bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Systolic Blood Pressure Variation as an Indicator of Pulmonary Capillary Wedge Pressure in Ventilated Patients
Authors: Marik P. E. 
Published: January 2019

Animal data have suggested that the systolic pressure variation (SPV) noted during positive pressure ventilation may be a sensitive indicator of hypovolaemia. The aim of this study was to correlate the SPV with the pulmonary capillary wedge pressure (PCWP) in a heterogeneous group of ICU patients on volume-cycled ventilation. Three hundred data sets were collected on 226 patients. The correlation coefficient between the SPV and PCWP for the first half of the data set was - 0.84 (P<0.001). The linear regression formula from this data set was: PCWP = 20- (SPV*0.7). Using this formula the predicted PCWP was then correlated with the measured PCWP using the second half of the data base. The correlation coefficient was 0.87 (P<0.001). The correlation coefficient between the SPV and PCWP for the entire data base (300 observations) was -0.86 (P<0.001). It is concluded that analysis of the arterial pressure tracing may be useful in estimating the pulmonary capillary wedge pressure in ventilated patients.
Changes in Respiratory Mechanics during Abdominal Laparoscopic Surgery in Children
Authors: Bergesio R. , Habre W. , Lanteri C. , Sly P. 
Published: January 2019

We designed this study in order to measure the changes in respiratory mechanics during laparoscopic surgery in children. Ventilation parameters (Flow (Ví) and Peak Pressure (Pmax)) were measured and total respiratory system mechanics (resistance (Rrs) and compliance(Crs)) were derived using multiple linear regression analysis in 11 children aged 8 months to 11 years. The Pmax increased by 26.6% and the Rrs increased by 20.2% whilst the Crs decreased by 38.9% after pneumoperitoneum. These findings suggest that clinically important changes in respiratory mechanics occur as a result of the pneumoperitoneum produced during abdominal laparoscopic surgery.
Reducing return of disease activity in patients with relapsing multiple sclerosis transitioned from natalizumab to teriflunomide: 12-month interim results of teriflunomide therapy
Authors: Cohan Stanley L , Edwards Keith , Lucas Lindsay , Gervasi-Follmar Tiffany , O’Connor Judy , Siuta Jessica , Kamath Vineetha , Garten Lore , Chen Chiayi , Thomas James , Smoot Kyle , Kresa-Reahl Kiren , Spinelli Kateri J 
Published: January 2019

Background Natalizumab is an effective treatment for relapsing multiple sclerosis. Return of disease activity upon natalizumab discontinuance creates the need for follow-up therapeutic strategies. Objective To assess the efficacy of teriflunomide following natalizumab discontinuance in relapsing multiple sclerosis patients. Methods Clinically stable relapsing multiple sclerosis patients completing 12 or more consecutive months of natalizumab, testing positive for anti-John Cunningham virus antibody, started teriflunomide 14 mg/day, 28 ± 7 days after their final natalizumab infusion. Physical examination, Expanded Disability Status Scale, laboratory assessments, and brain magnetic resonance imaging were performed at screening and multiple follow-up visits. Results Fifty-five patients were enrolled in the study. The proportion of patients relapse-free was 0.94, restricted mean time to first gadolinium-enhancing lesion was 10.9 months and time to 3-month sustained disability worsening was 11.8 months. The mean number of new or enlarging T2 lesions per patient at 12 months was 0.42. Exploratory analyses revealed an annualized relapse rate of 0.08, and a proportion of patients with no evidence of disease activity of 0.68. Forty-seven patients (85.5%) reported adverse events, 95% of which were mild to moderate. Conclusions Teriflunomide therapy initiated without natalizumab washout resulted in a low rate of return of disease activity. Clinicians may consider this a worthwhile strategy when transitioning clinically stable patients off natalizumab to another therapy. ClinicalTrials.gov Identifier: NCT01970410
Systematic review and meta-analysis of the prevalence of cognitive impairment no dementia in the first year post-stroke
Authors: Sexton Eithne , McLoughlin Affraic , Williams David J , Merriman Niamh A , Donnelly Nora , Rohde Daniela , Hickey Anne , Wren Maev-Ann , Bennett Kathleen 
Published: January 2019

