bluuebunny/crossref_metadata_2025_split huggingface dataset:
First trimester screening for pre‐eclampsia in Chinese pregnancies: case–control study
Authors: Cheng YKY , Leung TY , Law LW , Ting YH , Law KM , Sahota DS 
Published: October 2017

ObjectiveTo assess the potential of screening for pre‐eclampsia (PE) in a Chinese population.DesignCase–control study.SettingTeaching hospital in Hong Kong.PopulationA total of 3330 women having a viable singleton pregnancy attending first‐trimester Down‐syndrome screening.MethodsMean arterial pressure (MAP), bilateral uterine artery pulsatility index (UtA‐PI), and placental growth factor (PlGF) were measured. Screening markers were transformed to multiples of the gestational median (MoM) and adjusted for maternal and pregnancy characteristics. MoM distributions in PE and non‐PE pregnancies were compared with published expected values. PE screening performance was assessed using area under receiver operating curves (AUROC).Main outcome measuresPE detection rate.ResultsA total of 30 (0.9%) women developed either early (<34 weeks) or late (≥34 weeks) onset PE. MAP was dependent on maternal BMI, UtA‐PI on fetal crown rump length, uterine artery peak systolic velocity (UtA‐PSV) on maternal age and gestation, and PlGF on gestation in non‐PE pregnancies. MoM distributions determined using published Fetal Medicine Foundation models deviated significantly from one for both MAP (P < 0.0001) and PI (P < 0.0001), but not PlGF (P = 0.52) in non‐PE pregnancies, whilst PlGF MoM distributions in those who developed early as opposed to late onset PE were significantly higher (P = <0.05). AUROC for any PE using multiple markers was 0.72 (95% CI: 0.64–0.81) with detection rates of 72 and 55% for early and late PE, respectively, for a 10% false positive rate.ConclusionDetection rates for PE in our Chinese population were lower than the expected 90–95% even after adjusting MoM for local women's characteristics.FundingGeneral Research Fund (Project number 470513).Tweetable abstractPre‐eclampsia screening in the Chinese population had detection rates lower than previously published results.
Third Generation Ventricular Assist Device: Mid‐Term Outcomes of the HeartWare HVAD in Pediatric Patients
Authors: Pac Mustafa , Kocabeyoglu Sinan Sabit , Kervan Umit , Sert Dogan Emre , Koca Serhat , Ece Ibrahim , Pac Feyza Aysenur 
Published: October 2017

AbstractThe HeartWare HVAD is a small, third generation continuous flow pump that is intracorporeally placed for support of a failing ventricle in adult patients. This device is small in size when compared to other left ventricular assist devices and can therefore be used in smaller sized pediatric patients. We present our initial experience using the HVAD as a bridge to heart transplantation in the pediatric population. We performed a retrospective, single center, nonrandomized review of 17 pediatric patients who underwent HVAD implantation between June 2013 and March 2016. The primary endpoints evaluated in this study were overall survival to heart transplantation, ongoing device support, or death. In this patient cohort, nine (53%) of 17 patients were male. The median age of the patients was 13.4 ± 3.8 (range 5–17) years. The median body surface area was 1.4 ± 0.4(0.7–2) m2. Etiologies of heart failure requiring HVAD support were dilated cardiomyopathy (n = 8), myocarditis (n = 5) and noncompaction cardiomyopathy (n = 4). The overall mean length of HVAD support was 254 ± 298 (range 2–804) days. A successful outcome (bridge to transplant and ongoing mechanical support) was achieved in 13 patients (76.5%). Of the 13 patients, nine (69.2%) were bridged to heart transplantation and four continue to receive support (30.7%) and are eligible for transplantation. Post‐transplant survival has been 100%, with a mean follow‐up of 296 ± 264.5 (range 18–785) days. The most common complication was pump thrombosis (23.5%) in follow‐up. Four patients (23.5%) experienced no complications. The HVAD continuous flow ventricular assist device can be safely used to bridge pediatric patients to cardiac transplantation. Favorable outcomes of this device are comparable to the adult population. This analysis demonstrated safe and effective implantation of the HVAD System in a child with a BSA of 0.7 m2.
IMPACT‐III is a valid and reliable questionnaire for assessing health‐related quality of life in Swedish children with inflammatory bowel disease
Authors: Uggla C , Lindh V , Lind T , Lindkvist M 
Published: October 2017

