bluuebunny/crossref_metadata_2025 huggingface dataset:
Scintillating Grid Illusion Without the Grid
Authors: Matsuno Toyomi
Published: July 2020

The scintillating grid illusion is a phenomenon where illusory black spots are perceived on white patches located at the intersections of a grid pattern. In this study, I report that the illusory spots as observed in the illusion are perceived with a stimulus pattern without grid bars. In two experiments, I investigated the perceptual properties of the scintillating illusion without grid bars. I found that the strength of the illusion depends on the contour shape of the patch components as in the scintillating grid illusion, while neither the density nor spatial alignment largely affect the illusory percepts. These findings undermine the previous theories on the mechanism of the scintillating grid illusion, as it was assumed that the grid bars are the essential component to induce the illusion. The results suggest that the illusory spots of the scintillating grid illusion could be induced by the limited processing of the patch stimuli in the peripheral vision and that the grid could play a supplementary role by enhancing the effect by further interfering with the processing.
Continuous subcutaneous insulin infusion and flash glucose monitoring in diabetic hemiballism-hemichorea
Authors: Qiang Wei , Chen Xia , Gao Chuqi , Wang Zhaoxu , Shang Jin , Fu Jiao , Guo Hui
Published: July 2020

A 71-year-old man without previous history of diabetes was hospitalized after suffering polyuria for 1 month and involuntary movement of the left arm for 1 week. His random serum glucose was 42.05 mmol/l and his hemoglobin A1C was 14% (129 mmol/mol). His serum osmolarity was normal and his urine ketone was negative. Cerebral CT revealed hyperdensity in the right basal ganglia. The patient was diagnosed with diabetic hemiballism-hemichorea (HH). Intravenous insulin was given and later shifted to continuous subcutaneous insulin infusion. During the hospital stay, insulin titration was guided mainly by flash glucose monitoring (FGM). Finger-prick glucose was occasionally checked to verify the accuracy of the FGM. Rapid correction of severe hyperglycemia was achieved without hypoglycemia. HH resolved within 1 week after euglycemia was achieved. This case emphasized the importance of being alert for HH as the initial presentation of diabetes and neuroimaging negative diabetic HH. In addition, interstitial glucose-monitoring technologies including continuous glucose monitoring and FGM can facilitate inpatient intensive insulin therapy in diabetic HH by avoiding hypoglycemia.
HIV-associated vacuolar myelopathy: A rare initial presentation of HIV
Authors: Rezaie Aida , Parmar Rajeshwar , Rendon Casey , Zell Steven C
Published: July 2020

HIV-associated vacuolar myelopathy, or AIDS-associated myelopathy, is a rare initial presentation of HIV. One of the common HIV-associated neurocognitive disorders, HIV-associated vacuolar myelopathy presents with advanced immunosuppression in patients and is frequently associated with dementia. However, most cases are subclinical with characteristic findings identified through physical examination and/or imaging modalities. HIV-associated vacuolar myelopathy is characterized by progressive spastic paraparesis, gait disturbance and lower extremity sensory abnormalities including vibratory sensation. Magnetic resonance imaging findings in the spinal cord are abnormal in some patients with HIV-associated myelopathy, characteristically showing spinal cord atrophy at the level of the thoracic spine, but they may also be normal. Unfamiliarity with this as initial presentation of HIV infection may lead to failure to diagnose and intervene appropriately. We present a case of newly diagnosed HIV with myelopathy and dementia with minimal spinal cord involvement on magnetic resonance imaging.
Book review: Thales S. Teixeira, Unlocking the Customer Value Chain: How Decoupling Drives Customer Disruption
Authors: Behera Mukti Prakash
Published: July 2020

Thales S. Teixeira, Unlocking the Customer Value Chain: How Decoupling Drives Customer Disruption, 1st ed. New York, NY: CURRENCY, 2019, 324 pp., $28.00. ISBN: 978-1-5247-6308-4.
Effect of Preoperative Frozen Shoulder on Clinical Outcomes After Arthroscopic Rotator Cuff Repair
Authors: Jeong Jeung Yeol , Shim Seung Bo , Hong Jin Ho , Im Wooyoung , Lee Sang Min , Yoo Jae Chul
Published: July 2020

Background:

A concomitant rotator cuff tear (RCT) with frozen shoulder is a common but challenging clinical scenario. The effect of frozen shoulder on clinical outcomes is open to discussion.

Purpose/Hypothesis:

This study aimed to evaluate the effect of preoperative frozen shoulder on postoperative clinical outcomes of an RCT. We hypothesized that the treatment results of an RCT concomitant with preoperative frozen shoulder would be comparable with those of an isolated RCT.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A total of 212 patients were divided into 2 groups: 154 in the non–frozen shoulder (NFS) group and 58 in the preoperative frozen shoulder (FS) group. All patients underwent a thorough preoperative evaluation that included range of motion (ROM) and the pain visual analog scale, functional visual analog scale, Constant score, and American Shoulder and Elbow Surgeons (ASES) score. The same evaluation was performed at 6 months and 1 and 2 years postoperatively. The healing status of the repaired RCT of all patients was evaluated by postoperative magnetic resonance imaging.

