bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantifying the Impact of Axillary Surgery and Nodal Irradiation on Breast Cancer–Related Lymphedema and Local Tumor Control: Long-Term Results From a Prospective Screening Trial
Authors: Naoum George E. , Roberts Sacha , Brunelle Cheryl L. , Shui Amy M. , Salama Laura , Daniell Kayla , Gillespie Tessa , Bucci Loryn , Smith Barbara L. , Ho Alice Y. , Taghian Alphonse G. 
Published: July 2020

PURPOSE To independently evaluate the impact of axillary surgery type and regional lymph node radiation (RLNR) on breast cancer–related lymphedema (BCRL) rates in patients with breast cancer. PATIENTS AND METHODS From 2005 to 2018, 1,815 patients with invasive breast cancer were enrolled in a lymphedema screening trial. Patients were divided into the following 4 groups according to axillary surgery approach: sentinel lymph node biopsy (SLNB) alone, SLNB+RLNR, axillary lymph node dissection (ALND) alone, and ALND+RLNR. A perometer was used to objectively assess limb volume. All patients received baseline preoperative and follow-up measurements after treatment. Lymphedema was defined as a ≥ 10% relative increase in arm volume arising > 3 months postoperatively. The primary end point was the BCRL rate across the groups. Secondary end points were 5-year locoregional control and disease-free-survival. RESULTS The cohort included 1,340 patients with SLNB alone, 121 with SLNB+RLNR, 91 with ALND alone, and 263 with ALND+RLNR. The overall median follow-up time after diagnosis was 52.7 months for the entire cohort. The 5-year cumulative incidence rates of BCRL were 30.1%, 24.9%, 10.7%, and 8.0% for ALND+RLNR, ALND alone, SLNB+RLNR, and SLNB alone, respectively. Multivariable Cox models adjusted for age, body mass index, surgery, and reconstruction type showed that the ALND-alone group had a significantly higher BCRL risk (hazard ratio [HR], 2.66; P = .02) compared with the SLNB+RLNR group. There was no significant difference in BCRL risk between the ALND+RLNR and ALND-alone groups (HR, 1.20; P = .49) and between the SLNB-alone and SLNB+RLNR groups (HR, 1.33; P = .44). The 5-year locoregional control rates were similar for the ALND+RLNR, ALND-alone, SLNB+RLNR, and SLNB-alone groups (2.8%, 3.8%, 0%, and 2.3%, respectively). CONCLUSION Although RLNR adds to the risk of lymphedema, the main risk factor is the type of axillary surgery used.
Criminal Culpability for Acts Committed During a Possible Episode of REM Sleep Behavior Disorder
Authors: Kass Joseph S. , Rose Rachel V. 
Published: July 2020

ABSTRACT
Rapid eye movement (REM) sleep behavior disorder (RBD) may result in a patient injuring a bed partner while acting out a dream. This article examines the complexities associated with RBD as a criminal defense strategy as well as the legal implications for physicians and their duty to patients and their families to mitigate risks associated with possible injuries related to RBD.
Evaluating the Sleepy and Sleepless Patient
Authors: Malhotra Raman K. 
Published: July 2020

ABSTRACT

PURPOSE OF REVIEW
This article explains the clinical approach to patients presenting with sleepiness or sleeplessness in a neurologic practice setting. Addressing the patient’s sleep symptoms may help improve symptoms of their other underlying primarily neurologic disorder.

RECENT FINDINGS
New diagnostic modalities at home such as home sleep apnea testing have improved access and diagnosis of sleep apnea. Consumer health tracking devices have also helped patients focus on their sleep duration and quality, prompting them to bring their concerns to their neurologist.

