bluuebunny/crossref_metadata_2025_split huggingface dataset:
Human papillomavirus type 16 (HPV16) DNA copy number in oral rinse samples from oral cavity cancer patients
Authors: Shigeishi Hideo , Yokoyama Sho , Ohta Kouji , Takechi Masaaki , Sugiyama Masaru 
Published: April 2018

Objectives: The objective of this study is to examine the human papillomavirus type 16 (HPV16) DNA copy number in the oral cavity of cancer patients using oral rinse samples. Methods: We analyzed the HPV16 DNA copy number of oral rinse samples in 13 primary oral cavity cancer patients (mean age 67.8 years, range 48–84 years) who visited the Department of Oral and Maxillofacial Reconstructive Surgery of Hiroshima University Hospital (Hiroshima, Japan). The 13 oral cavity cancers included 6 carcinomas in situ and 7 squamous cell carcinomas. Real-time PCR analysis was performed to examine the number of HPV16 E6 viral copies in oral rinse samples. Additionally, the HPV16 integration status was investigated using the real-time PCR findings for HPV16 E2 genes in HPV16 E6-positive oral rinse samples. Results: HPV16 E6 copy numbers above the detection limit in a standard curve for HPV16 E6 DNA were assessed as HPV16 positive in oral rinse samples from 6 of 13 patients. The average number of HPV16 E6 viral copies was 1.71 ± 1.72 per cell (range, 0.39–4.96 copies/cell) in six oral rinse samples. The HPV16 E2 viral load was detected in four of the six HPV16-positive oral rinse samples. Two of the six HPV16-positive oral rinse samples showed HPV16 E2 copy numbers below the detection limit, indicating the full integration of HPV16 DNA. Conclusions: The number of patients in this study was small; therefore, further investigation using a larger number of participants is required to clarify the level of HPV16 viral copy number in the oral cavity of cancer patients.
Empathy in Internal Medicine Residents at Community-based Hospitals: A Cross-sectional Study
Authors: Foreback Jami , Kusz Halina , Lepisto Brenda Lovegrove , Pawlaczyk Barbara 
Published: April 2018

Introduction: Many research reports revealed declining empathy in medical schools that continues in postgraduate years of training. Objective: The aim of this study is to examine the self-reported empathy levels of internal medicine (IM) residents in 3 community-based teaching hospitals. Methods: The Jefferson Scale of Physician Empathy, Health Professionals version, is an online, self-administered, questionnaire that was offered to 129 current and incoming residents at 1 osteopathic and 2 allopathic, IM training programs in Flint, Michigan. Results: Forty-five residents responded (35% response rate). Our residents’ cumulative mean empathy score was 112.5 with a SD of 12.72, which is comparable with the cumulative empathy scores for IM residents at university hospitals. There was an increase in empathy score from the beginning level of training, postgraduate year 0 (PGY0), to the PGY1 level, and a noticeable, although statistically non-significant, decrease in empathy score for both PGY2 and PGY3 residents. The graduating residents’ scores were higher compared with incoming residents. Conclusions: The cumulative mean empathy score in community-based IM residents showed an increase in the beginning of residents’ training and decrease in empathy score by the end of training. There were significant differences in empathy scores by level of training at individual hospitals. This might be related to different targeted curricula.
Incidence and determinants of cerebrovascular events in outpatients with stable coronary artery disease
Authors: Cordonnier Charlotte , Lemesle Gilles , Casolla Barbara , Bic Matthieu , Caparros François , Lamblin Nicolas , Bauters Christophe 
Published: April 2018

