bluuebunny/crossref_metadata_2025_split huggingface dataset:
Overview of a novel paediatric surgical simulation‐based medical education programme in Myanmar
Authors: Nataraja Ramesh M. , Oo Yin Mar , Ljuhar Damir , Webb Nathalie R. , Pacilli Maurizio , Win Nyo Nyo , Aye Aye 
Published: August 2020

AbstractBackgroundSimulation‐based medical education (SBME) is an integral part of undergraduate and postgraduate training in high‐income countries (HICs). Despite potential benefits to low‐ and middle‐income countries (LMICs), it has not been widely applied. Our aim was to use SBME to address some essential paediatric surgery learning needs in a LMIC.MethodsEleven SBME courses were designed, implemented and evaluated over a 4‐year period in partnership with local paediatric surgeons and the University of Medicine 1 in Yangon, Myanmar. All courses were simulation‐based and different major SBME modalities were utilized. Evaluation included pre‐ and post‐course questionnaires, other evaluation assessments including Likert scale self‐rated confidence in different domains, as well as, mixed method evaluation and Kirkpatrick's hierarchy of evaluation.ResultsOver 4 years, a multidisciplinary team consisting of surgical consultants, fellows, and educational specialists delivered 11 courses at a tertiary LMIC paediatric surgical centre. Attendance varied between 23 and 50 healthcare professionals, with some participants attending all of the educational activities. SBME modalities were utilized to meet each courses' learning objectives. All educational courses scored highly and showed statistically significant differences in all the self‐rated pre and post‐course confidence Likert scale domains. SBME was accepted and embraced by local participants and faculty, and transition to local delivery of educational content has begun. Level 4 of Kirkpatrick's hierarchy of evaluation was demonstrated.ConclusionSBME can be used to meet essential learning objectives of local staff in a LMIC. Through various modalities, it offers a reliable, proven and affordable means of teaching multiple aspects of paediatric surgical clinical practice. By employing innovative simulation‐based solutions, it can be adapted by local faculty to continue meeting ongoing learning needs.
Risk factors and management of primary choledocholithiasis: a systematic review
Authors: Zhang Jie , Ling Xiaofeng 
Published: August 2020

AbstractBackgroundPrimary choledocholithiasis (PC) is a common disease in biliary surgery. The treatment is always challenging due to its high recurrence. A systemic review is undertaken to determine the risk factors for recurrence and provide with the individualized management strategy.MethodsElectronic databases PubMed (Medline), Embase and Cochrane Central Register of Controlled Studies were searched for relevant articles on risk factors for PC recurrence. Its therapeutic intervention was also collected and analysed.ResultsA total of 36 articles were eligible for inclusion. The recurrent risk factors include abnormalities of biliary anatomy (peripapillary diverticulum), dynamics (choledochal dilation, sharp angulation and stone number), metabolism (advanced age and hypothyroidism) and bacterial infection (Enterobacter and Helicobacter pylori). These factors eventually induce cholestasis and stone formation. At present, there is no guideline and expertise consensus for PC management. The treatment mainly consists of stone retrieval approaches and internal drainage surgeries. The former are minimally invasive methods: endoscopic sphincterotomy (EST), papillary balloon dilation (EPBD) and laparoscopic common bile duct exploration (LCBDE). The latter include choledochoduodenostomy (CDS) and choledochojejunostomy (CJS) with Roux‐en‐Y reconstruction. By far, the internal drainage surgeries have significantly lower recurrence than stone retrieval approaches.ConclusionAbnormal biliary anatomy, dynamics, metabolism and bacterial infection are the risk factors for PC. Both EST/EPBD and LCBDE can be performed as initial treatment. For recurrent PC, CDS is more suitable to the elderly, while Roux‐en‐Y CJS reserves for young patients or those in good conditions.
Local excision versus radical resection in patients with rectal neuroendocrine tumours: a propensity score match analysis
Authors: Zhao Beiqun , Hollandsworth Hannah M. , Lopez Nicole E. , Parry Lisa A. , Abbadessa Benjamin , Cosman Bard C. , Ramamoorthy Sonia L. , Eisenstein Samuel 
Published: August 2020

