bluuebunny/crossref_metadata_2025_split huggingface dataset:
Brain Death Evaluation in Children With Suspected or Confirmed Coronavirus Disease 2019
Authors: Kirschen Matthew P. , McGowan Nancy , Topjian Alexis 
Published: December 2020

Objectives:
To discuss the challenges of conducting a death by neurologic criteria or brain death evaluation in the coronavirus disease 2019 era and provide guidance to mitigate viral transmission risk and maintain patient safety during testing.

Design:
Not applicable.

Setting:
Not applicable.

Patients:
Children with suspected or confirmed coronavirus disease 2019 who suffer catastrophic brain injury due to one of numerous neurologic complications or from an unrelated process and require evaluation for death by neurologic criteria.

Interventions:
Not applicable.

Measurements and Main Results:
There is a risk to healthcare providers from aerosol generation during the neurologic examination and apnea test for determination of death by neurologic criteria. In this technical note, we provide guidance to mitigate transmission risk and maintain patient safety during each step of the death by neurologic criteria evaluation. Clinicians should put on appropriate personal protective equipment before performing the death by neurologic criteria evaluation. Risk of aerosol generation and viral transmission during the apnea test can be mitigated by using continuous positive airway pressure delivered via the ventilator as a means of apneic oxygenation. Physicians should assess the risk of transporting coronavirus disease 2019 patients to the nuclear medicine suite to perform a radionucleotide cerebral blood flow study, as disconnections to and from the ventilator for transport and inadvertent ventilator disconnections during transport can increase transmission risk.

Conclusions:
When conducting the neurologic examination and apnea test required for death by neurologic criteria determination in patients with suspected or confirmed coronavirus disease 2019, appropriate modifications are needed to mitigate the risk of viral transmission and ensure patient safety.
Pre-examinations Improve Automated Metastases Detection on Cranial MRI
Authors: Deike-Hofmann Katerina , Dancs Dorottya , Paech Daniel , Schlemmer Heinz-Peter , Maier-Hein Klaus , Bäumer Philipp , Radbruch Alexander , Götz Michael 
Published: December 2020

Objective
The aim of this study was to assess the diagnostic value of inclusion of prediagnosis magnetic resonance imaging (MRI) and different MRI sequences when training a convolutional neural network (CNN) in detection of metastases from malignant melanoma (MM) on an annotated real-life cranial MRI dataset.
Diagnostic performance was challenged by extracerebral-intracranial MM and by inclusion of MRI with varying sequence parameters.

Materials and Methods
Our local ethics committee approved this retrospective monocenter study.
First, a dual-time approach was assessed, for which the CNN was provided sequences of the MRI that initially depicted new MM (diagnosis MRI) as well as of a prediagnosis MRI: inclusion of only contrast-enhanced T1-weighted images (CNNdual_ce) was compared with inclusion of also the native T1-weighted images, T2-weighted images, and FLAIR sequences of both time points (CNNdual_all).
Second, results were compared with the corresponding single time approaches, in which the CNN was provided exclusively the respective sequences of the diagnosis MRI.
Casewise diagnostic performance parameters were calculated from 5-fold cross-validation.

Results
In total, 94 cases with 494 MMs were included. Overall, the highest diagnostic performance was achieved by inclusion of only the contrast-enhanced T1-weighted images of the diagnosis and of a prediagnosis MRI (CNNdual_ce, sensitivity = 73%, PPV = 25%, F1-score = 36%). Using exclusively contrast-enhanced T1-weighted images as input resulted in significantly less false-positives (FPs) compared with inclusion of further sequences beyond contrast-enhanced T1-weighted images (FPs = 5/7 for CNNdual_ce/CNNdual_all, P < 1e-5). Comparison of contrast-enhanced dual and mono time approaches revealed that exclusion of prediagnosis MRI significantly increased FPs (FPs = 5/10 for CNNdual_ce/CNNce, P < 1e-9).
Approaches with only native sequences were clearly inferior to CNNs that were provided contrast-enhanced sequences.

Conclusions
Automated MM detection on contrast-enhanced T1-weighted images performed with high sensitivity. Frequent FPs due to artifacts and vessels were significantly reduced by additional inclusion of prediagnosis MRI, but not by inclusion of further sequences beyond contrast-enhanced T1-weighted images. Future studies might investigate different change detection architectures for computer-aided detection.
The Macrocyclic Gadolinium-Based Contrast Agents Gadobutrol and Gadoteridol Show Similar Elimination Kinetics From the Brain After Repeated Intravenous Injections in Rabbits
Authors: Frenzel Thomas , Ulbrich Hannes-Friedrich , Pietsch Hubertus 
Published: December 2020

Objective
The gadolinium (Gd) concentrations in the cerebellum and cerebrum of rabbits and the elimination kinetics were compared after repeated injection of the macrocyclic Gd-based contrast agents (GBCAs) gadobutrol and gadoteridol.

