bluuebunny/crossref_metadata_2025 huggingface dataset:
Stone-Free Rate after Treating Kidney Stones Exceeding 10 mm via Flexible Ureteroscopy: Can Endoscopic Assessment Replace Low-Dose Computed Tomography Control?
Authors: Wilhelm Konrad , Hahn Oliver , Schoenthaler Martin , Hein Simon , Neubauer Jakob , Schnabel Marco , Neisius Andreas
Published: September 2019

Introduction: It is unclear whether endoscopic assessment of the stone-free rate after flexible ureteroscopy (fURS) is as effective as assessment with low-dose computed tomography (CT) scan. Methods: Prospective documentation of patients with kidney stones > 10 mm diameter from 2 different centers (Freiburg, Regensburg), who underwent fURS and were declared to be endoscopically completely stone-free. Low-dose CT control performed 4–8 weeks postoperatively. Results/Conclusion: Thirty-eight patients were treated between October 2015 and August 2016 (12 F, 26 M). Average age was 55.9 years (range 19–82, SD 17.24), and body mass index was 29.7 kg/m2 (range 23.5–42.5, SD 4.37). There were 2.0 (range 1–7, SD 1.55) stones with a mean diameter of 15 mm (range 10–40, SD 6.78) per kidney. Mean surgery time was 74 min (range 38–124, SD 24.28), and lithotripsy was necessary in 33 cases. CT was performed 5.4 weeks afterwards (range 4–8, SD 1.43). One patient had a 2 mm residual which was extracted by URS. Strictly speaking, endoluminal stone removal control failed in only that patient, yielding a negative predictive value of 97%. A routine postoperative CT scan would thus appear unnecessary in the case of negative endoscopic control for residual fragments and should be avoided to reduce radiation exposure. Further investigations with larger patient populations are necessary.
Ductal Carcinoma in situ after Core Needle Biopsy: In Which Cases Is a Sentinel Node Biopsy Necessary?
Authors: van Leeuwen Robbert J.H. , Kortmann Birgitta , Rijna Herman
Published: September 2019

Introduction: In some hospitals it is still common practice to carry out a sentinel node biopsy (SNB) if ductal carcinoma in situ (DCIS) is determined in preoperative staging, although this is against international guidelines. The reason for this is because an infiltrative component can be demonstrated frequently in the final pathohistological examination. In this study, we wanted to investigate possible predictors for infiltrative growth, to select patients to do an SNB or to omit it. Material and Methods: All patients with DCIS in the core needle biopsy (CNB), who were treated with surgery including an SNB, were included in a prospective data registry. Patient characteristics were collected through physical examination, mammography and ultrasonography. All characteristics of the DCIS were noted. After surgery, the pathological results were collected. Results: From the 287 patients, 39 (13.6%) had an infiltrative component in the definitive pathological examination despite only DCIS in preoperative CNB. In total, there were only 14 (4.9%) positive SNBs, of which 11 patients had infiltrative growth in the breast tumor and 3 (1.2% of patients with DCIS alone in the final pathology) did not. In addition, characteristics of the CNB, including microcalcifications and comedonecrosis, did not show a statistically significant higher risk for infiltration. Discussion: Considering the low rates of positive SNBs in our population, we think that an SNB should not be performed in advance when DCIS is diagnosed, because if infiltrative growth is found in the final biopsy, an SNB could always be performed afterwards. Only if an SNB cannot be performed afterwards is an SNB indicated.
Dual Therapy with Vonoprazan and Amoxicillin Is as Effective as Triple Therapy with Vonoprazan, Amoxicillin and Clarithromycin for Eradication of Helicobacter pylori
Authors: Furuta Takahisa , Yamade Mihoko , Kagami Takuma , Uotani Takahiro , Suzuki Takahiro , Higuchi Tomohiro , Tani Shinya , Hamaya Yasushi , Iwaizumi Moriya , Miyajima Hiroaki , Umemura Kazuo , Osawa Satoshi , Sugimoto Ken
Published: September 2019

Backgrounds/Aims: Vonoprazan (VPZ) is the first clinically available potassium competitive acid blocker. This class of agents provides faster and more potent acid inhibition than proton pump inhibitors. Most strains of Helicobacter pylori are sensitive to amoxicillin. We hypothesized that dual therapy with VPZ and amoxicillin would provide the sufficient eradication rate for H. pylori infection. To evaluate this, we compared the eradication rate by the dual VPZ/amoxicillin therapy with that by the standard triple VPZ/amoxicillin/clarithromycin therapy. Methods: Non-inferiority of the eradication rate of H. pylori by the dual therapy with VPZ 20 mg twice daily (bid) and amoxicillin 500 mg 3 times daily (tid) for 1 week to that by the triple therapy with VPZ 20 mg bid, amoxicillin 750 mg bid and clarithromycin 200 mg bid for 1 week was retrospectively studied. Propensity score matching was performed to improve comparability between 2 regimen groups. Successful eradication was diagnosed using the [13C]-urea breath test at 1–2 months after the end of eradication therapy. Results: The intention-to-treat analysis demonstrated that the eradication rate by the dual therapy (92.9%; 95% CI 82.7–98.0%, 52/56) was not inferior to that of the triple therapy (91.9%; 95% CI 80.4–97.0%, 51/56; OR 1.275, 95% CI 0.324–5.017%, p = 0.728). There were no statistically significant differences in incidences of adverse events between 2 regimens. Conclusion: VPZ-based dual therapy (VPZ 20 mg bid and amoxicillin 500 mg tid for 1 week) provides an acceptable eradication rate of H. pylori infection without the need for second antimicrobial agents, such as clarithromycin.
Urine Osmolality and Renal Outcome in Patients with Chronic Kidney Disease: Results from the KNOW-CKD
Authors: Lee Mi Jung , Chang Tae Ik , Lee Joongyub , Kim Yeong Hoon , Oh Kook-Hwan , Lee Sung Woo , Kim Soo Wan , Park Jung Tak , Yoo Tae-Hyun , Kang Shin-Wook , Choi Kyu Hun , Ahn Curie , Han Seung Hyeok
Published: September 2019

