bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cry wolf and inflate medical urgency to expedite consult resolution through gastrointestinal endoscopy
Authors: Sonnenberg Amnon 
Published: November 2016

Background and aims
To expedite a consult resolution, referring physicians sometimes inflate the urgency and need for endoscopic workup. The aim of the present decision analysis was to study the impact of inflationary indication on the expected benefits to gastroenterologists and referring physicians.

Methods
The study aims were pursued in terms of game theory and medical decision analysis using decision trees. Different outcomes associated with true versus false urgent indication in immediate versus delayed endoscopy were ranked according to different preference schemes of gastroenterologists versus referring physicians.

Results
The decision analysis shows that inflating the urgency of indication for endoscopy reduces the benefit from the perspective of gastroenterologists and referring physicians alike. Raising the level of false urgent indications results in a lost opportunity for immediate endoscopy among patients with true urgent indications and, thus, diminishes the overall benefit of endoscopy. By comparison, all other influences play only a marginal role. For referring physicians, the small benefit of expediting nonurgent endoscopies by exaggerated claims does not compensate for the concomitant loss of truly needed endoscopy slots. For gastroenterologists, a small benefit derived from delaying endoscopies in patients with false urgent endoscopies rapidly wears off as inflationary indications become common practice.

Conclusion
An underlying communication problem between referring physicians and gastroenterologists needs to be resolved by educating referring physicians about the operative exigencies of endoscopy units and about the true appearance of alarm symptoms in common digestive diseases.
Endoscopic Recurrence 6 Months After Ileocecal Resection in Children With Crohn Disease Treated With Azathioprine
Authors: Zarubova Kristyna , Hradsky Ondrej , Copova Ivana , Rouskova Blanka , Pos Lucie , Skaba Richard , Bronsky Jiri 
Published: November 2016

ABSTRACTObjectives:Intestinal surgery is an important part of Crohn disease (CD) treatment in children. The aim of the present study was to compare the rate of endoscopic recurrence at the sixth month after ileocecal resection (ICR) in children with CD treated with azathioprine between patients who received prior antitumor necrosis factor alpha (anti‐TNF‐α) therapy and those who were not administered this therapy. Moreover, we tried to identify the potential risk factors for disease recurrence and describe the schedule of long‐term follow‐up after surgery.Methods:We prospectively collected data from pediatric patients with CD, who underwent ICR between October 2011 and June 2015 at our hospital and were treated with azathioprine monotherapy after ICR. We evaluated the endoscopic recurrence (Rutgeerts score) at the sixth month after ICR in all included patients.Results:Among 21 included patients, 13 achieved endoscopic remission (Rutgeerts score < i2) at the sixth month after ICR. No difference was found between patients who received prior anti‐TNF‐α therapy and those who did not. We did not find any clinically relevant factors associated with endoscopic recurrence rate at the sixth month.Conclusions:Prior anti‐TNF‐α therapy does not seem to be a strong risk factor for endoscopic recurrence within 6 months after ICR. Further studies on large sample of patients are needed to identify potential predictors of disease recurrence.
Discrimination Between Patients With Alzheimer Disease and Healthy Subjects Using Layer Analysis of Cerebral Blood Flow and Xenon Solubility Coefficient in Xenon-Enhanced Computed Tomography
Authors: Sase Shigeru , Yamamoto Homaro , Kawashima Ena , Tan Xin , Sawa Yutaka 
Published: November 2016

Objective
The aim of this study was to develop a method for discriminating between patients with Alzheimer disease (AD) and healthy subjects using layer analysis of cerebral blood flow (CBF) and xenon solubility coefficient (λ) in xenon-enhanced computed tomography (CT).

Methods
Xenon-enhanced CT was performed on 27 patients with AD (81.7 [3.3] years old) and 15 healthy volunteers (78.6 [4.0] years old) using a wide volume CT. For each subject, we created the first- (surface) to sixth-layer images of CBF and λ for the 6 viewing directions (layer thickness, 5 mm). For the discriminant views, receiver operating characteristic curves for the ratio of CBF to λ were created to identify patients with AD.

Results
For the third- and fourth-layer left lateral views, which were designated as the discriminant views, areas under the receiver operating characteristic curve were 96.8% and 97.4%, respectively.

