bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Management of Idiopathic Constipation in Pediatric Patients
Authors: Cheng Lily , Goldstein Allan 
Published: February 2018

AbstractConstipation is a common childhood problem, but an anatomic or physiologic cause is identified in fewer than 5% of children. By definition, idiopathic constipation is a diagnosis of exclusion. Careful clinical evaluation and thoughtful use of imaging and other testing can help exclude specific causes of constipation and guide therapy. Medical management with laxatives is effective for the majority of constipated children. For those patients unresponsive to medications, however, several surgical options can be employed, including anal procedures, antegrade colonic enemas, colorectal resection, and intestinal diversion. Judicious use of these procedures in properly selected patients and based on appropriate preoperative testing can lead to excellent outcomes. This review summarizes the surgical options available for managing refractory constipation in children and provides guidance on how to choose the best procedure for a given patient.
Enteric Duplication
Authors: Jeziorczak Paul , Warner Brad 
Published: February 2018

AbstractEnteric duplications have been described throughout the entire gastrointestinal tract. The usual perinatal presentation is an abdominal mass. Duplications associated with the foregut have associated respiratory symptoms, whereas duplications in the midgut and hindgut can present with obstructive symptoms, perforation, nausea, emesis, hemorrhage, or be asymptomatic, and identified as an incidental finding. These are differentiated from other cystic lesions by the presence of a normal gastrointestinal mucosal epithelium. Enteric duplications are located on the mesenteric side of the native structures and are often singular with tubular or cystic characteristics. Management of enteric duplications often requires operative intervention with preservation of the native blood supply and intestine. These procedures are usually very well tolerated with low morbidity.
Current Approaches to Pediatric Polyposis Syndromes
Authors: Fahy Aodhnait , Moir Christopher 
Published: February 2018

AbstractColorectal adenomatous polyposis syndromes encompass a diverse group of disorders with varying modes of inheritance and penetrance. Children may present with overt disease or within screening programs for families at high risk. We provide an overview of the array of pediatric polyposis syndromes, current screening recommendations, and surgical indications and technical considerations. Optimal disease management for these pediatric patients is still evolving and has implications for screening, surveillance, pediatric surgical management, and transition of care gastroenterologic neoplasia physicians and surgeons.
Nanopore sequencing technology and tools for genome assembly: computational analysis of the current state, bottlenecks and future directions
Authors: Senol Cali Damla , Kim Jeremie S , Ghose Saugata , Alkan Can , Mutlu Onur 
Published: February 2018

AbstractNanopore sequencing technology has the potential to render other sequencing technologies obsolete with its ability to generate long reads and provide portability. However, high error rates of the technology pose a challenge while generating accurate genome assemblies. The tools used for nanopore sequence analysis are of critical importance, as they should overcome the high error rates of the technology. Our goal in this work is to comprehensively analyze current publicly available tools for nanopore sequence analysis to understand their advantages, disadvantages and performance bottlenecks. It is important to understand where the current tools do not perform well to develop better tools. To this end, we (1) analyze the multiple steps and the associated tools in the genome assembly pipeline using nanopore sequence data, and (2) provide guidelines for determining the appropriate tools for each step. Based on our analyses, we make four key observations: (1) the choice of the tool for basecalling plays a critical role in overcoming the high error rates of nanopore sequencing technology. (2) Read-to-read overlap finding tools, GraphMap and Minimap, perform similarly in terms of accuracy. However, Minimap has a lower memory usage, and it is faster than GraphMap. (3) There is a trade-off between accuracy and performance when deciding on the appropriate tool for the assembly step. The fast but less accurate assembler Miniasm can be used for quick initial assembly, and further polishing can be applied on top of it to increase the accuracy, which leads to faster overall assembly. (4) The state-of-the-art polishing tool, Racon, generates high-quality consensus sequences while providing a significant speedup over another polishing tool, Nanopolish. We analyze various combinations of different tools and expose the trade-offs between accuracy, performance, memory usage and scalability. We conclude that our observations can guide researchers and practitioners in making conscious and effective choices for each step of the genome assembly pipeline using nanopore sequence data. Also, with the help of bottlenecks we have found, developers can improve the current tools or build new ones that are both accurate and fast, to overcome the high error rates of the nanopore sequencing technology.
Extrema-weighted feature extraction for functional data
Authors: van den Boom Willem , Mao Callie , Schroeder Rebecca A , Dunson David B 
Published: February 2018

