bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasonographic assessment of right heart intracardiac mass in patients with hepatitis B virus infection
Authors: Su Chunling , Jin Chunna , Han Jing , Hu Xing , Shi Dongli , Meng Fankun 
Published: November 2019

Objective:
The characteristics of right heart intracardiac mass in hepatitis B virus infection patients are not well known. Our aim is to describe their ultrasonographic features and nature of such masses.

Methods:
We retrospectively reviewed imaging reports of hepatitis B virus infection patients from January 2014 to December 2018. Patients with a confirmed finding of right heart intracardiac mass were included, whose pathology reports and contrast-enhanced images were analyzed. Various masses were compared to a general control group from a published study.

Results:
Thirty-eight cases were finally included. Different types of masses presented with a variety of echocardiographic manifestations. Thirty-six cases had masses located in the right atrium, including five thrombus and 31 metastatic carcinoma. The later included one metastatic non-Hodgkin lymphoma and 30 metastatic hepatic carcinoma cases (27 of which had inferior vena cava tumor thrombus). Two cases presented with masses in the right ventricle that included one multiple myxoma and one tricuspid valve leaflet vegetation. Compared with the general population, no primary malignant tumor was found in our study (65% vs. 100%, P = 0.001), and hepatic metastasis was the most common type of malignant tumors (P < 0.001).

Conclusion:
The nature and ultrasonographic features of right heart intracardiac masses in hepatitis B virus infection patients are diverse, and the incidence of malignant tumors was similar to that seen in the general population. Hepatic metastasis, possibly extending via the inferior vena cava into the right atrium, was the most common type. Our study may improve understanding of the right heart intracardiac mass in hepatitis B virus infection patients.
Clostridium difficile caused changes in fatty acids profile and resolvin D1 content in plasma of infected patients
Authors: Dróżdż Mirosław , Gdula-Argasińska Joanna , Biesiada Grażyna , Jurczyszyn Artur , Perucki William , Wołkow Paweł , Borys Agnieszka , Sroczyńska Katarzyna , Zając Anna , Librowski Tadeusz , Garlicki Aleksander , Czepiel Jacek 
Published: November 2019

Objectives

Clostridium difficile infection (CDI) is an acute gastrointestinal infection caused by anaerobic, toxin-producing bacteria. During the course of CDI, there is a general inflammatory state. In order to gain a deeper understanding of the role of fatty acids (FAs) in the pathogenesis of acute infection we analyzed their plasma content in both patients with CDI and controls.

Methods
The study groups included 40 patients with CDI and 40 healthy volunteers. Plasma FA content was analyzed by gas chromatography, resolvin D1 (RvD1) level using ELISA assay, and we assessed the white blood cell (WBC) count, neutrophil count and C-reactive protein (CRP) level.

Results
Patients with CDI were characterized by significantly higher values of WBC, neutrophils, platelets and CRP compared with the control group. The saturated FA index was statistically higher and total n-3 FA was significantly decreased in the plasma of CDI patients as compared with the control group. RvD1 content was significantly higher in the control group as compared with patients with CDI.

Conclusion
In patients with good outcomes, we probably observed the effective resolution of inflammation, as reflected in n-3 FA metabolism and their significant decrease in plasma. This may indicate the therapeutic role of n-3 FA in CDI infection.
Parental involvement in the manual reduction of pulled elbow in children
Authors: Cho Wonjin , Lee Seung Chul , Lee Jeong Hun , Seo Jun Seok , Do Han Ho , Kim Yong Won , Lee Sanghun 
Published: November 2019

Objective
To investigate the effect of parental involvement in the manual reduction of pulled elbow in children.

Methods
We conducted a prospective case-control study from January to December 2018. The patients were under 6 years old with suspected radial head subluxation and were randomly assigned to two groups (an intervention group with a physician’s and a parent’s finger placed on the patient’s radial head and a control group with the physician’s finger only placed on the patient’s radial head) according to the method of reduction. The results of a questionnaire given to the parent and physician were analyzed.

Results
A total of 150 patients were included in the study: 75 in the intervention group and 75 in the control group. There were no significant differences between the groups. The average number of attempts at manual reduction was 1.29 ± 0.73 in the intervention group and 1.31 ± 0.72 in the control group (P = 0.91) and the success rate of manual reduction was 96.0 and 94.7% (P = 0.70), respectively. The ease of conducting the procedure by the doctors did not show a significant difference between the two groups. However, the parents’ understanding and satisfaction was significantly higher in the intervention group.

