bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Noninvasive Method—Shear-Wave Elastography Compared With Transient Elastography in Evaluation of Liver Fibrosis in Patients With Chronic Hepatitis B
Authors: Xia Shujun , Ren Xinping , Ni Zhongxin , Zhan Weiwei 
Published: February 2019

Abstract
The aim of our study was to investigate the efficiency and feasibility of shear-wave elastography (sound touch elastography [STE], sound touch quantification [STQ]) compared with transient elastography (FibroScan) assessment in noninvasively and quantitatively identifying the degree of liver fibrosis. A total of 158 patients with chronic hepatitis B were included, and all accepted STE, STQ, and FibroScan assessments. Young's modulus (kPa) of STE, STQ, and FibroScan were evaluated, and the diagnostic performance of the 3 techniques on liver fibrosis stage was compared. The final diagnosis was based on histological findings from liver biopsy. Of all these patients, 36 patients were categorized as G/S < 2, and 122 were as G/S ≥ 2 according to Scheuer G/S scoring system. STEmean and STQmean measurements were positively correlated with liver fibrosis stage with high correlation (r = 0.852 and r = 0.803, respectively). Receiver operating characteristic analysis of STE, STQ, and FibroScan revealed that the areas under the curve of STE and STQ were markedly increased compared with that of FibroScan when differentiating early stage of liver fibrosis (S1, S2). It was concluded that shear-wave elastography (STE, STQ, and FibroScan) performs well in evaluation of liver fibrosis in patients with chronic hepatitis B, and the efficacies of STE and STQ are better than that of FibroScan.
Ultrasonography-Guided Core Needle Biopsy Did Not Reduce Diagnostic Lobectomy for Thyroid Nodules Diagnosed as Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance
Authors: Yoon Jung Hyun , Kwak Jin Young , Moon Hee Jung , Kim Eun-Kyung 
Published: February 2019

Abstract
In this study, we evaluated the role of ultrasonography-guided core needle biopsy (US-CNB) in deciding upon management for prior atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) results. From May 2013 to June 2015, 149 thyroid nodules in 149 patients diagnosed as having AUS/FLUS were included. Of the 149 thyroid nodules, 86 (57.5%) had repeat US-guided fine needle aspiration (US-FNA) and 63 (42.3%) had US-CNB. Histopathology results were divided according to various indications for diagnostic lobectomy, and rates of diagnosis that are candidates for diagnostic lobectomy were compared. Of the 149 thyroid nodules included, 86 (57.7%) were diagnosed as benign, 27 (18.1%) as malignancy, and 36 (24.2%) as inconclusive. Repeat US-FNA had significantly higher rates of inconclusive diagnosis compared with US-CNB, 33.7% to 11.1% (P = 0.003). Nodules with US-CNB had significantly higher rates of surgery or follow-up, whereas those with US-FNA had higher rates of repeated biopsy (P < 0.001). Rates of cytopathologic candidates for diagnostic lobectomy did not show significant differences between repeat US-FNA and US-CNB for any of the indications (all P > 0.05). Based on this, we concluded that US-CNB has higher diagnostic rates than did repeat US-FNA, but it does not provide superior guidance over repeat US-FNA in deciding upon diagnostic lobectomy for thyroid nodules with prior AUS/FLUS cytology results.
Risk Threshold Algorithm for Thyroid Nodule Management Demonstrates Increased Specificity and Diagnostic Accuracy as Compared With American College of Radiology Thyroid Imaging, Reporting and Data System; Society of Radiologists in Ultrasound; and American Thyroid Association Management Guidelines
Authors: Clark Toshimasa James , McKinney Kristin , Jensen Alexandria , Patel Nayana U. 
Published: February 2019

