bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alterations in bacterial communities, SCFA and biomarkers in an elderly HIV-positive and HIV-negative population in western Mexico
Authors: González-Hernández Luz A. , Ruiz-Briseño Mariana del Rocio , Sánchez-Reyes Karina , Alvarez-Zavala Monserrat , Vega-Magaña Natali , López-Iñiguez Alvaro , Díaz-Ramos Julio A. , Martínez-Ayala Pedro , Soria-Rodriguez RA , Ramos-Solano Moises , Andrade-Villanueva Jaime F. 
Published: March 2019

Abstract

Background
The study of stool microbiota has taken great relevance in the last years, given its role in the maintenance of the intestinal metabolic, physiological, and immunological homeostasis, as well as, its effect over HIV biomarkers levels such as CD4/CD8 ratio, high sensitivity C-Reactive Protein (hs-CRP), related to poor outcomes (rapid progression to AIDS). Several efforts have been made to characterize the gut microbiome. In HIV infection, most of the studies report the presence of a dysbiotic pattern; however, few of them have made an approach in elderly HIV-positive subjects despite the fact that nowadays this subgroup is rising. In this study, we compared the composition of faecal microbiota, Short Chain Fatty Acids (SCFAs), and systemic biomarkers between elderly HIV-positive and HIV-negative subjects.

Methods
A cross-sectional study with 18 HIV-negative controls and 20 HIV-positive patients. The quantification of Bacteroidetes, Firmicutes, Proteobacteria, Actinobacteria, Lactobacillus, Enterobacteriaceae, Bifidobacterium, Escherichia coli, Clostridium leptum, Clostridium coccoides was performed in faecal samples by qPCR. The analysis was performed by calculating the ΔCq of each microorganism using 16S rDNA as a reference gene. Faecal SCFAs were measured by HPLC. The hs-CRP and sCD14 were performed by ELISA.

Results
An increase in the Firmicutes/Bacteroidetes ratio, coupled with a significant increase in the proteobacteria phylum was detected in HIV-positive subjects. In contrast, a decrease in the Clostridium leptum group was observed. Nevertheless, these elderly HIV-positive patients showed higher levels of total SCFAs mainly by an augmented propionic acid values, compared to HIV-negative subjects. Whereas high levels of hs-CRP were positively correlated with sCD14 in the HIV-positive group.

Conclusions
Alterations in bacterial communities reveals a dysbiotic state related to an unbalance of faecal SCFAs. Therefore, these intestinal conditions might drive an increase of poor prognostic biomarkers in elderly HIV-positive subjects.
Telepsychiatry in intellectual disability psychiatry: literature review
Authors: Madhavan Giri 
Published: March 2019

Aims and MethodThe aims of this review were to explore the effectiveness and patient and provider acceptability of telepsychiatry consultations in intellectual disability, contrasting this with direct face-to-face consultations and proposing avenues for further research and innovation. Computerised searches of databases including AMED and EMBASE were conducted.ResultsFour USA studies of intellectual disability telepsychiatry services have been reported. The majority (75%) focused on children with intellectual disability. Sample sizes ranged from 38 to 900 participants, with follow-up from 1 to 6 years. Outcome measures varied considerably and included cost savings to patients and healthcare providers, patient and carer satisfaction and new diagnoses.Clinical implicationsThe innovations summarised suggest a requirement to further explore telepsychiatry models. Despite some promising outcomes, there is a relative dearth in the existing literature. Further studies in other healthcare systems are required before concluding that telepsychiatry in intellectual disability is the best approach for providing psychiatric services to this population.Declaration of interestNone.
Mental health professionals' knowledge, skills and attitudes on domestic violence and abuse in the Netherlands: cross-sectional study
Authors: Ruijne Roos E. , Kamperman Astrid M. , Trevillion Kylee , Garofalo Carlo , Jongejan Femke E. , Bogaerts Stefan , Howard Louise M. , Mulder Niels L. 
Published: March 2019

