bluuebunny/crossref_metadata_2025 huggingface dataset:
Calibration and Statistical Performance of Al2O3:C Optically Stimulated Luminescent Dosimeters With and Without Annealing Using a 137Cs Source
Authors: Liu Kevin , Golduber Robert M. , Trimas David J. , Abraham Sara A. , Latosz Logan V. , Mapes Jasmine L. , Miller Jonathan M. , Kearfott Kimberlee J.
Published: November 2018

A series of experiments were conducted using commercially available Al2O3:C optically stimulated luminescent dosimeters to provide a technical basis for their precise calibration and statistical performance at irradiated air kerma doses between 0.02 mGy and 5 mGy using 137Cs. This study examines the dose response linearity, studies the background signal for annealed dosimeters, and compares the statistical performance of dosimeters that were annealed and not annealed prior to their irradiation and readout. The average and standard deviation for the response of groups of dosimeters annealed and nonannealed prior to their irradiation were determined at each delivered dose. The batch of dosimeters that were annealed prior to their irradiation exhibited a coefficient of variation in its mean dose response below 10% when using three or more irradiation trials at each delivered air kerma dose between 0.02 mGy and 5 mGy. The reader calibration factor was calculated using the response of the annealed batch of dosimeters and was determined to be 756 ± 7 photomultiplier tube counts per mGy. Best estimates of the individual sensitivity factors were determined to be between 0.79 and 1.12 for the annealed batch of dosimeters. The minimum number of irradiations required to accurately determine the sensitivity factor of each individual dosimeter is reported with the recommended reader and dosimeter calibration procedures.
Synopsis of the Oak Ridge Radiation Protection Research Needs Workshop
Authors: Davis Jason , Dewji Shaheen Azim , Abelquist Eric , Hertel Nolan
Published: November 2018

Radiation protection is foundational to harnessing the societal benefits of radiation in nuclear energy, security, and medicine applications. Significant challenges in radiation protection remain unaddressed for the nuclear fuel cycle, nuclear medicine, emergency response, national defense, and space exploration, as the United States is lacking a coherent research strategy prioritizing radiation protection mission needs and gaps in scientific knowledge to meet these needs. Research and development in the field of radiation protection calls for cooperation among governmental agencies, emergency responders, research organizations, and the academic community. Amidst atrophying national expertise in radiation protection, the Radiation Protection Research Needs Workshop was spearheaded by the Oak Ridge Associated Universities, Oak Ridge National Laboratory, and the Health Physics Society. This workshop facilitated critical dialogue among radiation stakeholders in the governmental and scientific communities, including national laboratories, academic institutions, and industry partners. The workshop featured presentations representing 12 federal agencies and breakout sessions involving the identification of scientific drivers by subject matter experts in each of the following areas: new fuel cycles/reactors, dosimetry, medical physics, instrumentation and operations, decontamination and decommissioning, space radiation, national defense, emergency response, environmental modeling, and low-dose effects. The goal of this workshop was to seek stakeholder input toward the development of a national strategic research agenda in the field of radiation protection. Consequently, the Health Physics Society has established a Special Task Force on Health Physics Research Needs, tasked with the prioritization of scientific drivers in radiation protection for the development of a national strategic research agenda.
Quality Appraisal of Systematic Reviews for Behavioral Treatments of Attention Disorders in Traumatic Brain Injury
Authors: Roitsch Jane , Redman Rachael , Michalek Anne M. P. , Johnson Rachel K. , Raymer Anastasia M.
Published: November 2018

Objective:

This review appraised the quality of systematic reviews (SRs) and meta-analyses (MAs) to summarize research on behavioral interventions for attention disorders in persons with traumatic brain injury.

Methods:

A search of 7 databases revealed 15 MAs/SRs reporting outcomes for attention treatments in traumatic brain injury. Two examiners independently coded the quality of reviews with the Critical Appraisal of Systematic Review or Meta-Analysis and the Evidence in Augmentative and Alternative Communication Systematic Review Scale.

Results:

The findings of both scales were highly correlated. Four reviews were conducted with high methodologic rigor indicated by a score of 60% or greater on both scales. No other study scored above 45%. Among the well-conducted SRs/MAs, evidence for direct attention training effects was limited to basic attention exercises, with little generalization to functional activities. Strategy training for activities and tasks requiring attentional abilities had a stronger evidence base in 1 rigorous MA.

Conclusions:

This appraisal provides valuable practice information. The conclusions of 4 rigorous reviews suggest that there is only limited positive scientific support for the effects of attention treatments for traumatic brain injury. Future SRs/MAs would benefit from adherence to review guidelines.
A Systematic Review of Sleep-Wake Disturbances in Childhood Traumatic Brain Injury: Relationship with Fatigue, Depression, and Quality of Life
Authors: Botchway Edith N. , Godfrey Celia , Anderson Vicki , Catroppa Cathy
Published: November 2018

Objective:

To systematically appraise the literature on the prevalence, types, and predictors of sleep-wake disturbances (SWD), and on the relationship between SWD, fatigue, depression, and quality of life in children and adolescents with traumatic brain injury (TBI).

Methods:

MEDLINE, PubMed, PsychInfo, Web of Science, and EMBASE databases were searched, reference lists of retrieved articles were also searched for relevant articles, and study methods were evaluated for risk of bias.

