bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subtotal Colectomy for Colon Cancer Reduces the Need for Subsequent Surgery in Lynch Syndrome
Authors: Renkonen-Sinisalo Laura , Seppälä Toni T. , Järvinen Heikki J. , Mecklin Jukka-Pekka 
Published: July 2017

BACKGROUND:
The risk of metachronous colorectal cancer is high after surgical resection for first colon cancer in Lynch syndrome.

OBJECTIVE:
This study aimed to examine whether extended surgery decreases the risk of subsequent colorectal cancer and improves long-term survival.

DESIGN:
This was a retrospective study.

SETTING:
Data were collected from a nationwide registry.

PATIENTS:
Two hundred forty-two Lynch syndrome pathogenic variant carriers who underwent surgery for a first colon cancer from 1984 to 2009 were included.

INTERVENTIONS:
Patients underwent standard segmental colectomy (n = 144) or extended colectomy (n = 98) for colon cancer. Patients were followed a median of 14.6 up to 25 years.

MAIN OUTCOME MEASURES:
Risk of subsequent colorectal cancer in either group, overall and disease-specific survival, and operative mortality were the primary outcomes measured.

RESULTS:
Subtotal colectomy decreased the risk of subsequent colorectal cancer (HR, 0.20; 95% CI, 0.08–0.52; p = 0.001), compared with segmental resection. Subsequent colorectal cancer decreased in MLH1 carriers. The MSH2 carriers showed no statistical difference, possibly because of their small number. Disease-specific and overall survival within 25 years did not differ between the standard and extended surgeries (82.7% vs 87.2%, p = 0.76 and 47.2% vs 41.4%, p = 0.83). The cumulative risk of subsequent colorectal cancer was 20% in 10 years and 47% within 25 years after standard resection and 4% and 9% after extended surgery. The cumulative risk of metachronous colorectal cancer was 7% within 25 years after subtotal colectomy with ileosigmoidal anastomosis. One patient died of postoperative septicemia within 30 days after segmental colectomy.

LIMITATIONS:
Data on surgical procedures were primarily collected retrospectively.

CONCLUSIONS:
Lynch syndrome pathogenic variant carriers may undergo subtotal colectomy to manage first colon cancer and avoid repetitive abdominal surgery and to reduce the remaining bowel to facilitate easier endoscopic surveillance. It provides no survival benefit, compared with segmental colon resection. See Video Abstract at http://links.lww.com/DCR/A319.
Does a Defunctioning Stoma Impair Anorectal Function After Low Anterior Resection of the Rectum for Cancer? A 12-Year Follow-up of a Randomized Multicenter Trial
Authors: Gadan Soran , Floodeen Hannah , Lindgren Rickard , Matthiessen Peter 
Published: July 2017

BACKGROUND:
Anorectal function after low anterior resection of the rectum for cancer is often impaired, and long-term outcome has not frequently been reported.

OBJECTIVE:
We evaluated anorectal function 12 years after rectal resection with regard to whether patients had a defunctioning temporary stoma at the initial rectal resection.

DESIGN:
An exploratory cross-sectional investigation of a previously randomized study population.

SETTINGS:
Twenty-one Swedish hospitals performing rectal cancer surgery during a 5-year period participated in the trial.

PATIENTS:
Patients operated on with low anterior resection for cancer were included.

INTERVENTIONS:
Patients were randomly assigned to receive or not receive a temporary defunctioning stoma.

MAIN OUTCOME MEASURES:
We evaluated anorectal function 12 years after low anterior resection in patients who were initially randomly assigned to temporary stoma or not, by means of using the low anterior resection syndrome score questionnaire, which assesses incontinence for flatus, incontinence for liquid stools, defecation frequency, clustering, and urgency. Self-perceived health status was evaluated by the EQ-5D-3L questionnaire.

RESULTS:
Eighty-nine percent (87/98) of the patients responded to the questionnaires, including 46 with and 41 without an initial temporary stoma. Patient demography was comparable between the groups. No differences regarding major, minor, and no low anterior resection syndrome categories were found between the groups. The stoma group had increased incontinence for flatus (p = 0.03) and liquid stools (p = 0.005) and worse overall low anterior resection syndrome score (p = 0.04) but no differences regarding frequency, clustering, and urgency.

