bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is pituitary MRI screening necessary in cluster headache?
Authors: Grangeon Lou , O’Connor Emer , Danno Daisuke , Ngoc Thanh Mai Pham , Cheema Sanjay , Tronvik Erling , Davagnanam Indran , Matharu Manjit 
Published: January 2021

Objective To determine the prevalence and clinical predictors of pituitary adenomas in cluster headache patients, in order to determine the necessity of performing dedicated pituitary magnetic resonance imaging in patients with cluster headache. Methods A retrospective study was conducted of all consecutive patients diagnosed with cluster headache and with available brain magnetic resonance imaging between 2007 and 2017 in a tertiary headache center. Data including demographics, attack characteristics, response to treatments, results of neuroimaging, and routine pituitary function tests were recorded. Results Seven hundred and eighteen cluster headache patients attended the headache clinic; 643 underwent a standard magnetic resonance imaging scan, of whom 376 also underwent dedicated pituitary magnetic resonance imaging. Pituitary adenomas occurred in 17 of 376 patients (4.52%). Non-functioning microadenomas (n = 14) were the most common abnormality reported. Two patients, one of whom lacked the symptoms of pituitary disease, required treatment for their pituitary lesion. No clinical predictors of those adenomas were identified after multivariate analysis using random forests. Systematic pituitary magnetic resonance imaging scanning did not benefit even a single patient in the entire cohort. Conclusion The prevalence of pituitary adenomas in cluster headache is similar to that reported in the general population, thereby precluding an over-representation of pituitary lesions in cluster headache. We conclude that the diagnostic assessment of cluster headache patients should not include specific pituitary screening. Only patients with standard brain magnetic resonance imaging findings or symptoms suggestive of a pituitary disorder require brain magnetic resonance imaging with dedicated pituitary views.
Effects of Anxiety and Depression Measured via the Hospital Anxiety and Depression Scale on Early Pain and Range of Motion After Rotator Cuff Repair
Authors: Park Joo Hyun , Rhee Sung-Min , Kim Hyong Suk , Oh Joo Han 
Published: January 2021

Background: Preoperative anxiety and depression are independent predictors of clinical outcomes after arthroscopic rotator cuff repair. However, few studies have evaluated correlations between outcomes such as pain and range of motion (ROM) after arthroscopic rotator cuff repair and preoperative anxiety and depression. Purpose: To evaluate the effects of preoperative anxiety and depression, measured using the Hospital Anxiety and Depression Scale (HADS), on early pain and ROM after rotator cuff repair. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 144 consecutive patients who underwent arthroscopic rotator cuff repair were enrolled and divided into 2 groups according to HADS scores: group A, those with a healthy psychological status (n = 103; anxiety ≤7 and depression ≤7), and group B, those with psychological distress (n = 41; anxiety ≥8 or depression ≥8). Clinical outcomes were assessed using the visual analog scale for pain (pVAS) and ROM at 3 and 6 months postoperatively and annually. Results: There were no significant preoperative differences in age, sex, tear size, pVAS scores, and ROM. However, at 3 months postoperatively, group A showed significantly lower mean pVAS scores (2.2 ± 1.3 vs 3.4 ± 1.8, respectively; P = .001) and significantly higher mean forward flexion (146.4°± 23.0° vs 124.1°± 28.2°, respectively; P < .001) than group B, as well as significantly higher mean levels of internal rotation at the back (T11.5 ± 2.8 vs L1.9 ± 2.5, respectively; P < .001) and significantly higher mean external rotation (42.4°± 15.9° vs 35.2°± 16.8°, respectively; P = .019). At 6 months postoperatively, the mean pVAS score was still significantly lower in group A than in group B (0.8 ± 1.6 vs 1.8 ± 2.1, respectively; P = .016), but other ROM measurements had no significant differences. There was also no significant difference in clinical and functional outcomes at the final follow-up. Conclusion: Anxiety and depression negatively affected clinical outcomes after rotator cuff repair. Recovery from pain and of ROM after arthroscopic rotator cuff repair occurred more quickly in patients with a healthy psychological status. Therefore, assessments of preoperative psychological status should be emphasized to improve early clinical outcomes after arthroscopic rotator cuff repair.
Diagnostic Radiology Residency Assessment Tools: A Scoping Review
Authors: Tu Wendy , Hibbert Rebecca , Kontolemos Mario , Dang Wilfred , Wood Tim , Verma Raman , McInnes Matthew D. F. 
Published: January 2021