SUMMARY
Like many neurologic disorders, a detailed history and physical examination are critical in the evaluation of patients with sleepiness or sleeplessness. Patients who have neurologic disorders are more likely to have poor-quality sleep. Questions about the patient’s sleep schedule or screening patients for common sleep disorders such as sleep apnea and restless legs syndrome (RLS) are useful to add to a typical neurologic evaluation to better recognize sleep disorders in this population. Polysomnography, home sleep apnea testing, multiple sleep latency tests, and actigraphy can be used with the available history and examination to determine the proper diagnosis and management plan for these patients.
Sleep-Wake Disorders in Childhood
Authors: Licis Amy 
Published: July 2020

ABSTRACTPURPOSE OF REVIEWThe presentation of sleep issues in childhood differs from the presentation in adulthood and may be more subtle. Sleep issues may affect children differently than adults, and distinct treatment approaches are often used in children.RECENT FINDINGSSodium oxybate was approved by the US Food and Drug Administration (FDA) in October 2018 for an expanded indication of treatment of sleepiness or cataplexy in patients with narcolepsy type 1 or narcolepsy type 2 aged 7 years or older, with side effect and safety profiles similar to those seen in adults. Restless sleep disorder is a recently proposed entity in which restless sleep, daytime sleepiness, and often iron deficiency are observed, but children do not meet the criteria for restless legs syndrome or periodic limb movement disorder.SUMMARYChildren’s sleep is discussed in this article, including normal sleep patterns and effects of insufficient sleep. Sleep disorders of childhood are reviewed, including insomnia, obstructive sleep apnea, restless legs syndrome, parasomnias, narcolepsy, and Kleine-Levin syndrome. Children with neurologic issues or neurodevelopmental disorders frequently have sleep disorders arising from an interaction of heterogeneous factors. Further attention to sleep may often be warranted through a polysomnogram or referral to a pediatric sleep specialist. Sleep disorders may cause indelible effects on children’s cognitive functioning, general health, and well-being, and awareness of sleep disorders is imperative for neurologists who treat children.
Reader characteristics and mammogram features associated with breast imaging reporting scores
Authors: Trieu Phuong Dung(Yun) , Lewis Sarah J , Li Tong , Ho Karen , Tapia Kriscia A , Brennan Patrick C 
Published: July 2020

Objectives:
This study aims to explore the reading performances of radiologists in detecting cancers on mammograms using Tabar Breast Imaging Reporting and Data System (BIRADS) classification and identify factors related to breast imaging reporting scores.

Methods:
117 readings of five different mammogram test sets with each set containing 20 cancer and 40 normal cases were performed by Australian radiologists. Each radiologist evaluated the mammograms using the BIRADS lexicon with category 1 - negative, category 2 - benign findings, category 3 - equivocal findings (Recall), category 4 - suspicious findings (Recall), and category 5 - highly suggestive of malignant findings (Recall). Performance metrics (true positive, false positive, true negative, and false negative) were calculated for each radiologist and the distribution of reporting categories was analyzed in reader-based and case-based groups. The association of reader characteristics and case features among categories was examined using Mann-Whitney U and Kruskal-Wallis tests.

Results:
38% of cancer-containing mammograms were reported with category 3 which decreased to 32.3% with category 4 and 16.2% with category 5 while 16.6 and 10.3% of cancer cases were marked with categories 1 and 2. Female readers had less false-negative rates when using categories 1 and 2 for cancer cases than male readers (p &lt; 0.01). A similar pattern as gender category was also found in Breast Screen readers and readers completed breast reading fellowships compared with non-Breast Screen and non-fellowship readers (p &lt; 0.05). Radiologists with low number of cases read per week were more likely to record the cancer cases with category 4 while the ones with high number of cases were with category 3 (p &lt; 0.01). Discrete mass and asymmetric density were the two types of abnormalities reported mostly as equivocal findings with category 3 (47–50%; p = 0.005) while spiculated mass or stellate lesions were mostly selected as highly suggestive of malignancy with category 5 (26%, p = 0.001).

Conclusions:
Most radiologists used category 3 when reporting cancer mammograms. Gender, working for BreastScreen, fellowship completion, and number of cases read per week were factors associated with scoring selection. Radiologists reported higher Tabar BIRADS category for specific types of abnormalities on mammograms than others.

