bluuebunny/crossref_metadata_2025_split huggingface dataset:
Circulating Tumor Cells are an Independent Predictor of Shorter Survival in Patients Undergoing Resection for Pancreatic and Periampullary Adenocarcinoma
Authors: Hugenschmidt Harald , Labori Knut Jørgen , Brunborg Cathrine , Verbeke Caroline Sophie , Seeberg Lars Thomas , Schirmer Cecilie Bendigtsen , Renolen Anne , Borgen Elin Faye , Naume Bjørn , Wiedswang Gro 
Published: September 2018

Objective:
We evaluated the prognostic impact of circulating tumor cells (CTCs) for patients with presumed resectable pancreatic and periampullary cancers.

Summary of Background Data:
Initial treatment decisions for this group are currently taken without a reliable prognostic marker. The CellSearch system allows standardized CTC-testing and has shown excellent specificity and prognostic value in other applications.

Methods:
Preoperative blood samples from 242 patients between September 2009 and December 2014 were analyzed. One hundred seventy-nine patients underwent tumor resection, of whom 30 with stage-I tumors and duodenal cancer were assigned to the low-risk group, and the others to the high-risk group. Further 33 had advanced disease, 30 benign histology. Observation ended in December 2016. Cancer-specific survival (CSS) and disease-free survival (DFS) were calculated by log-rank and Cox regression.

Results:
CTCs (CTC-positive; ≥1 CTC/7.5 mL) were detected in 6.8% (10/147) of the high-risk patients and 6.2% (2/33) with advanced disease. No CTCs (CTC-negative) were detected in the low-risk patients or benign disease. In high-risk patients, median CSS for CTC-positive versus CTC-negative was 8.1 versus 20.0 months (P < 0.0001), and DFS 4.0 versus 10.5 months (P < 0.001). Median CSS in advanced disease was 7.7 months. Univariate hazard ratio (HR) of CTC-positivity was 3.4 (P < 0.001). In multivariable analysis, CTC-status remained independent (HR: 2.4, P = 0.009) when corrected for histological type (HR: 2.7, P = 0.030), nodal status (HR: 1.7, P = 0.016), and vascular infiltration (HR: 1.7, P = 0.001).

Conclusion:
Patients testing CTC-positive preoperatively showed a detrimental outcome despite successful tumor resections. Although the low CTC-rate seems a limiting factor, results indicate high specificity. Thus, preoperative analysis of CTCs by this test may guide treatment decisions and warrants further testing in clinical trials.
Clinical Outcome After Rectal Replacement With Side-to-End, Colon-J-Pouch, or Straight Colorectal Anastomosis Following Total Mesorectal Excision
Authors: Marti Walter R. , Curti Gaudenz , Wehrli Heinz , Grieder Felix , Graf Michael , Gloor Beat , Zuber Markus , Demartines Nicolas , Fasolini Fabrizio , Lerf Bruno , Kettelhack Christoph , Andrieu Christiane , Bigler Martin , Hayoz Stefanie , Ribi Karin , Hamel Christian 
Published: September 2018

Objective:
To compare, in a phase 3, prospective, randomized, multi-center clinical trial functional outcome of reconstruction procedures following total mesorectal excision (TME).

Summary Background Data:
Intestinal continuity reconstruction following TME is accompanied by postoperative defecation dysfunctions known as “anterior resection syndrome.” Commonly used reconstruction techniques are straight colorectal anastomosis (SCA), colon J -pouch (CJP), and side-to-end anastomosis (SEA). Comparison of their functional outcomes in prospective, randomized, multi-center studies, including long-term assessments, is lacking.

Methods:
Patients requiring TME for histologically proven rectal tumor, with or without neoadjuvant treatment, age ≥ 18 years, normal sphincter function without history of incontinence, any pretreatment staging or adenoma, expected R0-resection, were randomized for standardized SCA, CJP, or SEA procedures. Primary endpoint was comparison of composite evacuation scores 12 months after TME. Comparison of composite evacuation and incontinence scores at 6, 18 and 24 months after surgery, morbidity, and overall survival represented secondary endpoints. Analysis was based on “per protocol” (PP) population, fully complying with trial requirements, and intention-to treat (ITT) population.

