bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome analysis in 270 radiologically guided implantations of totally implantable venous access ports via basilic vein
Authors: Kao Chia-Yu , Fu Chien-Hua , Cheng Yun-Chung , Chen Jian-Ling , Cheng Yu-Chi , Chen Clayton Chi-Chang , Chai Jyh-Wen 
Published: January 2020

Background:
Totally implantable venous access ports (TIVAPs) are widely applied in patients who require chemotherapy, parenteral nutrition, or frequent intravenous drug infusion. Although various venous access routes are possible for TIVAP insertion, the best method remains a topic of controversy. We present a single-center retrospective study of radiologically guided placement of TIVAPs through the basilic vein, with analysis of technical feasibility, patient safety, and device-related complications.

Methods:
We retrospectively reviewed 270 patients who received TIVAP implantation through the basilic vein from November 2013 to July 2016, under imaging guidance by an interventional radiology team at our institution. Fluoroscopic images, chest radiographs, computed tomography scans, and medical records were reviewed after port implantation. Catheter maintenance days were calculated and catheter-related complications were recorded.

Results:
The procedural success rate was 99.3%. In total, 270 TIVAPs were implanted in 270 patients, of which 150 remained functional at the end of the study period. The total catheter maintenance days was 77 543 days, and the mean catheter indwelling duration was 287 ± 207 days. In 20 (7.4%) patients, TIVAP-related complications occurred during the follow-up period, resulting in a postprocedural complication rate of 0.26 incidences per 1000 catheter days. No significant relationship was observed between complications and gender (p = 0.188), age (p = 0.528), body mass index (p = 0.547), the type of primary malignancy (p = 0.914), or between the left and right basilic veins (p = 0.319).

Conclusion:
Real-time ultrasound and fluoroscopic guidance provides a safe method for TIVAP implantation through the basilic vein, with a high technical success rate and few device-related complications.
The cumulative false-positive rate in colorectal cancer screening: a Markov analysis
Authors: Haug Ulrike , Coupé Veerle M.H. 
Published: January 2020

Background:
Faecal occult blood testing is widely used in colorectal cancer screening. However, there is little empirical long-term evidence on the accumulation of false-positive test results over several screening rounds. We aimed to systematically explore and quantify the cumulative false-positive rate for various scenarios of colorectal cancer screening.

Methods:
Using a Markov analysis, we estimated the lifetime cumulative number of false-positive test results (cumFP) per 100 000 50-year-old persons. We varied the screening interval and the specificity of a single screening test and the starting age of screening.

Results:
For a test with a specificity of 98% used from 50 to 74 years, the cumFP at age 74 was 26 260 (1-year interval), 15 102 (2-year interval), and 10 819 (3-year interval), respectively. For a test with a specificity of, respectively, 95 and 92% used at a 2-year interval, the cumFP at age 74 was 2.2 times and 3.0 times higher as compared to a test with a specificity of 98%. The cumFP at age 74 was 18% lower for screening persons aged 54–74 years vs. 50–74 years.

Conclusion:
Our findings quantitatively illustrate the large variation of the cumFP in colorectal cancer screening between screening strategies, which is relevant to informed decision making and adequate resource planning.
Rapid Postnatal Upregulation of Intestinal Farnesoid X Receptor‐Fibroblast Growth Factor 19 Signaling in Premature Pigs
Authors: Smith Victoria , Jiang Yanjun , Thymann Thomas , Sangild Per , Maj Magdalena , Manjarin Rodrigo , Burrin Douglas 
Published: January 2020

