bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sarcomatoid Variant of Primary Cutaneous Anaplastic Large Cell Lymphoma
Authors: Natsuaki Yohei , Muto Ikko , Kawamura Miyuki , Saruta Hiroshi , Teye Kwesi , Ohshima Koichi , Nakama Takekuni , Ohata Chika 
Published: July 2019

Abstract:
Sarcomatoid variant of primary cutaneous anaplastic large cell lymphoma is rare and is a diagnostic challenge. Clinical manifestation often mimics that of an infectious disease. Predominance of spindle cells in the biopsy specimen prevents from suspecting lymphoma. Here, we report the fourth case of this entity with good prognosis. A 30-year-old woman presented with several nodules on the whole body. The biopsy revealed infiltration of spindle cells in the dermis with myxomatous background. The spindle cells were positive for CD4 and CD30 and negative for CD3, CD8, CD20, and anaplastic lymphoma kinase. Although most of the skin lesions spontaneously resolved, a new red nodule progressively expanded on the left axilla. Finally, the patient received chemotherapy, which resulted in complete remission. The patient is free of disease for 18 months.
Depressive symptoms and associated factors among Iranian women at midlife: a community-based, cross-sectional study
Authors: Azizi Marzieh , Fooladi Ensieh , Bell Robin J. , Elyasi Forouzan , Masoumi Maryam , Davis Susan R. 
Published: July 2019

Abstract

Objective:
Little is known of depressive symptoms in Iranian women at midlife. This population-based study was undertaken to document the prevalence of, and factors associated with, depressive symptoms using validated questionnaires.

Methods:
A total of 1,520 community-dwelling women, aged 40 to 64 years, residing in Sari, Northern Iran, were recruited, using multistage cluster sampling, to this cross-sectional study, between October 2016 and April 2017. Participants completed the Menopause Quality of Life Questionnaire, the Beck Depression Inventory-II, and the World Health Organization Well-being Index.

Results:
Participants’ mean age was 49.1 (7.0) years and 88.7% were married. Overall, 167 (11%) women had moderate–severe depressive symptoms, 837 (55.1%) had low psychological well-being, and 172 (11.3%) reported taking psychotropic medication in the prior month. Factors independently associated with moderate–severe depressive symptoms included moderate–severe vasomotor symptoms (VMS) (adjusted odds ratio [AOR] 2.6, 95% CI, 1.5-4.6; P = 0.001), age 60 years or older (AOR = 1.9, 95% CI, 1.1-3.5; P = 0.03), body mass index 30 to 39 kg/m2 (AOR = 1.8, 95% CI, 1.0-3.1; P = 0.04), and housing insecurity (AOR = 5.6, 95% CI, 3.7-8.3; P < 0.001). Education beyond high school was associated with a lower risk (AOR = 0.5, 95% CI, 0.3-0.9; P = 0.04). Women reporting low marital satisfaction (19.2% of married women) were more likely than women who were very satisfied to have moderate–severe depressive symptoms (AOR = 27.9, 95% CI, 10.5-74.2; P < 0.001).

Conclusions:
Marital relationship dissatisfaction, reported by one in five women, was strongly associated with moderate–severe depressive symptoms in women at midlife in Iran, in addition to moderate–severe VMS, housing insecurity, obesity, and older age.
A Prediction Model for Uncontrolled Type 2 Diabetes Mellitus Incorporating Area-level Social Determinants of Health
Authors: Basu Sanjay , Narayanaswamy Rajiv 
Published: July 2019

Background:
Social determinants of health (SDH) at the area level are understood to influence the likelihood of having poor glycemic control for patients with type 2 diabetes mellitus (T2DM).

Objectives:
To develop a model for predicting whether a person with T2DM has uncontrolled diabetes (hemoglobin A1c ≥9%), incorporating individual and area-level (census tract) covariates.

Research Design:
Development and validation of machine learning models.

Subjects:
Total of N=1,015,808 privately insured persons in claims data with T2DM.

Measures:

C-statistic, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.

Results:
A standard logistic regression model selecting among the available individual-level covariates and area-level SDH covariates (at the census tract level) performed poorly, with a C-statistic of 0.685, sensitivity of 25.6%, specificity of 90.1%, positive predictive value of 56.9%, negative predictive value of 70.4%, and accuracy of 68.4% on a 25% held-out validation subset of the data. By contrast, machine learning models improved upon risk prediction, with the highest performance from a random forest algorithm with a C-statistic of 0.928, sensitivity of 68.5%, specificity of 94.6%, positive predictive value of 69.8%, negative predictive value of 94.3%, and accuracy of 90.6%. SDH variables alone explained 16.9% of variation in uncontrolled diabetes.

