bluuebunny/crossref_metadata_2025_split huggingface dataset:
Human Papillomavirus Genotypes in Anal High-Grade Squamous Intraepithelial Lesion (HSIL): Anal Intraepithelial Neoplasia Grades 2 (AIN2) and 3 (AIN3) Are Different
Authors: Roberts Jennifer M. , Poynten Isobel M. , Molano Monica , Machalek Dorothy A. , Hillman Richard J. , Guzman Patricia , Jin Fengyi , Templeton David J. , Fairley Christopher K. , Law Carmella , Garland Suzanne M. , Grulich Andrew E. , Cornall Alyssa M. 
Published: July 2020

Abstract

Background:
Anal high-grade squamous intraepithelial lesion (HSIL) can be histomorphologically categorized into anal intraepithelial neoplasia (AIN) grade 2 (AIN2) and grade 3 (AIN3). Different risk factors for these two categories have been described. We investigated whether there were also differences in lesion-specific human papillomavirus (HPV) genotypes.

Methods:
The Study of the Prevention of Anal Cancer (SPANC) recruited 617 gay and bisexual men (GBM); 36% of participants were HIV positive. At baseline, 196 men (31.8%) had histologic HSIL lesions. Tissue was available for genotyping in 171, with a total of 239 HSIL lesions (183 AIN3 and 56 AIN2). Using laser capture microdissection, each lesion revealed a maximum of one genotype.

Results:
High-risk HPV (HR-HPV) genotypes were found in 220 (92.1%) HSIL lesions, with no significant difference between AIN3 (93.4%) and AIN2 (87.5%). AIN3 lesions had significantly more HPV16 (42.1%) than AIN2 lesions (12.5%; P &lt; 0.001) and AIN2 lesions had significantly more non-16 HR-HPV types (75.0%) than AIN3 lesions (51.4%; P = 0.002). These associations were similar for HIV-negative men with HPV16 in 51.1% AIN3 and 18.2% AIN2 (P = 0.001) and non-16 HR-HPV in 40.0% AIN3 and 75.8% AIN2 (P &lt; 0.001). For HIV-positive men, HPV16 remained more frequently detected in AIN3 (33.3% vs. 4.4% for AIN2; P = 0.004), but there was no difference between AIN3 and AIN2 for non-16 HR-HPV (62.4% vs. 73.9%; P = 0.300).

Conclusions:
As HPV16 has the strongest link with anal cancer, the subcategorization of HSIL may enable stratification of lesions for anal cancer risk and guide anal HSIL management.

Impact:
Stratification of anal cancer risk by histologic HSIL grade.
The Impact of Anticoagulation on Trauma Outcomes
Authors: Nguyen Rosalynn K. , Rizor James H. , Damiani Michael P. , Powers Andrew J. , Fagnani Jacob T. , Monie Daphne L. , Cooper Shelby S. , Griffiths Andrew D. , Hellenthal Nicholas J. 
Published: July 2020

Background Increased prevalence of patients on anticoagulants and the advent of new therapies raise concern over how these patients fare if they sustain a traumatic injury. We investigated the role of prehospitalization anticoagulation therapy in trauma-related mortality and postacute disposition. Methods A retrospective analysis was performed on patients who sustained traumatic injury identified in the 2017 National Trauma Data Bank (NTDB). Patients with and without anticoagulation therapy were analyzed to identify differences in demographics, injury type, Injury Severity Score (ISS), and trauma outcomes including hospital length of stay, ER, final hospital disposition, and mortality. Logistic regression was used to correlate anticoagulation to mortality and facility discharge. Results Of the 1 000 596 patients included, 73 602 (7%) patients were on anticoagulants at the time of their trauma. Increased age was the strongest predictor for anticoagulation therapy (odds ratio 5.54, 95% CI 5.44-5.63), but being female and white were also independent predictors of anticoagulation ( P < .001). Patients on anticoagulants had a significantly longer length of stay (5.11 days; 95% CI 5.06-5.15) than those who were not (4.37 days, 95% CI 4.36-4.39), were 2.20 times more likely to die (95% CI 2.12-2.28, P < .001), and were 2.77 times more likely to be discharged to a facility (95% CI 2.73-2.81, P < .001). Anticoagulation remained a significant predictor of worse trauma outcomes even when accounting for age and ISS in multivariate analysis. Discussion Anticoagulation preceding trauma-related admission is associated with higher mortality and an increased likelihood of the need for a posthospital care facility.
End-of-life care for homeless people in shelter-based nursing care settings: A retrospective record study
Authors: van Dongen Sophie I , Klop Hanna T , Onwuteaka-Philipsen Bregje D , de Veer Anke JE , Slockers Marcel T , van Laere Igor R , van der Heide Agnes , Rietjens Judith AC 
Published: July 2020

