bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neck Ultrasound for the Detection of Cervical Lymphadenopathy in Sarcoidosis
Authors: Ahmed Mohammed , Daneshvar Cyrus , Breen David 
Published: April 2019

Background:
Sarcoidosis is diagnosed by demonstration of granulomatous inflammation and exclusion of other potential causes. Lung parenchyma and intrathoracic lymph nodes are currently the commonest sites from which tissue is obtained in clinical practice, but historically scalene lymph node biopsy was the procedure of choice for diagnosing sarcoidosis in many institutions.

Aim:
We aimed to assess the utility of neck ultrasound (NUS) and cervical lymph node needle sampling among patients with stage 1 and 2 sarcoidosis. In addition, we analyzed the potential predictors of cervical lymphadenopathy in this retrospective cohort study.

Methods:
Patients with evidence of intrathoracic lymphadenopathy and suspected sarcoidosis referred for an endobronchial ultrasound underwent NUS. Those with enlarged cervical lymph nodes underwent fine-needle aspiration and core needle biopsy when technically feasible.

Results:
A total of 38 patients were included of which 34 (89.5%) underwent endobronchial ultrasound. Sixteen patients had enlarged lymph nodes on ultrasound and 8 (50%) of these underwent needle sampling. Non-necrotizing granulomas were detected in 6 cases (16.8%, 95% confidence interval, 6.1%–31.3%). Cervical lymphadenopathy was significantly associated with the presence of upper paratracheal lymphadenopathy (P=0.018) and the size of mediastinal lymph nodes on computed tomography (P=0.011).

Conclusion:
NUS and needle sampling of cervical lymph nodes is a potential modality that can be used for the diagnosis of sarcoidosis in a selected group of patients.
The Impact of an Interventional Pulmonary Program on Nontherapeutic Lung Resections
Authors: Polcz Monica E. , Maiga Amelia W. , Brown Lawrence B. , Deppen Stephen A. , Montgomery Chandler , Rickman Otis , Grogan Eric L. 
Published: April 2019

Background:
Pulmonary resection can concurrently diagnose and treat known or suspected lung cancer, but is not without risk. Benign resection rates range widely (9% to 40%). We evaluated the impact of an Interventional Pulmonology (IP) program and dedicated Pulmonary Nodule Clinic on surgical benign resection rates at a single institution.

Methods:
An IP program was initiated in August 2010 that offered advanced diagnostic techniques and a dedicated Pulmonary Nodule Clinic was opened in August 2013. We retrospectively reviewed all patients who underwent resection for known or suspected lung cancer between 2005 and 2015 at our tertiary referral hospital. Demographics, preoperative tissue diagnoses, surgical procedure, final pathology, and staging were collected. Quarterly benign resection rates were calculated and plotted on a statistical quality control chart (P-Chart) to determine the impact of the IP program and Pulmonary Nodule Clinic on benign resection rates over time.

Results:
Of 1112 resections, 209 (19%) were benign. Variation in quarterly benign resection rates decreased after introduction of the IP program in 2010, and a significant (P<0.05) sustained decrease in the quarterly benign resection rate occurred after introduction of the pulmonary nodule clinic in 2013 to a new baseline of 12% compared with 24% before 2010. After introduction of the IP program, mean quarterly preoperative tissue diagnostic rates increased from 45% to 58% (P<0.01).

Conclusion:
Integration of an IP program employing advanced diagnostic bronchoscopic techniques has improved preoperative diagnostic rates of suspicious pulmonary nodules and in combination with a pulmonary nodule clinic has resulted in fewer benign resections.
Insanity
Authors: Weiss Kenneth J. , Friedman Susan Hatters , Shand John P. 
Published: April 2019

Abstract
The term “insanity” has been retired from medical nomenclature for about 100 years. Formerly interchangeable with the legal term, implying unsoundness of mind, it persists as a legal determination, mainly in criminal matters. However, the most prevalent uses of “insanity” are in colloquial speech and media. We track “insanity” in medical and legal parlance, reasons for its disappearance from psychiatry, and its persistence in popular culture. During the 19th century, specific types of legal insanity fell out of favor, especially “moral insanity,” referring to irresistible impulses. The term persisted, for example, in some civil cases and in criminal cases, both denoting lack of capacity. In America, early 20th century focus on disease classification and nomenclature shifted from catchall terms (such as insanity, dementia, mania, and idiocy) to medical labels (psychosis and neurosis). Psychiatrist William Alanson White led the movement to change nomenclature. In 1921, the American Journal of Insanity became the American Journal of Psychiatry. By the time White was the American Psychiatric Association president in 1925, the medical use of “insanity” had been replaced in textbooks by progressive terminology. However, variations on “insane,” suggesting loss of reason without diagnostic specificity, have become a staple among film tropes.
Skeletal surveys lack efficacy in obtunded polytrauma patients
Authors: Dmochowski Jakub M. , Wendell Cole , Bruggers Jennifer L. , Becher Stephen J. 
Published: April 2019

