bluuebunny/crossref_metadata_2025_split huggingface dataset:
Conventional 3D conformal radiotherapy and volumetric modulated arc therapy for cervical cancer: Comparison of clinical results with special consideration of the influence of patient- and treatment-related parameters
Authors: Dröge Leif Hendrik , von Sivers Franziska-Felicitas , Schirmer Markus Anton , Wolff Hendrik Andreas 
Published: May 2021

Abstract
Purpose
Intensity-modulated radiotherapy (IMRT) for cervical cancer yields favorable results in terms of oncological outcomes, acute toxicity, and late toxicity. Limited data are available on clinical results with volumetric modulated arc therapy (VMAT). This study’s purpose is to compare outcome and toxicity with VMAT to conventional 3D conformal radiotherapy (3DCRT), giving special consideration to the influence of patient- and treatment-related parameters on side effects.

Materials and methods
Patients with cervical cancer stage I–IVA underwent radiotherapy alone or chemoradiotherapy using 3DCRT (n = 75) or VMAT (n = 30). Survival endpoints were overall survival, progression-free survival, and locoregional control. The National Cancer Institute Common Terminology Criteria for Adverse Events and the Late Effects of Normal Tissues criteria were used for toxicity assessment. Toxicity and patient- and treatment-related parameters were included in a multivariable model.

Results
There were no differences in survival rates between treatment groups. VMAT significantly reduced late small bowel toxicity (OR = 0.10, p = 0.03). Additionally, VMAT was associated with an increased risk of acute urinary toxicity (OR = 2.94, p = 0.01). A low body mass index (BMI; OR = 2.46, p = 0.03) and overall acute toxicity ≥grade 2 (OR = 4.17, p < 0.01) were associated with increased overall late toxicity.

Conclusion
We demonstrated significant reduction of late small bowel toxicity with VMAT treatment, an improvement in long-term morbidity is conceivable. VMAT-treated patients experienced acute urinary toxicity more frequently. Further analysis of patient- and treatment-related parameters indicates that the close monitoring of patients with low BMI and of patients who experienced relevant acute toxicity during follow-up care could improve late toxicity profiles.
Intraoperative radiotherapy boost as part of breast-conservation therapy for breast cancer: a single-institution retrospective analysis
Authors: Stoian Raluca , Erbes Thalia , Zamboglou Constantinos , Scholber Jutta , Gainey Mark , Sachpazidis Ilias , Haehl Erik , Spohn Simon K. B. , Verma Vivek , Krug David , Rühle Alexander , Juhasz-Böss Ingolf , Grosu Anca-Ligia , Nicolay Nils H. , Sprave Tanja 
Published: May 2021

Abstract
Background
There are currently no data from randomized controlled trials on the use of intraoperative radiotherapy (IORT) as a tumor bed boost as part of a breast-conservation approach for breast cancer. This study retrospectively reviewed the safety and efficacy of IORT as a boost treatment at a tertiary cancer center.

Methods
From 2015 to 2019, patients underwent breast-conserving surgery with axillary lymph node staging and a single dose of 20 Gy IORT with 50-kV photons, followed by whole-breast irradiation (WBI) and adjuvant systemic therapy (if applicable). Patients were followed for assessment of acute and late toxicities (using the Common Terminology Criteria for Adverse Events version 5.0) at 3–6-month intervals. Outcomes included ipsilateral (IBTR) and contralateral breast progression-free survival (CBE), distant metastasis-free survival (DMFS), and overall survival (OS).

Results
Median follow-up for the 214 patients was 28 (range 2–59) months. Most patients had T1 disease (n = 124) and were clinically node negative. Only few patients had high-grade and/or triple-negative disease. The vast majority of patients underwent sentinel node biopsy, and 32 (15%) required re-resection for initially positive margins. Finally, all tumor bed margins were clear. Nine (4.2%) and 48 (22.4%) patients underwent neoadjuvant and adjuvant chemotherapy, respectively. WBI was predominantly performed as conventionally fractionated WBI (n = 187, 87.4%), and the median time from BCS to WBI was 54.5 days. IORT was delivered with a single dose of 20 Gy. The median WBI dose was 50 Gy (range 29.4–50.4 Gy). No patients experienced grade 4 events; acute grade 3 toxicities were limited to 17 (8%) cases of radiation dermatitis. Postoperative toxicities were mild. After WBI only one case of late grade ≥ 2 events was reported. There were two recurrences in the tumor bed and one contralateral breast event.

