bluuebunny/crossref_metadata_2025_split huggingface dataset:
Individualized surveillance of chronic hepatitis B patients according to hepatocellular carcinoma risk based on PAGE-B scores
Authors: Kim Ji Hyun , Kang Seong Hee , Lee Minjong , Choi Hoon Sung , Jun Baek Gyu , Kim Tae Suk , Choi Dae Hee , Suk Ki Tae , Kim Moon Young , Kim Young Don , Cheon Gab Jin , Baik Soon Koo , Kim Dong Joon 
Published: August 2020

Background and aims
Current guidelines for chronic hepatitis B (CHB) patients are to undergo surveillance for hepatocellular carcinoma (HCC) with 6-month ultrasonography. We aimed to compare detection rates of very-early-stage HCC in two groups: group A, undergoing 6-month ultrasonography versus group B, undergoing 6-month ultrasonography alternating with dynamic computed tomography (CT).

Methods
This retrospective study assessed 2151 CHB patients under entecavir/tenofovir therapy from 2007 to 2016. Detection rates of very-early-stage HCC were compared between groups A/B at intermediate/high risk based on platelets, age, gender-hepatitis B scores. The primary endpoint was the proportion of patients in each group with very-early-stage HCC. Cox proportional hazards model was used to assess the effect of surveillance modalities to detect very-early-stage HCC.

Results
Five-year cumulative HCC incidence rates in group A were 15.0% not significantly different from 18.2% in group B at high risk (P = 0.17). Detection rates of very-early-stage HCC were significantly higher in group B than in group A (P < 0.001), and surveillance using CT alternating with ultrasonography was significantly associated with detection of very-early-stage HCC (hazard ratio 3.89, P < 0.001). Among intermediate-risk patients, difference between detection rates of very-early-stage HCC in groups A and B was not significant (P = 0.30), and surveillance using CT alternating with ultrasonography was not significantly associated with detection of very-early-stage HCC (hazard ratio 1.61, P = 0.23).

Conclusion
In high-risk CHB patients, surveillance using CT alternating with ultrasonography led to higher detection rates of very-early-stage HCC compared to surveillance using ultrasonography.
IL-10-1082G>A polymorphism, use of opioids and age affect the course of acute pancreatitis
Authors: Matic Sanja , Radosavljevic Ivan , Jankovic Slobodan , Natasa Djordjevic 
Published: August 2020

Purpose
We aimed to determine the association of two of the most important functional polymorphisms of IL-8 and IL-10 with the clinical course and outcome of acute pancreatitis.

Method
Ninety-three patients with acute pancreatitis were genotyped for IL-8-251T>A and IL-10-1082G>A using PCR-RFLP. The severity of the disease was determined based on the Atlanta Classification system.

Results
In patients treated with opioids, the odds for severe form of acute pancreatitis, its complications, and death were increased. Advanced age was associated with higher odds of organ/multiple organ failure and other systemic complications. Multivariate logistic regression analyses confirmed the observed effect of age and use of opioids, and revealed higher odds for the development of severe form of acute pancreatitis [P = 0.017, odds ratio (OR): 4.324, 95% confidence interval (CI): 1.305–14.323], its complications in general (P = 0.011, OR: 4.936, 95% CI: 1.442–16.897), pancreatic necrosis (P = 0.032, OR: 3.922, 95% CI: 1.122–13.707) and systemic inflammatory response syndrome (P = 0.037, OR: 3.838, 95% CI: 1.085–13.583) in the absence of IL-10-1082G>A variant allele. The effect of IL-8 -251T>A on acute pancreatitis severity or mortality was not detected.

Conclusion
Our study suggests the IL-10 -1082A allele as a protective factor in acute pancreatitis. Opioid analgesics treatment in acute pancreatitis is associated with severity, complications and mortality, while advanced age increases the risk of systemic complications.
Increased liver stiffness by transient elastography and acoustic radiation force impulse imaging in patients with extrahepatic cholestasis
Authors: Darweesh Samar K. , Zayed Naglaa , Atef Mira , Ramzy Eman , Yousry Ayman , Musa Sherief 
Published: August 2020

Background
Transient elastography and acoustic radiation force impulse (ARFI) imaging are noninvasive tools for liver stiffness measurement (LSM), which may be influenced by cholestasis.

Aim
The aim of the study was to evaluate the performance of transient elastography and ARFI in extrahepatic cholestasis and correlate changes in LSM with biochemical activity.

