bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of Upfront Docetaxel With Androgen Deprivation Therapy for Castration-Sensitive Metastatic Prostate Cancer Among Minority Patients
Authors: Pathak Surabhi , Thekkekara Romy , Yadav Udit , Ahmed Ahmed Tarig , Yim Barbara , Lad Thomas E. , Mullane Michael , Batra Kumar Kunnal , Aronow Wilbert S. , Psutka Sarah P. 
Published: May 2020

Background:
Upfront docetaxel (UD) with androgen deprivation therapy (ADT) has been demonstrated to improve survival outcomes in metastatic castration-sensitive prostate cancer (mCSPC). However, existing studies have included predominantly Caucasian patients.

Study Question:
To compare the efficacy of addition of UD to ADT in mCSPC to ADT alone among minority patients.

Study Design:
Retrospective study of mCSPC patients.

Measures and Outcomes:
Patients treated with UD and ADT between January 2014 and December 2017 (UD + ADT, n = 44) were compared with those treated with ADT alone between January 2008 and January 2017 (ADT, n = 38); patients of Caucasian ethnicity were excluded. The outcome of interest was progression-free survival (PFS), which was estimated using Kaplan–Meier analysis and Cox proportional hazard analysis.

Results:
Overall, 63 (76.8%) patients were African American and 16 (19.5%) were Hispanic. Fifty-five (67%) patients had high-volume mCSPC. The median follow-up was 14 months [95% confidence interval (CI): 10.4–16.5] for UD + ADT and 42 months (95% CI: 17–66.9) for ADT. Median PFS did not differ between groups: UD + ADT: 16 versus ADT: 18 months [hazard ratio (HR) for UD + ADT = 0.88, 95% CI: 0.48–1.62; P = 0.70]. In patients with high-volume disease, median PFS remained similar (UD + ADT: 16 vs. ADT: 14 months (HR for UD + ADT = 0.64, 95% CI: 0.33–1.25; P = 0.19). On multivariable analysis, prolonged time to nadir PSA, HR = 0.83 (95% CI: 0.76–0.90), was independently associated with PFS. The most common toxicities in UD + ADT were anemia and fatigue. Major limitations include small sample size and potential for selection bias due to the retrospective study design.

Conclusions:
In this retrospective review of a minority mCSPC cohort, UD + ADT was not associated with improved PFS compared with ADT alone. Although further study with larger sample size is needed, these results underscore the importance of ensuring accrual of minorities in clinical trials, reflective of the real-world setting.
Short Versus Long Timing of Flushing of Totally Implantable Venous Access Devices When Not Used Routinely
Authors: Clari Marco , Spoto Maria , Franceschi Giordana , Acuto Martina , Tonella Simone , Caristia Silvia , Buratti Giulia , Gaboardi Samanta , Rasero Laura , Campagna Sara , Busca Erica , Dal Molin Alberto 
Published: May 2020

Background
Flushing and locking of totally implantable venous access devices (TIVADs) is recommended to maintain their patency when not in use. Although manufacturers’ recommendations indicate monthly access for TIVAD maintenance, there is a tendency in real life to prolong this interval.

Objectives
To assess the effectiveness of prolonged versus short flushing and locking intervals to prevent TIVAD occlusions in adults with cancer.

Methods
A systematic search was carried out in MEDLINE, EMBASE, CINAHL, and Web of Science. Two reviewers independently selected studies, assessed quality, and extracted data. Study findings were summarized, and a meta-analysis conducted.

Results
Six articles were included in the review, with a total of 1255 participants. Differences in types of cancers, flushing and locking techniques, and volume and concentration of heparin were described. Pooled results from 4 studies showed fewer catheter occlusions in favor of prolonged flushing and locking intervals (relative risk, 0.81), even if not statistically significant (95% confidence interval, 0.41–1.61) with no heterogeneity among studies (I
2 = 0.00%, P = .69). The quality of evidence was very low.

Conclusions
Very low-quality evidence suggests that prolonged schedule flushing and locking intervals has no effect on catheter patency. However, because of low number and poor quality of evidence derived from the studies analyzed, findings of this meta-analysis should be interpreted with caution.

