bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term Oncologic Outcomes After Neoadjuvant Chemoradiation Followed by Intersphincteric Resection With Coloanal Anastomosis for Locally Advanced Low Rectal Cancer
Authors: Park Jun Seok , Park Soo Yeun , Kim Hye Jin , Cho Seung Hyun , Kwak Sang Gyu , Choi Gyu-Seog 
Published: January 2019

BACKGROUND:
To date only few data have been available relating to the oncologic safety of intersphincteric resection in such advanced tumors.

OBJECTIVE:
This study aimed to elucidate the oncologic outcomes and clinical factors affecting the long-term survival of patients who underwent preoperative chemoradiotherapy followed by intersphincteric resection for locally advanced rectal cancers.

DESIGN:
This was a retrospective analysis of prospectively collected departmental data.

SETTINGS:
The study was conducted at a department of colorectal surgery in a tertiary care teaching hospital between January 2009 and September 2015.

PATIENTS:
A cohort of 147 consecutive patients with low rectal cancer undergoing intersphincteric resection after preoperative chemoradiotherapy was included.

MAIN OUTCOME MEASURES:
Kaplan–Meier analyses were used to evaluate the 3-year disease-free survival and local recurrence rates. Logistic regression analyses were used to analyze the influence of tumor response and other prognostic factors on survival outcomes.

RESULTS:
Median follow-up was 34 months (range, 8–94 mo). The estimated overall 3-year disease-free survival and local recurrence rates were 64.9% and 11.7%. Circumferential resection margin involvement and pathologic T stage (ypT stage) were significant predictors of cancer relapse. The 3-year disease-free survival was 47.4% for patients with ypT3 tumors compared with 82.0% for those with ypT0–2 tumors (p = 0.001). The 3-year disease-free survival was 36.5% for patients with involved circumferential resection margins compared with 69.7% for those with a noninvolved circumferential resection margin (p = 0.003). On multivariate analysis, ypT stage, ymrT stage, and circumferential resection margin status were associated with worse disease-free survival. Clinical T-stage and pathologic distal margin status were not independent factors affecting oncologic outcomes.

LIMITATIONS:
This study is limited with respect to its retrospective design.

CONCLUSIONS:
In these patients with locally advanced low rectal cancers, intersphincteric resection after preoperative chemoradiotherapy was associated with acceptable oncologic outcomes. See Video Abstract at http://links.lww.com/DCR/A941.
Early Results of a Phase I Trial Using an Adipose-Derived Mesenchymal Stem Cell-Coated Fistula Plug for the Treatment of Transsphincteric Cryptoglandular Fistulas
Authors: Dozois Eric J. , Lightner Amy L. , Mathis Kellie L. , Chua Heidi K. , Kelley Scott R. , Fletcher Joel G. , Dietz Allan B. , Friton Jessica J. , Butler Greg W. , Faubion William A. 
Published: January 2019

BACKGROUND:
Management of transsphincteric cryptoglandular fistulas remains a challenging problem and the optimal surgical approach remains elusive. Mesenchymal stem cells, increasingly being utilized for perianal Crohn’s disease, offer a novel therapy to treat cryptoglandular fistulas.

OBJECTIVES:
This study aimed to determine safety and feasibility of using an autologous mesenchymal stem cell-coated fistula plug in patients with transsphincteric cryptoglandular fistulas.

DESIGN:
This study is a phase I clinical trial.

SETTING:
This study was conducted at a tertiary academic medical center.

PATIENTS:
Adult (>18 years) male and female patients with transsphincteric cryptoglandular fistulas were selected.

MAIN OUTCOMES MEASURES:
The primary outcomes measured were the safety, feasibility, and efficacy of a mesenchymal stem cell-coated fistula plug in patients with transsphincteric fistulas.

RESULTS:
Fifteen patients (8 women, mean age 39.8 years) with a single-tract transsphincteric fistula received a mesenchymal stem cell-loaded fistula plug and were followed for 6 months. Duration of disease at the time of study enrollment was a median of 3.0 years (range, 1–13 years) with a median of 3.5 (range, 1–20) prior surgical interventions. Adverse events included 1 plug extrusion, 1 abdominal wall seroma, 3 perianal abscesses requiring drainage, and 1 patient with perianal cellulitis. There were no serious adverse events. At 6 months, 3 patients had complete clinical healing, 8 had partial healing, and 4 patients showed no clinical improvement. Radiographic improvement was seen in 11 of 15 patients.

LIMITATIONS:
This study was limited by the small cohort and short follow-up.

