bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Term Outcome of Patients With a Hematologic Malignancy and Multiple Organ Failure Admitted at the Intensive Care
Authors: de Vries Vera A. , Müller Marcella C. A. , Arbous M. Sesmu , Biemond Bart J. , Blijlevens Nicole M. A. , Kusadasi Nuray , Span Lambert R. F. , Vlaar Alexander P. J. , van Westerloo David J. , Kluin-Nelemans Hanneke C. , van den Bergh Walter M. 
Published: October 2018

Objectives:
Historically, patients with a hematologic malignancy have one of the highest mortality rates among cancer patients admitted to the ICU. Therefore, physicians are often reluctant to admit these patients to the ICU. The aim of our study was to examine the survival of patients who have a hematologic malignancy and multiple organ failure admitted to the ICU.

Design:
This retrospective cohort study, part of the HEMA-ICU study group, was designed to study the survival of patients with a hematologic malignancy and organ failure after admission to the ICU. Patients were followed for at least 1 year.

Setting:
Five university hospitals in the Netherlands.

Patients:
One-thousand ninety-seven patients with a hematologic malignancy who were admitted at the ICU.

Interventions:
None.

Measurements and Main Results:
Primary outcome was 1-year survival. Organ failure was categorized as acute kidney injury, respiratory failure, hepatic failure, and hemodynamic failure; multiple organ failure was defined as failure of two or more organs. The World Health Organization performance score measured 3 months after discharge from the ICU was used as a measure of functional outcome. The 1-year survival rate among these patients was 38%. Multiple organ failure was inversely associated with long-term survival, and an absence of respiratory failure was the strongest predictor of 1-year survival. The survival rate among patients with 2, 3, and 4 failing organs was 27%, 22%, and 8%, respectively. Among all surviving patients for which World Health Organization scores were available, 39% had a World Health Organization performance score of 0–1 3 months after ICU discharge. Functional outcome was not associated with the number of failing organs.

Conclusions:
Our results suggest that multiple organ failure should not be used as a criterion for excluding a patient with a hematologic malignancy from admission to the ICU.
Endoscopic third ventriculostomy and ventriculoperitoneal shunt for patients with noncommunicating hydrocephalus
Authors: Jiang Lin , Gao Guangzhong , Zhou Yanfeng 
Published: October 2018

Abstract

Background:
The surgical methods of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VS) for patients with noncommunicating hydrocephalus have rapidly increased in the past 2 decades. However, there is controversy regarding the efficacy and safety of these 2 surgical methods for noncommunicating hydrocephalus. The purpose of this study was to identify whether ETV is safer and more efficacious than VS for patients with noncommunicating hydrocephalus.

Methods:
We performed electronic searches in PubMed, Embase, China National Knowledge Internet, and the Cochrane Library to identify studies published up to February 03, 2018. The study summary results included improvement of symptoms, major complications, hematoma, infection, reoperation, mortality, duration of surgery, and hospital stay. Odds ratios (ORs) or standard mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random-effects models.

Results:
We identified 10 observational studies (4 prospective and 6 retrospective studies) with data collected from 2017 patients with noncommunicating hydrocephalus. First, there was no significant difference between ETV and VS for symptom improvement (OR: 0.83; 95%CI: 0.46–1.50; P = .534). Second, ETV was associated with lower incidence of major complications when compared with VS (OR: 0.31; 95%CI: 0.17–0.56; P < .001). Third, ETV has little or no significant effect on hematoma (OR: 0.65; 95%CI: 0.22–1.92; P = .433) and mortality (OR: 0.90; 95%CI: 0.11–7.72; P = .926). Fourth, ETV were associated with lower incidence of infection (OR: 0.20; 95%CI: 0.06–0.69; P = .010) and reoperation (OR: 0.22; 95%CI: 0.08–0.56; P = .002). Finally, patients who received ETV had shorter duration of surgery (SMD: -1.71; 95%CI: -3.16 to -0.27; P = .020) and hospital stay (SMD: −0.91; 95%CI: −1.45 to −0.38; P = .001).

