bluuebunny/crossref_metadata_2025_split huggingface dataset:
No difference between direct-acting antivirals for hepatitis C in hepatocellular carcinoma risk
Authors: Mun Elijah J. , Green Pamela , Berry Kristin , Ioannou George N. 
Published: August 2018

Background and aims
It is unclear whether there are differences between direct-acting antivirals (DAAs) for hepatitis C virus in risk of hepatocellular carcinoma (HCC) after antiviral therapy. We aimed to compare different DAA regimens with respect to risk of de novo HCC following antiviral therapy.

Patients and methods
We identified 33 137 patients who initiated hepatitis C virus antiviral treatment in the Veterans Affair healthcare system between 6 December 2013 and 31 December 2015 with one of four DAA-only regimens (± ribavirin): paritaprevir/ritonavir/ombitasvir/dasabuvir (n=6289), sofosbuvir (n=4356), sofosbuvir+simeprevir (n=3210), and ledipasvir/sofosbuvir (n=19 282). We retrospectively followed patients until 15 June 2017 to identify incident (de novo) cases of HCC. We used propensity score-adjusted Cox proportional hazards regression to compare different DAA regimens with respect to HCC risk.

Results
During a mean follow-up of 1.52 years, 741 new cases of HCC were diagnosed after antiviral treatment (annual incidence=1.47%). Patients treated with sofosbuvir+simeprevir had the highest annual HCC incidence (2.47%), followed by sofosbuvir (1.91%), ledipasvir/sofosbuvir (1.26%), and paritaprevir/ritonavir/ombitasvir/dasabuvir (0.95%). However, there were great differences between DAA-treated patients in the prevalence of cirrhosis, markers of advanced fibrosis, thrombocytopenia, and other HCC risk factors. After adjustment for baseline characteristics associated with HCC, there were no significant differences in HCC risk between the four DAA regimens.

Conclusion
There are no significant differences between DAA regimens in HCC risk after antiviral treatment. This suggests that DAAs do not have direct carcinogenic effects as it would be unlikely that different DAAs would have identical carcinogenic effects.
To transfuse or not transfuse: an intensive appraisal of red blood cell transfusions in the ICU
Authors: Hayes Margaret M. , Uhl Lynne 
Published: August 2018

Purpose of review
This review is a critical appraisal of the current data comparing restrictive vs. liberal transfusion strategies for patients who are critically ill in ICUs. We focus on four subsets of critically ill patients: pediatric patients, patients with gastrointestinal bleeds, septic patients and patients undergoing cardiac surgery.

Recent findings
Almost a decade after the TRICC trial, a randomized trial showing the safety of a restrictive transfusion threshold in critically ill patients, four large randomized controlled trials have shown that a restrictive transfusion strategy is safe in pediatric critically ill patients, patients with acute upper gastrointestinal bleeds, patients with septic shock and patients undergoing cardiac surgery. A large multicenter randomized trial is underway to determine the safety of a restrictive strategy in myocardial infarction.

Summary
A restrictive transfusion threshold is recommended in nearly all critically ill patients. This is at least noninferior to more liberal transfusion practice; in addition, a restrictive threshold has shown improved outcomes in some patients and decreased chances of adverse events in patients. Judicious use of red cells improves patient outcome and protects the blood supply, a limited resource. More data are needed to determine appropriate transfusion threshold recommendations for patients with traumatic brain injury and acute coronary syndrome.
Next-generation sequencing-based minimal residual disease monitoring in patients receiving allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia or myelodysplastic syndrome
Authors: Shapiro Roman M. , Kim Dennis Dong Hwan 
Published: August 2018

Purpose of review
The monitoring of minimal residual disease (MRD) has important clinical implications in both the pre and postallogeneic stem cell transplant (SCT) setting in acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). Next-generation sequencing (NGS) is a rapidly improving technology whose application to the monitoring of MRD is an active area of research. We aim to describe existing methods of MRD in AML and MDS, with a focus on the utility of NGS in patients undergoing SCT.

