bluuebunny/crossref_metadata_2025_split huggingface dataset:
Symptom Clusters and Influencing Factors in Children With Acute Leukemia During Chemotherapy
Authors: Li Rongrong , Ma Jinling , Chan Yuying , Yang Qi , Zhang Chunxu 
Published: May 2019

Background:
Acute leukemia is the most common malignancy in childhood. Identification of symptom clusters and their influencing factors in children with acute leukemia may improve the management of symptoms.

Objective:
The aims of this study were to investigate symptom clusters in children with acute leukemia during chemotherapy and analyze the factors influencing their severity.

Methods:
A cross-sectional survey was administered to 159 Chinese children with acute leukemia during chemotherapy. A demographic questionnaire and the Memorial Symptom Assessment Scale 10-18 were completed by the patients and their parents. Exploratory factor analysis was used to identify symptom clusters. Univariate analyses and multiple linear regression analyses were performed to analyze the factors affecting symptom clusters.

Results:
Six clusters were identified, including gastrointestinal cluster, emotional cluster, head-related cluster, self-image disorder cluster, skin itching/irritation cluster, and somatic cluster. Factors influencing the severity of symptom clusters included age, gender, stage of chemotherapy, and medical reimbursement.

Conclusions:
There are multiple symptom clusters in children with acute leukemia during chemotherapy. Medical care staff should manage symptoms from the perspective of symptom cluster and carry out personalized interventions according to factors influencing these clusters.

Implications for Practice:
The ability to predict symptom clusters in children with acute leukemia undergoing chemotherapy may assist with optimal clinical decision making in order to alleviate the symptom burden and improve children’s quality of life.
Case Report: Vitamin A Deficiency and Nyctalopia in a Patient with Chronic Pancreatitis
Authors: Lee Anne , Tran Nina , Monarrez Jennifer , Mietzner David 
Published: May 2019

SIGNIFICANCE
Vitamin A deficiency is a known concern in developing countries, but it is often overlooked in developed regions. A history of conditions causing alimentary malabsorption should be considered when patients present with complaints of nyctalopia.

PURPOSE
A case of vitamin A deficiency with nyctalopia in a patient with chronic pancreatitis including pertinent diagnostic testing, treatment, and management is presented. The intent is to draw attention to the condition as a differential diagnosis for nyctalopia due to increased prevalence of conditions causing malabsorption.

CASE REPORT
A patient with a history of chronic pancreatitis and pancreatic tumor presented with symptoms of nyctalopia and xerophthalmia. Given his systemic history, testing was ordered to determine serum vitamin A levels and retinal function. After results had confirmed depleted vitamin A levels and diminished retinal function, treatment with both oral and intramuscular vitamin A supplementation was initiated to normalize vitamin A levels and improve retinal photoreceptor function. Subjective improvement in symptoms was reported shortly after beginning supplementation, and ultimately, vitamin A levels and retinal function showed improvement after intramuscular treatment.

CONCLUSIONS
Detailed case history and a careful review of systems along with serum vitamin A testing and, if available, electroretinography to assess retinal function can help to make a definitive diagnosis. With appropriate comanagement with the patient's primary care physician, it is possible for those with nyctalopia to begin vitamin A supplementation and regain retinal function.
Comparison of the Fisher Anatomical Subunit and Modified Millard Rotation-Advancement Cleft Lip Repairs
Authors: Patel Terral A. , Patel Krishna G. 
Published: May 2019

Background:
When analyzing cleft lip repair techniques, the modified rotation-advancement repair is most widely used; however, the anatomical subunit approach is gaining popularity. The purpose of this study was to compare the outcomes of these two surgical techniques performed by the same surgeon.

Methods:
Anthropometric measurements were performed on postoperative photographs of cleft lip repairs performed by a single surgeon. As described by Rossell-Perry, four parameters were measured: lip height, lip width, vermilion height, and alar base width. An aesthetic ratio of cleft to noncleft sides for each measurement was used as a quantitative measure of outcome. Qualitative analysis of cleft lip repair was evaluated using the Steffensen criteria.

Results: Twelve
modified rotation-advancement repairs and 10 anatomical subunit repairs were analyzed. A one-sample t test was used to assess the difference of each aesthetic ratio from the perfect ratio of 1.00. For repairs involving an incomplete cleft lip, statistically significant asymmetry was detected in vermilion height for the rotation-advancement repair and no measurements in the anatomical subunit approach. For repairs involving a complete cleft lip, statistically significant asymmetry was detected in lip height, vermilion height, and alar base for the rotation-advancement repair and in lip height for the anatomical subunit approach.

