The names of the authors of the published version of the above article were incorrectly presented... more The names of the authors of the published version of the above article were incorrectly presented. The names are now correctly presented above. The original article has been corrected.
Comparison of chest X-ray interpretation by pediatric pulmonologists, pediatric radiologists, and pediatric residents in children with suspected foreign body aspiration—a retrospective cohort study
Epistatic Interaction between <i>AVPR1a</i> and <i>SLC6A4</i> Contributes to the Creative Dance Phenotype
<p>Promoter region polymorphisms in the AVPR1a receptor region possibly contribute to regio... more <p>Promoter region polymorphisms in the AVPR1a receptor region possibly contribute to regional differences in brain arginine receptor 1a expression patterns [<a href="http://www.plosgenetics.org/article/info:doi/10.1371/journal.pgen.0010042#pgen-0010042-b42" target="_blank">42</a>]. Vasopressin release, and subsequent AVPR1a receptor activation, is partially regulated by serotonin (5-HT) [<a href="http://www.plosgenetics.org/article/info:doi/10.1371/journal.pgen.0010042#pgen-0010042-b28" target="_blank">28</a>]. 5-HT is removed from the synapse by the serotonin transporter <i>(SLC6A4),</i> which plays a major role in regulation of synaptic levels of this neurotransmitter. In turn, synaptic <i>SLC6A4</i> mRNA and protein levels are controlled in part by the presence or absence of a promoter region 44-bp insertion/deletion [<a href="http://www.plosgenetics.org/article/info:doi/10.1371/journal.pgen.0010042#pgen-0010042-b19" target="_blank">19</a>]. Subjects with polymorphic variants of these two genes are therefore predicted to show differences in serotonergic and vasopressin tone that contribute to differences in higher psychological constructs including TPQ Reward Dependence (associated with <i>AVPR1a</i> and <i>AVPR1a</i> × <i>SLC6A4</i> gene × gene interaction) and TAS (associated with <i>SLC6A4</i> and <i>AVPR1a</i> × <i>SLC6A4</i> gene × gene interaction). Dancers score high on these two personality constructs, suggesting the hypothesis that the association between <i>AVPR1a</i> and <i>SLC6A4</i> polymorphisms and dancing is likely mediated by the action of these two genes primarily on social communication (measured by TPQ Reward Dependence scores) and spirituality (measured by TAS scores). Similar to genes contributing to other complex traits, there are no “dancing” genes but rather common polymorphisms that contribute to simpler endophenotypes [<a href="http://www.plosgenetics.org/article/info:doi/10.1371/journal.pgen.0010042#pgen-0010042-b77" target="_blank">77</a>], such as TPQ Reward Dependence and TAS, that constitute some of the critical psychological underpinnings of the dance phenotype.</p
Dancing, which is integrally related to music, likely has its origins close to the birth of Homo ... more Dancing, which is integrally related to music, likely has its origins close to the birth of Homo sapiens, and throughout our history, dancing has been universally practiced in all societies. We hypothesized that there are differences among individuals in aptitude, propensity, and need for dancing that may partially be based on differences in common genetic polymorphisms. Identifying such differences may lead to an understanding of the neurobiological basis of one of mankind's most universal and appealing behavioral traits-dancing. In the current study, 85 current performing dancers and their parents were genotyped for the serotonin transporter (SLC6A4: promoter region HTTLPR and intron 2 VNTR) and the arginine vasopressin receptor 1a (AVPR1a: promoter microsatellites RS1 and RS3). We also genotyped 91 competitive athletes and a group of nondancers/nonathletes (n ¼ 872 subjects from 414 families). Dancers scored higher on the Tellegen Absorption Scale, a questionnaire that correlates positively with spirituality and altered states of