bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of small hepatocellular carcinoma: perfusion quantification and time-concentration curve evaluation using color-coded and quantitative digital subtraction angiography
Authors: Chen Chien-Wei , Hsu Li-Sheng , Weng Jun-Cheng , Weng Hsu-Huei , Ye Yu-Ling , Hsu Sheng-Lung , Lin Wei-Ming 
Published: November 2018

Abstract
To explore the role of quantitative digital subtraction angiography (QDSA) in the diagnosis of small hepatocellular carcinoma (HCC).
Between November 2015 and November 2017, all patients who underwent chemoembolization for HCC were retrospectively reviewed. Patients with tumors measuring more than 5 cm or evident post-processing imaging artifacts were excluded. Images were post-processed using the QDSA technique. Regions of interest were manually drawn on proper hepatic artery (as a reference), target HCC and peritumoral liver. Time-concentration curves and flow parameters of the peak ratio, subtracted time-to-peak (TTP), and area under the curve (AUC) ratio was obtained and analyzed.
A total of 146 HCCs (mean diameter, 1.6 cm) of 71 cirrhotic patients (54 men, 17 women; mean age, 67.7 years) were enrolled. Compared with liver parenchyma, HCCs showed an increased and more rapid flow (peak ratio, AUC ratio, subtracted TTP, and wash-in slope; all P <.001). Compared with untreated HCCs, chemoembolized HCCs showed a slower flow (subtracted TTP and wash-in slope, P = .004 and .002, respectively). HCCs with a typical enhancement pattern on computed tomography (CT) or magnetic resonance imaging (MRI) had a trend toward Type III (washout pattern) time-concentration curves (P <.001). Chemoembolized HCCs had a trend toward Type II (plateau pattern) time-concentration curves (P = .005).
QDSA technology can be used to quantify perfusion measurements of HCC and hepatic parenchyma and to assess perfusion changes after HCC chemoembolization.
Increased red cell width distribution to lymphocyte ratio is a predictor of histologic severity in primary biliary cholangitis
Authors: Meng Jing , Xu Hongqin , Liu Xu , Wu Ruihong , Niu Junqi 
Published: November 2018

Abstract
Primary biliary cholangitis (PBC) is a chronic disease that is increasingly being recognized in recent years. In this study, we sought to identify noninvasive markers of the severity of cirrhosis in patients with PBC based on routinely investigated laboratory parameters.
Ninety-four patients with histologically-confirmed PBC based on liver biopsy performed between January 2013 and December 2017 at the First Hospital of Jilin University were divided into 2 groups: early-stage cirrhosis (fibrosis stage F1 and F2; n = 74) and advanced-stage cirrhosis (fibrosis stage F3 and F4; n = 20).
Patients with advanced-stage had significantly higher red blood cell distribution width (RDW) (15.2 vs 13.7; P = .003) and significantly lower platelet (163.35 vs 202.73; P = .032) and lymphocyte counts (1.47 vs 1.79; P = .018) as compared with patients with early-stage cirrhosis. Advanced-stage cirrhosis was associated with significantly higher RDW to platelet ratio (RPR), RDW to lymphocyte ratio (RLR), aspartate aminotransferase to platelet ratio index (APRI), and fibrosis index based on the 4 factors (FIB-4) as compared with early-stage cirrhosis. RLR showed the highest area under receiver operating characteristic curve (AUROC) (0.744). The sensitivity and specificity of RLR were 65% and 78.3%, respectively. RLR had higher AUROC than the other 3 noninvasive markers.
The noninvasive markers RPR, RLR, APRI, and FIB-4 showed good diagnostic accuracy for advanced-stage cirrhosis. These markers are easily acquired by routine laboratory tests and are reproducible predictors of the severity of PBC. RLR is a novel marker that may serve as a valuable supplement to APRI and FIB-4 for predicting the severity of cirrhosis.
Secondary pituitary abscess following transsphenoidal surgery with recurrent meningitis
Authors: Li Ziquan , Yang Chengxian , Bao Xinjie , Yao Yong , Feng Ming , Deng Kan , Liu Xiaohai , Xing Bing , Wang Renzhi 
Published: November 2018

Abstract

Rationale:
The transsphenoidal surgical (TS) approach to sellar masses is the preferred surgical route in most cases. Secondary pituitary abscess (PA) following TS is an extremely rare but serious postoperative complication with potentially high disability and mortality.

Patient concerns:
We describe an uncommon case of secondary PA in a 42-year-old woman, who underwent uncomplicated transsphenoidal procedures without cerebrospinal fluid leak, to treat primary Rathke cleft cyst. Without obvious cause, the patient suffered recurrent meningitis with complaints of headache, hyperpyrexia, and chills from 1 month after the operation.

