bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reduced Mortality and Radiation Necrosis After Surgery With Postoperative Stereotactic Radiation in Patients With Multiple Brain Metastases
Authors: Bhave Varun M. , Lamba Nayan , Tjong Michael C. , Aizer Ayal A. , Bi Wenya Linda 
Published: July 2023

BACKGROUND AND OBJECTIVES:
Although stereotactic radiation has frequently supplanted whole-brain radiation therapy (WBRT) in treating patients with multiple brain metastases, the role of surgery for these patients remains unresolved. No randomized trials have compared surgical resection with postoperative stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) to SRS/SRT alone. Previous studies addressing surgery for patients with multiple brain metastases are often limited by small sample sizes, a lack of appropriate comparison groups, or a focus on patients treated before recent advances in targeted therapy and immunotherapy. We compared outcomes in patients with multiple brain metastases treated with surgical resection and postoperative SRS/SRT to those treated with SRS/SRT alone.

METHODS:
We studied 734 patients with multiple newly diagnosed brain metastases (surgery with SRS/SRT, n = 228; SRS/SRT alone, n = 506) from 2011 to 2022 in a retrospective, single-institution cohort. Patients who received upfront whole-brain radiotherapy were excluded. Cox proportional hazards models were constructed for overall survival and additional intracranial outcomes.

RESULTS:
After adjustment for potential confounders, surgery with postoperative SRS/SRT was associated with decreased all-cause mortality compared with SRS/SRT alone (hazard ratio [HR]: 0.67, 95% CI [0.50-0.89], P = 5.56 × 10−3). The association between surgical resection and overall survival was replicated in a subset of the cohort after cardinality matching (HR: 0.64, 95% CI [0.46-0.88], P = 6.68 × 10−3). Patients with melanoma benefited significantly less from surgical resection compared with patients with other tumor types, most notably non–small-cell lung cancer. Compared with definitive SRS/SRT, cavity SRS/SRT was associated with a significantly reduced risk of both symptomatic radiation necrosis (HR: 0.22, 95% CI [0.08-0.59], P = 2.70 × 10−3) and radiographic radiation necrosis (HR: 0.23, 95% CI [0.09-0.57], P = 1.43 × 10−3) in multivariable models.

CONCLUSION:
In patients with multiple brain metastases, surgical resection before SRS/SRT is associated with reduced mortality and radiation necrosis. Prospective studies may further delineate patient populations that benefit from aggressive local, brain-directed treatment even with significant intracranial disease burden.
Is Choosing Wisely Wise for Lobular Carcinoma in Patients Over 70 Years of Age? A National Cancer Database Analysis of Sentinel Node Practice Patterns
Authors: Goldhaber Nicole H. , O’Keefe Thomas , Kang Jessica , Douglas Sasha , Blair Sarah L. 
Published: July 2023

Abstract
Background
Controversy continues in the treatment of breast cancer in women over 70 years of age. In 2016, the Society of Surgical Oncology recommended against routine use of sentinel lymph node biopsy (SLNBx) as part of the ‘Choosing Wisely Campaign’. This study examines the oncologic safety of avoidance of routine SLNBx in patients over 70 years of age with invasive lobular carcinoma (ILC).

Methods
The National Cancer Database was used to identify women with invasive ductal carcinoma (IDC) and ILC diagnosed between 2012 and 2020. Clinical and pathological staging, axillary staging, surgery type, and lymph node positivity between patients with IDC or ILC were compared.

Results
Among women with T1 tumors, 85,949 (79.6%) patients with IDC and 12,761 (81.5%) patients with ILC underwent SLNBx (p < 0.001). Among patients who underwent SLNBx, those with IDC were more likely to have positive nodes (n = 7535, 8.8%) than those with ILC (n = 1041, 8.2%; p = 0.02). During the time interval of interest, for both IDC and ILC patients, the rate of axillary lymph node dissection decreased and rates of SLNBx or no axillary staging increased. On multivariate analysis, ILC histology was associated with use of SLNBx, but without nodal positivity.

