bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systematic Review of Treatments for Colorectal Metastases in Elderly Patients to Guide Surveillance Cessation Following Hepatic Resection for Colorectal Liver Metastases
Authors: Alabraba Edward , Gomez Dhanny 
Published: March 2021

Background:
Although included in surveillance programmes for colorectal cancer (CRC) metastases, elderly patients are susceptible to declines in health and quality of life that may render them unsuitable for further surveillance. Deciding when to cease surveillance is challenging.

Methods:
There are no publications focused on surveillance of elderly patients for CRC metastases. A systematic review of studies reporting treatment outcomes for CRC metastases in elderly patients was performed to assess the risk-benefit balance of the key objectives of surveillance; detecting and treating CRC metastases.

Results:
Sixty-eight eligible studies reported outcomes for surgery and chemotherapy in the elderly. Liver resections and use of chemotherapy, including biologics, are more conservative and have poorer outcomes in the elderly compared with younger patients. Selected studies demonstrated poorer quality-of-life (QoL) following surgery and chemotherapy. Studies of ablation in elderly patients are limited.

Discussion:
The survival benefit of treating CRC metastases with surgery or chemotherapy decreases with advancing age and QoL may decline in the elderly. The relatively lower efficacy and detrimental QoL impact of multimodal therapy options for detected CRC metastases in the elderly questions the benefit of surveillance in some elderly patients. Care of elderly patients should thus be customized based on their preference, formal geriatric assessment, natural life-expectancy, and the perceived risk-benefit balance of treating recurrent CRC metastases. Clinicians may consider surveillance cessation in patients aged 75 years and above if geriatric assessment is unsatisfactory, patients decline surveillance, or patient fitness deteriorates catastrophically.
Clinical Outcomes of Patients With pT1-T2N0 Oral Tongue Squamous Cell Carcinoma
Authors: Wilson Jessica M. , Lumley Catherine , Tan Xianming , Shen Colette , Coniglio Andrew , Weissler Mark , Yarbrough Wendell G. , Hackman Trevor , Blumberg Jeffrey , Zanation Adam , Thorp Brian , Patel Samip N. , Chera Bhishamjit S. 
Published: March 2021

Objective:
The objective of this study was to evaluate the clinical outcomes in a cohort of patients with early-stage oral tongue squamous cell carcinoma (OTSCC).

Materials and Methods:
We conducted a retrospective analysis of patients with pT1-T2N0 (American Joint Committee on Cancer [AJCC] seventh edition) OTSCC treated from 2000 to 2018. Two-year actuarial rates of local regional control, cancer-specific survival, and overall survival were calculated for the entire cohort and patients with/without adjuvant radiation.

Results:
Ninety-six patients met the criteria with a median follow-up of 4 years; 14 had adjuvant radiation, while 82 had surgery alone. Two-year local regional control was 82.7% (75.4% to 90.8%) for the entire cohort, 84.9% (77.8% to 93.2%) for surgery only, and 70.7% (50.2% to 99.6%) for patients with adjuvant radiation. Two-year progression-free survival was 82.7% (75.3% to 90.8%). Of the 20 patients with recurrence, 11 (55%) were successfully salvaged.

Conclusion:
Local regional recurrence remains modest in early-stage OTSCC, but salvage is possible with high survival rates.

Level of Evidence:
Level III—retrospective cohort study.
Intercostobrachial Nerve (ICBN) Preservation Versus Sacrifice in Axillary Dissection
Authors: Melhem Jamal , Amarin Marzouq , Odeh Ghada , Al-Bustami Nadwa , Al-Lauzy Hatem , Ayoub Rami 
Published: March 2021

Objectives:
Whether to preserve or sacrifice the intercostobrachial nerves (ICBN) is a controversial issue. In this trial, we aim to assess the effects of preservation of the ICBN during axillary dissection for patients with breast cancer in terms of pain score immediately postoperatively and several hours later, need for simple analgesia and narcotics, numbness and arm swelling.

Materials and Methods:
This is a single-institution, single-surgeon randomized controlled trial where a sample of 48 patients with breast cancer, of various age groups, were allocated randomly to any of the 2; preservation or sacrifice categories. Postoperatively, patients were asked by a physician to fill a predesigned questionnaire to assess the studied items during hospitalization and after discharge.

