bluuebunny/crossref_metadata_2025 huggingface dataset:
Impacts of the COVID-19 Pandemic on Communication and Healthcare Access for Adults With Hearing Loss
Authors: Wilson Harper L. , Crouch Jacob , Schuh Marissa , Shinn Jennifer , Bush Matthew L.
Published: May 2021

Objective:

Adults with hearing loss are at risk of negative impacts of the pandemic. Specific factors, such as hearing loss severity and location of residence, may disproportionately impact patients during the pandemic. The objective of this study was to assess the relative impact of the COVID-19 pandemic on hearing loss patients, based on hearing device type and location of residence.

Study Design:

Prospective cross-sectional questionnaire study.

Setting:

Tertiary referral center.

Patients:

Adults with hearing loss.

Main Outcome Measures:

Data included sociodemographic data, communication challenges, pandemic preparedness, access to healthcare, and mental and emotional health.

Results:

A total of 614 patients responded (27.8% response rate). Compared with hearing aid users, cochlear implant users reported more difficulty communicating with family/friends (53% versus 41%, p = 0.017), obtaining pandemic information (10% versus 3%, p = 0.002), and understanding live broadcasts (47% versus 17%, p = 0.001) during the pandemic. CI users were less likely than hearing aid users to seek general (52% versus 69%, p = 0.001) and hearing healthcare services (20% versus 34%, p = 0.002). Rural residents reported greater difficulty than urban residents communicating with friends/family (53% versus 39%, p = 0.001), obtaining food/supplies (41% versus 20%, p = 0.004), understanding live broadcasts (31% versus 20%, p = 0.001) during the pandemic. Compared with urban residents, rural residents reported greater difficulty accessing general (57% versus 42%, p = 0.004) and hearing healthcare (49% versus 34%, p = 0.043). Rural residents reported poorer mental/emotional health than urban residents.

Conclusions:

Among adults with hearing loss, cochlear implant users and rural residents experience greater challenges in communication, pandemic preparedness, and access to healthcare during the COVID-19 pandemic.
Effect of Surgical Start Time on Stapedotomy Outcomes
Authors: Conway Robert M. , Babu Seilesh C. , Sioshansi Pedrom C. , Howard Anthony L. , Tu Nathan C. , Minutello Katrina , Schettino Amy E. , Bojrab Dennis I. , Schutt Christopher A.
Published: May 2021

Objective:

To examine if performing stapedotomy as the first case of the day provides improved outcomes compared with those performed later in the day.

Study Design:

Retrospective chart review.

Setting:

Tertiary referral center.

Patients:

Adult patients undergoing stapedotomy for otosclerosis.

Main Outcome Measure(s):

Patients were separated into either a first case group or a later case group based on surgical start time. Audiologic outcomes and complications were compared between the two groups.

Results:

The first case group had a smaller postoperative air-bone gap (ABG) compared with the later case group of 9.81 dB HL compared with 11.73dB HL and 3.79 dB HL compared with 6.29 dB HL at 1000 and 2000 Hz, respectively (p = 0.03, p < 0.01). The mean postoperative ABG was 10.63 dB HL for the first start group compared with 12.12 dB HL for the later start group, which was statistically significant (p = 0.05).

Conclusions:

First start stapedotomy is associated with slightly improved audiologic outcomes compared with those starting later in the day, although both groups had significantly improved postoperative outcomes overall. There was no significant difference in complications when comparing stapedotomy by case start time.
Quality Indicators for the Diagnosis and Management of Sudden Sensorineural Hearing Loss
Authors: Cottrell Justin , Zahr Siraj K. , Yip Jonathan , Agrawal Sumit , Archibald Jason , Chau Justin , Lea Jane , Lin Vincent , Mick Paul , Morris David , Parnes Lorne , Schramm David , Chan Yvonne , de Almeida John , Eskander Antoine , Witterick Ian J. , Monteiro Eric
Published: May 2021

Objective:

Sudden sensorineural hearing loss (SSNHL) is an ideal entity for quality indicator (QI) development, providing treatment challenges resulting in variable or substandard care. The American Academy of Otolaryngology—Head and Neck Surgery recently updated their SSNHL guidelines. With SSNHL demonstrating a large burden of illness, this study sought to leverage the updated guidelines and develop QIs that support quality improvement initiatives at an individual, institutional, and systems level.

Methods:

Candidate indicators (CIs) were extracted from high-quality SSNHL guidelines that were evaluated using the Appraisal of Guidelines for Research and Evaluation II tool. Each CI and its supporting evidence were summarized and reviewed by a nine-member expert panel based on validity, reliability, and feasibility of measurement. Final QIs were selected from CIs using the modified RAND Corporation-University of California, Los Angeles appropriateness methodology.

Results:

Fifteen CIs were identified after literature review. After the first round of evaluations, the panel agreed on 11 candidate indicators as appropriate QIs with 2 additional CIs suggested for consideration. An expert panel meeting provided a platform to discuss areas of disagreement before final evaluations. The expert panel subsequently agreed upon 11 final QIs as appropriate measures of high-quality care for SSNHL.

