bluuebunny/crossref_metadata_2025 huggingface dataset:
P14.93 The utility of the brain 18-FDG-PET and perfusion magnetic resonance imaging in the radionecrosis differential diagnosis
Authors: Mongay N , Vidal N , Lucas A , Macià M , Plans G , Fernandez-Coello A , Majos C , Rodriguez-Bel L , Alemany M , Bruna J
Published: September 2019

BACKGROUND

Radiation-induced necrosis (RDN) is a side effect observed in patients who underwent stereotactic radiosurgery (SRS) alone or combined with whole brain radiotherapy (WBRT) as treatment for their brain tumors. Nowadays, RDN diagnosis and differentiation from tumor progression using the standard imaging techniques represents a challenge, and histological diagnosis still is the gold standard.Our aim is to assess the positive and negative predictive values (PPV, NPV) of FDG-PET and perfusion magnetic resonance imaging (MRI) in RDN diagnosis.

MATERIAL AND METHODS

From our Pathology department database, all patients with RDN or mixed (tumor plus RDN) brain lesions diagnosis during last 5 years were reviewed. Demographic, clinical and oncologic treatment characteristics were recorded. MRI and FDG-PET images at the suspicion (clinical or radiological) of progression or RDN were registered and compared with the definite diagnosis provided by the tissue sample analysis. Sensitivity, specificity, as such as PPV and NPV for perfusion MRI sequences and FDG-PET image analysis were calculated.

RESULTS

162 patients underwent SRS+/- WBRT in a 5 year period. During follow-up, 11 patients had surgery-confirmed RDN. There are 11 patients (3 women) with 12 lesions, 3 from a breast cancer, 6 from a lung tumor, 1 from a melanoma, 1 atypical meningioma and 1 glioblastoma. 9 of them were treated with both SRS and WBRT, and the 3 others with WBRT alone. The mean age was 65.36 (range: 44–77) years. The median time between the completion of radiation therapy and the suspicion of RDN was 19.7 (range: 3–34) months. With the evolution, it was observed an evident increase in the size of surronding oedema (2–6 times) by FLAIR RMI. We estimate a PPV 0.40 and NPV 0.80 for perfusion MRI, and PPV 0.25 and NPV 0.75 for FDG-PET, respectively.

CONCLUSION

The diagnostic performance of both techniques in our series is low and similar to published data; therefore its results must be carefully interpreted in each case. It is peremptory to implement new diagnostic tools in the standard of care with better diagnostic outcomes.
P14.98 Improving the targeting of Gamma-Knife radiosurgery for recurrent high-grade gliomas (WHO grades III and IV) with 11C-Methionine PET/CT
Authors: Chaskis E , Van Simaeys G , Martens C , De Witte O , Goldman S , Lefranc F
Published: September 2019

BACKGROUND

The survival of the patients with high-grade gliomas may be improved through a multidisciplinary approach including stereotactic re-irradiation such as Gamma-Knife at recurrence in a selected population. We report our experience in targeting the hypermetabolic areas of high-grade gliomas using 11C-Methionine PET/CT in selected patients.

MATERIAL AND METHODS

We retrospectively evaluated the local response in patients treated by Gamma-Knife for recurrent high-grade gliomas in our Institution between 2000 and 2018, targeting the hypermetabolic area with Methionine PET/CT.

RESULTS

We included 25 patients bearing high-grade gliomas (14 female, 11 male) with a median age of 45 years (5–64). There were 11 WHO grade III gliomas (6 astrocytomas, 5 oligodendrogliomas) and 14 glioblastomas. A total number of 33 Gamma-Knife procedures were performed. In all patients, the targeting was based on the hypermetabolic area as defined by Methionine PET/CT. Four patients were treated concomitantly on 2 or more targets. One patient was treated twice on different targets. We observed a positive response in 29 Gamma-Knife procedures, after a median interval of 2 months (1–33) and no response after 4 procedures (4 glioblastomas). In most cases, progression after Gamma-Knife was observed 4 months after irradiation.

CONCLUSION

Targeting the hypermetabolic areas with Methionine PET/CT was associated with favorable response in most patients treated by Gamma-Knife radiosurgery for local high-grade gliomas recurrence. Our results must be confirmed by a prospective study with regular and homogeneous morphological and metabolic monitoring.
P14.103 Patterns of diffuse glioma progression
Authors: Kobyakov G L , Belyashova A , Trunin Y , Absalyamova O , Lodygina K , Kobiakov N
Published: September 2019

BACKGROUND

According to WHO 2016 Classification, all gliomas are considered potentially malignant. Earlier it was thought that the ultimate goal for treatment is local control of tumor growth: maximal surgical resection with subsequent local radiotherapy +/- chemotherapy. Disease progression was primarily linked only to local relapse. In the recent years, different progression patterns of diffuse glioma were identified: from distant growth into an anatomically unrelated area far from primary lesion, to bone metastases and even to visceral organ metastases.

MATERIAL AND METHODS

In this study we analyzed glioblastoma progression patterns in a cohort of 170 patients, who received radiation therapy as one of the treatment options for local relapse in Burdenko Neurosuregry Institute. All patients had a first relapse of glioblastoma at the age of 16 to 74 years old, 72 patients were female and 98 male. All patients initially underwent surgery and local radiotherapy (in combination with temozolomide) for a solitary supratentorial lesion of glioblastoma. Various methods of radiotherapy (including radiosurgery and hypofractionated radiation therapy) were used as one of the treatment options for recurrent tumor. One of our aims was to evaluate glioblastoma progression patterns in this cohort.