Advances in knowledge:
The study identified factors associated with the decision of radiologists in assigning a BIRADS Tabar score for mammograms with abnormality. These findings will be useful for individual training programs to improve the confidence of radiologists in recognizing abnormal lesions on screening mammograms.
Impact of global warming on Raynaud’s phenomenon: a modelling study
Authors: Khouri Charles , Roustit Matthieu , Cracowski Jean-Luc 
Published: July 2020

Background: Raynaud’s phenomenon is induced by excessive vasoconstriction of the peripheral microcirculation in response to environmental factors, essentially cold, but also stress or emotions. The objective of the present study is to evaluate the impact of global warming on the worldwide prevalence and severity of Raynaud’s phenomenon over the 21st century. Method: We first estimated the correlation between average temperature and prevalence and severity of Raynaud’s phenomenon. Then, we mapped the prevalence and the severity of Raynaud’s phenomenon worldwide at Christmas 1999 using historical data and, using climate projections from the Inter-Sectoral Impact Model Intercomparison Project, we predicted the prevalence and severity of Raynaud’s phenomenon at Christmas 2099 according to four greenhouse-gas emission scenarios. Results: The prevalence of Raynaud’s phenomenon in the general population is expected to decrease by 0.5% per degree Celsius increase. Furthermore, patients are expected to suffer from one less attack per week for each increase of 2.5 degrees Celsius. Conclusions: Our study shows that global warming may have a significant impact on the prevalence and the severity of Raynaud’s phenomenon over the 21st century. However, as expected, this will greatly depend on the level of greenhouse-gas emissions.
Longitudinal trajectories of brain age in young individuals at familial risk of mood disorder from the Scottish Bipolar Family Study
Authors: de Nooij Laura , Harris Mathew A. , Hawkins Emma L. , Clarke Toni-Kim , Shen Xueyi , Chan Stella W. Y. , Ziermans Tim B. , McIntosh Andrew M. , Whalley Heather C. 
Published: July 2020

Background:Within young individuals, mood disorder onset may be related to changes in trajectory of brain structure development. To date, however, longitudinal prospective studies remain scarce and show partly contradictory findings, with a lack of emphasis on changes at the level of global brain patterns. Cross-sectional adult studies have applied such methods and show that mood disorders are associated with accelerated brain ageing. Currently, it remains unclear whether young individuals show differential brain structure aging trajectories associated with onset of mood disorder and/or presence of familial risk.Methods:Participants included young individuals (15-30 years, 53%F) from the prospective longitudinal Scottish Bipolar Family Study with and without close family history of mood disorder. All were well at time of recruitment. Implementing a structural MRI-based brain age prediction model, we globally assessed individual trajectories of age-related structural change using the difference between predicted brain age and chronological age (brain-predicted age difference (brain-PAD)) at baseline and at 2-year follow-up. Based on follow-up clinical assessment, individuals were categorised into three groups: (i) controls who remained well (C-well,n= 93), (ii) high familial risk who remained well (HR-well,n= 74) and (iii) high familial risk who developed a mood disorder (HR-MD,n= 35).Results:At baseline, brain-PAD was comparable between groups. Results showed statistically significant negative trajectories of brain-PAD between baseline and follow-up for HR-MD versus C-well (β= -0.60,pcorrected< 0.001) and HR-well (β= -0.36,pcorrected= 0.02), with a potential intermediate trajectory for HR-well (β= -0.24 years,pcorrected= 0.06). Conclusions:These preliminary findings suggest that within young individuals, onset of mood disorder and familial risk may be associated with a deceleration in brain structure aging trajectories. Extended longitudinal research will need to corroborate findings of emerging maturational lags in relation to mood disorder risk and onset.
Implementing an intensive care registry in India: preliminary results of the case-mix program and an opportunity for quality improvement and research
Authors: Adhikari Neill K. J. , Arali Rajeshwari , Attanayake Udara , Balasundaram Sampath , Beane Abi , Chakravarthy Vijay , Channanath Ashraf Niyaz , Darshana Sri , Devaprasad Dedeepiya , Dondorp Arjen M. , Fowler Robert , Haniffa Rashan , Ishani Pramodya , James Augustian , Jawad Issrah , Jayakumar Devachandran , Kodipilly Chamira , Laxmappa Rakesh , Mangal Kishore , Mani Ashwin , Mathew Meghena , Patodia Sristi , Pattnaik Rajyabardhan , Priyadarshini Dilanthi , Pulicken Mathew , Rabindrarajan Ebenezer , Ramachandran Pratheema , Ramesh Kavita , Rani Usha , Ranjit Suchitra , Ramaiyan Ananth , Ramakrishnan Nagarajan , Ranganathan Lakshmi , Rashan Thalha , Dominic Savio Raymond , Selva Jaganathan , Tirupakuzhi Vijayaraghavan Bharath Kumar , Tripathy Swagata , Tolppa Timo , Udayanga Ishara , Venkataraman Ramesh , Vijayan Deepak 
Published: July 2020

