bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety of antithrombotic therapy for patients with acute ischemic stroke harboring unruptured intracranial aneurysm
Authors: Shono Yuji , Sugimori Hiroshi , Matsuo Ryu , Fukushima Yoshihisa , Wakisaka Yoshinobu , Kuroda Junya , Ago Tetsuro , Kamouchi Masahiro , Kitazono Takanari
Published: March 2018

Background

The safety of antithrombotic therapy for patients with acute ischemic stroke harboring unruptured intracranial aneurysms remains unclear.

Aims

This study was performed to determine whether treatment with antiplatelets, anticoagulants, or intravenous thrombolytic agents is safe for patients with acute ischemic stroke and unruptured intracranial aneurysms.

Methods

Among 9149 patients with acute ischemic stroke enrolled in the Fukuoka Stroke Registry from June 2007 to December 2014, 8857 patients with data on cerebrovascular imaging and three-month outcomes were included in this study. The frequency of adverse events, including intracranial hemorrhage, symptomatic intracranial hemorrhage, and in-hospital mortality, was compared between patients with and without unruptured intracranial aneurysms. The risk of a poor functional outcome (modified Rankin scale score of ≥3) at three months after stroke onset was estimated after adjusting for confounding factors by logistic regression analysis.

Results

Unruptured intracranial aneurysms were identified in 412 (4.7%) patients, and the mean diameter was 4.1 ± 3.2 mm. There was no significant difference in the frequency of any adverse events between patients with and without unruptured intracranial aneurysms among the overall patients or patients receiving antiplatelets, anticoagulants, or intravenous thrombolytic agents. The odds ratios of a poor functional outcome were not significantly higher in the presence of unruptured intracranial aneurysms, even in patients undergoing antiplatelet therapy, anticoagulation therapy, or intravenous thrombolysis.

Conclusions

These findings suggest that unruptured intracranial aneurysms are not associated with increased risks of adverse events or poor functional outcomes even after antithrombotic therapy for acute ischemic stroke. However, accumulation of cases is required to verify these findings.
The START nomogram for individualized prediction of the probability of unfavorable outcome after intravenous thrombolysis for stroke
Authors: Cappellari Manuel , Turcato Gianni , Forlivesi Stefano , Bagante Fabio , Cervellin Gianfranco , Lippi Giuseppe , Bonetti Bruno , Bovi Paolo , Toni Danilo
Published: March 2018

Background and purpose

The nomogram is an important component of modern medical decision-making, which calculates the probability of an event entirely based on individual characteristics. We aimed to develop and validate a nomogram for individualized prediction of the probability of unfavorable outcome in intravenous thrombolysis-treated stroke patients included in the large multicenter Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register.

Methods

All patients registered in the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register by 179 Italian centers between May 2001 and March 2016 were originally included. The main outcome measure was three-month unfavorable outcome (modified Rankin Scale 3–6). Four non-categorical predictors of unfavorable outcome (baseline National Institutes of Health (NIH) Stroke Scale score: 0–25, age ≥18 years, pre-stroke modified Rankin Scale score: 0–2, and onset-to-treatment time: 0–270 min) were identified a-priori by three neurologists with expertise in the management of stroke. To generate the NIHSS STroke Scale score, Age, pre-stroke mRS score, onset-to-treatment Time (START), the pre-established predictors were entered into a logistic regression model. The discriminative performance of the model was assessed using the area under the receiver operating characteristic curve.

Results

A total of 15,862 patients with complete data for generating the START was randomly dichotomized into training (2/3, n = 10,574) and test (1/3, n = 5288) sets. The area under the receiver operating characteristic curve of START was 0.800 (95% confidence interval: 0.792–0.809) in the training set and 0.815 (95% confidence interval: 0.804–0.822) in the test set.

Conclusions

By using a limited number of non-categorical predictors, the START is the first nomogram developed and validated in a large Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register cohort, which reliably calculates the probability of unfavorable outcome in intravenous thrombolysis-treated stroke patients.
Characterization of phenyl pyrimidine derivatives that inhibit cytomegalovirus immediate-early gene expression
Authors: Yamada Koh-Hei , Majima Ryuichi , Yamaguchi Toyofumi , Inoue Naoki
Published: March 2018

Background

Previously, we established a reporter cell line for human cytomegalovirus and screened anti-human cytomegalovirus compounds using the cell line. In this study, we characterized one of the identified compounds, 2,4-diamino-6–(4-methoxyphenyl)pyrimidine (coded as 35C10).

Methods

50% Effective concentrations (EC50s) and 50% cytotoxic concentrations (CC50s) of 35C10 and its derivatives in human fibroblasts were determined by X-gal staining of the cells infected with human cytomegalovirus Towne strain expressing β-galactosidase.

Results

EC50 and CC50 of 35C10 were 4.3 µM and >200 µM, respectively. Among several 35C10 derivatives, only one lacking 4-amino group of pyrimidine showed a similar EC50. 35C10 weakly inhibited murine cytomegalovirus, herpes simplex virus type 1, and varicella-zoster virus. A “time of addition” experiment suggested that 35C10 inhibited an early phase of the infection. Although 35C10 did not inhibit viral attachment to the cells nor the delivery of viral DNA to the nuclei, it decreased the number of infected cells expressing immediate-early 1 and 2 (IE1/IE2) proteins. 35C10 also inhibited the activation of a promoter for TRL4 in the reporter cells upon human cytomegalovirus infection, but not in the same reporter cells transfected with a plasmid expressing IE2.

