bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antimicrobial drug use in the first decade of life influences saliva microbiota diversity and composition
Authors: Raju Sajan C. , Viljakainen Heli , Figueiredo Rejane A. O. , Neuvonen Pertti J. , Eriksson Johan G. , Weiderpass Elisabete , Rounge Trine B. 
Published: August 2020

AbstractBackgroundThe human microbiota contributes to health and well-being. Antimicrobials (AM) have an immediate effect on microbial diversity and composition in the gut, but next to nothing is known about their long-term contribution to saliva microbiota. Our objectives were to investigate the long-term impact of AM use on saliva microbiota diversity and composition in preadolescents. We compared the lifetime effects by gender and AMs. We used data from 808 randomly selected children in the Finnish Health In Teens (Fin-HIT) cohort with register-based data on AM purchases from the Social Insurance Institution of Finland. Saliva microbiota was assessed with 16S rRNA (V3-V4) sequencing. The sequences were aligned to the SILVA ribosomal RNA database and classified and counted using the mothur pipeline. Associations between AM use and alpha-diversity (Shannon index) were identified with linear regression, while associations between beta-diversity (Bray-Curtis dissimilarity) and low, medium or high AM use were identified with PERMANOVA.ResultsOf the children, 53.6% were girls and their mean age was 11.7 (0.4) years. On average, the children had 7.4 (ranging from 0 to 41) AM prescriptions during their lifespan. The four most commonly used AMs were amoxicillin (n= 2622, 43.7%), azithromycin (n= 1495, 24.9%), amoxicillin-clavulanate (n= 1123, 18.7%) and phenoxymethylpenicillin (n= 408, 6.8%). A linear inverse association was observed between the use of azithromycin and Shannon index (b− 0.015,pvalue = 0.002) in all children, the effect was driven by girls (b− 0.032,pvalue = 0.001), while not present in boys. Dissimilarities were marked between high, medium and low users of all AMs combined, in azithromycin users specifically, and in boys with amoxicillin use. Amoxicillin and amoxicillin-clavulanate use was associated with the largest decrease in abundance ofRikenellaceae. AM use in general and phenoxymethylpenicillin specifically were associated with a decrease ofPaludibacterand pathways related to amino acid degradations differed in proportion between high and low AM users.ConclusionsA systematic approach utilising reliable registry data on lifetime use of AMs demonstrated long-term effects on saliva microbiota diversity and composition. These effects are gender- and AM-dependent. We found that frequent lifelong use of AMs shifts bacterial profiles years later, which might have unforeseen health impacts in the future. Our findings emphasise a concern for high azithromycin use, which substantially decreases bacterial diversity and affects composition as well. Further studies are needed to determine the clinical implications of our findings.
Relationship between dexamethasone added to periarticular anesthetic infiltration and postoperative nausea and vomiting following total knee arthroplasty under general anesthesia: a retrospective observational study
Authors: Yano Toshiyuki , Imaizumi Takashi , Matsu-ura Hidemi , Takahashi Tomoki 
Published: August 2020

AbstractBackgroundPeriarticular anesthetic infiltration (PAI) with a corticosteroid is a modality for pain control following total knee arthroplasty (TKA). Systemic corticosteroids are an established antiemetic for the prophylaxis of postoperative nausea and vomiting (PONV). The purpose of this retrospective observational study was to elucidate the relationship between dexamethasone added to PAI and PONV in patients who underwent TKA.MethodsData from 435 patients who received PAI using ropivacaine with or without dexamethasone were reviewed. The primary outcome was the incidence of PONV within 24 h following TKA. The incidence of deep incisional and organ/space surgical site infection (SSI) within the first year was also assessed.ResultsThe overall incidence of PONV was 23.2%. A multivariate logistic regression analysis showed that dexamethasone added to PAI was independently associated with a reduced incidence of PONV (adjusted odds ratio, 0.23; 95% confidence interval, 0.12–0.44,P< 0.001). The incidence of PONV and rescue analgesic requirements within 24 h were lower in patients who received PAI with dexamethasone than in those who received PAI alone (19.5% vs 49.1%,P< 0.001, 7.9% vs 29.1%,P< 0.001, respectively). SSI developed in one out of the 55 patients who received PAI alone, but in none of those who received PAI with dexamethasone.ConclusionsDexamethasone added to PAI for postoperative pain management was independently associated with a lower risk of PONV within 24 h of TKA.
Role of multi-detector CT venography in evaluation of pelvic congestion syndrome
Authors: Awad Ahmad Sayed , Taha Mohammed Medhat Mohammed , Manaf Mohammed Hamam Abd , Gad Mostafa Mahmoud Mohamad , Mashhour Shady Nabil 
Published: August 2020