Background: The epidemiology of critical illness in India is distinct from high-income countries. However, limited data exist on resource availability, staffing patterns, case-mix and outcomes from critical illness. Critical care registries, by enabling a continual evaluation of service provision, epidemiology, resource availability and quality, can bridge these gaps in information. In January 2019, we established the Indian Registry of IntenSive care to map capacity and describe case-mix and outcomes. In this report, we describe the implementation process, preliminary results, opportunities for improvement, challenges and future directions. Methods: All adult and paediatric ICUs in India were eligible to join if they committed to entering data for ICU admissions. Data are collected by a designated representative through the electronic data collection platform of the registry. IRIS hosts data on a secure cloud-based server and access to the data is restricted to designated personnel and is protected with standard firewall and a valid secure socket layer (SSL) certificate. Each participating ICU owns and has access to its own data. All participating units have access to de-identified network-wide aggregate data which enables benchmarking and comparison. Results: The registry currently includes 14 adult and 1 paediatric ICU in the network (232 adult ICU beds and 9 paediatric ICU beds). There have been 8721 patient encounters with a mean age of 56.9 (SD 18.9); 61.4% of patients were male and admissions to participating ICUs were predominantly unplanned (87.5%). At admission, most patients (61.5%) received antibiotics, 17.3% needed vasopressors, and 23.7% were mechanically ventilated. Mortality for the entire cohort was 9%. Data availability for demographics, clinical parameters, and indicators of admission severity was greater than 95%. Conclusions: IRIS represents a successful model for the continual evaluation of critical illness epidemiology in India and provides a framework for the deployment of multi-centre quality improvement and context-relevant clinical research.
Why the lungs became a target organ due to ischemic-reperfusion syndrome of the limb, caused by the use of haemostatic tourniquet
Authors: Volotovska Nataliya 
Published: July 2020

Much attention has been paid to the ambiguous effects of the tourniquets and hemostatic bandages - namely the local and systemic consequences of planned operations, as well as the changes that occur after the cessation of bleeding from a wounded limb on the battlefield. However, there is still no consensus on the ischemic-reperfusion syndrome (IRS). Aim. Detect changes in the activity of lipid peroxidation in lung tissue on the background of experimental modifications of IRS. For this goal 260 male white rats aged 5-5.5 months were divided into 5 experimental groups: 1) EG1 - imposition of the tourniquet on the thigh for 2 h; 2) EG2 - modeling of venous blood loss in the amount of 40% of the volume of circulating blood; 3) EG3 - a combination of hemostatic tourniquet and blood loss 4) EG4 - mechanical injury to the thigh bone 5) a combination of hemostatic tourniquet and mechanical trauma. The biochemical study in 10 % lung homogenate was performed by reacting of peroxidation derivatives with thiobarbituric acid. Conclusions. It was found that each of these types of intervention caused the activation of lipid peroxidation in the lungs. The peculiarities of the reaction were such increase of this rate, which was the highest on the background of blood loss combined with the use of a tourniquet. However, the concentration of malonic dialdehyde was higher in the group where the imposition of the tourniquet was combined with mechanical trauma, compared with isolated mechanical trauma of the thigh. This has shown the role of the tourniquet as a factor that complicated the course of traumatic disease due to ischemic reperfusion.
Perception of the media image of health care in society
Authors: Jańczyk Magdalena , Samek Ilona , Bator Damian , Dąbrowska Justyna , Wójcik Magdalena , Milanowska Joanna 
Published: July 2020

Introduction and purpose: The mass media deal with, among others creating the image of health care. Most often, information published in the media is negative because it aims to show sensation and increase the interest of recipients. To present the perception of the media image of health care in society.Material and method: The research was carried out using the author's questionnaire. 210 responses were collected and analyzed.Results: The study involved men (29%) and women (71%). Majority (89.52%) of respondents were in favor of an unfavorable or neutral overall image of health care created by the media. Information reached almost 70% of respondents on long queues for visits to specialists, half a year or more. The respondents (83.81%) also drew attention to references spreading in publishers about the lack of staff among medical workers. However, most people (69.52%) did not share the healthcare model shaped by the "fourth authority" based on their experience.Conclusions: Based on the analysis, a negative media impact on the healthcare picture was confirmed. The data suggests that society does not quite agree with the media image of healthcare.
The effectiveness of complex therapy in patients with gout using carbon enterosorbent
Authors: Mudra Uliana , Andreychyn Serhiy 
Published: July 2020