Introduction There are limited data on cerebrovascular events in patients with stable coronary artery disease. To study the risk of cerebrovascular event, the relative proportion of ischaemic stroke and intracranial haemorrhage, and their prognostic factors in stable coronary artery disease are investigated. Patients and methods The CORONOR registry prospectively recruited, between February 2010 and April 2011, 4184 unselected stable coronary artery disease outpatients. All events occurring during a five-year follow-up were adjudicated. Results Ninety-six patients had an ischaemic stroke and 34 had an intracranial haemorrhage, reaching a cumulative incidence after five years of 3.2 (2.7–3.8)%. During the same period, 677 deaths and 170 myocardial infarctions (ST-elevation MI, n = 55; non-ST-elevation MI, n = 115) occurred. In elderly individuals, the number of cerebrovascular events was higher than that of myocardial infarctions and largely exceeded that of ST-elevation myocardial infarctions. Predictors of ischaemic stroke were: previous history of stroke (subhazard ratio (SHR)=3.16(1.95–5.14)), absence of statin therapy at inclusion (SHR = 2.45(1.47–4.10), increasing age (SHR = 1.45(1.16–1.82) per 10-year increase) and diabetes mellitus (SHR = 1.65(1.10–2.49)). Predictors of intracranial haemorrhage were: combination of vitamin K antagonists with an antiplatelet agent at inclusion (SHR = 5.41(2.49–11.75), single antiplatelet therapy as reference), and increasing age (SHR = 1.47(1.12–1.93) per 10-year increase). Discussion In stable coronary artery disease patients, the brain deserves attention. In patients at high risk of ischaemic stroke, secondary prevention could be intensified. Our results raise awareness of the hazard of the association of antiplatelet drugs with oral anticoagulants in stable coronary artery disease patients. Conclusion While improving the prevention of future vaso-occlusive events should be our ultimate goal in coronary artery disease patients, the net clinical benefit of our treatments should carefully be studied.
A Randomized, Double-Blind Clinical Trial of a Probiotic Nutritional Intervention in the Treatment of Mild to Moderate Non-Scalp Psoriasis
Authors: Kaur Mandeep , Conde Jennifer , Willard Joy D. , Taylor Sarah , Camacho Fabian , Fleischer Alan B. , Feldman Steven R. 
Published: April 2018

Background The cellular immune system plays an important role in the pathogenesis of psoriasis. The digestive system (by virtue of the profile, number and species of bacteria present at any given time and nutritional factors) can influence the status of the immune system. Bacterial pathogens influence specific cytokine activity due to the activity of superantigens. Modulation of bacterial gut flora offers a potential target for psoriasis treatment. Methods Forty-two subjects with mild to moderate plaque-type psoriasis were enrolled in a 12-week, randomized, placebo-controlled trial of a lactobacillus nutritional supplement. The supplement or placebo was taken orally once daily for eight weeks. The primary outcome of this study was the change from baseline to week 12 (or end of treatment) in the composite score of the signs of psoriasis (erythema, scaling, plaque thickness) for target lesions. Other outcomes included Investigator's and Subject's Global Assessment of Response and change in pruritus score. Results Data were evaluable for 40 subjects (18 on the nutritional supplement and 22 on placebo). No significant improvement was found with the lactobacillus nutritional supplement compared to placebo-treated patients. Conclusion Patients commonly seek out alternative treatments for psoriasis. Nutritional supplementation is an intriguing way to manage the disease, offering the potential for a very safe treatment, however we found little to no benefit for lactobacillus nutritional supplement in this group of subjects with mild to moderate psoriasis.
Practical Management and Monitoring of Psoriasis Patients on Biologic Therapy: A Survey of Opinion Leaders and Practitioners
Authors: Halverstam Caroline P. 
Published: April 2018

Objective To provide practical guidance to dermatologists on how to monitor psoriasis patients on biologic therapies. Design Survey of health care providers on monitoring and vaccination practices in patients on biologic therapies. Participants 21 present and former members of the Medical Board of the National Psoriasis Foundation. Results The survey revealed a wide variety of practices, but some general trends emerged. Most of the experts who were surveyed checked screening hematology with all of the drugs and continued to check it every two to six months. CD4+ counts were only checked with alefacept and were generally taken at screening and at least every two weeks. Serum chemistry and liver function monitoring were usually checked at screening and then every two to six months, especially in patients on infliximab. Most of the practitioners surveyed did not check for antinuclear antibodies (ANA) at screening. However, approximately one-third did screen for ANA in patients on tumor necrosis factor (TNF)-blocking agents; only a few continued to check it every three to six months. Tuberculosis screening was generally done for patients on all of the biologic therapies, but was almost universally done in patients treated with TNF-blocking drugs. Yearly tuberculin skin testing was continued by approximately two-thirds of the practitioners. Approximately half of respondents gave influenza vaccines to patients on biologic therapy. Conclusions Currently there are no guidelines for the monitoring of patients on biologic therapy and there is a lack of consistency among practitioners. However, medical literature provides a great deal of information on which to base monitoring practices. Monitoring and vaccination practices should vary from patient to patient depending on many factors, so these findings should not be viewed as guidelines.
The Direct Correlation between Total Body Surface Area Involvement and PASI Scores in Judging Psoriasis Severity
Authors: Chinn Steven , Zeichner Joshua A. 
Published: April 2018

