bluuebunny/crossref_metadata_2025_split huggingface dataset:
What should be the goal of cholesterol-lowering treatment? A quantitative evaluation dispelling guideline myths
Authors: Durrington Paul N. , Bashir Bilal , Soran Handrean 
Published: September 2022

Purpose of review
Guidelines for cholesterol-lowering treatment generally include extensive review of epidemiological and clinical trial evidence. However, the next logical step, the translation of evidence into clinical advice, occurs not entirely by reasoning, but by a form of consensus in which the prejudices and established beliefs of the societies with interests in cardiovascular disease convened to interpret the evidence are prominent. Methods, which are the subject of this review, have, however, been developed by which clinical trial evidence can be translated objectively into best practice.

Recent findings
Guidelines differ in their recommended goals for cholesterol-lowering treatment in the prevention of atherosclerotic cardiovascular disease (ASCVD). Proposed goals are LDL-cholesterol 2.6 mmol/l (100 mg/dl) or less in lower risk, LDL-cholesterol 1.8 mmol/l (70 mg/dl) or less in higher risk, non-HDL-cholesterol decrease of at least 40% or LDL-cholesterol 1.8 mmol/l (70 mg/dl) or less or decreased by at least 50% whichever is lower. Evidence from clinical trials of statins, ezetimibe and proprotein convertase subtilisin/kexin type 9-inhibitors can be expressed in simple mathematical terms to compare the efficacy on ASCVD incidence of clinical guidance for the use of cholesterol-lowering medication. The target LDL-cholesterol of 2.6 mmol/l (100 mg/dl) is ineffective and lacks credibility. Cholesterol-lowering medication is most effective in high-risk people with raised LDL-cholesterol. The best overall therapeutic target is LDL-cholesterol 1.8 mmol/l (70 mg/dl) or less or decreased by at least 50% whichever is lower. The use of non-HDL-cholesterol as a therapeutic goal is less efficacious. Aiming for LDL-cholesterol 1.4 mmol/l (55 mg/dl) or less as opposed to 1.8 mmol/l produces only a small additional benefit. Evidence for apolipoprotein B targets in hypertriglyceridaemia and in very high ASCVD risk should be more prominent in future guidelines.

Summary
The LDL-cholesterol goal of 2.6 mmol/l or less should be abandoned. Percentage decreases in LDL-cholesterol or non-HDL-cholesterol concentration are better in people with initial concentrations of less than 3.6 mmol/l. The LDL-cholesterol target of 1.8 mmol/l is most effective when initial LDL-cholesterol is more than 3.6 mmol/l in both primary and secondary prevention.
The role of surgery for locally advanced urothelial cancers
Authors: Ibilibor Christine , Kennady Emmett H. , Greene Kirsten L. 
Published: September 2022

Purpose of review
Extirpative surgery can play an important role in the management strategies for locally advanced urothelial carcinoma. The current review is intended to relay current information reported in the literature over the past 12 months regarding the usage of surgical resection in advanced urothelial cancers of the bladder and upper tracts, document operative outcomes, and oncologic efficacy.

Recent findings
Multimodal therapy is key to long-term overall survival for advanced urothelial carcinoma. Radical cystectomy with bilateral pelvic lymph node dissection can be performed after an observable response to chemotherapy or immunotherapy for cT4 or cN2 and higher node-positive disease of the bladder. Moreover, radical cystectomy after trimodal therapy similarly yields durable local response. For upper tract disease, nephroureterectomy with regional lymphadenectomy is the primary surgical modality used often in conjunction with perioperative cisplatin-based chemotherapy.

Summary
Surgical resection as a monotherapy is not curative in patients with locally advanced urothelial carcinoma. However, its use in combination with systemic agents can potentiate durable long-term survival in a subset of patients. Future studies investigating patient-reported outcomes among those receiving consolidative surgery for locally advanced disease are warranted to guide clinical recommendations.
Testosterone therapy in prostate cancer: is it still a controversy?
Authors: Bart Alex S. , Van Hoof Alexander , Badre-Hume Ryan , Selvarajah Joshua , Robillard Kristian , Albala David M. 
Published: September 2022

Purpose of review
The benefits of testosterone therapy (TTh) in the hypogonadal male can be dramatic. Historically, TTh has been contraindicated in prostate cancer (PCa). Current evidence has redefined our understanding of the influence serum testosterone has on prostatic androgen activity. Increasing numbers of hypogonadal men with coexisting PCa emphasizes the importance of describing those who may safely receive TTh. This review aims to present literature that evaluates the efficacy and safety of TTh in men with coexisting PCa.