Introduction. Gout is a serious medical, social and economic problem today. It becomes even more important due to its comorbidity. The relationship of pathogenetic mechanisms in the development and progression of gout and non-alcoholic fatty liver disease (NAFLD) has been proven. The presence of concomitant pathology enhances the inflammatory reaction in the body and significantly complicates the course of the underlying disease.The aim of the study – to evaluate the indicators of systemic inflammatory response in patients with gout and gout with NAFLD when included in the complex therapy of the disease carbon enterosorbent carboline.Materials and Methods. 123 patients with gout in the period of exacerbation were examined, who were divided into two groups. Group I included 65 patients with gout without liver damage, group II – 58 people with concomitant NAFLD. To determine the effectiveness of treatment, both groups were divided into subgroups: IA (27 people) and IIA (23 patients) who received conventional treatment. Subgroups IB (38 patients) and IIB (35 subjects) additionally received enterosorbent carboline. The control group consisted of 30 healthy individuals. A general clinical examination (collection of complaints, history, objective examination), determination of pain intensity on a visual-analog scale (VAS), biochemical (uric acid level (UA), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) ) and enzyme-linked immunosorbent assays (tumor necrosis factor-α) (TNF-α), interleukins 1 (IL-1β) and 10 (IL-10) were conducted.Results. Patients in both groups had typical clinical signs of joint syndrome. In patients with gout an increase in UA, CRP, ESR, imbalance of cytokine regulation (IL-1β, TNF-α, IL-10) was revealed. These changes increased in the presence of concomitant NAFLD. Significant decrease in the concentration of UA, CRP, ESR, cytokine content after treatment was in all subgroups, but more in patients who received carbon enterosorbent with basic therapy.Conclusions. The inclusion of the carbon enterosorbent carboline in the complex treatment of patients with gout and gout with NAFLD in the acute phase, promotes faster reverse dynamics of the clinical manifestations of the disease, accompanied by a more significant decrease of the level of UA, CRP, ESR and cytokines in blood serum.
Contemporary methods of prevention and early detection of cervical cancer - a review of the literature
Authors: Zygmunt Ewelina , Chojeta Dariusz , Zimna Aleksandra , Wróblewski Hubert , Maziarz Barbara , Piecewicz-Szczęsna Halina 
Published: July 2020

Cervical carcinoma remains a significant health problem, despite the progressive fall in the mortality rate during the past 60 years. However, cervical carcinoma is still the most common cancer among women worldwide and the leading cancer cause of death in many countries. The primary strategy to reduce the incidence and death rate from cervical carcinoma is screening by cervical cytology. The knowledge that persistent human papillomavirus (HPV) infection is the main cause of cervical cancer has resulted in the development of prophylactic vaccines to prevent HPV infection and HPV assays that detect nucleic acids of the virus. This study is a review of currently available methods of prevention and early detection of cervical cancer.
Splendid Isolation: a Practical Guide to the Use of Rubber Dam Part 1
Authors: Mackenzie Louis , Waplington Mike , Bonsor Steve 
Published: July 2020

Rubber dam isolation is generally considered to be the optimal method of moisture control in dentistry and is taught at the majority of dental schools worldwide. Unfortunately, undergraduate training does not always translate into use in dental practice, with the majority of clinicians never using a rubber dam, even for endodontic procedures, where its use is regarded as best practice in the United Kingdom (UK) and elsewhere. The COVID-19 pandemic has increased interest in the use of rubber dam as a highly effective infection control barrier. As professional and patient experience of rubber dam isolation is extremely limited, these two papers are designed to support the practical training of clinical teams in the confident, skilful use of rubber dam, to outline its advantages and to help overcome barriers to its routine use. Part one provides an update of the latest equipment and materials for rubber dam isolation and part two provides a practical guide to rubber dam isolation techniques for endodontic and operative/restorative procedures.CPD/Clinical Relevance: Mastering rubber dam isolation will enhance patient care and be professionally rewarding for clinical teams.