bluuebunny/crossref_metadata_2025 huggingface dataset:
Physiotherapist-Led Physical Activity Interventions Are Efficacious at Increasing Physical Activity Levels: A Systematic Review and Meta-analysis
Authors: Kunstler Breanne E. , Cook Jill L. , Freene Nicole , Finch Caroline F. , Kemp Joanne L. , O'Halloran Paul D. , Gaida James E.
Published: October 2017

Objective:

Physical activity (PA) interventions to address noncommunicable disease (NCD) risk are commonly delivered in private practice and outpatient physiotherapy settings. This study reviewed the efficacy of physiotherapist-led physical activity (PLPA) interventions at improving PA levels.

Data sources:

Twelve databases were searched using terms related to both physiotherapy and PA. English-language studies of all designs in adults were included. Meta-analyses were conducted separately for interventions measuring the following: (1) participants meeting recommended PA levels; (2) total PA at short- and long-term follow-up; and (3) total PA achieved after short and long PLPA interventions. Pooled effects were calculated using a fixed-effects model as standardized mean differences (SMDs). Nonstatistical analysis was used to identify the effect of PLPA interventions on the volume of PA performed at different intensities.

Main Results:

From an initial 4140 studies, 8 were retained, and risk of bias ranged from low to high. Meta-analysis showed the odds of adults meeting minimum recommended PA levels were doubled in groups provided a PLPA intervention [OR = 2.15, 95% confidence interval (CI) = 1.35-3.43]. Total PA levels were increased in the short term (SMD = 0.15, 95% CI = 0.03-0.27) but not in the long term. Longer term interventions did not improve outcomes. Nonstatistical analysis identified that PLPA interventions were efficacious at increasing the amount of PA adults performed at all intensities.

Conclusions:

Clinic-based PLPA interventions delivered in private practice, primary care, and outpatient settings were efficacious at increasing PA in adults at risk of NCDs. Improvements did not last long term and were not enhanced with longer interventions.
Head Impact Exposure in Youth Soccer and Variation by Age and Sex
Authors: Chrisman Sara P. D. , Ebel Beth E. , Stein Elizabeth , Lowry Sarah J. , Rivara Frederick P.
Published: October 2017

Objective:

To examine variation in head impact exposure (HIE) by age and sex in youth soccer.

Design:

Prospective cohort study.

Setting and Participants:

Youth soccer athletes (11-14 years old) in local clubs.

Exposures:

Age and sex.

Outcome Measures:

Head impact exposure measured using adhesive-mounted accelerometers during 1 month of soccer.

Results:

Forty-six youth athletes (54% female) participated. No athlete reported a concussion during the study. More males than females had at least 1 head impact ≥15 g (P = 0.02). Of those who sustained a head impact above the 15-g threshold (57%), females sustained HIE of greater magnitude than males (median 47.4 g vs 33.3 g, P = 0.04). Eighty-five percent of athletes on U14 teams had at least 1 head impact ≥15 g compared with 15% of athletes on U12 teams (P < 0.001). Poisson regression stratified by sex and controlling for team-suggested age effects were significant only for females (P = 0.02). There was significant variation in HIE by team. There were no decrements in concussion symptoms, health-related quality of life, or neuropsychological testing after 1 month of soccer play.

Conclusions:

There is significant variation in HIE in youth soccer, which seems to be influenced by age and sex. Further studies are needed to better understand potential significance for injury prevention.
Association Between Previous Injury and Risk Factors for Future Injury in Preprofessional Ballet and Contemporary Dancers
Authors: Kenny Sarah J. , Palacios-Derflingher Luz , Shi Qian , Whittaker Jackie L. , Emery Carolyn A.
Published: October 2017

Objectives:

To determine the prevalence of self-reported 1-year injury history and examine its association with preparticipation evaluation components aimed at predicting future injury risk (PPE-IP) among preprofessional ballet and contemporary dancers.

Design:

Cross-sectional study.

Setting:

Preprofessional ballet school, university contemporary dance program.

Participants:

Full-time preprofessional ballet and contemporary dancers.

Assessment of Risk Factors:

Preparticipation evaluation consisted of the Athletic Coping Skills Inventory-28, body mass index, total bone mineral density, ankle range of motion, active standing turnout, lumbopelvic control, unipedal dynamic balance, and Y-Balance test.

Main Outcome Measure:

Self-reported 1-year history of dance-related medical attention and/or time-loss injury.

Results:

A total of 155 ballet [n = 90, 80 females, median age 15 years (range 11-19)] and contemporary [n = 65, 63 females, median age 20 years (range 17-30)] dancers participated. Forty-six percent (95% confidence interval (CI), 38.4-54.6) reported a 1-year injury history. Self-reported injury history was not associated with any PPE-IP, however, an influence of age and psychological coping skills on the relationship between 1-year injury history and PPE-IP was identified. Multivariable analyses revealed that prevalence of 1-year injury history did not differ by age [referent group <15 years; 15-18 years: odds ratio (OR) 0.80 (95% CI, 0.35-1.79); >18 years: OR 0.69 (95% CI, 0.30-1.56)], or level of psychological coping skills [OR 1.35 (95% CI, 0.61-2.94)].

Conclusions:

The prevalence of self-reported 1-year injury history among preprofessional ballet and contemporary dancers is high. Although measures of PPE-IP did not differ based on injury history, it is important that age and psychological coping skills are considered in future dance injury prevention and prediction research.

