bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring Inflammatory Mediators in Fetal and Maternal Compartments During Human Parturition
Authors: Menon Ramkumar , Taylor Brandie D. 
Published: September 2019

OBJECTIVE:
To examine inflammatory mediators in three fetomaternal biological compartments to inform theory related to the fetal and maternal inflammatory contributions to parturition at term and preterm.

METHODS:
We conducted a cross-sectional study of amniotic fluid, cord blood, and maternal plasma from women with singleton pregnancies. Women had one of four conditions: term labor (n=11), term not in labor (n=13), spontaneous preterm birth with intact membranes (preterm birth; n=13), or preterm prelabor rupture of membranes (PROM; n=8). We measured two damage-associated molecular pattern markers (high-mobility group box-1 [HMGB1] and uric acid) and two acute phase response markers (interleukin [IL]-6 and C-reactive protein [CRP]) using enzyme-linked immunosorbent assay. The distribution of each analyte within amniotic fluid, cord blood, and maternal plasma across the four conditions (term not in labor, term labor, preterm birth, and preterm PROM) were calculated. To explore whether there were distributional differences in each analyte across each of the four labor conditions, we used a nonparametric Kruskal-Wallis test. For analytes that differed across groups, we further compared distributions by labor group (term labor vs term not in labor, and preterm PROM vs preterm birth).

RESULTS:
Fetal compartments (amniotic fluid and cord blood) showed higher HMGB1 in term labor vs term not in labor and preterm PROM vs preterm birth. Amniotic fluid IL-6, cord blood CRP and cord blood uric acid were higher in term vs term not in labor. Cord blood uric acid was higher in preterm PROM vs preterm birth. Only maternal plasma IL-6 was higher in term labor vs term not in labor.

CONCLUSION:
Accumulation of HMGB1 and an overall increase in inflammation observed on the fetal side, but not the maternal side, may be signals of parturition. Understanding fetal-derived proparturition inflammatory signals at term and preterm, especially in preterm PROM, might provide fetal-specific biomarkers and identify underlying mechanisms and targets for interventions to reduce the risk of preterm birth and preterm PROM.
A National Survey of Profiles of Clerkship Directors in Obstetrics and Gynecology
Authors: Morgan Helen Kang , Graziano Scott C. , Craig LaTasha B. , Everett Elise N. , Forstein David A. , Hampton Brittany S. , Hopkins Laura , McKenzie Margaret L. , Pradhan Archana , Royce Celeste , Madani-Sims Shireen , Morosky Christopher M. ,   for the Undergraduate Medical Education Committee, Association of Professors of Gynecology and Obstetrics
Published: September 2019

OBJECTIVE:
To monitor demographics and factors associated with quality of life among obstetrics and gynecology clerkship directors. A secondary goal was to compare current demographics and survey responses to a 1994 survey of clerkship directors.

METHODS:
A 36-item electronic survey was developed and distributed to the 182 U.S. clerkship directors with active memberships with the Association of Professors of Gynecology and Obstetrics. Items queried respondents on demographics, attitudes about being a clerkship director, quality of life, and burnout.

RESULTS:
A total of 113 of the 182 (62%) clerkship directors responded to the survey. The mean full-time time equivalent allocated for clerkship director responsibilities was 25%. When compared with clerkship directors from 1994, current clerkship directors are younger, work fewer total hours per week, spend more time on patient care, and less time on research. Notably, 78% (87) of respondents were female compared with 21% (31) of respondents in 1994. Overall, most current clerkship directors responded optimistically to quality of life and burnout measures, with 25% (28) reporting symptoms of high emotional exhaustion and 17% (19) reporting symptoms of depersonalization. Clerkship directors' perception of support from their medical school was significantly correlated with increased personal fulfilment and positive quality of life, as well as decreased burnout and emotional exhaustion measures.

CONCLUSION:
The gender demographics of obstetrics and gynecology undergraduate medical education leadership have dramatically shifted over the past 25 years; however, many of the changes are not correlated with quality of life and burnout. The association between perceived support from the medical school and multiple quality of life measures point to the vital importance of support for our medical educators.
Reproductive Health in Xeroderma Pigmentosum
Authors: Merideth Melissa , Tamura Deborah , Angra Divya , Khan Sikandar G. , Ferrell Joyln , Goldstein Alisa M. , DiGiovanna John J. , Kraemer Kenneth H. 
Published: September 2019

OBJECTIVE:
To assess the age at menarche and menopause of women with xeroderma pigmentosum, a DNA repair disease with premature aging, in a longitudinal natural history study.

