bluuebunny/crossref_metadata_2025_split huggingface dataset:
Design of a Reconfigurable Quality Assurance Phantom for Verifying the Spatial Accuracy of Radiosurgery Treatments for Multiple Brain Metastases
Authors: Cobi Alban C. , Gray Luke , Mittmann Elizabeth R. , Link Steven B. , Hanumara Nevan C. , Lyatskaya Yulia , Roche Ellen , Slocum Alexander H. , Zygmanski Piotr 
Published: August 2019

Abstract
Radiation therapy frequently involves highly customized and complex treatments, employing sophisticated equipment, that require extensive patient-specific validation to verify the accuracy of the treatment plan as part of the clinical quality assurance (QA) process. This paper introduces a novel, reconfigurable QA phantom developed for the spatial validation of radiosurgery treatments of multiple brain metastases (MBM). This phantom works in conjunction with existing electronic portal imaging detector (EPID) technology to rapidly verify MBM treatment plans with submillimeter accuracy. The device provides a 12 × 12 × 12 cm3 active volume and multiple, independently configurable markers, in the form of 3 mm diameter radiopaque spheres, which serve as surrogates for brain lesions. The device is lightweight, portable, can be setup by a single operator, and is adaptable for use with external beam radiotherapy (EBRT) techniques and stereotactic linear accelerators (LINACs). This paper presents the device design and fabrication, along with initial testing and validation results both in the laboratory, using a coordinate measuring machine (CMM) and under simulated clinical conditions, using a radiosurgery treatment plan with 15 lesions. The device has been shown to place markers in space with a 0.45 mm root-mean-square error, which is satisfactory for initial clinical use. The device is undergoing further testing under simulated clinical conditions and improvements to reduce marker positional error.
Medical encounters, cardiac arrests and deaths during a 109 km community-based mass-participation cycling event: a 3-year study in 102 251 race starters—SAFER IX
Authors: Killops Jannelene , Schwellnus Martin , Janse van Rensburg Dina Christina , Swanevelder Sonja , Jordaan Esme 
Published: August 2019

BackgroundThere are few data on medical encounters, including deaths during mass-participation cycling events.ObjectiveTo determine the incidence and nature of medical encounters during a community-based mass-participation cycling event.DesignCross-sectional study across three annual events.Setting2012–2014 Cape Town Cycle Tour (109 km), South Africa.Participants102 251 race starters (male=80 354, female=21 897).MethodsMedical encounters (moderate, serious life-threatening, sudden cardiac arrest/death), using the 2019 international consensus definitions, were recorded on race day for 3 years as incidence rates (IR per 1000 starters; 95% CI). Overall illness-related (by organ system) or injury-related (by anatomical region) encounters, and severity were recorded.ResultsWe recorded 539 medical encounters (IR 5.3; 4.8 to 5.7). The IR was 3.2 for injuries (2.9 to 3.6), 2.1 for illnesses (1.0 to 2.4) and 0.5 for serious life-threatening medical encounters (0.4 to 0.7). In the 3-year study, we encountered three cardiac arrests and one death (2.9 and 1.0 per 100 000 starters, respectively). Injury IRs included upper limb (1.9; 1.6 to 2.1), lower limb (1.0; 0.8 to 1.0) and head/neck (0.8; 0.6 to 1.0). Illness IRs included fluid/electrolyte abnormalities (0.6; 0.5 to 0.8) and the cardiovascular system (0.5; 0.4 to 0.6).ConclusionIn a 109 km community-based mass-participation cycling event, medical encounters (moderate to severe) occurred in about 1 in 200 cyclists. Injury-related (1/300 cyclists) encounters were higher than illness-related medical encounters (1 in about 500). Serious life-threatening medical encounters occurred in 1/2000 cyclists. These data allow race organisers to anticipate the medical services required and the approximate extent of demand.
LASI-DAD study: a protocol for a prospective cohort study of late-life cognition and dementia in India
Authors: Lee Jinkook , Banerjee Joyita , Khobragade Pranali Yogiraj , Angrisani Marco , Dey A B 
Published: August 2019

