bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatitis B in Pregnancy Screening, Treatment, and Prevention of Vertical Transmission
Authors: Dionne-Odom J. , Tita A.T. , Silverman N.S.
Published: November 2016

(Am J Obstet Gynecol 2016;214(1):6–14)

Obstetric providers are challenged continuously with the evaluation of the potential benefits and harms of new diagnostic and therapeutic procedures or treatments for patients (mother and fetus), often in the setting of limited high-quality data (eg, from randomized clinical trials). Between 800,000 and 1.4 million people in the United States and >240 million people worldwide are infected with hepatitis B virus (HBV). Specific to pregnancy, an estimated prevalence of 0.7% to 0.9% for chronic hepatitis B infection among pregnant women in the United States has been reported, with >25,000 infants at risk for infection born annually to these women. The purpose of this document is to aid clinicians in counseling their patients regarding the risk and management options available after receiving a positive hepatitis B surface antigen (HBsAg) test result.
Early Onset Preeclampsia and Cerebral Palsy: A Double Hit Model?
Authors: Mor O. , Stavsky M. , Yitshak-Sade M. , Mastrolia S.A. , Beer-Weisel R. , Rafaeli-Yehudai T. , Besser L. , Hamou B. , Mazor M. , Erez O.
Published: November 2016

(Am J Obstet Gynecol 2016;214:105.e1–105.e9)

Premature birth, especially at <28 weeks of gestation, is the leading risk factor for the development of cerebral palsy (CP) at 2 to 3 years of age. The prevalence of CP rises in a positive correlation with the severity of premature delivery and can reach up to 15% in preterm neonates who are delivered at 24 to 27 weeks of gestation. Therefore, the aims of this study were to determine (1) the association between preeclampsia and CP and (2) the risk factors for the development of CP in these patients.
Planned Home VBAC in the United States, 2004 to 2009: Outcomes, Maternity Care Practices, and Implications for Shared Decision Making
Authors: Cox K.J. , Bovbjerg M.L. , Cheyney M. , Leeman L.M.
Published: November 2016

(Birth 2015;42(4):299–308)

Approximately 32.7% of parturients in the United States had a cesarean delivery in 2013 and will have to choose between a repeat cesarean delivery or a trial of labor after cesarean (TOLAC) during subsequent pregnancies. Vaginal birth after cesarean (VBAC) rates decreased from 28.3% to 10.6% as hospitals and obstetricians stopped offering TOLAC services due to concerns regarding safety as there is risk for uterine rupture. Consequently, the proportion of home births in women who have undergone previous cesarean delivery has increased. Earlier studies using data from the Midwives Alliance of North America Statistics Project (MANA Stats) 2.0 cohort reported the outcomes of 16,924 planned home births of which 87% undergoing a TOLAC had a successful VBAC.
Incidence, Risk Factors, Management and Outcomes of Amniotic-fluid Embolism: A Population-based Cohort and Nested Case-Control Study
Authors: Fitzpatrick K.E. , Tuffnell D. , Kurinczuk J.J. , Knight M.
Published: November 2016

(BJOG 2016;123:100–109)

Amniotic fluid embolism (AFE) is a rare disorder, but it remains a leading cause of maternal mortality in high-income countries. The typical presentation includes sudden cardiovascular collapse without an obvious etiology, respiratory distress and disseminated intravascular coagulation. Because AFE is a rare condition with its diagnosis being one of exclusion, it is difficult to obtain reliable data about the disease. The goal of this study was to report on the incidence, risk factors, management, and outcomes of AFE based on recent data.
A Longitudinal Study to Evaluate Pregnancy-induced Endogenous Analgesia and Pain Modulation
Authors: Carvalho Brendan , Granot Michal , Sultan Pervez , Wilson Hilary , Landau Ruth
Published: November 2016

(Reg Anesth Pain Med 2016;41:175–180)

Pregnancy-induced analgesia has been demonstrated in both animal and human studies, although the latter has yielded mixed results. The authors of the present study thus assessed inhibitory and excitatory pain modulation pathways during each trimester of pregnancy and during the postpartum period in healthy pregnant women. The objectives were to determine if conditioned pain modulation (CPM), mechanical temporal summation (mTS), and temperature-inducing pain 6 of 10 (pain-6) underwent pregnancy-related changes. CPM evaluates descending inhibitory pathways, and mTS evaluates excitatory pathway modulation. The authors hypothesized that there would be an increase in CPM and decrease in mTS during pregnancy, with changes resolving in the postpartum period.
A Smartphone-based Decision Support Tool Improves Test Performance Concerning Application of the Guidelines for Managing Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy
Authors: McEvoy M.D. , Hand W.R. , Stiegler M.P. , DiLorenzo A.N. , Ehrenfeld J.M. , Moran K.R. , Lekowski R. , Nunnally M.E. , Manning E.L. , Shi Y. , Shotwell M.S. , Gupta R.K. , Corey J.M. , Schell R.M.
Published: November 2016

(Anesthesiology 2016;124:186–198)

Decision support tools (DSTs) are used by clinicians for easy decision-making due to a number of difficulties associated with using clinical guidelines. American Society of Regional Anesthesia and Pain Medicine (ASRA) guidelines on regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy are recognized guidelines world-wide, but due to the length of the document, most clinicians are unfamiliar with all the details mentioned in the guidelines.
Intracranial Subdural Hematoma Following Neuraxial Anesthesia in the Obstetric Population: A Literature Review With Analysis of 56 Reported Cases
Authors: Cuypers V. , Van de Velde M. , Devroe S.
Published: November 2016

