bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nutritional support in patients with extracorporeal life support and ventricular assist devices
Authors: Stoppe Christian , Nesterova Ekaterina , Elke Gunnar 
Published: May 2018

Purpose of reviewExtracorporeal life support (ECLS) including venovenous and venoarterial extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VAD) provide mechanical pulmonary and circulatory support, respectively, in patients with acute pulmonary or cardiovascular failure. This review discusses recently published data regarding specific topics of nutritional support in patients with ECLS and VAD.Recent findingsECLS may aggravate loss of endogenous and exogenous micronutrients and macronutrients. Observational studies have shown that enteral nutrition is feasible and most commonly used in patients with ECLS. Indirect calorimetry may be feasible for measuring energy expenditure during ECLS. Specific tools are available to assess malnutrition or nutrition risk in patients with VAD but require further validation in the perioperative setting. If parenteral nutrition is indicated, the use of intravenous lipid emulsions may be associated with membrane oxygenator dysfunction of the ECLS device or increased infectious risk in patients with VAD.SummaryDespite the exponential use of ECLS and VAD over the last decade, the role of nutrition on clinical outcome in this patient population remains an important but yet underinvestigated field.
Management of Pancreatolithiasis
Authors: Inui Kazuo , Masamune Atsushi , Igarashi Yoshinori , Ohara Hirotaka , Tazuma Susumu , Sugiyama Masanori , Suzuki Yutaka , Miyoshi Hironao , Yamamoto Satoshi , Takeyama Yoshifumi , Nakano Eriko , Takuma Kensuke , Sakagami Junichi , Hayashi Kazuki , Kogure Atsuko , Ito Tetsuya , Mukai Tsuyoshi , Maetani Iruru , Nagahama Masatsugu , Serikawa Masahiro , Ueki Toshiharu , Furuya Ken , Isayama Hiroyuki , Moriyama Ichiro , Shigeno Masaya , Mizukami Kazuhiro , Nanashima Atsushi , Oana Shuhei , Ikehata Atsushi , Watanabe Noriko , Hirooka Yoshiki , Ogoshi Keiichiro , Sasaki Yoji , Iwata Yoshinori , Kudo Yasushi , Nakayama Ataru , Nakamura Masafumi 
Published: May 2018

Objectives
The aim of this study was to assess prevailing treatment of pancreatolithiasis in Japan.

Methods
We surveyed clinical data from 1834 patients (1479 men and 355 women) at 125 hospitals.

Results
Extracorporeal shock-wave lithotripsy (ESWL) was performed alone in 103 patients (5.6%), ESWL plus an endoscopic procedure in 446 (24.3%), endoscopic treatment alone in 261 (14.2%), and surgery in 167 (9.1%). Other treatments were given to 358 (19.5%), whereas 499 (27.2%) received no treatment. Symptoms were relieved in 85.7% after ESWL, 80.8% after endoscopic treatment alone, and 92.8% after surgery. Early complication rates within 3 months after ESWL, endoscopic treatment alone, and surgery were 8%, 4.5%, and 27.1%, respectively. Late complications after ESWL, endoscopic procedures alone, and surgery were 1.7%, 2.5%, and 8.2%, respectively. Symptom relief but also early and late complications were greater after surgery than after ESWL and endoscopic treatment. Among 417 patients undergoing ESWL, 61 (14.6%) required surgery, as did 32 (16%) of 200 patients treated endoscopically. Surgery was required less frequently following initial operative treatment (11/164 patients [6.7%]). Nonsurgical initial treatments were chosen more frequently.

