bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized clinical trial of the effect of a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy
Authors: Schindl M , Függer R , Götzinger P , Längle F , Zitt M , Stättner S , Kornprat P , Sahora K , Hlauschek D , Gnant M 
Published: April 2018

Abstract

Background
The potential for a fibrin sealant patch to reduce the risk of postoperative pancreatic fistula (POPF) remains uncertain. The aim of this study was to evaluate whether a fibrin sealant patch is able to reduce POPF in patients undergoing pancreatoduodenectomy with pancreatojejunostomy.

Methods
In this multicentre trial, patients undergoing pancreatoduodenectomy were randomized to receive either a fibrin patch (patch group) or no patch (control group), and stratified by gland texture, pancreatic duct size and neoadjuvant treatment. The primary endpoint was POPF. Secondary endpoints included complications, drain-related factors and duration of hospital stay. Risk factors for POPF were identified by logistic regression analysis.

Results
A total of 142 patients were enrolled. Forty-five of 71 patients (63 per cent) in the patch group and 40 of 71 (56 per cent) in the control group developed biochemical leakage or POPF (P = 0·392). Fistulas were classified as grade B or C in 16 (23 per cent) and ten (14 per cent) patients respectively (P = 0·277). There were no differences in postoperative complications (54 patients in patch group and 50 in control group; P = 0·839), drain amylase concentration (P = 0·494), time until drain removal (mean(s.d.) 11·6(1·0) versus 13·3(1·3) days; P = 0·613), fistula closure (17·6(2·2) versus 16·5(2·1) days; P = 0·740) and duration of hospital stay (22·1(2·2) versus 18·2(0·9) days; P = 0·810) between the two groups. Multivariable logistic regression analysis confirmed that obesity (odds ratio (OR) 5·28, 95 per cent c.i. 1·20 to 23·18; P = 0·027), soft gland texture (OR 9·86, 3·41 to 28·54; P &lt; 0·001) and a small duct (OR 5·50, 1·84 to 16·44; P = 0·002) were significant risk factors for POPF. A patch did not reduce the incidence of POPF in patients at higher risk.

Conclusion
The use of a fibrin sealant patch did not reduce the occurrence of POPF and complications after pancreatoduodenectomy with pancreatojejunostomy. Registration number: 2013-000639-29 (EudraCT register).
Mortality in patients with permanent hypoparathyroidism after total thyroidectomy
Authors: Almquist M , Ivarsson K , Nordenström E , Bergenfelz A 
Published: April 2018

Abstract

Background
Permanent hypoparathyroidism remains the most common adverse outcome after total thyroidectomy, but long-term effects of hypoparathyroidism are unknown. The aim was to investigate mortality in patients with permanent hypoparathyroidism after total thyroidectomy.

Methods
Data from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery were linked with the Swedish National Prescription Register for Pharmaceuticals and the Swedish National Inpatient Register. Patients who underwent total thyroidectomy between 1 July 2005 and 30 June 2014 for benign thyroid disease, and who used active vitamin D for at least 6 months after surgery, were classified as having permanent hypoparathyroidism and included in the study cohort. Risk of death was assessed using Cox regression analysis, adjusting for age, sex, thyrotoxicosis and co-morbidity.

Results
There were 4899 patients, with a mean(s.d.) age of 46·3(15·8) years; 83·1 per cent were women, and 2932 patients (59·8 per cent) had thyrotoxicosis. In all, 246 patients (5·2 per cent) were classified as having permanent hypoparathyroidism. Mean(s.d.) follow-up was 4·4(2·4) years, and 109 patients (2·2 per cent) died during follow-up. Compared with patients without permanent hypoparathyroidism, the risk of death was significantly higher among patients with permanent hypoparathyroidism after total thyroidectomy (adjusted hazard ratio 2·09, 95 per cent c.i. 1·04 to 4·20).

