bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mucinous Rectal Adenocarcinoma Is Associated with a Poor Response to Neoadjuvant Chemoradiotherapy: A Systematic Review and Meta-analysis
Authors: McCawley Niamh , Clancy Cillian , O’Neill Brian D. P. , Deasy Joseph , McNamara Deborah A. , Burke John P. 
Published: November 2016

BACKGROUND:
Mucinous adenocarcinoma represents a potentially poor prognostic subgroup of rectal cancer. A consensus on the effect of mucinous cancer on outcomes following neoadjuvant chemoradiotherapy and curative resection for rectal cancer has not been reached.

OBJECTIVE:
The aim of the current study is to use meta-analytical techniques to assess the association between mucinous histology and response to neoadjuvant chemoradiotherapy in rectal cancer.

DATA SOURCES:
A comprehensive literature search of PubMed, Embase, and The Cochrane Library was performed.

STUDY SELECTION:
All studies examining the effect of mucinous histology on chemotherapeutic response in rectal cancer were included.

INTERVENTIONS:
No direct interventions were performed.

MAIN OUTCOME MEASURES:
Outcomes of mucinous rectal adenocarcinoma were compared with nonmucinous tumors by using random-effects methods to analyze data. Data are presented as ORs with 95% CIs. The main outcomes measured were the rates of pathological complete response, tumor and nodal downstaging, positive resection margin rate, local recurrence, and overall mortality.

RESULTS:
Eight comparative series describing outcomes in 1724 patients were identified, 241 had mucinous tumors (14%). Mucinous tumors had a reduced rate of pathological complete response (OR, 0.078; 95% CI, 0.015–0.397; p = 0.002) and tumor downstaging (OR, 0.318; 95% CI, 0.185–0.547; p < 0.001) following neoadjuvant chemoradiotherapy with an increased rate of positive resection margin (OR, 5.018; 95% CI, 3.224–7.810; p < 0.001) and poorer overall survival (OR, 1.526; 95% CI, 1.060–2.198; p = 0.023) following resection. Mucin expression did not significantly affect nodal downstaging (OR, 0.706; 95% CI, 0.295–1.693; p = 0.435) or local recurrence (OR, 1.856; 95% CI, 0.933–3.693; p = 0.078). There was no across-study heterogeneity for any end point.

LIMITATIONS:
Most studies were retrospectively designed, and there were variations in patient populations and duration of follow-up.

CONCLUSIONS:
Mucinous rectal adenocarcinoma represents a biomarker for poor response to preoperative chemoradiotherapy and is an adverse prognostic indicator.
Correlation Between Echodefecography and 3-Dimensional Vaginal Ultrasonography in the Detection of Perineal Descent in Women With Constipation Symptoms
Authors: Murad-Regadas Sthela M. , Pinheiro Regadas Francisco Sergio , Rodrigues Lusmar V. , da Silva Vilarinho Adjra , Buchen Guilherme , Borges Livia Olinda , Veras Lara B. , da Cruz Mariana Murad 
Published: November 2016

BACKGROUND:
Defecography is an established method of evaluating dynamic anorectal dysfunction, but conventional defecography does not allow for visualization of anatomic structures.

OBJECTIVE:
The purpose of this study was to describe the use of dynamic 3-dimensional endovaginal ultrasonography for evaluating perineal descent in comparison with echodefecography (3-dimensional anorectal ultrasonography) and to study the relationship between perineal descent and symptoms and anatomic/functional abnormalities of the pelvic floor.

DESIGN:
This was a prospective study.

SETTING:
The study was conducted at a large university tertiary care hospital.

PATIENTS:
Consecutive female patients were eligible if they had pelvic floor dysfunction, obstructed defecation symptoms, and a score >6 on the Cleveland Clinic Florida Constipation Scale.

INTERVENTIONS:
Each patient underwent both echodefecography and dynamic 3-dimensional endovaginal ultrasonography to evaluate posterior pelvic floor dysfunction.

MAIN OUTCOME MEASURES:

Normal perineal descent was defined on echodefecography as puborectalis muscle displacement ≤2.5 cm; excessive perineal descent was defined as displacement >2.5 cm.

