bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors for Blood Transfusion with Neck Dissection
Authors: Azmy Monica C. , Pinto Juanita , Patel Nirali M. , Govindan Aparna , Kalyoussef Evelyne 
Published: April 2019

ObjectivesTo identify risk factors of perioperative blood transfusions (PBTs) for neck dissection and identify the association of PBTs with other postoperative outcomes.MethodsThis is a retrospective study of the American College of Surgeons National Surgical Quality Improvement Program (ACS‐NSQIP) database. The database was queried for neck dissection procedures performed by otolaryngologists from 2006 to 2014. Multivariable logistic regression was used to determine associations between demographic and preoperative factors, mortality, unplanned reoperation, and unplanned readmission with PBTs.ResultsOf the 3090 patients included in our study, 346 (11.2%) received a PBT, 249 patients (72.0%) received blood intraoperatively or on postoperative day (POD) 0, and 97 patients (28.0%) received blood within 5 PODs. American Society of Anesthesiologists (ASA) class ≥3 (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.4‐3.2), preoperative weight loss (OR, 2.2; 95% CI, 1.5‐3.2), and anemia (OR, 5.5; 95% CI, 4.1‐7.6) were independently associated with PBTs. Free flaps were also significantly associated with PBTs. PBTs were significantly associated with unplanned return to the operating room within 30 days (OR, 4.31; 95% CI, 3.01‐6.18) but not with 30‐day unplanned readmission or 30‐day mortality.DiscussionEleven percent of patients undergoing neck dissection receive a PBT. Identifying associated risk factors may reduce PBT among patients with cancer. Comorbid data, such as weight loss, anemia, and ASA class, may be useful in determining risk for transfusion during these procedures.Implications for PracticeAwareness of preoperative risk factors for PBT may lead surgeons to reduce the risk of PBT, anticipate the need for transfusion, and manage these patients carefully to prevent unplanned reoperation.
Effects of a compound vitamin B mixture in combination with GeneTime® on radiation-induced oral mucositis
Authors: Sun Hui , Zhu Xiaoshuai , Li Dan , Cheng Tao 
Published: April 2019

Objective Both compound vitamin B mixtures and GeneTime® have been used in treatment of oral inflammation. This study aimed to assess the therapeutic effects of a compound vitamin B mixture combined with GeneTime® on radiation-induced oral mucositis. Methods A total of 100 patients with radiation-induced oral mucositis were randomly divided into a control group (vitamin B alone; n = 50 patients) and an observation group (vitamin B plus GeneTime®, n = 50 patients). Clinical outcomes were compared between the two groups for the following 3 weeks. Results The observation group had a significantly greater number of grade 0–I patients and significantly fewer grade II–IV patients than the control group. Among patients in the observation group, a significantly greater number of ulcers healed within 1–2 weeks, compared with those in patients in the control group. Significantly fewer ulcers healed among patients in the observation group at 3 weeks; notably, there were fewer ulcers to heal in the observation group, compared with the control group. Conclusions Use of a compound vitamin B mixture combined with GeneTime® exerted obvious therapeutic effects on radiation-induced oral mucositis and markedly shortened ulcer healing time. Therefore, this strategy may be useful in clinical applications.
Heart transplant secondary to cobalt toxicity after hip arthroplasty revision
Authors: Sanz Pérez Marta I , Rico Villoras Alberto M , Moreno Velasco Aurelio , Bartolomé García Sergio , Campo Loarte Jesús 
Published: April 2019

Introduction: Cobalt toxicity in patients with hip arthroplasty is a rare complication, but it should be considered in those patients who, after a ceramic fracture, were implanted with a metal-on-polyethylene prosthesis. The complete removal of ceramic particles during revision surgery can be complicated. If the bearing surface is replaced with a metal-on-polyethylene prosthesis, these residual ceramic particles may wear down the chrome-cobalt head, producing localised metallosis. This can trigger blood metal ion levels to rise, causing systemic toxicity. Visual and auditory alterations, cognitive deterioration, hypothyroidism, neuropathy, cardiomyopathy, anorexia, fatigue, diabetes, polycythemia, and respiratory and cutaneous symptoms are some of the clinical manifestations of prosthetic cobaltism. Case description: A young patient presented with multiorgan failure secondary to cobalt toxicity after a ceramic fracture and revision with a metal-on-polyethylene prosthesis; his serum cobalt and chromium levels were 652 μg/L and 270 μg/L, respectively. The patient needed a heart transplant after presenting with cobalt-induced cardiogenic shock. Conclusions: In a patient with a ceramic fracture who is subjected to revision surgery with a metal-on-polyethylene bearing, it is necessary to rule out the possibility of cobalt intoxication. Serum cobalt levels > 20 μg/L are inadmissible; in these cases, surgical treatment should be considered in the short term. A wide synovectomy and replacement of components should be performed with hard friction options, preferably with a ceramic-on-ceramic prosthesis.
Outcome after intravenous thrombolysis in patients with acute lacunar stroke: An observational study based on SITS international registry and a meta-analysis
Authors: Matusevicius Marius , Paciaroni Maurizio , Caso Valeria , Bottai Matteo , Khurana Dheeraj , de Bastos Mario , Martins Sheila CO , Krespi Yakup , Cooray Charith , Toni Danilo , Ahmed Niaz 
Published: April 2019

