bluuebunny/crossref_metadata_2025_split huggingface dataset:
A case report of immune-mediated arthritis in a patient with cutaneous melanoma receiving checkpoint inhibition therapy
Authors: Papaxoinis George , Anastasopoulou Amalia , Laskari Katerina , Diamantopoulos Panagiotis , Benopoulou Olga , Gogas Helen 
Published: March 2020

Abstract

Introduction:
Immune checkpoint inhibitors (ICIs) represent an important advance in the treatment of melanoma. ICIs may induce autoimmune phenomena caused by concurrent activation of the immune system against normal cells. During the last years, cases of musculoskeletal side effects, especially immune-mediated arthritis (IA), have been increasingly reported.

Patient concerns:
We present a 59-year-old woman, who was treated with pembrolizumab for a relapsed BRAF V600E mutated cutaneous malignant melanoma. The patient presented with right knee arthritis on week 30.

Diagnosis:
The erythrocyte sedimentation rate and serum C-reactive protein levels were elevated, while rheumatoid factor and anti-cyclic citrullinated peptide antibodies were negative. Imaging confirmed the presence of fluid mainly in the suprapatellar bursa. Synovial fluid analysis revealed an inflammatory effusion, while other etiologies of inflammatory arthritis were excluded.

Interventions:
Arthritis improved with an intra-articular injection of 8 mg dexamethasone. Twelve days later the arthritis relapsed in both knees, and although it was resistant to nonsteroidal anti-inflammatory treatment, it improved with systemic steroids. Tapering of methylprednisolone dose was feasible with the coadministration of leflunomide and subsequently hydroxychloroquine.

Outcomes:
Arthritis resolved and the patient is free of complications and disease activity 20 months after the initiation of the second line systemic treatment.

Conclusions:
We present an unusual case of IA associated with pembrolizumab treatment. The originality of the current report is based on the late occurrence, the monoarticular initial distribution, and uncommon location of IA at the knee.
Mammotome-assisted removal with minimal incision of large juvenile fibroadenoma of breast
Authors: Wang Tongling , Zhu Lin 
Published: March 2020

Abstract

Introduction:
Giant juvenile breast fibroadenoma can cause deformity and should be excised. Cosmesis is an important consideration in young patients.

Patient concerns:
The patient was admitted to our hospital for a mass of 6 × 6 cm in her left breast.

Diagnose:
A giant juvenile fibroadenoma.

Interventions:
With the help of Mammotome, we translated the larger mass to smaller one and removed it via a small circumareolar incision with no residual tumor.

Outcomes:
There was no recurrence of disease after 2 years.

Conclusion:
Mammotome-combined resection is a new approach that can be used to excise giant fibroadenomas with a minimal incision, and provides a favorable contour to the breast.
Five Waves of an Online HIV Self-Test Giveaway in New York City, 2015 to 2018
Authors: Edelstein Zoe R. , Wahnich Amanda , Purpura Lawrence J. , Salcuni Paul M. , Tsoi Benjamin W. , Kobrak Paul H. , Santos Paul A. , Andaluz Adriana , MacGregor Jennifer H. , Matsuki Jennifer D.M. , Katz David A. , Daskalakis Demetre C. , Myers Julie E. 
Published: March 2020

Background
HIV self-tests increase HIV status awareness by providing convenience and privacy, although cost and access may limit use. Since 2015, the New York City (NYC) Health Department has conducted 5 waves of an online Home Test Giveaway.

Methods
We recruited adult cisgender men who have sex with men (MSM) and transgender and gender-nonconforming (TGNC) individuals who had sex with men, who were living in NYC, not previously HIV diagnosed, and using paid digital advertisements (4–8 weeks per wave). Eligible respondents were e-mailed a code to redeem on the manufacturer's website for a free HIV self-test and an online follow-up survey ~2 months later. For key process and outcome measures, we present means across 5 waves.

Results
Across the 5 waves of Home Test Giveaway, there were 28,921 responses to the eligibility questionnaire: 17,383 were eligible, 12,182 redeemed a code for a free HIV self-test, and 7935 responded to the follow-up survey (46% of eligible responses). Among eligible responses, approximately half were Latino/a (mean, 32%) or non-Latino/a, black (mean, 17%). Mean report of never testing before was 16%. Among 5903 follow-up survey responses who reported test use, 32 reported reactive results with no known previous diagnosis (0.54%), of whom 78% reported receiving confirmatory testing. Report of likelihood of recommending the Home Test Giveaway to friends was high (mean, 96%).