Results:
Among the 48 included patients, ICBN was sacrificed in 24 patients; of which 18 patients (75%) developed numbness in the inner aspect of the arm. While in the ICBN preservation group (24 patients) only 6 patients suffered numbness (25%) with a significant P-value of 0.001. Estimated duration of surgery with ICBN preservation was 100±22.02 minutes, while it is significantly shorter in the ICBN sacrifice group (83.48±21.55). However, with regard to other variables of pain, seroma formation, need of simple analgesia and narcotics, hospital admission days and arm swelling, there was no significant difference between the 2 groups.

Conclusion:
This study can conclude that preservation of ICBN during axillary dissection in patients with breast CA can save these patients’ additional suffering from inner arm numbness. That is at the expense of surgery duration, around 20 minutes longer, for the surgeon to take his/her time in carefully dissecting the axilla properly without injuring these ICBN.
Management of hypertension in heart failure with preserved ejection fraction: is there a blood pressure goal?
Authors: Myhre Peder L. , Selvaraj Senthil , Solomon Scott D. 
Published: March 2021

Purpose of review
Hypertension remains a leading risk factor for heart failure with preserved ejection fraction (HFpEF), and elevated blood pressure (BP) portends an adverse prognosis in patients with established HFpEF. We summarize current evidence for mechanisms linking hypertension to HFpEF and management of hypertension in HFpEF.

Recent findings
Data suggest a complex, multifactorial pathophysiology driving the association between hypertension and HFpEF, including left ventricular hypertrophy, diastolic dysfunction, atrial dysfunction, coronary microvascular disease, endothelial dysfunction, myocardial injury and fibrosis. Although intensive BP control may attenuate these processes, this hypothesis has not been tested on clinical outcomes in a dedicated randomized controlled trial (RCT) in HFpEF. Antihypertensive therapies variably improve key surrogate markers in HFpEF, though BP reduction generally does not account for these benefits. Accordingly, BP targets are extrapolated from observational studies and RCTs testing heart failure therapies that affect BP in addition to dedicated RCT data in patients at elevated risk (without heart failure).

Summary
Clinicians should recognize the risk of disease progression and poor outcomes associated with uncontrolled hypertension in HFpEF. Intensive BP control, preferably by therapies known to improve outcomes in heart failure, may slow key pathways in disease progression. Future RCTs testing intensified BP control strategies in HFpEF are warranted.
Central pulse pressure is inversely associated with proximal aortic remodelling
Authors: Tosello Francesco , Guala Andrea , D’ascenzo Fabrizio , Bollati Martina , Leone Dario , Sabia Luca , Bruno Giulia , Mingrone Giulia , Astarita Anna , Vallelonga Fabrizio , Avenatti Eleonora , Moretti Claudio , Veglio Franco , Ridolfi Luca , Milan Alberto 
Published: March 2021

Objectives:
Hypertension leads to aortic stiffening and dilatation but unexpected data from the Framingham Heart Study showed an inverse relationship between brachial pulse pressure and aortic diameter. Aortic dilatation would not only lead to lower pulse pressure but also to a worse prognosis (cardiac events, heart failure). Invasive pressure may be more informative but data are lacking.

Aim:
This study evaluated the relationship between invasively measured central blood pressure and proximal aortic diameter.

Methods:
In 71 consecutive patients referred to invasive haemodynamic study, proximal aortic remodelling was evaluated in terms of Z-score, comparing diameters measured at the sinus of Valsalva to the diameter expected according to patients’ age, sex and body height. Pressures were recorded directly in the proximal aorta by means of a catheter before coronary assessment.

Results:
The mean invasive aortic SBPs and DBPs were 146 ± 23 and 78 ± 13 mmHg, respectively, giving a central pulse pressure (cPP inv) of 68 ± 21 mmHg. Proximal aortic diameter was 34.9 ± 19.4 mm, whereas Z-score was −0.3 ± 1.7. Patients with higher cPPinv showed a significantly lower Z-score (−0.789 vs. 0.155, P = 0.001). cPPinv was inversely related to Z-score (R = −0.271, P = 0.022) independently from age, mean blood pressure and heart rate (β = -0.241, P = 0.011).

