bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prophylaxis in High-Risk Patients With eGFR < 30 mL/min/1.73 m2
Authors: Nijssen Estelle C. , Nelemans Patty J. , Rennenberg Roger J. , Theunissen Ralph A. , van Ommen Vincent , Wildberger Joachim E. 
Published: April 2019

Objectives
Clinical guidelines recommend prophylactic intravenous fluids for patients with estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73 m2 to prevent adverse postcontrast outcomes. These patients represent a small minority of the population receiving intravascular iodinated contrast material, and data are not readily available. The current study aim is to gain insight into positive and negative effects of prophylaxis by comparing postcontrast outcomes in high-risk patients who did and did not receive prophylaxis.

Materials and Methods
Observational data were gathered over 4 years. Inclusion criteria were age 18 years or older, eGFR less than 30 mL/min/1.73 m2, and elective intravascular iodinated contrast administration. Exclusion criteria were dialysis and nonstandard periprocedural prophylaxis. Primary outcome was postcontrast acute kidney injury (>25% or >44 μmol/L serum creatinine increase within 2–5 days). Secondary outcomes were change in eGFR, 5 mL/min/1.73 m2 or greater eGFR decline, dialysis, and mortality at 1 month postcontrast including primary cause, as well as complications of prophylaxis. Results were stratified by contrast procedure type and corrected for potential confounders.

Results
Of all 55,474 elective procedures with intravascular contrast administration, 362 patients met the inclusion criteria: 281 (78%) received standard 0.9% NaCl prophylaxis and 81 (22%) received no prophylaxis. Prophylaxis versus no prophylaxis adjusted odds ratios were nonsignificant and less than 1 for postcontrast renal outcomes (postcontrast acute kidney injury, eGFR decline, dialysis), indicating a trend toward a protective effect of prophylaxis. For mortality, adjusted odds ratios were nonsignificant and greater than 1, indicating a trend toward higher mortality risk after prophylaxis. Of the primary causes of death analyzed in prophylaxis patients, 24% (5/21) were related to prophylaxis. Among 281 prophylaxis patients, 18 (6.4%) complications of prophylaxis occurred: 15 heart failures and 3 arrhythmias.

Conclusions
Based on this study, no standard recommendation with regard to giving or withholding prophylaxis can be given. Prophylactic fluids may confer some protection against postcontrast renal adverse events but may also contribute toward increased risk of short-term death. In this setting, benefits and risks of prophylaxis must be carefully weighed and cardiac parameters assessed for each individual patient.
Increased Retention of Gadolinium in the Inflamed Brain After Repeated Administration of Gadopentetate Dimeglumine
Authors: Wang Shuangqing , Hesse Bernhard , Roman Marco , Stier Deborah , Castillo-Michel Hiram , Cotte Marine , Suuronen Jussi-Petteri , Lagrange Adrien , Radbruch Helena , Paul Friedemann , Taupitz Matthias , Schellenberger Eyk , Sack Ingolf , Infante-Duarte Carmen 
Published: April 2019

Objectives
The aim of this study was to determine in vivo if brain inflammation leads to increased gadolinium (Gd) retention in brain tissue after repeated applications of Gd-based contrast agents (GBCAs).

Materials and Methods
Experimental autoimmune encephalomyelitis (EAE) was induced in female SJL/J mice (n = 6). Experimental autoimmune encephalomyelitis and healthy control mice (n = 4) received 2.5 mmol/kg Gd-DTPA over 10 days (8 injections, cumulated dose of 20 mmol/kg), starting at day 14 post immunization when EAE mice reached the maximal clinical disability. In a group of mice, T1-weighted 2-dimensional RARE images were acquired before the first GBCA injection and 1 day after the last injection. Mice were killed either 1 day or 10 days after the last Gd application. From each single animal, a brain hemisphere was used for Gd detection using inductively coupled plasma mass spectrometry, whereas the other hemisphere was processed for histology and synchrotron x-ray fluorescence spectroscopy (SR-XRF) analysis.