Diagnosis:
There were no significant imaging findings until a new rim-enhancement lesion was seen in the sellar region on magnetic resonance imaging during the 6th episode of meningitis 11 months after the initial surgery. A diagnosis of secondary PA was considered;

Interventions:
Therefore, she underwent a 2nd TS with pus evacuation and antibiotic treatment.

Outcomes:
She improved remarkably and had no recurrence of symptoms during the 9-month follow-up.

Lessons:
Our aim was to present this rare case and discuss the most likely etiologies and preventive measures for this condition. In patients with recurrent meningitis but dormant imaging manifestations after TS, the possibility of secondary PA should considered. Adequate surgical drainage with microbiology-guided antibiotic therapy is the 1st choice for treatment.
Long-term clinical response of advanced lung adenocarcinoma to maintenance treatment of gemcitabine
Authors: Lv Xingxing , Gou Fusheng , Shen Yuan , Lu Hong , Chen Juan , Liu Juan , Chen Hui , Zhang Xuan , Yu Danfei 
Published: November 2018

Abstract

Rationale:
Advanced non-small-cell lung cancer (NSCLC) is an aggressive malignancy that generally leads to poor outcomes, with <5% long-term survival at 5 years; however, several researches have shown improvements in the progression-free survival (PFS) and overall survival (OS) on the maintenance therapy after the first-line chemotherapy. we report a case of metastatic NSCLC patient treated with maintenance therapy of gemcitabine with brilliant results.

Patient concerns:
Clinical data and treatment of a 68-year-old man with NSCLC are summarized. The Ethics Committee of People's hospital of Leshan, approved this study.

Diagnosis:
Lung adenocarcinoma metastasized to the mediastinal lymph node, cervical lymph node, and adrenal gland, without epidermal growth factor receptor (EGFR) mutation.

Interventions:
Continued treatment with gemcitabine alone following the 6 cycles of cisplatin–gemcitabine chemotherapy, prolonging the interval of chemotherapy when he could not tolerate the toxicity of the drug.

Outcomes:
Partial response of the disease for 4.5 years and significant clinical benefit.

Lessons:
This case shows that patients will benefit from the maintenance therapy, and gemcitabine may be a good choice.
Rivaroxaban versus enoxaparin for the prevention of venous thromboembolism after total knee arthroplasty
Authors: Huang Hai-Feng , Li Shan-Shan , Yang Xian-Teng , Xie Quan , Tian Xiao-Bin 
Published: November 2018

Abstract

Objective:
This article analyzed the clinical efficacy and tolerability of rivaroxaban and enoxaparin in patients undergoing total knee arthroplasty (TKA) surgery.

Methods:
Five randomized, controlled clinical trials on rivaroxaban versus enoxaparin in patients who underwent TKA were identified and included in this meta-analysis.

Results:
The meta-analysis indicated that rivaroxaban prophylaxis was associated with lower rates of symptomatic venous thromboembolism (VTE) (relative risk[RR]:0.55; 95% confidence interval [CI]: 0.35–0.86; P = .009), symptomatic deep vein thrombosis (DVT) (RR 0.44, 95% CI 0.25–0.80, P = .007), asymptomatic DVT (RR: 0.57; 95% CI: 0.37–0.89; P = .01), distal DVT (RR: 0.62; 95% CI: 0.45–0.85; P = .003) and proximal DVT (RR: 0.42; 95% CI: 0.24–0.75; P = .004). Compared with the enoxaparin group, the incidence of symptomatic pulmonary embolism (PE) (RR: 0.48; 95% CI: 0.19–1.24; P = .13) in the rivaroxaban group was not significantly different. A nonsignificant trend towards all-cause death (RR: 0.38; 95% CI: 0.03–4.92; P = .46) or major bleeding (RR: 1.59; 95% CI: 0.77–3.27; P = .21) risk between rivaroxaban and enoxaparin prophylaxis was found.

Conclusion:
Compared with the enoxaparin group, the group using rivaroxaban after TKA had a significantly lower rate of symptomatic VTE, symptomatic DVT, asymptomatic DVT, distal DVT, and proximal DVT. Our study shows that rivaroxaban after TKA is more effective than enoxaparin and did not increase major bleeding or all-cause mortality.