Background: Urine osmolality indicates the ability of the kidney to concentrate the urine and reflects the antidiuretic action of vasopressin. However, results about the association between urine osmolality and adverse renal outcomes in chronic kidney disease (CKD) are conflicting. We investigated the association between urine osmolality and adverse renal outcomes in a nationwide prospective CKD cohort. Methods: A total of 1,999 CKD patients were categorized into 3 groups according to their urine osmolality tertiles. Primary outcome was a composite of 50% decline in the estimated glomerular filtration rate (eGFR), initiation of dialysis, or kidney transplantation. Results: During a mean follow-up of 35.2 ± 19.0 months, primary outcome occurred in 432 (21.6%) patients; 240 (36.4%), 162 (24.3%), and 30 (4.5%) in the lowest, middle, and highest tertiles, respectively. Low urine osmolality was independently associated with a greater risk of CKD progression (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.12–2.59). This association was particularly evident in patients with CKD stages 3–4 (per 10 mosm/kg decrease; HR, 1.02; 95% CI, 1.00–1.03). Adding urine osmolality to a base model with conventional factors significantly increased the ability to predict CKD progression (C-statistics, 0.86; integrated discrimination improvement [IDI], 0.021; both p < 0.001). However, adding both urine osmolality and eGFR did not further improve the predictive ability compared with the addition of eGFR only (C-statistics, p = 0.29; IDI, p = 0.09). Conclusions: Low urine osmolality was an independent risk factor for adverse renal outcomes in CKD patients, but its predictive ability did not surpass eGFR. Thus, kidney function should be considered while interpreting the clinical significance of urine osmolality.
Peak Growth Hormone Response to Combined Stimulation Test in 315 Children and Correlations with Metabolic Parameters
Authors: Yau Mabel , Chacko Elizabeth , Regelmann Molly O. , Annunziato Rachel , Wallach Elizabeth J. , Chia Dennis , Rapaport Robert
Published: September 2019

Background/Aims: Studies are lacking regarding the timing of peak growth hormone (PGH) response. We aim to elucidate the timing of PGH response to arginine and levodopa (A-LD) and evaluate the influence of body mass index (BMI) and other metabolic parameters on PGH. Methods: During growth hormone (GH) stimulation testing (ST) with A-LD, serum GH was measured at baseline and every 30 min up to 180 min. The PGH cut-off was defined as <10 ng/mL. IGF-1, IGF BP3, BMI, and metabolic parameters were obtained in a fasting state at baseline. Results: In the 315 tested children, stimulated PGH levels occurred at or before 120 min in 97.8% and at 180 min in 2.2%. GH area under the curve (AUC) positively correlated with PGH in all patients and with IGF-1 in pubertal males and females. BMI negatively correlated with PGH in all subjects. GH AUC negatively correlated with HOMA-IR and total cholesterol. Conclusion: We propose termination of the GH ST with A-LD at 120 min since omission of GH measurement at 180 min did not alter the diagnosis of GH deficiency based on a cut-off of < 10 ng/mL. BMI should be considered in the interpretation of GH ST with A-LD. The relationships between GH AUC and metabolic parameters need further study.
Autologous Adrenal Transplantation for the Treatment of Refractory Cushing’s Disease
Authors: Dong Dexin , Ji Zhigang , Li Hanzhong
Published: September 2019

Objective: To report our management of bilateral adrenalectomy with autologous adrenal gland transplantation for persistent Cushing’s disease, and to discuss the feasibility of autologous adrenal transplantation for the treatment of refractory Cushing’s disease. Material and Methods: A retrospective analysis was performed in 4 patients (3 females, aged 14–36 years) who underwent autologous adrenal transplantation for persistent Cushing’s disease after endonasal transsphenoidal resection of a pituitary tumor. The procedure was performed by implanting a vascularized adrenal graft into the left iliac fossa with direct and indirect anastomoses. Postoperative follow-up was performed in 1, 1.5, 8, and 10 years, and an over 8-year long-term follow-up was reached in 2 out of the 4 cases. Hormone replacement dosage was guided by clinical symptoms and endocrine results including serum cortisol (F), 24 h urine-free cortisol, and adrenocorticotrophic hormone levels. Results: All 4 patients with symptomatic Cushing’s disease experienced resolution of symptoms after autotransplantation without Nelson Syndrome. Functional autografts were confirmed through clinical evaluation and endocrine results. One year after transplantation, adrenal function and hormone replacement dosage remained stable without adrenal hyperplasia. After long-term follow-up, dosages of hormone replacement were reduced in all patients. Conclusions: In this series of 4 patients, we demonstrate the long-term efficacy of bilateral adrenalectomy with autologous adrenal transplantation and propose this procedure as a viable treatment option for refractory Cushing’s disease.
Metachronous and Synchronous Cancers in Patients with Neuroendocrine Tumors
Authors: Verrico Monica , Rossi Luigi , Tomao Silverio , Colonna Maria , Vici Patrizia , Tomao Federica
Published: September 2019

