bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment response lowers tumor symptom burden in recurrent and/or metastatic head and neck cancer
Authors: Hecht Markus , Hahn Dennis , Wolber Philipp , Hautmann Matthias G. , Reichert Dietmar , Weniger Steffi , Belka Claus , Bergmann Tobias , Göhler Thomas , Welslau Manfred , Große-Thie Christina , Guntinas-Lichius Orlando , von der Grün Jens , Balermpas Panagiotis , Orlowski Katrin , Messinger Diethelm , Stenzel Karsten G. , Fietkau Rainer 
Published: September 2020

Abstract
Background
Head and neck squamous cell cancer (HNSCC) frequently causes severe symptoms that may be reduced, when the tumor is successfully treated. The SOCCER trial studied the association of treatment response with patient reported tumor symptom burden in first line treatment of recurrent and/or metastatic HNSCC.

Methods
In this prospective, multi-center, non-interventional trial patients were treated either with platinum-based chemotherapy and cetuximab or radiotherapy and cetuximab. Tumor symptom burden was assessed every four weeks with a questionnaire containing ten visual analogue scales (VAS, range 0–100), which were summarized to the overall VAS score.

Results
Fourhundred seventy patients were registered in 97 German centers. A total of 315 patients with at least the baseline and one subsequent questionnaire were available for analysis. Changes in the VAS score were rated as absolute differences from baseline. Negative values indicate improvement of symptoms. The overall VAS score improved significantly at the first post-baseline assessment in responders (− 2.13 vs. non-responders + 1.15, p = 0.048), and even more for the best post-baseline assessment (− 7.82 vs. non-responders − 1.97, p = 0.0005). The VAS for pain (− 16.37 vs. non-responders − 8.89, p = 0.001) and swallowing of solid food (− 16.67 vs. non-responders − 5.06, p = 0.002) improved significantly more in responders (best post-baseline assessment). In the multivariable Cox regression analysis, worse overall VAS scores were associated with worse overall survival (hazard ratio for death 1.12 per 10 points increment on the overall VAS scale, 95% CI 1.05–1.20, p = 0.0009).

Conclusion
In unselected patients beyond randomized controlled trials, treatment response lowers tumor symptom burden in recurrent and/or metastatic HNSCC.

Trial registration
ClinicalTrials.gov, NCT00122460. Registered 22 Juli 2005,
Choroidal vascular changes in retinitis pigmentosa patients detected by optical coherence tomography angiography
Authors: Shen Chang , Li Yang , Wang Qian , Chen Yu-Ning , Li Wei , Wei Wen-Bin 
Published: September 2020

Abstract
Background
To evaluate choroidal vascular changes, including choriocapillaris (CC) and middle/large choroidal vessels, in retinitis pigmentosa (RP) patients using wide-angle optical coherence tomography angiography (OCTA) and to determine whether changes in the choroidal vascularity have a relationship with visual function and retinal structural changes.

Methods
34 patients with a confirmed diagnosis of RP and 48 controls were recruited. All patients underwent detailed ophthalmologic and imaging examinations, including two types of OCTA (Optovue, 3 × 3 mm, 6 × 6 mm; VG-200, 12 × 12 mm). CC defects were defined according to the choroidal vascular structure in five degrees. To evaluate middle and large choroidal vascular changes, the choroidal vascularity index (CVI), which was the luminance volume to the total choroidal volume, was used.

Results
Defects of choroidal vascularity of RP eyes were detected in comparison to control eyes. The defects were observed in the CC layer with a concentric or lobular pattern at different degrees. CVI, which was used to reflect middle/large choroidal vascularity, decreased in the perifoveal, pararetinal and periretinal regions in the RP eyes. CC defects degree were correlated with the BCVA (p = 0.001, r = − 0.556), the Humphrey indexes (mean deviation, MD, p < 0.001, r = − 0.673; PVF, p = 0.003, r = − 0.639; 10° mean sensitivity, 10° MS, p = 0.002, r = − 0.651) and microperimetry index (mean sensitivity, MS, p < 0.001, r = − 0.807). The preserved CC area (mean value: 28.65 ± 12.50 mm2) was negatively correlated with MS measured by microperimetry (p = 0.005, r = − 0.449). Ordinary regression analysis revealed that the CC defect degree was associated with the CVI of perifovea (p = 0.002, 95% CI: − 102.14 to − 24.01), the EZ length (p = 0.006, 95% CI: − 0.006 to − 0.001) and the VAD (vascular area density) of the DCP (deep capillary plexus) in the fovea (p = 0.022, 95% CI: 0.038–0.478). No correlations were detected between BCVA and CVI in any retinal regions. No correlations were found between the CVI and the VAD in any retinal regions.

