bluuebunny/crossref_metadata_2025_split huggingface dataset:
Allergic Immune Diseases and the Risk of Mortality Among Patients Hospitalized for Acute Infection*
Authors: Verhoef Philip A. , Bhavani Sivasubramanium V. , Carey Kyle A. , Churpek Matthew M. 
Published: October 2019

Objectives:
The immune response during sepsis remains poorly understood and is likely influenced by the host’s preexisting immunologic comorbidities. Although more than 20% of the U.S. population has an allergic-atopic disease, the type 2 immune response that is overactive in these diseases can also mediate beneficial pro-resolving, tissue-repair functions. Thus, the presence of allergic immunologic comorbidities may be advantageous for patients suffering from sepsis. The objective of this study was to test the hypothesis that comorbid type 2 immune diseases confer protection against morbidity and mortality due to acute infection.

Design:
Retrospective cohort study of patients hospitalized with an acute infection between November 2008 and January 2016 using electronic health record data.

Setting:
Single tertiary-care academic medical center.

Patients:
Admissions to the hospital through the emergency department with likely infection at the time of admission who may or may not have had a type 2 immune-mediated disease, defined as asthma, allergic rhinitis, atopic dermatitis, or food allergy, as determined by International Classification of Diseases, 9th Revision, Clinical Modification codes.

Interventions:
None.

Measurements and Main Results:
Of 10,789 admissions for infection, 2,578 (24%) had a type 2 disease; these patients were more likely to be female, black, and younger than patients without type 2 diseases. In unadjusted analyses, type 2 patients had decreased odds of dying during the hospitalization (0.47; 95% CI, 0.38–0.59, p < 0.001), while having more than one type 2 disease conferred a dose-dependent reduction in the risk of mortality (p < 0.001). When adjusting for demographics, medications, types of infection, and illness severity, the presence of a type 2 disease remained protective (odds ratio, 0.55; 95% CI, 0.43–0.70; p < 0.001). Similar results were found using a propensity score analysis (odds ratio, 0.57; 95% CI, 0.45–0.71; p < 0.001).

Conclusions:
Patients with type 2 diseases admitted with acute infections have reduced mortality, implying that the type 2 immune response is protective in sepsis.
Circulating biomarkers for the detection of tumor recurrence in the postsurgical follow-up of differentiated thyroid carcinoma
Authors: Giovanella Luca 
Published: October 2019

Purpose of review
To discuss advances and challenges in thyroglobulin and Tg-antibody (TgAb) measurement and their impact on clinical management of differentiated thyroid carcinoma (DTC).

Recent findings
Basal high-sensitive Tg (hsTg) measurement avoids the need for stimulation and greatly simplifies DTC patients’ management. In addition, patients with undetectable hsTg after thyroid ablation are at a very low risk of recurrence and can be safely managed by periodic hsTg measurement alone. When TgAb is present, its trend over time serves as primary (surrogate) tumor marker. However, an undetectable hsTg measurement appears to indicate a complete remission of DTC even in the presence of TgAb. Finally, reliable reference values are not yet available for low-risk DTC who are treated with less than total thyroid ablation, and caution is needed before well-designed studies addressing these issues have been published.

Summary
The use of hsTg assays has changed paradigms for DTC monitoring even in the presence of TgAb, and greatly reduced patients’ discomfort and overall case-management costs. Reliable Tg interpretation criteria are urgently needed for patients treated with less than total thyroid ablation.
Malignant pheochromocytoma and paraganglioma: management options
Authors: Corssmit Eleonora P.M. , Snel Marieke , Kapiteijn Ellen 
Published: October 2019

Purpose of review
Although the majority of pheochromocytoma and paraganglioma are benign, 15–17% develop metastatic disease, being present at the initial diagnosis in about 11–31% of cases. The natural course of metastasized disease is highly heterogeneous, with an overall 5-year survival rate varying between 40% and 85%. For individual patients, overall survival, progression-free survival, and clinical outcome are difficult to predict. Management of metastasized pheochromocytoma and paraganglioma is challenging. Currently available therapeutic options are surgical debulking, treatment with radiopharmaceuticals (131I-MIBG, 90Y and 177Lu-DOTATATE), chemotherapy and targeted therapy.

