bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relative Hyperglycemia Is an Independent Determinant of In-Hospital Mortality in Patients With Critical Illness
Authors: Lee Tien F. , Drake Sophie M. , Roberts Gregory W. , Bersten Andrew , Stranks Stephen N. , Heilbronn Leonie K. , Mangoni Arduino A. , Burt Morton G. 
Published: January 2020

Objectives:
To determine whether relative hyperglycemia was associated with in-hospital mortality in critically ill patients independent of other prognostic variables and whether this association is affected by background glycemia.

Design:
Prospective observational study.

Setting:
Mixed medical-surgical ICU in a metropolitan teaching hospital.

Patients:
From 2,617 admissions to ICU between January 27, 2016, and March 30, 2017, 1,262 consecutive patients who met inclusion and exclusion criteria were studied.

Interventions:
Glycosylated hemoglobin was used to estimate average glucose concentration over the prior 3 months. Glucose concentration on ICU admission was divided by estimated average glucose concentration to calculate the stress hyperglycemia ratio, an index of relative glycemia. Risk of death score was calculated using data submitted to the Australia and New Zealand Intensive Care Society.

Measurements and Main Results:
In this study, there were 186 deaths (14.7%). Admission glucose was significantly associated with mortality in univariate analysis (odds ratio = 1.08 per mmol/L glucose increment; p < 0.001) but not after adjustment for risk of death score (odds ratio = 1.01; p = 0.338). In contrast, stress hyperglycemia ratio was significantly associated with mortality both in univariate analysis (odds ratio = 1.09 per 0.1 stress hyperglycemia ratio increment; p < 0.001) and after adjustment for risk of death score (odds ratio = 1.03; p = 0.014). Unlike admission glucose concentration, stress hyperglycemia ratio was significantly associated with mortality in patients with glycosylated hemoglobin less than 6.5% (odds ratio = 1.08 per 0.1 stress hyperglycemia ratio increment; p < 0.001) and glycosylated hemoglobin greater than or equal to 6.5% (48 mmol/mol) (odds ratio = 1.08 per 0.1 stress hyperglycemia ratio increment; p = 0.005).

Conclusions:
Unlike absolute hyperglycemia, relative hyperglycemia, as assessed by the stress hyperglycemia ratio, independently predicts in-hospital mortality in critically ill patients across the glycemic spectrum. Future studies should investigate whether using measures of relative hyperglycemia to determine individualized glycemic treatment targets improves outcomes in ICU.
Examining the Impact of Corneal Tissue Transnational Activity, and Transplantation, on Import and Export Nations: A Review of the Literature
Authors: Machin Heather , Arslan Janan , Baird Paul N. 
Published: January 2020

Purpose:
Globally, an estimated 12.7 million people await a corneal transplant. Of these, 53% are without routine access to a domestic supply and are reliant on transnational activity (TNA) (importation) of corneal tissue (CT) for transplantation. Although CT TNA commenced in 1961, there has been no evaluation of its impact on import and export nations.

Methods:
We wished to examine the impact of clinical and nonclinical CT TNA on export and import nations, with nonclinical aspects our primary focus, to help guide future practice. We conducted a review of the academic literature through various search engines. We prefix and place our review in the relevant historical practice and global context.

Results:
Despite commencement in 1961, we only located 14 studies (11 clinical and 3 nonclinical) pertaining to CT TNA. These were published between 1991 and 2018. Clinical papers reported death-to-preservation time, preservation-to-transplantation time, logistics, donor and recipient selection, and quality as relevant. Nonclinical studies identified emerging themes pertaining to financial, ethical, and sustainability aspects of TNA.

Conclusions:
All aspects of CT TNA are grossly under-reported, resulting in our inability to effectively analyze the overall impact to export and import nations. The few clinical studies in our review concluded that despite endothelial cell loss and other risk factors, imported CT appears comparable with domestic CT and remains an option in the absence of domestic supply. Nonclinical aspects (eg, ethical, equitable, and economic) have also not been adequately addressed.
Corneal Light Scatter After Ultrathin Descemet Stripping Automated Endothelial Keratoplasty Versus Descemet Membrane Endothelial Keratoplasty in Descemet Endothelial Thickness Comparison Trial: A Randomized Controlled Trial
Authors: Hirabayashi Kristin E. , Chamberlain Winston , Rose-Nussbaumer Jennifer , Austin Ariana , Stell Laurel , Lin Charles C. 
Published: January 2020

Purpose:
To compare the degree of corneal light scatter as measured by densitometry in ultrathin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK) and Descemet Membrane Endothelial Keratoplasty (DMEK) in the Descemet endothelial thickness comparison trial.