LIMITATIONS:
The study was limited by its sample size (n = 98) based on a previously randomized trial population (n = 234).

CONCLUSIONS:
After low anterior resection for cancer, the incidence of the categories major, minor, and no low anterior resection syndrome were comparable in the stoma and the no-stoma groups. Incontinence for flatus and liquid stools was more commonly reported by patients who were randomly assigned to temporary stoma, as compared with those without, which may indicate an association between temporary stoma and impaired anorectal function. See Video Abstract at http://links.lww.com/DCR/A413.
Therapeutic Drug Monitoring of Gentamicin Peak Concentrations in Critically Ill Patients
Authors: Hodiamont Caspar J. , Janssen Julie M. , de Jong Menno D. , Mathôt Ron A. , Juffermans Nicole P. , van Hest Reinier M. 
Published: July 2017

Background:
Adequate gentamicin peak concentrations (Cmax) are important for optimal clinical efficacy. Within a critically ill patient, substantial variability in Cmax can occur over time, hampering the usefulness of therapeutic drug monitoring (TDM). The aim of this study was to evaluate the effect of gentamicin dosing based on Cmax after the first dose on gentamicin target attainment in critically ill patients.

Methods:
From gentamicin-treated critically ill patients, dosing information, clinical parameters, and serum concentrations were collected prospectively. A population pharmacokinetic model was developed using nonlinear mixed-effects modeling to estimate Cmax after each dose. To evaluate the usefulness of routine TDM, percentages of Cmax within (%Cther, 15–20 mg/L), above (>20 mg/L), and below (%Csubther, <15 mg/L) the therapeutic range after the first and second doses were compared. In addition, simulations were performed to evaluate the impact of TDM.

Results:
Four hundred sixteen measurements from 59 patients receiving 130 gentamicin doses were included. In the 30 patients who received >1 dose, TDM increased %Cther from 40% after a first median dose of 5.0 mg/kg to 50% after the second dose, and decreased %Csubther from 47% to 30%. Simulations using a 5 mg/kg starting dose revealed %Cther after the second dose of 28.4% without and 36.8% with TDM and %Csubther of 56.9% and 29.3%, respectively. Increasing the simulated starting dose to 6 mg/kg increased %Cther after the first dose from 27.7% to 33.5% and decreased %Csubther from 58.6% to 35.6%. TDM after a first dose of 6 mg/kg had no substantial effect on %Cther or %Csubther after the second dose.

Conclusions:
Gentamicin dosing based on Cmax after the first dose increased %Cther and decreased %Csubther, but did not result in therapeutic Cmax in half of the patients. When simulating a higher starting dose, %Csubther after the first dose decreased, and TDM showed no additional influence. These data suggest that a starting dose of 6 mg/kg should be considered and that repeated Cmax measurements are not of added value.
Brain processing of the temporal dimension of acute pain in short-term memory
Authors: Khoshnejad Mina , Roy Mathieu , Martinu Kristina , Chen Jen-I , Cohen-Adad Julien , Grondin Simon , Rainville Pierre 
Published: July 2017

AbstractThe dynamics of noxious sensation shapes pain perception, yet the memory of the temporal dimension of pain remains almost completely unexplored. Here, brain activity during the memory of pain duration was contrasted with that associated with the memory of pain intensity using functional magnetic resonance imaging and a delayed reproduction task. Participants encoded, maintained during a short delay, and reproduced (1) the “duration” of pain (ie, onset-to-offset), (2) the “dynamics” of pain (ie, evolution of pain over time), or (3) the intensity of pain (ie, control with no explicit temporal processing required). Results show that the inferior frontal gyrus/insula and adjacent striatal structures as well as the supramarginal and middle temporal gyri are activated in the duration task compared to the control intensity task. Specific examination of the memory delay of the duration task further revealed activation in the supramarginal gyrus extending to the parietal operculum (possibly SII) and primary somatosensory cortex (SI). In contrast, the memory delay of the dynamic task involved the bilateral supplementary motor area and the frontoparietal attentional network. Although SI, SII, and insula may contribute to the memory trace of pain sensation, other areas less commonly reported in pain studies are associated with time processing and may therefore contribute to the processing of temporal aspects of pain. Results further suggest a differential role of core timing regions of the brain depending on specific task instructions and attentional allocations to the single dimension of time, as compared to the joint processing of both time and intensity.
Bariatric endoscopy: state-of-the-art
Authors: Kumbhari Vivek , Hill Christine , Sullivan Shelby 
Published: July 2017

Purpose of review
This review aims to present the current state of the field, highlight recent developments, and describe the clinical outcomes of these endoscopic bariatric and metabolic procedures.

