bluuebunny/crossref_metadata_2025_split huggingface dataset:
Total bone mineral density is inversely associated with stroke: a family osteoporosis cohort study in rural China
Authors: Zhu B , Yang J , Zhou Z , Ling X , Cheng N , Wang Z , Liu L , Huang X , Song Y , Wang B , Qin X , Zalloua P , Xu X P , Yang L , Zhao Z 
Published: December 2020

Summary

Background
The relationship of osteoporosis and stroke is still not fully clarified. Apart from the well-known risk factors for stroke, bone mineral density (BMD) has gained more interest in recent years.

Aim
To further elucidate the relationship between BMD and stroke risk, a prospective cohort study in the Chinese rural population was conducted.

Design
Retrospective analysis of a family osteoporosis cohort.

Methods
Our subjects were selected from an osteoporosis cohort conducted in Anqing, China. All participants underwent a questionnaire assessment, clinical examinations and laboratory assessments. During the follow-up period, the number of people who had a stroke was recorded. Generalized estimating equation regression analysis was performed to determine the significance of the association between BMD and stroke.

Results
A total of 17868 people were included. A two-way interaction test of sex and BMD on stroke was significant (P = 0.002). There was a significant difference in BMD and stroke morbidity in the male group (P = 0.003). When BMD was assessed as quartiles and the lowest quartile was used as reference, a significantly lower risk for stroke was observed in Q2–4. Notably, no significant difference was observed in female participants with adjusted odds ratio (P &gt; 0.05). The P-value for interaction was calculated. The body mass index (P = 0.014) and waist-to-hip ratio (P = 0.027) were found to be significantly associated with BMD and stroke risk in female participants.

Conclusions
In Chinese rural areas, total BMD may negatively correlated with stroke, especially in men.
Frontiers in HER2-positive breast cancer in 2020
Authors: Peddi Parvin F. , Slamon Dennis J. 
Published: December 2020

Purpose of review
The field of HER2-positive breast cancer has seen tremendous advances in the last 2 years with largest number of new drugs in decades. The present review aims to summarize the cutting-edge research of the past 2 years and future directions.

Recent findings
This review will go over four new drugs, three of which have gained FDA approval within the past 18 months, in the treatment of HER2-positive breast cancer. We will go over early and mature clinical data on these therapeutics and ongoing clinical trials further exploring their role in the treatment of patients with advanced HER2-positive breast cancer and HER2 low breast cancer. Will also discuss ongoing trials using immunotherapy and CDK4/6 inhibitors in the advanced HER2-positive setting.

Summary
: The therapies described in this review have quickly become standard of care for patients with HER2-positive breast cancer. Furthermore, they have the potential to change the landscape of breast cancer therapy further to include even patients with HER2 low breast cancer.
Pregnancy and type 1 diabetes: updates on technology and treatment
Authors: Kennedy-Grant Abigail , Golden Lauren 
Published: December 2020

Purpose of review
The goal of this article is to review recent research of technology use, including insulin pumps, continuous glucose monitors, and smartpens, for pregnant women with preexisting type 1 diabetes.

Recent findings
Recent research shows that there may be benefits from technology use in type 1 diabetes pregnancies given the changes in insulin sensitivity throughout the span of pregnancy as well as allowing for more monitoring to allow for sooner titration of insulin doses.

Summary
There may be utility in incorporation of technology during pregnancy with appropriate medical guidance. Additional research would be helpful to further assess the ability of newer automated insulin systems to aid in tight glucose management goals during pregnancy and show value in receiving FDA approval.
Cellular and Molecular Mechanisms of Breast Implant–Associated Anaplastic Large Cell Lymphoma
Authors: DeCoster Ryan C. , Clemens Mark W. , Di Napoli Arianna , Lynch Evan B. , Bonaroti Alisha R. , Rinker Brian D. , Butterfield Timothy A. , Vasconez Henry C. 
Published: December 2020

