bluuebunny/crossref_metadata_2025 huggingface dataset:
ELECTOR: evaluator for long reads correction methods
Authors: Marchet Camille , Morisse Pierre , Lecompte Lolita , Lefebvre Arnaud , Lecroq Thierry , Peterlongo Pierre , Limasset Antoine
Published: November 2019

The error rates of third-generation sequencing data have been capped >5%, mainly containing insertions and deletions. Thereby, an increasing number of diverse long reads correction methods have been proposed. The quality of the correction has huge impacts on downstream processes. Therefore, developing methods allowing to evaluate error correction tools with precise and reliable statistics is a crucial need. These evaluation methods rely on costly alignments to evaluate the quality of the corrected reads. Thus, key features must allow the fast comparison of different tools, and scale to the increasing length of the long reads. Our tool, ELECTOR, evaluates long reads correction and is directly compatible with a wide range of error correction tools. As it is based on multiple sequence alignment, we introduce a new algorithmic strategy for alignment segmentation, which enables us to scale to large instances using reasonable resources. To our knowledge, we provide the unique method that allows producing reproducible correction benchmarks on the latest ultra-long reads (>100 k bases). It is also faster than the current state-of-the-art on other datasets and provides a wider set of metrics to assess the read quality improvement after correction. ELECTOR is available on GitHub (https://github.com/kamimrcht/ELECTOR) and Bioconda.
Male hormone-interfering drugs and meningioma development
Authors: Giraldi Laura , Hansen Jørgen Vinsløv , Wohlfahrt Jan , Melbye Mads , Fugleholm Kåre , Munch Tina Nørgaard
Published: November 2019

Background

Extremely strong associations between male hormone-interfering drugs and meningiomas have been reported in two previous studies, but these findings are limited by small size of the study populations and possibly by surveillance- and selection bias. Thus, such possible and indeed very interesting association must be investigated in a large, unselected cohort. Accordingly, the aim of this study was to determine whether patients exposed to male hormone-interfering drugs had a higher risk of meningioma development in a nationwide cohort study.

Methods

A retrospective Danish nationwide cohort study with follow-up from January 1, 1996 to December 31, 2016. Exposure was use of male hormone-interfering drugs (5-α-reductase-inhibitors, luteinizing hormone-releasing hormone agonist, steroidal antiandrogen, and nonsteroidal antiandrogen). Hazard ratio of first-time diagnosis of meningioma according to drug use was estimated using Cox proportional hazards model with adjustment for age and birth year.

Results

The cohort included 244,696 men of which 64,047 had used male hormone-interfering drugs. Overall 444 meningiomas occurred during follow-up. No significant association was observed between use of male hormone-interfering drugs and the occurrence of meningioma (hazard ratio 1.02, 95% confidence interval 0.82–1.27). Similar results were observed 0–1, 2–4, and 5+ years after first use. In explorative analyses, no elevated risk association was observed for specific drugs (5-α-reductase-inhibitors, luteinizing hormone-releasing hormone agonist, steroidal antiandrogen, and nonsteroidal antiandrogen).

Conclusion

As opposed to previous studies, we found no evidence of an increased risk of meningioma in men treated with male hormone-interfering drugs.
Diagnosis and management of malignant peripheral nerve sheath tumors: Current practice and future perspectives
Authors: Prudner Bethany C , Ball Tyler , Rathore Richa , Hirbe Angela C
Published: November 2019

One of the most common malignancies affecting adults with the neurofibromatosis type 1 (NF1) cancer predisposition syndrome is the malignant peripheral nerve sheath tumor (MPNST), a highly aggressive sarcoma that typically develops from benign plexiform neurofibromas. Approximately 8–13% of individuals with NF1 will develop MPNST during young adulthood. There are few therapeutic options, and the vast majority of people with these cancers will die within 5 years of diagnosis. Despite efforts to understand the pathogenesis of these aggressive tumors, the overall prognosis remains dismal. This manuscript will review the current understanding of the cellular and molecular progression of MPNST, diagnostic workup of patients with these tumors, current treatment paradigms, and investigational treatment options. Additionally, we highlight novel areas of preclinical research, which may lead to future clinical trials. In summary, MPNST remains a diagnostic and therapeutic challenge, and future work is needed to develop novel and rational combinational therapy for these tumors.
Nitrate Induction of Primary Root Growth Requires Cytokinin Signaling in Arabidopsis thaliana
Authors: Naulin Pamela A , Armijo Grace I , Vega Andrea S , Tamayo Karem P , Gras Diana E , de la Cruz Javiera , Gutiérrez Rodrigo A
Published: November 2019

Nitrate can act as a potent signal to control growth and development in plants. In this study, we show that nitrate is able to stimulate primary root growth via increased meristem activity and cytokinin signaling. Cytokinin perception and biosynthesis mutants displayed shorter roots as compared with wild-type plants when grown with nitrate as the only nitrogen source. Histological analysis of the root tip revealed decreased cell division and elongation in the cytokinin receptor double mutant ahk2/ahk4 as compared with wild-type plants under a sufficient nitrate regime. Interestingly, a nitrate-dependent root growth arrest was observed between days 5 and 6 after sowing. Wild-type plants were able to recover from this growth arrest, while cytokinin signaling or biosynthesis mutants were not. Transcriptome analysis revealed significant changes in gene expression after, but not before, this transition in contrasting genotypes and nitrate regimes. We identified genes involved in both cell division and elongation as potentially important for primary root growth in response to nitrate. Our results provide evidence linking nitrate and cytokinin signaling for the control of primary root growth in Arabidopsis thaliana.
Efficient root metabolism improves drought resistance of Festuca arundinacea
Authors: Perlikowski Dawid , Augustyniak Adam , Skirycz Aleksandra , Pawłowicz Izabela , Masajada Katarzyna , Michaelis �nne , Kosmala Arkadiusz
Published: November 2019

