bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retrospective Review of Preoperative Wire Localization for Peripheral Ground Glass Opacities
Authors: Merchant Natalie N. , McKenna Robert , Sier Rachel , Onugha Osita 
Published: November 2020

Video-assisted thoracoscopy (VATS) is performed for diagnosis and treatment of peripheral lung nodules. Localization of peripherally located ground-glass opacities (GGOs) can be challenging. We report the results and usefulness of preoperative computed tomography (CT)-guided wire localization. Records for patients who underwent CT-guided wire localization prior to VATS resection for peripherally located GGOs were analyzed. Our technique for targeting the GGOs, complications, and histopathology of GGOs is reviewed. Forty patients (mean age 68 years) underwent pulmonary resections following CT-guided wire localization. The mean diameter of the GGO was 11.0 mm. The mean distance from the pleural surface to the peripheral margin of the GGO was 18.6 mm. Complications from the wire localization included pneumothorax in 5 patients (12.5%), none of whom required insertion of a chest tube; parenchymal hemorrhage in 3 patients (7.5%); and pleural effusion requiring chest tube drainage (unrelated to the wire) in 1 patient (2.5%). The mean operative time was 74 (range: 21-186 ) minutes. Pathological examination revealed lung malignancy in 36 patients (90%). The diagnostic yield was 100%. Preoperative CT-guided wire localization for solitary or multiple peripherally located GGOs allows for determination of histopathologic diagnosis and high diagnostic yield.
The Supply Chain Disruption Framework Post COVID-19: A System Dynamics Model
Authors: Sinha Deepankar , Bagodi Virupaxi , Dey Debasri 
Published: November 2020

The COVID pandemic seems to have raised the question, ‘whether existing supply chain (SC) disruption philosophies and strategies continue to remain valid?’. This article assesses the differences in the business scenarios pre-and post-COVID. The authors capture the mathematical and operational relationships amongst the relevant factors and propose a System Dynamics (SD) model to carry out the simulations. The approach considers the impact of the force majeure condition, that is, COVID period on individuals’ income, prices and demand of goods, cost of input and supply of finished goods. The results show that earnings may increase demand but, disruption in supplies of raw materials and finished products nullify the effect. On the other hand, even if flow returns to normal, reduced income affects normal goods businesses. JEL Codes: R41
Prevalence and correlates of psychological distress among a national population-based sample of adults in Solomon Islands
Authors: Pengpid Supa , Peltzer Karl 
Published: November 2020

Background: Psychological distress is an undersearched cause of poorer health in the Pacific island countries. Aims: The study aimed to investigate the prevalence and associated factors of psychological distress in a population-based survey among 18–69 year-old persons in Solomon Islands. Method: Cross-sectional nationally representative data of 2,533 18–69 year-old persons (38 years were the median age) from the 2015 Solomon Islands STEPS survey were analysed. Results: The results indicate that 18.9% of participants had psychological distress (⩾20 scores), 13.4% had mild (20–24 scores), 4.3% moderate (25–29 scores) and 1.1% severe (30–50 scores) psychological distress. In adjusted logistic regression analysis, being divorced, separated, or widowed (AOR: 2.76, 95% CI: 1.60–4.78), having had a heart attack or stroke (AOR: 3.34, 95% CI: 2.23–4.99), alcohol dependence (AOR: 1.72, 95% CI: 1.04–2.84), and sedentary behaviour (AOR: 1.90, 95% CI: 1.28–2.84), were positively and the consumption of 3–4 servings of fruit and vegetables (AOR: 0.62, 95% CI: 0.42–0.92), were negatively associated with psychological distress (⩾20 scores). In addition, in a sex stratified adjusted logistic regression analysis among men, current smokeless tobacco use (AOR: 4.95, 95% CI: 1.66–14.75), was associated with psychological distress. Furthermore, in the overall unadjusted analysis, stop smoking attempts in the past 12 months and consumption of too much salt was associated with psychological distress. Conclusion: Almost one in five participants were reported psychological distress and several factors were detected which could be targeted in intervention activities.
B-Lines Scores Derived From Lung Ultrasound Provide Accurate Prediction of Extravascular Lung Water Index: An Observational Study in Critically Ill Patients
Authors: Mayr Ulrich , Lukas Marina , Habenicht Livia , Wiessner Johannes , Heilmaier Markus , Ulrich Jörg , Rasch Sebastian , Schmid Roland M. , Lahmer Tobias , Huber Wolfgang , Herner Alexander 
Published: November 2020

