bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Bleeding Uretero-Arterial Fistula: Open Repair After Unsuccessful Endovascular Treatment
Authors: Tijunaitis Karolis , Mosenko Valerija , Baltrūnas Tomas 
Published: September 2020

Introduction: Uretero-arterial fistula (UAF) poses major challenges in management and diagnosis due to the rarity of this condition and associated high morbidity/mortality rates. Methods: We describe a case of a UAF associated with previous aorto-biiliac grafting, ureteric stenting and right nephrectomy because of chronic pielonephritis and complicated by surgical site infection. This case illustrates a very complex pathology, with a challenging diagnosis and multiple treatment options. Results: A 72 year-old woman was referred to Vilnius Vascular Unit for open UAF repair. The patient had a history of open abdominal aortic aneurysm repair using a bifurcated graft 25 years ago. The right ureter was injured during the operation and a rigid indwelling ureteric stent was inserted. Six months prior to referral, she underwent a right nephrectomy due to a chronic pyelonephritis, complicated by surgical site infection, which was still present at the time of admission. Initial CTA demonstrated bilateral iliac aneurysms, but no signs of UAF. A further CTA revealed a UAF between the right ureteral stump and the right common iliac artery (CIA) para-anastomotic aneurysm. After unsuccessful attempts to embolize the UAF using both coils and glue, the patient was referred to Vilnius Vascular Unit for open repair. Left axillo-bifemoral bypass reconstruction was performed followed by UAF repair and bifurcated graft explantation. Follow-up after 2 years showed no recurrence of haematuria, good function of the remaining kidney and patent axillo-bifemoral bypass with no signs of infection around the prosthetic aortic stump. Conclusions: Uretero-arterial fistula is a uncommon condition in everyday clinical practice. The rarity of this condition may lead to delayed or missed diagnosis which can result in life-threating consequences. A multidisciplinary approach involving urologists, vascular surgeon and radiologist are crucial to both the diagnosis and managment of this rare entity.
Centrifuged-Concentrated Intravitreal Slurry Triamcinolone Acetonide: An Inexpensive, Easy, and Viable Alternative to Long-Term Steroid Delivery
Authors: Malinowski Susan M. , Wasserman Jason Adam 
Published: September 2020

Purpose: This work reports the duration, safety, and viability of intravitreal slurry triamcinolone acetonide (TA; 1.0 mL of 40-mg/mL TA centrifuge concentrated into a 0.1-mL pellet) to treat cystoid macular edema (CME). Methods: A retrospective, consecutive review was conducted of patients undergoing intravitreal slurry TA injections, July 2009 to December 2018. Results: In 143 eyes of 120 patients, slurry TA resolved CME for a mean of 327.15 (SD = 213.11) days, or 10.76 (SD = 7.00) months, per intravitreal injection (n = 466). In 100 eyes requiring multiple injections (n = 423), mean duration was 270.95 (SD = 177.14) days, or 8.91 (SD = 5.82) months, between injections. In 43 single-injection eyes, duration was 749.30 (SD = 483.17) days, or 24.63 (SD = 15.88) months. Mean duration decreased from 337.89 (SD = 210.46) days, or 11.11 (SD = 6.92) months, in nonvitrectomized eyes to 279.74 (SD 179.63) days, or 9.20 (SD = 5.91) months, in vitrectomized eyes (n = 74 injections, t = 2.24, P = .014, 1-tailed). Central foveal thickness as shown on optical coherence tomography decreased by 173.89μ (SD = 147.56μ), from 459.16μ (SD = 47.14μ) to 285.27μ (SD = 77.27μ; t = –25.31, P < .001), within 43.41 days (SD = 36.86). Visual acuity improved from 20/100 (logMAR 0.70, SD = 0.33) to 20/74 (logMAR 0.57, SD = 0.31; SD = 0.21; t = –11.01, P < .001), within 33.98 (SD 24.98) days. Fifteen of 31 phakic eyes (48.39%) underwent cataract extraction. Fifty-seven eyes (39.86%) developed a steroid response (> 10 mm Hg increase from baseline) 94.79 days (SD = 85.52 days), or 3.11 (SD = 2.81) months, following injection. Conclusions: A single injection of slurry TA lasted on average 10.76 months with significant improvement of CME and visual acuity. Adverse ocular effects were comparable to currently available, long-term, implantable steroids. Slurry TA appears to be an easily reproducible, safe, and cost-effective alternative to long-term intraocular steroid delivery.
Competencies to promote collaboration between primary and secondary care doctors: an integrative review
Authors: Janssen Marijn , Sagasser Margaretha H. , Fluit Cornelia R. M. G. , Assendelft Willem J. J. , de Graaf Jacqueline , Scherpbier Nynke D. 
Published: September 2020

Abstract
Background
In a society where ageing of the population and the increasing prevalence of long-term conditions are major issues, collaboration between primary and secondary care is essential to provide continuous, patient-centred care. Doctors play an essential role at the primary-secondary care interface in realising ‘seamless’ care. Therefore, they should possess collaborative competencies. However, knowledge about these collaborative competencies is scarce. In this review we explore what competencies doctors need to promote collaboration between doctors at the primary-secondary care interface.