Recent findings
Flow cytometry and quantitative PCR have been recommended by the European Leukemia Net as the preferred methods of MRD in AML and MDS, but these methods have limitations in cases without a disease-defining phenotype and genotype. Clinical trials are currently ongoing to assess the use of NGS in the setting of SCT for MDS and AML. Few studies have so far assessed the optimal method of MRD monitoring in the posttransplant setting.

Summary
The optimal method for the monitoring of MRD in AML and MDS both pre and post transplant may require more than one technology. NGS holds great promise for the monitoring of MRD, with prospective trials currently ongoing to evaluate its efficacy in this regard.
The role of genomics in transfusion medicine
Authors: Wheeler Marsha M. , Johnsen Jill M. 
Published: August 2018

Purpose of review
To summarize recent advances in red blood cell (RBC) blood group genotyping, with an emphasis on advances in the use of NGS next generation sequencing (NGS) to detect clinically relevant blood group gene variation.

Recent findings
Genetic information is useful in predicting RBC blood group antigen expression in several clinical contexts, particularly, for patients at high-risk for allosensitization, such as multiple transfused patients. Blood group antigen expression is directed by DNA variants affecting multiply genes. With over 300 known antigens, NGS offers the attractive prospect of comprehensive blood group genotyping. Recent studies from several groups show that NGS reliably detects blood group gene single nucleotide variants (SNVs) with good correlation with other genetic methods and serology. Additionally, new custom NGS methods accurately detect complex DNA variants, including hybrid RH alleles. Thus, recent work shows that NGS detects known and novel blood group gene variants in patients, solves challenging clinical cases, and detects relevant blood group variation in donors.

Summary
New work shows that NGS is particularly robust in identifying SNVs in blood group genes, whereas custom genomic tools can be used to identify known and novel complex structural variants, including in the RH system.
Current status and future direction of uterus transplantation
Authors: Brännström Mats 
Published: August 2018

Purpose of review
The current review gives an updated synopsis of all cases of uterus transplantation (UTx) that has been published and technical details about surgery. The live births that so far have been reported are described regarding pregnancy and outcome. In addition, the review highlights some specific areas of live donor UTx, deceased donor UTx and UTx in general that need further research for clarification/optimization. It is predicted that the clinical field of UTx will expand rapidly and recommendations for a scientific development of the UTx field are presented.

Recent findings
The first successful UTx was performed in Sweden in February 2013, with the proof of success being the first UTx live birth (September 2014). This proof-of-concept of UTx as a treatment of absolute uterine factor infertility has been followed by several more births in Sweden, USA and Brazil. Live births have occurred both after live donor UTx and deceased donor UTx.

Summary
UTx is still at the experimental stage and new UTx cases should be within registered trials and with data accumulated in an international registry, to collect data and results to further optimize the procedure concerning efficiency and safety.
Minimal Clinically Important Difference of the 6-Minute Walk Test in People With Stroke
Authors: Fulk George D. , He Ying 
Published: August 2018

Background and Purpose:
The 6-minute walk test (6MWT) is commonly used in people with stroke. The purpose of this study was to estimate the minimal clinically important difference (MCID) of the 6MWT 2 months poststroke.

Methods:
We performed a secondary analysis of data from a rehabilitation trial. Participants underwent physical therapy between 2 and 6 months poststroke and the 6MWT was measured before and after. Two anchors of important change were used: the modified Rankin Scale (mRS) and the Stroke Impact Scale (SIS). The MCID for the 6MWT was estimated using receiver operating characteristic curves for the entire sample and for 2 subgroups: initial gait speed (IGS) <0.40 m/s and ≥0.40 m/s.

Results:
For the entire sample, the estimated MCID of the 6MWT was 71 m with the mRS as the anchor (area under the curve [AUC] = 0.66) and 65 m with the SIS as the anchor (AUC = 0.59). For participants with IGS <0.40 m/s, the estimated MCID was 44 m with the mRS as the anchor (AUC = 0.72) and 34 m with the SIS as the anchor (AUC = 0.62). For participants with IGS ≥0.40 m/s, the estimated MCID was 71 m with the mRS as the anchor (AUC = 0.59) and 130 m with the SIS as the anchor (AUC = 0.56).

