bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abdominoperineal Excision: Technical Challenges in Optimal Surgical and Oncological Outcomes after Abdominoperineal Excision for Rectal Cancer
Authors: Holm Torbjörn 
Published: November 2017

AbstractTreatment results in rectal cancer have improved significantly during the recent two decades, but local control and survival after abdominoperineal excision (APE) have not improved to the same degree as that seen after anterior resection (AR). The reason for this is an increased risk of inadvertent bowel perforations and tumor involved margins after APE as compared with AR. The conventional synchronous combined APE has not been a standardized procedure and consequently oncological outcomes have varied considerably between different institutions and in different reports. With the new concept of APE, based on well-defined anatomical structures, the procedure can be categorized as intersphincteric APE, extralevator APE, and ischioanal APE. This article discusses the technical aspects and results from this approach.
Distance Education Course about Sexuality for Obstetrics and Gynecology Residents
Authors: Vieira Teresa Cristina Souza Barroso , Nakamura Mary Uchiyama , Silva Ivaldo da , Torloni Maria Regina , Ribeiro Meireluci Costa , Souza Eduardo de 
Published: November 2017

Purpose To describe the experience of a distance education course on sexual issues during pregnancy and after birth for residents.
Methods This prospective educational intervention study was conducted by investigators from the Universidade Federal de São Paulo, Brazil, between April and September 2014. The participants were 219 physicians (residents from the 1st to the 6th years). The duration of the course was of 24 hours (10 video lectures and online chats). At baseline, the participants answered questions about their training, attitude and experience regarding sexual issues during pregnancy and after birth; before and after the course, they answered questions to assess their knowledge about the topic; at the end of the course, they answered questions on the quality of the course. The Student t-test was used to compare the before and after scores of the knowledge tests; values of p < 0.05 were considered statistically significant.
Results A total of 143 residents concluded the course; most were in their 1st (27.2%) or 3rd (29.4%) years of residency. There was a significant increase in the mean scores of the questionnaires that assessed the knowledge of the topic: 4.4 (±1.6) versus 6.0 (±1.3; maximum score: 10), before and after the course respectively (p < 0.0001). Most of the participants (74.1%) declared that the quality of the course as a whole reached their expectations, and 81.1% would recommend the course to a friend.
Conclusions The online Sexology course for Obstetrics and Gynecology residents increased their knowledge about the sexual issues during pregnancy and after birth, and fulfilled the participants' expectations. The experience described here may serve as a model for other sexuality courses targeting similar audiences.
Molecular Biology: Are We Getting Any Closer to Providing Clinically Useful Information?
Authors: Karagkounis Georgios , Kalady Matthew 
Published: November 2017

AbstractAdvances in molecular biology and biomarker research have significantly impacted our understanding and treatment of multiple solid malignancies. In rectal cancer, where neoadjuvant chemoradiation is widely used for locally advanced disease, most efforts have focused on the identification of predictors of response in an attempt to appropriately select patients for multimodality therapy. A variety of biomarkers have been studied, including genetic mutations, chromosomal copy number alterations, and single as well as multigene expression patterns. Also, as transanal resection of rectal tumors requires accurate preoperative detection of lymph node metastasis, the identification of biomarkers of regional nodal involvement has been another important field of active research. While preliminary results have been promising, lack of external validation means has a limited translation to clinical use. This review summarizes recent developments in rectal cancer biomarker research, highlighting the challenges associated with their adoption, and evaluating their potential for clinical use.
Assessment of Length of Maternal Cervix between 18 and 24 weeks of Gestation in a Low-Risk Brazilian Population
Authors: Andrade Soraya Gomes de Amorim , Andrade Fernando Moreira de , Araujo Júnior Edward , Pires Cláudio Rodrigues , Mattar Rosiane , Moron Antonio Fernandes 
Published: November 2017

