bluuebunny/crossref_metadata_2025_split huggingface dataset:
Community-Level Factors and HIV Health Among Older People Living With HIV (PLWH) in Alabama, United States: A Qualitative Analysis
Authors: Lee Yookyong , Walton Rick , Jackson Lindsey , Batey D. Scott 
Published: December 2020

Abstract
As the number of older people living with HIV (PLWH) is increasing, there is an urgent need for research on community-level factors to better understand the health care needs of this population. In-depth interview transcripts of 20 older PLWH who participated in a community-based participatory research study conducted in Alabama, in the United States, were analyzed through a phenomenological research approach. Results suggest that crime, lack of resources, and social isolation experienced at the community levels were found to be associated with the wellbeing of older PLWH. Moreover, community characteristics may confound older PLWH's comorbid conditions and resultant polypharmacy. An increased understanding of the impact of contextual factors on HIV health can inform more holistic individual- and community-level interventions aimed at addressing barriers to retention or re-engagement in HIV medical care and viral suppression among older PLWH.
The effectiveness of far-infrared irradiation on foot skin surface temperature and heart rate variability in healthy adults over 50 years of age
Authors: Peng Tai-Chu , Chang Su-Ping , Chi Lee-Mei , Lin Li-Mei 
Published: December 2020

Abstract

Background:
Far-infrared irradiation (FIR) is used in the medical field to improve wound healing, hemodialysis with peripheral artery occlusive disease, and osteoarthritis but seldom used in ameliorating poor lower extremity circulation. The purpose of this study was to evaluate the effect of FIR on changes in foot skin surface temperature (FSST) and autonomic nerve system (ANS) activity to evaluate its effectiveness in improving lower limb circulation.

Methods:
A randomized controlled study was conducted. Subjects (n = 44), all over the age of 50 years and satisfying the inclusion criteria, were randomly allocated into 2 groups. The intervention group received FIR on a lower limb for 40 minutes and the control group received no intervention. Left big toe (LBT), right big toe (RBT), left foot dorsal (LFD), right foot dorsal (RFD) surface skin temperature, autonomic nervous activity, and blood pressure were assessed.

Results:
The main results were skin surface temperature at the LBT increased from 30.8 ± 0.4°C to 34.8 ± 0.4°C, at RBT increased from 29.6 ± 0.4°C to 35.3 ± 0.4°C and LFD increased from 31.9 ± 0.3°C to 36.4 ± 0.4°C, RFD increased from 30.7 ± 0.3°C to 37.7 ± 0.2°C. FIR caused a significant increase of the FSST ranging in a 4°C to 7°C increase after 40 minutes irradiation (P < .001). The ANS low-frequency (LF) and high-frequency (HF) activity showed a statistically significant increase in the FIR group (P < .05) but not the LF/HF ratio.

Conclusion:
FIR significantly increased the FSST from between 4°C and 7°C after 40 minutes irradiation, which might improve lower extremity circulation and regulation of ANS activity.
Adversarial attack on deep learning-based dermatoscopic image recognition systems
Authors: Allyn Jérôme , Allou Nicolas , Vidal Charles , Renou Amélie , Ferdynus Cyril 
Published: December 2020

