bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of mediastinal lymph node metastases from adenocarcinoma of the esophagogastric junction versus lower esophageal squamous cell carcinoma with involvement of the esophagogastric junction
Authors: Mine S , Watanabe M , Kumagai K , Okamura A , Yuda M , Hayami M , Yamashita K , Imamura Y , Ishizuka N 
Published: February 2019

SUMMARY
The distribution of mediastinal lymph node metastasis in patients with adenocarcinoma of the esophagogastric junction (AEG) remains unclear. Additionally, the distribution of nodal mediastinal metastasis from squamous cell carcinoma (SCC) of the lower esophagus with involvement of the esophagogastric junction remains unclear, given the very limited number of these patients. In this retrospective review, we compared the outcomes of radical lymphadenectomy of the mediastinum, including upper mediastinal lymphadenectomy, between patients with AEG and those with SCC. From 2005 to 2017, 69 consecutive patients underwent esophagectomy via right thoracotomy or minimally invasive esophagectomy for a Siewert type I or II tumor with esophageal invasion ≥3 cm. We analyzed the incidences of mediastinal lymph node metastasis in this group relative to those of 73 patients with SCC with involvement of the esophagogastric junction who consecutively underwent esophagectomy during the same period. Mediastinal lymph node metastasis was seen in 26 of 69 patients with AEG (38%), with upper, middle, lower mediastinal nodal metastasis instances of 20%, 17%, and 23%, respectively. Mediastinal lymph node metastasis was seen in 23 of 73 patients with SCC (32%), with upper, middle, lower mediastinal nodal metastasis instances of 12%, 16%, and 19%, respectively. This mediastinal lymph nodal metastasis distribution did not statistically differ between patients with AEG and those with SCC. The relapse-free survival outcomes were poor for patients with clinical (P &lt; 0.01) or pathological (P &lt; 0.01) nodal metastasis of the mediastinum with AEG. In contrast, patients with clinical or pathological mediastinal nodal metastases of SCC did not have extremely poor survival outcomes, compared to patients with AEG. Despite the limited dataset available for analysis, patients with AEG and those with SCC might exhibit similar incidences and distribution of mediastinal lymph node metastasis. However, the clinical or pathological metastasis of AEG to the mediastinum was associated with poor survival outcomes, even if radical mediastinal lymphadenectomy including the upper mediastinal lymphadenectomy was performed.
Discrepancy in Frailty Identification: Move Beyond Predictive Validity
Authors: Xue Qian-Li , Tian Jing , Walston Jeremy D , Chaves Paulo H M , Newman Anne B , Bandeen-Roche Karen 
Published: February 2019

Abstract

Background
To evaluate the discordance in frailty classification between the frailty index (FI) and the physical frailty phenotype (PFP) and identify factors discriminating those with discordant frailty classification from each other and from those for whom the assessments agree.

Methods
A prospective observational study of older adults aged 65 and older selected from Medicare eligibility lists in four U.S. communities (n = 5,362). The PFP was measured by the Cardiovascular Health Study PFP. Participants meeting three or more of the five criteria were deemed frail. The FI was calculated as the proportion of deficits in an a priori selected set of 48 measures, and participants were classified as frail if FI is greater than 0.35.

Results
The prevalence of frailty was 7.0% by the PFP and 8.3% by the FI. Of the 730 deemed frail by either instrument, only 12% were in agreement, whereas 39% were classified as frail by the PFP, but not the FI, and 48% were classified as frail by the FI, but not the PFP. Participants aged 65–72 years or with greater disease burden were most likely to be characterized as being FI-frail, but not PFP-frail. The associations of frailty with age and mortality were stronger when frailty was measured by the PFP rather than the FI.

Conclusions
Despite comparable frailty prevalence between the PFP and the FI, there was substantial discordance in individual-level classification, with highest agreement existing only in the most vulnerable subset. These findings suggest that there are clinically important contexts in which the PFP and the FI cannot be used interchangeably.
Shift work, DNA methylation and epigenetic age
Authors: White Alexandra J , Kresovich Jacob K , Xu Zongli , Sandler Dale P , Taylor Jack A 
Published: February 2019

Abstract

Background
Shift work has been associated with increased risk of age-related morbidity and mortality. Biological age, estimated using DNA methylation (DNAm), may quantify the biological consequences of shift work on the risk of age-related disease. We examined whether prior employment in shift-working occupations was associated with epigenetic age acceleration.

