bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictive Roles of HER2 Gene Amplification and Neutrophil-to-Lymphocyte Ratio on Survival in HER2-Positive Advanced Gastric Cancer Treated With Trastuzumab-Based Chemotherapy
Authors: Park Joo-Hwan , Yeo Ja Hyun , Kim Young Saing , Park Inkeun , Ahn Hee Kyung , Shin Dong Bok , Lee Woon-Ki , Yang Jun-Young , Kim Hyung-Sik , Sym Sun Jin 
Published: March 2021

Objectives:
Trastuzumab is used as an agent against human epidermal growth factor receptor 2 (HER2)-positive advanced gastric cancer (AGC). The aim of this study was to determine how HER2 gene amplification and neutrophil-to-lymphocyte ratio (NLR) could predict long-term survival in AGC patients that underwent trastuzumab-based chemotherapy.

Methods:
We retrospectively reviewed medical records of 112 patients between 28 and 91 years old (median of 66 y) with AGC treated with first-line trastuzumab-based chemotherapy. The level of HER2 gene amplification was determined by the HER2/centromere enumerator probe 17 (CEP17) ratio and HER2 gene copy number (GCN). NLR was calculated as the neutrophil count divided by the lymphocyte counts.

Results:
Median HER2/CEP17 ratio, HER2 GCN, and NLR values were 2.85, 7.1, and 2.81, respectively. Objective response rate in both high HER2/CEP17 ratio (59.4% vs. 28.1%, P=0.012) and HER2 GCN groups (62.1% vs. 33.3%, P=0.032) was higher than that of each group. High NLR correlated with significantly worse median overall survival (OS) (median OS, 8.2 vs. 18.9 mo, P=0.002) and progression free survival (PFS) (median PFS: 5.1 vs. 8.0 mo, P=0.005). However, median OS and PFS were not significantly different according to HER2/CEP17 ratio or HER2 GCN. In the multivariate analysis, high NLR, Eastern Cooperative Group performance status, and poorly differentiated/signet ring cell type were independent factors for OS.

Conclusions:
NLR was a significant predictor of long-term survival in AGC patients treated with first-line trastuzumab-based chemotherapy. Future validation of prospective trials with larger patient populations will be needed.
Low admission blood pressure as a marker of poor 1-year survival in patients with revascularized critical limb ischemia
Authors: Yannoutsos Alexandra , Lin Franck , Billuart Olivier , Buronfosse Anne , Sacco Emmanuelle , Beaussier Hélène , Mourad Jean-Jacques , Emmerich Joseph , Lazareth Isabelle , Priollet Pascal 
Published: March 2021

Objective:
To contrast the association between blood pressure (BP) level and antihypertensive medications at hospital admission with 1-year mortality in patients undergoing revascularization for critical limb ischemia (CLI).

Methods:
From November 2013 to May 2019, 315 consecutive patients were retrospectively included. A median of seven (IQR 3–13) separate readings were recorded for each patient before revascularization procedure and the average represented patient's mean BP. BP-lowering medications, clinical and biological parameters were recorded at baseline. The main outcome was total 1-year mortality.

Results:
The cohort included 172 men (55%) and 143 women (45%), with a mean age of 77.9 ± 11.9 years. Treated hypertension was present in 245 (78%) patients; 288 (91%) patients had BP-lowering drug prescriptions (2.1 ± 1.3 medications at baseline). Mean SBP, DBP, mean BP (MBP) and pulse pressure (PP) were 132 ± 18, 70 ± 8, 90 ± 10 and 62 ± 16mmHg. During 1-year follow-up, 80 (25.4%) patients died. In single-pressure multivariate analysis, SBP (hazard ratio 0.97; 95% CI 0.96–0.99; P = 0.005), MBP (hazard ratio 0.96; 95% CI 0.92–0.99; P = 0.01), PP (hazard ratio 0.97; 95% CI 0.95–0.99; P = 0.009), but not DBP, were inversely correlated with 1-year mortality, independently of age, coronary heart disease, left ventricular ejection fraction, brain natriuretic peptide, serum albumin, institutionalized status and antihypertensive drugs. Association between SBP, MBP and PP with 1-year mortality had a quite linear reverse pattern.

