bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of adjuvant chemotherapy in T2N0M0 periampullary cancers
Authors: Ostwal Vikas , Harris Caleb , Sirohi Bhawna , Goel Mahesh , Bal Munita , Kannan Sadhana , Shrikhande Shailesh V 
Published: December 2016

AbstractAimsSurgery is the only modality that offers cure for periampullary adenocarcinoma. However, surgery alone results in failure in 60% of patients. Studies have shown some benefits of chemotherapy in node positive and higher tumor stage patients. We sought to determine the role of adjuvant chemotherapy in early tumors with uninvolved nodes.MethodsA retrospective analysis of a prospectively maintained database of patients resected of periampullary tumors from 2007 to 2014 was performed. Patients were studied for adverse risk factors, adjuvant therapy received and the survival.ResultsOf 105 patients, 14 patients received adjuvant chemotherapy and 85 were observed. After a median follow‐up of over 36 months, the overall 3‐year survival was 94.2% in the observed group and 100% in the group that received chemotherapy (P = 0.33), with the 3‐year disease‐free survival being 81.9% and 90.9%, respectively, (P = 0.477). Serum CA 19‐9 levels above 100 U/mL were a poor prognostic factor.ConclusionThis study did not find a benefit with the use of adjuvant chemotherapy, but chemotherapy might improve survival. The benefit for adjuvant chemotherapy needs further confirmation in prospective trials.
Prenatal diagnosis of congenital heart diseases by fetal echocardiography in second trimester: a Chinese multicenter study
Authors: Chu Chen , Yan Yingliu , Ren Yunyun , Li Xiaotian , Gui Yonghao 
Published: December 2016

AbstractIntroductionThe objective of our study was to evaluate the performance of detailed fetal echocardiography by skilled obstetric physician sonologists in the diagnosis of congenital heart disease (CHD) in a Chinese population.Material and methodsThis investigation included a multicenter prospective cohort of 10 259 pregnant women attending 10 regional tertiary hospitals in China. The inclusion criteria were singleton pregnancy and gestational age from 18 to ≤28 weeks. Women with multiple pregnancies were excluded. A detailed fetal echocardiography was performed by trained physicians with at least 3 years of experience. The primary outcome measures included sensitivity, specificity, and positive and negative likelihood ratios of detailed fetal echocardiography in prenatal detection of CHD.ResultsThe sensitivity and specificity of fetal echocardiography in detecting any CHD were 33.9 and 99.8%, respectively, in the low‐risk population, and 68.8 and 99.4%, respectively, in the high‐risk population. For detecting major CHDs, fetal echocardiography had a high sensitivity and specificity, and satisfactory positive and negative likelihood ratios in both the low‐risk population (88.2, 100%, 6947.7, and 0.118, respectively) and high‐risk population (100, 99.9%, 833.3, and <0.0001, respectively). The sensitivity and likelihood ratios were substantially lower for detecting minor CHDs in both populations.ConclusionsDetailed fetal echocardiography performed by skilled physicians had high detection rate for major CHD in both low‐risk and high‐risk populations. However, its value for detecting minor CHD was limited. The incorporation of fetal echocardiography with multiple cardiac views into routine ultrasound screening may improve the detection rate of fetal major CHD and facilitate appropriate parental counseling.
“I received a leaflet and that is all”: Father experiences of a diagnosis of autism
Authors: Potter Carol A. 
Published: December 2016

Accessible summary

Little is known about what fathers think and feel about a diagnosis of autism.

Fathers experienced strong emotion around diagnosis and were given little support.

Services should support mother and fathers in ways which meet their individual needs.

More positive messages should be given to families at diagnosis.

