bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long‐term functional and clinical outcomes following transanal advancement flap for complex anal fistula repair: are there predictors of recurrence and incontinence?
Authors: Uribe N. , Balciscueta Z. , Cuneo B. , Martín M.C. , Tabet J. , Torrijo I. , López M. 
Published: July 2020

AbstractAimTransanal flap is an attractive technique for complex fistulas. The aim of this study was to identify factors associated with poor outcome, recurrence and incontinence.MethodAll patients who underwent an advancement flap for the treatment of a complex anal fistula between 1995 and 2019 were prospectively enrolled. The patient data obtained included age, sex, body mass index, comorbid conditions and smoking history. The fistula characteristics analysed included previous anal surgery, anatomy of the fistula according to Park's classification, horseshoe or supralevator extension and preoperative seton drainage. The postoperative data registered included complications, postoperative stay, recurrence and incontinence. Predictive factors for recurrence and incontinence were identified using univariate and multivariate analysis.ResultsOne hundred and ninety patients were included; 134 (70.5%) were men and the mean patient age was 50 years. The median length of follow‐up was 44.6 months. The fistula recurred in 14 patients (7.3%). Before surgery, 20 patients (10.5%) reported incontinence symptoms. In the continent patients a Wexner postoperative score of 0 was identified in 79.4%. Wexner scores between 1 and 3 were observed in 17% and scores of 4 or more in five patients (3%). Factors associated with recurrence included age < 50 years (OR = 4.8, P = 0.02, 95% CI 1.2–19), smoking (OR = 4.1, P = 0.03, 95% CI 1–16.5) and suprasphincteric fistula (OR = 0.5, P = 0.01, 95% CI 0.2–0.8) in multivariate log regression analysis. Major incontinence was influenced by female sex and previous anal surgery (OR = 7.5, P = 0.003, 95% CI 1.6–34 and OR = 0.1, P = 0.007, 95% CI 0.1–0.7, respectively).ConclusionFull‐thickness transanal advancement flap is a good treatment for complex anal fistula repair. This study provides relevant information on risk factors for failure of therapy and incontinence, which can help in advising patients before surgery and planning a good treatment strategy.
Minimally invasive organ‐preserving approaches in the management of mesh erosion after laparoscopic ventral mesh rectopexy
Authors: Ratnatunga K. , Singh S. , Bolckmans R. , Goodbrand S. , Gorissen K. , Jones O. , Lindsey I. , Cunningham C. 
Published: July 2020

AbstractAimThis is a systematic approach for minimally invasive methods in the management of mesh erosion after laparoscopic ventral mesh rectopexy.MethodsAll patients managed with organ‐preserving techniques for mesh erosion were identified from a prospective database and clinical records were reviewed. Each patient was contacted via telephone and a structured questionnaire was applied. A Likert score was used to assess patient symptoms and overall satisfaction with management. One or more of the following techniques were used: (i) transanal or transvaginal trimming/excision of exposed mesh and sutures, with or without using transanal endoscopic micro surgery or transanal minimally invasive surgery; (ii) laparoscopic pelvic assessment and detachment of mesh from the sacral promontory.ResultsEleven patients were managed for mesh erosion with organ‐preserving techniques. All were women with a median age of 60 years [interquartile range (IQR) 53.5–68.5]. Vaginal, rectal, perineal erosion and recto‐vaginal fistulation occurred in five, four, one and one patient respectively. Vaginal erosions presented at a median of 51 months (IQR 36–56) after index laparoscopic ventral mesh rectopexy compared to 17.5 months (IQR 14.5–27.25) for the rectal erosions. Median follow‐up time was 24 months (IQR 19–49). Four of the meshes (36%) were removed completely whereas seven (63%) were partially removed. Vaginal erosions required a median of two procedures to achieve resolution as opposed to five for rectal. Out of 11 patients, eight were satisfied with the outcome of their management, whereas two were not and one remained ambivalent.ConclusionAn organ‐sparing minimally invasive approach is feasible in managing mesh erosions but requires multiple procedures and months to complete.
Sonographic detection of physiological lower leg oedema in the late afternoon in healthy young women
Authors: Shibasaki Shohei , Kishino Tomonori , Yokoyama Tomomi , Sunahara Sakura , Harashima Keiichiro , Nakajima Satoshi , Ohnishi Hiroaki , Watanabe Takashi 
Published: July 2020