RESULTS

Comparing neuroimaging data at the time of tumor progression with initial MRI we found that in 127 of 170 patients disease progression was identified anatomically close to the primary tumor site, i.e. disease progressed as a local relapse. Recurrent lesions without obvious anatomical relation to primary site were identified in 33 patients (19.4%); in particular, 7 patients had a lesion in contralateral hemisphere, one patient had spinal subarachnoid dissemination. A combination of local and distant tumor progression was identified in 10 of these 33 patients.

CONCLUSION

We identified the following progression patterns for diffuse glioma based to these data and previous clinical experience: (a) local brain relapse - anatomically close to the primary lesion; (b) brain and spinal subarachnoid spread; (c) distant relapse - anatomically unrelated to primary tumor (can be both in ipsilateral or contralateral brain hemisphere); (d) local tumor progression as infiltration of soft tissues of the head and cranial bones; (e) regional lymph node metastases; (f) distant metastases - skeletal bone metastases and/or visceral organ metastases. Naturally, different combinations of these diffuse malignant glioma progression patterns are possible. A quite high incidence and differences between diffuse glioma progression patterns require a more thorough evaluation both because of treatment strategies as well as to understand the origins of glial tumors (e.g. Why in some cases of complete remission at the primary tumor site there is tumor progression in contralateral hemisphere?)
P14.104 The outcomes of conservatively observed asymptomatic nonfunctioning pituitary adenomas with optic nerve compression
Authors: Hwang K , Kim Y , Kim C , Han J
Published: September 2019

BACKGROUND

We investigated the natural history of asymptomatic nonfunctioning pituitary adenomas (NFPAs) abutting on optic nerve.

MATERIAL AND METHODS

Eighty-three patients with asymptomatic NFPAs with documented optic nerve compression on magnetic resonance imaging (MRI) at the time of detection between 2000 and 2016 were included in this study. Patients were evaluated with a hormone test, visual acuity test, visual field test and MRI at the time of diagnosis, and then, yearly, without any treatment (including surgery and radiation).

RESULTS

The mean age was 57.7±13.6 (range, 15 - 81) years. The mean follow-up duration was 66.6±39.0 (range, 12 - 184) months. Tumor volume growth ≥ 20% was observed in 64 (77.1%) patients. Ten (12.2%) patients experienced any kind of hormonal dysfunction, and gonadotropin deficiency was the most common type of hormonal deficiency [n=9 (10.8%)]. Visual deterioration quantified by Visual Impairment Scale was seen 27 (32.5%) patients. There was no statistically significant factor for tumor growth or visual aggravation. Fourteen (16.9%) patients eventually underwent tumor resection. From multivariate analysis, the significant predictors for eventual surgical intervention were cavernous sinus invasion (OR=20.95; 95% CI, 2.754–159.3; p=0.003) and last follow-up visual field defect score (OR=1.170; 95% CI, 1.049–1.305; p=0.005). All patients who underwent surgery did not experience any neurologic or endocrinological deficits postoperatively.

CONCLUSION

The clinical outcomes of conservatively observed NFPAs with optic nerve compression can be acceptable. The decision for surgical intervention should be made by balancing the risk and benefits.
P14.106 One-year survival of radiotherapy vs conservative therapy in patients with metastatic brain disease in Cipto Mangunkusumo General Hospital 2014–2016
Authors: Aninditha T , Pratama P Y , Imran D , Aman R A , Werdhani R A , Sofyan H R , Odilo J , Ranakusuma T A S
Published: September 2019

BACKGROUND

There are several palliative treatment choices in patients with brain metastasis. Radiotherapy is one of palliative treatment modality in brain metastasis. The role of radiotherapy in metastatic brain disease has already been established. Patients with metastatic brain disease also treated conservatively. Sole conservative treatment were also done in regarding qualification of patient. This study aimed to compare radiotherapy and conservative treatment in one-year survival on brain metastasis patients.

MATERIAL AND METHODS

This study was a retrospective cohort study. The data acquired from Dept. of Neurology Cipto Mangunkusumo General Hospital between 2014–2016. Subjects with metastatic brain disease underwent radiotherapy and conservative treatment were included in this study. Sex, age, marital status, survival time, were retrieved from the subjects. The follow-up period were 1 year. Univariate analysis were done using t-test and chi-square test. Multivariate analysis were done using Log-rank test and Cox regression.

RESULTS

There were 41 subjects included in the study. Of 41 subjects, 21 (51.2%) underwent radiotherapy. The mean age of subjects underwent radiotherapy were 53.3 (SD ±12.6) vs 43.1 (SD ±14.7) in subjects with conservative management (P = 0.022). Women accounted for 27 out of 41 (65.9%) subjects. Married subjects accounted for 32 out of 41 (78%) subjects. There were no significance difference of treatment choices between married and unmarried subjects (P = 0.130). At the end of follow-up period, only 4 (19%) subjects from conservative treatment and 2 (10%) subjects from radiotherapy treatment survived (P = 0.854). Median survival of radiotherapy treatment were 5 month and 4 month in conservative treatment. Palliative treatment didn’t raise risk of death compared to conservative treatment [Hazard Ratio (HR) 0.94, 95% Confidence Interval (CI): 0.48–1.85, P = 0.867).