Level of Evidence:

Level 3 evidence.
Resolution of Persistent Post-Stapedotomy Vertigo With Migraine Prophylactic Medication
Authors: Moshtaghi Omid , Mahboubi Hossein , Haidar Yarah M. , Sahyouni Ronald , Lin Harrison W. , Djalilian Hamid R.
Published: October 2017

Objective:

To describe persistent post-stapedotomy vertigo (PSV) and its treatment using migraine prophylaxis.

Patients:

A retrospective review of all patients with persistent PSV spanning 10 years at a tertiary academic hospital was performed. Patients who experienced persistent vertigo for a minimum of 3 months after surgery were included. Those with possible perilymph fistula, long prosthesis, and benign paroxysmal positional vertigo were excluded.

Interventions:

All patients received instructions on migraine dietary and lifestyle changes and Vitamin B2 and magnesium. In addition, prophylactic treatment with nortriptyline, verapamil, or a combination thereof was started.

Main Outcome Measure:

Changes in vertigo frequency was the main outcome variable. The secondary outcome variables included the time period and medications necessary to achieve symptomatic resolution.

Results:

Four women and one man with an average age of 53 years were identified that met criteria for persistent PSV indicating an incidence of 0.9% at our institution. The onset of vertigo symptoms was on average 20 days postoperatively. All five patients had daily vertigo episodes and experienced complete resolution with no vertigo episodes after treatment. Symptomatic resolution was achieved over an average of 9 weeks after initiating treatments.

Conclusions:

Persistent PSV beyond 3 months is a rare occurrence and its treatment can be challenging when there is no evidence of an underlying pathology. This subset of patients may be suffering from migraine, which was triggered postoperatively. Treatment with migraine prophylaxis in this cohort of patients may result in resolution of vertigo.
Cochlear Implantation in Cochlear Ossification: Retrospective Review of Etiologies, Surgical Considerations, and Auditory Outcomes
Authors: Vashishth Ashish , Fulcheri Andrea , Prasad Sampath Chandra , Bassi Margherita , Rossi Gianluca , Caruso Antonio , Sanna Mario
Published: October 2017

Objectives:

1) To review the surgical and auditory outcomes and complications of cochlear implantation in cases with cochlear ossification. 2) To evaluate association between the extent and etiology of ossification to outcomes.

Study Design:

Retrospective study.

Setting:

Otology and skull base surgery center.

Subjects and Methods:

Charts of 40 patients (42 ears) with cochlear ossification undergoing cochlear implantation were reviewed. Demographic features, operative findings, auditory outcomes, and complications were analyzed. Operative findings included extent of cochlear ossification, extent of drilling required to obtain patent cochlear lumen, approach (posterior tympanotomy/subtotal petrosectomy), electrode insertion (partial/complete, scala tympani/vestibuli), and complications. Auditory outcomes were assessed over a 4-year follow-up period using vowel, word, sentence, and comprehension scores. Patients were divided into groups (otosclerotic/non-otosclerotic and round window/basal turn ossification) for comparison of auditory outcomes. Outcomes were compared with 60 randomly identified controls (adults with postlingual deafness) who underwent implantation with no cochlear ossification.

Results:

The median age and duration of deafness of patients was 54.39 and 27.15 years, respectively. Etiology of cochlear ossification was otosclerosis in 23 of 42 ears and mixed in 19 of 42 ears (chronic otitis media, temporal bone fractures, idiopathic, meningitis, Cogan's syndrome) with exclusive round window involvement in 54.7% of cases and the rest having partial or complete basal turn ossification. 59.5% ears underwent subtotal petrosectomy for implantation. Three patients underwent scala vestibuli insertion and five had incomplete electrode insertion. Auditory outcomes were comparable in otosclerotic and non-otosclerotic cases and in round window and basal turn ossification cases. No significant differences were observed in auditory scores when compared with controls with no ossification.

Conclusions:

Cochlear implantation in cochlear ossification is feasible despite surgical challenges and modifications. Auditory outcomes in basal turn ossification appear to be comparable to cases with no ossification with extent of ossification having no significant association with outcomes.
Cochlear Implant Associated Labyrinthitis: A Previously Unrecognized Phenomenon With a Distinct Clinical and Electrophysiological Impedance Pattern
Authors: Itayem Deeyar A. , Sladen Douglas , Driscoll Colin L. , Neff Brian A. , Beatty Charles W. , Carlson Matthew L.
Published: October 2017

Objectives:

To report a unique clinical entity “cochlear implant associated labyrinthitis,” characterized by a distinct constellation of clinical symptoms and pattern of electrode impedance fluctuations.

Study Design:

Retrospective chart review.

Methods:

All patients that underwent cochlear implantation between January 2014 and December 2016 were retrospectively reviewed. All subjects with acute onset dizziness, device performance decline, and characteristic erratic pattern of electrode impedances occurring after an asymptotic postoperative interval were identified and reported.

Results:

Five patients with the above criteria were identified, representing 1.4% of all implant surgeries performed during this time. The median age at time of implantation was 71 years, and the median time interval between implantation and onset of symptoms was 126 days. All patients exhibited acute onset dizziness, subjective performance deterioration, erratic impedance pattern, and two experienced worsening tinnitus. Two of five patients underwent subsequent CT imaging, where good electrode placement was confirmed without cochlear ossification. Two of five patients received oral prednisone therapy. All patients reported a subjective improvement in symptoms and stabilization of electrode impedances. Three patients subsequently received vestibular testing, where significantly reduced peripheral vestibular function was identified.

