bluuebunny/crossref_metadata_2025_split huggingface dataset:
Salvage Reirradiation Options for Locally Recurrent Prostate Cancer: A Systematic Review
Authors: Zhong Jim , Slevin Finbar , Scarsbrook Andrew F. , Serra Maria , Choudhury Ananya , Hoskin Peter J. , Brown Sarah , Henry Ann M. 
Published: September 2021

BackgroundReirradiation using brachytherapy (BT) and external beam radiation therapy (EBRT) are salvage strategies with locally radiorecurrent prostate cancer. This systematic review describes the oncologic and toxicity outcomes for salvage BT and EBRT [including Stereotactic Body Radiation Therapy (SBRT)].MethodsAn International Prospective Register of Systematic Reviews (PROSPERO) registered (#211875) study was conducted using Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. EMBASE and MEDLINE databases were searched from inception to December 2020. For BT, both low dose rate (LDR) and high dose rate (HDR) BT techniques were included. Two authors independently assessed study quality using the 18-item Modified Delphi technique.ResultsA total of 39 eligible studies comprising 1967 patients were included (28 BT and 11 SBRT). In 35 studies (90%), the design was single centre and/or retrospective and no randomised prospective studies were found. Twelve BT studies used LDR only, 11 HDR only, 4 LDR or HDR and 1 pulsed-dose rate only. All EBRT studies used SBRT exclusively, four with Cyberknife alone and 7 using both Cyberknife and conventional linear accelerator treatments. Median (range) modified Delphi quality score was 15 (6-18). Median (range) follow-up was 47.5 months (13-108) (BT) and 25.4 months (21-44) (SBRT). For the LDR-BT studies, the median (range) 2-year and 5-year bRFS rates were 71% (48-89.5) and 52.5% (20-79). For the HDR-BT studies, the median (range) 2-year and 5-year bRFS rates were 74% (63-89) and 51% (45-65). For the SBRT studies, the median (range) 2-year bRFS for the SBRT group was 54.9% (40-80). Mean (range) acute and late grade≥3 GU toxicity rates for LDR-BT/HDR-BT/SBRT were 7.4%(0-14)/2%(0-14)/2.7%(0-8.7) and 13.6%(0-30)/7.9%(0-21.3%)/2.7%(0-8%). Mean (range) acute and late grade≥3 GI toxicity rates for LDR-BT/HDR-BT/SBRT were 6.5%(0-19)/0%/0.5%(0-4%) and 6.4%(0-20)/0.1%(0-0.9)/0.2%(0-1.5). One third of studies included Patient Reported Outcome Measures (PROMs).ConclusionsSalvage reirradiation of radiorecurrent prostate cancer using HDR-BT or SBRT provides similar biochemical control and acceptable late toxicity. Salvage LDR-BT is associated with higher late GU/GI toxicity. Challenges exist in comparing BT and SBRT from inconsistencies in reporting with missing data, and prospective randomised trials are needed.
Pancreatic Enzyme Replacement Therapy in Patients Undergoing First-Line Gemcitabine Plus nab-paclitaxel for Advanced Pancreatic Adenocarcinoma
Authors: Trestini Ilaria , Carbognin Luisa , Peretti Umberto , Sperduti Isabella , Caldart Alberto , Tregnago Daniela , Avancini Alice , Auriemma Alessandra , Orsi Giulia , Pilotto Sara , Frulloni Luca , Capurso Gabriele , Bria Emilio , Reni Michele , Tortora Giampaolo , Milella Michele 
Published: September 2021

BackgroundThe clinical consequences of pancreatic exocrine insufficiency and its treatment in advanced pancreatic ductal adenocarcinoma (PDAC) are poorly investigated. This retrospective study aims at investigating the pancreatic enzyme replacement therapy (PERT) use and its impact on survival and maldigestion-related symptoms in advanced PDAC patients undergoing chemotherapy.MethodsA retrospective analysis was conducted on advanced PDAC patients, treated with first-line gemcitabine plus nab-paclitaxel at two academic institutions (March 2015-October 2018). Data were correlated with overall survival (OS) using Cox regression model. Kaplan-Meier curves were compared using Log-Rank test.ResultsData from 110 patients were gathered. PERT was administered in 55 patients (50%). No significant differences in baseline characteristics with those who did not receive PERT were found. Median OS for the entire group was 12 months (95% CI 9-15). At multivariate analysis, previous surgical resection of the primary tumor, (HR 2.67, p=0.11), weight gain after 3 months (HR 1.68, p=0.07) and PERT (HR 2.85, p ≤ 0.001) were independent predictors of OS. Patients who received PERT reported an improvement of maldigestion-related symptoms at 3 months more frequently than patients who did not (85.2% vs 14.8%, p ≤ 0.0001).ConclusionPERT is associated with significantly prolonged survival and maldigestion-related symptoms alleviation in advanced PDAC patients.
MRI-Based Nomogram of Prostate Maximum Sectional Area and Its Zone Area for Prediction of Prostate Cancer
Authors: Jiang Shaoqin , Huang Zhangcheng , Liu Bingqiao , Chen Zhenlin , Xu Yue , Zheng Wenzhong , Wen Yaoan , Li Mengqiang 
Published: September 2021

