bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical management of tailgut cysts
Authors: Li Jiannan , Song Xiaowei , Shi Jian , Zhang Kai , Liu Tongjun 
Published: February 2019

Abstract

Rationale:
Tailgut cysts are a type of very rare congenital polycystic lesions that are always located posterior to the rectum and anterior to the sacrum. The symptoms of tailgut cysts are nonspecific and misleading. Therefore, a full understanding of the characteristics of tailgut cysts is important for their diagnosis and treatment.

Patient concerns:
We report a 46-year-old female with a sacrococcygeal mass that had been present for about 2 years.

Diagnoses:
Pelvic magnetic resonance imaging (MRI) indicated several cystic masses, the largest of which had a diameter of about 2.8 cm, near the ligaments of the sacrospinous and rectum. Pathological examination confirmed the tailgut cysts, with no signs of malignant transformation.

Interventions:
The patient received complete surgical cysts resection, which was performed through the sacrococcygeal region.

Outcomes:
The patient recovered well with no obvious complication and was discharged on the sixth-day post-surgery. Follow-up 6 months later revealed no signs of cyst recurrence.

Lessons:
The symptoms and diagnostic characteristics of tailgut cysts should be fully understood. Complete surgical resection through the sacrococcygeal region is vital to treat tailgut cysts.
Renal impairment is associated with increased risk of mortality in patients with cirrhosis
Authors: Umemura Takeji , Joshita Satoru , Shibata Soichiro , Sugiura Ayumi , Yamazaki Tomoo , Fujimori Naoyuki , Matsumoto Akihiro , Tanaka Eiji 
Published: February 2019

Abstract
Although renal impairment is a frequent complication in cirrhosis that is associated with a poor prognosis, little has been reported on the clinical significance of renal impairment in cirrhosis in Japan. This retrospective study assessed the impact of renal impairment on mortality in Japanese cirrhosis patients taking conventional diuretics.
A total of 157 patients with cirrhosis receiving diuretic treatment were evaluated for the presence and status of renal impairment, defined as an increase in serum creatinine of ≥ 0.3 mg/dL or by ≥ 50%, and then classified according to the International Club of Ascites (ICA)-Acute Kidney Injury (AKI) staging system.
Eighty of 157 (51%) patients fulfilled the criteria for renal impairment. Thirty-four (43%) patients had ICA-AKI stage 1, 32 (40%) stage 2, and 14 (18%) stage 3. Multivariate analysis revealed female gender (hazard ratio [HR] = 0.407, 95% confidence interval = 0.193–0.857; P = .018), ALT ≥35 IU/L (HR = 3.841, 95% confidence interval = 1.785–8.065; P = .001), and the presence of renal impairment (HR = 4.275, 95% confidence interval = 1.962–9.312; P < .001) as independent factors significantly increasing the risk of mortality. Cumulative survival rates increased significantly with ICA–AKI stage (log-rank test, P = .009).
Renal impairment was a predictive marker of mortality in Japanese patients with cirrhosis. Stratification according to ICA–AKI criteria of kidney function impairment may be a good prognostic indicator of cirrhosis outcome.
Surgical outcomes and quality of life between laparoscopic and open approach for hepatic hemangioma
Authors: Liu Qinqin , Liu Fei , Ding Jingjing , Wei Yonggang , Li Bo 
Published: February 2019

Abstract
The main objective of the study was to compare the surgical outcomes and quality of life (QOL) of patients with hepatic hemangioma either by laparoscopic or open surgery using a propensity score analysis.
We retrospectively reviewed patients with hepatic hemangioma undergoing laparoscopic liver surgery (LLS) or open liver surgery (OLS) between January 2016 and December 2017. Intraoperative and postoperative characteristics, and quality of life, according to Short Form-36 Healthy Survey (SF-36) questionnaire, were compared between groups. We performed 1:1 propensity score matching (PSM) between the LLS and OLS groups.
A total of 205 patients who involved in the analysis (80 LLS vs 125 OLS) were matched (1:1) by age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) score, previous upper abdominal surgery, comorbidities, operation method, type of resection, tumor localization, size, and number. After PSM, 73 well-matched patients in each group were obtained. LLS was associated with significantly less blood loss, shorter postoperative hospital stay and fewer complications. The QOL scores weren’t significantly different between the 2 groups, though the LLS group tended to be superior to the OLS group in terms of bodily pain (BP) and mental health (MH) at 3 months after surgery.
In comparison with the conventional open approach, laparoscopic liver surgery for hepatic hemangioma appears to have improved short-term surgical outcomes and comparable QOL in selected patients.
A Tool to Guide Clinical Nurse Specialist Orientation, Professional Development, and Evaluation
Authors: McNeill Margaret M. , Ahluwalia Anushree R. , Young Samantha , Randell Tania Vucich , Moore Denise Ann 
Published: February 2019