Conclusion
The choroidal vascularity was widely defected in RP. Choriocapillaris and middle/large choroidal vascularity defects were correlated with each other. Visual function and retinal structural changes were found to be associated with choriocapillaris defects but not with middle/large choroidal vascular defects.
Histopathological assessment of optic nerve invasion guided by radiological findings in enucleated globes with retinoblastoma
Authors: Abusayf Mohammed M. , Alkatan Hind M. , Elkhamary Sahar , Almesfer Saleh A. , Maktabi Azza M. Y. 
Published: September 2020

Abstract
Background
Optic nerve (ON) invasion is an important high-risk feature, and an indicator for neoadjuvant chemotherapy and prognosis. We aim through this study to correlate the detected-ON invasion by Magnetic resonance imaging (MRI) with the corresponding confirmed histopathological level of invasion.

Methods
A retrospective study of enucleated globes with the diagnosis of retinoblastoma received in the histopathology department(s) from January 2015 to December 2016 (2 years). Slides were reviewed for ON invasion assessment, charts were reviewed for basic demographic data. All patients underwent MRI under sedation upon diagnosis and MRI findings were collected for the above correlation.

Results
A total of 38 patients were included: 21 males and 17 females. 29 (77.3%) had unilateral involvement, 7 (18.4%) had bilateral involvement and 2 cases had trilateral disease. The overall mean age at diagnosis was 22.63 ± 15.15 months. Histopathological examination revealed ON invasion in 28 cases (74%) distributed as follows: prelaminar (31.6%), laminar (18.4%), and post-laminar (23.7%). MRI confirmed post-laminar ON invasion in 8 cases (true positive) but failed to detect this in 1 case. Additionally, MRI detected another 8 cases of ON invasion that were false positive on histopathology (accuracy: 63.3%; sensitivity: 88.9%; specificity: 72.4%; Positive predictive value (PPV): 50%; Negative predictive value (NPV): 95.5%).

Conclusions
MRI is found to be less sensitive in evaluating prelaminar and laminar ON invasion (0.0 and 42.9%) compared to post-laminar invasion (88.9%). MRI has generally better specificity in detecting ON invasion irrespective of the invasion level. In our study, obtaining deeper and/or additional histologic sections from the other surface of the tissue block in cases where a post-laminar ON invasion by MRI is found but not confirmed histopathologically in routine sections is essential to avoid missing such an important high-risk feature.
Comparison of ultrasound cycloplasty and transscleral cyclophotocoagulation for refractory glaucoma in Chinese population
Authors: Yu Qiuli , Liang Ya , Ji Fangfang , Yuan Zhilan 
Published: September 2020

Abstract
Background
To compare the efficacy and safety of focused ultrasound cycloplasty (UCP) and transscleral cyclophotocoagulation (TSCP) in the treatment of refractory glaucoma in a Chinese population.

Methods
We retrospectively compared twenty-eight eligible patients with refractory glaucoma, who were divided into the UCP group and TSCP group. Patients in these two groups underwent a corresponding procedure from June 2018 to February 2019. The intraocular pressure (IOP), visual acuity, the number of anti-glaucoma agents used and complications were reviewed and compared between groups. Proper statistical methods were selected according to comparison models under IBM SPSS 25 software.