Methods:
This was a prespecified secondary analysis of the Descemet endothelial thickness comparison trial, which was a prospective, randomized controlled trial. Subjects with isolated endothelial dysfunction were enrolled and were randomized to either UT-DSAEK or DMEK. Corneal opacity was quantitatively measured by Pentacam densitometry (OCULUS) at 3, 6, and 12 months.

Results:
Fifty eyes of 38 patients were enrolled at the Casey Eye Institute at Oregon Health & Science University and the Byers Eye Institute at Stanford University. Corneal densitometry for the anterior and posterior layers improved in both UT-DSAEK and DMEK after surgery. The decrease was more pronounced in the posterior layer for both groups. However, there was no difference in the degree of corneal light scatter between UT-DSAEK and DMEK at postoperative month 12, and no difference in change in densitometry was observed between the 2 arms from baseline to month 12.

Conclusions:
Both UT-DSAEK and DMEK experience an improvement in the degree of corneal light scatter after surgery. However, there was no difference in densitometry between the 2 groups at month 12. Therefore, other factors such as higher order aberrations in the posterior cornea rather than stromal–stromal interface haze mediate the superior visual outcomes in DMEK compared with UT-DSAEK.
Multidisciplinary Management of Hepatocellular Carcinoma Improves Access to Therapy and Patient Survival
Authors: Agarwal Parul D. , Phillips Paulina , Hillman Luke , Lucey Michael R. , Lee Fred , Mezrich Josh D. , Said Adnan 
Published: January 2020

Background:
Given the complexity of managing hepatocellular carcinoma (HCC), it is widely accepted that a multidisciplinary team approach (tumor boards) offers the best approach to individualize therapy. The aim of this study was to determine utilization of therapies and outcomes for patients with HCC, comparing those managed through our multidisciplinary tumor board (MDTB) to those who were not.

Methods:
A database analysis of all patients with HCC managed through our MDTB, from 2007 until 2011, was performed. A database of all patients with HCC from 2002 to 2011, not managed through MDTB, was similarly created.

Results:
A total of 306 patients with HCC, from 2007 to 2011 were managed through our MDTB, in comparison with 349 patients, from 2002 to 2011 who were not. There were no significant differences in baseline demographic data or model for end-stage liver disease at presentation. Patients managed through MDTB were more likely to present at an earlier tumor stage and with lower serum alpha fetoprotein (AFP) (P=0.007). The odds of receiving any treatment for HCC was higher in patients managed through MDTB (odds ratio, 2.80; 95% confidence interval, 1.71-4.59; P<0.0001) independent of model for end-stage liver disease score, serum AFP, and tumor stage. There was significantly greater survival of patients managed through MDTB (19.1±2.5 vs. 7.6±0.9 mo, P<0.0001). Independent predictors for improved survival included management through MDTB, receipt of any HCC treatment, lower serum AFP, receipt of liver transplant, and T2 tumor stage.

Conclusions:
Patients with HCC managed through a MDTB had significantly higher rates of receipt of therapy and improved survival compared with those who were not.
Safety and Efficacy of Wireless pH Monitoring in Patients Suspected of Gastroesophageal Reflux Disease
Authors: Kessels Sharon J.M. , Newton Skye S. , Morona Judy K. , Merlin Tracy L. 
Published: January 2020

Introduction:
The primary aim of this systematic review was to determine the safety, technical efficacy, and effectiveness of 48-hour wireless pH monitoring (WM) for gastroesophageal reflux disease (GERD), compared with no pH monitoring in patients who failed to tolerate a catheter. In the absence of eligible studies, the secondary aim was to determine these performance characteristics for WM relative to catheter-based pH monitoring (CBM) in patients suspected of GERD, who are able to tolerate a catheter.

Methods:
A protocol was registered on the PROSPERO database (CRD42013005852) before conducting the systematic review, which included the study selection criteria, and critical appraisal methods. Several key databases were searched to identify eligible comparative studies.

Results:
Chest pain occurred more often with WM compared with CBM; however, other adverse events were reported less frequently with WM. Technical failures, mostly due to attachment failures and early capsule detachments, were 3 times higher with WM, compared with CBM, [pooled relative risk (from meta-analysis)=3.3; 95% confidence interval, 1.63-6.81; I
2=0%; P=0.012; k=8). The sensitivity and specificity of WM varied widely, depending on type of analysis, monitoring time, capsule placement, reference standard, and diagnostic threshold.

