bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mucoepidermoid Carcinoma: A 23‐Year Experience with Emphasis on Low‐Grade Tumors with Close/Positive Margins
Authors: Spellman Joseph , Calzada Gabriel 
Published: January 2018

ObjectiveDescribe outcomes for mucoepidermoid carcinoma by histologic grade and evaluate outcomes for patients with low‐grade tumors with close/positive margins after initial surgical resection.Study DesignCohort study.SettingKaiser Permanente Southern California Medical Group from 1993 to 2016.Subjects and MethodsRetrospective review of 154 patients with major and minor salivary gland mucoepidermoid carcinoma of the head and neck. Disease‐specific and recurrence‐free survival were stratified by tumor grade. Subgroup analysis of recurrence‐free survival in patients with low‐grade disease with close or positive margins was also performed.ResultsFive‐year recurrence‐free and disease‐specific survival were excellent for both low‐ and intermediate‐grade tumors, while there was there was a high rate of recurrence and mortality among patients with high‐grade tumors. Patients with low‐grade tumors with close or positive margins who were observed had no difference in recurrence‐free survival compared to those who underwent revision surgery and/or adjuvant radiotherapy.ConclusionsHigh‐grade mucoepidermoid carcinoma has poor outcomes despite aggressive treatment. Among patients with low‐grade tumors with close or positive margins on initial resection, additional treatment had no impact on survival or recurrence. Observation may be a reasonable alternative to additional treatment in this select group of patients.
Effectiveness of Transmastoid Plugging for Semicircular Canal Dehiscence Syndrome
Authors: Banakis Hartl Renee M. , Cass Stephen P. 
Published: January 2018

Objectives(1) Evaluate changes in subjective symptoms in patients following transmastoid canal plugging for superior semicircular canal dehiscence (SSCD) syndrome. (2) Quantify changes in hearing in patients who have undergone transmastoid canal plugging for SSCD syndrome.Study DesignCase series with chart review.SettingSingle tertiary care institution.Subjects and MethodsWe retrospectively reviewed patients with SSCD who underwent repair with canal plugging via a transmastoid approach between January 2012 and January 2017. Symptom severity was assessed prospectively (autophony, sound/pressure‐induced vertigo, disequilibrium, aural fullness, and pulsatile tinnitus) and after surgery. Pure‐tone and speech audiometry were measured before and after surgery. Two‐sided Wilcoxon rank‐sum tests were used to evaluate changes in subjective symptoms and audiometric outcomes.ResultsSeventeen patients (19 ears) met inclusion criteria. The superior canal was successfully plugged via the transmastoid approach in all cases. Patients reported a statistically significant improvement in autophony, vertigo, aural fullness, and pulsatile tinnitus (P <. 01), without significant improvement in disequilibrium rating (P =. 06). There were no changes noted in pure‐tone average or word recognition score; however, there was a statistically significant improvement in air‐bone gap at 250 Hz of 10.9 dB (P =. 04) with 12.9‐dB improvement in air conduction thresholds (P =. 02) and no difference (0.9 dB, P =. 9) in bone conduction thresholds.ConclusionIn our study, patients with SSCD demonstrated excellent hearing outcomes and resolution of most otologic symptoms after surgical repair. Transmastoid canal plugging, which has been described to date only in smaller case series, is a safe and effective alternative to the traditional middle cranial fossa approach.
Genetic variation of SMAD3 is associated with hip osteoarthritis in a Chinese Han population
Authors: Zhong Fuhua , Lu Jianwei , Wang Yangxin , Song Hongpu 
Published: January 2018

Objective This study was performed to investigate the association between genetic variation in SMAD3 and hip osteoarthritis (OA) in a Chinese Han population. Methods The frequency of two single nucleotide polymorphisms of SMAD3, rs1470002 and rs12901499, was examined in 500 patients with hip OA and 1080 healthy controls in a Chinese Han population. Further analysis was performed according to sex and age. Results We detected statistically significant differences in the allele frequency and genotype between the hip OA and healthy control groups. The frequency of the GA+GG and GA genotypes of rs12901499 and the G variant were much higher in patients with hip OA than in healthy controls. This association was also present when the participants were stratified by sex and age. However, there was no significant association between the risk of hip OA and the presence of rs1470002 GA, AA, or GA+AA genotypes, even after sex- and age-stratified analysis. Conclusions The SMAD3 SNP rs12901499 GA genotype and G variant may increase the risk of hip OA in Chinese Han patients.
Effectiveness of Vancomycin or Beta-Lactam Therapy in Ampicillin-Susceptible Enterococcus spp. Bloodstream Infections
Authors: Fletcher Jesse M. , Kram Shawn J. , Sarubbi Christina B. , Anderson Deverick J. , Kram Bridgette L. 
Published: January 2018

