bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of the train-of-five bipolar technique to provide reliable, spatially accurate motor cortex identification in asleep patients
Authors: Bander Evan D. , Shelkov Evgeny , Modik Oleg , Kandula Padmaja , Karceski Steven C. , Ramakrishna Rohan 
Published: February 2020

OBJECTIVEIntraoperative cortical and subcortical mapping techniques have become integral for achieving a maximal safe resection of tumors that are in or near regions of eloquent brain. The recent literature has demonstrated successful motor/language mapping with lower rates of stimulation-induced seizures when using monopolar high-frequency stimulation compared to traditional low-frequency bipolar stimulation mapping. However, monopolar stimulation carries with it disadvantages that include more radiant spread of electrical stimulation and a theoretically higher potential for tissue damage. The authors report on the successful use of bipolar stimulation with a high-frequency train-of-five (TOF) pulse physiology for motor mapping.METHODSBetween 2018 and 2019, 13 patients underwent motor mapping with phase-reversal and both low-frequency and high-frequency bipolar stimulation. A retrospective chart review was conducted to determine the success rate of motor mapping and to acquire intraoperative details.RESULTSThirteen patients underwent both high- and low-frequency bipolar motor mapping to aid in tumor resection. Of the lesions treated, 69% were gliomas, and the remainder were metastases. The motor cortex was identified at a significantly greater rate when using high-frequency TOF bipolar stimulation (n = 13) compared to the low-frequency bipolar stimulation (n = 4) (100% vs 31%, respectively; p = 0.0005). Intraoperative seizures and afterdischarges occurred only in the group of patients who underwent low-frequency bipolar stimulation, and none occurred in the TOF group (31% vs 0%, respectively; p = 0.09).CONCLUSIONSUsing a bipolar wand with high-frequency TOF stimulation, the authors achieved a significantly higher rate of successful motor mapping and a low rate of intraoperative seizure compared to traditional low-frequency bipolar stimulation. This preliminary study suggests that high-frequency TOF stimulation provides a reliable additional tool for motor cortex identification in asleep patients.
Accuracy analysis of fMRI and MEG activations determined by intraoperative mapping
Authors: Ellis David G. , White Matthew L. , Hayasaka Satoru , Warren David E. , Wilson Tony W. , Aizenberg Michele R. 
Published: February 2020

OBJECTIVEBy looking at how the accuracy of preoperative brain mapping methods vary according to differences in the distance from the activation clusters used for the analysis, the present study aimed to elucidate how preoperative functional neuroimaging may be used in such a way that maximizes the mapping accuracy.METHODSThe eloquent function of 19 patients with a brain tumor or cavernoma was mapped prior to resection with both functional MRI (fMRI) and magnetoencephalography (MEG). The mapping results were then validated using direct cortical stimulation mapping performed immediately after craniotomy and prior to resection. The subset of patients with equivalent MEG and fMRI tasks performed for motor (n = 14) and language (n = 12) were evaluated as both individual and combined predictions. Furthermore, the distance resulting in the maximum accuracy, as evaluated by the J statistic, was determined by plotting the sensitivities and specificities against a linearly increasing distance threshold.RESULTSfMRI showed a maximum mapping accuracy at 5 mm for both motor and language mapping. MEG showed a maximum mapping accuracy at 40 mm for motor and 15 mm for language mapping. At the standard 10-mm distance used in the literature, MEG showed a greater specificity than fMRI for both motor and language mapping but a lower sensitivity for motor mapping. Combining MEG and fMRI showed a maximum accuracy at 15 mm and 5 mm—MEG and fMRI distances, respectively—for motor mapping and at a 10-mm distance for both MEG and fMRI for language mapping. For motor mapping, combining MEG and fMRI at the optimal distances resulted in a greater accuracy than the maximum accuracy of the individual predictions.CONCLUSIONSThis study demonstrates that the accuracy of language and motor mapping for both fMRI and MEG is heavily dependent on the distance threshold used in the analysis. Furthermore, combining MEG and fMRI showed the potential for increased motor mapping accuracy compared to when using the modalities separately.Clinical trial registration no.: NCT01535430 (clinicaltrials.gov)
Вплив ранньої ліпідознижувальної терапії різної інтенсивності на функцію ендотелію у хворих з гострим інфарктом міокарда з елевацією сегмента ST
Authors: Parkhomenko O. M. , Stepura A. O. , Lutay Y. M. , Irkin O. I. , Bilyi D. O. 
Published: February 2020

