bluuebunny/crossref_metadata_2025 huggingface dataset:
Heterozygous Tsc2 (Tsc2+/–) mouse model to study induced renal cancer in response to ionizing radiation at low doses
Authors: M A Sureshkumar , Delma Caroline R , Manickam Krishnan , Mohan Sumathy , Habib Samy L , Natarajan Mohan
Published: November 2018

Kidneys are one of the main dose-limiting organs in radiotherapeutic procedures of lower abdomen. Likewise, the threat of exposure of radiosensitive organs such as kidneys in warfare or radiation accidents among military personal or due to terrorist activities in general public is of increasing concern. These events warrant the need for appropriate animal models to study the acute and chronic effects of low- and high-dose rate radiation exposures. In this study, for the first time, we validated Tsc2+/– mouse model to study whether radiation accelerates carcinogenesis in kidneys. Tsc2+/– mice at increasing age groups at 8 and 10 months were exposed to repeated doses of gamma radiation (0.4 Gy × 5) and assessed for aggravated kidney tumor formation at 2 months post-irradiation. Animals from irradiated group showed a significant increase in numbers of bilateral, multifocal tumors compared with mock-irradiated animals. Intra-glomerular reactive oxygen species (ROS) levels measured by dihydroethidium florescence showed significant increases in ROS production in irradiated Tsc2+/– mice compared with non-irradiated animals. Similarly, selective hematological parameters and glomerular filtration rate were further reduced significantly in irradiated Tsc2+/– mice. Tsc2 protein, tuberin in irradiated mice, however, remains at the same reduced levels as that of the mock-irradiated heterozygous Tsc2 mice. The results indicate that radiation alters kidney homeostatic function and influences high spontaneous incidence of renal cell carcinoma in this rodent model. Repurposing of Tsc2+/– mice model will, therefore, provide a unique opportunity to study acute and delayed effects of radiation in the development of kidney cancers.
I See Your Effort: Force-Related BOLD Effects in an Extended Action Execution–Observation Network Involving the Cerebellum
Authors: Casiraghi Letizia , Alahmadi Adnan A S , Monteverdi Anita , Palesi Fulvia , Castellazzi Gloria , Savini Giovanni , Friston Karl , Gandini Wheeler-Kingshott Claudia A M , D’Angelo Egidio
Published: November 2018

Action observation (AO) is crucial for motor planning, imitation learning, and social interaction, but it is not clear whether and how an action execution–observation network (AEON) processes the effort of others engaged in performing actions. In this functional magnetic resonance imaging (fMRI) study, we used a “squeeze ball” task involving different grip forces to investigate whether AEON activation showed similar patterns when executing the task or observing others performing it. Both in action execution, AE (subjects performed the visuomotor task) and action observation, AO (subjects watched a video of the task being performed by someone else), the fMRI signal was detected in cerebral and cerebellar regions. These responses showed various relationships with force mapping onto specific areas of the sensorimotor and cognitive systems. Conjunction analysis of AE and AO was repeated for the “0th” order and linear and nonlinear responses, and revealed multiple AEON nodes remapping the detection of actions, and also effort, of another person onto the observer’s own cerebrocerebellar system. This result implies that the AEON exploits the cerebellum, which is known to process sensorimotor predictions and simulations, performing an internal assessment of forces and integrating information into high-level schemes, providing a crucial substrate for action imitation.
Quantifying How Different Clinical Presentations, Levels of Severity, and Healthcare Attendance Shape the Burden of Influenza-associated Illness: A Modeling Study From South Africa
Authors: Tempia Stefano , Walaza Sibongile , Moyes Jocelyn , Cohen Adam L , McMorrow Meredith L , Treurnicht Florette K , Hellferscee Orienka , Wolter Nicole , von Gottberg Anne , Nguweneza Arthemon , McAnerney Johanna M , Dawood Halima , Variava Ebrahim , Madhi Shabir A , Cohen Cheryl
Published: November 2018

Background

Burden estimates of medically and nonmedically attended influenza-associated illness across syndromes and levels of severity are lacking.

Methods

We estimated the national burden of medically and nonmedically attended influenza-associated illness among individuals with different clinical presentations (all-respiratory, all-circulatory, and nonrespiratory/noncirculatory) and levels of severity (mild, fatal, and severe, nonfatal) using a combination of case-based (from laboratory-confirmed influenza surveillance) and ecological studies, as well as data from healthcare utilization surveys in South Africa during 2013–2015. In addition, we compared estimates of medically attended influenza-associated respiratory illness, obtained from case-based and ecological studies. Rates were reported per 100 000 individuals in the population.

Results

The estimated mean annual number of influenza-associated illness episodes was 10 737 847 (19.8% of 54 096 705 inhabitants). Of these episodes, 10 598 138 (98.7%) were mild, 128 173 (1.2%) were severe, nonfatal, and 11 536 (0.1%) were fatal. There were 2 718 140 (25.6%) mild, 56 226 (43.9%) severe, nonfatal, and 4945 (42.8%) medically attended should be after fatal episodes. Influenza-associated respiratory illness accounted for 99.2% (10 576 146) of any mild, 65.5% (83 941) of any severe, nonfatal, and 33.7% (3893) of any fatal illnesses. Ecological and case-based estimates of medically attended, influenza-associated, respiratory mild (rates: ecological, 1778.8, vs case-based, 1703.3; difference, 4.4%), severe, nonfatal (rates: ecological, 88.6, vs case-based, 75.3; difference, 15.0%), and fatal (rates: ecological, 3.8, vs case-based, 3.5; difference, 8.4%) illnesses were similar.