Purpose: The multifaceted nature of learning in diagnostic radiology residency requires a variety of assessment methods. However, the scope and quality of assessment tools has not been formally examined. A scoping review was performed to identify assessment tools available for radiology resident training and to evaluate the validity of these tools. Methods: A literature search was conducted through multiple databases and on-line resources. Inclusion criteria were defined as any tool used in assessment of radiology resident competence. Data regarding residents, evaluators and specifics of each tool was extracted. Each tool was subjected through a validation process with a customized rating scale using the 5 categories of validity: content, response process, internal structure, relations to other variables, and consequences. Results: The initial search returned 447 articles; 35 were included. The most evaluated competency being overall knowledge (31%), most common published journal was Academic Radiology (24%) ; evaluations were most commonly set in the United States (57%). In terms of validation, we found low adherence to modern integrated validity, with 34% of studies including a definition of validity. When specifically examining the 5 domains of validation evidence presented, most were either absent or of low rigor (70%). Only one study presented a modern definition of validation (3%, 1/35). Conclusion: We identified 35 evaluation tools covering a variety of competency areas. However, few of these tools have been validated. Development of new validated assessment tools or validation of existing tools is essential for the ongoing transition to a competency-based curriculum.
Predictive models of infection in patients with systemic lupus erythematosus: A systematic literature review
Authors: Restrepo-Escobar Mauricio , Granda-Carvajal Paula A , Aguirre Daniel C , Hernández-Zapata Johanna , Vásquez Gloria M , Jaimes Fabián 
Published: January 2021

Introduction Having reliable predictive models of prognosis/the risk of infection in systemic lupus erythematosus (SLE) patients would allow this problem to be addressed on an individual basis to study and implement possible preventive or therapeutic interventions. Objective To identify and analyze all predictive models of prognosis/the risk of infection in patients with SLE that exist in medical literature. Methods A structured search in PubMed, Embase, and LILACS databases was carried out until May 9, 2020. In addition, a search for abstracts in the American Congress of Rheumatology (ACR) and European League Against Rheumatism (EULAR) annual meetings’ archives published over the past eight years was also conducted. Studies on developing, validating or updating predictive prognostic models carried out in patients with SLE, in which the outcome to be predicted is some type of infection, that were generated in any clinical context and with any time horizon were included. There were no restrictions on language, date, or status of the publication. To carry out the systematic review, the CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) guideline recommendations were followed. The PROBAST tool (A Tool to Assess the Risk of Bias and Applicability of Prediction Model Studies) was used to assess the risk of bias and the applicability of each model. Results We identified four models of infection prognosis in patients with SLE. Mostly, there were very few events per candidate predictor. In addition, to construct the models, an initial selection was made based on univariate analyses with no contraction of the estimated coefficients being carried out. This suggests that the proposed models have a high probability of overfitting and being optimistic. Conclusions To date, very few prognostic models have been published on the infection of SLE patients. These models are very heterogeneous and are rated as having a high risk of bias and methodological weaknesses. Despite the widespread recognition of the frequency and severity of infections in SLE patients, there is no reliable predictive prognostic model that facilitates the study and implementation of personalized preventive or therapeutic measures. Protocol registration number: PROSPERO CRD42020171638.
Retrospective comparison between single reading plus an artificial intelligence algorithm and two-view digital tomosynthesis with double reading in breast screening
Authors: Graewingholt Axel , Duffy Stephen 
Published: January 2021

