bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between chest computed tomography findings and respiratory adverse events in rheumatoid arthritis patients undergoing long‐term biological therapy
Authors: Matsumoto Takuya , Iwano Shingo , Takahashi Nobunori , Asai Shuji , Watanabe Tatsuo , Asai Nobuyuki , Sobue Yasumori , Ito Satoru , Ishiguro Naoki , Kojima Toshihisa 
Published: November 2018

AbstractObjectiveThis study aimed to assess the association between chest computed tomography (CT) findings and incidence of respiratory adverse events (RAEs), and to detect risk factors for RAEs, in RA patients treated with long‐term biological therapy.MethodsClinical and radiological data of 332 RA patients who were treated with biological disease‐modifying antirheumatic drugs were collected. CT data were assessed by an experienced radiologist. Patients were categorized into the interstitial lung disease (ILD) group (n = 29), airway disease (AD) group (n = 76), co‐existing ILD and AD (Co‐existing) group (n = 6), and the group without detectable change (WDC, n = 221) based on CT findings and scores. The incidence of RAEs was calculated for each group, and risk factors for RAEs from CT findings were explored.ResultsWe identified 41 RAEs, including acute onset or exacerbation of ILD (ILD events, n = 15), respiratory tract infection events (infection events, n = 21), and other events (n = 6). Cumulative incidences of ILD events were 20.2, 3.75, 47.2, and 1.94 (/1000 patient‐years: PY) in the ILD, AD, Co‐existing, and WDC groups, respectively, and those of infection events were 11.3, 17.6, 23.6, and 2.39 (/1000PY), respectively. Severity, as assessed by CT scores, was correlated with the incidence of RAEs. Risk factors for ILD events were reticular and honeycomb changes, and those for infection events were consolidation, bronchial wall thickening, bronchiectasis, bronchiolitis, air trapping, and atelectasis after adjusting for background factors.ConclusionOur findings highlight particular CT findings that are associated with RAEs in RA patients undergoing long‐term biological therapy.
Association between PD‐L1 expression and lymph node metastasis in cutaneous squamous cell carcinoma
Authors: Kamiya Shiori , Kato Junji , Kamiya Takafumi , Yamashita Toshiharu , Sumikawa Yasuyuki , Hida Tokimasa , Horimoto Kohei , Sato Sayuri , Takahashi Hitomi , Sawada Masahide , Kubo Terufumi , Torigoe Toshihiko , Uhara Hisashi 
Published: November 2018

AbstractAimTo clarify the relationship between programmed cell death ligand 1 (PD‐L1) expression in cutaneous squamous cell carcinoma (cSCC) and clinicopathological variables.MethodsWe examined PD‐L1 expression in tumor cells (TCs) and tumor infiltrating immune cells (ICs) in 46 cases of cSCC by immunohistochemistry. In each case, we employed two methods—intensity and proportion scores—to evaluate PD‐L1 expression in TCs. For the evaluation of PD‐L1 expression in ICs, only the proportion score was used. Association between PD‐L1 expression and clinicopathological variables was analyzed using Fisher's exact test.ResultsHigh intensity scores in TCs were observed in 18 of the 46 cases (39.1%) and low intensity scores were observed in 28 cases (60.9%). Applying the proportions, using cut‐off values of ≥1% and 50%, positive scores in TCs were observed in 36 (78.3%) and 20 cases (43.5%), respectively. PD‐L1‐positive ICs were observed in 29 (63%) and seven cases (15.2%), using cut‐off values of ≥1% and 10%, respectively. The high intensity scores in TCs correlated with lymph node metastasis (P = 0.008) and female gender (P = 0.017), although positive proportions in TCs or ICs were not significantly related to lymph node metastasis. A multivariate analysis showed that high intensity of PD‐L1 expression in TCs was an independent risk factor for lymph node metastasis.ConclusionsThe results suggested that high intensity of PD‐L1 expression in TCs is associated with lymph node metastasis in cSCC.
Treatment of alopecia areata: An Australian expert consensus statement
Authors: Cranwell William C , Lai Vivien WY , Photiou Louise , Meah Nekma , Wall Dmitri , Rathnayake Deepani , Joseph Shobha , Chitreddy Vijaya , Gunatheesan Shyamalar , Sindhu Kamaldeep , Sharma Pooja , Green Jack , Eisman Samantha , Yip Leona , Jones Leslie , Sinclair Rodney 
Published: November 2018