Conclusion:
Aortic root Z-score is inversely associated with invasively measured central pulse pressure in a cohort of patients undergoing invasive coronary assessment. Remodelling at the sinuses of Valsalva may be a compensatory mechanism to limit pulse pressure.
Prevalence of Surgical, Anesthetic, and Device-related Complications Among Infants Implanted Before 9 and 12 Months of Age Versus Older Children: Evidence for the Continued Expansion of Pediatric Cochlear Implant Candidacy Criteria
Authors: Chweya Cynthia M. , Smith Alyssa J. , May Matthew M. , Lohse Christine M. , Neff Brian A. , Driscoll Colin L. W. , Carlson Matthew L. 
Published: March 2021

Objective:
To compare the prevalence of surgical, anesthetic, and device-related complications among infants and older children receiving cochlear implantation (CI).

Study Design:
Retrospective chart review.

Setting:
Tertiary academic referral center.

Patients:
Pediatric patients who underwent CI from November 1990 to January 2020.

Intervention:
CI.

Main Outcome Measures:
Surgical, anesthetic, and device-related complication rates were compared by age group (<12 versus 12–23 versus 24+ months with subset analysis of <9 versus 9–11 months).

Results:
A total of 406 primary pediatric CI surgeries encompassing 482 ears were analyzed, including 45 ears in 23 patients implanted less than 9 months and 89 ears in 49 patients less than 12 months. No anesthetic complications occurred. Postoperative surgical and device-related complication rates were not significantly different among the less than 12, 12 to 23, and 24+ month groups (16% versus 16% versus 12%; p = 0.23) or between the less than 9 and 9 to 11 month groups (22% versus 9%; p = 0.09). Thirty-day readmission was significantly higher for patients less than 12 months compared with patients 24+ months (6% versus <1%; p = 0.011), but was not significantly higher compared with patients 12 to 23 months (6% versus 3%; p = 0.65). Reoperation rates did not differ significantly among the less than 12, 12 to 23, and 24+ month groups (10% versus 7% versus 6%; p = 0.31).

Conclusions:
The prevalence of surgical, anesthetic, and device related complications was not significantly different among infants implanted less than 9 or less than 12 months of age when compared with older children. These data provide evidence for the continued expansion of pediatric cochlear implant candidacy criteria to include appropriately selected infants less than 9 months of age.
CT Assessment of Otic Capsule Bone Density in Paget's Disease of the Temporal Bone and Its Relationship With Hearing Loss
Authors: Amilibia Emilio , Pérez-Grau Marta , Callejo Àngela , Cuadras Patricia , Roca-Ribas Francesc , Puyalto Paloma 
Published: March 2021

Objectives:
To study computed tomography findings in Paget's disease of temporal bone (PDTB) and analyze the relations between otic capsule bone mineral density values measured in Hounsfield Units (HU) and hearing loss (HL).

Study Design:
Observational case-control study.

Setting:
Tertiary referral center.

Patients:
Radiographically confirmed PDTB cases and control group.

Intervention:
Diagnostic.

Main Outcome Measures:
Hearing thresholds and computed tomography bone density values.

Results:
Twenty-three ears in the case group (PDTB) and 27 control ears were included. In the PDTB group, HL was found in 87% of the ears (43% mixed) and an air-conduction threshold of 50.7 dB (SD = 19.8). In the control group, 48% of the ears showed HL (7% mixed) and an air-conduction threshold of 34.5 dB (SD = 20.6) was found; the difference was statistically significant (p < 0.05). Measurements of bone density (HU) in the otic capsule (regions of interest [ROI] 1 and 2) and in the petrous bone (ROI 3) were significantly lower (p < 0.05) in the PDTB group than in controls.
The PDTB group presented a significant association between otic capsule bone density in ROI 1 and mean otic capsule density with air and bone-conduction thresholds (p < 0.05). In controls, no association was observed between any density value and audiometric thresholds.

Conclusion:
PDTB patients showed more frequent HL, lower thresholds, and a higher proportion of mixed HL than controls. Bone density (HU) was decreased in all ROIs in PDTB patients in comparison with controls. Bone density in the otic capsule was associated with HL in PDTB patients, but no association was observed between bone density and HL in controls.
Predictors of Fibrotic and Bone Tissue Formation With 3-D Reconstructions of Post-implantation Human Temporal Bones
Authors: Danielian Arman , Ishiyama Gail , Lopez Ivan A. , Ishiyama Akira 
Published: March 2021

Hypothesis:
Years of implantation, surgical insertion approach, and electrode length will impact the volume of new tissue formation secondary to cochlear implantation.