RESULTS:
Of 61 women, 29 (48%) had normal perineal descent; 32 (52%) had excessive perineal descent. Endovaginal ultrasonography identified 27 of the 29 patients in the normal group as having anorectal junction displacement ≤1 cm (mean = 0.6 cm; range, 0.1–1.0 cm) and a mean anorectal junction position of 0.6 cm (range, 0–2.3 cm) above the symphysis pubis during the Valsalva maneuver and correctly identified 30 of the 32 patients in the excessive perineal descent group. The κ statistic showed almost perfect agreement (κ = 0.86) between the 2 methods for categorization into the normal and excessive perineal descent groups. Perineal descent was not related to fecal or urinary incontinence or anatomic and functional factors (sphincter defects, pubovisceral muscle defects, levator hiatus area, grade II or III rectocele, intussusception, or anismus).

LIMITATIONS:
The study did not include a control group without symptoms.

CONCLUSIONS:
Three-dimensional endovaginal ultrasonography is a reliable technique for assessment of perineal descent. Using this technique, excessive perineal descent can be defined as displacement of the anorectal junction >1 cm and/or its position below the symphysis pubis on Valsalva maneuver.
Treating schizophrenia during menopause
Authors: Brzezinski Amnon , Brzezinski-Sinai Noa A. , Seeman Mary V. 
Published: November 2016

Abstract

Objective:
The aim of this review is to examine three questions: What are the risks and benefits of treating women with schizophrenia with hormone therapy (HT) at menopause? Should the antipsychotic regimen be changed at menopause? Do early- and late-onset women with schizophrenia respond differently to HT at menopause?

Methods:
MEDLINE databases for the years 1990 to 2016 were searched using the following interactive terms: schizophrenia, gender, menopause, estrogen, and hormones. The selected articles (62 out of 800 abstracts) were chosen on the basis of their applicability to the objectives of this targeted narrative review.

Results:
HT during the perimenopause in women with schizophrenia ameliorates psychotic and cognitive symptoms, and may also help affective symptoms. Vasomotor, genitourinary, and sleep symptoms are also reduced. Depending on the woman's age and personal risk factors and antipsychotic side effects, the risk of breast cancer and cardiovascular disease may be increased. Antipsychotic types and doses may need to be adjusted at menopause, as may be the mode of administration.

Conclusions:
Both HT and changes in antipsychotic management should be considered for women with schizophrenia at menopause. The question about differences in response between early- and late-onset women cannot yet be answered.
Eight-strand Cross-locked Cruciate Flexor Tendon Repair Using Double-stranded Suture: A Description of the Surgical Technique
Authors: Watanabe Kentaro , Ota Hideyuki , Sasaki Hiroshi 
Published: November 2016

Summary:
This article describes a technique for improved repair of digital flexor tendon laceration. Eight-strand cross-locked cruciate repair using 4-0 caliber double-stranded suture is not bulky and has a smooth configuration for tendon gliding. Additionally, it has sufficient strength for early postoperative active motion exercise.
MULTIPLE EVANESCENT WHITE DOT SYNDROME WITH CENTRAL VISUAL LOSS
Authors: Barile Gaetano R. , Harmon Sarah A. 
Published: November 2016

Purpose:
To report the clinical case of a 64-year-old man who developed several features of multiple evanescent white dot syndrome (MEWDS) but with central visual loss that persisted because of significant structural macular disease.

Methods:
A case report was generated by a review of the clinical course and imaging investigations of one patient, along with review of the literature.

Results:
A 64-year-old man noted decreased vision in the right eye for 2 weeks, associated with a central scotoma with shimmering, gauze effect of the vision. He had a good vision with normal ophthalmic examinations in the past. Ophthalmic examination revealed acuity of 20/400 with central scotoma and trace pupillary defect in the right eye, normal anterior segment, no evidence of intraocular inflammation, and fundus findings of unilateral MEWDS associated with a central zone of macular pigmentary atrophy. Autofluorescence imaging revealed reflectance changes of MEWDS as well as prominent central hypofluorescence and a zone of hyperfluorescence in inferior macula. Spectral-domain optical coherence tomography identified mild disruptions of outer retina in the regions of the MEWDS lesions and disorganization of the outer retina in the macular region overlying a shallow irregular retinal pigment epithelial detachment. The choroid demonstrated increased thickness compared with the fellow eye with suggestions of dilated outer vessels/pachyvessels. Fluorescein angiography and indocyanine green angiography revealed window defects and staining and hypocyanescence, respectively, of the central macular lesion. The MEWDS lesions resolved without evolution to chorioretinal scars, and the central vision and lesions did not benefit from a systemic steroid course or intravitreal anti–vascular endothelial growth factor therapy.

