bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elevated Cerebrospinal Fluid Sodium and Chloride Levels in a Saltwater Drowning Death
Authors: Garland Jack , Philcox Winston , Kesha Kilak , McCarthy Sinead , Lam Leo (Chi Sing) , Palmiere Cristian , Hensby-Bennett Sarah , Stables Simon , Tse Rexson 
Published: January 2019

Abstract
To ascribe a cause of death from drowning in a body immersed in water can be difficult because of the absence of specific postmortem findings and unreliable ancillary tests. Postmortem vitreous biochemical analysis is documented to be a useful adjunct ancillary test to aid the diagnosis of saltwater drowning. A major confounding factor in using postmortem vitreous is the effect of electrolyte diffusion and water osmosis during immersion. A recent animal study suggested that cerebrospinal fluid (CSF) biochemical analysis, which is unaffected by immersion, may be an alternative. However, to date, there are no human data to support this. We report a saltwater drowning death from presumed suicide in which the postmortem CSF sodium and chloride level was elevated compared with nonimmersion deaths. This case gives evidence to support the potential use of postmortem CSF sodium and chloride level as an adjunct to the diagnosis of saltwater drowning.
Transferred-tissue Microarray for Fluorescence In Situ Hybridization Test for Human Epidermal Growth Factor Receptor 2 in Breast Cancer
Authors: Lin Chih-Hung , Wen Chien-Hui , Liu Chia-Hsing , Yang Ching-Hsiu 
Published: January 2019

Context:
Human epidermal growth factor receptor 2 (HER2) status of breast carcinomas is usually determined by immunohistochemical (IHC) staining and, if the IHC results are equivocal, in situ hybridization (ISH). Multiple ISH tests are sometimes required for multiple primary or metastatic tumors. A method for multiplex ISH test on tissues from multiple blocks is helpful in these situations.

Object:
To evaluate the clinical application of transferred-tissue microarray (TTM) followed by a dual-probe HER2 fluorescence in situ hybridization (FISH).

Design:
A 3×3 TTM technique was successfully established using 152 invasive mammary carcinoma tissue fragments. To evaluate detection of HER2 positive tumors, this cohort was enriched with tumors with IHC scores of 2 and 3.

Results:
The HER2 FISH analyses revealed that all transferred-tissue fragments were adequate for determining HER2 amplification. Tissue loss was minimal and had no major adverse effects on interpretation of the test results. Of the 81 tumors with IHC scores of 3, 72 (88.8%) were positive for HER2 FISH. The remaining tumors were negative for HER2 FISH in both TTM and reflex whole tissue section. Finally, FISH results for tumors with IHC scores of 2 were compared between TTM and whole tissue section. Concordance was high in overall positivity/negativity (100%), HER2 copy number (97.5%), and HER2/CEP17 ratio (100%).

Conclusions:
This novel technique is a reliable option for performing multiple HER2 FISH tests simultaneously in clinical and research-oriented settings with less tissue damage compared with conventional tissue microarray techniques.
Catecholaminergic Polymorphic Ventricular Tachycardia: The Cardiac Arrest Where Epinephrine Is Contraindicated*
Authors: Bellamy David , Nuthall Gabrielle , Dalziel Stuart , Skinner Jonathan R. 
Published: January 2019

Objectives:
To raise awareness among pediatric intensive care specialists of catecholaminergic polymorphic ventricular tachycardia; an uncommon cause of polymorphic ventricular tachycardia and ventricular fibrillation arrest in children and young adults where epinephrine (adrenaline), even when given according to international protocols, can be counter-productive and life-threatening. We review three cases of cardiac arrest in children, later proven to be catecholaminergic polymorphic ventricular tachycardia related, where delay in recognition of this condition resulted in significantly longer resuscitation efforts, more interventions, and a longer time to return of spontaneous circulation.

Design:
Retrospective case series.

Setting:
Tertiary children’s hospital.

Patients and Results:
Three previously well children 4, 5, and 10 years old presented with cardiac arrest triggered by light activity, partial water immersion, and running, respectively. Initial resuscitation was bystander cardiopulmonary resuscitation and community defibrillation in all three cases. Electrocardiograms revealed multifocal ventricular ectopy, and in two (4 and 10 yr old), this correlated with repeated administration of epinephrine during repeated ventricular tachycardia and ventricular fibrillation cardiac arrest resuscitation cycles. This ultimately resolved immediately (at 78 and 140 min, respectively) with IV opiates once catecholaminergic polymorphic ventricular tachycardia was suspected. During recovery, on extracorporeal membrane oxygenation, epinephrine challenge in two children induced polymorphic ventricular tachycardia, bidirectional ventricular tachycardia, and ventricular fibrillation, which was cardioverted with flecainide in the 4-year-old. The third case was recognized early as catecholaminergic polymorphic ventricular tachycardia and was managed by avoiding epinephrine and using opiates and general anesthesia after the initial (single) cardioversion, and had a much better clinical course, without recourse to extracorporeal membrane oxygenation. All three carried de novo RyR2 (cardiac ryanodine) mutations.

