bluuebunny/crossref_metadata_2025 huggingface dataset:
Calibration of Thermocouple by Comparison against Standard Radiation Thermometer in a Blackbody Comparator
Authors: Trisna Beni Adi , Suherlan  , Hapiddin Asep , Zaini Helmi , Wiriadinata Hidayat , Zaid Ghufron
Published: November 2018

A set-up to calibrate thermocouple up to 1500 °C by comparison against radiation thermometer is recently established in Research Center for Metrology – LIPI (RCM – LIPI). A blackbody cavity, made of silicon carbide, is put in a single-zone-controller furnace as a comparator block. A radiation thermometer standard (worked at λ = 650 nm) is employed to determine the reference temperature of the calibration. In this work, a type B thermocouple is calibrated in the range of 1000 – 1500 °C. The expanded uncertainty (k = 2) is evaluated to be 2.4 °C at 1500 °C. The uncertainty due to inhomogeneity of the thermocouple contributes more than 50% (1.4 °C) of the total uncertainty.
Systolic Blood Pressure Trajectories in the Acute Phase and Clinical Outcomes in 2-Year Follow-up Among Patients With Ischemic Stroke
Authors: Li Changwei , Zhang Yonghong , Xu Tan , Peng Hao , Wang Dali , Xu Tian , Sun Yingxian , Bu Xiaoqing , Chen Chung-Shiuan , Wang Aili , Wang Jinchao , Li Qunwei , Ju Zhong , Geng Deqin , Zhang Jintao , Chen Jing , He Jiang ,   CATIS investigators
Published: November 2018

BACKGROUND

Optimal blood pressure (BP) levels during acute ischemic stroke have not been established. We studied associations between systolic BP trajectories during acute phase and subsequent clinical outcomes among patients with ischemic stroke.

METHODS

A total of 4,036 patients with acute ischemic stroke and elevated BP from the China Antihypertensive Trial in Acute Ischemic Stroke trial were included in this analysis. Three BPs were measured every 2 hours in day 1, every 4 hours during days 2 and 3, and every 8 hours thereafter until hospital discharge or death. Clinical outcomes were assessed at 3, 12, and 24 months. Latent variable mixture modeling was used to identify subgroups that share a similar underlying trajectory of systolic BP during the first 7 days after stroke onset. Logistic regression and Cox proportional hazards models were used to examine the associations between systolic BP trajectories and clinical outcomes during follow-up.

RESULTS

We identified 5 systolic BP trajectories of high, high-to-moderate-low, moderate-high, moderate-low, and low. Compared to participants in high trajectory, multiple-adjusted odds ratios (95% confidence interval) of all-cause mortality at 3 months for individuals in high-to-moderate-low, moderate-high, moderate-low, and low were 0.34 (0.15–0.77), 0.58 (0.32–1.04), 0.29 (0.15–0.56), and 0.56 (0.26–1.19), respectively. Likewise, the corresponding hazard ratios for all-cause mortality in 24 months were 0.66 (0.44–1.00), 0.74 (0.53–1.05), 0.45 (0.32–0.66), and 0.61 (0.40–0.93), respectively. Similar associations were observed for recurrent stroke and cardiovascular disease, and in both the intervention and control groups.

CONCLUSIONS

Patients with moderate-low systolic BP during acute ischemic stroke had a lower risk of adverse clinical outcomes.
APOE-ε4 Genotype is Associated with Elevated Post-Concussion Symptoms in Military Veterans with a Remote History of Mild Traumatic Brain Injury
Authors: Merritt Victoria C , Lapira Kristina M , Clark Alexandra L , Sorg Scott F , Werhane Madeleine L , Jak Amy J , Bondi Mark W , Schiehser Dawn M , Delano-Wood Lisa
Published: November 2018

Objective

We evaluated the influence of the APOE-ε4 allele on post-concussive symptoms in military Veterans with a remote history of mild traumatic brain injury (mTBI).

Method

Participants (N = 77) were administered neuropsychiatric measures, on average, approximately 5 years following their most recent mTBI and provided a DNA sample for APOE genotyping. Veterans were divided into two groups based on their ε4 status (n = 14 ε4+, n = 63 ε4–). The Neurobehavioral Symptom Inventory (NSI) was the primary outcome measure, from which a total score was derived, as well as three symptom clusters (somatic, cognitive, and affective).

Results

ANCOVAs showed a significant main effect of ε4 genotype on the NSI total score and somatic symptom cluster after adjusting for posttraumatic stress symptoms and mTBI history (p = .019–.028, ηp2 = .064–.073), such that ε4+ Veterans endorsed significantly greater symptoms than ε4– Veterans.

Conclusions

Our findings suggest that genetic risk may help to explain the poorer long-term outcomes often observed in this population.
Bayesian inference of networks across multiple sample groups and data types
Authors: Shaddox Elin , Peterson Christine B , Stingo Francesco C , Hanania Nicola A , Cruickshank-Quinn Charmion , Kechris Katerina , Bowler Russell , Vannucci Marina
Published: November 2018