Level of evidence II
Clinical significance of the EMD/mesorectum ratio of T3 mid-low rectal cancer
Authors: Gu Chaoyang , Yang Xuyang , Zhang Xubing , Zheng Erliang , Deng Xiangbing , Hu Tao , Wu Qingbin , Bi Liang , Wu Bing , Su Minggang , Wang Ziqiang 
Published: November 2018

Abstract
Previous studies suggested that the extramural distance (EMD) should be considered in therapeutic decision-making of rectal cancer because it can be used as an indicator of the T3 subclassification; however, reports of impact of EMD/mesorectum ratio on prognosis are rare.
The objectives of this study were to evaluate the feasibility of the extramural distance EMD/mesorectum ratio as a maker of the T3 subclassification for T3 mid-low rectal cancer and find the potential radiological marker on MRI for neoadjuvant chemoradiotherapy (nCRT).
From December 2012 to December 2016, 287 consecutive patients with MRI-staged T3 mid-low rectal cancer were enrolled. The EMD was defined as the distance from the outer edge of the muscularis propria to the outer edge of tumor, and the mesorectum was measured as the distance from outer edge of muscularis propria to mesorectal fascia (MRF) in the same layer. The association of the EMD/mesorectum ratio and other MRI or clinicopathological factors with survival was analyzed. The independent prognostic factors were estimated by Cox regression analysis.
The mean EMD/mesorectum ratio was 0.43. Based on ROC analysis, we chose a EMD/mesorectum ratio of 0.3 for further analyses. Of 287 patients, 163 (56.8%) had a EMD/mesorectum ratio ≥ 0.3. Patients with an EMD/mesorectum ratio ≥ 0.3 had a decreased recurrence free survival (RFS) and overall survival (OS) (P < .001; P = .034, respectively). Of the 163 patients, patients with nCRT had a higher RFS than patients without nCRT (P = .001). Multivariate analysis showed that the EMD/mesorectum ratio was the only independent prognostic factors for RFS.
Our study provided evidence that the EMD/mesorectum ratio could be used for T3 subclassification, the optimal cut-off value of EMD/mesorectum ratio was 0.3 when the ratio was applied to classify T3 mid-low rectal cancer patients, and nCRT should be performed for these patients when the EMD/mesorectum ratio is ≥ 0.3.
Effect of computer navigation-assisted minimally invasive direct lateral interbody fusion in the treatment of patients with lumbar tuberculosis
Authors: Jiang Jianzhong , Gan Fengping , Tan Haitao , Xie Zhaolin , Luo Xiang , Huang Guoxiu , Li Yin , Huang Shengbin 
Published: November 2018

Abstract
The benefits of navigation-assisted technologies are not entirely understood. Therefore, this study aimed to examine the outcomes of patients with lumbar tuberculosis who received computer navigation-assisted minimally invasive direct lateral interbody fusion (DLIF).
This was a retrospective study of 33 patients with lumbar tuberculosis who underwent minimally invasive DLIF at the Department of Spine and Orthopedics of Guigang People's Hospital (Guangxi, China) between January 2015 and December 2016. The patients were pathologically diagnosed as lumbar tuberculosis and grouped into the navigation-assisted fluoroscopy (NAV; n = 18) and non-navigation-assisted fluoroscopy (non-NAV; n = 15) groups. X-ray exposure and operation times were assessed in all patients.
All surgical procedures were successfully completed. No case was converted into open surgery. The NAV group had longer surgical preparation time but shorter operation time compared with the non-NAV group (both P <.01). Total operation time showed no significant difference between the 2 groups (P = .1). The time of radiation exposure in the non-NAV group was longer compared with that of the NAV group (53.2 ± 9.9 vs 13.5 ± 2.6 s; P <.01). There were no significant differences regarding intraoperative blood loss, postoperative drainage volume, length of hospital stay, bone fusion and complications between the 2 groups (all P >.05).
Computer navigation-assisted minimally invasive DLIF could significantly reduce intraoperative radiation exposure, with no increase in total operation time.
Effect of atrial fibrillation in Asian patients undergoing percutaneous coronary intervention with drug-eluting stents for stable coronary artery disease
Authors: Han Seungbong , Park Gyung-Min , Kim Yong-Giun , Hwang Ki Won , Roh Jae-Hyung , Won Ki-Bum , Ann Soe Hee , Kim Shin-Jae , Lee Sang-Gon 
Published: November 2018

