bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systemic Chemotherapy for Advanced Rare Pancreatic Histotype Tumors
Authors: Brunetti Oronzo , Aprile Giuseppe , Marchetti Paolo , Vasile Enrico , Casadei Gardini Andrea , Scartozzi Mario , Barni Sandro , Delfanti Sara , De Vita Fernando , Di Costanzo Francesco , Milella Michele , Cella Chiara Alessandra , Berardi Rossana , Cataldo Ivana , Scarpa Aldo , Basile Debora , Mazzuca Federica , Graziano Giusi , Argentiero Antonella , Santini Daniele , Reni Michele , Cascinu Stefano , Silvestris Nicola 
Published: May 2018

ObjectivesTwo issues were put forth by clinicians in the management of the advanced stages of rare variants of pancreatic ductal adenocarcinoma and other exocrine histotypes with peculiar clinical and pathological features: Do chemotherapy regimens recommended in pancreatic ductal adenocarcinoma patients have a clinical activity in rare pancreatic tumors? Or should other chemotherapy combinations be considered in this subset of patients?MethodsWe conducted a multicenter retrospective study that collected data from 2005 to 2016 at 14 Italian cancer centers with the aim to evaluate tumor response and time to progression for first- and second-line and overall survival.ResultsOf approximately 4300 exocrine pancreatic cancer patients, 79 advanced cases affected by rare histological types were identified, with pancreatic acinar cell cancer (n = 23), pancreatic adenosquamous cancer (n = 16), and mucinous cystic neoplasm with an associated invasive mucinous cystadenocarcinoma (n = 15) most represented. Survival analyses for each subgroup in relation with the different chemotherapy regimens showed the lack of statistical significance correlations.ConclusionsBecause of the lack of clinical trials in patients affected by these rare pancreatic histotypes, only their molecular classification would help clinicians in future therapeutic choice.
Repeat Human Immunodeficiency Virus Testing by Transmission Risk Group and Rurality of Residence in North Carolina
Authors: Billock Rachael M. , Samoff Erika , Cope Anna B. , Sampson Lynne A. , Hurt Christopher B. , Powers Kimberly A. 
Published: May 2018

Background
Understanding of repeat human immunodeficiency virus (HIV) testing (RHT) is limited and the impact of rural residence as a potential barrier to RHT is unknown. Rural populations are of particular interest in the Southeastern United States because of their disproportionate HIV burden.

Methods
We used HIV surveillance data from publicly funded HIV testing sites in North Carolina to assess repeat testing by transmission risk group and residential rurality in a retrospective cohort study. Linear binomial regression models were used to estimate adjusted, 1-year cumulative incidences and cumulative incidence differences comparing RHT within transmission risk populations by level of rurality.

Results
In our total study population of 600,613 persons, 19,275 (3.2%) and 9567 (1.6%) self-identified as men who have sex with men (MSM) and persons who inject drugs (PWID), respectively. A small minority, 13,723 (2.3%) resided in rural ZIP codes. Men who have sex with men were most likely to repeat test (unadjusted, 1-year cumulative incidence after an initial negative test, 16.4%) compared with PWID (13.2%) and persons who did not identify as either MSM or PWID (13.6%). The greatest effect of rurality was within PWID; the adjusted, 1-year cumulative incidence of RHT was 6.4 (95% confidence interval, 1.4–11.4) percentage points higher among metropolitan versus rural PWID.

Conclusions
One-year cumulative incidence of RHT was low among all clients of publicly funded HIV testing sites in North Carolina, including MSM and PWID for whom annual testing is recommended. Our findings suggest a need for public health efforts to increase access to and support for RHT, particularly among rural PWID.
Disappearing Digits: Analysis of National Trends in Amputation and Replantation in the United States
Authors: Reavey Patrick L. , Stranix John T. , Muresan Horatiu , Soares Marc , Thanik Vishal 
Published: May 2018

Background:
Significantly fewer replantations have been performed at the authors’ institution in recent years, with similar trends observed across the United States. A study of three national databases was performed to evaluate this trend, its possible cause, and national health care implications.

Methods:
The National Electronic Injury Surveillance System, Bureau of Labor Statistics, and National Inpatient Sample databases were queried for cases with a diagnosis of finger amputation over available years from 2000 to 2011. Data were weighted and analyzed to give appropriate national estimates of amputations, replantations, and related clinical variables. Trend analysis was performed using modified Poisson regression.