Conclusions: The authors’
findings show that when separating the complete and incomplete cleft lips, the rotation-advancement technique seemed to have asymmetry in more parameters than the anatomical subunit approach. This seems to suggest that the outcomes of the anatomical subunit technique are less dependent on cleft lip severity.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
AcidoCEST-UTE MRI for the Assessment of Extracellular pH of Joint Tissues at 3 T
Authors: Ma Ya-Jun , High Rachel A. , Tang Qingbo , Wan Lidi , Jerban Saeed , Du Jiang , Chang Eric Y. 
Published: May 2019

Objectives
The goal of this study was to demonstrate feasibility of measuring extracellular pH in cartilage and meniscus using acidoCEST technique with a 3-dimensional ultrashort echo time readout (acidoCEST-UTE) magnetic resonance imaging (MRI).

Materials and Methods
Magnetization transfer ratio asymmetry, radiofrequency (RF) power mismatch, and relative saturation transfer were evaluated in liquid phantoms for iopromide, iopamidol, and iohexol over a pH range of 6.2 to 7.8, at various agent concentrations, temperatures, and buffer concentrations. Tissue phantoms containing cartilage and meniscus were evaluated with the same considerations for iopamidol and iohexol. Phantoms were imaged with the acidoCEST-UTE MRI sequence at 3 T. Correlation coefficients and coefficients of variations were calculated. Paired Wilcoxon rank-sum tests were used to evaluate for statistically significant differences.

Results
The RF power mismatch and relative saturation transfer analyses of liquid phantoms showed iopamidol and iohexol to be the most promising agents for this study. Both these agents appeared to be concentration independent and feasible for use with or without buffer and at physiologic temperature over a pH range of 6.2 to 7.8. Ultimately, RF power mismatch fitting of iohexol showed the strongest correlation coefficients between cartilage, meniscus, and fluid. In addition, ratiometric values for iohexol are similar among liquid as well as different tissue types.

Conclusions
Measuring extracellular pH in cartilage and meniscus using acidoCEST-UTE MRI is feasible.
FDG PET/CT in a Case of Bilateral Tuberculous Epididymo-orchitis
Authors: Ran Pengcheng , Liang Xiang , Zhang Yu , Sun Pengtao , Dong Aisheng 
Published: May 2019

AbstractIsolated genital tuberculosis is rare. We present a case of bilateral tuberculous epididymo-orchitis showing high FDG uptake on FDG PET/CT. In addition, the patient had a prostatic FDG-avid lesion, consistent with tuberculous prostatitis. This case indicates tuberculous epididymo-orchitis, especially in tuberculosis-endemic regions, should be considered as a differential diagnosis in patients with hypermetabolic epididymal or testicular lesions, including benign and malignant tumors, bacterial epididymo-orchitis, abscess, idiopathic granulomatous orchitis, and sarcoidosis.
18F-FACBC PET/MRI in Diagnostic Assessment and Neurosurgery of Gliomas
Authors: Karlberg Anna , Berntsen Erik Magnus , Johansen Håkon , Skjulsvik Anne Jarstein , Reinertsen Ingerid , Dai Hong Yan , Xiao Yiming , Rivaz Hassan , Borghammer Per , Solheim Ole , Eikenes Live 
Published: May 2019

Purpose
This pilot study aimed to evaluate the amino acid tracer 18F-FACBC with simultaneous PET/MRI in diagnostic assessment and neurosurgery of gliomas.

Materials and Methods
Eleven patients with suspected primary or recurrent low- or high-grade glioma received an 18F-FACBC PET/MRI examination before surgery. PET and MRI were used for diagnostic assessment, and for guiding tumor resection and histopathological tissue sampling. PET uptake, tumor-to-background ratios (TBRs), time-activity curves, as well as PET and MRI tumor volumes were evaluated. The sensitivities of lesion detection and to detect glioma tissue were calculated for PET, MRI, and combined PET/MRI with histopathology (biopsies for final diagnosis and additional image-localized biopsies) as reference.

