bluuebunny/crossref_metadata_2025 huggingface dataset:
Symptomatic Venous Thromboembolism After Adolescent Knee Arthroscopy
Authors: Murphy Robert F. , Heyworth Benton , Kramer Dennis , Naqvi Manahil , Miller Patricia E. , Yen Yi-Meng , Kocher Mininder S. , Shore Benjamin J.
Published: November 2016

Background:

The frequency of knee arthroscopy procedures is increasing in pediatric and adolescent patients. In general, complications after these procedures in adolescents are uncommon. The purposes of this study are to report the incidence of venous thromboembolism (VTE) in adolescent patients after knee arthroscopy procedures, as well identify risk factors in this patient population.

Methods:

Medical records were reviewed in all pediatric and adolescent patients (≤19 y) who underwent an arthroscopic knee procedure from 2010 to 2014 and were diagnosed with a symptomatic VTE in the postoperative period. Demographic features were recorded, and included age, sex, body mass index, clinical characteristics (diagnosis, type of surgical intervention, tourniquet time), VTE risk factors [family history of VTE, obesity (body mass index >30), oral contraceptive use, and smoking use/exposure] and treatment (anticoagulation type/duration).

Results:

Out of 2783 patients who underwent knee arthroscopy during the 5-year study period, 7 patients (3 males, 4 females, mean age, 16.9 y, range, 15 to 18) developed a symptomatic postoperative VTE (incidence, 0.25%, 95% confidence interval, 0.11%-0.54%). There were 6 unilateral deep venous thrombosis, and 1 bilateral deep venous thrombosis. Arthroscopic procedures performed in this cohort included anterior cruciate ligament reconstruction (3), isolated lateral release (1), meniscectomy (2), and patellar realignment with arthroscopic lateral release, open tibial tubercle osteotomy, and open proximal medial retinacular reefing (1). VTE was diagnosed an average of 9 days following surgery (range, 3 to 16). All patients were initially treated with low–molecular-weight heparin, and 2 were converted to warfarin. Mean duration of anticoagulation treatment was 64 days (range, 28 to 183). All patients had at least 1 identifiable medical or surgical risk factor, including oral contraceptive use (2), smoking (2), obesity (2), an arthroscopically assisted open procedure (4), or tourniquet time >60 minutes (3).

Conclusions:

VTE after adolescent knee arthroscopy has not been well described. The incidence is ∼0.25%. Previously established risk factors for VTE were present in 100% of the affected population. Low–molecular-weight heparin was used to successfully treat this complication.

Level of Evidence:

Level IV.
Effects of Low-Load Motor Control Exercises and a High-Load Lifting Exercise on Lumbar Multifidus Thickness
Authors: Berglund Lars , Aasa Björn , Michaelson Peter , Aasa Ulrika
Published: November 2016

Study Design.

Randomized controlled trial.

Objective.

The aim of this study was to compare the effects of low-load motor control (LMC) exercises and a high-load lifting (HLL) exercise, on lumbar multifidus (LM) thickness on either side of the spine and whether the effects were affected by pain intensity or change in pain intensity.

Summary of Background Data.

There is evidence that patients with low back pain (LBP) may have a decreased size of the LM muscles with an asymmetry between sides in the lower back. It has also been shown that LMC training can affect this asymmetry. It is, however, not known whether a high-load exercise has the same effect.

Methods.

Sixty-five participants diagnosed with nociceptive mechanical LBP were included and randomized into LMC exercises or a HLL exercise, the deadlift. The LM thickness was measured using rehabilitative ultrasound imaging (RUSI), at baseline and after a 2-month training period.

Results.

There were no differences between interventions regarding effect on LM muscle thickness. However, the analysis showed a significant effect for asymmetry. The thickness of the LM muscle on the small side increased significantly compared with the large side in both intervention groups, without influence of pain at baseline, or change in pain intensity.

Conclusion.

At baseline, there was a difference in thickness of the LM muscles between sides. It seems that exercises focusing on spinal alignment may increase the thickness of the LM muscles on the small side, irrespective of exercise load. The increase in LM thickness does not appear to be mediated by either current pain intensity or the magnitude of change in pain intensity.

Level of Evidence: 2
Rotational Osteotomy for Hallux Valgus. A New Technique for Primary and Revision Cases
Authors: Wagner Pablo , Ortiz Cristian , Wagner Emilio
Published: November 2016

More than 200 different surgical techniques exist for hallux valgus (HV). Some of them are designed for mild, moderate, or severe deformities depending on their correction power. Nevertheless, they all correct only the coronal and/or sagittal plane deformity. Just a handful of them correct the known axial malrotation that exists in most HV cases. This malrotation is one possible factor that could be the source of recurrence of an operated HV as it has been described. We describe a new technique which simultaneously corrects the metatarsal internal rotation and varus deformity by rotating the metatarsal through an oblique plane osteotomy. This is performed with no bone wedge resection. Also, there is a broader bone surface contact than on a transverse proximal osteotomy. This technique is easy to remember and relatively simple to perform in primary and revision cases. The authors results show that it is as safe and effective as other procedures, with some advantages to be discussed.

