bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of accuracy of elastography point quantification versus other noninvasive modalities in staging of fibrosis in chronic hepatitis C virus patients
Authors: Fouad Rabab , Elbaz Tamer , Abdel Alem Shereen , Elsharkawy Aisha , Negm Mohamed , Khairy Marwa , Hassany Mohamed , Cordie Ahmed , El Akel Wafaa , Esmat Gamal 
Published: May 2018

Background
Elastography point quantification (ElastPQ) is a newly noninvasive method incorporated into a conventional ultrasound system for staging of liver fibrosis in patients with chronic liver diseases.

Aim
The aim was to evaluate ElastPQ reproducibility and its accuracy in staging of liver fibrosis in hepatitis C virus (HCV) patients in comparison with transient elastography (TE) and fibrosis scores [FIB-4 and aspartate aminotransferase-to-platelet ratio index (APRI)] using liver biopsy as a reference standard and also to predict the sensitivity and specificity of ElastPQ as well as proposing a cut-off for advanced fibrosis.

Patients and methods
A single-center, cross-sectional study enrolled 72 chronic HCV patients. Baseline demographic and laboratory data were recorded. ElastPQ and TE were performed. Fibrosis scores were calculated. The performance of ElastPQ was compared with that of TE and noninvasive methods (FIB-4, APRI) using liver biopsy as a reference standard using receiver operating characteristic curve analysis.

Results
ElastPQ is a valuable diagnostic tool for the diagnosis of F≥1, F≥2, and F≥3, with area under the receiver operating characteristic curve of 0.79, 0.74, and 0.83, respectively. The best cut-off values for ElastPQ were 4.9, 6.6, and 10.7 kPa for mild fibrosis, significant fibrosis, and advanced fibrosis, respectively. ElastPQ correlated positively with all other fibrosis indices (TE, APRI, and FIB-4) as well as liver biopsy. Area under the curve for the diagnosis of advanced fibrosis (F3/F4) using ElastPQ was 0.83 at a cut-off value of 10.7 kPa (P<0.01).

Conclusion
ElastPQ is a promising noninvasive US-based method for assessing liver fibrosis in HCV-related chronic liver disease patients with good diagnostic performance comparable to that of liver biopsy and TE.
Human mesenchymal stem cells for hepatitis B virus-related acute-on-chronic liver failure: a systematic review with meta-analysis
Authors: Chen Bin , Wang Yong-Hong , Qian Jin-Qin , Wu Dong-Bo , Chen En-Qiang , Tang Hong 
Published: May 2018

Background and aim
Acute-on-chronic liver failure (ACLF) is a condition with high mortality. New strategies are urgently required. The present review aims to provide a comprehensive understanding of the efficacy and safety of mesenchymal stem cells (MSC) treatment in patients with ACLF associated with hepatitis B virus infection.

Materials and methods
The MEDLINE, Embase, and Cochrane Library databases were searched for the relevant publications. If appropriate, a meta-analysis was carried out for the following outcomes: survival rate, model for end-stage liver disease score, and liver function.

Results
Three studies were eligible for the present systematic review. A total of 198 hepatitis B virus-ACLF patients were enrolled for this review. Ninety-one patients were treated with MSC and 107 patients were treated with standard medical therapy (SMT) as controls. Pooled results showed that MSC treatment could significantly reduce the mortality rate at week 12 [risk ratio: 0.50; 95% confidence interval (CI): 0.33, 0.76; P=0.00009] and the mortality rate at the final follow-up (risk ratio: 0.54; 95%CI: 0.37, 0.78; P=0.001) compared with the SMT group. Furthermore, pooled estimates showed that MSC treatment could significantly reduce the total bilirubin level at week 4 (mean difference: 58.89; 95%CI: 14.47, 103.32; P=0.009) compared with the SMT group. No severe complication associated with MSC treatment was observed.

Conclusion
Our pooled results suggested that MSC treatment could significantly reduce the mortality rate, without increasing the incidence of severe complications.
Predictive ability of shear wave elastography for pruritus in chronic hepatitis C patients with sustained virological response
Authors: Tachi Yoshihiko , Hirai Takanori , Kojima Yuko , Ishizu Yoji , Honda Takashi , Kuzuya Teiji , Hayashi Kazuhiko , Ishigami Masatoshi , Goto Hidemi , Katano Yoshiaki 
Published: May 2018

Background and aims
Pruritus is one of the complications with chronic liver disease and markedly worsens quality of life. However, the current status of pruritus in chronic hepatitis C patients who have achieved a sustained virological response (SVR) has not been clarified sufficiently. The aim of this study was to investigate the predictors of pruritus in post-SVR patients treated with direct-acting antivirals (DAA).

