bluuebunny/crossref_metadata_2025_split huggingface dataset:
Whole-Slide Image Analysis Reveals Quantitative Landscape of Tumor–Immune Microenvironment in Colorectal Cancers
Authors: Yoo Seung-Yeon , Park Hye Eun , Kim Jung Ho , Wen Xianyu , Jeong Seorin , Cho Nam-Yun , Gwon Hwang Gwan , Kim Kwangsoo , Lee Hye Seung , Jeong Seung-Yong , Park Kyu Joo , Han Sae-Won , Kim Tae-You , Bae Jeong Mo , Kang Gyeong Hoon 
Published: November 2019

Abstract

Purpose:
Despite the well-known prognostic value of the tumor–immune microenvironment (TIME) in colorectal cancers, objective and readily applicable methods for quantifying tumor-infiltrating lymphocytes (TIL) and the tumor–stroma ratio (TSR) are not yet available.

Experimental Design:
We established an open-source software-based analytic pipeline for quantifying TILs and the TSR from whole-slide images obtained after CD3 and CD8 IHC staining. Using a random forest classifier, the method separately quantified intraepithelial TILs (iTIL) and stromal TILs (sTIL). We applied this method to discovery and validation cohorts of 578 and 283 stage III or high-risk stage II colorectal cancers patients, respectively, who were subjected to curative surgical resection and oxlaliplatin-based adjuvant chemotherapy.

Results:
Automatic quantification of iTILs and sTILs showed a moderate concordance with that obtained after visual inspection by a pathologist. The K-means–based consensus clustering of 197 TIME parameters that showed robustness against interobserver variations caused colorectal cancers to be grouped into five distinctive subgroups, reminiscent of those for consensus molecular subtypes (CMS1-4 and mixed/intermediate group). In accordance with the original CMS report, the CMS4-like subgroup (cluster 4) was significantly associated with a worse 5-year relapse-free survival and proved to be an independent prognostic factor. The clinicopathologic and prognostic features of the TIME subgroups have been validated in an independent validation cohort.

Conclusions:
Machine-learning–based image analysis can be useful for extracting quantitative information about the TIME, using whole-slide histopathologic images. This information can classify colorectal cancers into clinicopathologically relevant subgroups without performing a molecular analysis of the tumors.
Recanalization of Emergent Large Intracranial Vessel Occlusion through Intravenous Thrombolysis: Frequency, Clinical Outcome, and Reperfusion Pattern
Authors: Serna Candel Carmen , Aguilar Pérez Marta , Hellstern Victoria , AlMatter Muhammad , Bäzner Hansjörg , Henkes Hans 
Published: November 2019

<b><i>Background:</i></b> According to a recent meta-analysis, 1 out of 10 patients with emergent large intracranial vessel occlusion (ELVO) causing stroke have recanalization after intravenous thrombolysis (IVT) alone. However, rate, clinical outcome, and recanalization pattern of this phenomenon are poorly understood. <b><i>Objectives and Methods:</i></b> Patients with ELVO recanalized only by IVT were analyzed, and frequency of recanalization, clinical outcome, safety variables, and reperfusion pattern were assessed. These patients were compared to a group of patients with ELVO who underwent endovascular thrombectomy with or without prior IVT. <b><i>Results:</i></b> Successful or sufficient recanalization after IVT alone occurred in 81 of 760 patients (10.6%) with ELVO who had been referred for endovascular thrombectomy. These 81 patients (group 1) were compared to a group of patients receiving endovascular thrombectomy with prior IVT (group 2) or without (group 3). A good clinical outcome at 90 days was seen in 61.7% of patients in group 1, 32.2% in group 2, and 34.5% in group 3 (<i>p</i> &#x3c; 0.001). The 3 groups had no significant differences in intracranial hemorrhage. IVT was not independently associated with symptomatic intracranial hemorrhage, parenchymal hematoma, or subarachnoid hemorrhage. Mortality at 90 days was 9.9% in group 1, 20.7% in group 2, and 29.6% in group 3 (<i>p</i> &#x3c; 0.001). After adjusting for all relevant variables, outcome and mortality differences were nonsignificant. No difference in the rate of successful reperfusion (modified treatment in cerebral ischemia [mTICI] 2b/3) was found. A reperfusion mTICI 3 was achieved in 18.5% in group 1, 60.7% in group 2, and 57.1% in group 3 (<i>p</i> &#x3c; 0.001). Patients in group 1 had lower chance of achieving a complete recanalization (mTICI 3) compared to patients in group 2, OR 0.15 (95% CI 0.08–0.29) and in group 3, OR 0.17 (95% CI 0.09–0.32; <i>p</i> &#x3c; 0.001). <b><i>Conclusions:</i></b> Primary IVT in ELVO caused a recanalization rate of 10.6%, making endovascular treatment either unnecessary or impossible. Early recanalization of ELVO with only IVT is associated with a 61.7% independence rate at 90 days and similar successful reperfusion rates (mTICI2b/3) compared to ELVO treated with endovascular treatment, with or without previous IVT. However, recanalization only through IVT achieves a lower rate of mTICI 3 reperfusion when compared to endovascular treatment.
Outcomes With Deferred Versus Performed Revascularization of Coronary Lesions With Gray-Zone Fractional Flow Reserve Values
Authors: Megaly Michael , Khalil Charl , Saad Marwan , Xenogiannis Iosif , Omer Mohamed , Anantha Narayanan Mahesh , Pershad Ashish , Garcia Santiago , Seto Arnold H. , Burke M. Nicholas , Brilakis Emmanouil S. 
Published: November 2019