Methods
We conducted an integrative literature review. After a systematic search 44 articles were included in the review. They were analysed using a thematic analysis approach.

Results
We identified six themes regarding collaborative competencies: ‘patient-centred care: a common concern’, ‘roles and responsibilities’, ‘mutual knowledge and understanding’, ‘collaborative attitude and respect’, ‘communication’ and ‘leadership’. In every theme we specified components of knowledge, skills and attitudes as found in the reviewed literature. The results show that doctors play an important role, not only in the way they collaborate in individual patient care, but also in how they help shaping organisational preconditions for collaboration.

Conclusions
This review provides an integrative view on competencies necessary for collaborative practice at the primary-secondary care interface. They are part of several domains, showing the complexity of collaboration. The information gathered in this review can support doctors to enhance and learn collaboration in daily practice and can be used in educational programmes in all stages of medical education.
Effects of probiotic bacterium Weissella cibaria CMU on periodontal health and microbiota: a randomised, double-blind, placebo-controlled trial
Authors: Kang Mi-Sun , Lee Dong-Suk , Lee Seung-Ah , Kim Myoung-Suk , Nam Seoul-Hee 
Published: September 2020

Abstract
Background
Weissella cibaria CMU (oraCMU) has been commercially available in the market for several years as oral care probiotics. The present study aimed to evaluate the effects of oraCMU-containing tablets on periodontal health and oral microbiota.

Methods
A randomised, double-blind, placebo-controlled trial was conducted in 92 adults without periodontitis (20–39 years of age). All subjects received dental scaling and root planing, and were randomly assigned to either probiotic or placebo groups. The tablets were administered once daily for 8 weeks. Periodontal clinical parameters included bleeding on probing (BOP), probing depth (PD), gingival index (GI), and plaque index (PI). In addition, microbiota in the gingival sulcus were analysed.

Results
BOP improved more in the probiotic group over 8 weeks. There were statistically significant differences in BOP of the maxilla buccal and lingual sites between the groups during the intervention (P < 0.05). No significant inter-group differences in PD, GI, and PI were observed during the intervention. Oral bacteria were observed to be fewer in the probiotic group. There was a significant change in levels of Fusobacterium nucleatum at four and 8 weeks between the two groups. Besides, there were significant differences at 8 weeks in levels of Staphylococcus aureus.

Conclusions
We reported an improvement in BOP and microbial environment and demonstrated the antimicrobial activity of oraCMU against F. nucleatum. Thus, its supplementation may contribute to overall oral health.

Trial registration
Ethical issues approved by the Kangwon National University Institutional Review Board with a number of KWNUIRB-2018-05-003-005 and CRIS code Number of KCT0005078 were retrospectively registered on 06/02/2020. This study was conducted in the period of July to November 2018.
Visit-to-visit fasting plasma glucose variability is associated with left ventricular adverse remodeling in diabetic patients with STEMI
Authors: Yang Chen Die , Shen Ying , Ding Feng Hua , Yang Zhen Kun , Hu Jian , Shen Wei Feng , Zhang Rui Yan , Lu Lin , Wang Xiao Qun 
Published: September 2020

Abstract
Background
Patients with type 2 diabetes mellitus (T2DM) are predisposed to poor cardiovascular outcomes after ST-segment elevation myocardial infarction (STEMI). Left ventricular adverse remodeling (LVAR) triggered upon myocardial infarction is recognized as the predominant pathological process in the development of heart failure. In the present study, we sought to investigate whether visit-to-visit fasting plasma glucose (FPG) variability is a potential predictor of LVAR in T2DM patients after STEMI.

Methods
From January 2014 to December 2018 in Ruijin Hospital, T2DM patients with STEMI who underwent primary percutaneous coronary intervention were consecutively enrolled and followed up for ~ 12 months. The changes in left ventricular geometric and functional parameters between baseline and 12-month follow-up were assessed by echocardiography. The incidence of LVAR, defined as 20% increase in indexed left ventricular end-diastolic volume (LVEDV), and its relationship with visit-to-visit FPG variability were analyzed. Multivariate regression models were constructed to test the predictive value of FPG variability for post-infarction LVAR.

