bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased Leak Rates Following Stapled Versus Handsewn Ileocolic Anastomosis in Patients with Right-Sided Colon Cancer: A Nationwide Cohort Study
Authors: Nordholm-Carstensen Andreas , Schnack Rasmussen Morten , Krarup Peter-Martin 
Published: November 2018

BACKGROUND:
Data on anastomotic leak rates after stapled versus handsewn ileocolic anastomosis are conflicting. In a Cochrane review, the combined estimate favored the stapled technique, but recent cohort studies demonstrated a 2-fold increase in anastomotic leak with the stapled approach.

OBJECTIVE:
The purpose of this study was to investigate anastomotic leak rates following stapled versus handsewn ileocolic anastomosis.

DESIGN:
This was a nationwide, retrospective cohort study.

SETTING:
Data were obtained from the Danish Colorectal Cancer Group and National Patient Registry databases.

PATIENTS:
Danish patients, ≥18 years of age, undergoing right hemicolectomy for a first-time diagnosis of adenocarcinoma in the right colon with primary anastomosis between October 2014 and December 2015 were included.

MAIN OUTCOME MEASURES:
The primary outcome was anastomotic leak rate. Secondary outcomes included 30-day mortality. Covariates included demographics, comorbidity, tumor stage, and surgical variables. Multivariable logistic regression and propensity score matching were used to adjust for confounding.

RESULTS:
The 1414 patients included 391 (28%) in the stapled group and 1023 (72%) in the handsewn group. Forty-five patients (3.2%) developed anastomotic leak: 21 of 391 (5.4%) and 24 of 1023 (2.4%) in the stapled and handsewn group (p = 0.004). This difference was confirmed in multivariable analysis (adjusted OR, 2.91; 95% CI, 1.53–5.53; p < 0.001), and after propensity score matching (OR, 2.41; 95% CI, 1.24–4.67; p = 0.009). Thirty-day mortality was 15.6% (7/45) and 2.1% (29/1369) in patients with and without anastomotic leak (p < 0.001), with no difference between the stapled and handsewn approach.

LIMITATIONS:
The study’s design was retrospective, with no information on allocation to the stapled or handsewn approach.

CONCLUSIONS:
The present study demonstrated a 2-fold increase in anastomotic leak after stapled versus handsewn ileocolic anastomoses. Previous opinions on the optimal anastomosis technique for colon cancer should be scrutinized given the devastating short-term outcome of anastomotic leak. See Video Abstract at http://links.lww.com/DCR/A819.
Assessing the Value of Endoscopy Simulator Modules Designed to Prepare Residents for the Fundamentals of Endoscopic Surgery Examination
Authors: Byrne Raphael M. , Hoops Heather E. , Herzig Daniel O. , Diamond Sarah J. , Lu Kim C. , Brasel Karen J. , Tsikitis V. Liana 
Published: November 2018

BACKGROUND:
The Fundamentals of Endoscopic Surgery examination is required for all general surgery residents. The test modules are not available for practice before the examination; however, similar modules are commercially available.

OBJECTIVE:
This study aims to determine which modules are most valuable for resident training and preparation for the examination by evaluating which correlates best with experience level.

DESIGN:
This was a single-institution study.

SETTING:
A virtual reality endoscopy simulator was utilized.

PARTICIPANTS:
General surgery residents and faculty endoscopists performed endoscopy simulator modules (Endobasket 2, Endobubble 1 and 2, Mucosal Evaluation 2, and Basic Navigation) designed to prepare residents for the Fundamentals of Endoscopic Surgery examination. Residents were assigned into junior and senior groups based on the completion of a dedicated endoscopy rotation.

MAIN OUTCOME MEASURES:
The primary outcomes measured were the mean time to completion, mean number of balloons popped, and mean number of wall hits for the 3 groups.

RESULTS:
A total of 21 junior residents, 11 senior residents, and 3 faculty participated. There were significant differences among groups in the mean time to completion for the Endobasket, Endobubble, and Mucosal Evaluation modules. The modules that correlated best with experience level were Endobubble 2 and Mucosal Evaluation 2. For Endobubble 2, juniors were slower than seniors, who were in turn slower than faculty (junior 118.8 ± 20.55 seconds, senior 100.3 ± 11.78 seconds, faculty 87.67 ± 2.848 seconds; p < 0.01). Juniors popped fewer balloons than seniors, who popped fewer balloons than faculty (junior 9.441 ± 3.838, senior 15.62 ± 4.133, faculty 28.78 ± 1.712; p < 0.001). For Mucosal Evaluation 2, juniors were slower than seniors, who were in turn slower than faculty (junior 468.8 ± 123.5 seconds, senior 368.6 ± 63.42 seconds, faculty 233.1 ± 70.45 seconds; p < 0.01).

