bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence of Connected Consciousness after Tracheal Intubation
Authors: Sanders Robert D. , Gaskell Amy , Raz Aeyal , Winders Joel , Stevanovic Ana , Rossaint Rolf , Boncyk Christina , Defresne Aline , Tran Gabriel , Tasbihgou Seth , Meier Sascha , Vlisides Phillip E. , Fardous Hussein , Hess Aaron , Bauer Rebecca M. , Absalom Anthony , Mashour George A. , Bonhomme Vincent , Coburn Mark , Sleigh Jamie 
Published: December 2016

Abstract

Background
The isolated forearm technique allows assessment of consciousness of the external world (connected consciousness) through a verbal command to move the hand (of a tourniquet-isolated arm) during intended general anesthesia. Previous isolated forearm technique data suggest that the incidence of connected consciousness may approach 37% after a noxious stimulus. The authors conducted an international, multicenter, pragmatic study to establish the incidence of isolated forearm technique responsiveness after intubation in routine practice.

Methods
Two hundred sixty adult patients were recruited at six sites into a prospective cohort study of the isolated forearm technique after intubation. Demographic, anesthetic, and intubation data, plus postoperative questionnaires, were collected. Univariate statistics, followed by bivariate logistic regression models for age plus variable, were conducted.

Results
The incidence of isolated forearm technique responsiveness after intubation was 4.6% (12/260); 5 of 12 responders reported pain through a second hand squeeze. Responders were younger than nonresponders (39 ± 17 vs. 51 ± 16 yr old; P = 0.01) with more frequent signs of sympathetic activation (50% vs. 2.4%; P = 0.03). No participant had explicit recall of intraoperative events when questioned after surgery (n = 253). Across groups, depth of anesthesia monitoring values showed a wide range; however, values were higher for responders before (54 ± 20 vs. 42 ± 14; P = 0.02) and after (52 ± 16 vs. 43 ± 16; P = 0.02) intubation. In patients not receiving total intravenous anesthesia, exposure to volatile anesthetics before intubation reduced the odds of responding (odds ratio, 0.2 [0.1 to 0.8]; P = 0.02) after adjustment for age.

Conclusions
Intraoperative connected consciousness occurred frequently, although the rate is up to 10-times lower than anticipated. This should be considered a conservative estimate of intraoperative connected consciousness.
Meta-Analysis of Therapeutic Hypothermia for Traumatic Brain Injury in Adult and Pediatric Patients*
Authors: Crompton Ellie M. , Lubomirova Irina , Cotlarciuc Ioana , Han Thang S. , Sharma Sapna D. , Sharma Pankaj 
Published: December 2016

Objective:
Therapeutic hypothermia has been used to attenuate the effects of traumatic brain injuries. However, the required degree of hypothermia, length of its use, and its timing are uncertain. We undertook a comprehensive meta-analysis to quantify benefits of hypothermia therapy for traumatic brain injuries in adults and children by analyzing mortality rates, neurologic outcomes, and adverse effects.

Data Sources:
Electronic databases PubMed, Google Scholar, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov and manual searches of studies were conducted for relevant publications up until February 2016.

Study Selection:
Forty-one studies in adults (n = 3,109; age range, 18–81 yr) and eight studies in children (n = 454; age range, 3 mo to 18 yr) met eligibility criteria.

Data Extraction:
Baseline patient characteristics, enrollment time, methodology of cooling, target temperature, duration of hypothermia, and rewarming protocols were extracted.

Data Synthesis:
Risk ratios with 95% CIs were calculated. Compared with adults who were kept normothermic, those who underwent therapeutic hypothermia were associated with 18% reduction in mortality (risk ratio, 0.82; 95% CI, 0.70–0.96; p = 0.01) and a 35% improvement in neurologic outcome (risk ratio, 1.35; 95% CI, 1.18–1.54; p < 0.00001). The optimal management strategy for adult patients included cooling patients to a minimum of 33°C for 72 hours, followed by spontaneous, natural rewarming. In contrast, adverse outcomes were observed in children who underwent hypothermic treatment with a 66% increase in mortality (risk ratio, 1.66; 95% CI, 1.06–2.59; p = 0.03) and a marginal deterioration of neurologic outcome (risk ratio, 0.90; 95% CI, 0.80–1.01; p = 0.06).