Purpose/Objectives:
Currently, orientation for clinical nurse specialists (CNSs) in the Baltimore region is based on past practices: facility-specific or position-specific. A Chesapeake Bay affiliate work group identified a need to develop a theory-driven, competency-based program and tool to guide orientation and ongoing professional development reflecting the scope of CNS practice.

Description of the Project/Program:
The tool incorporates Benner’s concepts of novice-to-expert competence levels, guides progressive development of the CNS, and has relevant assessment metrics that highlight contributions to the patient, nurse, and system.

Outcome:
The group developed a comprehensive orientation tool grounded in the spheres of influence and advanced practice competencies and specific, measurable behavioral statements related to competencies from the 2018 National Association of Clinical Nurse Specialists’ draft. This program is adaptable to guide the practice of a CNS in any facility, validate competence, and relate to those with varied experience in the role.

Conclusion:
In a method similar to the process for developing nationally recognized educational standards used to develop the competencies, the program was revised based on an iterative, stepwise process. It was distributed to the membership for evaluation and feedback, which was incorporated into the final version.
A Multifaceted Approach to the Prevention of Clostridioides (Clostridium) Difficile
Authors: Pate Kimberly , Reece Jennifer , Smyre Alex 
Published: February 2019

Purpose/Objectives
The purpose of this project was to design and implement a sustainable program to reduce hospital-acquired cases of Clostridioides difficile.

Description of the Project
Experiencing higher rates in a large, academic medical center, hospital leaders were assembled. The overall facility rate was 6.9% in 2014 with a first quarter rate of 8.4% in 2015. Individual unit rates were as high as 19.8%. A team of key stakeholders was assembled to plan, execute, and reevaluate targeted solutions. Strategies implemented were an innovative, automated screening tool, an evidence-based prevention bundle; and staff education.

Outcomes
A facility-wide C difficile prevention program was implemented with a sustained decrease in rates observed from 8.4% in the first quarter of 2015 to 6.0% in the fourth quarter of 2017. The standardized infection ratio ranged from 0.541 to 0.889, consistently below the national mean.

Conclusion

Clostridioides difficile is a leading cause of hospital-associated diarrhea and a tremendous burden on healthcare systems increasing morbidity, mortality, and financial strain. A multidisciplinary, multifaceted approach was critical to ensure early detection, reduce risk of transmission, and decrease overall rates.
Health-Related Quality of Life Among Survivors of Pediatric Sepsis*
Authors: Killien Elizabeth Y. , Farris Reid W. D. , Watson R. Scott , Dervan Leslie A. , Zimmerman Jerry J. 
Published: February 2019

Objectives:
Mortality from pediatric sepsis has steadily declined over the past several decades; however, little is known about morbidity among survivors. We aimed to determine the prevalence of and risk factors for failure to recover to baseline health-related quality of life following community-acquired pediatric sepsis.

Design:
Retrospective cohort study.

Setting:
Seattle Children’s Hospital.

Patients:
Children aged 1 month to 21 years admitted to the inpatient wards or ICUs from 2012 to 2015 who met 2005 consensus sepsis criteria within 4 hours of hospitalization and were enrolled in the hospital’s Outcomes Assessment Program with baseline, admission, and post-discharge health-related quality of life data available.

Interventions:
None.