IntroductionAlzheimer’s disease and related dementias can be considered the epidemic of the 21st century. Particularly, the predicted growth in the size of elderly populations in low-income and middle-income countries is expected to produce a dramatic surge in dementia prevalence and incidence. Although a rising burden of dementia presents an urgent challenge for India, previous efforts to study dementia in the country have relied on non-representative samples in geographically restricted regions. The Harmonised Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD) will provide rich, population-representative data on late-life cognition and dementia and their risk factors for the first time in India.MethodsThe LASI-DAD will recruit a sample of 3000 people aged 60+ years. Their family members or friends, whom respondents nominate as informants, participate in the computer-assisted personal interview. The study sample is drawn from the ongoing, nationally representative Longitudinal Aging Study in India, a multipurpose panel survey of aging. We aim to collect rich data on cognitive and neuropsychological tests, informant reports, and epidemiological data through a comprehensive geriatric assessment, and venous blood collection and assays. For a subsample, we collect neuroimaging data. Data collection is currently in progress in 14 States and Union Territories of India. Clinicians will provide clinical consensus diagnosis based on the Clinical Dementia Rating.Ethics and disseminationEthics approval was obtained from the Indian Council of Medical Research and all collaborating institutions. Anonymised data will be available for the larger research community through a secured website hosted by the Gateway to Global Aging Data platform. Research findings from the LASI-DAD team will be disseminated through journal publications and presentations at professional conferences.
Rationale, development and feasibility of group antenatal care for immigrant women in Sweden: a study protocol for the Hooyo Project
Authors: Byrskog Ulrika , Ahrne Malin , Small Rhonda , Andersson Ewa , Essen Birgitta , Adan Aisha , Ahmed Fardosa Hassen , Tesser Karin , Lidén Yvonne , Israelsson Monika , Åhman-Berndtsson Anna , Schytt Erica 
Published: August 2019

IntroductionSomali-born women comprise a large group of immigrant women of childbearing age in Sweden, with increased risks for perinatal morbidity and mortality and poor experiences of care, despite the goal of providing equitable healthcare for the entire population. Rethinking how care is provided may help to improve outcomes.Overall aimTo develop and test the acceptability, feasibility and immediate impacts of group antenatal care for Somali-born immigrant women, in an effort to improve experiences of antenatal care, knowledge about childbearing and the Swedish healthcare system, emotional well-being and ultimately, pregnancy outcomes. This protocol describes the rationale, planning and development of the study.Methods and analysisAn intervention development and feasibility study. Phase I includes needs assessment and development of contextual understanding using focus group discussions. In phase II, the intervention and evaluation tools, based on core values for quality care and person-centred care, are developed. Phase III includes the historically controlled evaluation in which relevant outcome measures are compared for women receiving individual care (2016–2018) and women receiving group antenatal care (2018–2019): care satisfaction (Migrant Friendly Maternity Care Questionnaire), emotional well-being (Edinburgh Postnatal Depression Scale), social support, childbirth fear, knowledge of Swedish maternity care, delivery outcomes. Phase IV includes the process evaluation, investigate process, feasibility and mechanisms of impact using field notes, observations, interviews and questionnaires. All phases are conducted in collaboration with a stakeholder reference group.Ethics and disseminationThe study is approved by the Regional Ethical Review Board, Stockholm, Sweden. Participants receive information about the study and their right to decline/withdraw without consequences. Consent is given prior to enrolment. Findings will be disseminated at antenatal care units, national/international conferences, through publications in peer-reviewed journals, seminars involving stakeholders, practitioners, community and via the project website. Participating women will receive a summary of results in their language.
Liver biopsy in primary biliary cholangitis: is sinusoidal fibrosis the missing key?
Authors: Warnes Thomas , Roberts Stephen , Smith Alexander , Haboubi Najib , McMahon Raymond F 
Published: August 2019