The aim – to evaluate the effect of different hypolipidemic therapy on changes in endothelial function in patients with acute myocardial infarction with ST segment elevation (STEMI).Materials and methods. The study enrolled 135 patients with STEMI within the 12 hours of symptoms onset (average 4.7±1.0) who were admitted to the intensive care unit at NSC «M.D. Strazhesko Institute of Cardiology». Patients were distributed into 4 groups by envelope method. At the enrolment to the hospital patients were prescribed hypolipidemic therapy till the procedure of revascularization – percutaneous coronary intervention. The first (1st) group included 26 pts who were prescribed a combination of atorvastatin (10 mg) and ezetimibe (10 mg). The second (2nd) group included 24 pts, who were prescribed atorvastatin at a dose of 40 mg. The third (3rd) group included 43 pts, who received 80 mg of atorvastatin, the fourth (4th) group included 42 pts who were prescribed a combination of atorvastatin 40 mg and ezetimibe 10 mg. Basic therapy was formed according to the current guidelines of the European Society of Cardiologists and the National Diagnostic Protocols. The selected groups did not have difference in clinical and anamnestic characteristics and methods of treatment. Determination of reactive hyperemia using flow-dependent vasodilatation (FDV) was performed on the 1st and 10th days of the hospital period and within the 90th day of onset of the disease onset. Results and discussion. Prescription of high-intensity lipid-lowering therapy using 80 mg of atorvastatin (group 3) and 40 mg of atorvastatin and 10 mg of ezetimibe (group 4) caused a greater lipid-lowering effect compared to the medium-intensity therapy (group 1 and 2) in the dynamics of observation. Group 3 patients experienced a significant decrease in low-density lipoprotein cholesterol (LDL cholesterol) on the 10th and 90th days, and its decrease reached values ​​below the recommended values ​​(up to 1.75±0.11 mmol/L. In group 4 on we recorded a significant decrease in LDL cholesterol on the 10th day and by the 90th day it was 1.55 mmol/L. The mean LDL cholesterol level below the target was only reached in groups 3 and 4. Normalization of endothelial function (FDV greater than 10 %) was significantly more frequently observed in patients who reached less than 1.8 mmol/L by the 90th day of target LDL cholesterol.Conclusions. For the normalization of endothelial function (increase in FDV) during hypolipidemic therapy in patients undergoing STEMI, it is necessary to achieve the target values ​​of LDL cholesterol up to 90 days of the disease, which is possible only when conducting high-intensity hypolipidemic therapy. The absence of improvement in endothelial function during observation in a constant number of patients suggests that there may be additional, possibly genetic, factors that are not affected by the treatments used.
Who Benefits Most from Collaborative Dementia Care from a Patient and Payer Perspective? A Subgroup Cost-Effectiveness Analysis
Authors: Rädke Anika , Michalowsky Bernhard , Thyrian Jochen René , Eichler Tilly , Xie Feng , Hoffmann Wolfgang 
Published: February 2020

Background: Dementia care management (DCM) aims to provide optimal treatment for people with dementia (PwD). Treatment and care needs are dependent on patients’ sociodemographic and clinical characteristics and thus, economic outcomes could depend on such characteristics. Objective: To detect important subgroups that benefit most from DCM and for which a significant effect on cost, QALY, and the individual cost-effectiveness could be achieved. Methods: The analysis was based on 444 participants of the DelpHi-trial. For each subgroup, the probability of DCM being cost-effective was calculated and visualized using cost-effectiveness acceptability curves. The impact of DCM on individual costs and QALYs was assessed by using multivariate regression models with interaction terms. Results: The probability of DCM being cost-effective at a willingness-to-pay of 40,000€ /QALY was higher in females (96% versus 16% for males), in those living alone (96% versus 26% for those living not alone), in those being moderately to severely cognitively (100% versus 3% for patients without cognitive impairment) and functionally impaired (97% versus 16% for patients without functional impairment), and in PwD having a high comorbidity (96% versus 26% for patients with a low comorbidity). Multivariate analyses revealed that females (b = –10,873; SE = 4,775, p = 0.023) who received the intervention had significantly lower healthcare cost. DCM significantly improved QALY for PwD with mild and moderate cognitive (b = +0.232, SE = 0.105) and functional deficits (b = +0.200, SE = 0.095). Conclusion: Patients characteristics significantly affect the cost-effectiveness. Females, patients living alone, patients with a high comorbidity, and those being moderately cognitively and functionally impaired benefit most from DCM. For those subgroups, healthcare payers could gain the highest cost savings and the highest effects on QALYs when DCM will be implemented.
Alcohol Consumption, Brain Amyloid-β Deposition, and Brain Structural Integrity Among Older Adults Free of Dementia
Authors: Koch Manja , Costanzo Simona , Fitzpatrick Annette L. , Lopez Oscar L. , DeKosky Steven , Kuller Lewis H. , Price Julie , Mackey Rachel H. , Jensen Majken K. , Mukamal Kenneth J. 
Published: February 2020