Abstract
Background
Pelvic congestion syndrome (PCS) is a problematic cause of chronic pelvic pain in women. It is thought to result from venous insufficiency of either ovarian or pelvic veins. Patients also present a variety of symptoms including dysuria and dyspareunia as well as vulva and buttock varicosities. The aim of this study is to evaluate the efficacy of multi-detector CT (MDCT) in diagnosis of PCS. Two hundred patients were included in our study and underwent CT venography of the abdomen and pelvis.

Results
We performed a prospective comparative study conducted on 200 patients. Thirty patients (15%) were diagnosed as PCS. There were congestion of the ovarian venous plexus and uterine venous engorgement in all patients. Filling of the veins across the midline was noted in 10 patients and filling of the vulval and thigh varicosities was noted in 3 patients. Ten patients had right ovarian vein dilatation; 12 patients had left ovarian vein dilatation; while 8 patients had bilateral ovarian vein dilatation. The right ovarian vein mean diameter (± SD) = 7.1 ± 0.8 mm; while the left ovarian vein mean diameter (± SD) = 7.6 ± 1 mm. Left ovarian venous reflux was found in 6 cases while no pathological reflux depicted on right side.

Conclusions
CT venography is considered as one of the initial investigations for the diagnosis of PCS in female patients with chronic pelvic pain making the further assessment by ovarian venography is for interventional management of diagnosed cases.
Randomized Phase II Trial of Nivolumab With Stereotactic Body Radiotherapy Versus Nivolumab Alone in Metastatic Head and Neck Squamous Cell Carcinoma
Authors: McBride Sean , Sherman Eric , Tsai C. Jillian , Baxi Shrujal , Aghalar Jahan , Eng Juliana , Zhi Wanqing Iris , McFarland Daniel , Michel Loren Scott , Young Robert , Lefkowitz Robert , Spielsinger Daniel , Zhang Zhigang , Flynn Jessica , Dunn Lara , Ho Alan , Riaz Nadeem , Pfister David , Lee Nancy 
Published: August 2020

PURPOSE The objective response rate (ORR) for single-agent anti–programmed death receptor 1 (anti–PD-1) therapy is modest in patients with metastatic or recurrent head and neck squamous cell carcinoma (HNSCC). We aimed to test whether radiotherapy may act synergistically with anti–PD-1 therapy to improve response through the abscopal effect. PATIENTS AND METHODS We conducted a single-center, randomized, phase II trial of nivolumab (anti–PD-1 therapy) versus nivolumab plus stereotactic body radiotherapy (SBRT) in patients with metastatic HNSCC. Patients had at least two metastatic lesions: one that could be safely irradiated and one measurable by RECIST version 1.1. Patients were randomly assigned (1:1), stratified by human papillomavirus status, to nivolumab (3 mg/kg intravenously every 2 weeks) or nivolumab (same dose) plus SBRT (9 Gy × 3) to 1 lesion. The primary end point was ORR in nonirradiated lesions, which was assessed by RECIST in patients with at least one available set of on-treatment images; safety was assessed in a per-protocol population. RESULTS Between March 11, 2016, and June 22, 2018, 62 patients were randomly assigned to nivolumab (n = 30) or nivolumab plus SBRT (n = 32). There was no statistically significant ORR difference between arms (34.5% [95% CI, 19.9% to 52.7%] v 29.0% [95% CI, 16.1% to 46.6%]; P = .86). There was no significant difference in overall survival ( P = .75), progression-free survival ( P = .79), or response duration ( P = .26). Grade 3-5 toxicities were similar (13.3% v 9.7%; P = .70). CONCLUSION We found no improvement in response and no evidence of an abscopal effect with the addition of SBRT to nivolumab in unselected patients with metastatic HNSCC.
Changes in Intravenous Immunoglobulin Usage for Hypogammaglobulinemia After Implementation of a Stewardship Program
Authors: Derman Benjamin A. , Schlei Zachary , Parsad Sandeep , Mullane Kathleen , Knoebel Randall W. 
Published: August 2020