Conclusions:

We describe a unique clinical entity, “cochlear implant associated labyrinthitis,” characterized by a distinct constellation of clinical symptoms and corresponding electrode impedance anomalies. The exact cause for this event remains unknown, but may be related to viral illness, delayed foreign body reaction to the electrode, or a reaction to electrical stimulation. Future studies characterizing this unique clinical entity are needed to further elucidate cause and optimal management.
Decrease of trabecular bone score reflects severity of Crohn’s disease: results of a case–control study
Authors: Krajcovicova Anna , Kuzma Martin , Hlavaty Tibor , Hans Didier , Koller Tomas , Jackuliak Peter , Leskova Zuzana , Sturdik Igor , Killinger Zdenko , Payer Juraj
Published: October 2017

Objectives

Osteoporosis and osteopaenia are known chronic complications of inflammatory bowel diseases. The trabecular bone score (TBS) provides an indirect measurement of bone microarchitecture, independent of bone mineral density (BMD).

Patients and methods

The study was designed as a case–control study with the aim to assess and compare bone quantity and quality in patients with Crohn’s disease (CD). We purposefully excluded postmenopausal women and patients on long-term corticosteroid therapy.

Results

The cohort consisted of 50 CD patients and 25 healthy controls who matched in age, sex, weight, or vitamin D status. There was no significant difference between CD patients versus controls in the mean lumbar BMD of 0.982±0.119 versus 0.989±0.12 g/cm2 and the mean TBS score of 1.37±0.12 versus 1.38±0.12. We observed significantly lower TBS, but not lumbar BMD, in CD patients with stricturing (B2, 1.36±0.08) or penetrating (B3, 1.32±0.11) disease compared with those with luminal disease (B1, 1.42±0.11; P=0.003 and <0.0001, respectively). We also observed lower mean±SD TBS in patients on versus not on anti-tumour necrosis factor-α therapy: 1.341±0.138 versus 1.396±0.099, respectively. However, the difference between these groups failed to reach statistical significance (P=0.11). No similar finding was seen comparing lumbar BMD in these groups.

Conclusion

For the first time, it was observed that TBS, but not BMD, correlates with the severity of CD. Our results therefore suggest that TBS can potentially help to identify high fracture risk CD patients better than BMD alone.
Beware of the force of the horse: mechanisms and severity of equestrian-related injuries
Authors: Van Balen Pieter-Jan , Barten Dennis G. , Janssen Loes , Fiddelers Audrey A.A. , Brink Peter R. , Janzing Heinrich M.J.
Published: October 2017

Background

Equestrian-related injuries (ERIs) are relatively severe compared with injuries in other popular sports. Previous studies on epidemiology of ERIs vary widely and mainly focus on incidence instead of severity of the injury.

Purpose

The aim of this study was to determine incidence, mechanisms and severity of ERIs in two Dutch hospitals (level 1 and level 2 trauma centers) over a 5-year period.

Patients and methods

All patients with ERIs who visited the emergency departments of VieCuri Medical Centre in Venlo and Maastricht University Medical Centre+ in Maastricht, The Netherlands, between July 2010 and June 2015 were retrospectively included. Clinical data were extracted from medical records.

Results

Most ERIs occurred in mounted riders (646 events; 68%); 94.9% of which involved a fall. Being kicked (42.5%) or trapped (30.1%) was the most common cause of injury in unmounted riders. Most frequently injured body parts were the upper extremities (43.8%) in mounted riders and lower extremities (40.5%) in the unmounted group. A relatively high percentage of facial injuries (9.7%) were found in the unmounted group. Seventeen per cent of all ERIs required admission. The median Injury Severity Score was 5 in the admitted population and 1 in the total population.

Conclusion

Horseback riding is a risky activity. Prior studies particularly studied admitted patients in level 1 trauma centers outside of Europe and demonstrated a high risk of significant injury. However, our study demonstrates that these studies in selected groups might have overestimated the severity of ERIs in the general population.
Dural Venous Sinus Thrombosis and Pulmonary Embolism Following Immunoglobulin Treatment in Pediatric Patient With Immune Thrombocytopenic Purpura
Authors: Park Kyung Mi , Yang Eu Jeen , Lim Young Tak
Published: October 2017

Intravenous immunoglobulin (IVIG) is a widely used agent as the first choice of treatment of immune thrombocytopenic purpura (ITP). IVIG has several side effects, but it is a relatively safe treatment. Life-threatening thrombosis has been reported in adults and rarely in children. We report a case of a 14-year-old boy with dural venous sinus thrombosis and pulmonary embolism after treatment with IVIG for ITP. The patient was treated with low–molecular-weight heparin followed by warfarin and the symptoms were recovered. If a patient with ITP shows mental change or respiratory difficulty, we should consider thrombosis as well as hemorrhage.
Metacognition Is Necessary for the Emergence of Motivation in People With Schizophrenia Spectrum Disorders
Authors: Luther Lauren , Bonfils Kelsey A. , Firmin Ruth L. , Buck Kelly D. , Choi Jimmy , Dimaggio Giancarlo , Popolo Raffaele , Minor Kyle S. , Lysaker Paul H.
Published: October 2017

