bluuebunny/crossref_metadata_2025_split huggingface dataset:
Counteracting Throwaway Culture in Daily Clinical Practice
Authors: Fuchs Jeffrey W. , Fuchs Joseph R. 
Published: June 2020

Since his election in March 2013, Pope Francis has brought significant attention to the concept of “throwaway culture.” This moral paradigm—which has been defined by Francis in various speeches and the encyclical Laudato si’—characterizes a present-day culture in which food, disposable objects, and even human beings themselves are “discarded as ‘unnecessary.’” As Catholic physicians, it is our duty to ensure that we are working to counteract throwaway culture in our daily clinical practice by embracing and exhibiting a culture of encounter. When throwaway culture is discussed within the context of medical practice, it is easy to think of major life and systemic issues including abortion, assistive reproductive technology, physician assisted suicide, and so on. However, rejection of throwaway culture has much broader implications for Catholic physicians. We are called to resist this perverse culture whenever we experience a situation that requires special attention to the respect of human dignity. In this article, we present two common situations encountered in clinical practice in which it is essential to counteract throwaway culture and embrace a culture of encounter: in working with patients who are isolation settings and those who require translation services. Various studies are cited which demonstrate a lack of respect for human dignity that can be seen when working with these patient populations, and recommendations are provided which illustrate how to embrace a culture of encounter in each scenario. The authors conclude that through adoption of a culture of encounter, Catholic physicians as a community can be role models for coworkers, trainees, and students, promoting a culture in which we validate human dignity and ensure the quality and just care of even our most vulnerable patients. Summary: Pope Francis had defined a “throwaway culture” in which “Human life, the person, are no longer seen as a primary value to be respected and safeguarded.” In this article we present two common situations encountered in clinical practice in which it is essential to counteract throwaway culture and embrace a culture of encounter: in working with patients who are isolation settings and those who require translation services. We conclude that, as Catholic physicians, it is our duty to ensure that we are working to counteract throwaway culture in our daily clinical practice by embracing and exhibiting a culture of encounter.
Sinonasal Squamous Cell Carcinoma Outcomes: Does Treatment at a High‐Volume Center Confer Survival Benefit?
Authors: Teitelbaum Jordan I. , Issa Khalil , Barak Ian R. , Ackall Feras Y. , Jung Sin‐Ho , Jang David W. , Abi Hachem Ralph 
Published: June 2020

ObjectiveTo determine whether treatment of sinonasal squamous cell carcinoma (SCC) at a high‐volume facility affects survival.Study DesignRetrospective database analysis.SettingNational Cancer Database (2004‐2014).Subjects and MethodsThe National Cancer Database was queried for sinonasal SCC from 2004 to 2014. Patient demographics, tumor characteristics and classification, resection margins, treatment regimen, and facility case‐specific volume—averaged per year and grouped in tertiles as low (0%‐33%), medium (34%‐66%), and high (67%‐100%)—were compared. Overall survival was compared with Cox proportional hazards regression analysis.ResultsA total of 3835 patients treated for sinonasal SCC between 2004 and 2014 were identified. Therapeutic options included surgery alone (18.6%), radiotherapy (RT) alone (29.1%), definitive chemoradiation (15.4%), surgery with adjuvant RT (22.8%), and combinations (14.1%) of the aforementioned treatments. Patients who underwent surgery with adjuvant RT had better overall survival (hazard ratio [HR], 0.74; P <. 001; 95% CI, 0.63‐0.86). As for treatment volume per facility, 7.4% of patients were treated at a low‐volume center, 17.5% at a medium‐volume center, and 75.1% at a high‐volume center. Univariate analysis showed that treatment at a high‐volume facility conferred a significantly better overall survival (HR, 0.77; P =. 002). Multivariable Cox proportional hazards regression analysis, adjusting for age, sex, tumor classification, and treatment regimen, demonstrated that patients who underwent treatment at a high‐volume facility (HR, 0.81; P <. 001) had significantly improved survival.ConclusionThis study shows a better overall survival for sinonasal SCC treated at high‐volume centers. Further study may be needed to understand the effect of case volume on the paradigms of sinonasal SCC management.
MicroRNA-17 as a potential diagnostic biomarker in pulmonary arterial hypertension
Authors: Li Haiwen , Yang Zhiming , Gao Fen , Zhang Yueying , Meng Weihao , Rong Shuling 
Published: June 2020

