bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between Sleep-Disordered Breathing and Hypertensive Disorders of Pregnancy and Gestational Diabetes Mellitus
Authors: Facco Francesca L. , Parker Corette B. , Reddy Uma M. , Silver Robert M. , Koch Matthew A. , Louis Judette M. , Basner Robert C. , Chung Judith H. , Nhan-Chang Chia-Ling , Pien Grace W. , Redline Susan , Grobman William A. , Wing Deborah A. , Simhan Hyagriv N. , Haas David M. , Mercer Brian M. , Parry Samuel , Mobley Daniel , Hunter Shannon , Saade George R. , Schubert Frank P. , Zee Phyllis C. 
Published: December 2016

OBJECTIVE:
To estimate whether sleep-disordered breathing during pregnancy is a risk factor for the development of hypertensive disorders of pregnancy and gestational diabetes mellitus (GDM).

METHODS:
In this prospective cohort study, nulliparous women underwent in-home sleep-disordered breathing assessments in early (6–15 weeks of gestation) and midpregnancy (22–31 weeks of gestation). Participants and health care providers were blinded to the sleep test results. An apnea–hypopnea index of 5 or greater was used to define sleep-disordered breathing. Exposure–response relationships were examined, grouping participants into four apnea–hypopnea index groups: 0, greater than 0 to less than 5, 5 to less than 15, and 15 or greater. The study was powered to test the primary hypothesis that sleep-disordered breathing occurring in pregnancy is associated with an increased incidence of preeclampsia. Secondary outcomes were rates of hypertensive disorders of pregnancy, defined as preeclampsia and antepartum gestational hypertension, and GDM. Crude and adjusted odds ratios and 95% confidence intervals (CIs) were calculated from univariate and multivariate logistic regression models.

RESULTS:
Three thousand seven hundred five women were enrolled. Apnea–hypopnea index data were available for 3,132 (84.5%) and 2,474 (66.8%) women in early and midpregnancy, respectively. The corresponding prevalence of sleep-disordered breathing was 3.6% and 8.3%. The prevalence of preeclampsia was 6.0%, hypertensive disorders of pregnancy 13.1%, and GDM 4.1%. In early and midpregnancy the adjusted odds ratios for preeclampsia when sleep-disordered breathing was present were 1.94 (95% CI 1.07–3.51) and 1.95 (95% CI 1.18–3.23), respectively; hypertensive disorders of pregnancy 1.46 (95% CI 0.91–2.32) and 1.73 (95% CI 1.19–2.52); and GDM 3.47 (95% CI 1.95–6.19) and 2.79 (95% CI 1.63–4.77). Increasing exposure–response relationships were observed between apnea–hypopnea index and both hypertensive disorders and GDM.

CONCLUSION:
There is an independent association between sleep-disordered breathing and preeclampsia, hypertensive disorders of pregnancy, and GDM.
Systematic Review and Meta-analysis of Prophylactic Mesh During Primary Stoma Formation to Prevent Parastomal Hernia
Authors: Chapman Stephen J. , Wood Benjamin , Drake Thomas M. , Young Neville , Jayne David G. 
Published: December 2016

BACKGROUND:
Implantation of mesh at the time of stoma formation may reduce the rate of parastomal hernia. Until recently, the evidence has been limited to only a few small randomized controlled trials.

OBJECTIVE:
We present an updated systematic review and meta-analysis to assess the effect of mesh prophylaxis on rates of parastomal hernia. We examine ongoing and unpublished trials via online registries and propose recommendations for future research.

DATA SOURCES:
MEDLINE, EMBASE, and the Cochrane Library were searched up to March 2016 for published randomized controlled trials. Sixteen international trial registries were inspected for ongoing and unpublished trials.

STUDY SELECTION:
Randomized controlled trials comparing mesh versus no mesh on the incidence of parastomal hernia after colostomy or ileostomy formation were selected.

MAIN OUTCOME MEASURES:
The primary outcome measure was rate of parastomal hernia at least 12 months after stoma formation. Secondary outcomes included rates of stoma-related complications.

RESULTS:
Of 3005 studies identified, 7 randomized controlled trials (432 patients) were eligible for inclusion in the final analysis. All were at high risk of bias. Mesh reduced the incidence of clinically detected parastomal hernia (10.8% vs 32.4%; p = 0.001) (risk ratio, 0.34; 95% CI, 0.18–0.65; I
2 = 39%) and the rate of radiologically detected parastomal hernia (34.6% vs 55.3%; p = 0.01) (risk ratio, 0.61; 95% CI, 0.42–0.89; I
2 = 44%). No increase in the incidence of stoma-related complications was observed with the use of prophylactic mesh. Results from ongoing and unpublished randomized controlled trials are expected, but few will report on alternative mesh types or surgical techniques.

