bluuebunny/crossref_metadata_2025 huggingface dataset:
Seasonal Variation in Demand for Smoking Cessation Treatment and Clinical Outcomes
Authors: Veldhuizen Scott , Zawertailo Laurie , Ivanova Anna , Hussain Sarwar , Selby Peter
Published: October 2020

Introduction

Smoking behaviour shows seasonal variation, with cigarette consumption and youth smoking onset highest in summer and smoking-related web searches and sales of nicotine replacement products highest in winter. Variation in demand for clinical care and in outcomes has not been explored.

Aims and Methods

We measure seasonal variation in enrolments, total clinical visits, visits per enrolment, and treatment outcome (7-day abstinence at 6-month follow-up) from 2015 to 2018 in a large (n = 85 869) clinical cohort from 454 clinics across Ontario, Canada. We model seasonality using harmonic logistic and negative binomial regression. For individual-level outcomes, we adjust for variables, selected a priori, known to be associated with treatment use or outcomes. Data are nearly complete for 3 outcomes, but 6m abstinence is missing for 45% of participants. We use multiple imputation to adjust for missing data.

Results

All four outcomes showed significant seasonal variation (all p <.001). Total enrolments and visits were 20%–25% higher in January–April than in June–September. Visits per enrolment varied slightly, with lowest levels from May–July. Abstinence at 6 months was lowest among individuals enrolled from February–May and highest for those enrolled from July–November, with an absolute peak-trough difference of 4.3% (95% CI = 3.2% to 5.5%).

Conclusions

There is meaningful seasonal variation in demand for, and outcomes of, smoking cessation treatment. Climate and weather may be indirectly responsible. Seasonal differences underscore the general importance of contextual factors in smoking cessation, may be useful in program promotion, and may explain some variability in outcomes in evaluation and research.

Implications

Demand for tobacco cessation treatment and clinical outcomes vary seasonally. This underscores the importance of context in substance-related problems, and implies that some variability in research and evaluation results may be due to the time of year data were collected. Promotion efforts might usefully consider seasonal effects to smooth out demand and possibly improve outcomes.
Styles of Representation in Constituencies in the Homeland and Abroad: The Case of Italy
Authors: Østergaard-Nielsen Eva , Camatarri Stefano
Published: October 2020

The role orientation of political representatives and candidates is a longstanding concern in studies of democratic representation. The growing trend in countries to allow citizens abroad to candidate in homeland elections from afar provides an interesting opportunity for understanding how international mobility and context influences ideas of representation among these emigrant candidates. In public debates, emigrant candidates are often portrayed as delegates of the emigrant constituencies. However, drawing on the paradigmatic case of Italy and an original data set comprising emigrant candidates, we show that the perceptions of styles of representation abroad are more complex. Systemic differences between electoral districts at home and abroad are relevant for explaining why and how candidates develop a trustee or delegate orientation.
Brachial Plexus Neuropathies During the COVID-19 Pandemic: A Retrospective Case Series of 15 Patients in Critical Care
Authors: Miller Caroline , O'Sullivan Joel , Jeffrey Jack , Power Dominic
Published: October 2020

Objective

The use of the prone position to treat patients with COVID-19 pneumonia who are critically ill and mechanically ventilated is well documented. This case series reports the location, severity, and prevalence of focal peripheral nerve injuries involving the upper limb identified in an acute COVID-19 rehabilitation setting. The purpose of this study was to report observations and to explore the challenges in assessing these patients.

Methods

Participants were patients with suspected peripheral nerve injuries following discharge from COVID-19 critical care who were referred to the peripheral nerve injury multidisciplinary team. Data were collected retrospectively on what peripheral neuropathies were observed, with reference to relevant investigation findings and proning history.

Results

During the first wave of the COVID-19 pandemic in the United Kingdom, 256 patients were admitted to COVID-19 critical care of Queen Elizabeth Hospital, Birmingham, United Kingdom. From March to June 2020, a total of 114 patients required prone ventilation. In this subgroup, a total of 15 patients were identified with clinical findings of peripheral nerve injuries within the upper limb. In total, 30 anatomical nerve injuries were recorded. The most commonly affected nerve was the ulnar nerve (12/30) followed by the cords of the brachial plexus (10/30). Neuropathic pain and muscle wasting were identified, signifying a high-grade nerve injury.

Conclusion

Peripheral nerve injuries can be associated with prone positioning on intensive care units, although other mechanisms, such as those of a neuroinflammatory nature, cannot be excluded.

Impact

Proning-related upper limb peripheral nerve injuries are not discussed widely in the literature and could be an area of further consideration when critical care units review their proning protocols. Physical therapists treating these patients play a key part in the management of this group of patients by optimizing the positioning of patients during proning, making early identification of peripheral nerve injuries, providing rehabilitation interventions, and referring to specialist services if necessary.