Background:
New tissue formation, fibrosis, and osteoneogenesis after cochlear implantation have been implicated in increasing impedance and affecting performance of the cochlear implant.

Methods:
3-D reconstructions of 15 archival human temporal bones from patients with a history of cochlear implantation (CI) were generated from H&E histopathologic slides to study factors which affect volume of tissue formation.

Results:
Years of implantation was a predictor of osteoneogenesis (r = 0.638, p-value = 0.011) and total new tissue formation (r = 0.588, p-value = 0.021), however not of fibrosis (r = 0.235, p-value = 0.399). Median total tissue formation differed between cochleostomy and round window insertions, 25.98 and 10.34%, respectively (Mann–Whitney U = 7, p = 0.018). No correlations were found between electrode length or angular insertion depth and total new tissue (p = 0.192, p = 0.35), osteoneogenesis (p = 0.193, p = 0.27), and fibrosis (p = 0.498, p = 0.83), respectively. However, the type II error for electrode length and angular insertion depth ranged from 0.73 to 0.90, largely due to small numbers of the shorter electrodes.

Conclusions:
With numbers of cochlear implant recipients increasing worldwide, an understanding of how to minimize intracochlear changes from implantation is important. The present study demonstrates that increasing years of implantation and inserting electrodes via a cochleostomy compared with a round window approach are associated with significantly greater degree of new tissue volume formation. While previous studies have demonstrated increased intracochlear damage in the setting of translocation with longer electrodes, length, and angular insertion depth of CI electrodes were not associated with increased tissue formation.
Secondary Obliteration Surgery for Troublesome Mastoid Cavities: A Prospective Series of 228 Pediatric and Adult Cases
Authors: Patil Sachin , Trinidade Aaron , Wong Billy , Yung Matthew W. 
Published: March 2021

Objective:
To present the results of a 15-year longitudinal study in a pediatric and adult population with secondary obliteration of troublesome mastoid cavities.

Study Design:
Prospective longitudinal study.

Patients:
Children (≤16 yrs) and adults who had obliteration surgery (228 ears) between 2000 and 2017.

Interventions:
Therapeutic.

Setting:
Tertiary referral center.

Main Outcome Measures:
1) Incidence of recurrent or residual cholesteatoma; 2) creation of a dry ear at 5 years postsurgery; 3) postoperative complications; 4) waterproof status of ear; 5) number of subsequent ear surgery required.

Results:
Thirty-one pediatric and 197 adult cases contributed to the study. At 5 years 11 of 98 (10.8%) had been lost to follow-up. Using Kaplan–Meier survival analysis, the residual rate after 5 years was 4.2% (95% CI: 0.3%–8.2%) and the recurrence rate was 1% (95% CI: 0.0%–3.0%). Of the 223 ears available for assessment, 209 (93.7%) achieved a dry state, 6 (2.7%) had intermittent discharge, 6 (2.7%) had flap necrosis requiring flap trimming, and 1 (0.4%) developed meatal stenosis. Using a cross-sectional analysis at 12 months of follow-up, the otorrhea risk was 19.2% and the risk of definitive waterproofing was 10.9%. There was a reoperation risk of 10% within 5 years which included second-stage ossiculoplasty.

Conclusions:
Secondary mastoid obliteration is a safe and useful technique in treating the troublesome mastoid cavity in both children and adults. It is associated with a low cholesteatoma recidivism rate and high rate of a trouble-free ear in the long term.
Efficacy of immune checkpoint inhibitors in the treatment of non-small cell lung cancer patients with different genes mutation
Authors: Zhang Rui , Zhu Jing , Liu Ying , Xin Ying , Wang Ying , Niu Kai , Wei Huafang 
Published: March 2021

Abstract

Background:
Latest clinical trials have proved the better overall survival (OS) for the use of immune checkpoint inhibitors verse chemotherapy in non-small cell lung cancer (NSCLC) patients. However, we still have no clear ideas of the factors which could affect the efficacy of immune checkpoint inhibitors. Cancer, essentially, is a disease related to genes mutation. Therefore, we conducted a systematic review and meta-analysis to compare efficacy of immune checkpoint inhibitors for NSCLC patients with different genes mutation.