Conclusion
Permanent hypoparathyroidism after total thyroidectomy for benign disease is common and associated with an increased risk of death.
Multicentre phase II trial of near-infrared imaging in elective colorectal surgery
Authors: Ris F , Liot E , Buchs N C , Kraus R , Ismael G , Belfontali V , Douissard J , Cunningham C , Lindsey I , Guy R , Jones O , George B , Morel P , Mortensen N J , Hompes R , Cahill R A 
Published: April 2018

Abstract

Background
Decreasing anastomotic leak rates remain a major goal in colorectal surgery. Assessing intraoperative perfusion by indocyanine green (ICG) with near-infrared (NIR) visualization may assist in selection of intestinal transection level and subsequent anastomotic vascular sufficiency. This study examined the use of NIR-ICG imaging in colorectal surgery.

Methods
This was a prospective phase II study (NCT02459405) of non-selected patients undergoing any elective colorectal operation with anastomosis over a 3-year interval in three tertiary hospitals. A standard protocol was followed to assess NIR-ICG perfusion before and after anastomosis construction in comparison with standard operator visual assessment alone.

Results
Five hundred and four patients (median age 64 years, 279 men) having surgery for neoplastic (330) and benign (174) pathology were studied. Some 425 operations (85·3 per cent) were started laparoscopically, with a conversion rate of 5·9 per cent. In all, 220 patients (43·7 per cent) underwent high anterior resection or reversal of Hartmann's operation, and 90 (17·9 per cent) low anterior resection. ICG angiography was achieved in every patient, with a median interval of 29 s to visualization of the signal after injection. NIR-ICG assessment resulted in a change in the site of bowel division in 29 patients (5·8 per cent) with no subsequent leaks in these patients. Leak rates were 2·4 per cent overall (12 of 504), 2·6 per cent for colorectal anastomoses and 3 per cent for low anterior resection. When NIR-ICG imaging was used, the anastomotic leak rates were lower than those in the participating centres from over 1000 similar operations performed with identical technique but without NIR-ICG technology.

Conclusion
Routine NIR-ICG assessment in patients undergoing elective colorectal surgery is feasible. NIR-ICG use may change intraoperative decisions, which may lead to a reduction in anastomotic leak rates.
Prophylactic thyroidectomy in children with multiple endocrine neoplasia type 2
Authors: Prete F P , Abdel-Aziz T , Morkane C , Brain C , Kurzawinski T R , Hindmarsh P , Dattani M , Spoudeas H , Amin R , Watkinson J , Shaw N , Alvi S , Squire R , Harrison B , Wales J , Wright N , Clayton P , Eatock F , Buchanan C , Albanese A , Bano G , Storr H , Korbonits M , Gevers E , Randell T , Denvir L , Davies J , Cheetham T , Lennard T , Warner J , Smith D , Crowne L , Hulse T , Izatt L , Blair J 
Published: April 2018

Abstract

Background
In patients with multiple endocrine neoplasia type 2 (MEN2) syndrome, genetic testing offers early diagnosis, stratifies the risk of developing medullary thyroid cancer (MTC) and informs the timing of thyroidectomy. The efficacy of treatment, which depends on timely and safe surgery, is not well established.

Methods
This was a retrospective review of diagnostic and clinicopathological outcomes of prophylactic thyroidectomy in children with MEN2 between 1995 and 2013 in the UK. American Thyroid Association (ATA) 2009 guidelines were used as a benchmark for adequate treatment.

Results
Seventy-nine children from 16 centres underwent total thyroidectomy. Thirty-eight patients (48 per cent) underwent genetic testing and 36 (46 per cent) had an operation performed above the age recommended by the ATA 2009 guidelines; pathology showed MTC in 30 patients (38 per cent). Late surgery, above-normal preoperative calcitonin level and MTC on pathology correlated with late genetic testing. Twenty-five children had lymphadenectomy; these patients had more parathyroid glands excised (mean difference 0·61, 95 per cent c.i. 0·24 to 0·98; P = 0·001), and were more likely to have hypocalcaemia requiring medication (relative risk (RR) 3·12, 95 per cent c.i. 1·54 to 6·32; P = 0·002) and permanent hypoparathyroidism (RR 3·24, 1·29 to 8·11; P = 0·010) compared with those who underwent total thyroidectomy alone. Age did not influence the development of complications.