Objective To examine the breast cancer detection rate by single reading of an experienced radiologist supported by an artificial intelligence (AI) system, and compare with two-dimensional full-field digital mammography (2D-FFDM) double reading. Materials and methods Images (3D-tomosynthesis) of 161 biopsy-proven cancers were re-read by the AI algorithm and compared to the results of first human reader, second human reader and consensus following double reading in screening. Detection was assessed in subgroups by tumour type, breast density and grade, and at two operating points, referred to as a lower and a higher sensitivity threshold. Results The AI algorithm method gave similar results to double-reading 2D-FFDM, and the detection rate was significantly higher compared to single-reading 2D-FFDM. At the lower sensitivity threshold, the algorithm was significantly more sensitive than reader A (97.5% vs. 89.4%, p = 0.02), non-significantly more sensitive than reader B (97.5% vs. 94.4%, p = 0.2) and non-significantly less sensitive than the consensus from double reading (97.5% vs. 99.4%, p = 0.2). At the higher sensitivity threshold, the algorithm was significantly more sensitive than reader A (99.4% vs. 89.4%, p < 0.001) and reader B (99.4% vs. 94.4%, p = 0.02) and identical to the consensus sensitivity (99.7% in both cases, p = 1.0). There were no significant differences in the detection capability of the AI system by tumour type, grading and density. Conclusion In this proof of principle study, we show that sensitivity using single reading with a suitable AI algorithm is non-inferior to that of standard of care using 2D mammography with double reading, when tomosynthesis is the primary screening examination.
Cholinesterase Inhibitor Use in Patients With Dementia Admitted to a Palliative Care Unit
Authors: Perri Giulia-Anna , Wilson Jessica , Gardner Sandra , Berall Anna , Kirstein Anne , Khosravani Houman 
Published: January 2021

Objectives: Current guidelines suggest that patients with severe dementia on cholinesterase inhibitors (CHEIs) should discontinue their CHEIs by taper. This study aims to define the prevalence of patients admitted to a palliative care unit (PCU) with dementia on a CHEI and to determine whether these patients were tapered off their CHEIs according to current deprescribing guidelines. Design: This is a descriptive retrospective chart review that examined patients admitted to a PCU with dementia on a CHEI from January 2015 to June 2019. Methods: Individuals admitted to the PCU with a primary or comorbid diagnosis of dementia were identified. Their corresponding CHEI dose, frequency and discontinuation pattern were identified. Data were analyzed using descriptive statistics. Results: A total of 36 patients were admitted to the PCU with dementia on a CHEI (prevalence of 2.3%). The median length of stay was 21 days. For 31 of these patients, their CHEI was discontinued, only 9 of which had a taper. Of the 24 patients who discontinued their CHEI suddenly, 10 patients had an order to discontinue their CHEI in the last 2 days before their date of death. Conclusion: This study suggests that although patients admitted to a PCU with dementia have their CHEI discontinued, the discontinuation was done without a taper. In many cases the CHEIs were continued through the active stage of dying. Future work should explore reasons why PCU physicians are mostly late to taper CHEIs for patients admitted with dementia.
A Systematic Review of Sleep and Circadian Rhythms in Children with Attention Deficit Hyperactivity Disorder
Authors: Bondopadhyay Upasana , Diaz-Orueta Unai , Coogan Andrew N. 
Published: January 2021

Objective: Children and adults with ADHD often report sleep disturbances that may form part of the etiology and/or symptomatology of ADHD. We review the evidence for sleep changes in children with ADHD. Methods: Systematic review with narrative synthesis assessing sleep and circadian function in children aged 5 to 13 years old with a diagnosis of ADHD. Results: 148 studies were included for review, incorporating data from 42,353 children. We found that sleep disturbances in ADHD are common and that they may worsen behavioral outcomes; moreover, sleep interventions may improve ADHD symptoms, and pharmacotherapy for ADHD may impact sleep. Conclusion: Sleep disturbance may represent a clinically important feature of ADHD in children, which might be therapeutically targeted in a useful way. There are a number of important gaps in the literature. We set out a manifesto for future research in the area of sleep, circadian rhythms, and ADHD.
Retrospective evaluation of refeeding syndrome in cats: 11 cases (2013–2019)
Authors: Cook Simon , Whitby Emily , Elias Neus , Hall Georgina , Chan Daniel L 
Published: January 2021

