bluuebunny/crossref_metadata_2025_split huggingface dataset:
CT reconstruction with thick slices not only underestimates lymph node size but also reduces data reproducibility in colorectal cancer
Authors: Onuma Yurina , Tsuruta Chie , Okita Kenji , Hamabe Atsushi , Ogura Keishi , Takemasa Ichiro , Hatakenaka Masamitsu 
Published: October 2020

Background Reliable size measurement of lymph node (LN) metastases is important for the evaluation of cancer treatment. However, image analyses without proper settings may result in inappropriate diagnoses and staging. Purpose To investigate whether reconstruction slice thickness in computed tomography (CT) affects measurements of LN size and reproducibility. Material and Methods We analyzed 48 patients with histological diagnoses of sigmoid colon and rectal cancer who underwent contrast-enhanced CT colonography as part of a surgical treatment preparation. A board-certified radiologist selected 106 LNs whose short-axis diameter was ≥5 mm on 1-mm-thick images; the short-axis diameters were measured on 1- and 5-mm-thick images by the radiologist and residents and compared using Wilcoxon matched-pairs signed rank test. Data variation and reproducibility were evaluated using the F test and Bland–Altman analysis. P<0.05 was considered significant. Results Short-axis diameters measured on 5-mm-thick images were significantly lower than those measured on 1-mm-thick images ( P<0.01), even in the LNs whose short-axis diameters were over twice the slice thickness ( P<0.05). Of the 106 LNs, 57 showed short-axis diameter <5 mm on 5-mm-thick images; the maximum short-axis diameter was 6.7 mm on a 1-mm thick image. Data variation was significantly larger on 5-mm thick images than 1-mm-thick images in small LNs ( P<0.05) and reproducibility on 5-mm-thick images was inferior to that on 1-mm-thick images. Conclusion Thick reconstruction slices in CT can result in an underestimation of LN size and reduce data reproducibility. When measuring LN size, a thin reconstruction slice would be recommended based on targeted LN size.
Value of contrast-enhanced malignancy imaging features in secondary grade diagnosis of BI-RADS-US type 4 breast lesions
Authors: Gao Junxi , Han Wei , Ai Si Mu Tu La Di Li Mu La Ti , Hou Xueqin , Li Zhi Ming , Song Tao 
Published: October 2020

Purpose: To explore the value of contrast-enhanced malignancy imaging features in secondary grade diagnosis of Breast Imaging Reporting and Data System for Ultrasonography (BI-RADS-US) type 4 breast lesions. Methods: After initial diagnosis by ultrasound, 124 BI-RADS-US type 4 patients with 130 lesions were examined by contrast-enhanced ultrasound (CEUS) and were classified again before surgery according to five contrast-enhanced malignancy imaging features: inhomogeneous enhancement, peripheral ring-like enhancement, expansive enhancement, internal filling defects, and surrounding radioactive convergence. Lesions with no contrast-enhanced features of malignancy were categorized as type 3; lesions with one, two, or three features of malignancy were categorized as type 4A, 4B, or 4C, respectively; and lesions with four or more indices of malignancy were categorized as type 5. The value of contrasted imaging features of malignancy in diagnosing BI-RADS-US type 4 breast lesions was analyzed. Results: The accuracy of CEUS diagnosis for type 3 lesions was 93.8% (46/49), 76.9% (10/13) for type 4A, 71.4% (5/7) for type 4B, 75.0% (9/12) for type 4C, and 93.8% (46/49) for type 5 lesions. The sensitivity of CEUS in diagnosing malignant lesions was 90.4%, specificity was 83.6%, and accuracy was 86.9%. CEUS decreased the benign lesion biopsy ratio to 68.5% (46/67) and increased the diagnosis ratio of malignant lesions to 73.0% (46/63). Conclusions: CEUS can further optimize the classification of BI-RADS-US type 4 breast lesions and may provide a better reference basis for clinical diagnosis and treatment of those breast lesions.
Actual body weight dosing of temozolomide and overall survival in patients with glioblastoma
Authors: Hsu Phoebe (Yu Hsuan) , Folkman Frances , Ghosh Sunita , de Robles Paula , Leckie Catriona , Dersch-Mills Deonne , Coppens Roland , Chambers Carole 
Published: October 2020

