bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interobserver agreement of the visual Herder scale for the assessment of solitary pulmonary nodules on 18F Fluorodeoxyglucose PET/computed tomography
Authors: Ordidge Katherine L. , Gandy Nemi , Arshad Mubarik A. , Wallitt Kathryn , Soneji Neil , Khan Sameer , Barwick Tara D. 
Published: January 2020

Background
British Thoracic Society guidelines recommend 18F Fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) for solitary pulmonary nodule (SPN) follow-up in high-risk individuals or if the CT Brock score is >10%. Nodule tracer uptake is assessed visually in comparison to the surrounding lung tissue and mediastinal blood pool (Herder score). This score is used to calculate the risk of malignancy and guide patient management. Despite its widespread use, there have been no studies to date looking at interobserver agreement using the Herder scale.

Patients and methods

18F-FDG PET/CT studies of 100 consecutive patients imaged for the evaluation of SPN were retrospectively analysed. Anonymized images were reviewed independently by three Consultant Nuclear Medicine Radiologists and the Herder score was documented, along with a confidence score graded 1–3, where 1 indicated ‘not at all confident’ and 3 indicated ‘very confident’. Interobserver agreement was assessed using interclass correlation coefficient modelling.

Results
There was complete reviewer agreement in 81% cases, and interclass correlation with Cronbach’s alpha was excellent at 0.973 (95% confidence interval, 0.962–0.981). The agreement between pairs of reviewers was good and confidence scores using the Herder scale were high, with reviewers giving a confidence score of 3 in an average of 78% of cases.

Conclusion
Our study suggests excellent interobserver agreement for use of the Herder scale in evaluating SPNs. Reviewer confidence scores were high reflecting high confidence in the use of the Herder scale for evaluating SPN.
Tumor protein 53 mutations in acute myeloid leukemia: conventional induction chemotherapy or novel therapeutics
Authors: Asghari Hannah , Talati Chetasi 
Published: January 2020

Purpose of review
Tumor protein 53 (TP53) protein is involved in fundamental processes of cancer, aging, and DNA repair. Thus, TP53 dysfunction is implicated in malignant processes and remains the most commonly mutated gene in cancer but represents a relatively small proportion in acute myeloid leukemia (AML). Patients with TP53-mutated AML attain inferior responses to therapy resulting in poor overall outcomes.

Recent findings
Traditional treatment approaches with conventional chemotherapy yields suboptimal responses for patients with TP53 mutant AML compared with wildtype TP53. In recent years, there is increasing interest in understanding the role and underlying biology of TP53 mutations in AML with efforts to harness the physiological tumor suppressive function of TP53 protein. Novel combination and targeted therapies may contribute to improved outcomes; however, responses to therapy may be short-lived and ongoing research is indicated to evaluate relapse-risk reduction strategies. These patients may benefit from consideration of enrollment in clinical trials or lower intensity therapy approaches in lieu of intensive chemotherapy.

Summary
Pharmacological treatments targeting the TP53 pathway in addition to novel emerging therapeutics and immunotherapy-based approaches hold promise for treatment of TP53 mutant AML.
Student Perceptions Related to Immediate Workplace Usefulness of RN-to-BSN Program Content
Authors: Sitzman Kathleen , Carpenter Tristin , Cherry Kim 
Published: January 2020

BACKGROUND
Despite a national directive for associate degree in nursing (ADN) nurses to complete BSN degrees, there is limited research related to student perceptions of the value added by BSN education.

PURPOSE
The purpose was to explore perceptions of immediate workplace usefulness of RN-to-BSN content for ADNs.

METHODS
Qualitative narrative data provided by 263 RN-BSN students in their final semester before graduating with a BSN were analyzed. Students were asked, “How have you used what you are learning in the RN-BSN program at work?”

RESULTS
Themes included the following: research and evidence-based practice, leadership, professionalism, communication, intentional holistic caring, critical thinking, cultural competence, safety and quality improvement, interdisciplinarity, population-based care, and fiscal awareness.

CONCLUSION
Results clarified content that students found useful and provided insight into specific benefits that employers might expect to see when ADNs complete BSN-level education.
Sepsis in Complex Patients in the Emergency Department
Authors: Fesnak Sarah , Abbadessa Mary Kate , Hayes Katie , Ostapenko Svetlana , Lavelle Jane , Zorc Joseph J. , Balamuth Fran 
Published: January 2020

Objectives
To compare timeliness of sepsis recognition and initial treatment in patients with and without high-risk comorbid conditions.

