bluuebunny/crossref_metadata_2025_split huggingface dataset:
Organ-preserving approach via radiotherapy for small cell carcinoma of the bladder: an analysis based on the Japanese Radiation Oncology Study Group (JROSG) survey
Authors: Akamatsu Hiroko , Nakamura Katsumasa , Ebara Takeshi , Inaba Koji , Itasaka Satoshi , Jingu Keiichi , Kosaka Yasuhiro , Murai Taro , Nagata Kenji , Soejima Toshinori , Takahashi Shigeo , Toyoda Tatsuya , Toyoshima Shinichiro , Nemoto Kenji , Akimoto Tetsuo 
Published: April 2019

AbstractSmall cell carcinoma of the bladder is extremely rare, accounting for <1% of all malignant tumours in the urinary tract. Thus, no standard therapy modality for this malignancy has been established. This study aimed to retrospectively analyse the clinical outcomes associated with definitive radiotherapy for small cell carcinoma of the bladder. A questionnaire-based survey of patients with pathologically proven small cell carcinoma of the bladder treated with definitive radiation therapy between 1990 and 2010 was conducted by the Japanese Radiation Oncology Study Group. The clinical records of 12 eligible patients were collected from nine institutions. The median age of the patients was 70.5 years (range: 44–87 years), and the median follow-up period was 27.3 months (range: 3.3–117.8 months). The median prescribed dose was 60 Gy (range: 50.0–61.0 Gy), and a median of 2.0 Gy (range: 1.2–2.0 Gy) was administered per fraction. Systemic chemotherapy combined with radiotherapy was performed in eight cases (66.7%). The 3- and 5-year overall survival rates were 50.0% and 33.3%, respectively. And the 3- and 5-year local control rates were 66.7% and 55.6%, respectively. Chemotherapy significantly improved overall survival and relapse-free survival (P = 0.006 and 0.001, respectively). No serious adverse events occurred in the observation period. All patients who achieved local control maintained functional bladders. In conclusion, radiotherapy is a potential local treatment option and has an important role in maintaining quality of life. Systemic chemotherapy combined with local radiotherapy seems to be effective in improving survival.
Reasonable Expectations of Privacy and Disclosure of Health Data
Authors: Taylor Mark J , Wilson James 
Published: April 2019

Abstract
The law of confidence allows for a range of defined circumstances in which confidential patient information (CPI) can be disclosed without breach of confidence—including statutory gateway and overriding public interest. Outside such circumstances, current guidance to health professionals (the ‘standard account’) assumes that CPI can only be lawfully disclosed with patient consent. This article argues that the standard account has not yet caught up with judgments, post the Human Rights Act 1998 coming into force, which have reinterpreted the law of confidence in the light of Article 8 of the European Convention on Human Rights. In particular, the article explains the significance of the concept of a ‘reasonable expectation of privacy’ to an action for breach of confidence and thus to legal liability for disclosure of health data. It argues that conformity with a reasonable expectation of privacy provides an alternative account for the lawful disclosure of CPI, and may provide a more sustainable and authentic approach to meeting obligations under the law of confidence than the standard account. The article concludes with recommendations for an evolution of the standard account in a way that could allow restatement of associated concepts (such as consent) free from particular pressure to bend them out of shape. The evolution proposed continues to bring to the fore the patient perspective and allows protection of their ‘reasonable expectations’ regarding uses of data collected about them rather than those of the profession.
Cosmological magnetic braking and the formation of high-redshift, super-massive black holes
Authors: Pandey Kanhaiya L , Sethi Shiv K , Ratra Bharat 
Published: April 2019

Abstract
We study the effect of magnetic braking due to a primordial magnetic field in the context of the formation of massive (≳104M⊙) direct-collapse black holes (DCBHs) at high redshifts. Under the assumption of axial symmetry, we analytically compute the effect of magnetic braking on the angular momentum of gas collapsing into the potential well of massive dark matter haloes (≃107−9M⊙) which are spun up by gravitational tidal torques. We find that a primordial magnetic field of strength B0 ≃ 0.1 nG (comoving) can remove the initial angular momentum gained by the in-falling gas due to tidal torques, thus significantly lowering the angular momentum barrier to the formation of DCBHs. These magnetic field strengths are consistent with the bounds on primordial fields from astrophysical and cosmological measurements and they are large enough to seed observed galactic magnetic fields.
H α emission in the nebular spectrum of the Type Ia supernova ASASSN-18tb
Authors: Kollmeier Juna A , Chen Ping , Dong Subo , Morrell Nidia , Phillips M M , Kushnir Doron , Prieto J L , Piro Anthony L , Simon Joshua D 
Published: April 2019

