bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identification of specific EBUS sonographic characteristics for predicting benign mediastinal lymph nodes
Authors: Ayub Irfan Ismail , Mohan Anant , Madan Karan , Hadda Vijay , Jain Deepali , Khilnani G. C. , Guleria Randeep 
Published: November 2016

AbstractObjectiveReliable differentiation of benign from malignant mediastinal lymphadenopathy is important, especially in countries with a high tuberculosis burden. We hypothesized that specific sonographic features on endobronchial ultrasonography (EBUS) may differentiate benign from malignant nodes. In this study, the sonographic features of non‐malignant and malignant nodes were compared.MethodsThis was a retrospective analysis of patients with intrathoracic lymphadenopathy who underwent EBUS‐guided transbronchial needle aspiration (TBNA). Sonographic features such as nodal size, margin (distinct or indistinct), echogenicity (heterogeneous or homogeneous), and presence or absence of calcification, a central hilar structure, coagulation necrosis sign, and nodal conglomeration were recorded and compared in the 2 groups.ResultsDuring the study period, a diagnosis of tuberculosis (n = 71), sarcoidosis (n = 63), and malignancy (n = 36) was made in 170 patients by EBUS‐TBNA. A total of 312 lymph node stations were examined. Presence of central hilar structure (15.6% versus 4%, P = .03) and the presence of nodal conglomeration (27.5% versus 8%, P < .01) were significantly higher in benign nodes. Further, logistic regression analysis revealed that the presence of well‐defined nodal margins, the presence of central hilar structure, and the presence of conglomeration of lymph nodes were independent predictive factors for the diagnosis of benign mediastinal lymphadenopathy.ConclusionSonographic features of well‐defined margins, presence of central hilar structure, and presence of nodal conglomeration in the lymph nodes on EBUS are predictive of benign disease.
Visceral fat is strongly associated with post‐transplant diabetes mellitus and glucose metabolism 1 year after kidney transplantation
Authors: von Düring Marit Elizabeth , Jenssen Trond , Bollerslev Jens , Åsberg Anders , Godang Kristin , Hartmann Anders 
Published: November 2016

AbstractBody composition after kidney transplantation is linked to glucose metabolism, and impaired glucose metabolism is associated with increased risk of cardiovascular events and death. One year after transplantation, we examined 150 patients for post‐transplant diabetes performing oral glucose tolerance tests and body composition measurements including visceral adipose tissue (VAT) content from dual‐energy X‐ray absorptiometry scans. We found that glucose metabolism was generally improved over the first year post‐transplant, and that the levels of VAT and percentage VAT of total body fat mass (VAT%totBFM) were lowest in those with normal glucose tolerance and highest in those with post‐transplant diabetes mellitus. In a multivariable linear regression analysis, 87.4% of the variability in fasting glucose concentration was explained by insulin resistance (P<.001, HOMA‐IR index), beta cell function (P<.001, HOMA‐beta), VAT%totBFM (P=.007), and body mass index (BMI; P=.015; total model P<.001), while insulin resistance (P<.001) and beta cell function (P<.001) explained 31.9% of the variability in 2‐hour glucose concentration in a multivariable model (total model P<.001). VAT was associated with glucose metabolism to a larger degree than BMI. In conclusion, VAT is associated with hyperglycemia one year after kidney transplantation, and insulin resistance and beta cell function estimates are the most robust markers of glucose metabolism.
Cost and clinical outcome of islet transplantation in Norway 2010‐2015
Authors: Schive Simen W. , Foss Aksel , Sahraoui Afaf , Kloster‐Jensen Kristine , Hafsahl Geir , Kvalheim Gunnar , Lundgren Torbjørn , von Zur‐Mühlen Bengt , Felldin Marie , Rafael Ehab , Lempinen Marko , Korsgren Olle , Jenssen Trond G. , Mishra Vinod , Scholz Hanne 
Published: November 2016