Abstract
We studied diagnostic performance of an algorithm guiding thyroid nodule management using a malignancy risk model as compared with extant management guidelines. Single-institution, retrospective study was performed with sequential cases from pathology registry from 2012 to 2015. Seventy-eight patients were enrolled, with benign and malignant groups defined by aspiration results. Risk Threshold Algorithm determined management based off of a logistic regression model and a risk threshold. American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS), Society of Radiologists in Ultrasound (SRU), and American Thyroid Association (ATA) guidelines were used in comparison. Sensitivity, specificity, positive/negative predictive values, receiver operating characteristic (ROC) values were derived, with significance assessed via McNemar and permutation tests. Forty-four benign nodules and 40 papillary thyroid carcinomas were included. Risk Threshold Algorithm area under the ROC curve was 0.80 versus 0.59 (ACR TI-RADS), 0.49 (SRU), and 0.44 (ATA); all areas under the ROC curve differences were statistically significant. Risk Threshold Algorithm demonstrates sensitivity, specificity, positive predictive value, and negative predictive values of 63%, 91%, 86%, and 73% at the risk threshold maximizing diagnostic performance, compared with 85%, 39%, 56%, and 74% (ACR TI-RADS); 85%, 18%, 50%, and 57% (SRU); and 89%, 11%, 50%, and 83% (ATA). Sensitivity and specificity were significantly different between all groups except SRU versus TI-RADS. The Risk Threshold Algorithm, based on a malignancy risk model, demonstrates increased overall diagnostic accuracy as compared with ACR TI-RADS, SRU, and ATA management guidelines. Through eliminating unnecessary biopsy, patient anxiety, and morbidity can be reduced.
The Ultrasound Anatomy of Nerves in the Interscalene Groove
Authors: Verdecchia Nicole M. , Ibinson James W. , Orebaugh Steven L. 
Published: February 2019

Abstract
In the interscalene groove, nerve structures are in close proximity and may not be visible as separate structures, increasing the risk of insertion of the needle tip within the epineurium. We evaluated whether experienced regional anesthesiologists can distinguish between nerve elements lying in close proximity on ultrasound images.
Brachial plexus elements from 4 nonpreserved cadavers were arranged in a water bath. Ultrasound images of the nerve roots and trunks were taken. Regional anesthesiologists and residents were asked whether they could distinguish the nerves as 2 separate structures and if they could identify a pair of nerve roots versus a single trunk.
Attending anesthesiologists reported the ability to discriminate 2 nerve structures when a 2-mm space was arranged between them in 54% of images; however, when in direct contact, this recognition was significantly lower. The residents reported a higher ability to discriminate the 2 nerves in all scenarios. In addition, the attending anesthesiologists successfully identified paired nerve roots versus nerve trunks in 70% of the images, significantly higher than chance (P = 0.01), whereas the fraction of correct resident responses was not significantly different from guessing.
When nerves were placed in close proximity, experienced regional anesthesiologists had difficulty identifying them as separate structures and were incorrect nearly one-third of the time in discriminating 2 closely positioned roots versus a nerve trunk. This underscores the importance of cautious needle insertion into the interscalene groove, where nerve elements are often juxtaposed one to another.
Multimodality Imaging of Congenital Variants in the Gallbladder
Authors: Whittle Carolina , Skoknic Velimir , Maldonado Ignacio , Schiappacasse Giancarlo , Pose Georgette 
Published: February 2019

Abstract
Congenital variants of the gallbladder development are infrequent and sometimes represent an asymptomatic imaging finding. In this case series, we want to present multimodality imaging findings that permit the diagnosis. Ultrasound, multidetector computed tomography, and magnetic resonance images are included.
The proper recognition of these infrequent congenital benign entities avoids unnecessary complementary examinations and misdiagnosis. Although ultrasound represents the most commonly used initial diagnostic tool, the increased use of magnetic resonance imaging and the wide use of multidetector computed tomography make it crucial to know how these entities are seen.
A retrospective review of cases of congenital variants of gallbladder through different imaging modalities was performed in our computer archives. Representative images were selected. Agenesis, hypoplasia, septated, duplicated, intrahepatic, and left-sided gallbladder are described.
Better understanding and recognition of congenital anomalies in gallbladder images will avoid misdiagnosis.
Shear-Wave Elastography in the Characterization of Pleural Effusions
Authors: Ozgokce Mesut , Durmaz Fatma , Yavuz Alpaslan , Üney İbrahim , Yildiz Hanifi , Arslan Harun , Dundar Ilyas , Havan Nuri , Ogul Hayri 
Published: February 2019