consciousness, as well as the Reward Dependence factor in Cloninger's Tridimensional Personality Questionnaire, a measure of need for social contact and openness to communication. Highly significant differences in AVPR1a haplotype frequencies (RS1 and RS3), especially when conditional on both SLC6A4 polymorphisms (HTTLPR and VNTR), were observed between dancers and athletes using the UNPHASED program package (Cocaphase: likelihood ratio test [LRS] ¼ 89.23, p ¼ 0.000044). Similar results were obtained when dancers were compared to nondancers/nonathletes (Cocaphase: LRS ¼ 92.76, p ¼ 0.000024). These results were confirmed using a robust family-based test (Tdtphase: LRS ¼ 46.64, p ¼ 0.010). Association was also observed between Tellegen Absorption Scale scores and AVPR1a (Qtdtphase: global chi-square ¼ 26.53, p ¼ 0.047), SLC6A4 haplotypes (Qtdtphase: chi-square ¼ 2.363, p ¼ 0.018), and AVPR1a conditional on SCL6A4 (Tdtphase: LRS ¼ 250.44, p ¼ 0.011). Similarly, significant association was observed between Tridimensional Personality Questionnaire Reward Dependence scores and AVPR1a RS1 (chi-square ¼ 20.16, p ¼ 0.01). Two-locus analysis (RS1 and RS3 conditional on HTTLPR and VNTR) was highly significant (LRS ¼ 162.95, p ¼ 0.001). Promoter repeat regions in the AVPR1a gene have been robustly demonstrated to play a role in molding a range of social behaviors in many vertebrates and, more recently, in humans. Additionally, serotonergic neurotransmission in some human studies appears to mediate human religious and spiritual experiences. We therefore hypothesize that the association between AVPR1a and SLC6A4 reflects the social communication, courtship, and spiritual facets of the dancing phenotype rather than other aspects of this complex phenotype, such as sensorimotor integration.
The purpose of this study was to determine the rate and risk factors for the development of irrev... more The purpose of this study was to determine the rate and risk factors for the development of irreversible hepatotoxicity after transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) and synthetic hepatic dysfunction. Two hundred fifty-one consecutive patients with HCC and hepatic dysfunction who underwent 443 TACE procedures from 2005 to 2010 were retrospectively reviewed. The included patients met one of the following criteria: a pre-TACE bilirubin level 2 mg/dL, an international normalized ratio (INR) > 1.5, a creatinine level > 1.2 mg/dL, a platelet count 60,000/ mL, a Model for End-Stage Liver Disease (MELD) score > 15, Child-Turcotte-Pugh class B or C, ascites, or portal vein thrombosis. Hepatotoxicity was defined as new or worsening ascites, encephalopathy, or grade 3 or 4 toxicity (bilirubin, aspartate aminotransferase, alanine aminotransferase, creatinine, or INR) according to the National Cancer Institute Common Terminology Criteria for Adverse Events. The rate and risk factors for death or urgent liver transplantation within 6 weeks of TACE and irreversible hepatotoxicity were determined with a generalized estimating equation analysis. Reversible hepatotoxicity developed after 90 procedures (20%) in 78 patients (31%). Irreversible hepatotoxicity developed after 41 procedures (9%) in 37 patients (15%). Six patients (2%) underwent urgent liver transplantation, and 11 (4%) died within 6 weeks of TACE. Patients at increased risk for procedure-related mortality or urgent liver transplantation within 6 weeks of TACE had a baseline serum bilirubin level 4.0 mg/dL (P ¼ 0.01), an elevated INR (P < 0.001), hypoalbuminemia with an albumin level < 2.0 g/L (P ¼ 0.01), a serum creatinine level > 2.0 mg/dL (P ¼ 0.02), large ascites (P ¼ 0.002), encephalopathy (P ¼ 0.005), or a MELD score 20 (P < 0.001). In conclusion, TACE can be performed safely in patients with baseline hepatic dysfunction. However, a poor hepatic reserve increases the risk of irreversible hepatotoxicity, which may lead to death or the need for urgent liver transplantation.