Conclusions:
Therapeutic hypothermia is likely a beneficial treatment following traumatic brain injuries in adults but cannot be recommended in children.
Dermatofibrosarcoma Protuberans-Like Tumor With COL1A1 Copy Number Gain in the Absence of t(17;22)
Authors: Saab Jad , Rosenthal Ian M. , Wang Lu , Busam Klaus J. , Nehal Kishwer S. , Dickson Mark A. , Hameed Meera R. , Hollmann Travis J. 
Published: December 2016

Abstract:
A 57-year-old woman presented with a 3-year history of a progressive firm plaque on the right cheek. Skin biopsies revealed a bland, storiform, spindle-cell proliferation involving the deep dermis and subcutaneous fat. By immunohistochemistry, the tumor cells were diffusely positive for CD34 and caldesmon with multifocal reactivity for epithelial membrane antigen and focal, weak staining for smooth muscle actin. Retinoblastoma protein expression was not detectable in tumor cells by immunohistochemistry. An interphase fluorescence in situ hybridization analysis for platelet-derived growth factor B (PDGFB) gene rearrangement was negative. A single-nucleotide polymorphism array study detected 1) a gain of chromosome segment 17q21.33-q25.3 which overlapped the entire COL1A1 gene with a breakpoint at 17q21.33, approximately 250 Kb centromeric to the 3′ end of COL1A1 gene, 2) several segmental gains on chromosome 11, and 3) an RB1 gene locus with normal copy number and allele frequency. Although the current case resembles dermatofibrosarcoma protuberans, it is unique in that it demonstrates a copy number gain of chromosome 17q in the absence of fusion of COL1A1 and PDGFB genes and an unusual immunohistochemical staining profile. The morphologic and molecular findings suggest a novel molecular variant of dermatofibrosarcoma protuberans not detectable with standard fluorescence in situ hybridization for PDGFB rearrangement. This variant appears to respond to imatinib after 9 months of follow-up.
Noninvasive Submental Fat Compartment Treatment
Authors: Shamban Ava T. 
Published: December 2016

Background:
KYBELLA, ATX-101, is an injectable form of sodium deoxycholic acid. It is currently the only Food and Drug Administration–approved injectable drug for the reduction of submental fat.

Objectives:
A literature review and discussion of the treatment of submental fat.

Results:
KYBELLA is a well-tolerated alternative for the treatment of submental fat.

Conclusions:
KYBELLA is a safe and efficacious, first in class, injectable drug for the reduction of submental fat.
Global Updates on the Future Directions of Neurotoxins and Fillers
Authors: Downie Jeanine B. , Patel Anup , Heningburg Jade 
Published: December 2016

Summary:
Neurotoxins and fillers continue to remain in high demand, comprising a large part of the growing business of cosmetic minimally invasive procedures. Multiple Food and Drug Administration–approved safe yet different products exist within each category, and the role of each product continues to expand. The authors review the literature to provide an overview of the use of neurotoxins and fillers and their future directions.
ASSOCIATION BETWEEN PARAFOVEAL CAPILLARY NONPERFUSION AND MACULAR FUNCTION IN EYES WITH BRANCH RETINAL VEIN OCCLUSION
Authors: Manabe Saki , Osaka Rie , Nakano Yuki , Takasago Yukari , Fujita Tomoyoshi , Shiragami Chieko , Hirooka Kazuyuki , Muraoka Yuki , Tsujikawa Akitaka 
Published: December 2016

Purpose:
To investigate the parafoveal perfusion status of the superficial and deep capillary layer in eyes with resolved branch retinal vein occlusion, and to study its effects on retinal sensitivity.