Conclusions
We recruited diverse NYC MSM and TGNC and distributed a large number of HIV self-tests to them. Among respondents who reported newly reactive tests, the majority reported confirmatory testing. This seems to be one acceptable way to reach MSM and TGNC for HIV testing, including those who have never tested before.
Evaluation of the National Sexually Transmitted Disease Curriculum: Reach, Utilization, and Engagement
Authors: Snoeyenbos Newman Gretchen , Bauer Karin , Karpenko Andrew , Unruh Kenton T. , Johnston Christine , Marrazzo Jeanne M. , Workowski Kimberly A. , Spach David H. 
Published: March 2020

Background
With increasing rates of sexually transmitted infections in the United States, there is a critical need to educate health professionals on the prevention, diagnosis, and treatment of sexually transmitted infections. The National Sexually Transmitted Disease Curriculum (NSTDC, https://www.std.uw.edu) is a free, online curriculum, funded by the Centers for Disease Control and Prevention. The purpose of this article is to evaluate the reach, utilization, and engagement of users with the curriculum.

Methods
Data on NSTDC utilization was collected for 24 months after the February 1, 2017 launch. For all users, Google Analytics was used to determine total number of users, geographic location, age and sex, and average session duration. For registered users, additional data analysis included work-role, demographics, and completion of self-study modules, check-on-learning questions, and question banks. User satisfaction was measured on a 5-point Likert scale.

Results
During the evaluation period, 136,270 individual users accessed the NSTDC, including 24,652 registered users. Among all registered users, 10,660 (43.2%) were registered nurses, 2810 (11.4%) physicians, 4942 (20.1%) Advanced Practice Nurses and Physician Assistants, and 6213 (25.2%) nonclinicians. Among registered users, 18,533 (75.2%) completed at least 1 module, 7898 (32.0%) completed all 7 modules, and 19,804 (80.4%) answered optional check-on-learning questions. Median satisfaction with the content was (5) very satisfied (interquartile range, 4–5).

Conclusions
The NSTDC is a free, guideline-based, online curriculum with novel dual functionality that has achieved extensive reach with a broad array of health professionals who engage deeply with the material. The wide usage of NSTDC demonstrates the need for high-quality, unbiased, free content in user-focused formats.
Presence and Concentrations of Select Bacterial Vaginosis-Associated Bacteria Are Associated With Increased Risk of Pelvic Inflammatory Disease
Authors: Haggerty Catherine L. , Ness Roberta B. , Totten Patricia A. , Farooq Fouzia , Tang Gong , Ko Daisy , Hou Xuezhou , Fiedler Tina L. , Srinivasan Sujatha , Astete Sabina G. , Fredricks David N. 
Published: March 2020

Abstract
In a vaginal 16S ribosomal RNA gene quantitative PCR study of 17 pelvic inflammatory disease (PID) cases and 17 controls who tested positive for Chlamydia trachomatis, women who additionally tested positive for Atopobium vaginae, Sneathia spp., Megasphaera spp., Eggerthella-like bacterium or Prevotella amnii were more likely to develop PID.
Severe E-Cigarette, or Vaping, Product Use Associated Lung Injury Requiring Venovenous Extracorporeal Membrane Oxygenation
Authors: Aldy Kim , Cao Dazhe James , McGetrick Molly , Willcutts David , Verbeck Guido , De Silva Imesha , Hsu Stephanie 
Published: March 2020

Objectives:
To report a severe case of e-cigarette or vaping product use-associated lung injury with complex course requiring venovenous extracorporeal membrane oxygenation.

Design:
Case report.

Setting:
PICU in an academic medical center.

Patients:
A 16-year-old girl presenting with gastrointestinal and respiratory symptoms was admitted to our PICU after having progressive respiratory failure and bilateral pulmonary ground-glass opacities on chest CT.