Conclusion:
Among patients undergoing revascularization for CLI, there is an inverse correlation between admission SBP, MBP and PP with 1-year mortality. BP may represent a modifiable therapeutic target to prevent poor outcome in CLI patients.
Antihypertensive treatment decrease stroke occurrence: a prospective cohort study
Authors: Zuo Yingting , Wang Anxin , Wu Shouling , Chen Shuohua , Tian Xue , Li Haibin , He Yan 
Published: March 2021

Objective:
Among the risk factors of stroke, hypertension was one of the most important and modifiable factors. The current study aimed to assess whether antihypertensive treatment to ideal levels of blood pressure can eliminate stroke risk in a prospective cohort study.

Methods:
The Kailuan study was a prospective longitudinal cohort study on stroke risk factors and events. We analyzed association of baseline antihypertensive treatment efficacy with the risk of stroke during 11.0-year follow-up, and further evaluated association of newly antihypertensive treatment efficacy at 4-year follow-up with subsequent stroke. Multivariate Cox proportion models were used to calculated hazard ratios and their 95% confidence intervals (CIs) for stroke.

Results:
A total of 97 772 participants (median age: 51.65 years) without previous stroke were included. At baseline, 55 518 participants had normotension, 2339 treated and controlled, 32 331 untreated hypertension and 7584 treated but uncontrolled. Compared with normotension, individuals with treated and controlled, untreated hypertension and treated but uncontrolled, had 83, 97 and 162% higher risk of developing total stroke after adjusting for potential stroke risk factors, respectively (hazard ratio 1.83 [95% CI 1.56–2.15], 1.97 [95% CI 1.85–2.11] and 2.62 [95% CI 2.40–2.86]; all P < 0.05). Whereas, normotension at baseline, who were newly normotension with antihypertensives at 4-year follow-up, exhibited no elevated total stroke risk (hazard ratio, 1.41 [95% CI 0.87–2.30]). Similar results existed for stroke subtypes (ischemic stroke and hemorrhagic stroke).

Conclusion:
The data suggest that, antihypertensive treatment to normotensive individuals can reduce stroke risk in a short time.
Blood pressure, blood pressure variability and the risk of poststroke dementia
Authors: Hilkens Nina A. , Klijn Catharina J.M. , Richard Edo 
Published: March 2021

Objective:
High blood pressure and blood pressure variability are potential, modifiable risk factors of poststroke dementia. We aimed to investigate the association between achieved blood pressure, blood pressure variability and poststroke dementia.

Methods:
We studied 17 064 patients with noncardioembolic ischemic stroke included in the Prevention Regimen for Effectively avoiding Second Strokes (PRoFESS) trial. We analysed the data as a single observational cohort. We studied mean achieved SBP and DBP and blood pressure variability defined as coefficient of variation (SD/mean∗100). The association between blood pressure and dementia was investigated with logistic regression analysis, correcting for sociodemographic factors and cardiovascular risk factors.

Results:
During 39 818 person-years of follow-up, 817 patients were diagnosed with dementia (2.1 per 100 person-years). We found a significant nonlinear association between mean SBP and the risk of dementia, implying a U-shaped association between mean SBP and dementia. Mean SBP of 120–129 mmHg was associated with a significantly higher risk of dementia than 130–139 mmHg [odds ratio (OR) 1.28; 95% confidence interval (95% CI) 1.03–1.58]. There was no indication of a U-shaped association between mean DBP and dementia, and no significant association between mean DBP categories and dementia. Higher blood pressure variability was associated with an increased risk of dementia (OR 1.06 per point increase, 95% CI 1.02–1.04), independent of mean SBP.

Conclusion:
Among patients with a recent noncardioembolic ischemic stroke, there appears to be a U-shaped association between achieved SBP and dementia. High blood pressure variability is associated with an increased risk of poststroke dementia.
Opioids and ophthalmology: review of the current literature
Authors: Starr Matthew R. , Patel Luv G. , Ammar Michael , Yonekawa Yoshihiro 
Published: March 2021

Purpose of review
The number of opioid-related overdose deaths has rapidly increased since 2000, increasing more than five-fold from 1999 to 2016. Although surgeons only write 10% of opioid prescriptions annually, with ophthalmologists writing only a fraction of this amount, all physicians need to be cognizant of the current opioid epidemic and ways to decrease unnecessary opioid prescriptions.

