bluuebunny/crossref_metadata_2025_split huggingface dataset:
Total Neoadjuvant Treatment for Rectal Cancer: Preliminary Experience
Authors: Gilshtein Hayim , Ghuman Amandeep , Dawoud Mirelle , Yellinek Shlomo , Kent Ilan , Sharp Stephen P. , Nagarajan Arun , Wexner Steven D. 
Published: November 2020

Introduction Administration of chemotherapeutic regimens such as FOLFOX or CAPEOX with chemoradiation in the neoadjuvant setting, termed total neoadjuvant treatment (TNT), was introduced in recent years. By increasing the complete pathologic and clinical responses, patients with locally advanced rectal cancer may have better oncologic outcomes and potentially abstain from undergoing a proctectomy. Methods All patients who underwent TNT at a single National Accreditation Program for Rectal Cancer accredited referral center were included. A retrospective analysis was performed using a computerized Institutional Review Board-approved database. Patient demographics, diagnostic workup, treatment regimens, and surgical and pathological reports were reviewed. Complete pathological response was the primary outcome. Univariable and multivariable logistic regression analyses were performed to identify potential factors predisposing to complete pathological response. Results Thirty patients met the inclusion criteria, 14(46.6%) of whom had complete pathologic response. There was no difference in baseline demographic characteristics between patients who achieved complete pathological response and those who did not. Pathology revealed a 92% intact mesorectum rate in the complete pathologic response group and a mean of 24 harvested lymph nodes in the entire study cohort. Both univariable and multivariable logistic regression analyses failed to demonstrate statistically significant factors predicting complete pathologic response, magnetic resonance imaging (MRI) tumor size, and posttreatment MRI lymph node positivity. Conclusion TNT is safe and efficient for patients with locally advanced rectal cancer. It increases complete pathological and clinical response rates and may more widely evolve to be the treatment of choice in this group of patients in the near future.
Prehabilitation for Hepatopancreatobiliary Surgical Patients: Interim Analysis Demonstrates a Protective Effect From Neoadjuvant Chemotherapy and Improvement in the Frailty Phenotype
Authors: Baimas-George Maria , Watson Michael , Thompson Kyle , Shastry Vivek , Iannitti David , Martinie John B. , Baker Erin , Parala-Metz Armida , Vrochides Dionisios 
Published: November 2020

Background Prehabilitation encompasses multidisciplinary interventions to improve health and lessen incidence of surgical deterioration by reducing physiologic stress and functional decline. This study presents an interim analysis to demonstrate prehabilitation for hepatopancreatobiliary (HPB) surgical patients. Methods In 2018, a structured prehabilitation pilot program was implemented. Eligibility required HPB malignancy, neoadjuvant chemotherapy, and residence within hour drive. Patients were enrolled into the 4-month program. The fitness component was composed of timed up and go test and grip strength with exercise recommendations. Nutrition involved evaluation of sarcopenic obesity, glucose management, and smoking and alcohol counseling. Psychological services included psychosocial assessments and advanced care planning, with social work referrals. Component were evaluated monthly by a physician using laboratory results, nutritional data and questionnaires, psychological assessments, and validated fitness tests. Nurse navigators spoke with patients weekly to monitor compliance. Results At 12 months, nineteen patients were enrolled. Ten completed prehabilitation, neoadjuvant chemotherapy and underwent their surgical procedure. There were no differences found after prehabilitation in functional status, physical performance, psychosocial assessments, or nutrition. Frailty, as assessed by Fried frailty criteria, improved significantly after prehabilitation ( P < .0001). Symptom severity and laboratory values did not change. Length of stay was 6.5 days and all patients were discharged to home. There was 1 readmission for transient ischemic attack and 90-day mortality rate was 0%. Discussion Prehabilitation to improve recovery is a promising concept encompassing a wide array of multidisciplinary assessments and interventions. It may demonstrate a protective effect on physiologic decline from chemotherapy and may reverse frailty phenotypes.
Brachial Plexus Injury Significantly Increases Risk of Axillosubclavian Vessel Injury in Blunt Trauma Patients With Clavicle Fractures
Authors: Tay Erika , Grigorian Areg , Schubl Sebastian D. , Lekawa Michael , de Virgilio Christian , Scolaro John , Kabutey Nii-Kabu , Nahmias Jeffry 
Published: November 2020