AbstractBackground: A diagnosis of childhood autism can be an extremely stressful experience for parents, but little is known concerning paternal perceptions of the process.Methods: This study investigated father perspectives on a diagnosis of autism, through an online survey.Results: An analysis of 184 replies to an open‐ended question identified the following themes: strong initial emotional response and a range of immediate anxieties about the future, struggle to gain a diagnosis; anger in response to insensitive delivery of diagnosis together with insufficient information at the time and lack of support afterwards.Conclusion: Fathers experienced a range of significant challenges during a diagnostic process in which most felt unsupported. Service provision should be more gender‐differentiated, taking into account of the particular needs and perspectives of both mothers and fathers at this critical juncture in family life.
Thyroid abnormalities following the use of cytotoxic T‐lymphocyte antigen‐4 and programmed death receptor protein‐1 inhibitors in the treatment of melanoma
Authors: Morganstein D.L. , Lai Z. , Spain L. , Diem S. , Levine D. , Mace C. , Gore M. , Larkin J. 
Published: December 2016

SummaryContextCheckpoint inhibitors are emerging as important cancer therapies but are associated with a high rate of immune side effects, including endocrinopathy.ObjectiveTo determine the burden of thyroid dysfunction in patients with melanoma treated with immune checkpoint inhibitors and describe the clinical course.Design and patientsConsecutive patients with melanoma treated with either ipilimumab, nivolumab, pembrolizumab or the combination of ipilimumab and nivolumab were identified. Baseline thyroid function tests were used to exclude those with pre‐existing thyroid abnormalities, and thyroid function tests during treatment used to identify those with thyroid dysfunction.ResultsRates of overt thyroid dysfunction were in keeping with the published phase 3 trials. Hypothyroidism occurred in 13·0% treated with a programmed death receptor‐1 (PD‐1) inhibitor and 22·2% with a combination of PD‐1 inhibitor and ipilimumab. Transient subclinical hyperthyroidism was observed in 13·0% treated with a PD‐1 inhibitor, 15·9% following a PD‐1 inhibitor, and 22·2% following combination treatment with investigations suggesting a thyroiditic mechanism rather than Graves’ disease, and a high frequency of subsequent hypothyroidism. Any thyroid abnormality occurred in 23·0% following ipilimumab, 39·1% following a PD‐1 inhibitor and 50% following combination treatment. Abnormal thyroid function was more common in female patients.ConclusionThyroid dysfunction occurs commonly in patients with melanoma treated with immune checkpoint inhibitors, with rates, including subclinical dysfunction, occurring in up to 50%.
Clinical measures of obesity and cumulative cardiometabolic risk in adolescents
Authors: Jayawardene W. P. , Lohrmann D. , Dickinson S. , Talagala S. , Torabi M. 
Published: December 2016

SummaryObesity tracks from childhood to adulthood most strongly of all cardiometabolic risk factors. To determine relationship of body mass index (BMI) and waist circumference (WC) with cardiometabolic risk (dyslipidemia, hyperglycemia and elevated blood pressure) in a large U.S. population ages 12–19 and demographic subgroups. Pooled 1999–2014 National Health and Nutrition Examination Survey data were analyzed (N = 23 438). In addition to standard cutoffs of BMI and WC, risk levels were identified for each laboratory variable: HDL‐cholesterol, LDL‐cholesterol, triglycerides, total cholesterol (category = lipids); fasting glucose, glycated haemoglobin (category = glucose); systolic/diastolic pressures (category =blood pressure). Within each category, being high‐risk on any of the variables was high‐risk; being borderline‐risk on any, without being high‐risk on any, was borderline‐risk. Obesity severity was strongly associated with increased cardiometabolic risk, with prevalence of borderline‐risk greater than high‐risk. Anthropometric indicators in males and Hispanics, versus females and Whites/Blacks, respectively, had stronger associations with cardiometabolic risks. BMI and WC performed well for identifying adolescents with at least one borderline‐risk or high‐risk level measure for lipids, glucose and blood pressure; relationship strength varying by gender and race/ethnicity. Thus, to prevent or better manage clinical diseases of adolescents with elevated BMI and/or WC, all recommended laboratory tests are warranted.
Factors related to inter‐observer reproducibility of conventional Pap smear cytology: a multilevel analysis of smear and laboratory characteristics
Authors: Baena A. , Guevara E. , Almonte M. , Arias‐Stella J. , Sasieni P. , Sanchez G. I. 
Published: December 2016