Conclusion
Late genetic testing may preclude age-appropriate surgery, increasing the risk of operating when MTC has already developed. Early genetic testing and age-appropriate surgery may help avoid unnecessary lymphadenectomy and improve outcomes.
Mortality following surgery for trauma in an Indian trauma cohort
Authors: Mansourati M , Kumar V , Khajanchi M , Saha M L , Dharap S , Seger R , Gerdin Wärnberg M 
Published: April 2018

Abstract

Background
India accounts for 20 per cent of worldwide trauma mortality. Little is known about the quality of trauma surgery in an Indian setting. The aim of this study was to estimate the overall perioperative mortality rate, and to assess the association between type of acute surgical intervention and perioperative mortality among adult patients treated for trauma in an urban Indian setting.

Methods
Data were obtained from injured adult patients enrolled in four urban Indian hospitals during 2013–2015. Those who had surgery within 24 h of arrival at hospital were included in the analysis. Patients with missing data were excluded. The perioperative mortality rate was measured at 48 h and 30 days after arrival at hospital. Generalized linear mixed models were used for risk adjustment of procedure-specific mortality.

Results
Among 2986 patients who underwent trauma surgery, the overall 48-h mortality rate was 6·0 per cent, and the 30-day mortality rate was 23·1 per cent. The highest adjusted odds ratios (ORs) for 48-h mortality were found for patients who underwent surgery on the peripheral vasculature (OR 4·71, 95 per cent c.i. 1·18 to 16·59; P = 0·030) and the digestive system and spleen (OR 3·77, 1·33 to 9·01; P = 0·010) compared with those who had nervous system surgery.

Conclusion
In this study of surgery in an Indian trauma cohort, there was an excess of late perioperative deaths. Mortality differed significantly according to the type of surgery being undertaken.
Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial
Authors: Negenborn V L , Dikmans R E G , Bouman M B , Winters H A H , Twisk J W R , Ruhé P Q , Mureau M A M , Smit J M , Tuinder S , Hommes J , Eltahir Y , Posch N A S , van Steveninck-Barends J M , Meesters-Caberg M A , van der Hulst R R W J , Ritt M J P F , Mullender M G 
Published: April 2018

Abstract

Background
In the multicentre randomized trial BRIOS (Breast Reconstruction In One Stage), direct-to-implant (DTI) breast reconstruction with an acellular dermal matrix (ADM) was associated with a markedly higher postoperative complication rate compared with two-stage tissue expander/implant breast reconstruction. This study aimed to identify factors that contribute to the occurrence of complications after DTI ADM-assisted breast reconstruction.

Methods
Data were obtained from the BRIOS study, including all patients treated with DTI ADM-assisted breast reconstruction. Logistic regression analyses were performed to identify factors predictive of postoperative complications.

Results
Fifty-nine patients (91 breasts) were included, of whom 27 (35 breasts) developed a surgical complication. Reoperations were performed in 29 breasts (32 per cent), with prosthesis removal in 22 (24 per cent). In multivariable analyses, mastectomy weight was associated with complications (odds ratio (OR) 1·94, 95 per cent c.i. 1·33 to 2·83), reoperations (OR 1·70, 1·12 to 2·59) and removal of the implant (OR 1·55, 1·11 to 2·17). Younger patients (OR 1·07, 1·01 to 1·13) and those who received adjuvant chemotherapy (OR 4·83, 1·15 to 20·24) more frequently required reoperation. In univariable analyses, adjuvant radiotherapy showed a trend towards more complications (OR 7·23, 0·75 to 69·95) and removal of the implant (OR 5·12, 0·76 to 34·44), without reaching statistical significance.

