bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biomarkers in systemic sclerosis
Authors: Skaug Brian , Assassi Shervin 
Published: August 2019

Purpose of review
To discuss recent advances in identification of biomarkers in systemic sclerosis for disease severity, prognosis, and treatment response.

Recent findings
Recent reports describe novel circulating markers of disease severity, autoantibody associations with specific manifestations including cancer, and skin gene expression-based predictors of modified Rodnan skin score progression and treatment response. Moreover, there is converging evidence that C-reactive protein and pneumoproteins such as Krebs von den Lungen-6 and chemokine ligand 18 could serve as prognostic biomarkers in systemic sclerosis-associated interstitial lung disease.

Summary
Several novel biomarkers show promise in improving the assessment of systemic sclerosis (SSc) disease severity, prognosis, and treatment response. Their potential utility in prospective selection of patients for clinical trials and in individual patient management require additional research.
Oncologic Accuracy of Image-guided Percutaneous Core-Needle Biopsy of Peripheral Nerve Sheath Tumors at a High-volume Sarcoma Center
Authors: Graham Danielle S. , Russell Tara A. , Eckardt Mark A. , Motamedi Kambiz , Seeger Leanne L. , Singh Arun S. , Bernthal Nicholas M. , Kalbasi Anusha , Dry Sarah M. , Nelson Scott D. , Elashoff David , Levine Benjamin D. , Eilber Fritz C. 
Published: August 2019

Objectives:
Peripheral nerve sheath tumors (PNSTs) are clinically heterogenous, comprising benign (BPNST) and malignant (MPNST) variants. BPNSTs can be managed with nerve-sparing excision or observation. MPNSTs require radical resection and multidisciplinary oncologic management (1, 15). Image-guided core-needle biopsy (IGCNBx) is the well-established standard to obtain preoperative tissue diagnosis of soft tissue tumors. However, there has been resistance to performing IGCNBx of PNSTs because of the presumed risk of nerve injury and unknown accuracy in determining malignancy. We sought to define the accuracy and safety of IGCNBx in PNSTs.

Materials and Methods:
All patients that underwent both IGCNBx and surgical resection of a PNST at our institution between 2002 and 2016 were analyzed. The accuracy of IGCNBx in determining malignancy was calculated, including subgroup analyses by histologic subtype and neurofibromatosis 1 status. Complication data were collected and analyzed.

Results:
Among the 78 PNSTs with IGCNBx and postresection surgical pathology, 76% (n=59) had BPNST and 24% (n=19) had MPNST on postresection surgical pathology. IGCNBx accurately determined malignancy in 94% of cases. IGCNBx demonstrating schwannoma or MPNST were 100% accurate in determining malignancy. IGCNBx demonstrating neurofibroma or indeterminate results were 33% and 57% malignant on postresection surgical pathology, respectively. There were no long-term complications, including sensory or motor deficits, from IGCNBx.

Conclusions:
Percutaneous IGCNBx demonstrates 94% accuracy in differentiating benign from malignant PNSTs. IGCNBx demonstrating neurofibroma or indeterminate pathology should be interpreted with caution because of risk of malignant reclassification on surgical pathology. Our results reaffirm the safety of IGCNBx, as no patients experienced long-term complications.
Early Corneal Wound Healing Response After Small Incision Lenticule Extraction
Authors: Sun Yuan , Zhang Ting , Liu Manli , Zhou Yugui , Weng Shengbei , Yang Xiaonan , Liu Quan 
Published: August 2019

Purpose:
To evaluate the corneal wound healing response after small incision lenticule extraction surgery.

Methods:
Small incision lenticule extraction was performed in both eyes of 12 New Zealand White rabbits. The refractive spherical correction was set at −6.00 D. Two animals were analyzed at each time point (1 hour, 4 hours, 1 day, 3 days, 7 days, and 28 days). The corneas were evaluated using slit-lamp and in vivo confocal microscopy. After euthanatization, the corneal tissues were subjected to light microscopy, transferase 2′-Deoxyuridine 5′-Triphosphate (dUTP) nick end labeling assay, and immunofluorescence microscopy (CD11b, fibronectin, tenascin, alpha-smooth muscle actin [α-SMA]).

