bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adrenal Lesions in Patients With (Attenuated) Familial Adenomatous Polyposis and MUTYH-Associated Polyposis
Authors: Kallenberg Frank G.J. , Bastiaansen Barbara A.J. , Nio C. Yung , Soeters Maarten R. , Boermeester Marja A. , Aalfs Cora M. , Bossuyt Patrick M.M. , Dekker Evelien 
Published: September 2017

BACKGROUND:
The reported proportion of patients with familial adenomatous polyposis who have adrenal lesions varies between 7% and 13% compared with 4% in the general population; the prevalence of adrenal lesions in patients with attenuated familial adenomatous polyposis and MUTYH-associated polyposis is unknown. Data on the clinical relevance and clinical course are limited.

OBJECTIVE:
We aimed to report on the frequency, characteristics, and progression of adrenal lesions in polyposis patients.

DESIGN:
This was a historical cohort study.

SETTINGS:
The study was performed at the Academic Medical Center, Amsterdam.

PATIENTS:
All of the patients with familial adenomatous polyposis, attenuated familial adenomatous polyposis, and MUTYH-associated polyposis were included. Medical charts and imaging reports were analyzed for data on adrenal lesions. A radiologist reassessed all of the images. Patients had not routinely been screened for adrenal lesions.

MAIN OUTCOME MEASURES:
The frequency, characteristics, and progression of adrenal lesions in patients with polyposis who underwent abdominal imaging were assessed. Findings were compared with a reference.

RESULTS:
A total of 39 adrenal lesions were identified in 23 (26%) of 90 patients with familial adenomatous polyposis, 2 (18%) of 11 with attenuated familial adenomatous polyposis, and 5 (24%) of 21 with MUTYH-associated polyposis. Mean age at time of detection was 50.7 years (range, 17.1–83.3 y). Median lesion size at baseline was 1.4 cm (range, 1.0–5.0 cm) versus 1.7 cm (range, 1.0–5.7 cm) after a median of 3.5 years (range, 1.0–11.4 y). Two patients were diagnosed with a hyperfunctioning lesion, and 4 underwent adrenalectomy: 3 lesions appeared benign, and 1 was oncocytic of uncertain malignant potential. The OR for detecting at least 1 lesion in a patient with polyposis versus reference was 6.2 (95% CI, 3.2–12.3), with no significant differences in ORs among the 3 syndromes.

LIMITATIONS:
The study was limited by its retrospective design.

CONCLUSIONS:
Adrenal lesions are frequent in patients with polyposis who undergo abdominal imaging. They appear to follow a benign and slowly progressive course and are mostly nonhyperfunctioning. See Abstract Video at http://links.lww.com/DCR/A323.
Uptake of Transanal Total Mesorectal Excision in North America: Initial Assessment of a Structured Training Program and the Experience of Delegate Surgeons
Authors: Atallah Sam B. , DuBose Arielle C. , Burke John P. , Nassif George , deBeche-Adams Teresa , Frering Taylor , Albert Matthew R. , Monson John R.T. 
Published: September 2017

BACKGROUND:
Transanal total mesorectal excision is a new approach to curative-intent rectal cancer surgery. Training and surgeon experience with this approach has not been assessed previously in America.

OBJECTIVE:
The purpose of this study was to characterize a structured training program and to determine the experience of delegate surgeons.

DESIGN:
Data were assimilated from an anonymous, online survey delivered to attendees on course completion. Data on surgeon performance during hands-on cadaveric dissection were collected prospectively.

SETTINGS:
This study was conducted at a single tertiary colorectal surgery referral center, and cadaveric hands-on training was conducted at a specialized surgeon education center.

MAIN OUTCOME MEASURES:
The main outcome measurement was the use of the course and surgeon experience posttraining.

RESULTS:
During a 12-month period, eight 2-day transanal total mesorectal excision courses were conducted. Eighty-one colorectal surgeons successfully completed the course. During cadaveric dissection, 71% achieved a complete (Quirke 3) specimen; 26% were near complete (Quirke 2), and 3% were incomplete (Quirke 1). A total of 9.1% demonstrated dissection in the incorrect plane, whereas 4.5% created major injury to the rectum or surrounding structures, excluding the prostate. Thirty eight (46.9%) of 81 surgeon delegates responded to an online survey. Of survey respondents, 94.6% believed training should be required before performing transanal total mesorectal excision. Posttraining, 94.3% of surgeon delegates planned to use transanal total mesorectal excision for distal-third rectal cancers, 74.3% for middle-third cancers, and 8.6% for proximal-third cancers. The most significant complication reported was urethral injury; 5 were reported by the subset of survey respondents who had performed this operation postcourse.