Abstract
Deep learning algorithms have shown excellent performances in the field of medical image recognition, and practical applications have been made in several medical domains. Little is known about the feasibility and impact of an undetectable adversarial attacks, which can disrupt an algorithm by modifying a single pixel of the image to be interpreted. The aim of the study was to test the feasibility and impact of an adversarial attack on the accuracy of a deep learning-based dermatoscopic image recognition system.
First, the pre-trained convolutional neural network DenseNet-201 was trained to classify images from the training set into 7 categories. Second, an adversarial neural network was trained to generate undetectable perturbations on images from the test set, to classifying all perturbed images as melanocytic nevi. The perturbed images were classified using the model generated in the first step. This study used the HAM-10000 dataset, an open source image database containing 10,015 dermatoscopic images, which was split into a training set and a test set. The accuracy of the generated classification model was evaluated using images from the test set. The accuracy of the model with and without perturbed images was compared. The ability of 2 observers to detect image perturbations was evaluated, and the inter observer agreement was calculated.
The overall accuracy of the classification model dropped from 84% (confidence interval (CI) 95%: 82–86) for unperturbed images to 67% (CI 95%: 65–69) for perturbed images (Mc Nemar test, P < .0001). The fooling ratio reached 100% for all categories of skin lesions. Sensitivity and specificity of the combined observers calculated on a random sample of 50 images were 58.3% (CI 95%: 45.9–70.8) and 42.5% (CI 95%: 27.2–57.8), respectively. The kappa agreement coefficient between the 2 observers was negative at -0.22 (CI 95%: −0.49–−0.04).
Adversarial attacks on medical image databases can distort interpretation by image recognition algorithms, are easy to make and undetectable by humans. It seems essential to improve our understanding of deep learning-based image recognition systems and to upgrade their security before putting them to practical and daily use.
Clinical usefulness of single photon emission tomography/computed tomography with stress analysis in early diagnoses of stem instability of noncemented hip arthroplasty
Authors: Zhang Li-Zhi , Li Shuang , Jiang Yao , Qiu Zhong-Ling , Wang Yang , Lu Han-Kui , Zhu Rui-Sen , Tuladhar Rujan , Chang Shi-Min 
Published: December 2020

Objective
Hip pain arising from implant instability is generally caused by repetitive stress injury, which subsequently leads to induction or exacerbation of abnormal metabolism of bone around the implant. single photon emission tomography/computed tomography (SPECT–CT) has advantages in localizing areas of increased tracer uptake that reflects such abnormal bone metabolism. Therefore, we investigated whether the application of SPECT/CT with stress analysis can be an effective practice in evaluating the instability of stem in noncemented hip arthroplasty or not.

Method
In total 16 patients were collected for unexplained painful hip arthroplasties. When physical examination and blood tests were unremarkable, radiographs were inconclusive and bone scan indicated increased scintigraphic uptake at the proximal part and at the tip of the stem; SPECT/CT was performed. Stem stability was assessed by measuring whether there was consistency between the increased scintigraphic uptake and the direction of the stress around the implant along with the location of the prosthesis.

Result
Among the 16 symptomatic hips, 9 hips showed the stability of the stem, 3 hips showed the stem instability and 4 hips showed the acetabular loosening with the stem stability. With the application of SPECT/CT with stress analysis, 15 out of 16 (93.7%) cases were found to have the change in the diagnoses, and managements were implemented in 11 out of 16 (68.7%) cases. When comparing before and after SPECT/CT, there was no significant association in clinical diagnosis and management (Pearson chi- square test = 4.61 and 1.33, P = 0.33 and 0.25).

Conclusion
SPECT/CT combined with stress analysis can be a useful tool in early diagnosis of stem instability and can assist surgeons in subsequent management and decision implementation when other radiographic imagings are inconclusive.
Baseline metabolic tumor volume calculation using different SUV thresholding methods in Hodgkin lymphoma patients: interobserver agreement and reproducibility across software platforms
Authors: Tutino Francesca , Puccini Giulia , Linguanti Flavia , Puccini Benedetta , Rigacci Luigi , Kovalchuk Sofya , Sciagrà Roberto , Berti Valentina 
Published: December 2020

Aim:
Although it is not yet used in clinical practice, metabolic tumor volume (MTV) assessed on the baseline FDG-PET has shown consistent prognostic value in various lymphoma types. The aim of our study was to compare interobserver agreement and reproducibility across platforms of MTV calculation using different SUV thresholding methods in a large series of patients with newly diagnosed Hodgkin lymphoma.

Materials and methods:
We retrospectively studied 121 patients. MTV at baseline FDG-PET was independently computed by three readers with three programs of semi-automatic segmentation, Fiji, LifeX, and Accurate. MTV measurement was performed with different thresholds: SUV >2.5, SUV >4, and SUV >41% of SUV max.

