bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systematic review and meta-analysis of breast cancer brain metastasis and primary tumor receptor expression discordance
Authors: Kotecha Rupesh , Tonse Raees , Rubens Muni , McDermott Michael W , Odia Yazmin , Appel Haley , Mehta Minesh P 
Published: January 2021

Abstract

Background
Change in hormone receptor (estrogen [ER] and progesterone [PR]) and/or human epidermal growth factor receptor type 2 (HER2) status during the evolutionary course of metastatic breast cancer and the effect of tumor classification subtype switching remain understudied and underappreciated in brain metastasis patients.

Methods
Using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a systematic review of series published prior to April 2020 obtained from the Medline database of biopsied or resected breast cancer brain metastasis (BCBM) was performed. Weighted random effects models were used to calculate pooled estimates.

Results
15 full-text articles were included with receptor expression analyses on 1373 patients who underwent biopsy or resection of at least one intracranial lesion to compare to the primary tumor. Primary tumor receptor expression immunophenotypes were 45.0% ER+, 41.0% ER−, 31.0% PR+, 51.0% PR−, 35% HER2+, and 47.0% HER2−. Corresponding BCBM immunophenotypes were 19.0% ER+, 31.0% ER−, 13.0% PR+, 40.0% PR−, 21.0% HER2+, and 26.0% HER2−. On primary/BCBM comparison, 540 patients (42.6%) exhibited discordance in any receptor with 17.0% (95% CI: 13.0%–23.0%) discordant on ER, 23.0% (95% CI: 18.0%–30.0%) discordant on PR, and 12.0% (95% CI: 8.0%–16.0%) discordant on HER2 status. The most common receptor conversions found in BCBM were ER loss 11.0% (95% CI: 8.0%–16.0%), PR loss 15.0% (95% CI: 11.0%–21.0%), and HER2 gain 9.0% (95% CI: 7.0%–11.0%).

Conclusions
BCBM exhibits significant receptor expression discordance in comparison to primary tumors in approximately 40% of patients. Classification patterns need to be analyzed to determine factors predictive of BCBM/primary tumor discordance. Overall, tumor subtype switching and its effect on clinical management remains underappreciated.
Association of plasma cell-free DNA with survival in patients with IDH wild-type glioblastoma
Authors: Bagley Stephen J , Till Jacob , Abdalla Aseel , Sangha Hareena K , Yee Stephanie S , Freedman Jake , Black Taylor A , Hussain Jasmin , Binder Zev A , Brem Steven , Desai Arati S , O’Rourke Donald M , Long Qi , Nabavizadeh Seyed Ali , Carpenter Erica L 
Published: January 2021

Abstract

Background
We aimed to determine whether plasma cell-free DNA (cfDNA) concentration is associated with survival in patients with isocitrate dehydrogenase (IDH) wild-type glioblastoma (GBM).

Methods
Pre-operative and post-chemoradiotherapy blood samples were prospectively collected from patients with newly diagnosed IDH wild-type GBM. Patients underwent surgical resection or biopsy and received adjuvant radiotherapy with concomitant temozolomide. Cell-free DNA (cfDNA) was isolated from plasma and quantified using SYBR Green-based q polymerase chain reaction (qPCR).

Results
Sixty-two patients were enrolled and categorized into high vs. low cfDNA groups relative to the pre-operative median value (25.2 ng/mL, range 5.7–153.0 ng/mL). High pre-operative cfDNA concentration was associated with inferior PFS (median progression-free survival (PFS), 3.4 vs. 7.7 months; log-rank P = .004; hazard ratio [HR], 2.19; 95% CI, 1.26–3.81) and overall survival (OS) (median OS, 8.0 vs. 13.9 months; log-rank P = .01; HR, 2.43; 95% CI, 1.19–4.95). After adjusting for risk factors, including O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status, pre-operative cfDNA remained independently associated with PFS (HR, 2.70; 95% CI, 1.50–4.83; P = .001) and OS (HR, 2.65; 95% CI, 1.25–5.59; P = .01). Post-hoc analysis of change in cfDNA post-chemoradiotherapy compared to pre-surgery (n = 24) showed increasing cfDNA concentration was associated with worse PFS (median, 2.7 vs. 6.0 months; log-rank P = .003; HR, 4.92; 95% CI, 1.53–15.84) and OS (median, 3.9 vs. 19.4 months; log-rank P &lt; .001; HR, 7.77; 95% CI, 2.17–27.76).