Lay Summary

During the COVID-19 pandemic, patients who are very ill can be placed for long periods of time on their stomach to improve their chances of survival. The potential consequences of prolonged time in this position are weakness and pain in the arms due to potential nerve damage. There are some recommended treatments to take care of these problems.
Fracture risk in systemic lupus erythematosus patients over 28 years
Authors: Garelick Daniela , Pinto Sara Moreira , Farinha Filipa , Pires Tatiana , Khan Emon , Isenberg David
Published: October 2020

Objectives

Chronic glucocorticoid use is complicated by osteoporosis and increases the risk of fragility fractures. EULAR guidelines on SLE management recommend reducing chronic glucocorticoid dosage to ≤7.5 mg/day to minimize this risk. We examined the relationship of glucocorticoid dose to fragility fracture risk in a cohort of SLE patients.

Methods

Retrospective analysis of SLE patients attending University College Hospital over 28 years was undertaken. Collected data included consecutive steroid dose, dual-energy X-ray absorptiometry scans and fragility fractures.

Results

We collected data on 250 patients with a median of 17 years’ follow-up. Fragility fractures were diagnosed in 28 (11.2%) patients and the mean ± s.d. age of first fracture was 51 ± 16 years. A total of 94% received glucocorticoids, the average dose being 6.20 mg/day. Patients with fragility fractures had a lower average daily dose (5.36 vs 6.23 mg/day) but a higher median cumulative dose (25.19 vs 20.96 g). These differences were not significant (P = 0.127 and 0.229, respectively). Some 93% of patients received vitamin D, and 85% received calcium. Cox regression analysis showed older age at SLE diagnosis, osteoporosis and secondary hyperparathyroidism were associated with fragility fractures. Glucocorticoid dose was not significantly associated with the occurrence of fragility fractures. Twenty-two patients with fractures were treated with bisphosphonates, two with denosumab and two with teriparatide.

Conclusions

We found no significant association between glucocorticoid treatment and fragility fractures in our group of patients; however, a prospective study including more patients not treated with CS would be necessary to confirm these results.
Influence and evaluation of saturated soil shield construction on existing highway
Authors: Xu Liuqi , Wu Chongfu , Wang Liwei , Xu Shuangjun
Published: October 2020

In order to study the shield construction under an existing highway, the initial displacement and the excess pore water pressure solution from Biot consolidation equation were used to derive the analytical solutions of the vertical deformation and pore water pressure of saturated soil caused by the frontal friction and side friction of the cutterhead. In addition, by introducing the layered method and combining it with other theoretical analytical equations, the expressions of total vertical deformation and total pore water pressure caused by tunnel excavation with different overlying materials were obtained. The simulation results on an engineering project showed that the angle α between the direction of the road and the propulsion axis of the shield had a significant influence on the surface settlement of the road. When the angle α was increased, the settlement curve had higher variation; but the variation would not exceed the maximum settlement value above the shield axis. When the road was perpendicular to the shield axis, a critical point of the road bulging and settlement was formed above the incision. Due to the grinding resistance of the cutterhead, the pore water pressure under the roadbed was distributed asymmetrically on both sides of the shield axis.
Interrelationships of Polydolopidae (Mammalia: Marsupialia) from South America and Antarctica
Authors: Chornogubsky Laura
Published: October 2020

Polydolopidae is a family of Palaeogene marsupials recorded from outcrops in southern South America and the Antarctic Peninsula. They are mostly represented by skull fragments or maxillary, dentary and molar remains. A taxonomic and systematic revision is carried out with the inclusion of a phylogenetic analysis encompassing almost every polydolopid species and five marsupial species found to be related to them in previous analyses (Bonapartherium hinakusijum, Epidolops ameghinoi, Microbiotherium tehuelchum, Prepidolops didelphoides and Roberthoffstetteria nationalgeographica). The Polydolopidae was recovered as a monophyletic group, even though no resolution about its sister-group can be found. The following genera are recovered: Antarctodolops, Amphidolops, Archaeodolops, Eudolops, Hypodolops gen. nov., Kramadolops, Pliodolops, Pseudolops and two unidentified genera (Gen. et sp. indet 1 and 2). One genus and three new species are recognized. The family appeared at the beginning of the Palaeocene and disappeared during the Early Oligocene. The extinction of the group could be related to climatic deterioration in the Early Oligocene, when temperature and the humidity dropped, provoking desertification in the region where Polydolopids evolved.
Role and In Vivo Localization of Fusarium oxysporum f. sp. strigae and Bacillus subtilis in an Integrated Striga hermonthica Biocontrol System
Authors: Anteyi Williams Oyifioda , Rasche Frank
Published: October 2020