Conclusion

Our findings suggest that 35C10 is a novel compound that inhibits IE gene expression in human cytomegalovirus-infected cells.
Late open conversion after endovascular repair of abdominal aneurysm failure: Better and easier option than complex endovascular treatment
Authors: Bonardelli Stefano , Nodari Franco , De Lucia Maurizio , Botteri Emanuele , Benenati Alice , Cervi Edoardo
Published: March 2018

Aim

Conversion to open repair becomes the last option in case of endovascular repair of abdominal aneurysm failure, when radiological interventional procedures are unfeasible. While early conversion to open repair generally derives from technical errors, aetiopathogenesis and results of late conversion to open repair often remain unclear.

Methods

We report data from our Institute’s experience on late conversion to open repair. Twenty-two late conversion to open repairs out of 435 consecutive patients treated during a 18 years period, plus two endovascular repair of abdominal aneurysms performed in other centres, are analysed. The indication for conversion to open repair was aneurysm enlargement because of type I, type III, type II endoleak and endotension. Even if seven cases (23%) had shown an initial aneurysmal shrinkage, in a later phase, the sac began to enlarge again. In 12 patients, conversion to open repair was the last chance after unsuccessful secondary endovascular procedures.

Results

Three cases (12.5%) were treated in emergency. Aortic cross-clamping was only infrarenal in 10 cases, only or temporarily suprarenal in 14 and temporarily supraceliac in 9 cases, for 19 total and 5 partial endograft excisions. Two patients died for Multiple Organ Failure (MOF), on 42nd (endovascular repair of abdominal aneurysm infection) and 66th postoperative day. No other conversion to open repair-related deaths or major complications were revealed by follow-up post-conversion to open repair (mean: 68 months ranging from 24 to 180 months).

Conclusion

Late conversion to open repair is often an unpredictable event. It represents a technical challenge: specifically, the most critical point is the proximal aortic clamping that often temporarily excludes the renal circulation. In our series, conversion to open repair can be performed with a low rate of complications. In response to an endovascular repair of abdominal aneurysm failure, before applying complex procedures of endovascular treatment, conversion to open repair should be taken into account.
Prevalence and characteristics of coronary microvascular dysfunction among chest pain patients in the emergency department
Authors: Safdar Basmah , D’Onofrio Gail , Dziura James , Russell Raymond R , Johnson Caitlin , Sinusas Albert J
Published: March 2018

Aims:

Coronary microvascular dysfunction (CMD) is common in patients with non-obstructive coronary arteries but has not been described in low-risk symptomatic patients. We therefore assessed the prevalence and characteristics of CMD in low to moderate risk patients with chest pain in an emergency department.

Methods and results:

We used three-dimensional Rb82 cardiac positron emission tomography/computed tomography to diagnose coronary artery disease (known or new regional defect, any coronary calcification) and CMD (low coronary flow reserve without coronary artery disease) in chest pain patients after being ruled out for acute myocardial infarction. Exclusions included age 30 years or less, acute myocardial infarction, hemodynamic instability, heart failure and dialysis. Among 195 participants undergoing cardiac positron emission tomography/computed tomography, 42% had CMD, 36% had coronary artery disease and 22% had normal flows; 70% were women and 84% were obese. Patients with CMD and coronary artery disease had significantly lower coronary flow reserve than normal patients (mean coronary flow reserve 1.6 and 1.9 vs. 2.6, respectively, P<0.05). However, CMD patients were younger (mean age 51 vs. 61 years), and had fewer traditional cardiac risk factors ( P<0.05) than patients with coronary artery disease. Nearly one third (31%) of patients had a prior emergency department visit for chest pain within three years of index presentation. Women were four times as likely to have CMD as men (adjusted odds ratio 4.2; 95% confidence interval 1.8, 9.6) after controlling for age, race, hypertension, diabetes, smoking, dyslipidemia, obesity and family history of coronary artery disease.

Conclusions:

Despite their low-risk profile, nearly one half of symptomatic and mostly obese emergency department patients without evidence of myocardial infarction or coronary artery disease had CMD. The results could explain the high rates of return visits associated with chest pain, although their application to the general emergency department population require validation.
Role of computed tomography morphodensitometry in predicting the outcome of shock wave lithotripsy
Authors: Rathee Vazir Singh , HC Vivek , Khan Sartaj Wali , Singh AK , Shukla Pushpendra Kumar , Verma Ashish , Trivedi Sameer , Dwivedi Udai Shankar
Published: March 2018

Objectives:

The objective of this study was to predict the outcome of shock wave lithotripsy (SWL) on the basis of computed tomography (CT) morphodensitometry for ureteral and renal stones. We also assessed the possibility that Hounsfield unit (HU) values and the location of the stones could be used to predict the outcome of SWL.

Material and methods:

A prospective study was performed to measure stone size, location, composition, surface area, surface volume, stone burden, the skin-to-stone distance and the HU for solitary renal and ureteral stones by non-contrast CT studies (NCCT) from August 2013 to September 2015. Success of SWL was defined as: (1) being stone-free or (2) residual stone fragments < 4 mm by radiography/NCCT.