Recent findings
Previous work within ophthalmology has shown that retrobulbar anesthesia along with peri-operative intravenous or oral nonopioid analgesics can lead to decreased postoperative opioid use following ophthalmic surgery. Recent literature has shifted focus towards the use of opioid prescription guidelines in managing postoperative pain and decreasing the number of unnecessary opioids being prescribed by ophthalmologists. Overall, the frequency of opioid prescriptions may have gradually declined the past few years with such efforts, increased awareness, and new healthcare policies to monitor opioid prescriptions. However, ophthalmologists still continue to prescribe a substantial number of opioid medications, much of which may not be necessary.

Summary
This review serves as a tool to aid all ophthalmologists in managing postoperative pain. There is a recent trend in addressing the opioid epidemic and efforts are being made to limit the overprescribing of opioids. Continued efforts are still required by all ophthalmologists to address the current opioid epidemic.
Depression and Severity of Glaucoma Among Older Adults in Urban and Suburban Areas
Authors: Tharmathurai Sangeetha , Muhammad-Ikmal Mohamad K. , Razak Asrenee A. , Che-Hamzah Jemaima , Azhany Yaakub , Fazilawati Qamaruddin , Liza-Sharmini Ahmad T. 
Published: March 2021

Précis:
Depression increases with severity of visual field defect in older adults with primary open-angle glaucoma (POAG).

Purpose:
This study aimed to determine the prevalence of depression among patients with POAG and examine the relationship between depression and the severity of POAG in older adults.

Materials and Methods:
Three hundred and sixty patients with POAG aged 60 years or above were recruited from 2 tertiary centers located in an urban and suburban area. The participants were stratified according to the severity of their glaucoma based on the scores from the modified Advanced Glaucoma Intervention Study (AGIS) to mild, moderate, severe, and end stage. Face-to-face interviews were performed using the Malay Version Geriatric Depression Scale 14 (mGDS-14) questionnaire. Depression is diagnosed when the score is ≥8. One-way analysis of variance was used to compare the subscores between the groups. Multifactorial analysis of variance was also applied with relevant confounding factors.

Results:
Depression was detected in 16% of older adults with POAG; a higher percentage of depression was seen in those with end stage disease. There was a significant increase in the mean score of mGDS-14 according to the severity of POAG. There was evidence of an association between depression and severity of visual field defect (P<0.001). There was a significant difference in mGDS-14 score between the pairing of severity of POAG [mild-severe (P=0.003), mild-end stage (P<0.001), moderate-severe (P<0.001), and moderate-end stage (P<0.001)] after adjustment to living conditions, systemic disease, and visual acuity.

Conclusion:
Ophthalmologists should be aware that older adults with advanced visual field defects in POAG may have depression. The detection of depression is important to ensure adherence and persistence to the treatment of glaucoma.
Pharmacokinetics and Safety of Single-dose Tedizolid Phosphate in Children 2 to <12 Years of Age
Authors: Arrieta Antonio C. , Ang Jocelyn Y. , Espinosa Claudia , Fofanov Oleksandr , Tøndel Camilla , Chou Margaret Z. , De Anda Carisa S. , Kim Jason Y. , Li Dan , Sabato Philip , Sears Pamela S. , Bradley John S. 
Published: March 2021

Background:
Infections with Gram-positive bacteria, including acute bacterial skin and skin structure infections (ABSSSIs), are common in children. We describe a single-dose pharmacokinetics and safety study of tedizolid phosphate, a new oxazolidinone under investigation for the treatment of ABSSSIs in children, in hospitalized participants 2 to <12 years of age.

Methods:
This open-label, multicenter, phase 1 trial (NCT02750761) enrolled hospitalized children 2 to <12 years of age receiving treatment for a confirmed/suspected Gram-positive bacterial infection. Participants were stratified by age (2 to <6 years and 6 to <12 years) to receive a single oral or intravenous dose of tedizolid phosphate. Evaluations included safety and pharmacokinetics of tedizolid phosphate and its active metabolite, tedizolid. Palatability of the oral suspension was also evaluated.

