bluuebunny/crossref_metadata_2025 huggingface dataset:
Topical Oxandrolone Reduces Ear Hypertrophic Scar Formation in Rabbits
Authors: Sobec Raluca L. , Fodor Lucian , Bodog Florian
Published: July 2019

Background:

Wound healing is a complex process. Despite extensive studies, hypertrophic and keloid scars still occur, and can be functionally and cosmetically problematic. In an attempt to prevent hypertrophic scar formation, the effects of topical oxandrolone, using hyaluronic acid as a biomaterial, were studied on ear wounds in rabbits.

Methods:

Deep second-degree burns were inflicted on each ear in 10 New Zealand rabbits. On the left ears, considered the control side, hyaluronic acid gel was applied, whereas on the right ears, the study side, a combination of oxandrolone and hyaluronic acid was applied. Dressings were changed every 2 days for 2 weeks. At week 10, biopsy specimens from the postburn scars were harvested for histologic and immunohistochemical examinations.

Results:

Fourteen wounds were studied, half on the control side and half on the study side. Six hypertrophic scars were encountered on the control side and only one scar was encountered on the study side. In addition, an increased degree of inflammation, an increased amount of collagen and fibroblast cellularity, increased vascularization, and increased myofibroblast activity were observed on the control side.

Conclusion:

Topical administration of oxandrolone using hyaluronic acid as a biomaterial led to better healing and prevented hypertrophic scar formation.
Risk-to-Benefit Relationship of Contralateral Prophylactic Mastectomy: The Argument for Bilateral Mastectomies with Immediate Reconstruction
Authors: Alba Brandon , Schultz Benjamin D. , Cohen Danielle , Qin Alex L. , Chan William , Tanna Neil
Published: July 2019

Background:

The increasing trend of women with unilateral breast cancer to electively undergo contralateral prophylactic mastectomy in addition to treatment of the index breast has been controversial. The authors set out to better frame the risks and benefits of contralateral prophylactic mastectomy in the treatment of unilateral breast cancer by evaluating outcomes of a large, consecutive cohort of patients.

Methods:

An institutional review board–approved review of a single-surgeon (N.T.) experience (2013 to 2018) was conducted of all consecutive patients with unilateral breast cancer treated with mastectomy and immediate reconstruction. Patient characteristics, surgical pathologic results, and 30-day complications were assessed. Outcomes of patients with unilateral cancer who underwent unilateral mastectomy versus bilateral mastectomy (with one breast being contralateral prophylactic mastectomy) were compared. Logistic regression models evaluated various risk factors for potential associations with positive pathologic findings in the contralateral prophylactic mastectomy specimen and/or postoperative complications.

Results:

Of 244 patients, 68 (27.9 percent) underwent unilateral mastectomy and 176 (72.1 percent) underwent contralateral prophylactic mastectomy. Surgical pathologic results of the prophylactic breast revealed occult ductal carcinoma in situ or invasive cancer in 13 patients (7.3 percent) and lobular carcinoma in situ in eight patients (4.6 percent). Incidence of complications was similar between groups [unilateral mastectomy, 19.12 percent (n = 13); contralateral prophylactic mastectomy, 13.07 percent (n = 23); p = 0.234].

Conclusions:

Immediate reconstruction for unilateral mastectomy and contralateral prophylactic mastectomy have similar complication risk profiles, among patients as a whole and between individual breasts. These findings contribute to our understanding of the clinical impact prophylactic mastectomy and reconstruction may have on optimizing the counseling among extirpative surgeons, reconstructive surgeons, and patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Natural Course of Ophthalmoplegia after Iatrogenic Ophthalmic Artery Occlusion Caused by Cosmetic Filler Injections
Authors: Yang Hee Kyung , Lee Yunjin , Woo Se Joon , Park Kyu Hyung , Kim Ji-Soo , Hwang Jeong-Min
Published: July 2019

Background:

Besides the devastating complication of blindness, paralysis of the eye muscles, namely ophthalmoplegia, may occur after cosmetic facial filler injection. However, little is known of the clinical characteristics and prognosis of such complications. This study was performed to investigate the natural course of ophthalmoplegia and development of sensory strabismus secondary to blindness after iatrogenic occlusion of the ophthalmic artery and its branches resulting from cosmetic facial filler injection.

Methods:

A retrospective study of 21 patients with occlusion of the ophthalmic artery and its branches after cosmetic facial filler injection was performed. The clinical characteristics and prognosis of ophthalmoplegia after cosmetic filler injection were evaluated. At the final examination, development of sensory strabismus defined as deviation of the eye secondary to unilateral vision loss was evaluated.

Results:

At initial presentation, ophthalmoplegia was found in 15 of 21 patients (71 percent) and was significantly associated with the presence of anterior segment ischemia (p = 0.017). Among patients with ophthalmoplegia at initial presentation, ocular motility recovered completely in 77 percent and incomplete recovery was found in 23 percent. At the final examination, sensory strabismus developed in 42 percent after an average follow-up of 2.5 years.

