bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a vancomycin dosing approach for critically ill patients receiving hybrid hemodialysis using Monte Carlo simulation
Authors: Lewis Susan J , Mueller Bruce A 
Published: May 2018

Objectives: Prolonged intermittent renal replacement therapy is an increasingly popular treatment for acute kidney injury in critically ill patients that runs at different flow rates and durations than conventional hemodialysis or continuous renal replacement therapies. Pharmacokinetic studies conducted in patients receiving prolonged intermittent renal replacement therapy are scarce; consequently, clinicians are challenged to dose antibiotics effectively. The purpose of this study was to develop vancomycin dosing recommendations for patients receiving prolonged intermittent renal replacement therapy. Methods: Monte Carlo simulations were performed in thousands of virtual patients derived from previously published demographic, pharmacokinetic, and dialytic information derived from critically ill patients receiving vancomycin and other forms of renal replacement therapy. We conducted “in silico” vancomycin pharmacokinetic/pharmacodynamics analyses in these patients receiving prolonged intermittent renal replacement therapy to determine what vancomycin dose would achieve vancomycin 24-h area under the curve (AUC24h) of 400–700 mg·h/L, a target associated with positive clinical outcomes. Nine different vancomycin dosing regimens were tested using four different, commonly used prolonged intermittent renal replacement therapy modalities. A dosing nomogram based on serum concentration data achieved after the third dose was developed to individualize vancomycin therapy. Results: An initial vancomycin dose of 15 or 20 mg/kg immediately followed by 15 mg/kg after subsequent prolonged intermittent renal replacement therapy treatments achieved AUC24h of ≥400 mg·h/L for ≥90% of patients regardless of prolonged intermittent renal replacement therapy duration, modality, or time of vancomycin dose relative to prolonged intermittent renal replacement therapy. Many patients experienced AUC24h of ≥700 mg·h/L, but once the dosing nomogram was applied to serum concentrations obtained after the third vancomycin dose, 67%–88% of patients achieved AUC24h of 400–700 mg·h/L. Conclusion: An initial loading dose of 15–20 mg/kg followed by a maintenance regimen of 15 mg/kg after every prolonged intermittent renal replacement therapy session coupled with serum concentration monitoring should be used to individualize vancomycin dosing. These predictions need clinical verification.
Triaging patients to primary biopsy or prostate MRI based on digital rectal examination improves the detection rate of TRUS biopsy and avoids unnecessary biopsies
Authors: Day Elizabeth , Nalagatla Sarika , Shin Je Song , Nair Biju , Gurun Murat , Meddings Bob , McLaughlin George , Chanock David , Clark Ross 
Published: May 2018

Objective: The objective of this study is to describe how the use of digital rectal exam to triage patients to standard transrectal ultrasound (TRUS) biopsies or magnetic resonance imaging (MRI) then MRI fusion biopsies impacts cancer detection rates, departmental resources and the diagnostic journey. Patients and methods: A retrospective analysis of all patients undergoing prostate biopsies in a 15-month period following the introduction of triage digital rectal exam (DRE) and MRI at Ayr University Hospital was conducted. MRI usage and patient journeys were also examined. Results: A total of 95.5% of patients proceeding directly to TRUS had malignant histology and less than 1% required further investigation. Forty-nine per cent of patients who underwent triage MRI avoided biopsy and over one-third of patients with previously benign TRUS biopsies had clinically significant malignancy on MRI fusion biopsies. The pathway eliminated repeat TRUS biopsy and the number of biopsies a month decreased. MRI usage doubled and waiting times to diagnostic biopsy increased when compared to a one-stop diagnostic clinic. Conclusion: Triaging according to DRE avoided delays in cases of overt malignancy and increased the detection rate of standard TRUS. For those patients with a benign DRE, MRI enabled half to avoid biopsy. The increase in demand on MRI was mitigated, in part, by using a shorter detection protocol but institutions must be aware of the potential for delays to diagnosis. Level of evidence: 4
Feasibility of synthetic MRI in knee imaging in routine practice
Authors: Boudabbous Sana , Neroladaki Angeliki , Bagetakos Ilias , Hamard Marion , Delattre Bénédicte MA , Vargas Maria Isabel 
Published: May 2018