Recent findings
Our study, a comprehensive review of published literature regarding TTh in men with a history of PCa, consisted of studies conducted from the 1940s to 2022. Our review discusses evidence in accordance with previous studies that TTh has a role in patients with localized PCa as it has not been reported to increase rates of recurrence or progression of PCa.

Summary
The use of TTh in hypongonadal men with a localized PCa has been shown to have positive clinical outcomes without increasing the rate of disease progression or recurrence. Further research, in a randomized controlled setting, is warranted.
Care Transition From the Perspectives of Oncological Patients and the Multiprofessional Care Team
Authors: Rodrigues Caroline Donini , Lorenzini Elisiane , Onwuegbuzie Anthony J. , Oelke Nelly D. , Garcia Cledir França , Malkiewiez Michelle Mariah , Kolankiewicz Adriane Cristina Bernat 
Published: September 2022

Background
Integration into the health system is essential for safe care and efficient use of resources.

Objectives
The aims of this study were to analyze the transition of care from the perspective of adult patients with neoplasia of the digestive tract and the multiprofessional care team, identify factors that influence the transition of care, and, collectively with professionals, create actions to improve the transition of care at the study site.

Methods
The Care Transitions Measure-15 was administered in a mixed methods study, with a QUAN→QUAL sequential explanatory approach. The principles of deliberative dialogue were used as a knowledge translation strategy, and data integration was carried out.

Results
The average score of the Care Transitions Measure-15 considered satisfactory was 74.3. The care plan factor had an unsatisfactory score of 66. Strategies to improve the care transition were listed by the focus group participants, such as supplementary care protocol for patients with neoplasms of the digestive tract, and providing a single discharge plan containing all information relevant to the treatment and continuity of patient care.

Conclusion
The low score for the care plan factor indicates weakness in the care transition.

Implications for Practice
The integrated analysis results indicated that the care transition can be improved by an educational process during discharge planning, implementation of protocols for patients with neoplasia of the digestive tract, and identification of a reference caregiver to help patients navigate the healthcare system.
Calcitonin Gene-Related Peptide, Vascular Endothelial Growth Factor, and Clinical Manifestations in Women With Fibromyalgia
Authors: Rus Alma , López-Sánchez José Alberto , García-Ríos María Carmen , Tapia-Haro Rosa María , Casas-Barragán Antonio , Correa-Rodríguez María , Aguilar-Ferrándiz María Encarnación 
Published: September 2022

Background
Fibromyalgia is a complex illness to diagnose and treat, which significantly impairs patients’ quality of life.

Objectives
The study aims were to compare levels of calcitonin gene-related peptide and vascular endothelial growth factor between patients with fibromyalgia and healthy controls and to examine their relationship with the main clinical manifestations of fibromyalgia.

Methods
This case–control study included 42 women diagnosed with fibromyalgia and 22 healthy women. Serum calcitonin gene-related peptide and vascular endothelial growth factor levels were spectrophotometrically analyzed by enzyme-linked immunosorbent assay. Clinical manifestations were assessed by means of self-administered questionnaires, including functional capacity in daily living activities, musculoskeletal pain, fatigue, anxiety, and sleep quality. The predictive value of these parameters in fibromyalgia was determined by receiver operating characteristic curve analysis.

Results
Serum calcitonin gene-related peptide levels significantly increased in the fibromyalgia group in comparison to the control group. However, there were no significant differences in vascular endothelial growth factor levels between patients and controls. No significant correlations were found between calcitonin gene-related peptide and vascular endothelial growth factor and the symptoms analyzed.

Discussion
Serum calcitonin gene-related peptide levels were dysregulated in women with fibromyalgia and may be a reliable parameter to help diagnose this complex syndrome.
Impact of Cerebellar Injury on Neurodevelopmental Outcomes in Preterm Infants with Cerebral Palsy
Authors: Kim Yoo Jinie , Kim Ee-Kyung , Cheon Jung-Eun , Song Huijin , Bang Moon Suk , Shin Hyung-Ik , Shin Seung Han , Kim Han-Suk 
Published: September 2022

Abstract

Objective
We aimed to analyze brain imaging findings and neurodevelopmental outcomes of preterm infants diagnosed with cerebral palsy (CP).