Conclusions:

Ophthalmoplegia frequently occurs after iatrogenic occlusion of the ophthalmic artery and its branches caused by cosmetic facial filler injection. Ocular motility recovers spontaneously in most patients. However, as most patients are blind, sensory strabismus may develop in nearly half of patients during follow-up that requires strabismus surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, IV.
Direct Lateral Canthal Approach to the Zygomaticotemporal Branch of the Trigeminal Nerve for Surgical Treatment of Migraines
Authors: Hamawy Adam , Li Xingchen , Sanniec Kyle , Amirlak Bardia
Published: July 2019

Surgical treatment of migraine headaches involves avulsion or decompression of the affected peripheral nerves. One of the sites targeted is site II, the zygomaticotemporal branch of the trigeminal nerve. Although traditionally the procedure involved either an endoscopic or transpalpebral approach to access the nerve, both methods involve general anesthesia in an operating room. The senior authors developed a new technique to directly access the nerve by means of a transverse lateral canthal extension incision that can be performed under local anesthesia in an office setting. A cadaver dissection to assess safety and anatomical variability was performed with visualization and complete avulsion of the zygomaticotemporal branch of the trigeminal nerve in all cases, with no injury to surrounding structures. An office-based procedure for zygomaticotemporal branch of the trigeminal nerve compression can help reduce the risks and costs associated with a general anesthetic and can be used for patients with isolated migraines localized to the zygomaticotemporal branch of the trigeminal nerve or recurrent secondary triggers to that area.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
The Importance of Reproducibility in Plastic Surgery Research
Authors: Ascha Mona , Ascha Mustafa S. , Gatherwright James
Published: July 2019

With the advent of big data and database-driven research, the need for reproducible methods has become especially relevant. Given the rise of evidence-based practice, it is crucial to ensure that findings making use of big data can be consistently replicated by other physician-scientists. A call for transparency and reproducibility must occur at the individual, institutional, and national levels. Given the rising popularity of national and large databases in research, the responsibility of authors to ensure reproducibility of clinical research merits renewed discussion. In this article, the authors offer strategies to increase clinical research reproducibility at both the individual and institutional levels, within the context of plastic surgery.
Optimizing Outcomes in 2-Stage Prepectoral Breast Reconstruction Utilizing Round Form-Stable Implants
Authors: Sbitany Hani , Lee Kenneth R.
Published: July 2019

Prepectoral breast reconstruction carries many benefits to patients, including its minimally invasive (muscle-sparing) nature, and its reduction in symptoms such as pain and animation deformity, relative to subpectoral reconstruction. However, without the traditional use of the pectoralis major muscle to mask the upper pole of the implant, and dictate the shape of the upper pole, certain steps must be taken to ensure the optimal aesthetic outcome in prepectoral reconstruction. Surgeons have utilized acellular dermal matrices, fat grafting, and highly cohesive implants to improve outcomes. Among the most important steps is the proper implant selection. To this end, the authors routinely utilize round form-stable gel implants, when performing prepectoral breast reconstruction. These implants offer improved aesthetic outcomes, given their ability to reduce rates of rippling and edge visibility. Furthermore, the characteristics of a soft and naturally shaped breast are achieved despite the lack of muscle coverage. The authors believe that reproducibly successful prepectoral reconstruction is dependent on proper technique. In this article, we present the proper techniques necessary for optimizing outcomes when using these implants in 2-stage prepectoral breast reconstruction.
Tradeoffs in Implant Selection for Reconstructive Surgery and Adjuncts Utilized to Maximize Aesthetic Outcomes
Authors: Unger Jacob G. , Keller Patrick R.
Published: July 2019

Background:

With many US Food and Drug Administration–approved cohesive gel implant styles currently available in the United States, surgeons and patients may feel overwhelmed by the implant-selection process. We discuss the relative merits of the most commonly used silicone cohesive gel implants and associated adjuncts, particularly in the reconstructive setting.

Methods:

A literature review was conducted in PubMed to identify articles that assessed the clinical impact of differing cohesive silicone gel implants and associated adjuncts on aesthetic outcomes and complications profile.

Results:

First, we review how the shape, cohesivity, and texture of cohesive gel implants impact breast aesthetics and complications after implant-based breast reconstruction (IBBR). Second, we review common adjuncts used in IBBR, including fat grafting and acellular dermal matrix (ADM), and we explore their roles in prepectoral IBBR. Finally, we review future directions in IBBR, including nanoscale implant surface modifications.

Conclusions:

In the absence of data showing that shaped implants are aesthetically preferable over round implants, we turn to a risk-benefit analysis of the complication profile of each type of implant. In selecting a smooth, round cohesive silicone implant that offers a variety of cohesivity levels, the patient can enjoy the benefits of smooth shells and avoid the drawbacks of textured shells, all without sacrificing clinically significant visual aesthetics. In the era of the bioengineered breast, this remains even more true.
Association of Statin Use With Kidney Damage and Function Among HIV-Infected Men
Authors: Ascher Simon B. , Scherzer Rebecca , Nishtala Arvind , Jotwani Vasantha , Grunfeld Carl , Parikh Chirag R. , Ng Derek , Wang Ruibin , Palella Frank J. , Shlipak Michael G. , Estrella Michelle M.
Published: July 2019

Background:

Chronic kidney disease (CKD) occurs commonly among HIV-infected persons. Statins may delay CKD onset and progression through their cholesterol-lowering and pleiotropic effects.