Abstract

Objectives:
To evaluate if a skeletal survey protocol initiated after 48 hours of intubation will decrease time to diagnosis and the treatment of occult fractures in the obtunded polytrauma patient.

Design:
Prospective cohort trial with a retrospective cohort comparison arm.

Setting:
A single level 1 trauma center.

Patients:
Forty-seven patients were identified prospectively for the skeletal survey protocol to screen for occult fractures. The results of the new protocol were compared to a retrospective comparison arm of 46 patients who would have met the same criteria.

Intervention:
A skeletal survey protocol using 2-view x-rays of the patients’ extremities to evaluate for any occult injuries after 48 hours of intubation in trauma patients with altered mental status and an unreliable tertiary examination.

Main Outcome Measure:
Time to diagnosis of delayed fractures and surgical intervention from date of admission.

Results:
The average time to fracture diagnosis and time to surgical intervention in days was not statistically significant between the retrospective and prospective groups [fracture diagnosis: 1.6 ± 5.1 (retrospective) versus 0.5 ± 0.9 (prospective) (P = .159); time to initial surgery: 2.7 ± 5.6 (retrospective) versus 1.1 ± 1.7 (prospective) (P = .064); time to final surgery: 5.3 ± 8.5 (retrospective) versus 2.4 ± 3.0 (prospective) (P = .029)]. In addition, only 24% (4/17) of patients with a delayed fracture diagnosis required surgical intervention making most nonoperative.

Conclusions:
Given the inability to have a clinically or statistically significant impact on time to fracture diagnosis or subsequent treatment, we cannot advocate for the routine use of a skeletal survey protocol in obtunded polytrauma patients.
Level of Evidence: Level III
Sudden Unexpected Death in a Child From an Anaplastic Ependymoma
Authors: Harrison William T. , Bouldin Thomas , Buckley Anne , Estrada Januario , McLendon Roger , Janssen Kimberly 
Published: April 2019

Abstract
Primary central nervous system tumors are an extremely rare cause of sudden, unexpected death in children as most patients develop symptoms because of increased intracranial pressure and seek medical attention. Rarely, a forensic pathologist may encounter a primary intracranial neoplasm in a pediatric decedent that was not suspected before death. Herein, we present a case of a supratentorial neuroepithelial tumor found at autopsy in a 3-year-old African American boy without any reported significant medical history. The tumor had significant mass effect and caused cerebral edema, which ultimately resulted in transtentorial herniation and death. The gross, histopathological, immunohistochemical, and ultrastructural findings were most consistent with an anaplastic ependymoma.
Early Outcomes of a High-Resolution Anoscopy-Based Anal Cancer Screening Program Among People With HIV Enrolled in an Integrated Health Care System
Authors: Barnell Gregory M. , Merchant Maqdooda , Lam Jennifer O. , Silverberg Michael J. 
Published: April 2019

Background:
Few studies have examined outcomes of high-resolution anoscopy (HRA)-based screening for people with HIV infection (PWH), a population at increased risk for anal cancer.

Setting:
Large integrated health care system.

Methods:
Cohort study of 13,552 people with HIV infection, comparing incidences of anal cancer and advanced anal cancer (higher stage, recurrence, death, or surgical salvage) before and after HRA became available (2008). Calendar time was divided as 1998–2007, 2008–2010, and 2011–2012. Rate ratios (RRs) were obtained from Poisson regression models with adjustment for baseline demographic and health variables. Cohort cases during 2008–2012 were included in a nested case–control study, evaluating association of screening with anal cancer (33 cases, 330 controls) and advanced anal cancer (19 cases, 190 controls). Odds ratios (ORs) for receipt of screening were obtained from conditional logistic regression models with adjustment for baseline demographic and health history variables.