Methods:
In 27 enrolled eyes (27 patients) with resolved branch retinal vein occlusion, superficial and deep capillaries in the macular area (3- × 3-mm, centered on the fovea) were examined with optical coherence tomography angiography. Retinal sensitivity was examined with fundus-monitored microperimetry.

Results:
Optical coherence tomography angiography clearly showed the parafoveal superficial and deep capillaries individually. On the affected side of retina, 25 eyes (92.6%) showed capillary nonperfusion; 23 (85.2%) in the superficial layer and 22 (81.5%) in the deep layer. Capillary nonperfusions of both layers frequently overlapped and appeared to be connected with each other. Mean (±SD) retinal sensitivity at the superficial capillary nonperfusion was 19.2 ± 6.3 dB, significantly lower than that at the superficial capillary perfusion (24.4 ± 2.8 dB, P < 0.001). Similarly, mean retinal sensitivity at the deep capillary nonperfusion was 20.8 ± 5.0 dB, significantly lower than that at deep capillary perfusion (24.3 ± 2.8 dB, P = 0.0016). Mean retinal sensitivity with superficial capillary nonperfusion was significantly lower than that with deep capillary nonperfusion (P = 0.0226).

Conclusion:
Optical coherence tomography angiography visualized parafoveal capillary nonperfusion in superficial and deep layers individually in eyes with resolved branch retinal vein occlusion. Retinal sensitivity was significantly reduced at these capillary nonperfusions.
Age-Stratified Analysis of Diabetes and Pseudophakia Effects on Corneal Endothelial Cell Density: A Retrospective Eye Bank Study
Authors: Chen Yicheng , Tsao Sean W. , Heo Moonseong , Gore Patrick K. , McCarthy Mitchell D. , Chuck Roy S. , Channa Prabjot 
Published: December 2016

Purpose:
To perform an age-stratified analysis of the effect of diabetes and pseudophakia on corneal endothelial cell density (ECD).

Methods:
This is a comparative analysis of donor characteristics from data supplied by the Lions Eye Institute for Transplant and Research on tissue harvested from July 1, 2007, through May 23, 2014. The mixed-effects model was used to compare age-adjusted mean corneal ECD between donors with and without diabetes.

Results:
A total of 20,026 nondiabetic donor eyes and 13,617 diabetic donor eyes were included in this study. ECD was 2604 cells per square millimeter in nondiabetic corneas and 2576 cells per square millimeter in diabetic corneas (P < 0.001). Among phakic patients, diabetic ECD was significantly less in the middle-age subgroups: −33 cells per square millimeter in the 21-to-40-year-old subgroup (P = 0.048) and −25 cells per square millimeter in the 41-to-60-year-old subgroup (P = 0.009). Among pseudophakic patients, diabetic ECD was significantly less only in the subgroup 61 years or older: −56 cells per square millimeter (P = 0.026). The magnitude of difference in ECD between phakic and pseudophakic donors was greater in patients with diabetes in the subgroup 61 years or older (P < 0.001).

Conclusions:
Donor eyes with a history of diabetes had a slightly lower ECD (−29 cells/mm2) than eyes without a history of diabetes. Although this statistical relationship is consistent with our pathophysiologic understanding of diabetes and the corneal endothelium, such a minor difference in ECD would be expected to have minimal clinical impact on overall corneal endothelial function.
The Glasgow Prognostic Score at the Time of Palliative Esophageal Stent Insertion is a Predictive Factor of 30-Day Mortality and Overall Survival
Authors: Driver Robert J. , Handforth Catherine , Radhakrishna Ganesh , Bennett Michael I. , Ford Alexander C. , Everett Simon M. 
Published: December 2016

Background:
Optimizing the timing of esophageal stent insertion is a challenge, partly due to difficulty predicting survival in advanced malignancy. The Glasgow prognostic score (GPS) is a validated tool for predicting survival in a number of cancers.

Goals:
To assess the utility of the GPS in predicting 30-day mortality and overall survival postesophageal stent insertion.