Festuca arundinacea is a model to work on the mechanisms of drought resistance in grasses. The crucial components of that resistance still remain not fully recognized. It was suggested that deep root system could be a crucial trait for drought avoidance strategy but the other components of root performance under water deficit have not paid much attention of scientists. In this study, two genotypes of F. arundinacea with a different ability to withstand soil water deficit were selected to perform comprehensive research, including analysis of root architecture, phytohormones, proteome, primary metabolome and lipidome under progressive stress conditions, followed by a rewatering period. The experiments were performed in tubes, thus enabling undisturbed development of root systems. We demonstrated that long roots are not sufficient to perfectly avoid drought damage in F. arundinacea and to withstand adverse environmental conditions without a disturbed cellular metabolism (with respect to leaf relative water potential and cellular membrane integrity). Furthermore, we proved that metabolic performance of roots is as crucial as its architecture under water deficit, to cope with drought stress via avoidance, tolerance and regeneration strategies. We believe that the presented studies could be a good reference for the other, more applied experiments, in closely related species.
Home Bias and Local Contagion: Evidence from Funds of Hedge Funds
Authors: Sialm Clemens , Sun Zheng , Zheng Lu
Published: November 2019

Our paper analyzes the geographical preferences of hedge fund investors and the implication of these preferences for hedge fund performance. We find that funds of hedge funds overweigh their investments in hedge funds located in the same geographical areas and that funds with a stronger local bias exhibit superior performance. Local bias also gives rise to excess flow comovement and extreme return clustering within geographic areas. Overall, our results suggest that while funds of funds benefit from local advantages, their local bias also creates market segmentation that can destabilize the underlying hedge funds.
Teaching Evidence-Based Medicine to Medical Students Using Wikipedia as a Platform
Authors: Murray Heather , Walker Melanie , Dawson Jennifer , Simper Natalie , Maggio Lauren A.
Published: November 2019

Problem

While ideal curricular structures for effective teaching of evidence-based medicine (EBM) have not been definitively determined, optimal strategies ensure that EBM teaching is interactive and clinically based, aligns with major trends in education and health care, and uses longitudinally integrated, whole-task activities.

Approach

The authors developed a longitudinal, semester-long project, embedded in a first-year medicine course, through which they taught EBM using Wikipedia as a platform. Students worked individually and in small groups to choose a medicine-related Wikipedia article, identify information gaps, search for high-quality resources, appraise the sources, and incorporate the new information into the article (i.e., by editing Wikipedia). Students also applied their new appraisal skills to critique a second article. The authors used an online tool to track and record student editing, and they obtained qualitative data on student perceptions of the project via survey. Duplicate marking of a sample of assignments was performed using the Valid Assessment of Learning in Undergraduate Education critical thinking rubric developed by Finley and Rhodes.

Outcomes

In fall 2017, 101 students made over 1,000 unique edits to 16 online Wikipedia articles, adding over 10,000 words. Through thematic analysis of qualitative data, the authors highlighted several aspects of the project that students appreciated, as well as barriers related to completing their projects. Correlation of the 17 consenting students’ final assignments with the critical thinking rubric supports the assignment structure as a tool for assessing critical thinking.

Next Steps

This authentic task adheres to the principles of high-quality EBM instruction and could be implemented by a variety of health care educational programs. Modifications to the delivery model are underway to address challenges identified.
Internal Medicine Residency Program Directors’ Screening Practices and Perceptions About Recruitment Challenges
Authors: Angus Steven V. , Williams Christopher M. , Stewart Emily A. , Sweet Michelle , Kisielewski Michael , Willett Lisa L.
Published: November 2019

Purpose

To examine internal medicine residency program directors’ (PDs’) screening practices and perceptions about current recruitment challenges.

Method

In March–May 2017, the Association of Program Directors in Internal Medicine Survey Committee sent a survey to 373 Alliance for Academic Internal Medicine member residency programs. PDs rated the importance of 23 inclusion and 11 exclusion criteria for interview invitation decision making, provided United States Medical Licensing Examination (USMLE) cutoff scores for U.S. medical school and international medical graduates, and indicated changes in recruitment practices due to application inflation, including their ability to conduct holistic review and interest in potential solutions to address application inflation. Exploratory factor analysis was used to identify and confirm factors that were most important to interview invitation decision making.

Results

The response rate for eligible programs was 64% (233/363). USMLE Step 2 Clinical Knowledge scores were the criteria most frequently reported to be “very important” (131/233, 57%). Among respondents who reported any criteria as “very important,” 155/222 (70%) identified a single most important (SMI) criterion. Non-USMLE criteria were frequently reported as an SMI criterion (68%). Concerning exclusion criteria, 157/231 (68%) reported they “absolutely would not invite” applicants with hints of unprofessional behavior. Of the 214/232 (92%) who reported an increase in applications, 138 (64%) adjusted recruitment practices. Respondents were most interested in limiting the number of applications per applicant (163/231, 71%), allowing applicants to indicate high interest in a subset of programs (151/229, 66%), and creating a national database of qualities of matched applicants for each program (121/228, 53%).

