bluuebunny/crossref_metadata_2025 huggingface dataset:
Symbol, Vision, Mother
Authors: O'Brien Catherine
Published: September 2019

Several papal documents have acknowledged the power (and attendant controversies) associated with the cinema since its invention in 1895. Filmic representations of the Virgin Mary increase the potential for contention by interconnecting with gender issues in addition to theology. Paying attention to these polemical dimensions, this chapter explores three cinematic approaches to Mariology: (i) the symbolic effect of the Marian image, which may provide a Catholic cultural context or a plot device; (ii) Marian apparitions and the attendant shrines; and (iii) filmic adaptations of the life of the mother of Jesus that touch upon dogmatic definitions (by accident or design). Despite different perspectives, the productions underline the ongoing significance of Mary as an inspiration for filmmakers, regardless of the religious affiliation (or none) of the directors.
Retention and response rates in 14 261 PsA patients starting TNF inhibitor treatment—results from 12 countries in EuroSpA
Authors: Brahe Cecilie Heegaard , Ørnbjerg Lykke Midtbøll , Jacobsson Lennart , Nissen Michael J , Kristianslund Eirik Klami , Mann Herman , Santos Maria José , Reino Juan Gómez , Nordström Dan , Rotar Ziga , Gudbjornsson Bjorn , Onen Fatos , Codreanu Catalin , Lindström Ulf , Möller Burkhard , Kvien Tore K , Pavelka Karel , Barcelos Anabela , Sánchez-Piedra Carlos , Eklund Kari K , Tomšič Matija , Love Thorvardur Jon , Can Gercek , Ionescu Ruxandra , Loft Anne Gitte , van der Horst-Bruinsma I E , Macfarlane Gary J , Iannone Florenzo , Hyldstrup Lise Hejl , Krogh Niels Steen , Østergaard Mikkel , Hetland Merete Lund
Published: September 2019

Objective

To investigate TNF inhibitor (TNFi) retention and response rates in European biologic-naïve patients with PsA.

Methods

Prospectively collected data on PsA patients in routine care from 12 European registries were pooled. Heterogeneity in baseline characteristics between registries were explored (analysis of variance and pairwise comparison). Retention rates (Kaplan–Meier), clinical remission [28-joint count DAS (DAS28) <2.6; 28 joint Disease Activity index for Psoriatic Arthritis ⩽4] and ACR criteria for 20% improvement (ACR20)/ACR50/ACR70 were calculated, including LUNDEX adjustment.

Results

Overall, 14 261 patients with PsA initiated a first TNFi. Considerable heterogeneity of baseline characteristics between registries was observed. The median 12-month retention rate (95% CI) was 77% (76, 78%), ranging from 68 to 90% across registries. Overall, DAS28/28 joint Disease Activity index for Psoriatic Arthritis remission rates at 6 months were 56%/27% (LUNDEX: 45%/22%). Six-month ACR20/50/70 responses were 53%/38%/22%, respectively. In patients initiating a first TNFi after 2009 with registered fulfilment of ClASsification for Psoriatic ARthritis (CASPAR) criteria (n = 1980) or registered one or more swollen joint at baseline (n = 5803), the retention rates and response rates were similar to those found overall.

Conclusion

Approximately half of >14 000 patients with PsA who initiated first TNFi treatment in routine care were in DAS28 remission after 6 months, and three-quarters were still on the drug after 1 year. Considerable heterogeneity in baseline characteristics and outcomes across registries was observed. The feasibility of creating a large European database of PsA patients treated in routine care was demonstrated, offering unique opportunities for research with real-world data.
Physical activity, sedentary behaviour and their associations with cardiovascular risk in systemic lupus erythematosus
Authors: Legge Alexandra , Blanchard Chris , Hanly John G
Published: September 2019

Objective

Using a novel isotemporal substitution paradigm, this study aimed to estimate the cross-sectional associations of objectively measured sedentary behaviour and physical activity (PA) with cardiovascular risk factors among patients with SLE.

Methods

This was a cross-sectional study of adult SLE patients without documented cardiovascular disease (CVD). Cardiovascular risk factors were measured, including BMI, blood pressure, fasting glucose and lipid profile. Ten-year CVD risk was estimated using the American College of Cardiology/American Heart Association risk assessment tool. Time in sedentary behaviour, light PA, and moderate–vigorous PA (MVPA) was measured by accelerometry. We used three linear regression models—single-activity models, partition models, and isotemporal substitution models—to evaluate the associations of time spent at each movement intensity with each CVD risk variable.

Results

There were 100 SLE patients [92% female; mean (s.d.) age 52.4 (14.4) years]. Only 11 participants adhered to current PA recommendations (⩾150 MVPA min/week in ⩾10-min bouts). In isotemporal substitution, reallocating 10 min from sedentary behaviour to MVPA was associated with lower systolic (β = –2.15 mmHg; P = 0.01) and diastolic blood pressure (β = –1.56 mmHg; P = 0.01), as well as lower estimated 10-year CVD risk (RR 0.81, 95% CI 0.70, 0.93). Time reallocation from light PA to MVPA was associated with lower diastolic blood pressure (β = –1.45 mmHg; P = 0.01) and lower 10-year CVD risk estimates (RR 0.80, 95% CI 0.69, 0.94).