Results
Gadolinium deposition in inflamed brains was mapped by SR-XRF 1 day after the last Gd-DTPA injections, although only mild signal hyperintensity was found on unenhanced T1-weighted images. In addition, using inductively coupled plasma mass spectrometry, we detected and quantified Gd in both healthy and EAE brains up to 10 days after the last injections. However, EAE mouse brains showed higher levels of Gd (mean ± SD, 5.3 ± 1.8 μg/g; range, 4.45–8.03 μg/g) with respect to healthy controls (mean ± SD, 2.4 ± 0.6 μg/g; range, 1.8–3.2 μg/g). By means of micro–SR-XRF, we identified submicrometric Gd hotspots in all investigated samples containing up to 5893 μg Gd/g tissue. Nano–SR-XRF further indicated that Gd small hotspots had an average size of ~160 nm diameter and were located in areas of high inflammatory activity.

Conclusions
After repeated administrations of Gd-DTPA, ongoing inflammation may facilitate the retention of Gd in the brain tissue. Thus, neuroinflammation should be considered as a risk factor in the recommendation on use of linear GBCA-enhanced MRI.
Preventive Effect of Changing Contrast Media in Patients With A Prior Mild Immediate Hypersensitivity Reaction to Gadolinium-Based Contrast Agent
Authors: Ryoo Chang Hyun , Choi Young Hun , Cheon Jung-Eun , Yoon Soon Ho , Kang Hye-Ryun , Park Sae-Jin , Lee Whal 
Published: April 2019

Objectives
Currently, the prevention of recurrent immediate hypersensitivity reactions (HSRs) to contrast media (CM) requests premedication and changing the culprit contrast agent. However, strategies for the prevention of immediate HSRs to gadolinium-based magnetic resonance contrast agents (GBCAs) have not yet been established. This study aimed to evaluate the effectiveness of changing the contrast agent and single-dose premedication for HSR recurrence prevention in patients with a history of mild immediate HSR to GBCA.

Materials and Methods
The outcomes of patients with mild immediate HSR to GBCA who subsequently underwent enhanced magnetic resonance imaging between October 2012 and July 2017 were analyzed. The institutional CM monitoring system was retrospectively reviewed, and data on the application of premedication and choice of CM were obtained. Gadolinium-based magnetic resonance contrast agents were classified into 3 classes according to their molecular structure (macrocyclic ionic, macrocyclic nonionic, and linear ionic). Intravenous chlorpheniramine 4 mg, 30 minutes before the GBCA administration, or intravenous methylprednisolone sodium succinate 40 mg plus chlorpheniramine 4 mg, 1 hour before the GBCA administration, was administrated as premedication regimen. Recurrence rates of immediate HSR were compared according to prevention strategies.

Results
A total of 185 patients with a history of mild immediate HSR to GBCA were re-exposed to GBCA 397 times during the study period. The overall recurrence rate was 19.6% (78/397). Changing the culprit GBCA significantly reduced the recurrence rate, compared with reusing the culprit GBCA (6.9%, 9/130 and 25.8%, 69/267; P < 0.001). The recurrence rate was lowest when the GBCA was changed to a different molecular structure class from the culprit agent, followed by changing to CM with the same molecular structure and reusing the culprit GBCA (6.2%, 7/113 vs 11.8%, 2/17 vs 25.8%, 69/267; P < 0.001 with χ2 test for trend). Single-dose premedication demonstrated no significant prophylactic effect on recurrence (20.4%, 17/98 vs 17.3%, 61/299 with and without premedication, respectively; P = 0.509). Premedication in addition to changing CM also showed no additional prophylactic effect (7.2%, 7/97 and 6.1%, 2/33, respectively; P = 0.821).

Conclusions
Changing the CM from the culprit agent could reduce the chance of HSR recurrence in patients with prior mild immediate HSR to GBCA, especially when the CM was changed to one of a different molecular structure class. However, single-dose premedication administration did not show significant HSR recurrence rate difference.
Dual-Source Computed Tomography of the Chest in Blunt Thoracic Trauma
Authors: Liang Teresa , McLaughlin Patrick D. , Nugent James P. , Rai Shamir , Schmiedeskamp Heiko , Louis Luck , Khosa Faisal , Nicolaou Savvas 
Published: April 2019

Purpose:
The purpose of this study was to evaluate the clinical utility of temporal resolution optimization (TR-Opt), a computed tomography (CT) postprocessing technique, in reducing aortic motion artifacts in blunt thoracic trauma patients.