Conclusion
A trend de-escalation of axillary staging was identified in this study, however the majority of patients meeting the ‘Choosing Wisely’ criteria are still undergoing SLNBx. No increased risk of nodal positivity was identified among patients with ILC, suggesting that surgeons can continue to choose wisely and limit the use of SLNBx in women over 70 years of age with T1 ILC tumors.
Mortality due to traffic accidents in Colombia: Profiles of pedestrians and cyclists, 1998-2019
Authors: Montenegro-Martínez Gino , Agudelo-Cifuentes Maite-Catalina , Muñoz-Rodriguez Diana-Isabel 
Published: July 2023

Background: Traffic accidents are an important issue for public health and a threat for sustainable development, with pedestrians and cyclists having been recognized as the most vulnerable actors on the streets. The objective of this study was to analyze the profiles of pedestrians and cyclists who died as a result of traffic accidents in Colombia during the 1998-2019 period. Methods: An observational and descriptive study, with the deaths due to traffic accidents in Colombia between 1998 and 2019 as data source. Secondary data were taken from the Vital statistics of Colombia (EEVV), published by Departamento Administrativo Nacional de Estadística (DANE). A trend analysis of the number of deaths during the period under study was performed, and such number was examined against sex to identify potential differences. Multiple correspondence analysis was employed to elaborate the profile of pedestrians and cyclists who die due to traffic accidents. Three profiles were prepared for each road actor: a global profile, one for 1998, and another for 2019. Results: The mortality profiles are different for pedestrians and cyclists, and, in turn, there are also demographic, geographic, and socioeconomic conditions in each type of road actor, which determine higher mortality risks. High population density, younger age group in the cyclists and adults among the pedestrians, low schooling levels and absence of health insurance are suggested as key factors in these profiles. Related to sex, for men is not possible to establish a profile. Women's cases are commonly related to health insurance, age, and population density. Conclusions: Several contextual and demographic characteristics in pedestrians and cyclists allow delimiting mortality profiles. The profiles that were identified suggest the need to articulate road safety policies with other social and development policies in order to coordinate and integrate intersectoral actions that reduce mortality in these road actors.
Prevalence and predictors of virologic failure among HIV patients on antiretroviral therapy in Makueni County: a cross-sectional study
Authors: Kamau Yvonne N. , Mweu Marshal , Mulinge Martin 
Published: July 2023

Background: The growing number of people on antiretroviral therapy in Kenya has led to a decrease in HIV morbidity and mortality. However, virologic failure (VF) threatens to reverse these gains. In Makueni County, existing data indicate challenges in achieving viral load (VL) suppression among persons living with HIV (PLHIV). Few studies have been carried out investigating VF in the region despite its high incidence of HIV infections. Methods: An analytical cross-sectional study was conducted among PLHIV in Makueni County to investigate the determinants and estimate the prevalence of VF. The prevalence of VF and its associated 95% exact binomial confidence interval was estimated, and a mixed-effects logistic regression model used to evaluate the relationship between the predictors and VF. Results: The estimated period prevalence of VF between October 2018 and June 2019 was 13.2% (95% CI: 12.7%–13.8%). Being 15 years or older (aOR=0.53; 95% CI: 0.44 – 0.645) and having blood samples tested for reasons other than baseline VL measurement was associated with lower odds of VF: breastfeeding mothers (aOR=0.1; 95% CI: 0.01 – 0.97); clinical failure (aOR=0.08; 95% CI: 0.01 – 0.44); confirmation of VF (aOR=0.2; 95% CI: 0.07 – 0.62); no VL data (aOR=0.06; 95% CI: 0.01 – 0.31); routine VL (aOR=0.04; 95% CI: 0.01 – 0.12); drug substitution (aOR=0.03; 95% CI: 0.01 – 0.08). Taking ABC-based, AZT-based, or other non-TDF-Based regimens increased the odds of VF (aOR=1.61; 95% CI: 1.34 – 1.94), (aOR=1.75; 95% CI: 1.52 - 2.01), and (aOR=1.55; 95% CI: 0.99 - 2.44) respectively. Conclusion: This study showed that over 13% of HIV patients on ART in Makueni County had VF between October 2018 and June 2019. The significant risk factors associated with VF were found to be age lower than 15 years, taking a non-TDF-based ART regimen, and blood sampling for baseline VL measurements.
The prevalence of depression and its associated factors among the geriatric age group living in the rural area of Wardha District Maharashtra: A cross-sectional study
Authors: vishwakrma deepak , Gaidhane Dr. Abhay 
Published: July 2023