Methods:

Among 850 HIV-infected men from the Multicenter AIDS Cohort Study with stored urine samples (2009–2011), we evaluated cross-sectional associations of statin use with urine biomarkers of kidney damage [albumin-to-creatinine ratio (ACR), alpha-1-microglobulin, interleukin-18, kidney injury molecule-1, and procollagen type III N-terminal propeptide] using multivariable linear regression. We evaluated the longitudinal associations of statin use with annual change in estimated glomerular filtration rate by creatinine (eGFR) using linear mixed models, and with incident proteinuria and incident CKD (eGFR <60 mL/min/1.73 m2) using Cox proportional hazards regression. We used inverse probability weighting to address potential confounding related to statin use.

Results:

Statin users comprised 30% of participants. In adjusted analyses, each year of cumulative statin use was associated with 4.0% higher baseline ACR levels (P = 0.05), but there was no association with baseline levels of other urine biomarkers. Statin use had no overall association with annual eGFR decline. Among participants with baseline proteinuria, statin use was modestly associated with slower annual eGFR decline compared to non-use (adjusted difference: 1.33 mL/min/1.73 m2 per year; 95% confidence interval: −0.07 to 2.70). Statin use was not associated with risk of incident proteinuria or incident CKD.

Conclusions:

Statin use was associated with higher baseline ACR, but not with biomarkers of tubulointerstitial injury. Statin use was associated with modestly slower eGFR decline only among participants with baseline proteinuria. Although these findings may be susceptible to confounding by indication, they suggest a limited effect of statins on CKD risk among HIV-infected men.
Pharmacologic Treatment of Psychiatric Disorders and Time With Unsuppressed HIV Viral Load in a Clinical HIV Cohort
Authors: Levy Matthew E. , Monroe Anne K. , Horberg Michael A. , Benator Debra A. , Molock Sherry , Doshi Rupali K. , Powers Happ Lindsey , Castel Amanda D. ,   on behalf of the DC Cohort Executive Committee
Published: July 2019

Objective:

To evaluate associations of mood, anxiety, stress-/trauma-related, and psychotic disorders, both treated and untreated, with duration of unsuppressed HIV viral load (VL) among persons living with HIV (PLWH).

Setting:

The DC Cohort, an observational clinical cohort of PLWH followed from 2011 to 2018 at 14 sites in Washington, DC.

Methods:

Among PLWH ≥18 years old who received primary care at their HIV clinic, we determined in a time-updated manner whether participants had diagnoses and pharmacologic prescriptions for mood, anxiety, stress-/trauma-related, and/or psychotic disorders. Associations between psychiatric disorders/treatments and the proportion of subsequent days with VL ≥200 copies/mL were assessed using multivariable Poisson regression with generalized estimating equations.

Results:

Among 5904 participants (median age 51; 70% men; 82% Black), 45% had ≥1 psychiatric disorder, including 38% with mood disorders (50% treated), 18% with anxiety or stress-/trauma-related disorders (64% treated), and 4% with psychotic disorders (52% treated). Untreated major depressive disorder (adjusted rate ratio = 1.17; 95% confidence interval: 1.00 to 1.37), untreated other/unspecified depressive disorder (1.23; 1.01 to 1.49), untreated bipolar disorder (1.39; 1.15 to 1.69), and treated bipolar disorder (1.25; 1.02 to 1.53) (vs. no mood disorder) predicted more time with VL ≥200 copies/mL. Treated anxiety disorders (vs. no anxiety disorder) predicted less time (0.78; 0.62 to 0.99). Associations were weaker and nonsignificant for treated depressive disorders (vs. no mood disorder) and untreated anxiety disorders (vs. no anxiety disorder).

Conclusions:

PLWH with depressive and bipolar disorders, particularly when untreated, spent more time with unsuppressed VL than PLWH without a mood disorder. Treatment of mood disorders may be important for promoting sustained viral suppression.
Recent data on hepatitis E
Authors: Colson Philippe , Decoster Claire
Published: July 2019

Purpose of review

Hepatitis E virus (HEV) has gained increased global recognition in recent years, particularly in developed countries. We summarized here a selection of the literature published since the 1st of June, 2017.

Recent findings

Longitudinal studies are increasingly conducted in Europe, to determine trends in HEV prevalence. The spectrum of mammals infected with HEV and potentially capable to transmit it to humans has widened. New virological data on HEV repCon and pathogenicity have been reported and clinical features of HEV infections have been precised or newly described. Finally, there are some new data on the therapeutic management of HEV infections in various clinical settings.

HEV emergence in developed countries appears to be based on improved diagnosis tools and increased awareness of clinicians that HEV transmission is essentially autochthonous and is a possible cause of life-threatening acute hepatitis, chronic hepatitis, cirrhosis, and extra-hepatic symptoms. In addition, the distribution of HEV strains evolves. Ribavirin remains to date the only specific treatment recommended for HEV infection, being efficient in the majority but not in all cases.
Development and Testing of a Visual Tool for Assessing Risk of Falls
Authors: Arihisa Katsuhiko , Yamamoto Akihiko , Hayashi Tatsuhiro , Hayashi Ayu , Ishizuki Chinami , Miyaguchi Hideki
Published: July 2019

Background:

To develop a “Time Pressure-Kiken Yochi Training (TP-KYT) system” for measuring risk prediction ability of health care professionals.