Interventions:
Venovenous extracorporeal membrane oxygenation

Measurements and Main Results:
After extensive infectious workup was unrevealing, she reported a history of vaping e-cigarette containing either nicotine or delta-9-tetrahydrocannabinol oil prior to symptom onset. She was given a presumptive diagnosis of e-cigarette or vaping product use-associated lung injury. The PICU team in consultation with pulmonology and medical toxicology started high-dose IV methylprednisolone 1 mg/kg bid. Despite initial improvements, she continued to require positive pressure ventilation and developed pneumomediastinum with progression to tension pneumothoraces and a persistent air leak. Unable to maintain her oxygenation, she was placed on venovenous extracorporeal membrane oxygenation for a prolonged course and had a tracheostomy placement. The clinical course, severity, and range of interventions in affected patients around the country have varied widely. Respiratory symptoms have been the most severe, but the constellation of symptoms in e-cigarette or vaping product use-associated lung injury include constitutional symptoms (fevers, weight-loss) and gastrointestinal symptoms (nausea, vomiting, diarrhea). In many cases, steroid use led to rapid clinical improvements. However, other cases with severe illness, like our patient, necessitated high-dose IV steroids, intubation, and venovenous extracorporeal membrane oxygenation. The underlying etiology and pathophysiology of e-cigarette or vaping product use-associated lung injury remains unknown. The Centers for Disease Control and Prevention in conjunction with state/local health departments and the Food and Drug Administration is actively investigating the outbreak.

Conclusions:
Clinicians need to be aware of the current outbreak of e-cigarette or vaping product use-associated lung injury and ask about vaping in patients presenting with gastrointestinal and respiratory symptoms. Treatment options are anecdotal and necessitate a multidisciplinary approach.
Access to Outpatient Pediatric Mental Health Care After Emergency Department Discharge
Authors: Sheridan David C. , Marshall Rebecca , Nunez Morales Andrea , Johnson Kyle 
Published: March 2020

Objectives
Pediatric mental health presentations to emergency departments (EDs) have shown dramatic increases nationally. This study aimed to identify the ability of patients discharged with mental health from the ED to establish outpatient care.

Methods
This was a cross-sectional study of all mental health patients aged 7 to 19 years who were seen by a child psychiatry consult team in a tertiary care pediatric ED from September 2016 to January 2017. Patients were contacted by phone at least 6 months after discharge. Data obtained included time to follow-up, reasons for delayed follow-up, type of provider seen, and frequency of outpatient visits.

Results
Two hundred twenty-eight charts were reviewed and 51 were successfully interviewed. The median age was 14 years and 61% were female. Most patients (61%) reported seeing a psychiatrist or therapist, whereas 19% reported a primary care provider and 19% reporting “other.” The majority were able to establish care within 1 month (73%), whereas 9% reported never obtaining outpatient follow-up. Most patients (58%) were able to be seen more than once per month. The most common reason for delayed follow-up was provider availability.

Conclusions
This study found that a large number of patients were able to be seen within 1 month of discharge for mental health care. However, almost 10% of patients never established outpatient care, which is concerning and is an area needing further research.
Challenges Faced by Therapists Providing Services for Infants With or at Risk for Cerebral Palsy
Authors: Gmmash Afnan S. , Effgen Susan K. , Goldey Katie 
Published: March 2020

Objective:
The purpose of this study was to identify the challenges physical therapists (PTs) and occupational therapists (OTs) have in providing early intervention (EI) for infants with or at risk for cerebral palsy.

Methods:
Therapists' responses to an open-ended question were collected via survey that was distributed to EI providers and analyzed using content analysis.

Results:
The primary self-reported barriers to PT/OT EI services had 5 themes: (1) inadequate communication and collaboration, (2) challenges in coordination with family, (3) policy limitations, (4) meeting the child's individual medical needs, and (5) unequal access to resources.

Conclusion:
Respondents reported that barriers are complex and exist at the individual, family, team, and societal levels. Further research is needed to explore barriers and solutions at each of these levels, from meeting a child's individual medical needs to improving interprofessional communication to increasing equitable access to resources.
Oxygen Consumption While Walking With Multijoint Neuromuscular Electrical Stimulation After Stroke
Authors: Makowski Nathaniel S. , Kobetic Rudi , Foglyano Kevin M. , Lombardo Lisa M. , Selkirk Stephen M. , Pinault Gilles , Triolo Ronald J. 
Published: March 2020