Results:
Three hundred thirty-six patients from 15 hospitals were randomized. PP population included 257 patients (JCP = 63; SEA = 95; SCA = 99). Composite evacuation scores of PP and ITT populations did not show statistically significant differences among the 3 groups at any time point. Similarly, composite incontinence scores for PP and ITT populations showed no statistically significant difference among the 3 trial arms at any time point.

Conclusions:
Within boundaries of investigated procedures, surgeons in charge may continue to perform reconstruction of intestinal continuity following TME at their technical preference.
The Learning Curve for Surgeons Regarding Endoscopic Thyroidectomy via the Oral-vestibular Approach
Authors: Qu Rui , Wang Jianxue , Li Jinyi , Dong Zhiyong , Yang Jingge , Liu Daosheng , Wang Cunchuan 
Published: September 2018

Background:
For selected patients, endoscopic thyroidectomy via the oral-vestibular approach (ETOVA) can be used to achieve a very good esthetic effect. This study aimed to assess the learning curve for ETOVA and identify improvements.

Patients and Methods:
This retrospective study evaluated the outcomes of 101 patients who underwent ETOVA by surgeons A and B. The patients were classified according to whether they had undergone surgery during the primary or advanced stage of the learning curve, respectively. Proficiency with the procedure in various types of cases and the operation time, operative blood loss, hospital stay length, and postoperative complications were analyzed.

Results:
In total, 56 and 45 patients were treated by surgeons A and B, respectively. For both surgeons, the operation times decreased considerably after 20 cases. Statistically significant differences with respect to stage were observed in terms of operation time (P<0.05) and drainage tube reservation (P<0.05). By contrast, significant differences were not observed between stages in terms of operative blood loss (P>0.05) or postoperative hospital stay length (P>0.05). The total postoperative complication rate was low and comparable with that of open surgery.

Conclusions:
The specific learning curve identified for ETOVA suggests that surgeons with sufficient endoscopic surgery experience could achieve a stable proficiency after ∼20 cases. A standardized training program and exposure to more cases would reduce the learning curve.
Comparison of Efficacy of Laparoscopic and Open Splenectomy Combined With Selective and Nonselective Pericardial Devascularization in Portal Hypertension Patients
Authors: Chen Hao , Yang Fang , Li Ting-ting , Zhang Ke-nan , Sun Zhen-gang , Yu Chun-zhao , Sun Yuan 
Published: September 2018

Background:
Recent advances in laparoscopic techniques have demonstrated that laparoscopy is superior for managing portal hypertension. This study aimed to compare the efficacy of laparoscopic splenectomy plus selective pericardial devascularization (LSSD) and open splenectomy and nonselective pericardial devascularization (OSD) in patients with portal hypertension.

Methods:
A total of 127 patients with portal hypertension underwent either LSSD or OSD at Jingzhou Central Hospital from January 2014 to December 2016. A total of, 55 patients received LSSD, including 29 male and 26 female individuals (age, 56.0±11.6 y); 72 patients received OSD, including 45 male and 27 female individuals (age, 53.4±10.9 y). The parameters of operation and outcomes were measured and compared.

Results:
Intraoperative blood loss, postoperative complications, and hospital stay were significantly lower in LSSD group but operation time was significantly lower in OSD group. Postoperative Child-Pugh score was significantly lower in LSSD group than in OSD group.

Conclusions:
LSSD is a safe and effective treatment for liver cirrhosis patients with portal hypertension.
Use of Ultrasound Urodynamics to Identify Differences in Bladder Shape Between Individuals With and Without Overactive Bladder
Authors: Glass Clark Stephanie , Nagle Anna S. , Bernardo Rachel , Vinod Naomi , Carucci Laura , Carroll Ashley , Speich John , Klausner Adam P. 
Published: September 2018

Objectives
The objective of this study was to identify differences in bladder shape changes between individuals with overactive bladder (OAB) and unaffected individuals during ultrasound urodynamics.