Materials and Methods:
This was an IRB-approved study of 61 patients with blunt thoracic trauma carried out between February 18 and September 6, 2014; the patients had been imaged using a standardized dual-source high-pitch (DSHP) CT protocol. Image raw data were retrospectively postprocessed using the TR-Opt algorithm (DSHP-TR-Opt) and compared with conventional images (DSHP). Diagnostic ability to confidently identify and exclude potential injuries and qualitative aortic motion artifacts using a 5-point Likert scale (1=absence of motion artifacts; 5=severe motion artifact) was graded by 2 readers at multiple thoracic locations. Signal-to-noise and contrast-to-noise ratios were generated as quantitative indices of image quality.

Results:
Motion artifacts degrading interpretation and limiting diagnosis of aortic injuries were present in 45% (442/976) of the assessed regions on DSHP. TR-Opt algorithm eliminated motion artifacts in 85% of the motion-degraded areas (375/442), leaving persistent motion artifacts in only 15% (67/442). Motion artifacts were most improved at the interventricular septum (1±1 vs. 3±1), aortic valve (2±1 vs. 4±1.5), and ascending aorta (1±1 vs. 3±2, P<0.005). Mean aorta noise (NAo) was 41.7% higher in the DSHP-TR-Opt images (26.5 vs. 18.7 HU, P<0.0001).

Conclusions:
Temporal resolution optimized reconstruction is a raw data–based CT postprocessing technique that can be used to remove the majority of thoracic aortic motion artifacts that commonly degrade interpretation when imaging blunt thoracic trauma patients.
Intracavitary Coronary Artery
Authors: Hossain Rydhwana , Chelala Lydia , Amin Sagar B. , Bergquist Peter J. , Vairavamurthy Jenanan , Jeudy Jean , White Charles S. 
Published: April 2019

Purpose:
A few case reports of intracavitary coronary arteries (ICCA) have been reported and only a single case series on the coronary computed tomography angiography (CCTA) prevalence rate of ICCA of the right coronary artery (RCA). We describe several cases of ICCA that were noted incidentally and also determine the overall prevalence rate of anomalous ICCA.

Materials and Methods:
A retrospective analysis of ICCA was performed consisting of consecutive CCTA cases as well as a group of ICCA from teaching files. To establish a prevalence rate, we reviewed 464 consecutive CCTA referred to our center for transcatheter aortic valve replacement. The presence of ICCA and several imaging features were evaluated.

Results:
Our cohort comprises a total of 12 patients with ICCA, with 1 patient containing 2 anomalous ICCA. 83.3% of affected patients were adult males, with an average age of 69.8 years. The RCA was the most commonly affected vessel (53.8%). The mean length of the intracavitary segment was 33.4 mm for the RCA and 27 mm for the LAD. No cases involved the left circumflex coronary artery. Six of the cases were identified routinely as part of clinical practice and therefore not included in the prevalence analysis. On review of our transcatheter aortic valve replacement database, there was a 1.3% prevalence rate of ICCA. RCA had a prevalence of 0.4%, whereas LAD had a prevalence of 0.9%.

Conclusions:
Although rare, our study suggests that ICCA may be more common than previously described. Its presence is important to communicate to clinicians prior to invasive cardiac procedures to prevent potentially catastrophic outcomes.
Role of Ultrasonography in Severe Distal Median Nerve Neuropathy
Authors: Iyer Vasudeva 
Published: April 2019

Purpose:
Electrodiagnostic studies do not differentiate severe lesions of the median nerve in the distal forearm from those within the carpal tunnel when compound muscle action potential over the abductor pollicis brevis and sensory nerve action potential are absent; needle electromyography showing denervation confined to the abductor pollicis brevis is presumed to suggest localization to the carpal tunnel, although the lesion may be in the forearm. Under these circumstances, the patient may undergo carpal tunnel release without benefit. This retrospective study looked at patients with clinical picture of severe carpal tunnel syndrome who had no compound muscle action potential or sensory nerve action potential on median nerve stimulation; the goal was to determine how often ultrasonic imaging pointed to a location other than the carpal tunnel.