Results:

Of the 620 articles assessed, 16 met inclusion criteria. Sleep-wake disturbances were common in childhood TBI. The most common types of SWD reported were insomnia and excessive daytime sleepiness, with mild TBI participants showing a trend toward more sleep maintenance insomnia, while sleep-onset insomnia was typical in those with moderate-severe TBI. Predictors of SWD reported in studies involving mild TBI participants included TBI severity, male sex, preexisting SWD, high body weight, and depression; while injury severity and internalizing problems were associated with SWD in moderate-severe TBI participants. Sleep-wake disturbances were also associated with fatigue and poor quality of life following TBI.

Conclusion:

Sleep-wake disturbances are highly prevalent in childhood TBI, regardless of injury severity. Routine assessments of SWD in survivors of childhood TBI are recommended.
Preliminary Efficacy of Online Traumatic Brain Injury Professional Development for Educators: An Exploratory Randomized Clinical Trial
Authors: Glang Ann E. , McCart Melissa , Slocumb Jody , Gau Jeff M. , Davies Susan C. , Gomez Doug , Beck Laura
Published: November 2018

Objective:

To examine the efficacy of an online traumatic brain injury (TBI) professional development intervention, In the Classroom After Concussion: Best Practices for Student Success.

Design:

A randomized controlled trial with a sample of 100 general educators, who were randomly assigned to the In the Classroom Web site (treatment group) or the LEARNet Web site (control group). Participants completed the pretest, accessed the In the Classroom or LEARNet site and the posttest and completed follow-up assessments 60 days after posttest.

Measures:

(1) Knowledge of effective strategies for working with students with TBI; (2) knowledge application; (3) self-efficacy in handling situations presented in text and video scenarios, and (4) a standardized self-efficacy measure.

Results:

On the posttest assessment, In the Classroom educators showed significantly greater gains in knowledge (P < .0001, d = 1.36 [large effect]), TBI knowledge application (P = .0261, d = 0.46), and general self-efficacy (P = .0106, d = 0.39) than the LEARNet controls. In the Classroom educators maintained significant gains in knowledge (P = .001, d = 0.82) and general self-efficacy (P = .018, d = 0.38) but not in TBI knowledge application (P = .921, d = 0.02).

Conclusion:

Given the prevalence of TBI, it is important to develop evidence-based, cost-effective approaches to knowledge transfer and exchange in TBI professional development. In the Classroom is one such approach.
Potential Explanations for Increasing Methylphenidate Use in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder in Germany From 2004 to 2013
Authors: Langner Ingo , Haug Ulrike , Scholle Oliver , Lindemann Christina , Schröder Carsten , Riedel Oliver
Published: November 2018

Background

Despite a decreasing population of children and adolescents, the cumulative total amount of dispensed methylphenidate (MPH), the first-choice treatment of attention-deficit/hyperactivity disorder (ADHD) in this age group, has increased dramatically in Germany. We investigated potential reasons for this increase such as changes in the ADHD prevalence over time and other potential explanations including the cumulative amount of dispensed MPH per person.

Methods

Based on German claims data, we calculated standardized annual ADHD prevalence rates, proportions of ADHD cases treated with MPH and/or psychotherapy, and mean cumulative defined daily doses of ADHD drugs for 3- to 17-year-old children and adolescents from 2004 to 2013.

Results

The ADHD prevalence increased continuously from 2004 to 2011 and remained stable thereafter. In ADHD cases, there was little variation in the proportion of individuals treated with drugs and in the frequency of psychotherapeutic treatment during the whole study period. The annual cumulative mean amount of MPH defined daily doses increased by approximately 30% from 2004 to 2008.

Conclusions

Our analyses suggest that the increase in MPH use in Germany was mainly influenced by an increasing ADHD prevalence and increasing amounts of dispensed MPH per person.
Evaluation of Hospital-wide Readmission Risk Calculator to Predict 30-Day Readmission in Neurocritical Care Patients
Authors: Peacock Sarah , Siegel Jason , Harmer Emily , Alejos David , Freeman W. David
Published: November 2018

Background and Purpose: Thirty-day hospital readmissions have been shown to be a measure of quality and result in higher mortality and increased costs. Readmissions are a target for hospitals and payers; thus, several centers have developed predictive readmission scores to identify high-risk patients. The purpose of this study was to evaluate the current hospital-wide readmission risk calculator and the ability of this tool to predict 30-day readmissions in the neurocritical care population. Methods: A retrospective chart review was performed that included 340 consecutive patients admitted to our neuroscience critical care unit. Data including readmission scores, reason for admission, length of stay, and whether they were readmitted were recorded. Results: After removing patients without readmission scores or who died at the end of the original admission, the records of N = 279 patients were analyzed. Patients were more likely to be readmitted if they were initially emergently hospitalized or if there was a history of malignancy. Readmitted patients had a longer original hospital length of stay. Furthermore, 65.8% of the patients who were given a “low risk” for readmission were readmitted within 30 days. Conclusions: This small set of data in a specific patient population found that the current risk prediction score was inaccurate in predicting readmission in the neuroscience intensive care unit population. Further evaluation is needed of a larger patient population to generalize these results for all neuroscience intensive care unit patients. To design an accurate readmission risk tool, centers should create unique readmission scores based on less heterogeneous patient populations.
Feasibility and Variability of Automated Pupillometry Among Stroke Patients and Healthy Participants: Potential Implications for Clinical Practice
Authors: Marshall Matthew , Deo Ritesh , Childs Charmaine , Ali Ali
Published: November 2018