ObjectiveTo identify factors that influence the inter‐observer reproducibility of the routine, conventional Pap smear cytology (Pap smear test) in a network of certificated laboratories in a middle‐income Latin American country.MethodsTwenty‐six laboratories provided each an average of 26 negative for malignancy (NILM) and high‐grade squamous intraepithelial lesion (HSIL) Pap smears. An external panel reviewed the slides. The kappa index and multilevel logistic regression were used to estimate the reproducibility and odds ratios (OR) of a false result with 95% confidence intervals (95% CI), respectively. Results are presented for laboratories that collect (collector laboratories) and do not collect (non‐collector laboratories) samples.ResultsThe agreements ranged widely (median kappa 0.51, range 0.16–0.70). The overall false‐positive (FP) and false‐negative (FN) rates were 31% (95% CI 27–35) and 11% (95% CI 7–17). Among collector laboratories (N = 14), a bigger sample collection volume decreased the probability of a FP (OR‐adjusted 0.05, 95% CI 0.02–0.1) whereas the number of quality defects (OR‐adjusted 1.67, 95% CI 1.25–2.24), high workload (OR‐adjusted 5.52, 95% CI 3.85–7.92) and collection by cytotechnologists (OR‐adjusted 1.28, 95% CI 1.15–1.42) or health professionals (OR‐adjusted 2.26, 95% CI 2.04–2.49) instead of nursing assistants increased it. Among non‐collector laboratories (N = 9), the FP rate increased with the number of quality defects (OR‐adjusted 1.86, 95% CI 1.06–3.26) but decreased if the samples were collected by health professionals instead of nursing assistants (OR‐adjusted 0.37, 95%CI 0.17–0.80). No significant associations were observed for FN.ConclusionsStaff in charge of cervical sampling significantly determined the reproducibility of the Pap smear test, but this depended on whether the laboratory collects samples or read samples collected elsewhere.
New horizons in the understanding of the causes and management of diabetic foot disease: report from the 2017 Diabetes UK Annual Professional Conference Symposium
Authors: Clokie M. , Greenway A. L. , Harding K. , Jones N. J. , Vedhara K. , Game F. , Dhatariya K. K. 
Published: December 2016

AbstractDiabetes‐related foot disease remains a common problem. For wounds, classic teaching recommends the treatment of any infection, offloading the wound and ensuring a good blood supply, as well as ensuring that the other modifiable risk factors are addressed and optimized. There remain, however, several questions about these and other aspects of the care of diabetes‐related foot disease. Some of these questions are addressed in the present report; in particular, the impact of newer technologies in the identification of any organisms present in a wound, as well as the use of novel approaches to treat infections. The use of new remote sensing technology to identify people at risk of developing foot ulceration is also considered, in an attempt to allow early intervention and prevention of foot ulcers. The psychological impact of foot disease is often overlooked, but with an increasing number of publications on the subject, the cause‐and‐effect role that psychology plays in foot disease, such as ulcers and Charcot neuroarthropathy, is considered. Finally, because of heterogeneity in diabetic foot studies, comparing results is difficult. A recently published document focusing on ensuring a standardized way of reporting foot disease trials is discussed.
Historical foundations and future directions in macrosystems ecology
Authors: Rose Kevin C. , Graves Rose A. , Hansen Winslow D. , Harvey Brian J. , Qiu Jiangxiao , Wood Stephen A. , Ziter Carly , Turner Monica G. 
Published: December 2016

AbstractMacrosystems ecology is an effort to understand ecological processes and interactions at the broadest spatial scales and has potential to help solve globally important social and ecological challenges. It is important to understand the intellectual legacies underpinning macrosystems ecology: How the subdiscipline fits within, builds upon, differs from and extends previous theories. We trace the rise of macrosystems ecology with respect to preceding theories and present a new hypothesis that integrates the multiple components of macrosystems theory. The spatio‐temporal anthropogenic rescaling (STAR) hypothesis suggests that human activities are altering the scales of ecological processes, resulting in interactions at novel space–time scale combinations that are diverse and predictable. We articulate four predictions about how human actions are “expanding”, “shrinking”, “speeding up” and “slowing down” ecological processes and interactions, and thereby generating new scaling relationships for ecological patterns and processes. We provide examples of these rescaling processes and describe ecological consequences across terrestrial, freshwater and marine ecosystems. Rescaling depends in part on characteristics including connectivity, stability and heterogeneity. Our STAR hypothesis challenges traditional assumptions about how the spatial and temporal scales of processes and interactions operate in different types of ecosystems and provides a lens through which to understand macrosystem‐scale environmental change.
Limited effect of the massive tsunami caused by the 2011 Great East Japan Earthquake on the shallow sandy shore demersal fish assemblages in Sendai Bay
Authors: Okazaki Yuji , Kurita Yutaka , Uehara Shinji 
Published: December 2016