Results:

Of the 100 assessed patients, 68 patients (68%) were stone-free, 12 (12%) had residual stone fragments < 4 mm (clinically insignificant residual fragments) and 20 (20%) had residual stone fragments ≥ 4 mm/ancillary procedures. Multivariate analysis revealed that stone location and mean HU were significant predictors of SWL success. Receiver operating characteristic curves defined cut-off values for predicting treatment outcome. Treatment success rates were significantly higher for stones < 800 HU than with stones > 800 HU ( p = 0.160).

Conclusion:

Evaluation of stone HU values and stone location prior to SWL can predict treatment outcome and aid in the development of treatment strategies.

Level of evidence

2 & 4
Policy, practice and regulatory issues in mobile technology treatment for forensic clients
Authors: Ross Stuart
Published: March 2018

This article examines developments in mobile technologies that target the treatment and support needs of offenders in the community, and sets out three challenges that must be addressed if these interventions are to become part of the correctional programs environment. These are: how to identify good quality mobile applications that will yield genuine benefits for practitioners and service users; how to adapt forensic treatment approaches to work effectively in a mobile application environment, and how to make mobile applications available to forensic clients and motivate people to use them. Until these challenges are addressed the potential value of mobile technologies in providing greater access to forensic treatment will not be realised.
Anesthetic Management During Surgery for Tetralogy of Fallot With Pulmonary Atresia and Major Aortopulmonary Collateral Arteries
Authors: Quinonez Zoel A. , Downey Laura , Abbasi Rania K. , Kuan Calvin , Asija Ritu , McElhinney Doff B. , Hanley Frank L. , Mainwaring Richard D. , Wise-Faberowski Lisa
Published: March 2018

Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collaterals (TOF/PA/MAPCAs) is a heterogeneous disease with varying degrees of severity, requiring complex anesthetic management. Our institution has adopted the approach of early complete repair with incorporation of all lung segments, extensive lobar and branch segmental pulmonary artery reconstruction, and ventricular septal defect closure. While the surgical management of TOF/PA/MAPCAs has been extensively described and varies depending on the institution, there is a paucity of literature on the anesthetic management for such procedures. Herein, we describe our anesthetic management based on our own institution’s surgical approach at Lucile Packard Children’s Hospital/Stanford University.
Nigerian Newspapers’ Use of Euphemism in Selection and Presentation of News Photographs of Terror Acts
Authors: Ojebuyi Babatunde Raphael , Salawu Abiodun
Published: March 2018

Selection of photographs is part of the complex process of creating the multimodal textual elements that news editors use to represent and interpret social reality. This article, guided by Aristotle’s golden mean and Halliday’s theoretical notion of metafunctions, used critical visual analysis to examine the nature of photographs that news editors of Nigerian newspapers selected and used to frame news stories about acts of terrorism by the Boko Haram sect. The pattern established through the visual analysis shows that, although the stories of terror act by the Boko Haram sect present deviant and negative social realities, news editors of the selected newspapers exercised ethical restraint by choosing images with nuanced configurations that are less likely to amplify moral panic or intensify horrid feelings. Using euphemistic photographs to tell stories about terror acts is a demonstration of ethical responsibility that has great implications for public peace especially in an African country like Nigeria with security concerns.
Vascular injuries due to cerclage passer: Relevant anatomy and note of caution
Authors: Devendra Agraharam , Avinash M , Chidambaram Dinesh , Dheenadhayalan Jayaramaraju , Rajasekaran S
Published: March 2018

Purpose:

The cerclage passer instrument was introduced for aiding percutaneous reduction in spiral femur fractures, thereby overcoming the risk of devascularization of the fracture ends commonly associated with traditional open cerclage wiring techniques. This may, however, predispose to iatrogenic vascular injuries owing to the proximity of the vessels and several other factors. We report four cases with femoral artery (superficial and deep) injuries caused by the cerclage passer in proximal femur and distal femur shaft fractures and incidence of these injuries in our institution.

Methods:

Retrospective analysis of hospital records of femoral fractures from 2011 to 2015. All cases of femoral fractures and periprosthetic femoral fractures with cerclage wiring done using the standard or the Synthes® cerclage passer were included. Cases with wiring done for trochanteric fractures and other locations were excluded.

Results:

Incidence of vascular injuries due to the cerclage passer in proximal femur shaft fractures was 1.59%, whereas in distal femur shaft fractures it was 7.14%. There were two patients with a deep femoral artery (DFA) system injury and two with a superficial femoral artery (SFA) injury caused by the cerclage passer (Synthes) in two proximal femur shaft and two distal femur shaft fractures, respectively. End-to-end anastomosis for the SFA and ligation for DFA system injuries were used, with an uneventful postoperative period in all patients.