In this article, we develop a graphical modeling framework for the inference of networks across multiple sample groups and data types. In medical studies, this setting arises whenever a set of subjects, which may be heterogeneous due to differing disease stage or subtype, is profiled across multiple platforms, such as metabolomics, proteomics, or transcriptomics data. Our proposed Bayesian hierarchical model first links the network structures within each platform using a Markov random field prior to relate edge selection across sample groups, and then links the network similarity parameters across platforms. This enables joint estimation in a flexible manner, as we make no assumptions on the directionality of influence across the data types or the extent of network similarity across the sample groups and platforms. In addition, our model formulation allows the number of variables and number of subjects to differ across the data types, and only requires that we have data for the same set of groups. We illustrate the proposed approach through both simulation studies and an application to gene expression levels and metabolite abundances on subjects with varying severity levels of chronic obstructive pulmonary disease. Bayesian inference; Chronic obstructive pulmonary disease (COPD); Data integration; Gaussian graphical model; Markov random field prior; Spike and slab prior.
Outbreak of Tattoo-associated Nontuberculous Mycobacterial Skin Infections
Authors: Griffin Isabel , Schmitz Ann , Oliver Christine , Pritchard Scott , Zhang Guoyan , Rico Edhelene , Davenport Emily , Llau Anthoni , Moore Emily , Fernandez Danielle , Mejia-Echeverry Alvaro , Suarez Juan , Noya-Chaveco Pedro , Elmir Samir , Jean Reynald , Pettengill James B , Hollinger Katherine A , Chou Kyson , Williams-Hill Donna , Zaki Sherif , Muehlenbachs Atis , Keating M Kelly , Bhatnagar Julu , Rowlinson Marie-Claire , Chiribau Calin , Rivera Lillian
Published: November 2018

Background

On 29 April 2015, the Florida Department of Health in Miami-Dade County (DOH Miami-Dade) was notified by a local dermatologist of 3 patients with suspected nontuberculous mycobacterial (NTM) infection after receiving tattoos at a local tattoo studio.

Methods

DOH Miami-Dade conducted interviews and offered testing, described below, to tattoo studio clients reporting rashes. Culture of clinical isolates and identification were performed at the Florida Bureau of Public Health Laboratories. Characterization of NTM was performed by the Centers for Disease Control and Prevention and the US Food and Drug Administration (FDA), respectively. Whole-genome sequencing (WGS) and single-nucleotide polymorphism (SNP) analyses were used to construct a phylogeny among 21 Mycobacterium isolates at the FDA.

Results

Thirty-eight of 226 interviewed clients were identified as outbreak-associated cases. Multivariate logistic regression revealed that individuals who reported gray tattoo ink in their tattoos were 8.2 times as likely to report a rash (95% confidence interval, 3.1–22.1). Multiple NTM species were identified in clinical and environmental specimens. Phylogenetic results from environmental samples and skin biopsies indicated that 2 Mycobacterium fortuitum isolates (graywash ink and a skin biopsy) and 11 Mycobacterium abscessus isolates (5 from the implicated bottle of graywash tattoo ink, 2 from tap water, and 4 from skin biopsies) were indistinguishable. In addition, Mycobacterium chelonae was isolated from 5 unopened bottles of graywash ink provided by 2 other tattoo studios in Miami-Dade County.

Conclusions

WGS and SNP analyses identified the tap water and the bottle of graywash tattoo ink as the sources of the NTM infections.
Measles Seroprevalence and Vaccine Responses in Human Immunodeficiency Virus–infected Adolescents and Adults: A Systematic Review
Authors: Loevinsohn Gideon , Rosman Lori , Moss William J
Published: November 2018

Background

The World Health Organization (WHO) recommends an additional dose of measles-containing vaccine (MCV) for human immunodeficiency virus (HIV)–infected children receiving highly active antiretroviral therapy following immune reconstitution. We conducted a systematic review to synthesize available evidence regarding measles seroprevalence and measles vaccine immunogenicity, efficacy, and safety in HIV-infected adolescents and adults to provide the evidence base for recommendations on the need for measles vaccination.

Methods

We conducted searches of 8 databases through 26 September 2017. Identified studies were screened independently by 2 reviewers.

Results

The search identified 30 studies meeting inclusion criteria. Across studies, measles seroprevalence among HIV-infected adolescents and adults was high (median, 92%; 27 studies), with no significant difference compared to HIV-uninfected participants (10 studies). In 6 studies that evaluated the immunogenicity of MCVs among seronegative HIV-infected adults, measles seropositivity at end of follow-up ranged from 0% to 56% (median, 39%). No severe adverse events were reported following measles vaccination in HIV-infected patients.

Conclusions

Based on similar measles seroprevalence between HIV-infected and HIV-uninfected adolescents and adults, and the low response to vaccination, these studies do not support the need for an additional dose of MCV in HIV-infected adolescents and adults. These findings support WHO guidelines that measles vaccine be administered to potentially susceptible, asymptomatic HIV-infected adults, and may be considered for those with symptomatic HIV infection if not severely immunosuppressed. Measles-susceptible adolescents and adults, regardless of HIV status, may require targeted vaccination efforts to reach critical vaccination thresholds and achieve regional elimination goals.
Prevalence and risk factors of root resorption of adjacent teeth in maxillary canine impaction, among untreated children and adolescents
Authors: Rafflenbeul Frédéric , Gros Catherine-Isabelle , Lefebvre François , Bahi-Gross Sophie , Maizeray Raphaëlle , Bolender Yves
Published: November 2018

Objectives

The aim of this retrospective study was to assess in maxillary canine impaction cases both the prevalence of root resorption of adjacent teeth among untreated children and adolescents, and its associated risk factors.

Subjects and methods

Sixty subjects (mean age 12.2 years; SD 1.9; range 8–17 years) with 83 displaced maxillary canines and without any past or ongoing orthodontic treatment were included in this study. The presence of root resorption was evaluated on images from a single cone beam computed tomography (CBCT) unit. Potential risk factors were measured on the CBCT images and on panoramic reconstructions of the 3D data sets. The sample was characterized by descriptive statistics and multiple logistic regressions were performed to predict root resorption.