Results:

The FS group showed statistically significantly worse functional outcomes than the NFS group at 6 months and 1 year postoperatively ( P < .05). At 2 years postoperatively, active assisted ROM was equivalent between the groups, although the ASES and Constant scores were significantly lower for the FS group ( P < .033 and P < .001, respectively). The retear rates were 5.3% and 12.3% for the FS and NFS groups, respectively ( P = .013).

Conclusion:

Preoperative frozen shoulder positively affected rotator cuff healing but negatively affected most functional outcomes, including ROM, at 6 months and 1 year postoperatively. At 2 years after surgery, there was no significant difference in active motion, but outcome scores remained lower in the FS group. For patients with preoperative frozen shoulder, a delay in surgery for additional physical therapy might not be necessary. The retear rate for the NFS group was more than double that for the FS group in the current study, which indicates that surgery for an RCT combined with frozen shoulder might provide better results in the long term because of an intact, healed rotator cuff.
Pneumonia Hospitalization Coding Changes Associated With Transition From the 9th to 10th Revision of International Classification of Diseases
Authors: Smithee Ryan B. , Markus Tiffanie M. , Soda Elizabeth , Grijalva Carlos G. , Xing Wei , Shang Nong , Griffin Marie R. , Lessa Fernanda C.
Published: July 2020

Objectives:

To evaluate the impact of International Classification of Disease, 10th revision, Clinical Modification ( ICD-10-CM) implementation on pneumonia hospitalizations rates, which had declined following pneumococcal conjugate vaccine introduction for infants in 2000.

Methods:

We randomly selected records from a single hospital 1 year before (n = 500) and after (n = 500) October 2015 implementation of ICD-10-CM coding. We used a validated ICD-9-CM algorithm and translation of that algorithm to ICD-10-CM to identify pneumonia hospitalizations pre- and post-implementation, respectively. We recoded ICD-10-CM records to ICD-9-CM and vice versa. We calculated sensitivity and positive predictive value (PPV) of the ICD-10-CM algorithm using ICD-9-CM coding as the reference. We used sensitivity and PPV values to calculate an adjustment factor to apply to ICD-10 era rates to enable comparison with ICD-9-CM rates. We reviewed primary diagnoses of charts not meeting the pneumonia definition when recoded.

Results:

Sensitivity and PPV of the ICD-10-CM algorithm were 94% and 92%, respectively, for young children and 74% and 79% for older adults. The estimated adjustment factor for ICD-10-CM period rates was −2.09% (95% credible region [CR], −7.71% to +3.0%) for children and +6.76% (95% CR, −3.06% to +16.7%) for older adults. We identified a change in coding adult charts that met the ICD-9-CM pneumonia definition that led to recoding in ICD-10-CM as chronic obstructive pulmonary disease (COPD) exacerbation.

Conclusions:

The ICD-10-CM algorithm derived from a validated ICD-9-CM algorithm should not introduce substantial bias for evaluating pneumonia trends in children. However, changes in coding of pneumonia associated with COPD in adults warrant further study.
Clinical value of measurable residual disease testing for assessing depth, duration, and direction of response in multiple myeloma
Authors: Martinez-Lopez Joaquin , Wong Sandy W. , Shah Nina , Bahri Natasha , Zhou Kaili , Sheng Ying , Huang Chiung-Yu , Martin Thomas , Wolf Jeffrey
Published: July 2020

Few clinical studies have reported results of measurable residual disease (MRD) assessments performed as part of routine practice. Herein we present our single-institution experience assessing MRD in 234 multiple myeloma (MM) patients (newly diagnosed [NDMM = 159] and relapsed [RRMM = 75]). We describe the impact of depth, duration, and direction of response on prognosis. MRD assessments were performed by next-generation sequencing of immunoglobulin genes with a sensitivity of 10−6. Those achieving MRD negativity at 10−6, as well as 10−5, had superior median progression-free survival (PFS). In the NDMM cohort, 40% of the patients achieved MRD negativity at 10−6 and 59% at 10−5. Median PFS in the NDMM cohort was superior in those achieving MRD at 10−5 vs <10−5 (PFS: 87 months vs 32 months; P < .001). In the RRMM cohort, 36% achieved MRD negativity at 10−6 and 47% at 10−5. Median PFS was superior for the RRMM achieving MRD at 10−5 vs <10−5 (PFS: 42 months vs 17 months; P < .01). Serial MRD monitoring identified 3 categories of NDMM patients: (A) patients with ≥3 MRD 10−6 negative samples, (B) patients with detectable but continuously declining clonal numbers, and (C) patients with stable or increasing clonal number (≥1 log). PFS was superior in groups A and B vs C (median PFS not reached [NR], NR, 55 respectively; P < .001). This retrospective evaluation of MRD used as part of clinical care validates MRD as an important prognostic marker in NDMM and RRMM and supports its use as an endpoint in future clinical trials as well as for clinical decision making.
Treosulfan-based conditioning is feasible and effective for cord blood recipients: a phase 2 multicenter study
Authors: Milano Filippo , Gutman Jonathan A. , Deeg H. Joachim , Nemecek Eneida R. , Baumgart Joachim , Thur Laurel , Dahlberg Ann , Salit Rachel B. , Summers Corinne , Appelbaum Frederick R. , Delaney Colleen
Published: July 2020

