bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term scintigraphic and clinical follow up in patients with differentiated thyroid cancer and iodine avid bone metastases
Authors: Talaat Omnia Mohamed , Ali Ismail Mohamed , Abolyazid Sherif Maher , Abdelmaksoud Bader , Nasr Ibrahim Mansour 
Published: March 2020

Aim
The aim of this study was to evaluate the long-term overall therapy outcomes and clinicopathological risk factors in patients with differentiated thyroid cancer (DTC) and iodine avid bone metastases.

Methods
Our study included 93 patients [female to male ratio (2:1)]. All patients were subjected to clinical examination, laboratory assessment, I-131 whole body scan, and neck ultrasound. Iodine avid metastases were treated with successive radioactive iodine-131 (RAI-131) doses. The overall response was defined as complete response (CR), incomplete response (IR) [partial response (PR) and stable disease (SD)], and progressive disease (PD).

Results
Fifty-four patients had follicular carcinoma and 39 with papillary type. Isolated bone metastases, bone and lung metastases, and multi-organ metastases were found in 45, 34, and 14 patients, respectively. The overall CR, PR, SD, and PD were found in 8.6%, 28%, 46.2%, and 17.2% patients, respectively. Adjunctive radiotherapy resulted in more CR, IR, and low PD rates compared to RAI-131 therapy (9.0%, 78.3%, 12.7% vs. 7.9%, 56.8%, and 23.7%, respectively) (P = 0.03). The overall survival rate was 88.2% and median follow-up period was 123 months. Female patients, papillary carcinoma, and single focal lesion had better overall response rate. Males, extrathyroidal extension, vascular invasion, and lymph nodes metastases had increased PD and decreased global response rates.

Conclusion
Despite of low CR rate (8.6%), most patients with DTC and iodine avid bone metastases had SD (46.2%) and long lived (88.2%). Adjunctive radiotherapy reduced PD and improved outcome. Males, extra thyroid extension and vascular invasion were bad prognostic factors.
Exercise-Induced Brain Excitability Changes in Progressive Multiple Sclerosis: A Pilot Study
Authors: Chaves Arthur R. , Devasahayam Augustine J. , Kelly Liam P. , Pretty Ryan W. , Ploughman Michelle 
Published: March 2020

Background and Purpose:
Even a single bout of aerobic exercise (AE) enhances corticospinal excitability (CSE), a biomarker of neuroplasticity. Because neurodegeneration limits capacity for neuroplasticity, it is not clear whether AE would induce CSE changes in people with progressive multiple sclerosis (MS).

Methods:
People with progressive MS (n = 10) requiring ambulatory assistive devices completed a graded maximal exercise test. Dual-energy x-ray absorptiometry was used to quantify body fat and lean mass. Before and following one 40-minute AE session using body weight–supported (<10% support) treadmill at moderate intensity, CSE was measured using transcranial magnetic stimulation. Variables included resting and active motor thresholds, motor evoked potential (MEP) amplitudes, recruitment curves, and length of the cortical silent period (CSP).

Results:
Aerobic exercise reduced inhibition (shorter CSP) and increased excitation (increased MEP amplitude) only in the hemisphere corresponding to the stronger hand. Controlling for age, higher fitness and lower body fat significantly predicted exercise-induced reduction in resting motor threshold (ΔR
2 = +0.458, P = 0.046) and CSP (ΔR
2 = +0.568, P = 0.030), respectively.

Discussion and Conclusions:
Despite high levels of disability, capacity for exercise-induced neuroplasticity was retained among people with progressive MS. The hemisphere contralateral to the weaker hand was resistant to exercise-induced CSE changes, suggesting less neuroplastic potential. Lower fitness and higher body fat were associated with diminished exercise-induced CSE benefits, suggesting that therapists should consider interventions aimed at improving fitness and combating sedentarism to ultimately enhance the benefits of exercise on the brain.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A302).
Evaluation of Two Strategies for Alleviating the Impact on the Circadian Cycle of Smartphone Screens
Authors: Teran Emiliano , Yee-Rendon Cristo-Manuel , Ortega-Salazar Jesus , De Gracia Pablo , Garcia-Romo Efrain , Woods Russell L. 
Published: March 2020

SIGNIFICANCE
Electronic display devices used before bed may negatively affect sleep quality through the effects of short-wavelength (blue) light on melatonin production and the circadian cycle. We quantified the efficacy of night-mode functions and blue-light–reducing lenses in ameliorating this problem.