AbstractIslet transplantation is a minimally invasive β‐cell replacement strategy. Islet transplantation is a reimbursed treatment in Norway. Here, we summarize the cost and clinical outcome of 31 islet transplantations performed at Oslo University Hospital (OUS) from January 2010 to June 2015. Patients were retrospectively divided into three groups. Thirteen patients received either one or two islet transplantation alone (ITA), while five patients received islet transplantation after previous solid organ transplantation. For the group receiving 2 ITA, Kaplan‐Meier estimates show an insulin independence of 20% more than 4 years after their last transplantation. An estimated 70% maintain at least partial graft function, defined as fasting C‐peptide >0.1 nmol L−1, and 47% maintain a HbA1c below 6.5% or 2 percent points lower than before ITA. For all groups combined, we estimate that 44% of the patients have a 50% reduction in insulin requirement 4 years after the initial islet transplantation. The average cost for an islet transplantation procedure was 347 297±60 588 NOK, or 35 424±6182 EUR, of which isolation expenses represent 34%. We hereby add to the common pool of growing experience with islet transplantation and also describe the cost of the treatment at our center.
Impact of insurance status on heart transplant wait‐list mortality for patients with left ventricular assist devices
Authors: Emani Sitaramesh , Tumin Dmitry , Foraker Randi E. , Hayes Don , Smith Sakima A. 
Published: November 2016

AbstractObjectivesTo test the hypotheses that receipt of Medicaid or Medicare (versus private insurance or self‐pay) and low socioeconomic status (SES) leads to increased mortality and lower chances of transplantation among heart transplant (HTx) candidates with bridge to transplant left ventricular assist devices (BTT LVADs).BackgroundSurvival while awaiting HTx has improved with the use of BTT LVADs. However, it is unknown whether benefits extend uniformly across patient groups based on insurance status.MethodsData from the United Network of Organ Sharing (UNOS) registry between 2006 and 2015 were examined for first‐time HTx candidates ≥18 and <65 years who had LVAD support while wait‐listed. Multivariable survival analysis was conducted on competing outcomes of mortality and time to transplant stratified by insurance source at the time of listing. Additional covariates included demographic information and SES.ResultsA total of 4626 patients met inclusion criteria, with 3353 being used for multivariable analysis. A majority of patients (68%) underwent HTx during the study period. BTT LVAD wait‐list mortality was found to be greater among Medicaid beneficiaries vs. private insurance (SHR 1.57, P<.05) and did not diminish with the inclusion of neighborhood SES. Transplantation as an outcome demonstrated no difference by insurance status.ConclusionMedicaid insurance status is associated with worse survival on the HTx wait‐list among patients with BTT LVADs, although access to transplant was not different among insurance groups. The disparity is not reflective of SES in general and therefore points to other barriers inherent to Medicaid beneficiaries.
Centralized versus Decentralized Competition for Price and Lead‐Time Sensitive Demand
Authors: Pekgün Pelin , Griffin Paul M. , Keskinocak Pınar 
Published: November 2016

ABSTRACTWe study two firms that compete on price and lead‐time decisions in a common market. We explore the impact of decentralizing these decisions, as made by the marketing and production departments, respectively, with either marketing or production as the leader. We compare scenarios in which none, one, or both of the firms are decentralized to see whether decentralization can be the equilibrium strategy. We find that under intense price competition, with intensity characterized by the underlying parameters of market demand, firms may suffer from a decentralized structure, particularly under high flexibility induced by high capacity, where revenue‐based sales incentives motivate sales/marketing to make aggressive price cuts that often erode profit margins. In contrast, under intense lead‐time competition, a decentralized strategy with marketing as the leader can not only result in significantly higher profits, but also be the equilibrium strategy. Moreover, decentralization may no longer lead to lower prices or longer lead‐times if the production department chooses capacity along with lead‐time.
Quantitative echocardiographic measures in the assessment of single ventricle function post‐Fontan: Incorporation into routine clinical practice
Authors: Rios Rodrigo , Ginde Salil , Saudek David , Loomba Rohit S. , Stelter Jessica , Frommelt Peter 
Published: November 2016