Recent findings
There are an increasing number of devices and techniques that are available for the endoluminal treatment of obesity. It is now possible to offer FDA approved endoscopic therapies for patients with BMI as high as 55 kg/m2. Although tremendous advances have been made, there is room for additional emphasis with regards to the metabolic improvements seen with these therapies, in addition to highlighting weight loss outcomes. Furthermore, for optimal outcomes, it is imperative that all endoluminal techniques are combined with at least a moderate intensity diet and lifestyle intervention for a minimum of 12 months.

Summary
This field bridges a gap between lifestyle counseling with or without pharmaceutical treatment and the most effective treatment of obesity, bariatric surgery. Owing to its minimally invasive nature, endoscopic metabolic and bariatric therapy has the potential to appeal patients who either do not qualify or do not want bariatric surgery and have not been adequately treated with medical therapy. In addition, these therapies may be beneficial early on in the onset of obesity.
Immunology of pancreatitis and environmental factors
Authors: Lee Bomi , Zhao Qinglan , Habtezion Aida 
Published: July 2017

Purpose of review
This report reviews recent aspects of pancreatitis immunology and environmental factors that link to development and progression of disease.

Recent findings
Limited human and animal model studies have recently attempted to understand immune mechanisms that lead to the pathogenesis of acute and chronic pancreatitis. Based on these studies innate immune responses emerge as critical elements in disease pathogenesis and severity of inflammation. The immune basis for environmental factors such as smoking, which are highly associated with disease progression highlight novel cross talk mechanisms between immune and nonimmune pancreatic cells such as the pancreatic stellate cells.

Summary
Better understanding of immune responses and signaling pathways are emerging as important contributors in pancreatitis development and progression. Such mechanisms are likely to offer future targetable therapies that can either halt or reverse disease progression.
Protein changes in non-LDL-lipoproteins in familial hypercholesterolemia: implications in cardiovascular disease manifestation and outcome
Authors: Badimon Lina , Padró Teresa , Cubedo Judit 
Published: July 2017

Purpose of review
Familial hypercholesterolemia, represents one of the most extreme clinical entities associated with premature coronary artery disease (CAD). However, clinical manifestation of CAD varies across cohorts and individual patients suggesting the existence of additional non-LDL factors potentially contributing to their cardiovascular burden.

Recent findings
Changes in HDL-associated proteins appear as one of the potential additional factors contributing to the cardiovascular risk in familial hypercholesterolemia. Specifically, the content of Apo M-SP1 in HDL3 has been directly associated with cholesterol efflux capacity. In addition, a coordinated decrease in the content of Apo L1 and LCAT in HDL3 has been related to the presence of corneal arcus and to bad prognosis in familial hypercholesterolemia patients after an acute ischemic event. In fact, HDL3 particles of familial hypercholesterolemia patients have diminished antioxidant and anti-inflammatory function.

Summary
The identification of the specific changes in HDL-associated proteins that contribute to the increased cardiovascular risk of familial hypercholesterolemia patients could be useful for the development of novel therapeutic targets. These novel strategies, in combination with current lipid-lowering therapies, may help to reduce the residual risk found in these patients.
Distinct Lipoprotein Curves in Normal Weight, Overweight, and Obese Children and Adolescents
Authors: Interator Hagar , Lebenthal Yael , Hoshen Moshe , Safra Inbar , Balicer Ran , Leshno Moshe , Shamir Raanan 
Published: July 2017

ABSTRACT

Objectives:
Pediatric lipoprotein curves are based on population-based samples. As obesity, may alter lipoprotein levels, cutoffs not adjusted for body mass index (BMI) are potentially inappropriate. We aimed to develop distinct serum lipid curves based on sex- and BMI-percentiles for children and adolescents.