Levels of Evidence: Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence.
Yellow fever vaccine 17D administered to healthy women aged between 40 and 54 years halves breast cancer risk: an observational study
Authors: Mastrangelo Giuseppe , Pavanello Sofia , Fadda Emanuela , Buja Alessandra , Fedeli Ugo
Published: November 2016

Transcripts of human endogenous retrovirus K are expressed in most breast cancers (BCs). Yellow fever vaccine 17D (YFV) expresses a protein with a closely homologous epitope. Cross-reactive immunity could hypothetically inhibit BC growth at least in women aged around 50 years at diagnosis, in whom the prognosis of BC was found to be better than that in women younger or older. A cohort of 12 804 women who received YFV in the Veneto Region, Italy, was divided into two subcohorts according to age at vaccination and followed up through the Veneto Tumor Registry. The time since vaccination until cancer incidence was categorized (≤1.9; 2–3.9; 4–5.9; 6–7.9; 8–10.9; ≥11 years) and, using the lowest class as a reference, the incidence rate ratio for BC with a 95% confidence interval and P-value was estimated by Poisson regression in each time since vaccination class, adjusting for age and calendar period. In 3140 women vaccinated at 40–54 years of age, YFV administration resulted in a protective effect of long duration slowly fading over time with a U-shaped pattern of response. Overall, BC risk was reduced by about 50% (incidence rate ratio=0.46; 95% confidence interval=0.26–0.83; P=0.009) 2 years after vaccination. Cross-reactive antigens could not be the mechanism because no protection was observed in women vaccinated before 40 or after 54 years of age. BC cells in a microscopic stage of disease can be destroyed or severely damaged by YFV if BC is not very aggressive. To prove that treatment is truly effective, a placebo-controlled double-blind trial should be conducted.
Examining a Partial Biopsychosocial Model for Monthly Alcohol, Tobacco, and Marijuana Use Among Adolescents
Authors: Smith Matthew Lee , Barry Adam E. , Merianos Ashley L.
Published: November 2016

Alcohol, tobacco, and marijuana are commonly used substances among adolescents. In the context of the Biopsychosocial Model (BPSM), this study investigated the relationships between psychological and normative factors associated with adolescent alcohol, tobacco, and marijuana use. Data were analyzed from 1053 middle and high school students. Structural equation modeling was used to examine the relationships between BPSM constructs. Results indicate that latent constructs of the BPSM are significant antecedent factors to alcohol, tobacco, and marijuana use; however, the relationships between study constructs were inconsistent with those theorized by BPSM. Findings support the importance of theory testing for complex models applied to new topics and new populations.
Systematic Braiding of 2 Evidence-Based Parent Training Programs
Authors: Guastaferro Kate , Miller Katy , Shanley Chatham Jenelle R. , Whitaker Daniel J. , McGilly Kate , Lutzker John R.
Published: November 2016

An effective approach in early intervention for children and families, including child maltreatment prevention, is home-based services. Although several evidence-based programs exist, they are often grouped or delivered together, despite having different foci and approaches. This article describes the development and pilot phases of a trial evaluating the systematic braiding of 2 evidence-based home-based models, SafeCare and Parents as Teachers. We describe the methodology for braiding model implementation and curriculum, specifically focusing on how structured qualitative feedback from pilot families and providers was used to create the braided curriculum and implementation. Systematic braiding of 2 models at the implementation and curriculum levels is a mechanism that has the potential to meet the more comprehensive needs of families at risk for maltreatment.
Development of an UHPLC-UV-Method for Quantification of Direct Oral Anticoagulants: Apixaban, Rivaroxaban, Dabigatran, and its Prodrug Dabigatran Etexilate in Human Serum
Authors: Boehr Sebastian , Haen Ekkehard
Published: November 2016

Background:

Direct oral anticoagulants currently have no indication for monitoring even though there are data that imply that individual dosing can improve and add safety to the therapy.

Methods:

An ultra-high performance liquid chromatography method with ultra violet detection has been developed and validated for apixaban, dabigatran, dabigatran etexilate, and rivaroxaban. Protein precipitation with methanol (1:3 vol/vol) was used as sample preparation. Analyses were performed on an Agilent 1290 ultra-high performance liquid chromatography system with an Agilent Poroshell 120 EC-C18-RP column using eluents [A] H2O and [B] methanol with 0.1% formic acid added to each. A gradient run was performed with a flow of 0.7 mL/min at 35°C. Apixaban was detected at 280 nm, dabigatran at 294 nm, dabigatran etexilate at 340 nm, and rivaroxaban at 249 nm.

Results:

Retention times were 1.83 minutes for dabigatran, 4.10 minutes for rivaroxaban, 4.30 minutes for apixaban, and 6.10 minutes for dabigatran etexilate within a total run time of 7 minutes. Linearity was given over a range from 20 to 300 ng/mL with r2 >0.999. The limit of detection ranged from 4 to 5 ng/mL and the limit of quantification from 15 to 19 ng/mL, respectively. Usability in daily routine was demonstrated in 27 samples from patients receiving rivaroxaban and 11 samples from patients receiving apixaban. In the absence of validated therapeutic ranges, we estimated “assumed therapeutically effective concentrations” from dose-related ranges for the respective licensed dosages.

Conclusions:

The method offers a fast, reliable, and low-cost way to quantify direct oral anticoagulants in daily routine even in smaller laboratories without access to liquid chromatography-mass spectrometry.
Tear Film Osmolarity in Response to Long-Term Orthokeratology Treatment
Authors: Nieto-Bona Amelia , Nombela-Palomo María , Felipe-Márquez Gema , Teus Miguel A.
Published: November 2016

Purpose:

To compare tear film osmolarity (TFO) measurements in non–contact lens (CL) wearers and wearers of hydrogel or overnight orthokeratology (OK) CLs, and to assess possible effects of long-term OK on TFO.

