bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of In-Hospital and Long-term Outcomes of Sublobar Lung Cancer Surgery by VATS and Open Techniques
Authors: Tuminello Stephanie , Liu Bian , Wolf Andrea , Alpert Naomi , Taioli Emanuela , Flores Raja M. 
Published: April 2018

Objective:
Sublobar resection is often used as an alternative surgical approach in lung cancer patients who are unlikely to tolerate a full lobe resection. This study aims to assess outcomes of video-assisted thoracoscopic surgeries (VATS) sublobar resection as a surgical technique.

Materials and Methods:
The SEER-Medicare database was queried to identify patients with primary lung cancer who had VATS or open sublobar resection. Baseline clinical differences between VATS and open patients were adjusted for in logistic regression and by propensity score matching to investigate surgical outcomes.

Results:
Patients undergoing VATS had a greater number of comorbidities (adjusted odds ratio [ORadj], 0.90; 95% confidence interval [CI], 0.85-0.96) and were less likely to have later stage cancer (ORadj, 0.80; 95% CI, 0.67-0.95), squamous compared with adenocarcinoma (ORadj, 0.82; 95% CI, 0.68-0.99), large (>30 mm) tumor size (ORadj, 0.56; 95% CI, 0.0.41-0.75). VATS patients were less likely to have nodes removed for examination during surgery (ORadj, 0.76; 95% CI, 0.64-0.90). After propensity matching (n=2148), patients who underwent VATS were less likely to experience in-hospital complications, blood transfusions, and a prolonged length of hospital stay than those who had open surgery. There was no statistically significant difference in in-hospital or long-term mortality between patients with VATS and open surgery.

Conclusion:
In the most compromised lung cancer patients, VATS sublobar resection might be the best option.
Mortality After Stereotactic Radiosurgery for Brain Metastases and Implications for Optimal Utilization
Authors: Rydzewski Nicholas R. , Khan Atif J. , Strauss Jonathan B. , Chmura Steven J. 
Published: April 2018

Objectives:
Brain metastases are associated with cancer progression and poor outcomes. The use of stereotactic radiosurgery (SRS) to treat brain metastases has been increasing due to its potential to quickly treat metastatic disease while avoiding the morbidity associated with surgery or whole brain radiation therapy (WBRT). This study seeks to analyze practice patterns of the use of SRS for brain metastases, focusing on the endpoint of short-term mortality.

Materials and Methods:
This study used the National Cancer Database to observe cancer patients diagnosed with a non-Central Nervous System primary from 2010 to 2012 who presented at diagnosis with metastatic disease to the brain and received either WBRT or SRS. The primary endpoint was time to mortality determined by the Kaplan-Meier product-limit estimate of the failure function.

Results:
A total of 18,604 patients were included in the analysis from first day of treatment (16,219 patients received WBRT and 2385 received SRS). At 90 days, mortality was 39.3% for those who received WBRT and 20.0% for those who received SRS. For patients 70 and older who received SRS, mortality was 30.2% at 90 days.

Conclusions:
Analysis of short-term mortality after treatment for brain metastases by using the National Cancer Database provides a window into national treatment patterns and associated outcomes. Roughly 1 in 5 patients who receive SRS and roughly 1 in 3 patients 70 and older who receive SRS die within 90 days of treatment. These data suggest some degree of overutilization of SRS in some patient populations, most notably those patients over the age of 70.
Inhibiting the Inflammatory Injury After Myocardial Ischemia Reperfusion With Plasma-Derived Alpha-1 Antitrypsin: A Post Hoc Analysis of the VCU-α1RT Study
Authors: Abouzaki Nayef Antar , Christopher Sanah , Trankle Cory , Van Tassell Benjamin Wallace , Carbone Salvatore , Mauro Adolfo Gabriele , Buckley Leo , Toldo Stefano , Abbate Antonio 
Published: April 2018

Background:
Despite the benefits of reperfusion in limiting myocardial injury, the infarct size continues to expand after reperfusion because of secondary inflammatory injury. Plasma-derived alpha-1 antitrypsin (AAT) inhibits the inflammatory injury in myocardial ischemia and reperfusion. To explore the effects of plasma-derived AAT on the inflammatory response to ischemia-reperfusion injury, we analyzed time-to-reperfusion and enzymatic infarct size estimates in a post hoc analysis of the VCU-α1RT clinical trial (clinicaltrials.gov NCT01936896).