Methods
This was a retrospective cohort study of patients presenting to a pediatric emergency department (ED) who triggered a vital sign-based electronic sepsis alert resulting in bedside “huddle” assessment per institutional practice. A positive sepsis alert was defined as age-specific tachycardia or hypotension, concern for infection, and at least 1 of the following: abnormal capillary refill, abnormal mental status, or a high-risk condition. High-risk conditions were derived from the American Academy of Pediatrics sepsis alert tool. Patients with a positive alert underwent bedside huddle resulting in a decision regarding initiation of sepsis protocol. Placement on the protocol and time to initiation of protocol and individual therapies were compared for patients with and without high-risk conditions.

Results
During the 1-year study period, there were 1107 sepsis huddle alerts out of 96,427 ED visits. Of these, 713 (65%) had identified high-risk conditions, and 394 (35%) did not. Among patients with sepsis huddles, there was no difference in sepsis protocol initiation for patients with high-risk conditions compared with those without (24.8% vs 22.0%, P = 0.305). Between patients with high-risk conditions and those without, there were no differences in median time from triage to sepsis protocol activation, triage to initial intravenous antibiotic, triage to initial intravenous fluid therapy, or ED length of stay.

Conclusions
Timeliness of care initiation was no different in high-risk patients with sepsis when using an electronic sepsis alert and protocolized sepsis care.
An Update on Cryopreservation of Adipose Tissue
Authors: Gal Shaili , Pu Lee L. Q. 
Published: January 2020

Summary:
Currently, fat transplantation occurs immediately after harvesting procedures. Because low rates of fat graft take are well reported in the literature, many patients require multiple surgical procedures for fat graft harvest. These subsequent procedures lead to increased cost, donor-site morbidity, and patient discomfort in the long term. The ability to preserve our patients’ own adipose aspirate would allow us to counteract these shortcomings and ultimately improve the clinical outcome after fat grafting. Unfortunately, there is no optimal and practical adipose tissue cryopreservation protocol for use by the plastic surgeon at the present time. Because of this dilemma, the senior author (L.L.Q.P.) has investigated this concept in an effort to create a protocol that is both technically sound and clinically achievable to allow for the long-term preservation of adipose tissue. In this article, the authors aim to outline this effort, review current clinical applications that have been reported in the literature, and detail exciting future perspectives in the use of preserved lipoaspirates for repeated fat grafting procedures or in the form of cell-based therapy engineered for reconstructive endeavors for their patients.
Pain in Clients Attending a South African Voluntary Counseling and Testing Center Was Frequent and Extensive But Did Not Depend on HIV Status
Authors: Wadley Antonia L. , Lazarus Erica , Gray Glenda E. , Mitchell Duncan , Kamerman Peter R. 
Published: January 2020

Background:
The frequency of pain is reported to be high in people living with HIV, but valid comparisons between people living with HIV and HIV-negative cohorts are rare. We investigated whether HIV infection influenced frequency and characteristics of pain in adults undergoing voluntary testing for HIV.

Setting:
Participants were recruited from an HIV voluntary counseling and testing center at the Chris Hani Baragwanath Academic Hospital, Soweto, South Africa.

Methods:
Pain was assessed using the Wisconsin Brief Pain Questionnaire. Depressive and anxiety symptomatology was determined using the Hopkins Symptom checklist-25. We then stratified by HIV status.

Results:
Data from 535 black South Africans were analyzed: HIV-infected n = 70, HIV-uninfected n = 465. Overall, frequency of any current pain was high with 59% [95% confidence interval (CI): 55 to 63, n: 316/535] of participants reporting pain, with no difference related to HIV status: HIV-infected 50% (95% CI: 37 to 61, n: 35/70), HIV-uninfected 60% (95% CI: 56 to 65, n: 281/465). Pain intensity and number of pain sites were similar between the groups as were symptoms of anxiety and depression: mean Hopkins Symptom Checklist-25 1.72 (95% CI: 1.57 to 1.87) HIV-infected participants and 1.68 (95% CI: 1.63 to 1.73) HIV-uninfected participants. Univariate analysis showed female sex and greater depressive and anxiety symptomatology associated with pain. In a multivariable modeling, only depressive and anxiety symptomatology was retained in the model.