ABSTRACT
As part of the 100IAS survey, a program aimed to obtain nebular-phase spectra for a volume-limited and homogeneous sample of Type Ia supernovae (SNe Ia), we observed ASASSN-18tb (SN 2018fhw) at 139 d past maximum light. ASASSN-18tb was a fast-declining, sub-luminous event that fits well within the observed photometric and spectroscopic distributions of the SN Ia population. We detect a prominent H α emission line (LH α = 2.2 ± 0.2 × 1038 ergs s−1) with FWHM ≈ 1100 km s−1 in the nebular-phase spectrum of this SN Ia. High-luminosity H α emission (LH α ≳ 1040 ergs s−1) has previously been discovered in a rare class of SNe Ia-like objects showing circum-stellar medium (CSM) interactions (SNe Ia–CSM). They predominantly belong to overluminous (Mmax &lt; −19 mag in optical) 1991T-like SNe Ia and are exclusively found in star-forming galaxies. By contrast, ASASSN-18tb is a sub-luminous SN Ia (MB,max ∼ −17.7 mag) found in an early-type galaxy dominated by old stellar populations. We discuss possible origins for the observed hydrogen. Of the 75 SNe Ia for which we have so far obtained nebular spectra in 100IAS, no other SN shows a ${\sim } 1000 \, {\rm km\, s^{-1}}$ H α emission line with comparable line luminosity as ASASSN-18tb, emphasizing the rarity of such emission in the nebular phase. Based on preliminary results from our survey, the rate for ASASSN-18tb-like nebular H α emission could be as high as ${\sim } 10{{\ \rm per\ cent}}$ among sub-luminous SNe Ia.
Effect of probiotics on gastrointestinal symptoms and immune parameters in systemic sclerosis: a randomized placebo-controlled trial
Authors: Marighela Thais Fernandes , Arismendi Maria Izabel , Marvulle Valdecir , Brunialti Milena Karina Coló , Salomão Reinaldo , Kayser Cristiane 
Published: April 2019

AbstractObjectivesChanges in the intestinal microbiota have been associated with the pathogenesis of SSc. Probiotics act by modulating the microbiome and the immune response. This study aimed to evaluate the efficacy of probiotics on gastrointestinal (GI) symptoms and immune responses in SSc patients.MethodsPatients with SSc with a moderate–severe total score on the University of California Los Angeles Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 (UCLA GIT 2.0) instrument were randomly assigned to receive a daily dose of probiotics (Lactobacillus paracasei, Lactobacillus rhamnosus, Lactobacillus acidophillus and Bifidobacterium lactis, 109 colony-forming units per capsule) or placebo for 8 weeks. The primary endpoint was improvement in the UCLA GIT 2.0 total score after 8 weeks. Secondary outcomes included changes in Th1, Th2, Th17 and regulatory T cell circulating levels and in the HAQ Disability Index (HAQ-DI) score. Parameters were assessed at baseline and after 4 and 8 weeks of treatment.ResultsA total of 73 patients were randomized to receive probiotics (n = 37) or placebo (n = 36). After 8 weeks, there was no difference in the UCLA GIT 2.0 score between the two groups. At week 8, the probiotic group showed a significant decrease in the proportion of Th17 cells compared with placebo (P = 0.003). There was no difference in the proportion of Th1, Th2 and regulatory T cells or in the HAQ-DI score between the groups.ConclusionProbiotics did not improve GI symptoms in SSc patients. The reduction in Th17 cell levels suggests an immunomodulatory effect of probiotics on SSc.Trial registrationClinicalTrials.gov (http://clinicaltrials.gov), NCT 02302352.
Treatment Discrepancy for Pelvic Fracture Patients With Urethral Injuries: A Survey of Orthopaedic and Urologic Surgeons
Authors: Johnsen Niels V. , Firoozabadi Reza , Voelzke Bryan B. 
Published: April 2019

Objectives:
In patients with traumatic pelvic fracture urethral injuries (PFUI), the interaction between urethral management and orthopaedic decision making remains unknown. We aimed to survey orthopaedic and urologic surgeons to assess interdisciplinary interactions in the management of PFUI.