Conclusion:

Caution and accuracy is imperative to avoid vascular injuries while using the cerclage passer in femur fractures, and strict vigilance is essential for early identification and prompt management.
Usefulness of Image Theater Workshops for Exploring Dilemmas in Diabetes Self-Management Among Adolescents
Authors: Kupper Frank , Peters Louk W. H. , Stuijfzand Sarah M. , den Besten Heleen A. A. , van Kesteren Nicole M. C.
Published: March 2018

Diabetes treatment involves a demanding self-management regime that is particularly challenging to adolescents. There is a need for qualitative research into the specific contexts in which adolescents attempt to balance self-management demands with the needs and desires of adolescent life. This study investigates the usefulness of image theater, a participatory form of theater using the body as an expressive tool, to articulate these dilemmas in daily life contexts. We performed a qualitative analysis of two image theater workshops with 12- to 18-year-old adolescents living with diabetes. Our results show three areas of application: (a) unraveling the contextual complexity of lived experience, (b) the articulation of implicit understandings and underlying motives, and (c) the playful exploration of new behavior. We conclude that image theater is a promising method, especially with respect to the opportunities of a more contextual and action-oriented understanding of the trade-offs made in self-management provide for diabetes education and counseling.
What Are the Perceptions, Experiences, and Behaviors of Health Care Providers After Implementation of a Comprehensive Smoke-Free Hospital Policy?
Authors: Luck Kerrie E. , Doucet Shelley
Published: March 2018

The aim of this study was to explore the perceptions, experiences, and behaviors of health care providers (HCPs) after the implementation of a comprehensive smoke-free policy. This qualitative descriptive study, using semi-structured interviews, was conducted with 28 HCPs working in a Canadian hospital. Four overarching themes emerged from the analysis including (a) greater support for tobacco reduction, (b) enhanced patient care and interactions, (c) improved staff morale, and (d) some barriers still exist. The main findings suggest a comprehensive smoke-free hospital environment can strengthen the tobacco-free workplace culture within a hospital setting among HCPs where support for tobacco reduction is amplified, patient care and interactions regarding tobacco dependence are improved, and staff morale is enhanced. While there are still some challenging barriers as well as opportunities for improvements, the implementation of a comprehensive smoke-free policy heightened the call-to-action among HCPs to take a more active role in tobacco reduction.
Scoping Review of the Role of Shared Decision Making in Dental Implant Consultations
Authors: Alzahrani A.A.H. , Gibson B.J.
Published: March 2018

To what extent does dental research on implant consultations focus on the use of shared decision making? There has been an explosion in the use of implant therapies in dentistry, but very little is known about the decision-making processes involved in the provision of dental implants. The use of shared decision making (SDM) has been found to reduce undesirable outcomes and increase patient and clinician satisfaction in other health care fields. This scoping review reports on the current status of SDM in research on implant therapies. A scoping review methodology was used. Web of Knowledge, MEDLINE via OvidSP, MEDLINE via PubMed, Embase, Scopus, Cochrane, DARE, and CINAHL databases were reviewed between 1900 and December 1, 2017. The search strategy resulted in 2,289 eligible articles; 1,892 duplicated articles were deleted, resulting in a hand search of 397 titles and abstracts. These were subsequently evaluated while applying the inclusion and exclusion criteria, resulting in 48 articles for full-text evaluation. After full-text evaluation of these 48 studies, a further 27 were eliminated as not being relevant, leading to the inclusion of 21 studies for the review. No studies to date have examined how patients and dentists engage in decisions to place dental implants. Aspects that were discussed in the literature related to the decision-making process included a discussion about patients’ values and discussing possible treatment options. How patients and dentists interacted during implant consultations was poorly explored. Shared decision making has been shown to improve health care quality and increase clinician and patient satisfaction. Further research concerning dental implant decisions is warranted with emphasis on evaluating patients’ contributions to treatment, which is currently poorly understood. Exploring existed methods for examining the SDM process in implant consultations should facilitate improve care and consent.

Knowledge Transfer Statement: The findings of this scoping review can be used by all dentists when deciding which decision-making model they wish to use when planning implant therapy. The article places special emphasis on the role of shared decision making in improving health care quality and increasing patients’ and clinicians’ satisfaction.
Impact of diabetes mellitus on ischemic cardiomyopathy. Five-year follow-up. REVISION-DM trial
Authors: Hueb Thiago , Rocha Mauricio S. , Siqueira Sergio F. , Nishioka Silvana Angelina D´Orio , Peixoto Giselle L. , Saccab Marcos M. , Lima Eduardo Gomes , Garcia Rosa Maria Rahmi , Ramires José Antonio F. , Kalil Filho Roberto , Martinelli Filho Martino
Published: March 2018

Background

Patients with ischemic cardiomyopathy and severe left ventricular dysfunction have a worse survival prognosis than patients with preserved ventricular function. The role of diabetes in the long-term prognosis of this patient group is unknown. This study investigated whether the presence of diabetes has a long-term impact on left ventricular function.

Methods

Patients with coronary artery disease who underwent coronary artery bypass graft surgery, percutaneous coronary intervention, or medical therapy alone were included. All patients had multivessel disease and left ventricular ejection fraction measurements. Overall mortality, nonfatal myocardial infarction, stroke, and additional interventions were investigated.