PURPOSE:Intravenous immunoglobulin (IVIG) is used to replenish immunoglobulins in hypogammaglobulinemia (HG) caused by hematologic malignancies (HM) or their treatment (autologous stem-cell transplantation [ASCT] and chimeric antigen receptor T-cell therapy [CAR-T]), in an effort to reduce the risk of infections. However, there is limited evidence to support this use, and IVIG supplies are limited and shortages are common.METHODS:An IVIG stewardship program (ISP) was implemented with the following requirements for IVIG administration: immunoglobulin G (IgG) level < 400 mg/dL (corrected for paraprotein) for post-ASCT and post–CAR-T patients, or IgG < 400 mg/dL with a history of a bacterial infection within the preceding 3 months for those with HM. Comparisons of the amount of IVIG administered, the incidence of infections, and the use of antimicrobials were performed between the 3 months before ISP and the 3 months after ISP.RESULTS:IVIG administered for HG decreased from 4,902 g in 86 patients before ISP to 1,777 g in 55 patients after ISP, a cost savings of $44,700. Adherence to ISP guidelines was 80%. Compared with before ISP, patients who stopped receiving IVIG after ISP had lower nadir IgG, fewer infections/patient-months, less antimicrobial usage, and a lower hospitalization rate for infection; no deaths occurred. Compared with before ISP, patients receiving IVIG after ISP had lower predose IgG and fewer infections/patient-months; the antibiotic usage, hospitalization rate for infection, and deaths from infection remained stable.CONCLUSION:To our knowledge, this is the first ISP to lead to a dramatic decrease in IVIG usage with high adherence, primarily by selecting out patients at low risk of infection after IVIG discontinuation. Such an ISP is replicable and warrants adoption.
Quantitative and Functional Analysis of PD-1+ NK Cells in Patients With Autoimmune Thyroid Disease
Authors: Ortega-Rodríguez Alma Cesleste , Martínez-Hernández Rebeca , Monsiváis-Urenda Adriana , Serrano-Somavilla Ana , Sánchez-Gutiérrez Raquel , González-Amaro Roberto , Marazuela Mónica 
Published: August 2020

Abstract

Context
Natural killer (NK) cells have an important role in innate immunity and in the regulation of immune response. The role of NK cells expressing the programmed cell death protein-1 (PD-1) regulatory receptor has not been explored in patients with autoimmune thyroid disease (AITD).

Purpose
To analyze the levels and function of PD-1+ NK cells in samples from AITD patients.

Design
Cases and controls, observational study.

Setting
Hospital Universitario la Princesa, Spain.

Patients
Forty patients with AITD, 16 with Hashimoto thyroiditis (HT), 24 with Graves’ disease (GD), and 15 healthy controls.

Intervention
Multiparametric flow cytometry analysis of peripheral blood NK cells. In vitro assays of cytotoxic activity of NK cells, and synthesis of cytokines.

Main outcome measures
Levels and function of PD-1+ NK cells in blood samples from AITD patients and controls.

Results
Increased levels of NK cells and the CD56dimPD-1+ subset were observed in GD patients. In HT, an enhanced expression of the regulatory receptors NKG2A and NKG2C by CD56brightPD-1+ NK cells was detected. AITD patients showed an increased synthesis of IL-10 by CD56brightPD-1– NK cells, whereas CD56dimPD-1+ cells from GD patients exhibited an enhanced production of interferon-γ. PD-1+ NK cells from patients with GD and HT showed an increased cytotoxic activity. Significant associations were observed in patients with GD or HT between the levels of PD-1+ NK cells and clinical laboratory parameters.

Conclusions
The different abnormalities in NK cell subset levels, in the expression of PD-1 and its function in AITD patients’ further support the complex role of these cells in this pathogenesis.
Whole-Body Vibration Stimulates Microvascular Blood Flow in Skeletal Muscle
Authors: BETIK ANDREW C. , PARKER LEWAN , KAUR GUNVEEN , WADLEY GLENN D. , KESKE MICHELLE A. 
Published: August 2020

ABSTRACT

Purpose
Whole-body vibration (WBV) therapy has been reported to potentially act as an exercise mimetic by improving muscle function and exercise capacity in a variety of healthy and clinical populations. Considering the important role that microvascular blood flow plays in muscle metabolism and exercise capacity, we investigated the muscle microvascular responses of acute WBV to knee extension exercise (KEX) in healthy individuals.