Introduction Increasing attention is being paid to interventions for cognitive impairment (CI) post-stroke, including for CI that does not meet dementia criteria. The aim of this paper was to conduct a systematic review and meta-analysis of the prevalence of cognitive impairment no dementia (CIND) within one year post-stroke. Patients and methods Pubmed, EMBASE and PsychInfo were searched for papers published in English in 1995–2017. Included studies were population or hospital-based cohort studies for first-ever/recurrent stroke, assessing CIND using standardised criteria at 1–12 months post-stroke. Abstracts were screened, followed by full text review of potentially relevant articles. Data were extracted using a standard form, and study quality was appraised using the Crowe Critical Appraisal Tool. A pooled prevalence of CIND with 95% confidence intervals (CI) was estimated using random-effects meta-analysis. Heterogeneity was measured using the I2 statistic. Results A total of 7000 abstracts were screened, followed by 1028 full text articles. Twenty-three articles were included in the systematic review, and 21 in the meta-analysis. The pooled CIND prevalence was 38% [95% CI = 32–43%] (I2=92.5%, p < 0.01). Study quality emerged as one source of heterogeneity. The five studies with the highest quality scores had no heterogeneity (I2=0%, p = 0.99), with a similar pooled prevalence (39%, 95%CI = 35–42%). Other sources of heterogeneity were stroke type, inclusion of pre-stroke CI, and age at assessment time. Discussion and conclusion: Meta-analysis of available studies indicates that in the first year post-stroke, 4 in 10 patients display a level of cognitive impairment that does not meet the criteria for dementia.
NCF1 (p47phox)–deficient chronic granulomatous disease: comprehensive genetic and flow cytometric analysis
Authors: Kuhns Douglas B. , Hsu Amy P. , Sun David , Lau Karen , Fink Danielle , Griffith Paul , Huang Da Wei , Priel Debra A. Long , Mendez Laura , Kreuzburg Samantha , Zerbe Christa S. , De Ravin Suk See , Malech Harry L. , Holland Steven M. , Wu Xiaolin , Gallin John I. 
Published: January 2019

AbstractMutations in NCF1 (p47phox) cause autosomal recessive chronic granulomatous disease (CGD) with abnormal dihydrorhodamine (DHR) assay and absent p47phox protein. Genetic identification of NCF1 mutations is complicated by adjacent highly conserved (&gt;98%) pseudogenes (NCF1B and NCF1C). NCF1 has GTGT at the start of exon 2, whereas the pseudogenes each delete 1 GT (ΔGT). In p47phox CGD, the most common mutation is ΔGT in NCF1 (c.75_76delGT; p.Tyr26fsX26). Sequence homology between NCF1 and its pseudogenes precludes reliable use of standard Sanger sequencing for NCF1 mutations and for confirming carrier status. We first established by flow cytometry that neutrophils from p47phox CGD patients had negligible p47phox expression, whereas those from p47phox CGD carriers had ∼60% of normal p47phox expression, independent of the specific mutation in NCF1. We developed a droplet digital polymerase chain reaction (ddPCR) with 2 distinct probes, recognizing either the wild-type GTGT sequence or the ΔGT sequence. A second ddPCR established copy number by comparison with the single-copy telomerase reverse transcriptase gene, TERT. We showed that 84% of p47phox CGD patients were homozygous for ΔGT NCF1. The ddPCR assay also enabled determination of carrier status of relatives. Furthermore, only 79.2% of normal volunteers had 2 copies of GTGT per 6 total (NCF1/NCF1B/NCF1C) copies, designated 2/6; 14.7% had 3/6, and 1.6% had 4/6 GTGT copies. In summary, flow cytometry for p47phox expression quickly identifies patients and carriers of p47phox CGD, and genomic ddPCR identifies patients and carriers of ΔGT NCF1, the most common mutation in p47phox CGD.
Validation of the United Kingdom copy-number alteration classifier in 3239 children with B-cell precursor ALL
Authors: Hamadeh Lina , Enshaei Amir , Schwab Claire , Alonso Cristina N. , Attarbaschi Andishe , Barbany Gisela , den Boer Monique L. , Boer Judith M. , Braun Marcin , Dalla Pozza Luciano , Elitzur Sarah , Emerenciano Mariana , Fechina Larisa , Felice Maria Sara , Fronkova Eva , Haltrich Irén , Heyman Mats M. , Horibe Keizo , Imamura Toshihiko , Jeison Marta , Kovács Gábor , Kuiper Roland P. , Mlynarski Wojciech , Nebral Karin , Ivanov Öfverholm Ingegerd , Pastorczak Agata , Pieters Rob , Piko Henriett , Pombo-de-Oliveira Maria S. , Rubio Patricia , Strehl Sabine , Stary Jan , Sutton Rosemary , Trka Jan , Tsaur Grigory , Venn Nicola , Vora Ajay , Yano Mio , Harrison Christine J. , Moorman Anthony V. 
Published: January 2019