LIMITATIONS:
Heterogeneity of interventions, small patient populations, and a high risk of bias seen in all studies implicate cautious interpretation of the results.

CONCLUSION:
Mesh prophylaxis at the time of stoma formation appears safe and effective in preventing parastomal hernia; however, limitations of the primary evidence justify larger, more rigorous randomized controlled trials.
Postoperative Venous Thromboembolism in Patients Undergoing Abdominal Surgery for IBD: A Common but Rarely Addressed Problem
Authors: Brady Matthew T. , Patts Gregory J. , Rosen Amy , Kasotakis George , Siracuse Jeffrey J. , Sachs Teviah , Kuhnen Angela , Kunitake Hiroko 
Published: December 2016

BACKGROUND:
Venous thromboembolism after abdominal surgery occurs in 2% to 3% of patients with Crohn’s disease and ulcerative colitis. However, no evidence-based guidelines currently exist to guide postdischarge prophylactic anticoagulation.

OBJECTIVE:
We sought to determine the use of postoperative postdischarge venous thromboembolism chemical prophylaxis, 90-day venous thromboembolism rates, and factors associated with 90-day thromboembolic events in IBD patients following abdominal surgery.

DESIGN:
This was a retrospective evaluation of an administrative database.

DATA SOURCE:
Data were obtained from Optum Labs Data Warehouse, a large administrative database containing claims on privately insured and Medicare Advantage enrollees.

PATIENTS:
Seven thousand seventy-eight patients undergoing surgery for Crohn’s disease or ulcerative colitis were included in the study.

MAIN OUTCOME MEASURES:
Primary outcomes were rates of postdischarge venous thromboembolism prophylaxis and 90-day rates of postdischarge thromboembolic events. In addition, patient clinical characteristics were identified to determine predictors of postdischarge venous thromboembolism.

RESULTS:
Postdischarge chemical prophylaxis was given to only 0.6% of patients in the study. Two hundred thirty-five patients (3.3%) developed a postdischarge thromboembolic complication. Postdischarge thromboembolism was more common in patients with ulcerative colitis than with Crohn’s disease (5.8% vs 2.3%; p < 0.001). Increased rates of venous thromboembolism were seen in patients undergoing colectomy or proctectomy with simultaneous stoma creation compared with colectomy or proctectomy alone (5.8% vs 2.1%; p < 0.001). The strongest predictors of thromboembolic complications were stoma creation (adjusted OR, 1.95; 95% CI, 1.34–2.84), J-pouch reconstruction (adjusted OR, 2.66; 95% CI, 1.65–4.29), preoperative prednisone use (adjusted OR, 1.57; 95% CI, 1.19–2.08), and longer length of stay (adjusted OR, 1.89; 95% CI, 1.41–2.52).

LIMITATIONS:
This study is limited by its retrospective design.

CONCLUSIONS:
The use of postdischarge venous thromboembolism prophylaxis in this patient sample was infrequent. Development of evidence-based guidelines, particularly for high-risk patients, should be considered to improve the outcomes of IBD patients undergoing abdominal surgery.
Using Modified Frailty Index to Predict Safe Discharge Within 48 Hours of Ileostomy Closure
Authors: Wen Yuxiang , Jabir Murad A. , Dosokey Eslam M. G. , Choi Dongjin , Petro Clayton C. , Brady Justin T. , Steele Scott R. , Delaney Conor P. 
Published: December 2016

BACKGROUND:
Enhanced recovery pathways allow for safe discharge and optimal outcomes within 48 hours after ileostomy closure. Unfortunately, some patients undergoing ileostomy closure have prolonged hospital stays. We have shown previously that the Modified Frailty Index can help predict patients who will fail early discharge after laparoscopic colorectal surgery.

OBJECTIVE:
The purpose of this study was to use the Modified Frailty Index to identify patients who were safe for early discharge after ileostomy closure.

DESIGN:
This was a retrospective review.

SETTINGS:
The study was conducted at a tertiary referral center.

PATIENTS:
Patients who underwent ileostomy closure (2006–2015) were stratified into early (≤48 hours) and late discharge groups.

