bluuebunny/crossref_metadata_2025_split huggingface dataset:
A novel and effective method for validation and measurement of output factors for Leksell Gamma Knife® Icon™ using TRS 483 protocol
Authors: Cyriac Swapna Lilly , Liu Jian , Calugaru Emel , Chang Jenghwa 
Published: September 2020

AbstractThe objective of this work was to identify the exact location of the effective point of measurement (EPM) of four different active detectors to compare the relative collimator output factors (ROF) of Leksell Gamma Knife (LGK) according to IAEA TRS‐483 recommendations. ROF was measured at the center of the spherical LGK‐Solid Water (LGK‐SW) Phantom for three (4‐, 8‐, and 16‐mm in diameter) collimators using four (PTW‐TN60008, PTW‐TN60016, PTW‐TN60017, and PTW‐60019 diode/diamond) detectors. Since diode detectors have a much smaller sensitive volume than the PTW‐31010 ion chamber used for reference dosimetry, its EPM might not be at the center of the phantom, or (100, 100, 100) of the Leksell Coordinate System, particularly in the z‐direction. Hence for each diode detector, a CBCT image was acquired after it was inserted into the phantom, from which the z‐Leksell coordinate of EPM was determined. Relative collimator output factors was then measured by focusing GK beams on the determined EPM of each diode. Measured ROFs were compared with the vendor‐provided values in GK treatment planning system. For validation, a plan was generated to measure the output of 4‐mm collimator for PTW‐TN60017 at various couch locations along the z‐axis. For PTW‐TN60008, the percentage variations were 0.6 ± 0.4%, and −0.8 ± 0.2% for 4 and 8‐mm collimators, respectively. For PTW‐TN60016, the percentage variations were 0.8 ± 0.0%, and 0.2 ± 0.1%, respectively. The percentage variations were −3.3 ± 0.0% and −0.9 ± 0.1%, respectively, for PTW‐TN60017, and −0.5 ± 0.0% and −0.8 ± 0.2%, respectively, for PTW‐TN60019. Center of the measured profile for PTW‐TN60017 was only 0.1 mm different from that identified using the CBCT. In conclusion, we have developed a simple and effective method to determine the EPMs of diode detectors when inserted into the existing LGK‐SW phantom. With the acquired positional information and using TRS‐483 protocol, good agreements were obtained between the measured ROFs and manufacturer recommended values.
Deficiency of Adenosine Deaminase 2 in Adults and Children: Experience From India
Authors: Sharma Aman , Naidu GSRSNK , Sharma Vikas , Jha Saket , Dhooria Aaadhar , Dhir Varun , Bhatia Prateek , Sharma Vishal , Bhattad Sagar , Chengappa K. G. , Gupta Vikas , Misra Durga Prasanna , Chavan Pallavi Pimpale , Malaviya Sourabh , Dudam Rajkiran , Sharma Banwari , Kumar Sathish , Bhojwani Rajesh , Gupta Pankaj , Agarwal Vikas , Sharma Kusum , Singhal Manphool , Rathi Manish , Nada Ritambhra , Minz Ranjana W. , Chaturvedi Ved , Aggarwal Amita , Handa Rohini , Grossi Alice , Gattorno Marco , Huang Zhengping , Wang Jun , Jois Ramesh , Negi V. S. , Khubchandani Raju , Jain Sanjay , Arostegui Juan I. , Chambers Eugene P. , Hershfield Michael S. , Aksentijevich Ivona , Zhou Qing , Lee Pui Y. 
Published: September 2020