Conclusion:

The 11 proposed QIs from this study are supported by evidence and expert consensus, facilitating measurement across a wide breadth of quality domains. With the recently updated SSNHL guidelines, and a greater focus on quality improvement opportunities, these QIs may be used by healthcare providers for targeted quality improvement initiatives.
Optimization of Nanoclay/Polyacrylonitrile Scaffold Using Response Surface Method for Bone Differentiation of Human Mesenchymal Stem Cells
Authors: Esmaeili Elaheh , Malaie-Balasi Zahra , Kabiri Mahboubeh , Khojasteh Arash , Mohamadyar-Toupkanlou Farzaneh , Sadeghzadeh Negar , ZAREI-BEHJANI Zeinab , Hosseinzadeh Simzar
Published: May 2021

Response surface methodology (RSM) based on the D-optimal algorithm was employed here for the electrospinning of nanoclay/polyacrylonitrile (PAN) composite scaffold by the aim of obtaining the lower fiber diameter and better mechanical properties for bone regeneration. The input parameters included the electrospinning voltage, flow rate and the ratio of nanoclay/PAN and the obtained values for the optimum point were 17 kV for the applied voltage, 0.41 ml/hr for flow rate, and 19.06% for the nanoclay/PAN ratio. The composite scaffold was fabricated in accordance with these optimum values and then studied by scanning electron microscopy and tensile apparatus. The fiber diameter and Young's modulus of the prepared scaffold were respectively 145 ± 12 nm and 267 ± 8.7 MPa that the values were between predicted by RSM. Moreover, the biocompatibility and osteogenic differentiation of the composite scaffold were evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and alkaline phosphatase assays. The bare scaffold and tissue culture polystyrene were used as control groups. The results approved stronger bioactivity and bone regeneration with the composite scaffold as a presence of clay nanoparticles.
An External Validation of Scoring Systems in Mortality Prediction in Veno-Venous Extracorporeal Membrane Oxygenation
Authors: Man Man-Yee , Shum Hoi-Ping , Lam Sin-Man , Yu Judianna S.Y. , KING Bobby H.S. , Yan Wing-Wa
Published: May 2021

Veno-venous extracorporeal membrane oxygenation (VV ECMO) offers the last resort in the treatment of acute respiratory distress syndrome (ARDS). Various scoring systems have been established, yet external validation of these scoring systems in the Asian population remains scarce. We aim to identify factors associated with hospital mortality and to validate various scoring systems in the prediction of hospital mortality. A retrospective analysis of adults admitted to Pamela Youde Nethersole Eastern Hospital intensive care unit who received VV ECMO from January 1, 2010 to June 30, 2019 was performed. Demographics, ventilation strategies, rescue therapies, and clinical outcomes were compared. The primary outcome was hospital mortality and secondary outcomes were intensive care unit (ICU) mortality, ICU, and hospital length of stay. There were 122 VV ECMO performed for ARDS, of which 78 survived and 44 died. VV ECMO performed for viral pneumonitis was significantly associated with better survival (55.1% vs. 25%, p = 0.001) compared with other causes. As for prediction scores, the PREdiction of Survival on ECMO Therapy-Score had the highest area under receiver operator curve of 0.733 (95% confidence interval [CI]: 0.643–0.823), whereas that of PRedicting dEath for SEvere ARDS on VV ECMO score was 0.662 (95% CI: 0.561–0.764), Respiratory Extracorporeal Membrane Oxygenation Survival Prediction score was 0.657 (95% CI: 0.553–0.761), Sequential Organ Failure Assessment score was 0.652 (95% CI: 0.547–0.757), and VV ECMO mortality score was 0.637 (95% CI: 0.532-0.742). In our cohort, VV ECMO performed for viral pneumonitis was associated with a higher hospital survival. Prediction scores are helpful in our population and provide a useful reference to hospital mortality.
Pre-left Ventricular Assist Device Cognition: A Comparison of Rural and Urban Implant Recipients
Authors: Woods Mallory J. , Lundgren Scott W. , Poon Cecilia Y. M. , Kupzyk Kevin A. , Alonso Windy W.
Published: May 2021

Mild cognitive impairment (MCI) is common in patients before left ventricular assist device (LVAD) placement. The consequences of these deficits may differentially impact groups of patients with limited access to postimplantation resources, such as those in rural areas. However, to date, no studies have examined preimplantation cognition in rural and urban patients. Therefore, the purpose of this study was to compare cognition in rural and urban patients before LVAD implantation. This observational cohort study is a secondary analysis of 265 patients undergoing LVAD implantation between July 2004 and June 2019. Preimplantation cognitive function was assessed. Rural-Urban Commuting Area Codes designated rural and urban. Independent-samples Mann-Whitney U tests were used to compare rural and urban cohorts. Subjects were 75.8% (201/265) male, 75.4% (200/265) urban, and 56.6% (±13.2) years old. Rural subjects scored significantly lower on the Mini Mental Status Exam (MMSE) (27 ± 2.20) and Wide Range Achievement Test (WRAT) (32 ± 22.9) compared with urban counterparts (MMSE, 27.6 ± 2.7) (p = 0.009); WRAT (44.4 ± 26.2) (p = 0.02) pre-LVAD. These findings suggest rural patients may have greater MCI before LVAD implantation. Rural LVAD recipients with MCI may require additional intensive education and tailored resource identification before discharge.
Prodromal Signs and Symptoms of Chronic Pancreatitis
Authors: Thompson Bridie S. , Philcox Stephen , Devereaux Benedict , Metz Andrew J. , Croagh Daniel , Gray Andrew , Hamarneh Zaki , Windsor John A. , Neale Rachel E.
Published: May 2021

Goal:

We aimed to extract the percent of signs and symptoms at the time of diagnosis from published studies and to pool these using meta-analytic techniques.

Background:

Delayed or misdiagnosis of chronic pancreatitis may occur because the signs and symptoms are nonspecific and varied.

Study:

We performed a systematic review of studies reporting the signs and symptoms of chronic pancreatitis at diagnosis. The percentage of patients with each sign and symptom was extracted and random-effects meta-analyses used to calculate pooled percentages.