Conclusions
With the use of the discriminant views obtained by xenon-enhanced CT, we could effectively discriminate between patients with AD and healthy subjects using both CBF and λ.
Effect of a Low-Rank Denoising Algorithm on Quantitative Magnetic Resonance Imaging-Based Measures of Liver Fat and Iron
Authors: Allen Brian C. , Lugauer Felix , Nickel Dominik , Bhatti Lubna , Dafalla Randa A. , Dale Brian M. , Jaffe Tracy A. , Bashir Mustafa R. 
Published: November 2016

Purpose
This study aimed to assess the effect of a low-rank denoising algorithm on quantitative magnetic resonance imaging-based measures of liver fat and iron.

Materials and Methods
This was an institutional review board–approved, Health Insurance Portability and Accountability Act–compliant, retrospective analysis of 42 consecutive subjects who were imaged at 3T using a multiecho gradient echo sequence that was reconstructed using the multistep adaptive fitting algorithm to obtain quantitative proton density fat fraction (PDFF) and R2* maps (original maps). A patch-wise low-rank denoising algorithm was then applied, and PDFF and R2* maps were created (denoised maps). Three readers independently rated the PDFF maps in terms of vessel and liver edge sharpness and image noise using a 5-point scale. Two other readers independently measured mean and standard deviation of PDFF and R2* values for the original and denoised maps; values were compared using intraclass correlation coefficients (ICCs) and mean difference analyses.

Results
Qualitatively, the denoised maps were preferred by all 3 readers based on image noise (P < 0.001) and by 2 of 3 readers based on vessel edge sharpness (P < 0.001–0.99). No reader had a significant preference regarding liver edge sharpness (P = 0.16–0.48). Quantitatively, agreement was near perfect between the original and denoised maps for PDFF (ICC = 0.995) and R2* (ICC = 0.995) values. Mean quantitative values obtained from the original and denoised maps were similar for liver PDFF (7.6 ± 7.7% vs 7.7 ± 7.8%; P = 0.63) and R2* (52.9 ± 40.3s−1 vs 52.8 ± 41.1 s−1, P = 0.74).

Conclusions
Applying the low-rank denoising algorithm to liver fat and iron quantification reduces image noise in PDFF and R2* maps without adversely affecting mean quantitative values or subjective image quality.
Spectral Computed Tomography Imaging of Gastric Schwannoma and Gastric Stromal Tumor
Authors: Liu Jianli , Chai Yanjun , Zhou Junlin , Dong Chi , Zhang Wenjuan , Liu Bin 
Published: November 2016

Objective
Gastric schwannomas (GSs) and gastrointestinal stromal tumors (GSTs) are grossly similar submucosal neoplasms with different prognoses. We explored the value of spectral computed tomography (CT) to distinguish between them.

Methods
Patients diagnosed with GS or GST at Lanzhou University Second Hospital, China, between May 2013 and June 2015 were included retrospectively. The subjects underwent spectral CT examination before surgery and had histologically confirmed diagnosis of GS or GST.

Results
Twelve patients with GS (3 men; 9 women; mean [SD] age, 47.0 [11.5] years) and 20 with GST (7 men; 13 women; mean [SD] age, 54.7 [9.9]) showed significant differences in terms of arterial phase (AP) at 70 keV (P < 0.001), portal phase (PP) at 70 keV (P = 0.002), AP iodine concentration, PP iodine concentration, AP water concentration, AP slope of spectral curve, and PP slope of spectral curve (all P < 0.001).

Conclusions
Spectral CT may be useful for noninvasive diagnosis of submucosal tumors.
Heart-Rate Reduction With Adjusted-Dose Ivabradine in Patients Undergoing Coronary Computed Tomographic Angiography: A Randomized Trial
Authors: Kacijan Blaž , Novak Zala , Jug Borut , Dolenc Novak Maja , Vrtovec Matjaž , Gužič Salobir Barbara 
Published: November 2016

Objective
Our prospective, randomized, open-label study assessed the efficacy of a heart rate–lowering, adjusted-dose protocol with ivabradine prior to coronary computed tomographic angiography (CCTA).

Methods
Patients undergoing CCTA were randomized to 7 days of adjusted-dose ivabradine or standard care (ie, no additional medication). Heart rate and β-blocker and antianxiety medication use on the day of the CCTA were recorded.

