bluuebunny/crossref_metadata_2025_split huggingface dataset:
Challenges Associated With Cervical Cancer Screening and Management in Obese Women: A Provider Perspective
Authors: Clarke Megan A. , Massad L. Stewart , Khan Michelle J. , Smith Katie M. , Guido Richard S. , Mayeaux EJ , Darragh Teresa M. , Huh Warner K. , Johnson Amanda L. , Gold Michael A. , Schiffman Mark , Wentzensen Nicolas 
Published: April 2020

Objectives
Obese women are at increased risk of cervical cancer, partly due to missed detection of cervical precancers during routine cervical cancer screening. We administered a clinician survey to better understand specific challenges and identify potential solutions to performing cervical cancer screening and management in obese women.

Materials and Methods
We administered a web-based survey to 2,319 members of the American Society of Colposcopy and Cervical Pathology including questions related to challenges associated with cervical sampling and visualization in obese compared with normal weight women and potential strategies for improvement. We summarized providers' responses using descriptive statistics and used Fisher exact tests to evaluate associations between provider characteristics and challenges with cervical sampling, visualization, and biopsy.

Results
Of the 240 providers that completed the survey, 89% and 93% reported that cervical sampling and visualization are more challenging in obese women, respectively, whereas 80% reported that taking a biopsy was more challenging. Commonly reported barriers included vaginal prolapse, difficulty visualizing and accessing the cervix, and lack of long enough sampling devices and large enough speculums. Frequently used techniques to improve sampling and visualization included use of a condom or examination glove finger to sheath a speculum and using a tenaculum. Most providers identified training for cervical sampling and colposcopy in obese women as a learning gap, and only 8% reported receiving such training.

Conclusions
Cervical cancer screening and management are more challenging in obese compared with normal weight women. Major barriers to cervical sampling and visualization included lack of adequately sized equipment and lack of education and training.
Trends in Patient Demographics and Diagnostic Yield at an Academic Colposcopy Clinic From 2008 to 2018
Authors: Manning-Geist Beryl L. , Davis Michelle , Vitonis Allison F. , Feldman Sarah 
Published: April 2020

Objective
The aim of the study was to review trends in colposcopy rates and diagnoses of high-grade dysplasia and cancer for the past 10 years at an academic colposcopy clinic.

Materials and Methods
A registry of patients seen January 2008 to December 2018 at an academic colposcopy clinic was queried to examine trends in patient characteristics, cytology and histology results, and interventions during the study period, which coincided with the implementation of revised national guidelines. Differences in characteristics were examined with analysis of variance and χ2 tests. Trends in diagnoses were examined with logistic regression. Trends in interventions were modeled with binomial distribution, logit link, Poisson distribution, and log link.

Results
Among 5,103 women referred for abnormal pap testing, human papillomavirus, or dysplasia, the mean age increased over time (30.6 in 2008 to 38.4 in 2018, p < .0001) and fewer pregnant patients were served (11.3% in 2008 vs 2.8% in 2018, p < .0001). There were decreased rates of low-grade cytology (81.3% in 2008 vs 73.6% in 2018, p = .006) and increased rates of human papillomavirus positivity (4.1% in 2008 vs. 14.4% in 2018, p < .0001) on referral. Fewer colposcopies were performed per patient per year (1.2 in 2008 vs. 0.7 in 2018, p < .0001), and with this targeted intervention, there was an increased percentage of patients diagnosed with high-grade histology over time (adjusted p = .05).

Conclusions
Over time, the number of colposcopies performed per patient decreased, especially in younger and pregnant women. Meanwhile, the percentage of patients diagnosed with high-grade histology increased, suggesting that guidelines decreased unnecessary procedures while increasing the percentage of patients diagnosed with precancerous lesions.
Explore structural and functional brain changes in insomnia disorder: A PRISMA-compliant whole brain ALE meta-analysis for multimodal MRI
Authors: Wu Yangyang , Zhuang Yuan , Qi Jun 
Published: April 2020