Summary:
Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is an emerging and highly treatable cancer of the immune system that can form around textured-surface breast implants. Although the underlying cause has yet to be elucidated, an emerging theme—linking pathogenesis to a chronic inflammatory state—continues to dominate the current literature. Specifically, the combination of increasing mutation burden and chronic inflammation leads to aberrant T-cell clonal expansion. However, the impetus remains largely unknown. Proposed mechanisms include a lipopolysaccharide endotoxin response, oncogenic transformation related to viral infection, associated trauma to the breast pocket, particulate matter digestion by capsular macrophages, chronic allergic inflammation, and genetic susceptibility. The Janus kinase–signal transducer and activator of transcription 3 (JAK-STAT3) pathway is a major signaling pathway that regulates a variety of intracellular growth and survival processes. Constitutive activation of JAK-STAT3 has been implicated in several malignancies, including lymphomas, and has recently been identified as a potential key mediator in BIA-ALCL. The purpose of this article is to review the cellular and molecular mechanisms of BIA-ALCL with a focus on the role of oncogenic JAK-STAT3 signaling in BIA-ALCL tumorigenesis and progression. Selected experimental work from the authors’ group on aberrant JAK-STAT3 signaling in BIA-ALCL is also included. The authors discuss how an inflammatory microenvironment may facilitate malignant transformation through the JAK-STAT3 pathway—highlighting its potential mechanistic role. The authors’ hope is that further investigation of this signaling pathway will reveal avenues for using JAK-STAT3 signaling as a prognostic indicator and novel therapeutic target in the case of advanced disease.
Incidence of Cancer and Premalignant Lesions in Surgical Specimens of Transgender Patients
Authors: Jacoby Adam , Rifkin William , Zhao Lee C. , Bluebond-Langner Rachel 
Published: December 2020

Background:
Gender-affirming surgery is becoming increasingly more common. Procedures including chest masculinization, breast augmentation, vaginoplasty, metoidioplasty, and phalloplasty routinely generate discarded tissue. The incidence of finding an occult malignancy or premalignant lesion in specimens from gender-affirming surgery is unknown. The authors therefore conducted a retrospective review of all transgender patients at their institution who underwent gender-affirming surgery to determine the incidence of precancerous and malignant lesions found incidentally.

Methods:
A retrospective review of transgender patients who underwent gender-affirming surgery at the authors’ institution between 2017 and 2018 performed by a single plastic surgeon and a single reconstructive urologic surgeon was conducted. Only transgender patients who underwent gender-affirming surgery that led to routine pathologic review of discarded tissue (mastectomy, vaginoplasty, vaginectomy as part of phalloplasty) were included. Charts were reviewed and patient demographics, duration of hormonal therapy, medical comorbidities, genetic risk factors for cancer, medications (including steroids or other immunosuppressants), pathology reports, and cancer management were recorded.

Results:
Between 2017 and 2018, 295 transgender patients underwent gender-affirming surgery that generated discarded tissue sent for pathologic evaluation. During this period, 193 bilateral mastectomies, 94 vaginoplasties with orchiectomies, and eight vaginectomies were performed; 6.4 percent of all patients had an atypical lesion found on routine pathologic evaluation.

Conclusions:
Gender-affirming surgery is increasingly more common given the increase in access to care. The authors’ review of routine pathologic specimens generated from gender-affirming surgery yielded a 6.4 percent rate of finding atypical lesions requiring further evaluation. The authors advocate that all specimens be sent for pathologic evaluation.
Improving Results in Oncoplastic Surgery
Authors: Losken Albert , Chatterjee Abhishek 
Published: December 2020

Learning Objectives:
After studying this article, the participant should be able to: 1. Describe the risks, benefits, and safety profile of oncoplastic procedures for partial breast reconstruction, and how they compare to breast conservation-therapy alone. 2. Have a working knowledge of oncoplastic techniques and how they are addressed from the multidisciplinary perspective. 3. Understand the limitations of oncoplastic techniques and how to avoid unfavorable results.

Summary:
Oncoplastic surgical techniques have expanded indications for breast conservation and have improved both oncologic and reconstructive outcomes. This article will focus on some of the barriers to adoption and discuss ways to improve safety through streamlining the process, understanding the oncologic concerns, and evaluating unfavorable outcomes that might interfere with the appropriate delivery of breast cancer care.
Low-Cost, Three-Dimensionally–Printed, Anatomical Models for Optimization of Orbital Wall Reconstruction
Authors: Dvoracek Lucas A. , Lee Jonathan Y. , Unadkat Jignesh V. , Lee Yan H. , Thakrar Darshit , Losee Joseph E. , Goldstein Jesse A. 
Published: December 2020

Background:
Orbital blowout fracture reconstruction often requires an implant, which must be shaped at the time of surgical intervention. This process is time-consuming and requires multiple placement trials, possibly risking complications. Three-dimensional printing technology has enabled health care facilities to generate custom anatomical models to which implants can be molded to precisely match orbital anatomy. The authors present their early experience with these models and their use in optimizing orbital fracture fixation.