Background Intravenous thrombolysis (IVT) for lacunar stroke (LS) is debated, as the underlying pathophysiological mechanism may not be thrombogenic. Aims To investigate outcomes after IVT in LS in the SITS International Stroke Thrombolysis Register and perform a meta-analysis. Methods LS was identified by both baseline NIHSS-subscores and discharge ICD-10 codes, and contrasted by IVT to non-IVT treated. IVT patients were predominantly from Europe, non-IVT patients predominantly from South America and Asia. Outcome measurements were functional independence (modified Rankin Scale [mRS] score ≤2), excellent outcome (mRS ≤ 1), and mortality at three months. Matched-control comparisons of symptomatic intracerebral hemorrhage (SICH) between IVT-treated LS and IVT-treated non-LS patients were performed. Additionally, we performed a meta-analysis. Results Median age for IVT-treated LS patients ( n = 4610) was 66 years vs. 64 years and NIHSS score was 6 vs. 3, compared to non-IVT-treated LS ( n = 1221). Univariate outcomes did not differ; however, IVT-treated LS patients had higher adjusted odds ratios (aOR) for functional independence (aOR = 1.65, 95% CI = 1.28–2.13) but similar mortality at three months (aOR = 0.57, 0.29–1.13) than non-IVT-LS. Propensity-score matched analysis showed that IVT-treated LS patients had a 7.1% higher chance of functional independency than non-IVT LS patients ( p < 0.001). IVT-treated LS patients had lower odds for SICH (aOR = 0.33, 0.19–0.58 per SITS, aOR = 0.40, 0.27–0.57 per ECASS-2) than matched non-LS controls, which was mirrored in the meta-analysis. Conclusions Our adjusted results show that IVT treatment in LS patients was associated with better functional outcome than non-IVT-treated LS and less SICH than IVT-treated non-LS patients.
Risk factors for cognitive impairment in older people with diabetes: a community-based study
Authors: Xiu Shuangling , Liao Qiuju , Sun Lina , Chan Piu 
Published: April 2019

Aim: The aim of this study was to investigate the risk factors for cognitive impairment in older people with diabetes. Methods: This cross-sectional study included 2626 community-dwelling participants with diabetes aged ⩾55 years, living in Beijing, China. The participants were screened for risk factors, including smoking, obesity, hypertension, stroke, coronary heart disease, dyslipidemia, depression, apolipoprotein E (APOE) genotype, and low physical activity. Cognitive function was assessed with the scholarship-adjusted Mini-Mental State Examination (MMSE): MMSE ⩽17 for iliterate participants; MMSE ⩽20 for primary school graduates (⩾6 years of education); and MMSE ⩽24 for junior school graduates or above (⩾9 years of education). Results: The prevalence of cognitive impairment in older people with diabetes was 9.90%. Multiple logistic regression analysis demonstrated that stroke [odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.20–2.43], less than 0.5 h exercise per day (OR = 1.89, 95% CI = 1.37–2.61), and depression (OR = 1.64, 95% CI = 1.06–2.54), but not smoking, obesity, hypertension, dyslipidemia, and coronary heart disease, were independent risks for cognitive impairment in older people with diabetes. In addition, being married (OR = 0.66, 95% CI = 0.47–0.93) and urban living (OR = 0.33, 95% CI = 0.22–0.48) could decrease the risk of cognitive impairment. Conclusions: Stroke, depression, and less than 0.5 h exercise per day were independent risks for cognitive impairment in older people with diabetes, whereas being married and urban living were protective.
Outcomes Following Interposition Arthroplasty of the First Metatarsophalangeal Joint for the Treatment of Hallux Rigidus: A Systematic Review
Authors: Emmons Brendan R. , Carreira Dominic S. 
Published: April 2019

