bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inter- and intraobserver agreement in standard and ultra-fast single-photon emission computed tomography/computed tomography for the assessment of bone metastases
Authors: Zacho Helle D. , Aleksyniene Ramune , Ejlersen June A. , Fledelius Joan , Petersen Lars J. 
Published: July 2020

Objective
To investigate inter- and intraobserver agreement using standard (std)-single-photon emission computed tomography/computed tomography (SPECT/CT) or ultra-fast acquisition (UF)-SPECT/CT as an add-on to planar whole-body bone scintigraphy (WB-BS) for the detection of bone metastases in patients with known cancer.

Methods
Images from patients (n = 104) participating in a prospective trial comparing SPECT/CT as an add-on to WB-BS with two different acquisition methods (std-SPECT/CT; 20 s per view, 32 views and UF-SPECT/CT; 16 views of 10 s per view) were included. The combinations of WB-BS with the two different SPECT/CT acquisition methods were independently evaluated by two experienced observers using a three-point scale (M0: no metastases, Me: equivocal for bone metastases and M1: bone metastases). The observers re-evaluated the scans 6 months later. Inter- and intraobserver agreement was calculated using linear weighted kappa.

Results
The linear weighted kappa for the interobserver agreement was 0.78 [95% confidence interval (CI) 0.61–0.94] for WB-BS with std-SPECT/CT and 0.84 (95% CI 0.67–1.00) for WB-BS with UF-SPECT/CT. Similar values were observed for the intraobserver agreement, in which the linear weighted kappa was 0.76 (95% CI 0.60–0.92) and 0.73 (95% CI 0.57–0.90) for std-SPECT/CT and UF-SPECT/CT, respectively.

Conclusion
Satisfactory inter- and intraobserver agreement was seen for both acquisition methods, emphasizing that the use of SPECT/CT as an add-on to WB-BS is a robust method for the detection of bone metastases even when conducted with a very short acquisition time.
Identification of Distinct Profiles of Cancer-Related Fatigue and Associated Risk Factors for Breast Cancer Patients Undergoing Chemotherapy
Authors: Huang Qingmei , Geng Zhaohui , Fang Qiong , Stinson Jennifer , Yuan Changrong 
Published: July 2020

Background
Cancer-related fatigue is a complex, multidimensional, subjective experience that affects patients physically, emotionally, and mentally. The interindividual variability in symptoms of cancer-related fatigue merits further exploration.

Objective
Our objective was to identify distinct profiles of cancer-related fatigue experienced by breast cancer patients undergoing chemotherapy and to evaluate how subgroups vary demographically in clinical characteristics and in modifiable factors such as physical activity, sleep quality, and exercise self-efficacy.

Methods
Fatigue was assessed with the Chinese Cancer-Related Fatigue Scale, and a latent class analysis was performed to identify subgroups of patients with distinct fatigue profiles.

Results
A total of 427 breast cancer patients were included in the data analyses. Five different fatigue profiles were identified: all low-risk fatigue, all high-risk fatigue, high-risk physical fatigue, high-risk emotional fatigue, and high-risk mental fatigue. Patients in different subgroups were characterized by different risk factors. For example, patients in the high-risk emotional fatigue group had less education, lower monthly household incomes, lower exercise self-efficacy scores, less sedentary behavior, poorer sleep, and poorer quality-of-life outcomes compared with those in the all low-risk fatigue group.

Conclusion
These findings reveal that breast cancer patients undergoing chemotherapy show significant heterogeneity in their experience of cancer-related fatigue.

Implications for Practice
Characteristics associated with different fatigue profiles, in particular the high-risk profiles, can be used by clinicians to target patients at greater risk of poorer symptom and quality-of-life outcomes to provide interventions tailored to their different needs.
Evaluation of Outcomes Before and After Implementation of a Standardized Postoperative Care Pathway in Pediatric Posterior Spinal Fusion Patients
Authors: Nelson Kembral L. , Locke Lindsey L. , Rhodes Leslie N. , Mabry William A. , Sawyer Jeffrey R. , Warner William C. , Jones Tamekia , Spence David D. , Kelly Derek M. 
Published: July 2020

BACKGROUND:
Standardized pathways decrease variability and improve outcomes and safety.

PURPOSE:
The article aims to evaluate outcomes of a standardized postoperative care pathway compared with individual surgeon preference.