LIMITATIONS:
The study was limited by inherent reporting bias, including observer and recall biases.

CONCLUSIONS:
Although this structured training program for transanal total mesorectal excision was found to be useful by the majority of respondents, the risk of iatrogenic injury after training remains high, suggesting that this training pedagogy alone is insufficient. See Video Abstract at http://links.lww.com/DCR/A335.
Prognostic Significance of Peritoneal Metastasis in Stage IV Colorectal Cancer Patients With R0 Resection: A Multicenter, Retrospective Study
Authors: Arakawa Keiichi , Kawai Kazushige , Ishihara Soichiro , Hata Keisuke , Nozawa Hiroaki , Oba Koji , Sugihara Kenichi , Watanabe Toshiaki 
Published: September 2017

BACKGROUND:
Stage IV colorectal cancer encompasses various clinical conditions. The differences in prognosis after surgery between different metastatic organs have not been fully investigated.

OBJECTIVE:
This study aimed to assess prognostic significance in peritoneal metastasis in R0 resected stage IV colorectal cancer.

DESIGN:
We conducted a multicenter retrospective study of patients with R0 resected stage IV colorectal cancer; they were categorized into 3 groups according to the number and location of metastatic organs, including single-organ metastasis in the peritoneum, single-organ metastasis at sites except the peritoneum, and multiple-organ metastases.

SETTINGS:
This study used data accumulated by the Japanese Study Group for Postoperative Follow-Up of Colorectal Cancer.

PATIENTS:
A total of 1133 patients with R0 resected stage IV colorectal cancer were registered retrospectively between 1997 and 2007 in 20 referral hospitals.

MAIN OUTCOME MEASURES:
Cancer-specific survival rates between the groups were measured.

RESULTS:
The median cancer-specific survival of the single-organ metastasis in the peritoneum group was considerably shorter than that of the single-organ metastasis at a site other than the peritoneum group and was almost comparable to that of the multiple-organ metastases group (3.41 years, 6.20 years, and 2.99 years). In a multivariate analysis of cancer-specific survival, peritoneal dissemination was confirmed as an independent prognostic factor of survival. The median postrecurrence survival of single-organ metastasis in the peritoneum group was considerably shorter than that of the single-organ metastasis at a site other than the peritoneum group. Approximately half of the patients who experienced recurrence of single-organ metastasis in the peritoneum experienced peritoneal recurrence.

LIMITATIONS:
This was a retrospective, population-based study that requires a prospective design to validate its conclusions.

CONCLUSIONS:
Peritoneal metastasis of colorectal cancer frequently recurred in the peritoneum even after R0 resection. The cancer-specific survival of the single-organ metastasis in the peritoneum group was as poor as that of the multiple-organ metastases group. See Video Abstract at http://links.lww.com/DCR/A398.
Quality of Life in Rectal Cancer Patients After Chemoradiation: Watch-and-Wait Policy Versus Standard Resection – A Matched-Controlled Study
Authors: Hupkens Britt J.P. , Martens Milou H. , Stoot Jan H. , Berbee Maaike , Melenhorst Jarno , Beets-Tan Regina G. , Beets Geerard L. , Breukink Stéphanie O. 
Published: September 2017

BACKGROUND:Fifteen to twenty percent of patients with locally advanced rectal cancer have a clinical complete response after chemoradiation therapy. These patients can be offered nonoperative organ-preserving treatment, the so-called watch-and-wait policy. The main goal of this watch-and-wait policy is an anticipated improved quality of life and functional outcome in comparison with a total mesorectal excision, while maintaining a good oncological outcome.OBJECTIVE:The aim of this study was to compare the quality of life of watch-and-wait patients with a matched-controlled group of patients who underwent chemoradiation and surgery (total mesorectal excision group).DESIGN:This was a matched controlled study.SETTINGS:This study was conducted at multiple centers.PATIENTS:The study population consisted of 2 groups: 41 patients after a watch-and-wait policy and 41 matched patients after chemoradiation and surgery. Patients were matched on sex, age, tumor stage, and tumor height. All patients were disease free at the moment of recruitment after a minimal follow-up of 2 years.MAIN OUTCOME MEASURES:Quality of life was measured by validated questionnaires covering general quality of life (Short Form 36, European Organization for Research and Treatment of Cancer QLQ-C30), disease-specific total mesorectal excision (European Organization for Research and Treatment of Cancer QLQ-CR38), defecation problems (Vaizey and low anterior resection syndrome scores), sexual problems (International Index of Erectile Function and Female Sexual Function Index), and urinary dysfunction (International Prostate Symptom Score).RESULTS:The watch-and-wait group showed better physical and cognitive function, better physical and emotional roles, and better global health status compared with the total mesorectal excision group. The watch-and-wait patients showed fewer problems with defecation and sexual and urinary tract function.LIMITATIONS:This study only focused on watch-and-wait patients who achieved a sustained complete response for 2 years. In addition, this is a study with a limited number of patients and with quality-of-life measurements on nonpredefined and variable intervals after surgery.CONCLUSIONS:After a successful watch-and-wait approach, the quality of life was better than after chemoradiation and surgery on several domains. However, chemoradiation therapy on its own is not without long-term side effects, because one-third of the watch-and-wait patients experienced major low anterior resection syndrome symptoms, compared with 66.7% of the patients in the total mesorectal excision group. SeeVideo Abstractat http://links.lww.com/DCR/A395.
Condyloma Acuminatum, Anal Intraepithelial Neoplasia, and Anal Cancer in the Setting of HIV: Do We Really Understand the Risk?
Authors: Fazendin Edward A. , Crean Alexander J. , Fazendin Jessica M. , Kucejko Robert J. , Gill Harkenwar S. , Poggio Juan L. , Stein David E. 
Published: September 2017

