bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fondazione Italiana Linfomi (FIL) expert consensus on the use of intensity-modulated and image-guided radiotherapy for Hodgkin’s lymphoma involving the mediastinum
Authors:   on behalf of the Fondazione Italiana Linfomi (FIL) Radiotherapy Committee, Filippi Andrea Riccardo , Meregalli Sofia , DI Russo Anna , Levis Mario , Ciammella Patrizia , Buglione Michela , Guerini Andrea Emanuele , De Marco Giuseppina , De Sanctis Vitaliana , Vagge Stefano , Ricardi Umberto , Simontacchi Gabriele 
Published: March 2020

Abstract
Aim
Advances in therapy have resulted in improved cure rates and an increasing number of long-term Hodgkin's lymphoma (HL) survivors. However, radiotherapy (RT)-related late effects are still a significant issue, particularly for younger patients with mediastinal disease (secondary cancers, heart diseases). In many Centers, technological evolution has substantially changed RT planning and delivery. This consensus document aims to analyze the current knowledge of Intensity-Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT) for mediastinal HL and formulate practical recommendations based on scientific evidence and expert opinions.

Methods
A dedicated working group was set up within the Fondazione Italiana Linfomi (FIL) Radiotherapy Committee in May 2018. After a first meeting, the group adopted a dedicated platform to share retrieved articles and other material. Two group coordinators redacted a first document draft, that was further discussed and finalized in two subsequent meetings. Topics of interest were: 1) Published data comparing 3D-conformal radiotherapy (3D-CRT) and IMRT 2) dose objectives for the organs at risk 3) IGRT protocols and motion management.

Results
Data review showed that IMRT might allow for an essential reduction in the high-dose regions for all different thoracic OAR. As very few studies included specific dose constraints for lungs and breasts, the low-dose component for these OAR resulted slightly higher with IMRT vs. 3D-CRT, depending on the technique used. We propose a set of dose objectives for the heart, breasts, lungs, and thyroid. The use of IGRT is advised for margin reduction without specific indications, such as the use of breath-holding techniques. An individual approach, including comparative planning and considering different risk factors for late morbidity, is recommended for each patient.

Conclusions
As HL therapy continues to evolve, with an emphasis on treatment reduction, radiation oncologists should use at best all the available tools to minimize the dose to organs at risk and optimize treatment plans. This document provides indications on the use of IMRT/IGRT based on expert consensus, providing a basis for clinical implementation and future development.
Clinical validation of a graphical method for radiation therapy plan quality assessment
Authors: Ventura Tiago , Dias Joana , Khouri Leila , Netto Eduardo , Soares André , da Costa Ferreira Brigida , Rocha Humberto , Lopes Maria do Carmo 
Published: March 2020

Abstract
Background
This work aims at clinically validating a graphical tool developed for treatment plan assessment, named SPIDERplan, by comparing the plan choices based on its scoring with the radiation oncologists (RO) clinical preferences.

Methods
SPIDERplan validation was performed for nasopharynx pathology in two steps. In the first step, three ROs from three Portuguese radiotherapy departments were asked to blindly evaluate and rank the dose distributions of twenty pairs of treatment plans. For plan ranking, the best plan from each pair was selected. For plan evaluation, the qualitative classification of ‘Good’, ‘Admissible with minor deviations’ and ‘Not Admissible’ were assigned to each plan. In the second step, SPIDERplan was applied to the same twenty patient cases. The tool was configured for two sets of structures groups: the local clinical set and the groups of structures suggested in international guidelines for nasopharynx cancer. Group weights, quantifying the importance of each group and incorporated in SPIDERplan, were defined according to RO clinical preferences and determined automatically by applying a mixed linear programming model for implicit elicitation of preferences. Intra- and inter-rater ROs plan selection and evaluation were assessed using Brennan-Prediger kappa coefficient.

Results
Two-thirds of the plans were qualitatively evaluated by the ROs as ‘Good’. Concerning intra- and inter-rater variabilities of plan selection, fair agreements were obtained for most of the ROs. For plan evaluation, substantial agreements were verified in most cases. The choice of the best plan made by SPIDERplan was identical for all sets of groups and, in most cases, agreed with RO plan selection. Differences between RO choice and SPIDERplan analysis only occurred in cases for which the score differences between the plans was very low. A score difference threshold of 0.005 was defined as the value below which two plans are considered of equivalent quality.

