bluuebunny/crossref_metadata_2025_split huggingface dataset:
Histopathology of Pouch and Para-Pouch Inflammatory and Neoplastic Disorders
Authors: Ballentine Samuel , Lee Hwajeong , Liu Xiuli 
Published: July 2022

BACKGROUND:
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is used to treat patients with ulcerative colitis or familial adenomatous polyposis who need colectomy. While this procedure substantially improves patient’s quality of life and reduces cancer risk, it is associated with a variety of sequelae‚ including surgical complications, inflammatory disorders, and neoplasia. Pouchitis, cuffitis, and Crohn’s disease of the pouch are the most common inflammatory disorders of the pouch and para-pouch.

OBJECTIVE:
This study aimed to elaborate on the histopathology of common inflammatory and neoplastic disorders of the pouch and para-pouch.

DATA SOURCES:
A Medline search for English language studies published between 1981 and 2021 using the PubMed search engine. The terms “ileal pouch-anal anastomosis,” “pouchitis,” “pouchitis activity score,” “secondary pouchitis,” “Crohn’s disease of the pouch,” “Crohn’s-like conditions of the pouch,” “pre-pouch ileitis,” “cuffitis,” “pouch adenocarcinoma,” and “pouch neoplasia” were used.

STUDY SELECTION:
The published human studies that reported histopathology of common inflammatory and neoplastic disorders of the ileal pouch were selected and reviewed.

CONCLUSIONS:
Histologic examination plays an essential role in confirming inflammation in pouchitis, identifying etiology and clues for secondary pouchitis, and diagnosing neoplasia. A standardized, simple, and reproducible histologic grading system for pouchitis is needed. Pouch and para-pouch glandular dysplasia diagnosis is challenging and should always be reviewed by at least one gastrointestinal pathologist.
Construction of J-Pouch and S-Pouch
Authors: Justiniano Carla F. , Hull Tracy L. 
Published: July 2022

BACKGROUND:
Pelvic pouch surgery evolved under the late Dr. Victor Fazio’s influence.

OBJECTIVE:
To describe construction of J- and S-pouches according to Fazio’s teachings.

TECHNICAL POINTS:
There are several key points to consider for pelvic pouch construction, starting with the decision of performing a 2- or 3-stage procedure and handling of the rectal stump. At time of pouch construction, ileal reach must be assessed early in the operative course and mesenteric lengthening maneuvers are deployed as warranted. If these maneuvers still do not allow sufficient length, alternatives include an S-pouch, longer rectal stump/anal transition zone, or returning to the operating room at a later date. The rectum is then mobilized sufficiently to allow a straight stapler firing to avoid outlet obstruction from impinged nearby tissues. The 15-20-cm pouch is constructed ensuring its staple lines are straight, staple line bleeding is addressed, the tip of the J is closed to be as short as possible, and a leak test is performed. At the time of the anastomosis, it is crucial to keep the mesentery and pouch straight, ensure no bowel is trapped below the mesentery, confirm that anterior structures are not being incorporated into the anastomosis, and perform a leak test, adding transanal sutures as needed to repair any defects. An ileostomy is then created.

CONCLUSION:
Pouch construction is challenging. At each stage, consider the patient, who carries the ultimate risk. The end goal is a functional, long-lasting pouch.
Surgical Techniques Following Free Cartilage Grafting
Authors: Hill Sheena T. , Delost Rachel L. , Wee Corinne E. , Long Tobias C. , Bordeaux Jeremy S. , Scott Jeffrey F. 
Published: July 2022

BACKGROUND
Reconstruction of surgical defects with free cartilage grafts poses unique challenges.

OBJECTIVES
To characterize surgical techniques following free cartilage grafting.

MATERIALS AND METHODS
A literature review was performed using the Embase, PubMed Medline, Cochrane Library, ClinicalTrials.gov, and Web of Science databases from inception to May 21, 2021. Studies describing free cartilage grafts harvested from the ear or nose under local anesthesia, specifically for reconstruction of facial surgical defects, were selected for inclusion. Only surgical defects resulting from tumor resection were included.

RESULTS
In total, 34 studies involving 713 patients with 723 surgical defects met inclusion criteria. The mean age of patients was 63.3 ± 10.4 years. Free cartilage grafts were most commonly harvested from the ear (93.1%). The most common recipient site was the nose (90.3%), followed by the lower eyelid (6.7%) and ear (3.0%).