PURPOSE
The purpose of this study was to compare the radiation produced by smartphones that reaches the eye when using night-mode functions or blue-light–reducing spectacle lenses.

METHODS
Radiant flux of 64 smartphones was measured with an integrating sphere. The retinal illuminance was calculated from the radiant flux of the smartphones. For the night-mode functions, the spectra produced by the smartphones were measured. The transmittance of four blue-light–reducing spectacle lenses, which filter light with either antireflective coatings or tints, was measured using a spectrometer. To determine the impact of blue-light–reducing spectacles, the radiant flux of the smartphone was weighted by the transmission spectrum of these glasses. Visual and nonvisual (circadian) parameters were calculated to compute the melatonin suppression values (MSVs) through a logistic fitting of previously published data. The MSV was used as the figure of merit to evaluate the performance of blue-light spectacles and smartphone night-mode functions.

RESULTS
Night-mode functions in smartphones reduced MSVs by up to 93%. The warmest mode produced the least suppression. Blue-light–reducing spectacles reduced melatonin suppression by 33%, the coated lenses being more efficient than tinted lenses.

CONCLUSIONS
All smartphones in this study emit radiant power in the short-wavelength region of the visible spectrum. Such smartphones may impair the regulation of circadian cycles at nighttime. The activation of night-mode functions was more efficient than the commercially available blue-light–reducing spectacle lenses in reducing the amount of short-wavelength light (up to 2.25 times). These results can be extrapolated to most electronic devices because they share the same type of white radiant sources with smartphones.
Classification of Keratoconus Based on Anterior Corneal High-order Aberrations: A Cross-validation Study
Authors: Ortiz-Toquero Sara , Fernandez Itziar , Martin Raul 
Published: March 2020

SIGNIFICANCE
Placido disc–based videokeratography is one of the most extensively used methods for corneal topographic assessments in keratoconus. Anterior corneal wavefront analysis has been demonstrated to be an effective tool to manage keratoconus eyes. However, currently, there is no clinically adequate classification system for keratoconus.

PURPOSE
The aim of this study was to analyze the usefulness of anterior corneal high-order aberrations in keratoconus classification provided by Placido disc–based videokeratography conducting a cross-validation analysis.

METHODS
Corneal topography of 70 normal and 77 keratoconic eyes (divided according to the Amsler-Krumeich classification [n = 21, stage 1; n = 30, stage 2; and n = 26, stage 3]) was assessed using Placido disc–based videokeratography (Oculus Keratograph [Oculus Optikgeräte GmbH, Wetzlar, Germany]). Receiver operating characteristic curve analysis was used to compare the mean values of coma, trefoil, tetrafoil, secondary astigmatism, spherical aberration, and coma-like, third-, and fourth-order root mean square (RMS) to calculate cutoff values, sensitivity, and specificity to discriminate between normal and stage 1 keratoconus eyes and between each keratoconus stage after cross-validation analysis.

RESULTS
All wavefront aberrations were significantly different between the normal and keratoconus groups (P ≤ .01). The coma and third-order RMS values (cutoff values, 0.367 and 0.359 μm, respectively) provide better sensitivity (99 and 100%, respectively) and specificity (100%) to discriminate keratoconus (stage 1) from healthy eyes compared with trefoil, tetrafoil, secondary astigmatism, spherical aberration, and coma-like and fourth-order RMS values (sensitivity >84% and specificity >57%). The coma and third-order RMS values showed the highest specificity (100%) and great sensitivity (90 and 87%, respectively) to differentiate between stages 1 and 2 and good sensitivity (97 and 100%) and specificity (81 and 88%) to differentiate between stages 2 and 3.

