bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of automated volumetric breast density software in comparison with visual assessments in an Asian population
Authors: Rahmat Kartini , Ab Mumin Nazimah , Ramli Hamid Marlina Tanty , Fadzli Farhana , Ng Wei Lin , Muhammad Gowdh Nadia Fareeda 
Published: September 2020

Abstract
This study aims to compare Quantra, as an automated volumetric breast density (Vbd) tool, with visual assessment according to ACR BI-RADS density categories and to determine its potential usage in clinical practice.
Five hundred randomly selected screening and diagnostic mammograms were included in this retrospective study. Three radiologists independently assigned qualitative ACR BI-RADS density categories to the mammograms. Quantra automatically calculates the volumetric density data into the system. The readers were blinded to the Quantra and other readers assessment. Inter-reader agreement and agreement between Quantra and each reader were tested. Region under the curve (ROC) analysis was performed to obtain the cut-off value to separate dense from a non-dense breast. Results with P value <.05 was taken as significant.
There were 40.4% Chinese, 27% Malays, 19% Indian and 3.6% represent other ethnicities. The mean age of the patients was 57. 15%, 45.6%, 30.4%, and 9% of patients fall under BI-RADS A, B, C and D density category respectively. Fair agreement with Kappa (κ) value: 0.49, 0.38, and 0.30 were seen for Reader 1, 2 and 3 versus Quantra. Moderate agreement with κ value: 0.63, 0.64, 0.51 was seen when the data were dichotomized (density A and B to “non-dense”, C and D to “dense”). The cut-off Vbd value was 13.5% to stratify dense from non-dense breasts with a sensitivity of 86.2% and specificity of 83.1% (AUC 91.4%; confidence interval: 88.8, 94.1).
Quantra showed moderate agreement with radiologists visual assessment. Hence, this study adds to the available evidence to support the potential use of Quantra as an adjunct tool for breast density assessment in routine clinical practice in the Asian population. We found 13.5% is the best cut-off value to stratify dense to non-dense breasts in our study population. Its application will provide an objective, consistent and reproducible results as well as aiding clinical decision-making on the need for supplementary breast ultrasound in our screening population.
Prognostic and predictive value of KRAS mutation number in metastatic colorectal cancer
Authors: Ucar Gokhan , Ergun Yakup , Aktürk Esen Selin , Acikgoz Yusuf , Dirikoc Merve , Esen İrfan , Bal Öznur , Uncu Doğan 
Published: September 2020

Abstract
Colorectal cancer (CRC) is the third most common cancer in the world and is the second leading cause of cancer-related deaths. Several mutations are involved in the development of CRC. The prognostic significance of the KRAS mutation has been discussed in many studies. We aimed to investigate the prognostic significance of the number of KRAS mutations in metastatic CRC (mCRC).
Patients with mutations in the KRAS gene were included in the study. They were divided into 2 groups as single mutation and multiple mutations in the KRAS gene.
For the study, 425 CRC patients were screened. KRAS mutation was positive in 191 patients (45%). One hundred ninety-one patients were included in the study, 171 patients (90%) had single mutations and 20 patients (10%) had multiple mutations. Median progression-free survival was 12.8 months in patients with multiple mutations, while it was 8.8 months in patients with single mutations (P: .05). The median overall survival of patients with multiple mutations was 40.7 months, while it was 22.7 months for patients with single mutations (P = .01)
We found that the presence of multiple mutations in KRAS mutant patients was associated with better overall survival and progression-free survival than a single mutation.
Usefulness of 99mTc-ASC lymphoscintigraphy and SPECT/CT in the evaluation of rare lymphatic disorders
Authors: Hou Guozhu , Jiang Yuanyuan , Jing Hongli , Xu Wenshuai , Xu Kai-Feng , Chen Libo , Li Fang , Cheng Wuying 
Published: September 2020

Abstract
The purpose of this study was to investigate the role of 99mTc-antimony sulfide colloid (ASC) lymphoscintigraphy and single photon emission computed tomography/computed tomography (SPECT/CT) in the evaluation of rare lymphatic disorders, including Gorham--Stout disease (GSD), lymphangioma, and lymphangioleiomyomatosis (LAM).
Nine patients suspected to have rare lymphatic disorders were included in this retrospective study. All patients underwent 99mTc-ASC lymphoscintigraphy and SPECT/CT to evaluate the lesions. The lymphoscintigraphy results were compared with the clinical and immunopathological findings.

