bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cervical Adenocarcinoma: A Comparison of the Reproducibility of the World Health Organization 2003 and 2014 Classifications
Authors: Sar Aylin , Duan Qiuli , Khalil Moosa , DiFrancesco Lisa M. , Ewanowich Carol , Lytwyn Alice , Djordjevic Bojana , Itani Doha , Lee Sandra , Köbel Martin , Glaze Sarah , Park Elena , Duggan Máire A. 
Published: February 2018

Objective
The aim of the study was to compare the reproducibility of malignant glandular tumors of the uterine cervix classified per World Health Organization (WHO) 2003 and 2014.

Materials and Methods
Two pathologists reviewed 228 cases composed of adenocarcinoma in situ and 22 adenocarcinoma histotypes and selected 405 representative hematoxylin and eosin slides, which were digitally scanned. Six other pathologists (3 gynecological and 3 anatomical) independently reviewed and classified the images per both WHO classifications. One year later, they classified a random sample of 25 cases. Inter- (inter-OR) and intra-observer (intra-OR) reproducibility of the 6 pathologists and separately for gynecological compared with anatomical pathologists was tested using κ statistics.

Results
Both classifications were collapsed into 6 categories as benign, adenocarcinoma in situ, and mucinous, endometrioid, rare, and adenosquamous-miscellaneous carcinomas. WHO 2014 had an additional category: endocervical adenocarcinoma, usual type. Inter-observer κ values were more reliable than the intra-OR results based on 95% CIs. The average inter-OR κ values with both classifications were moderate between the 6 pathologists and between the 3 anatomical pathologists. In contrast, they were substantial between the 3 gynecological pathologists. With both classifications, the average intra-OR κ values of the 6 pathologists and both pathologist groups trended toward substantial.

Conclusions
Reproducibility among 6 pathologists is unaffected by changes in the WHO 2014 classification and averages moderate between different and trends toward substantial between the same pathologist. Reproducibility between different pathologists can improve to substantial when they have expertise in gynecological pathology.
Reduced Antifungal Susceptibility of Vulvovaginal Candida Species at Normal Vaginal pH Levels: Clinical Implications
Authors: Spitzer Mark , Wiederhold Nathan P. 
Published: February 2018

Objective
The aims of the study were to assess for differences in antifungal in vitro potency at pH 7 and pH 4 and to discuss any potential clinical implications of that difference.

Materials and Methods
A retrospective analysis of 217 first positive yeast cultures from 217 patients. Yeast isolates underwent antifungal susceptibility testing, with minimum inhibitory concentrations (MICs) (microgram per milliliter) measured at pH 7 and pH 4 for fluconazole, itraconazole, miconazole, clotrimazole, terconazole, and nystatin. Only the first isolates collected from each patient were included in the analysis.

Results
Yeast first isolates included 173 Candida albicans, 15 Candida glabrata, and 29 isolates from 8 other species. Geometric mean (GM) MIC values for all antifungals were significantly higher when tested at pH 4 (p < .001 for all comparisons). For C. albicans, the largest GM MIC differences were observed for terconazole (0.17 pH 7 vs 6.17 pH 4) and clotrimazole (0.04 vs 0.24). For terconazole, 97.7% of the isolates had a MIC of 1 or less at pH 7 but 83.2% had a MIC of 4 or higher at pH 4. For C. glabrata, terconazole (GM MIC = 0.26 pH 7 vs >64 pH 4), clotrimazole (0.13 vs 6.96), miconazole (0.06 vs 0.76), and fluconazole (3.17 vs 26.6) were most affected. All C. glabrata isolates had a MIC of 1 or less for terconazole at pH 7 and one had a MIC of 8 at pH 4, whereas all the rest were highly resistant (MIC > 64).

Conclusions
Antifungals have reduced in vitro potency when tested at lower pH. Candida glabrata is more affected than C. albicans. The impact may be greatest for the antifungal terconazole and against C. glabrata isolates.
The safety and efficacy of ledipasvir/sofosbuvir with or without ribavirin in the treatment of orthotopic liver transplant recipients with recurrent hepatitis C: real-world data
Authors: Pyrsopoulos Nikolaos , Trilianos Panagiotis , Lingiah Vivek A. , Fung Phoenix , Punnoose Merlin 
Published: February 2018

Background
Recurrent hepatitis C (RHC) in orthotopic liver transplantation (OLT) population is associated with accelerated rates of fibrosis, low efficacy and decreased tolerability with traditional therapies.