Measurements and Main Results:
We assessed health-related quality of life with the Pediatric Quality of Life Inventory for pre-admission baseline, admission, and post-discharge (median, 31 d) status. We determined associations between patient and illness characteristics with failure to recover within 4.5 points of baseline at follow-up (the minimum clinically significant difference between two scores). Of 790 patients, 23.8% failed to recover to baseline health-related quality of life at follow-up. Factors associated with failure to recover were septic shock, older age, private insurance, complex chronic disease, immune compromise, CNS infection or bacteremia, ICU admission, and longer length of stay. On multivariable analysis controlling for time to follow-up, failure to recover was independently associated with septic shock (relative risk, 1.79; 95% CI, 1.24–2.58), older age (relative risk, 1.02/yr; 95% CI, 1.01–1.05), immune compromise (relative risk, 1.83; 95% CI, 1.40–2.40), and length of stay (relative risk, 1.03/d; 95% CI, 1.01–1.04).

Conclusions:
Nearly one-quarter of children surviving hospitalization for community-acquired sepsis experienced a clinically significant deterioration in health-related quality of life. We identify risk factors for poor outcomes following sepsis and highlight the need for ongoing evaluation and treatment by primary and specialty care providers for pediatric sepsis survivors after hospital discharge.
Proving the Effectiveness of the Fundamentals of Robotic Surgery (FRS) Skills Curriculum
Authors: Satava Richard M. , Stefanidis Dimitrios , Levy Jeffrey S. , Smith Roger , Martin John R. , Monfared Sara , Timsina Lava R. , Darzi Ara Wardkes , Moglia Andrea , Brand Timothy C. , Dorin Ryan P. , Dumon Kristoffel R. , Francone Todd D. , Georgiou Evangelos , Goh Alvin C. , Marcet Jorge E. , Martino Martin A. , Sudan Ranjan , Vale Justin , Gallagher Anthony G. 
Published: February 2019

Objective:
To demonstrate the noninferiority of the fundamentals of robotic surgery (FRS) skills curriculum over current training paradigms and identify an ideal training platform.

Summary Background Data:
There is currently no validated, uniformly accepted curriculum for training in robotic surgery skills.

Methods:
Single-blinded parallel-group randomized trial at 12 international American College of Surgeons (ACS) Accredited Education Institutes (AEI). Thirty-three robotic surgery experts and 123 inexperienced surgical trainees were enrolled between April 2015 and November 2016. Benchmarks (proficiency levels) on the 7 FRS Dome tasks were established based on expert performance. Participants were then randomly assigned to 4 training groups: Dome (n = 29), dV-Trainer (n = 30), and DVSS (n = 32) that trained to benchmarks and control (n = 32) that trained using locally available robotic skills curricula. The primary outcome was participant performance after training based on task errors and duration on 5 basic robotic tasks (knot tying, continuous suturing, cutting, dissection, and vessel coagulation) using an avian tissue model (transfer-test). Secondary outcomes included cognitive test scores, GEARS ratings, and robot familiarity checklist scores.

Results:
All groups demonstrated significant performance improvement after skills training (P < 0.01). Participating residents and fellows performed tasks faster (DOME and DVSS groups) and with fewer errors than controls (DOME group; P < 0.01). Inter-rater reliability was high for the checklist scores (0.82–0.97) but moderate for GEARS ratings (0.40–0.67).

Conclusions:
We provide evidence of effectiveness for the FRS curriculum by demonstrating better performance of those trained following FRS compared with controls on a transfer test. We therefore argue for its implementation across training programs before surgeons apply these skills clinically.
Open Versus Laparoscopic Versus Robotic Versus Transanal Mesorectal Excision for Rectal Cancer
Authors: Simillis Constantinos , Lal Nikhil , Thoukididou Sarah N. , Kontovounisios Christos , Smith Jason J. , Hompes Roel , Adamina Michel , Tekkis Paris P. 
Published: February 2019

Objective:
To compare techniques for rectal cancer resection.

Summary Background Data:
Different surgical approaches exist for mesorectal excision.

Methods:
Systematic literature review and Bayesian network meta-analysis performed.

