bluuebunny/crossref_metadata_2025_split huggingface dataset:
Novel Dose Escalation Approaches for Stereotactic Body Radiotherapy to Adrenal Oligometastases
Authors: Figura Nicholas B. , Oliver Daniel E. , Mohammadi Homan , Martinez Kaylee , Grass George D. , Hoffe Sarah E. , Johnstone Peter A.S. , Frakes Jessica M. 
Published: November 2019

Objectives:
The role of local disease control in the oligometastatic setting is evolving. Stereotactic body radiation therapy (SBRT) is a noninvasive treatment option for oligometastases; however, using ablative radiation doses for adrenal metastases raises concern given the proximity to radiosensitive organs. Novel treatment techniques may allow for selective dose escalation to improve local control (LC) while minimizing dose to nearby critical structures.

Materials and Methods:
We retrospectively reviewed patients with adrenal oligometastases treated with SBRT from 2013 to 2018. LC, disease-free survival, and overall survival were estimated using Kaplan-Meier methods. Predictors of outcomes were evaluated by log-rank and Cox proportional hazard analyses.

Results:
We identified 45 adrenal oligometastases in 41 patients treated with SBRT. The median age at treatment was 67 years (range, 40 to 80). The most common primary histologies were non–small cell lung cancer (51%), renal cell carcinoma (24%), and small cell lung cancer (10%). The median prescription dose was 50 Gy (range, 25 to 60 Gy), with 30 (67%) lesions receiving ≥50 Gy and 14 (31%) receiving 60 Gy. In total, 26 (58%) lesions received a simultaneous-integrated boost. Of the 42 treatment simulations, 26 (62%) were supine, 5 (12%) prone, and 11 (26%) in the left lateral decubitus position. At a median follow-up of 10.5 months, there were 3 local failures with a 12-month LC rate of 96%.

Conclusions:
Adrenal SBRT for oligometastatic disease is a feasible, noninvasive option with excellent LC and minimal toxicity. Lesions in close proximity to radiosensitive organs may benefit from dynamic patient positioning and selective simultaneous-integrated boost techniques to allow for dose escalation, while also limiting toxicity risks.
Tumor Deposits in Stage III Colon Cancer
Authors: Pricolo Victor E. , Steingrimsson Jon , McDuffie Tracey J. , McHale Joshua M. , McMillen Brian , Shparber Mark 
Published: November 2019

Objectives:National Comprehensive Cancer Network (NCCN) guidelines for stage III colon cancer define low-risk versus high-risk patients based on T (1 to 3 vs. 4) and N (1 vs. 2) status, with some variations in treatment. This study analyzes the impact of tumor deposits (TDs), T and N status, poor differentiation (PD), perineural invasion (PNI), and lymphovascular invasion (LVI) on survival.Materials and Methods:A retrospective analysis (2010-2015) of the National Cancer Database of stage III colon cancer patients treated with both surgery and chemotherapy was conducted. Data was extracted on sex, race, age at diagnosis, Charlson-Deyo Score, histopathologic variables, and survival rates. Statistical analysis used the test of proportions, log-rank test for Kaplan-Meier curves, and Cox proportional hazard models.Results:For the 42,901 patients analyzed, 5-year survival rates were similar for LN+TD−(59.8%) and LN−TD+(58.2%), but significantly worse for LN+TD+(41.5%) (P<0.001). The presence of LN+TD+was more often associated with T4 (36.9%), N2 (55.1%), PD+(37.4%), PNI+(34.5%), and LVI+(69.1%), than LN+TD−or LN−TD+(P<0.001). The hazard ratios for each variable were: TD: 1.34; T4: 1.71; N2: 1.44; PD+: 1.37; PNI: 1.11; LVI+: 1.18. LN−patients with ≥3 TD+(N1c) had worse overall survival than those with 1 to 2 TD+(P<0.01), but similar to ≥4 LN+TD−(N2) and 1 to 3 LN+TD+(N1a-b). In our model, 5-year survival ranged from 23.4% for high-risk to 78.1% for low-risk patients (P<0.001).Conclusion:This National Cancer Database (NCDB) analysis offers greater risk stratification and may prompt consideration of changes in American Joint Committee on Cancer (AJCC) classification (N2c, in addition to N1c) to reflect the different prognosis and guide management, as well as survivorship strategies, for TD+stage III colon cancer patients.
Elderly Patients Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion May Have Similar Clinical Outcomes, Perioperative Complications, and Fusion Rates As Their Younger Counterparts
Authors: Goh Graham Seow-Hng , Tay You Wei Adriel , Liow Ming Han Lincoln , Gatot Cheryl , Ling Zhixing Marcus , Fong Poh Ling , Soh Reuben Chee Cheong , Guo Chang Ming , Yue Wai-Mun , Tan Seang-Beng , Chen John Li-Tat 
Published: November 2019

