bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic impact of preoperative neutrophil–lymphocyte ratio for surgically resected gastrointestinal stromal tumors
Authors: Yang Jing , Gu YuanHui , Huang XianBin , Xu JiaYu , Zhang Yan , Yang XiaoJun , Tian HongWei , Zhan WeiPeng 
Published: April 2019

Abstract
Neutrophil–lymphocyte ratio (NLR) was shown to be prognostic value in various malignancies. There are limited data about predictive or prognostic role of NLR during gastrointestinal stromal tumors (GISTs) patients. This study evaluated the prognostic significance of preoperative NLR in patients with GIST.
We retrospectively enrolled 72 primary GIST patients who received initial curative surgical resection with or without adjuvant imatinib therapy. The preoperative NLR in the peripheral blood was calculated. Univariate and multivariate Cox proportional hazard regression models were used to identify potential predictors of tumor outcomes.
The NLR cut-off value of 4.18 was selected. Multivariate analysis revealed that high NLR was associated with a unfavorable prognosis of GISTs (P < .05). Tumor size, tumor location, and age were significantly correlated with the NLR (P < .05).
High NLR was an unfavorable prognostic factor of overall survival in GISTs and may be a useful preoperative biomarker of the prognosis of GISTs.
Maternal lipid profiles in women with and without gestational diabetes mellitus
Authors: Wang Jing , Li Zhi , Lin Li 
Published: April 2019

Abstract
To determine the longitude lipid profiles in women with and without gestational diabetes mellitus (GDM), and to investigate the relationship between lipid disturbances in the 1st trimester and GDM.
Blood samples were collected from 1283 normal pregnant women and 300 women with GDM. Serum lipids which include total cholesterol (TC), triglycerides (TGs), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured and the TG/HDL-C ratio was calculated in the 1st, 2nd, and 3rd trimesters of pregnancy and then we got the longitudinal lipid profiles. We compared the differences of lipid profiles between patients with GDM and normal pregnant women using 2-way repeated measures analysis of variance. Also additional propensity-based subgroup analyses were performed. The logistic regression analysis was used to determine the relationship between the lipid disturbances in the 1st trimester and GDM.
TG, TC, LDL-C concentrations, and TG/HDL-C ratio increased progressively throughout pregnancy; while HDL-C amounts increased from the 1st to the 2nd trimester with a slight decrease in the 3rd trimester. The GDM group showed higher TG concentrations, higher TG/HDL-C ratio, and lower HDL-C concentrations throughout pregnancy. There were no significant differences in TC and LDL-C concentrations in the 1st, 2nd, and 3rd trimesters (P > .05), between the GDM group and the control group. Logistic regression analysis showed that maternal age, prepregnancy body mass index (BMI), and TG/HDL ratio in the 1st trimester were associated with an increased risk of GDM.
The lipid profile alters significantly in patients with GDM, and maternal age, prepregnancy BMI, and TG/HDL ratio in the 1st trimester were associated with an increased risk of GDM.
Subcutaneous tissue-sparing dorsal slit with new marking technique
Authors: Jiang Zhao-Long , Sun Cheng-Wen , Sun Jian , Shi Gao-Feng , Li Hu 
Published: April 2019

Abstract
Circumcision is a very common surgical procedure that is performed for medical and traditional purposes in the world. However, many technical of circumcision is needed to improve. Thus, this study introduced a novel method of circumcision that is a refined version of the sleeve technique, termed subcutaneous tissue sparing dorsal slit with new marking, and evaluated the safety and efficacy of this novel method of circumcision.
The randomized clinical trial included 93 adult patients with redundant foreskin or phimosis treated from May 2015 to March 2017. Patients were randomly divided into the novel circumcision method (n = 45) or conventional dissection (n = 48). The groups were compared regarding rates of intraoperative hemorrhage, operative time, pain, healing, satisfaction with penis appearance, and relevant adverse events.
No patient suffered any obvious complication. Compared with the patients given conventional dissection, the patients who underwent the new surgical device experienced significantly less wound healing time, scar width, and recovery time (P <.05). The new method resulted in greater intraoperative bleeding volume and surgical time (P <.05). The rate of satisfaction with appearance of the penis was significantly higher in the group treated with the novel technique. In addition, the cost of surgery of these 2 methods was similar.
Based on the above research, we found that subcutaneous tissue-sparing dorsal slit with new marking technique was an effective and safe procedure for circumcision, and deserved further application in clinical practice.
Successful conservative treatment of primary endometrial marginal zone lymphoma (MALT type)
Authors: Zhang Xiuming , Zhou Feng 
Published: April 2019

Abstract

Rationale:
Primary endometrial marginal zone lymphoma (mucosa-associated lymphoid tissue [MALT] type) is a rare histological type of non-Hodgkin lymphoma (NHL); therefore, this disease is challenging to diagnosis and treatment.

