bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of Abdominal Surgery in Pregnancy Among Women Who Have Undergone Bariatric Surgery
Authors: Stuart Andrea , Källen Karin 
Published: April 2017

OBJECTIVE:
To compare the rates of abdominal surgery during pregnancy among women with previous bariatric surgery (women in the case group) and women with first-trimester body mass index (BMI) greater than 35 and no previous bariatric surgery (women in the control group).

METHODS:
We conducted a national cohort study, merging data from the Swedish Medical Birth Registry and the Swedish National Patient Registry, comparing women who had bariatric surgery from 1987 to 2011 with women in a control group with first-trimester BMI greater than 35 who had not had bariatric surgery. Primary outcome variables were diagnosis and surgical procedure codes grouped as five outcome categories: 1) intestinal obstruction, 2) gallbladder disease, 3) appendicitis, 4) hernia, and 5) diagnostic laparoscopy or laparotomy without the presence of a diagnosis or surgical code for outcomes in outcome categories 1–4. Odds ratios were computed using multivariate linear regression analysis for each separate pregnancy. For all pregnancies in a given woman, general estimating equations with robust variance estimation were used. Adjustment was made for smoking, year of delivery, maternal age, and previous abdominal surgery.

RESULTS:
During the first pregnancy after bariatric surgery, the rate of surgery for intestinal obstruction was 1.5% (39/2,543; 95% confidence interval [CI] 1.1–2.0%) in women in the case group compared with 0.02% (4/21,909; 95% CI 0.0–0.04%) among women in the control group (adjusted odds ratio [OR] 34.3, 95% CI 11.9–98.7). Similarly, the rate of diagnostic laparoscopy or laparotomy was 1.5% (37/2,542; 95% CI 1.0–1.9%) among women in the case group compared with 0.1% (18/21,909; 95% CI 0.0–0.1%) among women in the control group (adjusted OR 11.3, 95% CI 6.9–18.5).

CONCLUSION:
Bariatric surgery is associated with an increased risk of abdominal surgery during pregnancy.
Oncological Outcomes of Lateral Pelvic Lymph Node Metastasis in Rectal Cancer Treated With Preoperative Chemoradiotherapy
Authors: Ishihara Soichiro , Kawai Kazushige , Tanaka Toshiaki , Kiyomatsu Tomomichi , Hata Keisuke , Nozawa Hioaki , Morikawa Teppei , Watanabe Toshiaki 
Published: April 2017

BACKGROUND:
Oncological outcomes of lateral pelvic lymph node metastasis in rectal cancer treated with preoperative chemoradiotherapy remain to be elucidated.

OBJECTIVE:
The purpose of this study was to clarify the therapeutic effect of chemoradiotherapy on lateral pelvic lymph node metastasis, the risk factors of lateral pelvic lymph node metastasis, and oncological outcomes of lateral pelvic lymph node dissection after chemoradiotherapy.

DESIGN:
This was a nonrandomized, retrospective study.

SETTINGS:
The study was conducted at a tertiary referral university hospital.

PATIENTS:
Patients with rectal cancer treated with chemoradiotherapy and radical surgery from 2003 to 2015 (N = 222) were included.

INTERVENTIONS:
Radiation (total, 50.4 Gy in 28 fractions) with concomitant fluorouracil-based chemotherapy was administered. Lateral pelvic lymph nodes with a diameter of ≥8 mm before chemoradiotherapy were selectively dissected.

MAIN OUTCOME MEASURES:
Frequency and risk factors of lateral pelvic lymph node metastasis were examined.

RESULTS:
Lateral pelvic lymph node dissection was performed in 31 patients (14.0%), and 16 (51.6%) of these patients were pathologically diagnosed as positive for metastasis. Among the patients treated with total mesorectal excision alone (n = 191), 2 (0.9%) had recurrence in the lateral pelvic lymph node area, which was pathologically confirmed after salvage R0 resection. T category downstaging (73.3% vs 12.5%; p < 0.01) and high histological regression of the primary lesion (73.3% vs 18.8%; p < 0.01) were more frequent in patients with pathologically negative lateral pelvic lymph nodes than in those with positive lateral pelvic lymph nodes. Young age, short distance from the anal verge, and enlarged lateral pelvic lymph node before chemoradiotherapy were associated with lateral pelvic lymph node metastasis.