Conclusion:
The high frequency of pain found in both HIV-infected and HIV-uninfected individuals presenting at a voluntary counseling and testing center was more likely to be associated with depression and anxiety, than with the presence or absence of HIV.
Uptake and Discontinuation of Integrase Inhibitors (INSTIs) in a Large Cohort Setting
Authors: Greenberg Lauren , Ryom Lene , Wandeler Gilles , Grabmeier-Pfistershammer Katharina , Öllinger Angela , Neesgaard Bastian , Stephan Christoph , Calmy Alexandra , Rauch Andri , Castagna Antonella , Spagnuolo Vincenzo , Johnson Margaret , Stingone Christof , Mussini Cristina , De Wit Stéphane , Necsoi Coca , Campins Antoni A. , Pradier Christian , Stecher Melanie , Wasmuth Jan-Christian , Monforte Antonella d'Arminio , Law Matthew , Puhr Rainer , Chkhartishvilli Nikoloz , Tsertsvadze Tengiz , Garges Harmony , Thorpe David , Lundgren Jens D. , Peters Lars , Bansi-Matharu Loveleen , Mocroft Amanda ,   RESPOND Study Group
Published: January 2020

Background:
Despite increased integrase strand transfer inhibitor (INSTI) use, limited large-scale, real-life data exists on INSTI uptake and discontinuation.

Setting:
International multicohort collaboration.

Methods:
RESPOND participants starting dolutegravir (DTG), elvitegravir (EVG), or raltegravir (RAL) after January 1, 2012 were included. Predictors of INSTI used were assessed using multinomial logistic regression. Kaplan–Meier and Cox proportional hazards models describe time to and factors associated with discontinuation.

Results:
Overall, 9702 persons were included; 5051 (52.1%) starting DTG, 1933 (19.9%) EVG, and 2718 (28.0%) RAL. The likelihood of starting RAL or EVG vs DTG decreased over time and was higher in Eastern and Southern Europe compared with Western Europe. At 6 months after initiation, 8.9% (95% confidence interval: 8.3% to 9.5%) had discontinued the INSTI (6.4% DTG, 7.4% EVG, and 14.0% RAL). The main reason for discontinuation was toxicity (44.2% DTG, 42.5% EVG, 17.3% RAL). Nervous system toxicity accounted for a higher proportion of toxicity discontinuations on DTG (31.8% DTG, 23.4% EVG, 6.6% RAL). Overall, treatment simplification was highest on RAL (2.7% DTG, 1.6% EVG, and 19.8% RAL). Factors associated with a higher discontinuation risk included increasing year of INSTI initiation, female gender, hepatitis C coinfection, and previous non–AIDS-defining malignancies. Individuals in Southern and Eastern Europe were less likely to discontinue. Similar results were seen for discontinuations after 6 months.

Conclusions:
Uptake of DTG vs EVG or RAL increased over time. Discontinuation within 6 months was mainly due to toxicity; nervous system toxicity was highest on DTG. Discontinuation was highest on RAL, mainly because of treatment simplification.
Comparison of Calcium Scoring Between 64-Multidetector Computed Tomography and 320-Multidetector Computed Tomography Using a Cardiac Phantom: Achieving Consistent Image Quality With Dose Optimization
Authors: Tsai Sung-Yi , Ding Xiao-Hua , Jin Shih-Chun , Yi Dong-Bo , Chen Jyh-Cheng 
Published: January 2020

Abstract
The purpose of this study was to evaluate the relationship between radiation dose and noise level on various coronary calcium scoring protocols between 64-multidetector computed tomography (MDCT) and 320-MDCT. The cardiac QRM phantoms (1 small size and 1 medium size) were used in this study. Lower-dose imaging protocols were proposed for optimization with the parameters of 120 kVp and 10 mAs for small-size phantom (0.336 mSv) in 64-MDCT imaging and small-size phantom (0.2 mSv) in 320-MDCT case, and 120 kVp and 80 mAs for medium-size phantom (2.73 mSv) in 64-MDCT imaging and medium-size phantom (1.58 mSv) in 320-MDCT case. Our results suggest that people can apply lower-dose protocols in the clinical use for early diagnosis of coronary disease without sacrificing diagnostic accuracy.
Cultured Epidermal Autograft for Total Scalp Reconstruction in a Neonate Following Necrotizing Fasciitis
Authors: Kimia Rotem , Azoury Saïd C. , Allukian Myron , Nguyen Phuong D. 
Published: January 2020

