bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hybrid Robotic Transanal Minimally Invasive Surgery Approach to Large and Low-Lying Rectal Polyps
Authors: Krezalek Monika A. , Contreras-Peraza Nicolas , Parker Maile E. , Kelley Scott R. , Behm Kevin T. 
Published: June 2020

BACKGROUND:
Transanal excision is the surgical treatment of choice for low-risk rectal pathology such as endoscopically unresectable polyps, very select early rectal cancers, as well as other benign and low-risk tumors. Robotic transanal minimally invasive surgery enhances the surgeon’s ability to work in the confined space of the rectum and helps overcome the limitations of other modalities for transanal excision. Large lesions that extend to the dentate line and cannot be excised transanally impart a particular challenge. Herein, we describe a hybrid robotic transanal minimally invasive surgery approach for excising large rectal lesions that extend to the dentate line and cannot be excised by utilizing traditional transanal techniques.

TECHNIQUE:
With the use of a standard transanal approach, the distal margin of the lesion is marked and lifted off of the internal sphincter muscle. The dissection is continued until above the anorectal ring, and a 5.5-cm transanal platform is introduced transanally. Insufflation with an 8-mm trocar is initiated and the robotic platform is docked transanally. A 1-cm circumferential proximal margin is marked, and the excision is continued robotically until en bloc resection of the lesion is completed. The defect is closed in a transverse fashion using barbed suture. For rare cases of circumferential or nearly circumferential full-thickness defects, interrupted barbed sutures are placed equidistant, the robot is undocked, the transanal platform is removed, and a handsewn coloanal anastomosis is performed allowing complete closure of the defect.

RESULTS:
A hybrid robotic transanal minimally invasive surgery approach to large and low-lying rectal lesions is feasible and safe, and it has advantages over standard transanal excision including enhanced ergonomics, dexterity, and optics, as well as reduced rates of specimen fragmentation.

CONCLUSION:
A hybrid robotic transanal minimally invasive surgery approach allows for complete resection of very large polyps, which would otherwise be extremely challenging with standard transanal approaches. See Video at http://links.lww.com/DCR/B231.
cGMP Signaling in Cardiovascular Diseases: Linking Genotype and Phenotype
Authors: Dang Tan An , Schunkert Heribert , Kessler Thorsten 
Published: June 2020

Abstract:
Cyclic guanosine 3′,5′-monophosphate (cGMP) is the key second messenger molecule in nitric oxide signaling. Its rapid generation and fate, but also its role in mediating acute cellular functions has been extensively studied. In the past years, genetic studies suggested an important role for cGMP in affecting the risk of chronic cardiovascular diseases, for example, coronary artery disease and myocardial infarction. Here, we review the role of cGMP in atherosclerosis and other cardiovascular diseases and discuss recent genetic findings and identified mechanisms. Finally, we highlight open questions and promising research topics.
Clinical trials of acute mechanical circulatory support in cardiogenic shock and high-risk percutaneous coronary intervention
Authors: Whitehead Evan , Thayer Katherine , Kapur Navin K. 
Published: June 2020

Purpose of review
Acute mechanical circulatory support devices have become widely used in cardiogenic shock and high-risk percutaneous coronary intervention (PCI) but there remains significant controversy over the evidence supporting their use and the specific roles of various devices. In this review, we summarize major recent studies and identify key areas of future investigation.

Recent findings
In cardiogenic shock, uncontrolled single arm studies emphasizing early mechanical circulatory support (MCS) have showed promising results, but randomized trials have either been stopped prematurely or enrolled patients with advanced shock unlikely to benefit from MCS. In high-risk PCI, only one randomized controlled trail has been performed, with practice guided largely by observational data.

Summary
Randomized trials of current-generation mechanical support devices incorporating contemporary best-practices and performed in clearly defined populations are badly needed to clarify the role of acute MCS devices in cardiogenic shock and high-risk PCI.
Review – current opinion in cardiology hypertension in chronic kidney disease
Authors: Alqudsi Muhannad , Hiremath Swapnil , Velez Juan Carlos Q. 
Published: June 2020

Purpose of review
Hypertension is a major risk factor for cardiovascular disease, cerebrovascular events, and progression to end-stage kidney disease (ESKD). The kidneys play a causative role in hypertension, but they are also organs vulnerable to hypertensive injury. Thus far, goals for optimal blood pressure in chronic kidney disease (CKD) and ESKD patients are not fully elucidated. Herein, we critically review the existing evidence.