Introduction: Visualization of B-lines via lung ultrasound provides a non-invasive estimation of pulmonary hydration. Extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) assessed by transpulmonary thermodilution (TPTD) represent the most validated parameters of lung water and alveolocapillary permeability, but measurement is invasive and expensive. This study aimed to compare the correlations of B-lines scores from extensive 28-sector and simplified 4-sector chest scan with EVLWI and PVPI derived from TPTD in the setting of intensive care unit (primary endpoint). Methods: We performed scoring of 28-sector and 4-sector B-Lines in 50 critically ill patients. TPTD was carried out with the PiCCO-2-device (Pulsion Medical Systems SE, Maquet Getinge Group). Median time exposure for ultrasound procedure was 12 minutes for 28-sector and 4 minutes for 4-sector scan. Results: Primarily, we found close correlations of 28-sector as well as 4-sector B-Lines scores with EVLWI (R2 = 0.895 vs. R2 = 0.880) and PVPI (R2 = 0.760 vs. R2 = 0.742). Both B-lines scores showed high accuracy to identify patients with specific levels of EVLWI and PVPI. The extensive 28-sector B-lines score revealed a moderate advantage compared to simplified 4-sector scan in detecting a normal EVLWI ≤ 7 (28-sector scan: sensitivity = 81.8%, specificity = 94.9%, AUC = 0.939 versus 4-sector scan: sensitivity = 81.8%, specificity = 82.1%, AUC = 0.902). Both protocols were approximately equivalent in prediction of lung edema with EVLWI ≥ 10 (28-sector scan: sensitivity = 88.9%, specificity = 95.7%, AUC = 0.977 versus 4-sector scan: sensitivity = 81.5%, specificity = 91.3%, AUC = 0.958) or severe pulmonary edema with EVLWI ≥ 15 (28-sector scan: sensitivity = 91.7%, specificity = 97.4%, AUC = 0.995 versus 4-sector scan: sensitivity = 91.7%, specificity = 92.1%, AUC = 0.978). As secondary endpoints, our evaluations resulted in significant associations of 28-sector as well as simplified 4-sector B-Lines score with parameters of respiratory function. Conclusion: Both B-line protocols provide accurate non-invasive evaluation of lung water in critically ill patients. The 28-sector scan offers a marginal advantage in prediction of pulmonary edema, but needs substantially more time than 4-sector scan.
Chronic Lateral Ankle Instability: Topical Review
Authors: Aicale Rocco , Maffulli Nicola 
Published: November 2020

Chronic ankle instability can result from untreated or badly managed acute lateral ankle ligament injuries. Conservative management is the modality of choice for acute lateral ankle ligament injuries, and operative treatment is reserved for special cases. Failure after strict rehabilitation may be an indication for surgery. Several operative options are available, including anatomic repair, anatomic reconstruction, and tenodesis procedures. Anatomic repair can be performed when the quality of the damaged ligaments permits. Anatomic reconstruction with an autograft or allograft should be considered when the torn ligaments are not adequate. Ankle arthroscopy is a useful adjunct to ligamentous procedures, performed at the time of repair to identify and treat intra-articular conditions that may be associated with chronic ankle instability. Tenodesis techniques are not recommended because of their suboptimal long-term results related to the modification of ankle and hindfoot biomechanics. Level of Evidence: Level V, expert opinion.
Protective effect of vitrectomy on the course of diabetic retinopathy: A case report
Authors: Iuliano Lorenzo , Corbelli Eleonora , Bandello Francesco , Codenotti Marco 
Published: November 2020

Purpose: To hypothesize the protective role of vitrectomy on the natural course of diabetic retinopathy. Methods: Case report. Results: A 66-year-old lady with a history of type 1 diabetes mellitus since the age of 10 was referred for evaluation. She received laser treatment in her left eye for proliferative diabetic retinopathy 6 years earlier, while her right eye underwent vitrectomy for retinal detachment 17 years before. Diabetic retinopathy was found to be substantially asymmetrical, as the vitrectomized right eye had only mild macular edema without significant vascular abnormalities, whereas the left eye had a complete confluent panretinal photocoagulation with advanced atrophic macular changes. Other reasons for this asymmetry, such as axial length disparity, carotid circulation impairment, or history of branch retinal vein occlusion, were not identified. Conclusions: Vitreous removal, performed for a reason other than diabetic retinopathy, may inhibit the retinal complications often associated with longstanding diabetes. Further clinical studies should be considered to ascertain such evidence.
Viral load Suppression and Associated Factors among HIV Patients on Antiretroviral Treatment in Bulambuli District, Eastern Uganda: A Retrospective Cohort Study
Authors: Wakooko Paul , Gavamukulya Yahaya , Wandabwa Julius N 
Published: November 2020