Abstract
Inconsistent results for comparison between insomnia disorder (ID) patients and healthy controls (HC) were obtained from previous neuroimaging studies. An activation likelihood estimation (ALE) meta-analysis was made for multimodal neuroimaging in ID. ALE analysis indicated that ID patients showed significant gray matter reductions in the right middle frontal gyrus (MFG), compared to HC. Regarding positron emission tomography studies, ALE analysis showed reduced relative cerebral glucose metabolism in the right amygdala, the right anterior cingulate cortex (ACC), and the right posterior cingulate gyrus (PCG) in ID patients, compared to HC. Regarding diffusion tensor imaging studies, the present study indicated that ID patients showed reduced fractional anisotropy values in the left putamen and the right caudate body, compared to HC. Additionally, ID patients showed reduced amplitude of low frequency fluctuations (ALFF) in the left fusiform gyrus (FG), the left middle temporal gyrus (MTG), the right MTG, the right anterior lobe (AL), and the left PCG, compared to HC. ID patients showed increased ALFF in the left MFG, compared to HC. ID patients showed reduced regional homogeneity (ReHo) in the left parahippocampal gyrus, the left sublobar, the left cuneus, the left precentral gyrus (PCG), the right AL, the right ACC, and the right PCG, compared to HC. ID patients showed increased ReHo in the left FG, the left precuneus, and the right cingulate gyrus, compared to HC. Moreover, the ALE analysis showed hypoactivation relative to HC in the left superior temporal gyrus (STG), the left MTG, the right inferior frontal gyrus, the right cuneus, and the right STG in ID patients. Via this ALE meta-analysis, we obtained these key regions suffering from deficits in ID.
Prognostic value of carbohydrate antigen125 and carcino embryonic antigen expression in patients with colorectal carcinoma and its guiding significance for chemotherapy
Authors: Mao Jie , Du Peng , Yang Han-teng , Hu Huan , Wang Shi-Yao , Wu Xia , Cheng Zhi-Bin 
Published: April 2020

Abstract
The aim of this study is to evaluate the predictive value of carbohydrate antigen125 (CA125) and carcino embryonic antigen (CEA) expression and its guiding role of choosing chemotherapy regimen in post-operation patients with colorectal carcinoma.
The clinical data of all patients, including laboratory data and pathological data, were collected from the electronic medical records. Kaplan-Meier Log rank test, COX regression model and subgroup analyses were employed to assess the correlation between the expression of CA125 and CEA in patients with colorectal carcinoma and the survival, and the effect on chemotherapy efficacy.
Kaplan-Meier showed that CA125 expression is negatively related to the progression-free survival (PFS) of the post-operative patients, Median PFS was 1140 days in the patients with high expression, and Median PFS was 1387 days in the patients with low expression (χ

2
= 4.715, P = .030); CEA expression is also negatively associated with the PFS of the post-operative patients, Median PFS was 1197 days in the patients with high expression, and Median PFS was 1424 days in the patients with low expression (χ

2
= 4.992, P = .025). Subgroup analysis also showed that the patients with normal CA125 and CEA had better prognosis, median PFS was 1505 days, and the patients with CA125 and (or) CEA high expression had poor prognosis and median PFS was 1162 days (χ

2
= 13.346, P = .001), and found that there was no statistical difference in patients with oxaliplatin plus capecitabine (XELOX) and oxaliplatin, 5-fluorouracil and Calcium folinate (FOLFOX) chemotherapy in patients with CA125 and CEA low expression. However, in these patients with CA125 or (and) CEA high expression, the median PFS of patients treated with XELOX was 1082 days, and the median PFS of patients treated with FOLFOX chemotherapy was 1335 (χ

2
= 4.547, P = .033).
Expression of CA125 and CEA associated with the survival of patients, and have some guiding significance for chemotherapy in patients with colorectal cancer after operation; Compared with XELOX, FOLFOX chemotherapy is more effective for CA125 or (and) CEA high expression patients with colorectal carcinoma.
Association of resting heart rate with nonalcoholic fatty liver disease in postmenopausal women
Authors: Kim Hong-Bae , Lee Yong-Jae 
Published: April 2020