Introduction: Neuroendocrine tumors (NETs) are a heterogeneous group of malignancies with various clinical presentations and growth rates. NET incidence has been estimated to 2.5–5 per 100,000 people per year, and NET prevalence is 35 per 100,000. They are frequently associated with synchronous or metachronous second primary malignancies (SPM). Methods: We retrospectively reviewed our institutional database on NET patients. We report on 30 patients with NETs and SPMs from a series of 262 patients with NETs: 10 patients with synchronous NETs (33.3%) and 20 with metachronous SPMs (66.6%). Results: The median patient age was 67 years. Of the 10 synchronous lesions, 50% were observed in the GI tract. The most common locations of these lesions were the colon (15%) and pancreas (25%). In 2 patients, there was an association of prostate neoplasia with a subsequent NET of the pancreas. Conclusions: Only few studies have examined the association between NETs and SPMs. Our study showed that the risk of second cancer following NETs is increased. In this single-institution retrospective review, our incidence of additional malignancies in patients with NET was 11.4%.
Strategies to Tackle the Global Burden of Diabetic Retinopathy: From Epidemiology to Artificial Intelligence
Authors: Wong Tien Yin , Sabanayagam Charumathi
Published: September 2019

Diabetes is a global public health disease projected to affect 642 million adults by 2040, with about 75% residing in low- and middle-income countries. Diabetic retinopathy (DR) affects 1 in 3 people with diabetes and remains the leading cause of blindness in working-aged adults. There are 3 broad strategic imperatives to prevent blindness caused by DR. Primary prevention requires preventing or delaying the onset of DR in those with diabetes by systems-level lifestyle modifications such as increasing physical activity or dietary modifications, pharmacological interventions for glycaemic and blood pressure control, and systematic screening for the onset of DR. Secondary prevention requires preventing the progression of DR in patients with DR by continuing systemic risk factor control, regular screening to monitor for the progression of mild DR to vision-threatening stages, and the development and implementation of evidence-based guidelines for managing DR. In this aspect, telemedicine-based DR screening incorporating artificial intelligence technology has the potential to facilitate more widespread and cost-effective screening, particularly in low- and middle-income countries. Tertiary prevention of DR blindness has been the main focus of the clinical ophthalmology community, classically based on laser photocoagulation treatment and ocular surgery but with an increasing use of anti-vascular endothelial growth factor (anti-VEGF) for vision-threatening DR. Evidence from serial epidemiological studies shows blindness due to DR has declined in high-income countries (e.g., the USA and UK) due to coordinated public health education efforts, increased awareness, early detection by DR screening, sustained systemic risk factor control, and the availability of effective tertiary level treatment. However, the progress made in reducing DR blindness in high-income countries may be overwhelmed by the increasing numbers of patients with diabetes and DR in low- and middle-income countries (e.g., China, India, Indonesia, etc.). Thus, to tackle DR at a global level, a paradigm shift in strategic focus from tertiary towards secondary and primary prevention measures with a multi-pronged whole-of-society approach at regional and national levels is urgently needed.
Predicted Indirectly ReCognizable HLA Epitopes (PIRCHE) Are Associated with Poorer Outcome after Single Mismatch Unrelated Donor Stem Cell Transplantation: A Study of the Cooperative Transplant Study Group (KTS) of the German Group for Bone Marrow and Stem Cell Transplantation (DAG-KBT)
Authors: Ayuk Francis , Bornhäuser Martin , Stelljes Matthias , Zabelina Tatjana , Wagner Eva-Maria , Schmid Christoph , Christopeit Maximilian , Guellstorf Martina , Kröger Nicolaus , Bethge Wolfgang
Published: September 2019

There is no established standard for selection of mismatched unrelated donors. Indirect recognition of HLA mismatches can be predicted using the model of “Predicted Indirectly ReCognizable HLA Epitopes” (PIRCHE). We performed a multicenter retrospective study evaluating the impact PIRCHE on outcome after allogeneic stem cell transplantation (allo-HSCT) from single mismatched (HLA 9/10 matched) unrelated donors. The study cohort included 424 adult recipients of HLA 9/10 matched unrelated donor transplants (9/10 MUD), treated for AML or MDS at 6 transplant centers across Germany. Detection of PIRCHE was associated with lower overall survival (OS) (47 vs. 57%, p = 0.04), higher non-relapse mortality (NRM) (32 vs. 20%, p = 0.05), and higher incidence of chronic graft-versus-host disease (GVHD) (49 vs. 31%, p = 0.04) at 2 years. Cumulative incidence of acute GVHD grade 2–4 at 6 months was not significantly different (30 vs. 23%, p = 0.2). OS for 9/10 MUD with no PIRCHE was similar to 10/10 MUD (57 vs. 55%). In multivariate analysis, PIRCHE retained negative impact on OS (RR 1.5, 95% CI 1.0–2.1, p = 0.03) and NRM (RR 1.7, 95% CI 1.0–2.9, p = 0.03). To the best of our knowledge, for the first time, we show the association of PIRCHE and survival outcome after allo-HSCT. The PIRCHE model, if validated in an independent cohort, may allow selection of permissible HLA mismatches that enable improved transplant outcome.
Cyclosporine A for the Prevention of Ocular Graft versus Host Disease in Allogeneic Hematopoietic Stem Cell Transplant Recipients Is Safe and Feasible
Authors: Cantú-Rodríguez Olga Graciela , Vázquez-Mellado Alberto , González-Treviño Juan Luis , Martínez-Garza David Mauricio , Gómez-De León Andrés , Hawing-Zarate José Angel , Jaime-Pérez José Carlos , Gutierrez-Aguirre César Homero , Garza-Acosta Andrea Cecilia , Mancías-Guerra Consuelo , González-Llano Oscar , González-Cantú Graciela Alejandra , Herrera-Rojas Miguel Angel , Sada-Ovalle Isabel , Gómez-Almaguer David
Published: September 2019

