bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of Life and Its Predictors Among Children and Adolescents With Cancer
Authors: Pan Hsien-Ting , Wu Li-Min , Wen Shu-Hui 
Published: September 2016

Background:
Quality of life (QoL) increasingly is being assessed in pediatric patients with cancer. However, only a few studies focused on QoL predictors during and after treatment for pediatric patients with cancer.

Objective:
The aims of this study were to (1) assess differences of QoL, distress behavior, and fatigue among children and adolescents; (2) examine the relationship of distress behaviors, fatigue, and a variety of demographic factors to QoL; and (3) identify QoL predictors.

Methods:
A cross-sectional descriptive study involving 150 participants treated between 2012 and 2014 was conducted. All participants were given a diagnosis of cancer, ranged in age from 7 to 18 years, and had no developmental delay or mental illness. Three instruments including Pediatric Quality of Life, Distress Behaviors, and Multidimensional Fatigue Scale were administered.

Results:
Adolescents aged 16 to 18 years reported lower school functioning and experienced more general and sleep/rest fatigue. Fatigue and distress behaviors were associated with a poorer QoL. Diagnosis at a younger age, greater time since diagnosis, and family structure were associated with a better QoL. General fatigue, relationship distress, family structure, and time since diagnosis were significant predictors of QoL, accounting for 64% of the total variance.

Conclusions:
Factors associated with a poorer QoL included fatigue, distress behaviors, and diagnosis at an older age. Less general fatigue and relationship distress, greater time since diagnosis, and living in nuclear family predicted a better QoL.

Implications for Practice:
Routinely evaluating fatigue and school functioning in pediatric patients with cancer is warranted, as well as developing educational programs to enhance the management of fatigue and relationship issues, especially for those who were given a diagnosis recently or for late adolescents.
Is da Vinci Xi Better than da Vinci Si in Robotic Rectal Cancer Surgery? Comparison of the 2 Generations of da Vinci Systems
Authors: Ozben Volkan , Cengiz Turgut B. , Atasoy Deniz , Bayraktar Onur , Aghayeva Afag , Erguner Ilknur , Baca Bilgi , Hamzaoglu Ismail , Karahasanoglu Tayfun 
Published: September 2016

Background:
We aimed to compare perioperative outcomes for procedures using the latest generation of da Vinci robot versus its previous version in rectal cancer surgery.

Patients and Methods:
Fifty-three patients undergoing robotic rectal cancer surgery between January 2010 and March 2015 were included. Patients were classified into 2 groups (Xi, n=28 vs. Si, n=25) and perioperative outcomes were analyzed.

Results:
The groups had significant differences including operative procedure, hybrid technique and redocking (P>0.05). In univariate analysis, the Xi group had shorter console times (265.7 vs. 317.1 min, P=0.006) and total operative times (321.6 vs. 360.4 min, P=0.04) and higher number of lymph nodes harvested (27.5 vs. 17.0, P=0.008). In multivariate analysis, Xi robot was associated with a shorter console time (odds ratio: 0.09, P=0.004) with no significant differences regarding other outcomes.

Conclusions:
Both generations of da Vinci robot led to similar short-term outcomes in rectal cancer surgery, but the Xi robot allowed shorter console times.
The impact of early palliative care on the quality of care during the last days of life: what does the evidence say?
Authors: Zambrano Sofia C. , Fliedner Monica C. , Eychmüller Steffen 
Published: September 2016

Purpose of review
The aim of this review is to critically appraise the existing evidence on ‘early palliative care’ (EPC), discuss its relationship with advance care planning, and to reflect on the impact of EPC on the quality of care provided during the last days of life.

Recent findings
There are indicators that EPC may help to avoid aggressive treatment, shorten hospital stay, improve overall quality of life, and to see more frequently dying and death at the preferred place of care.

Summary
The evidence from randomized controlled trials supports the integration of palliative care early in the disease trajectory. However, in terms of outcomes and quality indicators for care in the last days of life, evidence is still lacking. Predominantly, when it comes to the outcomes which may be more difficult to assess, such as spiritual aspects, or the social network, for which more comprehensive information is needed. These outcomes should not be neglected in palliative care studies, particularly when they can provide meaningful information about patient and family adjustment, and focus on psychosocial aspects rather than physical symptom control.
Practical multimodal care for cancer cachexia
Authors: Maddocks Matthew , Hopkinson Jane , Conibear John , Reeves Annie , Shaw Clare , Fearon Ken C.H. 
Published: September 2016

Purpose of review
Cancer cachexia is common and reduces function, treatment tolerability and quality of life. Given its multifaceted pathophysiology a multimodal approach to cachexia management is advocated for, but can be difficult to realise in practice. We use a case-based approach to highlight practical approaches to the multimodal management of cachexia for patients across the cancer trajectory.