Although the use of treosulfan (TREO) in conventional donor hematopoietic cell transplantation (HCT) has been extensively evaluated, its use in cord blood transplantation (CBT) for hematologic malignancies has not been reported. Between March 2009 and October 2019, 130 CBT recipients were enrolled in this prospective multicenter phase 2 study. The conditioning regimen consisted of TREO, fludarabine, and a single fraction of 2 Gy total-body irradiation. Cyclosporine and mycophenolate mofetil were used for graft-versus-host disease prophylaxis. The primary end point was incidence of graft failure (GF), and based on risk of GF, patients were classified as low risk (arm 1, n = 66) and high risk (arm 2, n = 64). The median age was 45 years (range, 0.6-65 years). Disease status included acute leukemias in first complete remission (CR; n = 56), in ≥2 CRs (n = 46), and myelodysplastic (n = 25) and myeloproliferative syndromes (n = 3). Thirty-five patients (27%) had received a prior HCT. One hundred twenty-three patients (95%) engrafted, with neutrophil recovery occurring at a median of 19 days for patients on arm 1 and 20 days for patients on arm 2. The 3-year overall survival, relapse-free survival (RFS), transplant-related mortality, and relapse for the combined groups were 66%, 57%, 18%, and 24%, respectively. Among patients who had a prior HCT, RFS at 3 years was 48%. No significant differences in clinical outcomes were seen between the 2 arms. Our results demonstrate that TREO-based conditioning for CBT recipients is safe and effective in promoting CB engraftment with favorable clinical outcomes. This trial was registered at www.clinicaltrials.gov as #NCT00796068.
METROID: an automated method for robust quantification of subcellular fluorescence events at low SNR
Authors: Zoccoler Marcelo , de Oliveira Pedro X.
Published: July 2020

Background

In cell biology, increasing focus has been directed to fast events at subcellular space with the advent of fluorescent probes. As an example, voltage sensitive dyes (VSD) have been used to measure membrane potentials. Yet, even the most recently developed genetically encoded voltage sensors have demanded exhausting signal averaging through repeated experiments to quantify action potentials (AP). This analysis may be further hampered in subcellular signals defined by small regions of interest (ROI), where signal-to-noise ratio (SNR) may fall substantially. Signal processing techniques like blind source separation (BSS) are designed to separate a multichannel mixture of signals into uncorrelated or independent sources, whose potential to separate ROI signal from noise has been poorly explored. Our aims are to develop a method capable of retrieving subcellular events with minimal a priori information from noisy cell fluorescence images and to provide it as a computational tool to be readily employed by the scientific community.

Results

In this paper, we have developed METROID (Morphological Extraction of Transmembrane potential from Regions Of Interest Device), a new computational tool to filter fluorescence signals from multiple ROIs, whose code and graphical interface are freely available. In this tool, we developed a new ROI definition procedure to automatically generate similar-area ROIs that follow cell shape. In addition, simulations and real data analysis were performed to recover AP and electroporation signals contaminated by noise by means of four types of BSS: Principal Component Analysis (PCA), Independent Component Analysis (ICA), and two versions with discrete wavelet transform (DWT). All these strategies allowed for signal extraction at low SNR (− 10 dB) without apparent signal distortion.

Conclusions

We demonstrate the great capability of our method to filter subcellular signals from noisy fluorescence images in a single trial, avoiding repeated experiments. We provide this novel biomedical application with a graphical user interface at 10.6084/m9.figshare.11344046.v1, and its code and datasets are available in GitHub at https://github.com/zoccoler/metroid.
Correction to: Estimating the nationwide transmission risk of measles in US schools and impacts of vaccination and supplemental infection control strategies
Authors: Azimi Parham , Keshavarz Zahra , Cedeno Laurent Jose Guillermo , Allen Joseph G.
Published: July 2020

An amendment to this paper has been published and can be accessed via the original article.
Do-not-resuscitate orders in patients with community-acquired pneumonia: a retrospective study
Authors: Egelund Gertrud Baunbæk , Jensen Andreas Vestergaard , Petersen Pelle Trier , Andersen Stine Bang , Lindhardt Bjarne Ørskov , Rohde Gernot , Ravn Pernille , von Plessen Christian
Published: July 2020

Background

To investigate the use of do-not-resuscitate (DNR) orders in patients hospitalized with community-acquired pneumonia (CAP) and the association with mortality.

Methods

We assembled a cohort of 1317 adults hospitalized with radiographically confirmed CAP in three Danish hospitals. Patients were grouped into no DNR order, early DNR order (≤48 h after admission), and late DNR order (> 48 h after admission). We tested for associations between a DNR order and mortality using a cox proportional hazard model adjusted for patient and disease related factors.

Results

Among 1317 patients 177 (13%) patients received a DNR order: 107 (8%) early and 70 (5%) late, during admission. Patients with a DNR order were older (82 years vs. 70 years, p < 0.001), more frequently nursing home residents (41% vs. 6%, p < 0.001) and had more comorbidities (one or more comorbidities: 73% vs. 59%, p < 0.001). The 30-day mortality was 62% and 4% in patients with and without a DNR order, respectively. DNR orders were associated with increased risk of 30-day mortality after adjustment for age, nursing home residency and comorbidities. The association was modified by the CURB-65 score Hazard ratio (HR) 39.3 (95% CI 13.9–110.6), HR 24.0 (95% CI 11.9–48,3) and HR 9.4 (95% CI: 4.7–18.6) for CURB-65 score 0–1, 2 and 3–5, respectively.