Conclusions:
A predictive model developed through a machine learning approach may assist health care organizations to identify which area-level SDH data to monitor for prediction of diabetes control, for potential use in risk-adjustment and targeting.
Comparing Resource Use in Medical Admissions of Children With Complex Chronic Conditions
Authors: Silber Jeffrey H. , Rosenbaum Paul R. , Pimentel Samuel D. , Calhoun Shawna , Wang Wei , Sharpe James E. , Reiter Joseph G. , Shah Shivani A. , Hochman Lauren L. , Even-Shoshan Orit 
Published: July 2019

Background:
Children with complex chronic conditions (CCCs) utilize a disproportionate share of hospital resources.

Objective:
We asked whether some hospitals display a significantly different pattern of resource utilization than others when caring for similar children with CCCs admitted for medical diagnoses.

Research Design:
Using Pediatric Health Information System data from 2009 to 2013, we constructed an inpatient Template of 300 children with CCCs, matching these to 300 patients at each hospital, thereby performing a type of direct standardization.

Subjects:
Children with CCCs were drawn from a list of the 40 most common medical principal diagnoses, then matched to patients across 40 Children’s Hospitals.

Measures:
Rate of intensive care unit admission, length of stay, resource cost.

Results:
For the Template-matched patients, when comparing resource use at the lower 12.5-percentile and upper 87.5-percentile of hospitals, we found: intensive care unit utilization was 111% higher (6.6% vs. 13.9%, P<0.001); hospital length of stay was 25% higher (2.4 vs. 3.0 d/admission, P<0.001); and finally, total cost per patient varied by 47% ($6856 vs. $10,047, P<0.001). Furthermore, some hospitals, compared with their peers, were more efficient with low-risk patients and less efficient with high-risk patients, whereas other hospitals displayed the opposite pattern.

Conclusions:
Hospitals treating similar patients with CCCs admitted for similar medical diagnoses, varied greatly in resource utilization. Template Matching can aid chief quality officers benchmarking their hospitals to peer institutions and can help determine types of their patients having the most aberrant outcomes, facilitating quality initiatives to target these patients.
Diagnostic and Management Challenges in Vasoactive Intestinal Peptide Secreting Tumors
Authors: Angelousi Anna , Koffas Apostolos , Grozinsky-Glasberg Simona , Gertner Julian , Kassi Eva , Alexandraki Krystallenia , Caplin Martyn E. , Kaltsas Grigorios , Toumpanakis Christos 
Published: July 2019

ObjectivesVasoactive intestinal peptide–secreting tumors (VIPomas) are rare functioning neuroendocrine tumors often characterized by a difficult-to-control secretory syndrome and high potential to develop metastases. We hereby present the characteristics of 15 cases of VIPomas and provide a recent literature review.MethodsThis was a retrospective data analysis of 15 patients with VIPoma from 3 different centers and literature research through PubMed database during the last 10 years.ResultsFifteen patients with VIPomas (9 with hepatic metastases at diagnosis) with watery diarrhea and raised VIP levels were studied. Ten patients (67%) had grade 2 tumors, 6 of 15 had localized disease and underwent potentially curative surgery, whereas the remaining 9 received multiple systemic therapies; 3 patients died during follow-up. The median overall survival was 71 months (range, 41–154 months). Patients who were treated with curative surgery (n = 7) had longer median overall survival compared with patients who were treated with other therapeutic modalities (44 vs 33 months).ConclusionsThe management of VIPomas is challenging requiring the application of multiple treatment modalities. Patients who underwent surgical treatment with curative intent appear to have higher survival rate. Central registration and larger prospective studies are required to evaluate the effect of currently employed therapies in these patients.
Impact of Changes in the American Joint Committee on Cancer Staging Manual, Eighth Edition, for Pancreatic Ductal Adenocarcinoma
Authors: Kassardjian Ari , Stanzione Nicholas , Donahue Timothy R. , Wainberg Zev A. , Damato Lauren , Wang Hanlin L. 
Published: July 2019

Objective
Consistent and reliable tumor staging is a critical factor in determining treatment strategy, selection of patients for adjuvant therapy, and for therapeutic clinical trials. The aim of this study was to evaluate the number and extent of pancreatic ductal adenocarcinoma (PDAC) cases that would have a different pT, pN, and overall stages based on the new eighth edition American Joint Committee on Cancer staging system when compared with the seventh edition.

