bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term single-institute experience with trimodal bladder-preserving therapy with proton beam therapy for muscle-invasive bladder cancer
Authors: Takaoka Ei-ichiro , Miyazaki Jun , Ishikawa Hitoshi , Kawai Koji , Kimura Tomokazu , Ishitsuka Ryutaro , Kojima Takahiro , Kanuma Reiko , Takizawa Daichi , Okumura Toshiyuki , Sakurai Hideyuki , Nishiyama Hiroyuki 
Published: October 2016

Objective
We retrospectively elucidated the oncological outcomes, prognostic factors and toxicities of proton beam therapy in trimodal bladder-preserving therapy for muscle-invasive bladder cancer at our institution.

Methods
From 1990 to 2015, 70 patients with cT2–3N0M0 muscle-invasive bladder cancer underwent trimodal bladder-preserving therapy consisting of maximal transurethral resection of the bladder tumor, small pelvis photon irradiation, intra-arterial chemotherapy and proton beam therapy. The overall survival rate, progression-free survival rate, time to progression, predictive factors for progression and toxicities were analyzed. Progression was defined as when muscle-invasive recurrence, distant metastasis or upper urinary tract recurrence was observed.

Results
The patients’ median age was 65 (range 36–85) years. The median follow-up period was 3.4 (range 0.6–19.5) years. The 5-year cumulative overall survival rate, progression-free survival rate and time to progression rate were 82%, 77%, and 82%, respectively. In univariate and multivariate analyses, tumor multiplicity and tumor size (≥5 cm) were significant and independent factors associated with progression (hazard ratio 3.5, 95% confidence interval 1.1–12; hazard ratio 5.0, 95% confidence interval 1.3–17; P < 0.05 for all). As for toxicity, 26 (18%) patients had grade 3–4 acute hematologic toxicities and 2 (3%) patients had grade 3 late genitourinary toxicity. No patient had to discontinue the treatment due to acute toxicity.

Conclusions
Our bladder-preserving therapy with proton beam therapy was well tolerated and achieved a favorable mortality rate. Tumor multiplicity and tumor size were important risk factors for progression. Our findings indicate that this therapy can be an effective treatment option for selected muscle-invasive bladder cancer patients.
Ongoing Clinical Trials of Human Immunodeficiency Virus Latency-Reversing and Immunomodulatory Agents
Authors: Delagrèverie Héloïse M. , Delaugerre Constance , Lewin Sharon R. , Deeks Steven G. , Li Jonathan Z. 
Published: October 2016

AbstractIn chronic human immunodeficiency virus (HIV)-1 infection, long-lived latently infected cells are the major barrier to virus eradication and functional cure. Several therapeutic strategies to perturb, eliminate, and/or control this reservoir are now being pursued in the clinic. These strategies include latency reversal agents (LRAs) designed to reactivate HIV-1 ribonucleic acid transcription and virus production and a variety of immune-modifying drugs designed to reverse latency, block homeostatic proliferation, and replenish the viral reservoir, eliminate virus-producing cells, and/or control HIV replication after cessation of antiretroviral therapy. This review provides a summary of ongoing clinical trials of HIV LRAs and immunomodulatory molecules, and it highlights challenges in the comparison and interpretation of the expected trial results.
Allergen immunotherapy for the polyallergic patient
Authors: Wahn Ulrich 
Published: October 2016

Purpose of review
Currently, dramatic changes in allergy treatment can be observed in many countries: The availability of monocomponent products with pharmaceutical quality for sublingual immunotherapy is likely to have a strong impact on all immunotherapy practices and the specialty in general. The market for patient-named products with allergenic mixtures can be expected to shrink. Allergists are concerned about the possibility that single-source products for immunotherapy might be insufficient to serve the needs of all ‘polyallergic’ patients.

Recent findings
The availability of molecular IgE-testing as a novel diagnostic tool will clarify that much of the previously perceived ‘polyallergy’ has to be interpreted as ‘pseudo-polyallergy.’ It can be predicted that the needs of the vast majority of polysensitizations will be met by the novel allergen components, which are marketing for subcutaneous immunotherapy and sublingual immunotherapy.
In countries where compounding of ‘patient-tailored allergen extracts’ has been traditionally practiced, diagnostic and therapeutic procedures are currently being challenged. A recent survey (Allermix) in Europe suggests that allergists believe that the vast majority of polyallergic patients can be adequately treated with registered products without compounding. Compounding by allergists or allergen manufacturers will still be necessary for a limited number of patients with several independent allergies.