Prospective Evaluation of Absorbable Gastropexy Anchor Indwelling Time in 33 Patients
Journal of Vascular and Interventional Radiology, 2013
To evaluate the time to absorbable suture gastropexy anchor release and gastropexy-related compli... more To evaluate the time to absorbable suture gastropexy anchor release and gastropexy-related complications in patients receiving percutaneous image-guided transabdominal gastrostomy or gastrojejunostomy tube placement. Thirty-three consecutive patients (16 women; mean age, 63.5 y; range, 25-92 y) undergoing fluoroscopically guided (n = 32) or computed tomography-guided (n = 1) percutaneous transabdominal gastrostomy (n = 26) or gastrojejunostomy (n = 7) were prospectively enrolled in a single-center study. Each patient had three synthetic absorbable suture T-fasteners inserted and were followed until all gastropexy button-locks released naturally, were cut by a health care provider, or were lost to follow-up. Patients or caregivers were contacted weekly to determine timing of gastropexy button-lock release and assess for postprocedural complications. All three T-fastener button-type suture locks released naturally in 14 of 33 patients (42.4%) at a median of 29.5 days (mean, 26.7 d; range, 8-40 d). One or more T-fastener sutures were cut in 10 of 33 patients (30.3%), and nine patients (27.3%) were lost to follow-up. Accounting for patient censorship, T-fasteners in all 33 patients remained intact for a median of 35 days. Local infections developed in three patients (9%) on days 22, 25, and 34. Relative to nonabsorbable gastropexy sutures, absorbable suture gastropexy anchors offer the potential to reduce complications associated with long gastropexy indwelling times. However, absorbable gastropexy anchor buttons usually remain intact for longer than 3 weeks after insertion. A postprocedural plan for gastropexy inspection and removal within 3 weeks should continue to be emphasized to avoid local complications, even for absorbable suture kits.
An ellipsoid approximation of renal volume calculated from renal measurements correlates closely ... more An ellipsoid approximation of renal volume calculated from renal measurements correlates closely with differential renal function obtained from radionuclide studies. This method is simple and reproducible between observers. Obtaining both anatomical and functional information from a single study saves time and resources whilst exposing the patient to less radiation.
Purpose The hypothesis of this study was that more stable fixation of acute scaphoid fractures ma... more Purpose The hypothesis of this study was that more stable fixation of acute scaphoid fractures may be achieved by a screw placed perpendicular to the fracture plane than along the long axis of the scaphoid, as previously suggested. We examined this assumption on different fracture patterns using a finite element analysis model. Methods A computed tomography scan of an intact scaphoid of a young man provided the data set for all fracture models. We used semiautomatic segmentation to create 3-dimensional computer models of the 3 simple fracture configurations: oblique, transverse waist, and proximal fractures, according to the Herbert classification. Each fracture type was analyzed, using finite elements, for its biomechanical response to 2 types of virtual fixation: a screw placed either perpendicular to the fracture plane or centrally along the long axis of the scaphoid. We measured motion at the fracture plane (in millimeters) and strain in the screw threads (in millipascals). Considerably less motion was measured at the fracture plane with the perpendicular screw compared with the long axis screw, especially in the oblique-type fractures: (1) Herbert-type B1 oblique fracture mean motion of 0.05 mm (Ϯ0.03) for the perpendicular screw versus 0.28 mm (Ϯ0.05) for the long axis screw; (2) B2 transverse waist fracture mean motion of 0.06 mm (Ϯ0.03) for the perpendicular screw versus 0.18 mm (Ϯ0.06) for the long axis screw; and (3) B3 proximal fracture mean motion of 0.07 mm (Ϯ0.01) for the perpendicular screw versus 0.28 mm (Ϯ0.011) for the long axis screw. Higher strains were measured on the screw placed perpendicular to the fracture. Conclusions According to this model, higher fixation stability is achieved when the scaphoid is fixated perpendicular to the fracture. In transverse waist fractures, a centrally placed screw will also be perpendicular to the fracture, which explains the results of previous models.
Pulmonary-Nodule Detection Using an Ensemble of 3D SE-ResNet18 and DPN68 Models
This short paper describes our contribution to the LNDb - Grand Challenge on automatic lung cance... more This short paper describes our contribution to the LNDb - Grand Challenge on automatic lung cancer patient management [1]. We only participated in Sub-Challenge A: Nodule Detection. The officially stated goal of this challenge is From chest CT scans, participants must detect pulmonary nodules. We developed a computer-aided detection (CAD) system for the identification of small pulmonary nodules in screening CT scans. The two main modules of our system consist of a CNN based nodule candidate detection, and a neural classifier for false positive reduction. The preliminary results obtained on the challenge database is discussed.