AbstractBackgroundThe rectum is a common site for neuroendocrine tumours of the gastrointestinal tract. Diagnosis of these tumours has been increasing in recent years, highlighting the need to better define treatment options for patients with rectal neuroendocrine tumours (rNETs).MethodsWe performed a retrospective analysis using the National Cancer Database (2004–2014) to compare overall survival (OS) between local excision (LE) and radical resection (RR). To minimize bias, we performed three propensity score‐matched comparisons stratified by tumour size: <10 mm, 10–20 mm, >20 mm. We compared OS by Kaplan–Meier analysis. We also examined margin status and postoperative outcomes for each comparison.ResultsA total of 12 996 patients underwent surgical treatment for rNET. There was no significant difference in probability of 10‐year OS between LE and RR for patients with tumours <10 mm (88.6% versus 83.8%, P = 0.631, respectively) and tumours 10‐20 mm (69.5% versus 69.3%, P = 0.226, respectively). In patients with tumours >20 mm, probability of 10‐year OS was significantly longer in the LE group (76.5% versus 37.0%, P < 0.001). For all tumour sizes <10 mm and >20 mm, RR had significantly higher rates of 30‐day readmission and negative margins. In subset analysis, there was no difference in OS for patients with positive margins after LE versus negative margins after RR for all tumour size groups.ConclusionsOur findings suggest that LE is a reasonable treatment option in patients with rNETs, especially for patients with high perioperative risk. Limitations to this study include its retrospective nature and inability to analyse surgeon decision‐making.
Laparoscopic total mesorectal excision combined with en‐bloc seminal vesicle and prostate resection for rectal cancer after chemoradiotherapy
Authors: Zhang Xubing , Deng Xiangbing , Li Jin , Ding Yanling , Liu Sheng , Wang Ziqiang 
Published: August 2020

AbstractBackgroundThis study aimed to explore the surgical outcomes of laparoscopic total mesorectal excision (TME) combined with en‐bloc seminal vesicle resection (SVR) and partial prostate resection (PPR) for locally advanced rectal cancer (LARC) after chemoradiotherapy (CRT).MethodsPatients receiving TME combined with en‐bloc SVR and PPR for LARC after CRT from 2014 to 2019 were enrolled retrospectively. Patients' characteristics and surgical outcomes were collected and analysed.ResultsA total of six male patients were enrolled in this study. Among them, four patients proved to be T4b stage including three Denonvilliers fascia invasion and one seminal vesicle invasion. R0 resection was achieved in all patients. With a median follow‐up time of 24 months, no local recurrence was observed.ConclusionIt is safe and feasible to perform laparoscopic TME combined with en‐bloc SVR and PPR in selected LARC patients after neoadjuvant CRT. It can provide a safe circumferential resection margin and R0 resection. More studies are warranted to improve the diagnostic accuracy for T4b stage after CRT and avoid unnecessary extended resection.
Diagnostic approaches for pancreatic cystic lesions
Authors: Kanani Trisha , Isherwood John , Chung Wen Yuan , Dennison Ashley 
Published: August 2020

AbstractBackgroundCystic lesions of the pancreas (PCLs) may be inflammatory or proliferative and making an accurate and timely pre‐operative diagnosis remains a significant clinical challenge. This is principally due to the heterogeneity of the pathological processes involved. PCLs constitute an entity with diverse histology and although infrequent, the possible potential for malignant transformation of these lesions and the opportunity for curative surgery mandates that our diagnostic approaches are up to date and evidence based. In addition, improved diagnostic accuracy is crucial to prevent unnecessary surgical procedures with the inevitable associated morbidity.MethodsThis narrative review examines the current diagnostic benchmarks and identifies novel diagnostic techniques that warrant further consideration, a number of which are beginning to be included in routine clinical practice when these PCLs are being investigated. A computerized search was made of MEDLINE, EMBASE and PubMed using the search words ‘diagnostic approaches to pancreatic cystic lesions’. All relevant articles in English language or with an English abstract were retrieved and additionally cross referenced.ConclusionThe increasing accuracy of available imaging techniques together with the wider availability of endoluminal ultrasound and the development of additional novel methods to assess PCLs presents an opportunity to significantly improve the pre‐operative diagnosis rate. This is essential to classify the type of PCL and hence guide the management particularly with lesions where there is a likelihood of progression to more serious pathology. We have highlighted the need for a comprehensive and standardized algorithm for the diagnosis and management of PCLs.
The handicap for enhanced solidarity across advanced economies: The greater the economic openness higher the unequal distribution of income
Authors: Özdemir Onur 
Published: August 2020