Purpose To determine cervical biometry in pregnant women between 18 and 24 weeks of gestation and the ideal mode of measurement of cervical length in cases of curved and straight cervical morphology.Methods The uterine cervices of 752 low-risk pregnant women were assessed using transvaginal ultrasound in a prospective cross-sectional study. In women with straight uterine cervices, cervical biometry was performed in a continuous manner. In women with curved uterine cervices, the biometry was performed using both the continuous and segmented techniques (in segments joining the cervical os). Polynomial regression models were created to assess the correlation between the cervical length and gestational age. The paired Student t-test was used to compare measuring techniques.Results The cervical biometry results did not vary significantly with the gestational age and were best represented by linear regression (R2 = 0.0075 with the continuous technique, and R2 = 0.0017 with the segmented technique). Up to the 21st week of gestation, there was a predominance of curved uterine cervix morphology (58.9%), whereas the straight morphology predominated after this gestational age (54.2%). There was a significant difference between the continuous and the segmented measuring methods in all the assessed gestational ages (p < 0.001).Conclusion Cervical biometry in pregnant women between 18 and 24 weeks was represented by a linear regression, independently of the measuring mode. The ideal measuring technique was the transvaginal ultrasound performed at a gestational age ≥21 weeks.
Evaluation of the Implantable Doppler Probe for Free Flap Monitoring in Lower Limb Reconstruction
Authors: Gross Ruth , Penna Vincenzo , Bannasch Holger , Stark G. , Eisenhardt Steffen , Lenz Yvonne 
Published: November 2017

Background Timely reexploration and reanastomoses can salvage failing free flaps. The use of the implantable Doppler probe provides direct evidence of vascular impairment of the microvascular anastomoses and allows for postoperative NPWT. The aim of this retrospective study was to compare the Doppler probe to conventional monitoring techniques for free flap monitoring in lower limb reconstruction and to identify risk factors for perfusion disturbance and reexploration.
Methods All patients receiving free muscle flap reconstruction for lower limb soft tissue defects at our department from 2000 to 2013 were included, and all adverse events, timely detection of perfusion problems, and outcome of revision surgery were assessed by chart analysis.
Results For lower limb reconstruction, 110 free muscle transfers were performed of which 41 muscle flaps were conventionally monitored and 69 flaps were monitored using the implantable Doppler probe. In 18 cases, the free muscle flaps needed revision because of perfusion disturbances. The salvage rate was 80% with monitoring by the implantable Doppler probe compared with 62.5% using conventional monitoring methods resulting in success rates of 95.7 and 92.7%, respectively.
Conclusion The use of the implantable Cook–Swartz Doppler probe represents a safe monitoring method for lower limb reconstruction, which allows for the additional use of NPWT. Higher salvage and revision success rates can be attributed to an earlier detection of perfusion impairment. However, a larger patient cohort is necessary to verify superiority over conventional postoperative monitoring.
Finding the Petroclival Carotid Artery: The Vidian–Eustachian Junction as a Reliable Landmark
Authors: Oakley Gretchen , Ebenezer Jareen , Hamizan Aneeza , Sacks Peta-Lee , Rom Darren , Sacks Raymond , Winder Mark , Davidson Andrew , Teo Charles , Solares C. , Harvey Richard 
Published: November 2017

Introduction Identifying the internal carotid artery (ICA) when managing petroclival and infratemporal fossa pathology is essential for the skull base surgeon. The vidian nerve and eustachian tube (ET) cartilage come together at the foramen lacerum, the vidian–eustachian junction (VEJ). The ICA position, relative to the VEJ is described.
Methods Endoscopic dissection of adult fresh-frozen cadaver ICAs and a case series of patients with petroclival pathology were performed. The relationship of the VEJ to the ICA horizontal segment, vertical segment, and second genu was assessed. The distance of the ICA second genu to VEJ was determined in coronal, axial, and sagittal planes. The length of the vidian nerve and ET was measured from the pterygopalatine fossa (PPF) and nasopharyngeal orifice to the VEJ.
Results In this study, 10 cadaver dissections (82.3 ± 6.7 years, 40% female) were performed. The horizontal petrous ICA was at or behind VEJ in 100%, above VEJ in 100%, and lateral to VEJ in 80%. The vertical paraclival segment was at or behind VEJ in 100%, above in 100%, and medial in 100%. The second genu was at or behind VEJ in 100% (3.3 ± 2.4 mm), at or above in 100% (2.5 ± 1.6 mm), and medial in 100% (3.4 ± 2.0 mm). The VEJ was successfully used to locate the ICA in nine consecutive patients (53.3 ± 13.6 years, 55.6% female) where pathology was also present. The VEJ was 15.0 ± 6.0 mm from the ET and 17.4 ± 4.1 mm from the PPF.
Conclusion The VEJ is an excellent landmark as it defines both superior and posterior limits when isolating the ICA in skull base surgery.
A Systematic Review of the Efficacy of Levetiracetam in Neonatal Seizures
Authors: McHugh Daryl , Lancaster Shannon , Manganas Louis 
Published: November 2017

