bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Extrapancreatic Malignancies Among Patients With Intraductal Papillary Mucinous Neoplasms of the Pancreas
Authors: Panic Nikola , Macchini Federico , Solito Sonia , Boccia Stefania , Leoncini Emanuele , Larghi Alberto , Berretti Debora , Pevere Sara , Vadala Salvatore , Marino Marco , Zilli Maurizio , Bulajic Milutin 
Published: May 2018

Objectives
We conducted a study in order to assess the prevalence of extrapancreatic malignancies (EPMs) in a cohort of patients with intraductal papillary mucinous neoplasms (IPMNs) from northeastern Italy.

Methods
A study was conducted in hospital Santa Maria della Misericordia, Udine, Italy. Hospital records were screened in order to identify newly diagnosed IPMN cases in the period from January 1, 2009, to December 31, 2015. We searched for EPMs diagnosed previous to, synchronous to, or after the IPMN. The ratio of the observed (O) number of patients with EPMs to the expected (E) was calculated.

Results
We identified 72 EPMs in 63 (31.8%) of 198 patients included. Among them, 51 (70.8%) were diagnosed previous to, 17 (23.6%) synchronous to, and 4 (5.6%) after the IPMN. Most frequently diagnosed were colorectal (12 patients [6.1%]), breast (8 patients [6.8%, in females]), renal cell (8 patients [4.0%]), and prostate cancer (7 patients [8.6%, in males]). The O/E ratios for EPMs were significantly increased for cancer in general (3.66; 95% confidence interval [CI], 2.39–5.37), renal cell (9.62; 95% CI, 1.98–28.10), prostate (4.91; 95% CI, 1.59–11.45), and breast cancer (3.16; 95% CI, 1.03–7.37).

Conclusions
We report an increased risk of EPMs in patients with IPMN, especially for renal cell, prostate, colorectal, and breast cancer.
Axis II Personality Disorders Are Linked to an Adverse Course of Bipolar Disorder
Authors: Post Robert M. , McElroy Susan , Kupka Ralph , Suppes Trisha , Hellemann Gerhard , Nolen Willem , Frye Mark , Keck Paul , Grunze Heinz , Rowe Michael 
Published: May 2018

Abstract
The relationship of personality disorder (PD) psychopathology to the course of bipolar disorder remains inadequately described. After giving informed consent, more than 782 outpatients with bipolar disorder rated themselves on the 99-item Personality Disorder Questionnaire, Version 4 (PDQ4) when depressed or euthymic. They also rated six poor prognosis factors (PPFs). The relationships of the PPFs to the total PDQ4 score were examined by a linear regression. Even after correcting for the higher PDQ4 scores observed when patients were suffering depression, the PDQ4 was significantly related to a history of child abuse, early age of onset, an anxiety disorder comorbidity, rapid cycling, and 20 or more previous episodes, but not substance abuse. The data suggest close relationships between the total burden of PD psychopathology and correlates of an adverse outcome of bipolar disorder. The nature of this of association and approaches to treatment of comorbid PD remain to be further explored.
Complexities of the Diagnostic Process
Authors: Schildkrout Barbara 
Published: May 2018

Abstract
The diagnostic process is a highly complex, problem-solving enterprise. Yet, traditional case reports have not focused directly on this endeavor. Physicians could use the case format to present actual experiences of getting to a diagnosis. This approach would allow for modeling of nonjudgmental, self-reflective practices and also provide information to aid in studying the diagnostic endeavor. Given that diagnostic errors in medicine are widespread and constitute a serious public health problem, it is crucial for physicians to understand the diagnostic process as one step toward improving error rates. This article uses clinical examples to illustrate and discuss the numerous areas of competence that are involved in coming to a diagnosis. The dual-process cognition model for understanding diagnostic decision making is introduced; the role of creativity is emphasized. Psychiatrists have important contributions to make in understanding the diagnostic process, given the field's long history of valuing self-reflection and conceptualizing clinician-patient dynamics.
Combining Postmortem Vitreous Sodium and Chloride and Lung-Body Ratio in Aiding the Diagnosing Saltwater Drowning
Authors: Tse Rexson , Garland Jack , Kesha Kilak , Morrow Paul , Lam Leo , Elstub Hannah , Cala Allan , Spark Amy , Palmiere Cristian , Stables Simon 
Published: May 2018