Conclusion
Parental involvement did not affect the procedure of physician, but it improved the understanding and satisfaction of the parents.
Diagnostic performance of prehospital ultrasound diagnosis for traumatic pneumothorax by a UK Helicopter Emergency Medical Service
Authors: Oliver Prudence , Bannister Peter , Bootland Duncan , Lyon Richard M. 
Published: November 2019

Objective
Up to 20% of major trauma patients may sustain a pneumothorax. Traumatic pneumothoraces can be difficult to diagnose on scene. Although the use of handheld ultrasound (HHUS) is becoming increasingly widespread, there remains uncertainty about its efficacy as a diagnostic tool in the prehospital setting. The aim of this study was to determine the diagnostic performance of prehospital chest HHUS in trauma patients.

Method
Retrospective review of trauma patients who received a prehospital chest HHUS and subsequently conveyed to the Royal Sussex County Hospital (RSCH) between 1 July 2013 and 24 September 2018. Data including patient age, sex, mechanism of injury and clinical interventions were obtained. Prehospital ultrasound findings were compared with the computer tomography (CT) scan performed on arrival at the hospital.

Results
Four hundred eleven patients were conveyed to RSCH, the single largest group being following road traffic collisions. The majority of HHUS (66%) were performed by doctors. Three hundred sixty-one patients (88%) subsequently had a CT scan. Of these, 98 patients (27%) were found to have pneumothoraces. For pneumothorax diagnosis, prehospital HHUS had a sensitivity of 28% [95% confidence interval (CI): 19–37%] and specificity of 98% [95% CI: 97–99%].

Conclusion
In this retrospective study, sensitivity of prehospital HHUS for diagnosing a pneumothorax was lower than is often reported in in-hospital studies. This suggests that caution should be exercised in using HHUS for the exclusion of pneumothorax in the prehospital setting.
In primary lymph nodal staging of patients with high-risk and intermediate-risk prostate cancer, how critical is the role of Gallium-68 prostate-specific membrane antigen positron emission tomography-computed tomography?
Authors: Kulkarni Smita Chinmay , Sundaram Palaniswamy Shanmuga , Padma Subramanyam 
Published: November 2019

Objective
To assess the diagnostic performance of Gallium-68 prostate-specific membrane antigen positron emission tomography-computed tomography (68Ga-PSMA PET-CT) in primary lymphnodal staging of patients with intermediate-risk and high-risk prostate cancer and to compare it with multiparametric MRI (mp-MRI) whenever available.

Materials and methods

68Ga-PSMA PET-CT scans of 51 patients (average age 66.0 ± 7.0 years) with biopsy-proven intermediate-risk and high-risk prostatic cancer who were managed by radical prostatectomy and extended pelvic lymph nodal dissection were retrospectively analyzed. Diagnostic performance of 68Ga-PSMA PET-CT in primary lymph nodal staging was analyzed using histopathology as reference. Diagnostic performance of mp-MRI, which was available in 35/51 patients was compared with that of 68Ga-PSMA PET-CT.

Results
Univariate analysis of patient characteristics showed significant influence of the pathological T-stage and maximum standard uptake value (SUV)max of the primary lesion on presence of nodal metastasis. In 51 patients, for patient-based analysis, the sensitivity, specificity and accuracy of 68Ga-PSMA PET-CT in detecting lymphnodal metastases were 80, 90.3 and 86.3%, respectively, and for lesion-based analysis 69.2, 99.6 and 98.4%, respectively. In 35/51 patients (who also had undergone mp-MRI), the patient-based and lesion-based sensitivity, specificity, and accuracy of 68Ga-PSMA PET-CT were 81.3, 84.2, 82.8% and 70.9, 99.5, 98.2%, respectively, and that of mp-MRI were 43.7, 78.9, 62.8% and 32.2, 98.5, 95.5%, respectively. For lesion-based analysis, 68Ga-PSMA PET-CT performed better than mp-MRI (P value = 0.04).