(Int J Obstet Anesth. 2016;25:58–65)

Intracranial subdural hematoma is a rare but life-threatening complication of dural puncture that can occur following epidural or spinal anaesthesia. Severe neurological sequelae can be avoided, however, if early diagnosis is made and prompt treatment initiated. The objective of this study was to identify cases of intracranial subdural hematoma following neuraxial anesthesia in obstetric patients, summarize presentation and outcomes and identify risk factors.
Nationwide Incidence of Serious Complications of Epidural Analgesia in the United States
Authors: Rosero E.B. , Joshi G.P.
Published: November 2016

(Acta Anaesthesiol Scand. 2016;60:810–820)

Epidural analgesia (EA) is the gold standard for labor analgesia and provides effective pain relief after cesarean delivery. However, serious complications like spinal hematoma and abscess can occur. Currently, published data on the incidence of these complications are conflicting and involve variable methodology, sample size limitations, and exclusive patient populations. In order to address these issues, the authors of the present study used a large, administrative national database to describe the incidence of in-hospital spinal hematoma and epidural abscess associated with EA in obstetric and nonobstetric patients. They also investigated the factors associated with an increased likelihood of these complications.
Surgical Management of Abnormally Invasive Placenta: A Retrospective Cohort Study Demonstrating the Benefits of a Standardized Operative Approach
Authors: Brennan D.J. , Schulze B. , Chetty N. , Crandon A. , Petersen S.G. , Gardener G. , Perrin L.
Published: November 2016

(Acta Obstet Gynecol Scand. 2015;94:1380–1386)

Research has established that one of the major causes of maternal morbidity and mortality is an abnormally invasive placenta (AIP). AIP occurs when all parts or particular parts of the placenta do not separate from the uterine wall following delivery; this includes placenta accreta, increta and percreta. Complications of surgery to treat this problem include urologic and bowel injury, sepsis, fistula formation, and complications associated with massive blood loss and transfusion. Hence the objective of this study was to assess the role of a gynecologic oncologist’s (GO) involvement in AIP cases with an emphasis on the surgical approach used and how this might affect maternal and neonatal morbidity.
Increasing Incidence of Postpartum Hemorrhage: The Dutch Piece of the Puzzle
Authors: Van Stralen G. , Von Schmidt Auf Altenstadt J.F. , Bloemenkamp K.W. , Van Roosmalen J. , Hukkelhoven C.W.
Published: November 2016

(Acta Obstet Gynecol Scand 2016. [Epub ahead of print])

The global maternal mortality ratio has declined significantly since the 1990s and, currently, is very low in countries like the Netherlands (7/100,000 live births). One of the leading causes of maternal mortality is postpartum hemorrhage (PPH), defined in this study as >1000 mL blood loss within 24 hours of childbirth, regardless of delivery mode. PPH has recently been linked to several potential risk factors, ranging from ethnicity and obesity to cesarean section (planned and emergency) and augmented labor. However, studies are not consistent. In order to elucidate PPH trends and any associations that PPH may have with such risk factors, the authors of the present study described the incidence of PPH in the Netherlands over a period of 13 years (2000 to 2013).
Oral Nifedipine Versus Intravenous Labetalol for Severe Hypertension During Pregnancy: A Systematic Review and Meta-Analysis
Authors: Shekhar S. , Gupta N. , Kirubakaran R. , Pareek P.
Published: November 2016

(BJOG. 2016;123(1):40–47)

Hypertensive disorders of pregnancy affect 10% of pregnant women, and are a major cause of maternal and perinatal mortality and morbidity. Oral nifedipine, along with intravenous labetalol and hydralazine, are recommended for the treatment of severe hypertension in parturients by most authorities. Despite the low cost, wide availability and easy administration of nifedipine, usage patterns suggest a strong preference among most physicians for the use of labetalol. This may reflect a lack of trust in oral nifedipine use for pregnant women among health care providers, perhaps due to reports of adverse cardiovascular events or concern about a potential effect on uterine activity. The aim of this study was to determine the efficacy and safety of oral nifedipine for treatment of severe hypertension of pregnancy, compared with that of intravenous labetalol.
Immediate Delivery Compared With Expectant Management After Preterm Prelabor Rupture of the Membranes Close to Term (PPROMT Trial): A Randomized Controlled Trial
Authors: Morris Jonathan M. , Roberts Christine L. , Bowen Jennifer R. , Patterson Jillian A. , Bond Diana M. , Algert Charles S. , Thornton Jim G. , Crowther Caroline A.
Published: November 2016

(Lancet. 2016;387:444–452)

Rupture of the membranes before the onset of labor is a common problem, occurring in 20% of all births and 40% of preterm births. The management of preterm prelabor rupture of membranes close to term varies among different countries. The professional obstetric societies in the United States and United Kingdom do recommend immediate delivery from 34 weeks gestation onward. However, these recommendations are based on scant scientific evidence. The goal of this current study (named the PPROMT trial) was to establish whether immediate birth or expectant management resulted in better outcomes in the setting of ruptured membranes close to term in singleton pregnancies.
Comparing Variation in Hospital Rates of Cesarean Delivery Among Low-risk Women Using 3 Different Measures
Authors: Armstrong J.C. , Kozhimannil K.B. , McDermott P. , Saade G.R. , Srinivas S.K.
Published: November 2016

