bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elevated Pretreatment CEA and CA19-9 Levels are Related to Early Treatment Failure in Esophageal Adenocarcinoma
Authors: van der Kaaij Rosa T. , Voncken Francine E.M. , van Dieren Jolanda M. , Snaebjornsson Petur , Korse Catharina M. , Grootscholten Cecile , Aleman Berthe M.P. , van Sandick Johanna W. 
Published: February 2019

Introduction:
Chemoradiotherapy and surgery are the basis of the potentially curative treatment for esophageal cancer. Approximately 1 in 5 patients, however, do not benefit from this intensive treatment due to early treatment failure. The aim of this study was to evaluate levels of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 at diagnosis, in relation to survival and early treatment failure (disease recurrence or death within 1 year after surgery).

Methods:
Patients with esophageal adenocarcinoma scheduled for chemoradiotherapy followed by surgery between 1998 and 2014 were selected from a retrospectively collected database if both CEA and CA19-9 levels were measured before the start of treatment.

Results:
Pretreatment CEA and CA19-9 levels were known in 102 patients. Median overall survival differed (P<0.001) between patients with normal levels of both CEA and CA19-9 (n=59; 51 mo), patients with elevated CEA only (n=13; 43 mo), patients with elevated CA19-9 only (n=19; 24 mo), and those with elevated levels of both CEA and CA19-9 (n=11; 11 mo). Elevation of both CEA and CA19-9 was associated with early treatment failure (odds ratio: 10.4; 95% confidence interval: 2.4-45.5, P=0.002). Median time to tumor recurrence was 34 months in patients with normal CEA and CA19-9 levels, and 7 months in those with elevated levels of both (P=0.003).

Conclusions:
Pretreatment elevated CEA and CA19-9 levels were significantly associated with early treatment failure and decreased overall survival in this esophageal adenocarcinoma patient cohort treated with curative intent. Until prospective validation, CEA and CA19-9 might play a role in identifying high-risk patients before the start of intensive locoregional therapy.
Curious Case of a Year-Long History of Cold Subcutaneous Abscesses
Authors: Frani Ian Adrian F. , Asad Shadaba 
Published: February 2019

Abstract
Cold subcutaneous abscess (CSA) is an abscess lacking classic inflammatory signs. This is a case of a 27-year-old incarcerated African American man who presented with 1-year history of soft, painless, mobile, masses on his limbs. Chest computed tomography scan showed diffuse reticulonodular infiltrates with right lower lobe mass. Computed tomography scan of the right upper extremity showed fluid density with no deep tissue involvement. Coccidioides complement fixation titers are 1:64, IgG 1.315, and IgM 0.242. Lung biopsy and CSA aspiration showed thick walled black spherules with endospores consistent with disseminated coccidioidomycosis (DCM). Cold subcutaneous abscess is a rarely reported manifestation of DCM. Defective cell-mediated immunity and inhibition of inflammation were thought to play a role in DCM and CSA pathogenesis. Cold subcutaneous abscess can remain unnoticed because of lack of inflammation. Our patient has longest time a CSA lasted without other symptoms of DCM. It is important to recognize it early to uncover a potentially dangerous disease.
Risk Factors and Outcomes of Vancomycin-Resistant Versus Vancomycin-Sensitive Enterococcal Bloodstream Infections in Patients With Acute Myeloid Leukemia
Authors: Hackney Noah , Addisu Anteneh , Nanjappa Sowmya , Greene John 
Published: February 2019

Background
Studies have shown increased mortality from vancomycin-resistant enterococcal (VRE) bloodstream infections (BSI) in neutropenic patients. Whether these mortality differences pertain to acute myeloid leukemia (AML) patients is unknown. We compared risk factors and outcomes between VRE and vancomycin-sensitive enterococcal (VSE) BSIs in AML patients.

Methods
We conducted a single-center, 5-year, retrospective cohort study of AML patients with enterococcal BSI. Neutropenia duration, Enterococcus species, vancomycin exposure, VRE colonization, 7- and 30-day mortality, age, sex, length of stay, and central line status were compared and analyzed.

Results
There were a total of 77 AML patients with enterococcal BSI, 54.5% had VRE. Enterococcus faecalis and Enterococcus faecium accounted for 28.5% and 62.3% of BSI, respectively. The E. faecalis isolates were more likely to be VSE (91% vs 9%, P < 0.001) and E. faecium isolates to be VRE (71% vs 29%, P < 0.001). Duration of neutropenia was significantly longer (27.3 days vs 2.7 days, P < 0.005) among VRE patients. Recent vancomycin use and VRE colonization were associated with VRE BSI. There were no differences in bacteremia duration, length of stay, or 7- and 30-day mortality between VRE and VSE BSI.