Background Synthetic magnetic resonance (MR) is a method allowing reduction of examination time and access to quantitative imaging. Purpose This study sought to assess the image quality and diagnostic accuracy of synthetic magnetic resonance imaging (MRI) compared to standard MRI in patients with knee pain. Material and Methods In total, 22 patients underwent standard 1.5 knee MRI with an added synthetic sequence. Quantitative T1, T2, and proton density (PD) images were generated synthetically; T1, PD, and short tau inversion recovery (STIR) weighted images were created with chosen echo time (TE), repetition time (TR), and inversion time (TI). Two blinded musculoskeletal radiologists evaluated the overall sequence quality, visualization of anatomic structures, and presence of artifacts using a 3-point score. Results The synthetic sequence was acquired in 39% less time than the conventional MRI. Synthetic PD, T1, and STIR images were rated fair (2%, 5%, and 2%, respectively) or good quality (98%, 95%, and 98%, respectively), despite the presence of popliteal artery artifacts. Cartilage and meniscus were well visualized in all cases. Anterior cruciate ligament visualization was rated poor in 7%, 14%, and 30% of PD, STIR, and T1 images, respectively. Conclusion Our pilot study confirmed the feasibility of synthetic MRI in knee examinations, proving faster and achieving appropriate quality and good diagnostic confidence.
Outcomes of Fusions From the Cervical Spine to the Pelvis
Authors: Iyer Sravisht , Kim Han Jo , Theologis Alexander , Nemani Venu M. , Albert Todd J. , Lenke Lawrence G. , Burch Shane , Boachie-Adjei Oheneba , Deviren Vedat , Protopsaltis Themistocles S. , Smith Justin S. , Scheer Justin K. , Mizutani Jun , Kleinberg Eric O. , Ames Christopher P. 
Published: May 2018

Study Design: Retrospective cohort study. Objective: Determine the indications, complications, and clinical outcomes in patients requiring fusions from the cervical spine to the pelvis. Several investigators have examined fusions from the thoracic spine to the sacrum, but no similar study has been performed for cervical-to-pelvis fusions. Methods: Patients from 2003 to 2014 with an upper instrumented vertebrae (UIV) in the cervical spine (any level) and a lower instrumented vertebrae (LIV) in the sacrum or pelvis were included in the study. Those with infectious or acute trauma-related deformities were excluded. Patient demographics, medical history, diagnosis, operative procedure, and health-related quality of life measures were analyzed. Student’s t test, Kruskal-Wallis test, and χ2 test were used as appropriate; significance was set at P < .05 for all tests. Results: Fifty-five patients met inclusion criteria for the study. Average follow-up was 2.8 years. Proximal junctional kyphosis was the most common indication for cervical-to-pelvis fusions (36%). The most common UIV was C2 (29%) followed by C7 (24%). There was an average 31° correction in maximum kyphosis and a 3.3 cm improvement in sagittal vertical axis. In adults, the rate of complication was 71.4%, with a major complication rate of 39.3% and reoperation rate of 53.6%. There was significant improvement in the Scoliosis Research Society (SRS-22r) score (3.0 to 3.5; P < .01). Conclusion: Proximal junctional kyphosis is the most common indication for patients requiring fusion to the cervical spine. Adult patients incur a significant risk of major complications and reoperations. However, significant improvement in SRS-22r outcomes are noted in these patients.
The Effects of Chronic Preoperative Steroid Therapy on Perioperative Complications Following Elective Posterior Lumbar Fusion
Authors: Ranson William A. , White Samuel J. W. , Cheung Zoe B. , Mikhail Christopher , Ye Ivan , Kim Jun S. , Cho Samuel K. 
Published: May 2018

Study Design: Retrospective cohort study. Objectives: Chronic steroid therapy is used in the treatment of various inflammatory and autoimmune conditions, but it is known to be associated with adverse effects. There remains a gap in the literature regarding the role of chronic steroid therapy in predisposing patients to perioperative complications following elective posterior lumbar fusion (PLF). We aimed to identify the effects of chronic preoperative steroid therapy on 30-day perioperative complications in patients undergoing PLF. Methods: A retrospective analysis was performed using the 2011-2014 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. We identified 22 903 patients who underwent elective PLF. There were 849 patients (3.7%) who received chronic preoperative steroid therapy. Univariate and multivariate analyses were performed to examine steroid therapy as an independent risk factor for 30-day perioperative complications. A subgroup analysis of patients on chronic steroid therapy was then performed to identify additional patient characteristics that further increased the risk for perioperative complications. Results: Chronic preoperative steroid therapy was an independent risk factor for 7 perioperative complications, including superficial surgical site infection (SSI), deep SSI, wound dehiscence, urinary tract infection, pulmonary embolism, nonhome discharge, and readmission. Subgroup analysis demonstrated that morbid obesity further predisposed patients on chronic steroid therapy to an increased risk of superficial SSI and wound dehiscence. Conclusions: Patients on chronic preoperative steroid therapy are at increased risk of multiple perioperative complications following elective PLF, particularly surgical site complications and venous thromboembolic events. This risk is further elevated in patients who are morbidly obese.
Epidemiology of Hip and Groin Injuries in Collegiate Athletes in the United States
Authors: Kerbel Yehuda E. , Smith Christopher M. , Prodromo John P. , Nzeogu Michael I. , Mulcahey Mary K. 
Published: May 2018