Results:
Compared with 1998–2007 (pre-HRA), 2008–2010 adjusted RRs were 1.32 [95% confidence intervals (CI): 0.77 to 2.27; P = 0.31] for anal cancer and 2.11 (95% CI: 0.99 to 4.48; P = 0.053) for advanced anal cancer; and 2011–2012 adjusted RRs were 0.35 (95% CI: 0.12 to 0.99; P = 0.048) for anal cancer and 0.23 (95% CI: 0.03 to 1.77; P = 0.16) for advanced anal cancer. Individual history of screening did not reach statistical significance for anal cancer (OR 1.7; 0.6–4.6) or advanced anal cancer (OR 0.44; 0.1–3.8).

Conclusions:
Despite the possible effect of secular trends, we found 2008–2012 incidence trends for anal cancer and advanced anal cancer that seem consistent with expected findings of a beneficial screening program.
Cognitive and Motor Impairment Severity Related to Signs of Subclinical Wernicke's Encephalopathy in HIV Infection
Authors: Le Berre Anne-Pascale , Fama Rosemary , Sassoon Stephanie A. , Pfefferbaum Adolf , Sullivan Edith V. , Zahr Natalie M. 
Published: April 2019

Background:
Wernicke's encephalopathy (WE) is a neurological condition resulting from thiamine deficiency. Although commonly associated with alcoholism, nonalcoholic WE has been described in individuals with HIV infection, but subclinical WE may be underdiagnosed. The current study questioned whether the presence of subclinical WE signs underlies cognitive and motor deficits in HIV individuals as observed in alcoholism.

Setting:
Fifty-six HIV-positive individuals (HIV+) and 53 HIV-negative controls (HIV−) were assessed on 6 cognitive and motor domains: attention/working memory, production, immediate and delayed episodic memory, visuospatial abilities, and upper-limb motor function.

Methods:
Based on a rating scheme by Caine et al, HIV+ individuals were categorized by subclinical WE risk factors (dietary deficiency, oculomotor abnormality, cerebellar dysfunction, and altered mental state). Performance was expressed as age- and education-corrected Z-scores standardized on controls.

Results:
Sorting by Caine criteria yielded 20 HIV+ as Caine 0 (ie, meeting no criteria), 22 as Caine 1 (ie, meeting one criterion), and 14 as Caine 2 (ie, meeting 2 criteria). Comparison among HIV+ Caine subgroups revealed a graded effect: Caine 0 performed at control levels, Caine 1 showed mild to moderate deficits on some domains, and Caine 2 showed the most severe deficits on each domain.

Conclusion:
This graded severity pattern of performance among Caine subgroups suggests that signs of subclinical WE can partly explain the heterogeneity in HIV-related cognitive and motor impairment. This study highlights the utility of Caine criteria in identifying potential causes of HIV-related neurocognitive disorders and has implications for disease management.
In Vivo Flattening of the Central Aponeurosis of the Rectus Femoris Due to Knee Extension Torque in Healthy Young and Elderly Individuals With Knee Osteoarthritis
Authors: Takahashi Yusuke , Saito Akira , Sato Hiromichi , Shibata Kazuyuki , Okura Kazuki , Kinoshita Kazuo , Seto Arata , Osawa Shinjiro , Wakasa Masahiko , Kimoto Minoru , Okada Kyoji 
Published: April 2019

Abstract
We aimed to elucidate the relationship between active force production and the curvature of the central aponeurosis (CA) of the rectus femoris in young healthy participants as fundamental data and compare the muscle CA curvature before and after straight leg raising (SLR) training in participants with knee osteoarthritis (OA). Central aponeurosis curvature was determined during submaximal and maximal voluntary contractions (MVCs) using ultrasonography. Twenty-five young healthy female volunteers underwent ultrasonographic measurements under conditions of isometric MVC. They were divided into a flat shaped CA group (flat) and an incompletely flat shaped CA group (remnant). Central aponeurosis curvature was calculated as the ratio of CA height and length in the axial view. Central aponeurosis shape and muscular strength before and after muscle training were measured in 11 participants with knee OA. In the young healthy individuals, maximal voluntary torque and changes in CA curvature were significantly higher in the flat group than in the remnant group (2.15 Nm/kg and − 17.7% vs 1.75 Nm/kg and −9.8%, respectively; P = 0.005). The rate of change of the CA curvature during contraction was significantly correlated with maximal voluntary torque corrected for body mass (r = 0.512). The CA curvature progressively decreased as %MVC increased. In the OA group, CA curvature during MVC after SLR training was significantly lower than that before SLR training (3.2% vs 7.2%; P = 0.031). Central aponeurosis curvature was associated with muscle strength, and the results supported our hypothesis that geometric observation of CA changes during contractions may reflect muscle fiber function. We aim to develop a new ultrasonographic skeletal muscle evaluation method based on our present findings.
Injury-specific variables improve risk adjustment and hospital quality assessment in severe traumatic brain injury
Authors: Dawes Aaron J. , Sacks Greg D. , Needleman Jack , Brook Robert H. , Mittman Brian S. , Ko Clifford Y. , Cryer H. Gill 
Published: April 2019