Results

Root resorption of at least one adjacent tooth was detected in 67.5 per cent of the affected quadrants. It was found that 55.7 per cent of the lateral incisors, 8.4 per cent of the central incisors, and 19.5 per cent of first premolars were resorbed. Of the detected resorptions, 71.7 per cent were considered slight, 14.9 per cent moderate, and 13.4 per cent severe. Contact between the displaced canine(s) and the adjacent teeth roots was the only identified statistically significant risk factor, all teeth being considered (odds ratio [OR] = 18.7, 95% confidence interval: 2.26–756, P < 0.01). An enlarged canine dental follicle, a peg upper lateral, or an upper lateral agenesis were not significantly associated with root resorption of adjacent teeth, nor were age nor gender.

Conclusions

Root resorption of adjacent teeth was detected in more than two-thirds of a sample of sixty untreated children and adolescents.
Exponential Concentration for Zeroes of Stationary Gaussian Processes
Authors: Basu Riddhipratim , Dembo Amir , Feldheim Naomi , Zeitouni Ofer
Published: November 2018

We show that for any centered stationary Gaussian process of absolutely integrable covariance, whose spectral measure has compact support, or finite exponential moments (and some additional regularity), the number of zeroes of the process in $[0,T]$ is within $\eta T$ of its mean value, up to an exponentially small in $T$ probability.
Integrating ontologies of human diseases, phenotypes, and radiological diagnosis
Authors: Finke Michael T , Filice Ross W , Kahn Charles E
Published: November 2018

Mappings between ontologies enable reuse and interoperability of biomedical knowledge. The Radiology Gamuts Ontology (RGO)—an ontology of 16 918 diseases, interventions, and imaging observations—provides a resource for differential diagnosis and automated textual report understanding in radiology. An automated process with subsequent manual review was used to identify exact and partial matches of RGO entities to the Disease Ontology (DO) and the Human Phenotype Ontology (HPO). Exact mappings identified equivalent concepts; partial mappings identified subclass and superclass relationships. A total of 7913 distinct RGO entities (46.8%) were mapped to one or both of the two target ontologies. Integration of RGO’s causal knowledge resulted in 9605 axioms that expressed direct causal relationships between DO diseases and HPO phenotypic abnormalities, and allowed one to formulate queries about causal relations using the abstraction properties in those two ontologies. The mappings can be used to support automated diagnostic reasoning, data mining, and knowledge discovery.
The computational content of atomic polymorphism
Authors: Ferreira Gilda , Vasconcelos Vasco T
Published: November 2018

We show that the number-theoretic functions definable in the atomic polymorphic system (${\mathbf{F}}_{\mathbf{at}}$) are exactly the extended polynomials. Two proofs of the above result are presented: one, reducing the functions’ definability problem in ${\mathbf{F}}_{\mathbf{at}}$ to definability in the simply typed lambda calculus ($\lambda ^{\rightarrow }$) and the other, directly adapting Helmut Schwichtenberg’s strategy for definability in $\lambda ^{\rightarrow }$ to the atomic polymorphic setting. The uniformity granted in the polymorphic system, when compared with the simply typed lambda calculus, is emphasized.
Dancing with Venus in the shadow of the Earth: a pair of genetically related near-Earth asteroids trapped in a mean-motion resonance
Authors: de la Fuente Marcos C , de la Fuente Marcos R
Published: November 2018

YORP-induced fission events may form dynamically coherent pairs or even families of asteroids. The outcome of this process is well documented among members of the main asteroid belt, but not in the case of the near-Earth asteroid (NEA) population because their paths randomize very efficiently in a short time-scale. Mean-motion resonances (MMRs) may stabilize the orbits of small bodies by making them avoid close encounters with planets. In theory, YORP-induced fission of asteroids trapped in MMRs can preserve evidence of this process even in near-Earth space. Here, we show that two NEAs, 2017 SN16 and 2018 RY7, are currently following an orbital evolution in which their relative mean longitude does not exhibit any secular increase due to the stabilizing action of the 3:5 MMR with Venus. The mechanism that makes this configuration possible may be at work both in the Solar system and elsewhere. Our analysis suggests that the pair 2017 SN16–2018 RY7 may have had its origin in one out of two mechanisms: YORP-induced splitting or binary dissociation.
Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers or both in incident end-stage renal disease patients without cardiovascular disease: a propensity-matched longitudinal cohort study
Authors: Ferreira João Pedro , Couchoud Cécile , Gregson John , Tiple Aurélien , Glowacki François , London Gerard , Agarwal Rajiv , Rossignol Patrick
Published: November 2018

Background

End-stage renal disease (ESRD) patients even without known cardiovascular (CV) disease have high mortality rates. Whether neurohormonal blockade treatments improve outcomes in this population remains unknown. The aim of this study was to assess the effect of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs), β-blockers or both in all-cause mortality rates in incident ESRD patients without known CV disease starting renal replacement therapy (RRT) between 2009 and 2015 in the nationwide Réseau Epidémiologie et Information en Néphrologie registry.

Methods

Patients with known CV disease and those who started emergency RRT, stopped RRT or died within 6 months were excluded. Propensity score matching models were used. The main outcome was all-cause mortality.

Results

A total of 13 741 patients were included in this analysis. The median follow-up time was 24 months. When compared with matched controls without antihypertensive treatment, treatment with ACEi/ARBs, β-blockers and ACEi/ARBs + β-blockers was associated with an event-rate reduction per 100 person-years: ACEi/ARBs 7.6 [95% confidence interval (CI) 7.1–8.2] versus matched controls 9.5 (8.8–10.1) [HR 0.76 (95% CI 0.69–0.84)], β-blocker 7.1 (6.6–7.7) versus matched controls 9.5 (8.5–10.2) [HR 0.72 (0.65–0.80)] and ACEi/ARBs + β-blockers 5.8 (5.4–6.4) versus matched controls 7.8 (7.2–8.4) [HR 0.68 (0.61–0.77)].