Objective Seizures are the most common neurological complication in neonatal intensive care units. Phenobarbital (PB) remains the first-line antiepileptic drug (AED) for neonatal seizures despite known neurotoxicity. Levetiracetam (LEV) is a newer AED not approved for neonates. Retrospective and pilot studies have investigated the use of LEV in neonatal seizures. Our objective was to compare the efficacy of LEV to PB in neonatal seizures based upon published data.
Methods We searched PubMed to perform a systematic review. We found no studies of LEV with comparison or control groups; therefore, we utilized data from two randomized controlled trials of PB as our comparison group.
Results Five studies of LEV met all inclusion/exclusion criteria. The pooled sample size for LEV was 102 (48 received primary LEV, 54 received secondary LEV). The pooled sample size for primary PB was 52. Complete or near-complete seizure cessation was achieved as follows: primary LEV 37/48 (77%), secondary LEV 34/54 (63%), and primary PB 24/52 (46%).
Conclusion Our findings suggest that LEV may be at least as or more effective for neonatal seizures as PB. Our review, though limited, is the first to examine LEV efficacy compared with PB in neonates.
4H Leukodystrophy: Lessons from 3T Imaging
Authors: Cayami Ferdy , Bugiani Marianna , Pouwels Petra , Bernard Geneviève , van der Knaap Marjo , Wolf Nicole 
Published: November 2017

Abstract4H leukodystrophy is characterized by hypomyelination, hypodontia, and hypogonadotropic hypogonadism. With its variability in clinical symptoms, application of pattern recognition to identify specific magnetic resonance imaging (MRI) features proved useful for the diagnosis. We collected 3T MR imaging data of 12 patients with mutations in POLR3A (n = 8), POLR3B (n = 3), and POLR1C (n = 1), all obtained at the same scanner. We assessed these images and compared them with previously obtained 1.5T images in 8 patients. Novel MRI findings were myelin islets, closed eye sign, and a cyst-like lesion in the splenium. Myelin islets were variable numbers of small T1 hyperintense and T2 hypointense dots, mostly in the frontal and parietal white matter, and present in all patients. This interpretation was supported with perivascular staining of myelin protein in the hypomyelinated white matter of a deceased 4H patient. All patients had better myelination of the medial lemniscus with a relatively hypointense signal of this structure on axial T2-weighted (T2W) images (“closed eye sign”). Five patients had a small cyst-like lesion in the splenium. In 10 patients with sagittal T2W images, we also found spinal cord hypomyelination. In conclusion, imaging at 3T identified additional features in 4H leukodystrophy, aiding the MRI diagnosis of this entity.
Gap-Balancing versus Measured Resection Technique in Total Knee Arthroplasty: A Comparison Study
Authors: Churchill Jessica , Khlopas Anton , Sultan Assem , Harwin Steven , Mont Michael 
Published: November 2017

AbstractProper femoral component alignment in the axial plane during total knee arthroplasty (TKA) depends on accurate bone cuts and soft tissue balancing. Two methods that are used to achieve this are “measured resection” and “gap balancing.” However, a controversy exists as to which method is more accurate and leads to better outcomes. Therefore, the purpose of this study was to evaluate: (1) implant survivorship, (2) patient outcomes, (3) complications, and (4) radiographic analysis comparing patients who underwent TKA with either gap-balancing or measured resection techniques. A total of 214 consecutive patients (221 knees) underwent primary TKA by a single surgeon between 2011 and 2012. Component alignment was achieved by using measured resection in 116 knees and gap balancing was used in 105 knees. The patients had a mean age of 66 years (range, 44–86 years) and a mean body mass index of 32 kg/m2 (range, 22–52 kg/m2). Patient range-of-motion (ROM) and Knee Society (KS) function and pain scores, and radiographic assessment, were assessed preoperatively and postoperatively at ∼6 weeks, 3 months, 1 year, and then annually. The mean follow-up time was 3 years. A Kaplan–Meier's analysis was performed to calculate the survivorship. The aseptic survivorship was 98% in both the measured resection and gap-balancing groups. The mean ROM was not significantly different between the measured resection and gap-balancing groups (123 vs. 123 degrees, p = 0.990). There were no significant differences between the two groups in terms of the KS function scores (86 vs. 85 points, p = 0.829) or the KS pain scores (93 vs. 92 points, p = 0.425). Otherwise, the radiographic evaluation at latest follow-up did not demonstrate any evidence of progressive radiolucencies or loosening, of any prosthesis. The results of this study found that at a mean follow-up of 3 years, both the measured resection and gap-balancing techniques achieved excellent survivorship and postoperative outcomes. This demonstrates that both methods can be used to achieve accurate femoral component alignment with similar short-term outcomes.
Coronal Correction for Severe Deformity Using Robotic-Assisted Total Knee Arthroplasty
Authors: Marchand Robert , Sodhi Nipun , Khlopas Anton , Sultan Assem , Higuera Carlos , Stearns Kim , Mont Michael 
Published: November 2017