Aim
The aim of this study was to evaluate the safety and efficacy of ledipasvir/sofosbuvir (LED/SOF) with or without ribavirin (RBV) in OLT patients with RHC.

Patients and methods
Patients at least 3 months post-OLT and with documented RHC were treated with LED/SOF with or without RBV for either 12 or 24 weeks. End-of-treatment and sustained virological response 12 weeks after the completion of treatment were documented. Patients were closely monitored for treatment-related adverse effects and the potential need for adjustment in their immunosuppression.

Results
Seventy-one patients were included in the study. Median age was 62 years. Median time from OLT was 55 months. Twenty-six (36.6%) patients were treatment-naive and 45 (63.4%) had previously failed interferon-based therapies. The majority of patients (57.7%) had stage F0–F2 fibrosis. Sixty-seven (94.3%) patients completed 12 weeks of LED/SOF with RBV, three patients completed 12 or 24 weeks of LED/SOF without RBV, and one patient completed only 8 weeks of LED/SOF without RBV owing to severe allograft dysfunction. Sustained virological response was near universal in our cohort (98.5%) regardless of genotype, fibrosis stage, and regimen or treatment duration. Most commonly reported side effects were malaise and gastrointestinal upset. No patient required adjustment in immunosuppression and no episodes of rejection were documented during treatment.

Conclusion
The combination of LED/SOF with RBV for 12 weeks or LED/SOF for 24 weeks is very effective and safe in treating OLT recipients with RHC.
Relationships Between Early Nutrition and Blood Glucose Concentrations in Very Preterm Infants
Authors: Tottman Anna C. , Bloomfield Frank H. , Cormack Barbara E. , Harding Jane E. , Mohd Slim M. Atif , Weston Abigail F. , Alsweiler Jane M. 
Published: February 2018

ABSTRACTObjectives:The aim of the study was to determine whether changes to early nutrition are associated with levels of glycemia in very preterm infants.Methods:A retrospective, observational study of infants <1500 g or <30 weeks’ gestation admitted to Neonatal Intensive Care, National Women's Hospital, New Zealand, before (Old Protocol) and after (New Protocol) a change in nutritional protocol. Nutritional intakes were calculated and averaged by day for postnatal days 1 to 7 (week 1) and 1 to 28 (month 1). Relationships between glycemia measures, macronutrient intakes, and achievement of 10% enteral feeds (≥10% total intake) were explored using logistic regression.Results:Old Protocol (n = 190) and New Protocol (n = 267) groups had similar baseline characteristics. In week 1, New Protocol infants received more protein, less fat, and carbohydrate, had lower mean blood glucose concentrations (BGCs) (mean ± SD 4.9 ± 1.2 vs 5.6 ± 1.4 mmoll/L, P < 0.0001), less hyperglycemia (BGC > 8.5 mmol/L, 71 [27%] vs 80 [42%], P = 0.0005), but similar hypoglycemia (BGC < 2.6). In month 1, New Protocol infants also had less hyperglycemia (105 [39%] vs 96 [51%], P = 0.02) and lower mean BGC (5.0 ± 1.1 vs 5.5 ± 1.1 mmol/L, P < 0.0001), but insulin usage was similar. After adjustment for birth weight z score and gestational age, hyperglycemia was significantly associated with week 1 intakes (g · kg−1 · day−1) of protein (odds ratio [95% confidence intervals] 0.47 [0.23–0.79], P = 0.004), fat (0.54 [0.40–0.74], P < 0.0001), and carbohydrate (1.25 [1.09–1.44], P < 0.0001). These relationships were similar for month 1. Each additional day to achieve 10% enteral feeds was associated with increased odds of hypoglycemia (1.09 [1.00–1.18], P = 0.04) and hyperglycemia (1.16 [1.06–1.28], P = 0.002).Conclusions:In very preterm infants, macronutrient balance and small, early enteral feeds may assist glycemic control.
Fertility Preservation Toolkit: A Clinician Resource to Assist Clinical Discussion and Decision Making in Pediatric and Adolescent Oncology
Authors: Kemertzis Matthew A. , Ranjithakumaran Harene , Hand Meredith , Peate Michelle , Gillam Lynn , McCarthy Maria , Super Leanne , McQuillan Sarah , Drew Sarah , Jayasinghe Yasmin , Orme Lisa 
Published: February 2018

Purpose:
Fertility preservation (FP) discussions in children with cancer presents unique challenges due to ethical considerations, lack of models-of-care, and the triadic nature of discussions. This study evaluated a fertility toolkit for clinicians involved in FP discussions with pediatric, adolescent, and young adult patients and parents.