Background: In India, the percentage of adults over 60 years is rising. Depression is the most prevalent neuropsychiatric condition. People live longer, and households are smaller and crowded, creating stress. These issues influence the mental health of elderly persons and can cause depression. Depression poses a serious threat to public health, especially for senior citizens and inhibits cognitive function and decreases the quality of life. The objective of this study is to determine the prevalence of depression and evaluate its relationship with sociodemographic factors among older people. Methods: Cross-sectional community research will be conducted in the Wardha district. The whole sample of elderly age groups will be examined using a semi-structured survey to identify the sociodemographic features and related risk factors for depression. Using a pre-tested survey called the short version of the Geriatric depression scale (GDS-15), the prevalence of depression in the geriatric age groups of both sexes will be assessed. Conclusions: Older people (those 60 years and older) play important roles in families and the workplace as volunteers. This study will help formulate policies that will inculcate old people to get an insight into how much mental health implications impact everyone, be it adolescents, middle-aged people, or old people. Its significance in public health will pave the road to include mental health screening of old people in non-governmental bodies like NGOs and other organizations like old age homes. Furthermore, the government should pay more attention to old-age depression in the current mental health program so that the burden of the disease can be overcome.
The trend of oral cancer screening in Bangladesh, perceptions, and risk factors: a model comparison approach
Authors: Yasmin Irin , Rokon Md. Shahariar , Illias Elnaz , Khan Md. Nafiul Alam , Alam Md. Mahbub , Hawlader Mohammad Delwer Hossain , Malakar Rajib Kumar , Mohsin Faroque Md. 
Published: July 2023

Background: Oral cancer (OC) is a leading cause of death among cancer patients and a major public health concern in Bangladesh. Timely OC screening can help in the early detection of OC and could reduce the mortality rate in Bangladesh. We aimed to assess the tend of OC screening, perception and risk factors among dental patients. Methods: This was a facility-based cross-sectional study among 423 participants with dental problems using a convenience sampling technique. The collected data were analyzed by IBM SPSS 25 and various statistics, such as the chi-squared test, Poisson regression, logistic regression, etc., were used to attain the objectives. Results: Only 2.4% of the study participants underwent OC screening before the study period. The use of smokeless tobacco and smoking were significantly associated with the tend of OC screening. According to the Poisson model, previous smokeless tobacco users were 5 times (odds ratio (OR): 5.403, P<0.05) more likely than non-users to go for OC screening, which was 8 times (OR: 7.729, P=0.033) for the binary logistic regression. Having a family history of OC increased the odds of receiving an OC screening by nine times (OR: 9.544, P<0.002) compared to individuals without a family history of OC; it was 16 times (OR: 16.438, P=0.001) for the binary logistic regression. Conclusions: This study shows former smokeless tobacco users and past smokers are more likely to uptake OC screening than non-users. In addition, patients having a family history of OC increased the odds of receiving OC screening than subjects without a family history of OC. The lack of OC screening in Bangladesh highlights the need to implement a national-level screening program to help with the early diagnosis of OC and its prevention.
Use of lithium in psychiatric, viral and neurological disorders - a review
Authors: Denys Barbara , Góra Karolina , Zdziennicki Wojciech , Zimnicki Patryk , Lato Marta , Iberszer Konrad , Litwiniuk Maria , Zaniuk Marcin , Hurkała Kamil , Antonik Dominika 
Published: July 2023