Results
A total of 437 patients with type 2 diabetes and STEMI were included in the final analysis. During a mean follow-up of 12.4 ± 1.1 months, the incidence of LVAR was 20.6% and mean enlargement of indexed LVEDV was 3.31 ± 14.4 mL/m2, which was significantly increased in patients with higher coefficient variance (CV) of FPG (P = 0.002) irrespective of baseline glycemic levels. In multivariate analysis, FPG variability was independently associated with incidence of post-infarction LVAR after adjustment for traditional risk factors, baseline HbA1c as well as mean FPG during follow-up (OR: 3.021 [95% CI 1.081–8.764] for highest vs. lowest tertile of CV of FPG). Assessing FPG variability by other two measures, including standard deviation (SD) and variability independent of the mean (VIM), yielded similar findings.

Conclusions
This study suggests that visit-to-visit FPG variability is an independent predictor of incidence of LVAR in T2DM patients with STEMI.
Trial registration Trials number, NCT02089360; registered on March 17,2014.
SARS-CoV-2 and pulmonary embolism: who stole the platelets?
Authors: Tran Michael , Sheth Chirag , Bhandari Rohan , Cameron Scott J. , Hornacek Deborah 
Published: September 2020

Abstract
Background
Patients infected with SARS-CoV-2 often develop venous and arterial thrombosis. The high patient mortality is partly attributed to thrombotic events. An emerging trend is the presence of immunological phenomena including antiphospholipid antibodies which may promote thrombosis. The mechanism for these observations is not clear though many patients with SARS-CoV-2 develop thrombocytopenia.

Case presentation
We describe a patient with SARS-CoV-2 pneumonitis who presented with intermediate risk pulmonary embolism (PE). Careful attention to his daily platelet count suggested the possibility of immune mediated heparin-induced thrombocytopenia (HIT) which was confirmed by laboratory testing and resolved when anticoagulation was switched to a direct thrombin inhibitor.

Conclusions
Since excessive platelet activation and in situ thrombosis occur in HIT, this case underscores the need to consider that thrombocytopenia in patients with SARS-CoV-2—most of whom receive heparinoids—may be unrecognized HIT. A central role for the platelet in the etiology of thrombosis during the COVID-19 pandemic should be explored.
Evaluation of the Cochrane Consumers and Communication Group’s systematic review priority-setting project
Authors: Synnot Anneliese , Tong Allison , Ryan Rebecca , Hill Sophie 
Published: September 2020

ABSTRACT
Background
Health researchers and funders are increasingly consulting with stakeholders to set their research agendas but these activities are rarely evaluated. The Cochrane Consumers and Communication Group (CCCG) conducted a priority-setting project for systematic reviews in partnership with stakeholders (consumers/patients, health professionals, policy-makers and others). In this paper, we aim to describe our evaluation of the project’s processes and outcomes.

Methods
We used a 10-element conceptual framework designed to evaluate processes (e.g. stakeholder engagement, use of explicit process) and outcomes (e.g. improved decision-making quality, stakeholder acceptance and understanding) of health priority-setting. Data sources included empirical data (feedback surveys, project documents and CCCG editorial policies) and CCCG staff reflections. Data were analysed using content analysis.

Results
The project met three and partially met two of the process elements, for example, by engaging key stakeholders throughout the project and using pre-determined and transparent methods that offered multiple and meaningful ways to contribute. The project met three and partially met two of the outcome elements. Stakeholders were satisfied with and accepted the process and an additional six Cochrane Review titles aligned with stakeholder priorities are now being conducted in partnership with stakeholders. The project has also directly influenced the editorial work of CCCG, for example, by shifting its organisational focus towards coproduction, and indirectly influenced the work of Cochrane’s prioritisation and coproduction activities. Some areas were identified as having room for improvement, for example, there was low participation by people from diverse backgrounds, stakeholders could contribute to most but not all project stages, and there was no formal way for stakeholders to appeal decisions at project end. In the 3 years since its completion, the Cochrane Reviews are nearing completion but none of the reviews have been published.