Materials and Methods:
A survey-based, longitudinal study of clinicians at The Royal Children’s Hospital Melbourne involved in FP discussions undertaken at 3 time-points: 2014, alongside an education session for baseline assessment of oncofertility practices (survey 1); after each toolkit use to evaluate case-specific implementation (survey 2); 2016, to evaluate impact on clinical practice (survey 3).

Results:
Fifty-nine clinicians completed survey 1. Over 66% reported baseline dissatisfaction with the existing FP system; 56.7% were not confident in providing up-to-date information. Only 34.5% “often” or “always” provided verbal information; 14.0% “often” or “always” provided written information. Survey 2 was completed after 11 consultations. All clinicians were satisfied with the discussions and outcomes using the toolkit. Thirty-nine clinicians completed survey 3. Over 70% felt confident providing up-to-date FP knowledge, 67.7% “often” or “always” provided verbal information, and 35.4% “often” or “always” provided written information.

Conclusions:
Clinicians desire improvement in FP practice. The toolkit provided significant perceived and actual benefits.
Clinical and Serological Predictors of Suicide in Schizophrenia and Major Mood Disorders
Authors: Dickerson Faith , Origoni Andrea , Schweinfurth Lucy A.B. , Stallings Cassie , Savage Christina L.G. , Sweeney Kevin , Katsafanas Emily , Wilcox Holly C. , Khushalani Sunil , Yolken Robert 
Published: February 2018

Abstract
Persons with serious mental illness are at high risk for suicide, but this outcome is difficult to predict. Serological markers may help to identify suicide risk. We prospectively assessed 733 persons with a schizophrenia spectrum disorder, 483 with bipolar disorder, and 76 with major depressive disorder for an average of 8.15 years. The initial evaluation consisted of clinical and demographic data as well as a blood samples from which immunoglobulin G antibodies to herpes viruses and Toxoplasma gondii were measured. Suicide was determined using data from the National Death Index. Cox proportional hazard regression models examined the role of baseline variables on suicide outcomes. Suicide was associated with male sex, divorced/separated status, Caucasian race, and elevated levels of antibodies to Cytomegalovirus (CMV). Increasing levels of CMV antibodies were associated with increasing hazard ratios for suicide. The identification of serological variables associated with suicide might provide more personalized methods for suicide prevention.
The Effect of Oral Phenazopyridine on Perioperative Voiding After Midurethral Slings (EPIPhANy Study)
Authors: Dueñas-Garcia Omar Felipe , Sierra Tania , Taylor Danielle , Leung Katherine , Hall Cynthia D. , Flynn Michael K. 
Published: February 2018

Objective
To determine the effect of preoperative oral phenazopyridine on postoperative voiding dysfunction in women undergoing a retropubic midurethral sling.

Methods
A single-institution randomized clinical trial was performed from September 2015 to March 2017, comparing 200 mg of oral phenazopyridine versus no phenazopyridine in patients undergoing a retropubic midurethral sling under general anesthesia with no concomitant procedures. A power calculation indicated that we required at least 40 subjects per arm. Preoperative demographics, intraoperative medications, blood loss, and complications were recorded. A standardized voiding trial was performed before discharge. Voiding dysfunction was determined by the proportion of subjects who failed a postoperative voiding trial. Pain scores were obtained before and 2 to 3 hours after the surgical procedure. Patient characteristics and surgical data were compared using χ2, Fisher exact test, or Wilcoxon rank sum test.

Results
Ninety-two subjects were enrolled in the study. Three patients cancelled their surgery and 1 had an intraoperative urethral injury, leaving 88 patients for the final analysis (44 per arm). Patient demographics showed no differences between groups. Phenazopyridine did not reduce the proportion of patients who failed the voiding trial (27%) compared with subjects who did not receive the medication (21%) (P = 0.453). Postoperative visual analog pain scores were higher in those not receiving phenazopyridine (1.76 vs 1.21, P = 0.046), but after adjusting for the difference in preoperative and postoperative pain scores, the groups showed no difference (P = 0.087).

Conclusions
Our prospective trial shows that phenazopyridine has no effect on short-term postoperative voiding dysfunction. This condition appears to be multifactorial, and further research is needed.
FACE: Female Pelvic Medicine and Reconstructive Surgery Awareness Campaign: Increasing Exposure
Authors: Barr Susan A. , Crisp Catrina C. , White Amanda B. , Malik Shazia A. , Kenton Kimberly 
Published: February 2018

Objective
The aims of this study are to identify screening, treatment, and referral practices of primary care physicians (PCPs) for patients with pelvic floor disorders (PFDs) and evaluate awareness of the Female Pelvic Medicine and Reconstructive Surgery (FPMRS) subspecialty.