Metacognition deficits are a putative cause of reduced motivation in people with schizophrenia spectrum disorders. However, it is unclear whether certain levels of metacognition are necessary for motivation to emerge. This study used a Necessary Condition Analysis to test whether metacognition was necessary for the presence of motivation and to identify the minimum level of metacognition necessary for high motivation to be possible in people with schizophrenia spectrum disorders (N = 175). Participants completed clinician-rated measures of metacognition and motivation. Necessary Condition Analysis revealed that metacognition is a necessary condition for motivation and that high levels of motivation were only possible, although not guaranteed, when at least a basic level of metacognition was present. The findings suggest that metacognition is a necessary building block for the development of motivation. Results suggest that targeting metacognition may be essential for improving motivation among people with schizophrenia spectrum disorders who do not meet this metacognition threshold.
Current Trends in Postmastectomy Breast Reconstruction
Authors: Panchal Hina , Matros Evan
Published: October 2017

Postmastectomy immediate breast reconstruction in the U.S. continues to experience an upward trend owing to heightened awareness, innovations in reconstructive technique, growing evidence of improved patient-reported outcomes, and shifts in mastectomy patterns. Women with unilateral breast cancer are increasingly electing to undergo contralateral prophylactic mastectomy, instead of unilateral mastectomy or opting for breast conservation. The ascent in prophylactic surgeries correlates temporally to a shift toward prosthetic methods of reconstruction as the most common technique. Factors associated with the choice for implants include younger age, quicker recovery time, along with documented safety and enhanced aesthetic outcomes with newer generations of devices. Despite advances in autologous transfer, its growth is constrained by the greater technical expertise required to complete microsurgical transfer and potential barriers such as poor relative reimbursement. The increased use of radiation as an adjuvant treatment for management of breast cancer has created additional challenges for plastic surgeons who need to consider the optimal timing and method of breast reconstruction to perform in these patients.
Evolving Approaches to Tissue Expander Design and Application
Authors: Morrison Kerry A. , Ascherman Benjamin M. , Ascherman Jeffrey A.
Published: October 2017

Prosthetic reconstruction utilizing a 2-stage saline tissue expander-to-implant procedure is the most common technique for breast reconstruction in the United States. For nearly the past 50 years, 2-stage breast reconstruction using saline tissue expanders has been the standard of care. However, in December 2016, a carbon dioxide–filled, remote-controlled tissue expander received U.S. Food and Drug Administration clearance. This tissue expander, known as the AeroForm Tissue Expander System (AirXpanders, Inc., Palo Alto, Calif.), is a novel, patient-controlled, needle-free expander operated by a wireless remote control device, which allows patients the comfort and convenience of home expansion, precluding the need for percutaneous saline injections. A multicenter, randomized, prospective clinical trial has revealed statistically significant shorter times to full expansion as well as shorter overall reconstructive times. It is the first tissue expander device designed successfully with an alternative filling medium to saline, namely carbon dioxide. This CO2-filled expander thus provides several potential advantages over previous expander designs, including patient-controlled expansion, obviation of saline injections, and shorter expansion times.
Developing, Conducting, and Publishing Appropriate Systematic Review and Meta-Analysis Articles
Authors: Kelley Brian P. , Chung Kevin C.
Published: October 2017

The volume of medical literature is growing at a rate that renders decision-making difficult without specialized summary tools. Systematic reviews and meta-analyses are important research instruments used to condense and clarify a broad scope of information into manageable summaries. When used effectively, these reports can pool cumulative data across primary studies, formulate clinical guidelines, and guide future research endeavors. However, errors in study design can result in ineffective or misleading analyses. This article presents the appropriate uses for systematic review and meta-analysis by introducing a framework for creating summary studies, and supplying specific examples of pitfalls in study design and execution.
Complications After Stent Placement for Aortic Coarctation
Authors: Boccalini Sara , den Harder Annemarie M. , Witsenburg Maarten , Breur Johannes M.P.J. , Krestin Gabriel P. , van Beynum Ingrid M. , Stagnaro Nicola , Marasini Maurizio , de Jong Pim A. , Leiner Tim , Budde Ricardo P.J.
Published: October 2017

Stent placement is commonly used to treat aortic coarctation. Although invasive angiography remains the gold standard, follow-up is often performed using computed tomography, which allows rapid, noninvasive assessment of the aorta and surrounding tissues. The goal of this pictorial essay is to provide a guide to the interpretation of these examinations. Normal and abnormal computed tomographic appearance of different stent types is shown along with reconstructions that can help assess stent integrity and the stent position in relation to the aortic wall and branches. Furthermore, imaging findings of complications including aortic wall injuries, restenosis, and intimal hyperplasia are depicted.
Surgical Hypercorrection of Trigonocephaly: Evaluation of Surgical Outcomes
Authors: Bennett Katelyn G. , Liang Fan , Ranganathan Kavitha , Muraszko Karin M. , Vercler Christian J. , Buchman Steven R.
Published: October 2017

Background:

A lasting correction of trigonocephaly is difficult to achieve, as a durable correction requires significant expansion to overcome galeal restriction and soft tissue recoil of the scalp. High rates of relapse have been reported throughout the literature. The specific aim of this study was to determine if the senior author's method of “hypercorrection” decreases relapse and the need for subsequent revisional surgery.

Methods:

Patients who underwent operative correction of metopic craniosynostosis between 1988 and 2011 were reviewed. All patients underwent the “hypercorrection” technique performed by the senior author. Hypercorrection consisted of a fronto-orbital advancement of 2.5 to 3.5 cm and a concomitant hyperexpansion of bitemporal projection. Split cranial bone grafting ensured adequate coverage of the significantly expanded cranial vault. Only patients who had at least 5 years of follow-up were included for review of outcomes. Relapse was defined as recurrence of bitemporal constriction or lateral orbital retrusion, requiring surgical correction.