Methods:

Overall, 108 subjects with moderate myopia participated in 2 experiments, and TFO was measured using the TearLab osmolarity system. In experiment 1, TFO measurements were made in 77 right eyes of 23 non-CL wearers, 26 hydrogel wearers, and 28 OK wearers. Subjects in the last 2 groups had worn their CL for at least 3 years. In experiment 2, 31 individuals (habitual soft CL wearers) were enrolled for prospective long-term follow-up of OK treatment. These subjects were fitted with Paragon-CRT (n=16) or Seefree (n=15) lenses, and TFO readings were taken at baseline and after 1 month and 1 year of lens wear and after 1 month of OK treatment interruption.

Results:

Values of TFO were within the normal limits in all 3 subject groups, although significantly lower osmolarities (P<0.01) were observed in non-CL wearers (281.7±5.9 mOsm/L) compared with hydrogel (291±16.5 mOsm/L) or OK lens wearers (301.7±10.8 mOsm/L). In experiment 2, TFO differed significantly at baseline between the Paragon-CRT and Seefree groups (P<0.05), and a significant decrease in TFO compared with baseline (P<0.01) was observed in the Paragon-CRT group after 1 month of cessation of lens wear.

Conclusion:

Higher TFO values were observed in lens wearers (hydrogel or OK) than non-CL wearers. After interruption of OK treatment, TFO returned to similar values to those found in non-CL wearers.
Trends and Determinants of Familial Consent for Corneal Donation in Chinese
Authors: Lee Allie , Ni Michael Y. , Luk Amanda C. K. , Lau Jessie K. P. , Lam Karen S. Y. , Li Tom K. , Wong Catherine S. M. , Wong Victoria W. Y.
Published: November 2016

Purpose:

Corneal transplantation is the treatment of choice for many corneal diseases. At present, there is a global shortage of corneal transplant tissues, and failure to obtain consent from families of potential donors is a major limiting factor in tissue procurement.

Methods:

All family members of potential donors after cardiac death approached by the local eye bank staff members from January 2008 to December 2014 in Hong Kong were included. Reasons for consent or refusal and sociodemographic details of the deceased and the family members approached were reviewed. Trends in consent rates from 2008 to 2014 were examined. Multivariable logistic regression was performed to examine determinants of donation among cases from 2013 to 2014.

Results:

A total of 1740 cases were identified. The overall consent rate was 36.8%, and the consent rate did not change significantly over the 7-year study period (P= 0.24). The most common reason for consent by family members was “the wish to help others” (86.0%), and the most common reason for refusal was “traditional Chinese culture to keep the body intact after death” (42.7%). From the multivariable analysis in the subset of cases from 2013 to 2014 (n = 628), family members were more likely to consent when the deceased was female (adjusted odds ratio 1.45,P= 0.03), with a do-not-resuscitate order (adjusted odds ratio 2.27,P< 0.001).

Conclusions:

The consent rate for eye donation did not change significantly from 2008 to 2014. Our findings suggest that health education and promotion campaigns need to address cultural barriers to organ donation.
Evaluation of Management of Uncomplicated Community-Acquired Pneumonia
Authors: Walsh Thomas L. , DiSilvio Briana E. , Speredelozzi Daniel , Hammer Crystal D. , Hu Kurt , Abdulmassih Rasha , Makadia Jina T. , Sandhu Rikinder , Naddour Mouhib , Vishwanathan Swati , Chan-Tompkins Noreen H. , Trienski Tamara L. , Moffa Matthew A. , Bremmer Derek N.
Published: November 2016

Background

Community-acquired pneumonia (CAP) remains a leading cause of hospitalization and mortality in the United States. Studies have shown that interventions such as shorter antibiotic therapy and early intravenous (IV) to oral conversion can be safely performed. We evaluated areas of improvement at our institutions that could help optimize patient management while reducing collateral damage associated with excessive antibiotic usage.

Methods

In this retrospective analysis, all patients aged 18 years and older with a primary International Classification of Diseases, Ninth Revision code for CAP admitted from March 1, 2014, to October 31, 2014, were analyzed. The primary outcome was duration of antibiotic therapy for uncomplicated CAP (appropriate treatment duration defined as 7 days or less). Secondary objectives included duration of IV antibiotic therapy, duration of inpatient length of stay, and 30-day readmission rate related to CAP.

Results

Of the 141 patients evaluated, 98 (69.5%) met inclusion criteria. The mean total duration of antibiotic therapy was 10.1 ± 3.4 days, and the mean duration of IV therapy was 4.9 ± 3.3 days. Only 26.5% of patients received 7 days or less of antibiotic therapy, whereas 38.8% received greater than 10 days of therapy.

Conclusions

Our findings are concerning given the available data demonstrating that short-course therapy with 5 to 7 days is clinically as effective as long-course therapy and associated with fewer adverse events. The management of uncomplicated CAP represents a significant opportunity for antimicrobial stewardship intervention.
Steerable Robot-assisted Micromanipulation in the Middle Ear: Preliminary Feasibility Evaluation
Authors: Yasin Rashid , O’Connell Brendan P. , Yu Haoran , Hunter Jacob B. , Wanna George B. , Rivas Alejandro , Simaan Nabil
Published: November 2016

Hypothesis:

The use of a robotic manipulator with a dexterously orientable gripper will expand the ability of middle ear surgeons to perform precise tasks and access otherwise challenging anatomic regions.