Methods:
Ten patients with ST-segment elevation acute myocardial infarction (STEMI) were enrolled in an open-label, single-arm treatment study of Prolastin C, plasma-derived AAT, at 60 mg/kg infused intravenously within 12 hours of reperfusion. Biomarkers were measured serially over the first 72 hours, and patients were followed clinically for the occurrence of new-onset heart failure, recurrent MI, or death. Twenty patients with STEMI who had been enrolled in previous randomized trials with identical inclusion/exclusion criteria and had been assigned to placebo served as historical controls.

Results:
Time to percutaneous coronary intervention and time to drug did not significantly differ between groups. AAT-treated patients had a significantly shorter time-to-peak creatine kinase myocardial band (CK-MB) values (525 [480–735] vs. 789 [664–959] minute, P = 0.005) and CK-MB area under the curve (from 1204 [758–2728] vs. 2418 [1551–4289] U·day, P = 0.035), despite no differences in peak CK-MB (123 [30–196] vs. 123 [71–213] U/mL, P = 0.71).

Conclusions:
A single administration of Prolastin C given hours after reperfusion in patients with STEMI led to a significant shorter time to peak and area under the curve for CK-MB, despite similar peak CK-MB values. These preliminary data support the hypothesis that Prolastin C shortens the duration of the ischemia-reperfusion injury in patients with STEMI.
Vascular dysfunction across the stages of the menopausal transition is associated with menopausal symptoms and quality of life
Authors: Hildreth Kerry L. , Ozemek Cemal , Kohrt Wendy M. , Blatchford Patrick J. , Moreau Kerrie L. 
Published: April 2018

Abstract

Objective:
The menopausal transition is associated with somatic symptoms and increased rates of depression, which can impair quality of life (QOL) and increase cardiovascular disease (CVD) risk. This period is also associated with accelerated vascular aging (arterial stiffening and endothelial dysfunction), an antecedent to CVD. This secondary analysis sought to explore associations between depression, menopausal symptoms and QOL, and vascular aging across menopause stages.

Methods:
Arterial stiffness (carotid artery compliance), endothelial function (brachial artery flow-mediated dilation [FMD]), menopausal symptoms (Menopausal Symptom List [MSL]), depression (Center for Epidemiologic Studies Depression Scale [CES-D]), and QOL (Utian QOL Scale [UQOL]) were measured in 138 women (19-70 years) classified as premenopausal (n = 41, 34 ± 8 years; mean ± SD), early (n = 25, 49 ± 3 years), or late perimenopausal (n = 26, 50 ± 4 years), or early (n = 22, 55 ± 4 years) or late postmenopausal (n = 24, 61 ± 5 years). Differences across menopause stages were determined using one-way analysis of variance; associations between vascular measures and MSL, CES-D, and UQOL were tested using Pearson's correlation analyses.

Results:
Menopausal symptoms, depression, and QOL worsened across menopause stages, particularly in late perimenopausal women. Vasosomatic symptom frequency, and general somatic symptom frequency and severity were inversely correlated with carotid artery compliance and FMD (r = −0.27 to −0.18, all P < 0.05). Only correlations with general somatic symptoms were significant after adjusting for multiple comparisons. Total QOL was positively correlated with carotid artery compliance (r = 0.23, P = 0.01). CES-D scores were not correlated with carotid artery compliance or FMD (r = −0.08, −0.03, P = 0.35).