AimsThe role of liver biopsy in primary biliary cholangitis (PBC) is controversial, as is the optimal method of histological assessment. We compared the Ludwig and Ishak systems and three components of the Japanese (Nakanuma) staging system to evaluate their clinical and biochemical correlations and prognostic value.MethodsWe reviewed biopsies from 106 patients with PBC, derived from a previous trial of colchicine therapy with 24–34 years’ follow-up, following which five clinical outcomes were evaluated: hepatic decompensation, cholestatic PBC death/liver transplant, portal hypertensive PBC death, all PBC deaths and overall survival.ResultsLudwig and Ishak stages correlated well with prognostically significant parameters, including serum bilirubin, and both Mayo and Child Scores. Serum aspartate aminotransferase correlated with interface hepatitis (IFH), and alkaline phosphatase with orcein deposition, bile duct (BD) loss and cholestasis. Ludwig correlated with all five clinical outcomes, while Ishak stage was only significantly correlated with two. While sinusoidal fibrosis, orcein deposition, BD loss and cholestasis all predicted hepatic death/transplant, after correction for Mayo Score, the only histological parameters predictive of clinical outcomes were IFH (associated with two) and sinusoidal fibrosis (associated with all five).ConclusionLiver biopsy is required in the diagnosis of around 20% of patients with PBC. The Ludwig system is of more prognostic value than both Ishak and any of the three individual components of the Nakanuma staging system, but the major histological parameter providing independent prognostic value beyond the Mayo Score is sinusoidal fibrosis.
Hyperuricemia is associated with impaired intestinal permeability in mice
Authors: Xu Daxing , Lv Qiulan , Wang Xiaofeng , Cui Xuena , Zhao Peng , Yang Xiaomin , Liu Xiu , Yang Wan , Yang Guanpin , Wang Guangtao , Wang Pengjun , Wang Zenglan , Li Zhiyuan , Xing Shichao 
Published: August 2019

Hyperuricemia is associated with many metabolic diseases. However, the underlying mechanism remains unknown. The gut microbiota has been demonstrated to play significant roles in the immunity and metabolism of the host. In the present study, we constructed a hyperuricemic mouse model to investigate whether the metabolic disorder caused by hyperuricemia is related to intestinal dysbiosis. A significantly increased intestinal permeability was detected in hyperuricemic mice. The difference in microflora between wild-type and hyperuricemic mice accompanies the translocation of gut microbiota to the extraintestinal tissues. Such a process is followed by an increase in innate immune system activation. We observed increased LPS and TNF-α levels in the hyperuricemic mice, indicating that hyperuricemic mice were in a state of low-grade systemic inflammation. In addition, hyperuricemic mice presented early injury of parenteral tissue and disordered lipid metabolism. These findings suggest that intestinal dysbiosis due to an impaired intestinal barrier may be the key cause of metabolic disorders in hyperuricemic mice. Our findings should aid in paving a new way of preventing and treating hyperuricemia and its complications. NEW & NOTEWORTHY Hyperuricemia is associated with many metabolic diseases. However, the underlying mechanism remains unknown. We constructed a hyperuricemic mouse model to explore the relationship between intestinal dysbiosis and metabolic disorder caused by hyperuricemia.
Low resting diffusion capacity, dyspnea, and exercise intolerance in chronic obstructive pulmonary disease
Authors: Elbehairy Amany F. , O'Donnell Conor D. , Abd Elhameed Asmaa , Vincent Sandra G. , Milne Kathryn M. , James Matthew D. , Webb Katherine A. , Neder J. Alberto , O’Donnell Denis E. ,   Canadian Respiratory Research Network
Published: August 2019

