bluuebunny/crossref_metadata_2025_split huggingface dataset:
Setup Error Assessment and Correction in Planar kV Image- Versus Cone Beam CT Image-Guided Radiation Therapy: A Clinical Study of Early Breast Cancer Treated With External Beam Partial Breast Irradiation
Authors: Wang Wei , Yu Ting , Xu Min , Shao Qian , Zhang Yingjie , Li Jianbin 
Published: June 2019

Objective: To compare differences in setup error assessment and correction between planar kilovolt images and cone beam computed tomography images for external beam partial breast irradiation during free breathing. Methods: Nineteen patients who received external beam partial breast irradiation after breast-conserving surgery were recruited. Interfraction setup error was acquired using planar kilovolt images and cone beam computed tomography. After online setup correction, the residual error was calculated, and the setup error was compared. The residual error and setup margin were quantified for planar kilovolt and cone beam computed tomography images. Results: The largest setup error was observed in the anteroposterior direction for both cone beam computed tomography and planar kilovolt imaging (−1.45 mm, 1.74 mm). The cone beam computed tomography–based setup error (systematic error [Σ]) was less than the planar kilovolt images based on Σ in the anteroposterior direction (–1.2 mm vs 2.00 mm; P = .005), and no significant differences were observed for random error (σ) in 3 dimensions ( P = .948, .376, .314). After online setup correction, cone beam computed tomography significantly reduced the residual setup error compared with planar kilovolt images in the anteroposterior direction (Σ: −0.20 mm vs 0.50 mm, P = .008; σ: 0.45 mm vs 1.34 mm, P = .002). The cone beam computed tomography–based setup margin was smaller than the planar kilovolt image-based setup margin in the anteroposterior direction (−1.39 mm vs 5.57 mm, P = .003; 0.00 mm vs 3.20 mm, P = .003). Conclusions: Discrepancy between the setup errors observed with planar kilovolt and cone beam computed tomography was obvious in the anteroposterior direction. Compared to cone beam computed tomography, the elapsed treatment time was smaller when the initial alignment used kilovolt planar imaging. Whether using planar kilovolt or cone beam computed tomography, residual errors can be reduced to 1.5 mm for external beam partial breast irradiation procedures.
Vincristine-induced anemia in hereditary spherocytosis
Authors: Michlitsch Jennifer , Larkin Sandra , Vichinsky Elliott , Kuypers Frans A 
Published: June 2019

Vincristine, a vinca alkaloid, is widely used in many hematologic disorders and pediatric cancers, and acts by binding to the tubulin protein, to inhibit effective cell division. Vincristine-induced anemia has been observed, but its mechanism is not well understood. We describe a case involving serious vincristine-induced anemia in a patient with congenital spherocytosis and provide the explanation to the underlying mechanism. This report demonstrates that vincristine administration to patients with a red cell disorder may require additional clinical interventions to compensate for the vincristine-induced anemia. Impact statement Therapy with vincristine (VCR), a vinca alkaloid, is widely used in many hematologic disorders and pediatric cancers, and acts by binding to the tubulin protein, to inhibit effective cell division. Our paper indicates that treatment of patients with a red cell disorder may require additional clinical interventions to compensate for the VCR-induced anemia. Careful evaluation of other hematologic disorders is important in using a well-known oncology treatment. Whereas extreme concentrations of VCR were shown to alter red cell viability, data did not show negative effects in patients treated. Our data show that under conditions of increased hematopoiesis, hemoglobin in the circulation drops rapidly requiring transfusion. VCR administration to patients with a red cell disorder may require additional clinical interventions to compensate for the VCR-induced anemia.
Cost-effectiveness of interventions to reduce the risk of healthcare-acquired infections in middle-income countries: A systematic review
Authors: Gamalathge Pushpa Udayangani , Kularatna Sanjeewa , Carter Hannah E , Senanayake Sameera , Graves Nicholous 
Published: June 2019