CONCLUSION

Radiotherapy treatment didn’t increase one-year survival in patients with metastatic brain disease. Other confounding factors that influenced survival should be included in further study to understand factors that interact with palliative treatment in brain metastases.
P14.108 Bevacizumab versus alkylating chemotherapy in recurrent glioblastoma
Authors: Seystahl K , Hentschel B , Loew S , Gramatzki D , Felsberg J , Herrlinger U , Westphal M , Schackert G , Thon N , Schlegel U , Tatagiba M , Pietsch T , Reifenberger G , Löffler M , Wick W , Weller M
Published: September 2019

BACKGROUND

The use of alkylating chemotherapy versus bevacizumab for recurrent glioblastoma remains controversial. Here we tested the hypothesis that the activity of alkylators, but not that of bevacizumab, would be associated with the O6-methylguanine DNA methyltransferase (MGMT) promoter methylation status

PATIENTS AND METHODS

We analyzed a cohort of patients treated at centers of the German Glioma Network or the University Hospital Zurich with alkylating agent-based chemotherapy (n=260) or bevacizumab without or with irinotecan (n=84) for first recurrence of glioblastoma. Outcome was stratified for MGMT status and cross-over to bevacizumab or alkylators at further tumor progression.

RESULTS

Median post-recurrence survival-1 (PRS-1) for patients receiving alkylating agent chemotherapy at first recurrence was longer than for patients receiving bevacizumab (11.1 versus 7.4 months, p<0.001). The use of alkylating agents was associated with longer PRS-1 for patients with a methylated versus an unmethylated MGMT promoter (p=0.017). For patients receiving bevacizumab, PRS-1 was not different with or without MGMT promoter methylation. PRS-1 was longer in the group receiving alkylating chemotherapy compared to bevacizumab for patients with a methylated (p<0.001) or unmethylated MGMT promoter (p=0.034). For patients with alkylators at first recurrence receiving bevacizumab at any further recurrence, PRS-1 was longer than in patients receiving bevacizumab first and alkylators thereafter (p=0.002).

CONCLUSION

This study confirms limited value of bevacizumab in recurrent glioblastoma independent of MGMT status. Alkylating agents have activity in recurrent glioblastoma, especially in the context of a methylated MGMT promoter.
P14.113 The role of maintenance high-dose methotrexate chemotherapy in elderly primary CNS lymphoma patients with complete response to induction immunochemotherapy
Authors: Mishima K , Shirahata M , Adachi J , Suzuki T , Fujimaki T , Nishikawa R
Published: September 2019

BACKGROUND

The addition of high-dose methotrexate (HD-MTX)-based chemotherapy to whole brain irradiation (WBRT) has improved the prognosis of primary central nervous system lymphoma (PCNSL). However, the high neurotoxicity rates observed, especially in the elderly, raised interest in chemotherapy-only treatments. Withholding radiotherapy substantially decreases the risk of neurotoxicity, however, disease control may be compromised. Therefore, developing a novel treatment for the elderly PCNSL patients (ePCNSL) is crucial. In the elderly who cannot tolerate WBRT as a consolidation, maintenance treatment may serve as a feasible approach after an initial response. We treated ePCNSL with induction immunochemotherapy with rituximab (RIT) and HD-MTX, maintenance chemotherapy with HD-MTX and deferred WBRT. Here, we retrospectively investigated the prognosis for ePCNSL that became CR after the induction chemotherapy.

MATERIAL AND METHODS

Newly diagnosed ePCNSL (median age: 74 years) received biweekly RIT/ HD-MTX (375 mg/m2/dose; 3.5g/m2/dose) for 6 cycles (induction) followed by monthly RIT/MTX for 2 cycles (consolidation) and then were treated differently according to the radiological response. With CR patients, HD-MTX was continued with every 3 months (maintenance) for 2 years. Patients who did not obtain consent for maintenance therapy were followed up.

RESULTS

Of the 42 ePCNSL (median age 74 years), 26 had CR after induction and consolidation, of which 18 cases were carried out maintenance (M +) and 8 cases were followed up (M-). The median age was 74 and 76, respectively. Median progression-free survival (mPFS) was 73 months in the M+ group and 24.6 months in the M- group. Median overall survival (mOS) is 92.5 months versus 27.6 months, respectively. Both mPFS (P= 0.025) and mOS (P =0.0003) were significantly prolonged by maintenance therapy. In addition, ePCNSL with tumors involvement of deep brain structure had a poor prognosis.

CONCLUSION

It was suggested that maintenance treatment with HD-MTX may improve the prognosis for ePCNSL that reached complete response after induction therapy.
P14.115 A Neurologist’s Foray into Gamma Knife: Lessons Learned from the first 100 cases:
Authors: Stevens G H J , Chao S T , Murphy E S , Suh J H , Yu J , Neyman G
Published: September 2019

BACKGROUND

Gamma Knife Radiosurgery typically involves a neurosurgeon, radiation oncologist and physicist. Neurologists performing Gamma Knife provides a potential paradigm shift.

METHODS

The first 100 Gamma Knife procedures were completed on an Elekta Perfexion or ICON system between October 2015 and August 2018. Head frames were placed by the treating neurologist who also completed the contouring and targeting. The Radiation Oncologist defined the prescription dose and verified the plan, along with the physicist.