Results
Overall sensitivity for lesion detection was 54.5% (95% confidence interval [CI], 23.4–83.3) for PET, 45.5% (95% CI, 16.7–76.6) for contrast-enhanced MRI (MRICE), and 100% (95% CI, 71.5–100.0) for combined PET/MRI, with a significant difference between MRICE and combined PET/MRI (P = 0.031). TBRs increased with tumor grade (P = 0.004) and were stable from 10 minutes post injection. PET tumor volumes enclosed most of the MRICE volumes (>98%) and were generally larger (1.5–2.8 times) than the MRICE volumes. Based on image-localized biopsies, combined PET/MRI demonstrated higher concurrence with malignant findings at histopathology (89.5%) than MRICE (26.3%).

Conclusions
Low- versus high-grade glioma differentiation may be possible with 18F-FACBC using TBR. 18F-FACBC PET/MRI outperformed MRICE in lesion detection and in detection of glioma tissue. More research is required to evaluate 18F-FACBC properties, especially in grade II and III tumors, and for different subtypes of gliomas.
Predictive Value of 16α-[18F]-Fluoro-17β-Estradiol PET as a Biomarker of Progestin Therapy Resistance in Patients With Atypical Endometrial Hyperplasia and Low-Grade Endometrial Cancer
Authors: Yamada Shizuka , Tsuyoshi Hideaki , Tsujikawa Tetsuya , Okazawa Hidehiko , Yoshida Yoshio 
Published: May 2019

Abstract
For early-stage endometrial cancer patients who wish to preserve fertility, progestin treatment is effective. However, repeated endometrial curettage to evaluate treatment response may cause infertility. The clinical courses of 3 patients who were treated with fertility-sparing progestin treatment and underwent serial 18F-FES PET before and after treatment are presented. The SUVmean decreased greatly in patients with pathologically complete response (44.2%, 46.2%), whereas there was only a small change (22.5%) in the patient with pathologically stable disease who finally underwent hysterectomy. 18F-FES PET can be a noninvasive method to evaluate response to fertility-sparing progestin treatment.
A Critical Assessment of the Linear No-Threshold Hypothesis
Authors: Siegel Jeffry A. , Brooks Antone L. , Fisher Darrell R. , Zanzonico Pat B. , Doss Mohan , O'Connor Michael K. , Silberstein Edward B. , Welsh James S. , Greenspan Bennett S. 
Published: May 2019

Abstract
The Society of Nuclear Medicine and Molecular Imaging convened a task group to examine the evidence for the risk of carcinogenesis from low-dose radiation exposure and to assess evidence in the scientific literature related to the overall validity of the linear no-threshold (LNT) hypothesis and its applicability for use in risk assessment and radiation protection. In the low-dose and dose-rate region, the group concluded that the LNT hypothesis is invalid as it is not supported by the available scientific evidence and, instead, is actually refuted by published epidemiology and radiation biology. The task group concluded that the evidence does not support the use of LNT either for risk assessment or radiation protection in the low-dose and dose-rate region.
Thyroid Cancer Brain Metastasis
Authors: Osborne Joseph R. , Kondraciuk Jessica D. , Rice Samuel L. , Zhou Xiaosun , Knezevic Andrea , Spratt Daniel E. , Sabra Mona , Larson Steven M. , Grewal Ravinder K. 
Published: May 2019

Purpose
Brain metastases (BMs) in patients with differentiated thyroid cancer (DTC) are rare but associated with poor prognosis. We examined risk factors for overall survival (OS) in this population and explored the pattern of genomic alterations.

Methods
Single-institution, retrospective review of all patients with DTC from January 2000 to November 2016 identified 79 patients for analysis. Multiple prognostic factors, including age, gender, distal metastasis (DM), diagnosis time, DM sites, BM diagnosis time, BM number and size, genomic sequencing data, craniectomy, external beam radiation therapy, and kinase inhibitor therapies, were evaluated. Univariate and multivariate analyses were performed.

Results
Median survival after BM was 18 months. One- and 3-year survival rates were 63% and 33%, respectively. Univariate analysis identified 4 covariates correlated with prolonged survival: time between DTC diagnosis and BM for less than 3 years (P = 0.01), time from initial DM diagnosis to BM for 22 months or less (P = 0.03), 3 BM sites or fewer (P = 0.002), and craniectomy (P = 0.05). Multivariate model revealed 3 variables associated with OS: DTC diagnosis to BM time of less than 3 years (P = 0.04), craniectomy (P = 0.06), and patients with fewer than 3 BM sites (P = 0.06). The majority of patients with BM had a telomerase reverse transcriptase promoter mutation, However, mutational status was not an independent predictor of survival.