Background: Hospital-acquired infections (HAI) contribute to prolonged hospital stays and account for a substantial economic burden to healthcare systems. Middle-income countries (MICs) experience a greater burden of HAI than developed countries. Evidence on the cost-effectiveness of interventions to reduce HAI is required to inform decision-making in these settings. Aim: To synthesise the evidence on cost-effectiveness as related to HAI interventions in MICs and to assess the quality of this evidence. Methods: A systematic review of published literature on the cost-effectiveness of interventions to reduce the incidence of HAI in MICs between 2000 and 2018 was conducted. Results: Six studies met the pre-determined inclusion criteria. The studies were from three countries: Thailand; India; and Vietnam. The evidence suggests that interventions to reduce HAI are cost-effective and, in most cases, cost-saving to healthcare systems. The quality of the reporting varied across studies. Conclusions: The implementation of HAI prevention interventions appears to be a high value use of resources in MICs. There is a need for further cost-effectiveness analyses in a wider range of MICs in order to confirm these findings. Improved standardisation and quality of reporting is required.
Patterns of treatment and outcome with 500-mg fulvestrant in postmenopausal women with hormone receptor-positive/HER2-negative metastatic breast cancer: a real-life multicenter Italian experience
Authors: Palumbo Raffaella , Sottotetti Federico , Quaquarini Erica , Gambaro Anna , Ferzi Antonella , Tagliaferri Barbara , Teragni Cristina , Licata Luca , Serra Francesco , Lapidari Pietro , Bernardo Antonio 
Published: June 2019

Background: Fulvestrant 500 mg (F500) is the most active endocrine single agent in hormone receptor-positive (HR+)/HER2-negative metastatic breast cancer (MBC). Few data are available regarding the effectiveness of the drug in a real-world setting. Patients and methods: This prospective, multicenter cohort study aimed to describe the patterns of treatment and performance of F500 in a large population of unselected women with MBC, focusing on potential prognostic or predictive factors for disease outcome and response. The primary endpoints were progression-free survival (PFS) and clinical benefit rate. Results: From January 2011 to December 2015, 490 consecutive patients treated with F500 were enrolled. Overall, three different cohorts were identified and analyzed: the first received F500 after progression from previous chemotherapy (CT) or endocrine therapy; the second received the drug for de novo metastatic disease; and the third was treated as maintenance following disease stabilization or a response from a previous CT line. Median overall survival (OS) in the whole population was 26.8 months, ranging from 32.4 in first line to 22.0 and 13.7 months in second line and subsequent lines, respectively. Both the presence of liver metastasis and the treatment line were significantly associated with a worse PFS, while only the presence of liver metastasis maintained its predictive role for OS in multivariate analysis. Conclusions: The effectiveness of F500 was detected in patients treated both upon disease progression and as maintenance. The relevant endocrine sensitivity of 80% of patients included in the study could probably explain the good results observed in terms of outcome.
Spinal subarachnoid space tapering in patients with syringomyelia
Authors: Rutan Emily , Madan Neel , Zea Ryan , Haughton Victor 
Published: June 2019

Background and purpose Cervical spine tapering affects cerebrospinal fluid dynamics. Cervical spine taper ratios derived from anteroposterior diameters reportedly differ between patients with syringomyelia and controls. We attempted to verify the differences in diameter and to show differences in cross-sectional area between syringomyelia and controls. Methods Cervical spine magnetic resonance images in syringomyelia patients (idiopathic or Chiari I related) and control patients were examined. In each subject, the anteroposterior diameter of the spinal canal was measured at each cervical level, and C1–C4, C4–C7, and C1–C7 taper ratios were calculated. Differences in taper ratio between groups were tested for statistical significance with the t-test. Cross-sectional areas of the spinal canal were measured at each cervical spinal level, and tapering was calculated. Results Eighteen patients with idiopathic syringomyelia, 28 with Chiari I, and 29 controls were studied. Chiari and syringomyelia patients had significantly steeper diameter-based taper ratios than controls. The dural sac areas tapered proportionally with the diameter-based taper ratio in all groups. Conclusions Cervical spine anteroposterior diameter tapering and dural sac cross-sectional areas tapering differ between syringomyelia patients and controls.
Prevalence and Site of Rotator Cuff Lesions in Shoulders With Recurrent Anterior Instability in a Young Population
Authors: Ueda Yusuke , Sugaya Hiroyuki , Takahashi Norimasa , Matsuki Keisuke , Tokai Morihito , Hoshika Shota , Onishi Kazutomo , Hamada Hiroshige 
Published: June 2019

