bluuebunny/crossref_metadata_2025_split huggingface dataset:
Molecular subtypes of invasive breast cancer: correlation between PET/computed tomography and MRI findings
Authors: Akin Meliha , Orguc Sebnem , Aras Feray , Kandiloglu Ali Riza 
Published: May 2020

Objective
The aim of the study was to investigate the diagnostic value of fluorodeoxyglucose-18 (FDG)-PET/computed tomography (CT) and MRI parameters in determining the molecular subtypes of invasive breast cancer.

Methods
Data from 55 primary invasive breast cancer masses in 51 female patients who underwent pre-treatment PET/CT and MRI scans, and histopathological diagnosis at the authors’ center were retrospectively reviewed. The relationship between FDG-PET/CT and MRI parameters, including maximum and mean standard uptake values (SUVmax and SUVmean, respectively), mean metabolic index (MImean) and metabolic tumor volume (MTV) values obtained from FDG-PET, and shape, margin, internal contrast-enhancement characteristics, kinetic curve types, functional tumor volume (FTV), apparent diffusion coefficient (ADC) values obtained from MRI was evaluated. Subsequently, differences among molecular subtypes (i.e. luminal A, luminal B, c-erbB-2 positive, and triple-negative) in terms of PET/CT and MRI parameters were evaluated.

Results
The luminal B subtype of invasive breast cancer had higher SUVmax and SUVmean (P = 0.002 and P = 0.017, respectively) values than the luminal A subtype. In addition, the triple-negative subtype had a higher SUVmax (P = 0.028) than the luminal A subtype. There was a statistically significant positive correlation between pathological tumor volume (PTV) and SUVmean (P = 0.019, r = 0.720). SUVmax and ADC were negatively correlated (P = 0.001; r = −0.384). A very strong positive correlation was detected between MTV and FTV (P = 0.000; r = 0.857), and between MTV and PTV (P = 0.006, r = 0.796), and between FTV and PTV (P = 0.006, r = 0.921).

Conclusion
Results of the present study suggest that SUVmax was superior to MRI findings in predicting molecular subtypes and that MRI was superior to PET/CT in predicting PTV.
Hematopoietic regeneration under the spell of epigenetic-epitranscriptomic factors and transposable elements
Authors: Clapes Thomas , Trompouki Eirini 
Published: May 2020

Purpose of review
Since the discovery of master transcription factors that regulate hematopoietic regeneration following different stressors, many more layers of regulation have been discovered. The purpose of this review is to outline the recent discoveries of epigenetic and epitranscriptomic control of hematopoietic regeneration and highlight the novel involvement of transposable elements in this process.

Recent findings
Over the past 2 years, we have gained additional knowledge in the role of epigenetic regulators in hematopoietic regeneration. Histone modifiers, like SETD1A, JARID2, KDM6B, and classic DNA methylation regulators, like DNMT3A and TET2, govern hematopoietic regeneration. Concomitantly, the significance of RNA modifications and the expanding functions of transposable elements establish novel layers of regulation of hematopoietic regeneration. Capitalizing on this newly acquired knowledge may provide insights on new therapies or drug targets that will improve or accelerate hematopoietic regeneration.

Summary
The spectrum of epigenetic and epitranscriptomic modifications that affect hematopoietic regeneration is continually expanding. Transposable elements are also emerging as potent responders of stress stimuli that affect the self-renewal capacity of hematopoietic stem cells. The future challenge is to understand the hierarchy of these control mechanisms and how they integrate and consolidate information from transcription factors and external stimuli.
Systemic treatment options for metastatic hormone-sensitive prostate cancer: making sense of the data
Authors: Baston Catalin , Preda Adrian , Guler-Margaritis Silviu S. , Sinescu Ioanel , Gingu Constantin 
Published: May 2020

Purpose of review
Systemic treatment options for metastatic hormone-sensitive prostate cancer (mHSPC) have recently shifted from the traditional androgen deprivation therapy (ADT) monotherapy to multidrug approaches incorporating drugs initially approved for castration-resistant state and ADT. However, clinicians have difficulties in choosing the adequate combination therapy for individualized patient care, because of the lack of consensus regarding disease risk factors, differences in study design of the major clinical trials and lack of direct comparisons between drugs. The aim of this review is to provide an update of the current treatment options for this heterogenous group of patients.