Background: Homeless people experience multiple health problems and early mortality. In the Netherlands, they can get shelter-based end-of-life care, but shelters are predominantly focused on temporary accommodation and recovery. Aim: To examine the characteristics of homeless people who reside at the end-of-life in shelter-based nursing care settings and the challenges in the end-of-life care provided to them. Design: A retrospective record study using both quantitative and qualitative analysis methods. Setting/participants: Two Dutch shelter-based nursing care settings. We included 61 homeless patients who died between 2009 and 2016. Results: Most patients had somatic (98%), psychiatric (84%) and addiction problems (90%). For 75% of the patients, the end of life was recognised and documented; this occurred 0–1253 days before death. For 26%, a palliative care team was consulted in the year before death. In the three months before death, 45% had at least three transitions, mainly to hospitals. Sixty-five percent of the patients died in the shelter, 27% in a hospital and 3% in a hospice. A quarter of all patients were known to have died alone. Documented care difficulties concerned continuity of care, social and environmental safety, patient–professional communication and medical-pharmacological alleviation of suffering. Conclusions: End-of-life care for homeless persons residing in shelter-based nursing care settings is characterised and challenged by comorbidities, uncertain prognoses, complicated social circumstances and many transitions to other settings. Multilevel end-of-life care improvements, including increased interdisciplinary collaboration, are needed to reduce transitions and suffering of this vulnerable population at the end of life.
The value of the apparent diffusion coefficient in differentiating type II from type I endometrial carcinoma
Authors: Chen Jingya , Fan Weimin , Gu Hailei , Wang Yaohui , Liu Yuting , Chen Xiao , Ren Shuai , Wang Zhongqiu 
Published: July 2020

Background Diagnostic type II endometrial carcinoma (EC) is considered more aggressive and has a poorer prognosis than type I EC; differentiation between them is helpful for preoperative clinical decision-making. However, the diagnostic value of the apparent diffusion coefficient (ADC) in differentiating them remains unclear. Purpose To investigate the value of ADC in differentiating type II EC from type I EC. Material and Methods Ninety-four patients with EC who underwent diffusion-weighted imaging (DWI) were retrospectively included and divided into type I and type II subgroups, based on the postoperative pathologic results. We analyzed the clinical characteristics, conventional magnetic resonance imaging manifestations, and ADC mean values (ADCmean), ADC minimum values (ADCmin), and ADC max values (ADCmax). Receiver operating characteristic (ROC) curve analysis was further used to assess the predictive performance. Results The ADCmean, ADCmin, and tumor size differed significantly between the two subtypes. The area under the ROC curve (AUC) for ADCmean and ADCmin was 0.787 (95% confidence interval [CI] = 0.692–0.88) and 0.835 (95% CI = 0.751–0.919) for predicting type II EC, respectively. The optimal cut-off value of ADCmean for prediction was 0.757 × 10–3 mm2/s with a sensitivity of 91%, a specificity of 58%, and an accuracy of 74%, while for ADCmin was 0.637 × 10–3 mm2/s with a sensitivity of 82%, a specificity of 73%, and an accuracy of 75%. Conclusion EC with lower ADCmean and ADCmin values derived from DWI, and a larger size, are indicative of type II EC.
Predictors of ISUP score upgrade in patients with low-risk prostate cancer
Authors: Haberal Hakan Bahadir , Artykov Meylis , Hazir Berk , Citamak Burak , Altan Mesut , Yazici Sertac , Akdogan Bulent , Ozen Haluk 
Published: July 2020