Abstract
Genetic abnormalities provide vital diagnostic and prognostic information in pediatric acute lymphoblastic leukemia (ALL) and are increasingly used to assign patients to risk groups. We recently proposed a novel classifier based on the copy-number alteration (CNA) profile of the 8 most commonly deleted genes in B-cell precursor ALL. This classifier defined 3 CNA subgroups in consecutive UK trials and was able to discriminate patients with intermediate-risk cytogenetics. In this study, we sought to validate the United Kingdom ALL (UKALL)–CNA classifier and reevaluate the interaction with cytogenetic risk groups using individual patient data from 3239 cases collected from 12 groups within the International BFM Study Group. The classifier was validated and defined 3 risk groups with distinct event-free survival (EFS) rates: good (88%), intermediate (76%), and poor (68%) (P &lt; .001). There was no evidence of heterogeneity, even within trials that used minimal residual disease to guide therapy. By integrating CNA and cytogenetic data, we replicated our original key observation that patients with intermediate-risk cytogenetics can be stratified into 2 prognostic subgroups. Group A had an EFS rate of 86% (similar to patients with good-risk cytogenetics), while group B patients had a significantly inferior rate (73%, P &lt; .001). Finally, we revised the overall genetic classification by defining 4 risk groups with distinct EFS rates: very good (91%), good (81%), intermediate (73%), and poor (54%), P &lt; .001. In conclusion, the UKALL-CNA classifier is a robust prognostic tool that can be deployed in different trial settings and used to refine established cytogenetic risk groups.
Tumor-Infiltrating Lymphocytes and Prognosis: A Pooled Individual Patient Analysis of Early-Stage Triple-Negative Breast Cancers
Authors: Loi Sherene , Drubay Damien , Adams Sylvia , Pruneri Giancarlo , Francis Prudence A. , Lacroix-Triki Magali , Joensuu Heikki , Dieci Maria Vittoria , Badve Sunil , Demaria Sandra , Gray Robert , Munzone Elisabetta , Lemonnier Jerome , Sotiriou Christos , Piccart Martine J. , Kellokumpu-Lehtinen Pirkko-Liisa , Vingiani Andrea , Gray Kathryn , Andre Fabrice , Denkert Carsten , Salgado Roberto , Michiels Stefan 
Published: January 2019

