bluuebunny/crossref_metadata_2025 huggingface dataset:
Amniotic Membrane Scaffolds Support Organized Muscle Regeneration in A Murine Volumetric Muscle Defect Model
Authors: Awad Mohamed , Kurlander David E. , Kotha Vikas S. , Malone Kevin , Davidson Edward H. , Kumar Anand R.
Published: September 2022

Background:

Current treatment for volumetric muscle loss is limited to muscle transfer or acellular collagen scaffold (ACS) therapies that are associated with donor site morbidity and nonfunctional fibrosis, respectively. The aim of this study is to assess the utility of amniotic membrane scaffold (AMS) for volumetric muscle loss treatment.

Methods:

Murine quadriceps defects were created and randomized to three groups (n = 5/group): untreated controls, ACS, and AMS. In vivo muscle regeneration volume was quantified by MRI and microcomputed tomography. Muscle explants were analyzed using standard histology and whole-mount immunofluorescence at 8 weeks.

Results:

The cross-sectional muscle regeneration ratio was 0.64 ± 0.3 for AMS, 0.48 ± 0.07 for ACS, and 0.4 0 ± 0.03 for controls as assessed by MRI (P = 0.09) and 0.61 ± 0.28 for AMS, 0.50 ± 0.06 for ACS, and 0.43 ± 0.04 for controls as assessed by microcomputed tomography (P = 0.2). Histologically, AMS demonstrated significantly higher cellular density (900 ± 2 70 nuclei/high powered field) than ACS (210 ± 36) and control (130 ± 4) groups (P = 0.05). Immunofluorescence for laminin (AMS 623 ± 11 versus ACS 339 ± 3 versus control 115 ± 7; P < 0.01) and myosin heavy chain (AMS 509 ± 7 versus ACS 288 ± 5 versus control 84 ± 5; P = 0.03) indicated greater organized muscle fiber formation with AMS.

Conclusion:

AMS mediated muscle healing was characterized by increased cellular infiltration and organized muscle formation when compared with controls and ACS.
Distal and Proximal Predictors of Rehospitalization Over 10 Years Among Survivors of TBI: A National Institute on Disability, Independent Living, and Rehabilitation Research Traumatic Brain Injury Model Systems Study
Authors: Lercher Kirk , Kumar Raj G. , Hammond Flora M. , Hoffman Jeanne M. , Verduzco-Gutierrez Monica , Walker William C. , Zafonte Ross D. , Dams-O'Connor Kristen
Published: September 2022

Objective:

To describe the rates and causes of rehospitalization over a 10-year period following a moderate-severe traumatic brain injury (TBI) utilizing the Healthcare Cost and Utilization Project (HCUP) diagnostic coding scheme.

Setting:

TBI Model Systems centers.

Participants:

Individuals 16 years and older with a primary diagnosis of TBI.

Design:

Prospective cohort study.

Main Measures:

Rehospitalization (and reason for rehospitalization) as reported by participants or their proxies during follow-up telephone interviews at 1, 2, 5, and 10 years postinjury.

Results:

The greatest number of rehospitalizations occurred in the first year postinjury (23.4% of the sample), and the rates of rehospitalization remained stable (21.1%-20.9%) at 2 and 5 years postinjury and then decreased slightly (18.6%) at 10 years postinjury. Reasons for rehospitalization varied over time, but seizure was the most common reason at 1, 2, and 5 years postinjury. Other common reasons were related to need for procedures (eg, craniotomy or craniectomy) or medical comorbid conditions (eg, diseases of the heart, bacterial infections, or fractures). Multivariable logistic regression models showed that Functional Independence Measure (FIM) Motor score at time of discharge from inpatient rehabilitation was consistently associated with rehospitalization at all time points. Other factors associated with future rehospitalization over time included a history of rehospitalization, presence of seizures, need for craniotomy/craniectomy during acute hospitalization, as well as older age and greater physical and mental health comorbidities.

Conclusion:

Using diagnostic codes to characterize reasons for rehospitalization may facilitate identification of baseline (eg, FIM Motor score or craniotomy/craniectomy) and proximal (eg, seizures or prior rehospitalization) factors that are associated with rehospitalization. Information about reasons for rehospitalization can aid healthcare system planning. By identifying those recovering from TBI at a higher risk for rehospitalization, providing closer monitoring may help decrease the healthcare burden by preventing rehospitalization.
Clinical and Socioeconomic Burden of Respiratory Syncytial Virus in Iceland
Authors: Oskarsson Ymir , Haraldsson Asgeir , Oddsdottir Bryndis Hogna I , Asgeirsdottir Tinna Laufey , Thors Valtyr
Published: September 2022

Introduction:

Respiratory syncytial virus (RSV), a very common pathogen, causes variable disease severity. In addition to considerable clinical burden on children, their families and healthcare facilities, RSV infections in children also carry significant direct and indirect socioeconomic burden.

Methods:

We analyzed data from 5 consecutive RSV seasons (2015–2020) and used virologically confirmed RSV infections and age <5 years as case definition. Clinical information was retrieved from electronic patient records. Costs were estimated by assuming an annual 30% attack rate and a combination of direct medical costs and calculations of societal costs of lost productivity.

Results:

A total of 716 children younger than 5 years of age had confirmed RSV infection of which 254 needed hospitalizations, most of whom were previously healthy. The median length of admission was 3.6 days and 13 patients needed intensive care. The hospital admission incidence rate was 2.5/1000 children/year, but 9.1 for children younger than 1 years of age. The total annual cost of RSV was estimated at €4.3 million, of which 10% was direct healthcare costs.