Background: Early neurological deterioration (END) is common after stroke and represents a poor prognostic marker. Manual pupillary assessment to detect END is subjective and has poor interrater reliability. Novel methods of automated pupillometry may be more reliable and accurate. This study aims to evaluate the acceptability and feasibility of automated pupillometry in patients with acute stroke and healthy volunteers and compare its interrater reliability with that of the traditional manual method. Methods: Automated and manual pupillary assessments were recorded between 2 independent observers alongside routine neurological observations from 12 acute stroke patients at a high risk of END. The proportion of completed measurements, adverse events, and qualitative feedback from patients and staff nurses was used to assess acceptability and feasibility of automated pupillometry. Paired automated and manual assessments were supplemented with measures from healthy volunteers to analyze measures of variability and agreement. Results: Automated pupillometry was acceptable and safe among 12 acute stroke patients, but feasibility criteria were not attained. Interrater agreement for automated pupillometry was superior to manual assessment for measurements of pupil size, anisocoria, and pupillary light reactivity, for both patients and healthy volunteers. Substantial disparity existed in agreement between automated and manual assessments of these parameters. Conclusions: Automated pupillometry represents an alternative to manual pupillary assessment that may have greater interrater agreement and reliability. As an optimized method of neurological assessment, it has the potential to improve detection and treatment of conditions leading to END after stroke.
Validity and Reliability of the Finnish Version of the Locomotor Capabilities Index-5 in Patients Fitted with a Prosthesis after Major Lower Extremity Amputation
Authors: Becker Paju , Repo Jussi P. , Piitulainen Kirsi , Tukiainen Erkki J. , Roine Risto P. , Järvenpää Salme , Ylinen Jari , Häkkinen Arja H.
Published: November 2018

Introduction

There has been a lack of psychometrically sound instruments in Finnish for assessment of mobility after major lower-limb amputation. This study aimed to translate the Locomotor Capabilities Index-5 (LCI-5) into Finnish and assess its psychometric properties.

Materials and Methods

The LCI-5 was translated and cross-culturally adapted into Finnish. Lower-limb prosthesis users (N = 112, mean time since amputation 9 years) completed the questionnaire compilation twice in a 2-week interval.

Results

No semantic discord emerged during the translation process. The mean (SD) total LCI-5 score was 42 (15), and intraclass correlation coefficient was 0.95 (95% confidence interval [CI], 0.93–0.96). Cronbach's alpha was 0.96 (95% CI, 0.95–0.97). Item-to-total correlations varied between 0.70 and 0.88. The LCI-5 correlated strongly with the 15D Mobility dimension (r = 0.76; P < 0.01), Houghton scale (r = 0.78; P < 0,001), and the Mobility section of the Prosthesis Evaluation Questionnaire (0.70; P < 0.001). The LCI-5 discriminated between transtibial and transfemoral amputation groups and had a moderate correlation with patients' age. Maximum scores were reached by 24% of the respondents.

Conclusions

Based on the findings of the present study, the Finnish LCI-5 has good reliability and validity for assessing mobility in patients who have undergone major lower-limb amputation and successful prosthesis fitting.
CDC Guideline on Mild Traumatic Brain Injury in Children: Important Practice Takeaways for Sports Medicine Providers
Authors: Sarmiento Kelly , Waltzman Dana , Lumba-Brown Angela , Yeates Keith O. , Putukian Margot , Herring Stanley
Published: November 2018

Objectives:

The Centers for Disease Control and Prevention (CDC) published an evidence-based guideline on the diagnosis and management of pediatric mild traumatic brain injury (mTBI) in 2018. This commentary provides key practice takeaways for sports medicine providers outlined in the Guideline recommendations.

Data Sources:

The CDC Pediatric mTBI Guideline was developed through a rigorous scientific process using a modified Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. A systematic review of the scientific literature published over a 25-year period for all causes of pediatric mTBI formed the basis of the Guideline.

Main Results:

The key practice takeaways for sports medicine providers focus on preseason evaluations, neuroimaging, symptom-based assessment, managing recovery, monitoring for persistent symptoms, and return to activity, including sport and school.

Conclusions:

Sports medicine providers play an integral part in the implementation of evidence-based practices that promote appropriate diagnosis and management of mTBI in children. This commentary highlights key practice takeaways that sports medicine providers can implement.
Alternative strategies to improve success rate of mitral isthmus block
Authors: Lee Ji Hyun , Nam Gi-Byoung , Go Tae-Hwa , Hwang Jongmin , Kim Minsu , Hwang You Mi , Kim Jun , Choi Kee-Joon , Kim You-Ho
Published: November 2018

Achieving bidirectional conduction block (BDB) across the mitral isthmus (MI) is technically challenging. We describe our experience using different ablation strategies for achieving successful MI block.

We reviewed the records of patients who had undergone MI ablation for peri-mitral (PM) flutter at our institution from January 2010 to May 2015. We investigated ablation strategies for achieving MI block and their long-term outcomes in terms of recurrence of atrial tachyarrhythmia.

Single endocardial MI ablation with or without distal coronary sinus (CS) ablation achieved MI block in 129 out of 236 (54.7%) patients. After failure of MI block, a new MI line ablation, ablation targeting the vein of Marshall (VOM), or anterior line ablation was performed in selected patients. The MI block was achieved in 13 (52.0%) out of 25 patients with new MI line ablation and in 13 (68.4%) out of 19 patients with VOM ablation. Anterior line ablation was tried in 23 patients and the line of block was achieved in 12 (52.2%) patients. Finally, overall PM BDB (PMB, MI block or anterior line block) was achieved in 167 (70.8%) of 236 patients. The incidence atrial tachyarrhythmia was similar between the patients with successful PMB and those with failed PMB (32.9% vs 42.0%, P = .18). In multivariable Cox regression analysis, the PMB was not associated with recurrence of atrial tachyarrhythmia (hazard ratio [HR]: 0.70, 95% confidence interval [CI]: 0.43–1.12).