Conclusion
Breast size appeared to be the most significant predictor of complications in DTI ADM-assisted breast reconstruction. The technique should preferably be performed in patients with small to moderate sized breasts. Registration number: NTR5446 (http://www.trialregister.nl).
Prognostic value of pathological node status after neoadjuvant radiotherapy for rectal cancer
Authors: Duchalais E , Glyn Mullaney T , Spears G M , Kelley S R , Mathis K , Harmsen W S , Larson D W 
Published: April 2018

Abstract

Background
The prognostic value of pathological lymph node status following neoadjuvant radiotherapy (ypN) remains unclear. This study was designed to determine whether ypN status predicted overall survival.

Methods
Patients with locally advanced rectal adenocarcinoma who underwent neoadjuvant long-course radiation between 2005 and 2014 were identified from the National Cancer Data Base, and divided into ypN0, ypN1 and ypN2 groups. The primary outcome was overall survival. Univariable and multivariable analyses were used to determine factors associated with overall survival.

Results
Of 12 271 patients, 3713 (30·3 per cent) were found to have residual nodal positivity. A majority of patients with ypN1 (1663 of 2562) and ypN2 (878 of 1151) disease had suspected lymph node-positive disease before neoadjuvant therapy, compared with 3959 of 8558 with ypN0 tumours (P &lt; 0·001). Moreover, ypN1 and ypN2 were significantly associated with ypT3–4 disease (65·7 and 83·0 per cent respectively versus 39·4 per cent for ypN0; P &lt; 0·001). In unadjusted analyses, survival differed significantly between ypN groups (P &lt; 0·001). Five-year survival rates were 81·6, 71·3 and 55·0 per cent for patients with ypN0, ypN1 and ypN2 disease respectively. After adjustment for confounding variables, ypN1 and ypN2 remained independently associated with overall survival: hazard ratio (HR) 1·61 (95 per cent c.i. 1·46 to 1·77) and 2·63 (2·34 to 2·95) respectively (P &lt; 0·001). Overall survival was significantly longer in patients with ypN1–2 combined with ypT0–2 status than among those with ypT3–4 tumours even with ypN0 status (P = 0·031). Clinical nodal status before neoadjuvant therapy was not significantly associated with overall survival (HR 1·05, 0·97 to 1·13; P = 0·259).

Conclusion
Both ypT and ypN status is of prognostic significance following neoadjuvant therapy for rectal cancer.
The effects of cognitive behavioral therapy on resting‐state functional brain network in drug‐naive patients with obsessive–compulsive disorder
Authors: Li Ping , Yang Xiangyun , Greenshaw Andrew J. , Li Sufang , Luo Jia , Han Haiying , Liu Jing , Zhong Zhaoxi , Guo Zhihua , Xiong Hongfang , Yao Shumin , Chen Yunhui , Sun Jing , Li Zhanjiang 
Published: April 2018