Conclusion
This investigation provides additional preliminary data supporting the using of IORT in the boost setting and corroborates the existing literature. These encouraging results should be prospectively validated by the eventual publication of randomized studies such as TARGIT‑B.
„Palliative care“ bei Patienten mit Linksherzunterstützungssystem: systematische Übersichtsarbeit
Authors: Tenge T. , Schlieper D. , Schallenburger M. , Meier S. , Schwartz J. , Neukirchen M. 
Published: May 2021

Zusammenfassung
Hintergrund
Bei terminal herzinsuffizienten Patienten gewinnt die Implantation von Linksherzunterstützungssystemen (LVAD) als Therapieoption zunehmend an Bedeutung. Diese Systeme werden als Überbrückung bis zu einer Herztransplantation (BTT) oder als definitive Therapie (DT) eingesetzt. Sie können die Lebensqualität verbessern und die Lebenszeit verlängern. Trotzdem bleibt die Prognose besonders bei DT oder bei Wechsel von BTT zu DT mit Blick auf die Lebenszeit und auftretende Komplikationen ungünstig. Bisher ist ungeklärt, ob eine LVAD-Implantation eine Indikation für eine frühzeitige Integration von Palliativmedizin darstellt.

Ziel der Arbeit
Erfassung der aktuellen Studienlage über den Einfluss einer palliativmedizinischen Behandlung bei LVAD-Patienten.

Material und Methoden
Im Mai 2020 wurde eine systematische Literaturrecherche in 6 verschiedenen Datenbanken durchgeführt.

Ergebnisse
Von den 491 Treffern der Literaturrecherche wurden 21 Arbeiten in diese Übersichtsarbeit eingeschlossen. Durch die frühzeitige Integration der Palliativmedizin vor LVAD-Implantation erhöhte sich die Anzahl der Patienten mit vorausschauender Versorgungsplanung und Vorsorgeinstrumenten. Außerdem zeigte sich ein positiver Einfluss auf das familiäre Umfeld, das Symptommanagement und die Umstände des Versterbens. Es gibt verschiedene Formate für die Integration palliativmedizinischer Konzepte in die LVAD-Therapie.

Diskussion
Die frühzeitige und kontinuierliche Einbindung der Palliativmedizin im Verlauf einer LVAD-Therapie kann die Behandlungsqualität verbessern. Die Ausarbeitung von spezifischen Handlungsempfehlungen ist in Abhängigkeit vom Therapieziel (BTT oder DT) sinnvoll. Empfohlen werden Schulungen für Palliativmediziner und LVAD-Spezialisten.
Die induzierbare laryngeale Obstruktion (ILO) – Ursachen, klinische Präsentation, Diagnostik und Therapie
Authors: Dillenhöfer S. , Hinrichs B. , Kohl A. , Kuhnigk M. , Maas R. , Pfeiffer-Kascha D. , Rutt T. , Schlegtendal A. , Seidenberg J. , Spindler T. , Suerbaum C. , Wilmsmeyer B. , Zeidler S. , Koerner-Rettberg C. 
Published: May 2021