MAIN OUTCOME MEASURES:
The Modified Frailty Index, morbidity, and readmission rates were measured.

RESULTS:
A total of 272 patients undergoing ileostomy closure were evaluated. Overall length of stay was 3.64 days (±3.23 days), with 114 patients (42%) discharged within 48 hours. Sex, age, and ASA scores were similar between early and later discharge groups (p > 0.2). Univariate logistic regression demonstrated that a Modified Frailty Index score of 0 was associated with early discharge (p = 0.03), whereas a Modified Frailty Index score ≤1 and ≤2 were not. There was no significant association between the Modified Frailty Index and complication or readmission rates. Postoperative complications occurred in 39 patients (14.3%), and 1 patient died secondary to an anastomotic leak. Fifteen patients (5.5%) were readmitted within 30 days. Readmission rate within 30 days was 3.2%, with a Modified Frailty Index score of 0, 6.1% for a Modified Frailty Index score of <1, and 5.9% for a Modified Frailty Index score of <2, for which there was not an association based on univariate logistic regression (Modified Frailty Index = 0, p = 0.13; <1, p = 0.55; <2, p = 0.53).

LIMITATIONS:
The study was limited by nature of being a retrospective review.

CONCLUSIONS:
Patients undergoing ileostomy closure with a Modified Frailty Index score of 0 are associated with higher rates of discharge within 48 hours of ileostomy closure surgery than those with a higher Modified Frailty Index, without higher readmission rates. This information can be helpful to better manage patient and resource use expectations for the duration of inpatient recovery.
Natural Orifice Specimen Extraction With Single Stapling Colorectal Anastomosis for Laparoscopic Anterior Resection: Feasibility, Outcomes, and Technical Considerations
Authors: Saurabh Bansal , Chang Sheng-Chi , Ke Tao-Wei , Huang Yu-Chun , Kato Takashi , Wang Hwei-Ming , Tzu-Liang Chen William , Fingerhut Abe 
Published: December 2016

BACKGROUND:
Double and triple stapling techniques to close the rectal stump in laparoscopic anterior resection are fraught with technical drawbacks that could possibly be avoided with the use of the single stapling technique. However, little is known of its safety in laparoscopic surgery or outcomes when combined with natural orifice specimen extraction.

OBJECTIVE:
This study aims to analyze the feasibility and the operative and immediate postoperative outcomes of single-stapled anastomosis and natural orifice specimen extraction with conventional techniques. It intends to evaluate technical variations related to colon, mesentery, and pelvic anatomy characteristics.

DESIGN AND PATIENTS:
A consecutive series of 188 patients underwent elective surgery for benign or malignant lesions between 10 and 40 cm from the anal verge, 5 cm or less in diameter on radiological examination, stage T1 to T3, Nx, M0, with 2 different methods of rectal stump closure (pursestring vs linear-stapled closure) associated with single or double stapling and per anus vs conventional specimen extraction.

SETTING:
This study was conducted at China Medical University Hospital, Taiwan, a tertiary referral center, between January 2012 and April 2015.

MAIN OUTCOME MEASURES:
The main outcomes measured are feasibility and operative and immediate postoperative outcomes.

RESULTS:
Single-stapled resection with natural orifice specimen extraction was feasible in 94% patients with an 11% perioperative morbidity rate. The patients required statistically significantly less analgesia, had earlier return of bowel movements, and shorter hospital stay, whereas there was no statistically significant difference in the overall readmission rate and overall morbidity, including anastomotic leakage.

LIMITATIONS:
This was a single-center, retrospective case-matched study.

CONCLUSION:
Anatomic variations (short colon and short mesentery) can be managed adequately with intracorporeal anvil head fixation. The single stapling technique is feasible and as safe as conventional double stapling techniques, although it is technically more demanding. The transanal endoscopic operation platform can be useful when the rectal stump is long.
Excimer Light Treatment for Idiopathic Guttate Hypomelanosis: A Pilot Study
Authors: Gordon Jennifer R.S. , Reed Kellie E. , Sebastian Katherine R. , Ahmed Ammar M. 
Published: December 2016