Conclusion

Given that reallocating time from other movement intensities to MVPA is associated favourably with lower cardiovascular risk, PA interventions are needed to address suboptimal MVPA levels among SLE patients.
WHAT ANATOMIC FEATURES GOVERN PERSONAL LONG-TERM HEALTH RISKS FROM BREAST CANCER RADIOTHERAPY?
Authors: Kundrát Pavel , Simonetto Cristoforo , Eidemüller Markus , Remmele Julia , Rennau Hannes , Sebb Sabine , Wolf Ulrich , Hildebrandt Guido
Published: September 2019

Breast cancer radiotherapy may in the long term lead to radiation-induced secondary cancer or heart disease. These health risks hugely vary among patients, partially due to anatomy-driven differences in doses deposited to the heart, ipsilateral lung and contralateral breast. We identify four anatomic features that largely cover these dosimetric variations to enable personalized risk estimates. For three exemplary, very different risk scenarios, the given parameter set reproduces 63–74% of the individual risk variability for left-sided breast cancer patients. These anatomic features will be used in the PASSOS software to support decision processes in breast-cancer therapy.
Evaluation of essential oils and a prebiotic for newborn dairy calves1
Authors: Swedzinski Caitlin , Froehlich Kelly A , Abdelsalam Karim W , Chase Christopher , Greenfield Tony J , Koppien-Fox Jessica , Casper David P
Published: September 2019

A blend of essential oils (EO) and a prebiotic were combined (EOC) to formulate a colostrum-based liquid birth supplement and a separate feeding supplement (Start Strong and Stay Strong, Ralco Inc., Marshall, MN). These products were designed to promote immunity and stimulate appetite to diminish health challenges and stresses experienced by newborn calves. The hypothesis was that calves supplemented with an oral dose of liquid EOC at birth (10-mL aliquot at birth and 10 mL at 12 h of age) when fed the EOC feeding supplement would result in improved growth performance, health, and immunity. The objective was to determine if an additional feeding of liquid EOC at birth in combination with EOC in the milk replacer (MR) would allow calves to demonstrate improved growth, health, and immunity compare with calves only offered EO in MR. Sixty-one Holstein calves (18 males and 43 females) from a commercial dairy operation were blocked by birth date and randomly assigned to 1 of 3 treatments. Treatments were 1) Control (CON): a 24% crude protein (CP):20% fat (as-fed basis) MR; 2) EP: a 24:20 MR with EOC mixed at 1.25 g/d; or 3) EPC: a 24:20 MR with EOC mixed at 1.25 g/d in addition to calves receiving one 10-mL oral dose of liquid EOC at birth and 10 mL again at 12 h. The 24:20 MR was fed via bucket 2 times per day at a rate of 0.57 kg/calf daily for 14 d, increased to 0.85 kg/calf at 2 times per day until 35 d and was reduced to 0.43 kg at 1 time per day at 36 d to facilitate weaning after 42 d. Decoquinate was added to the MR at 41.6 mg/kg for coccidiosis control. Calves were housed in individual hutches bedded with straw with ad libitum access to a 20% CP-pelleted calf starter and water. All data were analyzed using PROC MIXED as a randomized complete block design. Calves in this study had similar (P > 0.10) average daily gains, body weight, and growth measurements. Calves fed EPC had significantly (P < 0.05) higher IgA titers on day 0 of the trial compared with calves fed EP or CON, which was expected as calves were supplemented with liquid EOC at birth and 12 h later demonstrating an increase in immune response. The use of a liquid EOC product being administrated after birth can improve IgA titers to improve the immune status of the new born calf to fight off potential diseases and pathogens. A formulation error resulted in the EOC being fed at half the rate of the previous experiment of 2.5 g/d, which appears to be below an efficacious dosage.
Low socio-economic status associated with increased risk of dengue haemorrhagic fever in Taiwanese patients with dengue fever: a population-based cohort study
Authors: Lai Yun-Ju , Lai Hsin-Hao , Chen Yu-Yen , Ko Ming-Chung , Chen Chu-Chieh , Chuang Pei-Hung , Yen Yung-Feng , Morisky Donald E
Published: September 2019

Background

Evidence indicates that socio-economic status (SES) may affect health outcomes in patients with chronic diseases. However, little is known about the impact of SES on the prognosis of acute dengue. This nationwide cohort study determined the risk of dengue haemorrhagic fever (DHF) in Taiwanese dengue fever patients from 2000 to 2014.

Methods

From 1 January 2000, we identified adult dengue cases reported in the Taiwan Centers for Disease Control Notifiable Diseases Surveillance System Database. Dengue cases were defined as positive virus isolation, nucleic acid amplification tests or serological tests. Associations between SES and incident DHF were estimated using a Cox proportional hazards model.

Results

Of 27 750 dengue patients, 985 (3.5%) had incident DHF during the follow-up period, including 442 (4.8%) and 543 (2.9%) with low and high SES, respectively. After adjusting for age, sex, history of dengue fever and comorbidities, low SES was significantly associated with an increased risk of incident DHF (adjusted hazard ratio [AHR] 1.61 [95% confidence interval {CI} 1.42 to 1.83]). Rural-dwelling dengue patients had a higher likelihood of DHF complication than their urban counterparts (AHR 2.18 [95% CI 1.90 to 2.51]).