BackgroundDespite the high prevalence of domestic violence and abuse (DVA) among patients with psychiatric conditions, detection rates are low. Limited knowledge and skills on DVA in mental healthcare (MHC) professionals might contribute to poor identification.AimsTo assess the level of, and factors associated with, DVA knowledge and skills among MHC professionals.MethodA total of 278 professionals in Dutch MHC institutions completed a survey assessing factual knowledge, perceived knowledge, perceived skills and attitudes about DVA.ResultsOn average, low scores were reported for perceived skills and knowledge. MHC professionals in primary care scored higher than those working with individuals with severe mental illness (P<0.005). Levels of factual knowledge were higher; levels of attitudes moderate. Previous training was positively associated with skills (odds ratios (OR) = 3.0) and attitudes (OR = 2.7). Years of work was negatively associated with factual knowledge (OR = 0.97). Larger case-loads predicted higher scores on skills (OR = 2.1).ConclusionsTraining is needed, particularly for clinicians working with patients with severe mental illness.Declaration of interestNone.
Active surveillance and watchful waiting for low-risk prostate cancer in black patients: A population-based analysis.
Authors: Butler Santino , Muralidhar Vinayak , D'Amico Anthony Victor , Nguyen Paul L. , Rebbeck Timothy , Mahal Brandon Arvin Virgil 
Published: March 2019

10 Background: Evidence from clinical trials supports conservative management as an acceptable alternative to definitive therapy for low-risk prostate cancer (LRPC). The optimal approach for Black men, however, remains unclear given trial underrepresentation and concern about racial differences in disease aggressiveness. We therefore sought to determine U.S. conservative management utilization rates for Black men with LRPC. Methods: The Surveillance, Epidemiology, and End Results (SEER) Program Prostate with Active Surveillance/Watchful Waiting (AS/WW) Database queried 50,302 LRPC patients (N = 5218 Black), diagnosed from 2010-2015. Trends in AS/WW utilization over time were determined, stratified by race (Black versus non-Black) and number of positive biopsy cores (≤2 versus ≥3). Results: From 2010 to 2015, AS/WW utilization increased from 12.6% to 36.4% among Black men (Ptrend< 0.001) and from 14.8% to 43.3% among non-Black men (Ptrend< 0.001). AS/WW rates reached 52.0% and 57.3% by 2015 for Black (Ptrend< 0.001) and non-Black (Ptrend< 0.001) men with ≤2 positive biopsy cores, respectively. Rates continually increased for all subgroups except Black men with ≥3 positive biopsy cores, where rates plateaued at 22.9% by 2013. Conclusions: In this report from the largest U.S. population of Black LRPC patients with quality assured AS/WW data, AS/WW rates have nearly tripled for Black men from 2010-2015, suggesting AS/WW is viewed as a safe management option in all races.
Risk factors for postprostate biopsy infection.
Authors: Shoag Jonathan , Sun Tianyi , Pantuck Morgan , Gorin Michael A. , Schaeffer Edward M. , Sedrakyan Art , Hu Jim 
Published: March 2019

103 Background: Prostate biopsy is a common procedure that many U.S. men endure during their lifetime. Evidence suggests that the risk of post-biopsy infections is increasing. We aimed to characterize risk factors for post-biopsy infections using nationally representative data. Methods: We analyzed Surveillance, Epidemiology and End Results (SEER)-Medicare data to identify 246,299 male Medicare beneficiaries aged over 65 years who underwent prostate biopsy between 2001 and 2013. Multivariable logistic regression was used to assess risk factors for post-biopsy infection.The primary outcomes were any infection within 30 days of prostate biopsy, and infections requiring hospital admission within 30 days of biopsy. Results: In this cohort, 7.0% of men developed an infection within 30 days and 1.0% required hospital admission for infection. The vast majority of biopsies were performed transrectally (99.5%) without a rectal swab culture performed prior to biopsy to direct antimicrobial prophylaxis (99.7%). Risk factors for post-biopsy infection and hospitalization on multivariable analysis included age over 80 years, odds ratio (OR) 1.23 (95% confidence interval (CI) 1.17 to 1.29, for any infection, and OR 1.71 (95% CI 1.52 to 1.92) for infection requiring hospitalization, Black race, OR 1.29 (95% CI 1.23 to 1.35) for any infection, and OR 1.41 (95% CI 1.25 to 1.58) for hospitalization, and Hispanic ethnicity, OR 1.61 (95% CI 1.46 to 1.77) for any infection, and OR 1.92 (95% CI 1.52 to 2.42) for hospitalization. The risk of infection also increased with Charlson score of 3 or greater, OR 1.32 (95% CI 1.25 to 1.39), and OR 2.04 (95% CI 1.73 to 2.40) for any infection or hospitalization, respectively. High surgeon volume (>11.6 cases) was protective, OR 0.92 (95% CI 0.88 to 0.96) for any infection, and OR 0.76 (95% CI 0.69 to 0.85) for hospitalization. Conclusions: Among other factors, we identify patient age, Charlson score, race, ethnicity, and surgeon volume as significant predictors of post-prostate biopsy infection and hospitalization. These results should aid in identifying patients who may benefit from alternative techniques, such as targeted or augmented antimicrobial prophylaxis, or transperineal biopsy, to minimize this common source of morbidity.
One and done?: Utility of PSA density as a predictor of number of cores needed to detect clinically significant prostate cancer.
Authors: Hale Graham , Bloom Jonathan , Lebastchi Amir H , Gold Samuel A , Mehralivand Sherif , Shih Joanna H. , Turkbey Baris , Pinto Peter A. 
Published: March 2019