99mTc-ASC lymphoscintigraphy and SPECT/CT could provide lymphatic draining and anatomical information for rare lymphatic disorders. Among the 9 patients, 3 were diagnosed with GSD (1 female, 2 males; aged 15–34 years, range 27.0 ± 10.4 years), 3 with lymphangioma (1 female, 2 males; aged 17–42 years, range 32.0 ± 13.2 years), and 3 patients were diagnosed with LAM (3 females; aged 33–50 years, range 43.7 ± 9.3 years]. GSD is characterized by multiple bone destruction, including spine, ribs, ilium, pubis, ischium, and femur. The tracer uptake of involved bones and soft tissue around bone is increased, accompanied by chylothorax, chylopericardium, and chylous leakage in abdominal and pelvic cavity. Lymphangiomas present as multiple cystic lesions with increased tracer uptake in the peripancreatic, retroperitoneal, and iliac areas, and in the abdominopelvic cavity. LAM presents as multiple thin-walled cysts in the bilateral lungs and multiple retroperitoneal enlarged lymph nodes with increased tracer uptake.

99mTc-ASC lymphoscintigraphy and SPECT/CT could comprehensively and specifically detect some rare lymphatic disorders, namely, GSD, lymphangioma, and LAM. This technique is useful for the evaluation of GSD, lymphangioma, and LAM.
Effects of visual feedback balance training with the Pro-kin system on walking and self-care abilities in stroke patients
Authors: Zhang Min , You Hong , Zhang Hongxia , Zhao Weijing , Han Tingting , Liu Jia , Jiang Shangrong , Feng Xianhui 
Published: September 2020

Abstract
Some scholars’ studies have demonstrated that Pro-kin balance system training is able to promote the recovery of the balance function in stroke patients. The present study has expanded on those studies, and was not merely limited to studying balance, but also encompassed walking and self-care abilities of the patients; furthermore, the association among balance and walking and self-care abilities was also explored.
A total of 40 stroke patients were randomly and equally divided into 2 groups: the control group (n = 20) and the treatment group (n = 20). Both groups underwent conventional balance training, although the treatment group also underwent visual feedback balance training with the Pro-kin system. The balance function was assessed using the Berg Balance Scale (BBS), the Timed “Up & Go” (TUG) test, and Pro-kin system parameters. The Pro-kin system parameters included the perimeter and ellipse area, which were both tested once with eyes open (EO) and eyes closed (EC). Walking ability was assessed using the Holden Walking Ability Scale, according to the Functional Ambulation Classification (FAC). The self-care abilities were assessed with the Barthel Index (BI). The tests were conducted prior to training, and 3 weeks after the end of the training programme.
No significant differences were noted among the groups before the training. After 3 weeks of training, for both the groups, significant improvements in balance and the walking and self-care abilities were noted: The BBS value was significantly increased (P < .05), whereas the TUG, perimeter, and ellipse area with EO and EC measurements were significantly decreased after treatment (P < .05). The FAC and BI readings were significantly increased after treatment (P < 0.05), and the treatment group outperformed the control group (P < .05). Furthermore, the balance function was shown to be strongly correlated with the walking and self-care abilities (P < .01).
The present study has demonstrated that the use of the Pro-kin visual feedback balance training system in combination with conventional training is a viable method for improving walking and self-care abilities of stroke patients.
Effects of tactile vibration feedback system on balance function and walking ability of a unilateral transtibial amputee with a prosthesis
Authors: Wang Shi-Qi , Gao Ya-Qian , Xu Ze-Hua , Xu Fang-Yuan , Yuan Li 
Published: September 2020

Abstract

Rationale:
There is still a lack of case reports about tactile vibration feedback devices for the treatment of transtibial amputees so far. This case report aims to introduce a tactile vibration feedback device designed to improve the balance and walking function of the transtibial amputee.