Background A national analysis of clavicle fractures is lacking and the risk of concomitant axillosubclavian vessel injury (ASVI) in patients with clavicle fractures is unknown. A minority of patients may have a combined brachial plexus injury (BPI). We sought to describe risk factors for concomitant ASVI in patients with a clavicle fracture; hypothesizing patients with combined clavicle fracture and BPI has a higher risk of ASVI. Methods The Trauma Quality Improvement Program (2010-2016) was queried for blunt trauma patients with a clavicle fracture. A multivariable logistic regression model was used to determine risk factors for ASVI. A subset analysis on patients with isolated clavicle fractures was additionally performed. Results From 59 198 patients with clavicle fractures, 341 (.6%) had concomitant ASVI. Compared to patients without ASVI, patients with ASVI had a higher median injury severity score (24 vs. 17, P < .001) and rates of pulmonary contusions (43.4% vs. 37.7%, P = .029) and BPI (18.2% vs. .4%, P < .001). After controlling for associated chest wall injuries and humerus fracture, the BPI odds ratio (OR 49.17, 35.59-67.92, P < .001) was independently associated with risk for ASVI. In a subset analysis of isolated clavicle fractures, BPI remained associated with risk of ASVI (OR 60.01, confidence intervals 25.29-142.39, P < .001). Conclusion The rate of concomitant ASVI in patients with a clavicle fracture is <1%. Patients presenting with a clavicle fracture had a high rate of injuries including pulmonary contusion. Patients with findings suggestive of underlying BPI had a nearly 50 times increased associated risk of ASVI. Thus, a detailed physical exam in this setting including brachial-brachial index appears warranted.
Adenoid Cystic Carcinoma of the Larynx: A SEER Database Review
Authors: Mur Taha , Jaleel Zaroug , Agarwal Pratima , Edwards Heather A. 
Published: November 2020

Background: Adenoid cystic carcinoma (AdCC) of the larynx is an uncommon malignancy of the head and neck with very little literature discussing treatment paradigms and prognostic factors influencing survival. Methods: This retrospective cohort study uses data obtained from the Surveillance, Epidemiology and End Result database comprising of patients diagnosed with laryngeal AdCC from 1978 to 2016. Results: A total of 89 records were analyzed. High histologic grade was a significant negative prognostic factor compared to low histologic grade disease for overall survival (OS; 5-year OS: 35.7% vs 90.5%, P < .005) and disease-specific survival (DSS; 5-year DSS: 38.7% vs 95.2%, P < .005). No differences in OS (5-year OS: 88.9% vs 76.4%, P = .287) or DSS (5-year DSS: 100% vs 79.1%, P = .159) were noted between patients with early versus late American Joint Committee on Cancer (AJCC) stage disease. No differences in DSS was noted in cohorts treated with just definitive surgery versus surgery and adjuvant radiation (5-year DSS: 92.9% vs 74.3%, P = .140) even when stratified for late stage disease (5-year DSS: 100% vs 78.6%, P = .290) or high-grade histology (5-year DSS: 100% vs 83.3%, P = .773). Conclusions: Histologic grade may be a more significant prognostic factor than AJCC stage for survival in laryngeal AdCC. Treatment with surgery and radiation may provide no additional survival advantage compared to just definitive surgery in these patients, although further study is warranted.
Translation and Validation of the Facial Clinimetric Evaluation Scale to Spanish
Authors: Garcia‐Iza Leire , Chiesa‐Estomba Carlos Miguel , Rosell‐Romero Nuria , Ibarguren‐Esnal Eneritz , Soriano‐Reixach Maria , Rivera‐Schmitz Teresa , Altuna Xabier , Gonzalez‐García Jose Angel 
Published: November 2020

