bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of Cancer in Middle-aged Patients With Gout: A Nationwide Population-based Study in Korea
Authors: Lee Jung Sun , Myung Jisun , Lee Hyun Ah , Hong Seokchan , Lee Chang-Keun , Yoo Bin , Oh Ji Seon , Kim Yong-Gil 
Published: November 2020

ObjectiveGout is reportedly associated with a higher incidence of cancer. However, patients with gout tend to have several cancer-related factors including obesity, smoking, and alcohol consumption; thus, the precise association between gout and cancer risk remains unclear. We aimed to investigate the risk of cancer in Korean patients with gout.MethodsBased on the Korea Health Insurance Service database, the subjects comprised patients aged 41–55 years with gout newly diagnosed between 2003 and 2007. We used a multivariable-adjusted Cox proportional hazards model in gout patients and a 1:2 ratio for the matched controls by age, sex, and index year.ResultsWe compared 4176 patients with gout with 8352 controls. The mean age and follow-up duration were 48.8 years and 10.1 years in both groups. Overall cancer risk was significantly different between gout patients and controls (HR 1.224, 95% CI 1.073–1.398). The all-cause mortality (HR 1.457, 95% CI 1.149–1.847) and cancer mortality (HR 1.470, 95% CI 1.020–2.136) were higher in patients with gout. In the subgroup analysis, the cancer risks of the stomach (HR 1.710, 95% CI 1.221–2.395), head and neck (HR 1.850, 95% CI 1.071–3.196), and hematologic or lymphoid organ (HR 2.849, 95% CI 1.035–7.844) were higher in patients with gout.ConclusionPatients aged 41–55 years with gout have a higher risk of cancer and all-cause and cancer mortality compared with the general population. Therefore, special attention should be paid to higher cancer risk and mortality in these patients who are diagnosed in middle age.
Development and Testing of Reduced Versions of the Manual Muscle Test-8 in Juvenile Dermatomyositis
Authors: Rosina Silvia , Varnier Giulia C. , Pistorio Angela , Pilkington Clarissa , Maillard Susan , Civino Adele , Tsitsami Elena , Bracaglia Claudia , Jelusic Marija , Cespedes-Cruz Adriana , Espada Graciela , Cimaz Rolando , Couillault Gerard , Joos Rik , Quartier Pierre , Rao Anand P. , Malattia Clara , Ruperto Nicolino , Consolaro Alessandro , Ravelli Angelo 
Published: November 2020

Objective.To develop and test shortened versions of the Manual Muscle Test-8 (MMT-8) in juvenile dermatomyositis (JDM).Methods.Construction of reduced tools was based on a retrospective analysis of individual scores of MMT-8 muscle groups in 3 multinational datasets. The 4 and 6 most frequently impaired muscle groups were included in MMT-4 and MMT-6, respectively. Metrologic properties of reduced tools were assessed by evaluating construct validity, internal consistency, discriminant ability, and responsiveness to change.Results.Neck flexors, hip extensors, hip abductors, and shoulder abductors were included in MMT-4, whereas MMT-6 also included elbow flexors and hip flexors. Both shortened tools revealed strong correlations with MMT-8 and other muscle strength measures. Correlations with other JDM outcome measures were in line with predictions. Internal consistency was good (0.88–0.96) for both MMT-4 and MMT-6. Both reduced tools showed strong ability to discriminate between disease activity states, assessed by the caring physician or a parent (P< 0.001), and between patients whose parents were satisfied or not satisfied with illness course (P< 0.001). Responsiveness to change (assessed by both standardized response mean and relative efficiency) of MMT-4 and, to a lesser degree, MMT-6, was slightly superior to that of MMT-8.Conclusion.Overall, the metrologic performance of MMT-4 and MMT-6 was comparable to that of the other established muscle strength tools, which indicates that they may be suitable for use in clinical practice and research, including clinical trials. The measurement properties of these tools should be further tested in other patient populations and evaluated prospectively.
Hydroxychloroquine Suppresses Interferon-inducible Genes and B Cell Activating Factor in Patients With Incomplete and New-onset Systemic Lupus Erythematosus
Authors: Lambers Wietske M. , Westra Johanna , Bootsma Hendrika , de Leeuw Karina 
Published: November 2020