LIMITATIONS:
The study was limited by its retrospective nature and small study population.

CONCLUSIONS:
The incidence of lateral pelvic lymph node metastasis after chemoradiotherapy was estimated to be 8.1% (18/222). Young age, short distance from the anal verge, and enlarged lateral pelvic lymph node before chemoradiotherapy were risk factors of lateral pelvic lymph node metastasis after chemoradiotherapy.
Predictors of Anastomotic Leak in Elderly Patients After Colectomy: Nomogram-Based Assessment From the American College of Surgeons National Surgical Quality Program Procedure-Targeted Cohort
Authors: Rencuzogullari Ahmet , Benlice Cigdem , Valente Michael , Abbas Maher A. , Remzi Feza H. , Gorgun Emre 
Published: April 2017

BACKGROUND:
Elderly patients undergoing colorectal surgery have increasingly become under scrutiny by accounting for the largest fraction of geriatric postoperative deaths and a significant proportion of all postoperative complications, including anastomotic leak.

OBJECTIVE:
This study aimed to determine predictors of anastomotic leak in elderly patients undergoing colectomy by creating a novel nomogram for simplistic prediction of anastomotic leak risk in a given patient.

DESIGN:
This study was a retrospective review.

SETTINGS:
The database review of the American College of Surgeons National Surgical Quality Improvement Program was conducted at a single institution.

PATIENTS:
Patients aged ≥65 years who underwent elective segmental colectomy with an anastomosis at different levels (abdominal or low pelvic) in 2012–2013 were identified from the multi-institutional procedure-targeted database.

MAIN OUTCOME MEASURES:
We constructed a stepwise multiple logistic regression model for anastomotic leak as an outcome; predictors were selected in a stepwise fashion using the Akaike information criterion. The validity of the nomogram was externally tested on elderly patients (≥65 years of age) from the 2014 American College of Surgeons National Surgical Quality Improvement Program colectomy-targeted database.

RESULTS:
A total of 10,392 patients were analyzed, and anastomotic leak occurred in 332 (3.2%). Of the patients who developed anastomotic leak, 192 (57.8%) were men (p < 0.001). Based on unadjusted analysis, factors associated with an increased risk of anastomotic leak were ASA score III and IV (p < 0.001), chronic obstructive pulmonary disease (p = 0.004), diabetes mellitus (p = 0.003), smoking history (p = 0.014), weight loss (p = 0.013), previously infected wound (p = 0.005), omitting mechanical bowel preparation (p = 0.005) and/or preoperative oral antibiotic use (p < 0.001), and wounds classified as contaminated or dirty/infected (p = 0.008). Patients who developed anastomotic leak had a longer length of hospital stay (17 vs 7 d; p < 0.001) and operative time (191 vs 162 min; p < 0.001). A multivariate model and nomogram were created.

LIMITATIONS:
This study was limited by its retrospective nature and short-term follow-up (30 d).

CONCLUSIONS:
An accurate prediction of anastomotic leak affecting morbidity and mortality after colorectal surgery using the proposed nomogram may facilitate decision making in elderly patients for healthcare providers.
Short-term Variability of Repolarization Is Superior to Other Repolarization Parameters in the Evaluation of Diverse Antiarrhythmic Interventions in the Chronic Atrioventricular Block Dog
Authors: Bossu Alexandre , Varkevisser Rosanne , Beekman Henriette D. M. , Houtman Marien J. C. , van der Heyden Marcel A. G. , Vos Marc A. 
Published: April 2017

