bluuebunny/crossref_metadata_2025 huggingface dataset:
The Judiciary of International Criminal Law
Authors: Christensen Mikkel Jarle
Published: August 2019

The article investigates the judiciary of international criminal law and its development over time. Inspired by the sociological tools of Pierre Bourdieu and building on an original dataset, the article analyses the judiciary of three international criminal courts, namely the International Criminal Tribunal for the former Yugoslavia, the International Criminal Court and the Extraordinary Chambers in the Courts of Cambodia. The focus of the analysis is on how the composition of expertise in the judiciary of these courts reflects the wider power structure in the field of international criminal law as well as temporal developments in this structure. Reflecting and responding to these transformations, the judiciary of international criminal law has been affected by a double decline of positions and prestige and a turn towards practice as the core expertise of the field. However, despite this turn to practice, the accumulation of political expertise continues to structure access to elite positions in the international criminal law judiciary.
From Stranger to Family or Something in Between: Donor Linking in an Era of Retrospective Access to Anonymous Sperm Donor Records in Victoria, Australia
Authors: Kelly Fiona , Dempsey Deborah , Power Jennifer , Bourne Kate , Hammarberg Karin , Johnson Louise
Published: August 2019

In June 2015, the state of Victoria, Australia retrospectively opened its sperm and egg donors’ records, becoming only the second jurisdiction in the world to do so and the first where substantial pre-legislative records are available and stored in a central register. The new legislation gave donor-conceived adults and donors who were conceived or donated under conditions of anonymity (ie prior to 1988) the right to apply to the state’s Central Register for each other’s identifying information, which is released to them if the subject of the application consents. Between the introduction of the law and its further amendment in March 2017, more than 100 applications were made. Through a thematic analysis of donor-conceived adults’ and donors’ Statements of Reasons – a written document applicants were required to complete when they applied – the article explores applicants’ motivations for applying, the information they sought, and their goals with regard to contact. The study found that most applicants were driven by curiosity and a desire for personal information about the other party. They also expressed a strong desire to meet and have an ongoing relationship with the subject of their application. The study also revealed an unanticipated desire on the part of previously anonymous donors for information about their offspring, suggesting future research could explore the emotional needs of donors in greater depth.
Phenotypic redshifts with self-organizing maps: A novel method to characterize redshift distributions of source galaxies for weak lensing
Authors: Buchs R , Davis C , Gruen D , DeRose J , Alarcon A , Bernstein G M , Sánchez C , Myles J , Roodman A , Allen S , Amon A , Choi A , Masters D C , Miquel R , Troxel M A , Wechsler R H , Abbott T M C , Annis J , Avila S , Bechtol K , Bridle S L , Brooks D , Buckley-Geer E , Burke D L , Carnero Rosell A , Carrasco Kind M , Carretero J , Castander F J , Cawthon R , D’Andrea C B , da Costa L N , De Vicente J , Desai S , Diehl H T , Doel P , Drlica-Wagner A , Eifler T F , Evrard A E , Flaugher B , Fosalba P , Frieman J , García-Bellido J , Gaztanaga E , Gruendl R A , Gschwend J , Gutierrez G , Hartley W G , Hollowood D L , Honscheid K , James D J , Kuehn K , Kuropatkin N , Lima M , Lin H , Maia M A G , March M , Marshall J L , Melchior P , Menanteau F , Ogando R L C , Plazas A A , Rykoff E S , Sanchez E , Scarpine V , Serrano S , Sevilla-Noarbe I , Smith M , Soares-Santos M , Sobreira F , Suchyta E , Swanson M E C , Tarle G , Thomas D , Vikram V ,   (DES Collaboration)
Published: August 2019

Wide-field imaging surveys such as the Dark Energy Survey (DES) rely on coarse measurements of spectral energy distributions in a few filters to estimate the redshift distribution of source galaxies. In this regime, sample variance, shot noise, and selection effects limit the attainable accuracy of redshift calibration and thus of cosmological constraints. We present a new method to combine wide-field, few-filter measurements with catalogues from deep fields with additional filters and sufficiently low photometric noise to break degeneracies in photometric redshifts. The multiband deep field is used as an intermediary between wide-field observations and accurate redshifts, greatly reducing sample variance, shot noise, and selection effects. Our implementation of the method uses self-organizing maps to group galaxies into phenotypes based on their observed fluxes, and is tested using a mock DES catalogue created from N-body simulations. It yields a typical uncertainty on the mean redshift in each of five tomographic bins for an idealized simulation of the DES Year 3 weak-lensing tomographic analysis of σΔz = 0.007, which is a 60 per cent improvement compared to the Year 1 analysis. Although the implementation of the method is tailored to DES, its formalism can be applied to other large photometric surveys with a similar observing strategy.
A hyper-runaway white dwarf in Gaia DR2 as a Type Iax supernova primary remnant candidate
Authors: Ruffini Nicholas J , Casey Andrew R
Published: August 2019

Observations of stellar remnants linked to Type Ia and Type Iax supernovae are necessary to fully understand their progenitors. Multiple progenitor scenarios predict a population of kicked donor remnants and partially burnt primary remnants, both moving with relatively high velocity. But only a handful of examples consistent with these two predicted populations have been observed. Here we report the likely first known example of an unbound white dwarf that is consistent with being the fully cooled primary remnant to a Type Iax supernova. The candidate, LP 93-21, is travelling with a galactocentric velocity of $v_{\textrm {gal}} \simeq 605\, {\rm km}\, {\rm s}^{-1}$, and is gravitationally unbound to the Milky Way. We rule out an extragalactic origin. The Type Iax supernova ejection scenario is consistent with its peculiar unbound trajectory, given anomalous elemental abundances are detected in its photosphere via spectroscopic follow-up. This discovery reflects recent models that suggest stellar ejections likely occur often. Unfortunately the intrinsic faintness of white dwarfs, and the uncertainty associated with their direct progenitor systems, makes it difficult to detect and confirm such donors.
EC 22536-5304: SALT identifies a new lead-rich intermediate helium subdwarf★
Authors: Jeffery C S , Miszalski B
Published: August 2019