Conclusions:
This meta-analysis provides robust evidence that ETV has greater benefits in terms of major complications, infection, reoperation, duration of surgery, and hospital stay than VS for patients with noncommunicating hydrocephalus.
Efficacy and safety of a 260-cm Amplatz Super Stiff guidewire during transradial percutaneous coronary intervention
Authors: Feng Xuguang , Zhang Xiaoyun , Dai Jun , Bin Jianping 
Published: October 2018

Abstract

Background
Although transradial percutaneous coronary intervention (TR-PCI) is widely used in clinical practice, guidewire-related complications are an important cause of transradial approach failure. We investigated the prognostic value of the 260-cm Amplatz Super Stiff guidewire for reducing the complication rate during TR-PCI.

Methods
Five hundred patients with positive Allen's test results were divided into 3 groups according to the type of angiography guidewire: group A, 150-cm Emerald guidewire standard J-tip (n = 160); group B, 150-cm Radifocus guidewire M (n = 176); and group C, exchangeable 260-cm Amplatz Super Stiff guidewire after placement of a 150-cm Radifocus guidewire M (n = 164).

Results
Group C had the highest success rate (P = .008) and the lowest incidence of operative complications such as radial artery spasms and hematomas (P = .030 and P = .036, respectively). In addition, the groups differed significantly in terms of fluoroscopy and catheter placement times (P = .02. and P < .001, respectively); group C had the shortest times for these occurrences.

Conclusions
The exchangeable 260-cm Amplatz Super Stiff guidewire markedly decreased the incidence of guidewire-related complications, reduced fluoroscopy times, and increased the procedural success rate. Therefore, this tool can be considered a safe, effective, and feasible exchangeable guidewire for TR-PCI.
Long-term benefits of high-intensity atorvastatin therapy in Chinese acute coronary syndrome patients undergoing percutaneous coronary intervention
Authors: Liu Hui , Dong Aiqiao , Wang Haiyan 
Published: October 2018

AbstractThere is lack of long-term data on high-intensity statin therapy of Chinese acute coronary syndrome (ACS) patients scheduled to undergo percutaneous coronary intervention (PCI). In this retrospective study, we compared the long-term efficacy and safety of high-intensity and conventional atorvastatin therapy in reducing low-density lipoprotein cholesterol (LDL-C) and plaque size, and improving cardiac function of ACS patients who underwent PCI.We retrospectively analyzed the clinical records of 120 consecutive ACS patients who underwent PCI at our hospital. Group I received a loading dose of atorvastatin (80 mg/day) prior to PCI, followed by a maintenance dose of 40 mg/day for 3 months post-PCI. Group II received a regular dose of atorvastatin (20 mg/day) from the date of admission until 1 year post-PCI. The composite primary efficacy end point was the mean percent change in calculated LDL-C from baseline to week 48 in both groups and percentage of patients achieving the LDL-C target of ≤1.81 mmol/L.Group I had significantly higher mean baseline LDL-C than group II. Moreover, 8.3% of group I patients had an LDL-C ≤1.81 mmol/L versus 43.3% for group II. At week 24, 75.0% and 90.0% of group I and II patients, respectively, achieved the LDL-C target. At week 48, 85.0% and 96.7% of group I and II patients, respectively, achieved the LDL-C target. Additionally, the mean percent changes at week 4 from baseline in LDL-C were −33.6% ± 20.0% for group I versus −12.8% ± 19.6% for group II, and −47.0% ± 25.5% at week 48 for group I versus −36.4% ± 20.2% for group II. Meanwhile, significant reduction in plaque size and marked improvement in cardiac function were seen in patients receiving high-intensity atorvastatin therapy.Compared to conventional therapy, high-intensity statin therapy is more effective in reducing LDL-C and improving cardiac function of ACS patients, with a general benign safety profile over a period of 48 weeks. Our findings support the use of high-intensity statin therapy for Chinese ACS patients to improve the proportion of patients attaining the LDL-C target and reduction in plaque size and improvement cardiac function.
Duration and Time Trends in Hospital Stay for Very Preterm Infants Differ Across European Regions*
Authors: Maier Rolf F. , Blondel Béatrice , Piedvache Aurélie , Misselwitz Bjoern , Petrou Stavros , Van Reempts Patrick , Franco Francesco , Barros Henrique , Gadzinowski Janusz , Boerch Klaus , van Heijst Arno , Draper Elizabeth S. , Zeitlin Jennifer 
Published: October 2018

Objectives:
To compare duration and changes over time in length of hospital stay for very preterm and extremely preterm infants in 10 European regions.

Design:
Two area-based cohort studies from the same regions in 2003 and 2011/2012.

Setting:
Ten regions from nine European countries.

