bluuebunny/crossref_metadata_2025_split huggingface dataset:
Human Herpesvirus-6 may be Neurologically Injurious in Some Immunocompetent Children
Authors: You Su Jeong 
Published: October 2019

Purpose: Human herpesvirus 6 (HHV-6) can infect the central nervous system in immunocompromised individuals. Less is known, however, about HHV-6 infection in immunocompetent patients. This study evaluated the neurologic features and prognosis of HHV-6 infection in immunocompetent patients. Methods: The medical records of patients aged 1 month to 18 years who underwent cerebrospinal fluid examinations and were tested for 6 viruses, including HHV-6, by multiplex polymerase chain reaction were evaluated retrospectively. Results: During the study period, 252 children were included. None had underlying disease and all were immunocompetent. Their mean age at diagnosis was 40.98 ± 47.65 months. Of these 252 patients, 144 (57.1%) were diagnosed with meningitis, 84 (33.3%) with febrile seizure not induced by meningitis, and 24 (9.5%) with encephalitis. Of the 9 patients positive for HHV-6, 3 (33.3%) had encephalitis, 3 (33.3%) had meningitis, 1 (11.1%) had complex febrile seizure, and the other 2 patients had fever alone. Outcomes were worse in the seizure group (Fisher exact test, P = .048), especially in patients with status epilepticus (Fisher exact test, P = .012), than in the other groups. Encephalitis patients with and without HHV-6 differed significantly in age (24.0 ± 10.8 vs 63.4 ± 47.7 months, t-test P < .05), with status epilepticus being more frequent in those with HHV-6 (Fisher exact test, P = .010). All 3 encephalitis patients positive for HHV-6 had neurologic sequelae; 2 who had mild sequelae were treated with antiviral agents and intravenous immunoglobulin. Conclusions: HHV-6 may not be completely benign in immunocompetent children. It can be associated with encephalitis and poor prognosis.
Performance of Critical Care Outcome Prediction Models in an Intermediate Care Unit
Authors: Brusca Rebeccah M. , Simpson Catherine E. , Sahetya Sarina K. , Noorain Zeba , Tanykonda Varshitha , Stephens R. Scott , Needham Dale M. , Hager David N. 
Published: October 2019

Background: Intermediate care units (IMCUs) are heterogeneous in design and operation, which makes comparative effectiveness studies challenging. A generalizable outcome prediction model could improve such comparisons. However, little is known about the performance of critical care outcome prediction models in the intermediate care setting. The purpose of this study is to evaluate the performance of the Acute Physiology and Chronic Health Evaluation version II (APACHE II), Simplified Acute Physiology Score version II (SAPS II) and version 3 (SAPS 3), and Mortality Probability Model version III (MPM0III) in patients admitted to a well-characterized IMCU. Materials and Methods: In the IMCU of an academic medical center (July to December 2012), the discrimination and calibration of each outcome prediction model were evaluated using the area under the receiver–operating characteristic and Hosmer-Lemeshow goodness-of-fit test, respectively. Standardized mortality ratios (SMRs) were also calculated. Results: The cohort included data from 628 unique IMCU admissions with an inpatient mortality rate of 8.3%. All models exhibited good discrimination, but only the SAPS II and MPM0III were well calibrated. While the APACHE II and SAPS 3 both markedly overestimated mortality, the SMR for the SAPS II and MPM0III were 0.91 and 0.91, respectively. Conclusions: The SAPS II and MPM0III exhibited good discrimination and calibration, with slight overestimation of mortality. Each model should be further evaluated in multicenter studies of patients in the intermediate care setting.
Assessment of Functional Performance in Acute Geriatric Psychiatry – Time for New Strategies?
Authors: Trumpf Rieke , Morat Tobias , Zijlstra Wiebren , Haussermann Peter , Fleiner Tim 
Published: October 2019