AbstractAimThis study examined the reliability, validity and factor structure of the Swedish version of the IMPACT‐III questionnaire for assessing health‐related quality of life in children with inflammatory bowel disease.MethodsWe recruited 202 participants aged eight to 18 years, who were enrolled from 16 of the 23 paediatric gastroenterology clinics across Sweden during 2010–2013. This cross‐sectional study compared two versions of the IMPACT‐III questionnaire – one with six factors and 35 items and one with four factors and 19 items – plus the Paediatric Quality of Life Inventory 4.0 Generic Core Scale. Disease activity was assessed and defined as active or inactive.ResultsThe mean total score for the six‐factor IMPACT‐III scale was 143.7/175, with a standard deviation (SD) of 17.9. There was a significant difference in mean total scores between the 133 children with inactive disease (147.8, SD: 14.9) and the 52 with active disease (133.0, SD: 20.3). Confirmatory factor analysis showed that the four‐factor scale was more robust than the original six‐factor scale. Concurrent validity and discriminant validity were high for both versions.ConclusionThe Swedish version of the IMPACT‐III questionnaire was valid and reliable, but the shorter, four‐factor version is quicker and may be more convenient in clinical settings.
Muscle‐specific differences in expression and phosphorylation of the Janus kinase 2/Signal Transducer and Activator of Transcription 3 following long‐term mechanical ventilation and immobilization in rats
Authors: Salah H. , Fury W. , Gromada J. , Bai Y. , Tchkonia T. , Kirkland J. L. , Larsson L. 
Published: October 2017

AbstractAimMuscle wasting is one of the factors most strongly predicting mortality and morbidity in critically ill intensive care unit (ICU). This muscle wasting affects both limb and respiratory muscles, but the understanding of underlying mechanisms and muscle‐specific differences remains incomplete. This study aimed at investigating the temporal expression and phosphorylation of the Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway in muscle wasting associated with the ICU condition to characterize the JAK/STAT proteins and the related changes leading or responding to their activation during exposure to the ICU condition.MethodsA novel experimental ICU model allowing long‐term exposure to the ICU condition, immobilization and mechanical ventilation, was used in this study. Rats were pharmacologically paralysed by post‐synaptic neuromuscular blockade and mechanically ventilated for durations varying between 6 hours and 14 days to study muscle‐specific differences in the temporal activation of the JAK/STAT pathway in plantaris, intercostal and diaphragm muscles.ResultsThe JAK2/STAT3 pathway was significantly activated irrespective of muscle, but muscle‐specific differences were observed in the temporal activation pattern between plantaris, intercostal and diaphragm muscles.ConclusionThe JAK2/STAT3 pathway was differentially activated in plantaris, intercostal and diaphragm muscles in response to the ICU condition. Thus, JAK2/STAT3 inhibitors may provide an attractive pharmacological intervention strategy in immobilized ICU patients, but further experimental studies are required in the study of muscle‐specific effects on muscle mass and function in response to both short‐ and long‐term exposure to the ICU condition prior to the translation into clinical research and practice.
Impact of ureteroscopy before radical nephroureterectomy for upper tract urothelial carcinomas on oncological outcomes: a meta‐analysis
Authors: Guo Run‐Qi , Hong Peng , Xiong Geng‐Yan , Zhang Lei , Fang Dong , Li Xue‐Song , Zhang Kai , Zhou Li‐Qun 
Published: October 2017

ObjectivesTo investigate whether ureteroscopy (URS) before radical nephroureterectomy (RNU) for upper tract urothelial carcinomas (UTUCs) has an impact on oncological outcomes.Patients and MethodsWe performed a systematic literature search of PubMed, Web of Science, and EMBASE for citations published prior to September 2017 that described URS performed on patients with UTUC and conducted a standard meta‐analysis on survival outcomes.ResultsOur meta‐analysis included eight eligible studies containing 3975 patients. The results were as follows: cancer‐specific survival (CSS; hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.59–0.99; P = 0.04), overall survival (OS; HR 0.76, 95% CI 0.48–1.21; P = 0.24), recurrence‐free survival (RFS; HR 0.89, 95% CI 0.69–1.14; P = 0.37), metastasis‐free survival (MFS; HR 1.06, 95% CI 0.82–1.36; P = 0.66), and intravesical recurrence‐free survival (IRFS; HR 1.51, 95% CI 1.29–1.77; P < 0.001). When excluding previous bladder tumour history, the result for IRFS was a HR of 1.81 (95% CI 1.53–2.13; P < 0.001).ConclusionsThis meta‐analysis indicated that URS before RNU did not have a negative impact on CSS, OS, RFS, or MFS in patients with UTUC. However, patients were at higher risk of intravesical recurrence after RNU when they had undergone URS before RNU. Further studies are needed to assess the effects of post‐URS intravesical chemotherapy on intravesical recurrence.
National cohort study comparing severe medium‐term urinary complications after robot‐assisted vs laparoscopic vs retropubic open radical prostatectomy
Authors: Sujenthiran Arunan , Nossiter Julie , Parry Matthew , Charman Susan C. , Aggarwal Ajay , Payne Heather , Dasgupta Prokar , Clarke Noel W. , van der Meulen Jan , Cathcart Paul 
Published: October 2017

