bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Surgical Management of Ileal Pouch Strictures
Authors: Aviran Eyal , Zaghiyan Karen , Fleshner Phillip 
Published: November 2022

BACKGROUND:
Total proctocolectomy with IPAA reconstruction is the surgical approach of choice in ulcerative colitis, indeterminate colitis, familial adenomatous polyposis, and selected patients with Crohn’s disease. Pouch stricture is a common complication after IPAA.

OBJECTIVE:
This study aims to identify surgical management options for pouch stricture and offer a treatment algorithm.

DATA SOURCES:
A computer-assisted search of the online bibliographic databases MEDLINE and Embase from 1990 to 2021 was performed.

STUDY SELECTION:
Randomized controlled trials, cohort studies, observational studies, and case reports were considered.

INTERVENTIONS:
Mechanical dilation, strictureplasty, stapler resection, pouch advancement, bypass, and repeat IPAA were included.

MAIN OUTCOMES:
Twenty-three articles were considered eligible. Overall incidence of strictures varied from 5% to 38%. Strictures were categorized into 3 areas: pouch inlet (with a reported incidence of 9% to 56%), mid-pouch (with a reported incidence of 2%), and pouch-anal anastomosis (with a reported incidence of 43% to 87%). Pouch-anal strictures were initially managed using bougie or Hegar dilation, with various surgical procedures advocated when initial dilation failed. Mid-pouch strictures are relatively unstudied with scant data. Pouch inlet strictures can be surgically managed by various transabdominal techniques‚ including resection and reconnection, strictureplasty, or bypass.

RESULTS:
Pouch-anal strictures should be managed in a step-up strategy as conservative procedures are associated with acceptable success rates. Initial mechanical dilation using bougie or Hegar dilation has a success rate of >80%, although it is likely to require repeat dilations. When these measures fail, transanal surgical approaches using strictureplasty, stapler resection‚ or pouch advancement should be offered. Transabdominal pouch revision should be offered to patients refractory to a transanal approach. In mid-pouch strictures, the treatment of choice is pouch revision and reanastomosis. Pouch inlet strictures can be managed by resection, strictureplasty, or bypass depending on the location and length of the stricture and surgeon experience.

LIMITATIONS:
Studies were often small and retrospectively analyzed. There were no randomized controlled trials or comparison between different treatment options.
Computer-aided Surgical Planning and Osteosynthesis Plates for Bimaxillary Orthognathic Surgery: A Study of 14 Consecutive Patients
Authors: Shakoori Pasha , Yang Robin , Nah Hyun-Duck , Scott Michelle , Swanson Jordan W. , Taylor Jesse A. , Bartlett Scott P. 
Published: November 2022

Background:
Computer-aided surgical planning has become popular for planning orthognathic surgery (OS) as it saves surgeons’ time and effort. A recent advancement has been the utilization of patient-specific cutting guides and osteosynthesis. The purpose of this study is to report the postoperative bimaxillary position utilizing custom plates for both jaws versus custom plates used in the maxilla only in 23 consecutive patients.

Methods:
All patients who underwent bimaxillary OS in 2017–2018 with preoperative computed tomography (CT) scan, postoperative day 1 CT scan, and at least 6 months follow-up were included in the study. Group 1 utilized maxillary preprinted plates (maxilla only). Group 2 utilized bimaxillary preprinted plates (maxillomandibular). Eight cephalometric landmarks to evaluate the movements were chosen. The ranges of the angle between the sella/nasion plane and the nasion/A plane (SNA), the angle between the sella/nasion plane and the nasion/B plane (SNB), and the angle created by the A point‚ nasion‚ and B point‚ which measures the relative position of maxilla to mandible, were analyzed to assess the angular change. Mean-squared displacement and the SD of the distances were used to assess movement in space.

Results:
Twenty-three patients (nine in group 1 and 14 in group 2) met the inclusion criteria. Results showed interarch relationships using custom plates for both jaws with ANB 0.4 compared to ANB 1.4 for maxillary custom plates only. Mandibular landmarks showed greater variation, and the t test study revealed the right mandibular first molar landmark showing the greatest variation (P = 0.03).