Patients and methods
In this retrospective study, we enrolled 110 hepatitis C patients with SVR who underwent serial shear wave elastography before DAA therapy and at the end of treatment. The severity of pruritus was evaluated using Kawashima’s pruritus scores and a visual analog scale.

Results
The prevalence of pruritus before treatment and after SVR was 28.2 and 25.5%. Multivariate logistic regression analysis confirmed that a history of hepatocellular carcinoma [odds ratio (OR): 9.72; 95% confidence interval (CI): 2.05–46.15; P=0.004], high γ-glutamyl transpeptidase levels at baseline (OR: 5.77; 95% CI: 1.83–18.21; P=0.003), low serum albumin at the end of treatment (OR: 4.85; 95% CI: 1.31–17.99; P=0.018), and high liver stiffness measurement assessed by shear wave elastography at the end of treatment (OR: 3.16; 95% CI: 1.19–11.01; P=0.024) were significant independent factors associated with pruritus in patients who had achieved an SVR following DAA therapy.

Conclusions
In chronic hepatitis C patients with SVR after DAA therapy, the incidence of pruritus is not uncommon. Liver stiffness measurement is useful for predicting the incidence of pruritus. Thus, even if SVR is achieved, patients with higher liver stiffness at the end of treatment must be monitored carefully for pruritus.
Role of Immune Checkpoint Inhibitors in Small Cell Lung Cancer
Authors: Cooper Maryann R. , Alrajhi Abdullah M. , Durand Cheryl R. 
Published: May 2018

Background:
Small cell lung cancer (SCLC) accounts for approximately 13% of all lung cancer diagnoses each year. SCLC is characterized by a rapid doubling time, early metastatic spread, and an unfavorable prognosis overall.

Areas of Uncertainty:
Most patients with SCLC will respond to initial treatment; however, the majority will experience a disease recurrence and response to second-line therapies is poor. Immune checkpoint inhibitors may be an option given the success in other diseases.

Data Sources:
A literature search was conducted using Medline (1946–July week 1, 2017) and Embase (1996–2017 week 28) with the search terms small cell lung cancer combined with nivolumab or ipilimumab or pembrolizumab or atezolizumab or tremelimumab or durvalumab. Five clinical trials, including extended follow-up for 2, that evaluated immune checkpoint inhibitors in limited stage or extensive stage SCLC were included.

Results:
In 2 phase 2 trials, ipilimumab was added to upfront chemotherapy. In both trials, an improvement in progression-free survival was seen. Toxicity, when combined with a platinum and etoposide, was significant. In a confirmatory phase 3 trial, ipilimumab did not prolong overall survival when added to first-line chemotherapy. Overall, response rates were similar between the placebo and ipilimumab groups. A phase 1/2 trial evaluated nivolumab alone or in combination with ipilimumab in recurrent SCLC. Results revealed that nivolumab monotherapy and the combination of nivolumab and ipilimumab were relatively safe and had antitumor activity. Pembrolizumab has been evaluated in a multicohort, phase 1b trial. Preliminary data showed a durable response in the second-line setting.

Conclusion:
Given the lack of overall survival data and significant toxicity associated with the combination of ipilimumab with first-line chemotherapy, this treatment is not a reasonable option at this time. Nivolumab alone or in combination with ipilimumab is a valid option for recurrent SCLC.
Rheumatoid Meningitis
Authors: Parsons Angela M. , Zuniga Leslie A. , Hoxworth Joseph M. , Lyons Mark , Aslam Fawad , Goodman Brent P. 
Published: May 2018

Introduction:
Rheumatoid meningitis (RM) is a rare complication of rheumatoid arthritis (RA) and has a high mortality rate. It can present as a first diagnosis of RA, in long-standing disease, or in active or well-controlled disease. Neurological manifestations vary widely.