ObjectiveDeficiency of adenosine deaminase 2 (DADA2) is a potentially fatal monogenic syndrome characterized by variable manifestations of systemic vasculitis, bone marrow failure, and immunodeficiency. Most cases are diagnosed by pediatric care providers, given the typical early age of disease onset. This study was undertaken to describe the clinical phenotypes and treatment response both in adults and in children with DADA2 in India.MethodsA retrospective analysis of pediatric and adult patients with DADA2 diagnosed at various rheumatology centers across India was conducted. Clinical characteristics, diagnostic findings, and treatment responses were analyzed in all subjects.ResultsIn total, 33 cases of DADA2 were confirmed in this cohort between April 2017 and March 2020. Unlike previous studies, nearly one‐half of the confirmed cases presented during adulthood. All symptomatic patients exhibited features of vasculitis, whereas constitutional symptoms and anemia were more common in pediatric patients. Cutaneous and neurologic involvement were common, and 18 subjects had experienced at least one stroke. In addition, the clinical spectrum of DADA2 was expanded by recognition of novel features in these patients, including pancreatic infarction, focal myocarditis, and diffuse alveolar hemorrhage. Treatment with tumor necrosis factor inhibitors (TNFi) was initiated in 25 patients. All of the identified disease manifestations showed marked improvement after initiation of TNFi, and disease remission was achieved in 19 patients. Two cases were complicated by tuberculosis infection, and 2 deaths were reported.ConclusionThis report presents the first case series of patients with DADA2 from India, diagnosed by adult and pediatric care providers. The findings raise awareness of this syndrome, particularly with regard to its presentation in adults.
Association of Urinary Matrix Metalloproteinase 7 Levels With Incident Renal Flare in Lupus Nephritis
Authors: Wang Guobao , Wu Liling , Su Huanjuan , Feng Xiaodan , Shi Meng , Jin Lingwei , Yang Manqiu , Zhou Zhanmei , Su Cailing , Yang Bihui , Li Yajing , Cao Wei 
Published: September 2020

ObjectiveFlares of lupus nephritis (LN) are frequent and associated with impaired renal prognosis. One major management obstacle in LN flare is the lack of effective methods to identify at‐risk patients earlier in their disease course. This study was undertaken to test the utility of measurement of urinary matrix metalloproteinase 7 (MMP‐7) for the dynamic surveillance of renal disease activity and prediction of renal flares in LN.MethodsA prospective, 2‐stage cohort study was performed in patients with LN. Urinary MMP‐7 levels at the time of biopsy were evaluated in 154 patients with newly diagnosed LN in 2 independent cohorts. Urinary MMP‐7 levels were assessed for correlation with renal histologic activity. Furthermore, after a minimum period of 12 months of renal disease remission, urinary MMP‐7 levels were monitored bimonthly for 2 years in 65 patients with LN. The association between urinary MMP‐7 levels and development of LN flare was analyzed.ResultsUrinary MMP‐7 levels were elevated in patients with LN. A higher urinary MMP‐7 level in LN was associated with greater renal histologic activity. As a marker for identifying LN patients with more severe renal histologic activity (i.e., a histologic activity index of ≥7), the level of urinary MMP‐7 outperformed other clinical markers and improved their predictive performance, thus linking urinary MMP‐7 levels to renal disease activity. Furthermore, among patients who had follow‐up measurements of urinary MMP‐7 after achievement of long‐term remission of renal disease activity, an elevated urinary MMP‐7 level during follow‐up was independently associated with an increased risk of LN flare. This elevation in the urinary MMP‐7 level hinted at the risk of an LN flare at an earlier time point prior to indications using conventional laboratory measures. Thus, use of the urinary MMP‐7 level in conjunction with other clinical measures improved the prognostic value for prediction of an LN flare.ConclusionUrinary MMP‐7 levels in LN are correlated with renal histologic activity. An elevated urinary MMP‐7 level detected after achievement of long‐term renal disease remission is associated with a higher risk of incident renal flare in patients with LN.
Association Between Urinary Epidermal Growth Factor and Renal Prognosis in Lupus Nephritis
Authors: Mejia‐Vilet Juan M. , Shapiro John P. , Zhang Xiaolan L. , Cruz Cristino , Zimmerman Grant , Méndez‐Pérez R. Angélica , Cano‐Verduzco Mayra L. , Parikh Samir V. , Nagaraja Haikady N. , Morales‐Buenrostro Luis E. , Rovin Brad H. 
Published: September 2020