Methods
We conducted a cross-sectional survey of PCPs using a random sample of 1005 American College of Physicians members, stratified by demographic region. Electronic survey content included awareness of FPMRS certification, comfort diagnosing and treating PFDs, and PFD referral patterns for PCPs.

Results
The 399 survey respondents were predominately male and of diverse ages, geographic distribution, and experience level.
Forty-eight percent were aware of the FPMRS subspecialty, 31% of FPMRS board certification, and 25% of American Urogynecologic Society. Less than one third screened for PFDs, only two thirds were comfortable diagnosing urinary complaints, and even fewer felt comfortable diagnosing pelvic organ prolapse and fecal incontinence (FI).
Eighty-five percent recommended pelvic floor exercises for stress urinary incontinence and referred to urology (29%) or FPMRS (25%) as second-line therapy, whereas 55% recommended medication/fiber for FI and referred to gastroenterology/colorectal surgery (31%) and FPMRS (2%) as second-line therapy.
Primary care physicians referred to colorectal surgery for FI (60%), to Ob/Gyn for obstetric anal sphincter injury (38%) and pelvic organ prolapse (57%), and to urology for microscopic hematuria (80%), overactive bladder (60%), recurrent urinary tract infection (75%), stress urinary incontinence (48%), and voiding dysfunction (84%).

Conclusions
Most PCPs do not routinely screen for PFDs, and fewer feel comfortable treating. The majority is unaware of FPMRS and American Urogynecologic Society and more commonly refers PFD patients to other specialists.
Pelvic Organ Prolapse and Urinary Incontinence in Women After Bariatric Surgery: 5-Year Follow-up
Authors: Gabriel Iwona , Tavakkoli Ali , Minassian Vatche A. 
Published: February 2018

Objective
The objective of this study was to determine if weight loss surgery is associated with decreased prevalence of urinary incontinence (UI) and pelvic organ prolapse (POP) symptoms.

Methods
A survey was conducted among previously morbidly obese women who underwent bariatric surgery at Brigham and Women's Hospital, Boston from 2007 to 2015. In addition to the Pelvic Floor Distress Inventory 20, we collected demographic and clinical data including symptoms of and treatment for UI and POP before surgery. Participants were divided into 4 quartiles based on self-reported postsurgical weight loss: less than 26.1 kg, 26.1 to 36.2 kg, 36.3 to 46.2 kg, and greater than 46.2 kg. Cox proportional hazard ratios were used to estimate risk of UI and POP by quartile. Kruskal-Wallis test was used to compare bother scores between the groups.

Results
A total of 447 women responded to the survey. Mean follow-up from surgery was 5 years. Women with Roux-en-Y gastric bypass had significantly greater weight loss than gastric banding or sleeve gastrectomy. The adjusted hazard ratios of current UI, stress UI, urgency UI, and prolapse decreased with increasing weight loss quartile (P trend <0.005). Based on the Pelvic Floor Distress Inventory 20, prevalence of POP symptoms was 26% with a mean bother score of 50. Although symptom bother by quartile of weight loss was not statistically significant, the trend (from the first to fourth quartile) for the mean values of Urogenital Distress Inventory 6 (from 13 to 9) and Pelvic Organ Prolapse Distress Inventory 6 (from 26 to 20) showed an improvement in bother symptoms.

Conclusions
There exists an inverse relationship between amount of weight loss and subsequent POP and UI symptoms 5 years after bariatric surgery.
A Systematic Review of Frailty Assessments in Women With Pelvic Floor Disorders: Are We Following the American College of Surgeons National Surgical Quality Improvement Program/American Geriatric Society Guidelines?
Authors: Zeno Aldene , Alvarez Pedro , Yazdany Tajnoos 
Published: February 2018

Introduction
Associations between frailty and women with pelvic floor disorders (PFDs) are not well understood. This study seeks to describe studies among women with PFD and the associated frailty assessments as recommended in the American College of Surgeons National Surgical Quality Improvement Program/American Geriatric Society (ACS NSQIP/AGS) guidelines.

Methods
This systematic review was registered with PROSPERO using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The GRADE (Grading of Recommendations, Assessment, Development and Evaluations) criteria are applied to assess study quality. Data synthesis is descriptive. Outcomes of interest include the ratio of studies adhering to the ACS NSQIP/AGS guidelines and evidence for frailty assessments versus usual care for women with PFDs.