Implications for Practice
No statistically significant difference in occlusion rate between short and long timing of flushing was found. However, further studies are necessary to strengthen the safe implementation of longer intervals in clinical practice.
The Diagnostic Value of the Changes in the Renal Glomerulus in the Postmortem Diagnosis of Freshwater Drownings
Authors: Demirci Tuba , Sener Mustafa Talip , Sahpaz Ahmet , Sener Ebru , Kok Ahmet Nezih 
Published: May 2020

AbstractDrowning is one of the major causes of unintentional injury death worldwide. As there are no pathomorphological findings specific to the diagnosis of drowning, definitive postmortem diagnosis of drowning continues to be a significant problem in forensic medicine. This study aims to present an additional diagnostic sign in cases of freshwater drowning by investigating the histopathological changes of renal tissue in the postmortem diagnosis of freshwater drowning. For this purpose, 103 cases were investigated in which the causes of death were freshwater drowning (n = 45), traffic accidents (n = 33) and acute myocardial infarction (n = 25). Renal corpuscular structures of selected cases were examined stereologically and histopathologically. Renal corpuscle diameter, renal corpuscle surface area, glomerular tuft surface area, and Bowman space were calculated by stereological method. When compared with the glomeruli of the control group, renal corpuscle diameter, renal corpuscle surface area, glomerular tuft surface area, and Bowman space values of kidney tissues of all freshwater drowning cases were found to be decreased (P< 0.001). These changes may be considered as an essential histopathological finding in postmortem diagnosis of freshwater drowning cases.
An Evaluation of Age-Based Differences in the Demographic Features and Clinical Outcomes of Trauma Rehabilitation Patients
Authors: MacDonald Shannon L. , Robinson Lawrence R. 
Published: May 2020

Objective
The aims of the study were to describe potential age-related differences in injury type and mechanism, comorbidities, and physical medicine and rehabilitation–relevant complications in patients admitted after major trauma and to examine whether functional outcomes vary by age group after traumatic injury.

Design
This is a subanalysis of a pre-post study. Individuals admitted to a level 1 trauma center who sustained major trauma were divided into three age groups (young, middle age, and elderly). The demographic, acute care, and rehabilitation factors for these patients were then compared across the three age groups.

Results
Based on an age distribution plot, the age categories were defined as follows: young, 18–39 yrs (n = 120); middle age, 40–64 yrs (n = 124); and elderly, 65 yrs or older (n = 85). Patients 65 yrs or older demonstrated a greater frequency of comorbidities (P < 0.001) and complications (P < 0.001). For individuals admitted to inpatient rehabilitation, admission and discharge functional independence measure scores were lower for the elderly individuals, but functional independence measure change was not significantly different between groups.

Conclusions
Although the elderly trauma patient demonstrates important differences from the younger one, capacity for improvement with rehabilitation seems similar.
Optimizing High-risk Infant Follow-up in Nonresearch-based Paradigms: The New England Follow-up Network
Authors: Litt Jonathan S. , Edwards Erika M. , Lainwala Shabnam , Mercier Charles , Montgomery Angela , O’Reilly Deirdre , Rhein Lawrence , Woythaler Melissa , Hartman Tyler 
Published: May 2020

Objectives:
To establish the first regional quality improvement collaborative solely dedicated to follow-through care of high-risk infants after Neonatal intensive care unit (NICU) discharge and to characterize extremely low birth weight (ELBW) follow-up in New England.

Methods:
Eleven of 14 follow-up programs in New England partnered with the Vermont Oxford Network (VON) ELBW project for an initial data collection project. We collected information about the health status and developmental outcomes of infants born ≤1,000 g or younger than 28 weeks 2014–2016 at the 18–24 months corrected for gestational age (CGA) follow-up visit. VON collected and compiled the data.

Results:
Of 993 eligible infants, 516 (52.0%) had follow-up visits. The rehospitalization rate was 33.9%, mostly respiratory illness. Ninety-six children (19.3%) had weight less than 10th percentile and 44 (8.9%) had weight less than third percentile at 18–24 months. Only 170 (61.4%) children had recommended hearing screening after NICU discharge. Forty-six (9.1%) had cerebral palsy; 81 of the 441 infants that completed all 3 sections of the Bayley Scales of Infant Development, third edition (18.4%) had any composite score less than 70. Over half of the social and demographic data were missing.