ObjectivePeripheral facial palsy is a disabling condition; thus, assessing its impact on quality of life is one of the greatest challenges within this discipline. The Facial Clinimetric Evaluation (FaCE) Scale has been validated for this purpose. The aim of this study is to translate and validate the Spanish version of the FaCE Scale.Study DesignWe performed a forward‐backward translation of the original English FaCE Scale. A pilot test and a posterior prospective validation study were performed.SettingA pilot test and a posterior prospective validation study were conducted in a specialized facial palsy unit in a tertiary hospital.MethodsA validation study was carried out in 85 patients to calculate the scale’s internal consistency and validity and to compare outcomes with the Sunnybrook Facial Grading System and the Facial Disability Index (FDI).ResultsInternal consistency was evaluated by Cronbach’s α coefficient, which showed a value of 0.841 (95% CI, 0.786‐0.886). The total FaCE Scale score correlates well with the Sunnybrook, FDI physical function, and FDI social/well‐being function scores: r = 0.773, r = 0.883, and r = 0.523, respectively. The FDI social/well‐being function has the highest correlation with the FaCE Scale social function domain (r = 0.595).ConclusionThe Spanish version of the FaCE Scale demonstrated a high psychometric property that allows it to be used for clinical practice to assess the quality of life of Spanish‐speaking patients with peripheral facial palsy.
Comparison between video-lighted stylet (Intular Scope™) and direct laryngoscope for endotracheal intubation in patients with normal airway
Authors: Lee Ji Yeon , Hur Ho Jin , Park Hee Yeon , Jung Wol Seon , Kim Jiro , Kwak Hyun Jeong 
Published: November 2020

Objective The Intular Scope™ (Medical Park, South Korea) (IS) is a video-lighted stylet that can be used for endotracheal intubation with excellent visualization by adding a camera to its end. We compared the efficacy of a direct laryngoscope (DL) with that of the IS based on hemodynamic changes, ease of intubation, and postoperative airway morbidities. Methods Seventy patients with expected normal airways were randomized for intubation using an IS (n = 35) or DL (n = 35). The primary outcome was the mean arterial pressure during intubation. The secondary outcomes were the time to intubation (TTI), percentage of glottic opening (POGO) score, and number of intubation attempts. The incidence and severity of bleeding, hoarseness, and sore throat after intubation were also recorded. Results Hemodynamic changes during intubation were not significantly different between the groups. The TTI was longer in the IS than DL group. The POGO score was higher in the IS than DL group. Hoarseness and sore throat were significantly less severe in the IS than DL group. Conclusions Using the IS did not significantly improve hemodynamics and resulted in a longer TTI. However, the IS was associated with less severe postoperative airway morbidities compared with the DL.
Assessment of Enamel Demineralization Adjacent to Orthodontic Brackets Using a Polarized Microscope
Authors: Ramegowda Santosh , Joy Shilpa , Gowda Nishitha C , AM Shailaja , Reddy Bharath , Goel Anmol 
Published: November 2020

Background and Objectives: This study was conducted to assess the effect of light-curable fluoride varnish on enamel demineralization adjacent to orthodontic brackets using polarized light microscopy and to compare the depth of demineralization at different time periods. Method: In 15 patients, the first premolars were allocated into 2 groups. In the experimental group light-curable fluoride varnish was applied. At the end of each time period (60, 90, and 120 days), first premolar brackets were debonded and premolars were extracted. Buccolingual sections were evaluated under a polarized light microscope and depth of demineralization was assessed. Results: The depth of demineralization in the control group increased from 60 to 120 days, and the experimental group did not show any significant difference during the time period. Conclusion: Single application of light-curable fluoride varnish, Clinpro XT can be effective in reducing enamel demineralization during fixed orthodontic mechanotherapy, especially in noncompliant patients.
Association between sources of stress and depressive mood in Korean adults
Authors: Hwang In Cheol , Ahn Hong Yup 
Published: November 2020

Objective: The present study investigated the association between different sources of stress and depressive mood in Korean adults. Methods: A total of 4464 adults who completed the 2018 Korean National Health and Nutrition Examination Survey were included in the analysis. Data included sources of stress, depressive mood assessed by the nine-item Patient Health Questionnaire, sociodemographic characteristics, and health-related habits. Multiple logistic regression models were applied to calculate the odds ratio for depressive mood according to each source of stress and stratified by sex and age. Results: Fully adjusted models revealed that individuals who reported a financial problem or health concern as their main source of stress were more likely to experience depressive mood; when data were stratified by sex, these associations remained significant among females only. An age-stratified analysis indicated that financial problems were associated with depressive mood in middle-aged individuals and health concerns were associated with depressive mood in elderly. Conclusion: Korean adults with specific sources of stress should be monitored for the development of emotional distress.
Impact of baseline COPD symptom severity on the benefit from dual versus mono-bronchodilators: an analysis of the EMAX randomised controlled trial
Authors: Vogelmeier Claus F. , Kerwin Edward M. , Bjermer Leif H. , Tombs Lee , Jones Paul W. , Boucot Isabelle H. , Naya Ian P. , Lipson David A. , Compton Chris , Barnes Neil , Maltais François 
Published: November 2020