ABSTRACTObjectives:Bile acid (BA) homeostasis is regulated by intestinal cellular signaling involving the farnesoid X receptor (FXR) and fibroblast growth factor 19 (FGF19) secretion. Using preterm and term pigs as a model, we examined postnatal changes in expression of the FXR‐FGF19 axis that is poorly characterized in human infants.Methods:Pigs delivered by caesarean section at 10‐day preterm and near full term (115‐day gestation) were fitted with orogastric and umbilical arterial catheters. Pigs were fed combined parenteral nutrition and minimal enteral nutrition for 5 days, followed by milk formula until 26 d days. Plasma and tissue samples were collected at days 0, 5, 11, and 26. Plasma FGF19 concentration and liver and distal intestinal gene expression of FGF19 and other FXR target genes were quantified.Results:Plasma FGF19 levels were lower in preterm versus term newborn pigs (P < 0.05), increased markedly by 5 days, especially in preterm pigs, and decreased in both groups until day 26. Likewise, intestinal FXR and FGF19 expression was lower (P ≤ 0.05) in premature versus term newborn pigs and decreased (P ≤ 0.05) between days 5 and 26. Hepatic expression of cholesterol 7α‐hydroxylase (CYP7A1) was inversely correlated with plasma FGF19 in both groups.Conclusions:We conclude that the activity of FXR‐FGF19 axis is lower in preterm than in term newborn pigs but increases transiently and then declines by the first month of age. We also provide supportive evidence of negative feedback between plasma FGF19 and hepatic CYP7A1 expression.
Comparison of Detection Methods for Tracheoesophageal Fistulae With a Novel Method
Authors: Yasuda Jessica L. , Staffa Steven J. , Ngo Peter D. , Clark Susannah J. , Jennings Russell W. , Manfredi Michael A. 
Published: January 2020

ABSTRACTBackground:Tracheoesophageal fistulae (TEF) are difficult to detect and require a high index of suspicion. We hypothesized that capnography to identify a spike in end‐tidal carbon dioxide (etCO2) during esophagoscopy with carbon dioxide (CO2) insufflation would facilitate TEF diagnosis because of gas passage from the esophagus to the trachea.Methods:Medical records of 42 consecutive cases of recurrent, acquired, or missed congenital TEF diagnosed between January 2015 and November 2019 that underwent esophagoscopy with CO2 insufflation were reviewed. A control cohort of 97 similarly endoscopically evaluated patients with surgical confirmation of absence of recurrent TEF (eg, patients undergoing posterior tracheopexy) was also collected. All patients underwent pre‐operative esophagoscopy, bronchoscopy, and capnography; diagnostic abilities of various combinations of modalities for TEF identification were calculated.Results:Statistical analysis identified a maximum intra‐esophagoscopy end‐tidal CO2 level of 68 mmHg as the optimal discriminator between cases and controls, though in practice, we anecdotally find that recurrent TEFs typically permit rapid rise ≥90 mmHg. Increasing numbers of diagnostic modalities increased diagnostic sensitivity to detect recurrent TEF; the highest diagnostic sensitivity for TEF identification was achieved by the combination of intra‐esophagoscopy fluoroscopy with bronchoscopy and capnography ≥68 mmHg (sensitivity = 88.1%). There were multiple cases of TEF (N = 7 for etCO2 ≥68 mmHg, N = 3 for etCO2 ≥90 mmHg) identified by capnography that were missed by esophagoscopy. There were 5 (for etCO2 ≥68 mmHg) or 6 (for etCO2 ≥90 mmHg) cases of recurrent TEF that were missed by all nonsurgical methods.Conclusion:Attention to etCO2 during esophagoscopy with CO2 insufflation represents a simple, novel way to detect TEF. Identification of TEF remains challenging, though combinations of diagnostic modalities improve diagnostic sensitivity.
Evaluation of the clinical effect of pharmacist intervention
Authors: Farrag Dina K. , Sabri Nagwa A. , Tawfik Amr S. , Shaheen Sara M. 
Published: January 2020

Abstract

Introduction:
Breast cancer is one of the most common cancers among Egyptian women. Health-related quality of life (QOL) and reduction of side-effects play an important role for the treatment of cancer patients. The purpose of this prospective study was to determine if pharmacist's intervention could improve clinical outcomes of patient with breast cancer.

Patients and methods:
This study was a single-center interventional prospective study carried out on a group of 60 breast cancer patients at Clinical Oncology Department, Ain Shams University Hospitals from June 2017 to May 2018 patients were subjected to a thorough history taking, assessment of treatment-related adverse events before each cycle and at the end of the treatment. In addition, assessment of QOL was done at the baseline and at the end of treatment to evaluate the effect of the pharmacist's interventions.