CONCLUSION
Free cartilage grafts are an effective reconstructive option for patients with deep or cartilaginous defects that have compromised structural support on the nose, ear, or eyelid.
Negative Control Exposures: Causal Effect Identifiability and Use in Probabilistic-bias and Bayesian Analyses With Unmeasured Confounders
Authors: Flanders W. Dana , Waller Lance A. , Zhang Qi , Getahun Darios , Silverberg Michael , Goodman Michael 
Published: July 2022

Background:
Probabilistic bias and Bayesian analyses are important tools for bias correction, particularly when required parameters are nonidentifiable. Negative controls are another tool; they can be used to detect and correct for confounding. Our goals are to present conditions that assure identifiability of certain causal effects and to describe and illustrate a probabilistic bias analysis and related Bayesian analysis that use a negative control exposure.

Methods:
Using potential-outcome models, we characterized assumptions needed for identification of causal effects using a dichotomous, negative control exposure when residual confounding exists. We defined bias parameters, characterized their relationships with the negative control and with specified causal effects, and described the corresponding probabilistic-bias and Bayesian analyses. We present analytic examples using data on hormone therapy and suicide attempts among transgender people. To address possible confounding by healthcare utilization, we used prior tetanus–diphtheria–pertussis (TdaP) vaccination as a negative control exposure.

Results:
Hormone therapy was weakly associated with risk (risk ratio [RR] = 0.9). The negative control exposure was associated with risk (RR = 1.7), suggesting confounding. Based on an assumed prior distribution for the bias parameter, the 95% simulation interval for the distribution of confounding-adjusted RR was (0.17, 1.6), with median 0.5; the 95% credibility interval was similar.

Conclusions:
We used dichotomous negative control exposure to identify causal effects when a confounder was unmeasured under strong assumptions. It may be possible to relax assumptions and the negative control exposure could prove helpful for probabilistic bias analyses and Bayesian analyses.
The role of telemedicine in minimally invasive gynecologic surgery
Authors: Siedhoff Matthew T. , Truong Mireille D. , Wright Kelly N. 
Published: July 2022

Purpose of review
Telemedicine has been available for decades but has had minimal use in the USA prior to the COVID-19 pandemic. We aim to educate readers on the benefits of telemedicine and provide insight from our experience to optimize care in this setting.

Recent findings
The COVID-19 pandemic ushered in a massive increase in use of telemedicine, offering several advantages with comparable clinical outcomes.

Summary
This review summarizes the recent vast expansion of telemedicine, describes the benefits specific to minimally invasive gynecologic surgery, and offers practical suggestions for maintaining a successful practice that incorporates both in-person and virtual experiences for patients, anticipating continued use of telemedicine beyond the end of the current public health emergency.
Prevention and management of vaginal cuff dehiscence: an updated review
Authors: Pinho Gabriella , Liu Ying Xin , Kim Sara , Lian Xun 
Published: July 2022

Purpose of review
Minimally invasive hysterectomy has gained popularity because of its many benefits. However, laparoscopic and robotic assisted hysterectomy have been associated with increased risk of vaginal cuff dehiscence. This review is meant to address risk management and prevention of vaginal cuff dehiscence in patients undergoing minimally invasive hysterectomy.

Recent findings
Recent findings in the literature focus on addressing modifiable risk factors in patients and on using good surgical technique to help minimize the risk of vaginal cuff dehiscence.

Summary
The focus of this review is to help surgeons identify patient risk factors and address them preoperatively and to review surgical techniques that can minimize the risk of vaginal cuff dehiscence.
Current trends in artificial intelligence in reproductive endocrinology
Authors: Bhaskar Dhananjay , Chang T. Arthur , Wang Shunping 
Published: July 2022

Purpose of review
Artificial Intelligence, a tool that integrates computer science and machine learning to mimic human decision-making processes, is transforming the world and changing the way we live. Recently, the healthcare industry has gradually adopted artificial intelligence in many applications and obtained some degree of success. In this review, we summarize the current applications of artificial intelligence in Reproductive Endocrinology, in both laboratory and clinical settings.

Recent findings
Artificial Intelligence has been used to select the embryos with high implantation potential, proper ploidy status, to predict later embryo development, and to increase pregnancy and live birth rates. Some studies also suggested that artificial intelligence can help improve infertility diagnosis and patient management. Recently, it has been demonstrated that artificial intelligence also plays a role in effective laboratory quality control and performance.