Conclusion
We demonstrated that our priority-setting methods were broadly in line with best practice and the project resulted in many positive outcomes beyond just identifying the top priorities for research. Our evaluation framework and recommendations for future evaluations may be of use to priority-setting researchers planning similar activities.
Rising serum CA-125 levels within the normal range is strongly associated recurrence risk and survival of ovarian cancer
Authors: Piatek Szymon , Panek Grzegorz , Lewandowski Zbigniew , Bidzinski Mariusz , Piatek Dominika , Kosinski Przemyslaw , Wielgos Miroslaw 
Published: September 2020

Abstract
Background
In clinical practice alterations in CA-125 concentration within normal range in patients with ovarian cancer after first-line treatment are common. Even minor increase in CA-125 concentration is associated with patients’ anxiety and difficult interpretation and counselling for clinicians. The aim of this study was to evaluate the significance of CA-125 fluctuations within reference level in patients who suffered from ovarian cancer with complete response after first-line treatment.

Results
168 patients with epithelial ovarian cancer, who achieved complete remission after first line treatment were enrolled in the study. CA-125 concentration assessment was carried out during follow up visits. The recurrence of the disease was diagnosed on the first appearance of symptoms: clinical, radiological or histopathological/cytological. PFS and 5-year survival rate was calculated with Kaplan-Meier plots. Statistical analysis was performed with SAS / STAT® 9.4 / 14.4, SAS Institute Inc., Cary, NC, USA, 2017. Median concentration of CA-125 after first-line therapy was 10 U/ml. Increasing CA-125 concentration by > 5 U/ml, 3 and 6 months after the treatment was associated with higher risk of relapse (HR = 7.6, p < 0.0001 and HR = 5.29, p < 0.0001 respectively). 5-year survival rate was significantly lower in patients with increased CA-125 by 5 U/ml, 3 and 6 months after therapy (56.79% vs 0 and 50.62% vs 15.55%).

Conclusions
Increased concentration of CA-125 by > 5 U/ml within normal range, 3 and 6 months after treatment was unfavorable prognostic factor in ovarian cancer patients with complete response to primary therapy.
Improving patient experience and safety at transitions of care through the Your Care Needs You (YCNY) intervention: a study protocol for a cluster randomised controlled feasibility trial
Authors: Baxter Ruth , Murray Jenni , O’Hara Jane K. , Hewitt Catherine , Richardson Gerry , Cockayne Sarah , Sheard Laura , Mills Thomas , Lawton Rebecca ,   on behalf of the PACT research team
Published: September 2020

Abstract
Background
Patients, particularly older people, often experience safety issues when transitioning from hospital to home. Although the evidence is currently equivocal as to how we can improve this transition of care, interventions that support patient involvement may be more effective. The ‘Your Care Needs You’ (YCNY) intervention supports patients to ‘know more’ and ‘do more’ whilst in hospital in order that they better understand their health condition and medications, maintain their daily activities, and can seek help at home if required. The intervention aims to reduce emergency hospital readmissions and improve safety and experience during the transition to home.

Methods
As part of the Partners At Care Transitions (PACT) programme of research, a multi-centred cluster randomised controlled trial (cRCT) will be conducted to explore the feasibility of the YCNY intervention and trial methodology. Data will be used to refine the intervention and develop a protocol for a definitive cRCT.
Ten acute hospital wards (the clusters) from varying medical specialties including older peoples’ medicine, trauma and orthopaedics, cardiology, intermediate care, and stroke will be randomised to deliver YCNY or usual care on a 3:2 basis. Up to 200 patients aged 75 years and over and discharged to their own homes will be recruited to the study. Patients will complete follow-up questionnaires at 5-, 30-, and 90-days post-discharge and readmission data up to 90-days post-discharge will be extracted from their medical records.
Study outcomes will include measures of feasibility (e.g. screening, recruitment, and retention data) and processes required to collect routine data at a patient and ward level. In addition, interviews and observations involving up to 24 patients/carers and 28 staff will be conducted to qualitatively assess the acceptability, usefulness, and feasibility of the intervention and implementation package to patients and staff. A separate sub-study will be conducted to explore how accurately primary outcome data (30-day emergency hospital readmissions) can be gathered for the definitive cRCT.

Discussion
This study will establish the feasibility of the YCNY intervention which aims to improve safety and experience during transitions of care. It will identify key methodological and implementation issues that need to be addressed prior to assessing the effectiveness of the YCNY intervention in a definitive cluster randomised controlled trial.