Abstract
Resting heart rate, a simple and useful indicator of autonomic function, and its imbalance has emerged as an independent predictor of cardio metabolic diseases. Nonalcoholic fatty liver disease (NAFLD) is increasingly being diagnosed worldwide and is strongly associated with the features of cardiometabolic diseases. This study aimed to examine the association between resting heart rate and NAFLD in postmenopausal women.
The cross-sectional study included 1017 postmenopausal women aged ≥46 years, who attended a health examination program. Resting heart rate and NAFLD were measured in all subjects who underwent a medical examination. Resting heart rate quartiles were categorized as follows: Q1: 56 to 65, Q2: 66 to 71, Q3: 72 to 78, and Q4: 79 to 99 beats/min. The odds ratios and 95% confidence intervals for NAFLD were calculated after adjusting for confounding variables across resting heart rate quartiles using multiple logistic regression analysis.
The prevalence of NAFLD increased with increasing resting heart rate quartiles: 28.2% for Q1, 31.5% for Q2, 33.4% for Q3, and 38.1% for Q4 (P < .001). Compared to the 1st quartile, the odds ratio (95% confidence intervals) of NAFLD in the 4th quartile of resting heart rates was 2.11 (1.17–3.42) after adjusting for age, body mass index, cigarette smoking, regular exercise, blood pressure, total cholesterol, triglyceride, aspartate aminotransferase, and alanine aminotransferase levels.
Resting heart rate was positively associated with NAFLD in postmenopausal women, suggesting that it could be a useful additional measure to assess the risk for NAFLD in postmenopausal women.
The characteristics of the whole pelvic morphology in slipped capital femoral epiphysis
Authors: Wako Masanori , Koyama Kensuke , Takayama Yoshihiro , Haro Hirotaka 
Published: April 2020

Abstract
Slipped capital femoral epiphysis (SCFE) is a very common disorder affecting the adolescent hip. The etiology of SCFE is multifactorial and mechanical force associated with the characteristic morphology of the hip is considered one of the causes of SCFE. We investigated the characteristics of whole pelvic morphology including pelvic incidence (PI) in patients with SCFE and compared it with pelvic morphology in healthy children. We retrospectively assessed the whole pelvic morphology of 17 patients with SCFE and 51 healthy children using their pelvic computed tomography data. We measured superior iliac angle, inferior iliac angle, and ischiopubic angle as the parameters of pelvic rotation. Additionally, we measured acetabular anteversion of the superior acetabulum (AVsup) and of the center of the acetabulum (AVcen), and measured anterior acetabular sector angle (AASA), posterior acetabular sector angle, and the superior acetabular sector angle (SASA) as parameters of acetabular coverage and PI. Each measurement was compared between the 2 groups. AASA and SASA of patients with SCFE were significantly greater than that of controls, and AVsup of patients with SCFE was significantly smaller. There were no significant differences in pelvic rotation, PI, or AVcen between the 2 groups. This is the 1st report to evaluate SCFE patients’ whole pelvic morphology including PI and pelvic rotation. Our results showed that patients with SCFE have excessive coverage of the anterior and superior acetabulum, and a more retroverted cranial acetabulum as compared with healthy control subjects. Such characteristic pelvic morphology may be involved in the onset of SCFE. To clarify the mechanical forces involved in SCFE onset, further investigations of pelvic morphology and alignment, including the femur and spine, are needed.
Effect of acupuncture on hormone level in patients with gastrointestinal dysfunction after general anesthesia
Authors: Liu Lisha , Yuan Xiuli , Yang Lei , Zhang Jingyuan , Luo Jing , Huang Guangqiang , Huo Jian 
Published: April 2020

Abstract

Background:
Postoperative gastrointestinal dysfunction (PGD) refers to one of the common postoperative complications. Acupuncture can facilitate the recovery of PGD, whereas no therapeutic schedule of acupuncture has been internationally recognized for treating PGD. In the present study, a scientific trial protocol has been proposed to verify the feasibility of acupuncture in treating gastrointestinal dysfunction after laparoscopic cholecystectomy under general anesthesia. We conduct this protocol to investigate whether acupuncture recovery gastrointestinal dysfunction by influencing the expression of gastrointestinal hormone.

Method:
The present study refers to a randomized, evaluator blinded, controlled, multi-center clinical trial; it was designed complying with the Consolidated Standards of Reporting Trials (CONSORT 2010) as well as the Standard for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA). The subjects will be taken from the inpatients having undergone laparoscopic surgery of Mianyang Affiliated Hospital of Chengdu University of traditional Chinese medicine, Mianyang Third Hospital and Mianyang Anzhou Hospital. Based on the random number yielded using SPSS 25.0 software, the qualified subjects will be randomly classified to the experimental group and the control group. Therapies will be performed 30 min once after operation, the experimental group will be treated with acupuncture, while the control group will receive intravenous injection of granisetron. The major outcome will be the time to first flatus, and the secondary outcomes will include the time to first defecation, abdominal pain, dosage of analgesia pump, abdominal distention, nausea, vomiting, gastrointestinal hormone, as well as mental state. The efficacy and safety of acupuncture will be also assessed following the principle of Good Clinical Practice (GCP).