Conclusions

This study suggests low SES is an independent risk factor for DHF. Future dengue control programs should particularly target dengue patients with low SES for improved outcomes.
Intimate Partner Violence: The Influence of Job Opportunities for Men and Women
Authors: Bhalotra Sonia , Kambhampati Uma , Rawlings Samantha , Siddique Zahra
Published: September 2019

This study examines the association of unemployment variation with intimate partner violence using representative data from thirty-one developing countries, from 2005 to 2016. It finds that a 1 percent increase in the male unemployment rate is associated with an increase in the incidence of physical violence against women by 0.50 percentage points, or 2.75 percent. This is consistent with financial and psychological stress generated by unemployment. Female unemployment rates have the opposite effect, a 1 percent decrease being associated with an increase in the probability of victimization of 0.52 percentage points, or 2.87 percent. That an improvement in women's employment opportunities is associated with increased violence is consistent with male backlash. The study finds that this pattern of behaviors emerges entirely from countries in which women have more limited access to divorce than men.
Solving the Liolaemus bibronii puzzle, an integrative taxonomy approach: redescription of L. bibronii and description of three new species (Iguania: Liolaemidae)
Authors: Quinteros A S , Ruiz-Monachesi M R , Abdala C S
Published: September 2019

We redescribe Liolaemus bibronii and describe three new species of Liolaemus, a genus of lizards distributed across South America. These species belong to the L. alticolor–bibronii group, which are included in the subgenus Liolaemus s.s. Liolaemus bibronii was previously proposed as a species complex, but many populations initially assigned to this complex were described as valid species. The three new species described here were populations denominated under L. bibronii. In order to validate the new species, we apply an integrative approach, including molecular and morphological evidence. Also, we perform phylogenetic analyses applying parsimony and Bayesian inference. The three new species described here show a set of character states that allow them to be distinguished from L. bibronii, from each other and from all other species of Liolaemus. Our phylogenies show that the newly described species are more related to other species than to L. bibronii. With this study, we are closer to solving the taxonomic puzzle that L. bibronii represents.
Phylogenetic Diversity and Effect of Temperature on Pathogenicity of Colletotrichum lupini
Authors: Dubrulle Guillaume , Pensec Flora , Picot Adeline , Rigalma Karim , Pawtowski Audrey , Nicolleau Sophie , Harzic Nathalie , Nodet Patrice , Baroncelli Riccardo , Le Floch Gaétan
Published: September 2019

Although lupin anthracnose caused by Colletotrichum lupini is a significant threat for spring and winter lupin crops, it has been poorly studied so far. This study aimed at characterizing the (i) phylogenetic, (ii) morphological, and (iii) physiological diversity of collected isolates from anthracnose-affected lupins. The genetic identification of representative isolates (n = 71) revealed that they were all C. lupini species, further confirming that lupin anthracnose is caused by this species. However, multilocus sequencing on these isolates and 16 additional reference strains of C. lupini revealed a separation into two distinct genetic groups, both of them characterized by a very low genetic diversity. The diversity of morphological characteristics of a selected subset of C. lupini isolates was further evaluated. To the best of our knowledge, microsclerotia production observed for some isolates has never been reported so far within the Colletotrichum acutatum species complex. Finally, the modeling of growth responses of a subset of C. lupini strains revealed the capacity of some strains to grow in vitro at 5°C. This ability was also evidenced in planta, because C. lupini DNA was detectable in plants from 14 days postinoculation at 5°C onward, whereas symptoms began to appear a week later, although at a very low level. Since lupin crops are planted during winter or early spring, growth studies in vitro and in planta demonstrated the capability of the species to grow at temperatures ranging from 5 to 30°C, with an optimum close to 25°C. In this study, C. lupini-specific primers were also designed for real-time quantitative PCR on fungal DNA and allowed the detection of C. lupini in asymptomatic field samples. These results open perspectives to detect earlier and limit the development of this pathogen in lupin crops.
Diversity and Distribution of Rice Blast (Pyricularia oryzae Cavara) Races in Vietnam
Authors: Nguyet Nguyen T. M. , Long Hoang H. , Ngoc Nguyen B. , Nhai Nguyen T , Thuy Nguyen T. T. , Hayashi Nagao , Fukuta Yoshimichi
Published: September 2019

A total of 239 isolates of blast (Pyricularia oryzae Cavara) collected from northern and central Vietnam showed a wide variation in pathogenicity based on the reaction patterns to 25 differential varieties (DVs) harboring 23 resistance genes and susceptible cultivar Lijiangxintuanheigu (LTH). The frequencies of isolates virulent toward DVs for Pish, Pik-m, Pi1, Pik-h, Pik, Pik-p, Pi7(t), Pi9(t), Piz-5, Pita-2, and Pita were low, but they were high for DVs for Pib, Pit, Pia, Pii, Pi3, Pi5(t), Pik-s, Piz, Piz-t, Pi12(t), Pi19(t), and Pi20(t). Isolates were classified into three cluster groups Ia, Ib, and II based on reaction patterns to DVs and LTH. The frequencies of isolates virulent toward 11 DVs for Pik-m, Pi1, Pik-h, Pik, Pik-p, Pi7(t), Pi9(t), Piz, Piz-5, Pita-2, and Pita in cluster II and DV for Piz-t were higher and lower than those of Ia and Ib, respectively. The frequencies to DVs for Pii, Pi3, Pi5(t), and Piz-t were different between clusters Ia and Ib. Clusters Ia and Ib were distributed with similar frequencies in the northeast, north central, and south central coast regions, but the frequencies among three cluster groups in the Red River Delta and northwest regions were different. This means that the blast races in these two regions were different from the others. Overall, the blast isolates were categorized into 153 races. Among them, 26 were selected as a set of standard differential blast isolates for characterizing 23 resistance genes and developing a differential system in Vietnam.
First Morphological and Molecular Report ofAphelenchoides blastophthoruson Strawberry Plants in Switzerland
Authors: Consoli Erika , Ruthes Andrea C. , Reinhard Eder , Dahlin Paul
Published: September 2019

