bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vasa Previa Diagnosis, Clinical Practice, and Outcomes in Australia
Authors: Sullivan Elizabeth A. , Javid Nasrin , Duncombe Gregory , Li Zhuoyang , Safi Nadom , Cincotta Robert , Homer Caroline S. E. , Halliday Lesley , Oyelese Yinka 
Published: August 2017

OBJECTIVE:To estimate the incidence of women with vasa previa in Australia and to describe risk factors, timing of diagnosis, clinical practice, and perinatal outcomes.METHODS:A prospective population-based cohort study was undertaken using the Australasian Maternity Outcomes Surveillance System between May 1, 2013, and April 30, 2014, in hospitals in Australia with greater than 50 births per year. Women were included if they were diagnosed with vasa previa during pregnancy or childbirth, confirmed by clinical examination or placental pathology. The main outcome measures included stillbirth, neonatal death, cesarean delivery, and preterm birth.RESULTS:Sixty-three women had a confirmed diagnosis of vasa previa. The estimated incidence was 2.1 per 10,000 women giving birth (95% CI 1.7–2.7). Fifty-eight women were diagnosed prenatally and all had a cesarean delivery. Fifty-five (95%) of the 58 women had at least one risk factor for vasa previa with velamentous cord insertion (62%) and low-lying placenta (60%) the most prevalent. There were no perinatal deaths in women diagnosed prenatally. For the five women with vasa previa not diagnosed prenatally, there were two perinatal deaths with a case fatality rate of 40%. One woman had an antepartum stillbirth and delivered vaginally and the other four women had cesarean deliveries categorized as urgent threat to the life of a fetus with one neonatal death. The overall perinatal case fatality rate was 3.1% (95% CI 0.8–10.5). Two thirds (68%) of the 65 neonates were preterm and 29% were low birth weight.CONCLUSION:The outcomes for neonates in which vasa previa was not diagnosed prenatally were inferior with higher rates of perinatal morbidity and mortality. Our study shows a high rate of prenatal diagnosis of vasa previa in Australia and associated good outcomes.
Patient, Hospital, and Geographic Disparities in Laparoscopic Surgery Use Among Surveillance, Epidemiology, and End Results–Medicare Patients With Colon Cancer
Authors: Ratnapradipa Kendra L. , Lian Min , Jeffe Donna B. , Davidson Nicholas O. , Eberth Jan M. , Pruitt Sandi L. , Schootman Mario 
Published: August 2017

BACKGROUND:
Surgical resection is the primary treatment for colon cancer, but use of laparoscopic approaches varies widely despite demonstrated short- and long-term benefits.

OBJECTIVE:
The purpose of this study was to identify characteristics associated with laparoscopic colon cancer resection and to quantify variation based on patient, hospital, and geographic characteristics.

DESIGN:
Bayesian cross-classified, multilevel logistic models calculated adjusted ORs and CIs for patient, surgeon, hospital, and geographic characteristics and unexplained variability (predicted vs. observed values) using adjusted median odds ratios for hospitals and counties.

SETTINGS:
The Surveillance, Epidemiology, and End Results–Medicare claims database (2008–2011) supplemented with county-level American Community Survey (2008–2012) demographic data was used.

PATIENTS:
A total of 10,618 patients ≥66 years old who underwent colon cancer resection were included.

MAIN OUTCOME MEASURES:
Nonurgent/nonemergent resections for colon cancer patients ≥66 years old were classified as laparoscopic or open procedures.

RESULTS:
Patients resided in 579 counties and used 950 hospitals; 47% of patients underwent laparoscopic surgery. Medicare/Medicaid dual enrollment, age ≥85 years, and higher tumor stage and grade were negatively associated with laparoscopic surgery receipt; proximal tumors and increasing hospital size and surgeon caseload were positively associated. Significant unexplained variability at the hospital (adjusted median OR = 3.31; p < 0.001) and county levels (adjusted median OR = 1.28; p < 0.05) remained after adjustment.

LIMITATIONS:
This was an observational study lacking generalizability to younger patients without Medicare or those with Health Maintenance Organization coverage and data set did not reflect national hospital studies or hospital volume. In addition, we were unable to account for specific types of comorbidities, such as obesity, and had broad categories for surgeon caseload.