BACKGROUND
Hospital benchmarking is essential to quality improvement, but its usefulness depends on the ability of statistical models to adequately control for inter-hospital differences in patient mix. We explored whether the addition of injury-specific clinical variables to the current American College of Surgeons-Trauma Quality Improvement Program (TQIP) algorithm would improve model fit.

METHODS
We analyzed a prospective registry containing all adult patients who presented to a regional consortium of 14 trauma centers between 2010 and 2011 with severe traumatic brain injury (TBI). We used hierarchical logistic regression and stepwise forward selection to develop two novel risk-adjustment models. We then tested our novel models against the current TQIP model and ranked hospitals by their risk-adjusted mortality rates under each model to determine how model selection affects quality benchmarking.

RESULTS
Seven hundred thirty-four patients met inclusion criteria. Stepwise selection resulted in two distinct models: one that added three TBI-specific variables (pupil reactivity, cerebral edema, loss of basal cisterns) to the model specification currently used by TQIP and another that combined two TBI-specific variables (pupil reactivity, cerebral edema) with a three-variable subset of TQIP (age, Abbreviated Injury Scale score for the head region, Glasgow Coma Scale motor score). Both novel models outperformed TQIP. Although rankings remained largely unchanged across model configurations, several hospitals moved across quality terciles.

CONCLUSION
The inclusion of injury-specific variables improves risk adjustment for patients with severe TBI. Trauma Quality Improvement Program should consider replacing several of its general patient characteristics with injury-specific clinical predictors to increase efficiency, reduce the risk of overfitting, and improve the accuracy of hospital benchmarking.

LEVEL OF EVIDENCE
Prognostic and epidemiological, level II.
Cognitive Complaints in Nondemented Parkinson’s Disease Patients and Their Close Contacts do not Predict Worse Cognitive Outcome
Authors: AlDakheel Amaal , Gasca-Salas Carmen , Armstrong Melissa J. , Duff-Canning Sarah , Marras Connie 
Published: April 2019

Objectives:
The main purpose of this study was to investigate 4 methods of eliciting subjective cognitive complaints (SCCs) in Parkinson’s disease (PD) patients without dementia and determine the relationship between their SCC and cognitive performance.

Design:
This study was a retrospective analysis of a prospective cohort study.

Setting:
Six North American movement disorder clinics.

Measurements:
SCCs were elicited through a modified Neurobehavioral Inventory administered to patients and close contacts, a general complaint question, and Movement Disorders Society Unified Parkinson's Disease Rating Scale item question 1.1 administered to patients. Clinical evaluation, formal neuropsychological testing and Disability Assessment for Dementia were conducted in Ontario state. Agreement between SCCs eliciting methods was calculated. Associations between SCC, cognitive testing, and mild cognitive impairment (MCI) were assessed.

Results:
Of 139 participating nondemented PD patients, 42% had PD-MCI at baseline. Agreement between SCC eliciting methods was low. Neither patient-reported nor close contact-reported SCCs were associated with impaired baseline cognitive testing or PD-MCI nor were they associated with cognitive decline over time. In PD patients with normal baseline cognition, 26% of patients with 1-year follow-up and 20% of patients with 2-year follow-up met MCI criteria.

Conclusions:
Agreement between SCC eliciting methods is poor and no SCC method was associated with cognitive testing or decline over time. With no clear superior method for eliciting SCCs, clinicians should consider performing regular screening.
Which MCI Patients Should be Included in Prodromal Alzheimer Disease Clinical Trials?
Authors: Grill Joshua D. , Nuño Michelle M. , Gillen Daniel L. 
Published: April 2019

Background:
Prodromal Alzheimer disease (AD) clinical trials enroll patients with mild cognitive impairment (MCI) meeting biomarker criteria, but specific enrollment criteria vary among trials.

Methods:
We used data from AD Neuroimaging Initiative (ADNI) MCI participants to assess AD biomarker eligibility, variation in trial outcome measures, and statistical power.

