bluuebunny/crossref_metadata_2025 huggingface dataset:
Comprehensive Perioperative Approach to Complex Spine Deformity Management
Authors: Camargo Celeste , Abode-Iyamah Kingsley , Shah Jaimin S. , Bechtle Perry S. , Freeman William D.
Published: August 2021

Objective:

Study perioperative strategies for optimizing neuroprotection in complex spine deformity correction surgery.

Methods:

We report the case of a patient with severe lumbar dextroscoliosis, thoracolumbar junction hyperkyphosis with a 40-degree Cobb angle levoconvex scoliosis who underwent spinal deformity correction with loss of neuromonitoring during surgery. We performed a literature review on perioperative management of complex spine deformity.

Results:

A 50-year-old man presented with lumbar pain and right L4 radiculopathy. Surgical intervention for deformity correction and decompression was indicated with T4−L4 posterior instrumentation L2/L3 and L3/L4 transforaminal lumbar interbody fusion. Surgery was aborted due to the loss of neuromonitoring. Postsurgery, the patient had left sensory deficit and the neurocritical care team clinically suspected and deduced the anatomic location of the spinal cord compression. Magnetic resonance imaging confirmed a T10−T11 hyperintensity suggestive of cord ischemia due to osteophyte compressing the spinal cord. The patient underwent a second corrective surgery with no intraoperative events and has no long-term neurological sequela.

Conclusions:

This case illustrates that a comprehensive perioperative approach and individualized risk factor assessment is useful in complex spine deformity surgery. Further research is needed to determine how this individualized comprehensive approach can lead to intraoperative and postoperative countermeasures that improved spine surgery outcomes.

Level of Evidence:

Level V.
Long-chain noncoding ribonucleic acids affect the survival and prognosis of patients with esophageal adenocarcinoma through the autophagy pathway: construction of a prognostic model
Authors: Wu Liusheng , Zheng Yuzhen , Ruan Xin , Wu Dingwang , Xu Pengcheng , Liu Jixian , Wu Da , Li Xiaoqiang
Published: August 2021

Autophagy-related long-chain noncoding ribonucleic acids play a vital role in the development of esophageal adenocarcinoma. This study aimed to construct a prognostic model of autophagy-related long-chain noncoding ribonucleic acids and identify potential therapeutical targets for esophageal adenocarcinoma. We downloaded 261 long-chain noncoding RNA transcript samples and clinical data of 87 esophageal adenocarcinoma patients from the Cancer Genome Atlas and 307 autophagy-related genes from www.autophagy.com. We performed Kyoto Encyclopedia of Genes and Genomes and Gene Ontology enrichment analyses and Gene Set Enrichment Analysis to determine risk characteristics and bioinformatics functions of signal transduction pathways. Univariate and multivariate Cox regression analyses were used to determine the correlation between autophagy-related long-chain noncoding ribonucleic acids and independent risk factors. The receiver operating characteristic analysis was used to evaluate the feasibility of the prognostic model. Finally, we performed survival analysis, risk analysis and independent prognostic analysis to verify the prognostic model of esophageal adenocarcinoma. We identified 22 autophagic long-chain noncoding ribonucleic acids that were highly correlated with the overall survival of esophageal adenocarcinoma patients. The areas under the receiver operating characteristic curve (0.941) and the calibration curve were significantly similar. Moreover, univariate and multivariate Cox regression analyses indicated that autophagy-related long-chain noncoding ribonucleic acids were independent predictors of esophageal adenocarcinoma. We found that autophagy-related long-chain noncoding ribonucleic acids might affect tumor development and prognosis in esophageal adenocarcinoma patients. The findings indicate that the prognostic model of esophageal adenocarcinoma has potential therapeutic applications in patients with esophageal adenocarcinoma.
A Neglected Acne Scar Type: Papular Acne Scars and Their Correlations With Keloid Scars
Authors: Lee Ye-Jin , Lee Chan-Yang , Shin Min Kyung
Published: August 2021

BACKGROUND

Acne scarring can be divided into 2 types: atrophic and hypertrophic scars. Papular acne scars are commonly encountered, skin-colored papules on the chin and back.

OBJECTIVE

This study aimed to estimate the prevalence of each acne scar type and to investigate the clinical manifestations of papular acne scars.

METHODS

This retrospective study included 416 patients with acne scars. Dermatologists classified the scars into 3 types (atrophic, papular, and keloid type) based on clinical photographs and analyzed the clinical and histologic features of papular acne scars.

RESULTS

Among 416 patients with acne scars, 410 patients (98.56%) had atrophic scars, 53 patients (12.74%) had keloid scars, and 46 patients (11.06%) had papular acne scars. Twenty patients (4.81%) had both papular and keloid acne scars. Histologic analysis showed fibrotic tissue in both keloid and papular acne scars. Fibrosis of the papular scar was limited to the upper dermis.

CONCLUSION

Papular acne scars were significantly more prevalent in patients with keloid scars than in those without keloid scars. These results provide a basis for understanding papular acne scars, which have been under-recognized. The association between papular and keloid acne scars can suggest the decision for scar treatment.
FOVEAL MÜLLER CELL CONE AS A PROGNOSTIC OPTICAL COHERENCE TOMOGRAPHY BIOMARKER FOR INITIAL RESPONSE TO ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT IN CYSTOID DIABETIC MACULAR EDEMA
Authors: Choi Mihyun , Yun Cheolmin , Oh Jong-Hyun , Kim Seong-Woo
Published: August 2021

Purpose:

To investigate the effect of the foveal Müller cell cone structure on the anatomical and functional response to intravitreal bevacizumab treatment in patients with diabetic macular edema.