Trial registration
UK Clinical Research Network Portfolio: 42191; ISTCRN: ISRCTN51154948. Registered 16/07/2019.
Impact of mucosal biofilm and bony osteitis on chronic rhinosinusitis with nasal polyps
Authors: El Ibiary Hassan , Samir Naglaa , Kamal Ehab , Ashmawy Tarek 
Published: September 2020

Abstract
Background
Chronic rhinosinusitis (CRS) is a common inflammatory disorder whose underlying etiopathogenesis has not yet been completely understood and appears to be multifactorial. Microbial biofilms and bony osteitis are gaining an increased concern as they are considered to be among the possible factors that contribute to the overall local inflammatory load in chronic rhinosinusitis (CRS). This study investigated the impact of mucosal biofilm and bony osteitis on the pathophysiology and severity of chronic rhinosinusitis with nasal polyps (CRSwNP).

Results
Forty-five CRSwNP patients performing functional endoscopic sinus surgery (FESS) and 10 control patients were involved in this cross-sectional study. Mucosal and bony specimens from ethmoid sinus were obtained for both light and scanning electron (SEM) microscopic examination. The histopathologic bony grade was positive in 40/45 of CRSwNP patients versus 6/10 of the control patients (P = 0.300); histopathologic mucosal grade was 44/45 versus 4/10 (P < 0.001), and tissue eosinophilia was 45/45 versus 6/10 (P < 0.001); biofilm was positive in 37/45 versus 4/10 (P = 0.012). The mean of the sinonasal outcome treatment score (SNOT)-22 is 39.8 versus 50.5 (P = 0.067); Lund-Mackay score (LMS) is 19.6 versus 3.1 (P < 0.0001).

Conclusion
(1) Mucosal biofilms and osteitis were detected in patients undergoing FESS for CRSwNP and also in controls without CRS. This suggests that mucosal biofilms and osteitis may not alone be the etiology of CRS without other cofactors. The pathogenesis of biofilms could be related to host factors. (2) The high odds ratio and wide confidence interval in our study suggest that there is a statistically significant association between biofilm formation and CRSwNP. (3) The high grade of mucosal inflammation and tissue eosinophilia suggests the inflammatory load added by osteitis and bacterial biofilm (BBF).
RNA Sequencing and Somatic Mutation Status of Adrenocortical Tumors: Novel Pathogenetic Insights
Authors: Di Dalmazi Guido , Altieri Barbara , Scholz Claus , Sbiera Silviu , Luconi Michaela , Waldman Jens , Kastelan Darko , Ceccato Filippo , Chiodini Iacopo , Arnaldi Giorgio , Riester Anna , Osswald Andrea , Beuschlein Felix , Sauer Sascha , Fassnacht Martin , Appenzeller Silke , Ronchi Cristina L 
Published: September 2020

Abstract

Context
Pathogenesis of autonomous steroid secretion and adrenocortical tumorigenesis remains partially obscure.

Objective
To investigate the relationship between transcriptome profile and genetic background in a large series of adrenocortical tumors and identify new potential pathogenetic mechanisms.

Design
Cross-sectional study.

Setting
University Hospitals of the European Network for the Study of Adrenal Tumors (ENSAT).

Patients
We collected snap-frozen tissue from patients with adrenocortical tumors (n = 59) with known genetic background: 26 adenomas with Cushing syndrome (CS- cortisol-producing adenoma [CPA]), 17 adenomas with mild autonomous cortisol secretion (MACS-CPAs), 9 endocrine-inactive adenomas (EIAs), and 7 adrenocortical carcinomas (ACCs).

Intervention
Ribonucleic acid (RNA) sequencing.

Main Outcome Measures
Gene expression, long noncoding RNA (lncRNA) expression, and gene fusions. Correlation with genetic background defined by targeted Sanger sequencing, targeted panel- or whole-exome sequencing.

Results
Transcriptome analysis identified 2 major clusters for adenomas: Cluster 1 (n = 32) mainly consisting of MACS-CPAs with CTNNB1 or without identified driver mutations (46.9% of cases) and 8/9 EIAs; Cluster 2 (n = 18) that comprised CP-CPAs with or without identified driver mutation in 83.3% of cases (including all CS-CPAs with PRKACA mutation). Two CS-CPAs, 1 with CTNNB1 and 1 with GNAS mutation, clustered separately and relatively close to ACC. lncRNA analysis well differentiate adenomas from ACCs. Novel gene fusions were found, including AKAP13-PDE8A in one CS-CPA sample with no driver mutation.

Conclusions
MACS-CPAs and EIAs showed a similar transcriptome profile, independently of the genetic background, whereas most CS-CPAs clustered together. Still unrevealed molecular alterations in the cAMP/PKA or Wnt/beta catenin pathways might be involved in the pathogenesis of adrenocortical tumors.