bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-Effectiveness Analysis of Upfront SBRT for Oligometastatic Stage IV Non–Small Cell Lung Cancer Based on Mutational Status
Authors: Kim Hayeon , Vargo John A. , Ling Diane C. , Beriwal Sushil , Smith Kenneth J. 
Published: October 2019

Objectives:
Current National Comprehensive Cancer Network (NCCN) guidelines support systemic therapy based on mutational status in stage IV non–small cell lung cancer (NSCLC), with stereotactic body radiation therapy (SBRT) reserved for oligoprogression. We aimed to evaluate the cost-effectiveness of the routine addition of SBRT to upfront therapy in stage IV NSCLC by mutational subgroup.

Materials and Methods:
A Markov state transition model was constructed to perform a cost-effectiveness analysis comparing SBRT plus maintenance therapy with maintenance therapy alone for oligometastatic NSCLC. Three hypothetical cohorts were analyzed: epidermal growth factor receptor or anaplastic lymphoma kinase mutation-positive, programmed death ligand-1 expressing, and mutation-negative group. Clinical parameters were obtained largely from clinical trial data, and cost data were based on 2018 Medicare reimbursement. Strategies were compared using the incremental cost-effectiveness ratio with effectiveness in quality-adjusted life years (QALYs) and evaluated with a willingness to pay threshold of $100,000 per QALY gained.

Results:
SBRT plus maintenance therapy was not cost-effective at a $100,000/QALY gained threshold, assuming the same survival for both treatments, resulting in an incremental cost effectiveness ratio of $564,186 and $299,248 per QALY gained for the epidermal growth factor receptor or anaplastic lymphoma kinase positive and programmed death ligand-1 positive cohorts, respectively. Results were most sensitive to the cost of maintenance therapy. A large overall survival gain with SBRT could potentially result in upfront SBRT becoming cost-effective. For the mutation-negative cohort, upfront SBRT was nearly cost-effective, costing $128,424 per QALY gained.

Conclusion:
Adding SBRT to maintenance therapy is not a cost-effective strategy for oligometastatic NSCLC compared with maintenance therapy alone for mutation-positive groups. However, this should be validated via randomized trials.
Role of Perioperative Chemotherapy in Lymph Node-negative Esophageal Cancer After Resection
Authors: Yang Yang , Zhou Xia , Tang Luoyong , Xu Xiaoling , Du Xianghui , Qiu Guoqin 
Published: October 2019

Background:
Multimodality treatment is increasingly accepted and becoming the standard care for local advanced esophageal cancer (EC) patients. However, for early stage lymph node-negative EC patients, surgery alone is still the primary treatment approach, and the role of perioperative chemotherapy remains unclear.

Methods:
Patients with lymph node-negative EC were identified from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2013. Survival was compared by the log-rank test. Cox proportional hazards analysis was used to identify covariates associated with overall survival (OS). Propensity score-matched analysis was also performed to control for confounding.

Results:
A total of 3071 patients (T1-4N0M0) were identified, 1363 (44.4%) of which received perioperative chemotherapy. The effect of chemotherapy on OS was remarkably dependent on the T stage. For stage T1 patients, chemotherapy was inversely associated with OS (hazard ratio [HR]=1.54; 95% confidence interval [CI], 1.27-1.86), and no impact of chemotherapy on OS was found for T2 patients (HR=0.92; 95% CI, 0.712-1.18), whereas a significant improvement in OS was observed with the addition of chemotherapy for patients with stages T3 (HR=0.52; 95% CI, 0.43-0.62) and T4 (HR=0.60; 95% CI, 0.36-0.98) disease. Multivariable analysis with demonstrated that chemotherapy usage, age, sex, tumor grade, and T stage (P<0.05) were significantly associated with OS in T3-T4 patients. The results were similar in subgroup analyses stratified by confounding covariates, and the propensity score-matched analysis.