Background Adult glioblastoma patients receiving standard radiation therapy and concurrent temozolomide chemotherapy have a median survival of 14.6 months. Based on the pivotal trial data by Stupp et al., temozolomide doses were calculated based on body surface area. However, no details regarding the weight used to calculate body surface area was included in the study. As a result, temozolomide doses have been variable across the province. Methods This retrospective chart review was conducted to determine the correlation between dose of first line temozolomide with overall survival. Patients between January 1st, 2009 and December 31st, 2014 who were newly diagnosed, pathology confirmed glioblastoma treated first line with temozolomide within Alberta Health Services were included in the study. Temozolomide doses above and below determined cut points were compared through the Kaplan-Meier method, then assessed using the log-rank test. Results A cut point of 97.8% of actual body weight calculated body surface area dosing was determined for concurrent phase temozolomide. At doses above this cut point, there was a statistically significant (p = 0.0158) increase of 0.3 years in median overall survival. As for toxicity concerns, there was a statistically significant increase in the proportion of temozolomide dose reductions due to toxicity in patients dosed above the cut point. Conclusion Temozolomide doses at full actual body weight calculated body surface area dosing during the concurrent phase is required to achieve a similar median OS as seen in the pivotal trial by Stupp et al.
Comparative analysis of two different types of intracorneal implants in keratoconus: A corneal tomographic study
Authors: Sedaghat Mohammad-Reza , Momeni-Moghaddam Hamed , Belin Michael W , Piñero David P , Akbarzadeh Reyhaneh , Ambrósio Renato , Hosseini Seyed Rafi 
Published: October 2020

Objective: To evaluate changes in visual acuity and corneal tomographic outcomes at 6 months after femtosecond-laser assisted implantation of two different types of intracorneal implants in keratoconus. Methods: A total of 39 keratoconus eyes implanted with two segments KeraRing ( n = 22 eyes) or MyoRing ( n = 17 eyes) were enrolled. Tomographic data (Pentacam system, Oculus) were analyzed and correlated with enhancement in uncorrected (UDVA) and corrected distance visual acuity (CDVA). The tomographic indices were front maximum keratometry (Kmax), corneal asphericity (Q-value) on both surfaces, average pachymetric progression indices (PPI), maximum Ambrosio relational thickness (ARTmax), Belin-Ambrósio enhanced ectasia total deviation index (BAD-D), index of surface variance (ISV), vertical asymmetry (IVA), height asymmetry (IHA) and height decentration (IHD). Results: LogMAR UDVA and CDVA improved 2.1 ( p = 0.003) and 0.7 ( p = 0.074) lines with KeraRing, and 8 and 2.5 lines with MyoRing ( p = 0.001). The highest and lowest mean differences in the tomographic indices between both groups were related to ISV and IHD, respectively. Changes in all indices differed significantly between two groups except for changes in front corneal astigmatism, ARTmax, ISV, IVA, IHD and IHA ( p > 0.05). Correlation of changes in CDVA with changes in other parameters was statistically significant only for IHD in the KeraRing group, while changes in in UDVA were significantly correlated with changes in spherical equivalent, back Q-value, ISV, IVA, and IHA only in the MyoRing group. Conclusion: Both implants promote corneal shape regularization and an enhancement in UDVA in keratoconus. A considerable flattening effect and reduction in prolateness in the front corneal surface were observed with MyoRing.
Enablers and barriers for being physically active: experiences from adults with congenital heart disease
Authors: Bay Annika , Lämås Kristina , Berghammer Malin , Sandberg Camilla , Johansson Bengt 
Published: October 2020

Abstract

Background
In general, adults with congenital heart disease have reduced exercise capacity and many do not reach the recommended level of physical activity. A physically active lifestyle is essential to maintain health and to counteract acquired cardiovascular disease, therefore enablers and barriers for being physically active are important to identify.

Aim
To describe what adults with complex congenital heart diseases consider as physical activity, and what they experience as enablers and barriers for being physically active.

Methods
A qualitative study using semi-structured interviews in which 14 adults with complex congenital heart disease (seven women) participated. The interviews were analysed using qualitative content analysis.

Results
The analysis revealed four categories considered enablers and barriers – encouragement, energy level, approach and environment. The following is exemplified by the category encouragement as an enabler: if one had experienced support and encouragement to be physically active as a child, they were more positive to be physically active as an adult. In contrast, as a barrier, if the child lacked support and encouragement from others, they had never had the opportunity to learn to be physically active.