In conclusion, single endocardial MI line with or without distal CS ablation showed limited success for achieving MI block. Additional substrate modifications such as a new MI line ablation, anterior line ablation, or ablation targeting the VOM may improve the success rate of PMB block. However, the benefits of PMB were not clear in this study.
A multi-facet comparative analysis of neuromyelitis optica spectrum disorders in patients with seropositive and seronegative AQP4-IgG
Authors: Wang Xiaojuan , Chen Xiaoyang , Zhu Chaoxia , Ma Haichang , Wang Fang , Qin Lingzhi , Li Wei
Published: November 2018

Introduction:

Neuromyelitis optica spectrum disorders (NMOSD), a rare, serious, demyelinating disease of the central nervous system (CNS), is associated with immunoglobulin G (IgG) antibodies targeting aquaporin-4 (AQP4-IgG). This study retrospectively analyzed the clinical features of 67 patients. 49 and 18 of 67 cases (male/female: 11/56) were AQP4-IgG (+) and AQP4-IgG (−), respectively. The initial symptoms were optic neuritis [n = 34, AQP4-IgG (+)/(−): 31/3], myelitis [n = 18, AQP4-IgG(+)/(−): 13/5], co-occurrence of ON and myelitis [n = 15, AQP4-IgG (+)/(−): 5/10].

Conclusions:

There was no statistically significant difference between the 2 groups in terms of ages, and magnetic resonance imaging findings, but the patients had a significant difference (P <.05) in sex, the course of disease and Expanded Disability Status Scale (EDSS) scores after drug treatment. Patients with AQP4-IgG (−) are likely to have a better prognosis and a favorable monophasic course.
Computed tomography portography of patients with cirrhosis with normal body mass index
Authors: Liu Sulan , Sheng Huaqiang , Shi Hao , Li Wei , Fan Jingli , He Jingzhen , Sun Hongjun
Published: November 2018

This study is to investigate the computed tomography (CT) image quality of the low- tube-voltage protocol with low contrast agent dose.

CT portography was performed in 118 cirrhosis patients with body mass index (BMI) less than 25 kg/m2 under 2 protocols: Protocol A, tube voltage of 90 kVp/395 mAs and contrast agent dosage of 1.2 mL/kg, and, Protocol B, tube voltage of 120 kVp/200 mAs and contrast agent dosage of 1.5 mL/kg.

The number of patients in each protocol was 59. The CT value noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) in portal veins was comparatively analyzed between the 2 protocols. The subjective image quality was further assessed on 5-point scales. Radiation dose was also recorded and statistical analysis was performed.

The CT value, CNR, and SNR of the images were higher at 90 kVp than those at 120 kVp (P < .05). There was no significant difference in image noise between the 2 protocols (P > .05). The CT dose index volume, dose-length product, and effective dose at 90 kVp were 18.2%, 16.0%, and 16.0% less than that at 120 kVp, respectively. There was no difference in image quality score between the 2 protocols (P > .05). The average amount of contrast agent was decreased by 17.8% when the 90 kVp protocol was used.

CT portography at 90 kVp combined with low-dosage contrast agent leads to a significant reduction in radiation dose and improved SNR and CNR, without deterioration of image quality.
Improvement of bone microarchitecture parameters after 12 months of treatment with asfotase alfa in adult patient with hypophosphatasia
Authors: Freitas Thiago Quadrante , Franco André Silva , Pereira Rosa Maria Rodrigues
Published: November 2018

Rationale:

Hypophosphatasia is an inborn error of metabolism that can appear any time in life, mainly with bone manifestations due to low alkaline phosphatase activity. Asfotase alfa is a specific enzyme reposition treatment that has shown promising results in children; however, there are few reports about the outcomes in adult patients.

Patient concerns:

A 36-year-old male presented with an early history of craniosynostosis, short stature, and multiple fractures since the age of 13 years—which needed numerous surgical corrections. He was admitted with a previous diagnosis of osteogenesis imperfecta, taking alendronate, calcium carbonate, cholecalciferol, and calcitriol. Bone mineral density was low (lumbar spine Z-score = −3.0 SD), with impairment of all parameters of high-resolution peripheral quantitative computed tomography (HR-pQCT). Kidney impairment was also observed with reduced creatinine clearance, nephrolithiasis, and nephrocalcinosis.

Diagnosis:

Alkaline phosphatase was unexpectedly low (6 U/L, reference value: 30–120 U/L), with high serum vitamin B6 (260 mcg/L, reference value: 5.2–34.1). Genetic testing showed a homozygous missense mutation in ALPL gene c.443 C>T: p.Thr148Ile.

Intervention:

Asfotase alfa was requested due to important bone deterioration, ambulatory disability, and kidney impairment. It was given subcutaneously 2 mg/kg per dose, 3 times a week, for 12 months before reassessment.

Outcomes:

Bone mineral densities of the lumbar spine and whole body, besides almost all HR-pQCT microstructural parameters of the distal tibia, showed improvements and the patient was able to walk without assistant device. Kidney function did not further deteriorate.

Lessons:

Hypophosphatasia should be considered as a differential diagnosis in young patients with multiple fractures and kidney impairment, since the use of antiresorptive drugs, calcium and vitamin D, commonly used to treat fractures, worsen its symptoms and prognosis. A 12-month asfotase alfa treatment improved bone density and structural parameters even in an adult patient with late diagnosis.
Cardiac inflammatory myofibroblastic tumor in interventricular septum
Authors: Deng Ming-dan , Han Jun-yang , Lin Ke , Tang Hong
Published: November 2018

Rationale:

Cardiac inflammatory myofibroblastic tumor (IMT) is a rare primary cardiac tumor which is currently considered as a low-grade neoplasm. The tumor has a predilection in infants and adolescents and primarily occurs as an endocardial-based cavitary mass. However, cardiac IMT that only involves the interventricular septum in middle-aged adults is extremely rarely reported. Considering its infrequency, we report a rare clinical case, with the aim of sharing our experience during the diagnostic procedures.