Discussion:

The clinical and socioeconomic disease burden of RSV in Iceland is substantial despite slightly lower hospital admission rates than other high-income countries. The prevention of RSV in young children, either through maternal or infant vaccination, has the potential to decrease both clinical and financial impact of the annual epidemics.
Breast Milk and Saliva for Postnatal Cyto†megalovirus Screening among Very Low Birth Weight Infants
Authors: Mukhopadhyay Sagori , Itell Hannah L. , Hartman Erica , Woodford Emily , Dhudasia Miren B. , Steppe Justin T. , Valencia Sarah , Roark Hunter , Wade Kelly C. , Weimer Kristin E. D. , Permar Sallie R. , Puopolo Karen M.
Published: September 2022

Background:

The optimal approach to managing postnatal cytomegalovirus disease (pCMV) among very low birth weight (VLBW) infants remains unknown. Methods to facilitate screening are needed.

Objective:

Determine whether mother’s milk and infant saliva can be used to reliably identify maternal cytomegalovirus (CMV) serostatus and detect infant pCMV acquisition.

Methods:

This was a single-center, prospective cohort study of VLBW infants, and their mothers, born between 2017 and 2020. Maternal milk samples were tested for CMV immunoglobulin G (IgG) using a CMV glycoprotein B binding enzyme-linked immunosorbent assay and the results were compared with maternal serum CMV IgG results. Biweekly paired saliva and urine samples were collected from infants born to mothers with positive or unknown CMV serostatus. Saliva samples were tested for CMV DNA by quantitative real-time polymerase chain reaction (PCR) and compared with urine CMV qualitative PCR results obtained from a clinical laboratory.

Results:

Among 108 infants without congenital CMV included in the study, 10 (9%) acquired pCMV. Both milk and blood CMV serology results were available for 70 mothers. Maternal milk antibody testing had a sensitivity of 97.2% (95% CI: 85.5–99.9%) and specificity of 91.2% (95% CI: 76.3–98.1%) in establishing CMV serostatus. Paired serially collected saliva and urine samples (n = 203) were available for 66 infants. Saliva PCR had a sensitivity of 30.0% (95% CI: 6.7–65.2%) and specificity of 92.7% (95% CI: 88.1–96.0%) in detecting pCMV acquisition.

Conclusions:

Maternal breast milk is a reliable alternative sample to determine CMV serostatus. Serial testing of infant saliva was not adequately sensitive for identifying pCMV acquisition in preterm infants.
Actinomycosis of the Middle Ear in Children: Case Report and Literature Review
Authors: Ohnishi Takuma , Sato Satoshi , Asanuma Satoshi , Uejima Yoji , Suganuma Eisuke
Published: September 2022

Actinomycosis of the middle ear is a rare infectious disease, characterized by a slowly progressive clinical course. We report the case of a 9-year-old girl with recurrent otitis media, who presented with clinical signs of a cholesteatoma. She underwent tympanoplasty and ossiculoplasty. After surgery, actinomycosis was diagnosed histologically. We also provide a review of 16 published pediatric cases.
The Impact of a Multifaceted Tertiary Pediatric Hospital’s Antimicrobial Stewardship Service
Authors: Goff Zoy , Abbotsford Joanne , Yeoh Daniel K. , Bowen Asha C. , Campbell Anita J. , Foley David A. , Ford Timothy J. , Hazelton Briony , Thu Le Huong , McLeod Charlie , Ware Benjamin , Snelling Thomas , Blyth Christopher C.
Published: September 2022

Background:

Antimicrobials are the most commonly prescribed drug class in children. Overuse through inappropriate prescribing is a key driver of antimicrobial resistance and is recognized as one of the top 10 threats to global health by the World Health Organization.

Methods:

A prospective observational cohort study was performed following implementation of a multifaceted Antimicrobial Stewardship (AMS) program (January 2014 to December 2020). Data were collected on AMS and “handshake” ward rounds from patient information sources and directly from clinicians responsible for patient care. Primary outcomes include appropriateness of therapy (drug, dose, antimicrobial spectrum, duration and route), compliance with prescribing guidelines, antimicrobial expenditure, use of high-priority antimicrobials and duration of hospitalization. We compared outcomes across 3 time periods; January 2014–December 2015, January 2016–December 2017 and January 2018–December 2020.

Results:

The appropriateness of individual antimicrobial orders improved across the study periods from 6111/7040 (79.4%) in the first 2 years following implementation of the AMS program to 17,819/19,229 (92.3%) in the latter period. Guideline compliance increased from 5426/7700 (70.5%) to 17,822/19,316 (92.3%). A reduction in overall antimicrobial expenditure (34% reduction, equivalent to $12.52 per bed day) and a decrease in antifungal expenditure (37% reduction, equivalent to $5.56 per bed day) was observed across the time periods.

Conclusions:

This study quantifies a comprehensive pediatric AMS program’s sustained impact on reducing inappropriate antimicrobial use and expenditure and improving compliance with guidelines. The effectiveness of these interventions has been demonstrated and should be considered by institutions seeking to improve rational antimicrobial use in children.
Capsular tension ring as protective measure against in-the-bag dislocations after cataract surgery
Authors: Mayer-Xanthaki Christoph F. , Hirnschall Nino , Pregartner Gudrun , Gabriel Maximilian , Falb Thomas , Sommer Michael , Haas Anton
Published: September 2022

Purpose:

To assess the influence of capsular tension ring (CTR) implantation on the development of in-the-bag (ITB) dislocations after cataract surgery.

Setting:

Department of Ophthalmology Graz, Graz, Austria.

Design:

Single-center, retrospective cohort study.