Background: Hip and groin pain is a common complaint among athletes. Few studies have examined the epidemiology of hip and groin injuries in collegiate athletes across multiple sports. Purpose: To describe the rates, mechanisms, sex-based differences, and severity of hip/groin injuries across 25 collegiate sports. Study Design: Descriptive epidemiology study. Methods: Data from the 2009-2010 through 2013-2014 academic years were obtained from the National Collegiate Athletic Association Injury Surveillance Program (NCAA ISP). The rate of hip/groin injuries, mechanism of injury, time lost from competition, and need for surgery were calculated. Differences between sex-comparable sports were quantified using rate ratios (RRs) and injury proportion ratios (IPRs). Results: In total, 1984 hip/groin injuries were reported, giving an overall injury rate of 53.06 per 100,000 athlete-exposures (AEs). An adductor/groin tear was the most common injury, comprising 24.5% of all injuries. The sports with the highest rates of injuries per 100,000 AEs were men’s soccer (110.84), men’s ice hockey (104.90), and women’s ice hockey (76.88). In sex-comparable sports, men had a higher rate of injuries per 100,000 AEs compared with women (59.53 vs 42.27, respectively; RR, 1.41 [95% CI, 1.28-1.55]). The most common injury mechanisms were noncontact (48.4% of all injuries) and overuse/gradual (20.4%). In sex-comparable sports, men had a greater proportion of injuries due to player contact than women (17.0% vs 3.6%, respectively; IPR, 4.80 [95% CI, 3.10-7.42]), while women had a greater proportion of injuries due to overuse/gradual than men (29.1% vs 16.7%, respectively; IPR, 1.74 [95% CI, 1.46-2.06]). Overall, 39.3% of hip/groin injuries resulted in time lost from competition. Only 1.3% of injuries required surgery. Conclusion: Hip/groin injuries are most common in sports that involve kicking or skating and sudden changes in direction and speed. Most hip/groin injuries in collegiate athletes are noncontact and do not result in time lost from competition, and few require surgery. This information can help guide treatment and prevention measures to limit such injuries in male and female collegiate athletes.
From a Mission Statement to a Sense of Mission: Emotion Coding to Strengthen Digital Engagements
Authors: Straker Karla , Wrigley Cara 
Published: May 2018

The emergence of new technologies has revolutionized the way companies interact and build relationships with customers. This study aims to understand the emotion behind the company strategy and how they can be used to inform the design of digital channel engagements. A content analysis of 100 international companies from a range of industries and sectors was conducted with multiple data sources to develop an emotional coding scheme, for clarifying and refining the meaning behind a company’s strategy and its relationship to corresponding digital channels. This study identifies 10 distinct emotional channel typologies across 16 sectors through the analysed companies. This research contributes a theoretical and empirical understanding of emotion as a strategy. Outcomes guide practitioners on the selection and design of digital engagements based on the emotion code of their strategy as well as an industry sector. This article provides a novel approach to understanding and designing digital channel engagements by starting with meaning and purpose of the company.
How and when I do allogeneic transplant in CLL
Authors: Gribben John G. 
Published: May 2018

Abstract
Allogenic stem cell transplantation (allo-SCT) has been considered the treatment of choice for high-risk patients with chronic lymphocytic leukemia (CLL) and the only approach offered with curative intent in this disease. The availability novel agents, including the B-cell receptor inhibitors ibrutinib, acalabrutinib, and idelalisib, as well as venetoclax, which targets the BCL2 pathway, and the success of these agents in treating high-risk disease patients have made it more difficult to assess who should be considered for allo-SCT and when in the treatment course. In this review, I will discuss the different treatment options available for the treatment of high-risk CLL and how allo-SCT fits into the treatment algorithm in the era of novel agents.
Phase 2 study of everolimus for relapsed or refractory classical Hodgkin lymphoma
Authors: Johnston Patrick B. , Pinter-Brown Lauren C. , Warsi Ghulam , White Kristen , Ramchandren Radhakrishnan 
Published: May 2018

