bluuebunny/crossref_metadata_2025_split huggingface dataset:
PD-L1 Expression in Extramammary Paget Disease: A Case Series
Authors: Fowler Mark R. , Flanigan Kendall L. , Googe Paul B. 
Published: March 2020

Abstract:
The PD-1/PD-L1 pathway plays a critical role in the physiologic inhibition and modulation of the immune response in normal tissue. Many tumors evade immune detection and response by upregulating PD-L1 expression. Humanized monoclonal PD-1 and PD-L1 antibodies have proven as both tolerable and effective treatment in many neoplasms. Extramammary Paget disease (EMPD) is a deformative and debilitating cutaneous malignancy in which definitive treatment options are limited with high recurrence rates after surgical excision. To the best of our knowledge, there is little published information regarding EMPD and PD-L1 expression. We evaluated 18 EMPD surgical pathology cases for tumor cell and tumor-associated inflammatory (TAI) cell PD-L1 expression. We identified PD-L1 tumor cell expression in 3 (17%) of the cases: 2 of 4 invasive cases (50%) and 1 of 14 (7%) noninvasive cases. One invasive case had lymph nodal metastasis with PD-L1 tumor cell expression. The host inflammatory response intensity and PD-L1 expression were variable in cases negative for tumor cell PD-L1 expression; however, a marked inflammatory response and TAI PD-L1 expression were present in all cases positive for tumor cell PD-L1 expression. In conclusion, 1 in 14 (7%) in situ EMPD cases showed tumor cell PD-L1 expression and 2 of 4 invasive cases (50%) showed tumor cell PD-L1 expression. TAI cells were more often positive (83%) than tumor cells (17%) for PD-L1 expression.
Serum uric acid is independently associated with diabetic nephropathy but not diabetic retinopathy in patients with type 2 diabetes mellitus
Authors: Xia Qun , Zhang Shu-Hua , Yang Sheng-Mei , Zhu Xiao-Li , Su Shuang , Hu Ai-Ping , Zhu Jian , Li Dong-Mei 
Published: March 2020

Background:
This study aims to investigate the relationship between serum uric acid (SUA) and the severity of diabetic nephropathy (DN) and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).

Methods:
A total of 2961 patients were enrolled in the present cross-sectional study. The severity of DN was determined by 24-hour urinary albumin excretion (UAE), which was classified as normal (UAE <30 mg/24 h), microalbuminuria (UAE: 30-299 mg/24 h), and macroalbuminuria (≥300 mg/24 h). The severity of DR was determined by non–mydriatic retinal photography and was classified as non–diabetic retinopathy (NDR), non–proliferative diabetic retinopathy (NPDR), and proliferative DR (PDR).

Results:
Patients with high SUA levels (≥420 μmol/L for males and ≥360 μmol/L for females) had a significantly higher prevalence of DN (UAE ≥30 mg/24 h, 39.3% vs 26.3%; p < 0.001), higher UAE levels (140 ± 297 vs 63 ± 175 mg/24 h; p < 0.001), and lower estimated glomerular filtration rate (eGFR; 79.3 ± 26.8 vs 96.8 ± 19.6 mL/min/1.73 m2; p < 0.001), when compared with patients with normal SUA levels. However, the prevalence of DR, NPDR, or PDR did not differ. Furthermore, the concentration of SUA was higher in patients with higher severity of DN (all, p < 0.001) and patients with PDR (compared with NDR or NPDR, p < 0.05). SUA levels were positively associated with male gender, body mass index, the use of diuretics, triglyceride, low-density lipoprotein, and UAE levels, whereas they were negatively correlated with high-density lipoprotein, fasting blood glucose, glycosylated hemoglobin, and eGFR. After adjustment, SUA remained significantly associated with UAE (r = 0.069, p < 0.001).