Results
After the 12-months follow-up, postoperative IOP and number of anti-glaucoma agents used in the two groups were both reduced than the baseline level, and the differences were statistically significant (P < 0.05). There were no significant differences in IOP, number of anti-glaucoma agents and the best-corrected visual acuity between the two groups at each follow-up time point (P>0.05). In terms of complications, the pain at 1 day after surgery in the UCP group was significantly milder than that in the TSCP group (P < 0.05). And there were no significant differences in other complications between the two groups (P > 0.05).

Conclusions
Both UCP and TSCP are safe and effective methods for the treatment of refractory glaucoma. Nevertheless, pain is less severe after UCP.
Vagus nerve stimulation as adjunctive therapy in patients with difficult-to-treat depression (RESTORE-LIFE): study protocol design and rationale of a real-world post-market study
Authors: Young Allan H. , Juruena Mario F. , De Zwaef Renske , Demyttenaere Koen 
Published: September 2020

Abstract
Background
Depressive illness is associated with significant adverse consequences for patients and their families, and for society. Clinical challenges are encountered in the management of patients suffering from depression whether they are designated difficult-to-treat or treatment-resistant. Prospective serial depression treatment trials have shown that less than 40% of patients with major depressive disorder remit with an initial pharmacotherapy trial, and a progressively smaller proportion of patients remit with each subsequent trial. For patients who suffer from difficult-to-treat depression (DTD), treatments should focus on patient-centred symptom control, patient functioning, and improving patient quality of life. Among the treatment options for patients with DTD is Vagus Nerve Stimulation (VNS) Therapy. VNS Therapy involves intermittent electrical stimulation of the left cervical vagus nerve and has been shown to be efficacious for long-term management of patients with DTD.

Methods
RESTORE-LIFE is a prospective, observational, multi-site, global post-market study intended to assess short-, mid-, and long-term effectiveness and efficiency outcomes in a ‘real-world’ setting among patients with DTD treated with adjunctive VNS Therapy. A minimum of 500 patients will be implanted with a VNS Therapy System at up to 80 global sites. Eligible patients will participate in a baseline visit between 1 and 6 weeks before device implant and will be followed for a minimum of 36 months and a maximum of 60 months. The diagnosis of depression and comorbid disorders will be determined using the Mini-International Neuropsychiatric Interview (MINI). The primary endpoint is response rate, defined as a decrease of ≥50% in Montgomery Åsberg Depression Rating Scale (MADRS) total score from baseline to 12 months post-implant.

Discussion
A standardized approach in the management of DTD may not be appropriate for the treatment of such a complex heterogenous patient population. This study has been designed to evaluate whether VNS Therapy meaningfully improves and sustains clinical and depressive symptom outcomes in patients with DTD. This study will investigate the durability of VNS response in DTD and utility of VNS for long-term disease management of DTD. In addition, the study results will potentially clarify clinical, functional, and health economic questions in a real-world patient population with DTD.

Trial registration
ClinicalTrials.gov NCT03320304. Registered 25 October 2017
The reliability and validity of PHQ-9 in patients with major depressive disorder in psychiatric hospital
Authors: Sun Yue , Fu Zhaoyan , Bo Qijing , Mao Zhen , Ma Xin , Wang Chuanyue 
Published: September 2020

Abstract
Background
To assess the reliability and validity of Patient Health Questionnaire-9 (PHQ-9) for patients with major depressive disorder (MDD) and to assess the feasibility of its use in psychiatric hospitals in China.

Methods
One hundred nine outpatients or inpatients with MDD who qualified the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria completed PHQ-9 and Hamilton Depression Scale (HAMD-17). Two weeks after the initial evaluation, 54 randomly selected patients underwent repeat assessment using PHQ-9. For validity analysis, the construct validity and criterion validity were assessed. The internal concordance coefficient and the test-retest correlation coefficients were used for reliability analysis. The correlation between total score and scores for each item and the correlation between scores for various items were evaluated using Pearson correlation coefficient.