Results:
Most (65%) participants meet eligibility criteria based on low cerebrospinal fluid amyloid beta (Aβ). Relative to trials enrolling exclusively based on low cerebrospinal fluid Aβ, trials including participants with a high ratio of phosphorylated tau to Aβ would include an additional 15% of participants. Fewer (34% to 62%) participants met criteria for Aβ and tau. Differences in clinical and demographic characteristics of modeled trial samples were minimal. Those with low Aβ and high tau showed the greatest change over time on outcome measures.

Conclusions:
Eligibility rates for prodromal trials vary depending on the specific biomarker criteria, though differences in demographics and the variation associated with outcome measures are minimal. Broadening inclusion criteria beyond amyloid alone may facilitate recruitment but include patients showing slower progression over time. Biomarker criteria selection should be informed by the goal of enrolling individuals most likely to utilize and benefit from the intervention under investigation in a particular setting.
Women and Men Presenting to a Rural and Remote Memory Clinic in Saskatchewan, Canada Show Similar Cognitive Findings for Dementia
Authors: Robertson Olivia , Kirk Andrew , Karunanayake Chandima , Morgan Debra , O’Connell Megan E. 
Published: April 2019

Introduction:
The course of dementia may differ between men and women. Men, for example, are more likely to exhibit aggression. It is unclear if sex differences are present at initial presentation. The present study examines sex differences among patients at initial referral to a memory clinic.

Materials and Methods:
Three hundred seventy-five (159 males, 216 females) patients referred to the University of Saskatchewan’s Rural and Remote Memory Clinic participated. Data were collected from patients and caregivers at initial assessment. Cognitive, functional, and demographic information were compared between males and females.

Results:
Males and females presented to the clinic at similar ages. Females were more likely to have a son or daughter caregiver and to live alone. Males were more likely to be currently working. No statistically significant differences were found for cognitive or functional assessment scores.

Discussion:
Within this rural and remote sample, there was equivalence between male and female level of cognitive decline, function and neuropsychiatric symptoms at initial referral. Both sexes were of similar ages at the time of initial presentation. These findings may provide reassurance to patients and their family members as it does not appear that patients of one sex were referred later than the other.
Kelch13 and MDR1 Polymorphisms, and Drug Effectiveness at Day 3 after Dihydroartemisinin-Piperaquine Treatment for Plasmodium falciparum Malaria on Bioko Island, Equatorial Guinea: 2014-2017
Authors: Zheng Yu-Zhong , Chen Jiang-Tao , Liang Xue-Yan , Ehapo Carlos Salas , Eyi Urbano Monsuy , Huang Hui-Ying , Chen Wei-Zhong , Lin Li-Yun , Xie Dong-De , Wang Yu-Ling , Chen Guo-Wei , Liu Xiang-Zhi , Zha Guang-Cai , Mo Huan-Tong , Chen Xin-Yao , Li Jian , Jiang Ting-Ting , Lin Min 
Published: April 2019

ABSTRACTArtemisinin (ART) combination therapies were introduced on malaria endemic Bioko Island in 2004 through Bioko Island Malaria Control Project. Recently, ART-resistant Plasmodium falciparum strain with Kelch13 (K13) propeller M579I mutation originating from Equatorial Guinea was observed as an increased parasite clearance time on day 3 after dihydroartemisinin-Piperaquine (DHA-PIP) treatment (D3 positivity). Here, we surveyed DHA-PIP effectiveness and molecular markers of drug resistance at D3 after DHA-PIP treatment on Bioko Island from 2014 to 2017. Among the 371 uncomplicated P. falciparum patients, 86.3% (320/471) were successfully followed up at D3. 5.9% (19/320) of patients showed D3 positivity. K13 and MDR1 gene were successfully sequenced from 46 patients collected at D0 (baseline population) and 19 D3-positivity patients. Five non-synonymous K13 mutations (H136N; K189N; K248N; K326E; K332N) were found. There was no statistical difference in the frequency of these K13 mutations between baseline population and D3-positivity samples (p>0.05). Additionally, none of the K13 propeller polymorphisms known to be involved in ART-resistance in Asia or Africa were detected. For MDR1 gene, 38.5% (25/65) carried N86Y mutation; 73.8% (48/65) the Y184F mutation. Parasites surviving DHA-PIP at D3 post-treatment were significantly more likely than the baseline population to carry the N86Y (p <0.05). These results suggest that K13 is not the best predictive molecular marker for ART resistance in Africa. More isolates from cases with delayed parasite clearance after DHA-PIP treatment indicated that in vitro and in vivo monitoring for ART derivatives and ACT partner drugs should be regularly performed on Bioko Island, Equatorial Guinea.