Conclusion

In this representative Danish cohort, 13% of patients hospitalized with CAP received a DNR order. DNR orders were associated with higher mortality after adjustment for clinical risk factors. Thus, we encourage researcher to take DNR orders into account as potential confounder when reporting CAP associated mortality.
Effects of delayed hip replacement on postoperative hip function and quality of life in elderly patients with femoral neck fracture
Authors: Song Jidong , Zhang Gensheng , Liang Jialin , Bai Chuanyi , Dang Xiaoqian , Wang Kunzheng , He Caiyou , Liu Ruiyu
Published: July 2020

Background

For various reasons, some elderly patients with femoral neck fracture undergo delayed surgical treatment. There is little information about the effect of delayed treatment on postoperative hip function and quality of life. The aim of this study was to investigate the effect of delayed hip arthroplasty on hip function, quality of life, and satisfaction in patients with femoral neck fractures.

Methods

Forty-seven patients with femoral neck fracture and hip replacement delayed over 21 days served as the delayed group (D group). Patients with femoral neck fracture, matched 1:1 for age and sex, and hip replacement within 7 days served as the control group (C group). The Harris hip score (HHS) and health-related quality of life (HRQoL) were assessed before surgery and 3 months, 6 months and 1 year postoperatively. The satisfaction questionnaires were completed by the patients themselves at the last follow-up.

Results

The HHS in the C group was lower than that in the D group (32.64 ± 9.11 vs. 46.32 ± 9.88, P < 0.05) before surgery but recovered faster after surgery. The HHS in the D group was lower than that in the C group 1 year postoperatively (85.2 ± 3.80 vs. 89.8 ± 3.33, P < 0.05). The patients’ quality of life changed similarly to their HHS. The HHS 1 year after surgery was related to the preoperative HHS in group D (rs = 0.521, P < 0.01). Patients in the D group showed significantly higher satisfaction scores than those in the C group (P < 0.05).

Conclusions

Hip function in patients with femoral neck fracture surgery delayed over 21 days recovered more slowly than that in those who underwent surgery within 7 days. However, they were more satisfied with the surgery. Moderate hip movement to ameliorate the lower limb muscle atrophy was recommended for patients facing a temporary inability to undergo surgery.
Correction to: Systematic review and meta-analysis of case-crossover and time-series studies of short term outdoor nitrogen dioxide exposure and ischemic heart disease morbidity
Authors: Stieb David M. , Zheng Carine , Salama Dina , Berjawi Rania , Emode Monica , Hocking Robyn , Lyrette Ninon , Matz Carlyn , Lavigne Eric , Shin Hwashin H.
Published: July 2020

An amendment to this paper has been published and can be accessed via the original article.
Reclassification of tumor size for solitary HBV-related hepatocellular carcinoma by minimum p value method: a large retrospective study
Authors: Liu Hongzhi , Yang Yuan , Chen Chuanchun , Wang Lei , Huang Qizhen , Zeng Jianxing , Lin Kongying , Zeng Yongyi , Guo Pengfei , Zhou Weiping , Liu Jingfeng
Published: July 2020

Background and objectives

Tumor size is one of the most important issues for hepatocellular carcinoma (HCC) treatment and prognosis, but the classification of it is still controversial. The aim of this study was to screen appropriate cutoffs for size of solitary hepatitis B virus (HBV)-related HCC.

Methods

A cohort of 1760 patients with solitary HBV-related HCC undergoing curative liver resection was divided into 11 groups based on tumor size in 1-cm interval. The minimum p value method was used to screen the appropriate size cutoff according to overall survival (OS). If multiple cutoffs meet the above standard, a univariate analysis will be performed by using the Cox proportional hazards regression model, and hazard ratio (HR) will be considered as a criterion to assess the difference in survival.

Results

There are 8 dichotomy, 8 trichotomy, and no inquartation cutoffs that were screened when classifying tumor sizes in accordance with OS. The HR values of tumor size at these trichotomy cutoffs for OS were compared, and the highest HR value is 2.79 when size cutoff is 3/9 cm. Then, we reclassified patients into three new classifications: ≤ 3 cm (n = 422), > 3 and ≤ 9 cm (n = 1072), and > 9 cm (n = 266). The comparison of clinicopathologic characteristics among these three classifications showed that the increase of tumor size was associated with the increase of α-fetoprotein (AFP), microvascular invasion (MVI), tumor differentiation, and liver cirrhosis. And the comparison of the OS among three classifications showed statistical differences.

Conclusions

This study suggested that size criteria of 3 cm and 9 cm in solitary HBV-related HCC patients were appropriate based on biological characteristics and prognostic significance.
Understanding transmission and control of the pork tapeworm with CystiAgent: a spatially explicit agent-based model
Authors: Pray Ian W. , Wakeland Wayne , Pan William , Lambert William E. , Garcia Hector H. , Gonzalez Armando E. , O’Neal Seth E. ,   for the Cysticercosis Working Group in Peru
Published: July 2020

Background

The pork tapeworm, Taenia solium, is a serious public health problem in rural low-resource areas of Latin America, Africa and Asia, where the associated conditions of nuerocysticercosis (NCC) and porcine cysticercosis cause substantial health and economic harms. An accurate and validated transmission model for T. solium would serve as an important new tool for control and elimination, as it would allow for comparison of available intervention strategies, and prioritization of the most effective strategies for control and elimination efforts.