(Am J Obstet Gynecol. 2016;214(2):153–163)

Maternity care clinicians and health care delivery systems have been working toward safely lowering the cesarean delivery rate in low-risk pregnancies. Currently, there are 2 low-risk cesarean delivery rate measures that are being used for hospital reporting: the first developed by The Joint Commission (TJC); and the second developed by the Agency for Healthcare Research and Quality (AHRQ). The definition of “low-risk” according to both these measures includes term, singleton, live birth deliveries without high-risk diagnoses. However, both these measures are not clinically comprehensive.
Effects of Intrathecal κ-Opioid Receptor Agonist on Morphine-induced Itch and Antinociception in Mice
Authors: Sakakihara M. , Imamachi N. , Saito Y.
Published: November 2016

(Reg Anesth Pain Med. 2016;41:69–74)

The μ-opioid receptor agonist-induced itch is a common adverse effect associated with opioid pain treatment administered through systemic, spinal, and epidural routes. Studies have suggested that systemically administered κ-opioid receptor (KOR) agonists alleviate intrathecal morphine-induced itch; moreover, systemic KOR agonists in combination with intrathecal morphine display additive antinociceptive effects against a thermal stimulus in primates. However, adverse effects, such as insomnia induced by systemically administered KOR agonists, may limit the usefulness of their antipruritic effects in patients. The aim of this study was to investigate the effects of intrathecal TRK-820 a KOR agonist, on intrathecal morphine-induced itch, antinociception, and sedation.
Anesthetic Management of a Parturient With Hypermobility Phenotype but Possible Vascular Genotype Ehlers-Danlos Syndrome
Authors: Fedoruk Kelly , Chong Karen , Sermer Mathew , Carvalho Jose C.A.
Published: November 2016

(Can J Anesth. 2015;62:1308–1312)

Ehlers-Danlos syndrome (EDS) is a rare connective tissue disorder that has 6 major subtypes; it displays diverse symptoms. This syndrome poses a host of challenges in parturients. It causes hypermobility, pelvic pain, preterm delivery, perineal lacerations, and postpartum hemorrhage. Patients with vascular type EDS are susceptible to vascular and visceral fragility. Obstetricians and anesthesiologists face significant challenges in managing both vaginal and cesarean deliveries. The case report discussed the care of a woman who was diagnosed with hypermobility type EDS.
The PTSD Toolkit for Nurses
Authors: Hanrahan Nancy P. , Judge Kate , Olamijulo Grace , Seng Lisa , Lee Matthew , Wall Pamela Herbig , Leake Sandy C. , Czekanski Elizabeth , Thorne-Odem Suzanne , DeMartinis Erika E. , Kelly Ursula A. , Blair Lucas , Longmire Warren
Published: November 2016

Approximately 20% of veterans suffer from posttraumatic stress disorder (PTSD). NPs are well positioned to provide early detection and assist veterans with access to life-saving treatment. The PTSD Toolkit for Nurses helps nurses improve their skills in assessing PTSD and provides a specialized intervention and referral procedure that promotes help-seeking behavior among veterans.
Cognitive-Behavioral and Self-Management Strategies for the Clinician
Authors: Obremskey William T.
Published: November 2016

Most clinicians realize that many factors have a large effect on long-term outcome of patients. Patient factors such as age, sex, socioeconomic level, level of education, social support systems, as well as patient’s psychological makeup may drive the long-term outcome more than an injury or musculoskeletal condition, or the intervention by the clinician. We have attempted to identify many of these factors and address some of the information and literature to be able to help clinicians understand the impact these “other factors” have on patient outcomes. In other words, we have stated that it is “not just the x-rays.” In total patient care to address issues that also drive patient outcomes, it is important to take a multiprolonged approach in addition to taking care of yourself to help take care of your patient’s. You need to: (1) prevent and deal with pain; (2) prevent and deal with narcotic abuse; (3) Empower and employ the patient and families; (4) talk about psychiatric and cognitive deficits and problems; (5) refer for appropriate help; and (6) address work and life issues in every patient, every time.
The follicular variant of papillary thyroid cancer and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)
Authors: Scharpf Joseph , Kamani Dipti , Sadow Peter M. , Randolph Gregory W.
Published: November 2016

Purpose of review

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a new terminology proposed for encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC). Recently, thyroid cancer incidence has increased dramatically, without affecting related mortality rate. This increase is widely attributed to the intensified surveillance leading to a substantial increase in the diagnosis of small classic papillary thyroid cancers and EFVPTCs. Recent studies emphasize the indolent behavior of the EFVPTC. Recently, there has been a reclassification of EFVPTC as NIFTP, a benign entity. The financial and emotional burden of ‘cancer’ diagnosis and treatment can be significant.

Recent findings

This review recapitulates the literature supporting the reclassification of EFVPTC as NIFTP, a benign entity, and reviews standardized diagnostic criteria for EFVPTC.