Conclusions
First-line treatment of pancreatolithiasis should be ESWL with or without endoscopy because of minimal invasiveness and fewer complications.
Downregulation of GEP100 Improved the Growth Inhibition Effect of Erlotinib Through Modulating Mesenchymal Epithelial Transition Process in Pancreatic Cancer
Authors: Xie Chuan-gao , Sun Shi-long , Wei Shu-mei , Xu Xiao-ming , Shao Li-ming , Chen Jia-min , Cai Jian-ting 
Published: May 2018

Objective
The epidermal growth factor receptor is overexpressed in the majority of pancreatic cancer. Epidermal growth factor receptor tyrosine kinase inhibitor erlotinib was approved to treat patients combining with gemcitabine. However, the sensitivity is low. Here, we try to reveal the regulatory role of guanine nucleotide exchange protein 100 (GEP100) in erlotinib sensitivity.

Methods
We investigated the correlation between GEP100 expression and sensitivity to erlotinib in different pancreatic cancer cell lines, followed by examination of the effect of GEP100 on erlotinib sensitivity by establishing the stable knocked-down cell line. The expression level of epithelial mesenchymal transition–related protein was examined by Western blot, and the regulatory mechanism was investigated by short hairpin RNA. Xenograft experiment was also performed in nude mice.

Results
We identified a significant correlation between sensitivity to erlotinib and expression of GEP100. GEP100 downregulation increased its sensitivity to erlotinib. E-cadherin short hairpin RNA treatment inhibited this sensitivity. Immunohistochemical staining showed a mutual exclusive expression pattern of GEP100 and E-cadherin in human pancreatic cancer tissues. Xenograft showed that downregulation of GEP100 enhanced the growth inhibition of erlotinib in nude mice.

Conclusions
Our results suggested that GEP100 and E-cadherin have the predictive value for responsiveness to erlotinib in pancreatic cancer.
A Multicenter Open-Label Randomized Controlled Trial of Pancreatic Enzyme Replacement Therapy in Unresectable Pancreatic Cancer
Authors: Saito Tomotaka , Nakai Yousuke , Isayama Hiroyuki , Hirano Kenji , Ishigaki Kazunaga , Hakuta Ryunosuke , Takeda Tsuyoshi , Saito Kei , Umefune Gyotane , Akiyama Dai , Watanabe Takeo , Takagi Kaoru , Takahara Naminatsu , Hamada Tsuyoshi , Uchino Rie , Mizuno Suguru , Mouri Dai , Yagioka Hiroshi , Kogure Hirofumi , Togawa Osamu , Matsubara Saburo , Ito Yukiko , Yamamoto Natsuyo , Tada Minoru , Koike Kazuhiko 
Published: May 2018

Objective
Exocrine pancreatic insufficiency may impair the nutritional status in pancreatic cancer (PC), but the role of pancreatic enzyme replacement therapy (PERT) is not fully evaluated. Therefore, we conducted this multicenter open-label randomized controlled trial to evaluate the role of PERT in PC patients.

Methods
Patients with unresectable PC receiving chemotherapy were randomly assigned to pancrelipase and nonpancrelipase groups. Patients in the pancrelipase group took oral pancrelipase of 48,000 lipase units per meal. N-benzoyl-tryrosyl para-aminobenzoic acid (NBT-PABA) test was performed at baseline. Our primary endpoint was change in body mass index (BMI) at 8 weeks. Secondary endpoints were change in other nutritional status at 8 weeks and overall survival.

Results
A total of 88 patients were enrolled between May 2014 and May 2016. The NBT-PABA test was lower than the normal range in 90%. There were no significant differences in change in BMI at 8 weeks: 0.975 and 0.980 in the pancrelipase and the nonpancrelipase groups, respectively (P = 0.780). The other nutritional markers were also comparable. The median overall survival was 19.0 and 12.0 months (P = 0.070).