CONCLUSIONS:
Determining sources of hospital-level variation among poor insured patients may help increase laparoscopic resection to maximize health outcomes and reduce cost. See Video Abstract at http://links.lww.com/DCR/A363.
Outcomes of Immediate Internal Pudendal Artery Perforator Flap Reconstruction for Irradiated Abdominoperineal Resection Defects
Authors: Coltro Pedro S. , Busnardo Fábio F. , Mônaco Filho Franklin C. , Olivan Marcelo V. , Millan Lincoln S. , Grillo Victor A. , Marques Carlos F. , Nahas Caio S. , Nahas Sérgio C. , Ribeiro Ulysses , Gemperli Rolf 
Published: August 2017

BACKGROUND:There are many previous reports for using the internal pudendal artery perforator flap in vulvovaginal reconstruction; however, reports of this flap for perineal reconstruction after abdominoperineal excision of the rectum are scarce.OBJECTIVE:The purpose of this study was to evaluate the outcomes of immediate internal pudendal artery perforator flap reconstruction for irradiated abdominoperineal resection defects.DESIGN:This was a prospective case series.SETTINGS:This flap could represent a step forward over other perineal flap approaches or primary closure.PATIENTS:A total of 73 consecutive patients with anorectal tumors were included.INTERVENTIONS:The study included immediate perineal reconstruction using 122 internal pudendal artery perforator flaps after abdominoperineal excision of the rectum.MAIN OUTCOME MEASURES:Dimensions of the perineal defect (in centimeters squared), hospital stay (days), healing time (days), and postoperative complications (Clavien–Dindo grades) were measured.RESULTS:The means of the perineal defect, hospital stay, and healing time were 51.62 cm2, 15.94 days, and 38.52 days. The higher the patient BMI, the longer healing time (p= 0.02); Clavien–Dindo complications grades III to IV were greater in patients with perineal defect ≥60 cm2(p= 0.03; OR = 10.56); postoperative complications were higher both in patients with anal squamous cell carcinoma (p= 0.005; OR = 6.09) and in patients with comorbidities (p= 0.04; OR = 2.78); hospital stay (p= 0.001) and healing time (p< 0.001) were higher in patients who had postoperative complications. The complete perineal wound healing at 12 weeks was achieved by 95% of patients, and our 30-day mortality rate was 4%.LIMITATIONS:As a nonrandomized study, our results have to be interpreted with caution.CONCLUSIONS:Multiple previously described advantages associated with internal pudendal artery perforator flap were also observed here, reinforcing the idea that it is reliable, versatile, and a useful option for perineal reconstruction after abdominoperineal excision of the rectum. Therefore, we propose that this flap could be considered as the first choice for perineal reconstruction in selected patients with moderate and some large defects after abdominoperineal excision of the rectum. SeeVideo Abstractat http://links.lww.com/DCR/A367.
Squamous Cancers of the Rectum Demonstrate Poorer Survival and Increased Need for Salvage Surgery Compared With Squamous Cancers of the Anus
Authors: Kulaylat Audrey S. , Hollenbeak Christopher S. , Stewart David B. 
Published: August 2017

BACKGROUND:
Squamous cell cancers of the anus are rare GI malignancies for which neoadjuvant chemoradiation is the first-line treatment for nonmetastatic disease. Squamous cancers of the rectum are far less common, and it is unclear to what degree chemoradiotherapy improves their outcomes.

OBJECTIVE:
The purpose of this study was to compare stage-specific survival for anal and rectal squamous cancers stratified by treatment approach.

DESIGN:
This was a retrospective cohort study.

SETTINGS:
The study was conducted at Commission on Cancer designated hospitals.

PATIENTS:
Patients (2006–2012) identified in the National Cancer Database with pretreatment clinical stage I to III cancers who underwent chemoradiotherapy, with and without subsequent salvage surgical resection (low anterior resection or abdominoperineal resection), ≥12 weeks after chemoradiotherapy were included in the study.

MAIN OUTCOME MEASURES:
Overall survival and the need for salvage surgery were measured.

RESULTS:
Anal cancers (n = 11,224) typically presented with stage II (45.7%) or III (36.3%) disease, whereas rectal cancer stages (n = 1049) were more evenly distributed (p < 0.001). More patients with rectal cancer underwent low anterior or abdominoperineal resections 12 weeks or later after chemoradiotherapy versus those undergoing abdominoperineal resection for anal cancer (3.8% versus 1.2%; p < 0.001). Stage I and II rectal cancer was associated with poorer survival compared with anal cancer (stage I, p = 0.017; stage II, p < 0.001); survival was similar for stage III disease. Salvage surgery for anal cancer was associated with worse survival for stage I to III cancers; salvage surgery did not significantly affect survival for rectal cancer.