AbstractDiagnosing death due to drowning can be difficult, and several postmortem findings have been postulated to aid the diagnosis. Increased lung weights are often seen in drowning deaths. Lung-body (LB) ratio was described to be the best anatomical lung measurement in diagnosing drowning. Postmortem vitreous humor sodium and chloride (PMVSC) was reported to be a useful biochemical test in diagnosing saltwater drowning when the immersion time is less than 1 hour (SWD1). The presented study compared the diagnostic accuracies between LB ratio, PMVSC, and their combination in diagnosing SWD1 in 20 SWD1 and 50 nonimmersion deaths. Classification tree models were used for analysis and revealed that combination of PMVSC and LB ratio was most accurate in diagnosing SWD1 (misclassification rate, 4%), followed by PMVSC (misclassification rate, 10%) and LB ratio (misclassification rate, 24%). A quantifiable diagnostic improvement was established when both LB ratio and PMVSC were used. After adjusting for interlaboratory variations, the developed tree models can be a reliable way in aiding the diagnosis of SWD1.
Vagal Mediation of Low-Frequency Heart Rate Variability During Slow Yogic Breathing
Authors: Kromenacker Bryan W. , Sanova Anna A. , Marcus Frank I. , Allen John J.B. , Lane Richard D. 
Published: May 2018

ABSTRACT

Objective
Changes in heart rate variability (HRV) associated with breathing (respiratory sinus arrhythmia) are known to be parasympathetically (vagally) mediated when the breathing rate is within the typical frequency range (9–24 breaths per minute [bpm]; high-frequency HRV). Slow yogic breathing occurs at rates below this range and increases low-frequency HRV power, which may additionally reflect a significant sympathetic component. Yogic breathing techniques are hypothesized to confer health benefits by increasing cardiac vagal control, but increases in low-frequency HRV power cannot unambiguously distinguish sympathetic from parasympathetic contributions. The aim of this study was to investigate the autonomic origins of changes in low-frequency HRV power due to slow-paced breathing.

Methods
Six healthy young adults completed slow-paced breathing with a cadence derived from yogic breathing patterns. The paced breathing took place under conditions of sympathetic blockade, parasympathetic (vagal) blockade, and placebo. HRV spectral power was compared under 11 breathing rates during each session, in counterbalanced order with frequencies spanning the low-frequency range (4–9 bpm).

Results
HRV power across the low-frequency range (4–9 bpm) was nearly eliminated (p = .016) by parasympathetic blockade (mean (SD) spectral power at breathing frequency = 4.1 (2.1)) compared with placebo (69.5 (8.1)). In contrast, spectral power during sympathetic blockade 70.2 (9.1) and placebo (69.5 (8.1)) was statistically indistinguishable (p = .671).

Conclusions
These findings clarify the interpretation of changes in HRV that occur during slow-paced breathing by showing that changes in low-frequency power under these conditions are almost entirely vagally mediated. Slow-paced breathing is an effective tool for cardiac vagal activation.
Tackling Ambulatory Safety Risks Through Patient Engagement: What 10,000 Patients and Families Say About Safety-Related Knowledge, Behaviors, and Attitudes After Reading Visit Notes
Authors: Bell Sigall K. , Folcarelli Patricia , Fossa Alan , Gerard Macda , Harper Marvin , Leveille Suzanne , Moore Caroline , Sands Kenneth E. , Sarnoff Lee Barbara , Walker Jan , Bourgeois Fabienne 
Published: May 2018

Background
Ambulatory safety risks including delayed diagnoses or missed abnormal test results are difficult for clinicians to see, because they often occur in the space between visits. Experts advocate greater patient engagement to improve safety, but strategies are limited. Patient access to clinical notes (“OpenNotes”) may help close the safety gap between visits.

Methods
We surveyed patients and families who logged on to the patient portal and had at least one ambulatory note available in the past 12 months at two academic hospitals during June to September 2016, focusing on patient-reported effects of OpenNotes on safety knowledge, behaviors, and attitudes.

Results
A total of 6913 (28%) of 24,722 patients at an adult hospital and 3672 (17%) of 21,579 participants at the children’s hospital submitted surveys. Approximately 75% of patients and parents each reported that reading notes helped them understand the reason for both tests and referrals, and approximately 50% felt that it helped them complete tests and referrals. Roughly 75% of participants were more likely to check and understand test results. Overall, 97% of participants reported that trust in the provider, activation, patient-provider goal alignment, and teamwork were each better or the same after reading 1 note or more. Nonwhite participants and those with high school education or less were 30% to 50% more likely to report that reading notes helped them complete tests compared with white and more educated respondents, respectively.