Objective.Hydroxychloroquine (HCQ) is commonly used as first-line treatment for systemic lupus erythematosus (SLE). Interferon (IFN)-inducible gene expression, IFN-γ–induced protein 10 (IP-10) and B cell activating factor (BAFF) are early mediators in SLE. The purpose of this study was to analyze the effects of HCQ on these factors.Methods.Patients with incomplete SLE (iSLE; antinuclear antibody titer ≥ 1:80, symptoms < 5 years, ≥ 1 objectified clinical American College of Rheumatology or SLE International Collaborating Clinics criteria), or new-onset, mild SLE were included when HCQ treatment was started for clinical reasons. Blood samples were taken at start and after 16 weeks. Three SLE-related IFN-inducible genes were measured in whole blood by real-time PCR, and an IFN score was calculated. Serum levels of IP-10 and BAFF were measured using ELISA.Results.In total, 9 patients were included: 7 with iSLE and 2 with new-onset SLE. The median SLE Disease Activity Index (SLEDAI) was 4. After 16 weeks of treatment with HCQ, the expression of IFN-inducible genes decreased in 8 of 9 patients, and the IFN-3 score decreased significantly (P = 0.012). There was a trend towards lower IP-10 levels (P = 0.055), and a significant decrease in BAFF levels (P = 0.023).Conclusion.HCQ suppresses IFN score and BAFF levels in patients with iSLE or new-onset SLE, and there is a trend towards lowering IP-10 levels. As these biomarkers are early mediators in SLE, this might support the hypothesis that HCQ could influence disease progression. However, prospective research with a larger sample size and longer follow-up is needed.
Hospitalization Rates Are Highest in the First 5 Years of Systemic Sclerosis: Results From a Population-based Cohort (1980–2016)
Authors: Coffey Caitrin M. , Sandhu Avneek S. , Crowson Cynthia S. , Achenbach Sara J. , Matteson Eric L. , Osborn Thomas G. , Warrington Kenneth J. , Makol Ashima 
Published: November 2020

Objective.Few studies have estimated the healthcare resource usage of patients with systemic sclerosis (SSc). The purpose of this study was to compare hospitalization among incident cases of SSc vs age- and sex-matched comparators.Methods.A retrospective, population-based cohort of patients with SSc in Olmsted County, Minnesota, from January 1, 1980, to December 31, 2016, was assembled. A 2:1 cohort of age- and sex-matched patients without SSc from the same population was randomly selected for comparison. All hospitalizations in the geographic area from January 1, 1987, to September 30, 2018, were obtained. Rates of hospitalization, lengths of stay, and readmissions were compared between groups.Results.There were 76 incident SSc cases and 155 non-SSc comparators (mean age 56 ± 16 yrs at diagnosis/index, 91% female) included. Rates of hospitalization among cases and comparators were 31.9 and 17.9 per 100 person-years, respectively (rate ratio [RR] 1.78, 95% CI 1.52–2.08). Hospitalization rates were higher in patients with SSc than comparators during the first 5 years after SSc diagnosis (RR 2.16, 95% CI 1.70–2.74). This difference decreased over time and was no longer significant at ≥ 15 years after SSc incidence/index. Lengths of stay (median [IQR] 4 [2–6] vs 3 [2–6], P = 0.52) and readmission rates (25% vs 23%, P = 0.51) were similar between groups.Conclusion.Patients with SSc were hospitalized more frequently than comparators, indicating high inpatient care needs in this population. Hospitalization rates were highest during the first 5 years following SSc diagnosis.
Does Including Pain, Fatigue, and Physical Function When Assessing Patients with Early Rheumatoid Arthritis Provide a Comprehensive Picture of Disease Burden?
Authors: Pazmino Sofia , Lovik Anikó , Boonen Annelies , De Cock Diederik , Stouten Veerle , Joly Johan , Bertrand Delphine , Van der Elst Kristien , Westhovens Rene , Verschueren Patrick 
Published: November 2020