The names of the authors of the published version of the above article were incorrectly presented... more The names of the authors of the published version of the above article were incorrectly presented. The names are now correctly presented above. The original article has been corrected.
Comparison of chest X-ray interpretation by pediatric pulmonologists, pediatric radiologists, and pediatric residents in children with suspected foreign body aspiration—a retrospective cohort study
Epistatic Interaction between <i>AVPR1a</i> and <i>SLC6A4</i> Contributes to the Creative Dance Phenotype
<p>Promoter region polymorphisms in the AVPR1a receptor region possibly contribute to regio... more <p>Promoter region polymorphisms in the AVPR1a receptor region possibly contribute to regional differences in brain arginine receptor 1a expression patterns [<a href="http://www.plosgenetics.org/article/info:doi/10.1371/journal.pgen.0010042#pgen-0010042-b42" target="_blank">42</a>]. Vasopressin release, and subsequent AVPR1a receptor activation, is partially regulated by serotonin (5-HT) [<a href="http://www.plosgenetics.org/article/info:doi/10.1371/journal.pgen.0010042#pgen-0010042-b28" target="_blank">28</a>]. 5-HT is removed from the synapse by the serotonin transporter <i>(SLC6A4),</i> which plays a major role in regulation of synaptic levels of this neurotransmitter. In turn, synaptic <i>SLC6A4</i> mRNA and protein levels are controlled in part by the presence or absence of a promoter region 44-bp insertion/deletion [<a href="http://www.plosgenetics.org/article/info:doi/10.1371/journal.pgen.0010042#pgen-0010042-b19" target="_blank">19</a>]. Subjects with polymorphic variants of these two genes are therefore predicted to show differences in serotonergic and vasopressin tone that contribute to differences in higher psychological constructs including TPQ Reward Dependence (associated with <i>AVPR1a</i> and <i>AVPR1a</i> × <i>SLC6A4</i> gene × gene interaction) and TAS (associated with <i>SLC6A4</i> and <i>AVPR1a</i> × <i>SLC6A4</i> gene × gene interaction). Dancers score high on these two personality constructs, suggesting the hypothesis that the association between <i>AVPR1a</i> and <i>SLC6A4</i> polymorphisms and dancing is likely mediated by the action of these two genes primarily on social communication (measured by TPQ Reward Dependence scores) and spirituality (measured by TAS scores). Similar to genes contributing to other complex traits, there are no “dancing” genes but rather common polymorphisms that contribute to simpler endophenotypes [<a href="http://www.plosgenetics.org/article/info:doi/10.1371/journal.pgen.0010042#pgen-0010042-b77" target="_blank">77</a>], such as TPQ Reward Dependence and TAS, that constitute some of the critical psychological underpinnings of the dance phenotype.</p
Dancing, which is integrally related to music, likely has its origins close to the birth of Homo ... more Dancing, which is integrally related to music, likely has its origins close to the birth of Homo sapiens, and throughout our history, dancing has been universally practiced in all societies. We hypothesized that there are differences among individuals in aptitude, propensity, and need for dancing that may partially be based on differences in common genetic polymorphisms. Identifying such differences may lead to an understanding of the neurobiological basis of one of mankind's most universal and appealing behavioral traits-dancing. In the current study, 85 current performing dancers and their parents were genotyped for the serotonin transporter (SLC6A4: promoter region HTTLPR and intron 2 VNTR) and the arginine vasopressin receptor 1a (AVPR1a: promoter microsatellites RS1 and RS3). We also genotyped 91 competitive athletes and a group of nondancers/nonathletes (n ¼ 872 subjects from 414 families). Dancers scored higher on the Tellegen Absorption Scale, a questionnaire that correlates positively with spirituality and altered states of