Conclusions
Overall, the majority of more than 10,000 patients and parents reported reading notes helped them understand and follow through on tests and referrals. As information transparency spreads, OpenNotes can help activate patients and families, facilitate safety behaviors, and forge stronger partnerships with clinicians.
Differential Patterns of Risk and Vulnerability Suggest the Need for Novel Prevention Strategies for Black Bisexual Men in the HPTN 061 Study
Authors: Dyer Typhanye V. , Khan Maria R. , Regan Rotrease , Harawa Nina T. , Nelson LaRon E. , Wilton Leo , Wang Lei , Peng Lili , Ou San San , Shoptaw Steve 
Published: May 2018

Background:
Black men who have sex with men (BMSM) and some who also have sex with women (BMSMW) account for over 70% of new HIV infections in the United States representing an elevated HIV risk in this group, also informing risks of HIV transmission to other BMSM and female sexual partners.

Settings:
We examined trajectories of self-reported substance use, HIV-related sexual risk behaviors, and psychosocial vulnerabilities among BMSMW versus BMSM over a 1-year study period.

Methods:
We analyzed baseline, 6-, and 12-month follow-up data from the HIV Prevention Trials Network “BROTHERS” Study (HPTN 061; n = 1126). Categorizing participants by sexual partner type across 3 time points: (1) BMSMO: having male and no female partners across assessments and (2) BMSMW: having sex with male and one or more female partners at least at 1 time point. Using generalized estimating equations, we estimated associations between being BMSMW (versus BMSMO) and changes in psychosocial vulnerability, substance use, and HIV-related sexual risk behaviors.

Results:
Generalized estimating equation models controlling for sociodemographics, time-varying effects, and intervention status showed that BMSMW versus BMSMO had 50% increased odds of crack use, 71% increased odds of alcohol use during condomless anal intercourse (CAI), 51% greater odds of using drugs at last CAI, and twice the odds of receiving goods at last CAI.

Conclusions:
Findings show stable and comparatively elevated illicit drugs, alcohol, and exchange sex during last CAI among BMSMW. Future intervention research should focus on ways to address changes in substance-related HIV-transmission behaviors over time in this population of men.
Brief Report: Cutaneous Melanoma Risk Among People With HIV in the United States and Canada
Authors: Yanik Elizabeth L. , Hernández-Ramírez Raúl U. , Qin Li , Lin Haiqun , Leyden Wendy , Neugebauer Romain S. , Horberg Michael A. , Moore Richard D. , Mathews W. Christopher , Justice Amy C. , Hessol Nancy A. , Mayor Angel M. , Gill M. John , Brooks John T. , Sun Jing , Althoff Keri N. , Engels Eric A. , Silverberg Michael J. , Dubrow Robert 
Published: May 2018

Background:
Cutaneous melanoma incidence may be modestly elevated in people with HIV (PWH) vs. people without HIV. However, little is known about the relationship of immunosuppression, HIV replication, and antiretroviral therapy (ART) with melanoma risk.

Methods:
PWH of white race in the North American AIDS Cohort Collaboration on Research and Design were included. A standardized incidence ratio was calculated comparing risk with the white general population, standardizing by age, sex, and calendar period. Associations between melanoma incidence and current, lagged, and cumulative measures of CD4 count, HIV RNA level, and ART use were estimated with Cox regression, adjusting for established risk factors such as age and annual residential ultraviolet B (UVB) exposure.

Results:
Eighty melanomas were diagnosed among 33,934 white PWH (incidence = 40.75 per 100,000 person-years). Incidence was not elevated compared with the general population [standardized incidence ratio = 1.15, 95% confidence interval (95% CI) = 0.91 to 1.43]. Higher melanoma incidence was associated with older age [adjusted hazard ratio (aHR) per decade increase = 1.50, 95% CI = 1.20 to 1.89] and higher UVB exposure (aHR for exposure ≥35 vs. <35 mW/m2 = 1.62, 95% CI = 0.99 to 2.65). Current, lagged, and cumulative CD4 and HIV RNA were not associated with melanoma incidence. Melanoma incidence was higher among people ART-treated for a larger proportion of time in the previous 720 days (aHR per 10% increase = 1.16, 95% CI = 1.03 to 1.30).