Background:
Management of coronary lesions with fractional flow reserve values in the gray zone (0.75–0.80) remains controversial due to conflicting data on the performance versus deferral of revascularization.

Methods:
We performed a systematic review and meta-analysis of 7 observational studies including 2683 patients that compared the outcomes of deferred versus performed revascularization of coronary lesions with gray-zone fractional flow reserve values.

Results:

During a mean follow-up of 31±9 months, the incidence of major adverse cardiovascular events (12.54 % versus 11.25%; odds ratio [OR], 1.64 [95% CI, 0.78–3.44];
P
=0.19, I2=84%), cardiac mortality (1.25% versus 0.72%; OR, 1.78 [95% CI, 0.58–5.46];
P
=0.31, I2=18%), and myocardial infarction (1.28% versus 2.66%; OR, 0.79 [95% CI, 0.22–2.79];
P
=0.71, I2=65%) was similar with deferral versus performance of revascularization in coronary lesions with gray-zone fractional flow reserve. Deferral of revascularization was associated with a higher incidence of target vessel revascularization (9.12% versus 5.78%; OR, 1.85 [95% CI, 1.03–3.33];
P
=0.04, I2=62%). When the analysis was limited only to studies that used percutaneous coronary intervention for revascularization, deferred revascularization remained associated with a higher risk of target vessel revascularization (18% versus 7.3%; OR, 3.04 [95% CI, 1.53–6.02];
P
<0.001) and was associated with a higher risk of major adverse cardiovascular event (23.2% versus 13.4%; OR, 3.38 [95% CI, 1.92–5.95];
P
<0.001).

Conclusions:
In lesions with gray-zone fractional flow reserve, revascularization was associated with a similar incidence of major adverse cardiovascular event but a lower incidence of target vessel revascularization over a mean follow-up of approximately 2.5 years.

Clinical Trial Registration:

URL:
https://www.crd.york.ac.uk/prospero/
. Unique identifier: CRD42019128076.
Identification of Adipsin as a Novel Prognostic Biomarker in Patients With Coronary Artery Disease
Authors: Ohtsuki Tomohiro , Satoh Kimio , Shimizu Toru , Ikeda Shohei , Kikuchi Nobuhiro , Satoh Taijyu , Kurosawa Ryo , Nogi Masamichi , Sunamura Shinichiro , Yaoita Nobuhiro , Omura Junichi , Aoki Tatsuo , Tatebe Shunsuke , Sugimura Koichiro , Takahashi Jun , Miyata Satoshi , Shimokawa Hiroaki 
Published: November 2019

Background
Circulating proteins are exposed to vascular endothelial layer and influence their functions. Among them, adipsin is a member of the trypsin family of peptidases and is mainly secreted from adipocytes, monocytes, and macrophages, catalyzing the rate‐limiting step of the alternative complement pathway. However, its pathophysiological role in cardiovascular disease remains to be elucidated. Here, we examined whether serum adipsin levels have a prognostic impact in patients with coronary artery disease.