Recent findings
Four cases with lung cancer spanning surgical resection, radical chemoradiotherapy, palliative chemotherapy and no anticancer treatment are presented. We propose multimodal care approaches that incorporate nutritional support, exercise, and anti-inflammatory agents, on a background of personalized oncology care and family-centred education. Collectively, the cases reveal that multimodal care is part of everyone's remit, often focuses on supported self-management, and demands buy-in from the patient and their family. Once operationalized, multimodal care approaches can be tested pragmatically, including alongside emerging pharmacological cachexia treatments.

Summary
We demonstrate that multimodal care for cancer cachexia can be achieved using simple treatments and without a dedicated team of specialists. The sharing of advice between health professionals can help build collective confidence and expertise, moving towards a position in which every team member feels they can contribute towards multimodal care.
Analysis of Surgical Outcomes and Determinants of Litigation Among Women With Transvaginal Mesh Complications
Authors: Zoorob Dani , Karram Mickey , Stecher Anna , Maxwell Rose , Whiteside James 
Published: September 2016

Objectives
To identify litigation predictors among women with complications of transvaginal mesh.

Methods
Chart review and patient survey were conducted among women who had undergone a complication-related explant of a transvaginal prolapse or incontinence sling mesh. Trained study personnel administered a 57-question survey addressing subjective complaints related to bowel, bladder, sexual dysfunction, and development of pain or recurrent prolapse. These data were analyzed with respect to the subject's reported pursuit of litigation related to the mesh complication. Categorical and continuous variables were analyzed using the χ2 test and the t test as indicated.

Results
Ninety-five (68%) of 139 women completed the surveys with 60% of the patients pursuing litigation at the time of the survey. Individual risk factors for pursuing litigation included development of vaginal pain after mesh placement (P = 0.01); dyspareunia after mesh placement (P = 0.01); persistence of dyspareunia, suprapubic pain, and groin pain after mesh excision (P = 0.04, P = 0.02, and P = 0.001, respectively); unsuccessful attempts at conservative management of pelvic pain using pelvic floor rehabilitation (P = 0.002).

Conclusion
There is an association between a higher likelihood of pursuing litigation and new-onset or persistent pain symptoms attributable to transvaginal mesh.
Female Urethral Diverticulum: Presentation, Diagnosis, and Predictors of Outcomes After Surgery
Authors: El-Nashar Sherif A. , Singh Ruchira , Bacon Melissa M. , Kim-Fine Shunaha , Occhino John A. , Gebhart John B. , Klingele Christopher J. 
Published: September 2016

Introduction and Hypothesis
To report on clinical presentation, diagnosis, and outcomes after treatment of female urethral diverticulum (UD).

Methods
Using a record linkage system, women with a new diagnosis of UD at Mayo Clinic from January 1, 1980, through December 31, 2011, were identified. The presenting symptoms, clinical characteristics, diagnosis, and management of women presenting with UD were recorded. Outcomes after surgery were assessed using survival analysis. All statistical analyses were 2-sided and P values less than 0.05 were considered significant. Statistical analysis was done using SAS version 9.2 and JMP version 9.0 (SAS Institute Inc.).

Results
A total of 164 cases were identified. Median age at diagnosis was 46 years (range, 21–83). The most common presenting symptom was recurrent urinary tract infection (98, 59.8%), followed by urinary incontinence (81, 49.4%), dysuria (62, 37.8%), dyspareunia (37, 22.6%), and hematuria (15, 9.1%). Examination revealed vaginal mass in 55 (33.5%) of the women. A significant trend was noted toward an increase in use of both magnetic resonance imaging and computed tomography (P < 0.001) along with a progressive decrease in use of urethrogram (P < 0.001) for diagnosis of UD over the years. Among 114 women who underwent surgical treatment for UD, 14(12.3%) women presented with recurrent UD and the 5-year recurrence rate after surgery for UD was 23.4% (95% confidence interval, 13.9–37.0) and a reoperation rate of 17.0% (95% confidence interval, 8.8–30.2) at 5 years.