Objectives: The aim of this study was to investigate the feasibility and reliability of functional performance tests in people living with dementia and depression. Method: A cross-sectional study was conducted in a geriatric psychiatry hospital. People living with dementia, depression, and healthy older adults were included. Feasibility of the timed up and go test (TUG), the short physical performance battery (SPPB), and the multisurface obstacle test for older adults (MSOT) was assessed based on valid test executions. Test-retest reliability was evaluated by mean difference (MD), coefficient of variation (CV), standardized MD, intraclass correlation coefficient (ICC), and correlation coefficient ( rs). Results: A total of 53 people in acute geriatric psychiatry and 21 healthy older adults were included. In people living with dementia (n = 23), feasibility was 65.2% (MSOT), 8.7% (TUG), and 8.7% (SPPB). In people living with depression (n = 30), feasibility was 83.3% (MSOT), 80.0% (TUG), and 46.7% (SPPB). Intraclass correlation coefficients and rs for the MSOT were high (ICC > 0.70) in both groups. Coefficient of variations of the MSOT were between 10.7% and 18.0% (dementia) and 7.1% and 17.0% (depression). Reliability of the TUG and SPPB was not analyzed in people living with dementia, due to low feasibility. In people living with depression, ICCs and rs were between 0.86 and 0.87 with CVs of 7.2% (TUG) and 0.69 and 0.95 with CVs of 7.8% and 15.1% (SPPB). Conclusion: Feasibility and reliability of established functional performance tests in acute geriatric psychiatry are limited, especially in people living with dementia. New strategies, for example, sensor-based approaches, may allow measurement of functional performance apart from standardized instruction-based test procedures in this clinical population.
Clinical characteristics and risk factors of microvascular involvement in primary antiphospholipid syndrome: a longitudinal single-center study in China
Authors: Sun Y , Zhao J , Zhang P , Wu C , Jiang N , Zhou J , Zhang S , Wu Q , Wang Q , Li M , Zeng X 
Published: October 2019

Objectives The objective of this study was to investigate risk factors of microvascular involvement and survival in Chinese patients with primary antiphospholipid syndrome. Methods In this single-center, retrospective study, we enrolled 112 patients with a confirmed diagnosis of primary antiphospholipid syndrome who were admitted to Peking Union Medical College Hospital from January 2004 to December 2016. Demographic data, clinical characteristics, laboratory results, and follow-up records were collected. Results A total of 112 patients with primary antiphospholipid syndrome were studied. Microvascular involvement was identified in 21 patients (18.75%). Patients with microvascular involvement experienced fewer episodes of arterial or venous thrombosis (28.6% vs. 84.6%) and a higher incidence of thrombocytopenia (85.7% vs. 54.9%), respectively. Low complement and elevated high-sensitivity CRP levels were observed more frequently in the microvascular group compared with the non-microvascular group (complement 38.1% vs. 18.7%; high-sensitivity CRP 71.4% vs. 31.9%, respectively). Anti-β2-glycoprotein I antibodies were more prevalent in patients with microvascular involvement than in patients without (66.7% vs. 33.0%, respectively). Multivariate logistic regression analysis revealed that thrombocytopenia (odds ratio = 4.523, 95% confidence interval 1.139–17.962), elevated high-sensitivity CRP levels (odds ratio = 6.385, 95% confidence interval 1.969–20.704), and anti-β2-glycoprotein I antibody positivity (odds ratio = 5.042, 95% confidence interval 1.555–16.352) were independent risk factors for microvascular involvement. A Kaplan–Meier analysis revealed that survival was significantly poorer in patients with microvascular involvement compared with patients without ( p = 0.0278). Conclusions In addition to arterial and venous thrombosis, antiphospholipid syndrome can affect the microvasculature of select organs. It is thus important for clinicians to be aware that antiphospholipid syndrome-associated microvascular involvement has a unique pathogenesis and can be a life-threatening condition.
Moral identity and palliative sedation: A systematic review of normative nursing literature
Authors: Wright David Kenneth , Gastmans Chris , Vandyk Amanda , de Casterlé Bernadette Dierckx 
Published: October 2019