AbstractLower leg oedema occurs physiologically in the evening after daytime activity. Various oedema‐related sonographic findings have recently been reported, but this physiological oedema has not been evaluated quantitatively using imaging examinations. The present study investigated whether sonography could detect physiological lower leg oedema, comparing measured values between the morning and late afternoon. Diameters of leg veins were also measured as a possible source of leg oedema. Subjects comprised 55 healthy young women (mean age, 21 ± 1 years). Oedema‐related findings such as papillary dermis thickness, subcutaneous adipose tissue thickness and echogenicity (as estimated in grey‐scale using image analysis software) increased in the late afternoon when compared with those in the morning (1.4 [1.1–1.7] mm vs. 1.4 [1.1–1.8] mm, p < .01; 7.3 [6.0–8.1] mm vs. 7.3 [6.1–8.3] mm, p < .05; and 37.3 [31.5–39.4] vs. 39.8 [35.7–44.1], p < .01, respectively). Diameters of leg veins such as the great saphenous vein, small saphenous vein and dorsal vein of the foot were all reduced towards late afternoon (p < .01 each). Sonography quantitatively and precisely detected physical changes associated with physiological lower leg oedema after daytime activity in healthy young women.
National survey of physicians’ perspectives on pharmacogenetic testing in solid organ transplantation
Authors: Deininger Kimberly M. , Tsunoda Shirley M. , Hirsch Jan D. , Anderson Heather , Lee Yee Ming , McIlvennan Colleen K. , Page Robert L. , Tran Jacinda N. , Aquilante Christina L. 
Published: July 2020

AbstractIntroductionOur objective was to evaluate physicians' perspectives on the clinical utility of pharmacogenetic (PGx) testing in kidney, liver, heart, and lung transplantation (KLHL‐Tx).MethodsA 36‐question web‐based survey was developed and administered to medical and surgical directors of US KLHL‐Tx centers.ResultsThere were 82 respondents (10% response rate). The majority were men (78%), non‐Hispanic whites (70%), medical directors (72%), and kidney transplant physicians (35%). Although 78% of respondents reported having some PGx education, most reported lack of confidence in their PGx knowledge and ability to apply a PGx test. Participants reported mixed views about the clinical utility of PGx testing—most agreed with the efficacy of PGx testing, but not the benefits relative to the risks or standard of care. While 55% reported that testing was available at their institution, only 38% ordered a PGx test in the past year, most commonly thiopurine‐S‐methyltransferase. Physician‐reported barriers to PGx implementation included uncertainty about the clinical value of PGx testing and patient financial burden.ConclusionTogether, our findings suggest prospective PGx research and pilot implementation programs are needed to elucidate the clinical utility and value of PGx in KLHL‐Tx. These initiatives should include educational efforts to inform the use of PGx testing.
Incorporating patient and caregiver feedback into lung transplant referral guidelines for individuals with cystic fibrosis—Preliminary findings from a novel paradigm
Authors: Smith Patrick J. , Dunitz Jordan M. , Lucy Amy , Hempstead Sarah E. , Tallarico Erin , Faro Albert , Pilewski Joseph M. , Ramos Kathleen J. 
Published: July 2020

AbstractBackgroundLung transplantation is a common therapeutic option for individuals with cystic fibrosis (CF) and advanced lung disease, yet many individuals with CF are not appropriately referred for evaluation. The present study sought to enhance CF transplant referral guidelines by integrating patient‐centered input to identify possible psychosocial barriers contributing to suboptimal referral for appropriate CF transplant candidates.MethodsAs a component of developing the Cystic Fibrosis Foundation (CFF) Lung Transplant Referral Consensus Guidelines, we convened a focus group of lung transplant recipients with CF and two spouses of CF recipients. Each session involved standardized approaches to elicit qualitative, thematic content.ResultsCF patients and caregivers characterized five areas for improvement, which were integrated into formal CFF referral guidelines. These included (a) timing of transplant discussion with CF providers, (b) accuracy of transplant‐related knowledge and expectations, (c) stigma associated with the need for transplantation, (d) treatment team transition issues, and (e) social support and mental health concerns. Earlier introduction of transplant, greater details regarding manageable aspects of treatment, and greater provision of social support were all associated with better psychosocial experiences.ConclusionsIntegrating patient‐centered input into guideline development yielded important and previously unknown psychosocial barriers contributing to suboptimal transplant referral.
Impact of warm ischemia time on outcomes for kidneys donated after cardiac death Post‐KAS
Authors: Brennan Corey , Sandoval Pedro Rodrigo , Husain Syed Ali , King Kristen L. , Dube Geoffrey K. , Tsapepas Demetra , Mohan Sumit , Ratner Lloyd E. 
Published: July 2020