SALT spectra of the helium-rich hot subdwarf EC 22536-5304 show strong absorption lines of triply-ionized lead. Analysis of the HRS spectrum and a follow-up SALT/RSS spectrum show EC 22536-5304 to have surface properties (temperature, gravity, helium/hydrogen ratio) similar to other heavy-metal subdwarfs. With a lead overabundance of 4.8 dex relative to solar, EC 22536-5304 is the most lead-rich intermediate helium subdwarf discovered so far.
Predictors of leptomeningeal disease following hypofractionated stereotactic radiotherapy for intact and resected brain metastases
Authors: Nguyen Timothy K , Sahgal Arjun , Detsky Jay , Atenafu Eshetu G , Myrehaug Sten , Tseng Chia-Lin , Husain Zain , Heyn Chris , Maralani Pejman , Ruschin Mark , Perry James , Soliman Hany
Published: August 2019

Background

The objective was to evaluate the risk and predictors of developing leptomeningeal disease (LMD) in patients with brain metastases treated with 5-fraction hypofractionated stereotactic radiotherapy (HSRT).

Methods

Patients treated with HSRT for intact brain metastases and/or surgical cavities were reviewed from a prospectively maintained database. Radiographic patterns of LMD were classified as focal classical, diffuse classical, focal nodular, and diffuse nodular.

Results

HSRT was delivered, most commonly 30 Gy in 5 fractions, to 320 intracranial lesions (57% intact and 43% surgical cavities) in 235 patients. The median follow-up was 13.4 months (range, 0.8 to 60 mo). LMD developed in 19% of patients with a 1-year LMD rate of 12%. From the diagnosis of LMD, the median overall survival (OS) was 3.8 months (range, 2–20.8 mo). The most common LMD pattern was diffuse nodular (44%). No difference in OS was observed between LMD patterns (P = 0.203). Multivariable analysis identified surgical cavities at significantly higher risk of LMD compared with intact lesions (odds ratio [OR] = 2.30, 95% CI: 1.24, 4.29, P = 0.008). For cavities, radiosensitive tumors (OR = 2.35, 95% CI: 1.04, 5.35, P = 0.041) predicted for LMD, while, for intact metastases, patients receiving treatment with targeted agents or immunotherapy (TA/I) were at lower risk (OR = 0.178, 95% CI: 0.04, 0.79, P = 0.023).

Conclusions

Patients who had a brain metastasis resected were at an increased risk of LMD. OS was poor despite treatment of LMD, and no differences in OS based on the pattern of LMD was observed. Treatment with TA/I was observed to be protective against LMD and requires further study.
The 5-HTTLPR polymorphism impacts moral permissibility of impersonal harmful behaviors
Authors: Yang Yafang , Wang Chunlan , Li Xiaohan , Yu Rongjun , Zhang Mengfei , Xue Mengying , Guo Wenxuan , He Linlin , Gao Xiaocai , Gong Pingyuan
Published: August 2019

Inspired by the roles of serotonin in an emotional aversion to harmful actions, we examined to what extent serotonin transporter gene (5-HTT)–linked polymorphic region (5-HTTLPR), a proxy for measuring serotonin function, underpinned the individual differences in moral judgment through cross-sectional analysis and two-wave comparison. The cross-sectional analysis with a larger cohort (N = 1197) showed that the SS carriers of the 5-HTTLPR polymorphism, corresponding to the low ratio of serotonin recycling from the synaptic cleft, rated impersonal harmful actions (e.g. flipping a switch to divert a train to hit one person instead of five people) as more permissible as compared with the L-allele carriers. The two-wave comparison with a subsample from the larger cohort (N = 563) indicated that the association between 5-HTTLPR polymorphism and moral permissibility of impersonal harmful actions was stable from wave 1 to wave 2. Thus, these findings highlight the importance of the 5-HTTLPR polymorphism to harmful moral behaviors.
Ambiguity in identification of peer-reviewed publications in the Finnish and Flemish performance-based research funding systems
Authors: Pölönen Janne , Engels Tim , Guns Raf
Published: August 2019

In performance-based research funding systems evidence of peer review is often considered a requirement for publications to be included. Originating from the sciences, pre-publication peer review is very common in the publishing process, also in the social sciences and humanities. Sometimes, however, it is ambiguous whether a publication is peer-reviewed or not. In this contribution, we analyse the ambiguity in identifying a journal’s or publication’s peer-review status by comparing the classification of journals in Finland and Flanders, and by taking stock of Finnish authors’ reporting of peer-review status of publications. We find that ambiguity in terms of peer review status is rather common, especially in the humanities. Indeed, we find differences in peer review status in about 10 per cent of all cases, both when comparing Finland and Flanders, and when comparing author-reported and centralised identification of peer-review status.
Acute Kidney Injury in Children with Severe Malaria Is Common and Associated with Adverse Hospital Outcomes
Authors: Oshomah-Bello Eunice O , Esezobor Christopher I , Solarin Adaobi U , Njokanma Fidelis O
Published: August 2019

Background

The prevalence of acute kidney injury (AKI) in children with severe malaria in sub-Saharan African may have been underestimated. The study aimed to determine the prevalence of AKI in children with severe malaria and its association with adverse hospital outcomes.