Conclusions:
Vascular dysfunction across the stages of menopause was associated with greater frequency and severity of menopausal symptoms, and lower QOL, but not depression. Mechanisms underlying these associations (eg, inflammation, oxidative stress) should be explored.
Double-Bubble Technique in Descemet Membrane Endothelial Keratoplasty for Vitrectomized Eyes: A Case Series
Authors: Hayashi Takahiko , Kobayashi Akira 
Published: April 2018

Purpose:
To describe a modified technique for Descemet membrane endothelial keratoplasty (DMEK) in vitrectomized eyes that had undergone transscleral-sutured intraocular lens (IOL) implantation (IOL-suture) and pars plana vitrectomy.

Methods:
This was a prospective interventional case series. Patients exhibiting endothelial dysfunction with aphakia, or dislocated IOLs, who underwent IOL-suture and pars plana vitrectomy, were enrolled. Patients underwent DMEK using the “double-bubble technique,” which is characterized by the placement of 2 bubbles, 1 above and 1 beneath the graft. One small air bubble is placed over the graft for the purpose of unfolding the graft; the other large bubble is injected under the graft to enable fixation of the graft. Best spectacle-corrected visual acuity, central corneal thickness, endothelial cell density, the time of graft unfolding (using a surgical video), and the incidence of intraoperative/postoperative complications were analyzed.

Results:
This study included 6 eyes of 6 patients (3 men and 3 women; mean age 78.0 ± 2.5 years). Although the unfolding time was relatively long (10.1 ± 4.5 minutes), all surgeries were uneventful. Rebubbling was required in 1 eye (16.6%). Best spectacle-corrected visual acuity improved significantly in all eyes. There was no primary graft failure.

Conclusions:
This technique (double bubble technique) enables safe and easy DMEK surgery, even in eyes that have been previously vitrectomized and IOL-sutured. Further clinical studies with a large number of patients exhibiting complex eyes are required to definitively establish the clinical value of this technique.
Distribution of Adrenergic Receptor Subtypes and Responses to Topical 0.5% Apraclonidine in Patients With Blepharoptosis
Authors: Park Seong Jun , Jang Sun Young , Baek Ji Sun , Chin Susie , Jang Jae Woo 
Published: April 2018

Purpose:
To determine the relationship between the distribution of adrenergic receptors in the human eyelid and the eyelid elevation after topically instilling 0.5% apraclonidine in blepharoptosis patients.

Methods:
A total of 26 blepharoptotic patients (30 eyelids) were included in the experimental study. Marginal reflex distance 1 was measured before and after topical instillation of 0.5% apraclonidine. Eyelids were divided into 2 groups according to the responses to topical 0.5% apraclonidine. Patients who positively responded to apraclonidine were classified as group A and those that negatively responded to it were classified as group B. Müller’s muscle was obtained during the blepharoptotic surgery, followed by immunohistochemical staining and scoring. This study was approved by the Institutional Review Board of Kim’s Eye Hospital and the study protocol adhered to the tenets of the Declaration of Helsinki.

Results:
α-1D staining intensity was significantly higher in group A than in B (p < 0.001) and α-2C and β-1 staining intensities were significantly higher in group B than in A (p < 0.001 and p < 0.05, respectively). The difference in β-2 staining intensity between groups A and B was not statistically significant.

Conclusions:
α-1D adrenoceptor was predominant in patients showing a positive response to topical 0.5% apraclonidine. Because apraclonidine has an α-1 agonistic effect, α-1D adrenoceptor may contribute to apraclonidine’s elevating effect in patients with blepharoptosis.
Eye-Preserving Surgery Followed by Adjuvant Radiotherapy for Lacrimal Gland Carcinoma: Outcomes in 37 Patients
Authors: Woo Kyung In , Sagiv Oded , Han Jisang , Frank Steven J. , Kim Yoon-Duck , Esmaeli Bita 
Published: April 2018

Purpose:
To describe the clinical outcomes of eye-preserving surgery followed by adjuvant radiotherapy in patients with lacrimal gland carcinoma.