Results:
The present study has shown that the clinical pharmacist interventions were associated with significant decrease of toxicity grades of patients, for example, anemia where the percentage of patients of grade 2 decreased from 17% to 1.7%; moreover, 5% of patients had grade 4 nausea/vomiting, while after pharmacist intervention, it became 0%. Regarding patients’ QOL, results of the present study showed improvement of mean ± standard deviation of most of the QOL scales such as systematic therapy side-effects decreased from 80.8 ± 19.53 to 42.8 ± 16.8, all with P < 0.001.

Conclusions:
Most treatments for breast cancer despite beneficial result in toxicities, primarily anemia, neutropenia, nausea, and pain. These side-effects adversely impact patient QOL and can lead to treatment discontinuation. Clinical pharmacist intervention resulted in beneficial clinical outcomes in patients with breast cancer such as the reduction of treatment-related side-effects and the improvement of patients’ QOL.
Optimizing aerosol delivery of antibiotics in ventilated patients
Authors: Ehrmann Stephan , Luyt Charles-Edouard 
Published: January 2020

Purpose of review
The aim of the article is to review the evidence to select ventilated patients most likely to benefit from inhaled antibiotic therapy and summarize the optimal implementation setup to favor clinical success.

Recent findings
Although a large body of literature describes the optimal ventilator circuit and settings to implement to favor a high amount of inhaled antibiotic delivery to ventilated patients, recent clinical trials failed to show a significant benefit on patient-centered outcomes. Currently, inhaled antibiotic therapy can only be recommended as a therapeutic modality of last resort after case-by-case discussion among specific patients or settings with high antimicrobial resistances.

Summary
Currently, inhaled antibiotic therapy may only be recommended to treat ventilator-associated pneumonia caused by extensively resistant bacteria only susceptible to colistin, and should be used either after documentation of such an infection or empirically in settings with a high probability of such an infection. A similar approach may be considered for aminoglycoside-only-susceptible pneumonia. In these cases, inhaled antibiotics should be ideally delivered as a complement to intravenous therapy placing a vibrating mesh nebulizer upstream in the inspiratory limb, reducing inspiratory flow and increasing inspiratory time, avoiding gas humidification under close clinical and pharmacological monitoring.
Effect of Vaginal Lactobacillus Species on Escherichia coli Growth
Authors: Hudson Patricia L. , Hung Kristin J. , Bergerat Agnes , Mitchell Caroline 
Published: January 2020

Objectives

Lactobacillus probiotics have been proposed as an antibiotic-sparing prevention strategy for urinary tract infections (UTIs). Our objective was to examine the relative ability of the 4 most common vaginal Lactobacillus species to inhibit the growth of Escherichia coli, the most common cause of UTIs.

Methods
Conditioned media (CM) was created from 4 laboratory strains of Lactobacillus species: Lactobacillus crispatus, Lactobacillus jensenii, Lactobacillus gasseri, and Lactobacillus iners, and 6 clinical strains of L. crispatus. One laboratory strain of E. coli was cocultured with each CM, as well as with various acidic solutions. Three clinical strains of E. coli from women with acute cystitis were cocultured with the CM from a laboratory strain of L. crispatus. Bacterial growth was compared between experimental variants and media control using analysis of variance.

Results
Growth of E. coli was inhibited by CM from L. crispatus, L. jensenii, and L. gasseri, but not L. iners. The magnitude of inhibition was correlated with the pH of the individual CM and the concentration of d-lactic acid. Different acids inhibited E. coli growth in proportion to the pH of the acid solution. Similar levels of inhibition were seen when L. crispatus was incubated with clinical E. coli strains as with laboratory E. coli.

Conclusions
Three of the most common vaginal Lactobacillus species inhibit E. coli growth, likely through creating a low pH environment. However, L. iners, one of the most common species found after menopause, does not. These findings might be leveraged to more effectively manage UTIs.
Surgical Management of Pelvic Organ Prolapse in Ethiopian Women: What Is the Preferred Approach?
Authors: Kenne Kimberly , Abreha Melaku , Hart Kyle D. , Gregory W. Thomas , Nardos Rahel 
Published: January 2020

Objectives
The aim of this study was to determine the most effective approach to surgical repair of pelvic organ prolapse for Ethiopian women and to characterize this population.