Conclusion

68Ga-PSMA PET-CT allows accurate detection of lymphnodal metastases in patients with intermediate-risk and high-risk prostate cancer prior to definitive surgical treatment. It performed better than mp-MRI in a subset of patients.
Osgood–Schlatter disease: a 2020 update of a common knee condition in children
Authors: Ladenhauf Hannah N. , Seitlinger Gerd , Green Daniel W. 
Published: November 2019

Purpose of review
Osgood–Schlatter disease (OSD) is one of the most common causes for anterior knee pain in children and adolescents resulting from a traction apophysitis of the tibial tubercle. While a peak in boys aged 12–15 years old was well documented, there seems to be no difference in sex distribution nowadays. This may result from increased participation of young females in high-impact sports. This review provides an up-to-date account on contemporary prophylaxis as well as diagnostic and therapeutic approaches.

Recent findings
Numerous studies have examined risk factors for OSD. These include body weight, muscle tightness, muscle weakness during knee extension and flexibility of hamstring muscles. In particular, shortening of the rectus femoris may substantially alter biomechanical functions of the knee. Conservative management remains successful in over 90% of patients. However, if disabling symptoms and pain persistent after physeal closure, operative treatment may be necessary.

Summary
OSD is a mostly self-limiting apophysitis of the tibial tubercle and the adjacent patella tendon in young active patients with open physis. Prevention strategies include quadriceps and hamstring stretching and therefore should be implemented in everyday practice routines for children who partake in regular sports activities.
Ruptured Esophageal Varices From Metastatic Tumor in the Liver
Authors: Mathew Suneeth , Kesha Kilak , Stables Simon , Morrow Paul , Glenn Charley , Tse Rexson 
Published: November 2019

Abstract
Ruptured esophageal varices can present as sudden death from gastrointestinal hemorrhage. The most common underlying pathology causing esophageal varices is cirrhosis leading to portal hypertension. However, not all esophageal varices arise from portal hypertension, and not all portal hypertensions are caused by cirrhosis. We present a rare case of ruptured esophageal varices casing death in an individual with metastatic tumor (high-grade) neuroendocrine tumor in the liver causing portal hypertension. This is, to the best of our knowledge, the first case report in the literature reporting a neuroendocrine tumor causing esophageal varices. This case report aims to document this rather rare entity, highlight another mechanism on how metastatic disease can result in sudden death, and give a brief review of literature on metastatic tumor in the liver causing esophageal varices.
Validity and Reliability of the Brazilian Portuguese Version of the Pediatric Confusion Assessment Method for the ICU
Authors: de Castro Roberta Esteves Vieira , Prata-Barbosa Arnaldo , de Magalhães-Barbosa Maria Clara , Cunha Antônio J. L. A. da , Cheniaux Elie , Smith Heidi A. B. 
Published: November 2019

Objectives:
To determine the validity and reliability of the Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU for diagnosing delirium in patients with chronological and developmental ages from 5 to 17 years in Brazilian PICUs.

Design:
Prospective, cross-sectional study.

Settings:
Eight Brazilian PICUs (seven in Rio de Janeiro and one in São Paulo).

Patients:
One-hundred sixteen patients, 5–17 years old, without developmental delay, submitted to mechanical ventilation or not.

Interventions:
To assess the inter-observer reliability, two previously trained researchers concomitantly applied the Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU and independently rated the same patient. To assess the criterion validity, a pediatric neurologist or psychiatrist, blinded to the Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU assessments, evaluated the same patient within 30 minutes, using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, considered the reference standard.

Measurements and Main Results:
One-hundred forty-nine paired assessments were included (some patients had more than one). Delirium was diagnosed in 11 of 149 assessments (7%), or eight of 116 patients (7%), using both the Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. There was one false positive and one false negative diagnosis, which resulted in 90.9% sensitivity (95% CI, 58.7–99.8%) and 99.3% specificity (95% CI, 96–100%) for the Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU. The inter-rater reliability was considered almost perfect (κ = 1.0).