Methods:
PubMed, EMBASE, Web of Science, and the Cochrane Library databases were searched for all clinical trials in NSCLC until December 16, 2019. The hazard ratio (HR) and 95% confidence intervals (CIs) of OS or progression-free survival (PFS) were used.

Results:
A total of 4453 patients from 7 randomized controlled trials (RCTs) were included. Immune checkpoint inhibitors significantly prolonged the OS (HR, 0.67; 95% CI, 0.60–0.67) in NSCLC patients having epidermal growth factor receptor (EGFR) wild-type versus chemotherapy. Meanwhile, they prolonged the OS (HR, 0.61; 95% CI, 0.39–0.94) in NSCLC patients with Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation. No matter PD-L1 tumor proportion scores were >1% or <1%, immune checkpoint inhibitors were more effective than chemotherapy (HR, 0.64; 95% CI, 0.55–0.75).

Conclusion:
Immune checkpoint inhibitors are more efficacious than chemotherapy in NSCLC patients with EGFR wild-type, KRAS mutation, and any PD-L1 tumor proportion scores.
Prevalence and influencing factors of depression of caregivers in children with epilepsy in southwestern China: a cross-sectional study
Authors: Yang Chunsong , Yao Tang , Huang Yuanlong , Zhao Li , Zhang Lingli 
Published: March 2021

Abstract
This study investigated the epidemiological status of depression and its influencing factors among caregivers of children with epilepsy in southwestern China.
This was a cross-sectional study. Caregivers of children with epilepsy were recruited from February to June 2018 at the Pediatric Neurology Department of the West China Second Hospital. Depression status was assessed using the Zung Self-Rating Depression Scale. Multiple linear regression analysis was used to assess correlations between depression status and its influencing factors.
A total of 319 participants were included. The mean Zung Self-Rating Depression Scale score was 36.37 ± 10.178 and 5.3% (17/319) of participants were classified as depressed. Regression analysis showed that place of residence (B = 0.114; standard error = 0.643; P = .039), attitude towards seizures (B = −0.121; standard error = 1.215; P = .029), medical expenses payment (B = −0.111; standard error = 2.002; P = .044), and children's medication adherence (B = −0.124; standard error = 0.393; P = .025) were related to depression.
Some caregivers of children with epilepsy in southwestern China experience depression. Health care providers should pay particular attention to caregivers who live in rural areas, who fear seizures, who experience difficulty paying medical expenses, and whose children show low medication adherence.
Clinical therapeutic effects of gastrodin in combination with betahistine on vertigo
Authors: Qiao Yu-Lin , Xiang Wen-Qiang , Liu Fang , Jin Sheng 
Published: March 2021

Abstract

Background:
Vertigo is a well-known presenting complaint common in the main care offices as well as departments. It is also regarded as a symptom of vestibular dysfunction and has been expressed as a feeling of motion, specifically rotational motion. As patients grow older, vertigo also becomes a commonly presenting complaint. The current study will carry out a widespread systematic review to estimate clinical therapeutic effects of gastrodin in combination with betahistine on vertigo.

Methods:
We will systematically search different databases, including PubMed, EMBASE, Web of Science, the Cochrane Library, Chinese BioMedical Literature Database (CBM), China National Knowledge Infrastructure Database (CNKI), and WanFang to collect the randomised controlled studies that evaluate the efficiency of gastrodin and betahistine in treating patients with vertigo from their inception to November 2020. However, only studies in English or Chinese will be included. Two authors will independently perform selection, data extraction, and assessment of risk of bias for the included papers. Accordingly, any disagreements between the independent authors will be addressed via discussion or by consulting a third author when needful. Additionally, we will use RevMan 5.3 software to perform the data synthesis.

Results:
The efficiency of gastrodin and betahistine in treating patients with vertigo will be systematically evaluated.

Conclusions:
The current study aims to stipulate more consistent substantiation to explore whether gastrodin combined with betahistine is more effective for the treatment of vertigo.

Registration number:
DOI 10.17605/OSF.IO/HQTZA (https://osf.io/hqtza/)