Results:
At inter-observer agreement analysis all Intraclass Correlation Coefficients (ICCs) were excellent (ICC >0.9), except for Accurate SUV >41% of SUV max (ICC = 0.8). The highest correlations were obtained at the SUV >4 threshold. The second best was SUV >2.5 threshold. Regarding reproducibility across software, we found statistically significant differences between Fiji versus LifeX and Accurate at fixed thresholds and between LifeX and Accurate at SUV >41% of SUV max, while no significant differences emerged between LifeX and Accurate using fixed thresholds.

Conclusion:
The three SUV thresholds studied are all suitable for MTV calculation in terms of reproducibility. The best reproducibility is achieved using fixed thresholds, both SUV >4 and SUV >2.5. If more than one software has to be used in a study, we suggest the use of fixed thresholds and the platforms LifeX and Accurate.
Is F-18 FDG PET/computed tomography a useful tool to restage the patients with tongue carcinoma?
Authors: Jain Tarun Kumar , Singh Guman , Goyal Sumit , Malhotra Hemant , Yadav Ajay , Kumbhaj Prashant , Yadav Dinesh , Khunteta Nitin 
Published: December 2020

Objective
The aim of this study was to evaluate the diagnostic performance of contrast-enhanced F-18 fluoro-2-deoxyglucose (F-18 FDG) PET/computed tomography (CT) in restaging of tongue carcinoma.

Material and methods
Retrospectively analysis of carcinoma tongue patients (n = 110) who were treated and referred for FDG PET/CT. Histopathological examination and clinical or imaging follow-up were taken as gold standard.

Results
Of 110 patients, FDG PET/CT detected FDG avid lesions in 69 (62.7%) patients. Sensitivity, specificity and diagnostic accuracy of FDG PET/CT were 92.9%, 90.0% and 91.8%, respectively, for residual/recurrence disease detection (P < 0.05). Additionally, in six patients, metachronous primaries were also detected [lung (4), esophagus and lymphoma (1) each]. The mean maximum standardized uptake value (SUVmax) with 95% confidence interval for primary site recurrence, regional lymph nodes and metastatic lesions was 11.51 (9.53–13.48), 69 (62.7%) (7.88–11.48) and 8.94 (3.11–14.76), respectively.

Conclusion
FDG PET/CT demonstrates high diagnostic accuracy for detection of residual/recurrent disease in treated tongue cancer patients and PET/CT should be considered as first-line diagnostic investigation in these patients.
Circulating extracellular vesicles as new inflammation marker in HIV infection
Authors: Falasca Katia , Lanuti Paola , Ucciferri Claudio , Pieragostino Damiana , Cufaro Maria Concetta , Bologna Giuseppina , Federici Luca , Miscia Sebastiano , Pontolillo Michela , Auricchio Antonio , Del Boccio Piero , Marchisio Marco , Vecchiet Jacopo 
Published: December 2020

Background:
Extracellular vesicles, released by cell pullulation, are surrounded by a phospholipid bilayer and carry proteins as well and genetic material. It has been shown that extracellular vesicles mediate intercellular communication in several conditions, such as inflammation, immunodeficiency, tumor growth, and viral infections. Here, we analyzed circulating levels of extracellular vesicles in order to clarify their role in chronic inflammation mechanisms characterizing HIV patients.

Methods:
We analyzed and subtyped circulating levels of extracellular vesicles, through a recently developed flow cytometry method. In detail, endothelial-derived extracellular vesicles (CD31+/CD41a−/CD45−, EMVs), extracellular vesicles stemming from leukocytes (CD45+, LMVs) and platelets (CD41a+/CD31+) were identified and enumerated. Moreover, we analyzed the extracellular vesicle protein cargo with proteomic analysis.

Results:
Circulating levels of total extracellular vesicles, EMVs and LMVs were significantly lower in the HIV+ patients than in healthy subjects, whereas platelet-derived extracellular vesicles resulted higher in patients than in the healthy population. Proteomic analysis showed the upregulation of gammaIFN and IL1α, and down-regulation of OSM, NF-kB, LIF, and RXRA signaling resulted activated in this patients.

