bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in Mode of Hysterectomy After the U.S. Food and Drug Administration Power Morcellation Advisory
Authors: Ottarsdottir Helga , Cohen Sarah L. , Cox Mary , Vitonis Allison , Einarsson Jon I. 
Published: May 2017

OBJECTIVE:
To evaluate the trends in mode of surgery for benign hysterectomy after the 2014 U.S. Food and Drug Administration (FDA) morcellation guidelines.

METHODS:
This is a retrospective review of all patients who underwent a hysterectomy for benign indications, specifically for leiomyomas, at Brigham and Women's Hospital from 2013 to 2015. The rates of abdominal, vaginal, laparoscopic, and robotic-assisted laparoscopic hysterectomy as well as the perioperative outcomes were compared over the study period. Analysis was performed using multivariable linear, multinomial, and logistic regression. Regression models were adjusted for potential confounders.

RESULTS:
From 2013 to 2015, 1,530 patients underwent a hysterectomy for benign indications and 639 patients underwent the procedure for the indication of uterine leiomyomas; there was a decrease in the number of hysterectomy cases in the later years. Focusing on the patients with leiomyomas alone, there was a 40–60% decreased odds of a minimally invasive procedure in 2014 or 2015 compared with 2013 [adjusted odds ratio (OR) 0.53 (0.29–0.97) in 2014 and adjusted OR 0.40 (0.22–0.74) in 2015, P=.003]. A 24% decrease in the supracervical approach to hysterectomy was also noted. Despite these trends, the majority of cases in each year were still performed in a minimally invasive fashion. The factor most strongly associated with undergoing a minimally invasive hysterectomy was having a fellowship-trained surgeon perform the procedure [adjusted OR 6.80 (3.65–12.7), P<.001]. There was no significant difference between the year of surgery and occurrence of intraoperative complications or reoperation.

CONCLUSION:
Although key perioperative outcomes remained similar, the overall rate of minimally invasive surgery declined at our institution after the FDA's recommendations. With changing practice patterns and vigilance surrounding power morcellation, gynecologic surgeons may still offer patients minimally invasive procedures with all of the accompanying advantages.
Adult Posttraumatic Reconstruction Using a Magnetic Internal Lengthening Nail
Authors: Rozbruch S. Robert 
Published: May 2017

Summary:
A new generation of internal lengthening nail is now available that has reliable remote-controlled mechanisms. This allows accurate and well-controlled distraction rate and rhythm, and early clinical results have been very positive. In this article, 2 posttraumatic cases are presented that illustrate deformity correction and lengthening using the internal lengthening nail. Surgical planning and adjuvant techniques of fixator-assisted nailing and the use of blocking screws are discussed.
The Evolution of Remote-Controlled Intramedullary Lengthening and Compression Nails
Authors: Green Stuart A. 
Published: May 2017

Summary:
The operative elongation of limbs has long been a goal of orthopaedic surgeons. Indeed, the very first external skeletal fixators, although designed for stabilization of displaced fractures, were also used to overcome the posttrauma shortening that so commonly accompanies fracture deformities.
Prospective Evaluation of Posttraumatic Stress Disorder and Depression in Orthopaedic Injury Patients With and Without Concomitant Traumatic Brain Injury
Authors: Roden-Foreman Kenleigh , Solis Jaicus , Jones Alan , Bennett Monica , Roden-Foreman Jacob W. , Rainey Evan E. , Foreman Michael L. , Warren Ann Marie 
Published: May 2017

Objectives:
Psychological morbidities after injury [eg, posttraumatic stress disorder (PTSD) and depression] are increasingly recognized as a significant determinant of overall outcome. Traumatic brain injury (TBI) negatively impacts outcomes of patients with orthopaedic injury, but the association of concurrent TBI, orthopaedic injury, and symptoms of PTSD and depression has not been examined. This study's objective was to examine symptoms of PTSD and depression in patients with orthopaedic trauma with and without TBI.

Design:
Longitudinal prospective cohort study.

Setting:
Urban Level I Trauma Center in the Southwest United States.

Patients/Participants:
Orthopaedic trauma patients older than 18 years admitted for ≥24 hours.

Main Outcome Measurements:
Questionnaires examining demographics, injury-related variables, PTSD, and depression were administered during hospitalization and 3, 6, and 12 months later. Orthopaedic injury and TBI were determined based on ICD-9 codes. Generalized linear models determined whether PTSD and depression at follow-up were associated with TBI.