Methods:
Maxillofacial computed tomographic scans from patients with orbital floor or wall fractures were prospectively obtained and digitally reconstructed. Both injured-side and mirrored unaffected-side models were produced in-house by stereolithography printing technique. Models were used as templates for molding titanium reconstruction plates, and plates were implanted to reconstruct the patients’ orbital walls.

Results:
Nine patients (mean age, 15.5 years) were included. Enophthalmos was present in seven patients preoperatively and resolved in six patients with surgery. All patients had excellent conformation of the implant to the fracture site on postoperative computed tomographic scan. Postoperative fracture-side orbital volumes were significantly less than preoperative, and not significantly different from unfractured-side orbital volumes. Total model preparation time was approximately 10 hours. Materials cost was at most $21. Plate bending time was approximately 60 seconds.

Conclusions:
Patient-specific orbital models can speed the shaping of orbital reconstruction implants and potentially improve surgical correction of orbital fractures. Production of these models with consumer-grade technology confers the same advantages as commercial production at a fraction of the cost and time.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Platelet-Rich Plasma: Evolving Role in Plastic Surgery
Authors: Chamata Edward S. , Bartlett Erica L. , Weir David , Rohrich Rod J. 
Published: December 2020

Background:
The use of platelet-rich plasma has emerged as one of the most desired nonsurgical treatments for facial rejuvenation and hair restoration. It has grown to encompass a wide variety of applications within the field of plastic surgery, including its use in combination with microneedling, laser, and fat-grafting procedures.

Methods:
In this article, the authors aim to (1) describe the preparation process of platelet-rich plasma; (2) discuss the proposed science behind platelet-rich plasma with regard to its evolving role in hair restoration and facial rejuvenation; and (3) highlight the recent literature examining its widespread use.

Results:
Based on the available literature, there is a therapeutic advantage to the use of platelet-rich plasma as a single treatment modality for alopecia and skin rejuvenation and in combination with laser skin treatment and fat grafting. There is, however, a considerable amount of variability in the processing, preparation, and treatment modalities.

Conclusions:
Despite a lack of standardized protocols for platelet-rich plasma preparation and a scarcity of large-scale studies with long-term follow-up, there is convincing evidence with objective measurement modalities that display positive outcomes after treatment for skin rejuvenation, hair regrowth, wound healing, and fat graft take.
Donor-derived Cell-free DNA Combined With Histology Improves Prediction of Estimated Glomerular Filtration Rate Over Time in Kidney Transplant Recipients Compared With Histology Alone
Authors: Huang Edmund , Gillespie Matthew , Ammerman Noriko , Vo Ashley , Lim Kathlyn , Peng Alice , Najjar Reiad , Sethi Supreet , Jordan Stanley C. , Mirocha James , Haas Mark 
Published: December 2020

Background.
Higher Banff inflammation and chronicity scores on kidney transplant biopsies are associated with poorer graft survival, although histology alone has limitations in predicting outcomes. We investigated if integrating donor-derived cell-free DNA (dd-cfDNA, Allosure; CareDx, Inc.) with Banff biopsy scores into a predictive model for estimated glomerular filtration rate over time can improve prognostic assessment versus histology alone.

Methods.
We identified 180 kidney transplant patients with dd-cfDNA assessed within 1 mo of biopsy. Using linear mixed–effects models, a prediction model of Banff histology scores and dd-cfDNA on estimated glomerular filtration rate over time was derived. Nested models were compared using the likelihood-ratio test, Akaike Information Criterion, and Bayesian Information Criterion to assess if inclusion of dd-cfDNA into a model consisting of Banff biopsy scores would improve model fit.