To improve the efficiency of Striga hermonthica biological control in the context of an integrated biocontrol system, the role/impact of coinoculating the mycoherbicide Fusarium oxysporum f. sp. strigae (Fos) with a plant growth promoting rhizobacterium, Bacillus subtilis isolate GB03, on S. hermonthica attachment and sorghum biomass was investigated. Fos isolates (Foxy-2, FK3) and GB03, including Trichoderma viride (IMB12098 strain) as reference, were applied as single and combined treatments to S. hermonthica-infested rhizoboxes with sorghum as the host crop. In vivo localization/interaction of Fos and GB03 in S. hermonthica was monitored by fluorescent gene expression of transformed Fos and transformed GB03. Combined treatments of FK3 + GB03 and Foxy-2 + GB03 increased sorghum aboveground dry biomass (P < 0.05), but not IMB12098 + GB03. None of the combined treatments suppressed S. hermonthica attachment. Single treatments of FK3 and GB03 increased sorghum aboveground dry biomass (P < 0.05), but Foxy-2 and IMB12098 did not. Only FK3, of all single treatments, suppressed S. hermonthica attachment (P < 0.05). GB03 promoted sorghum yield when applied alone or combined with Fos (P < 0.05). Fos penetration of S. hermonthica through trichome entry was revealed. Although Fos, either as sporal (conidia) or vegetative form (mycelium), co-occupied common ecological niches with GB03 (they colocalize) in diseased S. hermonthica shoots, mainly in flavonoid-rich regions. Nevertheless, GB03 thwarted Fos suppressive activity against S. hermonthica attachment. In the given setup, coinoculation of Fos with GB03 presented no added advantage in suppressing the incidence of the sampled S. hermonthica.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Twenty-two Years of Pediatric Musculoskeletal Firearm Injuries: Adverse Outcomes for the Very Young
Authors: Boschert Emily N. , Stubblefield Connor E. , Reid Kimberly J. , Schwend Richard M.
Published: October 2020

Background:

Firearm injuries are a significant cause of morbidity and mortality for children in the United States. The purpose of this study is to investigate the 22-year experience of pediatric firearm-related musculoskeletal injuries at a major pediatric level 1 hospital and to analyze the risk of adverse outcomes in children under 10 years of age.

Methods:

An institutional review board-approved, retrospective cohort analysis was conducted on pediatric firearm-related musculoskeletal injuries at our institution from 1995 to 2017. A total of 189 children aged 0 to 18 years were identified using International Classification of Diseases, 9th Revision/10th Revision codes, focusing on musculoskeletal injuries by firearms. Exclusion criteria were primary treatment at an outside hospital, isolated nonmusculoskeletal injuries (eg, traumatic brain injury), and death before orthopaedic intervention. Two cohorts were included: age below 10 years and age 10 years and above. Primary outcome measure was a serious adverse outcome (death, growth disturbance, amputation, or impairment). Standard statistical analysis was used for demographic data, along with linear mixed models and multivariable logistic regression for adverse outcome.

Results:

Of the 189 children, 46 (24.3%) were below 10 years of age and 143 (75.7%) were 10 years and above. Fifty-two (27.5%) of the total group had an adverse outcome, with 19 (41.3%) aged below 10 years and 33 (23.1%) aged 10 years and above (P=0.016). Adverse outcomes were 3 deaths, 17 growth disturbances, 7 amputations, and 44 impairments. For those below 10 years of age, rural location (P=0.024), need for surgical treatment (P=0.041), femur injury (P=0.032), peripheral nerve injury (P=0.006), and number of surgeries (P=0.022) were associated with an adverse outcome.

Conclusions:

Over one fourth of survivors of musculoskeletal firearm injuries had an adverse outcome. Children 10 years and above represent the majority of firearm injuries in our population; however, when injured, those below 10 years are more likely to have an adverse outcome.

Level of Evidence:

Level III.
Saucerization and Repair of Discoid Lateral Menisci With Peripheral Rim Instability: Intermediate-term Outcomes in Children and Adolescents
Authors: Perkins Crystal A. , Busch Michael T. , Christino Melissa A. , Willimon S. Clifton
Published: October 2020

Background:

Historically, total meniscectomy was recommended as the treatment for a symptomatic discoid meniscus. Improved meniscal repair techniques and inferior long-term outcomes associated with meniscectomy have resulted in a trend toward meniscal preservation, with saucerization and repair of meniscocapsular tears. Reoperation rates after treatment of torn discoid menisci vary, with some series reporting high rates of reinjury and reoperation. The purpose of this study is to describe the intermediate-term outcomes of pediatric patients treated with saucerization and meniscocapsular repair of discoid lateral menisci with peripheral rim instability.

Methods:

A single-institution retrospective review was performed of consecutive patients less than 18 years of age treated with saucerization and repair for a meniscocapsular tear of a discoid lateral meniscus from 2013 to 2017. All patients had a minimum 24-month follow-up. A chart review was performed to describe tear location and repair type. The primary outcomes were revision meniscus surgery and Pedi-International Knee Documentation Committee and Tegner activity scores obtained at the final follow-up.

Results:

In total, 32 knees in 30 patients, including 15 males and 15 females with a mean age of 12 years (range, 5 to 17 y), were included. Tear patterns included anterior meniscocapsular (14 knees), posterior meniscocapsular (16 knees), and both anterior and posterior meniscocapsular (2 knees). Arthroscopic saucerization and meniscocapsular repair were performed in all knees. Repair types were outside-in (10 knees), inside-out (8 knees), all-inside (8 knees), and hybrid (6 knees). The mean follow-up was 54 months (range, 30 to 86 mo). Three knees (9%) underwent revision meniscus surgery, including 2 all-inside repairs and 1 partial meniscectomy. At the final follow-up, mean International Knee Documentation Committee score was 96 (range, 82 to 100). A total of 89% of patients reported returning to the same or higher level of activity following surgery.

Conclusions:

Saucerization of discoid lateral menisci with repair of meniscocapsular tears is associated with low rates of revision surgery and good intermediate-term outcomes.