Discussion:
WM is usually better tolerated than CBM but has more technical problems. Test accuracy was highly variable between studies; therefore, conclusions could not be drawn regarding the performance of the 2 tests. To make meaningful comparisons between WM and CBM a consensus is needed on the diagnostic threshold for GERD, monitoring time, appropriate capsule positioning, and the reference standard.
Iodine-131 metaiodobenzylguanidine (131I-mIBG) treatment in relapsed/refractory neuroblastoma
Authors: Anongpornjossakul Yoch , Sriwatcharin Wattanun , Thamnirat Kanungnij , Chamroonrat Wichana , Kositwattanarerk Arpakorn , Utamakul Chirawat , Sritara Chanika , Chokesuwattanasakul Payap , Thokanit Nintita Sripaiboonkij , Pakakasama Samart , Anurathapan Usanarat , Pongphitcha Pongpak , Chotipanich Chanisa , Hongeng Suradej 
Published: January 2020

Background

131I-meta-iodo-benzylguanidine (131I-mIBG) therapy has been used in treatment of for advanced neuroblastoma for many years with promising results. There are several studies regarding predictors and outcomes of 131I-mIBG therapies in relapsed/refractory neuroblastoma patients.

Objective
To identify the predictors and outcomes of 131I-mIBG treatment in relapsed/refractory neuroblastoma.

Methods
This study was a retrospective review of 22 patients with high risk stage IV relapsed/refractory neuroblastoma who received at least one cycle of 131I-mIBG therapy. Patient’ characteristics, hematologic toxicity, scintigraphic semi-quantitative scoring, and overall survival were recorded. Factors predicting survival were analyzed.

Results
Twenty-two patients (50% male) with mean age of 3.7 years (4.8 months to 8.3 years) received 131I-mIBG therapies at an average of 3.8 and mean dose of 136 mCi (5032 MBq) per treatment. Most common acute hematologic toxicity was thrombocytopenia. Overall 5-year survival rate was 37% (95% confidence interval: 16.3–58.0) and median survival time was 2.8 year (95% confidence interval: 1.38–6.34). Patients with rising Curie score of ≥25% upon the second therapy were major determinants of overall survival with poorer response to treatment. At least three treatments of 131I-mIBG were needed to identify some degrees of survival prolongation (crude hazard ratio: P-value = 0.003). Age, sex, metastatic status, and baseline Curie scoring system were good predictors associated with survival. Seven patients (32%) demonstrated objective responses.

Conclusion
Despite multimodality therapy, high risk neuroblastoma had a propensity of treatment failure in terms of relapsed or refractory, with some objective responses after 131I-mIBG treatments. The declined or non-rising Curie score upon second post-treatment total body scan was an important predictor of survival and aided a decision whether or not to proceed with bone marrow transplantation.
Effects of nucleo(s)tide analogs therapy on chronic hepatitis B as evaluated by hepatosplenic radionuclide angiography
Authors: Wang Li , Wu Zhe , Wang Ange , Jin Xuehang , Qiu Yunqing 
Published: January 2020

Objectives
Hepatosplenic radionuclide angiography is a relatively noninvasive method for evaluating hepatic portal perfusion. We used hepatosplenic radionuclide angiography to assess the effects of nucleo(s)tide analogs therapy on patients with chronic hepatitis B (CHB).

Patients and methods
A retrospective analysis was performed on patients who underwent hepatosplenic radionuclide angiography from January 2012 to May 2017 at the First Affiliated Hospital, College of Medicine, Zhejiang University. The correlations between the results of routine laboratory tests and hepatic perfusion index (HPI) were evaluated. The Wilcoxon signed-rank test and one-way ANOVA of repeated measures were used to compare the HPIs of patients who received nucleo(s)tide analogs therapy.

Results
There is a positive correlation between HPI and cholinesterase and serum albumin (ALB) and a negative correlation between HPI and aspartate aminotransferase-to-platelet ratio index and bilirubin (TBiL). An improvement in HPI was observed in patients with an initial HPI <61% after nucleo(s)tide analogs therapy.