Objective This study aimed to detect circulating microRNA (miR)-17 and miR-20a levels in patients with pulmonary arterial hypertension (PAH), and to investigate whether circulating miR-17 levels are associated with PAH. Methods Thirty-five PAH patients and 20 healthy controls were enrolled in the study. Circulating miR-17 and miR-20a levels were measured using real-time PCR analysis. Results miR-17 levels were significantly increased in PAH patients compared with healthy controls. They were also higher in PAH patients at World Health Organization functional class (WHO FC) III–IV than WHO FC I–II PAH patients. There was no significant difference in miR-20a levels between PAH patients and controls. miR-17 had a high area under the corresponding receiver operating characteristic curve. Further, we found that circulating miR-17 levels correlated with the 6-minute walk distance, mean pulmonary artery pressure, and mean right atrial pressure in PAH patients. Conclusion Circulating miR-17 levels may be associated with human PAH. Therefore, miR-17 could be used as a diagnostic index and prognostic factor for PAH patients.
Th17 cell frequency and IL-17A production in peripheral blood of patients with non-small-cell lung cancer
Authors: Chen Gang , Zhang Pei-Gang , Li Jun-Sheng , Duan Jing-Jing , Su Wen , Guo Shi-Ping , Wang Yan-Feng , Sun Jun-Ning , Yang Xiao-Tang 
Published: June 2020

Objective This study investigated the frequency of T-helper (Th)17 lymphocytes and production of cytokine interleukin (IL)-17 in peripheral blood of patients with non-small-cell lung cancer (NSCLC) and their use as a marker of clinical value. Methods Sixty patients with NSCLC and 60 healthy volunteers were enrolled in the study. Flow cytometry was used to detect the frequency of Th17 lymphocytes in peripheral blood, and enzyme-linked immunosorbent assay (ELISA) was used to detect serum levels of IL-17. We analyzed the association of Th17 lymphocytes and IL-17 levels in the peripheral blood of patients with their clinicopathological features. Results Frequency of Th17 lymphocytes and production of IL-17 were significantly higher in the NSCLC group than in the control group and were higher in patients with a smoking history compared with non-smokers. Moreover, Th17 lymphocyte and IL-17 expression levels were higher in patients with squamous cell carcinoma than in patients with adenocarcinoma, and significantly higher in patients with stage III and IV cancers than in patients at stage I or II. Conclusion Th17 lymphocytes and IL-17 play an important role in the development of NSCLC in patients and may have clinical value as markers for treatment of NSCLC.
Psychological aspects of infertility. A systematic review
Authors: Szkodziak Filip , Krzyżanowski Jarosław , Szkodziak Piotr 
Published: June 2020

Objective Fertility may be defined as a capacity to conceive and produce offspring. Infertility is characterized by failure to establish a clinical pregnancy after 12 months of regular and unprotected sexual intercourse. Infertility concerns an estimated 8–12% of the global population, and is associated with factors including time of unwanted non-conception, age of female partner and number of diseases impacting fertility. Unexplained infertility is described as idiopathic. This study aimed to analyse and evaluate the influence of mental disorders, often considered as reasons for idiopathic infertility, on female and male fertility, including stress, depression, sleep and eating disorders, and addictions. Methods This systematic review comprised a search of MEDLINE, Cochrane and PubMed databases for relevant articles that were analysed by two independent reviewers. Results A total of 106 articles published between 1955–2019 were included. Mental disorders modify endocrine gland and immune system functioning at both the tissue and cellular level, and are negatively associated with female and male fertility. Conclusion Mental disorders may negatively impact female and male fertility. Further studies are required to explain the exact role and contribution of mental disorders to fertility.
Sex- and age-specific mild cognitive impairment is associated with low hand grip strength in an older Chinese cohort
Authors: Liu Xinji , Chen Jun , Geng Renwen , Wei Rong , Xu Peiru , Chen Beijing , Liu Kaiyong , Yang Linsheng 
Published: June 2020