Purpose: To evaluate the safety and efficacy of ocular cyclosporine in the prevention of the development of ocular graft versus host disease (oGVHD) in patients undergoing allogeneic hematopoietic stem cell transplantation (AHSCT) in comparison with historic data. Design: We developed a longitudinal, observational, prospective nonrandomized study. We evaluated the feasibility of prophylactic use of topical cyclosporine A (CsA) to prevent or decrease the incidence of oGVHD and compared this with historic data. Methods: Patients undergoing AHSCT were treated with prophylactic topical CsA for 12 months after engraftment, followed by serial ophthalmic evaluations, including the Schirmer test. Results: Twenty patients were included. No serious adverse effects were reported. Poor adherence was documented in 15% of patients. In spite of observing extra-ocular GVHD (acute and chronic GVHD incidence of 50 and 45%, respectively), only 1 in 20 patients developed oGVHD over the 20-month follow-up for the entire cohort. No statistically significant difference was observed in the incidence of oGVHD when compared to a historical cohort. Conclusions: Topical CsA as a prophylactic measure for oGVHD, administered over a period of 1 year after grafting, is safe and feasible and may decrease the incidence of ophthalmic manifestations of GVHD. These findings must be confirmed in a randomized trial.
Gastrointestinal Manifestations in a Patient with Calciphylaxis: A Case Report
Authors: Kang Shaun Jia Wei , Madhan Krishan
Published: September 2019

Calciphylaxis is a rare condition usually seen in patients with significant renal disease, affecting 1–4% of patients undergoing haemodialysis. Although the disease usually manifests as lesions in the subcutaneous tissue, there have been rare occurrences of calciphylaxis presenting as lesions in the gastrointestinal tract, leading to complications of bowel necrosis and haemorrhage. In view of this, we report the case of suspected gastrointestinal tract calciphylaxis in a 63-year-old patient with end-stage kidney disease (ESKD) who presented with painful swelling in the medial and lateral aspect of both thighs. Physical examination revealed extensive tender subcutaneous tissue nodules suggestive of calciphylaxis. During her hospital admission, the patient developed an episode of gastrointestinal bleeding requiring multiple blood transfusions. A computed tomography scan of the abdomen showed widespread vascular calcification within the aorta and its somatic and visceral branches as well as a splenic infarct. Oesophagogastroduodenoscopy revealed a large gastric ulcer, while flexible sigmoidoscopy revealed necrosis of the rectal mucosa. She was started on vitamin D supplementation and intravenous sodium thiosulphate during each dialysis session. She clinically improved with no further gastrointestinal haemorrhage and partial resolution of her rectal necrosis and was transferred to a rehabilitation facility for further care and discharge planning.
Candidate Biomarkers for the Diagnosis of Transient Ischemic Attack: A Systematic Review
Authors: Dolmans L. Servaas , Rutten Frans H. , Koenen Niels C.T. , Bartelink Marie-Louise E.L. , Reitsma Johannes B. , Kappelle L. Jaap , Hoes Arno W.
Published: September 2019

Background and Purpose: A rapid serum biomarker that confirms or rules out a transient ischemic attack (TIA) would be of great value in clinical practice. We aimed to systematically review current evidence for the diagnostic accuracy of blood biomarkers in the early diagnosis of TIA. Methods: This is a systematic review with quality appraisal of individual studies using the QUADAS-2 tool. MEDLINE and EMBASE databases were searched up to May 1, 2017, to select primary diagnostic accuracy studies evaluating potential biomarkers in blood for the diagnosis of TIA or ischemic stroke. Results: Of 4,215 studies retrieved, 78 met our eligibility criteria. Forty-five studies restricted their population to ischemic stroke patients, 32 included both TIA and ischemic stroke patients, and only one study was restricted to TIA patients. In total 62/78 (79.5%) studies had a case-control design comparing TIA or stroke patients with healthy subjects. Overall, 125 single biomarkers and 5 biomarker panels were studied, with a median number of participants per study of 92.0 (interquartile range 44.8–144.5), varying from 8 to 915. Sufficient information to extract 2 × 2 tables was available for 35 (44.9%) articles, and for 60 (48.0 %) biomarkers. Several markers, such as NR2A/B (antibodies), Parkinson 7, nucleoside diphosphate kinase A, ubiquitin fusion degradation protein-1, and heart-type fatty acid binding protein, have shown moderate to high diagnostic accuracy in multiple studies. Conclusions: Although the methodological quality of studies evaluating biomarkers of brain ischemia was poor, several biomarkers have shown the potential to detect transient brain ischemia in an early phase. Diagnostic accuracy studies in suspected cases of TIA are needed to determine their true clinical value.
High Prevalence of Dystonia in the Faroe Islands: A Population-Based Study
Authors: Louis Elan D. , Eliasen Eina H. , Kim Christine Y. , Ferrer Monica , Gaini Shahin , Petersen Maria Skaalum
Published: September 2019