LIMITATIONS:
Study residents have not completed the Fundamentals of Endoscopic Surgery examinations, so correlation with examination performance is not yet possible.

CONCLUSIONS:
Performance on Endobasket, Endobubble, and Mucosal Evaluation correlated well with experience level, providing benchmarks for each level to attain in preparation for the Fundamentals of Endoscopic Surgery examination. See Video Abstract at http://links.lww.com/DCR/A823.
Extended Mortality Follow-up of a Cohort of Dry Cleaners
Authors: Callahan Catherine L. , Stewart Patricia A. , Blair Aaron , Purdue Mark P. 
Published: November 2018

Background:
Dry cleaning workers are commonly exposed to tetrachloroethylene, a suspected bladder carcinogen, and other organic solvents. The health risks associated with solvent exposures in this industry are unclear.

Methods:
We extended mortality follow-up of 5,369 dry cleaning union members in St. Louis to further investigate solvent-related risks. We added 22 years of follow-up, from 1993 through 2014, via linkage to the National Death Index. Using Cox proportional hazards modeling, we computed hazard ratios (HRs) and 95% confidence intervals (CIs) relating cause-specific mortality with levels of a solvent exposure index previously developed by an industrial hygienist based on workers’ job titles from union records. The models were fit adjusting for age, sex, and decade of union enrollment, and assuming different exposure lags.

Results:
In internal analyses of estimated solvent exposure with a 20-year lag, we observed exposure–response relationships for bladder cancer (HR medium exposure = 4.2; 95% CI = 0.7, 24.5 and HR high exposure = 9.2; 95% CI = 1.1, 76.7 vs. no exposure; P
trend = 0.08) and kidney cancer (HR = 4.1; 95% CI = 0.7, 22.5 and 24.4; 2.9, 201.6; P
trend = 0.004). High exposure was also associated with heart disease (HR = 1.6; 95% CI = 1.1, 2.2) and lymphatic/hematopoietic malignancies (HR = 4.3; 95% CI = 1.4, 13.6).

Conclusions:
These findings are, to the best of our knowledge, the first cohort evidence relating solvent exposure levels among dry cleaners to elevated risks of selected cancers and heart disease. Additional studies employing solvent-specific exposure assessment are needed to clarify cancer risks associated with tetrachloroethylene.
Establishing the Minimal Clinically Important Difference for the Hospital Anxiety and Depression Scale in Patients With Cardiovascular Disease
Authors: Lemay Kyle R. , Tulloch Heather E. , Pipe Andrew L. , Reed Jennifer L. 
Published: November 2018

Purpose:
The Hospital Anxiety and Depression Scale (HADS) is frequently used by clinicians to assess anxiety and depression in patients with cardiovascular disease; yet, its minimal clinically important difference (MCID) has not been established. The purpose of this study was to establish an MCID for the HADS in patients with cardiovascular disease.

Methods:
A sample of 591 patients (74% male; ethnicity = 89% white; mean ± standard deviation [SD]: age = 63 ± 10 yr; and body mass index = 29.1 ± 5.6 kg/m2) with cardiovascular disease enrolled in a 3-mo cardiac rehabilitation program were included in this study. The MCID for the HADS was estimated using distribution-based methods (ie, standard deviation, effect size, standard error of measurement, and minimal detectable change), anchor-based methods (ie, health transition question, correlation and linear regression, and receiver operating characteristic curve), and Delphi methodology (ie, clinical consensus).

Results:
A total of 18 MCID values were calculated ranging from 0.81 to 5.21 (Anxiety subscale) and 0.5 to 5.57 (Depression subscale). The final MCID for the HADS, triangulated from the distribution-based, anchor-based, and Delphi-based findings, was 1.7 points.