AbstractNecrotizing fasciitis in the pediatric population is a particularly difficult diagnostic and management challenge. Options for soft tissue reconstruction of wounds following surgical debridement have been historically limited, yet recent advancements in bioengineered tissue and matrices have introduced alternative methods of treatment for these patients. We present a case of neonatal necrotizing fasciitis of the scalp requiring full-thickness surgical debridement, which was successfully reconstructed using Epicel cultured epidermal autograft (CEA). A 4-day-old female neonate (gestational age 40 weeks) presented with scalp erythema, blistering, and sepsis following peripartum fetal scalp electrode monitoring. She underwent surgical excision of the scalp to healthy bleeding tissue resulting in a defect of approximately 97% of the scalp, measuring 18 × 19 cm including 4 × 3.5 cm of exposed bone at the occiput. Initial provisional coverage of the defect was obtained with Integra collagen matrix bilayer dressing to stimulate granulation over exposed bone. Concurrently, a 2 × 4-cm excisional biopsy of the left groin skin was obtained for CEA in vitro expansion over 21 days. Then, autograft sheets were applied to achieve total scalp coverage. Clinical assessments at 1 week, 1 month, and 2 months postoperatively exhibited, approximately, 60% take, 80% take, and 90% take, respectively. Scalp involvement in neonatal necrotizing infections is a notably rare presentation as surmised by our review of the literature, and to our knowledge, this is the first report on the use of Integra and CEA for near-total neonatal scalp coverage.
Long-term Outcomes of Endoscopic Resection for Gastric Subepithelial Tumors
Authors: Li D.M. , Ren L.L. , Jiang Y.P. 
Published: January 2020

Objective:
The purpose of the current study was to analyze the safety and efficacy of endoscopic resection for gastric subepithelial tumors (SETs) using long-term patient outcome data.

Patients and Methods:
A retrospective analysis of 73 consecutive patients with gastric SETs was performed from June 2014 to December 2016. The treatment methods included submucosal dissection, submucosal excavation or endoscopic full-thickness resection (EFTR). In addition to epidemiological data (sex and age), tumor size, surgical parameters, length of stay, complications, costs, and endoscopic, clinicopathologic, and follow-up data were analyzed to compare treatments.

Results:
The complete resection rate was 97.3% (71/73). Three patients experienced complications (4.1%), including 2 with delayed perforation and 1 with perioperative infection. The median postoperative feeding time was 3 days, and the median postoperative hospital stay was 5 days. The median follow-up period was 19 months, with no patient death or tumor recurrence. Among the 38 patients with gastrointestinal stromal tumors, the complete resection rate was 97.4% (37/38). The complete resection and complication rates between the endoscopic submucosal excavation (ESE) group and the EFTR group were not statistically significant. There was no recurrence or metastasis detected among either group; however, the ESE group had earlier postoperative feeding, a shorter postoperative hospital stay, and less hospitalization expenses.

Conclusions:
Endoscopic resection for gastric SETs (<3 cm) is safe and feasible concerning medium-term and long-term effects. Compared with the EFTR group, the ESE group had earlier postoperative feeding, a shorter postoperative hospital stay, and less hospitalization expenses. Even so, gastric SETs with malignant potential are at risk of recurrence. Larger prospective multicenter studies are warranted.
Association of More Intensive Induction With Less Acute Rejection Following Intestinal Transplantation: Results of 445 Consecutive Cases From a Single Center
Authors: Vianna Rodrigo , Farag Ahmed , Gaynor Jeffrey J. , Selvaggi Gennaro , Tekin Akin , Garcia Jennifer , Beduschi Thiago 
Published: January 2020

Background.
In intestinal transplantation, acute cellular rejection (ACR) remains a significant challenge to achieving long-term graft survival. It is still not clear which are the most important prognostic factors.

Methods.
We performed a Cox multivariable analysis of the hazard rates of developing any ACR, severe ACR, and cause-specific graft loss during the first 60 months posttransplant among 445 consecutive intestinal transplant recipients at our institution since 1994. Of particular interest was to determine the prognostic influence of induction type: rabbit antithymocyte globulin (rATG; 2 mg/kg × 5)/rituximab (150 mg/m2 × 1; begun in 2013), alemtuzumab (2001–2011), and less intensive forms.