Results:
Of the total sample (N = 214), 44 (21%) sustained a TBI. Those with TBI had higher rates of PTSD symptoms, 12 months postinjury (P = 0.04). The TBI group also had higher rates of depressive symptoms, 6 months postinjury (P = 0.038).

Conclusions:
Having a TBI in addition to orthopaedic injury was associated with significantly higher rates of PTSD at 12 months and depression at 6 months postinjury. This suggests that sustaining a TBI in addition to orthopaedic injury places patients at a higher risk for negative psychological outcomes. The findings of this study may help clinicians to identify patients who are in need for psychological screening and could potentially benefit from intervention.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Adult desmoid tumors: biology, management and ongoing trials
Authors: Penel Nicolas , Chibon Frédéric , Salas Sébastien 
Published: May 2017

Purpose of reviewTo summarize the current knowledge about the biology and clinical management of adult desmoid tumors.Recent findingsIn the past decade, we have learned that desmoid tumors are driven by alterations of the Wnt/APC/β-catenin pathway, sporadic desmoid tumors are associated with somatic mutations ofCTNNB1, and germline mutations of APC and somatic mutations ofCTNNB1are probably mutually exclusive. One-third of desmoid tumors are misdiagnosed; a second pathological opinion is therefore of major importance for desmoid tumor. Surgery is no longer regarded as the cornerstone of desmoid tumors; several retrospective studies have demonstrated the safety of a ‘wait and see’ policy in sporadic abdominal wall desmoid tumor. Desmoid tumors is no longer regarded as an absolute contraindication for pregnancy. At least two new investigational drugs targeting the Wnt/APC/β-catenin pathway are currently being developed.SummaryThe management of desmoid tumors requires multidisciplinary expertise by an experienced team. We must fully understand the physiopathology of the disease (factors influencing the natural history of the disease) and learn how to avoid desmoid tumors occurrence in patients with APC germline mutations, identify reliable prognostic/predictive factors and better assess the efficacy of systemic treatment.
Pharmacology of Thiopurine Therapy in Inflammatory Bowel Disease and Complete Blood Cell Count Outcomes: A 5-Year Database Study
Authors: Meijer Berrie , Wilhelm Abraham J. , Mulder Chris J. J. , Bouma Gerd , van Bodegraven Adriaan A. , de Boer Nanne K. H. 
Published: May 2017

Background:
Thiopurines are the prerequisite for immunomodulation in inflammatory bowel disease (IBD) therapy. When administered in high (oncological) dose, thiopurine metabolites act as purine antagonists, causing DNA-strand breakage and myelotoxicity. In lower IBD dosages, the mode of action is primarily restricted to anti-inflammatory effects. Then, myelosuppression and hepatotoxicity are the most common adverse events of thiopurines. The aim of this study was to assess the effect of thiopurine metabolites on hematologic and hepatic parameters and to determine which patient characteristics are related to generation of thiopurine metabolites.

Methods:
The authors scrutinized the therapeutic drug monitoring database of the VU University medical center and subsequently merged this database with the Clinical Laboratory database of our hospital covering the same time period (2010–2015).

Results:
The authors included 940 laboratory findings of 424 unique patients in this study. Concentrations of 6-thioguanine nucleotides (6-TGN) correlated negatively with red blood cell count, white blood cell count, and neutrophil count in both azathioprine (AZA) and mercaptopurine users. There was a positive correlation with mean corpuscular volume. In patients using 6-thioguanine, 6-TGN concentrations correlated positively with white blood cell count. Furthermore, there was an inverse correlation between patient's age and 6-TGN concentrations in patients using AZA or 6-thioguanine, and we observed an inverse correlation between body mass index and 6-TGN concentrations in patients using AZA or mercaptopurine. No relations were observed with liver test abnormalities.

Conclusions:
Thiopurine derivative therapy influenced bone marrow production and the size of red blood cells. Age and body mass index were important pharmacokinetic factors in the generation of 6-TGN.
Outcomes for Ab Interno Bleb Revision With a Novel Translimbal Sclerostomy Spatula
Authors: Grover Davinder S. , Fellman Ronald L. 
Published: May 2017

Purpose:
To report outcomes for a novel ab interno bleb revision technique and spatula.

Patients and Methods:
This is a retrospective chart review.