Conclusions:
Our work provides the first estimates of an MCID by triangulating multiple methodologies for the HADS in patients with cardiovascular disease. This MCID may serve as an indicator of treatment success for clinicians and researchers and guide future interventions to improve the mental health of patients with cardiovascular disease.
USTUR Case 0846: Modeling Americium Biokinetics After Intensive Decorporation Therapy
Authors: Breustedt Bastian , Avtandilashvili Maia , McComish Stacey L. , Tolmachev Sergei Y. 
Published: November 2018

Abstract
Decorporation therapy with salts of diethylenetriamine-pentaacetic acid binds actinides, thereby limiting uptake to organs and enhancing the rate at which actinides are excreted in urine. International Commission on Radiological Protection reference biokinetic models cannot be used to fit this enhanced exertion simultaneously with the baseline actinide excretion rate that is observed prior to the start of therapy and/or after the effects of therapy have ceased. In this study, the Coordinated Network on Radiation Dosimetry approach, which was initially developed for modeling decorporation of plutonium, was applied to model decorporation of americium using data from a former radiation worker who agreed to donate his body to the US Transuranium and Uranium Registries for research. This individual was exposed to airborne 241Am, resulting in a total-body activity of 66.6 kBq. He was treated with calcium-diethylenetriamine-pentaacetic acid for 7 y. The time and duration of intakes are unknown as no incident reports are available. Modeling of different assumptions showed that an acute intake of 5‐μm activity median aerodynamic diameter type M aerosols provides the most reasonable description of the available pretherapeutic data; however, the observed 241Am activity in the lungs at the time of death was higher than the one predicted for type M material. The Coordinated Network on Radiation Dosimetry approach for decorporation modeling was used to model the in vivo chelation process directly. It was found that the Coordinated Network on Radiation Dosimetry approach, which only considered chelation in blood and extracellular fluids, underestimated the urinary excretion of 241Am during diethylenetriamine-pentaacetic acid treatment; therefore, the approach was extended to include chelation in the liver. Both urinary excretion and whole-body retention could be described when it was assumed that 25% of chelation occurred in the liver, 75% occurred in the blood and ST0 compartment, and the chelation rate constant was 1 × 10−10 pmol−1 d−1. It was observed that enhancement of urinary excretion of 241Am after injection of diethylenetriamine-pentaacetic acid exponentially decreased to the baseline level with an average half-time of 2.2 ± 0.7 d.
Modeling the Optimum Prussian Blue Treatment for Acute Radiation Syndrome Following 137Cs Ingestion
Authors: Adams Grace G. , Casagrande Rocco 
Published: November 2018

Abstract
Accidents or radiological attacks may lead to ingestion of 137Cs by large numbers of the public. This work models the efficacy of Prussian blue, the medical countermeasure for internal contamination with 137Cs, to prevent acute radiation syndrome as a function of the duration of treatment and the time that treatment starts after uptake. Risk of acute radiation syndrome is modeled using the International Commission on Radiological Protection’s acute radiation hazard model. Dose rates to target organs from 137Cs ingestion were based on the data published by the US Environmental Protection Agency and the retention of 137Cs in the reference man. Modeling found that treatment is most effective if begun within 15 d of ingestion, and the course length should be at least 75 d to mitigate cancer risk and 290 d to mitigate fatalities due to acute radiation syndrome. Both of these course lengths are much longer than the minimum Prussian blue treatment regimen of 30 d. Extending the treatment time for contaminated individuals would increase demand for Prussian blue following an accident or attack and in turn, would require a larger stockpile of Prussian blue to meet demand. Not enough data is available to determine if this longer treatment time would lead to adverse medical outcomes due to the toxicity of the treatment itself.
Diagnosis and Treatment of Chronic Myelomonocytic Leukemias in Adults
Authors: Itzykson Raphael , Fenaux Pierre , Bowen David , Cross Nicholas C.P. , Cortes Jorge , De Witte Theo , Germing Ulrich , Onida Francesco , Padron Eric , Platzbecker Uwe , Santini Valeria , Sanz Guillermo F. , Solary Eric , Van de Loosdrecht Arjan , Malcovati Luca ,   European Hematology Association, the European LeukemiaNet
Published: November 2018

AbstractChronic myelomonocytic leukemia (CMML) is a disease of the elderly, and by far the most frequent overlap myelodysplastic/myeloproliferative neoplasm in adults. Aside from the chronic monocytosis that remains the cornerstone of its diagnosis, the clinical presentation of CMML includes dysplastic features, cytopenias, excess of blasts, or myeloproliferative features including high white blood cell count or splenomegaly. Prognosis is variable, with several prognostic scoring systems reported in recent years, and treatment is poorly defined, with options ranging from watchful waiting to allogeneic stem cell transplantation, which remains the only curative therapy for CMML. Here, we present on behalf of the European Hematology Association and the European LeukemiaNet, evidence‐ and consensus‐based guidelines, established by an international group of experts, from Europe and the United States, for standardized diagnostic and prognostic procedures and for an appropriate choice of therapeutic interventions in adult patients with CMML.
A Cerebrovascular Hypothesis of Neurodegeneration in mTBI
Authors: Sullivan Danielle R. 
Published: November 2018

Objectives:
Mild traumatic brain injury (mTBI) is a major public health concern that has generated considerable scientific interest as a complex brain disorder that is associated with long-term neural consequences. This article reviews the literature on cerebrovascular dysfunction in chronic mTBI, with a focus on the long-term neural implications of such dysfunction.