AbstractAlthough robotic-assisted total knee arthroplasty (TKA) has the potential to accurately reproduce neutral alignment, it is still unclear if this correction is attainable in patients who have severe varus or valgus deformities. Therefore, the purpose of this study was to assess a single surgeon's experience with correcting coronal deformities using the robotic-assisted TKA device. Specifically, we looked at correction of varying degrees of varus and valgus deformity in patients who underwent robotic arm-assisted TKA. A total of 330 robotic-assisted TKA cases performed by a single surgeon were analyzed. Preoperative CT scans were registered to the robotic-assisted software to create a three-dimensional rendering from which coronal alignment was measured. Postoperative coronal alignment measurements were taken in the operating room using the robotic-assisted device after trial component placement. The robotic-assisted device uses optical tracking from navigation probes placed on the distal femur and proximal tibia. The robotic-assisted software can register these probes as bony landmarks to measure coronal alignment in the distal plane of the femoral component and proximal plane of the tibial component. A total of 261 cases were of varus knees, 46 cases were of valgus knees, and 23 cases had 0° preoperative alignment. Severe deformity was defined as 7° or greater deformity. Preoperative neutral alignment was defined as 0°, while postoperative neutral alignment was defined as 0° ± 3°. There were 129 patients with and initial severe varus and 7 patients with an initial severe valgus deformity of 7° or greater. Patients were divided into varus or valgus cohorts, and analysis was performed on the overall cohort, as well as nonsevere (<7°) and severe (7° or greater) deformity cohorts.All 132 knees with initial varus deformity of less than 7° were corrected to neutral (mean 1°, range -1–3°). A total of 82 knees (64%) with 7° or greater varus deformity were corrected to neutral (mean 2°, range 0–3°). However, roughly 30% of patients with severe deformity who were not corrected to neutral were still corrected within a couple of degrees of neutral. There were seven knees with 7° or greater valgus deformity, and all were corrected to neutral (mean 2°, range 0–3°). This study demonstrated that all knees were corrected in the appropriate direction within a few degrees of neutral, and no knees were overcorrected. The implication of this ability to achieve alignment goals on clinical outcomes will need to be evaluated in future studies. The results from this study demonstrate the potential for the robotic-assisted device during TKA in helping surgeons achieve a preoperatively planned desired neutral alignment.
Outcome of Cesarean Myomectomy: Is it a Safe Procedure?
Authors: Senturk Mehmet , Polat Mesut , Doğan Ozan , Pulatoğlu Çiğdem , Yardımcı Oğuz , Karakuş Resul , Tayyar Ahter 
Published: November 2017

Abstract
Objective Myomectomy performed during cesarean section is still controversial because of the potential for associated complications, especially with large myomas. Many obstetricians avoid performing cesarean myomectomy procedures because of the risk of uncontrollable hemorrhage. However, the prevalence of pregnant women with myomas is increasing, leading to an increase in the likelihood that physicians will encounter this issue. The aim of this study was to compare outcomes and complications of patients who either had or did not have cesarean myomectomy.
Method A total of 361 patients were evaluated in this retrospective study. Patients who had cesarean section with myomectomy and patients had cesarean section without myomectomy were compared with regard to demographics, drop in hemoglobin levels, complications, blood transfusion rates and duration of operation. These parameters were also compared when the diameter of the myoma was larger than 5 cm. Values of p < 0.01 and p < 0.05 were considered statistically significant.
Results While maternal age and gravidity were similar in both groups (p > 0.05), the mean myoma diameter was smaller and the duration of operation was longer in the group who underwent cesarean myomectomy (p < 0.05). The reduction in hemoglobin level, rate of complications, and number of transfusions were similar in both groups (p > 0.05).
Conclusion This study shows that myomectomy during cesarean section does not increase complications or transfusion rates and appears to be a safe procedure.
Neue Therapieansätze bei entzündlichen Gelenkerkrankungen
Authors: Benesova Karolina , Kai Bender Niko , Lorenz Hanns-Martin 
Published: November 2017