RESULTS

Of the first 100 cases completed by the treating neurologist, 52 were females and 48 males. The average age was 61.4 years. There were 64 metastatic cases, 25 meningiomas, 8 gliomas, 2 hemangioblastoma and 1 pituitary adenoma. There were 245 individual lesions targeted. No frame related placement complications occurred. Five large metastasis were treated as a staged procedure 1 month apart. A bolus was used on 4 occasions for lesions invading the skull. Secondary to large bifrontal craniotomies, cheek posts were used on 2 occasions, and 3 posts were used in 5 cases secondary to large unilateral frontal craniotomies. Four cases were completed under general anesthesia. In one patient with a very large head, the frame would not fit and was deconstructed, placed around the neck, reconstructed with pins placed in the cheeks. 64 of the treated patients are still alive.

CONCLUSION

While unconventional, neurologists can function as a surgical surrogate to treat intracranial neoplasms with Gamma Knife. This offers unique advantages, especially in regards to continuity of care as many of these patients had been followed and will continue to follow with neurology. With the advent of the ICON frameless based system, concerns about frame placement also become less of an issue and more facile for neurologists to perform these procedures.
P14.119 Clinical-radiological description of a retrospective series of patients diagnosed with stroke due to hypercoagulability associated with cancer
Authors: Esparragosa I , Valenti-Azcarate R , Moreno-Ajona D , Toledano-Illan C , Irimia Sieira P , Martinez-Vila E , Gallego Perez de Larraya J
Published: September 2019

OBJECTIVES

To describe the clinical-radiological characteristics of a monocentric series of patients with stroke due to a state of hypercoagulability associated with cancer.

MATERIAL AND METHODS

We retrospectively reviewed the clinical, radiological and laboratory data of 32 patients diagnosed of ischemic stroke secondary to a state of hypercoagulability associated with cancer between 2007 and 2017.

RESULTS

15/32 were women. The median age was 65 years (range: 48–82). In 4/32 patients, stroke led to the diagnosis of advanced stage cancer, and in 15/32 it occurred in the context of uncontrolled cancer progression. 24/32 patients had at least an additional vascular risk factor. Complementary tests were performed (blood analysis, carotid echo-Doppler, ECG-monitoring, echocardiogram) to rule out other aetiologies. 25/32 patients had acute ischemic lesions in 3 to 5 cerebrovascular territories. 23/32 had multiorgan infarctions in body CT. The D-Dimer was analysed in 14/32 patients, being elevated in 13/14 patients. Half of patients (16/32) suffered a recurrence of stroke in the first 4 weeks. Most frequently detected tumours were lung adenocarcinoma (11/32) and pancreatic adenocarcinoma (8/32). The median survival after the stroke was 1 month (range: 0.2–25 months).

CONCLUSIONS

Uncontrolled cancer may lead to a prothrombotic state that facilitates the development of strokes in multiple cerebrovascular territories. Recurrences are frequent despite anticoagulant therapy, and prognosis is poor because of the underlying cancer and stroke-related neurological deterioration.
P14.125 Retrospective analysis of long-term response to bevacizumab in combination with irinotecan for recurrent glioblastoma: identification of prognostic factors
Authors: Besson C , Morisse M , Brut H , Waissi W , Noel G , Chauffert B , Prébay D , Schott R , Etienne-Selloum N
Published: September 2019

BACKGROUND

In absence of standard treatment for recurrent glioblastoma (rGBM), numerous prospective and retrospective studies have evaluated the off-label combination of bevacizumab (BEV) with irinotecan (IRI) in patients with rGBM. We report here our single center experience with this combination and we investigated prognostic factors for long-term response.

MATERIAL AND METHODS

We performed a retrospective analysis of consecutive patients treated initially by Stupp protocol and with BEV-IRI for a rGBM between 2007 and 2017. Times to progression and overall survival, as well as toxicities, were investigated and analysed. Patients without progression at least 12 month after the first administration of BEV-IRI were considered as long-term responders. The primary end-point was overall survival post-BEV-IRI (OS-BEV-IRI).

RESULTS

One-hundred eleven patients were eligible for the analysis. Median age at the diagnosis was 57 years and the value of WHO Performance Status (PS) at the recurrence was 0 to 1 for 67,5% of patients. Kaplan-Meier median progression-free survival (PFS-BEV-IRI) and overall survival (OS-BEV-IRI) at recurrence estimates (calculated from start of BEV-IRI) were 6.51 and 10.41 months, respectively. The median OS (calculated from diagnosis) was 22,4 months. Twenty-Three patients (20,7%) were long-term responders to BEV-IRI regimen. This subgroup was not significantly different than the short-term responders according to age or PS distribution, but the relative proportion of biopsy in comparison to other surgery modalities was significantly increased in long-term responders (p<0,0001). Univariate analysis showed that PS 0–1 (p=0,007), biopsy (p=0,0022) are significantly associated with a better prognosis, but not age. Eighty three patients (75%) had toxicities, mainly grade 1 and 2 (92%), such as hypertension, proteinuria, haemorrhage, thrombosis, nausea, diarrhoea, fatigue or neutropenia. Most of the grade 3 and grade 4 toxicities were related to BEV treatment. Adverse events were significantly more frequent in long-term responders (p=0,0096).