Materials and methods
A total of 38 patients with extrahepatic cholestasis prospectively underwent transient elastography and ARFI. Changes in LSM by transient elastography/ARFI were evaluated after 1 week of ERCP and correlated with biochemical parameters. The optimal ARFI cutoffs according to stages of clinical interest were analyzed.

Results
Biliary obstruction was calcular in 21 (55.3%) and noncalcular in 17 (44.7%) (benign n = 15, malignant n = 2). After 1 week, adequate biliary drainage reduced total bilirubin from 7.7 to 2.2 mg/dL (P < 0.001) which significantly correlated with reduction of LSM by transient elastography from 12.38 ± 6.68 kPa to 8.08 ± 3.21 kPa (P < 0.001), and by ARFI from 1.73 ± 0.51 m/s to 1.56 ± 0.70 m/s (P = 0.014). The LSM percentage change showed a decrease (nonsignificant, P = 0.843) by 25.83% using transient elastography and a significant decrease (P < 0.001) by 18.42% using ARFI in the improved patients. At initial visit, transient elastography positively correlated with ARFI, bilirubin and platelets, also, transient elastography had a positive correlation with ARFI, bilirubin, alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGT) in follow-up visit. LSM by ARFI (visit 1) negatively correlated with ALT, while in (visit 2), ARFI positively correlated with bilirubin, ALP, GGT and negatively correlated with albumin.

Conclusion
The increased LSM in patients with extrahepatic cholestasis is reduced after adequate biliary drainage, implying that increased values are not solely due to liver fibrosis, but due to biliary congestion leading temporarily to increased elasticity.
The utility of two-dimensional real-time shear wave elastography for assessing liver fibrosis in patients with chronic hepatitis C virus infection
Authors: Numao Hiroshi , Shimaya Koji , Kakuta Akihisa , Shibutani Koichi , Igarashi Syohei , Hasui Keisuke , Hanabata Norihiro , Kanazawa Kosuke , Munakata Masaki 
Published: August 2020

Objective
Two-dimensional shear wave elastography (2D-SWE) is a new ultrasound-based elastography method to evaluate liver fibrosis in the daily practice. However, the utility of 2D-SWE among the other liver fibrosis markers is unclear.

Methods
We enrolled 141 consecutive patients with hepatitis C virus infection, 66 men and 75 women (median age, 67 years), who underwent liver biopsy and 2D-SWE (LOGIQ E9, GE Healthcare, Wauwatosa, WI, USA). We compared the diagnostic accuracy of the 2D-SWE with those of magnetic resonance elastography (MRE; MR-Touch, GE Healthcare, Milwaukee, WI, USA), Mac-2 binding protein glycosylation isomer (M2BPGi), fibrosis-4 index (FIB-4) and platelet counts (PLT), using the histologic METAVIR scoring as the reference standard.

Results
The areas under the receiver operating characteristics curves (AUROCs) of 2D-SWE, MRE, M2BPGi, FIB-4 and PLT for ≥F2, ≥F3 and F4 were 0.86, 0.88, 0.79, 0.81 and 0.77; 0.92, 0.93, 0.86, 0.87 and 0.83; and 0.91, 0.97, 0.85, 0.85 and 0.82, respectively. For diagnosing ≥F2 and ≥F3, the AUROCs of 2D-SWE and those of MRE showed no significant differences, and both 2D-SWE and MRE showed significantly higher AUROCs than the other markers. For diagnosing F4, the AUROC of MRE was significantly higher than those of other fibrosis markers.

Conclusion
2D-SWE has an excellent diagnostic accuracy equivalent to that of MRE for assessing significant (≥F2) and severe (≥F3) fibrosis. MRE demonstrated a higher AUROC than 2D-SWE, but this last one has advantages such as lower cost, fewer contraindications and greater ease of performance than MRE.
A randomized, double-blind, placebo-controlled pilot study to evaluate the efficacy and tolerability of a novel oral bioadhesive formulation for the treatment of nonerosive reflux disease-related symptoms
Authors: Ribaldone Davide Giuseppe , Rajesh Pendlimari , Chandradhara Divya , Astegiano Marco , Pellicano Rinaldo 
Published: August 2020

Objective
The use of antisecretory drugs can provide symptomatic relief in 70–80% of patients suffering from gastro-oesophageal reflux disease (GORD), although this benefit is reduced by 20–30% in the case of nonerosive reflux disease (NERD). The current study evaluates the efficacy and safety of a patented oral formulation (liquid sachets containing hyaluronic acid, a mixture of amino acids including proline, hydroxyl-proline and glutamine, and rice extract dispersed in a bioadhesive polymer matrix) for relieving the symptoms of NERD.