Conclusions

PDs rely heavily on USMLE scores when making interview invitation decisions. However, collectively, non-USMLE criteria were more frequently reported as an SMI criterion. Most programs adjusted recruitment practices to respond to application volume. Several potential solutions to address application inflation garnered wide support.
A new anchoring technique for tibialis anterior tendon transfer
Authors: Yasin Ebeed S. , Amin Hosam E. , Ghani Hisham A.
Published: November 2019

Tibialis anterior tendon transfer was described as an effective method in the management of dynamic supination as well as prevention of clubfoot relapse in children. Different successful methods were described for anchoring the transferred tibialis anterior tendon; however, each of which has its own complications that were avoided by using this novel technique. This study included 26 feet in 18 patients, who underwent tibialis anterior tendon transfer as a part of management of their congenital clubfoot. The mean age was 3.6 years (ranging from 2.5 to 5 years), all patients were followed up for 6 to 30 months (mean = 14 months). The transferred tibialis anterior tendon was anchored in the third cuneiform using transfixing K wires. This novel technique resulted in successful and stable anchoring of the transferred tibialis anterior tendon. The transferred tendon was well palpated in all patients with active dorsiflexion, with no associated tendon rupture, anchoring problems, or wound complication. Our technique is secure, reliable, and economic with no special equipment needed. It could successfully avoid the plantar skin complications associated with pullout sutures and neurovascular injury.
Critical Care Management of Toxicities Associated With Targeted Agents and Immunotherapies for Cancer
Authors: Gutierrez Cristina , McEvoy Colleen , Munshi Laveena , Stephens R. Scott , Detsky Michael E. , Nates Joseph L. , Pastores Stephen M.
Published: November 2019

Objectives:

To describe the most common serious adverse effects and organ toxicities associated with emerging therapies for cancer that may necessitate admission to the ICU.

Data Sources and Study Selection:

PubMed and Medline search of relevant articles in English on the management of adverse effects of immunotherapy for cancer.

Data Extraction and Data Synthesis:

Targeted therapies including tyrosine kinase inhibitors, monoclonal antibodies, checkpoint inhibitors, and immune effector cell therapy have improved the outcome and quality of life of patients with cancer. However, severe and life-threatening side effects can occur. These toxicities include infusion or hypersensitivity reactions, cytokine release syndrome, pulmonary, cardiac, renal, hepatic, and neurologic toxicities, hemophagocytic lymphohistiocytosis, opportunistic infections, and endocrinopathies. Cytokine release syndrome is the most common serious toxicity after administration of monoclonal antibodies and immune effector cell therapies. Most of the adverse events from immunotherapy results from an exaggerated T-cell response directed against normal tissue, resulting in the generation of high levels of proinflammatory cytokines. Toxicities from targeted therapies are usually secondary to “on target toxicities.” Management is largely supportive and may include discontinuation of the specific agent, corticosteroids, and other immune suppressing agents for severe (grade 3 or 4) immune-related adverse events like neurotoxicity and pneumonitis.

Conclusions:

The complexity of toxicities associated with modern targeted and immunotherapeutic agents for cancer require a multidisciplinary approach among ICU staff, oncologists, and organ specialists and adoption of standardized treatment protocols to ensure the best possible patient outcomes.
Nonparametric Population Pharmacokinetic Modeling of Isoniazid in Colombian Patients With Tuberculosis
Authors: Rodriguez Carlos A. , Zuluaga Andres F. , Neely Michael N. , Sierra Yamile , Morales-Gutierrez Jessica , Zapata Julian , Zapata Juan D. , Naranjo Tonny W. , Agudelo Yuli
Published: November 2019

Background:

Isoniazid (INH) is a first-line antituberculosis (TB) agent with a pharmacokinetic profile characterized by high interindividual variation; however, population pharmacokinetic studies in patients with TB are scarce. The aim was to develop a population model for INH in Colombian patients with TB suitable for predicting drug exposure and assessing the probability of target attainment of pharmacodynamic goals.

Methods:

Ten hospitalized adult patients with TB undergoing INH treatment were recruited. After an 8-hour fasting, subjects took 300 mg of INH, and 10 samples were taken from 0 to 12 hours. INH was quantified by high-performance liquid chromatography–UV, and data were analyzed with the Pmetrics R package software. A Monte Carlo simulation with the model parameters was run to determine the probability of target attainment for optimal efficacy.

Results:

The best model included 2 compartments, first-order absorption (Ka), delayed absorption (Tlag), and linear clearance (CL). Median Tlag was 0.25 hours, 5.54 hour−1 for Ka,

JOURNAL/thdm/04.03/00007691-201912000-00005/inline-formula1/v/2023-08-14T203520Z/r/image-tiff

for CL,

JOURNAL/thdm/04.03/00007691-201912000-00005/inline-formula2/v/2023-08-14T203520Z/r/image-tiff

for the volume of the central compartment (Vc), 1.04 L/h for intercompartmental clearance (Q), and 788 L for the volume of the peripheral compartment (Vp). CL and Vc were allometrically scaled on basis of the normalized body weight.