Materials and Methods
Male white New Zealand rabbits (2.4–3.1 kg) in 2 study groups (n = 21 each) received 3 injections of either gadobutrol or gadoteridol at 0.9 mmol Gd/kg within 5 days (total dose, 2.7 mmol Gd/kg). Animals in one control group (n = 9) received 3 injections of saline (1.8 mL/kg). After 2, 6, and 12 weeks, 7 animals from each study group and 3 from the control group were killed and the Gd concentrations in the cerebellum, cerebrum, in blood and in urine were determined by inductively coupled plasma mass spectrometry. The chemical species of excreted Gd in urine were determined by high pressure liquid chromatography.

Results
No significant (P > 0.05) differences in the Gd concentrations in the brain of rabbits were observed between the 2 macrocyclic GBCAs gadoteridol and gadobutrol at all time points. In the gadobutrol group, the mean Gd concentrations in the cerebellum and cerebrum decreased from 0.26 and 0.21 nmol Gd/g after 2 weeks, to 0.040 and 0.027 nmol Gd/g after 12 weeks, respectively, and in the gadoteridol group, from 0.25 and 0.21, to 0.037 and 0.023 nmol Gd/g, respectively. The plasma levels decreased from 0.11 and 0.13 nmol Gd/mL at 2 weeks for gadobutrol and gadoteridol to below the limit of quantification (<0.005 nmol Gd/mL) at 12 weeks. The urine concentration dropped in a biphasic course from 2 to 6 and from 6 to 12 weeks for both agents. The Gd excreted after 12 weeks was still present in the urine in the chemical form of the intact Gd complex for both agents.

Conclusions
Contrary to what had been reported in rats, no significant differences in the elimination kinetics from brain tissue in rabbits were observed after intravenous injection of multiple doses of the macrocyclic GBCAs gadobutrol and gadoteridol.
Adults With Unilateral Cleft Lip and Palate Present Reduced Internal Nasal Volumes: Findings of a Three-Dimensional Morphometric Assessment in Cone-Beam Computed Tomography Scans
Authors: dos Inocentes Renan Jhordan Mettelziefen , Marzano-Rodrigues Maria Noel , de Espíndola Guilherme Gonçalves , García-Usó Michele , Yatabe-Ioshida Marília Sayako , Trindade Inge Elly Kiemle , Trindade-Suedam Ivy Kiemle 
Published: December 2020

Abstract
The main purpose was to assess and compare nasal cavity (NC) volumes among adults with unilateral (UCLP) and bilateral cleft lip and palate (BCLP) and in noncleft controls (CON), by means of cone-beam computed tomography (CBCT) three-dimensional reconstructions. Forty-five scans of individuals with class III skeletal pattern, matched by age, were gathered in 3 groups: UCLP (n = 15), BCLP (n = 15) and (CON) (n = 15). The NC volume was assessed three-dimensionally, using Dolphin 11.8 software. Descriptive normally distributed data was presented as mean (±SD). Comparisons of NC volume among groups was performed using ANOVA test (P ≤ 0.05). The NC mean volumes corresponded to 14.7(±2.2) cm3 (UCLP), 17.1(±2.2) cm3 (BCLP) and 18.1(±3.8) cm3 (CON), respectively. UCLP individuals presented a significantly reduced NC volume when compared to controls (P = 0.006). No differences were observed between UCLP versus BCLP or BCLP versus CON. The intraclass correlation coefficient suggested a high intra- and inter-examiners agreement (>.075). Individuals with unilateral cleft lip and palate presented reduced NC when compared to individuals without cleft lip and palate. CBCT scans can be considered a highly accurate tool for morphometric assessments of craniofacial structures.
Sarcoidosis Mimicking Chronic Sialadenitis of Parotid Gland
Authors: Shadamarshan R Arunkumar , Sharma Rohit , Grewal Ritu 
Published: December 2020

Abstract
Non-specific Chronic sialadenitis of the Parotid gland is an inflammatory disorder that leads to several anatomical and functional changes within the glandular structure. The exact etiopathogenesis of this disorder is unknown due to its relatively rare occurrence. Primary sarcoidosis of the Parotid gland masquerading the peripheral changes of Chronic sialadenitis has never been reported in literature. We report such a case of Primary Sarcoidosis of the Parotid gland presenting with non-specific chronic sialadenitis along with ipsilateral non-reducing disc displacement of the Temporomandibular joint along with its management.
Volume of Pancreas-Adjacent Operations Favorably Influences Pancreaticoduodenectomy Outcomes at Lower Volume Pancreas Centers
Authors: de Geus Susanna W. L. , Hachey Krista J. , Nudel Jacob D. , Ng Sing Chau , McAneny David B. , Davies Joshua D. , Tseng Jennifer F. , Sachs Teviah E. 
Published: December 2020

Objective:
This study assesses how the volume of pancreatic-adjacent operations (PAO) impacts the outcomes of pancreaticoduodenectomy (PD).