consciousness, as well as the Reward Dependence factor in Cloninger's Tridimensional Personality Questionnaire, a measure of need for social contact and openness to communication. Highly significant differences in AVPR1a haplotype frequencies (RS1 and RS3), especially when conditional on both SLC6A4 polymorphisms (HTTLPR and VNTR), were observed between dancers and athletes using the UNPHASED program package (Cocaphase: likelihood ratio test [LRS] ¼ 89.23, p ¼ 0.000044). Similar results were obtained when dancers were compared to nondancers/nonathletes (Cocaphase: LRS ¼ 92.76, p ¼ 0.000024). These results were confirmed using a robust family-based test (Tdtphase: LRS ¼ 46.64, p ¼ 0.010). Association was also observed between Tellegen Absorption Scale scores and AVPR1a (Qtdtphase: global chi-square ¼ 26.53, p ¼ 0.047), SLC6A4 haplotypes (Qtdtphase: chi-square ¼ 2.363, p ¼ 0.018), and AVPR1a conditional on SCL6A4 (Tdtphase: LRS ¼ 250.44, p ¼ 0.011). Similarly, significant association was observed between Tridimensional Personality Questionnaire Reward Dependence scores and AVPR1a RS1 (chi-square ¼ 20.16, p ¼ 0.01). Two-locus analysis (RS1 and RS3 conditional on HTTLPR and VNTR) was highly significant (LRS ¼ 162.95, p ¼ 0.001). Promoter repeat regions in the AVPR1a gene have been robustly demonstrated to play a role in molding a range of social behaviors in many vertebrates and, more recently, in humans. Additionally, serotonergic neurotransmission in some human studies appears to mediate human religious and spiritual experiences. We therefore hypothesize that the association between AVPR1a and SLC6A4 reflects the social communication, courtship, and spiritual facets of the dancing phenotype rather than other aspects of this complex phenotype, such as sensorimotor integration.
The purpose of this study was to determine the rate and risk factors for the development of irrev... more The purpose of this study was to determine the rate and risk factors for the development of irreversible hepatotoxicity after transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) and synthetic hepatic dysfunction. Two hundred fifty-one consecutive patients with HCC and hepatic dysfunction who underwent 443 TACE procedures from 2005 to 2010 were retrospectively reviewed. The included patients met one of the following criteria: a pre-TACE bilirubin level 2 mg/dL, an international normalized ratio (INR) > 1.5, a creatinine level > 1.2 mg/dL, a platelet count 60,000/ mL, a Model for End-Stage Liver Disease (MELD) score > 15, Child-Turcotte-Pugh class B or C, ascites, or portal vein thrombosis. Hepatotoxicity was defined as new or worsening ascites, encephalopathy, or grade 3 or 4 toxicity (bilirubin, aspartate aminotransferase, alanine aminotransferase, creatinine, or INR) according to the National Cancer Institute Common Terminology Criteria for Adverse Events. The rate and risk factors for death or urgent liver transplantation within 6 weeks of TACE and irreversible hepatotoxicity were determined with a generalized estimating equation analysis. Reversible hepatotoxicity developed after 90 procedures (20%) in 78 patients (31%). Irreversible hepatotoxicity developed after 41 procedures (9%) in 37 patients (15%). Six patients (2%) underwent urgent liver transplantation, and 11 (4%) died within 6 weeks of TACE. Patients at increased risk for procedure-related mortality or urgent liver transplantation within 6 weeks of TACE had a baseline serum bilirubin level 4.0 mg/dL (P ¼ 0.01), an elevated INR (P < 0.001), hypoalbuminemia with an albumin level < 2.0 g/L (P ¼ 0.01), a serum creatinine level > 2.0 mg/dL (P ¼ 0.02), large ascites (P ¼ 0.002), encephalopathy (P ¼ 0.005), or a MELD score 20 (P < 0.001). In conclusion, TACE can be performed safely in patients with baseline hepatic dysfunction. However, a poor hepatic reserve increases the risk of irreversible hepatotoxicity, which may lead to death or the need for urgent liver transplantation.