Recent findings
Current oncological guidelines strongly recommend that patients with newly diagnosed mHSPC and high-volume disease (CHAARTED criteria) should receive docetaxel and ADT, whereas those with high-risk disease (LATITUDE criteria) abiraterone and ADT. Recently, the Food and Drug Administration approved apalutamide and enzalutamide for mHSPC. Moreover, new data support the efficacy of docetaxel and abiraterone in patients with mHSPC, regardless of metastatic burden.

Summary
Today, the combination approach should be recommended for newly diagnosed mHSPC over ADT monotherapy, but treatment initiation must be personalized based on disease, drug and patient characteristics. Thanks to continuous efforts and progress in patient and disease-related outcomes, mHSPC could become a chronic disease.
Standardized Perioperative Feeding Protocol Improves Outcomes in Patients With d-Transposition of the Great Arteries Undergoing Arterial Switch Operation
Authors: Clark Stephen T. , Law Mark A. , Alten Jeffrey A. 
Published: May 2020

Objective:
To determine whether the presence of a standardized feeding protocol improves outcomes in a subset of neonates undergoing cardiac surgery.

Design:
Retrospective cohort study.

Setting:
Cardiovascular ICU at a freestanding academic children’s hospital.

Patients:
Neonates with a diagnosis of d-transposition of the great arteries undergoing arterial switch operation from January 2007 to June 2017.

Interventions:
Initiation of perioperative feeding protocols.

Measurements and Main Results:
Patients were evaluated before and after implementation of standardized perioperative feeding protocols in neonates with d-transposition of the great arteries undergoing arterial switch operation. Low-risk patients born after initiation of nurse-driven protocols were compared with a similar historical group. Data obtained included time to achievement of feeding goals, with primary outcome being weight gain at hospital discharge. Other measures analyzed included duration of mechanical ventilation and postoperative hospital length of stay. Overall, 33 patients in the protocol group were compared with 44 patients in the historical group. No significant baseline differences existed between the two cohorts. The protocol group achieved improved feeding outcomes in nearly all measured categories, including introduction to enteral feeds preoperatively (91% vs 59%; p < 0.01) and earlier attainment of postoperative full enteral feeds of 120 mL/kg/d (2 vs 5 d; p < 0.01). Protocol patients had significantly improved weight gain at the time of discharge (60 vs 1 g; p < 0.01), while achieving shorter postoperative length of stay (10.1 vs 12.6 d; p = 0.04).

Conclusions:
An aggressive, but safe, perioperative feeding protocol implemented in a homogenous low-risk neonatal cardiac surgical population improves feeding outcomes, including increased weight gain, as well as decreased postoperative length of stay. Consideration for perioperative feeding protocol implementation and further study should be given.
Which Ultrasound Parameter Is More Accurate in the Diagnosis of Carpal Tunnel Syndrome
Authors: Ciloglu Osman , Görgülü Feride Fatma 
Published: May 2020

Objective
The aim of this study was to compare the accuracy of cross-sectional area (CSA), resistive index (RI), and strain ratio (SR) in carpal tunnel syndrome (CTS).

Design
This prospective and case-control study included patients with a diagnosis of CTS and a healthy control group. The participants were examined with an ultrasound Doppler system equipped with a high-resolution (5–18 MHz) linear probe (Philips L18-5). CSA, RI, and SR values were compared.

Results
CSA, RI, and SR were found to be effective tools to detect the presence of CTS (regardless of severity). The cut-off value of 11.25 mm2 for CSA had a sensitivity and specificity of 97.2% and 88.0%, respectively. The cut-off value of 0.740 for RI had a sensitivity and specificity of 94.4% and 94.0%, respectively. The cut-off value of 1.95 for SR had a sensitivity and specificity of 97.2% and 84.0%, respectively. In respect of the severity of CTS, ultrasound was found to be an effective method to classify severe CTS cases only.

Conclusion
The CSA, SR, and RI seem to have excellent accuracy in the diagnosis of CTS. When the grading of severity is considered, ultrasound seems to be sensitive and specific in differentiating severe CTS cases from mild or moderate CTS cases.
Establishment of a Novel Porcine Model to Study the Impact of Active Stretching on a Local Carrageenan-Induced Inflammation
Authors: Vergara Dennis Muñoz , Berrueta Lisbeth , Carmody Colleen , An Xingxing , Wayne Peter M. , Zavacki Ann Marie , Langevin Helene M. 
Published: May 2020

Objective
Active stretching of the body is integral to complementary mind-body therapies such as yoga, as well as physical therapy, yet the biologic mechanisms underlying its therapeutic effects remain largely unknown. A previous study showed the impact of active stretching on inflammatory processes in rats. The present study tested the feasibility of using a porcine model, with a closer resemblance to human anatomy, to study the effects of active stretching in the resolution of localized inflammation.