Conclusions
For BM from DTC, time interval between DTC diagnosis and BM, number of BM sites, and craniectomy were independently associated with OS. Further studies are needed to define the role of genomic mutations in advanced cancer.
Renal Pelvis Involvement of Immunoglobulin G4–Related Disease Mimicking Malignancy on 18F-FDG PET/CT
Authors: Jiang Yuanyuan , Hou Guozhu , Cheng Wuying 
Published: May 2019

Abstract
A 70-year-old woman with bilateral submandibular gland enlargement was referred to our hospital. Submandibular gland biopsy indicated immunoglobulin G4 (IgG4)–related disease (IgG4-RD) involvement. Contrast-enhanced CT was undergone for evaluation of IgG4-RD and revealed a mass located at the left renal pelvis. 18F-FDG PET/CT showed bilateral FDG-avid submandibular gland and a hypermetabolic mass in the left renal pelvis. The lesions were decreased in both size and metabolism on follow-up PET/CT 2 months after treatment with prednisone. This case illustrated a rare site for IgG4-RD, and the renal pelvis involvement should be considered into differential diagnosis in patients with IgG4-RD history.
Bone Pseudometastasis on 18F-FDG PET in Japanese Patients With Esophageal Cancer
Authors: Okuyama Chio , Higashi Tatsuya , Ishizu Koichi , Nakamoto Ryusuke , Takahashi Masaaki , Kusano Kuninori , Kagawa Shinya , Yamauchi Hiroshi 
Published: May 2019

Purpose of the Report
False-positive bone lesions mimicking bone metastases (bone pseudometastasis) on 18F-FDG PET/CT have often been reported in patients with esophageal cancer. We aimed to evaluate the prevalence and features of these lesions in Japanese patients with esophageal cancer.

Methods
In this retrospective study, we analyzed 83 FDG PET/CT studies for initial staging of esophageal cancer, and extracted patients with 1 or more localized high uptake sites with no subsequent progression, which were therefore judged to be bone pseudometastasis. The FDG PET/CT imaging features of the bone pseudometastasis were evaluated, and other available imaging and clinical features reviewed.

Results
Of the 83 patients, 7 had bone pseudometastasis. All 7 were males diagnosed with squamous cell cancer, of which 5 had T1a tumors. Bone pseudometastasis showed normal or ill-defined hyperdense (nonosteolytic) sites compared with the surrounding area on the CT. Additionally, accumulation in the upper vertebral levels of each case was contiguously high compared with the lumbar spines (we named this finding “contiguous accumulation”). On MRI, these findings were visualized as low signals on T1-weighted imaging (T1WI) and T2WI images but were unclear on fat-suppressed T2WI images.

Conclusions
Among all PET/CT performed for staging of esophageal cancer, 8.3% demonstrated bone pseudometastasis characterized by heterogeneous distribution with severe fatty degeneration of bone marrow accompanied by contiguous accumulation. Caution is required during diagnoses of bone lesions in esophageal cancer patients in Japan to prevent inappropriate therapeutic choices.
Area Under Trough Concentrations of Tacrolimus as a Predictor of Progressive Renal Impairment After Liver Transplantation
Authors: Rodríguez-Perálvarez Manuel , Guerrero Marta , De Luca Laura , Gros Beatriz , Thorburn Douglas , Patch David , Aumente María D. , Westbrook Rachel , Fernández Rocío , Amado Víctor , Aguilar Patricia , Montero Jose Luis , O’Beirne James , Briceño Javier , Tsochatzis Emmanuel , De la Mata Manuel 
Published: May 2019

Background.
Tacrolimus minimization is usually restricted to patients with pretransplant renal impairment, and this strategy could result into worse renal outcomes after liver transplantation (LT).

Methods.
A consecutive cohort of 455 LT patients receiving tacrolimus-based immunosuppression was studied (2008–2013). Cumulative exposure to tacrolimus was calculated as the area under curve of trough concentrations (AUCtc). Patients were stratified as tacrolimus minimization, conventional, or high exposure, according to the thresholds based in the COMMIT consensus. Estimated glomerular filtration rates (eGFR) were assessed by the Modification of Diet in Renal Disease formula (MDRD-4) up to 5 years after LT.

