bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morbidity Following Coloanal Anastomosis: A Comparison of Colonic J-Pouch vs Straight Anastomosis
Authors: Brown Shaun , Margolin David A. , Altom Laura K. , Green Heather , Beck David E. , Kann Brian R. , Whitlow Charles B. , Vargas Herschel David 
Published: January 2018

BACKGROUND:
Low rectal tumors are often treated with sphincter-preserving resection followed by coloanal anastomosis.

OBJECTIVE:
The purpose of this study was to compare the short-term complications following straight coloanal anastomosis vs colonic J-pouch anal anastomosis.

DESIGN:
Patients were identified who underwent proctectomy for rectal neoplasia followed by coloanal anastomosis in the 2008 to 2013 American College of Surgeons National Surgical Quality Improvement Program database. Demographic characteristics and 30-day postoperative complications were compared between groups.

SETTINGS:
A national sample was extracted from the American College of Surgeons National Surgical Quality Improvement Project database.

PATIENTS:
Inpatients following proctectomy and coloanal anastomosis for rectal cancer were selected.

MAIN OUTCOME MEASURES:
Demographic characteristics and 30-day postoperative complications were compared between the 2 groups.

RESULTS:
One thousand three hundred seventy patients were included, 624 in the straight anastomosis group and 746 in the colonic J-pouch group. Preoperative characteristics were similar between groups, with the exception of preoperative radiation therapy (straight anastomosis 35% vs colonic J-pouch 48%, p = 0.0004). Univariate analysis demonstrated that deep surgical site infection (3.7% vs 1.4%, p = 0.01), septic shock (2.25% vs 0.8%, p = 0.04), and return to the operating room (8.8% vs 5.0%, p = 0.0006) were more frequent in the straight anastomosis group vs the colonic J-pouch group. Major complications were also higher (23% vs 14%, p = 0.0001) and length of stay was longer in the straight anastomosis group vs the colonic J-pouch group (8.9 days vs 8.1 days, p = 0.02). After adjusting for covariates, major complications were less following colonic J-pouch vs straight anastomosis (OR, 0.57; CI, 0.38–0.84; p = 0.005). Subgroup analysis of patients who received preoperative radiation therapy demonstrated no difference in major complications between groups.

LIMITATIONS:
This study had those limitations inherent to a retrospective study using an inpatient database.

CONCLUSION:
Postoperative complications were less following colonic J-pouch anastomosis vs straight anastomosis. Patients who received preoperative radiation had similar rates of complications, regardless of the reconstructive technique used following low anterior resection. See Video Abstract at http://links.lww.com/DCR/A468.
Pelvic Pain and Quality of Life Before and After Laparoscopic Bowel Resection for Rectosigmoid Endometriosis: A Prospective, Observational Study
Authors: Riiskjær Mads , Forman Axel , Kesmodel Ulrik S. , Andersen Lars M. , Ljungmann Ken , Seyer-Hansen Mikkel 
Published: January 2018

BACKGROUND:Surgery for rectosigmoid endometriosis carries a substantial risk of short- and long-term complications, which has to be counterbalanced against the potential effect of the procedure. Prospective data are scarce in the field of deep infiltrating endometriosis surgery.OBJECTIVE:The study aimed to assess pelvic pain and quality of life before and after laparoscopic bowel resection for rectosigmoid endometriosis.DESIGN:The study involved prospectively collected data regarding pelvic pain and quality of life before and after surgery.SETTINGS:It was conducted at a tertiary endometriosis referral unit at Aarhus University Hospital.PATIENTS:A total of 175 women were included.INTERVENTION:Patients underwent laparoscopic bowel resection for endometriosis.MAIN OUTCOME MEASURES:Questionnaires for pain (Numerical Rating Scale) and quality of life (RAND Short Form-36) were answered before and 1 year after surgery. Data on analgesic and hormone treatment were collected. Preoperative and postoperative pelvic pain and quality-of-life scores were compared, and risk factors for improvement/worsening were identified.RESULTS:A total of 97.1% of the women completed the 1-year follow up. A significant decrease (p= 0.0001) was observed on all pelvic pain parameters. Most profound was the decrease in dyschezia. A significant improvement on all quality-of-life scores was observed (p= 0.0001). A surgical complication did not have a negative impact on outcome 1 year after surgery. The postoperative outcome was not related to the type of surgery.LIMITATIONS:This is an observational study without a control group. Risk factor data should be interpreted with caution, because the study was relatively underpowered for some of the rare outcomes.CONCLUSIONS:A significant and clinically relevant improvement in pelvic pain and quality of life 1 year after laparoscopic bowel resection for endometriosis was found. We strongly recommend surgery for rectosigmoid endometriosis that is unresponsive to conservative treatment. SeeVideo Abstractat http://links.lww.com/DCR/A472.
Prognostic Factors for Locoregional Recurrence in Neuroendocrine Tumors of the Rectum
Authors: Tsang Erica S. , McConnell Yarrow J. , Schaeffer David F. , Yin Yaling , Speers Caroline H. , Kennecke Hagen F. 
Published: January 2018