Results:
Although workplace finger amputation rates decreased 40 percent from 2000 to 2010 (p < 0.0001), the overall finger amputation incidence did not change significantly (26,668 versus 24,215; p = 0.097). Compared with 930 replantations in 2001, only 445 were performed in 2011, more than a 50 percent decrease (p < 0.001). In all years, the majority of hospitals performing replantation performed only one (49.3 to 64.1 percent) each year, with a small minority (2.2 to 8.1 percent) performing more than 10 per year. In 2000, 120 hospitals (12.1 percent) performed at least one replantation, compared with only 80 hospitals (7.6 percent) in 2010, a 4.6 percent annual decline (p = 0.002).

Conclusions:
There has been a striking decline in digital replantations being performed, despite a relatively stable incidence of amputations. Apparently independent of declining work-related injuries, evolving clinical decision-making may be responsible for this trend. Decreasing replantation experience among hand surgeons lends credence to the development of specialized regional centers designed to treat these complex injuries.
The Accuracy of Conflict-of-Interest Disclosures Reported by Plastic Surgeons and Industry
Authors: Lopez Joseph , Samaha Georges , Purvis Taylor E. , Siegel Gabriel , Jabbari Javaneh , Ahmed Rizwan , Milton Jacqueline , Tufaro Anthony P. , May James W. , Dorafshar Amir H. 
Published: May 2018

Background:
The purpose of this study was to analyze the frequency and nature of self-reported conflict-of-interest disclosures in the plastic surgery literature and to compare these findings to the Physician Payments Sunshine Act database.

Methods:
All articles published from August of 2013 through December of 2013 in four major plastic surgery journals were analyzed. For every publication, the conflict-of-interest disclosure statement for each investigator was reviewed. These statements were then compared to transactions of value for each investigator as reported by biomedical companies in the Sunshine Act database. An analysis was performed to identify and characterize specific factors associated with conflict-of-interest disclosures.

Results:
A total of 1002 independent investigators/authors were identified. Of these, 90 investigators (9 percent) self-reported a conflict of interest. In contrast, a total of 428 authors (42.7 percent) were found to have received transactions of value from a biomedical company according to the Sunshine Act database. Conversely, a total of 22 authors (2.2 percent) self-reported a conflict of interest but were not found to have received transactions of value in the Sunshine Act database. Our analysis found that (1) academic investigators, (2) transactions of value in excess of $500, and (3) publishing articles related to the sponsoring biomedical company were all statistically associated with reporting conflicts of interest (p < 0.0001).

Conclusions:
Discordance exists between investigator/authors self-reporting in scientific journals and the government-mandated reporting of conflicts of interest by industry. Factors associated with conflict-of-interest disclosure include academic status, transaction amount, and article content related to the sponsoring biomedical company.
Supportive Use of Adipose-Derived Stem Cells in Cell-Assisted Lipotransfer for Localized Scleroderma
Authors: Chen Bo , Wang Xiaojun , Long Xiao , Zhang Mingzi , Huang Jiuzuo , Yu Nanze , Xu Jing 
Published: May 2018

Background:
The authors aimed to analyze factors related to lipotransfer for localized scleroderma, and to explore the feasibility of cell-assisted lipotransfer for localized scleroderma treatment.

Methods:
Abdominal fat samples were taken from six scleroderma patients without corticosteroid therapy, five scleroderma patients with corticosteroid therapy, and 10 normal liposuction patients. Their quantity, morphology, and proliferation ability were measured. Blood flow was measured by laser speckle contrast imaging in localized scleroderma lesions and normal contralateral regions for eight localized scleroderma patients. Bleomycin-induced skin fibrosis nude mice were also used to investigate differences between lipotransfer and cell-assisted lipotransfer. Fat weight was measured, and expression of transforming growth factor (TGF)-β1 and type III collagen in the injected skin was determined by immunohistochemistry.

Results:
The number of stem cells from scleroderma patients with corticosteroid treatment was significantly reduced. Mean blood perfusion in localized scleroderma lesions was not significantly different than in the contralateral normal regions. In normal nude mice, there were no significant changes in TGF-β1 and type III collagen between the control, lipotransfer, and cell-assisted lipotransfer groups, whereas in bleomycin-induced skin fibrosis nude mice, lipotransfer and cell-assisted lipotransfer reduced TGF-β1 and type III collagen expression.

