bluuebunny/crossref_metadata_2025_split huggingface dataset:
Loop Ileostomy Closure as an Overnight Procedure: Institutional Comparison With the National Surgical Quality Improvement Project Data Set
Authors: Berger Nicholas G. , Chou Raymond , Toy Elliot S. , Ludwig Kirk A. , Ridolfi Timothy J. , Peterson Carrie Y. 
Published: July 2017

BACKGROUND:
Enhanced recovery pathways have decreased length of stay after colorectal surgery. Loop ileostomy closure remains a challenge, because patients experience high readmission rates, and validation of enhanced recovery pathways has not been demonstrated. This study examined a protocol whereby patients were discharged on the first postoperative day and instructed to advance their diet at home with close telephone follow-up.

OBJECTIVE:
The hypothesis was that patients can be safely discharged the day after loop closure, leading to shorter length of stay without increased rates of readmission or complications.

DESIGN:
Patients undergoing loop ileostomy closure were queried from the American College of Surgeons National Surgical Quality Improvement Project and compared with a single institution (2012–2015). Length of stay, 30-day readmission, and 30-day morbidity data were analyzed.

SETTINGS:
The study was conducted at a tertiary university department.

PATIENTS:
The study includes 1602 patients: 1517 from the National Surgical Quality Improvement Project database and 85 from a single institution.

MAIN OUTCOME MEASURES:
Length of stay and readmission rates were measured.

RESULTS:
Median length of stay was less at the single institution compared with control (2 vs 4 d; p < 0.001). Thirty-day readmission (15.3% vs 10.4%; p = 0.15) and overall 30-day complications (15.3% vs 16.7%; p = 0.73) were similar between cohorts. Estimated adjusted length of stay was less in the single institution (2.93 vs 5.58 d; p < 0.0001). There was no difference in the odds of readmission (p = 0.22).

LIMITATIONS:
The main limitations of this study include its retrospective nature and limitations of the National Surgical Quality Improvement Program database.

CONCLUSIONS:
Next-day discharge with protocoled diet advancement and telephone follow-up is acceptable after loop ileostomy closure. Patients can benefit from decreased length of stay without an increase in readmission or complications. This has the potential to change the practice of postoperative management of loop ileostomy closure, as well as to decrease cost. See Video Abstract at http://links.lww.com/DCR/A310.
Applicability of American Joint Committee on Cancer and College of American Pathologists Regression Grading System in Rectal Cancer
Authors: Jäger Tarkan , Neureiter Daniel , Urbas Romana , Klieser Eckhard , Hitzl Wolfgang , Emmanuel Klaus , Dinnewitzer Adam 
Published: July 2017

BACKGROUND:
Different tumor grading systems have been proposed to predict the association between tumor response and clinical outcome after preoperative chemoradiotherapy in patients with rectal cancer. The American Joint Committee on Cancer and College of American Pathologists regression grading system was recommended as the standard tumor regression grading system for rectal adenocarcinoma.

OBJECTIVE:
This study evaluated the clinical applicability of the American Joint Committee on Cancer and College of American Pathologists regression grading system in neoadjuvant-treated patients with rectal cancer.

DESIGN:
This is a retrospective cohort study based on clinical data from a prospectively maintained colorectal cancer database.

SETTINGS:
This study was performed at a single tertiary referral center.

PATIENTS:
A total of 144 patients with primary locally advanced mid-to-low rectal adenocarcinoma who underwent preoperative long-course chemoradiotherapy and total mesorectal excision between 2003 and 2012 were included.

MAIN OUTCOMES MEASURES:
The primary outcome measures were the 5-year overall survival rate, the relapse-free survival rate, the cancer-specific survival rate, and cumulative recurrence rates.

