bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-Reported Unmet Needs in Colorectal Cancer Survivors After Treatment for Curative Intent
Authors: Vu Joceline Vuong-Thu , Matusko Niki , Hendren Samantha , Regenbogen Scott E. , Hardiman Karin M. 
Published: January 2019

BACKGROUND:
With improving survival from colorectal cancer, there is a growing population of patients undergoing surveillance. National accreditation organizations have increasingly endorsed formal survivorship care planning. To effectively design patient-centered survivorship programs, an understanding of the prevalence of unmet psychosocial and symptomatic needs is required.

OBJECTIVE:
The aim of this study is to understand the breadth of unmet needs among survivors of colorectal cancer.

DESIGN:
This is a cross-sectional survey of patients undergoing surveillance after curative-intent therapy for colorectal cancer.

SETTING:
This study was conducted June 2017 to January 2018 at an academic cancer center.

PATIENTS:
There were 99 patients (58 with colon cancer, 41 with rectal cancer).

MAIN OUTCOME MEASURES:
We measured patient-reported unmet needs by using a modification of the Cancer Survivor Unmet Needs instrument, within domains of emotional (stress, concerns about recurrence), relationship (fertility, interpersonal), logistical (need for accessible parking, case management), financial, treatment-related (neuropathy, bowel function), and surveillance-related needs.

RESULTS:
The mean (±SD) age was 58 (±12), and the time from diagnosis was 34 (±18) months. Overall, 74% of patients reported at least one unmet need, 49% reported emotional needs, 24% relationship needs, 24% financial needs, 25% logistical needs, and 33% surveillance needs. Thirty-six (62%) patients with colon cancer and 37 (90%) patients with rectal cancer reported at least one ongoing problem (p = 0.002). Thirty-five (82%) patients with rectal cancer reported an unmet treatment-related need in comparison with 23 (40%) patients with colon cancer (p < 0.001). The median (interquartile range) number of ongoing needs were 1 (0–5) in patients with colon cancer and 4 (2–8) in patients with rectal cancer (p = 0.007).

LIMITATIONS:
This study was limited by its small sample size and lack of generalizability, given the tertiary care setting.

CONCLUSIONS:
The majority of colorectal cancer survivors reported unmet needs years after completion of curative-intent therapy. Patients with rectal cancer were significantly more likely to have unmet needs and may benefit from additional care during survivorship. Colorectal cancer survivorship programs should incorporate psychosocial and symptomatic care in addition to cancer surveillance. See Video Abstract at http://links.lww.com/DCR/A885.
Rethinking the techno vagina: a case series of patient complications following vaginal laser treatment for atrophy
Authors: Gordon Catherine , Gonzales Savanah , Krychman Michael L. 
Published: January 2019

Abstract

Objective:
The treatment of genitourinary syndrome of menopause (GSM) includes prescription hormone therapy, nonhormonal over-the-counter products, and most recently, laser treatment. Although the Food and Drug Administration has cleared fractional carbon dioxide (CO2) laser for a variety of dermatologic and gynecologic indications, lasers have not to date, been approved for use for vulvar/vaginal atrophy, or sexual dysfunction.

Methods:
Four case studies that were referred to a tertiary sexual medicine center regarding laser treatment complications for GSM are reported. Patient data were Health Insurance Portability and Accountability Act of 1996 protected and informed consent was obtained by all patients.

Results:
Four cases are presented, which demonstrate complications after completion of three consecutive laser treatments for GSM. Case 1 is a 65-year-old woman with GSM and moderate vaginal stenosis who had two vaginal wall lacerations after resumption of intercourse. Case 2 is a 61-year-old woman who had persistent dyspareunia following vaginal laser treatments. Case 3 is a 68-year-old woman who reported worsening dyspareunia and had a fibrous band mid vagina that impinged on the canal. Case 4 is a 55-year-old woman who complained of dyspareunia and insertional pain, after her laser. Assessment and follow-up treatment are presented.