AbstractMotivationAlthough there is a rich literature on methods for assessing the impact of functional predictors, the focus has been on approaches for dimension reduction that do not suit certain applications. Examples of standard approaches include functional linear models, functional principal components regression and cluster-based approaches, such as latent trajectory analysis. This article is motivated by applications in which the dynamics in a predictor, across times when the value is relatively extreme, are particularly informative about the response. For example, physicians are interested in relating the dynamics of blood pressure changes during surgery to post-surgery adverse outcomes, and it is thought that the dynamics are more important when blood pressure is significantly elevated or lowered.ResultsWe propose a novel class of extrema-weighted feature (XWF) extraction models. Key components in defining XWFs include the marginal density of the predictor, a function up-weighting values at extreme quantiles of this marginal, and functionals characterizing local dynamics. Algorithms are proposed for fitting of XWF-based regression and classification models, and are compared with current methods for functional predictors in simulations and a blood pressure during surgery application. XWFs find features of intraoperative blood pressure trajectories that are predictive of postoperative mortality. By their nature, most of these features cannot be found by previous methods.Availability and implementationThe R package ‘xwf’ is available at the CRAN repository: https://cran.r-project.org/package=xwf.Supplementary informationSupplementary data are available at Bioinformatics online.
A three-dimensional view on biodiversity changes: spatial, temporal, and functional perspectives on fish communities in the Baltic Sea
Authors: Frelat Romain , Orio Alessandro , Casini Michele , Lehmann Andreas , Mérigot Bastien , Otto Saskia A , Sguotti Camilla , Möllmann Christian 
Published: February 2018

AbstractFisheries and marine ecosystem-based management requires a holistic understanding of the dynamics of fish communities and their responses to changes in environmental conditions. Environmental conditions can simultaneously shape the spatial distribution and the temporal dynamics of a population, which together can trigger changes in the functional structure of communities. Here, we developed a comprehensive framework based on complementary multivariate statistical methodologies to simultaneously investigate the effects of environmental conditions on the spatial, temporal and functional dynamics of species assemblages. The framework is tested using survey data collected during more than 4000 fisheries hauls over the Baltic Sea between 2001 and 2016. The approach revealed the Baltic fish community to be structured into three sub-assemblages along a strong and temporally stable salinity gradient decreasing from West to the East. Additionally, we highlight a mismatch between species and functional richness associated with a lower functional redundancy in the Baltic Proper compared with other sub-areas, suggesting an ecosystem more susceptible to external pressures. Based on a large dataset of community data analysed in an innovative and comprehensive way, we could disentangle the effects of environmental changes on the structure of biotic communities—key information for the management and conservation of ecosystems.
Etiology of Acute Coronary Syndrome after Noncardiac Surgery
Authors: Helwani Mohammad A. , Amin Amit , Lavigne Paul , Rao Srikar , Oesterreich Shari , Samaha Eslam , Brown Jamie C. , Nagele Peter 
Published: February 2018

Abstract

Background
The objective of this investigation was to determine the etiology of perioperative acute coronary syndrome with a particular emphasis on thrombosis versus demand ischemia.

Methods
In this retrospective cohort study, adult patients were identified who underwent coronary angiography for acute coronary syndrome within 30 days of noncardiac surgery at a major tertiary hospital between January 2008 and July 2015. Angiograms were independently reviewed by two interventional cardiologists who were blinded to clinical data and outcomes. Acute coronary syndrome was classified as ST–elevation myocardial infarction, non–ST–elevation myocardial infarction, or unstable angina; myocardial infarctions were adjudicated as type 1 (plaque rupture), type 2 (demand ischemia), or type 4b (stent thrombosis).

Results
Among 215,077 patients screened, 146 patients were identified who developed acute coronary syndrome: 117 were classified as non–ST–elevation myocardial infarction (80.1%); 21 (14.4%) were classified as ST–elevation myocardial infarction, and 8 (5.5%) were classified as unstable angina. After coronary angiography, most events were adjudicated as demand ischemia (type 2 myocardial infarction, n = 106, 72.6%) compared to acute coronary thrombosis (type 1 myocardial infarction, n = 37, 25.3%) and stent thrombosis (type 4B, n = 3, 2.1%). Absent or only mild, nonobstructive coronary artery disease was found in 39 patients (26.7%). In 14 patients (9.6%), acute coronary syndrome was likely due to stress-induced cardiomyopathy. Aggregate 30-day and 1-yr mortality rates were 7 and 14%, respectively.