Summary
In this review, we discuss various applications of artificial intelligence in different areas of reproductive medicine. We summarize the current findings with their potentials and limitations, and also discuss the future direction for research and clinical applications.
Clinical Utility of Bronchoalveolar Lavage in Pediatric Oncology Patients
Authors: Shanthikumar Shivanthan , Colenutt Samuel , Cole Theresa , Conyers Rachel , Rozen Tom , Harrison Jo , Robinson Philip , Haeusler Gabrielle M. 
Published: July 2022

Background:
Lower airway sampling is important in the assessment of lower respiratory tract infection in children with cancer or posthematopoietic stem cell transplant and can be done via bronchoalveolar lavage (BAL). Clinicians can struggle with balancing the benefits of BAL against the risks. This study aimed to define the diagnostic and clinical utility of BAL in this population.

Methods:
A single-center retrospective review of BAL performed in children with cancer or posthematopoietic stem cell transplant. Data extracted included demographics, BAL method and results and antimicrobial treatment. Variables significantly associated with diagnostic yield, diagnostic impact (confirmation or exclusion of infection), and clinical impact (any change in antimicrobial or nonantimicrobial therapy) were assessed in both univariate and multivariate analysis.

Results:
Seventy-three BAL episodes were included. In 26 (35.6%) episodes, a pathogen was identified on BAL. Forty-nine (67%) BAL episodes had a diagnostic impact and 15 (21%) had a clinical impact. Late BAL (>72 hours) compared with early BAL (odds ratio 3.27; 95% CI: 1.03–10.86), and flexible bronchoscopy compared with nonbronchoscopic lavage (odds ratio 6.10; 95% CI: 1.90–24.0), were more likely to have a diagnostic impact on multivariate analysis. No associations were found for clinical impact.

Conclusions:
One-third of BAL episodes identified a pathogen, two-thirds had a diagnostic impact, and almost a quarter of episodes impacted antimicrobial prescribing. The method and timing of BAL may be important, with flexible bronchoscopy 6-fold more likely and late BAL 3-fold more likely to have a diagnostic impact.
Impact of COVID-19 Containment Strategies and Meningococcal Conjugate ACWY Vaccination on Meningococcal Carriage in Adolescents
Authors: McMillan Mark , Bednarz Jana , Leong Lex E.X. , Lawrence Andrew , Marshall Helen S. 
Published: July 2022

Objectives:
To examine if COVID-19 containment strategies were associated with reduced pharyngeal carriage of meningococci in adolescents. Also, to observe if carriage prevalence of meningococcal A, C, W and Y differed in meningococcal conjugate ACWY vaccinated and unvaccinated adolescents.

Design:
Repeat cross-sectional study of pharyngeal carriage.

Setting:
In 2020, recruitment commenced from February to March (pre-COVID-19) and recommenced from August to September (during COVID-19 measures) in South Australia.

Participants:
Eligible participants were between 17 and 25 years of age and completed secondary school in South Australia in 2019.

Results:
A total of 1338 school leavers were enrolled in 2020, with a mean age of 18.6 years (standard deviation 0.6). Pharyngeal carriage of disease-associated meningococci was higher during the COVID-19 period compared with the pre-COVID-19 period (41/600 [6.83%] vs. 27/738 [3.66%]; adjusted odds ratio [aOR], 2.03; 95% CI: 1.22–3.39; P = 0.01). Nongroupable carriage decreased during COVID period (1.67% vs. 3.79%; aOR, 0.45; 95% CI: 0.22–0.95). Pharyngeal carriage of groups A, C, W and Y was similar among school leavers vaccinated with meningococcal conjugate ACWY (7/257 [2.72%]) compared with those unvaccinated (29/1081 [2.68%]; aOR, 0.86; 95% CI: 0.37–2.02; P = 0.73). Clonal complex 41/44 predominated in both periods.