Recent findings
The pathogenesis of pheochromocytoma and paraganglioma (PPGL) is largely driven by genomic alterations in PPGL susceptibility genes related to three different clusters: altered pseudo-hypoxic signaling (cluster-1), altered MAP-kinase signaling (cluster-2) and altered Wnt signaling (cluster-3). Novel targeted therapies (tyrosine kinase inhibitors) and potential future therapeutic options, guided by improved knowledge about the oncogenic cluster 1–3 signaling pathways, will be discussed.

Summary
Treatment of metastasized pheochromocytoma and paraganglioma remains challenging. Profiling of gene expression and methylation can serve as a powerful tool for characterizing disease clusters and for guiding targeted therapy to improve selectivity and efficacy. Current knowledge of signatures involved in molecular signaling, metabolism, and resistance mechanisms of PPGLs suggests that therapeutic regimens can be optimized to each molecular subtype.
Chemotherapy remains a cornerstone in the treatment of nonsmall cell lung cancer
Authors: Pirker Robert 
Published: October 2019

Purpose of review
The purpose of the review is to summarize the current and future role of chemotherapy in the treatment of patients with nonsmall cell lung cancer (NSCLC).

Recent findings
Chemotherapy has been established in early-stage, locally advanced and metastatic NSCLC. Patients with driver mutation-positive NSCLC receive tyrosine kinase inhibitors as first-line therapy and chemotherapy later during the course of their disease. Immune checkpoint inhibitors have entered clinical practice as single agents or in combination with chemotherapy. These novel treatments will supplement chemotherapy in all tumor stages of NSCLC.

Summary
Targeted drugs and immune checkpoint inhibitors are gaining increasing importance in the treatment of NSCLC. They will supplement but not replace chemotherapy in the future.
Epstein–Barr Virus–Induced Cutaneous Diffuse Large B-Cell Lymphoma in a Patient With Angioimmunoblastic T-Cell Lymphoma
Authors: Poon Flora , Ieremia Eleni , Collins Graham , Matin Rubeta N. 
Published: October 2019

Abstract:
Cutaneous manifestations of Epstein–Barr virus (EBV)-driven B-cell lymphoid proliferations occur rarely as a result of severe immunodeficiency. To date, only a few cases of extranodal EBV-associated B-cell lymphomas arising in patients with angioimmunoblastic T-cell lymphoma (AITL) have been reported, and less common is a cutaneous presentation. AITL is a rare aggressive tumor that carries a poor prognosis and prompt diagnosis, and recognition of EBV-associated diffuse B-cell lymphoma is essential in these patients to instigate the correct treatment.
Analysis of Neuroretinal Rim by Age, Race, and Sex Using High-Density 3-Dimensional Spectral-Domain Optical Coherence Tomography
Authors: Antar Hussein , Tsikata Edem , Ratanawongphaibul Kitiya , Zhang Jing , Shieh Eric , Lee Ramon , Freeman Madeline , Papadogeorgou Georgia , Simavli Huseyin , Que Christian , Verticchio Vercellin Alice C. , Khoueir Ziad , de Boer Johannes F. , Chen Teresa C. 
Published: October 2019

Précis:
Neuroretinal rim minimum distance band (MDB) thickness is significantly lower in older subjects and African Americans compared with whites. It is similar in both sexes.

Purpose:
To evaluate the relationship between age, race, and sex with the neuroretinal rim using high-density spectral-domain optical coherence tomography optic nerve volume scans of normal eyes.

Methods:
A total of 256 normal subjects underwent Spectralis spectral-domain optical coherence tomography optic nerve head volume scans. One eye was randomly selected and analyzed for each subject. Using custom-designed software, the neuroretinal rim MDB thickness was calculated from volume scans, and global and quadrant neuroretinal rim thickness values were determined. The MDB is a 3-dimensional neuroretinal rim band comprised of the shortest distance between the internal limiting membrane and the termination of the retinal pigment epithelium/Bruch’s membrane complex. Multiple linear regression analysis was performed to determine the associations of age, race, and sex with neuroretinal rim MDB measurements.

Results:
The population was 57% female and 69% white with a mean age of 58.4±15.3 years. The mean MDB thickness in the normal population was 278.4±47.5 µm. For this normal population, MDB thickness decreased by 0.84 µm annually (P<0.001). African Americans had thinner MDBs compared with whites (P=0.003). Males and females had similar MDB thickness values (P=0.349).