METHODS:
A review of patients prestandardization and poststandardization was performed. Patients between the ages of 10–21 years with adolescent idiopathic scoliosis (ICD-9 code 737.30) admitted to the hospital for posterior spinal fusion (CPT code 22630) were included in the study. The prestandardization group (25 patients) was enrolled from April 1, 2010, through March 30, 2011, and the poststandardization group (25 patients) from April 1, 2014, to March 30, 2015. Exclusion criteria were renal disease, epilepsy, neurological disorder, or postoperative complications that led to change in routine care including ileus or fever greater than 102 °F. Data were analyzed using the Wilcoxon signed rank test, with significance set at p < .001.

RESULTS:
The length of stay (p = .0166), time to ambulation (p < .0001), patient-controlled analgesia use (p < .0001), and postoperative time to resumption of regular diet (p < .0001) were all significantly decreased in the poststandardization group. There were no complications or readmissions in either group.

CONCLUSION:
The standardized pathway resulted in shorter length of stay, decreased narcotic use, decreased time to regular diet, and decreased time to ambulation with no increase in complication rates.
Gout
Authors: Pascual Eliseo , Andres Mariano , Sivera Francisca 
Published: July 2020

Abstract
In the field of rheumatic and musculoskeletal diseases, no other condition has evolved so significantly since the mid-1950s as gout. In this period, the cause of gout has been firmly established; the close relationship with other conditions clarified; a rapid, unequivocal diagnostic test established; and agents effective in dissolving monosodium urate crystals and controlling inflammation made widely available. All these insights have ultimately led to deem gout as curable, an end point formerly considered out of reach. Unfortunately, diagnosis and management of gout in clinical practice have not paralleled the scientific advances and remain far from established quality standards. This paradox is the topic of the present review article, intending to increase the widespread interest of clinicians in gout.
Going Further: Comprehensive Disease Control of Rheumatoid Arthritis, Targeting Cytokines and Chemokines
Authors: Chavarria-Avila Efrain , Vazquez-Del Mercado Monica , Pizano-Martínez Oscar , Roman-Lugo German , Arrona-Rios Karla , Perez-Vazquez Felipe , De-La-Cruz Jeniffer P. , Calderon-Espinoza Ivette , Aguilar-Vazquez Andrea , Esesarte-Rodriguez Marisol , Rubio-Arrellano Edy D. , Duran-Barragan Sergio 
Published: July 2020

Objectives
Mechanism of action of biological and synthetic disease-modifying antirheumatic drugs (DMARDs) includes the inhibition of specific proinflammatory cytokines. This study aimed to elucidate the cytokines and chemokines inhibited by different treatments (conventional synthetic DMARD [csDMARD], biological and targeted synthetic DMARD) in rheumatoid arthritis (RA).

Methods
Fifty-nine RA patients with low disease activity or remission included in a cross-sectional study were classified by treatment in groups: abatacept, certolizumab, rituximab (RTX), tocilizumab, tofacitinib (TOF), baricitinib (BAR), and csDMARD. Cytokine and chemokine serum levels were measured by LEGENDplex Human Inflammation panel. Quantitative variables were compared using Student t or Mann-Whitney U test as appropriate, whereas qualitative variables were compared using χ2 or Fisher exact test. p < 0.05 was considered significant.

Results
Certolizumab, RTX, tocilizumab, and TOF showed that most cytokine pathways inhibited: tumor necrosis factor α, interferon γ, interleukin 1β (IL-1β), IL-12, IL-18, and IL-23; in addition, csDMARDs showed a similar inhibition patron except for IL-23. Serum level of tumor necrosis factor α pathway was one of the most inhibited being undetectable in RTX, TOF, and BAR groups. Interleukin 6 was shown to be inhibited by abatacept, RTX, and TOF; however, higher levels were observed in 3 patients treated with tocilizumab. Abatacept, certolizumab, RTX, and TOF downregulated IL-10 in this group of patients but remained detectable in almost half of the subjects, with the highest levels in the BAR group. The active pathways that remained the most were CC chemokine ligand 2, IL-8, IL-17, and IL-33.