AbstractWe examined the effects of the 11 March 2011 tsunami event on demersal fish assemblages in the shallow (3–17 m) waters of Sendai Bay, Japan. Fish samples were obtained during the 7 yr before the tsunami, the year of the tsunami (2011), and in two subsequent years (2012–2013) using an identical sampling procedure. During the 10 yr, 5757 fish from 70 taxa were sampled during 301 tows. Although the tsunami reached 6 m in height in Sendai Bay, fish abundance, diversity, and species composition in samples immediately after the tsunami (2011) and in 2012–2013 were generally within the range of variability observed over the previous 7 yr (2004–2010). Moreover, the percent occurrence of species varied during the sampling period, but the composition of the dominant species after the tsunami was similar to that before the tsunami. Only the small dragonet species Eleutherochir mirabilis decreased in abundance in 2011 among the dominant taxa, although their abundance recovered in 2012 and 2013. Furthermore, Japanese flounder, Paralichthys olivaceus, increased in abundance after 2011. The reasons for these minimal effects on the shallow water demersal fish community are unclear. We can only speculate that the limited changes to habitat and the mobility of fish may have enabled the high survival rate of the shallow water fish assemblages in Sendai Bay during and after the tsunami. Thus, we conclude that the fish assemblages of the shallow sandy shore were highly resistant and resilient to unusual and extreme perturbations.
Transcranial Magnetic Stimulation: Basic Principles and Clinical Applications in Migraine
Authors: Barker Anthony T. , Shields Kevin 
Published: December 2016

PurposeTranscranial magnetic stimulation (TMS) is a neurophysiological technique with a long established pedigree of safety, tolerability, and efficacy. Initially TMS was used to study the function of the cerebral cortex, but it has now become a treatment for migraine, one of the most common and debilitating neurological conditions. In this review we discuss the scientific background and development of the technique. We explore its application for the treatment of migraine and ponder the possible mechanisms of action in this most common neurological condition.Overview: The generation of brief magnetic pulses by a suitable coil can induce electrical fields in the body. When applied to the cerebral cortex, currents are painlessly induced in cortical neurons. These currents can lead to neuronal depolarization and may influence cortical excitability by means that are as yet not fully understood. This ability to modulate cortical excitability has been exploited as a treatment for migraine with aura. Aura is implicated in the pathophysiology of migraine. Experimental studies have shown that transcranial magnetic pulses can block waves of cortical spreading depression – the experimental equivalent of migrainous aura.DiscussionMigraine is a debilitating condition characterized by headache, nausea, and sensory hypersensitivity. It may affect up to 15% of the population, yet current drug treatments are often poorly tolerated. Clinical studies have shown that TMS is an effective treatment for migraine. In addition, it has the added advantages of being safe and well tolerated by patients.
A Systematic Review and Meta‐Analysis of the Efficacy of Cognitive Behavioral Therapy for the Management of Pediatric Migraine
Authors: Ng Qin Xiang , Venkatanarayanan Nandini , Kumar Lakshmi 
Published: December 2016

IntroductionMigraine headaches are common in children and adolescents. Current pharmacologic treatment options are limited despite the prevalence and debilitating effects of pediatric migraine. Cognitive behavioral therapy (CBT) is an evidence‐based practice that focuses on the development of coping strategies and cognitive restructuring to alter the pain experience. Till date, no meta‐analysis has been done to examine the use of CBT in pediatric migraine.MethodsUsing the keywords (cognitive behavioral therapy OR cognitive behavior therapy OR cognitive behavioral therapy OR cognitive behavior therapy OR CBT) AND (headache OR migraine), a preliminary search on the PubMed and Ovid database yielded 3841 articles published in English between 1 Jan 1980 and 1 May 2016. Full articles were also reviewed for references of interest. After data extraction, 14 studies were included in the meta‐analysis.ResultsThe results of the meta‐analysis well‐support the clinical role of CBT in the management of pediatric migraine. The pooled odds ratios of clinically significant improvement, that is, 50% or greater headache activity reduction post‐treatment and at follow‐up (3 months or later) were OR 9.11 (95% CI: 5.01 to 16.58, P < .001) and OR 9.18 (95% CI: 5.69 to 14.81, P < .001) respectively, demonstrating significant clinical improvement with CBT as compared with wait‐list control, placebo, or standard medication. Furthermore, the clinical improvement was stable, even at a 1‐year follow‐up as evident in some of the studies.ConclusionThere is good evidence that CBT is beneficial to children suffering from migraine, and may also augment the efficacy of standard medications such as amitriptyline.
The influence of Helicobacter pylori on the ethnic distribution of esophageal eosinophilia
Authors: Sonnenberg Amnon , Dellon Evan S. , Turner Kevin O. , Genta Robert M. 
Published: December 2016