Background: Partial articular supraspinatus tendon avulsion (PASTA) lesions are often seen in shoulders of throwing athletes. PASTA lesions in anterior instability are also found in recurrent anterior glenohumeral instability. Purpose: To investigate the prevalence and location of rotator cuff tears (RCTs), including PASTA lesions, in shoulders with recurrent anterior instability. Study Design: Case series; Level of evidence, 4. Methods: A total of 842 shoulders in 801 patients with recurrent anterior instability (647 men, 154 women; mean age, 24 years; age range, 13-40 years) who underwent arthroscopic surgery at the age of 40 years or younger were enrolled. During surgery, the thickness and the sites of RCTs as well as patient factors associated with RCTs were examined. Results: RCTs were found in 57 shoulders (7%) in 56 patients. There were 4 shoulders with full-thickness RCTs and 53 shoulders with PASTA lesions. All lesions but 1 involved the anterior border of the supraspinatus (SSP). Participation in high-level athletics and older age at injury were associated with RCTs. Conclusion: The incidence of RCTs was 7% in shoulders with recurrent anterior instability at age 40 years or younger. Most RCTs were PASTA lesions that involved the anterior border of the SSP.
The role of CPAP treatment in elderly patients with moderate obstructive sleep apnoea: a multicentre randomised controlled trial
Authors: Ponce Silvia , Pastor Esther , Orosa Belen , Oscullo Grace , Catalán Pablo , Martinez Alfonso , Hernández Luis , Muriel Alfonso , Chiner Eusebi , Martínez-García Miguel Ángel 
Published: June 2019

The efficacy of continuous positive airway pressure (CPAP) treatment in elderly patients with nonsevere obstructive sleep apnoea (OSA) is controversial. The objective of this study was to assess the effect of CPAP treatment in elderly patients with moderate OSA in terms of clinical, quality-of-life and neurocognitive measures.This was an open-label, randomised, multicentre clinical trial in 145 elderly patients (≥70 years old) with confirmed moderate OSA (apnoea–hypopnoea index 15–29.9 events·h−1) randomised to receive CPAP (n=73) or no CPAP (n=72) for 3 months. The primary end-point was the Epworth Sleepiness Scale (ESS) score, and the secondary end-points included quality of life (Quebec Sleep Questionnaire (QSQ) domain scores), sleep-related symptoms, presence of anxiety/depression, office-based blood pressure measurements and some neurocognitive tests. The analysis was performed according to the intention-to-treat principle.Mean±sdage was 74.9±4.6 years. The CPAP group achieved a greater improvement in the ESS score (adjusted difference of 2.6 (95% CI 3.6–1.6) points; effect size 1) in some sleep-related symptoms and in some dimensions of the QSQ questionnaire (nocturnal symptoms: −0.7 (95% CI −0.3–−1.0) points; p<0.0001 and emotions: −0.4 (95% CI −0.1–−0.7) points; p=0.023). However, CPAP did not demonstrate any effect on either neurocognitive tests (including anxiety and depression) or blood pressure levels. There was a positive correlation between the effect of CPAP and the improvement in ESS scores and quality of life domains.CPAP treatment resulted in a significant improvement in diurnal hypersomnia and some sleep-related symptoms and quality of life domains in elderly patients with moderate OSA.
Donor human leukocyte antigen-G single nucleotide polymorphisms are associated with post-lung transplant mortality
Authors: Lazarte Julieta , Ma Jin , Martinu Tereza , Levy Liran , Klement William , White Matthew , Pelling Jacob , Guan Zehong , Azad Sassan , Tikkanen Jussi , Rao Vivek , Tomlinson George , Delgado Diego , Keshavjee Shaf , Juvet Stephen C. 
Published: June 2019