Methods:
Thirty-seven patients with lacrimal gland carcinoma who underwent eye-preserving surgery were studied.

Results:
At last follow up, 32 patients were alive without disease, 3 patients were alive with disease with distant metastasis, 1 patient had died of disease, and 1 patient had died of other cause. The 5-year recurrence-free survival rate was worse in patients without than in patients with adjuvant radiotherapy (p = 0.001) and worse in patients with T3-T4 tumors than in patients with T1-T2 tumors (p = 0.027). At last follow up, 25 patients (68%) had visual acuity of 20/40 or better.

Conclusions:
In patients with lacrimal gland carcinoma, eye-preserving surgery and adjuvant radiotherapy is associated with reasonable local control rates and visual and ocular function. Postoperative adjuvant radiotherapy seems to enhance local control rates.
Oral Care Clinical Trial to Reduce Non–Intensive Care Unit, Hospital-Acquired Pneumonia: Lessons for Future Research
Authors: McNally Edel , Krisciunas Gintas P. , Langmore Susan E. , Crimlisk Janet T. , Pisegna Jessica M. , Massaro Joseph 
Published: April 2018

ABSTRACT
Hospital-acquired pneumonia (HAP) contributes greatly to patient mortality and healthcare costs. Studies have shown that aggressive oral care in intensive care units (ICUs) can significantly reduce pneumonia rates, and hospitals have implemented stringent protocols in this setting. However, little is known about the effectiveness of aggressive oral care in reducing HAP in non–intensive care wards, prompting us to conduct a nonrandomized controlled clinical trial. A structured toothbrushing program was provided to an experimental cohort of patients. A control group received usual care. Patient demographics, toothbrushing frequency, and pneumonia diagnosis were recorded over a 3.5-month period. Difference in pneumonia rates was computed using unadjusted and multivariate logistic regression analyses. No significant difference in pneumonia rates between control and experimental groups was found (1.7% versus 1.8%). Toothbrushing rates increased significantly in the experimental group (p = .002) but fell short of protocol frequency. It became apparent that aggressive toothbrushing program implementation requires nursing-led interdisciplinary involvement, more intensive training, a streamlined documentation system, and efficient compliance tracking. Lessons from this study should be used for future large-scale research. A secondary analysis of these data did, however, suggests that increasing toothbrushing rates may have the potential to reduce pneumonia in the non-ICU acute care setting.
Evaluation of postprandial hypoglycemia in patients with nonalcoholic fatty liver disease by oral glucose tolerance testing and continuous glucose monitoring
Authors: Oki Yusuke , Ono Masafumi , Hyogo Hideyuki , Ochi Tsunehiro , Munekage Kensuke , Nozaki Yasuko , Hirose Akira , Masuda Kosei , Mizuta Hiroshi , Okamoto Nobuto , Saibara Toshiji 
Published: April 2018

Objective
Nonalcoholic fatty liver disease (NAFLD) is often associated with insulin resistance and glucose intolerance. Postprandial hypoglycemia frequently occurs in NAFLD patients; however, the details remain unclear.

Patients and methods
The 75-g oral glucose tolerance test (75gOGTT) in 502 patients with biopsy-proven NAFLD and continuous glucose monitoring (CGM) in 20 patients were performed, and the characteristics and causes of postprandial hypoglycemia were investigated.