Methods

At presentation, we measured complete blood count, serum bilirubin, and serum electrolytes, urea and creatinine in children with severe malaria. At 24 h after hospitalization, we repeated serum creatinine measurement. Urine passed in the first 24 h of hospitalization was also measured. We defined AKI and its severity using the Kidney Disease: Improving Global Outcome AKI guidelines.

Results

The study involved 244 children (53.3% males) with a median age of 3.5 (1.9–7.0) years. One hundred and forty-four (59%) children had AKI, and it reached maximum Stages 1, 2 and 3 in 56 (23%), 45 (18.4%) and 43 (17.6%) children, respectively. The majority (86.1%) with AKI had only elevated serum creatinine. Mortality increased with increasing severity of AKI on univariate analysis but weakened on multiple logistic regression. Mortality was also higher in those with both oliguria and elevated serum creatinine than in those with elevated serum creatinine only (50% vs. 4.8%, p < 0.001). Furthermore, children with AKI spent three days more in hospital than those without AKI (p < 0.001).

Conclusions

Acute kidney injury complicates severe malaria in 6 out of every 10 children and is commonly identified using elevated serum creatinine. It is also associated with adverse hospital outcome.
Managing gestational diabetes
Authors: Dugan Joy A. , Ma-Crawford Julianna
Published: August 2019

Gestational diabetes is diabetes diagnosed in the second or third trimester of pregnancy in a patient who was not diagnosed with diabetes before pregnancy. Timely identification and management of gestational diabetes is important to prevent fetal, infant, and maternal complications. Physical activity and dietary changes remain the hallmark of treatment, with insulin becoming the medication of choice if further intervention is needed. This article reviews the steps clinicians can take to screen for patients with gestational diabetes, recommendations for future type 2 diabetes screening, and how to manage gestational diabetes during the course of a patient's pregnancy based on the American Diabetes Association's current standards of care.
Loneliness in adults
Authors: Pearson Tamera
Published: August 2019

Loneliness is a complex psychophysiologic concept, a health risk factor, and a worrisome trend across the globe. This article reviews the latest research on the negative health effects associated with loneliness. Evidence-based NP interventions aimed at improving patients' perceived social connections are also explored.
Association Between Year of Birth and 1-Year Survival Among Extremely Preterm Infants in Sweden During 2004–2007 and 2014–2016
Authors: Norman Mikael , Hallberg Boubou , Abrahamsson Thomas , Björklund Lars J. , Domellöf Magnus , Farooqi Aijaz , Foyn Bruun Cathrine , Gadsbøll Christian , Hellström-Westas Lena , Ingemansson Fredrik , Källén Karin , Ley David , Maršál Karel , Normann Erik , Serenius Fredrik , Stephansson Olof , Stigson Lennart , Um-Bergström Petra , Håkansson Stellan
Published: August 2019

(Abstracted from JAMA 2019;321(12):1188–1199)

The long-term health outcomes for preterm infants have improved over time, but infants born at extreme preterm gestational ages continue to present issues of optimal antenatal and postnatal management, resource allocation and costs, quality of care, and long-term health outcomes. To better understand variations and time trends for management and outcomes of extremely preterm birth, study of international populations is needed.
Antibiotic Exposure Profiles in Trials Comparing Intensity of Continuous Renal Replacement Therapy
Authors: Jang Soo Min , Pai Manjunath P. , Shaw Alexander R. , Mueller Bruce A.
Published: August 2019

Objectives:

To determine whether the probability of target attainment over 72 hours of initial therapy with beta-lactam (cefepime, ceftazidime, piperacillin/tazobactam) and carbapenem (imipenem, meropenem) antibiotics were substantially influenced between intensive and less-intensive continuous renal replacement therapy groups in the Acute Renal Failure Trial Network trial and The RENAL Replacement Therapy Study trial.

Design:

The probability of target attainment was calculated using pharmacodynamic targets of percentage of time that free serum concentrations (fT): 1) were above the target organism’s minimum inhibitory concentration (≥ fT > 1 × minimum inhibitory concentration); 2) were above four times the minimum inhibitory concentration (≥ % fT > 4 × minimum inhibitory concentration); and 3) were always above the minimum inhibitory concentration (≥ 100% fT > minimum inhibitory concentration) for the first 72 hours of antibiotic therapy. Demographic data and effluent rates from the Acute Renal Failure Trial Network and RENAL Replacement Therapy Study trials were used. Optimal doses were defined as the dose achieving greater than or equal to 90% probability of target attainment.

Setting:

Monte Carlo simulations using demographic data from Acute Renal Failure Trial Network and RENAL Replacement Therapy Study trials.

Patients:

Virtual critically ill patients requiring continuous renal replacement therapy.

Interventions:

None.

Measurements and Main Results:

The pharmacodynamic target of fT greater than 1 × minimum inhibitory concentration led to similarly high rates of predicted response with antibiotic doses often used in continuous renal replacement therapy. Achieving 100% fT greater than minimum inhibitory concentration is a more stringent benchmark compared with T greater than 4 × minimum inhibitory concentration with standard antibiotic dosing. The intensity of effluent flow rates (less intensive vs intensive) did not substantially influence the probability of target attainment of antibiotic dosing regimens regardless of pharmacodynamic target.