Foliar nematodes represent a minor feeding group within the genus Aphelenchoides Fischer, 1894. The facultative plant parasitic species A. blastophthorus can cause crinkling of leaves, reduced vigor, and stunting of agricultural and ornamental plants. Here we report the first finding of A. blastophthorus in leaves, crowns, and roots of strawberry plants collected in Switzerland in 2018. Species identification was confirmed by morphological and morphometric characterization supported by molecular barcoding of 18S ribosomal RNA (18S), 28S ribosomal RNA (28S), and cytochrome c oxidase I (COI) gene fragment analyses. Phylogenetic analysis of 18S indicated that A. blastophthorus was grouped within close distance to A. fragariae, a well-known foliar nematode affecting strawberry plants. Furthermore, the newly generated molecular barcodes of the partial 28S and COI of A. blastophthorus will support species identification in the future.
Nonsevere combined immunodeficiency T-cell lymphopenia identified through newborn screening
Authors: Patrawala Meera , Kobrynski Lisa
Published: September 2019

Purpose of review

Although severe combined immunodeficiency (SCID) is the primary target condition for newborn screening (NBS), over 25 secondary targets, conditions other than SCID, have been identified. There is no standard method for evaluating neonates with non-SCID T-cell lymphopenia (TCL) and no standard approaches to treatment. We will describe these conditions and discuss recommendations for evaluating and follow-up of non-SCID TCL detected by NBS.

Recent findings

The birth prevalence of non-SCID TCL detected through SCID NBS is higher than SCID and can be a burden on NBS programs. We will present some publications discussing outcomes and comorbidities in these patients.

NBS for SCID has been very successful in identifying infants with SCID at birth to institute early life saving therapies. TCL due to other conditions can cause significant immune deficiency and treatment is dependent on the cause of the defect, as well as the magnitude of the immunodeficiency. Data collection from NBS programs should include assessment of various therapies and clinical outcomes. Better systems for recording long-term outcomes of SCID NBS including both SCID and non-SCID conditions should become a priority for NBS programs. This will help to advance the goal of NBS programs: improve outcomes in the most cost-effective manner.
Total Elbow Arthroplasty for Distal Humerus Fractures Provided Similar Outcomes When Performed as a Primary Procedure or After Failed Internal Fixation
Authors: Logli Anthony L. , Shannon Steven F. , Boe Chelsea C. , Morrey Mark E. , O'Driscoll Shawn W. , Sanchez-Sotelo Joaquin
Published: September 2019

Objectives:

To compare clinical and functional outcomes of total elbow arthroplasty (TEA) for distal humerus fractures (DHF) performed either as a primary procedure or after internal fixation.

Design:

Retrospective, observational study.

Setting:

Mayo Clinic, Rochester, MN (1998 through 2016).

Patients/Participants:

Twenty-two TEA for acute DHF and 66 TEA after previous internal fixation.

Main Outcome Measurements:

Primary outcome measures included the Mayo Elbow Performance Score and motion. Reoperation rates and complications were also compared.

Results:

The mean time between internal fixation and arthroplasty was 7.3 years, and the main indications for conversion to TEA were nonunion (36%) and posttraumatic osteoarthritis (32%). There were female predominance (70%) and significant differences in age (74 years vs. 60 years, P < 0.0001) and tobacco use (0 vs. 23%; P = 0.02) between the primary and the salvage cohorts, respectively. Cohort demographics were otherwise comparable. TEA provided similar outcomes in both cohorts in terms of the Mayo Elbow Performance Score (acute 85, salvage 81, P = 0.32) and motion (acute 95/82/75 degrees, salvage 112/81/72 degrees in ulnohumeral/pronation/supination, P = 0.07/P = 0.85/P = 0.65). Reoperation rates were also similar (36% acute vs. 39% salvage, P = 1.00). Aseptic loosening (2 acute, 8 salvage) and deep infection (2 acute, 7 salvage) were the most common complications.

Conclusions:

The clinical outcomes and reoperation rates of TEA for DHF seem to be similar when performed as a primary procedure or as salvage after previous internal fixation. The benefit of avoiding elbow arthroplasty in the acute setting needs to be balanced with the potential for 2 surgical procedures if internal fixation was to be unsuccessful.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Surgical, Urinary, and Survival Outcomes of Nerve-sparing Versus Traditional Radical Hysterectomy
Authors: Li Lei , Ma Shuiqing , Tan Xianjie , Zhong Sen , Wu Ming
Published: September 2019

Purpose:

The purpose of this retrospective study was to compare the surgical, urinary, and survival outcomes between nerve-sparing radical hysterectomy (NSRH) and traditional radical hysterectomy (TRH) for stage IB cervical cancer, in which all the primary procedures were performed by a single physician.

Methods:

Patients with cervical cancer of International Federation of Gynecology and Obstetrics (FIGO) stage IB were included if they received radical hysterectomy of class III or type C in 1 center between February 2001 and November 2015. The epidemiological, clinicopathologic, surgical, and urinary data were collected and compared between the NSRH and TRH groups. The follow-up period ended in December 2016.

Results:

A total of 406 patients were identified, including 111 (27.3%) in the TRH group and 295 (72.7%) in the NSRH group. Most epidemiological and clinicopathologic characteristics were balanced between the 2 groups. The NSRH and TRH groups had similar mean operating times and comparable short-term postoperative complications, but NSRH had less mean estimated blood loss and a shorter mean postoperative stay (allP<0.001). Within 12 months from surgeries, patients in the NSRH group had less residual urine and fewer urinary dysfunctions. For the 371 patients with definite survival outcomes, in the multivariate analysis, both overall survival (hazard ratio=1.79, 95% confidence interval: 0.64-5.02) and disease-free survival (hazard ratio=1.50, 95% confidence interval: 0.72-3.11,P=0.280) of the NSRH group were similar to those of the TRH group.