Background:

Middle ear surgery presents unique challenges because of the constrained operative space and limited access to certain anatomic regions.

Methods:

A custom-designed robot with a sideways-reaching gripper was used to evaluate feasibility of manipulation tasks in different middle-ear anatomical zones. Reachable workspace within the middle ear, accuracy of free-space path following, and tool steadiness were compared between robotic telemanipulation and manual control. Preliminarily assessments of the robot's clinical utility included: 1) touching the round window niche, Eustachian tube orifice, and sinus tympani; 2) placing a stapes prosthesis; 3) removal of mockup diseased tissue in the sinus tympani.

Results:

The reachable workspace in the middle ear was considerably greater with the robot as compared with manual manipulation using a Rosen needle. In a simple path-tracing task outside the ear, robotic telemanipulation was associated with significantly reduced error. Within the middle ear, the robot contributed to steadier movement, but longer task completion time. The gripper successfully placed a 4.5 mm piston prosthesis, accessed the round window niche, Eustachian tube orifice, and removed mockup disease from the sinus tympani.

Conclusion:

This study demonstrates that robotic assistance using steerable tools allows surgeons to access challenging anatomic regions of the middle ear. Coordinated and accurate manipulation is evidenced by motion analyses and completion of feasibility tasks within the middle ear.
Hepatocellular Carcinoma Surveillance Among Patients With Cirrhosis in a Population-based Integrated Health Care Delivery System
Authors: Singal Amit G. , Tiro Jasmin , Li Xilong , Adams-Huet Beverley , Chubak Jessica
Published: November 2016

Purpose:

Fewer than 1 in 5 patients with cirrhosis receive hepatocellular carcinoma (HCC) surveillance; however, most studies were performed in select patient populations, which may not be informative of practice patterns in population-based community practices. Further, few reported guideline-concordant consistent surveillance rates.

Goals:

Characterize guideline-concordant HCC surveillance rates and patient-level factors associated with surveillance among a population-based cohort of patients with cirrhosis.

Study:

We retrospectively characterized HCC surveillance among cirrhosis patients followed between January 2010 and December 2012 at an integrated health care delivery system in Washington state. Consistent surveillance was defined as an ultrasound every 6 months, and inconsistent surveillance was defined as ≥1 ultrasound during the 2-year follow-up period. Univariate and multivariate analyses were conducted to identify correlates of HCC surveillance receipt.

Results:

Of 1137 patients with cirrhosis, 22 (2%) underwent consistent surveillance, 371 (33%) had inconsistent surveillance, and 744 (65%) received no surveillance during follow-up. Correlates of HCC surveillance receipt in multivariate analysis included Gastroenterology/Hepatology subspecialty care [odds ratio (OR), 1.88; 95% confidence interval (CI), 1.44-2.46], Child Pugh B/C cirrhosis (OR, 1.61; 95% CI, 1.07-2.43), elevated aspartate aminotransferase (OR, 1.63; 95% CI, 1.13-2.35), and etiology of liver disease. Compared with hepatitis C-infected patients, patients with hepatitis B infection were more likely to undergo surveillance (OR, 2.72; 95% CI, 1.28-5.81), whereas patients with alcohol-related cirrhosis (OR, 0.63; 95% CI, 0.42-0.93) and nonalcoholic steatohepatitis (OR, 0.39; 95% CI, 0.28-0.56) were less likely to undergo surveillance.

Conclusions:

Although one third of patients undergo inconsistent HCC surveillance, <2% of patients receive guideline-concordant biannual HCC surveillance.
Cry wolf and inflate medical urgency to expedite consult resolution through gastrointestinal endoscopy
Authors: Sonnenberg Amnon
Published: November 2016

Background and aims

To expedite a consult resolution, referring physicians sometimes inflate the urgency and need for endoscopic workup. The aim of the present decision analysis was to study the impact of inflationary indication on the expected benefits to gastroenterologists and referring physicians.

Methods

The study aims were pursued in terms of game theory and medical decision analysis using decision trees. Different outcomes associated with true versus false urgent indication in immediate versus delayed endoscopy were ranked according to different preference schemes of gastroenterologists versus referring physicians.

Results

The decision analysis shows that inflating the urgency of indication for endoscopy reduces the benefit from the perspective of gastroenterologists and referring physicians alike. Raising the level of false urgent indications results in a lost opportunity for immediate endoscopy among patients with true urgent indications and, thus, diminishes the overall benefit of endoscopy. By comparison, all other influences play only a marginal role. For referring physicians, the small benefit of expediting nonurgent endoscopies by exaggerated claims does not compensate for the concomitant loss of truly needed endoscopy slots. For gastroenterologists, a small benefit derived from delaying endoscopies in patients with false urgent endoscopies rapidly wears off as inflationary indications become common practice.

Conclusion

An underlying communication problem between referring physicians and gastroenterologists needs to be resolved by educating referring physicians about the operative exigencies of endoscopy units and about the true appearance of alarm symptoms in common digestive diseases.
Endoscopic Recurrence 6 Months After Ileocecal Resection in Children With Crohn Disease Treated With Azathioprine
Authors: Zarubova Kristyna , Hradsky Ondrej , Copova Ivana , Rouskova Blanka , Pos Lucie , Skaba Richard , Bronsky Jiri
Published: November 2016

Objectives:

Intestinal surgery is an important part of Crohn disease (CD) treatment in children. The aim of the present study was to compare the rate of endoscopic recurrence at the sixth month after ileocecal resection (ICR) in children with CD treated with azathioprine between patients who received prior antitumor necrosis factor alpha (anti‐TNF‐α) therapy and those who were not administered this therapy. Moreover, we tried to identify the potential risk factors for disease recurrence and describe the schedule of long‐term follow‐up after surgery.