Conclusions
cfDNA concentration is a promising prognostic biomarker for patients with IDH wild-type GBM. Plasma cfDNA can be obtained noninvasively and may enable more accurate estimates of survival and effective clinical trial stratification.
Durometry in SSc: The hard facts. A systematic literature review and additional pilot study
Authors: Vanhaecke Amber , Verschuere Sven , Vilela Veronica , Heeman Lise , Cutolo Maurizio , Smith Vanessa 
Published: January 2021

Abstract

Objectives
To investigate the reliability of durometry in systemic sclerosis (SSc), by means of a systematic review and additional pilot study.

Methods
Literature was systematically reviewed according to the PRISMA guidelines to identify all original studies assessing the reliability of durometry in SSc. Additionally, in the pilot study, intra-rater reliability was evaluated in a first cohort of 74 SSc patients (61 female, 13 LSSc/53 LcSSc/8 DcSSc). In a second separate set of 30 SSc patients (21 female, 4 LSSc/20 LcSSc/6 DcSSc), intra- and inter-rater reliability were evaluated.

Results
Only two unique records identified through the systematic review were qualified to generate conclusions. Regarding intra-rater reliability, Kissin reported excellent intra-class correlation coefficient values (ICC, 0.86–0.94) for measurements at nine skin sites in two DcSSc patients. Merkel and Kissin described, both in five DcSSc patients, good to excellent inter-rater reliability (ICC, 0.82–0.96 and 0.61–0.85) for measurements at respectively, six and nine skin sites. In our pilot study, ICC for intra-rater reliability at 17 standardized skin sites were excellent in both cohorts, ranging 0.93–0.99 and 0.78–0.98, respectively. ICC for inter-rater reliability at 17 standardized skin sites were good to excellent 0.63–0.93, except for the feet (0.48 and 0.52).

Conclusion
The preliminary findings in the literature are supported by our pilot study in which we have attested the reliability of durometry in SSc patients. However, prior to including durometry as an (additional) outcome measure in SSc clinical trials, its validation status in the assessment of skin fibrosis needs to be completely attested.
Mind-wandering Is Accompanied by Both Local Sleep and Enhanced Processes of Spatial Attention Allocation
Authors: Wienke Christian , Bartsch Mandy V , Vogelgesang Lena , Reichert Christoph , Hinrichs Hermann , Heinze Hans-Jochen , Dürschmid Stefan 
Published: January 2021

Abstract
Mind-wandering (MW) is a subjective, cognitive phenomenon, in which thoughts move away from the task toward an internal train of thoughts, possibly during phases of neuronal sleep-like activity (local sleep, LS). MW decreases cortical processing of external stimuli and is assumed to decouple attention from the external world. Here, we directly tested how indicators of LS, cortical processing, and attentional selection change in a pop-out visual search task during phases of MW. Participants’ brain activity was recorded using magnetoencephalography, MW was assessed via self-report using randomly interspersed probes. As expected, the performance decreased under MW. Consistent with the occurrence of LS, MW was accompanied by a decrease in high-frequency activity (HFA, 80–150 Hz) and an increase in slow wave activity (SWA, 1–6 Hz). In contrast, visual attentional selection as indexed by the N2pc component was enhanced during MW with the N2pc amplitude being directly linked to participants’ performance. This observation clearly contradicts accounts of attentional decoupling that would predict a decrease in attention-related responses to external stimuli during MW. Together, our results suggest that MW occurs during phases of LS with processes of attentional target selection being upregulated, potentially to compensate for the mental distraction during MW.
COVID-19: Knowledge of Mode of Spread and Preventive Practices among College Adolescents in Nigeria
Authors: Aronu Ann E , Chinawa Awoere T , Ossai Edmund N , Onukwuli Vivian O , Chinawa Josephat M 
Published: January 2021

Abstract

Background
Corona virus pandemic (COVID 19) has emerged as the single most important topical issue and poses a challenge to medicine. Adolescent school children are exposed to a varying degree.

Objectives
The study is aimed to determine the knowledge of the mode of spread and preventive practices among college adolescents attending six secondary schools in Enugu metropolis.

Methodology
This was a cross-sectional study carried out in 6 secondary schools among 500 college adolescents. A pretested, interviewer-administered questionnaire was used for data collection.