LIMITATIONS:
This was a retrospective study without cancer-specific survival measures.

CONCLUSIONS:
Squamous rectal cancers are associated with significantly worse survival than squamous cancers of the anus for clinical stage I and II disease. Despite both cancers exhibiting squamous histology, rectal cancers may be less radiosensitive than anal cancers, as suggested by the greater incidence of salvage surgery that does not appear to significantly improve overall survival. See Video Abstract at http://links.lww.com/DCR/A422.
Quality of Local Excision for Rectal Neoplasms Using Transanal Endoscopic Microsurgery Versus Transanal Minimally Invasive Surgery: A Multi-institutional Matched Analysis
Authors: Lee Lawrence , Edwards Kimberly , Hunter Iain A. , Hartley John E. , Atallah Sam B. , Albert Matthew R. , Hill James , Monson John R. 
Published: August 2017

BACKGROUND:
There are no data comparing the quality of local excision of rectal neoplasms using transanal endoscopic microsurgery and transanal minimally invasive surgery.

OBJECTIVE:
The purpose of this study was to compare the incidence of tumor fragmentation and positive margins for patients undergoing local excision of benign and malignant rectal neoplasms using transanal endoscopic microsurgery versus transanal minimally invasive surgery.

DESIGN:
This was a multi-institutional cohort study using coarsened exact matching.

SETTINGS:
The study was conducted at high-volume tertiary institutions with specialist colorectal surgeons.

PATIENTS:
Patients undergoing full-thickness local excision for benign and malignant rectal neoplasms were included.

INTERVENTIONS:
Transanal endoscopic microsurgery and transanal minimally invasive surgery were the included interventions.

MAIN OUTCOME MEASURES:
The incidence of poor quality excision (composite measure including tumor fragmentation and/or positive resection margin) was measured.

RESULTS:
The matched cohort consisted of 428 patients (247 with transanal endoscopic microsurgery and 181 with transanal minimally invasive surgery). Transanal minimally invasive surgery was associated with shorter operative time and length of stay. Poor quality excision was similar (8% vs 11%; p = 0.233). There were also no differences in peritoneal violation (3% vs 3%; p = 0.965) and postoperative complications (11% vs 9%; p = 0.477). Cumulative 5-year disease-free survival for patients undergoing transanal endoscopic microsurgery was 80% compared with 78% for patients undergoing transanal minimally invasive surgery (log rank p = 0.824). The incidence of local recurrence for patients with malignancy who did not undergo immediate salvage surgery was 7% (8/117) for transanal endoscopic microsurgery and 7% (7/94) for transanal minimally invasive surgery (p = 0.864).

LIMITATIONS:
All of the procedures were also performed at high-volume referral centers by specialist colorectal surgeons with slightly differing perioperative practices and different time periods.

CONCLUSIONS:
High-quality local excision for benign and rectal neoplasms can be equally achieved using transanal endoscopic microsurgery or transanal minimally invasive surgery. The choice of operating platform for local excisions of rectal neoplasms should be based on surgeon preference, availability, and cost. See Video Abstract at http://links.lww.com/DCR/A382.
Hormone therapy use in the Canadian Longitudinal Study on Aging: a cross-sectional analysis
Authors: Costanian Christy , Edgell Heather , Ardern Chris I. , Tamim Hala 
Published: August 2017

AbstractObjective:The aim of the study was to assess the prevalence and factors associated with hormone therapy (HT) use among Canadian women.Methods:Baseline data from the Tracking cohort of the Canadian Longitudinal Study on Aging (CLSA) was used for this analysis. The main outcome was HT use among women aged 45-85 years, defined as current, past, and never users. Multinomial logistic regression models were used to examine the differences between current, past, and never HT users in terms of sociodemographic, health behavior, and health-related variables.Results:Overall, 9.5% of the sample reported current use of HT, whereas 21.9% reported past use. The main factors associated with a lower likelihood of current HT use were older age (>80 y), nonwhite ethnic background, current employment, regular smoking, obesity, and breast cancer. By contrast, alcohol consumption, and the presence of allergies or mood disorders were positively associated with current HT use.Conclusions:These findings provide a recent national picture of HT use in Canada that may be used to inform opportunities for improved physician–patient communication regarding menopause management.
TREATMENT PATTERNS AND 2-YEAR VISION OUTCOMES WITH BEVACIZUMAB IN DIABETIC MACULAR EDEMA
Authors: Fong Donald S. , Luong Tiffany Q. , Contreras Richard , Jimenez Jennifer J. , Custis Peter H. , Patel Vaishali , Campbell Joanna H. 
Published: August 2017

Purpose:
To assess health care utilization and vision outcomes over 2 years in patients receiving bevacizumab treatment in clinical practice for diabetic macular edema.