Conclusions

There was a substantial burden of influenza-associated symptomatic illness, including severe, nonfatal and fatal illnesses, and a large proportion was nonmedically attended. Estimates, including only influenza-associated respiratory illness, substantially underestimated influenza-associated, severe, nonfatal and fatal illnesses. Ecological and case-based estimates were found to be similar for the compared categories.
Criteria2Query: a natural language interface to clinical databases for cohort definition
Authors: Yuan Chi , Ryan Patrick B , Ta Casey , Guo Yixuan , Li Ziran , Hardin Jill , Makadia Rupa , Jin Peng , Shang Ning , Kang Tian , Weng Chunhua
Published: November 2018

Objective

Cohort definition is a bottleneck for conducting clinical research and depends on subjective decisions by domain experts. Data-driven cohort definition is appealing but requires substantial knowledge of terminologies and clinical data models. Criteria2Query is a natural language interface that facilitates human-computer collaboration for cohort definition and execution using clinical databases.

Materials and Methods

Criteria2Query uses a hybrid information extraction pipeline combining machine learning and rule-based methods to systematically parse eligibility criteria text, transforms it first into a structured criteria representation and next into sharable and executable clinical data queries represented as SQL queries conforming to the OMOP Common Data Model. Users can interactively review, refine, and execute queries in the ATLAS web application. To test effectiveness, we evaluated 125 criteria across different disease domains from ClinicalTrials.gov and 52 user-entered criteria. We evaluated F1 score and accuracy against 2 domain experts and calculated the average computation time for fully automated query formulation. We conducted an anonymous survey evaluating usability.

Results

Criteria2Query achieved 0.795 and 0.805 F1 score for entity recognition and relation extraction, respectively. Accuracies for negation detection, logic detection, entity normalization, and attribute normalization were 0.984, 0.864, 0.514 and 0.793, respectively. Fully automatic query formulation took 1.22 seconds/criterion. More than 80% (11+ of 13) of users would use Criteria2Query in their future cohort definition tasks.

Conclusions

We contribute a novel natural language interface to clinical databases. It is open source and supports fully automated and interactive modes for autonomous data-driven cohort definition by researchers with minimal human effort. We demonstrate its promising user friendliness and usability.
Speech recognition for clinical documentation from 1990 to 2018: a systematic review
Authors: Blackley Suzanne V , Huynh Jessica , Wang Liqin , Korach Zfania , Zhou Li
Published: November 2018

Objective

The study sought to review recent literature regarding use of speech recognition (SR) technology for clinical documentation and to understand the impact of SR on document accuracy, provider efficiency, institutional cost, and more.

Materials and Methods

We searched 10 scientific and medical literature databases to find articles about clinician use of SR for documentation published between January 1, 1990, and October 15, 2018. We annotated included articles with their research topic(s), medical domain(s), and SR system(s) evaluated and analyzed the results.

Results

One hundred twenty-two articles were included. Forty-eight (39.3%) involved the radiology department exclusively and 10 (8.2%) involved emergency medicine; 10 (8.2%) mentioned multiple departments. Forty-eight (39.3%) articles studied productivity; 20 (16.4%) studied the effect of SR on documentation time, with mixed findings. Decreased turnaround time was reported in all 19 (15.6%) studies in which it was evaluated. Twenty-nine (23.8%) studies conducted error analyses, though various evaluation metrics were used. Reported percentage of documents with errors ranged from 4.8% to 71%; reported word error rates ranged from 7.4% to 38.7%. Seven (5.7%) studies assessed documentation-associated costs; 5 reported decreases and 2 reported increases. Many studies (44.3%) used products by Nuance Communications. Other vendors included IBM (9.0%) and Philips (6.6%); 7 (5.7%) used self-developed systems.

Conclusion

Despite widespread use of SR for clinical documentation, research on this topic remains largely heterogeneous, often using different evaluation metrics with mixed findings. Further, that SR-assisted documentation has become increasingly common in clinical settings beyond radiology warrants further investigation of its use and effectiveness in these settings.
Determining Frankliniella fusca (Thysanoptera: Thripidae) Egg Distribution in Neonicotinoid Seed-Treated Cotton
Authors: D’Ambrosio Damon A , Huseth Anders S , Kennedy George G
Published: November 2018

Frankliniella fusca (Hinds) (Thysanoptera: Thripidae) is an early-season cotton pest. Seedlings are injured by larvae, which hatch from eggs oviposited into seedlings and feed on developing plant tissue. Better understanding F. fusca oviposition in cotton may improve their management and address new challenges such as resistance to neonicotinoid seed treatments (NSTs). Cotton seedlings exposed to F. fusca were either cleared and stained to determine egg density and location, or dissected and washed to determine larval distribution. Experiments were conducted in the greenhouse with a susceptible population and field with a NST-resistant population. Eggs of both populations were recovered predominantly in cotyledons. Larvae were more uniformly distributed on seedlings. On NST seedlings, oviposition by the susceptible population was reduced and preference shifted to true leaves. NSTs did not alter egg placement by the resistant population. These findings suggest that injury to cotton seedlings is primarily caused by F. fusca emerging on the cotyledons, and then moving to developing leaves. The oviposition shift in NST plants correlates with how systemic NSTs have been reported to concentrate in cotyledons. This can better inform management tactics in cotton, such as well-timed foliar sprays, which, given the current resistance issue, are needed to maintain effective thrips management.
Correcting HIRES/Keck radial velocities for small systematic errors
Authors: Tal-Or Lev , Trifonov Trifon , Zucker Shay , Mazeh Tsevi , Zechmeister Mathias
Published: November 2018