Results

From January 2009 to January 2010, 918 consecutive patients were selected and followed until May 2015. They were separated into 4 groups: G1, 266 patients with diabetes and ventricular dysfunction; G2, 213 patients with diabetes without ventricular dysfunction; G3, 213 patients without diabetes and ventricular dysfunction; and G4, 226 patients without diabetes but with ventricular dysfunction. Groups 1, 2, 3, and 4, respectively, had a mortality rate of 21.6, 6.1, 4.2, and 10.6% (P < .001); nonfatal myocardial infarction of 5.3, .5, 7.0, and 2.6% (P < .001); stroke of .40, .45, .90, and .90% (P = NS); and additional intervention of 3.8, 11.7, 10.3, and 2.6% (P < .001).

Conclusion

In this sample, regardless of the treatment previously received patients with or without diabetes and preserved ventricular function experienced similar outcomes. However, patients with ventricular dysfunction had a worse prognosis compared with those with normal ventricular function; patients with diabetes had greater mortality than patients without diabetes.

Trial registrationhttp://www.controlled-trials.com. Registration Number: ISRCTN66068876
Incidence of unipolar and bipolar depression, and mania in adults with intellectual disabilities: prospective cohort study
Authors: Cooper Sally-Ann , Smiley Elita , Allan Linda , Morrison Jillian
Published: March 2018

Background

Incidence and determinants of affective disorders among adults with intellectual disabilities are unknown.

Aims

To investigate affective disorder incidence, and determinants of unipolar depression, compared with general population reports.

Method

Prospective cohort study measuring mental ill health of adults with mild to profound intellectual disabilities living within a defined community, over 2 years.

Results

There was 70% cohort retention (n= 651). Despite high mood stabiliser use (22.4%), 2-year incident mania at 1.1% is higher than the general population; 0.3% for first episode (standardised incident ratio (SIR) = 41.5, or 52.7 excluding Down syndrome). For any bipolar episode the SIR was 2.0 (or 2.5 excluding Down syndrome). Depression incidence at 7.2% is similar to the general population (SIR = 1.2), suggesting more enduring/undertreatment given the higher prevalence. Problem behaviours (odds ratio (OR) = 2.3) and life events (OR = 1.3) predict incident unipolar depression.

Conclusions

Depression needs improved treatment. Mania has received remarkably little attention in this population, despite high prevalence and incidence (similar to schizophrenia), and given the importance of clinician awareness for accurate differential diagnosis from attention-deficit hyperactivity disorder and problem behaviours.

Declaration of interest

None.
A Centrifuge Study of Seismic Structure-Soil-Structure Interaction on Liquefiable Ground and Implications for Design in Dense Urban Areas
Authors: Kirkwood Peter , Dashti Shideh
Published: March 2018

Current practice in seismic design often assumes free-field conditions for the estimation of liquefaction-induced building settlement. This is inaccurate, as a structure places additional stresses on the soil, resulting in changes to the spatial and temporal occurrence of liquefaction, accelerations, and deformations. Further complications arise in dense urban environments where closely spaced structures may interact through structure-soil-structure interaction (SSSI). Previous studies have shown that SSSI may have positive or negative effects on the response of adjacent structures in terms of permanent settlement, rotation, and flexural deformations. However, little is known regarding how to maximize the benefits of SSSI with minimal risk of adverse consequence. In this study, centrifuge tests were conducted on both isolated and closely spaced structures to identify how the building separation and ground motion characteristics affect the response of adjacent structures founded on a layered, liquefiable soil profile. Results indicate that properly planned configurations and interactions may be employed in combination with traditional mitigation strategies to improve the settlement-rotation response of adjacent structures, while also reducing the demand imposed on the superstructure.
Field Monitoring of Strong Ground Motion in Urban Areas: The Kalochori Accelerometric Network (KAN), Database and Web-GIS Portal
Authors: Rovithis Emmanouil , Makra Konstantia , Kirtas Emmanouil , Manesis Charalambos , Bliziotis Dimitrios , Konstantinidou Kiriaki
Published: March 2018

The Kalochori Accelerometric Network (KAN) has been operating since 2014 in the urban area of Kalochori, 7 km west of Thessaloniki in Northern Greece. KAN is composed of seven accelerometric stations: three ground stations installed in distinct urban zones (i.e., residential, industrial, and tanks zone); three stations on top of a selected structure within each urban zone; and one free-field station away from the built environment. The stations are documented with installation and operating features, available characteristics of the housing structures, and geotechnical data. A set of 78 earthquakes that have been recorded by KAN between 16 January 2014 and 31 December 2016 are reported, allowing investigation of local site effects on seismic motion, variation of ground surface motion within different urban environments, and evaluation of dynamic response features of the instrumented structures. KAN stations monographs, processed acceleration recordings, and metadata of the recorded earthquakes are available online through a Web-GIS platform. Indicative example applications are discussed for possible data use in the field of soil and structural dynamics. The DOI linked to the complete set of KAN data is 10.6084/m9.figshare.5044804.
The Hysteretic Energy as a Performance Measure in Analytical Studies
Authors: Kazantzi Athanasia K. , Vamvatsikos Dimitrios
Published: March 2018