ObjectiveTo reduce unnecessary prostate biopsies, we designed a magnetic resonance imaging (MRI)-based nomogram prediction model of prostate maximum sectional area (PA) and investigated its zone area for diagnosing prostate cancer (PCa).MethodsMRI was administered to 691 consecutive patients before prostate biopsies from January 2012 to January 2020. PA, central gland sectional area (CGA), and peripheral zone sectional area (PZA) were measured on axial T2-weighted prostate MRI. Multivariate logistic regression analysis and area under the receiver operating characteristic (ROC) curve were performed to evaluate and integrate the predictors of PCa. Based on multivariate logistic regression coefficients after excluding combinations of collinear variables, three models and nomograms were generated and intercompared by Delong test, calibration curve, and decision curve analysis (DCA).ResultsThe positive rate of PCa was 46.74% (323/691). Multivariate analysis revealed that age, PSA, MRI, transCGA, coroPZA, transPA, and transPAI (transverse PZA-to-CGA ratio) were independent predictors of PCa. Compared with no PCa patients, transCGA (AUC = 0.801) was significantly lower and transPAI (AUC = 0.749) was significantly higher in PCa patients. Both of them have a significantly higher AUC than PSA (AUC = 0.714) and PV (AUC = 0.725). Our best predictive model included the factors age, PSA, MRI, transCGA, and coroPZA with the AUC of 0.918 for predicting PCa status. Based on this predictive model, a novel nomogram for predicting PCa was conducted and internally validated (C-index = 0.913).ConclusionsWe found the potential clinical utility of transCGA and transPAI in predicting PCa. Then, we firstly built the nomogram based on PA and its zone area to evaluate its diagnostic efficacy for PCa, which could reduce unnecessary prostate biopsies.
Development and Verification of a Prostate Cancer Prognostic Signature Based on an Immunogenomic Landscape Analysis
Authors: Cheng Hong , Wang Yi , Liu Chunhui , Wu Tiange , Chen Shuqiu , Chen Ming 
Published: September 2021

PurposeProstate cancer (PCa) has a high incidence among older men. Until now, there are no immunological markers available to predict PCa patients’ survival. Therefore, it is necessary to explore the immunological characteristics of PCa.MethodsFirst, we retrieved RNA-seq and clinical data of 499 PCa and 52 normal prostate tissue samples from the Cancer Genome Atlas (TCGA). We identified 193 differentially expressed immune-related genes (IRGs) between PCa and normal prostate tissues. Functional enrichment analyses showed that the immune system can participate in PCa initiation. Then, we constructed a correlation network between transcription factors (TFs) and IRGs. We performed univariate and multivariate Cox regression analyses and identified five key prognostic IRGs (S100A2, NOX1, IGHV7-81, AMH, and AGTR1). Finally, a predictive nomogram was established and verified by the C-index.ResultsWe successfully constructed and validated an immune-related PCa prediction model. The signature could independently predict PCa patients’ survival. Results showed that high-immune-risk patients were correlated with advanced stage. We also validated the S100A2 expression in vitro using PCa and normal prostate tissues. We found that higher S100A2 expressions were related to lower biochemical recurrences. Additionally, higher AMH expressions were related to higher Gleason score, lymph node metastasis and positive rate, and tumor stages, and higher ATGR1 expressions were related to lower PSA value.ConclusionOverall, we detected five IRGs (S100A2, NOX1, IGHV7-81, AMH, and AGTR1) that can be used as independent PCa prognostic factors.
Management of Recurrent Endometrial Cancer or Atypical Endometrial Hyperplasia Patients After Primary Fertility-Sparing Therapy
Authors: Chen Junyu , Cao Dongyan , Yang Jiaxin , Yu Mei , Zhou Huimei , Cheng Ninghai , Wang Jinhui , Zhang Ying , Peng Peng , Shen Keng 
Published: September 2021

