bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Anesthesia on Long-term Outcomes in Patients With Supratentorial High-grade Glioma Undergoing Tumor Resection: A Retrospective Cohort Study
Authors: Dong Jia , Zeng Min , Ji Nan , Hao Shuyu , Zhou Yang , Gao Zhixian , Gu Hongqiu , Zhang Li , Ma Daqing , Peng Yuming , Han Ruquan 
Published: February 2019

Background:
Intravenous and inhalational anesthesia might have different associations with long-term outcome in cancer patients, with reports of adverse effects of inhalation anesthesia. However, the effects of anesthesia in patients with high-grade glioma (HGG) are not known.

Methods:
This study investigated 154 patients who received propofol and 140 patients who received sevoflurane for maintenance of anesthesia during HGG tumor resection. The primary outcomes were progression-free survival and overall survival.

Results:
Median progression-free survival was 10 months (interquartile range [IQR], 6 to 18) versus 11 months (IQR 6 to 20; P=0.674), and median overall survival was 18 months (IQR, 11 to 39) versus 18 months (IQR, 10 to 44; P=0.759) in patients maintained with propofol and sevoflurane, respectively. Higher preoperative Karnofsky performance status and postoperative chemotherapy were associated with a reduced hazard of tumor progression or death, whereas higher age-adjusted Charlson comorbidity index and longer duration of anesthesia were associated with an increased hazard of progression or death. World Health Organization tumor classification IV and incomplete tumor resection were associated with an increased hazard of tumor progression but not death. Anesthesia maintenance with sevoflurane increased the risk of death in patients with Karnofsky performance status <80 compared with propofol (hazard ratio, 1.66; 95% confidence interval, 1.08-2.57; P=0.022).

Conclusions:
Compared with maintenance of anesthesia with propofol, sevoflurane did not worsen progression-free or overall survival in patients with HGG undergoing tumor resection. However, propofol might be beneficial in patients with poor preoperative Karnofsky performance status.
Alvimopan Significantly Reduces Length of Stay and Costs Following Colorectal Resection and Ostomy Reversal Even Within an Enhanced Recovery Protocol
Authors: Hyde Laura Z. , Kiely James Mark , Al-Mazrou Ahmed , Zhang Haiqing , Lee-Kong Steven , Kiran Ravi Pokala 
Published: February 2019

BACKGROUND:
Alvimopan accelerates GI recovery after colorectal resection. Data on real-world cost-effectiveness have been mixed.

OBJECTIVE:
This study aimed to evaluate if adding alvimopan to an enhanced recovery pathway reduces length of stay.

DESIGN:
Patients undergoing colorectal resection or ostomy reversal for the year before and after the introduction of alvimopan were evaluated.

SETTING:
This study was conducted at a single academic medical center.

PATIENTS:
Patients undergoing elective colorectal resection (488) or ostomy reversal (148) were included.

MAIN OUTCOME MEASURES:
The primary outcomes measured were length of stay and prolonged length of stay defined as >75th percentile for each procedure.

RESULTS:
Two hundred eighty-six patients (45%) received alvimopan. Alvimopan and no-alvimopan groups had similar demographics, comorbidities, operative indication, and case mix. In the alvimopan group, more of the colorectal resections were laparoscopic (87% vs 79%, p = 0.015). Length of stay was reduced with alvimopan (6.2 vs 4.9 days, p = 0.003), and this effect persisted when controlling for procedure type, approach, and ASA class (decreased length of stay by 1.0 day, p = 0.014). The alvimopan group had lower risk of prolonged length of stay (14.7% vs 23.1%, p = 0.007) and ileus (10.8% vs 16.2%, p = 0.05). On multivariable analysis, no alvimopan use (OR, 1.8; 95% CI, 1.2–2.7), ASA ≥3 (OR, 2.0; 95% CI, 1.3–3.1), and history of cardiac surgery (OR, 2.8; 95% CI, 1.2–6.5) were significant predictors of prolonged length of stay. Alvimopan use was associated with a lower risk of infectious complications other than surgical site infection (2.8% vs 6.7%, p = 0.025), and did not increase risk of any adverse outcomes. The addition of alvimopan to the protocol resulted in cost savings of $708.39 per patient.

LIMITATIONS:
Data collected from a single center limit external validity.