Methods:

The TP-KYT was developed using responses from 51 experts with at least 5 years of clinical experience (8.7 ± 5.3 years). Participants extracted risk items by scoring 5 illustrations depicting fall-related medical accidents. With 77 “Experts” (34.0 ± 5.6 years old; clinical experience, 9.1 ± 4.8 years), 34 “Competents” (26.8 ± 5.5 years old; clinical experience, 1.1 ± 0.9 years), 34 “Advanced Beginners” (21.9 ± 0.7 years old), and 44 “Novices” (18.7 ± 1.9 years old), TP-KYT was validated using 1-way analysis of variance and Tukey's HSD (honestly significant difference) test. Risk prediction ability was evaluated using receiver operating characteristic curve analysis.

Results:

Experts scored significantly higher than others (Competents: P < .05; Advanced Beginners: P = 6.32E-10; and Novices: P = 4.53E-13). Area under the curve for Experts versus Competents was 0.73 and for Competents versus Advanced Beginners was 0.66. Sensitivity and specificity for Expert scores set at 212/213 were 54.5% and 82.4%, respectively, and for Competent scores set at 137/138 were 76.5% and 52.9%, respectively. The TP-KYT scores varied on the basis of the test taker's clinical experience.

Conclusions:

Validity and reliability of the TP-KYT were demonstrated. The TP-KYT can be a useful tool to quantify health professionals' ability to predict patients' fall risk under time pressure.
Manual and Fully Automated Segmentation to Determine the Ferromagnetic Status of Bullets Using Computed Tomography Dual-Energy Index: A Phantom Study
Authors: Ognard Julien , Dissaux Brieg , Diallo Idris , Attar Lakdar , Saccardy Claire , Ben Salem Douraied
Published: July 2019

Objective

The aim was to determine if dual-energy computed tomography (DECT) can discriminate ferromagnetic bullets from nonferromagnetic ones.

Methods

The ferromagnetic properties of 29 bullets were determined. All bullets underwent a DECT evaluation, and a manual measurement of the dual-energy index was performed by 2 radiologists, followed by a fully automatic measurement, in 3 different positions in a phantom (air, water, and bone).

Results

Twenty-one bullets were found to be nonferromagnetic. There were significant differences between the mean of the dual-energy index measured in the core of ferromagnetic projectiles and those of nonferromagnetic ones in the lung position of the phantom (P = 0.007). Specificity was 86.36%, and negative predictive value was 90.48%. Among the 29 bullets, 24 were correctly classified.

Conclusions

Our study demonstrates that DECT can assess the ferromagnetic status of bullets and their magnetic resonance imaging compatibility using an extended computed tomography scale in an ex vivo phantom model.
Evaluation of Gall Bladder Stones Using Susceptibility Weighted Imaging
Authors: Gupta Rakesh Kumar , Neelavalli Jaladhar , Gupta Mamta , Ramaniharan Anandh K. , Sinha Bijendra Kumar , Kriplani Ajay Kumar , Saini Jitendra , Verma Radha Krishan , Verma Manoj Kumar , Bhattacharjee Rupsa , Saha Indrajit
Published: July 2019

Objective

To evaluate the visualization of gallbladder stones on susceptibility-weighted imaging (SWI).

Materials and Methods

Imaging data from 47 patients who underwent clinically indicated cholecystectomy was reviewed. Breath-hold SWI was added to the magnetic resonance imaging protocol and magnitude and phase data was reviewed for gall-stones visualization. Phase signature, that is, diamagnetic, paramagnetic, or mixed, was also noted in the stones. Magnetic susceptibility value of surgically extracted gallstones were imaged ex vivo (n = 37).

Results

In 45 of 47 cases, gallstones were surgically confirmed. In 43 cases, gallstones were visualized in the SWI. In 1 case, although routine imaging failed, stones were visualized on SWI. In 29 diamagnetic, 7 paramagnetic and 9 cases mixed phase were seen. In an ex vivo study, magnetic susceptibility of stones was found ranging between −0.102 and −0.916 ppm for diamagnetic and 0.203 and 486 ppm for paramagnetic stones.

Conclusions

Gallbladder stones can be visualized with SWI and may be added to the routine magnetic resonance imaging protocol for its evaluation.
Modulating Diffusion-Weighted Magnetic Resonance Imaging for Screening in Oncologic Tertiary Prevention
Authors: Dreher Constantin , Kuder Tristan Anselm , König Franziska , Paech Daniel , Tavakoli Andrej , Laun Frederik Bernd , Flothow Florian , Gnirs Regula , Benkert Thomas , Nickel Dominik , Strecker Ralf , Schlemmer Heinz-Peter , Bickelhaupt Sebastian
Published: July 2019

Introduction

Diffusion-weighted imaging (DWI) is an important part of oncological magnetic resonance imaging (MRI) examinations, especially for tertiary cancer prevention in terms of early detection of recurrent disease. However, abdominal studies can be challenged by motion artifacts, poor signal-to-noise ratios, and visibility of retroperitoneal structures, which necessitates sequence optimization depending on the investigated region. This study aims at prospectively evaluating an adapted DWI sequence ex vivo and in vivo in oncologic patients undergoing abdominal MRI.