Results:

In total, 22 observational studies were included. Across 14 studies, 55% of chronic pancreatitis patients were classified as having alcoholic etiology. Abdominal pain was the most common symptom (76%), and weight loss was reported in 22% of patients. Jaundice occurred in 11% of patients and steatorrhoea in 3%. Half of the patients had a history of acute pancreatitis, and 28% had diabetes mellitus at diagnosis. Heterogeneity between the studies was high for all signs and symptoms.

Conclusions:

This research has identified some common features of patients with chronic pancreatitis, but the high heterogeneity makes it difficult to draw solid conclusions. Carefully designed studies to examine the signs and symptoms leading up to a diagnosis of chronic pancreatitis, and common combinations, are required. These would enable the development of a tool to aid in the early identification of chronic pancreatitis in the primary care setting, with potential for improved short-term and long-term outcomes for patients.
Pepsin and pH of Gastric Juice in Patients With Gastrointestinal Reflux Disease and Subgroups
Authors: Ergun Pelin , Kipcak Sezgi , Dettmar Peter W. , Fisher Jeanine , Woodcock Andrew D. , Bor Serhat
Published: May 2021

Goal:

The aim of this study was to investigate the pepsin values and pH results of gastric juice among the subtypes of gastroesophageal reflux disease (GERD) and functional heartburn.

Background:

The major destructive agents of GERD on the esophageal epithelium are gastric acid and pepsin. No precise information about pepsin concentration in gastric juice exists.

Study:

Ninety patients with GERD, 39 erosive reflux disease (ERD) Los Angeles (LA) grade A/B, 13 ERD LA grade C/D, 19 nonerosive reflux disease (NERD), 8 esophageal hypersensitivity, 11 functional heartburn, and 24 healthy controls were included in the study. During endoscopy gastric juices from the patients were aspirated and their pH readings immediately recorded. Gastric juice samples were analyzed using Peptest, a lateral flow device containing 2 unique human monoclonal antibodies to detect any pepsin present in the gastric juice sample.

Results:

The highest mean gastric pepsin concentration (0.865 mg/mL) and the lowest median gastric pH (1.4) was observed in the LA grade C/D group compared with the lowest mean gastric pepsin concentration (0.576 mg/mL) and the highest median gastric pH (2.5) seen in the NERD group. Comparing pH, the NERD patient group was significantly higher (P=0.0018 to P=0.0233) when compared with all other GERD patient groups.

Conclusions:

The basal gastric pepsin level in the healthy control group was comparable to literature values. There was good correlation and a significant linear relationship between the gastric pepsin level and gastric pH within the patient groups. The severity of the GERD disease is related to the lowest pH and the highest pepsin concentration in gastric juice.
Gluten-induced Neurocognitive Impairment
Authors: Edwards George Jessica B. , Aideyan Babatunde , Yates Kayla , Voorhees Kristin N. , O’Flynn Jennifer , Sweet Kristen , Avery Kate , Ehrlich Alan , Bast Alice , Leffler Daniel A.
Published: May 2021

Goals:

This study aimed to understand the neurocognitive symptoms associated with gluten exposure in individuals with self-reported celiac disease (CD) and nonceliac gluten sensitivity (NCGS).

Background:

While gluten-induced neurocognitive impairment (GINI; eg, “celiac fog” or “brain fog”) is commonly described by individuals with CD and NCGS, there are little data regarding the prevalence and symptoms associated with these experiences.

Study:

A 9-question online survey was accessed by 1396 individuals (1143 with CD; 253 with NCGS). Forced choice and free-response questions were asked of participants to obtain a description of neurocognitive symptoms experienced after gluten ingestion. Free-response answers were coded using a coding structure developed based on the Health-Related Quality of Life Instrument.

Results:

The majority of survey participants (89% of CD and 95% of NCGS) reported having GINI symptoms. When describing symptoms, the most common word descriptors for both groups were difficulty concentrating, forgetfulness, and grogginess. Timing of symptoms, including onset and symptom peak, were similar across the 2 groups. Coding of free responses found the most common references were to cognitive, physical, psychological, and overall quality of life impacts.

Conclusions:

This survey suggests that GINI is common and may be severe in both individuals with CD and NCGS. Cognitive impairment and decline in physical functioning may be similar to that occurring in other illnesses, such as lupus. Clinical follow-up with both individuals with CD and NCGS should include assessment of GINI symptoms. Further research is warranted, including the development of a patient-reported outcome measure including neurocognitive effects of gluten exposure.
Proton Pump Inhibitors Versus Histamine-2-Receptor Antagonists for Stress Ulcer Prophylaxis in Critically Ill Patients
Authors: Deliwala Smit S. , Hamid Kewan , Goyal Hemant , Ponnapalli Anoosha , Zayed Yazan , Bala Areeg , Lakshman Harini , Malladi Shrikanth , Jones Shane , Santana Maria , Leon Brianna , An Minh T. , Chawla Saurabh
Published: May 2021

Goals and Background:

Stress ulcer prophylaxis has been shown to lower gastrointestinal bleeding (GIB) rates. Various agents have been studied, and the optimal strategy continues to be contested. This study evaluates the efficacy between proton pump inhibitors (PPIs) and histamine-2-receptor antagonists. Small sample sizes and methodology flaws limited prior studies.