Results
Twenty studies regarding frailty and PFDs were included for systematic review. Studies were categorized as relating to (1) epidemiology, (2) frailty and incontinence, (3) postoperative morbidity, and (4) surgical choice. Most studies (5/20) did not define frailty or failed to follow the ACS NSQIP/AGS guidelines. All studies were of very low to low quality. Collectively, each category generated very low GRADE quality evidence of frailty and the relationship to PFDs.

Conclusions
Most studies regarding frailty among women with PFDs did not define frailty as recommended in the ACS NSQIP/AGS guidelines. The evidence regarding PFDs and frailty is of very low quality. This is the first systematic review regarding frailty assessments specifically among women with PFDs. Paucity of data regarding frailty in women with PFDs, particularly with regard to surgical choice and surgical counseling, highlights the need for further study in this area.
Sequence of Pelvic Examination Affects Patient-Reported Pain
Authors: Rinko Rebecca , Yu Ian , Bakillah Emna , Alper Lauren , Delaney Colleen , Su Marisa , Dawson Melissa , Gracely Edward J. , Whitmore Kristene E. 
Published: February 2018

Objective
The purpose of this trial is to compare patient-reported pain based on the sequence of the pelvic examination and to assess the relationship between pain during the examination and quality of life, self-esteem, and sexual function.

Methods
A randomized controlled trial of women presenting for annual gynecologic examinations. Women were assigned to either group A: a Q-tip touch test, speculum examination, then bimanual examination or group B: Q-tip touch test, bimanual examination, then speculum examination. The primary outcome was visual analog scales to assess pain at baseline and after each portion of the examination. Secondary outcomes were responses to questionnaires for self-esteem, quality of life, and sexual function.

Results
Of 200 women who enrolled, 192 (96%) completed all visual analog scale data points. Each portion of the examination caused minimal pain over baseline in each group. Pain during the speculum examination was higher than pain during the bimanual examination in both groups (P = 0.007 and P < 0.001). Group B, however, had significantly higher pain scores after the speculum examination than group A (P = 0.044). The groups did not differ on bimanual pain scores (P = 0.76). Pain scores were not statistically different when analyzed by age, parity, sexual activity, sexual orientation, education, or previous hysterectomy. Within both groups, patients who documented having any pain after the speculum examination or the bimanual examination were also more likely to have lower quality of life scores (P < 0.001 and P < 0.001).

Conclusions
Pain associated with the speculum examination was lower in those undergoing speculum before bimanual examination. Speculum pain was greater than bimanual pain in both groups. Most patients reported minimal or no pain during the different portions of the examination.
The Utility of Preoperative Laboratory Testing Before Urogynecologic Surgery
Authors: Husk Katherine E. , Willis-Gray Marcella G. , Dieter Alexis A. , Wu Jennifer M. 
Published: February 2018

Objectives
National guidelines for preoperative laboratory testing are based on limited, low-quality evidence. The role of age as a risk factor for testing is unclear. We sought to compare the prevalence of abnormal preoperative laboratory results in older vs younger urogynecologic surgical patients.

Methods
In this retrospective cohort study of women undergoing urogynecologic surgery, we compared older (age, ≥65 years) with younger (age, 50–64 years) women. Our primary outcome was the prevalence of an abnormal preoperative laboratory result.

Results
We included 317 women, with 167 (52.7%) in the older cohort (ages, 65–91 years; mean, 73.3 ± 5.6 years) and 150 (47.3%) in the younger cohort (ages, 50–64 years; mean, 57.3 ± 4.1 years). Overall, 18.3% of participants had at least one abnormal preoperative laboratory, with older women more likely to have an abnormal result (28.7% vs 10.7%, P < 0.001). Compared with the younger cohort, older women had higher rates of abnormal hemoglobin (13.8% vs 6.0%, P = 0.02) and creatinine values (10.8% vs 2.7%, P = 0.005), with no significant differences for platelets (3.0% vs 1.3%, P = 0.53), sodium (3.0% vs 0.7%, P = 0.22), or potassium (6.0% vs 3.3%, P = 0.27). After adjusting for potential confounders, older age remained associated with an abnormal preoperative result (odds ratio, 3.6; 95% confidence interval, 1.9–7.1).

Conclusions
In our sample, women 65 years or older had a greater than 25% chance of having an abnormal preoperative laboratory result and were at higher risk compared with younger women. Age 65 years or greater should be considered as a criterion for preoperative laboratory testing in urogynecologic patients.