Background: HIV viral load suppression (VLS) is the most important indicator of successful antiretroviral therapy. In 2016, Bulambuli District started monitoring HIV patients on ART using viral load tests in an effort to meet the third 90 of the UNAIDS 90-90-90 strategy which is VLS. The objective of this study was to determine the progress in Bulambuli District towards achievement of VLS among HIV infected patients on ART and associated factors that affect this programme. Methods: A retrospective cohort study design was used. One thousand, one hundred and one medical records of HIV infected patients on ART who attended HIV clinic at Muyembe Health Centre IV from June 2016 to April 2018 were reviewed. A data abstraction tool was used for data collection. Chi Square was used to determine factors associated with VLS and logistic regression was used to determine the magnitude by which the ART and clinical factors influence VLS. Data were summarized using descriptive statistics for categorical variables and by computing proportions, means and standard deviation for continuous variables. Results: Of the patients (n = 944, 85.7%) had attained VLS. Adjusting for known confounders, only adherence to ART was a significant predictor of VLS. Individuals with fair adherence (80%-95%) had 2.667 times the odds of VLS, CI = 1.122-9.370, P-value of <.002 compared to individuals with good (>95%) adherence which was used as the reference while those with poor (<80%) adherence had 4.553 times the odds of attaining VLS, CI = 1.31-13.930, P-value of <.001 compared to individuals with good adherence. Conclusion: These findings suggest that Bulambuli District, at 85.7% VLS is on track to attaining the third 90 of the 90, 90, 90 global targets by 2020. It further reveals that adherence is the only significant predictor of VLS in the District.
Combinatorial Therapy of High Dose Vitamin C and PARP Inhibitors in DNA Repair Deficiency: A Series of 8 Patients
Authors: Demiray Mutlu 
Published: November 2020

Background: Tumor-specific DNA repair defects are ubiquitous in cancerous tissue, which offers a potential for clinical gain to build on these perturbations. Intravenous high-dose vitamin C (IVC) triggers the formation of hydrogen peroxide (H2O2), which contributes to Fenton chemistry producing hydroxyl radicals (-OH), causing selective damage to DNA. Herein, we evaluated the therapeutic response to IVC and PARP inhibitors (PARPi) in combination in 8 patients with a deficiency of homologous recombination repair system (dHRR) in a 3-year period. Material and Methods: Eight patients with progressive stage IV malignancy, who were pre-treated with conventional methods, were admitted to our clinic. Subsequent therapy has included IVC at a dose that was set to be in the range of 1 to 1.5 g/kg, although 1.25 g/kg was dominantly administered. Furthermore, following genomic evaluation, PARPi (niraparib or olaparib or talazoparib) was chosen to be used in combination with IVC which was administered 2 to 4 times a week. Results: In the present study, we achieved partial response in 5 patients and complete response in 3 patients. Grade 2 anemia and fatigue toxicities were observed in some cases, while grade 3 toxicity was not found in any of the patients. Conclusion: Our 8 patient case study shows that IVC could be a plausible additional therapy for HRR deficiency. Although the single agent PARPi therapy is effective for metastatic disease, an overall survival (OS) advantage has not been demonstrated. Our results suggest that adding IVC can improve PARPi therapy outcomes. To fully endorse the results stated above, combinatorial therapy of intravenous high dose vitamin C and PARP inhibitors needs to be reviewed in broader cohorts of patients.
Improving Accelerometry-Based Measurement of Functional Use of the Upper Extremity After Stroke: Machine Learning Versus Counts Threshold Method
Authors: Lum Peter S. , Shu Liqi , Bochniewicz Elaine M. , Tran Tan , Chang Lin-Ching , Barth Jessica , Dromerick Alexander W. 
Published: November 2020