CONCLUSIONS:
Autologous mesenchymal stem cell-coated fistula plug treatment of transsphincteric cryptoglandular fistulas was safe and feasible and resulted in complete or partial healing in a majority of patients. See Video Abstract at http://links.lww.com/DCR/A897.
Anatomical Variations of Iliac Vein Tributaries and Their Clinical Implications During Complex Pelvic Surgeries
Authors: Kanjanasilp Prapon , Ng Jia Lin , Kajohnwongsatit Krittin , Thiptanakit Charnjiroj , Limvorapitak Thitithep , Sahakitrungruang Chucheep 
Published: January 2019

BACKGROUND:
During high sacrectomies and lateral pelvic compartment exenterations, isolating the external and internal iliac veins within the presacral area is crucial to avoid inadvertent injury and severe hemorrhage. Anatomical variations of external iliac vein tributaries have not been previously described, whereas multiple classifications of internal iliac vein tributaries exist.

OBJECTIVE:
We sought to clarify the iliac venous system anatomy using soft-embalmed cadavers.

DESIGN:
This is a descriptive study.

SETTINGS:
This study was conducted in Chulalongkorn University, Thailand.

PATIENTS:
We examined 40 iliac venous systems from 20 human cadavers (10 males, 10 females).

INTERVENTIONS:
Blue resin dye infused into the inferior vena cava highlighted the iliac venous system, which was meticulously dissected and traced to their draining organs.

MAIN OUTCOME MEASURES:
Iliac vein tributaries and their valvular system were documented and analyzed.

RESULTS:
The external iliac vein classically receives 2 tributaries (inferior epigastric and deep circumflex iliac) near the inguinal ligament. However, external iliac vein tributaries in the presacral area were found in 20 venous systems among 15 cadavers (75%). The mean diameter of each tributary was 4.0 ± 0.35 mm, with 72% arising laterally. We propose a simplified classification for internal iliac vein variations: pattern 1 in 12 cadavers (60%) where a single internal iliac vein joins a single external iliac vein to drain into the common iliac vein; pattern 2 in 7 cadavers (35%) where the internal iliac vein is duplicated; and pattern 3 in 1 cadaver (5%) where bilateral internal iliac veins drain into a common trunk before joining the common iliac vein bifurcation.

LIMITATIONS:
This study is limited by the number of cadavers included.

CONCLUSIONS:
A comprehensive understanding of previously unreported highly prevalent external iliac vein tributaries in the presacral region is vital during complex pelvic surgery. A simplified classification of internal iliac vein variations is proposed. See Video Abstract at http://links.lww.com/DCR/A900.
A Comparative Dose-response Relationship Between Sexes for Mortality and Morbidity of Radiation-induced Lung Injury in the Rhesus Macaque
Authors: Thrall Karla D. , Mahendra S. , Jackson M.K. , Jackson William , Farese Ann M. , MacVittie Thomas J. 
Published: January 2019

Abstract
Radiation-induced lung injury is a characteristic, dose- and time-dependent sequela of potentially lethal, delayed effects of acute radiation exposure. Understanding of these delayed effects to include development of medical countermeasures requires well-characterized and validated animal models that mimic the human response to acute radiation and adhere to the criteria of the US Food and Drug Administration Animal Rule. The objective herein was to establish a nonhuman primate model of whole-thorax lung irradiation in female rhesus macaques. Definition of the dose-response relationship to include key signs of morbidity and mortality in the female macaque served to independently validate the recent model performed with male macaques and importantly, to establish the lack of sex and institutional bias across the dose-response relationship for radiation-induced lung injury. The study design was similar to that described previously, with the exception that female rhesus macaques were utilized. In brief, a computed tomography scan was conducted prior to irradiation and used for treatment planning. Animals in 5 cohorts (n = 8 per cohort) were exposed to a single 6‐MV photon exposure focused on the lung as determined by the computed tomography scan and treatment planning at a dose of 9.5, 10, 10.5, 11, or 11.5 Gy. Subject-based supportive care, including administration of dexamethasone, was based on trigger-to-treat criteria. Clearly defined euthanasia criteria were used to determine a moribund condition over the 180‐day study duration post-whole-thorax lung irradiation. Percent mortality per radiation dose was 12.5% at 9.5 Gy, 25% at 10 Gy, 62.5% at 10.5 Gy, 87.5% at 11 Gy, and 100% at 11.5 Gy. The resulting probit plot for the whole-thorax lung irradiation model estimated an LD50/180 of 10.28 Gy, which was not significantly different from the published estimate of 10.27 Gy for the male rhesus. The key parameters of morbidity and mortality support the conclusion that there is an absence of a sex influence on the radiation dose-response relationship for whole-thorax lung irradiation in the rhesus macaque. This work also provides a significant interlaboratory validation of the previously published model.
Assessment of miR-182, miR-183, miR-184, and miR-221 Expressions in Primary Pterygium and Comparison With the Normal Conjunctiva
Authors: İçme Gökhan , Yilmaz Ayça , Dinç Erdem , Görür Ayşegül , Fidanci Şenay Balci , Tamer Lülüfer 
Published: January 2019

