bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determining the role of adjuvant radiotherapy in the management of meningioma: a Surveillance, Epidemiology, and End Results analysis
Authors: Reddy Abhinav K. , Ryoo James S. , Denyer Steven , McGuire Laura S. , Mehta Ankit I. 
Published: June 2019

OBJECTIVEThe aim of this study was to illustrate the demographic characteristics of meningioma patients and observe the effect of adjuvant radiation therapy on survival by using the Surveillance, Epidemiology, and End Results (SEER) database. More specifically, the authors aimed to answer the question of whether adjuvant radiotherapy following resection of atypical meningioma confers a cause-specific survival benefit. Additionally, they attempted to add to previous characterizations of the epidemiology of primary meningiomas and assess the effectiveness of the standard of care for benign and anaplastic meningiomas. They also sought to characterize the efficacy of various treatment options in atypical and anaplastic meningiomas separately since nearly all other analyses have grouped these two together despite varying treatment regimens for these behavior categories.METHODSSEER data from 1973 to 2015 were queried using appropriate ICD-O-3 codes for benign, atypical, and anaplastic meningiomas. Patient demographics, tumor characteristics, and treatment choices were analyzed. The effects of treatment were examined using a multivariate Cox proportional hazards model and Kaplan-Meier survival analysis.RESULTSA total of 57,998 patients were included in the analysis of demographic, meningioma, and treatment characteristics. Among this population, cases of unspecified WHO tumor grade were excluded in the multivariate analysis, leaving a total of 12,931 patients to examine outcomes among treatment paradigms. In benign meningiomas, gross-total resection (HR 0.289, p = 0.013) imparted a significant cause-specific survival benefit over no treatment. In anaplastic meningioma cases, adjuvant radiotherapy imparted a significant survival benefit following both subtotal (HR 0.089, p = 0.018) and gross-total (HR 0.162, p = 0.002) resection as compared to gross-total resection alone. In atypical tumors, gross-total resection plus radiotherapy did not significantly change the hazard risk (HR 1.353, p = 0.628) compared to gross-total resection alone. Similarly, it was found that adjuvant radiation did not significantly benefit survival after a subtotal resection (HR 1.440, p = 0.644).CONCLUSIONSThe results of this study demonstrate that the role of adjuvant radiotherapy, especially after the resection of atypical meningioma, remains somewhat unclear. Thus, given these results, prospective randomized clinical studies are warranted to provide clear information on the effects of adjuvant radiation in meningioma treatment.
A comparison of readmission and complication rates and charges of inpatient and outpatient multiple-level anterior cervical discectomy and fusion surgeries in the Medicare population
Authors: Khalid Syed I. , Kelly Ryan , Wu Rita , Peta Akhil , Carlton Adam , Adogwa Owoicho 
Published: June 2019

OBJECTIVEThis study aims to assess the relationship of comorbidities and postoperative complications to rates of readmission for geriatric patients undergoing anterior cervical discectomy and fusion (ACDF) involving more than 2 levels on an inpatient or outpatient basis. With the rising costs of healthcare in the United States, understanding the safety and efficacy of performing common surgical interventions (including ACDF) as outpatient procedures could prove to be of great economic impact.Objective This study aims to assess the effect of comorbidities and postoperative complications on the rates of readmission of geriatric patients undergoing multilevel anterior cervical discectomy and fusion (ACDF) procedures (i.e., ACDF involving 3 or more levels) on an inpatient or outpatient basis. Same-day surgery has been demonstrated to be a safe and cost-effective alternative to the traditional inpatient option for many surgical interventions. With the rising costs of healthcare, understanding the safety and efficacy of performing common surgical interventions as outpatient procedures could prove to be of great economic impact.METHODSThe study population included total of 2492 patients: 2348 inpatients and 144 outpatients having ACDF procedures involving 3 or more levels in the Medicare Standard Analytical Files database. Age, sex, comorbidities, postoperative complications, readmission rates, and surgical procedure charges were compared between both cohorts. For selected variables, logistic regression was used to model odds ratios for various comorbidities against readmission rates for both inpatient and outpatient cohorts. Chi-square tests were also calculated to compare these comorbidities with readmission in each cohort.RESULTSOverall complication rates within 30 postoperative days were greater for inpatients than for outpatients (44.2% vs 12.5%, p < 0.001). More inpatients developed postoperative urinary tract infection (7.9% vs 0%, p < 0.001), and the inpatient cohort had increased risk of readmission with comorbidities of anemia (OR 1.52, p < 0.001), smoking (OR 2.12, p < 0.001), and BMI ≥ 30 (OR 1.43, p < 0.001). Outpatients had increased risk of readmission with comorbidities of anemia (OR 2.78, p = 0.047), diabetes mellitus type 1 or 2 (OR 3.25, p = 0.033), and BMI ≥ 30 (OR 3.95, p = 0.008). Inpatients also had increased readmission risk with a postoperative complication of surgical site infection (OR 2.38, p < 0.001). The average charges for inpatient multilevel ACDF were significantly higher than for multilevel ACDF performed on an outpatient basis ($12,734.27 vs $12,152.18, p = 0.0019).CONCLUSIONSThis study suggests that ACDF surgery involving 3 or more levels performed as an outpatient procedure in the geriatric population may be associated with lower rates of readmissions, complications, and surgical charges.
Can machine learning algorithms accurately predict discharge to nonhome facility and early unplanned readmissions following spinal fusion? Analysis of a national surgical registry
Authors: Goyal Anshit , Ngufor Che , Kerezoudis Panagiotis , McCutcheon Brandon , Storlie Curtis , Bydon Mohamad 
Published: June 2019