The HIRES spectrograph, mounted on the 10-m Keck-I telescope, belongs to a small group of radial-velocity (RV) instruments that produce stellar RVs with long-term precision down to ∼1 m s−1. In 2017, the HIRES team published 64,480 RVs of 1699 stars, collected between 1996 and 2014. In this bank of RVs, we identify a sample of RV-quiet stars, whose RV scatter is <10 m s−1, and use them to reveal two small but significant nightly zero-point effects: a discontinuous jump, caused by major modifications of the instrument in August 2004, and a long-term drift. The size of the 2004 jump is 1.5 ± 0.1 m s−1, and the slow zero-point variations have a typical magnitude of ≲ 1 m s−1. In addition, we find a small but significant correlation between stellar RVs and the time relative to local midnight, indicative of an average intra-night drift of 0.051 ± 0.004 m s−1 h−1. We correct the 64 480 HIRES RVs for the systematic effects we find, and make the corrected RVs publicly available. Our findings demonstrate the importance of observing RV-quiet stars, even in the era of simultaneously-calibrated RV spectrographs. We hope that the corrected HIRES RVs will facilitate the search for new planet candidates around the observed stars.
David Hume: Aesthetics
Authors: Costelloe Timothy M.
Published: November 2018

Unlike other writers in the tradition of 18th-century aesthetics, Hume never devoted a major work to the subject despite his promise in the advertisement to the Treatise of Human Nature (1739–1740) to write a supplementary volume on “criticism” that, along with one on morals and politics, would complete his philosophical system. This lacuna notwithstanding, Hume did devote a number of essays to the subject, and his corpus is replete with references to and discussions of various themes that are sufficiently numerous and substantive enough to constitute an original contribution to the field and its history. As such, Hume’s aesthetics has come to stand as a distinctive and identifiable part of his philosophy, even though its form and content must, in large part, be constructed from the various writings that make up his corpus as a whole.
Public Opinion and Foreign Policy
Authors: Kertzer Joshua D.
Published: November 2018

How does the public think about foreign affairs, and how do these public preferences shape foreign policymaking? Over the past several decades, scholarship on public opinion and foreign policy has proliferated, partially due to a growing interest in the “first image” and the ways in which individuals matter in international relations, partially due to an experimental revolution that gave political scientists new methods they could use to study public opinion, and partially due to a range of searing debates—on topics ranging from the Iraq War to globalization—whose fault lines political scientists attempted to map. Scholarship in this area is thus so vast that it is impossible to comprehensively capture in an annotated bibliography of this length. Instead, the discussion that follows focuses on a curated sampling of the field, focusing, in particular, on six sets of substantive questions, drawing on a mix of classic and contemporary scholarship. It begins by reviewing what we know about how foreign policy attitudes are structured, before focusing on public opinion about two different areas of foreign policy: the use of force, and foreign economic issues like trade and investment. It then turns to the effects of sex and gender, along with the role of cue givers in shaping foreign policy preferences—whether partisan elites, international organizations, or social peers. It concludes by reviewing the relationship between public opinion and foreign policy, whether in democracies (as in theories of democratic constraint and accountability), transnational public opinion (as in theories of soft power and anti-Americanism), or in nondemocratic regimes, a relatively new area of research.
Pilgrimage
Authors: Eade John , Mesaritou Evgenia
Published: November 2018

The multifaceted nature of contemporary pilgrimage cannot be understood from one particular discipline and, as a consequence, its study has become increasingly multidisciplinary and global in approach. Anthropologists have made a major contribution to pilgrimage studies but significant research has also been produced by those based in history, religious studies, tourism studies, geography, ethnology and folklore studies, for example, and by those undertaking research outside Europe and North America, including in the Near East, northern and southern Africa, the Asia Pacific region, Oceania, and Latin America. The contemporary practice of pilgrimage is also not restricted to institutional religion. Visits to nonreligious sites have become increasingly popular, reflecting historical change. Large numbers of people are attracted to sites of suffering, such as the First World War battlefields in France, Belgium, and Turkey; the site of the Auschwitz concentration camp in Poland and the Vietnam Memorial in Washington, DC, and places associated with icons of popular culture, e.g., Elvis Presley’s grave in Memphis, Tennessee (see Reader and Walter 1993, cited under Development of the Anthropological Study of Pilgrimage). Furthermore, those journeying to and from religious pilgrimage sites have often little or no interest in institutional religion. Moreover, pilgrimage cannot be studied in isolation from wider contexts. Hence, as detailed in various sections in this article, close attention has been paid to the intimate relationship between pilgrimage and tourism, while increasing interest is being shown in the role played by political and economic processes in the development of pilgrimage. Evgenia Mesaritou’s Fellowship has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 752103.
Tsai Ming-liang
Authors: Tsai Beth
Published: November 2018

