bluuebunny/crossref_metadata_2025_split huggingface dataset:
There Are Many More Positive Maps Than Completely Positive Maps
Authors: Klep Igor , McCullough Scott , Šivic Klemen , Zalar Aljaž 
Published: August 2017

Abstract
A $\ast$-linear map $\Phi$ between matrix spaces is positive if it maps positive semidefinite matrices to positive semidefinite ones, and is called completely positive if all its ampliations $I_n\otimes \Phi$ are positive. In this article, quantitative bounds on the fraction of positive maps that are completely positive are proved. A main tool is the real algebraic geometry techniques developed by Blekherman to study the gap between positive polynomials and sums of squares. Finally, an algorithm to produce positive maps that are not completely positive is given.
Successful Treatment of Influenza-Associated Acute Necrotizing Encephalitis in an Adult Using High-Dose Oseltamivir and Methylprednisolone: Case Report and Literature Review
Authors: Alsolami Ahmed , Shiley Kevin 
Published: August 2017

Abstract
A case of influenza-associated acute necrotizing encephalitis (ANE) is described in an otherwise healthy adult. The patient was treated successfully with a combination of high-dose methylprednisolone and high-dose oseltamivir. The patient relapsed after discontinuing 150 mg twice daily oseltamivir but quickly improved and eventually recovered after reinitiation of high-dose oseltamivir for an additional 2 weeks. The clinical presentation, pathogenesis, and treatment of influenza-associated ANE is reviewed. The use of high-dose oseltamivir in combination with methylprednisolone may offer additional therapeutic benefit for this rare and poorly understood complication of influenza infection.
The Academy of Master Clinicians: Recognition of Clinical Excellence Within an Academic Medical Center
Authors: Glick John H. , Mulhern Victoria , Olthoff Kim M. , Ende Jack 
Published: August 2017

Problem
Academic health centers face increasing challenges in pursuing and maintaining clinical excellence in their tripartite mission. At Penn Medicine, an institution-wide strategic planning process was initiated in 2012. Among the recommendations that arose from that process was to enhance the recognition of Penn Medicine’s most outstanding clinicians. The Academy of Master Clinicians (AoMC) was founded in 2013.

Approach
The ad hoc committee charged with the development and implementation of the AoMC provided a mission statement, eligibility criteria, and a process for nomination and selection of AoMC members. This process was inclusive, extending to all entities of Penn Medicine. Various forms of institutional service were incorporated into the expectations for membership.

Outcomes
To date, 53 clinicians have been selected for membership in the AoMC. Members meet monthly to focus on significant institutional issues. Initiatives are identified for member leadership and participation. Members are engaged in activities and programs for medical students, residents, and faculty, focusing on areas such as career advising, faculty development, physician burnout, and practice operations. The executive vice president (EVP)/dean has commented that the AoMC is “highly visible and impactful.”

Next Steps
A yearly report on outcomes and impact of the AoMC is provided to the EVP and chief executive officer. In addition, at the end of each academic year, the members of the AoMC determine two to three new initiatives on which to work to formulate issues and potential actions.
Synthetic Cannabis Analogues and Suicidal Behavior: Case Report
Authors: Oliveira Pedro Miguel dos Santos , Morais Ana Sofia Félix , Madeira Nuno Gonçalo Gomes Fernandes 
Published: August 2017

Introduction:
Despite growing legal control, a wide range of synthetic cannabis analogues is currently used for recreational purposes, notwithstanding their well adverse outcomes, which appear to be more frequent and more serious than those associated with cannabis use. We present the case report of a patient with paranoid schizophrenia, who attempted suicide by serious bodily harm after a single use of “Shiva Ultra Strong,” a compound of several synthetic cannabis analogues.

Case Summary:
A 32-year-old male patient with paranoid schizophrenia was brought to the emergency department presenting with a severe self-inflicted wound to the neck which lacerated the right jugular vein and ipsilateral airway, and narrowly missed the carotid bifurcation. On examination, the patient exhibited psychomotor agitation and anxiety. Laboratory tests, which included routine substance use screening, proved unremarkable. The patient was admitted to the ENT Department for surgical treatment, after which he was transferred to our Psychiatry Department, exhibiting consistent improvement with his usual antipsychotic regimen, to which he had good previous adherence. Later, after discharge, he admitted to having used a smartshop drug, so-called “Shiva Ultra Strong,” shortly before the suicide attempt.