Conclusion
Generally, SPIDERplan response successfully reproduced the ROs plan selection. SPIDERplan assessment performance can represent clinical preferences based either on manual or automatic group weight assignment. For nasopharynx cases, SPIDERplan was robust in terms of the definitions of structure groups, being able to support different configurations without losing accuracy.
A population-based propensity-matched study of regional dissections in patients with metastatic osteosarcoma
Authors: Wang Wenjuan , Ding Hongzhi , Sun Zhenyu , Jin Chen , Zhu Yanhui , Wang Xiang 
Published: March 2020

Abstract
Background
The survival rates of patients with metastatic osteosarcoma are poor, and the prognosis is closely related to the choice of treatment, especially surgery. This study aimed to evaluate the survival outcomes of patients with metastatic osteosarcoma undergoing regional dissections.

Methods
We collected data on patients with metastatic osteosarcoma between 2004 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan–Meier curves were used to compare overall survival (OS) and cancer-specific survival (CSS), while univariate and multivariate Cox regression analyses were used to evaluate outcomes. Propensity score matching (PSM) was used to minimize the effects of confounding factors.

Results
The SEER database had records of 2768 patients diagnosed with osteosarcoma, of whom 398 were included in our study. Of the included patients, 116 (29.15%) underwent regional dissections, while 282 (70.85%) underwent non-regional dissections. The univariate and multivariate Cox regression analyses, prior to PSM, showed that OS (hazard ratio (HR): 0.34, 95% confidence interval (CI): 0.26–0.44, P<0.001 and HR: 0.47, 95% CI: 0.35–0.64, P<0.001, respectively) and CSS (HR: 0.33, 95% CI: 0.25–0.43, P<0.001 and HR: 0.46, 95% CI: 0.34–0.63, P<0.001, respectively) were better in patients who underwent regional dissections than those who underwent non-regional dissections. Compared with non-regional dissections, regional dissections, which included both primary tumour resection (PTR) and primary tumour and metastatic site resection (PTMR), were associated with better OS (P<0.001) and CSS (P<0.001) . However, the survival outcomes following PTR and PTMR showed no significant difference. After PSM, patients in the regional dissection group still had a higher OS (P<0.001) and CSS (P<0.001) than those in the non-regional dissection group.

Conclusions
Compared with non-regional dissection, regional dissection resulted in better survival in patients with metastatic osteosarcoma.
A comparison of respiratory function in pigs anaesthetised by propofol or alfaxalone in combination with dexmedetomidine and ketamine
Authors: Lervik Andreas , Toverud Simen Forr , Krontveit Randi , Haga Henning Andreas 
Published: March 2020

Abstract
Background
General anaesthesia in pigs maintained with intravenous drugs such as propofol may cause respiratory depression. Alfaxalone gives less respiratory depression than propofol in some species. The aim of the investigation was to compare respiratory effects of propofol–ketamine–dexmedetomidine and alfaxalone–ketamine–dexmedetomidine in pigs. Sixteen pigs premedicated with ketamine 15 mg/kg and midazolam 1 mg/kg intramuscularly were anaesthetised with propofol or alfaxalone to allow endotracheal intubation, followed by propofol 8 mg/kg/h or alfaxalone 5 mg/kg/h in combination with ketamine 5 mg/kg/h and dexmedetomidine 4 µg/kg/h given as a continuous infusion for 60 min. The pigs breathed spontaneously with an FIO2 of 0.21. Oxygen saturation (SpO2), end-tidal CO2 concentration (PE′CO2), respiratory rate (fR) and inspired tidal volume (VT) were measured, and statistically compared between treatments. If the SpO2 dropped below 80% or if PE′CO2 increased above 10.0 kPa, the pigs were recorded as failing to complete the study, and time to failure was statistically compared between treatments.

Results
Alfaxalone treated pigs had significantly higher respiratory rates and lower PE′CO2 than propofol treated pigs, with a fR being 7.3 /min higher (P = 0.01) and PE′CO2 0.8 kPa lower (P = 0.05). SpO2 decreased by 0.6% and fR by 1.0 /min per kg increase in body weight in both treatment groups. Three of eight propofol treated and two of eight alfaxalone treated pigs failed to complete the study, and times to failure were not significantly different between treatments (P = 0.75).