Results:
A total of 21 eyes of 21 patients underwent ab interno bleb revision with the Grover-Fellman biplanar sclerostomy spatula. Mitomycin C was given at least 1 week preoperation. The mean age of the patients and blebs were 67 and 6.75 years, respectively. The mean follow-up is 10.6 months (range: 3 to 17 mo). Mean preoperative intraocular pressure (IOP) (SD) was 21.9 (9.1) mm Hg on 3.7 (1.2) glaucoma medications. At 12 months follow-up, the mean IOP was 12.1 mm Hg on 0.86 medications. Four eyes failed due to uncontrolled IOP needing a tube shunt. One eye failed due to uncontrolled IOP but was lost to follow-up before a tube shunt could be performed. All failures occurred within 3 months. Two eyes had an IOP of <5 mm Hg after 1 month with no evidence of hypotony maculopathy. These cases resolved after 3 months without surgical intervention. All successful cases had blebs that were low, diffuse, and posterior.

Conclusions:
After a failed filtration surgery, a low-diffuse bleb was reestablished by pretreating with subconjunctival mitomycin C followed by ab interno bleb revision with the Grover-Fellman biplanar sclerostomy spatula, decreasing further more invasive glaucoma procedures.
Obesity/Bariatric Surgery and Crohn’s Disease
Authors: Korelitz Burton I. , Sonpal Niket , Schneider Judy , Swaminath Arun , Felder Joseph , Roslin Mitchell , Aronoff Jeffrey 
Published: May 2017

Background:
Crohn’s disease (CD) following bariatric surgery has been previously described. It is not clear whether the clinical entity is due to rapid metabolism of fat, change in the bacterial milieu of the bowel, the loss of defense mechanisms of the stomach, or even a coincidence.

Objectives:
To present observations which might serve to sort out these various etiologies.

Design:
We present 5 cases of colitis, ileocolitis or enteritis, some with fistula formation, with clinical onset following bariatric surgery and add these to the 7 cases previously identified as CD reported elsewhere. We provide the clinical features of these 12 cases to reconcile with causative mechanisms.

Limitations:
It remains possible that the onset of CD (or other inflammatory bowel disease) precedes the bariatric surgery which then accelerates the clinical manifestations described. Furthermore, without controls the association could remain a coincidence.

Conclusions:
We review the evidence for release of proinflammatory cells and cytokines contained in fat following the bariatric surgery, and also consider the roles that the surgical resection of stomach and shortening of the bowel may also bring about this syndrome. The earlier onset is more likely due to surgical loss of defenses of the stomach and the later onset to a metabolic alteration of the presurgical obesity, involving fat metabolism, and/or the microbiome. The role of characteristic creeping fat of CD is also addressed.
Systematic Review
Authors: Gibson Philippa S. , Lang Sarah , Dhawan Anil , Fitzpatrick Emer , Blumfield Michelle L. , Truby Helen , Hart Kathryn H. , Moore J. Bernadette 
Published: May 2017

ABSTRACTObjectives:The aim of the study was to evaluate efficacy of nutrition and physical activity interventions in the clinical management of paediatric nonalcoholic fatty liver disease. The prevalence of paediatric nonalcoholic fatty liver disease continues to rise alongside childhood obesity. Weight loss through lifestyle modification is currently first‐line treatment, although supplementation of specific dietary components may be beneficial.Methods:Medline, CINAHL, EMBASE, Scopus, and Cochrane Libraries were systematically searched to identify randomized controlled trials assessing nutritional and physical activity interventions. Primary outcome measures were changes to liver biomarkers assessed by imaging, histology, or serum liver function tests. Study quality was evaluated using the American Dietetic Association Quality Criteria Checklist.Results:Fifteen articles met eligibility criteria investigating nutritional supplementation (vitamin E [n = 6], probiotics [n = 2], omega‐3 fatty acids [n = 5]), dietary modification (low glycaemic load [n = 1] and reducing fructose intake [n = 1]). No randomized controlled trials examining physical activity interventions were identified. Vitamin E was ineffective at improving alanine transaminase levels, whereas omega‐3 fatty acids decreased hepatic fat content. Probiotics gave mixed results, whereas reduced fructose consumption did not improve primary outcome measures. A low glycaemic load diet and a low‐fat diet appeared equally effective in decreasing hepatic fat content and transaminases. Most studies were deemed neutral as assessed by the American Dietetic Association Quality Criteria Checklist.Conclusions:The limited evidence base inhibits the prescription of specific dietary and/or lifestyle strategies for clinical practice. General healthy eating and physical activity guidelines, promoting weight loss, should remain first‐line treatment until high‐quality evidence emerges that support specific interventions that offer additional clinical benefit.
Differentiation Between Crohn Disease and Intestinal Tuberculosis in Children
Authors: Singh Sumit K. , Srivastava Anshu , Kumari Niraj , Poddar Ujjal , Yachha Surender K. , Pandey Chandra M. 
Published: May 2017