Abstract:
Short-term variability (STV), to quantify beat-to-beat variability of repolarization, is a surrogate parameter that reliably identifies proarrhythmic risk in preclinical models. Examples include not only the use in the chronic atrioventricular block (CAVB) dog model whereby it was developed but also in vulnerable patients with heart failure or drug-induced long QT syndrome. In the CAVB dog model, STV can specifically distinguish between safe and unsafe drugs in proarrhythmic screening. Conversely, this dog model also offers the possibility to evaluate antiarrhythmic strategies in a setting of Torsades de Pointes (TdP) induction with a standard IKr inhibitor. The different antiarrhythmic interventions studied in suppression and prevention of drug-induced TdP in vivo in the CAVB dog model and in vitro in canine ventricular cardiomyocytes are described in this overview. We provide evidence that STV predicts the magnitude of antiarrhythmic effect against TdP better than other repolarization parameters in both suppression and prevention conditions. Moreover, suppression and prevention experiments revealed the same level of antiarrhythmic efficacy, whereas cellular experiments seem more sensitive in comparison with drug testing in vivo. Together, these observations suggest that STV could be used as a consistent indicator to rank efficacy of antiarrhythmic interventions in a number of conditions.
Aripiprazole Once-Monthly in the Treatment of Acute Psychotic Episodes in Schizophrenia
Authors: Ismail Zahinoor , Peters-Strickland Timothy , Miguelez Maia , Baker Ross A. , Hertel Peter , Eramo Anna , Jin Na , Perry Pamela , Sanchez Raymond , McQuade Robert D. , Kane John M. 
Published: April 2017

Abstract

Background
Long-acting injectable antipsychotics are treatment options for acute and long-term treatment of patients with schizophrenia. In a previously published 12-week randomized, double-blind, placebo-controlled clinical trial of patients with schizophrenia experiencing an acute psychotic episode, aripiprazole once-monthly 400 mg (AOM 400) produced significantly greater improvement than placebo on the primary endpoint, Positive and Negative Syndrome Scale (PANSS) total score at week 10.

Methods
To examine the efficacy of AOM 400 across a broader representation of schizophrenia symptoms, including agitation, a post hoc analysis of this trial was carried out to assess the change in PANSS Marder factor domains (positive symptoms, negative symptoms, disorganized thought, uncontrolled hostility/excitement, and anxiety/depression) and the PANSS excited component (equivalent to Marder factor domain uncontrolled hostility/excitement plus the tension item) by comparing differences in change from baseline between AOM 400 and placebo using a mixed model for repeated measures.

Results
The differences between treatment and placebo for all factors were statistically significant, with improvements seen as early as week 1 or 2, and maintained through week 12. Thus, AOM 400, supplemented with oral aripiprazole in the first 2 weeks, showed significantly greater efficacy versus placebo in acutely ill patients with schizophrenia in all 5 Marder illness domains, as well as in agitation as conceptualized by the PANSS excited component score.

Conclusions
These findings indicate that AOM 400 is efficacious across the spectrum of schizophrenia symptoms in acutely ill patients, with implications for both short-term and, by extension, long-term patient outcomes.
The Path to Advanced Practice Licensure for Clinical Nurse Specialists in Washington State
Authors: Schoonover Heather 
Published: April 2017

Purpose:
The aim of this study was to provide a review of the history and process to obtaining advanced practice licensure for clinical nurse specialists in Washington State. Before 2016, Washington State licensed certified nurse practitioners, certified nurse midwives, and certified nurse anesthetists under the designation of an advanced registered nurse practitioner; however, the state did not recognize clinical nurse specialists as advanced practice nurses. The work to drive the rule change began in 2007.

Description of the Project:
The Washington Affiliate of the National Association of Clinical Nurse Specialists used the Power Elite Theory to guide advocacy activities, building coalitions and support for the desired rule changes.

Outcome:
On January 8, 2016, the Washington State Nursing Care Quality Assurance Commission voted to amend the state's advanced practice rules, including clinical nurse specialists in the designation of an advanced practice nurse. Since the rule revision, clinical nurse specialists in Washington State have been granted advanced registered nurse practitioner licenses.

Conclusions:
Driving changes in state regulatory rules requires diligent advocacy, partnership, and a deep understanding of the state's rule-making processes. To be successful in changing rules, clinical nurse specialists must build strong partnerships with key influencers and understand the steps in practice required to make the desired changes.
Orienting and Onboarding Clinical Nurse Specialists
Authors: Garcia Mayra G. , Watt Jennifer L. , Falder-Saeed Karie , Lewis Brennan , Patton Lindsey 
Published: April 2017