RESULTS:
Of the 144 patients, 16 (11%) were diagnosed as American Joint Committee on Cancer and College of American Pathologists regression grade 0, 43 patients (30%) as grade 1, 61 patients (42%) as grade 2, and 25 patients (17%) as grade 3.
After a median follow-up time of 83 months (range, 3 to 147 mo), 5-year survival estimates for grades 0, 1, 2, and 3, were 93%, 77%, 81%, and 54% for overall survival (p = 0.006); 93%, 82%, 75%, and 55% for relapse-free survival (p = 0.03); and 100%, 86%, 89%, and 63% for cancer-specific survival (p = 0.006). The multivariate Cox regression analyses confirmed the American Joint Committee on Cancer and College of American Pathologists regression grading system as a prognostic factor for overall (p = 0.04), relapse-free (p = 0.02), and cancer-specific survival (p = 0.04).

LIMITATIONS:
This was a retrospective study.

CONCLUSIONS:
Our study findings confirm the clinical relevance and applicability of the American Joint Committee on Cancer and College of American Pathologists regression grade system as a predictive factor for patients with rectal cancer. See Video Abstract at http://links.lww.com/DCR/A320.
Lamotrigine Drug Interactions in Combination Therapy and the Influence of Therapeutic Drug Monitoring on Clinical Outcomes of Adult Patients
Authors: Grundmann Milan , Koristkova Blanka , Brozmanova Hana , Kacirova Ivana 
Published: July 2017

Background:
The aim was to study the impact of therapeutic drug monitoring (TDM) on patients on lamotrigine (LTG) therapy and the evaluation of possible drug interactions, especially in triple antiepileptic drug combinations.

Methods:
During the period of 2001–2014, 3118 predose samples were taken from 1137 patients >15 years of age as part of their routine TDM. Drug interactions were evaluated using calculation of LTG clearance (CL).

Results:
Valproic acid (VPA) decreased LTG CL by 66% in bitherapy, and by 35% and 31% in triple therapy with carbamazepine (CBZ) and phenytoin (PHT), respectively. CBZ and PHT increased LTG CL by 52% and 96% in respective bitherapies but by 88% in triple therapy. Clonazepam, levetiracetam, and topiramate had no effect. The LTG therapeutic range (TR) was exceeded in 1% of cases in monotherapy, and in 4%–5% of cases in combination therapy. Only 54% of results were within the TR during 2001–2005, whereas 60%–62% were within the TR during 2006–2014. Adverse drug reactions (ADRs) were reported in 88 cases and occurred more frequently during TR during 2001–2005. Higher number of supratherapeutic levels in combination therapy led to a 3-fold higher incidence of ADR and poorer seizure control, as seizures occurred more often monthly (2.5%) or a few per year (41%) and fewer patients were seizure free (18%). Seizures occurred more often daily and monthly during the first period and in patients with 3 or 4 drugs in combination.

Conclusions:
A significantly higher number of supratherapeutic levels were found in combinations with VPA, despite lower doses of LTG. Hepatic enzyme inducers, such as CBZ and PHT only partially compensated for the inhibitory effect of VPA. Decrease of both the frequency of seizures and the incidence of ADRs after TDM implementation suggests that TDM may have given clinicians the opportunity to achieve more optimal patient treatment.
Brain imaging of pain sensitization in patients with knee osteoarthritis
Authors: Pujol Jesus , Martínez-Vilavella Gerard , Llorente-Onaindia Jone , Harrison Ben J. , López-Solà Marina , López-Ruiz Marina , Blanco-Hinojo Laura , Benito Pere , Deus Joan , Monfort Jordi 
Published: July 2017