ABSTRACTObjectives:The aim of the study was to evaluate clinical, endoscopic, radiologic, and histopathological features helpful in differentiating Crohn disease (CD) from intestinal tuberculosis (ITB) in children.Methods:Patients diagnosed to have CD or ITB based on standard recommended criteria were enrolled. Children with inflammatory bowel disease unclassified or suspected ITB or CD with incomplete work‐up or lost to follow‐up were excluded. The clinical and laboratory (radiology, endoscopy, and histology) details of children were analyzed.Results:Twenty cases of ITB (14 [3–17] years) and 23 of CD (11 [1–17] years) were enrolled. Presentation with chronic diarrhea (82% vs 40%; P = 0.006) and blood in stool (74% vs 10%; P = 0.001) favored CD, whereas subacute intestinal obstruction (20% vs 0%; P = 0.04) and ascites (30% vs 0%; P = 0.005) favored ITB. Presence of deep ulcers (61% vs 30%; P = 0.04), longitudinal ulcers (48% vs 15%; P = 0.02), involvement of multiple colonic segments (70% vs 35%; P = 0.02), left‐sided colon (87% vs 40%; P = 0.003), extraintestinal manifestations (21.7% vs 0%; P = 0.02), and higher platelet count (3.9 vs 2.6 × 105/mm3; P = 0.02) favored CD. Isolated ileocecal involvement (40% vs 8.7%; P = 0.03) was a feature of ITB. TB bacilli were demonstrated in 40% ITB cases (colon‐6, ascites‐1, abdominal lymph node‐1). On multivariate analysis, presence of blood in stool (odds ratio: 37.5 [confidence interval: 3.85–365.72], P = 0.002) and left‐sided colonic involvement (odds ratio: 16.2 [confidence interval: 1.63–161.98], P = 0.02) were independent predictors of CD.Conclusions:Microbiologic confirmation of tuberculosis is possible in 40% ITB cases. Presence of blood in stool and left‐sided colonic involvement are the most important features favoring CD.
Closer Look at the Nutritional Outcomes of Patients After Primary Repair of Congenital Diaphragmatic Hernia
Authors: Vu Lan T. , McFarland Carrie , Bratton Barbara , Lee Hanmin 
Published: May 2017

ABSTRACTObjectives:We hypothesize that the patients after primary repair of congenital diaphragmatic hernia (CDH) can have poor nutritional outcomes and plan to identify risk factors to further stratify these patients.Methods:Retrospective cohort of patients who had primary repair of CDH between 2000 and 2014 and had follow‐up at our institution. Z scores (weight for age and weight for length) were calculated using the World Health Organization and Centers for Disease Control and Prevention growth standards.Results:For the 67 patients in the cohort, the median age at the time of repair was 3 days (interquartile range 2–5) and at the time of discharge was 20.5 days (interquartile range 16–30). Fifteen percent of the patients required supplemental tube feeding for inadequate oral intake and 69% required fortified feedings for inadequate growth at discharge (4 patients subsequently needed gastrostomy tube placement). The median z scores at discharge were −1.0 (−2.1 to −0.3) and −1.2 (−2.3 to −0.5) in weight for age and weight for length, respectively. The risk factors for low z scores included open repair and longer periods of postoperative intubation or hospitalization. The z scores were similar at 6 months of age compared to discharge, but then statistically improved at 12 months of age.Conclusions:Patients with primary repair of CDH are at risk for poor nutritional outcomes at the time of hospital discharge and require follow‐up to ensure adequate growth. Patients at highest risk are those who had an open repair and had prolonged intubation or hospitalization.
Fluid Overload and Cumulative Thoracostomy Output Are Associated With Surgical Site Infection After Pediatric Cardiothoracic Surgery
Authors: Sochet Anthony A. , Nyhan Aoibhinn , Spaeder Michael C. , Cartron Alexander M. , Song Xiaoyan , Klugman Darren , Brown Anna T. 
Published: May 2017

Objectives:
To determine the impact of cumulative, postoperative thoracostomy output, amount of bolus IV fluids and peak fluid overload on the incidence and odds of developing a deep surgical site infection following pediatric cardiothoracic surgery.