Summary Background Data:
It is well-established that regionalization benefits outcomes after PD. However, due to a multitude of factors, including geographic, financial, and personal, not all patients receive their care at high-volume pancreas surgery centers.

Methods:
The National Cancer Database was queried for pancreatic cancer patients who underwent PD. Hospital volume was calculated for PD and PAO (defined as gastric, hepatic, complex biliary, or pancreatic operations other than PD) and dichotomized as low- and high-volume centers based on the median. Three study cohorts were created: low-volume hospitals (LVH) for both PD and PAO, mixed-volume hospital (MVH) with low-volume PD but high-volume PAO, and high-volume PD hospital (HVH).

Results:
In total, 24,572 patients were identified, with 41.5%, 7.2%, and 51.3% patients treated at LVH, MVH, and HVH, respectively. Thirty-day mortality for PD was 5.6% in LVH, 3.2% in MVH, and 2.5% in HVH. On multivariable analyses, LVH was predictive for higher 30-day mortality compared to HVH [odds ratio (OR) 2.068; 95% confidence interval (CI) 1.770–2.418; P<0.0001]. However, patients at MVH demonstrated similar 30-day mortality to patients treated at HVH (OR 1.258; 95% CI 0.942–1.680; P = 0.1203).

Conclusions:
PD outcomes at low-volume centers that have experience with complex cancer operations near the pancreas are similar to PD outcomes at hospitals with high PD volume. MVH provides a model for PD outcomes to improve quality and access for patients who cannot, or choose not to, receive their care at high-volume centers.
Correlation of Glomerular Size With Donor–Recipient Factors and With Response to Injury
Authors: Grande Joseph P. , Helgeson Erika S. , Matas Arthur J. 
Published: December 2020

Background.
Glomerular size in renal allografts is impacted by donor–recipient factors and response to injury. In serial biopsies of patients with well-functioning grafts, increased glomerular size correlates with better survival. However, no previous study has addressed the association of glomerular size at the time of a for-cause biopsy and clinical/histopathologic markers of injury, or effect on long-term graft outcome.

Methods.
Two cohorts of kidney transplant recipients enrolled in the Deterioration of Kidney Allograft Function study were evaluated. The prospective cohort (PC, n = 581): patients undergoing first for-cause kidney biopsy 1.7 ± 1.4 (mean ± SD) y posttransplant; and the cross-sectional cohort (CSC, n = 446): patients developing new-onset renal function deterioration 7.7 ± 5.6 y posttransplant. Glomerular planar surface area and diameter were measured on all glomeruli containing a vascular pole. Kidney biopsy was read centrally in a blinded fashion according to the Banff criteria.

Results.
Glomerular area was significantly higher in the CSC than the PC; time from transplant to indication biopsy was associated with glomerular area in both cohorts (P values ≤ 0.001). Glomerular area was associated with indices of microvascular inflammation (glomerulitis, peritubular capillary infiltrates; P values ≤ 0.001) and segmental glomerulosclerosis (P value < 0.0001). In the CSC, higher glomerular area was associated with higher estimated glomerular filtration rate (P value ≤ 0.001) and increased graft survival after accounting for microvascular inflammation (adjusted hazard ratio = 0.967; 95% confidence interval: 0.948-0.986; hazard ratio in biopsies without evidence of diabetes or antibody mediated rejection = 0.919, 95% confidence interval: 0.856-0.987).

Conclusions.
Glomerular size is associated with histopathologic features present at the time of indication biopsy and with increased graft survival in the CSC.
Success Rate of Obtaining Baseline Somatosensory and Motor Evoked Potentials in 695 Consecutive Cranial and Spine Surgeries
Authors: Gonzalez Andres A. , Droker Brian S. , Kim Eric S. , Parikh Pooja 
Published: December 2020

Purpose:
Intraoperative neurophysiological monitoring has been well documented as an adjunctive technique that significantly decreases the risk of developing inadvertent sensory and motor deficits during cranial and spine surgeries. The ability to detect neurologic problems intraoperatively depends largely on accurately identifying changes that occur in somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) during each procedure. Therefore, obtaining accurate and reproducible SSEP and MEP data during the initial setup is paramount for intraoperative monitoring. In 2007, Chen et al. found the overall success rate for establishing reliable MEP responses to be 94.8% in the upper extremities and 66.6% in the lower extremities. Since then, the success rate of obtaining baseline sensory and motor evoked potential responses has not been specifically reevaluated. The main goal of this study was to evaluate the current success rates of obtaining adequate SSEP and MEP baseline data in the current era, as well as take a closer look into some of the factors that can reduce the success rates.