Study:
Patients at a tertiary referral center who had received an esophageal stent for palliation of dysphagia were included if they had a measurement of albumin and C-reactive protein (CRP) in the week preceding the procedure (n=209). Patients with both an elevated CRP (>10 mg/L) and hypoalbuminemia (<35 g/L) were given a GPS score of 2 (GPS2). Patients with only one of these abnormalities were assigned as GPS1 and those with normal CRP and albumin were assigned as GPS0. Clinical and pathologic parameters were also collected to assess for potential confounding factors in the survival analysis.

Results:
Increasing GPS was associated with 30-day mortality; for patients with GPS0, 30-day mortality was 5% (2/43), for GPS1 it was 23% (26/114), and for GPS2 it was 33% (17/52). The adjusted hazard ratio for overall poststent mortality was 1.6 (95% confidence interval, 1.1-2.4; P=0.02) for GPS1 and 2.4 (95% confidence interval, 1.5-3.8; P<0.001) for GPS2 patients compared with GPS0.

Conclusions:
GPS is an independent prognostic factor of 30-day mortality and overall survival after esophageal stent insertion. It is a potential adjunct to clinical assessment in identifying those patients at high-risk of short-term mortality poststent.
Adherence to Surveillance Guidelines in Nondysplastic Barrett’s Esophagus
Authors: Dalal Kunal S. , Coffing Jessica , Imperiale Thomas F. 
Published: December 2016

Introduction:
Surveillance patterns in Barrett’s esophagus (BE) are not well characterized. Guidelines published between 2002 and 2008 recommended surveillance esophagogastroduodenoscopy (sEGD) at 3-year intervals for nondysplastic BE (NDBE). We assessed guideline adherence in incident NDBE in a Veterans Affairs (VA)-based study.

Methods:
At a single VA center, we identified incident cases of biopsy-confirmed NDBE between January, 2006 and December, 2008. We excluded patients aged 76 years and above and those who developed BE-associated dysplasia or cancer during follow-up. All sEGDs through October, 2014 were documented. Our primary criteria classified cases as guideline adherent if a sEGD was performed within 6 months of each expected 3-year surveillance interval; in cases with ≥2 sEGDs, 1 sEGD >6 months, and ≤1 year outside an interval was allowed if the average interval was between 2.5 and 3.5 years. Comorbidity, primary care encounters, presence of long-segment BE (LSBE), endoscopist recommendations, and Charlson comorbidity index (CCI) were assessed.

Results:
We identified 110 patients (96.4% male, 93.6% white) with mean age 58.9±8.5 years at index EGD. Median follow-up was 6.7 years (range, 3.7 to 8.6). Thirty-three (30.0%) cases were guideline adherent; 77 (70.0%) cases were nonadherent, including 52 (47.3%) with irregular surveillance and 25 (22.7%) with no surveillance. Forty cases (14 adherent) had 1 sEGD, 36 (18 adherent) had 2, 8 (1 adherent) had 3, and 1 nonadherent case had 4. Adherent cases were significantly older (61.5 vs. 57.9 y, P=0.04), and tended to have more LSBE (33.3% vs. 20.8%, P=0.16). There were no differences between adherent and nonadherent cases in annual primary care encounters (72.7% vs. 66.2%, P=0.66), CCI≥4 (15.2% vs. 15.6%, P=0.95), biopsy-positive sEGDs (75.8% vs. 76.6%, P=0.92), and any recommendation for subsequent surveillance (81.8% vs. 77.9%, P=0.65). A logistic regression model using age, CCI, and LSBE showed an independent association between adherence and older age (P=0.03).