Study:

A systematic search of MEDLINE, EMBASE, CENTRAL, Web of Science, and ClinicalTrials.gov for randomized controlled trials reporting the use of PPI and histamine-2-receptor antagonist reporting rates of GIB and standardized intensive care outcomes. Risk ratios (RR) and standardized mean difference (SMD) with 95% confidence intervals (CIs). A trial sequential analysis was performed to guard against errors.

Results:

A total of 14 randomized controlled trials of 28,526 patients with a mean age of 57.83±17.35 years and 30.82% females. In our pooled analysis, PPI outperformed its comparator (RR: 0.68; 95% CI: 0.57-0.82) in clinically significant GIB. PPI re-demonstrated significant reduction in overt GIB (RR: 0.61; 95% CI: 0.39-0.97). No differences between groups was noted toward all-cause mortality (RR: 1.05; 95% CI: 1.00-1.10) or incidence of pneumonia (RR: 1.11; 95% CI: 0.82-1.51). Duration of stay (SMD: 0.07; 95% CI: −0.04-0.17) and ventilator days (SMD: 0.01; 95% CI: −0.01-0.04) were indifferent between the groups.

Conclusions:

Among critically ill patients, PPI was associated with reduced clinically significant or overt GIB. No differences in pneumonia were seen with the use of either agent. Trial sequential analysis for clinically significant GIB ruled out the risk for false-positive results, and thereby it is unlikely that future trials will affect our conclusions.
Interassessor agreement of portfolio-based competency assessment for orthotists/prosthetists in Australia: a mixed method study
Authors: Dillon Michael P. , Puli Louise , Ridgewell Emily , Anderson Sarah P , Chiavaroli Neville , Clarke Leigh
Published: May 2021

Background:

Internationally qualified orthotists/prosthetists who want to practice in Australia must pass a portfolio-based competency assessment. Testing the agreement between independent assessors is important to engender confidence in the assessment, and continually improve the processes.

Objectives:

To quantify interassessor agreement for all 68 performance indicators in the Australian Orthotic Prosthetic Association's Entry Level Competency Standards and where there was significant disagreement between assessors, to explore the reasons why.

Study design:

Mixed methods: explanatory sequential.

Method:

Fifteen portfolios were assigned to independent assessors. Assessors determined whether the evidence presented met the requirements of each performance indicator. Interassessor agreement was calculated using Gwet's Agreement Coefficient 1 (AC1), and these data informed semistructured interviews to explore the reasons for disagreement.

Results:

Most performance indicators (87%) had moderate to substantial agreement (AC1 > 0.71), which could be attributed to a variety of factors including the use of a simple assessment rubric with supporting guidelines and assessor training to establish shared expectations. The remaining performance indicators (13%) had fair to slight agreement (AC1 ≤ 0.7). Interviews with assessors suggested that disagreement could be attributed to the complexity of some performance indicators, unconscious bias, and the appropriateness of the evidence presented.

Conclusions:

Although most performance indicators in Australian Orthotic Prosthetic Association's Entry Level Competency Standard were associated with moderate to substantial interassessor agreement, there are opportunities to improve agreement by simplifying the wording of some performance indicators and revising guidelines to help applicants curate the most appropriate evidence for each performance indicator.
Chemical exchange saturation transfer for detection of antiretroviral drugs in brain tissue
Authors: Bade Aditya N. , Gendelman Howard E. , McMillan JoEllyn , Liu Yutong
Published: May 2021

Objective:

Antiretroviral drug theranostics facilitates the monitoring of biodistribution and efficacy of therapies designed to target HIV type-1 (HIV-1) reservoirs. To this end, we have now deployed intrinsic drug chemical exchange saturation transfer (CEST) contrasts to detect antiretroviral drugs within the central nervous system (CNS).

Design and methods:

CEST effects for lamivudine (3TC) and emtricitabine (FTC) were measured by asymmetric magnetization transfer ratio analyses. The biodistribution of 3TC in different brain sub-regions of C57BL/6 mice treated with lipopolysaccharides was determined using MRI. CEST effects of 3TC protons were quantitated by Lorentzian fitting analysis. 3TC levels in plasma and brain regions were measured using ultraperformance liquid chromatography tandem mass spectrometry to affirm the CEST test results.

Results:

CEST effects of the hydroxyl and amino protons in 3TC and FTC linearly correlated to drug concentrations. 3TC was successfully detected in vivo in brain sub-regions by MRI. The imaging results were validated by measurements of CNS drug concentrations.

Conclusion:

CEST contrasts can be used to detect antiretroviral drugs using MRI. Such detection can be used to assess spatial--temporal drug biodistribution. This is most notable within the CNS where drug biodistribution may be more limited with the final goal of better understanding antiretroviral drug-associated efficacy and potential toxicity.
Phase2Phase
Authors: Eldeniz Cihat , Gan Weijie , Chen Sihao , Fraum Tyler J. , Ludwig Daniel R. , Yan Yan , Liu Jiaming , Vahle Thomas , Krishnamurthy Uday , Kamilov Ulugbek S. , An Hongyu
Published: May 2021

Objectives

Respiratory binning of free-breathing magnetic resonance imaging data reduces motion blurring; however, it exacerbates noise and introduces severe artifacts due to undersampling. Deep neural networks can remove artifacts and noise but usually require high-quality ground truth images for training. This study aimed to develop a network that can be trained without this requirement.