Methods:

The medical records of patients who underwent cataract operation between 1996 and 2017 were analyzed. Cox proportional hazards regression analysis was used to assess the influence of CTR implantation and other predisposing factors (pseudoexfoliation [PEX], age, retinitis pigmentosa, sex, zonular weakness, uveitis, high myopia, and intraocular lens design and material) on ITB dislocations.

Results:

ITB dislocations were found in 111 (0.16%) of 68199 eyes (46 632 patients). In the multivariate analysis adjusted for other predisposing risk factors, a CTR implantation was associated with a lower risk of an ITB dislocation (hazard ratio [HR], 0.29; 95% CI, 0.11-0.80; P = .017). In eyes with PEX, a CTR implantation was associated with an HR of 0.16 (95% CI, 0.04-0.70; P = .015), whereas eyes without PEX had an HR of 0.80 (95% CI, 0.14-4.41; P = .793). A CTR implantation in eyes with zonular weakness resulted in a potentially lower risk (HR, 0.37; 95% CI, 0.12-1.12; P = .078).

Conclusions:

According to the dataset, implantation of a CTR was a protective measure against an ITB dislocation. Especially in patients with zonular weakness and PEX, the CTR implantation was association with a lower risk of ITB dislocations. In patients without PEX, no association was established.
Predictive Model for Quality of Life in Patients With Heart Failure
Authors: Park Ju-Kyung , Ahn Jeong-Ah , Hayman Laura L. , Park Jin-Sun , Kim Chun-Ja
Published: September 2022

Background

Although many studies have been conducted to examine predictors of quality of life (QoL), little information exists on the real-world application of Rector's conceptual model for QoL related to heart failure (HF).

Objectives

In this study, we aimed to examine a hypothetical model of QoL based on Rector's conceptual model for QoL in relation to HF and the existing literature on patients with HF.

Methods

Using a cross-sectional survey, 165 patients with HF were recruited from an outpatient clinic in Korea. Data were collected based on Rector's model constructs, such as cardiac function, symptoms, functional limitation, depression, distress, and QoL. Left ventricular ejection fraction for cardiac function was measured using echocardiography.

Results

Functional limitation, depression, and distress, but not symptoms, had a direct effect on QoL (all Ps < .001). Cardiac function and symptoms directly affected functional limitation (β = 0.186, P = .004, and β = −0.488, P = < .001, respectively), whereas cardiac function, symptoms, and depression affected QoL through functional limitation and distress.

Conclusions

These results confirm that the Rector's model is suitable for predicting QoL in patients with HF. These findings have potential to guide and inform intervention programs designed to alleviate symptoms in patients with HF, enhance their physical functioning, and moderate their psychological distress with the ultimate goal of improving their QoL.
Utility of a Handheld Blood Ketone Meter as a Postmortem Indicator of Diabetic Ketoacidosis
Authors: Mitchell Caris , McCleskey Brandi
Published: September 2022

When investigating a death potentially due to diabetic ketoacidosis (DKA), it is challenging to assess the glucose level in the blood, but β-hydroxybutyrate, the most prevalent ketone body in the blood, is relatively stable after death. The aim of this project is to prove that a commercially available ketone meter can be used on postmortem blood samples to aid the diagnosis of DKA in a novel setting (during coroner/medical examiner examination). Samples with acetone detected via gas chromatography were chosen retrospectively to determine whether the meter could detect ketones in postmortem blood (proof-of-concept). In all of the thawed samples, the meter detected an elevated ketone level. Samples were then obtained in a prospective manner to include those with a possible cause of death from DKA along with controls. We correctly identified 16 cases in which death was due to DKA with use of the ketone manner. The ketone levels ranged from 2.6 to 5.4 mmol/L in those cases. The diagnosis was confirmed with a greatly elevated vitreous glucose concentration or glycated hemoglobin concentration. Detecting the presence of ketones while in the autopsy suite allowed for more accurate preliminary diagnoses and utilization of resources.
Opioid Co-Prescribing with Sedatives After Implant-Based Breast Reconstruction
Authors: Santosa Katherine B. , Wang Christine S. , Hu Hsou-Mei , Mullen Connor R. , Brummett Chad M. , Englesbe Michael J. , Bicket Mark C. , Myers Paige L. , Waljee Jennifer F.
Published: September 2022

Background:

Skeletal muscle relaxants (SMR) and benzodiazepines are thought to mitigate against postoperative muscle contraction. The Centers for Disease Control and the Food and Drug Administration warn against co-prescribing opioids with SMR/benzodiazepines due to increased risks of overdose and death. We evaluated the frequency of co-prescribing of opioids with SMRs/benzodiazepines after implant-based reconstruction.

Methods:

We examined healthcare claims to identify women (18-64 years old) who underwent implant-based breast reconstruction (IBBR) between January 2008 and June 2019 to determine the frequency of co-prescribing and associated factors. We determined factors associated with co-prescribing of opioids and SMRs/benzodiazepines, and the impact on opioid refills within 90 days of reconstruction.

Results:

86.7% (7,574) of women who had IBBR filled an opioid prescription peri-operatively. Of these, 27.7% of women filled opioids and benzodiazepines, 14.4% filled opioids and SMRs, and 2.4% filled opioids, benzodiazepines, and SMRs. Risk factors for co-prescribing opioids and benzodiazepines include use of acellular dermal matrix, immediate reconstruction, and history of anxiety. Women who filled opioids and SMRs, opioids and benzodiazepines, and opioids with SMRs and benzodiazepines were significantly more likely to refill opioid prescriptions, even when controlling for preoperative opioid exposure.