BACKGROUND:
The gold standard for surveillance of patients with anal lesions is unclear.

OBJECTIVE:
The aim of this study was to stratify patients for risk of progression of disease and to determine appropriate intervals for surveillance of patients with anal disease.

DESIGN:
This was a retrospective chart review for patients treated for anal lesions between 2007 and 2014. Only patients with ≥1 year of follow-up from index evaluation, pathology, documented physical examination, and anoscopy findings were included for analysis.

SETTINGS:
The study was conducted at an urban university hospital.

PATIENTS:
HIV-positive patients with anal lesions treated with excision and fulguration were included.

MAIN OUTCOME MEASURES:
Recurrence of anal lesions, progression of disease, and progression to cancer were measured.

RESULTS:
Ninety-one patients met inclusion criteria. The mean age was 41.6 years, and mean follow-up was 38.6 months (range, 11.0–106.0 mo). On initial pathology, 8 patients (8.8%) had a diagnosis of condyloma acuminatum without dysplasia, 20 patients (22%) had anal intraepithelial neoplasia I, 32 (35.2%) had anal intraepithelial neoplasia II, and 31 (34.1%) had anal intraepithelial neoplasia III. Sixty-nine patients (75.8%) had repeat procedures. Seven (87.5%) of 8 patients with condyloma and 6 (30%) of 20 patients with anal intraepithelial neoplasia I progressed to high-grade lesions. Five (15.6%) of 32 patients progressed from anal intraepithelial neoplasia II to III, and 2 patients with anal intraepithelial neoplasia III (6.5%) developed squamous cell carcinoma (2.3% for the entire cohort).

LIMITATIONS:
This was a single institution study. High-resolution anoscopy was not used.

CONCLUSIONS:
All of the HIV-positive patients with condyloma or anal intraepithelial neoplasia, regardless of the presence of dysplasia, should be surveyed at equivalent 3-month time intervals, because their risk of progression of disease is high. Video Abstract at http://links.lww.com/DCR/A389.
Transanal Total Mesorectal Excision: Pneumodissection of Retroperitoneal Structures Eases Laparoscopic Rectal Resection
Authors: Hüscher Cristiano G.S. , Lirici Marco Maria 
Published: September 2017

INTRODUCTION:
Laparoscopic total mesorectal excision is effective and safe but often technically challenging because of inadequate exposure. Transanal total mesorectal excision was introduced to mitigate this limitation and improve the quality of mesorectal dissection in even the most challenging cases. Currently, the technique for transanal total mesorectal excision dissection is not standardized.

TECHNIQUE:
The sequential approach to transanal total mesorectal excision mirrors the principles of the transanal abdominal transanal procedure. It begins with the transanal step, followed by the laparoscopic step, and then the transanal total mesorectal excision. The perirectal space is entered via a full-thickness dissection of the anterior rectal wall. Carbon dioxide is left flowing, widening the embryonic planes between the mesorectal and pelvic fascias, then moving upward through the retroperitoneal space. The surgeon switches to the abdominal field and begins laparoscopic dissection, consisting of inferior mesenteric artery dissection and division, inferior mesenteric vein dissection and division, and possible splenic flexure dissection. Pneumodissection facilitates this procedure by distancing the inferior mesenteric artery from the hypogastric nerves and opening the embryonic fusion plane between the Toldt and Gerota fascias to allow faster division of the left colon lateral attachments. The operation continues with a switch to the perineal field and mesorectal excision.