Patient concerns:
The amputee was a 20-year-old man with right transtibial amputation in a car accident four years ago.

Diagnose:
The clinical diagnosis of him was “Right transtibial amputation,” and the rehabilitation diagnosis was “Motor dysfunction (Balance function abnormality and Gait abnormality).”

Interventions:
The patient was reminded to adjust their posture in time via the tactile vibration feedback device.

Outcomes:
The balance and walking function of the volunteer transtibial amputee was improved.

Conclusion:
The tactile vibration feedback device has the potential to improve the balance and walking function of the transtibial amputee after installation. Potential fields that can be recommended for future research include intelligent prosthetics, feedback training, motor function, prosthetic acceptance, compliance, social communication, and the quality of life.
Acute basilar artery occlusion with recurrent shivering
Authors: Lee Chan-Hyuk , Jeon Seung-Ho , Kim Sang Yeon , Shin Byoung-Soo , Kang Hyun Goo 
Published: September 2020

Abstract

Rationale:
Shivering is an important physiological response of the body that causes muscle tremors to maintain temperature homeostasis. Traumatic brain injuries that affect the hypothalamus cause hypothermia, and physical removal of suprasellar tumors causes thermoregulation imbalance. However, no study has reported shivering due to ischemic stroke.

Patient concerns:
A 58-year-old male patient was admitted to our emergency department to evaluate severe stenosis of the basilar artery. While waiting for further examination, he exhibited coarse shivering and severe dysarthria.

Diagnosis:
Brain computed tomography angiography revealed occlusion of the entire basilar artery, and cerebral hypoperfusion was diagnosed in that area.

Interventions:
Transfemoral cerebral angiography (TFCA) was immediately performed, followed by thrombectomy of the basilar artery.

Outcomes:
Neurological deficits, including shivering, were rapidly reversed. The same symptom reoccurred 5 hours later, and TFCA was performed for thrombectomy and stenting, and neurological symptoms immediately reversed. The patient's neurological symptoms did not worsen during hospitalization.

Lessons:
Patients with acute basilar artery occlusion need prompt management because they have a higher mortality rate than those with other intracranial artery occlusions. When a patient exhibits neurological deficits accompanied by abrupt shivering for no specific reason, basilar artery occlusion must be considered.
Ultrasound-guided pulsed radiofrequency treatment for distal suprascapular neuropathy
Authors: Chung Yang-Hoon , Lee Joon-Ho , Koo Bon-Sung , Jung Jaewoong , Lee So Jeong 
Published: September 2020

Abstract

Rationale:
Suprascapular neuropathy is a rare cause of shoulder pain, and patients usually presents with posterosuperior shoulder pain and weakness on forward flexion and external rotation. Suprascapular neuropathy associated with rotator cuff pathology has received attention as an emerging cause of this condition. Suprascapular nerve (SSN) block can be used in these patients, and pulsed radio frequency (PRF) can be applied to achieve a long-term effect. Several studies have reported on PRF treatment of the SSN for shoulder pain, but most applied treatment to the nerve trunk under the transverse scapular ligament. This report describes a patient with suprascapular neuropathy treated with selective application of PRF to the distal SSN under ultrasound guidance.

Patient concerns:
A 68-year-old woman suffered from right posterior shoulder pain after traumatic full thickness rotator cuff tear. Her pain was not diminished despite of 2 surgeries.

Diagnoses:
She was diagnosed with entrapment of the distal SSN in the spino-glenoid (SGN) notch and suprascapular neuropathy.

Interventions:
She underwent surgery to decompress the entrapped SSN in the SGN. After that, we applied PRF on the distal SSN under ultrasound guidance for persistent pain. This treatment was repeated 3 times.

Outcomes:
PRF treatment resulted in a slight reduction in the visual analogue scale (VAS) pain score from 7–8/10 to 5–6/10 at the 2 weeks follow-up, and to 2–3/10 at the 1 month follow-up. The reduction in pain was maintained at the 1 year follow-up.