Design
A total of 12 pigs were trained to stretch before subcutaneous bilateral Carrageenan injection in the back at the L3 vertebrae, 2 cm from the midline. Animals were randomized to no-stretch or stretch, twice a day for 5 mins over 48 hrs. Animals were euthanized for tissue collection 48 hrs postinjection.

Results
The procedure was well tolerated by the pigs. On average, lesion area was significantly smaller by 36% in the stretch group compared with the no-stretch group (P = 0.03).

Conclusion
This porcine model shows promise for studying the impact of active stretching on inflammation-resolution mechanisms. These results are relevant to understanding the stretching-related therapeutic mechanisms of mind-body therapies. Future studies with larger samples are warranted.
Historical and Contemporary Management of Infantile Hepatic Hemangioma
Authors: Macdonald Alexander , Durkin Natalie , Deganello Annamaria , Sellars Maria E. , Makin Erica , Davenport Mark 
Published: May 2020

Objective:
To describe outcome of infants with hemangioma(s) of the liver.

Summary of Background Data:
Infantile hepatic hemangiomas exhibit a diverse phenotype. We report our 30-year experience and describe optimal management based on precise radiological classification.

Methods:
Retrospective review of 124 infants (66 female) 1986–2016. Categorical analysis with Chi2 and nonparametric comparison. Data expressed as median (range) and P < 0.05 considered significant.

Results:
Lesions classified as focal (n = 70, 56%); multifocal (n = 47, 38%) or diffuse (n = 7, 6%) and of these 80(65%) were symptomatic (eg, cardiac failure n = 39, 31%; thrombocytopenia n = 12, 10%).
Increased hepatic artery velocity was seen in 63 (56%). Median hepatic artery velocity was greatest in diffuse lesions [245 (175–376) cm/s vs focal 120 (34–242) cm/s vs multifocal 93 (36–313) cm/s; P = 0.0001]. Expectant management alone was followed in 55 (44%). Medical therapy was utilised in 57(46%) and sufficient for symptom control in 29/57 (51%). Propranolol therapy (from 2008) was sufficient for symptom control in 22/28 (79%). Surgery (hepatic artery ligation n = 26; resection n = 13; embolization n = 1) was required in 40 (32%). Median maximal lesion diameter was 3 (0.5–17.1) cm and greater in those requiring surgery (7 cm vs 4.9 cm; P = 0.04). The proportion requiring surgery decreased markedly in the propranolol era [pre-propranolol 25/48 (52%) vs post-propranolol 16/76 (21%) (P = 0.0003)]. Systematic follow-up with ultrasound to a median of 2.6 (0.02–16) years.

Conclusions:
A proportion of infantile hepatic hemangiomas remain asymptomatic permitting observation until resolution but the majority require complex multi-modal therapy. First-line pharmacotherapy with propranolol has reduced but not abolished the need for surgery.
A Qualitative Study of the System-level Barriers to Bariatric Surgery Within the Veterans Health Administration
Authors: Funk Luke M. , Alagoz Esra , Jolles Sally A. , Shea Grace E. , Gunter Rebecca L. , Raffa Susan D. , Voils Corrine I. 
Published: May 2020

Objective:
To characterize system-level barriers to bariatric surgery from the perspectives of Veterans with severe obesity and obesity care providers.

Summary of Background Data:
Bariatric surgery is the most effective weight loss option for Veterans with severe obesity, but fewer than 0.1% of Veterans with severe obesity undergo it. Addressing low utilization of bariatric surgery and weight management services is a priority for the veterans health administration.

Methods:
We conducted semi-structured interviews with Veterans with severe obesity who were referred for or underwent bariatric surgery, and providers who delivered care to veterans with severe obesity, including bariatric surgeons, primary care providers, registered dietitians, and health psychologists. We asked study participants to describe their experiences with the bariatric surgery delivery process in the VA system. All interviews were audio-recorded and transcribed. Four coders iteratively developed a codebook and used conventional content analysis to identify relevant systems or “contextual” barriers within Andersen Behavioral Model of Health Services Use.