Methods:
Patients with newly diagnosed diabetic macular edema who received an intravitreal bevacizumab injection within 12 months of initial diagnosis were identified from Kaiser Permanente's 350,000 patients with diabetes mellitus treated between 2008 and 2013. Snellen best-corrected visual acuity (BCVA), number of intravitreal injections, and patient characteristics were abstracted from the electronic record. The main outcome measure was change in BCVA.

Results:
Three hundred and nine patients met the inclusion criteria and had 2 years of follow-up after their first bevacizumab injection. These patients had a mean of 3.1 injections (range, 1–17) during the 2-year follow-up. Mean BCVA improvement was 5.4 letters at 12 months and 5.3 letters at 24 months. Only 29.8% of patients demonstrated ≥3 lines of vision improvement from baseline, whereas 12.3% had ≥3 lines of vision loss from baseline at 24 months.

Conclusion:
This is the largest U.S. clinical practice–based study of bevacizumab use in diabetic macular edema. Consistent with national studies, the frequency of injection was low. Average BCVA improvement was lower than in anti–vascular endothelial growth factor trials. Significant BCVA improvement was achieved in approximately 30% of patients with newly diagnosed diabetic macular edema.
HOLE-DOOR SIGN
Authors: Kumar Vinod , Yadav Bhupendra 
Published: August 2017

Purpose:
To describe a novel intraoperative finding during pars plana vitrectomy for macular hole using operating microscope-integrated spectral domain optical coherence tomography that predicts the closure of macular hole.

Methods:
Twenty-five eyes of 25 patients with macular hole, who underwent 25-gauge pars plana vitrectomy over a period of 16 months at a tertiary eye care center by a single surgeon, were recruited in this retrospective interventional study. All eyes were assessed with intraoperative spectral domain optical coherence tomography before and after internal limiting membrane peeling. The patients were assessed in terms of best-corrected visual acuity, preoperative minimal hole diameter, and type of hole closure.

Results:
After the internal limiting membrane was peeled, vertical pillars of tissue were seen at the edges of hole projecting into the vitreous cavity. This appearance was similar to that of an open door over the macular hole and was termed “hole-door sign.” Hole-door sign was seen in 15 of 25 eyes (60%). All the eyes with hole-door sign had Type-1 closure of macular hole (100%), whereas only 6 of 10 eyes (60%) without hole-door sign had Type-1 closure of the macular hole.

Conclusion:
Hole-door sign is a novel intraoperative finding that predicts postoperative Type-1 closure of macular hole. This may add to the utility of intraoperative optical coherence tomography in clinical practice.
VISUAL AND ANATOMICAL OUTCOMES AFTER DIABETIC TRACTION AND TRACTION-RHEGMATOGENOUS RETINAL DETACHMENT REPAIR
Authors: Storey Philip P. , Ter-Zakarian Anna , Philander Shannon A. , Olmos de Koo Lisa , George Meena , Humayun Mark S. , Rodger Damien C. , Ameri Hossein 
Published: August 2017

Purpose:
To evaluate visual and anatomical outcomes of diabetic tractional retinal detachment repaired with pars plana vitrectomy.

Methods:
Operative records were used to retrospectively identify all patients with tractional retinal detachments secondary to proliferative diabetic retinopathy surgically repaired with pars plana vitrectomy between November 1, 2009, and January 1, 2015 at the LAC + USC (Los Angeles County + University of Southern California) Medical Center.