Background Few studies have demonstrated the impact of characteristics like age and sex on the association between hand grip strength (HGS) and mild cognitive impairment (MCI). In this cross-sectional study, we aimed to examine the effects of sex and age on the relationship between HGS and MCI. Methods We enrolled older adults age ≥60 years (n = 1009) and measured HGS and MCI in all participants. We analyzed the differences in MCI prevalence among the different variables. The role of sex and age in the association between MCI and HGS was analyzed using binary logistic regression. Results Women had significantly higher prevalence of MCI than men, as did the older group (age ≥70 years) compared with the younger group (age 60–70 years). In men, the low and middle HGS tertiles were significantly associated with MCI. In contrast, only the low tertile of HGS was associated with MCI in women. In the older group, the low tertile of HGS was significantly associated with MCI, which was not observed in the younger group. Conclusions HGS was associated with MCI in older adults, and this association was stronger in men. HGS may be useful for evaluating MCI in older adults.
Venovenous extracorporeal membrane oxygenation versus conventional mechanical ventilation to treat refractory hypoxemia in patients with acute respiratory distress syndrome: a retrospective cohort study
Authors: Tongyoo Surat , Permpikul Chairat , Sucher Siwalai , Thomrongpairoj Preecha , Poompichet Akekarin , Ratanarat Ranistha , Chierakul Nitipatana 
Published: June 2020

Objective To compare the treatment outcome of venovenous extracorporeal membrane oxygenation (VV-ECMO) versus mechanical ventilation in hypoxemic patients with acute respiratory distress syndrome (ARDS) at a referral center that started offering VV-EMCO support in 2010. Methods This retrospective cohort study enrolled adults with severe ARDS (PaO2/FiO2 ratio of <100 with FiO2 of ≥90 or Murray score of ≥3) who were admitted to the intensive care unit of Siriraj Hospital (Bangkok, Thailand) from January 2010 to December 2018. All patients were treated using a low tidal volume (TV) and optimal positive end-expiratory pressure. The primary outcome was hospital mortality. Results Sixty-four patients (ECMO, n = 30; mechanical ventilation, n = 34) were recruited. There was no significant difference in the baseline PaO2/FiO2 ratio (67.2 ± 25.7 vs. 76.6 ± 16.0), FiO2 (97 ± 9 vs. 94 ± 8), or Murray score (3.4 ± 0.5 vs. 3.3 ± 0.5) between the ECMO and mechanical ventilation groups. The hospital mortality rate was also not significantly different between the two groups (ECMO, 20/30 [66.7%] vs. mechanical ventilation, 24/34 [70.6%]). Patients who underwent ECMO were ventilated with a significantly lower TV than patients who underwent mechanical ventilation (3.8 ± 1.8 vs. 6.6 ± 1.4 mL, respectively). Conclusion Although VV-ECMO promoted lower-TV ventilation, it did not improve the in-hospital mortality rate. Trial registration: www.clinicaltrials.gov (NCT 04031794).
Histogram Analysis of ADC Maps for Differentiating Brain Metastases From Different Histological Types of Lung Cancers
Authors: Bozdağ Mustafa , Er Ali , Çinkooğlu Akın 
Published: June 2020

Purpose: Our study aimed to investigate the role of histogram analysis derived from apparent diffusion coefficient (ADC) maps in brain metastases (BMs) from lung cancer for differentiating histological subtype. Methods: A total of 61 BMs (45 non-small cell lung cancer [NSCLC] comprising 32 adenocarcinoma [AC], 13 squamous cell carcinoma [SCC], and 16 small-cell lung cancer [SCLC]) in 50 patients with histopathologically confirmed lung cancer were retrospectively included in this study. Pretreatment cranial diffusion-weighted imaging was performed, and the corresponding ADC maps were generated. Regions of interest were drawn on solid components of the BM on all slices of the ADC maps to obtain parameters, including ADCmax, ADCmean, ADCmin, ADCmedian, ADCrange, skewness, kurtosis, entropy, ADC10, ADC25, ADC75, and ADC90. Apparent diffusion coefficient histogram parameters were compared among histological type groups. Kruskal-Wallis, Mann-Whitney U, chi-square tests, and receiver-operating characteristic (ROC) curve were used for statistical assessment. Results: ADCmin, ADC10, and ADC25 were found to be significantly different among AC, SCC, and SCLC groups; these parameters were higher for AC group, moderate for SCC group, and significantly lower for SCLC group. Skewness and kurtosis were not significantly different among all groups. The ROC analysis for differentiating BMs of NSCLC from SCLC showed that ADC25 achieved the highest area under the curve at 0.922 with 93.02% sensitivity and 81.25% specificity. Conclusion: Apparent diffusion coefficient histogram analysis of BMs from lung cancer has significant prognostic value in differentiating histological subtypes of lung cancer.
Symptom Score: A New Instrument to Assess Orthostatic Intolerance in Children and Adolescents
Authors: Cai Hong , Wang Shuo , Zou Runmei , Liu Ping , Yang Hong , Wang Yuwen , Wang Cheng 
Published: June 2020

