bluuebunny/crossref_metadata_2025_split huggingface dataset:
P14.113 The role of maintenance high-dose methotrexate chemotherapy in elderly primary CNS lymphoma patients with complete response to induction immunochemotherapy
Authors: Mishima K , Shirahata M , Adachi J , Suzuki T , Fujimaki T , Nishikawa R 
Published: September 2019

Abstract

BACKGROUND
The addition of high-dose methotrexate (HD-MTX)-based chemotherapy to whole brain irradiation (WBRT) has improved the prognosis of primary central nervous system lymphoma (PCNSL). However, the high neurotoxicity rates observed, especially in the elderly, raised interest in chemotherapy-only treatments. Withholding radiotherapy substantially decreases the risk of neurotoxicity, however, disease control may be compromised. Therefore, developing a novel treatment for the elderly PCNSL patients (ePCNSL) is crucial. In the elderly who cannot tolerate WBRT as a consolidation, maintenance treatment may serve as a feasible approach after an initial response. We treated ePCNSL with induction immunochemotherapy with rituximab (RIT) and HD-MTX, maintenance chemotherapy with HD-MTX and deferred WBRT. Here, we retrospectively investigated the prognosis for ePCNSL that became CR after the induction chemotherapy.

MATERIAL AND METHODS
Newly diagnosed ePCNSL (median age: 74 years) received biweekly RIT/ HD-MTX (375 mg/m2/dose; 3.5g/m2/dose) for 6 cycles (induction) followed by monthly RIT/MTX for 2 cycles (consolidation) and then were treated differently according to the radiological response. With CR patients, HD-MTX was continued with every 3 months (maintenance) for 2 years. Patients who did not obtain consent for maintenance therapy were followed up.

RESULTS
Of the 42 ePCNSL (median age 74 years), 26 had CR after induction and consolidation, of which 18 cases were carried out maintenance (M +) and 8 cases were followed up (M-). The median age was 74 and 76, respectively. Median progression-free survival (mPFS) was 73 months in the M+ group and 24.6 months in the M- group. Median overall survival (mOS) is 92.5 months versus 27.6 months, respectively. Both mPFS (P= 0.025) and mOS (P =0.0003) were significantly prolonged by maintenance therapy. In addition, ePCNSL with tumors involvement of deep brain structure had a poor prognosis.

CONCLUSION
It was suggested that maintenance treatment with HD-MTX may improve the prognosis for ePCNSL that reached complete response after induction therapy.
P14.115 A Neurologist’s Foray into Gamma Knife: Lessons Learned from the first 100 cases:
Authors: Stevens G H J , Chao S T , Murphy E S , Suh J H , Yu J , Neyman G 
Published: September 2019

Abstract

BACKGROUND
Gamma Knife Radiosurgery typically involves a neurosurgeon, radiation oncologist and physicist. Neurologists performing Gamma Knife provides a potential paradigm shift.

METHODS
The first 100 Gamma Knife procedures were completed on an Elekta Perfexion or ICON system between October 2015 and August 2018. Head frames were placed by the treating neurologist who also completed the contouring and targeting. The Radiation Oncologist defined the prescription dose and verified the plan, along with the physicist.

RESULTS
Of the first 100 cases completed by the treating neurologist, 52 were females and 48 males. The average age was 61.4 years. There were 64 metastatic cases, 25 meningiomas, 8 gliomas, 2 hemangioblastoma and 1 pituitary adenoma. There were 245 individual lesions targeted. No frame related placement complications occurred. Five large metastasis were treated as a staged procedure 1 month apart. A bolus was used on 4 occasions for lesions invading the skull. Secondary to large bifrontal craniotomies, cheek posts were used on 2 occasions, and 3 posts were used in 5 cases secondary to large unilateral frontal craniotomies. Four cases were completed under general anesthesia. In one patient with a very large head, the frame would not fit and was deconstructed, placed around the neck, reconstructed with pins placed in the cheeks. 64 of the treated patients are still alive.