Abstract
This case study evaluated the effect of implanted multijoint neuromuscular electrical stimulation gait assistance on oxygen consumption relative to walking without neuromuscular electrical stimulation after stroke. The participant walked slowly with an asymmetric gait pattern after stroke. He completed repeated 6-min walk tests at a self-selected walking speed with and without hip, knee, and ankle stimulation assistance. His walking speed with neuromuscular electrical stimulation more than doubled from 0.28 ± 0.01 m/sec to 0.58 ± 0.04 m/sec, whereas average step length and cadence increased by 0.12 m and 24 steps/min, respectively. As a result, energy cost of walking with neuromuscular electrical stimulation decreased by 0.19 ml O2/kg per meter as compared with walking without stimulation while oxygen consumption increased by 1.1 metabolic equivalent of tasks (3.9 ml O2/kg per minute). These metabolic demands are similar to those reported for stroke survivors capable of walking at equivalent speeds without stimulation, suggesting the increase in oxygen consumption and decreased energy cost result from improved efficiency of faster walking facilitated by neuromuscular electrical stimulation. Although the effect of neuromuscular electrical stimulation on gait economy has implications for community walking within the user’s metabolic reserves, this case study’s results should be interpreted with caution and the hypothesis that multijoint neuromuscular electrical stimulation improves metabolic efficiency should be tested in a wide population of stroke survivors with varied deficits.
A descriptive analysis of pediatric post-tonsillectomy pain and recovery outcomes over a 10-day recovery period from 2 randomized, controlled trials
Authors: Postier Andrea C. , Chambers Christine , Watson David , Schulz Craig , Friedrichsdorf Stefan J. 
Published: March 2020

Abstract
Pediatric tonsillectomy involves an often painful and lengthy recovery period, yet the extended recovery process is largely unknown. This article describes postoperative recovery outcomes for 121 children aged 4 to 15 (mean 6.6 years, SD = 2.3) years enrolled in 1 of 2 clinical trials of analgesia safety and efficacy after tonsillectomy. Postoperative analgesia included scheduled opioid analgesic plus acetaminophen/ibuprofen medication use (first 5 days) and “as-needed” use (last 5 days). Clinical recovery as measured daily by the Parents' Postoperative Pain Measure (PPPM; an observational/behavioral pain measure), children's self-reported pain scores, side-effect assessments, need for unanticipated medical care, and satisfaction with recovery over 10 days was assessed. Higher Parents' Postoperative Pain Measure scores were correlated with poorer sleep, receipt of breakthrough analgesics, distressing side effects, higher self-reported pain scores, and need for unanticipated medical care. Higher self-reported pain scores were associated with more distressing adverse events, including nausea, vomiting, insomnia, lower parent satisfaction, and unplanned medical visits and hospitalizations. Pain and symptoms improved over time, although 24% of the children were still experiencing clinically significant pain on day 10. Scheduled, multimodal analgesia and discharge education that sets realistic expectations is important. This study adds to the emerging body of literature that some children experience significant postoperative pain for an extended period after tonsillectomy.
Ambulatory Blood Pressure Response to Romantic Partner Interactions and Long-Term Cardiovascular Health Outcomes
Authors: Cornelius Talea , Birk Jeffrey L. , Edmondson Donald , Schwartz Joseph E. 
Published: March 2020

ABSTRACTObjectiveLower blood pressure (BP) during romantic partner interactions may underlie the association between romantic relationships and better long-term cardiovascular health. This secondary analysis examined the effect of momentary ambulatory BP (ABP) response to partner interactions on between-person changes in left ventricular mass index and mean systolic and diastolic BP over time.MethodsParticipants were 538 married, working adults (mean [SD] = 46.9 [8.8] years, 56.7% female) with a screening BP of ≤160/105 mm Hg. Participants completed questionnaires, 24-hour ABP monitoring, and an echocardiogram at waves 1 and 2 (mean [SD] = 6.2 [1.0] years later). Associations between ABP response to partner (versus nonpartner) interactions and cardiovascular outcomes were examined using multilevel structural equation models.ResultsParticipants with lower diastolic BP during partner interactions at wave 1 had a lesser increase in systolic BP at wave 2 (B= 1.68, SE = 0.61,p= .006; 9.84 mm Hg differential change in systolic BP for participants at +1/−1 SD diastolic ABP response to partner interactions). Participants with lower diastolic ABP during partner-specific interactions at wave 1 also had a lesser increase in diastolic BP (B= 0.83, SE = 0.42,p= .045; 4.89 mm Hg differential change in diastolic BP at +1/−1 SD). Systolic ABP response to partner-specific interactions did not predict changes in cardiovascular outcomes; diastolic ABP response did not predict changes in left ventricular mass index.ConclusionsMomentary diastolic ABP response to partner-specific interactions may function as a mechanism underlying the cardioprotective effect of romantic relationships on long-term BP outcomes.
Self-Rated Health and Age-Related Differences in Ambulatory Blood Pressure: The Mediating Role of Behavioral and Affective Factors
Authors: Uchino Bert N. , Birmingham Wendy , Landvatter Joshua , Cronan Sierra , Scott Emily , Smith Timothy W. 
Published: March 2020

ABSTRACT

Objective
Despite the well-established association between self-rated health (SRH) and health, little is known about the potential psychobiological mechanisms responsible for such links and if these associations differ by age. The main goals of this study were to investigate the links between SRH and ambulatory blood pressure (ABP), if age moderated the risk, and the health behavior/affective mechanisms responsible for such links.