Methods:

In 93 treatment-naive eyes with center-involved cystic type diabetic macular edema, spectral-domain optical coherence tomography scans of baseline were retrospectively evaluated to determine the foveal Müller cell cone structure and prognostic features including length of disorganization in the retinal inner layers and ellipsoid zone disruption. The area and circularity of the foveal avascular zone of the superficial and deep capillary plexus 1 month after intravitreal bevacizumab treatment were evaluated using optical coherence tomography angiography.

Results:

Destruction of the foveal Müller cell cone structure and a large foveal avascular zone in the deep capillary plexus (mm2) correlated strongly with a poor anatomical response (CST > 250 µm) at 1 month after first intravitreal bevacizumab (Exp [B] = 29.444, P = 0.002 and Exp [B] = 12.419, P = 0.013, respectively). A destroyed Müller cell cone structure (P = 0.008) and length of ellipsoid zone disruption (P < 0.001) at baseline were associated with poor visual acuity at 1 month after the first intravitreal bevacizumab.

Conclusion:

The foveal Müller cell cone structure correlates with the response to initial antivascular endothelial growth factor treatment.
Patient Perspectives on the Long-term Management of Celiac Disease
Authors: Elias Evan D. , Silvester Jocelyn A. , Bernstein Charles N. , Rigaux Lisa N. , Graff Lesley A. , Duerksen Donald R.
Published: August 2021

Goal:

The aim of this study was to survey adults with celiac disease (CD) on the utility of specific aspects of follow-up and on information needs.

Background:

Currently, the treatment for CD is strict gluten avoidance. Although this places the onus on the patient for disease management, patient perspectives on CD care have not been formally assessed.

Study:

The Manitoba Celiac Disease Cohort prospectively enrolled adults newly diagnosed with CD using serology and histology. At the 24-month study visits, participants rated the utility of aspects of CD care on a 5-point scale anchored by “not at all useful” and “very useful” and the helpfulness of information on CD-related topics on a 6-point scale anchored by “not at all helpful” and “very helpful.”

Results:

The online survey was completed by 149 of 211 cohort members [median age 40 (interquartile range 30 to 56) y; 68% female]. Adherence to a gluten-free diet was good. Most participants (87%) responded that they should be seen regularly for medical follow-up of CD, preferably every 6 (26%) or 12 months (48%). Blood tests were the most highly rated care component (rated scored ≥4/5 by 78% of respondents), followed by the opportunity to ask about vitamins and supplements (50%), symptom review (47%), and information on CD research (44%). Diet review was not considered helpful.

Conclusions:

Two years after diagnosis, most individuals with CD find regular specialist follow-up helpful, particularly for biochemical assessment of disease activity and its complications. Furthermore, information on research and long-term complications of CD is also valued.
Prevalence of Microscopic Colitis in Diarrhea-predominant Irittable Bowel Syndrome Patients
Authors: Ebeid Basel , Eid Ragaey A. , Attia Dina , Daoud Sahar A. , Tawfik Mohammad M. , Abdel Fattah Ali M.
Published: August 2021

Background and Aim:

There is controversy about colonoscopy and taking biopsy from the normal colonic mucosa in patients with a clinical diagnosis of diarrhea-predominant irritable bowel syndrome (D-IBS). This study aims to estimate the prevalence of microscopic colitis (MC) in D-IBS patients and to select patients without the well-known alarming features who will benefit from colonoscopy and biopsies from the normal colonic mucosa.

Patients and Methods:

We performed a cohort cross-sectional study over 6 months duration in a total of 129 patients with Rome III criteria of D-IBS after excluding cases with features of organic diseases. Cases were subjected to colonoscopy and biopsies from the colonic mucosa that seemed normal.

Results:

Histopathologic examination of biopsies taken from cases with normal colonic mucosa revealed 86 (71.66%) cases with nonspecific colitis, 26 (21.66%) cases with MC and 8 (6.66%) cases with ulcerative colitis. Concomitant immunologic diseases (P=0.00005) and triggering drugs intake (P=0.006) were significantly more common in the MC group. The mean duration of diarrhea in MC patients was significantly longer than that of nonspecific colitis and ulcerative colitis patients (P=0.0006).

Conclusions:

Prevalence of MC in D-IBS patients from Upper Egypt is relatively high (21.66%). Concomitant immunologic diseases, possible triggering drugs intake, and long duration of diarrhea are significant risk factors for undiagnosed MC in D-IBS patients.
Predictive value of cytokeratin-18 fragment levels for diagnosing steatohepatitis in patients with nonalcoholic fatty liver disease
Authors: Tada Toshifumi , Saibara Toshiji , Ono Masafumi , Takahashi Hirokazu , Eguchi Yuichiro , Hyogo Hideyuki , Kawanaka Miwa , Kumada Takashi , Toyoda Hidenori , Yasuda Satoshi , Nakajima Atsushi , Yoneda Masato , Tanaka Saiyu , Shimada Keiji , Hoshino Hideaki , Aishima Shinichi , Kage Masayoshi , Sumida Yoshio
Published: August 2021

Objective

Several noninvasive markers have been developed to predict nonalcoholic steatohepatitis (NASH). We investigated the predictive value of the cytokeratin-18 fragment (CK18-F) level and FIB-4 index for diagnosing NASH in patients with nonalcoholic fatty liver disease (NAFLD).