CONCLUSION

BEV-IRI Combination is well tolerated and may offer some clinical benefits in recurrent GBM patients, more particularly if only biopsy was performed instead of surgery. Our results strengthened the role of these agents for the treatment of recurrent GBM.
Rapid phenotypic evolution with shallow genomic differentiation during early stages of high elevation adaptation in Eurasian Tree Sparrows
Authors: Qu Yanhua , Chen Chunhai , Xiong Ying , She Huishang , Zhang Yong E , Cheng Yalin , DuBay Shane , Li Dongming , Ericson Per G P , Hao Yan , Wang Hongyuan , Zhao Hongfeng , Song Gang , Zhang Hailin , Yang Ting , Zhang Chi , Liang Liping , Wu Tianyu , Zhao Jinyang , Gao Qiang , Zhai Weiwei , Lei Fumin
Published: September 2019

Known as the ‘third polar region’, the Qinghai-Tibet Plateau represents one of the harshest highland environments in the world and yet a number of organisms thrive there. Previous studies of birds, animals and humans have focused on well-differentiated populations in later stages of phenotypic divergence. The adaptive processes during the initial phase of highland adaptation remain poorly understood. We studied a human commensal, the Eurasian Tree Sparrow, which has followed human agriculture to the Qinghai-Tibet Plateau. Despite strong phenotypic differentiation at multiple levels, in particular in muscle-related phenotypes, highland and lowland populations show shallow genomic divergence and the colonization event occurred within the past few thousand years. In a one-month acclimation experiment investigating phenotypic plasticity, we exposed adult lowland tree sparrows to a hypoxic environment and did not observe muscle changes. Through population genetic analyses, we identified a signature of polygenic adaptation, whereby shifts in allele frequencies are spread across multiple loci, many of which are associated with muscle-related processes. Our results reveal a case of positive selection in which polygenic adaptation appears to drive rapid phenotypic evolution, shedding light on early stages of adaptive evolution to a novel environment.
Diabetes, Glycemic Control, and Risk of Infection Morbidity and Mortality: A Cohort Study
Authors: Chang Chia-Hsuin , Wang Jiun-Ling , Wu Li-Chiu , Chuang Lee-Ming , Lin Hsien-Ho
Published: September 2019

Objective

Diabetic patients have an elevated risk of infection, but the optimal level of glycemic control with the lowest infection risk remains unclear, especially among the elderly. We aimed to investigate the relation between fasting plasma glucose (FPG) level and risk of infection-related morbidity and mortality.

Method

The participants were from a community-based health screening program in northern Taiwan during 2005–2008 (n = 118 645) and were followed up until 2014. Incidence of hospitalization for infection and infection-related death was ascertained from the National Health Insurance Database and National Death Registry. Cox proportional hazards regression modelling was used to estimate the hazard ratio (HR) between FPG and risk of infection.

Results

During a median follow-up of 8.1 years, the incidence rate of hospitalization for any infection was 36.33 and 14.26 per 1000 person-years among diabetics and nondiabetics, respectively, in the total study population, but increased to 70.02 and 45.21 per 1000 person-years, respectively, in the elderly. In the Cox regression analysis, the adjusted HR comparing diabetics to nondiabetics was 1.59 (95% confidence interval [CI], 1.52–1.67) for any hospitalization for infection and 1.71 (95% CI, 1.36–2.16) for infection-related mortality. The hazard for infection morbidity and mortality was higher at both extremes (<90 and >200 mg/dl) of FPG. The excess risk associated with FPG ≤ 90 mg/dl was attenuated after controlling for multiple comorbidities.

Conclusions

Poor glycemic control (FPG > 200 mg/dl) was associated with a higher risk of infection-related morbidity and mortality, especially in the elderly population where the baseline infection risk was high.
Digital media: Promoting healthy screen use in school-aged children and adolescents
Authors:   Canadian Paediatric Society, Digital Health Task Force, Ottawa, Ontario
Published: September 2019

Digital media are integrated into the everyday lives of children and adolescents, with potential benefits and risks for learning, mental and physical health, and for social life. This statement examines the cognitive, psychosocial, and physical effects of digital media on school-aged children and adolescents, with a focus on family routines, context, and activities. Evidence-based guidance for clinicians and families involves four principles: healthy management, meaningful screen use, positive modelling, and balanced, informed monitoring of screen time and behaviours.
Thermodynamics of a generalized graphene-motivated (2+1) D Gross–Neveu model beyond the mean field within the Beth–Uhlenbeck approach
Authors: Ebert Dietmar , Blaschke David
Published: September 2019

We investigate the thermodynamics at finite density of a generalized $(2 + 1)$D Gross–Neveu model of $N$ fermion species with various types of four-fermion interactions. The motivation for considering such a generalized schematic model arises from taking the Fierz transformation of an effective Coulomb current–current interaction and certain symmetry-breaking interaction terms, as considered for graphene-type models in Ref. [29]. We then apply path-integral bosonization techniques, based on the large-$N$ limit, to derive the thermodynamic potential. This includes the leading-order mean-field (saddle point) contribution as well as the next-order contribution of Gaussian fluctuations of exciton fields. The main focus of the paper is then the investigation of the thermodynamic properties of the resulting fermion–exciton plasma. In particular, we derive an extended Beth–Uhlenbeck form of the thermodynamic potential, and discuss the Levinson theorem and the decomposition of the phase of the exciton correlation into resonant and scattering parts.
The 1984 Cartagena Declaration: A Critical Review of Some Aspects of Its Emergence and Relevance
Authors: Fischel de Andrade José H
Published: September 2019