Objectives The aim of this study was to describe the clinicopathological findings, management and outcome of cats with refeeding syndrome (RS) following prolonged starvation. Methods Records from four referral hospitals were searched between May 2013 and November 2019 and retrospectively evaluated. Inclusion criteria were the presence of a risk factor for RS, such as severe weight loss or emaciation following a period of presumed starvation, hypophosphataemia or a delta phosphorous exceeding 30% reduction following refeeding, being treated on the basis of a clinical diagnosis of RS and one or more derangement of hypokalaemia, hypoglycaemia or hyperglycaemia. Results Eleven cats were identified, which had been missing for a median of 6 weeks (range 3–104 weeks). Mean ± SD percentage weight loss was 46% ± 7% (n = 8). Eight of 11 cats developed hypophosphataemia with a mean delta phosphorous of −47% ± 9%. All cats were documented to be hypokalaemic. During hospitalisation, 10/11 cats developed hyperglycaemia and 7/11 cats developed hypoglycaemia. Cardiovascular, gastrointestinal and neurological signs were common. Eight of 11 cats displayed new or progressive neurological deficits after refeeding, including mentation changes and cerebellar dysfunction. All cats became anaemic and seven cats required a blood transfusion. Eight cats survived to discharge after a mean of 14 ± 4 days of hospitalisation. Six cats developed acute kidney injury (AKI; International Renal Interest Society stage 1). The presence of AKI ( P = 0.024) was associated with non-survival and maximum bilirubin concentration was significantly higher in non-survivors ( P = 0.018). Conclusions and relevance Cats with RS in this cohort had been missing, presumed starved, for more than 3 weeks. In addition to hypophosphataemia and hypokalaemia, altered glucose homeostasis and organ damage involving the liver and kidneys were common. Cats with RS appear to have a good prognosis, but prolonged intensive care is required.
Optimal In Situ Fenestration Technique With Laser Perforation and Balloon Dilation for Aortic Stent-Grafts
Authors: Lin Jing , Rodriguez Limael E. , Nutley Mark , Jun Lu , Mao Ying , Parikh Niraj , Alie-Cusson Fanny , Zhang Ze , Wang Lu , Panneton Jean M. , Guidoin Robert 
Published: January 2021

Purpose: To evaluate the response of various stent-grafts after laser fenestration and dilation with noncompliant balloons to determine the optimal therapeutic combination for this treatment technique. Materials and Methods: Five aortic stent-grafts were evaluated ex vivo: the Bolton RelayPlus, Jotec E-vita Thoracic 3G, Medtronic Valiant, Cook Zenith Alpha, and Vascutek Anaconda. Small holes were created using an excimer laser with the grafts submerged in saline. Five rows of 5 fenestrations were created, 4 holes in each row were dilated once with a 6-, 8-, 10-, or 12-mm-diameter noncompliant balloon to the specified nominal pressure (one hole served as the control). The saline solution from each stent-graft was collected and qualitatively analyzed for debris. The fenestrations were evaluated under light and scanning electron microscopes. The maximum diameter and area for each fenestration were measured. The direction and length of tears were assessed. Results: The fenestration was feasible and reproducible in all the stent-grafts. The mean area of fenestration ranged from 7.63±1.63 to 14.75±0.73 mm2 when using balloons of 6- and 8-mm diameter, respectively. The 10- and 12-mm-diameter balloons caused a significant increase in area, variability, and tearing. The Anaconda graft tended to tear in the weft direction, while the other devices tore in the warp direction when using the 10- and 12-mm-diameter balloons. Dilation of the RelayPlus and Anaconda grafts with 6- and 8-mm-diameter balloons provided minimal tearing and precise fenestrations. Melted fiber remnants were observed after filtration of the saline solution for all devices. Conclusion: Laser fenestration and dilation with noncompliant balloons is a relatively simple and reproducible option for revascularization in urgent, complex aortic endovascular repairs. In our model, large balloons (ie, >10 mm) increased the destruction and tearing of the fabric. The maximum dilation recommended is 6 to 8 mm to avoid significant tears. Development of stent-grafts or novel fabrics designed explicitly for fenestration is needed to reduce potential complications.
Stroke units in the Philippines: An observational study
Authors: Navarrro Jose C , Escabillas Cyrus , Aquino Abdias , Macrohon Christina , Belen Allan , Abbariao Maritoni , Cuasay Edna , Lao Annabelle , Sarfati Soccorro , Hiyadan John H , Reyes Fe delos , Salazar Gerald , Dadgardoust Pariessa , De leon-Gacrama Franchesca , Reandelar Macario 
Published: January 2021