Background: There are fewer than 5 population-based studies of dystonia worldwide. Only one utilized a movement disorders neurologist. Given the potential for founder effects, and the highly genetic nature of dystonia, the Faroe Islands provide a particularly interesting setting to study the prevalence of dystonia. Objective: To estimate the prevalence of dystonia. Methods: We used a 2-phase, population-based design, screening 1,334 randomly selected Faroese individuals aged ≥40 years from which a subsample of 227 participated in an in-person clinical evaluation. Dystonia was assessed by 2 movement disorder neurologists using videotaped examinations. Results: Two of 227 (0.88%, 95% CI –0.33 to 2.09%) were diagnosed with cervical or segmental dystonia. An unusual form of thumb flexion dystonia was noted in 75 more, yielding a combined prevalence of 33.92% (95% CI 27.73–40.11%). Conclusions: The prevalence of cervical or segmental dystonia was as high as in one prior population-based study using similar methods. Furthermore, an unusual form of thumb flexion dystonia was uncovered, which yielded an extraordinarily high prevalence of dystonia in this population. Although our methods likely contributed to more complete capture of subtle dystonia, founder effects are highly likely to have been an additional major contributor to these findings.
Safety and Efficacy of Tinzaparin Anticoagulation during Nocturnal Hemodialysis
Authors: Bugeja Ann , Harris Sophie , McCormick Brendan , Brown Pierre-Antoine , Liberty Channing , Krepelka Theresa , St-Cyr Guylaine , Akbari Ayub
Published: September 2019

Background: The safety and efficacy of low-molecular-weight heparin in the prevention of extracorporeal dialysis circuit clotting among in-center extended duration nocturnal hemodialysis (INHD) patients are unknown. The aim of this study was to determine the safety and efficacy of 2 doses of tinzaparin, among INHD patients receiving 6–8 h hemodialysis, 3 times per week. Methods: We conducted a retrospective cohort study to examine antifactor Xa levels at time 0, 2 h, 4 h mid-hemodialysis (mid-HD), 6 h, and at end of each INHD session for 4 weeks and to determine extracorporeal dialysis circuit clotting and bleeding events after switching from unfractionated heparin to tinzaparin, using a standard protocol of tinzaparin delivery at the initiation and midpoint of HD. Results: All 16 patients in The Ottawa Hospital INHD program were converted to tinzaparin and followed for 177 INHD sessions. Mean antifactor Xa level at 2 h of HD was 0.41 ± 0.21 (SD) IU/mL, at 4 h (mid-HD) 0.19 ± 0.17 IU/mL, at 6 h 0.44 ± 0.21 IU/mL, and at dialysis end 0.26 ± 0.14 IU/mL. Antifactor Xa levels were undetectable at the start of INHD, suggesting no tinzaparin accumulation. Five patients required an increase in tinzaparin due to extracorporeal dialysis circuit clotting. There were no bleeding events. One patient required a switch to fondaparinux due to an adverse reaction. Conclusion: Tinzaparin was safe and efficacious for most INHD patients without accumulation or bleeding. The conversion from unfractionated heparin to tinzaparin required an increased tinzaparin dose for 31% of INHD patients.
Outcomes of Direct-Acting Antiviral Treatment of Psychiatric Patients with Comorbid Hepatitis C Virus Infection
Authors: Gayam Vijay , Jegede Oluwole , Tiongson Benjamin , Mandal Amrendra Kumar , Sidhu Jasdeep , Garlapati Pavani
Published: September 2019

Background: The highest burden of hepatitis C virus (HCV) infection is seen in patients with psychiatric disorders who have been excluded from traditional treatments with Interferon due to treatment-emergent neuropsychiatric adverse effects. The goal of this study is to determine the tolerability, treatment retention, and efficacy of direct-acting antivirals with psychiatric disorders and comorbid substance use disorders in real-life settings. Methods: This is a retrospective cohort observational study of HCV patients treated with direct-acting antivirals between January 2016 and December 2018. Patients were stratified and sub-stratified based on their psychiatric diagnosis and substance use. The primary assessment was the sustained virologic response at 12 weeks post-treatment (SVR12). Results: Among the 291 patients analyzed, patients with psychiatric diagnosis and non-psychiatric patients made up 51.2% (n = 149) and 48.8% (n = 142) respectively. Majority of the patients included in the study were African-Americans (68.7%, n = 200). Overall, 95.3% (142/149) and 94.4% (134/142) of psychiatric and non-psychiatric patients, respectively, achieved SVR12 and treatment response was similar between the groups (p = 0.72). Among psychiatric patients, only the prior treatment status was identified as a predictor of treatment response (OR 0.153, 95% CI 0.03–0.79; p = 0.05). No statistical difference was observed among the patients with SVR12 based on their primary psychiatric diagnoses or by comorbid substance abuse. Conclusion: The results of our study show that direct-acting antiviral treatments are well tolerated in psychiatric patients, and an overwhelming majority of patients achieved SVR12. Our study highlights the need to integrate HCV screening with treatment linkage in psychiatry and primary care practice.
Initial Observations on the Effect of Repeated Surfactant Dose on Lung Volume and Ventilation in Neonatal Respiratory Distress Syndrome
Authors: Kallio Merja , van der Zwaag Anne-Sea , Waldmann Andreas D. , Rahtu Marika , Miedema Martijn , Papadouri Thalia , van Kaam Anton H. , Rimensberger Peter C. , Bayford Richard , Frerichs Inéz
Published: September 2019