Conclusions
No major differences in respiratory variables were found when comparing treatments. Respiratory supportive measures must be available when using both protocols.
An ethnographic study of the implementation of a transitional discharge model: peer supporters’ perspectives
Authors: Forchuk Cheryl , Martin Mary-Lou , Sherman Deborrah , Corring Deborah , Srivastava Rani , O’Regan Tony , Gyamfi Sebastian , Harerimana Boniface 
Published: March 2020

Abstract
Background
Over the last three decades, there has been worldwide recognition of peer support contributions to improve mental healthcare provision. However, in the current literature, little attention has been paid to exploring perspectives of peer supporters on their involvement in mental health services provision. The purpose of the present study was to examine peer supporters’ perspectives on the implementation of a transitional discharge model (TDM), an intervention for the community integration of people with mental illness.

Methods
This paper represents ethnographic qualitative data collected as part of a study that used mixed methods to evaluate the implementation of TDM across nine hospitals from the Province of Ontario, in Canada. The study involved a sample of 66 peer supporters, who were recruited from participating Consumer/Survivor Initiative Organizations and Peer Support Programs. The study collected data using two sets of focus groups, which were held at 6 months and 1-year post implementation. Data analysis used an ethnography model of qualitative analysis.

Results
Peer supporters expressed that their involvement in mental healthcare enhanced clients’ autonomy and hope about their recovery, as well as established a safety net and reduced hospital readmissions. Peer supporters articulated that they assumed several roles to facilitate clients’ transition from hospital to the community. These roles included: assisting clients in building their capacity and developing healthy routines; attending regular on-ward and community meetings; accompanying clients to their appointments; and working with clients to set goals for their recovery. The study showed hindrances to effective implementation of peer support programs, such as a lack of understanding and appreciation of peer supporter roles, lack of careful allocation of peer supporters to clients, and an absence of appropriate protocols for ensuring the safety and supervision of the peer supporters.

Conclusions
Results of the TDM implementation demonstrated that involving peer supporters in mental healthcare delivery may benefit clients by enhancing autonomy and hope about their recovery, as well as establishing a safety net and reducing hospital readmissions. Results from the study have the potential to inform healthcare professionals and managers of strategies for developing effective peer support programs.
Role of ICU-acquired weakness on extubation outcome among patients at high risk of reintubation
Authors: Thille Arnaud W. , Boissier Florence , Muller Michel , Levrat Albrice , Bourdin Gaël , Rosselli Sylvène , Frat Jean-Pierre , Coudroy Rémi , Vivier Emmanuel 
Published: March 2020

Abstract
Background
Whereas ICU-acquired weakness may delay extubation in mechanically ventilated patients, its influence on extubation failure is poorly known. This study aimed at assessing the role of ICU-acquired weakness on extubation failure and the relation between limb weakness and cough strength.

Methods
A secondary analysis of two previous prospective studies including patients at high risk of reintubation after a planned extubation, i.e., age greater than 65 years, with underlying cardiac or respiratory disease, or intubated for more than 7 days prior to extubation. Patients intubated less than 24 h and those with a do-not-reintubate order were not included. Limb and cough strength were assessed by a physiotherapist just before extubation. ICU-acquired weakness was clinically diagnosed as limb weakness defined as Medical Research Council (MRC) score < 48 points and severe weakness as MRC sum-score < 36. Cough strength was assessed using a semi-quantitative 5-Likert scale. Extubation failure was defined as reintubation or death within the first 7 days following extubation.

Results
Among 344 patients at high risk of reintubation, 16% experienced extubation failure (56/344). They had greater severity and lower MRC sum-score (41 ± 16 vs. 49 ± 13, p < 0.001) and were more likely to have ineffective cough than the others. The prevalence of ICU-acquired weakness at the time of extubation was 38% (130/244). The extubation failure rate was 12% (25/214) in patients with no limb weakness vs. 18% (12/65) and 29% (19/65) in those with moderate and severe limb weakness, respectively (p < 0.01). MRC sum-score and cough strength were weakly but significantly correlated (rho = 0.28, p < .001). After multivariate logistic regression analyses, the lower the MRC sum-score the greater the risk of reintubation; severe limb weakness was independently associated with extubation failure, even after adjustment on cough strength and severity at admission.