Conclusions

Neurohormonal blocking therapies were associated with death rate reduction in incident ESRD without CV disease. Whether these relationships are causal will require randomized controlled trials.
EU’s Emerging Strategic Cyber Culture(s)
Authors: Nagyfejeo Eva
Published: November 2018

This paper focuses on the European Union’s collective efforts to address cybercrime and argues that the European Union (consisting of 28 Member States) has more than a single overarching ‘strategic cyber culture’. This is due to the differences in attitudes and experiences of cyber security among Member States that has created fragmentation in the EU’s cyber security institutional system. This paper therefore considers the institutional developments by examining the main ‘carriers’ of EU strategic cyber culture such as the Directorate-General for Migration and Home Affairs (DG HOME), Eurojust, and Europol/EC3, together with the strengths and weaknesses of the EU’s particular approach to cybercrime.
Recommendations for the management of secondary hypogammaglobulinaemia due to B cell targeted therapies in autoimmune rheumatic diseases
Authors: Wijetilleka Sonali , Jayne David R , Mukhtyar Chetan , Ala Aftab , Bright Philip D , Chinoy Hector , Harper Lorraine , Kazmi Majid A , Kiani-Alikhan Sorena , Li Charles K , Misbah Siraj A , Oni Louise , Price-Kuehne Fiona E , Salama Alan D , Workman Sarita , Wrench David , Karim Mohammed Yousuf
Published: November 2018

Objectives

The association of B cell targeted therapies with development of hypogammaglobulinaemia and infection is increasingly recognized. Our aim was to develop consensus recommendations for immunoglobulin replacement therapy for management of hypogammaglobulinaemia following B cell targeted therapies in autoimmune rheumatic diseases.

Methods

A modified Delphi exercise involved a 17-member Taskforce committee, consisting of immunologists, rheumatologists, nephrologists, haematologists, a gastroenterologist, an immunology specialist nurse and a patient representative. The first round identified the most pertinent topics to address in the recommendations. A search string was agreed upon for the identification of publications in PubMed focusing on these areas, for a systematic literature review. Original data was presented from this review to the Taskforce committee. Recommendations from the British Society for Rheumatology, the UK Department of Health, EULAR, the ACR, and the American Academy of Allergy, Asthma, and Immunology were also reviewed. The evidence was discussed in a face-to-face meeting to formulate recommendation statements. The levels of evidence and statements were graded according to Scottish Intercollegiate Guidelines Network methodology.

Results

Three overarching principles, eight recommendation statements and a research agenda were formulated. The Taskforce committee voted on these statements, achieving 82–100% agreement for each recommendation. The strength of the recommendations was restricted by the low quality of the available evidence, with no randomized controlled trial data. The recommendations cover risk factors, monitoring, referral for hypogammaglobulinaemia; indications, dosage and discontinuation of immunoglobulin replacement therapy.

Conclusion

These are the first recommendations specifically formulated for B cell targeted therapies related to hypogammaglobulinaemia in autoimmune rheumatic diseases. The recommendations are to aid health-care professionals with clinical decision making for patients with hypogammaglobulinaemia.
Factor Analysis of Negative Symptom Items in the Structured Interview for Prodromal Syndromes
Authors: Azis Matilda , Strauss Gregory P , Walker Elaine , Revelle William , Zinbarg Richard , Mittal Vijay
Published: November 2018

Background

Negative symptoms occur early in the clinical high risk (CHR) state and indicate increased risk of conversion to psychotic disorder and poor functional outcome. However, while the negative symptom domain has shown to be parsimoniously explained by a 2-factor construct in schizophrenia, there has yet to be an established factor structure of negative symptoms in CHR.

Methods

214 individuals meeting the Structured Interview for Psychosis-Risk Syndromes (SIPS) criteria for CHR were recruited through 3 active research programs in the United States. Exploratory Factor Analysis was conducted on the 6 negative symptom items of the SIPS, and factors were evaluated with respect to functional outcome and depression.

Results

Factor analysis indicated a 2-factor hierarchical model with 2 negative symptom dimensions reflecting volition (Occupational Functioning and Avolition) and emotion (Expression of Emotion, Experience of Emotion and Social Anhedonia). Linear Regression showed that the emotion factor was associated with poor social function, and the volition factor was associated with poor role function and depression.

Conclusions

Similar to factor solutions identified in adults diagnosed with psychotic disorders, results indicated that the SIPS negative symptom subscale is not a unidimensional construct. Rather, the SIPS negative subscale has 2 distinct factors that have different associations with clinical outcome and should be interpreted independently. Results have significant relevance for informing the valid assessment and conceptual interpretation of early clinical phenomenology in the psychosis prodrome.
RELATIONSHIP BETWEEN ABNORMALITIES OF PHOTORECEPTOR MICROSTRUCTURES AND MICROVASCULAR STRUCTURES DETERMINED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN EYES WITH BRANCH RETINAL VEIN OCCLUSION
Authors: Ogasawara Yasunobu , Iwase Takeshi , Yamamoto Kentaro , Ra Eimei , Terasaki Hiroko
Published: November 2018

Purpose:

To determine whether the size of the foveal avascular zone (FAZ) is significantly correlated with the best-corrected visual acuity (BCVA) and to examine the relationship between the size and microstructural changes of the photoreceptors in eyes with a branch retinal vein occlusion.