104 Background: MRI/US fusion guided prostate biopsy (FBx) has been shown to detect clinically significant prostate cancer (csCaP) at higher rates and with fewer cores than standard prostate biopsy. However, the number of targeted cores needed to accurately characterize lesions identified on multiparametric MRI (mpMRI) is unknown. This study sought to determine factors that predict the number of cores needed to accurately characterize lesions during FBx of patients on active surveillance. Methods: A retrospective analysis of a prospectively maintained database of all patients undergoing FBx at an academic referral center between May 2014 and January 2018 was conducted. At least two FBx cores were taken from each lesion identified on mpMRI. Patient and lesion specific factors were analyzed to determine factors that predict the necessity to obtain additional cores to detect csCaP. GEE-based univariate logistic regression model with exchangeable correlation was used to estimate the effects of clinical characteristics including race, BMI, PSA, PSA density (PSAD), lesion location, and PI-RADS score on the proportion of positive and negative agreement. Predictability of a significant continuous predictor was quantified by AUC. The most significant patient-level predictor (PSAD) was further analyzed to determine thresholds at which multiple cores per lesion are needed to avoid missing csCaP. Results: An analysis of a total of 1141 FBx were performed during the study time interval. PSA (OR=1.57, 1.20-2.05, p<0.01) and PSAD (OR=1.43, 1.11-1.85, p<0.01) significantly predicted positive agreement of csCaP. AUC for positive and negative agreement was 57.4 and 61.0 for PSA and 56.4 and 72.3 for PSAD, respectively. Using these thresholds, only 56% lesions would need double core targeted biopsy. In other words, up to 44% of lesions would be accurately characterized with a single biopsy core of the targeted lesion. Conclusions: These data indicate that in patients with a PSAD less than 0.11 ng/ml2 or greater than 0.26 ng/ml2, lesions may be acceptably characterized with a single targeted biopsy core.
The cost of prostate cancer care to society and to patients in the United States.
Authors: Zaorsky Nicholas George , Lin John , Ba Djibril , Segel Joel E , Mackley Heath B. , Drabick Joseph , Liu Guodong , Leslie Doug 
Published: March 2019

116 Background: Our objectives are to characterize prostate cancer patient resource consumption and cost (I) to society, in 1 calendar year; and (II) to the patient, 1 year after his diagnosis. Methods: The MarketScan database was used to summarize cost, including gross payment to provider for service, copayment, and deductibles. We identified the top 20 Current Procedural Terminology (CPT) codes to characterize which procedures drove costs for both objectives. For Objective I, diagnoses were identified in 1 calendar year (2014); codes and their costs for all patients were calculated. For Objective II, diagnoses were set at time = 0, and all CPT and International Classification of Diseases codes were characterized 1 year after diagnosis (2012-2013). Results: For objective I, there were 95,642 procedures totalling $38,696,423. The plurality of procedures were hospital consultations, level 2 (i.e. history + physical + straightforward decision-making; 17,103 performed, average $80 each, total $1,418,954) and level 3 (+ low complexity decision-making; 9,726 performed; average $127 each, total $1,232,928). The most costly procedure to society was a radical prostatectomy (8,883 performed, average $2,003 each, total $17,694,508) with accompanying anesthesia (7,960 performed, average $1262 each, total $10,048,653). For objective II (characterized in Table), the mean payment per month was $2,794, including mean gross cost $2,673, mean copayment $32, and mean deductible $46. Conclusions: The typical cost of therapy to a prostate cancer patient is $2,800/month after diagnosis, primarily from surgery (constituting the majority of cost to society) and subsequently from office visits (constituting the plurality of procedures). Societal measures to reduce cost should be aimed at the operating room and consultations.[Table: see text]
Significance of tertiary pattern 5 in patients with gleason score 7 after radical prostatectomy.
Authors: Li Jiakun , Guo Yaochuan , Qiu Shi , He Mingjing , Jin Kun , Liao Xinyang , Zheng Xiaonan , Tu Xiang , Yang Lu , Wei Qiang 
Published: March 2019