Methods:

We prospectively collected data from pediatric patients with CD, who underwent ICR between October 2011 and June 2015 at our hospital and were treated with azathioprine monotherapy after ICR. We evaluated the endoscopic recurrence (Rutgeerts score) at the sixth month after ICR in all included patients.

Results:

Among 21 included patients, 13 achieved endoscopic remission (Rutgeerts score < i2) at the sixth month after ICR. No difference was found between patients who received prior anti‐TNF‐α therapy and those who did not. We did not find any clinically relevant factors associated with endoscopic recurrence rate at the sixth month.

Conclusions:

Prior anti‐TNF‐α therapy does not seem to be a strong risk factor for endoscopic recurrence within 6 months after ICR. Further studies on large sample of patients are needed to identify potential predictors of disease recurrence.
Kid's Menu Portion Sizes
Authors: Cohen Deborah A. , Lesser Lenard I. , Wright Cameron , Story Mary , Economos Christina D.
Published: November 2016

Extra-large portions served at restaurants put consumers at risk of overweight and obesity, including children. Developing standards for portions sizes for kids' menus could reduce the risk that children will be served more food than they need for normal growth. We reviewed the calorie content of foods offered on kids' menus at franchised restaurants and US Department of Agriculture published recipes for use in schools. Using an expert panel, we developed recommendations for portion sizes for different food categories at restaurants that would reduce the likelihood that children would be served too much when they dine out. We found that portions of a la carte items offered on kids' menus averaged 147% more calories than the portions recommended by the panel, with hundreds of single servings exceeding 600 calories, the amount recommended as a maximum for an entire children's meal. Expert panel members recommended that single servings of entrees not exceed 300 calories, fried potatoes not exceed 100 calories, and desserts not exceed 150 calories on kids' menus. Restaurants should revise their portions for children and downsize them to match with recommendations that will reduce the risk that children will be served too much. The current kid's menu offerings are likely to be partly responsible for childhood obesity. New guidelines offer reasonable benchmarks for food service to children.
Discrimination Between Patients With Alzheimer Disease and Healthy Subjects Using Layer Analysis of Cerebral Blood Flow and Xenon Solubility Coefficient in Xenon-Enhanced Computed Tomography
Authors: Sase Shigeru , Yamamoto Homaro , Kawashima Ena , Tan Xin , Sawa Yutaka
Published: November 2016

Objective

The aim of this study was to develop a method for discriminating between patients with Alzheimer disease (AD) and healthy subjects using layer analysis of cerebral blood flow (CBF) and xenon solubility coefficient (λ) in xenon-enhanced computed tomography (CT).

Methods

Xenon-enhanced CT was performed on 27 patients with AD (81.7 [3.3] years old) and 15 healthy volunteers (78.6 [4.0] years old) using a wide volume CT. For each subject, we created the first- (surface) to sixth-layer images of CBF and λ for the 6 viewing directions (layer thickness, 5 mm). For the discriminant views, receiver operating characteristic curves for the ratio of CBF to λ were created to identify patients with AD.

Results

For the third- and fourth-layer left lateral views, which were designated as the discriminant views, areas under the receiver operating characteristic curve were 96.8% and 97.4%, respectively.

Conclusions

With the use of the discriminant views obtained by xenon-enhanced CT, we could effectively discriminate between patients with AD and healthy subjects using both CBF and λ.
Effect of a Low-Rank Denoising Algorithm on Quantitative Magnetic Resonance Imaging-Based Measures of Liver Fat and Iron
Authors: Allen Brian C. , Lugauer Felix , Nickel Dominik , Bhatti Lubna , Dafalla Randa A. , Dale Brian M. , Jaffe Tracy A. , Bashir Mustafa R.
Published: November 2016

Purpose

This study aimed to assess the effect of a low-rank denoising algorithm on quantitative magnetic resonance imaging-based measures of liver fat and iron.

Materials and Methods

This was an institutional review board–approved, Health Insurance Portability and Accountability Act–compliant, retrospective analysis of 42 consecutive subjects who were imaged at 3T using a multiecho gradient echo sequence that was reconstructed using the multistep adaptive fitting algorithm to obtain quantitative proton density fat fraction (PDFF) and R2* maps (original maps). A patch-wise low-rank denoising algorithm was then applied, and PDFF and R2* maps were created (denoised maps). Three readers independently rated the PDFF maps in terms of vessel and liver edge sharpness and image noise using a 5-point scale. Two other readers independently measured mean and standard deviation of PDFF and R2* values for the original and denoised maps; values were compared using intraclass correlation coefficients (ICCs) and mean difference analyses.

Results

Qualitatively, the denoised maps were preferred by all 3 readers based on image noise (P < 0.001) and by 2 of 3 readers based on vessel edge sharpness (P < 0.001–0.99). No reader had a significant preference regarding liver edge sharpness (P = 0.16–0.48). Quantitatively, agreement was near perfect between the original and denoised maps for PDFF (ICC = 0.995) and R2* (ICC = 0.995) values. Mean quantitative values obtained from the original and denoised maps were similar for liver PDFF (7.6 ± 7.7% vs 7.7 ± 7.8%; P = 0.63) and R2* (52.9 ± 40.3s−1 vs 52.8 ± 41.1 s−1, P = 0.74).