Conclusion
Enterococcal infections among AML patients are more likely to be caused by vancomycin-resistant E. faecium. The risk is increased by VRE colonization and vancomycin exposure. In a relatively homogenous group of patients, treatment-related factors may affect outcome more than species type or susceptibility of bacterial isolates. This finding is important for future development of patient education, preventive, and treatment protocols.
Twenty-Four–Hour Measures of Heart Rate–Corrected QT Interval, Peak-to-End of the T-Wave, and Peak-to-End of the T-Wave/Corrected QT Interval Ratio During Antipsychotic Treatment
Authors: Tümüklü Mevhibe N. , Tümüklü Mustafa M. , Nesterenko Vladislav , Jayathilake Karu , Beasley Charles M. , Meltzer Herbert Y. 
Published: February 2019

AbstractPurpose/BackgroundProlonged ventricular repolarization, measured by heart rate–corrected QT interval (QTc) prolongation, might be a biomarker for risk of torsade de pointes (TdP) and sudden cardiac death. However, the predictive value of QTc has been challenged, and a component of QTc, peak-to-end of the T-wave (Tpe), and a high Tpe/QT ratio might be superior biomarkers because they better reflect increased transmural dispersion of ventricular myocyte repolarization, which can lead to TDP. The purpose of this pilot study was to provide the first measurements of heart rate, QTc, Tpe, Tpe/QTc, and their variability over 24 hours in medication-free patients with schizophrenia, during treatment with ziprasidone or other antipsychotic drugs, and healthy controls.MethodsSubjects included 12 patients treated with ziprasidone, 30 treated with other antipsychotic drugs, 3 unmedicated patients, and 15 normal controls. Subjects underwent 24-hour analog Holter recording, and the recordings were digitized. A cardiologist blind to treatment selected multiple 10-cycle segments throughout each recording and measured the electrocardiogram metrics.ResultsVariability in QTc, Tpe, and Tpe/QTc over the 24 hours was present in all groups; 91.1% of patients and 100% of controls had 1 or more QTc values of 450 milliseconds or greater. Mean QTc length was significantly greater in the ziprasidone-treated than the non–ziprasidone-treated patients (P= 0.02). Mean Tpe was not elevated in the ziprasidone patients, whereas mean Tpe/QTc was lower (P< 0.01).ConclusionsThe large variability in QTc, Tpe, and Tpe/QTc observed supports the need for 24-hour electrocardiogram recordings to provide an accurate assessment of risk of TdP. Heart rate–corrected QT interval alone does not capture the risk of TdP.
Fluoroscopy and Dynamic Pressure-Based Foot Orthoses for Children With Flatfoot
Authors: Liu Xue-Cheng , Rizza Robert , Van Valin Scott , Al-Ramahi Jehad , Lyon Roger , Thometz John 
Published: February 2019

ABSTRACTIntroductionThe current nonsurgical treatment for pediatric flatfoot includes shoe modification, inserts, and foot orthoses (FOs). However, these methods do not affect the course of flatfoot in children and have only limited evidence of correction of foot pronation. The goals of this study are 1) to describe how to design novel customized FOs using plantar pressure and fluoroscopic measurements; and 2) to assess kinematics and kinetics of the foot and ankle joint and functional outcomes at baseline and 12-month follow-up.Materials and MethodsOne child with bilateral flatfeet received trio-pressure measurements, including dynamic plantar pressure, single sensor pressures on the lateral calcaneus, and medial talar head. The two-dimensional (2D) foot motion in the sagittal plane during the stance phase using single gantry fluoroscopy was recorded. Three-dimensional (3D) surface images of the entire foot and distal lower limb were registered.ResultsA total of 14 pressure metrics and three-dimensional (3D) foot and ankle topography were used to design the new orthoses and generate a computer-aided design model. Data from the fluoroscopic images were used to evaluate the orthotic design. Finally, two orthoses were designed and manufactured with a rapid prototype system (SLS).DiscussionThe gait-based software was successfully developed to design the new orthoses. Features included use of navicular height, talar and calcaneal alignment, pressure metrics, and foot geometry. This case study had 12-month follow-up and showed that the new FOs reduced pain and improved functional outcomes.ConclusionsUse of gait-based software allows a further approach directly into the rapid prototype systems for orthoses designed to address pes valgus deformity.
Organ dysfunction in cirrhosis: a mechanism involving the microcirculation
Authors: Brito-Azevedo Anderson , Perez Renata M. , Maranhão Priscila A. , Coelho Henrique S. , Fernandes Eduardo S.M. , Castiglione Raquel C. , de Souza Maria D. , Villela-Nogueira Cristiane A. , Bouskela Eliete 
Published: February 2019

