bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics and Outcome of Cancer Patients Admitted to the ICU in England, Wales, and Northern Ireland and National Trends Between 1997 and 2013*
Authors: Ostermann Marlies , Ferrando-Vivas Paloma , Gore Carmen , Power Sarah , Harrison David 
Published: July 2017

Objective:
To describe trends in outcomes of cancer patients with an unplanned admission to the ICU between 1997 and 2013 and to identify risk factors for mortality of those admitted between 2009 and 2013.

Design:
Retrospective analysis.

Setting:
Intensive Care National Audit & Research Centre Case Mix Programme Database including data of ICUs in England, Wales, and Northern Ireland.

Patients:
Patients (99,590) with a solid tumor and 13,538 patients with a hematological malignancy with an unplanned ICU admission between 1997 and 2013; 39,734 solid tumor patients and 6,652 patients with a hematological malignancy who were admitted between 2009 and 2013 were analyzed in depth.

Interventions:
None.

Measurements and Main Results:
In solid tumor patients admitted between 2009 and 2013, hospital mortality was 26.4%. Independent risk factors for hospital mortality were metastatic disease (odds ratio, 1.99), cardiopulmonary resuscitation before ICU admission (odds ratio, 1.63), Intensive Care National Audit & Research Centre Physiology score (odds ratio, 1.14), admission for gastrointestinal (odds ratio, 1.12), respiratory (odds ratio, 1.48) or neurological (odds ratio, 1.65) reasons, and previous ICU admission (odds ratio, 1.18). In patients with a hematological malignancy admitted between 2009 and 2013, hospital mortality was 53.6%. Independent risk factors for hospital mortality were age (odds ratio, 1.02), cardiopulmonary resuscitation before ICU admission (odds ratio, 1.90), Intensive Care National Audit & Research Centre Physiology Score (odds ratio, 1.12), admission for hematological (odds ratio, 1.48) or respiratory (odds ratio, 1.56) reasons, bone marrow transplant (odds ratio, 1.53), previous ICU admission (odds ratio, 1.43), and mechanical ventilation within 24 hours of admission (odds ratio, 1.33). Trend analysis showed a significant decrease in ICU and hospital mortality and length of stay between 1997 and 2013 despite little change in severity of illness during this time.

Conclusions:
Between 1997 and 2013, the outcome of cancer patients with an unplanned admission to ICU improved significantly. Among those admitted between 2009 and 2013, independent risk factors for hospital mortality were age, severity of illness, previous cardiopulmonary resuscitation, previous ICU admission, metastatic disease, and admission for respiratory reasons.
Endoscopic Submucosal Tunnel Dissection: A Feasible Solution for Large Superficial Rectal Neoplastic Lesions
Authors: Yang Jin-Lin , Gan Tao , Zhu Lin-Lin , Wang Yi-Ping , Yang Li , Wu Jun-Chao 
Published: July 2017

BACKGROUND:
Although endoscopic submucosal tunnel dissection has been used for the resection of esophageal and stomach neoplastic lesions, there are still no reports about large superficial rectal neoplastic lesions. Compared with esophageal and stomach endoscopic submucosal dissection, the dissection of large superficial rectal neoplastic lesions is more difficult because of the flimsy bowel wall with abundant vasculature in the submucosal region, which results in poor endoscopic maneuverability and serious complications, such as bleeding and perforation.

OBJECTIVE:
The study aimed to assess the efficacy and safety of endoscopic submucosal tunnel dissection for large superficial rectal neoplastic lesions over 5 to 24 months in selected patients.

DESIGN:
This was a prospective, single-center evaluation.

SETTINGS:
The study was conducted at a digestive endoscopic center.

PATIENTS:
Patients with large superficial rectal neoplastic lesions were included.

INTERVENTIONS:
Endoscopic submucosal tunnel dissection was performed in all of the patients with large, superficial rectal neoplastic lesions. The submucosal tunnel was created via a submucosal incision from the anal incision to the oral incision. Next, tunnel wall resection was performed to completely remove the lesion.

MAIN OUTCOME MEASURES:
Dissection speed, complications, and recurrence rate were measured.

RESULTS:
A total of 19 patients, including 13 men and 6 women, with an average age of 60.1 ± 12.2 years (range, 34.0–75.0 y) underwent endoscopic submucosal tunnel dissection. The average size of lesions was 17.54 ± 13.47 cm2. The mean operative time was 84.84 ± 53.49 minutes, and the operating speed was 21.01 ± 9.00 mm2/min. En bloc resections with negative basal margins were achieved in all cases without serious intraoperative complications. No recurrence was observed in any patient within 5 to 24 months after the operations.