BACKGROUNDIdiopathic guttate hypomelanosis (IGH) is a commonly acquired benign leukoderma characterized by multiple discrete, hypo- or depigmented macules often on extremities that can be aesthetically undesirable for patients. This is the first study using excimer laser for treatment.OBJECTIVETo determine the effectiveness of excimer laser for repigmentation of idiopathic guttate hypomelanosis.METHODS AND MATERIALSIn this longitudinal, split-body controlled, single-blinded pilot study, 6 patients were treated with excimer laser for 12 weeks using the vitiligo protocol. Effectiveness was graded by the blinded observer scale through photographic comparisons at the end of the study. Participants also graded their progress at intervals during the study. A descriptive trend analysis and an ANOVA model were used to determine outcomes.RESULTSLesions that received the excimer treatment had significantly higher repigmentation by the end of the study compared with baseline and untreated lesions.CONCLUSIONExcimer laser treatments are already considered to be a safe modality for a variety of skin conditions. This study suggests that excimer is an effective treatment option with acceptable cosmetic outcomes for IGH.
Unaltered Dopamine Transporter Availability in Drug-Naive Patients With Schizophrenia After 6 Months of Antipsychotics Treatment
Authors: Chang Wei Hung , Chen Kao Chin , Lee I Hui , Chi Mei Hung , Chen Po See , Yao Wei Jen , Chiu Nan Tsing , Yang Yen Kuang 
Published: December 2016

Abstract

Background
Dopaminergic dysfunction, namely, dopamine transporter (DAT) availability variations in patients with drug-naive schizophrenia after long-term treatment, is still not well understood. The aims of the study were to explore (i) whether the DAT availability in patients with drug-naive schizophrenia differed after antipsychotic treatment and (ii) whether treatment with different generations of antipsychotics influenced the DAT availability after follow-up for 6 months.

Methods
Twenty-four first-episode, drug-naive patients with schizophrenia were divided into first- and second-generation antipsychotic groups naturalistically. After 6 months of follow-up, 7 patients who received first-generation antipsychotic treatment and 17 patients who received second-generation antipsychotic treatment completed the study. The patients underwent premedication and 6-month follow-up measurements using single-photon emission computed tomography with technetium Tc 99m (99mTc) TRODAT-1. Psychopathological evaluations and adverse effects were recorded using appropriate scales.

Results
Both of the treatment groups significantly improved according to Positive and Negative Symptoms Scale evaluation. However, no significant difference was noticed between the premedication and 6-month follow-up DAT scans. Nonsignificant differences existed even in the groups of different generations of antipsychotics.

Conclusions
Improvements in psychotic symptoms in patients with schizophrenia may not be influenced by DAT availability, even under treatment with different antipsychotics for a sufficient treatment period.
Chelation Therapy for Nickel Allergy
Authors: Rundle Chandler , Jacob Sharon E. 
Published: December 2016

ABSTRACT
By definition, a drug is a medicine or substance that exerts a physiologic effect on an organism. In dermatology, medications and substances are utilized on a daily basis from topical treatments to anesthetics in micrographic surgery. The purpose of this column is to focus on some of the more common drugs used in dermatology, specifically their mechanism of action, how they are utilized, and routine alternatives (if available). This article revisits the history of chelation therapy for nickel allergy; discusses its role in dermatology with an emphasis on the mechanism of action, adverse effects, and how it compares with alternative treatment options; and highlights the future implications in medical therapy.
Compensatory Saccades Are Associated With Physical Performance in Older Adults: Data From the Baltimore Longitudinal Study of Aging
Authors: Xie Yanjun , Anson Eric R. , Simonsick Eleanor M. , Studenski Stephanie A. , Agrawal Yuri 
Published: December 2016

Objective:
To determine whether compensatory saccade metrics observed in the video head impulse test, specifically saccade amplitude and latency, predict physical performance.

Study Design:
Cross-sectional analysis of the Baltimore Longitudinal Study of Aging, a prospective cohort study.

Setting:
National Institute on Aging Intramural Research Program Clinical Research Unit in Baltimore, Maryland.

Patients:
Community-dwelling older adults.

Intervention(s):
Video head impulse testing was performed, and compensatory saccades and horizontal vestibulo-ocular reflex (VOR) gain were measured. Physical performance was assessed using the Short Physical Performance Battery (SPPB), which included the feet side-by-side, semitandem, tandem, and single-leg stance; repeated chair stands; and usual gait speed measurements.

Main Outcome Measure(s):
Compensatory saccade amplitude and latency, VOR gain, and SPPB performance.

Results:
In 183 participants who underwent vestibular and SPPB testing (mean age 71.8 yr; 53% females), both higher mean saccade amplitude (odds ratio [OR] =1.62, p = 0.010) and shorter mean saccade latency (OR = 0.88, p = 0.004) were associated with a higher odds of failing the tandem stand task. In contrast, VOR gain was not associated with any physical performance measure.