Patients:
Infants born between 22 + 0 and 31 + 6 weeks of gestational age and surviving to discharge (Models of Organising Access to Intensive Care for Very Preterm Births cohort in 2003, n = 4,011 and Effective Perinatal Intensive Care in Europe cohort in 2011/2012, n = 4,336).

Interventions:
Observational study, no intervention.

Measurements and Main Results:
Maternal and infant characteristics were abstracted from medical records using a common protocol and length of stay until discharge was adjusted for case-mix using negative binomial regression. Mean length of stay was 63.6 days in 2003 and varied from 52.4 to 76.5 days across regions. In 2011/2012, mean length of stay was 63.1 days, with a narrower regional range (54.0–70.1). Low gestational age, small for gestational age, low 5-minute Apgar score, surfactant administration, any surgery, and severe neonatal morbidities increased length of stay. Infant characteristics explained some of the differences between regions and over time, but large variations remained after adjustment. In 2011/2012, mean adjusted length of stay ranged from less than 54 days in the Northern region of the United Kingdom and Wielkopolska, Poland to over 67 days in the Ile-de-France region of France and the Eastern region of the Netherlands. No systematic decrease in very preterm length of stay was observed over time after adjustment for patient case-mix.

Conclusions:
A better understanding of the discharge criteria and care practices that contribute to the wide differences in very preterm length of stay across European regions could inform policies to optimize discharge decisions in terms of infant outcomes and health system costs.
The Effect of Pelvic Floor Muscle Contraction on Detrusor Overactivity Pressure in Neurogenic and Nonneurogenic Women During Urodynamic Study
Authors: Lúcio Adélia , Lourenço Christiane Boaventura , Damasceno Benito Pereira , de Moraes Lopes Maria Helena Baena , D'ancona Carlos Arturo Levi 
Published: October 2018

ObjectiveThe aims of this study were to investigate whether detrusor overactivity can be influenced by a pelvic floor muscle contraction in multiple sclerosis–associated overactive bladder and idiopathic overactive bladder volunteers and to compare urodynamic findings between the two groups.DesignEighteen women with multiple sclerosis–associated overactive bladder and 17 women with overactive bladder responded the overactive bladder V8 questionnaire and performed urodynamic study with electromyography of pelvic floor muscle to confirm the presence of a 15-sec pelvic floor muscle contraction during a detrusor overactivity, when present. Variables were the following: overactive bladder-V8 questionnaire, maximum cystometric capacity, volume at first detrusor overactivity, maximum detrusor overactivity amplitude, and percentage of detrusor overactivity pressure reduction.ResultsAll participants had a reduction in detrusor overactivity pressure when pelvic floor muscle contraction was requested. Multiple sclerosis–associated overactive bladder group showed significant higher detrusor overactivity amplitude than overactive bladder group (P= 0.02). Overactive bladder group had their detrusor overactivity pressure reduced in a greater extent when compared with multiple sclerosis–associated overactive bladder group (P= 0.01).ConclusionsThe results suggest that pelvic floor muscle contraction is able to reduce detrusor overactivity pressure in multiple sclerosis–associated overactive bladder and overactive bladder population.
Comprehensive Complication Index Validates Improved Outcomes Over Time Despite Increased Complexity in 3707 Consecutive Hepatectomies
Authors: Cloyd Jordan M. , Mizuno Takashi , Kawaguchi Yoshikuni , Lillemoe Heather A. , Karagkounis Georgios , Omichi Kiyohiko , Chun Yun Shin , Conrad Claudius , Tzeng Ching-Wei D. , Odisio Bruno C. , Huang Steven Y. , Hicks Marshall , Wei Steven H. , Aloia Thomas A. , Vauthey Jean-Nicolas 
Published: October 2018

Objective:
The aim of this study was to evaluate trends over time in perioperative outcomes for patients undergoing hepatectomy.

Background:
As perioperative care and surgical technique for hepatectomy have improved, the indications for and complexity of liver resections have evolved. However, the resulting effect on the short-term outcomes over time has not been well described.

Methods:
Consecutive patients undergoing hepatectomy during 1998 to 2015 at 1 institution were analyzed. Perioperative outcomes, including the comprehensive complication index (CCI), were compared between patients who underwent hepatectomy in the eras 1998 to 2003, 2004 to 2009, and 2010 to 2015.