Background: Exogenous surfactant administration is an essential part of respiratory distress syndrome treatment in preterm infants. Current guidelines recommend the first dose to be given as early as possible, followed by an additional dose if symptoms persist. The effect of additional dosing on regional ventilation and lung volume has not been investigated so far. Objectives: The aim of this study was to assess changes in ventilation distribution, lung volume, and gas exchange following repeated surfactant dosing in invasively ventilated neonates. Method: Preterm infants requiring invasive ventilation and repeated surfactant treatment, and participating in the prospective observational multicenter trial “Continuous Regional Analysis Device for neonate Lung (CRADL)” were included in this analysis. Ventilation distribution, end-expiratory lung impedance (EELZ), and tidal impedance variation were determined by electrical impedance tomography together with clinical parameters before and after repeat endotracheal surfactant treatment. Results: Nine neonates (gestational age 32.7 ± 2.7 weeks, weight 1,724 ± 691 g) received an additional dose of surfactant at a median postnatal age of 33.5 h (IQR 9.1–46.6). One patient was excluded from the analysis due to simultaneous interventions confounding data analysis. Repeated surfactant dose did not significantly affect ventilation distribution. There were no significant changes in EELZ or tidal impedance variation. SpO2/FiO2 increased from 248 ± 104 to 367 ± 92 (p = 0.001), while FiO2 was reduced from 0.41 ± 0.20 to 0.27 ± 0.10 (p = 0.004). Expiratory tidal volume fell from 4.3 ± 0.6 to 3.0 ± 1.2 mL/kg (p = 0.03), while other ventilator and clinical parameters remained stable. Conclusions: Repeated surfactant dose during invasive ventilation improves oxygenation without measurable changes in EELZ or ventilation distribution.
Comparison of Different Selection Strategies for Tolvaptan Eligibility among Autosomal Dominant Polycystic Kidney Disease Patients
Authors: Wulfmeyer Vera C. , Auber Bernd , Haller Hermann , Schmitt Roland
Published: September 2019

Background: Tolvaptan can slow down renal function decline in autosomal dominant polycystic kidney disease (­ADPKD). While there is consensus across international recommendations that the drug should only be used in patients with high risk of rapid progression, identification criteria for rapid progression vary. Here, we investigated different assessment strategies using a real-life ADPKD cohort. Methods: Observational retrospective cohort analysis. The study included 131 ADPKD patients aged 19–78 years who were referred to the Hannover Medical School outpatient clinic for evaluation of tolvaptan treatment. Six different assessment strategies for tolvaptan eligibility were tested for each patient. Comparative analysis for different assessments was performed in the total study population, the subpopulation with available computed tomography/magnetic resonance imaging data, and the genotyped subpopulation. Results: Comparing 6 assessment strategies revealed strong variations in the individual selection processes resulting in treatment recommendations for 14.5–64.9% of patients. The highest patient number was selected by the Scottish and the lowest by the Japanese approach. Few patients had positive recommendations by all 6 systems, but strong congruency was observed between the Scottish, U.K. and Canadian patient selection. The lowest number of overlapping patients was found between the Japanese and the ERA-EDTA selection. Important discrepancies were also found between the ERA-EDTA and the U.S. system due to different emphases on parameters of kidney function versus kidney volume. Limitations of the study included the restricted sample size, heterogeneity in parameter availability and lack of outcome data. Conclusions: The study draws attention to important discrepancies between different decision algorithms for tolvaptan eligibility in ADPKD patients.
May High Levels of Systemic Immune-Inflammation Index and Hematologic Inflammation Markers Suggest a Further Stage in Testicular Tumours?
Authors: Imamoglu Goksen Inanc , Eren Tulay , Baylan Burhan , Karacın Cengız
Published: September 2019

Introduction: Due to variety of treatment alternatives for testicular tumours, parameters other than existing staging criteria are also needed. Most studies have revealed the correlation between cancer and inflammation. In this study, we aimed to investigate the value of preoperative inflammatory markers between early-stage testicular tumours and patients with advanced-stage, their relationship with tumour pathology and their importance in predicting stage. To calculate the differences between inflammatory markers, stage 1 tumours localized to the testis and advanced-stage tumours spread beyond the testis were classified into 2 groups according to tumour pathology. Materials and Methods: The data of 112 patients undergoing inguinal orchiectomy in between 2008 and 2018 were recorded retrospectively. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) and systemic immune-inflammation index (SII) were calculated by using the numbers of blood cell counts based systemic markers of inflammation. The differences between markers of inflammation were calculated by dividing tumours into 2 groups including early-stage and advanced- stage testicle tumours. Results: According to the results of preoperative inflammatory markers in predicting the stage; in the seminoma group, the difference between the median NLR (2.37 vs. 4.39, p = 0.012), LMR (3.80 vs. 2.40, p = 0.018) and SII (612 vs. 1,127, p = 0.009) of stage 1 and advanced stage were statistically significant, while in the non-seminoma group, only the difference between median PLR (99 vs. 154, p = 0.002) of stage 1 and advanced stage was statistically significant. Sensitivity and specificity of predicting advanced stage according to cut-off values of markers were 69 and 75% in NLR (3.21), 83 and 75% in LMR, and 59 and 75% in SII in the seminoma group; on the other hand, in the non-seminoma group, the sensitivity, and specificity of predicting the advanced stage of PLR cut-off (104) were 71 and 88% respectively. Conclusions: The clinical use of inflammatory biomarkers in testicular tumours may represent an important step in understanding germ cell tumours biology and in supporting staging criteria and prognostic criteria.
Incidence and Predictors of Deep Vein Thrombosis in Patients with Elevated Serum D-Dimer Prior to Surgery for Urologic Malignancy
Authors: Fujiwara Ryo , Numao Noboru , Ishikawa Yudai , Inoue Toru , Ogawa Masahiro , Masuda Hitoshi , Yuasa Takeshi , Yamamoto Shinya , Fukui Iwao , Yonese Junji
Published: September 2019