RESULTS:
A total of 102 patients underwent transanal total mesorectal excision as described. Mean operative time was 185.0 + 87.5 minutes (range, 60–480 min), and there was no conversion to open surgery. Postoperative morbidity was 33.3%. Mortality rate at 30 days was 1.96% (2 cases). Quality of mesorectal excision according to Quirke was assessed in all of the specimens and found to be complete in 99 cases (97.1%) and nearly complete in 2.9% of cases.

CONCLUSIONS:
Transanal total mesorectal excision may benefit from pneumodissection, expedites the laparoscopic step, and the sequential approach facilitates the visualization of the correct dissection planes. The safety and cost-effectiveness of the procedure still warrant consideration. See Video at http://links.lww.com/DCR/A418.
YouTube Videos on Botulinum Toxin A for Wrinkles: A Useful Resource for Patient Education
Authors: Wong Katharine , Doong Judy , Trang Trinh , Joo Sarah , Chien Anna L. 
Published: September 2017

BACKGROUND
Patients interested in botulinum toxin type A (BTX-A) for wrinkles search for videos on YouTube, but little is known about the quality and reliability of the content.

OBJECTIVE
The authors examined the quality, reliability, content, and target audience of YouTube videos on BTX for wrinkles.

MATERIALS AND METHODS
In this cross-sectional study, the term “Botox” was searched on YouTube. Sixty relevant videos in English were independently categorized by 2 reviewers as useful informational, misleading informational, useful patient view, or misleading patient view. Disagreements were settled by a third reviewer. Videos were rated on the Global Quality Scale (GQS) (1 = poor, 5 = excellent).

RESULTS
Sixty-three percent of the BTX YouTube videos were useful informational (GQS = 4.4 ± 0.7), 33% as useful patient view (GQS = 3.21 ± 1.2), 2% as misleading informational (GQS = 1), and 2% as misleading patient view (GQS = 2.5).

CONCLUSION
The large number of useful videos, high reliability, and the wide range of content covered suggests that those who search for antiwrinkle BTX videos on YouTube are likely to view high-quality content. This suggests that YouTube may be a good source of videos to recommend for patients interested in BTX.
A-101, a Proprietary Topical Formulation of High-Concentration Hydrogen Peroxide Solution: A Randomized, Double-Blind, Vehicle-Controlled, Parallel Group Study of the Dose–Response Profile in Subjects With Seborrheic Keratosis of the Face
Authors: DuBois Janet C. , Jarratt Michael , Beger Brian B. , Bradshaw Mark , Powala Christopher V. , Shanler Stuart D. 
Published: September 2017

BACKGROUND
Seborrheic keratosis (SK) is a common benign skin tumor, yet no topical treatments are approved in the United States.

OBJECTIVE
To evaluate the proprietary, stabilized, high-concentration hydrogen peroxide–based topical solution A-101 (32.5% and 40% concentrations) for treatment of facial SK lesions.

MATERIALS AND METHODS
In this multicenter, double-blind, vehicle-controlled study, eligible subjects were randomly assigned to receive up to 2 treatments of A-101 40%, A-101 32.5%, or vehicle solution applied to a single facial SK lesion. The primary efficacy assessment was the Physician's Lesion Assessment (PLA), a validated 4-ordinal scale.

RESULTS
The primary end point, the mean reduction in PLA grade from baseline to Day 106 was 1.7 for A-101 40%, 1.4 for A-101 32.5%, and 0.1 for vehicle (p < .001, both concentrations vs vehicle). Lesions for 68%, 62%, and 5% of subjects, respectively, were judged to be clear or near clear (p < .001, both concentrations vs vehicle). Local skin reactions were predominantly mild and transient. No subjects discontinued because of treatment-related adverse events.

CONCLUSION
A-101 solution demonstrated efficacy in treating SKs on the face. Greater magnitude of effect was seen with the 40% concentration than the 32.5% concentration. A-101 solution had a favorable safety and tolerability profile at both concentrations.
Clinical and Histological Evaluations of Enlarged Facial Skin Pores After Low Energy Level Treatments With Fractional Carbon Dioxide Laser in Korean Patients
Authors: Kwon Hyuck Hoon , Choi Sun Chul , Lee Won-Yong , Jung Jae Yoon , Park Gyeong-Hun 
Published: September 2017

BACKGROUND
Enlarged facial pores can be an early manifestation of skin aging and they are a common aesthetic concern for Asians. However, studies of improving the appearance of enlarged pores have been limited.

OBJECTIVE
The authors aimed to study the application of CO2 fractional laser treatment in patients with enlarged facial pores.