Conclusions
Understanding the cytokine chemokine pathways inhibition could help rheumatologists to prescribe a tailored therapy using the arsenal of DMARDs for individualized RA treatment in an evidence-based decision manner.
A Deep Learning Model for the Accurate and Reliable Classification of Disc Degeneration Based on MRI Data
Authors: Niemeyer Frank , Galbusera Fabio , Tao Youping , Kienle Annette , Beer Meinrad , Wilke Hans-Joachim 
Published: July 2020

Objectives
Although magnetic resonance imaging–based formalized grading schemes for intervertebral disc degeneration offer improved reproducibility compared with purely subjective ratings, their intrarater and interrater reliability are not nearly good enough to be able to detect small to medium effects in clinical longitudinal studies. The aim of this study thus was to develop a method that enables automatic and therefore reproducible and reliable evaluation of disc degeneration based on conventional clinical image data and Pfirrmann's grading scheme.

Materials and Methods
We propose a classifier based on a deep convolutional neural network that we trained on a large, manually evaluated data set of 1599 patients (7948 intervertebral discs). To improve upon the status quo, we focused on the quality of the training data and performed extensive hyperparameter optimization. We assessed the potential benefits of optimizing loss functions beyond common cross-entropy loss, such as soft kappa loss, ordinal cross-entropy loss, or regression losses. We furthermore experimented with ways to mitigate class imbalance by pooling classes or using class-weighted loss functions. During model development and hyperparameter optimization, we used a fixed 90%/10% training/validation set split. To estimate real-world prediction performance, we performed 10-fold cross-validation.

Results
The evaluated image data results in a Gaussian degeneration grade distribution, and thus grades 1 and 5 are slightly underrepresented in the training set. Our default cross-entropy–based classifier achieves a reliability of κ = 0.92 (Cohen κ), an average sensitivity of 90.2%, and an average precision of 92.5%. In 99.2% of validation cases, the network's prediction deviates at most 1 Pfirrmann grades from the ground truth. Framed as an ordinal regression problem, the mean absolute error between the ground truth and the prediction is 0.08 Pfirrmann grade with a correlation of r = 0.96. The results of the 10-fold cross validation confirm those performance estimates, indicating no substantial overfitting. More sophisticated loss functions, class-based loss weighting, or class pooling did not lead to improved classification performance overall.

Conclusions
With a reliability of κ > 0.9, our system clearly outperforms average human interrater as well as intrarater reliability. With an average sensitivity of more than 90%, our classifier also surpasses state-of-the-art machine learning solutions for automatically grading disc degeneration.
Defect Reconstruction Using the Propeller Flaps Based on the Perforators Derived From the Lateral Circumflex Femoral Artery System
Authors: Zhu Shan , Zang Mengqing , Xu Boyang , Chen Bo , Li Shanshan , Han Tinglu , Liu Yuanbo 
Published: July 2020

BackgroundAlthough propeller flaps are a useful option for soft tissue defect reconstruction, reports based on the perforators of the lateral circumflex femoral artery (LCFA) are rare. We aimed to present our experience in defect reconstruction using the propeller flaps based on perforators from different branches of LCFA and apply these flaps in soft tissue defect reconstruction of the lower extremities.MethodsTwenty nine patients (32 flaps) underwent defect reconstruction using propeller flaps based on the perforator of the LCFA. Defects were located from the groin to the proximal leg. According to the source vessels from which the perforator originated, flaps were categorized into types I, II, III and IV, which represented perforators from the transverse, descending, oblique, and rectus femoris branches, respectively. Type II flaps were subdivided into types IIa and IIb flaps based on antegrade and reverse flows of the descending branch.ResultsFlap sizes ranged from 12 × 6 cm to 30 × 15 cm (average, 22.69 × 9.19 cm) with the length of the vascular pedicle ranging from 3 to 7 cm (average, 4.86 cm). Flaps were rotated from 60° to 180° (average, 144.06°). There were 3 type I, 10 type IIa, 4 type IIb, 13 type III and, and 2 type IV flaps. Twenty-nine flaps survived after surgery. Total flap necrosis and venous congestion of the distal flap portion occurred in 1 and 2 patients, respectively.ConclusionsReconstruction using propeller flaps based on perforators of the LCFA is a safe, reliable, and versatile option for defect reconstruction of the lower extremities; however, it requires meticulous surgical dissection and patience.
The effects of human prothrombin complex concentrate on hemorrhagic shock-induced lung injury in rats: Implications for testing human blood products in rodents
Authors: Potter Daniel R. , Trivedi Alpa , Lin Maximillian , Miyazawa Byron Y. , Vivona Lindsay R. , McCully Belinda , Nair Alison , Schreiber Martin A. , Pati Shibani 
Published: July 2020

BACKGROUND
Hemorrhagic shock (HS) and trauma can result in an endotheliopathy of trauma, characterized by endothelial compromise, inflammation, and aberrant coagulation. Kcentra, a prothrombin concentrate, has been demonstrated to mitigate pulmonary vascular leak in a murine model of HS. We investigated the effects of Kcentra in a rat model of HS, to achieve physiologic endpoints of relevance.