Recent findings
Large randomized controlled trials (RCTs) continue to be deemed as the best source of evidence to guide optimal blood pressure goals in CKD and ESKD patients. Despite recent advances, the growing body of literature does not permit drawing definitive conclusions. Few adequately powered RCTs have specifically assessed goals for treatment of hypertension in patients with CKD. The most recent large RCT in hypertension, the Systolic Blood Pressure Intervention Trial, included a subset of patients with CKD and provided some insights. For the ESKD population, trials to evaluate blood pressure goals are even more scarce. The Blood Pressure in Dialysis Trial was a relatively small pilot study that can be deemed as hypothesis generating.

Summary
Management of hypertension in CKD is essential for optimization of cardiovascular, cerebrovascular and renal outcomes. To date, the existing evidence does not fully clarify ideal targets for blood pressure control in this patient population.
Intraocular lens calculations in patients with keratoectatic disorders
Authors: Smith Ryan G. , Knezevic Alexander , Garg Sumit 
Published: June 2020

Purpose of review
Intraocular lens (IOL) calculations in patients with keratoconus and other keratoectatic disorders continues to be a challenge for today's cataract surgeon. In this article, we review data published over the past 18 months (June 2018 to January 2020).

Recent findings
Cataract surgery in keratoconus patients has the potential to greatly improve patients’ vision. However, keratoconic eyes are notorious for unpredictable outcomes because of difficulty in obtaining proper preoperative biometry and lack of data and consensus on IOL calculation formulas that can reliable in providing the desired outcome. Recent studies suggest the Barrett II Universal calculation is the most accurate in mild-to-moderate keratoconic eyes. All studies note the level of predictability decreases with the steepness of keratometric readings. Historically, the SRK/T has been shown to provide the most reliable calculations.

Summary
There is still no consensus on which formula is best for IOL calculation in keratoconic eyes. On the basis of the most recent literature, we recommend using the Barrett II Universal in conjunction with the SRK/T formula for mild-to-moderate eyes. Preoperative counseling of expectations with the patient is the key to achieving a satisfied patient and avoiding an unpleasant situation in the result of refractive surprise.
Intereye Symmetry of 24-Hour Intraocular Pressure–related Patterns in Untreated Glaucoma Patients Using a Contact Lens Sensor
Authors: Mansouri Kaweh , Gillmann Kevin 
Published: June 2020

Purpose:
Scarce data are available on the symmetry of 24-hour intraocular pressure (IOP) variations between fellow eyes of glaucoma patients, and such evidence could have profound consequences on the interpretation of monocular therapeutic trials. The objective is to evaluate the intereye correlation of continuously measured circadian IOP-related patterns in untreated glaucoma patients.

Methods:
In this single-center prospective study, a total of 29 untreated patients with open-angle glaucoma underwent bilateral ambulatory 24-hour monitoring of IOP-related patterns using a contact lens sensor (CLS; SENSIMED Triggerfish). IOP was measured before and after CLS monitoring using Goldmann applanation tonometry. Intereye agreement of 24-hour patterns was calculated using Spearman correlation (r) of raw data and after cosinor rhythmometry modeling.

Results:
Complete bilateral CLS data could be obtained in 20 patients (mean age: 55.5±15.7 y; 51.7% women). On average, intereye correlation was r=0.76±0.19 (range: 0.16 to 0.95) and r=0.77±0.15 (range: 0.49 to 0.91), after excluding 8 patients with lower quality recordings. Cosine rhythmometry modeling showed mean acrophases occurring at 4:21±2:20 am in left eyes and 3:39±1:50 am in right eyes (r=0.48; P=0.034). Mean acrophase amplitude was 110.9±51.9 for left eyes and 107.8±46.2 for right eyes (r=0.79; P<0.001). No serious adverse events related to CLS monitoring were recorded. Transient conjunctival hyperemia (13 patients) and blurred vision (11 patients) were the most frequent adverse events.