ZusammenfassungWiederholt episodenhaft auftretende Atemnot ist im Kindes- und Jugendalter ein häufiges Symptom. Neben anstrengungsinduzierter Bronchialobstruktion im Rahmen eines Asthma bronchiale ist eine funktionelle Genese eine sehr häufige Differenzialdiagnose. Dennoch wird diese Diagnose häufig nicht oder mit langer Latenz gestellt. Unter dem Oberbegriff „ILO“ („inducible laryngeal obstruction“) werden sowohl funktionelle supraglottische Obstruktionen durch Kollaps der Knorpelstrukturen als auch Dysfunktionen auf Glottisebene wie „vocal cord dysfunction“ (VCD) subsumiert. Körperliche Anstrengung ist ein häufiger Auslöser; es werden jedoch auch Beschwerdebilder ohne Anstrengungsbezug beobachtet. Es wird der Erkenntnisstand zur Pathophysiologie referiert und die klinische Präsentation beschrieben. Ein wesentlicher Fokus des Artikels liegt im Folgenden auf der Darstellung eines sinnvollen und Ressourcen-orientierten diagnostischen Vorgehens. Der CLE-Test („continuous laryngoscopy exercise test“) als Provokationsmethode unter Wach-Videolaryngoskopie ist der Goldstandard, jedoch wird diese Diagnostik im deutschsprachigen Raum nicht flächendeckend vorgehalten. Dieses Positionspapier stellt daher die diagnostische Wertigkeit verschiedener anderer Diagnostik-Algorithmen und anamnestischer Informationen heraus. Ein weiterer Schwerpunkt des Papiers besteht in der detaillierten Vorstellung geeigneter atemphysiotherapeutischer Interventionen.
The effect of local Suicide Prevention Action Networks (SUPRANET) on stigma, taboo and attitudes towards professional help-seeking: an exposure–response analysis
Authors: van der Burgt Margot C. A. , Beekman Aartjan T. F. , Hoogendoorn Adriaan W. , Berkelmans Guus , Franx Gerdien , Gilissen Renske 
Published: May 2021

Abstract
Purpose
In 2017, the European Alliance against Depression (EAAD) programme was introduced in the Netherlands through the creation of six local Suicide Prevention Action Networks (SUPRANET Community). This programme consists of interventions on four levels: (1) a public awareness campaign, (2) training local gatekeepers, (3) targeting high-risk persons in the community and (4) training of primary care professionals. This study aims to gain insight into the effectiveness of the SUPRANET programme on attitudinal changes in the general public by studying the exposure–response relationship.

Methods
A repeated cross-sectional design, using general population surveys to measure key variables over time. The surveys were conducted in the six intervention regions (N = 2586) and in the Netherlands as a whole as a control region (N = 4187) and include questions on socio-demographic variables, brand awareness of the Dutch helpline, perceived taboo on suicide, attitudes towards depression and help-seeking. To examine the exposure–response relationship, regions were differentiated into 3 groups: low, medium and high exposure of the SUPRANET programme.

Results
The results revealed that respondents in the intervention regions considered professional help to be more valuable and were more likely to be familiar with the Dutch helpline than respondents in the control region. In the exposure–response analyses, the grading of effects was too small to reach statistical significance.

Conclusion
Our study provides the first evidence for the effectiveness of the SUPRANET Community programme on creating attitudinal change in the general public.
Medial unicondylar knee arthroplasty should be reserved for patients with complete joint space collapse
Authors: Wurm Alexander , Zechling Anna , Leitner Hermann , Dammerer Dietmar , Pfeifer Bernhard , Krismer Martin , Liebensteiner Michael 
Published: May 2021

Abstract
Purpose
To determine whether preoperative radiologic joint space width (JSW) is related to the outcome of medial unicondylar knee arthroplasty (UKA) (primary hypothesis).

Methods
A retrospective comparative analysis was performed. One group was comprised of UKA patients with preoperative JSW 0–1 mm. Another group was made up of patients with preoperative JSW ≥ 2 mm (range 0–4 mm). The JSW was measured from preoperative weight-bearing Schuss-view radiographs. The clinical outcome was determined with the Western Ontario and MacMaster Universities (WOMAC) Osteoarthritis Index score preoperatively and 1 year after medial UKA. Implant survival data were obtained from the arthroplasty register of Tyrol.