Conclusion:

NSRH for stage IB cervical cancer patients had better urinary outcomes than TRH without sacrificing the safety and survival benefits.
“Personalized Excision” of Malignant Melanoma—Need for a Paradigm Shift in the Beginning Era of Personalized Medicine
Authors: Weyers Wolfgang
Published: September 2019

The premises on which guidelines for the excision of primary cutaneous melanoma are based are illogical and fail to take into account peculiarities of the individual lesion. The horizontal margins of excision continue to be adjusted to the vertical thickness of the neoplasm, and recommended clinical margins do not reflect the histopathologic borders of melanoma. Micrographically controlled surgery has become accepted for acral melanomas and melanomas of the face and neck but not for melanomas on the trunk, arms, and legs, although the latter tend to be more sharply confined. Extending margins of excision for the purpose of removing inapparent metastases is fallacious because the latter are rare, their localization cannot be foretold, and satellite metastases are usually associated with distant metastases, so that patients do not profit from early removal of cutaneous lesions. The only meaningful objective of excision is complete removal of the primary melanoma. The success of excision must be controlled histopathologically. Because of limitations of the method, a histopathologic safety margin should be observed that must depend on the characteristics of the individual lesion. In sharply confined melanomas, a histopathologic margin of at least 1 mm is sufficient. In the case of poor demarcation, with solitary atypical melanocytes extending far beyond the bulk of the lesion, a broader histopathologic safety margin is advisable. Special caution should be exercised in the presence of regression and for desmoplastic melanomas, acral melanomas, and melanomas on the face and scalp. Instead of wide and deep excisions with standardized margins, “personalized excisions” are required for primary cutaneous melanoma. The concept of clinical safety margins is a relic of former times that has no place in modern medicine.
Systematic Review of Pelvic Exenteration With En Bloc Sacrectomy for Recurrent Rectal Adenocarcinoma: R0 Resection Predicts Disease-free Survival
Authors: Sasikumar Amarasingam , Bhan Chetan , Jenkins John T. , Antoniou Anthony , Murphy Jamie
Published: September 2019

BACKGROUND:

The management of recurrent rectal cancer is challenging. At the present time, pelvic exenteration with en bloc sacrectomy offers the only hope of a lasting cure.

OBJECTIVE:

The purpose of this study was to evaluate clinical outcome measures and complication rates following sacrectomy for recurrent rectal cancer.

DATA SOURCES:

A search was conducted on Pub Med for English language articles relevant to sacrectomy for recurrent rectal cancer with no time limitations.

STUDY SELECTION:

Studies reported sacrectomy with survival data for recurrent rectal adenocarcinoma.

MAIN OUTCOME MEASURE:

Disease-free survival following sacrectomy for recurrent rectal cancer was the main outcome measured.

RESULTS:

A total of 220 patients with recurrent rectal cancer were included from 7 studies, of which 160 were men and 60 were women. Overall median operative time was 717 (570–992) minutes and blood loss was 3.7 (1.7–6.2) L. An R0 (>1-mm resection margin) resection was achieved in 78% of patients. Disease-free survival associated with R0 resection was 55% at a median follow-up period of 33 (17–60) months; however, none of the patients with R1 (<1-mm resection margin) survived this period. Postoperative complication rates and median length of stay were found to decrease with more distal sacral transection levels. In contrast, R1 resection rates increased with more distal transection.

LIMITATION:

The studies assessed by this review were retrospective case series and thus are subject to significant bias.

CONCLUSION:

Sacrectomy performed for patients with recurrent rectal cancer is associated with significant postoperative morbidity. Morbidity and postoperative length of stay increase with the level of sacral transection. Nevertheless, approximately half of patients eligible for rectal excision with en bloc sacrectomy may benefit from disease-free survival for up to 33 months, with R0 resection predicting disease-free survival in the medium term.
Accuracy of MRI in Restaging Locally Advanced Rectal Cancer After Preoperative Chemoradiation
Authors: van den Broek Joris J. , van der Wolf Floor S. W. , Lahaye Max J. , Heijnen Luc A. , Meischl Christof , Heitbrink Martin A. , Schreurs W. Hermien
Published: September 2019

BACKGROUND:

Patients with a locally advanced rectal carcinoma benefit from preoperative chemoradiotherapy. MRI is considered the first choice imaging modality after preoperative chemoradiation, although its reliability for restaging is debatable.

OBJECTIVE:

The purpose of this study was to determine the accuracy of MRI in restaging locally advanced rectal cancer after preoperative chemoradiation.

DESIGN:

This was a retrospective study.

SETTINGS:

The study was conducted in a Dutch high-volume rectal cancer center.

PATIENTS:

A consecutive cohort of 48 patients with locally advanced rectal cancer treated with a curative intent was identified.

MAIN OUTCOME MEASURES:

Three readers independently evaluated the MRI both for primary staging and for restaging after preoperative chemoradiation and were blinded to results from the other readers as well as histological results. Interobserver variability was determined. Accuracy of the restaging MRI was assessed through the comparison of tumor characteristics on MRI with histopathologic outcomes.

RESULTS:

T stage was correctly predicted by the 3 readers in 47% to 68% and N stage in 68% to 70%. Overstaging was more common than understaging. Positive predictive values (PPV) among the 3 readers for T0 were 0%, and negative predictive values (NPVs) varied from 84% to 85%. For T1/2, PPVs and NPVs were 50% to 67% and 72% to 90%, and for T3/4 they were 54% to 62% and 33% to 78%. PPVs and NPVs for N0 stage were 81% to 95% and 58% to 73%. Tumor regression grade on MRI did not correspond with histopathologic tumor regression grade; PPVs for good response (tumor regression grade on MRI 1–2) were 48% to 61%, and NPVs were 42% to 58%. Interobserver agreement was fair to moderate for T stage, N stage, and tumor response (κ = 0.20–0.41) and fair to substantial for the relation with the mesorectal fascia (κ = 0.33–0.77). In none of the patients was the surgical plan changed after the restaging MRI.