Prospective Evaluation of Absorbable Gastropexy Anchor Indwelling Time in 33 Patients
Journal of Vascular and Interventional Radiology, 2013
To evaluate the time to absorbable suture gastropexy anchor release and gastropexy-related compli... more To evaluate the time to absorbable suture gastropexy anchor release and gastropexy-related complications in patients receiving percutaneous image-guided transabdominal gastrostomy or gastrojejunostomy tube placement. Thirty-three consecutive patients (16 women; mean age, 63.5 y; range, 25-92 y) undergoing fluoroscopically guided (n = 32) or computed tomography-guided (n = 1) percutaneous transabdominal gastrostomy (n = 26) or gastrojejunostomy (n = 7) were prospectively enrolled in a single-center study. Each patient had three synthetic absorbable suture T-fasteners inserted and were followed until all gastropexy button-locks released naturally, were cut by a health care provider, or were lost to follow-up. Patients or caregivers were contacted weekly to determine timing of gastropexy button-lock release and assess for postprocedural complications. All three T-fastener button-type suture locks released naturally in 14 of 33 patients (42.4%) at a median of 29.5 days (mean, 26.7 d; range, 8-40 d). One or more T-fastener sutures were cut in 10 of 33 patients (30.3%), and nine patients (27.3%) were lost to follow-up. Accounting for patient censorship, T-fasteners in all 33 patients remained intact for a median of 35 days. Local infections developed in three patients (9%) on days 22, 25, and 34. Relative to nonabsorbable gastropexy sutures, absorbable suture gastropexy anchors offer the potential to reduce complications associated with long gastropexy indwelling times. However, absorbable gastropexy anchor buttons usually remain intact for longer than 3 weeks after insertion. A postprocedural plan for gastropexy inspection and removal within 3 weeks should continue to be emphasized to avoid local complications, even for absorbable suture kits.
An ellipsoid approximation of renal volume calculated from renal measurements correlates closely ... more An ellipsoid approximation of renal volume calculated from renal measurements correlates closely with differential renal function obtained from radionuclide studies. This method is simple and reproducible between observers. Obtaining both anatomical and functional information from a single study saves time and resources whilst exposing the patient to less radiation.
Purpose The hypothesis of this study was that more stable fixation of acute scaphoid fractures ma... more Purpose The hypothesis of this study was that more stable fixation of acute scaphoid fractures may be achieved by a screw placed perpendicular to the fracture plane than along the long axis of the scaphoid, as previously suggested. We examined this assumption on different fracture patterns using a finite element analysis model. Methods A computed tomography scan of an intact scaphoid of a young man provided the data set for all fracture models. We used semiautomatic segmentation to create 3-dimensional computer models of the 3 simple fracture configurations: oblique, transverse waist, and proximal fractures, according to the Herbert classification. Each fracture type was analyzed, using finite elements, for its biomechanical response to 2 types of virtual fixation: a screw placed either perpendicular to the fracture plane or centrally along the long axis of the scaphoid. We measured motion at the fracture plane (in millimeters) and strain in the screw threads (in millipascals). Considerably less motion was measured at the fracture plane with the perpendicular screw compared with the long axis screw, especially in the oblique-type fractures: (1) Herbert-type B1 oblique fracture mean motion of 0.05 mm (Ϯ0.03) for the perpendicular screw versus 0.28 mm (Ϯ0.05) for the long axis screw; (2) B2 transverse waist fracture mean motion of 0.06 mm (Ϯ0.03) for the perpendicular screw versus 0.18 mm (Ϯ0.06) for the long axis screw; and (3) B3 proximal fracture mean motion of 0.07 mm (Ϯ0.01) for the perpendicular screw versus 0.28 mm (Ϯ0.011) for the long axis screw. Higher strains were measured on the screw placed perpendicular to the fracture. Conclusions According to this model, higher fixation stability is achieved when the scaphoid is fixated perpendicular to the fracture. In transverse waist fractures, a centrally placed screw will also be perpendicular to the fracture, which explains the results of previous models.
Pulmonary-Nodule Detection Using an Ensemble of 3D SE-ResNet18 and DPN68 Models
This short paper describes our contribution to the LNDb - Grand Challenge on automatic lung cance... more This short paper describes our contribution to the LNDb - Grand Challenge on automatic lung cancer patient management [1]. We only participated in Sub-Challenge A: Nodule Detection. The officially stated goal of this challenge is From chest CT scans, participants must detect pulmonary nodules. We developed a computer-aided detection (CAD) system for the identification of small pulmonary nodules in screening CT scans. The two main modules of our system consist of a CNN based nodule candidate detection, and a neural classifier for false positive reduction. The preliminary results obtained on the challenge database is discussed.
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