Conclusions:
Meningococcal carriage prevalence was not impacted by public health strategies to reduce severe acute respiratory syndrome coronavirus 2 transmission and is unlikely to be the mechanism for lower meningococcal disease incidence. As international travel resumes and influenza recirculates, clinicians must remain vigilant for signs and symptoms of meningococcal disease. Vaccinating people at the highest risk of invasive meningococcal disease remains crucial despite containment strategies.
Suppressed serological vitamin A in patients with liver cirrhosis is associated with impaired liver function and clinical detoriation
Authors: Nagel Michael , Labenz Christian , Dobbermann Henrike , Czauderna Carolin , Wallscheid Nina Cabezas , Schattenberg Jörn M. , Wörns Marcus A. , Galle Peter R. , Marquardt Jens U. 
Published: July 2022

Background
The liver is of critical importance for the homeostasis of metabolic and immunomodulatory properties as well as the storage of vitamins, especially vitamin A. In this prospective analysis, the incidence of serological vitamin A deficiency and the association with disease severity as well as clinical complications in patients with liver cirrhosis were investigated.

Method
From May 2017 to May 2018, 159 patients with primarily alcohol-associated and non-alcoholic steatohepatitis (NASH)-associated preexisting liver cirrhosis were prospectively enrolled and vitamin A status was collected. Clinical complications and infections were followed and recorded over a period of 1-year follow-up. Selected findings were validated in an independent cohort of 44 patients.

Results
At study inclusion, 77% of patients showed decreased serological vitamin A. Suppressed vitamin A was more common in alcoholic (52 vs. 8%) and NASH-associated liver cirrhosis (16 vs. 9%) than in viral-associated liver cirrhosis. MELD score as well as Child-Pugh score were significantly associated with suppressed vitamin A (P < 0.001). The association between the degree of vitamin A suppression and liver function was confirmed in univariate and multivariate regression analysis. After 1 year of follow-up, 57 patients died and 21 patients received a liver transplant. In addition, low vitamin A levels were more commonly observed in patients with severe ascites (P = 0.001), hepatic encephalopathy (P = 0.002) and hepatorenal syndromes (P = 0.008). In addition, patients with reduced vitamin A showed an increased incidence of infections (P = 0.02), especially respiratory infections (P = 0.04).

Conclusion:
Suppressed serological Vitamin A is common in patients with liver cirrhosis and is associated with liver function. Clinical complications and infections are more frequent in patients with liver cirrhosis and vitamin A suppression.
Diverting Ileostomy in Children With Functional Constipation
Authors: Rodriguez Leonel , Colliard Kitzia , Nurko Samuel , Flores Alejandro , Buchmiller Terry L. 
Published: July 2022

Objectives:Pediatric functional constipation (FC) may require invasive evaluations [like colon manometry (CM)] and surgical interventions [including diverting ostomy (DO)]. We evaluated the utility of CM in guiding surgery after DO.Methods:Children with medically refractory FC undergoing an ostomy were included. Institutional Review Board approval was obtained for this retrospective study. Demographics and CM variables [high amplitude propagating contractions (HAPCs)] were recorded. Outcome measures: response to ostomy closure defined as successful if no need for further surgery after ostomy closure, and improvement on baseline CM after ostomy. A CM‐guided ostomy closure algorithm was developed based on previous studies. We evaluated the association between response to ostomy closure and demographics, ostomy indication and CM improvement, and evaluated the role of CM predicting response using algorithm.Results:A total of 60 children underwent ostomy for FC (median age: 7.1 years, range 0.15–23.6 years, 50% female). Ostomy was closed in 30 patients and deemed successful in 23 of 30. CM was performed in 42 of 60 patients before ostomy and in 29 of 30 before ostomy closure. We found no association between ostomy outcome and age, gender, weight, imaging studies, follow‐up time, time with ostomy, HAPCs, and CM improvement. We found an association between failed response and ostomy indication of antegrade colonic enemas (ACE) failure (P = 0.026) and successful response when ostomy closure was guided by algorithm (P = 0.03).Conclusions:DO is a useful intervention in selected children with medically refractory FC, improving colon motility in most. CM can successfully guide the timing and type of ostomy closure. Larger studies are needed to further validate our findings.
Subtyping of Eosinophilic Esophagitis Based on Disease Presentation in a pediatric Cohort
Authors: Sessions Julia , Purington Natasha , McGhee Sean , Bass Dorsey , Wang Yiwen , Goyal Alka , Khavari Nasim 
Published: July 2022