Conclusions:

The Monte Carlo simulation indicated that 300 mg of INH per day is appropriate for Mycobacterium tuberculosis strains with minimal inhibitory concentration (MIC) up to 0.03 mg/L (target: area under the concentration–time curve/MIC >597); however, to cover strains with MIC up to 0.125 mg/L (80% of clinical isolates), a dose of 900 mg per day would be required.
Lymphedema Liposuction with Immediate Limb Contouring
Authors: Chen Wei F. , Zeng Wei-Feng , Hawkes Patrick J , Man Jeanette , Bowen Mindy
Published: November 2019

Background:

Liposuction is the treatment of choice for solid predominant extremity lymphedema. The classic lymphedema liposuction technique does not remove skin excess created following bulk removal. The skin excess is presumed to resolve with spontaneous skin contracture. We investigated the technique of simultaneously performing liposuction with immediate skin excision in patients with solid predominant lymphedema and compared the outcome with that from the classic technique.

Methods:

Modified liposuction with skin excision (mLIPO) and standard liposuction without skin excision (sLIPO) were offered to patients with solid predominant extremity lymphedema. Skin traction of 4 cm and undulating skin mobility constituted positive “flying squirrel” sign. Patients with negative “flying squirrel” sign were excluded. mLIPO patients underwent skin excision. Surgical outcomes and postoperative complications were compared.

Results:

The study enrolled 15 and 26 patients into the sLIPO and mLIPO groups, respectively. mLIPO patients demonstrated statistically significant decrease in seroma/hematoma, contour irregularity, and skin necrosis, while experiencing increased procedural satisfaction.

Conclusions:

Skin excision following liposuction for solid predominant lymphedema is safe. It decreases postoperative complication and improves surgical outcome.
ASSOCIATION OF TREATMENT RESPONSE WITH QUANTITATIVE CHANGES IN CHOROIDAL NEOVASCULARIZATION AND CHOROIDAL VESSEL IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Lee Hyungwoo , Lee Minsub , Kim Myung Ae , Chung Hyewon , Kim Hyung Chan
Published: November 2019

Purpose:

To evaluate the association between treatment response and quantitative morphological changes in choroidal neovascularization and outer choroidal vessels using optical coherence tomography angiography (OCTA) and en face OCT in neovascular age-related macular degeneration (nAMD).

Methods:

We retrospectively analyzed 75 eyes of typical nAMD patients and 53 polypoidal choroidal vasculopathy eyes of 124 patients with OCTA performed at least 6 months after initial antivascular endothelial growth factor treatment. Quantitative parameters, including vessel area, vessel diameter, branch vessel length, fractal dimension, and lacunarity were analyzed based on en face images of the choroidal neovascularization and choroidal vessel in Haller's layer. Parameters associated with loss of logarithm of the minimum angle of resolution visual acuity with the basis of 0.3 and the treatment interval (good vs. poor responder based on 12 weeks) were analyzed. Analyses were conducted for “before OCTA” (initial visit to OCTA) and “after OCTA” (OCTA to 6 months post-OCTA).

Results:

In typical nAMD, visual acuity loss before OCTA was associated with a higher SD of choroidal neovascularization diameter and lower choroidal fractal dimension. Visual acuity loss after OCTA in typical nAMD was associated with higher lacunarity of the choroid. Poor responders before OCTA were not associated with any factor. Poor responders after OCTA were associated with a lower SD of outer choroidal vessel diameter in typical nAMD. In polypoidal choroidal vasculopathy, no factor was associated with clinical outcomes in either period.

Conclusion:

Quantitative analyses of choroidal neovascularization on OCTA and choroidal vessels on en face OCT provide information about treatment response, including changes in visual acuity and treatment interval, in nAMD.
LATE RECURRENCE OF CHOROIDAL NEOVASCULARIZATION IN PATIENTS WITH MULTIFOCAL CHOROIDITIS: CLINICAL SURVEILLANCE IN PERPETUITY
Authors: Orellana-Rios Jorge , Leong Belinda C. S. , Fernández-Avellaneda Pedro , Gattoussi Sarra , Freund K. Bailey , Yannuzzi Lawrence A.
Published: November 2019

Purpose:

To report a very late recurrence of choroidal neovascularization (CNV) in elderly patients with noninfectious multifocal choroiditis (MFC).

Methods:

Retrospective case series of patients with MFC with confirmed recurrence of CNV. Choroidal neovascularization was diagnosed with multimodal imaging, including optical coherence tomography angiography. Multifocal choroiditis–associated CNV eyes were treated with intravitreal injections of anti–vascular endothelial growth factor medication.

Results:

Four eyes of three patients were included in our study, with a mean (range) age of 73 years (67–78). The period between the original CNV and the recurrence was 53 years, with a range of 48–60 years. The mean number (range) of injections given after the late recurrence per eye was 7 (5–11). The mean duration (range) of follow-up post-treatment initiation was 93 (40–122) weeks. All eyes improved to 20/30 visual acuity or better at 6 months after initial treatment.

Conclusion:

Patients with MFC are never exempt from recurrent CNV, warranting follow-up in perpetuity. Age-related factors are important to consider which may increase the susceptibility for activating MFC-associated CNV in elderly people. Macular neovascularization could respond to a standard approach to management, in these patients with MFC, by a judicious use of intravitreal injections of anti–vascular endothelial growth factor therapy.
Career Development Training for Interventional Pulmonary Fellows
Authors: Shafiq Majid , Akulian Jason , Desai Neeraj , French Kim , Sachdeva Ashutosh , Lamb Carla , Shojaee Samira , Argento Angela C. , Lee Hans J.
Published: November 2019

Background:

Interventional pulmonary (IP) fellows spend ≥6 years of postgraduate medical education before IP training. Given the high employment attrition rates of early medical professionals, we investigated the IP fellows’ self-assessed readiness for employment and the role of an intense preemployment educational intervention on improving the same.