Background: De-escalation to a beta-lactam improves outcomes for patients with a methicillin-susceptible Staphylococcus aureus bloodstream infection (BSI). Whether a similar strategy is appropriate for enterococcal species is less clear. Objective: To determine whether definitive antibiotic selection affects outcomes for patients with an ampicillin-susceptible enterococcal BSI. Methods: This retrospective cohort study included patients over 18 years of age receiving definitive therapy with vancomycin or a beta-lactam for one or more blood cultures positive for Enterococcus spp. isolates between 2007 and 2014. Survival differences were examined using a Kaplan-Meier curve with log-rank test. Results: One-hundred eighty-six patients received definitive therapy with either vancomycin (n = 45, 24.2%) or a beta-lactam (n = 141, 75.8%). The primary outcome, 30-day all-cause mortality, was not different between groups (6.7% vs 7.1%; P = .992). A post hoc analysis of all-cause mortality 1 year after the index BSI was significantly higher in the vancomycin group (51% vs 33%; P = .032). In a Cox proportional hazards regression model, definitive vancomycin was associated with an increased risk of all-cause mortality at 1 year (hazard ratio [HR]: 2.39; 95% confidence interval [CI]: 1.41-4.04). Conclusion: For patients with an ampicillin-susceptible enterococcal BSI, definitive therapy with vancomycin or a beta-lactam was not independently associated with a difference in 30-day all-cause mortality. Whether definitive vancomycin is associated with poor long-term outcomes warrants further exploration.
Long-term mortality and morbidity of patients with systemic lupus erythematosus: a single-center cohort study in China
Authors: Wang Z , Li M , Wang Y , Xu D , Wang Q , Zhang S , Zhao J , Su J , Wu Q , Shi Q , Leng X , Zhang W , Tian X , Zhao Y , Zeng X 
Published: January 2018

Objective This study aims to exhibit the prognosis, both mortality and morbidity, of patients with systemic lupus erythematosus (SLE) in a single-center cohort in China. Methods A cohort of Chinese SLE patients were recruited from April 2009 to February 2010, and followed up regularly in clinic at Peking Union Medical College Hospital (PUMCH). Data for baseline, follow-up, and survival were collected, including demography, manifestations, activity, the Systemic Lupus International Collaborating/American College of Rheumatology (SLICC/ACR) Damage Index (SDI), and medications. The Kaplan–Meier method was adopted for survival analysis. Predicting and risk factors for both mortality and morbidity were evaluated by the Cox proportional hazard model. Associated factors were analyzed by the logistic regression model. Results A total of 260 patients were included at entry. The one-, three-, and five-year survival rates were 98.4%, 95.5%, and 93.8%. The proportion of patients with organ damage increased from 13.4% at baseline to 28.4% at year 6. Regression analysis showed that organ damage led to higher mortality, and organ-involved flare was associated with more future damage. Time from onset to diagnosis > 1 year, nephropathy and severe organ involvement were potential prognostic factors. Furthermore, onset age > 50 and previous organ damage were predictors for further damage. Conclusion Organ damage, severe organ involvement, and prolonged remission could be targets for the management of Chinese SLE patients to further reduce mortality. Early diagnosis, paying more attention to severe organ involvement, and preventing organ-involved flares and new organ damage would be crucially important in the future for Chinese SLE patients.
HumanMethylation450K Array–Identified Biomarkers Predict Tumour Recurrence/Progression at Initial Diagnosis of High-risk Non-muscle Invasive Bladder Cancer
Authors: Kitchen Mark O , Bryan Richard T , Emes Richard D , Luscombe Christopher J , Cheng KK , Zeegers Maurice P , James Nicholas D , Gommersall Lyndon M , Fryer Anthony A 
Published: January 2018