Methods

This institutional review board–approved, prospective study included phantom measurements, volunteer examinations, and oncologic patient examinations of the abdomen. Fifty-seven MRI examinations in 54 patients (mean age, 58 years; range, 21–90 years) were included into the analysis. The MRI examination were performed at a 1.5 T MRI scanner (MAGNETOM Aera; Siemens Healthcare, Erlangen, Germany) and included both a standard EPI-DWI (s-DWI; b = 50, 900 s/mm2) and an adapted DWI (opt-DWI; EPI-DWI with b = 0, 50, 900, 1500 s/mm2, acquisition with higher spatial resolution and optimized processing for the abdomen including motion correction, adaptive image combination, and background suppression). For b = 900 s/mm2, the ratio of signal intensity in the normal tissue and the standard deviation of the noise in the surrounding air was quantitatively calculated; image quality and tissue differentiation parameters were rated by 2 independent, blinded readers using a 5-point Likert scale. Statistics included Wilcoxon signed-rank test and kappa statistic (P < 0.05/0.0125 after Bonferroni correction).

Results

The DWI phantom demonstrated an optimized contour sharpness and inlay differentiation for opt-DWI. The apparent ratio of normal tissue signal/standard deviation of background noise at b = 900 s/mm2 of the right/left hemiabdomen was significantly increased in opt-DWI (mean, 71.9 ± 23.5/86.0 ± 43.3) versus s-DWI (mean, 51.4 ± 15.4/63.4 ± 36.5; P < 0.001). Image quality parameters (contour sharpness and tissue differentiation of upper abdominal and retroperitoneal structures) were significantly increased in opt-DWI versus s-DWI (P < 0.001). Interreader reliability test showed good agreement (kappa = 0.768; P < 0.001).

Discussion

This study prospectively evaluated the potential of adapted DWI for screening in tertiary prevention of oncologic patients. An optimized DWI protocol with advanced processing achieved improved image quality in quantitative and qualitative analyses. Oncological optimization of DWI should be performed before its application in cancer patients to improve both screening and follow-up examinations, to better unleash the diagnostic potential of DWI.
Current Epidemiology of Surgical Sepsis
Authors: Brakenridge Scott C. , Efron Philip A. , Cox Michael C. , Stortz Julie A. , Hawkins Russell B. , Ghita Gabriela , Gardner Anna , Mohr Alicia M. , Anton Stephen D. , Moldawer Lyle L. , Moore Frederick A.
Published: July 2019

Objective:

We sought to compare traditional inpatient outcomes to long-term functional outcomes and mortality of surgical intensive care unit (SICU) patients with sepsis.

Summary of Background Data:

As inpatient sepsis mortality declines, an increasing number of initial sepsis survivors now progress into a state of chronic critical illness (CCI) and their post-discharge outcomes are unclear.

Methods:

We performed a prospective, longitudinal cohort study of SICU patients with sepsis.

Results:

Among this recent cohort of 301 septic SICU patients, 30-day mortality was 9.6%. Only 13 (4%) patients died within 14 days, primarily of refractory multiple organ failure (62%). The majority (n = 189, 63%) exhibited a rapid recovery (RAP), whereas 99 (33%) developed CCI. CCI patients were older, with greater comorbidities, and more severe and persistent organ dysfunction than RAP patients (all P < 0.01). At 12 months, overall cohort performance status was persistently worse than presepsis baseline (WHO/Zubrod score 1.4 ± 0.08 vs 2.2 ± 0.23, P > 0.0001) and mortality was 20.9%. Of note at 12 months, the CCI cohort had persistent severely impaired performance status and a much higher mortality (41.4%) than those with RAP (4.8%) after controlling for age and comorbidity burden (Cox hazard ratio 1.27; 95% confidence interval, 1.14–1.41, P < 0.0001). Among CCI patients, independent risk factors for death by 12 months included severity of comorbidities and persistent organ dysfunction (sequential organ failure assessment ≥6) at day 14 after sepsis onset.

Conclusions:

There is discordance between low inpatient mortality and poor long-term outcomes after surgical sepsis, especially among older adults, increasing comorbidity burden and patients that develop CCI. This represents important information when discussing expected outcomes of surgical patients who experience a complicated clinical course owing to sepsis.
Academic Advancement in Global Surgery: Appointment, Promotion, and Tenure
Authors: Wren Sherry M. , Balch Charles M. , Doherty Gerard M. , Finlayson Samuel R. , Kauffman Gordon L. , Kibbe Melina R. , Haider Adil H. , Minter Rebecca M. , Mock Charles , Muguti Godfrey I. , Numann Patricia J. , Olutoye Oluyinka O. , Roy Nobhojit , Weigel Ronald J.
Published: July 2019

There is growing interest in global surgery among US academic surgical departments. As academic global surgery is a relatively new field, departments may have minimal experience in evaluation of faculty contributions and how they integrate into the existing academic paradigm for promotion and tenure. The American Surgical Association Working Group on Global Surgery has developed recommendations for promotion and tenure in global surgery, highlighting criteria that: (1) would be similar to usual promotion and tenure criteria (eg, publications); (2) would likely be undervalued in current criteria (eg, training, administrative roles, or other activities that are conducted at low- and middle-income partner institutions and promote the partnerships upon which other global surgery activities depend); and (3) should not be considered (eg, mission trips or other clinical work, if not otherwise linked to funding, training, research, or building partnerships).
Sex Disparity in Outcomes of Ruptured Abdominal Aortic Aneurysm Repair Driven by In-hospital Treatment Delays
Authors: Wang Linda J. , Locham Satinderjit , Dakour-Aridi Hanaa , Lillemoe Keith D. , Clary Bryan , Malas Mahmoud B.
Published: July 2019

Objective:

We sought to assess whether sex-related differences in timely repair of ruptured abdominal aortic aneurysm (rAAA) were associated with excess risk of early mortality in women.