Conclusions
The dominant mechanism of perioperative acute coronary syndrome in our cohort was demand ischemia. A subset of patients had no evidence of obstructive coronary artery disease, but findings were consistent with stress-induced cardiomyopathy.
Can Mathematical Modeling Explain the Measured Magnitude of the Second Gas Effect?
Authors: Korman Ben , Dash Ranjan K. , Peyton Philip J. 
Published: February 2018

Abstract

Background
Recent clinical studies suggest that the magnitude of the second gas effect is considerably greater on arterial blood partial pressures of volatile agents than on end-expired partial pressures, and a significant second gas effect on blood partial pressures of oxygen and volatile agents occurs even at relatively low rates of nitrous oxide uptake. We set out to further investigate the mechanism of this phenomenon with the help of mathematical modeling.

Methods
Log-normal distributions of ventilation and blood flow were generated representing the range of ventilation-perfusion scatter seen in patients during general anesthesia. Mixtures of nominal delivered concentrations of volatile agents (desflurane, isoflurane and diethyl ether) with and without 70% nitrous oxide were mathematically modeled using steady state mass-balance principles, and the magnitude of the second gas effect calculated as an augmentation ratio for the volatile agent, defined as the partial pressure in the presence to that in the absence of nitrous oxide.

Results
Increasing the degree of mismatch increased the second gas effect in blood. Simultaneously, the second gas effect decreased in the gas phase. The increase in blood was greatest for the least soluble gas, desflurane, and least for the most soluble gas, diethyl ether, while opposite results applied in the gas phase.

Conclusions
Modeling of ventilation-perfusion inhomogeneity confirms that the second gas effect is greater in blood than in expired gas. Gas-based minimum alveolar concentration readings may therefore underestimate the depth of anesthesia during nitrous oxide anesthesia with volatile agents. The effect on minimum alveolar concentration is likely to be most pronounced for the less soluble volatile agents in current use.
Impact of Frailty and Comorbidities on Surgical Outcomes and Complications in Adult Spinal Disorders
Authors: Yagi Mitsuru , Fujita Nobuyuki , Okada Eijiro , Tsuji Osahiko , Nagoshi Narihito , Tsuji Takashi , Asazuma Takashi , Nakamura Masaya , Matsumoto Morio , Watanabe Kota 
Published: February 2018

Study Design.
Retrospective review of surgically treated 481 adult patients with spinal disorders.

Objective.
The aim of this study was to elucidate the effect of frailty and comorbidities on postoperative health-related quality of life (HRQoL) and complication rates.

Summary of Background Data.
Elective surgeries for spinal disorders not only improve clinical outcomes but also have high complication rates.

Methods.
We retrospectively reviewed the results of consecutive elective spine surgeries for 156 adult spinal deformities (ASDs: 65 ± 9 years), 152 degenerative spondylolisthesis (DS: 64 ± 10 years), or 173 lumbar spinal canal stenosis (LSCS: 71 ± 9 years) with follow-up of at least 2 years. Modified Frailty Index (mFI) and Charlson Comorbidity Index (CCI) were determined from baseline demographics. We compared the prevalence and the influence of mFI and CCI on postoperative outcomes and complication rates.

Results.
The mFI and CCI were significantly worse in ASD than in others (mFI: ASD 0.09 ± 0.12, DS 0.06 ± 0.06, LSCS 0.04 ± 0.05, P < 0.01. CCI: ASD 2.1 ± 1.6, DS 1.4 ± 0.7, LSCS 1.6 ± 0.9, P < 0.01). Postoperative HRQoL deteriorated as mFI worsened in ASD (nofrail: Oswestry Disability Index [ODI] 26 ± 11, Scoliosis Research Society Questionnaire [SRS] 3.7 ± 0.7; prefrail: ODI 32 ± 12, SRS 3.6 ± 0.6; frail: ODI 42 ± 15, SRS 3.2 ± 0.7). In DS and LSCS, however, SF-36 physical component score and mental component score improved regardless of mFI and CCI. The 2-year major complications rate increased with frailty (36%, 58%, and 81%) in ASD, but not in others.