Conclusions
In this randomized controlled trial, pancrelipase failed to improve the change in BMI at 8 weeks in PC patients receiving chemotherapy.
Vitamin D Intervention and Bone
Authors: Karlsland Åkeson Pia , Åkesson Kristina E. , Lind Torbjörn , Hernell Olle , Silfverdal Sven‐Arne , Öhlund Inger 
Published: May 2018

ABSTRACTObjectives:The aim of the study was to evaluate vitamin D status and effects of vitamin D intervention on bone mineral density (BMD) and content (BMC) in children with fair and dark skin in Sweden during winter.Methods:In a 2‐center prospective double‐blinded randomized intervention study 5‐ to 7‐year‐old children (n = 206) with fair and dark skin in Sweden (55°N–63°N) received daily vitamin D supplements of 25 μg, 10 μg, or placebo (2 μg) during 3 winter months. We measured BMD and BMC for total body (TB), total body less head (TBLH), femoral neck (FN), and spine at baseline and 4 months later. Intake of vitamin D and calcium, serum 25‐hydroxy vitamin D (S‐25[OH]D), and related parameters were analyzed.Results:Despite lower S‐25(OH)D in dark than fair‐skinned children, BMD of TB (P = 0.012) and TBLH (P = 0.002) and BMC of TBLH (P = 0.04) were higher at baseline and follow‐up in those with dark skin. Delta (Δ) BMD and BMC of TB and TBLH did not differ between intervention and placebo groups, but FN‐BMC increased more among dark‐skinned children in the 25 μg (P = 0.038) and 10 μg (P = 0.027) groups compared to placebo. We found no associations between Δ S‐25(OH)D, P‐parathyroid hormone, P‐alkaline phosphatase, and Δ BMD and BMC, respectively.Conclusions:BMD and BMC remained higher in dark‐ than fair‐skinned children despite lower vitamin D status. Even though no difference in general was found in BMD or BMC after vitamin D intervention, the increase in FN‐BMC in dark‐skinned children may suggest an influence on bone in those with initially insufficient vitamin D status.
Early Life Incidence of Gastrointestinal and Respiratory Infections in Children With Gastroschisis
Authors: Bannister Jessica , Szatkowski Lisa , Sharkey Don , Tan Shin , Fiaschi Linda , Ban Lu 
Published: May 2018

ABSTRACTObjectives:Survival in infants with gastroschisis is increasing although little is known about early childhood morbidity. In the context of a hypothesized link between the gastrointestinal (GI) tract and immune function, this study explores rates of GI and respiratory infections in children with gastroschisis.Methods:We conducted a population‐based retrospective cohort study using data from the Health Improvement Network, a large database of UK primary care medical records. We identified children born from 1990 to 2013, and extracted follow‐up data to their fifth birthday. We calculate incidence rates (IR) of GI and respiratory tract infections, overall and stratified by age, sex, socioeconomic status, and gestational age at birth, and compared these between children with and without gastroschisis by calculating adjusted incidence rate ratios (aIRR).Results:Children with gastroschisis had a 65% higher IR of GI infection compared to children without (aIRR 1.65, 95% confidence interval [CI] 1.37–1.99, P < 0.001). Children with gastroschisis had a 27% higher IR of all respiratory tract infections (aIRR 1.27, 95% CI 1.12–1.44, P < 0.001) and more than 2‐fold increase in lower respiratory tract infections compared to children without the condition (aIRR 2.15, 95% CI 1.69–2.74, P < 0.001).Conclusions:Children born with gastroschisis have a significantly higher incidence of GI and respiratory tract infections compared to children without gastroschisis. This association requires further investigations but could be related to the neonatal care they receive such as delayed enteral feeding or frequent antibiotic courses altering the gut microbiome and developing immune system.
Postmortem Analysis of 4 Mutation Hotspots of KCNQ1, KCNH2, and SCN5A Genes in Sudden Unexplained Death in Southwest of China
Authors: Jia Peng-Lin , Wang Yue-Bing , Fu Hua , Huang Wen-Li , Zhong Shu-Rong , Ma Lin , Li Yu-Hua , Dong Yi , Sun Zhong-Chun , Yang Lin , Qu Peng-Fei , Zhao Su , Qu Yong-Qiang , Xi Yan-Mei , Wang Shang-Wen , Tang Xue , Lei Pu-Ping 
Published: May 2018