Methods
A total of 188 men and women (94 married couples; ages, 18–63 years) completed a standard measure of SRH and a 1-day ABP assessment. Multilevel models were run to examine whether SRH was associated with daily ABP and whether these links were moderated by age. The Monte Carlo method was used to construct confidence intervals for mediation analyses.

Results
Results indicated that poor SRH was associated with higher ambulatory systolic blood pressure (SBP; b = 3.14, SE = 0.68, p < .001) and diastolic blood pressure (DBP; b = 1.34, SE = 0.43, p = .002) levels. Age also moderated the links between SRH and ambulatory SBP (b = 0.19, SE = 0.08, p = .011) and DBP (b = 0.14, SE = 0.05, p = .004), with links being stronger in relatively older individuals. However, only daily life negative affect significantly mediated the age by SRH interaction for both ambulatory SBP and DBP.

Conclusions
These results highlight the potential psychobiological mechanisms linking SRH to longer-term health outcomes. Such work can inform basic theory in the area as well as intervention approaches that target such pathways.
68Ga–Prostate-Specific Membrane Antigen Uptake in Dissecting Abdominal Aortic Aneurysm
Authors: Wong Veronica Chi Ken , Yip Joshua Wei Liang , Stevanovic Amanda , Le Ken , Mansberg Robert 
Published: March 2020

Abstract
An 81-year-old man with prostate adenocarcinoma (Gleason 4 + 3 = 7) treated with brachytherapy and intermittent androgen deprivation therapy was referred for serial 68Ga–prostate-specific membrane antigen (PSMA-HBED-CC) PET/CT scans for rising prostate-specific antigen. Findings were suggestive of local prostatic recurrence and nodal metastases. An incidental PSMA-avid focus was noted in the anterior wall of an infrarenal aortic aneurysm, with a contrast-enhanced hyperdense region surrounded by a semilunar hypodense region anteriorly, consistent with enlarging dissecting thrombus. Increased PSMA avidity in atherosclerotic hypertensive lesions may relate to active plaque instability, indicating a need for further evaluation.
FASpecT/CT, A New SPECT/CT Acquisition With Higher Sensitivity and Efficiency in Radioiodine Thyroid Cancer Imaging
Authors: Phillips William T. , Kukkar Vishal , Francis Gary L. , Gorzell Brandon C. , Cooper Albert W. , Metter Darlene F. , Lancaster Jack L. 
Published: March 2020

Purpose
This article demonstrates the use of a new SPECT/CT acquisition protocol in patients with differentiated thyroid cancer (DTC).

Methods
SPECT/CT scans (FASpecT/CT) with fewer angle acquisitions were retrospectively reviewed in 30 DTC patients treated with radioiodine at University Hospital, San Antonio, Tex, from July 2017 to March 2019. This FASpecT/CT of 12 versus 60 to 64 sampled views for convention SPECT was made possible by iterative reconstruction.

Results
The FASpecT/CT protocol was judged to increase lesion detection in patients with low count rates. Furthermore, in patients with higher count rates, this technique reduced the acquisition time. FASpecT/CT patient images are shown as case examples in 4 of the 30 patients reviewed.

Conclusions
This FASpecT/CT acquisition in radioiodine-treated DTC offers the potential of higher sensitivity for metastatic lymph node detection in low count rates and a significant decrease in imaging time in high count rates. These advantages make SPECT/CT imaging more acceptable for patients who have difficulty with longer imaging times, to include the pediatric population.
Elevated 68Ga-DOTATATE Activity in Fibrous Cortical Defect
Authors: Wen Zhe , Zhang Lin , Batra Vandana , Zhuang Hongming 
Published: March 2020

Abstract
FDG PET/CT was performed for staging in a 15-year-old adolescent girl with cholangiocarcinoma, which showed only mild activity in the tumor but more impressive FDG activity in right femoral fibrous cortical defect without any other hypermetabolic lesions elsewhere. Pathological examination of the resected cholangiocarcinoma revealed significant neuroendocrine differentiation, which lead to subsequent 68Ga-DOTATATE PET/CT study. Unexpectedly, the same femoral fibrous cortical defect also had increased 68Ga-DOTATATE activity.