Background: Interposition arthroplasty of the first MTP joint has recently experienced renewed interest as a treatment for hallux rigidus. The purpose of this study was to systematically review the rapidly expanding literature on PRO following interposition arthroplasty of the first MTP joint. Methods: PubMed Central, Embase, and the Cochrane Central Register for Controlled Trials (CENTRAL) were searched. Inclusion criteria included length of time to follow-up, number of patients, outcome measure, and use of allogeneic or autogenous soft tissue or a synthetic matrix as interposition. Results: 20 studies were included in the review, comprising 498 patients and 539 feet with mean time to follow-up of 4.5 years. The most common substance used for interposition in the included studies was autogenous first MTPJ capsular tissue, a technique reported on in 12 (60.0%) of the included articles. In studies reporting preoperative and postoperative outcomes by way of a standardized outcome scoring system, mean group improvements exceed minimal clinically important differences in the majority of studies. Eighty-five percent of the studies included in this review were of Level IV quality evidence, and of this subset of studies, 70.6% were of a retrospective nature. Progression to further surgery was observed in 3.8% of toes. The most common complication reported was transfer metatarsalgia of 1 or more lesser toes, observed in up to 57.9% of patients in one study. Conclusion: Interposition arthroplasty appears to be a viable option for the treatment of moderate to severe hallux rigidus in patients looking to salvage motion through the first metatarsophalangeal joint. A wide array of autogenous, allogeneic, and synthetic implant materials have surfaced in recent years, but long-term follow-up and prospective, comparative study designs with low risk of bias are limited. Level of Evidence: Level IV, systematic review of Level III-IV studies
Pediatric Evans syndrome is associated with a high frequency of potentially damaging variants in immune genes
Authors: Hadjadj Jérôme , Aladjidi Nathalie , Fernandes Helder , Leverger Guy , Magérus-Chatinet Aude , Mazerolles Fabienne , Stolzenberg Marie-Claude , Jacques Sidonie , Picard Capucine , Rosain Jérémie , Fourrage Cécile , Hanein Sylvain , Zarhrate Mohammed , Pasquet Marlène , Abou Chahla Wadih , Barlogis Vincent , Bertrand Yves , Pellier Isabelle , Colomb Bottollier Elodie , Fouyssac Fanny , Blouin Pascale , Thomas Caroline , Cheikh Nathalie , Dore Eric , Pondarre Corinne , Plantaz Dominique , Jeziorski Eric , Millot Frédéric , Garcelon Nicolas , Ducassou Stéphane , Perel Yves , Leblanc Thierry , Neven Bénédicte , Fischer Alain , Rieux-Laucat Frédéric 
Published: April 2019

Abstract
Evans syndrome (ES) is a rare severe autoimmune disorder characterized by the combination of autoimmune hemolytic anemia and immune thrombocytopenia. In most cases, the underlying cause is unknown. We sought to identify genetic defects in pediatric ES (pES), based on a hypothesis of strong genetic determinism. In a national, prospective cohort of 203 patients with early-onset ES (median [range] age at last follow-up: 16.3 years ([1.2-41.0 years]) initiated in 2004, 80 nonselected consecutive individuals underwent genetic testing. The clinical data were analyzed as a function of the genetic findings. Fifty-two patients (65%) received a genetic diagnosis (the M+ group): 49 carried germline mutations and 3 carried somatic variants. Thirty-two (40%) had pathogenic mutations in 1 of 9 genes known to be involved in primary immunodeficiencies (TNFRSF6, CTLA4, STAT3, PIK3CD, CBL, ADAR1, LRBA, RAG1, and KRAS), whereas 20 patients (25%) carried probable pathogenic variants in 16 genes that had not previously been reported in the context of autoimmune disease. Lastly, no genetic abnormalities were found in the remaining 28 patients (35%, the M− group). The M+ group displayed more severe disease than the M− group, with a greater frequency of additional immunopathologic manifestations and a greater median number of lines of treatment. Six patients (all from the M+ group) died during the study. In conclusion, pES was potentially genetically determined in at least 65% of cases. Systematic, wide-ranging genetic screening should be offered in pES; the genetic findings have prognostic significance and may guide the choice of a targeted treatment.
Leflunomide regulates c-Myc expression in myeloma cells through PIM targeting
Authors: Buettner Ralf , Morales Corey , Caserta Enrico , Troadec Estelle , Gunes Emine G. , Viola Domenico , Khalife Jihane , Li Hongzhi , Keats Jonathan J. , Christofferson Austin , Wu Xiwei , Synold Timothy W. , Palmer Joycelynne , Sanchez James F. , Pozhitkov Alexander , Vaidehi Nagarajan , Marcucci Guido , Krishnan Amrita , Rosenzweig Michael A. , Pichiorri Flavia , Rosen Steven T. 
Published: April 2019