Methods
A prospective urodynamic study was performed with concurrent transabdominal ultrasound (ultrasound urodynamics) on individuals with and without OAB based on validated International Consultation on Incontinence Questionnaire - OAB survey scores. Three-dimensional ultrasound images were acquired at 1-minute increments during filling and used to measure bladder diameters in the height, width, and depth orientations. The engineering strain for each diameter was compared between participants with OAB and controls during urodynamic filling. The height-to-width ratio at capacity was used to determine if individuals were shape outliers.

Results
A total of 22 subjects were enrolled, including 11 with OAB and 11 without OAB. During urodynamic filling in both groups, the greatest degree of geometric strain was found in the height orientation, indicating that bladders generally fill in a craniocaudal shape. The mean ± SD height-to-width ratio of the control group was 1.06 ± 0.12 yielding a 95% confidence interval of 0.82 to 1.30. Five (45.5%) of 11 OAB subjects had height-to-width ratios outside this interval as compared with none of the control subjects, identifying a potential shape-mediated subgroup of OAB.

Conclusions
Three-dimensional ultrasound urodynamics can be used to identify differences in bladder shape comparing individuals with and without OAB. This method may be used to identify a subset of OAB patients with abnormal bladder shapes which may play a role in the pathophysiology of their OAB symptoms.
To shunt or not to shunt in combined orthopedic and vascular extremity trauma
Authors: Wlodarczyk Jordan R. , Thomas Alexander S. , Schroll Rebecca , Campion Eric M. , Croyle Caroline , Menaker Jay , Bradley Matthew , Harvin John A. , Collum Morgan L. , Cho Jayin , Seamon Mark J. , Leonard Jennifer , Tiller Michael , Inaba Kenji , Moore Margaret M. 
Published: September 2018

BACKGROUND
There exists a long established but not validated practice of placing temporary intravascular shunts (TIVS) in cases of combined vascular and orthopedic extremity trauma. Though logical to prioritize blood flow, large-scale data to support this practice is lacking. We hypothesize that the order of repair yields no difference in outcomes in combined vascular and orthopedic extremity trauma and offer a larger-scale analysis than is previously available.

METHODS
A retrospective chart review was conducted at six Level I trauma centers from 2004 to 2015 comparing patients who received a TIVS during their initial surgery versus those who did not. Nonshunted patients were further divided into initial definitive vascular repair versus initial orthopedic fixation groups. Metrics were used to control for sampling bias while revision rate, amputation, hospital length of stay (HLOS), and development of thrombosis and compartment syndrome were used to assess outcomes.

RESULTS
Of 291 total patients, 72 had TIVS placement, 97 had initial definitive vascular repair, and 122 had initial orthopedic fixation. The shunted group had a higher Abbreviated Injury Scale (3.0 vs. 2.8 p = 0.04) and Mangled Extremity Severity Score (6.1 vs. 5.7 p = 0.006) and a significantly lower rate of compartment syndrome (15% vs. 34% p = 0.002). Among patients who developed compartment syndrome, those who were shunted were younger (23 vs. 35 yrs, p = 0.03) and were more likely sustain a penetrating injury (p = 0.007). Those receiving initial orthopedic fixation had a longer HLOS (HLOS >15 days in 61% vs. 38%, p = 0.049) and a higher amputation rate (20% vs. 7%, p = 0.006) when compared with those undergoing initial definitive vascular repair.

CONCLUSION
Lack of TIVS was associated with a significant increase in the development of compartment syndrome. Though it seems to have become common practice to proceed directly to vascular repair during the initial surgery, morbidity is improved with the placement of a TIVS.

LEVEL OF EVIDENCE
Therapeutic cohort, level III.
Traumatic rectal injuries: Is the combination of computed tomography and rigid proctoscopy sufficient?
Authors: Trust Marc D. , Veith Jacob , Brown Carlos V.R. , Sharpe John P. , Musonza Tashinga , Holcomb John , Bui Eric , Bruns Brandon , Andrew Hopper H. , Truitt Michael , Burlew Clay , Schellenberg Morgan , Sava Jack , Vanhorn John , Eastridge Brian , Cross Alicia M. , Vasak Richard , Vercuysse Gary , Curtis Eleanor E. , Haan James , Coimbra Raul , Bohan Phillip , Gale Stephen , Bendix Peter G. 
Published: September 2018

BACKGROUND
There are no clear guidelines for the best test or combination of tests to identify traumatic rectal injuries. We hypothesize that computed tomography (CT) and rigid proctoscopy (RP) will identify all injuries.