Methods

We developed a spatially-explicit agent-based model (ABM) for T. solium (“CystiAgent”) that differs from prior T. solium models by including a spatial framework and behavioral parameters such as pig roaming, open human defecation, and human travel. In this article, we introduce the structure and function of the model, describe the data sources used to parameterize the model, and apply sensitivity analyses (Latin hypercube sampling-partial rank correlation coefficient (LHS-PRCC)) to evaluate model parameters.

Results

LHS-PRCC analysis of CystiAgent found that the parameters with the greatest impact on model uncertainty were the roaming range of pigs, the infectious duration of human taeniasis, use of latrines, and the set of “tuning” parameters defining the probabilities of infection in humans and pigs given exposure to T. solium.

Conclusions

CystiAgent is a novel ABM that has the ability to model spatial and behavioral features of T. solium transmission not available in other models. There is a small set of impactful model parameters that contribute uncertainty to the model and may impact the accuracy of model projections. Field and laboratory studies to better understand these key components of transmission may help reduce uncertainty, while current applications of CystiAgent may consider calibration of these parameters to improve model performance. These results will ultimately allow for improved interpretation of model validation results, and usage of the model to compare available control and elimination strategies for T. solium.
Loss of Tdp-43 disrupts the axonal transcriptome of motoneurons accompanied by impaired axonal translation and mitochondria function
Authors: Briese Michael , Saal-Bauernschubert Lena , Lüningschrör Patrick , Moradi Mehri , Dombert Benjamin , Surrey Verena , Appenzeller Silke , Deng Chunchu , Jablonka Sibylle , Sendtner Michael
Published: July 2020

Protein inclusions containing the RNA-binding protein TDP-43 are a pathological hallmark of amyotrophic lateral sclerosis and other neurodegenerative disorders. The loss of TDP-43 function that is associated with these inclusions affects post-transcriptional processing of RNAs in multiple ways including pre-mRNA splicing, nucleocytoplasmic transport, modulation of mRNA stability and translation. In contrast, less is known about the role of TDP-43 in axonal RNA metabolism in motoneurons. Here we show that depletion of Tdp-43 in primary motoneurons affects axon growth. This defect is accompanied by subcellular transcriptome alterations in the axonal and somatodendritic compartment. The axonal localization of transcripts encoding components of the cytoskeleton, the translational machinery and transcripts involved in mitochondrial energy metabolism were particularly affected by loss of Tdp-43. Accordingly, we observed reduced protein synthesis and disturbed mitochondrial functions in axons of Tdp-43-depleted motoneurons. Treatment with nicotinamide rescued the axon growth defect associated with loss of Tdp-43. These results show that Tdp-43 depletion in motoneurons affects several pathways integral to axon health indicating that loss of TDP-43 function could thus make a major contribution to axonal pathomechanisms in ALS.
Revealing unique inscriptions of a Nazi collaborator in Doodencel 601 of the Oranjehotel
Authors: Wempe Joost , van den Brink Rick , Mooldijk Esmée , Feirabend Nienke , Wiersma Ruben , Sietsma Jilt , Dik Joris
Published: July 2020

During the Second World War the German occupants of the Netherlands made ample use of the Scheveningen prison near The Hague, popularly nicknamed the Oranjehotel. One former death cell in this infamous prison (Doodencel 601) has been preserved in its original condition, showing wartime inscriptions on the cell walls. Interestingly, a small section of the wall has been given an additional plaster layer, presumably covering inscriptions. Here, we report on the visualization of this enigmatic text, which so far had escaped the reach of historians. Our visualization methodology was threefold. First, we determined the cell-wall stratigraphy and its composition based on a sample cross-section. Second, we prepared a physical model wall, mimicking the layering of the original cell wall. Third, we tested a combination of raking light photography and infrared thermography on the model wall. Applying this methodology on the original wall revealed the inscriptions, including the author’s name Daniël de Blocq van Scheltinga, a prominent Nazi collaborator, as well as a calendar and an important date of his post-war trial in the fall of 1945. Our visualizations flawlessly dovetail with archival findings. Together, they offer an intimate view of an early post-war inmate of the Scheveningen prison, whose message was covered up once the cell was transformed into a war monument in 1946.
How social capital can inform targeting formal social safety net interventions in vulnerable communities in eastern Ethiopia: an ethnographic case study
Authors: Endris Getachew Shambel , Kibwika Paul , Obaa Bernard B. , Hassan Jemal Yousuf
Published: July 2020

Safety nets in Ethiopia are targeted and delivered in a context in which informal social capital practices also operate. But the role of social relations is largely overlooked in welfare programming. Understanding how social capital is mobilized and under which condition it enhances or constrains social safety net targeting may inform policy to design sustainable and inclusive welfare programs to improve household resilience. Using an ethnographic case study design, we studied the role of social capital in the implementation of a welfare intervention. Data were collected through observations and interviews with 30 households. Besides, data on household social network characteristics were collected using semi-structured interviews. The result suggested that greater access to social capital by a household enhances the efficiency of safety net targeting and delivery. Positioning the social transfer instruments within the broader sets of community social arrangements can optimize the allocation of scarce safety net resources and improves community relationships.
The use of 3D additive manufacturing technology in autogenous dental transplantation
Authors: Cahuana-Bartra Pau , Cahuana-Cárdenas Abel , Brunet-Llobet Lluís , Ayats-Soler Marta , Miranda-Rius Jaume , Rivera-Baró Alejandro
Published: July 2020

Background

In medicine and dentistry, 3D technology allows the virtual planning and printing of surgical replicas of anatomical structures that can facilitate certain transplant procedures. In dentistry, 3D technology is useful in autogenous tooth transplantation.