Design
Brain magnetic resonance imaging (MRI) of preterm infants born between 23 and 32 weeks’ gestation and diagnosed with CP at two years corrected age (CA) were evaluated. Brain lesions were categorized as periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH), and cerebellar hemorrhage (CBH) and graded by the severity. Neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) at 18–24 months CA, and the Korean Ages and Stages Questionnaire (K-ASQ) at 18 and 24 months CA.

Results
CP was found in 38 (6.1%) children among 618 survivors. Cerebellar injury (CI) of high-grade CBH and/or atrophy accounted for 25%. Among patients with supratentorial lesions, those having CI showed significantly lower scores on each K-ASQ domain except gross motor than patients without CI. They also revealed a high proportion of patients below the cut-off value of K-ASQ in language, fine motor, and problem-solving domains (P < 0.05), and lower Bayley-III language composite scores (P = 0.038).

Conclusions
Poor neurodevelopmental outcomes other than motor function were associated with CI. Evaluation of the cerebellum may help predict functional outcomes of patients with CP.
Perceived facilitators and barriers to participation in golf for people with vision impairment: a qualitative study
Authors: Beukes Eldré W. , Hynes Niall , Mann David L. , Hawkes Roger , Jayabalan Prakash , Allen Peter M. 
Published: September 2022

ABSTRACT

Objectives
This study aimed to identify facilitators and barriers to participation in vision impaired (VI) golf.

Design
Semi-structured interviews were conducted with 12 VI golfers, 10 guides, and 5 novices during the British VI Golf Open tournament in August 2021.

Results
Qualitative content analysis identified the benefits, facilitators, and challenges of playing VI golf. The role of guides and future developments of the sport were furthermore identified. The benefits extend beyond those related to health, including personal development and a sense of purpose for players, and of reward for guides. Facilitators were largely organizational and having appropriate support and a guide. The challenges to playing and guiding were practical, financial, and logistical. The need to attract a more diverse range of players, along with a reconsideration of the eligibility criteria were central to the perceived sustainability of VI golf.

Conclusion
These results highlight the practical, financial, and logistical challenges contributing to VI golf activity limitations and participation restrictions. Due to the health, personal, and psychosocial benefits, ways of providing practical, financial, and support networks to facilitate engagement in VI golf should be sought. An evidence-based, sport-specific eligibility system was thought to be critical for the future promotion of VI golf.
Outcomes of Heller Myotomy for Esophageal Achalasia
Authors: Tassi Valentina , Lugaresi Marialuisa , Pilotti Vladimiro , Bassi Francesco , Daddi Niccolò , D’Ovidio Frank , Leiva-Juarez Miguel M. , Mattioli Sandro 
Published: September 2022

Objective:
To provide information on long-term outcomes of Heller myotomy for esophageal achalasia with or without an antireflux fundoplication.

Background:
Since the adoption of the Heller myotomy, surgeons have modified the original technique in order to balance the cure of dysphagia and the consequent cardial incontinence.

Methods:
Totally, 470 patients underwent primary Heller myotomy between 1955 and 2020. A long abdominal myotomy (AM) was performed in 83 patients, the Ellis limited transthoracic myotomy (TM) in 30, the laparotomic Heller-Dor (L-HD) in 202, the videolaparoscopic Heller-Dor (VL-HD) in 155. The HD was performed under intraoperative manometric assessment. Starting on 1973 these patients underwent a prospective follow-up program of timed lifelong clinical, radiological, endoscopic evaluations.

Results:
Median follow-up time was 23.06 years [interquantile range (IQR): 15.04–32.06] for AM, 29.22 years (IQR: 13.46–40.17) for TM, 14.85 years (IQR: 11.05–21.56) for L-HD and 7.51 years (IQR: 3.25–9.60) for VL-HD. In AM, relapse of dysphagia occurred in 25/71 (35.21%), in TM in 11/30 (36.66%), in LH-D in 10/201 (4.97%), in VL-HD in 3/155 (1.93%). Erosive-ulcerative esophagitis was diagnosed for AM in 28.16%, for TM in 30%, for L-HD in 8.45%, for VL-HD in 2.58%. Overall, the outcome was satisfactory in 52.11% for AM, 41.9% for TM, 89.05% for L-HD, 96.12% for VL-HD.