Case Report:
A patient with a 30-year history of RA, well controlled with methotrexate therapy, presented with new-onset seizures. Magnetic resonance imaging showed leptomeningeal and pachymeningeal enhancement. A de novo workup resulted in diagnosis of RM.

Conclusions:
Cerebrospinal fluid findings for RM are nonspecific, typically lymphocytic pleocytosis; however, they can be neutrophilic, as in this case. Magnetic resonance imaging findings consist of leptomeningeal and pachymeningeal enhancement but can also involve the parenchyma. The diagnosis is typically confirmed with meningeal biopsy. Treatment involves high-dose corticosteroids or immunomodulatory therapy, or both. Long-term follow-up with radiologic surveillance typically ranges from improvement to resolution.
Ongoing Photosensitivity in An Elderly Patient With Jeavons Sydrome
Authors: Gülen Abanoz Yeşim , Abanoz Yasin , Özkara Çiğdem 
Published: May 2018

Introduction:
Photosensitivity, which is a main feature of Jeavons syndrome, can be seen in other types of idiopathic or genetic epilepsies with focal or generalized seizures and tends to disappear spontaneously usually in the second decade. Although it responds well to antiepileptic treatment, especially to valproic acid, it may continue into adulthood in rare cases.

Case Report:
We describe a 63-year-old male patient with eyelid myoclonia with absences, generalized tonic-clonic seizures, and severe photosensitivity accompanied by eyelid myoclonia. Seizures were treated with antiepileptic treatment, whereas photosensitivity still continued on electroencephalogram without clinical findings.

Conclusion:
Our elderly patient with Jeavons syndrome with ongoing remarkable photosensitivity demonstrated that it may continue to older ages, although it is uncommon.
Spot Sign in Acute Intracerebral Hemorrhage in Magnetic Resonance Imaging
Authors: Khan Zalan , Nattanmai Premkumar , George Pravin , Newey Christopher R. 
Published: May 2018

Introduction:
Intracranial hemorrhage (ICH) is associated with significant mortality and morbidity. Current treatment paradigms focus on correcting hypertension and coagulopathy to prevent hematoma expansion. Magnetic resonance imaging (MRI) is becoming more common in the hyperactive phase of ICH management. The finding of contrast extravasation (ie, spot sign) on MRI may be a marker of active bleeding. We present a case of MRI spot sign and review of the literature.

Case Report:
We present a patient on oral coumadin for history of deep venous thrombosis and pulmonary embolus who presented with a right basal ganglia hemorrhage. She had a computed tomography angiography showing contrast extravasation and also had a hyperacute MRI showing similar contrast extravasation. Follow-up imaging showed hematoma enlargement.

Discussion:
We present here a case of corroboration of the computed tomography angiography spot sign with the MRI spot sign. The prognostic value of the MRI spot sign is unclear. Future studies should evaluate the prognostic value of the hyperacute MRI in ICH management.
Effects of Repetitive Transcranial Magnetic Stimulation on Walking and Balance Function after Stroke
Authors: Li Yi , Fan Jingjing , Yang Jingyi , He Chengqi , Li Shasha 
Published: May 2018

Objective
The aim of this study was to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on walking and balance function in patients with stroke.

Design
MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, CENTRAL, and the Physiotherapy Evidence Database were comprehensively searched for randomized controlled trials published through March 2017 that investigated the effects of rTMS on lower limb function. Main outcomes included walking speed, balance function, motor function, and cortical excitability.

Results
Nine studies were included. The meta-analysis revealed a significant effect of rTMS on walking speed (standardized mean difference, 0.64; 95% confidence interval [CI], 0.32–0.95), particularly ipsilesional stimulation (standardized mean difference, 0.80; 95% CI, 0.36–1.24). No significant effects were found for balance function (standardized mean difference, 0.10; 95% CI, −0.26 to 0.45), motor function (mean difference, 0.50, 95% CI: −0.68 to 1.68), or cortical excitability (motor-evoked potentials of the affected hemisphere: mean difference, 0.21 mV; 95% CI, −0.11 to 0.54; motor-evoked potentials of the unaffected hemisphere: mean difference, 0.09 mV; 95% CI, −0.16 to −0.02).