AbstractAlopecia areata (AA) severity varies from a single small patch to complete loss of scalp hair, body hair, eyelashes and eyebrows. While 40% of all affected individuals only ever get one patch and will achieve a spontaneous complete durable remission within 6 months, 27% will develop additional patches but still achieve complete durable remission within 12 months and 33% will develop chronic AA. Without systemic treatment, 55% of individuals with chronic AA will have persistent multifocal relapsing and remitting disease, 30% will ultimately develop alopecia totalis and 15% will develop alopecia universalis. The unpredictable course and psychological distress attributable to AA contributes to the illness associated with AA. Numerous topical, intralesional and systemic agents are currently used to treat AA; however, there is a paucity of data evaluating their use, effectiveness and tolerability. Topical therapy, including topical glucocorticosteroids, minoxidil and immunotherapy, can be used in cases of limited disease. There are no universally agreed indications for initiating systemic treatment for AA. Possible indications for systemic treatment include rapid hair loss, extensive disease (≥50% hair loss), chronic disease, severe distress or a combination of these factors. Currently available systemic treatments include glucocorticosteroids, methotrexate, ciclosporin, azathioprine, dapsone, mycophenolate mofetil, tacrolimus and sulfasalazine. The optimal treatment algorithm has not yet been described. The purpose of this consensus statement is to outline a treatment algorithm for AA, including the indications for systemic treatment, appropriate choice of systemic treatment, satisfactory outcome measures and when to discontinue successful or unsuccessful treatment.
Multicentre retrospective study to assess diagnostic accuracy of ultrasound for superficial endometriosis—Are we any closer?
Authors: Chowdary Prathima , Stone Kate , Ma Tony , Readman Emma , McIlwaine Kate , Druitt Marilla , Ellett Lenore , Cameron Melissa , Maher Peter 
Published: November 2018

BackgroundTo establish whether the ultrasound findings of minimal endometriosis are confirmed at laparoscopy and that a correlation can be established as to the anatomical sites in this mild form of the disease.AimsPatients with pain and suspicion of endometriosis had an ultrasound scan by a sonologist with expertise in endometriosis as part of their pre‐operative workup.Measurements and Main resultsThe clinical histories of 53 patients who had laparoscopy to investigate pelvic pain were reviewed. Ultrasounds were performed between 2012 and 2015 by a single sonologist with expertise in endometriosis assessments. The ultrasound findings were divided into subgroups as follows – presence of uterosacral ligament thickness, thickened pericolic fat, ovarian mobility and focal tenderness. These were compared with operative findings of those patients with superficial endometriosis. Evidence Level 3 – observational studies with controls and health services research that includes adjustment for likely confounding factors.ResultsSeventy‐nine percent (42/53) of the patients had laparoscopic findings consistent with their ultrasound findings (95% CI 68–90%, P < 0.0001). Of the subgroups that we reviewed, uterosacral thickening (P < 0.05) and thickened pericolic fat (P < 0.05) were the most associated with superficial endometriosis at the time of laparoscopy.ConclusionMarkers on ultrasound that reliably demonstrated inflammation (thickened uterosacral ligaments and thickened pericolic fat) were shown to be significantly associated with the disease.
Radiation effects on male fertility
Authors: De Felice F. , Marchetti C. , Marampon F. , Cascialli G. , Muzii L. , Tombolini V. 
Published: November 2018

SummaryBackgroundSpermatogenesis is a process of dynamic cell differentiation. Ionizing radiation impairs spermatogenesis, and spermatogonia are more radiosensitive than spermatocytes or spermatids. Consistent with this assumption and due to improvement in tumor curability, nowadays, fertility preservation represents a public health need.ObjectivesTo discuss radiotherapy‐induced risk to male fertility and raise oncologic awareness of male fertility in daily clinical practice.Materials and MethodsPubMed and Clinicaltrials.gov databases were searched for papers in English.ResultsWe provide an overview of clinical landscape. Four main issues were proposed: (i) spermatogenesis and radiobiological general concepts; (ii) impairment of spermatogenesis; (iii) impairment of testosterone‐producing Leydig cells; (iv) clinical radiotherapy evidence in oncology.ConclusionThis review can be useful in daily clinical work and offer some directions for future research.
Variations in sagittal and coronal stem tilt and their impact on prosthetic impingement in total hip arthroplasty
Authors: Tanaka Takeyuki , Takao Masaki , Sakai Takashi , Hamada Hidetoshi , Tanaka Sakae , Sugano Nobuhiko 
Published: November 2018