Abstract
Long QT syndrome (LQTS) is known to be involved in some sudden unexplained death (SUD) cases. To make clear whether the pathogenic genes of LQTS are involved in SUD in Yunnan province, southwest of China, we examined 4 mutation hotspot segments of KCNQ1, KCNH2, and SCN5A genes in 83 SUD cases using polymerase chain reaction and direct DNA sequencing. Genomic DNA was extracted from paraffin-embedded tissues in 83 cases of sudden cardiac death. One novel homozygous missense variant was identified in exon 3 of KCNQ1, c. 575G>T (p.R192L) in one case. One novel heterozygous missense variant was identified in exon 7 of KCNH2, c.1789T>A (p.Y597N) in 1 case. One novel heterozygous missense variant was identified in exon 7 of KCNH2, c.1800C>A (p.S600R) in 9 cases. In addition, 18 individuals were found to have heterozygous missense variant in exon 7 of KCNH2, c.1801G>A (p.G601S). Our study suggests that some SUDs in Yunnan province may be related with the pathogenic genes of LQTS.
Acute Rheumatic Fever
Authors: Rhodes Kelsey L. , Rasa Malia M. , Yamamoto Loren G. 
Published: May 2018

Abstract
The Jones criteria of 2 major criteria or 1 major plus 2 minor criteria that have been classically used to establish the diagnosis have been significantly modified in 2015 by the American Heart Association. The criteria now include the utilization of echocardiography and Doppler color flow mapping as diagnostic tools for carditis, along with defining criteria in relation to overall population risk, delineating low- versus moderate-high risk populations. Monoarthritis and polyarthralgia are now major criteria for moderate- to high-risk groups.
Pediatric Lung Abscess
Authors: Kraft Clara , Lasure Benjamin , Sharon Melinda , Patel Paulina , Minardi Joseph 
Published: May 2018

Abstract
The diagnosis of lung abscess can be difficult to make and often requires imaging beyond plain chest x-ray. The decision to further image with computed tomography should be weighed against the risks of radiation exposure, especially in pediatric patients. In addition, the cost and potential impact on length of stay from obtaining computed tomography scans should be considered. In this report, we describe a case of lung abscess made immediately using point-of-care ultrasound in the emergency department. To our knowledge, there are no previous cases describing lung abscess diagnosed by point-of-care ultrasound. This case report aims to describe a case of pediatric lung abscess, review the ultrasound findings, and discuss relevant literature on the topic.
Assessment of pain quality reveals distinct differences between nociceptive innervation of low back fascia and muscle in humans
Authors: Schilder Andreas , Magerl Walter , Klein Thomas , Treede Rolf-Detlef 
Published: May 2018

Abstract

Introduction/Objectives:
Verbal descriptors are an important pain assessment parameter. The purpose of this study was to explore the ability to discriminate deep muscle pain and overlying fascia pain according to verbal descriptors and compare the pattern with skin stimulation (from previously published data).

Methods:
In 16 healthy human subjects, electrical stimulation was chosen to excite a broad spectrum of nociceptive primary afferents innervating the respective tissues. The 24-item Pain Perception Scale (Schmerzempfindungsskala [SES]) was used to determine the induced pain quality.

Results:
Overall, affective (P = 0.69) and sensory scores (P = 0.07) were not significantly different between muscle and fascia. Factor analysis of the sensory descriptors revealed a stable 3-factor solution distinguishing superficial thermal (“heat pain” identified by the items “burning,” “scalding,” and “hot”) from superficial mechanical (“sharp pain” identified by the items “cutting,” “tearing,” and “stinging”) and “deep pain” (identified by the items “beating,” “throbbing,” and “pounding”). The “deep pain” factor was more pronounced for muscle than fascia (P < 0.01), whereas the other 2 factors were more pronounced for fascia (both P < 0.01). The patterns of skin and fascia matched precisely in sensory factors and on single-item level.