Summary
It appears that a limited portfolio aligned to health authority recommendations will be sufficient to answer treatment habits of allergists even in polysensitized patients.
Management of Mucosal Basal Cell Carcinoma of the Lip: An Update and Comprehensive Review of the Literature
Authors: Loh Tiffany , Rubin Ashley G. , Brian Jiang Shang I 
Published: October 2016

BACKGROUND
Basal cell carcinoma (BCC) is the most common malignancy in the United States. Most BCCs occur on cutaneous surfaces, but rare cases on the mucosal lip have also been documented. Because only a small number of mucosal BCC (mBCC) cases have been reported, data on their clinical characteristics and management are limited.

OBJECTIVE
To perform an updated literature review of the management of mBCCs on the lip.

METHODS
A comprehensive literature review was conducted through a search of the PubMed database with the key phrases “mucosal basal cell carcinoma,” “basal cell carcinoma mucosa,” and “basal cell carcinoma lip mucosa.”

RESULTS
Forty-eight cases of mBCCs have been reported, and 35 had sufficient data for analysis. The average age at presentation was 66.8 years, and 57% (n = 20) had a history of skin cancer. Most cases were treated with surgical excision or Mohs micrographic surgery (MMS), with only 1 recurrence in the literature. Furthermore, the authors present 8 additional cases of mBCCs successfully treated with MMS.

CONCLUSION
Mucosal basal cell carcinomas are rare, and skin cancer history may be a risk factor. Because the lip is a cosmetically and functionally important area, MMS may be the preferred treatment method for mBCCs in this location.
Vulvar, Perianal and Perineal Cancer After Hidradenitis Suppurativa: A Systematic Review and Pooled Analysis
Authors: Makris Georgios-Marios , Poulakaki Nikiforita , Papanota Aristea-Maria , Kotsifa Evgenia , Sergentanis Theodoros N. , Psaltopoulou Theodora 
Published: October 2016

BACKGROUND
Hidradenitis suppurativa (HS) is a chronic inflammatory disease that frequently involves the perineal and perianal regions. The association between HS and malignant transformation is a rare but under recognized phenomenon.

OBJECTIVE
This systematic review aims to summarize all available cases of vulvar and perianal/perineal cancer emerging in patients with HS, describing clinical and therapeutic particularities of these coexisting conditions in female patients.

MATERIALS AND METHODS
This systematic review and pooled analysis was performed in accordance with the PRISMA guidelines; end-of-search date was June 15, 2015.

RESULTS
A total of 13 eligible articles were identified; 7 cases of vulvar cancer and 6 cases of perineal/perianal carcinomas in patients with HS were noted. A majority of published cases pertained to rather advanced carcinomas; only occasionally early stage carcinomas were identified. The optimal modifications in the treatment scheme of vulvar, perianal, and perineal cancer in patients with HS have not been established; detailed reporting of recurrence- and survival-related aspects is advised.

CONCLUSION
Vulvar, perianal, and perineal cancer represent a rare but serious complication of HS.
Multicenter Testing of a Risk Assessment Survey for Soft Contact Lens Wearers With Adverse Events: A Contact Lens Assessment in Youth Study
Authors: Sorbara Luigina , Zimmerman Aaron B. , Mitchell G. Lynn , Richdale Kathryn , Lam Dawn Y. , Kinoshita Beth T. , Chalmers Robin L. , Wagner Heidi 
Published: October 2016

Purpose:
To test the ability of responses to the Contact Lens Assessment in Youth (CLAY) Contact Lens Risk Survey (CLRS) to differentiate behaviors among participants with serious and significant (S&S) contact lens–related corneal inflammatory events, those with other events (non-S&S), and healthy controls matched for age, gender, and soft contact lens (SCL) wear frequency.

Methods:
The CLRS was self-administered electronically to SCL wearers presenting for acute clinical care at 11 clinical sites. Each participant completed the CLRS before their examination. The clinician, masked to CLRS responses, submitted a diagnosis for each participant that was used to classify the event as S&S or non-S&S. Multivariate logistic regression analyses were used to compare responses.