The information highlighted in this review will affect surgical decision making and may promote the offering of hemithyroidectomy over a total thyroidectomy to some patients with ‘indeterminate’ cytopathological category; postoperative radioiodine ablation will not be required for NIFTP patients.
Amygdala-mediated mechanisms regulate visceral hypersensitivity in adult females following early life stress: importance of the glucocorticoid receptor and corticotropin-releasing factor
Authors: Prusator Dawn K. , Greenwood-Van Meerveld Beverley
Published: November 2016

Alterations in amygdala activity are apparent in women who report a history of early life stress (ELS) and those diagnosed with chronic pain disorders. Chronic stress in adulthood induces visceral hypersensitivity by alterations in glucocorticoid receptor (GR) and corticotropin-releasing factor (CRF) expression within the central amygdala (CeA). Here, we hypothesized that unpredictable ELS, previously shown to induce visceral hypersensitivity in adult female rats, alters GR and CRF expression in the CeA. After neonatal ELS, visceral sensitivity and GR and CRF gene expression were quantified in adult female rats. After unpredictable ELS, adult female rats exhibited visceral hypersensitivity and increased expression of GR and CRF in the CeA. After predictable ELS, adult female rats demonstrated normosensitive behavioral pain responses and upregulation of GR but not CRF in the CeA. After the ELS paradigms, visceral sensitivity and gene expression within the CeA were unaffected in adult male rats. The role of GR and CRF in modulating visceral sensitivity in adult female rats after ELS was investigated using oligodeoxynucleotide sequences targeted to the CeA for knockdown of GR or CRF. Knockdown of GR increased visceral sensitivity in all rats but revealed an exaggerated visceral hypersensitivity in females with a history of predictable or unpredictable ELS compared with that of controls. Knockdown of CRF expression or antagonism of CRF1R in the CeA attenuated visceral hypersensitivity after unpredictable ELS. This study highlights a shift in GR and CRF regulation within the CeA after ELS that underlies the development of visceral hypersensitivity in adulthood.
An Autoethnographic Story of Abuse: Healing and Finding Hope Through a Sexual Health Promotion Project for Adolescents With Developmental Disabilities
Authors: Murray B. Lee
Published: November 2016

This case report is the story of my son's alleged abuse, told from my perspective. At the time, Jordan, a boy with Down syndrome, was 14 years old when his disclosure of sexual abuse by a school employee occurred. As part of the healing process, I use autoethnography to tell the story. I also describe and discuss a school-based program, which I developed and deliver, to provide sexual health promotion and sexual abuse prevention to adolescents with developmental disabilities.
The Experiences of Registered Nurses Who are Injured by Interpersonal Violence While on Duty in an Emergency Department
Authors: Wright-Brown Salena , Sekula Kathleen , Gillespie Gordon , Zoucha Rick
Published: November 2016

A successful career as an emergency department registered nurse (RN) requires the ability to respond quickly to a wide variety of potentially life-threatening illnesses and injuries. The unpredictable nature of this work can evoke emotional and physical stress on the RN beyond that which might be experienced by nurses who work in more stable, controlled, and predictable environments. Emergency healthcare is predicated on unexpected illness or injury leading to unscheduled episodic work. Additional stress is placed on the RN by the potential for violence that occurs in emergency departments. This mixed method pilot study describes the experiences of RNs who have been injured by violence while working in an emergency department. The study included an assessment of the job satisfaction of RNs in the emergency department based on Porter's Need Satisfaction Scale. This scale addresses need fulfillment in five categories: security, social, esteem, autonomy, and self-actualization. The self-actualization subscale measures satisfaction with personal growth, worthwhile accomplishments, and self-fulfillment. During the second strand of the study, phenomenological informed interviews were held with RNs who had been injured while on duty in an emergency department. The findings indicate that the largest reported gaps between the current state and the desired state were found in the area of security and self-actualization. RNs in the emergency department who answered the survey indicated that they desired a safe, secure worksite where they could achieve personal growth, worthwhile accomplishments, and self-fulfillment; but they were not satisfied with their current status in these areas.
SANE-A-PALOOZA: Logistical Development and Implementation of a Clinical Immersion Course for Sexual Assault Nurse Examiners
Authors: Baker Jodi , Kelly Patricia J. , Carlson Kimberly , Colbert Sharon , Cordle Carolyn , Witt Jacki S.
Published: November 2016

SANE-A-PALOOZA, a continuing education program that utilizes hands-on practice with standardized patients and human simulators, was developed to fulfill a portion of the required supervised clinical experience for certification as a sexual assault nurse examiner. The program is designed to provide concentrated clinical skill practice application, eliminate the time gap between gaining and applying clinical knowledge, and decrease discontinuity among multiple preceptors. This article provides an overview of SANE-A-PALOOZA logistics, with the goal of aiding other organizations in developing skill-building experiences for new or less-experienced sexual assault nurse examiners.
Gender Differences in Self-Perceptions About Aging and Sleep Among Elderly Chinese Residents in Taiwan
Authors: Lin Jong-Ni
Published: November 2016

Background:

Previous research has revealed the existence of gender differences in sleep patterns among older adults from various ethnic groups. Data on how gender affects the sleep patterns of Taiwanese are limited.

Purpose:

The purposes of the current study were to (a) describe perceptions about aging and the influence of these perceptions on sleep in elderly men and women, respectively, and (b) determine whether there are gender differences in perceptions and appraisal of sleep.

Methods:

A mixed method design was used. In-depth interview data from 23 men and 27 women were integrated with data from the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI).

Results:

The mean CPSQI score for the entire sample was 6.1 ± 3.5 (men: 4.8 ± 1.6, women: 7.1 ± 4.3). Participants who held negative attitudes about aging were more likely to report poor sleep quality, short sleep duration, and difficulty in falling asleep than those who did not hold negative attitudes. Women had more negative perceptions about aging (e.g., feelings of powerlessness) and more sleep complaints than men. Furthermore, women reported significantly poorer sleep quality (p = .02) and lower sleep efficiency (p = .03) on the CPSQI than men.