Discuss:
A standardized and scientific clinical trial is conducted to assess the efficacy and safety of acupuncture for gastrointestinal dysfunction after laparoscopic cholecystectomy under general anesthesia. The aim is to objectively evidence and improves the clinical practice of acupoint prescription, as an attempt to promote the clinical application of this technology.
A Bayesian network meta-analysis of 5 different fusion surgical procedures for the treatment of lumbar spondylolisthesis
Authors: Tang Linjun , Wu Yong , Jing Daping , Xu Yong , Wang Cheng , Pan Jingjing 
Published: April 2020

Abstract
Lumbar fusion has been widely used to treat lumbar spondylolisthesis, which can be classified into 5 types according to its approach, including posterolateral fusion (PLF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), posterolateral fusion plus anterior lumbar interbody fusion (PLFplusALIF), and posterolateral fusion plus posterior lumbar interbody fusion (PLFplusPLIF). Theoretically, each approach has its own advantages and disadvantages, however, no studies are available to compare them.
A network meta-analysis (NMA) was performed in this study and the results were illustrated by the mean difference (MD) or odds ratio (OR). Meanwhile, the preferable treatments were indicated using the surface under the cumulative ranking curve (SUCRA). All data were analyzed and graphs were plotted using R 3.4.1.
A total of 28 literatures were included in this meta-analysis. PLIF was the most effective treatment for pain relief. Conversely, TLIF was the most effective method for reducing vertebral slippage. For patients with isthmic spondylolisthesis (IS), PLIF performed the best in terms of Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI) score, fusion rate, blood loss, and complication rate. For patients with degenerative spondylolisthesis (DS), TLIF was the best from the points of view of VAS, complication rate, and vertebral slippage reduction.
PLIF and TLIF are identified as the optimal treatments for all lumbar spondylolisthesis cases, among which, PLIF may be the preferred choice for pain relief, while TLIF can offer the best outcomes in terms of vertebral slippage reduction. Furthermore, TLIF has displayed the best clinical outcomes and tolerability for DS patients.
A new radiographic finding of adult symptomatic discoid lateral meniscus
Authors: Lu Xin , Qian Jun , Yang Bo , Li Zheng , Fan Yu , Jiang Bo 
Published: April 2020

Abstract
Discoid lateral meniscus is one of the most common knee problems in clinical practice. Several radiographic findings have been reported to screen discoid lateral meniscus, but the diagnostic value of those signs varies.
We introduce a new method of measurement on plain radiograph for initial screening discoid lateral meniscus and describe its efficacy and correlation to symptomatic discoid lateral meniscus.
This is a retrospective case-control study.
Seventy-eight arthroscopic proven symptomatic discoid lateral meniscus adult patients plus 73 patients of matched control group were retrospectively reviewed at our institution between 2012 and 2017. We studied their standardized non-weight-bearing knee radiograph anterior-posterior view and measured the following parameters: lateral joint space height, lateral tibia spine height, fibular head height, lateral tibia plateau obliquity (LTPO), and lateral condyle convex angle (LCCA).
Significant statistical differences were found in the lateral joint space height, lateral tibia spine height, fibular head height, LTPO and LCCA measurements between the 2 groups (P < .05). Also, we found the phenomenon that angle parameters such as LTPO and LCCA had high sensitivities with relatively low specificities compared with height parameters.
We propose that LCCA is a new measurement which is statistically larger in discoid meniscus patients. Furthermore, it can be useful for screening discoid lateral meniscus on plain radiograph with its relative high sensitivity.
Level of Evidence: Level III, Case-control study.
Cardiovascular outcomes in patients with co-existing coronary artery disease and rheumatoid arthritis
Authors: Wang Hong , Li Xinxin , Gong Guoping 
Published: April 2020

Abstract

Background:
Through this analysis, we aimed to systematically compare the cardiovascular outcomes observed in patients with co-existing coronary artery disease (CAD) and rheumatoid arthritis (RA).

Methods:
Mendeley, Web of Science (WOS), MEDLINE, Cochrane central, EMBASE, Google scholar, and http://www.ClinicalTrials.gov were searched for English-based publications on CAD and RA. Selective cardiovascular outcomes were the endpoints in this analysis. The statistical software RevMan 5.3 was used for data assessment. Risk ratios (RR) with 95% confidence intervals (CI) were used to represent each subgroup analysis.