Methods
Patients diagnosed with PDAC who underwent pancreaticoduodenectomy, total pancreatectomy, or distal pancreatectomy from 2007 to 2017 were retrospectively reviewed. A total of 340 cases were included.

Results
According to the seventh edition, the vast majority of tumors in our cohort were staged as pT3 tumors (88.2%). Restaging these cases with the new size-based pT system resulted in a more equal distribution among the 3 pT categories, with higher percentage of pT2 cases (55%).

Conclusions
The newly adopted pT stage protocol for PDAC is clinically relevant, ensures a more equal distribution among different stages, and allows for a significant prognostic stratification. In contrast, the new pN classification (pN1 and pN2) based on the number of positive lymph nodes failed to show survival differences and remains controversial.
Acute Recurrent and Chronic Pancreatitis as Initial Manifestations of Cystic Fibrosis and Cystic Fibrosis Transmembrane Conductance Regulator–Related Disorders
Authors: Baldwin Christina , Zerofsky Melissa , Sathe Meghana , Troendle David M. , Perito Emily R. 
Published: July 2019

Objectives
Recurrent pancreatitis is considered a rare manifestation of cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction; this case series highlights that pancreatitis can be a presenting symptoms of cystic fibrosis (CF) or a CFTR-related disorder (CFTR-RD).

Methods
Retrospective review of patients younger than 30 years diagnosed as having acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP) and subsequently diagnosed as having CF or CFTR-RD.

Results
Among 18 patients, median time from diagnosis of ARP/CP to diagnosis of CF was 0.4 years (range, 0–33 years). Eight were classified as having CF by elevated sweat chloride testing (SCT). Five had intermediate SCT (30–59 mmol/L) with 2 pathogenic mutations. Five had CFTR-RD with intermediate SCT and 0 to 1 pathogenic mutations. Eight patients (44%) had exocrine pancreatic insufficiency, and pancreatic fluid collections were more common in this group. Based on the CFTR mutation, 6 patients were eligible for CFTR potentiator therapy, although none received it during the study period. Nine of the 18 had ≥1 other likely CF manifestations, including sinusitis (33%), nasal polyps (11%), pneumonia (22%), and gallbladder disease (22%).

Conclusions
Cystic fibrosis or CFTR-RD can present as ARP/CP. Complete diagnostic testing for CFTR-RD in patients with ARP/CP will broaden treatment options and help to identify comorbid illness.
Induction Therapy in Localized Pancreatic Cancer
Authors: Shaib Walid L. , Sayegh Layal , Zhang Chao , Belalcazar Astrid , Ip Andrew , Alese Olatunji B. , Akce Mehmet , Wu Christina , Qu Yuesheng , Maithel Shishir K. , Kooby David , Cardona Kenneth , Sarmeinto Juan M. , El-Rayes Bassel F. 
Published: July 2019

Objectives
Pancreatic cancer (PDAC) with localized stage includes resectable (RPC), borderline resectable (BRPC), or locally advanced unresectable (LAPC). Standard of care for RPC is adjuvant chemotherapy. There are no prospective randomized trials for best treatment of BRPC and LAPC. We evaluate the impact of induction chemotherapy on localized PDAC.

Methods
Charts of PDAC patients treated at Emory University between 2009 and 2016 were reviewed. The primary end point was overall survival (OS).

Results
A total of 409 localized PDACs were identified. Resectability was prospectively determined at a multidisciplinary tumor conference. Median age was 67 years (range, 30–92 years), 49% were male, 66% were white, 171 had RPC, 131 had BRPC, and 107 had LAPC. Median OSs for RPC, BRPC, and LAPC were 19.5, 16.1, and 12.7 months, respectively. Type of chemotherapy and age were predictors of OS. Induction chemotherapy was used in 106 with BRPC (81%) and 74 with RPC (56.5%); patients with BRPC who received combination chemotherapy and resection had a median OS of 31.5 compared with 19.5 months in patients with RPC (P = 0.0049). Patients with LAPC had a median OS of 12.7 months.

Conclusions
In patients with BRPC who undergo resection after induction treatment, the OS was significantly better than in patients with RPC. Neoadjuvant treatment should be considered for all localized PDACs.
Correlation of DOTATOC Uptake and Pathologic Grade in Neuroendocrine Tumors
Authors: Chan Hilary , Moseley Christian , Zhang Li , Bergsland Emily K. , Pampaloni Miguel Hernandez , Van Loon Katherine , Hope Thomas A. 
Published: July 2019

Objectives

68Gallium (Ga)–DOTATOC is a somatostatin analog used to detect neuroendocrine tumors (NETs). Ki-67 proliferation index (Ki-67 PI) has been established as a prognostic factor in NETs. We aimed to evaluate whether a correlation exists between Ki-67 PI and somatostatin receptor positron emission tomography (SSTR-PET) uptake.