Human leukocyte antigen (HLA)-G is a non-classical HLA that inhibits immune responses. Its expression is modified by single nucleotide polymorphisms (SNPs), which are associated with transplant outcomes. Our aim was to investigate the association of donor and recipient HLA-G SNPs with chronic lung allograft dysfunction (CLAD) and mortality after lung transplantation.In this single-centre study, we examined 11 HLA-G SNPs in 345 consecutive recipients and 297 donors of a first bilateral lung transplant. A multivariable Cox proportional hazards model assessed associations of SNPs with death and CLAD. Transbronchial biopsies (TBBx) and bronchoalveolar lavage (BAL) samples were examined using quantitative PCR, ELISA and immunofluorescence.Over a median of 4.75 years, 142 patients (41%) developed CLAD; 170 (49%) died. Multivariable analysis revealed donor SNP +3142 (GG+CGversusCC) was associated with increased mortality (hazard ratio 1.78, 95% CI 1.12–2.84; p=0.015). In contrast, five donor SNPs, -201(CC), -716(TT), -56(CC), G*01:03(AA) and 14 bp INDEL, conferred reduced mortality risk. Specific donor–recipient SNP pairings reduced CLAD risk. Predominantly epithelial HLA-G expression was observed on TBBx without rejection. Soluble HLA-G was present in higher concentrations in the BAL samples of patients who later developed CLAD.Specific donor SNPs were associated with mortality risk after lung transplantation, while certain donor–recipient SNP pairings modulated CLAD risk. TBBx demonstrated predominantly epithelial, and therefore presumably donor-derived, HLA-G expression in keeping with these observations. This study is the first to demonstrate an effect of donor HLA-G SNPs on lung transplantation outcome.
Disease severity and clinical outcomes of community-acquired pneumonia caused by non-influenza respiratory viruses in adults: a multicentre prospective registry study from the CAP-China Network
Authors: Zhou Fei , Wang Yimin , Liu Yingmei , Liu Xuedong , Gu Li , Zhang Xiaoju , Pu Zenghui , Yang Guoru , Liu Bo , Nie Qingrong , Xue Bing , Feng Jing , Guo Qiang , Liu Jianhua , Fan Hong , Chen Jin , Zhang Yongxiang , Xu Zhenyang , Pang Min , Chen Yu , Nie Xiuhong , Cai Zhigang , Xu Jinfu , Peng Kun , Li Xiangxin , Xiang Pingchao , Zhang Zuoqing , Jiang Shujuan , Su Xin , Zhang Jie , Li Yanming , Jin Xiuhong , Jiang Rongmeng , Dong Jianping , Song Yuanlin , Zhou Hong , Wang Chen , Cao Bin 
Published: June 2019

Although broad knowledge of influenza viral pneumonia has been established, the significance of non-influenza respiratory viruses in community-acquired pneumonia (CAP) and their impact on clinical outcomes remains unclear, especially in the non-immunocompromised adult population.Hospitalised immunocompetent patients with CAP were prospectively recruited from 34 hospitals in mainland China. Respiratory viruses were detected by molecular methods. Comparisons were conducted between influenza and non-influenza viral infection groups.In total, 915 out of 2336 adult patients with viral infection were enrolled in the analysis, with influenza virus (28.4%) the most frequently detected virus, followed by respiratory syncytial virus (3.6%), adenovirus (3.3%), human coronavirus (3.0%), parainfluenza virus (2.2%), human rhinovirus (1.8%) and human metapneumovirus (1.5%). Non-influenza viral infections accounted for 27.4% of viral pneumonia. Consolidation was more frequently observed in patients with adenovirus infection. The occurrence of complications such as sepsis (40.1%versus39.6%; p=0.890) and hypoxaemia (40.1%versus37.2%; p=0.449) during hospitalisation in the influenza viral infection group did not differ from that of the non-influenza viral infection group. Compared with influenza virus infection, the multivariable adjusted odds ratios of CURB-65 (confusion, urea >7 mmol·L−1, respiratory rate ≥30 breaths·min−1, blood pressure <90 mmHg (systolic) or ≤60 mmHg (diastolic), age ≥65 years) ≥3, arterial oxygen tension/inspiratory oxygen fraction <200 mmHg, and occurrence of sepsis and hypoxaemia for non-influenza respiratory virus infection were 0.87 (95% CI 0.26–2.84), 0.72 (95% CI 0.26–1.98), 1.00 (95% CI 0.63–1.58) and 1.05 (95% CI 0.66–1.65), respectively. The hazard ratio of 90-day mortality was 0.51 (95% CI 0.13–1.91).The high incidence of complications in non-influenza viral pneumonia and similar impact of non-influenza respiratory viruses relative to influenza virus on disease severity and outcomes suggest more attention should be given to CAP caused by non-influenza respiratory viruses.
Communication difficulties reported by patients diagnosed with idiopathic pulmonary fibrosis and their carers: a European focus group study
Authors: Masefield Sarah , Cassidy Nicola , Ross Derek , Powell Pippa , Wells Athol 
Published: June 2019

This paper explores commonalities in the experience and unmet needs of idiopathic pulmonary fibrosis (IPF) patients and carers in Europe throughout the care pathway, focusing specifically on the unmet communication needs of patients and carers.Four patient organisations/groups in Europe held focus groups (Italy (seven patients and four carers); Belgium (six patients); Ireland (23 patients and 10 carers); and England, UK (five patients and three carers)). A focus group schedule was provided and translated into the language of each focus group by the European Lung Foundation (ELF). Content analysis was conducted by the ELF and verified by the authors of the paper.Three main themes emerged: professional−patient, professional−professional and patient−patient communication. Within these themes, eight priority areas were highlighted by two or more of the focus groups. In addition, 17 suggested action points were identified.Patients and carers in Europe have unmet communication needs, which could be met by specialist physicians and specialist centres providing more effective information and signposting to support services, including support groups and patient organisations.
Clinical Relevance of Noncoding Adenosine-to-Inosine RNA Editing in Multiple Human Cancers
Authors: Gu Tongjun , Fu Audrey Q. , Bolt Michael J. , White Kevin P. 
Published: June 2019