Results
Majority of the respondents, 98.4% were aware of COVID-19. Although, a higher proportion of the respondents, 52.0% were aware COVID-19 could be transmitted through contact with infected persons, only a minor proportion of them, 42.4% had a good knowledge of the mode of spread of COVID-19. However, a high proportion of the respondents, 69.2% practiced good preventive measures against COVID-19. Also, respondents whose parents were self-employed were 1.4 times more likely to have good knowledge of the mode of spread of COVID-19 when compared with those whose parents were on paid employment [adjusted odd ratio (AOR) = 1.4, 95% confidence interval (CI): 0.9–2.0]. The respondents whose fathers have attained tertiary education were 1.6 times more likely to have good preventive practices against COVID-19 when compared with those who had secondary school and below (AOR = 1.6, 95% CI: 1.04–2.5).

Conclusion
Though college adolescents were aware of COVID-19, not a significant proportion practiced good preventive measures against COVID-19. Knowledge of mode of spread and preventive practices were significantly enhanced by fathers’ educational status and being a female adolescent child.
Designing transmissible viral vaccines for evolutionary robustness and maximum efficiency
Authors: Layman Nathan C , Tuschhoff Beth M , Nuismer Scott L 
Published: January 2021

Abstract
The danger posed by emerging infectious diseases necessitates the development of new tools that can mitigate the risk of animal pathogens spilling over into the human population. One promising approach is the development of recombinant viral vaccines that are transmissible, and thus capable of self-dissemination through hard to reach populations of wild animals. Indeed, mathematical models demonstrate that transmissible vaccines can greatly reduce the effort required to control the spread of zoonotic pathogens in their animal reservoirs, thereby limiting the chances of human infection. A key challenge facing these new vaccines, however, is the inevitability of evolutionary change resulting from their ability to self-replicate and generate extended chains of transmission. Further, carrying immunogenic transgenes is often costly, in terms of metabolic burden, increased competition with the pathogen, or due to unintended interactions with the viral host regulatory network. As a result, natural selection is expected to favor vaccine strains that down-regulate or delete these transgenes resulting in increased rates of transmission and reduced efficacy against the target pathogen. In addition, efficacy and evolutionary stability will often be at odds; as when longer, more efficacious antigens experience faster rates of evolutionary decay. Here, we ask how such trade-offs influence the overall performance of transmissible vaccines. We find that evolutionary instability can substantially reduce performance, even for vaccine candidates with the ideal combination of efficacy and transmission. However, we find that, at least in some cases, vaccine stability and overall performance can be improved by the inclusion of a second, redundant antigen. Overall, our results suggest that the successful application of recombinant transmissible vaccines will require consideration of evolutionary dynamics and epistatic effects, as well as basic measurements of epidemiological features.
The Impact of 2 Weight-Based Standard Parenteral Nutrition Formulations Compared With One Standard Formulation on the Incidence of Hyperglycemia and Hypernatremia in Low Birth-Weight Preterm Infants
Authors: Garner Sandra S. , Cox Toby H. , Safirstein Julie , Groat Erna K. , Breznak Katherine , Taylor Sarah N. 
Published: January 2021

Background:
Standardized parenteral nutrition (PN) formulations are used in at-risk neonates to provide nutrition immediately following birth. However, evidence for the optimal formulation(s) to maximize growth while reducing the risks of glucose and electrolyte abnormalities is limited.

Purpose:
The purpose of this study was to compare the rates of hypernatremia and hyperglycemia with 2 weight-based standardized PN formulations versus one standard PN in low birth-weight preterm neonates.

Methods:
This was a single-center observational study of infants less than 1800 g birth weight and less than 37 weeks' gestation who received standardized PN in the first 48 hours of life. Patients in the weight-based PN group were compared with a historical group of patients receiving single standard PN. Rates of hypernatremia and hyperglycemia were compared by χ2 analysis.

Results:
There was a nonsignificant (P = .147) reduction in hypernatremia in the weight-based PN group (9 of 87; 10.3%) compared with the single PN group (16 of 89; 18.0%). However, hyperglycemia was significantly more frequent in the weight-based group than in the single PN group (24.1% vs 12.4%, P = .035).

Implications for Practice:
The 2 weight-based PN standardized formulations studied did not significantly decrease the incidence of hypernatremia or hyperglycemia.

Implications for Research:
Future studies to determine optimal standardized PN to provide early nutrition in high-risk neonates are warranted.
A New Technique for Patient Registration During Navigated Total Hip Arthroplasty
Authors: Oragui Emeka , Du-Moulin Will , Adie Sam , Molnar Robert , Harris Laura 
Published: January 2021

Background:
This study describes a new technique of computer navigation for total hip arthroplasty (THA) that uses a customized perspex board to register the coronal plane of a patient in the lateral position. Cup placement is then referenced to the coronal plane.