BackgroundQuantitative echocardiographic measurements of single ventricular (SV) function have not been incorporated into routine clinical practice.MethodsA clinical protocol, which included quantitative measurements of SV deformation (global circumferential and longitudinal strain and strain rate), standard deviation of time to peak systolic strain, myocardial performance index (MPI), dP/dT from an atrioventricular valve regurgitant jet, and superior mesenteric artery resistance index, was instituted for all patients with a history of Fontan procedure undergoing echocardiography. All measures were performed real time during clinically indicated studies and were included in clinical reports.ResultsA total of 100 consecutive patients (mean age = 11.95±6.8 years, range 17 months–31.3 years) completed the protocol between September 1, 2014 to April 29, 2015. Deformation measures were completed in 100% of the studies, MPI in 93%, dP/dT in 55%, and superior mesenteric artery Doppler in 82%. The studies were reviewed to assess for efficiency in completing the protocol. The average time for image acquisition was 27.4±8.8 (range 10–62 minutes). The average time to perform deformation measures was 10.8±5.5 minutes (range 5‐35 minutes) and time from beginning of imaging to report completion was 53.4±13.7 minutes (range 27–107 minutes). There was excellent inter‐observer reliability when deformation indices were blindly repeated. Patients with a single left ventricle had significantly higher circumferential strain and strain rate, longitudinal strain and strain rate, and dP/dT compared to a single right ventricle. There were no differences in quantitative indices of ventricular function between patients <10 vs. >10 years post‐Fontan.ConclusionAdvanced quantitative assessment of SV function post‐Fontan can be consistently and efficiently performed real time during clinically indicated echocardiograms with excellent reliability.
Antibiotic resistance in healthcare‐related and nosocomial spontaneous bacterial peritonitis
Authors: Lutz Philipp , Nischalke Hans Dieter , Krämer Benjamin , Goeser Felix , Kaczmarek Dominik J. , Schlabe Stefan , Parcina Marijo , Nattermann Jacob , Hoerauf Achim , Strassburg Christian P. , Spengler Ulrich 
Published: November 2016

AbstractBackgroundSpontaneous bacterial peritonitis (SBP) can be life threatening in patients with liver cirrhosis. In contrast to community‐acquired SBP, no standard treatment has been established for healthcare‐related and nosocomial SBP.Materials and methodsWe prospectively collected healthcare‐related and nosocomial SBP cases from March 2012 till February 2016 at the Department of Internal Medicine I of the University of Bonn and analysed the prevalence of antibiotic resistance among the isolated bacteria. SBP was diagnosed according to international guidelines. Ciprofloxacin, ceftriaxone and meropenem were used as reference substance for resistance to quinolones, third‐generation cephalosporins and carbapenems, respectively.ResultsNinety‐two SBP episodes in 86 patients were identified: 63 episodes (69%) were nosocomial. Escherichia coli, Klebsiella species, enterococci and streptococci were most frequently isolated. Frequencies of these microorganisms were comparable for healthcare‐related and nosocomial SBP (14% vs. 11%, 14% vs. 8%, 14% vs. 5% and 10% vs. 6%, respectively). In general, antibiotic resistance was higher in isolates from nosocomial than from healthcare‐related SBP (50% vs. 18% for quinolones, 30% vs. 11% for piperacillin–tazobactam; P > 0·05), but comparable concerning third‐generation cephalosporins (30% vs. 33%). All microorganisms were sensitive to carbapenems apart from nosocomial infections with Enterococcus faecium (n = 3) and Candida albicans (n = 1) due to intrinsic resistance or lack of microbiological efficacy, respectively. No multidrug‐resistant microorganisms were detected. Resistance to initial antibiotic treatment affected 30‐day survival negatively (18% vs. 68%; P = 0·002).ConclusionResistance to initial antibiotic treatment was associated with increased mortality. With resistance to cephalosporins being frequent, piperacillin–tazobactam or carbapenems might be preferred as treatment of SBP.
Association between complete response and outcomes in transplant‐eligible myeloma patients in the era of novel agents
Authors: van de Velde Helgi , Londhe Anil , Ataman Ozlem , Johns Helen L. , Hill Stephen , Landers Emma , Berlin Jesse A. 
Published: November 2016

AbstractObjectivesAchieving complete response (CR) has been linked to improved progression‐free (PFS) and overall (OS) survival in myeloma. A meta‐analysis was conducted to investigate whether this holds true in the era of novel agents (bortezomib, lenalidomide, thalidomide).MethodsA total of 24 studies in newly diagnosed patients undergoing autologous stem cell transplantation (ASCT) that reported associations between responses and long‐term outcomes (PFS/OS rates post‐ASCT by response, or hazard ratios with 95% confidence intervals from Cox models) were identified and analyzed.ResultsAchievement of CR vs. <CR post‐ASCT reduced risk of progression/death by 38% [risk ratio (RR): 0.62, P < 0.0001]; risk of death was 41% lower (RR: 0.59, P < 0.0001). Subgroup meta‐analyses showed significant PFS risk reduction with CR post‐ASCT with novel (RR: 0.32, P < 0.006) and non‐novel (RR: 0.72, P < 0.0001) agents, and corresponding OS risk reduction with novel (RR: 0.33, P = 0.0013) and non‐novel (RR: 0.64, P < 0.0001) agents. Risk reduction was greater with novel vs. non‐novel agents (PFS: P = 0.047; OS: P = 0.058).ConclusionsAchieving CR during first‐line therapy remains important in the novel‐agent era; magnitude of association between achieving CR and outcomes appears higher for CR obtained using novel vs. non‐novel agents.
Modelling idiopathic Parkinson disease as a complex illness can inform incidence rate in healthy adults: the PREDIGT score
Authors: Schlossmacher Michael G. , Tomlinson Julianna J. , Santos Goncalo , Shutinoski Bojan , Brown Earl G. , Manuel Douglas , Mestre Tiago 
Published: November 2016