Background: Light to moderate alcohol consumption has been variably associated with lower or higher risk of dementia, but effects on Alzheimer’s disease pathology are less clear. Objective: We determined whether late-life alcohol consumption was associated with Alzheimer’s disease pathology among older adults. Methods: We assessed the associations of alcohol consumption self-reported in 2000–2002 with brain amyloid-β deposition on PET scans, and white matter lesion and hippocampal volume on MRIs measured 7–9 years later in 189 participants of the Ginkgo Evaluation of Memory Study (age 75–87 years at baseline) who were free of clinical dementia, using multivariable-adjusted and inverse probability-weighted robust linear regression models. Results: Alcohol consumption was not statistically significantly associated with amyloid-β deposition (standardized uptake value ratio difference per drink: –0.013 [95% CI: –0.027, 0.002]). Both non-drinkers and participants consuming ≥1 drink(s)/week had higher white matter lesion volume (% intracranial volume) than did the reference group of those consuming <1 drink/week (differences: 0.25 % [95% CI: 0.01, 0.50]; 0.26 % [95% CI: 0.02, 0.50]). The association of alcohol consumption and hippocampal volume was modified by age ( p = 0.02). Among participants younger than 77 years, participants consuming 1–7 drinks/week had larger hippocampal volume compared with participants consuming <1 drink/week. Conclusions: Alcohol consumption was not statistically significantly associated with amyloid-β deposition 7–9 years later. Non-drinking and greater alcohol consumption were associated with higher white matter lesion volume compared with drinking <1 drink/week. Moderate drinking was associated with higher hippocampal volume in younger individuals. Given the selective nature of this population and adverse health effects of excessive alcohol consumption, these findings warrant further investigation, but cannot be translated into clinical recommendations.
Day-to-Day Home Blood Pressure Variability is Associated with Cerebral Small Vessel Disease Burden in a Memory Clinic Population
Authors: de Heus Rianne A.A. , Reumers Stacha F.I. , van der Have Alba , Tumelaire Maxime , Tully Phillip J. , Claassen Jurgen A.H.R. 
Published: February 2020

Background: High visit-to-visit blood pressure variability (BPV) has been associated with cognitive decline and cerebral small vessel disease (cSVD), in particular cerebrovascular lesions. Whether day-to-day BPV also relates to cSVD has not been investigated. Objective: To investigate the cross-sectional association between day-to-day BPV and total cSVD MRI burden in older memory clinic patients. Methods: We included outpatients referred to our memory clinic, who underwent cerebral MRI as part of their diagnostic assessment. We determined the validated total cSVD score (ranging from 0–4) by combining four markers of cSVD that were visually rated. Home blood pressure (BP) measurements were performed for one week, twice a day, according to international guidelines. BPV was defined as the within-subject coefficient of variation (CV; standard deviation/mean BP*100). We used multivariable ordinal logistic regression analyses adjusted for age, sex, smoking, diabetes, antihypertensive medication, history of cardiovascular disease, and mean BP. Results: For 82 patients (aged 71.2±7.9 years), mean home BP was 140/79±15/9 mmHg. Dementia and mild cognitive impairment were diagnosed in 46% and 34%, respectively. 78% had one or more markers of cSVD. Systolic CV was associated with cSVD burden (adjusted odds ratio per point increase in CV = 1.29, 95% confidence interval = 1.04–1.60, p = 0.022). There were no differences in diastolic CV and mean BP between the cSVD groups. When we differentiated between morning and evening BP, only evening BPV remained significantly associated with total cSVD burden. Conclusion: Day-to-day systolic BPV is associated with cSVD burden in memory clinic patients. Future research should indicate whether lowering BPV should be included in BP management in older people with memory complaints.
Serial Reaction Time Task Performance in Older Adults with Neuropsychologically Defined Mild Cognitive Impairment
Authors: Hong Yue , Alvarado Rachel L. , Jog Amod , Greve Douglas N. , Salat David H. 
Published: February 2020