The Psoriasis Area and Severity Index (PASI) is a psoriasis severity measurement tool used by clinicians, which evaluates different regions of the body and rates the corresponding psoriatic lesions based on their level of erythema, induration and scaliness. It is a highly quantitative method that has been used by some insurance companies to establish minimum requirements for approval of the biologic therapeutics alefacept (Amevive), efalizumab (Raptiva) or etanercept (Enbrel) for psoriasis. A large insurance company proposed a minimum PASI score of 10 to justify reimbursement for biologic therapies. However, calculating the PASI score was burdensome. We hypothesized that the method of calculating percentage of body surface area (BSA) affected would be easier and more time-efficient, and thus could serve as a suitable proxy for the PASI score. We analyzed the BSA percentages and corresponding PASI scores in 96 patients whose psoriasis was prospectively graded in clinical trials. We hypothesized that BSAs of 10% to 15% correlated to a PASI of 10, the threshold score for the insurance company to authorize the use of the biologics. Our results show that with a minimum BSA involvement of 13%, only two out of 15 patients had PASI scores less than 10, and both of those patients had PASI scores greater than 9. Like the PASI score, BSA is an imperfect tool for the assessment of psoriasis severity, but it is much easier to use than the PASI score.
Safety and Efficacy of 16 Weeks of 30 mg/Week Intramuscular Alefacept in the Treatment of Chronic Plaque Psoriasis
Authors: Gosnell Amy L. , Kaur Mandeep , Carroll Christie , Pearce Daniel J. , Boles Ann F , Camacho Fabian , Fleischer Alan B. , Feldman Steven R. 
Published: April 2018

Background The biological agent alefacept (Amevive) induces sustained clinical improvement in patients with chronic plaque-type psoriasis.1 Multiple or extended courses of therapy are associated with higher response rates and an increased duration of results.2,3 Objective To obtain pilot information on the safety and efficacy of a 16-week course of intramuscular alefacept in doses of 30 mg per week. Methods All subjects in this open-label, single-center study received a starting dose of 15 mg intramuscular (IM) alefacept, followed by 30 mg per week for 15 weeks. Outcomes were assessed every two weeks throughout the 16-week drug administration phase and every four weeks during the 12-week follow-up phase using the Psoriasis Area and Severity Index (PASI), the Physician Global Assessment (PGA), Subject's Global Assessment (SGA), pruritus visual analog scale (VAS), measurement of CD4 counts and adverse event reporting. Results Of the 19 enrolled subjects, 17 completed treatment and 16 completed 12-week follow-up. PASI, PGA, SGA, and VAS scores improved from baseline to week 16 with 59% of subjects achieving a 50% reduction in PASI (PASI 50), and 18% achieving a 75% reduction (PASI 75). Clinical improvement occurred during the treatment phase and continued into follow-up. CD4 counts decreased significantly from week 2 to week 16, but a linear trend was not seen. No adverse events occurred that required discontinuation of treatment. One subject had a CD4 count < 250 cells/μL for 4 consecutive weeks, leading to the discontinuation of treatment in accordance with the protocol. Conclusion A16-week extended course of higher dose (30 mg) IM alefacept was well-tolerated and may offer additional therapeutic benefit to some patients. However, the higher dose and extended course did not dramatically improve efficacy seen with lower doses in previous trials.
TNF-α Blocker-Induced Psoriasiform Dermatitis
Authors: Hayashi Genki , Becker Emily , Berger Tim , Koo John 
Published: April 2018