Methods:

The medical records of 69 eyes of patients (mean age, 64.6 ± 11.7 years) with a branch retinal vein occlusion were reviewed after the resolution of macular edema. All the patients underwent optical coherence tomography angiography for measurement of the FAZ area and spectral domain optical coherence tomography for determination of microstructural changes of the photoreceptors at the fovea.

Results:

The superficial and deep FAZ areas in eyes with a branch retinal vein occlusion were 0.39 ± 0.36 mm2 and 0.63 ± 0.18 mm2, respectively, and both were significantly larger than those observed in the fellow eyes (both, P < 0.001). The superficial FAZ area correlated with the posttreatment BCVA (r = 0.285, P = 0.027) but not with any parameters regarding the microstructures of the photoreceptors. Multivariate linear regression analysis showed that the pretreatment BCVA (β = 0.519, P < 0.001) and integrity of the external limiting membrane (β = −0.373, P = 0.001) were independent factors that significantly correlated with the posttreatment BCVA.

Conclusion:

There was no significant correlation between the FAZ area and microstructural parameters. However, the integrity of the external limiting membrane was significantly correlated with the posttreatment BCVA in eyes with a branch retinal vein occlusion.
POSTTREATMENT POLYP REGRESSION AND RISK OF MASSIVE SUBMACULAR HEMORRHAGE IN EYES WITH POLYPOIDAL CHOROIDAL VASCULOPATHY
Authors: Cho Joon Hee , Park Young Joo , Cho Soo Chang , Ryoo Na-Kyung , Cho Kwan Hyuk , Park Sang Jun , Park Kyu Hyung , Woo Se Joon
Published: November 2018

Purpose:

To study the association between the risk of massive submacular hemorrhage (SMH) and polyp regression after initial treatment of polypoidal choroidal vasculopathy using long-term follow-up data.

Methods:

Retrospective study of 223 patients who were diagnosed with polypoidal choroidal vasculopathy and were followed up for up to 11 years. Subjects were categorized into “regression” and “no regression” groups, according to their polyp status after the initial treatment. Kaplan–Meier survival analyses were performed on development of massive SMH. The association between treatment methods and the occurrence of massive SMH was also analyzed.

Results:

The incidence rates of massive SMH at 3, 6, and 9 years in the “no regression” group were 6.50, 22.59, and 38.03%, respectively, and in the “regression” group were 1.14, 6.47, and 10.92%, respectively (P = 0.005, log-rank test). The hazard ratio of massive SMH was 3.677 for cluster-type polyps and 0.271 for polyp regression after initial treatment. A higher rate of polyp regression was associated with photodynamic therapy (PDT) than anti-VEGF monotherapy (64.4 vs. 33.3%, P < 0.001). Additional anti-VEGF treatments after initial PDT showed lower risk of massive SMH than PDT only. (9.5 vs 38.5%, P = 0.005).

Conclusion:

The long-term risk of massive SMH after initial treatment on polypoidal choroidal vasculopathy is significantly higher in eyes with persistent polyps than those with regressed polyps. Ophthalmologists should pay attention to the risk of massive SMH and the polyp status when treating polypoidal choroidal vasculopathy.
Behavioural discrimination of noxious stimuli in infants is dependent on brain maturation
Authors: Green Gabrielle , Hartley Caroline , Hoskin Amy , Duff Eugene , Shriver Adam , Wilkinson Dominic , Adams Eleri , Rogers Richard , Moultrie Fiona , Slater Rebeccah
Published: November 2018

Changes in facial expression are an essential form of social communication and in nonverbal infants are often used to alert care providers to pain-related distress. However, studies of early human brain development suggest that premature infants aged less than 34 weeks' gestation do not display discriminative brain activity patterns to equally salient noxious and innocuous events. Here we examine the development of facial expression in 105 infants, aged between 28 and 42 weeks' gestation. We show that the presence of facial expression change after noxious and innocuous stimulation is age-dependent and that discriminative facial expressions emerge from approximately 33 weeks' gestation. In a subset of 49 infants, we also recorded EEG brain activity and demonstrated that the temporal emergence of facial discrimination mirrors the developmental profile of the brain's ability to generate discriminative responses. Furthermore, within individual infants, the ability to display discriminative facial expressions is significantly related to brain response maturity. These data demonstrate that the emergence of behavioural discrimination in early human life corresponds to our brain's ability to discriminate noxious and innocuous events and raises fundamental questions as to how best to interpret infant behaviours when measuring and treating pain in premature infants.
Comparison of dipeptidyl peptidase-4 inhibitors and pioglitazone combination therapy versus pioglitazone monotherapy in type 2 diabetes
Authors: Wang Ben , Sun Yan , Sang Yiquan , Liu Xuekui , Liang Jun
Published: November 2018

Background:

Dipeptidyl peptidase-4 (DPP-4) inhibitor and pioglitazone combination therapy have been widely used for patients with inadequate glycemic control on monotherapy. This meta-analysis assessed the efficacy and safety of this combination therapy in patients with type 2 diabetes mellitus (T2DM).

Methods:

We searched the MEDLINE, Embase, and Cochrane databases. Studies were eligible if they were randomized controlled trials (RCTs) on DPP-4 inhibitor and pioglitazone combination therapy in patients with T2DM through the end of February 2016, using the keywords “alogliptin,” “dutogliptin, ” “linagliptin,” “saxagliptin,” “sitagliptin,” “vildagliptin,” “gliptins,” “DPP-4 inhibitor,” and “pioglitazone.” RCTs were selected if they compared DPP-4 inhibitors and pioglitazone as combination therapy; treatment duration was ≥12 weeks; and the reported data included hemoglobin A1c (HbA1c) or fasting plasma glucose (FPG) change, total or any other system Adverse Events (AEs). We estimated effect size with random-effects or fixed-effects meta-analysis, I
2 statistic was used to estimate heterogeneity of results.