Conclusions:
Laser therapy for the vagina shows excellent promise for the treatment of GSM in some women; however, complications such as fibrosis, scarring, agglutination, and penetration injury have been documented. Food and Drug Administration–approved products for GSM should be considered frontline treatments until long-term, prospective, randomized, sham-controlled trials are conducted that confirm efficacy and safety for device treatments.
Plasticity of Unmyelinated Fibers in a Side-to-end Tubulization Model
Authors: Tognon-Miguel Vânia , Nascimento-Elias Adriana H. , Schiavoni Maria C. L. , Barreira Amilton A. 
Published: January 2019

Background:
Histomorphometric studies of unmyelinated fibers of the rat fibular nerves are uncommon, and side-to-end neurorrhaphy studies using the fibular nerve investigate primarily motor fibers. We investigated side-to-end tubulization (SET) technique, in which occurs collateral sprouting from the intact donor nerve fibers to the distal stump of receptor nerve, with muscle reinnervation and functional rehabilitation, to assess whether there is a successful growth of unmyelinated fibers in this model.

Methods:
Adult Wistar rats fibular nerves were sectioned to create a 5-mm gap. A 6-mm silicone tube was attached between a side of the intact tibial nerve and the sectioned fibular nerve distal stump (SET group), with the left fibular nerve as normal (sham group). Seventy days postsurgery, unmyelinated fibers from the distal segment of the fibular nerve were quantified using light and transmission electron microscopy and their diameters were measured.

Results:
The number of unmyelinated fibers was similar between sham (1,882 ± 270.9) and SET (2,012 ± 1,060.8), but axons density was significantly greater in the SET (18,733.3 ± 5,668.6) than sham (13,935.0 ± 1,875.8). Additionally, the axonal diameters differed significantly between groups with mean measures in sham (0.968 ± 0.10) > SET (0.648 ± 0.08).

Conclusions:
Unmyelinated fiber growth occurred even with a 5-mm distance between the donor and receptor nerves, reaching similar axonal number to the normal nerve, demonstrating that the SET is a reliable technique that can promote a remarkable plasticity of unmyelinated axons.
CHOROIDAL NEVUS IMAGING FEATURES IN 3,806 CASES AND RISK FACTORS FOR TRANSFORMATION INTO MELANOMA IN 2,355 CASES
Authors: Shields Carol L. , Dalvin Lauren A. , Ancona-Lezama David , Yu Michael D. , Di Nicola Maura , Williams Basil K. , Lucio-Alvarez J. Antonio , Ang Su Mae , Maloney Sean , Welch R. Joel , Shields Jerry A. 
Published: January 2019

Purpose:
To use multimodal imaging for identification of risk factors for choroidal nevus transformation into melanoma.

Methods:
Retrospective chart review of 3806 consecutive choroidal nevi with imaging and 2355 choroidal nevi with additional follow up to identify factors predictive of transformation of choroidal nevus into melanoma.

Results:
The median patient age was 62.5 years and Caucasian race in 3167 (95%). The choroidal nevus demonstrated median basal diameter of 4.0 mm and thickness of 1.4 mm. Imaging included optical coherence tomography (OCT) showing subretinal fluid (SRF) in 312 (9%), ultrasonography (US) with acoustic hollowness in 309 (9%), and hyper-autofluorescence (AF) in 100 (3%). Of those 2355 choroidal nevi with follow up, Kaplan-Meier estimates of nevus transformation into melanoma at 1, 5, and 10 years were 1.2%, 5.8%, and 13.9%, respectively. Multivariate analysis, using multimodal imaging for detection of factors predictive of nevus transformation into melanoma, included thickness >2 mm on US (hazard ratio (HR) 3.80, p < 0.0001), SRF on OCT as cap over nevus (HR 3.00, p < 0.0001) or SRF ≤3 mm from nevus margin (HR 3.56, p = 0.0003), symptomatic vision loss ≤20/50 on Snellen visual acuity (VA) (HR 2.28, p = 0.005), orange pigment (lipofuscin) hyperautofluorescence on AF (HR 3.07, p = 0.0004), acoustic hollowness on US (HR 2.10, p = 0.0020), and tumor diameter >5 mm on photography (HR 1.84, p = 0.0275). These factors can be recalled by the mnemonic “To Find Small Ocular Melanoma Doing IMaging” (TFSOM-DIM) representing Thickness >2 mm (US), Fluid subretinal (OCT), Symptoms vision loss (VA), Orange pigment (AF), Melanoma hollow (US), and DIaMeter >5mm (photography). The mean 5-year estimates of nevus growth into melanoma were 1% (HR 0.8) for those with 0 risk factor, 11% (HR 3.09) with 1 factor, 22% (HR 10.6) with 2 factors, 34% (HR 15.1) with 3 factors, 51% (HR 15.2) with 4 factors, 55% (HR 26.4) with 5 risk factors, and not-estimable with all 6 risk factors.