Patient concerns:

A 45-year-old, previously healthy female, with no medical history was admitted to the outpatient clinic due to the identification of an abnormal radiographic finding during a routine health examination.

Diagnosis:

Transthoracic echocardiography (TTE) revealed a 3.5 cm × 4.0 cm × 4.5 cm heterogeneous mass in the interventricular septum. Color Doppler echocardiography detected sparse blood flow signals inside the mass. Magnetic resonance imaging (MRI) confirmed a hyperintense T2-weighted, isointense T1-weighted mass. Three-dimensional (3D) TTE demonstrated a spherical mass in the middle part of the interventricular septum. Postoperative histopathological examinations revealed a mesenchymal tumor composed of scattered spindle myofibroblasts with a myxoid atypia, associated with infiltration of lymphocytes and plasma cells.

Interventions:

Complete tumor resection was successfully performed via median sternotomy under general anesthesia.

Outcomes:

After surgery, the patient recovered successfully. The patient was in good general health without any clinical symptoms. The echocardiographic examination at the 12-month follow-up period revealed normal function of the heart, and there was no evidence of tumor recurrence.

Lessons:

To our knowledge, cardiac IMT only the involving interventricular septum in a middle-aged adult has never been previously reported before. Echocardiography plays a critical role in establishing the primary diagnosis of cardiac IMT and evaluating regular follow-up examinations. Complete surgical resection of the mass is considered the first-line treatment despite the absence of symptoms.
Long-term results of vascularized os pisiform transfer for advanced Kienböck disease after follow-up for at least 15 years
Authors: Tan Zhenwei , Xiang Zhou , Huang Fuguo , Yang Zhiming , Xiao Cong , Duan Xin
Published: November 2018

No surgical procedure perfectly treats advanced Kienböck disease. Although vascularized os pisiform transferring (VOPT) is one of the main therapeutic approaches, reports on long-term follow-up and case series for this technique are scarce.

We collected postoperative results in 11 patients with advanced Kienböck disease who underwent VOPT between 1986 and 2001 in our Hospital. Follow-up durations ranged from 15 to 26 years.

At the last follow-up, excellent and good results were found in 81.8% according to the Modified Green and O’Brien score. Postoperative imaging revealed significantly reduced pisiform bone; carpal height ratio and Nattrass index were decreased, while the radioscaphoid angle was increscent, compared with preoperative and mid-term follow-up results.

The favorable long-term results demonstrated that VOPT is a dependable and durable procedure for the treatment of advanced Kienböck disease, with pain relief and functional improvement despite some radiographic findings such as wrist osteoarthritis occurrence.
Role of ethnicity and environment on lifestyle and cardiometabolic profile in the Native American Mapuche population
Authors: Fernández-Cao José C. , Doepking Carlos
Published: November 2018

Introduction:

Cardiometabolic risk factors contribute to increase the incidence of some of the most widespread noncommunicable diseases today. The propensity to present an elevated cardiometabolic risk appears to especially affect non-Caucasians ethnic groups, such as the Native American Mapuche population. In addition, urbanization process has also a great impact on lifestyle and cardiometabolic profile. Therefore, a systematic review and meta-analysis will be conducted to summarize the relevant evidence regarding lifestyle and cardiometabolic profile in Mapuche population, and to assess the role of the ethnicity and the urbanization process on the lifestyle and cardiometabolic profile in Mapuche people with respect to European descendants.

Methods:

A comprehensive search until 2019 will be performed using PubMed/MEDLINE, SciELO, Web of Science and Scopus. Observational studies, carried out in general population of Mapuche ethnicity living in rural and urban areas, with data of lifestyle and/or cardiometabolic profile, will be selected. A qualitative summary, as well as meta-analyzes when possible, will be done to present the information. Random effects meta-analyzes will be performed using the generic inverse variance method. Pooled effect size will be expressed as mean difference with 95% confidence intervals. Heterogeneity will be assessed using the Cochran Q-statistic and the I
2 statistic. Stratified analyzes, meta-regressions, and sensitivity analyzes will be performed to evaluate potential sources of heterogeneity. In addition, random effects meta-regressions and stratified analyzes will also be used to examine the impact of covariates on the effect size estimated. Publication bias will be investigated using Egger and Begg test, and risk of bias will be assessed using the Research Triangle Institute Item Bank (RTI-IB). Finally, the quality of evidence will be evaluated through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines.

Results:

The results of meta-analyzes will provide important information about differences in lifestyle and cardiometabolic profile between Mapuche people and European descendants, as well as between Mapuche people living in urban and rural areas.

Conclusion:

This systematic review and meta-analysis will be helpful to obtain a more reliable understanding of lifestyle and cardiometabolic profile in Mapuche population compared to European descendants, and the impact of the transition from rural to urban areas in this ethnic group.
Assessment of small hepatocellular carcinoma: perfusion quantification and time-concentration curve evaluation using color-coded and quantitative digital subtraction angiography
Authors: Chen Chien-Wei , Hsu Li-Sheng , Weng Jun-Cheng , Weng Hsu-Huei , Ye Yu-Ling , Hsu Sheng-Lung , Lin Wei-Ming
Published: November 2018

To explore the role of quantitative digital subtraction angiography (QDSA) in the diagnosis of small hepatocellular carcinoma (HCC).