METHODS
Rats subjected to a grade intravenous splenic injury and controlled hemorrhage for 60 minutes were resuscitated with shed volumes of (1) Lactated Ringer’s (LR) solution, (2) LR + 20 IU/kg Kcentra, (3) LR + 50 IU/kg Kcentra, (4) rat fresh frozen plasma (RFFP), or (5) human fresh frozen plasma (HFFP). Blood was harvested for monitoring metabolic and coagulation function. Rat lungs were evaluated for lung injury and permeability.

RESULTS
Animals resuscitated with LR displayed a significant increase in pulmonary vascular permeability (sham, 407.9 ± 122.4; shock + LR, 2040 ± 1462). Resuscitation with RFFP (606.5 ± 169.3) reduced leak; however, treatment with Kcentra (HS + Kcentra [20 IU/kg]: 1792 ± 903.4, HS + Kcentra [50 IU/kg]: 1876 ± 1103), and HFFP (1450 ± 533.2) had no significant effect on permeability. Kcentra modestly altered clotting parameters. Metabolic measures, such as lactate, pH, and base deficit, were restored to baseline levels by both RFFP and HFFP, but not Kcentra or LR.

CONCLUSION
Kcentra did not alter pulmonary vascular permeability, but modestly increased clotting potential in injured rats. This suggests that there may be a xenogenic reaction of human products in rats and that the effects of Kcentra on vascular stability may be distinct from its ability to modulate clotting. Our data indicate that the species chosen and utilized for in vivo preclinical testing of human derived blood products is of critical importance in determining their efficacy in animal models and is the primary impetus to communicate these results.
Kidney Rejection Following Simultaneous Liver-kidney Transplantation
Authors: Shah Sapna , Suddle Abid , Callaghan Christopher , Karydis Nicholas , Shaw Olivia , Horsfield Catherine , Koffman Geoff , Heaton Nigel 
Published: July 2020

Background.
Donor-specific antibodies are reported to increase the risk of rejection and reduce allograft survival following simultaneous liver-kidney transplantation. Optimal immunosuppression regimens to reduce this risk and to treat rejection episodes are underinvestigated.

Methods.
Cohort analysis of the first 27 simultaneous liver-kidney transplant recipients, between 2014 and 2018 at our unit, is performed under a new risk stratification policy. Those with donor-specific antibodies to class II HLA with a mean fluorescence intensity >10 000 are considered high risk for antibody-mediated rejection (AMR). These patients received immunosuppression, which consisted of induction therapy, tacrolimus, mycophenolate mofetil, and prednisolone. All other patients are considered low risk and received tacrolimus and prednisolone alone.

Results.
Three patients were high risk for rejection, and 2 of these patients developed AMR, which was treated with plasma exchange and intravenous immunoglobulin. At 1 y, their estimated glomerular filtration rate (eGFR) were 50 and 59 mL/min. Two other patients developed AMR, which was similarly treated, and their 1-y eGFR was 31 and 50 mL/min. The overall histologically proven acute rejection rate within the first year was 33%, and median eGFR, for the 27 patients, at 1 y was 52 mL/min and at 2 y was 49 mL/min.

Conclusions.
This study confirms that there is a risk of AMR following simultaneous liver-kidney transplantation despite increased immunosuppression. This can be effectively treated with plasma exchange and intravenous immunoglobulin.
Early Experiences With COVID-19 Testing in Transplantation
Authors: Boyarsky Brian J. , Massie Allan B. , Love Arthur D. , Werbel William A. , Durand Christine M. , Avery Robin K. , Jackson Kyle R. , Kernodle Amber B. , Thomas Alvin G. , Ronin Matthew , Altrich Michelle , Niles Patricia , Trahan Chad , Hewlett Jonathan , Segev Dorry L. , Garonzik-Wang Jacqueline M. 
Published: July 2020

Background.
The early effects of coronavirus disease 2019 (COVID-19) on transplantation are dramatic: >75% of kidney and liver programs are either suspended or operating under major restrictions. To resume transplantation, it is important to understand the prevalence of COVID-19 among transplant recipients, donors, and healthcare workers (HCWs) and its associated mortality.