Hysteretic energy dissipation is often employed as a measure of performance for systems subjected to earthquake excitation. This mainly stems from quasi-static cyclic tests where fuller hysteresis loops (i.e., higher energy absorption) are taken to indicate better performance when comparing systems with similar strength under the same cyclic loading protocol. However, seismic loading offers a different proving ground, where energy absorption is strongly correlated with energy input, while the nonstationary loads imply that the beneficial hysteretic effects observed in a cyclic test may never be realized. Given the current state of art in models and methods of performance-based earthquake engineering, we ask whether earthquake records at a given seismic intensity will cause peak/residual displacements or accelerations that favor models having fuller hysteresis. Using incremental dynamic analysis on story-level oscillators with varying hysteretic characteristics, it is demonstrated that hysteretic energy dissipation does not consistently correlate with seismic performance.
Generalized Competing Event Models Can Reduce Cost and Duration of Cancer Clinical Trials
Authors: Zakeri Kaveh , Panjwani Neil , Carmona Ruben , Shen Hanjie , Vitzthum Lucas K. , Zhang Qiang E. , Murphy James D. , Mell Loren K.
Published: March 2018

Purpose

Generalized competing event (GCE) models improve stratification of patients according to their risk of cancer events relative to competing causes of mortality. The potential impact of such methods on clinical trial power and cost, however, is uncertain. We sought to test the hypothesis that GCE models can reduce estimated clinical trial cost in elderly patients with cancer.

Methods

Patients with nonmetastatic head and neck (n = 9,677), breast (n = 22,929), or prostate cancer (n = 51,713) were sampled from the SEER-Medicare database. Using multivariable Cox proportional hazards models, we compared risk scores for all-cause mortality (ACM) and cancer-specific mortality (CSM) with GCE-based risk scores for each disease. We applied a cost function to estimate the cost and duration of clinical trials with a primary end point of overall survival in each population and in high-risk subpopulations. We conducted sensitivity analyses to examine model uncertainty.

Results

For the purpose of enriching subpopulations, GCE models reduced estimated clinical trial cost compared with Cox models of ACM and CSM in all disease sites. The relative cost reductions with GCE models compared with ACM and CSM models, respectively, were −68.4% and −14.4% in prostate cancer, −38.8% and −18.3% in breast cancer, and −17.1% and −4.1% in head and neck cancer. Cost savings in breast and prostate cancers were on the order of millions of dollars. The GCE model also reduced relative clinical trial duration compared with CSM and ACM models for all disease sites. The optimal risk score cutoff for clinical trial enrollment occurred near the top tertile for all disease sites.

Conclusion

GCE models have significant potential to improve clinical trial efficiency and reduce cost, with a potentially large impact in prostate and breast cancers.
Survival Analysis After Neoadjuvant Chemotherapy With Trastuzumab or Lapatinib in Patients With Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer in the GeparQuinto (G5) Study (GBG 44)
Authors: Untch Michael , von Minckwitz Gunter , Gerber Bernd , Schem Christian , Rezai Mahdi , Fasching Peter A. , Tesch Hans , Eggemann Holm , Hanusch Claus , Huober Jens , Solbach Christine , Jackisch Christian , Kunz Georg , Blohmer Jens-Uwe , Hauschild Maik , Fehm Tanja , Nekljudova Valentina , Loibl Sibylle ,   for the GBG and the AGO-B Study Group
Published: March 2018

Purpose

The GeparQuinto phase III trial demonstrated a lower pathologic complete response (pCR; pT0 ypN0) rate when lapatinib was added to standard anthracycline–taxane chemotherapy compared with trastuzumab in patients with human epidermal growth factor receptor 2 (HER2) –positive breast cancer. Here, we report the long-term outcomes.

Methods

Patients with HER2-positive tumors (n = 615) received neoadjuvant treatment with epirubicin (E) plus cyclophosphamide (C), followed by docetaxel (T) in combination with either lapatinib (L) or trastuzumab (H; ECH-TH arm: n = 307; ECL-TL arm: n = 308). All patients received adjuvant trastuzumab for a total of 12 months and 18 months in the ECH-TH and ECL-TL arms, respectively. Median follow-up was 55 months.

Results

Three-year disease-free survival (DFS), distant DFS (DDFS), and overall survival (OS) were not significantly different between the two treatment arms. Long-term outcomes correlated with pCR (DFS: hazard ratio [HR], 0.63; P = .042; DDFS: HR, 0.55; P = .021; and OS: HR, 0.31; P = .004). A benefit only for OS was observed in patients who were treated with trastuzumab and achieved pCR versus no pCR (HR, 0.15; P = .010), whereas no difference was found in patients with pCR versus without pCR in the lapatinib arm. DFS and DDFS remained unchanged in both treatment arms according to hormone receptor status, whereas OS was significantly better in hormone receptor–positive patients who were treated with neoadjuvant lapatinib (HR, 0.32; P = .019), followed by adjuvant trastuzumab. No difference was observed in hormone receptor–negative patients; however, the small number of events limits this interpretation. Within the hormone receptor–negative cohort, pCR was significantly associated with DFS, DDFS, and OS ( P = .002, .005, and .002, respectively).