Background: Studies have found that individuals with mild cognitive impairment (MCI) exhibit a range of deficits outside the realm of primary explicit memory, yet the role of response speed and implicit learning in older adults with MCI have not been established. Objective: The current study aims to explore and document response speed and implicit learning in older adults with neuropsychologically defined MCI using a simple serial reaction (SRT) task. In addition, the study aims to explore the feasibility of a novel utilization of the simple cognitive task using machine learning procedures as a proof of concept. Method: Participants were 22 cognitively healthy older adults and 20 older adults with MCI confirmed through comprehensive neuropsychological evaluation. Two-sample t-test, multivariate regression, and mixed-effect models were used to investigate group difference in response speed and implicit learning on the SRT task. We also explored the potential utility of SRT feature analysis through random forest classification. Results: With demographic variables controlled, the MCI group showed overall slower reaction time and higher error rate compared to the cognitively healthy volunteers. Both groups showed significant simple motor learning and implicit learning. The learning patterns were not statistically different between the two groups. Random forest classification achieved overall accuracy of 80.9%. Conclusions: Individuals with MCI demonstrated slower reaction time and higher error rate compared to cognitively healthy volunteers but demonstrated largely preserved motor learning and implicit sequence learning. Preliminary results from random forest classification using features from SRT performance supported further research in this area.
Improved Criteria for the Classification of Titin Variants in Inherited Skeletal Myopathies
Authors: Savarese Marco , Johari Mridul , Johnson Katherine , Arumilli Meharji , Torella Annalaura , Töpf Ana , Rubegni Anna , Kuhn Marius , Giugliano Teresa , Gläser Dieter , Fattori Fabiana , Thompson Rachel , Penttilä Sini , Lehtinen Sara , Gibertini Sara , Ruggieri Alessandra , Mora Marina , Maver Ales , Peterlin Borut , Mankodi Ami , Lochmüller Hanns , Santorelli Filippo Maria , Schoser Benedikt , Fajkusová Lenka , Straub Volker , Nigro Vincenzo , Hackman Peter , Udd Bjarne 
Published: February 2020

BACKGROUND: Extensive genetic screening results in the identification of thousands of rare variants that are difficult to interpret. Because of its sheer size, rare variants in the titin gene ( TTN) are detected frequently in any individual. Unambiguous interpretation of molecular findings is almost impossible in many patients with myopathies or cardiomyopathies. OBJECTIVE: To refine the current classification framework for TTN-associated skeletal muscle disorders and standardize the interpretation of TTN variants. METHODS: We used the guidelines issued by the American College of Medical Genetics and Genomics (ACMG) and the Association for Molecular Pathology (AMP) to re-analyze TTN genetic findings from our patient cohort. RESULTS: We identified in the classification guidelines three rules that are not applicable to titin-related skeletal muscle disorders; six rules that require disease-/gene-specific adjustments and four rules requiring quantitative thresholds for a proper use. In three cases, the rule strength need to be modified. CONCLUSIONS: We suggest adjustments are made to the guidelines. We provide frequency thresholds to facilitate filtering of candidate causative variants and guidance for the use and interpretation of functional data and co-segregation evidence. We expect that the variant classification framework for TTN-related skeletal muscle disorders will be further improved along with a better understanding of these diseases.
Ductus arteriosus and failed medical therapy
Authors: den Harink Tamara , Clur Sally-Ann B. , van der Lee Robin , van Deutekom Arend W. 
Published: February 2020