LIMITATIONS:
This was a single-center study.

CONCLUSIONS:
Endoscopic submucosal tunnel dissection is feasible, safe, and effective for the treatment of large, superficial rectal neoplastic lesions in selected patients. See Video Abstract at http://links.lww.com/DCR/A321.
Management of Low Colorectal Anastomotic Leakage in the Laparoscopic Era: More Than a Decade of Experience
Authors: Boyce Stephen Alexander , Harris Craig , Stevenson Andrew , Lumley John , Clark David 
Published: July 2017

BACKGROUND:
Anastomotic leak after colorectal surgery increases postoperative mortality, cancer recurrence, permanent stoma formation, and poor bowel function. Anastomosis between the colon and rectum is a particularly high risk. Traditional management mandates laparotomy, disassembly of the anastomosis, and formation of an often-permanent stoma. After laparoscopic colorectal surgery it may be possible to manage anastomotic failure with laparoscopy, thus avoiding laparotomy.

OBJECTIVE:
The purpose of this study was to determine the feasibility of the laparoscopic management of failed low colorectal anastomoses.

SETTING:
This was a single-institute case series.

PATIENTS:
A total of 555 laparoscopic patients undergoing anterior resection with primary anastomosis within 10 cm of the anus in the period 2000–2012 were included.

MAIN OUTCOME MEASURES:
Anastomotic failure, defined as any clinical or radiological demonstrable defect in the anastomosis; complications using the Clavien–Dindo system; mortality within 30 days; and patient demographics and risk factors, as defined by the Charlson index, were measured.

RESULTS:
Leakage occurred in 44 (7.9%) of 555 patients, 16 patients with a diverting ileostomy and 28 with no diverting ileostomy. Leakage was more common in those with anastomoses <5 cm form the anus, male patients, and those with a colonic J-pouch and rectal cancer. Diverting ileostomy was not protective of anastomotic leakage. In those patients with anastomotic leakage and a primary diverting ileostomy, recourse to the peritoneal cavity was required in 4 of 16 patients versus 24 of 28 without a diverting ileostomy (p = 0.0002). In 74% of those cases, access to the peritoneal cavity was achieved through laparoscopy. Permanent stoma rates were very low, including 14 (2.5%) of 555 total patients or 8 (18.0%) of 44 patients with anastomotic leakage. Thirty-day mortality was rare (0.6%).

LIMITATIONS:
This study was limited by the lack of a cohort of open cases for comparison.

CONCLUSIONS:
Laparoscopic anterior resection is associated with low levels of complications, including anastomotic leak, postoperative mortality, and permanent stoma formation. Anastomotic leakage can be managed with laparoscopy in the majority of cases. See Video Abstract at http://links.lww.com/DCR/A353.
Multimodal Therapy of Squamous Cell Carcinoma of the Anus With Distant Metastasis: A Single-Institution Experience
Authors: Evesque Ludovic , Benezery Karen , Follana Philippe , Tuan Falk Alexander , Doyen Jerome , Reure Juliette , Cavaglione Gerard , François Eric 
Published: July 2017

BACKGROUND:
Because of the rarity of the condition, studies concerning the management of patients with squamous cell carcinoma of the anus with distant metastasis are scarce. The available studies indicate poor outcomes with exclusive chemotherapy.

OBJECTIVE:
Our aim was to evaluate the impact of multidisciplinary treatment on overall survival among patients presenting with metastatic squamous cell carcinoma of the anus.

DESIGN:
This was a retrospective study.

SETTINGS:
The study was conducted at a single French institution between 2000 and 2014.

PATIENTS:
Consecutive patients with histologically proven, newly diagnosed, or recurrent metastatic squamous cell carcinoma of the anus were included.

INTERVENTIONS:
Study interventions included multimodal therapy combining systemic chemotherapy and local ablative treatment to remove all metastases through surgery, radiofrequency ablation, or radiotherapy.

MAIN OUTCOME MEASURES:
The primary outcome measure was overall survival.