Introduction: The literature contains few studies that focus on the relationship between International Society of Urological Pathology (ISUP) score upgrade and complete blood count (CBC) parameters for patients with low-risk prostate cancer and studies achieved inconclusive results. Methods: We retrospectively analyzed our institutional database for patients with prostate cancer who underwent radical prostatectomy (RP) between 1994 and 2017. In total, we included 633 patients with low-risk prostate cancer in the study. We investigated the effects of clinicopathologic factors on ISUP score upgrade. Moreover, we compared RP pathologic outcomes between the patients with and without ISUP score upgrade. Results: The mean age and follow-up periods were 61.09±6.61 years and 41.9±1.8 months, respectively. ISUP score upgrade was observed in 207 patients (32.7%). In multivariate analysis, high prostate-specific antigen (PSA) density and percentage of positive cores were found to be significantly associated with ISUP score upgrade ( p = 0.003 and p = 0.003, respectively). The neutrophil–lymphocyte ratio, platelet–lymphocyte ratio, monocyte–lymphocyte ratio, and eosinophil–lymphocyte ratio were found to have no effect on ISUP score upgrade ( p = 0.856, p = 0.353, p = 0.128, and p = 0.074, respectively). The percentage of tumors, surgical margin positivity, seminal vesicle invasion rate, and extraprostatic extension rate in RP pathology were higher in patients with ISUP score upgrade ( p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). Conclusions: Approximately one-third of the patients in our series had ISUP score upgrade in RP pathology. PSA density and the percentage of positive cores were found to be the factors significantly associated with ISUP score upgrade. CBC-related factors had no effect on ISUP score upgrade.
Is transcatheter arterial chemoembolization plus sorafenib better than chemoembolization plus placebo in the treatment of hepatocellular carcinoma?
Authors: Xie Yong , Tian Huan , Xiang Hua 
Published: July 2020

Objective: To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) plus sorafenib compared with TACE plus placebo for hepatocellular carcinoma (HCC) using meta-analytical techniques. Methods: A search of PubMed, EMBASE, and Cochrane Library databases were done from inception to December 27, 2019. Published trials including a treatment group receiving TACE + sorafenib and a control group receiving TACE + placebo with data for at least 1-year survival or tumor response or time to progression were included. Results: Our study suggested that there was no evidence that TACE plus sorafenib was associated with a lower risk of disease progression compared with TACE plus placebo for treatment of HCC (hazard ratio 0.94 [95% confidence interval (CI), 0.84–1.05]), and no significant difference for treatment of HCC compared with TACE plus placebo in terms of 0.5-, 1-, 1.5-, and 2-year survival rates (risk ratio [RR] 1.01 [95% CI, 0.97–1.05]; RR 1.00 [95% CI, 0.92–1.08], RR 1.04 [95% CI, 0.89–1.23], RR 0.98 [95% CI, 0.72–1.34], respectively). The meta-analysis also showed that TACE + sorafenib seemed to have no significant difference for treatment of HCC compared with TACE + placebo in terms of complete response, partial response, stable disease, progressive disease, overall response rate, and disease control rate. There was an increased incidence of fatigue of grade 3/4 and elevation of aspartate aminotransferase and alanine aminotransferase of grade 3/4 in patients receiving TACE plus sorafenib compared with those receiving TACE plus placebo. Conclusions: There is no additive benefit of TACE plus sorafenib compared to TACE plus placebo for HCC.
Neurofilament light chain as biomarker in idiopathic intracranial hypertension
Authors: Beier Dagmar , Korsbæk Johanne Juhl , Madsen Jonna Skov , Olsen Dorte Aalund , Molander Laleh Dehghani , Hagen Snorre M , Teunissen Charlotte , Beier Christoph P , Jensen Rigmor Højland 
Published: July 2020