ObjectivesTo evaluate the occurrence of severe urinary complications within 2 years of surgery in men undergoing either robot‐assisted radical prostatectomy (RARP), laparoscopic radical prostatectomy (LRP) or retropubic open radical prostatectomy (ORP).Patients and MethodsWe conducted a population‐based cohort study in men who underwent RARP (n = 4 947), LRP (n = 5 479) or ORP (n = 6 873) between 2008 and 2012 in the English National Health Service (NHS) using national cancer registry records linked to Hospital Episodes Statistics, an administrative database of admissions to NHS hospitals. We identified the occurrence of any severe urinary or severe stricture‐related complication within 2 years of surgery using a validated tool. Multi‐level regression modelling was used to determine the association between the type of surgery and occurrence of complications, with adjustment for patient and surgical factors.ResultsMen undergoing RARP were least likely to experience any urinary complication (10.5%) or a stricture‐related complication (3.3%) compared with those who had LRP (15.8% any or 5.7% stricture‐related) or ORP (19.1% any or 6.9% stricture‐related). The impact of the type of surgery on the occurrence of any urinary or stricture‐related complications remained statistically significant after adjustment for patient and surgical factors (P < 0.01).ConclusionMen who underwent RARP had the lowest risk of developing severe urinary complications within 2 years of surgery.
Utilization and quality outcomes of cT1a, cT1b and cT2a partial nephrectomy: analysis of the national cancer database
Authors: Fero Katherine , Hamilton Zachary A. , Bindayi Ahmet , Murphy James D. , Derweesh Ithaar H. 
Published: October 2017

ObjectiveTo describe the utilization and compare quality outcomes of partial nephrectomy (PN) for cT1a, cT1b and cT2a renal masses using a large national database.MethodsWe conducted a retrospective analysis of patients from the US National Cancer Database who underwent PN for cT1a/cT1b/T2a renal cell carcinoma between 2004 and 2013. We examined the use of PN over time and assessed quality indicators [positive surgical margin (PSM) and 30‐day postoperative readmission rates]. Multivariable analysis was conducted to determine predictors for outcome comparisons.ResultsA total of 43 749 patients underwent PN for cT1a, cT1b and cT2a renal masses (cT1a, n = 34 796; cT1b, n = 8 040; cT2a, n = 913). The proportion of patients undergoing PN increased from 30.8% in 2004 to 56.7% in 2013 (P < 0.001), and this trend was apparent for all clinical stages. The PSM rate was 6.8%. Predictive factors for increased risk of PSMs included cT1a stage (P = 0.03), age [odds ratio (OR) 1.01; P < 0.001] and later year of diagnosis (OR: 1.05; P < 0.001). The 30‐day readmission rate was 4.2%. Predictive factors for increased risk of readmission included cT1b (P < 0.001), high Charlson comorbidity score (OR: 1.32; P = 0.001) and lack of private insurance (OR: 1.21–1.97; P < 0.05); later year of diagnosis was associated with decreased odds of readmission (OR: 0.96; P < 0.001). Subset analysis of the 2010–2013 cohort showed increases in the proportion of minimally invasive PN for cT1a (52.8–69.6%; P < 0.001), cT1b (39.9–59.6%; P < 0.001) and cT2a tumours (33.3–47.3%; P = 0.01). The PSM rate was also increased, at 7.3%. Predictive factors for PSMs included increasing age (OR: 1.01; P < 0.001), minimally invasive surgical approach (OR: 1.52; P < 0.001), and conversion to open surgery (OR: 1.52; P = 0.01), but not clinical stage (P = 0.75–0.99). The 30‐day readmission rate was 4.0%. Predictive factors for readmission included lack of private insurance (P < 0.001) and conversion to open surgery (OR: 1.63; P < 0.001).ConclusionThe use of PN has increased significantly over time for all clinical stage groups. PSM rates increased, while 30‐day readmission rates decreased. The PSM rate increase was driven by increasing use of minimally invasive approaches, and not by higher clinical stage. The 30‐day readmission rate was driven by patient comorbidities and socio‐economic factors. Rising PSM rates represent a quality‐of‐care concern.
Incidentally detected testicular lesions <10 mm in diameter: can orchidectomy be avoided?
Authors: Scandura Glenda , Verrill Clare , Protheroe Andrew , Joseph Johnson , Ansell Wendy , Sahdev Anju , Shamash Jonathan , Berney Daniel M. 
Published: October 2017