Results:

Seven RCTs were included. Compared with pioglitazone monotherapy, combination DPP-4 inhibitor and pioglitazone therapy were associated with increased reduction in HbA1c ([MD]-0.64%;−0.73 to −0.55) and FPG ([MD] −0.94; −1.12 to −0.76) levels, more patients in the combination therapy groups versus pioglitazone monotherapy groups had an A1c of < 7% ([OR]2.52; 2.18, 3.17) at the end of the studies, but was not associated with further reduction in higher risk of hypoglycaemia, edema, or any other system AEs. We also noticed that DPP-4 inhibitor and pioglitazone combination therapy were associated with better improvement of pancreatic β-cell function.

Conclusions:

DPP-4 inhibitor and pioglitazone combination therapy provided better glycemic control, both according to HbA1c and FPG levels, than pioglitazone monotherapy. Safety analysis showed well tolerance of combination therapy, even in hypoglycemic and edema AEs. However, additional large-scale, high quality, long-term follow-up clinical trials are necessary to confirm its long-term effectiveness.
Common atrium and the associated malformations
Authors: Zhang Yi , Yang Zhi-gang , Yang Meng-xi , Shi Ke , Li Rui , Diao Kai-yue , Guo Ying-kun
Published: November 2018

Common atrium (CA) is a rare complex congenital heart disease. The studies of CA are mostly case reports, while few have been done regarding its morphological characteristics. We aimed to determine CA characteristics and diagnostic accuracy in assessing associated malformations in these patients with low-dose dual-source computed tomography (DSCT).

Twenty-one pediatric and adolescent CA patients underwent low-dose DSCT. Different ventricular types and associated malformations were assessed. The diagnostic accuracy of DSCT and transthoracic echocardiography (TTE) in evaluating associated malformations were assessed. The effective doses of DSCT were calculated.

Patients (n = 21) were divided into CA with biventricular physiology (n = 7) and CA with single ventricle (SV) (n = 14). There were 3 types of SV morphology: single left ventricle (n = 5), single right ventricle (n = 6), and undifferentiated ventricle (n = 3). In all, 22 associated malformations were seen in CA and 56 in CA with SV. DSCT was superior to TTE for detecting intracardiac anomalies (sensitivity: DSCT, 92.31% vs TTE, 76.92%), great vessels anomalies (sensitivity: DSCT, 100.00% vs TTE, 77.50%), and of collateral vessels (sensitivity: DSCT, 100% vs TTE, 20.00%). The estimated mean effective dose was 0.95 ± 0.44 mSv (<1 mSv).

This study indicated that low-dose DSCT is an ideal alternative for pediatric and adolescent patients with CA, providing morphological details of CA and associated malformations with high accuracy.
Cancer antigen-125 levels correlate with pleural effusions and COPD-related complications in people living at high altitude
Authors: Li Shengmei , Ma Huiying , Gan Lijun , Ma Xiuqing , Wu Shangjie , Li Mangui , Tang Chih-Hsin , Tsai Hsiao-Chi
Published: November 2018

Chronic obstructive pulmonary disease (COPD) is the most frequently encountered progressive lung disease in clinical practice. This study sought to determine the predictive ability of the tumor biomarker cancer antigen-125 (CA-125) in the identification of COPD in a cohort of 284 patients with COPD living at high altitude (with an average elevation of over 2500 m).

Patients were classified by pleural effusion volumes into 4 categories and serum CA-125 concentrations were measured in each category. The analyses revealed that CA-125 concentrations were positively and significantly correlated with pleural effusion volume. CA-125 concentrations were also positively correlated with pulmonary heart disease and acute exacerbations of COPD, and negatively correlated with pulmonary hypertension.

The study evidence suggests that serum CA-125 concentrations are positively correlated with the risk of pleural effusions among patients with COPD living in high-altitude areas, and that CA-125 concentrations are also correlated with pulmonary heart disease, acute exacerbations, and pulmonary hypertension.
Radial artery occlusion with a kaolin-filled pad after transradial cardiac catheterization
Authors: Chiang Chun-Yen , Chang Weng-Ting , Ho Chung-Han , Hong Chon-Seng , Shih Jhih-Yuan , Wu Wen-Shiann , Chen Zhih-Cherng , Chou Ming-Ting
Published: November 2018

Radial artery occlusion (RAO) occurs in 2% to 18% of patients after transradial access (TRA) cardiac catheterization. Using a kaolin-filled pad (QuikClot) reduces compression time during TRA and might reduce RAO. We examined the RAO risk with the kaolin-filled pad after TRA cardiac catheterization.

This was a prospective cross-sectional study of 260 patients who underwent TRA cardiac catheterization in a cardiac ward of a Medical Center from 2012 to 2016. Patients were randomly assigned to 1 of 2 groups: the case group (n = 130) was postoperatively treated with a kaolin-filled pad, and the control group (n = 130) was treated with conventional hemostasis. Color duplex ultrasound was used to evaluate the 24-hour and 1-month postoperative radial artery flow velocity, diameter, patency, and RAO risk.

RAO risk was not significantly different between the case and control groups after 24 hours (4.6% vs 5.4%, P = .776) or after 1 month (5.4% vs 6.1%, P = .789), regardless of whether it was a first TRA cardiac catheterization (after 24 hours [P = .153] or after 1month [P = .617], respectively) or a repeated TRA cardiac catheterization (after 24 hours [P = .754] or after 1month [P = .753], respectively).