Conclusion:
These data demonstrate, for the first time that HIV infection induces the production of extracellular vesicles containing mediators that possibly feed the chronic inflammation and the viral replication. These two effects are connected as the inflammation itself induces the viral replication. We, therefore, hypothesize that HIV infection inhibits the production of extracellular vesicles that carry anti-inflammatory molecules.
High-risk human papillomavirus test in anal smears: can it optimize the screening for anal cancer?
Authors: Kimura Cintia M.S. , Nahas Caio S.R. , Silva-Filho Edésio V. , Ribeiro Vinícius L. , Segurado Aluisio C. , Alcântara Flávio F.P. , Cecconello Ivan , Nahas Sergio C. 
Published: December 2020

Objective:
The current method for screening anal cancer is anal cytology, which has low sensitivity. Since high-risk human papillomavirus (HR-HPV) is associated with almost 90% of cases of anal cancer, the objective of this study is to evaluate whether testing for HR-HPV can optimize the screening.

Design:
Prospective study with patients enrolled in a screening program for anal dysplasia. Considering high-resolution anoscopy (HRA)-guided biopsy as the gold standard for diagnosis of high-grade squamous intraepithelial lesions, the diagnostic performance of anal cytology, HR-HPV testing, and the combination of both was calculated.

Settings:
A single center for anal dysplasia.

Participants:
A total of 364 patients (72% males, 82% HIV-positive).

Intervention:
Patients underwent anal cytology, HR-HPV test, and HRA-guided biopsy of the anal canal.

Main outcome measures:
Ability of cytology and HR-HPV test (individually and combined) to detect high-grade squamous intraepithelial lesions, and analysis of the cost of each diagnostic algorithm.

Results:
Cytology alone was the cheapest approach, but had the lowest sensitivity [59%, 95% confidence interval (CI) 46–71%], despite of highest specificity (73%, 95% CI 68–78%). Cotesting had the highest sensitivity (85%, 95% CI 74–93%) and lowest specificity (43%, 95% CI 38–49%), and did not seem to be cost-effective. However, HR-HPV testing can be used to triage patients with normal and atypical squamous cells of undetermined significance cytology for HRA, resulting in an algorithm with high sensitivity (80%, 95% CI 68–89%), and specificity (71%, 95% CI 65–76%), allied to a good cost-effectiveness.

Conclusion:
HR-HPV testing is helpful to optimize the screening in cases of normal and atypical squamous cells of undetermined significance cytology.
Enhanced and Timely Investigation of ARVs for Use in Pregnant Women
Authors: Abrams Elaine J. , Mofenson Lynne M. , Pozniak Anton , Lockman Shahin , Colbers Angela , Belew Yodit , Clayden Polly , Mirochnick Mark , Siberry George K. , Ford Nathan , Khoo Saye , Renaud Francoise , Vitoria Marco , Venter Willem D. F. , Doherty Meg , Penazzato Martina ,   on Behalf of the PADO and CADO Experts Groups
Published: December 2020

Background:
Concerns have been voiced that the exclusion of pregnant women from clinical trials results in a lack of safety and pharmacokinetic data for antiretroviral drugs (ARVs) in pregnancy, creating clear risks to pregnant women living with HIV (PWLHIV), and their infants.

Setting:
The World Health Organization convened a Paediatric Antiretroviral Drug Optimization group meeting, December 10–12, 2018, in Geneva, Switzerland.

Methods:
The group, comprised of clinicians, scientists, HIV program managers, regulators, and community representatives, were tasked to consider how ARVs are studied in PWLHIV, define alternative approaches to studying ARVs in PWLHIV, identify ways to shorten the timeline to determine safe use of new agents during pregnancy, and define strategies to collaborate with regulators and industry to change longstanding practices.