Abstract
A relevant aspect in osteoarthritic pain is neural sensitization. This phenomenon involves augmented responsiveness to painful stimulation and may entail a clinically worse prognosis. We used functional magnetic resonance imaging (fMRI) to study pain sensitization in patients with knee osteoarthritis. Sixty patients were recruited and pain sensitization was clinically defined on the basis of regional spreading of pain (spreading sensitization) and increased pain response to repeated stimulation (temporal summation). Functional magnetic resonance imaging testing involved assessing brain responses to both pressure and heat stimulation. Thirty-three patients (55%) showed regional pain spreading (simple sensitization) and 19 patients (32%) showed both regional spreading and temporal summation. Sensitized patients were more commonly women. Direct painful pressure stimulation of the joint (articular interline) robustly activated all of the neural elements typically involved in pain perception, but did not differentiate sensitized and nonsensitized patients. Painful pressure stimulation on the anterior tibial surface (sensitized site) evoked greater activation in sensitized patients in regions typically involved in pain and also beyond these regions, extending to the auditory, visual, and ventral sensorimotor cortices. Painful heat stimulation of the volar forearm did not discriminate the sensitization phenomenon. Results confirm the high prevalence of pain sensitization secondary to knee osteoarthritis. Relevantly, the sensitization phenomenon was associated with neural changes extending beyond strict pain-processing regions with enhancement of activity in general sensory, nonnociceptive brain areas. This effect is in contrast to the changes previously identified in primary pain sensitization in fibromyalgia patients presenting with a weakening of the general sensory integration.
Increasing access to hearing rehabilitation for older adults
Authors: Nieman Carrie L. , Lin Frank R. 
Published: July 2017

Purpose of review
To provide an update on the recent research and policy developments affecting the current and future care of the 23 million older Americans with untreated hearing loss.

Recent findings
Increasing evidence supports the association of age-related hearing loss with significant negative outcomes that affect the ability of older adults to age well. Despite an evolving understanding of the role hearing loss plays in the well being and vitality of older adults, the vast majority of older adults go untreated and hearing health care disparities exist. Recent work to understand the multitude of factors involved in hearing health care decisions, coupled with innovative approaches and technology to deliver hearing care, aim to provide more older adults with equal access to the tools needed to age well. Most importantly, significant national efforts and policy proposals substantiate these efforts and will be reviewed.

Summary
Age-related hearing loss is a critical public health issue that affects almost all older adults. Through the application of novel approaches and perspectives, the delivery of hearing health care for older adults is evolving to provide more affordable and accessible care. Accompanying policy efforts provide the necessary support needed to increase access to care significantly.
Functional Balance Deterioration on Daily Activities in Patients With Migraine
Authors: Carvalho Gabriela F. , Florencio Lidiane L. , Pinheiro Carina F. , Dach Fabiola , Bigal Marcelo E. , Bevilaqua-Grossi Débora 
Published: July 2017

Objective
This study aimed to assess functional activities in different subgroups of patients with migraine.

Design
One-hundred forty subjects were uniformly divided into the following four groups: headache-free controls, migraine with aura, without aura, and chronic migraine. Subjects performed the tests walk across, tandem walk, sit to stand, and step up and over at the Balance Master system (Neurocom).

Results
All migraine groups had slower velocity and shorter step length at the walk across test (P < 0.0009). The step width was wider in migraine with aura and chronic migraine groups (P < 0.03). At the tandem walk test, patients with migraine exhibited slower velocity and wider step width (P < 0.03). All migraine groups were different than controls at weight transfer and rising index of the sit-to-stand test (P < 0.002). At the step-up-and-over test, there were differences in all outcomes of both legs between headache-free controls versus migraine groups (P < 0.02) and at one outcome between without aura versus migraine with aura (P < 0.01). Moderate to high effect sizes were found for all tests on at least two outcomes assessed, mostly between controls compared with migraine groups.

Conclusions
Migraine is related to changes in the performance of functional tasks, suggesting early motor control deterioration. Proper balance assessment and rehabilitation strategies should be considered for these patients.
Effect of Cervical Siphon of External and Internal Carotid Arteries
Authors: Singh Rajani , Tubbs Richard Shane 
Published: July 2017