Between November 2015 and November 2017, all patients who underwent chemoembolization for HCC were retrospectively reviewed. Patients with tumors measuring more than 5 cm or evident post-processing imaging artifacts were excluded. Images were post-processed using the QDSA technique. Regions of interest were manually drawn on proper hepatic artery (as a reference), target HCC and peritumoral liver. Time-concentration curves and flow parameters of the peak ratio, subtracted time-to-peak (TTP), and area under the curve (AUC) ratio was obtained and analyzed.

A total of 146 HCCs (mean diameter, 1.6 cm) of 71 cirrhotic patients (54 men, 17 women; mean age, 67.7 years) were enrolled. Compared with liver parenchyma, HCCs showed an increased and more rapid flow (peak ratio, AUC ratio, subtracted TTP, and wash-in slope; all P <.001). Compared with untreated HCCs, chemoembolized HCCs showed a slower flow (subtracted TTP and wash-in slope, P = .004 and .002, respectively). HCCs with a typical enhancement pattern on computed tomography (CT) or magnetic resonance imaging (MRI) had a trend toward Type III (washout pattern) time-concentration curves (P <.001). Chemoembolized HCCs had a trend toward Type II (plateau pattern) time-concentration curves (P = .005).

QDSA technology can be used to quantify perfusion measurements of HCC and hepatic parenchyma and to assess perfusion changes after HCC chemoembolization.
Increased red cell width distribution to lymphocyte ratio is a predictor of histologic severity in primary biliary cholangitis
Authors: Meng Jing , Xu Hongqin , Liu Xu , Wu Ruihong , Niu Junqi
Published: November 2018

Primary biliary cholangitis (PBC) is a chronic disease that is increasingly being recognized in recent years. In this study, we sought to identify noninvasive markers of the severity of cirrhosis in patients with PBC based on routinely investigated laboratory parameters.

Ninety-four patients with histologically-confirmed PBC based on liver biopsy performed between January 2013 and December 2017 at the First Hospital of Jilin University were divided into 2 groups: early-stage cirrhosis (fibrosis stage F1 and F2; n = 74) and advanced-stage cirrhosis (fibrosis stage F3 and F4; n = 20).

Patients with advanced-stage had significantly higher red blood cell distribution width (RDW) (15.2 vs 13.7; P = .003) and significantly lower platelet (163.35 vs 202.73; P = .032) and lymphocyte counts (1.47 vs 1.79; P = .018) as compared with patients with early-stage cirrhosis. Advanced-stage cirrhosis was associated with significantly higher RDW to platelet ratio (RPR), RDW to lymphocyte ratio (RLR), aspartate aminotransferase to platelet ratio index (APRI), and fibrosis index based on the 4 factors (FIB-4) as compared with early-stage cirrhosis. RLR showed the highest area under receiver operating characteristic curve (AUROC) (0.744). The sensitivity and specificity of RLR were 65% and 78.3%, respectively. RLR had higher AUROC than the other 3 noninvasive markers.

The noninvasive markers RPR, RLR, APRI, and FIB-4 showed good diagnostic accuracy for advanced-stage cirrhosis. These markers are easily acquired by routine laboratory tests and are reproducible predictors of the severity of PBC. RLR is a novel marker that may serve as a valuable supplement to APRI and FIB-4 for predicting the severity of cirrhosis.
Secondary pituitary abscess following transsphenoidal surgery with recurrent meningitis
Authors: Li Ziquan , Yang Chengxian , Bao Xinjie , Yao Yong , Feng Ming , Deng Kan , Liu Xiaohai , Xing Bing , Wang Renzhi
Published: November 2018

Rationale:

The transsphenoidal surgical (TS) approach to sellar masses is the preferred surgical route in most cases. Secondary pituitary abscess (PA) following TS is an extremely rare but serious postoperative complication with potentially high disability and mortality.

Patient concerns:

We describe an uncommon case of secondary PA in a 42-year-old woman, who underwent uncomplicated transsphenoidal procedures without cerebrospinal fluid leak, to treat primary Rathke cleft cyst. Without obvious cause, the patient suffered recurrent meningitis with complaints of headache, hyperpyrexia, and chills from 1 month after the operation.

Diagnosis:

There were no significant imaging findings until a new rim-enhancement lesion was seen in the sellar region on magnetic resonance imaging during the 6th episode of meningitis 11 months after the initial surgery. A diagnosis of secondary PA was considered;

Interventions:

Therefore, she underwent a 2nd TS with pus evacuation and antibiotic treatment.

Outcomes:

She improved remarkably and had no recurrence of symptoms during the 9-month follow-up.

Lessons:

Our aim was to present this rare case and discuss the most likely etiologies and preventive measures for this condition. In patients with recurrent meningitis but dormant imaging manifestations after TS, the possibility of secondary PA should considered. Adequate surgical drainage with microbiology-guided antibiotic therapy is the 1st choice for treatment.
Long-term clinical response of advanced lung adenocarcinoma to maintenance treatment of gemcitabine
Authors: Lv Xingxing , Gou Fusheng , Shen Yuan , Lu Hong , Chen Juan , Liu Juan , Chen Hui , Zhang Xuan , Yu Danfei
Published: November 2018

Rationale:

Advanced non-small-cell lung cancer (NSCLC) is an aggressive malignancy that generally leads to poor outcomes, with <5% long-term survival at 5 years; however, several researches have shown improvements in the progression-free survival (PFS) and overall survival (OS) on the maintenance therapy after the first-line chemotherapy. we report a case of metastatic NSCLC patient treated with maintenance therapy of gemcitabine with brilliant results.