Abstract

Background
Although several studies have suggested that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) may be especially beneficial in the elderly population due to lower operative morbidity and faster postoperative recovery, there are limited studies investigating the functional outcomes, quality of life, and satisfaction in elderly patients after MIS-TLIF. Furthermore, existing studies had substantial clinical, diagnostic, and surgical heterogeneity.

Questions/purposes
We asked if elderly patients could experience comparable (1) patient-reported pain, disability and quality of life, (2) perioperative complications, and (3) radiological fusion rates as their younger counterparts after MIS-TLIF.

Methods
Prospectively collected registry data of patients undergoing primary, single-level, MIS-TLIF for degenerative spondylolisthesis between 2012 and 2014 were reviewed. We included 168 patients, 39 of whom were at least 70 years old. Of the 129 patients younger than 70 years old, propensity-score matching was used to select 39 younger controls with adjustment for sex, BMI, American Society of Anesthesiologists score, and baseline clinical outcomes. Perioperative complications and radiologic data were compared.

Results
There was no difference in back pain (mean difference -0.3 [95% confidence interval -1.0 to 0.5]; p = 0.52); leg pain (mean difference -0.1 [95% CI to 0.6-0.5]; p = 0.85); Oswestry Disability Index (mean difference -2.9 [95% CI -8.0 to 2.2]; p = 0.26); and SF-36 physical (mean difference 3.0 [95% CI -0.7 to 6.8]; p = 0.107); and mental component summary (mean difference 1.9 [95% CI -4.5 to 8.2]; p = 0.56); up to 2 years postoperatively; 85% of younger patients and 85% of elderly patients were satisfied (p > 0.99) while 87% and 80%, respectively, had fulfilled expectations (p = 0.36). Four perioperative adverse events occurred in each group. There was also no difference in the rate of fusion (87% in younger patients and 90% in elderly patients; p = 0.135).

Conclusions
When clinical and surgical heterogeneity were minimized, elderly patients undergoing minimally invasive transforaminal lumbar interbody fusion not only had comparable rates of perioperative complications but also experienced similar improvements in pain, function, and quality of life. A high rate of satisfaction was achieved.

Level of Evidence
Level II, prognostic study.
Unilateral Periocular Intralymphatic Histiocytosis, Associated With Rosacea (Morbihan Disease)
Authors: Belousova Irena E. , Kastnerova Liubov , Khairutdinov Vladislav R. , Kazakov Dmitry V. 
Published: November 2019

Abstract:
Intralymphatic histiocytosis is a rare reactive skin condition characterized by a nonspecific clinical presentation and, microscopically, by the collections of mononuclear histiocytes within the lumina of dilated lymphatic vessels. We report a rare case of intralymphatic histiocytosis associated with rosacea and prominent periocular edema (Morbihan disease). The patient is a 56-year-old woman with a 12-year history of rosacea who suddenly developed edema of the right upper eyelid that persisted 6 months before she sought medical advice. Because of an unclear clinical diagnosis, surgical excision of the edematous upper eyelid was performed. The histologic slides showed interstitial edema of the dermis with dilated vascular channels and small epithelioid cell granulomas around hair follicles. In addition, there were aggregates of cells inside numerous lymphatic vessels that were immunohistochemically positive for CD45, CD4, CD68, CD163, CD64, CD14, CD11c, and lysozyme and negative for CD3, CD20, CD30, CD56, S100, CD1a, and langerin.
A Changing World Demands Care That Takes a Consumer-Centric Approach
Authors: Robinson Edmondo 
Published: November 2019