Conclusion:
For patients with T2DM, higher SUA levels are associated with higher UAE, lower eGFR, and higher prevalence of DN, but not DR.
The Effects of Meditation, Race, and Anxiety on Stroke Survivor Resilience
Authors: Love Mary F. , Sharrief Anjail , LoBiondo-Wood Geri , Cron Stanley G. , Sanner Beauchamp Jennifer E. 
Published: March 2020

ABSTRACT

BACKGROUND: Significant gaps exist in the identification and management of psychological effects of stroke on survivors. Interventions to enhance resilience, the ability to rebound from stress or adversity, could positively impact stroke recovery. The purpose of this study was to test the effect of meditation on resilience of community-dwelling stroke survivors and to identify resilience predictor variables in these survivors. METHODS: This was a substudy with secondary analysis of existing data from the parent study, MEditatioN for post stroke Depression. The effect of meditation on stroke survivor resilience in the intervention group (n = 20) was evaluated with a paired samples t test, with measures at baseline and immediately after the 4-week intervention. Baseline resilience predictor variables for all stroke survivors (n = 35) were evaluated with univariable analysis and multiple linear regression modeling. RESULTS: The increase in stroke survivor resilience scores from baseline (mean [SD], 3.46 [0.81]) to intervention completion (mean [SD], 3.58 [1.02]) was not statistically significant (t = 0.60, df = 19, P = .56). One-way analysis of variance with Tukey post hoc analysis revealed that baseline resilience was significantly lower (P = .02) for non-Hispanic black participants than for non-Hispanic white participants. Multiple linear regression with resilience as the dependent variable, race as a fixed factor, and trait anxiety as a covariate was significant (F
3,33 = 6.32, P = .002) and accounted for nearly 33% of the variance in baseline resilience. CONCLUSION: The effects of meditation on stroke survivor resilience should be tested in larger clinical trials that would explore the influence of social determinants of health, perceived stress, race-related stress, and anxiety subtypes on resilience.
Urban-Rural Differences in the Duration of Injury-Related Work Disability in Six Canadian Provinces
Authors: Macpherson Robert A. , Amick Benjamin C. , Collie Alex , Hogg-Johnson Sheilah , Koehoorn Mieke , Smith Peter M. , McLeod Christopher B. 
Published: March 2020

Objective:
To examine associations between injury-related work disability duration and urban-rural place of residence and whether associations differed across the disability distribution and by industry sector.

Methods:
Workers’ compensation claims from six Canadian provinces were extracted between 2011 and 2015. Multivariable quantile regression models tested the associations between urban-rural place of residence and disability days paid between the 50th and 95th percentiles of the distribution.

Results:
Compared to workers residing in metropolitan areas, those in all other areas experienced more disability days paid. Urban-rural differences increased toward the upper end of disability distribution and were largest in the construction, and transportation and warehousing sectors.

Conclusion:
Tailored interventions for workers in rural areas, particularly those in sectors associated with mobile work environments, may be warranted to reduce inequities in injury-related work disability duration by place of residence.
Increased risk of dementia after distal radius, hip, and spine fractures
Authors: Kim So Young , Lee Joon Kyu , Lim Jae-Sung , Park Bumjung , Choi Hyo Geun 
Published: March 2020

Abstract
This study aimed to evaluate the risk of dementia after distal radius, hip, and spine fractures.
Data from the Korean National Health Insurance Service-National Sample Cohort were collected for the population ≥ 60 years of age from 2002 to 2013. A total of 10,387 individuals with dementia were matched for age, sex, income, region of residence, and history of hypertension, diabetes, and dyslipidemia with 41,548 individuals comprising the control group. Previous histories of distal radius, hip, and spine fractures were evaluated in both the dementia and control groups. Using ICD-10 codes, dementia (G30 and F00) and distal radius (S525), hip (S720, S721, and S722), and spine (S220 and S320) fractures were investigated. The crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of dementia in distal radius, hip, and spine fracture patients were analyzed using conditional logistic regression analyses. Subgroup analyses were conducted according to age, sex and region of residence.
The adjusted ORs for dementia were higher in the distal radius, hip, and spine fracture group than in the non-fracture group (adjusted OR = 1.23, 95% CI = 1.10 –1.37, P < .001 for distal radius fracture; adjusted OR = 1.64, 95% CI = 1.48 – 1.83, P < .001 for hip fracture; adjusted OR = 1.31, 95% CI = 1.22 – 1.41, P < .001 for spine fracture). The results in subgroup analyses according to age, sex and region of residence were consistent.
Distal radius, hip, and spine fractures increase the risk of dementia.
The effect of transcranial direct current stimulation of pharyngeal motor cortex on swallowing function in patients with chronic dysphagia after stroke
Authors: Li Yabin , Feng Haixia , Li Jiao , Wang Hongxia , Chen Ning , Yang Jiali 
Published: March 2020