Methods
We retrospectively reviewed 238 DOTATOC PET scans between 2014 and 2016. Patients were excluded if DOTATOC PET was performed more than 365 days from the date of biopsy. Maximum standardized uptake values (SUVmax) of SSTR-PET from biopsied lesions were measured and correlated with Ki-67 PI using the Pearson correlation coefficient.

Results
Among 110 lesions from 90 patients, DOTATOC PET had 92.7% sensitivity and 100% specificity (102 true positives, 8 false negatives) for detection of NETs. Among 63 lesions from 54 patients with Ki-67 PI available, there were 27 grade 1 lesions [median Ki-67 PI, 1.0%; interquartile range (IQR), 1.0–2.0], 30 grade 2 lesions (median, Ki-67 PI 7.5%; IQR, 5–10), and 6 grade 3 lesions (median Ki-67 PI, 30%; IQR, 26–34). There was a correlation between Ki-67 PI and SUVmax (r
2 = −0.3, P = 0.018).

Conclusions
Our analysis demonstrates an inverse correlation between Ki-67 PI and SUVmax in NETs. Somatostatin receptor–PET provides additional information that can help guide management of NETs.
New-Onset Diabetes Mellitus After Chronic Pancreatitis Diagnosis
Authors: Zhu Xiangyun , Liu Dechen , Wei Qiong , Lin Hao , Zhi Mengmeng , Chen Yuling , Qi Liang , Waldron Richard T. , Lugea Aurelia , Pandol Stephen J. , Li Ling 
Published: July 2019

Objectives
The aim of this study was to assess the occurrence of new-onset diabetes mellitus (DM) after chronic pancreatitis (CP) diagnosis via systematic review and meta-analysis.

Methods
A systematic review of literature and meta-analysis of relevant reports were performed. The primary outcome measures studied were newly diagnosed DM and DM treated with insulin. For the binary outcomes, pooled prevalence and 95% confidence interval (CI) were calculated.

Methods
Fifteen studies involving 8970 patients were eligible. The incidence of new-onset DM after CP diagnosis was 30% (95% CI, 27%–33%). Among all patients, 17% (95% CI, 13%–22%) developed insulin-dependent new-onset DM. The prevalence of newly diagnosed DM after CP diagnosis increased from 15% within 36 months to 33% after 60 months. The proportion of alcoholic CP, sex, age, and body mass index had minimal effect on the studied outcomes.

Conclusions
This systematic review identified a clinically relevant risk of new-onset DM after CP diagnosis. Therefore, patients should be informed of the risk of DM and monitored.
The Importance of a Conjoint Analysis of Tumor-Associated Macrophages and Immune Checkpoints in Pancreatic Cancer
Authors: Xu Jun-Ying , Wang Wang-Sheng , Zhou Jing , Liu Chao-Ying , Shi Jing-Ling , Lu Pei-Hua , Ding Jun-Li 
Published: July 2019

Objectives
Tumor-associated macrophages are dominant players in establishing the inmmunosuppressive microenvironment in pancreatic ductal adenocarcinoma (PDAC). Immune checkpoint inhibitor monotherapy has achieved limited clinical effectiveness. To date, the interaction of macrophages and checkpoint regulators and their correlation with clinicopathologic characteristics in PDAC have been largely unavailable.

Methods
Macrophages and immune checkpoint expression were assessed by immunohistochemistry from 80 PDAC samples. Clinicopathologic features and the prognostic value of each marker were evaluated. In vitro changes in the expression of immune markers in cocultured macrophages and PDAC cells were detected by Western blot and immunosorbance assays.

Results
The macrophages marker CD163 and the checkpoint marker programmed death-ligand 1 (PD-L1) remained as the independent prognostic factors for overall survival (hazard ratio, 2.543; P = 0.017 and hazard ratio, 2.389; P = 0.021). Furthermore, integrated analysis of CD163 and PD-L1 served as more optimal indicators of survival (P = 0.000). In vitro coculture of macrophages and PDAC cells significantly increased the expression of CD163 and PD-L1, compared with monocultured counterpart (P < 0.05).