Conclusion:
In this analysis, multimodal imaging was capable of detecting risk factors for nevus transformation into melanoma, including thickness >2 mm (US), fluid subretinal (OCT), symptoms vision loss (Snellen acuity), orange pigment (AF), melanoma hollowness (US), and diameter >5 mm (photography). Increasing number of risk factors imparts greater risk for nevus transformation into melanoma, including thickness >2 mm (US), fluid subretinal (OCT), symptoms vision loss (Snellen acuity), orange pigment (AF), melanoma hollowness (US), and diameter >5 mm (photography). Increasing number of risk factors imparts greater risk for transformation.
Hedonic drinking engages a supraspinal inhibition of thermal nociception in adult rats
Authors: Davies Alexander J. , Kim Doyun , Park Jeongrak , Lee Jeong-Yun , Vang Hue , Pickering Anthony E. , Oh Seog Bae 
Published: January 2019

Abstract
The taste of sucrose is commonly used to provide pain relief in newborn humans and is innately analgesic to neonatal rodents. In adulthood, sucrose remains a strong motivator to feed, even in potentially hazardous circumstances (ie, threat of tissue damage). However, the neurobiological mechanisms of this endogenous reward–pain interaction are unclear. We have developed a simple model of sucrose drinking–induced analgesia in Sprague–Dawley rats (6-10 weeks old) and have undertaken a behavioral and pharmacological characterization using the Hargreaves' test of hind-paw thermal sensitivity. Our results reveal an acute, potent, and robust inhibitory effect of sucrose drinking on thermal nociceptive behaviour that unlike the phenomenon in neonates is independent of endogenous opioid signalling and does not seem to operate through classical descending inhibition of the spinal cord circuitry. Experience of sucrose drinking had a conditioning effect whereby the apparent expectancy of sucrose enabled water alone (in euvolemic animals) to elicit a short-lasting placebo-like analgesia. Sweet taste alone, however, was insufficient to elicit analgesia in adult rats intraorally perfused with sucrose. Instead, the sucrose analgesia phenomenon only appeared after conditioning by oral perfusion in chronically cannulated animals. This sucrose analgesia was completely prevented by systemic dosing of the endocannabinoid CB1 receptor antagonist rimonabant. These results indicate the presence of an endogenous supraspinal analgesic circuit that is recruited by the context of rewarding drinking and is dependent on endocannabinoid signalling. We propose that this hedonic sucrose-drinking model may be useful for further investigation of the supraspinal control of pain by appetite and reward.
7 Is the New 8: Improving Adherence to Restrictive PRBC Transfusions in the Pediatric ICU
Authors: Badke Colleen M. , Borrowman Julie A. , Haymond Shannon , Rychlik Karen , Malakooti Marcelo R. 
Published: January 2019

ABSTRACT
Up to 30%–40% of children admitted to the pediatric intensive care unit (PICU) have anemia, and approximately 15% receive packed red blood cell (pRBC) transfusions. Current literature supports a pRBC transfusion threshold of hemoglobin less than or equal to seven for most PICU patients. Our objective was to determine pRBC transfusion rates, assess compliance with transfusion guidelines, understand patient-level variables that affect transfusion practices, and use cross-industry innovation to implement a practice strategy. This was a pre–post study of pediatric patients admitted to our PICU. We collected baseline data on pRBC transfusion practices. Next, we organized an innovation platform, which generated multi-industry ideas and produced an awareness campaign to effect pRBC ordering behavior. Innovative educational interventions were implemented, and postintervention transfusion practices were monitored. Statistical analysis was performed using linear mixed models. A p value < .05 was considered statistically significant. At baseline, 41% of pRBC transfusions met restrictive transfusion guidelines with a pretransfusion hemoglobin less than or equal to 7 g/dl. In the postintervention period, 53% of transfusions met restrictive transfusion guidelines (odds ratio 1.66, 95% confidence interval 1.21–2.28). Implementation of a behavioral campaign using multi-industry innovation led to improved adherence to pRBC transfusion guidelines in a tertiary care PICU.
STD Partner Services to Monitor and Promote HIV Pre-exposure Prophylaxis Use Among Men Who Have Sex With Men
Authors: Katz David A. , Dombrowski Julia C. , Barry Michael , Spellman Dawn , Bell Teal R. , Golden Matthew R. 
Published: January 2019