Results
Principal components factor analysis showed good construct validity of the PHQ-9. PHQ-9 total score showed a positive correlation with HAMD-17 total score (r = 0.610, P < 0.001). With HAMD as the standard, PHQ-9 depression scores of 7, 15, and 21 points were used as cut-offs for mild, moderate, and severe depression, respectively. Consistency assessment was conducted between the depression severity as assessed by PHQ-9 and HAMD (Kappa = 0.229, P < 0.001). Intraclass correlation coefficient between PHQ-9 total score and HAMD total score was 0.594 (95% confidence interval, 0.456–0.704, P < 0.001). The Cronbach’s α coefficient of PHQ-9 was 0.892. Correlation coefficients between each item score and the total score ranged from 0.567–0.789 (P < 0.01); the correlation coefficient between various item scores ranged from 0.233–0.747. The test-retest correlation coefficient for total score was 0.737.

Conclusions
PHQ-9 showed good reliability and validity, and high adaptability for patients with MDD in psychiatric hospital. It is a simple, rapid, effective, and reliable tool for screening and evaluation of the severity of depression.
Evidence of practice gaps in emergency psychiatric care for borderline personality disorder: how can this be explained?
Authors: Cases Cécile , Lafont Rapnouil Stéphanie , Gallini Adeline , Arbus Christophe , Salles Juliette 
Published: September 2020

Abstract
Background
Recent research has highlighted that patients with borderline personality disorder (BPD) could experience symptomatic remissions. This led to the production of guidelines concerning the most appropriate care. In addition, as BPD patients frequently present at an emergency department (ED), specific recommendations concerning how they should be cared for there have also been developed. The recommendations include the referral of patients to inpatient, outpatient or specific crisis care. However, an issue that has not been addressed is the capacity of ED services to apply the care recommendations. The objective of our study, therefore, was to identify the factors limiting their use in the ED of Toulouse University Hospital.

Methods
A panel of psychiatrists specializing in BPD care examined the medical files of 298 patients with a BPD diagnosis to determine which referrals were consistent or not, according to the care recommendations. A logistic regression was then performed to identify which sociodemographic, clinical, organizational or professional-training factors were associated with inconsistent referrals.

Results
32% of patients experienced an inconsistent referral. Consultations performed during an on-call or day-off schedule were linked with inconsistent referrals, while an active follow-up was associated with the provision of consistent care.

Conclusion
Changing how evaluations of BPD patients in the ED are organized during on-call and day-off schedules could improve the application of the care recommendations regarding the most appropriate referrals.
Mortality and cause of death in physical activity and insufficient physical activity participants: a longitudinal follow-up study using a national health screening cohort
Authors: Min Chanyang , Yoo Dae Myoung , Wee Jee Hye , Lee Hyo-Jeong , Byun Soo Hwan , Choi Hyo Geun 
Published: September 2020

AbstractBackgroundFew studies have examined the association between physical activity (PA) and various causes of mortality in Korea. The aim of our study was to evaluate mortality and causes of death between PA and insufficient PA using Korean national cohort data.MethodsThe health screening cohort data from the Korean National Health Insurance Service-National Sample Cohort from 2009 to 2015 were used. ‘PA’ was determined if participants walked or performed moderate-intensity activity ≥5 d/week for ≥30 min, or vigorous-intensity activity ≥3 d/week for ≥20 min. Other participants were classified as ‘insufficient PA’. The PA and insufficient PA groups were matched by age, sex, income, and region of residence in a 1:1 ratio. Causes of death were classified into 13 categories. Crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for all mortality rates were analyzed using a stratified Cox proportional hazard model. Age, sex, income, and region of residence were stratified. Subgroup analyses were performed according to age, sex, and obesity status. The odds ratio according to the causes of death was calculated by the chi-square test.ResultsThe adjusted HR for mortality in the PA group was 0.85 (95% CI = 0.82–0.88). In subgroup analyses according to age, sex, and obesity status, results were consistent with the main findings in < 60-year-old females, ≥ 60-year-old males and females, and in all subgroups by obesity. The death rate by neoplasm, mental diseases, neurologic disease, circulatory disease, respiratory disease, digestive disease, abnormal finding, and trauma were lower in the PA than the insufficient PA group.ConclusionsThese results suggest that PA is inversely associated with mortality caused specifically by diseases reflected by mental, respiratory, cancer, and cardiovascular conditions. Additionally, PA is inversely associated with mortality compared to insufficient PA in all obesity status.
Mind the treatment gap: the prevalence of common mental disorder symptoms, risky substance use and service utilization among young Swiss adults
Authors: Werlen Laura , Puhan Milo A. , Landolt Markus A. , Mohler-Kuo Meichun 
Published: September 2020