Results:
Most new ARVs are not studied in pregnant populations until after drug licensure, primarily opportunistically among women who become pregnant while taking the ARV of interest. Acceleration of the timeline will require earlier completion of preclinical studies and a new paradigm, namely—under certain conditions—allow women who become pregnant while participating in phase III ARV studies the option of remaining on study and enroll pregnant women into phase III trials of new agents to obtain preliminary safety and dosing and efficacy data.

Conclusion:
A revision of the current approach to the study of antiretrovirals in pregnant women is urgently needed to improve timely access and safe use of new agents during pregnancy.
Compliance of Familial Mediterranean Fever Patients With Regular Follow-up Visits and Associated Factors
Authors: Bilici Salman Reyhan , Babaoglu Hakan , Satiş Hasan , Yapar Dilek , Avanoglu Güler Aslihan , Karadeniz Hazan , Ataş Nuh , Haznedaroğlu Şeminur , Öztürk Mehmet Akif , Göker Berna , Tufan Abdurrahman 
Published: December 2020

Background
Follow-up is crucial to detect asymptomatic complications of familial Mediterranean fever (FMF). The current European League Against Rheumatism recommendations state that patients with FMF should be evaluated at least every 6 months to monitor attacks, acute phase response, and proteinuria.

Objectives
This study aimed to assess compliance of FMF patients with regular follow-up visits and the associated factors.

Methods
Adult patients with a diagnosis of FMF who had their initial visit at least over 1 year ago were included. Demographic and socioeconomic data, family history, and comorbid diseases were obtained from medical records. The International Severity Score for FMF and the Autoinflammatory Disease Damage Index scores were calculated. We defined patients as “compliant with follow-up visits” both if they had at least 2 visits during the previous year and a compatible physician's assessment. The characteristics of the compliant and noncompliant patients were compared, and multivariable logistic regression analysis was used to determine the factors influencing visit compliance.

Results
Four hundred seventy-four patients with FMF were included. Two hundred thirty (48.5%) were compliant, and 244 (51.5%) were noncompliant with follow-up visits. A family history of FMF in parents, the absence of a family history of FMF in siblings, treatment with biologic agents, concomitant medication use, multisite involvement during FMF attacks, and treatment satisfaction were independent predictors of visit compliance.

Conclusions
Only half of the patients with FMF were compliant with follow-up visits. Better strategies should be implemented to increase the compliance of FMF patients. Identifying independent predictors would help to build one.
bootComb - An R Package to Derive Confidence Intervals for Combinations of Independent Parameter Estimates
Authors: Henrion Marc Y. R. 
Published: December 2020

AbstractMotivationThe epidemiologist sometimes needs to combine several independent parameter estimates: e.g. (i) adjust an incidence rate for healthcare utilisation, (ii) derive a disease prevalence from the conditional prevalence on another condition and the prevalence of that condition, (iii) adjust a seroprevalence for test sensitivity and specificity. While obtaining the combined parameter estimate is usually straightforward, deriving a corresponding confidence interval often is not.bootCombis an R package using parametric bootstrap sampling to derive such confidence intervals.ImplementationbootCombis a package for the statistical computation environment R.General featuresAs well as a function that returns confidence intervals for parameters combined from several independent estimates,bootCombprovides auxiliary functions for 6 common distributions (beta, normal, exponential, gamma, Poisson and negative binomial) to derive best-fit distributions (and their sampling functions) for parameters given their reported confidence intervals.AvailabilitybootCombis available from the Comprehensive R Archive Network (https://CRAN.R-project.org/package=bootComb).Key FeaturesbootCombderives confidence intervals with the required coverage for parameters that are computed from independent parameter estimates for which confidence intervals are reported.Includes auxilliary functions for 6 common distributions (beta, normal, exponential, gamma, Poisson and negative binomial) to derive best-fit distributions (and their sampling functions) for parameters given their reported confidence intervals.R package: open-source, easy-to-use, platform independent.Stable version hosted on CRAN:https://CRAN.R-project.org/package=bootCombLatest development version available from GitHub:https://github.com/gitMarcH/bootComb