This article revisits some aspects of the emergence and relevance of the 1984 Cartagena Declaration on Refugees. After addressing the conceptual framework by proposing a definition of asylum regime and explaining which asylum sub-regimes exist at the regional level in Latin America, the article reviews the ideological nature of the historical set of facts that led to the adoption of the 1984 Cartagena Declaration. It then explains why was there a need for a change of regime in Central America, details both the drafting process that culminated in the 1984 Cartagena Declaration refugee definition and UNHCR’s role in it, and undertakes a critical analysis of the potential relevance of the Cartagena Declaration. The article’s general conclusion is that the 1984 Cartagena Declaration’s practical, political, and legal relevance is obsolescent and that its legacy is most likely to be found both in the broad refugee definitions that are captured in most of the region’s domestic legislations, and in the advocacy model which uses ad hoc and sui generis UNHCR-led events to advance conceptual frameworks for refugee protection policy.
Using Machine Learning in Psychiatry: The Need to Establish a Framework That Nurtures Trustworthiness
Authors: Chandler Chelsea , Foltz Peter W , Elvevåg Brita
Published: September 2019

The rapid embracing of artificial intelligence in psychiatry has a flavor of being the current “wild west”; a multidisciplinary approach that is very technical and complex, yet seems to produce findings that resonate. These studies are hard to review as the methods are often opaque and it is tricky to find the suitable combination of reviewers. This issue will only get more complex in the absence of a rigorous framework to evaluate such studies and thus nurture trustworthiness. Therefore, our paper discusses the urgency of the field to develop a framework with which to evaluate the complex methodology such that the process is done honestly, fairly, scientifically, and accurately. However, evaluation is a complicated process and so we focus on three issues, namely explainability, transparency, and generalizability, that are critical for establishing the viability of using artificial intelligence in psychiatry. We discuss how defining these three issues helps towards building a framework to ensure trustworthiness, but show how difficult definition can be, as the terms have different meanings in medicine, computer science, and law. We conclude that it is important to start the discussion such that there can be a call for policy on this and that the community takes extra care when reviewing clinical applications of such models..
Effects of rumen-protected long-chain fatty acid supplementation during the finishing phase of beef steers on live performance, carcass characteristics, beef quality, and serum fatty acid profile1
Authors: Bakker Christina E , Blair Amanda D , Grubbs Judson K , Taylor Anna R , Brake Derek W , Long Nathan M , Underwood Keith R
Published: September 2019

The effect of a rumen-protected long-chain fatty acid (LCFA) supplement on live performance, meat quality, blood serum fatty acid profile, and predicted carcass composition was evaluated in this study. Angus steer calves (n = 99) were fed a low energy diet for 77 d prior to finishing. Prior to study initiation, the steers were separated into 12 pens with eight or nine steers per pen. Steers were transitioned from the low energy forage–based diet to a high concentrate diet containing high moisture ear corn, corn silage, dry rolled corn, soybean meal, and a liquid supplement containing monensin across 21 d. Megalac-R (RPFA) was fed to six pens at 2% of the diet dry matter. Control pens (CON; n = 6) received an additional 2% of diet dry matter as dry rolled corn and soybean meal. The final finishing diet net energy for gain (NEg) was 1.20 and 1.19 mega calories·kg−1 of dry matter (DM) for RPFA and CON treatments, respectively. Steers were weighed every 28 d. Growth performance data including average daily gain (ADG), gain to feed ratio (G:F), and DM intake (DMI) were calculated as both monthly and overall data. After a 147-d finishing phase, steers were transported to a commercial abattoir for slaughter. After a 28-h chilling period, carcass data were obtained by trained personnel. Final live weights were greater (P = 0.01) for RPFA than CON cattle. Overall ADG and overall G:F was increased (P = 0.02; P = 0.01, respectively) for RPFA cattle. Ribeye area, backfat thickness, kidney pelvic heart fat, marbling score, and yield grade did not differ (P > 0.05) between treatments. Predicted percent carcass fat was increased for RPFA cattle (P = 0.05). Conversely, predicted percent carcass protein (P = 0.07) and bone (P = 0.06) tended to be greater for CON cattle. Long-chain fatty acid supplementation during the finishing phase did not increase marbling scores of the steers in this study but did increase final live weight, HCW, and predicted total body fat. These results suggest that RPFA supplementation has the potential to increase adipose tissue development. However, it is likely that animal age during supplementation and duration of supplementation impact the effect RPFAs have on carcass characteristics.
Focused Assessment with Sonography for Urinary Schistosomiasis (FASUS)—pilot evaluation of a simple point-of-care ultrasound protocol and short training program for detecting urinary tract morbidity in highly endemic settings
Authors: Remppis J , Verheyden A , Bustinduy A L , Heller T , García-Tardón N , Manouana G P , Obiang R , Adegnika A A , Grobusch M P , Ramharter M , Joekes E , Bélard S
Published: September 2019

Background

Urogenital schistosomiasis (UGS) causes inflammation and fibrosis of the urinary tract. In resource-limited settings, affordable tools for morbidity assessment in clinical care are needed. Point-of-care ultrasound has not yet been validated for UGS-related pathology.

Methods

We developed a protocol for Focused Assessment with Sonography for Urinary Schistosomiasis (FASUS), assessing pathology of the bladder wall, ureters and kidneys. Following standardized training, two clinicians performed FASUS on children and adults with hematuria in Lambaréné, Gabon. Recorded ultrasound clips were remotely reviewed by two ultrasound experts as a diagnostic reference.

Results

In 2015 and 2016, scans were performed in 118 patients. The image quality was sufficient in 90% of bladder views and more than 97% of kidney views. UGS-compatible pathology was detected in 51/118 (43%) by the operator and in 46/107 (43%) by the experts among baseline scans of sufficient quality. Inter-rater agreement between operators and experts was very good (κ > 0.8) for hydronephrosis and good (κ > 0.6) for bladder wall thickening.