Tsai Ming-liang (b. 1957) is a Taiwan-based, Malaysia-born filmmaker. He is regarded as one of the Second Wave directors of the Taiwan New Cinema movement, following precursors such as Hou Hsiao-hsien, Edward Yang, and Chen Kunhou. His films Vive L’Amour (1994), The River (1997), The Wayward Cloud (2005), and Stray Dogs (2013) have successively won, respectively, the Golden Lion Prize at the Venice Film Festival, the Grand Prize at the Berlin Film Festival, the Silver Bear Prize at the Berlin Film Festival, and the Grand Prize at the Venice Film Festival. He has been the recipient of five FIPRESCI Prizes, which are voted on by the International Federation of Film Critics. His first virtual reality film, The Home at Lan Re Temple (2017), was shortlisted for the VR competition at the 74th Venice Film Festival in 2017. During the last decade or so, his work has extended from feature-length works to short art films and installations, such as It’s a Dream (2007), Erotic Space (2010), The Theater in the Boiler Room (2011), and the Walker series (to date, ten short films made between 2012 and 2024). In 2009 his work Visage was commissioned by the Louvre Museum and became the first entry in the “The Louvre Invites Filmmakers” collection. Tsai is also a filmmaker with multiple identities. As an auteur, he tends to work with a set group of actors, especially with his muse, Lee Kang-sheng, who stars in all of Tsai’s features. His films are also known for their queer sensibility. As a director heavily invested in gay subjectivity, his films offer thematic representations of emotions and desires, and they focus principally on urban loneliness, cruising, and melancholy. He tends to explore moral boundaries in his films, especially with sexual taboos that made the director one of the most controversial figures within Taiwanese cinema. In addition, Tsai is a leading figure who contributes to the art of slow cinema. His signature style of long takes, long shots, and minimal dialogue can be seen as a formal representation of the postmodern condition and displacement. His later films and installations are seen as the ultimate exploration of pure cinematic form, a departure from his early focus on postcolonial Taipei and its social critique.
Pastures and Pastoralism
Authors: Schoof Nicolas , Luick Rainer
Published: November 2018

Pastureland (synonymously grassland) is land devoted to the production of forage for harvest by grazing, cutting, or both—no matter if the plant species are indigenous or introduced. They can be natural (native), semi-natural (managed and dominated by indigenous and naturally occurring plant species), and there is a significant share of pastureland with introduced species. Land is named rangeland, if vegetation is predominantly grasses, grasslike plants, forbs, and shrubs and if it is used for the production of livestock and/or wildlife. Finally, a pasture is a concrete spatial area where farmers keep livestock. Here we understood pastoralism simply as the agricultural activity of animal husbandry, no matter if performed on pastures or without spatial restrictions (nomadism). Estimates of the proportion of the earth’s land area covered by grasslands vary between 20–40 percent, depending on the definition. Those differences are due to a lack of harmonization in definitions (see Allen, et al. 2011). The selecting influence of grazers is the main difference to other natural grasslands (e.g., those growing beside natural tree lines). Livestock-grazed grasslands are the most important share of grasslands and occur in all biomes. The prehistoric populations of megafauna had a significant impact on ecosystems in certain geographical areas. Browsing, grazing, or selective feeding by these various species prevented many open landscapes from succession, thus allowing adapted communities to evolve. That is why a high biodiversity, often with rare species assemblages, characterizes (semi-)natural pasturelands. Grazers can form a multitude of vegetation depending on time and frequency of grazing throughout the year, the (livestock-)species including various breeds and its density per land unit. Today, vast pasturelands are overgrazed, causing serious environmental damages. Although some native and semi-natural grasslands are productive, the agricultural increase of productivity can often be achieved by intensification (e.g., by fertilizing or seeding non-native species/breeds). Such “improved” pasturelands tend to be species-poor and provide fewer ecosystem services. In many parts of the world, wooded pastures (woodlands) are quite common, mostly in landscapes, where agricultural intensification is restricted by natural constraints. Here, grazers distinguish a light canopy of trees/shrubs often mixed with grass/herbaceous species on the ground. Some of these systems are extraordinarily important for nature and environmental conservation. Pastoralism was and still is an essential part of humankind’s culture worldwide. It is a cultural heritage and object of investigation for countless studies focusing on the role of livestock for societies.
Point Inoculation Method for Measuring Adult Plant Response of Wheat to Stripe Rust Infection
Authors: Boshoff Willem H. P. , Prins Renée , de Klerk Corneli , Krattinger Simon G. , Bender Cornelia M. , Maree Gerrie J. , Rothmann Lisa , Pretorius Zacharias A.
Published: November 2018

Depending on the pathogenicity of the stripe rust fungus Puccinia striiformis f. sp. tritici, the nature of resistance in the wheat host plant, and the environment, a broad range of disease phenotypes can be expressed. Therefore, the phenotyping of partial adult plant stripe rust resistance requires reliable and repeatable procedures, especially under controlled conditions. In this study, the development of a flag leaf point inoculation method, which resulted in a 100% initial infection rate, is reported. Flag leaf inoculations were achieved by placing 6-mm antibiotic test paper discs, dipped into a urediniospore and water suspension and covered with water-proof plastic tape, on the adaxial side of leaves. Results from independent trials allowed for the statistical comparison of stripe rust lesion expansion rate in wheat entries that differ in resistance. The technique is inexpensive, reliable, and applicable to routine screening for adult plant response type, quantitative comparison of stripe rust progress, environmental influences, and pathogenicity of different isolates.
Hunter Syndrome
Authors: Joseph Rachel , DiCesare Emily B. , Miller Amy
Published: November 2018

Background:

Hunter syndrome, or mucopolysaccharidosis type II (MPS II), is a lysosomal storage disease that affects the breakdown of sugar in the body. Research has made it possible to reveal the cause of the disease, thus helping diagnose and treating this rare disorder. Enzyme replacement therapy will help children live longer and healthier lives.