ObjectiveTo evaluate the efficacy and prognosis of fertility-sparing re-treatment on patients with recurrent endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) who wish to preserve their uterus after complete remission (CR) for primary conservative therapy.MethodsWe performed a retrospective study on recurrent EC or AEH patients who received fertility-sparing re-treatment after achieving CR. Data regarding clinicopathological factors, adverse events, treatment efficacy, tumor prognosis, and reproductive outcome were analyzed.ResultsOf the 98 recurrent patients with a median disease-free interval period of 19 (3–96) months, 18 patients decided to receive hysterectomy directly, and 80 patients received fertility-preserving re-treatment. Seventy-one (88.6%) cases achieved CR, 96.0% in AEH and 75.8% in EC patients, with the 6 (3–16) months’ median CR time. Seven (8.8%) patients failed to achieve CR and then underwent the hysterectomy: one partial response (PR), four stable disease (SD), and two progressive disease (PD). Forty-nine women attempted to get pregnant after CR, 13 (26.5%) became pregnant, seven (14.3%) successfully delivered, and six (12.2%) miscarried. During the follow-up period, 22 (31.0%) women had developed a second relapse with the median recurrence time of 12 (4–90) months, and 10 patients decided to receive the third round of fertility-sparing treatment. Seven (70.0%) patients, 33.3% in EC and 85.7% in AEH, achieved CR again. Hysterectomy was performed in two (20.0%) patients due to SD. After the third-round treatment, six women had the desire to conceive but no one became pregnant successfully.ConclusionFor patients with recurrent EC and AEH after primary conservative treatment, fertility-preserving re-treatment can still achieve a promising response, and patients have possibilities of completing childbirth.
Compensatory Changes in the Anterior Segment and Vascular System of the Eye in Myopic Children After Orthokeratology
Authors: Chen Yanwei , Shen Xi 
Published: September 2021

Purpose: To analyze changes in the anterior segment, retinal vessel density, and choroidal thickness (ChT) after orthokeratology (Ortho-K).Methods: Myopic children were enrolled from Ruijin Hospital, Shanghai, China. Ortho-K lenses and single-vision spectacles were fitted for myopia correction. Ocular measurements were taken at baseline and 6 months, including axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), white to white (WTW), ChT, macular vessel density (MVD), and optic disc vessel density (OVD).Results: Seventy-six patients were enrolled in this study, including 40 in the Ortho-K group and 36 in the control group. At baseline, no parameters between the two groups were statistically different. After 6 months, changes in CCT and ACD decreased in the Ortho-K group compared with those in the control group (p &lt; 0.05); LT and ChT in the Ortho-K group were thicker than those in the control group (p &lt; 0.05), while there was no difference in MVD and OVD compared with those in the control group (p &gt; 0.05). There were moderate positive correlations between ChT and LT and between ChT and OVD in the Ortho-K group (p &lt; 0.05).Conclusion: The changes in the anterior and posterior segments of the eye after Ortho-K lens wearing suggest that the human eye has a powerful compensatory effect on the imposed defocus.
Primary Posterior Tracheopexy in Esophageal Atresia Decreases Respiratory Tract Infections
Authors: van Tuyll van Serooskerken E. Sofie , Tytgat Stefaan H. A. J. , Verweij Johannes W. , Bittermann Arnold J. N. , Coenraad Saskia , Arets Hubertus G. M. , van der Zee David C. , Lindeboom Maud Y. A. 
Published: September 2021

Background:Esophageal atresia (EA) is often accompanied by tracheomalacia (TM). TM can lead to severe respiratory complaints requiring invasive treatment. This study aims to evaluate if thoracoscopic primary posterior tracheopexy (PPT) can prevent the potential sequelae of TM in patients with EA.Methods:A cohort study including all consecutive EA patients treated between 2014 and July 2019 at the Wilhelmina Children's Hospital was conducted. Two groups were distinguished: (group 1) all EA patients born between January 2014 and December 2016 and (group 2) all EA patients born between January 2017 and July 2019, after introduction of PPT. In the latter group, PPT was performed in EA patients with moderate (33–66%) or severe (67–100%) tracheomalacia, seen during preoperative bronchoscopy. Group differences were assessed using the Fisher's exact test for bivariate variables and the Mann–WhitneyU-test for continuous variables.Results:A total of 64 patients were included in this study (28 patients in group 1; 36 patients in group 2). In group 2, PPT was performed in 14 patients. Respiratory tract infections (RTIs) requiring antibiotics within the first year of life occurred significantly less in group 2 (61 vs. 25%,p= 0.004). Brief resolved unexplained events (BRUEs) seemed to diminish in group 2 compared to group 1 (39 vs. 19%,p= 0.09).Conclusion:Thoracoscopic primary posterior tracheopexy decreases the number of respiratory tract infections in EA patients. The clinical impact of reducing RTIs combined with the minimal additional operating time and safety of PPT outweighs the risk of overtreatment.
Peripheral Dopamine Directly Acts on Insulin-Sensitive Tissues to Regulate Insulin Signaling and Metabolic Function
Authors: Tavares Gabriela , Martins Fatima. O. , Melo Bernardete. F. , Matafome Paulo , Conde Silvia. V. 
Published: September 2021