Abstract
Although the prevalence of atrial fibrillation (AF) and percutaneous coronary intervention (PCI) are increasing in Asia, there is a paucity of data concerning the effect of AF in Asian patients undergoing PCI with drug-eluting stents (DESs). Furthermore, the majority of previous studies investigating the effect of AF on prognosis following PCI have exclusively evaluated patients with myocardial infarction (MI). We aimed to evaluate the effect of AF on clinical outcomes of Asian patients undergoing PCI with DES for coronary artery disease (CAD) excluding acute MI.
From national health insurance claims data in South Korea, a total of 45,288 patients aged 18 years or older without a known history of CAD, who underwent PCI with DES for the diagnosis of CAD excluding acute MI between 2011 and 2015, were enrolled. Based on the presence or absence of a history of AF at baseline, patients were categorized into the AF group (n = 1715, 3.8%) and no-AF group (n = 43,573, 96.2%). Outcomes including all-cause death, the composite outcome of all-cause death/MI/coronary revascularization, and stroke were compared between 2 groups using a propensity-score-matched analysis.
After propensity-score matching, 1709 matched pairs were obtained. During the follow-up period (mean, 2.2 years), the incidence of all-cause death (hazard ratio [HR] 1.117, 95% confidence interval [CI] 0.885–1.411, P = .35) and the composite outcome of all-cause death/MI/coronary revascularization (HR 1.004, 95% CI 0.846–1.192, P = .97) were not significantly different between 2 groups. However, the incidence of stroke was significantly increased in the AF group (HR 1.983, 95% CI 1.474–2.667, P < .001).
In Asian patients undergoing PCI for stable CAD, a history of AF was not associated with mortality, but was associated with increased risk of stroke.
Conceptual Model of Lean Body Mass in Pediatric Inflammatory Bowel Disease
Authors: Barnes Margaux J. , Lynch Mary K. , Lisenby Molly D. , Jester Traci , Maclin Jeanine , Knight Taylor , Fisher Gordon , Gower Barbara 
Published: November 2018

ABSTRACTYouth with inflammatory bowel disease (IBD) demonstrate deficits in lean mass (LM) placing them at increased risk for future health problems, including reduction of bone mass and impaired bone architecture. Research suggests that deficits in LM are multifactorial, including influences from the disease and its treatment, and health behaviors such as diet and physical activity. Based on a systematic literature review examining factors related to LM deficits in IBD, this article presents a conceptual model to explain the development of LM in youth with IBD. The model considers predictors of LM across 4 domains: demographic; medical; diet; and physical activity. Much existing research is cross‐sectional, but suggests multiple factors work together to promote or inhibit LM accrual in youth with IBD. The conceptual model, developed based on empirical findings to date, can be used to understand and further elucidate the process through which LM is developed and maintained, to inform the development of empirically supported clinical interventions, and to guide future research objectives and priorities.
Incorporating Patient-Centeredness Into Case Management Practice
Authors: Garrett Michael B. 
Published: November 2018

Purpose of Manuscript:
Patient-centeredness is a cornerstone of case management practice. Professional case managers must conduct a clinical assessment to develop a care plan that addresses the clinical issues as well as the patient's needs, preferences, values, and choices. To achieve patient-centeredness, the case manager must engage with the patient in order to build a relationship that supports the patient-identified goals and addresses gaps in care. This article provides information on key terms in patient-centeredness, such as patient satisfaction, patient experience, and patient empowerment. The article ends with two case examples to show how the interventions outlined can be applied in specific situations.

Primary Practice Setting:
Patient-centeredness applies to all settings and levels of care.

Implications for Case Management:
The case manager will learn about successful organizational strategies that can be deployed to support patient-centeredness. The article also identifies several key case-specific strategies that can be deployed when case managers work with patients. The metrics used in evaluating and improving patient-centeredness are also described.
Long-Term Services and Supports
Authors: Treiger Teresa M. 
Published: November 2018

Purpose/Objectives:
The Centers for Medicare & Medicaid (CMS) announced that, beginning in 2019, Medicare Advantage health plans may begin offering additional benefits for nonmedical home services. In 2019, this change impacts the Long-Term Services and Supports (LTSS) landscape dramatically. This two-part article describes LTSS, its traditional demographic and health care footprint, the regulatory and accreditation landscape, quality measurement and outcomes, and the critical importance of maintaining care continuity for individuals receiving LTSS. The objectives are to:
define LTSS,identify client demographics,identify delivery models,discuss regulation and accreditation environments,discuss quality improvement and outcomes initiatives,identify promising practices and best practices, andidentify useful resources.

Primary Practice Setting(s):
Applicable to all health care sectors where case management is practiced.

Findings/Conclusions:
Historically, once Medicare recognizes a product or service, managed health plans and commercial insurance carriers follow suit. Professional case managers must become fluent in the language of LTSS, the implications of these CMS changes, and the impact on case management practice across the care continuum.