OBJECTIVENonhome discharge and unplanned readmissions represent important cost drivers following spinal fusion. The authors sought to utilize different machine learning algorithms to predict discharge to rehabilitation and unplanned readmissions in patients receiving spinal fusion.METHODSThe authors queried the 2012–2013 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) for patients undergoing cervical or lumbar spinal fusion. Outcomes assessed included discharge to nonhome facility and unplanned readmissions within 30 days after surgery. A total of 7 machine learning algorithms were evaluated. Predictive hierarchical clustering of procedure codes was used to increase model performance. Model performance was evaluated using overall accuracy and area under the receiver operating characteristic curve (AUC), as well as sensitivity, specificity, and positive and negative predictive values. These performance metrics were computed for both the imputed and unimputed (missing values dropped) datasets.RESULTSA total of 59,145 spinal fusion cases were analyzed. The incidence rates of discharge to nonhome facility and 30-day unplanned readmission were 12.6% and 4.5%, respectively. All classification algorithms showed excellent discrimination (AUC > 0.80, range 0.85–0.87) for predicting nonhome discharge. The generalized linear model showed comparable performance to other machine learning algorithms. By comparison, all models showed poorer predictive performance for unplanned readmission, with AUC ranging between 0.63 and 0.66. Better predictive performance was noted with models using imputed data.CONCLUSIONSIn an analysis of patients undergoing spinal fusion, multiple machine learning algorithms were found to reliably predict nonhome discharge with modest performance noted for unplanned readmissions. These results provide early evidence regarding the feasibility of modern machine learning classifiers in predicting these outcomes and serve as possible clinical decision support tools to facilitate shared decision making.
How does the cervical spine respond to hyperkyphosis correction in Scheuermann’s disease?
Authors: Xu Liang , Shi Benlong , Qiu Yong , Chen Zhonghui , Chen Xi , Li Song , Du Changzhi , Zhou Qingshuang , Zhu Zezhang , Sun Xu 
Published: June 2019