Methods
In a sample of non-Hispanic White women aged 35–74 (n = 2574), we measured DNAm using the Illumina Infinium Human450 BeadChip and calculated DNAm age using three established epigenetic clocks. Age-acceleration metrics were derived by regressing DNAm age on chronological age and predicting the residuals. Using linear regression, we estimated associations between shift work history and age acceleration. We also conducted an epigenome-wide association study using robust linear-regression models corrected with false discovery rate (FDR) q-values.

Results
Approximately 7% of women reported any shift work. Higher age acceleration was observed for a 1-year increase in overall [β = 0.11, 95% confidence interval (CI): 0.02–0.21] and night-specific shift work (β = 0.12, 95% CI: 0.03–0.21). The association was strongest for ≥10 years of night shift work (β = 3.16, 95% CI: 1.17–5.15). From the epigenome-wide association study, years of overall and night shift work were associated with DNAm at 66 and 85 CpG sites (FDR < 0.05), respectively. Years of night shift work was associated with lower methylation of a CpG in the gene body of ZFHX3 (cg04994202, q = 0.04), a gene related to circadian rhythm.

Conclusions
Shift work was associated with differential CpG site methylation and with differential DNAm patterns, measured by epigenetic age acceleration, consistent with long-term negative health effects.
Deep long asymmetric occultation in EPIC 204376071
Authors: Rappaport S , Zhou G , Vanderburg A , Mann A , Kristiansen M H , Oláh K , Jacobs T L , Newton E , Omohundro M R , LaCourse D , Schwengeler H M , Terentev I A , Latham D W , Bieryla A , Soares-Furtado M , Bouma L G , Ireland M J , Irwin J 
Published: February 2019

Abstract
We have discovered a young M star of mass 0.16 M⊙ and radius 0.63 R⊙, likely in the Upper Sco Association, that exhibits only a single 80 per cent deep occultation of 1-d duration. The star has frequent flares and a low-amplitude rotational modulation, but is otherwise quiet over 160 d of cumulative observation during K2 campaigns C2 and C15. We discuss how such a deep eclipse is not possible by one star crossing another in any binary or higher order stellar system in which no mass transfer has occurred. The two possible explanations we are left with are (1) orbiting dust or small particles (e.g. a disc bound to a smaller orbiting body, or unbound dust that emanates from such a body); or (2) a transient accretion event of dusty material near the corotation radius of the star. In either case, the time between such occultation events must be longer than ∼80 d. We model a possible orbiting occulter both as a uniform elliptically shaped surface (e.g. an inclined circular disc) and as a ‘dust sheet’ with a gradient of optical depth behind its leading edge. The required masses in such dust features are then ≳3 × 1019 g and ≳1019 g, for the two cases, respectively.
Molecular profiling and targeted therapy in pediatric gliomas: review and consensus recommendations
Authors: Miklja Zachary , Pasternak Amy , Stallard Stefanie , Nicolaides Theodore , Kline-Nunnally Cassie , Cole Bonnie , Beroukhim Rameen , Bandopadhayay Pratiti , Chi Susan , Ramkissoon Shakti H , Mullan Brendan , Bruzek Amy K , Gauthier Angela , Garcia Taylor , Atchison Christie , Marini Bernard , Fouladi Maryam , Parsons D William , Leary Sarah , Mueller Sabine , Ligon Keith L , Koschmann Carl 
Published: February 2019

AbstractAs the field of neuro-oncology makes headway in uncovering the key oncogenic drivers in pediatric glioma, the role of precision diagnostics and therapies continues to rapidly evolve with important implications for the standard of care for clinical management of these patients. Four studies at major academic centers were published in the last year outlining the clinically integrated molecular profiling and targeting of pediatric brain tumors; all 4 demonstrated the feasibility and utility of incorporating sequencing into the care of children with brain tumors, in particular for children and young adults with glioma. Based on synthesis of the data from these studies and others, we provide consensus recommendations for the integration of precision diagnostics and therapeutics into the practice of pediatric neuro-oncology. Our primary consensus recommendation is that next-generation sequencing should be routinely included in the workup of most pediatric gliomas.
Association Between Baseline Creatinine Clearance and Treatment Failure in Patients With Hepatitis C Virus Treated With Ledipasvir and Sofosbuvir
Authors: Jansen Jeffrey W , Linneman Travis W , Powderly Gillian M , Moenster Ryan P , Nayak Leela 
Published: February 2019