Materials and Methods

This retrospective study was conducted on 33 participants enrolled between November 2016 and June 2019. Free-breathing magnetic resonance imaging was performed using a radial acquisition. Self-navigation was used to bin the k-space data into 10 respiratory phases. To simulate short acquisitions, subsets of radial spokes were used in reconstructing images with multicoil nonuniform fast Fourier transform (MCNUFFT), compressed sensing (CS), and 2 deep learning methods: UNet3DPhase and Phase2Phase (P2P). UNet3DPhase was trained using a high-quality ground truth, whereas P2P was trained using noisy images with streaking artifacts. Two radiologists blinded to the reconstruction methods independently reviewed the sharpness, contrast, and artifact-freeness of the end-expiration images reconstructed from data collected at 16% of the Nyquist sampling rate. The generalized estimating equation method was used for statistical comparison. Motion vector fields were derived to examine the respiratory motion range of 4-dimensional images reconstructed using different methods.

Results

A total of 15 healthy participants and 18 patients with hepatic malignancy (50 ± 15 years, 6 women) were enrolled. Both reviewers found that the UNet3DPhase and P2P images had higher contrast (P < 0.01) and fewer artifacts (P < 0.01) than the CS images. The UNet3DPhase and P2P images were reported to be sharper than the CS images by 1 reviewer (P < 0.01) but not by the other reviewer (P = 0.22, P = 0.18). UNet3DPhase and P2P were similar in sharpness and contrast, whereas UNet3DPhase had fewer artifacts (P < 0.01). The motion vector lengths for the MCNUFFT800 and P2P800 images were comparable (10.5 ± 4.2 mm and 9.9 ± 4.0 mm, respectively), whereas both were significantly larger than CS2000 (7.0 ± 3.9 mm; P < 0.0001) and UNnet3DPhase800 (6.9 ± 3.2; P < 0.0001) images.

Conclusions

Without a ground truth, P2P can reconstruct sharp, artifact-free, and high-contrast respiratory motion-resolved images from highly undersampled data. Unlike the CS and UNet3DPhase methods, P2P did not artificially reduce the respiratory motion range.
Real-Time Deformability Cytometry Detects Leukocyte Stiffening After Gadolinium-Based Contrast Agent Exposure
Authors: Jacobi Angela , Ariza de Schellenberger Angela , Uca Yavuz Oguz , Herbig Maik , Guck Jochen , Sack Ingolf
Published: May 2021

Objectives

Reports on gadolinium (Gd) retention in soft tissues after administration of Gd-based contrast agents (GBCAs) raise concerns about Gd-induced changes in the biophysical properties of cells and tissues. Here, we investigate if clinical GBCAs of both classes of linear and macrocyclic structure cause changes in the mechanical properties of leukocytes in human blood samples.

Material and Methods

Real-time deformability cytometry was applied to human blood samples from 6 donors. The samples were treated with 1 mM gadoteric acid (Dotarem), gadopentetic acid (Magnevist), gadobutrol (Gadovist), or Gd trichloride at 37°C for 1 hour to mimic clinical doses of GBCAs and exposure times. Leukocyte subtypes—lymphocytes, monocytes, and neutrophils—were identified based on their size and brightness and analyzed for deformability, which is inversely correlated with cellular stiffness.

Results

We observed significant stiffening (3%–13%, P < 0.01) of all investigated leukocyte subtypes, which was most pronounced for lymphocytes, followed by neutrophils and monocytes, and the effects were independent of the charge and steric structure of the GBCA applied. In contrast, no changes in cell size and brightness were observed, suggesting that deformability and cell stiffness measured by real-time deformability cytometry are sensitive to changes in the physical phenotypes of leukocytes after GBCA exposure.

Conclusions

Real-time deformability cytometry might provide a quantitative blood marker for critical changes in the physical properties of blood cells in patients undergoing GBCA-enhanced magnetic resonance imaging.
The Discriminative Power and Stability of Radiomics Features With Computed Tomography Variations
Authors: Jimenez-del-Toro Oscar , Aberle Christoph , Bach Michael , Schaer Roger , Obmann Markus M. , Flouris Kyriakos , Konukoglu Ender , Stieltjes Bram , Müller Henning , Depeursinge Adrien
Published: May 2021

Objectives

The aims of this study were to determine the stability of radiomics features against computed tomography (CT) parameter variations and to study their discriminative power concerning tissue classification using a 3D-printed CT phantom based on real patient data.

Materials and Methods

A radiopaque 3D phantom was developed using real patient data and a potassium iodide solution paper-printing technique. Normal liver tissue and 3 lesion types (benign cyst, hemangioma, and metastasis) were manually annotated in the phantom. The stability and discriminative power of 86 radiomics features were assessed in measurements taken from 240 CT series with 8 parameter variations of reconstruction algorithms, reconstruction kernels, slice thickness, and slice spacing. Pairwise parameter group and pairwise tissue class comparisons were performed using Wilcoxon signed rank tests.

Results

In total, 19,264 feature stability tests and 8256 discriminative power tests were performed. The 8 CT parameter variation pairwise group comparisons had statistically significant differences on average in 78/86 radiomics features. On the other hand, 84% of the univariate radiomics feature tests had a successful and statistically significant differentiation of the 4 classes of liver tissue. The 86 radiomics features were ranked according to the cumulative sum of successful stability and discriminative power tests.

Conclusions

The differences in radiomics feature values obtained from different types of liver tissue are generally greater than the intraclass differences resulting from CT parameter variations.
Diagnostic Performance of 9 Quantitative Ultrasound Parameters for Detection and Classification of Hepatic Steatosis in Nonalcoholic Fatty Liver Disease
Authors: Pirmoazen Amir M. , Khurana Aman , Loening Andreas M. , Liang Tie , Shamdasani Vijay , Xie Hua , El Kaffas Ahmed , Kamaya Aya
Published: May 2021

Background

Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease worldwide. Quantitative ultrasound (QUS) parameters based on radiofrequency raw data show promise in quantifying liver fat.