Conclusion:
Although current data on the suicide risk of synthetic cannabis analogues are limited, there is growing evidence of relevant psychiatric effects after their use. Patients with serious mental disorders could prove particularly vulnerable to these drugs, resulting in severe behavioral changes and self-harm.
Human Immunodeficiency Virus Viral Load Rebound Near Delivery in Previously Suppressed, Combination Antiretroviral Therapy–Treated Pregnant Women
Authors: Boucoiran Isabelle , Albert Arianne Y. K. , Tulloch Karen , Wagner Emily C. , Pick Neora , van Schalkwyk Julie , Harrigan P. Richard , Money Deborah 
Published: August 2017

OBJECTIVE:
To assess the stability of human immunodeficiency virus (HIV) viral load suppression within 1 month before birth in pregnant women receiving antenatal combination antiretroviral therapy (CART).

METHODS:
This is a retrospective cohort study of a Canadian provincial perinatal HIV database from 1997 to 2015. Inclusion criteria were live birth and CART received for at least 4 weeks. Viral load rebound, defined as viral load greater than 50 copies/mL (or greater than 400 copies/mL for 1997–1998) and measured within 1 month before delivery, was identified in women who had at least one previous undetectable viral load during pregnancy. Logistic regressions were conducted to identify the risk factors for viral load rebound.

RESULTS:
Among the 470 women in the database, 318 met inclusion criteria. Viral load rebound was experienced by 19 women (6.0%, 95% CI 3.7–9.3%) with a mean log10 viral load near delivery of 2.71 copies/mL (=513 copies/mL). Six (32%) had a viral load above 1,000 copies/mL. The rebound was detected within 1 day before delivery in 50% of the women. Aboriginal ethnicity, cocaine use, and hepatitis C virus polymerase chain reaction positivity were significantly associated with viral load rebound. There were no HIV vertical transmissions.

CONCLUSION:
Even women attending for HIV care and achieving viral suppression in pregnancy can experience viral load rebound predelivery.
Association Between Type of Screening for Gestational Diabetes Mellitus and Cesarean Delivery
Authors: Palatnik Anna , Swanson Kate , Churchill Tessa , Bilski Ania , Grobman William A. , Miller Emily S. 
Published: August 2017

OBJECTIVE:
To compare maternal and neonatal outcomes using two different testing strategies for gestational diabetes mellitus (GDM) diagnosis: the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) and Carpenter-Coustan approaches. Specifically, we wanted to compare the rates of cesarean delivery between the two epochs.

METHODS:
This was a retrospective cohort study of women with a singleton pregnancy delivering at 37 0/7 weeks of gestation or greater, between 2010 and 2015, in a single tertiary care center. The IADPSG testing was used for GDM diagnosis from December 2010 until July 2013 when institutional guidelines changed to Carpenter-Coustan testing. Maternal and neonatal outcomes were compared between these two different epochs using bivariable and multivariable analyses. The primary outcome was the frequency of cesarean delivery.

RESULTS:
The analysis included a total of 23,509 women: 14,074 (60%) from the IADPSG epoch and 9,435 (40%) from the Carpenter-Coustan epoch. The incidence of GDM diagnosis was higher using the IADPSG compared with Carpenter-Coustan criteria (8.3% compared with 7.5%, P=.042). The total (27.0% compared with 25.5% P=.022) as well as primary cesarean delivery rates (19.1% compared with 18.0%, P=.041) were higher during the IADPSG epoch. The rates of total (39.1% compared with 37.5%, P=.594) and primary (27.3% compared with 27.0%, P=.903) cesarean delivery among women with GDM did not differ between the two epochs. Secondary outcomes of shoulder dystocia (2.5% compared with 2.1%, P=.043) and neonatal intensive care unit admission (3.2% compared with 2.0%, P<.001) also were significantly higher in women screened during the IADPSG epoch, whereas hypertensive disease of pregnancy (6.9% compared with 7.7%, P=.018) was less frequent during the IADPSG epoch. These findings persisted after adjusting for potential confounding factors.

CONCLUSION:
Compared with testing using the Carpenter-Coustan criteria, the IADPSG criteria for diagnosis of GDM were associated with higher rates of GDM, cesarean delivery, shoulder dystocia, and neonatal intensive care unit admission. Obstetric care provider knowledge of GDM diagnosis might have affected decision-making regarding the route of delivery.
MRI scoring methods used in evaluation of muscle involvement in patients with idiopathic inflammatory myopathies
Authors: Kubínová Kateřina , Mann Heřman , Vencovský Jiří 
Published: August 2017

Purpose of review
MRI is a promising imaging method commonly used to assess muscle involvement in patients with idiopathic inflammatory myopathies (IIM). MRI enables evaluation of both activity and damage and is therefore an ideal noninvasive diagnostic and monitoring tool. Despite its widespread use, there is no universally accepted method for scoring and reporting of MRI findings. The aim of this review is to provide an overview of systems used in the evaluation of MR images in patients with IIM.