Patient concerns:
A 61-year-old (gravidity 2, parity 2) female was admitted complaining of postmenopausal vaginal bleeding for 2 months.

Diagnoses:
An ultrasound revealed a slightly thickened endometrium. Histology revealed a dense lymphoid infiltrate in the endometrium, which was suggestive of an NHL. The atypical lymphocytes were positive for CD20 and BCL-2. Moreover, the PCR demonstrated monoclonal heavy chain gene rearrangement. Taken together, the diagnosis of primary endometrial marginal zone lymphoma (MALT type) was established. According to Ann Arbor criteria, the disease was staged IEA.

Interventions:
Dilatation and curettage was performed, and no additional surgery or radiotherapy and chemotherapy was administered.

Outcomes:
The patient was alive with no evidence of cancer for ≥41 months.

Lessons:
Primary endometrial marginal zone lymphoma (MALT Type) is a very rare indolent tumor, and its prognosis seems to be good. Thus, conservative treatment and no further therapy were suggested based on the tumor biology.
Anti-angiogenesis treatment in a patient with appendix metastasis of small cell lung cancer
Authors: Xue Peng , Wang NingJun , Mao Yun , Zhu Shijie 
Published: April 2019

Abstract

Rationale:
Small-cell lung cancer (SCLC) is a common pathological type of lung cancer, but appendiceal metastasis of SCLC was rare. At present, clinical studies on the maintenance therapy of SCLC have not reached a significant conclusion.

Patient concerns:
We reported on a 52-year-old man who diagnosed as extensive stage SCLC with abdominal pain for 2 months, aggravated for 2 days.

Diagnoses:
The patient was diagnosed with extensive-stage SCLC, relapsed with appendix metastasis after treatment by emergency abdominal surgery.

Interventions:
The patient received systemic treatments, including surgery, bevacizumab in combination with chemotherapy and bevacizumab alone was continued as maintenance therapy.

Outcomes:
The patient had an overall survival would more than 23 months, and he gained another 8 months of progression-free survival after first-line radiochemotherapy.

Lessons:
Although SCLC appendix metastasis is rare, continuous anti-angiogenic therapy combined with bevacizumab maintenance therapy after surgical treatment can prolong survival.
Patient-tailored FOLFIRINOX as first line treatment of patients with advanced pancreatic adenocarcinoma
Authors: Ulusakarya Ayhan , Teyar Nahla , Karaboué Abdoulaye , Haydar Mazen , Krimi Sarra , Biondani Pamela , Gumus Yusuf , Chebib Amale , Almohamad Wathek , Morère Jean-François 
Published: April 2019