Conclusions:
In a single-center VA cohort, sEGD of NDBE was mostly nonadherent to guidelines. Adherent cases were older at baseline with a trend toward more LSBE. A larger study is needed to identify medical and social factors associated with adherence or nonadherence to surveillance.
Creatively Improving Care Delivery
Authors: Boyle Brendan M. , Hill Ivor 
Published: December 2016

ABSTRACTThe medical community has been challenged to improve upon deficiencies in the delivery of patient care. Quality improvement methods are therefore increasingly used in everyday clinical practice. As demonstrated in this review, creative and impactful improvement projects within pediatric gastroenterology can be successfully achieved as either multicenter projects or single‐center efforts. Through our willingness to accept the challenge to improve, practitioners within the pediatric gastroenterology community have become leaders in using quality improvement to change practice and improve clinical outcomes.
Management of Pregnancy in Women Who Have Undergone Bariatric Surgery
Authors: Dolin Cara , Ude Welcome Akuezunkpa O. , Caughey Aaron B. 
Published: December 2016

Importance
As the problem of obesity continues to grow, more patients are choosing to undergo bariatric surgery to lose weight and treat comorbidities, such as diabetes. Of the more than 200,000 procedures performed each year, 80% are in women, many of reproductive age. Taking care of a pregnant woman who has undergone bariatric surgery requires understanding of the risks, the need for additional surveillance, and the limitations of our knowledge about how bariatric surgery affects pregnancy.

Objective
The aims of this study were to review the current literature on bariatric surgery and pregnancy and summarize the important evidence to help the obstetrician care for a pregnant woman after bariatric surgery.

Evidence Acquisition
Evidence for this review was acquired using PubMed.

Conclusions
Pregnancy after bariatric surgery is safe and may be associated with improved pregnancy outcomes; however, more research is needed to better understand how to manage pregnant women with a history of bariatric surgery.

Relevance
Obstetricians will increasingly be caring for women who have undergone bariatric surgery and subsequently become pregnant.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After participating this activity, the learner should be better able to understand the indications for bariatric surgery and how different types of bariatric procedures change gastrointestinal physiology and nutrient metabolism; appropriately counsel patients about the risks and benefits of pregnancy after bariatric surgery; and understand the importance of monitoring nutritional status and supplementation in pregnancies after bariatric surgery.
Effect of Vaginal Estrogen on Pessary Use
Authors: Dessie Sybil G. , Armstrong Katherine , Modest Anna M. , Hacker Michele R. , Hota Lekha S. 
Published: December 2016

(Abstracted from Int Urogynecol J 2016;27:1423–1429)
A simple, noninvasive, treatment option for patients with pelvic organ prolapse (POP) or stress urinary incontinence is the pessary. Serious adverse effects associated with its use, such as fistula development, fecal impaction, or hydronephrosis, are rare and almost always result from neglected pessary care.
Stress and Burnout Among Gynecologic Oncologists: A Society Of Gynecologic Oncology Evidence-Based Review and Recommendations
Authors: Cass Ilana , Duska Linda R. , Blank Stephanie V. , Cheng Georgina , duPont Nefertiti C. , Frederick Peter J. , Hill Emily K. , Matthews Carolyn M. , Pua Tarah L. , Rath Kellie S. , Ruskin Rachel , Thaker Premal H. , Berchuck Andrew , Gostout Bobbie S. , Kushner David M. , Fowler Jeff M. 
Published: December 2016

(Abstracted from Gynecol Oncol 2016;143:421–427)
Burnout in physicians is a significant problem in all fields of medicine. A 2008 survey of members of the American College of Surgeons (ACS) and a 2014 survey of members of the Society of Gynecologic Oncology (SGO) reported that physician burnout occurs in 32% to 40% of gynecologic oncologists and surgeons This article describes the risk factors responsible for burnout in gynecologic oncologists and other physicians and the consequences of burnout and explores potential solutions.
A Randomized Controlled Trial of Intramuscular Versus Vaginal Progesterone for the Prevention of Recurrent Preterm Birth
Authors: Elimian Andrew , Smith Katie , Williams Marvin , Knudtson Eric , Goodman Jean R. , Escobedo Marilyn B. 
Published: December 2016