CONCLUSION
While unconventional, neurologists can function as a surgical surrogate to treat intracranial neoplasms with Gamma Knife. This offers unique advantages, especially in regards to continuity of care as many of these patients had been followed and will continue to follow with neurology. With the advent of the ICON frameless based system, concerns about frame placement also become less of an issue and more facile for neurologists to perform these procedures.
P14.119 Clinical-radiological description of a retrospective series of patients diagnosed with stroke due to hypercoagulability associated with cancer
Authors: Esparragosa I , Valenti-Azcarate R , Moreno-Ajona D , Toledano-Illan C , Irimia Sieira P , Martinez-Vila E , Gallego Perez de Larraya J 
Published: September 2019

Abstract

OBJECTIVES
To describe the clinical-radiological characteristics of a monocentric series of patients with stroke due to a state of hypercoagulability associated with cancer.

MATERIAL AND METHODS
We retrospectively reviewed the clinical, radiological and laboratory data of 32 patients diagnosed of ischemic stroke secondary to a state of hypercoagulability associated with cancer between 2007 and 2017.

RESULTS
15/32 were women. The median age was 65 years (range: 48–82). In 4/32 patients, stroke led to the diagnosis of advanced stage cancer, and in 15/32 it occurred in the context of uncontrolled cancer progression. 24/32 patients had at least an additional vascular risk factor. Complementary tests were performed (blood analysis, carotid echo-Doppler, ECG-monitoring, echocardiogram) to rule out other aetiologies. 25/32 patients had acute ischemic lesions in 3 to 5 cerebrovascular territories. 23/32 had multiorgan infarctions in body CT. The D-Dimer was analysed in 14/32 patients, being elevated in 13/14 patients. Half of patients (16/32) suffered a recurrence of stroke in the first 4 weeks. Most frequently detected tumours were lung adenocarcinoma (11/32) and pancreatic adenocarcinoma (8/32). The median survival after the stroke was 1 month (range: 0.2–25 months).

CONCLUSIONS
Uncontrolled cancer may lead to a prothrombotic state that facilitates the development of strokes in multiple cerebrovascular territories. Recurrences are frequent despite anticoagulant therapy, and prognosis is poor because of the underlying cancer and stroke-related neurological deterioration.
P14.125 Retrospective analysis of long-term response to bevacizumab in combination with irinotecan for recurrent glioblastoma: identification of prognostic factors
Authors: Besson C , Morisse M , Brut H , Waissi W , Noel G , Chauffert B , Prébay D , Schott R , Etienne-Selloum N 
Published: September 2019

Abstract

BACKGROUND
In absence of standard treatment for recurrent glioblastoma (rGBM), numerous prospective and retrospective studies have evaluated the off-label combination of bevacizumab (BEV) with irinotecan (IRI) in patients with rGBM. We report here our single center experience with this combination and we investigated prognostic factors for long-term response.

MATERIAL AND METHODS
We performed a retrospective analysis of consecutive patients treated initially by Stupp protocol and with BEV-IRI for a rGBM between 2007 and 2017. Times to progression and overall survival, as well as toxicities, were investigated and analysed. Patients without progression at least 12 month after the first administration of BEV-IRI were considered as long-term responders. The primary end-point was overall survival post-BEV-IRI (OS-BEV-IRI).

RESULTS
One-hundred eleven patients were eligible for the analysis. Median age at the diagnosis was 57 years and the value of WHO Performance Status (PS) at the recurrence was 0 to 1 for 67,5% of patients. Kaplan-Meier median progression-free survival (PFS-BEV-IRI) and overall survival (OS-BEV-IRI) at recurrence estimates (calculated from start of BEV-IRI) were 6.51 and 10.41 months, respectively. The median OS (calculated from diagnosis) was 22,4 months. Twenty-Three patients (20,7%) were long-term responders to BEV-IRI regimen. This subgroup was not significantly different than the short-term responders according to age or PS distribution, but the relative proportion of biopsy in comparison to other surgery modalities was significantly increased in long-term responders (p<0,0001). Univariate analysis showed that PS 0–1 (p=0,007), biopsy (p=0,0022) are significantly associated with a better prognosis, but not age. Eighty three patients (75%) had toxicities, mainly grade 1 and 2 (92%), such as hypertension, proteinuria, haemorrhage, thrombosis, nausea, diarrhoea, fatigue or neutropenia. Most of the grade 3 and grade 4 toxicities were related to BEV treatment. Adverse events were significantly more frequent in long-term responders (p=0,0096).