Conclusions:
Custom osteosynthesis plates for OS show good accuracy for the maxilla and higher variation in the mandible. Further studies will determine the margin of error that cannot be corrected with postoperative orthodontics.
Development of Inflammatory Bowel Disease in Children With Juvenile Idiopathic Arthritis Treated With Biologics
Authors: Broekaert Ilse J. , Klein Ariane , Windschall Daniel , Rogalski Betina , Weller-Heinemann Frank , Oommen Prasad , Küster Michael , Foeldvari Ivan , Minden Kirsten , Hospach Anton , Hufnagel Markus , Berger Thomas , Geikowski Til , Quietzsch Jürgen , Horneff Gerd 
Published: November 2022

Objective:
The aim of our study was to describe the distinct features of inflammatory bowel disease (IBD) in juvenile idiopathic arthritis (JIA) patients and to identify risk factors for its development.

Methods:
Data from the German biologics in pediatric rheumatology registry (Biologika in der Kinderrheumatologie) collected between 2001 and 2021 were analyzed retrospectively.

Results:
In 5009 JIA patients, 28 developed confirmed IBD before the age of 18 years: 23 (82.1%) with Crohn disease (CD), 4 (14.3%) with ulcerative colitis (UC), and 1 (3.6%) with IBD-unclassified (IBD-U). The incident rate of IBD during 20 years of observation was 0.56% (0.46% for CD, 0.08% for UC, and 0.02% for IBD-U), of whom 20.3% were HLA-B27 positive, 25% had enthesitis-related arthritis, and 14.3% psoriatic arthritis. Within 90 days before IBD diagnosis, 82.1% (n = 23) received treatment with etanercept (ETA), 39.3% (n = 11) non-steroidal anti-inflammatory drugs, 17.9% (n = 5) systemic corticosteroids, 8 (28.6%) methotrexate (MTX), 14.3% (n = 4) sulfasalazine, 10.7% (n = 3) leflunomide, and 3.6% (n = 1) adalimumab and infliximab, respectively. The incidence of IBD was lower in patients treated with MTX, but higher in patients treated with ETA except if ETA was combined with MTX. Also in patients on leflunomide or sulfasalazine, the IBD incidence was higher.

Conclusions:
In our JIA cohort, an increased IBD incidence is observed compared to the general population, and the ratio of CD to UC is markedly higher hinting at a distinct phenotype of IBD. Pretreatment with MTX seems to be protective. Treatment with ETA does not prevent IBD development and JIA patients treated with leflunomide and sulfasalazine may be at an increased risk for IBD development.
Dolutegravir-containing HIV therapy reversibly alters mitochondrial health and morphology in cultured human fibroblasts and peripheral blood mononuclear cells
Authors: Ajaykumar Abhinav , Caloren Loïc C. , Povshedna Tetiana , Hsieh Anthony Y.Y. , Zakaria Aya , Cai Renying , Smith Marie-Soleil R. , Thompson Connor A.H. , Becquart Pierre , Uday Prakruti , Pattanshetti Rutuja , Quandt Jacqueline A. , Wong Judy M.Y. , Côté Hélène C.F. 
Published: November 2022

Objectives:
Given the success of combination antiretroviral therapy (cART) in treating HIV viremia, drug toxicity remains an area of interest in HIV research. Despite newer integrase strand transfer inhibitors (InSTIs), such as dolutegravir (DTG) and raltegravir (RAL), having excellent clinical tolerance, there is emerging evidence of off-target effects and toxicities. Although limited in number, recent reports have highlighted the vulnerability of mitochondria to these toxicities. The aim of the present study is to quantify changes in cellular and mitochondrial health following exposure to current cART regimens at pharmacological concentrations. A secondary objective is to determine whether any cART-associated toxicities would be modulated by human telomerase reverse transcriptase (hTERT).

Methods:
We longitudinally evaluated markers of cellular (cell count, apoptosis), and mitochondrial health [mitochondrial reactive oxygen species (mtROS), membrane potential (MMP) and mass (mtMass)] by flow cytometry in WI-38 human fibroblast with differing hTERT expression/localization and peripheral blood mononuclear cells. This was done after 9 days of exposure to, and 6 days following the removal of, seven current cART regimens, including three that contained DTG. Mitochondrial morphology was assessed by florescence microscopy and quantified using a recently developed deep learning-based pipeline.