Background The anti-TNF-α agents adalimumab, infliximab and etanercept are indicated for a variety of autoimmune diseases such as rheumatoid arthritis (RA), Crohn's disease (CD), ankylosing spondylitis (AS), psoriatic arthritis (PsA) and psoriasis (Pso). In some patients treated for nonpsoriatic conditions such as rheumatoid arthritis and Crohn's disease, these agents have been associated with the appearance of psoriasis (either its emergence or exacerbation)—a term previously coined TNF-α antagonist induced psoriasis. Objective This article reviews published data demonstrating this phenomenon. Methods Studies with English abstracts between 2000–2008, identified in MEDLINE and PUBMED with keywords anti-TNF, psoriasis, TNF-α antagonist and induced, were retrospectively reviewed. Results An association between use of anti-TNF agents and the appearance of psoriasis was seen in a total of 219 patients from 38 reports. Conclusion There is an association between use of anti-TNF agents and appearance of psoriasis, but the specific nature of the relationship is unknown. Recent studies help to delineate patient characteristics common among the group, as well as theorize proposed mechanisms for the emergence of psoriasis. At this time, however, further investigation into this multi-factorial condition is needed.
A Practical Approach to the Use of Infliximab
Authors: Pancir Darcy , Lebwohl Mark 
Published: April 2018

Infliximab is one of the most effective treatments available for severe psoriasis. It has been used successfully to treat severe plaque psoriasis, pustular psoriasis and erythrodermic psoriasis, and is one of the most rapidly effective treatments available. Relative contraindications include severe infliximab hypersensitivity, severe heart failure and significant infections including tuberculosis, malignancies and demyelinating diseases. Baseline screening must include testing for tuberculosis (TB) and most advise routine chemistry screen and complete blood count (CBC). The drug is administered by intravenous (IV) infusion. The development of infusion reactions may necessitate treatment with acetaminophen, diphenhydramine and epinephrine. Pre-treatment with acetaminophen and diphenhydramine can prevent infusion reactions. Follow-up monitoring should include screening for tuberculosis, chemistry screens with liver function tests, CBC and monitoring for infection or malignancy. Side effects include reactivation of tuberculosis, exacerbation of heart failure, reactivation of hepatitis B, hepatotoxicity, exacerbation of demyelinating diseases, the development of lupus-like syndromes and infusion reactions.
Calcitriol 3 μg/g Ointment: A New Topical Treatment for Psoriasis
Authors: Zeichner Joshua , Bowes Mark P. 
Published: April 2018

Vitamin D receptor modulators have been used extensively for years in the treatment of psoriasis. These agents have demonstrated comparable efficacy to mid-potency corticosteroids and have a good safety profile. Vitamin D receptor modulators are useful as single agents and when used in combination, rotational or sequential therapy with other psoriasis treatments. Calcitriol ointment (1α,25-dihydroxyvitamin D3), the naturally occurring, endogenous, biologically active metabolite of vitamin D3, has recently been approved in the United States as the only Vitamin D3 ointment (Vectical™) available for the topical treatment of psoriasis. Two randomized, double-blind, placebo-controlled clinical trials demonstrated the application of calcitriol 3 μg/g ointment twice daily for eight weeks produced significantly greater improvement than did vehicle ointment on physician-rated and patient-rated scores of global psoriasis severity and improvement in psoriasis symptoms from baseline. Long-term clinical trials have demonstrated that twice-daily calcitriol was safe and well-tolerated for one year or longer and that calcium homeostasis was not significantly affected by continuous treatment up to 52 weeks. A direct comparison of calcitriol and calcipotriol [calcipotriene (Dovonex®)] in patients with chronic plaque psoriasis found that the two agents produced generally similar improvements in psoriasis severity but that calcitriol was associated with fewer cutaneous adverse events. A second comparative study that examined calcitriol and calcipotriene for the treatment of psoriasis in sensitive areas found that calcitriol produced significantly less perilesional edema, erythema and stinging/burning than did calcipotriene. Several clinical trials also support calcitriol as part of combination therapy. Topical calcitriol ointment is a new, safe, effective and well-tolerated treatment that offers considerable flexibility in psoriasis care.
Can Adalimumab Make a Smooth and Easy Transition from Cyclosporine a Reality? A Case Series of Successful Transitions
Authors: Gattu Shilpa , Wu Jashin J. , Koo John Y.M. 
Published: April 2018