Objectives:
The aim of this study was to investigate the expression levels of miR-126-3p, miR-182-5p, miR-183-5p, miR-184, miR-221-3p, and miR-205-5p in primary pterygium tissue and compare these levels with those in healthy conjunctiva tissue.

Methods:
Twenty-four patients who were diagnosed with grade 3 primary pterygium and scheduled for surgery between January 2014 and January 2016 and had no systemic disease or other ocular pathology were included in the study. The control group comprised nasal interpalpebral conjunctival tissue specimens from 24 age- and sex-matched patients with no history of systemic disease or ocular pathology other than cataract. Expression levels of miR-126-3p, miR-182-5p, miR-183-5p, miR-184, miR-221-3p, and miR-205-5p were determined and compared between the pterygium and conjunctiva specimens.

Results:
Expression levels of miR-182-5p, miR-183-5p, and miR-184 were significantly higher in pterygium tissue compared with normal conjunctival specimens (P<0.0001, P=0.01, and P=0.01, respectively), whereas expression of miR-221-3p was significantly lower (P=0.02). Expression levels of miR-126-3p and miR-205-5p did not differ significantly between the 2 groups (P>0.05).

Conclusions:
Expression levels of miR-182-5p, miR-183-5p, and miR-184 are increased, whereas expression of miR-221-3p is decreased in primary pterygium tissue, and these miRNAs may play a role in the pathogenesis of pterygium.
Quality of CT Imaging of Periocular Metallic Foreign Bodies Using Artifact Reduction Software
Authors: Willett Keirnan L. , Sheng Mike , Gorry Thomasine , Woo John H. 
Published: January 2019

Purpose:
CT is the standard of care for assessment of ocular and orbital trauma; however, artifacts from metallic foreign bodies can limit the utility of CT. The authors hypothesize that implementation of metal artifact reduction techniques can improve image quality and diagnostic confidence for a diverse group of interpreters.

Methods:
A case series of ten subjects with retained periocular metallic foreign bodies imaged with CT were identified retrospectively from a large urban trauma center. Postacquisition images were processed with an iterative-based metal streak artifact reduction software. The severity of the metal streak artifact was assessed by clinicians including radiologists (4), ophthalmologists (4), and oculoplastic specialists (3) using a numeric scale to grade images on seven clinically relevant criteria. Each image was also analyzed to measure the size of the artifact and degree of streaking.

Results:
Overall confidence in diagnosis and severity of metallic streak was improved with metallic artifact reduction (p < 0.001, Wilcoxon signed-rank test). Similarly, confidence in assessing specific features—including extra-ocular muscle, optic nerve, globe rupture, orbital fracture and identification of foreign bodies—was improved after metallic artifact reduction (p < 0.001, Wilcoxon signed-rank test). The standard deviation of pixel intensity for a path surrounding the foreign body as well as the area of the streak artifact decreased in the metallic artifact reduction-processed images (p < 0.001, paired t test).

Conclusions:
Metal artifact reduction in CT has potential benefits in improving image quality and reader confidence for periocular trauma cases in real-world settings.
Safety With Mobilization and Ambulation During Physical Therapy Sessions for Patients on Mechanical Circulatory Support 50 Days or Greater
Authors: Decker Lauren M. , Mumper Valerie A. , Russell Scott P. , Smith Beth A. 
Published: January 2019

Purpose:
The growing incidence of critically ill patients on mechanical circulatory support (MCS) for many weeks at our center prompted an institutional review of minor and major adverse events experienced by patients on MCS greater than 50 days, who participated in mobility both inside and outside of the intensive care unit as part of physical therapy (PT) treatment interventions.

Methods:
A retrospective medical chart review was conducted to collect information on adverse events and highest level of mobility reached during 454 PT sessions. Patients were receiving venovenous extracorporeal membrane oxygenation or Centrimag bilateral ventricular assist device support and were on prolonged MCS for 50 days or greater.