Purpose:

The purpose of this literature review is to explore the existing knowledge on MPS II and to inform the nursing community about the prevalence of MPS II and examine why it is important to offer screening to parents of a newborn or child.

Search Strategy:

CINAHL, PubMed, Cochrane, and Google Scholar were searched using the key words to find publications in English on MPS II during 2009 to 2018.

Findings:

Early detection is key for successful management of MPS II. Early initiation of enzyme replacement therapy will enhance the health of children. Support groups advocate for services for the children and their families.

Implications for Practice:

Earlier initiation of treatment leads to better outcomes, and healthcare providers should advocate for including MPS II in newborn screening. Families should be offered genetic counseling and support services.

Implications for Research:

More research is essential to identify the long-term effects on families and the effect of enzyme replacement therapy on children with MPS II.

Conclusion:

The birth of a child with the rare disorder such as MPS II will change the lives of families forever. Early identification and treatment can slow down decline in health and improve quality of life of children and their families.
Sterile Adhesive Tape as an Isolation Device in Phalangeal Fracture Fixation
Authors: Haji Yakob Mohammad , Badge Ravindra
Published: November 2018

Phalangeal fractures are common injuries in the upper limb. Frequently, fluoroscopy is utilized to assist in the surgical management of these injuries. The use of sterile adhesive tape is a simple and cost-effective technique that minimizes radiation exposure.
Outcomes and Characteristics of Patients Receiving Second-line Therapy for Advanced Pancreatic Cancer
Authors: Tsang Erica S. , Wong Hui-li , Wang Ying , Renouf Daniel J. , Cheung Winson Y. , Lim Howard J. , Gill Sharlene , Loree Jonathan M. , Kennecke Hagen F.
Published: November 2018

Objectives:

There is limited randomized data to guide second-line chemotherapy selection in advanced pancreatic cancer (APC). We aimed to characterize predictors and outcomes of second-line chemotherapy in patients with APC.

Methods:

We identified all patients with APC [locally advanced (LAPC) or metastatic (MPC)] who received ≥1 cycle of first-line chemotherapy between January 2012 and December 2015 across 6 cancer centers in British Columbia, Canada. Baseline characteristics and survival outcomes were summarized.

Results:

Of 676 patients with APC (31% LAPC, 69% MPC) who received ≥1 cycle of chemotherapy, 164 (24%) received second-line chemotherapy. These patients were younger, with lower ECOG and higher CA19-9 at presentation, compared with patients who did not receive second-line chemotherapy. There were no differences in rates of second-line chemotherapy between LAPC and MPC (28% vs. 23%; P=0.18). Only first-line FOLFIRINOX was associated with second-line chemotherapy. Median overall survival (OS) from second-line chemotherapy was longer with second-line gemcitabine/nab-paclitaxel than fluoropyrimidine or gemcitabine (7.9 vs. 5.1 vs. 4.3 mo; P=0.008). On multivariable analysis, longer OS from second-line chemotherapy was associated with gemcitabine/nab-paclitaxel, lower ECOG, and LAPC.

Conclusions:

In this population-based cohort, first-line FOLFIRINOX was the strongest predictor of second-line chemotherapy. Duration of therapy remains short and novel treatments are urgently needed.
Increased Leak Rates Following Stapled Versus Handsewn Ileocolic Anastomosis in Patients with Right-Sided Colon Cancer: A Nationwide Cohort Study
Authors: Nordholm-Carstensen Andreas , Schnack Rasmussen Morten , Krarup Peter-Martin
Published: November 2018

BACKGROUND:

Data on anastomotic leak rates after stapled versus handsewn ileocolic anastomosis are conflicting. In a Cochrane review, the combined estimate favored the stapled technique, but recent cohort studies demonstrated a 2-fold increase in anastomotic leak with the stapled approach.

OBJECTIVE:

The purpose of this study was to investigate anastomotic leak rates following stapled versus handsewn ileocolic anastomosis.

DESIGN:

This was a nationwide, retrospective cohort study.

SETTING:

Data were obtained from the Danish Colorectal Cancer Group and National Patient Registry databases.

PATIENTS:

Danish patients, ≥18 years of age, undergoing right hemicolectomy for a first-time diagnosis of adenocarcinoma in the right colon with primary anastomosis between October 2014 and December 2015 were included.

MAIN OUTCOME MEASURES:

The primary outcome was anastomotic leak rate. Secondary outcomes included 30-day mortality. Covariates included demographics, comorbidity, tumor stage, and surgical variables. Multivariable logistic regression and propensity score matching were used to adjust for confounding.

RESULTS:

The 1414 patients included 391 (28%) in the stapled group and 1023 (72%) in the handsewn group. Forty-five patients (3.2%) developed anastomotic leak: 21 of 391 (5.4%) and 24 of 1023 (2.4%) in the stapled and handsewn group (p = 0.004). This difference was confirmed in multivariable analysis (adjusted OR, 2.91; 95% CI, 1.53–5.53; p < 0.001), and after propensity score matching (OR, 2.41; 95% CI, 1.24–4.67; p = 0.009). Thirty-day mortality was 15.6% (7/45) and 2.1% (29/1369) in patients with and without anastomotic leak (p < 0.001), with no difference between the stapled and handsewn approach.

LIMITATIONS:

The study’s design was retrospective, with no information on allocation to the stapled or handsewn approach.