AbstractFifty‐five years after the concept of dopamine replacement therapy was introduced, Parkinson disease (PD) remains an incurable neurological disorder. To date, no disease‐modifying therapeutic has been approved. The inability to predict PD incidence risk in healthy adults is seen as a limitation in drug development, because by the time of clinical diagnosis ≥ 60% of dopamine neurons have been lost. We have designed an incidence prediction model founded on the concept that the pathogenesis of PD is similar to that of many disorders observed in ageing humans, i.e. a complex, multifactorial disease. Our model considers five factors to determine cumulative incidence rates for PD in healthy adults: (i) DNA variants that alter susceptibility (D), e.g. carrying a LRRK2 or GBA risk allele; (ii) Exposure history to select environmental factors including xenobiotics (E); (iii) Gene–environment interactions that initiate pathological tissue responses (I), e.g. a rise in ROS levels, misprocessing of amyloidogenic proteins (foremost, α‐synuclein) and dysregulated inflammation; (iv) sex (or gender; G); and importantly, (v) time (T) encompassing ageing‐related changes, latency of illness and propagation of disease. We propose that cumulative incidence rates for PD (PR) can be calculated in healthy adults, using the formula: PR (%) = (E + D + I) × G × T. Here, we demonstrate six case scenarios leading to young‐onset parkinsonism (n = 3) and late‐onset PD (n = 3). Further development and validation of this prediction model and its scoring system promise to improve subject recruitment in future intervention trials. Such efforts will be aimed at disease prevention through targeted selection of healthy individuals with a higher prediction score for developing PD in the future and at disease modification in subjects that already manifest prodromal signs.
Amygdala mu‐opioid receptors mediate the motivating influence of cue‐triggered reward expectations
Authors: Lichtenberg Nina T. , Wassum Kate M. 
Published: November 2016

AbstractEnvironmental reward‐predictive stimuli can retrieve from memory a specific reward expectation that allows them to motivate action and guide choice. This process requires the basolateral amygdala (BLA), but little is known about the signaling systems necessary within this structure. Here we examined the role of the neuromodulatory opioid receptor system in the BLA in such cue‐directed action using the outcome‐specific Pavlovian‐to‐instrumental transfer (PIT) test in rats. Inactivation of BLA mu‐, but not delta‐opioid receptors was found to dose‐dependently attenuate the ability of a reward‐predictive cue to selectively invigorate the performance of actions directed at the same unique predicted reward (i.e. to express outcome‐specific PIT). BLA mu‐opioid receptor inactivation did not affect the ability of a reward itself to similarly motivate action (outcome‐specific reinstatement), suggesting a more selective role for the BLA mu‐opioid receptor in the motivating influence of currently unobservable rewarding events. These data reveal a new role for BLA mu‐opioid receptor activation in the cued recall of precise reward memories and the use of this information to motivate specific action plans.
Steady‐state VEP responses to uncomfortable stimuli
Authors: O'Hare Louise 
Published: November 2016

AbstractPeriodic stimuli, such as op‐art, can evoke a range of aversive sensations included in the term visual discomfort. Illusory motion effects are elicited by fixational eye movements, but the cortex might also contribute to effects of discomfort. To investigate this possibility, steady‐state visually evoked responses (SSVEPs) to contrast‐matched op‐art‐based stimuli were measured at the same time as discomfort judgements. On average, discomfort reduced with increasing spatial frequency of the pattern. In contrast, the peak amplitude of the SSVEP response was around the midrange spatial frequencies. Like the discomfort judgements, SSVEP responses to the highest spatial frequencies were lowest amplitude, but the relationship breaks down between discomfort and SSVEP for the lower spatial frequency stimuli. This was not explicable by gross eye movements as measured using the facial electrodes. There was a weak relationship between the peak SSVEP responses and discomfort judgements for some stimuli, suggesting that discomfort can be explained in part by electrophysiological responses measured at the level of the cortex. However, there is a breakdown of this relationship in the case of lower spatial frequency stimuli, which remains unexplained.
Long‐term monitoring of cardiorespiratory patterns in drug‐resistant epilepsy
Authors: Goldenholz Daniel M. , Kuhn Amanda , Austermuehle Alison , Bachler Martin , Mayer Christopher , Wassertheurer Siegfried , Inati Sara K. , Theodore William H. 
Published: November 2016