Using a kaolin-filled pad after TRA cardiac catheterization did not significantly reduce RAO risk compared with conventional hemostasis.
Phase IV noninferiority controlled randomized trial to evaluate the impact on diagnostic thinking and patient management and the test–retest reproducibility of the Gaxilose test for hypolactasia diagnosis
Authors: Monsalve-Hernando Carmen , Crespo Laura , Ferreiro Blanca , Martín Verónica , Aldeguer Xavier , Opio Verónica , Fernández-Gil Pedro Luis , Gaspar María Jesús , Romero Eduardo , Lara Carmen , Santander Cecilio , Torrealba Leyanira , Savescu Theodora , Hermida Carmen
Published: November 2018

Background:

The diagnostic accuracy of the Gaxilose test (GT) for hypolactasia diagnosis has already been proved. The objectives of this clinical trial were to demonstrate the noninferiority of the GT compared to the hydrogen breath test (HBT) on the impact on diagnostic thinking and patient management, to evaluate the GT reproducibility with urine accumulated from 0 to 4 hours and from 0 to 5 hours and to assess test safety.

Methods:

We conducted a randomized, parallel, noninferiority clinical trial. Patients with clinical symptoms suggestive of lactose intolerance were screened for inclusion and randomly assigned to the GT arm or the HBT arm of the study. The impact on diagnostic thinking and patient management was analyzed with pretest and posttest questionnaires in which the investigators indicated their estimated probability of hypolactasia diagnosis and the intended management before and after the GT or the HBT (noninferiority margin: −10%). The primary outcome of the study was the impact on diagnostic thinking, expressed as the mean of the absolute values of the differences between the pretest and posttest probabilities of hypolactasia diagnosis. Patients randomized to the GT arm performed also the retest to evaluate the reproducibility of the GT.

Results:

A total of 147 patients were included in the intend-to-treat (ITT) population. Among them, 74 performed the HBT and 73 performed the GT. The results proved the noninferiority of the GT compared to the HBT on the impact on diagnostic thinking (ImpactGT = 31.74 ± 23.30%; ImpactHBT = 24.28 ± 19.87%; ΔGT−HBT = 7.46%; 95% confidence interval of ΔGT−HBT: 1.55%, infinite) and on patient management. The test–retest reproducibility was better for the GT with urine accumulated from 0 to 5 h: the intraclass correlation coefficient (ICC) was 0.5761, and the Kappa coefficient was 0.7548, indicative of substantial agreement between both tests. No serious adverse events were reported during the study.

Conclusions:

The GT has an impact on diagnostic thinking and patient management noninferior to that of the HBT, is reproducible and well tolerated. These results prove the clinical benefit of its use in the clinical practice (ClinicalTrials.gov identifier: NCT02636413).
Meta-analysis of clinical trials comparing the efficacy and safety of liposomal cisplatin versus conventional nonliposomal cisplatin in nonsmall cell lung cancer (NSCLC) and squamous cell carcinoma of the head and neck (SCCHN)
Authors: Xu Bei , Zeng Min , Zeng Jiawei , Feng Jiafu , Yu Lin
Published: November 2018

Background:

While liposomal cisplatin has shown enhanced drug tolerability and higher targeting property as compared with the conventional cisplatin, the doubt remains whether lipoplatin could improve its anticancer efficacy. What's more, there is still no systematic evaluation of the safety profiles of lipoplatin comparing with original cisplatin. Thus, we performed a systematic literature search for randomized clinical trials directly comparing efficacy and safety of liposomal cisplatin versus its conventional nonliposomal cisplatin.

Methods:

The electronic search was conducted in PubMed, Embase, The Cochrane Library, and ClinicalTrials.gov from inception to February 10, 2018. The pooled odds ratio (OR) and 95% confidence intervals (CIs) of progressive disease (PD), partial response (PR), stable disease (SD), and adverse events (AEs) were obtained to assess the efficacy and safety. Heterogeneity was estimated using the I

2
test (I

2
 > 50%, significant heterogeneity).

Results:

The search yielded 5 clinical trials that meet inclusion criteria, with a total of 523 patients. We found that the liposome encapsulated cisplatin was more clinical efficacious than cisplatin as assessed by PD rate (OR, 0.46; 95% CI, 0.28–0.74; P = .002), while subgroup analysis of the only nonsmall cell lung cancer (NSCLC) patients showed higher response rates in PR (OR, 0.46; 95% CI, 0.28–0.74; P = .002) and PD (OR, 0.46; 95% CI, 0.28–0.74; P = .002) simultaneously. In addition, the toxicity meta-analysis revealed lipoplatin was much less toxic than the original cisplatin, with respect to grade 3 to 4 neurotoxicity (OR, 0.18; 95% CI, 0.04–0.74; P = .02), grade 3 to 4 leukopenia (OR, 0.47; 95% CI, 0.26–0.85; P = .01), grade 3 to 4 neutropenia (OR, 0.26; 95% CI, 0.09–0.71; P = .009), grade 1 and 2 nausea/vomiting (OR, 0.50; 95% CI, 0.32–0.77; P = .002), and grade 3 and 4 asthenia (OR, 0.11; 95% CI, 0.03–0.42; P = .001).

Conclusions:

This meta-analysis revealed that with both NSCLC and squamous cell carcinoma of the head and neck (SCCHN) patients, liposomal cisplatin-based chemotherapy offers significant advantages regarding the PD and reduced toxicities relative to conventional cisplatin.
Ureteral inflammatory myofibroblastic tumor
Authors: Li Faping , Guo Hui , Qiu Heping , Hou Yuchuan
Published: November 2018

Rationale:

Inflammatory myofibroblastic tumor (IMT) is a rare soft-tissue neoplasm which has been described in a variety of locations. In the urogenital system, IMT predominantly occurs in the bladder and the kidney. IMT arising from the ureter is exceedingly rare and has been sporadically reported before.