Introduction: Lithium is one of the longest used drugs in psychiatry and is currently a mainstay in the long-term prophylaxis of bipolar disorder, preventing recurrent manic and depressive episodes. It also remains an important drug in the treatment of acute episodes of mania and depression. Out of the normothymic drugs, lithium has the greatest effect in preventing suicidal behavior. It also exhibits antiviral activity and in recent years evidence has also accumulated of the drug's neuroprotective properties.
Aim of the study: The aim was to collect and analyze publications on the use of lithium in affective disorders, dementia and viral diseases, as well as its effect on reducing suicidal tendencies.
Materials and Methods: The literature available in the PubMed database was reviewed, using the key words: "lithium"; "bipolar disorder"; "mania", "depression"; "suicidal risk", "side effects".
Results: Chronic use of lithium in patients with bipolar disorder has an effect on preventing recurrence of manic and depressive episodes and can successfully last for 40 years or longer. Studies support the theory that long-term lithium pharmacotherapy has a significant impact on preventing suicidal tendencies among patients with affective disorders. In recent years, the antiviral and neuroprotective properties of the drug have also become known. Despite the rather high risk of overdose, as well as the occurrence of numerous side effects, lithium is still very often used in the treatment of affective disorders due to its high efficacy.
Conclusions: Lithium has been one of the mainstays of psychopharmacology for several decades and is a precursor to mood-stabilizing drugs. In recent years evidence has also been collected for its potential use in non-psychiatric conditions. Conducting further research on lithium will certainly allow for wider use of the drug and a more thorough understanding of its mechanism of action.
use of retinoids in the treatment of skin lesions and prevention of signs of skin aging - a systematic review
Authors: Zapała Magdalena , Hunek Adrian , Kaziród Karolina , Chmielarz Karolina , Wiśniewska-Skomra Joanna , Tylutka Kinga , Hapon Anna , Dadziak Mikołaj 
Published: July 2023

Retinoids are a group of substances that include vitamin A and its natural and synthetic derivatives. They are used in the treatment of various skin diseases, such as: rosacea, acne vulgaris, psoriasis. In addition, recently there is a lot of information about the action of preventing photoaging. Oral retinoids have been proven to be the most effective treatment for acne of various severity available today. Through their comprehensive action, affecting the four main factors associated with the pathogenesis of acne, they significantly reduce skin changes. Externally applied retinoids regulate the renewal of epidermal cells, stimulate the production of collagen fibers, increase the production of elastin, and lead to an increase in the number and activity of fibroblasts. Therefore, more and more people are using preparations containing retinoids to prevent skin aging. It has been proven that this procedure leads to shallower wrinkles and slows down the appearance of new ones, and evens out the skin tone. Retinoids are effective substances, but their use is associated with the risk of various side effects, the most common of which are: skin irritation, photosensitisation, headaches, muscle and joint pain, and teratogenicity.
Portfolio Selection, Periodic Evaluations and Risk Taking
Authors: Tse Alex S. L. , Zheng Harry 
Published: July 2023

Portfolio risk taking when periodic performance matters Incentives of portfolio managers in real life are typically tied to their periodic performance—a criterion that has received very little attention to date. How does the repeated nature of the rewards influence the portfolio managers’ trading strategies? Tse and Zheng address this question via a dynamic model of investment in “Portfolio selection, periodic evaluations, and risk taking.” The return benchmark of the periodic evaluations plays a crucial role. A reasonable benchmark in conjunction with periodic payouts can mitigate excessive risk taking during market downturns. However, an overly aggressive benchmark could result in limited portfolio growth as well as ruin risk over the long run. The theoretical findings yield policy implications over incentives management and remuneration structure design to better align the short-term periodic interest of the portfolio managers and the long-term performance goal of the stakeholders.
100 W, tunable in-band thulium fiber amplifier pumped by incoherently combined 1.9 µm fiber lasers
Authors: Cook Justin , Sincore Alex , Vail Nicholas , Krämer Ria G. , Goebel Thorsten A. , Roumayah Patrick , Bryan Joshua , Bodnar Nathan , Nolte Stefan , Richardson Martin 
Published: July 2023

We detail the design and performance of a high efficiency in-band pumped thulium fiber amplifier operating at the 100 W level. Using a novel pumping architecture based on three incoherently combined thulium fiber oscillators at 1904 nm and a seed laser tunable from 1970–1990 nm, efficient amplification is demonstrated in a high dopant concentration 25/65/250 µm thulium fiber. Here we use the 65 µm pedestal surrounding the core as a pump cladding to increase the cladding to core overlap and improve the overall pump absorption. Up to 89% slope efficiency is obtained with ∼100 W output power at 1990 nm. These results indicate that in-band pumping is a viable route to circumvent the thermal limitations associated with 793 nm diode pumping and provide a pathway for development of multi-kW laser sources in the 2 µm spectral window.
Analysis of bacterial vaginosis, the vaginal microbiome, and sexually transmitted infections following the provision of menstrual cups in Kenyan schools: Results of a nested study within a cluster randomized controlled trial
Authors: Mehta Supriya D. , Zulaika Garazi , Agingu Walter , Nyothach Elizabeth , Bhaumik Runa , Green Stefan J. , van Eijk Anna Maria , Kwaro Daniel , Otieno Fredrick , Phillips-Howard Penelope 
Published: July 2023

Background
Nonhygienic products for managing menstruation are reported to cause reproductive tract infections. Menstrual cups are a potential solution. We assessed whether menstrual cups would reduce bacterial vaginosis (BV), vaginal microbiome (VMB), and sexually transmitted infections (STIs) as studies have not evaluated this.

