults With Severe or Profound Hearing Impairment: A Prospective, Longitudinal, Controlled, Multicenter Study
Authors: Mertens Griet , Andries Ellen , Claes Annes J. , Topsakal Vedat , Van de Heyning Paul , Van Rompaey Vincent , Calvino Miryam , Sanchez Cuadrado Isabel , Muñoz Elena , Gavilán Javier , Bieńkowska Katarzyna , Świerniak Weronika , Skarżyński Piotr Henryk , Skarżyński Henryk , Tapper Lynne , Killan Catherine , Ridgwell Jillian , McGowan Janet , Raine Christopher , Tavora-Vieira Dayse , Marino Roberta , Acharya Aanand , Lassaletta Luis 
Published: October 2020

Objective:
To compare the cognitive evolution of older adults with severe or profound hearing impairment after cochlear implantation with that of a matched group of older adults with severe hearing impairment who do not receive a cochlear implant (CI).

Design:
In this prospective, longitudinal, controlled, and multicenter study, 24 older CI users were included in the intervention group and 24 adults without a CI in the control group. The control group matched the intervention group in terms of gender, age, formal education, cognitive functioning, and residual hearing. Assessments were made at baseline and 14 months later. Primary outcome measurements included the change in the total score on the Repeatable Battery for the Assessment of Neuropsychological Status for Hearing impaired individuals score and on its subdomain score to assess cognitive evolution in both groups. Secondary outcome measurements included self-reported changes in sound quality (Hearing Implant Sound Quality Index), self-perceived hearing disability (Speech, Spatial, and Qualities of Hearing Scale), states of anxiety and depression (Hospital Anxiety and Depression Scale), and level of negative affectivity and social inhibition (Type D questionnaire).

Results:
Improvements of the overall cognitive functioning (p = 0.05) and the subdomain “Attention” (p = 0.02) were observed after cochlear implantation in the intervention group; their scores were compared to the corresponding scores in the control group. Significant positive effects of cochlear implantation on sound quality and self-perceived hearing outcomes were found in the intervention group. Notably, 20% fewer traits of Type D personalities were measured in the intervention group after cochlear implantation. In the control group, traits of Type D personalities increased by 13%.

Conclusion:
Intervention with a CI improved cognitive functioning (domain Attention in particular) in older adults with severe hearing impairment compared to that of the matched controls with hearing impairment without a CI. However, older CI users did not, in terms of cognition, bridge the performance gap with adults with normal hearing after 1 year of CI use. The fact that experienced, older CI users still present subnormal cognitive functioning may highlight the need for additional cognitive rehabilitation in the long term after implantation.
Performance Comparison of a Novel Rapid Stand-alone Molecular Test and a 2-Step Diagnostic Algorithm for Clostridioides difficile Detection in Children
Authors: Brotons Pedro , Saucedo Jesica , Simó Silvia , Gené Amadeu , Muñoz-Almagro Carmen 
Published: October 2020

Background:
We aimed to evaluate diagnostic performance of the cobas® Liat® Cdiff test, a novel single-step automated polymerase chain reaction (PCR) assay for rapid diagnosis of toxigenic Clostridioides difficile infection (CDI) in stool samples from children with clinical symptoms of CDI.

Methods:
Assessment of cobas Liat Cdiff diagnostic yield, time of analytical process and agreement of results with those of a 2-step diagnostic algorithm. The sequential algorithm combined an enzyme immunoassay (EIA) targeting antigen glutamate dehydrogenase (GDH), enterotoxin-A and cytotoxin-B, and a confirmatory PCR in EIA GDH-positive and toxin-negative samples. Fresh stool samples were collected prospectively from patients 2–18 years of age that were attended in Hospital Sant Joan de Deu (Barcelona, Spain) during December 2018–August 2019.

Results:
A total of 122 specimens were collected from 91 children (mean age, 8 years; 69.7% male). cobas Liat Cdiff identified 24 (19.7%) positive samples. EIA yielded 97 (79.5%) GDH- and toxin-negative results, 11 (9.0%) GDH- and toxin-positive results, and 14 (11.5%) GDH-positive and toxin-negative results, of which 11 (9.0%) were positive for the toxin by the confirmatory PCR. Overall, GDH- and toxin-positive samples detected by the sequential algorithm were 22 (18.0%). Comparatively, the new test reduced time of the analytical process significantly (20 vs. 35.4 minutes, P < 0.001).