Purposes:
This paper looks at the outcome of this technique.

Materials and Methods:
Seventeen patients who underwent a total of 18 THA were included. During surgery, the patient was placed in a lateral decubitus position and care taken to ensure the patient was secured perpendicular to the table. The coronal plane was registered using a customized perspex board aligned with the long axis of the operating table. The intraoperative target for acetabular cup placement was 20-degree anteversion and 40-degree inclination with respect to the coronal plane. Radiographs were taken 6 weeks postoperatively.

Results:
The mean cup angle of anteversion was larger in the postoperative method (M=22.83, SD=4.436) than in the intraoperative method (M=22.39, SD=4.629). A 1-sample t test indicated the difference between means was not statistically significant. The mean cup angle of inclination was larger in the intraoperative method (M=44.83, SD=3.400) than in the postoperative method (M=41.56, SD=4.693). A 1-sample t test indicated the difference between means was significant although still within the prescribed safe zones.

Conclusion:
Using a customized perspex board to register the patient and targeting cup placement to a safe zone referenced to the coronal plane result in optimal cup placement when assessed by postoperative radiographs. This avoids the need to turn the patient after registration and obviates the effect of pelvic tilt on cup placement.

Level of Evidence:
Level IV—case series.
Posterolateral Tibial Plateau Depression Fracture Reduction and Fixation: A Novel Approach
Authors: Fletcher Jason , Bateman Edward 
Published: January 2021

Introduction:
Reduction and fixation of pure depression fractures of the posterolateral tibial plateau are technically challenging. Surgical approach and exposure are complicated by the presence of the fibular head and important ligamentous, and neurovascular structures. Current lateral-based plate options may also leave the elevated articular surface unsupported and risk subsequent collapse.

Materials and Methods:
We present a case of a 37-year-old female rugby player with acute isolated posterolateral tibial plateau depression fracture. We utilized a novel surgical strategy that included a standard anterolateral approach, indirect reduction of the depressed articular surface using a targeted lateral tibial plateau osteotomy, and fixation with anterolateral periarticular and 1/3 tubular plate used in “blade” manner. The reduction was confirmed by fluoroscopy and arthroscopy. Fixation was augmented by femoral strut allograft to fill subsequent defect.

Results:
Postoperative progress was uncomplicated. At a 3-month review, the fracture was united and the patient had a full range of knee motion and function.

Conclusions:
This article presents a technique for reduction and stabilization of posterolateral articular impaction fractures while minimizing potential neurovascular and soft tissue complications.
Static Spacer Construction Using Carbon Fiber Rods in 2-stage Revision for Periprosthetic Knee Infection: A Novel Technique and Indications
Authors: Scott Brandon , Levins James , Mariorenzi Michael , Marcaccio Steven , Cohen Eric 
Published: January 2021

Background:
Traditionally, 2-stage exchange arthroplasty is preferred to eradicate chronic periprosthetic joint infections after total knee arthroplasty. However, for cases with significant bone destruction and/or soft tissue damage, the risk of knee instability increases with this technique, leading to a number of complications such as tibiofemoral dislocation, wound healing complications, extensor mechanism rupture, or failure of extensor mechanism repair. Intramedullary fixator rods reinforcing static spacers have been utilized to provide improved stability, but persistent infections were still prevalent. Antibiotic static spacers with intramedullary fixator rods coated with antibiotic cement can lower these reinfection rates.

Surgical Technique:
The surgical sequence requires removal of the infected prosthesis and placement of a carbon fiber rod and nonarticulating antibiotic spacer. This remains in situ for ~6 to 12 weeks while the patient receives systemic antibiotic treatment. Following confirmation of successful treatment, the antibiotic spacer and carbon fiber rod are removed, and revision arthroplasty is performed in a standard manner.

Results:
After a minimum of 1-year follow-up, no recurrent infections were diagnosed, 1 patient suffered a complication requiring expedited antibiotic spacer removal, and 1 patient expired in this cohort.