Introduction
Microcirculation is essential for adequate tissue perfusion and organ function. Microcirculatory changes may occur in cirrhosis, inducing loss of multiorgan function. The aim was to evaluate preliver transplantation and postliver transplantation aspects of multiorgan function, microcirculation, inflammatory, and endothelial biomarkers and survival in a controlled study including cirrhotic outpatients.

Patients and methods
We accessed functional capillary density (FCD) and red blood cell acceleration (RBCA) by nailfold videocapillaroscopy. Inflammatory and endothelial biomarkers [interleukin-6 (IL-6), soluble intercellular adhesion molecule-1, endothelin-1, and tumor necrosis factor-α] were analyzed. Cerebral and renal functions were assessed to represent organ dysfunction and regression analyses were carried out. Receiver operating characteristic curves were constructed and survival Kaplan–Meier analysis was carried out.

Results
Fifty-four patients and 18 controls were included. Inflammatory and endothelial markers increased in advanced disease. FCD was reduced and RBCA was progressively lower according to disease severity. RBCA correlated inversely with inflammatory and endothelial biomarkers, and directly with renal function. The presence of hepatic encephalopathy correlated inversely with RBCA and directly with IL-6 and endothelin-1. In multivariate analysis, RBCA was an independent factor for organ dysfunction. The area under the receiver operating chartacteristic curve for IL-6 for survival was 0.74 (0.59–0.89), P=0.05. Transplant-free survival was 97.5% for values under 5.78 ng/ml (IL-6 best cutoff) and 83.9% above 5.78 ng/ml, log-rank=0.018. Eleven patients underwent transplantation, with an overall improvement in microcirculatory function.

Conclusion
Our results suggest a mechanism of organ damage in cirrhosis, where microcirculatory dysfunction could be correlated to inflammatory and endothelial biomarkers, and loss of multiorgan function. IL-6 seems to be an important survival marker of inflammation. Liver transplantation improved microcirculatory dysfunction, corroborating this hypothesis.
Can l-carnitine supplementation and exercise improve muscle complications in patients with liver cirrhosis who receive branched-chain amino acid supplementation?
Authors: Hiraoka Atsushi , Kiguchi Daisuke , Ninomiya Tomoyuki , Hirooka Masashi , Abe Masanori , Matsuura Bunzo , Hiasa Yoichi , Michitaka Kojiro 
Published: February 2019

Background
The aim of this study was to elucidate the efficacy of the combination of l-carnitine and exercise, reported to prevent muscle wasting, for muscle complications (function, volume, and cramping) in patients with liver cirrhosis (LC) who received branched-chain amino acid supplementation.

Materials and methods
From December 2017 to April 2018, 18 patients with LC who had been given branched-chain amino acid granule supplementation (12.45 g/day) were enrolled (mean age 68.4±10.8 years; 10 males and eight females; Child–Pugh A : B=9 : 9). After evaluating the average number of daily steps, oral l-carnitine supplementation (1000 mg/day) and additional exercise (plus 2000 steps/day) were added for 6 months. Every 4 weeks, a pedometer, a hand dynamometer, ergometer, and bioelectrical impedance analysis were used to evaluate daily steps, muscle function and muscle volume, and muscle cramps were recorded using a numerical rating scale.

Results
Average steps and serum levels of total and free carnitine were increased from before treatment to the final measurement (1883.5±1211.6 vs. 3165.1±1800.0/day, 62.6±16.5 vs. 110.9±28.6 μmol/l, and 47.7±15.2 vs. 83.2±21.5 μmol/l, respectively; P<0.01), whereas there were no significant changes in the ratios of handgrip strength, leg strength, and muscle volume after 6 months [1.00±0.13 (P=0.991), 1.07±0.13 (P=0.073), and 0.992±0.036 (P=0.390), respectively]. However, the frequency of complaints of muscle cramping was reduced as compared with the start of therapy (baseline, 3 months, and 6 months: 6.3±4.8, 3.1±3.3, and 2.1±2.0, respectively) (P=0.025, Holm’s method), whereas numerical rating scale did not show any significant improvement.