Dopamine is a key regulator of glucose metabolism in the central nervous system. However, dopamine is also present in the periphery and may have direct effects on insulin-sensitive tissues. Dopamine receptor 2 (D2R) agonist bromocriptine is a FDA-approved drug for type 2 diabetes. Herein, we explored the role of peripheral dopamine and its receptors in regulating glucose uptake and metabolism on insulin-sensitive tissues. Peripheral dopamine effect in [3H]2-deoxyglucose uptake in insulin-sensitive tissues was tested in vivo in rats. Direct effects on [3H]2-deoxyglucose uptake, insulin receptor phosphorylation, and regulation of metabolic function were tested ex vivo in the liver, soleus muscle, and white and brown adipose tissues. Bromocriptine and the antagonists domperidone, D2R antagonist, and haloperidol, antagonist of both dopamine receptor 1 (D1R) and D2R, were used to disclose dopamine receptors’ involvement.Peripheral dopamine increases glucose uptake in vivo. Ex vivo, only dopamine increased glucose uptake in the soleus, while bromocriptine increased it in the liver; the effects were reverted by haloperidol and domperidone, respectively. In adipose tissue, domperidone reverted dopamine- and bromocriptine-mediated potentiation of insulin-induced glucose uptake, but in turn increased the insulin receptor, Akt, AMPK, HSL, ACC, and ACL, phosphorylation. In the soleus muscle, AMPK-phosphorylation increased with bromocriptine and dopamine whose effects were suppressed by domperidone and haloperidol.In conclusion, peripheral dopamine stimulates glucose uptake with its receptors being differentially involved in glucose uptake in insulin-sensitive tissues. Dopamine also has a role in lipid metabolism in white adipose tissue. Altogether, these results suggest that peripheral modulation of the dopaminergic system should be further evaluated as a putative therapeutic approach for metabolic disorders.
Antidepressant and Anxiolytic Effects of Medicinal Cannabis Use in an Observational Trial
Authors: Martin Erin L. , Strickland Justin C. , Schlienz Nicolas J. , Munson Joel , Jackson Heather , Bonn-Miller Marcel O. , Vandrey Ryan 
Published: September 2021

Background: Anxiety and depressive disorders are highly prevalent. Patients are increasingly using medicinal cannabis products to treat these disorders, but little is known about the effects of medicinal cannabis use on symptoms of anxiety and depression. The aim of the present observational study was to assess general health in medicinal cannabis users and non-using controls with anxiety and/or depression.Methods: Participants (368 Cannabis Users; 170 Controls) completed an online survey assessing anxiety and depressive symptoms, cannabis product use, sleep, quality of life, and comorbid chronic pain. Participants that completed this baseline survey were then invited to complete additional follow-up surveys at 3-month intervals. Baseline differences between Cannabis Users and Controls were assessed using independent-samples t-tests and generalized linear mixed effects models were used to assess the impact of initiating cannabis product use, sustained use, or discontinuation of use on anxiety and depressive symptoms at follow-up.Results: Medicinal cannabis use was associated with lower self-reported depression, but not anxiety, at baseline. Medicinal cannabis users also reported superior sleep, quality of life, and less pain on average. Initiation of medicinal cannabis during the follow-up period was associated with significantly decreased anxiety and depressive symptoms, an effect that was not observed in Controls that never initiated cannabis use.Conclusions: Medicinal cannabis use may reduce anxiety and depressive symptoms in clinically anxious and depressed populations. Future placebo-controlled studies are necessary to replicate these findings and to determine the route of administration, dose, and product formulation characteristics to optimize clinical outcomes.
The Impact of COVID-19 on Hospital Admissions in Croatia
Authors: Kalanj Karolina , Marshall Ric , Karol Karl , Tiljak Mirjana Kujundžić , Orešković Stjepan 
Published: September 2021