Results:

Fifty-eight patients met criteria. Mean age at the time of surgery was 11 months. Mean follow-up was 9.0 years. During this time, 2 patients exhibited relapse requiring camouflage procedures. Cranial bone defects were found in 4 patients (7%), 3 of whom underwent cranial bone grafting, while 1 underwent methylmethacrylate placement at an outside institution. One patient underwent fat grafting for areas of soft tissue irregularity. No patients exhibited persistent sequelae of hypercorrection significant enough to require repeat fronto-orbital advancement.

Conclusion:

Surgical hypercorrection of trigonocephaly seems to minimize relapse and the need for revision in long-term follow-up and is therefore an important technique to consider.
Single-Stage Repair of Palatal Fistula and Velopharyngeal Incompetence by the New L Flap
Authors: El-Anwar Mohammad Waheed , Elsheikh Ezzeddin , Askar Sherif
Published: October 2017

Objective:

To describe and assess the results of use of the new L-shaped posterior pharyngeal flap for repair of both palatal fistula and velopharyngeal incompetence.

Methods:

This study included 10 patients who were diagnosed to have soft palate fistula and persistent velopharyngeal insufficiency (VPI). L-shaped superiorly based pharyngeal flap was harvested from oropharynx and inserted into the soft palate closing the fistula after fistula trimming. The palatal part of the flap (transverse limb) was spread 1 cm horizontally and 1 cm in the anteroposterior direction in soft palate at fistula site closing it without tension. Prior to and after surgery, patients were assessed by examination, video-nasoendoscopy, and speech assessment.

Results:

Closure of the palatal fistula could be achieved in all patients. Postoperative speech assessment showed significant improvement in the nasal emission, resonance, intraoral pressure, and articulation defects. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in all patients. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea reported.

Conclusion:

The new used L-shaped pharyngeal flap could properly close palatal fistula and correct velopharyngeal functions (closure and speech) in patients with persistent VPI with no reported significant complication and without the need for palatal dissection or flaps.
More Than Meets the Eye: The Effect of Intercanthal Distance on Perception of Beauty and Personality
Authors: Naran Sanjay , Wes Ari M. , Mazzaferro Daniel M. , Bartlett Scott P. , Taylor Jesse A.
Published: October 2017

In judging normalcy, surgeons rely on established facial anthropometric measures and proportions. However, there exists a range of “normal,” and a degree of disproportion may be considered more attractive. The authors set out to determine how changes in only intercanthal distance affect the layperson's perception of beauty and personality traits of a face. The authors used Amazon.com's Mechanical Turk (MTurk), a crowdsourcing tool, to determine how changes in intercanthal distance affect overall perception of beauty and personality. MTurk respondents provided demographic information and were asked to survey 16 female subjects, each digitally edited to be hypoteloric or hyperteloric. Data were collected from 490 MTurk crowd raters. Paired t test analysis found that respondents perceived subjects to be more submissive, friendly, and attractive with increased intercanthal distance (P < 0.05). Women respondents were less likely to perceive change in regards to how unthreatening and how intelligent the subject appeared upon intercanthal widening (P < 0.05). Compared with Caucasian respondents, minorities (Asian- and African-American) were more likely to perceive difference in submissiveness, threat, intelligence, and attractiveness with increased intercanthal distance (P < 0.05). All respondents >46 years of age were less likely to perceive a change in any of the 7 traits upon intercanthal widening, compared with respondents between 18 and 25 years of age (P < 0.05). The layperson perceives significant increases in a female subject's submissivness, friendliness, and attractiveness with an intercanthal distance increase of 10% from normal. Surgeons should be aware of this when correcting hypertelorism, given the potential positive impact of a slightly increased intercanthal distance on perceived beauty and personality.
Alterations in Nasal Sensibility Following Calcium Hydroxyapatite Dorsal Augmentation
Authors: Alharethy Sami
Published: October 2017

Background:

There are a many types of filler products that surgeons used for soft tissue augmentation. Soft Tissue Fillers, also known as injectable grafts, is a medical device implants. One of the materials used in soft tissue fillers is calcium hydroxylapatite (CaHA) that is commonly used for treating nasal deformities and nasal reshaping too. Calcium hydroxylapatite is a kind of mineral that can be found in human teeth and bones. It is considered long-lasting but nonpermanent filler and is biocompatible with human tissue.

Aim:

The aim of this study is to measure the alterations in sensibility and patient satisfaction following CaHA filler injection.

Patient/Methods:

In a prospective study, 30 patients who underwent CaHA filler injections from January to December 2016 at a Private Tertiary Care Hospital in Riyadh, Saudi Arabia were included.

Results:

Means and standard deviations were measured for pressure threshold values at each test area preprocedure 2 weeks after procedure (Table 1

JOURNAL/jcrsu/04.03/00001665-201803000-00070/table1/v/2023-10-09T171147Z/r/image-tiff

). Alterations between pre and postprocedure values were verified using the match-paired Student t test preprocedures. None of the patients had any subjective sensory symptoms. Majority of patients were extremely satisfied with the results.