Results:
Patients participated in gait outside of the room and/or intensive care unit during 108 (23.8% of total) sessions. Major or minor adverse events occurred in less than 4% of 454 PT sessions.

Conclusions:
In one academic medical center, patients on prolonged MCS engaged in PT sessions that included ambulation outside of the intensive care unit and outdoors with infrequent adverse events. Effectiveness of PT sessions was not evaluated.
Oregon's Coordinated Care Organization Experiment: Are Members' Experiences of Care Actually Changing?
Authors: Wright Bill J. , Royal Natalie , Broffman Lauren , Li Hsin-Fang , Dulacki Kristen 
Published: January 2019

ABSTRACT
In 2012, Oregon embarked on an ambitious plan to redesign financing and care delivery for Medicaid. Oregon's Coordinated Care Organizations (CCOs) are the first statewide effort to use accountable care principles to pay for Medicaid benefits. We surveyed 8,864 Medicaid-eligible participants approximately 1 year before and 12 months after CCO implementation to assess the impact of CCOs on member-reported outcomes. We compared changes in outcomes over time between Medicaid CCO members, Medicaid fee-for-service (FFS) members, and those who were uninsured. After 1 year, Medicaid beneficiaries enrolled in CCOs reported better access to care, better quality care, and better connections to primary care than Medicaid FFS or uninsured persons. We did not find early evidence of improvements in preventive care and screenings or in ED utilization. Although these are early indicators, results suggest that Oregon's delivery system transformation is having a positive impact on patient experience outcomes.
Mindfulness-Based Group Cognitive Behavior Therapy for Provoked Localized Vulvodynia: A Randomized Controlled Trial
Authors: Guillet Alyson D. , Cirino Nicole H. , Hart Kyle D. , Leclair Catherine M. 
Published: January 2019

Objective
The aim of the study was to compare the effectiveness of mindfulness-based group cognitive behavior therapy (M-gCBT) versus education support group therapy for the pain and distress associated with provoked localized vulvodynia.

Materials and Methods
Participants were randomized to M-gCBT or education support group therapy. Mindfulness-based group cognitive behavior participants attended 8 weekly sessions. Education support group participants received 8 weeks of online education with 3 in-person group visits. Vaginal insertion pain (tampon test) was the primary outcome. Secondary outcomes (Generalized Anxiety Disorder 7, Beck's Depression Index, Female Sexual Distress Scale, Female Sexual Function Index, and Pain Catastrophizing) were administered before intervention and at the completion of the study period, 3 months, and 6 months. Sample size was based on the ideal number for group dynamics of 6 to 12 participants per group.

Results
Participants were enrolled from August 1, 2016, to January 30, 2017. Thirty-two participants were enrolled and 31 were randomized: 14 to M-gCBT and 17 to education support. Baseline characteristics did not differ significantly. Vaginal insertion pain decreased in both groups but was not statistically different between groups (difference of 1.23; 95% CI = −0.52 to 2.98). At 6 months, participants in the M-gCBT group showed statistically significant improvement in the Female Sexual Function Index, Generalized Anxiety Disorder 7, and Beck's Depression Index compared with the education support group.

Conclusions
Mindfulness-based group cognitive behavior and education support group therapy are effective in reducing pain and distress. However, women in the M-gCBT program showed greater improvement in certain secondary outcomes, indicating that M-gCBT may offer some advantages in reducing distress associated with provoked localized vulvodynia.
Should We Always Biopsy in Clinically Evident Lichen Sclerosus?
Authors: McCarthy Siobhan , MacEoin Neil , O'Driscoll Michael , O'Connor Roisin , Heffron Cynthia C.B.B. , Murphy Michelle 
Published: January 2019

Objective
The aims of the study were to review cases of clinically diagnosed lichen sclerosus (LS) and to compare the histological features found on biopsy to clinical features seen on examination.

Methods
A retrospective chart review was undertaken of patients attending a specialist vulval service between 2013 and 2015 with a clinical diagnosis of LS. Patients in whom there was clinical diagnostic uncertainty or those with features of lichen planus or lichen planus/LS overlap were excluded. We determined the proportion of these patients who underwent vulval biopsy and reviewed their histology.

Results
One hundred fifteen charts were reviewed. Sixty-nine (69/115, 60%) had a firm diagnosis of established LS, and of these, 39 (39/69, 56.5%) had a biopsy performed in the previous 5 years. Thirteen (13/39, 33.3%) of these biopsies fell short of a diagnosis of LS histologically with some suggestive but nondiagnostic and some showing nonspecific features.