Abstract
FOLFIRINOX is one of the most effective reference regimens in the 1st line treatment of locally advanced (LA) and metastatic pancreatic cancer (mPC), despite its high toxicity. We evaluated our real-life experience with “patient-tailored intent to treat FOLFIRINOX” in patients with LA or mPC compared to other reports along with the pivotal phase III trial.
We analyzed data from all consecutive patients with pancreatic ductal adenocarcinoma treated with dose-modified FOLFIRINOX in 2016 at Paul Brousse University Hospital. Irinotecan was administered whenever initial serum bilirubin was <1.5 × upper limit of normal. Oxaliplatin was stopped for severe sensory neuropathy. Initial dose reductions were made according to patient profile (eg, age, comorbidities) and later due to toxicity. The treatment was continued until surgery or disease progression. Endpoints were time to progression (TTP), overall survival (OS), objective response rate (ORR), and secondary complete resection (R0R1).
Thirty-seven patients with unresectable LA or mPC received patient-tailored FOLFIRINOX as 1st line chemotherapy. There were 22 male (59%) and 15 female patients (41%) aged 44 to 81 years with LA (18 patients, 49%) and mPC (19 patients, 51%). They had World Health Organization-performance status of 0 (59%) or 1 (41%). A total of 384 cycles were administered. Median dose intensities (mg/m2/w) were 28.9 for oxaliplatin, 56.8 for irinotecan, and 886.2 for 5-fluorouracil. Thirty-four patients were assessed for response; ORR and disease control rates were 47% and 85%, respectively. R0R1 rate was 30%. Median TTP and OS were 9.6 and 14.6 months. LA disease was associated with significantly longer TTP and OS (P < .001).
FOLFIRINOX with patient-tailored dose adaptations seems to offer better results in patients with advanced PC. This approach in the neoadjuvant setting results in a macroscopic R0R1 in 61% of patients with initially unresectable disease. It deserves prospective evaluation to further improve outcomes in the management of advanced PC.
Laparoscopic-assisted colorectal surgery benefits visceral obesity patients: a propensity-matched analysis
Authors: Ye Xing-Zhao , Chen Xi-Yi , Ruan Xiao-Jiao , Chen Wei-Zhe , Ma Liang-Liang , Dong Qian-Tong , Cai Hui-Yang , Yu Zhen , Chen Xiao-Lie 
Published: April 2019

Background
We aimed to determine the safety and effectiveness of laparoscopic-assisted surgery (LAS) in visceral obesity patients with colorectal cancer (CRC).

Patients and methods
We retrospectively collected the clinical data of consecutive patients who underwent colorectal surgery for CRC between August 2014 and July 2018. The third lumbar vertebra visceral fat area was measured to diagnose visceral obesity. One-to-one propensity score matching was performed to compare the short-term outcomes between the open surgery (OS) and LAS in visceral obesity patients. Univariate and multivariate analyses were performed to evaluate the risk factors of postoperative complications.

Results
A total of 280 visceral obesity patients were included in this study with 140 patients for each group. Compared with the OS group, the LAS group had more lymph nodes harvested, longer surgical duration, and shorter postoperative hospital stay. The overall incidence of complications in OS was significantly higher than LAS (32.1 vs. 20.0%, P=0.021). Multivariate analysis revealed that age of at least 65 years (odds ratio: 1.950, 95% confidence interval: 1.118–3.403; P=0.019) was an independent risk factor for postoperative complications, whereas LAS (odds ratio: 0.523, 95% confidence interval: 0.302–0.908; P=0.021) was a protective factor.

Conclusion
LAS in visceral obesity patients with CRC was a safer and less invasive alternative than open surgery, with fewer complications within the first 30 days postoperatively.
Immune Checkpoint Inhibitors–Related Cardiotoxicity
Authors: Konala Venu Madhav , Adapa Sreedhar , Aronow Wilbert S. 
Published: April 2019

Background:
Immunotherapy is a significant breakthrough in cancer therapy in the last decade. Immunotherapy is better tolerated compared with chemotherapy. However, it does have side effects, and one of the rare and serious side effects of immunotherapy is cardiotoxicity. Cardiotoxicity has been described with other cancer-related treatments such as chemotherapy and targeted therapy. A high index of suspicion is required, and prompt management with immunosuppression needs to be instituted as soon as possible to prevent fatal outcomes.

Areas of Uncertainty:
Research is still ongoing to identify biomarkers that will help us to choose the patients, who will respond well to immunotherapy. Tumor-infiltrating lymphocytes, tumor PD-L1 expression, and tumor mutational burden explored as potential biomarkers. There are no predictive biomarkers to identify patients who are at higher risk of severe cardiotoxicity. Both cardiologists and oncologists should be aware of cardiac toxicity from immune checkpoint inhibitors.