Summary Background Data:

rAAA is a surgical emergency and timeliness of intervention affects outcomes. A door-to-intervention time of <90 minutes is recommended.

Methods:

All rAAA repairs in the Vascular Quality Initiative from 2003 to 2017 were reviewed. Patients were stratified by sex and time-delay cohorts. Univariate and multivariate analyses were performed.

Results:

There were 3719 rAAA repairs, of which 797 (21%) were performed in women. Sex did not affect repair type: open versus endovascular (21% females, each). Despite similar presentation delays [median 6 hours (inter quartile range, IQR: 3–16)], admission-to-intervention time was longer for women than men [median 1.5 hours (IQR 1–4] vs 1.2 hours (IQR 1–3), P=0.047]. Overall, 45% of patients had a >90-minute delay from admission to repair, with more women than men experiencing this delay (49% vs 44%, P=0.01). Neither were more likely to undergo transfer for treatment. After risk adjustment, female sex was associated with a 48% increase in 30-day mortality. Sex differences in mortality were no longer observed in patients with intervention delays of ≤90 minutes. In patients with >90-minute delays, a 77% increase in 30-day mortality of women over men was noted.

Conclusions:

Nearly half of rAAA patients have a door-to-intervention time longer than recommended societal guidelines. Sex differences in mortality after rAAA repair seem to be driven by in-hospital treatment delays.
The Effect of Perioperative Music on Medication Requirement and Hospital Length of Stay
Authors: Fu Victor X. , Oomens Pim , Klimek Markus , Verhofstad Michiel H. J. , Jeekel Johannes
Published: July 2019

Objective:

To assess and quantify the effect of perioperative music on medication requirement, length of stay and costs in adult surgical patients.

Summary Background Data:

There is an increasing interest in nonpharmacological interventions to decrease opioid analgesics use, as they have significant adverse effects and opioid prescription rates have reached epidemic proportions. Previous studies have reported beneficial outcomes of perioperative music.

Methods:

A systematic literature search of 8 databases was performed from inception date to January 7, 2019. Randomized controlled trials investigating the effect of perioperative music on medication requirement, length of stay or costs in adult surgical patients were eligible. Meta-analysis was performed using random effect models, pooled standardized mean differences (SMD) were calculated with 95% confidence intervals (CI). This study was registered with PROSPERO (CRD42018093140) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines.

Results:

The literature search yielded 2414 articles, 55 studies (N = 4968 patients) were included. Perioperative music significantly reduced postoperative opioid requirement (pooled SMD −0.31 [95% CI −0.45 to −0.16], P < 0.001, I
2 = 44.3, N = 1398). Perioperative music also significantly reduced intraoperative propofol (pooled SMD −0.72 [95% CI −1.01 to −0.43], P < 0.00001, I
2 = 61.1, N = 554) and midazolam requirement (pooled SMD −1.07 [95% CI −1.70 to −0.44], P < 0.001, I
2 = 73.1, N = 184), while achieving the same sedation level. No significant reduction in length of stay (pooled SMD −0.18 [95% CI −0.43 to 0.067], P = 0.15, I
2 = 56.0, N = 600) was observed.

Conclusions:

Perioperative music can reduce opioid and sedative medication requirement, potentially improving patient outcome and reducing medical costs as higher opioid dosage is associated with an increased risk of adverse events and chronic opioid abuse.
Sarcopenia: looking to muscle mass to better manage pancreatic cancer patients
Authors: Basile Debora , Corvaja Carla , Caccialanza Riccardo , Aprile Giuseppe
Published: July 2019

Purpose of review

Overall survival of patients with pancreatic cancer is strongly conditioned by tumor biology and the incidence of malnutrition and metabolic disorders. In this landscape, the assessment of body composition is crucial to properly manage the clinical implications of muscle wasting. The pathogenesis of this condition is the result of a complex interplay between cancer and the host. In particular, sarcopenia is induced by an inadequate nutritional intake, hormonal abnormalities, inflammation and imbalance between anabolic and catabolic pathways.

Recent findings

Recent evidences have highlighted the role of sarcopenia in cancer patients, revealing a prognostic impact on morbidity, mortality and survival.