Methods:
An anonymous cross-sectional survey of members of the Orthopaedic Trauma Association (OTA) and the Society of Genitourinary Reconstructive Surgeons (GURS) was conducted between September 2017 and August 2018. Participants were queried regarding the impact of urethral injuries and their management on orthopaedic operative decision making.

Results:
Fifty-three GURS and 64 OTA members responded (17% response rate). For urethral injury management, 73% of OTA respondents preferred that suprapubic tubes (SPTs) were not placed for urethral injury management, whereas 43% of GURS respondents preferred SPTs (P = 0.08). Ninety-two percent of OTA respondents stated that SPTs increase hardware infection risks in patients undergoing pelvic open reduction with internal fixation (ORIF), whereas only 8% of GURS respondents agreed (P < 0.01). Although 66% of GURS respondents reported not considering the operative plans of orthopaedics when determining urethral management, 75% of OTA respondents reported that they were less inclined to proceed with ORIF, and 70% would perform external fixation in the setting of an SPT, despite 78% believing that this resulted in an inferior outcome for the patient.

Conclusions:
There is discordance between urologists and orthopaedists as to the optimal management of PFUI patients, with significant disagreement regarding the infectious risks of SPT in the setting of ORIF. Improved data and interdisciplinary dialogue are required to maximize patient outcomes.

Level of Evidence:
Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
Atypical Fibroxanthoma: The Washington University Experience
Authors: Phelan Patrick S. , Rosman Ilana S. , Council M. Laurin 
Published: April 2019

BACKGROUND
Atypical fibroxanthoma (AFX) is a rare dermal neoplasm typically occurring on sun-exposed skin in the elderly. As AFX remains a diagnosis of exclusion, updated characterization and treatment assessments are necessary to support informed diagnosis and management.

OBJECTIVE
Characterization of contemporary AFX and surgical outcomes by Mohs micrographic surgery (MMS) and conventional local excision (LE).

METHODS
Retrospective cohort analysis of all cases of AFX at our institution from January 2000 through July 2016.

RESULTS
Among 75 cases with median age at diagnosis 73 years, most occurred on the head and neck (68) independent of age. Most treated cases (42) underwent MMS alone, with median tissue removal greater for LE (2.6 cm, 4.5 cm2) than MMS (0.6 cm, 1.2 cm2). Over a median 26 months of follow-up, 6 recurrences were observed among 50 cases, with metastases in 2 cases. Intent-to-treat recurrence rates were 3.4% for MMS and 25% for LE. One nonrecurrent and 2 recurrent cases received revised diagnoses after initial treatment, yielding a true recurrence rate of 8.5%.

CONCLUSION
Despite diagnostic confounding by similar pathologies, surgical treatment of AFX remains effective. Tissue-sparing resection by MMS affords the potential for cosmetic and reconstructive advantage, without compromising recurrence compared with conventional excision.
Supplementary Sorafenib Therapies for Hepatocellular Carcinoma—A Systematic Review and Meta-Analysis
Authors: Huang Yuanjian , Cheng Xiang , Sun Ping , Li Tong , Song Zifang , Zheng Qichang 
Published: April 2019

Background:
Hepatocellular carcinoma (HCC) is the third deadliest cancer worldwide. Sorafenib is considered a supplementary treatment to surgical or locoregional therapies for improving outcomes. We evaluated the efficacy of sorafenib as a supplementary therapy for HCC.

Methods:
We conducted a meta-analysis including 11 randomized controlled trials. Patients with HCC and studies in which sorafenib was administered alone and compared with placebo or those in which sorafenib was administered in combination with another treatment and compared with that treatment alone were included. The overall effects (OEs) on overall survival and time to progression were pooled as hazard ratios.