Conclusions:

Nearly half of women filled an opioid prescription with a benzodiazepine, SMR, or both after IBBR. Co-prescribing of opioids with SMRs may potentiate opioid use after surgery and should be avoided given the risks of sedation. Identifying strategies that avoid sedatives to manage pain following breast reconstruction is critical to mitigate high-risk prescribing practices.
Clinical Evaluation of Safety and Efficacy of Radio-Frequency Assisted Lipolysis (RFAL) on Breast Envelope and Nipple-Areolar Complex (NAC) Position
Authors: Unger Jacob G. , Agochukwu-Nwubah Nneamaka , Theodorou Spero , Maxwell G. Patrick
Published: September 2022

Background/Purpose:

Breast ptosis as a result of pregnancy and/or breastfeeding, age, genetics and weight loss is a common complaint amongst women visiting a plastic surgeon. This study sought to evaluate the utility, efficacy and safety of radiofrequency assisted lipolysis on the breast and nipple-areola complex position in women with breast ptosis.

Methods:

This was a single center (Maxwell Aesthetics) study of female desiring tightening of the breast envelope and elevation of the nipple areolar complex (NAC). Each patient underwent 1 treatment with RFAL in the operating room. RFAL was applied to each breast with a BodyTite Pro handpiece. Patients were evaluated preoperatively and postoperatively at: 6 weeks, 3 months, 6 months and 12 months via manual and 3D computer generated measurements (Vectra).

Results:

10 female patients were enrolled. Ages ranged from 23-54. Follow up was 12 months. Data was captured for seven measurements from the nipple longitudinally at five time points. The sternal notch to the nipples (SN-N) distance, nipple to inframammary fold (N-IMF) and nipple to nipple (N-N), improved statistically at 6- week follow-up ,which persisted through the 12-month follow-up (p<0.05). Patient questionnaires revealed moderate to excellent satisfaction.

Conclusions:

Radiofrequency assisted Lipolysis with a bipolar device to deliver RF energy to the breast is an effective modality to moderately improve breast ptosis. This study demonstrates that this treatment improves breast measurements across time, regardless of measurement type (manual versus Vectra). This modality affords a minimally-invasive, effective method to improve mild to moderate breast ptosis with minimal scarring and high patient satisfaction.
“Restylane® Lyft for aesthetic shaping of the nasal dorsum and radix - A randomized, no-treatment control, multi-center study”
Authors: Wang Xiaojun , Li Bi , Li Qin
Published: September 2022

Background:

Hyaluronic acid fillers are widely used in non-surgical rhinoplasty.

Methods:

We performed a no-treatment control, multi-center, 12-month follow-up study to evaluate efficacy and safety of Restylane® Lyft (Galderma Aesthetics, Sweden) in shaping the nasal dorsum and radix. Assignment to Restylane Lyft or no-treatment control was randomized (3:1). The Restylane Lyft group received ≤1 mL Restylane Lyft on Day 1; the control group was offered ≤1 mL Restylane Lyft at Month 6. Both groups were offered re-treatment (≤0.5 mL Restylane Lyft) at Month 12. Outcome assessments included blinded evaluation of 3D photography measurements of change in volume (primary endpoint; Month 6) and elevation of the nasal dorsum and radix, aesthetic improvement, adverse events (AEs) and diary-reported injection-site reactions.

Results:

132 Chinese subjects were enrolled. The Restylane Lyft group had a greater increase in volume of the nasal dorsum and radix than the no-treatment control (mean difference at Month 6: 0.71 mL [95% confidence interval: 0.59-0.83; p<0.001]). Restylane Lyft was also more effective than no-treatment control in achieving an elevation of the nasal dorsum and radix. The increase in volume and elevation persisted up to 12 months after injection, and was supported by clinical assessments of aesthetic improvement. Treatment-related AEs were mild-to-moderate, non-serious and resolved during the study. Injection-site reactions were mostly mild-to-moderate, and resolved within one week.

Conclusions:

Restylane Lyft injection was effective for aesthetic shaping of the nasal dorsum and radix and achieved aesthetic improvement for up to 12 months with an acceptable safety profile.
Added Value of Magnetic Resonance Over Computed Tomography in Distinguishing Nonneoplastic Complex Thymic Cysts From Malignant Cystic Thymic Neoplasms
Authors: Madan Rachna , Phillips William W. , Colson Yolonda L. , Hammer Mark Morris
Published: September 2022

Purpose

The aim of the study was to evaluate cystic thymic masses by using computed tomography (CT) and magnetic resonance (MR) scoring systems to differentiate nonneoplastic thymic cysts from cystic thymic neoplasms.

Methods

This retrospective multisite study included adult patients who underwent CT and MR imaging of the chest between 2007 and 2020 with any of the following impressions on cross-sectional imaging studies: “thymic mass with cystic component,” “unilocular or multilocular cystic thymic lesion,” “complex thymic cyst,” “thymic cyst with hemorrhage.” Two blinded radiologists reviewed and recorded specific imaging features as well as overall impressions on both CT and MR using a Likert scale scoring system. Data were analyzed, and diagnostic accuracy of CT and MR was compared using areas under the receiver operating characteristic curves (AUC).

Results

Fifty-six patients were included, of which 45 (80%) had benign masses. Total of 21 patients (38%) had indeterminate scores on CT of which 3 (14%) were malignant, while only 6 (11%) had indeterminate scores on MR and 1 was malignant. Magnetic resonance scoring system (AUC, 0.95) performed better than CT scoring system (AUC, 0.86) in distinguishing benign versus malignant lesions (P = 0.06). Lack of enhancement within the mass was completely predictive of benign etiology (P < 0.001). Wall thickness of an enhancing cyst was predictive of malignancy, with AUC 0.93.