Results:
Exposure to DTG-containing regimens increased apoptosis, mtROS, mtMass, induced fragmented mitochondrial networks compared with non-DTG-containing regimens, including a RAL-based combination. These effects were unmodulated by telomerase expression. All effects were fully reversible following removal of drug pressure.

Conclusion:
Taken together, our observations indicate that DTG-containing regimens negatively impact cellular and mitochondrial health and may be more toxic to mitochondria, even among the generally well tolerated InSTI-based cART.
Case volume and rate are associated with outcomes in geriatric trauma: A case for geriatric trauma centers?
Authors: Kojima Mitsuaki , Endo Akira , Zakhary Bishoy , Shoko Tomohisa , Firek Matthew , Coimbra Raul 
Published: November 2022

BACKGROUND
Increased morbidity and mortality in geriatric trauma patients are usually due to decreased physiologic reserve and increased comorbidities. It is unclear whether geriatric trauma case volume and rates correlate with survival. We hypothesized that geriatric patients would have increased survival when treated in high-case volume and rate trauma centers.

METHODS
A retrospective cohort study was conducted using the Trauma Quality Improvement Program database between 2015 and 2019. Geriatric trauma patients (≥65 years) with severe injury (Injury Severity Score ≥16) were included. Geriatric case volume (GCV) was defined as the mean annual number of treated geriatric trauma patients, while geriatric case rate (GCR) was the mean annual number of elderly trauma patients divided by all trauma patients in each center. Trauma centers were classified into low-, medium-, and high-volume and rate facilities based on GCV and GCR. The association of GCV and GCR with in-hospital mortality and complication rates was assessed using the generalized additive model (GAM) and multivariate generalized linear mixed model adjusted for patient characteristics (age, sex, Injury Severity Score, Revised Trauma Score, and Modified Frailty Index) as fixed-effect variables and hospital characteristics as random effect variables.

RESULTS
A total of 164,818 geriatric trauma patients from 812 hospitals were included in the analysis. The GAM plots showed that the adjusted odds of in-hospital mortality decreased as GCV and the GCR increased. The generalized linear mixed model revealed that both high GCV and high GCR hospitals had lower mortality rates than low GCV and GCR hospitals (adjusted odds ratio [95% confidence interval], high GCV and high GCR centers; 0.82 [0.72–0.92] and 0.81 [0.73–0.90], respectively).

CONCLUSION
Both high geriatric trauma volume and rates were associated with decreased mortality of geriatric trauma patients. Consolidation of care for elderly patients with severe injury in specialized high-volume centers may be considered.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
DCD Hepatitis C Virus–positive Donor Livers Can Achieve Favorable Outcomes With Liver Transplantation and Are Underutilized
Authors: Myers Bryan , Bekki Yuki , Kozato Akio , Crismale James F. , Schiano Thomas D. , Florman Sander 
Published: November 2022

Background.
Hepatitis C virus (HCV)–positive donors (antibody-positive [Ab+] or nucleic acid test positive [NAT+] donors) have been underutilized. The aim of this study was to evaluate the utilization of livers from HCV-positive with donation after circulatory death (DCD) and to assess outcomes in recipients of these grafts.

Methods.
Data between 2015 and 2019 were obtained from the United Network for Organ Sharing database. The utilization rates and graft survival among 8455 DCD liver and nonliver donors and 2278 adult DCD liver transplantation (LT) recipients were reviewed on the basis of donor HCV Ab/NAT status.

Results.
The utilization of Ab+/NAT– donors <40 y and Ab+/NAT+ donors ≥40 y was low than utilization of HCV-negative donors (P < 0.001). Multivariate analysis identified HCV status (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.06-2.48 in Ab+/NAT–, and OR, 1.49; 95% CI, 1.09-2.05 in Ab+/NAT+) as an independent predictor of nonutilization of liver grafts. The rate of significant liver fibrosis was comparable in Ab+/NAT– (3.5%; P = 0.84) but was higher in Ab+/NAT+ (8.7%; P = 0.03) than that in Ab–/NAT– donors. Kaplan-Meier survival curves demonstrated comparable 3-y patient survival in recipients of HCV-positive grafts compared with recipients of HCV-negative grafts (P = 0.63; 85.6% in Ab–/NAT–, 80.4% in Ab+/NAT–, and 88.7% in Ab+/NAT+).