Background Wrist-worn accelerometry provides objective monitoring of upper-extremity functional use, such as reaching tasks, but also detects nonfunctional movements, leading to ambiguity in monitoring results. Objective Compare machine learning algorithms with standard methods (counts ratio) to improve accuracy in detecting functional activity. Methods Healthy controls and individuals with stroke performed unstructured tasks in a simulated community environment (Test duration = 26 ± 8 minutes) while accelerometry and video were synchronously recorded. Human annotators scored each frame of the video as being functional or nonfunctional activity, providing ground truth. Several machine learning algorithms were developed to separate functional from nonfunctional activity in the accelerometer data. We also calculated the counts ratio, which uses a thresholding scheme to calculate the duration of activity in the paretic limb normalized by the less-affected limb. Results The counts ratio was not significantly correlated with ground truth and had large errors ( r = 0.48; P = .16; average error = 52.7%) because of high levels of nonfunctional movement in the paretic limb. Counts did not increase with increased functional movement. The best-performing intrasubject machine learning algorithm had an accuracy of 92.6% in the paretic limb of stroke patients, and the correlation with ground truth was r = 0.99 ( P < .001; average error = 3.9%). The best intersubject model had an accuracy of 74.2% and a correlation of r =0.81 ( P = .005; average error = 5.2%) with ground truth. Conclusions In our sample, the counts ratio did not accurately reflect functional activity. Machine learning algorithms were more accurate, and future work should focus on the development of a clinical tool.
Clinical characteristics associated with sentinel headache in patients with unruptured intracranial aneurysms
Authors: Wan Zheng , Meng Hao , Xu Ning , Liu Tianyi , Chen Zhongping , Sun Yang , Wang Honglei 
Published: November 2020

Objective Sentinel headache (SH) is considered as a signal of the impending rupture of an aneurysm. However, it is difficult to diagnose whether the headaches of patients are associated with unstable aneurysms. Therefore, there is some doubt about the importance of headaches in patients with unruptured intracranial aneurysms (UIAs). This study was performed to explore the existence and clinical characteristics of SH associated with aneurysms. Methods Thirty-six patients with a single UIA were collected in this study. Patients were symptomatically categorized into two groups: SH and non-SH. The PHASES scores and patient and aneurysm characteristics were analyzed. Two independent MRI experts who were blinded to the patients’ clinical history conducted the analysis of the SWI results. Results There were 15 patients with sentinel headache. No significant difference was found in patient’s basic information and history. The SH group had a higher PHASES score than the non-SH group (P < 0.05). In univariable analysis, abnormal SWI signals were significantly more frequent in the SH group (P < 0.01) and the inflow angle was significantly lower in the non-SH group (P < 0.05). In multivariable analysis, abnormal signals in SWI were an independent factor associated with SH (P < 0.01). Conclusions SH exists in patients with UIAs and may indicate a high risk of aneurysm rupture. Abnormal signals on SWI may serve as a clinical feature to identify aneurysm-related SH and be helpful for the formulation of therapeutic strategy. Aneurysm geometry may also be related to SH but need further studies in the future.
Pharmacokinetics and tolerability of LIQ861, a novel dry‐powder formulation of treprostinil
Authors: Roscigno Robert , Vaughn Toby , Anderson Stephanie , Wargin William , Hunt Thomas , Hill Nicholas S. 
Published: November 2020

A dry‐powder inhaled formulation of treprostinil (LIQ861) produced using PRINT® technology offers a substantial advantage over current nebulized therapy. Treprostinil is a synthetic prostacyclin analogue that is currently approved for inhalation administration to patients with pulmonary arterial hypertension via nebulized Tyvaso® inhalation solution. LTI‐101 was a phase 1, placebo‐controlled, double‐blind, randomized, single‐center study that evaluated the ascending single‐dose pharmacokinetics of LIQ861 in healthy subjects. Six sequential, escalating doses (25, 50, 75, 100, 125, and 150 mcg) were studied to investigate treprostinil exposure from LIQ861 inhalation. Subjects (n = 57) were randomly assigned in a 3:1 ratio to receive a single dose of either LIQ861 (n = 43) or placebo (n = 14); 56 subjects completed all protocol‐defined assessments. Following single‐dose administration, treprostinil exposure from LIQ861 increased proportionally across the dose range studied, and the pharmacokinetics profile of treprostinil administered as LIQ861 was similar to prior reports of inhaled treprostinil. All doses of LIQ861 were generally well‐tolerated with no deaths, serious adverse events, or dose‐limiting toxicities. The most frequently reported treatment‐emergent adverse events related to study drug administration were coughing and throat irritation, which are common to dry‐powder formulations. Treatment‐related treatment‐emergent adverse events were reported more frequently at higher dose levels; however, all were assessed as mild in severity. We conclude that the pharmacokinetics profile of treprostinil using a dry‐powder inhaled formulation increased in proportion to dose as anticipated and was similar to earlier reports of inhaled, nebulized treprostinil (Tyvaso®). Based on these results, a phase 3 study (INSPIRE; Clinicaltrials.gov Identifier NCT03399604) evaluating the long‐term safety and tolerability of LIQ861 in patients with pulmonary arterial hypertension was initiated.
Cortical brain activity in transfemoral or knee-disarticulation prosthesis users performing single- and dual-task walking activities
Authors: Möller Saffran , Ramstrand Nerrolyn , Hagberg Kerstin , Rusaw David 
Published: November 2020