Conclusions
Hepatosplenic radionuclide angiography can reflect the functional reserve of the liver and monitor liver fibrosis indirectly. It can also comprehensively assess the effects of antiviral therapy on patients with CHB, and antiviral therapy is critical for the treatment of hepatitis.
Micronutrients, Metabolic Complications, and Inflammation in Ugandan Children With HIV
Authors: Dirajlal‐Fargo Sahera , Shan Lingpeng , Sattar Abdus , Kulkarni Manjusha , Bowman Emily , Funderburg Nicholas , Nazzinda Rashidah , Karungi Christine , Kityo Cissy , Musiime Victor , McComsey Grace A. 
Published: January 2020

ABSTRACTBackground:Selenium, zinc, and chromium are essential micronutrients. Their alterations have been associated with HIV disease progression, metabolic complications, and mortality.Methods:This is a cross‐sectional study in children with perinatally acquired HIV (PHIV, n = 57), HIV‐exposed uninfected (HEU, n = 59), and HIV‐unexposed uninfected (HIV−, n = 56) children aged 2 to 10 years old, age‐ and sex‐matched, enrolled in Uganda. PHIV were on stable antiretroviral therapy (ART) with undetectable viral load. We measured plasma concentrations of selenium, zinc, and chromium as well as markers of systemic inflammation, monocyte activation, and gut integrity.Results:Among PHIV children, 93% had viral load ≤20 copies/mL, median CD4 was 37%, and 77% were receiving a nonnucleotide reserve transcriptase regimen. Median age of all participants was 8 years and 55% were girls. Median selenium concentrations were higher in PHIV compared with the HEU and HIV groups (P < 0.001), 46% of children overall had low zinc status (P = 0.18 between groups). Higher selenium, but not chromium or zinc, was associated with lower IL6, sTNFRI and II, and higher beta d glucan, a marker of fungal translocation, zonulin, a marker of gut permeability, oxidized LDL and insulin resistance (P ≤ 0.01).Conclusion:In this cohort of PHIV on ART in Uganda, there is a high prevalence of low zinc status overall. Higher plasma selenium concentrations were associated with lower systemic inflammation and higher gut integrity markers. Although our findings do not support the use of micronutrient supplementation broadly for PHIV in Uganda, further studies are warranted to assess the role of selenium supplements in attenuating heightened inflammation.
PrEP4Love: The Role of Messaging and Prevention Advocacy in PrEP Attitudes, Perceptions, and Uptake Among YMSM and Transgender Women
Authors: Phillips Gregory , Raman Anand B. , Felt Dylan , McCuskey David J. , Hayford Christina S. , Pickett Jim , Lindeman Peter T. , Mustanski Brian 
Published: January 2020

Background:
Despite high efficacy, use of pre-exposure prophylaxis (PrEP) remains low among young men who have sex with men (MSM) and transgender women (TW), primarily because of barriers such as stigma and resource awareness. We evaluated a social marketing campaign known as PrEP4Love that works to eliminate PrEP stigma; and awareness gaps through targeted advertising.

Setting:
Chicago, Illinois.

Methods:
Participants were enrolled within a cohort study of young MSM and TW (RADAR). Data were collected between June 2017 and April 2018 from HIV-negative individuals attending a follow-up visit. Surveys assessed demographics, PrEP attitudes and perceptions, and PrEP4Love campaign awareness. Associations between PrEP4Love awareness and PrEP perceptions, uptake, and behaviors were assessed using multiple logistic regression controlling for age, race/ethnicity, gender, sexual identity, and ever having used PrEP.

Results:
Of 700 participants, the majority (75.9%) indicated seeing PrEP4Love ads in Chicago. Those who had seen ads were more likely to be out to their providers (odds ratio = 1.95; 95% confidence interval: 1.17 to 3.23) than those who had not, and those who had conversations were significantly more likely to have initiated the conversation themselves. Individuals who had seen ads were more likely to have taken PrEP in the last 6 months (odds ratio = 1.87; 95% confidence interval: 1.15 to 3.16) and more likely to believe their friends and the general public approved of and used PrEP.

Conclusion:
Social marketing campaigns are promising interventions that have the potential to alleviate barriers to HIV prevention, particularly among MSM and TW. Future research should evaluate the impact of these initiatives at multiple time points.
Estimated Number of Men Who Have Sex With Men With Indications for HIV Pre-exposure Prophylaxis in a National Sexual Network Study
Authors: Weiss Kevin M. , Prasad Pragati , Ramaraju Ramya , Zlotorzynska Maria , Jenness Samuel M. 
Published: January 2020

Background:
A 2015 CDC analysis estimated that 24.7% of sexually active men who have sex with men (MSM) had indications for HIV pre-exposure prophylaxis (PrEP) based on 2014 US Public Health Service (USPHS) clinical practice guidelines. Given that the USPHS revised these guidelines in 2017, updated estimates of the fraction of MSM indicated for PrEP overall and stratified by demographic factors and geography are needed to scale-up PrEP for MSM in the US.