Results:
One thousand four hundred forty six (1446) participants had co-existing CAD and RA whereas 205,575 participants were in the control group (only CAD without RA). This current analysis showed that the risk of asymptomatic or stable angina was similar in CAD patients with versus without RA (RR: 0.98, 95% CI: 0.84 – 1.14; P = .78). However, all-cause mortality (RR: 1.47, 95% CI: 1.34 – 1.61; P = 0.00001), cardiac death (RR: 1.51, 95% CI: 1.05 – 2.17; P = .03) and congestive heart failure (RR: 1.41, 95% CI: 1.27 – 1.56; P = .00001) were significantly higher in CAD patients with RA. However, multi-vessel disease (RR: 2.03, 95% CI: 0.57 – 7.26; P = .28), positive stress test (RR: 1.69, 95% CI: 0.70 – 4.08; P = .24), and ischemic events (RR: 1.18, 95% CI: 0.81 – 1.71; P = .40) were similar in both groups. The risk for myocardial infarction, repeated revascularization, and the probability of patients undergoing percutaneous coronary intervention (PCI) (RR: 1.20, 95% CI: 0.75 – 1.93; P = .45) were also similar in CAD patients with versus without RA. When we considered outcomes only in those patients who underwent revascularization by PCI, all-cause mortality (RR: 1.43, 95% CI: 1.29 – 1.60; P = .00001) was still significantly higher in CAD patients with RA.

Conclusions:
This analysis showed a significantly higher mortality risk in CAD patients with RA when compared to the control group. Congestive heart failure also significantly manifested more in CAD patients with co-existing RA. However, the risks all the other cardiovascular outcomes were similar in both groups. Nevertheless, due to the several limitations of this analysis, this hypothesis should be confirmed in forthcoming trials based on larger numbers of CAD patients with co-existing RA.
Co-occurrence of PML-RARA gene fusion, chromosome 8 trisomy, and FLT3 ITD mutation in a young female patient with de novo acute myeloid leukemia and early death
Authors: Tripon Florin , Crauciuc George Andrei , Bogliş Alina , Moldovan Valeriu , Sándor-Kéri Johanna , Benedek István Jr , Trifa Adrian Pavel , Bănescu Claudia 
Published: April 2020

Abstract

Rationale:
Co-occurrence of cytogenetic and molecular abnormalities is frequently seen in patients with acute myeloid leukemia (AML). The clinical outcome and genetic abnormalities of AML may vary; therefore, genetic investigation must be complex, using several techniques, to have an appropriate characterization of the AML genome and its clinical impact. The available molecular markers can predict prognosis only partially. Acute promyelocytic leukemia subtype M3 (AML M3) is a subtype of AML characterized by the presence of promyelocytic leukemia-retinoic acid receptor alpha (PML-RARA) genes fusion. Targeted treatment with all-trans-retinoic acid (ATRA) and ATRA combined with arsenic trioxide significantly improved the survival of AML M3 patients. Unknown prognostic factors could contribute to the early death of these patients.

Patient Concerns:
We present the case of a young female (20 years old) patient, who presented at the emergency department 5 months after giving birth to her first child, complaining of asthenia, fatigue, general musculoskeletal pain, and fever (38°C), symptoms having been present for the previous 6 days. The patient denied any chronic diseases in her medical and family history.

Diagnosis:
Laboratory analysis revealed severe pancytopenia. Cytogenetic and molecular analyzes revealed chromosomal abnormalities (trisomy 8), PML-RARA gene fusion, and fms-like tyrosine kinase 3 (FLT3) gene mutation. The immunophenotypic analysis was also suggestive for AML M3 according to the FAB classification.

Interventions:
Specific treatment was initiated for AML M3 and for secondary conditions. Molecular and cytogenetic analyzes were performed to have a more detailed characterization of the patient's genome.

Outcome:
Seventy-two hours after admission, she developed psychomotor agitation, confusion, coma, and convulsion. Subsequent deterioration and early death were caused by intracerebral hemorrhage with multiple localization and diffuse cerebral edema.

Lessons:
The presence of FLT3 internal tandem duplication (ITD) mutation may explain the rapid and progressive degradation of this AML M3 case and it may be used as a prognostic marker even when co-occuring with other markers such as PML-RARA gene fusion and trisomy 8. We consider that FLT3 ITD mutation analysis in young patients with AML should be performed as soon as possible. New strategies for patients’ education, AML (or cancers in general) prevention, and treatment are needed.