METHODS:
We conducted a natural history study that reviewed medical records for gynecologic and reproductive health of all female patients with xeroderma pigmentosum aged older than 9 years examined at the National Institutes of Health (NIH). We performed gynecologic and laboratory examinations on a subset of the patients. Women in a second subset, who could not be examined, were interviewed using a questionnaire. Women who were deceased or lost to follow-up formed a third subset.

RESULTS:
Sixty females with xeroderma pigmentosum aged older than 9 years (median 29 years, range 10–61 years) were evaluated at the NIH from 1971 to 2018. Of these 60, 31 had history, questionnaire, record review, and gynecologic evaluation; 14 had record review and questionnaire interview by telephone; and 15 had only NIH record review. Menarche in females with xeroderma pigmentosum occurred at a median age of 12.0 years (range 9–17 years), which was comparable with the U.S. general population. Among the 18 patients with menopause, the median age at menopause of 29.5 years (range 18–49.5 years) was more than 20 years younger than in the U.S. general population (52.9 years). Premature menopause (before age 40 years) occurred in 14 of the 45 (31%) women aged 18 years or older, and primary ovarian insufficiency was documented in nine of them. There were 32 live births among 21 of the women, five of whom subsequently developed premature menopause.

CONCLUSION:
Females with xeroderma pigmentosum in our study had a normal age at menarche and were fertile but had increased incidence of premature menopause. Premature menopause, a symptom of premature aging, should be considered for gynecologic and reproductive health as well as implicating DNA repair in maintaining normal ovarian function.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT00001813.
Performance of Two-Stage Cervical Cancer Screening With Primary High-Risk Human Papillomavirus Testing in Women Living With Human Immunodeficiency Virus
Authors: Luckett Rebecca , Mogowa Neo , Li Howard J. , Erlinger Adrienne , Hacker Michele R. , Esselen Katharine , Feldman Sarah , Shapiro Roger , Morroni Chelsea , Ramogola-Masire Doreen 
Published: September 2019

OBJECTIVE:
To evaluate the performance of cervical cancer screening algorithms for women living with human immunodeficiency virus (HIV), using primary high-risk human papillomavirus (HPV) testing followed by cytology, visual inspection with acetic acid, or colposcopy.

METHODS:
We conducted a prospective cohort study of women living with HIV in Botswana. All participants underwent high-risk HPV testing. Participants with positive high-risk HPV test results underwent cytology, visual inspection with acetic acid, colposcopy, and biopsy. Participants with negative high-risk HPV test results also underwent cytology. Histopathology was the reference standard for determination of preinvasive cervical disease and cervical cancer. Sensitivity, specificity, positive predictive value (PPV), negative predictive value, and likelihood ratios (LR) of high-risk HPV-based two-stage screening algorithms were calculated.

RESULTS:
Among 300 women screened, 88 (29%) had a positive high-risk HPV test result, and 29 of the 88 (35%) women who tested positive for high-risk HPV had CIN 2 or higher on histopathology. High-risk HPV followed by colposcopy resulted in a sensitivity of 83%, specificity of 49%, PPV of 47%, LR+ of +1.6, and LR− of −0.4. High-risk HPV followed by visual inspection with acetic acid resulted in a reduced sensitivity of 59%, specificity of 49%, PPV of 39%, LR+ of +1.2, and LR− of −0.8. High-risk HPV testing followed by cytology also resulted in a reduced sensitivity of 62%, specificity of 77%, PPV of 60%, LR+ of +2.7, and LR− of −0.5. Stratification by HPV 16/18/45 did not improve performance of the algorithms.

CONCLUSION:
In a high-risk population with HIV, high-risk HPV testing followed by colposcopy demonstrated the highest sensitivity and PPV in detecting high-grade cervical dysplasia. Allocating resources to colposcopy in resource-limited settings may be more effective than other screening strategies.
The Effect of Preoperative Symptom Duration on Postoperative Outcomes After Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Yoo Joon S. , Patel Dillon S. , Hrynewycz Nadia M. , Brundage Thomas S. , Mogilevsky Franchesca A. , Singh Kern 
Published: September 2019

Study Design:
Retrospective.