Materials and Methods:

Over 2 consecutive academic years, IP fellows nationally were invited to a mid-year career development symposium focusing on employment search strategy and early career development. Attendees were anonymously surveyed presymposium/postsymposium and 6 months later at graduation. Both quantitative and qualitative data were collected. Attendees’ knowledge and skills were rated on a 5-point Likert scale. A control group of IP fellows that did not attend the symposium were also surveyed at graduation.

Results:

In total, 53 of 55 attendees (96% response rate) completed the presymposium survey and 50 of 55 (91%) completed the final survey at graduation. Overall, 16 of 18 (89%) nonattendees also completed the final survey at graduation. IP Fellows reported low baseline self-assessment scores on all question domains. Scores increased significantly postsymposium and were sustained at graduation (P<0.05). At graduation, the average response score of symposium attendees was significantly higher than that of nonattendees (P=0.04). Overall, 84% reported that the symposium helped them with their employment search.

Conclusion:

Advanced IP fellows were not well-equipped for a strategic employment search and early career development at the onset of their IP fellowship training. Participation in an intense educational intervention significantly improved fellows’ self-assessment scores, an effect that was sustained at 6 months.
Clinical Presentation, Management, and Outcomes of Idiopathic Pain in Percutaneous Bone-anchored Hearing Implants
Authors: Caspers Coosje Jacoba Isabella , Nelissen Rik Chrétien , Verhamme Luc Martijn , Meijer Frederick Jan Anton , Mylanus Emmanuel Antonius Maria , Hol Myrthe Karianne Sophie
Published: November 2019

Objective:

To identify clinical features and investigate treatment outcomes of patients with idiopathic pain related to a percutaneous bone-anchored hearing implant (BAHI) and to propose management recommendations.

Study Design:

Retrospective chart analysis.

Setting:

Tertiary referral center.

Patients:

The clinical data of 14 patients who were treated for idiopathic pain around their percutaneous BAHI between May 2007 and February 2018 at our tertiary referral center were reviewed.

Main Outcome Measures:

Pain after treatment and implant loss.

Results:

All 14 patients received treatment with oral antibiotics. Nine patients received oral antibiotic combination therapy for 4 weeks, whereafter pain resolved in 4. Out of the five other patients, receiving either antibiotic monotherapy or shortened antibiotic combination therapy, pain resolved in two. In case of persistent pain (57.1%) after initial treatment, other pain management therapies were attempted, however all with only limited effect. Six patients (42.8%) underwent elective removal of the implant. In two patients spontaneous implant loss occurred. In two of the four patients who underwent reimplantation, pain relapsed. In one of these, pain resolved after the removal of the new implant. In the other patient, pain persisted, despite abutment removal. With exception of this latter patient, all other 13 patients were pain free at the latest follow-up. Cone beam computed tomography did not offer additional information regarding diagnosis or treatment.

Conclusion:

Idiopathic pain in BAHI is a rare but bothersome symptom which can result in implant removal. After oral antibiotic combination treatment, symptoms resolved in approximately 40% of patients. Therefore, we think conservative treatment with these antibiotics before implant removal surgery, is worth considering.
Retrospective analysis of brain abscess in 183 patients
Authors: Wu Shenglian , Wei Yiting , Yu Xiaobo , Peng Yucong , He Pingyou , Xu Hangzhe , Qian Cong , Chen Gao
Published: November 2019

This study aims to identify predictive factors related to clinical outcome, reoperation, and complications in patients with brain abscess.

Patients with a diagnosis of brain abscess at discharge at the Second Affiliated Hospital of Zhejiang University School of Medicine between 2008 and 2018 were reviewed. Logistic regression was used to identify predictive factors associated with Glasgow Outcome Scale (GOS) at discharge, GOS at 1 year after discharge, reoperation and complications.

Among 183 patients enrolled into the study, 142 patients had a good outcome at discharge (GOS ≥ 4) and 41 had a poor outcome (GOS ≤ 3). During the follow-up period, 20 additional patients had a good outcome. A total of 156 patients were treated by open craniotomy excision (n = 72) and aspiration (n = 84), 10 of whom underwent reoperation. Complications in surgical patients for brain abscess occurred in 54 patients. Poor outcome was related to Glasgow coma scale (P = .007) and ventricular proximity (P = .001). Surgical method was associated with reoperation (P = .04) and complications (P < .001). Seizure at admission was related to epilepsy (P < .001). Surgical method was related to postoperative intracranial hemorrhage (P = .02).

Glasgow coma scale (GCS) and ventricular proximity were associated with poor outcome. Further, patients who underwent aspiration were more likely to experience reoperation, while open craniotomy excision (OCE) was related to complications. Patients presenting seizure at admission were more likely to develop epilepsy. Patients who underwent OCE tended to experience postoperative intracranial hemorrhage.
Reversible posterior leukoencephalopathy syndrome following apatinib for gastric cancer in an adult
Authors: Lv Yajuan , Zhang Yan , Zhang Jiandong , Liang Ning , Liu Fengjun , Liu Ruixue
Published: November 2019

Rationale:

Reversible posterior leukoencephalopathy syndrome (RPLS) is characterized by rapidly progressive hypertension, headache, and disturbance of consciousness. Moreover, RPLS is rarely reported after apatinib treatment.