Methods
This is a prospective cohort study of women presenting for prolapse repair. Demographics and assessments of prolapse were obtained preoperatively. Information surrounding the surgical encounter was collected. The same anatomic and symptomatic measures were ascertained postoperatively. Information regarding surgical complications was collected.

Results
Two hundred thirty-three women with stage III or IV prolapse underwent surgical prolapse repair between March 2015 and November 2017. Seventy-eight of these women participated with a median length of follow-up of 255 days. All of the sacrocolpopexy patients (n = 21) and 56 of 57 vaginal repair patients had follow-up anatomic data. Anatomic failure as defined by Pelvic Organ Prolapse–Quantification (Ba, C, or Bp > 0) occurred in 0% (0/21) of sacrocolpopexy patients and 34% (19/56) of vaginal repair patients (P = 0.005). Symptomatic failure, as defined by self-reported recurrence of vaginal bulge, occurred in 0% (0/21) of sacrocolpopexy patients and 23% (13/56) of vaginal repair patients (P = 0.015). A global assessment of improvement (worse, same, or improved) revealed that 100% (21/21) of sacrocolpopexy patients reported improvement, whereas 91% (50/55) of vaginal repair patients reported improvement, 7% (4/55) reported being the same, and 2% (1/55) reported being worse. There were 2 intraoperative complications and 3 postoperative complications. There were no cases of mesh erosion.

Conclusions
Although both vaginal and abdominal routes of prolapse surgery seem to be safe, an abdominal approach with mesh augmentation may be the preferred surgical repair in Ethiopian women.
Competency by Design for Electroconvulsive Therapy in Psychiatry Postgraduate Training
Authors: Al-Qadhi Samim A. , Chawla Taran , Seabrook Jamie A. , Campbell Craig , Burhan Amer M. 
Published: January 2020

Introduction
Psychiatry is in the process of shifting curricula in postgraduate training to a competency-by-design approach. One core aspect of postgraduate psychiatry training is the knowledge and practice of electroconvulsive therapy (ECT). The aim of this study was to develop and validate the corresponding set of competencies that need to be developed during postgraduate training in psychiatry.

Methods
This study involves the proposal of a set of competencies by an ECT curriculum committee from the University Department of Psychiatry, based on the competency-by-design principles, followed by a modified Delphi process, to reach expert consensus on the proposed, modified, and added competencies.

Results
Six ECT experts meeting the preset criteria were recruited to the study from 6 academic centers across Canada and participated in the 2 Delphi rounds. Thirty-one competencies were proposed in the first round. Twenty-three proceeded to the second round by meeting 80% agreement on a score of ≥4 using a 5-point Likert scale. Three competencies required rewording based on qualitative feedback; accordingly, 10 new competencies were suggested. Thirty-five competencies were rated by experts and reached the threshold of agreement and rating. Cronbach α increased from 0.89 after the first round to 0.95 after the second iteration.

Discussion
Consensus was generated on 35 competencies that need to be achieved during postgraduate training in psychiatry. These competencies can serve as the basis for developing ECT curricula in postgraduate psychiatry training. The method used is feasible and can be adopted for the development of other competencies and curricula in psychiatry and other medical fields.
Incubation Period and Other Epidemiological Characteristics of 2019 Novel Coronavirus Infections with Right Truncation: A Statistical Analysis of Publicly Available Case Data
Authors: Linton Natalie M. , Kobayashi Tetsuro , Yang Yichi , Hayashi Katsuma , Akhmetzhanov Andrei R. , Jung Sung-mok , Yuan Baoyin , Kinoshita Ryo , Nishiura Hiroshi 
Published: January 2020