RESULTS:
Fifty patients (median age, 62 years; men/women: 8/42) fulfilled the inclusion criteria, and 39 were available for Response Evaluation Criteria in Solid Tumors. Forty had metastatic relapse after previous treatment of localized disease, and 10 presented with synchronous metastasis. P16 status was not available. Patients received at least 1 chemotherapy regimen, including 5-fluorouracil–mitomycin C (n = 22), cisplatin–5-fluorouracil (n = 20), or 5-fluorouracil alone (n = 3). Thirteen also had surgical metastasectomy, 11 had radiotherapy, and 6 had radiofrequency ablation. Median overall survival was 20.0 months (95% CI, 18.2–21.8 mo), and median time to failure of strategy was 6.0 months (95% CI, 2.9–9.1 mo). Overall response rate was 56% (95% CI, 40%–73%). Outcomes from the 5-fluorouracil–mitomycin C and cisplatin regimens did not statistically differ. Patients treated with multimodal therapy had a median overall survival of 22.0 months (95% CI, 15.3–28.6 mo) versus 13.0 months (95% CI, 9.5–16.5 mo; p = 0.002). Median time to failure of strategy was 10.0 months (95% CI, 4.2–15.7 mo) versus 5.0 months (95% CI, 2.8–7.2; p = 0.007). After 2 years, 40% of patients with multimodal treatment and 20% of those without ablative treatment were alive.

LIMITATIONS:
This study is limited by its retrospective design and modest sample size.

CONCLUSIONS:
Stage IV squamous cell carcinoma of the anus outcomes are poor, but first-line chemotherapy can enable good response rates. Other treatment modalities, including surgery, radiotherapy, and thermoablation, should be considered, because they may provide a survival advantage. See Video Abstract at http://links.lww.com/DCR/A336.
Early Colonoscopy Improves the Outcome of Patients With Symptomatic Colorectal Cancer
Authors: Alonso-Abreu Inmaculada , Alarcón-Fernández Onofre , Gimeno-García Antonio Z. , Romero-García Rafael , Carrillo-Palau Marta , Nicolás-Pérez David , Jiménez Alejandro , Quintero Enrique 
Published: July 2017

BACKGROUND:Long waiting times from early symptoms to diagnosis and treatment may influence the staging and prognosis of patients with colorectal cancer. We analyzed the effect of colonoscopy timing on the outcome of these patients.OBJECTIVE:This study aimed to compare the outcome (tumoral staging and long-term survival) of patients with suspected colorectal cancer according to diagnostic colonoscopy timing.DESIGN:This study is an analysis of a prospectively maintained database.SETTINGS:The study was conducted at the Open Access Endoscopy Service of the tertiary public healthcare center Hospital Universitario de Canarias, in the Spanish island of Tenerife.PATIENTS:Consecutive patients diagnosed of colorectal cancer between February 2008 and October 2010, fulfilling 1 or more National Institute for Health and Clinical Excellence criteria, were assigned to early colonoscopy (<30 days from referral) or to standard-schedule colonoscopy at the discretion of the referring physician. Tumor staging (TNM classification) at diagnosis and long-term survival after treatment were compared in both strategies.MAIN OUTCOME MEASURES:The primary outcomes measured were the stage at presentation and overall survival, as determined by prompt or standard referral.RESULTS:Overall, 257 patients with colorectal cancer were diagnosed (101 at early colonoscopy and 156 at standard-schedule colonoscopy). TNM stages I and II were found in 52 (54.2%) and 60 (41.7%) patients in the early colonoscopy group and standard-schedule colonoscopy group. Stage IV was confirmed in 13 patients (13.5%) diagnosed in the early colonoscopy group and in 40 (28%) detected in the standard-schedule colonoscopy group. Survival rates at 12 and 60 months after treatment were significantly higher in the early colonoscopy group compared with the standard-schedule colonoscopy group (p< 0.001).LIMITATIONS:Controlled randomization of early versus standard-referral colonoscopy, size and scope of analysis, the time interval from symptom onset to first physician assessment, and the different locations of colorectal cancer between groups were limitations of the study.CONCLUSIONS:Colonoscopy within 30 days from referral improves outcome in patients with symptomatic colorectal cancer. SeeVideo Abstractat http://journals.lww.com/dcrjournal/Pages/videogallery.aspx.
Critical Evaluation of Risk Factors of Infection Following 2-Stage Implant-Based Breast Reconstruction
Authors: Long Chao , Sue Gloria R. , Chattopadhyay Arhana , Huis In’t Veld Eva , Lee Gordon K. 
Published: July 2017

Background:
Infection is a dreaded complication following 2-stage implant-based breast reconstruction that can prolong the reconstructive process and lead to loss of implant. This study aimed to characterize outcomes of reconstructions complicated by infection, identify patient and surgical factors associated with infection, and use these to develop an infection management algorithm.