Conclusion:
Most quality initiatives in neonatology stop at NICU discharge. This first project by the New England Follow-up Network showed a low rate for clinical follow-up. It demonstrated many opportunities to improve postdischarge follow-through specific to NICU-based care. Future projects will aim to improve the quality of follow-through services through collaborative learning, data sharing, and comparative outcomes.
The Efficacy of Breast Implant Irrigant Solutions: A Comparative Analysis Using an In Vitro Model
Authors: Ngaage Ledibabari M. , Elegbede Adekunle , Brao Kristen , Chopra Karan , Gowda Arvind U. , Nam Arthur J. , Ernst Robert K. , Shirtliff Mark E. , Harro Janette , Rasko Yvonne M. 
Published: May 2020

Background:
Infections are challenging complications of implant-based breast reconstruction and augmentation. They pose a clinical challenge, with significant economic implications. One proposed solution is implant irrigation at the time of placement. There is no consensus on the optimal irrigant solution.

Methods:
The authors tested the relative efficacy of 10% povidone-iodine, Clorpactin, Prontosan, triple-antibiotic solution, or normal saline (negative control) against two strains each of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis. Sterile, smooth silicone implant disks were immersed in irrigant solution, then incubated in suspensions of methicillin-resistant S. aureus or S. epidermidis overnight. The disks were rinsed and sonicated to displace adherent bacteria from the implant surface, and the displaced bacteria were quantified. Normalized values were calculated to characterize the relative efficacy of each irrigant.

Results:
Povidone-iodine resulted in reductions of the bacterial load by a factor of 104 to 105 for all strains. Prontosan-treated smooth breast implant disks had a 10-fold reduction in bacterial counts for all but one methicillin-resistant S. aureus strain. In comparison to Prontosan, triple-antibiotic solution demonstrated a trend of greater reduction in methicillin-resistant S. aureus bacterial load and weaker activity against S. epidermidis strains. Clorpactin reduced the recovered colony-forming units for only a single strain of S. epidermidis. Povidone-iodine demonstrated the greatest efficacy against all four strains. However, Clorpactin, triple-antibiotic solution, and Prontosan demonstrated similar efficacies.

Conclusions:
Povidone-iodine was the most efficacious of the irrigants at reducing methicillin-resistant S. aureus and S. epidermidis contamination. Given the recent lifting of the U.S. Food and Drug Administration moratorium, larger clinical studies of povidone-iodine as a breast implant irrigant solution are warranted.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Projecting the impact of equity-based preexposure prophylaxis implementation on racial disparities in HIV incidence among MSM
Authors: Goedel William C. , Bessey S. , Lurie Mark N. , Biello Katie B. , Sullivan Patrick S. , Nunn Amy S. , Marshall Brandon D.L. 
Published: May 2020

Background:
It is unknown what levels of preexposure prophylaxis (PrEP) use are needed to reduce racial disparities in HIV incidence among men who have sex with men (MSM). Using an agent-based model, we quantified the impact of achieving PrEP coverage targets grounded in equity on racial disparities in HIV incidence among MSM in an urban setting in the Southeastern United States.

Methods:
An agent-based model was adapted to simulate HIV transmission in a network of Black/African American and White MSM aged 18–39 years in the Atlanta–Sandy Springs–Roswell metropolitan area over 10 years (2015–2024). Scenarios simulated coverage levels consistent with targets based on the ratio of the number of individuals using PrEP to the number of individuals newly diagnosed in a calendar year (i.e., the ‘PrEP-to-need ratio’), ranging from 1 to 10. Incidence rate ratios and differences were calculated as measures of disparities.

Results:
Without PrEP, the model predicted a rate ratio of 3.82 and a rate difference of 4.50 comparing HIV incidence in Black/African American and White MSM, respectively. Decreases in the rate ratio of at least 50% and in the rate difference of at least 75% were observed in all scenarios in which the PrEP-to-need ratio among Black/African American MSM was 10, regardless of the value among White MSM.