Background:
Men who have sex with men (MSM) with bacterial sexually transmitted diseases (STDs) are at elevated risk of HIV. We evaluated the integration of pre-exposure prophylaxis (PrEP) referrals into STD partner services (PS) for MSM.

Setting:
King County, Washington.

Methods:
Disease Intervention Specialists (DIS) in King County attempt to provide PS to all MSM with early syphilis and, as resources allow, MSM with gonorrhea or chlamydia. Our health department defines MSM with any of the following as at high HIV risk: early syphilis, rectal gonorrhea, methamphetamine/poppers use, sex work, or an HIV-unsuppressed partner. DIS offer high-risk MSM referral to our STD Clinic for PrEP and other MSM referral to community providers. In 2017, we interviewed a random sample of MSM offered referrals in 2016 to assess PrEP initiation after PS.

Results:
From August 2014 to August 2017, 7546 cases of bacterial STDs were reported among HIV-negative MSM. DIS provided PS to 3739 MSM, of whom 2055 (55%) were at high risk. DIS assessed PrEP use in 1840 (90%) of these men, 895 (49%) of whom reported already using PrEP. DIS offered referrals to 693 (73%) of 945 MSM not on PrEP; 372 (54%) accepted. Among 132 interviewed for the random sample, men who accepted referrals at initial interview were more likely to report using PrEP at follow-up (32/68 = 47%) than those who did not (12/64 = 19%) (P = 0.0006). An estimated 10.4% of all interviewed MSM initiated PrEP following PS-based referral.

Conclusions:
Integrating PrEP referrals into STD PS is an effective population-based strategy to link MSM at high HIV risk to PrEP.
Procalcitonin to guide antibiotic decision making
Authors: Branche Angela , Neeser Olivia , Mueller Beat , Schuetz Philipp 
Published: January 2019

Purpose of review
There is convincing evidence linking antibiotic-stewardship efforts which include the infection marker procalcitonin (PCT) to more rational use of antibiotics with improvements in side-effects and clinical outcomes. This is particularly true in the setting of respiratory infection and sepsis. Yet, some recent trials have shown no benefit of PCT-guided care. Our aim was to discuss the benefits and limitations of using PCT for early infection recognition, severity assessment and therapeutic decisions in individual patients based on most the recent study data.

Recent findings
Current evidence from randomized trials, and meta-analyses of these trials, indicates that PCT-guided antibiotic stewardship results in a reduction in antibiotic use and antibiotic side-effects, which translates into improved survival of patients with respiratory infections and sepsis. Notably, initial PCT levels have been found to be helpful in defining the risk for bacterial infection in the context of a low pretest probability for bacterial infections (i.e., patients with bronchitis or chronic bastructive pulmonary disease exacerbation). Monitoring of repeated PCT measurements over time has also been found helpful for estimating recovery from bacterial infection and prognosis in higher risk situations (i.e., pneumonia or sepsis) and results in early and safe discontinuation of antibiotic therapy. Some trials, however, did not find a strong effect of PCT guidance which may be explained by low protocol adherence, assessment using only a single rather than repeat PCT levels and lower antibiotic exposure in control group patients. Using PCT in the right patient population, with high-sensitivity assays and with adequate training of physicians is important to increase protocol adherence and reduce antibiotic exposure.

Summary
Inclusion of PCT into antibiotic stewardship algorithms has the potential to improve the diagnostic and therapeutic management of patients presenting with respiratory illnesses and sepsis, and holds great promise to mitigate the global bacterial resistance crisis and move from a default position of standardized care to more personalized treatment decisions.
Biomarkers of fungal lung infection
Authors: Paiva José-Artur , Pereira José M. 
Published: January 2019

Purpose of review
The incidence of lung fungal infections, namely invasive pulmonary aspergillosis (IPA) and mucormycosis, is increasing in neutropenic and nonneutropenic patients. As they are a major cause of death, early diagnosis and antifungal therapy are crucial for outcome. The role of biomarkers in the management of this infections is the scope of this review.