OBJECTIVEThis study aimed to quantify the response of the cervical spine to the surgical correction of Scheuermann’s kyphosis (SK) and to postoperative proximal junctional kyphosis (PJK).METHODSFifty-nine patients (mean age 14.6 ± 2.3 years) were enrolled in the study: 35 patients in a thoracic SK (T-SK) group and 24 in a thoracolumbar SK (TL-SK) group. The mean follow-up period was 47.2 ± 17.6 months. Radiographic data, PJK-related complications, and patient-reported outcomes were compared between groups.RESULTSThe global kyphosis significantly decreased postoperatively, and similar correction rates were observed between the two groups (mean 47.1% ± 8.6% [T-SK] vs 45.8% ± 9.4% [TL-SK], p = 0.585). The cervical lordosis (CL) in the T-SK group notably decreased from 21.4° ± 13.3° to 13.1° ± 12.4° after surgery and was maintained at 14.9° ± 10.7° at the latest follow-up, whereas in the TL-SK group, CL considerably increased from 7.2° ± 10.7° to 11.7° ± 11.1° after surgery and to 13.8° ± 8.9° at the latest follow-up. PJK was identified in 16 patients (27.1%). Its incidence in the TL-SK group was notably higher than it was in the T-SK group (41.6% [n = 10] vs 17.1% [n = 6], p = 0.037). Compared with non-PJK patients, PJK patients had greater CL and lower pain scores on the Scoliosis Research Society–22 questionnaire (p < 0.05).CONCLUSIONSHyperkyphosis correction eventually resulted in reciprocal changes in the cervical spine, with CL notably decreased in the T-SK group but significantly increased in the TL-SK group. Patients developing PJK have increased CL, which seems to have a negative effect on patients’ health-related quality of life.
Medial Temporal Atrophy in Amyloid-Negative Amnestic Type Dementia Is Associated with High Cerebral White Matter Hyperintensity
Authors: Wong Benjamin Yi Xin , Yong Ting Ting , Lim Levinia , Tan Jayne Yi , Ng Adeline Su Lyn , Ting Simon Kang Seng , Hameed Shahul , Ng Kok Pin , Zhou Juan Helen , Kandiah Nagaendran 
Published: June 2019

Background: Non-amyloid mechanisms behind neurodegeneration and cognition impairment are unclear. Cerebrovascular disease (CVD) may play an important role in suspected non-Alzheimer’s pathophysiology (SNAP), especially in Asia. Objective: To examine the association between CVD and medial temporal lobe atrophy (MTA) in amyloid-β negative patients with mild amnestic type dementia. Methods: Thirty-six mild dementia patients with complete neuropsychological, cerebrospinal fluid (CSF) biomarker, and neuroimaging information were included. Only patients with clinically significant MTA were recruited. Patients were categorized based on their CSF Aβ levels. Neuroimaging and neuropsychological variables were analyzed. Results: Despite comparable MTA between Aβ positive and negative patients, Aβ-negative patients had significantly greater white matter hyperintensities (WMH; Total Fazekas Rating) than their Aβ-positive counterparts (6.42 versus 4.19, p = 0.03). A larger proportion of Aβ-negative patients also had severe and confluent WMH. Regression analyses controlling for baseline characteristics yielded consistent results. Conclusion: Our findings demonstrate that MTA is associated with greater CVD burden among Aβ-negative patients with amnestic type dementia. CVD may be an important mechanism behind hippocampal atrophy. This has implications on clinical management strategies, where measures to reduce CVD may slow neurodegeneration and disease progression.
Tau Protein is Associated with Longitudinal Memory Decline in Cognitively Healthy Subjects with Normal Alzheimer’s Disease Cerebrospinal Fluid Biomarker Levels
Authors: Tort-Merino Adrià , Olives Jaume , León María , Peñaloza Claudia , Valech Natalia , Santos-Santos Miguel A. , Càmara Estela , Grönholm-Nyman Petra , Martínez-Lage Pablo , Fortea Juan , Molinuevo José L. , Sánchez-Valle Raquel , Laine Matti , Rodríguez-Fornells Antoni , Rami Lorena 
Published: June 2019

Background: We investigated a sample of cognitively healthy subjects with normal Alzheimer’s disease (AD) cerebrospinal fluid (CSF) biomarker levels to identify the earliest variables related to longitudinal memory changes. Objective: Employing a new highly demanding learning and memory test (the Ancient Farming Equipment Test; AFE-T), we aimed to investigate whether a biomarker related to neurodegeneration (i.e., CSF tau) was associated with longitudinal memory decline. Methods: Thirty-two cognitively and biologically normal (CBN) subjects underwent MRI, neuropsychological assessment, and the AFE-T at baseline and 18 months later. To explore the relationship between cognitive performance and relevant factors, a linear model was set up. For a secondary analysis that further explore the effect of tau, the subjects were divided into CBN-Tau↓ (tau < 228.64 pg/ml; n = 16) and CBN-Tau↑ (tau > 228.64 pg/ml; n = 16). We also performed voxel-based morphometry (VBM) to identify regions of grey matter volume that would predict both baseline and longitudinal cognitive performance. Results: Our main finding was an association between CSF tau and longitudinal memory decline measured with AFE-T ( B = –0.17, p < 0.05; r = –0.414; p < 0.01), and further analyses showed different evolvement between subgroups, with an accelerated decline in individuals with higher tau (F(1,31) = 8.37; p < 0.01). VBM results suggested that AFE-T performance is related to grey matter volume in a medial temporal, middle frontal, and posterior cerebellar network at baseline, and that there are strategic brain areas driving the longitudinal cognitive changes. Conclusions: The present findings provide evidence for structural and biological markers linked to cognitive aging by highlighting the role of tau, a marker of neurodegeneration, which can be related with the earliest memory changes in healthy subjects.
A REVIEW ON COMPARATIVE STUDY ON THE SAFETY AND EFFECTIVENESS OF SACUBITRIL-VALSARTAN COMBINATION WITH ACE/ARB THERAPY IN CARDIAC PATIENTS
Authors: Suresh Bhagya , George Mathew , Joseph Lincy 
Published: June 2019