Purpose

The aim of this study was to evaluate the diagnostic performance of 9 QUS parameters compared with magnetic resonance imaging (MRI)–estimated proton density fat fraction (PDFF) in detecting and staging hepatic steatosis in patients with or suspected of NAFLD.

Materials and Methods

In this Health Insurance Portability and Accountability Act–compliant institutional review board–approved prospective study, 31 participants with or suspected of NAFLD, without other underlying chronic liver diseases (13 men, 18 women; average age, 52 years [range, 26–90 years]), were examined. The following parameters were obtained: acoustic attenuation coefficient (AC); hepatorenal index (HRI); Nakagami parameter; shear wave elastography measures such as shear wave elasticity, viscosity, and dispersion; and spectroscopy-derived parameters including spectral intercept (SI), spectral slope (SS), and midband fit (MBF). The diagnostic ability (area under the receiver operating characteristic curves and accuracy) of QUS parameters was assessed against different MRI-PDFF cutoffs (the reference standard): 6.4%, 17.4%, and 22.1%. Linearity with MRI-PDFF was evaluated with Spearman correlation coefficients (p).

Results

The AC, SI, Nakagami, SS, HRI, and MBF strongly correlated with MRI-PDFF (P = 0.89, 0.89, 0.88, −0.87, 0.81, and 0.71, respectively [P < 0.01]), with highest area under the receiver operating characteristic curves (ranging from 0.85 to 1) for identifying hepatic steatosis using 6.4%, 17.4%, and 22.1% MRI-PDFF cutoffs. In contrast, shear wave elasticity, shear wave viscosity, and shear wave dispersion did not strongly correlate to MRI-PDFF (P = 0.45, 0.38, and 0.07, respectively) and had poor diagnostic performance.

Conclusion

The AC, Nakagami, SI, SS, MBF, and HRI best correlate with MRI-PDFF and show high diagnostic performance for detecting and classifying hepatic steatosis in our study population.

Summary Statement

Quantitative ultrasound is an accurate alternative to MRI-based techniques for evaluating hepatic steatosis in patients with or at risk of NAFLD.

Key Findings

Our preliminary results show that specific quantitative ultrasound parameters accurately detect different degrees of hepatic steatosis in NAFLD.
Laparoscopic Appendectomy in the Days of COVID-19
Authors: Abramov Roi , Neymark Mariya , Harbi Asaf , Gilshtein Hayim
Published: May 2021

Background:

Acute appendicitis is one of the most common emergencies treated by general surgeons. The treatment of choice in the majority of cases is laparoscopic appendectomy. In the era of the COVID-19 pandemic, there is a concern for a delayed referral of patients and thus a more advanced presentation of the disease leading to a prolonged and complicated course.

Methods:

Retrospective review of a computerized database of patients who were admitted with acute appendicitis and underwent laparoscopic appendectomy during the COVID pandemic in a single tertiary center in Israel. Patients were compared with those who were admitted and operated for appendicitis in the same period in the previous year.

Results:

One hundred twenty-three patients underwent laparoscopic appendectomy in the study period in 2020, compared with 109 who had surgery in 2019. During the COVID pandemic 41 patients presented with complicated appendicitis versus 22 patients in 2019 (P=0.0174). The placement of peritoneal drains was more prevalent during the pandemic, 5.5% versus 11.4%, and the use of stapler device for appendicular stump closure (P=0.0105).

Conclusions:

During the first stage of the COVID-19 pandemic, there was a significant increase in the rate of complicated appendicitis. Patients should be strongly encouraged not to refrain from medical treatment and go to the emergency room with the persistence of symptoms.
Keratinocyte Cancer Mortality in Kidney Transplant Recipients
Authors: Shao Emily Ximin , Betz-Stablein Brigid , Khosrotehrani Kiarash , Campbell Scott , Isbel Nicole , Green Adele C.
Published: May 2021

Background.

Kidney transplant recipients are at increased risk of developing and dying from keratinocyte cancer. Risk factors for keratinocyte cancer death have not been previously described.

Methods.

In a cohort of kidney transplant recipients transplanted in Queensland from 1995 to 2014, we identified keratinocyte cancer deaths by searching national transplant and state death registries to March 2020. Standardized keratinocyte cancer mortality rates and mortality ratios were calculated. We used a competing risks model to identify factors associated with keratinocyte cancer death and calculated relative risks (RRs) and 95% confidence intervals (CIs).

Results.

There were 562 deaths in 1866 kidney transplant recipients (62% male individuals; 86% Caucasian) with 25 934 person-y of follow-up, of which 36 were due to squamous cell carcinoma and 1 to basal cell carcinoma with standardized mortality rates of 78 (95% CI, 53-111) and 2 (95% CI, 0.1-11) per 100 000 person-y, respectively. The standardized mortality ratio for keratinocyte cancer was 23 (95% CI, 23-24). Besides Caucasian ethnicity (associated with 100% of keratinocyte cancer deaths), male sex (RR, 3.24; 95% CI, 1.26-8.33), and older age at transplantation (≥50 versus <50 y; RR, 3.09; 95% CI, 1.38-6.89) were associated with increased risk of keratinocyte cancer death.

Conclusions.