CONCLUSIONS:
The introduction of alvimopan to a postoperative protocol following elective colorectal resection or ostomy reversal significantly reduces length of stay and is associated with cost savings even within an enhanced recovery protocol. See Video Abstract at http://links.lww.com/DCR/A911.
SINGLE NUCLEOTIDE POLYMORPHISMS IN RETINAL DETACHMENT PATIENTS WITH AND WITHOUT PROLIFERATIVE VITREORETINOPATHY
Authors: Lumi Xhevat , Jelen Mateja M. , Zupan Andrej , Boštjančič Emanuela , Ravnik-Glavač Metka , Hawlina Marko , Glavač Damjan 
Published: February 2019

Purpose:
To investigate differences in genotype distributions of single nucleotide polymorphisms within genes, encoding inflammatory mediators, among patients with rhegmatogenous retinal detachment (RRD) and patients with proliferative vitreoretinopathy (PVR).

Methods:
A genetic association study was performed on 191 Slovenian patients, divided into 2 groups: 113 RRD patients with PVR and 78 RRD patients without PVR. Genotype distributions were investigated within the following 13 single nucleotide polymorphisms: rs3760396 (CCL2), rs9990554 (FGF2), rs17561 (IL1A), rs2069763 (IL2), rs1800795 (IL6), rs1800871 (IL10), rs3008 (JAK3), rs2229094 (LTA), rs1042522 (TP53), rs7656613 (PDGFRA), rs7226855 (SMAD7), rs1800471 (TGFB1), and rs1800629 (TNF).

Results:
Differences in genotype distributions between patients with RRD with or without PVR were detected in rs1800795 (IL6) (P = 0.04), rs1800871 (in the vicinity of the IL10) (P = 0.034), and rs1800471 (TGFB1) (P = 0.032). After adjustment none of the 13 analyzed single nucleotide polymorphisms showed statistically significant associations in single nucleotide polymorphism genotype distributions between patients with RRD with and without PVR.

Conclusion:
Further research is needed, particularly expanded multicentric population-based studies, to clarify the issue of genetic contribution to PVR from different genetic, clinical, and population-based aspects.
Neuropsychiatric Safety and Efficacy of Varenicline, Bupropion, and Nicotine Patch in Smokers With Psychotic, Anxiety, and Mood Disorders in the EAGLES Trial
Authors: Evins A. Eden , Benowitz Neal L. , West Robert , Russ Cristina , McRae Thomas , Lawrence David , Krishen Alok , St Aubin Lisa , Maravic Melissa Culhane , Anthenelli Robert M. 
Published: February 2019

Abstract

Background
Neuropsychiatric safety and relative efficacy of varenicline, bupropion, and transdermal nicotine patch (NRT) in those with psychiatric disorders are of interest.

Methods
We performed secondary analyses of safety and efficacy outcomes by psychiatric diagnosis in EAGLES (Evaluating Adverse Events in a Global Smoking Cessation Study), a 12-week, randomized, double-blind, triple-dummy, placebo- and active (NRT)–controlled trial of varenicline and bupropion with 12-week follow-up, in a subset population, n = 4092, with a primary psychotic (n = 390), anxiety (n = 792), or mood (n = 2910) disorder. Primary end-point parameters were incidence of prespecified moderate and severe neuropsychiatric adverse events (NPSAEs) and weeks 9 to 12 continuous abstinence rates (9–12CAR).

Results
The observed NPSAE incidence across treatments was 5.1% to 6.3% in those with a psychotic disorder, 4.6% to 8.0% in those with an anxiety disorder, and 4.6% to 6.8% in those with a mood disorder. Neither varenicline nor bupropion was associated with significantly increased NPSAEs relative to NRT or placebo in the psychiatric cohort or any psychiatric diagnostic subcohort. There was a significant effect of treatment on 9–12CAR (P < 0.0001) and no significant treatment-by-diagnostic subcohort interaction (P = 0.24). Abstinence rates with varenicline were superior to bupropion, NRT, and placebo, and abstinence with bupropion and NRT was superior to placebo. Within-diagnostic subcohort comparisons of treatment efficacy yielded estimated odds ratios for 9–12CAR versus placebo of greater than 3.00 for varenicline, greater than 1.90 for bupropion, and greater than 1.80 for NRT for all diagnostic groups.

Conclusions
Varenicline, bupropion, and nicotine patch are well tolerated and effective in adults with psychotic, anxiety, and mood disorders. The relative effectiveness of varenicline, bupropion, and NRT versus placebo did not vary across psychiatric diagnoses.
Decisional Balance for Insulin Injection: Scale Development and Psychometric Testing
Authors: HSU Hui-Chun , CHEN Shi-Yu , HUANG Yu-Chi , WANG Ruey-Hsia , LEE Yau-Jiunn , AN Ling-Wang 
Published: February 2019

ABSTRACT

Background
Insulin-naive patients are often reluctant to receive insulin treatment, and even insulin-treated patients frequently have poor rates of adherence to their prescribed insulin injection regimes. Assessing attitudes toward insulin injection may help in the design of interventions that improve the insulin injection behaviors of patients with type 2 diabetes (T2DM). The concept of decisional balance has been associated with behavior in many studies and may be useful in assessing the attitude of patients with T2DM toward insulin injection. Decisional balance for insulin injection (DBII) has not been widely assessed in patients with T2DM.