Purpose The aim of the current study was to conduct a pooled analysis of studies that have investigated the prognostic value of tumor-infiltrating lymphocytes (TILs) in early-stage triple negative breast cancer (TNBC). Methods Participating studies had evaluated the percentage infiltration of stromally located TILs (sTILs) that were quantified in the same manner in patient diagnostic samples of early-stage TNBC treated with anthracycline-based chemotherapy with or without taxanes. Cox proportional hazards regression models stratified by trial were used for invasive disease-free survival (iDFS; primary end point), distant disease-free survival (D-DFS), and overall survival (OS), fitting sTILs as a continuous variable adjusted for clinicopathologic factors. Results We collected individual data from 2,148 patients from nine studies. Average age was 50 years (range, 22 to 85 years), and 33% of patients were node negative. The average value of sTILs was 23% (standard deviation, 20%), and 77% of patients had 1% or more sTILs. sTILs were significantly lower with older age ( P = .001), larger tumor size ( P = .01), more nodal involvement ( P = .02), and lower histologic grade ( P = .001). A total of 736 iDFS and 548 D-DFS events and 533 deaths were observed. In the multivariable model, sTILs added significant independent prognostic information for all end points (likelihood ratio χ2, 48.9 iDFS; P < .001; χ2, 55.8 D-DFS; P < .001; χ2, 48.5 OS; P < .001). Each 10% increment in sTILs corresponded to an iDFS hazard ratio of 0.87 (95% CI, 0.83 to 0.91) for iDFS, 0.83 (95% CI, 0.79 to 0.88) for D-DFS, and 0.84 (95% CI, 0.79 to 0.89) for OS. In node-negative patients with sTILs ≥ 30%, 3-year iDFS was 92% (95% CI, 89% to 98%), D-DFS was 97% (95% CI, 95% to 99%), and OS was 99% (95% CI, 97% to 100%). Conclusion This pooled data analysis confirms the strong prognostic role of sTILs in early-stage TNBC and excellent survival of patients with high sTILs after adjuvant chemotherapy and supports the integration of sTILs in a clinicopathologic prognostic model for patients with TNBC. This model can be found at www.tilsinbreastcancer.org .
Continuous Noninvasive Arterial Pressure Monitoring in Obese Patients During Bariatric Surgery: An Evaluation of the Vascular Unloading Technique (Clearsight system)
Authors: Rogge Dorothea E. , Nicklas Julia Y. , Schön Gerhard , Grothe Oliver , Haas Sebastian A. , Reuter Daniel A. , Saugel Bernd 
Published: January 2019

BACKGROUND:
Continuous monitoring of arterial pressure is important in severely obese patients who are at particular risk for cardiovascular complications. Innovative technologies for continuous noninvasive arterial pressure monitoring are now available. In this study, we compared noninvasive arterial pressure measurements using the vascular unloading technique (Clearsight system; Edwards Lifesciences Corp, Irvine, CA) with invasive arterial pressure measurements (radial arterial catheter) in severely obese patients during laparoscopic bariatric surgery.

METHODS:
In 35 severely obese patients (median body mass index, 47 kg/m2), we simultaneously recorded noninvasive and invasive arterial pressure measurements over a period of 45 minutes. We compared noninvasive (test method) and invasive (reference method) arterial pressure measurements (sampling rate 1 Hz = 1/s) using Bland-Altman analysis (accounting for multiple measurements per subject), 4-quadrant plot/concordance analysis (2-minute interval, 5 mm Hg exclusion zone), and error grid analysis (calculating the proportions of measurements in risk zones A–E with A indicating no risk, B low risk, C moderate risk, D significant risk, and E dangerous risk for the patient due to the risk of wrong clinical interventions because of measurement errors).