Results:
Thirty-two participants were enrolled and received 3–6 mg/kg of study medication. For both routes of administration, tedizolid phosphate was rapidly converted to tedizolid; median time to maximum tedizolid plasma concentration was 1–2 hours after initiation of the 1-hour intravenous infusion and 2–3 hours after oral dosing. The tedizolid mean terminal half-life was 5–6 hours and 6–7 hours for the intravenous and oral administration groups, respectively. The oral tedizolid phosphate suspension demonstrated high bioavailability comparable to that of the parenteral administration. A single dose of intravenous or oral tedizolid phosphate was well tolerated; no unexpected safety findings were observed.

Conclusions:
Pharmacokinetic and safety observations provide the information necessary for the continued development of tedizolid phosphate for the treatment of Gram-positive infections in children, particularly ABSSSIs.
The Effect of Zero Gravity on Eyelid and Brow Position
Authors: Karlin Justin N. , Farajzadeh Justin , Stacy Stephanie , Esfandiari Mahtash , Rootman Daniel B. 
Published: March 2021

Purpose:
To describe the effect of spaceflight on upper eyelid and brow position.

Materials and Methods:
Images of astronauts on earth and in space were collected from a National Aeronautics and Space Administration image library. For each astronaut, front facing portraits captured within a 5-year period were obtained. At least 6 photos were collected per astronaut, 3 taken on earth, and 3 in zero gravity. Measurements from the center of the pupil to the upper eyelid margin (MRD1) and center of the pupil to the inferior eyebrow margin [pupil-to-brow (PTB)] were performed digitally for each image and averaged for each condition and each individual. Differences in mean MRD1 and PTB were assessed to illustrate the effects of zero gravity on eyelid and eyebrow position respectively. Linear-mixed effects modeling, analysis of variance and post hoc power analysis were performed.

Results:
One hundred and twelve photographs (55 earth, 57 space) from 18 astronauts (4 women, 14 men; mean age 45.9 years) were retrieved. Zero gravity resulted in a mean PTB increase of 3.7 mm (p < 0.01) but did not result in significant change in MRD1 (p = 0.21). Post hoc power analysis of the measured MRD1 difference was performed by simulation. At an MRD1 difference of 0.5 mm, the probability of a type II error is 2.6%, equivalent to a beta power of 97.4%. Thus, we can be 97.4% confident that a difference in MRD of 0.5 mm or greater would be detected.

Conclusions:
While spaceflight led to significant elevation of PTB, it did not consistently alter MRD1. As such, the brow and eyelid appear to be independently regulated with respect to gravitational changes.
Preliminary Development of Value Scorecards as ICU Telemedicine Evaluation Tools
Authors: Nadig Nandita , Hynden Liz , Sterba Katherine , McElligott James , Valenta Shawn , Warr Emily , Beeks Rebecca , Ford Dee 
Published: March 2021

EXECUTIVE SUMMARY
Intensive care unit (ICU) telemedicine has grown exponentially to the point that approximately 10% of U.S. hospitals use such programs. However, no studies have focused on strategic decision tools in the context of rural hospitals. We applied the pervasive balanced scorecard framework and used a sequential, mixed methods design with qualitative and quantitative data sources. We then triangulated them to generate value scorecards for four rural South Carolina hospitals. Four domains, each with numerous components, were identified and compiled to create a composite value scorecard. Domains and numbers of components included organizational (n = 10), clinical (n = 5), financial (n = 8), and strategic (n = 3) effects of ICU telemedicine. When weighting each component within domains and then comparing across hospitals, we identified substantial variation in the relative value derived from ICU telemedicine. Our novel, multidimensional value scorecard could be prospectively applied by hospitals seeking a structured approach to decision-making for ICU telemedicine investments.
Factors Affecting Burnout Among Medical Assistants
Authors: Seay-Morrison Timothy P. , Hirabayshi Kimberly , Malloy Courtney L. , Brown-Johnson Catherine 
Published: March 2021

EXECUTIVE SUMMARY
Medical assistants—key professionals supporting physician practices—have not been studied with regard to burnout and professional fulfillment, which may affect other healthcare professionals. This study examined the factors associated with burnout among medical assistants in an academic healthcare organization while validating the use of a tool previously used to assess burnout in physicians. Using portions of the Professional Fulfillment Index (PFI) and questions designed for this mixed methods study, medical assistants employed across Stanford Health Care were surveyed. The authors assessed demographic characteristics and the impact of control, organizational culture, team knowledge, self-efficacy, and professional fulfillment/meaningfulness on burnout. Of the 505 eligible participants, 261 (52%) completed the survey; 76% were women. The study validated the PFI for use with this population and validated three additional scales. Burnout was found to be low among medical assistants (M = 2.32); professional fulfillment/meaningfulness of work was found to be high (M = 4.08). Organizational culture, professional fulfillment, and self-efficacy were found to be predictors of burnout (R