Methods

A total of 246 patients histologically diagnosed with NASH (n = 185) or nonalcoholic fatty liver (n = 61) were enrolled. We analyzed weighted receiver operating characteristic (ROC) curves for the prediction of NASH and determined the relationship between the CK18-F level and the histological features of NASH. In addition, we investigated the predictive value of the combination of the CK18-F level and FIB-4 index for diagnosing NASH.

Results

The area under the ROC curve (AUROC) value of the CK18-F level was 0.77. With a CK18-F cutoff level of 260 U/L, the sensitivity and specificity for diagnosing NASH were 82.7 and 57.4%, respectively. Multiple comparisons showed that the CK18-F level did not differ among fibrosis stages but did significantly differ among hepatocyte ballooning grades. Overall, 95.7% (66/69) of patients with a FIB-4 index of ≥2.67 had NASH. In patients with a FIB-4 index of <2.67, the AUROC value of the CK18-F level for predicting NASH was 0.77 and a CK18-F cutoff level of 260 U/L resulted in a sensitivity and specificity of 82.4 and 56.9%.

Conclusions

The CK18-F level had a good predictive ability for diagnosing NASH in patients with NAFLD. Additionally, the combination of the CK18-F level and FIB-4 index accurately and noninvasively predicted NASH, even those with a low FIB-4 index.
An unusual cause of diarrhoea: case report and literature review of olmesartan-associated enteropathy
Authors: Mauloni Paula Antonia , Capuani Federica , Paone Clara , Marasco Giovanni , Bellacosa Lara , Cogliandro Rosanna Francesca , Cremon Cesare , Barbara Giovanni , Vasuri Francesco , Stanghellini Vincenzo
Published: August 2021

Olmesartan is an angiotensin II receptor blocker, approved in 2002 by the Food and Drug Administration for the treatment of hypertension. During chronic therapy with olmesartan, sprue-like enteropathy can occur, being mainly characterised by non-bloody diarrhoea, weight loss and variable degrees of duodenal mucosal damage, which resolved after withdrawal of olmesartan. We hereby report the case of a 77-year-old, poli-treated male patient with a 3-month history of diarrhoea, vomiting and weight loss, associated with severe intestinal villous atrophy and lymphocytic infiltration of gastric and colonic mucosa. After extensive investigations aimed at excluding other possible causes of chronic diarrhoea, a diagnosis of olmesartan-associated enteropathy was made, which was later confirmed by clinical improvement after the discontinuation of the drug. Repeated endoscopy 8 months later showed complete healing of duodenal mucosa with normal villous architecture. Villous atrophy and lymphocytic infiltration of duodenal mucosa are the most described pathologic finding, but several cases of gastric and colonic involvement have also been reported. We, therefore, reviewed the available literature, focussing on the extent of mucosal damage throughout the whole intestine and on its possible causative factors.
Therapeutic drug monitoring in Crohn’s disease patients treated with anti-TNF: a comparison of two techniques
Authors: Bodini Giorgia , Demarzo Maria Giulia , Djahandideh Afscin , Ziola Sebastiano , Risso Paolo , Bertani Lorenzo , Baldissarro Isabella , Testa Tommaso , Marchi Santino , Savarino Edoardo , Giannini Edoardo Giovanni
Published: August 2021

Background

Therapeutic drug monitoring is a useful clinical decision aid in managing patients with inflammatory bowel disease treated with anti-tumor necrosis factor (anti-TNF). Various techniques are available to evaluate drug trough levels, and among these a point-of-care (POC) method has been proposed to overcome the limitations inherent to other methodologies. In this study we aimed to evaluate the capability of POC to discriminate between relapse and remission disease phases, and to assess the concordance of the POC and homogeneous mobility shift assay (HMSA) results.

Methods

Drug trough level of 46 Crohn’s disease patients treated with either adalimumab or infliximab were evaluated with both a POC technique and an HMSA at various time points (week-16 and -48) during anti-TNF treatment.

Results

Median adalimumab trough level of patients in remission were significantly higher as compared to relapsing patients using both HMSA (week 16, P = 0.0001; week48, P = 0.001) and POC (week 16, P = 0.0003; week 48, P = 0.0012), and similar results were observed with infliximab trough level at week 16 (HMSA, P = 0.019; POC, P = 0.0072). Overall, we observed a good correlation between the techniques for both infliximab (r = 0.76; P 
< 0.0001) and adalimumab (r = 0.75; P 
< 0.0001), with no difference in discriminatory accuracy between assays (infliximab: HMSA versus POC c-index, 0.921 versus 0.895, P =0.149; adalimumab: HMSA versus POC c-index, 0.817 versus 0.850, P = 0.197).

Conclusion

Both POC and HMSA assays are able to reliably differentiate relapse and remission phases in Crohn’s disease patients treated with anti-TNF. These techniques showed good concordance and we feel that their preferential use should be based on local accessibility, physicians’ experience and preference, and the need for timeliness availability of results.
Race, Ethnicity, Neighborhood Characteristics, and In-Hospital Coronavirus Disease-2019 Mortality
Authors: Hu Jianhui , Bartels Christie M. , Rovin Richard A. , Lamb Laura E. , Kind Amy J.H. , Nerenz David R.
Published: August 2021

Background:

Despite many studies reporting disparities in coronavirus disease-2019 (COVID-19) incidence and outcomes in Black and Hispanic/Latino populations, mechanisms are not fully understood to inform mitigation strategies.