Lessons:
PRF treatment of the SSN is typically approached from the main branch in the suprascapular notch. We selectively applied PRF to the distal SSN close to the SGN. This technique was safe and effective.
Effect of a multidisciplinary program to improve organ donation in the emergency department
Authors: Kim Kahyun , Lee Soo Hoon , Kim Dong Hoon , Lim Daesung , Kang Changwoo , Jeong Jin Hee , Lee Sang Bong , Lee Youn Jung 
Published: September 2020

Background and importance
As the emergency department (ED) is an important source of potential organ donors, it may play an important role in the organ donation process.

Objective
To assess the effectiveness of the multidisciplinary organ donation improvement program (ODIP) on identifying potential donors and improving organ donation in South Korean EDs.

Design, settings, and participants
This study was a retrospective, observational study of the ED-inclusive ODIP implemented in 55 tertiary teaching hospitals contracted with the Korea Organ Donation Agency (KODA) since 2014. The inclusion criteria were: patients in the ED with a serious brain injury and futile prognosis or expected death of the patient within a few days, no contraindications for organ donation, and no objections registered in the donor registry.

Intervention
The ED-inclusive multidisciplinary approach was implemented to improve organ donation. It included regular meetings of the ODIP committee, hospital visits and staff education, improvement of notifications, and support of a coordination team.

Outcomes measure and analysis
We assessed the changes in the number of deceased organ donors per year and notifications of potential brain-dead donors by medical staff after the implementation of the new ED-inclusive ODIP. The entire organ donation process was monitored and measured.

Results
There was a significant increase in deceased organ donors per million population after the implementation of the ED-inclusive multidisciplinary ODIP of KODA compared to the pre-intervention period: 5.21 vs. 9.72, difference 4.51 (95% confidence interval 2.11–6.91). During the study period, the proportion of deceased organ donors occurred from KODA-contracted hospitals increased from 25.3 to 50.3% in South Korea’s total deceased organ donors. Emergency physicians of KODA-contracted hospitals notified increasingly more potential brain-dead donors each year throughout the study period (36 in 2014 vs. 135 in 2018). The longer the period contracted with KODA, the higher the potential brain-death identification rates (P < 0.001).

Conclusion
In this retrospective study, the implementation of multidisciplinary ODIP in the ED led to significantly higher deceased organ donors per million population and awareness of potential brain-dead donors in South Korea.
The Impact of Misaligned Wavefront-guided Correction in a Scleral Lens for the Highly Aberrated Eye
Authors: Rijal Sujata , Hastings Gareth D. , Nguyen Lan Chi , Kauffman Matthew J. , Applegate Raymond A. , Marsack Jason D. 
Published: September 2020

SIGNIFICANCE
To achieve maximum visual benefit, wavefront-guided scleral lens corrections (WGCs) are aligned with the underlying wavefront error of each individual eye. This requirement adds complexity to the fitting process. With a view toward simplification in lens fitting, this study quantified the consequences of placing WGCs at two pre-defined locations.

PURPOSE
This study aimed to quantify performance reduction accompanying the placement of the WGC at two locations: (1) the average decentered location (ADL; average decentration observed across individuals wearing scleral lenses) and (2) the geometric center (GC) of the lens.

METHODS
Deidentified residual aberration and lens translation data from 36 conventional scleral lens–wearing eyes with corneal ectasia were used to simulate WGC correction in silico. The WGCs were decentered from the eye-specific pupil position to both the ADL and GC locations. The impact of these misalignments was assessed in terms of change (from the aligned, eye-specific pupil position) in higher-order root mean square (HORMS) wavefront error, change in log of the visual Strehl ratio (logVSX), and predicted change in logMAR visual acuity (VA).

RESULTS
As expected, HORMS increased, logVSX decreased, and predicted VA was poorer at both ADL and GC compared with the aligned condition (P < .001). Thirty-four of 36 eyes had greater residual HORMS, and 33 of 36 eyes had worse logVSX values at the GC than at the ADL. In clinical terms, 19 of 36 eyes at the ADL and 35 of 36 eyes at the GC had a predicted loss in VA of three letters or greater.