Conclusions/Implications for Practice:

Negative perceptions about aging are associated with reports of poor sleep quality. There are gendered differences in perceptions about aging and appraisals of sleep. As the process of aging and patterns of sleep change over time, longitudinal research designs are recommended for future studies.
Developing and Psychometrically Testing the Functions of Diabetes Peer Support Group Scale
Authors: Chiou Chii-Jun , Huang Hsiao-Ling , Lin Ying-Chun , Wang Ruey-Hsia
Published: November 2016

Background:

Peer support groups for people with diabetes are increasingly considered a part of the healthcare system. Understanding the functions of peer support groups assist healthcare professionals to provide critical assistance.

Purpose:

The purpose of this study was to develop and assess the psychometric properties of the Functions of Diabetes Peer Support Group (F-DPSG) scale.

Methods:

This study used a cross-sectional design. A 16-item F-DPSG scale was developed and administered to 589 patients with Type 2 diabetes who were selected from 34 diabetes peer support groups in Taiwan. Construct validity was evaluated using exploratory and confirmatory factor analyses and by examining the correlation with the score of the Chinese Diabetes Management Self-Efficacy Scale. Reliability was tested using internal consistency and test–retest reliability.

Results:

The 16-item F-DPSG scale, including four subscales, was supported by a second-order confirmatory factor analysis, with the following fit indices: χ2/df ratio = 2.60, comparative fit index = .94, normed fit index = .91, and root mean square error of approximation = .07. The four subscales were “enhancing self-care practice,” “obtaining knowledge and skills,” “psychological support,” and “collective identification.” The score of the F-DPSG scale correlated significantly with the score of the Chinese Diabetes Management Self-Efficacy Scale (r = .45, p < .001). The Cronbach’s α and test–retest reliability of the F-DPSG global scale and subscales were all above .70.

Conclusions/Implications for Practice:

The F-DPSG scale showed satisfactory reliability and validity. Healthcare providers may use the F-DPSG scale to assess the functions of peer support groups for people with diabetes and to provide necessary assistance.
A Comparison of the Strength of Association of Reid Colposcopic Index and Swede Score With Cervical Histology
Authors: Ranga Renu , Rai Shweta , Kumari Aruna , Mathur Sandeep , Kriplani Alka , Mahey Reeta , Agarwal Nutan , Kachhawa Garima , Vanamail Perumal , Bhatla Neerja
Published: November 2016

Objective

Colposcopic scoring systems provide an objective diagnosis and select patients who require treatment. A new scoring system, Swede score, has added lesion size as a parameter. This study aimed to compare the strength of association of Reid colposcopic index versus Swede score and assess their utility in low-resource settings.

Methods

In this prospective study, 150 women aged 30 to 59 years with abnormal screening result were enrolled. All women underwent colposcopy; the findings were scored by both Reid colposcopic index and Swede score, biopsy taken from all abnormal areas. Performances of both the scores were calculated.

Results

A total of 33 (22%) CIN 2+ lesions were detected. Reid colposcopic index at a cutoff of 5 had sensitivity, specificity, positive predictive value, and negative predictive value for detecting CIN2+ lesions of 96.97%, 95.35%, 88.89%, and 98.8%, respectively. Using Swede score at a cutoff of 8, sensitivity, specificity, positive predictive value, and negative predictive value were 42.42%, 100%, 100%, and 81.9%, and with a cutoff of 5, these were 100%, 88.37%, 76.74%, and 100%, respectively. The correlation coefficient (R
2) was 0.919. By Spearman rank correlation coefficient, the strength of correlation between Swede score and RCI was 0.937 (p < .001).

Conclusions

Swede score can be used flexibly depending on the setting. The lower threshold (5) with high sensitivity can be used for screening, whereas the higher threshold (8) with high specificity can be used for screen-and-treat selection to decrease the overtreatment rate. Thus, it is a more attractive option for cancer prevention programs in low-resource settings.
Caudal septum surgery techniques reviewed
Authors: Cobo Roxana , Caldas Angie
Published: November 2016

Purpose of review

The caudal septum has important functional and aesthetic implications. Deviations in this area can result in important nasal obstruction due not only to blockage of the nasal passage but also to compromise of the internal nasal valve. Cosmetically, alterations in the caudal septum can result in a twisted nasal tip, loss of projection, rotation, and imbalance in the ala-columellar relationship. Contemporary surgical options will be discussed showing how to preserve, reshape, and reinforce the caudal septum to obtain a final looking nose that is not only functional but also aesthetically pleasing.

Recent findings

Recent publications have shown that cartilage preservation and remodeling techniques can be efficient in the treatment of the caudal septum. Adequate preoperative diagnosis must be made to be able to create a step-wise approach evolving from simple suturing techniques to more complex ones that require the use of grafts to reposition and keep the caudal septum in the midline with an adequate functional and cosmetic outcome.