Discussion and Conclusions:
Between 2 and 6 months poststroke, people whose IGS is <0.40 m/s and experience a 44-m improvement in the 6MWT may exhibit meaningful improvement in disability. However, we were not able to estimate an accurate MCID for the 6MWT in people whose IGS was ≥0.40 m/s. MCID values should be estimated across different levels of function and anchors of importance.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A232).
Aspirin for the Prevention of Preterm and Term Preeclampsia: Systematic Review and Meta-analysis
Authors: Roberge Stephanie , Bujold Emmanuel , Nicolaides Kypros H. 
Published: August 2018

(Abstracted from Am J Obstet Gynecol 2018;218:287–293.e1)
Several randomized studies have found contradictory results while examining the possibility of preventing preeclampsia with a prophylactic daily dose of aspirin. Preeclampsia is a major cause of morbidity and mortality in mothers and their newborns, and it can have particularly adverse consequences if associated with preterm birth.
Pediatric Neurocritical Care: Evolution of a New Clinical Service in PICUs Across the United States
Authors: LaRovere Kerri L. , Murphy Sarah A. , Horak Robin , Vittner Patrick , Kapur Kush , Proctor Mark , Tasker Robert C. 
Published: August 2018

Objectives:
Pediatric neurocritical care as a conceptual service is relatively new, and implementation of such specialized services may improve outcomes for children with disorders of the brain or spinal cord. How many pediatric neurocritical care services currently exist in the United States, and attitudes about such a service are unknown.

Design:
Web-based survey, distributed by e-mail.

Setting:
Survey was sent to PICU Medical Directors and Program Directors of Pediatric Neurosurgery fellowship and Child Neurology residency programs.

Patients:
None.

Interventions:
None.

Measurements and Main Results:
A total of 378 surveys were distributed; 161 respondents representing 128 distinct hospitals completed the survey (43% response rate). Thirty-five percent (45/128) reported having a pediatric neurocritical care service. The most common type of service used a consultation model (82%; 32/39 responses). Other types of services were intensivist-led teams in the PICU (five hospitals) and dedicated PICU beds (two hospitals). Hospital characteristics associated with availability of pediatric neurocritical care services were level 1 trauma status (p = 0.017), greater numbers of PICU beds (χ2 [6, n = 128] = 136.84; p < 0.01), and greater volume of children with pediatric neurocritical care conditions (χ2 [3, n = 128] = 20.16; p < 0.01). The most common reasons for not having a pediatric neurocritical care service were low patient volume (34/119 responses), lack of subspecialists (30/119 responses), and lack of interest by PICU faculty (25/119 responses). The positive impacts of a pediatric neurocritical care service were improved interdisciplinary education/training (16/45 responses), dedicated expertise (13/45 responses), improved interservice communication (9/45 responses), and development/implementation of guidelines and protocols (9/45 responses). The negative impacts of a pediatric neurocritical care service were disagreement among consultants (2/45 responses) and splitting of the PICU population (2/45 responses).

Conclusions:
At least 45 specialized pediatric neurocritical care services exist in the United States. Eighty percent of these services are a consultation service to the PICU. Hospitals with level 1 trauma status, greater numbers of PICU beds, and greater numbers of patients with pediatric neurocritical care conditions were associated with the existence of pediatric neurocritical care as a clinical service.
Benefits of Maxillary Expansion for a Patient With Spinal Muscular Atrophy Type 2
Authors: Abeleira María Teresa , Limeres Jacobo , Outumuro Mercedes , Vidal Paula Sofía , Diniz-Freitas Marcio , Ruíz-Piñón Manuel , Diz Dios Pedro 
Published: August 2018