Patient concerns:

Clinical data and treatment of a 68-year-old man with NSCLC are summarized. The Ethics Committee of People's hospital of Leshan, approved this study.

Diagnosis:

Lung adenocarcinoma metastasized to the mediastinal lymph node, cervical lymph node, and adrenal gland, without epidermal growth factor receptor (EGFR) mutation.

Interventions:

Continued treatment with gemcitabine alone following the 6 cycles of cisplatin–gemcitabine chemotherapy, prolonging the interval of chemotherapy when he could not tolerate the toxicity of the drug.

Outcomes:

Partial response of the disease for 4.5 years and significant clinical benefit.

Lessons:

This case shows that patients will benefit from the maintenance therapy, and gemcitabine may be a good choice.
Rivaroxaban versus enoxaparin for the prevention of venous thromboembolism after total knee arthroplasty
Authors: Huang Hai-Feng , Li Shan-Shan , Yang Xian-Teng , Xie Quan , Tian Xiao-Bin
Published: November 2018

Objective:

This article analyzed the clinical efficacy and tolerability of rivaroxaban and enoxaparin in patients undergoing total knee arthroplasty (TKA) surgery.

Methods:

Five randomized, controlled clinical trials on rivaroxaban versus enoxaparin in patients who underwent TKA were identified and included in this meta-analysis.

Results:

The meta-analysis indicated that rivaroxaban prophylaxis was associated with lower rates of symptomatic venous thromboembolism (VTE) (relative risk[RR]:0.55; 95% confidence interval [CI]: 0.35–0.86; P = .009), symptomatic deep vein thrombosis (DVT) (RR 0.44, 95% CI 0.25–0.80, P = .007), asymptomatic DVT (RR: 0.57; 95% CI: 0.37–0.89; P = .01), distal DVT (RR: 0.62; 95% CI: 0.45–0.85; P = .003) and proximal DVT (RR: 0.42; 95% CI: 0.24–0.75; P = .004). Compared with the enoxaparin group, the incidence of symptomatic pulmonary embolism (PE) (RR: 0.48; 95% CI: 0.19–1.24; P = .13) in the rivaroxaban group was not significantly different. A nonsignificant trend towards all-cause death (RR: 0.38; 95% CI: 0.03–4.92; P = .46) or major bleeding (RR: 1.59; 95% CI: 0.77–3.27; P = .21) risk between rivaroxaban and enoxaparin prophylaxis was found.

Conclusion:

Compared with the enoxaparin group, the group using rivaroxaban after TKA had a significantly lower rate of symptomatic VTE, symptomatic DVT, asymptomatic DVT, distal DVT, and proximal DVT. Our study shows that rivaroxaban after TKA is more effective than enoxaparin and did not increase major bleeding or all-cause mortality.

Level of evidence II
Clinical significance of the EMD/mesorectum ratio of T3 mid-low rectal cancer
Authors: Gu Chaoyang , Yang Xuyang , Zhang Xubing , Zheng Erliang , Deng Xiangbing , Hu Tao , Wu Qingbin , Bi Liang , Wu Bing , Su Minggang , Wang Ziqiang
Published: November 2018

Previous studies suggested that the extramural distance (EMD) should be considered in therapeutic decision-making of rectal cancer because it can be used as an indicator of the T3 subclassification; however, reports of impact of EMD/mesorectum ratio on prognosis are rare.

The objectives of this study were to evaluate the feasibility of the extramural distance EMD/mesorectum ratio as a maker of the T3 subclassification for T3 mid-low rectal cancer and find the potential radiological marker on MRI for neoadjuvant chemoradiotherapy (nCRT).

From December 2012 to December 2016, 287 consecutive patients with MRI-staged T3 mid-low rectal cancer were enrolled. The EMD was defined as the distance from the outer edge of the muscularis propria to the outer edge of tumor, and the mesorectum was measured as the distance from outer edge of muscularis propria to mesorectal fascia (MRF) in the same layer. The association of the EMD/mesorectum ratio and other MRI or clinicopathological factors with survival was analyzed. The independent prognostic factors were estimated by Cox regression analysis.

The mean EMD/mesorectum ratio was 0.43. Based on ROC analysis, we chose a EMD/mesorectum ratio of 0.3 for further analyses. Of 287 patients, 163 (56.8%) had a EMD/mesorectum ratio ≥ 0.3. Patients with an EMD/mesorectum ratio ≥ 0.3 had a decreased recurrence free survival (RFS) and overall survival (OS) (P < .001; P = .034, respectively). Of the 163 patients, patients with nCRT had a higher RFS than patients without nCRT (P = .001). Multivariate analysis showed that the EMD/mesorectum ratio was the only independent prognostic factors for RFS.

Our study provided evidence that the EMD/mesorectum ratio could be used for T3 subclassification, the optimal cut-off value of EMD/mesorectum ratio was 0.3 when the ratio was applied to classify T3 mid-low rectal cancer patients, and nCRT should be performed for these patients when the EMD/mesorectum ratio is ≥ 0.3.
Effect of computer navigation-assisted minimally invasive direct lateral interbody fusion in the treatment of patients with lumbar tuberculosis
Authors: Jiang Jianzhong , Gan Fengping , Tan Haitao , Xie Zhaolin , Luo Xiang , Huang Guoxiu , Li Yin , Huang Shengbin
Published: November 2018

The benefits of navigation-assisted technologies are not entirely understood. Therefore, this study aimed to examine the outcomes of patients with lumbar tuberculosis who received computer navigation-assisted minimally invasive direct lateral interbody fusion (DLIF).