METHODS
A total of 32 patients with dilated facial pores completed 3 consecutive sessions of low energy level treatments with a fractional CO2 laser at 4-week intervals. Image analysis was performed to calculate the number of enlarged pores before each treatment session and 12 weeks after the final treatment.

RESULTS
After application of laser treatments, there was a significant decrease in the number of enlarged pores. The mean number of enlarged pores was decreased by 28.8% after the second session and by 54.5% at post-treatment evaluation. Post-treatment side effects were mild and transitory. Histological and immunohistochemical analyses demonstrated clear increases in the number of collagen fibers and the expression of transforming growth factor–β1.

CONCLUSION
The short-term results showed that treatment with low energy level CO2 fractional laser therapy could be a safe and effective option for patients with Fitzpatrick skin Types III and IV who are concerned with enlarged pores.
RETINAL MICROVASCULATURE AND VISUAL ACUITY AFTER INTRAVITREAL AFLIBERCEPT IN EYES WITH CENTRAL RETINAL VEIN OCCLUSION
Authors: Winegarner Andrew , Wakabayashi Taku , Hara-Ueno Chikako , Sato Tatsuhiko , Busch Caleb , Fukushima Yoko , Sayanagi Kaori , Nishida Kentaro , Sakaguchi Hirokazu , Nishida Kohji 
Published: September 2017

Purpose:
To investigate vascular perfusion and foveal avascular zone area in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) after intravitreal aflibercept therapy in central retinal vein occlusion eyes and their association with best-corrected visual acuity.

Methods:
Thirty-five subjects with central retinal vein occlusion and macular edema were evaluated. After macular edema resolution following intravitreal aflibercept, subjects underwent optical coherence tomography angiography to measure SCP and DCP perfusion and the foveal avascular zone within a 3 × 3-mm area. Correlations between best-corrected visual acuity and optical coherence tomography angiography measurements were examined.

Results:
After intravitreal aflibercept therapy, mean retinal vascular area was 3.41 ± 0.74 mm2 in the SCP and 3.25 ± 0.91 mm2 in the DCP. Foveal avascular zone area was 1.03 ± 1.04 mm2 in the SCP and 1.78 ± 1.73 mm2 in the DCP. Improved best-corrected visual acuity was significantly associated with better SCP and DCP perfusion (both P < 0.001) and with smaller SCP and DCP foveal avascular zone areas (both P < 0.001). Additionally, SCP and DCP perfusion were negatively correlated with macular edema before treatment (P < 0.05) and ischemia (determined via pretreatment fluorescein angiography, P < 0.05), and positively correlated with photoreceptor integrity (P < 0.001).

Conclusion:
Patients with better retinal perfusion and less retinal ischemia are associated with better visual outcomes after aflibercept in eyes with central retinal vein occlusion.
DETECTION OF TREATMENT-NAIVE CHOROIDAL NEOVASCULARIZATION IN AGE-RELATED MACULAR DEGENERATION BY SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Ahmed Daniel , Stattin Martin , Graf Alexandra , Forster Julia , Glittenberg Carl , Krebs Ilse , Ansari-Shahrezaei Siamak 
Published: September 2017

Purpose:
To compare the detection rate of choroidal neovascularization (CNV) in treatment-naive neovascular age-related macular degeneration by swept source optical coherence tomography angiography (SS-OCTA, Topcon's DRI Triton) working at 1,050 nm wavelength versus fluorescence angiography.

Methods:
Cross-sectional analysis of 156 eyes (107 neovascular age-related macular degeneration and 49 dry AMD) in 98 patients, previously diagnosed by multimodal imaging using fluorescein (FA) and indocyanine green angiography (Heidelberg's Spectralis) in a tertiary retina center, evaluated by SS-OCTA 4.5 mm × 4.5 mm and 6 mm × 6 mm macular cubes. Main outcome measures were sensitivity and specificity of SS-OCTA in AMD. Potential factors influencing CNV detection rate were analyzed.

Results:
Swept source optical coherence tomography angiography detected CNV in 81 of 107 eyes, resulting in a sensitivity of 75.7%. In 49 eyes with dry AMD, no CNV could be identified (specificity 100%). A statistical significance was calculated for nondetection of treatment-naive CNV by SS-OCTA in pigment epithelial detachment over 400 μm (P = 0.0238).

Conclusion:
Topcon's SS-OCTA was not able to detect all CNV lesions. Large pigment epithelial detachments were associated with signal loss. Fluorescence angiography still remains the gold standard, but the tested SS-OCTA device can be considered as a feasible additional diagnostic tool in AMD.