Abstract
Variant courses, configuration, and branching pattern of the external and internal carotid arteries, especially when curved in S-shape, are important for hemodynamic changes and clinical implications. Therefore, the aim of the study is to report abnormal cervical siphons observed in external and internal carotid arteries to explore clinical significance by review of literature and hemodynamic changes theoretically.
The right common carotid artery bifurcated into external and internal carotid arteries at the level of the upper border of thyroid cartilage in a 70-year-old female cadaver. After bifurcation, the external carotid artery underwent severe tortuosity coursing through 5 bends at points A, B, C, D, and E from its origin to termination and 2 bends at A’ and B’ in internal carotid artery in the cervical region. The angles between inflow and out flow of the blood at the bends were measured and the change in velocity at each bend was computed for both arteries. Hemodynamic changes were calculated, compared and relevant clinical complications were theoretically correlated.
The angles of 20°, 30°, 51°, 52°, 60°, and 28°, 48° were formed by 5 bends of external and 2 bends of internal carotid arteries, respectively. The curved courses of these arteries caused reduction in velocity/stasis, turbulence, and low shear stress. Such kinks might cause stroke, ischemia and mistaken for tumors and abscess in imagery leading to or otherwise producing iatrogenic repercussions. This study will be useful for anatomists, clinicians, and radiologists.
Respiratory problems in low-resource settings
Authors: Leng Mhoira E.F. , Daniel Sunitha , Munday Daniel 
Published: July 2017

Purpose of review
Chronic breathlessness is common in patients with advanced illness who require palliative care. Achieving good symptom control can be challenging. More people with advanced illness live in low and middle income than in high-income countries, but they are much less likely to receive palliative care. Most of the emerging evidence for the palliative management of chronic breathlessness is from high-income countries. This review explores the context of chronic breathlessness in low-income settings, how evidence for control of chronic breathlessness might relate to these settings and where further work should be focused.

Recent findings
Systems for control of noncommunicable diseases (NCDs) in these low-income contexts are poorly developed and health services are often overwhelmed with high levels both of NCD and communicable disease. Multidisciplinary and holistic approaches to disease management are often lacking in these settings. Developing an integrated primary care approach to NCD management is increasingly recognized as a key strategy and this should include palliative care. Most evidence-based approaches to the control of chronic breathlessness could be adapted for use in these contexts

Summary
Hand held fans, breathing techniques, graded exercise and use of low-dose morphine can all be used in low-income settings particularly in the context of holistic care. Research is needed into the most effective ways of implementing such interventions and palliative care needs to be promoted as a fundamental aspect of NCD management.
Can High-Dose Levetiracetam Be Safe? A Case Report of Prolonged Accidental High-Dose Levetiracetam Administration and Review of the Literature
Authors: Kartal Ayse 
Published: July 2017

Abstract
Levetiracetam is an antiepileptic drug that has been used both as adjunctive therapy and monotherapy in pediatric patients with epilepsy. We report a patient with cerebral palsy and epilepsy who took 200 mg/kg per day of levetiracetam for 55 days with no apparent adverse effects. Four other cases of accidental overdose were found in the literature; none of these was associated with any apparent adverse effects. These findings suggest that, in at least some cases, levetiracetam doses much higher than the recommended maximum of 60 mg/kg per day can be administered without apparent adverse effects.
The Insula in Temporal Plus Epilepsy
Authors: Barba Carmen , Minotti Lorella , Job Anne-Sophie , Kahane Philippe 
Published: July 2017

Summary:
Temporal lobe epilepsy (TLE) surgery is the most common type of surgical treatment offered to patients with drug-resistant focal seizures. However, the proportion of patients experiencing long-term freedom from seizures after TLE surgery remains suboptimal. Temporal plus epilepsy, which is characterized by a primary temporal epileptogenic zone extending to neighboring regions, has been demonstrated to be a major predictor of TLE surgery failures. In the context of the temporoperisylvian epilepsies, i.e., the most common type of temporal plus epilepsy, a possible role of the insula has often been hypothesized. As this area is buried deep within the lateral sulcus, the use of invasive recordings is often required. Identifying patients with temporal plus seizures is a relevant issue, as they appear to have a worse postsurgical seizure outcome compared with patients with “pure” temporal lobe seizures. Owing to these prognostic implications, it becomes important to identify, among patients suffering from “atypical” nonlesional TLEs, those who should undergo invasive investigations, in particular to explore the insula. In fact, only a primary involvement of the insula in the epileptogenic network may require to include this area in the resection to achieve seizure freedom. Using modern neurosurgical techniques, insular epilepsy surgery has proved to be safe and beneficial, making the “true” role of the insula in TLE surgery failures more relevant to understand. Further studies are needed to evaluate the efficacy of multilobar resections in patients with temporal plus epilepsy, in particular, when eloquent or difficult to access areas such as insula are suspected to be involved.
Increased risk of many early-life diseases after surgical removal of adenoids and tonsils in childhood
Authors: Byars Sean G. , Stearns Stephen C. , Boomsma Jacobus J. 
Published: July 2017