Results.
Univariate models identified significant covariate-by-time interactions for cg = 3 versus <3 (coefficient: −1.3 mL/min/1.73 m2/mo; 95% confidence interval [CI], −2.4 to −0.2; P = 0.02) and ci + ct ≥ 3 versus <3 (coefficient: −0.7 mL/min/1.73 m2/mo; 95% CI, −1.3 to −0.1; P = 0.03) and a trend toward significant covariate-by-time interaction for dd-cfDNA (coefficient: −0.5 mL/min/1.73 m2/mo; 95% CI, −1.0 to 0.1; P = 0.08). Addition of acute inflammation (i, t, and v), microvascular inflammation (g and ptc), and inflammation in area of interstitial fibrosis and tubular atrophy scores to chronicity scores (cg ≥ 3 and ci + ct ≥ 3) did not improve model fit. However, a model including dd-cfDNA with cg and ci + ct with covariate-by-time interactions had a better model fit compared with cg and ci + ct alone (likelihood-ratio test statistic = 21.1; df = 2; P < 0.001).

Conclusions.
Addition of dd-cfDNA to Banff biopsy scores provided better prognostic assessment over biopsy characteristics alone.
Efficacy and safety of TiNO-coated stents versus drug-eluting coronary stents. Systematic literature review and meta-analysis
Authors: Daoud Frederic C. , Létinier Louis , Moore Nicholas , Coste Pierre , Karjalainen Pasi P. 
Published: December 2020

AbstractObjectivesTo compare clinical outcomes after percutaneous coronary intervention (PCI) using titanium-nitride-oxide coated stents (TiNOS) versus drug-eluting stents (DES) in coronary artery disease (CAD) including acute coronary syndrome (ACS).DesignProspective systematic literature (SLR) conducted according to PRISMA. Medline, Embase, Cochrane, Web of Science were searched in March 2018 and updated.SettingInterventional cardiology.ParticipantsPatients with CAD, including ACS, requiring PCI.InterventionsAll prospective randomized controlled trials (RCTs) that compared clinical outcomes after PCI with DES versus TiNOS.Outcome measuresThe pooled risk ratios (RR), TiNOS over DES, with 95% confidence intervals (CI) are computed for device-oriented Major Adverse Cardiac Events (MACE), non-fatal myocardial infarction (MI), cardiac death (CD), clinically driven target lesion revascularization (TLR), probable or definite stent thrombosis (ST), total mortality, at one to five years after PCI. Pooled RRs are stratified according to baseline ACS versus other CAD. Sensitivity analysis (SA) and certainty of the evidence are rated per GRADE.ResultsFive RCTs are eligible with 1,855 patients with TiNOS versus 1,363 with DES at 1-year follow-up and 783 versus 771 at 5-year. Three RCTs included patients with ACS only. One-year RRs in ACS are: MACE 0.93 [0.72, 1.20], MI 0.48 [0.31, 0.73], CD 0.66 [0.33, 1.31], TLR 1.55 [1.10, 2.19] and ST 0.35 [0.20, 0.64]. One-year MACE, MI, and ST are robust to SA. The certainty of the evidence is high in MACE, moderate in MI, and low or very low in the other endpoints. There are too few observations to conclude about other CAD and 5-year outcomes. However, 5-year interim results are consistent with 1-year conclusions.ConclusionsA similar risk of MACE is found in TiNOS and DES, with potentially fewer MI and ST but more TLR in TiNOS. TiNOS are safe and effective in ACS at 1-year follow-up.RegistrationPROSPERO CRD42018090622Strengths and limitations of this study-Strengths:The level of certainty of the evidence is high for the primary endpoint at one-year follow-up in patients treated for acute coronary syndrome.The primary endpoint and critical secondary endpoints are robust to sensitivity analysis.-Limitations:Outcomes in patients treated for chronic coronary artery disease cannot be analyzed.The level of certainty of the evidence of secondary endpoints is moderate or low.Analysis of five-year outcomes is still at an interim stage.
Nothing but hot air? – On the molecular ballistic analysis of backspatter generated by and the hazard potential of blank guns
Authors: Euteneuer Jan , Gosch Annica , Courts Cornelius 
Published: December 2020