ObjectiveTo investigate the pathology of excised testicular lesions <10 mm in size.Patients and MethodsThe pathological reports of 2 681 patients with testicular lesions from Barts Health NHS Trust and Oxford University Hospitals NHS Foundation Trust were reviewed as part of a service evaluation audit from January 2003 to May 2016. Cases in which the lesion had a maximum diameter of <10 mm were selected. Clinical features were also accessed, where available, to examine patient demographics, prediagnostic levels of serum markers, ultrasonographic findings and clinical details.ResultsA total of 81 patients with a lesion size <10 mm on histology were identified and, of these, 16 (20%) had a lesion diameter <5 mm. Of the 81 patients, 56 (69%) had benign lesions. Of 16 patients with a benign lesion <5 mm in diameter, 15 underwent orchidectomy and just one underwent partial orchidectomy. Preoperative tumour markers were available in 47/81 patients. None of the 16 malignant tumours in these 47 patients were associated with raised tumour markers, while seven of 31 remaining patients with benign lesions had raised α‐fetoprotein and lactate dehydrogenase levels. In total there were 25/81 malignant cases (31%), which were all germ cell tumours (GCTs): 15 seminomas (60%) and 10 non‐seminomatous GCTs (40%). Only one GCT had a diameter of <5 mm, and this was a regressed tumour within an 18‐mm area of granulomatous inflammation. Only one GCT relapsed: a clinical stage I, embryonal carcinoma of 6 mm in maximum diameter. The 56 ‘benign’ cases included 34 sex cord stromal tumours, including 23 Leydig cell tumours (41%), eight Sertoli cell tumours (14%) and three mixed sex cord stromal tumours (5%). None showed any malignant features. The remaining 22/56 lesions (40%) were lesions with no further follow‐up. Benign lesions seemed to be associated with a small diameter, and we found <5 mm to be the best threshold for predicting benign vs malignant lesions (P = 0.002).ConclusionThe majority of testicular lesions <10 mm, identified by radiology, were benign, although approxmiately one‐third were malignant. In the present study, 100% of lesions <5 mm in diameter were benign. Tumour markers appear to be unhelpful in the distinction of these small tumours. We suggest that regular ultrasound surveillance be more widely used for testicular lesions of this size. Testicular tumours now have a very high cure rate and changes in size of lesions may be monitored prospectively with minimal risk of increased morbidity. Patients who undergo an orchidectomy for lesions <5 mm are ‘victims of modern imaging technology’. If surgery is undertaken in lesions 5–10 mm, patients should be counselled that two‐thirds of cases are benign.
Pyruvate kinase isozyme M2 and glutaminase might be promising molecular targets for the treatment of gastric cancer
Authors: Kitayama Kishu , Yashiro Masakazu , Morisaki Tamami , Miki Yuichiro , Okuno Tomohisa , Kinoshita Haruhito , Fukuoka Tatsunari , Kasashima Hiroaki , Masuda Go , Hasegawa Tsuyoshi , Sakurai Katsunobu , Kubo Naoshi , Hirakawa Kosei , Ohira Masaichi 
Published: October 2017

The aim of this study was to analyze the significance of glucose metabolism‐related enzymes in the proliferation of gastric cancer under hypoxia. Four hypoxia‐resistant gastric cancer cell lines and four parent cell lines were used. Reverse transcription–PCR was used to evaluate the mRNA expression levels of the following metabolism‐related enzymes: pyruvate kinase isozyme M2 (PKM2), glutaminase (GLS), enolase 1 (ENO1), glucose‐6‐phosphate dehydrogenase (G6PDH), and PKM1. The effects of these enzymes on the proliferation of gastric cancer cells were examined using siRNAs, shikonin as a PKM2 inhibitor, or BPTES as a GLS inhibitor, in vitro and in vivo. Levels of both PKM2 and GLS mRNA were significantly high in all hypoxia‐resistant cell lines, compared with those of their parent cells. Knockdown of PKM2 and GLS significantly decreased the proliferation of all hypoxia‐resistant cells. The combination of siPKM2 and siGLS significantly decreased proliferation compared with treatment by siPKM2 or siGLS alone. The knockdown of ENO1, G6PDH, or PKM1 did not decrease the proliferation of all hypoxia‐resistant cells. Combination treatment using shikonin and BPTES inhibited the proliferation of all hypoxia‐resistant cancer cells more than that by either agent alone. The in vivo study indicated that the tumor size treated by the combination of shikonin and BPTES was significantly smaller than that of vehicle‐treated group. These findings suggested that PKM2 and GLS might play important roles in the proliferation of hypoxic gastric cancer cells. A combination of PKM2 and GLS inhibitors could be therapeutically promising for the treatment of gastric cancer.
Clinical significance of lactate clearance for the development of early allograft dysfunction and short‐term prognosis in deceased donor liver transplantation
Authors: Kim Deok Gie , Lee Jee Youn , Jung Yoon Bin , Song Seung Hwan , Lee Jae Geun , Han Dai Hoon , Joo Dong Jin , Ju Man Ki , Choi Gi Hong , Choi Jin Sub , Kim Myoung Soo , Kim Soon Il 
Published: October 2017