Conclusions:

Antibiotic pharmacodynamic target attainment rates likely were not meaningfully different in the low- and high-intensity treatment arms of the Acute Renal Failure Trial Network and RENAL Replacement Therapy Study Investigators trials.
Impact of Stressful Climates on Provider Perceptions of Integrated Behavioral Health Services in Pediatric Primary Care: An Exploratory Study
Authors: Hsiung Kimberly S. , Hart Jonathan , Kelleher Kelly J. , Kolko David J.
Published: August 2019

Objective:

Pediatric primary care providers (PCPs) work in challenging environments and are increasingly called to implement complex interventions, such as behavioral health (BH) service integration. We explore how perceived stressful practice climates (1) change over time in and (2) influence provider perceptions of collaborative care versus usual care, 2 models of integrated BH care.

Methods:

Secondary exploratory analysis using hierarchical linear modeling was performed on an 18-month cluster-randomized trial of 8 pediatric primary care practices to Doctor-Office Collaborative Care (DOCC), where an on-site care manager delivered BH services in coordination with PCPs, or Enhanced Usual Care (EUC), where a care manager facilitated referrals to local BH providers. Various indicators of PCP perceptions of BH services, including satisfaction with practice, burdens and beliefs regarding psychosocial problems, and effectiveness in treating behavioral problems, were assessed as outcomes. Moderators were 2 domains of stressful climates, role conflict and role overload.

Results:

Role conflict and role overload stayed stable in both conditions. Role conflict strengthened the positive effect of DOCC on PCP perceived effectiveness in treating behavioral problems (β [SE], 0.04 [0.02]; p = 0.04) and improvement in managing oppositional/aggressive behavior (0.02 [0.01]; p = 0.02). Role overload strengthened the positive effect of DOCC on PCP-perceived improvement in managing attention-deficit hyperactivity disorder (0.03 [0.01]; p = 0.01). Stressful climates did not influence perceptions for EUC providers.

Conclusions:

Providers experiencing more stressful practice climates developed more positive perceptions of collaborative care. This may encourage stressed providers to make effective practice changes and promote practice integration of BH services.
Microneedling Treatment of Striae Distensae in Light and Dark Skin With Long-Term Follow-Up
Authors: Alster Tina S. , Li Monica K.
Published: August 2019

BACKGROUND

Striae distensae have notoriously been difficult to treat due to their extensive involvement of nonfacial skin. Microneedling with its lack of thermal injury during microneedling treatment renders it a viable treatment option in darker skin tones and nonfacial regions due to the reduced risk of postinflammatory hyperpigmentation.

OBJECTIVE

To describe the clinical results and side effects of microneedling in a series of 25 individuals with striae distensae.

MATERIALS AND METHODS

Twenty-five consecutive adults (SPT I–V) with striae distensae involving the trunk and extremities were treated using a microneedling device. No additional treatments (topical or intralesional) were applied. Two assessors blinded to treatment protocol rated clinical improvement of striae on a 5-point scale. Side effects were monitored and tabulated.

RESULTS

Patients received 1 to 3 consecutive monthly treatments. All striae improved at least 50% after an average of 1.8 treatments, and 28% of patients demonstrated more than 75% clinical improvement. Striae in thicker skin regions (e.g., buttocks/thighs) showed comparable clinical improvement than those in thinner skin areas (e.g., breasts) and did not require additional treatment sessions. Side effects were limited to transient erythema in all skin phototypes. No infections or dyspigmentation were observed.

CONCLUSION

The clinical results obtained in this study support the safe and effective treatment of striae distensae with microneedling in light and dark skin tones in various body locations. Standardization of treatment protocols are anticipated with further (ongoing) studies.
Vision Blinding of Participants in Limb Prosthetic Research Is Unnecessary
Authors: Clark Anna Marie , Fiedler Goeran
Published: August 2019

Introduction

This research addresses a common limitation in prosthetic and orthotic research, where subject blinding, for example, concealment of the group assignment, is difficult to implement. The purpose of this study was to investigate how effectively people with limb prostheses can be blinded to a typical research intervention. It was hypothesized that vision blinding reduces the accuracy of patients' assessment of prosthesis alignment changes.

Methods

Users of a lower-limb prosthesis who were able to walk without aid were recruited as participants for this randomized crossover intervention study. Exclusion criteria were visual impairments and use of a prosthesis that disallows temporary alignment changes. Blinding (four levels) and prosthetic ankle alignment perturbation (five levels) were combined to result in a total of 20 randomized conditions per participant. Participants' accuracy and surety of assessing the alignment perturbation were evaluated as the main outcome measures.

Results

Correctness of alignment assessment with and without blinding was not found to be significantly different (P = 0.230). Subject's surety about their own assessments was significantly lower with vision blinding (P = 0.005).

Conclusions

Vision blinding did not seem to affect subjects' awareness of prosthetic interventions.
Predictive risk stratification using HEART (history, electrocardiogram, age, risk factors, and initial troponin) and TIMI (thrombolysis in myocardial infarction) scores in non-high risk chest pain patients
Authors: Bhattacharya Priyanka T. , Golamari Reshma R. , Vunnam Sandhya , Moparthi Smitha , Venkatappa Neethi , Dollard Denis J. , Missri Jose , Yang Wei , Kimmel Stephen E.
Published: August 2019

Validated risk scoring systems in African American (AA) population are under studied. We utilized history, electrocardiogram, age, risk factors, and initial troponin (HEART) and thrombolysis in myocardial infarction (TIMI) scores to predict major adverse cardiovascular events (MACE) in non-high cardiovascular (CV) risk predominantly AA patient population.