Objective: To develop an orthostatic intolerance symptom scoring system to assess orthostatic intolerance and then to compare the symptom score among different head-up tilt test responses. Methods: 272 subjects (5-18 years) presenting with orthostatic intolerance symptoms finished questionnaire and head-up tilt test. According to head-up tilt test hemodynamic responses, the subjects were divided into head-up tilt test negative, vasovagal syncope, and postural tachycardia syndrome groups. Results: We built up a symptom score according to the frequency of dizziness, headache, blurred vision, palpitations, chest discomfort, gastrointestinal symptoms, profuse perspiration, and syncope. The median score in postural tachycardia syndrome subjects was highest. A score of 2.5 for predicting vasovagal syncope yielded a sensitivity of 75.0% and specificity of 50.3%, a score of 5.5 for predicting postural tachycardia syndrome yielded a sensitivity of 69.7% and specificity of 72.0%. Furthermore, the median score in postural tachycardia syndrome subjects was significantly higher than that in head-up tilt test negative subjects with heart rate increment of 30-39 beats/min ( P < .01). Conclusions: This suggests that the symptom score has some predictive value in head-up tilt test results, which can be served as a preliminary assessment instrument.
Percutaneous CT-Guided Cryoablation of the Bilateral Pudendal Nerves for Palliation of Intractable Pain Related to Pelvic Neoplasms
Authors: Prologo John David , Manyapu Sivasai , Bercu Zachary L. , Mittal Ashmit , Mitchell Jason W. 
Published: June 2020

Objectives: The purpose of this report is to describe the effect of computed tomography–guided bilateral pudendal nerve cryoablations on pain and time to discharge in the setting of acute hospitalizations secondary to refractory pelvic pain from cancer. Methods: Investigators queried the medical record for patients who underwent pudendal nerve cryoablation using the Category III Current Procedural Technology code assignment 0442T or Category I code 64640 for cases prior to 2015. The resulting list was reviewed, and procedures performed on inpatients for intractable pelvic pain related to neoplasm were selected. The final cohort was then analyzed with regard to patient demographics, procedure details, technical success, safety, pain scores, and time to discharge. Results: Ten patients underwent cryoablation by 3 operators for palliation of painful pelvic neoplasms between June 2014 and January 2019. All probes were satisfactorily positioned and freeze cycles undertaken without difficulty. There were no procedure-related complications or adverse events. The mean difference in pre- and posttreatment worst pain scores was significant (n = 5.20, P = .003). The mean time to discharge following the procedure was 2.3 days. Conclusion: Computed tomography–guided percutaneous cryoablation of the bilateral pudendal nerves may represent a viable option in the setting of acute hospitalization secondary to intractable pain in patients with pelvic neoplasms.
Atrial Fibrillation and Mitral Regurgitation: Clinical Performance of Direct Oral Anticoagulants in a Real-World Setting
Authors: Melillo Enrico , Rago Anna , Proietti Riccardo , Attena Emilio , Carrella Maddalena , Golino Paolo , D’Onofrio Antonio , Nigro Gerardo , Russo Vincenzo 
Published: June 2020

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is frequently present in patients with mitral regurgitation (MR). Currently, there is a lack of real-world evidence specifically addressing the clinical performance of direct oral anticoagulants (DOACs) in patients with AF and concomitant MR. Therefore, the aim of the present study was to assess the efficacy and safety profile of DOACs therapy in patients with AF and MR. Methods: Data for this study were sourced from the Atrial Fibrillation Research Database in the Department of Cardiology at Monaldi Hospital. The database was queried for AF patients with MR who were prescribed DOACs therapy. The primary safety outcome was defined as the annual incidence rate of major bleeding events and the primary effectiveness outcome as the annual incidence rate of all events classified as ischemic stroke, transient ischemic attacks, and systemic embolisms. Results: Consecutive AF patients with concomitant mild to severe MR who received DOACs therapy (n = 259) were included. Patients were dichotomized in 2 groups according to MR severity: a mild-to-moderate group (MR 1-2+; n = 151) and a moderate-to-severe group (MR 3-4+; n = 108). The incidence rate of major bleedings was significantly higher in MR 3-4+ group (3.92%) compared with the MR 1-2+ group (1.18%; hazard ratio [HR]: 3.2; 95% CI: 1.4-7.3; P = .0059). The incidence rate of thromboembolic events between MR 3-4+ group (0.66%) and MR 1-2+ group (0.62%) was not significantly different (HR: 0.75; P = .823). Conclusions: In the present study, there was no difference in the efficacy profile of DOACs between AF patients with mild-to-moderate and moderate-to-severe MR. Considering the increased bleeding risk, a close and careful follow-up should be warranted for patients with moderate-to-severe MR.
Perioperative cardiovascular complications rate and activity of coagulation and fibrinolysis among patients undergoing vascular surgery for peripheral artery disease and abdominal aortic aneurysm
Authors: Polok Kamil , Górka Jacek , Fronczek Jakub , Iwaniec Teresa , Górka Karolina , Szczeklik Wojciech 
Published: June 2020