Recent findings
A number of semi-quantitative and quantitative methods have been used to evaluate and record the severity of myopathy on MRI. These scoring systems differ in the number and type of parameters assessed and in their complexity; furthermore, they were evaluated in different patient populations, all of which make comparisons between them difficult.

Summary
There is a need to create a standardized and validated protocol for evaluation of pathological changes in muscle MRI in IIM. The most appropriate number and distribution of muscle groups as well as evaluated pathological features need to be determined. Based on this literature search, the future scoring system should include assessment of muscle oedema, fatty infiltration, muscle atrophy and possibly the presence of fascial and subcutaneous inflammation. Whether the quantitative methods provide more reliable information regarding disease activity remains unclear.
A Novel Derivation Predicting Survival After Primary Tumor Resection in Stage IV Colorectal Cancer: Validation of a Prognostic Scoring Model and an Online Calculator to Provide Individualized Survival Estimation
Authors: Tan Winson Jianhong , Dorajoo Sreemanee Raaj , Chee Madeline Yen Min , Tan Wah Siew , Foo Fung Joon , Tang Choong Leong , Chew Min Hoe 
Published: August 2017

BACKGROUND:
A prognostic scoring model has been devised previously to predict survival following primary tumor resection in patients with metastatic colorectal cancer and unresectable metastases. This has yet to be validated.

OBJECTIVE:
The main objectives of this study are to validate the proposed prognostic scoring model and create an interactive online calculator to estimate an individual’s survival after primary tumor resection.

DESIGN:
Clinical data and survival outcomes of patients were extracted from a prospectively maintained database. Patients were categorized into good, moderate, or poor survivor groups based on the previously proposed scoring algorithm. Discrimination was assessed and recalibration was performed, with the recalibrated model implemented as an interactive Web application to provide individualized survival probability.

SETTINGS:
This study was conducted at a tertiary referral center.

PATIENTS:
The study included 324 consecutive patients with metastatic colorectal carcinoma and unresectable metastases who underwent primary tumor resection between January 2008 and December 2013.

MAIN OUTCOME MEASURES:
The primary outcome measured was overall survival.

RESULTS:
Three hundred twenty-four patients were included in the study. Median survival in the good, moderate, and poor prognostic groups was 56.8, 25.7, and 19.9 months (log rank test, p = 0.003). The κ statistic was 0.638 and R
2

D
was 0.101. Significant differences in survival were found between the moderate and good prognostic groups (HR, 2.79; 95% CI, 1.51–5.15; p = 0.001) and between poor and good prognostic groups (HR, 4.12; 95% CI, 1.98–8.55; p < 0.001). The model was implemented as an interactive online calculator to provide individualized survival estimation after primary tumor resection (http://bit.ly/Stage4PrognosticScore).

LIMITATIONS:
Selection bias and single-center data preclude the generalizability of the proposed model. Information regarding the severity or likelihood of developing symptoms from the primary tumor were also not accounted for in the prognostic scoring model proposed.

CONCLUSIONS:
The prognostic scoring model provides good prognostic stratification of survival after primary tumor resection and may be a useful tool to predict survival after primary tumor resection. See Video Abstract at http://links.lww.com/DCR/A330.
Laparoscopic Versus Open Lateral Lymph Node Dissection for Locally Advanced Low Rectal Cancer: A Subgroup Analysis of a Large Multicenter Cohort Study in Japan
Authors: Yamaguchi Tomohiro , Konishi Tsuyoshi , Kinugasa Yusuke , Yamamoto Seiichiro , Akiyoshi Takashi , Okamura Ryosuke , Ito Masaaki , Nishimura Yoji , Shiozawa Manabu , Yamaguchi Shigeki , Hida Koya , Sakai Yoshiharu , Watanabe Masahiko 
Published: August 2017

BACKGROUND:
Mesorectal excision with lateral lymph node dissection is the standard treatment for locally advanced low rectal cancer in Japan. However, the safety and feasibility of laparoscopic lateral lymph node dissection remain to be determined.

OBJECTIVE:
The purpose of this study was to evaluate the safety and feasibility of laparoscopic versus open lateral lymph node dissection for locally advanced low rectal cancer.

DESIGN:
This was a retrospective cohort study using an exact matching method.