Patient concerns:

We present a case of RPLS induced by apatinib in this report. The patient had dizziness and bilateral lower limb weakness after apatinib use for 12 days.

Diagnosis and interventions:

Cranial T2-weighted magnetic resonance imaging (MRI) revealed symmetrical increased signal intensity in bilateral areas of the basal ganglia, radiation crown, frontal lobe, parietal lobe, and occipital lobe, which was suggestive of RPLS. The patient discontinued apatinib use and was administered dexamethasone, mannitol, and antihypertensive drugs.

Outcomes:

The patient's blood pressure returned to normal and neurological symptoms improved after 3 days of discontinuation of apatinib use. Moreover, brain MRI showed complete resolution of previous changes after 44 days of discontinuation of apatinib use.

Lessons:

Increased blood pressure may damage the normal blood-brain barrier, resulting in the extravasation of the fluid into the brain parenchyma. Hypertension is a significant cause of RPLS. It is important to strictly monitor blood pressure during apatinib treatment.
The efficiency and safety of oral tranexamic acid in total hip arthroplasty
Authors: Xu Yipeng , Sun Shaoting , Feng Qing , Zhang Guanfeng , Dong Bin , Wang Xiaoyan , Guo Ming
Published: November 2019

Background:

Intravenous (IV), topical and combination of both application of tranexamic acid (TXA) can reduce blood loss, hemoglobin drop, and transfusion rate in patients following total hip arthroplasty (THA). Lately, published articles reported that oral TXA had as similar blood-saving as IV and topical TXA in THA. The purpose of this meta-analysis is to investigate the efficiency and safety of oral TXA in THA.

Methods:

We systematically searched articles about oral administration of TXA in THA from PubMed, Embase, Scopus, Web of Science, the Cochrane Library, and the Chinese Wanfang database. Study eligibility criteria:

The outcomes were collected and analyzed by the Review Manager 5.3.

Results:

Nine RCTs and 1 CCT, containing 1305 patients, were ultimately included according to the inclusion criteria and exclusion criteria in the meta-analysis. The effectiveness of oral TXA was as similar as the IV or topical TXA in regard to hemoglobin drop (SMD = −0.14; 95% CI, [−0.28, 0.01]; P = .06), total blood loss (SMD = 0.01; 95% CI, [−0.13, 0.16]; P = .84), transfusion rate (OR = 0.76; 95% CI, [0.38, 1.55]; P = .37). Compared with single oral TXA or blank group, multiple oral TXA effectively reduced hemoglobin drop (SMD = −1.06; 95% CI, [−1.36, −0.77]; P < .05), total blood loss (SMD = −1.30; 95% CI, [−1.66, −0.94]; P < .05), transfusion rate (OR = 0.53; 95% CI, [0.29, 0.95]; P = .03). There were no significant difference in terms of length of stay and complication among all of enrolled studies.

Conclusion:

Oral TXA has favorable effect of blood-saving and do not increase risk of complication in patients following THA. Oral TXA may have no effect in the length of stay. More high quality RCTs are necessary.
Accuracy evaluation of placements of three different alternative C2 screws using the freehand technique in patients with high riding vertebral artery
Authors: Park Jong-Hyeok , Lee Jong Beom , Lee Ho Jin , Kim Il Sup , Hong Jae Taek
Published: November 2019

An observational study.

To evaluate the safeties of placing three different alternative C2 screws using the freehand technique under high riding vertebral artery (HRVA) and to analyze the C2 morphometry in patients with HRVA.

A retrospective analysis of radiologic data was performed on patients that underwent C2 instrumentation from September 2004 to December 2017. Two hundred fifty-one patients were included, and 90 of these patients (35.9%) had a unilateral or bilateral HRVA. We placed three alternative C2 screws including superior pars, inferior pars, and translaminar screws. Computed tomography was used to assess cortical breeches of screw placement and obtain morphometric measurements of C2 pars and lamina, that is, superior pars height/length, inferior pars length, and laminar thickness/length. We used the modification of the all India Institute of Medical Sciences outcome to define cortical breach.

In total, 117 alternative C2 screws were inserted in 90 patients; 7 superior pars screws (6%), 69 inferior pars screws (59.0%), and 41 translaminar (35%) screws. Although cortical breaches occurred during 31 screw placements (26.5%), these were unacceptable in only two cases (1.7%). No symptomatic neurovascular complication was observed after screw placement in any case. Mean height of C2 superior pars was 3.8 ± 1.8 mm and mean thickness of C2 lamina was 5.2 ± 1.1 mm. Mean lengths of superior pars, inferior pars, and lamina were 17.8 ± 3.0 mm, 13.6 ± 2.2 mm, and 26.7 ± 3.3 mm, respectively. Superior pars height and lamina thickness < 3.5 mm that was a minimal diameter of cervical screw were 49.6% and 6.8%, alternative C2 screw was not available in these cases.