Objective.To explore the possibility of integrating patient-important outcomes like pain, fatigue, and physical function into the evaluation of disease status in early rheumatoid arthritis (ERA) without compromising correct disease activity measurement.Methods.Patients from the 2-year Care in Early Rheumatoid Arthritis (CareRA) trial were included. Pain and fatigue (visual analog scales), Health Assessment Questionnaire (HAQ), standard components of disease activity [swollen/tender joint counts (SJC/TJC), C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR), physician (PhGH) and patient (PaGH) global health] were recorded at every visit (n = 10). Pearson correlation and exploratory factor analyses (EFA), using multiple imputation (15×) and outputation (1000×), were performed per timepoint and overall, on standard components of disease activity scores with and without pain, fatigue, and HAQ. Each of the 15,000 datasets was analyzed using EFA with principal component extraction and oblimin rotation to determine which variables belong together.Results.We included 379 patients. EFA on standard composite score components extracted 2 factors with no substantial cross-loadings. Still, pain (0.83), fatigue (0.65), and HAQ (0.59) were strongly correlated with PaGH. When rerunning the EFA with the inclusion of pain, fatigue, and HAQ, the 2-factor model had substantial cross-loadings between factors. However, a 3-factor model was optimal, with Factor 1: patient assessment, Factor 2: clinical assessment (PhGH, SJC, and TJC), and Factor 3: laboratory assessment (ESR/CRP).Conclusion.PaGH, pain, fatigue, and physical function represent a separate aspect of the disease burden of patients with ERA, which could be further explored as a target for care apart from disease activity. [ClinicalTrials.gov: NCT01172639].
Lifestyle and Clinical Risk Factors for Incident Rheumatoid Arthritis-associated Interstitial Lung Disease
Authors: Kronzer Vanessa L. , Huang Weixing , Dellaripa Paul F. , Huang Sicong , Feathers Vivi , Lu Bing , Iannaccone Christine K. , Gill Ritu R. , Hatabu Hiroto , Nishino Mizuki , Crowson Cynthia S. , Davis John M. , Weinblatt Michael E. , Shadick Nancy A. , Doyle Tracy J. , Sparks Jeffrey A. 
Published: November 2020

ObjectiveTo determine the association between novel lifestyle factors on risk of rheumatoid arthritis (RA)-associated interstitial lung disease (ILD), define the threshold at which smoking increases RA-ILD risk, and calculate the degree to which known lifestyle and clinical factors predict RA-ILD.MethodsThis nested case-control study matched incident RA-ILD cases to RA non-ILD controls on age, sex, RA duration, rheumatoid factor, and time from exposure assessment to RA-ILD. Exposures included education, BMI, smoking, anticyclic citrullinated peptide antibodies, race, joint erosions, rheumatoid nodules, C-reactive protein (CRP), disease activity score, functional status, disease-modifying antirheumatic drug use, and glucocorticoid use. OR for each exposure on risk of RA-ILD were obtained from logistic regression models. Area under the curve (AUC) was calculated based on all lifestyle and clinical exposures.ResultsWe identified 84 incident RA-ILD cases and 233 matched controls. After adjustment, obesity, high-positive CRP (≥ 10 mg/L), and poor functional status (multidimensional Health Assessment Questionnaire [MDHAQ] ≥ 1) were associated with increased risk of RA-ILD (OR 2.42, 95% CI 1.11–5.24 vs normal BMI; OR 2.61, 95% CI 1.21–5.64 vs CRP < 3 mg/L; OR 3.10, 95% CI 1.32–7.26 vs MDHAQ < 0.2). Smoking 30 pack-years or more was strongly associated with risk of RA-ILD compared to never smokers (OR 6.06, 95% CI 2.72–13.5). Together, lifestyle and clinical risk factors for RA-ILD had an AUC of 0.79 (95% CI 0.73–0.85).ConclusionObesity, CRP, functional status, and extensive smoking may be novel risk factors for RA-ILD that may be useful for RA-ILD risk assessment and prevention. The overall ability to predict RA-ILD remains modest.
Concerns, Healthcare Use, and Treatment Interruptions in Patients With Common Autoimmune Rheumatic Diseases During the COVID-19 Pandemic
Authors: George Michael D. , Venkatachalam Shilpa , Banerjee Shubhasree , Baker Joshua F. , Merkel Peter A. , Gavigan Kelly , Curtis David , Danila Maria I. , Curtis Jeffrey R. , Nowell W. Benjamin 
Published: November 2020