Methods:
We performed a retrospective review of all consecutive implant-based breast reconstructions performed by the senior author (2006–2015) and collected data regarding patient demographics, medical history, operative variables, presence of other complications (necrosis, seroma, hematoma), and infection characteristics. Univariate and multivariate binomial logistic regression analyses were performed to identify independent predictors of infection.

Results:
We captured 292 patients who underwent 469 breast reconstructions. In total, 14.1% (n = 66) of breasts were complicated by infection, 87.9% (n = 58) of those were admitted and given intravenous antibiotics, 80.3% (n = 53) of all infections were cleared after the first attempt, whereas the remaining recurred at least once. The most common outcome was explantation (40.9%; n = 27), followed by secondary implant insertion (21.2%; n = 14) and operative salvage (18.2%; n = 12). Logistic regression analysis demonstrated that body mass index (P = 0.01), preoperative radiation (P = 0.02), necrosis (P < 0.001), seroma (P < 0.001), and hematoma (P = 0.03) were independent predictors of infection.

Conclusions:
We observed an overall infectious complication rate of 14.1%. Heavier patients and patients who received preoperative radiation were more likely to develop infectious complications, suggesting that closer monitoring of high risk patients can potentially minimize infectious complications. Further, more aggressive management may be warranted for patients whose operations are complicated by necrosis, seroma, or hematoma.
A Limited Submuscular Direct-to-Implant Technique Utilizing AlloMax
Authors: Brichacek Michal , Dalke Kimberly , Buchel Edward , Hayakawa Thomas E.J. 
Published: July 2017

Background:
This study evaluates a novel limited submuscular direct-to-implant technique utilizing AlloMax where only the upper few centimeters of the implant is covered by the pectoralis, whereas the majority of the implant including the middle and lower poles are covered by acellular dermal matrix.

Methods:
The pectoralis muscle is released off its inferior and inferior-medial origins and allowed to retract superiorly. Two sheets of AlloMax (6 × 16 cm) are sutured together and secured to the inframammary fold, serratus fascia, and the superiorly retracted pectoralis. Thirty-seven breasts in 19 consecutive patients with follow-up at 6 months were reviewed.

Results:
Nineteen consecutive patients with 37 reconstructed breasts were studied. Average age was 50 years, average BMI was 24.3. Ptosis ranged from grade 0–III, and average cup size was B (range, A–DDD). Early minor complications included 1 seroma, 3 minor postoperative hematomas managed conservatively, and 3 minor wound healing problems. Three breasts experienced mastectomy skin flap necrosis and were managed with local excision. There were no cases of postoperative infection, red breast, grade III/IV capsular contractures, or implant loss. A single patient complained of animation postoperatively. One patient desired fat grafting for rippling.

Conclusions:
The limited submuscular direct-to-implant technique utilizing AlloMax appears to be safe with a low complication rate at 6 months. This technique minimizes the action of the pectoralis on the implant, reducing animation deformities but still providing muscle coverage of the upper limit of the implant. Visible rippling is reduced, and a vascularized bed remains for fat grafting of the upper pole if required.
The Supra-Inframammary Fold Approach to Breast Augmentation: Avoiding a Double Bubble
Authors: Swanson Eric 
Published: July 2017

Background:
The inframammary incision for breast augmentation is commonly made at or below the existing inframammary fold (IMF) in an effort to keep the scar in the crease. In recent studies, surgeons inferiorly relocate the IMF, center the implant at nipple level, and attempt to secure the new IMF with sutures. The fascial attachments (also called ligaments) holding the IMF are released, risking a bottoming-out deformity or a double bubble.

Methods:
This retrospective study evaluated 160 consecutive women undergoing primary subpectoral breast augmentation. An incision was made 0.5–1.0 cm above the IMF. Dissection proceeded directly to the pectoralis margin, preserving IMF fascial attachments. The pectoralis origin was released from the lower sternum. Surveys were administered to obtain patient-reported outcome data. Ninety-eight patients (61%) participated.

Results:
Implants often appear high on the chest at early follow-up appointments but gradually settle. One patient (0.6%) developed a double bubble. No reoperations were needed for implant malposition. One patient had a mild animation deformity. There were no cases of symmastia. The mean result rating was 9.1/10. Four percent of surveyed patients found their implants too high; 8% found them too low. Ninety-two patients (94%) reported that their scars were well-hidden. Ninety-six women (98%) said that they would redo the surgery.