Conclusions
Combined analysis of CD163 and PD-L1 was enhanced indicators of survival in PDAC patients. The interaction of macrophages and immune checkpoints implied the value of the combination therapy.
Get In, Get Tested, Get Care: STD Services in Urban Urgent Care Centers
Authors: Williams Samantha P. , Kinsey Jennine , Carry Monique G. , Terry Latasha , Wells Joy , Kroeger Karen 
Published: July 2019

Background
Recent evidence indicates increased use of urgent care centers (UCCs) for sexually transmitted disease (STD) testing. We sought to learn more about STD services in UCCs in a large metropolitan area.

Method
Using a modified rapid gap assessment approach, we interviewed staff from 19 UCCs in metro Atlanta, GA. The UCCs were identified using two online search engines. We focused on a 50-mile radius around Atlanta. We then excluded duplicates and closed UCCs, and the ones outside Atlanta's five contiguous counties. Using a prioritization process, we visited UCCs in or adjacent to areas with mid to high local STD morbidity, or facilities from which STD cases were reported the year prior. We collected checklist-based data on STD testing, treatment, and preventive services, as well as supportive services (eg, substance use/mental health referrals). Checklist data, notes, and open-ended questions were summarized and analyzed descriptively.

Results
All UCCs (n = 19) reported offering basic to comprehensive STD testing. Although most could treat on-site for chlamydia and gonorrhea, most relied on referrals, or prescriptions and “return to facility” practices to treat syphilis. Sources for STD information/management included the health department/Centers for Disease Control and Prevention, online medical sites, and electronic medical record embedded information. Challenges UCCs acknowledged included staying up-to-date with treatment guidance and laboratory reporting requirements, inadequate time for sexual risk reduction counseling, and linking patients with extended care needs (eg, HIV+ case management, supportive services), or following up with patients.

Conclusions
Urgent cares are STD testing resources. Service availability varies, but opportunities exist to enhance STD services in UCC settings and in communities.
The Effect of Levosimendan Versus Milrinone on the Occurrence Rate of Acute Kidney Injury Following Congenital Heart Surgery in Infants: A Randomized Clinical Trial*
Authors: Thorlacius Elin M. , Suominen Pertti K. , Wåhlander Håkan , Keski-Nisula Juho , Vistnes Maria , Ricksten Sven-Erik , Synnergren Mats , Romlin Birgitta S. , Castellheim Albert 
Published: July 2019

Objectives:
It has been shown that, in contrast to other inotropic agents, levosimendan improves glomerular filtration rate after adult cardiac surgery. The aim of this study was to investigate the efficacy of levosimendan, compared with milrinone, in preventing acute kidney dysfunction in infants after open-heart surgery with cardiopulmonary bypass.

Design:
Two-center, double-blinded, prospective, randomized clinical trial.

Setting:
The study was performed in two tertiary pediatric centers, one in Sweden (Gothenburg) and one in Finland (Helsinki).

Patients:
Infants between 1 and 12 months old, diagnosed with Tetralogy of Fallot, complete atrioventricular septal defect or nonrestrictive ventricular septal defect, undergoing total corrective cardiac surgery with cardiopulmonary bypass.

Interventions:
Seventy-two infants were randomized to receive a perioperative infusion of levosimendan (0.1 µg/kg/min) or milrinone (0.4 µg/kg/min). The infusion was initiated at the start of cardiopulmonary bypass and continued for 26 hours.

Measurements and Main Results:
The primary outcome variable was the absolute value of serum creatinine data on postoperative day 1. Secondary outcomes included the following: 1) acute kidney injury according to the serum creatinine criteria of the Kidney Diseases: Improving Global Outcomes; 2) acute kidney injury with serum creatinine corrected for fluid balance; 3) plasma neutrophil gelatinase-associated lipocalin; 4) cystatin C; 5) urea; 6) lactate; 7) hemodynamic variables; 8) use of diuretics in the PICU; 9) need of dialysis; 10) length of ventilator therapy; and 11) length of PICU stays. There was no significant difference in postoperative serum creatinine between the treatment groups over time (p = 0.65). The occurrence rate of acute kidney injury within 48 hours was 46.9% in the levosimendan group and 39.5% in the milrinone group (p = 0.70). There were no significant differences in other secondary outcome variables between the groups.

Conclusions:
Levosimendan compared with milrinone did not reduce the occurrence rate of acute kidney injury in infants after total corrective heart surgery for atrioventricular septal defect, ventricular septal defect, or Tetralogy of Fallot.