Design:
A single-center, nested, retrospective, matched case-control study.

Setting:
A 26-bed cardiac ICU in a 303-bed tertiary care pediatric hospital.

Patients:
Cases with deep surgical site infection following cardiothoracic surgery were identified retrospectively from January 2010 through December 2013 and individually matched to controls at a ratio of 1:2 by age, gender, Risk Adjustment for Congenital Heart Surgery score, Society of Thoracic Surgeons—European Association for Cardiothoracic Surgery category, primary cardiac diagnosis, and procedure.

Interventions:
None.

Measurements and Main Results:
Twelve cases with deep surgical site infection were identified and matched to 24 controls without detectable differences in perioperative clinical characteristics. Deep surgical site infection cases had larger thoracostomy output and bolus IV fluid volumes at 6, 24, and 48 hours postoperatively compared with controls. For every 1 mL/kg of thoracostomy output, the odds of developing a deep surgical site infection increase by 13%. By receiver operative characteristic curve analysis, a cutoff of 49 mL/kg of thoracostomy output at 48 hours best discriminates the development of deep surgical site infection (sensitivity 83%, specificity 83%). Peak fluid overload was greater in cases than matched controls (12.5% vs 6%; p < 0.01). On receiver operative characteristic curve analysis, a threshold value of 10% peak fluid overload was observed to identify deep surgical site infection (sensitivity 67%, specificity 79%). Conditional logistic regression of peak fluid overload greater than 10% on the development of deep surgical site infection yielded an odds ratio of 9.4 (95% CI, 2–46.2).

Conclusions:
Increased postoperative peak fluid overload and cumulative thoracostomy output were associated with deep surgical site infection after pediatric cardiothoracic surgery. We suspect the observed increased thoracostomy output, fluid overload, and IV fluid boluses may have altered antimicrobial prophylaxis. Although analysis of additional pharmacokinetic data is warranted, providers may consider modification of antimicrobial prophylaxis dosing or alterations in fluid management and diuresis in response to assessment of peak fluid overload and fluid volume shifts in the immediate postoperative period.
Effect of Family Presence on Advanced Trauma Life Support Task Performance During Pediatric Trauma Team Evaluation
Authors: O'Connell Karen J. , Carter Elizabeth A. , Fritzeen Jennifer L. , Waterhouse Lauren J. , Burd Randall S. 
Published: May 2017

Importance
In many hospitals, family members are separated from their children during the early phases of trauma care. Including family members during this phase of trauma care varies by institution and is limited by concerns for adverse effects on clinical care.

Objective
The aim of this study is to evaluate the effect of family presence (FP) on advanced trauma life support primary and secondary survey task performance by pediatric trauma teams. We hypothesized that trauma care with FP would be noninferior to care when families were absent.

Design
We performed a retrospective video review of consecutive pediatric trauma evaluations. Family presence status was determined by availability of the family.

Setting
The study was conducted at an American College of Surgeons–designated level I pediatric trauma center that serves the Washington, DC, metropolitan area.

Participants
Participants included patients younger than 16 years of age who met trauma activation criteria and were evaluated by the trauma team in our emergency department.

Outcome Measures
We compared task performance between patients with and without FP.

Results
Video recordings of 135 trauma evaluations were reviewed. Family was present for 88 (65%) evaluations. Patients with FP were younger (mean age, 6.4 years [SD = 4.1] vs 9.0 years [SD = 4.9]; P < 0.001) and more likely to have sustained blunt injuries (95% vs 85%, P = 0.03). Noninferiority of frequency and timeliness of completion of all primary survey tasks were confirmed for evaluations with FP. Noninferiority of frequencies of secondary survey task completion was confirmed for most tasks except for examination of the neck, pelvis, and upper extremities. Family members did not directly interfere with patient care in any case.

Conclusions
Performance of most advanced trauma life support tasks during pediatric trauma evaluation was not worsened by FP. Our data provide additional evidence supporting FP during the acute management of injured children.