Purpose
The aim of this study was to develop an insulin injection (DBII) scale that is valid for insulin-naive and insulin-treated patients and to test the psychometric characteristics of this scale based on the concept of decisional balance.

Methods
This cross-sectional study administered an 18-item DBII scale, including pro and con subscales, to 95 insulin-naive and 237 insulin-treated patients in Taiwan. The decisional balance score was calculated as the mean score of the pro subscale minus the mean score of the con subscale. Construct validity was examined using exploratory factor analysis and confirmatory factor analysis; concurrent validity was assessed by examining the association between the score of the DBII scale and the stages of behavioral change and of hemoglobin A1c for, respectively, insulin-naive patients and insulin-treated patients; and reliability was assessed using internal consistency and test–retest reliability.

Results
A 13-item DBII scale supported by exploratory factor analysis and confirmatory factor analysis was developed. The stages of behavioral change and hemoglobin A1c levels were found to be significantly associated with the scores of decisional balance of the 13-item DBII scale for both insulin-naive and insulin-treated patients. The Cronbach's α ranged between .78 and .92.

Conclusions
The 13-item DBII scale is appropriately short and possesses satisfactory validity and reliability for both insulin-naive and insulin-treated patients with T2DM. Healthcare providers may use this scale as a checklist to guide clinical discussions related to insulin therapy with both insulin-naive and insulin-treated patients with T2DM across time.
Surgical Outcomes on Hearing and Vestibular Symptoms in Barotraumatic Perilymphatic Fistula
Authors: Ahn Jungmin , Son Se-Eun , Choi Ji Eun , Cho Young Sang , Chung Won-Ho 
Published: February 2019

Objective:
To analyze surgical results on hearing and vestibular symptoms in patients with barotraumatic perilymphatic fistula (PLF) according to diagnostic criteria.

Methods:
A total of 39 patients (41 ears) who underwent surgery on suspicion of barotraumatic PLF from January 2005 to December 2017 were included. Pure tone audiometry and videonystagmography (VNG) recording for spontaneous nystagmus and positional tests were performed preoperatively and postoperatively at 1 week and 1 month. Surgical outcomes were analyzed based on hearing results, subjective dizziness, and change of nystagmus.

Results:
Preoperative hearing level was 75.5 ± 28.7 dB for definite PLF and 88.5 ± 22.8 dB for probable PLF, and levels were not significantly different between groups. Preoperatively, subjective dizziness was present in 18 (94.7%) and 19 (95%) in each group. Among 39 patients, 24 had VNG recordings. Positional nystagmus was recorded in 87.5% (7/8) and 87.5% (14/16) of the definite and probable PLF groups, respectively. Postoperatively, hearing was improved in 65% (13/20 ears) of definite PLF and 61.9% (13/21 ears) of probable PLF. There was no significant difference between the two groups. Hearing gain was significantly correlated with the time interval between symptom onset and surgical timing. Subjective dizziness was improved immediately after surgical repair in 97.4% (17/18) of definite PLF patients and 100% (19/19) of probable PLF patients. Even though dizziness was improved in most patients, some had persistent positional nystagmus and recurrent dizziness.

Conclusions:
Surgical sealing of both windows in suspected barotraumatic PLF is an effective treatment to improve hearing and subjective dizziness.
Improvement or Recovery From Sudden Sensorineural Hearing Loss With Steroid Therapy Does Not Preclude the Need for MRI to Rule Out Vestibular Schwannoma
Authors: Puccinelli Cassandra , Carlson Matthew L. 
Published: February 2019