Conclusion:

With correct anatomic knowledge and precise technique in doing the CaHA gel injection procedure, nasal sensibility will not be altered. In addition, injection of CaHA gel can be valuable tool for plastic surgeons to consider for nasal reshaping.
The Southampton Consensus Guidelines for Laparoscopic Liver Surgery
Authors: Abu Hilal Mohammad , Aldrighetti Luca , Dagher Ibrahim , Edwin Bjorn , Troisi Roberto Ivan , Alikhanov Ruslan , Aroori Somaiah , Belli Giulio , Besselink Marc , Briceno Javier , Gayet Brice , D’Hondt Mathieu , Lesurtel Mickael , Menon Krishna , Lodge Peter , Rotellar Fernando , Santoyo Julio , Scatton Olivier , Soubrane Olivier , Sutcliffe Robert , Van Dam Ronald , White Steve , Halls Mark Christopher , Cipriani Federica , Van der Poel Marcel , Ciria Ruben , Barkhatov Leonid , Gomez-Luque Yrene , Ocana-Garcia Sira , Cook Andrew , Buell Joseph , Clavien Pierre-Alain , Dervenis Christos , Fusai Giuseppe , Geller David , Lang Hauke , Primrose John , Taylor Mark , Van Gulik Thomas , Wakabayashi Go , Asbun Horacio , Cherqui Daniel
Published: October 2017

Objective:

The European Guidelines Meeting on Laparoscopic Liver Surgery was held in Southampton on February 10 and 11, 2017 with the aim of presenting and validating clinical practice guidelines for laparoscopic liver surgery.

Background:

The exponential growth of laparoscopic liver surgery in recent years mandates the development of clinical practice guidelines to direct the speciality's continued safe progression and dissemination.

Methods:

A unique approach to the development of clinical guidelines was adopted. Three well-validated methods were integrated: the Scottish Intercollegiate Guidelines Network methodology for the assessment of evidence and development of guideline statements; the Delphi method of establishing expert consensus, and the AGREE II-GRS Instrument for the assessment of the methodological quality and external validation of the final statements.

Results:

Along with the committee chairman, 22 European experts; 7 junior experts and an independent validation committee of 11 international surgeons produced 67 guideline statements for the safe progression and dissemination of laparoscopic liver surgery. Each of the statements reached at least a 95% consensus among the experts and were endorsed by the independent validation committee.

Conclusion:

The European Guidelines Meeting for Laparoscopic Liver Surgery has produced a set of clinical practice guidelines that have been independently validated for the safe development and progression of laparoscopic liver surgery. The Southampton Guidelines have amalgamated the available evidence and a wealth of experts’ knowledge taking in consideration the relevant stakeholders’ opinions and complying with the international methodology standards.
Use of Prophylactic Mesh When Creating a Colostomy Does Not Prevent Parastomal Hernia
Authors: Odensten Christoffer , Strigård Karin , Rutegård Jörgen , Dahlberg Michael , Ståhle Ulrika , Gunnarsson Ulf , Näsvall Pia
Published: October 2017

Objective:

The aim of this study was to determine whether parastomal hernia (PSH) rate can be reduced by using synthetic mesh in the sublay position when constructing permanent end colostomy. The secondary aim was to investigate possible side-effects of the mesh.

Background:

Prevention of PSH is important as it often causes discomfort and leakage from stoma dressing. Different methods of prevention have been tried, including several mesh techniques. The incidence of PSH is high; up to 78%.

Methods:

Randomized controlled double-blinded multicenter trial. Patients undergoing open colorectal surgery, including creation of a permanent end colostomy, were randomized into 2 groups, with and without mesh. A lightweight polypropylene mesh was placed around the colostomy in the sublay position. Follow up after 1 month and 1 year. Computerized tomography and clinical examination were used to detect PSH at the 1-year follow up. Data were analyzed on an intention-to-treat basis.

Results:

After 1 year, 211 of 232 patients underwent clinical examination and 198 radiologic assessments. Operation time was 36 minutes longer in the mesh arm. No difference in rate of PSH was revealed in the analyses of clinical (P = 0.866) and radiologic (P = 0.748) data. There was no significant difference in perioperative complications.

Conclusions:

The use of reinforcing mesh does not alter the rate of PSH. No difference in complication rate was seen between the 2 arms. Based on these results, the prophylactic use of mesh to prevent PSH cannot be recommended.
The Impact of Positive Resection Margins on Survival and Recurrence Following Resection and Adjuvant Chemotherapy for Pancreatic Ductal Adenocarcinoma
Authors: Ghaneh Paula , Kleeff Jorg , Halloran Christopher M. , Raraty Michael , Jackson Richard , Melling James , Jones Owain , Palmer Daniel H. , Cox Trevor F. , Smith Chloe J. , O’Reilly Derek A. , Izbicki Jakob R. , Scarfe Andrew G. , Valle Juan W. , McDonald Alexander C. , Carter Ross , Tebbutt Niall C. , Goldstein David , Padbury Robert , Shannon Jennifer , Dervenis Christos , Glimelius Bengt , Deakin Mark , Anthoney Alan , Lerch Markus M. , Mayerle Julia , Oláh Attila , Rawcliffe Charlotte L. , Campbell Fiona , Strobel Oliver , Büchler Markus W. , Neoptolemos John P.
Published: October 2017

Objective and Background:

Local and distant disease recurrence are frequently observed following pancreatic cancer resection, but an improved understanding of resection margin assessment is required to aid tailored therapies.

Methods:

Analyses were carried out to assess the association between clinical characteristics and margin involvement as well as the effects of individual margin involvement on site of recurrence and overall and recurrence-free survival using individual patient data from the European Study Group for Pancreatic Cancer (ESPAC)-3 randomized controlled trial.