Conclusions

Magnetic resonance yielded higher specificity allowing a larger number of lesions to be confidently assigned a benign diagnosis. This could help in averting unnecessary follow-up, biopsies, or surgery. The authors recommend follow-up imaging with MR for prevascular masses, even those appearing “solid” on CT.
Distinguishing Intrathyroid Parathyroid Adenoma from Colloid Nodules and Papillary Thyroid Carcinomas Using Multiphasic Multidetector Computed Tomography
Authors: Debnam J. Matthew , Chi T. Linda , Kwon Michael , Sun Jia , Schellingerhout Dawid , Golant Brandon T. , Ahmed Salmaan , Perrier Nancy D. , Vu Thinh
Published: September 2022

Objective

The aim of the study is to determine whether multiphase multidetector computed tomography (4D-MDCT) can differentiate between intrathyroid parathyroid adenomas (ITPAs), colloid nodules, and papillary thyroid carcinoma (PTC).

Methods

We studied 22 ITPAs, 22 colloid nodules, and 11 PTCs in 55 patients. Hounsfield unit (HU) values of the nodules were measured on 4D-MDCT in the precontrast, arterial, venous, and delayed phases. Raw HU values, phase with peak enhancement, and washout percentages between the phases were evaluated.

Results

Regardless of size, all ITPAs (22/22) showed peak enhancement in the arterial phase, which was significantly greater than both colloid nodules (15/22) and PTC (6/11, P = 0.002); thus, nodules with peak enhancement in the venous or delayed phase were not ITPAs (specificity = 1). For nodules with peak enhancement in the arterial phase, the percentage washout in the arterial-to-venous phases separated ITPAs from PTC and colloid nodules (P < 0.001) with greater than or equal to 23.95% loss of HU value implying IPTA (area under curve, 0.79). This left a subset of colloid nodules or PTC that either peaked in the venous or delayed phase or had an arterial-to-venous phase washout of less than 23.95%. From this subset, PTC measuring 1 cm or greater could be separated from colloid based on HU values in the arterial phase with a cutoff HU value less than 81.4 for PTC (area under curve, 0.72) and an HU value greater than 164.5 suggested colloid.

Conclusions

Intrathyroid parathyroid adenomas can be distinguished from colloid nodules and PTC by peak enhancement in the arterial phase and rapid washout. A subset of colloid and PTC measuring 1 cm or greater can be separated using arterial phase HU values.
A 3-Dimensional Evaluation of Bone Density in Alveolar Cleft Grafting Methods: Bone Substitutes Versus Autologous Bone
Authors: Bianchi Alberto , Cicciù Marco , Ruggiero Federica , Crimi Salvatore , Amadori Sara , Bassi Massimo , Gurrera Giorgio , Marchetti Claudio
Published: September 2022

Introduction:

Secondary alveolar cleft repair using autologous bone graft is currently the gold standard in treating residual alveolar clefts. Despite its effectiveness, this technique is still burdened by several withdrawals, mostly related to donor site morbidity. To decrease disadvantages for patients, numerous attempts in the literature regarding bone substitutes have been described. The aim of this study is to compare the viability of bovine-based replacement bone material with respect of autologous bone graft in alveolar cleft reconstruction, through 3-dimensional alveolar cleft segmentation and bone density evaluation from preoperative and postoperative cone-beam computed tomography.

Patients and Methods:

A retrospective cohort study of 10 patients who underwent surgical procedure for alveolar cleft grafting at Sant’Orsola Malpighi University Hospital of Bologna from December 2012 to December 2016 was undertaken. Five patients received autologous bone graft and 5 a bovine bone substitute graft. Preoperative and immediate postoperative orthopanoramic x-rays were recorded. Cone-beam computed tomography scans have recorded both pre and postoperatively. Volumetric evaluation on 3-dimensional cone-beam computed tomography images was performed.

Results:

Alveolar clefts repaired using substitute bovine bone/biological membrane scaffold had a mean fill of 69.00% of total cleft volume, while this figure was of 67.07% with autologous bone grafting. The immediate postoperative course and subsequent discharge were uneventful for both groups, with a difference in timing. The cost of substitute bovine bone was offset by cost savings associated with a reduction in operative and postoperative and hospitalization time.

Conclusions:

Bone substitutes showed to be a promising solution in alveolar cleft grafting.
II-Y–Shaped Vascular Anastomosis for Free Flap Transfer in Head and Neck Reconstruction in Vessel-Depleted Neck
Authors: Miao Cheng , Ma Zhongkai , Li Chunjie
Published: September 2022

In vessel-depleted neck, salvage free flap transfer for head and neck reconstruction is challenging because the difficulty of selecting the recipient vessel and the discrepancy of vessel diameters. Here, the authors describe a novel technique for vascular anastomosis, which allows 2 thin donor veins end-to-end anastomosed with the larger recipient vein. This II-Y–shaped vascular anastomosis for free flap reconstruction were performed at Department of Head and Neck Surgery, Oral and Maxillofacial Oncology, West China Stomatology Hospital, Sichuan University. The patient received anterolateral thigh flap transfer after tumor excision. The ligated stump of external jugular vein was anastomosed to the enlarged accompanying veins of the anterolateral thigh flap. The flap survived completely without complications. The II-Y–shaped vascular anastomosis procedures were easy to perform and no complications were observed. Result suggests this novel technique could be useful in free flap transfer in vessel-depleted neck as an efficient way of adjusting the limited diameters.
Textbook Outcome as a Quality Metric in Living and Deceased Donor Kidney Transplantation
Authors: Schenk Austin D , Logan April J , Sneddon Jeffrey M , Faulkner Daria , Han Jing L , Brock Guy N , Washburn William K
Published: September 2022

BACKGROUND:

Quality in kidney transplantation is measured using 1-year patient and graft survival. Because 1-year patient and graft survival exceed 95%, this metric fails to measure a spectrum of quality. Textbook outcomes (TO) are a composite quality metric offering greater depth and resolution. We studied TO after living donor (LD) and deceased donor (DD) kidney transplantation.