Objective:There is a common misconception that improvement in sudden sensorineural hearing loss (SSNHL) after treatment with steroid therapy effectively excludes the diagnosis of a vestibular schwannoma (VS) and such cases do not warrant an MRI. Paralleling this, steroids are commonly withheld for SSNHL in patients with an existing diagnosis of VS, believing that this condition is not steroid-responsive. This study seeks to underscore that improvement or recovery of SSNHL with steroid therapy does not exclude the diagnosis of VS and does not preclude the need for magnetic resonance imaging.Methods:A retrospective chart review was performed (2002–2017) of patients with previously untreated sporadic VS who developed SSNHL that improved after steroid treatment. A clinically significant audiometric improvement was defined as an increase of more than or equal to 15% in word recognition score (WRS) and/or decrease of more than or equal to 15 dB in 4-frequency pure-tone average (PTA). To supplement these data, a separate population of patients with incomplete or missing audiometric data, who reported unequivocal subjective improvement in hearing after steroid treatment, were also described to reinforce the study objective. Patient demographics, tumor characteristics, steroid regimen, and data regarding treatment response were recorded.Results:A total of 29 patients (55% women; median age of 47 yr) met inclusion criteria. Fourteen (48%) cases had objective audiometric documentation of SSNHL, while 15 (52%) had either subjective report only or incomplete audiometric data available. Eighteen (62%) had a single event, while 11 (38%) had more than one episode of SSNHL that was treated with steroids. For all patients, the median time between SSNHL and diagnosis of VS was 1.3 months (range, 0.13–148.4 mo). At the time of diagnosis, 15 tumors were purely intracanalicular, while 15 tumors had cerebellopontine angle extension. Of the latter, the median cisternal tumor size was 15.9 mm (range, 5.3–33). Twenty-six (90%) cases received oral steroid therapy alone, two (9%) had intratympanic steroid therapy alone, and one (3%) required combination therapy. The median PTA improvement with steroid therapy was 21 dB HL (range, –10–101.2) and the median WRS improvement was 40% (range, 4–100%).Conclusion:A therapeutic response to steroid therapy for SSNHL does not exclude the diagnosis of VS. All patients with SSNHL should undergo appropriate diagnostic imaging to prevent delays in diagnosis and potential treatment.
Ascertainment of Aspirin Exposure Using Structured and Unstructured Large-scale Electronic Health Record Data
Authors: Bustamante Ranier , Earles Ashley , Murphy James D. , Bryant Alex K. , Patterson Olga V. , Gawron Andrew J. , Kaltenbach Tonya , Whooley Mary A. , Fisher Deborah A. , Saini Sameer D. , Gupta Samir , Liu Lin 
Published: February 2019

Background:
Aspirin impacts risk for important outcomes such as cancer, cardiovascular disease, and gastrointestinal bleeding. However, ascertaining exposure to medications available both by prescription and over-the-counter such as aspirin for research and quality improvement purposes is a challenge.

Objectives:
Develop and validate a strategy for ascertaining aspirin exposure, utilizing a combination of structured and unstructured data.

Research Design:
This is a retrospective cohort study.

Subjects:
In total, 1,869,439 Veterans who underwent usual care colonoscopy 1999–2014 within the Department of Veterans Affairs.

Measures:
Aspirin exposure and dose were obtained from an ascertainment strategy combining query of structured medication records available in electronic health record databases and unstructured data extracted from free-text progress notes. Prevalence of any aspirin exposure and dose-specific exposure were estimated. Positive predictive value and negative predictive value were used to assess strategy performance, using manual chart review as the reference standard.

Results:
Our combined strategy for ascertaining aspirin exposure using structured and unstructured data reached a positive predictive value and negative predictive value of 99.2% and 97.5% for any exposure, and 92.6% and 98.3% for dose-specific exposure. Estimated prevalence of any aspirin exposure was 36.3% (95% confidence interval: 36.2%–36.4%) and dose-specific exposure was 35.4% (95% confidence interval: 35.3%–35.5%).

Conclusions:
A readily accessible approach utilizing a combination of structured medication records and query of unstructured data can be used to ascertain aspirin exposure when manual chart review is impractical.
Is Whole-Body CT Associated With Reduced In-Hospital Mortality in Children With Trauma? A Nationwide Study*
Authors: Abe Toshikazu , Aoki Makoto , Deshpande Gautam , Sugiyama Takehiro , Iwagami Masao , Uchida Masatoshi , Nagata Isao , Saitoh Daizoh , Tamiya Nanako 
Published: February 2019

Objectives:
We aimed to investigate whether whole-body CT for children with trauma is associated with a different mortality than only selective CT.

Design:
A multicenter, retrospective cohort study.

Setting:
Nationwide trauma registry from 183 tertiary emergency medical centers in Japan.

Patients:
We enrolled pediatric trauma patients less than 16 years old who underwent whole-body CT or selective CT from 2004 to 2014.

Interventions:
We classified the patients into a whole-body CT group if they underwent head, chest, abdomen, and pelvis CT and a selective CT group if they underwent at least one, but not all, of the above scans.