Background Damage of the optic nerve is the major complication of idiopathic intracranial hypertension. A biomarker indicative for optic nerve damage would help identifying high-risk patients requiring surgical procedures. Here, we studied the potential of cerebrospinal fluid neurofilament to predict idiopathic intracranial hypertension-induced optic nerve damage. Methods In two centers, serum and cerebrospinal fluid of 61 patients with clinically suspected idiopathic intracranial hypertension were prospectively collected. Neurofilament concentrations were measured and related to ophthalmological assessment. Results The average cerebrospinal fluid neurofilament concentration in patients with moderate and severe papilledema was increased compared to patients with minor and no papilledema (1755 ± 3507 pg/ml vs. 244 ± 102 pg/ml; p < 0.001). Cerebrospinal fluid neurofilament concentrations correlated with the maximal lumbar puncture opening pressure (r = 0.67, p < 0.001). In patients fulfilling the Friedman criteria for idiopathic intracranial hypertension with or without papilledema (n = 35), development of bilateral visual field defects and bilateral atrophy of the optic nerve were associated with increased average age-adjusted cerebrospinal fluid neurofilament concentrations. At last follow-up (n = 30), 8/13 of patients with increased, but only 3/17 with normal, cerebrospinal fluid neurofilament had developed bilateral visual field defects and/or bilateral optic nerve atrophy resulting in a sensitivity of 72.7% and a specificity of 73.7% of cerebrospinal fluid neurofilament to detect permanent optic nerve damage. Conclusions Cerebrospinal fluid neurofilament is a putative biomarker for optical nerve damage in idiopathic intracranial hypertension.
Repeat Head CT for Neurologically Stable Patients With Mild Traumatic Subarachnoid Hemorrhage During Interfacility Transfer and Follow-Up Does Not Alter Patient Care
Authors: Pillenahalli Maheshwarappa Ravishankar , Valand Hardik A. , Locke Thomas , Soni Neetu , Bathla Girish 
Published: July 2020

Purpose: To evaluate the impact of repeat head computed tomography (CT) during (1) interfacility transfer and (2) inpatient and/or outpatient follow-up on management, cost-effectiveness, and radiation dose in neurologically stable patients with mild traumatic subarachnoid hemorrhage (tSAH). Material and Methods: This is a single-center retrospective study evaluating patients with mild tSAH presenting between January 2017 and July 2019. A total of 101 and 140 patients met the eligibility criteria for the first and second subgroups, respectively. Common inclusion criteria were isolated mild tSAH, Glasgow Coma Scale between 13 and 15, and neurological stability. Additional inclusion criteria for the first subgroup were availability of brain imaging at the outside institution prior to transfer and the second subgroup was the availability of follow-up imaging. Results: In the first subgroup, 76.20% of patients had stable SAH, 18.80% had reduced SAH, while 5% had an interval increase in SAH. None required any surgical intervention. Additional per-patient mean radiation exposure was 1.77 ± 0.26 mSv. In the second subgroup, all 140 patients had complete resolution of tSAH. One patient had a new tiny subdural hemorrhage, which subsequently resolved on follow-up. The additional mean radiation exposure was 2.47 ± 1.29 mSv. A total of 256 avoidable CT scans were performed resulting in excess health care costs of about US$531 696. Conclusion: In neurologically stable isolated tSAH patients, repeat brain imaging during interfacility transfer and inpatient and/or outpatient follow-up do not alter patient management despite increased health care costs and radiation burden.
Supporting the vulnerable: developing a strategic community mental health response to the COVID-19 pandemic
Authors: Thomson Sumana , Doan Trung , Liu Dennis , Schubert Klaus Oliver , Toh Julian , Boyd Mark A , Galletly Cherrie 
Published: July 2020