AbstractObjectivesAlthough cognitive behavioral therapy (CBT) is an effective treatment for obsessive–compulsive disorder (OCD), the treatment mechanisms remain poorly understood. This study aimed to investigate the effects of CBT on changes in the intrinsic whole‐brain functional network of OCD patients.Materials and MethodsTwenty drug‐naive and noncomorbid OCD patients were recruited, and resting‐state functional magnetic resonance imaging was performed before and after 12 weeks of CBT. Moreover, 20 healthy controls were scanned twice with a 12‐week interval. A graph‐theory degree centrality (DC) approach and functional connectivity method were used to analyze the whole‐brain functional network hub and connectivity changes in OCD patients before and after CBT treatment.ResultsA significant group × time interaction on DC was found in the left dorsolateral prefrontal cortex (DLPFC); the DC in the left DLPFC was significantly reduced after CBT treatment. Resting‐state functional connectivity (RSFC) between the left DLPFC and right orbitofrontal cortex was increased in the OCD patients at baseline, and normalized after CBT treatment. RSFC changes between the left DLPFC and default mode network (DMN) positively correlated with changes in clinical symptoms in OCD patients.ConclusionsThese findings suggest that CBT can modulate changes in intrinsic functional network hubs in the cortico–striato–thalamo‐cortical circuit in OCD patients. Cognitive control network and DMN connectivity may be a potential imaging biomarker for evaluating CBT treatment for OCD.
Living on a farm, contact with farm animals and pets, and childhood acute lymphoblastic leukemia: pooled and meta‐analyses from the Childhood Leukemia International Consortium
Authors: Orsi Laurent , Magnani Corrado , Petridou Eleni T. , Dockerty John D. , Metayer Catherine , Milne Elizabeth , Bailey Helen D. , Dessypris Nick , Kang Alice Y. , Wesseling Catharina , Infante‐Rivard Claire , Wünsch‐Filho Victor , Mora Ana M. , Spector Logan G. , Clavel Jacqueline 
Published: April 2018

AbstractThe associations between childhood acute lymphoblastic leukemia (ALL) and several factors related to early stimulation of the immune system, that is, farm residence and regular contacts with farm animals (livestock, poultry) or pets in early childhood, were investigated using data from 13 case–control studies participating in the Childhood Leukemia International Consortium. The sample included 7847 ALL cases and 11,667 controls aged 1–14 years. In all studies, the data were obtained from case and control parents using standardized questionnaires. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by unconditional logistic regression adjusted for age, sex, study, maternal education, and maternal age. Contact with livestock in the first year of life was inversely associated with ALL (OR = 0.65, 95% CI: 0.50, 0.85). Inverse associations were also observed for contact with dogs (OR = 0.92, 95% CI: 0.86, 0.99) and cats (OR = 0.87, 95% CI: 0.80, 0.94) in the first year of life. There was no evidence of a significant association with farm residence in the first year of life. The findings of these large pooled and meta‐analyses add additional evidence to the hypothesis that regular contact with animals in early childhood is inversely associated with childhood ALL occurrence which is consistent with Greaves’ delayed infection hypothesis.
Clinical significance of TM4SF1 as a tumor suppressor gene in gastric cancer
Authors: Peng Xing‐Chun , Zeng Zhi , Huang Yu‐Ning , Deng Yun‐Chao , Fu Guo‐Hui 
Published: April 2018

AbstractTransmembrane‐4‐L‐six‐family member‐1 (TM4SF1), a tumor‐associated antigen, is overexpressed in most epithelial cell carcinomas and a potential target for antibody‐mediated therapy. However, the role of TM4SF1 in gastric cancer has not been elucidated. The aim of this study was to investigate the clinical significance of TM4SF1 expression in gastric carcinoma (GC) tissues using 152 GC tissue samples and matched adjacent nontumor tissue samples analyzed by immunohistochemistry, and 13 fresh GC tissue samples analyzed by Western blotting. The results showed that TM4SF1 was heterogeneously expressed in normal gastric mucosa, with a high expression rate in fundus mucosa. Higher levels and strong expression rate of TM4SF1 were associated with GC tissues of higher‐grade differentiation. TM4SF1 levels were lower in gastric cancer tissues than gastric noncancerous tissues. Expression of TM4SF1 was not correlated with USP10 (P = 0.157), S100A12 (P = 0.479), p53 (P = 0.249), or Ki67 (P = 0.166) in GC. The expression of TM4SF1 was significantly and negatively correlated with depth of invasion (P = 0.031), nodal metastasis (P = 0.042), TNM stage (P = 0.030), and Lauren classification (P = 0.026). There was no significant correlation between TM4SF1 expression and age, gender, tumor size, or distant metastasis (P > 0.05). The expression of TM4SF1 was associated with well overall survival (P = 0.0164). The 5‐year survival rate for patients with GC showing TM4SF1 positive was 58.82% (10/17), and the median survival time was 78 months, higher than that (12.90%, 12/93) of patients who were TM4SF1 negative, whose median survival time was 62 months. These data suggested that low expression of TM4SF1 is associated with carcinogenesis and development, tumor progression and invasion of gastric cancer, and poor overall survival of patients with GC. TM4SF1 is a tumor suppressor for GC and a novel prognostic marker for patients with GC.
Myricetin‐induced oxidative stress suppresses murine T lymphocyte activation
Authors: Ghassemi‐Rad Javad , Maleki Mahdis , Knickle Allison F. , Hoskin David W. 
Published: April 2018