A retrospective emergency department (ED) charts review of 1266 chest pain patients where HEART and TIMI scores were calculated for each patient. Logistic regression model was computed to predict 6-week and 1-year MACE and 90-day cardiac readmission. Decision curve analysis (DCA) was constructed to differentiate between clinical strategies in non-high CV risk patients.

Of the 817 patients included, 500 patients had low HEART score vs. 317 patients who had moderate HEART score. Six hundred sixty-three patients had low TIMI score vs. 154 patients had high TIMI score. The univariate logistic regression model shows odds ratio of predicting 6-week MACE using HEART score was 3.11 (95% confidence interval [CI] 1.43–6.76, P = .004) with increase in risk category from low to moderate vs. 2.07 (95% CI 1.18–3.63, P = .011) using TIMI score with increase in risk category from low to high and c-statistic of 0.86 vs. 0.79, respectively. DCA showed net benefit of using HEART score is equally predictive of 6-week MACE when compared to TIMI.

In non-high CV risk AA patients, HEART score is better predictive tool for 6-week MACE when compared to TIMI score. Furthermore, patients presenting to ED with chest pain, the optimal strategy for a 2% to 4% miss rate threshold probability should be to discharge these patients from the ED.
Predicting in-hospital death in patients with type B acute aortic dissection
Authors: Zhang Jing , Cheng Baoshan , Yang Mengsi , Pan Jianyuan , Feng Jun , Cheng Ziping
Published: August 2019

The outcome of patients with acute type B aortic dissection (BAAD) is largely dictated by whether or not the case is “complicated.” The purpose of this study was to investigate the risk factors leading to in-hospital death among patients with BAAD and then to develop a predictive model to estimate individual risk of in-hospital death.

A total of 188 patients with BAAD were enrolled. Risk factors for in-hospital death were investigated with univariate and multivariable logistic regression analysis. Significant risk factors were used to develop a predictive model.

The in-hospital mortality rate was 9% (17 of 188 patients). Univariate analysis revealed 7 risk factors to be statistically significant predictors of in-hospital death (P < .1). In multivariable analysis, the following variables at admission were independently associated with increased in-hospital mortality: hypotension (odds ratio [OR], 4.85; 95% confidence interval [CI], 1.12–18.90; P = .04), ischemic complications (OR, 8.24; 95% CI, 1.25–33.85; P < .001), renal dysfunction (OR, 12.32; 95% CI, 10.63–76.66; P < .001), and neutrophil percentage ≥80% (OR, 5.76; 95% CI, 2.58–12.56; P = .03). Based on these multivariable results, a reliable and simple prediction model was developed, a total score of 4 offered the best point value.

Independent risk factors associated with in-hospital death can be predicted in BAAD patients. The prediction model could be used to identify the prognosis for BAAD patients and assist physicians in their choice of management.
Pseudo progression in heterogeneity of right-sided metastatic colon carcinoma during nivolumab therapy
Authors: Wang Jing , Zhen Wei , Kang Xindan
Published: August 2019

Rationale:

Pseudo progression is a noted phenomenon of immune checkpoint inhibitors therapy, which has been defined as a response after an initial enlargement of the tumor followed by tumor reduction. In July 2017, the Food and Drug Administration granted accelerated approval of nivolumab for the treatment of metastatic colorectal cancer patients whose tumor harbors deficient mismatch repair.

Patient concerns and diagnosis:

We present a patient who received nivolumab for heterogeneity of right-sided metastatic colon carcinoma.

Intervention:

The patient was treated with nivolumab combined with chemotherapy.

Outcome:

The computed tomography showed mass lesion in the left lobe of liver remained stable while metastasis tumors under envelop of liver were exacerbated after 6 cycles of nivolumab combined with chemotherapy, and later regressed.

Lessons:

The status of mismatch repair in primary tumor and metastatic liver carcinoma is contradictory but using nivolumab demonstrated encouraging efficacy. This is the first case of pseudo progression undergoing immunotherapy for heterogeneity of right-sided metastatic colon carcinoma.
The impact of Medicare part D prescription drug benefit program on generic drug prescription
Authors: Jung Changmi , Padman Rema , Anwar Shamena
Published: August 2019

To examine whether the Medicare Part D program had an impact on the generic drug prescription rate among residents in long-term care facilities.

We analyzed prescription data for 3 drug classes (atypical antipsychotic, proton pump inhibitor, and statin) obtained from a regional online pharmacy serving long-term care centers in Pennsylvania from January 2004 to December 2007.

Difference-in-difference is used as a primary analysis method, and different regression methods (probit and multinomial) are used to accommodate different types of outcome measures.

Contrary to expectations, the Part D program did not have a statistically significant impact on the generic prescription rate in the long-term care setting during the study period. Only the statin class showed a dramatic increase in generic drug prescriptions, mainly due to the loss of patent protection for one of the most popular brand-name drugs in the class.

The complex dynamics of the prescription drug market, particularly the availability of generic versions of popular prescription medications, had a bigger role in increasing the prescription rate of generic drugs than the Part D program. This warrants the need to relax prescription medicines’ patent policies and for further study on the impact of such policies.
Efficacy and safety of Kanglaite injection combined with radiochemotherapy in the treatment of advanced pancreatic cancer
Authors: Liu Jianling , Yu Lingbo , Ding Wei
Published: August 2019

Background:

Kanglaite (KLT) injection, a kind of Chinese medicine, is considered a promising complementary therapeutic option for malignant cancer treatment. This study aimed to systematically investigate the efficacy and safety of the combination of KLT injection and radiochemotherapy for the treatment of advanced pancreatic cancer (PC).