Objectives: The COVID-19 pandemic poses significant risks to the vulnerable patient population supported by community mental health (CMH) teams in South Australia. This paper describes a plan developed to understand and mitigate these risks. Methods: Public health and psychiatric literature was reviewed and clinicians in CMH teams and infectious disease were consulted. Key risks posed by COVID-19 to CMH patients were identified and mitigation plans were prepared. Results: A public health response plan for CMH teams was developed to support vulnerable individuals and respond to the COVID-19 pandemic. This plan will be reviewed regularly to respond to changes in public health recommendations, research findings and feedback from patients and clinicians. Conclusions: The strategic response plan developed to address risks to vulnerable patients from COVID-19 can assist other CMH services in managing the COVID-19 pandemic.
Lipoprotein Apheresis and Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors in Patients With Heterozygous Familial Hypercholesterolemia: A One Center Study
Authors: Kolovou Vana , Katsiki Niki , Makrygiannis Stamatis , Mavrogieni Sophie , Karampetsou Nikoletta , Manolis Athanasios , Melidonis Andreas , Mikhailidis Dimitri P. , Kolovou Genovefa D. 
Published: July 2020

Aim: We evaluated the lipid-lowering (LL) effect of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) in patients with heterozygous familial hypercholesterolemia (HeFH) treated with LL-drugs and lipoprotein apheresis (LA). Patients and Methods: The PCSK9i treatment (evolocumab 420 mg/4 weeks, alirocumab 150 mg/2 weeks, or alirocumab 75 mg/2 weeks: 9, 6, and 2 patients, respectively) was initiated in patients with HeFH (n = 17; aged 35-69 years, 10 men, previously treated with statins + ezetimibe ± colesevelam and LA sessions for 2-12 years). A lipid profile was obtained before and immediately after the LA session and before, 1 and 2 months after switching to PCSK9i treatment. The duration of PCSK9i therapy ranged from 3 to 18 months. Results: Median total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) levels before LA were 268, 198, 46, and 126 mg/dL, respectively, and decreased (at the end of the LA session) to 117, 50, 40, and 51 mg/dL, respectively ( P < .001 for TC and P = .001 for all other comparisons). The median time-averaged LDL-C levels following LA were 155 (121, 176; median [25th, 75th percentile]) mg/dL. Median TC, LDL-C, and TG levels before PCSK9i therapy were 269, 190, and 127 mg/dL and decreased to 152, 100, and 95 mg/dL, respectively ( P = .002, P < .002, and P < .03, respectively). Steady LDL-C levels with PCSK9i treatment were significantly lower compared with time-averaged LDL-C levels following LA (median value: 100 vs 155 mg/dL; P = .008). With PCSK9i, from 13 patients with CHD, 6 (46.1%) patients achieved LDL-C <70 mg/dL, and 2 patients (15.4%) achieved LDL-C <100 mg/dL. Lipoprotein apheresis was discontinued in all patients except for 2 who continued once monthly. Conclusions: PCSK9i can reduce LDL-C more consistently over time compared with a transient decrease following LA in HeFH patients. PCSK9i therapy may reduce the frequency of LA. Larger trials are required to establish the clinical implications of PCSK9i in patients previously on LA.
How Counseling Based on Acceptance and Commitment Therapy and Supported With Motivational Interviewing Affects the Perceptions of Treatment Motivation in Patients Diagnosed With Schizophrenia: A Qualitative Study
Authors: Yıldız Erman , Aylaz Rukuye 
Published: July 2020