Abstract
About 11% to 13% of patients with acute dysphagia induced by stroke remain chronic dysphagia 6 months after stroke which usually leads to many severe complications and poor quality of life.
To investigate the effect of transcranial direct current stimulation (tDCS) on swallowing function in the patients with chronic dysphagia after stroke.
26 post-stroke patients with chronic dysphagia who received tDCS were identified by electronic medical records between July 2016 and April 2018. Of which, 13 were treated by unilateral hemispheric anodal tDCS at affected pharyngeal motor cortex. 13 eligible patients only treated by conventional therapies but without tDCS were randomly selected by matching on date of admission (±2 weeks) of the patients receiving unilateral tDCS. The swallowing function and quality of life were evaluated before and 2 weeks after treatment.
The patients in three groups were comparable. The swallowing function and quality of life of the patients in all the 3 groups had been improved over time. Comparing to the group without tDCS, both the groups with unilateral or bilateral tDCS had shorter oral transit time (1.69 ± 0.95, 0.97 ± 0.71 seconds, respectively) and higher scores of quality of life (159.76 ± 12.59, 179.69 ± 11.81, respectively) after treatment.
Both unilateral and bilateral hemispheric anodal tDCS combined with conventional therapies are helpful for recovery of swallowing function in patients with chronic dysphagia induced by stroke, but bilateral anodal tDCS substantially improve more.
The association between smartphone addiction and thumb/wrist pain
Authors: Baabdullah Ayman , Bokhary Diyaa , Kabli Yousof , Saggaf Omar , Daiwali Motaz , Hamdi Amre 
Published: March 2020

Abstract
Many smartphone users experience pain in the thumb/wrist. This pain can be due to certain types of hand injuries as well as inflammation of the extensor pollicis brevis and the abductor pollicis longus tendon sheaths, known as De Quervain tenosynovitis. The objective of this study was to evaluate the association between smartphone addiction and wrist/thumb pain and to determine the severity of the pain, as well as to calculate the prevalence of De Quervain tenosynovitis among medical students at King Abdulaziz University (KAU) in Jeddah.
A total of 387 medical students were enrolled. The smartphone addiction scale-short version (SAS-SV) was used to divide participants into the smartphone addict group and non-addict group. Both groups completed the self-administered patient-rated wrist and hand evaluation (PRWHE) questionnaire to evaluate wrist/hand pain. The Finkelstein test was administered to those who reported pain in the thumb/wrist.
Two hundred fifty-seven (66.4%) participants were smartphone addicts; 74 (19.1%) had a positive Finkelstein test. There was a significant correlation between smartphone addiction and high PRWHE scores (P = .036).
Our study found the prevalence of smartphones addiction among university students to be high (66%), furthermore a correlation between heavy smartphones usage and hand pain was found which indicates that heavy usage of these devices can cause subclinical effects on the human hand.
A multicenter retrospective investigation on the efficacy of perioperative oral management in cancer patients
Authors: Yamada Shin-Ichi , Soutome Sakiko , Hasegawa Takumi , Tojyo Itaru , Nakahara Hirokazu , Kawakami Mao , Hirose Marina , Fujita Shigeyuki , Komori Takahide , Kirita Tadaaki , Shibuya Yasuyuki , Umeda Masahiro , Kurita Hiroshi 
Published: March 2020

Abstract
Patients develop a number of oral complications during cancer treatments. Oral bacteria are associated with the onset of dental focal infections and the progression of oral mucositis. Dental focal infections are frequently associated with the systemic onset of bacteremia, sepsis, and pneumonia. The degeneration of oral function with these complications may become an obstacle to cancer treatments. Although comprehensive oral management, including oral care, the removal of dental focal infections, and improvements in oral function with dentures, is conducted for cancer patients in Japan, few studies have assessed its efficacy.
The aim of the present study was to investigate the incidence of dental/oral complications in cancer patients with perioperative oral managements (POMs) based on a large number of case series with a multicenter retrospective analysis.
The medical records of cancer patients with POMs were retrospectively reviewed and the incidence of oral complications and efficacy of oral management were investigated.
A total of 2744 cancer patients with POMs (1684 males and 1080 females, mean age 65.9 ± 13.0 years) were included and investigated in the present study. Among these patients, 2097 (76.4%) started POM before the initiation of cancer treatments, with 2130 (77.6%) receiving oral care only and 391 (14.2%) being subjected to invasive treatments, such as tooth extraction. The incidence of dental focal infections during the period of cancer treatments was 8.2%. The most frequent infection was acute periodontitis, including alveolar abscesses (112 patients, 4.1%). The incidence of grade 2 and 3 oral mucositis was 2.8%. Prolonged fever was observed in 113 patients (4.1%), with 7 having dental focal infections (6.2%). These incidence rates were lower than those reported previously.
Based on analyses of a large number of patients, the present results support the efficacy of oral management in cancer patients. However, further studies are needed to establish adequate oral management guidelines for cancer patients.
The value of apolipoprotein E in distinguishing benign and malignant unilateral pleural effusions
Authors: Xue Qing , Fang Guiju , Deng Xinyu , Zhang Canhui , Liu Zhixin , Peng Zhiwen , Lai Zibiao , Peng Yunjuan , Wu Jianhui 
Published: March 2020