Abstract
This case report involves a 10-yr-old boy diagnosed with spinal muscular atrophy type 2 who underwent nighttime mechanical ventilation with bilevel positive airway pressure. The oral examination revealed restricted mouth opening, lip interposition, dental crowding, and maxillary compression. After maxillary expansion, the upper airway volume increased 18.6%; 13 episodes of airway infections (20 days of hospitalization) were recorded in the 2 yrs before the maxillary expansion and only 4 episodes (no hospital admissions) in the 2 subsequent years. In conclusion, maxillary expansion in children with systemic disease that involves respiratory impairment may, in some cases, provide functional and clinical improvements, increase upper airway airflows, and possibly decrease the number of respiratory infections
Chemical Components Separation: Concepts, Evidence, and Outcomes
Authors: Motz Benjamin M. , Schlosser Kathryn A. , Heniford B. Todd 
Published: August 2018

Summary:
Ventral hernias with loss of domain pose a significant challenge to the hernia surgeon. Techniques such as advancement flaps, component separation, progressive pneumoperitoneum, and preoperative injection of botulinum toxin A (BTA) aim to alter the abdominal wall length or form to achieve tension-free primary fascial repair in abdominal wall reconstruction (AWR). Here, we review the current literature on BTA injection as an adjunct to AWR. A literature review identified 22 articles discussing the use of BTA associated with ventral hernia repair. Six primary studies reported preoperative use of BTA. Treatment regimens are not standardized, varying from 300 to 500 u injection on 3–5 sites per laterality, from 4 weeks before the day of surgery. After injection, computed tomography scans demonstrate elongated and thinned abdominal wall muscles with decreased mean defect size and hernia size. Primary fascial closure is usually achieved. Postoperative pain control may be improved with perioperative administration of BTA, and no adverse events associated with BTA injection were reported. Preoperative BTA injection is a promising adjunct to AWR, creating abdominal wall laxity and enabling primary fascial repair. Further investigation will be needed to determine the ideal dosage, timing, and patient population.
Mesh Selection in Abdominal Wall Reconstruction
Authors: Lak Kathleen L. , Goldblatt Matthew I. 
Published: August 2018

Summary:
Selection of mesh for ventral hernia repair and abdominal wall reconstruction can be challenging. Since the adoption of a tension-free mesh repair, the recurrence rates and outcomes after ventral hernia repair have substantially improved. The market for medical prostheses is constantly changing, with new technology in development attempting to create the ideal mesh for each clinical scenario. Permanent mesh is typically used for clean wounds. The various mesh materials, density, and pore sizes are discussed. In addition, the materials commonly used for contaminated wounds (absorbable synthetic and biologic meshes) are described. The latest literature regarding the use of various mesh materials is reviewed and organized to help make an informed decision regarding the appropriate use of reinforcing material.
The Perfect Plane: A Systematic Review of Mesh Location and Outcomes, Update 2018
Authors: Sosin Michael , Nahabedian Maurice Y. , Bhanot Parag 
Published: August 2018

Background:
The principal approach to abdominal wall reconstruction requires implantation of mesh to decrease ventral hernia recurrence. This study compared current surgical outcomes and complications by location of anatomic mesh placement following ventral hernia repair with onlay, interposition, retromuscular, or underlay mesh reconstruction.

Methods:
A systematic search of the PubMed database published from 2013 to 2018 was performed to identify patients who underwent abdominal wall reconstruction using either biologic or prosthetic mesh for ventral hernia repair. Demographic information and outcomes were obtained from each study.

Results:
Fifty-one articles met inclusion criteria, resulting in 6,227 patients who underwent mesh repair of a ventral hernia. Mesh position included onlay in 7.6% of patients, interposition in 13.2%, retromuscular in 35.9%, and underlay placement in 43.4%. Prosthetic mesh was used in 68.5% of repairs and biological mesh in 31.5%. The mean patient age was 53.1 years (range, 18–95 years), and mean BMI was 29.1 kg/m2 (range, 15–70.9 kg/m2). The mean follow-up was 37.5 ± 2.3 months. The overall mean recurrence rate was 8.3%, with retromuscular (5.8%) and underlay (10.9%) mesh placement trending toward less recurrence than onlay (12.9%) and interposition (21.6%) mesh placement (P = 0.023). Inferior recurrence rates were identified in the onlay and interposition placement of biologic mesh (28.6% and 29.1%, respectively), and analysis of open approaches yielded significant differences with onlay and interposition repairs having the highest hernia recurrence rates (10.9% and 25.4%, respectively). Laparoscopic interposition mesh location showed highest recurrence (10%) as compared with retromuscular (0.1%) and underlay (4.2%) (P = 0.041).