Abstract
The aim of the study was to investigate the efficacy of shear-wave elastography (SWE) in the differentiation of transudative and exudative pleural effusions. This monocentric study comprised 60 cases (17 transudative, 43 exudative).Transthoracic SWE was performed in 60 cases for whom to use thoracentesis for the pleural fluid analysis was planned. The mean SWE values of each patient were recorded, and the correlation between the biochemical analysis results of pleural fluid after thoracentesis and SWE findings was evaluated. The effusion SWE values and biochemical analysis results were compared. Of the 60 patients who participated in this study, 32 (53.4) were male and 28 (46.6%) were female. The mean ± SD age was 59 ± 17.09 years (range = 21–89 years). Simultaneous serum biochemical analysis was performed for the patients with PE. The mean ± SD shear-wave velocity value of the transudative fluid was calculated 2.29 ± 0.41 (1.6–2.94), whereas the mean ± SD shear-wave velocity value of the exudative pleural fluid was calculated as 3.29 ± 0.63 (2.01–4.88) (P < 0.001). The receiver operating characteristic analysis showed that sensitivity and specificity were found as 91% and 76.5%, respectively, when the cutoff value was selected as 2.52 m/s in the differentiation of the transudative and exudative effusions.
Shear-wave elastography may help in the differentiation of transudative and exudative of the pleural effusions.
The Clinical Value of New Scoring System of Cervical Lymph Node
Authors: Shen Haolin , Lv Guorong , Ke Linfang , Li Ling , Zheng Chunnuan , Yang Shuping 
Published: February 2019

AbstractTo distinguish malignant cervical lymphadenopathy, we established a new scoring system based on ultrasound features. Two hundred sixty-three patients with cervical lymphadenopathy received ultrasonic examination and underwent ultrasound-guided core needle biopsy or fine needle aspiration. The scoring system was proposed by multivariate logistic regression analysis and compared with Liao scoring system (0.06 × age + 4.76 × shortest-to-longest axis ratio + 2.15 × internal echo + 1.80 × vascular pattern). A new scoring system model, 1.346 × margin + 1.339 × hilum + 2.411 × calcification + 2.619 × vascular pattern + 0.837 × shortest-to-longest axis ratio, was generated. Lymph nodes were regarded as malignancy when the score was ≥2.4. Compared with the Liao scoring system, the new scoring system had larger area under the curve (0.86 versus 0.76,P= 0.036), specificity (86.7% versus 75.0%,P= 0.001), accuracy (87.1% versus 80.6%,P= 0.007), and positive predictive value (89.0% versus 80.0%,P= 0.043). Sensitivity (87.4% versus 85.3%,P= 0.647) and negative predictive value (85.0% versus 81.0%,P= 0.395) did not differ. We concluded that the new scoring system is more reliable and can play an important role in the differential diagnosis of cervical lymph nodes.
The Role of the US Surgeon in Global Care
Authors: Corlew Daniel Scott 
Published: February 2019

Abstract
There is a great mismatch between surgeon workforce capacity in the US and other high income countries (HICs) and that in low and lower middle income countries (LMICs). Many surgeons in HICs are willing to try to be of assistance in LMICs. It is not intuitive, though, exactly how such assistance is best delivered. Similarly, the body of literature describing what is known about the needs in LMICs may not be in the usual cadre of journals and sources accessed by many practicing surgeons. Consequently, many surgeons who are capable and willing to help in LMICs are often not sure how their abilities might be best used.
This essay presents a very brief overview of what is known about those needs, then presents some commentary on how the practicing surgeon in the US and other HICs may be best utilized, with particular attention to the short term trip model. Deployment in the short term trip model is often the most practical and available means of making this effort for HIC surgeons. This model has come under significant criticism in recent years, often for good reason, but it is argued that details of the implementation of that model can determine its applicability to developmental needs. Given the practicality of short term deployments for HIC surgeons, it behooves Ministries of Health and NGOs to examine how trips of this nature can be incorporated into the overall bigger picture of surgical development.
This essay aims to help the perspective of the HIC surgeon as s/he seeks to contribute to the development of surgical access and quality for the approximately five billion people in the world who do not have adequate access to surgical care.
Distal Finger Reconstruction by Bilateral Lateral Hallux Osteo-onychocutaneous Free Flap
Authors: Wang Zengtao , Sun Wenhai , Lineaweaver William C. , Hao Liwen , Qiu Shenqiang , Zhang Lishan , Chen Chao , Chiu Yung-Cheng , Yilihamu Yilizati , Zhang Feng 
Published: February 2019

Objective
In this report, we present our experience on the use of bilateral lateral hallux osteo-onychocutaneous free flaps for reconstruction of distal finger and the aesthetic and functional results of this technique in a series of cases.