Conclusions:
Those involved in resuscitation of young people should be aware of catecholaminergic polymorphic ventricular tachycardia and be suspicious of persistent ventricular ectopy, polymorphic, or bidirectional ventricular tachycardia during resuscitation. Appropriate management is avoidance of epinephrine, administration of general anesthesia, IV opiates, and consideration of flecainide.
Extremity Arterial Thromboses in Hospitalized Children: A National Database Analysis of Prevalence and Therapeutic Interventions
Authors: Totapally Balagangadhar R. , Raszynski Andre , Khan Danyal , Amjad Ibrahim , Biehler Jefry 
Published: January 2019

Objectives:
The purpose of this study was to evaluate the prevalence, demographics, predisposing conditions, therapeutic interventions, and outcomes of extremity arterial thrombosis in hospitalized children.

Design:
Retrospective cohort study.

Patients:
National discharge database analysis.

Measurements and Main Results:
Cases of extremity arterial thrombosis in children and neonates were extracted from the Kids’ Inpatient Database 2012. These were analyzed and compared with other discharges for prevalence, demographics, treatments, outcomes, and further analyzed by age group and select predisposing conditions. A total of 961 children with extremity arterial thrombosis (prevalence of 2.35/10,000 discharges) were included in our analysis. The median age of extremity arterial thrombosis patients was significantly lower when compared with other pediatric discharges (1 yr [interquartile range, 0–15 yr) vs 3 yr [interquartile range, 0–16 yr]; p < 0.0001). The proportion of females with extremity arterial thrombosis was lower (41.4% vs 53.3%; odds ratio, 0.62; 95% CI, 0.55–0.70) with no racial/ethnic variation in the prevalence of extremity arterial thrombosis. An upper extremity was involved in 18.1% and a lower extremity in 83.3%. Arterial cannulation and cardiac catheterization were much more common in the younger age groups. External trauma was documented in 13.2% of all patients with extremity arterial thrombosis and was more frequent in older age groups. A systemic thrombolytic medication was administered to 5.7% of the patients, thromboembolectomy was performed in 11.8% of the cases, and 3.1% of the patients required amputation. There was a significant variation in the use of thrombolysis, thrombectomy/embolectomy, or requirement for amputation limb based on age groups and underlying predisposing condition.

Conclusions:
The study describes the national prevalence of extremity arterial thrombosis in hospitalized children. The management strategies of extremity arterial thrombosis vary with age and underlying predisposing factors.
Frequency-Specific Microcurrent for Treatment of Longstanding Congenital Muscular Torticollis
Authors: Thompson Regina , Kaplan Sandra L. 
Published: January 2019

Purpose:
This case describes the first episode of care, using conservative treatment, massage, and frequency-specific microcurrent (FSM), for a 19-month-old boy with grade 8 left congenital muscular torticollis with fibrotic nodules.

Methods:
Ten weeks of physical therapy provided stretching, strengthening, massage, and parent education, adding FSM in weeks 3 to 10 for this patient.

Results:
Full passive cervical rotation and lateral flexion, 4/5 lateral cervical flexion strength, improved head tilt, and inability to palpate fibrotic nodules were achieved by week 8, with partial home program adherence.

Conclusions and Recommendations for Practice:
Excellent outcomes were achieved with conservative care in a patient with poor prognosis and likelihood of surgical referral. Combining stretching, strengthening, massage, postural reeducation, and FSM resulted in full range and good strength in an exceptionally short time. The combination of massage and FSM, not previously reported, are tools that may be effective in congenital muscular torticollis treatment.
Brief Report: Comparing Sexual Risk Behavior in a High-Risk Group of Men Who Have Sex With Men and Transgender Women in Lima, Peru
Authors: Long Jessica E. , Montaño Michalina , Cabello Robinson , Sanchez Hugo , Lama Javier R. , Duerr Ann 
Published: January 2019

Background:
Transgender women (TW) and men who have sex with men (MSM) are often conflated in HIV research and prevention programs, despite clear differences that exist in culture and behavior.