Conclusion.
ASDs were more frail and had more comorbidities than the other populations. In ASD, postsurgical outcomes and complication rates deteriorated as frailty and CCI increased, whereas surgery produced favorable outcomes and acceptable complication rates in DS and LSCS regardless of frailty and CCI. Careful patient selection and treatment of comorbidities before surgery may decrease complications and improve outcomes for the surgical treatment of ASD.

Level of Evidence: 4
Rheumatoid Arthritis Is Associated With an Increased Risk of Postoperative Infection and Revision Surgery in Elderly Patients Undergoing Anterior Cervical Fusion
Authors: Horowitz Jason A. , Puvanesarajah Varun , Jain Amit , Li Xudong J. , Shimer Adam L. , Shen Francis H. , Hassanzadeh Hamid 
Published: February 2018

Study Design.
Retrospective review.

Objective.
To identify the incidence and analyze the risk of postoperative complications amongst elderly patients with rheumatoid arthritis undergoing anterior cervical fusion.

Summary of Background Data.
Previous studies have reported elevated risks of postoperative complications for patients with rheumatoid arthritis undergoing orthopedic procedures. However, little is known about the risk of postoperative complications in rheumatoid arthritis patients after spine surgery.

Methods.
A commercially available database was queried for all Medicare patients 65 years of age and older undergoing one- or two-level primary anterior cervical fusion surgeries from 2005 to 2013. Complications, hospitalization costs, and length of stay were queried. Multivariate logistic regression analyses were performed to estimate the odds ratio for each complication adjusted for age, sex, and Charlson Comorbidity Index.

Results.
A total of 6067 patients with a history of rheumatoid arthritis and 113,187 controls were identified. Significantly higher incidences of major medical complications (7.5% vs. 5.9%, P < 0.001), postoperative infections (2.6% vs. 1.5%, P < 0.001), and revision surgery (1.1% vs. 0.6%, P < 0.001) were observed amongst the rheumatoid arthritis cohort. Significantly greater average cost of hospitalization ($17,622 vs. $12,489, P < 0.001) and average length of stay (3.13 vs. 2.08 days, P < 0.001) were also observed.

Conclusion.
Patients with rheumatoid arthritis undergoing anterior cervical fusion face increased risks of postoperative infection and revision surgery compared to normal controls. This information is valuable for preoperative counseling and risk stratification.

Level of Evidence: 3
Management of Early Deep Wound Infection After Thoracolumbar Instrumentation
Authors: Yuan Wei , Liu Xuan , Zhou Xiaoshu , Pei Lei , Zhu Yue 
Published: February 2018

Study Design.
A retrospective study.

Objective.
The aim of this study was to compare the clinical outcomes of continuous irrigation suction systems (CISS) or vacuum-assisted closure system (VACS) in early deep wound infection (DWI) after thoracolumbar instrumentation.

Summary of Background Data.
DWI after thoracolumbar instrumentation is challenging and debridement followed by either CISS or VACS has been proven to be effective. So far, which one of the system has more advantages over the other remains unclear.

Methods.
Patients after thoracolumbar instrumentation were evaluated at our spine surgery center from 2005 to 2015. Patients who were diagnosed with early deep DWI after spinal instrumentation and treated by meticulous debridement in the operating room followed by either CISS or VACS were included. Detailed information was obtained from the medical records, including clinical features, results of laboratory examinations, medical therapies, and outcomes. A follow-up was conducted to observe whether recurrent spinal infection or other complications happened.

Results.
We identified 11 patients in the CISS group and 12 patients in the VACS group. There were no significant differences in terms of age, gender, follow-up duration, symptoms of infection, laboratory examinations, etc. The number of CISS or VACS replacement was 1.3 and 1.6, respectively, before wound healing (P > 0.05). And there were significant differences in terms of hospital stay and extra cost of infection treatment between the two groups. In the follow-up period, we observed sinus tract formation and low back pain in both groups and one patient in the VACS group died of pulmonary infection 4 years after the initial surgery.

Conclusion.
Thorough debridement followed by CISS or VACS are comparable in treating early DWI after thoracolumbar instrumentation. The CISS treatment was statistically significant in comparison to the VACS treatment in terms of hospital stay and cost.