SUMMARY

Consumerism is a buzzword in healthcare. Consumers expect personalized healthcare journeys, a standard consistent with their interactions in other industries. The opportunity to build consumer-focused approaches to healthcare has emboldened disruptors, investors, and innovative incumbents alike. A consumerism strategy embraces the concepts of convenience, access, and transparency. Digital tools and technologies are an important accelerant in the move to healthcare consumerism; leveraging data to create value from the customer’s perspective is another critical component.
In the face of increasing competition, regulatory challenges, and cost pressures, healthcare must work to engage and empower the consumer. CEOs must initiate and champion the shift to consumerism in their own organizations. The barriers to organizational transformation in this regard are similar to those associated with any other enterprise change initiative; addressing people, processes, and culture is essential to laying the groundwork for innovation. Healthcare consumers see impressive technological solutions, and they understand that these new technologies can improve both their medical experiences and their overall health.
Risk of new-onset autoimmune diseases in primary aldosteronism: a nation-wide population-based study
Authors: Er Leay Kiaw , Chen Likwang , Tsai Yao-Chou , Lin Yen-Hung , Huang Wei-Chieh , Chang Chin-Chen , Lu Ching-Chu , Huang Kuo-How , Chueh Jeff S. , Wu Kwan-Dun , Wu Vin-Cent 
Published: November 2019

Objective:
The association between hyperaldosteronism and autoimmune disorders has been postulated. However, long-term incidence of a variety of new-onset autoimmune diseases (NOAD) among patients with primary aldosteronism has not been well investigated.

Methods:
From Taiwan's National Health Insurance Research Database with a 23-million population insurance registry, the identification of primary aldosteronism, essential hypertension and NOAD as well as all-cause mortality were ascertained by a validated algorithm.

Results:
From 1997 to 2009, 2319 primary aldosteronism patients without previously autoimmune disease were identified and propensity score-matched with 9276 patients with essential hypertension. Among those primary aldosteronism patients, 806 patients with aldosterone-producing adenomas (APA) were identified and matched with 3224 essential hypertension controls. NOAD incidence is augmented in primary aldosteronism patients compared with its matched essential hypertension (hazard ratio 3.82, P < 0.001, versus essential hypertension). Furthermore, NOAD incidence is also higher in APA patients compared with its matched essential hypertension (hazard ratio = 2.96, P < 0.001, versus essential hypertension). However, after a mean 8.9 years of follow-up, primary aldosteronism patients who underwent adrenalectomy (hazard ratio = 3.10, P < 0.001, versus essential hypertension) and took mineralocorticoid receptor antagonist (MRA) still had increased NOAD incidence (hazard ratio = 4.04, P < 0.001, versus essential hypertension).

Conclusion:
Primary aldosteronism patients had an augmented risk for a variety of incident NOAD and all-cause of mortality, compared with matched essential hypertension controls. Notably, the risk of incident NOAD remained increased in patients treated by adrenalectomy or MRA compared with matched essential hypertension controls. This observation supports the theory of primary aldosteronism being associated with a higher risk of multiple autoimmune diseases.
Angle Anatomy and Glaucoma in Patients With Boston Keratoprosthesis
Authors: Nascimento e Silva Rafaella , Taniguchi Elise V. , Cruzat Andrea , Paschalis Eleftherios I. , Pasquale Louis R. , Colby Kathryn A. , Dohlman Claes H. , Chodosh James , Shen Lucy Q. 
Published: November 2019

Purpose:
To quantitatively analyze the angle anatomy in eyes with a Boston type 1 keratoprosthesis (KPro) using anterior segment optical coherence tomography (AS-OCT) and to assess the diagnostic ability of AS-OCT in KPro-associated glaucoma.

Methods:
AS-OCT (RTVue) images from KPro eyes with and without glaucoma were reviewed. The angle opening distance at 500 μm from the scleral spur (AOD500), trabecular–iris angle at 500 μm from the scleral spur (TIA500), and trabecular–iris surface area at 500 μm from the scleral spur (TISA500) were measured by 2 observers masked to the diagnosis. The measurements for each visible quadrant were compared between KPro eyes with and without glaucoma.

Results:
Twenty-two eyes with glaucoma and 17 eyes without glaucoma from 39 patients with KPro were included. Of the 4 quadrants imaged, the temporal angle was the most visible (79.5%) and angle measurements of the temporal quadrant were the only ones that differentiated the 2 groups: the mean AOD500, TIA500, and TISA500 were significantly lower in KPro eyes with glaucoma than without glaucoma (388.2 ± 234.4 μm vs. 624.5 ± 310.5 μm, P = 0.02; 26.1 ± 14.0 degrees vs. 39.1 ± 17.1 degrees, P = 0.03; and 0.15 ± 0.09 mm2 vs. 0.23 ± 0.12 mm2, P = 0.03; respectively). The highest area under the receiver operating characteristic curve for detecting glaucoma was 0.75 for temporal TIA500 (95% confidence interval 0.57–0.94, P = 0.02) with 50% specificity at 80% of sensitivity and a cutoff value of 37 degrees.