LIMITATIONS:

This study was limited by its small sample size and retrospective nature.

CONCLUSIONS:

MRI has low accuracy for restaging locally advanced rectal cancer after preoperative chemoradiation, and the interobserver variability is significant.
Early Postoperative Decrease of Serum Albumin Predicts Surgical Outcome in Patients Undergoing Colorectal Resection
Authors: Ge Xiaolong , Dai Xujie , Ding Chao , Tian Hongliang , Yang Jianbo , Gong Jianfeng , Zhu Weiming , Li Ning , Li Jieshou
Published: September 2019

BACKGROUND:

A simple and accurate predictor of postoperative complications is needed for early and safe discharge after surgery. A decrease in serum albumin is commonly observed early after surgery, even in patients with normal preoperative levels. However, whether it predicts patient postoperative outcome is unknown.

OBJECTIVE:

The purpose of this study was to evaluate whether the reduction in serum albumin within 2 postoperative days compared with the preoperative level could serve as an independent predictor of postoperative complications after colorectal surgery.

DESIGN:

This was a retrospective study from a single institution.

SETTINGS:

The study was conducted in a tertiary referral hospital.

PATIENTS:

A total of 626 patients undergoing major colorectal surgery between December 2012 and January 2016 were eligible for this study.

MAIN OUTCOME MEASURES:

Univariate and multivariate analyses were performed to identify risk factors for postoperative complications and to identify the factors associated with Δalbumin. Receiver operating characteristic curves were developed to examine the cutoff value of the change in albumin in predicting postoperative complications.

RESULTS:

Among all of the patients, the median Δalbumin after surgery was 15%. ΔAlbumin was an independent risk factor for overall complications (p < 0.01). The cutoff value was 15%, and an increased area under the curve compared with C-reactive protein occurred on postoperative day 3 or 4. Patients with a Δalbumin ≥15% experienced more postoperative major complications, a higher comprehensive complication index, a longer postoperative stay, and increased surgical site infections (p < 0.05) than those <15%. ΔAlbumin correlated with sex, type of surgery, stoma creation, C-reactive protein on postoperative day 3 or 4, and intraoperative blood transfusion. Postoperative C-reactive protein remained independently associated with Δalbumin (p < 0.01).

LIMITATIONS:

The study was limited by its retrospective nature.

CONCLUSIONS:

A cutoff value of a 15% reduction in serum albumin within 2 postoperative days could help to identify patients with a high probability of postoperative complications and permit safe and early discharge after colorectal surgery.
Robotic Resection is a Good Prognostic Factor in Rectal Cancer Compared with Laparoscopic Resection: Long-term Survival Analysis Using Propensity Score Matching
Authors: Kim Jin , Baek Se-Jin , Kang Dong-Woo , Roh Young-Eun , Lee Jae Won , Kwak Han-Deok , Kwak Jung Myun , Kim Seon-Hahn
Published: September 2019

BACKGROUND:

Robotic total mesorectal excision for rectal cancer has rapidly increased and has shown short-term outcomes comparable to conventional laparoscopic total mesorectal excision. However, data for long-term oncologic outcomes are limited.

OBJECTIVE:

The aim of this study is to evaluate long-term oncologic outcomes of robotic total mesorectal excision compared with laparoscopic total mesorectal excision.

DESIGN:

This was a retrospective study.

SETTINGS:

This study was conducted in a tertiary referral hospital.

PATIENTS:

A total of 732 patients who underwent totally robotic (n = 272) and laparoscopic (n = 460) total mesorectal excision for rectal cancer were included in this study.

MAIN OUTCOME MEASURES:

We compared clinicopathologic outcomes of patients. In addition, short- and long-term outcomes and prognostic factors for survival were evaluated in the matched robotic and laparoscopic total mesorectal excision groups (224 matched pairs by propensity score).

RESULTS:

Before case matching, patients in the robotic group were younger, more likely to have undergone preoperative chemoradiation, and had a lower tumor location than those in the laparoscopic group. After case matching most clinicopathologic outcomes were similar between the groups, but operative time was longer and postoperative ileus was more frequent in the robotic group. In the matched patients excluding stage IV, the overall survival, cancer-specific survival, and disease-free survival were better in the robotic group, but did not reach statistical significance. The 5-year survival rates for robotic and laparoscopic total mesorectal excision were 90.5% and 78.0% for overall survival, 90.5% and 79.5% for cancer-specific survival, and 72.6% and 68.0% for disease-free survival. In multivariate analysis, robotic surgery was a significant prognostic factor for overall survival and cancer-specific survival (p = 0.0040, HR = 0.333; p = 0.0161, HR = 0.367).

LIMITATIONS:

This study has the potential for selection bias and limited generalizability.

CONCLUSIONS:

Robotic total mesorectal excision for rectal cancer showed long-term survival comparable to laparoscopic total mesorectal excision in this study. Robotic surgery was a good prognostic factor for overall survival and cancer-specific survival, suggesting potential oncologic benefits.
Effects of Hysterectomy on Pelvic Floor Disorders: A Longitudinal Study
Authors: Kocaay Akin Firat , Oztuna Derya , Su Filiz Akin , Elhan Atilla Halil , Kuzu Mehmet Ayhan
Published: September 2019

BACKGROUND:

Hysterectomy might adversely affect pelvic floor functions and result in many different symptoms, such as urinary and anal incontinence, obstructed defecation, and constipation.