Objectives: To analyze the incidence and predictors of deep vein thrombosis (DVT) in patients with elevated D-dimer prior to surgery for urologic malignancy. Methods: Between January 2015 and September 2017, 987 consecutive patients underwent surgery for urologic malignancy under general anesthesia in our institution. Of these, 191 patients underwent preoperative venous ultrasonography of the lower extremities for DVT due to elevated D-dimer. We analyzed the incidence and predictors of DVT in these patients. Results: The median age was 69 years. DVT was detected in 18% of patients (35/191). Multivariate analysis showed that the primary site of urologic malignancy (p < 0.01) and older age (p < 0.01) were independent predictors of DVT. Patients with bladder cancer had the highest incidence of DVT. When bladder cancer and age of 70 or older were defined as predictors for DVT, the incidence of DVT in zero, 1, and 2 predictors was 3.4% (3/89), 29% (22/77), and 44% (11/25), respectively. Conclusions: DVT was found in 18% of patients with elevated D-dimer prior to surgery for urologic malignancy. Bladder cancer patients and older patients in whom D-dimer has been elevated should undergo careful early examination for DVT.
Continuous Renal Replacement Therapy Might Mask Immobilization-Induced Hypercalcemia in Critically Ill Patients
Authors: Madureira Ricardo Mondoni , Callas Silvia Helena , Caires Renato Antunes , Ferraz Crispilho Shirley , Ayroza Galvão Paulo César , Moysés Rosa Maria Affonso
Published: September 2019

Immobilization and prolonged bed rest are harmful to the skeleton, which suffers increased resorption, and contribute to reducing survival rates among patients in critical care units. We report a patient who presented hypercalcemia 10 days after continuous venovenous hemofiltration has ended. Investigative tests showed an increase of serum C-terminal telopeptide of type I collagen (CTx), with suppressed parathormone and calcitriol. Denosumab was administered with a significant response, decreasing ionized calcium and CTx levels. The calcium infusion rate during dialysis procedures, used for citrate anticoagulation compensation, has progressively decreased, suggesting that endogenous calcium was taking part in the citrate chelation. In this report, we highlight the challenges in early diagnosis of immobilization-induced hypercalcemia among patients who are on continuous renal replacement therapy undergoing citrate anticoagulation.
Ex vivo Comparison of 2 Disposable versus a State-of-the-Art Reusable Ureterorenoscope
Authors: Bourdoumis Andreas , El Howairis Mohammed El Fatih , Stephen Binu , Buchholz Noor
Published: September 2019

Introduction: The success of upper urinary tract endoscopy on one hand and the high cost of purchase and maintenance of the scopes on the other hand have driven the development of disposable digital flexible ureterorenoscopy (fURS). Materials and Methods: We performed an ex vivo comparison of 2 disposable digital fURS from different companies with a state-of-the-art reusable endoscope from another well-established scope manufacturer. The scopes were tested comparing parameters such as instrument handling, irrigation flow, image quality, and deflection. For the disposable scopes, the latter 2 were evaluated both, before and after vigorous stress testing. Results: Expectedly, the most consistent finding among the 3 instruments was the marked decrease on irrigation flow following insertion of a working element, most notably a guidewire. Depth perception and ergonomic handling were comparable in all 3 instruments. Poststress testing revealed a significant loss of upward deflection in both disposable instruments, more so when an auxiliary instrument is inserted into the working channel. However, this did not appear to be the case in downward deflection. Conclusions: To our knowledge, this is the first study that used a vigorous stress testing protocol comparing disposable and reusable fURS. The newer generation disposable scope fared better than the older one. Results are encouraging and indicate that improvements are ongoing and progressing, bringing the quality of disposable scopes to the level that we are used to from our reusable high performance scopes while at the same time avoiding costly damage repairs. Continuous research and evidence-based interpretation of results in the absence of commercial bias are paramount to ensure this ongoing development.
Spoilt for Choice: A Survey of Current Practices of Surgical Urinary Stone Treatment and Adherence to Evidence-Based Guidelines among Swiss Urologists
Authors: Betschart Patrick , Zumstein Valentin , Jichlinski Patrice , Herrmann Thomas R.W. , Knoll Thomas , Engeler Daniel Stephan , Müllhaupt Gautier , Schmid Hans-Peter , Abt Dominik
Published: September 2019

Introduction: Urologists have to master a variety of techniques to be able to offer the most appropriate surgical stone treatment for each individual patient. Therefore, we performed a survey among board-certified Swiss urologists to assess the availability of the different surgical methods, the current practices of surgical treatment of urolithiasis and the adherence to evidence-based guideline recommendations in Switzerland. Methods: A 14-question survey assessed the working environment, equipment, perioperative settings and decision trees for specific stone scenarios. Data was analyzed using descriptive statistics and chi-square tests to determine differences between frequencies of answers. Results: Hundred and five members of Swiss Urology (38%) completed the survey. All treatment modalities are available for the majority of respondents. Ureterorenoscopy was found to have the highest availability (100%) and was the preferred choice in the majority of stone scenarios. A high adherence to the guidelines was found for the treatment of ureteral stones <10 mm (100% proximal and distal), and >10 mm (69% proximal, 94% distal). All respondents answered in accordance with the guidelines regarding the treatment of middle and upper pole stones <10 mm, 10–20 mm and lower pole stones 10–20 mm. Guideline adherence was 99% for lower pole stones <10 mm, 78% for lower pole stones >20 mm, and 63% for middle/upper pole stones >20 mm. Conclusion: This survey provides a detailed insight into current stone treatment practices in Switzerland. The full spectrum of urinary stone treatment options is available for the majority of Swiss urologists. The choice of treatment shows a high accordance with evidence-based guidelines and a preference for retrograde endoscopic surgery in the majority of stone scenarios.
Diffusion-Weighted Imaging Patterns According to the Right-to-Left Shunt Amount in Cryptogenic Stroke
Authors: Nam Ki-Woong , Guk Hyung Seok , Kwon Hyung-Min , Lee Yong-Seok
Published: September 2019