Methods:
We examined baseline data from a large treatment-as-prevention study among TW and MSM in Lima, Peru, to assess differences in risk behavior. Baseline assessment included HIV testing and a questionnaire including sociodemographics, sexual behavior, social venue attendance, and drug and alcohol use. Poisson regression with robust standard errors was used to calculate prevalence ratios adjusted for confounding variables [adjusted prevalence ratio (aPR)] and 95% confidence intervals (CIs) comparing the prevalence of covariates related to HIV risk in MSM and TW.

Results:
Overall, 310 TW and 2807 MSM participated between July 2013 and September 2015 and were included in this analysis. TW engaged in some protective sexual health practices more than MSM, including HIV testing in the last year (aPR = 1.62; 95% CI: 1.42 to 1.84) and condom use at the last sexual encounter (aPR = 1.20; 95% CI: 1.06 to 1.36). TW were more likely to have sex while using alcohol (aPR 1.15, 95% CI: 1.01 to 1.31) or drugs (aPR 2.24, 95% CI: 1.47 to 3.41), have alcohol dependency (aPR 1.38, 95% CI: 1.15 to 1.66), engage in receptive anal sex (aPR 1.31, 95% CI: 1.26 to 1.36), and have received money, gifts, or favors in exchange of anal sex (1.96, 95% CI: 1.74 to 2.20).

Conclusions:
TW and MSM exhibited distinct risk profiles, suggesting that interventions specifically targeted to each group may provide new opportunities for more effective HIV prevention programs.
Risk Factors for Low CD4+ Count Recovery Despite Viral Suppression Among Participants Initiating Antiretroviral Treatment With CD4+ Counts > 500 Cells/mm3: Findings From the Strategic Timing of AntiRetroviral Therapy (START) Trial
Authors: Boatman Jeffrey A. , Baker Jason V. , Emery Sean , Furrer Hansjakob , Mushatt David M. , Sedláček Dalibor , Lundgren Jens D. , Neaton James D. ,   for the INSIGHT START Study Group
Published: January 2019

Background:
Low CD4+ recovery among HIV-positive individuals who achieve virologic suppression is common but has not been studied among individuals initiating treatment at CD4+ counts of >500 cells/mm3.

Setting:
United States, Africa, Asia, Europe and Israel, Australia, Latin America.

Methods:
Among participants randomized to immediate antiretroviral therapy (ART) in the Strategic Timing of AntiRetroviral Therapy trial, low CD4+ recovery was defined as a CD4+ increase of <50 cells/mm3 from baseline after 8 months despite viral load of ≤200 copies/mL. Risk factors for low recovery were investigated with logistic regression.

Results:
Low CD4+ recovery was observed in 39.7% of participants. Male sex [odds ratio (OR), 1.53; P = 0.007], lower screening CD4+ cell counts (OR, 1.09 per 100 fewer cells/mm3; P = 0.004), higher baseline CD8+ cell counts (OR, 1.05 per 100 more cells/mm3; P < 0.001), and lower HIV RNA levels (OR, 1.93 per log10 decrease; P < 0.001) were associated with low CD4+ recovery. D-dimer had a quadratic association with low CD4+ recovery, with lowest odds occurring at 0.32 μg/mL. At lower HIV RNA levels, the odds of low CD4+ recovery were elevated across the levels of screening CD4+ count; but at higher HIV RNA levels, the odds of low CD4+ recovery were higher among those with lower vs. higher screening CD4+.

Conclusions:
Low CD4+ recovery is frequent among participants starting ART at high CD4+ counts. Risk factors include male sex, lower screening CD4+ cell counts, higher CD8+ cell counts, and lower HIV RNA levels. More follow-up is required to determine the impact of low CD4+ recovery on clinical outcomes.
What's new in the epidemiology of skin and soft tissue infections in 2018?
Authors: Poulakou Garyphallia , Lagou Styliani , Tsiodras Sotirios 
Published: January 2019

Purpose of review
Skin and soft tissue infections (SSTIs) are among the most common infections in outpatients and the most frequent infectious cause of referrals to emergency departments in developed world, contributing to significant morbidity and healthcare expenditures. We sought to review recent literature covering epidemiology of SSTIs.

Recent findings

Staphylococcus aureus and streptococci predominate and methicillin-resistant S. aureus (MRSA) poses additional challenges; community-acquired-MRSA in some areas is superseding methicillin-susceptible S. aureus and multidrug resistance is evolving. Incidence data of SSTIs from United States show a decreasing trend, whereas trends of hospitalization rates were increasing. Despite low mortality associated with SSTIs, high rates of treatment failure and relapses are of concern. Diagnosis and management decisions in the emergency department (ED) lack validated tools for prediction of clinical response particularly among elderly, immunocompromised, obese, and patients with comorbidities. A variety of modifiable and nonmodifiable risk factors of the host and data from local epidemiology should be considered to prevent recurrence and treatment failure.