Background: The COVID-19 pandemic disrupted hospital care, as hospitals had to deal with a highly infectious virus, while at the same time continuing to fulfill the ongoing health service needs of their communities. This study examines the direct effects of COVID-19 on the delivery of inpatient care in Croatia.Materials and Methods: The research is a retrospective, comparative analysis of the hospital admission rate across all Diagnosis Related Group (DRG) classes before and during the pandemic. It is based on DRG data from all non-specialized acute hospitals in Croatia, which account for 96% of national inpatient activity. The study also used COVID-19 data from the Croatian Institute of Public Health (CIPH).Results: The results show a 21% decrease in the total number of admissions [incident rate ratio (IRR) 0.8, p &lt; 0.0001] across the hospital network during the pandemic in 2020, with the greatest drop occurring in April, when admissions plunged by 51%. The decrease in activity occurred in non-elective DRG classes such as cancers, stroke, major chest procedures, heart failure, and renal failure. Coinciding with this reduction however, there was a 37% increase (IRR 1.39, p &lt; 0.0001) in case activity across six COVID-19 related DRG classes.Conclusions: The reduction in hospital inpatient activity during 2020, can be attributed to a number of factors such as lock-downs and quarantining, reorganization of hospital operations, the rationing of the medical workforce, and the reluctance of people to seek hospital care. Further research is needed to examine the consequences of disruption to hospital care in Croatia. Our recommendation is to invest multidisciplinary effort in reviewing response procedures to emergencies such as COVID-19 with the aim of minimizing their impact on other, and equally important community health care needs.
The Long-Term Impact of the COVID-19 Pandemic on Loneliness in People Living With Disability and Visual Impairment
Authors: Heinze Nikki , Hussain Syeda F. , Castle Claire L. , Godier-McBard Lauren R. , Kempapidis Theofilos , Gomes Renata S. M. 
Published: September 2021

Background: There has been growing concern about the impact of restrictions put in place to contain the coronavirus pandemic on loneliness, particularly in individuals with disabilities. This study explored the longitudinal impact of the pandemic on loneliness in these individuals, with a focus on those living with visual impairment (VI).Methods: An online survey was conducted in April-2020 and repeated in March 2021 to explore current life circumstances, health-related behaviours, sleep (Pittsburgh Sleep Quality Index) and social well-being, including state anxiety (State-Trait Anxiety Index) and loneliness (UCLA Loneliness scale). A convenience sample of 602 participants completed the first survey. Participants who agreed to be re-contacted were invited to take part in the follow-up survey.Results: Data is presented for the 160 participants who completed both timepoints. At both timepoints, median loneliness was significantly higher in participants with disabilities and those with VI than in participants with no disabilities. While there was no significant change in loneliness in any of the three subgroups, participants with VI experienced the largest increase in median loneliness. Loneliness was associated with having a mental health condition and higher levels of state anxiety at both timepoints.Conclusions: Individuals with disabilities such as VI experienced consistently higher levels of loneliness than those with no disabilities throughout the pandemic. While loneliness remained relatively stable in individuals with no disabilities, it increased, albeit to a non-significant level, in those with disabilities and particularly those with VI. Interventions designed to alleviate loneliness may benefit from addressing state anxiety.
Incidence and Outcome of Acute Myocardial Infarction in Patients With Aortic Dissection and Risk Factor Control
Authors: Liu Fang , Qian Si-Chong , Jing Shuai , Wang Zhe , Yang Xin-Chun , Chen Mu-Lei 
Published: September 2021

Background and Aims: The contradiction of management modality between acute myocardial infarction(AMI) and aortic dissection(AD) may result in clinical catastrophe. Data on risk factors, incidence, and outcome of AD and AMI are limited, and there have been no studies on the long-term outcomes of AMI in patients with AD. So we aimed to investigate long-term outcomes after AMI in patients with AD, and propose a useful diagnostic paradigm.Methods: Consecutively enrolled patients with AD and AMI who were referred to our center from 2010 to 2017. Baseline patient characteristics, risk factors, all medical treatments, echocardiographic parameters, laboratory data, and treatment were recorded. All patients were followed up from the first hospitalization until a first heart event, death, or 17 March, 2018.Results: 0.13% in AMI and 7.49% in AD patients had a concomitant diagnosis of AD and AMI. The average patient age was 53.3 ± 12.1 years and 84.6% were male. The most prevalent vascular risk factors were hypertension (69.2%) and current smoker (64.1%). Of all the 39 patients, 66.7% were managed surgically. Overall in-hospital mortality was 10.3%. The 30-day and 5-year fatality rates were 23.1% and 35.9%, but were higher for female than for male (66.7 vs. 30.3%, log-rank P = 0.045) on 5-year mortality. The overall survival of females was inferior to the males (log-rank P = 0.045).Conclusions: Patients with AMI and AD exhibit high 5-year fatality rates. For these patients, surgical management tends to have lower mortality. Improved management of hypertension and smoking, may reduce future incidence rates.