Objective:

The aim was to test whether neighborhood factors beyond individual patient-level factors are associated with in-hospital mortality from COVID-19. We hypothesized that the Area Deprivation Index (ADI), a neighborhood census-block-level composite measure, was associated with COVID-19 mortality independently of race, ethnicity, and other patient factors.

Research Design:

Multicenter retrospective cohort study examining COVID-19 in-hospital mortality.

Subjects:

Inclusion required hospitalization with positive SARS-CoV-2 test or COVID-19 diagnosis at three large Midwestern academic centers.

Measure(s):

The primary study outcome was COVID-19 in-hospital mortality. Patient-level predictors included age, sex, race, insurance, body mass index, comorbidities, and ventilation. Neighborhoods were examined through the national ADI neighborhood deprivation rank comparing in-hospital mortality across ADI quintiles. Analyses used multivariable logistic regression with fixed site effects.

Results:

Among 5999 COVID-19 patients median age was 61 (interquartile range: 44–73), 48% were male, 30% Black, and 10.8% died. Among patients who died, 32% lived in the most disadvantaged quintile while 11% lived in the least disadvantaged quintile; 52% of Black, 24% of Hispanic/Latino, and 8.5% of White patients lived in the most disadvantaged neighborhoods.

Living in the most disadvantaged neighborhood quintile predicted higher mortality (adjusted odds ratio: 1.74; 95% confidence interval: 1.13–2.67) independent of race. Age, male sex, Medicare coverage, and ventilation also predicted mortality.

Conclusions:

Neighborhood disadvantage independently predicted in-hospital COVID-19 mortality. Findings support calls to consider neighborhood measures for vaccine distribution and policies to mitigate disparities.
Comparing Web and Mail Protocols for Administering Hospital Consumer Assessment of Healthcare Providers and Systems Surveys
Authors: Fowler Floyd J. , Brenner Philip S. , Hargraves J. Lee , Cleary Paul D.
Published: August 2021

Objective:

The objective of this study was to compare results of using web-based and mail (postal) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data collection protocols.

Research Design:

Patients who had been hospitalized in a New England Hospital were surveyed about their hospital experience. Patients who provided email addresses were randomized to 1 of 3 data collection protocols: web-alone, web with postal mail follow-up, and postal mail only. Those who did not provide email addresses were surveyed using postal mail only. Analyses compared response rates, respondent characteristics, and patient-reported experiences.

Subjects:

For an 8-week period, patients were discharged from the study hospital to home.

Measures:

Measures included response rates, characteristics of respondents, 6 composite measures of their patient experiences, and 2 ratings of the hospital.

Results:

Response rates were significantly lower for the web-only protocol than the mail or combined protocols, and those who had not provided email addresses had lower response rates. Those over 65 were more likely than others to respond to all protocols, especially for the mail-only protocols. Respondents without email addresses were older, less educated, and reported worse health than those who provided email addresses. After adjusting for respondent differences, those in the combined protocol differed significantly from the mail (postal) only respondents on 2 measures of patient experience; those in the web-only protocol differed on one. Those not providing an email address differed from those who did on one measure.

Conclusion:

If web-based protocols are used for HCAHPS surveys, adjustments for a mode of data collection are needed to make results comparable.
Hearing restoration and the stria vascularis: evidence for the role of the immune system in hearing restoration
Authors: Samaha Nadia L. , Almasri Mohamad M. , Johns J. Dixon , Hoa Michael
Published: August 2021

Purpose of review

This article reviews the current literature regarding the pathogenesis of immune-mediated sensorineural hearing loss, utilizes previously published single-nucleus transcriptional profiles to characterize cytokine and cytokine receptor expression in the adult stria vascularis cell types to support immune system interaction with the stria vascularis and reviews the current literature on immunomodulatory agents currently being used for hearing-restoration treatment.

Recent findings

The literature review highlights recent studies that elucidate many cytokines and immune markers, which have been linked to various immune-mediated disease processes that have been observed with sensorineural hearing loss within the stria vascularis and highlights recent publications studying therapeutic targets for these pathways.

This review highlights the current literature regarding the pathogenesis of immune-mediated hearing loss. The role of cochlear structures in human temporal bones from patients with immune-mediated sensorineural hearing loss are highlighted, and we review cytokine signalling pathways relevant to immune-mediated sensorineural hearing loss and localize genes encoding both cytokine and cytokine receptors involved in these pathways. Finally, we review immunomodulatory therapeutics in light of these findings and point to opportunities for the application of novel therapeutics by targeting these signalling pathways.
Understanding the differentiation and epigenetics of cochlear sensory progenitors in pursuit of regeneration
Authors: Kwan Kelvin Y. , White Patricia M.
Published: August 2021

Purpose of review

Sensory hair cells (HCs) of the inner ear are responsible for our ability to hear and balance. Loss of these cells results in hearing loss. Stem cell replacement and in situ regeneration have the potential to replace lost HCs. Newly discovered contributions of transcription factor regulatory networks and epigenetic mechanisms in regulating HC differentiation and regeneration are placed into context of the literature.

Recent findings

A wealth of new data has helped to define cochlear sensory progenitors in their developmental trajectories. This includes transcription factor networks, epigenetic manipulations, and cochlear HC subtype specification.