Introduction Walking with a prosthesis while performing secondary tasks increases demand on cognitive resources, compromising balance and gait. This study investigated effects of a secondary task on patterns of brain activity and temporospatial gait parameters in individuals using a prosthesis with or without a microprocessor-controlled prosthetic knee(MPK) and controls. Methods A cross-sectional study with repeated measures was performed. Twenty-nine individuals with amputations and 16 controls were recruited. Functional near-infrared spectroscopy was used to evaluate changes in oxygenated and de-oxygenated haemoglobin in the prefrontal cortex and temporospatial variables during single-and dual-task walking. Results Differences in brain activity were observed within the MPK-group and controls without changes in temporospatial parameters. The Trail-Walking test was associated with highest levels of brain activity in both groups. No differences were observed between single- and dual-task walking in the non-MPK-group (p > 0.05). The Non-MPK and the MPK-group recorded higher levels of brain activity than controls during single-task walking and poorer results on temporospatial variables compared to controls. Conclusions For the MPK-group and controls, introduction of a secondary task led to an increase in brain activity. This was not seen in the Non-MPK-group. Significant differences in brain activity were observed in the absence of changes in temporospatial parameters.
Comparison Between the Japanese Orthopaedic Association (JOA) Score and Patient-Reported JOA (PRO-JOA) Score to Evaluate Surgical Outcomes of Degenerative Cervical Myelopathy
Authors: Oshima Yasushi , Takeshita Katsushi , Kato So , Doi Toru , Matsubayashi Yoshitaka , Taniguchi Yuki , Nakajima Koji , Oguchi Fumihiko , Okamoto Naoki , Sakamoto Ryuji , Tanaka Sakae 
Published: November 2020

Study Design: A retrospective cohort study. Objective: To investigate whether the Japanese Orthopaedic Association (JOA) score can be used for patients with degenerative cervical myelopathy as a patient-reported outcome (PRO) through the JOA written questionnaire. Methods: A total of 75 patients who underwent posterior decompression surgery for degenerative cervical myelopathy were reviewed. Patients responded to questionnaires including PRO-JOA, EuroQOL-5D, Neck Disability Index, and Short Form-12 preoperatively and at >12 months postoperatively. Spearman’s rho and Bland-Altman analyses were used to investigate the correlations. Results: Preoperative JOA and PRO-JOA scores were 10.8 and 10.6, respectively, with Spearman’s rho of 0.74. Similarly, postoperative JOA and PRO-JOA scores were 13.3 and 12.9, respectively, with Spearman’s rho of 0.68. However, the recovery rates for JOA and PRO-JOA scores were 42% and 27%, respectively, with Spearman’s rho of 0.45. Compared with other PROs, JOA and PRO-JOA scores were moderately correlated. The minimum clinically important difference was 2.5 for JOA score, 3.0 for PRO-JOA score, 42% for JOA recovery rate, and 33% for PRO-JOA recovery rate. Bland-Altman analyses revealed that limits of agreement were −4.3 to 4.7, −3.4 to 4.3, and −75% to 106% for the preoperative score, postoperative score, and recovery rate, respectively. Conclusion: PRO-JOA score can also be used as a disease-specific scoring measure instead of JOA score. However, although both measures demonstrate a similar trend as a group analysis, PRO-JOA and JOA scores should be regarded as different outcomes.