Results:
The corneas did not show any opacity at any time point except at the side-cut incision. By contrast, there was obvious scar tissue at the side-cut incision. Scattered, hyperreflective spots were seen by confocal microscopy from 1 hour postoperatively. Transferase dUTP nick end labeling-positive keratocytes were abundant near the femtosecond laser incision area at 1 hour and reached a peak at 4 hours postoperatively and then decreased. Inflammatory cells migrated from the incision into the central cornea, and this process began 1 hour after surgery and peaked at 7 days. Extracellular matrix components were deposited at the beginning of day 1 postoperatively, and the distribution pattern differed between the central cornea and the incision site. α-SMA–positive myofibroblasts were only detected at the side-cut incision.

Conclusions:
The scar tissue response in the peripheral cornea is related to the epithelium debridement. Inflammatory cells begin to be recruited by 1 hour after surgery. Therefore, it is necessary to implement antiinflammation interventions at a very early stage.
Does Preoperative or Postoperative Graft Thickness Influence Postoperative Visual Acuity in Descemet Stripping Automated Endothelial Keratoplasty for Advanced Pseudophakic Bullous Keratopathy?
Authors: Perone Jean-Marc , Rolland Le Moal Pauline , Sot Maxime , Bloch Florian , Maleki Alireza , Goetz Christophe , Lhuillier Louis , Zaidi Mohamed 
Published: August 2019

Purpose:
To describe the evolution of best spectacle-corrected visual acuity (BSCVA) after Descemet stripping automated endothelial keratoplasty (DSAEK) for very advanced pseudophakic bullous keratopathy (PBK) and to determine whether the thickness of corneal grafts in DSAEK surgery for advanced PBK correlates with BSCVA 6 months postoperatively.

Methods:
In a prospective, single-center, observational study, 141 eyes treated with DSAEK surgery were studied, from patients requiring posterior lamellar transplantation for advanced PBK. Graft thickness was measured during the surgery and in vivo 6 months later. The primary end point was BSCVA in LogMAR at 6 months.

Results:
BSCVA 6 months after surgery was slightly correlated with 6 months graft thickness (r = 0.24, P = 0.01), but not with preoperative graft thickness (r = 0.01, P = 0.93). After adjusting for preoperative BSCVA, a better 6 months BSCVA was best associated with thinner grafts at 6 months (P < 0.01), but not with preoperative graft thickness (P = 0.80).

Conclusions:
BSCVA after DSAEK was significantly related to graft thickness measured 6 months after surgery, suggesting that better BSCVA after DSAEK is related to a decrease in graft thickness after surgery and not to the use of a thinner graft during surgery. This decrease may be because of the good health of the endothelium, but this result may be biased because of the intrastromal scars inherent in severe PBK. This study shows that DSAEK is a good option for advanced PBK but has low visual acuity potential recovery because of stromal scarring. Therefore, a penetrating keratoplasty may be indicated to obtain maximal recovery of visual acuity or for monocular patients.
Nutrition Support of Children With Chronic Liver Diseases
Authors: Mouzaki Marialena , Bronsky Jiri , Gupte Girish , Hojsak Iva , Jahnel Jorg , Pai Nikhil , Quiros‐Tejeira Ruben E. , Wieman Renee , Sundaram Shikha 
Published: August 2019

ABSTRACTChronic liver disease places patients at increased risk of malnutrition that can be challenging to identify clinically and treat. Nutrition support is a key aspect of the management of these patients as it has an impact on their quality of life, morbidity, and mortality. There are significant gaps in the literature regarding the optimal nutrition support for patients with different types of liver diseases and the impact of these interventions on long‐term outcomes. This Position Paper summarizes the available literature on the nutritional aspects of the care of patients with chronic liver diseases. Specifically, the challenges associated with the nutritional assessment of these subjects are discussed, and recently investigated approaches to determining the patients’ nutritional status are reviewed. Furthermore, the pathophysiology of the malnutrition seen in the context of chronic liver disease is summarized and monitoring, as well as treatment, recommendations are provided. Lastly, suggestions for future research studies are described.
Learning Curve Analyses for Achieving Satisfactory Procedural Completion Rates in Paediatric Oesophagogastroduodenoscopy
Authors: Barraclough Harriet , Siau Keith , Ward Stephen T. , Dunckley Paul , Hawkes Neil , Thomson Mike , Narula Priya 
Published: August 2019