Placements of alternative C2 screws using the freehand technique were achieved accurately and safely in patients with HRVA. However, preoperative morphometric evaluation is essential to determine the best option for C2 instrumentation and C2 screw length to avoid neurovascular complications.
Theta burst stimulation for upper limb motor dysfunction in patients with stroke
Authors: Liu Xiao-bo , Zhong Jian-guo , Xiao Xi-li , Li Yu-xi , Huang Yi-jie , Liu Yong-guo , Zhang Chi , Jin Rong-jiang , Liu Tian-yu
Published: November 2019

Background:

Upper limb dysfunction is one of common sequelae of stroke which limits daily activities and decreases quality of life of patients, as well as increasing caregiving burden on families. Theta burst stimulation (TBS) is considered to be a beneficial therapy for post-stroke patients with upper limb motor dysfunction, but there is a lack of a high quality evidence. We aim to investigate the effectiveness and safety of TBS for upper limb motor dysfunction in patients with stroke.

Methods:

The following databases will be searched: PubMed, EMBASE, The Cochrane Library, Web of Science, China Biology Medicine (CBM), China National Knowledge infrastructure (CNKI), Technology Periodical Database (VIP) and WanFang Data from the inception to October 2019. All relevant randomized controlled trials (RCTs) using TBS to treat poststroke patients with upper limb motor dysfunction will be included. The primary outcome is Upper Limb Fugl-Meyer Assessment (UL-FMA). Secondary outcomes will include Action Research Arm Test (ARAT), Box and Block Test (BBT), Wolf Motor Function Test (WMFT), Motor Assessment Scale (MAS), Nine Hole Peg Test (NHPT), Grip strength and other scales evaluating the upper limb motor function. Adverse effects will also be evaluated. Two reviewers will screen studies, extract data and assess the risk of bias of included studies independently. Data analysis will be conducted using Review Manager software (RevMan, version 5.3.5) and R software (version 3.6.1).

Results:

Our SR will be conducted according to AMSTAR 2.0 and reported in compliance with PRISMA. The findings of this SR will be disseminated through peer-reviewed publications or conference presentations.

Conclusion:

Our study will provide evidence for the effectiveness and safety of theta burst stimulation for upper limb motor dysfunction in patients with stroke.

Ethics and dissemination:

This systematic review (SR) does not require formal ethical approval since no privacy health information will be included. The findings of this SR will be disseminated through peer-reviewed publications or conference presentations.

PROSPERO registration number:

CRD42019142462.
Efficacy of horizontal muscle augmentation combined inferior oblique muscle shortening for pediatric strabismus
Authors: Du Xiu-Mei
Published: November 2019

Background:

This study will explore the efficacy and safety of horizontal muscle augmentation (HMA) combined inferior oblique muscle shortening (IOMS) for the treatment of pediatric strabismus (PS).

Methods:

Literature search for studies will be carried out in the following databases: Cochrane Library, MEDILINE, EMBASE, CINAHL, Web of Science, PsycINFO, CBM, and CNKI. We will search all these databases without language and publication status restrictions. Two independent authors will perform selection of studies, data collection and management, risk of bias evaluation. A third author will be consulted with the help of discrepancies.

Results:

This study will provide a synthesis of existed evidence for HMA combined IOMS for the treatment of PS.

Conclusion:

The results of this study will provide evidence to evaluate the efficacy and safety of HMA combined IOMS for the treatment of PS, which can help to guide clinical decision-making.

Systematic review registration:

PROSPERO CRD42019149716.
Intravoxel incoherent motion diffusion-weighted imaging evaluated the response to concurrent chemoradiotherapy in patients with cervical cancer
Authors: Bian Hao , Liu Fenghai , Chen Sha , Li Guoce , Song Yancheng , Sun Min , Dong Honghuan
Published: November 2019

To evaluate the application of multiple b values diffusion-weighted imaging based on biexponential signal decay model to predict the response to concurrent chemoradiotherapy in cervical cancer patients.

This prospective study enrolled 28 patients (mean age: 50.89 ± 10.70 years) with cervical cancer confirmed by biopsy who received concurrent chemoradiotherapy. Pelvic magnetic resonance scans were performed 2 weeks before, 7 days and 21 days after the initiation of therapy, and 1 month after the end of the treatment. Diffusion-weighted imaging with b values of 0, 50, 450, and 850 s/mm2 were performed, and tumor volume, means of tumor apparent diffusion coefficient (ADC)min, ADCmean, ADCslow, ADCfast, and Ffast were measured.

Pretreatment ADCmin and ADCslow of good outcome group were significantly higher than those of poor outcome group (P < .05). At the 7th day of the treatment, Ffast and its change rate of good outcome group were significantly higher than those of poor outcome group (P < .05). At the 7th day and 21st day of the treatment, Ffast showed a slowly increasing tendency with no significant difference compared with pretreatment value in poor outcome group (P < .05). One month post-treatment, only ADCslow change rate was significantly higher in good outcome group than that in poor outcome group.

Intravoxel incoherent motion-related ADC values could be utilized to better predict the outcome of cervical cancer chemoradiotherapy.
The prognostic values of estrogen receptor alpha and beta in patients with gastroesophageal cancer
Authors: Zhang Dongyun , Ku Jianwei , Yi Yingjie , Zhang Junhui , Liu Rongzhi , Tang Nianya
Published: November 2019

Background:

Published studies have investigated the prognostic roles of estrogen receptor alpha (ERα) and estrogen receptor beta (ERβ) in gastroesophageal cancer patients with the controversial results. The aim of the study was to systematically evaluate the impacts of ERα and ERβ on the overall survival (OS) in patients.