Results:
The OEs of sorafenib as a first-line therapy versus placebo for unresectable HCC were 0.62 [95% confidence interval (CI): 0.50-0.77] and 0.58 (95% CI: 0.47-0.70), respectively. The OEs of sorafenib as a second-line therapy versus placebo for progressive HCC were 0.73 (95% CI: 0.47-1.13) and 0.54 (95% CI: 0.30-0.97), respectively. The OEs of sorafenib as an adjuvant therapy versus placebo for early HCC were 1.00 (95% CI: 0.76-1.30) and 0.89 (95% CI: 0.74-1.08), respectively. The OEs of sorafenib combined with transarterial chemoemboliztion (TACE) versus placebo combined with TACE were 0.80 (95% CI: 0.54-1.21) and 0.85 (95% CI: 0.70-1.04), respectively. The OEs of sorafenib as an adjuvant to TACE versus placebo as an adjuvant to TACE for intermediate HCC were 1.06 (95% CI: 0.69-1.64) and 0.65 (95% CI: 0.31-1.36), respectively.

Conclusions:
Sorafenib was effective as a first-line therapy for unresectable HCC, but it was ineffective as a second-line or adjuvant therapy. Sorafenib did not increase the efficacy of TACE.
High-resolution Manometry can Characterize Esophagogastric Junction Morphology and Predict Esophageal Reflux Burden
Authors: Rengarajan Arvind , Gyawali C. Prakash 
Published: April 2019

Background:
High-resolution manometry (HRM) allows characterization of esophagogastric junction (EGJ) morphology and identification of hiatus hernia using novel software tools.

Aim:
The main purpose of this study was to determine the impact of HRM-based EGJ and lower esophageal sphincter (LES) metrics in predicting abnormal reflux burden.

Methods:
Total, upright, and supine acid exposure times (AETs) were extracted from ambulatory reflux monitoring performed off therapy in 482 patients (54.2±0.6 y, 63.3% female patients). EGJ morphology was categorized into type 1 (superimposed LES and crural diaphragm), type 2 (<3 cm separation between LES and crural diaphragm), and type 3 (≥3 cm separation). EGJ-contractile integral (EGJ-CI) and distal contractile integral (DCI) were extracted. Conventional EGJ and LES metrics, including basal and end-expiratory LES pressure, and LES length were also analyzed. Univariate and multivariate analyses were performed to determine the value of HRM parameters in predicting abnormal esophageal reflux burden.

Results:
Type 1 EGJ was noted in 298 (61.8%), type 2 in 125 (25.9%), and type 3 in 59 (12.2%); EGJ-CI and mean DCI were lower with abnormal EGJ morphology. Mean AET, and proportions with abnormal AET increased as EGJ morphology became progressively disrupted (P<0.0001 across groups); low EGJ-CI was additive in predicting abnormal AET. All HRM parameters assessed (EGJ morphology, EGJ-CI, and DCI) were independent predictors for abnormal AET (P≤0.02). Conventional LES and EGJ metrics were also associated with abnormal reflux burden, but intra-abdominal LES length, and hiatus hernia size did not independently predict total AET.

Conclusions:
HRM-based EGJ morphology and EGJ barrier assessment independently predict esophageal reflux burden.
Ethical challenges in regionalization of pediatric surgical care
Authors: Carlisle Erica M. , Rowell Erin E. 
Published: April 2019

Purpose of review
Rapid advancement in the field of pediatric surgery has resulted in unprecedented opportunities to advance the care of children. However, assuring that the highest quality, most appropriate care is available to all pediatric patients remains challenging. Regionalization of care has been proposed as a means of obtaining this critical goal. In this review, we discuss the ethical challenges associated with regionalization of pediatric surgical care.

Recent findings
Regionalization of pediatric surgical care is associated with improved patient outcomes. Over half of pediatric surgeons favor regionalization of care. Despite these findings, regionalization of care may be associated with inequitable distribution of resources, financial and emotional burdens for patients and families, and surgeon dissatisfaction and technical decline.

Summary
Regionalization of pediatric surgical care is fraught with complex ethical issues. Development of a system of pediatric surgery networks may offer a solution to these challenges.
An update on allergic emergencies
Authors: Toy Dana , Braga Matthew S. , Greenhawt Matthew , Shaker Marcus 
Published: April 2019

Purpose of review
To provide an updated framework of management for allergic emergencies.

Recent findings
The most frequent causes of anaphylaxis include medications, foods, and stinging insects. Early and appropriate administration of epinephrine is critical to managing anaphylaxis. Although epinephrine is well tolerated and there is no absolute contraindication to using epinephrine in first-aid management of anaphylaxis, many patients at risk for anaphylaxis still fail to carry and use the medication prior to seeking emergency care. Outcomes of allergic emergencies can be improved by educational efforts that focus on adherence to emergency plans, as well as asthma controller treatments in patients with persistent asthma. Though venom immunotherapy is known to decrease the risk for stinging insect anaphylaxis, the role of emerging strategies for food allergen immunotherapy in reducing cases of anaphylaxis requires further study.