Conclusion
It is important for adults with congenital heart disease to have the opportunity to identify barriers and enablers for being physically active. They need knowledge about their own exercise capacity and need to feel safe that physical activity is not harmful. This knowledge can be used by healthcare professionals to promote, support and eliminate misconceptions about physical activity. Barriers can potentially be transformed into enablers through increased knowledge about attitudes and prerequisites.
Neovagina creation in congenital vaginal agenesis: New mini-laparoscopic approach applying intraoperative indocyanine green fluorescence
Authors: Fontoura Oliveira Andreia , Ferreira Hélder 
Published: October 2020

Background. There is still no standardized treatment for vaginal agenesis; surgical repair using a minimally invasive technique is a good option, as it offers rapid results along with a fast postoperative recovery. Objective. To describe a new modified Vecchietti procedure by a mini-laparoscopic approach with intraoperative use of indocyanine green fluorescence technology for the creation of a neovagina in the setting of congenital vaginal agenesis. Methods. Retrospective review of all cases of congenital vaginal agenesis submitted to a mini-laparoscopic modified Vecchietti procedure with intraoperative use of indocyanine green (ICG) fluorescence (between June and September 2019). Patient relevant medical history, surgical technique, postoperative care, outcomes, and complications are described. Results. Four patients with Mayer–Rokitansky–Küster–Hauser syndrome (mean age: 19 years; mean preoperative vaginal length: 1.5 cm) were included in the study. The procedure was completed successfully and uneventfully in all patients. External traction device was removed 5–7 days after surgery and replaced by external vaginal silicone dilators. This technique was able to create 10–11 cm neovaginas in 1 week; six weeks after surgery all patients had an epithelized 10.5–12 cm length and 2.5–3 cm diameter neovagina. Complications consisted of one case of isolated fever at the ninth postoperative day, solved with empiric antibiotic treatment. Conclusion. The mini-laparoscopic modified Vecchietti approach, associated with ICG fluorescence imaging, is feasible and effective in the treatment of congenital vaginal agenesis, as it is a simple and safe procedure with promising outcomes.
Icariin Promote Stem Cells Regeneration and Repair Acinar Cells in L-arginine / Radiation -Inducing Chronic Pancreatitis in Rats
Authors: Moustafa Enas M. , Moawed Fatma S. M. , Abdel-Hamid Gehan R. 
Published: October 2020

Objective: Chronic Pancreatitis (CP) is a multifactorial disease. It was characterized by severe inflammation and acinar cell destruction. Thus, the present study was initiated to evaluating the ability of bone marrow-based mesenchymal stem cell (MSCs) combined with Icariin to restore and regenerate acinar cells in the pancreas of rats suffering chronic pancreatitis. Methods: Chronic pancreatitis was induced in rats via both L-arginine plus radiation, repeated L-arginine injection (2.5g/Kg body-weight, 1, 4,7,10,13,16,19 days), then, on day 21, rats were exposed to a single dose of gamma-radiation (6 Gy), which exacerbate injury of pancreatic acinar cells. One day after irradiation, rats were treated with either MSCs (1 × 107 /rat, once, tail vein injection) labeled PKH26 fluorescent linker dye and/or Icariin (100 mg/Kg, daily, orally) for 8 weeks. Results: Icariin promotes MSCs proliferation boosting its productivity in vitro. MSCs, and/or icariin treatments has regulated molecular factors TGF-β/PDGF and promoted the regeneration of pancreatic tissues by releasing PDX-1 and MafA involved in the recruitment of stem/progenitor cell in the tissue, and confirmed by histopathological examination. Moreover, a significant decrease in IL-8 and TNF-α cytokines with significant amelioration of myeloperoxidase activity were noted. As well as, reduction in MCP-1 and collagen type-1 levels along with Hedgehog signaling down-regulating expression in such cells, Patched-1, Smoothened, and GLi-1. Conclusion: The potent bioactive therapeutic Icariin combined with MSCs induces a significantly greater improvement, compared to each therapy alone.
The PaCO2-ETCO2 gradient in pre-hospital intubations of all aetiologies from a single UK helicopter emergency medicine service 2015–2018
Authors: Hibberd Owen , Hazlerigg Antonia , Cocker Paul John , Wilson Alastair W , Berry Neil , Harris Tim 
Published: October 2020