Results
There were 80 patients with a preoperative JSW 0–1 mm (age 66, BMI 27.8) and 70 patients with a preoperative JSW ≥ 2 mm (age 64, IQR 15, BMI 28.1). WOMAC total was 10 ± 10 in patients with 0–1 mm JSW and 25 ± 47 in patients with ≥ 2 mm JSW at 1 year postoperative (p = 0.052). WOMAC pain at 1 year postoperative was 7 ± 16 in patients with 0–1 mm JSW and 18 ± 46 in patients with ≥ 2 mm JSW (p = 0.047). WOMAC function at 1 year postoperative was 10 ± 9 in patients with 0–1 mm JSW and 17 ± 51 in patients with ≥ 2 mm JSW (p = 0.048). In patients with 0–1 mm JSW 5 year prosthesis survival was 92.3% and in patients with ≥ 2 mm JSW, it was 81.1% (p = 0.016).

Conclusions
In patients with preoperative complete joint space collapse (0–1 mm JSW), clinical outcome was superior to that of patients with incomplete joint space collapse. This was true for both 1 year postoperative WOMAC pain and WOMAC function and for 5 year implant survival rates. On the basis of our findings, it is recommended that ‘complete joint space collapse’ especially be used to achieve best clinical outcome in medial UKA surgery.

Level of evidence
IV.
Diagnostic value of [18F]FDG-PET/CT for treatment monitoring in large vessel vasculitis: a systematic review and meta-analysis
Authors: van der Geest K. S. M. , Treglia G. , Glaudemans A. W. J. M. , Brouwer E. , Sandovici M. , Jamar F. , Gheysens O. , Slart R. H. J. A. 
Published: May 2021

Abstract
Purpose
Monitoring disease activity in patients with large vessel vasculitis (LVV) can be challenging. [18F]FDG-PET/CT is increasingly used to evaluate treatment response in LVV. In this systematic review and meta-analysis, we aimed to summarize the current evidence on the value of [18F]FDG-PET/CT for treatment monitoring in LVV.

Methods
PubMed/MEDLINE and the Cochrane library database were searched from inception through October 21, 2020. Studies containing patients with LVV (i.e. giant cell arteritis, Takayasu arteritis and isolated aortitis) that received treatment and underwent [18F]FDG-PET/CT were included. Screening, full-text review and data extraction were performed by 2 investigators. The risk of bias was examined with the QUADAS-2 tool. Meta-analysis of proportions and diagnostic test accuracy was performed by a random-effects model and bivariate model, respectively.

Results
Twenty-one studies were included in the systematic review, of which 8 studies were eligible for meta-analysis. Arterial [18F]FDG uptake decreased upon clinical remission in longitudinal studies. High heterogeneity (I2 statistic 94%) precluded meta-analysis of the proportion of patients in which the scan normalized during clinical remission. Meta-analysis of cross-sectional studies indicated that [18F]FDG-PET/CT may detect relapsing/refractory disease with a sensitivity of 77% (95%CI 57–90%) and specificity of 71% (95%CI 47–87%). Substantial heterogeneity was observed among the cross-sectional studies. Both variation in clinical aspects and imaging procedures contributed to the heterogeneity.

Conclusion
Treatment of LVV leads to reduction of arterial [18F]FDG uptake during clinical remission. [18F]FDG-PET/CT has moderate diagnostic accuracy for detecting active LVV. [18F]FDG-PET/CT may aid treatment monitoring in LVV, but its findings should be interpreted in the context of the clinical suspicion of disease activity. This study underlines the relevance of published procedural recommendations for the use of [18F]FDG-PET/CT in LVV.
CD38 identifies pre-activated CD8+ T cells which can be reinvigorated by anti-PD-1 blockade in human lung cancer
Authors: Wu Pin , Zhao Lufeng , Chen Yongyuan , Xin Zhongwei , Lin Mingjie , Hao Zhixing , Chen Xiaoke , Chen Di , Wu Dang , Chai Ying 
Published: May 2021

Abstract
Background
CD38 has been observed expressing in activated T cells, while the features and functions of CD38+ T cells in human NSCLC are still unclear.