Conclusion:
The differences in sensory descriptor patterns between muscle and fascia may potentially guide treatment towards muscle or fascia in low back pain physiotherapeutic regimes. The similarity of descriptor patterns between fascia and skin, both including the terms “burning” and “stinging,” opens the possibility that neuropathic back pain (when the dorsal ramus of the spinal nerve is affected) may be confused with low back pain of fascia origin.
Use of Antiretroviral Therapy During Pregnancy and Adverse Birth Outcomes Among Women Living With HIV-1 in Low- and Middle-Income Countries: A Systematic Review
Authors: Saleska Jessica Londeree , Turner Abigail Norris , Maierhofer Courtney , Clark Jan , Kwiek Jesse J. 
Published: May 2018

Background:
Worldwide, nearly 18 million women of reproductive age are living with HIV-1. Although increased access to antiretroviral therapy (ART) during pregnancy has significantly reduced HIV-1 mother-to-child transmission (MTCT), a similarly robust reduction in preterm birth (PTB) and low birthweight (LBW) among infants born to women living with HIV has not been observed. This study was designed to identify associations between classes of ART regimens and risk of PTB or LBW.

Setting:
Low- and middle-income countries.

Methods:
We conducted a systematic review of randomized and observational studies that assessed the effect of ART regimen on the risk of PTB (≤37 completed weeks of gestation) or LBW (<2500 g at birth) among pregnant women in low- and middle-income countries living with HIV-1. We searched Medline, COCHRANE, Web of Science, SCOPUS, and CPCI-S for included studies.

Results:
When compared to monotherapy, both nonnucleoside reverse transcriptase inhibitor– and protease inhibitor–based regimens had a consistent, harmful association with LBW. There is mixed evidence suggesting both potential harm and potential benefit for most other regimens on risk of LBW and PTB, and the harmful or protective effects of certain regimens varies depending on the drug backbone.

Conclusions:
Although the benefits of ART during pregnancy for prevention of MTCT are undisputed, this systematic review indicates that ART regimens vary substantially in their association with LBW and PTB. Although challenging, optimization of ART regimens could simultaneously promote maternal health, prevent MTCT, and also minimize risks of PTB and LBW.
Getting hypervirulent Klebsiella pneumoniae on the radar screen
Authors: Sellick John A. , Russo Thomas A. 
Published: May 2018

Purpose of review
Two pathotypes of Klebsiella pneumoniae cause human infections, classical (cKp) and hypervirulent (hvKp) K. pneumoniae. The present understanding of genetic elements, the need for an accurate test to identify hvKp, the clinical implications of infection, the knowledge gap on how and why hvKp colonization transitions to infection, and potential infection prevention and control issues for hvKp are discussed.

Recent findings
Infections because of hvKp are increasingly recognized worldwide. Its ability to cause organ and life-threatening disease in healthy individuals from the community merits concern, which has been magnified by increasing descriptions of multiply drug-resistant (MDR) and extensively drug-resistant (XDR) strains. Increased capsule and siderophore production by hvKp relative to cKp are critical virulence traits. Asians are most commonly infected, but whether this is mediated by a genetic susceptibility, or increased exposure and colonization is unknown. Specific studies about the epidemiology and transmission of hvKp are lacking, but precautions are appropriate for MDR/XDR strains and perhaps all infected/colonized individuals.

Summary
hvKp is evolving into an increasingly concerning pathogen, in part because of the development of XDR strains. An accurate test to identify hvKp is needed for optimal clinical care, epidemiological, and research studies. An improved understanding of how infection develops, if a genetic susceptibility exists, and appropriate infection prevention and control measures also are needed.
Clinical Evaluation of a Multiparametric Deep Learning Model for Glioblastoma Segmentation Using Heterogeneous Magnetic Resonance Imaging Data From Clinical Routine
Authors: Perkuhn Michael , Stavrinou Pantelis , Thiele Frank , Shakirin Georgy , Mohan Manoj , Garmpis Dionysios , Kabbasch Christoph , Borggrefe Jan 
Published: May 2018

Objectives
The aims of this study were, first, to evaluate a deep learning–based, automatic glioblastoma (GB) tumor segmentation algorithm on clinical routine data from multiple centers and compare the results to a ground truth, manual expert segmentation, and second, to evaluate the quality of the segmentation results across heterogeneous acquisition protocols of routinely acquired clinical magnetic resonance imaging (MRI) examinations from multiple centers.