Background: High-risk non-muscle invasive bladder cancer (HR-NMIBC) is a clinically unpredictable disease. Despite clinical risk estimation tools, many patients are undertreated with intra-vesical therapies alone, whereas others may be over-treated with early radical surgery. Molecular biomarkers, particularly DNA methylation, have been reported as predictive of tumour/patient outcomes in numerous solid organ and haematologic malignancies; however, there are few reports in HR-NMIBC and none using genome-wide array assessment. We therefore sought to identify novel DNA methylation markers of HR-NMIBC clinical outcomes that might predict tumour behaviour at initial diagnosis and help guide patient management. Patients and methods: A total of 21 primary initial diagnosis HR-NMIBC tumours were analysed by Illumina HumanMethylation450 BeadChip arrays and subsequently bisulphite Pyrosequencing. In all, 7 had not recurred at 1 year after resection and 14 had recurred and/or progressed despite intra-vesical BCG. A further independent cohort of 32 HR-NMIBC tumours (17 no recurrence and 15 recurrence and/or progression despite BCG) were also assessed by bisulphite Pyrosequencing. Results: Array analyses identified 206 CpG loci that segregated non-recurrent HR-NMIBC tumours from clinically more aggressive recurrence/progression tumours. Hypermethylation of CpG cg11850659 and hypomethylation of CpG cg01149192 in combination predicted HR-NMIBC recurrence and/or progression within 1 year of diagnosis with 83% sensitivity, 79% specificity, and 83% positive and 79% negative predictive values. Conclusions: This is the first genome-wide DNA methylation analysis of a unique HR-NMIBC tumour cohort encompassing known 1-year clinical outcomes. Our analyses identified potential novel epigenetic markers that could help guide individual patient management in this clinically unpredictable disease.
Targeted Treatment With Radio Frequency Ablation for Lingual Tonsil
Authors: Renkonen Suvi , Mäkitie Antti A , Bäck Leif 
Published: January 2018

Objectives: Benign enlargement of the lingual tonsils due to various causes may cause symptoms that warrant treatment. Conventional lingual tonsillectomy remains a challenging procedure, and there is no established standard procedure. We aimed to review the patients receiving different methods of lingual tonsil surgery for various indications at our institute. Methods: Retrospective clinical data on all patients with an ablative operation of the tongue base during the 8-year period between 2007 and 2014 at the Helsinki University Hospital, Helsinki, Finland, were reviewed. The larger cohort comprised 35 patients, of whom 26 were men (74%). Ten patients had undergone solely lingual tonsil radio frequency ablation (LTRFA). The minimum follow-up time for all patients was 2 years. Results: Of the 10 patients, 5 patients with LTRFA had been operated on because of symptomatic lingual tonsil hypertrophy and 5 because of periodic fever associated with possible lingual tonsil involvement. In 2 of the 5 patients with periodic fever, the fever cycles ended after the operation. Of the 5 patients, 3 patients with symptomatic lingual tonsil hypertrophy have been non-symptomatic after 1 to 3 treatment sessions. The last 2 patients continue to have persistent symptoms. There were no major complications. Conclusions: Development of new approaches for the management of various lingual tonsil conditions is warranted. Lingual tonsil volume reduction by LTRFA seems to be a treatment alternative with low morbidity but with limited curative effect only.
Same-day dual radial artery puncture examination in patients requiring percutaneous coronary intervention and the incidence of radial artery occlusion
Authors: Brancheau Daniel , Jain Sachin Kumar Amruthlal , Alexander Patrick B. 
Published: January 2018