Results:
Comparison of responses from 96 participants with S&S, 68 with non-S&S, and 207 controls showed that patients with S&S were more likely (always or fairly often) to report overnight wear versus patients with non-S&S (adjusted odds ratio [aOR], 5.2; 95% confidence interval [CI], 1.4–18.7) and versus controls (aOR, 5.8; CI, 2.2–15.2). Patients with S&S were more likely to purchase SCLs on the internet versus non-S&S (aOR, 4.9; CI, 1.6–15.1) and versus controls (aOR, 2.8; CI, 1.4–5.9). The use of two-week replacement lenses compared with daily disposables was significantly higher among patients with S&S than those with non-S&S (aOR, 4.3; CI, 1.5–12.0). Patients with S&S were less likely to regularly discard leftover solution compared with controls (aOR, 2.5; CI, 1.1–5.6).

Conclusions:
The CLRS is a clinical survey tool that can be used to identify risky behaviors and exposures directly associated with an increased risk of S&S events.
An Anatomical Murine Model of Heterotopic Periorbital Subunit Transplantation
Authors: Gao Bowen , Yu Qingxiong , Xie Feng , Sheng Lingling , Mao Xiyuan , Li Qingfeng , Zhu Hainan 
Published: October 2016

Background:
Conventional reconstructive methods fail to achieve satisfactory results in total eyelid defect cases. Vascularized composite tissue allotransplantation might provide both good appearance and function for these patients. The structure of the eyelid is exceptional because it simultaneously consists of skin, connective tissue, the striated muscle, fiber structure, aponeuroses, and mucosa. Thus, before clinical application of eyelid allotransplantation, more experiments are needed to clarify the impact of ischemia, immunal suppressive agents, and deinnervation effects on these sophisticated structures. We developed an heterotopic periorbital transplantation model in rats to facilitate further experiment in this field.

Methods:
Twenty-five inbred male Lewis rats were used for anatomy study (n=10), and as donors or recipients of the operations (n=10). In the anatomy study, the vascular distribution and innervation to the periorbital unit was identified and recorded. Then, according to the anatomy study, 10 heterotopic transplantations and 2 transplantations with pedicle ligated were performed. The posterior facial vein and the external carotid artery are selected as the graft pedicle. All transplanted eyelids were assessed daily. Micro-CT scanning and hematoxylin and eosin staining of the grafts were performed 60 days after the operation.

Results:
All recipients tolerated the operation well. All grafts without pedicles ligated survived and new hair growth was observed. All of the transplanted eyelids were pink and pliable during the entire observation period, and we did not observe any signs of arterial or venous occlusion. In the recipients with graft pedicle ligated, the grafts were necrosed and mummified within 4 to 5 days. MicroCT of the survived grafts showed good blood supply and histologic staining revealed normal histologic morphologies.

Conclusions:
Our study proved the anatomical feasibility of periorbital transplantation by establishing a heterotopic transplantation model, which might facilitate future eyelid allotransplantation-related experiments.
Haemostatic resuscitation in trauma: the next generation
Authors: Stensballe Jakob , Ostrowski Sisse R. , Johansson Pär I. 
Published: October 2016

Purpose of review
To discuss the recent developments in and evolvement of next generation haemostatic resuscitation in bleeding trauma.

Recent findings
Mortality from major trauma is a worldwide problem, and massive haemorrhage remains a major cause of potentially preventable deaths. Development of coagulopathy further increases trauma mortality emphasizing that coagulopathy is a key target in the phase of bleeding. The pathophysiology of coagulopathy in trauma reflects at least three distinct mechanisms that may be present isolated or coexist: acute traumatic coagulopathy, coagulopathy associated with the lethal triad, and consumptive coagulopathy. The concepts of ‘damage control surgery’ and ‘damage control resuscitation’ have been developed to ensure early control of bleeding and coagulopathy to improve outcome in bleeding trauma. Haemostatic resuscitation aims at controlling coagulopathy and consists of a ratio driven strategy aiming at 1 : 1 : 1, using tranexamic acid according to CRASH-2, and applying haemostatic monitoring enabling a switch to a goal-directed approach when bleeding slows. Haemostatic resuscitation is the mainstay of trauma resuscitation and is associated with improved survival.