AbstractProlonged warm (WIT) and cold (CIT) ischemia times are often important considerations in the discard of DCD kidneys, but their impact on post‐transplant outcomes in the post‐KAS era is unclear. We examined the association of ischemia time on delayed graft function (DGF) and death‐censored graft failure for DCD kidneys. The 2018 SRTR SAF was utilized to identify post‐KAS DCD kidney transplants occurring from 2015 to 2018. Relative risk and Cox regression were used to calculate risk of delayed graft function and hazard of death‐censored graft failure, respectively. We identified 4,680 kidneys from DCD donors transplanted from 2015 to 2018 with recorded WIT and CIT times. Median WIT was 21.0 minutes (IQR 14.0‐28.0), and CIT was 18.5 hours (IQR 13.9‐23.5). The overall incidence of DGF was 42.7%. In a univariable relative risk regression model, extended CIT (24‐30 hours:RR 1.37, 95% CI 1.15‐1.77; >30 hours:RR 1.47, 95% CI 1.22‐1.77) and WIT (20‐40 minutes:RR 1.10, 95% CI 1.03‐1.17) were associated with increased risk of DGF. When included in a multivariable model, neither prolonged CIT nor WIT were significantly associated with death‐censored graft failure. Prolonged WIT and CIT are associated with increased DGF but not death‐censored graft failure in recipients of DCD kidney transplants in the post‐KAS era. Extended ischemia alone should not be used as a basis for discard or non‐utilization of these organs.
Conversion to belatacept maintenance immunosuppression in HIV‐positive kidney transplant recipients
Authors: Santeusanio Andrew , Bhansali Arjun , De Boccardo Graciela , Sehgal Vinita , Delaney Veronica , Florman Sander , Shapiro Ron 
Published: July 2020

AbstractThere are only scattered case reports documenting belatacept use in HIV + kidney transplant recipients. We performed a retrospective review to describe short‐term outcomes following conversion to belatacept in a cohort of HIV + patients. Patients were included if they were converted to belatacept between May 2015 and May 2019, had an HIV‐ donor, and received ≥4 doses of belatacept. All patients were treated with non‐depleting induction and triple maintenance immunosuppression. Allograft and HIV‐related outcomes were collected from the date of belatacept infusion until May 2020. Ten HIV + kidney transplant recipients were identified, who were converted to belatacept a median of 364 days post‐transplant. At last follow‐up (median 3.3 years), 8 patients remained on belatacept therapy, and all patients were alive with functioning allografts. Mean estimated glomerular filtration rates (eGFR) improved from 31.6 mL/min at baseline to 42.8 mL/min at 1 year (P = .03). Two patients developed acute rejection, with one necessitating conversion back to tacrolimus. All patients maintained undetectable HIV‐1 viral loads at last follow‐up. One patient each developed pneumocystis pneumonia and Kaposi sarcoma following conversion, which were responsive to standard medical therapy. In our cohort of stable HIV + kidney transplant recipients, conversion to belatacept was associated with excellent early patient and allograft survival and improved eGFR at 1 year.
Heart transplantation in the early phase of the COVID‐19 pandemic: A single‐center case series
Authors: Hsu Jeffrey J. , Al‐Saffar Farah , Ardehali Reza , Baas Arnold S. , Carlson Margrit , Cruz Daniel , Deng Mario , Fan Ashley , Fraschilla Stephanie , Gaynor Pryce , Kamath Megan , Kubak Bernard M. , Schaenman Joanna , Stimpson Emily , Vucicevic Darko , Ardehali Abbas , Nsair Ali 
Published: July 2020

AbstractThe infectious disease coronavirus disease 2019 (COVID‐19) was declared a pandemic by the World Health Organization in March 2020. The impact of COVID‐19 on solid organ transplantations, including heart transplantation, is currently unclear. Many transplant programs have been forced to swiftly re‐evaluate and adapt their practices, leading to a marked decrease in transplants performed. This trend has been due to various factors, including increased donor COVID‐19 screening scrutiny and recipient waiting list management in anticipation of COVID‐19 critical care surge capacity planning. In the face of these unknown variables, determining when and how to proceed with transplantation in our population of patients with end‐stage cardiomyopathies is challenging. Here, we describe our center's experience with orthotopic heart transplantation (OHT) in one of the country's pandemic epicenters, where we performed eight OHTs in the first 2 months after community spread began in late February 2020.
Donor‐recipient age interaction and the impact on clinical results after heart transplantation
Authors: Lechiancole Andrea , Vendramin Igor , Sponga Sandro , Guzzi Giorgio , Ferrara Veronica , Nalli Chiara , Di Nora Concetta , Bortolotti Uberto , Livi Ugolino 
Published: July 2020