Conclusions:
These results suggest that HIV-induced immune dysfunction does not influence melanoma development. The association between ART and melanoma risk may be due to increased skin surveillance among PWH engaged in clinical care. Associations with age and UVB confirmed those established in the general population.
Body Mass Index and the Risk of Serious Non-AIDS Events and All-Cause Mortality in Treated HIV-Positive Individuals: D:A:D Cohort Analysis
Authors: Achhra Amit C. , Sabin Caroline , Ryom Lene , Hatleberg Camilla , Antonella d'Aminio Monforte , de Wit Stephane , Phillips Andrew , Pradier Christian , Weber Rainer , Reiss Peter , El-Sadr Wafaa , Bonnet Fabrice , Mocroft Amanda , Lundgren Jens , Law Matthew G. ,   for the D:A:D Study Group
Published: May 2018

Background:
The relationship between body mass index (BMI) [weight (kg)/height (m2)] and serious non-AIDS events is not well understood.

Methods:
We followed D:A:D study participants on antiretroviral therapy from their first BMI measurement to the first occurrence of the endpoint or end of follow-up (N = 41,149 followed for 295,147 person-years). The endpoints were cardiovascular disease (CVD); diabetes; non–AIDS-defining cancers (NADCs) and BMI-NADCs (cancers known to be associated with BMI in general population); and all-cause mortality. Using Poisson regression models, we analyzed BMI as time-updated, lagged by 1 year, and categorized at: 18.5, 23, 25, 27.5, and 30 kg/m2.

Results:
Participants were largely male (73%) with the mean age of 40 years (SD 9.7) and baseline median BMI of 23.3 (interquartile range: 21.2–25.7). Overall, BMI showed a statistically significant J-shaped relationship with the risk of all outcomes except diabetes. The relative risk (RR) for the BMI of <18.5 and >30 (95% confidence interval) compared with 23–25, respectively, was as follows: CVD: 1.46 (1.15–1.84) and 1.31 (1.03–1.67); NADCs: 1.78 (1.39–2.28) and 1.17 (0.88–1.54); and “BMI-NADCs”: 1.29 (0.66–2.55) and 1.92 (1.10–3.36). For all-cause mortality, there was an interaction by sex (P < 0.001): RR in males: 2.47 (2.12–2.89) and 1.21 (0.97–1.50); and in females: 1.60 (1.30–1.98) and 1.02 (0.74–1.42). RR remained around 1 for intermediate categories of BMI. The risk of diabetes linearly increased with increasing BMI (P < 0.001).

Conclusions:
Risk of CVD, a range of cancers, and all-cause mortality increased at low BMI (<18.5) and then tended to increase only at BMI > 30 with a relatively low risk at BMI of 23–25 and 25–30. High BMI was also associated with risk of diabetes.
Improved Cognitive Performance and Reduced Monocyte Activation in Virally Suppressed Chronic HIV After Dual CCR2 and CCR5 Antagonism
Authors: D'Antoni Michelle L. , Paul Robert H. , Mitchell Brooks I. , Kohorn Lindsay , Fischer Laurent , Lefebvre Eric , Seyedkazemi Star , Nakamoto Beau K. , Walker Maegen , Kallianpur Kalpana J. , Ogata-Arakaki Debra , Ndhlovu Lishomwa C. , Shikuma Cecilia 
Published: May 2018

Objective:
To evaluate changes in neuropsychological (NP) performance and in plasma and cell surface markers of peripheral monocyte activation/migration after treatment with cenicriviroc (CVC), a dual C-C chemokine receptor type 2 (CCR2) and type 5 (CCR5) antagonist, in treatment-experienced, HIV-infected individuals.

Setting:
Single-arm, 24-week, open-label clinical trial.

Methods:
HIV-infected individuals on antiretroviral therapy ≥1 year with plasma HIV RNA ≤50 copies per milliliter and below-normal cognitive performance [defined as age-, sex-, and education-adjusted NP performance (NPZ) <−0.5 in a single cognitive domain or in global performance] were enrolled. Changes over 24 weeks were assessed for global and domain-specific NPZ scores, plasma markers of monocyte/macrophage activation [neopterin, soluble (s)CD14, and sCD163] quantified by ELISA, and CCR2 and CCR5 expression on monocytes, and T cells measured by flow cytometry.

Results:
Seventeen of 20 enrolled participants completed the study. Improvements over 24 weeks were observed in global NPZ [median change (Δ) = 0.24; P = 0.008], and in cognitive domains of attention (Δ0.23; P = 0.011) and working memory (Δ0.44; P = 0.017). Plasma levels of sCD163, sCD14 and neopterin decreased significantly (P's < 0.01). CCR2 and CCR5 monocyte expression remained unchanged; however, CCR5 levels on CD4+ and CD8+ T cells and CCR2 expression on CD4+ T cells increased (P's < 0.01).