Methods.
To investigate this, we studied severe acute respiratory syndrome coronavirus 2 diagnostic test results among patients with end-stage renal disease or kidney transplants from the Johns Hopkins Health System (n = 235), and screening test results from deceased donors from the Southwest Transplant Alliance Organ Procurement Organization (n = 27), and donors, candidates, and HCWs from the National Kidney Registry and Viracor-Eurofins (n = 253) between February 23 and April 15, 2020.

Results.
We found low rates of COVID-19 among donors and HCWs (0%–1%) who were screened, higher rates of diagnostic tests among patients with end-stage renal disease or kidney transplant (17%–20%), and considerable mortality (7%–13%) among those who tested positive.

Conclusions.
These findings suggest the threat of COVID-19 for the transplant population is significant and ongoing data collection and reporting is critical to inform transplant practices during and after the pandemic.
Aerosol filtering efficiency of respiratory face masks used during the COVID-19 pandemic
Authors: Loupa Glykeria , Karali Dimitra , Rapsomanikis Spyridon 
Published: July 2020

AbstractThe spread of the COVID-19 pandemic, effected the imposition of personal protection measures in a large number of countries. The use of commercially available personal face masks was widely accepted as such a protective measure. Since the quality of the face masks scanned the spectrum from surgical to the home made fabric ones, it was considered appropriate to experimentally establish their effectiveness for stopping aerosol in entering the respiratory system of the bearer. Presently, only eight masks were tested with polydisperse indoor air. Their effectiveness was examined for aerosol of aerodynamic diameters of 0.006 μm to 10 μm. Of these masks, only two were effective for the whole range of aerosol. Cloth masks were found to be ineffective for the assigned task.
Pre-crastination: time uncertainty increases walking effort
Authors: Tiew E Hong , Seethapathi Nidhi , Srinivasan Manoj 
Published: July 2020

AbstractIn many circumstances, humans walk in a manner that approximately minimizes energy cost. Here, we performed human subject experiments to examine how having a time constraint affects the speeds at which humans walk. First, we measured subjects’ preferred walking speeds to travel a given distance in the absence of any time constraints. Then, we asked subjects to travel the same distance under different time constraints. That is, they had to travel the given distance within the time duration provided – they can arrive early, but not late. Under these constraints, subjects systematically arrived earlier than necessary. Surprisingly, even when the time duration provided was large enough to walk at their unconstrained preferred speeds, subjects walked systematically faster than their unconstrained preferred speed. We propose that this faster-than-energy optimal speeds may be due to human uncertainty in time estimation. We show that a model assuming that humans perform stochastic optimal feedback control to arrive on time with high probability while minimizing expected energy costs predicts walking speeds higher than energy optimal, as observed in experiment.
A New Mathematical Approach for the Estimation of epidemic Model Parameters with Demonstration on COVID-19 Pandemic in Libya
Authors: Saleh Mohamed Elmehdi , Saleh Zeinab Elmehdi 
Published: July 2020

ABSTRACTBackgroundThe SEIR model or a variation of it is commonly used to study epidemic spread and make predictions on how it evolves. It is used to guide officials in their response to an epidemic. This research demonstrates an effective and simple approach that estimates the parameters of any variations of the SEIR model. This new technique will be demonstrated on the spread of COVID-19 in Libya.MethodsA five compartmental epidemic model is used to model the COVID-19 pandemic in Libya. Two sets of data are needed to evaluate the model parameters, the cumulative number of symptomatic cases and the total number of active cases. This data along with the assumption that the cumulative number of symptomatic cases grows exponentially, to determine most of the model parameters.ResultsLibya’s epidemic start-date was estimated asto= −18 · 5 days, corresponding to May 5th. We mathematically demonstrated that the number of active cases follows two competing exponential distributions: a positive exponential function, measuring how many new cases are added, and a negative exponential function, measuring how many cases recovered. From this distribution we showed that the average recovery time is 48 days, and the incubation period is 15.2 days. Finally, the productive number was estimated as R0= 7·6.ConclusionsWith only the cumulative number of cases and the total number of active cases of COVID19, several important SEIR model parameters can be measured effectively. This approach can be applied for any infectious disease epidemic anywhere in the world.