Conclusions

Applying the low-rank denoising algorithm to liver fat and iron quantification reduces image noise in PDFF and R2* maps without adversely affecting mean quantitative values or subjective image quality.
Spectral Computed Tomography Imaging of Gastric Schwannoma and Gastric Stromal Tumor
Authors: Liu Jianli , Chai Yanjun , Zhou Junlin , Dong Chi , Zhang Wenjuan , Liu Bin
Published: November 2016

Objective

Gastric schwannomas (GSs) and gastrointestinal stromal tumors (GSTs) are grossly similar submucosal neoplasms with different prognoses. We explored the value of spectral computed tomography (CT) to distinguish between them.

Methods

Patients diagnosed with GS or GST at Lanzhou University Second Hospital, China, between May 2013 and June 2015 were included retrospectively. The subjects underwent spectral CT examination before surgery and had histologically confirmed diagnosis of GS or GST.

Results

Twelve patients with GS (3 men; 9 women; mean [SD] age, 47.0 [11.5] years) and 20 with GST (7 men; 13 women; mean [SD] age, 54.7 [9.9]) showed significant differences in terms of arterial phase (AP) at 70 keV (P < 0.001), portal phase (PP) at 70 keV (P = 0.002), AP iodine concentration, PP iodine concentration, AP water concentration, AP slope of spectral curve, and PP slope of spectral curve (all P < 0.001).

Conclusions

Spectral CT may be useful for noninvasive diagnosis of submucosal tumors.
Heart-Rate Reduction With Adjusted-Dose Ivabradine in Patients Undergoing Coronary Computed Tomographic Angiography: A Randomized Trial
Authors: Kacijan Blaž , Novak Zala , Jug Borut , Dolenc Novak Maja , Vrtovec Matjaž , Gužič Salobir Barbara
Published: November 2016

Objective

Our prospective, randomized, open-label study assessed the efficacy of a heart rate–lowering, adjusted-dose protocol with ivabradine prior to coronary computed tomographic angiography (CCTA).

Methods

Patients undergoing CCTA were randomized to 7 days of adjusted-dose ivabradine or standard care (ie, no additional medication). Heart rate and β-blocker and antianxiety medication use on the day of the CCTA were recorded.

Results

One hundred one patients were randomized (mean age, 60 [SD, 13] years; 66% women). Significantly more patients on ivabradine had heart rates of 60 beats per minute or less at the time of the CCTA scan (48% vs 8%, P < 0.01); accordingly, fewer patients on ivabradine needed additional heart rate lowering with β-blockers (40% vs 86%, P < 0.01), as well as antianxiety medication (18% vs 39%, P < 0.05), and also required lower doses of intravenous β-blockers (4 [SD, 2] vs 7 [SD, 5] mg, P < 0.05).

Conclusions

A 7-day premedication protocol with ivabradine effectively lowers heart rate in patients undergoing CCTA.
Accelerated Age-Related Arterial Stiffness in Systemic Lupus Erythematosus Patients
Authors: Ding Fa ming , Li Mengtao , Yang Xinglin , Ye Yicong , Kang Lin , Pang Haiyu , Wang Qian , Xu Dong , Zeng Xiaofeng , Zhang Shuyang
Published: November 2016

Background

An increased prevalence of arterial stiffness in systemic lupus erythematosus (SLE) patients has been established, but the mechanisms of progression of arterial stiffness with increasing age have not been fully explored.

Objectives

To investigate age-related progression of arterial stiffness among SLE patients relative to healthy controls.

Methods

A total of 161 female SLE patients who were enrolled in the Chinese SLE Treatment and Research group (CSTAR) registry and 135 age-matched healthy control subjects participated in this cross-sectional investigation. Traditional cardiovascular risk factors and SLE-related parameters were assessed on the day that brachial-ankle pulse wave velocity (baPWV) was examined. SAS 9.3 was used to perform all statistical analyses in this study. Linear regression and curvilinear regression models were utilized to analyze the association between age and arterial stiffness.

Results

Arterial stiffness based on baPWV significantly differed between the SLE patients and controls in the different age groups, and within the SLE group. The baPWV increments for each age group (<25, 25–34, 35–45, and >45) were 30 cm/s, 52 cm/s, and 121 cm/s for the controls and 61 cm/s, 132 cm/s, and 155 cm/s for the SLE patients, respectively. Curvilinear regression and linear regression revealed various trends of increased arterial stiffness among the SLE patients compared with the healthy controls. The correlation coefficients between age and arterial stiffness significantly differed among the SLE patients relative to the healthy controls (correlation coefficients of 0.46478 and 0.52612, respectively; t = 2.05; P = 0.0409). Multivariate analysis revealed that age, mean blood pressure (BP) (P < 0.0001), erythrocyte sedimentation rate (ESR) (P = 0.0073), prednisone course (P = 0.0144), and SLE disease activity (P = 0.0405) were associated with arterial stiffness among the SLE patients. Further, these patients exhibited earlier exposure to and higher frequencies of several risk factors compared with the controls in each age group (<25 years: OR = 6.3253; 25–34 years: OR = 3.1043; 35–45 years: OR = 3.1316; >45 years: OR = 3.6020).