AbstractOptimization of the combined anteversion of cup and stem has been emphasized to avoid prosthetic impingement in total hip arthroplasty (THA). However, no study has focused on the impact of variations in sagittal and coronal stem tilt against the whole femur on prosthetic range of motion. The purposes of the present study were a) to quantify the anatomical variation of sagittal and coronal tilt of the proximal canal axis against the femoral retrocondylar coordinate system, that is variation of sagittal and coronal stem tilt and b) to determine their impact on the zone of impingement‐free cup position using computer simulation. Preoperative computed tomography images of 477 femurs from 409 consecutive patients who underwent THA using computed tomography‐based computer navigation were stored. Virtual implantation of an anatomical stem was performed on the navigation workstation. The safe zone of the cup position with regard to prosthetic impingement was determined by motion simulation in the range of sagittal and coronal stem tilt of the subjects. The sagittal and coronal stem tilt varied by 10°, which was smaller than the stem anteversion variation. However, there was about 3 times the difference in the impingement‐free zone of cup position in the ranges of sagittal and coronal stem tilt. The safe zone was significantly decreased by posterior tilt and valgus tilt of the stem. Range of motion simulation revealed that the variations in sagittal or coronal stem tilt significantly influenced the safe zone of the cup. In conclusion, although the variations in sagittal and coronal stem tilt against the femoral retrocondylar coordinate system were small, their impact on prosthetic impingement was significant.
Silk enhances the ligamentization of the polyethylene terephthalate artificial ligament in a canine anterior cruciate ligament reconstruction model
Authors: Zhi Yunlong , Jiang Jia , Zhang Peng , Chen Shiyi 
Published: November 2018

AbstractAnterior cruciate ligament (ACL) reconstruction is the leading treatment for ACL rupture. Ligament Advanced Reinforcement System (LARS), which is made of polyethylene terephthalate (PET), is the most frequently used artificial ligament for ACL reconstruction. However, PET is hydrophobic, so it is difficult to induce the ingrowth of the autologous tissue. The aim of this study is to explore the effects of silk hybrid on the ligamentization of the PET artificial ligament in a canine ACL reconstruction model. Silk/PET hybrid suspensory ligament was fabricated with silk in the weft yarn and PET in the warp yarn, while PET suspensory ligament was fabricated with PET in both the weft and warp yarns. After fabrication, the micromorphology of the ligaments was observed and mechanical testing was performed. Though the failure loads of the degummed silk/PET hybrid suspensory ligaments were significantly lower than those of the PET suspensory ligaments (P < 0.001), both of them were enough for ACL reconstructions of beagle dogs. In the animal study, 14 beagle dogs were divided into PET suspensory ligament group and silk/PET hybrid suspensory ligament group randomly, with 7 dogs in each. The dogs underwent ACL reconstructions in their right knees. At postoperative 6 months, the dogs were sacrificed, and the specimens were evaluated with gross observation, histology, immunohistochemistry, and mechanical testing. The histological and immunohistochemical results showed that the native ACL of the beagle dog held abundant fibroblasts and collagen. The PET‐regenerated ligament was loose, and there was a small amount of autologous tissue and collagen. Compared to the PET‐regenerated ligament, the silk/PET hybrid‐regenerated ligament had a compact structure, and there was more regenerated autologous tissue and collagen. In conclusion, compared to the PET ligament, the silk/PET hybrid ligament kept greater ability to induce the ingrowth of the autologous tissue, indicating that the silk hybrid had enhanced the ligamentization of the PET artificial ligament.
Mediastinoscopic salvage esophagectomy for recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy in a previously pneumonectomized patient
Authors: Okumura Tomoyuki , Seto Yasuyuki , Aikou Susumu , Moriyama Makoto , Sekine Shinich , Hashimoto Isaya , Shibuya Kazuto , Hojo Shozo , Yoshioka Isaku , Nagata Takuya , Fujii Tsutomu 
Published: November 2018