Patient concerns:

We reported an extremely exceptional case of IMT arising from the ureteral submucosa in a 54-year-old man. The patient was hospitalized with the main complaint of intermittent and moderate left abdominal pain for 2 months.

Diagnoses and Interventions:

Computed tomography scan revealed a nearly circular mass in the left upper ureter. Ureteroscopy showed that the ureteral lumen mucosa was smooth. However, the upper ureter was compressed and narrow. Renal dynamic imaging was performed and the measured glomerular filtration rate was 46.98 mL/min (right renal) and 9.77 mL/min (left renal), respectively. A retroperitoneoscopic radical nephroureterectomy was performed. The histopathologic examination revealed that the soft-tissue neoplasm was mainly composed of myofibroblastic spindle cells proliferation with mixed inflammatory infiltrate, containing lymphocytes, neutrophils, and eosinophils. On immunohistochemical staining, the tumor was positive for smooth muscle actin and Ki-67 (<1%+), indicating a confirmed diagnosis of ureteral IMT.

Outcomes:

The patient recovered well with no occurrence of complications. At 3-year follow-up, there was no radiologic evidence of tumor recurrence or metastasis and the man was well.

Lessons:

Ureteral IMT is extremely rare and often asymptomatic, resulting in delayed diagnosis. Radiologic evidences may be suggestive of the diagnosis of IMT. However, it is necessary to make an accurate diagnosis in terms of histopathologic assessment. Complete lesion excision is the best therapeutic approach with rare recurrences and excellent survival.
CT diagnosis for metastasis of clear cell renal cell carcinoma to the pancreas
Authors: Yu Qian , Kan Fanggong , Ma Zhoupeng , Wang Tianke , Lin Guansheng , Chen Bingye , Zhao Wenliang
Published: November 2018

Rationale:

Clear cell renal cell carcinoma (CCRCC) metastasis to pancreas is clinically rare. Misdiagnosis for these cases is frequently due to the low incidence, lack of specific clinical symptoms, and laboratory results.

Patient concerns:

Three female patients aged 47 years, 69 years, and 76 years, respectively, were admitted to hospital for routine examination after resection of clear cell carcinoma of kidney for 69 months, 57 months, and 123 months, respectively. All 3 cases had no specific clinical symptoms. Routine laboratory tests and common tumor markers including CEA, AFP, CA19-9, and CA125 showed no obvious abnormality.

Diagnosis:

All 3 cases were finally diagnosed with CCRCC metastasis to pancreas on the basis of CT and pathological findings. On unenhanced CT, foci of the pancreas showed single or multiple nodules or masses with mildly low or equal density and obscure boundary. On enhanced CT, the enhanced mode of foci was similar to CCRCC and showed “fast in fast out.” The main body was confined in the pancreas. The peripheral structure was clear relatively. Obstruction of common bile duct, main pancreatic duct, and local infringement of foci cannot be seen. Additional metastases of right adrenal gland can be seen in one case.

Interventions:

All 3 cases underwent CT examination and surgical treatment, with complete removal of metastatic tumors.

Outcomes:

All 3 cases underwent surgical treatment successfully, and recovered successfully after operation.

Lessons:

The manifestations of pancreatic metastases from CCRCC on CT show certain characteristics, which may be useful to assess the histological features of pancreatic metastases from CCRCC and facilitate the preoperative diagnosis.
Efficacy of tasquinimod in men with metastatic castration-resistant prostate cancer
Authors: Gong Ping , Liu Hongjian , Liu Xinyu , Zhou Ge , Liu Meitian , Yang Xiaodi , Xiong Wenjing , Wang Qi , Ma Juan , Ren Zheng , He Minfu , Zhang Xiumin
Published: November 2018

Background:

Tasquinimod is an oral quinoline-3-carboxamide derivative for the treatment of metastatic castration-resistant prostate cancer (mCRPC). Tasquinimod has antiangiogenic, immunomodulatory, and antimetastatic properties, but it is also associated with toxicities, including skeletal pain, digestive disorders, fatigue, insomnia, and mental disorders. We aimed to perform a meta-analysis to evaluate the efficacy, safety, and long-term survival for tasquinimod in patients with mCRPC.

Methods:

Searches were carried out in PubMed, Embase, and the Cochrane Library. Eligible articles included randomized clinical trials (RCTs) comparing systemic or combination therapy (excluding primary or secondary androgen deprivation therapy, bone protective agents, or radionuclides) with placebo in men with mCRPC.

Results:

Three RCTs were selected for final evaluation. The pooled results from the 3 studies indicated that tasquinimod was associated with good radiologic progression-free survival (rPFS) in mCRPC. For adverse effects (AEs), the results of meta-analysis indicated that patients with mCRPC who received tasquinimod had obvious anemia (risk ratio (RR) 1.35, 95% confidence interval (CI) 1.06–1.73, P = .02), back pain (RR: 1.57, 95% CI: 1.01–2.47, P = .05), pain in the extremities (RR: 1.90, 95% CI: 1.14–3.17, P = .01), insomnia (RR: 1.50, 95% CI: 1.03–2.17, P = .03), vomiting (RR: 1.52, 95% CI: 1.04–2.21, P = .03), and peripheral edema (RR: 1.52, 95% CI: 1.03–2.23, P = .03).

Conclusions:

Tasquinimod is associated with better rPFS in mCRPC. The toxicity of tasquinimod requires further investigation, it is not recommended for routine clinical use.