CONCLUSIONS:

The present study demonstrated a 2-fold increase in anastomotic leak after stapled versus handsewn ileocolic anastomoses. Previous opinions on the optimal anastomosis technique for colon cancer should be scrutinized given the devastating short-term outcome of anastomotic leak. See Video Abstract at http://links.lww.com/DCR/A819.
Assessing the Value of Endoscopy Simulator Modules Designed to Prepare Residents for the Fundamentals of Endoscopic Surgery Examination
Authors: Byrne Raphael M. , Hoops Heather E. , Herzig Daniel O. , Diamond Sarah J. , Lu Kim C. , Brasel Karen J. , Tsikitis V. Liana
Published: November 2018

BACKGROUND:

The Fundamentals of Endoscopic Surgery examination is required for all general surgery residents. The test modules are not available for practice before the examination; however, similar modules are commercially available.

OBJECTIVE:

This study aims to determine which modules are most valuable for resident training and preparation for the examination by evaluating which correlates best with experience level.

DESIGN:

This was a single-institution study.

SETTING:

A virtual reality endoscopy simulator was utilized.

PARTICIPANTS:

General surgery residents and faculty endoscopists performed endoscopy simulator modules (Endobasket 2, Endobubble 1 and 2, Mucosal Evaluation 2, and Basic Navigation) designed to prepare residents for the Fundamentals of Endoscopic Surgery examination. Residents were assigned into junior and senior groups based on the completion of a dedicated endoscopy rotation.

MAIN OUTCOME MEASURES:

The primary outcomes measured were the mean time to completion, mean number of balloons popped, and mean number of wall hits for the 3 groups.

RESULTS:

A total of 21 junior residents, 11 senior residents, and 3 faculty participated. There were significant differences among groups in the mean time to completion for the Endobasket, Endobubble, and Mucosal Evaluation modules. The modules that correlated best with experience level were Endobubble 2 and Mucosal Evaluation 2. For Endobubble 2, juniors were slower than seniors, who were in turn slower than faculty (junior 118.8 ± 20.55 seconds, senior 100.3 ± 11.78 seconds, faculty 87.67 ± 2.848 seconds; p < 0.01). Juniors popped fewer balloons than seniors, who popped fewer balloons than faculty (junior 9.441 ± 3.838, senior 15.62 ± 4.133, faculty 28.78 ± 1.712; p < 0.001). For Mucosal Evaluation 2, juniors were slower than seniors, who were in turn slower than faculty (junior 468.8 ± 123.5 seconds, senior 368.6 ± 63.42 seconds, faculty 233.1 ± 70.45 seconds; p < 0.01).

LIMITATIONS:

Study residents have not completed the Fundamentals of Endoscopic Surgery examinations, so correlation with examination performance is not yet possible.

CONCLUSIONS:

Performance on Endobasket, Endobubble, and Mucosal Evaluation correlated well with experience level, providing benchmarks for each level to attain in preparation for the Fundamentals of Endoscopic Surgery examination. See Video Abstract at http://links.lww.com/DCR/A823.
Extended Mortality Follow-up of a Cohort of Dry Cleaners
Authors: Callahan Catherine L. , Stewart Patricia A. , Blair Aaron , Purdue Mark P.
Published: November 2018

Background:

Dry cleaning workers are commonly exposed to tetrachloroethylene, a suspected bladder carcinogen, and other organic solvents. The health risks associated with solvent exposures in this industry are unclear.

Methods:

We extended mortality follow-up of 5,369 dry cleaning union members in St. Louis to further investigate solvent-related risks. We added 22 years of follow-up, from 1993 through 2014, via linkage to the National Death Index. Using Cox proportional hazards modeling, we computed hazard ratios (HRs) and 95% confidence intervals (CIs) relating cause-specific mortality with levels of a solvent exposure index previously developed by an industrial hygienist based on workers’ job titles from union records. The models were fit adjusting for age, sex, and decade of union enrollment, and assuming different exposure lags.

Results:

In internal analyses of estimated solvent exposure with a 20-year lag, we observed exposure–response relationships for bladder cancer (HR medium exposure = 4.2; 95% CI = 0.7, 24.5 and HR high exposure = 9.2; 95% CI = 1.1, 76.7 vs. no exposure; P
trend = 0.08) and kidney cancer (HR = 4.1; 95% CI = 0.7, 22.5 and 24.4; 2.9, 201.6; P
trend = 0.004). High exposure was also associated with heart disease (HR = 1.6; 95% CI = 1.1, 2.2) and lymphatic/hematopoietic malignancies (HR = 4.3; 95% CI = 1.4, 13.6).

Conclusions:

These findings are, to the best of our knowledge, the first cohort evidence relating solvent exposure levels among dry cleaners to elevated risks of selected cancers and heart disease. Additional studies employing solvent-specific exposure assessment are needed to clarify cancer risks associated with tetrachloroethylene.
Establishing the Minimal Clinically Important Difference for the Hospital Anxiety and Depression Scale in Patients With Cardiovascular Disease
Authors: Lemay Kyle R. , Tulloch Heather E. , Pipe Andrew L. , Reed Jennifer L.
Published: November 2018

Purpose:

The Hospital Anxiety and Depression Scale (HADS) is frequently used by clinicians to assess anxiety and depression in patients with cardiovascular disease; yet, its minimal clinically important difference (MCID) has not been established. The purpose of this study was to establish an MCID for the HADS in patients with cardiovascular disease.