Conclusion:
We observed in a cohort of healthy older adults that compensatory saccade amplitude and latency were associated with tandem stance performance. Compensatory saccade metrics may provide insights into capturing the impact of vestibular loss on physical function in older adults.
The effect of intraoperative and 6-h postoperative intravenous administration of low-dose prostacyclin on the endothelium, hemostasis, and hemodynamics in patients undergoing a pancreaticoduodenoctemy: a randomized-controlled pilot study
Authors: Johansson Pär I. , Mortensen Christian R. , Nielsen Tatiana , Tollund Carsten , Stensballe Jakob , Hansen Carsten P. , Frederiksen Hans J. , Ostrowski Sisse R. 
Published: December 2016

Background
Capillary leakage, secondary to endothelial breakdown, is common in patients undergoing major surgical procedures with extensive tissue injury and this is associated with increased morbidity and mortality. Prostacyclin has been ascribed cytoprotective properties together with its vasodilatory and antiplatelet effects. The present pilot study investigated the safety and endothelial protective effects of low-dose prostacyclin infusion.

Patients and methods
A randomized placebo-controlled pilot study evaluating the effect of prostacyclin (iloprost) infusion (1.0 ng/kg/min) versus placebo (saline infusion) intraoperatively and 6 h postoperatively in patients undergoing a pancreaticoduodenoctemy was carried out. Hemodynamics were evaluated by Nexfin, hemostasis was evaluated by thrombelastography, and transfusion requirements were registered. Endothelial damage was evaluated by circulating sE-selectin, soluble thrombomodulin, and nucleosomes.

Results
Comparable baseline demography and surgical time were found. Hemodynamics were comparable between groups. The placebo group received more red blood cells, median 115 ml [interquartile range (IQR): 0–296 ml] versus 0 ml (IQR: 0–0 ml), P=0.027, at the postoperative ward and after 6 h. Thrombelastography maximum clot firmness decreased intraoperatively only in the placebo group (P=0.034)). Soluble thrombomodulin increased more in the placebo group postoperatively [1.63 ng/ml (IQR: 0.65–2.55 ng/ml) versus 0.40 ng/ml (IQR: 0.21–0.63 ng/ml), P=0.027] and 6 h postoperatively [1.83 (1.1–2.36) versus 0.67 (0.42–0.91), P=0.027]. Nucleosomes increased intraoperatively and postoperatively only in the placebo group; thus, the overall level of nucleosomes was higher in the placebo group (P=0.019).

Conclusion
Intraoperative and postoperative low-dose prostacyclin infusion is safe and associated with reduced endothelial cell damage in patients undergoing a pancreaticoduodenoctemy compared with those receiving placebo.
Short article: Absence of serological rheumatoid arthritis biomarkers in inflammatory bowel disease patients with arthropathies
Authors: Van Erp Sanne J.H. , Verheul Marije K. , Levarht E.W. Nivine , van der Reijden Johan J. , van der Heijde Désirée , van Gaalen Floris A. , Hommes Daniel W. , Norman Gary L. , Shums Zakera , Mahler Michael , Verspaget Hein W. , Trouw Leendert A. , van der Meulen-de Jong Andrea E. 
Published: December 2016

Objective
Biomarkers that are associated with future progression to rheumatoid arthritis (RA) and joint destruction have been discovered previously in patients with arthralgia. The present study examined these RA biomarkers in inflammatory bowel disease (IBD) patients with arthropathies.

Patients and methods
Sera from 155 IBD patients with and 99 IBD patients without arthropathies were analyzed for immunoglobulin (Ig) M rheumatoid factor (RF), IgA-RF, anti-cyclic citrullinated peptide 2, anti-cyclic citrullinated peptide 3.1, and anti-carbamylated protein antibody positivity using enzyme-linked immunosorbent assays. The prevalence of the autoantibodies in the IBD patients was compared with the prevalence in RA patients.

Results
No differences were found in biomarker positivity between IBD patients with and without arthropathies. Significantly more biomarker positivity (P<0.001) was observed in RA patients compared with IBD patients with arthropathies. Also, smoking turned out to be significantly associated with positivity for IgM-RF or IgA-RF.

Conclusion
Our findings suggest that there is no apparent clinical value in the detection of RA biomarkers in serum of IBD patients to help identify arthropathies.