Conclusions:
CVC given over 24 weeks was associated with improved NP test performance and decreased plasma markers of monocyte immune activation in virally suppressed, HIV-infected participants. These data potentially link changes in monocyte activation to cognitive performance. Further study of CVC for HIV cognitive impairment in a randomized controlled study is warranted.
Human Papillomavirus Genotypes in Invasive Cervical Carcinoma in HIV-Seropositive and HIV-Seronegative Women in Zimbabwe
Authors: Mudini Washington , Palefsky Joel M. , Hale Martin J. , Chirenje Michael Z. , Makunike-Mutasa Rudo , Mutisi Fiona , Murahwa Alltalents , Mario Altini 
Published: May 2018

Background:
Invasive cervical carcinoma (ICC) accounts for 23% of all cancer-related deaths in Zimbabwean women. Trials for a national program of genotype-specific human papillomavirus (HPV) vaccines are underway to prevent cervical carcinoma, but the distribution of HPV types among women with ICC according to HIV status is unknown.

Methods:
To determine prevalence and distribution of high-risk HPV genotypes by HIV status in women with ICC, we performed a cross-sectional study on women referred for ICC testing at 4 urban referral hospitals in Zimbabwe from June 2014 to December 2015. Cervical biopsies were obtained for histology and HPV genotyping. HIV serology testing was performed. HPV testing was performed using MY09/MY11 polymerase chain reaction followed by typing using dot-blot hybridization.

Results:
Of 107 participants with histologically proven ICC, HIV prevalence was 49.5% (53/107). HIV-positive women tended to be younger (median age 44 years) than HIV-negative women (median age 59 years). HPV prevalence was 94% (101/107), ranging from 1 to 5 genotypes per participant. HPV 16 (81.5%), 18 (24%), 33 (13%), 35 (11%), 56 (9%), and 45 (7.4%) were the most prevalent genotypes among HIV-negative participants; HPV 16 (67.9%), 18 (43.4%), 56 (18.9%), 45 (15.1%), 33 (11.3%), and 58 (9.4%) were the most prevalent among HIV-positive participants. Eighty-three percent of women were infected with either HPV-16 or HPV-18.

Conclusions:
Effective vaccination programs against HPV 16 and HPV 18 could prevent up to 83% of cases of cervical cancer in Zimbabwe. HIV may influence distribution of some HPV genotypes given the significant increase in prevalence of HPV 18 among HIV-positive participants.
Influenza vaccine strategies for solid organ transplant recipients
Authors: Hirzel Cédric , Kumar Deepali 
Published: May 2018

Purpose of review
The aim of this study was to highlight recent evidence on important aspects of influenza vaccination in solid organ transplant recipients.

Recent findings
Influenza vaccine is the most evaluated vaccine in transplant recipients. The immunogenicity of the vaccine is suboptimal after transplantation. Newer formulations such as inactivated unadjuvanted high-dose influenza vaccine and the administration of a booster dose within the same season have shown to increase response rates. Intradermal vaccination and adjuvanted vaccines did not show clear benefit over standard influenza vaccines. Recent studies in transplant recipients do not suggest a higher risk for allograft rejection, neither after vaccination with a standard influenza vaccine nor after the administration of nonstandard formulation (high-dose, adjuvanted vaccines), routes (intradermally) or a booster dose. Nevertheless, influenza vaccine coverage in transplant recipients is still unsatisfactory low, potentially due to misinterpretation of risks and benefits.

Summary
Annual influenza vaccination is well tolerated and is an important part of long-term care of solid organ transplant recipients.
Repairing a Facial Cleft by Polyether–Ether–Ketone Implant Combined With Titanium Mesh
Authors: Deng Yuan , Tang Weiwei , Li Zhengkang 
Published: May 2018

Abstract
The Tessier Number 4 cleft is one of the rarest, most complex craniofacial anomalies that presents difficulties in surgical treatment. In this article, we report a case of simultaneous facial depression, eye displacement, and medial canthus deformity. In this case, the maxillary bony defect was reconstructed using computer-assisted design computer-assisted manufacturing (CAD-CAM) polyether–ether–ketone (PEEK) material, and the orbital floor defect was repaired with AO prefabricated titanium mesh. Additionally, the medial canthus was modified with canthopexy and a single Z-plasty flap. Owing to its relative rarity and varied clinical presentations, no definitive operative methods have been accepted for Tessier No. 4 facial cleft. This study presents the combination of CAD-CAM manufactured PEEK material and titanium mesh as an alternative approach for reconstructing the bony defect of Tessier No. 4 facial clefts.