Patients and Methods
From February 2005 to May 2015, 7 patients underwent finger reconstruction distal to the distal interphalangeal joint using the bilateral lateral hallux osteo-onychocutaneous free flaps. The mean age was 29.3 years (range, 24–33 years). The lateral hallux osteo-onychocutaneous flaps were harvested from bilateral donor sites. The size of each flap was designed based on the size of half distal finger defect. The lateral hallux osteo-onychocutaneous free flaps from both donor sites were combined to reconstruct the distal finger. More than 50% of hallux nail was preserved in each of donor sites, which was covered with a local flap.

Results
All flaps used for reconstruction survived without complications after surgery. The average length of follow-up was 93.4 months (range, 16–163 months). All reconstructed distal fingers showed good aesthetic appearance, except one that underwent a secondary debulking procedure. The average total active motion of the finger was 215.7 degrees (range, 200–230 degrees). Neither pain nor numbness sensation in the reconstructed fingers was complained by the patients. The donor site morbidity was minimal. All patients had pain-free and good function outcome in both feet.

Conclusions
The use of the bilateral lateral hallux osteo-onychocutaneous free flaps may provide an option for distal finger reconstruction with satisfactory function and anesthetic outcomes with minimal hallux donor site morbidity.
Practice Site Contributions to the Overall Growth of a Burn Care Network
Authors: Mullins Fred , Lineaweaver William C. 
Published: February 2019

Abstract
Beginning in 2009, The Joseph M. Still Burn Center in Augusta, Georgia began to develop additional practice sites. By 2018, 6 burn centers had been established and the practice network had been organized as the Burn and Reconstructive Centers of America.Between 2015 and 2017, the entire network had 2 consecutive years of increasing burn admissions of +21% and +20%. The proportion of burn admissions managed by the additional sites grew from 37% to 47% during the same period. All practice sites, including the Augusta center, demonstrated sustained net growth of burn admissions.These data show that this practice development plan has achieved substantial growth in burn admissions throughout the practice, with the newly developed sites contributing disproportionately to overall network practice growth. These findings also suggest that the development of new sites could affect burn center accessibility and utilization for burn patients in these areas.
CCR5-Positive Inflammatory Monocytes are Crucial for Control of Sepsis
Authors: Castanheira Fernanda Vargas e Silva , de Lima Kalil Alves , Cebinelli Guilherme Cesar Martelossi , Sônego Fabiane , Kanashiro Alexandre , Colon David-Fernando , Borges Vanessa , Czaikoski Paula Giselle , Mota José Mauricio , Cunha Thiago Mattar , Alves-Filho José Carlos , Liew Foo Y. , Cunha Fernando Queiroz 
Published: February 2019

ABSTRACT
Neutrophils and inflammatory monocytes control sepsis by migration to the site of infection via their chemokine receptors. CCR5 is a chemokine receptor that is not expressed on neutrophils and inflammatory monocytes under homeostatic conditions. However, it has been demonstrated that CCR5 can become expressed on these cells during different models of inflammation. In the present study, we investigated if CCR5 is also expressed on neutrophil and inflammatory monocytes during sepsis, exerting an important role in the migration of these cells to the infectious focus. Using cecal ligation and puncture model to induce polymicrobial sepsis, we demonstrated that the expression of CCR5 is induced on CD11b+Ly6G−Ly6Chigh inflammatory monocytes, but not on neutrophils (CD11b+Ly6G+Ly6C−). Furthermore, CCR5 plays an important role for the migration of the inflammatory monocytes to infection focus during sepsis. CCR5-expressing inflammatory monocytes migrate from the bone marrow to the circulation and then into the site of infection, where they phagocytize and kill the bacteria. Consequently, CCR5−/− mice showed increased systemic inflammatory response and mortality compared to wild-type mice. These data therefore demonstrate a hitherto unrecognized protective role of CCR5 in sepsis.
Autoimmune glial fibrillary acidic protein astrocytopathy
Authors: Kunchok Amy , Zekeridou Anastasia , McKeon Andrew 
Published: February 2019

Purpose of review
To describe a recently characterized autoimmune, inflammatory central nervous system (CNS) disorder known as autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy.