Conclusions:
For scleroderma patients, fewer adipose-derived stem cells, because of a history of corticosteroid therapy and a local inflammatory microenvironment, are more important factors, whereas blood supply showed no significant change. Therefore, cell-assisted lipotransfer not only improves the survival rate of transplanted fat but also improves skin texture in bleomycin-induced skin fibrosis nude mice.
Innovative Surgical Approach Using a Mesh Sling for the Aging Neck
Authors: Gronovich Yoav 
Published: May 2018

Background:
Rejuvenation of the neck is essential to achieve a young facade. Different approaches for aging neck rejuvenation have been developed throughout the years. Most of them focus on specific elements that contribute to the aging neck. The main drawbacks of these techniques are recurrence of the platysma bands, malposition, deformations, salivary problems, and defatting. These disadvantages and limitations have led the author to create a novel surgical approach to improve the aging neck that would be suitable for most patients. Instead of dealing with each of the elements of the aging neck, the author’s approach involves use of a sling to elevate all the descending elements as a whole to create a natural and longstanding result.

Methods:
Since March of 2014, 10 patients have been operated on for neck lifting with this new approach. Four different types of material have been used: absorbable synthetic braided (Vicryl) in five patients, semiabsorbable synthetic braided and monofilament (Vypro) in one patient, absorbable synthetic matrix (TIGR) in three patients, and biological mesh–allograft material (AlloDerm) in one patient. Follow-up visits were made after 10 days, 3 months, 6 months, and annually.

Results:
In all cases, the operations were uneventful. There were no major complications. Minor complication occurred in one patient with the Vypro mesh. The mesh caused stiffness and was replaced. Final aesthetic results were satisfactory in all cases.

Conclusions:
Current approaches for improvement of the aging neck do not fit all aging neck cases and are suitable for only a specific dominant element. The aging neck tends to reappear faster than expected because of recurrence or dominance of another element. The author’s novel approach is more predictable and is suitable for most cases regardless of the dominant part causing the aging. More experience and longer follow-up are needed to choose the most appropriate material for the mesh.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Predictors of Patient Satisfaction and Postoperative Complications in Penile Inversion Vaginoplasty
Authors: Massie Jonathan P. , Morrison Shane D. , Van Maasdam Judy , Satterwhite Thomas 
Published: May 2018

Background:
Penile inversion vaginoplasty is the current gold standard procedure for male-to-female transgender patients seeking gender-confirming genital surgery. Although complication data have been reported extensively in the literature, studies on patient-reported outcomes are sparse. This study aimed to report both postoperative complications and patient-reported outcomes from the largest cohort in the United States to date to undergo penile inversion vaginoplasty. Ultimately, the authors hoped to identify the predictors of postoperative complications and patient satisfaction.

Methods:
A retrospective chart review of a single surgeon’s experience with penile inversion vaginoplasty was performed from July of 2014 to June of 2016. Patient demographic data, postoperative complications, and patient-reported outcome data were collected. Data were correlated by binary logistic regression to determine predictors of postoperative complications and patient satisfaction.

Results:
A total of 117 patients underwent penile inversion vaginoplasty. The most common complications were granulation tissue (26 percent), intravaginal scarring (20 percent), and prolonged pain (20 percent). Overwhelmingly, patients reported “feeling positively about their genitals” (94 percent) and “would do this operation again” (94 percent). Seventy-one percent of patients reported resolution of their gender dysphoria. The top predictors of patient dissatisfaction were intravaginal scarring, prolonged pain, excessive external scarring, loss of sensation, and hematoma/excessive bleeding.

Conclusions:
This is the largest study of penile inversion vaginoplasty in the United States to report on both postoperative complications and patient-reported outcomes. Despite moderate complication risk, patient satisfaction remains very high after penile inversion vaginoplasty, with the majority of patients reporting improvement of their gender dysphoria.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Self-Regulation and Executive Functioning as Related to Survival in Motor Neuron Disease: Preliminary Findings
Authors: Garcia-Willingham Natasha E. , Roach Abbey R. , Kasarskis Edward J. , Segerstrom Suzanne C. 
Published: May 2018

ABSTRACT

Objective
Disease progression varies widely among patients with motor neuron disease (MND). Patients with MND and coexisting dementia have shorter survival. However, implications of mild cognitive and behavioral difficulties are unclear. The present study examined the relative contribution of executive functioning and self-regulation difficulties on survival over a 6-year period among patients with MND, who scored largely within normal limits on cognitive and behavioral indices.

