bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of the Time Proportion of Respiratory Phases on Dosimetry in SBRT of Lung Tumor Near the Chest Wall or Diaphragm
Authors: Sun Xuanzi , Li Yi , Li Junjun , Zhang Xiaozhi 
Published: September 2019

Purpose: Large tumor motion often leads to larger dosimetric variation, especially in lung tumors located in lower lobe and adhered to chest wall or diaphragm. The purpose of this work is to discuss the impact of the time proportion of each respiratory phase on dosimetry in stereotactic body radiation therapy with lung cancer tumor close to chest wall or diaphragm. Methods: Participants include 14 patients with lung cancer located in the lower lobe. Each patient received treatment planning 3-dimensional computed tomography and an additional 4-dimensional computed tomography simulation under free-breathing condition. The percentage of time intervals for each respiratory phase in a whole respiratory cycle was calculated from respiratory motion curves recorded during 4-dimensional computed tomography scanning. Treatment plan was made upon treatment planning 3-dimensional computed tomography and then transformed onto each image of 4-dimensional computed tomography. The transformed doses on each image of 4-dimensional computed tomography were accumulated with equal weight or with weight of time proportion for each respiratory phase. Results: Compared to treatment planning 3-dimensional computed tomography dose, the mean dose of tumor, affected lung, contralateral lung, bilateral lungs, and V20 of affected lung decreased by 2.7%, 4.5%, 1.5%, 1.2%, and 4.1%, respectively, after equal-weighted accumulation, while mean dose of heart increased by 3.6% ( P < .05). Accumulated dose with weight of actual time proportion decreased in the mean dose of tumor, affected lung, contralateral lung, bilateral lungs, and V20 of affected lung by 2.37%, 5.19%, 3.61%, 3.46%, and 5.08%, respectively compared to treatment planning 3-dimensional computed tomography dose, but mean dose of heart increased by 5.12% ( P < .05). Conclusions: Doses received by tumor, lungs, and heart changed more significantly after time-weighted 4-dimensional accumulation than equal-weight 4-dimensional accumulation. Utilizing 4-dimensional computed tomography and deformable image registration to introduce time proportions of each respiratory phase to dose distribution evaluation is of significance for accuracy in lung cancer during stereotactic body radiation therapy treatment.
Retinal detachment
Authors: Holliday Lois , Wilde Caroline 
Published: September 2019

Around 5% of GP consultations are said to be eye-related, with loss of sight being the most feared long-term health condition. In 2013 there were 4 500 000 GP consultations related to eye health. The RCGP has stated that 50% of sight loss could be avoided through earlier diagnosis and improved eye care. It is essential that retinal detachment is recognised as an ophthalmological emergency and referred for urgent surgical repair to prevent visual loss. This article outlines the causes, presentation and management of retinal detachment, emphasising risk factors and clinical features that facilitate early diagnosis and prompt referral.
The effect of operative time on early postoperative complications in total shoulder arthroplasty: An analysis of the ACS-NSQIP database
Authors: Wilson Jacob M , Holzgrefe Russell E , Staley Christopher A , Karas Spero , Gottschalk Michael B , Wagner Eric R 
Published: September 2019

Background Total shoulder arthroplasty has been demonstrated to be an effective treatment for arthritis of the glenohumeral joint. Prior studies have identified longer operative times as a risk factor for complications after numerous types of procedures. We hypothesized that increased operative time, in 20-min intervals, would be associated with complications following total shoulder arthroplasty. Methods Patients undergoing total shoulder arthroplasty from 2006 to 2015 were identified from the ACS-NSQIP database. Patient demographic information, perioperative parameters, and 30-day outcomes were retrieved. Pearson's Chi-square test and multivariate Poisson regression with robust error variance were used to analyze the relationship of operative time and outcomes. Results A total of 10,082 patients were included. Multivariate analysis revealed that for each increase in 20 min of operative time, there were significantly increased rates of any complication (relative risk (RR) 1.24, 95% confidence interval (CI) 1.19–1.26), anemia requiring transfusion (RR 1.33, 95%CI 1.26–1.4), peripheral nerve injury (RR 1.88, 95%CI 1.53–2.31), and urinary tract infection (RR 1.24, 95%CI 1.09–1.41). Discussion This study indicates that increasing operative time confers increased risk for postoperative complications following total shoulder arthroplasty. We anticipate the results of this manuscript will be used for provider education, policy decision-making, and potentially to derive algorithms that can improve safety and efficiency in total shoulder arthroplasty. Level of evidence III.
The gut virome in inflammatory bowel disease pathogenesis: From metagenomics to novel therapeutic approaches
Authors: Ungaro Federica , Massimino Luca , D’Alessio Silvia , Danese Silvio 
Published: September 2019