The mechanisms linking reduced diffusing capacity of the lung for carbon monoxide (DlCO) to dyspnea and exercise intolerance across the chronic obstructive pulmonary disease (COPD) continuum are poorly understood. COPD progression generally involves both DlCO decline and worsening respiratory mechanics, and their relative contribution to dyspnea has not been determined. In a retrospective analysis of 300 COPD patients who completed symptom-limited incremental cardiopulmonary exercise tests, we tested the association between peak oxygen-uptake (V̇o2), DlCO, and other resting physiological measures. Then, we stratified the sample into tertiles of forced expiratory volume in 1 s (FEV1) and inspiratory capacity (IC) and compared dyspnea ratings, pulmonary gas exchange, and respiratory mechanics during exercise in groups with normal and low DlCO [i.e., <lower limit of normal (LLN)] using Global Lung Function Initiative reference values. DlCO was associated with peak V̇o2 ( P = 0.006), peak work-rate ( P = 0.005), and dyspnea/V̇o2 slope ( P < 0.001) after adjustment for other independent variables (airway obstruction and hyperinflation). Within FEV1 and IC tertiles, peak V̇o2 and work rate were lower ( P < 0.05) in low versus normal DlCO groups. Across all tertiles, low DlCO groups had higher dyspnea ratings, greater ventilatory inefficiency and arterial oxygen desaturation, and showed greater mechanical volume constraints at a lower ventilation during exercise than the normal DlCO group (all P < 0.05). After accounting for baseline resting respiratory mechanical abnormalities, DlCO<LLN was consistently associated with greater dyspnea and poorer exercise performance compared with preserved DlCO. The higher dyspnea ratings and earlier exercise termination in low DlCO groups were linked to significantly greater pulmonary gas exchange abnormalities, higher ventilatory demand, and associated accelerated dynamic mechanical constraints. NEW & NOTEWORTHY Our study demonstrated that chronic obstructive pulmonary disease patients with diffusing capacity of the lung for carbon monoxide (DlCO) less than the lower limit of normal had greater pulmonary gas exchange abnormalities, which resulted in higher ventilatory demand and greater dynamic mechanical constraints at lower ventilation during exercise. This, in turn, led to greater exertional dyspnea and exercise intolerance compared with patients with normal DlCO.
Lessons Learned from Checkpoint Blockade Targeting PD-1 in Multiple Myeloma
Authors: Lesokhin Alexander M. , Bal Susan , Badros Ashraf Z. 
Published: August 2019

Abstract
Immune checkpoints and agonists modulate ongoing, antigen-specific immune responses. Therapeutic blockade of CTLA-4, PD-1, and PD-L1 has proven to be an effective treatment approach for a subset of patients with a variety of cancers of epithelial, mesenchymal, or hematologic origin. In multiple myeloma, a B-cell lymphoid malignancy of terminally differentiated plasma cells, PD-1 pathway blockade is ineffective as a single agent. The initial promise in combination approaches utilizing anti–PD-1 with the immunomodulatory drugs, lenalidomide or pomalidomide, was not confirmed in randomized trials. Here, we explore available data for and against manipulation of the PD-1 pathway and other immune checkpoints in myeloma and highlight several promising concepts and challenges that face ongoing development of immunotherapeutics for this disease.
Racial and Ethnic Disparities in the Utilization of Thrombectomy for Acute Stroke
Authors: Rinaldo Lorenzo , Rabinstein Alejandro A. , Cloft Harry , Knudsen John M. , Castilla Leonardo Rangel , Brinjikji Waleed 
Published: August 2019

Background and Purpose—
Racial and ethnic disparities in the access to mechanical thrombectomy (MT) for treatment of acute ischemic stroke (AIS) secondary to large vessel occlusion have been previously described. The effect of recent randomized trials validating MT as an effective therapy for AIS secondary to large vessel occlusion on such disparities has not been investigated.

Methods—
Information on admissions for AIS to endovascular centers occurring between January 2016 and September 2018 was obtained from a national database. The number of patients receiving IV-tPA (intravenous tissue-type plasminogen activator) and MT at each institution was determined, and patient demographics were characterized according to age, sex, race/ethnicity, and insurance status. Comparisons of patients who did and did not undergo MT and between patients of different racial and ethnic backgrounds were performed. Demographic variables independently associated with the utilization of MT were identified using multivariate linear regression analysis.

Results—

There were 206 853 admissions to 173 endovascular centers during the time period of interest. The overall utilization of MT was 8.4%. The utilization of MT for black/Hispanic patients was lower than that among white/non-Hispanic patients (7.0% versus 9.8%;
P
<0.001). Black/Hispanic patients were also less likely to receive IV-tPA (16.2% versus 20.5%;
P
<0.001) and to be admitted to the endovascular center after transfer from a different hospital (20.0% versus 30.1%;
P
<0.001). On multivariate linear regression analysis, increasing institutional proportions of patients with female sex (β=−0.601;
P
<0.001), insurance with Medicaid or uninsured status (β=−0.153;
P
=0.029), and black/Hispanic race/ethnicity (β=−0.062;
P
=0.046) were independently associated with lower institutional utilization of MT.