Understanding how sensory progenitors differ and how HC subtypes arise will substantially inform efforts in hearing restoration.
Comprehensive management of nonmelanoma skin cancer involving the skull base
Authors: Matos Leandro Luongo , Cernea Claudio Roberto
Published: August 2021

Purpose of review

Skin cancers are the most prevalent malignant disorder affecting humans. Approximately 90% of these are nonmelanoma skin cancer (NMSC), and large tumors, especially at the ‘H-zone’, can invade deeply and access the skull base. The best treatment for these very advanced skin cancers is craniofacial resection followed by adjuvant treatment, but, currently, systemic therapy and neoadjuvant approaches could be considered for some patients. The current management of NMSC involving the skull base is discussed in this article.

Recent findings

Surgical resections with negative margins followed by adjuvant treatment are the best treatment for NMSC with skull base invasion and offer the best outcomes for those patients. This approach usually requires a free flap reconstruction, followed by external beam radiation therapy. The team must keep in mind that some factors, such as gross brain invasion and extensive dura mater extension, are associated with worse outcomes.

Although it occurs infrequently, very advanced NMSC can involve the skull base. In these very difficult clinical scenarios, the best therapeutic option is a multidisciplinary approach in a tertiary center.
Supporting Feeding of Late Preterm Infants in the Hospital
Authors: Lober Angela , Tussey Christina , Gorny Jenny
Published: August 2021

Background:

Feeding difficulty is the most common cause of delayed hospital discharge and readmission of late preterm infants. Frequent and adequate feedings from birth are protective against dehydration, hypoglycemia, and jaundice. The National Perinatal Association's feeding guidelines provide the foundation for late preterm infant standards of care. Feeding at least every 3 hours promotes nutritional status and neurologic development. One feeding assessment every 12 hours during the hospital stay can ensure quality of infant feeding.

Problem:

At a large urban hospital, medical record reviews were completed to evaluate nursing care practices consistent with the hospital's late preterm infant care standard policy. Feeding frequency and nurse assessment of feeding effectiveness were far below acceptable targets. A quality improvement team was formed to address inconsistency with expected practice.

Methods:

The project included an investigation using the define, design, implement, and sustain method of quality improvement. Parent education, nurse education, and visual cues were developed to sustain enhanced nursing practice.

Results:

Late preterm infants who received feedings at least every 3 hours increased from 2.5% (1 of 40) to 27% (11 of 40); (M = 0.275, SD = 0.446), p = 0.001. Documented breastfeeding assessments increased from 2% (5 of 264) to 8% (10 of 126), p = 0.001. Documented bottle-feeding assessments increased from 15% (39 of 264) to 31% (53 of 172), p < 0.001. Intervention time was cut short due to reprioritization of efforts in response to the COVID-19 pandemic.

Conclusion:

Interventions and implementation of this process improvement is easy to replicate through attainable and sustainable goals directed toward improved outcomes for late preterm infants.
Fibrohistiocytic Variant of Hepatic Pseudotumor
Authors: Arora Kshitij S. , Anderson Mark A. , Neyaz Azfar , Yilmaz Osman , Pankaj Amaya , Ferrone Cristina R. , Zen Yoh , England Jonathan , Deshpande Vikram
Published: August 2021

Inflammatory pseudotumor is a term used to designate inflammation-rich tumefactive lesions. Following the exclusion of specific entities such as IgG4-related disease and other neoplastic entities previously included in this entity, the majority of hepatic pseudotumors show a prominent fibrohistiocytic inflammatory reaction and have been previously categorized as fibrohistiocytic variant of hepatic pseudotumor (FHVHPT). The goal of this study was to examine the clinical, radiologic, histologic, and etiologic aspects of this entity. After excluding neoplastic diseases, we identified 30 patients with FHVHPT from 3 institutions between 2009 and 2019. We extracted demographic and clinical data, liver function tests as well as culture results and radiologic information. Hematoxylin and eosin–stained slides were reviewed for pattern of inflammation as well as its cellular composition. Immunohistochemistry for IgG4 and IgG was performed in all cases. The mean age of the 30 lesions characterized as FHVHPT was 56 years (range: 23 to 79 y). Nineteen patients showed solitary lesions; 11 were multiple. The mean size of the lesion was 3.8 cm (range: 1 to 7.5 cm). On imaging, a neoplastic process or metastasis was the leading diagnostic consideration (n=15, 50%). The most common symptom was abdominal pain (n=14/30); 8 patients presented with symptoms compatible with an infectious process, including fever. The inflammatory infiltrate was dominated by lymphocytes and plasma cells, and in most cases, a prominent histiocytic infiltrate (22/30). Neutrophils were identified in 12 cases, with microabscess noted in 8. Storiform pattern of fibrosis was seen in 14/30 cases; obliterative phlebitis was not identified. Culture identified a microorganism in 4 of 9 cases evaluated. The mean IgG4 count was 9.3 per HPF (range: 0 to 51) with 9 of the 26 (35%) biopsies showing >10 IgG4 positive plasma cells per HPF. The mean IgG4 to IgG ratio was 8% (range: 8% to 46%). A hepatectomy was performed in 4 cases. On broad spectrum antibiotics (n=14) the lesions either resolved or decreased in size. Eight patients did not receive specific therapy, nevertheless, the lesion(s) resolved spontaneously in 6 cases, remained stable or decreased in size in 2 cases. Notably, none of these patients showed evidence of a hepatic recurrence. FHVHPT, a tumefactive lesion that mimics hepatic neoplasia, is histologically characterized by a fibrohistiocytic infiltrate. In the majority of patients FHVHPT represents the organizing phase of hepatic abscess and can be successfully managed with antibiotic therapy.
Experience of Endoscopic Endonasal Approach for 803 Pituitary Tumors With Cavernous Sinus Invasion
Authors: Zhu Haibo , Li Chuzhong , Gui Songbai , Wang Xinsheng , Zong Xuyi , Zhao Peng , Bai Jiwei , Liu Chunhui , Cao Lei , Li Zhenye , Zhang Yazhuo
Published: August 2021