Conclusions:
In this group of untreated glaucoma patients, there was good intereye agreement for circadian IOP-related patterns using the CLS. These results show a higher degree of intereye symmetry, in terms of IOP peak timings and amplitudes, than previously reported with standard tonometry.
Clinical Utility of Triplicate En Face Image Averaging for Optical Coherence Tomography Angiography in Glaucoma and Glaucoma Suspects
Authors: Nelson Andrew J. , Chu Zhongdi , Burkemper Bruce , Chang Brenda R. , Xu Benjamin , Wang Ruikang K. , Richter Grace M. 
Published: June 2020

Précis:
Averaging triplicate en face angiograms of the radial peripapillary capillary (RPC) plexus with optical coherence tomography angiography (OCTA) improves vessel visualization, reduces vessel density parameters, and increases the diagnostic accuracy for glaucoma of one such parameter.

Purpose:
The purpose of this study was to test the hypothesis that triplicate averaging of the RPC layer improves visualization and diagnostic accuracy of OCTA for glaucoma.

Materials and Methods:
This is a cross-sectional study involving 63 primary open-angle glaucoma patients and 70 age-matched glaucoma suspects. Triplicate 6×6 mm OCTA scans of the optic nerve head were acquired, and the RPC layer was extracted. RPC en face images were registered and averaged. Parameters of global entropy, global standard deviation, local texture correlation, local homogeneity, signal-to-noise ratio, and intercapillary distance were used to measure the change in visualization with averaging. Vessel area density (VAD), vessel skeleton density (VSD), and flux parameters were calculated in a 2.8 mm annulus excluding the optic disc. The diagnostic accuracy of these parameters for glaucoma was assessed by calculating the area under the receiver operating curve (AUC) values.

Results:
Three-frame averaging resulted in decreased global entropy and global standard deviation (Ps<0.001), and increased local texture correlation, local homogeneity, signal-to-noise ratio, and intercapillary distance (Ps<0.001). Averaged images also had reduced VAD, VSD, and flux (Ps<0.001). AUC was significantly increased for VSD after image averaging (P=0.018), while no significant change in AUC was observed for VAD (P=0.229) or flux (P=0.193).

Conclusions:
Triplicate averaging improves visualization of the RPC layer and the diagnostic accuracy of VSD for glaucoma. The impact of image averaging on OCTA diagnostic performance and other potential applications warrants further exploration.
Knowledge, Attitudes, and Practices Toward Coronavirus Disease 2019 Among People in a Tertiary Care Hospital in India
Authors: Doke Purwa , Rege Sujata , Palkar Sonali 
Published: June 2020

Background
Novel coronavirus disease 2019 (COVID-19) has rapidly spread across the entire globe causing a lot of fear among the masses. India had more than 2,500 confirmed cases and more than 70 deaths at the time of submission of this article. This is probably the first study from India on the knowledge, attitudes, and practices toward COVID-19. Presently, there is only 1 similar study from China.

Methods
A cross-sectional observational study was performed in a tertiary care hospital in India to assess the knowledge, attitudes, and practices of the participants toward COVID-19 during the pandemic. The participants had to answer a questionnaire in the language well understood by them. It pertained to their basic knowledge about this disease, their attitudes, and correct practices. The participants were either doctors, staff, patients, or relatives visiting the hospital.

Results
Among the various age groups, the highest proportion (57.21%) of very good knowledge was in the 20 to 30 years age group. Among the respondents, poor knowledge was seen in the patients. Overall, 47.99% participants had an extremely optimistic attitude, whereas <50% doctors had extremely correct practices toward COVID-19. This is unacceptable during the ongoing pandemic and reveals scope for improvement.

Conclusions
The public health authorities at the regional and state level can use this information to increase awareness among the population, which may help to contain the pandemic. Educational campaigns targeting the correct population groups are essential to reduce the public anxiety toward this pandemic.
Management of malignant pleural effusions
Authors: Dipper Alexandra , Bhatnagar Rahul , Maskell Nick 
Published: June 2020

Purpose of review
Malignant pleural effusion (MPE) is a common cause of breathlessness indicative of advanced disease. Treatment approaches focus on relief of breathlessness and optimizing quality of life. A number of recent, high-impact publications give further insight into the advantages of different treatment options. This article provides a summary of the most up-to-date evidence in this area.