Conclusions:
The Dor fundoplication drastically reduces postmyotomy gastroesophageal reflux. The Heller-Dor operation is a competitive option for the cure of esophageal achalasia if this operation is performed according to the rules of surgical physiology learned by means of intraoperative manometry.
Transplantation for Nonresectable Colorectal Liver Metastases: Long-Term Follow-Up of the First Prospective Pilot Study
Authors: Solheim Jon M. , Dueland Svein , Line Pål-Dag , Hagness Morten 
Published: September 2022

Objective:
To determine whether liver transplantation (LT) can provide long-term overall survival (OS) in selected patients with nonresectable liver-only colorectal liver metastases (nrCRLM).

Background:
In 2005 the first prospective pilot study on LT for nrCRLM was initiated in Norway. We here report long-term data from this study.

Methods:
Main inclusion criteria were nrCRLM, excised primary tumors, and 6 weeks of chemotherapy. Carcinoembryonic antigen >80 µg/L, progressive disease on chemotherapy, size of largest lesion >5.5 cm, and <2 years from primary tumor resection to LT were previously found to be associated with survival. The sum of these factors constitutes the Oslo Score.

Results:
From 2006 to 2012, 23 patients underwent LT in the study. In February 2022, the actual 5-year and 10-year OS after LT were 43.5% and 26.1%, respectively. All patients alive were observed for more than 10 years (range: 133–168 months). Four patients were alive without signs of cancer and with no evidence for disease of median of 102 months (53–133 months). A fifth patient died of noncancer cause after 164 months with no evidence for disease for 31 months. For patients with Oslo Score of 0 or 1, the 5-year and 10-year actual OS was 75% and 50%, respectively (n=6). For patients with Oslo Score of 2, the 5-year and 10- year actual OS 50% was 33% (n=6). All patients with Oslo score 3 or 4 were deceased 86 months post-LT (n=9).

Conclusion:
LT for nrCRLM can provide long term survival and perhaps cure for selected patients. The OS is excellent compared to oncological treatment options and in line with results from studies on resectable CRLM.
Burden of Human Metapneumovirus-associated pneumonia among children attending a Tertiary Care Hospital, Kathmandu
Authors: Lamichhane Jyoti , Upreti Milan , Nepal Krishus , Upadhyay Bishnu Prasad , Maharjan Urusha , Shrestha Ram Krishna , Chapagain Ram Hari , Banjara Megha Raj , Thapa Shrestha Upendra 
Published: September 2022

ABSTRACTBackgroundAcute Respiratory Tract Infection (ARI) is one of the most common causes of mortality and morbidity worldwide. Every year millions of children suffer from viral Respiratory Tract Infections (RTIs) ranging from mild to severe illnesses. Human Metapneumovirus (HMPV) is among the most frequent viruses responsible for RTIs. However, HMPV infections and their severity among children have not been explored yet in Nepal. Therefore, the study aimed to determine the incidence of HMPV among children attending Kanti Children’s Hospital and assess the clinical characteristics of the infections as well as find out the co-infections.MethodsA hospital-based cross-sectional study was carried out from September 2018 to April 2019. A total of 105 throat swabs were collected from children clinically suspected of ARIs. The collected samples were tested for the presence of HMPV RNA by Multiplex Real-time PCR (RT-PCR) assay.ResultsThe incidence of HMPV in children in Kanti Children’s Hospital was found to be 13.3%. The HMPV was more prevalent in the age group less than three years (21.8%) which was found to be statistically significant (p - 0.038). Cough and fever were the most common clinical features present in all children infected with HMPV followed by rhinorrhea, sore throat, and wheezing. HMPV positive children were diagnosed with pneumonia (42.9%), bronchiolitis (28.5%), upper respiratory tract infections (14.3%) and asthma (14.3%). The incidence of HMPV was high in late winter (14.3%) followed by early spring (13.5%).ConclusionThis study provides the baseline information on HMPV and associated co-infection with other respiratory viruses for differential diagnosis and rational use of antibiotics in clinical management.
Combined therapy of prednisone and mTOR inhibitor sirolimus for treating retroperitoneal fibrosis
Authors: Gao Hui , Liu Shibo , Mai Yuanbang , Wang Yuying , Zhang Xue-wu , Zheng Shufen , Luo Chenghua , Pan Cuiping 
Published: September 2022