Results:
The study included 3707 hepatic resections. The number of hepatectomies increased in each era (794 in 1998 to 2003, 1402 in 2004 to 2009, and 1511 in 2010 to 2015). Technical complexity increased over time as evidenced by increases in the rates of major hepatectomy (20%, 23%, 30%, P < 0.0001), 2-stage hepatectomy (0%, 3%, 4%, P < 0.001), need for portal vein embolization (5%, 9%, 9%, P = 0.001), preoperative chemotherapy for colorectal liver metastases (70%, 82%, 89%, P < 0.001) and median operative time (180, 175, 225 minutes, P < 0.001). Significant decreases over time were observed in median blood loss (300, 250, 200 mL, P < 0.001), transfusion rate (19%, 15%, 5%, P < 0.001), median length of hospitalization (7, 7, 6 days, P < 0.001), rates of CCI ≥26.2 (20%, 22%, 16%, P < 0.001) and 90-day mortality (3.1%, 2.6%, 1.3%, P < 0.01). On multivariable analysis, hepatectomy in the most recent era 2010 to 2015 was associated with a lower incidence of CCI ≥26.2 (odds ratio 0.7, 95% confidence interval 0.6–0.8, P < 0.0001).

Conclusion:
Despite increases in complexity over an 18-year period, continued improvements in surgical technique and perioperative outcomes yielded a resultant decrease in CCI in the most current era.
Laparoscopic Versus Open Resection for Rectal Cancer
Authors: Acuna Sergio A. , Chesney Tyler R. , Ramjist Joshua K. , Shah Prakesh S. , Kennedy Erin D. , Baxter Nancy N. 
Published: October 2018

Objective:
To determine whether laparoscopic surgery is noninferior to open surgery for rectal cancer in terms of quality of surgical resection outcomes.

Background:
Randomized clinical trials (RCTs) have evaluated the oncologic safety of laparoscopic versus open surgery for rectal cancer with conflicting results. Prior meta-analyses comparing these operative approaches in terms of quality of surgical resection aimed to demonstrate if one approach was superior. However, this method is not appropriate and potentially misleading when noninferiority RCTs are included.

Methods:
MEDLINE, EMBASE, and Cochrane were searched to identify RCTs comparing these operative approaches. Risk differences (RDs) were pooled using random-effects meta-analyses. One-sided Z tests were used to determine noninferiority. Noninferiority margins (ΔNI) for circumferential resection margin (CRM), plane of mesorectal excision (PME), distal resection margin (DRM), and a composite outcome (“successful resection”) were based on the consensus of 58 worldwide experts.

Results:
Fourteen RCTs were included. Laparoscopic resection was noninferior compared with open resection for the rate of positive CRM [RD 0.79%, 90% confidence interval (CI) −0.46 to 2.04, ΔNI = 2.33%, P
NI = 0.026], incomplete PME (RD 1.16%, 90% CI −0.27 to 2.59, ΔNI = 2.85%, P
NI = 0.025), and positive DRM (RD 0.15%, 90% CI −0.58 to 0.87, ΔNI = 1.28%, P
NI = 0.005). For the rate of “successful resection” (RD 6.16%, 90% CI 2.30–10.02), the comparison was inconclusive when using the ΔNI generated by experts (ΔNI = 2.71%, P
NI = 0.07), although no consensus was achieved for this ΔNI.

Conclusions:
Laparoscopy was noninferior to open surgery for rectal cancer in terms of individual quality of surgical resection outcomes. These findings are concordant with RCTs demonstrating noninferiority for long-term oncologic outcomes between the 2 approaches.
Is Less More? A Microsimulation Model Comparing Cost-effectiveness of the Revised American Thyroid Association's 2015 to 2009 Guidelines for the Management of Patients With Thyroid Nodules and Differentiated Thyroid Cancer
Authors: White Craig , Weinstein Milton C. , Fingeret Abbey L. , Randolph Gregory W. , Miyauchi Akira , Ito Yasuhiro , Zhan Tiannan , Ali Ayman , Gazelle G. Scott , Lubitz Carrie C. 
Published: October 2018

Objective:
To assess relative clinical and economic performance of the revised American Thyroid Association (ATA) thyroid cancer guidelines compared to current standard of care.

Background:
Diagnosis of thyroid cancer in the United States has tripled whereas mortality has only marginally increased. Most patients present with small papillary carcinomas and have historically received at least a total thyroidectomy as a treatment. In 2015, the ATA released the revised guidelines recommending an option for active surveillance (AS) of small papillary thyroid carcinoma and thyroid lobectomy for larger unifocal tumors.