Objective:

The aim of this study was to investigate the effectiveness, safety, complications, and prognosis of endoscopic endonasal surgery for pituitary adenomas with cavernous sinus invasion (CSI).

Methods:

The clinical data of 803 pituitary adenomas with CSI surgeries performed in our single ward between January 1, 2006 and December 31, 2018 were retrospectively reviewed. The resection degree, bone invasion, endocrine examination, complications, and outcome were retrospectively summarized.

Results:

Gross total resection was achieved in 394 patients (49.1%) subtotal resection in 171 patients (21.3%) and partial resection in 238 patients (29.6%). Clinically variable analyses showed that there was a significant correlation between CSI and female, older age, operation history, and non-gross total resection (NGTR). Among the pituitary adenomas with CSI, there was a significant correlation between bone invasive and NGTR, Knosp classification, recurrence. K-M curves showed that young age, larger tumors, bilateral invasion, Grade 4 of Knosp classification, NGTR, and bone invasion were associated with pituitary adenomas regrowth. Multivariate analysis revealed that bone invasion, NGTR, and Grade 4 of Knosp classification were independent risk factors for pituitary adenomas regrowth. There was a significant correlation between CSI and female, older age, operation history, and tumor resection degree.

Conclusions:

There was a significant correlation between CSI and female, older age, operation history, and tumor resection degree. The patients with CSI and bone invasion were likely to recurrent. Non-gross total resection, bone invasion, and Grade 4 of Knosp classification were independent risk factors for pituitary adenomas regrowth. Endoscopic endonasal surgery is an excellent choice for pituitary adenomas with CSI.
Establishment of Objective Clinical Parameters for Assessment of Trigonocephaly: Are Caliper-Derived Clinical Measures Adequate?
Authors: Yan Yufan , McGrath Jennifer L. , Janes Lindsay E. , Gosain Arun K.
Published: August 2021

Objective:

Objective clinical parameters characterizing the severity of trigonocephaly are essential given the concern for computerized tomography (CT) scans and radiation in infants. The present study seeks to develop a clinical tool by which to characterize trigonocephaly.

Design:

Retrospective cohort study.

Setting:

Tertiary academically affiliated children's medical center.

Participants:

A retrospective review identified patients with trigonocephaly for whom surgery was recommended (group 1) and those with metopic ridging without significant trigonocephaly (group 2). Normal age-matched controls were also evaluated (group 3).

Interventions:

Cranial vault caliper measurements were compared across groups. Two ratios measuring anterior vault constriction were developed: (1) bitemporal width at the mid-forehead to the biparietal width, and (2) bitemporal width at the lateral brow to the biparietal width.

Main outcome measures:

Bitemporal width to biparietal width (ratio).

Results:

Caliper measures were obtained from 19 patients in group 1, 8 patients in group 2, and 19 patients in group 3 (controls). Cranial indices were not significantly different across groups. The bitemporal width at the mid-forehead to the biparietal width ratio was significantly lower in group 1, with no difference between groups 2 and 3. The bitemporal width at the lateral brow to the biparietal width ratio was significantly different between all 3 groups, with group 1 < group 2 < group 3, respectively.

Conclusions:

Bitemporal to biparietal ratios are a quantitative, objective clinical measure that can be used to differentiate patients with significant trigonocephaly from those with metopic ridging but no significant cranial deformity. These findings suggest that caliper-derived indices can assist in characterizing surgically relevant cranial vault deformities secondary to metopic synostosis and may circumvent CT-based analysis.
Inferolateral Transorbital Endoscopic Approach for Spheno-Orbital Meningiomas
Authors: Colombo Giovanni , Ferreli Fabio , Baram Ali , Mercante Giuseppe , Riva Marco , Di Maria Alessandra , Pessina Federico
Published: August 2021

Spheno-orbital meningiomas (SOM) are slow growing tumors that often cause proptosis and visual deficits, due to direct compression of adjacent structures or hyperostosis of surrounding bones.

Traditionally, these lesions are approached via a lateral transcranial route. Recent interest in mini-invasive surgery and endoscopy brought many authors to study different trans-nasal or transorbital approaches.

The authors report a surgical case series with 3 patients with proptosis due to SOM who underwent surgery in our institution via an inferolateral trans-orbital endoscopic approach. The authors described our surgical technique and the authorsretrospectively reviewed the clinical and radiological outcomes of the patients.

All 3 patients had an effective orbital decompression with improvement of the proptosis and pain relief. Histological examination was possible and no intraoperative nor postoperative complications were observed.