Level of Evidence:

Level IV.
Measured and Estimated Glomerular Filtration Rate in the ICU: A Prospective Study
Authors: Sangla Fréderic , Marti Pierre Emmanuel , Verissimo Thomas , Pugin Jérôme , de Seigneux Sophie , Legouis David
Published: October 2020

Objectives:

To compare estimated glomerular filtration rate using classical static and kinetic equations with measured glomerular filtration rate assessed by plasma iohexol clearance in a mixed population of critical care patients.

Patients:

Unselected patients older than 18 and admitted to a general ICU.

Design:

Interventional prospective single center study.

Intervention:

Measurement of glomerular filtration rate by the plasma clearance of an IV single dose of iohexol and estimation of glomerular filtration rate with creatinine or cystatin C–based standard and kinetic equations as well as urinary creatinine clearance.

Measurements and Main Results:

Sixty-three patients were included with a median age of 66 years old. The median measured glomerular filtration rate was 51 mL/min/1.73 m2 (interquartile range, 19–85 mL/min/1.73 m2). All used equations displayed significant biases, high errors, and poor accuracy when compared with measured glomerular filtration rate, overestimating renal function. The highest accuracy and lowest error were observed with cystatin C–based chronic kidney disease epidemiology collaboration equations. Both modification of diet in renal disease and Cockcroft-Gault equations displayed the lowest performance. Kinetic models did not improve performances, except in patients with unstable creatinine levels. Creatinine- but not cystatin C–based estimations largely derived over ICU stay, which appeared more related to sarcopenia than fluid balance. Finally, estimated glomerular filtration rate misclassified patients according to classical glomerular filtration rate categories in approximately half of the studied cases.

Conclusions:

All known estimated glomerular filtration rate equations displayed high biases and unacceptable errors when compared with measured glomerular filtration rate in a mixed ICU population, with the lowest performance related to creatinine-based equations compared with cystatin C. In the ICU, we advocate for caution when using creatinine based estimated glomerular filtration rate equations. Drifting of serum creatinine levels over time should also be taken into consideration when assessing renal function in the ICU.
Brain Radiation Induced Extracranial Abscopal Effects in Metastatic Melanoma
Authors: D’Andrea Mark A. , Reddy G. Kesava
Published: October 2020

Historically, the brain has been viewed as a specialized neurovascular inert organ with a distinctive immune privilege. Therefore, radiation-induced extracranial abscopal effects would be considered an unusual phenomenon due to the difficulty of the immunogenic signaling molecules to travel across the blood-brain barrier (BBB). However, it is now possible that localized central nervous system radiation has the ability to disrupt the structural integrity of the BBB and increase its endothelial permeability allowing the free passage of immunogenic responses between the intracranial and extracranial compartments. Thus, the nascent tumor–associated antigens produced by localized brain radiation can travel across the BBB into the rest of the body to modulate the immune system and induce extracranial abscopal effects. In clinical practice, localized brain radiation therapy–induced extracranial abscopal effects are a rarely seen phenomenon in metastatic melanoma and other advanced cancers. In this article, we provide a detailed overview of the current state of knowledge and clinical experience of central nervous system radiation–induced extracranial abscopal effects in patients with malignant melanoma. Emerging data from a small number of case reports and cohort studies of various malignancies has significantly altered our earlier understanding of this process by revealing that the brain is neither isolated nor passive in its interactions with the body’s immune system. In addition, these studies provide clinical evidence that the brain is capable of interacting actively with the extracranial peripheral immune system. Thus, localized radiation treatment to 1 or more locations of brain metastases can induce extracranial abscopal responses. Collectively, these findings clearly demonstrate that localized brain radiation therapy–induced abscopal effects traverses the BBB and trigger tumor regression in the nonirradiated extracranial locations.
Evaluation of Organ Doses for Pediatric Computed Tomography Using a Newly Designed Radiophotoluminescence Glass Dosimeter and Comparison with a Monte Carlo Simulation-based Dose Calculator
Authors: Chang Weishan , Koba Yusuke
Published: October 2020

Management of patient dose is an effective way to help optimize computed tomography (CT) scanning conditions and CT dose. Organ dose is one of the preferred quantities for radiation protection because of its correlation with radiation risk. To date, the WAZA-ARI dose calculator is the only freely available CT dose calculator also applicable for pediatric patients. However, no reports of its evaluation have appeared since the latest version of WAZA-ARI was released. In this study, to evaluate the latest version of WAZA-ARI, we measured the organ dose in a 5-y-old anthropomorphic phantom by a newly developed radiophotoluminescence glass dosimeter (RGD) dosimetry system and compared these results with the calculation results from WAZA-ARI. The newly designed RGDs have less angular dependence because of the additional filter. RGDs were individually calibrated with the ISOVOLT TITAN-320 x-ray generator. All the experimental measurements for this study were performed using a CT scanner. To consider the difference of CT output between the nominal and actual machine, the measured CTDIair was used to correct the calculation results obtained from WAZA-ARI. After the corrections using the measured CTDIair, the calculation results from WAZA-ARI were relatively lower than the measured results with a range of 8–20%, which corresponds to the dose difference caused by the difference in effective diameter. In conclusion, the calculation accuracy of WAZA-ARI is guaranteed when the normalization factor specific to each CT scanner (CTDIair) and the shape of the phantom are taken into consideration.
Exploring the Relationship of Race and Ethnicity to Other Characteristics Within Residency Applicants: An Analysis of RF-PTCAS Data From 2013 to 2018
Authors: Rapport Mary Jane , Chesbro Steven , Bannister Ryan , Watson Ellerbe Robyn , VanHoose Lisa
Published: October 2020

Introduction.