Conclusion
These results suggest that rTMS, particularly ipsilesional stimulation, significantly improves walking speed. Future studies with larger sample sizes and an adequate follow-up period are required to further understand the effects of rTMS on lower limb function and its relationship with changes in cortical excitability with the help of functional neuroimaging techniques.

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CME Objectives
Upon completion of this article, the reader should be able to: 1) Understand the potential neurophysiologic effects of rTMS; 2) Appreciate the potential benefits of rTMS on stroke recovery; and 3) Identify indications for including rTMS in a stroke rehabilitation program.

Level
Advanced

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Two-Year Longitudinal Changes in Lower Limb Strength and Its Relation to Loss in Function in a Large Cohort of Patients With Duchenne Muscular Dystrophy
Authors: Batra Abhinandan , Harrington Ann , Lott Donovan J. , Willcocks Rebecca , Senesac Claudia R. , McGehee William , Xu Dandan , Mathur Sunita , Daniels Michael J. , Rooney William D. , Forbes Sean C. , Triplett William , Deol Jasjit K. , Arpan Ishu , Bendixen Roxanne , Finkel Richard , Finanger Erika , Tennekoon Gihan , Byrne Barry , Russman Barry , Sweeney H. Lee , Walter Glenn , Vandenborne Krista 
Published: May 2018

Objective
The main objective of this study was to examine the effect of disease on strength in two functionally important lower limb muscles for a period of 2 yrs in children with Duchene muscular dystrophy.

Design
Seventy-seven Duchene muscular dystrophy children participated in this study. Plantar flexors, knee extensors, strength, and performance on timed tests (6-min walk, 4-stairs, 10-m walk, supine-up) were assessed yearly for 2 yrs. Multivariate normal regression was used to assess changes in strength over time in the Duchene muscular dystrophy group. Spearman correlations were computed to examine relationship between strength and function.

Results
Normalized plantar flexor and knee extensor strength showed a significant decrease (P < 0.05) over 2 yrs, with larger declines in knee extensor. At baseline, knee extensor strongly correlated with performance on timed tests. However, plantar flexor strength was found to be a stronger predictor of loss in ambulatory function. Modest correlations (r = 0.19–0.34) were found between the decline in strength and functional performance over 2 yrs.

Conclusions
This study describes the loss of lower limb strength in a large cohort of Duchene muscular dystrophy children for 2 yrs. The findings support that lower limb strength alone cannot account for the decline in performance on functional tests, and the role of other contributing factors, such as compensatory strategies, should be considered.
Corticosteroid Injections Into Lumbar Facet Joints
Authors: Kennedy David J. , Huynh Lisa , Wong Joe , Mattie Ryan , Levin Josh , Smuck Matthew , Schneider Byron J. 
Published: May 2018

Background
Corticosteroid injections into the intra-articular zygapophysial (z-joints) are frequently used to treat this cause of low back pain. No studies have been done on the efficacy of intra-articular corticosteroids in those with z-joint pain confirmed by dual comparative medial branch blocks.

Objective
The aim of the study was to determine whether an injection of a corticosteroid into lumbar z-joints is effective in reducing pain and the need for radiofrequency neurotomy.

Methods
This is a double-blind, prospective, randomized, placebo-controlled trial. The study was conducted in Academic Medical Center. Twenty-eight subjects with z-joint pain confirmed by medial branch blocks were included in the study. Subjects with confirmed z-joint pain via dual comparative medial branch block were randomized to receive either intra-articular corticosteroid (triamcinolone 20 mg) or saline via fluoroscopic guided injection.

Results
No statistically significant difference in the need for radiofrequency neurotomy (radiofrequency neurotomy) between the groups, with 75% (95% confidence interval = 50.5%–99.5%) of the saline group vs. 91% (95% confidence interval = 62.3%–100%) of the corticosteroid group receiving radiofrequency neurotomy. There is no difference in mean time to radiofrequency neurotomy between saline (6.1 wks) and corticosteroid (6.5 wks) groups. There is a need for radiofrequency neurotomy.

Conclusions
Corticosteroid injections into the lumbar z-joints were not effective in reducing the need for radiofrequency neurotomy of the medial branches in those with z-joint pain confirmed by dual comparative medial branch blocks.
The Use of Immersion Therapy Mattress With Low Air Loss in Patients With Myocutaneous Flaps
Authors: VanWyhe Judy , Willer Sue 
Published: May 2018

BACKGROUND:
In our hospital, air-fluidized therapy beds were used for all patients undergoing surgery for the creation of myocutaneous flaps. These beds were associated with staff injuries and patients reported dissatisfaction. The WOC nurses were asked to find an alternative support surface for postmyocutaneous flap patients.