Rationale: Symptom relief is a key treatment goal in patients with chronic obstructive pulmonary disease (COPD). However, there are limited data available on the response to bronchodilator therapy in patients at low risk of exacerbations with different levels of symptom severity. This study compared treatment responses in patients with a range of symptom severities as indicated by baseline COPD assessment test (CAT) scores. Methods: The 24-week EMAX trial evaluated the benefits of umeclidinium/vilanterol versus umeclidinium or salmeterol in symptomatic patients at low exacerbation risk who were not receiving inhaled corticosteroids. This analysis assessed lung function, symptoms, health status, and short-term deterioration outcomes in subgroups defined by a baseline CAT score [<20 ( post hoc) and ⩾20 (pre-specified)]. Outcomes were also assessed using post hoc fractional polynomial modelling with continuous transformations of baseline CAT score covariates. Results: Of the intent-to-treat population ( n = 2425), 56% and 44% had baseline CAT scores of <20 and ⩾20, respectively. Umeclidinium/vilanterol demonstrated favourable improvements compared with umeclidinium and salmeterol for the majority of outcomes irrespective of the baseline CAT score, with the greatest improvements generally observed in patients with CAT scores <20. Fractional polynomial analyses revealed consistent improvements in lung function, symptoms and reduction in rescue medication use with umeclidinium/vilanterol versus umeclidinium and salmeterol across a range of CAT scores, with the largest benefits seen in patients with CAT scores of approximately 10–21. Conclusions: Patients with symptomatic COPD benefit similarly from dual bronchodilator treatment with umeclidinium/vilanterol. Fractional polynomial analyses demonstrated the greatest treatment differences favouring dual therapy in patients with a CAT score <20, although benefits were seen up to scores of 30. This suggests that dual bronchodilation may be considered as initial therapy for patients across a broad range of symptom severities, not only those with severe symptoms (CAT ⩾20). Trial registration: NCT03034915, 2016-002513-22 (EudraCT number). The reviews of this paper are available via the supplemental material section.
The ‘patient voice’: patients who experience antidepressant withdrawal symptoms are often dismissed, or misdiagnosed with relapse, or a new medical condition
Authors: Guy Anne , Brown Marion , Lewis Stevie , Horowitz Mark 
Published: November 2020

Background: Stopping antidepressants commonly causes withdrawal symptoms, which can be severe and long-lasting. National Institute for Health and Care Excellence (NICE) guidance has been recently updated to reflect this; however, for many years withdrawal (discontinuation) symptoms were characterised as ‘usually mild and self-limiting over a week’. Consequently, withdrawal symptoms might have been misdiagnosed as relapse of an underlying condition, or new onset of another medical illness, but this has never been studied. Method: This paper outlines the themes emerging from 158 respondents to an open invitation to describe the experience of prescribed psychotropic medication withdrawal for petitions sent to British parliaments. The accounts include polypharmacy (mostly antidepressants and benzodiazepines) but we focus on antidepressants because of the relative lack of awareness about their withdrawal effects compared with benzodiazepines. Mixed method analysis was used, including a ‘lean thinking’ approach to evaluate common failure points. Results: The themes identified include: a lack of information given to patients about the risk of antidepressant withdrawal; doctors failing to recognise the symptoms of withdrawal; doctors being poorly informed about the best method of tapering prescribed medications; patients being diagnosed with relapse of the underlying condition or medical illnesses other than withdrawal; patients seeking advice outside of mainstream healthcare, including from online forums; and significant effects on functioning for those experiencing withdrawal. Discussion: Several points for improvement emerge: the need for updating of guidelines to help prescribers recognise antidepressant withdrawal symptoms and to improve informed consent processes; greater availability of non-pharmacological options for managing distress; greater availability of best practice for tapering medications such as antidepressants; and the vital importance of patient feedback. Although the patients captured in this analysis might represent medication withdrawal experiences that are more severe than average, they highlight the current inadequacy of health care systems to recognise and manage prescribed drug withdrawal, and patient feedback in general.
Inter and Intra-Rater Reliability of Using Computed Tomography to Assess Prosthesis Position Post Shoulder Arthroplasty
Authors: Kelly David A , Karamfiles Sharon J , Coward Jonathan C , Goebel Sven P 
Published: November 2020