Conclusions:
This population-based study indicates perioperative chemotherapy is associated with improved survival in stage T3-4N0M0 patients with EC, which needs to be further validated by randomized trials.
Suboptimal learning of tactile-spatial predictions in patients with complex regional pain syndrome
Authors: Brown Christopher A. , Scholtes Ingrid , Shenker Nicholas , Lee Michael C. 
Published: October 2019

Abstract
In complex regional pain syndrome (CRPS), tactile sensory deficits have motivated the therapeutic use of sensory discrimination training. However, the hierarchical organisation of the brain is such that low-level sensory processing can be dynamically influenced by higher-level knowledge, eg, knowledge learnt from statistical regularities in the environment. It is unknown whether the learning of such statistical regularities is impaired in CRPS. Here, we used a hierarchical Bayesian model of predictive coding to investigate statistical learning of tactile-spatial predictions in CRPS. Using a sensory change-detection task, we manipulated bottom-up (spatial displacement of a tactile stimulus) and top-down (probabilistic structure of occurrence) factors to estimate hierarchies of prediction and prediction error signals, as well as their respective precisions or reliability. Behavioural responses to spatial changes were influenced by both the magnitude of spatial displacement (bottom-up) and learnt probabilities of change (top-down). The Bayesian model revealed that patients' predictions (of spatial displacements) was found to be less precise, deviating further from the ideal (statistical optimality) compared with healthy controls. This imprecision was less context dependent, ie, more enduring across changes in the probabilistic context and less finely tuned to statistics of the environment. This caused greater precision on prediction errors, resulting in predictions that were driven more by momentary spatial changes and less by the history of spatial changes. These results suggest inefficiencies in higher-order statistical learning in CRPS. This may have implications for therapies based on sensory retraining whose effects may be more short-lived if success depends on higher-order learning.
Natural elimination of a video capsule after retention for 1 year in a patient with small bowel Crohn disease
Authors: Lee So Yeon , Lee Ju Yup , Lee Yoo Jin , Park Kyung Sik 
Published: October 2019

Abstract

Introduction:
Video capsule endoscopy (VCE) is a useful tool to differentiate small intestinal bleeding, inflammatory bowel disease, and other small bowel disease. The most common adverse effect of VCE is capsule retention; the incidence varies greatly depending on the underlying disease, which is known to increase from 1.5% in healthy individuals to 21% in patients with small bowel Crohn disease. We report this case on a patient who had asymptomatic capsule retention for 12 months and experienced natural elimination with medication.

Patient concerns:
A 21-year-old woman presented to the hospital with chronic abdominal pain and persistent diarrhea for 2 years.

Diagnoses:
The patient was diagnosed with small bowel Crohn disease using VCE, and radiography revealed capsule retention.

Intervention:
Symptoms of obstruction were not distinctive, it was decided to increase the dosages of azathioprine and infliximab to 50 and 500 mg (10 mg/kg), at 5 months after VCE. And at month 11 of capsule retention, she was admitted and started on a regimen of hydrocortisol 300 mg for 4 days and hydrocortisol injection 200 mg for 10 days.

Outcomes:
At month 12, abdominal radiography in the clinic confirmed that the capsule had been naturally retrieved.

Lessons:
Capsule retention could be initially treated conservatively with medication and if the treatment fails, it is recommended to remove the capsule surgically. But in the case of the clinical condition of the patient is favorable without symptoms of bowel obstruction, the medication should be continued and the patient followed up.
The effects of acupuncture on cognitive impairment of vascular dementia patients
Authors: Tang Yinshan , Shao Shujun , Zhou You , Xiong Bing , Cao Jin , Li Zhigang , Wu Jihong , Wang Chao 
Published: October 2019

Abstract

Background:
Vascular dementia (VaD) is the second prevalent dementia worldwide attributable to cognitive impairments. Acupuncture has been applied in clinic as a therapeutic modality to treat VaD. This systematic review and meta-analysis aims to evaluate current evidence to explore the effectiveness and safety of acupuncture treatment to cognitive impairment of VaD.

Methods:
Randomized controlled trials will be searched restricted to their inception from January 1, 2000 to September 15, 2019. The following literature databases will be searched, including 4 English databases: PubMed, Excerpta Medica Database, the Cochrane Library, Medline, and 4 Chinese databases, namely the China National Knowledge Infrastructure Database, the Wanfang Database, the Chinese Scientific Journal Database, and the Chinese BioMedical Literature Database. After the selection and extraction of eligible studies, a meta-analysis will be undertaken to assess the efficacy and safety of acupuncture on VaD. The Review Manager Software V.5.3.5 will be employed for meta-analysis to assess the risk of bias, data synthesis, and subgroup analysis.

Results:
The systematic review and meta-analysis will be carried out to evaluate the efficacy and safety of acupuncture in the treatment of VaD, further provide an evidence-based synthesis for clinical and research applications.