AbstractTo evaluate the impact of donor‐recipient age matching on clinical outcomes after heart transplantation, a total of 509 patients (January 1990‐December 2018, mean follow‐up 111 ± 80 months) were stratified into 4 groups (young‐R/young‐D, young‐R/old‐D, old‐R/young‐D, old‐R/old‐D) according to the recipient (young‐R < 60, old‐R ≥ 60 years) and the donor (young‐D < 50, old‐D ≥ 50 years) age. No difference was found among 30‐day mortality (P = .11) and postoperative complications between groups. Both unadjusted and adjusted survival was significantly higher for group young‐R/young‐D than that of other groups, in which survival was similar [adjusted HR for mortality of 2.0(1.2‐3.4), 2.1(1.4‐3.8) and 2.5(1.6‐4.1) for groups old‐R/young‐D, young‐R/old‐D, old‐R/old‐D, respectively]. Compared to other groups, the incidence of grade ≥ 2 CAV was significantly lower in old‐R/young‐D group [adjusted HR 0.4(0.2‐0.7)]. Among young recipients, the rate of acute grade ≥ 2 rejection episodes was higher in those receiving an old donor graft (P = .04). Old recipient groups were more affected by neoplasms and severe renal failure than young recipient groups (P < .01). Employment of hearts from donors ≥50 years of age adversely affects survival in recipients <60 years of age but does not influence outcomes in older recipients. Also, donor and recipient ages seem to have opposite effects on incidence of rejections and CAV of high grade.
Targeting the NLRP3 inflammasome to reduce warm ischemic injury in donation after circulatory death heart
Authors: Quader Mohammed , Mezzaroma Eleonora , Kenning Kristine , Toldo Stefano 
Published: July 2020

AbstractWhile the donation after circulatory death (DCD) heart transplantation is an emerging clinical practice, the primary source of donor hearts for transplantation remains donation after brain death (DBD) donors. DCD process induces formation of NOD‐like receptor family pyrin domain containing‐3 (NLRP3) inflammasome, a key mediator of inflammation‐driven damage to heart. Inhibition of NLRP3 inflammasome formation could be protective to DCD hearts. Five groups (n = 8 each) of mice were studied—control beating heart donor (CBD) wild‐type (WT), DCD WT, CBD NLRP3 knockout (KO), DCD NLRP3 KO, and DCD WT NLRP3 inhibitor group. Hearts were procured and reanimated on a Langendorff system to assess physiologic parameters and then for molecular assays. NLRP3 inhibitor (50 µmol/L) was administered to the DCD‐NLRP3 inhibitor group at reanimation. Tissue NLRP3 levels were 80% higher in the DCD WT group compared with the CBD‐WT group. Caspase‐1 activity was significantly elevated in DCD WT but not in KO or NLRP3 inhibitor groups. The developed pressures and ±dP/dt were significantly impaired in the DCD WT group compared with the CBD‐WT group, P < .05, but were well preserved in DCD‐NLRP3 inhibitor group. The DCD process activates the NLRP3 inflammasome, contributing to myocardial damage and dysfunction. NLRP3 inflammasome inhibition limits myocardial injury and preserves DCD heart function.
Basal cell carcinoma with perineural invasion: A prospective study examining subtype, tumor surface diameter, invasion depth, and anatomic site in 3005 consecutive cases
Authors: Pyne John H. , Myint Esther , Hou Ruihang , Clark Simon P. , Wong Cheri , Gorji Madhieh 
Published: July 2020