BACKGROUND:
Optimal management of rectal neuroendocrine tumors is not yet well defined. Various pathologic factors, particularly tumor size, have been proposed as prognostic markers.

OBJECTIVE:
We characterized sequential patients diagnosed with rectal neuroendocrine tumors in a population-based setting to determine whether tumor size and other pathologic markers could be useful in guiding locoregional management.

DESIGN:
This study is a retrospective analysis of data from the British Columbia provincial cancer registry.

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

PATIENTS:
Sequential patients diagnosed with rectal neuroendocrine tumors between 1999 and 2011 were identified. Neuroendocrine tumors were classified as G1 and G2 tumors with a Ki-67 ≤20% and/or mitotic count ≤20 per high-power field.

MAIN OUTCOME MEASURES:
Baseline clinicopathologic data including TNM staging, depth of invasion, tumor size, treatment modalities, and outcomes including survival data were measured.

RESULTS:
Of 91 rectal neuroendocrine tumors, the median patient age was 58 years, and 35 were men. Median tumor size was 6 mm. Median length of follow-up was 58.1 months, with 3 patients presenting with stage IV disease. Treatment included local ablation (n = 5), local excision (n = 79), surgical resection (n = 4), and pelvic radiation (n = 1; T3N1 tumor). Final margin status was positive in 17 cases. Local relapse occurred in 8 cases and 1 relapse to bone 13 months after T3N1 tumor resection. Univariate analysis demonstrated an association between local relapse and Ki-67, mitotic count, grade, and lymphovascular invasion (p < 0.01). Larger tumor size was associated with decreased disease-free survival.

LIMITATIONS:
Sample size was 91 patients in the whole provincial population over a 13-year time period because of the low incidence of rectal neuroendocrine tumors.

CONCLUSIONS:
In this population-based cohort, rectal neuroendocrine tumors generally presented with small, early tumors and were treated with local excision or surgical resection without pelvic radiation. Pathologic markers play a role in risk stratification and prognostication. See Video Abstract at http://links.lww.com/DCR/A514.
Seroprevalence of Hepatitis B Among HIV-infected Children and Adolescents Receiving Antiretroviral Therapy in the TREAT Asia Pediatric HIV Observational Database
Authors: Aurpibul Linda , Kariminia Azar , Vibol Ung , Fong Moy Siew , Le Oanh Ngoc , Hansudewechakul Rawiwan , Bunupuradah Torsak , Kurniati Nia , Chokephaibulkit Kulkanya , Kumarasamy Nagalingeswaran , Wati Dewi Kumara , Yusoff Nik Khairulddin Nik , Razali Kamarul Azahar Mohd , Nallusamy Revathy A. , Sohn Annette H. , Lumbiganon Pagakrong 
Published: January 2018

Background:
Hepatitis B (HBV)-HIV coinfection is associated with liver inflammation, which can progress to liver fibrosis/cirrhosis and hepatocellular carcinoma. We determined HBV seroprevalence in children and adolescents participating in the TREAT Asia Pediatric HIV Observational Database.

Methods:
A multisite cross-sectional study was conducted in HIV-infected patients currently <25 years old receiving antiretroviral treatment (ART) who had HBV surface antigen (HBsAg), or HBV surface antibody (anti-HBs) or HBV core antibody (anti-HBc) tested during 2012–2013. HBV coinfection was defined as having either a positive HBsAg test or being anti-HBc positive and anti-HBs negative, reflective of past HBV infection. HBV seroprotection was defined as having a positive anti-HBs test.