ObjectiveTo evaluate the role of urinary epidermal growth factor (EGF) as a biomarker of chronic kidney damage in lupus nephritis (LN).MethodsA proteomics approach was used to identify urinary EGF as a biomarker of interest in a discovery cohort of patients with LN. The expression of urinary EGF was characterized in 2 large multiethnic LN cohorts, and the association between urinary EGF levels at the time of flare and kidney outcomes was evaluated in a subset of 120 patients with long‐term follow‐up data. For longitudinal studies, the expression of urinary EGF over time was determined in 2 longitudinal cohorts of patients with LN from whom serial urine samples were collected.ResultsDiscovery analysis showed the urinary EGF levels as being low in patients with active LN (median peptide count 8.4, interquartile range [IQR] 2.8–12.3 in patients with active LN versus median 48.0, IQR 45.3–64.6 in healthy controls). The peptide sequence was consistent with that of proEGF, and this was confirmed by immunoblotting. The discovery findings were verified by enzyme‐linked immunosorbent assay. Patients with active LN had a significantly lower level of urinary EGF compared to that in patients with active nonrenal systemic lupus erythematosus (SLE), patients with inactive SLE, and healthy kidney donors (each P < 0.05). The urinary EGF level was inversely correlated with the chronicity index of histologic features assessed in kidney biopsy tissue (Spearman’s r = −0.67, P < 0.001). Multivariate survival analysis showed that the urinary EGF level was associated with time to doubling of the serum creatinine level (DSCr), a marker of future end‐stage kidney disease (ESKD) (hazard ratio 0.88, 95% confidence interval 0.77–0.99, P = 0.045). Patients whose LN symptoms progressed to DSCr and those who experienced progression to ESKD had a lower urinary EGF level at the time of flare, and urinary EGF levels decreased over the 12 months following flare. All patients who experienced progression to ESKD were identified based on a urinary EGF cutoff level of <5.3 ng/mg.ConclusionUrinary EGF levels are correlated with histologic kidney damage in patients with LN. Low urinary EGF levels at the time of flare and decreasing urinary EGF levels over time are associated with adverse long‐term kidney outcomes.
Patients’ Preoperative Expectations of Total Knee Arthroplasty and Satisfaction With Outcomes at One Year: A Prospective Cohort Study
Authors: Hawker Gillian A. , Conner‐Spady Barbara L. , Bohm Eric , Dunbar Michael J. , Jones C. Allyson , Ravi Bheeshma , Noseworthy Tom , Dick Donald , Powell James , Paul Paulose , Marshall Deborah A. ,   the BEST‐Knee Study Team
Published: September 2020