Conclusions:
The summary of our systematic review will determine whether acupuncture intervention to VaD is safe and well-tolerated in global status.
Familial hemophagocytic lymphohistiocytosis type 5 in a Chinese Tibetan patient caused by a novel compound heterozygous mutation in STXBP2
Authors: Tang Xue , Guo Xia , Li Qiang , Huang Zhuo 
Published: October 2019

Abstract

Rationale:
Familial hemophagocytic lymphohistiocytosis (FHL) is a fatal autosomal recessive immunodeficiency disease whose rapid and accurate diagnosis is paramount for appropriate treatment. Mutations in STXBP2 gene have been associated with FHL type 5 (FHL-5). Here, we report the first Tibetan Chinese patient diagnosed with FHL-5 caused by a novel compound heterozygous mutation in STXBP2.

Patient concerns:
A 9-year-old girl who presented with recurrent fever, splenomegaly, pancytopenia, hypofibrinogenemia, and conspicuous bone marrow hemophagocytosis was diagnosed with haemophagocytic lymphohistiocytosis (HLH).

Diagnosis:
FHL mutation analysis of the patient and her parents revealed that she presented compound heterozygosity for STXBP2: a novel missense mutation c.663G > C (p.Glu221Asp) and the known pathogenic splice-site mutation c.1247-1G > C (p.Val417LeufsX126). Bioinformatics analyses predicted that the new mutation was pathogenic and the FHL-5 diagnosis was confirmed.

Interventions:
Upon diagnosis, HLH-2004-directed chemotherapy was instituted, but there was a relapse. Allogeneic hematopoietic stem cell transplantation (HSCT) was performed.

Outcomes:
After transplantation, the patient presented implantation dysfunction, chronic graft-versus-host disease, and 5 episodes of pancreatitis. A follow-up after 5 years revealed that the patient had died of pancreatitis.

Lessons:
This finding expands the spectrum of FHL-5-related mutations in Chinese patients and indicates a clear genotype-phenotype correlation of FHL-5 in China.
Impact of circadian rhythms on female reproduction and infertility treatment success
Authors: Mills Jacqueline , Kuohung Wendy 
Published: October 2019

Purpose of review
In recent years, new studies have investigated the role and influence of sleep on female fertility and early pregnancy outcomes, providing a growing body of knowledge demonstrating how regulation by sleep of hormones are important to reproduction, and how disruptions in sleep, circadian rhythms, and genes regulating circadian rhythmicity can negatively impact fertility and early pregnancy outcomes. This review aims to summarize the most recent research on the relationship among circadian rhythms, fertility, and early pregnancy outcomes in women, and to explore possible fertility interventions.

Recent findings
Recent studies have found altered levels of FSH, LH, and prolactin with sleep disturbance or circadian dysrhythmia. Disruption of circadian rhythms in the form of shift work, jet lag, and daylight savings time changes have been associated with poorer fertility and early pregnancy outcomes. Alterations in the expression of circadian rhythm-regulating circadian locomotor output cycles kaput (CLOCK) genes have been associated with decreased fertility and increased rates of miscarriage.

Summary
Overall, undisrupted sleep and circadian rhythmicity appear to optimize fertility and early pregnancy outcomes and may play an important role in the success of fertility treatment.
Trough Levels of Infliximab at Week 6 Are Predictive of Remission at Week 14 in Pediatric Crohn's Disease
Authors: Courbette Olivier , Aupiais Camille , Viala Jérôme , Hugot Jean‐Pierre , Roblin Xavier , Candon Sophie , Louveau Baptiste , Chatenoud Lucienne , Martinez‐Vinson Christine 
Published: October 2019

ABSTRACTObjective:Infliximab (IFX) is a frequent therapeutic option for Crohn disease (CD) patients. Early detection of responders to IFX is critical for the management of CD in order to avoid long‐term exposure to the drug without benefit. This retrospective study aimed at analysing which early parameters recorded during the induction period are able to predict response to IFX during the maintenance period in pediatric CD.Patients and Methods:Medical records of all CD patients ages from 2 to 18 years who received IFX at a tertiary IBD center were retrospectively analyzed. Children were classified in 3 groups according to their response at week 14 (W14) (1) remission, (2) clinical response or (3), no response. The factors recorded at W0, W2, and W6, which were associated with remission at W14 were analyzed using a logistic regression.Results:Among the 111 patients included, 74.8% patients were responders to IFX at W14, including 38.7% in clinical remission and 36% with partial clinical response. Clinical remission at W14 was associated with normal growth (P < 0.01), and normal albuminemia (P = 0.01) at baseline, It was also associated with trough levels to IFX >8.3 μg/ml at week 6 (P < 0.01).Conclusion:Trough levels to IFX >8.3 μg/ml at week 6 are predictive of remission at W14 for luminal disease.
Retention Outcomes of New Graduate Nurse Residency Programs
Authors: Asber Samantha R. 
Published: October 2019

OBJECTIVE
The purpose of this integrative literature review is to examine the effects that nurse residency programs (NRPs) have on the retention of new graduates.