Results
The proportion of patients in the Hypo subgroup [plasma glucose (PG) at 180 min<fasting-PG (FPG)] among patients with normal glucose tolerance was significantly higher than that with diabetes mellitus and impaired glucose tolerance or impaired fasting glucose. FPG and hemoglobin A1c (HbA1c) were lower, and area under the curve of total insulin secretion within 120 min (<120 min) was higher in Hypo than Hyper in overall patients. Although FPG and PG at 30 min were higher in Hypo than Hyper, HOMA-IR and the insulinogenic index were not different in normal glucose tolerance and impaired glucose tolerance or impaired fasting glucose. In multivariate logistic regression analysis, low HbA1c, low fasting immunoreactive insulin, and high area under the curve of total insulin secretion (<120 min) were found to be independent factors associated with hypoglycemia. CGM showed postprandial hypoglycemia until lunch in 70% of NAFLD patients. However, no remarkable relationship in terms of hypoglycemia was identified between the 75gOGTT and CGM.

Conclusion
Postprandial hypoglycemia was identified in many NAFLD patients detected by 75gOGTT and CGM. It was clarified that important causes of postprandial hypoglycemia were related to low HbA1c, an early elevation of PG, low fasting and relatively low early insulin secretion, and delayed hyperinsulinemia.
Concurrent extrahepatic autoimmune disorders: unexplored dimension of autoimmune liver disease in children
Authors: Jain Vikas , Yachha Surender K. , Bhatia Eesh , Sarma Moinak S. , Srivastava Anshu 
Published: April 2018

Background and aim
No comprehensive and prospective data are available for concurrent extrahepatic autoimmune disorders (CEAIDs) in children with autoimmune liver disease (AILD). The aim of this study was to evaluate CEAIDs in AILD and their effect on AILD outcome.

Patients and methods
Enrolled AILD and CEAIDs children were diagnosed on the basis of simplified and standard diagnostic criteria, respectively. The clinicopathological profile, treatment response, and outcome were compared between AILD with CEAIDs (group A) and AILD without CEAIDs (group B).

Results
In 62 AILD children, CEAIDs were found in 42% (n=26) [vitiligo (42%), celiac disease (CD) (15%), potential CD (15%), autoimmune hemolytic anemia (AIHA) (15%)]. CEAIDs were asymptomatic in 75%. Single CEAID was found in 81% (21/26) and multiple CEAID was found in 19% (5/26). Significantly less biochemical remission (46.1 vs. 74.2%, P=0.03), more treatment failure (23 vs. 3.2%, P=0.04), and higher mortality (15.3 vs. 3.2%, P=0.04) were encountered in group A compared with group B. On multivariate analysis (n=57), less biochemical remission in vitiligo (P=0.04); more treatment failure in AIHA (P=0.004) and vitiligo (P=0.04); and high mortality in AIHA (P=0.02) subgroups were reported. CD treatment has good impact on AILD outcome. All cases of diabetes mellitus in AILD were steroid-induced rather than because of autoimmunity (absence of antibody against tyrosine phosphatase and glutamic acid decarboxylase and elevated C-peptide).

Conclusion
All AILD children should be screened for CEAIDs as the majority are asymptomatic. The AILD outcome was favorable in CD, but poor in vitiligo and AIHA. We suggest the incorporation of CEAIDs in a pediatric AILD scoring system.
A novel scoring model for predicting mortality risk in patients with cirrhosis and hepatorenal syndrome
Authors: Zhang Shuan , He Ling-Ling , Wang Xin-Hui , Dang Zhi-Bo , Liu Xiao-Li , Li Meng-Ge , Wang Xian-Bo , Yang Zhi-Yun 
Published: April 2018

Background and aims
This study aimed to create a risk scoring model for death from cirrhosis and hepatorenal syndrome, improve the detection rate of high-risk groups, and provide clinical evidence for early intervention treatment.

Patients and methods
We retrospectively recruited 196 patients with cirrhosis and hepatorenal syndrome between 1 January 2013 and 31 July 2014 at Beijing Ditan Hospital, Capital Medical University, China. The clinical information, biochemical values, age, and sex of the patients were included in the multivariate logistic regression model for screening independent risk factors. The model was validated in 56 patients with cirrhosis and hepatorenal syndrome between 1 August 2014 and 31 December 2014 at Beijing Ditan Hospital, Capital Medical University, China.