Abstract

Background
Hepatitis C remains a major cause of liver disease globally and is responsible for approximately 500 000 deaths annually. Newer direct-acting antivirals achieve cure rates at or above 90% with excellent tolerability for most patients. The literature focusing on identification of predictors of efficacy and safety with specific hepatitis C therapies has been inconclusive and often conflicting.

Methods
A retrospective, single-center, case–control analysis of all veteran patients aged ≥18 through ≤89 years who completed a treatment course of 8, 12, or 24 weeks with ledipasvir and sofosbuvir (LDV/SOF) combination therapy for hepatitis C infection was conducted. Patients who were identified and met inclusion criteria were assigned to either the case group (SVR12 failure; hepatitis C viral load detectable at least 11 weeks after therapy completion) or the control group (SVR12 success; hepatitis C viral load undetectable at least 11 weeks after therapy completion).

Results
Twenty-nine SVR12 failures and 411 SVR12 successes were included in the analysis. The overall failure rate was consistent with the current literature, at 6.6% (29/440). Bivariate analysis identified only baseline creatinine clearance &gt;80 mL min-1 (Cockcroft-Gault) as a possible predictor of SVR12 failure (P = .026). In the multivariate analysis, pretreatment creatinine clearance &gt;80 mL min-1 remained independently associated with SVR12 failure (odds ratio, 2.95; 95% confidence interval, 1.17–7.46; P = .023).

Conclusions
In hepatitis C patients treated with LDV/SOF, a pretreatment creatinine clearance of &gt;80 mL min-1 was associated with SVR12 failure.
Sleep hygiene in patients with chronic respiratory disease
Authors: Dobson Linda , Stutzman Sonja E. , Hicks Amber D. , Olson DaiWai M. 
Published: February 2019

Abstract:

Purpose:
This study assessed the effectiveness of patient-directed interventions for improving sleep quality in patients with cystic fibrosis and pulmonary hypertension.

Methods:
A nonrandomized, prospective pilot study was used to monitor the effectiveness of patient-initiated sleep preferences in 15 hospitalized patients.

Results:
During their stay, 53.3% of patients reported better sleep associated with the intervention, supporting the need for and efficacy of patient-driven sleep interventions.

Conclusion:
Patients unanimously recognized the need for sleep interventions and were open to seeking a good sleep hygiene regimen to improve their sleep quality while in the hospital.
Failure to Rescue as a Surgical Quality Indicator
Authors: Portuondo Jorge I. , Shah Sohail R. , Singh Hardeep , Massarweh Nader N. 
Published: February 2019

Abstract
Over the past decade, failure to rescue—defined as the death of a patient after one or more potentially treatable complications—has received increased attention as a surgical quality indicator. Failure to rescue is an appealing quality target because it implicitly accounts for the fact that postoperative complications may not always be preventable and is based on the premise that prompt recognition and treatment of complications is a critical, actionable point during a patient’s postoperative course. Although numerous patient and macrosystem factors have been associated with failure to rescue, there is an increasing appreciation of the key role of microsystem factors. Although failure to rescue is believed to contribute to observed hospital-level variation in both surgical outcomes and costs, further work is needed to delineate the underlying patient-level and system-level factors preventing the timely identification and treatment of postoperative complications. Therefore, the goals of this narrative review are to provide a conceptual framework for understanding failure to rescue, to discuss various associated patient- and system-level factors, to delineate the reasons it has become recognized as an important quality indicator, and to propose future directions of scientific inquiry for developing effective interventions that can be broadly implemented to improve postoperative outcomes across all hospitals.
International Multicenter Survey of Perioperative Management of External Ventricular Drains: Results of the EVD Aware Study
Authors: Lele Abhijit V. , Mills Brianna , Qiu Qian , Schloemerkemper Nina , Naik Bhiken Ishwarlal , Williams James , Venkat-Raghavan Lakshmikumar , Vavilala Monica S. 
Published: February 2019

Introduction:
The perioperative management of patients with external ventricular drains (EVDs) is not well defined, and adherence to published management guidelines unknown. This study investigates practice, patterns, and variability in the perioperative management of patients with EVDs.