Measurements and Main Results:
We analyzed data from 9,170 eligible patients (males, 6,362 [69%]; median age, 9 yr [6–12 yr]). Of these, 3,501 (38%) underwent whole-body CT. The overall in-hospital mortality was 180 of 9,170 (2.0%), that of patients who underwent whole-body CT was 102 of 3,501 (2.9%), and that of patients who underwent selective CT was 78 of 5,669 (1.4%). After adjusted multilevel logistic regressions and propensity score matching, the whole-body CT group demonstrated no significant difference in terms of in-hospital mortality compared with the selective CT group. The adjusted odds ratios (whole-body CT vs selective CT) for in-hospital mortality were as follows: multilevel logistic regression model 1 (1.05 [95% CI, 0.70–1.56]); multilevel logistic regression model 2 (0.72 [95% CI, 0.44–1.17]); propensity score-matched model 1 (0.98 [95% CI, 0.65–1.47]); and propensity score-matched model 2 (0.71 [95% CI, 0.46–1.08]). Subgroup analyses also revealed similarities between CT selection and in-hospital mortality.

Conclusions:
In this nationwide study, whole-body CT was frequently used among Japanese children with trauma. However, compared with the use of selective CT, our results did not support the use of whole-body CT to reduce in-hospital mortality. Selective use of imaging may result in less radiation exposure and provide more benefits than whole-body CT to pediatric trauma patients.
Acute Respiratory Failure With a Rare, Rapidly Progressing Pediatric Desmoid Tumor Anterior Mediastinal Mass
Authors: McAninch Scott A. , Glenn Jared W. , Quinn Kellie , Barney Jacob K. 
Published: February 2019

Abstract
We present an unusual case of a 6-year-old boy who presented with the sudden presence of left neck mass and acute hypoxemic respiratory failure, whose subsequent imaging demonstrated a previously undiagnosed anterior mediastinal mass (AMM) extending into the left neck. Biopsy of the mass was consistent with a desmoid tumor, which is a rare cause of AMM in children. Desmoid tumors are locally aggressive, often invading and enveloping surrounding tissues, but overall slow growing. The sudden growth of the neck mass suggests a very aggressive desmoid tumor, causing an unexpected respiratory compromise. Anterior mediastinal masses may cause symptoms by compressing the heart, great vessels, and airways. However, the patient may adapt and develop compensatory mechanisms to counter the compressive effects. Emergency care of the patient with an AMM who presents with acute respiratory distress includes optimizing oxygenation through promoting a calm environment, oxygenating while minimizing positive end-expiratory pressure, maintaining the patient's compensatory mechanisms by minimizing sedation and muscle relaxation, positioning the patient to minimize compressive effects of the mass on the vital thorax structures, and early consultation with pediatric specialists to develop a shared-emergency treatment strategy and to secure an expedited disposition to the appropriate venue of care.
Regional Differences in Pediatric Firearm-Related Emergency Department Visits and the Association With Firearm Legislation
Authors: Patel Shilpa J. , Badolato Gia M. , Parikh Kavita , Iqbal Sabah F. , Goyal Monika K. 
Published: February 2019

Objective
The objective of this study was to describe regional and temporal trends in pediatric firearm-related emergency department (ED) visits and investigate association with regional firearm legislation.

Methods
We conducted a cross-sectional analysis using the Nationwide Emergency Department Sample from 2009 to 2013 for children aged 21 years or younger. We calculated national estimates of firearm-related visits using annual census data and measured trends. We used state-level gun law scores to derive regional scores to measure strictness of firearm legislation. We used multivariable logistic and linear regression to measure regional differences in visits and their association with regional gun law scores, respectively.

Results
There were 111,839 (95% confidence interval, 101,248–122,431) ED visits for pediatric firearm-related injuries. Rates of visits varied by region, with the lowest rate in the Northeast and highest rate in the South (40.0 [34–45]; 70.8 [63.7–76.9] per 100,000 ED visits, respectively). Compared with the Northeast, odds of firearm-related ED visits were higher in the Midwest (adjusted odds ratio [aOR], 1.8; 1.4–2.3), West (aOR, 2.5; 2.0–3.2), and South (aOR, 1.9; 1.5–2.4). Firearm-related visits remained consistent over time. A higher (stricter) regional median Brady gun law score was associated with a lower rate of firearm-related visits (β = −0.8; R
2 = 0.9; P = 0.03).

Conclusions
Rates of pediatric firearm-related ED visits vary by region. Stricter regional gun laws were associated with lower rates of ED visits for pediatric firearm-related injuries. Further study of the social and cultural regional differences in gun ownership and the role of legislation in the prevention of pediatric firearm-related morbidity and mortality is warranted.