Conclusion:
Neuroretinal rim MDB thickness measurements decreased significantly with age. African Americans had thinner MDB neuroretinal rims than whites.
The burden of corticosteroid overload in severe and difficult to treat asthma: how to reduce this?
Authors: Slisz Tomas , Vasakova Martina 
Published: October 2019

Purpose of review
Severe asthma is a serious condition that requires an individualized approach combining several treatment agents administered simultaneously in order to reach adequate control. Glucocorticosteroid treatment, as the cornerstone of asthma pharmacotherapy, has great disease-controlling capability, although it may induce a vast amount of severe adverse effects. This review describes our current knowledge of the monitoring and managing options of these adverse effects and possibilities to prevent them, including new therapeutic options.

Recent findings
A large amount of new drugs is emerging, which may offer a better control of glucocorticosteroid-induced adverse effects. At the same time, major achievements in our understanding of the underlying mechanisms in severe asthma and in the field of biologic agents may help to substantially reduce the need of glucocorticosteroids in the first-line treatment.

Summary
We discuss new insights and approaches to treatment strategy of severe asthma allowing less oral glucocorticosteroid use and hence, substantial less severe adverse effects of the treatment.
Trend of Antitissue Transglutaminase Antibody Normalization in Children With Celiac Disease Started on Gluten‐free Diet
Authors: Sansotta Naire , Alessio Maria G. , Norsa Lorenzo , Previtali Giulia , Ferrari Alberto , Guerra Giovanni , D'Antiga Lorenzo 
Published: October 2019

ABSTRACTBackground:The aim of this study is to compare the performance of antitissue transglutaminase (atTG) chemiluminescence immunoassay (CLIA) with the standard enzyme‐linked immunosorbent assay (ELISA) methods in monitoring celiac children after the start of gluten‐free diet (GFD).Methods:Celiac children diagnosed between 2005 and 2016 at our centre were classified into 2 groups based on serum assay (ELISA vs CLIA) used for atTG monitoring, and were compared on percentage of decrease and time to normalization of atTG on GFD.Results:Among 260 included children, the rate of normalization of atTG levels at 30 months’ follow‐up was 86% and 70% in ELISA and CLIA group, respectively (P < 0.01). Median time to normalization was 11.7 and 14.7 months in ELISA and CLIA group respectively (P = 0.003). Marsh score at diagnosis was not associated with time to atTG normalization (P = 0.770), whereas older age at diagnosis and higher baseline atTG predicted longer time to atTG normalization (P = 0.01, P < 0.01).Conclusions:The percentage and the time of the atTG normalization in celiac children on GFD should be interpreted according to the utilized assay: at 30 months’ follow‐up children tested by CLIA are less likely to normalize atTG levels compared to those tested by ELISA. Younger age at diagnosis and lower baseline atTG are predictors of earlier atTG normalization, regardless of the adopted assay.
Improved Survival of Children, Adolescents, and Young Adults With Head and Neck Soft Tissue Sarcomas in Denmark
Authors: Mirian Christian , Grønhøj Christian , Rechnitzer Catherine , Charabi Birgitte , Hjalgrim Lisa L. , Krarup-Hansen Anders , von Buchwald Christian , Hjuler Thomas 
Published: October 2019

Aim:
The aim of this study was to estimate nationally the survival of children, adolescents, and young adults with head and neck soft tissue sarcomas.

Materials and Methods:
The authors included patients 0 to 21 years of age and diagnosed with rhabdomyosarcoma (RMS) or nonrhabdomyosarcoma soft tissue sarcoma (NRSTS) located in the head and neck between 1980 and 2014. Survival probabilities were estimated using the Kaplan-Meier method. The authors estimated the effect of covariates with univariate and multivariate Cox regression analyses. The cumulative recurrence in RMS was estimated when considering death as a competing risk.

Results:
We identified 72 patients (50% male individuals, whereas 72% had RMS). Elder patients (older than 15 y) did worse compared with younger patients (log-rank test P=0.001). Patients diagnosed from 1980 to 1999 did worse than patients diagnosed from 2000 to 2014 (log-rank test P=0.02). Similarly, younger (younger than 15 y) patients did significantly better when diagnosed from 2000 to 2014 with reference to those diagnosed from 1980 to 1999 (log-rank test P=0.026). The multivariate hazard ratio was 0.46 (95% confidence interval, 0.23-0.92) for patients diagnosed from 2000 to 2014 with reference to patients diagnosed from 1980 to 1999. The 1-year cumulative recurrence for RMS was 21.2% (95% confidence interval, 12.3%-35.0%).