Conclusions—
Despite the mainstream acceptance of MT for the treatment of AIS secondary to large vessel occlusion, racial and ethnic disparities in the utilization of MT persist.
Cochlear-Vestibular Impairment due to West Nile Virus Infection
Authors: Parrino Daniela , Brescia Giuseppe , Trimarchi Maria Vittoria , Tealdo Giulia , Sasset Lolita , Cattelan Anna Maria , Bovo Roberto , Marioni Gino 
Published: August 2019

Objectives: West Nile virus (WNV) has been spreading over the last 20 years. Human infection is asymptomatic in most cases. When the disease becomes clinically manifest, it may involve a range of issues, from a mild infection with flu-like symptoms to a neuroinvasive disease. Albeit rarely, WNV-associated sensorineural hearing loss (SNHL) has also been reported. Here we describe two new cases of SNHL and balance impairment caused by WNV infection. Methods: The patients were investigated with repeated audiometric tests and, for the first time, videonystagmography was also used. Results: Unlike findings in the few other published cases, an improvement in audiometric thresholds and vestibular function was documented in both of our patients. Conclusions: In the light of our findings, a prospective study would be warranted on a large series of patients with WNV infection in order: (i) to better define the epidemiology of the related cochlear-vestibular involvement; and (ii) to elucidate the virus-related changes to peripheral and central auditory and vestibular functions.
Cyanoacrylate closure for peripheral veins: Consensus document of the Australasian College of Phlebology
Authors: Parsi Kurosh , Roberts Stefania , Kang Mina , Benson Stephen , Baker Luke , Berman Ivor , Bester Lourens J , Connor David E , Dinnen Paul , Grace Joseph , Stirling Andrew , Ibrahim Nabeel , Lekich Christopher , Lim Adrian , Matar Luke , Nadkarni Sanjay , Paraskevas Peter , Rogan Christopher , Thibault Paul K , Thibault Simon , van Rij Andre , Yang Anes 
Published: August 2019

Background Cyanoacrylates are fast-acting adhesives used in procedural medicine including closure of superficial wounds, embolization of truncal vessels pre-operatively, vascular anomalies, visceral false aneurysms, endoleaks, gastrointestinal varices and gastrointestinal bleeding. More recently, catheter-directed cyanoacrylate adhesive closure was introduced as an alternative to endovenous thermal ablation (ETA) to occlude superficial veins of the lower limbs. Objectives To formulate policies for the safe and effective delivery of cyanoacrylate adhesive closure procedures in Australasia, based on current experience and evidence. Methods A panel of phlebologists including vascular surgeons, interventional radiologists, dermatologists and research scientists systematically reviewed the available data on cyanoacrylate products used in medicine and shared personal experience with the procedure. The reviewed material included bibliographic and biomedical data, material safety data sheets and data requested and received from manufacturers. Results and recommendations: Cyanoacrylate adhesive closure appears to be an effective treatment for saphenous reflux with occlusion rates at 36 months of 90–95%. We recommend a maximum dose of 10 mL of cyanoacrylate per treatment session. Serious complications are rare, but significant. Hypersensitivity to acrylates is reported in 2.4% of the population and is an important absolute contraindication to cyanoacrylate adhesive closure. 1 Post-procedural inflammatory reactions, including hypersensitivity-type phlebitis, occur in 10–20% of patients. 2 In the long term, cyanoacrylate adhesive closure results in foreign-body granuloma formation within 2–12 months of the procedure. We recommend against the use of cyanoacrylate adhesive closure in patients with uncontrolled inflammatory, autoimmune or granulomatous disorders (e.g. sarcoidosis). Caution should be exercised in patients with significant active systemic disease or infection and alternative therapies such as thermal ablation and foam sclerotherapy should be considered. Conclusions Cyanoacrylate adhesive closure appears to be an effective endovenous procedure, with short-term closure rates comparable to ETA and therefore greater efficacy than traditional surgery for treating superficial veins of the lower limbs. Ongoing data collection is required to establish the long-term safety.