Results:
A total of 3380 patients from 6 countries (Vietnam, Thailand, Cambodia, Malaysia, Indonesia and India) were included. The current median (interquartile range) age was 11.2 (7.8–15.1) years. Of the 2755 patients (81.5%) with HBsAg testing, 130 (4.7%) were positive. Of 1558 (46%) with anti-HBc testing, 77 (4.9%) were positive. Thirteen of 1037 patients with all 3 tests were anti-HBc positive and HBsAg and anti-HBs negative. One child was positive for anti-HBc and negative for anti-HBs but did not have HBsAg tested. The prevalence of HBV coinfection was 144/2759 (5.2%) (95% confidence interval: 4.4–6.1). Of 1093 patients (32%) with anti-HBs testing, 257 (23.5%; confidence interval: 21.0–26.0) had positive tests representing HBV seroprotection.

Conclusions:
The estimated prevalence of HBV coinfection in this cohort of Asian HIV-infected children and adolescents on ART was 5.2%. The majority of children and adolescents tested in this cohort (76.5%) did not have protective HBV antibody. The finding supports HBV screening of HIV-infected children and adolescents to guide revaccination, the use of ART with anti-HBV activity and future monitoring.
Continuing Play, Symptom Severity, and Symptom Duration After Concussion in Youth Athletes
Authors: Howell David R. , O'Brien Michael J. , Fraser Joana , Meehan William P. 
Published: January 2018

Objective:
To determine whether continuing to play after a concussion is associated with higher symptom burden or prolonged symptom duration.

Design:
Patients who presented for care at a sport concussion clinic within the first 3 weeks of injury were asked whether they continued to play immediately after their injury.

Setting:
Sport concussion clinic within a regional tertiary care hospital.

Main Outcome Measures:
Clinical outcomes including symptom severity, symptom duration, age, time from injury-clinical presentation, sex, sport type, previous concussion history, and whether or not they experienced loss of consciousness or amnesia at the time of injury were recorded. Univariable comparisons between those who did and did not report continuing play were conducted. Multivariable linear regression models were constructed to identify the independent association of continuing to play postinjury with symptom burden and symptom recovery time, while controlling for the effect of potential confounding variables.

Results:
A total of 516 patients were included in the study, assessed a mean of 12.1 ± 5.2 days postinjury (35% female, mean age = 14.5 ± 2.3 years). A total of 227 (44%) continued play after sustaining a concussion. Continuing to play postconcussion was independently associated with higher symptom severity during the initial clinical evaluation [β-coefficient = 6.144, 95% confidence interval (CI), 1.357-10.93], but not with symptom duration evaluation (β-coefficient = 1.794, 95% CI, −15.66 to 19.25).

Conclusion:
Those who continued to play postconcussion presented with more severe symptoms after injury. Recognition of suspected concussion and removal from play on diagnosis confirmation may lead to better initial clinical outcomes after concussion among child and adolescent athletes.
Labyrinthine Sequestrum: A Case Report and Review of the Literature
Authors: Guerin Julie B. , Vork Diana L. , Eguiguren Lourdes , Marston Alexander P. , Driscoll Colin L. W. , Carlson Matthew L. , Henry Nancy K. , Lane John I. 
Published: January 2018

Objective:
To report the presentation, diagnosis, management, and convalescence of labyrinthine sequestrum (LS) and summarize all previously published cases.

Patient(s):
Eleven-year-old female with LS.

Intervention(s):
Multidisciplinary diagnostic evaluation and treatment.

Main Outcome Measures:
Imaging and laboratory findings, medical and surgical treatment.

Results:
We describe a case of LS secondary to medically recalcitrant suppurative otitis media in an 11-year-old female and review all eight previously reported cases. The index patient presented after 6 months of otitis media, profound unilateral hearing loss, with symptoms suggesting meningitis. Temporal bone CT demonstrated marked bony destruction of the left otic capsule. Gadolinium-enhanced MRI showed an enhancing process with evidence of meningitis and subdural empyema. The patient was treated with surgical debridement and culture directed antibiotic therapy. Posttreatment imaging showed resolution of intracranial infection with fibrous bony healing of the otic capsule resembling fibrous dysplasia.