(Abstracted from Int J Gynecol Obstet 2016;134:169–172)
Preterm birth (PTB) is responsible for most of the neonatal deaths that occur in the absence of congenital anomalies. It is also a major cause of long-term disabilities, including cerebral palsy, blindness, and deafness in childhood.
Increased Immunoglobulin G4-positive Plasma Cells in Lymphadenoma of the Salivary Gland: An Immunohistochemical Comparison Among Lymphoepithelial Lesions
Authors: Kim Jiyoon , Song Joon Seon , Roh Jong-Lyel , Choi Seung-Ho , Nam Soon Yuhl , Kim Sang Yoon , Cho Kyung-Ja 
Published: December 2016

Background:
Lymphadenoma (LA) of the salivary gland, nonsebaceous type, is an uncommon benign lymphoepithelial neoplasm. The histogenesis of the lymphoid component of LA is under debate as in Warthin’s tumor. A recent study has described immunoglobulin (Ig) class switching to IgG4 in a subset of Warthin’s tumors. The aim of this study is to evaluate IgG4 status of LA and presume the role of IgG4 status in pathogenesis of LA.

Materials and Methods:
The distribution of IgG-positive and IgG4-positive cells was compared by immunohistochemistry among 15 lymphoepithelial lesions of the salivary gland (8 LAs, 3 lymphoepithelial carcinomas, and 4 lymphoepithelial cysts). Epstein-Barr virus in situ hybridization was also performed.

Results:
IgG-positive and IgG4-positive plasma cells were observed in all cases, but to a remarkable degree (IgG4>100/hpf) in 2 of 8 LAs. The IgG4 plasma cells in LA were distributed in interfollicular areas and in the vicinity of epithelial nests. Among all cases, the mean number of IgG4 plasma cells was not correlated with the presence of germinal centers (12/15) or Epstein-Barr virus positivity (2/15).

Conclusions:
Increased IgG4 plasma cells in LA suggest involvement of an immune reaction in the pathogenesis of LA similar to Warthin’s tumor.
Expression of CAS/CSE1L, the Cellular Apoptosis Susceptibility Protein, Correlates With Neoplastic Progression in Barrett’s Esophagus
Authors: Jiang Kun , Neill Kevin , Cowden Daniel , Klapman Jason , Eschrich Steven , Pimiento José , Malafa Mokenge P. , Coppola Domenico 
Published: December 2016

Background:
Identifying the molecular switch responsible for the neoplastic progression of Barrett’s esophagus (BE) and initiation of adenocarcinoma (ADC) is clinically essential and it will have a profound impact on patient diagnosis, prognosis, and treatment. The cellular apoptosis susceptibility gene CAS/CSE1L is overexpressed in various cancers, including a rare report on esophageal ADC; however, its expression in BE neoplasia has not been addressed.

Materials and Methods:
We investigated the expression of the CAS/CSE1L protein immunohistochemically in 56 esophageal resection specimens for ADC arising in BE. For each specimen, a full representative section of the invasive ADC was selected to include, when possible, BE, low-grade dysplasia (LGD) and high-grade dysplasia (HGD). Samples were stained for CAS/CSE1L expression using a rabbit polyclonal antibody recognizing the N-terminus of human CAS/CSE1L. Protein expression levels were measured using the Allred semiquantitative scoring system. The data were evaluated using χ2 statistical analysis. Gene expression Omnibus was queried for CAS/CSE1L and BE neoplasia.

Results:
We found minimal to absent CAS/CSE1L in all BE tissue samples; however, CAS/CSE1L was upregulated in 60% of LGD and overexpressed in HGD and ADC. The results were statistically significant (P<0.05). The localization of CAS/CSE1L protein was nuclear in BE; it became nuclear and cytoplasmic in LGD and HGD, and predominantly cytoplasmic in ADC. A similar progressive increase was observed for CAS/CSE1L gene expression.

Conclusion:
These findings show changes in CAS/CSE1L during BE progression. CAS/CSE1L may represent a potential marker for dysplasia/carcinoma.