Case presentation

We present a clinical case of an ectopic mandibular second premolar, describing the preoperative planning with dental replicas and the autotransplantation surgery. 3D prints of the surgical replica of the tooth to be transplanted was made using an Objet30 Prime® Printer, PolyJet. Clinical controls performed at 3, 6 and 12 months indicated the satisfactory evolution of the transplanted tooth.

Conclusion

3D additive manufacturing technology allows the preparation of a new recipient socket with the aid of a surgical replica of the tooth to be transplanted, thus minimizing handling and extraoral time.
Prestack reverse time imaging in tunnels based on the decoupled nonconversion elastic-wave equation
Authors: Ren Yuxiao , Yang Zhichao , Liu Bin , Xu Xinji , Chen Yangkang
Published: July 2020

The safety and efficiency of tunnel construction depend on the knowledge of complex geologic conditions. Hence, an accurate forward-prospecting technique is required to detect unexpected inhomogeneous geologic structures ahead of tunnel construction. As an accurate method to image geologic heterogeneities, elastic reverse time migration (ERTM) is introduced to the field of tunnel forward prospecting. However, in the tunnel environment, ERTM images may suffer from the interference of crosstalk artifacts, which are caused by converted waves on tunnel surfaces. Therefore, considering the actual influence of the tunnel body, the decoupled nonconversion elastic equation was incorporated into traditional ERTM. This method prevents the generation of converted waves but ensures independent P- and S-wave propagation. In addition, wave-mode separation for raw seismic data is required in our approach. Synthetic examples based on the real geologic environment of tunnels show that our method produces satisfactory results for P-wave and S-wave imaging and the S-wave can produce a better imaging effect in tunnels. Finally, we apply our method to the seismic data obtained from a real highway tunnel construction site to demonstrate its performance in real-world applications. The results indicate that the migrated images can help to accurately constrain the geologic formations ahead of the tunnel face.
Optimal Screening in Breast Cancer Survivors With Dense Breasts on Mammography
Authors: Rahbar Habib , Lee Janie M. , Lee Christoph I.
Published: July 2020

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.
From a Weather Report
Authors: Felton-Dansky Miriam
Published: July 2020

Miriam Felton-Dansky offers an introduction to the writer Sylvan Oswald and proposes that his work High Winds expands the boundaries of dramatic art by reshaping the form and the architectonics of trans storytelling. According to Felton-Dansky, “Changing the format of communication might change not only how we talk to one another but also what long-lost phantoms we might be able to access anew.”
Quantification and correction of distortion in diffusion-weighted MRI at 1.5 and 3 T in a muscle-invasive bladder cancer phantom for radiotherapy planning
Authors: Rogers Jane , Sherwood Victoria , Wayte Sarah C. , Duffy Jonathan A. , Manolopoulos Spyros
Published: July 2020

Objective:

Limited visibility of post-resection muscle-invasive bladder cancer (MIBC) on CT hinders radiotherapy dose escalation of the residual tumour. Diffusion-weighted MRI (DW-MRI) visualises areas of high tumour burden and is increasingly used within diagnosis and as a biomarker for cancer. DW-MRI could, therefore, facilitate dose escalation, potentially via dose-painting and/or accommodating response. However, the distortion inherent in DW-MRI could limit geometric accuracy. Therefore, this study aims to quantify DW-MRI distortion via imaging of a bladder phantom.

Methods:

A phantom was designed to mimic MIBC and imaged using CT, DW-MRI and T2W-MRI. Fiducial marker locations were compared across modalities and publicly available software was assessed for correction of magnetic susceptibility-related distortion.

Results:

Fiducial marker locations on CT and T2W-MRI agreed within 1.2 mm at 3 T and 1.8 mm at 1.5 T. The greatest discrepancy between CT and apparent diffusion coefficient (ADC) maps was 6.3 mm at 3 T, reducing to 1.8 mm when corrected for distortion. At 1.5 T, these values were 3.9 mm and 1.7 mm, respectively.

Conclusions:

Geometric distortion in DW-MRI of a model bladder was initially >6 mm at 3 T and >3 mm at 1.5 T; however, established correction methods reduced this to <2 mm in both cases.