ObjectiveTo assess the relationship between patients’ expectations for total knee arthroplasty (TKA) and satisfaction with surgical outcome.MethodsThis prospective cohort study recruited patients with knee osteoarthritis (OA) ages ≥30 years who were referred for TKA at 2 hip/knee surgery centers in Alberta, Canada. Those who received primary, unilateral TKA completed questionnaires pre‐TKA to assess TKA expectations (17‐item Hospital for Special Surgery [HSS] TKA Expectations questionnaire) and contextual factors (age, sex, Western Ontario and McMaster Universities Osteoarthritis Index pain score, Knee Injury and Osteoarthritis Outcome Score physical function short form [KOOS‐PS], 8‐item Patient Health Questionnaire depression scale, body mass index [BMI], comorbidities, and prior joint replacement), and 1‐year post‐TKA to assess overall satisfaction with TKA results. Using multivariate logistic regression, we examined the relationship between TKA expectations (HSS TKA outcomes considered to be very important) and postoperative satisfaction (very satisfied versus somewhat satisfied versus dissatisfied). Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated.ResultsAt 1 year, 1,266 patients with TKA (92.1%) reported their TKA satisfaction (mean ± SD age 67.2 ± 8.8 years, 60.9% women, and mean BMI 32.6 kg/m2); 74.7% of patients were very satisfied, 17.1% were somewhat satisfied, and 8.2% were dissatisfied. Controlling for other factors, an expectation of TKA to improve patients’ ability to kneel was associated with lower odds of satisfaction (adjusted OR 0.725 [95% CI 0.54–0.98]). An expectation of TKA to improve psychological well‐being was associated with lower odds of satisfaction for individuals in the lowest tertile of pre‐TKA KOOS‐PS scores (adjusted OR 0.49 [95% CI 0.28–0.84]), but higher odds for those in the highest tertile (adjusted OR 2.37 [95% CI 1.33–4.21]).ConclusionIn patients with TKA, preoperative expectations regarding kneeling and psychological well‐being were significantly associated with the level of TKA satisfaction at 1 year. Ensuring that patients’ expectations are achievable may enhance appropriate provision of TKA.
Hemodynamic Response to Treatment and Outcomes in Pulmonary Hypertension Associated With Interstitial Lung Disease Versus Pulmonary Arterial Hypertension in Systemic Sclerosis: Data From a Study Identifying Prognostic Factors in Pulmonary Hypertension Associated With Interstitial Lung Disease
Authors: Chauvelot Louis , Gamondes Delphine , Berthiller Julien , Nieves Ana , Renard Sébastien , Catella‐Chatron Judith , Ahmad Kais , Bertoletti Laurent , Camara Boubou , Gomez Emmanuel , Launay David , Montani David , Mornex Jean‐François , Prévot Grégoire , Sanchez Olivier , Schott Anne‐Marie , Subtil Fabien , Traclet Julie , Turquier Ségolène , Zeghmar Sabrina , Habib Gilbert , Reynaud‐Gaubert Martine , Humbert Marc , Cottin Vincent 
Published: September 2020

ObjectivePatients with systemic sclerosis and both pulmonary hypertension and interstitial lung disease (SSc–PH‐ILD) generally carry a worse prognosis than patients with SSc and pulmonary arterial hypertension (SSc‐PAH) without ILD. There is no evidence of the efficacy of PAH therapies in SSc–PH‐ILD. We undertook this study to compare survival of and response to treatment in patients with SSc–PH‐ILD and those with SSc‐PAH.MethodsWe analyzed 128 patients (66 with SSc–PH‐ILD and 62 with SSc‐PAH) from 15 centers, in whom PH was diagnosed by right‐sided heart catheterization; they were prospectively included in the PH registry. All patients received PAH‐specific therapy. Computed tomography of the chest was used to confirm or exclude ILD.ResultsAt baseline, patients with SSc–PH‐ILD had less severe hemodynamic impairment than those with SSc‐PAH (pulmonary vascular resistance 5.7 Wood units versus 8.7 Wood units; P = 0.0005) and lower diffusing capacity for carbon monoxide (median 25% [interquartile range (IQR) 18%, 35%] versus 40% [IQR 31%, 51%]; P = 0.0005). Additionally, patients with SSc–PH‐ILD had increased mortality (8.1% at 1 year, 21.2% at 2 years, and 41.5% at 3 years) compared to those with SSc‐PAH (4.1%, 8.7%, and 21.4%, respectively; P = 0.04). Upon treatment with PAH‐targeted therapy, no improvement in the 6‐minute walk distance was observed in either group. Improvement in the World Health Organization functional class was observed less frequently in patients with SSc–ILD‐PH compared to those with SSc‐PAH (13.6% versus 33.3%; P = 0.02). Hemodynamics improved similarly in both groups.ConclusionILD confers a worse prognosis to SSc‐PH. Response to PAH‐specific therapy is clinically poor in SSc–PH‐ILD but was not found to be hemodynamically different from the response observed in SSc‐PAH.
Health Assessment Questionnaire at One Year Predicts All‐Cause Mortality in Patients With Early Rheumatoid Arthritis
Authors: Fatima Safoora , Schieir O. , Valois M. F. , Bartlett S. J. , Bessette L. , Boire G. , Hazlewood G. , Hitchon C. , Keystone E. C. , Tin D. , Thorne C. , Bykerk V. P. , Pope J. E. ,   the CATCH Investigators
Published: September 2020