SummaryThe association of intestinal dysbiosis with the pathogenesis of inflammatory bowel disease has been well established. Besides bacteria, microbiota comprises yeasts, archaea, protists and viruses, neglected actors in inflammatory bowel disease‐associated microbiota. In the past, a great limitation in studying microbiota composition was the low sensitivity of sequencing technologies and that few computational approaches were sufficient to thoroughly analyse the whole microbiome. However, new cutting‐edge technologies in nucleic acid sequencing, ‐omics analysis and the innovative statistics and bioinformatics pipelines made possible more sensitive and accurate metagenomics, ultimately identifying novel players in intestinal inflammation, including prokaryotic and eukaryotic viruses, that together form the gut virome. The discovery of peculiar inflammatory bowel disease‐associated microbial strains will not only shed new light on inflammatory bowel disease aetiogenesis, they may also support the development of novel therapeutic strategies not merely treating symptoms, but precisely counteracting the primary cause of chronic intestinal inflammation.
Thinking Volume First: Developing a Multifaceted Systematic Approach to Volume Management in Hemodialysis
Authors: Blum Daniel , Beaubien-Souligny William , Silver Samuel A. , Wald Ron 
Published: September 2019

Purpose of review: Volume overload and hypovolemia-induced symptoms are common in the hemodialysis (HD) population and frequently result in emergency department visits and hospitalization. A structured strategy for the reporting, evaluation, and management of disordered volume status may improve clinical outcomes and the patient experience. We developed a new strategy that systematically addresses volume issues by leveraging the electronic medical record, technological adjuncts, and multidisciplinary expertise to institute new processes of care in our HD unit. Sources of information: This initiative was implemented in a unit located in an urban academic hospital where 250 patients receive maintenance HD. This initiative involved a multidisciplinary team of health professionals including physicians, nurse practitioners, social workers, and dieticians. Methods: We generated volume metrics for HD recipients based on routinely collected data from the unit’s electronic medical record. We then engaged stakeholders in a root cause analysis to identify the major causes of abnormal volume metrics locally. We subsequently developed interventions that were designed to address each of the major causes in a pragmatic and sustainable program. Key findings: The final product was a local volume management program with 3 components. First, we integrated volume metric reporting into the routine surveillance bloodwork reports across our unit. This enabled the clinical teams to more easily target patients at risk for volume-related adverse events and provide them with closer surveillance. Those identified with abnormal volume metrics were then evaluated with the use of technologic adjuncts such as lung ultrasound and bioimpedance spectroscopy to complement traditional assessments of volume status. Finally, those with abnormal volume metrics underwent rigorous interdisciplinary review for potential nutritional/social interventions. Limitations: While we report the successful initial implementation of the program within a single center, it remains unclear whether this initiative will lead to meaningful benefits for HD recipients, be readily applicable in other centers, or be sustainable in the long term. Implications: This volume management program will need further evaluation linked to outcome assessment and feasibility in other centers before wider adoption is advocated.
Risks and Complications Associated With Intra-articular Arthroscopy of the Knee and Shoulder in an Office Setting
Authors: McMillan Sean , Chhabra Anikar , Hassebrock Jeffrey D. , Ford Elizabeth , Amin Nirav H. 
Published: September 2019