Level of Evidence: 4
Impact of Psychiatric Comorbidities on Short-Term Outcomes Following Intervention for Lumbar Degenerative Disc Disease
Authors: Kalakoti Piyush , Sciubba Daniel M. , Pugely Andrew J. , McGirt Matthew J. , Sharma Kanika , Patra Devi P. , Phan Kevin , Madhavan Karthik , Menger Richard P. , Notarianni Christina , Guthikonda Bharat , Nanda Anil , Sun Hai 
Published: February 2018

Study Design.
Retrospective, observational cohort study.

Objective.
To investigate the impact of psychiatric diseases on short-term outcomes in patients undergoing fusion surgery for lumbar degenerative disc disease (LDDD).

Summary of Background Data.
Limited literature exists on the prevalence and impact of psychiatric comorbidities on outcomes in patients undergoing surgery for LDDD.

Methods.
Adult patients (>18 yr) registered in the Nationwide Inpatient Sample database (2002–2011) and undergoing an elective spine fusion for LDDD that met inclusion criteria formed the study population. Defined primary outcome measures were discharge disposition, length of stay, hospitalization cost, and short-term postsurgical complications (neurological, respiratory, cardiac, gastrointestinal, wound complication and infections, venous thromboembolism, and acute renal failure). Multivariable regression techniques were used to explore the association of psychiatric comorbidities on short-term outcomes by adjusting for patient demographics, clinical, and hospital characteristics.

Results.
Of the 126,044 adult patients undergoing fusion surgery for LDDD (mean age: 54.91 yr, 58% female) approximately 18% had a psychiatric disease. Multivariable regression analysis revealed patients with psychiatric disease undergoing fusion surgery have higher likelihood for unfavorable discharge (odds ratio [OR] 1.41; 95% confidence interval [CI] 1.35–1.47; P < 0.001), length of stay (OR 1.03; 95% CI 1.02–1.04; P < 0001), postsurgery neurologic complications (OR 1.25; 95% CI 1.13–1.37; P < 0.001), venous thromboembolic events (OR 1.38 95% CI 1.26–1.52; P < 0.001), and acute renal failure (OR 1.17; 95% CI 1.01–1.37; P = 0.040). Patients with psychiatric disease were also associated to have higher hospitalization cost (6.3% higher; 95% CI: 5.6%–7.1%; P < 0.001) compared to those without it.

Conclusion.
Our study quantifies the estimates for presence of concomitant psychiatric comorbid conditions on short outcomes in patients undergoing fusions for LDDD. The data provide supporting evidence for adequate preoperative planning and postsurgical care including consultation for mental health for favorable outcomes.

Level of Evidence: 4
Lymphocyte Count at 4 Days Postoperatively
Authors: Iwata Eiichiro , Shigematsu Hideki , Yamamoto Yusuke , Tanaka Masato , Okuda Akinori , Morimoto Yasuhiko , Masuda Keisuke , Nakajima Hiroshi , Koizumi Munehisa , Tanaka Yasuhito 
Published: February 2018

Study Design.
Case-control study.

Objective.
To identify laboratory markers for surgical site infection (SSI) in posterior lumbar decompression surgery, which are not affected by operative factors, and to determine the diagnostic cutoffs of these markers.

Summary of Background Data.
Numerous laboratory markers are used for the early detection of SSI; however, these markers may be affected by operative factors.

Methods.
The study included 182 participants. They were divided into an SSI group (patients who developed deep SSI; n = 8) and a no-SSI group (n = 174). We reviewed data on the C-reactive protein level and total white blood cell count and differential count before posterior lumbar decompression surgery and 1 and 4 days postoperatively. We determined which markers differed significantly between the groups and identified the markers that were not affected by operative factors (operative time, intraoperative blood loss, and number of operative segments) in the no-SSI group. We then determined the diagnostic cutoffs of these unaffected markers using receiver operating characteristic curves.

Results.
We identified the lymphocyte percentage at 4 days postoperatively (cutoff, <19.4%; sensitivity, 80.0%; specificity, 62.5%; area under the curve, 0.78) and lymphocyte count at 4 days postoperatively (cutoff, <1010/μL; sensitivity, 93.7%; specificity, 62.5%; area under the curve, 0.78) as reliable markers.

Conclusion.
Lymphocyte percentage and count at 4 days postoperatively are reliable markers for SSI after posterior lumbar decompression surgery. Lymphocyte count at 4 days postoperatively can be considered as a superior marker for screening because it has a high sensitivity and can be measured early.

Level of Evidence: 4