Conclusions
Reliance on biopsies solely to establish or exclude the diagnosis of LS is inadvisable. A good level of knowledge of the characteristic clinical features is imperative among gynecologists, dermatologists, and general practitioners.
Three-Year Clinical and Audiological Outcomes of Percutaneous Implants for Bone Conduction Devices: Comparison Between Tissue Preservation Technique and Tissue Reduction Technique
Authors: Kruyt Ivo J. , Kok Herman , Bosman Arjan , Nelissen Rik Chrétien , Mylanus Emmanuel Antonia Maria , Hol Myrthe Karianne Sofie 
Published: January 2019

Objectives:
To evaluate the three-year clinical and audiological outcomes of soft-tissue preservation compared to soft-tissue reduction in linear incision surgery for percutaneous implant for bone conduction (BC) devices.

Methods:
Twenty-five patients (25 implants) were enrolled in a prospective cohort for implant surgery with linear incision and tissue preservation. The control group consisted of 25 patients (25 implants) from a previous randomized controlled trial in which a linear incision with soft-tissue reduction was applied. Follow-up visits were scheduled at 7 and 21 days (fitting of sound processor); 12 weeks; 6 months; and at 1, 2, and 3 years after implantation. Main outcome measures were skin sensibility, soft-tissue status, Implant Stability Quotient (ISQ), skin height, implant survival, revision surgery, scar assessment, and hearing thresholds (BC in-situ between 250 Hz and 8 kHz with BC device on testband and abutment, and BC thresholds at 250Hz–4 kHz with a B71 bone conductor).

Results:
Tissue preservation resulted in superior sensibility (mean percentage correct responses 99.7% [SD 1.7] vs 92.0% [SD 9.2], p = 0.0001). No spontaneous implant loss occurred in either group. The abutment was removed in two tests and in one control patient. Two control patients needed skin revision surgery. Although not statistically significant, more adverse soft-tissue reactions (Holgers ≥2) were observed in the test-group (n = 9 [36%] vs n = 3 [12%], p = 0.095). ISQ increased significantly more in the test group compared to the control group (7.64 [SD 4.05] vs 4.29 [SD 3.93]). Skin thickening, scar assessment, and hearing outcomes were comparable.

Conclusion:
Tissue preservation demonstrated superior skin sensibility compared to tissue reduction while other clinical outcomes were comparably excellent.
Prevalence of Sporadic Vestibular Schwannoma: Reconciling Temporal Bone, Radiologic, and Population-based Studies
Authors: Marinelli John P. , Grossardt Brandon R. , Lohse Christine M. , Carlson Matthew L. 
Published: January 2019

Objective:
Reported epidemiologic data surrounding vestibular schwannoma (VS) are controversial. Temporal bone prevalence studies have suggested that VS affects up to 2.4% of the population, whereas magnetic resonance imaging (MRI) studies have reported VS to affect 0.017%. Moreover, existing population-based data seem to underestimate the commonness of VS. In an attempt to reconcile temporal bone, radiologic, and population-based reports regarding VS, the current study was conceived to determine the modern prevalence of VS using a unique epidemiological database.

Patients:
All persons living in Olmsted County, Minnesota on January 1, 2017 with a confirmed diagnosis of sporadic VS identified using the Rochester Epidemiology Project (REP) medical records-linkage system.

Main Outcome Measures:
Prevalence of all VS and asymptomatic, incidentally diagnosed VS.

Results:
Sixty-seven persons from a population of nearly 160,000 were living with VS on January 1, 2017, resulting in a point prevalence of 42.0 per 100,000 persons. The prevalence increased with older age, reaching 212.4 per 100,000 in those ≥ 70 years. Including only persons who have undergone head MRI, the prevalence of asymptomatic, incidentally diagnosed VS was 69.9 per 100,000 among adults age 20 years and older.

Conclusions:
Using the unique infrastructure of the REP, the current study suggests that the clinical prevalence of sporadic VS approximates 1 in 2,000 adults and 1 in every 500 persons aged 70 years and older, with the prevalence of incidentally diagnosed tumors closely paralleling past MRI studies. These data characterize a shift in the modern patient demographic of sporadic VS, as now many people bearing a diagnosis of VS would have previously died without knowledge of their disease. Moreover, they typify an unfolding transition from an era of microsurgery and radiosurgery to the beginnings of an era that will be largely comprised of “chronic disease management.”