Background: Classically, arthroscopy has been considered one of the diagnostic gold standards for assessing intra-articular knee and shoulder abnormality. Purpose: To assess the risks associated with in-office needle arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: A retrospective case series analysis was performed by evaluating consecutive diagnostic needle arthroscopies performed by 13 physicians at 13 independent institutions. The findings of both major and minor complications were reported by each of the 13 surgeons based on office documentation. The data were analyzed as a lump sum of both knee and shoulder cases and then subdivided and examined separately. The patients’ ages ranged from 14 to 78 years, and no statistical difference was noted between the numbers of men and women. A major complication was defined as infection, chondral toxicity, or the need for alternative treatment at an urgent care or emergency room secondary to the procedure. Minor complications were defined as a vasovagal event, pain that persisted after 24 hours, or the need for crutches or sling postprocedure. Results: Of the 1419 cases, no major complications were reported. The overall rate of vasovagal events was 1.9% for all procedures (1.6% in knees, 3% in shoulders). Persistent pain longer than 24 hours postprocedure was reported in 0.3% of cases. No patient required crutches or a sling. Postarthroscopy magnetic resonance imaging was needed in 1.4% of cases. No device failures were reported. Conclusion: Previous literature has evaluated the efficacy, sensitivity, and specificity of in-office diagnostic arthroscopy, and this study validates needle arthroscopy as safe in the office setting, with minimal risk of major or minor complications.
High Ankle Sprains in Professional Ice Hockey Players: Prognosis and Correlation Between Magnetic Resonance Imaging Patterns of Injury and Return to Play
Authors: Mollon Brent , Wasserstein David , Murphy Gráinne M. , White Lawrence M. , Theodoropoulos John 
Published: September 2019

Background: Hockey players sustain a greater incidence of ankle syndesmosis injuries than other athletes. These injuries have a higher morbidity and more unpredictable recovery than lateral ankle sprains. Magnetic resonance imaging (MRI) has been used to establish the diagnosis but has not been evaluated for its ability to predict return to play. Hypothesis: We hypothesized that patterns of injury defined on MRI could be used to predict return to play in a cohort of professional hockey players with syndesmosis sprains. Study Design: Cohort study; Level of evidence, 3. Methods: A prospectively collected National Hockey League (NHL) database was analyzed from the 2006-2007 to 2011-2012 seasons to assess return to play after an injury. A separate retrospective review of ankle MRI scans from professional hockey players with a documented high ankle sprain sustained between 2007 and 2012 was performed. Injuries were classified on MRI as complete or partial tears of the anterior-inferior tibiofibular ligament (AITFL), posterior-inferior tibiofibular ligament (PITFL), anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL), calcaneofibular ligament (CFL), and deltoid ligament. Fractures, bone contusions, and osteochondral lesions were also recorded. Results: A total of 105 NHL athletes sustained high ankle sprains over the 5 seasons studied. Of these athletes, 85 were unable to play and missed a median of 8 games (range, 0-65 games). A retrospective MRI evaluation of 21 scans identified complete AITFL tears in 13 (62%) and high-grade partial tears in 5 (24%) cases. In contrast, the PITFL was partially torn in 9 (43%) and normal in 12 (57%) cases. Bone contusions were seen in 71% of cases and lacked a consistent pattern. The most commonly associated ligamentous injury was of the ATFL, which was injured in 52% of cases (11/21; 3 complete and 8 partial). There was no difference in the mean number of days lost when players were stratified by patterns of injury (incomplete/complete AITFL tear ± additional ligamentous injury, bone contusion, syndesmosis width). Conclusion: A high ankle sprain resulted in significant variations in time of recovery among professional hockey players. A torn AITFL and bone bruising were the most common patterns of injury. Although MRI can be used to confirm the diagnosis of a syndesmosis injury, it did not predict return to play in this population.
Efficacy of Aflibercept in Bevacizumab-Resistant Macular Edema in Adult-Onset Coats Disease
Authors: Ku Cristy A. , Lema Gareth M. 
Published: September 2019