AbstractWe herein report a case of mediastinoscopic salvage esophagectomy for recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy in a previously pneumonectomized patient. A 66‐year‐old man with a medical history of left‐sided pneumonectomy for lung cancer was diagnosed with local recurrence of lower esophageal squamous cell carcinoma (cT3N0M0 cStage II) 9 years after definitive chemoradiotherapy. The mediastinoscopic cervical approach and laparoscopic transhiatal approach were combined, and the thoracic esophagus was safely mobilized to separate the esophagus from the stump of the left bronchus and to divide dense adhesions between the esophagus and fibrotic tissue at the site of the previous left mediastinal pleural resection. The esophagectomy was uneventful and followed by reconstruction with a gastric conduit via the retrosternal route. The pathological diagnosis was esophageal squamous cell carcinoma (pT3‐AD, pN1, M0, pStage III), indicating R0 resection. Even as salvage surgery, mediastinoscopic esophagectomy is a safe and curative treatment strategy for esophageal cancer patients who have previously undergone pneumonectomy.
Compassionate versus consequentialist conservation
Authors: Hampton Jordan O. , Warburton Bruce , Sandøe Peter 
Published: November 2018

AbstractEthical treatment of wildlife and consideration of animal welfare have become important themes in conservation, but ethical perspectives on how best to protect wild animals and promote their welfare are diverse. There are advantages to the consequentialist harms ethical framework applied in managing wild herbivores for conservation purposes. To minimize harms while achieving conservation goals, we argue that overabundant wild herbivores should in many cases be managed through consumptive in situ killing. Advantages of this policy are that the negative welfare states imposed on animals last only a short time; remaining animals are not deprived of positive welfare states (e.g., linked to rearing offspring); poor welfare states of animals in overabundant populations are avoided (e.g., starvation); negative welfare impacts on heterospecifics through resource depletion (i.e., competition) are prevented; harvesting meat reduces the number of (agricultural) animals raised to supply meat; and minimal costs maximize funding for other wildlife management and conservation priorities. Alternative ethical approaches to our consequentialist framework include deontology (containing animal rights) and virtue ethics, some of which underpin compassionate conservation. These alternative ethical approaches emphasize the importance of avoiding intentional killing of animals but, if no population reduction occurs, are likely to impose considerable unintentional harms on overabundant wildlife and indirectly harm heterospecifics through ineffective population reduction. If nonlethal control is used, it is likely that overabundant animals would be deprived of positive welfare states and economic costs would be prohibitive. We encourage conservation stakeholders to consider animal‐welfare consequentialism as an ethical approach to minimize harms to the animals under their care as well as other animals that policies may affect while at the same time pursuing conservation goals.
An experimental translocation identifies habitat features that buffer camouflage mismatch in snowshoe hares
Authors: Wilson Evan C. , Shipley Amy A. , Zuckerberg Benjamin , Peery M. Zachariah , Pauli Jonathan N. 
Published: November 2018

AbstractConservation for species impacted by climate change often occurs at scales impractical for local land managers. Snowshoe hares (Lepus americanus) are one of the most well‐documented species declining from climate change–specifically a reduction in snowcover–yet clear management strategies have yet to emerge. To test whether camouflage mismatch is reducing hare survival we translocated 96 hares to a site recently extirpated of snowshoe hares, and monitored coat color change, mismatch with snow, habitat use, and weekly survival in winter‐spring of 2017. Hare survival was low during periods of camouflage mismatch, and mismatched hares were 3.2 × less likely to survive, but this pattern varied by habitat. We found that aspen‐alder stands >5 hectares negated the mortality costs of mismatch. We provide experimental evidence that mismatch is driving the range contraction of snowshoe hares, and identify specific habitats to buffer the consequences of climate change on this declining winter specialist.
Pain management and safety profiles after preoperative vs postoperative thoracic epidural insertion for bilateral lung transplantation
Authors: Axtell Andrea L. , Heng Elbert E. , Fiedler Amy G. , Melnitchouk Serguei , D'Alessandro David A. , Tolis George , Astor Todd , Dalia Adam A. , Cudemus Gaston , Villavicencio Mauricio A. 
Published: November 2018