The occurrence of sarcopenia could amplify chemotherapy-induced toxicities, prolong hospitalizations and reduce adherence to anticancer treatment, worsening quality of life and survival. Although considerable efforts have been made to develop treatment strategies, no effective interventions have been identified so far. Nevertheless, if promptly and adequately supported, pancreatic cancer might benefit from adopted dietary intervention to avoid further loss of lean mass.
An Atypical Case of Abdominal Pain in a Toddler
Authors: Jordan Kathleen S.
Published: July 2019

Abdominal pain in the pediatric patient presents a unique diagnostic challenge for emergency department (ED) providers due to the wide range of possible etiologies and sequelae. The list of differential diagnoses is extensive and includes the spectrum of conditions that range from benign and self-limiting to those that are potentially life-threatening. This article describes a case of a young toddler with an acute appendicitis complicated by perforation and abscess formation. Although acute appendicitis is uncommon in infants and younger children, it does occur and, as this case illustrates, is often misdiagnosed, which leads to delayed treatment and a higher incidence of complications. This article includes a discussion of the challenges faced by ED providers in the clinical-decision making process when caring for a pediatric patient with abdominal pain due to an acute appendicitis. This discussion includes the age-associated epidemiology, pathophysiology, clinical presentation, and evidence-based recommendations for diagnosis and treatment.
Kawasaki Disease in Infancy
Authors: Fuller Martha Grant
Published: July 2019

Kawasaki disease (KD) is an acute vasculitis that primarily affects young children and, if untreated, is associated with development of coronary artery aneurysms in approximately 25% of those affected. Infants, especially those younger than 6 months, often have atypical (incomplete) presentations of KD and are most at risk for development of aneurysms. Identification of KD requires a careful and thorough history and physical examination because multiple other conditions cause similar findings. Providers in acute care settings need to have a high degree of suspicion for KD so that those affected may receive appropriate and timely treatment.
Dental Pain Relief in the Age of ALTO
Authors: May Erica , Wilbeck Jennifer
Published: July 2019

The opioid public health crisis necessitates that health care providers seek alternatives to opioid pain control. For patients presenting with dental pain, a dental nerve block provides effective, long-lasting pain relief without the use of opioid pain medications. This article presents the techniques required to safely and effectively administer 3 types of dental nerve blocks, allowing the emergency nurse practitioner to provide effective pain control to patients with dental pain.
A Video Intervention to Increase Organ Donor Registration at the Department of Motorized Vehicles
Authors: DuBay Derek , Morinelli Thomas , Redden David , Rodrigue James , Ivankova Nataliya , Herbey Ivan , Holt Cheryl , Siminoff Laura , Fouad Mona , Su Zemin , Martin Michelle
Published: July 2019

Background.

The goal of this study was to increase organ donor registrations at the Department of Motorized Vehicles (DMV) via utilization of a sustainable, low-cost, African American-centric organ donation educational video. Results from previous studies provided a framework to generate a 10-minute video that featured registered organ donors, deceased donor families, and transplant recipients.

Methods.

The video was presented via an interrupted time series design (repeating on 2 mo, off 2 mo) on televisions placed in 6 regional DMVs. During the 12-month study, 162 387 patrons visited the DMVs.

Results.

Increases in organ donor registration were consistently observed in each DMV while the video was on compared with off (mean = +2.3% [range +1.98% to +3.35%];P< 0.0001). Multivariable analysis demonstrated that females (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.26-1.31), younger age (OR, 0.982/y; 95% CI, 0.982-0.983), and the video intervention (OR, 1.09; 95% CI, 1.07-1.12) were significantly associated with increased registration; while compared with Caucasian race, African American race was not (OR, 0.22; 95% CI, 0.22-0.23). There was no video-dependent effect on registration between Caucasians and African Americans (P= 0.62). Exit interviews demonstrated only 16% of patrons could identify the key message in the video (becoming a registered organ donor).

Conclusions.

An educational video promoting organ donation resulted in increased organ donor registration at the DMV. The intervention was equally effective in African Americans and Caucasians. Future efforts should focus upon target-specific messaging and patron consumption of the educational video.
Integrating models of human behaviour between the individual and population levels to inform conservation interventions
Authors: Dobson Andrew D. M. , de Lange Emiel , Keane Aidan , Ibbett Harriet , Milner-Gulland E. J.
Published: July 2019

Conservation takes place within social–ecological systems, and many conservation interventions aim to influence human behaviour in order to push these systems towards sustainability. Predictive models of human behaviour are potentially powerful tools to support these interventions. This is particularly true if the models can link the attributes and behaviour of individuals with the dynamics of the social and environmental systems within which they operate. Here we explore this potential by showing how combining two modelling approaches (social network analysis, SNA, and agent-based modelling, ABM) could lead to more robust insights into a particular type of conservation intervention. We use our simple model, which simulates knowledge of ranger patrols through a hunting community and is based on empirical data from a Cambodian protected area, to highlight the complex, context-dependent nature of outcomes of information-sharing interventions, depending both on the configuration of the network and the attributes of the agents. We conclude by reflecting that both SNA and ABM, and many other modelling tools, are still too compartmentalized in application, either in ecology or social science, despite the strong methodological and conceptual parallels between their uses in different disciplines. Even a greater sharing of methods between disciplines is insufficient, however; given the impact of conservation on both the social and ecological aspects of systems (and vice versa), a fully integrated approach is needed, combining both the modelling approaches and the disciplinary insights of ecology and social science.