Adequate management of the caudal portion of the nasal septum is a challenge because of its importance in nasal function and cosmetic final results. There are many surgical options that can be used to correct and align this structure and there is no one single surgical technique that can be used in all cases. A step-wise approach is presented covering the different techniques used today evolving from simple to more complicated ones. The final surgical objective should be cosmetically pleasing noses that function appropriately.
Detection of Sepsis in Preterm Infants by Fecal Volatile Organic Compounds Analysis
Authors: Berkhout Daniel J.C. , Niemarkt Hendrik J. , Buijck Martin , van Weissenbruch Mirjam M. , Brinkman Paul , Benninga Marc A. , van Kaam Anton H. , Kramer Boris W. , Andriessen Peter , de Boer Nanne K.H. , de Meij Tim G.J.
Published: November 2016

Objectives:

Several studies associated altered gut microbiota composition in preterm infants with late‐onset sepsis (LOS), up to days before clinical onset of sepsis. Microbiota analysis as early diagnostic biomarker is, however, in clinical practice currently not feasible because of logistic aspects and high costs. Therefore, we hypothesized that analysis of fecal volatile organic compounds (VOCs) may serve as noninvasive biomarker to predict LOS at a preclinical stage, because VOC reflect the composition and activity of intestinal microbial communities.

Methods:

In a prospective multicenter study, fecal samples were collected daily from infants with a gestational age of <30 weeks. VOC signatures of fecal samples from infants with LOS, collected up to 5 days before diagnosis, were analyzed by means of an electronic nose technology (Cyranose 320) and compared to matched controls.

Results:

Fecal VOC profiles of infants with LOS (n = 36) could be discriminated from controls (n = 40) at 3 days (area under the curve [±95% confidence interval], P value, sensitivity, specificity; 70.2 [52.2–88.3], 0.033, 57.1%, 61.5%), 2 days (77.7 [62.7–92.7], 0.050, 75.0%, 70.8%), and 1 day (70.4 [49.6–91.3], 0.037, 64.3%, 64.3%) before the onset of LOS.

Conclusions:

Fecal VOC profiles of preterm infants with LOS could be discriminated from matched controls, up to 3 days before clinical onset of the disease, underlining the hypothesis that intestinal microbiota may play an etiological role in LOS. Notably, VOC profiling is clinically feasible and the potential of this technique in the early detection of LOS needs to be confirmed in future studies.
New initiatives to develop self-testing for HIV
Authors: Witzel T. Charles , Rodger Alison J.
Published: November 2016

Purpose of review

The purpose of this review is to describe the most recent literature on outcomes and issues associated with HIV self-testing (HIVST).

Recent findings

HIVST is acceptable to a range of populations in a variety of contexts, particularly if users’ values and preferences are taken into account in intervention development. Approaches being explored in ongoing and planned studies are the efficacy of HIVST to increase diagnosis of long-standing prevalent infections and to reduce the interval between HIV transmission and diagnosis, particularly in high-incidence groups. Though there is little evidence of harms related to HIVST, this remains a potential issue. Concerns remain about the reliability of currently available HIVST kits, which have lower sensitivity than testing options available in clinical settings, particularly in early HIV infection. Evidence on linkage to care for confirmatory testing after a reactive HIVST result and the cost-effectiveness of HIVST to increase rates of HIV diagnosis is currently limited.

HIVST is a relatively new innovation that is acceptable to key populations and which could increase HIV testing rates and rates of HIV diagnosis, especially in at-risk groups. Concerns remain about test sensitivity (particularly in early infection), and linkages to care for confirmatory testing after a reactive HIVST.
A Comparison of Open, Laparoscopic, and Robotic Surgery in the Treatment of Right-sided Colon Cancer
Authors: Kang Jeonghyun , Park Yoon Ah , Baik Seung Hyuk , Sohn Seung-Kook , Lee Kang Young
Published: November 2016

Introduction:

Multidimensional comparison between open, laparoscopy, and robotic surgery in the management of right-sided colon cancer are lacking. The aim of this study was to compare the early perioperative results and oncologic outcomes among the 3 different methods.

Patients and Methods:

Between June 2007 and 2011, a total of 96 patients who underwent right hemicolectomy in a single institution were classified into the open surgery (OS; n=33), the laparoscopy surgery (LS; n=43), and the robot surgery (RS; n=20) groups. Perioperative and oncologic outcomes were compared among the 3 groups.

Results:

Patient demographics were comparable. Operation time was significantly longer in the RS and LS than the OS (P<0.001). There was 1 OS conversion in LS. There was no difference of total retrieved lymph node numbers among the 3 groups. Postoperative recovery was faster and hospital stay was shorter in RS than OS. However, there was no difference between LS and RS. After the median 40 months’ follow-up, 5-year disease-free survival was similar among the OS, LS, and RS (87.7%, 84%, and 89.5%, respectively). Total charge and total patient charge were significantly higher in RS than the others.

Conclusions:

Our comparative study demonstrates that the RS have better short-term outcomes in reducing hospital stay compared with the OS, but similar to the LS. Although the oncologic outcomes are similar, the benefit of RS in right hemicolectomy is unclear considering a high cost of RS.
Real-time Continuous Esophageal High-resolution Manometry (HRM) During Laparoscopic Heller Myotomy and Dor Fundoplication for the Treatment of Achalasia. A Promising Novelty in Regards of Perfecting Surgical Technique: Could It Guide Surgical Technique Toward Excellent Results?
Authors: Triantafyllou Tania , Doulami Georgia , Papailiou Joanna , Mantides Apostolos , Zografos Georgios , Theodorou Dimitrios
Published: November 2016