Methods and Results:
Evidence is presented from human neuroimaging studies to support cerebrovascular involvement in long-term mTBI pathology. In addition, a pathway between mTBI and neurodegeneration via cerebrovascular dysfunction is explored.

Conclusions:
Future work focused on identifying the neurobiological mechanisms underlying the neural consequences of mTBI will be important to guide therapeutic interventions and long-term care for patients with mTBI.
A Cross-Sectional Study of Treatments for Behavioral Disorders Following Traumatic Brain Injury: Comparison With French Recommendations
Authors: Bourseau Tiphaine , Saoût Virginie , Ali Pauline , Pouliquen-Loriferne Uriell , Allain Philippe , Dinomais Mickaël 
Published: November 2018

Objective:
To give a cross-sectional overview of ongoing management of behavioral disorders following traumatic brain injury (TBI) in a region of France, to compare this with recent recommendations from the French Society of Physical Medicine and Rehabilitation (SOFMER), and to evaluate associations between treatments and participant characteristics.

Setting:
Outpatients referred to medical or community-based facilities in a region of France.

Participants:
One hundred twenty-nine adults with moderate to severe TBI, in the postacute period (over 3 months postinjury).

Design:
Cross-sectional cohort study.

Main Measures:
Sociodemographic data, ongoing interventions including psychotherapy and medication, behavioral disorders assessed by the Behavioral Dysexecutive Syndrome Inventory (BDSI).

Results:
Thirty-three percent of participants received ongoing psychotherapy and 43% were on medication. The most prescribed medications were antidepressants (21%), neuroleptics (18%), anxiolytics (16%), and mood stabilizers (14%). Eighty-five participants (71%) presented a current Behavioral Dysexecutive Syndrome (BDS) according to the BDSI. These participants more frequently received treatment (P = .004), psychotherapy (P = .048), medications (often 2 or more) (P = .007), and particularly antiepileptic mood stabilizers (P = .037) compared with those without BDS.

Conclusion:
Although recommended as first-line treatment, few participants with BDS received psychotherapy. Medications were overused, especially neuroleptics in view of their potential adverse effects. In contrast, recommended medications, such as mood stabilizers and β-blockers, did not appear to be highly prescribed whatever the evolution. Compliance with recommendations seemed insufficient.
The Role of Pain Catastrophizing in Cognitive Functioning Among Veterans With a History of Mild Traumatic Brain Injury
Authors: Hoffman Samantha N. , Herbert Matthew S. , Crocker Laura D. , DeFord Nicole E. , Keller Amber V. , Jurick Sarah M. , Sanderson-Cimino Mark , Jak Amy J. 
Published: November 2018

Objective:
To determine the role of pain catastrophizing (PC) in neuropsychological functioning in veterans with a history of mild traumatic brain injury (TBI).

Participants:
Thirty-nine Iraq and Afghanistan combat veterans evaluated in the post–acute phase following mild TBI.

Methods:
Participants underwent psychiatric and TBI clinical interviews, neuropsychological tests, and self-report assessments of PC, pain intensity, depression, and posttraumatic stress disorder symptoms. Cognitive functioning composite scores of executive functioning, processing speed, and learning and memory were created. Composites were entered as dependent variables into separate linear regressions to examine relations with PC.

Results:
Greater PC was associated with worse executive functioning and processing speed even when controlling for confounding variables.

Conclusions:
One's interpretation of pain, in addition to pain intensity, has implications for cognitive functioning. Future research is encouraged to determine whether adaptive pain coping mechanisms improve cognitive functioning or, alternatively, whether cognitive rehabilitation strategies reduce PC.
DIFFUSE CHORIORETINAL ATROPHY IN CHINESE HIGH MYOPIA
Authors: Liu Ran , Guo Xinxing , Xiao Ou , Li Zhixi , Zhang Jian , Lee Jonathan Tak Loong , Wang Decai , Sankaridurg Padmaja , Jong Monica , He Mingguang 
Published: November 2018

Purpose:
To explore the associations between diffuse chorioretinal atrophy (DCA) and age, sex, axial length, spherical equivalent, and best-corrected visual acuity (BCVA) among highly myopic eyes.