Results:

There were 1151 patients, of whom 505 (43.9%) had an R1 resection. The median and 95% confidence interval (CI) overall survival was 24.9 (22.9–27.2) months for 646 (56.1%) patients with resection margin negative (R0 >1 mm) tumors, 25.4 (21.6–30.4) months for 146 (12.7%) patients with R1<1 mm positive resection margins, and 18.7 (17.2–21.1) months for 359 (31.2%) patients with R1-direct positive margins (P < 0.001). In multivariable analysis, overall R1-direct tumor margins, poor tumor differentiation, positive lymph node status, WHO performance status ≥1, maximum tumor size, and R1-direct posterior resection margin were all independently significantly associated with reduced overall and recurrence-free survival. Competing risks analysis showed that overall R1-direct positive resection margin status, positive lymph node status, WHO performance status 1, and R1-direct positive superior mesenteric/medial margin resection status were all significantly associated with local recurrence.

Conclusions:

R1-direct resections were associated with significantly reduced overall and recurrence-free survival following pancreatic cancer resection. Resection margin involvement was also associated with an increased risk for local recurrence.
Time of Metastasis and Outcome in Colorectal Cancer
Authors: Rahbari Nuh N. , Carr Prudence R. , Jansen Lina , Chang-Claude Jenny , Weitz Jürgen , Hoffmeister Michael , Brenner Hermann
Published: October 2017

Objective:

The aim of this study was to evaluate outcomes of metastases at various time intervals after colorectal cancer (CRC) diagnosis.

Background:

Earlier studies have indicated a short time interval between CRC diagnosis and distant metastases to be associated with poor prognosis. The majority of studies assessed outcome from CRC diagnosis or metastasis resection rather than from metastasis diagnosis and might be subject to immortal time bias.

Methods:

Patients in the population-based DACHS study were stratified: metastases at/within 1 month (immediate), 2 to 6 months (early), 7 to 12 months (intermediate), and >12 months (late) after CRC diagnosis. The primary endpoint was overall survival (OS) from metastasis diagnosis. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CI). HRs were adjusted for important confounders and immortal time.

Results:

A total of 1027 patients were included. T4 (P < 0.0001) and node-positive tumors (P < 0.0001) were more frequent in the immediate group. Lung metastases (P < 0.0001) and single-site metastases (P < 0.0001) were more prevalent in the late group. In multivariable analysis, immediate metastases were not associated with poor OS compared to metastases at later time points (late vs immediate: HR 1.21; 95% CI, 0.98–1.48). Subgroup analyses revealed poor OS of late versus immediate metastases for females (1.45; 1.08–1.96), proximal colon cancer (1.54; 1.09–2.16), and N0 (1.46; 1.00–2.12) or N1 disease (1.88; 1.17–3.05).

Conclusions:

Immediate or early metastases are not associated with unfavorable outcome compared to late metastases. These findings challenge the current notion of poor outcome for CRC with immediate or early metastases.
The Role of Bowel Preparation in Colorectal Surgery
Authors: Klinger Aaron L. , Green Heather , Monlezun Dominique J. , Beck David , Kann Brian , Vargas Herschel D. , Whitlow Charles , Margolin David
Published: October 2017

Objective:

To analyze potential benefits with regards to infectious complications with combined use of mechanical bowel preparation (MBP) and ABP in elective colorectal resections.

Background:

Despite recent literature suggesting that MBP does not reduce infection rate, it still is commonly used. The use of oral antibiotic bowel preparation (ABP) has been practiced for decades but its use is also controversial.

Methods:

Patients undergoing elective colorectal resection in the 2012 to 2015 American College of Surgeons National Surgical Quality Improvement Program cohorts were selected. Doubly robust propensity score–adjusted multivariable regression was conducted for infectious and other postoperative complications.

Results:

A total of 27,804 subjects were analyzed; 5471 (23.46%) received no preparation, 7617 (32.67%) received MBP only, 1374 (5.89%) received ABP only, and 8855 (37.98%) received both preparations. Compared to patients receiving no preparation, those receiving dual preparation had less surgical site infection (SSI) [odds ratio (OR) = 0.39,P< 0.001], organ space infection (OR = 0.56,P ≤ 0.001), wound dehiscence (OR = 0.43,P= 0.001), and anastomotic leak (OR = 0.53,P< 0.001). ABP alone compared to no prep resulted in significantly lower rates of surgical site infection (OR = 0.63,P= 0.001), organ space infection (OR = 0.59,P= 0.005), anastomotic leak (OR = 0.53,P= 0.002). MBP showed no significant benefit to infectious complications when used as monotherapy.

Conclusions:

Combined MBP/ABP results in significantly lower rates of SSI, organ space infection, wound dehiscence, and anastomotic leak than no preparation and a lower rate of SSI than ABP alone. Combined bowel preparation significantly reduces the rates of infectious complications in colon and rectal procedures without increased risk ofClostridium difficileinfection. For patients undergoing elective colon or rectal resection we recommend bowel preparation with both mechanical agents and oral antibiotics whenever feasible.
Variation in Drain Management After Pancreatoduodenectomy
Authors: Beane Joal D. , House Michael G. , Ceppa Eugene P. , Dolejs Scott C. , Pitt Henry A.
Published: October 2017

Objective:

The objectives are to report practice patterns and management of operatively placed drains and to compare outcomes in patients with early versus delayed drain removal after pancreatoduodenectomy.

Background:

Early drain removal after pancreatoduodenectomy, when guided by postoperative day (POD) 1 drain fluid amylase (DFA-1), is associated with reduced rates of clinically relevant postoperative pancreatic fistula (CR-POPF). However, whether surgeons have altered their management based on this strategy is unknown.