Background Control of the arterial partial pressure of carbon dioxide (PaCO2) is important in the ventilated patient. End-tidal carbon dioxide (ETCO2) levels are often used as a proxy, but are clinically limited. The difference between the PaCO2 and ETCO2 has been suggested to be 0.5–1.0 kPa. However, this has not been consistently reflected in the physiologically unstable pre-hospital patient. This study aims to elucidate the PaCO2-ETCO2 gradient for pre-hospital intubated patients. Methods This was a retrospective, cohort study using data identified from the HEMSbase 2 database (Feb 2015–Nov 2018). Patients were included if they had documented ETCO2 and arterial PaCO2 measurements. Arterial PaCO2 data that could not be linked to within 5 minutes of ETCO2 were excluded. Bland-Altman plots were calculated to describe agreement. Results A total of 73 patients were identified. Aetiology was arranged into three categories: 13 (17.8%) medical, 22 (30.1%) traumatic and 38 (52.1%) out-of-hospital cardiac arrest (OHCA). The median PaCO2-ETCO2 gradient was 2.0 [1.3–3.1] kPa. A PaCO2-ETCO2 gradient of 0–1 kPa was seen for only 11 (15.1%) of total patients. The Bland-Altman agreement for all aetiologies was more than the accepted gradient of 0-1 kPa with the largest bias and widest limits of agreement seen for OHCA (–3.2 [0.3 – –6.8]). Conclusion The magnitude of the differences between the ETCO2 and PaCO2, levels of variation and inability to predict this suggest that ETCO2 is not a suitable surrogate upon which to base ventilatory settings in conditions where pH or PaCO2 require precise control.
Effect of post-extubation high-flow nasal cannula on reintubation in elderly patients: a retrospective propensity score-matched cohort study
Authors: Ko Ryoung-Eun , Park Chul , Nam Jimyoung , Ko Myeong Gyun , Na Soo Jin , Ahn Joong Hyun , Carriere Keumhee C. , Jeon Kyeongman 
Published: October 2020

Background: Studies of mechanically ventilated patients with a low risk of reintubation have suggested that the use of high-flow nasal cannula (HFNC) oxygen therapy reduces the risk of reintubation compared with conventional oxygen therapy (COT). However, the effect of HFNC following extubation in elderly patients with a high risk of reintubation remains unclear. Methods: All consecutive medical intensive care unit (ICU) patients aged >65 years who were mechanically ventilated for >24 h were prospectively registered between July 2017 and June 2018. Control was obtained from a historical database of patients attending the same ICU from January 2012 to December 2013. A total of 152 patients who underwent HFNC after planned extubation according to institutional protocols (HFNC group) were compared with a propensity-matched historical control group who underwent COT ( n = 175, COT group). The primary outcome was the proportion of reintubated patients within 48 h after planned extubation. Results: One hundred patients from the HFNC group and 129 patients from the COT group were matched by a propensity score that reflected the probability of receiving HFNC, and all variables were well matched. Post-extubation respiratory failure (41.0% versus 33.3%, p = 0.291) and reintubation rate within 48 h (16.0% versus 11.6%, p = 0.436) did not differ between the HFNC and COT groups. However, decreased levels of consciousness as a sign of post-extubation respiratory failure (27.0% versus 11.7%, p = 0.007) were significantly increased in the HFNC group compared with the COT group. Conclusion: Among elderly patients who underwent planned extubation, HFNC was not associated with a decrease in the risk of reintubation. Further prospective study evaluating the clinical benefits of post-extubation HFNC in elderly patients is needed. The reviews of this paper are available via the supplemental material section.
The Effect of Overexpression of Lrp5 on the Temporomandibular Joint
Authors: Utreja Achint , Motevasel Hengameh , Bain Carol , Holland Robert , Robling Alexander 
Published: October 2020