ABSTRACTBackground:The learning curve in paediatric oesophagogastroduodenoscopy (OGD) is unknown. Using ≥95% D2 (second part of the duodenum) intubation rates as a marker of technical competency, we conducted learning curve analyses to identify when trainees achieve competency in paediatric OGD. Factors associated with competency were also evaluated.Methods:This nationwide study analysed data from paediatric OGD procedures prospectively entered into the UK endoscopy training e‐portfolio between 2014 and 2018. Moving average and learning curve cumulative summation analyses were performed to determine procedural numbers required to achieve ≥95% D2 intubation rates. Factors associated with D2 intubation were assessed using a multivariable binary logistic regression approach.Results:A total of 8929 procedures performed by 61 trainees were identified. These 61 trainees had recorded a mean of 124.6 procedures (range 22–571, interquartile range 165). By moving average analysis, 95% D2 intubation was achieved after 79 procedures. By learning curve cumulative summation analysis, 81.6% of trainees were competent after 100 procedures. Multivariable factors associated with unassisted procedural completion included: lifetime procedure count (P < 0.001), higher trainee seniority (P < 0.001), patient age (P = 0.002), outpatient status (P < 0.001), and attendance at a national Basic Skills OGD course (P = 0.011).Conclusions:This study demonstrates that, on average, 79 procedures in paediatric OGD are required to attain the competency outcome of ≥95% D2 intubation rates. By 100 procedures, 81.6% of our sample had achieved ≥95% D2 intubation. The minimum procedural count of 100 set by the UK and international training programmes can be used alongside existing objective assessment measures to safeguard competency within a training cohort.
Health‐related Quality of Life in Newly Diagnosed Pediatric Patients With Celiac Disease
Authors: Shull Mary H. , Ediger Tracy R. , Hill Ivor D. , Schroedl Rose L. 
Published: August 2019

ABSTRACTObjectives:Celiac disease (CD) is a common chronic condition with potential adverse physical and psychosocial implications for affected children. The study purpose was to characterize health‐related quality of life (HRQOL) in a large sample of pediatric patients with newly diagnosed CD using the PedsQL 4.0 Generic Core Scales, and compare it to that of healthy children and children with nonceliac gastrointestinal (GI) conditions using historic data.Methods:The PedsQL was administered to 159 children with newly diagnosed CD and their parents at either the time of diagnostic esophagogastroduodenoscopy or before their initial dietitian appointment for gluten‐free diet teaching. Mean parent‐report and self‐report PedsQL summary and subscale scores were calculated, then compared to published means from a sample of healthy children and a sample of children with nonceliac GI symptoms using 1‐sample t tests.Results:Compared to the healthy children, those with newly diagnosed CD had lower Total Scores, Physical Health, Psychosocial Health, Emotional Functioning, and School Functioning on parent report (P < 0.008) with similar findings on self‐report. Within the CD sample, clinically significant scores were found in 55.9% for School Functioning, 62.7% for Physical Health, 54.4% for Emotional Functioning, 43.7% for Social Functioning, and 49% for Total Score.Conclusions:Children and adolescents with newly diagnosed CD had lower HRQOL than healthy children and similar HRQOL to that of patients with nonceliac GI conditions. Patients with deficits in domains such as school or emotional functioning may benefit from early interventions including a Section 504 plan or meeting with a psychologist or social worker.
Symptom Burden and Quality of Life Over Time in Pediatric Eosinophilic Esophagitis
Authors: Klinnert Mary D. , Atkins Dan , Pan Zhaoxing , Franciosi James P. , Aceves Seema S. , Spergel Jonathan M. , Furuta Glenn T. 
Published: August 2019