Methods
Patients with MND (N = 37, age = 59.97 ± 11.57, 46% female) completed the Wisconsin Card Sorting Task as an executive functioning perseveration index. The Behavior Rating Inventory of Executive Functions (BRIEF-A) was used as a behavioral measure of self-regulation in two subdomains self-regulatory behavior (Behavioral Regulation) and self-regulatory problem-solving (Metacognition). Cox proportional hazard regression analyses were used.

Results
In total, 23 patients died during follow-up. In Cox proportional hazard regressions adjusted for a priori covariates, each 10-point t-score increment in patient-reported BRIEF-A self-regulatory behavior and problem-solving difficulties increased mortality risk by 94% and 103%, respectively (adjusted HR = 1.94, 95% CI = 1.07–3.52; adjusted HR = 2.03, 95% CI = 1.19–3.48). In sensitivity analyses, patient-reported self-regulatory problem-solving remained significant independent of disease severity and a priori covariates (adjusted HR = 1.68, 95% CI = 1.01–2.78), though the predictive value of self-regulatory behavior was attenuated in adjusted models (HR = 1.67, 95% CI = 0.85–3.27). Caregiver-reported BRIEF-A ratings of patients and Wisconsin Card Sorting Task perseverative errors did not significantly predict survival.

Conclusions
Preliminary evidence suggests patient-reported self-regulatory problem-solving difficulties indicate poorer prognosis in MND. Further research is needed to uncover mechanisms that negatively impact patient survival.
Mixed-Methods Evaluation of Real-Time Safety Reporting by Hospitalized Patients and Their Care Partners: The MySafeCare Application
Authors: Collins Sarah A. , Couture Brittany , Smith Ann DeBord , Gershanik Esteban , Lilley Elizabeth , Chang Frank , Yoon Cathy , Lipsitz Stuart , Sheikh Aziz , Benneyan James , Bates David W. 
Published: May 2018

Objective
The aims of the study were to evaluate the amount and content of data patients and care partners reported using a real-time electronic safety tool compared with other reporting mechanisms and to understand their perspectives on safety concerns and reporting in the hospital.

Methods
This study used mixed methods including 20-month preimplementation and postimplementation trial evaluating MySafeCare, a web-based application, which allows hospitalized patients/care partners to report safety concerns in real time. The study compared MySafeCare submission rates for three hospital units (oncology acute care, vascular intermediate care, medical intensive care) with submissions rates of Patient Family Relations (PFR) Department, a hospital service to address patient/family concerns. The study used triangulation of quantitative data with thematic analysis of safety concern submissions and patient/care partner interviews to understand submission content and perspectives on safety reporting.

Results
Thirty-two MySafeCare submissions were received with an average rate of 1.7 submissions per 1000 patient-days and a range of 0.3 to 4.8 submissions per 1000 patient-days across all units, indicating notable variation between units. MySafeCare submission rates were significantly higher than PFR submission rates during the postintervention period on the vascular unit (4.3 [95% confidence interval = 2.8–6.5] versus 1.5 [95% confidence interval = 0.7–3.1], Poisson) (P = 0.01). Overall trends indicated a decrease in PFR submissions after MySafeCare implementation. Triangulated data indicated patients preferred to report anonymously and did not want concerns submitted directly to their care team.

Conclusions
MySafeCare evaluation confirmed the potential value of providing an electronic, anonymous reporting tool in the hospital to capture safety concerns in real time. Such applications should be tested further as part of patient safety programs.
Sustained Impact of a Pediatric Resident-Led Patient Safety Council
Authors: Parente Victoria , Feeney Colby , Page Laura , Johnson Shaina , Porada Kelsey , Cheifetz Ira , Stephany Alyssa 
Published: May 2018

Objectives
The aim of the study was to evaluate the impact of a resident-led patient safety council. This study measured change in resident perceptions and knowledge of safety issues for 3 years, as well as behavioral choices to participate in patient safety activities during and after residency.

