bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of 2 years of endurance and high-impact training on preventing osteoporosis in postmenopausal women: randomized clinical trial
Authors: García-Gomáriz Carmen , Blasco José M. , Macián-Romero Cecili , Guillem-Hernández Elías , Igual-Camacho Celedonia 
Published: October 2017

Abstract

Objective:
The aim of the study was to analyze the effects of endurance and high-impact training oriented toward preventing osteoporosis in postmenopausal women with calcium and vitamin D supplementation.

Methods:
This study was a randomized clinical trial. Thirty-six postmenopausal women were randomized to the control and experimental groups. Thirty-four women completed the 2-year interventions. The control group training involved walking at an intense pace. The experimental group conducted high-impact training specifically oriented to prevent osteoporosis. Dual-energy x-ray absorptiometry was used to estimate the T-scores of the lumbar spine and femoral neck.

Results:
The fast-walking group showed constant T-scores in the femoral neck and improved T-scores in the lumbar spine. High-impact exercises produced improvements in both anatomical levels. Significant differences were found in the femoral neck (ΔControl = −0.04, ΔExperimental = 0.28). The differences were not significant in the lumbar spine (ΔControl = 0.27, ΔExperimental = 0.47). Cohen's effect size (d = 0.52) suggested a medium practical significance of the trial. The power was 51%.

Conclusions:
Calcium plus vitamin D supplementation combined with specifically oriented exercises had a higher impact in the femoral neck than walking at an intense pace. As there were no differences at the lumbar spine level, the results were, however, inconclusive concerning which type of exercise was the most convenient. Importantly, the fact that the T-scores did not decrease after 2 years supports the belief that both proposed interventions can be conveniently used to prevent osteoporosis in postmenopausal women. A trial with a larger sample size would provide consistency to the findings and is warranted given the possible effects and benefits.
Depressive symptoms screening in postmenopausal women with symptomatic pelvic organ prolapse
Authors: Ai Fangfang , Deng Mou , Mao Meng , Xu Tao , Zhu Lan 
Published: October 2017

Abstract

Objective:
This study aimed to investigate the prevalence of depressive symptoms in postmenopausal women with symptomatic pelvic organ prolapse (POP) and to identify the factors associated with depressive symptoms in this population.

Methods:
We conducted a cross-sectional study involving postmenopausal women with symptomatic POP who visited the Center of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, between July 2016 and March 2017. We collected data pertaining to participants’ sociodemographic characteristics and medical histories. The participants enrolled in the study were evaluated by POP quantification (POP-Q), the Pelvic Floor Distress Inventory-20 (PFDI-20), and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), and the severity of their depressive symptoms was assessed by the Patient Health Questionnaire-9 (participants with scores ≥10 were considered “positive” for depressive symptoms, whereas participants with scores <10 were considered “negative” for depressive symptoms). We performed independent-sample t tests, Mann-Whitney U test, chi-square tests, Fisher's exact test, and logistic regression to analyze our data.

Results:
In all, 177 participants completed the entire study and were thus included in the analysis. Overall, 32.8% of participants were found to have depressive symptoms. We noted no differences in sociodemographic characteristics or POP-Q stage between participants with and without depressive symptoms (P > 0.05). However, depressive symptoms were associated with higher PFIQ-7 and PFDI-20 subscale scores (P < 0.001). PFIQ-7 subscale Urinary Impact Questionnaire (UIQ)-7 (odds ratio [OR] 1.038, 95% confidence interval [CI] 1.010-1.066, P = 0.008), PFDI-20 subscale UDI-6 (OR 1.025, 95% CI 1.007-1.044, P = 0.008), and Colorectal-Anal Distress Inventory-8 (OR 1.025, 95% CI 1.005-1.046, P = 0.016), which represented the impact on quality of life from lower urinary tract symptoms, the distress caused by lower urinary tract symptom and bowel dysfunction, respectively, were the risk factors that were independently associated with depressive symptoms after multiple logistic regression analysis.