Conclusion:
Overall survival has improved throughout the study period, which is attributable to advancement in diagnostics, treatment, and the application of standardized guidelines from international protocols.
Carbapenem-sparing strategy: carbapenemase, treatment, and stewardship
Authors: Corcione Silvia , Lupia Tommaso , Maraolo Alberto Enrico , Mornese Pinna Simone , Gentile Ivan , De Rosa Francesco G. 
Published: October 2019

Purpose of reviewdescribing the current role of carbapenems and carbapenem-sparing strategies in the setting of antimicrobial stewardship programs.Recent findingssparing carbapenems with other drugs appears to be an interesting perspective for a variety of reasons in the current context of the multidrug-resistant (MDR) pandemic. Specific algorithms should also be precisely investigated to define better how to spare carbapenems within empiric and targeted regimens, with combination treatment or monotherapies, aiming at the best use of the new drugs and improving de-escalation as soon as possible for most of the patients.Summarystewardship programs may be useful in reducing probable misuse and overuse of antibiotics, which has probably contributed to the emergence of carbapenem-resistant bacteria worldwide. The proposal of carbapenem-sparing strategies has then generated substantial scientific debate and, overall, the concept of sparing these drugs is well advocated together with judicious use of novel drugs, appropriate measures of infection control and prevention as well as in stewardship programs to curb the spread of MDR and XDR-strains in healthcare facilities.
Barriers to Pursuing a Career in Surgery
Authors: Giantini Larsen Alexandra M. , Pories Susan , Parangi Sareh , Robertson Faith C. 
Published: October 2019

Objective:
This study aimed to elucidate current medical student perceptions on barriers to a career in surgery, with a particular focus on gender-specific differences.

Summary Background Data:
Although gender parity in medical school composition has been reached, women continue to be underrepresented in the field of surgery.

Methods:
An anonymous, single-institution, internet-based survey conducted at Harvard Medical School.

Results:
Approximately 720 medical students were surveyed and 261 completed the questionnaire (36.3%; 58.6% women, 41% men, 0.4% transgender). Overall, there was no significant gender difference in intention to pursue surgery (27% of men, 22% of women; P = 0.38). Sixty-nine percent of all students and 75% of those pursuing surgery reported verbal discouragement from pursuing a surgical career. Women were significantly more likely to perceive that the verbal discouragement was based on gender (P < 0.0001), age (P < 0.0001), and family aspirations (P = 0.043) compared to men. Surgical work hours and time for outside interests were the greatest deterrents for both genders. Significantly more women reported concerns about time to date or marry (P = 0.042), time to spend with family (P = 0.015), finding time during residency to have a child (P < 0.0001), taking maternity/paternity leave during residency (P < 0.0001), and being too old after residency to have a child (P < 0.0001).

Conclusions:
Both men and women reported high rates of verbal discouragement, but more women perceived that the discouragement was gender-based. Concerns about marriage and childbearing/rearing significantly deterred more women than men. Family aspirations were also a significant factor for men to choose an alternative career path. Additional support within the surgical field is needed to mitigate these concerns and support trainees in both their career and familial aspirations.
Assessment of Restored Kidney Transplantation Including the Use of Wider Criteria for Accepting Renal Donors After Cancer Excision
Authors: Sprott Philip , Hibberd Adrian D. , Heer Munish K. , Trevillian Paul R. , Clark David A. , Johnson David W. , Oldmeadow Christopher , Chiu Simon , Attia John R. 
Published: October 2019

Background.
The transplantation of kidneys after cancer excision (restored kidney transplantation, RKT) warrants further evaluation as a source of kidneys for transplantation. We determined whether larger cancers can be safely transplanted, the risks of adverse events from RKT, and whether RKT confers a survival advantage for patients waiting for transplantation.

Methods.
In a retrospective cohort study, 23 dialysis patients awaiting transplant underwent RKT at John Hunter Hospital, Australia between 2008 and 2015. Patients were >60 years old and accepted onto the National Organ Matching Service. This RKT Group was divided into donor renal cancers ≤30 mm and >30–≤50 mm. Adverse event profiles for RKT recipients were compared with 22 standard live donor recipients using logistic regression analyses. Recipient and transplant survivals for RKT were compared with 2050 controls from Australian New Zealand Dialysis Transplant Registry using Cox regression models. To increase statistical power for survival analyses, data from 25 RKT recipients from Princess Alexandra Hospital, Brisbane were added, thus creating 48 RKT recipients.