METHODS
American Association for the Surgery of Trauma multi-institutional retrospective study (2004–2015) of patients who sustained a traumatic rectal injury. Patients with known rectal injuries who underwent both CT and RP as part of their diagnostic workup were included. Only patients with full thickness injuries (American Association for the Surgery of Trauma grade II-V) were included. Computed tomography findings of rectal injury, perirectal stranding, or rectal wall thickening and RP findings of blood, mucosal abnormalities, or laceration were considered positive.

RESULTS
One hundred six patients were identified. Mean age was 32 years, 85(79%) were male, and 67(63%) involved penetrating mechanisms. A total of 36 (34%) and 100 (94%) patients had positive CT and RP findings, respectively. Only 3 (3%) patients had both a negative CT and negative RP. On further review, each of these three patients had intraperitoneal injuries and had indirect evidence of rectal injury on CT scan including pneumoperitoneum or sacral fracture.

CONCLUSION
As stand-alone tests, neither CT nor RP can adequately identify traumatic rectal injuries. However, the combination of both test demonstrates a sensitivity of 97%. Intraperitoneal injuries may be missed by both CT and RP, so patients with a high index of suspicion and/or indirect evidence of rectal injury on CT scan may necessitate laparotomy for definitive diagnosis.

LEVEL OF EVIDENCE
Diagnostic, level IV.
The Efficiency of Evaluating Candidates for Living Kidney Donation: A Scoping Review
Authors: Habbous Steven , Woo Justin , Lam Ngan N. , Lentine Krista L. , Cooper Matthew , Reich Marian , Garg Amit X. 
Published: September 2018

IntroductionThe process of evaluating candidates for living kidney donation can be inefficient. A structured review of existing information on this topic can provide a necessary foundation for quality improvement.MethodsWe conducted a scoping review to map the published literature to different themes related to an efficient donor candidate evaluation. We reviewed the websites of living donor programs to describe information provided to candidates about the nature and length of the evaluation process.ResultsWe reviewed of 273 published articles and 296 websites. Surveys of living donor programs show variability in donor evaluation protocols. Computed tomography (a routinely done test for all successful candidates) may be used to assess split renal volume instead of nuclear renography when the 2 kidneys differ in size. Depending on the candidate’s estimated glomerular filtration rate, a nuclear medicine scan for measured glomerular filtration rate may not be needed. When reported, the time to complete the evaluation varied from 3 months to over a year. The potential for undesirable outcomes was reported in 23 studies, including missed opportunities for living donation and/or preemptive transplants. According to living donor websites, programs generally evaluate 1 candidate at a time when multiple come forward for assessment, and few programs describe completing most of the evaluation in a single in-person visit.ConclusionsData on the efficiency of the living donor evaluation are limited. Future efforts can better define, collect, and report indicators of an efficient living donor evaluation to promote quality improvement and better patient outcomes.
Optic Perineuritis Due to Tuberculosis
Authors: Yates William B. , Nothling Simon , Lawlor Mitchell 
Published: September 2018

Abstract:
A 30-year-old man experienced subacute peripheral visual field loss with preserved central vision in his right eye. He was diagnosed with optic perineuritis due to tuberculosis. Optic perineuritis is an uncommon disorder and, at times, can be difficult to distinguish from optic neuritis. The differentiation can have significant impact on diagnostic testing and patient management.
EEG Reactivity Evaluation Practices for Adult and Pediatric Hypoxic-Ischemic Coma Prognostication in North America
Authors: Amorim Edilberto , Gilmore Emily J. , Abend Nicholas S. , Hahn Cecil D. , Gaspard Nicolas , Herman Susan T. , Hirsch Lawrence J. , Lee Jong Woo , Cash Sydney S. , Westover M. Brandon ,   on behalf of the Critical Care EEG Monitoring Consortium (CCEMRC)
Published: September 2018