Methods:

Studies were identified by searching Cochrane Library, Web of Science, PubMed, Embase, China National Knowledge Infrastructure (CNKI), Chinese Biological Medicine Database (CBM), Wanfang database and Chinese Scientific Journal Database (VIP) before October 2018. The primary reported outcomes including efficacy, quality of life (QoL), and adverse events were systematically evaluated.

Results:

Data from 16 trials with 960 patients with advanced PC were included. Compared with radiochemotherapy alone, the combination of KLT injection and radiochemotherapy significantly improved the 1-year overall survival (OS, odds ratio [OR] = 2.58 95% CI: 1.12–5.93 P = .03), overall response (ORR, OR = 2.16 95% CI: 1.58–2.94 P <.00001) and disease control rates (DCR, OR = 2.50 95% CI: 1.84–3.38 P <.00001). The QoL of patients, who received a combination of radiochemotherapy and KLT injection, also improved compared with radiochemotherapy treatment alone as indicated by the increased quality of life improved rate (QIR, OR = 3.68 95%CI: 2.36–5.75 P <.00001), pain relief rate (PRR, OR = 3.70 95% CI: 2.23–6.14 P <.00001) and weight gain rate (WGR, OR = 3.69 95% CI: 2.22–6.13 P <.00001). Adverse events related to radiochemotherapy including gastrointestinal side effects, nephrotoxicity, leukopenia, thrombocytopenia, and myelosuppression were alleviated (P <.05) when KLT was injected to patients with PC.

Conclusions:

Evidence from the Meta-analysis suggested that the combinational treatment of radiochemotherapy and KLT injection is more effective in advanced PC treatment than radiochemotherapy alone. Additionally, the combination therapy improved QoL of the patients. KLT injection can alleviate the adverse effects associated with the radiochemotherapy.
Refractory adult-onset Still disease treated by tocilizumab combined with methotrexate
Authors: Wang Chun-yan , Guo Shao-hua , Wang Li-ping , Shen Hai-li
Published: August 2019

Some patients have poor response to adult-onset Still disease (AOSD) traditional treatment, which easily recurs during the reduction of prednisone. We observed the efficacy and safety of tocilizumab combined with methotrexate (MTX) in the treatment of refractory AOSD, and to explore the possibility of reducing the dosage of tocilizumab after disease control.

A total of 28 refractory AOSD cases who had an inadequate response to corticosteroids combined with at least 1 traditional immunosuppressive agent, and even large-dose prednisone could not relieve their conditions after recurrence, were selected in this study. They were treated with tocilizumab (intravenous 8 mg/kg) combined with MTX (oral 12.5 mg once a week). In detail, tocilizumab was firstly given every 4 weeks and after 6-month remission, it was then given every 8 weeks. Some items including body temperature, skin rash, joint swelling and pain, hepatosplenomegaly, blood routine, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serum ferritin, and dosage of prednisone were observed before treatment as well as 2, 4, 8, 12, 24, 36, and 48 weeks after treatment. The adverse reactions occurring during the treatment were recorded.

The body temperature was normal, the skin rash as well as joint swelling and pain disappeared, and laboratory indexes including CRP, ESR, white blood cell, neutrophilic granulocyte, platelet, hemoglobin, and ferritin were significantly improved after 8-week treatment (all P < .05). The clinical symptoms and laboratory indexes above mentioned were continuously improved 12, 24, 36, and 48 weeks after treatment. The mean dosage of prednisone was reduced from 71.4 ± 20.7 mg/day to 55.0 ± 11.1 mg/day after 2-week treatment, and to 3.3 ± 2.1 mg/day after 48-week treatment (all P < .05). Prednisone was discontinued in 5 cases after 36-week treatment and in 7 cases after 48-week treatment. No serious adverse reactions occurred during the treatment.

Tocilizumab can rapidly and markedly improve the clinical symptoms and laboratory indexes and contribute to reduction and discontinuation of prednisone in refractory AOSD. The patients’ conditions are stable after reduction or discontinuation of prednisone and the tocilizumab possesses good safety.
Efficacy and safety of interferon alpha therapy in children with chronic hepatitis B
Authors: Hu Yao , Ye Yingzi , Ye Lijing , Wang Xiaohong , Yu Hui
Published: August 2019

Interferon-alpha (IFN-α) is currently the preferred antiviral treatment for children with chronic hepatitis B (CHB) aged >1-year-old. However, the evidence regarding the exact efficacy and safety in the real world is not sufficient. This study aimed to investigate the efficacy of IFN-α therapy in children with CHB and to provide a theoretical basis for practically identifying ideal antiviral therapies for CHB children.

Clinical manifestations, baseline characteristics, related laboratory tests, and adverse events were retrospectively analyzed in children with CHB who visited the Children's Hospital of Fudan University, were treated with IFN-α and were followed up from January 2003 to October 2018.