OBJECTIVE:

The aim of this prospective study was to evaluate the influence of hysterectomy on pelvic floor disorders.

DESIGN:

This was a prospective and longitudinal study.

SETTINGS:

The study was conducted at the Ankara University Department of Surgery and the Dr Zekai Tahir Burak Women’s Health Research and Education Hospital between September 2008 and March 2011.

PATIENTS:

The study was performed on patients who underwent hysterectomy for benign pathologies.

MAIN OUTCOME MEASURES:

A questionnaire about urinary incontinence (International Continence Society scoring), anal incontinence, constipation, and obstructed defecation (Rome criteria and constipation severity score), along with an extensive obstetric history, was administered preoperatively and postoperatively annually for 4 years.

RESULTS:

Patients (N = 327) who had completed each of the 4 annual postoperative follow-ups were included in this study. Compared with the preoperative observations, the occurrence of each symptom was significantly increased at each of the follow-up years (p < 0.001). Over the 4 postoperative years, the frequencies for constipation (n = 245) were 7.8%, 8.2%, 8.6%, and 5.3%; those for obstructed defecation (n = 269) were 4.5%, 5.2%, 4.1%, and 3.0%; those for anal incontinence (n = 252) were 4.8%, 6.3%, 6.0%, and 5.2%, and those for urinary incontinence (n = 99) were 12.1%, 12.1%, 11.1%, and 13.1%. In addition, patients who had no preoperative symptom (n = 70) from any of the selected symptoms showed a postoperative occurrence of at least 1 of these symptoms of 15.8%, 14.3%, 11.4%, and 8.6% for the postoperative years 1, 2, 3, and 4.

LIMITATIONS:

Although the study had several limitations, no comparison with a control population was the most important one.

CONCLUSIONS:

Hysterectomy for benign gynecologic pathologies had a significant negative impact on pelvic floor functions in patients who had no previous symptoms.
Factors Influencing the Treatment Effect of Superelastic Wire Orthonyxia for Nail Plate Deformity
Authors: Won June-ho , Chun Ji-sun , Park Yong-hyun , Won Young-ho , Yun Sook Jung
Published: September 2019

BACKGROUND

Orthonyxia is an effective, noninvasive treatment for transverse nail curvature deformity.

OBJECTIVE

To discover the factors influencing treatment results of superelastic wire orthonyxia (SEWO).

MATERIAL AND METHODS

A retrospective study was conducted using clinical records of patients treated with SEWO. A multiple linear regression model was used to explain the correlation between correction pace (% per week) and the other collected variables (patient age, sex, position of treated toe, wire diameter [WD, mm], wire residence time [WRT, weeks], nail plate thickness [PT, mm], baseline nail curvature index [NCI], number of previous treatments, and the correction pace of previous treatments [CPT, % per week]). A logistic regression model was used to identify risk factors for adverse effects.

RESULTS

A total of 475 cases were collected from 197 patients. The correction pace was positively related to baseline NCI, WD, and correction pace in previous treatment. Also, it was negatively related to WRT and nail PT. No clinical factor was correlated with the occurrence of side effects.

CONCLUSION

The correction pace of SEWO is affected by the baseline NCI, the diameter of the wire, nail PT, the CPT, and the WRT.
Resorbable Implants for Mandibular Fracture Fixation: A Systematic Review and Meta-Analysis
Authors: Chocron Yehuda , Azzi Alain J. , Cugno Sabrina
Published: September 2019

Background:

Mandibular fractures in adults commonly require rigid fixation to ensure proper occlusion while minimizing infection risks. Numerous centers have assessed the efficacy of resorbable materials as a potential alternative to metallic plates. The purpose of the current systematic review and meta-analysis is to shed light on overall outcomes for resorbable implants and to compare these results to those for metallic counterparts.

Methods:

A systematic review of clinical studies reporting outcomes for resorbable plates for mandible fractures was carried out. The reported outcomes were hardware failure/exposure, infection, wound dehiscence, reoperation, malocclusion, and nonunion. The results were pooled descriptively and stratified according to fracture and implant type. A subset meta-analysis of prospective studies comparing metallic and resorbable implants was also carried out.

Results:

Eighteen studies were included for a total of 455 patients managed with resorbable implants (mean follow-up, 8.95 months) with an overall complication rate of 19.8 % (n = 90/455). Infection (n = 31/455, 6.8%) and wound dehiscence (n = 28/455, 6.2%) were the most common complications. Nonunion occurred in 1.1% (n = 5/455) of patients. Seven studies were included in a meta-analysis, and the rates of adverse events in the resorbable and metallic groups were 18.0% (n = 32/178) and 18.3% (n = 33/180), respectively, with no statistically significant difference between both cohorts (95% CI 0.58, 1.82, P = 0.93).

Conclusions:

This study suggests that there are no statistical differences in outcomes for patients with mandible fractures managed with resorbable or metallic implants. In the absence of meta-analyses or large randomized controlled trials, the current study provides surgeons with an evidence-based reference to guide decision-making.
Plastic Surgeons Defend Textured Breast Implants at 2019 U.S. Food and Drug Administration Hearing: Why It Is Time to Reconsider
Authors: Swanson Eric
Published: September 2019