Conclusions
Female UD is a rare and unique condition. Clinical presentation is usually nonspecific, and magnetic resonance imaging is commonly used for confirming the diagnosis. Recurrence is not uncommon, and repeat surgical intervention might be needed.
Long-Term Effectiveness of Uterosacral Colpopexy and Minimally Invasive Sacral Colpopexy for Treatment of Pelvic Organ Prolapse
Authors: Unger Cecile A. , Barber Matthew D. , Walters Mark D. , Paraiso Marie Fidela R. , Ridgeway Beri , Jelovsek J. Eric 
Published: September 2016

Objectives
The objective of this study was to estimate rates of recurrent pelvic organ prolapse (POP) 6 years after patients underwent transvaginal uterosacral colpopexy, or laparoscopic or robotic sacral colpopexy at a large tertiary care center. We hypothesized that recurrence rates would be higher than those previously reported.

Methods
This is a retrospective study of women who underwent uterosacral colpopexy, laparoscopic, and robotic sacral colpopexy for treatment of POP between 2006 and 2012. A composite outcome for recurrent POP was defined as subjective failure (vaginal bulge symptoms), objective failure (prolapse to or beyond the hymen), or any retreatment for POP (reoperation or use of a pessary). Kaplan-Meier survival curves were generated from each patient's date of follow-up, and parametric survival modeling was used to estimate recurrent POP over 6 years. Annual estimated recurrence rates by type of colpopexy are reported using the composite and individual definitions for recurrent POP.

Results
One thousand three hundred eighty-one subjects met inclusion criteria: 983 (71.1 %) uterosacral, 256 (18.5%) laparoscopic, and 142 (11.2%) robotic colpopexies. Median (range) months to failure using composite recurrence were as follows: uterosacral, 17.1 (7.6–41); laparoscopic, 10.1 (4.7–25.1); robotic, 9.7 (1.6–17.2). By year 6 in the model, the estimated composite recurrence rates for the uterosacral colpopexy, robotic, and laparoscopic sacral colpopexy groups were 43%, 49%, and 57%, respectively.

Conclusions
Estimated recurrence rates for uterosacral ligament colpopexy, laparoscopic, and robotic sacral colpopexy may be as high as 40% to 60% 6 years after surgery.
A Prospective Observational Study of the Classification of the Perineum and Evaluation of Perineal Repair at the Time of Posterior Colporrhaphy
Authors: Christmann-Schmid Corina , Wierenga Annemijn Philine Annette , Frischknecht Eveline , Maher Christopher 
Published: September 2016

Objective
The aim of this prospective observational study was to obtain a better understanding of the anatomy and to classify the observed different perineal presentations at the time of posterior colporrhaphy and to describe specific surgical techniques used.

Methods
To classify the observed perineal findings, the Pelvic Organ Prolapse Quantification System with a newly introduced additional measurement of the perineal ridge (PR) was taken intraoperatively and postoperatively in 121 consecutive women undergoing posterior colporrhaphy. Dependent on the preoperative classification of the perineum as being normal (type 1), deficient (type 2), or with a PR (type 3), a specific surgical repair was performed for each type of perineal presentation.

Results
The perineal presentations were categorized into 3 defined groups. Type 1 (normal perineum) was seen in 40%, type 2 (deficient perineum) in 13%, and type 3 (PR) in 47%. A type 1 correlates with prior cesarean section (P = 0.29), a type 2 correlates with prior vaginal delivery (P = 0.05), and type 3 perineum with prior pelvic floor surgery (P < 0.0001). When perineal type–specific surgical techniques were performed, the perineal body length increased postoperatively in type 2 (P < 0.05), decreased in type 3 (P < 0.05), and remained unchanged in those with type 1 defects.

Conclusions
This study demonstrates that the perineal region can be clearly defined into 3 categories. The distinct perineal presentation correlates with the previous gynecological history. With a specific perineal repair at the time of posterior colporrhaphy, the perineal anatomy can be restored in the short term.
Characterizing the Bladder's Response to Onabotulinum Toxin Type A Using a Rat Model
Authors: Dieter Alexis A. , Wu Jennifer M. , Siddiqui Nazema Y. , Degoski Danielle J. , Brooks Jillene M. , Dolber Paul C. , Fraser Matthew O. 
Published: September 2016

Objectives
The aim of this study was to characterize the response of the rat bladder neuromuscular system to intramural injection of onabotulinum toxin type A (BoNT/A) over 9 weeks using in vivo cystometry (CMG) and in vitro contractility (IVC).