Conclusions.
Patient and graft survival rates are similar between HCV-positive and HCV-negative DCD LT. However, HCV-positive donors are particularly underutilized for DCD LT.
Outcomes of Liver Transplantation in Patients With Preexisting Coronary Artery Disease
Authors: Reznicek Emily , Sasaki Kazunari , Montane Bryce , Sims Ariel , Beard Jonathan , Fares Maan , Sharma Vikram , Cywinski Jacek , Quintini Christiano , Aucejo Federico N. , Eghtesad Bijan , Miller Charles M. , Menon K.V. Narayanan 
Published: November 2022

Background.
Advances in surgical and medical technology over the years has made liver transplantation possible for older and higher risk patients. Despite rigorous preoperative cardiac testing, cardiovascular events remain a major cause of death after orthotopic liver transplantation (OLT). However, there are little data on the outcomes of OLT in patients with preexisting coronary artery disease (CAD). This study aimed to compare all-cause and cardiovascular mortality of patients with and without history of CAD undergoing OLT.

Methods.
Six hundred ninety-three adult patients with cirrhosis underwent liver transplantation between July 2013 and December 2018 (female n = 243, male n = 450; median age 59).

Results.
During the study period of 5 y (median follow-up, 24.1 mo), 92 of 693 patients (13.3%) died. All-cause mortality in the CAD group was significantly higher than in the non-CAD group (26.7% versus 9.6%; P<0.01). Cardiovascular events accounted for 52.5% of deaths (n = 21) in patients with CAD compared with 36.5% (n = 19) in non-CAD patients. At 6 mo, patients with combined nonalcoholic steatohepatitis (NASH)/CAD had significantly worse survival than those with CAD or NASH alone (P<0.01). After 6 mo, patients with CAD alone had similar survival to those with combined NASH/CAD.

Conclusions.
Patients with preexisting CAD before liver transplantation are at higher risk of death from any cause, specifically cardiovascular-related death. This risk increases with coexisting NASH. The presence of NASH and CAD at the time of liver transplant should prompt the initiation of aggressive risk factor modification for patients with CAD.
Examining the Role for Donor-specific Antibody Testing in Simultaneous Liver-kidney Transplantation: A Single-center Analysis of Outcomes
Authors: Das Anushka , Rocque Brittany , Remulla Daphne , Raza Muhammad , Barbetta Arianna , Bangerth Sarah , Goldbeck Cameron , Maw Thin Thin , Kim Jim , Kwon Yong , Emamaullee Juliet 
Published: November 2022

Background.
Simultaneous liver-kidney transplantation (SLKT) is increasingly used for patients with concurrent end-stage liver and renal disease. Emerging evidence suggests that simultaneous liver transplant can provide a tolerogenic benefit to multiorgan transplant recipients. Posttransplant donor-specific antibody (DSA) may be associated with worse outcomes; however, the role for testing DSA in SLKT is unclear.

Methods.
This study retrospectively assessed the impact of DSA on outcomes following primary SLKT at a large-volume center between 2008 and 2018. Patients were grouped by positive DSA, negative DSA, and DSA not tested, and data were obtained from our institutional database and chart review.

Results.
The cohort included 138 SLKT recipients with a mean age of 56.1 ± 9.7 y; 61.6% were male, and 55.8% were Hispanic. Overall, 62 patients were tested for DSA posttransplant, and 33 patients (23.9%) had at least 1 DSA detected. A total of 34 patients (24.6%) experienced at least 1 episode of liver rejection, and 23 patients (16.7%) experienced kidney rejection. Over 50% of patients with de novo DSA changed status during their posttransplant course. Rates of both liver and kidney rejection were slightly higher in the DSA+ group, but liver allograft, kidney allograft, and patient survival did not differ when grouped by whether DSA testing was performed or DSA positivity.