Background: Although patent foramen ovale (PFO) is considered to be the main cause of cryptogenic stroke, it is difficult to define “true” PFO-related stroke. Objective: In this study, we evaluated comprehensive diffusion-weighted imaging (DWI) findings in patients with cryptogenic stroke according to the right-to-left shunt (RLS) amounts on transcranial Doppler (TCD) sonography. Methods: We assessed consecutive patients with cryptogenic stroke between October 2010 and 2018. The RLS amount on TCD was assessed according to the International Consensus Criteria (ICC). Massive RLS was defined as the highest category of ICC (Curtain pattern). We assessed DWI findings, including the location of lesions, involved vascular territory, and DWI lesion patterns. Results: A total of 100 consecutive patients with cryptogenic stroke were assessed, and PFO was found in 59 patients. In multivariable analyses, massive RLS was noted to be positively associated with the presence of cortical lesion (adjusted OR [aOR] 15.75, 95% CI 1.94–127.71, p = 0.010), multiple territory involvement (aOR 5.24, 95% CI 1.57–17.53, p = 0.007), and number of DWI lesions (beta 0.713, 95% CI 0.245 to 1.181, p = 0.003) after adjusting for confounders. Conversely, massive RLS showed inverse correlations with posterior circulation involvement (aOR 0.22, 95% CI 0.06–0.87, p= 0.031) and number of large DWI lesions (beta –0.328, 95% CI –0.629 to –0.026, p = 0.034). Conclusions: We demonstrated that massive RLS on TCD was associated with multiple, small-scattered cortical lesion in patients with cryptogenic stroke. These DWI pattern is highly suggestive of PFO-related stroke.
O avesso do mito: escravidão e relações de dependência em O Guarani
Authors: Pereira Leonardo Affonso de Miranda
Published: September 2019

O romance O Guarani, publicado em 1857 por José de Alencar, constitui um poderoso mito inaugural da nacionalidade. No momento em que escrevia, no entanto, Alencar acompanhava os dilemas e debates sobre uma questão aparentemente ausente da trama: a escravidão, que constituía então o nexo fundamental da sociedade brasileira. Entender o modo pelo qual a reflexão sobre o tema se apresenta no romance é o objetivo deste artigo.
O Orfeu de carapinha rendido à musa de Guiné: a burlesca poética de Luiz Gama e o ideário de branqueamento racial no império do Brasil
Authors: Benevides José Lucas Góes , Silva Sandro Adriano , Coqueiro Wilma Dos Santos
Published: September 2019

O artigo tem como objeto de análise a obra Primeiras Trovas Burlescas de Getulino (1859), uma das pioneiras da literatura antiescravista nas letras brasileiras, de autoria de Luiz Gama, poeta negro, egresso da escravidão e líder abolicionista. Busca-se discutir a maneira como as poesias em questão constroem a imagem da etnia negra e dialogam com o discurso de inferioridade racial e a tese de branqueamento da população, vigentes no Brasil Império.
Formas narrativas em Samuel Rawet
Authors: Ginzburg Jaime
Published: September 2019

Neste artigo são estudados três contos de Samuel Rawet publicados em seu livro Os sete sonhos. Através das reflexões, podemos observar o emprego de recursos oníricos, suspendendo os limites entre imaginação e realidade. Nessas narrativas, a elipse é muito importante, assim como estratégias estéticas de choque. Para fundamentar o artigo, consideramos trabalhos de Berta Waldman e Rosana Kohl Bines sobre o autor.
Ar luz razão certa: João Cabral vendo Franz Weissmann
Authors: Nuernberger Renan
Published: September 2019

Este artigo propõe uma breve análise de “Exposição Franz Weissmann”, texto publicado por João Cabral de Melo Neto na década de 1960 e recuperado em Museu de tudo (1975), a fim de compreender a reflexão do poeta sobre a produção do artista plástico. Tendo em vista a similaridade entre os projetos estéticos de Weissmann e João Cabral, o artigo também pretende repensar o lugar específico do poema na própria obra do autor como um momento de problematização interna de seu ideário construtivista.
A new Microhyla species (Anura: Microhylidae) from riparian evergreen forest in the eastern Himalayan state of Arunachal Pradesh, India
Authors: BIJU S. D. , GARG SONALI , KAMEI RACHUNLIU G. , MAHESWARAN GOPINATHAN
Published: September 2019

A new frog species of the genus Microhyla (Anura, Microhylidae) is described from riparian mid-elevation (860 m asl) evergreen forest in Namdapha National Park, located in the eastern Himalayan state of Arunachal Pradesh, India. The new species can be morphologically distinguished from other congeners by a suite of characters such as adult size, dorsal and lateral colouration and markings, snout shape, foot webbing, and digit tip morphology. Phylogenetically, the new species is more closely related to some of the smallest known members of the genus. It forms a deeply divergent sister lineage to the clade containing members of the Microhyla zeylanica species group that are restricted to Peninsular India and Sri Lanka, and shows sequential relationship with Southeast Asian species M. superciliaris, followed by clade containing M. aurantiventris + M. butleri. The discovery indicates that novel taxa representing distinct evolutionary lineages still remain to be formally described in the genus Microhyla, especially from less explored regions such as the eastern Himalayan forests in Northeast India.