Abstract
Pleural effusion (PE) remains insurmountable challenge and public health problem, requiring novel noninvasive biomarkers for accurate diagnosis. The aim of this study was to assess the clinical significance of apolipoprotein E (Apo-E) in PE, in order to determine its potential use as a diagnostic biomarker for malignant PE (MPE).
PE samples were obtained from 127 patients and the etiology of PE was determined by multiple diagnostic techniques. Apo-E levels were then measured in the pleural fluid samples.
58 PE patients were diagnosed with tumors, while 69 were tumor-free. Apo-E levels in MPE patients were significantly higher than those with benign PE (BPE) (P < .05). An Apo-E cut-off of 69.96 ng/mL yielded sensitivity and specificity of 79.31% and 73.91% respectively for MPE detection. The area under the curve for Apo-E was 0.793 (95% confidence interval: 0.712 to 0.860), which was smaller than that of carcinoembryonic antigen (CEA) (Z = 2.081, P<.05). In addition, the combination of Apo-E and CEA detection yielded a higher sensitivity of 87.90% and specificity of 95.65% in diagnosing MPE.
In conclusion, Apo-E levels in PE may be a potential biomarker for the detection of MPE. The combined detection of Apo-E and CEA could improve the diagnostic sensitivity and specificity for MPE. These findings provide a simple and convenient method for clinical screening and detection of PE.
Prognostic significance of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio in patients with metastatic gastric cancer
Authors: Zhao Guanghui , Liu Ning , Wang Shasha , Guo Jing , Song Xiaoxu , Qi Yaoyue , Qiu Wensheng , Lv Jing 
Published: March 2020

Abstract
Advanced gastric cancer has a poor prognosis because of advanced gastric cancer is prone to metastasis. It is urgent for us to find an indicator to predict the prognosis of gastric cancer in a timely fashion. Research has revealed that inflammation has an important role in predicting survival in some cancers. The purpose of this study was to evaluate the significance of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) on the prognosis of metastatic gastric cancer (GC).
This was a retrospective review of 110 patients were at presentation diagnosed with stage IV metastatic GC and all patients received palliative chemotherapy between January 2012 and January 2016 at the Affiliated Hospital of Qingdao University. Pretreatment NLR and PLR, as well as clinicopathological characteristics were collected. Patients were divided into high and low groups according to the cutoff values for NLR and PLR. The Kaplan–Meier method was applied to estimate the overall survival (OS) and the Cox proportional hazards model to evaluate the related risk factors for OS. All tests were 2-tailed and a P < .05 was considered to indicate a statistically significant difference.
One hundred ten patients were enrolled. Eighty-four patients were men, 24 patients were women, 61 patients were ≥65 years of age, and 49 patients were <65 years of age. The Eastern Cooperative Oncology Group (ECOG) score of most patients (n = 107) ranged from 0 to 1. Ten patients were human epidermal growth factor receptor 2 (HER2)-positive. Seventy-one patients presented with an elevated carcinoembryonic antigen (CEA) level and 49 patients had an elevated Carcinoembryonic 199 (CA-199) level. Fifty-two patients received first-line chemotherapy only. Nineteen patients received third-line or greater chemotherapy. One hundred patients chose dual drug chemotherapy. The median duration of follow-up was 11.6 months. Based on the receiver operating characteristic (ROC) curve, the optimal cut-off value for NLR and PLR was 2.48 and 143.39. Patients with high NLR and high PLR had poor overall survival compared with those who had low NLR and low PLR (P < .001 and P = .013, respectively). In univariate analysis, old age (P = .013), liver metastasis (P = .001), >1 metastatic sites (P = .028), higher NLR (P = .000), and higher PLR (P = .014) were identified as poor prognostic factors associated with OS. Our multivariate analysis had indicated that high NLR (hazard ratio [HR]: 1.617, 95% CI: 1.032–2.525, P = .036) and peritoneal metastasis (HR: 1.547, 95% CI:1.009–2.454, P = .045) was independent prognostic factors for overall survival; however, the PLR was not shown to be an independent prognostic factor.
Our study suggested that the pretreatment NLR can be used as significant prognosis biomarker in metastatic gastric cancer patients receiving palliative chemotherapy.
Diagnosis and medical care for congenital cytomegalovirus infection
Authors: Lin Chiahsuan , Tomio Jun , Tanaka Hirokazu , Sonoda Masaki , Sano Kazuaki , Kobayashi Yasuki 
Published: March 2020