STUDY DESIGN:

United Network for Organ Sharing data for 69,165 transplant recipients between 2013 and 2017 were analyzed. TO was defined as patient and graft survival of 1 year or greater, 1-year glomerular filtration rate of greater than 40 mL/min, absence of delayed graft function, length of stay of 5 days or less, no readmissions during the first 6 months, and no episodes of rejection during the first year after transplantation. Bivariate analysis identified characteristics associated with TO, and covariates were incorporated into multivariable models. Five-year conditional survival was measured, and center TO rates were corrected for case complexity to allow center-level comparisons.

RESULTS:

The national average TO rates were 54.1% and 31.7% for LD and DD transplant recipients. The hazard ratio for death at 5 years for recipients who did not experience TO was 1.92 (95% CI 1.68 to 2.18, p ≤ 0.0001) for LD transplant recipients and 2.08 (95% CI 1.93 to 2.24, p ≤ 0.0001) for DD transplant recipients. Center-level comparisons identify 18% and 24% of centers under-performing in LD and DD transplantation. High rates of TO do not correlate with transplantation center volume.

CONCLUSION:

Kidney transplant recipients who experience TO have superior long-term survival. Textbook outcomes add value to the current standards of 1-year patient and graft survival.
Delay to Surgery for Patients with Symptomatic Cholelithiasis: Retrospective Analysis of an Administrative California Database after Discharge from the Emergency Department
Authors: Shenoy Rivfka , Kirkland Patrick , Jackson Nicholas J , DeVirgilio Michael , Zingmond David , Maggard-Gibbons Melinda , Russell Marcia M
Published: September 2022

BACKGROUND:

Timely receipt of surgery should be available for all patients. Few studies have examined differences in the treatment of symptomatic cholelithiasis (SC), a common surgical problem, based on race/ethnicity or insurance status. This study aimed to identify differences in repeat emergency department (ED) use and wait time to cholecystectomy for SC.

STUDY DESIGN:

Patients discharged from the ED with SC between July 1, 2016, and December 31, 2017, were identified from California administrative databases and followed for 1 year. Repeat ED use and wait time to elective and nonelective cholecystectomy after ED discharge were examined using logistic and negative binomial regression models.

RESULTS:

The final cohort analyzed 13,596 patients who underwent cholecystectomy within 1 year from index ED visit for SC. In adjusted analysis, non-Hispanic Black patients had higher odds for repeat ED use for biliary-related conditions before elective surgery and experienced longer waits for cholecystectomy (across several measures of wait times) compared with non-Hispanic White patients. Similar findings were seen for Medicaid and self-pay compared with privately insured patients. For example, self-pay patients had more than double the odds of experiencing repeat ED use while waiting for elective cholecystectomy compared with privately insured patients (adjusted odds ratio 2.49, 95% CI 1.88–3.31).

CONCLUSION:

Patients with SC receiving cholecystectomy within 1 year from index ED visit were more likely to have repeat ED use and longer waits to surgery based on their race/ethnicity and insurance status, even after adjusting for other measures of access. We identify a vulnerable population at risk for differences in treatment for a common surgical pathology.
Use of Direct Oral Anticoagulant and Associated Bleeding and Thrombotic Complication after Lower Extremity Bypass
Authors: Sutzko Danielle C , Kim Gloria Y , Novak Zdenek , Bamezai Sharika , Beaulieu Robert J , Henke Peter K , Osborne Nicholas H , Beck Adam W , Obi Andrea T
Published: September 2022

BACKGROUND:

Therapeutic anticoagulation with either a vitamin K antagonist (VKA) or direct anticoagulant (DOAC) is often newly prescribed to patients undergoing lower extremity bypass (LEB) to aid in graft patency when risk factors for thrombosis are present or to treat postoperative venous thromboembolism or atrial fibrillation. There is a gap in knowledge as to how DOAC usage impacts postoperative outcomes compared with the standard-of-care VKAs.

STUDY DESIGN:

To determine temporal trends in DOAC prescription after infrainguinal LEB, impact on length of stay (LOS), and associated bleeding and thrombotic complications, patients undergoing elective LEB were identified from the Vascular Quality Initiative between January 2013 and May 2019. Postoperative bleeding, LOS, and graft occlusion for patients receiving VKA compared with DOAC were evaluated.

RESULTS:

A total of 24,459 LEBs were performed during the study period. Among 2,656 patients newly prescribed an anticoagulant, 78.0% (n = 2,072) received VKA and 22.0% (n = 584) received a DOAC, with DOAC use increasing throughout the study period. There was no significant difference in postoperative bleeding (VKA 2.3%, DOAC 1.7%, p = 0.413) or graft occlusion (VKA 1.2%, DOAC 1.4%, p = 0.762) between the anticoagulant classes. LOS was shorter in the DOAC group than in the VKA group (5.7 vs 6.8 days; p < 0.001).