AbstractPerspectives on degree of economic openness have been discussed by different paradigms resulting in concluding remarks which differ widely from each other. However, the existing literature has passed over the importance of the relationship between economic openness and income distribution in relation to the bargaining framework and thus its effect on social solidarity. In this paper, the rationale is based on the argument that an increase in the degree of economic openness has a significant impact on the distribution of income through the channels of trade and financial account. The empirical results show that a more open economic environment leads to an unequal distribution of income, both reducing labor's share and increasing income inequality, through the collapse of bargaining power of labor in favor of capital across advanced economies over the 1996–2014 period. However, the results also suggest that the trade channel is a more effective influence on income distribution than the finance channel. Additionally, other globalization measures, including economic, social and political factors, also have negative effects on income distribution by way of reducing the bargaining power of labor, which results in the collapse of social solidarity and cohesion over time.
Quality and use of unlicensed vitamin D preparations in primary care in England: Retrospective review of national prescription data and laboratory analysis
Authors: Wan Mandy , Patel Anish , Patel Jignesh P. , Rait Greta , Jones Stuart A. , Shroff Rukshana 
Published: August 2020

AimTo evaluate the type (licensed vs unlicensed) and cost of preparations used to fulfil vitamin D prescriptions in England over time, and to compare measured vitamin D content of selected vitamin D preparations against labelled claim.MethodsRetrospective analysis of vitamin D prescription data in primary care in England (2008‐2018). Laboratory analysis of 13 selected vitamin D preparations.ResultsAlongside a rise in the number of oral licensed colecalciferol preparations from 0 to 27 between 2012 and 2018, the proportion of vitamin D prescriptions in which licensed vitamin D preparations were supplied increased from 11.8 to 54.2%. However, the use of unlicensed food supplements (dose strength 400‐50 000 IU) remained high, accounting for 39.7% of vitamin D prescriptions in 2018. The two licensed preparations showed mean (±SD) vitamin D content of 90.9 ± 0.7% and 90.5 ± 3.9% of the labelled claimed amount, meeting the British Pharmacopeia specification for licensed medicines (90‐125% of labelled claim). The 11 food supplements showed vitamin D content ranging from 41.2 ± 10.6% to 165.3 ± 17.8% of the labelled claim, with eight of the preparations failing to comply with the food supplement specification (80‐150% of labelled claim).ConclusionsDespite the increasing availability of quality assured licensed preparations, food supplements continued to be used interchangeably with licensed preparations to fulfil vitamin D prescriptions. Food supplements, manufactured under less stringent quality standards, showed wide variations between measured and declared vitamin D content, which could lead to the risk of under‐ and over‐dosing.
Evaluation of designs for renal drug studies based on the European Medicines Agency and Food and Drug Administration guidelines for drugs that are predominantly secreted
Authors: Pradhan Sudeep , Wright Daniel F.B. , Duffull Stephen B. 
Published: August 2020

AimsDose adjustment for drugs eliminated by the kidneys generally assume a linear relationship between renal drug clearance (CLR) and glomerular filtration rate (GFR). This assumption may not hold for drugs that undergo extensive tubular secretion where nonlinearity in drug handling is expected. The aim of this study is to determine if renal drug study designs recommended by the European Medicines Agency (EMA) and Food and Drug Administration (FDA) could distinguish linear from nonlinear renal drug handling.MethodsIn this simulation and estimation study, the study designs based on the EMA and FDA guidelines for Phase I renal drug studies were evaluated for their ability to discriminate a linear from a nonlinear relationship between CLR and GFR. The number of subjects for each simulated study ranged from 4 to 960. Power, relative standard error and bias were calculated.ResultsStudy designs under the EMA and FDA guidelines required ≥8 and ≥48 subjects, respectively, to achieve ≥80% power to discriminate a linear from nonlinear relationship between CLR and GFR. The relative standard error of estimated parameters were 13–37 and 17–44% for the designs with 24 subjects under the EMA and FDA guidelines, respectively. The bias in parameter estimates under the EMA designs were not evident, however, they were biased (13–21%) under the FDA designs.ConclusionThe EMA design was found to require fewer subjects (n = 8) compared to the FDA (n = 48) to discriminate linear from nonlinear drug renal handling at ≥80% study power while both the designs perform poorly for the parameter precision.
TERT promoter mutations in primary and secondary WHO grade III meningioma
Authors: Maier Andrea Daniela , Stenman Adam , Svahn Fredrika , Mirian Christian , Bartek Jiri , Juhler Marianne , Zedenius Jan , Broholm Helle , Mathiesen Tiit 
Published: August 2020