Methods:
Somatosensory evoked potential and MEP monitoring was attempted in a total of 695 consecutive brain and spine surgeries performed by neurosurgeons and orthopedic surgeons between January 2010 and July 2011. Somatosensory evoked potential and MEP baseline data were obtained after initiation of general anesthesia and before skin incision. The primary measure is the ability to obtain adequate SSEP and MEP baseline in each extremity. A secondary measure was to stratify the success rate based on preoperative diagnosis.

Results:
Six hundred ninety-five consecutive cranial and spinal cases that required intraoperative monitoring were reviewed. Baseline upper extremity SSEPs were successfully obtained in 679 cases (98.1%), and baseline lower extremity SSEPs were successfully obtained in 626 cases (90.1%). However, if the preoperative diagnosis was in the category spine trauma or spine infection, the success rate of obtaining adequate baseline in the lower extremities dropped to around 60% for both SSEPs and MEPs.

Conclusions:
The success rates of obtaining adequate baseline SSEP and MEP data are overall higher than previously reported. Preoperative diagnosis like spinal infection or trauma may predict lower success rates for acquiring adequate baseline SSEPs and MEPs.
Application of respiratory metagenomics for COVID-19 patients on the intensive care unit to inform appropriate initial antimicrobial treatment and rapid detection of nosocomial transmission
Authors: Charalampous Themoula , Alcolea-Medina Adela , Snell Luke B. , Williams Tom G.S , Batra Rahul , Camporota Luigi , Meadows Christopher I.S. , Wyncoll Duncan , Barrett Nicholas A. , Hemsley Carolyn J. , Bryan Lisa , Newsholme William , Boyd Sara E. , Green Anna , Mahadeva Ula , Patel Amita , Cliff Penelope R. , Page Andrew J. , O’Grady Justin , Edgeworth Jonathan D. 
Published: December 2020

AbstractBackgroundClinical metagenomics (CMg) is being evaluated for translation from a research tool into routine diagnostic service, but its potential to significantly improve management of acutely unwell patients has not been demonstrated. The SARS-CoV-2 pandemic provides impetus to determine that benefit given increased risk of secondary infection and nosocomial transmission by multi-drug resistant (MDR) pathogens linked with expansion of critical care capacity.MethodsProspective evaluation of CMg using nanopore sequencing was performed on 43 respiratory samples over 14 weeks from a cohort of 274 intubated patients across seven COVID-19 intensive care units.ResultsBacteria or fungi were cultured from 200 (73%) patients, with a predominance of Klebsiella spp. (31%) and C. striatum (7%) amongst other common respiratory pathogens. An 8 hour CMg workflow was 93% sensitive and 81% specific for bacterial identification compared to culture, and reported presence or absence of β-lactam resistance genes carried by Enterobacterales that would modify initial guideline-recommended antibiotics in every case. CMg was also 100% concordant with quantitative PCR for detecting Aspergillus fumigatus (4 positive and 39 negative samples). Single nucleotide polymorphism (SNP)-typing using 24 hour sequence data identified an MDR-K. pneumoniae ST307 outbreak involving 4 patients and an MDR-C. striatum outbreak potentially involving 14 patients across three ICUs.ConclusionCMg testing for ICU patients provides same-day pathogen detection and antibiotic resistance prediction that significantly improves initial treatment of nosocomial pneumonia and rapidly detects unsuspected outbreaks of MDR-pathogens.
Is Point-of-Care testing feasible and safe in care homes in England? An exploratory usability and accuracy evaluation of a point-of-care polymerase chain reaction test for SARS-COV-2
Authors: Micocci Massimo , Gordon Adam L , Seo Mikyung Kelly , Allen A. Joy , Davies Kerrie , Lasserson Dan , Thompson Carl , Spilsbury Karen , Akrill Cyd , Heath Ros , Astle Anita , Sharpe Claire , Perera Rafael , Hayward Gail , Buckle Peter 
Published: December 2020