Results.
First ACR and severe ACR occurred in 61.3% (273/445) and 22.2% (99/445) of cases. The following 3 multivariable predictors were associated with significantly lower hazard rates of developing ACR and severe ACR: transplant type modified multivisceral or full multivisceral (P = 0.0009 and P < 0.000001), rATG/rituximab induction (P < 0.000001 and P < 0.01), and alemtuzumab induction (P = 0.004 and P = 0.07). For both ACR and severe ACR, the protective effects of rATG/rituximab and alemtuzumab were highly significant (P ≤ 0.000005 for ACR; P ≤ 0.01 for severe ACR) but only during the first 24 days posttransplant (when the ACR hazard rate was at its peak). The prognostic effects of rATG/rituximab and alemtuzumab on ACR/severe ACR disappeared beyond 24 days posttransplant (ie, nonproportional hazards). While significant protective effects of both rATG/rituximab and alemtuzumab existed during the first 6 months posttransplant for the hazard rate of graft loss-due-to-rejection (P = 0.01 and P = 0.003), rATG/rituximab was additionally associated with a consistently lower hazard rate of graft loss-due-to-infection (P = 0.003). All significant effects remained after controlling for the propensity-to-be-transplanted since 2013.

Conclusions.
More intensive induction was associated with a significant lowering of ACR risk, particularly during the early posttransplant period.
Impaired Exercise Tolerance Early After Heart Transplantation Is Associated With Development of Cardiac Allograft Vasculopathy
Authors: Yu Mingxi D. , Liebo Max J. , Lundgren Scott , Salim Ahmed M. , Joyce Cara , Zolty Ronald , Moulton Michael J. , Um John Y. , Lowes Brian D. , Raichlin Eugenia 
Published: January 2020

Background.
Exercise performance remains limited in some patients after heart transplantation (HTx). The goal of this study was to assess for association between cardiopulmonary exercise test performance at 1 year after HTx and future development of cardiac allograft vasculopathy (CAV).

Methods.
Overall 243 HTx recipients performed cardiopulmonary exercise testing at 1 year after HTx. During the median follow-up period of 31 (interquartile range 19;61) months, 76 (32%) patients were diagnosed with CAV (CAV group).

Results.
The CAV group patients had lower exercise capacity (5.2 ± 1.9 versus 6.5 ± 2.2 metabolic equivalents; P = 0.001) and duration (9.6 ± 3.5 versus 11.4 ± 4.8 min; P = 0.008), lower peak oxygen consumption (VO2) (18.4 ± 5.4 versus 21.4 ± 6.1 mL/kg/min; P = 0.0005), lower normalized peak VO2 (63% ± 18% versus 71% ± 19%; P = 0.007), and higher minute ventilation (VE)/carbon dioxide production (VCO2) (34 ± 5 versus 32 ± 5, P = 0.04). On Cox proportional hazards regression analysis, normalized peak VO2 ≤60%, and VE/VCO2 ≥34 were associated with a high hazard for CAV (HR = 1.8 [95% CI 1.10-4.53, P = 0.03] and 2.5 [95% CI 1.01-8.81, P = 0.04], respectively). The subgroup of patients with both normalized peak VO2 ≤60% and VE/VCO2 ≥34 was at highest risk for development of CAV (HR = 5.2, 95% CI 2.27-15.17, P = 0.001).

Conclusions.
Normalized peak VO2 ≤60% and VE/VCO2 ≥34 at 1 year after HTx are associated with the development of CAV.
Identifying medullary bone in extinct avemetatarsalians: challenges, implications and perspectives
Authors: Canoville Aurore , Schweitzer Mary H. , Zanno Lindsay 
Published: January 2020

Medullary bone (MB) is a sex-specific tissue produced by female birds during the laying cycle, and it is hypothesized to have arisen within Avemetatarsalia, possibly outside Avialae. Over the years, researchers have attempted to define a set of criteria from which to evaluate the nature of purported MB-like tissues recovered from fossil specimens. However, we argue that the prevalence, microstructural and chemical variability of MB in Neornithes is, as of yet, incompletely known and thus current diagnoses of MB do not capture the extent of variability that exists in modern birds. Based on recently published data and our own observations of MB distribution and structure using computed tomography and histochemistry, we attempt to advance the discourse on identifying MB in fossil specimens. We propose: (i) new insights into the phylogenetic breadth and structural diversity of MB within extant birds; (ii) a reevaluation and refinement of the most recently published list of criteria suggested for confidently identifying MB in the fossil record; (iii) reconsideration of some prior identifications of MB-like tissues in fossil specimens by taking into account the newly acquired data; and (iv) discussions on the challenges of characterizing MB in Neornithes with the goal of improving its diagnosis in extinct avemetatarsalians.This article is part of the theme issue ‘Vertebrate palaeophysiology’.