A total of 18 immune-active patients without advanced fibrosis were enrolled, and their average age at the start of treatment was 4.45 ± 2.75 years old. IFN α-2b was administered subcutaneously by body surface area (BSA) category, based on 3 MU/m2, for a median 48 weeks. Before treatment, the alanine aminotransferase (ALT) range was 81 to 409 U/L (median 158 U/L). The median hepatitis B virus (HBV)-DNA load was 9.89 × 107 IU/mL, and the HBV-DNA load varied from 3.10 × 104 to 4.56 × 108 IU/mL. The ALT levels of 17 children became normal at an average of 12 weeks during treatment, and those of 1 child became normal at 6 weeks after IFN-α withdrawal. Sixteen (88.9%, 16/18) children became HBV-DNA negative (<103 IU/mL) at an average of 24 weeks during treatment, while 1 became negative at 96 weeks after IFN-α withdrawal and 1 remained HBV-DNA positive. HBV e antigen (HBeAg) seroconversion occurred in 13 of 14 (92.9%, 13/14) HBeAg-positive patients at an average of 12 weeks during treatment. HBV s antigen (HBsAg) loss or seroconversion occurred in 4 (22.2%, 4/18) patients at an average of 21 weeks during treatment. Only mild flu-like symptoms and transient neutropenia appeared in some children at the early treatment stage. No severe abnormal results were observed in other laboratory parameters.

The antiviral monotherapy of 48 weeks of IFN-α was well tolerated and good responded, which was associated with higher rates of HBeAg seroconversion and HBsAg clearance in the children in this study than in previously reported adults and pediatric patients.
A new sensitive and accurate model to predict moderate to severe obstructive sleep apnea in patients with obesity
Authors: Ahlin Sofie , Manco Melania , Panunzi Simona , Verrastro Ornella , Giannetti Giulia , Prete Anna , Guidone Caterina , Berardino Alessandro Di Marco , Viglietta Luca , Ferravante Anna , Mingrone Geltrude , Mormile Flaminio , Capristo Esmeralda
Published: August 2019

Obstructive sleep apnea (OSA) has a high prevalence in patients with obesity. Only patients with clinical symptoms of OSA are admitted to polysomnography; however, many patients with OSA are asymptomatic. We aimed to create and validate a population-based risk score that predicts the severity of OSA in patients with obesity.

We here report the cross-sectional analysis at baseline of an ongoing study investigating the long-term effect of bariatric surgery on OSA. One-hundred sixty-one patients of the Obesity Center of the Catholic University Hospital in Rome, Italy were included in the study. The patients underwent overnight cardiorespiratory monitoring, blood chemistry analyses, hepatic ultrasound, and anthropometric measurements. The patients were divided into 2 groups according OSA severity assessed by the apnea-hypopnea index (AHI): AHI < 15 = no or mild and AHI ≥ 15 moderate to severe OSA. A statistical prediction model was created and validated. C statistics was used to evaluate the discrimination performance of the model.

The prevalence of OSA was 96.3% with 74.5% of the subjects having moderate/severe OSA. Sex, body mass index, diabetes, and age were included in the final prediction model that had excellent discrimination ability (C statistics equals to 83%). An OSA risk chart score for clinical use was created.

Patients with severe obesity are at a very high risk for moderate or severe OSA in particular if they are men, older, more obese, and/or with type 2 diabetes. The OSA risk chart can be useful for general practitioners and patients as well as for bariatric surgeons to select patients with high risk of moderate to severe OSA for further polysomnography.
Acupoint injection treatment for primary osteoporosis
Authors: Huang Rui , Xu Shihong , Li Dingpeng , Xie Xingwen
Published: August 2019

Background:

Acupoint injection has currently received increasing attention as a treatment for primary osteoporosis (POP). A number of randomized controlled trials (RCTs) have reported that acupoint injection have some advantages in treatment of POP. However, no article has summarized the existing evidence. This study will evaluate the efficacy and safety of acupoint injection as a clinical treatment for POP, so as to provide an important reference for clinical decision-making.

Methods:

RCTs of acupoint injection compared with conventional non-acupoint injection for POP were identified in searches of 7 databases from their inception to March 2019. All data were assessed and extracted by 2 authors independently. The risk of bias assessment recommended by the Cochrane Collaboration was used to assess the quality of the selected studies. Review Manager 5.3 (Cochrane Collaboration) was used to conduct meta-analysis for the efficacy and safety of acupoint injection.

Result:

The results of this systemic review and meta-analysis will be submitted to a recognized journal for publication.

Conclusion:

This systemic review and meta-analysis will evaluate the efficacy and safety of acupoint injection as a clinical treatment for POP. We hope this study can make a definitive conclusion for acupoint injection in the treatment of POP.

Registration:

PROSPERO (registration number CRD42019130890).
18F-FDG PET/CT imaging findings of multiple solitary fibrous tumor
Authors: Liu Xiaofei , Zhu Wenhua , Zhou Xiaohong , Yao Hao , Su Jiagui , Ouyang Xiaohui , He Baoming
Published: August 2019

Rationale:

Solitary fibrous tumor(SFT) is a rare and distinct clinical entity. There are few descriptions in the literature regarding the PET manifestations of SFTs. Herein,we report a case of multiple malignant SFT with PET/CT imaging findings and PET/Contrast Enhanced CT image findings.

Patient concerns:

A 30-year-old woman presented with a history of a mass in neck increased gradually over 6 months without jaundice or other symptoms of obstruction.Serum laboratory results and tumor markers (AFP, CEA,CA199,CA724,CA153 and CA125)were normal. The whole body PET/CT scan showed lightly or mildly hypermetabolic and inhomogeneous metabolic which was different from other reports, and it was the first report of 18F-FDG-PET/CT findings of multiple malignant SFTs, which were confirmed by positive immunohistochemical staining for CD2-40, CD99, SMA and negative immunohistochemical staining for S100 and CD34.

Diagnoses:

She was diagnosed with multiple malignant solitary fibrous tumors which was confirmed by pathological results and 18F-FDG-PET/CT findings.

Interventions:

The patient didn’t receive any treatment because she was not suitable for surgery and refused any other therapy.