Implications for Professional Case Management Practice:
Professional case managers should understand LTSS, especially as it pertains to care transitions and continuity of health care services to our most vulnerable clients.
A Novel Model Demonstrates Variation in Risk-Adjusted Mortality Across Pediatric Cardiac ICUs After Surgery*
Authors: Tabbutt Sarah , Schuette Jennifer , Zhang Wenying , Alten Jeffrey , Donohue Janet , Gaynor J. William , Ghanayem Nancy , Jacobs Jeffrey , Pasquali Sara K. , Thiagarajan Ravi , Dimick Justin B. , Banerjee Mousumi , Cooper David , Gaies Michael 
Published: November 2018

Objective:
To develop a postoperative mortality case-mix adjustment model to facilitate assessment of cardiac ICU quality of care, and to describe variation in adjusted cardiac ICU mortality across hospitals within the Pediatric Cardiac Critical Care Consortium.

Design:
Observational analysis.

Setting:
Multicenter Pediatric Cardiac Critical Care Consortium clinical registry.

Participants:
All surgical cardiac ICU admissions between August 2014 and May 2016. The analysis included 8,543 admissions from 23 dedicated cardiac ICUs.

Interventions:
None.

Measurements and Main Results:
We developed a novel case-mix adjustment model to measure postoperative cardiac ICU mortality after congenital heart surgery. Multivariable logistic regression was performed to assess preoperative, intraoperative, and immediate postoperative severity of illness variables as candidate predictors. We used generalized estimating equations to account for clustering of patients within hospital and obtain robust ses. Bootstrap resampling (1,000 samples) was used to derive bias-corrected 95% CIs around each predictor and validate the model. The final model was used to calculate expected mortality at each hospital. We calculated a standardized mortality ratio (observed-to-expected mortality) for each hospital and derived 95% CIs around the standardized mortality ratio estimate. Hospital standardized mortality ratio was considered a statistically significant outlier if the 95% CI did not include 1. Significant preoperative predictors of mortality in the final model included age, chromosomal abnormality/syndrome, previous cardiac surgeries, preoperative mechanical ventilation, and surgical complexity. Significant early postoperative risk factors included open sternum, mechanical ventilation, maximum vasoactive inotropic score, and extracorporeal membrane oxygenation. The model demonstrated excellent discrimination (C statistic, 0.92) and adequate calibration. Comparison across Pediatric Cardiac Critical Care Consortium hospitals revealed five-fold difference in standardized mortality ratio (0.4–1.9). Two hospitals had significantly better-than-expected and two had significantly worse-than-expected mortality.

Conclusions:
For the first time, we have demonstrated that variation in mortality as a quality metric exists across dedicated cardiac ICUs. These findings can guide efforts to reduce mortality after cardiac surgery.
Local Boards of Health as Linkages Between Local Health Departments and Health Care and Other Community Organizations
Authors: Shah Gulzar H. , Leep Carolyn J. 
Published: November 2018

Introduction:
Efficient provision of essential public health services may be influenced by collaborative capacity of local health departments (LHDs). Local boards of health (LBoHs) are well positioned to facilitate partnerships.

Objectives:
We examined the degree to which LBoHs serve as a linkage between LHDs and 2 types of community organizations, health care providers and local government agencies, and the LBoH characteristics associated with tendency of LBoHs to perform such linkage function.

Methods:
We analyzed data from a recent cross-sectional survey, the 2015 National Survey of Local Boards of Health. This survey used a probability sample of 685 LHDs stratified by the state of LHD location and the population size of LHD jurisdiction, resulting in 394 responses for a response rate of 58%. We used multivariate logistic regression to pursue the study objectives.

Results:
LHD respondents reported that LBoHs served as a linkage with hospitals or other health care providers for 20% of LHDs and with local government agencies for 19% of LHDs. Significant association of LBoHs' performance of governance functions existed with their chances of linking LHDs with hospitals or other health care providers (adjusted odds ratio [AOR] = 1.25; P < .001) and with local government agencies (AOR = 1.23; P < .001). Among the factors associated with LBoHs serving as the linkage, the governance function oversight was the strongest, followed by governance functions policy development, continuous improvement, and resource stewardship. Legal authority had weakest association with both types of linkages. A strong positive association existed between LBoHs seeking community input from elected officials and LBoHs' tendency of serving as the linkage with both health care providers and local government agencies.

Conclusions:
The role of LBoHs in linking with hospitals, other health care providers, and government agencies could be further maximized, particularly given the high proportion of LBoHs that include members who are health care professionals.