SummaryObjectiveSudden unexplained death in epilepsy (SUDEP) during inpatient electroencephalography (EEG) monitoring has been a rare but potentially preventable event, with associated cardiopulmonary markers. To date, no systematic evaluation of alarm settings for a continuous pulse oximeter (SpO2) has been performed. In addition, evaluation of the interrelationship between the ictal and interictal states for cardiopulmonary measures has not been reported.MethodsPatients with epilepsy were monitored using video‐EEG, SpO2, and electrocardiography (ECG). Alarm thresholds were tested systematically, balancing the number of false alarms with true seizure detections. Additional cardiopulmonary patterns were explored using automated ECG analysis software.ResultsOne hundred ninety‐three seizures (32 generalized) were evaluated from 45 patients (7,104 h recorded). Alarm thresholds of 80–86% SpO2 detected 63–73% of all generalized convulsions and 20–28% of all focal seizures (81–94% of generalized and 25–36% of focal seizures when considering only evaluable data). These same thresholds resulted in 25–146 min between false alarms. The sequential probability of ictal SpO2 revealed a potential common seizure termination pathway of desaturation. A statistical model of corrected QT intervals (QTc), heart rate (HR), and SpO2 revealed close cardiopulmonary coupling ictally. Joint probability maps of QTc and SpO2 demonstrated that many patients had baseline dysfunction in either cardiac, pulmonary, or both domains, and that ictally there was dissociation—some patients exhibited further dysfunction in one or both domains.SignificanceOptimal selection of continuous pulse oximetry thresholds involves a tradeoff between seizure detection accuracy and false alarm frequency. Alarming at 86% for patients that tend to have fewer false alarms and at 80% for those who have more, would likely result in a reasonable tradeoff. The cardiopulmonary findings may lead to SUDEP biomarkers and early seizure termination therapies.
Stereo electroencephalography–guided radiofrequency thermocoagulation (SEEG‐guided RF‐TC) in drug‐resistant focal epilepsy: Results from a 10‐year experience
Authors: Bourdillon Pierre , Isnard Jean , Catenoix Hélène , Montavont Alexandra , Rheims Sylvain , Ryvlin Philippe , Ostrowsky‐Coste Karine , Mauguiere François , Guénot Marc 
Published: November 2016

SummaryObjectiveStereo electroencephalography (SEEG)–guided radiofrequency thermocoagulation (SEEG‐guided RF‐TC) has been proposed since 2004 as a possible treatment of some focal drug‐resistant epilepsy. The aim of this study is to provide extensive data about efficacy and safety of SEEG‐guided RF‐TC.MethodsOver a 10‐year period, 162 patients with drug‐resistant focal epilepsy were eligible for SEEG‐guided RF‐TG during phase II invasive investigation by SEEG. All follow‐up and safety data were collected prospectively. The primary outcome was seizure freedom at 2 months and at 1 year after SEEG‐guided RF‐TC. Secondary outcomes were the responders' rate (patient with at least 50% decrease in seizure frequency) and their long‐term follow‐up.ResultsTwenty‐five percent of patients were seizure‐free at 2 months and 7% at 1 year. We reported 67% of responders at 2 months and 48% at 1 year; 58% of responders maintained their status during the long‐term follow‐up. The seizure outcome was significantly better when the SEEG‐guided RF‐TC involved the occipital region (p = 0.007). When surgery followed an SEEG‐guided RF‐TC, the positive predictive value of being a responder 2 months after an SEEG‐guided RF‐TC and to be Engel's class I or II after surgery was 93%. We reported 1.1% of permanent deficit and 2.4% of transient side effects.SignificanceOur results, gathered in a large population over a 10‐year period, confirm that SEEG‐guided RF‐TC is a safe technique, being efficient in many cases. More than two thirds of patients showed a short‐term improvement, and almost half of them were responders at 1‐year follow‐up. The technique appears to be especially interesting for limited epileptic zone inaccessible to surgery and when epilepsy is related to a large unilateral network (network disruption by multiple RF‐TC). Furthermore, SEEG‐guided RF‐TC effect is a predictor of outcome after conventional cortectomy in patients eligible for surgery.