Summary
An evolving epidemiology of SSTIs make microbiologic documentation and surveillance of local data imperative. New assessment algorithms with potential use in the ED are a priority. The universal applicability of international guidelines is questioned in this setting.
Associations Between Magnetic Resonance Imaging Findings and Clincopathologic Factors in Triple-Negative Breast Cancer
Authors: Choi Bo Bae , Kim Sung Hun , Youn InKyung 
Published: January 2019

Objective
The aim of the study was to evaluate the magnetic resonance imaging findings associated with clinicopathologic factors in patients with triple-negative breast cancer.

Methods
One hundred one patients with surgically confirmed triple-negative breast cancer who underwent preoperative breast magnetic resonance imaging with diffusion-weighted imaging (DWI) were included in this study. Presence of rim enhancement on contrast-enhanced T1-weighted imaging and hyperintense rim on DWI were visually assessed. Pathologic data about presence of recurrence and presence of lymphovascular invasion (LVI) were reviewed. Statistics for relative risk of recurrence carried out.

Results
Of the 101, 13 cases (12.9%) were recurred after a median follow-up of 18.5 months. Rim enhancement was more frequently seen in the LVI-positive group (P = 0.046). Hyperintense rim on DWI and apparent diffusion coefficient values showed no significant relationship with clinical-pathologic factors.

Conclusions
Rim enhancement was significantly associated with positive LVI status in patients with triple-negative breast cancer. Our study suggests that rim enhancement may be useful to predict the prognosis.
The Application of Intravoxel Incoherent Motion Diffusion-Weighted Imaging in the Diagnosis of Hilar Obstructive Jaundice
Authors: Xu Xin , Zhang Xuening 
Published: January 2019

Objective
The aim of this study was to investigate the potential of intravoxel incoherent motion diffusion-weighted imaging in diagnosing hilar obstructive jaundice.

Methods
Fifty-nine patients diagnosed with hilar obstructive jaundice were enrolled in our hospital form January 2017 to January 2018. All the patients received scanning by a 3.0-T nuclear magnetic resonance scanner. The values of apparent diffusion coefficient (ADC)slow, ADCfast, and f were obtained and analyzed by 2 experienced radiologists. The differences between patients with hilar biliary obstruction and healthy volunteers in ADCslow, ADCfast, and f values were analyzed. Moreover, the differences between benign and malignant obstructive jaundice in ADCslow, ADCfast, and f values were analyzed. According to the serum levels of total bilirubin, patients were divided into 3 groups: mild, moderate, and severe obstructive jaundice. The differences between the 3 groups in ADCslow, ADCfast, and f values were also analyzed.

Results
The ADCfast values were obviously lower in patients with hilar obstructive jaundice than in healthy controls, whereas no significant difference in the values of ADCslow and f was found between both groups. The optimal cutoff value for ADCfast was 0.0341. The ADCfast values were significantly different between patients with benign and malignant hilar obstructive jaundice. The ADCfast values were negatively associated with the severity of hilar obstructive jaundice.

Conclusions
Intravoxel incoherent motion diffusion-weighted imaging was a promising method for diagnosing hilar biliary obstruction jaundice.
Highly Accelerated Breath-Hold Noncontrast Electrocardiographically- and Pulse-Gated Balanced Steady-State Free Precession Magnetic Resonance Angiography of the Thoracic Aorta: Comparison With Electrocardiographically-Gated Computed Tomographic Angiography
Authors: Lim Ruth P. , Singh Susan G. , Hornsey Emma , Kearney Leighton , Churilov Leonid , Storey Pippa , Begbie Mark , Shoobridge Jennifer , Xu Jian , Rayner Melanie , Matalanis George , Smith Gerard 
Published: January 2019

Objective
The aim of this study was to evaluate agreement of measured thoracic aortic caliber in patients with aortic disease, using electrocardiographically-(ECG) and pulse-gated breath-hold noncontrast balanced steady-state free precession MRA (ECG-MRA, P-MRA) at 1.5 T, compared with ECG-gated computed tomographic angiography (CTA).

Methods
Thirty-one patients underwent ECG-MRA, P-MRA, and CTA. Two readers independently measured aortic caliber in 7 segments, with agreement between techniques and readers evaluated. Image quality was qualitatively assessed.