Recent findings
Galactomannan in bronchoalveolar lavage shows the best discriminatory power for IPA diagnosis. At baseline, serum galactomannan may be useful to predict outcome and its kinetics may be informative to assess response to antifungal therapy. Recent standardization of PCR technology brought some improvements in IPA and mucormycosis diagnosis. Several new biomarkers are currently under investigation, but none showed a better performance than current available biomarkers. To improve diagnostic accuracy, a combination of biomarkers, including galactomannan, has been proposed.

Summary
Biomarkers may play an important role in the early diagnosis of fungal lung infections and in prognostic assessment and response monitoring, but more research is needed to determine the best strategy for their clinical use.
Composite Graft Pretreatment With Hydrogen Sulfide Delays the Onset of Acute Rejection
Authors: Fries C. Anton , Lawson Sharon D. , Wang Lin C. , Spencer Jerry R. , Roth Mark , Rickard Rory F. , Gorantla Vijay S. , Davis Michael R. 
Published: January 2019

IntroductionVascularized composite allotransplantation can reconstruct devastating tissue loss by replacing like-with-like tissues, most commonly in the form of hand or face transplantation. Unresolved technical and ethical challenges have meant that such transplants remain experimental treatments. The most significant barrier to expansion of this field is the requirement for systemic immunosuppression, its toxicity and effect on longevity.Hydrogen sulfide (H2S) has been shown experimentally to ameliorate the ischemia reperfusion injury associated with composite tissue autotransplantation, which has been linked to acute rejection in solid organ transplantation. In this protocol, a large-animal model was used to evaluate the effect of H2S on acute rejection after composite tissue allotransplantation.Materials and MethodsA musculocutaneous flap model in SLA-mismatched swine was used to evaluate acute rejection of allotransplants in 2 groups: control animals (n = 8) and a treatment group in which the allografts were pretreated with hydrogen sulfide (n = 8). Neither group was treated with systemic immunosuppression. Acute rejection was graded clinically and histopathologically by an independent, blinded pathologist. Data were analyzed byttests with correction for multiple comparisons by the Holm-Šídák method.ResultsClinically, H2S-treated tissue composites showed a delay in the onset of rejection that was statistically significant from postoperative day 6. Histopathologically, this difference between groups was also apparent, although evidence of a difference in groups disappeared beyond day 10.ConclusionsTargeted hydrogen sulfide treatment of vascularized composite allografts immediately before transplantation can delay acute rejection. This may, in turn, reduce or obviate the requirement for systemic immunosuppression.
Cheek Cutaneous Melanomas
Authors: Tas Faruk , Erturk Kayhan 
Published: January 2019

Background
Most head and neck melanomas occur on the face, with the cheek being the most frequently affected site. So far, small numbers of researches on cheek melanomas have yielded insufficient and controversial results. In this trial, we aimed to define the histopathological and clinical features specific to cheek melanomas and to compare them with other head and neck melanomas by using a large group of patients from a single tertiary center.

Patients and Methods
A total of 98 cheek melanomas and 183 other (noncheek) head and neck melanoma cases were analyzed retrospectively.

Results
The median age was 62 years and malar/zygomatic was the mostly affected site (78.6%). The cheek melanomas developed more frequently in females (61.2%) and most of them were associated with lentigo maligna histopathological subtype (49.2%) and early-stage disease (stage 0–II) (77.6%). The cheek melanomas were found more significantly associated with older patients (P = 0.05), females (P = 0.0001), lentigo maligna subtype (P = 0.0001), lower vertical growth phase (P = 0.03), and early-stage of disease (P = 0.0001) compared with other lesions that developed other sites. Furthermore, they were associated with lower relapse rates (18.6% vs 39.5%, P = 0.0001) and the 5-year recurrence-free survival rate of cheek melanomas was 80% (P = 0.002). Moreover, the 5-year overall survival rate of cheek melanomas was 62%, and they were found to be associated with a favorable overall survival (P = 0.004).

Conclusions
Cheek melanomas are associated with lower relapse rates and favorable outcomes compared with other (noncheek) head and neck melanomas.