Background: We sought to investigate the rate of radial artery occlusion (RAO) after same-day dual radial artery puncture. The trans-radial arterial approach (TRA) for diagnostic and interventional procedures has risen significantly in the United States. Although becoming more commonly performed, TRA is not without risk, and a potential complication is RAO. The rate of RAO after same-day dual artery puncture is unknown. Methods: A retrospective analysis of 27 patients who underwent same-day dual radial artery puncture for percutaneous coronary intervention (PCI) at our institution (Providence Heart Institute in Southfield, MI, USA) from November 2011 to December 2013 were included after initially presenting for cardiac catheterization at a non-PCI-capable facility. The study patients were asked to follow up for evaluation of the radial artery, including obtaining a duplex ultrasound evaluation. Results: The mean age of the patients was 65 years old with 66% of the patients being male. Of the 27 study participants, there were no symptoms reported that were related to RAO. Overall, one (3.7%) patient had an absent radial pulse. The modified Allen’s test was normal in all of the patients with a mean return of palmar flush time of 4 seconds. Duplex ultrasound revealed subtotal RAO in four (14.8%) patients and no patients experienced total occlusion following the intervention. Conclusion: Dual radial artery puncture appears to be a well-tolerated and viable strategy in patients that are transferred to a PCI-capable hospital for coronary interventions.
The impact of comorbidities, sex and age on the occurrence of acute kidney injury among patients undergoing nephron-sparing surgery
Authors: Hellou Elias , Bahouth Zaher , Sabo Edmond , Abassi Zaid , Nativ Ofer 
Published: January 2018

Background: The aim of this study was to report the impact of patients’ baseline characteristics on the incidence of acute kidney injury (AKI) after nephron-sparing surgery (NSS) for localized kidney cancer. Patients and methods: Data from our kidney cancer database were retrospectively extracted to include 402 patients who underwent NSS between March 2000 and June 2016, and had sufficient data. Definition of AKI was based on the postoperative serum creatinine levels and estimated glomerular filtration rate (eGFR) magnitude, which were measured during the 72 h after surgery. Results: Based on RIFLE and AKIN criteria, the overall rate of postoperative AKI was 35%. The average decrease in eGFR among patients who developed AKI was 20% as compared with the non-AKI subgroup (2%). In univariate analysis, variables that were associated with AKI included right-sided tumors ( p = 0.014), male sex ( p = 0.01), hypertension ( p = 0.003), baseline eGFR ( p = 0.009) and history of nephrolithiasis ( p = 0.039). However, multivariate analysis revealed that the only independent predictors of postoperative AKI were hypertension ( p = 0.009) and cigarette smoking ( p = 0.024). Conclusion: AKI is a common complication of NSS affecting about one-third of the patients. The most important risk factors are hypertension and smoking.
Development of a personalized therapeutic strategy for ERBB-gene-mutated cancers
Authors: Milewska Malgorzata , Cremona Mattia , Morgan Clare , O’Shea John , Carr Aoife , Vellanki Sri HariKrishna , Hopkins Ann M. , Toomey Sinead , Madden Stephen F. , Hennessy Bryan T. , Eustace Alex J. 
Published: January 2018

Background: The application of genomic technologies to patient tumor samples identified groups of signaling pathways which acquire activating mutations. Some cancers are dependent on these mutations and the aberrant proteins resulting from these mutations can be targeted by novel drugs which can eradicate the cancer. Methods: We used www.cbioportal.org to determine the frequency of ERBB mutations in solid tumors. We then determined the sensitivity of a panel of cell lines to clinically available PI3K inhibitors. Using proliferation and apoptosis assays as well as functional interrogation with reverse phase protein arrays we demonstrated the impact of targeting ERBB-mutant cancers with the combination of a PI3K inhibitor and the pan-HER family inhibitor afatinib. Results: In over 14,000 patients we found that 12% of their tumors have an ERBB family gene mutation (EGFR, ERBB2, ERBB3 and ERBB4). In cancers not commonly associated with HER family protein overexpression, such as ovarian, endometrial, melanoma and head and neck cancers ( n = 2116), we found that ERBB family mutations are enriched, occurring at rates from 14% to 34% and commonly co-occur with PIK3CA mutations. Importantly, we demonstrate that ERBB family mutant cancers are sensitive to treatment with PI3K inhibitors. Finally we show that the combination of afatinib and copanlisib represents a novel therapeutic strategy for patients whose cancers harbor both ERBB family and PIK3CA mutation. Conclusions: We demonstrate that ERBB family mutations are common in cancers not associated with overexpression or amplification of HER family proteins. These ERBB family mutant cancers are sensitive to treatment with PI3K inhibitors, and when combined with pan-HER inhibitors have synergistic antiproliferative effects.
Online Physical Therapy Protocol Quality, Variability, and Availability in Achilles Tendon Repair
Authors: Lightsey Harry M. , Noback Peter C. , Caldwell Jon-Michael E. , Trofa David P. , Greisberg Justin K. , Vosseller J. Turner 
Published: January 2018