Summary
Fatalities resulting from anaphylaxis and asthma are rare. Patient education serves an important role in preparing for unexpected emergencies, instituting prompt and appropriate treatment, and incorporating effective strategies into the lives of children and families.
Using Facebook To Recruit Pregnant Women for Research
Authors: Herbell Kayla 
Published: April 2019

Background
An estimated 80% of clinical trials fail to meet recruitment and enrollment goals. Recruitment can be even more challenging when vulnerable populations are the focus of the study. This problem may be mitigated with the use of contemporary and innovative methods such as Facebook recruitment.

Objectives
The purpose of this brief is to detail an account of diversifying recruitment strategies with the use of Facebook to recruit pregnant women into research.

Methods
This brief was derived from a parent study that aimed to examine relationships among social determinants of health, psychophysiological stress, and mental health in pregnant women. A Facebook account was created in which the principal investigator (PI) sought permission and posted in private Facebook groups about the research study. All data reported and analyzed in this brief are frequencies of Facebook activity including, likes, shares, comments, referrals (i.e., tags), and participants enrolled.

Results
Target enrollment for the parent study was met, with a total enrollment of 82 participants. The PI gained approval from 100% of the 61 private Facebook groups. Over 75% of the total sample was recruited in 48 days via Facebook. The greatest frequency of likes, shares, comments, and referrals by the recruitment flyer were generated from the sell/trade/jobs page. However, the greatest frequency of participants enrolled viewed the flyer in Facebook groups focused on parent discussion. Facebook groups classified as events, nonparent discussion, and miscellaneous were generally unsuccessful in yielding participants.

Discussion
In order to decrease the time lag between research and practice, and to enroll more participants, innovative strategies are necessary. Although there is evidence that Facebook was useful in recruiting a sample of pregnant women into research, Facebook may also be a useful resource in recruiting other populations into research as well.
Mediterranean Diet, Body Composition, and Activity Associated With Bone Health in Women With Fibromyalgia Syndrome
Authors: Correa-Rodríguez María , El Mansouri-Yachou Jamal , Tapia-Haro Rosa María , Molina Francisco , Rus Alma , Rueda-Medina Blanca , Aguilar-Ferrandiz María Encarnación 
Published: April 2019

BackgroundThere is very little scientific literature on the potential relationships between modifiable factors, including body composition, dietary pattern and physical activity (PA), and bone status in patients with fibromyalgia—a musculoskeletal condition characterized by chronic, widespread pain that is often accompanied by a broad spectrum of symptoms.ObjectivesThe aim of the study was to investigate the impact of body composition parameters, adherence to the Mediterranean diet (Med Diet), and PA on bone health in a population of premenopausal and postmenopausal women with fibromyalgia syndrome (FMS).MethodsNinety-five women diagnosed with FMS were included in this cross-sectional study. Body composition, including fat mass, percentage of fat mass, and lean mass (LM), were calculated using a body composition analyzer. Adherence to the Med Diet was measured through a validated 14-item questionnaire. The International Physical Activity Questionnaire was used to assess PA. Bone mass at the calcaneus was estimated through quantitative ultrasound.ResultsLinear regression analysis revealed that LM had a significant association with broadband ultrasound attenuation (β = 0.211, 95% CI [0.046, 1.259],p= .035) and stiffness index parameters (β = 0.201, 95% CI [0.019, 1.654],p= .045) after adjusting for age and menopausal status. The Med Diet was also significantly associated with broadband ultrasound attenuation (β = 1.693, 95% CI [0.508, 2.879],p= .006).DiscussionLM and the Med Diet were consistently associated with calcaneal quantitative ultrasound parameters, supporting the hypothesis that LM and adherence to the Med Diet play determinant roles in bone health in FMS women. Training programs to maximize LM and strategies for promoting good adherence to the Med Diet should be considered in order to prevent the development of osteoporosis in FMS women. Because nurses are involved in implementing preventive programs, their roles in promoting this adherence to the Med Diet and maximizing LM in patients with FMS should help reduce the impact of osteoporosis.