Conclusions

FASUS is a promising clinical, point-of-care tool for detecting UGS-related urinary tract morbidity in symptomatic patients. Based on larger validation studies, appropriate diagnostic and therapeutic algorithms for the use of FASUS should be established.
Chronic Conductive Hearing Loss Is Associated With Speech Intelligibility Deficits in Patients With Normal Bone Conduction Thresholds
Authors: Okada Masahiro , Welling D. Bradley , Liberman M. Charles , Maison Stéphane F.
Published: September 2019

Objectives:

The main objective of this study is to determine whether chronic sound deprivation leads to poorer speech discrimination in humans.

Design:

We reviewed the audiologic profile of 240 patients presenting normal and symmetrical bone conduction thresholds bilaterally, associated with either an acute or chronic unilateral conductive hearing loss of different etiologies.

Results:

Patients with chronic conductive impairment and a moderate, to moderately severe, hearing loss had lower speech recognition scores on the side of the pathology when compared with the healthy side. The degree of impairment was significantly correlated with the speech recognition performance, particularly in patients with a congenital malformation. Speech recognition scores were not significantly altered when the conductive impairment was acute or mild.

Conclusions:

This retrospective study shows that chronic conductive hearing loss was associated with speech intelligibility deficits in patients with normal bone conduction thresholds. These results are as predicted by a recent animal study showing that prolonged, adult-onset conductive hearing loss causes cochlear synaptopathy.
The Course of Orofacial Pain and Jaw Disability After Whiplash Trauma
Authors: Lampa Ewa , Wänman Anders , PhD Erik Nordh , Stålnacke Britt-Marie , Häggman-Henrikson Birgitta
Published: September 2019

Study Design.

Prospective cohort study.

Objective.

The aim of this study was to evaluate the course of orofacial pain and jaw disability in relation to neck pain, neck disability, and psychosocial factors at the acute stage and the chronic stage after whiplash trauma.

Summary of Background Data.

Many individuals report chronic pain in the orofacial region after whiplash trauma. The possible association between whiplash trauma and orofacial pain is debated. Prospective studies are therefore needed to evaluate the development of orofacial pain after whiplash trauma.

Methods.

Within 1 month following a whiplash trauma, 176 cases were examined and compared to 116 controls with questionnaires concerning neck and jaw pain and related disability, nonspecific physical symptoms and depression. At the 2-year follow-up, 119 cases (68%) and 104 controls (90%) were re-examined.

Results.

Compared to controls, cases reported more jaw and neck pain, both at baseline and follow-up. A majority (68%) of cases with pain in the jaw region in the acute stage also reported jaw pain at the follow-up. The intensity of jaw and neck pain was correlated both at baseline and follow-up. Both neck pain and jaw pain were correlated to nonspecific physical symptoms and to depression.

Conclusion.

Orofacial pain and jaw disability related to neck pain are often present already at the acute stage after whiplash trauma and persist into the chronic stage for most individuals. Assessment following whiplash trauma should therefore include both the neck and the orofacial regions. More studies are needed to further evaluate risk factors for development of orofacial pain after whiplash trauma.

Level of Evidence: 3
The Importance of C2 Slope, a Singular Marker of Cervical Deformity, Correlates With Patient-reported Outcomes
Authors: Protopsaltis Themistocles S. , Ramchandran Subaraman , Tishelman Jared C. , Smith Justin S. , Neuman Brian J. , Jr Gregory M. Mundis , Lafage Renaud , Klineberg Eric O. , Hamilton D. Kojo , LaFage Virginie , Gupta Munish C. , Hart Robert A. , Schwab Frank J. , Burton Douglas C. , Bess Shay , Shaffrey Christopher I. , Ames Christopher P.
Published: September 2019

Study Design.

Retrospective review of a prospectively collected database.

Objective.

To define a simplified singular measure of cervical deformity (CD), C2 slope (C2S), which correlates with postoperative outcomes.

Summary of Background Data.

Sagittal malalignment of the cervical spine, defined by the cervical sagittal vertical axis (cSVA) has been associated with poor outcomes following surgical correction of the deformity. There has been a proliferation of parameters to describe CD. This added complexity can lead to confusion in classifying, treating, and assessing outcomes of CD surgery.

Methods.

A prospective database of CD patients was analyzed. Inclusion criteria were cervical kyphosis>10°, cervical scoliosis>10°, cSVA>4 cm, or chin-brow vertical angle >25°. Patients were categorized into two groups and compared based on whether the apex of the deformity was in the cervical (C) or the cervicothoracic (CT) region. Radiographic parameters were correlated to C2S, T1 slope (T1S) and 1-year health-related quality-of-life outcomes as measured by the EuroQol 5 Dimension questionnaire (EQ5D), modified Japanese Orthopedic Association Scale, numeric rating scale for neck pain, and the Neck Disability Index (NDI).

Results.