Results:
Seventy-three semi-structured interviews with veterans (n = 33) and providers (n = 40) throughout the veterans health administration system were completed. More than three-fourths of Veterans were male, whereas nearly three-fourths of the providers were female. Eight themes were mapped onto Andersen model as barriers to bariatric surgery: poor care coordination, lack of bariatric surgery guidelines, limited primary care providers and referring provider knowledge about bariatric surgery, long travel distances, delayed referrals, limited access to healthy foods, difficulties meetings preoperative requirements, and lack of provider availability and/or time.

Conclusions:
Addressing system-level barriers by improving coordination of care and standardizing some aspects of bariatric surgery care may improve access to evidence-based severe obesity care within VA.
Effectiveness of Laparoscopic Sleeve Gastrectomy in Super-obese and Non–Super-obese Patients
Authors: Hidalgo Marta , Vilallonga Ramon , Ruiz de Godejuela Amador García , Rodríguez-Luna María R. , Balibrea José M. , Roriz-Silva Renato , González Oscar , Caubet Enric , Ciudin Andrea , Armengol Manel , Fort José M. 
Published: May 2020

Objectives:
The primary aim of this study was to assess the effectiveness of sleeve gastrectomy (SG) in super-obese patients. The secondary aim was to identify patient characteristics associated with worse SG outcomes in this group.

Methods:
A retrospective analysis was carried out of our electronic prospective bariatric surgery patient database, including all patients who underwent SG between January 2007 and January 2017. The sample was divided according to the initial body mass index (BMI) (> or <50 kg/m2). The initial characteristics and results in terms of weight loss and comorbidity resolution between the groups were compared. A subanalysis of the variable distributions was carried out according to whether or not the final BMI in the super-obese group had reached <35 kg/m2. Data analysis was carried out using STATA 13.1, with a P-value <0.05 considered to be significant.

Results:
The mean initial BMI was 42.8 kg/m2 in group 1 (<50 kg/m2) and 55 kg/m2 in group 2 (>50 kg/m2). The median follow-up (FU) was 56.2 months. Maximum weight loss was attained at the 18-month FU in both groups (BMI: 28.8 and 34.7 kg/m2, respectively). At the 5-year FU, percentage of total weight loss was higher in group 2 and percentage of excess weight loss was statistically higher in group 1 (29.6% vs. 33.1% and 67% vs. 59%, respectively). Outcomes for type 2 diabetes mellitus, hypertension, and dyslipidemia were similar in both groups. The variables associated with attaining a final BMI <35 kg/m2 in the super-obese group were lower initial BMI, absence of baseline weight-related conditions (type 2 diabetes mellitus, obstructive sleep apnea syndrome, home continuous positive airway pressure, arthropathy, heart disease), and absence of gastroesophageal reflux disease.

Conclusions:
We observed a statistically significant increase in poor outcomes in patients with a higher initial BMI and with weight-related comorbidities. These parameters could be considered to be potentially good predictors of less satisfactory outcomes in the super-obese patients.
Perioperative Adverse Events for Stress Urinary Incontinence Surgery: A National Analysis
Authors: Sappenfield Elisabeth C. , O’Sullivan David M. , Tulikangas Paul K. 
Published: May 2020

Objective
The aim of the study was to compare perioperative morbidity of stress urinary incontinence surgery using data from a nationwide cohort.

Methods
This is a retrospective cohort study of the American College of Surgeons’ National Surgical Quality Improvement Program database from 2005 to 2016. Stress urinary incontinence surgery was defined using current procedural terminology (CPT) for abdominal retropubic colposuspension (CPT 51840, 51841), laparoscopic retropubic colposuspension (CPT 51990, 51992), and suburethral sling (CPT 57288). Patients were excluded if they underwent any concomitant surgery except for cystoscopy (CPT 52000). Surgical approach and perioperative morbidity were examined using suburethral sling as the referent population. Patient characteristics, operative data, and 30-day postoperative events were collected.