Object:
This study aims to examine whether the time spanning from symptom onset to surgical intervention has an effect on postoperative clinical improvement in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Summary of Background Data:
Evidence is limited regarding the influence of preoperative symptom duration on patient-reported outcomes (PROs).

Methods:
Patients undergoing a primary, single-level minimally invasive transforaminal lumbar interbody fusion were retrospectively reviewed and stratified according to preoperative symptom duration (<12 mo and ≥12 mo). Differences in PROs, including Oswestry Disability Index (ODI), 12-Item Short-Form Physical Component Score (SF-12 PCS), Visual Analogue Scale (VAS) back pain, and VAS leg pain, at each postoperative timepoint and were compared between duration of symptoms (DOS) cohorts using linear regression. Achievement of minimal clinically important difference (MCID) for PROs was compared using χ2 analysis.

Results:
A total of 248 patients were included: 96 had a DOS <12 months and 152 had a DOS >12 months. When comparing PROs preoperatively, the shorter DOS cohort had significantly worse ODI, VAS leg pain, and SF-12 PCS compared with patients with longer DOS. However, there was no preoperative difference in VAS back pain between cohorts. Postoperatively, there were no significant differences in improvement of PROs throughout the 12-month timepoint. The shorter DOS cohort had a comparable number of patients achieving MCID for ODI, VAS back pain, VAS leg pain, and SF-12 PCS relative to the longer DOS cohort.

Conclusions:
In our study, patients with DOS <12 months exhibited significantly worse ODI and VAS leg pain scores at the time of surgery compared with patients with longer DOS. However, these patients demonstrated similar clinical improvement postoperatively regardless of preoperative symptom duration. These findings suggest that delayed surgical intervention may not lead to impaired functional recovery in patients with degenerative lumbar disease.
Management of leptomeningeal carcinomatosis and challenges of trial design
Authors: Gill Corey M. , Brastianos Priscilla K. 
Published: September 2019

Purpose of review
Highlight recent data in lung and breast cancer leptomeningeal disease and address clinical trials that are open for patients.

Recent findings
Patients with lung and breast cancer leptomeningeal disease have survival outcomes of less than 1 year, despite advances in treatment strategy. Efforts to develop liquid biopsy biomarkers of disease progression from cerebrospinal fluid and plasma are underway. There are over 10 clinical trials open for patients with leptomeningeal disease, half of which use immunotherapy.

Summary
Consortium-based, multicenter clinical trials for patients with leptomeningeal disease are urgently needed to expand the treatment armamentarium.
Systematic Literature Review and Meta-Analysis of Response to First-Line Therapies for Advanced/Metastatic Urothelial Cancer Patients Who Are Cisplatin Ineligible
Authors: Freshwater Tomoko , Li Haojie , Valiathan Chandni , Li Mengyao , Perini Rodolfo , Bracco Oswaldo L. , Frenkl Tara , Keefe Stephen 
Published: September 2019

Objective:
The purpose of this systematic literature review (SLR) and meta-analysis was to compile the response of historic treatment options in first-line settings for patient populations who are cisplatin ineligible.

Materials and Methods:
SLR was conducted to compile objective response rate (ORR), duration of response (DOR), progression-free survival (PFS), and overall survival (OS) of historic therapies for this population based on stringent criteria. Clinical trials published in English from January 1991 to June 2016 were identified by searching the PubMed (Medline), Cochrane, and Embase databases.

Results:
Eighteen studies (21 arms; N=810) were identified and used for this meta-analysis. For all treatments included in these studies, the pooled ORR was 0.36 (95% confidence interval [CI], 0.30-0.42). The ORR for the carboplatin+gemcitabine arms (6 arms; N=259), which is the National Comprehensive Cancer Network’s recommended first-line treatment (before approval of atezolizumab and pembrolizumab) for this population was 0.36 (95% CI, 0.30-0.42), the median DOR (4 arms) was 7.00 months (95% CI, 4.34-11.29), and the median OS was 8.39 months (95% CI, 7.05-9.98).