Conclusion

pCR correlated with long-term outcome. In patients with hormone receptor–positive tumors, prolonged anti-HER2 treatment—neoadjuvant lapatinib for 6 months, followed by adjuvant trastuzumab for 12 months—significantly improved survival compared with anti-HER2 treatment with trastuzumab alone.
Pilot Study on the Application of Telemedicine as a Tool for a Population-Based Cancer Registry in Hlegu Township, Yangon Region, Myanmar
Authors: Aye Khin Saw , Wai KhinThet , Swe Yan Naing , Mon Ssu Wynn , Mon Nan Cho Nwe , Naing Win Pa Pa , Aung Soe , Thant Kyaw Zin
Published: March 2018

Abstract 57

Purpose

The cancer burden is rising and threatens the social and economic development of low- and middle-income countries, including Myanmar, in the ASEAN region. A quality cancer registry plays a unique role in planning, the evaluation of cancer control program, treatment, and palliative care. To date, there is a paucity of studies in Myanmar that have focused on the implementation of a population-based cancer registry. In addition, the concept of telemedicine with the use of information technology applications as appropriate during implementation needs to be introduced. Such an approach may be beneficial to those working at the grassroots level for the overall improvement of the processes of community reporting, confirmation of diagnoses, effective referral for palliative care, and the establishment of cancer registries.

Methods

A pilot study was therefore carried out to formulate the strategic approach for establishing a population-based cancer registry in Hlegu Township in Northern Yangon District, Myanmar. First, the cancer data entry software was created and installed on mobile phones as an information technology tool to initialize telemedicine. Next, 15 health assistants in Hlegu Township were trained in the collection of data and the entry of basic information on patients with cancer, including name, age, gender, national ID, education, occupation, primary diagnosis, and the site of metastasis of confirmed cancer cases through mobile phone applications and reported to the cancer database unit at the Department of Medical Research.

Results

A total of 126 patients with cancer were registered in Hlegu Township from June 2016 to May 2017. The estimated prevalence of disease is 4.6 per 10,000 people. The most common age at cancer diagnosis was 46 to 65 years (73.58%). Female sex was 2.5 times predominant than male sex (72% v 27%). Among 91 registered female patients with cancer, the three most common cancers were breast (32.35%), cervix (16.17%) and uterine (15.17%). Eighty-five patients with cancer (67.46%) received their diagnosis in public hospitals. Overall, 59% of patients received combination treatment, 19% received surgery only, 16% were treated with traditional medicine, 3% were treated with radiotherapy only, and 3% were treated with chemotherapy only.

Conclusion

This study is a first step in applying the concept of telemedicine to the creation of a population-based cancer registry in a resource-limited setting. More concerted efforts are needed to move toward a well-established population-based cancer registry in Myanmar.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.
Breastfeeding Duration and the Risk of All-Cause and Breast Cancer Mortality Among Parous Women From the Mexican Teachers’ Cohort
Authors: Munguía Mishel Unar , Esparza Susana Lozano , Stern Dalia , Posadas Mónica Mazariegos , Ridaura Ruy López , Lajous Martin
Published: March 2018

Abstract 79

Purpose

Women who have breastfed have a lower risk of breast and ovarian cancer and other chronic diseases. Currently, breast cancer has become the leading cause of death from cancer in Mexican women. In Mexico, exclusive breastfeeding rates have declined one third in the last decade, and only 35% of women breastfed at least 1 year, which provides a unique scenario in which to analyze breastfeeding and mortality. The aim of the current study was to estimate the impact of lifetime breastfeeding duration on the risk of all-cause and breast cancer mortality in Mexican women.

Methods

We analyzed parous women who were enrolled in a Mexican Teachers’ Cohort since 2006 and observed over 10 years. Months of breastfeeding per pregnancy were self-reported at baseline. We categorized participants according to the accumulated duration of any mode of breastfeeding (never, < 6 months, 6 to 11 months, 12 to 23 months, and ≥ 24 months). Deaths were identified using the employer’s database and next of kin reports, and the date and cause of death were obtained from national mortality databases. We used Cox proportional hazards regression models adjusted for baseline age, parity (one, two, three, and four or more children), age at first birth (< 20, 20 to 24, 25 to 29, and ≥ 30 years), BMI at age 18 years (≤ 25 or > 25), socioeconomic level (tertiles), and smoking (current, past, and never) to estimate hazard ratios (HRs).

Results

Mean age at baseline was 43 ± 7 years. Over 767,600 person-years of follow-up, 952 all-cause deaths and 92 breast cancer deaths occurred among 92,794 parous women. Mean age at death was 57 ± 7 years. The incidence rate per 1,000 person-years of all-cause mortality was 1.8 for women who did not breastfeed, 1.18 (< 6 months), 1.21 (6 to 11 months), 1.01 (12 to 23 months), and 1.26 (≥ 24 months). HRs for all-cause mortality among parous women with lifetime breastfeeding of < 6 months was 0.79 (95% CI, 0.63 to 0.97), 0.85 (95% CI, 0.70 to 1.05) for 6 to 11 months, 0.78 (95% CI, 0.64 to 0.94) for 12-23 months, and 0.88 (95% CI, 0.69 to 1.10) for > 24 months compared with parous women who never breastfed. No dose-response relationship was found when comparing HRs of the different categories of breastfeeding. HR for breast cancer mortality for women who ever breastfed compared with parous women who never breastfed was 0.75 (95% CI, 0.45 to 1.33).