Conclusion:
Use of cobas Liat Cdiff showed similar detection yield compared with a 2-step diagnostic algorithm that combined an EIA and a confirmatory PCR while decreasing the time of the analytical process markedly in stool samples from children suspected of CDI.
Growth hormone control and cardiovascular function in patients with acromegaly
Authors: Lin Yi-Chun , Yu Wen-Chung , Kuo Chin-Sung , Chen Harn-Shen 
Published: October 2020

Background:
Acromegaly is associated with cardiovascular alterations. Up to 50% acromegalic patients suffered from treatment failure after multiple modalities. We investigated correlation between cardiovascular function and control of growth hormone (GH) in acromegalic patients following transsphenoidal adenomectomy (TSA).

Methods:
We recruited acromegalic patients who had undergone TSA between 2006 and 2014 in this cross-sectional study. Patients were assigned to group 1, controlled acromegaly (GH <1.0 ng/mL and normalized insulin-like growth factor-1 [IGF-1]); group 2, partially controlled acromegaly (either GH >1.0 ng/mL or non-normalized IGF-1); or group 3, uncontrolled acromegaly (GH >1.0 ng/mL and non-normalized IGF-1). Echocardiography evaluated the left ventricular mass index, left ventricular ejection fraction, and the early transmitral filling velocity (E)-to-late transmitral filling velocity (A) and the E-to-the early diastolic mitral annular velocity (E′) ratios. Carotid tonometry evaluated the intima-media thickness of the carotid artery, carotid-femoral pulse wave velocity, augmentation index, aortic characteristic impedance (Zc), and pulse pressure amplification.

Results:
Thirty-three patients participated in this study. Fourteen of the 33 patients were males (42%). Mean age at diagnosis was 50.33 years (SD 18.45). Compared to patients in group 1, patients in group 3 had younger age and shorter years after operation, without statistical significance. Cumulative GH levels were progressively higher from group 1 to group 3, without statistical significance. The groups did not differ with respect to cardiovascular structure and function evaluated by echocardiography and carotid tonometry. Only Zc value had a difference that was of borderline significance (group 1: 109.13 ± 32.99; group 2: 129.30 ± 32.27; group 3: 159.56 ± 77.4 dynes × s/cm5; ANOVA p = 0.088; p = 0.086 for group 1 vs group 3).

Conclusion:
In the patients with acromegaly who had undergone TSA, cardiac structure and vascular stiffness did not differ among the groups with different levels of GH control.
Measuring human leukocyte antigen alloantibodies: beyond a binary decision
Authors: Maguire Chelsea H. , Schinstock Carrie A. , Tambur Anat R. 
Published: October 2020

Purpose of review
Accurate measurement of human leukocyte antigen antibodies is critical for making clinical decisions treating patients awaiting transplantation or monitoring them post transplantation. Single antigen bead assay results are given as Mean Fluorescence Intensity, falling short of providing the required quantitative measure.

Recent findings
Titration studies were shown to circumvent the limitation of target-saturation that affect interpretation of single antigen bead assays especially in highly sensitized patients with strong antibodies. In fact, titration information can serve to measure efficacy of antibody removal during pretransplant desensitization using plasmapheresis/intravenous immunoglobulin (PP/IVIg) approaches. Moreover, recent studies indicate that knowing the donor-specific antibody titer has prognostic value that can guide PP/IVIg desensitization treatments. Newer data demonstrates an additional layer of information obtained by titration studies allowing to stratify patients with very high cPRA (>99%) based on the strength of the antibodies present, rather than the breadth. This data can thereby identify patients that are more likely to benefit from desensitization approaches on the transplant wait-list.

Summary
Titration studies have a prognostic value with regards to quantifying antibody strength. Obtaining this information does not require performing the complete set of dilutions. In fact, performing two to three specific dilutions can provide relevant information while maintaining practical cost.
Antiretroviral therapy reduces but does not normalize immune and vascular inflammatory markers in adults with chronic HIV infection in Kenya
Authors: Temu Tecla M. , Zifodya Jerry S. , Polyak Stephen J. , Wagoner Jessica , Wanjalla Celestine N. , Masyuko Sarah , Nyabiage Jerusha , Kinuthia John , Bloomfield Gerald S. , Page Stephanie T. , Farquhar Carey 
Published: October 2020

Introduction:
Markers of monocyte/macrophage activation and vascular inflammation are associated with HIV-related cardiovascular diseases (CVD) and mortality. We compared these markers among African people living with HIV (PLWH) and HIV-negative adults, and examined risk factors associated with elevated biomarkers (>75th percentile) in PLWH on antiretroviral therapy (ART).

Design:
Cross-sectional study.