ObjectiveHigher self‐reported disability (high Health Assessment Questionnaire [HAQ] score) has been associated with hospitalizations and mortality in established rheumatoid arthritis (RA), but associations in early RA are unknown.MethodsPatients with early RA (symptom duration <1 year) enrolled in the Canadian Early Arthritis Cohort who initiated disease‐modifying antirheumatic drugs and had completed HAQ data at baseline and 1 year were included in the study. Discrete‐time proportional hazards models were used to estimate crude and multi‐adjusted associations of baseline HAQ and HAQ at 1 year with all‐cause mortality in each year of follow‐up.ResultsA total of 1,724 patients with early RA were included. The mean age was 55 years, and 72% were women. Over 10 years, 62 deaths (3.6%) were recorded. Deceased patients had higher HAQ scores at baseline (mean ± SD 1.2 ± 0.7) and at 1 year (0.9 ± 0.7) than living patients (1.0 ± 0.7 and 0.5 ± 0.6, respectively; P < 0.001). Disease Activity Score in 28 joints (DAS28) was higher in deceased versus living patients at baseline (mean ± SD 5.4 ± 1.3 versus 4.9 ± 1.4) and at 1 year (mean ± SD 3.6 ± 1.4 versus 2.8 ± 1.4) (P < 0.001). Older age, male sex, lower education level, smoking, more comorbidities, higher baseline DAS28, and glucocorticoid use were associated with mortality. Contrary to HAQ score at baseline, the association between all‐cause mortality and HAQ score at 1 year remained significant even after adjustment for confounders. For baseline HAQ score, the unadjusted hazard ratio (HR) was 1.46 (95% confidence interval [95% CI] 1.02–2.09), and the adjusted HR was 1.25 (95% CI 0.81–1.94). For HAQ score at 1 year, the unadjusted HR was 2.58 (95% CI 1.78–3.72), and the adjusted HR was 1.75 (95% CI 1.10–2.77).ConclusionOur findings indicate that higher HAQ score and DAS28 at 1 year are significantly associated with all‐cause mortality in a large early RA cohort.
The Effectiveness of Collaborative Augmented Reality in Gross Anatomy Teaching: A Quantitative and Qualitative Pilot Study
Authors: Bork Felix , Lehner Alexander , Eck Ulrich , Navab Nassir , Waschke Jens , Kugelmann Daniela 
Published: September 2020

In the context of gross anatomy education, novel augmented reality (AR) systems have the potential to serve as complementary pedagogical tools and facilitate interactive, student‐centered learning. However, there is a lack of AR systems that enable multiple students to engage in collaborative, team‐based learning environments. This article presents the results of a pilot study in which first‐year medical students (n = 16) had the opportunity to work with such a collaborative AR system during a full‐day gross anatomy seminar. Student performance in an anatomy knowledge test, conducted after an extensive group learning session, increased significantly compared to a pre‐test in both the experimental group working with the collaborative AR system (P < 0.01) and in the control group working with traditional anatomy atlases and three‐dimensional (3D) models (P < 0.01). However, no significant differences were found between the test results of both groups. While the experienced mental effort during the collaborative learning session was considered rather high (5.13 ± 2.45 on a seven‐point Likert scale), both qualitative and quantitative feedback during a survey as well as the results of a System Usability Scale (SUS) questionnaire (80.00 ± 13.90) outlined the potential of the collaborative AR system for increasing students' 3D understanding of topographic anatomy and its advantages over comparable AR systems for single‐user experiences. Overall, these outcomes show that collaborative AR systems such as the one evaluated within this work stimulate interactive, student‐centered learning in teams and have the potential to become an integral part of a modern, multi‐modal anatomy curriculum.
Clinical management of hip fractures in elderly patients with dementia and postoperative 30‐day mortality: A population‐based cohort study
Authors: Petersen Jindong Ding , Siersma Volkert Dirk , Wehberg Sonja , Nielsen Connie Thurøe , Viberg Bjarke , Waldorff Frans Boch 
Published: September 2020