Methods and Results

In 370 consecutive patients undergoing diagnostic coronary angiography, we performed a cytokine array analysis for screening serum levels of 50 cytokines/chemokines and growth factors. Among them, classification and regression analysis identified adipsin as the best biomarker for prediction of their long‐term prognosis (median 71 months; interquartile range, 55–81 months). Kaplan–Meier curve showed that higher adipsin levels (≥400 ng/
mL
) were significantly associated with all‐cause death (hazard ratio [HR], 4.2; 95% CI, 1.7–10.6 [
P
<0.001]) and rehospitalization (
HR
, 2.4; 95% CI, 1.7–3.5 [
P
<0.001]). Interestingly, higher high‐sensitivity C‐reactive protein levels (≥1 mg/L) were significantly correlated with all‐cause death (
HR,
3.2; 95% CI, 1.7–5.9 [
P
<0.001]) and rehospitalization (
HR,
1.5, 95%
CI,
1.1–1.9 [
P
<0.01]). Importantly, the combination of adipsin (≥400 ng/
mL
) and high‐sensitivity C‐reactive protein (≥1 mg/L) was more significantly associated with all‐cause death (
HR,
21.0; 95%
CI,
2.9–154.1 [
P
<0.001]). Finally, the receiver operating characteristic curve demonstrated that serum adipsin levels predict the death caused by acute myocardial infarction in patients with coronary artery disease (C‐statistic, 0.847).

Conclusions
These results indicate that adipsin is a novel biomarker that predicts all‐cause death and rehospitalization in patients with coronary artery disease, demonstrating the novel aspects of the alternative complementary system in the pathogenesis of coronary artery disease.
The Expressive Limits of International Criminal Justice: Victim Trauma and Local Culture in the Iron Cage of the Law
Authors: Sander Barrie 
Published: November 2019

Scholarship within the field of international criminal justice has increasingly turned towards expressivist strands of thought, characterised by a concern for the didactic qualities of international criminal courts. Taking expressivism as its point of departure, this paper critically examines the expressive limits of international criminal justice. Specifically, the paper examines the extent to which international criminal courts have been expressively constrained both in their ability to alleviate the traumas of victims and in their receptivity to the local cultural values of conflict-affected communities. The paper argues that a critical reflection on the expressive limits of international criminal courts, paying particular attention to their retributive core and cultural assumptions, can help such institutions better navigate the complex terrain in which they operate, reducing aspirations concerning what they should be expected to achieve in practice and improving their legitimacy amongst local communities.
Factors Associated With Opiate Use Among Psychiatric Inpatients: A Population-Based Study of Hospital Admissions in Ontario, Canada
Authors: Aderibigbe Oluwakemi , Renda Anthony , Perlman Christopher M 
Published: November 2019

Background: Use of opiates, including synthetic opioids, is associated with a number of negative consequences, including increased risk of opioid use disorders and other mental health conditions. However, studies are limited in examining patterns of opiate use among persons in inpatient psychiatry, particularly those that consider the relationship between pain and opiate use. Objective: This study examined the prevalence in the prior 12 months to admission and patterns of opiate use and pain in a population-based study of persons admitted to inpatient psychiatry in Ontario, Canada. Methods: We conducted retrospective cross-sectional study of 165 434 persons admitted to inpatient psychiatry between January 1, 2006 and December 31, 2017. Using data from the Resident Assessment Instrument for Mental Health, we examined prevalence and factors associated with opiate use in the prior 12 months by a number of patient characteristics, including demographics, mental and physical health status, concurrent substance use, pain severity and frequency, and health region of residence. Results: The prevalence of opiate use within 12 months of admission was 7.5%, between 17% and 22% among those experiencing daily pain, and 27% among persons with a primary substance use disorder. Multivariable analyses revealed strong associations among demographic and clinical variables with opiate use ( c = 0.91), including being of younger age, use of other substances, greater frequency and severity of pain, and health region of residence. Conclusion: The strong relationship between pain and opiate use in this population, and the regional variation in this pattern, supports the need for integrated care for mental illness and substance use, and therapeutic approaches to pain management that reduce risks of problems associated with substance use for persons with mental health conditions.
Dyadic effects of type D personality and perceived control on health-related quality of life in cardiac arrest survivors and their spouses using the actor–partner interdependence model
Authors: Israelsson Johan , Persson Carina , Bremer Anders , Strömberg Anna , Årestedt Kristofer 
Published: November 2019