Background: Substantial progress has been made in characterizing the benefit of early functional rehabilitation following Achilles tendon repair (ATR). However, standardized ATR rehabilitation guidelines have yet to be produced. Furthermore, as patients increasingly use the Internet to independently retrieve health care content, access to standardized, clinically effective rehabilitation protocols is necessary. Methods: Online ATR physical therapy protocols from US academic orthopaedic programs were reviewed. A comprehensive scoring rubric was designed after reviewing all identified protocols and was used to assess each protocol for both the presence of various rehabilitation components as well as when those components were introduced. Results: Twenty-two of 155 US academic orthopaedic programs published postoperative Achilles rehabilitation protocols online, with a total of 27 individual protocols available for review. Twenty-one protocols (78%) recommended immediate postoperative splinting. Only one protocol recommended short-leg casting. Twenty-six protocols (96%) advised immediate nonweightbearing with progression to weightbearing as tolerated at an average of 3.0 weeks (range, 1-8 weeks) and to full weightbearing at an average of 7.3 weeks (range, 2-12 weeks). Active plantarflexion and dorsiflexion to neutral were included by most protocols (93%) at an average of 3.9 (range, 0-9) weeks and 3.4 (range, 0-8) weeks, respectively. There was considerable variability in the inclusion and timing of strengthening, stretching, proprioception, and basic cardiovascular exercises. Fourteen protocols (52%) recommended return to training after meeting certain athletic activity criteria. Conclusion: The purpose of this investigation was to evaluate the quality, variability, and patient accessibility of publicly available rehabilitation protocols for ATR provided by US orthoapedic teaching programs. To this end, we found that a minority of US academic orthopaedic programs publish ATR rehabilitation protocols online. While a trend away from traditional ankle casting is apparent, many programs have not adopted the accelerated weightbearing and controlled mobilization techniques that have been shown to produce better functional outcomes and greater patient satisfaction. There is also a substantial degree of variability in both the composition and timing of rehabilitation components across physical therapy protocols. Levels of Evidence: Level III: Retrospective comparative study
Utility of Third-Week Postoperative Radiographs in the Management of Ankle Fractures
Authors: Şahin Ercan , Kalem Mahmut 
Published: January 2018

Objectives. To evaluate the costs and efficacy of radiographs taken in the third week after fixation of bimalleolar and trimalleolar fractures. Patients and method. A retrospective evaluation was made of patients who underwent surgical fixation because of bimalleolar and trimalleolar fractures between January 1, 2008, and October 1, 2013. Patient demographics (age, gender, body mass index), fracture type, follow-up periods, and fixation methods were recorded, and the radiographs taken on postoperative day 1, at 3 weeks, 6 weeks, and the final follow-up were examined by 2 orthopedists. Measurements were taken of the medial clear space (MCS ≤ 4 mm), the tibiofibular clear space (TFCS < 5 mm), and the talocrural angle (TCA = 83° ± 4°) on the mortise radiograph and of the overlap between the tibial tubercle and fibula (TFO > 10 mm) on the anteroposterior radiograph; residual step (mm) was measured on the lateral radiograph. Results. A total of 263 patients were examined, and of these, 112 were included for evaluation. In the measurements of postoperative day 1, third week, and sixth week and the final radiographs, no statistically significant difference was determined in the MCS, TFCS, TCA, TFO, and residual step values. Because the cost of a series of 3-way ankle radiographs in Turkey is US$3.81 per patient, the cost of the control series for the 112 patients in this study was US$ 427.3. Conclusions. In patients treated surgically for bimalleolar and trimalleolar fractures, the radiographs taken in the third week rarely resulted in a change of patient management. Therefore, it simply constitutes an additional cost for the patient or the hospital. Levels of Evidence: Level III: Retrospective Cohort study