Results:
A total of 403 eyes with diabetic tractional retinal detachment in 359 patients were included. Successful reattachment of the retina was achieved in 87.6% of eyes after one surgery and 92.6% of eyes at the final follow-up. Best-corrected visual acuity at the final follow-up improved two or more lines in 56.3% of eyes, was stable in 23.8% of eyes, and decreased two or more lines in 19.9% of eyes. Eyes repaired with 23-gauge and 25-gauge vitrectomy systems had similar success rates as eyes treated with 20-gauge instrumentation (P = 0.73). Eyes receiving silicone oil tamponade had lower single-surgery reattachment rates (77.6% vs. 87.6%; P = 0.013), lower reattachment rates at the final follow-up (85.7% vs. 92.6%; P = 0.048), and higher rates of vision loss (34.7% vs. 19.9%; P < 0.0001) but were more likely to have concurrent rhegmatogenous detachment (47.0% vs. 21.3%; P < 0.0001) and macula involving detachment (74.5% vs. 60.0%; P < 0.0001).

Conclusion:
In this large, single-center retrospective study of patients with advanced diabetic tractional retinal detachment, vitrectomy achieved excellent anatomical outcome and improved or stabilized vision in 80.1% of eyes. Smaller gauge vitrectomy systems were found to have similar outcomes to 20-gauge instrumentation.
Incidence of Serotonin Syndrome With Combined Use of Linezolid and Serotonin Reuptake Inhibitors Compared With Linezolid Monotherapy
Authors: Karkow Diana C. , Kauer Jill F. , Ernst Erika J. 
Published: August 2017

AbstractPurposeLinezolid is a monoamine oxidase inhibitor that may increase the risk of serotonin syndrome in patients receiving combination selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs). The objective of this study was to compare the incidence of serotonin syndrome when linezolid was administered alone and in combination with SSRIs or SNRIs.MethodsThis was a retrospective case-control study of adult inpatients admitted to the University of Iowa Hospitals and Clinics who received linezolid between January 2010 and December 2014. Patients who received linezolid with or within 14 days of an SSRI or SNRI were eligible for inclusion in the combination therapy group. Patients who received linezolid alone were matched by age and gender to patients in the combination therapy group, and 3 monotherapy patients were included for each combination therapy patient. Clinical features consistent with serotonin syndrome were assessed using the Sternbach and Hunter criteria.ResultsA total of 348 patients were included in this study, of which 87 received combination therapy and 261 received linezolid monotherapy. One patient given combination therapy (1.1%) and 1 patient given linezolid monotherapy (0.4%) were determined to have a diagnosis of serotonin syndrome (P= 0.438; relative risk, 3.00; 95% confidence interval, 0.19–47.45). In both cases, signs and symptoms of serotonin syndrome reversed upon discontinuation of linezolid therapy.ConclusionsThere was no significant difference in the incidence of serotonin syndrome when linezolid was used alone or in combination with an SSRI or SNRI, and the overall incidence of serotonin syndrome was low.
Sensitivity and Specificity of Clinical and Laboratory Otolith Function Tests
Authors: Kumar Lokesh , Thakar Alok , Thakur Bhaskar , Sikka Kapil 
Published: August 2017

Objective:
To evaluate clinic based and laboratory tests of otolith function for their sensitivity and specificity in demarcating unilateral compensated complete vestibular deficit from normal.

Study Design:
Prospective cross-sectional study.

Setting:
Tertiary care hospital vestibular physiology laboratory.

Subjects:
Control group—30 healthy adults, 20–45 years age; Case group-15 subjects post vestibular shwannoma excision or post-labyrinthectomy with compensated unilateral complete audio-vestibular loss.

Intervention:
Otolith function evaluation by precise clinical testing (head tilt test—HTT; subjective visual vertical—SVV) and laboratory testing (headroll-eye counterroll—HR-ECR; vesibular evoked myogenic potentials—cVEMP).

Main Outcome Measure:
Sensitivity and specificity of clinical and laboratory tests in differentiating case and control subjects.

Results:
Measurable test results were universally obtained with clinical otolith tests (SVV; HTT) but not with laboratory tests. The HR-ECR test did not indicate any definitive wave forms in 10% controls and 26% cases. cVEMP responses were absent in 10% controls.
HTT test with normative cutoff at 2 degrees deviations from vertical noted as 93.33% sensitive and 100% specific. SVV test with normative cutoff at 1.3 degrees noted as 100% sensitive and 100% specific. Laboratory tests demonstrated poorer specificities owing primarily to significant unresponsiveness in normal controls.

Conclusions:
Clinical otolith function tests, if conducted with precision, demonstrate greater ability than laboratory testing in discriminating normal controls from cases with unilateral complete compensated vestibular dysfunction.