CONCLUSIONS
Anterior corneal high-order aberrations, specifically coma and third-order RMS, could be useful in keratoconus diagnosis and topographical classification. These new cutoff values could improve different stages of keratoconus eyes discrimination.
Efficacy of Swept-source Optical Coherence Tomography in Axial Length Measurement for Advanced Cataract Patients
Authors: Chirapapaisan Chareenun , Srivannaboon Sabong , Chonpimai Pratuangsri 
Published: March 2020

SIGNIFICANCEA major limitation of standard time-domain optical coherence tomography–based biometers (TD-OCT) is an inability to measure the axial length (AL) in advanced cataract. A new device that uses swept-source optical coherence tomography (SS-OCT) allows better light penetration. Hence, a considerable number of cataract patients who failed AL measurement by TD-OCT can be recovered by SS-OCT.PURPOSEThe purposes of this study were to evaluate the efficacy of an SS-OCT for AL measurement in advanced cataract patients and to identify characteristics of lens opacity that impede the AL measurement.METHODSAdvanced cataract patients who were unable to obtain AL measurement using a standard TD-OCT-based optical biometer (IOLMaster500; Carl Zeiss Meditec, Jena, Germany) were recruited in this study. The AL was remeasured using SS-OCT (IOLMaster700), followed by measurement with immersion ultrasonography (IU). The percentage of patients who achieved AL measurement by SS-OCT was recorded. The AL obtained from SS-OCT was then verified by comparing with the AL derived from IU. The cataract type of each patient was classified according to standard Lens Opacity Classification III score. The association between characteristics of cataract and successful AL measurement by SS-OCT was analyzed.RESULTSSixty-four eyes that failed AL measurement from TD-OCT were included. Fifty-six eyes (87.5%) were able to be measured by SS-OCT (95% confidence interval, 77.23 to 93.53%). The AL obtained by SS-OCT showed very high agreement with those derived from IU (intraclass correlation coefficient, 0.99). There was no statistically significant correlation between characteristics of lens opacity and the capability of SS-OCT for AL measurement (P> .05). However, there was a trend toward an inability to measure the AL in cataracts with a high grade of lens opacity.CONCLUSIONSThe efficacy of SS-OCT–based optical biometer was excellent. Of the patients with advanced cataract who failed the AL measurement by TD-OCT, 87.5% could be recovered by SS-OCT. However, there was no specific type of lens opacity associated with a failure of AL measurement using SS-OCT.
Work of Breathing in Mechanically Ventilated Preterm Neonates*
Authors: Vervenioti Aggeliki , Fouzas Sotirios , Tzifas Sotirios , Karatza Ageliki A. , Dimitriou Gabriel 
Published: March 2020

Objectives:
To compare the imposed work of breathing by means of pressure-time product of the diaphragm in newborn infants receiving different modes of mechanical ventilation.

Design:
Prospective observational crossover study.

Setting:
Tertiary care neonatal unit.

Patients:
Forty preterm newborns (gestational age ≤ 37 wk) in the phase of weaning from mechanical ventilation.

Interventions:
Participants were ventilated in assist control, synchronized intermittent mandatory ventilation, and intermittent mandatory ventilation mode, in a crossover manner. The combination synchronized intermittent mandatory ventilation–pressure support (SIMV–PS) at 50% (SIMV–PS50) and 75% (SIMV–PS75) of the difference between peak inflating and positive end-expiratory pressure, was also applied in a subset of infants (n = 11). Each mode was maintained for 30 minutes. Transdiaphragmatic pressure was obtained by digital subtraction of esophageal from gastric pressure (both measured using a dual pressure-tipped catheter), and pressure-time product of the diaphragm was computed by integration of transdiaphragmatic pressure over inspiratory time.