Methods:
This study included right eyes of 857 bilaterally highly myopic individuals from the ZOC-BHVI Cohort Study. Participants underwent examinations, including BCVA, ocular biometry, autorefraction, and color fundus photography. An Early Treatment Diabetic Retinopathy Study grid was applied on the fundus photographs to evaluate the location of DCA, which was graded into four categories (D0–D3). The characteristics and ocular biometry were compared between participants' eyes with and without DCA.

Results:
Diffuse chorioretinal atrophy was found in 177 (20.6%) eyes. The proportion of participants with DCA in age groups of 7 to 11, 12 to 18, 19 to 39, and ≥ 40 years old was 20.9%, 9.2%, 23.1%, and 52.9%, respectively. The proportion of DCA significantly increased with longer axial length and worse myopic spherical equivalent. Eyes with DCA had poorer BCVA (Snellen visual acuity 20/36, logarithm of minimal angle of resolution 0.26 ± 0.25) than those without DCA (Snellen visual acuity 20/23, logarithm of minimal angle of resolution 0.06 ± 0.14) (P < 0.001). The BCVA gradually declined as the lesion got closer to the fovea (P
for trend < 0.001).

Conclusion:
The proportion of DCA increased with older age, longer axial length, and more myopic spherical equivalent. Diffuse chorioretinal atrophy is a vision-threatening complication of high myopia where BCVA gradually worsens with foveal involvement.
RETINAL CAPILLARY MACROANEURYSMS
Authors: Spaide Richard F. , Barquet Luis Arias 
Published: November 2018

Purpose:
To investigate eyes with solitary large aneurysms arising from retinal capillaries.

Methods:
Consecutive patients with aneurysms greater than 200 µm in diameter were evaluated with a comprehensive ophthalmologic examination including optical coherence tomography, optical coherence tomography angiography, and fluorescein angiography. The aneurysms were solitary in the sense, and there was only one aneurysm larger than the threshold diameter and a few or no other aneurysms.

Results:
There were 5 patients, 3 male patients, who had aneurysms that reached a maximal mean size of 273.4 µm. One patient had stable diabetic retinopathy and had a documented growth of a capillary aneurysm to 331 µm over an 8-year 7-month period until the aneurysm was associated with widespread edema. The remaining 4 patients did not have diabetes or any discernable retinal vascular disease. Anti–vascular endothelial growth factor treatment was associated with a partial response in one patient and no apparent response in the others. Laser photocoagulation of the aneurysms resulted in resolution of the edema and involution of the lesions.

Conclusion:
Large aneurysms arising from retinal capillaries occur and have a candidate name of retinal capillary macroaneurysms. Histologic evaluation of retinal capillary aneurysms shows the presence of matrix metalloproteinase-9, which may function to decrease the wall strength in the face of increasing wall tension from aneurysmal expansion, as predicted by LaPlace's law. Thus, retinal capillary macroaneurysms may have multiple forces driving their formation.
Combined Keratectomy and Localized Limbal Cauterization for Treating Lisch Epithelial Corneal Dystrophy
Authors: Salvador-Culla Borja , Alonso-Agesta Maddi , Álvarez de Toledo Juan , Barraquer Rafael I. 
Published: November 2018

Purpose:
To present a new technique for treating Lisch epithelial corneal dystrophy (LECD) in cases of recurrence of the disease.

Methods:
We present a single case report of a 41-year-old man who presented to the cornea clinic with progressive loss of vision in the right eye. Slit-lamp examination showed a large white-gray whorl-like epithelial opacity connected to the limbus, which spread over the visual axis, affecting visual acuity. The left eye was uninvolved.

Results:
After epithelial debridement was performed, histological analysis showed the nonkeratinized stratified flat epithelium, coalescent cytoplasmic vacuoles in some keratinocytes, and isolated cells with granular cytoplasm and small PAS negative nuclei, which confirmed the diagnosis of LECD. Despite partially successful treatment with several sequential epithelial debridements, the patient presented with confirmed recurrence of the disease soon after every treatment. Thus, focal epitheliectomy combined with localized cauterization of the limbal focus of origin was performed. Vision returned to normal, and there were no signs of recurrence at final follow-up 2 years later.

Conclusions:
Simple epitheliectomy combined with focal cauterization of the limbal focus of origin can be a simple, safe, and minimally invasive option for treatment of LECD.