Conclusion

l-Carnitine may have an important role for prevention of muscle wasting and reducing the frequency of muscle cramping.
The promising role of probiotic and synbiotic therapy in aminotransferase levels and inflammatory markers in patients with nonalcoholic fatty liver disease – a systematic review and meta-analysis
Authors: Khan Muhammad Y. , Mihali Albana B. , Rawala Muhammad S. , Aslam Aysha , Siddiqui Waqas J. 
Published: February 2019

Background
Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. The pathogenesis of NAFLD is complex and multifactorial. There is growing evidence that altered gut microbiota plays a key role in NAFLD progression. Probiotics/synbiotics, by modifying gut microbiota, may be a promising treatment choice for NAFLD management.

Aim
The aim of this study was to study the effect of probiotics/synbiotics on various laboratory and radiographic parameters in NAFLD management.

Materials and methods
A systematic review and meta-analysis were carried out according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We searched PubMed, Medline, and Google Scholar for randomized-controlled trials that studied the role of probiotics/synbiotics in NAFLD. The primary outcome was change in baseline alanine aminotransferase and aspartate aminotransferase in the treatment arm. We used a random-effects model and inverse variance for the continuous data to estimate the mean difference (MD) and the standard mean difference (SMD) in RevMan Version 5.3.

Results
We included 12 randomized-controlled trials for analysis. The intervention arm, which comprised of the probiotic and/or the synbiotic arm, showed a significant improvement in alanine aminotransferase levels, MD=–13.93, confidence interval (CI)=–20.20 to –7.66, P value of less than 0.0001, I
2=92% and aspartate aminotransferase levels MD=−11.45, CI=−15.15 to −7.74, P value of less than 0.00001, I
2=91%. There was a reduction in high-sensitivity C-reactive protein levels in the intervention arm, SMD=–0.68, CI=–1.10 to –0.26, P value of 0.001, I
2=0%. The liver fibrosis score improved in the intervention arm, MD=–0.71, CI=–0.81 to –0.61, P value less than 0.00001, I
2=0%.

Conclusion
Probiotic/synbiotic use improves aminotransaminase levels and reduces proinflammatory marker high-sensitivity C-reactive protein and liver fibrosis in NAFLD patients.
Clinical relevance of human papillomavirus outside of oropharynx
Authors: Klozar Jan 
Published: February 2019

Purpose of review
The role of HPV in oropharyngeal cancer is well recognized. HPV DNA is also found in a fraction of head and neck tumors outside of oropharynx but its clinical importance is unknown. The purpose of this review is to sum up the present knowledge about the prevalence and possible impact of HPV presence in head and neck tumors in nonoropharyngeal sites.

Recent findings
The data demonstrating prevalence of HPV presence in tumors outside of oropharynx are inconsistent. However, it can be stated that it is substantially lower than in oropharynx. Most articles report the HPV DNA presence only but very few prove also the transcriptionally active viral presence. The fraction of really HPV-induced tumors is probably very small. The majority of literature shows no impact of HPV on prognosis in nonoropharyngeal locations. Also the role of high-risk HPV in malignant transformation of lesions potentially linked to malignancy like inverted papillomas, recurrent respiratory papillomatosis or laryngeal dysplasia was up to date not demonstrated.

Summary
Despite of the unknown role of HPV and lack of evidence regarding any clinical use of HPV knowledge in other than oropharyngeal tumors, further research is warranted.
Photodynamic therapy in head and neck cancer: indications, outcomes, and future prospects
Authors: Meulemans Jeroen , Delaere Pierre , Vander Poorten Vincent 
Published: February 2019

Purpose of review
To identify and review the recent literature on clinical applications, outcome, and new developments in photodynamic therapy (PDT) for the treatment of head and neck cancer.

Recent findings
Although PDT and surgery have a similar local control and recurrence rate, the gold standard of treatment for early-stage oral cavity cancer remains local surgery with, on indication, concurrent treatment of the neck. PDT proves its value in treatment of patients with field cancerization and patients with superficial recurrence after previous surgery and/or radiation, in whom surgical salvage would entail important morbidity. PDT is also promising as an adjuvant treatment after surgery in the presence of macroscopic or microscopic involved margins, in patients where reresection or reirradiation would imply an unacceptable risk. Recent progress in the field of PDT focuses on development and clinical application of new photosensitizing agents, photochemical internalization, and photoimmunotherapy.