AbstractObjectiveThoracic epidural analgesia provides effective pain control after lung transplantation; however, the optimal timing of placement is controversial. We sought to compare pain control and pulmonary and epidural morbidity between patients receiving preoperative vs postoperative epidurals.MethodsInstitutional records were reviewed for patients undergoing a bilateral lung transplant via a bilateral anterior thoracotomy with transverse sternotomy incision between January 2014 and January 2017. Pain control was measured using visual analog scale pain scores (0‐10). Pulmonary complications included a composite of pneumonia, prolonged intubation, and reintubation/tracheostomy.ResultsAmong 103 patients, 72 (70%) had an epidural placed preoperatively and 31 (30%) had an epidural placed within 72 hours posttransplant. There were no differences in the rates of cardiopulmonary bypass (3% vs 0%, P = 0.59); however, patients with a preoperative epidural were less likely to be placed on extracorporeal membrane oxygenation intraoperatively (25% vs 52%, P = 0.01). Pain control was similar at 24 hours (1.2 vs 1.7, P = 0.05); however, patients with a preoperative epidural reported lower pain scores at 48 (1.2 vs 2.1, P = 0.02) and 72 hours posttransplant (0.8 vs 1.7, P = 0.02). There were no differences in primary graft dysfunction (42% vs 56%, P = 0.28), length of mechanical ventilation (19.5 vs 24 hours, P = 0.18), or adverse pulmonary events (33% vs 52%, P = 0.12). No adverse events including epidural hematoma, paralysis, or infection resulted from epidural placement.ConclusionPreoperative thoracic epidural placement provides improved analgesia without increased morbidity following lung transplantation.
Accuracy of new recommendations for adrenal incidentalomas in the evaluation of excessive cortisol secretion and follow‐up
Authors: Ruiz Ana , Michalopoulou Theodora , Megia Ana , Näf Silvia , Simón‐Muela Inmaculada , Solano Esther , Martínez Laia , Vendrell Joan 
Published: November 2018

AbstractObjectiveTo evaluate whether the 2016 European Society of Endocrinology (ESE) recommendations for the management of adrenal incidentalomas accurately classifies those patients who do not require further follow‐up.Design and MethodsSingle centre retrospective study. From 2010 to 2015, 130 patients with adrenal incidentaloma were evaluated and followed‐up. Clinical, analytical and radiological data were recorded and the presence of comorbidities was assessed. Patients were grouped as nonfunctional or subclinical Cushing syndrome according to American guidelines; and nonfunctional, possible autonomous cortisol secretion and autonomous cortisol secretion, according to ESE guidelines.ResultsBased on American guidelines, 94% of patients had nonfunctional adrenal incidentalomas and 6% had subclinical Cushing syndrome. Based on ESE guidelines, patients were classified into nonfunctional (54%), possible autonomous cortisol secretion (40%) and autonomous cortisol secretion (6%) groups. No differences were observed in demographic characteristics and comorbidities between groups in either classification. Following ESE guidelines, no patient in the nonfunctional group was reclassified into the possible autonomous or autonomous cortisol secretion groups during follow‐up, but one patient in the possible autonomous cortisol secretion group was reclassified into the autonomous cortisol secretion group. Also, 30 patients included in the groups of possible autonomous or autonomous cortisol secretion experienced progression of a comorbidity associated with cortisol excess, with diabetes mellitus as the most frequent comorbidity observed.ConclusionAlthough adrenal incidentalomas with an excess of cortisol secretion were more frequently diagnosed with the new ESE recommendations, patients who did not require longer follow‐up after first evaluation were accurately classified.
Inhibitors in haemophilia A and B: Management of bleeds, inhibitor eradication and strategies for difficult‐to‐treat patients
Authors: Ljung Rolf , Auerswald Guenter , Benson Gary , Dolan Gerry , Duffy Anne , Hermans Cedric , Jiménez‐Yuste Victor , Lambert Thierry , Morfini Massimo , Zupančić‐Šalek Silva , Santagostino Elena 
Published: November 2018

AbstractThe standard therapy for patients with haemophilia is prophylactic treatment with replacement factor VIII (FVIII) or factor IX (FIX). Patients who develop inhibitors against FVIII/FIX face an increased risk of bleeding, and the likelihood of early development of progressive arthropathy, alongside higher treatment‐related costs. Bypassing agents can be used to prevent and control bleeding, as well as the recently licensed prophylaxis, emicizumab, but their efficacy is less predictable than that of factor replacement therapy. Antibody eradication, by way of immune tolerance induction (ITI), is still the preferred management strategy for treating patients with inhibitors. This approach is successful in most patients, but some are difficult to tolerise and/or are unresponsive to ITI, and they represent the most complicated patients to treat. However, there are limited clinical data and guidelines available to help guide physicians in formulating the next treatment steps in these patients. This review summarises currently available treatment options for patients with inhibitors, focussing on ITI regimens and those ITI strategies that may be used in difficult‐to‐treat patients. Some alternative, non‐ITI approaches for inhibitor management, are also proposed.