AbstractPurpose: TERT promoter mutation (TERTpMut) has a strong association to recurrence and has been suggested to act as a driver mutation for malignant transformation of WHO grade I and II meningiomas. TERTpMut has been investigated in selected high‐grade meningioma samples. The existence of TERTpMut across recurrent tumors in a population‐based cohort needs to be investigated in order to identify when TERTpMut emerges across recurrent samples and to validate prognostic impact among WHO grade III tumors. Methods: We gathered material from a consecutive single‐center cohort of 40 patients with malignant meningioma (WHO grade III) treated between 2000 and 2018, including specimens from primary and secondary malignant meningiomas with the corresponding earlier benign specimens and later malignant recurrences. In total 107 tumor samples were studied by Sanger sequencing for TERT promoter mutational status. Results: Seven of 40 patients (17.5%) harbored TERTpMut thus validating the incidence of TERTpMut in previous non‐population‐based cohorts. In 6/7 patients, the TERTpMut was present at initial surgery (WHO grade I–III) while in one patient the TERTpMut was found de novo when the meningioma became malignant. The incidences were 2/1.000.000/year for TERTpMut WHO grade III meningioma and 8/1.000.000/year for TERTpwt WHO grade III meningioma in our catchment area. We found a 1.7 times higher recurrence rate (CI 95% 0.65–4.44) and a 2.5 higher mortality rate per 10 person‐years (CI 95% 1.01–6.19) for TERTpMut compared to TERTpwt. Conclusion: TERTpMut can occur independently of malignant progression in meningioma and was most often present from the first tumor sample across recurring tumors. TERTpMut in WHO grade III may represent a marker of an aggressive subset of tumors.
Spectroscopic study of in situ‐formed metallocomplexes of proton pump inhibitors in water
Authors: Abramenko Nikita , Kejík Zdeněk , Kaplánek Robert , Tatar Ameneh , Brogyányi Tereza , Pajková Martina , Sýkora David , Veselá Kateřina , Antonyová Veronika , Dytrych Petr , Ikeda‐Saito Masao , Martásek Pavel , Jakubek Milan 
Published: August 2020

AbstractProton pump inhibitors, such as omeprazole, pantoprazole and lansoprazole, are an important group of clinically used drugs. Generally, they are considered safe without direct toxicity. Nevertheless, their long‐term use can be associated with a higher risk of some serious pathological states (e.g. amnesia and oncological and neurodegenerative states). It is well known that dysregulation of the metabolism of transition metals (especially iron ions) plays a significant role in these pathological states and that the above drugs can form complexes with metal ions. However, to the best of our knowledge, this phenomenon has not yet been described in water systems. Therefore, we studied the interaction between these drugs and transition metal ions in the surrounding water environment (water/DMSO, 99:1, v/v) by absorption spectroscopy. In the presence of Fe(III), a strong redshift was observed, and more importantly, the affinities of the drugs (represented as binding constants) were strong enough, especially in the case of omeprazole, so that the formation of a metallocomplex cannot be excluded during the explanation of their side effects.
Factors determining COVID-19 pneumonia severity in a country with routine BCG vaccination
Authors: Aksu K , Naziroğlu T , Özkan P 
Published: August 2020

Summary

Background
The impact of countries’ bacillus Calmette–Guérin (BCG) vaccination policies on the course of coronavirus disease (COVID-19) outbreak is a curiosity. In this study, the relationship between BCG vaccination status and severity of COVID-19 pneumonia and the factors affecting disease severity were investigated.

Methods
A retrospective cross-sectional study was conducted between March and June 2020 in patients diagnosed with COVID-19 pneumonia, confirmed by severe acute respiratory syndrome coronavirus-2 polymerase chain reaction positivity in a nasopharyngeal sample and pulmonary infiltrates in computed chest tomography, in a state hospital in Istanbul, Turkey. Socio-demographic features, body mass index, smoking status, concomitant diseases, income rates and BCG vaccination status of subjects were analyzed.