AbstractBACKGROUNDSurgical removal of the adenoids and tonsils are common pediatric procedures, with conventional wisdom suggesting their absence has little impact on health or disease. However, little is known about long-term health consequences beyond the perioperative risks. Such ignorance is significant, for these lymphatic organs play important roles in both the development and the function of the immune system.METHODSWe tested the long-term consequences of surgery in the population of Denmark by examining risk for 28 diseases with ̴1 million individuals followed from birth up to 30 years of age depending on whether any of three common surgeries (adenoidectomy, tonsillectomy, adenotonsillectomy) occurred in the first 9 years of life. To weigh costs and benefits, we also compared the absolute risks for these diseases to the risks for the conditions that these surgeries aimed to treat. We obtained robust results by using stratified Cox regressions with statistically well-powered samples of cases (with surgery) and controls (without surgery) whose general health was no different prior to surgery. We adjusted our estimates of risk for diseases occurring before surgery, stratified for sex (and other effects) and for 18 covariates, including parental disease history and birth metrics.RESULTSWe found significantly elevated relative risks for many diseases, with effects on respiratory, allergic and infectious disorders after removal of adenoids and tonsils being most pronounced. For some of these diseases, absolute risk increases were considerable. In comparison, many risks for conditions that surgeries aimed to treat were either not significantly different or significantly higher following surgery up to 30 years of age. This suggests that any immediate benefits of these surgeries may not continue longer-term, while resulting in slightly compromised early adult health due to significantly increased risk of many non-target diseases.CONCLUSIONSOur results indicate that surgical removal of tonsils and adenoids early in life are associated with longer-term health risks. They underline the importance of these organs and tissues for normal immune functioning and early immune development, and suggest that these longer-term disease risks may outweigh the short-term benefits of these surgeries.
Effects of autozygosity and schizophrenia polygenic risk on cognitive and brain developmental trajectories
Authors: Cordova-Palomera Aldo , Kaufmann Tobias , Bettella Francesco , Wang Yunpeng , Doan Nhat Trung , Meer Dennis van der , Alnæs Dag , Rokicki Jaroslav , Moberget Torgeir , Sønderby Ida Elken , Andreassen Ole A. , Westlye Lars T. 
Published: July 2017

ABSTRACTCognitive and brain development are determined by dynamic interactions between genes and environment across the lifespan. Aside from marker-by-marker analyses of polymorphisms, biologically meaningful features of the whole-genome (derived from the combined effect of individual markers) have been postulated to inform on human phenotypes including cognitive traits and their underlying biological substrate.Here, estimates of inbreeding and genetic susceptibility for schizophrenia calculated from genome-wide data –runs of homozygosity (ROH) and schizophrenia polygenic risk score (PGRS)– are analyzed in relation to cognitive abilities (n=4183) and brain structure (n=516) in a general-population sample of European-ancestry participants aged 8-22, from the Philadelphia Neurodevelopmental Cohort.The findings suggest that a higher ROH burden and higher schizophrenia PGRS are associated with higher intelligence. Cognition~ROH and cognition~PGRS associations obtained in this cohort may respectively evidence that assortative mating influences intelligence, and that individuals with high schizophrenia genetic risk who do not transition to disease status are cognitively resilient.Neuroanatomical data showed that the effects of schizophrenia PGRS on cognition could be modulated by brain structure, although larger imaging datasets are needed to accurately disentangle the underlying neural mechanisms linking IQ with both inbreeding and the genetic burden for schizophrenia.