Recent findings
Recent publications have demonstrated comparable pleurodesis outcomes of talc slurry to talc poudrage and explore strategies to combine the advantages of indwelling pleural catheters (IPCs) with a chemical pleurodesis. A daily IPC drainage regime improves the chances of pleurodesis success and early IPC removal in patients without significant trapped lung.

Summary
MPE is a diverse condition, with no one strategy representing the ‘best’ approach for all. Management decisions should be made in conjunction with the patient, taking their views and preferences into consideration.
Leucine-rich alpha-2 glycoprotein 1, high mobility group box 1, matrix metalloproteinase 3 and annexin A1 as biomarkers of ulcerative colitis endoscopic and histological activity
Authors: Kourkoulis Panagiotis , Michalopoulos George , Katifelis Hector , Giannopoulou Ioanna , Lazaris Andreas C. , Papaconstantinou Ioannis , Karamanolis George , Gazouli Maria 
Published: June 2020

Objective
The LRG, HMGB1, MMP3 and ANXA1 proteins have been implicated in different inflammatory pathways in ulcerative colitis (UC), but their role as specific biomarkers of both endoscopic and histological activity has yet to be elucidated. In the present study, we aimed to evaluate the LRG1, HMGB1, MMP3 and ANXA1 as potential serum biomarkers for UC endoscopic and histological activity.

Methods
This cross-sectional study included UC patients under 5-ASA, and healthy controls (HC) undergoing colonoscopy. Blood and biopsy samples were obtained and endoscopic Mayo sub-score (Ms) was recorded for the UC patients. Intramucosal calprotectin as a marker of histologic activity was evaluated in all biopsy samples and serum LRG1, HMGB1, MMP3 and ANXA1 levels were measured in the blood samples.

Results
The HCs ANXA1 level was lower compared to that of the UC group [P = 0.00, area under the curve (AUC) = 0.881] and so was the HCs MMP3 level compared to that of patients (P = 0.00, AUC = 0.835). The HCs ANXA1 levels were also lower compared to these of the independent Ms groups, even to the Ms = 0 (P = 0.00, AUC = 0.913). UC endoscopic activity was associated with MMP3 levels (r = 0.54, P = 0.000) but not with ANXA1, LRG1 and HMGB1 levels

Conclusion
Serum ANXA1 is a potential diagnostic biomarker of UC and serum MMP3 is a potential biomarker of UC endoscopic and histological activity.
Risk factors for endoscopic severity of diverticular disease of the colon and its outcome: a real-life case-control study
Authors: Tursi Antonio , Violi Alessandra , Cambie’ Ginevra , Franceschi Marilisa , Baldassarre Gianluca , Rodriguez Kryssia Isabel , Miraglia Chiara , Brandimarte Giovanni , Elisei Walter , Picchio Marcello , Di Mario Francesco 
Published: June 2020

Background
Diverticular disease is an increasing global problem.

Aims
To assess the factors associated with the severity of diverticular disease and its outcome, analyzing a real-life population.

Methods
A cohort of patients, submitted to colonoscopy from 1 January 2012 to 30 April 2018 was revised. The endoscopic severity of diverticular disease was scored according to the Diverticular Inflammation and Complications Assessment (DICA) classification.

Results:
A cohort of 11 086 patients was identified during the study period, 5635 with diverticulitis and 5451 without diverticulosis. Blood hypertension, diabetes and angiotensin receptor blocker users occurred more frequently in the study group, while the prevalence of colorectal cancer (CRC) was significantly lower. Age >70 years, BMI >30 and blood hypertension were factors independently related to the presence of diverticulosis, while diabetes and CRC were significantly associated with the absence of diverticulosis. Female sex, age, smoke, appendectomy, proton-pump inhibitors and acetyl-salicylic acid use were directly related to the severity of diverticular disease, while CRC and colonic polyp occurrence were inversely related to the severity of diverticular disease, significantly. Female sex, age >70 years and smoke were significantly related to the severity of diverticular disease. CRC and colonic polyps were significantly less in DICA 3 patients. DICA 3 patients were more often symptomatic, at higher risk of hospital admission, longer hospital stay and higher mean costs.