Methods
A single-centre, randomized, double-blind, parallel group, placebo-controlled clinical study was performed. Patients who experienced at least three episodes of moderate-severity heartburn during the 7-day run-in period were included and treated with three liquid sachets per day for 14 days. The primary objective was to evaluate the proportion of patients with at least a three-point reduction in the total symptom score (TSS).

Results
Overall, 20 patients were randomized to receive the investigational product and 20 to receive the placebo. At the end of treatment, a three-point reduction in the TSS was achieved by 95% of patients treated with the investigational product and by 20% of patients treated with placebo (P < 0.0001). No adverse events were reported.

Conclusion
The investigational product showed a statistically significant superiority to the placebo in relieving common symptoms in patients with NERD. Future studies will be aimed at clarifying the hypothesis that this symptomatic benefit is related to the strengthening of the oesophageal barrier against the damage induced by gastric contents.
Association of out of hospital paediatric early warning score with need for hospital admission in a Scottish emergency ambulance population
Authors: Corfield Alasdair R. , Booth Katherine L. , Clerihew Linda , Staines Harry , Stewart Elaine , Rooney Kevin D. 
Published: August 2020

Objective
Physiological derangement, as measured by paediatric early warning score (PEWS) is used to identify children with critical illness at an early point to identify and intervene in children at risk. PEWS has shown some utility as a track and trigger system in hospital and also as a predictor of adverse outcome both in and out of hospital. This study examines the relationship between prehospital observations, aggregated into an eight-point PEWS (Scotland), and hospital admission.

Methods
A retrospective analysis of all patients aged less than 16 transported to hospital by the Scottish Ambulance Service between 2011 and 2015. Data were matched to outcome data regarding hospital admission or discharge and length of stay.

Results
Full data were available for 21 202 paediatric patients, of whom 6340 (29.9%) were admitted to hospital. Prehospital PEWS Scotland was associated with an odds ratio for admission of 1.189 [95% confidence interval (CI): 1.176–1.202; P < 0.001]. The area under receiver operating curve of 0.617 (95% CI: 0.608–0.625; P < 0.001) suggests poorly predictive ability for hospital admission. There was no association between prehospital PEWS Scotland and length of hospital stay.

Conclusion
These data show that a single prehospital PEWS Scotland was a poor predictor of hospital admission for unselected patients in a prehospital population. The decision to admit a child to hospital is not solely based on the physiological derangement of vital signs, and hence physiological-based scoring systems such as PEWS Scotland cannot be used as the sole criteria for hospital admission, from an undifferentiated prehospital population.
Sexuality After Treatment of Diffuse Large B-cell Lymphoma: Patients' Experiences and Psychometric Testing of the Sexual Adjustment Questionnaire-Swedish Version II
Authors: Olsson Cecilia , Josse Eklund Anna , Larsson Maria , Ringnér Anders 
Published: August 2020

Background
Sexuality is an important part of health-related quality of life. To ensure adequate supportive interventions, valid and reliable instruments specific to sexual changes and adjustments after cancer treatment are needed.

Objectives
The aims of this study were to test the psychometric properties of the Sexual Adjustment Questionnaire-Swedish version II (SAQ-SII) in patients treated for diffuse large B-cell lymphoma and to describe and explore patients' experiences of sexuality after treatment.

Methods
A cross-sectional study was conducted in 2019, using SAQ-SII and data from the National Quality Registry for Leukemia–subregistry for Lymphoma, which included 257 patients (25% response rate). An exploratory factor analysis was performed for psychometric evaluation. Internal consistency was assessed by Cronbach's α. Independent t tests, analysis of variance, and multiple regression were used to describe patients' experiences of sexuality.

Results
The exploratory factor analysis resulted in a 4-factor structure, explaining 65.7% of the total scale variance (SAQ-SII). The Cronbach's α for the SAQ-SII was 0.88 and varied between 0.70 and 0.89 across subscales. Sexuality was affected in various ways and extent. Sexual Interest was most affected, whereas Sexual Function was least affected. Being male, of younger age, without comorbidities, and in a relationship were associated to a higher Sexual Interest.

Conclusions
The SAQ-SII is a valid and reliable instrument to measure changes and adjustments in sexuality in patients treated for lymphoma.