Methods
Eleven healthy adults (age: 33 ± 2 yr; body mass index: 23.6 ± 1.1 kg·m−2) underwent 3 min of WBV, or 3 min of KEX at 25% of one-repetition maximum, in a randomized order separated by a minimum of 72 h. Femoral arterial blood flow was measured via Doppler ultrasound, and thigh muscle microvascular blood flow was measured via contrast-enhanced ultrasound at baseline and throughout the 3-min postintervention recovery period.

Results
Both WBV and KEX significantly increased peak microvascular blood flow (WBV, 5.6-fold; KEX, 21-fold; both P < 0.05) during the 3-min recovery period. Despite a similar increase in femoral arterial blood flow (~4-fold; both P < 0.05 vs baseline) and whole-body oxygen consumption measured by indirect calorimetry (WBV, 48%; KEX, 60%; both P < 0.05 vs baseline) in both conditions, microvascular blood flow was stimulated to a greater extent after KEX.

Conclusion
A single 3-min session of WBV in healthy individuals is sufficient to significantly enhance muscle microvascular blood flow. Despite KEX providing a more potent stimulus, WBV may be an effective method for improving microvascular blood flow in populations reported to exhibit microvascular dysfunction such as patients with type 2 diabetes.
Interaction of Exercise Intensity and Simulated Burn Injury Size on Thermoregulation
Authors: BELVAL LUKE N. , CRAMER MATTHEW N. , MORALEZ GILBERT , HUANG MU , CIMINO FRANK A. , WATSO JOSEPH C. , CRANDALL CRAIG G. 
Published: August 2020

ABSTRACT
The U.S. Department of Defense’s Medical Standards for Appointment, Enlistment, or Induction into the Military Services excludes personnel with burn injuries covering 18% or more of their body surface area (BSA). However, this requirement does not consider the metabolic heat loads associated with physical activities of different intensities that may influence a burn survivor’s ability to perform his/her duties.

Purpose
This study aimed to test the hypothesis that the elevation in internal body temperature during exercise in a hot environment is influenced by the combination of exercise intensity and BSA burned.

Methods
Ten healthy participants (8 males, 2 females; 32 ± 9 yr; 75.3 ± 11.7 kg) completed eight exercise trials on a cycle ergometer, each with different combinations of metabolic heat productions (low, 4 W·kg−1; moderate, 6 W·kg−1) and simulated BSA burn in a hot environmental chamber (39.9°C ± 0.3°C, 20.1% ± 1.5% RH). Burns were simulated by covering 0%, 20%, 40%, or 60% of participants’ BSA with a highly absorbent, vapor-impermeable material. Gastrointestinal temperature (T
GI) was recorded, with the primary analysis being the increase in T
GI after 60 min of exercise.

Results
We identified an interaction effect for the increase in T
GI (P < 0.01), suggesting T
GI was influenced by both intensity and simulated burn BSA. Regardless of the percentage BSA burn simulated, the increase in T
GI was similar across low-intensity trials (0.70°C ± 0.26°C, P > 0.11 for all). However, during moderate-intensity exercise, the increase in T
GI was greater for the 60% (1.78°C ± 0.38°C, P < 0.01) and 40% BSA coverage trials (1.33°C ± 0.44°C, P = 0.04), relative to 0% (0.82°C ± 0.36°C). There were no differences in T
GI responses between 0% and 20% trials.

Conclusion
These data suggest that exercise intensity influences the relationship between burn injury size and thermoregulatory responses in a hot environment.
Sharp recanalization of peripheral arterial chronic total occlusions
Authors: Kim Kyungmin , Moore Christian , Alfahad Aws 
Published: August 2020