Purpose:The aim of this study was to assess the variability in EEG reactivity evaluation practices during cardiac arrest prognostication.Methods:A survey of institutional representatives from North American academic hospitals participating in the Critical Care EEG Monitoring Research Consortium was conducted to assess practice patterns involving EEG reactivity evaluation. This 10-question multiple-choice survey evaluated metrics related to technical, interpretation, personnel, and procedural aspects of bedside EEG reactivity testing and interpretation specific to cardiac arrest prognostication. One response per hospital was obtained.Results:Responses were received from 25 hospitals, including 7 pediatric hospitals. A standardized EEG reactivity protocol was available in 44% of centers. Sixty percent of respondents believed that reactivity interpretation was subjective. Reactivity bedside testing always (100%) started during hypothermia and was performed daily during monitoring in the majority (71%) of hospitals. Stimulation was performed primarily by neurodiagnostic technologists (76%). The mean number of activation procedures modalities tested was 4.5 (SD 2.1). The most commonly used activation procedures were auditory (83.3%), nail bed pressure (63%), and light tactile stimuli (63%). Changes in EEG amplitude alone were not considered consistent with EEG reactivity in 21% of centers.Conclusions:There is substantial variability in EEG reactivity evaluation practices during cardiac arrest prognostication among North American academic hospitals. Efforts are needed to standardize protocols and nomenclature according with national guidelines and promote best practices in EEG reactivity evaluation.
Automatic adaptation of model neurons and connections to build hybrid circuits with living networks
Authors: Reyes-Sanchez Manuel , Amaducci Rodrigo , Elices Irene , Rodríguez Francisco B. , Varona Pablo 
Published: September 2018

AbstractHybrid circuits built by creating mono- or bi-directional interactions among living cells and model neurons and synapses are an effective way to study neuron, synaptic and neural network dynamics. However, hybrid circuit technology has been largely underused in the context of neuroscience studies mainly because of the inherent difficulty in implementing and tuning this type of interactions. In this paper, we present a set of algorithms for the automatic adaptation of model neurons and connections in the creation of hybrid circuits with living neural networks. The algorithms perform model time and amplitude scaling, drift compensation, goal-driven synaptic and model tuning/calibration and also automatic parameter mapping. These algorithms have been implemented in RTHybrid, an open-source library that works with hard real-time constraints. We provide validation examples by building hybrid circuits in a central pattern generator. The results of the validation experiments show that the proposed dynamic adaptation facilitates building hybrid circuits and closed-loop communication among living and artificial model neurons and connections. Furthermore contributes to characterize system dynamics, achieve control, automate experimental protocols and extend the lifespan of the preparations.
Elucidation of Codon Usage Signatures across the Domains of Life
Authors: Novoa Eva Maria , Jaillon Olivier , Jungreis Irwin , Kellis Manolis 
Published: September 2018

AbstractDue to the degeneracy of the genetic code, multiple codons are translated into the same amino acid. Despite being ‘synonymous’, these codons are not equally used. Selective pressures are thought to drive the choice among synonymous codons within a genome, while GC content, which is generally attributed to mutational drift, is the major determinant of interspecies codon usage bias. Here we find that in addition to the bias caused by GC content, inter-species codon usage signatures can also be detected. More specifically, we show that a single amino acid, arginine, is the major contributor to codon usage bias differences across domains of life. We then exploit this finding, and show that the identified domain-specific codon bias signatures can be used to classify a given sequence into its corresponding domain with high accuracy. Considering that species belonging to the same domain share similar tRNA decoding strategies, we then wondered whether the inclusion of codon autocorrelation patterns might improve the classification performance of our algorithm. However, we find that autocorrelation patterns are not domain-specific, and surprisingly, are unrelated to tRNA reusage, in contrast to the common belief. Instead, our results reveal that codon autocorrelation patterns are a consequence of codon optimality throughout a sequence, where highly expressed genes display autocorrelated ‘optimal’ codons, whereas lowly expressed genes display autocorrelated ‘non-optimal’ codons.