Measurements and Main Results:
The pressure-time product of the diaphragm was 224.2 ± 112.8 in the intermittent mandatory ventilation mode, 165.8 ± 58.8 in the synchronized intermittent mandatory ventilation mode, and 125.5 ± 61.8 cm H2O × s × min–1 in the assist control mode; all values were significantly different to each other (p < 0.0001). The pressure-time product of the diaphragm difference between assist control and intermittent mandatory ventilation, and assist control and synchronized intermittent mandatory ventilation was negatively related to postmenstrual age (regression coefficient, –0.365; p = 0.020 and –0.341; p = 0.031, respectively). In the SIMV–PS subcohort, the pressure-time product of the diaphragm was significantly higher in the intermittent mandatory ventilation mode as compared with assist control (p < 0.0001) or SIMV–PS75 (p = 0.0027), and in the synchronized intermittent mandatory ventilation mode as compared with assist control (p = 0.0301).

Conclusions:
In preterm infants, patient-triggered ventilation modalities result in lower work of breathing than intermittent mandatory ventilation, while the assist control mode is also associated with lower pressure-time product of the diaphragm compared with synchronized intermittent mandatory ventilation. The difference in the imposed diaphragmatic workload between these ventilation modalities was inversely related to postmenstrual age, implying that less mature infants benefit more from assist control-based ventilation strategies.
Circulating Neurofilament Light Chain Is Associated With Survival After Pediatric Cardiac Arrest*
Authors: Kirschen Matthew P. , Yehya Nadir , Graham Kathryn , Kilbaugh Todd , Berg Robert A. , Topjian Alexis , Diaz-Arrastia Ramon 
Published: March 2020

Objectives:
To characterize neurofilament light levels in children who achieved return of spontaneous circulation following cardiac arrest compared with healthy controls and determine an association between neurofilament light levels and clinical outcomes.

Design:
Retrospective cohort study.

Setting:
Academic quaternary PICU.

Patients:
Children with banked plasma samples from an acute respiratory distress syndrome biomarker study who achieved return of spontaneous circulation after a cardiac arrest and healthy controls.

Interventions:
None.

Measurements and Main Results:
Neurofilament light levels were determined with a highly sensitive single molecule array digital immunoassay. Patients were categorized into survivors and nonsurvivors and into favorable (Pediatric Cerebral Performance Category score of 1–2 or unchanged from baseline) or unfavorable (Pediatric Cerebral Performance Category score of 3–6 or Pediatric Cerebral Performance Category score change ≥1 from baseline). Associations between neurofilament light level and outcomes were determined using Wilcoxon rank-sum test. We enrolled 32 patients with cardiac arrest and 18 healthy controls. Demographics, severity of illness, and baseline Pediatric Cerebral Performance Category scores were similar between survivors and nonsurvivors. Healthy controls had lower median neurofilament light levels than patients after cardiac arrest (5.5 [interquartile range 5.0–8.2] vs 31.0 [12.0–338.6]; p < 0.001). Neurofilament light levels were higher in nonsurvivors than survivors (78.5 [26.2–509.1] vs 12.4 [10.3–28.2]; p = 0.012) and higher in survivors than healthy controls (p = 0.009). The four patients who survived with a favorable outcome had neurofilament light levels that were not different from patients with unfavorable outcomes (21.9 [8.5––35.7] vs 37.2 [15.4–419.1]; p = 0.60) although two of the four patients who survived with favorable outcomes had progressive encephalopathies with both baseline and postcardiac arrest Pediatric Cerebral Performance Category scores of 4.

Conclusions:
Neurofilament light is a blood biomarker of hypoxic–ischemic brain injury and may help predict survival and neurologic outcome after pediatric cardiac arrest. Further study in a larger, dedicated cardiac arrest cohort with serial longitudinal measurements is warranted.
Central Venous Catheter Utilization and Complications in the Pediatric Cardiac ICU: A Report From the Pediatric Cardiac Critical Care Consortium (PC4)*
Authors: DiPietro Lisa M. , Gaies Michael , Banerjee Mousumi , Donohue Janet E. , Zhang Wenying , DeSena Holly C. , Graham Eric M. , Sasaki Jun , Moga Michael-Alice , Prodhan Parthak , Goldstein Stuart L. , Tabbutt Sarah , Cooper David S. 
Published: March 2020

Objectives:
Current central venous catheter utilization in patients within pediatric cardiac ICUs is not well elucidated. We aim to describe current use of central venous catheters in a multi-institutional cohort and to explore the prevalence and risk factors for central line–associated thrombosis and central line–associated bloodstream infections.