Methods:
We conducted a national web-based study of 4904 MSM aged 15–65 who had ever had sex with another man between July 2017 and January 2019. We estimated the percentage of HIV-negative, sexually active MSM meeting USPHS indications for PrEP by demographic category.

Results:
Of 3511 sexually active, HIV-negative MSM, 34.0% (95% confidence interval: 32.4 to 35.6) met USPHS indications for PrEP, with percentages consistent across US census region and varying slightly by race/ethnicity (Black: 32.2%, White: 33.7%, Hispanic: 36.4%, Other: 33.6%). Among individuals meeting USPHS PrEP indications, 93.5% reported condomless anal intercourse in the prior 6 months. Among all survey respondents, PrEP eligibility was lowest among non-Hispanic black (18.4%) and younger respondents (15–17: 4.1%; 18–24: 18.1%).

Conclusions:
Estimated percentages of MSM meeting indications for PrEP exceeded the previous CDC estimate across race/ethnicity, age, and census regions, with one-third of adult, sexually active, HIV-negative MSM exhibiting indications for PrEP. This study suggests, given current guidelines for PrEP indications, that a different fraction of eligible MSM could be receiving PrEP than previously estimated.
Image Quality Measured From Ultra-Low Dose Chest Computed Tomography Examination Protocols Using 6 Different Iterative Reconstructions From 4 Vendors, a Phantom Study
Authors: Afadzi Mercy , Fosså Kristian , Andersen Hilde Kjernlie , Aaløkken Trond Mogens , Martinsen Anne Catrine T. 
Published: January 2020

PurposeThis study aimed to evaluate image quality of ultra-low dose chest computed tomography using 6 iterative reconstruction (IR) algorithms.MethodA lung phantom was scanned on 4 computed tomography scanners using fixed tube voltages and the lowest mAs available on each scanner, resulting in dose levels of 0.1 to 0.2 mGy (80 kVp) and 0.3 to 1 mGy (140 kVp) volume CT dose index (CTDIvol). Images were reconstructed with IR available on the scanners. Image noise, signal-to-noise ratios, contrast-to-noise ratios, uniformity, and noise power spectrum (NPS) were assessed for evaluation of image quality.ResultsImage quality parameters increased with increasing dose for all algorithms. At constant dose levels, model-based techniques improved the contrast-to-noise ratio of lesions more than the statistical algorithms. All algorithms tested at 0.1 mGy showed lower NPS peak frequencies compared with 0.39 mGy. In contrast to the statistical techniques, model-based algorithms showed lower NPS peak frequencies at the lowest doses, indicating a coarser and blotchier noise texture.ConclusionThis study shows the importance of evaluating IR when introduced clinically.
Machine Learning to Predict the Rapid Growth of Small Abdominal Aortic Aneurysm
Authors: Hirata Kenichiro , Nakaura Takeshi , Nakagawa Masataka , Kidoh Masafumi , Oda Seitaro , Utsunomiya Daisuke , Yamashita Yasuyuki 
Published: January 2020

Objective
The purpose of this study was to determine whether computed tomography (CT) angiography with machine learning (ML) can be used to predict the rapid growth of abdominal aortic aneurysm (AAA).

Materials and Methods
This retrospective study was approved by our institutional review board. Fifty consecutive patients (45 men, 5 women, 73.5 years) with small AAA (38.5 ± 6.2 mm) had undergone CT angiography. To be included, patients required at least 2 CT scans a minimum of 6 months apart. Abdominal aortic aneurysm growth, estimated by change per year, was compared between patients with baseline infrarenal aortic minor axis. For each axial image, major axis of AAA, minor axis of AAA, major axis of lumen without intraluminal thrombi (ILT), minor axis of lumen without ILT, AAA area, lumen area without ILT, ILT area, maximum ILT area, and maximum ILT thickness were measured. We developed a prediction model using an ML method (to predict expansion >4 mm/y) and calculated the area under the receiver operating characteristic curve of this model via 10-fold cross-validation.

Results
The median aneurysm expansion was 3.0 mm/y. Major axis of AAA and AAA area correlated significantly with future AAA expansion (r = 0.472, 0.416 all P < 0.01). Machine learning and major axis of AAA were a strong predictor of significant AAA expansion (>4 mm/y) (area under the receiver operating characteristic curve were 0.86 and 0.78).

Conclusions
Machine learning is an effective method for the prediction of expansion risk of AAA. Abdominal aortic aneurysm area and major axis of AAA are the important factors to reflect AAA expansion.