Keratinocyte cancer mortality in kidney transplant recipients is over 20 times higher than in the general population. Most keratinocyte cancer deaths are due to cutaneous squamous cell carcinoma, however, basal cell carcinoma can be fatal. Education in skin cancer prevention is essential to avoid unnecessary deaths from keratinocyte cancer among kidney transplant recipients.
Novel Soluble Mediators of Innate Immune System Activation in Solid Allograft Rejection
Authors: Usuelli Vera , Loretelli Cristian , Seelam Andy Joe , Pastore Ida , D’Addio Francesca , Ben Nasr Moufida , Fiorina Paolo
Published: May 2021

During the past years, solid allograft rejection has been considered the consequence of either cellular- or antibody-mediated reaction both being part of the adaptive immune response, whereas the role of innate immunity has been mostly considered less relevant. Recently, a large body of evidence suggested that the innate immune response and its soluble mediators may play a more important role during solid allograft rejection than originally thought. This review will highlight the role of novel soluble mediators that are involved in the activation of innate immunity during alloimmune response and solid allograft rejection. We will also discuss emerging strategies to alleviate the aforementioned events. Hence, novel, feasible, and safe clinical therapies are needed to prevent allograft loss in solid organ transplantation. Fully understanding the role of soluble mediators of innate immune system activation may help to mitigate solid allograft rejection and improve transplanted recipients’ outcomes.
Ambient Air Pollution and Adverse Waitlist Events Among Lung Transplant Candidates
Authors: Hallett Andrew M. , Feng Yijing , Jones Miranda R. , Bush Errol L. , Merlo Christian A. , Segev Dorry L. , McAdams-DeMarco Mara
Published: May 2021

Background.

Air pollution is associated with cardiopulmonary disease and death in the general population. Fine particulate matter (PM2.5) is particularly harmful due to its ability to penetrate into areas of gas exchange within the lungs. Persons with advanced lung disease are believed to be particularly susceptible to PM2.5 exposure, but only a few studies have examined the effect of exposure on this population. Here we investigate the association between PM2.5 exposure and adverse waitlist events among lung transplant (LT) candidates.

Methods.

US registry data were used to identify LT candidates listed between January 1, 2010 and December 31, 2016. Annual PM2.5 concentration at year of listing was estimated for each candidate’s ZIP Code using National Aeronautics and Space Administration’s (NASA) Socioeconomic Data and Applications Center Global Annual PM2.5 Grids. We estimated crude and adjusted hazard ratios for adverse waitlist events, defined as death or removal, using Cox proportional hazards regression.

Results.

Of the 15 075 included candidates, median age at listing was 60, 43.8% were female individuals, and 81.7% were non-Hispanic White. Median ZIP Code PM2.5 concentration was 9.06 µg/m3. When compared with those living in ZIP Codes with lower PM2.5 exposure (PM2.5 <10.53 µg/m3), candidates in ZIP Codes in the highest quartile of PM2.5 exposure (≥10.53 µg/m3) had 1.14-fold (95% confidence interval, 1.04-1.25) risk of adverse waitlist events. The result remained significant after adjusting for demographics, education, insurance, smoking, lung allocation score, body mass index, and blood type (hazard ratio, 1.17; 95% confidence interval, 1.07-1.29).

Conclusions.

Elevated ambient PM2.5 concentration was associated with adverse waitlist events among LT candidates. These findings highlight the impact of air pollution on clinical outcomes in this critically ill population.
Machine Learning to Classify Relative Seizure Frequency From Chronic Electrocorticography
Authors: Sun Yueqiu , Friedman Daniel , Dugan Patricia , Holmes Manisha , Wu Xiaojing , Liu Anli
Published: May 2021

Purpose:

Brain responsive neurostimulation (NeuroPace) treats patients with refractory focal epilepsy and provides chronic electrocorticography (ECoG). We explored how machine learning algorithms applied to interictal ECoG could assess clinical response to changes in neurostimulation parameters.

Methods:

We identified five responsive neurostimulation patients each with ≥200 continuous days of stable medication and detection settings (median, 358 days per patient). For each patient, interictal ECoG segments for each month were labeled as “high” or “low” to represent relatively high or low long-episode (i.e., seizure) count compared with the median monthly long-episode count. Power from six conventional frequency bands from four responsive neurostimulation channels were extracted as features. For each patient, five machine learning algorithms were trained on 80% of ECoG, then tested on the remaining 20%. Classifiers were scored by the area-under-the-receiver-operating-characteristic curve. We explored how individual circadian cycles of seizure activity could inform classifier building.

Results:

Support vector machine or gradient boosting models achieved the best performance, ranging from 0.705 (fair) to 0.892 (excellent) across patients. High gamma power was the most important feature, tending to decrease during low-seizure-frequency epochs. For two subjects, training on ECoG recorded during the circadian ictal peak resulted in comparable model performance, despite less data used.

Conclusions:

Machine learning analysis on retrospective background ECoG can classify relative seizure frequency for an individual patient. High gamma power was the most informative, whereas individual circadian patterns of seizure activity can guide model building. Machine learning classifiers built on interictal ECoG may guide stimulation programming.
Seizures Noted by Responsive Neurostimulation From e-Cigarette Use (Vaping)
Authors: Oster Joel M. , Tatum Peter , Monigan Catherine , Kryzanski James
Published: May 2021

The health consequences of e-cigarette use (vaping) have recently garnered significant attention, most notably from reports of pulmonary pathologic examination although there are scattered case reports of vape-induced seizures, but thus far, there have been little objective data or rigorous study supporting this association with definitive quantification.
Are We Underestimating the Central Components of the Mixed Apneas?—A Hypothesis for Revised Scoring
Authors: Şenel Gülçin Benbir , Aliş Ceren , Karadeniz Derya
Published: May 2021

Purpose:

Apneas are classified in three categories, as obstructive, central, and mixed types. Mixed apneas are calculated together with the obstructive events in diagnosing obstructive sleep apnea syndrome (SAS). The clinical significance of mixed apneas needs to be specified.