Results
The death risk prediction scoring model included the following four independent risk factors: liver cancer, neutrophil above 70%, alanine aminotransferase higher than 40 U/l, and creatinine higher than 127 mmol/l. The sum death risk score ranged from 0 to 5: 0–2 identified patients with a lower risk of death (mortality rates: 12–41.4%), whereas 3–5 identified patients with a higher risk of death (mortality rates: 48.8–80%). Receiver-operating characteristic curves were constructed for the scoring model and the areas under the curves (AUC) were compared using the z-test. The AUC of the scoring model was 0.843. In addition, the AUC of validated model in 56 patients was 0.742.

Conclusion
The scoring model can accurately predict mortality risk in patients with hepatorenal syndrome.
Postmortem Vitreous Sodium and Chloride Elevate After 1 Hour and Magnesium After 2 Hours in Bovine Eyeballs Immersed in Salt Water
Authors: Tse Rexson , Kuo Ta-chen , Garland Jack , Lam Leo , Sunderland Michael , Kesha Kilak , Elstub Hannah , Cala Allan , Stables Simon 
Published: April 2018

Background
Postmortem vitreous sodium (Na) and chloride (Cl) are good ancillary tests in diagnosing salt-water drowning. Vitreous Na and Cl appear to elevate from salt-water drowning and immersion, whereas vitreous magnesium (Mg) appears to be unaffected by drowning, but elevates from immersion. The relative changes of these electrolytes during salt-water immersion are unknown, particularly with shorter immersion times. Understanding the relative changes may aid in the interpretation of vitreous electrolytes in bodies recovered from salt water.

Aim
The aim of this study was to compare the changes of vitreous Na, Cl, and Mg when immersed in salt water.

Methods
Bovine eyeballs were randomized into 2 groups (submerged in salt water and control). The vitreous Na, Cl, and Mg from 6 eyeballs were measured from each group (without replacement) at 1, 2, 4, and 6 hours.

Results
There were no statistically significant elevations in bovine vitreous Na and Cl for up to 1 hour and vitreous Mg for up to 2 hours.

Conclusions
Bovine vitreous Na and Cl elevate earlier than Mg when immersed in salt water. Assuming similar physical properties, an elevation in vitreous Mg in bodies immersed in salt water indicates the immersion effects of causing raised vitreous Na and Cl have started.
A Risk Scoring System for the Prediction of Functional Deterioration, Institutionalization, and Mortality Among Medicare Beneficiaries
Authors: McClintock Heather F. , Kurichi Jibby E. , Kwong Pui L. , Xie Dawei , Stineman Margaret G. , Bogner Hillary R. 
Published: April 2018

Objective
We sought to develop a risk scoring system for predicting functional deterioration, institutionalization, and mortality. Identifying predictors of poor health outcomes informs clinical decision-making, service provision, and policy development to address the needs of persons at greatest risk for poor health outcomes.

Design
This is a cohort study with 21,257 community-dwelling Medicare beneficiaries 65 yrs and older who participated in the 2001–2008 Medicare Current Beneficiary Survey.
Derivation of the model was conducted in 60% of the sample and validated in the remaining 40%. Multinomial logistic regression model generated β coefficients, which were used to create a risk scoring system. Our outcome was instrumental activity of daily living stage transitions (stable/improved function and functional deterioration), institutionalization, or mortality for 2 yrs of follow-up.

Results
A total of 18 factors were identified for functional deterioration (P < 0.05). In the derivation cohort, the likelihood of functional deterioration ranged from 6.27% to 33.51%, risk of institutionalization from 0.07% to 12.13%, and risk of mortality from 2.13% to 31.83%, in comparison with stable/improved function.

Conclusions
A risk scoring system predicting Medicare beneficiaries' risk of functional deterioration, institutionalization, and mortality based on demographic and clinical indicators may feasibly be developed with implications for healthcare delivery.