Background: In the last two decades, nursing authors have published ethical analyses of palliative sedation—an end-of-life care practice that also receives significant attention in the broader medical and bioethics literature. This nursing literature is important, because it contributes to disciplinary understandings about nursing values and responsibilities in end-of-life care. Research aim: The purpose of this project is to review existing nursing ethics literature about palliative sedation, and to analyze how nurses’ moral identities are portrayed within this literature. Research design: We reviewed discussion papers, written by nurses about the ethics of palliative sedation, which were cited in MEDLINE, CINAHL, Nursing and Allied Health, or Philosopher’s Index (search date March 2018). Twenty-one papers met selection criteria. We performed a comprehensive review and analysis (using the Qualitative Analysis Guide of Leuven), of the values, responsibilities, and relationships reflected in authors’ portrayal of the nursing role. Findings: Two different tones are apparent in the extant nursing ethics literature. One is educational, while the other is critically reflective. Irrespective of tone, all authors agree on the alleviation of suffering as a fundamental nursing responsibility. However, they differ in their analysis of this responsibility in relation to other values in end-of-life care, including those that depend on consciousness. Finally, authors emphasize the importance of subjective and experience-based understandings of palliative sedation, which they argue as depending on nurses’ proximity to patients and families in end-of-life care. Discussion and conclusion: Based on our findings, we develop three recommendations for future writing by nurses about palliative sedation. These relate to the responsibility of recognizing how consciousness might matter in (some) peoples’ moral experiences of death and dying, to the importance of moral reflectiveness in nursing practice, and to the value of a relational approach in conceptualizing the nursing ethics of palliative sedation.
Real-world experience managing blinatumomab toxicities in adults with relapsed/refractory acute lymphoblastic leukemia
Authors: Crist MacKenzie , Emadi Ashkan , Duffy Alison 
Published: October 2019

Purpose The purpose of this study was to determine the effect of blinatumomab toxicities on drug therapy modifications in an intended 28-day course of blinatumomab therapy. Methods Patients with acute lymphoblastic leukemia who received blinatumomab at the University of Maryland Marlene & Stewart Greenebaum Comprehensive Cancer Center from March 1, 2015 to April 30, 2018 were included. The primary objective of this study was to identify the frequency and severity of blinatumomab toxicities that led to drug therapy modifications; secondary objectives were to identify the frequency and duration of modifications and the total dose and duration of therapy received. Results This study included 23 patients. Seventy-eight percent of patients experienced cytokine release syndrome and/or neurotoxicity. Eighteen drug therapy modifications occurred due to toxicity with a median interruption time of nine hours. Drug therapy was continued for the majority of grade 1 or 2 events and discontinued during grade 3 or 4 neurotoxicity. The median number of days of therapy delivered was 28 days (range, 27–35). A median of 2 h (range, 0–16) of therapy or 0.2% (range, 0–2.4) of a total 28-day cycle was lost due to transition of care. Conclusion This retrospective study demonstrates a single center experience with blinatumomab toxicity management and appropriate delivery of drug during transitions of care. Overall, these results support to the importance of institutional guidelines in place to facilitate safe and effective delivery of blinatumomab.
Safe use of nivolumab in a patient with renal cell carcinoma and hepatitis B
Authors: Akar Emre , Baytekin Halil F , Deniz Hatice , Tural Deniz 
Published: October 2019

Introduction Immunotherapy with checkpoint inhibitors gains a major role in bladder cancer. Because of the treatment’s immune modulatory effects, patients may develop hepatitis. Hepatitis B was an exclusion criterion in clinical trials that investigated nivolumab. Therefore, its effects and risk of hepatitis B reactivation in nivolumab are not clinically investigated in renal cell carcinoma patients with hepatitis B. Case report In this case report, we presented a metastatic renal cell carcinoma patient who was treated with anti-viral treatment for hepatitis reactivation caused by previous sunitinib therapy. After progression, nivolumab was commenced and the patient was closely monitored with hepatic function tests. Management and outcome Nivolumab was well tolerated and no treatment-related adverse effect occurred. Hepatitis or viral hepatitis reactivation was not detected. Discussion This case supports the safety of nivolumab in patients with renal cell carcinoma and viral hepatitis.
Reliability and accuracy of individual Alberta Stroke Program Early CT Score regions using a medical and a smartphone reading system in a telestroke network
Authors: Salazar Antonio J , Useche Nicolás , Granja Manuel , Bermúdez Sonia , Morillo Aníbal J , Torres Oscar , Rueda Natalia , Ropero Brenda 
Published: October 2019

