bluuebunny/crossref_metadata_2025 huggingface dataset:
Efecto de selladores endodónticos sobre el pH del medio al cual son inmersos
Authors: C I Rourera , C Sotomayor , C Andrada Castillo , A Kaplan , G Martin
Published: January 2021

INTRODUCCIÓN: El uso de selladores en la obturación endodóntica es fundamental para lograr un sellado tridimensional del conducto radicular. Según su composición, se presentan selladores a base de resina epóxica, como el AH Plus y de biocerámico, como Bio-C Sealer y BioRoot RCS, siendo considerados los últimos como materialesbioactivos, por su capacidad de promover una reacción biológica específica sobre el tejido receptor, por la liberación de calcio y pH alcalino OBJETIVO: Evaluar, in vitro la capacidad de diferentes selladores endodónticos para modificar el pH de la solución en la cual son inmersos, en distintos períodos de tiempo. MATERIALES Y METODOS: Se prepararon 15 probetas de sellador en un molde de plástico. Se dejaron fraguar 24 hs en estufa a 37° C y posteriormente, cada una fue inmersa en un frasco consolución fisiológica. La muestra se dividió en tres grupos (n=5) según el sellador: 1) BioRoot RCS, 2) Bio-C Sealer y 3) AHPlus. Se determinó el pH de la solución de cada grupo en diferentes períodos de tiempo: inmediato, 40 min, 24 y 48 hs, 7, 14, 21 y 30 días. Los resultados fueron analizados estadísticamente mediante Análisis de Varianza con Medidas Repetidas (ANOVA). RESULTADOS: El sellador AH Plus mantuvo constante el pH del medio durante toda la experiencia. Ambos selladores biocerámicos elevaron el pH del medio hasta llegar a ser alcalino (11,2 y 11,5) a las 24 hs, el cual se mantuvo para el grupo BioRoot RCS hasta los 30 días, con un pH promedio de 11.5. Mientras que, a partir de los 7 días, en el grupoBio-C Sealer comenzó a descender el pH del medio. La evolución del pH a lo largo del tiempo arrojó diferencias significativas entre los distintos selladores evaluados (p<0,001). CONCLUSIONES: Bajo las condiciones del presente estudio, AH Plus no modificó el pH del medio y ambos selladores biocerámicos elevaron el pH, alcanzado su máximo valor de alcalinidad a los 7 días; a partir de los cuales, BioRoot RCS mantuvo el pH elevado del medio y con Bio-C Sealer se observó un ligero descenso del pH hasta los 30 días.
Predictors of home oxygen duration in chronic neonatal lung disease
Authors: Wong Matthew , Neylan Melissa , Williams Gordon , Zahir Syeda , Chawla Jasneek
Published: January 2021

Aims:  In infants with chronic neonatal lung disease (CNLD), we
aimed to identify predictors of home oxygen duration, predictors of
discharge oxygen flow rates and the association of oxygen flow rates
with respiratory outcomes.

Methods:  Retrospective review of infants with CNLD requiring
home oxygen in 2016 and 2017.  Hazard ratios (HR) were estimated from
Cox proportional hazards regression models in the cohort.  A multinomial
logistic regression model examined the effects of maternal and infant
variables on discharge oxygen flow rates.  Kruskal-Wallis test with
univariate linear regression and Fisher’s exact test with binomial
univariate logistic regression were used to examine associations between
oxygen flow groups and post-discharge clinical variables.

Results:  149 infants were included.  Median corrected
gestational age (CGA) at oxygen cessation was 6.8 months (IQR 4.4) with
87.2% of infants weaned by 12 months CGA.  Shorter initial neonatal
intensive care unit (NICU) stay predicted faster oxygen weaning at 9
months (HR 0.99, 95%CI 0.98-1.00, p=0.02) and 12 months (HR
0.99, 95%CI 0.98-1.00, p=0.02).  Infants with hypercarbia at
discharge or discharged from NICU at higher CGA had higher odds of
requiring ≥200mL/min relative to ≤125 mL/min oxygen.  Infants discharged
with >250mL/min oxygen were more likely to have a
respiratory related admission before two years chronologic age.

Conclusion:  Shorter initial NICU stay was the best predictor
of earlier home oxygen cessation.  At NICU discharge, infants with
hypercarbia or a higher CGA may require more home oxygen and experience
more respiratory related hospital admission in the first two years of
chronological age.
Large-scale Scientific Computing in the Fight Against COVID-19
Authors: West John
Published: January 2021