Conclusion:
All patients who are starting immune checkpoint inhibitors should undergo baseline cardiac risk factor assessment with referral to a cardiologist in a patient with multiple risk factors or previous history of cardiovascular disease. Cardiac immune-related adverse events are higher in patients taking combination therapy with anti–CTLA-4/anti–PD-1 agents compared with monotherapy. Patients with known cardiac comorbidities require a higher level of vigilance to monitor for cardiac toxicity because nonspecific symptoms can lead to rapid clinical deterioration and a higher rate of mortality when treated with checkpoint inhibitors.
Changes in Use of Postacute Care Associated With Accountable Care Organizations in Hip Fracture, Stroke, and Pneumonia Hospitalized Cohorts
Authors: Colla Carrie H. , Lewis Valerie A. , Stachowski Courtney , Usadi Benjamin , Gottlieb Daniel J. , Bynum Julie P.W. 
Published: April 2019

Objective:
To examine changes in more and less discretionary condition-specific postacute care use (skilled nursing, inpatient rehabilitation, home health) associated with Medicare accountable care organization (ACO) implementation.

Data Sources:
2009–2014 Medicare fee-for-service claims.

Study Design:
Difference-in-difference methodology comparing postacute outcomes after hospitalization for hip fracture and stroke (where rehabilitation is fundamental to the episode of care) to pneumonia, (where it is more discretionary) for beneficiaries attributed to ACO and non-ACO providers.

Principal Findings:
Across all 3 cohorts, in the baseline period ACO patients were more likely to receive Medicare-paid postacute care and had higher episode spending. In hip fracture patients where rehabilitation is standard of care, ACO implementation was associated with 6%–8% increases in probability of admission to a skilled nursing facility or inpatient rehabilitation (compared with home without care), and a slight reduction in readmissions. In a clinical condition where rehabilitation is more discretionary, pneumonia, ACO implementation was not associated with changes in postacute location, but episodic spending decreased 2%–3%. Spending decreases were concentrated in the least complex patients. Across all cohorts, the length of stay in skilled nursing facilities decreased with ACO implementation.

Conclusions:
ACOs decreased spending on postacute care by decreasing use of discretionary services. ACO implementation was associated with reduced length of stay in skilled nursing facilities, while hip fracture patients used institutional postacute settings at higher rates. Among pneumonia patients, we observed decreases in spending, readmission days, and mortality associated with ACO implementation.
Association Between Degrees of Separation in Physician Networks and Surgeons’ Use of Perioperative Breast Magnetic Resonance Imaging
Authors: Shi Yongren , Pollack Craig E. , Soulos Pamela R. , Herrin Jeph , Christakis Nicholas A. , Xu Xiao , Gross Cary P. 
Published: April 2019

Background:
Perioperative magnetic resonance imaging (MRI) is frequently used in breast cancer despite unproven benefits. It is unclear whether surgeons’ use of breast MRI is associated with the practices of other surgeons to whom they are connected through shared patients.

Methods:
We conducted a retrospective study using Medicare data to identify physicians providing breast cancer care during 2007–2009 and grouped them into patient-sharing networks. Physician pairs were classified according to their “degree of separation” based on patient-sharing (eg, physician pairs that care for the same patients were separated by 1 degree; pairs that both share patients with another physician but not with each other were separated by 2 degrees). We assessed the association between the MRI use of a surgeon and the practice patterns of surgical colleagues by comparing MRI use in the observed networks with networks with randomly shuffled rates of MRI utilization.

Results:
Of the 15,273 patients who underwent surgery during the study period, 28.8% received perioperative MRI. These patients received care from 1806 surgeons in 60 patient-sharing networks; 55.1% of surgeons used MRI. A surgeon was 24.5% more likely to use MRI if they were directly connected to a surgeon who used MRI. This effect decreased to 16.3% for pairs of surgeons separated by 2 degrees, and 0.8% at the third degree of separation.

Conclusions:
Surgeons’ use of perioperative breast MRI is associated with the practice of surgeons connected to them through patient-sharing; the strength of this association attenuates as the degree of separation increases.
Opioid-prescribing Outcomes of Medicare Beneficiaries Managed by Nurse Practitioners and Physicians
Authors: Muench Ulrike , Spetz Joanne , Jura Matthew , Guo Chaoran , Thomas Cindy , Perloff Jennifer 
Published: April 2019

Background:
Primary care providers are at the center of the opioid epidemic. Whether nurse practitioners (NPs) have different opioid-prescribing outcomes from physicians is not known.

Objective:
To examine opioid-prescribing outcomes of Medicare beneficiaries receiving care from NPs and physicians in primary care.