Advances in knowledge:

A phantom designed to mimic MIBC has been produced and used to show distortion in DW-MRI can be sufficiently mitigated for incorporation into the radiotherapy pathway. Further investigation is therefore warranted to enable individually adaptive image-guided radiotherapy of MIBC based upon DW-MRI.
The evolution of interventional oncology in the 21st century
Authors: Helmberger Thomas
Published: July 2020

Interventional oncology (IO) has proven to be highly efficient in the local therapy of numerous malignant tumors in addition to surgery, chemotherapy, and radiotherapy. Due to the advent of immune-oncology with the possibility of tumor control at the molecular and cellular levels, a system change is currently emerging. This will significantly rule oncology in the coming decades. Therefore, one cannot think about IO in the 21st century without considering immunology. For IO, this means paying much more attention to the immunomodulatory effects of the interventional techniques, which have so far been neglected, and to explore the synergistic possibilities with immuno-oncology. It can be expected that the combined use of IO and immuno-oncology will help to overcome the limitations of the latter, such as limited local effects and a high rate of side-effects. To do this, however, sectoral boundaries must be removed and interdisciplinary research efforts must be strengthened. In case of success, IO will face an exciting future.
Multiparametric MRI with diffusion-weighted imaging in predicting response to chemotherapy in cases of osteosarcoma and Ewing’s sarcoma
Authors: Saleh Mahmoud Mohamed , Abdelrahman Tamer Moustafa , Madney Youusef , Mohamed Ghada , Shokry Ahmed Mohammed , Moustafa Amr Farouk
Published: July 2020

Objective:

To evaluate the multiparametric MRI in predicting chemotherapy response in pathologically proven cases of osteosarcoma and Ewing’s sarcoma. Correlation between the tumor size changes and internal breakdown using RECIST 1.1, modified RECIST, quantitative apparent diffusion coefficient (ADC) and tumor volume as well as dynamic contrast-enhanced MRI (DCE-MRI).

Methods:

The study included 104 patients pathologically proved osteosarcoma (53) and Ewing`s sarcoma (51) underwent MRI examinations; before and after chemotherapy. All patients were assessed using the RECIST 1.1 criteria, m-RECIST, quantitative ADC, and tumor volume evaluation. 21 patients underwent DCE-MRI curve type with quantitative parameters. Correlation between the different evaluations was carried out. Results were correlated with the post-operative pathology in 42 patients who underwent surgery and for statistical evaluation, Those patients were classified into responders (≥90% necrosis) and non-responders (<90% necrosis).

Results:

The initial mean ADC of 104 patients of osteosarcoma and Ewing’s sarcoma (0.90 ± 0.29) and (0.71 ± 0.16) respectively, differed significantly from that after treatment (1.62 ± 0.46) and (1.6 ± 0.39) respectively with (p<0.001). ADC variations (ADC%) in the non-progressive group were higher than those of the progressive group (128.3 ± 63.49 vs 36.34 ± 78.7) % with (p<0.001). ADC values and ADC variations were inversely correlated with morphologic changes, regardless of the effectiveness of chemotherapy expressed as changes in tumor size based on (RECIST 1.1, RECIST, and 3D volume). Linear regression analysis revealed a Pearson correlation coefficient of r=-0.427, -0.498 and -0.408, respectively with (p<0.001). An increase in the ADC value was not always associated with a reduction in tumor volume. The disease control rate (defined as the percentage of CR+PR+SD patients) was 89.4% and 93.9% according to RECIST 1.1 and m-RECIST respectively. 42 out of the 104 patients had postsurgical histological evaluation as regards the chemotherapeutic response divided into two groups. ADC values showed a statistically significant difference between Group A and Group B being more evident with minimum ADC% (p<0.001).

Conclusion:

Quantitative diffusion-weighted imaging with ADC mapping and ADC % after chemotherapy allows a detailed analysis of the treatment response in osteosarcoma and Ewing’s sarcoma. The therapeutic response can be underestimated using RECIST 1.1, so the modified RECIST should be also considered.

Advances in knowledge:

Quantitative ADC especially ADC% provided an accurate non-invasive tool in the assessment of post-therapeutic cases of osteosarcoma and Ewing's sarcoma
Biomarkers in the setting of benign prostatic hyperplasia-induced lower urinary tract symptoms: what an interventional radiologist needs to know
Authors: Young Shamar , Gasparetto Alessandro , Jalaeian Hamed , Golzarian Jafar
Published: July 2020

With increasing evidence to support prostate artery embolization (PAE) in the treatment of benign prostatic hyperplasia (BPH)-induced lower urinary tract symptoms (LUTS), Interventional Radiologists have begun to play an important role in the management of these patients. One area of knowledge needed when developing a PAE practice is knowledge of prostate-specific antigen (PSA) and other biomarkers utilized to detect prostate cancer in this population and what role they should play in the work up and follow-up of patients presenting with presumed BPH-induced LUTS. Furthermore, understanding how to evaluate presumed BPH-induced LUTS and stratify the risk of prostate cancer is an important skill to develop. The goal of this review is to provide Interventional Radiologists who have begun or aim to begin a PAE practice with the information they need to know regarding PSA levels and prostate cancer risk stratification for this patient population.
Corrosive injury of the upper gastrointestinal tract: the evolving role of a radiologist
Authors: Agarwal Ayushi , Srivastava Deep Narayan , Madhusudhan Kumble Seetharama
Published: July 2020