Conclusion:
This case illustrates an unusual presentation of MEWDS characterized by unilateral retinal disease presenting with symptoms and signs of profound central macular dysfunction. The clinical course did not evolve into other inflammatory retinal phenotypes, such as multifocal choroiditis or AZOOR (acute zonal occult outer retinopathy) that can sometimes develop MEWDS-like features or central disease. The central structural disease resembles some features of the pachychoroid clinical spectrum, which may have represented a superimposed diagnosis unrelated to the inflammatory phenotype.
Caregiving Immediately After Stroke: A Study of Uncertainty in Caregivers of Older Adults
Authors: Byun Eeeseung , Riegel Barbara , Sommers Marilyn , Tkacs Nancy , Evans Lois 
Published: November 2016

ABSTRACT

Background: Caregivers of stroke survivors experience high rates of mental and physical morbidity. Stroke has sudden onset, and the outcome is not immediately known. Uncertainties surrounding the new caregiving role may not only necessitate major changes in the lives of family caregivers but also contribute to negative health outcomes for the caregiver. Purpose: The purposes of this study were to describe caregiver uncertainty across the early weeks after a family member’s stroke and to explore characteristics of caregivers and stroke survivors associated with that uncertainty. Methods: A prospective, longitudinal exploratory observational study was conducted with a convenience sample of 40 caregivers and older adult (≥65 years) stroke survivors recruited from urban acute care settings in the mid-Atlantic region. Caregivers were enrolled by 2 weeks poststroke (T1) and revisited 4 weeks later (T2). Uncertainty was measured usingthe Mishel Uncertainty in Illness Scale for Family Members. An unadjusted linear mixed model was computed to examine significant associations between each caregiver or stroke survivor characteristic and repeated measures of uncertainty. Results: Uncertainty at T1 (83.73 ± 23.47) was higher than reported in other caregiver populations and remained high 6 weeks poststroke (T2: 85.23 ± 23.94). Each of the following characteristics was independently associated with greater caregiver uncertainty: caregivers’ older age (p = .019), being a spouse (p = .01), higher stress (p < .001), more depressive symptoms (p = .001), more comorbidities (p = .035), and poorer coping capacity (p = .002) and stroke survivors’ recurrent stroke (p = .034), poorer functional status (p = .009), and insurance type (p = .008). Conclusions: Caregivers experienced persistently high uncertainty during the first 6 weeks poststroke. Better understanding of uncertainty, its associated characteristics, and its outcomes may help clinicians identify caregivers at highest risk who may benefit from targeted interventions.
Predictors of Postoperative Nausea and Vomiting in Neurosurgical Patients
Authors: Hellickson Jodi D. , Worden Wendy R. , Ryan Crystal , Miers Anne G. , Benike Deborah A. , Frank Sydney P. , Rhudy Lori M. 
Published: November 2016

ABSTRACT
In the neurosurgery patient population, one of the most frequent complications is postoperative nausea and vomiting (PONV). The purpose of this predictive correlational study was to examine the incidence and predictors of PONV in a cohort of 519 neurosurgery patients undergoing elective spinal and intracranial procedures. Patients were interviewed, and their medical records were reviewed every 24 hours for up to 72 hours postoperatively to identify risk factors for PONV development. After summarizing univariate associations, a multivariable logistic regression model for each outcome was developed using forward and backward stepwise selection, with the p value for a variable to enter or leave the model set to .05. Women, especially those who were younger and with a history of PONV, were most likely to have PONV. In addition, those undergoing craniotomy, particularly infratentorial craniotomy, were more likely to have PONV compared with patients undergoing spine surgery. This study provides a foundation for nursing and interdisciplinary intervention studies aimed at reducing this postoperative symptom in the most susceptible patients.
The Glasgow Coma Scale (GCS): Deciphering the Motor Component of the GCS
Authors: Maserati Megan , Fetzick Anita , Puccio Ava 
Published: November 2016