Methods
Here we uncovered the correlation between CD38 expression and survival and immune infiltration levels in tumor of NSCLC. Then, we collected samples from 51 NSCLC patients to study the biological feature and response to anti-PD-1 of tumor-infiltrating CD38+ CD8+ T cells in vitro.

Results
We found CD38 expression correlated with the survival and immune infiltration levels of NSCLC. It is interesting that CD38+ CD8+ T cells enriched in the tumors expressed higher level of cytotoxic molecule, cytokines and PD-1 than CD38− CD8+ T cells. Moreover, PD-1+ subset in tumor-infiltrating CD38+ CD8+ T cells expressed higher level of activated markers than PD-1+ CD38− CD8+ T cells. Next, we found tumor-infiltrating CD38+ CD8+ T cells expressed higher level of CD103, IFN-γ, TNF-α and perforin than CD38− CD8+ T cells when were reactivated in vitro. Finally, we observed that CD38+ CD8+ T cells isolated from tumors could be reinvigorated by anti-PD-1 in vitro.

Conclusions
Our findings demonstrate that CD38 expression defines a subset of CD8+ T cells enriched in tumors of NSCLC which have paradoxical phenotypes and response to anti-PD-1. Our results suggest a pre-priming of these cells is may exist in tumor and consequentially facilitate it acquiring both anti-tumor potency and exhausted phenotype which can be reinvigorated by PD-1 blockade.
Extremity Tourniquet Training at High Seas
Authors: Yánez Benítez Carlos , Ribeiro Marcelo A. F. , Khan Mansoor , Lorente‐Aznar Teófilo , Asensio Esther , López José Antonio , Martínez Isabel , Blas Juan L. , Güemes Antonio 
Published: May 2021

AbstractBackgroundFuture navy officers require unique training for emergency medical response in the isolated maritime environment. The authors issued a workshop on extremity bleeding control, using four different commercial extremity tourniquets onboard a training sail ship. The purposes were to assess participants' perceptions of this educational experience and evaluate self‐application simplicity while navigating on high seas.MethodsA descriptive observational study was conducted as part of a workshop issued to volunteer training officers. A post‐workshop survey collected their perceptions about the workshops' content usefulness and adequacy, tourniquet safety, self‐application simplicity, and device preference. Tourniquet preference was measured by frequency count while the rest of the studied variables on a one‐to‐ten Likert scale. Frequencies and percentages were calculated for the studied variables, and application simplicity means compared using the ANOVA test (p < 0.05).ResultsFifty‐one Spanish training naval officers, aged 20 or 21, perceived high sea workshop content's usefulness, adequacy, and safety level at 8.6/10, 8.7/10, and 7.5/10, respectively. As for application simplicity, CAT and SAM‐XT were rated equally with a mean of 8.5, followed by SWAT (7.9) and RATS (6.9), this one statistically different from the rest (p < 0.01). Windlass types were preferred by 94%.ConclusionsThe training sail ship's extremity bleeding control workshop was perceived as useful and its content adequate by the participating midshipmen. Windlass types were regarded as easier to apply than elastic counterparts. They were also preferred by nine out of every ten participants.
Management of particular clinical situations in psoriatic arthritis: an expert’s recommendation document based on systematic literature review and extended Delphi process
Authors: García-Vicuña Rosario , Garrido Noemí , Gómez Susana , Joven Beatriz , Queiro Rubén , Ramírez Julio , Rebollo Francisco , Loza Estíbaliz , Sellas Agustí 
Published: May 2021