Conclusions:
The temporal angle was the most visible on AS-OCT in eyes with a KPro. Significant narrowing of the temporal angle detected on AS-OCT was associated with glaucoma in these eyes.
Changes in Distribution of Dry Eye Diagnostic Status Among Visual Display Terminal Workers According to the Revised Criteria of the Asia Dry Eye Society
Authors: Yamanishi Ryutaro , Uchino Miki , Uchino Yuichi , Kawashima Motoko , Dogru Murat , Yokoi Norihiko , Tsubota Kazuo 
Published: November 2019

Purpose:
The present study aimed to compare the prevalence of dry eye disease (DED) among visual display terminal users using the revised and previous DED criteria.

Methods:
This cross-sectional study included 561 participants (187 women).

Results:
The distribution of diagnostic status according to the previous DED criteria was as follows: definite DED (n = 65, 11.6%), probable DED (n = 303, 54.0%), and non-DED (n = 193, 34.4%). According to the revised criteria, 329 participants (58.6%) were classified as DED and 232 participants (41.4%) were classified as non-DED.

Conclusions:
The prevalence of DED among visual display terminal users has increased to 58.6% from 11.6%, according to the revised DED diagnostic criteria of the Asia Dry Eye Society.
Relationship Between Foveal Threshold and Macular Structure/Function/Vessel Density in Glaucoma
Authors: Jeong Daun , Won Hun Jae , Jo Youn Hye , Song Min Kyung , Shin Joong Won , Kook Michael S. 
Published: November 2019

Purpose:
To investigate the hypothesis that macular structure, function, and vessel density (VD) measurements can predict foveal threshold (FT) outcomes in glaucomatous eyes.

Materials and Methods:
One hundred ninety-five eyes from 195 subjects (134 subjects with early-to-moderate stage open-angle glaucoma and 61 healthy controls) who underwent optical coherence tomography angiography imaging and 24-2 visual field (VF) testing with FT measurements on the same day were retrospectively enrolled in this study. The association of FT with macular structural/functional/VD measurements was evaluated using partial correlation analyses with adjustment for age and linear regression analyses.

Results:
FT showed significant correlations between the thickness of the macular ganglion cell-inner plexiform layer (mGCIPL) (r=0.330, P<0.001) and the mean sensitivity (MS) of the central 5 and 10 degrees VF points (r=0.448, P<0.001 and r=0.361, P<0.001). Significant correlations were also found between FT and VD measurements at the inferior and superior parafoveal sectors (r=0.455, P<0.001 and r=0.438, P<0.001). In multivariate linear regression analyses controlling the covariates, the thickness of the mGCIPL, central 5 degrees VF MS, and parafoveal VD were significantly associated with FT (all P<0.001). There was also a significant association between FT and logMAR best-corrected visual acuity (β=−5.647, P<0.001).

Conclusions:
Macular VD along with mGCIPL thickness and central 5 degrees VF MS independently predict FT outcomes even in the eyes of patients with early-to-moderate stage open-angle glaucoma.
Reducing the use of opioids by patients with chronic pain: an effectiveness study with long-term follow-up
Authors: Nicholas Michael K. , Asghari Ali , Sharpe Louise , Beeston Lee , Brooker Charles , Glare Paul , Martin Rebecca , Molloy Allan , Wrigley Paul J. 
Published: November 2019

Abstract
This study addresses the problem of long-term opioid use by chronic pain patients. The study involved a secondary analysis of unanalyzed data from a published study of 2 versions of cognitive-behavioural therapy-based interdisciplinary treatment for chronic pain. In this study, we examined whether the use of opioids by 140 chronic pain patients could be ceased sustainably over 12 months after participation in the comprehensive interdisciplinary pain management program aimed at enhancing pain self-management. On admission to the treatment, there were no significant differences between those patients taking or not taking opioids on usual pain, pain interference in daily activities, pain-related disability, depression severity, as well as in pain cognitions. After the treatment, the use of opioids was significantly reduced, both in numbers taking any and in mean doses, and these gains were maintained over the 12-month follow-up. Finally, cessation of opioids during treatment was associated with more substantial and consistent improvements in usual pain, depression severity, pain interference, pain-related disability, and pain cognitions, relative to those who reduced their opioids but did not cease them. These findings support the idea of using training in pain self-management strategies as a viable alternative to long-term opioid use by patients with chronic pain.
Evaluating a Fall Risk Assessment Tool in an Emergency Department
Authors: Luo Shuhong , Kalman Melanie , Haines Pamela 
Published: November 2019