Results:
Twenty-nine randomized controlled trials included, reporting on 6237 participants, comparing: open versus laparoscopic versus robotic versus transanal mesorectal excision. No significant differences identified between treatments in intraoperative morbidity, conversion rate, grade III/IV morbidity, reoperation, anastomotic leak, nodes retrieved, involved distal margin, 5-year overall survival, and locoregional recurrence. Operative blood loss was less with laparoscopic surgery compared with open, and with robotic surgery compared with open and laparoscopic. Robotic operative time was longer compared with open, laparoscopic, and transanal. Laparoscopic operative time was longer compared with open. Laparoscopic surgery resulted in lower overall postoperative morbidity and fewer wound infections compared with open. Robotic surgery had fewer wound infections compared with open. Time to defecation was longer with open surgery compared with laparoscopic and robotic. Hospital stay was longer after open surgery compared with laparoscopic and robotic, and after laparoscopic surgery compared with robotic. Laparoscopic surgery resulted in more incomplete or nearly complete mesorectal excisions compared with open, and in more involved circumferential resection margins compared with transanal. Robotic surgery resulted in longer distal resection margins compared with open, laparoscopic, and transanal.

Conclusions:
The different techniques result in comparable perioperative morbidity and long-term survival. The laparoscopic and robotic approaches may improve postoperative recovery, and the open and transanal approaches may improve oncological resection. Technique selection should be based on expected benefits by individual patient.
Inter- and Intra-Generation Genomic Predictions for Douglas-fir Growth in Unobserved Environments
Authors: Ratcliffe Blaise , Thistlethwaite Francis , El-Dien Omnia Gamal , Cappa Eduardo P. , Porth Ilga , Klápště Jaroslav , Chen Charles , Wang Tongli , Stoehr Michael , El-Kassaby Yousry A. 
Published: February 2019

ABSTRACTConifers are prime candidates for genomic selection (GS) due to their long breeding cycles. Previous studies have shown much reduced prediction accuracies (PA) of breeding values in unobserved environments, which may impede its adoption. The impact of explicit environmental heterogeneity modeling including genotype-by-environment (G×E) interaction effects using environmental covariates (EC) in a reaction-norm genomic prediction model was tested using single-step GBLUP (ssGBLUP). A three-generation coastal Douglas-fir experimental population with 14 genetic trials (n = 13,615) permitted estimation of intra- and inter-generation PA in unobserved environments using 66,969 SNPs derived from exome capture. Intra- and inter-generation PAs ranged from 0.447-0.640 and 0.317-0.538, respectively. The inclusion of ECs in the prediction models explained up to 23% of the phenotypic variation for the fully specified model and resulted in the best model fit. Modeling G×E effects in the training population increased PA up to 6% and 13% over the base model for inter- and intra-generations, respectively. GS-PA can be substantially improved using ECs to explain environmental heterogeneity and G×E effects. The ssGBLUP methodology allows historical genetic trials containing non-genotyped samples to contribute in genomic prediction, and, thus, effectively boosting training population size which is a critical step. Further pheno- and enviro-typing developments may improve GS-PA.
Epidemiological Analysis of Ear Diseases in 221 Dogs in Northwest of China
Authors: Tang F-L. , Yang H-Q. , Ma X-W. , Lu D-Z. 
Published: February 2019

AbstractEar disease is a relatively common disease in veterinary, and it will great effect on the pets’ life. This study mainly collected and collated the cases of Xi’an Teaching Hospital of Northwest A&F University from 2012 to 2016, and conducted an epidemiological analysis of the incidence of ear disease in dogs. In this study, the common ear diseases in dogs were divided into otitis externa, otitis media, otitis interna, and ear hematoma. The results showed that the total number of dog ear disease cases was 221, the highest incidence was otitis externa (84.62%), and the main cause of otitis externa was the bacterial infection (44.10%), which followed by fungal infection (32.31%). The ratio of male to female is 1:1.5. In terms of the dog species, the highest incidence was Teddy (18.55%), followed by the Golden Retriever (10.41%). The most common ear diseases in puppies was otitis externa, ear canal hyperplasia and ear canal tumors occur mainly in older dogs. Through the analysis of the 221 cases of ear diseases, we could better understand the development and epidemiology of dog ear diseases, and provide some reference for clinical diagnosis, treatment and prevention of dog ear diseases.
Murine Surf4 is essential for early embryonic development
Authors: Emmer Brian T. , Lascuna Paul J. , Kotnik Emilee N. , Saunders Thomas L. , Khoriaty Rami , Ginsburg David 
Published: February 2019