117 Background: To evaluate the association between tertiary Gleason pattern (TGP) 5 and the biochemical recurrence (BCR) in patients with prostate cancer (PCa) of Gleason score (GS) 7 after radical prostatectomy(RP). Methods: This retrospective study collected 387 patients received RP and diagnosed GS 7 (3+4 or 4+3) in the West China Hospital from January 2009 to December 2017.Regardlessly the first Gleason pattern, patients were divide into 2 groups: TGP5 absence and TGP5 presence. Furthermore, we added the primary Gleason pattern to divided patients into 4 groups: GS 3+4, GS 3+4/TGP 5, Gleason 4+3, Gleason 4+3/TGP 5. Cox proportional-hazards models was used to evaluate the association between the status of TGP5 and BCR after adjusting the confounding factors with follow-up time as the underlying time scale. All the analyses were conducted with the use of statistical software packages Rnand EmpowerStats and conducted as two sides and P values less than 0.05 were considered statistical significance. Results: In the results by using Cox proportional-hazards model, regardless the primary Gleason pattern, comparing TGP5 absence (89.7%) and presence (10.3%), the risk of BCR for patients with tertiary Gleason pattern 5 presence was statistically significantly higher than absence (P = 0.02, HR = 2.24, 95%Cl: 1.12-4.49). In terms of the patients with primary Gleason pattern 4, the risk of BCR for patients with Gleason 4+3/TGP5 was statistically significantly higher than Gleason 4+3.(P = 0.02, HR = 2.56, 95%Cl: 1.16-5.67). There was a marked trend that patients with Gleason 3+4/TGP 5 has a higher risk of BCR compared with patients with Gleason 3+4, although there was no statistical difference (P = 0.58, HR = 1.82, 95%Cl: 0.22-14.96). Conclusions: The TGP5 in patients with GS 7 had strong association with the risk of BCR and it was an independent predictor for BCR. This result was more obvious in patients with GS 7 (4+3) in our study. Further researches with larger data size were needed to confirm these funding.
State rurality does not increase risk of prostate cancer death.
Authors: Anderson Alexander Geoffrey Shaw , Murray Katie 
Published: March 2019

119 Background: Prostate cancer is the third most common cancer among men. PSA based screening for prostate cancer was introduced in the 1980s and resulted in a significant decline in prostate cancer mortality. Current AUA guidelines recommend PSA screening in average risk patients between the ages of 55 and 69. There are public health concerns in rural areas of the United States (US) potentially due to decreased access of care. In this study, we sought to evaluate the prevalence of prostate cancer screening and death rate in rural communities within the US. Methods: After IRB approval, data was collected from several different sources. Annual prostate cancer death rate (2011-2015) was obtained from the American Cancer Society. Data from the Behavioral Risk Factor Surveillance System regarding prostate cancer screening during this time interval was acquired. Data regarding populations was obtained from the US Census. Descriptive analyses were used to describe the population and Pearson Correlation Coefficient to determine screened, death rates and rurality correlations. All analyses were completed using SPSS. Results: The median percent of US population residing in rural and urban areas was 25.8% (IQR 22.1%) and 73.8% (IQR 22.1%), respectively. The median percent of male patients screened using PSA 50 years and older was 56.2% (IQR 7.0%). The median death rate (per 100,000) from prostate cancer per state was 19.5 (IQR 1.7%). Prostate cancer death rate was found to have no correlation to percent of population screened (p = 0.29) and percent rurality (p = 0.98). The percent rural population versus percent of screened men over the age of 50 was also not significant (p = 0.20). Conclusions: Neither death rate nor screening rate for prostate cancer using PSA demonstrated a significant association with the percent of patient’s living in rural communities. This is evidence that within the US, rural communities are following guidelines for PSA screening for prostate cancer and therefore there is no discrepancy in prostate cancer death in these areas compared to urban. This study is evidence that the barriers that may be associated with living in rural communities, such as decreased access to healthcare do not translate into worse outcomes related to prostate cancer.
Marijuana use history in patients presenting with localized prostate cancer.
Authors: Nichols Romaine Charles , Morris Christopher G , Bryant Curtis , Hoppe Bradford S. , Henderson Randal H. , Mendenhall William M. , Mendenhall Nancy Price 
Published: March 2019