Conclusions:
Mesh reinforcement of a ventral hernia repair continues to be safe and efficacious, and the anatomic location of mesh implantation appears to influence outcomes. Retromuscular or underlay mesh repair is associated with a lower recurrence rate.
Prevention and Treatment Strategies for Mesh Infection in Abdominal Wall Reconstruction
Authors: Kao Angela M. , Arnold Michael R. , Augenstein Vedra A. , Heniford B. Todd 
Published: August 2018

Background:
Mesh infection remains the most feared complication after abdominal wall reconstruction, requiring prolonged hospitalizations and often, mesh removal. Understanding of current prevention and treatment strategies is necessary in the management of a common surgical problem.

Methods:
A comprehensive review of the current surgical literature was performed to determine risk factors of mesh infection after abdominal wall reconstruction and best practices in their prevention and surgical management.

Results:
Patient-related risk factors for mesh infections include smoking, obesity, diabetes mellitus, and COPD. Surgical risk factors such as prolonged operative time and prior enterotomy should also be considered. Prevention strategies emphasize reduction of modifiable risk factors, including obesity and diabetes among other comorbidities. Biologic or biosynthetic mesh is recommended in contaminated fields and use of delayed wound closure or vacuum-assisted closure therapy should be considered in high-risk patients. Conservative treatment with antibiotics, percutaneous or surgical drainage, and negative-pressure vacuum-based therapies have demonstrated limited success in mesh salvage. Mesh infection often requires mesh explantation followed by abdominal wall reconstruction. Staged repairs can be performed; however, definitive hernia repair with biologic mesh has shown promising results.

Conclusions:
Management of mesh infections is a complex, yet commonly faced problem. Strategies used in the prevention and surgical treatment of infected mesh should continue to be supported by high-quality evidence from prospective studies.
The Value Proposition for Complex Abdominal Wall Reconstruction: How to Make It Work
Authors: Ramshaw Bruce , Forman Brandie , Barker Elizabeth , Grimsley Lauren 
Published: August 2018

Background:
The challenge for health care in the 21st century is to understand how to measure and improve value in the context of each patient care process for the entire cycle of care. For patients who undergo an abdominal wall reconstruction, there is a great opportunity to improve value because of the high cost and variability in outcomes for this complex operation.

Methods:
For almost a decade, our hernia team has been applying the principles of systems and data science to actual patient care. Tools from systems and data science applied to patient care include clinical quality improvement and nonlinear analytical methods such as factor analysis. The most important outcome to measure and improve is the value of care provided for the entire cycle of care.

Results:
Many measurement and improvement ideas have been applied to the abdominal wall reconstruction process in our hernia program, including the use of a less costly long-term resorbable mesh, multimodal pain management and enhanced recovery process improvement ideas, and surgical technique improvements that have led to decreased wound complications and the elimination of abdominal wall drains. More recently, the data analysis has shown an opportunity to improve outcomes through a robust prehabilitation program, including cognitive therapy to induce neural rewiring before surgery.

Conclusions:
Improving value for patients who undergo abdominal wall reconstruction and for all patients in our global health care system should be a unifying goal. Understanding and applying systems and data science tools appropriately are necessary to achieve this goal.
The Role and Impact of Registries on Abdominal Wall Reconstruction
Authors: Poulose Benjamin K. , Rosen Michael J. 
Published: August 2018

Summary:
Implicit to any surgeon’s abdominal wall reconstruction (AWR) practice should be the review of results after operations have been performed. This allows surgeons to ensure they are delivering high-quality care to patients. In addition, systematic collection of data centered around AWR greatly facilitates research and postmarket surveillance of medical devices and techniques. Unfortunately, systematic data collection across hospitals is a very challenging endeavor, often made difficult by health care systems focused on maximizing volume rather than delivering appropriate, high-quality care in the long term. Nonetheless, it is imperative that all stakeholders involved in AWR help clinicians collect data during routine health care delivery to help patients’ quality of life.