This was a retrospective study of 33 patients with lumbar tuberculosis who underwent minimally invasive DLIF at the Department of Spine and Orthopedics of Guigang People's Hospital (Guangxi, China) between January 2015 and December 2016. The patients were pathologically diagnosed as lumbar tuberculosis and grouped into the navigation-assisted fluoroscopy (NAV; n = 18) and non-navigation-assisted fluoroscopy (non-NAV; n = 15) groups. X-ray exposure and operation times were assessed in all patients.

All surgical procedures were successfully completed. No case was converted into open surgery. The NAV group had longer surgical preparation time but shorter operation time compared with the non-NAV group (both P <.01). Total operation time showed no significant difference between the 2 groups (P = .1). The time of radiation exposure in the non-NAV group was longer compared with that of the NAV group (53.2 ± 9.9 vs 13.5 ± 2.6 s; P <.01). There were no significant differences regarding intraoperative blood loss, postoperative drainage volume, length of hospital stay, bone fusion and complications between the 2 groups (all P >.05).

Computer navigation-assisted minimally invasive DLIF could significantly reduce intraoperative radiation exposure, with no increase in total operation time.
Effect of atrial fibrillation in Asian patients undergoing percutaneous coronary intervention with drug-eluting stents for stable coronary artery disease
Authors: Han Seungbong , Park Gyung-Min , Kim Yong-Giun , Hwang Ki Won , Roh Jae-Hyung , Won Ki-Bum , Ann Soe Hee , Kim Shin-Jae , Lee Sang-Gon
Published: November 2018

Although the prevalence of atrial fibrillation (AF) and percutaneous coronary intervention (PCI) are increasing in Asia, there is a paucity of data concerning the effect of AF in Asian patients undergoing PCI with drug-eluting stents (DESs). Furthermore, the majority of previous studies investigating the effect of AF on prognosis following PCI have exclusively evaluated patients with myocardial infarction (MI). We aimed to evaluate the effect of AF on clinical outcomes of Asian patients undergoing PCI with DES for coronary artery disease (CAD) excluding acute MI.

From national health insurance claims data in South Korea, a total of 45,288 patients aged 18 years or older without a known history of CAD, who underwent PCI with DES for the diagnosis of CAD excluding acute MI between 2011 and 2015, were enrolled. Based on the presence or absence of a history of AF at baseline, patients were categorized into the AF group (n = 1715, 3.8%) and no-AF group (n = 43,573, 96.2%). Outcomes including all-cause death, the composite outcome of all-cause death/MI/coronary revascularization, and stroke were compared between 2 groups using a propensity-score-matched analysis.

After propensity-score matching, 1709 matched pairs were obtained. During the follow-up period (mean, 2.2 years), the incidence of all-cause death (hazard ratio [HR] 1.117, 95% confidence interval [CI] 0.885–1.411, P = .35) and the composite outcome of all-cause death/MI/coronary revascularization (HR 1.004, 95% CI 0.846–1.192, P = .97) were not significantly different between 2 groups. However, the incidence of stroke was significantly increased in the AF group (HR 1.983, 95% CI 1.474–2.667, P < .001).

In Asian patients undergoing PCI for stable CAD, a history of AF was not associated with mortality, but was associated with increased risk of stroke.
Conceptual Model of Lean Body Mass in Pediatric Inflammatory Bowel Disease
Authors: Barnes Margaux J. , Lynch Mary K. , Lisenby Molly D. , Jester Traci , Maclin Jeanine , Knight Taylor , Fisher Gordon , Gower Barbara
Published: November 2018

Youth with inflammatory bowel disease (IBD) demonstrate deficits in lean mass (LM) placing them at increased risk for future health problems, including reduction of bone mass and impaired bone architecture. Research suggests that deficits in LM are multifactorial, including influences from the disease and its treatment, and health behaviors such as diet and physical activity. Based on a systematic literature review examining factors related to LM deficits in IBD, this article presents a conceptual model to explain the development of LM in youth with IBD. The model considers predictors of LM across 4 domains: demographic; medical; diet; and physical activity. Much existing research is cross‐sectional, but suggests multiple factors work together to promote or inhibit LM accrual in youth with IBD. The conceptual model, developed based on empirical findings to date, can be used to understand and further elucidate the process through which LM is developed and maintained, to inform the development of empirically supported clinical interventions, and to guide future research objectives and priorities.
Anaplastic Astrocytoma in a Child With Coffin-Siris Syndrome and a Germline SMARCE1 Mutation: A Case Report
Authors: Lin Beryl , Kesserwan Chimene , Quinn Emily A. , Einhaus Stephanie L. , Wright Karen D. , Azzato Elizabeth M. , Orr Brent A. , Upadhyaya Santhosh A.
Published: November 2018

Coffin-Siris syndrome (CSS) is a rare congenital disorder with variable clinical phenotype consisting of developmental delay and characteristic facial features. It is caused by mutations in the chromatin remodeling switch/sucrose nonfermenting complex. Although SWI/SNF genes are widely implicated in tumorigenesis, only 8 cases of neoplasm have been reported in patients with CSS. We report a case of anaplastic astrocytoma (WHO grade III) in an 18-month-old child with CSS due to a de novo germline missense SMARCE1 mutation. Additional molecular features of the tumor are described as well. The role of missense SMARCE1 mutations in tumor predisposition in children with CSS should be further investigated to better inform genetic counselling.