A centralized application process for applicants to physical therapy residency and fellowship education programs has been available through an online portal known as Residency Fellowship-Physical Therapy Centralized Application Service (RF-PTCAS) since 2013. None of these data have been described or analyzed to date beyond an initial internal report of applicant and application numbers. The purpose of this study was to analyze and describe applicants to physical therapist (PT) residency programs from 2013 to 2018, with a specific focus on race and ethnicity.

Demographic and admissions research related to PT residency education is limited, and we are unaware of any existing data on residency applicants based on racial and ethnic identity. At present, we can look to existing data from past and current Doctor of Physical Therapy (DPT) students to inform expected racial or ethnic composition of current and future residents. Both the Commission on Accreditation in Physical Therapy Education and PTCAS provide population demographics of PT students.

Methods.

A data set from RF-PTCAS was obtained for analysis of applicant data for the application cycles from 2013–2014 to 2017–2018. Applicants to residency programs through RF-PTCAS between 2013 and 2018 were included in this analysis (n = 4,373).

Results.

This growing applicant pool has remained relatively similar in applicant demographics from year to year over this 5-year period of analysis. The data show that applicants to residency are best characterized as: 26–30 years of age, female, White, graduated with their DPT degree within the same or the previous year of applying to residency, and living in a state in the Southern, Mid-West or Pacific-Coastal regions.

Discussion.

Overall, the race/ethnicity of White to non-White applicants has remained constant with little change in the growth of non-White applicants. Thus, despite the “call to action” among leaders in our profession, and an increase in other related health professions, we have had little change across 5 years of admissions data.

Conclusion.

Thus, despite the “call to action” among leaders in our profession, and an increase in other related health professions, we have had little change across 5 years of admissions data to residency programs.
Cochlear Implants and Magnetic Resonance Imaging: Experience With Over 100 Studies Performed With Magnets in Place
Authors: Fussell Wanda L. , Patel Neil S. , Carlson Matthew L. , Neff Brian A. , Watson Robert E. , Lane John I. , Driscoll Colin L. W.
Published: October 2020

Objective:

To evaluate adverse events and feasibility of performing 1.5-T MRI in patients with cochlear implants (CI) and auditory brainstem implants (ABI).

Setting:

Single tertiary academic referral center.

Patients:

CI and ABI recipients undergoing 1.5-T MRI without internal magnet removal.

Intervention(s):

MRI after tight headwrap application.

Main Outcome Measures:

Adverse events, patient tolerance.

Results:

A total of 131 MR studies in 79 patients were performed, with a total of 157 study ears. Sixty-one patients (77%) had unilateral devices. Four patients (5%) underwent MRI with ABI magnets in place. Sixteen patients (20%) had MRI-compatible devices that did not require a head wrap. There were no instances of device stimulation, device malfunction, or excessive heating of the receiver-stimulator package. Magnet tilt requiring manual repositioning occurred during seven studies (4.5%) and magnet displacement requiring operative intervention occurred during seven studies (4.5%). Significant pain where imaging had to be discontinued occurred during three episodes (2%). No adverse events were noted among patients who underwent MRI with an MRI-compatible magnet.

Conclusions:

MRI with CI or ABI magnets in place is associated with a low prevalence of adverse events when performed in a controlled setting. Many partial magnet displacements can be corrected with firm manual pressure. Devices with magnets that align with the field within their housing were not associated with any adverse events and do not require immobilization of the magnet during the scan. These may be valuable in patients with known or anticipated need for MRI.
Assessment of Temporal Bone Thickness for Implantation of a New Active Bone-Conduction Transducer
Authors: Rahne Torsten , Svensson Sara , Lagerkvist Helén , Holmberg Marcus , Plontke Stefan K. , Wenzel Claudia
Published: October 2020

Objective:

To investigate the minimum bone thickness in adults and children in the area of the skull affected by implantation of a new bone conduction device in patients without known medical history that indicates anatomical malformations.

Study Design:

Retrospective, non-interventional study on computer tomography (CT) scans on file at a university medical center.

Study Methods:

A digital model of the new bone conduction implant was virtually implanted in 3D reconstructions of temporal bones based on 197 CT scans, 132 from adults and 65 from children (evenly distributed in five different age groups). The bone thickness was measured in a total of 11 designated positions; five measurement points for the transducer (recess area), and six for the fixation screws, corresponding to three different positions for the fixation band holding the implant in place (screw area).