Background: There is a lack of knowledge about factors associated with health-related quality of life in cardiac arrest survivors and their spouses. In addition, survivors and spouses are likely to affect each other’s health-related quality of life. Aims: The aim was to investigate if a distressed personality and perceived control among cardiac arrest survivors and their spouses were associated with their own and their partner’s health-related quality of life. Methods: This dyadic cross-sectional study used the actor–partner interdependence model to analyse associations between a distressed personality (type D personality), perceived control (control attitudes scale), and health-related quality of life (EQ index and EQ visual analogue scale). Results: In total, 126 dyads were included in the study. Type D personality and perceived control in cardiac arrest survivors were associated with their own health-related quality of life. In their spouses, a significant association was found for type D personality but not for perceived control. In addition, type D personality and perceived control in survivors were associated with health-related quality of life in their spouses. Conclusions: Type D personality and perceived control are factors that might be considered during post cardiac arrest, because of the associations with health-related quality of life in survivors and spouses. More research is needed to test psychosocial interventions in the cardiac arrest population in order to improve health-related quality of life.
Analysis of the effect of production parameters on sound absorption and abrasion resistance performance of needlepunched nonwovens for automotive carpet applications using Taguchi method
Authors: Palak Handan , Karagüzel Kayaoğlu Burçak 
Published: November 2019

In this study, sound absorption and abrasion resistance performance of needlepunched nonwovens produced from blend of round polyethylene terephthalate/hexaflower polyethylene terephthalate/low melt polyethylene terephthalate fibers with various weight ratios, i.e. 50/40/10, 40/40/20, 70/20/10, 50/30/20, were reported. The carded webs were bonded by needlepunching at two punch densities, i.e. 400–500 punches/cm2 and penetration depths, i.e. 11-6-6 and 13-8-8 mm, then passed through an through-air thermal bonding oven to melt low melt polyethylene terephthalate fibers within the samples. Design of experiments was planned according to Taguchi method, and an optimum sample, produced according to optimum production levels, was determined. In order to further improve the sound absorption and abrasion resistance performance, as a first approach, a low denier nonwoven top layer was combined with the optimum sample. As a second method, samples were back coated with a styrene butadiene resin and the changes in sound absorption were analyzed. The effect of production parameters on sound absorption and abrasion resistance was analyzed using a Minitab statistical software. As a result, fiber blend ratio, penetration depth, and areal density significantly affected sound absorption and abrasion resistance performance of nonwoven samples. On the other hand, punch density was found to be statistically insignificant over sound absorption and abrasion resistance. The optimum sample reached to a sound absorption coefficient value of 0.273 at 2000 Hz, and showed a fiber loss percentage of 1.55% and was found to be a suitable facing material for automotive carpet applications.
Brain tissue strain and balance impairments in children following a concussion: An exploratory study
Authors: Rochefort Coralie , Cournoyer Janie , Post Andrew , Hoshizaki T Blaine , Zemek Roger , Sveistrup Heidi 
Published: November 2019