CONCLUSIONS:

This analysis demonstrates that DOAC use is increasing with time in Vascular Quality Initiative centers. DOACs are a safe and comparable alternative to VKAs in the postoperative setting with similar rates of bleeding complications and early graft patency and are associated with a reduced postoperative LOS.
How Well Is Surgical Improvement Being Conducted? Evaluation of 50 Local Surgery-Related Improvement Efforts
Authors: Ko Clifford Y , Shah Tejen , Nathens Avery , Grant Catherine , Evans-Labok Kim , Modla Lynn , Morgan Tammy , Pollitt Karen , Reuter Erin DeKoster , Nelson Heidi ,   for the American College of Surgeons Quality Programs Advisory Improvement Committee
Published: September 2022

BACKGROUND:

Delivering high-quality care is paramount; however, evaluations show mixed results. Studies assessing improvement efforts in nonsurgical disciplines show suboptimal conduct, yet little is known about how well improvement efforts in surgery are conducted. This study evaluates local surgical improvement efforts to determine whether opportunities exist to improve their conduct.

STUDY DESIGN:

Fifty consecutive improvement efforts were collected from hospitals participating in 1 of 5 American College of Surgeons Quality Accreditation/Verification Programs. Conduct of these efforts was evaluated using a quality framework (with 39 criteria grouped into 8 components). Descriptive, paired, and 1-way ANOVA analyses were undertaken.

RESULTS:

The mean percentage of 39 criteria fulfilled for the 50 improvement efforts was 36% (range 0% to 72%). Individual criterion scores ranged from 0% to 82%. The 2 highest scoring criteria were improvement planning and problem documentation; the 2 lowest scoring were value assessments and stakeholder value perspective. The highest scoring framework component addressed End-of-Project Decision-Making (47%); the lowest was Cost Evaluation (3%). Twenty-four percent of 50 improvement efforts reported full achievement of project goals, 32% reported partial achievement, and 44% reported no achievement. Higher scores were associated with projects having full/partial achievement of stated project goals vs projects not achieving project goals (p < 0.05). Higher scores were not associated with hospital characteristics (eg bed size, teaching status) or improvement characteristics (eg improvement strategy).

CONCLUSIONS:

Evaluation of local surgical improvement efforts shows opportunities for improvement. Better-conducted improvement efforts were associated with more effective improvement. To support better surgical quality of care, improvement efforts need to improve.
Ultrasound-Guided Anterior Quadratus Lumborum Block at Lateral Supra-Arcuate Ligament vs Thoracic Epidural Analgesia after Open Liver Surgery: A Randomized, Controlled, Noninferiority Trial
Authors: Gu Bin , Zhou Huidan , Lian Yanhong , Zhou Yiming , He Shuang , Xie Kangjie , Jiang Huifang
Published: September 2022

BACKGROUND:

Thoracic epidural analgesia (TEA) has demonstrated great analgesic benefits in open liver surgery. However, the increased risk of postoperative coagulopathy after open liver surgery has promoted interest in alternate analgesic research. We aimed to explore whether ultrasound-guided anterior quadratus lumborum block at the lateral supra-arcuate ligament (LAL-QLB) with intravenous analgesia was noninferior to TEA under multimodal analgesia after open liver surgery.

STUDY DESIGN:

Seventy-four patients undergoing open liver surgery were randomized (1:1) to the LAL-QLB or TEA group in this open-label study. The primary outcome was the numeric rating scale during coughing at 24 hours postoperatively with a noninferiority limit of 1.

RESULTS:

The mean difference of numeric rating scale during coughing at 24 hours postoperatively was 0.32 (95% CI –0.03 to 0.68), showing noninferiority. The TEA group had better pain scores at 1 and 6 hours, and the early postoperative pain of the LAL-QLB group was within the clinically acceptable limit with no differences at other time points. The LAL-QLB group received more opioids within 24 hours postoperatively. There were no differences in analgesia-related adverse reactions or rescue analgesia. Postoperative coagulopathy was responsible with 19.4% of delayed epidural removal. TEA outperformed LAL-QLB in terms of ambulation and bowel recovery. There were no differences in hospital stay or 30-day postoperative complications.

CONCLUSIONS:

LAL-QLB provided noninferior analgesia at 24 hours postoperatively. Despite regarding coagulopathy and delayed epidural removal, TEA was found to be better than LAL-QLB for pain management after open liver surgery. Epidural removal required close coagulation test.
Resolution of Mild Pilonidal Disease in Adolescents Without Resection
Authors: Check Nikki M , Wynne Nicole K , Mooney David P
Published: September 2022

BACKGROUND:

Pilonidal disease is a common condition of the gluteal crease, affecting around 1 in 2,000 adolescents and young adults.
1
Traditional options for management of pilonidal disease include improved hygiene with or without hair removal or resection of the nidus. Given a high recurrence rate associated with hygiene alone, nidus resection is often recommended, even for patients with mild pilonidal disease, despite significant postoperative morbidity. We present a consecutive series of patients with mild pilonidal disease managed in a dedicated Pilonidal Care Clinic using an alternate approach directed toward source control: improved hygiene to limit debris in the gluteal crease, excision of midline pilonidal pits under local anesthesia to prevent intrusion of debris with drainage of any nidus present, and laser ablation of midline follicles to prevent new pits from forming.
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STUDY DESIGN:

Data on demographics, disease severity, symptom scoring, treatments provided, and outcome for consecutive new patients presenting to an outpatient pilonidal care clinic with mild disease between August 2017 and September 2020 were analyzed.

RESULTS:

One hundred two patients presented; their mean age was 16.3 years, 56 (55%) were female, and 42 (41%) had undergone prior nidus incision and drainage. Twenty-four were lost to follow up, and 77 of the 78 who continued care had resolution of their pilonidal disease after a mean of 3 ± 2.5 laser epilations and 1.3 ± 1 pit excisions during 4 ± 2 clinic visits over a treatment duration of 30 ± 19 weeks.