Results:

The minimum bone thickness in the combined recess and screw area for adults was 5.55 ± 1.46 mm, with a 95% CI of 5.30 to 5.80 mm. For children, the thickness was 4.34 ± 2.29 mm (95% CI: 3.77–4.91 mm), increasing from 1.92 mm (0–4 yr) to 6.41 mm (12–14 yr). For all ages, the bone in the recess area was generally thicker compared with the screw area.

With an implantation depth of 3 mm the transducer fitted in all of the adult temporal bones (100%) and 99.2% (131/132) of the adults had a bone thickness of at least 2.7 mm in all six measured screw positions. In all children from the age of 5 the transducer fitted at an implantation depth of 3 mm, and in all children from the age of 9, the fixation screws fitted at a depth of 2.7 mm. In all CT scans except for a 6-month-old child the new bone conduction device could be implanted in at least one of the fixation band positions analyzed.

Conclusions:

In adults and many children without known medical history that indicates anatomical malformations, the average minimum bone thickness was thicker than both the maximum transducer depth of 3 mm and the 2.7 mm bone involvement of the osseointegrating fixation screws. The results indicate implant fit of the new bone conduction implant in all adult patients. The risks of compromising the sigmoid sinus and the dura as considered with larger implants are thus significantly reduced. Preoperative planning with CT would still be recommended for children below 9 years old.
18F-fluorodeoxyglucose uptake on PET/computed tomography in association with androgen receptor expression and other clinicopathologic factors in surgically resected triple-negative breast cancer
Authors: Lee Hyo-jae , Lim Hyo Soon , Ki So Yeon , Park Hye Mi , Lee Jong Eun , Jeong Won Gi , Shin Sang Soo , Kwon Seong Young , Park Min Ho , Lee Ji Shin
Published: October 2020

Objective

To evaluate whether androgen receptor expression in triple-negative breast cancer (TNBC) is associated with 18F-fluorodeoxyglucose (FDG) uptake and to identify predictive factors of 18F-FDG uptake in TNBC.

Methods

We retrospectively assessed data of 156 surgically resected primary TNBC in 156 consecutive patients who underwent 18F-FDG PET/computed tomography between July 2013 and May 2017. Clinicopathologic features, including androgen receptor expression, were categorized and the distribution of maximum standardized uptake value (SUVmax) was compared between the groups. We also evaluated the correlations between the predictive factors and SUVmax.

Results

Median SUVmax was higher in the androgen receptor-negative group than in the androgen receptor-positive group (8.8 vs. 7.1, P = 0.026) with negative correlation between androgen receptor and SUVmax (P = 0.041, correlation coefficient (r) = –0.163). On multivariate regression analysis, tumor size (>20 mm), histological grade, Ki-67 (≥14%), and the presence of ductal carcinoma in situ (DCIS) were significantly associated with SUVmax (P < 0.001, P = 0.012, P = 0.017 and P = 0.021, respectively). Tumor size, histological grade and Ki-67 were positively correlated with SUVmax (P < 0.001, r = 0.450; P = 0.004, r = 0.228; P = 0.001, r = 0.269, respectively), while the presence of DCIS showed negative correlation with SUVmax (P < 0.001, r = –0.292).

Conclusion

Androgen receptor-positive TNBC showed lower 18F-FDG uptake than androgen receptor-negative triple-TNBC. Tumor size, histological grade, Ki-67 and the presence of DCIS significantly influenced 18F-FDG uptake in TNBC.
New gender-specific formulae for estimating extracellular fluid volume from height and weight in adults
Authors: Bird Nicholas J. , Peters A. Michael
Published: October 2020

Aims

First, to derive gender-specific formulae for estimation of extracellular fluid volume (eECV) and second, compare eECV as a scaling metric for slope-intercept glomerular filtration rate (GFR) with estimated body surface area (eBSA), lean body mass (eLBM) and total body water (eTBW).

Methods

GFR and ‘slope-only’ GFR (GFR/ECV), both single compartment-corrected, were measured in a previously published multicentre database of healthy potential kidney transplant donors. Measured ECV (mECV) was obtained as ratio GFR-to-GFR/ECV. Formulae for eECV in men and women were derived from the relationship of mECV with height and weight and expressed as eECV = a.weight
x
.height
y
. In a population of prospective kidney transplant donors from a single centre, eECV was compared with mECV. GFR was scaled to eECV, eBSA, eLBM and eTBW, estimated from previously published formulae.

Results

In men and women, respectively, a was 0.0755 and 0.0399, x was 0.6185 and 0.6065 and y was 0.4982 and 0.6217. In the single centre, biases (±precisions) of eECV against mECV in men and women were 0.26 (±1.68) and 0.31 (±1.67) l. Mean GFR/eBSA was higher in men but mean GFR/eLBM and GFR/eTBW were higher in women. Mean GFR/ECV and mean GFR/eECV were very similar between the two genders. GFR/ECV and GFR/eECV showed correlations with each other that were almost identical between men and women.