AbstractIntroductionReliable rapid testing on COVID-19 is needed in care homes to reduce the risk of outbreaks and enable timely care. Point-of-care testing (POCT) in care homes could provide rapid actionable results. This study aimed to examine the usability and test performance of point of care polymerase chain reaction (PCR) for COVID-19 in care homes.MethodsPoint-of-care PCR for detection of SARS-COV2 was evaluated in a purposeful sample of four UK care homes. Test agreement with laboratory real-time PCR and usability and use errors were assessed.ResultsPoint of care and laboratory polymerase chain reaction (PCR) tests were performed on 278 participants. The point of care and laboratory tests returned uncertain results or errors for 17 and 5 specimens respectively. Agreement analysis was conducted on 256 specimens. 175 were from staff: 162 asymptomatic; 13 symptomatic. 69 were from residents: 59 asymptomatic; 10 symptomatic. Asymptomatic specimens showed 83.3% (95% CI: 35.9%-99.6%) positive agreement and 98.7% negative agreement (95% CI: 96.2%-99.7%), with overall prevalence and bias-adjusted kappa (PABAK) of 0.965 (95% CI: 0.932 – 0.999). Symptomatic specimens showed 100% (95% CI: 2.5%-100%) positive agreement and 100% negative agreement (95% CI: 85.8%-100%), with overall PABAK of 1. No usability-related hazards emerged from this exploratory study.ConclusionApplications of point-of-care PCR testing in care homes can be considered with appropriate preparatory steps and safeguards. Agreement between POCT and laboratory PCR was good. Further diagnostic accuracy evaluations and in-service evaluation studies should be conducted, if the test is to be implemented more widely, to build greater certainty on this initial exploratory analysis.Key pointsPoint of care tests (POCT) in care homes are feasible and could increase testing capacity for the control of COVID-19 infection.The test of agreement between POCT and laboratory PCR for care home residents and the staff was good.Adoption of POCT in care homes can be considered with appropriate preparatory steps and safeguards in place.Repetitive errors and test malfunctioning can be mitigated with bespoke training for care home staff.Integrated care pathways should be investigated to test the high variability of the context of use.
Genome-wide association study identifies RNF123 locus as associated with chronic widespread musculoskeletal pain
Authors: Rahman Md Shafiqur , Winsvold Bendik S , Chavez S.O. Chavez , Børte Sigrid , Tsepilov Yakov A. , Shapov Sodbo Zh. ,   HUNT All-In Pain, Aulchenko Yurii , Hagen Knut , Fors Egil A. , Hveem Kristian , Zwart John-Anker , van Meurs J.B.J. , Freidin Maxim B. , Williams Frances M.K. 
Published: December 2020

AbstractBackground and ObjectivesChronic widespread musculoskeletal pain (CWP) is a symptom of fibromyalgia and a complex trait with poorly understood pathogenesis. CWP is heritable (48-54%), but its genetic architecture is unknown and candidate gene studies have produced inconsistent results. We conducted a genome-wide association study to get insight into the genetic background of CWP.MethodsNorthern Europeans from UK Biobank comprising 6,914 cases reporting pain all over the body lasting more than 3 months and 242,929 controls were studied. Replication of three lead genome-wide significant single nucleotide polymorphisms (SNPs) was attempted in 6 independent European cohorts (N=43,080; cases=14,177). Genetic correlations with risk factors, tissue specificity, and colocalization were examined.ResultsThree genome-wide significant loci were identified (rs1491985, rs10490825, rs165599) residing within the genes RNF123, ATP2C1, and COMT. The RNF123 locus was replicated (meta-analysis p=0.0002), the ATP2C1 locus showed suggestive association (p=0.0227), and the COMT locus was not replicated. Partial genetic correlation between CWP and depressive symptoms, body mass index, age of first birth, and years of schooling were identified. Tissue specificity and colocalization analysis highlight the relevance of skeletal muscle in CWP.ConclusionsWe report a novel association of RNF123 locus with CWP and suggest a role of ATP2C1, consistent with a role of calcium regulation in CWP. The association to COMT, one of the most studied genes in chronic pain field, was not confirmed in the replication analysis.Key messagesWhat is already known about this subject?Chronic widespread musculoskeletal pain (CWP) is a primary diagnostic feature of fibromyalgia.CWP is moderately heritable, but precise genes involved in the pathogenesis of CWP are yet to be identified.What does this study add?This is the largest genetic study conducted on CWP to date and identified novel genetic risk loci (RNF123 and ATP2C1).The genetic signal points to peripheral pain mechanisms in CWP, and shows genetic correlation with other traits, including BMI and depression.How might this impact on clinical practice or future developments?The findings add to etiological basis of CWP.