Conclusions

The mechanisms of the age-related progression of arterial stiffness differed among the SLE patients relative to the healthy controls. Furthermore, accelerated arterial stiffness was observed among the SLE patients relative to the healthy controls with advancing age.
Review of Current Workforce for Rheumatology in the Countries of the Americas 2012–2015
Authors: Reveille John D. , Muñoz Roberto , Soriano Enrique , Albanese Miguel , Espada Graciela , Lozada Carlos Jose , Montúfar Ruben Antonio , Neubarth Fernando , Vasquez Gloria M. , Zummer Michel , Sheen Rosa , Caballero-Uribe Carlo V. , Pineda Carlos
Published: November 2016

Background

With the increases in and aging of the populations of the Americas, monitoring the number of rheumatologists is critical to address and focus on areas of greatest need.

Objectives

The aim of this study was to gather data on the rheumatology workforce from 21 national societies in the Pan American League of Associations for Rheumatology (PANLAR).

Methods

In September and October 2012 and again in October and November 2015, the heads of the 21 rheumatology national societies were contacted in the 2012 survey; all national societies responded except Cuba. In the 2015 survey, all responded except Nicaragua, for which information was provided by national society presidents in adjacent countries.

Results

The data from 21 societies contained in PANLAR consist of 10,166 adult and 678 pediatric rheumatologists serving 961 million people. The number of rheumatologists per 100,000 population varies greatly from 3.9 per 100,000 people (Uruguay) to 0.11 per 100,000 people (Nicaragua). The number of training programs also varies widely, with some countries having no indigenous programs. The distribution of rheumatologists is mainly in the large cities, particularly in the smaller countries. Pediatric rheumatologists have dramatically increased in number in 2012, but 96% reside in 6 countries. This remains an underserved area in most countries.

Conclusions

The rheumatology workforce in the Americas has improved between 2012 and 2015, especially in the number of pediatric rheumatologists. However, numerically and in the perception of the 21 member societies of PANLAR, the number is still inadequate to meet the increasing demands for rheumatologic care, especially in the care of children with rheumatic disease and in rural areas.
Tailored Duration of Contrast Material Injection in High-Pitch Computed Tomographic Aortography With a Double-Level Test Bolus Method
Authors: Nishii Tatsuya , Watanabe Yoshiaki , Shimoyama Shinsuke , Kono Atsushi K. , Sofue Keitaro , Mori Shumpei , Takahashi Satoru , Sugimura Kazuro
Published: November 2016

Objectives

To achieve the efficient usage of contrast material (CM) in high-pitch CT aortography, an appropriate duration of the CM injection is crucial. We used a modification of the double-level test bolus method for determination of proper injection duration with the aim of evaluating the image quality of tailored-duration CM injection compared with that of a fixed duration.

Materials and Methods

The institutional review board approved retrospective review of 80 consecutive subjects who had undergone high-pitch 70-kVp CT aortography with a modified double-level test bolus method. The interval between peak enhancement at the aortic root and femoral artery was derived from the time/attenuation curves. A total of 40 subjects underwent CT aortography with individually set duration time from the results. The remaining subjects underwent CT aortography with a fixed-duration time. The density values at several parts of the aorta were assessed. The differences in image quality and CM amount used for each method were assessed by Welch test.

Results

The injection duration was almost 50% shorter (median, 15 seconds; range, 11–25 seconds) when individually tailored. The mean CM amount was reduced by 50% (46.2–23.9 mL, P < 0.01). The range of mean CT attenuation throughout the aorta was not significantly different between the 2 methods (316–327 HU and 305–321 HU, P > 0.05, respectively).

Conclusions

The modified double-level test bolus method in high-pitch CT aortography can significantly reduce the amount of CM without adversely affecting image quality.
Efficacy of a Dehydrated Hydrogel Plug to Reduce Complications Associated With Computed Tomography–guided Percutaneous Transthoracic Needle Biopsy
Authors: Grage Rolf A. , Naveed Muhammad A. , Keogh Shane , Wang Dongliang
Published: November 2016

Purpose:

The aim of the study was to determine whether a hydrogel plug, when placed in the needle tract after a computed tomography–guided percutaneous transthoracic needle lung biopsy, reduces the rate of complications.

Materials and Methods:

This retrospective analysis included biopsies of lung lesions from 200 consecutive patients. The first 100 consecutive biopsies made up the control group, in which no plug intervention was used. The next 100 consecutive biopsies made up the treatment group, in which a hydrogel plug was deployed through a 19-G coaxial needle system after 20-G core samples were obtained.

Results:

The overall mean age was 64.92 years. No statistically significant differences in patient characteristics and procedure parameters were found between the control and treatment groups except for age (mean age, 62.92 vs. 66.92 y, P=0.022) and procedure duration (mean minutes, 7.81 vs. 6.47 min, P=0.021). The rate of pneumothorax in the control versus treatment group was 31% vs. 29% (P=0.498) and the rate of hemoptysis was 6% vs. 3% (P=0.354). The rate of chest tube insertion after pneumothorax was significantly higher in the control group than in the treatment group (10% vs. 2%, P=0.032) and the average length of hospital stay was longer in the control group (0.44 vs. 0.07 d, P=0.041). The difference was still statistically significant for the chest tube insertion rate (P=0.030) and close to statistically significant for the length of hospital stay (P=0.063), after adjusting for the confounding effect of age and procedure duration.