Materials and Methods
The data consisted of preoperative MRI scans (T1, T2, FLAIR, and contrast-enhanced [CE] T1) of 64 patients with an initial diagnosis of primary GB, which were acquired in 15 institutions with varying protocols. All images underwent preprocessing (coregistration, skull stripping, resampling to isotropic resolution, normalization) and were fed into an independently trained deep learning model based on DeepMedic, a multilayer, multiscale convolutional neural network for detection and segmentation of tumor compartments. Automatic segmentation results for the whole tumor, necrosis, and CE tumor were compared with manual segmentations.

Results
Whole tumor and CE tumor compartments were correctly detected in 100% of the cases; necrosis was correctly detected in 91% of the cases. A high segmentation accuracy comparable to interrater variability was achieved for the whole tumor (mean dice similarity coefficient [DSC], 0.86 ± 0.09) and CE tumor (DSC, 0.78 ± 0.15). The DSC for tumor necrosis was 0.62 ± 0.30. We have observed robust segmentation quality over heterogeneous image acquisition protocols, for example, there were no correlations between resolution and segmentation accuracy of the single tumor compartments. Furthermore, no relevant correlation was found between quality of automatic segmentation and volume of interest properties (surface-to-volume ratio and volume).

Conclusions
The proposed approach for automatic segmentation of GB proved to be robust on routine clinical data and showed on all tumor compartments a high automatic detection rate and a high accuracy, comparable to interrater variability. Further work on improvements of the segmentation accuracy for the necrosis compartments should be guided by the evaluation of the clinical relevance.
Therefore, we propose this approach as a suitable building block for automatic tumor segmentation to support radiologists or neurosurgeons in the preoperative reading of GB MRI images and characterization of primary GB.
Galactocele, Pitfall for the Evaluation by 18F-FDG PET/CT
Authors: Ceyrat Quentin , Ziade Caroline , Tlili Ghoufrane , Fernandez Philippe , Meyer Marie 
Published: May 2018

Abstract
A high 18F-FDG uptake was found in mammary lesions in a 36-year-old woman who underwent a PET/CT scan for initial staging of diffuse large B-cell lymphoma. The patient has given birth 2 months ago and was breastfeeding. Ultrasound-guided fine-needle aspiration of 1 lesion yielded creamy liquid consistent with milk and confirmed the diagnosis of galactocele.
68Ga-PSMA PET/MR–Positive, Histopathology-Proven Prostate Cancer in a Patient With Negative Multiparametric Prostate MRI
Authors: Muehlematter Urs J. , Rupp Niels J. , Mueller Julian , Eberli Daniel , Burger Irene A. 
Published: May 2018

Abstract
Multiparametric MRI incorporating T2-weighted, diffusion-weighted, and dynamic contrast material–enhanced sequences is currently used for detection and localization of clinically important prostate cancer (PCa). The 68Ga-labeled PET tracer targeting the prostate-specific membrane antigen (PSMA, 68Ga-PSMA-11) is a promising diagnostic approach for staging and restating PCa. Recent studies suggest that 68Ga-PSMA could also be used for primary PCa detection and localization. We report a case of a 68Ga-PSMA PET/MR-positive lesion of the peripheral zone in a 73-year-old man with a negative preceding multiparametric MRI. Radical prostatectomy and subsequent histopathologic examination confirmed a Gleason 4 + 4 PCa.