ObjectiveTo assess concerns and healthcare-related behaviors of patients with autoimmune rheumatic diseases during the coronavirus disease 2019 (COVID-19) pandemic.MethodsAdults from the United States with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), and systemic lupus erythematosus (SLE) from the ArthritisPower Patient-Powered Research Network and CreakyJoints patient community completed surveys. Concerns and behaviors were compared among patients with different autoimmune conditions, disease-modifying antirheumatic drug (DMARD) use, and geographic measures of urban status, income, education, and COVID-19 activity.ResultsAmong 1517 participants (925 RA, 299 PsA, 185 AS, 108 SLE), mean age was 55.1 years, 88.3% were female, and 89.5% were White. COVID-19 concerns were similar across the country and were higher in biologic users (P < 0.001). Avoidance of doctor’s office visits (56.6%) or laboratory testing (42.3%) and use of telehealth (29.5%) were more common in urban areas. Among participants receiving a DMARD without COVID-19 or other respiratory illness, 14.9% stopped a DMARD, with 78.7% of DMARD interruptions not recommended by a physician. DMARD stopping was more common in participants with lower socioeconomic status (SES) and in participants who avoided an office visit (OR 1.46, 95% CI 1.04–2.04) or reported lack of telehealth availability OR 2.26 (95% CI 1.25–4.08).ConclusionIn the early months of the COVID-19 pandemic, patients with RA, PsA, AS, and SLE frequently avoided office visits and laboratory testing. DMARD interruptions commonly occurred without the advice of a physician and were associated with SES, office visits, and telehealth availability, highlighting the need for adequate healthcare access and attention to vulnerable populations during the pandemic.
Increased Prevalence of Moderate to Severe Mitral and Aortic Valve Dysfunction in Systemic Sclerosis: A Case-control Study
Authors: Narváez Javier , LLuch Judit , Ruiz-Majoral Alejandro , Sánchez-Corral Miguel Angel , Claver Eduard , Nolla Joan M. 
Published: November 2020

ObjectiveTo investigate the prevalence, severity, and associated clinical factors of mitral and aortic valvular involvement in patients with systemic sclerosis (SSc).MethodsOur case-control study included 172 patients with SSc and 172 non-SSc adults without known cardiac disease matched by age, sex, and prevalence of cardiovascular (CV) risk factors. The screening of mitral and aortic valvular involvement was performed by transthoracic Doppler echocardiogram. The prevalence of aortic stenosis (AS) was also compared with that reported in a population-based study performed in our community during the same period.ResultsPatients with SSc showed an almost 5-fold increased prevalence of moderate to severe mitroaortic valve dysfunction compared to non-SSc controls (OR 4.60, 95% CI 1.51–13.98; P = 0.003). The most common lesion was mitral regurgitation (MR), which was observed in 5.2% of patients, followed by AS in 3.5%, and aortic regurgitation (AR) in 1.7%. Analyzing the different types of valvular lesion separately, we observed a significantly higher frequency of MR compared to controls (OR 4.69, 95% CI 1.12–22.04; P = 0.032), as well as a higher frequency of AS in the 65–75 (OR 7.51, 95% CI 1.22–46.23, P = 0.01) and 76–85 age groups (OR 3.53, 95% CI 1.03–12.22, P = 0.043) when compared to the general population in our community.ConclusionWe found an increased prevalence of moderate to severe MR and AS in SSc compared to age-matched non-SSc controls with similar CV comorbidities. While results from this study do not allow for establishing a direct causal relationship, they strongly support the contribution of SSc-specific factors in the development of these complications.
Priorities for High-quality Care in Rheumatoid Arthritis: Results of Patient, Health Professional, and Policy Maker Perspectives
Authors: Barber Claire E.H. , Lacaille Diane , Hall Marc , Bohm Victoria , Li Linda C. , Barnabe Cheryl , Hazlewood Glen S. , Marshall Deborah A. , Rankin James A. , Tsui Karen , English Kelly , MacMullan Paul , Homik Joanne , Mosher Dianne , Then Karen L. 
Published: November 2020