Results
One hundred one patients were randomized (mean age, 60 [SD, 13] years; 66% women). Significantly more patients on ivabradine had heart rates of 60 beats per minute or less at the time of the CCTA scan (48% vs 8%, P < 0.01); accordingly, fewer patients on ivabradine needed additional heart rate lowering with β-blockers (40% vs 86%, P < 0.01), as well as antianxiety medication (18% vs 39%, P < 0.05), and also required lower doses of intravenous β-blockers (4 [SD, 2] vs 7 [SD, 5] mg, P < 0.05).

Conclusions
A 7-day premedication protocol with ivabradine effectively lowers heart rate in patients undergoing CCTA.
Accelerated Age-Related Arterial Stiffness in Systemic Lupus Erythematosus Patients
Authors: Ding Fa ming , Li Mengtao , Yang Xinglin , Ye Yicong , Kang Lin , Pang Haiyu , Wang Qian , Xu Dong , Zeng Xiaofeng , Zhang Shuyang 
Published: November 2016

Background
An increased prevalence of arterial stiffness in systemic lupus erythematosus (SLE) patients has been established, but the mechanisms of progression of arterial stiffness with increasing age have not been fully explored.

Objectives
To investigate age-related progression of arterial stiffness among SLE patients relative to healthy controls.

Methods
A total of 161 female SLE patients who were enrolled in the Chinese SLE Treatment and Research group (CSTAR) registry and 135 age-matched healthy control subjects participated in this cross-sectional investigation. Traditional cardiovascular risk factors and SLE-related parameters were assessed on the day that brachial-ankle pulse wave velocity (baPWV) was examined. SAS 9.3 was used to perform all statistical analyses in this study. Linear regression and curvilinear regression models were utilized to analyze the association between age and arterial stiffness.

Results
Arterial stiffness based on baPWV significantly differed between the SLE patients and controls in the different age groups, and within the SLE group. The baPWV increments for each age group (<25, 25–34, 35–45, and >45) were 30 cm/s, 52 cm/s, and 121 cm/s for the controls and 61 cm/s, 132 cm/s, and 155 cm/s for the SLE patients, respectively. Curvilinear regression and linear regression revealed various trends of increased arterial stiffness among the SLE patients compared with the healthy controls. The correlation coefficients between age and arterial stiffness significantly differed among the SLE patients relative to the healthy controls (correlation coefficients of 0.46478 and 0.52612, respectively; t = 2.05; P = 0.0409). Multivariate analysis revealed that age, mean blood pressure (BP) (P < 0.0001), erythrocyte sedimentation rate (ESR) (P = 0.0073), prednisone course (P = 0.0144), and SLE disease activity (P = 0.0405) were associated with arterial stiffness among the SLE patients. Further, these patients exhibited earlier exposure to and higher frequencies of several risk factors compared with the controls in each age group (<25 years: OR = 6.3253; 25–34 years: OR = 3.1043; 35–45 years: OR = 3.1316; >45 years: OR = 3.6020).

Conclusions
The mechanisms of the age-related progression of arterial stiffness differed among the SLE patients relative to the healthy controls. Furthermore, accelerated arterial stiffness was observed among the SLE patients relative to the healthy controls with advancing age.
Review of Current Workforce for Rheumatology in the Countries of the Americas 2012–2015
Authors: Reveille John D. , Muñoz Roberto , Soriano Enrique , Albanese Miguel , Espada Graciela , Lozada Carlos Jose , Montúfar Ruben Antonio , Neubarth Fernando , Vasquez Gloria M. , Zummer Michel , Sheen Rosa , Caballero-Uribe Carlo V. , Pineda Carlos 
Published: November 2016

Background
With the increases in and aging of the populations of the Americas, monitoring the number of rheumatologists is critical to address and focus on areas of greatest need.

Objectives
The aim of this study was to gather data on the rheumatology workforce from 21 national societies in the Pan American League of Associations for Rheumatology (PANLAR).

Methods
In September and October 2012 and again in October and November 2015, the heads of the 21 rheumatology national societies were contacted in the 2012 survey; all national societies responded except Cuba. In the 2015 survey, all responded except Nicaragua, for which information was provided by national society presidents in adjacent countries.