Conclusions

New formulae are described for estimating eECV. Scaling GFR to eECV is more physiological than scaling to eBSA and accounts for gender. eECV used for measuring GFR from a single blood sample should be gender-specific.
Examination of metallic impurities of 68Ge/68Ga generators used for radioactive labeling of peptides in clinical PET applications
Authors: Uğur Ayşe , Yaylali Olga , Yüksel Doğangün
Published: October 2020

Background/aim

Especially suitable for PET due to its nuclear physical and radiochemical properties, the positron emitter Gallium-68 (68Ga) occurs by electron capture from Germanium-68 (68Ge). In such a radionuclide generator, the germanium is bound to an insoluble, inert column matrix and forms a secular radioactive balance with 68Ga obtained in the hour. As a result of the limited radiochemical selectivity of the elution process, the eluate obtained is basically contaminated with the main nuclide traces, so that the eluate becomes a mixture of 68Ga and 68Ge radionuclides. Also, the generator eluate contains a number to metal cations that reduce specific radioactivity and can compete with 68Ga. The presence of toxic metal that can be found in the eluate carries the risks of contamination at every step from the production of generators to radiopharmaceutical production.

Materials and method

In our study, by collecting the eluate of the 68Ge/68Ga generators used with different identities in different centers in Turkey, we report comparative analysis of metal contamination in the generator eluate. The eluates of 68Ge/68Ga generators to five different identities were collected. Eluates were analyzed by inductively coupled plasma–mass spectrometry.

Results and Conclusion

As a result, each generator contains metallic impurities different from its certificate.
Feasibility of prognosis assessment for cancer of unknown primary origin using texture analysis of 18F-fluorodeoxyglucose PET/computed tomography images of largest metastatic lymph node
Authors: Ishiwata Yoshinobu , Kaneta Tomohiro , Nawata Shintaro , Iizuka Hitoshi , Utsunomiya Daisuke
Published: October 2020

Objective

Cancers of unknown primary origin cannot be staged using images, making the prognosis difficult. We attempted to predict prognosis of patients with unknown primary origin using tumour heterogeneity recently introduced in 18F-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT).

Methods

Overall, 30 patients with unknown primary origin who underwent whole-body 18F-FDG PET/CT scans were retrospectively enrolled for texture analysis. The volume of interest was placed in the largest metastatic lymph nodes and conventional parameters and grey-level co-occurrence matrix (GLCM) were calculated. Statistical analysis of image-based variables was performed using Cox regression analyses. Patients were stratified into two groups based on cutoff values of GLCMentropy obtained using receiver operating characteristics (ROCs). Patients were analyzed, and overall survival (OS) was compared using Kaplan–Meier analysis.

Results

Univariate Cox regression analysis showed significant differences in prognosis for parenchymal organ metastasis (P < 0.01), GLCM homogeneity (P = 0.01), GLCMcontrast (P < 0.01), GLCMentropy (P < 0.01) and GLCMdissimilarity (P < 0.01). Multivariate Cox regression analysis showed a significant difference in reduced prognosis for GLCMentropy positive (P < 0.01). Stratification was performed based on the GLCMentropy cutoff value, determined using ROCs analysis, with smaller groups showing better OS.

Conclusions

Despite previous difficulties in predicting prognosis in patients with unknown primary origin, 18F-FDG PET/CT texture features may enable stratification of prognosis. This could be useful for appropriate patient selection and management and help identify a subset of patients with favourable outcomes. These novel findings may be helpful for prognostication and improving patient care.
Serum Amylase and Lipase for the Prediction of Pancreatic Injury in Critically Ill Children Admitted to the PICU
Authors: Liu Pingping , Xiao Zhenghui , Yan Haipeng , Lu Xiulan , Zhang Xinping , Luo Lan , Long Caixia , Zhu Yimin
Published: October 2020

Objectives:

Pancreatic injury is multifactorial and potentially devastating for critically ill children. We aimed to evaluate whether serum amylase and lipase among critically ill children could serve as an independent biomarker to predict pancreatic injury.

Design:

Retrospective cohort.

Setting:

PICU of a tertiary, pediatric medical center.

Patients:

Seventy-nine autopsies.

Interventions:

None.

Measurements and Main Results:

A group of 79 children who died of different causes were investigated by autopsy. They were divided into pancreatic injury group and pancreatic noninjury group according to autopsy findings. Data based on patients’ demographics, vital signs, laboratory findings, and clinical features at admission were collected and compared. Logistic regression was used to identify predictive factors for pancreatic injury. Receiver operating characteristic curve was constructed for assessing serum amylase and serum lipase to predicting pancreatic injury. Forty-one patients (51.9%) exhibited the pathologic changes of pancreatic injury. The levels of lactate, erythrocyte sedimentation rate, alanine transaminase, aspartate transaminase, and troponin-I in the injury group were significantly higher than that in the noninjury group, whereas the level of calcium was significantly lower than that in the noninjury group (p < 0.05). Multivariable logistic regression analysis showed that serum amylase, serum lipase, and septic shock were significantly associated with the occurrence rate of pancreatic injury. The statistically significant area under the curve results were as follows: serum amylase: area under the curve = 0.731, at a cutoff value of 97.5, sensitivity = 53.7, and specificity = 81.6; and serum lipase: area under the curve = 0.727, at a cutoff value of 61.1, sensitivity = 36.6, and specificity = 92.1.