Implications for Practice
Assessments of sexuality in a broad sense should be an integrated part of cancer care to ensure timely interventions for those who need and want support.
From Probands to Relatives
Authors: Seven Memnun , Shah Lisa L. , Yazici Hülya , Daack-Hirsch Sandra 
Published: August 2020

Background
The genetic risk communication from proband to relatives varies from family to family, and patients often need support with the communication of genetic test results and making decisions to manage hereditary cancer risks.

Objective
The aim of this study was to characterize the communication of BRCA1 or BRCA2 (BRCA1/2) genetic risk from proband to first-degree relatives (FDRs) using a social network framework.

Methods
We characterized network and nonnetwork factors to explore their association with which FDRs were told about the genetic risk and whether or not relatives underwent genetic testing. Ninety-two female probands with hereditary breast and ovarian cancer who have confirmed BRCA1/2 mutations participated in the study. Communication of hereditary breast and ovarian cancer risk was assessed between 92 probands and their 417 FDRs.

Results
Of 92 probands, 94.5% (n = 87) communicated their genetic test result to at least one of their FDRs. Of FDRs older than 18 years, 19.9% (n = 72) have genetic testing. Emotional closeness, educational level of the proband, and relative's age were significantly associated with communicating test results with FDRs.

Conclusion
Communication of genetic risk with the FDRs after having a BRCA1/2 gene-mutation–positive test result was high in this group of cancer patients. However, the rate of genetic testing among FDRs was low.

Implications for Practice
Probands' educational level and age of relatives for cascade genetic screening should be considered during counseling. Interventions to support women with BRCA1/2 mutations during the communication process and their family members' engagement in testing and risk-reducing strategies are needed.
Exploring Perceptions of Shift Length: A State-Based Survey of Registered Nurses
Authors: Haller Teresa , Quatrara Beth , Miller-Davis Claiborne , Noguera Ashley , Pannone Aaron , Keim-Malpass Jessica , Guterbock Thomas M. , Letzkus Lisa 
Published: August 2020

OBJECTIVE
The aim of this study was to explore clinical nurses' perspectives of shift length.

BACKGROUND
Discussions about scheduling practices, work rotations, and shift length are pervasive among nurses and nursing leadership. However, the science surrounding nurse perceptions of longer shifts is limited.

METHODS
A survey instrument was developed and distributed to nurses engaged in the state's professional association.

RESULTS
Data from 190 clinical nurses were included. When working a 40-hour work week, 76.3% reported a preference for 10-hour shifts, whereas 83.5% preferred a 12-hour shift during a 36-hour week. Those who chose longer shifts perceived improved work life balance and better patient care. Those identifying 8-hour shifts also pointed to work life balance as benefit.

CONCLUSIONS
The results capture the voice of the nurse regarding shift length. The preference for the 10-hour shift within the 40-hour work week is novel. These results may assist with efforts to initiate change, improve the work environment and enhance home life.
A Case of Crossbow Homicide With Review of Crossbow Injuries and Manner of Death Considerations
Authors: Tamburro Lo , Brown Theodore , Bauler Laura D. 
Published: August 2020

AbstractCrossbow fatalities are a rare occurrence, but crossbow use is on the rise. The manner of death in crossbow fatalities is overwhelmingly opined accident or suicide, not homicide. Despite their increasing use and reports of at least 14 crossbow-related homicides in the media for the last 5 years, crossbow homicides are rarely reported in the medical literature; only 10 articles that discussed 20 crossbow homicides were identified in the PubMed database. Here, we describe a case of a 20-year-old man who was found dead in his driveway after being shot in the abdomen with a crossbow by another person. The crossbow bolt had a mechanical 2-blade broadhead that transected the descending aorta and lodged in his vertebra. When completing a medicolegal death investigation and postmortem examination on suspected crossbow-related deaths, knowledge of crossbow components, its utility as a weapon, wound patterns, and how it can cause death are important. This case serves to build on the limited medical literature of crossbow homicides, educate forensic pathologists about the features of crossbow deaths, and highlight manner of death considerations.
Lost in the Clinics and Found in the Morgue
Authors: Krishnamurthy Kritika , Kochiyil Jyotsna , Tuda Claudio , Sriganeshan Vathany 
Published: August 2020