Background Computer models and cadaveric studies have demonstrated that humeral version has a significant impact on the impingement, stability, and range of motion of the prosthetic shoulder joint. Computed tomography (CT) has been used to measure native humeral version, however the reliability of using CT to measure humeral version post reverse total shoulder replacement has not yet been established. Aims To investigate the inter and intra-rater reliability of using CT to assess the post-operative humeral version following shoulder arthroplasty. Methodology Patients underwent a limited CT scan of the operative limb; positioned and protocoled by one consultant radiologist on one machine. The humeral version of the prostheses was calculated individually by two experienced, board certified consultant radiologists. They were blinded to each other’s measurements. The humeral version was calculated using the epicondylar axis. Data Overall, 20 shoulders are included; 12 females (60%), and 10 left-sided (50%). The median anteversion was 0° (range 33° retroversion–27° anteversion; IQ 6.75° retroversion–4.75° anteversion). The inter-rater reliability was 0.985 (95% CI: 0.964–0.994). The intra-rater reliability for radiologist A was 0.988 (95% CI: 0.969–0.995), and the intra-rater reliability for radiologist B was 0.976 (95% CI: 0.942–0.991). Conclusion The use of post operative CT has excellent inter and intra-rater reliability in measuring humeral version following shoulder arthroplasty. This study will facilitate future research regarding impact of the humeral version on patient outcomes.
Handling challenging questions in the management of chronic myeloid leukemia: when is it safe to stop tyrosine kinase inhibitors?
Authors: Rea Delphine 
Published: November 2020

AbstractThe paradigm for managing patients with chronic myeloid leukemia is evolving. In the recent past, restoring a normal life expectancy while patients are receiving never-ending targeted therapy with BCR–ABL1 tyrosine kinase inhibitors through prevention of progression to blast phase and mitigation of iatrogenic risks was considered the best achievable outcome. Now, long-term treatment-free remission with continued response off tyrosine kinase inhibitor therapy is recognized as the most optimal benefit of treatment. Indeed, numerous independent clinical trials provided solid proof that tyrosine kinase inhibitor discontinuation was feasible in patients with deep and sustained molecular responses. This article discusses when tyrosine kinase inhibitors may be safely stopped in clinical practice on the basis of the best and latest available evidence.
Social deprivation in Scottish populations with pulmonary hypertension secondary to connective tissue disease and chronic thromboembolic disease
Authors: McGettrick Michael , McCaughey Paul , MacLellan Alexander , Brewis Melanie , Church A. Colin , Johnson Martin K. 
Published: November 2020

Socioeconomic factors have been shown to have an adverse impact on survival in some respiratory diseases. Studies from the USA and China have suggested worse survival in idiopathic pulmonary arterial hypertension in low socioeconomic groups. We looked at the effect of deprivation on the outcomes in patients with connective tissue disease-associated pulmonary hypertension (CTDPH) and chronic thromboembolic pulmonary hypertension (CTEPH) in a retrospective observational study.Data were obtained from 232 patients with CTDPH and 263 with CTEPH who were under the care of the Scottish Pulmonary Vascular Unit, Glasgow, UK. We used Cox proportional hazards regression to assess for a relationship between deprivation and survival.We found no difference in survival across deprivation quintiles in the CTDPH (p=0.26) or CTEPH cohorts (p=0.18). We constructed multivariate models using enrolment time, age, sex and body mass index, with no significant change in findings. There was no difference between expected and observed population distribution of CTDPH (p=0.98) and CTEPH (p=0.36). Whilst there was no difference in presenting functional class in the CTDPH group, the CTEPH patients in more deprived quintiles presented in a worse functional class (p=0.032). There was no difference between quintiles of CTEPH patients who had distal or proximal disease (p=0.75), or who underwent surgery (p=0.5).Increased social deprivation is not associated with worse survival in patients with CTDPH and CTEPH managed in the Scottish National Health Service. Whilst there is no evidence of referral barriers in CTDPH, this may not be the case in CTEPH, as lower deprivation was associated with worse functional class at presentation.