Peripheral arterial chronic total occlusions (CTOs) usually have calcified caps at either ends. When attempting endovascular recanalization, these calcified CTO caps may prevent the interventionist in crossing the lesion with conventional catheter and guidewire techniques. Using specialized CTO devices or re-entry devices can help crossing the CTO, but such devices are usually expensive, not always readily available and require specialist training prior to usage.
“Sharp recanalization” is an alternative method of crossing the CTOs. If it is not possible to cross the CTO with conventional catheter and guidewire technique, one can take out the floppy end of the guidewire and use the stiff or the “sharp” end of the guidewire to break the hard CTO cap. Once the CTO cap is broken, the stiff end is replaced by the floppy end of the guidewire again to proceed with balloon angioplasty and/or stenting.
In order to safely use the sharp recanalization technique while minimizing the risk of perforation, sharp recanalization should only be attempted once conventional methods have failed. The interventionist should plan sharp recanalization with the vascular path in mind and decide in advance how far s/he will proceed. It can be helpful to set a time limit together with the intervention team, past which the sharp recanalization attempt will be abandoned. Using straight catheters can help directing the stiff guidewire tip to the center of the vascular lumen and reduce the risk of sub intimal dissection or arterial wall perforation.
Radiomic signatures derived from multiparametric MRI for the pretreatment prediction of response to neoadjuvant chemotherapy in breast cancer
Authors: Bian Tiantian , Wu Zengjie , Lin Qing , Wang Haibo , Ge Yaqiong , Duan Shaofeng , Fu Guangming , Cui Chunxiao , Su Xiaohui 
Published: August 2020

Objectives: To investigate the ability of radiomic signatures based on MRI to evaluate the response and efficiency of neoadjuvant chemotherapy (NAC) for treating breast cancers. Methods: 152 patients were included in this study at our institution between March 2017 and September 2019. All patients with breast cancer underwent a preoperative breast MRI and the Miller–Payne grading system was applied to evaluate response to NAC. Quantitative parameters were compared between patients with sensitive and insensitive responses to NAC and between those with pathological complete responses (pCR) and non-pCR. Four radiomic signatures were built based on T2W imaging, diffusion-weighted imaging, dynamic contrast-enhanced imaging and their combination, and radiomics scores (Rad-score) were calculated. The combination of the clinical factors and Rad-scores created a nomogram model. Multivariate logistic regression was performed to assess the association between MRI features and independent clinical risk factors. Results: 20 features and 18 features were selected to build the radiomic signature for evaluating sensitivity and the possibility of pCR, respectively. The combined radiomic signature and nomogram model showed a similar discrimination in the training (AUC 0.91, 0.92, 95% confidence interval [CI], 0.85–0.96, 0.86–0.98) and validation (AUC 0.93, 0.91, 95% CI, 0.86–1.00, 0.82–1.00) sets. The clinical factor model exhibited reduced performance (AUC 0.74, 0.64, 95% CI, 0.64–0.84, 0.46–0.82) in terms of NAC sensitivity and pCR. Conclusions: The combined radiomic signature and nomogram model exhibited potential predictive power for predicting effective NAC treatment which can aid in the prognosis and guidance of treatment regimens. Advances in knowledge: Identifying a means of assessing the efficacy of NAC before surgery can guide follow-up treatment and avoid chemotherapy-induced toxicity.
Patient-based low dose cone beam CT acquisition settings for prostate image-guided radiotherapy treatments on a Varian TrueBeam linear accelerator
Authors: Piliero Maria Antonietta , Casiraghi Margherita , Bosetti Davide Giovanni , Cima Simona , Deantonio Letizia , Leva Stefano , Martucci Francesco , Tettamanti Marino , Pupillo Francesco , Bellesi Luca , Richetti Antonella , Presilla Stefano 
Published: August 2020

Objective: To evaluate the performance of low dose cone beam CT (CBCT) acquisition protocols for image-guided radiotherapy of prostate cancer. Methods: CBCT images of patients undergoing prostate cancer radiotherapy were acquired with the settings currently used in our department and two low dose settings at 50% and 63% lower exposure. Four experienced radiation oncologists and two radiation therapy technologists graded the images on five image quality characteristics. The scores were analysed through Visual Grading Regression, using the acquisition settings and the patient size as covariates. Results: The low dose acquisition settings have no impact on the image quality for patients with body profile length at hip level below 100 cm. Conclusions: A reduction of about 60% of the dose is feasible for patients with size below 100 cm. The visibility of low contrast features can be compromised if using the low dose acquisition settings for patients with hip size above 100 cm. Advances in knowledge: Low dose CBCT acquisition protocols for the pelvis, based on subjective evaluation of patient images.