Purpose: This case is the first to our knowledge that demonstrates the efficacy of intravitreal aflibercept in bevacizumab-resistant, laser-naive macular edema (ME) in adult-onset Coats disease. Methods: A retrospective case report is presented. Results: A 74-year-old woman presented with central visual distortion in her right eye. Imaging and exam were consistent with adult-onset Coats disease with unilateral telangiectatic vessels, numerous macroaneurysms, and peripheral capillary dropout. There were also ME, lipid exudate, and localized hemorrhage. ME failed to respond to 4 intravitreal injections of bevacizumab but dramatically improved following initiation of aflibercept, with patient deferral of laser photocoagulation. Conclusions: To our knowledge, this is the first reported case of aflibercept as the sole treatment of bevacizumab-resistant ME in adult-onset Coats disease. Given the localized macular involvement more common to adult-onset Coats disease, antivascular endothelial growth factor (anti-VEGF) therapy may be sufficient, compared with classic childhood Coats disease, in which anti-VEGF therapy serves as an adjunct to laser photocoagulation or cryotherapy.
The whole-genome landscape of Burkitt lymphoma subtypes
Authors: Panea Razvan I. , Love Cassandra L. , Shingleton Jennifer R. , Reddy Anupama , Bailey Jeffrey A. , Moormann Ann M. , Otieno Juliana A. , Ong’echa John Michael , Oduor Cliff I. , Schroeder Kristin M. S. , Masalu Nestory , Chao Nelson J. , Agajanian Megan , Major Michael B. , Fedoriw Yuri , Richards Kristy L. , Rymkiewicz Grzegorz , Miles Rodney R. , Alobeid Bachir , Bhagat Govind , Flowers Christopher R. , Ondrejka Sarah L. , Hsi Eric D. , Choi William W. L. , Au-Yeung Rex K. H. , Hartmann Wolfgang , Lenz Georg , Meyerson Howard , Lin Yen-Yu , Zhuang Yuan , Luftig Micah A. , Waldrop Alexander , Dave Tushar , Thakkar Devang , Sahay Harshit , Li Guojie , Palus Brooke C. , Seshadri Vidya , Kim So Young , Gascoyne Randy D. , Levy Shawn , Mukhopadyay Minerva , Dunson David B. , Dave Sandeep S. 
Published: September 2019

Abstract
Burkitt lymphoma (BL) is an aggressive, MYC-driven lymphoma comprising 3 distinct clinical subtypes: sporadic BLs that occur worldwide, endemic BLs that occur predominantly in sub-Saharan Africa, and immunodeficiency-associated BLs that occur primarily in the setting of HIV. In this study, we comprehensively delineated the genomic basis of BL through whole-genome sequencing (WGS) of 101 tumors representing all 3 subtypes of BL to identify 72 driver genes. These data were additionally informed by CRISPR screens in BL cell lines to functionally annotate the role of oncogenic drivers. Nearly every driver gene was found to have both coding and non-coding mutations, highlighting the importance of WGS for identifying driver events. Our data implicate coding and non-coding mutations in IGLL5, BACH2, SIN3A, and DNMT1. Epstein-Barr virus (EBV) infection was associated with higher mutation load, with type 1 EBV showing a higher mutational burden than type 2 EBV. Although sporadic and immunodeficiency-associated BLs had similar genetic profiles, endemic BLs manifested more frequent mutations in BCL7A and BCL6 and fewer genetic alterations in DNMT1, SNTB2, and CTCF. Silencing mutations in ID3 were a common feature of all 3 subtypes of BL. In vitro, mass spectrometry–based proteomics demonstrated that the ID3 protein binds primarily to TCF3 and TCF4. In vivo knockout of ID3 potentiated the effects of MYC, leading to rapid tumorigenesis and tumor phenotypes consistent with those observed in the human disease.
Inbreeding depression due to recent and ancient inbreeding in Dutch Holstein–Friesian dairy cattle
Authors: Doekes Harmen P. , Veerkamp Roel F. , Bijma Piter , de Jong Gerben , Hiemstra Sipke J. , Windig Jack J. 
Published: September 2019