Textured breast implants were the subject of a U.S. Food and Drug Administration (FDA) hearing on March 25 and 26, 2019. Regulating agencies in other countries, including all of Europe and Canada, have already banned macrotextured implants. Patients affected by Breast Implant-Associated Anaplastic Large-Cell Lymphoma (BIA-ALCL) recounted their life-changing experiences, and requested a ban on textured devices. Plastic surgeons, many with industry ties, spoke in favor of keeping the devices available. The historical advantages of textured implants were presented, including a reduced capsular contracture rate. A 14-point plan to improve sterility at the time of implantation was promoted as an effective alternative to reduce both capsular contractures and BIA-ALCL risk. However, recent studies show that textured implants have not delivered on their early promise. Biocell implants perform worse, not better, than other implant types, and capsular contracture rates are not significantly reduced according to recent core studies. The only known risk factor for BIA-ALCL is textured implants. The lifetime risk for Biocell implants is at least 1:2, 200. There is no reliable evidence that surgical technique makes a difference in risk. This serious issue represents a case study of conflict of interest. In light of recent information, a re-analysis of the true risks and benefits of textured implants is justified. It is time for our professional societies to recognize that the device is the problem rather than surgical technique. On May 2, 2019, the FDA decided against a ban on textured breast implants.
Multilevel Breast Reduction: A Retrospective Study of 338 Breast Reduction Surgeries
Authors: Borenstein Amiram , Friedman Or
Published: September 2019

Background:

Aesthetic breast reduction is a common plastic surgery procedure with the potential for considerable improvement of the patient’s quality of life in addition to its aesthetic value. Many different approaches have been described for breast reduction to improve upon previous techniques in terms of scarring, nipple position, amount of breast tissue excised, shape, and longevity of the results. However, medium size resections in ptotic and wide breasts are difficult to treat using both the most common inferior pedicle wise procedure and the various vertical scar techniques.

Methods:

A retrospective study of 338 consecutive bilateral breast reduction patients between January of 2010 and January of 2018 at a single center by a single surgeon using a vertical scar technique. Demographic and postoperative outcome data were collected and evaluated.

Results:

Patient satisfaction with the results was high. Complication rates were comparable or lower than previously published series. Major complications requiring revision surgery: 3 (0.8%) hematomas; minor complications: 68 (20%) cases of superficial dehiscence; 12 (3.5%) superficial surgical site infections; 11 (3.2%) seromas; 4 (1.2%) fat necrosis; and 1 (0.2%) partial areola necrosis.

Conclusion:

The Borenstein Breast Reduction technique aims to recreate the breast mound support from the “bottom up” facilitating long-lasting results and high patient satisfaction rates. This approach can be helpful in all breast reductions and is most effective in wide ptotic breasts.
Sexually dimorphic therapeutic response in bortezomib-induced neuropathic pain reveals altered pain physiology in female rodents
Authors: Stockstill Katherine , Wahlman Carrie , Braden Kathryn , Chen Zhoumou , Yosten Gina L. , Tosh Dilip K. , Jacobson Kenneth A. , Doyle Timothy M. , Samson Willis K. , Salvemini Daniela
Published: September 2019

Chemotherapy-induced neuropathic pain (CINP) in both sexes compromises many current chemotherapeutics and lacks an FDA-approved therapy. We recently identified the sphingosine-1-phosphate receptor subtype 1 (S1PR1) and A3 adenosine receptor subtype (A3AR) as novel targets for therapeutic intervention. Our work in male rodents using paclitaxel, oxaliplatin, and bortezomib showed robust inhibition of CINP with either S1PR1 antagonists or A3AR agonists. The S1PR1 functional antagonist FTY720 (Gilenya) is FDA-approved for treating multiple sclerosis, and selective A3AR agonists are in advanced clinical trials for cancer and inflammatory disorders, underscoring the need for their expedited trials in patients with CINP as chemotherapy adjuncts. Our findings reveal that S1PR1 antagonists and A3AR agonists mitigate paclitaxel and oxaliplatin CINP in female and male rodents, but failed to block or reverse bortezomib-induced neuropathic pain (BINP) in females. Although numerous mechanisms likely underlie these differences, we focused on receptor levels. We found that BINP in male rats, but not in female rats, was associated with increased expression of A3AR in the spinal cord dorsal horn, whereas S1PR1 levels were similar in both sexes. Thus, alternative mechanisms beyond receptor expression may account for sex differences in response to S1PR1 antagonists. Morphine and duloxetine, both clinical analgesics, reversed BINP in female mice, demonstrating that the lack of response is specific to S1PR1 and A3AR agents. Our findings suggest that A3AR- and S1PR1-based therapies are not viable approaches in preventing and treating BINP in females and should inform future clinical trials of these drugs as adjuncts to chemotherapy.
Drug-induced acute kidney injury: diverse mechanisms of tubular injury
Authors: Perazella Mark A.
Published: September 2019

Purpose of review

Medications are a relatively common cause of acute kidney injury (AKI), especially in hospitalized patients who are exposed to numerous agents. Drug-related acute tubular/tubulointerstitial injury is the most common cause of AKI associated with these agents. Toxic effects of drugs and their renal handling often lead to various forms of AKI.

Recent findings

The inherent nephrotoxicity of drugs and their transport and metabolism by the kidneys play an important role in the occurrence of acute tubular injury. Apical transport of the aminoglycosides by endocytosis and apical pinocytosis of filtered hydroxyethyl starch into cells lead to acute tubular dysfunction. Transport of tenofovir and cisplatin by organic anion and cation transporters in the basolateral surface of the proximal tubule, respectively, are associated with intracellular drug accumulation and injury. Intratubular deposition of drug crystals with associated AKI occurs with several drugs, in particular the anticancer agent methotrexate. A potentially new mechanism of drug-induced AKI was described with vancomycin – acute vancomycin-related cast nephropathy. Immune-mediated acute tubulointerstitial injury is another cause of drug-induced AKI, as seen with immune checkpoint inhibitors.

Drugs lead to AKI through mechanisms that involve their inherent toxicity as well as their transport and handling by the kidneys.