Methods:

A sample of 591 patients (74% male; ethnicity = 89% white; mean ± standard deviation [SD]: age = 63 ± 10 yr; and body mass index = 29.1 ± 5.6 kg/m2) with cardiovascular disease enrolled in a 3-mo cardiac rehabilitation program were included in this study. The MCID for the HADS was estimated using distribution-based methods (ie, standard deviation, effect size, standard error of measurement, and minimal detectable change), anchor-based methods (ie, health transition question, correlation and linear regression, and receiver operating characteristic curve), and Delphi methodology (ie, clinical consensus).

Results:

A total of 18 MCID values were calculated ranging from 0.81 to 5.21 (Anxiety subscale) and 0.5 to 5.57 (Depression subscale). The final MCID for the HADS, triangulated from the distribution-based, anchor-based, and Delphi-based findings, was 1.7 points.

Conclusions:

Our work provides the first estimates of an MCID by triangulating multiple methodologies for the HADS in patients with cardiovascular disease. This MCID may serve as an indicator of treatment success for clinicians and researchers and guide future interventions to improve the mental health of patients with cardiovascular disease.
USTUR Case 0846: Modeling Americium Biokinetics After Intensive Decorporation Therapy
Authors: Breustedt Bastian , Avtandilashvili Maia , McComish Stacey L. , Tolmachev Sergei Y.
Published: November 2018

Decorporation therapy with salts of diethylenetriamine-pentaacetic acid binds actinides, thereby limiting uptake to organs and enhancing the rate at which actinides are excreted in urine. International Commission on Radiological Protection reference biokinetic models cannot be used to fit this enhanced exertion simultaneously with the baseline actinide excretion rate that is observed prior to the start of therapy and/or after the effects of therapy have ceased. In this study, the Coordinated Network on Radiation Dosimetry approach, which was initially developed for modeling decorporation of plutonium, was applied to model decorporation of americium using data from a former radiation worker who agreed to donate his body to the US Transuranium and Uranium Registries for research. This individual was exposed to airborne 241Am, resulting in a total-body activity of 66.6 kBq. He was treated with calcium-diethylenetriamine-pentaacetic acid for 7 y. The time and duration of intakes are unknown as no incident reports are available. Modeling of different assumptions showed that an acute intake of 5‐μm activity median aerodynamic diameter type M aerosols provides the most reasonable description of the available pretherapeutic data; however, the observed 241Am activity in the lungs at the time of death was higher than the one predicted for type M material. The Coordinated Network on Radiation Dosimetry approach for decorporation modeling was used to model the in vivo chelation process directly. It was found that the Coordinated Network on Radiation Dosimetry approach, which only considered chelation in blood and extracellular fluids, underestimated the urinary excretion of 241Am during diethylenetriamine-pentaacetic acid treatment; therefore, the approach was extended to include chelation in the liver. Both urinary excretion and whole-body retention could be described when it was assumed that 25% of chelation occurred in the liver, 75% occurred in the blood and ST0 compartment, and the chelation rate constant was 1 × 10−10 pmol−1 d−1. It was observed that enhancement of urinary excretion of 241Am after injection of diethylenetriamine-pentaacetic acid exponentially decreased to the baseline level with an average half-time of 2.2 ± 0.7 d.
Modeling the Optimum Prussian Blue Treatment for Acute Radiation Syndrome Following 137Cs Ingestion
Authors: Adams Grace G. , Casagrande Rocco
Published: November 2018

Accidents or radiological attacks may lead to ingestion of 137Cs by large numbers of the public. This work models the efficacy of Prussian blue, the medical countermeasure for internal contamination with 137Cs, to prevent acute radiation syndrome as a function of the duration of treatment and the time that treatment starts after uptake. Risk of acute radiation syndrome is modeled using the International Commission on Radiological Protection’s acute radiation hazard model. Dose rates to target organs from 137Cs ingestion were based on the data published by the US Environmental Protection Agency and the retention of 137Cs in the reference man. Modeling found that treatment is most effective if begun within 15 d of ingestion, and the course length should be at least 75 d to mitigate cancer risk and 290 d to mitigate fatalities due to acute radiation syndrome. Both of these course lengths are much longer than the minimum Prussian blue treatment regimen of 30 d. Extending the treatment time for contaminated individuals would increase demand for Prussian blue following an accident or attack and in turn, would require a larger stockpile of Prussian blue to meet demand. Not enough data is available to determine if this longer treatment time would lead to adverse medical outcomes due to the toxicity of the treatment itself.
Diagnosis and Treatment of Chronic Myelomonocytic Leukemias in Adults
Authors: Itzykson Raphael , Fenaux Pierre , Bowen David , Cross Nicholas C.P. , Cortes Jorge , De Witte Theo , Germing Ulrich , Onida Francesco , Padron Eric , Platzbecker Uwe , Santini Valeria , Sanz Guillermo F. , Solary Eric , Van de Loosdrecht Arjan , Malcovati Luca ,   European Hematology Association, the European LeukemiaNet
Published: November 2018