Objective:Eosinophilic esophagitis (EoE) is an immune-mediated inflammatory disease characterized by eosinophilic infiltration of esophageal tissue. Subtyping of EoE patients could be useful in predicting therapeutic response. We propose clinical subtypes, apply them to our pediatric EoE population retrospectively, and assess therapy choices and remission at one year.Methods:A retrospective chart review of pediatric patients diagnosed with EoE was conducted. Patients were grouped into proposed subtypes (severe, allergic, fibrostenotic, inflammatory, unclassified) based on presenting characteristics. The primary outcome was histologic remission, which was defined <15 eosinophils/high-powered-field (hpf) at the closest visit 1 year postdiagnosis.Results:Subtyping was possible in 242 of 256 patients and follow-up histological data were available in 75 subjects. The majority had an overlap in phenotype with 17% severe, 77% allergic, 15% fibrostenotic, 60% inflammatory, and 5% unclassified, whereas 45% of the cohort were assigned to a unique subtype. At 1 year, 43/75 (57%) of patients achieved histologic remission, with an overall average decrease of 33 (IQR −47, −12) eosinophils/hpf across the entire cohort. There was no difference in remission rates among subtypes. First-line therapy review revealed higher rates of proton pump inhibitor (PPI) ± topical steroids utilization in severe patients, while topical steroids were prescribed preferentially over dietary therapy in the fibrostenotic subtype.Conclusion:There were no observed differences in remission rates at 1 year among clinically defined subtypes of EoE, although this could be attributed to overlapping subtypes. Most patients responded well to medical therapy. Larger scale prospective studies designed to subtype patients and protocolize treatment may help personalize the approach to EoE management.
Functional Nasal Surgery
Authors: Avashia Yash J. , Glener Adam D. , Marcus Jeffrey R. 
Published: July 2022

Learning Objectives:
After studying this article, the participant should be able to: (1) understand the functional significance of nasal anatomy as it relates to rhinoplasty and perform a comprehensive functional nasal assessment. (2) Identify the anatomical level of obstruction based on the authors’ algorithmic approach and understand the current evidence supporting operative techniques for correcting nasal airway obstruction from septal deformity, inferior turbinate hypertrophy, internal nasal valve collapse, external nasal valve collapse. (3) Understand the current evidence supporting operative techniques for correcting nasal airway obstruction from septal deformity, inferior turbinate hypertrophy, internal nasal valve collapse, and external nasal valve collapse. (4) Appreciate the objective assessment tools for functional nasal surgery from a clinical and research perspective.

Summary:
The intent of functional rhinoplasty is to improve nasal airflow (and the perception thereof) by surgically correcting the anatomical sources of obstruction in the nasal airway. Cosmetic and functional rhinoplasty are not mutually exclusive entities, and the techniques that address one area, inevitably may affect the another. The rate of functional problems after cosmetic rhinoplasty range from 15 to 68 percent with nasal airway obstruction found to be the most common indication for secondary surgery. The objective of this CME article is to provide readers with an understanding of the (1) functional components of nasal anatomy, (2) clinical functional assessment, and (3) the current evidence supporting corrective maneuvers for each component.
Human-environment feedback and the consistency of proenvironmental behavior
Authors: Ecotière Claire , Billiard Sylvain , André Jean-Baptiste , Collet Pierre , Ferrière Régis , Méléard Sylvie 
Published: July 2022

AbstractAddressing global environmental crises such as anthropogenic climate change requires the consistent adoption of proenvironmental behavior by a large part of a population. Here, we develop a mathematical model of a simple behavior-environment feedback loop to ask how the individual assessment of the environmental state combines with social interactions to influence the consistent adoption of proenvironmental behavior, and how this feeds back to the perceived environmental state. In this stochastic individual-based model, individuals can switch between two behaviors, ’active’ (or actively proenvironmental) and ’baseline’, differing in their perceived cost (higher for the active behavior) and environmental impact (lower for the active behavior). We show that the deterministic dynamics and the stochastic fluctuations of the system can be approximated by ordinary differential equations and a Ornstein-Uhlenbeck type process. By definition, the proenvironmental behavior is adopted consistently when, at population stationary state, its frequency is high and random fluctuations in frequency are small. We find that the combination of social and environmental feedbacks can promote the spread of costly proenvironmental behavior when neither, operating in isolation, would. To be adopted consistently, strong social pressure for proenvironmental action is necessary but not sufficient – social interactions must occur on a faster timescale compared to individual assessment, and the difference in perceived environmental impact must be small. This simple model suggests a scenario to achieve large reductions in environmental impact, which involves incrementally more active and potentially more costly behavior being consistently adopted under increasing social pressure for proenvironmentalism.