Conclusions:
The Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU is a valid and reliable tool for diagnosing delirium in pediatric patients 5–17 years old who are spontaneously breathing and not pharmacologically sedated in Brazilian PICUs. The implementation of this tool may be useful to reduce underdiagnosis, ensure monitoring and earlier intervention, provide a better prognosis, and improve research on delirium in this age group in Brazil. Further studies are necessary to test the psychometric properties of the Brazilian Portuguese version of the Pediatric Confusion Assessment Method for the ICU in sedated and mechanically ventilated children.
Diverging trends in incidence of HIV versus other sexually transmitted infections in HIV-negative MSM in Amsterdam
Authors: van Bilsen Ward P.H. , Boyd Anders , van der Loeff Maarten F.S. , Davidovich Udi , Hogewoning Arjan , van der Hoek Lia , Prins Maria , Matser Amy 
Published: November 2019

Objectives:
We investigated changes in incidence rates of HIV and sexually transmitted infections (STIs) and trends in sexual behavior in MSM from 2009 to 2017.

Design:
Open prospective cohort study.

Methods:
HIV-negative MSM enrolled in the Amsterdam Cohort Studies were included. Participants semiannually completed a questionnaire on sexual behavior and were tested for HIV-1, syphilis, and urethral, anal and pharyngeal chlamydia and gonorrhea. Time trends in incidence rates were analyzed using exponential survival models.

Results:
During follow-up, 42 of 905 MSM acquired HIV. The HIV incidence rate was 1.9/100 person-years [95% confidence interval (CI) 1.0–3.7] in 2009 and decreased to 0.5/100 person-years (95% CI 0.2–1.4) in 2017 (P = 0.03). The largest decrease was observed in participants aged at least 35 years (P = 0.005), while the trend remained stable in 18–34 year olds (P = 0.4). The incidence rate for any bacterial STI was 16.8/100 person-years (95% CI 13.4–21.0) in 2010, and increased to 33.1/100 person-years (95% CI 29.0–37.9) in 2017 (P < 0.001). Between 2009 and 2017, the percentage reporting condomless anal sex with casual partners increased from 26.9 to 39.4% (P < 0.001), and the mean number of casual partners from eight (95% CI 8–8) to 11 (95% CI 10–11) (P = 0.05). Condomless anal sex with steady partner(s) remained stable over time (P = 0.5).

Conclusion:
Among MSM in Amsterdam, incidence rates of HIV versus other STI show diverging trends. The increase in STI incidence coincides with a decrease in condom use with casual partners. The decrease in HIV incidence, despite increased sexual risk behavior, suggests that other HIV prevention methods have been successful in reducing HIV transmission among MSM.
Association between quality-of-care indicators for HIV infection and healthcare resource utilization and costs
Authors: Nduaguba Sabina O. , Barner Jamie C. , Ford Kentya H. , Lawson Kenneth A. , Barnes James N. , Wilson James P. 
Published: November 2019

Objectives:
Multiple care quality indicators for HIV infection exist but few studies examine their impact on health outcomes. This study assessed which HIV care quality indicators were associated with healthcare resource utilization and costs.

Design:
Retrospective analysis of Texas Medicaid claims data (01 January 2012 to 31 September 2016).

Methods:
Included patients had at least two HIV-related medical claims during the identification period (01 July 2012 to 31 August 2014) (index = date of first HIV claim), were 18–62 years at index, and were continuously enrolled in the 6-month pre-index and 1-year post-index periods. Dependent variables included emergency department (ED) visits, inpatient hospitalizations, prescription count, and all-cause healthcare costs. Independent variables included CD4+ cell count monitoring, syphilis, chlamydia, gonorrhea, hepatitis B, hepatitis C, and tuberculosis screenings, influenza and pneumococcal vaccinations, retention in care, and HAART initiation. Covariates included age, chronic hepatitis C virus infection, AIDS diagnosis, sex, and baseline healthcare cost. The study objective was addressed using generalized linear modeling.

Results:
CD4+ cell count monitoring and HAART initiation were significantly associated with reduced emergency department visits (P < 0.0001 for each). Influenza vaccination was significantly associated with reduced inpatient hospitalization (P < 0.0001). CD4+ cell count monitoring (P < 0.0001), TB screening (P = 0.0006), influenza vaccination (P < 0.0001), and HAART initiation (P < 0.0001) were significantly associated with increase prescription claims. CD4+ cell count monitoring, TB screening, and HAART initiation (P < 0.0001 for each) were significantly associated with all-cause healthcare costs.