Recent findings
Affected patients present with symptoms of one or more of meningitis (headache and neck ache), encephalitis (delirium, tremor, seizures, or psychiatric symptoms), and myelitis (sensory symptoms and weakness). Optic disc papillitis (blurred vision) is common. CNS inflammation is evident in characteristic T1 postgadolinium enhancement of GFAP-enriched CNS regions, and lymphocytic cerebrospinal fluid (CSF) white cell count elevation. CSF is more reliable than serum for GFAP-immunoglobulin G (IgG) testing. Ovarian teratoma commonly coexists, particularly among patients with accompanying N-methyl-D-aspartate receptor or aquaporin-4 autoimmunity. Parainfectious autoimmunity is suspected in some other patients, though the culprit organism is rarely verified. Pathophysiologic relevance of T cells is underscored by neuropathology and cases of dysregulated T-cell function (HIV or checkpoint inhibitor cancer therapy). Corticosteroid-responsiveness is a hallmark of the disease. Relapses occur in approximately 20% of patients, necessitating transition to a steroid-sparing drug. Reported outcomes vary, though in the authors’ experience, early and sustained intervention usually portends recovery.

Summary
Autoimmune GFAP astrocytopathy is a treatable autoimmune CNS disease diagnosable by GFAP-IgG testing in CSF. This disease presents opportunities to explore novel mechanisms of CNS autoimmunity and inflammation.
Aripiprazole-Induced Hoarseness: A Case Report
Authors: Işik Ümit , Çam Ray Perihan 
Published: February 2019

Objectives
Aripiprazole is an atypical antipsychotic drug that is commonly used in children and adolescents.

Methods
The most common adverse effects of aripiprazole include fatigue, nausea, increased appetite, headache, sedation, and somnolence.

Results
To our knowledge, there are no data regarding aripiprazole-induced hoarseness in the existing literature.

Conclusions
We present a case of a preschool boy with attention-deficit/hyperactivity disorder and oppositional defiant disorder who displayed hoarseness after aripiprazole therapy.
Adaptation to drought is coupled with slow growth in marginal silver fir (Abies albaMill.) populations
Authors: Csilléry Katalin , Buchmann Nina , Fady Bruno 
Published: February 2019

AbstractDrought is increasingly considered as the most important selection pressure for forest trees in the context of climate change. We studied adaptation to drought in marginal populations of silver fir (Abies albaMill.) from the French Mediterranean Alps. Drought tolerance was assessed using proxies both from seedlings and adult trees. We measured water stress response, growth and bud break of seedlings originating from 16 populations in a greenhouse common garden experiment (N=8199) and water use efficiency viaδ13Cof adult trees of the source populationsin-situ(N=315). Further, 357 single nucleotide polymorphisms (SNPs) were used to uncover the demographic history of the populations. Demographic distances between populations were used to generate a null expectation for trait divergence, thereby detect the signature of natural selection. We found evidence for adaptive population divergence in drought tolerance across life stages. Seedlings originating from source populations with low soil water capacity resisted better to water stress in the greenhouse, and additionally, adult trees from these populations had a higher water use efficiency. Seedling growth showed an evolutionary trade-off with drought tolerance: seedlings with fast growth and high stature came from populations that had lower drought tolerance. In contrast, population divergence in bud break showed only a weak signal of adaptation, which was independent of that in drought tolerance. Variation in phenology between populations was associated with variance in temperature and drought frequency and severity at the source populations. Our results highlight the adaptive value of marginal populations, advance our understanding of the different processes that have allowed silver fir to cope with drought stress under a warming climate, and contribute to our knowledge to advise assisted migration programs.
Chemosymbiotic bivalves contribute to the nitrogen budget of seagrass ecosystems
Authors: Cardini Ulisse , Bartoli Marco , Lee Raymond , Lücker Sebastian , Mooshammer Maria , Polzin Julia , Weber Miriam , Petersen Jillian M. 
Published: February 2019

ABSTRACTIn many seagrass sediments, lucinid bivalves and their sulfur-oxidizing symbionts are thought to underpin key ecosystem functions, but little is known about their role in nutrient cycles, particularly nitrogen. We used natural stable isotopes, elemental analyses, and stable isotope probing to study the ecological stoichiometry of a lucinid symbiosis in spring and fall. Chemoautotrophy appeared to dominate in fall, when chemoautotrophic carbon fixation rates were up to one order of magnitude higher as compared to the spring, suggesting a flexible nutritional mutualism. In fall, an isotope pool dilution experiment revealed carbon limitation of the symbiosis and ammonium excretion rates up to 10-fold higher compared to fluxes reported for non-symbiotic marine bivalves. These results provide evidence that lucinid bivalves can contribute substantial amounts of ammonium to the ecosystem. Given the preference of seagrasses for this nitrogen source, lucinid bivalves’ contribution may boost productivity of these important blue carbon ecosystems.