Key Points
Teriflunomide, the active metabolite of leflunomide, downregulates c-Myc expression through inhibition of PIM kinases. Leflunomide together with lenalidomide significantly extended survival in an in vivo MM model.
Presenting symptoms in inflammatory bowel disease: descriptive analysis of a community-based inception cohort
Authors: Perler Bryce K. , Ungaro Ryan , Baird Grayson , Mallette Meaghan , Bright Renee , Shah Samir , Shapiro Jason , Sands Bruce E. 
Published: April 2019

Abstract
Background
Few data are currently available on the initial presenting symptoms of patients with inflammatory bowel disease (IBD).

Methods
We evaluated the initial symptom presentation of patients with IBD in the Ocean State Crohn’s and Colitis Area Registry (OSCCAR), a community-based inception cohort that enrolled Rhode Island IBD patients at time of diagnosis with longitudinal follow up. A 41-question symptom inventory was administered at time of enrollment to capture symptoms experienced during the 4 weeks preceding diagnosis of IBD. Frequencies of presenting symptoms were calculated. Principal component analysis (PCA) with promax rotation was used to examine possible symptom profiles among Crohn’s disease (CD) and ulcerative colitis (UC) patients, respectively. Using the Scree plot, the 4-component solution was found to be optimal for both CD and UC.

Results
A total of 233 CD and 150 UC patients were included. The most common presenting symptoms in CD were tiredness/fatigue (80.6%) and abdominal pain (80.4%) while passage of blood with bowel movements (BM) (86.6%) and loose/watery BMs (86.5%) were most common in UC. The 5 symptoms with greatest differences between UC and CD were passage of blood with BM (UC 86.6%/CD 45.3%), urgent BM (UC 82.5%/CD 63.9%), passage of mucus with BM (UC 67.7%/CD 36.9%), passage of blood from the anus (UC 59.7%/CD 32.1%), and anxiety about distance from bathroom (UC 59%/CD 38.7%). The PCA analysis yielded a 4 symptom components solution for CD and UC.

Conclusion
The most common presenting symptoms in CD are fatigue and abdominal pain while in UC bloody BM and diarrhea are most common. Distinct symptom phenotypes are seen with PCA analysis. Our study demonstrates symptomatic similarities and differences between CD and UC and suggests that patients may also be classified by symptom phenotype at time of diagnosis.
Effect of food intake on 92 oncological biomarkers by the Proseek Oncology II panel
Authors: Dencker Magnus , Björgell Ola , Hlebowicz Joanna 
Published: April 2019

Abstract
Objective
To evaluates the effect of food intake on 92 oncological biomarkers to evaluate whether the timing of blood sampling could be relevant. Twenty-two healthy subjects were investigated. A total of 92 biomarkers were measured before a standardised meal as well as 30 and 120 min afterwards with the Proseek Multiplex Oncology II kit.

Results
The levels of 6 biomarkers decreased significantly (P < 0.001) 30 min after food intake, and 4 biomarkers remained decreased (P < 0.001) 120 min after food intake. One biomarker was significantly increased (P < 0.001) at both 30 and 120 min after food intake. Some changes were less than 10%. Those biomarkers that showed a difference of more than 10% include: Granzyme H (13%), Methionine aminopeptidase 2 (14%), Secretory carrier-associated membrane protein 3 (39%), FAS-associated death domain protein (41%), and Pancreatic prohormone (79%). This study shows that food intake has a very modest effect on 92 different oncological biomarkers.
Trial registration National Library of Medicine trial registration number NCT01027507 (retrospectively registered on December 8, 2009)
Comparative Efficacy of Therapeutics for Chronic Cancer Pain: A Bayesian Network Meta-Analysis
Authors: Huang Rongzhong , Jiang Lihong , Cao Yu , Liu Hongli , Ping Minsheng , Li Wei , Xu Yu , Ning Jie , Chen Yuqing , Wang Xiaojing 
Published: April 2019