Purpose:Clinical nurse specialists (CNSs) have a unique advanced practice role. This article describes a process useful in establishing a comprehensive orientation and onboarding program for a newly hired CNS.Description:The project team used the National Association of Clinical Nurse Specialists core competencies as a guide to construct a process for effectively onboarding and orienting newly hired CNSs. Standardized documents were created for the orientation process including a competency checklist, needs assessment template, and professional evaluation goals. In addition, other documents were revised to streamline the orientation process.Outcome:Standardizing the onboarding and orientation process has demonstrated favorable results. As of 2016, 3 CNSs have successfully been oriented and onboarded using the new process.Conclusion:Unique healthcare roles require special focus when onboarding and orienting into a healthcare system. The use of the National Association of Clinical Nurse Specialists core competencies guided the project in establishing a successful orientation and onboarding process for newly hired CNSs.
The Thrombolytic Effect of Diagnostic Ultrasound–Induced Microbubble Cavitation in Acute Carotid Thromboembolism
Authors: Porter Thomas R. , Xie Feng , Lof John , Powers Jeffry , Vignon Francois , Shi William , White Matthew 
Published: April 2017

Background
Acute ischemic stroke is often due to thromboembolism forming over ruptured atherosclerotic plaque in the carotid artery (CA). The presence of intraluminal CA thrombus is associated with a high risk of thromboembolic cerebral ischemic events. The cavitation induced by diagnostic ultrasound high mechanical index (MI) impulses applied locally during a commercially available intravenous microbubble infusion has dissolved intravascular thrombi, especially when using longer pulse durations. The beneficial effects of this in acute carotid thromboembolism is not known.

Materials and Methods
An oversized balloon injury was created in the distal extracranial common CA of 38 porcine carotid arteries. After this, a 70% to 80% stenosis was created in the mid common CA proximal to the injury site using partial balloon inflation. Acute thrombotic CA occlusions were created just distal to the balloon catheter by injecting fresh autologous arterial thrombi. After angiographic documentation of occlusion, the common carotid thrombosis was treated with either diagnostic low MI imaging alone (0.2 MI; Philips S5-1) applied through a tissue mimicking phantom (TMP) or intermittent diagnostic high MI stable cavitation (SC)–inducing impulses with a longer pulse duration (0.8 MI; 20 microseconds' pulse duration) or inertial cavitation (IC) impulses (1.2 MI; 20 microseconds' pulse duration). All treatment times were for 30 minutes. Intravenous ultrasound contrast (2% Definity; Lantheus Medical) was infused during the treatment period. Angiographic recanalization in 4 intracranial and extracranial vessels downstream from the CA occlusion (auricular, ascending pharyngeal, buccinator, and maxillary) was assessed with both magnetic resonance 3-dimensional time-of-flight and phase contrast angiography. All magnetic resonance images were interpreted by an independent neuroradiologist using the thrombolysis in cerebral infarction (TICI) scoring system.

Results
By phase contrast angiography, at least mild recanalization (TICI 2a or higher) was seen in 64% of downstream vessels treated with SC impulses compared with 33% of IC treated and 29% of low MI alone treated downstream vessels (P = 0.001), whereas moderate or complete recanalization (TICI 2b or higher) was seen in 39% of SC treated vessels compared with 10% IC treated and 21% of low MI alone treated vessels (P = 0.001).

Conclusions
High MI 20-microsecond pulse duration impulses during a commercial microbubble infusion can be used to recanalize acutely thrombosed carotid arteries and restore downstream flow without anticoagulants. However, this effect is only seen with SC-inducing impulses and not at higher mechanical indices, when a paradoxical reversal of the thrombolytic effect is observed. Diagnostic ultrasound–induced SC can be a nonsurgical method of dissolving CA thrombi and preventing thromboembolization.
The role ofCdx2as a lineage specific transcriptional repressor for pluripotent network during trophectoderm and inner cell mass specification
Authors: Huang Daosheng , Han Xiaoping , Yuan Ping , Ralston Amy , Sun Lingang , Huss Mikael , Mistri Tapan , Pinello Luca , Hui Ng Huck , Yuan Guocheng , Ji Junfeng , Rossant Janet , Robson Paul , Guo Guoji 
Published: April 2017