Conclusions:
This technique represents an effective method of providing stability of the knee and delivering adequate antibiosis in patients with knee periprosthetic joint infections in the setting of extensor mechanism disruption and severe bone loss.
Transcranial Doppler Versus CT-Angiography for Detection of Cerebral Vasospasm in Relation to Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage: A Prospective Single-Center Cohort Study
Authors: van der Harst J. Joep , Luijckx Gert-Jan. R. , Elting Jan Willem J. , Bokkers Reinoud P.H. , van den Bergh Walter M. , Eshghi Omid S. , Metzemaekers Jan D.M. , Groen Rob J.M. , Mazuri Aryan , van Dijk J. Marc C. , Uyttenboogaart Maarten 
Published: January 2021

Objectives:
Cerebral vasospasm in the first 2 weeks after aneurysmal subarachnoid hemorrhage is recognized as a major predictor of delayed cerebral ischemia. The routine screening for cerebral vasospasm with either transcranial Doppler or CT angiography has been advocated, although its diagnostic value has not yet been determined. Our study investigated the diagnostic accuracy of detecting vasospasm by transcranial Doppler and CT angiography for the prediction of delayed cerebral ischemia and functional outcome. Additionally, agreement between transcranial Doppler and CT angiography was determined.

Design:
Prospective diagnostic accuracy study.

Settings:
Neurocritical care unit and neurosurgical ward at a tertiary academic medical center.

Patients:
Between 2013 and 2016, 59 consenting patients were included.

Intervention:
Patients undergo both transcranial Doppler and CT angiography for detection of cerebral vasospasm on days 5 and 10 after aneurysmal subarachnoid hemorrhage. Delayed cerebral ischemia was defined as secondary neurologic deterioration, not explained otherwise. Unfavorable outcome was defined modified Rankin Scale > 2 at 6 months.

Measurements and Main Results:
On transcranial Doppler, cerebral vasospasm was observed in 26 patients (45%). On CT angiography, vasospasm was observed in 54 patients (95%). The agreement between transcranial Doppler and CT angiography was 0.47. Delayed cerebral ischemia occurred in 16 patients (27%); unfavorable outcome in 12 patients (20%). Transcranial Doppler predicted delayed cerebral ischemia with a sensitivity of 0.44 (day 5) and 0.50 (day 10), with a specificity of 0.67 (day 5) and 0.57 (day 10). CT angiography predicted delayed cerebral ischemia with a sensitivity of 0.81 (day 5 and 10) and with a specificity of 0.070 (day 5) and 0.00 (day 10). The highest accuracy for predicting unfavorable outcome was on day 5 (0.61 for transcranial Doppler vs 0.27 for CT angiography).

Conclusion:
The diagnostic accuracy of both CT angiography and transcranial Doppler for detection of cerebral vasospasm as well as prediction of delayed cerebral ischemia and functional outcome is limited. The agreement between CT angiography and transcranial Doppler is low.
CHORIOCAPILLARIS FLOW IMPAIRMENT IN TYPE 3 MACULAR NEOVASCULARIZATION
Authors: Le Hoang Mai , Souied Eric H. , Querques Giuseppe , Colantuono Donato , Borrelli Enrico , Sacconi Riccardo , Amoroso Francesca , Capuano Vittorio , Jung Camille , Miere Alexandra 
Published: January 2021

Purpose:
To quantitatively analyze choriocapillaris alterations using swept-source optical coherence tomography angiography in eyes presenting with Type 3 macular neovascularization (MNV) and to compare these alterations with eyes presenting with intermediate AMD (iAMD).

Methods:
Macular 3 × 3-mm swept-source optical coherence tomography angiography scans were retrospectively analyzed in eyes with Type 3 MNV and in eyes with iAMD. The choriocapillaris en face slabs were extracted from the swept-source optical coherence tomography angiography device after manual segmentation. En face choriocapillaris flow images were compensated with en face choriocapillaris structure images, followed by the Phansalkar local thresholding method using a window radius of 4 and 8 pixels. The percentage of flow deficits (FD%), the number, size, and total area of FDs were computed for comparison. A secondary analysis was performed in the four corners of the image to include equidistant regions in all eyes.

Results:
Twenty-six Type 3 MNV eyes of 21 patients and 26 iAMD eyes of 17 patients were included. Compared with iAMD eyes, eyes with Type 3 MNV displayed a higher FD% (41.37% ± 14.74 vs. 19.80% ± 9.63 using radius 4 pixels [P < 0.001]; 45.24% ± 11.9 vs. 26.63% ± 8.96 using radius 8 pixels [P < 0.001]). The average size of FDs was significantly larger in Type 3 MNV eyes compared with iAMD eyes (P < 0.001), whereas the number of FDs was significantly lower in Type 3 MNV compared with iAMD eyes (P < 0.001).

Conclusion:
Type 3 MNV eyes present with increased choriocapillaris flow impairment compared with iAMD eyes. Reduced choriocapillaris perfusion may contribute to Type 3 MNV development and pathogenesis.