Research Design:
We used Medicare data from 2009 to 2013 and a propensity score–weighted analysis.

Subjects:
Beneficiaries residing in states in which NPs are able to prescribe controlled substances without physician oversight and who did not have a cancer diagnosis, hospice care, or end-stage renal disease.

Measures:
First, we measured whether beneficiaries received any opioid prescription. Second, for beneficiaries who received opioids, we measured acute (<90 d supply) and chronic (≥90 d supply) use at baseline (2009–2010) and follow-up (2012–2013). Third, we measured potential misuse of opioid prescribing using a daily morphine milligram equivalent dose of >100 mg, overlapping prescriptions of opioids >7 days, and overlapping prescriptions of opioids with benzodiazepines >7 days.

Results:
Beneficiaries managed by NPs were less likely to receive an opioid [odds ratio (OR), 0.87; P<0.001], were less likely to be acute users at baseline (OR, 0.84; P<0.001), and were more likely to receive a high daily opioid dose of morphine milligram equivalent >100 mg compared with physician-managed beneficiaries (OR, 1.11; P=0.048).

Conclusions:
Findings suggest educational programs and clinical guidelines may require approaches tailored to different providers. Future research should examine the contributing factors of these patterns to ensure high-quality pain management and guide policy makers on NP-controlled substance-prescribing regulations.
Apolipoprotein M/sphingosine-1-phosphate: novel effects on lipids, inflammation and kidney biology
Authors: Bisgaard Line S. , Christoffersen Christina 
Published: April 2019

Purpose of review
In 2011, the crystal structure of apolipoprotein M (apoM) and its capacity to bind sphingosine-1-phosphate (S1P) was characterized. Since then, a variety of studies has increased our knowledge on apoM biology and functionality. From being an unknown and hardly significant player in overall metabolism, apoM has gained significant interest.

Recent findings
Key discoveries in the last 2 years have indicated that the apoM/S1P complex has important roles in lipid metabolism (affecting triglyceride turnover), inflammation (a marker of severe sepsis and potentially providing anti-inflammatory signaling) and kidney biology (potential to protect against immunoglobulin A nephropathy).

Summary
Several studies suggest a potential for apoM/S1P as biomarkers for inflammation, sepsis and nephropathy. Also, a novel chaperone is characterized and could have potential as a drug for treatment in inflammation and nephropathy.
Balancing the risk and rewards of utilizing organs from hepatitis C viremic donors
Authors: Sise Meghan E. , Strohbehn Ian A. , Bethea Emily , Gustafson Jenna L. , Chung Raymond T. 
Published: April 2019

Purpose of review
Owing to long waitlist times and high waitlist morbidity and mortality, strategies to increase utilization of hepatitis C viremic-deceased donor organs are under investigation in kidney, liver, heart, and lung transplantation.

Recent findings
Direct-acting antiviral medications for hepatitis C virus infection have high cure rates and are well tolerated. Small, single-center trials in kidney and heart transplant recipients have demonstrated that with early posttransplant direct-acting antiviral therapy, 100% of uninfected recipients of hepatitis C viremic organs have been cured of infection after transplantation.

Summary
In this manuscript, we review the risks and rewards of utilizing hepatitis C viremic organs for transplantation.
Does the antibody mediated rejection grading scale have prognostic prediction? Yes, but the picture is still blurry
Authors: Potena Luciano , Moriconi Veronica , Sabatino Mario , Agostini Valentina , Leone Ornella 
Published: April 2019

Purpose of review
Antibody-mediated rejection (ABMR) is a condition difficult to diagnose and treat, which may significantly impair the outcome of heart transplant recipients. In clinical practice, diagnosis is based on immunopathology grading of endomyocardial biopsies (EMB). Despite its value, the current diagnostic system has several pitfalls that have been addressed in recent literature.

Recent findings
Pathology grading of ABMR (pAMR) has a relevant prognostic factor. However, it does not capture several nuances, such as chronic vs. acute ABMR, mixed rejection or microvascular inflammation. Molecular biology-based assays are shedding new light on the mechanisms of ABMR, which could improve the precision of ABMR diagnosis.

Summary
These new findings have the potential to rearrange EMB grading system and to guide more precisely decision-making, but studies validating the therapeutic management based on molecular-pathology coupling are still missing.