Cardiovascular (CV) disease is a major cause of morbidity and mortality in the developing and the developed world, and represents a major barrier to sustainable human development. Ischemic heart disease, cerebrovascular disease, cardiomyopathy and heart failure (HF), and hypertension among others represent major forms of CV disease. Heart failure (HF) is among the key contributors to the CV-related health care burden, a uninterrupted concern despite the utilization of clinically tried guideline-directed therapies. The most common cause for HF is reduced left cavum heart muscle perform. ARBs produce equivalent mortality benefits with fewer adverse effects than ACE inhibitors. Angiotensin converting enzyme (ACEI) reduces the combined risk of death or hospitalization, slow progression of HF, and reduced rate of reinfarction. Sacubitril/valsartan could be a first-in-class twin action molecule of the neprilysin (NEP) substance sacubitril (AHU-377) and therefore the angiotensin II (Ang II) sort one (AT1) receptor blocker (ARB) valsartan. The beneficial antihypertensive and HF effects of sacubitril/valsartan are mediated through the inhibition of NEP in catabolizing the natriuretic peptides (NPs) and the blockade of Ang II, AT1 receptor with valsartan. These actions of sacubitril/ valsartan end in general dilation and inflated symptoms and symptoms, resulting in decrease in peripheral tube resistance and plasma volume contraction, all necessary actions for the lowering of BP and improving HF symptoms.
Keywords: cardiovascular disease, left ventricular ejection fraction, angiotensin II receptor blocker, angiotensin converting enzyme, sacubitril/valsartan.
A REVIEW ON THE EFFECT OF FEBUXOSTAT IN CHRONIC KIDNEY PATIENTS, IT’S SIGNIFICANCE IN eGFR, URIC ACID AND ALBUMINURIA.
Authors: Jose Jinsu Deena , George Mathew , Joseph Lincy 
Published: June 2019

Chronic kidney disease is defined as the abnormality of the kidney structure or function for≥ 3 months and is associated with an irreversible reduction of the excretory and the endocrine functions of the kidney. An important risk factor for the development and progression of CKD is hyperuricemia. Hyperuricemia can occur as a result of the increased production or the reduced secretion of uric acid. Increased uric acid level is significantly associated with a greater decline in renal function and there is a higher risk of progression into kidney failure. Febuxostat is a nonpurine xanthine oxidase inhibitor for the treatment of hyperuricemia in patients with chronic kidney disease. It reduces serum uric acid concentrations by blocking the transformation of hypoxanthine to xanthine and xanthine to uric acid. Febuxostat is mainly metabolized in the liver and excreted through both urine and feces. Renal adjustment is also not required in CKD patients with mild to moderately reduced eGFR as it is metabolized mainly by glucuronidation and oxidation in the liver and well excreted by both urinary and fecal routes. Recent studies show that, in addition to lowering the uric acid level, febuxostat preserves the eGFR.
Keywords: Chronic kidney disease, hyperuricemia, febuxostat, eGFR
TO THE HISTORY OF COVERING THE PECULIARITIES OF THE DAGESTAN CARPET WEAVING
Authors: Ramazanova Z B , Garunova S M 
Published: June 2019