ABSTRACT
The Glasgow Coma Scale (GCS) was developed to standardize the assessment of neurologically compromised patients, to assist in triaging severity of injury, and to direct management decisions for an individualized plan of care. This examination allows for frequent assessments to ascertain worsening of neurological symptoms that would warrant additional radiological scans or interventions. The GCS score is composed of three components: eye, verbal, and motor, with motor being the most difficult to assess. A need for clarification of the motor component of the GCS was identified in a neurotrauma intensive care unit (ICU) at a level 1 hospital in the United States. The aim of this article is to illustrate the need for clear, common language to describe the patient’s motor response to a painful stimulus post head injury, to avoid communication breakdown between healthcare professionals. Proper training and understanding of the components of the GCS, particularly the motor component, will lead to proper use of the scale and thus clearer communication among healthcare professionals. Pre- and post-GCS training tests were administered during educational sessions, with demographics collected. A focus of training was on the motor component of the GCS. A multiple-choice selection included all motor score choices. Tests were de-identified with a matching number to calculate prescoring and postscoring. Of the 54 nurses tested, 50% incorrectly completed the pretest, of which 37% had ≥5 years ICU experience. Moreover, 93% of the posttests were correct. Further evaluation is required to assess accuracy of communicating examination findings to physicians and documentation in the electronic record.
The Emerging Role of the Gut Microbiome in Adult Patients With Multiple Sclerosis
Authors: Newland Pamela K. , Heitkemper Margaret , Zhou Yanjiao 
Published: November 2016

ABSTRACT

Background: Approximately 2.3 million people worldwide are currently living with multiple sclerosis (MS). The pathophysiologic mechanism of MS is not well known. It has been suggested that alterations in the normal gut flora may contribute to MS etiology and symptoms. Objective: The aims of this review are to describe the data suggesting a role for the gut microbiome in MS research and address its implications for practice. Methods: A literature search of the following databases (PubMed, CINAHL, Cochrane library database, MEDLINE, Scopus, and Psychology and Behavioral Sciences) was conducted to find published studies relevant to gut microbiome in patients with MS. Study Selection: Five articles met the inclusion criteria of research studies of human gut microbiome in adults in English language and those receiving disease-modifying medications. Exclusion criteria were case reports and reviews. Results: Human studies found that the gut microbiome was different among patients with MS, patients with MS who were treated with glatiramer acetate, and healthy controls. Discussion: There is beginning evidence to suggest that the gut microbiota is related to autoimmunity and the pathology of MS. However, more research is necessary to clarify these mechanisms. Implications for Practice: A better understanding of the role of the gut microbiota in MS may lead to the development of targeted individualized interventions affecting the gut microbiota. These interventions may emphasize symptom self-management strategies such as diet.
Clinical, psychological, and physiological correlates of patients who defecate after meal
Authors: Bouchoucha Michel , Devroede Ghislain , Mary Florence , Bon Cyriaque , Airinei Gheorges , Bejou Bakhtiar , Benamouzig Robert 
Published: November 2016

Background and aims
Food is the most important synchronizer of gastrointestinal motility and secretion. Many patients with functional bowel or anorectal disorders complain of fecal urge and stool output after eating.

Patients and methods
In this prospective observational study, 408 consecutive outpatients with functional bowel and/or anorectal disorders (74% female, 50.2±15.6 years, 24.8±5.0 kg/m²) filled Rome III questionnaires. Depression and anxiety scores, a physiological evaluation (total and segmental colonic transit time, colonic transit response to eating using a standard 1000 kcal test meal, and anorectal manometry), were measured. Univariate analysis and multivariate logistic regression were carried out according to the presence or not of stool output after eating.