High-resolution manometry (HRM) is the gold-standard diagnostic tool for achalasia of the esophagus. Laparoscopic Heller-Dor technique is the preferred surgical approach with success rate estimated 90%. The use of intraoperative HRM provides real-time estimation of intraluminal esophageal pressures and identifies the exact points of esophageal luminal pressure during laparoscopy. Ten patients with achalasia underwent surgery. All patients preoperatively completed 1 manometric study and Quality of Life questionnaires (EORTC QLQ-C30 version 3.0) with Eckardt scores. We collected intraoperative manometry data and repeated manometric studies, EORTC QLQ-C30, and Eckardt scores postoperatively. Median Eckardt score was decreased from 7.5 to 0.5, mean resting pressure decreased from 51.4 to 11.9 mm Hg, whereas mean residual pressure diminished from 45.9 to 9.5 mm Hg postoperatively. The simultaneous use of HRM during the Heller-Dor technique may lead to an individualized management of the disease.
Incidence of Port-Site Hernias: A Survey and Literature Review
Authors: Holihan Julie L. , Chen Jeffery S. , Greenberg James , Hehir Dermot , Johnston Sean M. , Marcus Daniel , Ryan Heidi , Tsuda Shawn , Liang Mike K.
Published: November 2016

Background:

The impact of laparoscopy on the prevalence of incisional hernias remains unclear. The aim of this study is to determine (1) surgeon perceptions of port-site hernias (PSHs), (2) the true incidence of PSH.

Materials and Methods:

A survey on PSH was given to determine the surgeon-reported rate of PSH. A literature review was performed for studies with a primary outcome of PSH. Studies were evaluated using checklists, and scores were used to compare risk of bias. Risk of bias was graphed against PSH incidence.

Results:

From 38 surgeons surveyed, the surgeon perceived rate of PSH was a median (range) of 0.5% (0% to 5%) for ports ≤5 mm, 5% (0.1% to 20%) for ports extended, and 5% (0.1% to 40%) for ports ≥10 mm. Thirty studies showed a PSH rate from 0% to 39.3%. Higher quality studies reported higher rates of PSH.

Conclusions:

Surgeons underestimate the incidence of PSH, but high-quality literature suggests that it may be nearly 40%.
The Use of Interventional Radiology Techniques in the Treatment of Pancreatic Fistula
Authors: Miłek Tomasz , Baranowski Krzysztof , Petryka Robert , Ciostek Piotr
Published: November 2016

One of the complications of pancreatic disease is the formation of pancreatic fistulae. The presence of fistula leads to body wasting and cachexia. The standard treatment is intubation of the Wirsung duct and in cases where there are no improvements the next proposed form of treatment is surgery. The aim of the study was to evaluate the efficacy of pancreatic fistula closure using interventional radiology techniques. In 2009 to 2014, 46 patients diagnosed with pancreatic fistula were treated with interventional radiology techniques. Treatment consisted of vascular coil implanted at the entry of the fistula and then sealed with tissue glue adhesive during endoscopic procedure. Technical success of vascular coil implantation and the use of tissue glue adhesive were reported in all patients. Pancreatic fistula recurred in 7 patients (15.2%). The latter group of patients underwent statistical analysis to determine what the risk factors in recurring pancreatic fistulas were. The results indicate a significant relationship between etiology of the fistula and treatment effect. In conclusion: (1) the use of interventional radiology methods in the closure of pancreatic fistula is an effective and safe procedure; and (2) the recurrence of fistula is dependent on the etiology and often occurs after surgery or trauma.
Three-Port Laparoscopic Sleeve Gastrectomy: A Novel Technical Modification
Authors: Dunford Gretchen , Philip Sunu , Kole Kerry
Published: November 2016

Laparoscopic sleeve gastrectomy has rapidly been adopted as a primary surgical procedure in bariatric patients. The technique of multiport sleeve gastrectomy is described using 4 to 6 ports and an additional port for a liver retractor. A technique of single-port sleeve gastrectomy has been described, the principal advantages of which appear to reduced postoperative pain and an improved cosmetic outcome. In this paper we describe a novel, and easily reproducible technique for the performance of a sleeve gastrectomy using only 3 ports that does not compromise the procedure and may offset the disadvantages of a multiport technique.
Comparison of Absorbable Versus Nonabsorbable Tackers in Terms of Long-term Outcomes, Chronic Pain, and Quality of Life After Laparoscopic Incisional Hernia Repair: A Randomized Study
Authors: Bansal Virinder K. , Asuri Krishna , Panaiyadiyan Sridhar , Kumar Subodh , Subramaniam Rajeshwari , Ramachandran Rashmi , Sagar Rajesh , Misra Mahesh C.
Published: November 2016

Background:

Laparoscopic incisional and ventral hernia repair (LIVHR) has been associated with a high incidence acute and chronic pain due to use of nonabsorbable tackers. Several absorbable tackers have been introduced to overcome these complications. This randomized study was done to compare 2 techniques of mesh fixation, that is, nonabsorbable versus absorbable tackers for LIVHR.

Materials and Methods:

Ninety patients admitted for LIVHR repair (defect size <15 cm) were randomized into 2 groups: nonabsorbable tacker fixation (NAT group, 45 patients) and absorbable tacker fixation (AT group, 45 patients). Intraoperative variables and postoperative outcomes were recorded and analyzed.