Conclusions:
Depressive symptoms were present in approximately one-third of postmenopausal women with symptomatic POP. Depressive symptoms are not associated with POP stage, but are associated with the lower urinary tract symptom and bowel dysfunction scores attributable to prolapse. Clinicians should be mindful of whether patients with symptomatic POP have depressive symptoms and should address POP and any concomitant depressive symptoms as early as possible.
FUNDUS-WIDE SUBRETINAL AND PIGMENT EPITHELIAL ABNORMALITIES IN MACULAR TELANGIECTASIA TYPE 2
Authors: Powner Michael B. , Woods Sasha M. , Zhu Meidong , Gillies Mark C. , Bernstein Paul S. , Hageman Gregory S. , Comer Grant M. , Egan Catherine , Fruttiger Marcus 
Published: October 2017

Purpose:
Macular telangiectasia Type 2 (MacTel) causes glial and photoreceptor cell death in a small, oval patch in the central retina. Beyond this oval area, no disease manifestations have been described so far. Here, we describe a novel pathological aspect of MacTel in the retinal pigment epithelium (RPE) that is not restricted to the clinically affected area but covers the entire retina.

Methods:
We have studied postmortem eyes from four patients with MacTel by immunohistochemistry and electron microscopy.

Results:
We found cellular debris in the subretinal space (between photoreceptor outer segments and RPE), consisting mainly of outer segments and RPE components. In healthy eyes, the RPE normally phagocytoses the tips of the continuously growing outer segments, a process considered to be essential for photoreceptor survival. However, in the patients with MacTel, we found no evidence of ongoing outer segment phagocytosis, and the apical surface of the RPE appeared abnormal throughout most of the retina.

Conclusion:
Reduced outer segment phagocytosis may explain the accumulating debris in the subretinal space but is a surprising finding because visual function in the peripheral retina is normal in patients with MacTel. Nevertheless, the subclinical pathology might induce a specific stress to which the central area is uniquely susceptible.
CHOROIDEREMIA ASSOCIATED WITH A NOVEL SYNONYMOUS MUTATION IN GENE ENCODING REP-1
Authors: Sengillo Jesse D. , Lee Winston , Bakhoum Mathieu F. , Cho Galaxy Y. , Chiang John (P-W) , Tsang Stephen H. 
Published: October 2017

Purpose:
To report a novel synonymous mutation in CHM and the associated phenotype in an affected man and carrier mother.

Methods:
Case report.

Results:
A 34-year-old man with a long history of progressive night blindness and visual field constriction was diagnosed with choroideremia based on ocular examination and multimodal retinal imaging. Extensive chorioretinal degeneration was noted on spectral domain optical coherence tomography and fundus autofluorescence imaging. Candidate CHM gene sequencing revealed a hemizygous c.1359C>T, p.(S453S) variant. This variant was heterozygous in the mother of the proband who exhibited the classic carrier phenotype of choroideremia on fundus autofluorescence imaging.

Conclusion:
A novel c.1359C>T, p.(S453S) variant in CHM is the first-identified synonymous mutation associated with disease manifestation in an affected man and carrier phenotype in a heterozygous mother.
Influence of Socioeconomic Deprivation on Visual Acuity in Patients Undergoing Corneal Transplantation
Authors: Robbie Scott J. , Jones Mark N. A. , Larkin Daniel F. P. ,   on behalf of the NHS Blood and Transplant Ocular Tissue Advisory Group and Contributing Ophthalmologists (OTAG Audit Study 22)
Published: October 2017

Purpose:
To determine whether there is an association between socioeconomic status and best-corrected visual acuity (BCVA) in patients undergoing corneal transplantation in the United Kingdom.

Methods:
Retrospective cohort study of 4306 patients registered on the national United Kingdom Transplant Registry and undergoing penetrating keratoplasty, anterior lamellar keratoplasty, or endothelial keratoplasty in 2002, 2008, and 2013. Socioeconomic status was determined by applying a validated deprivation index to generate a score based on 5 categories. Patients' demographic details, preoperative BCVA, copathology, surgical center volume, and socioeconomic status were analyzed for univariate effects of categorical and continuous variables. Binary logistic regression was used to determine whether preoperative BCVA was affected by socioeconomic status after adjusting for other factors.

Results:
A larger percentage of the most deprived group was female in each period compared with the least deprived, but this was only significant in 2002 (48.7% vs. 40.3%; P = 0.04). There was no interaction between socioeconomic status and the preoperative BCVA in the grafted eye. However, BCVA in the fellow eye was poorer for the most economically deprived patients compared with the least deprived in 2013 (P = 0.01).