One hundred four CD patients (C = 74, CT = 30; mean age 61 yr, 56% women, 42% revisions) were included. CT patients had higher baseline cSVA and T1S (P < 0.05). C2S correlated with T1 slope minus cervical lordosis (TS-CL) (r = 0.98, P < 0.001) and C0-C2 angle, cSVA, CL, T1S (r = 0.37–0.65, P < 0.001). Correlation of cSVA with C0-C2 was weaker (r = 0.48, P < 0.001). At 1-year postoperatively, higher C2S correlated with worse EQ-5D (r = 0.28, P = 0.02); in CT patients, higher C2S correlated with worse NDI, modified Japanese Orthopedic Association Scale, numeric rating scale for neck pain, and EQ5D (all r > 0.5, P≤0.05). Using linear regression, moderate disability by EQ5D corresponded to C2S of 20°(r2 = 0.08). For CT patients, C2S = 17° corresponded to moderate disability by NDI (r2 = 0.4), and C2S = 20° by EQ5D (r2 = 0.25).

Conclusion.

C2S correlated with upper-cervical and subaxial alignment. C2S correlated strongly with TS-CL (R = 0.98, P < 0.001) because C2S is a mathematical approximation of TS-CL. C2S is a useful marker of CD, linking the occipitocervical and cervico-thoracic spine. C2S defines the presence of a mismatch between cervical lordosis and thoracolumbar alignment. Worse 1-year postoperative C2 slope correlated with worse health outcomes.

Level of Evidence: 3
Understanding Thoracic Spine Morphology, Shape, and Proportionality
Authors: Lafage Renaud , Steinberger Jeremy , Pesenti Sebastien , Assi Ayman , Elysee Jonathan C. , Iyer Sravisht , Lenke Lawrence G. , Schwab Frank J. , Kim Han Jo , Lafage Virginie
Published: September 2019

Study Design.

Retrospective review.

Objective.

The aim of this study was to describe thoracic kyphosis (TK) in a normal asymptomatic population and to evaluate the association between TK magnitude and its shape.

Summary of Background Data.

Understanding spinal anatomy requires a three-dimensional appreciation of the spine's shape, morphology, and proportions. The customary definition of TK is the angle between T4 and T12. However, little is known on the actual shape of TK in adults.

Methods.

Asymptomatic volunteers were recruited; demographic data along with full-body standing radiographs were recorded. Radiographic data such as T1–12 and T4–12 angles were collected. Maximum TK and vertebral orientation/tilt were also collected, in addition to cumulative TK and Centered Kyphosis at T7. The cohort was stratified by T1–12 value (<40°, 40°–60°, and>60°) and comparisons and regressions were performed afterward.

Results.

One hundred nineteen subjects were included (average age 50.8 yrs, 81 female). Mean T1–12 kyphosis was 49.5°, mean T4–12 kyphosis 41.5°, and mean maximum TK was 52.6°. T1 was the most anteriorly tilted vertebra, L1 the most posteriorly tilted; T7 was horizontal, independently of T1–12 value or age. Cumulative kyphosis analysis revealed that the apex of kyphosis was located at T6-T7. Regression analysis predicting the value and the percentage of T1–7 both yielded T1–12 as a predictor (Adj. r2 = 0.32, Adj. r2 = 0.13).

Conclusion.

Changes in kyphosis distribution in an asymptomatic population suggest that TK is not a simple circle arc: with low TK, 2/3 of the kyphosis is located in the upper part and when TK increases, the distribution of kyphosis will be symmetric around T7. It is possible to predict the amount of kyphosis in the upper part using total kyphosis value. This could help estimate preoperative compensation and predict reciprocal change.

Level of Evidence: 3
Pelvic Compensation in Sagittal Malalignment
Authors: Beyer George , Khalifé Marc , Lafage Renaud , Yang Jingyan , Elysee Jonathan , Frangella Nicholas , Steinmetz Leah , Ge David , Varlotta Christopher , Stekas Nicholas , Manning Jordan , Protopsaltis Themistocles , Passias Peter , Buckland Aaron , Schwab Frank , Lafage Virginie
Published: September 2019

Study Design.

Single-center retrospective study.

Objective.

Investigate how differing degrees of pelvic incidence (PI) modulate the recruitment of pelvic tilt (PT) in response to similar amounts of sagittal malalignment as measured by T1-Pelvic Angle (TPA).

Summary of Background Data.

Past research has shown that some patients do not recruit PT in response to sagittal malalignment. Given the anatomic relationship between PI and PT, we sought to determine whether differing PI is associated with variable recruitment of PT.

Methods.

Single-center retrospective study of 2077 patients undergoing full body radiographs and TPA>10°. Five groups of patients (Very Low, Low, Average, High, and Very High PI) were defined utilizing PI ranges on a Gaussian distribution. Linear regression (LR) evaluated correlation of TPA to PT within each PI group. Multivariate LR evaluated whether correlation between TPA and PT differed between each PI group.

Results.

Mean PT increased with increasing levels of PI (P < 0.05). Within the full cohort, PT correlated with TPA (r = 0.80, P < 0.001). Multivariate LR revealed significant differences between slopes and intercepts of the linear relationship between PT and TPA within the PI groups. Compared with patients with an average PI, patients with Very Low PI had 3.4° lower PT while holding TPA constant (P < 0.001). Further, patients with Very High PI displayed a PT of 1.9° higher than patients with an Average PI while holding TPA constant (P = 0.01). A similar difference of −1.8°, and 1.2° with respect to the Average PI group was observed in the Low and High PI groups, respectively (P < 0.001). Means and standard deviations of PT at varying levels of TPA were defined for PI groups.

Conclusion.

This is the first study which demonstrated that PI is associated with varied recruitment of PT while maintaining constant sagittal malalignment. The results reported herein are intended to allow surgeons to assess a patient's magnitude of compensatory PT for an individual patient's PI.

Level of Evidence: 3