Introduction The aim of this study was to assess individual regions of the Alberta Stroke Program Early CT Score in noncontrast head computed tomography interpretations using a smartphone in a telestroke network, by comparison to a medical monitor. Methods The review board of our institution approved this retrospective study. A factorial design with 188 patients, four radiologists and two reading systems was used. Accuracy and reliability were evaluated. Results Very good interobserver agreements were observed on the total Alberta Stroke Program Early CT Score for both the medical and smartphone reading systems, with intraclass correlation coefficients of 0.91 and 0.84 respectively. Interobserver agreements were moderate to very good for the medical reading system (all intraclass correlation coefficients >0.74), whereas they were fair to very good for the smartphone (intraclass correlation coefficients ranged from 0.31–0.81). All intraobserver agreements were good (intraclass correlation coefficient >0.64), except for internal capsule (0.48) and M2 (0.55) regions. The areas under the receiver-operating curve ranged from 0.69–0.89 for the medical system, while for the smartphone ranged from 0.44–0.86. No statistical differences were observed between medical and smartphone reading systems for each region (all p >  0.05). Discussion If radiologists are better trained in the evaluation of the lesions in the insula, the internal capsule and the M2 regions, the total and the dichotomised Alberta Stroke Program Early CT Score will be more precise. Hence, ruling out contraindications to thrombolysis administration will be improved, allowing assessment of head computed tomography in a telestroke network using a smartphone to be a common practice.
Effects of mindfulness-based interventions on health-related outcomes for patients with heart failure: a systematic review
Authors: Zou Huijing , Cao Xi , Geng Jing , Chair Sek Ying 
Published: October 2019

Background: Mindfulness-based interventions may offer a promising approach for promoting psychological and physical health and wellbeing for patients with heart failure. However, the effects of mindfulness-based interventions for this population have not been systematically reviewed. Aims: This review aimed to synthesise available evidence to assess the effects of mindfulness-based interventions on psychological and physical outcomes and health-related quality of life in patients with heart failure. Methods: Seven English and two Chinese electronic databases were searched with keywords from inception to May 2019. Experimental studies that examined mindfulness-based interventions in adults with heart failure were eligible for inclusion. Two reviewers independently performed study selection, data extraction and study quality assessment. The results were then narratively synthesised. Results: This review identified five studies involving 467 patients with heart failure. The reviewed studies had weak to moderate quality. There were consistent findings that mindfulness-based interventions could significantly reduce depression (three studies) and anxiety (two studies) and improve health-related quality of life (two studies) after intervention. However, the effects on physical symptoms were inconsistent in three studies. The effects on physical function were only measured in one study, with non-significant changes being reported. Conclusions: This review provides preliminary evidence that mindfulness-based interventions are beneficial for patients with heart failure in reducing depression and anxiety and enhancing health-related quality of life in the short term. These findings should be carefully generalised considering the methodological limitations across studies. More rigorous studies are required to examine further the effects of mindfulness-based interventions in patients with heart failure.
Examining the technical feasibility of prostate cancer molecular imaging by transrectal photoacoustic tomography with transurethral illumination
Authors: Zhang Haonan , Huang Shengsong , Chen Yingna , Xie Weiya , Zhang Mengjiao , Pan Jing , Sato Naoto , Wang Xueding , Wu Denglong , Cheng Qian 
Published: October 2019