Conclusion
ICU-acquired weakness was diagnosed in 38% in this population of patients at high risk at the time of extubation and was independently associated with extubation failure in the ICU.
Effectiveness of LiuZiJue Qigong versus traditional core stability training for poststroke patients complicated with abnormal trunk postural control: study protocol for a single-center randomized controlled trial
Authors: Wang Chen , Yu Long , Yang Jian , Wang Ren Wei , Zheng Ya Nan , Zhang Ying 
Published: March 2020

Abstract
Background
Trunk function in stroke patients with hemiplegia is associated with respiration and core stability and is also found to be associated with balance and postural control and activities of daily living. LiuZiJue Qigong (LQG) is a traditional Chinese method of fitness based on breath pronunciation. The purpose of this study is to compare the clinical efficacy of LQG and traditional core stability training in the treatment of stroke patients with abnormal trunk posture. This protocol is written according to the SPIRIT 2013 statement.

Methods/design
This study is a single-center randomized controlled trial in which 160 stroke patients are randomly divided into a study group and a control group. Patients in the study group will receive LQG combined with conventional rehabilitation therapy, and patients in the control group will receive traditional core stability training combined with conventional rehabilitation therapy. All treatments will be done for 45 min/day, five times per week, for 2 weeks. The primary outcome (Trunk Impairment Scale) and secondary outcomes (Berg Balance Scale, Fugl-Meyer Assessment, Modified Barthel Index, Maximum Phonation Time, Dynamic and Static balance testing, and thickness and the mobile degrees of diaphragm) will be measured at baseline, 2 weeks, and the end of the rehabilitation course.

Discussion
The aim purpose of this research study is to compare the clinical efficacy of LQG and traditional core stability exercise in the treatment of stroke patients with abnormal trunk posture.

Trial registration
Chinese Clinical Trial Register, ChiCTR1800014864. Registered on 24 November 2018.
Outcome reporting in neonates experiencing withdrawal following opioid exposure in pregnancy: a systematic review
Authors: Shan Flora , MacVicar Sonya , Allegaert Karel , Offringa Martin , Jansson Lauren M. , Simpson Sarah , Moulsdale Wendy , Kelly Lauren E. 
Published: March 2020

AbstractBackgroundNeonatal withdrawal secondary to in utero opioid exposure is a growing global concern stressing the psychosocial well-being of affected families and scarce hospital resources. In the ongoing search for the most effective treatment, randomized controlled trials are indispensable. Consistent outcome selection and measurement across randomized controlled trials enables synthesis of results, fostering the translation of research into practice. Currently, there is no core outcome set to standardize outcome selection, definition and reporting. This study identifies the outcomes currently reported in the literature for neonates experiencing withdrawal following opioid exposure during pregnancy.MethodsA comprehensive literature search of MEDLINE, EMBASE and Cochrane Central was conducted to identify all primary research studies (randomized controlled trials, clinical trials, case-controlled studies, uncontrolled trials, observational cohort studies, clinical practice guidelines and case reports) reporting outcomes for interventions used to manage neonatal abstinence syndrome between July 2007 and July 2017. All “primary” and “secondary” neonatal outcomes were extracted by two independent reviewers and were assigned to one of OMERACT’s core areas of “pathophysiological manifestation”, “life impact”, “resource use”, “adverse events”, or “death”.ResultsForty-seven primary research articles reporting 107 “primary” and 127 “secondary” outcomes were included. The most frequently reported outcomes were “duration of pharmacotherapy” (68% of studies,N = 32), “duration of hospital stay” (66% of studies,N = 31) and “withdrawal symptoms” (51% of studies,N = 24). The discrepancy between the number of times an outcome was reported and the number of articles was secondary to the use of composite outcomes. Frequently reported outcomes had heterogeneous definitions or were not defined by the study and were measured at different times. Outcomes reported in the literature to date were mainly assigned to the core areas “pathophysiologic manifestations” or “resource use”. No articles reported included parent or former patient involvement in outcome selections.ConclusionsInconsistent selection and definition of primary and secondary outcomes exists in the present literature of pharmacologic and nonpharmacologic interventions for managing opioid withdrawal in neonates. No studies involved parents in the process of outcome selection. These findings hinder evidence synthesis to generate clinically meaningful practice guidelines. The development of a specific core outcome set is imperative.
A phase 2 randomised controlled trial of serelaxin to lower portal pressure in cirrhosis (STOPP)
Authors: Gifford Fiona J. , Dunne Philip D. J. , Weir Graeme , Ireland Hamish , Graham Catriona , Tuck Sharon , Hayes Peter C. , Fallowfield Jonathan A. 
Published: March 2020