Conclusion:
LS is a rare form of labyrinthitis characterized by centrifugal destruction of the otic capsule. The current index case highlights the importance of combined medical and surgical treatment and describes for the first time in the literature the fibrous ossification of the otic capsule following disease resolution.
How does ‘metabolic surgery’ work its magic? New evidence for gut microbiota
Authors: Peck Bailey C.E. , Seeley Randy J. 
Published: January 2018

Purpose of review
Metabolic surgery is recommended for the treatment of type 2 diabetes for its potent ability to improve glycemic control. However, the mechanisms underlying the beneficial effects of metabolic surgery are still under investigation. We provide an updated review of recent studies into the molecular underpinnings of metabolic surgery, focusing in on what is known about the role of gut microbiota. Over the last 7 years several reports have been published on the topic, however the field is expanding rapidly.

Recent findings
Studies have now linked the regulation of glucose and lipid metabolism, neuronal and intestinal adaptations, and hormonal and nutrient signaling pathways to gut microbiota. Given that the composition of gut microbiota is altered by metabolic surgery, investigating the potential mechanism and outcomes of this change are now a priority to the field.

Summary
As evidence for a role for microbiota builds, we expect future patients may receive microbe-based therapeutics to improve surgical outcomes and perhaps one day preclude the need for surgical therapies all together. In this review and perspective, we evaluate the current state of the field and its future.
Induction chemotherapy in acute myeloid leukaemia: origins and emerging directions
Authors: Upadhyay Vivek A. , Fathi Amir T. 
Published: January 2018

Purpose of review
This review summarizes the hallmark developments in induction chemotherapy for acute myeloid leukaemia and further describes future directions in its evolution.

Recent findings
We describe the origin of induction chemotherapy. We also describe notable modifications and adjustments to 7+3 induction chemotherapy since its development. Finally, we describe new efforts to modify and add new agents to induction therapy, including ‘7+3 Plus’ combinations.

Summary
Induction chemotherapy remains the standard of care for the majority of patients with acute myeloid leukaemia. However, its success is limited in a subset of patients by toxicity, failure to achieve remission and potential for subsequent relapse. Novel agents such as mutant fms like tyrosine kinase 3 inhibitors, mutant isocitrate dehydrogenase inhibitors, CD33-antibody drug conjugates and liposomal formulations have demonstrated significant potential as modifications to traditional induction chemotherapy.
A Systematic Review on Vaginal Laser Therapy for Treating Stress Urinary Incontinence: Do We Have Enough Evidence?
Authors: Pergialiotis Vasilios , Prodromidou Anastasia , Perrea Despina N. , Doumouchtsis Stergios K. 
Published: January 2018

(Abstracted from Int Urogynecol J 2017;28:1445–1451)
Treatment options proposed for stress urinary incontinence (SUI) range from conservative approaches, such as pelvic floor exercises, to surgery. When conservative treatment measures fail to improve symptoms, the mainstay of surgical treatment is midurethral slings.
Contraceptive Care of Obese Women
Authors: Morse Jessica Elizabeth , Pathak Prutha Rohit 
Published: January 2018

Importance
In the United States, 27% of reproductive-aged women are overweight, and 35% are obese. Until recently, contraceptive research excluded women greater than 130% of their ideal body weight. Gaps in data limit evidence-based decision making for effective contraceptive counseling and management in this rapidly growing population.

Objectives
The aims of this summary are to review the benefits, adverse effects, and risk factors associated with contraceptive methods in obese women, with special attention to effectiveness, and provide contraceptive management and counseling recommendations for best clinical practice.

Evidence Acquisition
We performed a thorough search of PubMed for current literature, including original research articles, review articles, and guidelines on contraceptive counseling and management in obese women in the United States. We reviewed the body of evidence with special attention to studies published since recent Cochrane and systematic reviews on this topic.

Conclusions
Contraceptive use is safer than pregnancy, especially for obese women who have increased pregnancy risks. Baseline health is compromised by obesity, but contraceptive risks remain low. Long-acting, reversible contraceptive methods offer superior effectiveness, minimal risk, and numerous noncontraceptive benefits across body mass index groups. No substantial evidence supports ineffectiveness of any method in obese women except oral emergency contraception and the patch. Pharmacokinetic changes of obesity associated with other oral methods do not seem to result in clinically significant declines in effectiveness. Future contraceptive efficacy studies should include obese women to better discuss their contraceptive needs.