Conclusion

Breastfeeding among parous Mexican women was associated with lower all-cause mortality. Breastfeeding could potentially reduce premature deaths in women.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.
Factors Associated With Early-Onset Esophageal Cancer in Tanzania: A Case-Control Study
Authors: Buckle Geoffrey , Mmbaga Elia J. , Paciorek Alan , Akoko Larry , Deardorff Katrina , Mgisha William , Mushi Beatrice , Mwaiselage Julius , Van Loon Katherine , Zhang Li
Published: March 2018

Abstract 89

Purpose

Previous studies have characterized geographic clusters of esophageal cancer (EC) in East Africa. Many of the epidemiologic features of EC in this context are shared globally with other clusters, including high rates, male predominance, and squamous cell histology. A unique feature in East Africa is the high proportion of young patients, with a recent case series reporting up to 24% of patients age < 45 years. The aim of the current study was to assess factors that are associated with early-onset EC in Tanzania (TZ).

Methods

We performed a secondary analysis of a previous case-control study. Patients with newly diagnosed EC were recruited at Muhimbili National Hospital and Ocean Road Cancer Institute in 2014 to 2016. Hospital controls were identified from patients with nonmalignant conditions and matched 1:1 for gender and age ± 10 years. Risk factors were assessed through interviews. Logistic regression was used to estimate age-specific odds ratios (ORs) of EC for exposures across age groups (30 to 44 years, 45 to 59 years, and ≥ 60 years) and for interactions with age.

Results

A total of 473 cases and 473 controls were enrolled. Median ages were 59 years (range, 30 to 91 years) for cases and 55 years (range, 31 to 88 years) for controls. Among cases, 102 patients (22%) were age 30 to 44 years, 144 patients (30%) were age 45 to 59 years, and 227 patients (48%) were age ≥ 60 years. High household income was protective for those age 30 to 44 years (OR, 0.08; 95% CI, 0.01 to 0.69) and 45 to 59 years (OR, 0.13; 95% CI, 0.04 to 0.45), but not for those age ≥ 60 years (effect modification P = .047). Family history of EC was associated with a higher risk of EC among those age 45 to 59 years (OR, 3.8; 95% CI, 1.02 to 14.47) and age ≥ 60 years (OR, 6.63; 95% CI, 1.50 to 29.37), with no effect among those age 30 to 44 years (effect modification P = .019). Second-hand smoke and infrequent teeth cleaning were also associated with early-onset EC, but did not differ significantly across age groups. Additional factors associated with EC risk across all ages were firewood use (cooking), kerosene use (lighting), work on a maize farm, and in-home grain and nut storage. Protective factors were the regular use of medication, surrogates of high socioeconomic status (TV, radio, refrigerator, indoor toilet, and electricity), and charcoal or gas cooking.

Conclusion

Multiple exposures were identified as risk factors for early-onset EC in TZ. In age-stratified analyses, household income, second-hand smoke, and poor dental hygiene emerged as possible risk factors, whereas family history of EC had strong associations among the older but not the young age group. Our results suggest that environmental factors may underlie the high incidence of young patients with EC in TZ.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.
Implementation of Anatomic Pathology Services in Mirebalais, Haiti
Authors: Anglade Fabienne , Mompremier Myrlene , Bhangdia Kayleigh , Greenberg Lauren , Orozco Juan Daniel , Brock Jane , Pepoon James , Milner Dan
Published: March 2018

Abstract 97

Purpose

Despite great barriers, implementing pathology services in resource-limited rural settings is achievable. Challenges include the lack of infrastructure, trained personnel, supply chain, and decentralized services, and have hindered the appropriate provision of cancer care to those who live in resource-limited settings. In Haiti, we began treating cancer at University Hospital Mirebalais (HUM) before pathology services existed, sending samples to the United States for diagnoses. This model allowed patients to receive treatment, but turnaround time was often delayed. Our goal is to implement pathology services at HUM that can provide high-quality diagnostics to patients who are enrolled in the cancer program. We demonstrate that, by rolling out a phased implementation of local pathology services with appropriate commitment from local and international partners, accurate pathologic diagnoses can exist in low- and middle-income countries.

Methods

Phase I—infrastructure and personnel—occurred fall 2016 with the construction of the laboratory and the hiring of a pathologist and laboratory technicians, which allowed samples to be grossed into paraffin blocks before being sent to Boston. Phase II—technology transfer and training—occurred fall 2017 with the procurement of additional equipment and hands-on histology training, which allowed samples to be cut, stained, and diagnosed on-site. In this phase, only complex samples that needed additional immunohistochemistry or a second opinion were sent to Boston. Phase III—testing capacity expansion—will occur summer 2018 and involves procuring immunohistochemistry and training, which will further limit the need to send cases to the United States. Phase IV—routine testing and quality assurance—will occur in tandem with phase III and involves implementing a telepathology system on-site in the HUM laboratory.

Results

Outcomes of this phased implementation will result in decentralized pathology services in the public sector and ultimately decreased turnaround times, producing better clinical outcomes. Our model demonstrates that it is possible to build local pathology capacity in rural areas. Since the opening of our laboratory, more than 1,000 cases have been processed into paraffin blocks before being sent to Boston. In September 2017, the first cases were diagnosed in country, and more than 100 cases have been processed and reported in Haiti.

Conclusion

Building on the foundational phases, the next phases of implementation involve long-term diagnostic support that will correlate directly with a substantial decrease in turnaround time.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.