ABSTRACTNewly synthesized proteins co-translationally inserted into the endoplasmic reticulum (ER) lumen may be recruited into anterograde transport vesicles by their association with specific cargo receptors. We recently identified a role for the cargo receptor SURF4 in facilitating the secretion of PCSK9 in cultured cells. To examine the function of SURF4 in vivo, we used CRISPR/Cas9-mediated gene editing to generate mice with germline loss-of-function mutations in Surf4. Surf4+/- mice exhibited grossly normal appearance, behavior, body weight, fecundity, and organ development and demonstrated no significant alterations in circulating plasma levels of PCSK9, apolipoprotein B, or total cholesterol. Surf4-/- mice exhibit embryonic lethality, with complete loss of all Surf4-/- offspring between embryonic days 3.5 and 9.5. Taken together with the much milder phenotypes of PCSK9 or apolipoprotein B deficiency in mice, these findings imply the existence of additional SURF4 cargoes or functions that are essential for murine early embryonic development.
Threonine synthase CoTHR4 is involved in infection-related morphogenesis during the pre-penetration stage in Colletotrichum orbiculare
Authors: Harata Ken , Okuno Tetsuro 
Published: February 2019

AbstractUpon recognition of host plants, Colletotrichum orbiculare, an anthracnose disease fungus of cucurbitaceous plants, initiates morphological differentiation, including conidial germination and appressorium formation on the cuticle layer. The series of infection processes of C. orbiculare requires enormous nutrient and energy, but the surface of the cucurbitaceous hosts is hardly nutrient-rich. Hence, C. orbiculare must exert tight management of its intracellular nutrients in order to properly induce infection-related morphogenesis. Here, we carried out a large-scale insertional mutagenesis screen using Agrobacterium tumefaciens-mediated transformation to identify novel genes involved in the pathogenicity of C. orbiculare and found that CoTHR4-encoded threonine synthase, a homolog of Saccharomyces cerevisiae THR4, is required for pathogenicity and conidiation in C. orbiculare. Threonine supplementation allowed the cothr4 mutant to produce conidia to a level equivalent to that of the wild-type. The conidia produced from the threonine-treated cothr4 mutant failed to germinate in the absence of threonine, but retained the ability to germinate and to form appressoria in the presence of threonine. However, the conidia produced from the threonine-treated cothr4 mutant remained attenuated in pathogenicity on cucumber cotyledons even in the presence of threonine. Cytorrhysis assays revealed that appressoria of the cothr4 mutant induced by exogenous threonine treatment showed low turgor generation. Taken together, these results showed that threonine synthase CoThr4 plays a pivotal role in infection-related morphogenesis during the pre-penetration stage of C. orbiculare.
Integration of facility management and building information modeling (BIM)
Authors: Dixit Manish K. , Venkatraj Varusha , Ostadalimakhmalbaf Mohammadreza , Pariafsai Fatemeh , Lavy Sarel 
Published: February 2019

Purpose
The purpose of this study is to investigate factors that impede the integration of facilities management (FM) into building information modeling (BIM) technology. The use of BIM technology in the commercial construction industry has grown enormously in recent years. Its application to FM, however, is still limited. The literature highlights issues that hinder BIM–FM integration, which are studied and discussed in detail in this paper.

Design/methodology/approach
A review of literature is conducted to identify and categorize key issues hampering the application of BIM to FM. This paper has also designed a questionnaire based on a literature review and surveyed FM professionals at two industry events. Using the collected responses, these issues are analyzed and discussed using non-parametric statistical analyses.

Findings
A total of 16 issues are identified through the literature review of 54 studies under the four categories of BIM-execution and information-management, technological, cost-based and legal and contractual issues. The results of the survey of FM professionals (with 57 complete responses) reveal that the single most important issue is the lack of FM involvement in project phases when BIM is evolving.

Originality/value
The findings of this study could assist the construction industry (e.g. building-material and equipment manufacturers, design professionals, general contractors, construction managers, owners and facility managers) with creating guidelines that would help in BIM–FM integration. BIM is a virtual database that contains important design and construction information, which can be used for effective and efficient life cycle management if building data are captured completely and accurately with a facility manager’s involvement.