Objective The temporomandibular joint (TMJ) is a unique fibrocartilaginous joint that adapts to mechanical loading through cell signaling pathways such as the Wnt pathway. Increased expression of low-density lipoprotein receptor-related protein 5 (Lrp5), a co-receptor of the Wnt pathway, is associated with a high bone mass (HBM) phenotype. The objective of this study was to analyze the effect of overexpression of Lrp5 on the subchondral bone and cartilage of the TMJ in mice exhibiting the HBM phenotype. Design Sixteen-week-old Lrp5 knock-in transgenic mice carrying either the A214V (EXP-A) or G171V (EXP-G) missense mutations, and wildtype controls (CTRL) were included in this study. Fluorescent bone labels, calcein, alizarin complexone, and demeclocycline were injected at 3.5, 7.5, and 11.5 weeks of age, respectively. The left mandibular condyle was used to compare the subchondral bone micro-computed tomography parameters and the right TMJ was used for histological analyses. Cartilage thickness, matrix proteoglycan accumulation, and immunohistochemical localization of Lrp5 and sclerostin were compared between the groups. Results Subchondral bone volume (BV) and percent bone volume (BV/TV) were significantly increased in both EXP-A and EXP-G compared with CTRL ( P < 0.05) whereas trabecular spacing (Tb.Sp) was decreased. Cartilage thickness, extracellular matrix production, and expression of Lrp5 and Sost were all increased in the experimental groups. The separation between the fluorescent bone labels indicated increased endochondral maturation between 3.5 and 7.5 weeks. Conclusions These data demonstrate that Lrp5 overexpression leads to adaptation changes in the mandibular condylar cartilage of the TMJ to prevent cartilage degradation.
An Introduction to Research for Primary Dental Care Clinicians
Authors: Santini Ario , Eaton Kenneth A 
Published: October 2020

This paper, the fifth in the series, will address the sixth of the ten stages of a research project suggested in the first paper. The ten suggested stages are: 1. The initial idea (asking a research question). 2. Searching the literature. 3. Refining the research question. 4. Planning the study. 5. Writing a protocol. 6. Obtaining ethical approval and funding. 7. Piloting the methodology and project management. 8. Collecting data. 9. Analysing the data. 10. Writing up and disseminating the results. A previous paper1 has outlined the how to plan a research project. The next stage has two elements, which are to obtain ethical approval and to obtain funding. Each is the topic of a separate paper. This paper outlines the key areas within the topic of funding and updates two previous publications.2,3
Autologous rectus fascia sling for post-vesicovaginal fistula repair stress incontinence: case series from a Nigerian experience
Authors: Lawal Olatunji Okikiola , Nasir Sadiya , Bello Oluwasomidoyin Olukemi , Abdus-salam Rukiyat Adeola , Morhason-Bello Imran Oludare , El-ladan A. M. , Ojengbede Oladosu Akanbi 
Published: October 2020

Abstract

Background
Successful outcome of a urinary fistula repair involves a successful closure of the fistula without residual incontinence. However, a few women have post-repair stress urinary incontinence despite closure of the fistula, which requires special surgical technique to achieve total continence.

Case presentation
Four women with post-vesicovaginal fistula repair residual incontinence were selected for sling operation using autologous rectus fascia in a low resource setting. Their ages ranged between 20 and 30 years. None had a fistulous opening on vaginal examination and dye test. Two patients had one previous attempt at repair of post-repair stress incontinence, while the others had two and three attempts, respectively, without success. The patients had none to mild vaginal adhesion. Following the procedure, they were followed up for 6 months and they remained continent of urine.

Conclusion
All patients achieved total urinary continence following autologous rectus fascia slings with minimal complications. This demonstrates the possibility of achieving a successful outcome despite lack of modern equipment for diagnosis and follow-up, a typical problem of low-income country like Nigeria.
Ocular syphilis with optic disc neovascularization treated with bevacizumab evaluated by OCT angiography and electroretinography
Authors: Miura Gen , Baba Takayuki , Takeishi Marie , Tatsumi Tomoaki , Yokouchi Hirotaka , Yamamoto Shuichi 
Published: October 2020

Abstract
We present our findings in an atypical case of ocular syphilis with optic disc neovascularization that was treated with intravitreal bevacizumab and followed by multimodal imaging and electroretinography. A 29-year-old man presented with a chief complaint of night blindness of one-year duration. Our initial examination showed that an optic disc neovascularization was present, and the optical coherence tomographic (OCT) images showed a reduction in the length of the ellipsoid zone of both eyes. Fluorescein angiography showed leakage from the optic disc neovascular tissue, and the presence of nonperfused areas in the peripheral retina. Blood test was strongly positive for syphilis. He was administered oral amoxicillin and prednisolone. He was also treated with an intravitreal injection of bevacizumab which led to a rapid suppression of the neovascularization. However, panretinal photocoagulation had to be performed because OCT angiography and fluorescein angiography detected residual neovascularization. Although these treatments suppressed the activity of the ocular syphilis, electrophysiological improvements were not seen even 1 year after the initial treatment. OCT angiography and electroretinogram are useful techniques for monitoring the effectiveness of the treatments.