Conclusions:
A supra-IMF approach anticipates the normal descent of implants after augmentation. Scars remain hidden both in standing and supine positions. This method reduces the short-term risk of reoperation for implant malposition or a double bubble.
INTEROCULAR ASYMMETRY IN CHOROIDAL THICKNESS AND RETINAL SENSITIVITY IN HIGH MYOPIA
Authors: Alzaben Zeyad , Cardona Genís , Zapata Miguel A. , Zaben Ahmad 
Published: July 2017

Purpose:
To investigate the normal range of interocular asymmetry in choroidal thickness and retinal sensitivity in high myopia without ocular fundus manifestations and to determine the relationship between interocular asymmetry and refractive error.

Methods:
Forty-three patients (35.07 ± 13.31 years) with high myopia and 45 healthy participants (39.9 ± 14.1 years) were administered an ocular coherence tomography and a microperimetry examination to determine choroidal thickness and retinal sensitivity at the foveal region and at 1, 2, and 3 mm, nasally, temporally, superiorly, and inferiorly. Absolute interocular differences were calculated to determine the normal range of asymmetry, in 95% confidence intervals.

Results:
The choroid was thinner in the myopic group at all explored locations (all P < 0.05), with larger absolute interocular differences in most of the choroidal locations under evaluation (all P < 0.05). Similarly, retinal sensitivity was reduced in the myopic group, although statistically significant differences were only encountered at the subfoveal location (P = 0.001). Retinal sensitivity asymmetry was found to increase with refractive error.

Conclusion:
The expanded range of choroidal thickness and retinal sensitivity asymmetry found in high myopia in the absence of disease is of relevance when exploring these patients for early signs of ocular pathology.
Nicotinic modulation of descending pain control circuitry
Authors: Umana Iboro C. , Daniele Claire A. , Miller Brooke A. , Abburi Chandrika , Gallagher Keith , Brown Meghan A. , Mason Peggy , McGehee Daniel S. 
Published: July 2017

Abstract
Along with the well-known rewarding effects, activation of nicotinic acetylcholine receptors (nAChRs) can also relieve pain, and some nicotinic agonists have analgesic efficacy similar to opioids. A major target of analgesic drugs is the descending pain modulatory pathway, including the ventrolateral periaqueductal gray (vlPAG) and the rostral ventromedial medulla (RVM). Although activating nAChRs within this circuitry can be analgesic, little is known about the subunit composition and cellular effects of these receptors, particularly within the vlPAG. Using electrophysiology in brain slices from adult male rats, we examined nAChR effects on vlPAG neurons that project to the RVM. We found that 63% of PAG-RVM projection neurons expressed functional nAChRs, which were exclusively of the α7-subtype. Interestingly, the neurons that express α7 nAChRs were largely nonoverlapping with those expressing μ-opioid receptors (MOR). As nAChRs are excitatory and MORs are inhibitory, these data suggest distinct roles for these neuronal classes in pain modulation. Along with direct excitation, we also found that presynaptic nAChRs enhanced GABAergic release preferentially onto neurons that lacked α7 nAChRs. In addition, presynaptic nAChRs enhanced glutamatergic inputs onto all PAG-RVM projection neuron classes to a similar extent. In behavioral testing, both systemic and intra-vlPAG administration of the α7 nAChR-selective agonist, PHA-543,613, was antinociceptive in the formalin assay. Furthermore, intra-vlPAG α7 antagonist pretreatment blocked PHA-543,613-induced antinociception via either administration method. Systemic administration of submaximal doses of the α7 agonist and morphine produced additive antinociceptive effects. Together, our findings indicate that the vlPAG is a key site of action for α7 nAChR-mediated antinociception.
Genetics of pancreatic cyst-cancer progression: standing on the shoulders of giants
Authors: Giri Bhuwan , Sethi Vrishketan , Dudeja Vikas , Banerjee Sulagna , Livingstone Alan , Saluja Ashok 
Published: July 2017

Purpose of review
Pancreatic cancer, despite years of study and some progress, presents with a grim prognosis in almost all cases. In the current review, we have discussed recent studies that have attempted to decipher the genetic makeup of pancreatic ductal adenocarcinoma and preneoplastic pancreatic cystic neoplasms.

Recent findings
With the advent of high throughput sequencing, the genetic code of pancreatic cancer is beginning to unravel and this new-found information heralds an era of precision cancer care where treatment will be guided by the genetic code of the neoplasm. Results from these studies have pointed towards the complexity and heterogeneity of the pancreatic cancer genome, provided avenues to “tailor therapy” based as well as shed light on progression of preneoplastic pancreatic neoplasms into full blown invasive pancreatic ductal adenocarcinoma.

Summary
While this progress has made us closer to the model of precision medicine, significant obstacles need to be overcome to use this new-found information to change the way we manage patients with pancreatic cancer.