BACKGROUND
The Institute of Medicine recommends implementing NRPs and evaluating their effectiveness. Nursing leaders need to understand if an investment in a residency program is beneficial to their organization.

METHODS
A database search was performed for research from 2010 to 2016 reporting outcomes of new graduate NRPs relating to retention.

RESULTS
In the articles reviewed, the 1-year retention was higher than the national average for new graduate nurses ranging from 74% to 100%. Higher rates were associated with national programs such as the University Hospital Consortium/American Association of Colleges of Nursing or Versant compared with organization-based programs.

CONCLUSIONS
NRPs can increase 1-year retention of new graduate nurses. More controlled and comparative studies are needed to evaluate program differences. Nurse leaders need evidence to ascertain which programs are the most effective in supporting retention and return on investment.
Exploring the Relationship Between Contact Frequency, Leader-Member Relationships, and Patient Safety Culture
Authors: Anderson Albert D. , Floegel Theresa A. , Hofler Linda , Swanson Melvin 
Published: October 2019

OBJECTIVE
This study uses Leader-Member Exchange theory to explore the associations between contact frequency (CF) of nurse leaders and their team members, leader-member relationship, and patient safety culture.

BACKGROUND
Leader-member relationships are an important part of patient safety culture development. The behaviors of leaders to achieve these relationships are unknown. This study explores CF as a leader behavior to improve patient safety culture.

METHODS
Cross-sectional survey of bedside nurses (N = 746) from an 8-hospital system.

RESULTS
A significant association was found between relationship strength and patient safety culture; CF's effect on relationship and patient safety culture was demonstrated.

CONCLUSION
Contact frequency may support relationships between leaders and members and improve patient safety culture on nursing units. Future studies should explore factors that could be enhancing and limiting CF.
Intervention Effects of the MINDBODYSTRONG Cognitive Behavioral Skills Building Program on Newly Licensed Registered Nurses' Mental Health, Healthy Lifestyle Behaviors, and Job Satisfaction
Authors: Sampson Marlene , Melnyk Bernadette M. , Hoying Jacqueline 
Published: October 2019

OBJECTIVE
The purpose of this study was to evaluate the effects of the MINDBODYSTRONG for Healthcare Professionals Program on stress, anxiety, depressive symptoms, healthy lifestyle behaviors, and job satisfaction on newly licensed RNs (NLRNs) participating in a nurse residency program.

BACKGROUND
The constellation of burnout, depression, and suicide in clinicians is a public health epidemic that affects the quality and safety of healthcare. The National Academy of Medicine's Action Collaborative on Clinician Well-being and Resilience has called for an increase in evidence-based interventions to combat this alarming problem. The MINDBODYSTRONG Program is a novel adaptation of an evidence-based cognitive behavioral skills–building intervention that provides a theory-based approach to improve the mental health, healthy lifestyle beliefs and behaviors, and job satisfaction of NLRNs.

METHODS
A 2-group, cluster randomized controlled trial was used with 89 new nurses participating in a new-graduate nurse residency program. The experimental intervention, MINDBODYSTRONG, consisted of 8 manualized weekly 45-minute sessions. Data were collected at baseline, immediately following, and 3 months after intervention that measured stress, depressive symptoms, anxiety, healthy lifestyle beliefs and behaviors, and job satisfaction. Repeated-measures analysis of variance was used for data analysis.

RESULTS
The intervention group scored significantly better with moderate to large positive effects on the mental health variables as well as healthy lifestyle beliefs and healthy lifestyle behaviors at both follow-up time points compared with the attention control group. Moderate to large positive effects also were found for job satisfaction.

CONCLUSIONS
The MINDBODYSTRONG Program has excellent potential as an evidence-based intervention for improving the mental health, healthy lifestyle beliefs and behaviors, and job satisfaction, in NLRNs.
Short- and Long-Term Outcome of Systemic Lupus Erythematosus Peripheral Neuropathy
Authors: Fargetti Simone , Ugolini-Lopes Michelle R. , Pasoto Sandra G. , Seguro Luciana P. C. , Shinjo Samuel K. , Bonfa Eloisa , Borba Eduardo F. 
Published: October 2019

Background/Objective
Our aim was to describe the short- and long-term outcome of peripheral neuropathy (PN) attributed exclusively to systemic lupus erythematosus (SLE).