Results
Overall, 19,093 women underwent a stress urinary incontinence surgery: 317 abdominal retropubic colposuspension, 357 laparoscopic retropubic colposuspension, and 18,419 suburethral sling. Patients undergoing abdominal retropubic suspension had more inpatient procedures compared with suburethral sling and laparoscopic retropubic colposuspension (65% vs 10.4% and 17.6%, P < 0.001) and longer length of stay (1.6 ± 2.9 vs 0.3 ± 2.7 and 0.3 ± 0.6, respectively, P < 0.001). Abdominal retropubic colposuspension had the longest odds ratio time compared with suburethral sling (72.0 ± 64.6 vs 38.1 ± 34.2 minutes, P < 0.001). Composite morbidity was significantly higher for abdominal retropubic colposuspension compared with suburethral sling and laparoscopic retropubic colposuspension (7.9% vs 3.4% and 2.0%, P < 0.001). After adjusting for comorbidities, composite morbidity was higher for abdominal retropubic suspension (P = 0.007) compared with suburethral sling.

Conclusions
Compared with suburethral sling, laparoscopic retropubic colposuspension had the lowest 30-day comorbidity and abdominal retropubic colposuspension had the highest 30-day comorbidity.
Rescue therapy for severe COVID-19–associated acute respiratory distress syndrome with tissue plasminogen activator: A case series
Authors: Barrett Christopher D. , Oren-Grinberg Achikam , Chao Edward , Moraco Andrew H. , Martin Matthew J. , Reddy Srinivas H. , Ilg Annette M. , Jhunjhunwala Rashi , Uribe Marco , Moore Hunter B. , Moore Ernest E. , Baedorf-Kassis Elias N. , Krajewski Megan L. , Talmor Daniel S. , Shaefi Shahzad , Yaffe Michael B. 
Published: May 2020

ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented stresses on modern medical systems, overwhelming the resource infrastructure in numerous countries while presenting a unique series of pathophysiologic clinical findings. Thrombotic coagulopathy is common in critically ill patients suffering from COVID-19, with associated high rates of respiratory failure requiring prolonged periods of mechanical ventilation. Here, we report a case series of five patients suffering from profound, medically refractory COVID-19–associated respiratory failure who were treated with fibrinolytic therapy using tissue plasminogen activator (tPA; alteplase). All five patients appeared to have an improved respiratory status following tPA administration: one patient had an initial marked improvement that partially regressed after several hours, one patient had transient improvements that were not sustained, and three patients had sustained clinical improvements following tPA administration.

LEVEL OF EVIDENCE
Therapeutic, Level V.
Early outcomes with utilization of tissue plasminogen activator in COVID-19–associated respiratory distress: A series of five cases
Authors: Christie D. Benjamin , Nemec Hannah M. , Scott Anthony M. , Buchanan John T. , Franklin Christopher M. , Ahmed Aftab , Khan Muhammad S. , Callender Charles W. , James Erskine A. , Christie Amy B. , Ashley Dennis W. 
Published: May 2020

BACKGROUND
Coronavirus patients demonstrate varying degrees of respiratory insufficiency; many will progress to respiratory failure with a severe version of acute respiratory distress syndrome refractory to traditional supportive strategies. Providers must consider alternative therapies to deter or prevent the cascade of decompensation to fulminant respiratory failure.

METHODS
This is a case-series of five COVID-19 positive patients who demonstrated severe hypoxemia, declining respiratory performance, and escalating oxygen requirements. Patients met the following criteria: COVID-19 positivity, worsening respiratory performance, severe hypoxemia (Pao
2 ≤ 80) despite traditional supportive measures, escalating supplemental oxygen requirements, and D-dimer greater than 1.5 μg/mL. All patients received protocol directed thrombolytic therapy with tissue plasminogen activator (tPA).

RESULTS
All five patients improved without deleterious effects of thrombolytic therapy. Patient one was on maximum ventilator support, paralytics, and prone positioning without improvement. During tPA administration his Pao
2/FIO2 ratio improved from 69 to 127. Ventilator support was weaned immediately on posttreatment day 1, and he was extubated on posttreatment day 12. Our second through fifth patients were not intubated at time of initiation of tPA therapy. These patients each required significant oxygen supplementation trending toward intubation. After tPA therapy, all patients demonstrated a noticeable increase in Pao
2 values overtime. Three of these patients avoided intubation due to COVID-19–associated respiratory failure.

CONCLUSION
Administration of thrombolytics was followed by overall improvement in patients' oxygen requirements, and in three cases, prevented progression to mechanical ventilation, without deleterious effects. Clinical trials of thrombolytic therapy would further serve to underscore the efficacy and utility of this therapy.

LEVEL OF EVIDENCE
Case series of therapeutic effect, Level V.