Background Balance impairments present in approximately 30% of concussion cases. Biomechanical reconstructions model the degree and location of brain tissue strain associated with injury. The objective was to examine the relationship between the magnitude and location of brain tissue strain and balance impairment following a concussion. Methods Children one month post-concussion (n = 33) and non-injured children (n = 33) completed two balance conditions while standing on a Wii Balance Board that recorded the centre of pressure during (i) double-leg stance with eyes closed (EC) and (ii) dual-task (DT) combining double-leg stance while completing a cognitive task. Injury reconstructions were performed for 10 of the concussed participants. A 5th percentile Hybrid III headform was used to obtain linear and rotational acceleration time-curves of the head impact. These data were input in the University College Dublin Brain Trauma Model (UCDBTM) to calculate maximum principal strains and cumulative strain damage values at 10% (CSDM-10) and 20% (CSDM-20) for different brain regions. Correlations between balance and reconstruction variables were calculated. Results Out of the 10 reconstructed cases, six participants had impaired balance on the EC condition, six had impaired balance on the DT condition and four had impaired balance on both the EC and DT conditions. For maximum principal strain values, correlations with balance variables ranged from −0.0190 to 0.394 for the DT condition and from −0.225 and 0.152 for the EC condition. For CSDM-10 values, correlations with balance variables ranged from 0.280 to 0.386 for the DT condition and from −0.103 to 0.252 for the EC condition. For CSDM-20 values, correlations with balance variables ranged from 0.0629 to 0.289 for the DT condition and from −0.353 to −0.155 for the EC condition. Conclusions Although a subset of the concussed participants continued to show balance impairments, no association was established between the presence of balance impairment and the magnitude and/or location of brain tissue strain. Maintaining balance is a complex process integrated into multiple subcortical regions, white matter tracts and cranial nerves, which were not represented in the brain model, and as a result the UCDBTM may not be sensitive to damage in these areas.
Decision-Making Process of International Undergraduate Students: An Exploratory Narrative Inquiry into Reflections of Chinese Students in Canada
Authors: Wu Hantian 
Published: November 2019

Purpose: This research is an exploratory narrative inquiry into reflections of three Chinese international undergraduate students in a Canadian university, University S, which reveals participants’ entire decision-making processes as potential international undergraduate students. Design/Approach/Methods: A two-dimensional analytical framework has been constructed. One dimension is based on three phases of the entire decision-making process: the phases of deciding whether or not to study abroad, selecting destination countries, and choosing target institutions. The second dimension is based on three kinds of hypothetically proposed environmental factors within each phase: policy factors, (family and regional) socioeconomic factors, and information factors. First-hand data were collected through semi-structured interviews conducted based on the analytical framework. Findings: This article suggests that both policymakers in the source country (i.e., China) and university administrators in the destination country (i.e., Canada) should further support potential international undergraduate students during each phase of their decision-making processes, particularly through optimizing information supply channels. Originality/Value: This article has the potential to construct a new theoretical framework as a supplement for analyzing the entire decision-making process of potential international students. As a pilot study, it provides a template for further investigations.
Suture Versus Screw Fixation of Tibial Spine Fractures in Children and Adolescents: A Comparative Study
Authors: Callanan Mark , Allen Judd , Flutie Brett , Tepolt Francis , Miller Patricia E. , Kramer Dennis , Kocher Mininder S. 
Published: November 2019

Background: Tibial spine fractures involve an avulsion injury of the anterior cruciate ligament (ACL) at the intercondylar eminence, typically in children and adolescents. Displaced fractures are commonly treated with either suture or screw fixation. Purpose: To investigate differences in various outcomes between patients treated with arthroscopic suture versus screw fixation for tibial spine avulsion fractures in one of the largest patient cohorts in the literature. Study Design: Cohort study; Level of evidence, 3. Methods: A search of medical records was performed with the goal of identifying all type 2 and type 3 tibial spine avulsion fractures surgically treated between 2000 and 2014 at a pediatric hospital. All patients had a minimum of 12 months clinical follow-up, suture or screw fixation only, and no major concomitant injury. Results: There were 68 knees in 67 patients meeting criteria for analysis. There were no differences with regard to postsurgical arthrofibrosis ( P = .59), ACL reconstruction ( P = .44), meniscal procedures ( P = .85), instability ( P = .49), range of motion ( P = .51), return to sport ( P >.999), or time to return to sport ( P = .11). Elevation of the repaired fragment on postoperative imaging was significantly greater in the suture group (5.4 vs 3.5 mm; P = .005). Postoperative fragment elevation did not influence surgical outcomes. The screw fixation group had more reoperations (13 vs 23; P = .03), a larger number of reoperations for implant removal (3 vs 22; P < .001), and nearly 3 times the odds of undergoing reoperation compared with suture patients (odds ratio, 2.9; P = .03). Conclusion: Clinical outcomes between suture and screw fixation were largely equivalent in our patients. Postoperative fragment elevation does not influence surgical outcomes. Consideration should be given for the greater likelihood of needing a second operation, planned or unplanned, after screw fixation.