AbstractTo establish practical recommendations for the management of patients with psoriatic arthritis (PsA) with particular clinical situations that might lead to doubts in the pharmacological decision-making. A group of six expert rheumatologists on PsA identified particular clinical situations in PsA. Then, a systematic literature review (SLR) was performed to analyse the efficacy and safety of csDMARDs, b/tsDMARDs in PsA. In a nominal group meeting, the results of the SLR were discussed and a set of recommendations were proposed for a Delphi process. A total of 65 rheumatologists were invited to participate in the Delphi. Agreement was defined if ≥ 70% of the participants voted ≥ 7 (from 1, totally disagree to 10, totally agree). For each recommendation, the level of evidence and grade of recommendation was established based on the Oxford Evidence-Based Medicine categorisation. Particular clinical situations included monoarthritis, axial disease, or non-musculoskeletal manifestations. The SLR finally comprised 131 articles. A total of 16 recommendations were generated, all but 1 reached consensus. According to them, it is crucial to carefully analyse the impact of individual manifestations on patients (disability, quality of life, etc.), but also to recognise the impact of each drug singularities on selected clinical phenotypes to adopt the most appropriate treatment strategy. Early diagnosis and treatment to target approach, along with a close risk management, is also necessary. These recommendations are intended to complement gaps in national and international guidelines by helping health professionals address and manage particular clinical situations in PsA.
Expanding the spectrum of reactive arthritis (ReA): classic ReA and infection-related arthritis including poststreptococcal ReA, Poncet’s disease, and iBCG-induced ReA
Authors: Taniguchi Yoshinori , Nishikawa Hirofumi , Yoshida Takeshi , Terada Yoshio , Tada Kurisu , Tamura Naoto , Kobayashi Shigeto 
Published: May 2021

AbstractReactive arthritis (ReA) is a form of sterile arthritis that occurs secondary to an extra-articular infection in genetically predisposed individuals. The extra-articular infection is typically an infection of the gastrointestinal tract or genitourinary tract. Infection-related arthritis is a sterile arthritis associated with streptococcal tonsillitis, extra-articular tuberculosis, or intravesical instillation of bacillus Calmette–Guérin (iBCG) therapy for bladder cancer. These infection-related arthritis diagnoses are often grouped with ReA based on the pathogenic mechanism. However, the unique characteristics of these entities may be masked by a group classification. Therefore, we reviewed the clinical characteristics of classic ReA, poststreptococcal ReA, Poncet’s disease, and iBCG-induced ReA. Considering the diversity in triggering microbes, infection sites, and frequency of HLA-B27, these are different disorders. However, the clinical symptoms and intracellular parasitism pathogenic mechanism among classic ReA and infection-related arthritis entities are similar. Therefore, poststreptococcal ReA, Poncet’s disease, and iBCG-induced ReA could be included in the expanding spectrum of ReA, especially based on the pathogenic mechanism.
Microhabitats of sharknose goby (Elacatinus evelynae) cleaning stations and their links with cleaning behaviour
Authors: Whittey Kathryn E. , Dunkley Katie , Young Grace C. , Cable Jo , Perkins Sarah E. 
Published: May 2021

AbstractCoral reefs are renowned for the complexity of their habitat structures and their resulting ability to host more species per unit area than any another marine ecosystem. Dedicated cleaner fish, which acquire all their food resources through client interactions, rely on both the habitat structures (by using topological cleaning stations) and the wide diversity of fish species available on coral reefs, to function. As a result of natural and anthropogenic threats, coral reef habitat structures and their complexity are being lost—despite this threat it is unclear how important reef geometry is to key ecological interactions, like cleaning. Using an established Caribbean reef study site, three-dimensional constructions of discrete coral heads were used to investigate how fine-scale structural complexity traits (structural complexity—measured by rugosity and vector dispersion—height, volume, surface area, percentage live coral cover and refuge availability) relate to cleaner occupancy, abundance and their cleaning interactions with clients. Coral height was a particularly important trait for cleaning, correlating with both the occurrence of cleaning stations on a reef, and with increased cleaning durations and reduced cleaning frequencies/rates. Cleaning stations were also more structurally complex than non-cleaning coral heads, and the increased availability of uneven surfaces (creating cracks and crevices) and refuge availability linked with increased cleaning durations/rates. By understanding habitat features important to cleaner fish on a typical Caribbean fringing reef, we can gain a better understanding of how important reef geometry might be for governing the occurrence and dynamics of such mutualisms.