2
= 0.438), with negative perceptions of organizational culture as the strongest predictor of burnout among medical assistants (β = –0.34). These results indicate that a survey tool is useful in understanding components of burnout and professional fulfillment in this population. Although limited to one site, this study could be replicated in other organizations.
Prognostic role of albumin level in heart failure
Authors: El Iskandarani Mahmoud , El Kurdi Bara , Murtaza Ghulam , Paul Timir K. , Refaat Marwan M. 
Published: March 2021

Abstract

Background:
Hypoalbuminemia (HA) is common in HF, however, its pathophysiology and clinical implications are poorly understood. While multiple studies have been published in the past decade investigating the role of serum albumin in HF, there is still no consensus on the prognostic value of this widely available measure. The objective of this study is to assess the prognostic role of albumin in heart failure (HF) patient

Methods:
Unrestricted searches of MEDLINE, EMBASE, Cochrane databases were performed. The results were screened for relevance and eligibility criteria. Relevant data were extracted and analyzed using Comprehensive Meta-Analysis software. The Begg and Mazumdar rank correlation test was utilized to evaluate for publication bias.

Results:
A total of 48 studies examining 44,048 patients with HF were analyzed. HA was found in 32% (95% confidence interval [CI] 28.4%–37.4%) HF patients with marked heterogeneity (I
2 = 98%). In 10 studies evaluating acute HF, in-hospital mortality was almost 4 times more likely in HA with an odds ratios (OR) of 3.77 (95% CI 1.96–7.23). HA was also associated with a significant increase in long-term mortality (OR: 1.5; 95% CI: 1.36–1.64) especially at 1-year post-discharge (OR: 2.44; 95% CI: 2.05–2.91; I
2 = 11%). Pooled area under the curve (AUC 0.73; 95% CI 0.67–0.78) was comparable to serum brain natriuretic peptide (BNP) in predicting mortality in HF patients.

Conclusion:
Our results suggest that HA is associated with significantly higher in-hospital mortality as well as long-term mortality with a predictive accuracy comparable to that reported for serum BNP. These findings suggest that serum albumin may be useful in determining high-risk patients.
Clinical study on cystogastrostomy and Roux-en-Y-type cystojejunostomy in the treatment of pancreatic pseudocyst
Authors: Ye Jun , Wang Lan , Lu Shan , Yang Dujiang , Hu Weiming , Lu Huimin , Zhang Yi 
Published: March 2021

Abstract
The main purpose is to compare the efficacy of cystogastrostomy (CG) and Roux-en-Y-type cystojejunostomy (RCJ) in the treatment of pancreatic pseudocyst (PPC), and to explore the risk factors of recurrence and complications after internal drainage.
Two hundred eight patients undergoing either CG or RCJ for PPC Between January 1, 2013and February 1, 2019, at West China Hospital of Sichuan University were retrospectively analyzed. The cure rate, complication rate and related factors were compared between the 2 groups.
Two hundred eight patients with PPC underwent either a CG (n = 119) or RCJ (n = 89). The median follow-up time was 42.7 months. Between the 2 cohorts, there were no significant differences in cure rate, reoperation rate, and mortality (all P > .05). The operative time, estimated intraoperative blood loss, install the number of drainage tubes and total expenses in CG group were lower than those in RCJ group (all P < .05). The Logistic regression analysis showed that over twice of pancreatitis’ occurrence was were independent risk factor for recurrence after internal drainage of PPC (OR 2.760, 95% CI 1.006∼7.571, P = .049). Short course of pancreatitis (OR 0.922, 95% CI 0.855∼0.994, P = .035), and RCJ (OR 2.319, 95% CI 1.033∼5.204, P = .041) were independent risk factors for complications after internal drainage of PPC.
Both CG and RCJ are safe and effective surgical methods for treating PPC. There were no significant differences in cure rate, reoperation rate, and mortality between the 2 groups, while the CG group had a short operation time, less intraoperative bleeding and less cost.