AbstractA number of polyphenolic compounds present in fruits and vegetables have the capacity to modulate immune responses; however, the impact of the common plant‐derived flavonoid myricetin on T lymphocyte function has not been investigated. We show that myricetin inhibited mouse T lymphocyte activation by bead‐immobilized anti‐CD3 and anti‐CD28 monoclonal antibodies, as indicated by a dose‐dependent reduction in cell proliferation and decreased synthesis of interferon‐γ, interleukin (IL)‐2, IL‐4, and IL‐17 associated with different T helper cell subsets. This effect was attributed to myricetin‐induced reactive oxygen species (ROS) since myricetin caused hydrogen peroxide (H2O2) to accumulate in cell‐free culture medium and H2O2 inhibited T cell proliferation and cytokine synthesis. In addition, the antioxidant N‐acetyl cysteine restored the ability of myricetin‐treated T lymphocytes to proliferate in response to a mitogenic stimulus. The presence of dendritic cells or bone marrow‐derived macrophages negated the inhibitory effect of myricetin on T cell activation, and H2O2 in T cell cultures that were treated with exogenous H2O2 was reduced when antigen‐presenting cells were also present. These findings suggest that antioxidant molecules produced by dendritic cells and macrophages protected T cells from myricetin‐induced oxidative stress, and underscore the importance of considering immune cell interactions when evaluating the immunomodulatory activity of ROS‐generating phytochemicals.
Iron deficiency without anemia – a clinical challenge
Authors: Soppi Esa T. 
Published: April 2018

Key Clinical MessageOne should always consider iron deficiency (without anemia) as the cause of persisting, unexplained unspecific, often severe, symptoms, regardless of the primary underlying disease. The symptoms of iron deficiency may arise from the metabolic systems where many proteins are iron containing. Long‐standing iron deficiency may be challenging to treat.
Fatal massive hemolysis caused by immunoglobulin M anti‐c antibody in a patient with newly diagnosed B‐cell acute lymphoblastic leukemia: a case report
Authors: Galvez Carlos , Abutaleb Abdulrahman , Iams Wade T. , Lindholm Paul F. , Kwaan Hau C. 
Published: April 2018

Key Clinical MessageDelayed hemolytic transfusion reactions (DHTRs) occur secondary to slow, mild IgG‐mediated processes against minor red blood cell antigens. Herein, we report the case of a rapidly fatal alloimmune anti‐c IgM‐mediated hemolysis, a rare, previously undescribed, pathophysiologic scenario. Early recognition of such phenomena can expedite supportive measures and optimize patient outcomes.
Belhassen anterior fascicular ventricular tachycardia: a case in a black African
Authors: Pessinaba Soulemane , Agbetiafa Messan , Aloumon Messanvi , Yayehd Komlavi , Atti Yawo Molba Dodzi , Damorou Findibe 
Published: April 2018

Key Clinical MessageBelhassen ventricular tachycardia can be characterized by a complete right branch block and a right axial deviation. This type, although rare, must be recognized to properly treat the patient, as verapamil treatment is effective.