ZusammenfassungNachdem in mehreren Phase-III-Studien die Wirksamkeit und Sicherheit gezeigt werden konnte, erhielten Anfang dieses Jahres die ersten beiden JAK-Inhibitoren (Baricitinib und Tofacitinib) auch in Deutschland die Zulassung zur Behandlung der mittelschweren bis schweren aktiven rheumatoiden Arthritis. Apremilast, ein selektiver Phosphodiesterase-4 (PDE4)-Inhibitor, wird seit Anfang 2015 als orale Therapie zur Behandlung der Psoriasis und Psoriasis-Arthritis eingesetzt. Bei Psoriasis-Arthritis führt Apremilast u. a. zu einer Verringerung des Schmerzes sowie einer Verbesserung der druckschmerzhaften und geschwollenen Gelenke, der Daktylitis und der Enthesitis. Secukinumab ist ein rekombinanter humaner monoklonaler Antikörper gegen Interleukin (IL)-17 A, der initial zur Behandlung erwachsener Patienten mit mittelschwerer bis schwerer Plaque-Psoriasis eingesetzt wurde. Im November 2015 hat die EMA die Zulassung von Secukinumab auf die Behandlung von Patienten mit aktiver Psoriasis-Arthritis und ankylosierender Spondylitis erweitert. Ustekinumab ist ein humaner monoklonaler Antikorper gegen IL-12/23 und seit 2009 für die Behandlung der Plaque-Psoriasis eingesetzt. Im September 2013 erhielt Ustekinumab durch die EMA auch die Zulassung für die Behandlung der Psoriasisarthritis.
Die akute und die elektive OP-Indikation
Authors: Henniger Martina , Kehl Gabriele , Rehart Stefan 
Published: November 2017

ZusammenfassungTrotz verbesserter Therapiemöglichkeiten bedeutet die Diagnose „Rheumatoide Arthritis“ nach wie vor für den Patienten eine erhebliche physische und psychische Belastung. Zu den Krankheitssymptomen wie Schmerzen, lang anhaltende Morgensteifigkeit, Funktionsstörungen, Müdigkeit kommen die Notwendigkeit einer medikamentösen Dauertherapie und in vielen Fällen auch Operationen. Häufig leiden die Patienten unter Verunsicherung, Ängsten und Zweifeln, bei den jüngeren Patienten eher im Hinblick auf Berufswahl, Familienplanung oder Freizeitaktivitäten, bei den älteren Patienten im Hinblick auf Verlust von Mobilität und Selbstständigkeit. Hinsichtlich der Frage der operativen Intervention findet sich oft eine ambivalente Haltung der Patienten. Einerseits besteht bei persistierenden Schmerzen und Funktionseinschränkungen der Wunsch nach Besserung, andererseits bestehen Ängste hinsichtlich möglicher Komplikationen. Die meisten rheumaorthopädischen Operationen werden elektiv durchgeführt, sodass vor der geplanten Operation genügend Zeit bleibt, um den Patienten bestmöglich auf den Eingriff vorzubereiten. Schon bei der Indikationsstellung müssen zusätzliche Funktionsstörungen bei polyartikulärem Befall berücksichtigt werden, ggf. muss eine sinnvolle Reihenfolge von Operationen gemeinsam mit dem Patienten festgelegt werden. Risiken, individuelle Besonderheiten z.B. durch Voroperationen/Vorerkrankungen, der Umgang mit den Medikamenten, Alternativen zum Eingriff, postoperative Behandlung und das zu erwartende Ergebnis des Eingriffs sollten mit dem Patienten im Vorfeld ausführlich besprochen werden. Hilfreich für solche Gespräche ist es, wenn der Patient schriftlich entsprechende Informationen für den Arzt mit sich führt. Auch psychische Vorerkrankungen oder Belastungen sollten miteinbezogen werden, da das Outcome erheblich vom Vorhandensein positiver Copingmechanismen profitiert.