129 Background: Determine the incidence of past marijuana use in a large cohort of men diagnosed with localized prostate cancer to determine if marijuana use was correlated with: patient age; pretreatment T stage; Prostate specific antigen (PSA); Gleason Score; or clinical risk group. Methods: From August, 2006 to October 2018, 4305 patients received treatment for localized prostate cancer and are included in an outcomes tracking protocol. All patients were requested to complete a pre treatment information form which included the question: “Have you ever used marijuana?” 4277 (97%) answered the question either affirmatively or negatively. Responses were stratified by: patient birth year; clinical T stage, PSA level; highest Gleason score; and clinical risk group. Results: 3.8% of men born before 1940 reported marijuana use compared to 17.4% born between 1940 and 1950 and 38.6% born after 1950 (p<0.0001). 19.8% of men with T1 tumors reported marijuana use compared to 18.1% of men with T2 tumors and 19.1% of men with T3 tumors (p=0.4494). 19.7% of men with a PSA less than 10 ng/ml reported marijuana use compared to 17.2% of men with a PSA between 10 and 20 ng/ml and 18.7% of men with a PSA over 20 ng/ml (p=0.4029). 20.8% of men with Gleason score of 6 or less reported marijuana use compared to 19.6% of men with a Gleason score of 7 and 13.5% with Gleason score of 8 or higher (p=0.0004). 20.8% of men with low risk presentation reported marijuana use compared to 19.9% of men with intermediate risk presentation and 14.1% of men with high risk presentation (p=0.0004). There was a significant positive association observed between increasing age and Gleason score (p<0.0001). Conclusions: Men presenting with higher Gleason score tumors and higher risk disease were significantly less likely to report past marijuana use. It is likely that this finding is due to the greater incidence of high grade tumors seen in older patients.
Late toxicity described using patient reported outcomes measures (PROMS) in men treated with salvage radiation following primary high intensity focal ultrasound (HIFU) for localized prostate cancer.
Authors: Davda Reena , Orczyk Clement , Prentice Mark , Sarova Aylin , Arya Manit , Ahmed Hashim , Emberton Mark , Moore Caroline , Mitra Anita , Payne Heather Ann 
Published: March 2019

131 Background: In primary treatment of localised prostate cancer, minimally invasive ablative therapies such as HIFU aim to achieve cancer control whilst offering a potentially favourable toxicity profile. At 5 years median follow up, 12% of patients treated with focal HIFU require salvage therapy. PROMS using Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC‐CP) provide a validated and clinically relevant tool to assess and quantify side effects from pelvic radiotherapy. There is limited data on late toxicity using PROMs with salvage radiotherapy in this setting. Methods: Retrospective analysis from prospectively collected data of 28 patients who received salvage radiotherapy at our institution 2010-2018 was performed. Late bowel and urinary toxicity measured by EPIC-CP is reported. Results: Gleason score at diagnosis: 3+3 4/28; 3+4 22/28; 4+3 2/28. HIFU treatment received: focal: 9/28; whole gland: 6/28; focal and redo focal: 7/28; focal and redo whole gland: 1/28; whole gland and redo: 5/28. All patients had mpMRI and biopsy proven recurrence with median PSA 6.6 ng/ml (0.57- 30.89). Median age at radiation was 67 years (55-80). Patients received 74 Gy to the prostate and 4 patients received additional pelvic lymph node irradiation. Three men received conformal radiotherapy (multiphase technique) and 25 arcing intensity modulated radiotherapy with hormone therapy as per risk stratification. Cumulative incidence of toxicity is reported at median follow-up of 43 months (7-99). Overall urinary function: no problem 8/28; very small problem 4/28; small problem 7/28; moderate problem 5/28; big problem 4/28 Urinary Incontinence Symptom Score: 2.5/12 (0-12) Urinary Irritation /Obstructive Symptom Score: 3.1/12 (0-12) Bowel Symptom Score: 3.5/12 (0-11) Biochemical relapse has occurred in 2/28 patients. Conclusions: Functional and oncological outcomes for a greater number of patients treated with minimally invasive ablative therapies followed by salvage radiation are required, however this data suggests radiation is a well-tolerated and effective salvage option following primary HIFU.