SUMMARYThe first cellular differentiation event in mouse development leads to the formation of the blastocyst consisting of the inner cell mass (ICM) and an outer functional epithelium called trophectoderm (TE). The lineage specific transcription factor CDX2 is required for proper TE specification, where it promotes expression of TE genes, and represses expression ofPou5f1(OCT4) by inhibiting OCT4 from promoting its own expression. However its downstream network in the developing early embryo is not fully characterized. Here, we performed high-throughput single embryo qPCR analysis inCdx2null embryos to identify components of the CDX2-regulated networkin vivo. To identify genes likely to be regulated by CDX2 directly, we performed CDX2 ChIP-Seq on trophoblast stem (TS) cells, derived from the TE. In addition, we examined the dynamics of gene expression changes using an inducible CDX2 embryonic stem (ES) cell system, so that we could predict which CDX2-bound genes are activated or repressed by CDX2 binding. By integrating these data with observations of chromatin modifications, we were able to identify novel regulatory elements that are likely to repress gene expression in a lineage-specific manner. Interestingly, we found CDX2 binding sites within regulatory elements of key pluripotent genes such asPou5f1andNanog, pointing to the existence of a novel mechanism by which CDX2 maintains repression of OCT4 in trophoblast. Our study proposes a general mechanism in regulating lineage segregation during mammalian development.
Thermodynamic projection of the antibody interaction network: the fountain energy landscape of binding
Authors: Prechl József 
Published: April 2017

AbstractThe complexity of the adaptive immune system in humans is comparable to that of the central nervous system in terms of cell numbers, cellular diversity and the network of interactions between components. While the application of molecular biological methods and bioinformatics has brought about an ever deepening and sharpening static description of the molecular and cellular components of the system, a unifying theoretical understanding of the laws governing the dynamics of the system is still lacking.We have recently developed a quantitative model for the description of antibody homeostasis as defined by the dimensions of antigen concentration, antigen-antibody interaction affinity and antibody concentration. In this paper we develop the concept of a novel thermodynamic representation of multiple molecular interactions in a system, the fountain energy landscape of binding. We show that the hypersurface of the binding fountain corresponds to the antibody-antigen interaction network projected onto an energy landscape defined by conformational entropy and free energy of binding. We demonstrate that thymus independent and thymus dependent antibody responses show distinct patterns of changes in the energy landscape. Overall, the binding fountain energy landscape concept allows a systems biological, thermodynamic perception of the functioning of the clonal humoral immune system.
Niche characteristics and potential distribution ofThelocactusspecies, a Mexican genus of globular cacti
Authors: Mosco Alessandro 
Published: April 2017

AbstractAimAlthough Mexican Cactaceae are a significative component of Mexican flora and have a relevant economic and ornamental value, the knowledge of the environmental factors characterising their niche is still quite incomplete. This study was aimed at defining the potential distribution and ecological niche ofThelocactusspecies.MethodsClimatic and environmental variables constraining the distribution ofThelocactusspecies were identified by means of environmental niche models (ENM) and ordination techniques, and used to generate potential distribution maps. The constructed ENMs were compared to assess the similarities of the ecological niche ofThelocactusspecies and to know if they share the same ecological niche space.ResultsThe distribution ofThelocactusspecies was mostly limited by a combination of two environmental factors, isothermality and precipitation of wettest quarter. The null hypothesis of the niche equivalency test was rejected for all paired comparisons between allThelocactusspecies except between the pairThelocactus leucacanthus-Thelocactus hastifer. The results of the niche similarity tests were quite varied, for some species pairs the niche similarities were higher than expected by chance, for others the null hypothesis was rejected, while in other species pairs niches were more similar than expected by chance, but only in one direction.Main conclusionsThe differences in habitat requirements were well documented by the significative differences in the niche ecological space as shown by the equivalency test, while the high percentage of niches that were more similar than expected by chance suggest a high degree of niche conservatism amongThelocactusspecies. The spatial predictions could serve to improve field design sampling to discover new populations, while niche characteristics could be relevant for improving preservation actions and guiding reintroduction programs for a better conservation ofThelocactusspecies.
The dynamic upper limit of human lifespan
Authors: Newman Saul , Simon Easteal 
Published: April 2017

AbstractWe respond to claims by Donget al. that human lifespan is limited below 125 years. Using the log-linear increase in mortality rates with age to predict the upper limits of human survival we find, in contrast to Donget al., that the limit to human lifespan is historically flexible and increasing. This discrepancy can be explained by Donget al.’suse of data with variable sample sizes, age-biased rounding errors, and log(0) instead of log(1) values in linear regressions. Addressing these issues eliminates the proposed 125-year upper limit to human lifespan.