ObjectiveTo elucidate the essential elements of high-quality rheumatoid arthritis (RA) care in order to develop a vision statement and a set of strategic objectives for a national RA quality framework.MethodsFocus groups and interviews were conducted by experienced qualitative researchers using a semistructured interview or focus group guide with healthcare professionals, patients, clinic managers, healthcare leaders, and policy makers to obtain their perspectives on elements essential to RA care. Purposive sampling provided representation of stakeholder types and regions. Recorded data was transcribed verbatim. Two teams of 2 coders independently analyzed the deidentified transcripts using thematic analysis. Strategic objectives and the vision statement were drafted based on the overarching themes from the qualitative analysis and finalized by a working group.ResultsA total of 54 stakeholders from 9 Canadian provinces participated in the project (3 focus groups and 19 interviews). Seven strategic objectives were derived from the qualitative analysis representing the following themes: (1) early access and timeliness of care; (2) evidence-informed, high-quality care for the ongoing management of RA and comorbidities; (3) availability of patient self-management tools and educational materials for shared decision making; (4) multidisciplinary care; (5) patient outcomes; (6) patient experience and satisfaction with care; and (7) equity, the last of which emerged as an overarching theme. The ultimate vision obtained was “ensuring patient-centered, high-quality care for people living with rheumatoid arthritis.”ConclusionThe 7 strategic objectives that were identified highlight priorities for RA quality of care to be used in developing the National RA Quality Measurement Framework.
Dall’autonomia alla responsabilità: il desiderio di maternità e la possibilità della FIVET
Authors: Furnari Marianna Gensabella 
Published: November 2020

Fino a che punto il desiderio di maternità, frustrato dalla sterilità, può servirsi delle nuove possibilità offerte dalla FIVET? Quale criterio ci consente di distinguere tra un dominio ragionevole ed uno irragionevole sulla natura? Il ripensamento dell’indissolubilità del nesso corpo-persona, e dell’imperativo kantiano, che impone di non considerare mai l’umanità solo come messo, aiutano a trovare una misura che appare smarrita. Ma è possibile applicare l’imperativo kantiano a tutti i soggetti coinvolti nella FIVET? Attraverso una discussione con le tesi della bioetica laica, si evidenzia come quell’imperativo vada inteso, non solo a tutela del diritto dei genitori al consenso libero e informato, ma anche a tutela dell’embrione. Al di là delle distinzioni strumentali tra pre-embrione ed embrione, e al di là della diversità di opinioni se l’embrione si o no persona, sta la certezza che l’embrione è un essere umano, certezza che impone di rispettarlo “come uno di noi”.
Nel confronto con tale imperativo il desiderio di maternità trova un limite che è spesso dimenticato. Iscritto nella sfera intima, inviolabile della corporeità, il desiderio di maternità sembra regolato solo dal principio di autonomia, che su quella sfera domina. Occorre però ripensare il principio di autonomia e il modio in cui intendiamo la nostra corporeità. Rifletto come nomos che si dà un autos che è corpo/persona, il principio di autonomia trova il limite della mia indipendenza non solo nella non interferenza con gli altri, ma nella legge iscritta nella stessa corporeità, cioè nella difesa della vita, mia e altrui. È lo stesso desiderio di maternità a guidarci in questa rilettura del principio di autonomia: iscritto nel corpo, tale desiderio va oltre il corpo proprio, aprendosi alla corporeità dell’altro perché un terzo abbia vita. Di fronte alla rivendicazione dell’autonomia del procreare si leva la voce della responsabilità, da sempre insita nell’esser-madre: una voce che invita a tutelare la vita che chiamiamo al mondo sin dal suo primo apparire, e a vigilare perché le siano assicurati i diritti fondamentali dell’identità parentale e della famiglia. Inteso nella sua verità, non come desiderio di avere un figlio ma come desiderio di essere madre, il desiderio di maternità, trova in se stesso la propria regola, il correttivo a quel dilatarsi indefinito dei fini, quasi una “festa del desiderio” a cui la FIVET eterologa apre. Ciò significa imparare a cadenzare, o addirittura a fermare, il passo del desiderio, seguendo le voci antiche di Logos e Cura.
La circoncisione maschile su neonati
Authors: Di Pietro Maria Luisa , Cicerone Marina 
Published: November 2020