BACKGROUND: Management of a patent ductus arteriosus (PDA) after pharmacological therapy failure in preterm neonates is controversial and shows marked practice variation. To evaluate which factors motivate the decision to ligate a PDA in clinical practice we examined several clinical and echocardiographic variables. METHODS: We conducted a retrospective single center cohort study. We included infants born at less than 37 weeks of gestation, admitted to our neonatal intensive care between 01.01.2008 and 31.12.2015 with a PDA detected on echocardiography after two or three courses of medical therapy. Logistic regression analyses were used to predict surgical ligation for twelve clinical and nine echocardiographic variables separately. We used the multiple imputation technique for missing values. RESULTS: A total of 89 neonates were included of which forty (45%), underwent surgical ligation of their PDA. In our final multivariate regression model, invasive respiratory support (OR 3.6, 95% CI 1.29–10.03), left atrial/aortic root ratio (OR 5.48, 95% CI 1.66–18.11) and presence of ductal steal (OR 3.82, 95% CI 1.47–9.91) were significant predictors for surgical ligation. The prediction model using clinical and echocardiographic variables explained 9% and 24% of the variability to ligate respectively, indicating significant residual variation due to unmeasured factors. CONCLUSIONS: Our results indicate that invasive respiratory support, increased left atrial/aortic root ratio and the presence of ductal steal were important predictors for surgical ligation in our center. However, this explained only a small proportion of the variability, which emphasizes the need for evidence-based guidelines in the management of preterm neonates after failed pharmacological therapy for a PDA.
Agreement Test of Documentation of Visual Inspection with Acetic Acid â€œDoVIAâ€ and Colposcopy findings as a Screening Tool for Cervical Cancer
Authors: Nuranna Laila , Wardany Renny Surya , Purwoto Gatot , Utami Tofan W. , Peters Lex 
Published: February 2020

Abstract
Objective:
To find out the suitability of Documentation of Visual Inspection with Acetic Acid (DoVIA) result compare to colposcopy result as a method of cervical cancer screening.

Method:
This is a descriptive study using cross sectional design that took place from April 2017 until March 2019. One hundred eighty two sampels of documentation photographs taken by the researcher were included. The photographs were reviewed by the 3 selected reviewers: oncology and gynecology consultant, obstetry and gynecology resident, and general practitioner that were trained about DoVIA and colposcopy. The review was based on kappa test which assessed the sharpness, squamo-columnar junction and white epitel visualization on the cervix.
Results:
Kappa score on DoVIA versus colposcopy was 0,717 (good). Inter-rater test was performed to assess consistency and the result was 0,764 (good) between consultant and resident, 0,703 (good) between consultant and general practitioner.
Conclusion:
Kappa test of IVA documentation â€DoVIAâ€ gives a good kappa value, so that it is expected to be an alternative screening for precancerous lesions.
Keyword: cervical cancer screening, VIA, DoVIA, colposcopy, mini colposcopy

Abstrak
Tujuan:
Untuk menemukan kesesuaian antara dokumentasi hasil inspeksi visual dengan asam asetat (DoVIA) dibanding dengan hasil kolposkopi sebagai metode skrining kanker serviks.
Metode
Penelitian deskripsi ini menggunakan desain cross sectional yang telah dilakukan sejak April 2017 hingga Maret 2019. Seratus delapan puluh dua sampel dokumentasi telah diambil oleh peneliti telah dimasukkan menjadi sampel. Hasil dokumentasi telah dinilai oleh 3 penilai yang terdiri dari konsultan onkologi dan ginekologi, residen obstetri dan ginekologi, dan dokter umum yang telah dilatih untuk DoVIA dan kolposkopi. Hasil penilaian dilakukan berdasarkan kappa untuk menilai ketajaman, sambungan skuamos kolumner dan visualisasi lesi putih di serviks
Hasil
Skor kappa pada DoVIA dibanding kolposkopi adalah 0,717 (baik). Hasil prbandingan penilaian antar penilai yang ditunjukkan untuk menilai konsistensi dan hasil adalah 0,764 (baik) antara konsultan dan residen, 0,703 (baik) antara konsultan dan dokter umum.
Kesimpulan
Tes kappa pada dokumentasi IVA (DoVIA) memberikan hasil kappa baik, sehingga DoVIA diharapkan dapat menjadi alternatif skrining untuk lesi prakanker.

Kata kunci : skrining kanker serviks, IVA, DoVIA, kolposkopi, minikolposkopi