Outcomes:

The patient has been followed up for one year,and she was still alive.

Lessons:

SFTs should be detected early and treated early.It was of high value in the diagnosis and differential diagnosis of SFTs by PET/CT imaging findings, which can not only identify the benign and malignant lesions, but also identify the lesion involved range.
Synergistic effect of enteral nutrition on remission induction in a patient with penetrating Crohn disease
Authors: Xie Chenxi , Lin Jinzhou , Su Jingling , Ren Jianlin
Published: August 2019

Rationale:

Crohn disease includes 3 phenotypes, inflammatory, stricturing, and penetrating. In cases where corticosteroids and immunosuppressive agents are not suitable treatment options, enteral nutrition (EN) can be used to reduce disease severity and enhance barrier defense with fewer potential adverse effects.

Patient concerns:

A 23-year-old man with abdominal pain and diarrhea presented at our hospital in 2014. The frequency of defecation was 3 or 4 times a day without mucus or blood in the stool. His body mass index was 15.8, and in laboratory tests the erythrocyte sedimentation rate was 42.4 mm/h, serum C reactive protein was 65.2 mg/L, the leukocyte count was 11.64 × 109/L, and hemoglobin was 111 g/L.

Diagnosis:

In computed tomography (CT) enterography the ascending colon was thickened, and there was effusion and enlarged lymph nodes around the colon. Colonoscopy revealed ulcer, polypoid proliferation, and bowel stenosis in many segments. Chronic inflammation was evident in multiple biopsies. Crohn disease was diagnosed based on the above observations.

Interventions:

Mesalazine was administered at a dose of 4 g daily for 2 years. The patient was hospitalized again due to severe abdominal pain and ongoing fever. Intestinal perforation was detected via CT. Percutaneous drainage was performed followed by administration of intravenous metronidazole (0.5 g) and ciprofloxacin (0.2 g) twice a day. Peptison liquid was used as exclusive EN. After 2 weeks the antibiotics regimen was changed to metronidazole 0.4 g twice a day and ciprofloxacin 0.25 g 3 times a day, both administered orally.

Outcomes:

CT revealed that the infection was eliminated and the fistula was healed after 10 weeks, at which point antibiotics and exclusive EN was discontinued. Azathioprine was prescribed at a dose of 2 mg/kg daily to maintain clinical remission. The patient did not report any pain or diarrhea at a 1-year follow-up visit.

Lessons:

The present case suggests that exclusive EN combined with antibiotics is useful in inducing remission in Crohn disease patients with active disease and penetrating complications.
Pulmonary sarcomatoid carcinoma presenting both ALK rearrangement and PD-L1 high positivity
Authors: D’Antonio Federica , De Sanctis Rita , Bolengo Isabella , Destro Annarita , Rahal Daoud , De Vincenzo Fabio , Santoro Armando
Published: August 2019

Rationale:

Pulmonary sarcomatoid carcinoma (PSC) represents <1% of all lung cancers and is characterized by a very poor prognosis. The optimal therapeutic regimen remains unclear. We describe a rare case of PSC with both anaplastic lymphoma kinase (ALK)-arranged and high levels of programmed death ligand 1 (PD-L1) expression.

Patient concerns:

A 46-year-old woman, nonsmoker, came to our attention due to uncontrolled pain in the lower left limb.

Diagnosis:

PSC with both ALK rearrangement and high levels of PD-L1 expression.

Interventions:

The patient started first-line systemic treatment with pembrolizumab reporting stable disease; at progression, she received second-line treatment with crizotinib. The treatment was not well-tolerated, and the patient then underwent 5 cycles of ceritinib treatment.

Outcomes:

The patient showed a partial response to targeted therapy. At progression, brigatinib was initiated, but the patients reported liver progression soon after the initiation of this therapy.

Lessons:

Molecular-driven investigation is necessary in PSC for treatment selection.
Could platelet-to-lymphocyte ratio be a predictor for contrast-induced nephropathy in patients with acute coronary syndrome?
Authors: Jiang Jie , Ji Hong-Yan , Xie Wei-Ming , Ran Lu-Sen , Chen Yu-Si , Zhang Cun-Tai , Quan Xiao-Qing
Published: August 2019

Background:

Contrast-induced nephropathy (CIN) is acute renal failure observed after administration of iodinated contrast media during angiographic or other medical procedures. In recent years, many studies have focused on biomarkers that recognize CIN and/or predict its development in advance. One of the many biomarkers studied is the platelet-to-lymphocyte ratio (PLR). We performed a systematic review and meta-analysis to evaluate the correlation between PLR level and CIN.

Methods:

Relevant studies were searched in PUBMED, EMBASE, and Web of Science until September 15, 2018. Case-control studies reporting admission PLR levels in CIN and non-CIN group in patients with acute coronary syndrome (ACS) were included. The pooled weighted mean difference (WMD) and 95% confidence intervals (95%CI) were calculated to assess the association between PLR level and CIN using a random-effect model.

Results:

Six relevant studies involving a total of 10452 ACS patients (9720 non-CIN controls and 732 CIN patients) met our inclusion criteria. A meta-analysis of 6 case-control studies showed that PLR levels were significantly higher in CIN group than those in non-CIN group (WMD = 33.343, 95%CI = 18.863 to 47.823, P < .001, I2 = 88.0%).

Conclusion:

For patients with ACS after contrast administration, our meta-analysis shows that on-admission PLR levels in CIN group are significantly higher than those of non-CIN group. However, large and matched cohort studies are needed to validate these findings and assess whether there is a real connection or just an association.