Conclusions:
The results of this SLR clearly demonstrate the paucity of clinical studies that assess therapeutic intervention in truly cisplatin-ineligible advanced/metastatic urothelial carcinoma subjects and highlight the development of novel therapies that can create real improvement in long-term outcomes. The recent approval of 2 checkpoint inhibitors, atezolizumab and pembrolizumab, were added in the National Comprehensive Cancer Network guidance as recommended first-line treatment for cisplatin-ineligible patients with advanced/metastatic urothelial carcinoma and has provided alternatives for this patient population.
Evaluation of Genetic Variants in MIR3142HG in Susceptibility to and Prognosis of Glioma
Authors: Guo Xiaoye , Zhang Ming , Li Qi , Zhao Junjie , Wang Bo , Wang Jia , Mao Ping , Song Jinning 
Published: September 2019

Objectives:
Studies have demonstrated that genetic variants in the miRNA-coding genes might be associated with cancer susceptibility and survival. Here, we aimed to investigate the influence of MIR3142HG single-nucleotide polymorphisms on the individual’s susceptibility to and patients’ prognosis of glioma.

Materials and Methods:
Six variants were genotyped by Agena MassARRAY iPLEX Gold assay among 529 glioma patients and 502 healthy controls. Association of MIR3142HG polymorphisms with the risk for and prognosis of glioma was analyzed by logistic regression analysis and Cox proportional hazards model, respectively.

Results:
In the risk analysis, rs17057846 (odds ratio [OR]=1.93, P=0.047), rs2961920 (OR=1.53, P=0.019), and rs58747524 (OR=1.23, P=0.046) polymorphisms were associated with increased glioma risk, while rs7727115 (OR=0.76, P=0.030) and rs1582417 (female individuals, OR=0.49, P=0.017) variants were associated with decreased risk. In the survival analysis, rs1582417 polymorphism (hazard ratio=1.26, P=0.017) contributed to poorer prognosis overall. Rs17057846, rs1582417, and rs2431689 polymorphisms were associated with prognosis of astrocytoma, and rs1582417, rs17057846, and rs58747524 variants were associated with the survival rate in patients with low-grade glioma (I to II).

Conclusion:
Our study provided the first evidence for the impact of rs1582417, rs17057846, rs2431689, rs2961920, rs58747524, and rs7727115 polymorphisms in MIR3142HG on the susceptibility to and/or prognosis of glioma in the Chinese Han population.
Intraoperative Three-dimensional Virtual Reality and Computed Tomographic Guidance in Temporomandibular Joint Arthroplasty of Syndromic Craniofacial Dysostoses
Authors: Bradley Daniel , Willson Thomas , Chang Jessica B. , Gandolfi Brad , Zhu Tian Ran , Bradley James P. , Lee Justine C. 
Published: September 2019

Summary:
Bony ankylosis of the temporomandibular joints (TMJ) occurs in up to 28% of patients with syndromic mandibular dysostoses. Release of complete osseous ankylosis is particularly challenging due to the lack of tissue planes separating the mandible from the skull base and the presence of congenital skeletal abnormalities. One recent advance in surgical imaging technology is three-dimensional virtual reality (3D VR), now in common use in neurosurgical resections. In this study, we describe the usage of 3D VR in TMJ arthroplasty and compare 3D VR to traditional computed tomographic (CT) guidance. Pediatric patients with syndromic mandibular micrognathia including Treacher Collins, Nager, and cerebrocostomandibular syndrome were retrospectively evaluated between 2008 and 2016. Patient characteristics, complications, inpatient times, and operative times were recorded. Of the 29 children with syndromic mandibular micrognathia treated between 2008 and 2016, 7 were diagnosed with TMJ ankyloses. Four consecutive pediatric patients (mean 8.7 years) undergoing interpositional TMJ arthroplasty with Matthews device placement were retrospectively evaluated. Two patients underwent traditional CT-guided versus 3D VR-guided temporomandibular joint arthroplasty (TMJA). No statistically significant differences were found among the age, complications, or inpatient hospitalization times. The average operative time in the traditional CT guidance group was 300 minute versus 134 minutes in the 3D VR group. Three-dimensional VR is a useful preoperative planning and intraoperative guidance tool. The major difference between VR and older technologies is the improved imaging in 3 dimensions for guidance, thereby potentially decreasing operative times.
The association between 24-h blood pressure patterns and left ventricular mechanics
Authors: Tadic Marijana , Cuspidi Cesare , Majstorovic Anka , Pencic Biljana , Mancia Giuseppe , Bombelli Michele , Grassi Guido , Kocijancic Vesna , Djukic Vladimir , Celic Vera 
Published: September 2019

Objective:
We sought to investigate left ventricular (LV) mechanics in the recently diagnosed hypertensive patients with different 24-h blood pressure (BP) patterns (dipping, nondipping, extreme dipping and reverse dipping).