Abstract
Background
The current standard of care for classical Hodgkin lymphoma (HL) is multiagent chemotherapy with or without radiation. In patients who relapse or fail to respond, additional high-dose chemotherapy with autologous hematopoietic stem cell transplantation (AHSCT) can improve progression-free survival (PFS). Novel therapies are required for patients refractory to chemotherapy and AHSCT. The mammalian target of rapamycin inhibitor everolimus has shown preliminary activity in preclinical models of HL and promising efficacy in patients with relapsed or refractory HL.

Methods
This was an open-label, two-stage, phase 2 study that enrolled 57 patients aged ≥ 18 years with classic HL that had progressed after standard therapy. Patients received everolimus 10 mg daily until disease progression, intolerable toxicity, withdrawal of consent, or investigator decision. The primary endpoint was overall response rate; secondary endpoints included PFS, overall survival, time to response, duration of response, and safety.

Results
Overall response rate was 45.6% (95% confidence interval [CI] 32.4–59.3%); five patients (8.8%) experienced a complete response and 21 patients had a partial response (36.8%). Median PFS was 8.0 months (95% CI 5.1–11.0 months). Seven patients (12%) were long-term responders (≥ 12 months). The most common study drug-related adverse events were thrombocytopenia (45.6%), fatigue (31.6%), anemia (26.3%), rash (24.6%), and stomatitis (22.8%).

Conclusions
Everolimus 10 mg/day demonstrated favorable results in patients with heavily pretreated, relapsed, or refractory classical HL. These findings support the further evaluation of everolimus in this indication.
Trial registration ClinicalTrials.gov NCT01022996. Registered November 25, 2009
Seismic resolution enhancement in shale-oil reservoirs
Authors: Liu Xiwu , Gao Fengxia , Zhang Yuanyin , Rao Ying , Wang Yanghua 
Published: May 2018

We developed a case study of seismic resolution enhancement for shale-oil reservoirs in the Q Depression, China, featured by rhythmic bedding. We proposed an innovative method for resolution enhancement, called the full-band extension method. We implemented this method in three consecutive steps: wavelet extraction, filter construction, and data filtering. First, we extracted a constant-phase wavelet from the entire seismic data set. Then, we constructed the full-band extension filter in the frequency domain using the least-squares inversion method. Finally, we applied the band extension filter to the entire seismic data set. We determined that this full-band extension method, with a stretched frequency band from 7–70 to 2–90 Hz, may significantly enhance 3D seismic resolution and distinguish reflection events of rhythmite groups in shale-oil reservoirs.
Applying Radiomics to Predict Pathology of Postchemotherapy Retroperitoneal Nodal Masses in Germ Cell Tumors
Authors: Lewin Jeremy , Dufort Paul , Halankar Jaydeep , O’Malley Martin , Jewett Michael A.S. , Hamilton Robert J. , Gupta Abha , Lorenzo Armando , Traubici Jeffrey , Nayan Madhur , Leão Ricardo , Warde Padraig , Chung Peter , Anson Cartwright Lynn , Sweet Joan , Hansen Aaron R. , Metser Ur , Bedard Philippe L. 
Published: May 2018