Results
The data from 21 societies contained in PANLAR consist of 10,166 adult and 678 pediatric rheumatologists serving 961 million people. The number of rheumatologists per 100,000 population varies greatly from 3.9 per 100,000 people (Uruguay) to 0.11 per 100,000 people (Nicaragua). The number of training programs also varies widely, with some countries having no indigenous programs. The distribution of rheumatologists is mainly in the large cities, particularly in the smaller countries. Pediatric rheumatologists have dramatically increased in number in 2012, but 96% reside in 6 countries. This remains an underserved area in most countries.

Conclusions
The rheumatology workforce in the Americas has improved between 2012 and 2015, especially in the number of pediatric rheumatologists. However, numerically and in the perception of the 21 member societies of PANLAR, the number is still inadequate to meet the increasing demands for rheumatologic care, especially in the care of children with rheumatic disease and in rural areas.
Tailored Duration of Contrast Material Injection in High-Pitch Computed Tomographic Aortography With a Double-Level Test Bolus Method
Authors: Nishii Tatsuya , Watanabe Yoshiaki , Shimoyama Shinsuke , Kono Atsushi K. , Sofue Keitaro , Mori Shumpei , Takahashi Satoru , Sugimura Kazuro 
Published: November 2016

Objectives
To achieve the efficient usage of contrast material (CM) in high-pitch CT aortography, an appropriate duration of the CM injection is crucial. We used a modification of the double-level test bolus method for determination of proper injection duration with the aim of evaluating the image quality of tailored-duration CM injection compared with that of a fixed duration.

Materials and Methods
The institutional review board approved retrospective review of 80 consecutive subjects who had undergone high-pitch 70-kVp CT aortography with a modified double-level test bolus method. The interval between peak enhancement at the aortic root and femoral artery was derived from the time/attenuation curves. A total of 40 subjects underwent CT aortography with individually set duration time from the results. The remaining subjects underwent CT aortography with a fixed-duration time. The density values at several parts of the aorta were assessed. The differences in image quality and CM amount used for each method were assessed by Welch test.

Results
The injection duration was almost 50% shorter (median, 15 seconds; range, 11–25 seconds) when individually tailored. The mean CM amount was reduced by 50% (46.2–23.9 mL, P < 0.01). The range of mean CT attenuation throughout the aorta was not significantly different between the 2 methods (316–327 HU and 305–321 HU, P > 0.05, respectively).

Conclusions
The modified double-level test bolus method in high-pitch CT aortography can significantly reduce the amount of CM without adversely affecting image quality.
Efficacy of a Dehydrated Hydrogel Plug to Reduce Complications Associated With Computed Tomography–guided Percutaneous Transthoracic Needle Biopsy
Authors: Grage Rolf A. , Naveed Muhammad A. , Keogh Shane , Wang Dongliang 
Published: November 2016

Purpose:
The aim of the study was to determine whether a hydrogel plug, when placed in the needle tract after a computed tomography–guided percutaneous transthoracic needle lung biopsy, reduces the rate of complications.

Materials and Methods:
This retrospective analysis included biopsies of lung lesions from 200 consecutive patients. The first 100 consecutive biopsies made up the control group, in which no plug intervention was used. The next 100 consecutive biopsies made up the treatment group, in which a hydrogel plug was deployed through a 19-G coaxial needle system after 20-G core samples were obtained.

Results:
The overall mean age was 64.92 years. No statistically significant differences in patient characteristics and procedure parameters were found between the control and treatment groups except for age (mean age, 62.92 vs. 66.92 y, P=0.022) and procedure duration (mean minutes, 7.81 vs. 6.47 min, P=0.021). The rate of pneumothorax in the control versus treatment group was 31% vs. 29% (P=0.498) and the rate of hemoptysis was 6% vs. 3% (P=0.354). The rate of chest tube insertion after pneumothorax was significantly higher in the control group than in the treatment group (10% vs. 2%, P=0.032) and the average length of hospital stay was longer in the control group (0.44 vs. 0.07 d, P=0.041). The difference was still statistically significant for the chest tube insertion rate (P=0.030) and close to statistically significant for the length of hospital stay (P=0.063), after adjusting for the confounding effect of age and procedure duration.