CONCLUSIONS
The placement of the WGC at either ADL or GC is predicted to lead to a noticeable reduction in VA for more than half of the eyes studied, suggesting the simplification of the fitting process is not worth the cost in performance.
A Narrative Review of Methods for Causal Inference and Associated Educational Resources
Authors: Landsittel Douglas , Srivastava Avantika , Kropf Kristin 
Published: September 2020

Background and Objectives:Root cause analysis involves evaluation of causal relationships between exposures (or interventions) and adverse outcomes, such as identification of direct (eg, medication orders missed) and root causes (eg, clinician's fatigue and workload) of adverse rare events. To assess causality requires either randomization or sophisticated methods applied to carefully designed observational studies. In most cases, randomized trials are not feasible in the context of root cause analysis. Using observational data for causal inference, however, presents many challenges in both the design and analysis stages. Methods for observational causal inference often fall outside the toolbox of even well-trained statisticians, thus necessitating workforce training.Methods:This article synthesizes the key concepts and statistical perspectives for causal inference, and describes available educational resources, with a focus on observational clinical data. The target audience for this review is clinical researchers with training in fundamental statistics or epidemiology, and statisticians collaborating with those researchers.Results:The available literature includes a number of textbooks and thousands of review articles. However, using this literature for independent study or clinical training programs is extremely challenging for numerous reasons. First, the published articles often assume an advanced technical background with different notations and terminology. Second, they may be written from any number of perspectives across statistics, epidemiology, computer science, or philosophy. Third, the methods are rapidly expanding and thus difficult to capture within traditional publications. Fourth, even the most fundamental aspects of causal inference (eg, framing the causal question as a target trial) often receive little or no coverage. This review presents an overview of (1) key concepts and frameworks for causal inference and (2) online documents that are publicly available for better assisting researchers to gain the necessary perspectives for functioning effectively within a multidisciplinary team.Conclusion:A familiarity with causal inference methods can help risk managers empirically verify, from observed events, the true causes of adverse sentinel events.
A Targeted Molecular Localization Imaging Method Applied to Tumor Microvasculature
Authors: Zhao Feifei , Unnikrishnan Sunil , Herbst Elizabeth B. , Klibanov Alexander L. , Mauldin F. William , Hossack John A. 
Published: September 2020

Objectives
Ultrasound contrast agents, consisting of gas-filled microbubbles (MBs), have been imaged using several techniques that include ultrasound localization microscopy and targeted molecular imaging. Each of these techniques aims to provide indicators of the disease state but has traditionally been performed independently without co-localization of molecular markers and super-resolved vessels. In this article, we present a new imaging technology: a targeted molecular localization (TML) approach, which uses a single imaging sequence and reconstruction approach to co-localize super-resolved vasculature with molecular imaging signature to provide simultaneous anatomic and biological information for potential multiscale disease evaluation.

Materials and Methods
The feasibility of the proposed TML technique was validated in a murine hindlimb tumor model. Targeted molecular localization imaging was performed on 3 groups, which included control tissue (leg), tumor tissue, and tumor tissue after sunitinib an-tivascular treatment. Quantitative measures for vascular index (VI) and molecular index (MITML) were calculated from the microvasculature and TML images, respectively. In addition to these conventional metrics, a new metric unique to the TML technique, reporting the ratio of targeted molecular index to vessel surface, was assessed.

Results
The quantitative resolution results of the TML approach showed resolved resolution of the microvasculature down to 28.8 μm. Vascular index increased in tumors with and without sunitinib compared with the control leg, but the trend was not statistically significant. A decrease in MITML was observed for the tumor after treatment (P < 0.0005) and for the control leg (P < 0.005) compared with the tumor before treatment. Statistical differences in the ratio of molecular index to vessel surface were found between all groups: the control leg and tumor (P < 0.05), the control leg and tumor after sunitinib treatment (P < 0.05), and between tumors with and without sunitinib treatment (P < 0.001).

Conclusions
These findings validated the technical feasibility of the TML method and pre-clinical feasibility for differentiating between the normal and diseased tissue states.