Conclusion:
Significant increases in PrEP use are needed among Black/African American MSM to reduce racial disparities in HIV incidence. PrEP expansion must be coupled with structural interventions to address vulnerability to HIV infection among Black/African American MSM.
Estimating the Population Size of Female Sex Workers in Zimbabwe: Comparison of Estimates Obtained Using Different Methods in Twenty Sites and Development of a National-Level Estimate
Authors: Fearon Elizabeth , Chabata Sungai T. , Magutshwa Sitholubuhle , Ndori-Mharadze Tendayi , Musemburi Sithembile , Chidawanyika Henry , Masendeke Absolom , Napierala Sue , Gonese Elizabeth , Herman Roloff Amy , Tippett Barr Beth A. , Kilmarx Peter H. , Wong-Gruenwald Ramona , Chidiya Samson , Mhangara Mutsa , Hanisch Dagmar , Edwards Jessie K. , Rice Brian , Taramusi Isaac , Mbengeranwa Tendai , Manangazira Portia , Mugurungi Owen , Hargreaves James R. , Cowan Frances M. 
Published: May 2020

Background:
National-level population size estimates (PSEs) for hidden populations are required for HIV programming and modelling. Various estimation methods are available at the site-level, but it remains unclear which are optimal and how best to obtain national-level estimates.

Setting:
Zimbabwe.

Methods:
Using 2015–2017 data from respondent-driven sampling (RDS) surveys among female sex workers (FSW) aged 18+ years, mappings, and program records, we calculated PSEs for each of the 20 sites across Zimbabwe, using up to 3 methods per site (service and unique object multipliers, census, and capture-recapture). We compared estimates from different methods, and calculated site medians. We estimated prevalence of sex work at each site using census data available on the number of 15–49-year-old women, generated a list of all “hotspot” sites for sex work nationally, and matched sites into strata in which the prevalence of sex work from sites with PSEs was applied to those without. Directly and indirectly estimated PSEs for all hotspot sites were summed to provide a national-level PSE, incorporating an adjustment accounting for sex work outside hotspots.

Results:
Median site PSEs ranged from 12,863 in Harare to 247 in a rural growth-point. Multiplier methods produced the highest PSEs. We identified 55 hotspots estimated to include 95% of all FSW. FSW nationally were estimated to number 40,491, 1.23% of women aged 15–49 years, (plausibility bounds 28,177–58,797, 0.86–1.79%, those under 18 considered sexually exploited minors).

Conclusion:
There are large numbers of FSW estimated in Zimbabwe. Uncertainty in population size estimation should be reflected in policy-making.
Brief Report: Diminished Coinhibitory Molecule 2B4 Expression Is Associated With Preserved iNKT Cell Phenotype in HIV Long-Term Nonprogressors
Authors: Ansari Abdul W. , Ahmad Fareed , Shankar Esaki M. , Yong Yean K. , Tan Hong Y. , Jacobs Roland , Larsson Marie , Velu Vijayakumar , Kamarulzaman Adeeba , Schmidt Reinhold E. 
Published: May 2020

Background:
We have previously shown an association of elevated coinhibitory molecule 2B4 expression with iNKT cells alterations in HIV disease. Herein, we show a comparative analysis of 2B4 expression on iNKT cells of HIV long-term nonprogressors (LTNPs) and progressors.

Methods:
Antiretroviral therapy–naive HIV-seropositive individuals (progressors, n = 16) and LTNPs (n = 10) were recruited for this study. We used multicolor flow cytometry on frozen peripheral blood mononuclear cells to determine iNKT subset frequencies, the levels of coinhibitory 2B4 expression, and intracellular interferon-γ (IFN-γ) production. CD1d tetramer was used to characterize iNKT cells.

Results:
We report significantly lower level of 2B4 expression on bulk LTNPs iNKT cells and on their CD4 subsets compared with HIV progressors. Furthermore, the iNKT cells from LTNPs produced higher amount of IFN-γ than HIV progressors as detected by intracellular cytokine staining. Interestingly, the frequency of 2B4+iNKT cells of progressors but not LTNPs significantly correlates with CD4 T-cell count, HIV viral load, and IFN-γ+ production by iNKT cells.

Conclusion:
Our results suggest that in addition to suppressed HIV replication, diminished 2B4 expression and associated coinhibitory signaling, and substantial production of IFN-γ could contribute to preserved iNKT cell phenotype in LTNPs.
Coronary Computed Tomography Angiography in the Clinical Workflow of Athletes With Anomalous Origin of Coronary Arteries From the Contralateral Valsalva Sinus
Authors: Marano Riccardo , Merlino Biagio , Savino Giancarlo , Natale Luigi , Rovere Giuseppe , Paciolla Fabiano , Muciaccia Massimo , Flammia Francesco C. , Larici Anna R. , Palmieri Vincenzo , Zeppilli Paolo , Manfredi Riccardo 
Published: May 2020

Purpose:
This study aimed to assess the role of coronary computed tomography-angiography (CCTA) in the workflow of competitive sports eligibility in a cohort of athletes with anomalous origin of the left-coronary artery (AOLCA)/anomalous origin of the right-coronary artery (AORCA) in an attempt to outline relevant computed tomography features likely to impact diagnostic assessment and clinic management.