Methods:
We measured serum concentrations of a gut integrity biomarker (intestinal-fatty acid binding protein), monocyte/macrophage activation biomarkers (soluble CD14 and CD163), and vascular inflammation biomarkers [soluble intercellular adhesion molecule 1 (sICAM-1) and soluble vascular adhesion molecule 1 (sVCAM-1)]. We assessed the relationship of these inflammatory parameters with HIV, using logistic regression adjusting for traditional CVD risk factors.

Results:
Among the 541 participants, median age was 43 years and half were female. Among 275 PLWH, median CD4+ T-cell count and duration of ART use was 509 cells/μl and 8 years, respectively. PLWH had significantly higher prevalence of elevated inflammatory biomarkers compared with HIV-negative individuals even after adjustment for traditional CVD risk factors. Compared with individuals without HIV, the prevalence of elevated biomarkers was highest among persons with detectable viral load and CD4+ T-cell counts 200 cells/μl or less. In a subanalysis among PLWH, nadir CD4+ T-cell count 200 cells/μl or less was associated with elevated soluble CD14 (sCD14); dyslipidemia with elevated sCD14, sICAM-1, and sVCAM-1; and overweight/obesity with reduced sCD14. Longer ART exposure (>4 years) was associated with reduced sVCAM-1 and sICAM-1.

Conclusion:
HIV and not traditional CVD risk factors is a primary contributor of monocyte/macrophage activation and inflammation despite ART. Anti-inflammatory therapies in addition to ART may be necessary to reduce these immune dysregulations and improve health outcomes of African PLWH.
Paget Schroetter Syndrome and Chylothorax After Rhinoplasty
Authors: Toros Sema Zer , Ertugay Omer Cagatay , Celep Sinan , Tanrikulu Handan 
Published: October 2020

Abstract
Paget-Schroetter syndrome is a rare clinical condition characterized by subclavian vein thrombosis following repetitive upper extremity effort. In this case, we presented a 35-year-old female patient who underwent septorhinoplasty in our clinic. A swelling of the left part of the neck extending to the clavicle was detected 4 hours after the operation. Computed tomography of the thorax revealed a pleural effusion at the base of the left lung and a computed tomography angiogram demonstrated a recanalized left subclavian vein thrombosis. History of the patient clarified that she had moved to another house and had lifted heavy furnitures 4 days before the surgery. The patient was diagnosed with Paget Schroetter syndrome followed by chylothorax. Paget-Schroetter syndrome followed by chylothorax could be presented after a surgical intervention of the head and neck. Early diagnosis is essential to reduce the risk of ongoing morbidity and mortality.
Influence of Radiographic Soft Tissue Findings on Clinical Entrapment in Patients With Orbital Fractures
Authors: Pontell Matthew E. , Jackson Kianna , Golinko Michael , Drolet Brian C. 
Published: October 2020

Introduction:
Radiographic assessment of facial fractures with computed tomography (CT) scanning has become standard of care. As imaging resolution has improved, findings such as herniation of extraocular muscles (EOM) have become a means of diagnosing conditions like orbital entrapment. However, the sensitivity and specificity of these findings has not been well-studied. We sought to evaluate the value of radiographic findings such as fat herniation, EOM contour irregularity, and EOM herniation in predicting orbital entrapment after orbital fracture. Secondary endpoints include diplopia, abnormal EOM motility, and the need for surgical fixation.

Methods:
A single institution, retrospective review at a regional level 1 trauma center was conducted. Patients with orbital fractures were identified by International Classification of Disease (ICD) codes and CT reports were queried for the terms “herniation,” “herniated,” “entrapped,” and “entrapment.” Four hundred records were analyzed.

Results:
Sixty-seven percent of radiology reports mentioned “entrapped” or “entrapment,” while the incidence of clinical entrapment was 2.8%. The odds of entrapment, diplopia, and abnormal EOM motility were higher in those with EOM herniation; however, EOM herniation had a positive predictive value of 7.9% for clinical entrapment. Fat herniation alone and EOM contour irregularity had positive predictive values of 4.2% and 4.8%, respectively.

Conclusions:
While the odds of entrapment appear higher in patients with EOM herniation, this imaging finding is not predictive of clinical entrapment. Fat herniation and EOM contour irregularity did not have higher odds of entrapment, nor were they predictive. Diagnosis of orbital entrapment should be based primarily on physical exam, with CT as an adjunct only. The assumption that radiographic findings indicate orbital emergencies may result in unnecessary interfacility transfers, subspecialist consultations, and emergency operative procedures.