Chronic myelomonocytic leukemia (CMML) is a disease of the elderly, and by far the most frequent overlap myelodysplastic/myeloproliferative neoplasm in adults. Aside from the chronic monocytosis that remains the cornerstone of its diagnosis, the clinical presentation of CMML includes dysplastic features, cytopenias, excess of blasts, or myeloproliferative features including high white blood cell count or splenomegaly. Prognosis is variable, with several prognostic scoring systems reported in recent years, and treatment is poorly defined, with options ranging from watchful waiting to allogeneic stem cell transplantation, which remains the only curative therapy for CMML. Here, we present on behalf of the European Hematology Association and the European LeukemiaNet, evidence‐ and consensus‐based guidelines, established by an international group of experts, from Europe and the United States, for standardized diagnostic and prognostic procedures and for an appropriate choice of therapeutic interventions in adult patients with CMML.
Maintenance Therapy With Interleukin‐2 for Childhood AML
Authors: Petit Arnaud , Ducassou Stéphane , Leblanc Thierry , Pasquet Marlène , Rousseau Alexandra , Ragu Christine , Cachanado Marine , Nelken Brigitte , Bertrand Yves , Michel Gérard , Gandemer Virginie , Cuccuini Wendy , Fenneteau Odile , Lapillonne Hélène , Auvrignon Anne , Baruchel André , Leverger Guy ,   SFCE
Published: November 2018

Supplemental Digital Content is available in the text
Rituximab With Involved Field Irradiation for Early‐stage Nodal Follicular Lymphoma
Authors: Herfarth Klaus , Borchmann Peter , Schnaidt Sven , Hohloch Karin , Budach Volker , Engelhard Marianne , Viardot Andreas , Engenhart‐Cabillic Rita , Keller Ulrich , Reinartz Gabriele , Eich Hans‐Theodor , Witzens‐Harig Mathias , Hess Clemens F. , Dörken Bernd , Dürig Jan , Wiegel Thomas , Hiddemann Wolfgang , Hoster Eva , Pott Christiane , Dreyling Martin
Published: November 2018

Supplemental Digital Content is available in the text
A Cerebrovascular Hypothesis of Neurodegeneration in mTBI
Authors: Sullivan Danielle R.
Published: November 2018

Objectives:

Mild traumatic brain injury (mTBI) is a major public health concern that has generated considerable scientific interest as a complex brain disorder that is associated with long-term neural consequences. This article reviews the literature on cerebrovascular dysfunction in chronic mTBI, with a focus on the long-term neural implications of such dysfunction.

Methods and Results:

Evidence is presented from human neuroimaging studies to support cerebrovascular involvement in long-term mTBI pathology. In addition, a pathway between mTBI and neurodegeneration via cerebrovascular dysfunction is explored.

Conclusions:

Future work focused on identifying the neurobiological mechanisms underlying the neural consequences of mTBI will be important to guide therapeutic interventions and long-term care for patients with mTBI.
A Cross-Sectional Study of Treatments for Behavioral Disorders Following Traumatic Brain Injury: Comparison With French Recommendations
Authors: Bourseau Tiphaine , Saoût Virginie , Ali Pauline , Pouliquen-Loriferne Uriell , Allain Philippe , Dinomais Mickaël
Published: November 2018

Objective:

To give a cross-sectional overview of ongoing management of behavioral disorders following traumatic brain injury (TBI) in a region of France, to compare this with recent recommendations from the French Society of Physical Medicine and Rehabilitation (SOFMER), and to evaluate associations between treatments and participant characteristics.

Setting:

Outpatients referred to medical or community-based facilities in a region of France.

Participants:

One hundred twenty-nine adults with moderate to severe TBI, in the postacute period (over 3 months postinjury).

Design:

Cross-sectional cohort study.

Main Measures:

Sociodemographic data, ongoing interventions including psychotherapy and medication, behavioral disorders assessed by the Behavioral Dysexecutive Syndrome Inventory (BDSI).

Results:

Thirty-three percent of participants received ongoing psychotherapy and 43% were on medication. The most prescribed medications were antidepressants (21%), neuroleptics (18%), anxiolytics (16%), and mood stabilizers (14%). Eighty-five participants (71%) presented a current Behavioral Dysexecutive Syndrome (BDS) according to the BDSI. These participants more frequently received treatment (P = .004), psychotherapy (P = .048), medications (often 2 or more) (P = .007), and particularly antiepileptic mood stabilizers (P = .037) compared with those without BDS.

Conclusion:

Although recommended as first-line treatment, few participants with BDS received psychotherapy. Medications were overused, especially neuroleptics in view of their potential adverse effects. In contrast, recommended medications, such as mood stabilizers and β-blockers, did not appear to be highly prescribed whatever the evolution. Compliance with recommendations seemed insufficient.
The Role of Pain Catastrophizing in Cognitive Functioning Among Veterans With a History of Mild Traumatic Brain Injury
Authors: Hoffman Samantha N. , Herbert Matthew S. , Crocker Laura D. , DeFord Nicole E. , Keller Amber V. , Jurick Sarah M. , Sanderson-Cimino Mark , Jak Amy J.
Published: November 2018

Objective:

To determine the role of pain catastrophizing (PC) in neuropsychological functioning in veterans with a history of mild traumatic brain injury (TBI).

Participants:

Thirty-nine Iraq and Afghanistan combat veterans evaluated in the post–acute phase following mild TBI.

Methods:

Participants underwent psychiatric and TBI clinical interviews, neuropsychological tests, and self-report assessments of PC, pain intensity, depression, and posttraumatic stress disorder symptoms. Cognitive functioning composite scores of executive functioning, processing speed, and learning and memory were created. Composites were entered as dependent variables into separate linear regressions to examine relations with PC.

Results:

Greater PC was associated with worse executive functioning and processing speed even when controlling for confounding variables.

Conclusions:

One's interpretation of pain, in addition to pain intensity, has implications for cognitive functioning. Future research is encouraged to determine whether adaptive pain coping mechanisms improve cognitive functioning or, alternatively, whether cognitive rehabilitation strategies reduce PC.