CASES:
We report findings from 5 patients placed on a low air loss immersion mattress after myocutaneous flap surgery. On week 2, per our hospital's clinical pathway, all were transferred to our critical access hospitals with the immersion therapy mattress. Upon discharge, all flap incisions were approximated and closed.

CONCLUSION:
Our experiences with these 5 cases suggest that a support surface combining immersion and low air loss feature is a viable alternative to an air-fluidized bed for postoperative management of patient undergoing myocutaneous flap surgery for the management of full-thickness pressure injuries.
The Impact of Pediatric Pressure Injury Prevention Bundle on Pediatric Pressure Injury Rates
Authors: Singh Charleen Deo , Anderson Cheryl , White Earla , Shoqirat Noordeen 
Published: May 2018

PURPOSE:
The primary aim of this study was to explore the relationship between a pediatric pressure injury prevention bundle (PPIPB) implemented by pediatric hospitals across the nation and pressure injury (PI) rates over a 6-year period. A secondary aim of this study was to identify whether any one risk factor addressed in the PPIPB had a greater effect on PI occurrences than any other factor.

DESIGN:
Nonexperimental, retrospective correlation analysis of secondary data.

SUBJECTS AND SETTING:
Analysis of data from 99 pediatric hospitals participating in the national initiative Solutions for Patient Safety (SPS).

METHODS:
Data were extracted from the SPS, an initiative designed to reduce PI rates in pediatric hospitals. We analyzed data related to nursing interventions implemented to ameliorate 5 factors associated with PI development. They were presence of medical devices, moisture, immobility, skin integrity, and absence of pressure redistribution with some support surfaces. Paired t test and correlation analysis were used to determine the relationship between the use of a PPIPB and PI incidence per 1000 patient-days.

RESULTS:
Findings indicated a 57% reduction in PI incidence when the PPIPB was used. A significant inverse relationship between the PPIPB and PI incidence was found. None of the 5 risk factors addressed by the PPIPB had a stronger correlation with PI occurrences than any other factor.

CONCLUSIONS:
Study findings strongly suggest the use of a PPIPB decreases PI incidence in pediatric hospitals and should be considered when implementing a PI prevention program.
A direct comparison of four high risk human papilloma virus tests versus the cobas test for detecting cervical intraepithelial neoplasia and cervical cancer
Authors: Xue Peng , Gao Li-Li , Yin Jian , Han Li-Li , Zhao Jing , Li Li , Seery Samuel , Han Xue-Yan , Li Ting-yuan , Jiang Yu , Shen Jie , Chen Wen 
Published: May 2018

ABSTRACTThis study is to evaluate performances and genotyping capabilities of four human papilloma virus (HR-HPV) tests based on real-time polymerase chain reaction (PCR) technology platforms compared with the cobas test. Discordant results were further analyzed using INNO-LiPA HPV genotyping test, the gold standard laboratory test to determine presence and type of HPV infection. Over 200 samples from Hospital patients were collected and analyzed using five HR-HPV tests. Women with positive test results were referred directly to colposcopy. If a positive result was returned, biopsies were administered for pathological classification. Clinical performances and genotyping capabilities between the four HR-HPV and cobas tests were compared and contrasted. High levels of agreement were observed, though all HR-HPV tests presented discrepancies compared with the cobas test. Cervical intraepithelial neoplasia Grade 2 or higher lesions (CIN2+) was set as the threshold, and all five tests performed with equally high sensitivity. Lower levels of specificity were observed across all five tests. Results suggest the four HR-HPV tests analyzed are as effective as the cobas test in genotyping capacities and diagnosing CIN. Therefore, these test kits should be used for HPV screening, especially in developing nations because they are cost effective and reliable. Minor discrepancies between tests are generally unavoidable though this may add complexity to the clinical decision-making process. As such, we recommend that efforts be made to standardize HPV genotyping tests as well as to optimize clinical sensitivity and specificity. Focusing on these issues will drive the development of HPV detection techniques, therefore save lives.