ABSTRACT

Introduction:
A hospital's emergency department (ED) used the Johns Hopkins fall risk assessment tool (JHFRAT), which was not developed to assess the ED patients. The ED committee recommended the memorial ED fall risk assessment tool (MEDFRAT) plus a “nursing judgment” category. However, the modified MEDFRAT needed to be evaluated before implementation. This research evaluated the modified MEDFRAT in ED patients and nurses' perception of the tool.

Methods:
A two-stage quantitative design was used. Stage 1 was a chart review using both tools for patients who fell (n = 57) in the past 4 years and the control patients (n = 57). Two tools were compared using t-tests, Bland–Altman, predictive abilities, and mismatch rates. Stage 2 was the assessment of all ED patients (n = 435) seen by the ED triage nurses for 1 week using both tools. The chi-squared test and mismatch rates were used to compare the tools. Time to complete both tools and nurses' perceptions to the modified MEDFRAT were analyzed.

Results:
Two tools were significantly different. The modified MEDFRAT had higher predictive ability and lower mismatch rates than the JHFRAT. It needed shorter time to complete and was preferred by most nurses.

Conclusions:
The modified MEDFRAT is adequate to use in the ED.
Inflationary noninvasive blood pressure measurement reduces the incidence of subcutaneous hemorrhage
Authors: Nukita Shizuko , Nakano Sumie , Morimoto Yasuhiro , Shiramoto Hiroko 
Published: November 2019

Objective
We verified the hypothesis that in noninvasive blood pressure (NIBP) measurement, inflationary NIBP measurement using the new type of cuff (YP-71xT series, Nihon Koden, Tokyo, Japan) might be associated with a reduced risk of subcutaneous hemorrhage.

Methods
The study involved 30 healthy volunteers (15 males and 15 females). The blood pressure was measured by deflationary NIBP measurement + conventional cuff (control group), deflationary NIBP measurement + cuff (YP-71xT series) (deflationary measurement group), or inflationary NIBP measurement + cuff (YP-71xT series) (inflationary measurement group). NIBP measurement was performed five times in a row, then the presence or of subcutaneous hemorrhage was evaluated. The three different methods were used as cross-over design at 1-week interval for each subject so that all three methods were used for all the subjects.

Results
The measurement time was significantly shorter in the inflationary measurement group than other groups. The incidence of subcutaneous hemorrhage significantly was lower in the inflationary measurement group (3%) than in control group (53%) (P < 0.001) and the deflationary measurement group (37%) (P = 0.002).

Conclusion
This study revealed that inflationary NIBP measurement was associated with a dramatically reduced incidence of subcutaneous hemorrhage. Synergistic effect of the newly designed cuff, short measurement time, and low inflation pressure may allow the risk of subcutaneous hemorrhage.
Techniques to monitor respiratory drive and inspiratory effort
Authors: Telias Irene , Spadaro Savino 
Published: November 2019

Purpose of review
There is increased awareness that derangements of respiratory drive and inspiratory effort are frequent and can result in lung and diaphragm injury together with dyspnea and sleep disturbances. This review aims to describe available techniques to monitor drive and effort.

Recent findings
Measuring drive and effort is necessary to quantify risk and implement strategies to minimize lung and the diaphragm injury by modifying sedation and ventilation. Evidence on the efficacy of such strategies is yet to be elucidated, but physiological and epidemiological data support the need to avoid injurious patterns of breathing effort.
Some techniques have been used in research for decades (e.g., esophageal pressure or airway occlusion pressure), evidence on their practical utility is growing, and technical advances have eased implementation. More novel techniques (e.g., electrical activity of the diaphragm and ultrasound) are being investigated providing new insights on their use and interpretation.

Summary
Available techniques provide reliable measures of the intensity and timing of drive and effort. Simple, noninvasive techniques might be implemented in most patients and the more invasive or time-consuming in more complex patients at higher risk. We encourage clinicians to become familiar with technical details and physiological rationale of each for optimal implementation.