AbstractBlank cartridge guns are prevalent especially in countries with laws restricting access to conventional firearms and it is a common misconception that these weapons are harmless and only used as toys or for intimidation. However, although their harming potential is well documented by numerous reports of accidents, suicides, and homicides, a systematic molecular biological investigation of traces generated by shots from blank cartridges at biological targets has not been done so far.Herein, we investigate the occurrence and analyzability of backspatter generated by shots of different types of blank cartridge guns firing different types of blank ammunition at ballistic gelatin model cubes doped with human blood and radiological contrast agent soaked into a spongious matrix and covered with three different variants of skin simulants.All skin simulants were penetrated and backspatter was created in 100% of the shots in amounts sufficient for forensic STR typing that resulted in correct identification of the respective blood donor. Visible backspatter was documented on the muzzle and/or inside the barrel in all cases, and in 75% of cases also on the outer surfaces and on the shooter’s hand(s).Wound cavities were measured and ranged between 1 and 4.5 cm in depth.Discussing our findings, we provide recommendations for finding, recovering and analyzing trace material from blank guns; and presenting a comprehensive overview of the pertinent literature on injuries inflicted by blank guns we emphasize the considerable hazard potential of these devices.
Preventing a cluster from becoming a new wave in settings with zero community COVID-19 cases
Authors: Abeysuriya Romesh G , Delport Dominic , Stuart Robyn M , Sacks-Davis Rachel , Kerr Cliff C , Mistry Dina , Klein Daniel J , Hellard Margaret , Scott Nick 
Published: December 2020

AbstractIn settings with zero community transmission, any new SARS-CoV-2 outbreaks are likely to be the result of random incursions. The level of restrictions in place at the time of the incursion is likely to considerably affect possible outbreak trajectories. We used an agent-based model to investigate the relationship between ongoing restrictions and behavioural factors, and the probability of an incursion causing an outbreak and the resulting growth rate. We applied our model to the state of Victoria, Australia, which has reached zero community transmission as of November 2020.We found that a future incursion has a 45% probability of causing an outbreak (defined as a 7-day average of >5 new cases per day within 60 days) if no restrictions were in place, decreasing to 23% with a mandatory masks policy, density restrictions on venues such as restaurants, and if employees worked from home where possible. A drop in community symptomatic testing rates was associated with up to a 10-percentage point increase in outbreak probability, highlighting the importance of maintaining high testing rates as part of a suppression strategy.Because the chance of an incursion occurring is closely related to border controls, outbreak risk management strategies require an integrated approaching spanning border controls, ongoing restrictions, and plans for response. Each individual restriction or control strategy reduces the risk of an outbreak. They can be traded off against each other, but if too many are removed there is a danger of accumulating an unsafe level of risk. The outbreak probabilities estimated in this study are of particular relevance in assessing the downstream risks associated with increased international travel.
Forecasting trachoma control and identifying transmission-hotspots
Authors: Blumberg Seth , Prada Joaquin M , Tedijanto Christine , Deiner Michael S , Godwin William W. , Emerson Paul M. , Hooper Pamela J , Borlase Anna , Hollingsworth T. Deirdre , Oldenburg Catherine E. , Porco Travis C , Arnold Benjamin F. , Lietman Thomas M ,   Trachoma survey collaborators
Published: December 2020

AbstractBackgroundTremendous progress towards elimination of trachoma as a public health problem has been made. However, there are areas where the clinical indicator of disease, trachomatous inflammation—follicular (TF), remains prevalent. We quantify the progress that has been made, and forecast how TF prevalence will evolve with current interventions. We also determine the probability that a district is a transmission-hotspot based on its TF prevalence (i.e. reproduction number greater than one).MethodsData on trachoma prevalence comes from the GET2020 global repository organized by the World Health Organization and the International Trachoma Initiative. Forecasts of TF prevalence and the percent of districts achieving local control is achieved by regressing the coefficients of a fitted exponential distribution for the year-by-year distribution of TF prevalence. The probability of a district being a transmission-hotspot is extrapolated from the residuals of the regression.ResultsForecasts suggest that with current interventions, 96.5% of surveyed districts will have TF prevalence among children aged 1-9 years <5% by 2030 (95% CI: 86.6-100.0%). Districts with TF prevalence < 20% appear unlikely to be transmission-hotspots. However, a district having TF prevalence of over 28% in 2016-2019 corresponds to at least 50% probability of being a transmission-hotspot.ConclusionsSustainable control of trachoma appears achievable. However there are transmission-hotspots that are not responding to annual mass drug administration of azithromycin and require enhanced treatment in order to reach local control