Conclusion:

These data show that the deployment of a hydrogel plug after a computed tomography–guided lung biopsy significantly reduced the rate of chest tube insertion along with a reduced length of hospital stay.
Safety of Laparoscopic Colorectal Resection in Patients With Severe Comorbidities
Authors: Ichikawa Nobuki , Homma Shigenori , Nakanishi Kazuaki , Kazui Keizo , Kashiwakura Sayuri , Ohira Masafumi , Tsuji Takeshi , Suzuki Takashi , Ishikawa Tomohiro , Taketomi Akinobu
Published: November 2016

We aimed to assess the safety of laparoscopic colorectal resection in patients with severe comorbidities. High operative risk was defined as an American Society of Anesthesiologists (ASA) class 3 score. Outcomes in 34 patients with an ASA score of 3 undergoing laparoscopic surgery (LAP3) were compared with 172 laparoscopic surgery patients with an ASA score ≤2 (LAP2) and 32 laparotomy patients with an ASA score of 3 (OP3). The postoperative complication rate in LAP3 was similar to that seen in LAP2 and significantly lower than that seen in OP3 (LAP2, 4.0%; LAP3, 5.9%; OP3, 31.2%). The incidence of postoperative hemorrhage, infection, ileus, and anastomotic leakage was similar between LAP3 and LAP2 and between LAP3 and OP3. However, the systemic complication rate in LAP3 was similar to that seen in LAP2 and significantly lower than that seen in OP3. Laparoscopic colorectal resection can be performed safely in patients with severe comorbidities.
Preperitoneal Suction Technique to Secure the Proper Mesh Position During Laparoscopic Herniorrhaphy
Authors: Soeta Nobutoshi , Saito Takuro , Ito Fujio , Gotoh Mitsukazu
Published: November 2016

Purpose:

Dislocation of the mesh is 1 cause of recurrence after laparoscopic inguinal hernia repair (LIHR). Here, we propose a new procedure, the “preperitoneal cavity suction technique,” to confirm mesh position during LIHR under a transabdominal preperitoneal approach (TAPP).

Patients and Methods:

We developed the “preperitoneal cavity suction technique” during LIHR by TAPP, visualizing the mesh through the closed peritoneum by vacuuming up the carbon dioxide and effusion at the preperitoneal cavity using a suction tube inserted through the tunnel from a laterally placed trocar into the preperitoneal space. We applied this technique in adults with inguinal hernias who were scheduled to undergo elective surgery in our hospital between April 2013 and March 2015.

Results:

In total, 84 lesions were treated in 74 consecutive LIHRs by TAPP. The “preperitoneal cavity suction technique” was applied to 83 lesions. We confirmed appropriate positioning of the mesh for 82 of the 83 lesions (98.8%), with dislocation of the mesh detected in 1 case. In that case, we reopened the peritoneal flap and repositioned the mesh correctly during the operation. No patients complained of pain or a sense of discomfort, and no hematoma was identified around the dissected area or anterior superior iliac spine on the affected side. Mean duration of hospitalization was 2.5 days. No cases of hernia recurrence were observed during follow-up (range, 7 to 31 mo; median, 15 mo).

Conclusions:

The “preperitoneal suction technique” seems useful to detect mesh dislocation and has potential to reduce TAPP-related complications.
Scalable latent-factor models applied to single-cell RNA-seq data separate biological drivers from confounding effects
Authors: Buettner Florian , Pratanwanich Naruemon , Marioni John C. , Stegle Oliver
Published: November 2016

Single-cell RNA-sequencing (scRNA-seq) allows heterogeneity in gene expression levels to be studied in large populations of cells. Such heterogeneity can arise from both technical and biological factors, thus making decomposing sources of variation extremely difficult. We here describe a computationally efficient model that uses prior pathway annotation to guide inference of the biological drivers underpinning the heterogeneity. Moreover, we jointly update and improve gene set annotation and infer factors explaining variability that fall outside the existing annotation. We validate our method using simulations, which demonstrate both its accuracy and its ability to scale to large datasets with up to 100,000 cells. Moreover, through applications to real data we show that our model can robustly decompose scRNA-seq datasets into interpretable components and facilitate the identification of novel sub-populations.
A nearest neighbour approach by genic distance to the assignment of individuals to geographic origin
Authors: Degen Bernd , Blanc-Jolivet Céline , Stierand Katrin , Gillet Elizabeth
Published: November 2016

During the past decade, the use of DNA for forensic applications has been extensively implemented for plant and animal species, as well as in humans. Tracing back the geographical origin of an individual usually requires genetic assignment analysis. These approaches are based on reference samples that are grouped into populations or other aggregates and intend to identify the most likely group of origin. Often this grouping does not have a biological but rather a historical or political justification, such as “country of origin”.

In this paper, we present a new nearest neighbour approach to individual assignment or classification within a given but potentially imperfect grouping of reference samples. This method, which is based on the genic distance between individuals, functions better in many cases than commonly used methods. We demonstrate the operation of our assignment method using two data sets. One set is simulated for a large number of trees distributed in a 120 km by 120 km landscape with individual genotypes at 150 SNPs, and the other set comprises experimental data of 1221 individuals of the African tropical tree speciesEntandrophragma cylindricum(Sapelli) genotyped at 61 SNPs. Judging by the level of correct self-assignment, our approach outperformed the commonly used frequency and Bayesian approaches by 15% for the simulated data set and by 5 to 7% for the Sapelli data set.

Our new approach is less sensitive to overlapping sources of genetic differentiation, such as genic differences among closely-related species, phylogeographic lineages and isolation by distance, and thus operates better even for suboptimal grouping of individuals.