Conclusions:

Serum amylase and lipase could serve as independent biomarkers to predict pancreatic injury in critically ill children.
Cardiac Function and Ventricular Interactions in Persistent Pulmonary Hypertension of the Newborn
Authors: Jain Amish , EL-Khuffash Afif F. , van Herpen Claar H. , Resende Maura H. F. , Giesinger Regan E. , Weisz Dany , Mertens Luc , Jankov Robert P. , McNamara Patrick J.
Published: October 2020

Objectives:

The aim of this study was to use a comprehensive imaging protocol to identify echocardiographic correlations of right and left ventricular size, function, and hemodynamics in neonates with persistent pulmonary hypertension of newborn and describe their relationship with key clinical variables.

Design:

Retrospective case-control echocardiography-based study of persistent pulmonary hypertension of newborn.

Setting:

A tertiary neonatal ICU in Canada.

Patients:

Forty-nine neonates (gestational age ≥ 35 wk old) diagnosed with persistent pulmonary hypertension of newborn within first 3 days after birth and 50 age-matched controls.

Interventions:

None.

Measurements and Main Results:

The echocardiographic measurements comprised of right ventricular and left ventricular functional markers, including tricuspid annular plane systolic excursion, fractional area change, tissue Doppler imaging, and deformation imaging. Sample size was based on detecting an intergroup difference of 10% in tricuspid annular plane systolic excursion, which was considered the primary outcome. Linear correlations between the right and left ventricular indices, as well as their association with the outcome of death or extracorporeal membrane oxygenation were evaluated. Persistent pulmonary hypertension of newborn was associated with lower tricuspid annular plane systolic excursion (6.81 ± 1.92 vs 9.25 ± 1.30 mm), right-ventricular global longitudinal strain (16.9% ± 5.4% vs –21.6% ± 4.6%); left ventricular ejection fraction (49% ± 7% vs 55% ± 6%), left ventricular global longitudinal strain (–16.7% ± 3.3% vs –21.4% ± 2.0%) (all p < 0.01). Right and left ventricular diastolic and global function was also lower in persistent pulmonary hypertension of newborn, with more pronounced changes seen for the right ventricle. Moderate-to-strong linear correlations were observed between the right and left ventricular functional markers, with right ventricular global longitudinal strain and left ventricular global longitudinal strain being the strongest (r = 0.8). Within persistent pulmonary hypertension of newborn group, hypoxic ischemic encephalopathy was associated with lower right and left ventricular systolic and right ventricular diastolic performance. Tricuspid annular plane systolic excursion (p =0.08) and left ventricular systolic velocity (p = 0.09) tended to be lower in patients who subsequently died/needed extracorporeal membrane oxygenation.

Conclusions:

Persistent pulmonary hypertension of newborn is characterized by global cardiac dysfunction, involving both the right and left ventricles, with significant interventricular functional correlation. Cardiac dysfunction early in disease course may identify patients at highest risk of adverse outcome.
Therapeutic Alliance Between Bereaved Parents and Physicians in the PICU
Authors: Suttle Markita , Hall Mark W. , Pollack Murray M. , Berg Robert A. , McQuillen Patrick S. , Mourani Peter M. , Sapru Anil , Carcillo Joseph A. , Startup Emily , Holubkov Richard , Dean J. Michael , Notterman Daniel A. , Meert Kathleen L.
Published: October 2020

Objectives:

Therapeutic alliance is the collaborative bond that develops between patients/families and healthcare providers. Our objective is to determine the extent of therapeutic alliance bereaved parents perceive to have occurred with their child’s physicians during their child’s PICU stay, and associated factors.

Design:

Multicenter observational study.

Setting:

Eight children’s hospitals affiliated with the Collaborative Pediatric Critical Care Research Network.

Patients:

Parents greater than or equal to 18 years old whose child died in a PICU (including cardiac ICU).

Interventions:

Bereaved parents completed the Human Connection Scale, a 16-item measure of therapeutic alliance, 6 months after their child’s death. Human Connection Scale scores range from 16 to 64 with higher scores indicating greater alliance. Parents provided sociodemographic data, and medical records were reviewed for the child’s clinical characteristics.

Measurements and Main Results:

Two-hundred and thirty-three parents of 157 deceased children responded to the Human Connection Scale with greater than or equal to 80% item completion. Among parents, 146 (62.7%) were female, 155 (66.5%) were White and 46 (19.7%) were Black, 175 (75.1%) were married, and 209 (89.7%) had at least a high-school education. Among children, median age at the time of death was 5.9 years (interquartile range, 0.64–13.9 yr) and 114 (72.6%) died after limitation or withdrawal of life support. Mean Human Connection Scale score was 51.4 ± 11.1 for all parents, 52.6 ± 9.0 for White parents, and 47.0 ± 13.7 for Black parents. In multivariable modeling predicting Human Connection Scale scores, race was the only parent or child characteristic in the final model. Human Connection Scale scores were significantly different (–4.56; 95% CI, –8.53 to –0.6; p = 0.025) between the Black and White parents with items about trust, care, and honest communication showing the greatest mean difference.

Conclusions:

Among parents bereaved in the PICU, therapeutic alliance with physicians is moderately high. Future research should identify strategies to strengthen therapeutic alliance with Black parents and examine the role of alliance on bereaved parents’ health outcomes.