Methods:

The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) 2014 Participant Use File was queried to identify patients having undergone pancreatoduodenectomy (n = 3093). Patients with intraoperatively placed drains were stratified according to measurement of DFA-1 and day of drain removal. Patients with POD 1 DFA-1 of ≤5000 U/L whose drains were removed by POD 3 were propensity score-matched with patients whose drains were removed after POD 3.

Results:

Of 2698 patients, 580 (21.5%) had a DFA-1 recorded. Measurement of DFA-1 was associated with earlier time to drain removal and shorter postoperative length of stay (P < 0.01). Propensity score matching revealed that early drain removal when DFA-1 was ≤5000 U/L was associated with significant (P < 0.05) reductions in overall morbidity (35.3% vs 52.3%), CR-POPF (0.9% vs 7.9%), and length of stay (6 vs 8 days).

Conclusions:

Significant variation exists in the use of drain fluid amylase in the management and timing of surgical drain removal after pancreatoduodenectomy. Clinical outcomes are best when drain fluid amylase is low and operatively placed drains are removed by POD 3.
Transplantation Versus Resection for Hilar Cholangiocarcinoma
Authors: Ethun Cecilia G. , Lopez-Aguiar Alexandra G. , Anderson Douglas J. , Adams Andrew B. , Fields Ryan C. , Doyle Maria B. , Chapman William C. , Krasnick Bradley A. , Weber Sharon M. , Mezrich Joshua D. , Salem Ahmed , Pawlik Timothy M. , Poultsides George , Tran Thuy B. , Idrees Kamran , Isom Chelsea A. , Martin Robert C. G. , Scoggins Charles R. , Shen Perry , Mogal Harveshp D. , Schmidt Carl , Beal Eliza , Hatzaras Ioannis , Shenoy Rivfka , Cardona Kenneth , Maithel Shishir K.
Published: October 2017

Objective:

To investigate the influence of type of surgery (transplant vs resection) on overall survival (OS) in patients with hilar cholangiocarcinoma (H-CCA).

Background:

Outcomes after resection for H-CCA are poor, yet transplantation is currently only reserved for well-selected patients with unresectable disease.

Methods:

All patients with H-CCA who underwent resection from 2000 to 2015 at 10 institutions were included. Three institutions additionally had active H-CCA transplant protocols with similar selection criteria over similar time periods.

Results:

Of 304 patients with suspected H-CCA, 234 underwent attempted resection and 70 were enrolled in a transplant protocol. Excluding incomplete/R2 resections (n = 43), patients who were enrolled, but did not undergo transplant (n = 24), and transplants without confirmed H-CCA diagnoses (n = 5), 191 patients underwent curative-intent resection and 41 curative-intent transplant. Compared with resection, transplant patients were younger (52 vs 65 years; P < 0.001), and more frequently had primary sclerosing cholangitis (PSC; 61% vs 2%; P < 0.001) and received chemotherapy and/or radiation (98% vs 57%; P < 0.001). Groups were otherwise similar in demographics and comorbidities. Patients who underwent transplant for confirmed H-CCA diagnosis had improved OS compared with resection (3-year: 72% vs 33%; 5-year: 64% vs 18%; P < 0.001). Among patients who underwent resection for tumors <3 cm with lymph-node negative disease, and excluding PSC patients, transplant was still associated with improved OS (3-year: 54% vs 44%; 5-year: 54% vs 29%; P = 0.03). Transplant remained associated with improved survival on intention-to-treat analysis, even after accounting for tumor size, lymph node status, and PSC (P = 0.049).

Conclusions:

Resection for hilar cholangiocarcinoma that meets criteria for transplantation (<3 cm, lymph-node negative disease) is associated with substantially decreased survival compared to transplant for the same criteria with unresectable disease. Prospective trials are needed and justified.
The Successful Implementation of a Modified Enhanced Recovery After Surgery (ERAS) Program for Bariatric Surgery in a South African Teaching Hospital
Authors: Loots Emil , Sartorius Benn , Paruk Imran M. , Clarke Damian L.
Published: October 2017

Background:

This study assessed the impact of strict adherence to perioperative pathways incorporating an enhanced recovery after surgery protocol on the outcomes of bariatric surgery at our center.

Methods:

Prospective data were collected on 62 patients undergoing bariatric surgery between January 2011 and March 2016. Outcomes were compared between those who adhered to the perioperative pathway and those who did not.

Results:

Fifty-three patients underwent laparoscopic sleeve gastrectomy, and 9 patients underwent Laparoscopic Roux-en-Y Gastric Bypass. The majority of subjects were female individuals (n=45; 72.6%). The mean age (±SD) was 40.5±9.8 years (range, 21 to 59 y). The mean preoperative body mass index (BMI) was 54.8±11.0. The mean BMI loss from baseline was 14.8 kg/m2 (−15.9 kg m2; P<0.001). There were no deaths, and there were only 2 postoperative complications (1 intra-abdominal bleeding postoperatively requiring reoperation and 1 patient requiring CPAP support in intensive care unit). Full adherence was achieved in 53 (85.5%) patients with a mean length of stay (LOS) of 3±0.8 days. The nonadherent group had a significantly longer LOS of 4±3.2 days (P=0.049). The time since last follow-up visit was on average 4.4±5.6 months in the fully adherent group and significantly longer in the nonadherent group at 10.6±11.3 months (P=0.013). Age, race, sex, and BMI did not significantly impact on adherence. The mean LOS among morbidly obese and super obese patients was comparable at 3 and 3.3 days, respectively (P=0.442).

Conclusion:

Adherence to enhanced recovery after surgery pathways was associated with a significantly shorter hospital stay and better follow-up in our surgical unit.