Background Cyclosporine, a calcineurin inhibitor of T cells, is an effective treatment option for generalized psoriasis. However, its duration of use is limited to one to two years due to its risk of organ toxicity, while its discontinuation raises concern for relapse. Initiating cyclosporine is often met with reluctance in the absence of a safe, long-term agent with which to transition patients after treatment with cyclosporine. Adalimumab, a tumor necrosis factor inhibitor recently approved for the treatment of psoriasis, may provide a safe alternative for long-term therapy. An experience of using sequential therapy with these two treatments to help prevent relapse in patients transitioning from cyclosporine to adalimumab is described. Methods A series of five representative patients is presented. Patients were informed of the off-label nature of concomitant use of cyclosporine and adalimumab for the treatment of psoriasis. Results Five patients with severe generalized psoriasis, ages 17, 21, 22, 31, and 41, were treated with cyclosporine for one to two years prior to beginning treatment with adalimumab. Cyclosporine was tapered over a period of 6, 12, 12, 8 and 11 weeks respectively and eventually discontinued. There was no decrease in Psoriasis Area and Severity Index (PASI) scores from the time of initiating adalimumab to discontinuation of cyclosporine. Serum labs and blood pressure readings remained normal for all five patients during this period and no adverse events were noted. Conclusion Patients may be smoothly transitioned from cyclosporine to adalimumab through sequential therapy to minimize risk of recurrence of psoriasis. The short duration of three months or less in young healthy individuals may allow safe concomitant use of these two drugs. Whether sequential therapy of cyclosporine and long-term treatment with adalimumab will be successful and safe must be validated by large controlled studies.
Golimumab: A User's Guide to a New Biologic Treatment
Authors: Michelon Melissa A. , Wang Andrew 
Published: April 2018

Background Golimumab is a new tumor necrosis factor (TNF) antagonist recently approved by the Food and Drug Administration for controlling the signs and symptoms of rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis, although it is not currently approved for use in psoriasis. Objective To give readers a review of current literature and clinical trials of golimumab and serve as a guide to this new biologic therapy. Methods A Medline search was performed using the following terms: golimumab, anti-TNF, psoriasis, and psoriatic arthritis. Product inserts were obtained from fda.gov/Drugs. Results In a phase III clinical trial comprising patients with psoriatic arthritis, patients receiving golimumab showed significant improvement in the signs and symptoms of disease. Significant changes in the Psoriasis Area and Severity Index were also observed in patients with at least 3% body surface area treated with golimumab. Other assessments included the Nail Psoriasis Severity Index, Physician's Global Assessment of psoriatic nail disease, and the psoriatic arthritis modified Maastricht Ankylosing Spondylitis Enthesitis Score, all of which showed notable improvement in golimumab-treated patients compared with placebo. Golimumab was usually well tolerated in phase III trials, but adverse events generally occurred more often in patients receiving golimumab compared with placebo. Long-term safety studies are ongoing. Conclusion Golimumab, one of the newest anti-TNF therapies, offers health care providers another effective treatment option for patients with psoriatic arthritis with a similar side effect profile and convenient dosing schedule relative to other available TNF antagonists.
OBSERVE-5, an Observational Post-Marketing Safety Surveillance Registry of Etanercept for the Treatment of Psoriasis: A Model for Studying New Psoriasis Therapies
Authors: Kimball Alexa B. , Pariser David , Yamauchi Paul S. , Menter Alan , Teller Craig F. , Shi Yifei , Creamer Kara , McCroskery Peter , Kricorian Gregory , Gelfand Joel M. 
Published: April 2018

Background OBSERVE-5 is collecting safety data from real-world use of etanercept in the treatment of psoriasis per a post-marketing commitment of the U.S. Food and Drug Administration. Methods This phase IV prospective, multicenter, 5-year observational registry was designed to enroll patients with plaque psoriasis for whom etanercept is indicated. Patients receive etanercept per standard medical care and can discontinue etanercept therapy at any time following receipt of the baseline dose. Visits occur at least twice yearly; follow-up will be up to 5 years. Conclusions Data from the OBSERVE-5 registry will complement safety data from clinical trials of etanercept.