Methods:
Cross-sectional analysis included all healthy children and adolescents (age range 2–17 years) with available serum lipid concentrations (n = 152,820 of approximately 1.2 million children and adolescents per study year). These children and adolescents were categorized according to sex- and age-stratified BMI-percentiles: 100,375 normal weight (5th–85th percentile), 26,028 overweight (85th–95th percentile) and 26,417 obese (≥95th percentile) individuals. Excluded were individuals with hyperlipidemia, gastrointestinal disease, thyroid disease and lipid-lowering medications. Lambda-Mu-Sigma, smoothed percentile lipid curves were computed.

Results:
Obese children had a lipid profile pattern throughout childhood and adolescence similar to that of normal weight subjects but with a significant upward shift in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non–high-density lipoprotein cholesterol (non-HDL-C), and triglycerides (TGs) and a downward shift in high-density lipoprotein-cholesterol (HDL-C). Obese boys had 13 mg/dL higher TC levels (P < 0.001), 11 mg/dL higher LDL-C levels, 15 mg/dL higher non-HDL-C levels, and 5 mg/dL lower HDL-C levels (P < 0.001). Obese girls had 6 mg/dL higher TC levels, 7 mg/dL higher LDL-C levels, 11 mg/dl higher non-HDL-C levels, and 6 mg/dL lower HDL-C levels (P < 0.001).

Conclusions:
Across a large, nationally representative cohort of children and adolescents, lipoprotein levels were found to vary in relation to weight status. On the basis of these findings, it is suggested that when evaluating the lipid profile in the pediatric population, in addition to sex-based curves, clinical decision making may require consideration of BMI-stratified curves.
Peroral Endoscopic Myotomy in Children With Achalasia
Authors: Miao Shijian , Wu Jie , Lu Junping , Wang Yuhuan , Tang Zifei , Zhou Ying , Huang Zhiheng , Ying Huang , Zhou Pinghong 
Published: July 2017

ABSTRACTBackground:Achalasia is a disease caused by neuromuscular dysfunction in the esophagogastric junction, with a relatively low incidence among children. Peroral endoscopic myotomy (POEM) is a new endoscopic procedure for the treatment of achalasia; however, it is rarely applied in children.Objectives:We aim to study the feasibility, safety, and effectiveness of POEM as a treatment for pediatric achalasia.Methods:A total of 21 pediatric patients (ages from 11 months to 18 years) diagnosed as having achalasia and treated with POEM from October of 2014 to October of 2016 in our hospital were included in our study. Indices such as clinical manifestations, nutritional status, Eckardt scores, high‐resolution esophageal manometric measurements, gastroduodenoscopic findings, and upper gastroenterographic findings after treatment were respectively compared with those before treatment to analyze the effectiveness and safety of POEM.Results:All of the 21 children successfully received POEM. The patients were followed up for duration ranged from 3 to 24 months. Among these children, symptoms such as vomiting and dysphagia were significantly alleviated or resolved. The Eckardt scores had an average drop of 7 points after treatment compared with those before treatment. Postoperative gastroduodenoscopy and upper gastroenterography showed that the opening of the cardiac orifice was significantly enlarged and obstruction at the lower esophagus was significantly relieved.Conclusions:POEM is a mini‐invasive technique and a promising new treatment for pediatric patients, making it worthy of further clinical research and application.
Stability of Cortisol and Cortisone in Human Breast Milk During Holder Pasteurization
Authors: van der Voorn Bibian , de Waard Marita , Dijkstra Lisette R. , Heijboer Annemieke C. , Rotteveel Joost , van Goudoever Johannes B. , Finken Martijn J.J. 
Published: July 2017

ABSTRACTHuman donor milk is the feeding of choice for preterm infants, when own mother's milk is not available. Holder pasteurization is necessary to secure the safety of donor milk, although it can affect milk quality by reduction of nutritional and bioactive components. Recently, research has focused on the potential role of breast milk glucocorticoids for infant development. At this moment, it is unknown whether pasteurization affects milk glucocorticoid levels. Therefore, we assessed whether Holder pasteurization, the most frequently used method nowadays, reduces breast milk cortisol and cortisone levels, using breast milk samples from 30 women who delivered at term. We found tight correlations between pre- and postpasteurization levels of cortisol (R2 = 0.99) and cortisone (R2 = 0.98), and good agreement in Passing and Bablok regression analysis. In conclusion, cortisol and cortisone in human term breast milk are not significantly affected by Holder pasteurization.
National Variation in the Use of Tracheostomy in Patients With Congenital Heart Disease*
Authors: Johnson Joyce T. , Marino Bradley S. , Klugman Darren , Shamszad Pirouz 
Published: July 2017