Abstract
In modern medicine, there is an increasing dependence on noninvasive imaging modalities, for diagnosis and management of diseases. Though there are definite advantages to this, they are at times offset by diagnostic pitfalls especially in entities with elusive clinical presentation.
Peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS) is an aggressive subtype of T-cell lymphomas that does not meet criteria for a specific subtype. Peripheral T-cell lymphoma usually has varied clinical presentations depending on the site of involvement. Vast majority of PTCL patients present with systemic disease, generalized lymphadenopathy and constitutional symptoms. Pulmonary involvement is relatively rare and is seen in approximately 10% of patients.
Here in we highlight a rare case of PTCL, masquerading as pneumonia due to extensive pulmonary involvement that went undiagnosed and was discovered at autopsy. This case of malignant lymphoma of T-cell origin involving the lung, which is very rare, highlights the continued importance of medical autopsies not only as a teaching tool but also as an important adjunct to investigative medicine in uncovering lapses that can subsequently be avoided to improve patient care and decrease mortality.
Progression of Respiratory Support Following Pediatric Extubation
Authors: Krasinkiewicz Johnny M. , Friedman Matthew L. , Slaven James E. , Tori Alvaro J. , Lutfi Riad , Abu-Sultaneh Samer 
Published: August 2020

Objectives:
High-flow nasal cannula and noninvasive positive pressure ventilation have become ubiquitous in contemporary PICUs. Practice patterns associated with the use of these modalities have not been well described. In this study, we aimed to describe the use of high-flow nasal cannula and noninvasive positive pressure ventilation in children after extubation and analyze the progression of usage in association with patient factors. Our secondary aim was to describe interventions used for postextubation stridor.

Design:
Single-center retrospective cohort study.

Setting:
A 36-bed quaternary medical-surgical PICU.

Patients:
Mechanically ventilated pediatric patients admitted between April 2017 and March 2018. Exclusions were patients in the cardiac ICU, patients requiring a tracheostomy or chronic ventilatory support, and patients with limited resuscitation status.

Interventions:
None.

Measurements and Main Results:
Data regarding respiratory modality use was collected for the first 72 hours after extubation. There were 427 patients included in the analysis; 51 patients (11.9%) were extubated to room air, 221 (51.8%) to nasal cannula, 132 (30.9%) to high-flow nasal cannula, and 23 (5.4%) to noninvasive positive pressure ventilation. By 72 hours, 314 patients (73.5%) were on room air, 52 (12.2%) on nasal cannula, 29 (6.8%) on high-flow nasal cannula, eight (1.9%) on noninvasive positive pressure ventilation, and 24 (5.6%) were reintubated. High-flow nasal cannula was the most used respiratory modality for postextubation stridor. Multivariate analysis demonstrated that longer duration of invasive mechanical ventilation increased the odds of initial high-flow nasal cannula and noninvasive positive pressure ventilation use, and a diagnosis of cerebral palsy increased the odds of escalating from high-flow nasal cannula to noninvasive positive pressure ventilation in the first 24 hours post extubation.

Conclusions:
High-flow nasal cannula is commonly used immediately after pediatric extubation and the development of postextubation stridor; however, its usage sharply declines over the following 72 hours. Larger multicenter trials are needed to identify high-risk patients for extubation failure that might benefit the most from prophylactic use of high-flow nasal cannula and noninvasive positive pressure ventilation after extubation.
Verifying the Versatility and Reliability of Free Lateral Arm Flap for Head and Neck Reconstruction
Authors: Kang Shin Hyuk , Jeon Sungmi , Jung Young Ho , Eun Seokchan 
Published: August 2020

Abstract
The lateral arm flap is an alternative to the conventional radial forearm flap and has been widely used due to advancements in flap characteristics. Especially, the fasciocutaneous flap has been widely used in head and neck reconstruction due to its versatile characteristics and surgical feasibility. This flap has successfully undergone several useful modifications based on various anatomical studies. Here, the authors aimed to verify the versatility and reliability of free lateral arm flap reconstruction of numerous head and neck defects. Twelve patients (6 men and 6 women; mean age, 66 years) with various types of lateral arm flaps from May 2017 to April 2019 were included. The anatomical reconstruction area was widely distributed across the facial subunits, tongue and oral cavity, and hypopharynx, among others. The flap varied in size from 3 × 5 cm to 17 × 7 cm, and the average pedicle length was 5.58 cm. The versatility of the lateral arm flap enabled successful coverage of various defects in all cases. Among 12 patients, the donor site outcome was rated as excellent and good by 2 and 10 patients, respectively. Three patients complained of post-operative hypoesthesia, which was subsequently resolved. The lateral arm flap is a unique and extremely versatile soft tissue free flap. Its versatility facilitates continuous modification of the flap and its application in various areas in different forms with excellent contour outcomes. The authors successfully verified the evolving methods and advantages of lateral arm flaps in the treatment of various head and neck defects.