Summary
The next generation of haemostatic resuscitation aims at applying a ratio 1 : 1 : 1 driven strategy while using antifibrinolytics, haemostatic monitoring and avoiding critical fibrinogen deficiency by substitution.
Advanced extracorporeal therapy in trauma
Authors: Zonies David , Merkel Matthias 
Published: October 2016

Purpose of review
The purpose is to review the current application of extracorporeal life support (ECLS) in trauma patients. In addition, programmatic development is described.

Recent findings
ECLS use is increasing among trauma patients. Several recent studies among trauma patients report survival rates of 65–79%. Despite the high bleeding risk, extracorporeal membrane oxygenation (ECMO) may be safely implemented in trauma patients based on a strict protocol-driven policy. Early implementation may improve overall outcomes. Alternative anticoagulants and heparin free periods may be well tolerated in trauma patients at high risk of hemorrhage.

Summary
ECMO is becoming a more routine option in severely injured trauma patients that develop severe respiratory failure. Well tolerated implementation and program development is possible among regional trauma centers. Although clinical knowledge gaps exist, ECMO is a promising treatment in this high-risk population.
Interferon-based hepatitis C therapy in a safety net hospital: access, efficacy, and safety
Authors: Nordstrom Eric M. , Keniston Angela , Baouchi Fafa , Martinez-Camacho Alvaro 
Published: October 2016

Aims
This study assesses the efficacy, accessibility, and safety of hepatitis C virus (HCV) treatment in a safety net hospital population.

Methods
Patients at Denver Health receiving pegylated interferon for HCV infection between 2008 and 2012 were included in this retrospective study. Sociodemographic, biochemical, and virologic data were collected on each patient. The primary outcomes were the rate of sustained virologic response and early treatment discontinuation, with reason for discontinuation documented. Multivariable analyses were performed to identify factors associated with the primary outcomes.

Results
Detectable HCV antibodies were found in 2912 patients, and 1630 had a detectable viral load. Eighty percent of these patients were uninsured/underinsured. Only 46% were seen in the hepatology clinic, and 8% received interferon-based HCV treatment. Of the 125 patients treated with interferon-containing regimens, 54% had genotype 1 infection. The overall rate of sustained virologic response (SVR) was 47%. Rapid virologic response, low FIB-4 score combined with age, and increasing number of days on therapy were associated with SVR in multivariable analysis. Therapy was prematurely discontinued in 43% of patients related to being lost to follow-up (30%), null response (24%), and intolerance to pegylated interferon/ribavirin (24%). Genotype 1 infection and unfavorable viral kinetics were associated with premature treatment discontinuation in multivariable analysis. There were no statistically significant associations between age, sex, ethnicity, race, diabetes, BMI, psychiatric comorbidities, income, employment status, homelessness, or insurance status and the primary outcomes.

Conclusion
An acceptable SVR rate is achievable in a safety net patient population. Addressing the barriers to care will be paramount when using direct-acting antivirals.
Preliminary Study of a Caregiver‐based Infant and Child Feeding and Swallowing Screening Tool
Authors: Barkmeier‐Kraemer Julie M. , Linn Chris , Thompson Heather L. , Byrd Robert S. , Steinfeld Mary B. , Hoffmann Raymond G. , Silverman Alan H. 
Published: October 2016

ABSTRACTObjectives:The Infant and Child Feeding Questionnaire (ICFQ) was created to facilitate early detection of feeding and swallowing problems. This is achieved by promoting effective communication between caregivers and health care providers resulting in referral for evaluation and treatment of feeding and swallowing problems by specialists. The purpose of this pilot study was to determine whether items from the ICFQ could be used to screen for differences between children with known feeding problems (FP) and without known feeding problems (NFP).Methods:Caregivers of children ages 36 months or younger with FP and NFP were recruited to complete the ICFQ and demographic questions. T tests were completed to compare demographic characteristics of the research groups. Responses to ICFQ items were analyzed using receiver operating characteristic analysis and odds ratios to determine whether questionnaire items distinguished between study groups.Results:Sixty‐four caregivers of children with FP and 57 caregivers of NFP children were recruited. Three participants in the NFP group did not meet inclusion criteria and were excluded from analysis. A combination of 4 ICFQ questions distinguished between groups (receiver operating characteristic = 0.974). Significant odds ratios were also found for 9 feeding behaviors that distinguished between groups.Conclusions:A subset of items from the ICFQ showed promise for distinguishing FP from NFP groups. Future work will expand the regional representation of the participant samples and obtain equal representation of participants across all age‐adjusted questionnaires to determine whether the same combination of ICFQ items continues to distinguish between FP and NFP groups.
Rectal Suction Biopsy in Patients With Previous Anorectal Surgery for Hirschsprung Disease
Authors: Vadva Zareen , Nurko Samuel , Hehn Rebecca , Vargas Sara O. 
Published: October 2016