Objectives:
The postsurgical care of children with congenital heart disease may be complicated by the need for cardiorespiratory support, including tracheostomy. The variation of the use of tracheostomy across multiple pediatric cardiac surgical centers has not been defined. We describe multicenter variation in the use of tracheostomy in children undergoing congenital heart surgery.

Design:
We retrospectively analyzed a multicenter cohort.

Setting:
Pediatric Health Information Systems database retrospective cohort.

Patients:
Children less than 18 years who underwent both tracheostomy and cardiac surgery (1/04–6/14).

Interventions:
Univariate and multivariate statistics were performed, stratifying by high (≥ 75th percentile) and low (≤ 25th percentile) tracheostomy volume and adjusting for patient characteristics in multivariate models.

Measurements and Main Results:
Out of 123,510 hospitalizations involving cardiac surgery, 1,292 tracheostomies (1.2%) were performed (46 hospitals). The rate of tracheostomy placement ranged from 0.3% to 2.5% with no difference in the rate of tracheostomy placement between high and low tracheostomy use centers (p = 0.8). The median time to tracheostomy was 63 days (interquartile range, 36–100), and there was no difference between high- and low-tracheostomy centers. High-tracheostomy centers had $420,000 lower hospital charges than low-volume centers (p = 0.03). Tracheostomy day greater than the median (63 d), Risk Adjustment for Congenital Heart Surgery-1 score 6, and extracorporeal membrane oxygenation were significantly associated with adjusted increased odds of mortality. Later hospital day of tracheostomy was associated with a $13,000/d increase in total hospital charges (p < 0.001).

Conclusions:
Variation in the usage of tracheostomy in infants and children undergoing congenital heart surgery exists across the country. High-tracheostomy centers had lower hospital charges. Late tracheostomy placement, higher congenital heart disease surgical risk, and extracorporeal membrane oxygenation use are independent predictors of in-hospital mortality in this population.
Elevated Preoperative Serum Bilirubin Improves Reperfusion Injury and Survival Postliver Transplantation
Authors: Spetzler Vinzent , Goldaracena Nicolas , Kaths Johann Moritz , Marquez Max , Selzner Markus , Selzner Nazia 
Published: July 2017

Background
The cytoprotective effects of hemeoxygenase-1 and its product biliverdin/bilirubin are widely acknowledged in experimental transplant medicine. However, its potentially beneficial effect during organ reperfusion is not established.

Methods
In a matched study, we compared markers of reperfusion injury (alanine aminotransferase/aspartate aminotransferase) and transplantation outcome (complication rates, liver function, and survival) between recipient groups with “normal” versus “increased” preoperative bilirubin values. Groups were matched for donor and recipient age, liver disease, year of transplantation, and recipient’s preoperative condition (modified model for end-stage liver disease score excluding bilirubin).

Results
The postoperative transaminase peak was significantly higher when comparing the “normal” to the “increased” bilirubin group (maximum aspartate aminotransferase “normal” 2013 [325-13 210] U/L vs “increased” 1360 [221-15 460] U/L, P = 0.006; maximum alanine aminotransferase “normal” 1151 [82-6595] U/L vs “increased” 820 [66-5382] U/L, P = 0.01). Grafts in the “increased” bilirubin group had faster recovery of graft function with faster decrease in international normalized ratio at days 3 and 7 posttransplantation in the “increased” vs “normal” bilirubin group. Although long-term functional parameters (international normalized ratio and bilirubin posttransplantation) as well as surgical and biliary complication rates were similar in both groups, 1-year survival rates were significantly higher in the group with increased preoperative bilirubin (graft survival, “normal” 86% vs “increased” 97%; P = 0.006).

Conclusions
Increased bilirubin levels of liver graft recipients before transplantation are associated with reduced reperfusion injury and improved survival after transplantation.