CONCLUSION
BEV-IRI Combination is well tolerated and may offer some clinical benefits in recurrent GBM patients, more particularly if only biopsy was performed instead of surgery. Our results strengthened the role of these agents for the treatment of recurrent GBM.
Rapid phenotypic evolution with shallow genomic differentiation during early stages of high elevation adaptation in Eurasian Tree Sparrows
Authors: Qu Yanhua , Chen Chunhai , Xiong Ying , She Huishang , Zhang Yong E , Cheng Yalin , DuBay Shane , Li Dongming , Ericson Per G P , Hao Yan , Wang Hongyuan , Zhao Hongfeng , Song Gang , Zhang Hailin , Yang Ting , Zhang Chi , Liang Liping , Wu Tianyu , Zhao Jinyang , Gao Qiang , Zhai Weiwei , Lei Fumin 
Published: September 2019

AbstractKnown as the ‘third polar region’, the Qinghai-Tibet Plateau represents one of the harshest highland environments in the world and yet a number of organisms thrive there. Previous studies of birds, animals and humans have focused on well-differentiated populations in later stages of phenotypic divergence. The adaptive processes during the initial phase of highland adaptation remain poorly understood. We studied a human commensal, the Eurasian Tree Sparrow, which has followed human agriculture to the Qinghai-Tibet Plateau. Despite strong phenotypic differentiation at multiple levels, in particular in muscle-related phenotypes, highland and lowland populations show shallow genomic divergence and the colonization event occurred within the past few thousand years. In a one-month acclimation experiment investigating phenotypic plasticity, we exposed adult lowland tree sparrows to a hypoxic environment and did not observe muscle changes. Through population genetic analyses, we identified a signature of polygenic adaptation, whereby shifts in allele frequencies are spread across multiple loci, many of which are associated with muscle-related processes. Our results reveal a case of positive selection in which polygenic adaptation appears to drive rapid phenotypic evolution, shedding light on early stages of adaptive evolution to a novel environment.
Diabetes, Glycemic Control, and Risk of Infection Morbidity and Mortality: A Cohort Study
Authors: Chang Chia-Hsuin , Wang Jiun-Ling , Wu Li-Chiu , Chuang Lee-Ming , Lin Hsien-Ho 
Published: September 2019

Abstract

Objective
Diabetic patients have an elevated risk of infection, but the optimal level of glycemic control with the lowest infection risk remains unclear, especially among the elderly. We aimed to investigate the relation between fasting plasma glucose (FPG) level and risk of infection-related morbidity and mortality.

Method
The participants were from a community-based health screening program in northern Taiwan during 2005–2008 (n = 118 645) and were followed up until 2014. Incidence of hospitalization for infection and infection-related death was ascertained from the National Health Insurance Database and National Death Registry. Cox proportional hazards regression modelling was used to estimate the hazard ratio (HR) between FPG and risk of infection.

Results
During a median follow-up of 8.1 years, the incidence rate of hospitalization for any infection was 36.33 and 14.26 per 1000 person-years among diabetics and nondiabetics, respectively, in the total study population, but increased to 70.02 and 45.21 per 1000 person-years, respectively, in the elderly. In the Cox regression analysis, the adjusted HR comparing diabetics to nondiabetics was 1.59 (95% confidence interval [CI], 1.52–1.67) for any hospitalization for infection and 1.71 (95% CI, 1.36–2.16) for infection-related mortality. The hazard for infection morbidity and mortality was higher at both extremes (&lt;90 and &gt;200 mg/dl) of FPG. The excess risk associated with FPG ≤ 90 mg/dl was attenuated after controlling for multiple comorbidities.

Conclusions
Poor glycemic control (FPG &gt; 200 mg/dl) was associated with a higher risk of infection-related morbidity and mortality, especially in the elderly population where the baseline infection risk was high.
Digital media: Promoting healthy screen use in school-aged children and adolescents
Authors:   Canadian Paediatric Society, Digital Health Task Force, Ottawa, Ontario
Published: September 2019

Abstract
Digital media are integrated into the everyday lives of children and adolescents, with potential benefits and risks for learning, mental and physical health, and for social life. This statement examines the cognitive, psychosocial, and physical effects of digital media on school-aged children and adolescents, with a focus on family routines, context, and activities. Evidence-based guidance for clinicians and families involves four principles: healthy management, meaningful screen use, positive modelling, and balanced, informed monitoring of screen time and behaviours.
Thermodynamics of a generalized graphene-motivated (2+1) D Gross–Neveu model beyond the mean field within the Beth–Uhlenbeck approach
Authors: Ebert Dietmar , Blaschke David 
Published: September 2019