Therefore, the authors consider inferolateral trans-orbital endoscopic approach as a feasible approach for lesions involving the lateral orbit compartment arising from middle cranial fossa or from orbit itself.
Half of Postoperative Deaths After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Could be Preventable
Authors: Houlzé-Laroye Constance , Glehen Olivier , Sgarbura Olivia , Gayat Etienne , Sourrouille Isabelle , Tuech Jean-Jacques , Delhorme Jean-Baptiste , Dumont Frédéric , Ceribelli Cécilia , Amroun Koceila , Arvieux Catherine , Moszkowicz David , Pirro Nicolas , Lefevre Jérémie H. , Courvosier-Clement Thomas , Paquette Brice , Mariani Pascale , Pezet Denis , Sabbagh Charles , Tessier Williams , Celerier Bertrand , Guilloit Jean-Marc , Taibi Abdelkader , Quenet François , Bakrin Naoual , Pocard Marc , Goéré Diane , Brigand Cécile , Piessen Guillaume , Eveno Clarisse
Published: August 2021

Objective:

To perform a retrospective root-cause analysis of postoperative death after CRS and HIPEC procedures.

Background:

The combination of CRS and HIPEC is an effective therapeutic strategy to treat peritoneal surface malignancies, however it is associated with significant postoperative mortality.

Methods:

All patients treated with a combination of CRS and HIPEC between January 2009 and December 2018 in 22 French centers and died in the hospital, were retrospectively analyzed. Perioperative data of the 101 patients were collected by a local senior surgeon with a sole junior surgeon. Three independent experts investigated the typical root cause of death and provided conclusions on whether postoperative death was preventable (PREV group) or not (NON-PREV group). A typical root cause of preventable postoperative death was classified on a cause-and-effect diagram.

Results:

Of the 5562 CRS+HIPEC procedures performed, 101 in-hospital deaths (1.8%) were identified, of which a total of 18 patients of 70 years old and above and 20 patients with ASA score of 3. Etiology of peritoneal disease was mainly colorectal. A total of 54 patients (53%) were classified in the PREV group and 47 patients (47%) in the NON-PREV group. The results of the study show that in the PREV group, WHO performance status 1-2 was more frequent and the Median Peritoneal Cancer Index was higher compared with those of the NON-PREV group. The cause of death in the PREV group was classified as: (i) preoperatively for debatable indication (59%), (ii) intraoperatively (30%) and (iii) postoperatively in 17 patients (31%). A multifactorial cause of death was found in 11 patients (20%).

Conclusion:

More than half of the postoperative deaths after combined CRS and HIPEC may be preventable, mainly by following guidelines regarding preoperative selection of the patients and adequate intraoperative decisions.
Improving Surgical Research Capacity in Low- and Middle-Income Countries
Authors: Ullrich Sarah J. , Kisa Phyllis , Muzira Arlene , White Erin M. , Nabukenya Mary , Tumukunde Janat , Kakembo Nasser , Sekabira John , Chang David C. , Ozgediz Doruk
Published: August 2021

Objective:

The aim of this study was to empirically determine the optimal sample size needed to reliably estimate perioperative mortality (POMR) in different contexts.

Summary Background Data:

POMR is a key metric for measuring the quality and safety of surgical systems and will need to be tracked as surgical care is scaled up globally. Continuous collection of outcomes for all surgical cases is not the standard in high-income countries and may not be necessary in low- and middle-income countries.

Methods:

We created simulated datasets to determine the sampling frame needed to reach a given precision. We validated our findings using data collected at Mulago National Referral Hospital in Kampala, Uganda. We used these data to create a tool that can be used to determine the optimal sampling frame for a population based on POMR rate and target POMR improvement goal.

Results:

Precision improved as the sampling frame increased. However, as POMR increased, lower sampling percentages were needed to achieve a given precision. A total of 357 eligible cases were identified in the Mulago database with an overall POMR rate of 14%. Precision of ±10% was achieved with 34% sampling, and precision of ±25% was obtained at 9% sampling. Using simulated datasets, a tool was created to determine the minimum sample percentage needed to detect a given mortality improvement goal.

Conclusions:

Reliably tracking POMR does not require continuous data collection. Data driven sampling strategies can be used to decrease the burden of data collection to track POMR in resource-constrained settings.
Impact of the COVID-19 Pandemic on Long-term Recovery From Traumatic Injury
Authors: Herrera-Escobar Juan P. , Wang Joyce , Lamarre Taylor , Patel Nikita , Orlas Claudia P. , El Moheb Mohamad , Levy-Carrick Nomi C. , Sanchez Sabrina E. , Velmahos George , Kaafarani Haytham MA , Salim Ali , Nehra Deepika
Published: August 2021

Objective:

Determine the proportion and characteristics of traumatic injury survivors who perceive a negative impact of the COVID-19 pandemic on their recovery and to define post-injury outcomes for this cohort.

Background:

The COVID-19 pandemic has precipitated physical, psychological, and social stressors that may create a uniquely difficult recovery and reintegration environment for injured patients.

Methods:

Adult (≥18 years) survivors of moderate-to-severe injury completed a survey 6 to 14 months post-injury during the COVID-19 pandemic. This survey queried individuals about the perceived impact of the COVID-19 pandemic on injury recovery and assessed post-injury functional and mental health outcomes. Regression models were built to identify factors associated with a perceived negative impact of the pandemic on injury recovery, and to define the relationship between these perceptions and long-term outcomes.