PURPOSE Opioids are the primary choice for managing chronic cancer pain. However, many nonopioid therapies are currently prescribed for chronic cancer pain with little published evidence comparing their efficacy. METHODS Electronic databases were searched for randomized controlled trials (RCTs) comparing any systemic pharmaceutical intervention and/or combination thereof in treating chronic cancer pain. The primary outcome was global efficacy reported as an odds ratio (OR). The secondary outcome was change in pain intensity reported as a standardized mean difference (SMD). RESULTS We included 81 RCTs consisting of 10,003 patients investigating 11 medication classes. Most RCTs (80%) displayed low risk of bias. The top-ranking classes for global efficacy were nonopioid analgesics (network OR, 0.30; 95% credibility interval [CrI], 0.13 to 0.67), nonsteroidal anti-inflammatory drugs (network OR, 0.44; 95% CrI, 0.22 to 0.90), and opioids (network OR, 0.49; 95% CrI, 0.27 to 0.86), whereas the top-ranked interventions were lidocaine (network OR, 0.04; 95% CrI, 0.01 to 0.18; surface under the cumulative ranking curve analysis [SUCRA] score, 98.1), codeine plus aspirin (network OR, 0.22; 95% CrI, 0.08 to 0.63; SUCRA score, 81.1), and pregabalin (network OR, 0.29; 95% CrI, 0.08 to 0.92; SUCRA score, 73.8). In terms of reducing pain intensity, we found that no class was superior to placebo, whereas the following top-ranked interventions were superior to placebo: ziconotide (network SMD, −24.98; 95% CrI, −32.62 to −17.35; SUCRA score, 99.8), dezocine (network SMD, −13.56; 95% CrI, −23.37 to −3.69; SUCRA score, 93.5), and diclofenac (network SMD, −11.22; 95% CrI, −15.91 to −5.80; SUCRA score, 92.9). CONCLUSION There are significant differences in efficacy among current regimens for chronic cancer pain. Our evidence suggests that certain nonopioid analgesics and nonsteroidal anti-inflammatory drugs can serve as effectively as opioids in managing chronic cancer pain.
Seven-Year Follow-Up Analysis of Adjuvant Paclitaxel and Trastuzumab Trial for Node-Negative, Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer
Authors: Tolaney Sara M. , Guo Hao , Pernas Sonia , Barry William T. , Dillon Deborah A. , Ritterhouse Lauren , Schneider Bryan P. , Shen Fei , Fuhrman Kit , Baltay Michele , Dang Chau T. , Yardley Denise A. , Moy Beverly , Marcom P. Kelly , Albain Kathy S. , Rugo Hope S. , Ellis Mathew J. , Shapira Iuliana , Wolff Antonio C. , Carey Lisa A. , Overmoyer Beth , Partridge Ann H. , Hudis Clifford A. , Krop Ian E. , Burstein Harold J. , Winer Eric P. 
Published: April 2019

PURPOSE The Adjuvant Paclitaxel and Trastuzumab trial was designed to address treatment of patients with small human epidermal growth factor receptor 2 (HER2)–positive breast cancer. The primary analysis of the Adjuvant Paclitaxel and Trastuzumab trial demonstrated a 3-year disease-free survival (DFS) of 98.7%. In this planned secondary analysis, we report longer-term outcomes and exploratory results to characterize the biology of small HER2-positive tumors and genetic factors that may predispose to paclitaxel-induced peripheral neuropathy (TIPN). PATIENTS AND METHODS In this phase II study, patients with HER2-positive breast cancer with tumors 3 cm or smaller and negative nodes received paclitaxel (80 mg/m2) with trastuzumab for 12 weeks, followed by trastuzumab for 9 months. The primary end point was DFS. Recurrence-free interval (RFI), breast cancer–specific survival, and overall survival (OS) were also analyzed. In an exploratory analysis, intrinsic subtyping by PAM50 (Prosigna) and calculation of the risk of recurrence score were performed on the nCounter analysis system on archival tissue. Genotyping was performed to investigate TIPN. RESULTS A total of 410 patients were enrolled from October 2007 to September 2010. After a median follow-up of 6.5 years, there were 23 DFS events. The 7-year DFS was 93% (95% CI, 90.4 to 96.2) with four (1.0%) distant recurrences, 7-year OS was 95% (95% CI, 92.4 to 97.7), and 7-year RFI was 97.5% (95% CI, 95.9 to 99.1). PAM50 analyses (n = 278) showed that most tumors were HER2-enriched (66%), followed by luminal B (14%), luminal A (13%), and basal-like (8%). Genotyping (n = 230) identified one single-nucleotide polymorphism, rs3012437, associated with an increased risk of TIPN in patients with grade 2 or greater TIPN (10.4%). CONCLUSION With longer follow-up, adjuvant paclitaxel and trastuzumab is associated with excellent long-term outcomes. Distribution of PAM50 intrinsic subtypes in small HER2-positive tumors is similar to that previously reported for larger tumors.