ABSTRACTObjective:The aim of the study was to evaluate whether children with eosinophilic esophagitis (EoE) demonstrated an association between health‐related quality of life (HRQoL) improvements and symptom reduction during 12 months of treatment; to examine age‐related EoE discrete symptom presentation; and to describe residual symptom and HRQoL burden.Methods:Children ages 2 to 18 years with EoE were assessed at the onset of treatment and 12 months later at 4 tertiary care centers. Continuous measures of symptoms and symptom severity were based on 8 discrete EoE symptoms. HRQoL was measured with the Pediatric Quality of Life (PedsQL) parent‐proxy (PR) report, child self‐report (CR), and Family Impact Module. Mixed‐effects modeling was used to test changes over time for symptom burden and child and family HRQoL.Results:One hundred nine children were followed (ages 2–18 years, mean age 7.6 [4.6] years, 77% boys, 87% white). Baseline symptom number mean was 3.5 (standard deviation = 2.3, range 0–8) and symptom severity mean was 5.5 (standard deviation = 4.3, range 0–24). EoE symptom number and symptom severity decreased significantly over the 12 months (P = 0.013, P < 0.001, respectively). PedsQL PR Total, Physical, Psychosocial, and Family Impact scores all improved significantly (P = 0.001, 0.012, 0.012, 0.015, respectively) but PedsQL child self‐report scores did not. Symptom reduction correlated with PR PedsQL improvement (P = 0.01). Few discrete symptoms completely remitted, but lowered severity ratings indicated clinically significant improvement.Conclusions:Year‐long treatment in multidisciplinary tertiary centers reduced most symptoms and improved parent‐reported HRQoL in children with EoE. The frequency of residual symptoms and persistently lower HRQoL, however, underscore the chronic nature of pediatric EoE.
Belief, Confidence, and Motivation to Use the Paretic Upper Limb in Daily Life Over the First 24 Weeks After Stroke
Authors: Waddell Kimberly J. , Tabak Rachel G. , Strube Michael J , Haire-Joshu Debra , Lang Catherine E. 
Published: August 2019

Background and Purpose:
The recovery patterns of upper limb (UL) impairment after stroke are established. Psychosocial factors such as belief that paretic UL recovery is possible, confidence, and motivation to use the paretic UL in everyday tasks are unexplored early after stroke. The purpose of this exploratory study was to characterize belief, confidence, and motivation to use the paretic UL in daily life, and self-perceived barriers to UL recovery over the first 24 weeks after stroke.

Methods:
This was a longitudinal cohort study (N = 30) with 8 assessment sessions over the first 24 weeks after stroke. Belief, confidence, and motivation to use the paretic UL and self-perceived barriers were quantified via survey and analyzed using descriptive statistics. Change in the number of self-perceived barriers between weeks 2 and 24 was tested using a paired-samples t test. The relationship between UL capacity, depressive symptomatology, cognition, and each psychosocial factor was examined using Spearman rank-order correlation analyses.

Results:
Twenty-two participants completed all study assessments. Belief, confidence, and motivation were high across the 24 weeks, with little variation. There was no difference between the average number of barriers from weeks 2 to 24. There was no relationship between the clinical measures and psychosocial factors at week 2, 12, or 24.

Discussion and Conclusions:
High levels of belief, confidence, and motivation appear consistent over the first 6 months after stroke. The lack of correlations between psychosocial factors and clinical measures suggests belief, confidence, and motivation may not be vulnerable to functional status early after stroke.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A283).
Poststroke Fatigue Is Related to Motor and Cognitive Performance: A Secondary Analysis
Authors: Goh Hui-Ting , Stewart Jill C. 
Published: August 2019

Background and Purpose:Poststroke fatigue (PSF) is a common debilitating and persistent symptom after stroke. The relationship between PSF and motor and cognitive function remains inconclusive partly due to lack of control for effects of depression and use of insensitive measures. We examined the relationship between PSF and motor and cognitive performance using a comprehensive set of behavioral measures and excluding individuals with depression.Methods:Fifty-three individuals poststroke (16 female) were included (median age: 63 years, median months poststroke: 20 months). Poststroke fatigue was quantified using the Fatigue Severity Scale (FSS) and cognitive performance was measured with the Montreal Cognitive Assessment, simple and choice reaction time (SRT and CRT) tasks. Lower extremity motor performance included Fugl-Meyer Motor Assessment, 5 times sit-to-stand test (5 × STS), Berg Balance Scale, Functional Ambulation Category, and gait speed. Upper extremity motor performance was indexed with Fugl-Meyer, grip strength, and Box and Block test. Spearman correlation and stepwise linear regression analyses were performed to examine relationships.Results:Two motor performance measures, Berg Balance Scale and Functional Ambulation Category, were significantly correlated with FSS (ρ = −0.31 and −0.27, respectively) while all cognitive measures were significantly correlated with FSS (ρ = −0.28 for Montreal Cognitive Assessment, 0.29 for SRT, and 0.29 for CRT). Regression analysis showed that Berg Balance Scale was the only significant determinant for FSS (R2= 0.11).Discussion and Conclusions:Functional gait, balance, and cognitive performance are associated with PSF. Fatigue should be considered when planning and delivering interventions for individuals with stroke. Future studies are needed to explore the potential efficacy of balance and cognitive training in PSF management.Video Abstract availablefor more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A287).
Distance-Induced Changes in Walking Speed After Stroke: Relationship to Community Walking Activity
Authors: Awad Louis , Reisman Darcy , Binder-Macleod Stuart 
Published: August 2019