To pave the road toward clinical application of photoacoustic imaging in prostate cancer (PCa) diagnosis, we studied the technical feasibility and performance of transrectal photoacoustic (PA) imaging in mapping the indocyanine green (ICG) contrast agent, which is approved by FDA, in entire prostates by using light illumination via the urethral track. Experiments were conducted on a clinically relevant ex vivo model involving whole human prostates harvested from radical prostatectomy. The light source placed in the urethral track was an array of light emitting diodes (LEDs), illuminating the prostate with a delivered light power on the urethral wall within the safety limit. A dual-modality imaging system acquired PA and ultrasound (US) images simultaneously in the same way as in transrectal ultrasound (TRUS), with the US imaging presenting the tissue structure and PA imaging detecting the ICG solution. The imaging results demonstrated that tubes containing ICG solution at different concentrations can be detected at different positions in the prostate within a 2 cm range around from the urethral wall. Considering the sizes of regular human prostates, the proposed transurethral illumination in combination with transrectal US detection can facilitate PA molecular imaging over the entire prostate in a non-invasive manner, which makes it possible to further improve the PCa diagnosing efficiency with better molecular sensitivity and resulted better biopsy accuracy and much reduced pain for patients. Impact statement Differentiating cancerous tissues from healthy ones is critical in the diagnosis of prostate cancer (PCa). However, due to the low sensitivity of ultrasound (US) imaging to cancerous tissues, transrectal ultrasound (TRUS) guided biopsies, current standard procedure for diagnosing PCa, suffer from low core yield, leading to under-sampling and under-grading of clinically significant tumors. Via the experiment on the ex vivo human prostates, we evaluated the translational potential of photoacoustic imaging (PAI) based on a safe light emitting diodes (LED) source for detecting the molecular information in deep human prostate. We showed that transurethral light illumination in combination with transrectal US detection can facilitate PA molecular imaging over an entire human prostate in a non-invasive manner. The success of this study in the clinically relevant ex vivo human prostate model suggested a new strategy for PA and US combined imaging and detection of PCa.
Refractory seizures: Prediction of outcome of surgical intervention based on results from PET-CT, PET-MRI and electroencephaolography
Authors: Johnson Rashad , Rizk Grace , Kaur Harleen , Ibekwe Henry , Atta Monica , Gayed Isis 
Published: October 2019

Purpose The purpose of this article is to evaluate the effectiveness of fluorodeoxyglucose (FDG) positron emission tomography (PET)-computed tomography (CT) and PET-magnetic resonance imaging (MRI) with scalp and intracranial electroencephalogram (EEG) in predicting surgical outcomes in patients with refractory seizures. Methods Patients who underwent PET-CT and MRI fusion, scalp and intracranial EEG, and subsequent surgical intervention were retrospectively included. PET-CT were fused with MRI and interpreted by an experienced blinded reader. An area of hypometabolism on PET was identified as the location of the epileptic focus. The site of seizure focus was correlated with scalp and intracranial EEG findings. Surgical outcomes were evaluated. Thirty-six patients were included; all had presurgical PET-CT, scalp EEG, and PET-MRI fusion, and 28 of these patients had intracranial EEGs. Results PET-CT showed concordance of epileptic foci with scalp EEG in 7/36 patients (19%) and with intracranial EEG in 9/28 patients (32%). PET-MRI was concordant with scalp EEG in 6/36 patients (17%) and with intracranial EEG in 8/28 patients (29%). All patients with concordance of epileptic foci between PET-CT and PET-MRI and scalp EEG had improvement or resolution of seizures postintervention, and 89% of patients had concordance between intracranial EEG and PET studies. However, 45% of patients with discordant PET-CT and scalp EEG, 37% with discordance PET-CT and intracranial EEG, 43% with discordant PET-MRI and scalp EEG, and 35% of patients with discordant PET-MRI and intracranial EEG did not improve postsurgically. Conclusion Concordance of epileptic foci localization between PET imaging and EEG yields favorable postoperative outcome in nearly all patients, whereas discordance has an equal probability of favorable vs unfavorable outcomes.