Conclusions
Several factors are associated with the severity of diverticular disease according to the DICA classification. The DICA classification is also predictive of the outcome of the disease in terms of hospital admission, stay and costs.
Endoscopic eradication therapy for Barrett's oesophagus: state of the art
Authors: Kolb Jennifer M. , Wani Sachin 
Published: June 2020

Purpose of review
Barrett's oesophagus is the only identifiable precursor lesion to oesophageal adenocarcinoma. The stepwise progression of Barrett's oesophagus to dysplasia and invasive carcinoma provides the opportunity to intervene and reduce the morbidity and mortality associated with this lethal cancer. Several studies have demonstrated the efficacy and safety of endoscopic eradication therapy (EET) for the management of Barrett's oesophagus related neoplasia. The primary goal of EET is to achieve complete eradication of intestinal metaplasia (CE-IM) followed by enrolment of patients in surveillance protocols to detect recurrence of Barrett's oesophagus and Barrett's oesophagus related neoplasia.

Recent findings
EET depends on early and accurate detection and diagnosis of Barrett's oesophagus related neoplasia. All visible lesions should be resected followed by ablation of the remaining Barrett's epithelium. After treatment, patients should be enrolled in endoscopic surveillance programmes. For nondysplastic Barrett's oesophagus, surveillance alone is recommended. For low-grade dysplasia, both surveillance and ablation are reasonable options and should be decided on an individual basis according to patient risk factors and preferences. EET is preferred for high-grade dysplasia and intramucosal carcinoma. For T1b oesophageal adenocarcinoma, esophagectomy remains the standard of care, but endoscopic therapy can be considered in select cases.

Summary
EET is now standard of care and endorsed by societal guidelines for the treatment of Barrett's oesophagus related neoplasia. Future studies should focus on risk stratification models using a combination of clinical data and biomarkers to identify ideal candidates for EET, and to predict recurrence. Optimal therapy for T1b cancer and surveillance strategy after CE-IM are topics that require further study.
An expanded role for dipeptidyl peptidase 4 in cell regulation
Authors: Ropa James , Broxmeyer Hal E. 
Published: June 2020

Purpose of review
Dipeptidyl peptidase 4 (DPP4) is a serine protease with diverse regulatory functions in healthy and diseased cells. Much remains unknown about the mechanisms and targets of DPP4. Here we discuss new studies exploring DPP4-mediated cellular regulation, provide an updated list of potential targets of DPP4, and discuss clinical implications of each.

Recent findings
Recent studies have sought enhanced efficacy of targeting DPP4's role in regulating hematopoietic stem and progenitor cells for improved clinical application. Further studies have identified DPP4 functions in different cellular compartments and have proposed ways to target this protein in malignancy. These findings, together with an expanded list of putative extracellular, cell surface, and intracellular DPP4 targets, provide insight into new DPP4-mediated cell regulation.

Summary
DPP4 posttranslationally modifies proteins and peptides with essential roles in hematopoietic cell regulation, stem cell transplantation, and malignancy. Targets include secreted signaling factors and may include membrane proteins and transcription factors critical for different hematopoietic functions. Knowing these targets and functions can provide insight into new regulatory roles for DPP4 that may be targeted to enhance transplantation, treat disease, and better understand different regulatory pathways of hematopoiesis.
Infectious complications of vascularized composite allograft transplantation
Authors: Steinbrink Julie M. , Wolfe Cameron R. 
Published: June 2020

Purpose of review
Vascularized composite allograft (VCA) transplants constitute multiple tissues transplanted together as one functional unit. These procedures are increasing in frequency and complexity, yet data about graft survival, quality of life, and infection risk remain limited.

Recent findings
Informative guidance for this patient population is often inferred from the solid organ transplantation literature. Yet, it is important to understand that VCA transplantation additionally carries its own significant and distinctive risk factors for infection.

Summary
In this review, we give an overview of previously described infectious complications of VCA transplantation in the literature, discuss risk factors for future infection in these patients, and discuss how to manage such obstacles.