ABSTRACTObjectives:The aim of the study was to determine rates of histologically positive, negative, and inconclusive rectal suction biopsies in post‐pull‐through patients with Hirschsprung disease evaluated for potential residual aganglionosis at our institution and to determine how patients were managed after a post‐pull‐through rectal suction biopsy.Methods:Thirty‐nine post‐pull‐through suction biopsies from our institution were reviewed. Samples, stained with H&E and often acetylcholinesterase and/or calretinin, were categorized as “histologically” positive, negative, or inconclusive for aganglionosis. Subsequent clinical action was categorized as bowel resection, no further procedure, or rebiopsy. Agreement between histologic diagnosis and clinical action was assessed.Results:Histologically, all biopsies were inconclusive (46%) or negative (54%) for residual aganglionosis. Postbiopsy clinical action included redo pull‐through (5%), no further procedure (59%), or rebiopsy (36%). Rebiopsy was sought in 2 of 21 histologically negative patients and in only 12 of 18 histologically indeterminate patients. Eventual redo pull‐through procedures in 6 of 39 patients showed 4 with residual aganglionosis and 2 with abnormalities suggesting residual “transition zone.”Conclusions:Our findings show that suction biopsy after pull‐through was frequently histologically indeterminate and never definitively positive for residual aganglionosis. When biopsy was histologically indeterminate, rebiopsy was pursued less commonly than may be expected. Our findings emphasize that suction biopsy examination is not a “criterion standard” for residual aganglionosis, but instead a component of a diagnosis that ultimately combines clinicopathologic factors, the constellation of which can sometimes spare patients from a more invasive full‐thickness biopsy.
Amniotic Fluid Embolism
Authors: Sundin Courtney Stanley , Mazac Lauren Bradham 
Published: October 2016

Abstract
Amniotic fluid embolism (AFE) is a rare but serious and potentially deadly complication of pregnancy that is unpreventable and unpredictable. Most AFE events occur during labor; however, approximately one third happen during the immediate postpartum period. Presentation is abrupt and thought to be an abnormal response to fetal materials entering maternal circulation through the placental insertion site. Care providers must recognize the signs and symptoms of AFE and react quickly to treat potential complications. This can be challenging as there are no set diagnostic criteria or specific laboratory tests. Generally, the diagnosis is based on clinical status when the classic triad of hypoxia, hypotension, and subsequent coagulopathy are noted in a laboring woman or woman who just gave birth, and no other plausible explanation can be determined. Proper treatment of AFE requires a multidisciplinary approach to decrease maternal morbidity and mortality. Knowledge, simulation, and familiarization of a Massive Obstetric Transfusion protocol can help all members of the perinatal team recognize and respond to women with AFE in a timely and effective manner. A case study is presented of a woman with a seemingly normal obstetric course that became complicated rapidly following development of an AFE.
Late Recognition of a Case of Oculo-Auriculo-Vertebral Spectrum
Authors: El Mansoury Jeylan , Mbekeani Joyce N. 
Published: October 2016

ABSTRACT

Purpose
To report the late recognition of a case oculo-auriculo-vertebral spectrum (OAVS).

Case Report
A 14-year-old male patient with a history of spinal scoliosis and anal atresia presented with a right ocular growth that was increasing in size and causing irritation. He was discovered to have a right limbal dermoid and forniceal lipodermoid. All visual functions were normal and the rest of the anterior and posterior segments were unremarkable. External examination revealed facial asymmetry and ipsilateral hemifacial microsomia and a pre-auricular skin tag. A diagnosis of oculo-auriculo-vertebral spectrum (OAVS) or Goldenhar syndrome was made.

Conclusions
Growth of a limbal dermoid helped identify oculo-auriculo-vertebral spectrum, a disorder with a wide phenotypic spectrum that can affect all systems. Early recognition and syndromic designation is imperative; full pediatric survey of suspected cases will help rule out the life-threatening manifestations of the spectrum.