Results
There was overall excellent agreement among ECG-MRA, P-MRA, and CTA for measured aortic caliber (Lin's concordance correlation coefficient ≥0.94, all comparisons); however, lower concordance was noted at the annulus (Lin's concordance correlation coefficient <0.6) at segmental assessment. There was excellent interreader agreement for aortic caliber for all 3 techniques (intraclass correlation coefficient >0.94). Image quality was poorer for both MRA techniques compared with CTA, particularly at the aortic root.

Conclusions
Electrocardiographically-gated MRA and P-MRA at 1.5 T achieve comparable thoracic aortic measurements to gated CTA in clinical patients, despite inferior image quality.
Magnetic Resonance–based Assessment of Myocardial 2-Dimensional Strain Using Feature Tracking
Authors: Zitzelsberger Tanja , Scholz Astrid , Hetterich Holger , Lorbeer Roberto , Bamberg Fabian , Auweter Sigrid D. , Heier Margit , Meisinger Christa , Rathmann Wolfgang , Nikolaou Konstantin , Reiser Maximilian F. , Peters Annette , Schlett Christopher L. 
Published: January 2019

Purpose:
Myocardial strain analysis is a promising tool for the detection of subtle but relevant alterations of left ventricular function, also in asymptomatic subjects. Thus, we determined the feasibility of cardiac magnetic resonance–based 2D global strain analysis using feature tracking and its association with cardiovascular risk factors in a sample from the general population.

Materials and Methods:
Subjects without a history of cardiocerebrovascular disease were enrolled in a substudy of the population-based KORA (Cooperative Health Research in the Region of Augsburg) cohort. In all participants with the absence of late gadolinium enhancement, longitudinal and circumferential global strains were measured on Cine SSFP imaging (TR: 29.97 ms, TE: 1.46 ms, ST: 8 mm), using a semiautomatic segmentation algorithm (CVI42, Circle, Canada). Differences in strain values according to age, sex, body mass index, hypertension, diabetes mellitus, and hyperlipidemia were derived using linear regression analysis.

Results:
Among 360 subjects (mean age, 56.2±9.2 y, 57% male), the average global systolic radial strain was 40.1±8.2%, circumferential 19.9±2.7%, and longitudinal 19.8±3.2%. Male sex was associated with decreased global strain values, independent of the strain direction (all P<0.001). Although many cardiovascular risk factors were correlated with strain in univariate analysis, mainly waist-to-hip ratio and HbA1c remained associated with decreased radial and circumferential strains in fully adjusted models. Similarly, higher radial and circumferential strains were observed in older subjects (β=0.14, P=0.01 and β=0.11, P=0.04, respectively).

Conclusions:
Strain analysis using magnetic resonance feature tracking is feasible in population-based cohort studies and shows differences with respect to age and sex as well as an independent association with markers of metabolic syndrome.
Performance of Deep Learning Model in Detecting Operable Lung Cancer With Chest Radiographs
Authors: Cha Min Jae , Chung Myung Jin , Lee Jeong Hyun , Lee Kyung Soo 
Published: January 2019

Purpose:
The aim of this study was to evaluate the diagnostic performance of a trained deep convolutional neural network (DCNN) model for detecting operable lung cancer with chest radiographs (CXRs).

Materials and Methods:
The institutional review board approved this study. A deep learning model (DLM) based on DCNN was trained with 17,211 CXRs (5700 CT-confirmed lung nodules in 3500 CXRs and 13,711 normal CXRs), finally augmented to 600,000 images. For validation, a trained DLM was tested with 1483 CXRs with surgically resected lung cancer, marked and scored by 2 radiologists. Furthermore, diagnostic performances of DLM and 6 human observers were compared with 500 cases (200 visible T1 lung cancer on CXR and 300 normal CXRs) and analyzed using free-response receiver-operating characteristics curve (FROC) analysis.

Results:
The overall detection rate of DLM for resected lung cancers (27.2±14.6 mm) was a sensitivity of 76.8% (1139/1483) with a false positive per image (FPPI) of 0.3 and area under the FROC curve (AUC) of 0.732. In the comparison with human readers, DLM demonstrated a sensitivity of 86.5% at 0.1 FPPI and a sensitivity of 92% at 0.3 FPPI with AUC of 0.899 at an FPPI range of 0.03 to 0.44 for detecting visible T1 lung cancers, which were superior to the average of 6 human readers [mean sensitivity; 78% (range, 71.6% to 82.6%) at an FPPI of 0.1% and 85% (range, 80.2% to 89.2%) at an FPPI of 0.3, AUC of 0.819 (range, 0.754 to 0.862) at an FPPI of 0.03 to 0.44).

Conclusions:
A DLM has high diagnostic performance in detecting operable lung cancer with CXR, demonstrating a potential of playing a pivotal role for lung cancer screening.