SETTING:
We conducted a multicenter study of 69 specialized centers in Japan.

PATIENTS:
Patients with consecutive midrectal or low rectal adenocarcinoma cancer stage II to III who underwent mesorectal excision with curative intent between 2010 and 2011 were recruited.

MAIN OUTCOME MEASURES:
Short-term and oncological outcomes were compared between the laparoscopic and open-surgery groups.

RESULTS:
Of the 1500 eligible patients, 676 patients who underwent lateral lymph node dissection were analyzed, including 137 patients who were treated laparoscopically and 539 patients who were treated with open surgery. After matching, the patients were stratified into laparoscopic (n = 118) and open-surgery (n = 118) groups. Operative times in the overall cohort were significantly longer (461 vs 372 min) in the laparoscopic versus the open-surgery group. In the laparoscopic group, the blood loss volume was significantly smaller (193 vs 722 mL), with fewer instances of blood transfusion (7.3% vs 25.5%) compared with the open-surgery group. The postoperative complication rates were 35.8% and 43.6% for the laparoscopic and open-surgery groups (p = 0.10). The 3-year relapse-free survival rates were 80.3% and 72.6% for the laparoscopic and open-surgery groups (p = 0.07).

LIMITATIONS:
The study was limited by its retrospective design and potential selection bias.

CONCLUSIONS:
Laparoscopic lateral lymph node dissection is safe and feasible for cancer stage II to III low rectal cancer and is associated with similar oncological outcomes as open lateral lymph node dissection. See Video Abstract at http://links.lww.com/DCR/A334.
Postoperative Chemoradiotherapy After Local Resection for High-Risk T1 to T2 Low Rectal Cancer: Results of a Single-Arm, Multi-Institutional, Phase II Clinical Trial
Authors: Sasaki Takeshi , Ito Yoshinori , Ohue Masayuki , Kanemitsu Yukihide , Kobatake Takaya , Ito Masaaki , Moriya Yoshihiro , Saito Norio 
Published: August 2017

BACKGROUND:
After treatment with local excision for TNM stage I low rectal cancer, the risk of local recurrence is not only high for T2 lesions but also for T1 lesions with features of massive invasion to the submucosal layer and/or lymphovascular invasion.

OBJECTIVE:
The purpose of this study was to determine the efficacy of chemoradiotherapy combined with local excision in the treatment of T1 to T2 low rectal cancer.

DESIGN:
We conducted a prospective, single-arm, phase II trial.

SETTINGS:
This was a multicenter study.

PATIENTS:
From April 2003 to October 2010, 57 patients were treated with local excision after additional external beam irradiation (45 Gy) plus continuous 5-week intravenous injection of 5-fluorouracil (250 mg/m2 per day) at 10 domestic hospitals. Fifty-three patients had clinical T1N0 lesions, and 4 had T2N0 lesions in the low rectum, located below the peritoneal reflection.

MAIN OUTCOMES MEASURES:
The primary end point was disease-free survival at 5 years.

RESULTS:
The completion rate for full-dose chemoradiotherapy was 86% (49/57). Serious, nontransient treatment-related complications were not reported. With a median follow-up of 7.3 years after local excision, the 5-year disease-free survival rate was 94% for the 53 patients with T1 lesions and 75% for the 4 patients with T2 lesions. There were 2 local recurrences during the entire observation period. Anal function after local excision and chemoradiation were kept at almost the same levels as observed before treatment.

LIMITATIONS:
The study was limited by the small number of registered T2 rectal cancers, retrospective evaluations of quality of life, and the exclusion of poorly differentiated adenocarcinoma (a high-risk feature of T1 lesions).

CONCLUSIONS:
The addition of chemoradiotherapy to local excision of T1 rectal adenocarcinomas with poor prognostic features including deep submucosal invasion and lymphovascular invasion could improve on less favorable historic oncologic outcomes of local excision alone in this high-risk group for lymph node metastasis. See Video Abstract at http://links.lww.com/DCR/A421.
Is the Failure of Laparoscopic Peritoneal Lavage Predictable in Hinchey III Diverticulitis Management?
Authors: Greilsamer Tristan , Abet Emeric , Meurette Guillaume , Comy Michel , Hamy Antoine , Lehur Paul-Antoine , Venara Aurélien , Duchalais Emilie 
Published: August 2017

BACKGROUND:
Laparoscopic peritoneal lavage is an alternative to sigmoid resection in Hinchey III diverticulitis (generalized purulent peritonitis). The main limitation of laparoscopic peritoneal lavage is the higher rate of reoperation for persistent sepsis in comparison with sigmoid resection.