Conclusions:
We found no evidence of a relationship between socioeconomic deprivation and BCVA in the transplant recipient eye. However, there was clear evidence of an association between socioeconomic deprivation and reduced acuity in fellow eyes, for which barriers to access or low patient demand may be possible contributors.
Treatment and Resolution of Filamentary Keratitis in a Patient with Stiff Person Syndrome
Authors: Bae Steven S. , Yeung Sonia N. , Chan Clara C. 
Published: October 2017

Purpose:
To report a rare case of filamentary keratitis associated with stiff person syndrome.

Methods:
Case report.

Results:
A 26-year-old woman with several autoimmune conditions was referred because of filamentary keratitis. Conservative management using lubrication, mucolytics, and bandage contact lenses failed to adequately relieve symptoms. Despite the addition of oral prednisone, cyclosporine, and azathioprine, the patient's condition persisted with numerous filaments and severe dry eye. One month later, the patient had an episode of sudden muscle cramps in her back, for which she was hospitalized. Investigations revealed a diagnosis of stiff person syndrome, positive for glutamic acid decarboxylase autoantibodies. Plasmapheresis and high-dose intravenous steroids were provided as initial therapy. On follow-up, her filamentary keratitis resolved and at the last visit, her ocular symptoms had completely resolved.

Conclusions:
Filamentary keratitis is a chronic, recurrent condition that can be challenging to treat. Effective management requires careful consideration of possible predisposing causes, especially in refractory cases.
Carcinoid Syndrome Complicating a Pancreatic Neuroendocrine Tumor
Authors: Gerson James N. , Witteles Ronald M. , Chang Daniel T. , Beygui Ramin E. , Iagaru Andrei H. , Kunz Pamela L. 
Published: October 2017

Abstract
Neuroendocrine tumors (NETs) comprise a heterogeneous group of neoplasms. These tumors can produce a wide variety of hormones that can lead to syndromes of hormone excess, such as carcinoid syndrome. We present the case of a 47-year-old man who presented with right upper quadrant abdominal pain and emesis. He was found to have metastatic pancreatic NET and was treated with systemic chemotherapy. He subsequently developed dyspnea on exertion and was found to have severe right-sided heart disease secondary to elevated levels of serum serotonin. He was successfully treated with surgical tricuspid and pulmonic valve replacement. True carcinoid syndrome with pancreatic NETs is rare, but, as a treatable complication of the disease, is an important entity for which oncologists should be familiar.
Fatty Pancreas
Authors: Majumder Shounak , Philip Nissy A. , Takahashi Naoki , Levy Michael J. , Singh Vijay P. , Chari Suresh T. 
Published: October 2017

AbstractThe metabolic consequences of visceral fat deposition are well known, and the presence of intrapancreatic fat (IPF) has been recognized for decades. However, our knowledge about the distribution of fat in the pancreas and its clinical implications is in a nascent stage. Various terms have been proposed to describe IPF; for the purpose of this narrative review, we chose the general termfatty pancreas. Herein, we describe the radiologic, endoscopic, and histopathologic aspects of diagnosing fatty pancreas and provide an overview of the diseases associated with this condition. Our purpose is to highlight diagnostic challenges and identify specific clinical questions that would benefit from further study. As evident in this review, IPF is associated with various metabolic diseases, pancreatitis, pancreatic cancer, and precancer—yet establishing causality needs careful, further study.
Autoimmune Hepatitis and Autoimmune Hepatitis Overlap With Sclerosing Cholangitis
Authors: Ferri Priscila M. , Simões e Silva Ana C. , Torres Karen C.L. , Silva Soraya L.C. , Aquino Diego J.Q. , Ferreira Maria L.M. , Fagundes Eleonora D.T. , Miranda Débora M. , Ferreira Alexandre R. 
Published: October 2017