AbstractThe geographic spread of 2019 novel coronavirus (COVID-19) infections from the epicenter of Wuhan, China, has provided an opportunity to study the natural history of the recently emerged virus. Using publicly available event-date data from the ongoing epidemic, the present study investigated the incubation period and other time intervals that govern the epidemiological dynamics of COVID-19 infections. Our results show that the incubation period falls within the range of 2–14 days with 95% confidence and has a mean of around 5 days when approximated using the best-fit lognormal distribution. The mean time from illness onset to hospital admission (for treatment and/or isolation) was estimated at 3–4 days without truncation and at 5–9 days when right truncated. Based on the 95th percentile estimate of the incubation period, we recommend that the length of quarantine should be at least 14 days. The median time delay of 13 days from illness onset to death (17 days with right truncation) should be considered when estimating the COVID-19 case fatality risk.
Altered thalamocortical structural connectivity in persons with schizophrenia and healthy siblings
Authors: Yao Beier , Neggers Sebastiaan F. W. , Kahn René S. , Thakkar Katharine N. 
Published: January 2020

AbstractSchizophrenia has long been framed as a disorder of altered brain connectivity, with dysfunction in thalamocortical circuity potentially playing a key role in the development of the illness phenotype, including psychotic symptomatology and cognitive impairments. There is emerging evidence for functional and structural hypoconnectivity between thalamus and prefrontal cortex in persons with schizophrenia spectrum disorders, as well as hyperconnectivity between thalamus and sensory and motor cortices. However, it is unclear whether thalamocortical dysconnectivity is a general marker of vulnerability to schizophrenia or a specific mechanism of schizophrenia pathophysiology. This study aimed to answer this question by using diffusion-weighted imaging to examine thalamocortical structural connectivity in 22 persons with schizophrenia or schizoaffective disorder (SZ), 20 siblings of individuals with a schizophrenia spectrum disorder (SIB), and 44 healthy controls (HC) of either sex. Probabilistic tractography was used to quantify structural connectivity between thalamus and six cortical regions of interest. Thalamocortical structural connectivity was compared among the three groups using cross-thalamic and voxel-wise approaches. Thalamo-prefrontal structural connectivity was reduced in both SZ and SIB relative to HC, while SZ and SIB did not differ from each other. Thalamo-motor structural connectivity was increased in SZ relative to SIB and HC, while SIB and HC did not differ from each other. Hemispheric differences also emerged in thalamic connectivity with motor, posterior parietal, and temporal cortices across all groups. The results support the hypothesis that altered thalamo-prefrontal structural connectivity is a general marker of vulnerability to schizophrenia, whereas altered connectivity between thalamus and motor cortex is related to illness expression or illness-related secondary factors.
Implementation of data access and use procedures in clinical data warehouses. A systematic review of literature and publicly available policies
Authors: Pavlenko Elena , Strech Daniel , Langhof Holger 
Published: January 2020

AbstractBackgroundThe promises of improved health care and health research through data-intensive applications rely on a growing amount of health data. At the core of large-scale data integration efforts, clinical data warehouses (CDW) are also responsible of data governance, managing data access and (re)use. As the complexity of the data flow increases, greater transparency and standardization of criteria and procedures is required in order to maintain objective oversight and control. This study assessed the spectrum of data access and use criteria and procedures in clinical data warehouses governance internationally.MethodsWe performed a systematic review of (a) the published scientific literature on CDW and (b) publicly available information on CDW data access, e.g., data access policies. A qualitative thematic analysis was applied to all included literature and policies.ResultsTwenty-three scientific publications and one policy document were included in the final analysis. The qualitative analysis led to a final set of three main thematic categories: (1) requirements, including recipient requirements, reuse requirements, and formal requirements; (2) structures and processes, including review bodies and review values; and (3) access, including access limitations.ConclusionsThe description of data access and use governance in the scientific literature is characterized by a high level of heterogeneity and ambiguity. In practice, this might limit the effective data sharing needed to fulfil the high expectations of data-intensive approaches in medical research and health care. The lack of publicly available information on access policies conflicts with ethical requirements linked to principles of transparency and accountability.CDW should publicly disclose by whom and under which conditions data can be accessed, and provide designated governance structures and policies to increase transparency on data access. The results of this review may contribute to the development of practice-oriented minimal standards for the governance of data access, which could also result in a stronger harmonization, efficiency, and effectiveness of CDW.