Method:

Relevant eligible studies were extracted from PubMed, Embase, Web of Science, CNKI and Wanfang databases (from the start date to November 2018) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. HR (hazard ratio) with 95% confidence intervals (CIs) were used to assess the prognostic values of ERα and ERβ for OS in patients.

Results:

High ERα expression was associated with poor OS (HR = 1.58, 95% CI = 1.29–1.94, P < .001) and ERβ with better OS (HR = 0.56, 95% CI = 0.37–0.83, P = .004) in gastroesophageal cancer. Furthermore, unfavorable OS was found in Chinese gastroesophageal patients with higher ERα expression (HR = 1.57, 95% CI = 1.25–1.96, P < .001) and better OS with higher ERβ expression (HR = 0.51, 95% CI = 0.31–0.83, P < .01) in our subgroup analysis. Meanwhile, worse OS was found in esophageal squamous cell carcinoma (ESCC) patients with high ERα expression (HR = 1.74, 95% CI = 1.33–2.26, P < .001), and favorable OS in ESCC with ERβ overexpression (HR = 0.40, 95% CI = 0.31–0.52, P < .001). Besides, high ERα expression was associated with lower tumor differentiation in ESCC (OR = 1.64; 95% CI = 1.02–2.64, P = .04) and ERβ was linked with better tumor differentiation in gastric adenocarcinoma (GCA) (OR = 0.49; 95% CI = 0.26–0.94, P = .03).

Conclusions:

ERα and ERβ might serve as potential prognostic biomarkers for gastroesophageal cancer patients. ERα overexpression predicted poor OS and lower tumor differentiation, and ERβ suggested favorable OS and better tumor differentiation. Further related studies should be performed to test these results.
The burden of health conditions across race and ethnicity for aging Americans
Authors: McGrath Ryan P. , Snih Soham Al , Markides Kyriakos S. , Faul Jessica D. , Vincent Brenda M. , Hall Orman T. , Peterson Mark D.
Published: November 2019

Despite evidence suggesting race and ethnicity are important factors in responses to environmental exposures, drug therapies, and disease risk, few studies focus on the health needs of racially- and ethnically-diverse aging adults.

The objective of this study was to determine the burden of 10 health conditions across race and ethnicity for a nationally-representative sample of aging Americans.

Data from the 1998 to 2014 waves of the Health and Retirement Study, an ongoing longitudinal-panel study, were analyzed.

Those aged over 50 years who identified as Black, Hispanic, or White were included. There were 5510 Blacks, 3423 Hispanics, and 21,168 Whites in the study.

At each wave, participants reported if they had cancer, chronic obstructive pulmonary disease, congestive heart failure, diabetes, back pain, hypertension, a fractured hip, myocardial infarction, rheumatism or arthritis, and a stroke. Disability-adjusted life years (DALYs) were calculated for each health condition by race and ethnicity. Ranked DALYs determined how race and ethnicity was differentially impacted by the burden of each health condition. Sample weights were utilized to make DALY estimates nationally-representative.

Weighted DALY estimates (in thousands) ranged from 1405 to 55,631 for Blacks, 931 to 28,442 for Hispanics, and 15,313 to 295,623 for Whites. Although the health conditions affected each race and ethnicity differently, hypertension had the largest number of DALYs, and hip fractures had the fewest across race and ethnicity. In total, there were an estimated 198,621, 101,462, and 1,187,725 DALYs for older Black, Hispanic, and White aging adults.

Our findings indicate that race and ethnicity may be influential on health and disease for aging adults in the United States. Monitoring DALYs may help guide the flow of health-related expenditures, improve the impact of health interventions, advance inclusive health care for diverse aging adult populations, and prepare healthcare providers for serving the health needs of aging adults.
Pediatric pancreatic teratoma
Authors: Wang Jian , Yin Yuan , Cai Zhaolun , Shen Chaoyong , Yin Xiaonan , Chen Xin , Zhao Zhou , Zhang Bo
Published: November 2019

Rationale:

Pediatric pancreatic teratoma (PPT) is a rare tumor with unclear clinicopathologic features and treatment strategy.

Patient concerns:

A 13-month-old boy was admitted to the hospital with a complaint of a palpable epigastric mass.

Diagnoses:

The lesion was diagnosed as benign mature cyst teratoma via postoperative pathological examination.

Interventions:

Pylorus-preserving pancreaticoduodenectomy (PPPD) was performed on the patient. The entire mass was resected from the head of the pancreas and sent to the laboratory for frozen section evaluation.

Outcomes:

The patient was followed up for 15 months. He did not undergo recurrence or PPPD-related complications.

Lessons:

The differential diagnosis of retroperitoneal occupying lesions among children must consider mature cystic teratomas. Compete surgical resection combined with subsequent postoperative outpatient follow-up remains the primary choice for the management of PPTs.

PPTs are extremely rare tumors with unclear clinicopathologic features and treatment strategy. This study aims to explore the clinical characteristics of and treatment strategy for these tumors. We reported a 13-month-old patient with pancreatic teratoma who underwent pylorus-preserving PPPD. The operation lasted approximately 6 hours. The mass was completely removed, and the patient recovered uneventfully. Complete surgical resection combined with outpatient follow-up is the primary choice for the management of PPTs.