Background: Lack of motivation is a common phenomenon in treatment of schizophrenia. Despite information that various psychosocial approaches may help overcome lack of motivation, their content and nature remain uncertain. However, in recent years, there is an increasing interest in psychosocial interventions such as acceptance and commitment therapy (ACT) and motivational interviewing (MI) techniques in approaching individuals diagnosed with schizophrenia (IDSs). In this study, the therapeutic models of ACT and MI were combined to create an innovative integrative approach to address the problem of lack of motivation in IDSs. Aims: This study was conducted to determine how a counseling program based on ACT and supported with MI affected the perceptions of treatment motivation in IDSs. Method: This study addressed the qualitative aspects of a doctoral dissertation designed as a quasi-experimental study that gathered both quantitative and qualitative data. Results: As a result of the content analysis, three main themes and 10 categories that motivated IDSs for compliance with regular treatment were developed. The participants in the experimental group expressed a focused treatment motivation to participate in daily life activities and social relations, acceptance of illness, satisfaction with life despite side effects and leading a value-oriented life in comparison with the control group. Conclusions: Counseling based on ACT and supported with the MI technique is effective in improving treatment motivation in IDSs. This counseling may be implemented as an effective psychiatric nursing intervention for IDSs.
The results of Baerveldt glaucoma implant surgery performed with the scleral flap and patch technique
Authors: Tojo Naoki , Hayashi Atsushi 
Published: July 2020

Background: We report the results of Baerveldt glaucoma implant (BGI) surgery performed with the scleral flap and patch technique. Patients and methods: This was a retrospective analysis of 97 consecutive patients (107 eyes) who underwent BGI surgery with the scleral flap and patch, and were followed up for >1 year. We evaluated the patients’ post-operative intraocular pressure (IOP), corneal endothelial cell density, and complications (corneal edema, Hoffmann elbow exposure). Results: The preoperative IOP was 32.9 ± 8.6 mmHg. BGI surgery significantly decreased the IOP to 11.1 ± 3.8, 11.3 ± 3.6, 11.3 ± 4.2, 10.7 ± 3.8, and 11.4 ± 3.2 mmHg at 1, 2, 3, 4, and 5 years post-surgery ( p < 0.001), respectively. The success rates at 1, 2, 3, 4, and 5 years were 96.3%, 94.8%, 94.8%, 88.5%, and 88.5%, respectively. Failure occurred in six eyes. The reasons for failure were as follows: a postoperative IOP ⩾21 mmHg in one patient, and loss of light sensation in five patients. No patients required additional glaucoma surgery. There were no cases of Hoffmann elbow erosion. Corneal edema occurred in five patients. Conclusion: BGI surgery performed with the scleral flap and patch significantly decreased the IOP, and no case of Hoffmann elbow erosion was observed over the 5-year post-operative period.
Acquired retinoschisis and vitreous hemorrhage as unusual findings in choroideremia: Case report
Authors: Mucciolo Dario Pasquale , Murro Vittoria , Giorgio Dario , Sodi Andrea , Passerini Ilaria , Virgili Gianni , Giansanti Fabrizio 
Published: July 2020

Purpose: To report a case of choroideremia characterized by peripheral retinoschisis with vascular abnormalities and vitreous hemorrhage. Observations: A 58-year-old man affected by advanced-stage choroideremia was diagnosed with peripheral retinoschisis in both eyes. Vitreous hemorrhage was present in the right eye with a peculiar clot-like lesion at the periphery. At the 1-year follow-up, the vitreous hemorrhage had reabsorbed and the vascular clot-like lesion in the periphery had almost completely disappeared. Conclusion and importance: We have reported fundoscopic and OCT features of peripheral-acquired retinoschisis with vascular abnormalities in a patient with choroideremia. OCT examination is extremely useful in clinical evaluation of the peripheral retinal alterations in these cases, where the absence of the retinal pigment epithelium and the choriocapillaris pose many diagnostic difficulties.