Design:
Observational analysis.

Setting:
Pediatric Cardiac Critical Care Consortium hospitals.

Patients:
Hospitalizations with at least one cardiac ICU admission from October 2013 to July 2016.

Interventions:
None.

Measurements and Main Results:
There were 17,846 hospitalizations and 69% included greater than or equal to one central venous catheter. Central venous catheter use was higher in younger patients (86% neonates). Surgical hospitalizations included at least one central venous catheter 88% of the time compared with 35% of medical hospitalizations. The most common location for central venous catheters was internal jugular (46%). Central venous catheters were in situ a median of 4 days (interquartile range, 2–10). There were 248 hospitalizations (2% overall, 1.8% medical, and 2.1% surgical) with at least one central line–associated thrombosis (271 total thromboses). Thrombosis was diagnosed at a median of 7 days (interquartile range, 4–14) after catheter insertion. There were 127 hospitalizations (1% overall, 1.4% medical, and 1% surgical) with at least one central line–associated bloodstream infection (136 total infections) with no association with catheter type or location. Central line–associated bloodstream infection was diagnosed at a median of 19 days (interquartile range, 8–36) after catheter insertion. Significant risk factors for central line–associated thrombosis and central line–associated bloodstream infection were younger age, greater surgical complexity, and total catheter days.

Conclusions:
Utilization of central venous catheters in pediatric cardiac ICUs differs according to indication for hospitalization. Although thrombosis and central line–associated bloodstream infection are infrequent complications of central venous catheter use in cardiac ICU patients, these events can have important short- and long-term consequences for patients. Total central venous catheter line days were the only modifiable risk factor identified. Future study must focus on understanding central venous catheter practices in high-risk patient subgroups that reduce the prevalence of thrombosis and central line–associated bloodstream infection.
The Course of Posttraumatic Stress in Children: Examination of Symptom Trajectories and Predictive Factors Following Admission to Pediatric Intensive Care*
Authors: Le Brocque Robyne M. , Dow Belinda L. , McMahon Hayley , Crothers Anna L. , Kenardy Justin A. , Williams Tara J. , Long Debbie A. 
Published: March 2020

Objectives:
This study investigated trauma symptom trajectories of children 2–16 years old following admission to pediatric intensive care and identified factors that predicted a child’s trauma symptom trajectory.

Design:
Prospective longitudinal design.

Setting:
Two tertiary care PICUs in Brisbane, Qld, Australia.

Patients:
Children 2–16 years old admitted to PICU for longer than 8 hours.

Measurements Main Results:
Maternal reported child posttraumatic stress symptoms (n = 272) on the Trauma Symptom Checklist for Young Children were used to assess posttraumatic stress symptoms up to 12 months post admission. Semiparametric group-based trajectory analyses were completed to identify patterns over time. Age, gender, length of stay, premorbid functioning, maternal perceived threat to life, and maternal acute distress were assessed as potential risk factors. Three likely trajectory groups were identified. The majority of children were resilient (83.8%); however, a significant minority experienced chronic symptoms (12.9%) or elevated stress symptoms which resolved quickly (3.3%). After controlling for other variables, maternal report of premorbid internalizing behavior significantly predicted both chronic (odds ratio, 6.3) and recovery (odds ratio, 38.0) trajectories. Maternal acute distress significantly predicted child chronic symptom trajectories (odds ratio, 5.2).

Conclusions:
Children with elevated trauma symptoms postintensive care need timely and effective intervention. The majority of children with high levels of acute symptoms will continue to have chronic, ongoing posttraumatic stress symptoms. In addition, acute maternal distress and preexisting internalizing child behavior predict ongoing psychologic distress after discharge from the PICU. Screening in the acute period post-PICU admission may identify children likely to experience ongoing chronic posttraumatic distress symptoms and enable targeted treatment of children at risk. This is the first study to examine symptom trajectories in children following pediatric intensive care admission and includes a sample of very young children.