Abstract
Although early detection and intervention may improve the outcome of the congenital cytomegalovirus (cCMV) infection, few studies assessed the real-world clinical practice for cCMV patients. We analyzed medical claims data to assess the patterns of diagnoses and medical care for cCMV patients.
We used a subset of medical claims database (JMDC Claims Database) in Japan, covering 207,547 newborns between April 2010 and March 2017 and observed for at least 6 months. The diagnosis of cCMV and related symptoms and sequelae and medical care, including essential examinations and antiviral treatment, were identified using standardized codes.
Overall, we identified 53 (25.5 per 100,000 newborns) cCMV patients diagnosed within 6 months after birth; of these, 83% were diagnosed within 1 month and 68% had at least 1 cCMV-related symptom at birth. Objective hearing tests and fundus examinations were performed within 6 months in 60% and 30% of patients, respectively. Antivirals were prescribed in 26% of patients. During the observation period (median = 33 months), sensorineural hearing loss (49%) and developmental problems (28%) were commonly identified as cCMV-related sequelae. The proportions of the patients continuously followed up with objective hearing tests up to 36 months were 30% in total and 56% in antiviral-treated patients, respectively.
The cCMV patients did not necessarily receive a timely diagnosis nor continuous follow-ups in usual clinical practice. Although the universal screening for cCMV may, if implemented, facilitate early diagnosis, it should be accompanied by strategic follow-up plans to support timely interventions.
Comparison between thromboelastography and the conventional coagulation test in detecting effects of antiplatelet agents after endovascular treatments in acute ischemic stroke patients
Authors: Liang Chunyang , Yang Yang , He Zijun , Ma Shang , Qu Xuenan , Luo Yongchun , Shen Chunsen , Xu Ruxiang 
Published: March 2020

AbstractAntiplatelet agents have been administered to patients with acute ischemic stroke after endovascular therapy. This study was designed to provide initial data to compare thromboelastography (TEG) with the conventional coagulation test (CCT) to analyze the coagulation function of antiplatelet drugs in such patients.The present retrospective cohort study included 240 patients who received endovascular therapy from September 2012 to December 2017. The baseline and clinical characteristics of these patients were collected with respect to TEG (parameters: R, K, maximal amplitude (MA), and α angle) and CCT (parameters: PT, activated partial thromboplastin time (APTT), fibrinogen (FIB), international normalized ratio (INR), and platelet count (PLT)) on day 5 after aspirin and clopidogrel post-endovascular interventions. The correlation and agreement of these 2 detecting methods were analyzed. Additionally, the area under the receiver operating characteristic curve (AUROC) was used to analyze the effectiveness of these 2 methods in detecting unfavorable clinical outcomes, including symptomatic intracranial hemorrhage and early neurological deterioration.The 3 pairs of parameters (R and APTT, K and APTT, and α angle and FIB) were in agreement for identifying hypercoagulability, while R and APTT, K and APTT, K and PLT, and α angle and PLT were in agreement for identifying hypocoagulability. The AUROC of parameter R for detecting symptomatic intracranial hemorrhage was 0.817, while that of parameter FIB for predicting early neurological deterioration was 0.887.Parameter FIB derived from CCT might be advantageous for evaluating early neurological deterioration, while parameter R detected by TEG might be superior for evaluating symptomatic intracranial hemorrhage.