Relevance
This review is beneficial for all providers caring for reproductive-aged women wanting to avoid unintended pregnancy.

Target Audience
Obstetricians and gynecologists, family physicians, and internal medicine physicians.

Learning Objectives
After completing this CME activity, physicians should be better able to (1) identify the general health, fertility, and pregnancy implications of obesity in reproductive-aged women; (2) describe the epidemiology and recent trends in unintended pregnancy rates in the United States; (3) discuss the significance of weighing risks, advantages, and adverse effects of all contraceptive methods compared with risks of unintended pregnancy in obese women; and (4) recognize evidence-based contraceptive counseling and management guidelines for obese women.
Accidental Rivaroxaban Intoxication in a Boy
Authors: Weirthein Julieta , Scolnik Dennis , Milshtein Nili Yanai , Capua Tali , Glatstein Miguel 
Published: January 2018

Abstract
Novel oral anticoagulants offer equivalent or improved therapeutic profiles compared with warfarin, with less risk of bleeding, no interactions with food, and no need for routine laboratory monitoring. Caution must be exercised in using these drugs in certain patient populations, for example, renal insufficiency, those receiving additional antithrombotic therapy, those with questionable compliance, children, and those with a high risk of gastrointestinal bleeding. One of the novel oral anticoagulants, rivaroxaban, is a direct Factor Xa inhibitor, used to reduce risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, deep vein thrombosis, and pulmonary embolism. We report a child who presented abnormal coagulation tests after unintended ingestion of 4 tablets of rivaroxaban. The patient was treated with fresh frozen plasma as well as admitted to intensive care and improved several hours later. We discuss his presentation and review of the literature on this topic.
The what, when and how in performing and interpreting microbiological diagnostic tests in skin and soft tissue infections
Authors: Navarro-San Francisco Carolina , Ruiz-Garbajosa Patricia , Cantón Rafael 
Published: January 2018

Purpose of review
To summarize and classify the most recent and relevant microbiological studies for each type of skin and soft tissue infection (SSTI).

Recent findings
Following Infectious Diseases Society of America and Food and Drug Administration classifications of SSTIs, we differentiate between two large groups, the superficial or uncomplicated infections and the complicated infections with deep involvement. It is not usually necessary to obtain microbiological samples in uncomplicated infections, except in cases of recurrences or for epidemiological control purposes. In the case of complicated infections, the samples are of two different types: those obtained from the affected area (surgical samples, punctures of abscesses or swabs) and systemic samples (i.e. blood cultures). The clinical condition also determines the type of samples to be obtained. In cases of systemic involvement, blood cultures are mandatory. For immunocompromised patients, who may present atypical infections, detection of antigens, serologies or molecular biology techniques may be helpful. The rapid diagnosis is currently the goal to be pursued by implementing techniques such as matrix assisted laser desorption ionization-time of flight, commercial real-time PCR or the promising metagenomics.

Summary
Microbiological diagnosis is one of the cornerstones of the management of SSTIs. Prompt obtaining and processing of the necessary samples, depending on the clinical situation of the patient, is of relevance in the decision-making process. Rapid and fluid reporting of the results (identification, mechanisms of resistance and antibiogram) will improve the management of these patients.
Telomeres and genomic evolution
Authors: Baird Duncan M. 
Published: January 2018

The terminal regions of eukaryotic chromosomes, composed of telomere repeat sequences and sub-telomeric sequences, represent some of the most variable and rapidly evolving regions of the genome. The sub-telomeric regions are characterized by segmentally duplicated repetitive DNA elements, interstitial telomere repeat sequences and families of variable genes. Sub-telomeric repeat sequence families are shared among multiple chromosome ends, often rendering detailed sequence characterization difficult. These regions are composed of constitutive heterochromatin and are subjected to high levels of meiotic recombination. Dysfunction within telomere repeat arrays, either due to disruption in the chromatin structure or because of telomere shortening, can lead to chromosomal fusion and the generation of large-scale genomic rearrangements across the genome. The dynamic nature of telomeric regions, therefore, provides functionally useful variation to create genetic diversity, but also provides a mechanism for rapid genomic evolution that can lead to reproductive isolation and speciation. This article is part of the theme issue ‘Understanding diversity in telomere dynamics'.This article is part of the theme issue ‘Understanding diversity in telomere dynamics’.