ABSTRACTObjective:The pathophysiology of autoimmune hepatitis (AIH) may involve the activation of immune cells and changes in the expression of cellular markers. The aim of the present study was to characterize the immunophenotype markers of lymphocytes and monocytes in the peripheral blood of children and adolescents with type 1 AIH and AIH overlap with sclerosing cholangitis (overlap syndrome [OS]).Methods:This is a cross‐sectional study of 20 children and adolescents diagnosed with type 1 AIH and 19 with OS. Fifteen healthy subjects were included as controls. Flow cytometric analysis was used to identify markers of inflammation and autoimmunity.Results:The total number of CD4+ T cells was higher in the AIH patients compared with the controls. The number of CD4+ T cells expressing CCR3 and CD28 was higher in the AIH group than in the control group. CD45RO was more highly expressed in the AIH group, whereas CD45RA was more highly expressed in the OS group. In regard to CD8+ T lymphocytes, the CCR3 expression was higher in both groups of patients. Patients with OS had the highest expression of CD45RA and CD25. In monocytes, human leukocyte antigen DR (HLA‐DR) was less expressed in both groups of patients.Conclusions:Complex phenotype features may be involved in the pathophysiology of AIH, accounting for changes in immune system regulation mechanisms. In conclusion, even after good response to treatment, patients still have immune activity signals at the cellular level.
Epidemiology and Predictors of Orbital Fractures in Children
Authors: Miller Andrew F. , Elman Daniel M. , Aronson Paul L. , Kimia Amir A. , Neuman Mark I. 
Published: October 2017

Objectives
Data regarding clinical predictors of orbital fractures in children are limited. We sought to describe the epidemiology of pediatric orbital fractures and identify the signs and symptoms of orbital fractures in children.

Methods
We performed a retrospective cohort study of children younger than 22 years who underwent a facial or orbital computed tomography (CT) scan to evaluate for orbital fracture. We included patients presenting to an emergency department of a tertiary care children's hospital between January 2009 and May 2013. The presence of an orbital fracture was assessed using the final interpretation of the CT by an attending radiologist in the electronic medical record.

Results
Among 326 children who underwent facial or orbital CT during the study period, 133 (41%) had an orbital fracture. The presence of nausea or vomiting, orbital tenderness, swelling, or ecchymosis and limitation of extraocular movement were each associated with the presence of an orbital fracture (P < 0.05 for each). Twenty-two children (6.7% of cohort and 16.5% of children with orbital fractures) underwent surgical repair for an orbital fracture. In the absence of orbital tenderness, swelling, or ecchymosis, there was 1 child with an orbital fracture who underwent operative intervention.

Conclusions
Fewer than half of children undergoing CT have an orbital fracture identified, and fewer than 7% have a fracture that requires operative intervention. In the absence of orbital tenderness, swelling, or ecchymosis, only 1 child had an orbital fracture requiring surgical repair.
Toxic Shock Syndrome
Authors: Gossack-Keenan Kira L. , Kam April J. 
Published: October 2017

Background
Toxic shock syndrome (TSS) is an acute, severe, toxin-mediated disease, characterized by fever, hypotension, and multiorgan system involvement. Toxic shock syndrome has made headlines because of its high associated morbidity and mortality rate in previously healthy young females. Incidence peaked in the early 1980s owing to increased usage of ultra-absorbent tampons. After improved patient education and tampon labeling, the incidence of menstrual TSS has declined.

Case
A previously healthy 14-year-old girl presented to an urgent care center with a 2-day history of fever, erythematous maculopapular rash, vomiting, diarrhea, and malaise. She was found to be tachycardic and hypotensive. Investigations revealed thrombocytopenia, an elevated white count and lactate, and acute kidney injury, consistent with septic shock. Recent tampon usage with menstruation was reported, and a pelvic examination revealed purulent vaginal discharge. The patient was transferred to a pediatric intensive care unit for antibiotic and vasopressor therapy. Vaginal swabs later tested positive for Staphylococcus aureus and TSS toxin-1.

Conclusions
Although the incidence of TSS has decreased in recent years, it is crucial that clinicians rapidly recognize and treat this life-threatening condition. Emergency physicians should always have a high index of suspicion for TSS in young females presenting without another obvious cause of shock. A pelvic examination should always be completed in these cases.
Brief Report: CD52 Expression on CD4+ T Cells in HIV-Positive Individuals on cART
Authors: Vojdeman Fie Juhl , Gaardbo Julie Christine , Hartling Hans Jakob , Gelpi Marco , Hove-Skovsgaard Malene , Pedersen Anders Elm , Nielsen Susanne Dam 
Published: October 2017

Background:
HIV persists in a latent state in quiescent CD4+ T cells preventing eradication of HIV. CD52 is a surface molecule modulated by HIV. We aimed at examining factors related to CD52 expression on CD4+ T cells in HIV-positive individuals and the impact of initiation of combination antiretroviral therapy (cART).