RESULTS:
We observed a mean of the differences (±SD, 95% limits of agreement) between the noninvasively and invasively assessed arterial pressure values of 1.1 mm Hg (±7.4 mm Hg, −13.5 to 15.6 mm Hg) for mean arterial pressure (MAP), 6.8 mm Hg (±10.3 mm Hg, −14.4 to 27.9 mm Hg) for systolic arterial pressure, and 0.8 mm Hg (±6.9 mm Hg, −12.9 to 14.4 mm Hg) for diastolic arterial pressure. The 4-quadrant plot concordance rate (ie, the proportion of arterial pressure measurement pairs showing concordant changes to all changes) was 93% (CI, 89%–96%) for MAP, 93% (CI, 89%–97%) for systolic arterial pressure, and 88% (CI, 84%–92%) for diastolic arterial pressure. Error grid analysis showed that the proportions of measurements in risk zones A–E were 89.5%, 10.0%, 0.5%, 0%, and 0% for MAP and 93.7%, 6.0%, 0.3%, 0%, and 0% for systolic arterial pressure, respectively.

CONCLUSIONS:
During laparoscopic bariatric surgery, the accuracy and precision of the vascular unloading technique (Clearsight system) was good for MAP and diastolic arterial pressure, but only moderate for systolic arterial pressure according to Bland-Altman analysis. The system showed good trending capabilities. In the error grid analysis, >99% of vascular unloading technique–derived arterial pressure measurements were categorized in no- or low-risk zones.
Music Interventions in Pediatric Surgery (The Music Under Surgery In Children Study): A Randomized Clinical Trial
Authors: Kühlmann A. Y. Rosalie , van Rosmalen Joost , Staals Lonneke M. , Keyzer-Dekker Claudia M. G. , Dogger Jaap , de Leeuw Tom G. , van der Toorn Fred , Jeekel Johannes , Wijnen Rene M. H. , van Dijk Monique 
Published: January 2019

BACKGROUND:
Perioperative music interventions have been shown to reduce anxiety and pain in adults. This inexpensive, easily applicable intervention could be of benefit to children as well. Our objective was to determine the effects of music interventions on distress, anxiety, and postoperative pain in infants undergoing surgery.

METHODS:
The Music Under Surgery In Children study was designed as a parallel, single-blind, randomized controlled trial with an a priori formulated hypothesis. Data were collected between August 2015 and October 2016 in a single tertiary care children’s hospital. There was a 24-hour follow-up with blind primary outcome assessment. A random sample of 432 eligible 0–3 years of age infants admitted for orchidopexy, hypospadias, or inguinal hernia repair receiving general anesthesia and caudal block were asked for participation. Subjects were assigned to a preoperative music intervention, pre- and intraoperative music intervention, or no music intervention (control) via random allocation using a computer-generated list with the use of opaque envelopes. The main outcome measure was the postoperative level of distress assessed with the COMFORT-Behavior scale, which is an observational scale; furthermore, preoperative level of distress, preoperative anxiety, and physiological measurements such as heart rate (HR) and blood pressure were measured. The trial was registered at the Dutch Trial Register, number NTR5402 (www.trialregister.nl).

RESULTS:
One hundred ninety-five infants with median age 6.9 months (interquartile range, 3.3–11.1) were randomized, 178 of whom were included in the primary analysis. A nonsignificant difference in COMFORT-Behavior scale scores between the pre- and intraoperative music intervention group and control group at 4 hours after surgery was found (mean difference, −1.22; 95% CI, 2.60–0.17; P = .085). Additional analysis showed weak nonsignificant evidence for an interaction effect between music exposure and COMFORT-Behavior score at baseline (P = .027 with a Bonferroni-adjusted significance level of .025). General linear modeling showed a statistically significantly reduced HR after the preoperative music intervention in the holding area in the combined preoperative music intervention and intraoperative music intervention group compared to the control group (P = .003). The differences in HR among the 3 study arms at all time points were not statistically significant (P = .069).