Methods
Systemic lupus erythematosus patients with defined PN (clinical and electroneuromyography) were retrospectively evaluated at onset, 1-year, and 5-year follow-up using a standardized electronic chart database that started in 2000. Exclusion criteria were comorbidities, drugs, and infections. Age-, sex-, and disease duration–matched SLE patients without PN were selected as controls.

Results
Lupus PN was identified in 38 (1.8%) of 2074 patients, and almost two thirds had PN onset in the first 5 years of SLE (63.2%). Peripheral neuropathy SLE had higher frequencies of cutaneous vasculitis (50% vs 21.1%, p = 0.002), lymphopenia (60.5% vs 36.8%, p = 0.027), anti-Sm (52.6% vs 27.6%, p = 0.013), and higher SLEDAI-2K scores (11.5 ± 10.5 vs 4.9 ± 6.7, p < 0.001) compared with controls. The most common type was polyneuropathy (71.1%) with sensory-motor pattern (68.4%). At PN diagnosis, all patients received glucocorticoid and 97.4% started immunosuppressive therapy (50% intravenous cyclophosphamide, 42.1% azathioprine). After 1-year follow-up, 92.1% had a favorable outcome with complete (36.8%) or partial remission (55.2%), in parallel with a decrease in prednisone dose (48.3 ± 17.9 vs 15.3 ± 13.4 mg/d, p < 0.001), symptomatic therapy (57.9% vs 29.7%, p = 0.02), and SLEDAI-2K score (11.5 ± 10.5 vs 1.7 ± 3.7, p < 0.001). SLEDAI-2K scores were higher in patients who had PN onset with less than 1 year of SLE duration, compared with those with more than 5 years of disease (21.3 ± 9.1 vs 3.9 ± 5.3, p < 0.001). Early-PN-onset group had a better response to treatment (complete remission at 1-year follow-up 61.5% vs 25%, p = 0.039). At 5-year follow-up, 89.3% remained with complete/partial remission.

Conclusions
Peripheral neuropathy attributed to SLE itself is a rare manifestation with a bimodal pattern, characterized by a predominant early-onset group associated with high disease activity and a higher rate of complete remission, and a late-onset group with low disease activity and a partial therapy response.
Learning Curve From 450 Cases of Robot-Assisted Pancreaticoduocectomy in a High-Volume Pancreatic Center
Authors: Shi Yusheng , Wang Weishen , Qiu Weihua , Zhao Shulin , Wang Jian , Weng Yuanchi , Huo Zhen , Jin Jiabin , Wang Yue , Deng Xiaxing , Shen Baiyong , Peng Chenghong 
Published: October 2019

Objective:
We aimed to describe our experience and the learning curve of 450 cases of robot-assisted pancreaticoduodenectomy (RPD) and optimize the surgical process so that our findings can be useful for surgeons starting to perform RPD.

Summary Background Data:
Robotic surgical systems were first introduced 20 years ago. Pancreaticoduodenectomy (PD) is a challenging surgery because of its technical difficulty. RPD may overcome some of these difficulties.

Methods:
The medical records of 450 patients who underwent RPD between May 2010 and December 2018 at the Shanghai Ruijin Hospital were retrospectively analyzed. Operative times and estimated blood loss (EBL) were analyzed and the learning curve was determined. A cumulative sum (CUSUM) analysis was used to identify the inflexion points. Other postoperative outcomes, postoperative complications, and long-term follow-up were also analyzed.

Results:
Operative time improved graduallyovertimefrom405.4 ± 112.9 minutes (case 1–50) to 273.6 ± 70 minutes (case 301–350) (P < 0.001). EBL improved from 410 ± 563.5 mL (case 1–50) to 149.0 ± 103.3 mL (case 351–400) (P
< 0.001). According to the CUSUM curve, there were 3 phases in the RPD learning curve. The inflexion points were around cases 100 and 250. The incidence of pancreatic leak in the last 350 cases was significantly lower than that in the first 100 cases (30.0% vs 15.1%, P = 0.003).

Conclusions:
RPD is safe and feasible for selected patients. Operative and oncologic outcomes were much improved after experience of 250 cases. Our optimization of the surgical process may have also contributed to this. Future prospective and randomized studies are needed to confirm our results.