CONCLUSION:

Mild pilonidal disease may be resolved with improved hygiene, pit excision, and laser epilation with minimal morbidity and no activity restrictions. Adoption of this approach may keep a large number of patients with pilonidal disease from undergoing unindicated resection.
Pancreatogenic Diabetes after Partial Pancreatectomy: A Common and Understudied Cause of Morbidity
Authors: Hamad Ahmad , Hyer J Madison , Thayaparan Varna , Salahuddin Aneesa , Cloyd Jordan M , Pawlik Timothy M , Ejaz Aslam
Published: September 2022

BACKGROUND:

Partial pancreatic resection is a known risk factor for new-onset pancreatogenic diabetes mellitus (P-DM). The long-term incidence of P-DM and its clinical impact after partial pancreatic resection remains unknown. The primary objective of this study is to determine the long-term incidence of P-DM and its clinical impact after partial pancreatic resection.

STUDY DESIGN:

The Medicare 100% Standard Analytic File (2013 to 2017) was queried for all patients who underwent partial pancreatic resection (pancreaticoduodenectomy, distal pancreatectomy). The primary outcome was the development of postoperative P-DM after surgery.

RESULTS:

Among 4,255 patients who underwent a pancreaticoduodenectomy or distal pancreatectomy, with a median follow-up of 10.8 months, the incidence of P-DM was 20.3% (n=863) and occurred at a median of 3.6 months after surgery. For patients with at least a 3-year follow-up, 32.2% of patients developed P-DM. Risk factors for developing P-DM included male sex (odds ratio [OR] 1.32, 95% CI 1.13 to 1.54), undergoing a distal pancreatectomy (OR 1.98, 95% CI 1.68 to 2.35), having a malignant diagnosis (OR 1.65, 95% CI 1.34 to 2.04), a family history of diabetes (OR 2.06, 95% CI 1.43 to 2.97; all p < 0.001), and being classified as prediabetic in the preoperative setting (OR 1.57, 95% CI 1.18 to 2.08; p = 0.002). Patients who developed P-DM were more commonly readmitted within 90 days of surgery and had higher postoperative healthcare expenditures in the year after surgery ($24,440 US dollars vs $16,130 US dollars; both p < 0.001) vs patients without P-DM.

CONCLUSIONS:

Approximately 1 in 5 Medicare beneficiaries who undergo a pancreatic resection develop P-DM after pancreatic resection. Appropriate screening and improved patient education should be conducted for these patients, in particular, for those with identified risk factors.
Development and Validation of Task-Specific Metrics for the Assessment of Linear Stapler-Based Small Bowel Anastomosis
Authors: Sankaranarayanan Ganesh , Parker Lisa M , Jacinto Kimberly , Demirel Doga , Halic Tansel , De Suvranu , Fleshman James W
Published: September 2022

INTRODUCTION:

Task-specific metrics facilitate the assessment of surgeon performance. This 3-phased study was designed to (1) develop task-specific metrics for stapled small bowel anastomosis, (2) obtain expert consensus on the appropriateness of the developed metrics, and (3) establish its discriminant validity.

METHODS:

In Phase I, a hierarchical task analysis was used to develop the metrics. In Phase II, a survey of expert colorectal surgeons established the importance of the developed metrics. In Phase III, to establish discriminant validity, surgical trainees and surgeons, divided into novice and experienced groups, constructed a side-to-side anastomosis on porcine small bowel using a linear cutting stapler. The participants’ performances were videotaped and rated by 2 independent observers. Partial least squares regression was used to compute the weights for the task-specific metrics to obtain weighted total score.

RESULTS:

In Phase II, a total of 45 colorectal surgeons were surveyed: 28 with more than 15 years, 13 with 5 to 15 years, and 4 with less than 5 years of experience. The consensus was obtained on all the task-specific metrics in the more experienced groups. In Phase III, 20 subjects participated equally in both groups. The experienced group performed better than the novice group regardless of the rating scale used: global rating scale (p = 0.009) and the task-specific metrics (p = 0.012). After partial least squares regression, the weighted task-specific metric score continued to show that the experienced group performed better (p < 0.001).

CONCLUSION:

Task-specific metric items were developed based on expert consensus and showed good discriminant validity compared with a global rating scale between experienced and novice operators. These items can be used for evaluating technical skills in a stapled small bowel anastomosis model.
The Canadian Consortium for Research in Pediatric Surgery: Roadmap for Creation and Implementation of a National Subspecialty Research Consortium
Authors: Emil Sherif , Guadagno Elena , Baird Robert , Puligandla Pramod , Romao Rodrigo , Van HouWelingen Lisa , Yanchar Natalie L ,   for the Canadian Consortium for Research in Pediatric Surgery (CanCORPS)
Published: September 2022

Clinical practice should be driven by high-quality research that produces evidence to inform best practices. Generation of such evidence is often challenging, particularly for smaller specialties, such as pediatric surgery, that treat many patients with rare diseases. Multi-institutional collaboration is seen as a major strategy to address these challenges. We have recently created the Canadian Consortium for Research in Pediatric Surgery, a national consortium that includes all major pediatric surgical services across Canada. The mission of the Consortium is to improve pediatric surgical care through high-quality collaborative research. In this article, we describe the rationale and methodology for creation of the Canadian Consortium for Research in Pediatric Surgery, demonstrate its achievements to date, and share a number of foundational concepts that are integral to its success. Our aim is to provide a model for creation of such consortia, ultimately leading to improvements in the quality of clinical research and patient care.