Methods
Chronic bladder catheters were implanted in female Sprague-Dawley rats, and either (1) BoNT/A (10 units in 20 μL saline) or (2) saline (20 μL) was injected in 5 × 4 μL doses throughout the bladder wall. At 1, 3, 6, and 9 weeks after injection, conscious restrained CMG was performed. At each time point, 25% of each group (8 BoNT/A and 4 controls) was euthanized and bladders harvested for IVC. We measured IVC in response to electric field stimulation, carbachol, and potassium chloride.

Results
In total, 47 animals were included; 31 underwent BoNT/A injection, and 16 received sham (saline). Bladder capacities did not differ significantly between groups for each time point. One week after injection BoNT/A animals exhibited significantly longer bladder contraction durations and lower voiding efficiencies compared with controls. By 3 weeks these values returned to control levels. For BoNT/A animals, contractile response to carbachol stimulation was enhanced at 3 weeks. Otherwise, there were no differences in IVC responses.

Conclusions
One week after BoNT/A injection, prolonged bladder contractions are noted in rats. This may reflect supraspinal compensation for denervation by increasing the duration of efferent drive during voiding. After 3 weeks postinjection, we observed no differences in either CMG or IVC responses suggesting either compensatory efferent sprouting, increased gap junction formation, or loss of BoNT/A effect.
National Assessment of Advancing Age on Perioperative Morbidity and Length of Stay Associated With Minimally Invasive Sacrocolpopexy
Authors: Chaudhry Zaid , Cohen Seth Ashley , Tarnay Christopher 
Published: September 2016

Objective
The aim of the study was to assess the impact of age on 30-day perioperative complications and length of stay (LOS) for minimally invasive sacrocolpopexy (MISC) using a national database.

Methods
We performed an institutional review board–exempt retrospective analysis of prospectively collected data, using the National Surgical Quality Improvement Program database to analyze MISC performed at participating hospitals from 2010 to 2013. Age was stratified into the following 5 categories: younger than 60, 60 to 64, 65 to 69, 70 to 74, and 75 years or older. Complications were tabulated on the basis of available categories and were assessed using logistic multivariate regression. Length of stay was deemed abnormal if 3 days or more.

Results
A total of 1201 patients were identified as having undergone MISC. Mean (SD) patients age was 61.3 (11.1) years. Most patients had an American Society of Anesthesiologists (ASA) class of 2 (68.3%) or an ASA class of 3 (23.6%). Older patients had a significantly higher ASA class and lower body mass index. The most common complications were urinary tract infection (3.4%), readmission (2.7%), and return to the operating room (1.5%). Urinary tract infection (P = 0.93), readmission (P = 0.38), and return to the operating room (P = 0.17) were not significantly different between age groups. Older patients did not have greater odds of having an LOS of 3 days or more versus 1 day or 0 to 2 days.

Conclusions
Returns to the operating room, readmission, and urinary tract infection were the most common adverse events and did not differ between age groups. Older patients did not have greater odds of having an increased LOS. Minimally invasive sacrocolpopexy seems to be safe among appropriately selected elderly patients.
Identifying Gaps and Inconsistencies in Urogynecologic Surgical Training of Obstetrics and Gynecology Residents
Authors: Weber LeBrun Emily E. , Asumu Hazel , Richardson Anne M. , Cooper LouAnn A. , Davis John D. 
Published: September 2016

Objective
This study aims to determine the expectations of Obstetrics and Gynecology (ObGyn) residency and Female Pelvic Medicine & Reconstructive Surgery (FPMRS) fellowship program directors (FPDs) for the independent performance of urogynecologic procedures during residency and to compare these expectations with the Council on Resident Education in Obstetrics and Gynecology (CREOG) educational objectives.

Materials and Methods
Two parallel, anonymous surveys were distributed simultaneously to all directors of accredited ObGyn residency and FPMRS fellowship programs in the United States. Respondents provided their own professional and program demographic information and indicated whether they expected their residents to independently perform 27 selected urogynecologic procedures.