CONCLUSIONS:
Music interventions do not seem to benefit all young infants undergoing surgery. The potential benefits of music interventions in the preoperative period and in more distressed children warrant further exploration.
The use of dual-mobility bearings in patients at high risk of dislocation
Authors: Jones C. W. , De Martino I. , D’Apolito R. , Nocon A. A. , Sculco P. K. , Sculco T. P. 
Published: January 2019

AimsInstability continues to be a troublesome complication after total hip arthroplasty (THA). Patient-related risk factors associated with a higher dislocation risk include the preoperative diagnosis, an age of 75 years or older, high body mass index (BMI), a history of alcohol abuse, and neurodegenerative diseases. The goal of this study was to assess the dislocation rate, radiographic outcomes, and complications of patients stratified as high-risk for dislocation who received a dual mobility (DM) bearing in a primary THA at a minimum follow-up of two years.Materials and MethodsWe performed a retrospective review of a consecutive series of DM THA performed between 2010 and 2014 at our institution (Hospital for Special Surgery, New York, New York) by a single, high-volume orthopaedic surgeon employing a single prosthesis design (Anatomic Dual Mobility (ADM) Stryker, Mahwah, New Jersey). Patient medical records and radiographs were reviewed to confirm the type of implant used, to identify any preoperative risk factors for dislocation, and any complications. Radiographic analysis was performed to assess for signs of osteolysis or remodelling of the acetabulum.ResultsThere were 151 patients who met the classification of high-risk according to the inclusion criteria and received DM THA during the study period. Mean age was 82 years old (73 to 95) and 114 patients (77.5%) were female. Mean follow-up was 3.6 years (1.9 to 6.1), with five patients lost to follow-up and one patient who died (for a reason unrelated to the index procedure). One patient (0.66%) sustained an intraprosthetic dislocation; there were no other dislocations.ConclusionAt mid-term follow-up, the use of a DM bearing for primary THA in patients at high risk of dislocation provided a stable reconstruction option with excellent radiographic results. Longer follow-up is needed to confirm the durability of these reconstructions.
Should postoperative haemoglobin and potassium levels be checked routinely following blood-conserving primary total joint arthroplasty?
Authors: Greco N. J. , Manocchio A. G. , Lombardi A. V. , Gao S. L. , Adams J. , Berend K. R. 
Published: January 2019

AimsDespite declining frequency of blood transfusion and electrolyte supplementation following total joint arthroplasty, postoperative blood analyses are still routinely ordered for these patients. This study aimed to determine the rate of blood transfusion and electrolyte restoration in arthroplasty patients treated with a perioperative blood conservation protocol and to identify risk factors that would predict the need for transfusion and electrolyte supplementation.Patients and MethodsPatients undergoing primary total joint arthroplasty of the hip or knee between July 2016 and February 2017 at a single institution were included in the study. Standard preoperative and postoperative laboratory data were collected and reviewed retrospectively. A uniform blood conservation programme was implemented for all patients. Need for blood transfusion or potassium supplementation was determined through a coordinated decision by the care team. Rates of transfusion and supplementation were observed, and patient risk factors were noted.ResultsThe overall rate of blood transfusion was 1.06% in the study population of 1132 total joint arthroplasties performed in 1023 patients. Of the 12 patients requiring transfusion, 11 were female, ten occurred in patients undergoing total hip arthroplasty, and all 12 patients had a preoperative haemoglobin level less than 130 g/l. Operative duration and surgical blood loss were significantly greater in those patients requiring blood transfusion. Nearly all patients requiring transfusion had a history of, or risk factors for, cardiovascular disease. Potassium supplementation was required in 15.5% of the study cohort; 72% of these patients receiving potassium presented with a potassium level less than 4 mmol/l during preoperative testing, while the remaining 28% had a past medical history of either significant anaemia, cardiopulmonary, cardiovascular, or renal diseases that had required substantial medical management.ConclusionA consistent blood-conserving perioperative strategy effectively minimized need for blood transfusion in total joint arthroplasty patients below previously reported rates in the literature. We suggest that postoperative full blood counts and basic metabolic panels should not routinely be ordered in these patients unless their preoperative haemoglobin and potassium is below 130 g/dl or 4 mmol/l respectively, and they have medical comorbidities.