Results:

Of 597 eligible trauma survivors who were contacted, 403 (67.5%) completed the survey. Twenty-nine percent reported that the COVID-19 pandemic negatively impacted their recovery and 24% reported difficulty accessing needed healthcare. Younger age, lower perceived-socioeconomic status, extremity injury, and prior psychiatric illness were independently associated with negative perceived impact of the COVID-19 pandemic on injury recovery. In adjusted analyses, patients who reported a negative impact of the pandemic on their recovery were more likely to have new functional limitations, daily pain, lower physical and mental component scores of the Short-Form-12 and to screen positive for PTSD and depression.

Conclusions:

The COVID-19 pandemic is negatively impacting the recovery of trauma survivors. It is essential that we recognize the impact of the pandemic on injured patients while focusing on directed efforts to improve the long-term outcomes of this already at-risk population.
Defining Global Benchmarks in Elective Secondary Bariatric Surgery Comprising Conversional, Revisional, and Reversal Procedures
Authors: Gero Daniel , Vannijvel Marie , Okkema Sietske , Deleus Ellen , Lloyd Aaron , Lo Menzo Emanuele , Tadros George , Raguz Ivana , San Martin Andres , Kraljević Marko , Mantziari Styliani , Frey Sebastien , Gensthaler Lisa , Sammalkorpi Henna , Garcia-Galocha José Luis , Zapata Amalia , Tatarian Talar , Wiggins Tom , Bardisi Ekhlas , Goreux Jean-Philippe , Seki Yosuke , Vonlanthen René , Widmer Jeannette , Thalheimer Andreas , Kasama Kazunori , Himpens Jacques , Hollyman Marianne , Welbourn Richard , Aggarwal Rajesh , Beekley Alec , Sepulveda Matias , Torres Antonio , Juuti Anne , Salminen Paulina , Prager Gerhard , Iannelli Antonio , Suter Michel , Peterli Ralph , Boza Camilo , Rosenthal Raul , Higa Kelvin , Lannoo Matthias , Hazebroek Eric J. , Dillemans Bruno , Clavien Pierre-Alain , Puhan Milo , Raptis Dimitri A. , Bueter Marco
Published: August 2021

Objective:

To define “best possible” outcomes for secondary bariatric surgery (BS).

Background:

Management of poor response and of long-term complications after BS is complex and under-investigated. Indications and types of reoperations vary widely and postoperative complication rates are higher compared to primary BS.

Methods:

Out of 44,884 BS performed in 18 high-volume centers from 4 continents between 06/2013-05/2019, 5,349 (12%) secondary BS cases were identified. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of centers. Benchmark cases had no previous laparotomy, diabetes, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, thromboembolic events, BMI> 50 kg/m2 or age> 65 years.

Results:

The benchmark cohort included 3143 cases, mainly females (85%), aged 43.8 ± 10 years, 8.4 ± 5.3 years after primary BS, with a BMI 35.2 ± 7 kg/m2. Main indications were insufficient weight loss (43%) and gastro-esophageal reflux disease/dysphagia (25%). 90-days postoperatively, 14.6% of benchmark patients presented ≥1 complication, mortality was 0.06% (n = 2). Significantly higher morbidity was observed in non-benchmark cases (OR 1.37) and after conversional/reversal or revisional procedures with gastrointestinal suture/stapling (OR 1.84). Benchmark cutoffs for conversional BS were ≤4.5% re-intervention, ≤8.3% re-operation 90-days postoperatively. At 2-years (IQR 1–3) 15.6% of benchmark patients required a reoperation.

Conclusion:

Secondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS.
Root-cause Analysis of Mortality After Pancreatic Resection (CARE Study)
Authors: Beugniez César , Sauvanet Alain , Sulpice Laurent , Gaujoux Sébastien , Turrini Olivier , Truant Stéphanie , Schwarz Lilian , Piessen Guillaume , Regimbeau Jean Marc , Muscari Fabrice , Adham Mustapha , Pattou François , Schneider Lucil , Clement Guillaume , Delpero Jean-Robert , Pruvot François-René , El Amrani Mehdi
Published: August 2021

Objectives:

Analyze a multicenter cohort of deceased patients after pancreatectomy in high-volume centers in France by performing a root-cause analysis (RCA) to define the avoidable mortality rate.

Background:

Despite undeniable progress in pancreatic surgery for over a century, postoperative outcome remains particularly worse and could be further improved.

Methods:

All patients undergoing pancreatectomy between January 2015 and December 2018 and died postoperatively within 90 days after were included. RCA was performed in 2 stages: the first being the exhaustive collection of data concerning each patient from preoperative to death and the second being blind analysis of files by an independent expert committee. A typical root cause of death was defined with the identification of avoidable death.

Results:

Among the 3195 patients operated on in 9 participating centers, 140 (4.4%) died within 90 days after surgery. After the exclusion of 39 patients, 101 patients were analyzed. The cause of death was identified in 90% of cases. After RCA, mortality was preventable in 30% of cases, mostly consequently to a preoperative assessment (disease evaluation) or a deficient postoperative management (notably pancreatic fistula and hemorrhage). An inappropriate intraoperative decision was incriminated in 10% of cases. The comparative analysis showed that young age and arterial resection, especially unplanned, were often associated with avoidable mortality.

Conclusions:

One-third of postoperative mortality after pancreatectomy seems to be avoidable, even if the surgery is performed in high volume centers. These data suggest that improving postoperative pancreatectomy outcome requires a multidisciplinary, rigorous, and personalized management.