Results.
Seventy patients (15.4%) had pretransplant eGFR < 60 mL/min, which was associated with increased mortality rates, particularly within the first 5 years post-LT (31.4% versus 17.5%; Breslow P = 0.010). After LT, there was an abrupt eGFR decline within the first 3 months (median 18.6 mL/min; P < 0.001), further decreasing up to 12 months (additional 3 mL/min), without any improvement thereafter. According to AUCtc, 33.7% of patients received tacrolimus minimization, 44.8% conventional exposure, and 21.5% high exposure. Conventional/high exposure to tacrolimus resulted in a more pronounced eGFR decline within the first 3 months when compared with minimization (23.3 mL/min versus 9.5 mL/min; P < 0.001). This gap was even higher in patients with initially preserved renal function. Tacrolimus AUCtc was an independent predictor of eGFR decline within the first 3 months after controlling for potential confounders.

Conclusions.
AUCtc is a surrogate of cumulative exposure to tacrolimus and may be helpful for routine dose adjustments. Tacrolimus minimization should be universally attempted after LT to preserve renal function.
Decreasing Incontinence-Associated Dermatitis in the Surgical Intensive Care Unit
Authors: Gates Brandon P. , Vess Joy , Long Mary Arnold , Johnson Emily 
Published: May 2019

PURPOSE:
The purpose of this quality improvement (QI) project was to determine if use of an algorithm focusing on skin care in patients with fecal and urinary incontinence reduces the rate of hospital-acquired incontinence-associated dermatitis (IAD) over a period of 4 months.

PARTICIPANTS AND SETTING:
The QI setting was an 18-bed surgical intensive care unit (SICU) in an acute care urban hospital located in the southeastern United States. Two hundred eleven patients participated in this pre/postintervention QI project.

APPROACH:
The algorithm for skin care used evidence-based bundled interventions for patients with fecal and urinary incontinence. The project comprised education of the SICU nursing staff in January 2018 and implementation of the algorithm from February 5, 2018, to June 5, 2018. Weekly chart reviews were conducted to determine algorithm compliance, documentation of fecal and urinary incontinence, and accuracy of IAD documentation. Descriptive statistics were used to determine the rate of hospital-acquired IAD, algorithm compliance, and average length of time from admission to the onset of hospital-acquired IAD.

OUTCOMES:
Seventy-nine individuals with incontinence were included in the 3-month preintervention period and 132 individuals with incontinence in the 3-month postintervention period. We observed a 24% reduction in the rate of hospital-acquired IAD following implementation of the algorithm (29% vs 5%). The average length of time from admission to the onset of hospital-acquired IAD increased from 15 days in February 2018 to 25 days in May 2018.

IMPLICATIONS FOR PRACTICE:
Our experience with this QI project suggest that IAD can be identified and managed at the bedside by first clinical nursing staff without expertise in skin assessment and wound care.
A probabilistic census-travel model to predict introduction sites of exotic plant, animal and human pathogens
Authors: Gottwald Tim , Luo Weiqi , Posny Drew , Riley Tim , Louws Frank 
Published: May 2019

International travel offers an extensive network for new and recurring human-mediated introductions of exotic infectious pathogens and biota, freeing geographical constraints. We present a predictive census-travel model that integrates international travel with endpoint census data and epidemiological characteristics to predict points of introduction. Population demographics, inbound and outbound travel patterns, and quantification of source strength by country are combined to estimate and rank risk of introduction at user-scalable land parcel areas (e.g. state, county, zip code, census tract, gridded landscapes (1 mi2, 5 km2, etc.)). This risk ranking by parcel can be used to develop pathogen surveillance programmes, and has been incorporated in multiple US state/federal surveillance protocols. The census-travel model is versatile and independent of pathosystems, and applies a risk algorithm to generate risk maps for plant, human and animal contagions at different spatial scales. An interactive, user-friendly interface is available online (https://epi-models.shinyapps.io/Census_Travel/) to provide ease-of-use for regulatory agencies for early detection of high-risk exotics. The interface allows users to parametrize and run the model without knowledge of background code and underpinning data.This article is part of the theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control’. This theme issue is linked with the earlier issue ‘Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes’.