AbstractBackgroundInbreeding decreases animal performance (inbreeding depression), but not all inbreeding is expected to be equally harmful. Recent inbreeding is expected to be more harmful than ancient inbreeding, because selection decreases the frequency of deleterious alleles over time. Selection efficiency is increased by inbreeding, a process called purging. Our objective was to investigate effects of recent and ancient inbreeding on yield, fertility and udder health traits in Dutch Holstein–Friesian cows.MethodsIn total, 38,792 first-parity cows were included. Pedigree inbreeding ($$F_{PED}$$FPED) was computed and 75 k genotype data were used to compute genomic inbreeding, among others based on regions of homozygosity (ROH) in the genome ($$F_{ROH}$$FROH).ResultsInbreeding depression was observed, e.g. a 1% increase in$$F_{ROH}$$FROHwas associated with a 36.3 kg (SE = 2.4) decrease in 305-day milk yield, a 0.48 day (SE = 0.15) increase in calving interval and a 0.86 unit (SE = 0.28) increase in somatic cell score for day 150 through to 400. These effects equalled − 0.45, 0.12 and 0.05% of the trait means, respectively. When$$F_{PED}$$FPEDwas split into generation-based components, inbreeding on recent generations was more harmful than inbreeding on more distant generations for yield traits. When$$F_{PED}$$FPEDwas split into new and ancestral components, based on whether alleles were identical-by-descent for the first time or not, new inbreeding was more harmful than ancestral inbreeding, especially for yield traits. For example, a 1% increase in new inbreeding was associated with a 2.42 kg (SE = 0.41) decrease in 305-day fat yield, compared to a 0.03 kg (SE = 0.71) increase for ancestral inbreeding. There were no clear differences between effects of long ROH (recent inbreeding) and short ROH (ancient inbreeding).ConclusionsInbreeding depression was observed for yield, fertility and udder health traits. For yield traits and based on pedigree, inbreeding on recent generations was more harmful than inbreeding on distant generations and there was evidence of purging. Across all traits, long and short ROH contributed to inbreeding depression. In future work, inbreeding depression and purging should be assessed in more detail at the genomic level, using higher density information and genomic time series.
Extent of inappropriate prescription of artemisinin and anti-malarial injections to febrile outpatients, a cross-sectional analytic survey in the Greater Accra region, Ghana
Authors: Bonful Harriet Affran , Awua Adolf Kofi , Adjuik Martin , Tsekpetse Doris , Adanu Richard Mawuko Kofi , Nortey Pricillia Awo , Ankomah Augustine , Koram Kwadwo Ansah 
Published: September 2019

AbstractBackgroundFebrile children seen in malaria hypo-endemic settings, such as the Greater Accra region (GAR) of Ghana are more likely to be suffering from a non-malarial febrile illness compared to those seen in hyper-endemic settings. The need for prescribers to rely on malaria test results to guide treatment practices in the GAR is even greater. This study was designed to investigate the factors associated with inappropriate artemisinin-based combination therapy (ACT) prescription.MethodsA survey was conducted in six health facilities in the region in 2015. Treatment practices for febrile outpatient department (OPD) patients were obtained from their records. Prescribers were interviewed and availability of malaria commodities were assessed. The primary outcome was the proportion of patients prescribed ACT inappropriately. Independent variables included patient age and access to care, prescriber factors (professional category, work experience, access to guidelines, exposure to training). Data were analysed using Stata at 95% CI (α-value of 0.05). Frequencies and means were used to describe the characteristics of patients and prescribers. To identify the predictors of inappropriate ACT prescription, regression analyses were performed accounting for clustering.ResultsOverall, 2519 febrile OPD records were analysed; 45.6% (n = 1149) were younger than 5 years. Only 40.0% of patients were tested. The proportion of patients who were prescribed ACT inappropriately was 76.4% (n = 791 of 1036). Of these 791 patients, 141 (17.8%) were prescribed anti-malarial injections. Patients seen in facilities with rapid diagnostic tests (RDT) in stock were less likely to be prescribed ACT inappropriately, (AOR: 0.04, 95% CI 0.01–0.14, p < 0.001) compared to those seen in facilities with RDT stock-outs. Prescribers who had been trained on malaria case management within the past year were 4 times more likely to prescribe ACT inappropriately compared to those who had not been trained (AOR: 4.1; 95% CI (1.5–11.6); p < 0.01). Patients seen by prescribers who had been supervised were 8 times more likely to be prescribed ACT inappropriately.ConclusionInappropriate ACT prescription to OPD febrile cases was high. Training and supervision of health workers appears not to be yielding the desired outcomes. Further research is needed to understand this observation.
Towards modular composition of agent-based voltage control concepts
Authors: Wolgast Thomas , Nieße Astrid 
Published: September 2019

Abstract
In the last years, diverse agent-based concepts for voltage control in distribution grids were presented in literature. All these approaches are developed manually. Up to now, no tailoring approach has been presented to adapt these concepts to different – likewise specific – grid situations. As the effectiveness of voltage control schemes is highly dependent on the specific grid situation, this can result in multiple problems with regard to performance, applicability and expandability of the proposed agent-based control. The ideal case would be a customizable agent system that is automatically tailored to the grid it shall be applied to, considering its specific characteristics. To address that complex task, this paper proposes an approach for the modular composition of voltage control agents by recombining existing concepts from literature to new fully functional agent systems. This approach makes the first move to an optimized and scenario-specific creation of agent-based control systems that are specifically designed and automatically tailored to a given power system.