Methods:
Patients with clinical picture of severe carpal tunnel syndrome with no sensory nerve action potential and no compound muscle action potential over the abductor pollicis brevis and second lumbrical underwent ultrasonic imaging; criteria for localization to the carpal tunnel included significant increase in the cross-sectional area of the median nerve at the carpal tunnel inlet and increase in the wrist/forearm cross-sectional area ratio.

Results:
In 42 of 46 cases, entrapment at the carpal tunnel was confirmed by ultrasonography; in four patients, other causes were located proximal to the carpal tunnel.

Conclusions:
Ultrasonic imaging is useful not only for confirming entrapment of the median nerve at the carpal tunnel in patients with nonlocalizing electrodiagnostic studies but also in detecting pathology in the forearm, which may mimic severe carpal tunnel syndrome.
Early EEG Features for Outcome Prediction After Cardiac Arrest in Children
Authors: Fung France W. , Topjian Alexis A. , Xiao Rui , Abend Nicholas S. 
Published: April 2019

Purpose:
We aimed to determine which early EEG features and feature combinations most accurately predicted short-term neurobehavioral outcomes and survival in children resuscitated after cardiac arrest.

Methods:
This was a prospective, single-center observational study of infants and children resuscitated from cardiac arrest who underwent conventional EEG monitoring with standardized EEG scoring. Logistic regression evaluated the marginal effect of each EEG variable or EEG variable combinations on the outcome. The primary outcome was neurobehavioral outcome (Pediatric Cerebral Performance Category score), and the secondary outcome was mortality. The authors identified the models with the highest areas under the receiver operating characteristic curve (AUC), evaluated the optimal models using a 5-fold cross-validation approach, and calculated test characteristics maximizing specificity.

Results:
Eighty-nine infants and children were evaluated. Unfavorable neurologic outcome (Pediatric Cerebral Performance Category score 4–6) occurred in 44 subjects (49%), including mortality in 30 subjects (34%). A model incorporating a four-level EEG Background Category (normal, slow-disorganized, discontinuous or burst-suppression, or attenuated-flat), stage 2 Sleep Transients (present or absent), and Reactivity–Variability (present or absent) had the highest AUC. Five-fold cross-validation for the optimal model predicting neurologic outcome indicated a mean AUC of 0.75 (range, 0.70–0.81) and for the optimal model predicting mortality indicated a mean AUC of 0.84 (range, 0.76–0.97). The specificity for unfavorable neurologic outcome and mortality were 95% and 97%, respectively. The positive predictive value for unfavorable neurologic outcome and mortality were both 86%.

Conclusions:
The specificity of the optimal model using a combination of early EEG features was high for unfavorable neurologic outcome and mortality in critically ill children after cardiac arrest. However, the positive predictive value was only 86% for both outcomes. Therefore, EEG data must be considered in overall clinical context when used for neuroprognostication early after cardiac arrest.
The rise of the X-ray atomic pair distribution function method: a series of fortunate events
Authors: Billinge Simon J. L. 
Published: April 2019

The atomic pair distribution function (PDF) technique is a powerful approach to gain quantitative insight into the structure of materials where the structural coherence extends only over a few nanometres. In this paper, I focus on PDF from synchrotron X-rays and describe what is the PDF and where it came from, as well as key moments on the journey that have contributed to its enormous recent growth and expanding impact in materials science today. Synchrotron X-ray sources played a starring role in this story.
This article is part of the theme issue ‘Fifty years of synchrotron science: achievements and opportunities’.
Preclinical immunoPET imaging of glioblastoma-infiltrating myeloid cells using Zirconium-89-labeled anti-CD11b antibody
Authors: Nigam Shubhanchi , McCarl Lauren , Kumar Rajeev , Edinger Robert S. , Kurland Brenda F. , Anderson Carolyn J. , Panigrahy Ashok , Kohanbash Gary , Edwards W. Barry 
Published: April 2019