Methods
Pediatric residents formed a resident-led safety council to engage their peers in patient safety activities. Surveys were distributed annually from 2013 to 2015 to measure residents’ perception and knowledge surrounding patient safety. The number of patient safety reports submitted by residents was tracked for the same period. In addition, recent graduates were surveyed to assess the influence of the council on postresidency involvement in patient safety.

Results
Resident perception of the institutional culture of safety improved and knowledge of basic patient safety concepts increased. The number of resident-submitted safety reports increased from 6.2 to 15.2 reports per month in the 2013 and 2015 academic years, respectively. Surveys of recent graduates suggest that involvement with the safety council during residency fostered future engagement in patient safety.

Conclusions
This resident-led council models successful involvement of trainees in system-based patient safety. Such involvement can help shape the safety culture within a training program and encourages continued participation in patient safety after residency completion.
Brief Report: The Association of Chronic Pain and Long-Term Opioid Therapy With HIV Treatment Outcomes
Authors: Merlin Jessica S. , Long Dustin , Becker William C. , Cachay Edward R. , Christopoulos Katerina A. , Claborn Kasey , Crane Heidi M. , Edelman E. Jennifer , Harding Richard , Kertesz Stefan G. , Liebschutz Jane M. , Mathews W. Christopher , Mugavero Michael J. , Napravnik Sonia , C. O'Cleirigh Connall , Saag Michael S. , Starrels Joanna L. , Gross Robert 
Published: May 2018

Background:
Chronic pain occurs in up to 85% of persons living with HIV and is commonly treated with long-term opioid therapy (LTOT). We investigated the impact of chronic pain and LTOT on HIV outcomes.

Methods:
This was prospective cohort study conducted between July 2015 and July 2016 in 5 HIV primary care clinics. Chronic pain was defined as ≥moderate pain for ≥3 months on the Brief Chronic Pain Questionnaire. Chronic pain and LTOT were assessed at an index visit. Suboptimal retention, defined as at least one “no-show” to primary care, and virologic failure were measured over the subsequent year. Multivariable logistic regression models were built for each outcome adjusting for site.

Results:
Among 2334 participants, 25% had chronic pain, 27% had suboptimal retention, 12% had virologic failure, and 19% were prescribed LTOT. Among individuals not on LTOT, chronic pain was associated with increased odds of suboptimal retention [adjusted odds ratio (aOR) 1.46, 95% confidence interval (CI): 1.10 to 1.93, P = 0.009] and virologic failure (aOR 1.97, 95% CI: 1.39 to 2.80, P < 0.001). Among individuals with chronic pain, there was no association between LTOT and retention, but LTOT was associated with lower rates of virologic failure (aOR 0.56, 95% CI: 0.33 to 0.96, P = 0.03).

Conclusions:
Chronic pain in participants not on LTOT was associated with virologic failure. This reinforces the need to identify effective chronic pain treatments for persons living with HIV and investigate their impact on HIV outcomes. The apparent protective association between LTOT and virologic failure in those with pain merits further exploration.
The Effect of Transtemperal Approach and Placement of Intracranial Pressure Sensor Into Temporal Horn of Lateral Ventricle in Management of Spontaneous Supratentorial Intracerebral Hemorrhage Broken Into Ventricles
Authors: Wang Fei , Yang Tao , Niu Chaoshi 
Published: May 2018

Abstract
To investigate the effect of transtemperal approach and placement of intracranial pressure sensor into temporal horn of lateral ventricle in management of spontaneous supratentorial intracerebral hemorrhage broken into ventricles, a total of 37 patients with spontaneous supratentorial intracerebral hemorrhage broken into ventricles treated by operation from January 2016 to December 20l6 were analyzed retrospectively, of which 25 patients in simple transtemporal approach group and 12 patients in transtemperal approach and placement of intracranial pressure sensor into temporal horn of lateral ventricle group. All patients were followed up for 8 months to 1.5 years. Two groups were estimated by mortality, clearance rate of hematoma, removal rate of bone flap, good prognosis rate of ADL and incidence of hydrocephalus. The good prognosis rate of ADL and the incidence of hydrocephalus are only statistically significant between the two groups (P < 0.05). According to the result, the transtemperal approach and placement of intracranial pressure sensor into temporal horn of lateral ventricle in management of spontaneous supratentorial intracerebral hemorrhage broken into ventricles is a safe, effective, and less complication of treatment measure.