Conclusions.
These data demonstrate that SLKT is associated with excellent long-term patient and allograft survival with a relatively low rate of rejection. In our experience, testing for DSA does not impact SLKT outcomes‚ and further multicenter analyses are needed to establish standard of care.
Aggregated eosinophils characterize airway mucus properties
Authors: Miyabe Yui , Fukuchi Mineyo , Tomizawa Hiroki , Nakamura Yuka , Jikei Mitsutoshi , Matsuwaki Yoshinori , Arima Misaki , Konno Yasunori , Moritoki Yuki , Takeda Masahide , Tanabe Naoya , Sima Hiroshi , Shiraishi Yusuke , Hirai Toyohiro , Ohta Nobuo , Takahata Junko , Matsubara Atsushi , Yamada Takechiyo , Asano Koichiro , Miyairi Isao , Melo Rossana C. N. , Weller Peter F. , Ueki Shigeharu 
Published: November 2022

AbstractUncontrolled airway mucus is associated with diverse diseases. We hypothesized that the physical characteristics of infiltrating granulocytes themselves affect the clinical properties of mucus. Surgically obtained nasal mucus from patients with eosinophilic chronic rhinosinusitis (ECRS) and neutrophil-dominant non-eosinophilic chronic rhinosinusitis (non-ECRS) was assessed in terms of computed tomography (CT) density, viscosity, water content, wettability, and granulocyte-specific proteins. In an observational study, we found that nasal mucus from patients with ECRS had significantly higher CT density, viscosity, dry weight, and hydrophobicity than mucus from patients with non-ECRS. The levels of eosinophil-specific proteins in nasal mucus correlated with its physical properties. When isolated human eosinophils and neutrophils were stimulated to induce extracellular traps followed by aggregate formation, we found that cell aggregates showed physical and pathological findings that closely resembled mucus. Co-treatment with heparin (which slenderizes the structure of eosinophil extracellular traps) and DNase efficiently induced a reduction in the viscosity and hydrophobicity of both eosinophil aggregates and eosinophilic mucus. The present study highlights the pathogenesis of mucus stasis in infiltrated granulocyte aggregates from a new perspective. The combination of DNase and heparin might be a novel therapeutic modality against pathologic viscous eosinophilic mucus.One Sentence SummaryIntraluminal accumulation and activation of eosinophils contribute to the clinical properties of airway mucus and may serve as a therapeutic target.
Understanding the effectiveness of water, sanitation, and hygiene interventions: a counterfactual simulation approach to generalizing the outcomes of intervention trials
Authors: Brouwer Andrew F. , Zahid Mondal H. , Eisenberg Marisa C. , Arnold Benjamin F. , Ashraf Sania , Benjamin-Chung Jade , Colford John M. , Ercumen Ayse , Luby Stephen P. , Pickering Amy J. , Rahman Mahbubur , Kraay Alicia N.M. , Eisenberg Joseph N.S. , Freeman Matthew C. 
Published: November 2022

AbstractBackgroundWhile water, sanitation, and hygiene (WASH) interventions can reduce diarrheal disease, many large-scale trials have not found the expected health gains for young children in low-resource settings. Evidence-based guidance is needed to inform interventions and future studies.ObjectivesWe aimed to estimate how sensitive the intervention effectiveness found in the WASH Benefits Bangladesh randomized controlled trial was to underlying WASH contextual and intervention factors (e.g.., baseline disease prevalence, compliance, community coverage, efficacy) and to generalize the results of the trial other contexts or scenarios.MethodsWe developed a disease transmission model to account for transmission across multiple environmental pathways, multiple interventions (water (W), sanitation (S), hygiene (H), nutrition (N)) applied individually and in combination, adherence to interventions, and the impact of individuals not enrolled in the study. Leveraging a set of mechanistic parameter combinations fit to the WASH Benefits Bangladesh trial (n=17,187) using a Bayesian sampling approach, we simulated trial outcomes under counterfactual scenarios to estimate how changes in intervention completeness, coverage, compliance, and efficacy, as well as preexisting WASH conditions and baseline disease burden, impacted intervention effectiveness.ResultsIncreasing community coverage had the greatest impact on intervention effectiveness (e.g., median increases in effectiveness of 34.0 and 45.5% points in the WSH and WSHN intervention arms when increasing coverage to 20%). The effect of community coverage on effectiveness depended on how much transmission was along pathways not modified by the interventions. Intervention effectiveness was reduced by lower levels of preexisting WASH conditions or increased baseline disease burden. Individual interventions had complementary but not synergistic effects when combined.DiscussionTo realize the expected health gains, future WASH interventions must address community coverage and transmission along pathways not traditionally covered by WASH. The effectiveness of individual-level WASH improvements will be blunted the further the community is from the high community coverage needed to achieve herd protection.