Purpose After chemotherapy, approximately 50% of patients with metastatic testicular germ cell tumors (GCTs) who undergo retroperitoneal lymph node dissections (RPNLDs) for residual masses have fibrosis. Radiomics uses image processing techniques to extract quantitative textures/features from regions of interest (ROIs) to train a classifier that predicts outcomes. We hypothesized that radiomics would identify patients with a high likelihood of fibrosis who may avoid RPLND. Patients and Methods Patients with GCT who had an RPLND for nodal masses > 1 cm after first-line platinum chemotherapy were included. Preoperative contrast-enhanced axial computed tomography images of retroperitoneal ROIs were manually contoured. Radiomics features (n = 153) were used to train a radial basis function support vector machine classifier to discriminate between viable GCT/mature teratoma versus fibrosis. A nested 10-fold cross-validation protocol was used to determine classifier accuracy. Clinical variables/restricted size criteria were used to optimize the classifier. Results Seventy-seven patients with 102 ROIs were analyzed (GCT, 21; teratoma, 41; fibrosis, 40). The discriminative accuracy of radiomics to identify GCT/teratoma versus fibrosis was 72 ± 2.2% (area under the curve [AUC], 0.74 ± 0.028); sensitivity was 56.2 ± 15.0%, and specificity was 81.9 ± 9.0% ( P = .001). No major predictive differences were identified when data were restricted by varying maximal axial diameters (AUC range, 0.58 ± 0.05 to 0.74 ± 0.03). The prediction algorithm using clinical variables alone identified an AUC of 0.76. When these variables were added to the radiomics signature, the best performing classifier was identified when axial masses were limited to diameter < 2 cm (accuracy, 88.2 ± 4.4; AUC, 0.80 ± 0.05; P = .02). Conclusion A predictive radiomics algorithm had a discriminative accuracy of 72% that improved to 88% when combined with clinical predictors. Additional independent validation is required to assess whether radiomics allows patients with a high predicted likelihood of fibrosis to avoid RPLND.
Positron Emission Tomography–Guided Therapy of Aggressive Non-Hodgkin Lymphomas (PETAL): A Multicenter, Randomized Phase III Trial
Authors: Dührsen Ulrich , Müller Stefan , Hertenstein Bernd , Thomssen Henrike , Kotzerke Jörg , Mesters Rolf , Berdel Wolfgang E. , Franzius Christiane , Kroschinsky Frank , Weckesser Matthias , Kofahl-Krause Dorothea , Bengel Frank M. , Dürig Jan , Matschke Johannes , Schmitz Christine , Pöppel Thorsten , Ose Claudia , Brinkmann Marcus , La Rosée Paul , Freesmeyer Martin , Hertel Andreas , Höffkes Heinz-Gert , Behringer Dirk , Prange-Krex Gabriele , Wilop Stefan , Krohn Thomas , Holzinger Jens , Griesshammer Martin , Giagounidis Aristoteles , Raghavachar Aruna , Maschmeyer Georg , Brink Ingo , Bernhard Helga , Haberkorn Uwe , Gaska Tobias , Kurch Lars , van Assema Daniëlle M.E. , Klapper Wolfram , Hoelzer Dieter , Geworski Lilli , Jöckel Karl-Heinz , Scherag André , Bockisch Andreas , Rekowski Jan , Hüttmann Andreas ,   on behalf of the PETAL Trial Investigators
Published: May 2018

Purpose Interim positron emission tomography (PET) using the tracer, [18F]fluorodeoxyglucose, may predict outcomes in patients with aggressive non-Hodgkin lymphomas. We assessed whether PET can guide therapy in patients who are treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). Patients and Methods Newly diagnosed patients received two cycles of CHOP—plus rituximab (R-CHOP) in CD20-positive lymphomas—followed by a PET scan that was evaluated using the ΔSUVmax method. PET-positive patients were randomly assigned to receive six additional cycles of R-CHOP or six blocks of an intensive Burkitt’s lymphoma protocol. PET-negative patients with CD20-positive lymphomas were randomly assigned or allocated to receive four additional cycles of R-CHOP or the same treatment with two additional doses rituximab. The primary end point was event-free survival time as assessed by log-rank test. Results Interim PET was positive in 108 (12.5%) and negative in 754 (87.5%) of 862 patients treated, with statistically significant differences in event-free survival and overall survival. Among PET-positive patients, 52 were randomly assigned to R-CHOP and 56 to the Burkitt protocol, with 2-year event-free survival rates of 42.0% (95% CI, 28.2% to 55.2%) and 31.6% (95% CI, 19.3% to 44.6%), respectively (hazard ratio, 1.501 [95% CI, 0.896 to 2.514]; P = .1229). The Burkitt protocol produced significantly more toxicity. Of 754 PET-negative patients, 255 underwent random assignment (129 to R-CHOP and 126 to R-CHOP with additional rituximab). Event-free survival rates were 76.4% (95% CI, 68.0% to 82.8%) and 73.5% (95% CI, 64.8% to 80.4%), respectively (hazard ratio, 1.048 [95% CI, 0.684 to 1.606]; P = .8305). Outcome prediction by PET was independent of the International Prognostic Index. Results in diffuse large B-cell lymphoma were similar to those in the total group. Conclusion Interim PET predicted survival in patients with aggressive lymphomas treated with R-CHOP. PET-based treatment intensification did not improve outcome.