Methods:

Patients with obstructive SAS having an index of mixed apneas ≥5/hour were evaluated. A new approach was developed to score the mixed apneas, and calculated them together with either obstructive or central type of events, depending on their obstructive and central components. The relationship between the development of complex SAS and the indices of abnormal respiratory events per standard and revised scoring was evaluated.

Results:

Ten of 56 patients (17.9%) developed complex SAS at titration polysomnography. The mean index of mixed apneas per standard scoring was significantly higher in patients who did not develop complex SAS (P = 0.006). The use of newly developed method in scoring mixed apneas resulted that three patients (5.4%) fulfilled the diagnostic criteria for the central SAS at first-night polysomnography (P < 0.001), and all of them had developed complex SAS at titration night requiring other modes of positive airway pressure therapy than the continuous mode (P = 0.004). Curve estimation models showed that the change from mixed apneas to central apneas was highly significant in patients developing complex SAS (r
2 = 0.501; P = 0.022).

Conclusions:

Our study showed that the summation of mixed apneas with the obstructive events conventionally underestimates the central components and the diagnosis of central SAS, which are fundamental in the risk stratification of complex SAS.
Motivated semantic control: Exploring the effects of extrinsic reward and self-reference on semantic retrieval in semantic aphasia
Authors: Souter Nicholas E. , Stampacchia Sara , Hallam Glyn , Thompson Hannah , Smallwood Jonathan , Jefferies Elizabeth
Published: May 2021

Recent insights show increased motivation can benefit executive control, but this effect has not been explored in relation to semantic cognition. Patients with deficits of controlled semantic retrieval in the context of semantic aphasia (SA) after stroke may benefit from this approach since ‘semantic control’ is considered an executive process. Deficits in this domain are partially distinct from domain-general deficits of cognitive control. We assessed the effect of both extrinsic and intrinsic motivation in healthy controls and semantic aphasia patients. Experiment 1 manipulated extrinsic reward using high or low levels of points for correct responses during a semantic association task. Experiment 2 manipulated the intrinsic value of items using self-reference; allocating pictures of items to the participant (‘self’) or researcher (‘other’) in a shopping game before people retrieved their semantic associations. These experiments revealed that patients, but not controls, showed better performance when given an extrinsic reward, consistent with the view that increased external motivation may help to ameliorate patients’ semantic control deficits. However, while self-reference was associated with better episodic memory, there was no effect on semantic retrieval. We conclude that semantic control deficits can be reduced when extrinsic rewards are anticipated; this enhanced motivational state is expected to support proactive control, for example, through the maintenance of task representations. It may be possible to harness this modulatory impact of reward to combat the control demands of semantic tasks in SA patients.
External validation of a clinical decision rule and neuroimaging rule-out strategy for exclusion of subarachnoid haemorrhage in the emergency department: A prospective observational cohort study
Authors: Roberts Tom , Hirst Robert , Hulme William , Horner Daniel
Published: May 2021

Background

The investigation of suspected subarachnoid haemorrhage (SAH) presents a diagnostic dilemma. The limited sensitivity of a negative CT brain scan has historically mandated hospital admission and a lumbar puncture to look for evidence of blood in the cerebrospinal fluid. However, emerging evidence has suggested the sensitivity of clinical decision rules and modern CT imaging protocols within early onset of symptoms, may be sufficient to exclude the diagnosis.

Methods

A prospective, multi-centre, observational study of consecutive adult patients with acute severe non-traumatic headache presenting to emergency departments. We plan to recruit 9000 patients from over a hundred sites across the UK. The primary outcome is adjudicated SAH as defined by neuroimaging or cerebrospinal fluid findings consistent with the diagnosis.

Data will be collected on clinical history, examination findings, phlebotomy and imaging results. All participants will be followed for 28-days to identify SAH and other clinically relevant outcomes using case note review, and later Hospital Episode Statistics. A proportionate opt-out model of consent will be used to maximise patient recruitment and study generalisability.

Discussion

Whilst there is increasing evidence that early neuroimaging strategies for the diagnosis of SAH are very sensitive, there have been no large studies to confirm this in the UK population. Furthermore, the test characteristics of CT brain beyond 6 hours from onset are not well understood and there is limited biological plausibility for this defined time cutpoint. Finally, the performance of the Ottawa clinical decision rule has shown promise in the Canadian population. However, its performance in the UK has not been studied and there are concerns that due to the low specificity it may result in increased, rather than decreased rate of investigations. This study will therefore aim to assess the test characteristics of both a CT brain up to 24h from presentation and the Ottawa SAH clinical decision rule.
What do we know about violence against women in pandemic times? Insights based on search trends
Authors: Guatimosim Rafaela Ferreira , Silva Teles Ana Luiza , Loureiro Fabiano Franca , da Silva Antônio Geraldo , de Miranda Débora Marques , Malloy-Diniz Leandro Fernandes
Published: May 2021

Purpose

This short communication aims to assess the situation of domestic violence against women in Brazil during social isolation due to the COVID-19 pandemic.

Methods

We extracted data from Google Trends showing the magnitude of searches on the topics domestic violence and complaint and then compared with the data of the complaint reports.

Results

Searches on Google containing those terms have increased while the complaints reports against domestic violence have decreased.

Conclusion

The growth of searches about domestic violence and domestic violence complaints indicates the possibility of a real rise in this type of violence in Brazil.