PURPOSERNA editing is a post-transcriptional process that alters the nucleotide sequences of certain transcripts, in vertebrate most often converting adenosines to inosines. Multiple studies have recently implicated RNA editing in cancer development; however, most studies have focused on recoding RNA editing events. The function and clinical relevance of noncoding RNA (ncRNA) editing events in cancers have not been systematically examined.PATIENTS AND METHODSWe improved our previously published pipeline to identify ncRNA editing sites from four human cancers: liver hepatocellular carcinoma, lung adenocarcinoma, kidney renal clear-cell carcinoma, and thyroid carcinoma. We then developed multiple advanced statistical models to identify significantly differential edited (DE) sites between tumor and normal samples and clinical relevance ncRNA editing sites, as well as to investigate the association between gene expression, ncRNA editing, and microRNAs. Finally, we validated computational results with experiments.RESULTSWe identified 3,788 ncRNA editing sites of high confidence from the four cancers. We found thousands of DE sites which had distinct profiles across the four cancers. In kidney cancer, which had the largest uncensored survival data among the four cancers, 80 DE sites were significantly associated with patient survival. We identified 3′ untranslated region (UTR) RNA editing sites that can affect gene expression, either independent of or by working with microRNAs. We validated that the 3′UTR RNA editing sites in CWF19L1 and F11R genes resulted in increased protein levels and that alterations of the expression of the two genes affected the proliferation of human embryonic kidney cells.CONCLUSIONOn the basis of our computational and experimental results, we hypothesize that 3′UTR editing sites may affect their host gene expression, thereby affecting cell proliferation.
Phase II Evaluation of Aggressive Dose De-Escalation for Adjuvant Chemoradiotherapy in Human Papillomavirus–Associated Oropharynx Squamous Cell Carcinoma
Authors: Ma Daniel J. , Price Katharine A. , Moore Eric J. , Patel Samir H. , Hinni Michael L. , Garcia Joaquin J. , Graner Darlene E. , Foster Nathan R. , Ginos Brenda , Neben-Wittich Michelle , Garces Yolanda I. , Chintakuntlawar Ashish V. , Price Daniel L. , Olsen Kerry D. , Van Abel Kathryn M. , Kasperbauer Jan L. , Janus Jeffrey R. , Waddle Mark , Miller Robert , Shiraishi Satomi , Foote Robert L. 
Published: June 2019

PURPOSEThe purpose of this study was to determine if dose de-escalation from 60 to 66 Gy to 30 to 36 Gy of adjuvant radiotherapy (RT) for selected patients with human papillomavirus–associated oropharyngeal squamous cell carcinoma could maintain historical rates for disease control while reducing toxicity and preserving swallow function and quality of life (QOL).PATIENTS AND METHODSMC1273 was a single-arm phase II trial testing an aggressive course of RT de-escalation after surgery. Eligibility criteria included patients with p16-positive oropharyngeal squamous cell carcinoma, smoking history of 10 pack-years or less, and negative margins. Cohort A (intermediate risk) received 30 Gy delivered in 1.5-Gy fractions twice per day over 2 weeks along with 15 mg/m2docetaxel once per week. Cohort B included patients with extranodal extension who received the same treatment plus a simultaneous integrated boost to nodal levels with extranodal extension to 36 Gy in 1.8-Gy fractions twice per day. The primary end point was locoregional tumor control at 2 years. Secondary end points included 2-year progression-free survival, overall survival, toxicity, swallow function, and patient-reported QOL.RESULTSAccrual was from September 2013 to June 2016 (N = 80; cohort A, n = 37; cohort B, n = 43). Median follow-up was 36 months, with a minimum follow-up of 25 months. The 2-year locoregional tumor control rate was 96.2%, with progression-free survival of 91.1% and overall survival of 98.7%. Rates of grade 3 or worse toxicity at pre-RT and 1 and 2 years post-RT were 2.5%, 0%, and 0%. Swallowing function improved slightly between pre-RT and 12 months post-RT, with one patient requiring temporary feeding tube placement.CONCLUSIONAggressive RT de-escalation resulted in locoregional tumor control rates comparable to historical controls, low toxicity, and little decrement in swallowing function or QOL.