Objectives To compare preoperative coagulation and fibrinolysis activity and incidence of perioperative complications between patients undergoing vascular procedures for peripheral artery disease and abdominal aortic aneurysm. Methods This is a substudy of a prospective observational cohort study (VISION; NCT00512109) in which we recruited patients aged ≥45 years, undergoing surgery for peripheral artery disease and abdominal aortic aneurysm. Blood samples were obtained 24 h preoperatively to measure platelet count, concentrations of coagulation coagulation (fibrinogen, factor VIII, von Willebrand factor:Ristocetin cofactor, antithrombin III), fibrinolysis (dimer D, plasmin–antiplasmin complexes, tissue plasminogen activator) markers and level of soluble CD40 ligand. Incidence of myocardial infarction, stroke, and death (composite endpoint) was assessed in 30-day follow-up. Results The study group included 131 patients at the mean age of 68.3 years among whom reason for surgery was peripheral artery disease in 77 patients (58.8%) and abdominal aortic aneurysm in 54 patients (41.2%). Peripheral artery disease group was characterized by higher platelet count (250.5 versus 209.5 (×10 3 /µl), p = 0.001), concentrations of fibrinogen (5.4 versus 4.1 (g/l), p < 0.001), factor VIII (176.9 versus 141.9 (%), p < 0.001), von Willebrand factor:Ristocetin cofactor (188.9 versus 152.3 (%), p = 0.009), and soluble CD40 ligand (9016.0 versus 7936.6 (pg/ml), p = 0.005). The dimer D level was higher (808.0 versus 2590.5 (ng/ml), p < 0.001) in the abdominal aortic aneurysm group. Incidence of major cardiovascular events (death, myocardial infarction, stroke) within 30 days from surgery did not differ between the groups (39.0% versus 29.6%, p = 0.27). Conclusions The study suggests higher activation of coagulation and relatively lower fibrinolytic activity in peripheral artery disease group compared to patients undergoing surgery for abdominal aortic aneurysm without a significant difference in cardiovascular outcomes.
Is group and save still a necessary test in the preoperative workup for breast cancer surgery?
Authors: Batt Jeremy , Chambers Alice , Mason Jennifer , Mullan Michelle 
Published: June 2020

Introduction Trust guidelines state that patients undergoing mastectomy have one group and save (G&S) sample preoperatively, or two for bilateral or complex mastectomy. Breast surgical patients rarely require blood transfusion, and G&S testing is costly and labour intensive. Our study assessed whether preoperative G&S testing is warranted for breast surgery patients. Methods Retrospective review of consecutive patients undergoing mastectomies from one centre, from June 2018 to June 2019 identified 190 women. Review of electronic records for G&S tests was performed and transfusions prescribed. Discussion with laboratory personnel regarding costs of processing G&S tests. Results Forty-six (32%) patients who underwent simple mastectomies had one G&S, eight (6%) patients had two. Twenty (45%) patients who underwent bilateral/complex mastectomy/reconstruction had one G&S and four (9%) had two. No patients required peri or postoperative blood transfusions. Seventy-eight G&S tests performed cost the trust £1,082. Conclusion Simple mastectomies rarely require blood transfusions. G&S tests cost £13.83 and are time consuming for the patient and laboratory. We propose that G&S tests are unnecessary for patients undergoing simple mastectomies and preoperative protocols require adjustment. Trust policy is to have ‘routine G&S'; however, 124 patients did not have any G&S testing. Had the guideline been followed, this would have cost the Trust a further £1,715.