Abstract
Background
In preclinical models, recombinant human relaxin-2 (serelaxin) had anti-fibrotic effects and ameliorated portal hypertension (PH). A small exploratory study in patients with cirrhosis also suggested that serelaxin could reduce portal pressure.

Methods
In a phase 2, double-blind, randomised controlled study conducted in a single centre (Royal Infirmary of Edinburgh, UK), male and female adult participants with cirrhosis and clinically significant PH (CSPH; hepatic venous pressure gradient (HVPG) > 10 mmHg) were enrolled. Participants were allocated to serelaxin or placebo in a 3:1 ratio. The placebo was matched to serelaxin on appearance and administration protocol to create and maintain blinding. The primary endpoint was the change from baseline in fasting HVPG after 2 h of peripheral i.v. serelaxin infusion (80 μg/kg/day for 60 min followed by 30 μg/kg/day for at least 60 min). Secondary endpoints included the change from baseline in hepatic blood flow and systemic haemodynamics (cardiac index, systemic vascular resistance index and aortic pulse wave velocity). Short-term safety and tolerability of serelaxin were assessed.

Results
A total of 17 participants were screened, 15 were randomised and 11 completed the study (n = 9 serelaxin, n = 2 placebo). Reasons for withdrawal were baseline HVPG < 10 mmHg (n = 2) and technical failure (n = 2). The trial ended early due to manufacturer discontinuation of the study drug. The median age was 56 (range 43–69) years and 73% of participants were male. Alcohol was the commonest cirrhosis aetiology (n = 10). Participants had a median Model for End-Stage Liver Disease score of 10 (range 6–14). The mean baseline HVPG was 16.3 (range 10.3–21.7) mmHg. Individual responses were variable, but overall there was no statistically significant change in HVPG after 2 h of i.v. serelaxin (arithmetic mean of difference ± SD was 0.4 ± 3.5 mmHg (95% CI –2.3, 3.1; p = 0.76)). There were also no substantial changes from baseline in hepatic or systemic haemodynamics. We recorded 12 adverse events in 7 participants treated with serelaxin; none were significant, and most were unrelated to the investigational medicinal product. There were no serious adverse events.

Conclusion
In a small randomised, phase 2, proof-of-concept study in patients with cirrhosis and CSPH, serelaxin infusion was safe and well-tolerated but had a neutral effect on HVPG.

Trial registration
ClinicalTrials.gov, NCT02669875. Registered on 1 February 2016.
On the coexistence of broadcast and unicast in hybrid networks for the transmission of video services using stochastic geometry
Authors: Shokair Ahmad , Nasser Youssef , Bazzi Oussama , Hélard Jean-François , Crussière Matthieu 
Published: March 2020

AbstractFollowing the increasing growth in the demand on mobile TV, hybrid broadcast/broadband networks emerged as a suitable approach to overtake the challenges introduced by each network separately in order to enhance users’ experience. This paper presents two possible scenarios for a hybrid, spatially separated, broadcast/broadband network to offer mobile TV linear services for the end users. Namely, the first scenario is based on shared spectrum access for both networks while the second one proposes a dedicated spectrum. Using a stochastic geometry approach, the paper derives analytical formulations for both the probability of coverage and ergodic capacity. These formulations are then used to optimize the hybrid network in terms of its key design parameters including the broadcast (BC) coverage radii, the broadband (BB) base stations’ (BS) density, and spectral capacity. The results have shown that an optimal BC radius maximizing the probability of coverage and capacity exists and it depends on the BS density of the BB network. Other design parameters have been provided and analyzed leading to an optimal network deployment. To the best of the author’s knowledge, this paper presents a first reference work dealing with the optimization of the hybrid network with the coexistence of broadband and broadcast networks, from stochastic geometry perspective, taking into account the inter-cell interference.