Methods:
A 31-question survey was sent to 1830 anesthesiologists from 27 institutions in North America, Europe, and Asia. A perioperative EVD Guideline Adherence Score was calculated for the preoperative, transport and intraoperative periods. Differences in management practices between neuroanesthesiologists and non-neuroanesthesiologists, and factors affecting EVD guideline adherence, were examined using bivariate significance tests and linear regression.

Results:
Among a sample of 599 anesthesiologists (survey response rate, 32.7%), compared with non-neuroanesthesiologists, neuroanesthesiologists were more likely to include baseline neurological examination (P=0.023), hourly cerebrospinal fluid output (P=0.006) and color (P<0.001), intracranial pressure trends (P<0.001), and EVD clamp trial (P<0.001) data in their routine preanesthetic assessment of patients with EVDs. There was a low prevalence of routine intracranial pressure monitoring during patient transport of patients with EVDs (14.4%). Overall, 25.9% of respondents were aware of EVD guidelines, and 21% reported receiving formal training in EVD management. The EVD Guideline Adherence Score was highest among anesthesiologists who reported being very comfortable in managing patients with EVDs compared with those who reported being uncomfortable (9.93 vs. 6.93, P<0.001).

Conclusions:
The EVD Aware study identifies opportunities for improvement in the perioperative management of patients with EVDS, including global awareness, formal EVD training, and dissemination of educational tools.
Intubating Laryngeal Mask Airway-assisted Flexible Bronchoscopic Intubation Is Associated With Reduced Cervical Spine Motion When Compared With C-MAC Video Laryngoscopy-guided Intubation: A Prospective Randomized Cross Over Trial
Authors: Swain Amlan , Bhagat Hemant , Gupta Vivek , Salunke Pravin , Panda Nidhi B. , Sahu Seelora 
Published: February 2019

Background:
In the evolving research into cervical spine mechanics during airway intervention, new devices are being constantly added to the armamentarium of anesthesiologists. In this study we compared cervical spine movement during orotracheal intubation using an intubating laryngeal mask airway (LMA Fastrach) assisted flexible bronchoscope or video laryngoscope.

Materials and Methods:
In total, 40 consenting patients without history of abnormalities of cervical spine and planned for elective neuroradiologic interventions in the angiography suite were enrolled in this randomized crossover trial. Every patient was subjected to LMA Fastrach-guided flexible bronchoscopic as well as video laryngoscopy guided intubation. Cervical spine motion at the occipital bone, C1-C5 vertebrae, the occiput-C1, C1-C2, C2-C3 and C4-C5 junctions was investigated using continuous fluoroscopy during intubation. The primary outcome of the study was combined craniocervical motion from occiput to C5 between the 2 intubation techniques.

Results:
There was less (62%) combined craniocervical movement from occiput to C5 during the LMA Fastrach-flexible bronchoscopy-guided technique as compared with video laryngoscopy-guided intubation (17.55±14.23 vs. 28.95±11.58 degrees, respectively; P<0.001). The LMA Fastrach flexible bronchoscopy-guided technique also produced significantly less movement as compared to the video laryngoscope at the occiput-C1 (9.75±8.59 vs. 15.00±10.48 degrees; P=0.000) and C1-C2 level (3.95±7.51 vs. 7.53±9.1 degrees; P=0.003).

Conclusions:
There was significantly less movement in the craniocervical and upper cervical spine during LMA Fastrach assisted flexible bronchoscopic intubation compared to video laryngoscopic intubation.
Addition of Intrathecal Morphine for Postoperative Pain Management in Pediatric Spine Surgery
Authors: Musa Arif , Acosta Frank L. , Tuchman Alexander , Movahedi Rana , Pendi Kasim , Nassif Leila , Farhan Saif Aldeen , Muallem Emile , Gucev Gligor 
Published: February 2019

Study Design:
Meta-analysis.

Objective:
The objective of this study was to determine whether adjunctive intrathecal morphine (ITM) reduces postoperative analgesic consumption following pediatric spine surgery.