Background and Purpose:
Physical inactivity is a major contributing factor to reduced health and quality of life. The total distance walked during the 6-Minute Walk Test is a strong indicator of real-world walking activity after stroke. The purpose of this study was to determine whether measurement of distance-induced changes in walking speed during the 6-Minute Walk Test improves the test's ability to predict community walking activity.

Methods:
For 40 individuals poststroke, community walking activity (steps/d), the total distance walked during the 6-Minute Walk Test (6MWTtotal), and the difference between the distances walked during the final and first minutes of the test (Δ6MWTmin6–min1) were analyzed using moderated regression. Self-efficacy, assessed using the Activities-specific Balance Confidence scale, was also included in the model.

Results:
Alone, 6MWTtotal explained 41% of the variance in steps/d. The addition of Δ6MWTmin6–min1 increased explanatory power by 29% (ΔR
2 = 0.29, P < 0.001). The final model accounted for 71% of steps/d variance (F
4,32 = 19.52, P < 0.001). Examination of a significant 6MWTtotal × Δ6MWTmin6–min1 interaction revealed a positive relationship between 6MWTtotal and steps/d, with individuals whose distances declined from minute 1 to minute 6 by 0.10 m/s or more presenting with substantially fewer steps/d than those whose distances did not decline.

Discussion and Conclusions:
Coassessment of distance-induced changes in walking speed during the 6-Minute Walk Test and the total distance walked substantially improves the prediction of real-world walking activity after stroke. This study provides new insight into how walking ability after stroke can be characterized to reduce heterogeneity and advance personalized treatments.
Nonaccidental Trauma Is an Independent Risk Factor for Mortality Among Injured Infants
Authors: Delaplain Patrick T. , Grigorian Areg , Won Eugene , Dosch Austin R. , Schubl Sebastian , Covarrubias Jose , Nahmias Jeffry 
Published: August 2019

Objectives
The Centers for Disease Control disclosed over 600,000 cases of child abuse or neglect in 2016. Single-institution studies have shown that nonaccidental trauma (NAT) has higher complication rates than accidental trauma (AT). Nonaccidental trauma is disproportionately represented in infants. We hypothesized that NAT would increase the risk of mortality in infants. This study aims to provide a contemporary descriptive analysis for infant trauma patients and determine the association between NAT and mortality.

Methods
Infants (<1 year of age) within the Pediatric Trauma Quality Improvement Program database (2014–2016) were identified. Descriptive statistics (χ2 and t test) were used to compare NAT infants to AT infants. A multivariable logistic regression was used to determine the risk of mortality associated with select variables including NAT.

Results
From 14,965 infant traumas, most presented to a level I pediatric trauma center (53.5%) with a median injury severity score of 9. The most common mechanism was falls (48.6%), followed by NAT (14.5%). Overall mortality was 2.1%. Although most NAT infants were white (60.2%), black infants were overrepresented (23.6% vs 18.3%; P < 0.0001) compared with AT infants. The incidence of mortality was higher in NAT infants (41.6% vs 13.9%; P < 0.0001), and they were more likely to have traumatic brain injury (TBI) (63.1% vs 50.6%; P < 0.001). Nonaccidental trauma [odds ratio (OR), 2.48; P < 0.001], hypotension within 24 hours (OR, 8.93; P < 0.001), injury severity score (OR, 1.12; P < 0.001), and severe abbreviated injury scale-head (OR 1.62, P = 0.014) had the highest association with mortality.

Conclusions
This study confirms the incidence of TBI and NAT in infants. Although providers should be vigilant for NAT, suspicion of NAT should prompt close surveillance, as there is a 2-fold increased risk of mortality independent of injury or TBI.