This article is part of the theme issue ‘Linking behaviour to dynamics of populations and communities: application of novel approaches in behavioural ecology to conservation’.
Contrasting Evidence to Reimbursement Reality for Off-label use (OLU) of Drug Treatments in Cancer Care – Rationale and Design of the CEIT-OLU-project
Authors: Herbrand AK , Schmitt AM , Briel M , Diem S , Ewald H , Hoogkamer A , Joerger M , Mc Cord KA , Novak U , Sricharoenchai S , Hemkens LG , Kasenda B
Published: July 2019

Background

Off-label drug use (OLU) reflects a perceived unmet medical need, which is common in oncology. Cancer drugs are often highly expensive and their reimbursement is a challenge for many health care systems. OLU is frequently regulated by reimbursement restrictions. For evidence-based health care, treatment ought to be reimbursed if there is sufficient clinical evidence for treatment benefit independently of patient factors not related to the treatment indication. However, little is known about the reality of OLU reimbursement and its association with the underlying clinical evidence. Here we aim to investigate the relationship of reimbursement decisions with the underlying clinical evidence.

Methods/Design

We extract patient characteristics and details on treatment and reimbursement of cancer drugs from over 3000 patients treated in three Swiss hospitals. We systematically search for clinical trial evidence on benefits associated with OLU in the most common indications. We will describe the prevalence of OLU in Switzerland and its reimbursement in cancer care, and use multivariable logistic regression techniques to investigate the association of approval/rejection of a reimbursement requests to the evidence on treatment effects and to further factors, including type of drug, molecular predictive markers and the health insurer.

Discussion

Our study will provide a systematic overview and assessment of OLU and its reimbursement reality in Switzerland. We may provide a better understanding of the access to cancer care that is regulated by health insurers and we hope to identify factors that determine the level of evidence-based cancer care in a highly diverse Western health care system.
Plant responses to butterfly oviposition partly explain preference-performance relationships on different brassicaceous species
Authors: Griese Eddie , Pineda Ana , Pashalidou Foteini G. , Iradi Eleonora Pizarro , Hilker Monika , Dicke Marcel , Fatouros Nina E.
Published: July 2019

According to the preference-performance hypothesis (PPH), also known as ‘mother-knows-best hypothesis’, herbivorous insects prefer those plants for oviposition, which yield the best offspring performance. Yet, most studies testing the PPH neglect the possibility that plant responses to insect eggs may affect both egg survival and larval performance. Here, we tested the PPH by studying responses of seven Brassicaceae plant species to oviposition by two cabbage white species. When including the egg phase, our study supports the ‘mother-knows-best hypothesis’: larvae ofPieris rapae(solitary) orP. brassicae(gregarious) gained most weight on those plant species which had received most eggs (B. nigraorB. montana, respectively). However, our experiments did not reveal any relationship between oviposition preference and egg survival. Brassicaceous species are known to respond to these butterfly eggs with a hypersensitive response (HR)-like necrosis, which can lower egg survival.Pieriseggs frequently induced necrosis in five of the tested plant species. Survival of clusteredP. brassicaeeggs was unaffected by HR-like in four of the five species. Therefore, our experiments did not reveal any relationship betweenP. brassicaeegg survival and oviposition preference. Females ofP. rapaepreferred oviposition on plant species which most frequently showed HR-like necrosis. Remarkably, although egg survival was lower on HR-like plants, larval biomass was higher compared to plants without a necrosis. We conclude that egg survival does not seem to be a deciding factor for oviposition choices. However, egg-mediated plant responses might be important to explain the PPH of the twoPierisspecies.

Lay summary

Egg-laying preferences of herbivorous insects can often be linked to offspring performance. Commonly, the fate of insect eggs and the plant responses to the eggs have been ignored when studying the link between preference and performance. By including the egg phase, our study supports the ‘mother-knows-best hypothesis’, explained by butterfly oviposition and associated egg and larval performances on different plant species. We especially found that egg-mediated responses seem a deciding factor for butterfly oviposition choices.
Epicardial therapy with atrial appendage micrografts salvages myocardium after infarction
Authors: Yanbo Xie , Lampinen Milla , Takala Juuso , Sikorski Vilbert , Soliymani Rabah , Tarkia Miikka , Lalowski Maciej , Mervaala Eero , Kupari Markku , Zheng Zhe , Hu Shengshou , Harjula Ari , Kankuri Esko ,   on behalf of the AADC consortium
Published: July 2019

Ischemic heart disease remains the leading cause of mortality and morbidity worldwide despite improved possibilities in medical care. Alongside interventional therapies, such as coronary artery bypass grafting, adjuvant tissue-engineered and cell-based treatments can provide regenerative improvement. Unfortunately, most of these advanced approaches require multiple lengthy and costly preparation stages without delivering significant clinical benefits.

We evaluated the effect of epicardially delivered minute pieces of atrial appendage tissue material, defined as atrial appendage micrografts (AAMs), in mouse myocardial infarction model. An extracellular matrix patch was used to cover and fix the AAMs onto the surface of the infarcted heart. The matrix-covered AAMs salvaged the heart from infarction-induced loss of functional myocardium and attenuated scarring. Site-selective proteomics of injured ischemic and uninjured distal myocardium from AAM-treated and untreated tissue sections revealed an increased expression of several cardiac regeneration-associated proteins (i.e. periostin, transglutaminases and glutathione peroxidases) as well as activation of pathways responsible for angio- and cardiogenesis in relation to AAMs therapy.

Epicardial delivery of AAMs encased in an extracellular matrix patch scaffold salvages functional cardiac tissue from ischemic injury and restricts fibrosis after myocardial infarction. Our results support the use of AAMs as tissue-based therapy adjuvants for salvaging the ischemic myocardium.