AbstractRetroperitoneal fibrosis (RPF) is a rare autoimmune disease with fibrous tissue growth and inflammation in retroperitoneum, whose development could encase surrounding organs and lead to severe conditions. Its current treatments involve long-term uptake of glucocorticoids (e.g., prednisone) for controlling inflammation; however, side effects are common, triggering search for replacement therapies. Here, we surveyed gene-disease databases and discovered that mTOR displayed significant changes in RPF, which we confirmed by immunohistological staining. Next, we inferred from drug-gene databases that mTOR inhibitor compound sirolimus could affect most biological pathways in RPF. We then designed a combined therapy in which a gradual reduction of prednisone was prescribed with a long-term, stable dosage of sirolimus. We implemented a single-arm clinical trial in RPF patients and assessed the treatment effects at three timepoints (0, 12 weeks and 48 weeks of treatment). By assessing fibrous tissue mass by computed tomography, inflammation markers and kidney functions by lab tests, immune cell types and abundances by flow cytometry, and plasma inflammation-related proteins by Olink proteomics, we revealed that our combined therapy resulted in significant fibrosis remission and an overall regression of the immune system towards healthy states. In addition, no obvious side effects were observed. We concluded that this new therapy had the potential to replace long-term steroid monotherapy for treating RPF.
Modeling vaccine allocation and equity implications of COVID-19 containment strategies
Authors: Nakamoto Ichiro 
Published: September 2022

AbstractGiven the shortage of global COVID-19 vaccines, a critical public concern is whether the strategy of allocation exerts a heterogeneous effect on settings that have imbalanced accessibility. Exacerbated by the mutational characteristics of the pathogen, traits of immunity protection of vaccines, and diversification of human behaviors, the pathway to the full eradication of the COVID-19 pandemic is becoming increasingly complicated and indeterminate. Population-wide evaluation of public interventions remains crucial to evaluate the performance of epidemiology policies. This study employs a mathematical compartmental model combined with the observational data of the United States to examine the potential effect of vaccine allocation on the trajectory of COVID-19 transmission and the elicited equity implications. The outcomes imply that allocation strategies substantially impact the cumulative equilibrium size of a pandemic controlling for confounding factors. Under a framework of a two-dose primary vaccination strategy aiming to curb the total infections for high-accessibility settings (HAS) and low-accessibility settings(LAS), the traits of vaccination, pathogen, and human effort integrally affect the equilibrium of the COVID-19 pandemic in the medium perspective (i.e., up to 5 years). Vaccine allocation increases the healthcare and cost burden for HAS temporarily, in contrast, it reduces the risk of COVID-19 transmission for the LAS. The effects are consistent across a variety of profiles. By enhancing the administration rates of primary doses (i.e., mainly through dose 1 and dose 2), the magnitude of the COVID-19 pandemic decreases contingent on confounding factors. To minimize the magnitude of infection, it is of importance to dynamically monitor the immunity protection of vaccines, the dynamics of virus transmission, and the gap in the human effort.
Modelling the impact of interventions on imported, introduced and indigenous malaria infections in Zanzibar, Tanzania
Authors: Das Aatreyee M. , Hetzel Manuel W. , Yukich Joshua O. , Stuck Logan , Fakih Bakar S. , Al-mafazy Abdul-wahid H. , Ali Abdullah , Chitnis Nakul 
Published: September 2022

AbstractMalaria cases can be classified as imported, introduced or indigenous cases. The World Health Organization definition of malaria elimination requires an area to demonstrate no new indigenous cases have occurred in the last three years. Here, we present a malaria transmission model that incorporates human mobility and distinguishes between imported, introduced and indigenous cases. We test the impact of several interventions on Zanzibar such as reactive case detection, reactive drug administration, treating infected travellers, and transmission reduction on Zanzibar and mainland Tanzania. We find that the majority of new cases on both major islands of Zanzibar are indigenous cases, despite high case importation rates. Combinations of interventions that increase the number of infections treated through reactive case detection or reactive drug administration can lead to substantial decreases in malaria incidence, but for elimination within the next 40 years, transmission reduction in both Zanzibar and mainland Tanzania is necessary.