Conclusion:
These data show that the deployment of a hydrogel plug after a computed tomography–guided lung biopsy significantly reduced the rate of chest tube insertion along with a reduced length of hospital stay.
Preperitoneal Suction Technique to Secure the Proper Mesh Position During Laparoscopic Herniorrhaphy
Authors: Soeta Nobutoshi , Saito Takuro , Ito Fujio , Gotoh Mitsukazu 
Published: November 2016

Purpose:
Dislocation of the mesh is 1 cause of recurrence after laparoscopic inguinal hernia repair (LIHR). Here, we propose a new procedure, the “preperitoneal cavity suction technique,” to confirm mesh position during LIHR under a transabdominal preperitoneal approach (TAPP).

Patients and Methods:
We developed the “preperitoneal cavity suction technique” during LIHR by TAPP, visualizing the mesh through the closed peritoneum by vacuuming up the carbon dioxide and effusion at the preperitoneal cavity using a suction tube inserted through the tunnel from a laterally placed trocar into the preperitoneal space. We applied this technique in adults with inguinal hernias who were scheduled to undergo elective surgery in our hospital between April 2013 and March 2015.

Results:
In total, 84 lesions were treated in 74 consecutive LIHRs by TAPP. The “preperitoneal cavity suction technique” was applied to 83 lesions. We confirmed appropriate positioning of the mesh for 82 of the 83 lesions (98.8%), with dislocation of the mesh detected in 1 case. In that case, we reopened the peritoneal flap and repositioned the mesh correctly during the operation. No patients complained of pain or a sense of discomfort, and no hematoma was identified around the dissected area or anterior superior iliac spine on the affected side. Mean duration of hospitalization was 2.5 days. No cases of hernia recurrence were observed during follow-up (range, 7 to 31 mo; median, 15 mo).

Conclusions:
The “preperitoneal suction technique” seems useful to detect mesh dislocation and has potential to reduce TAPP-related complications.
A nearest neighbour approach by genic distance to the assignment of individuals to geographic origin
Authors: Degen Bernd , Blanc-Jolivet Céline , Stierand Katrin , Gillet Elizabeth 
Published: November 2016

AbstractDuring the past decade, the use of DNA for forensic applications has been extensively implemented for plant and animal species, as well as in humans. Tracing back the geographical origin of an individual usually requires genetic assignment analysis. These approaches are based on reference samples that are grouped into populations or other aggregates and intend to identify the most likely group of origin. Often this grouping does not have a biological but rather a historical or political justification, such as “country of origin”.In this paper, we present a new nearest neighbour approach to individual assignment or classification within a given but potentially imperfect grouping of reference samples. This method, which is based on the genic distance between individuals, functions better in many cases than commonly used methods. We demonstrate the operation of our assignment method using two data sets. One set is simulated for a large number of trees distributed in a 120 km by 120 km landscape with individual genotypes at 150 SNPs, and the other set comprises experimental data of 1221 individuals of the African tropical tree speciesEntandrophragma cylindricum(Sapelli) genotyped at 61 SNPs. Judging by the level of correct self-assignment, our approach outperformed the commonly used frequency and Bayesian approaches by 15% for the simulated data set and by 5 to 7% for the Sapelli data set.Our new approach is less sensitive to overlapping sources of genetic differentiation, such as genic differences among closely-related species, phylogeographic lineages and isolation by distance, and thus operates better even for suboptimal grouping of individuals.
Slow and steady wins the race: encounters of myosin-5 and myosin-6 on shared actin filaments
Authors: Santos Alicja , Kalita Joanna , Rock Ronald S. 
Published: November 2016

AbstractIn the cellular environment multiple myosins use the same filamentous actin (F-actin) tracks, yet little is known about how this track sharing is achieved and maintained. To assess the influence that different myosin classes have on each other, we developed an assay that combines two dynamic elements: elongating actin filaments with identified barbed and pointed ends, and myosins moving along these filaments. We studied two different myosins, myosin-5 and myosin-6. These myosins have distinct functions in the cell and are known to travel in opposite directions along actin filaments. Myosin-5 walks towards the barbed end of F-actin and generally into dynamically rearranging actin at the cell periphery. Myosin-6 is a pointed-end directed myosin that generally walks towards the cell center. We successfully reconstituted simultaneous bidirectional motility of myosin-5 and myosin-6 on single polymerizing filaments of actin. We report and provide statistical analysis of encounters between myosin-5 and myosin-6 walking along the single filaments. When myosin-5 and myosin-6 collide, myosin-5 detaches more frequently than myosin-6. The experimental observations are consistent with a stochastic stepping model based upon known myosin kinetics, which suggests that faster motors are more likely to detach.