Results:

Patients in both the groups were comparable in terms of demographic profile and hernia characteristics. Mesh fixation time and operation time were also comparable. There was no significant difference in the incidence of immediate postoperative and chronic pain over a mean follow-up of 8.8 months. However, cost of the procedure was significantly higher in AT group (P<0.01) and NAT fixation was more cost effective as compared with AT. Postoperative quality of life outcomes and patient satisfaction scores were also comparable.

Conclusions:

NAT is a cost-effective method of mesh fixation in patients undergoing LIVHR with comparable early and late postoperative outcomes in terms of pain, quality of life, and patient satisfaction scores.
Mediastinoscopy-assisted Transhiatal Esophagectomy for Esophageal Cancer: A Single-Institutional Cohort Study
Authors: Nomura Tsutomu , Matsutani Takeshi , Hagiwara Nobutoshi , Fujita Itsuro , Nakamura Yoshiharu , Makino Hiroshi , Miyashita Masao , Uchida Eiji
Published: November 2016

We compared the therapeutic outcomes of mediastinoscopy-assisted transhiatal esophagectomy (MATHE) with transthoracic esophagectomy (TTE), and with video-assisted thoracoscopic esophagectomy (VATS-E) for the treatment of esophageal cancer. Twenty patients underwent MATHE in our institute from 2001 to 2005 were enrolled. We evaluated the therapeutic outcomes, including perioperative complications and long-term prognosis after surgery, and compared these with 15 patients who underwent TTE during the same time period and 15 who underwent VATS-E at a later date. MATHE was performed safely and the long-term prognosis were satisfactory compared with TTE. However, the number of dissected mediastinal lymph nodes, total blood loss, and sophistication of the procedure were inferior to VATS-E. MATHE represents a less invasive surgical procedure. However, in light of the risk of leaving lymph node metastasis around the tracheal bifurcation in patients with tumor invasion beyond the muscularis mucosa, MATHE should only be adopted in a minority of patients.
Colon Cancer Surgery: A Retrospective Study Based on a Large Administrative Database
Authors: Saia Mario , Buja Alessandra , Mantoan Domenico , Agresta Ferdinando , Baldo Vincenzo
Published: November 2016

Introduction:

Laparoscopic colectomy (LC) for colon cancer is considered as safe and effective as open colectomy. It has many benefits in terms of postoperative pain, length of hospital stay, and esthetic results. There is evidence in the United States of a positive trend in the proportion of oncologic patients undergoing LC. Our aim is to confirm this trend in Europe and identify factors associated with a greater use of LC.

Materials and Methods:

A retrospective cohort study based on hospital discharge records (HDR) collected from 2008 to 2013 in a north-eastern Italian region (Veneto). The sample included all HDR with colon cancer as their principal or secondary diagnosis, treated with partial or total colectomy. To establish the overall regional trend of LC, we standardized cases by age, referring to the number of procedures performed by age group in 2010. We calculated the annual percent change from the slope of the regression model over a given time interval.

Results:

Out of 14,085 colectomies, 29% were completed laparoscopically. The age-adjusted rates of LC by year ranged from 23.8% (2008) to 36.0% (2013). The mean annual increase in the LC rate was 2.4% overall (P<0.001). Factors associated with a higher proportion of LC were younger age (39% LC in patients below 65 y vs. 25% in those above 65 y), public hospitals (odds ratio: 1.71; 95% confidence interval, 1.51-1.94; P<0.05) and elective admissions (odds ratio: 4.19; 95% confidence interval, 3.76-4.67; P<0.05).

Discussion:

Although the proportion of LC is growing, there are factors that influence the likelihood of this procedure being conducted. Future efforts to extend the use of LC to all eligible patients and avoid disparities should target both surgeons and patients, promoting the development and dissemination of appropriate guidelines.
The Efficacy of Intralesional Steroid Injection in the Treatment of Corrosive Esophageal Strictures in Children
Authors: Divarci Emre , Celtik Ulgen , Dokumcu Zafer , Ozcan Coskun , Erdener Ata
Published: November 2016

Purpose of the Study:

Esophageal dilatation can be insufficient in the treatment of severe corrosive esophageal strictures. In this study, we aimed to present the efficacy of intralesional steroid injection as an adjunct to dilatation therapy.

Materials and Methods:

Retrospective analysis of children who underwent intralesional steroid injection between 2004 and 2014 was performed. Patients’ age, type of corrosive substance, length of stricture, number of injection and dilatation sessions and complications were reviewed. The success was evaluated by the comparison of number, frequency, and requirement of dilatation therapy before and after injection.

Results:

Intralesional steroid injection was performed to 32 children with a mean age of 3.6±2.5 years. The types of corrosive agents were alkali (24) or acid (8). Mean number of injection sessions was 2.5±1.1(1 to 6). Mean number of dilatation sessions was decreased from 10±8.8 to 5.4±4.6 after injection (P=0.003). Mean frequency of dilatations was extended from 3.6±0.9 weeks to 8.7±3.9 weeks (P=0.000). Dilatation treatment was successfully terminated in 25 of 27 children with short-segment strictures after injection (92%). Whereas all of the children with long-segment strictures could not resolved and finally required esophageal replacement (5 patients). One patient had transient cushingoid phenotype as a complication. There was not seen any major complication-like perforation. The mean follow-up period was 6±3 years.

Conclusions:

Intralesional steroid injection is an effective adjunct to dilatation in most of the children with short-segment strictures. It should be performed as a safe and efficient treatment option in patients with short-segment corrosive esophageal strictures resistant to dilatation therapy.