AbstractBackgroundEnvironmental factors associated with ethnicity may contribute to the occurrence of eosinophilic esophagitis. Our study aimed to investigate the influence of Helicobacter pylori on the ethnic variation of esophageal eosinophilia in a large national sample of patients undergoing esophago‐gastro‐duodenoscopy.MethodsThe Miraca Life Sciences Database is an electronic repository of histopathologic patient records. A case‐control study evaluated the influence of ethnicity on the occurrence of esophageal eosinophilia and how age, gender, and histologic diagnosis of H. pylori modify this relationship.ResultsThe total study population comprised 596 479 subjects, of whom 25 969 harbored a diagnosis of esophageal eosinophilia. Young age, male sex, and H. pylori infection in declining order exerted the strongest influence on the occurrence of esophageal eosinophilia. In comparison with the population comprising of Caucasians and African‐Americans, esophageal eosinophilia was less common among patients of African (OR=0.10, 95% CI=0.01‐0.46), Middle Eastern (0.22, 0.15‐0.31), East Asian (0.32, 0.26‐0.38), Indian (0.28, 0.21‐0.37), Hispanic (0.40, 0.37‐0.43), or Jewish descent (0.58, 0.51‐0.66), but more common among patients of Northern European descent (1.25, 1.07‐1.45). With the exception of Northern Europeans, all ethnic subgroups were characterized by a higher prevalence of H. pylori than the comparison group. A low prevalence of H. pylori was significantly associated with a high prevalence of esophageal eosinophilia (R2=0.90, P<.001).ConclusionEsophageal eosinophilia prevalence markedly varies by patient ethnicity. As there is a strong inverse correlation between H. pylori and esophageal eosinophilia, H. pylori infection may be in part responsible for the observed ethnic distribution of esophageal eosinophilia.
Immunoprofile of metaplastic carcinomas of the breast
Authors: Rakha Emad A , Coimbra Nuno D M , Hodi Zsolt , Juneinah Enaam , Ellis Ian O , Lee Andrew H S 
Published: December 2016

AimsMetaplastic breast carcinoma (MBC) is a rare type of breast cancer; its diagnosis in routine practice can be challenging, and may require immunohistochemical (IHC) characterization if no conventional invasive or in‐situ carcinoma is present. Previous IHC studies of MBC often had a small sample size and did not investigate the different histological subtypes. This study aimed to assess the immunoprofile of MBC subtypes in a large series.Methods and resultsA total of 172 MBC diagnosed in routine and referral practice in Nottingham during 26 years were reviewed by three breast pathologists. In addition, data on the immunoprofile of 730 MBC in 61 published studies were analysed. The antibodies to a broad spectrum of cytokeratins (AE1/AE3 and MNF116) are most frequently positive in MBC (approximately 80%). Basal cytokeratins (34βE12, CK5/6, CK14 and CK17) are positive in approximately 70%. Luminal cytokeratins (CK8/18, CK7 and CK19) are positive in approximately 30–60%. Myoepithelial markers are also frequently positive, particularly p63. Oestrogen receptor (ER), progestogen receptor (PR) and HER2 are usually all negative. CD34 (a marker often positive in phyllodes tumours) is consistently negative in MBC.ConclusionThis study provides data on the frequency of expression of a wide range of markers in MBC based on a large number of tumours. No consistent immunophenotype was identified and no individual marker was positive in all tumours, most probably reflecting the morphological and molecular heterogeneity of this tumour class and the practical need to use a panel of different antibodies when trying to establish the diagnosis of metaplastic breast carcinoma.