Summary of Background Data:
Previous studies that have tested supplemental ITM to manage pain after pediatric spine surgery have been limited by small sample sizes.

Methods:
A comprehensive search of PubMed, Web of Science, Clinicaltrials.gov, and the Cochrane Central Register of Controlled Trials was performed for clinical trials and observational studies. Time to first analgesic demand, postoperative analgesic use, pain scores, and complication data were abstracted from each study. Mean difference (MD) and 95% confidence interval (CI) were used to compare continuous outcomes and odds ratios (OR) and 95% CI were used for dichotomous outcomes.

Results:
A total of 5 studies, including 3 randomized controlled trials and 2 retrospective chart reviews, containing 636 subjects, were incorporated into meta-analysis. Subjects that were administered ITM in addition to postoperative analgesics (ITM group) were compared with those receiving postoperative analgesics only (control group). In the ITM group, time to first analgesic demand was longer (MD, 8.79; 95% CI, 4.20-13.37; P<0.001), cumulative analgesic consumption was reduced at 24 hours (MD, −0.40; 95% CI, −0.56 to −0.24; P<0.001), and cumulative analgesic consumption was reduced at 48 hours (MD, −0.43; 95% CI, −0.59 to −0.27; P<0.001). Neither postoperative pain scores at 24 hours (P=0.16) nor 48 hours (P=0.18) were significantly different between ITM and control groups. Rates of respiratory depression, nausea, vomiting, and pruritus were not different between groups (all Ps>0.05).

Conclusions:
Addition of ITM in pediatric spine surgery produced a potent analgesic effect in the immediate postoperative period. Patients administered ITM did not request opiates as early as control and consumed fewer opiates by the second postoperative day. Furthermore, use of ITM did not increase complications such as respiratory depression, nausea, vomiting, or pruritus.
Minimally Invasive Lateral Lumbar Interbody Fusion for Clinical Adjacent Segment Pathology
Authors: Park Hyung-Youl , Kim Young-Hoon , Ha Kee-Yong , Kim Sang-Il , Min Hyung-Ki , Oh In-Soo , Seo Jun-Yeong , Chang Dong-Gune , Park Jong-Tae 
Published: February 2019

Study Design:
This was a retrospective comparative study.

Objective:
The main objective of this article was to evaluate the clinical and radiologic efficacies of minimally invasive lateral lumbar interbody fusion (LLIF) for clinical adjacent segment pathology (ASP).

Summary of Background Data:
Minimally invasive techniques have been increasingly applied for spinal surgery. No report has compared LLIF with conventional posterior lumbar interbody fusion for clinical ASP.

Methods:
Forty patients undergoing LLIF with posterior fusion (hybrid surgery) were compared with 40 patients undergoing conventional posterior lumbar interbody fusion (posterior surgery). The radiologic outcomes including indirect decompression in hybrid surgery group, and clinical outcomes such as the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) were assessed. Postoperative major complications and reoperations were also compared between the 2 groups.

Results:
Correction of coronal Cobb’s angle and segmental lordosis in the hybrid surgery were significantly greater postoperatively (2.8 vs. 0.9 degrees, P=0.012; 7.4 vs. 2.5 degrees, P=0.009) and at the last follow-up (2.4 vs. 0.5 degrees, P=0.026; 4.8 vs. 0.8 degrees, P=0.016) compared with posterior surgery. As regards indirect decompression of the LLIF, significant increases in thecal sac (83.4 vs. 113.8 mm2) and foraminal height (17.8 vs. 20.9 mm) were noted on postoperative magnetic resonance imaging. Although postoperative back VAS (4.1 vs. 5.6, P=0.011) and ODI (48.9% vs. 59.6%, P=0.007) were significantly better in hybrid surgery, clinical outcomes at the last follow-up were similar. Moreover, intraoperative endplate fractures developed in 17.7% and lower leg symptoms occurred in 30.0% of patients undergoing hybrid surgery.

Conclusions:
Hybrid surgery for clinical ASP has advantages of segmental coronal and sagittal correction, and indirect decompression compared with conventional posterior surgery. However, LLIF-related complications such as endplate fracture and lower leg symptoms also developed. LLIF should be performed considering advantages and approach-related complications for the clinical ASP.