Corrosive injury is a devastating injury which carries significant morbidity. The upper gastrointestinal tract is predominantly affected with severity ranging from mild inflammation to full thickness necrosis which may result in perforation and death. Among the complications, stricture formation is most common, causing dysphagia and malnutrition. Endoscopy has a pivotal role in the diagnosis and management, with a few shortcomings. Imaging has an important role to play. Besides radiography, there is an increasing role of CT scan in the emergency setting with good accuracy in identifying patients who are likely to benefit from surgery. Further, CT scan has a role in the diagnosis of complications. Oral contrast studies help in assessing the severity and extent of stricture formation and associated fistulous complications in the subacute and chronic phase. The scope of intervention radiology for this condition is increasing. Fluoroscopy-guided balloon dilatation, drainage of collections or mucoceles, endovascular embolization of point bleeders, placement of feeding jejunostomy and image-guided biopsy are among the procedures that are being performed. Through this review we aim to stress the role the radiologist plays in the diagnosis and follow-up of these patients and in performing radiological interventions. Besides this, we have also highlighted few salient points to help understand the pathophysiology and management of such injuries which is paramount to ensure a good long-term outcome.
Epicardial fat attenuation, not volume, predicts obstructive coronary artery disease and high risk plaque features in patients with atypical chest pain
Authors: Pandey Niraj Nirmal , Sharma Sanjiv , Jagia Priya , Kumar Sanjeev
Published: July 2020

Objective:

This study sought to investigate the association between volume and attenuation of epicardial fat and presence of obstructive coronary artery disease (CAD) and high-risk plaque features (HRPF) on CT angiography (CTA) in patients with atypical chest pain and whether the association, if any, is independent of conventional cardiovascular risk factors and coronary artery calcium score (CACS).

Methods:

Patients referred for coronary CTA with atypical chest pain and clinical suspicion of CAD were included in the study. Quantification of CACS, epicardial fat volume (EFV) and epicardial fat attenuation (EFat) was performed on non-contrast images. CTA was evaluated for presence of obstructive CAD and presence of HRPF.

Results:

255 patients (median age [interquartile range; IQR]: 51[41-60] years, 51.8% males) were included. On CTA, CAD, obstructive CAD (≥50% stenosis) and CTA-derived HRPFs was present in 133 (52.2%), 37 (14.5%) and 82 (32.2%) patients respectively. A significantly lower EFat was seen in patients with obstructive CAD than in those without (−86HU [IQR:−88 to −82 HU] vs −84 [IQR:−87 HU to −82 HU]; p = 0.0486) and in patients with HRPF compared to those without (−86 HU [IQR:−88 to −83 HU] vs −83 HU [−86 HU to −81.750 HU]; p < 0.0001). EFat showed significant association with obstructive CAD (unadjusted Odd’s ratio (OR) [95% CI]: 0.90 [0.81–0.99];p = 0.0248) and HRPF (unadjusted OR [95% CI]: 0.83 [0.76–0.90];p < 0.0001) in univariate analysis, which remained significant in multivariate analysis. However, EFV did not show any significant association with neither obstructive CAD nor HRPF in multivariate analysis. Adding EFat to conventional coronary risk factors and CACS in the pre-test probability models increased the area-under curve (AUC) for prediction of both obstructive CAD (AUC[95% CI]: 0.76 [0.70–0.81] vs 0.71 [0.65–0.77)) and HRPF (AUC [95% CI]: 0.92 [0.88–0.95] vs 0.89 [0.85–0.93]), although not reaching statistical significance.

Conclusion:

EFat, but not EFV, is an independent predictor of obstructive CAD and HRPF. Addition of EFat to traditional cardiovascular risk factors and CACS improves estimation for pretest probability of obstructive CAD and HRPF.

Advances in knowledge:

EFat is an important attribute of epicardial fat as it reflects the “quality” of fat, taking into account the effects of brown-white fat transformation and fibrosis, as opposed to mere evaluation of “quantity” of fat by EFV. Our study shows that EFat is a better predictor of obstructive CAD and HRPF than EFV and can thus explain the inconsistent association of increased EFV alone with CAD.
The implementation of an empty bladder filling protocol for localised prostate volumetric modulated arctherapy (VMAT): early results of a single institution service evaluation
Authors: Chetiyawardana Gayan , Hoskin Peter J. , Tsang Yat Man
Published: July 2020

Objective:

To examine the impact of an empty bladder filling protocol on patients receiving radical RT for localised prostate cancer on post RT toxicity and biochemical progression free survival (bPFS).

Methods and materials:

Records of patients receiving radical external beam RT (EBRT) for localised prostate cancer with a full or empty bladder were reviewed. These included the bladder size on planning CT, daily online image guided RT (IGRT) setup data, treatment time and post treatment follow up data.These included bPFS, gastrointestinal(GI) and genitourinary(GU) toxicity scoring post RT using the CTCAE v4.0 scoring system. All patients included in the study were planned and treated under the same departmental clinical protocol with VMAT and daily online IGRT corrections.

Results:

90 patients were treated with 60 Gy in 20 fractions with a median follow up of 48 months. At 4 years bPFS in the empty bladder group was 100 and 98% in the full bladder group (p = 0.27). There were no statistically significant differences in cumulative ≥Grade 2GU (p = 0.10) and GI (p = 0.27) toxicity rates between the two bladder filling protocols. No statistically significant differences in the IGRT setup between the two groups of patients. Although the median treatment times per fraction were not statistically different between the two groups (p = 0.47), patients in the full bladder filling group were required to spend a longer time in the RT department per treatment session for bladder filling.

Conclusion:

An empty bladder filling protocol has non-inferior bPFS, GI and GU toxicities at 4 years in patients with localised prostate cancer using advanced RT techniques in comparison to a full bladder filling protocol. A longer follow up with a larger sample size is required to validate this approach.

Advances in knowledge:

This study suggests that an empty bladder filling protocol can be used in external beam EBRT for localised prostate cancer with non-inferior treatment outcomes.