Abstract
We investigate the thermodynamics at finite density of a generalized $(2 + 1)$D Gross–Neveu model of $N$ fermion species with various types of four-fermion interactions. The motivation for considering such a generalized schematic model arises from taking the Fierz transformation of an effective Coulomb current–current interaction and certain symmetry-breaking interaction terms, as considered for graphene-type models in Ref. [29]. We then apply path-integral bosonization techniques, based on the large-$N$ limit, to derive the thermodynamic potential. This includes the leading-order mean-field (saddle point) contribution as well as the next-order contribution of Gaussian fluctuations of exciton fields. The main focus of the paper is then the investigation of the thermodynamic properties of the resulting fermion–exciton plasma. In particular, we derive an extended Beth–Uhlenbeck form of the thermodynamic potential, and discuss the Levinson theorem and the decomposition of the phase of the exciton correlation into resonant and scattering parts.
The 1984 Cartagena Declaration: A Critical Review of Some Aspects of Its Emergence and Relevance
Authors: Fischel de Andrade José H 
Published: September 2019

Abstract
This article revisits some aspects of the emergence and relevance of the 1984 Cartagena Declaration on Refugees. After addressing the conceptual framework by proposing a definition of asylum regime and explaining which asylum sub-regimes exist at the regional level in Latin America, the article reviews the ideological nature of the historical set of facts that led to the adoption of the 1984 Cartagena Declaration. It then explains why was there a need for a change of regime in Central America, details both the drafting process that culminated in the 1984 Cartagena Declaration refugee definition and UNHCR’s role in it, and undertakes a critical analysis of the potential relevance of the Cartagena Declaration. The article’s general conclusion is that the 1984 Cartagena Declaration’s practical, political, and legal relevance is obsolescent and that its legacy is most likely to be found both in the broad refugee definitions that are captured in most of the region’s domestic legislations, and in the advocacy model which uses ad hoc and sui generis UNHCR-led events to advance conceptual frameworks for refugee protection policy.
Using Machine Learning in Psychiatry: The Need to Establish a Framework That Nurtures Trustworthiness
Authors: Chandler Chelsea , Foltz Peter W , Elvevåg Brita 
Published: September 2019

Abstract
The rapid embracing of artificial intelligence in psychiatry has a flavor of being the current “wild west”; a multidisciplinary approach that is very technical and complex, yet seems to produce findings that resonate. These studies are hard to review as the methods are often opaque and it is tricky to find the suitable combination of reviewers. This issue will only get more complex in the absence of a rigorous framework to evaluate such studies and thus nurture trustworthiness. Therefore, our paper discusses the urgency of the field to develop a framework with which to evaluate the complex methodology such that the process is done honestly, fairly, scientifically, and accurately. However, evaluation is a complicated process and so we focus on three issues, namely explainability, transparency, and generalizability, that are critical for establishing the viability of using artificial intelligence in psychiatry. We discuss how defining these three issues helps towards building a framework to ensure trustworthiness, but show how difficult definition can be, as the terms have different meanings in medicine, computer science, and law. We conclude that it is important to start the discussion such that there can be a call for policy on this and that the community takes extra care when reviewing clinical applications of such models..
Effects of rumen-protected long-chain fatty acid supplementation during the finishing phase of beef steers on live performance, carcass characteristics, beef quality, and serum fatty acid profile1
Authors: Bakker Christina E , Blair Amanda D , Grubbs Judson K , Taylor Anna R , Brake Derek W , Long Nathan M , Underwood Keith R 
Published: September 2019