Results
Defecation after eating was found in 21% of patients. These patients were not different according to the demographic characteristics of sex ratio (P=0.702), age (P=0.830), and BMI (P=0.314). In contrast, they had lower state anxiety (P=0.032), but similar scores of depression (P=0.240) and trait anxiety (P=0.933). They had similar manometric characteristics (anal pressure and rectal sensitivity), but a greater response to eating in all segments of the colon. There was an increase in the frequency of functional diarrhea (odds ratio=2.576, 95% confidence interval=1.312–5.056; P=0.006) and levator ani syndrome (odds ratio=2.331, 95% confidence interval=1.099–4.944; P=0.017), but no other functional bowel disorder including irritable bowel syndrome and its subtypes was found.

Conclusion
Stool output after eating is associated with clinical disorders but not physiological parameters. This symptom is not associated with irritable bowel syndrome, but a higher frequency of functional diarrhea.
The Feasibility of Dual-Energy Computed Tomography in Cardiac Contusion Imaging for Mildest Blunt Cardiac Injury
Authors: Sade Recep , Kantarci Mecit , Ogul Hayri , Bayraktutan Ummugulsum , Uzkeser Mustafa , Aslan Sahin , Aksakal Enbiya , Becit Necip 
Published: November 2016

Purpose
The purpose of this study was to evaluate the efficiency and feasibility of dual-energy computed tomography (DECT) used in the diagnosis of cardiac contusion with the mildest blunt cardiac injury.

Material and Methods
This study was performed between February 2014 and September 2015; a total of 17 consecutive patients (10 men and 7 women; median age, 51 years [range: 20–78]) were enrolled in the study. The DECT was performed within 48 hours of the trauma and a subsequent follow-up DECT was performed a little less than 1 year after the first examination. All examinations were analyzed on iodine map images by 2 experienced radiologists. Interobserver and intraobserver agreement was calculated. The correlation of initial troponin level, age, and sex with number of contusion areas in the left ventricle and complete recovery of contusion were measured.

Results
The contusion areas were amorphous, with considerable variation in their size, shape, and density. Contusions were primarily located in the left free wall of the ventricle, the ventricular septum, and the apex, respectively. In 10 patients, contusion areas disappeared on follow-up examination. In 4 patients, the contusion areas decreased but were still present in the follow-up examination. The interobserver agreements were almost perfect with respect to the presence of cardiac contusion, the anatomic location of contusions, and the contusion areas (kappa values of 1.0, 1.0, and 0.9 for intraobserver agreement and 1.0, 1.0, and 1.0 for intraobserver agreement, respectively). Correlations were found between age of patients and complete recovery of contusion (P = 0.01).

Conclusions
Dual-energy computed tomography can show cardiac contusion and could be useful and feasible for the diagnosis and follow-up of blunt cardiac injuries. Dual-energy computed tomography is a new, user-independent, and valuable imaging technique.
Introduction to provocative questions in left–right asymmetry
Authors: Levin Michael , Klar Amar J. S. , Ramsdell Ann F. 
Published: November 2016

Left–right asymmetry is a phenomenon that has a broad appeal—to anatomists, developmental biologists and evolutionary biologists—because it is a morphological feature of organisms that spans scales of size and levels of organization, from unicellular protists, to vertebrate organs, to social behaviour. Here, we highlight a number of important aspects of asymmetry that encompass several areas of biology—cell-level, physiological, genetic, anatomical and evolutionary components—and that are based on research conducted in diverse model systems, ranging from single cells to invertebrates to human developmental disorders. Together, the contributions in this issue reveal a heretofore-unsuspected variety in asymmetry mechanisms, including ancient chirality elements that could underlie a much more universal basis to asymmetry development, and provide much fodder for thought with far reaching implications in biomedical, developmental, evolutionary and synthetic biology. The new emerging theme of binary cell-fate choice, promoted by asymmetric cell division of a deterministic cell, has focused on investigating asymmetry mechanisms functioning at the single cell level. These include cytoskeleton and DNA chain asymmetry—mechanisms that are amplified and coordinated with those employed for the determination of the anterior–posterior and dorsal–ventral axes of the embryo.This article is part of the themed issue ‘Provocative questions in left–right asymmetry’.