Methods:
We created a Markov microsimulation model to evaluate the performance of the ATA's 2015 guidelines compared to the ATA's 2009 guidelines. We modeled a cohort of simulated patients with demographic and thyroid nodule characteristics representative of those presenting clinically in the United States. Outcome measures include life expectancy, quality-adjusted life years, costs, and frequency of surgical adverse events.

Results:
In our base case analysis, the ATA 2015 strategy dominates the ATA 2009 strategy. The ATA 2015 strategy delivers greater discounted average quality-adjusted life years (13.09 vs 12.43) at a lower discounted average cost ($14,752 vs $20,126). Deaths due to thyroid cancer under the 2015 strategy are higher than the 2009 strategy but this is offset by a reduction in surgical deaths, leading to greater average life expectancy under the ATA 2015 strategy. The optimal strategy is sensitive to patients who experience a greater decrement in quality of life while undergoing AS.

Conclusions:
The ATA 2015 Guidelines represent a cost-effective strategy regarding AS and extent of surgery.
Medical and Surgical Complications and Health-related Quality of Life After Esophageal Cancer Surgery
Authors: Kauppila Joonas H. , Johar Asif , Lagergren Pernilla 
Published: October 2018

Objective:To evaluate the impact of postoperative medical and surgical complications on health-related quality of life (HRQOL) in esophageal cancer.Background:Complications after esophageal surgery negatively affect HRQOL, but it is unclear whether medical and surgical complications differ in effects.Methods:This Swedish population-based, nationwide, and prospective cohort study enrolled 616 patients undergoing esophageal cancer surgery during 2001 to 2005, with 10 years of follow-up. The exposure was the occurrence of the predefined postoperative medical or surgical technical complications. The study outcome was HRQOL, evaluated by European Organisation for Research and Treatment of Cancer questionnaires at 6 months, and 3, 5, and 10 years after surgery. Linear mixed models, adjusted for confounders and complications, provided mean score differences (MDs) and 95% confidence intervals (CIs) for each HRQOL scale and item.Results:Of the 616 patients, 217 (35%) had medical and 163 (26%) had surgical postoperative complications. In patients with medical complications, HRQOL was generally worse at all time points, with worse global quality of life (QOL) (MD −10, 95% CI −18 to −2) and dyspnea (MD 16, 95% CI 5–27) from 3 years onwards, compared with those without. Patients with surgical complications had worse HRQOL outcomes up to 5 years after surgery, for example, dyspnea at 6 months (MD 11, 95% CI 4–19) and global QOL at 3 years (MD −13, 95% CI −22 to −5), than those without.Conclusion:Medical complications are associated with long-lasting impairments and worsening HRQOL, whereas the negative effects of surgical complications on HRQOL seem to minimize 5 years postsurgery.
The biggest losers: Habitat isolation deconstructs complex food webs from top to bottom
Authors: Ryser Remo , Häussler Johanna , Stark Markus , Brose Ulrich , Rall Björn C. , Guill Christian 
Published: October 2018

AbstractHabitat fragmentation is threatening global biodiversity. To date, there is only limited understanding of how the different aspects of habitat fragmentation (habitat loss, number of fragments and isolation) affect species diversity within complex ecological networks such as food webs. Here, we present a dynamic and spatially-explicit food web model which integrates complex food web dynamics at the local scale and species-specific dispersal dynamics at the landscape scale, allowing us to study the interplay of local and spatial processes in metacommunities. We here explore how the number of habitat patches, i.e. the number of fragments, and an increase of habitat isolation, affect the species diversity patterns of complex food webs (α-,β-,γ-diversity). We specifically test whether there is a trophic dependency in the effect of these to factors on species diversity. In our model, habitat isolation is the main driver causing species loss and diversity decline. Our results emphasise that large-bodied consumer species at high trophic positions go extinct faster than smaller species at lower trophic levels, despite being superior dispersers that connect fragmented landscapes better. We attribute the loss of top species to a combined effect of higher biomass loss during dispersal with increasing habitat isolation in general, and the associated energy limitation in highly fragmented landscapes, preventing higher trophic levels to persist. To maintain trophic-complex and species-rich communities calls for effective conservation planning which considers the interdependence of trophic and spatial dynamics as well as the spatial context of a landscape and its energy availability.