Materials and Methods:
Patients with suspected AOLCA/AORCA at transthoracic echocardiography or with inconclusive transthoracic echocardiography underwent CCTA to rule out/confirm and characterize the anatomic findings: partially interarterial course or full-INT, high-take-off, acute-take-off-angle (ATO), slit-like origin, intramural course (IM), interarterial-course-length, and lumen-reduction/hypoplasia (HYPO).

Results:
CCTA identified 28 athletes: 6 AOLCA (3 males; 20.3±11.0 y) and 22 AORCA (18 males; 29.1±16.5 y). Symptoms were present only in 13 athletes (46.4%; 10 AORCA). Four patients (3 AORCA) had abnormal rest electrocardiogram, 11 (40.7%; 9 AORCA) had abnormal stress-electrocardiogram. The INT course was observed in 15 athletes (53.6%): 6/6 AOLCA and 9/22 AORCA (40.9%). Slit-like origin was present in 7/22 AORCA (31.8%) and never in AOLCA. Suspected IM resulted in 3 AOLCA (50%), always with HYPO/ATO, and in 6/22 AORCA (27.3%) with HYPO. No statistically significant differences were found between asymptomatic/symptomatic patients in the prevalence of partially INT/INT courses, high-take-off/ATO, and slit-like ostium. A slightly significant relationship between suspected proximal-IM (r=0.47, P<0.05) and proximal-HYPO of anomalous vessel (r=0.65, P<0.01) resulted in AORCA and was confirmed on AOLCA/AORCA pooled analysis (r=0.58, P<0.01 for HYPO). All AOLCA/AORCA athletes were disqualified from competitive sports and warned to avoid vigorous physical efforts. Surgery was recommended to all AOLCA athletes and to 13 AORCA (3 asymptomatic), but only 6 underwent surgery. No major cardiovascular event/ischemic symptoms/signs developed during a mean follow-up of 49.6±39.5 months.

Conclusion:
CCTA provides essential information for safe/effective clinical management of athletes, with important prognostic/sport-activity implications.
Four-Corner Arthrodesis Versus Proximal Row Carpectomy for Scapholunate Advanced Collapse
Authors: Amer Kamil M. , Thomson Jennifer E. , Vosbikian Michael M. , Ahmed Irfan 
Published: May 2020

Background
Scapholunate advanced collapse (SLAC) of the wrist is one of the most common patterns of degenerative arthritis in the wrist. Surgical intervention is warranted for individuals with symptomatic SLAC and degenerative disease that affects the radioscaphoid joint. The most popular options for motion-preserving reconstruction and treatment of this disease include 4-corner arthrodesis and proximal row carpectomy. The purpose of this article was to conduct a systematic literature review and meta-analysis to identify any differences in the clinical outcomes of 4-corner arthrodesis and proximal row carpectomy for the treatment of SLAC.

Methods
An electronic literature search of PubMed, Embase, OVID, and the Cochrane Library was conducted to identify studies evaluating the clinical outcomes of 4-corner arthrodesis versus proximal row carpectomy for the treatment of SLAC. Primary outcome measures included flexion/extension range of motion, grip strength, and level of pain.

Results
Eight studies encompassing 311 patients met the inclusion criteria for the meta-analysis. Our meta-analysis indicated that when compared with 4-corner arthrodesis, patients who underwent proximal row carpectomy had statistically significantly increased flexion/extension range of motion by 6.2 degrees, significantly increased grip strength by 1.52%, and reduced level of pain by 0.3.

Conclusions
This study demonstrated that in comparative studies, there was a statistical difference favoring proximal row carpectomy to 4-corner arthrodesis for the treatment of SLAC. Although these differences were statistically significant, they remain very small and lack clinical relevance. This study further supports that both of these treatment options are equivalent for the treatment of this disease. Although not clinically significant, compared with 4-corner arthrodesis, patients treated with proximal row carpectomy had increased range of motion, increased grip strength, and decreased pain. Limitations to these findings are the small number of studies available and the increased heterogeneity between the studies. Further studies need to be conducted to confirm these findings.