Conclusion:
HAART may reduce use of emergency care services as early as 1 year following initiation.
Potential health gains in West and Central Africa through savings from lower cost HIV treatment
Authors: Stuart Robyn M. , Kelly Sherrie L. , Martin-Hughes Rowan , Wilson David P. 
Published: November 2019

Objective: :
Prices of antiretroviral (ARV) drugs in lower income countries have decreased substantially over the past two decades, helping to facilitate greatly expanded access to antiretroviral therapy (ART). However, ART coverage in many parts of the world remains low. We investigate the extent of epidemiological benefits that might be expected if ARV drug prices decline further.

Design:
A modeling study using data from seven countries in West and Central Africa (Cameroon, Democratic Republic of the Congo, Côte d’Ivoire, Niger, Nigeria, Senegal, and Togo).

Methods:
We investigated how the timing of ARV cost reductions could affect the impact and compared three different possible investment strategies: reinvesting in ART, reinvesting in the HIV response according to historical allocations, and reinvesting with the aim of minimizing HIV incidence and mortality.

Results:
If ARV drug prices fell by 37% relative to 2018 levels (i.e. following continued trend declines), we calculate ART unit costs could decrease by ∼20% (holding other cost components constant). If this could be achieved by 2020 and the savings were reinvested into ART, we estimate that an additional 8% of HIV infections and 11% of HIV-related deaths could be averted over 2020–2030 across the seven countries. Slightly greater gains could be attained if funds were reinvested in ART in combination with primary prevention. Delays in the year of introduction of ARV price reductions would reduce the impact by about 1% per year.

Conclusion:
ARV price reductions could free up funds that – if strategically invested – would help countries move closer toward the elimination of HIV.
Immune effects of Lactobacillus casei Shirota in treated HIV-infected patients with poor CD4+ T-cell recovery
Authors: Tenore Simone de Barros , Avelino-Silva Vivian Iida , Costa Priscilla Ramos , Franco Lucas M. , Sabino Ester Cerdeira , Kalil Jorge , Cerqueira Natalia Barros , Nakagawa Zelinda , Kallas Esper Georges 
Published: November 2019

Background:
HIV infection leads to depletion of intestinal CD4+ T cells, mucosal barrier dysfunction, increased gut permeability and microbial translocation even among patients on suppressive ART. Previous studies suggest probiotics may help restore intestinal function.

Methods:
In this double-blind, placebo-controlled pilot study, we enrolled HIV-infected patients on suppressive ART with poor CD4+ recovery to address the effect of daily oral use of Lactobacillus casei Shirota (LcS) on CD4+ T-cell count and CD4+/CD8+ ratio at 6 and 12 weeks after treatment initiation; immune activation and intestinal microbiome composition were addressed as secondary outcomes.

Results:
From January 2015 to July 2016, 48 patients were randomized (1 : 1) to active intervention or placebo. Groups had comparable demographic and clinical characteristics; only CD4+ T-cell nadir was statistically different between groups. All participants were virologically suppressed under ART. At week 6, the increment in CD4+ T-cell count was 17 cells/μl [interquartile range (IQR) −33 to 74] in the active intervention arm and 4 cells/μl (IQR −43 to 51) in the placebo arm (P = 0.291); at week 12, the change in CD4+ T-cell count was 8 cells//μl (IQR −30 to 70) in the active arm and 10 cells//μl (IQR −50 to 33) among participants allocated to placebo (P = 0.495). Median change in CD4+/CD8+ ratio at week 6 compared with baseline was 0 (IQR −0.04 to 0.05) in the active intervention arm and −0.01 in the placebo arm (IQR −0.06 to 0.03; P = 0.671). At week 12, the change in CD4+/CD8+ ratio was higher in the active product group compared with placebo (respectively 0.07 and 0.01), but this difference failed to reach statistical significance (P = 0.171). We found no significant effects of LcS on immune activation markers, CD4+ and CD8+ subpopulations, sCD14 levels or NK cells at week 12. Finally, we found no statistically significant differences between groups in the change of enteric microbiome at week 12.

Conclusion:
In this pilot study, we found no statistically significant effect of LcS probiotic on CD4+ T-cell counts, CD4+/CD8+ ratio, immune activation or intestinal microbiome among HIV-infected patients on suppressive ART with poor CD4+ recovery.