OBJECTIVE:
The purpose of the current study was to identify risk factors for laparoscopic peritoneal lavage failure in patients who have Hinchey III diverticulitis.

DESIGN:
This was a retrospective multicenter study.

SETTINGS:
The study was conducted in 3 clinical sites in France.

PATIENTS:
From 2006 to 2015, all consecutive patients undergoing emergent surgery for diverticulitis were reviewed. All patients operated on with laparoscopic peritoneal lavage for laparoscopically confirmed Hinchey III diverticulitis were included.

MAIN OUTCOME MEASURES:
The main outcome was laparoscopic peritoneal lavage failure, defined as reoperation or death at 30 postoperative days.

RESULTS:
A series of 71 patients (43 men, mean age 58 ± 15 years) were operated on with laparoscopic peritoneal lavage for Hinchey III diverticulitis. Laparoscopic peritoneal lavage failed in 14 (20%) of them: 1 died and 13 underwent reoperations. No major complication (Dindo-Clavien score ≥3) occurred after reoperation. Immunosuppressive drugs (p = 0.01) and ASA grade ≥3 (p = 0.02) were associated with laparoscopic peritoneal lavage failure after univariate analysis. Multivariate analysis identified only immunosuppressive drug intake (steroids or chemotherapy for cancer) as an independent predictive factor. Mean length of stay was 14.9 days (5–67). At the end of the 30 first postoperative days, 12 (17%) patients had a stoma.

LIMITATIONS:
The study was limited by its retrospective nature and the small size of the cohort.

CONCLUSION:
Our results highlight immunosuppressive drug intake as a major risk factor for laparoscopic peritoneal lavage failure in patients who have Hinchey III diverticulitis. Immunosuppression and severe comorbidities (ASA ≥3) should be considered when selecting a surgical option in patients with Hinchey III diverticulitis. See Video Abstract at http://links.lww.com/DCR/A423.
Is MRI of the Liver Needed During Routine Preoperative Workup for Colorectal Cancer?
Authors: Kang Sung Il , Kim Duck-Woo , Cho Jai Young , Park Jihoon , Lee Kyung Ho , Son Il Tae , Oh Heung-Kwon , Kang Sung-Bum 
Published: August 2017

BACKGROUND:
The clinical efficacy of gadoxetic acid–enhanced liver MRI as a routine preoperative procedure for all patients with colorectal cancer remains unclear.

OBJECTIVE:
The purpose of this study was to evaluate the efficacy of preoperative gadoxetic acid–enhanced liver MRI for the diagnosis of liver metastasis in patients with colorectal cancer.

DESIGN:
This was a retrospective analysis from a prospective cohort database.

SETTINGS:
All of the patients were from a subspecialty practice at a tertiary referral hospital.

PATIENTS:
Patients who received preoperative gadoxetic acid–enhanced liver MRI after CT and attempted curative surgery for colorectal cancer were included.

MAIN OUTCOME MEASURES:
The number of equivocal hepatic lesions based on CT and gadoxetic acid–enhanced liver MRI and diagnostic use of the gadoxetic acid–enhanced liver MRI were measured.

RESULTS:
We reviewed the records of 690 patients with colorectal cancer. Equivocal hepatic lesions were present in 17.2% of patients based on CT and in 4.5% based on gadoxetic acid–enhanced liver MRI. Among 496 patients with no liver metastasis based on CT, gadoxetic acid–enhanced liver MRI detected equivocal lesions in 15 patients and metastasis in 3 patients. Among 119 patients who had equivocal liver lesions on CT, gadoxetic acid–enhanced liver MRI indicated hepatic lesions in 103 patients (86.6%), including 90 with no metastasis and 13 with metastasis. Among 75 patients who had liver metastasis on CT, gadoxetic acid–enhanced liver MRI indicated that the hepatic lesions in 2 patients were benign, in contrast to CT findings. The initial surgical plans for hepatic lesions according to CT were changed in 17 patients (3%) after gadoxetic acid–enhanced liver MRI.

LIMITATIONS:
This study was limited by its retrospective design.

CONCLUSIONS:
The clinical efficacy of gadoxetic acid–enhanced liver MRI as a routine preoperative procedure for all patients with colorectal cancer is low, in spite of its high diagnostic value for detecting liver metastasis. However, this study showed gadoxetic acid–enhanced liver MRI was helpful in characterizing equivocal hepatic lesions identified in CT and could lead to change in treatment plans for some patients. See Video Abstract at http://links.lww.com/DCR/A420.