AbstractBackgroundBasal cell carcinoma (BCC) may present with or without perineural invasion (PNI). We reviewed BCC for PNI by subtype, microscopic tumor surface diameter, invasion depth, and anatomic site.MethodConsecutive excisions were prospectively collected in an Australian center 2016‐2018.ResultsTotal cases were 3005 including 40 with PNI: 28 in males, 12 in females. Superficial and nodular subtypes had no PNI. As the percentage tumor mass of infiltrative BCC increased beyond 90% the presence of PNI substantially escalated (OR7.0). Comparing PNI absent or present the respective maximum mean tumor microscopic surface diameters ranged from (95%CI [9.6‐10.0] P < .001) to 11.2 mm (95%CI [9.4‐13.0] P = .59). Respective maximum mean invasion depths were from 1.0 mm (95%CI [0.98‐1.05] P < .001) to 2.3 mm (95%CI [1.8‐2.7] P < .001). Respective maximum mean invasion depths were from 1.0 mm (95%CI [0.98‐1.05] P < .001) to 2.3 mm (95%CI [1.8‐2.7] P < .001) to 2.3 mm (95%CI[1.8‐2.7] P < .001). Males recorded most PNI on the scalp, followed by cheek and chin. Patients with more than two BCC cases had a greater proportional PNI risk (OR3.7). Mean PNI nerve diameters were 0.06 mm2 (males) and 0.03 mm2 (females).ConclusionIncreases in percentage infiltrative subtype within the tumor mass, microscopic tumor diameter, tumor invasion depth, and BCC cases per patient all recorded more PNI. Minimum invasion depths with PNI were 1.0 mm on males (nose) and 1.0 mm females (forehead).
Relevance of rosette patterns in variants of papillary thyroid carcinoma
Authors: Dell'Aquila Marco , Musarra Teresa , Fiorentino Vincenzo , Brunelli Chiara , De Marco Costanza , Raffaelli Marco , Traini Emanuela , Pio Lombardi Celestino , Fadda Guido , Larocca Luigi Maria , Pantanowitz Liron , Rossi Esther Diana 
Published: July 2020

AbstractIntroductionThe detection of rosette‐like clusters (RLC) of follicular cells in thyroid carcinoma has been reported mostly in the columnar cell variant of papillary thyroid carcinoma (PTC). Despite the fact that diagnosing variants of PTC is no longer encouraged by The Bethesda System for Reporting Thyroid Cytopathology, the identification of cytomorphological features such as RLC linked with these tumours might help reduce possible misinterpretation in thyroid fine needle aspiration (FNA) cytology. We accordingly investigated the potential correlation of architectural patterns including RLC with PTC variants.MethodsWe analysed 225 thyroid FNA cytology cases diagnosed as suspicious for malignancy (SFM) and positive for malignancy (M) over a 1‐year time where all samples had corresponding histology. We also included 150 benign lesions from the same period. The presence of RLC vs similar appearing solid clusters, papillary structures and microfollicles were evaluated. We also performed immunocytochemistry and molecular testing for BRAFV600E.ResultsWe included 100 (44.4%) SFM favouring PTC and 125 (55.6%) M cases with cyto‐histological correlation. On histology, all SFM and M cases showed malignancy including 140 (62.2%) classic PTC and 85 (37.8%) PTC variants. The cytomorphological patterns in all FNA samples included solid (74%), papillary (89%), microfollicular (70%), and pseudo‐RLC morphology (25.7%). We identified only pseudo‐RLC in 33 FNA specimens from PTC variant cases that included tall cell variant (42.4%), hobnail variant (21.2%) and miscellaneous variants (36.3%) of PTC. No definitive RLC were detected in our series. Immunocytochemistry and BRAFV600E were not specifically linked with an RLC pattern.ConclusionsThese findings demonstrate that in our dataset the architectural pattern of RLC was not recognised within PTC variants. However, we did identify a pseudo‐RLC pattern that was observed in association with tall cell variant and hobnail variant cases of PTC.
The link between per capita alcohol consumption and alcohol‐related harm in educational groups
Authors: Norström Thor , Landberg Jonas 
Published: July 2020

AbstractIntroduction and AimsResearch based on individual‐level data suggests that the same amount of alcohol yields more harm in low‐socioeconomic status (SES) groups than in high‐SES groups. Little is known whether the effect of changes in population‐level alcohol consumption on harm rates differs by SES‐groups. The aim of this study was to elucidate this issue by estimating the association between per capita alcohol consumption and SES‐specific rates of alcohol‐related mortality.Design and MethodsPer capita alcohol consumption was proxied by Systembolaget's alcohol sales (litres 100% alcohol per capita 15+). Quarterly data on mortality and alcohol consumption spanned the period 1991Q1‐2017Q4. We used two outcomes: (i) alcohol‐specific mortality (deaths with an explicit alcohol diagnosis); and (ii) violent deaths. SES was measured by education. We used three educational groups: (i) low (<10 years); (ii): intermediate (10–12 years); and (iii) high (13+ years). We applied error correction modelling to estimate the association between alcohol and alcohol‐specific mortality, and seasonal autoregressive integrated moving average‐modelling to estimate the association between alcohol and violent deaths.ResultsThe estimated associations between per capita consumption and the two outcomes were positive and statistically significant in the two groups with low and intermediate education, but not in the high education group. There was a significant gradient in the level of association between alcohol consumption and alcohol‐related harm by educational group; the association was stronger the lower the educational group.Discussion and ConclusionsOur findings suggest that the association between per capita consumption and alcohol‐related harm was stronger the lower the educational group.