Abstract:The effect of a rumen-protected long-chain fatty acid (LCFA) supplement on live performance, meat quality, blood serum fatty acid profile, and predicted carcass composition was evaluated in this study. Angus steer calves (n = 99) were fed a low energy diet for 77 d prior to finishing. Prior to study initiation, the steers were separated into 12 pens with eight or nine steers per pen. Steers were transitioned from the low energy forage–based diet to a high concentrate diet containing high moisture ear corn, corn silage, dry rolled corn, soybean meal, and a liquid supplement containing monensin across 21 d. Megalac-R (RPFA) was fed to six pens at 2% of the diet dry matter. Control pens (CON; n = 6) received an additional 2% of diet dry matter as dry rolled corn and soybean meal. The final finishing diet net energy for gain (NEg) was 1.20 and 1.19 mega calories·kg−1 of dry matter (DM) for RPFA and CON treatments, respectively. Steers were weighed every 28 d. Growth performance data including average daily gain (ADG), gain to feed ratio (G:F), and DM intake (DMI) were calculated as both monthly and overall data. After a 147-d finishing phase, steers were transported to a commercial abattoir for slaughter. After a 28-h chilling period, carcass data were obtained by trained personnel. Final live weights were greater (P = 0.01) for RPFA than CON cattle. Overall ADG and overall G:F was increased (P = 0.02; P = 0.01, respectively) for RPFA cattle. Ribeye area, backfat thickness, kidney pelvic heart fat, marbling score, and yield grade did not differ (P &gt; 0.05) between treatments. Predicted percent carcass fat was increased for RPFA cattle (P = 0.05). Conversely, predicted percent carcass protein (P = 0.07) and bone (P = 0.06) tended to be greater for CON cattle. Long-chain fatty acid supplementation during the finishing phase did not increase marbling scores of the steers in this study but did increase final live weight, HCW, and predicted total body fat. These results suggest that RPFA supplementation has the potential to increase adipose tissue development. However, it is likely that animal age during supplementation and duration of supplementation impact the effect RPFAs have on carcass characteristics.
Focused Assessment with Sonography for Urinary Schistosomiasis (FASUS)—pilot evaluation of a simple point-of-care ultrasound protocol and short training program for detecting urinary tract morbidity in highly endemic settings
Authors: Remppis J , Verheyden A , Bustinduy A L , Heller T , García-Tardón N , Manouana G P , Obiang R , Adegnika A A , Grobusch M P , Ramharter M , Joekes E , Bélard S 
Published: September 2019

Abstract

Background
Urogenital schistosomiasis (UGS) causes inflammation and fibrosis of the urinary tract. In resource-limited settings, affordable tools for morbidity assessment in clinical care are needed. Point-of-care ultrasound has not yet been validated for UGS-related pathology.

Methods
We developed a protocol for Focused Assessment with Sonography for Urinary Schistosomiasis (FASUS), assessing pathology of the bladder wall, ureters and kidneys. Following standardized training, two clinicians performed FASUS on children and adults with hematuria in Lambaréné, Gabon. Recorded ultrasound clips were remotely reviewed by two ultrasound experts as a diagnostic reference.

Results
In 2015 and 2016, scans were performed in 118 patients. The image quality was sufficient in 90% of bladder views and more than 97% of kidney views. UGS-compatible pathology was detected in 51/118 (43%) by the operator and in 46/107 (43%) by the experts among baseline scans of sufficient quality. Inter-rater agreement between operators and experts was very good (κ > 0.8) for hydronephrosis and good (κ > 0.6) for bladder wall thickening.

Conclusions
FASUS is a promising clinical, point-of-care tool for detecting UGS-related urinary tract morbidity in symptomatic patients. Based on larger validation studies, appropriate diagnostic and therapeutic algorithms for the use of FASUS should be established.
Chronic Conductive Hearing Loss Is Associated With Speech Intelligibility Deficits in Patients With Normal Bone Conduction Thresholds
Authors: Okada Masahiro , Welling D. Bradley , Liberman M. Charles , Maison Stéphane F. 
Published: September 2019

Objectives:The main objective of this study is to determine whether chronic sound deprivation leads to poorer speech discrimination in humans.Design:We reviewed the audiologic profile of 240 patients presenting normal and symmetrical bone conduction thresholds bilaterally, associated with either an acute or chronic unilateral conductive hearing loss of different etiologies.Results:Patients with chronic conductive impairment and a moderate, to moderately severe, hearing loss had lower speech recognition scores on the side of the pathology when compared with the healthy side. The degree of impairment was significantly correlated with the speech recognition performance, particularly in patients with a congenital malformation. Speech recognition scores were not significantly altered when the conductive impairment was acute or mild.Conclusions:This retrospective study shows that chronic conductive hearing loss was associated with speech intelligibility deficits in patients with normal bone conduction thresholds. These results are as predicted by a recent animal study showing that prolonged, adult-onset conductive hearing loss causes cochlear synaptopathy.