Results.
There were no significant differences in mortality, transplant failure nor AEs between the 2 cancer Groups. RKT increased the risks of Adverse event profiles (odds ratio: 6.48 [2.92–15.44]; P < 0.001). RKT reduced mortality risk by 30% (hazard ratio [HR]: 0.70 [0.36–1.07]; P = 0.299) compared with those continuing on the transplant list who may or may not be transplanted. RKT significantly reduced mortality risk for those remaining on dialysis (HR: 2.86 [1.43–5.72]; P = 0.003). Transplant survival for RKT was reduced compared with control deceased donor (HR: 0.42 [0.21–0.83]; P = 0.013) and live donor transplants (HR: 0.33 [0.02–0.86]; P =0.023).

Conclusions.
The use of larger carefully selected cancer-resected kidneys for transplantation appears safe and effective. RKT confers a possible survival advantage compared with waiting for transplantation, an increased survival compared with those remaining on dialysis but reduced transplant survival.
Living alone, loneliness and lack of emotional support as predictors of suicide and self-harm: a nine-year follow up of the UK Biobank cohort
Authors: Shaw Richard J. , Cullen Breda , Graham Nicholas , Lyall Donald M. , Mackay Daniel , Okolie Chukwudi , Pearsall Robert , Ward Joey , John Ann , Smith Daniel J. 
Published: October 2019

AbstractBackgroundThe association between loneliness and suicide is poorly understood. We investigated how living alone, loneliness and emotional support were related to suicide and self-harm in a longitudinal design.MethodsBetween 2006 and 2010 UK Biobank recruited and assessed in detail over 0.5 million people in middle age. Data were linked to prospective hospital admission and mortality records. Adjusted Cox regression models were used to investigate relationships between living arrangements, loneliness and emotional support, and both suicide and self-harm as outcomes.ResultsFor men, both living alone (Hazard Ratio (HR) 2.16, 95%CI 1.51-3.09) and living with non-partners (HR 1.80, 95%CI 1.08-3.00) were associated with death by suicide, independently of loneliness, which had a modest relationship with suicide (HR 1.43, 95%CI 0.1.01-2.03). For women, there was no evidence that living arrangements, loneliness or emotional support were associated with death by suicide. Associations between living alone and self-harm were explained by health for women, and by health, loneliness and emotional support for men. In fully adjusted models, loneliness was associated with hospital admissions for self-harm in both women (HR 1.89, 95%CI 1.57-2.28) and men (HR 1.74, 95%CI 1.40-2.16).LimitationsLoneliness and emotional support were operationalized using single item measures.ConclusionsFor men - but not for women - living alone or living with a non-partner increased the risk of suicide, a finding not explained by subjective loneliness. Overall, loneliness may be more important as a risk factor for self-harm than for suicide. Loneliness also appears to lessen the protective associations of cohabitation.HighlightsFirst cohort study to investigate loneliness’s relationship with deaths by suicideLoneliness is associated with a modest increased risk of death by suicide for menFor men, living with a partner reduces the risk of death by suicideLoneliness increases the risk of hospitalization for self-harm for men and women
Spatial suppression and sensitivity for motion in schizophrenia
Authors: Linares Daniel , Amoretti Silvia , Marin-Campos Rafael , Sousa André , Prades Laia , Dalmau Josep , Bernardo Miquel , Compte Albert 
Published: October 2019

ABSTRACTPerceptual spatial suppression is a phenomenon in which the perceived strength of a stimulus in some region of the space is reduced when the stimulus is surrounded by other stimuli. For contrast perception, several studies suggest that spatial suppression is reduced in patients with schizophrenia. For motion perception, only one study has been conducted in a cohort of 16 patients, suggesting that spatial suppression is reduced. It is unknown, however, whether this reduction is related to the lower IQ that schizophrenic patients usually show; as there is evidence that spatial suppression for motion increases with IQ in healthy individuals. Here, we sought to determine the spatial suppression for motion in a larger cohort of 33 patients with schizophrenia controlling for IQ. We found a weakened spatial suppression in patients with schizophrenia, consistent with the previous study (g = 0.47, CI = [0.055, 0.88], combining the previous and our study). For comparison, we performed a meta-analysis on spatial suppression for contrast and found a similar effect size. We found that patients had a lower IQ than controls, but this difference did not explain their weaker spatial suppression. Further, we found that spatial suppression of patients, but not controls increased with their IQ and decreased with age in both groups. Finally, as we estimated lapses of attention, we could estimate motion sensitivity and found that it was decreased in patients. We speculate about possible alterations in neurotransmission that might explain the reduced spatial suppression and sensitivity that we found.