Il termine “circoncisione” indica l’asportazione totale o parziale del prepuzio nel maschio, una pratica presente fin dall’antichità ed eseguita ancora oggi in diverse aree geografiche per motivazioni religiose e culturali.
Dopo un breve excursus storico, le Autrici analizzano le ragioni della circoncisione maschile neonatale (preventiva, terapeutica e rituale) e le eventuali complicanze (fisiche e psicologiche) ad essa correlate, al fine di avere dati obiettivi per valutarne l’utilità e l’efficacia sul piano clinico. Si tratta di una valutazione non facile, tanto che la proposta che generalmente viene avanzata è di lasciare ai genitori la scelta se circoncidere o meno il figlio.
Sono i genitori in grado di prendere la giusta decisione? Sono in grado di esprimere un consenso informato? E l’aver ottenuto il consenso da parte dei genitori risponde alla difesa del miglior interesse del figlio? Quale sarebbe stata l’adesione del figlio alla proposta di circoncisione se questi fosse stato in grado di intendere e di volere?
Un altro aspetto preso in considerazione è, poi, quello della richiesta di circoncisione rituale: deve farsi carico il Servizio Sanitario Nazionale anche di questo intervento? La questione, già presa in esame dal Comitato Nazionale per la Bioetica italiano, viene analizzata nell’ottica non tanto del riconoscimento o meno di forme di esercizio di culto, quanto della validità o meno a scopi profilattici della circoncisione.
Brachytherapy in comprehensive treatment of breast cancer
Authors: Svynarenko A .V. , Miroshnichenko L. H. 
Published: November 2020

Purpose. Based on the data analysis to define the role and function of brachytherapy in comprehensive treatment of breast cancer, indications and contraindications to brachytherapy, appropriate ways of effectiveness planning and control.
Materials and methods. The following scientometric databases were used: Google Scholar, Russian Science Citation Index (RSCI), Index Copernicus (IC), Bibliometrics of Ukrainian Science («Бібліометрика української науки»), Scholarometer, Microsoft Academic Search). The search was restricted to the studies published within the 1983-2020 time­frame.
Results. The analysis of irradiated volume study EORTC (unpublished data indicate a real decrease in the amount of irradiation 3 times in pa­tients who received intra-tissue boost compared with those who used a remote boost). Despite the reduction of exposure, the incidence of local recurrence is not increased.
Conclusions. The brachytherapy method makes it possible to reduce ra­diation exposure to surrounding tissues and to increase the total focal dose on the tumor mass. Along with that, following the results of observing lo­cal recurrence frequency and cosmetic effect, the effectiveness of internal tissue exposure in comprehensive treatment at early stages of breast can­cer has been proved.