AbstractObjectivesPatients with dementia have an increased 30‐day mortality after hip fracture. We investigated clinical management including time to surgery, out‐of‐hours admission and surgery, surgery on weekends, surgery volume per ward, and anesthesia technique for this excess mortality risk.MethodThis register‐ and population‐based study comprised 12,309 older adults (age 70+) admitted to hospital for a first‐time hip fracture in 2013–2014, of whom 11,318 underwent hip fracture surgery. Cox proportional hazards regression models were applied for the analysis.ResultsThe overall postoperative 30‐day mortality was 11.4%. Patients with dementia had a 1.5 times increased mortality risk than those without (HR = 1.50 [95% CI 1.31–1.72]). We observed no time‐to‐surgery difference by patient dementia status; additionally, the excess mortality risk in patients with dementia could not be explained by the clinical management factors we examined.ConclusionsIncreased mortality in patients with dementia could not be explained by the measured preoperative clinical management. Suboptimal handling of postoperative complication and rehabilitation are to be investigated for their role in the witnessed increased mortality for patients with dementia.
Nitrogen‐doped hierarchical few‐layered porous carbon for efficient electrochemical energy storage
Authors: Wang Peng , Qi Xiaohuan , Zhao Wei , Qian Meng , Bi Hui , Huang Fuqiang 
Published: September 2020

AbstractLarge surface area, high conductivity, and rich active site of carbon electrode materials are necessary characteristics for energy storage devices. However, high conductivity and high nitrogen doping of carbon electrode materials are difficult to coordinate. Here, a facile method via the carbonization of nitrogen‐containing Schiff base polymer has been developed to prepare high conductivity and high nitrogen‐doped hierarchical porous carbon. The organic components with a benzene ring structure in the polymer promote the formation of more sp2‐graphitized carbon, which is beneficial for the improvement of electrical conductivity. Nitrogen‐doped hierarchical porous carbon calcined at 900°C under the NH3 atmosphere possesses high nitrogen content of 7.48 at%, a large specific surface area of 1613.2 m2/g, and high electrical conductivity of 2.7 S/cm. As electrode materials in an aqueous‐based supercapacitor, nitrogen‐doped hierarchical porous carbon exhibits superior specific capacitance of 385 F/g at 1 A/g as well as excellent rate performance (242 and 215 F/g at a current density of 100 and 200 A/g, respectively). In addition, the specific capacitance of electrode measured in a two‐electrode system is 335 F/g at 1 A/g, and the long‐term cycling stability can be achieved with more than 94% initial capacitance after 10 000 cycles. The constructed symmetric supercapacitor delivers high energy density and high power density. The outstanding electrochemical performances combined with the novel and scalable synthetic approach make the nitrogen‐doped hierarchical porous carbon potential electrode material for electrochemical devices.
Recent Advances on Metal‐Organic Frameworks in the Conversion of Carbon Dioxide
Authors: Liu Xiongli , Li Jinli , Li Na , Li Baiyan , Bu Xian‐He 
Published: September 2020

AbstractWith the development of modern industry, global warming is becoming a challenging issue due to the emissions of large quantities of greenhouse gases, mainly carbon dioxide (CO2). The conversion of CO2 to useful compounds is considered as an effective and economic way to solve such a climate problem. Metal‐organic frameworks (MOFs) are an emerging class of porous crystalline materials that have shown great potential in the conversion of CO2. The advantages of MOFs in CO 2 conversion lie in their high surface areas, adjustable pore size, and high porosity. More importantly, desirable functional sites can be easily designed and precisely installed to the pore wall of target MOFs by pre‐assembly and/or post‐synthetic modification (PSM) ways. This review summarizes the recent advances in constructing MOF catalysts for the application in CO2 conversion. We believe that the design and synthesis of MOF catalysts for CO2 conversion can be a promising way to solve the “greenhouse effect”.