AbstractPurposeGlioblastoma is a lethal brain tumor, heavily infiltrated by tumor-associated myeloid cells (TAMCs). TAMCs are emerging as a promising therapeutic target as they suppress antitumor immune responses and promote tumor cell growth. Quantifying TAMCs using non-invasive immunoPET could facilitate patient stratification for TAMC-targeted treatments and monitoring of treatment efficacy. As TAMCs uniformly express the cell surface marker, integrin CD11b, we evaluated a89Zr-labeled anti-CD11b antibody for non-invasive imaging of TAMCs in a syngeneic orthotopic mouse glioma model.ProceduresA human/mouse cross-reactive anti-CD11b antibody (clone M1/70) was conjugated to a DFO chelator and radiolabeled with Zr-89. PET/CT and biodistribution with or without a blocking dose of anti-CD11b Ab were performed 72 hours post-injection of89Zr-anti-CD11b Ab in mice bearing established orthotopic syngeneic GL261 gliomas. Flow cytometry and immunohistochemistry of dissected GL261 tumors were conducted to confirm the presence of CD11b+TAMCs.ResultsSignificant uptake of89Zr-anti-CD11b Ab was detected at the tumor site (SUVmean = 2.60 ± 0.24) compared with the contralateral hemisphere (SUVmean = 0.6 ± 0.11). Blocking with a 10-fold lower specific activity of89Zr-anti-CD11b Ab markedly reduced the SUV in the right brain (SUVmean = 0.11 ± 0.06), demonstrating specificity. Spleen and lymph nodes (myeloid cell rich organs) also showed high uptake of the tracer, and biodistribution analysis correlated with the imaging results. CD11b expression within the tumor was validated using flow cytometry and immunohistochemistry, which showed high CD11b expression primarily in the tumoral hemisphere compared to the contralateral hemisphere.ConclusionThese data establish that89Zr-anti-CD11b Ab immunoPET targets CD11b+cells (TAMCs) with high specificity in a mouse model of GBM, demonstrating the potential for non-invasive quantification of tumor infiltrating CD11b+immune cells during disease progression and immunotherapy in patients with GBM.
Effect of geographic isolation on the nasal virome of indigenous children
Authors: Altan Eda , Carlos Dib Juan , Rojas Gulloso Andres , Escribano Juandigua Duamaco , Deng Xutao , Bruhn Roberta , Hildebrand Kristen , Freiden Pamela , Yamamoto Janie , Schultz-Cherry Stacey , Delwart Eric 
Published: April 2019

AbstractThe influence of living in small remote villages on the diversity of viruses in the nasal mucosa was investigated in three Colombian villages with increasing levels of geographic isolation. Viral metagenomics was used to characterize viral nucleic acids on nasal swabs of 63 apparently healthy young children. Sequences from human virus members of the families Anelloviridae, Papillomaviridae, Picornaviridae, Herpesviridae, Polyomaviridae, Adenoviridae, and Paramyxoviridae were detected in a decreasing fraction of children. The diversity of human viruses was not reduced in the most isolated indigenous Kogi villages. Multiple viral transmission clusters were also identified as closely related variants of rhinoviruses A or B in 2 to 4 children from each of villages. The number of papillomavirus detected was greater in the village most exposed to outside contacts while conversely more anellovirus infections were detected in the more isolated indigenous villages. Genomes of viruses not known to infect humans, including in the family Parvoviridae (genus densoviruses), Partitiviridae, Dicistroviridae, and Iflaviridae and circular Rep expressing ssDNA genomes (CRESS-DNA) were also detected in nasal swabs likely reflecting environmental contamination from insect, fungal, and unknown sources. Despite the high level of geographic and cultural isolation, the diversity of human viruses in the nasal passages of children was not reduced in indigenous villages indicating ongoing exposure to globally circulating viruses.ImportanceExtreme geographic and cultural isolation can still be found in some indigenous South American villages. Such isolation may be expected to limit the introduction of globally circulating viruses. Very small population size may also result in rapid local viral extinction due to lack of sufficient sero-negative subjects to maintain transmission chains of rapidly cleared viruses. We compared the viruses in the nasal passage of young children in three villages with increasing level of isolation. We find that isolation did not reduce the diversity of viral infections in the most isolated villages. Ongoing viral transmission of rhinoviruses could also be detected within all villages. We conclude that despite their geographic isolation remote villages are continuously exposed to globally circulating respiratory viruses.