Result
The study population comprised 123 adults with COVID-19 pneumonia [mean age = 49·7 years, standard deviation = 13·3 years; 82 (66·7%) male]. While the rate of cases vaccinated with BCG is lower (68·5 versus 88·2%, P = 0·026), mean age (54·0 ± 11·5 years versus 38·3 ± 10·7 years; P &lt; 0·001), diabetes (32·6 versus 5·9%, P = 0·002) and low income (84·3 versus 52·9%, P &lt; 0·001) are higher in patients with severe disease compared to those with mild disease. According to multivariate analysis increasing age [odds ratio (OR) = 1·119; 95% confidence interval (CI) = 1·062–1·178, P &lt; 0·001] and low income (OR = 3·209; 95% CI = 1·008–10·222, P = 0·049) are associated with severe disease in COVID-19 pneumonia.

Conclusion
This study reveals that BCG vaccination is not associated with disease severity in COVID-19 pneumonia. Age and low income are the main determinants of severe COVID-19 pneumonia.
Significance of aldosterone gradient within left adrenal vein in diagnosing unilateral subtype of primary aldosteronism
Authors: Ogata Masatoshi , Umakoshi Hironobu , Fukumoto Tazuru , Matsuda Yayoi , Yokomoto‐Umakoshi Maki , Nagata Hiromi , Wada Norio , Miyazawa Takashi , Sakamoto Ryuichi , Ogawa Yoshihiro ,   the Q‐AND‐A Study Group
Published: August 2020

AbstractContextThe success rate of cannulation of the right adrenal vein is limited. The aldosterone gradient within the same adrenal vein branch is specific for aldosterone‐producing adenoma.ObjectiveThis study was performed to investigate whether the absolute aldosterone gradient within the left adrenal vein (left‐AV absolute aldosterone gradient) indicates unilateral excess aldosterone.Design and settingA retrospective cross‐sectional study in a single referral centre.Patients and methodsIn total, 123 consecutive patients with primary aldosteronism who had successful adrenal vein sampling (AVS) data were examined. The left‐AV absolute aldosterone gradient was considered significant when a gradient of >4:1 in the aldosterone‐to‐cortisol ratio between the common trunk vein and central vein was found.Main outcome measureThe prevalence of the unilateral subtype in patients with a significant left‐AV absolute aldosterone gradient.ResultsThe prevalence of the unilateral subtype was higher in patients with than without a significant left‐AV absolute aldosterone gradient (88.2% [15/17] vs 21.7% [23/106], P < .001). Of 60 patients with spontaneous hypokalemia, left unilateral disease on computed tomography, or both, a significant left‐AV absolute aldosterone gradient was present only in patients with the unilateral subtype on AVS (42.9% [15/35]), but not in those with the bilateral subtype (0.0% [0/25]). These data were validated in an external cohort.ConclusionThe presence of a significant left‐AV absolute aldosterone gradient can be used to diagnose the left unilateral subtype of primary aldosteronism on AVS in patients with spontaneous hypokalemia, left unilateral disease on computed tomography or both.
Systematic review on the management of ileoanal pouch–vaginal fistulas after restorative proctocolectomy in the treatment of ulcerative colitis
Authors: Machin M. , Younan H.‐C. , Slesser A. A. P. , Mohsen Y. 
Published: August 2020

AbstractAimIleoanal pouch–vaginal fistula (PVF) is a relatively common complication of restorative proctocolectomy with ileal pouch–anal anastomosis. There are several operative approaches in the management of PVF. There is currently no consensus as to which approach is the most effective or which should be attempted first.MethodA systematic review was undertaken following a publicly available protocol registered with PROSPERO (CRD42019133750) in accordance with PRISMA guidelines. Online searches of databases MEDLINE and Embase, Cochrane Library, ClinicalTrials.gov, EU Clinical Trials and ISRCTN registry were performed.ResultsTwenty‐seven articles met the criteria for inclusion in the study: 13 retrospective cohort studies, two prospective cohort studies, eight case series, three case reports and a case–control study. A narrative synthesis was performed due to heterogeneity between included articles. Our study included 577 PVFs, and the incidence rate was 2.1%–17.1%. Both local and abdominal approaches were used in the management of PVF. The overall success of local and abdominal procedures was 44.9% and 60.2% respectively. ROBINS‐I assessment revealed a critical risk of bias. GRADE assessment indicated a very low certainty in effect size and evidence quality.ConclusionLocal interventions and abdominal approaches have a high failure rate. The results of this review will aid the counselling of patients with this condition. Furthermore, we provide an algorithm for discussion on the management of PVF based on experience at our local centre. The studies available on the management of PVF are low quality; a large prospective registry and Delphi consensus are required to further this area of research.