Abstract
Background
Common mental disorders (CMDs) are highly prevalent and contribute significantly to the global burden of disease, yet there is evidence of a large treatment gap. We aimed to quantify this gap among young adults with symptoms of CMDs and examine the relationship between substance use and perceived need for care and mental health service utilization.

Methods
In a nationally representative, cross-sectional survey of young Swiss adults’ mental health and wellbeing, we assessed symptoms of anxiety, depression, and attention deficit hyperactivity disorder (ADHD) with widely used screening instruments and asked about participant suicidal ideation, suicide attempts, mental health-related quality of life, alcohol and drug use, perceived need for mental health care, and mental health service utilization. We used these variables to calculate the treatment gap and weighted all analyses according to the stratified sampling plan.

Results
Around a quarter of young adults screened positive for at least one CMD. Participants who screened positive for anxiety and/or depression reported significantly more suicidal ideation and lifetime suicide attempts and reported worse mental health-related quality of life than participants who did not screen positive for a disorder. Women’s prevalence of anxiety and depression symptoms was significantly higher than men’s, while men were more likely to report most types of risky drug use. Among those with a CMD, only around half perceived lifetime need for care, and less than 20% reported currently utilizing mental health services. Young adults with a CMD reporting risky weekly use of alcohol were less likely to be currently using services.

Conclusion
The high prevalence of CMD symptoms could reflect a rising prevalence of these disorders mirroring increasing trends observed in other countries. To address the large treatment gap, interventions promoting mental health literacy and more research on additional barriers to inform further interventions are needed.
Modelling improved efficiency in healthcare referral systems for the urban poor using a geo-referenced health facility data: the case of Sylhet City Corporation, Bangladesh
Authors: Adams Alayne M. , Ahmed Rushdia , Ahmed Shakil , Yusuf Sifat Shahana , Islam Rubana , Zakaria Salam Ruman M. , Panciera Rocco 
Published: September 2020

Abstract
Background
An effective referral system is critical to ensuring access to appropriate and timely healthcare services. In pluralistic healthcare systems such as Bangladesh, referral inefficiencies due to distance, diversion to inappropriate facilities and unsuitable hours of service are common, particularly for the urban poor. This study explores the reported referral networks of urban facilities and models alternative scenarios that increase referral efficiency in terms of distance and service hours.

Methods
Road network and geo-referenced facility census data from Sylhet City Corporation were used to examine referral linkages between public, private and NGO facilities for maternal and emergency/critical care services, respectively. Geographic distances were calculated using ArcGIS Network Analyst extension through a “distance matrix” which was imported into a relational database. For each reported referral linkage, an alternative referral destination was identified that provided the same service at a closer distance as indicated by facility geo-location and distance analysis. Independent sample t-tests with unequal variances were performed to analyze differences in distance for each alternate scenario modelled.

Results
The large majority of reported referrals were received by public facilities. Taking into account distance, cost and hours of service, alternative scenarios for emergency services can augment referral efficiencies by 1.5–1.9 km (p < 0.05) compared to 2.5–2.7 km in the current scenario. For maternal health services, modeled alternate referrals enabled greater referral efficiency if directed to private and NGO-managed facilities, while still ensuring availability after working-hours. These referral alternatives also decreased the burden on Sylhet City’s major public tertiary hospital, where most referrals were directed. Nevertheless, associated costs may be disadvantageous for the urban poor.

Conclusions
For both maternal and emergency/critical care services, significant distance reductions can be achieved for public, NGO and private facilities that avert burden on Sylhet City’s largest public tertiary hospital. GIS-informed analyses can help strengthen coordination between service providers and contribute to more effective and equitable referral systems in Bangladesh and similar countries.