Results
Among residency program directors (RPDs) and FPDs, the online survey response rate was 24.8% (n = 59) and 51.9% (n = 27), respectively. More RPDs expected residents to perform prolapse procedures with mesh, including laparoscopic sacrocolpopexy, all apical suspensions, mesh excisions, and cystotomy repairs, than FPDs. In addition, RPDs expected mastery of most urogynecologic procedures by the Post Graduate Year 3 level, whereas most FPDs did not expect independent performance of these procedures during residency at all. There were notable differences between RPDs' expectations and CREOG objectives regarding several surgical procedures. Whereas CREOG recommends independent performance of anterior and posterior repair, vaginal suspension, vaginal hysterectomy, and transobturator slings, a significant number of RPDs did not report expecting mastery of these procedures during residency. Approximately 30% of RPDs expected residents to perform open sacrocolpopexy and vesicovaginal fistula repair, whereas CREOG recommends only the understanding of these, without procedural mastery.

Conclusions
Although community needs vary by region and setting, CREOG objectives serve as the standard for resident surgical education. This study highlights the discordance between these objectives and ObGyn RDPs' reported expectations for resident performance as well as those held by FPMRS FPDs, the outcome of which reflects a misalignment in graduate medical education between RPDs and FPDs, thus hindering a clear standard for resident surgical competencies.
The Real-time fMRI Neurofeedback Based Stratification of Default Network Regulation Neuroimaging Data Repository
Authors: McDonald Amalia R , Muraskin Jordan , Van Dam Nicholas T , Froehlich Caroline , Puccio Benjamin , Pellman John , Bauer Clemens CC , Akeyson Alexis , Breland Melissa M , Calhoun Vince D , Carter Steven , Chang Tiffany P , Gessner Chelsea , Gianonne Alyssa , Giavasis Steven , Glass Jamie , Homan Steven , King Margaret , Kramer Melissa , Landis Drew , Lieval Alexis , Lisinski Jonathan , Mackay-Brandt Anna , Miller Brittny , Panek Laura , Reed Hayley , Santiago Christine , Schoell Eszter , Sinnig Richard , Sital Melissa , Taverna Elise , Tobe Russell , Trautman Kristin , Varghese Betty , Walden Lauren , Wang Runtang , Waters Abigail B , Wood Dylan , Castellanos F Xavier , Leventhal Bennett , Colcombe Stanley J , LaConte Stephen , Milham Michael P , Craddoc R Cameron 
Published: September 2016

AbstractThis data descriptor describes a repository of openly shared data from an experiment to assess inter-individual differences in default mode network (DMN) activity. This repository includes cross-sectional functional magnetic resonance imaging (fMRI) data from the Multi Source Interference Task, to assess DMN deactivation, the Moral Dilemma Task, to assess DMN activation, a resting state fMRI scan, and a DMN neurofeedback paradigm, to assess DMN modulation, along with accompanying behavioral and cognitive measures. We report technical validation from n=125 participants of the final targeted sample of 180 participants. Each session includes acquisition of one whole-brain anatomical scan and whole-brain echo-planar imaging (EPI) scans, acquired during the aforementioned tasks and resting state. The data includes several self-report measures related to perseverative thinking, emotion regulation, and imaginative processes, along with a behavioral measure of rapid visual information processing.Technical validation of the data confirms that the tasks deactivate and activate the DMN as expected. Group level analysis of the neurofeedback data indicates that the participants are able to modulate their DMN with considerable inter-subject variability. Preliminary analysis of behavioral responses and specifically self-reported sleep indicate that as many as 73 participants may need to be excluded from an analysis depending on the hypothesis being tested.
Biosynthesis of the Antibiotic Nonribosomal Peptide Penicillin in Baker’s Yeast
Authors: Awan Ali R. , Blount Benjamin A. , Bell David J. , Ho Jack C. H. , McKiernan Robert M. , Ellis Tom 
Published: September 2016

AbstractFungi are a valuable source of enzymatic diversity and therapeutic natural products including antibiotics. By taking genes from a filamentous fungus and directing their efficient expression and subcellular localisation, we here engineer the baker’s yeastSaccharomyces cerevisiaeto produce and secrete the antibiotic penicillin, a beta-lactam nonribosomal peptide. Using synthetic biology tools combined with long-read DNA sequencing, we optimise productivity by 50-fold to produce bioactive yields that allow spentS. cerevisiaegrowth media to have antibacterial action againstStreptococcusbacteria. This work demonstrates thatS. cerevisiaecan be engineered to perform the complex biosynthesis of multicellular fungi, opening up the possibility of using yeast to accelerate rational engineering of nonribosomal peptide antibiotics.