Summary
The value of PDT in specific well-selected head and neck cancer clinical scenarios is well established. The basic research field is rapidly evolving and experimental findings are promising, maybe eventually leading to optimized results, less side-effects, and more indications.
Resistance-related determinants in clinically relevant Staphylococcus aureus isolated from teaching therapeutic centers, Tehran, Iran
Authors: Solgi Sana , Razavi Shabnam , Nateghian Alireza , Irajian Gholamreza , Pournajaf Abazar , Hasannejad-Bibalan Meysam , Rahmani Sara 
Published: February 2019

Objectives:
The purpose of this study was to determine the antimicrobial resistance-related genes in Staphylococcus aureus isolated from patients referred to 14 teaching hospitals, Tehran, Iran.

Methods:
A total of 225 S. aureus were obtained from clinical samples in a period of 12 months. Antimicrobial resistance, minimum inhibitory concentration minimal inhibitory concentration and Inducible resistance phenotypes were determined based on the Clinical laboratory standard institute (CLSI) guidelines. PCR was performed for amplification of mecA/B/C, iles-2, ermA/B/C and ereA/B genes.

Results:
39.5 and 40.8% of isolates were resistant to oxacillin and cefoxitin (FOX), respectively. The frequency of constitutive macrolide-lincosamide-streptograminB, inducible macrolide-lincosamide-streptograminB and MS phenotypes were 55.3, 28.6 and 16.1%, respectively. 40.8, 4, 7.5, 6.2, 16 and 3.1% of strains harbored the mecA, ileS-2, ermA, ermB, ermC and ereA genes, respectively.

Conclusion:
The frequency of methicillin-resistant S. aureus isolates in our hospitals was high and disk diffusion testing using FOX or oxacillin and/or FOX minimal inhibitory concentration E test as an alternative to PCR for identification of methicillin-resistant S. aureus is suggested. This study highlights the hypothesis that rapid testing plays an important role in antibiotic stewardship by getting patients on targeted therapy faster.
High-Intensity Interval Training in Panic Disorder Patients
Authors: Plag Jens , Ergec Deniz-Levent , Fydrich Thomas , Ströhle Andreas 
Published: February 2019

Abstract
High-intensity interval training (HIIT) may produce strong physiological but also psychological effects within a short period. However, it is questionable if this type of training is applicable and effective in patients with panic disorder (PD) because they are more vulnerable to the adverse effects of exercise. Twelve PD patients performed a 12-day HIIT trial. Every second day, patients performed 10 high-intensive 1-minute intervals at 77% to 95% of their maximum heart rate separated by 1-minute intervals with moderate to low intensity. All patients completed the 12-day training period. PD severity, agoraphobia, depression, general disorder severity, and endurance performance improved substantially with moderate to large effects sizes. Moreover, the increase in endurance performance was correlated with the reduction of depression and agoraphobia. HIIT was well tolerated by patients with PD and may induce rapid and strong therapeutic effects. A randomized controlled clinical trial is needed to verify our findings.
Alcohol Use Problems, Posttraumatic Stress Disorder, and Suicide Risk Among Trauma-Exposed Firefighters
Authors: Bing-Canar Hanaan , Ranney Rachel M. , McNett Sage , Tran Jana K. , Berenz Erin C. , Vujanovic Anka A. 
Published: February 2019

Abstract
Alcohol use problems are associated with suicidal desire and may provide an avenue to suicidal ideation and behavior. However, the influence of posttraumatic stress disorder (PTSD) on the nature of the relationship between alcohol use problems and suicide risk is not well understood. In particular, the potential for PTSD to moderate the association between alcohol use problems and suicide risk remains unexplored. The present study investigated the main and interactive effects of alcohol use problems (Alcohol Use Disorders Identification Test) and PTSD symptoms (PTSD Checklist for DSM-5) on suicide risk (Suicide Behaviors Questionnaire-Revised) in a sample of 632 trauma-exposed firefighters (93.5% men; M
age = 38.44 years, SD = 8.59). Hierarchical logistic regression analyses evaluated whether the main and interactive effects of PTSD symptom severity and alcohol use disorders were significantly related to suicide risk, above and beyond age and cumulative trauma. The main effects of PTSD symptom severity (odds ratio, 1.76; p < 0.001) and alcohol use problems (odds ratio, 1.37; p = 0.391) significantly positively predicted suicide risk; however, PTSD symptoms did not moderate an association between alcohol use problems and suicide risk after accounting for these main effects (p > 0.05). A secondary, exploratory aim demonstrated that all PTSD symptom clusters significantly positively predicted suicide risk (p's < 0.001), although none of these clusters interacted with alcohol use problems to predict suicide risk (p's > 0.05). Theoretical and clinical implications are discussed as they relate to the importance of screening for PTSD and alcohol use disorder among firefighter populations.