Background In high-income countries, the management of stroke has changed substantially over the years with the advent of thrombolysis and endovascular treatment. However, in low-income countries, such interventions may not be available, or patients may come to the hospital outside the time window no longer qualified for this therapy. Most studies on stroke units were conducted in high-income countries. Unfortunately, there has been no local multicenter data with large patient numbers showing the effectiveness of stroke units in the Southeast Asian region. Aim To compare the outcomes of patients allocated to stroke units (based on accepted criteria) to those allocated to general neurology wards in the Philippines. Methods This is an open, prospective, parallel, observational comparative study of patients from 11 institutions in the Philippines. Patients were allocated either to the stroke unit or to the general neurology ward by the admitting physician based on the criteria suggested by the Stroke Trialist Collaboration Group. The primary outcome was to determine in-hospital mortality at three- and six months in both stroke units and general neurology wards. The secondary outcomes were determined by a dichotomized modified Rankin scale: (0–2) independent and (3–5) dependent. Results A total of 1025 patients were included in the study. In the primary outcome, a higher mortality rate (8.4% vs 1.0%) in the general neurology ward (p = 0.000) was seen. The six-month mortality rate was statistically significant and higher among patients admitted to the general neurology ward (3.1% vs 0.8%) (p = 0.009). Patients admitted to the stroke unit attained an independent functional outcome (mRS 0–2) as compared to the general neurology ward (73% vs 61.5%) (p = 0.000). Analysis of functionality at six months favored patients admitted in the stroke unit (88.5% vs 81.4%) as compared to the general neurology ward. Conclusion Patients specifically admitted to stroke units in the Philippines based on established criteria have better outcomes than those admitted to general neurology wards.
Shape Factor of the Spinal Cord: A Possible Predictor of Surgical Outcome for Intradural Extramedullary Spinal Tumors in the Thoracic Spine
Authors: Matsumoto Yoshihiro , Saiwai Hirokazu , Iida Keiichiro , Okada Seiji , Endo Makoto , Setsu Nokitaka , Fujiwara Toshifumi , Kawaguchi Kenichi , Nakashima Yasuharu 
Published: January 2021

Study Design: Retrospective diagnostic analysis. Objectives: To establish a new predictor of surgical outcome after surgery for intradural extramedullary spinal tumor (IDEMT) in the thoracic spine, we introduced shape factor (SF), a mathematical description of the morphology of the spinal cord. SF was calculated by dividing object area by the square of perimeter. Materials and Methods: Forty-three consecutive patients with IDEMT, detected by magnetic resonance imaging at the thoracic level with myelopathic signs, were included. Preoperative transverse cross-sectional area (CSA) and perimeter of the spinal cord (perimeter) at the level of maximal compression were measured. SF was calculated as 4π × CSA/(perimeter)2. The association between clinicoradiological factors and surgical outcome of IDEMT was statistically analyzed. Results: Mean CSA, perimeter, and SF were 27.8 ± 15.8 mm2, 28.8 ± 6.1 mm, and 0.385 ± 0.14, respectively. A histogram distribution revealed that perimeter and SF, but not CSA, fit the normal distribution. The patients were subdivided into 2 groups according to postoperative modified Japanese Orthopedic Association Score (mJOA). [group F (favorable): n = 32, mJOA ≥ 9; group UF (unfavorable): n = 11, mJOA < 9). Group UF had significantly lower mean CSA and SF. In univariate analysis of possible predictive factors for IDEMT surgery, greater age, lower preoperative mJOA, and lower SF were significantly associated with unfavorable outcome. In multivariate analysis, lower SF was the only significant predictor of postoperative outcome (odds ratio = 2.66, 95% CI 1.10–6.39, p = 0.0115). Conclusion: Measurements of CSA and perimeter, followed by calculation of SF, may provide valuable quantitative information for the outcome of surgery for IDEMT.