he Article provides an overview of the historiography of the description of Dagestan carpet-weaving as a component of the domestic economy, material culture and aesthetic consciousness, as well as some ornamental and compositional and technical characteristics of local varieties of carpets and rugs. Analysis of literature data and field ethnographic materials suggests that Dagestan carpet-weaving is characterized by ornamental features and compositional diversity; by abundance of local centers which used to produce these carpets and rugs; by art and technical features of Dagestan carpets which visibly testified in which part of Dagestan, in what village they are woven. Actually, this seems the most impressive feature of the Dagestan carpet culture. It is noteworthy that many well known types of Caucasian rugs are
named as Lezgi (Mirakh, Akhty, Kabir, Akhty, Zahur (Zeihur), Chi-Chi), Kumyk (Kayakent, Kumtorkala), Avar (Tlyarota) villages. In the World there are no analogues to ornamental and color composition of flat-weave carpet types "dum","davagin", "salmag" "soumakh ", which were woven in a certain Kumyk, Avar, Lezgi villages. So, the particularly
of Dagestan carpet-weaving is expressed by:
a) the abundance of original carpet designs, developed to canonical level of perfection and clearly
localized in the districts and villages;
b) variability of the ornamental and technological characteristics:
с) plurality of local types of carpets;
g) fineness of weaving technique;
d) quality of wool of the Dagestan mountain breed of sheep;
e) coloring properties of the Derbent madder roots which, comparing with all known World species of this plant, has a superior content of the red colorant. All this, combined with the skillful, painstaking work of the weavers, determines the finesse of the Dagestan carpets, which is easily detected by the naked eye and without special knowledge.
Physical–Chemical Characteristics of Cutin Separated from Tomato Waste for the Preparation of Bio-lacquers
Authors: Cifarelli A. , Cigognini I. M. , Bolzoni L. , Montanari A. 
Published: June 2019

Green chemistry protocols are proposed to produce high-value chemicals from waste tomatoes. Long-chain hydroxy fatty acids (called cutin acids), in particular the 10,16-dihydroxyhexadecanoic acid and its oligomers, could be innovative building-block chemicals for the synthesis of novel bio-resins and lacquers suitable as internal protective coating for metal food packaging. However, these natural compounds are not currently commercially available. This study investigates the possibility of extracting cutin acids from tomato peels without the use of organic solvents and by an efficient, cost-effective, and environmentally safe method amenable to industrial scale-up. The first route investigated was based on alkaline hydrolysis of the tomato cuticle. The second involved the acid free-selective precipitation of cutin. Finally, cutin was isolated by hydrogen peroxide-assisted hydrolysis. GC-MS analysis revealed the main chemical compound isolated by all methods to be 10,16-dihydroxyhexadecanoic acid, the principal component of tomato cutin, with extraction yields ranging from 81 to 96%. Products are different in terms of appearance, solubility, the degree of crosslinking observed and molecular weight, as shown by GPC analysis. Furthermore, the products extracted were characterized by means of FT-IR spectroscopy and thermal analysis. The cutin obtained through alkaline hydrolysis results the best raw material for bio-resin preparation.
Improving access and continuity in general practice: practical and policy lessons
Authors: Hemmings Nina , Rosen Rebecca , Palmer William , Keeble Eilis , Williams Sally , Paddison Charlotte , Imison Candace 
Published: June 2019

BackgroundImproved access to general practice is seen by policy makers as essential to address patient expectations and reduce demand for A&E, but little is known about its impact on continuity.AimThis study examined the impact of policies to improve access on continuity and described practical approaches to delivering both improved access and continuity.
What is the evidence that continuity within general practice benefits patients, or is important to health professionals?Which primary care patients are more likely to want continuity of care, and how likely are they to report receiving it?How might policy initiatives to improve access affect continuity of care, and to what extent is there evidence of this?What factors might best support continuity of care in the context of improved access?MethodA rapid literature review, semi-structured interviews with providers and one commissioner, and two expert workshops were combined, with quantitative analysis of practice-level data and 2017 GP Patient Survey data.ResultsVarious sociodemographic and clinical factors shape patients’ desire for, and ability to obtain, continuity. We will present the limited evidence available on the impact of improved access on continuity and describe practical approaches to support continuity across three broad areas: service design, workforce development, and technology.ConclusionIt is possible to offer both improved access and continuity if this is an explicit objective of service redesign. Commissioners and policymakers should attach greater priority to continuity and commission further research to understand the longer-term impacts of improved access and working at scale on continuity, patient experience, and wider outcomes.