AbstractThis retrospective study evaluated lactate clearance (LC), measured at 6, 12, 18, and 24 hours after reperfusion, as a predictor of early allograft dysfunction (EAD) and short‐term outcomes in patients receiving deceased donor liver transplantation. Of 181 transplant recipients, 44 (24.3%) developed EAD and had lower LCs than those who did not develop EAD. A receiver operating characteristic analysis showed that LC determined at 6 hours showed the highest area under curve value of 0.828 (95% confidence interval [CI]: 0.755‐0.990) for predicting the development of EAD at a cutoff value of 25.8% with 76.7% sensitivity and 77.9% specificity. LC values that fell below the cutoff values were significantly associated with EAD in a multivariate analysis, with values at 6 hours having the highest adjusted odds ratio (11.891, 95% CI: 4.469‐31.639). In‐hospital and 6 month mortalities were higher in patients with LC values below the cutoffs compared with those above the cutoff values at each time point. Thus, LC calculated shortly after reperfusion of an allograft is significantly discriminative for the development of EAD and is associated with short‐term prognosis after deceased donor liver transplantation.
Team preparation for human uterus transplantation: Autologous transplantation in sheep model
Authors: Solomonov Evgeny , Marcus Braun Naama , Siman‐Tov Yariv , Ben‐Shachar Inbar 
Published: October 2017

AbstractWe performed autologous uterus transplantation using the living‐sheep donor model for team preparation before human uterine transplantation. Five sequential operations (in 3 ewes) were prospectively conducted. Surgical technique included uterus retrieval, graft preparation, and uterus transplantation. Anastomoses were performed at the level of the external iliac. At 3‐week follow‐up, the uterus and anastomoses were checked for strictures and thrombosis. Two successful auto‐transplantations were made, and one failed because of undeveloped uterine arteries (< 1 mm in diameter). In the first two ewes, we identified and used a deep, separate uterine vein, which was not described in other publications. In the third ewe, we used the utero‐ovarian vein. The team was able to perform safe dissection and auto‐transplantation, with no signs of strictures or thrombosis after 3 weeks. Cold ischemic time was 60 minutes, and warm ischemic time was between 40 and 60 minutes, with no need for re‐anastomoses. We noticed that using the deep uterine vein in the sheep model can anatomically simulate better the human uterine vein and the difficulty to approach it. To avoid using unsuitable vessels for anastomoses, the uterine transplantation protocol in humans should include imaging of the donor's uterine vessels.
The impact of intercenter sharing on the outcomes of pediatric split liver transplantation
Authors: Elsabbagh Ahmed M. , Williams Cassie , Girlanda Raffaele , Hawksworth Jason , Kroemer Alexander , Matsumoto Cal S. , Fishbein Thomas M. 
Published: October 2017

AbstractBackgroundSplit liver transplantation allows for expansion of the pool of organs available for pediatric liver transplantation. The impact of sharing segments of the same liver between centers has not been studied.Study DesignRetrospective analysis of 24 pediatric split liver transplant cases in a recent cohort. We evaluated the outcomes of pediatric recipients who shared organs with adult patients in our own center (group A) compared to recipients who shared organs with adult patients in other centers. (group B).ResultsOne‐, 3‐, and 5‐year graft survival for group A was 100%, 100%, and 100% vs 83%, 71%, and 57% for group B (P = .039). Postoperative complications included biliary complications (41.7% in group A vs 50% in group B, P = .682), vascular complications (8.3% in group A vs 41.7% in group B, P = .059), and postoperative bleeding (16.7% in group A vs 25% in group B, P = .615). High‐grade Clavien‐Dindo complications were 0% in group A vs 33.3% in group B, P = .028.ConclusionsOrgan sharing between centers appears to be associated with significantly poorer graft survival. Possible explanations include greater procurement‐related injury or suboptimal vessel distribution. Future larger studies focused on this area may be helpful to formulate policy considerations.