Methods:
Peripheral blood mononuclear cells from 18 HIV-positive individuals and 10 uninfected age- and sex-matched controls were examined by flow cytometry for CD38 and CD52 expression on CD4+ T cells. Stimulation assays were performed on 8 healthy blood donors to determine a cutoff for CD52 expression.

Results:
All examined CD4+ T cells expressed CD52. However, both CD4+ T cells with higher (CD52++) and with lower CD52 expression (CD52dim) were found in HIV-positive individuals compared to uninfected controls. Two % CD52dim cells defined groups of high and low CD52: the group of individuals with high CD52 had higher CD4 counts at baseline (447 vs. 54 cells/µL, P = 0.02) and higher increase in CD4 counts during follow-up compared with low CD52 (P = 0.02). After 12 months of cART, CD52 increased (median fluorescence intensity 4846 vs. 5621, P < 0.05), whereas CD38 decreased (median fluorescence intensity 1519 vs. 730, P < 0.0001).

Conclusions:
All HIV-positive individuals in this cohort had CD4+ T cells that expressed CD52. Higher CD4 counts were found in those with high CD52. Furthermore, an increase in CD52 was found after 12 months of cART, indicating that anti-CD52 antibodies may be more efficient for depletion of CD4+ T cells in HIV-positive individuals on cART.
Brief Report: AIDS-Defining Events and Deaths in HIV-Infected Children and Adolescents on Antiretrovirals: A 14-Year Study in Thailand
Authors: Traisathit Patrinee , Delory Tristan , Ngo-Giang-Huong Nicole , Somsamai Rosalin , Techakunakorn Pornchai , Theansavettrakul Sookchai , Kanjanavanit Suparat , Mekmullica Jutarat , Ngampiyaskul Chaiwat , Na-Rajsima Sathaporn , Lallemant Marc , Cressey Tim R. , Jourdain Gonzague , Collins Intira Jeannie , Le Coeur Sophie 
Published: October 2017

Background:
Data are scarce on the long-term clinical outcomes of perinatally HIV-infected children and adolescents receiving antiretroviral therapy (ART) in low/middle-income countries. We assessed the incidence of mortality before (early) and after (late) 6 months of ART and of the composite outcome of new/recurrent AIDS-defining event or death >6 months after ART start (late AIDS/death) and their associated factors.

Methods:
Study population was perinatally HIV-infected children (≤18 years) initiating ART within the Program for HIV Prevention and Treatment observational cohort (NCT00433030). Factors associated with late AIDS/death were assessed using competing risk regression models accounting for lost to-follow-up and included baseline and time-updated variables.

Results:
Among 619 children, “early” mortality incidence was 99 deaths per 1000 person-years of follow-up [95% confidence interval (CI): 69 to 142] and “late” mortality 6 per 1000 person-years of follow-up (95% CI: 4 to 9). Of the 553 children alive >6 months after ART initiation, median age at ART initiation was 6.4 years, CD4% 8.2%, and HIV-RNA load 5.1 log10 copies/mL. Thirty-eight (7%) children developed late AIDS/death after median time of 3.3 years: 24 died and 24 experienced new/recurrent AIDS-defining events (10 subsequently died). Factors independently associated with late AIDS/death were current age ≥13 years (adjusted subdistribution hazard ratio 4.9; 95% CI: 2.4 to 10.1), HIV-RNA load always ≥400 copies/mL (12.3; 95% CI: 4.0 to 37.6), BMI-z-score always <−2 SD (13.7; 95% CI: 3.4 to 55.7), and hemoglobin <8 g/dL at least once (4.6; 95% CI: 2.0 to 10.5).

Conclusions:
After the initial 6 months of ART, being an adolescent, persistent viremia, poor nutritional status, and severe anemia were associated with poor clinical outcomes. This supports the need for novel interventions that target children, particularly adolescents with poor growth and uncontrolled viremia.