Methods and findings
A cluster randomized controlled trial was performed in 96 Kenyan secondary schools, randomized (1:1:1:1) to control, menstrual cup, cash transfer, or menstrual cup plus cash transfer. This substudy assessing the impact of menstrual cups on BV, VMB, and STIs, included 6 schools from the control (3) and menstrual cup only (3) groups, both receiving BV and STI testing and treatment at each visit. Self-collected vaginal swabs were used to measure VMB (16S rRNA gene amplicon sequencing), BV (Nugent score), and STIs. STIs were a composite of Chlamydia trachomatis and Neisseria gonorrhoeae (nucleic acid amplification test) and Trichomonas vaginalis (rapid immunochromatographic assay). Participants were not masked and were followed for 30 months. The primary outcome was diagnosis of BV; secondary outcomes were VMB and STIs. Intention-to-treat blinded analyses used mixed effects generalized linear regressions, with random effects term for school. The study was conducted between May 2, 2018, and February 7, 2021. A total of 436 participants were included: 213 cup, 223 control. There were 289 BV diagnoses: 162 among control participants and 127 among intervention participants (odds ratio 0.76 [95% CI 0.59 to 0.98]; p = 0.038). The occurrence of Lactobacillus crispatus–dominated VMB was higher among cup group participants (odds ratio 1.37 [95% CI 1.06 to 1.75]), as was the mean relative abundance of L. crispatus (3.95% [95% CI 1.92 to 5.99]). There was no effect of intervention on STIs (relative risk 0.82 [95% CI 0.50 to 1.35]). The primary limitations of this study were insufficient power for subgroup analyses, and generalizability of findings to nonschool and other global settings.

Conclusions
Menstrual cups with BV and STI testing and treatment benefitted adolescent schoolgirls through lower occurrence of BV and higher L. crispatus compared with only BV and STI testing and treatment during the 30 months of a cluster randomized menstrual cup intervention.

Trial registration
ClinicalTrials.gov NCT03051789.
Patterns of testing in the extensive Danish national SARS-CoV-2 test set-up
Authors: Gram Mie Agermose , Steenhard Nina , Cohen Arieh Sierra , Vangsted Anne-Marie , Mølbak Kåre , Jensen Thøger Gorm , Hansen Christian Holm , Ethelberg Steen 
Published: July 2023

Background
The Danish national SARS-CoV-2 mass test system was among the most ambitious worldwide. We describe its set-up and analyse differences in patterns of testing per demography and time period in relation to the three waves of SARS-CoV-2 transmission in Denmark.

Methods
We included all reported PCR- and rapid antigen-tests performed between 27 February 2020 and 10 March 2022 among all residents aged 2 years or above. Descriptive statistics and Poisson regression models were used to analyse characteristics of individuals tested for SARS-CoV-2 using a national cohort study design.

Results
A total of 63.7 million PCR-tests and 60.0 million rapid antigen-tests were performed in the study period, testing 90.9% and 78.8% of the Danish population at least once by PCR or antigen, respectively. Female sex, younger age, Danish heritage and living in the capital area were all factors positively associated with the frequency of PCR-testing. The association between COVID-19 vaccination and PCR-testing changed from negative to positive over time.

Conclusion
We provide details of the widely available, free-of-charge, national SARS-CoV-2 test system, which served to identify infected individuals, assist isolation of infectious individuals and contact tracing, and thereby mitigating the spread of SARS-CoV-2 in the Danish population. The test system was utilized by nearly the entire population at least once, and widely accepted across different demographic groups. However, demographic differences in the test uptake did exist and should be considered in order not to cause biases in studies related to SARS-CoV-2, e.g., studies of transmission and vaccine effectiveness.