Methods:
The current cross-sectional study included 209 hypertensive patients who underwent 24-h ambulatory BP monitoring and comprehensive two-dimensional echocardiographic examination including multilayer strain analysis.

Results:
There was no difference in 24-h and daytime BP values between four groups. Night-time BP significantly and gradually increased from extreme dippers, across dippers and nondippers, to reverse dippers. LV global longitudinal and circumferential strains were greater in dippers and extreme dippers than in nondippers and reverse dippers. This was also found for endocardial and epicardial LV longitudinal and circumferential strains. Multivariate logistic regression analysis demonstrated that nondipping and reverse dipping patterns were associated with reduced LV longitudinal strain [odds ratio (OR) 1.71 (95% confidence interval (CI): 1.10–5.61) and OR 2.50 (95% CI: 1.31–6.82), respectively] independently of age, sex, 24-h SBP, LV mass index and E/è. Only the reverse dipping BP pattern was independently of clinical and echocardiographic parameters related with reduced LV circumferential strain [OR 1.90 (95% CI: 1.10–4.80)].

Conclusion:
Nondipping and reverse dipping BP patterns had stronger impact on LV mechanics compared with patients with dipping and extreme dipping BP patterns in hypertensive population. LV functional and mechanical remodeling deteriorated from extreme dippers and dippers, to nondippers and reverse dippers.
Additive Effect of Topical Nepafenac on Mydriasis in Patients With Diabetes Mellitus
Authors: Kiziltoprak Hasan , Koc Mustafa , Yetkin Esat , Tekin Kemal , Inanc Merve , Ozulken Kemal 
Published: September 2019

Objectives:
To evaluate the additive effect of topical nepafenac on pupil diameter (PD) in patients with diabetes mellitus (DM) and cataract.

Methods:
This prospective comparative study included the patients having cataract surgery with and without DM. Two consecutive PD measurements were taken using an automatic quantitative pupillometry system (MonPack One, Metrovision). A baseline measurement was taken, then one drop of nepafenac % 0.1 (Nevanac; Alcon, Fort Worth, TX) was instilled only to the eye that will be operated on (study eye). Cyclopentolate 1.0% (Sikloplejin; Abdi İbrahim, İstanbul, Turkey) was instilled to both eyes (study eye/fellow eye) 5 minutes later. The second measurement was taken at 1 hour after this application.

Results:
The DM group consisted of 43 patients, and the control group consisted of 39 participants. The baseline PDs of both eyes were similar in the DM group (P=0.070) and the control group (P=0.345). The change in pupil size from baseline to mydriasis was statistically significantly greater in the study eyes (2.69±0.53) than fellow eyes (2.54±0.61) in the DM group (P=0.009), but there was no statistically significant difference in the control group (2.94±0.63 vs. 2.86±0.58). When the groups were compared, the PD changes were similar in the study eyes between groups (P=0.065), while the PD changes in the fellow eyes were lower in the DM group (P=0.017).

Conclusions:
Nepafenac has been shown additive effect on pupil dilation in diabetic patients before cataract surgery.
Acute kidney injury in interstitial nephritis
Authors: Caravaca-Fontán Fernando , Fernández-Juárez Gema , Praga Manuel 
Published: September 2019

Purpose of review
The purpose of this review is to describe the most common causes of acute interstitial nephritis (AIN), the diagnostic work-up and the therapeutic management.

Recent findings
Several case series and registries have found an increasing incidence of AIN, especially among older patients. Drug-induced AIN still represents the most common cause. Early withdrawal of the culprit drug together with corticosteroid therapy remain the mainstay of treatment, although recent studies have shown that prolonged treatment beyond 8 weeks does not further improve kidney function recovery.

Summary
AIN is a common cause of acute kidney injury, and therefore, physicians should suspect this entity especially in patients exposed to multiple medications. While immune-allergic reaction to numerous drugs is the most common cause of AIN, other underlying systemic diseases may also be involved, and therefore, every patient should undergo a complete diagnostic evaluation. Kidney biopsy provides the definitive diagnosis of AIN, and certain histologic features may help to identify the underlying condition. In drug-induced AIN, an early discontinuation of the culprit drug is the mainstay of therapy, and unless a rapid recovery of kidney function is observed, a course of glucocorticoid therapy should be initiated.