U.S. computing leaders, including the National Science Foundation, have
partnered with universities, government agencies, and the private sector
to accelerate research into responses to COVID-19 – providing an
unprecedented collection of resources that include some of the fastest
computers in the world. This current work expands on last month’s
Leadership Computing article by continuing to showcase the range of
contributions that the national cyberinfrastructure is making to global
efforts to stop the pandemic. This article touches on research efforts
to learn how SARS-CoV-2 spreads among different populations, the biology
and structure of the virus and its mechanisms of infection, and to
develop effective vaccines for prevention and antiviral therapies for
treatment. Even though we are still early in the process of developing
an effective therapeutic response, the rapid mobilization of the
national research cyberinfrastructure is a timely reminder of the
strategic importance of robust, ongoing investments in large-scale
scientific computing.
Blow up and asymptotic behavior of solutions for a p(x)-Laplacian equations with delay term and variadle exponents
Authors: Antontsev Stanilslav , Ferreira Jorge , Pişkin Erhan , Yüksekkaya Hazal
Published: January 2021

In this paper, we consider a nonlinear p .x/Laplacian equation with
delay of time and variable exponents. Firstly, we prove the blow up of
solutions. Then, by applying an integral inequality due to Komornik, we
obtain the decay result. These results improve and extend earlier
results in the literature.
Midazolam infusion and disease severity affect the level of sedation in children: a parametric time-to-event analysis of data from the ‘daily sedation interruption in critically ill children’ trial
Authors: Upadhyay Parth , Vet Nienke , Goulooze Sebastiaan , Krekels Elke , wildt Saskia De , Knibbe Catherijne
Published: January 2021

Aim In critically ill mechanically ventilated children, midazolam is
used first line for sedation, however its sedative effects have been
difficult to quantify for which novel quantification methods are still
required. In this analysis, we use parametric time-to-event (PTTE)
analysis to quantify the effects of midazolam in critically ill
children. Methods For the PTTE analysis, data was analyzed from a
published sedation interruption study in mechanically ventilated
critically ill children. In this study, blinded midazolam or placebo
infusions were administered during the sedation interruption phase
until, based on COMFORT-B and NISS scores, patients became undersedated
and unblinded midazolam was restarted. Using NONMEM® v.7.4.3.,the
restart of unblinded midazolam was analysed as a clinical event,
followed by internal and external validation. Results Data contained 138
events from 79 individuals (37 blinded midazolam; 42 blinded placebo).
In the PTTE model, a constant function best described the baseline
hazard. The use of midazolam reduced the hazard for restart of unblinded
midazolam due to undersedation by 51%. In the blinded midazolam group,
time to midazolam restart was 26 h versus 58 h in patients with low
versus high disease severity upon admission (PRISM II <10
versus > 21), respectively. For blinded placebo these times
were 14 h and 33 h, respectively. The model performed well in an
external validation with 42 individuals. Conclusion The PTTE analysis
effectively quantified the effect of midazolam and the influence of
disease severity on sedation in mechanically ventilated critically ill
children and provides a valuable tool to quantify sedative efficacy
Sarcoidosis of the Ear, Nose and Throat: a review of the literature
Authors: Cereceda-Monteoliva Nicholas , Rouhani Maral , Maughan Elizabeth , Rotman Anthony , Orban Nara , Yaghchi Chadwan Al , Sandhu Guri
Published: January 2021

Objectives. Sarcoidosis is a multisystemic inflammatory disease with
extrathoracic manifestations, most commonly affecting the young and
middle-aged, female and black populations. Diagnosis usually requires
evidence of non-caseating granulomata and, when treated, prognosis is
usually favourable. We aim to establish the incidence, clinical features
and optimal treatment of ENT manifestations of this disease. Design. We
performed a review of the literature to determine the evidence-base
supporting this. Results. ENT manifestations are present in 10-15% of
patients with sarcoidosis, often as a presenting feature, and require
vigilance for swift recognition and coordinated additional treatment
specific to the organ. Laryngeal sarcoidosis presents with difficulty in
breathing, dysphonia and cough, and may be treated by Speech and
Language Therapy (SLT) or intralesional injection, dilatation or tissue
reduction. Nasal disease presents with crusting, rhinitis, nasal
obstruction and anosmia, usually without sinus involvement. It is
treated by topical nasal or intralesional treatments but may also
require endoscopic sinus surgery, laser treatment or even nasal
reconstruction. Otological disease is uncommon but includes
audiovestibular symptoms, both sensorineural and conductive hearing
loss, and skin lesions. Conclusions. The consequences of ENT
manifestations of sarcoidosis can be uncomfortable, disabling and even
life threatening. Effective management strategies require good
diagnostic skills and use of specific therapies combined with
established treatments such as corticosteroids. Comparisons of treatment
outcomes are needed to establish best practice in this area.
Oral paclitaxel with encequidar compared to intravenous paclitaxel in patients with advanced cancer: a randomised crossover pharmacokinetic study.
Authors: Jackson Christopher , Hung C , Segelov Eva , Barlow Paula , Prenen Hans , McLaren Blair , Hung Noelyn , Clarke Katriona , Chao Tsu-Yi , Dai Ming-Shen , Yeh Hsien-Tang , Cutler David , Kramer Doug , He Jimmy , Zhi Jay , Chan Wing-Kai , Kwan Rudolf , Deva Sanjeev
Published: January 2021

Background and purpose: Paclitaxel is a widely used anti-neoplastic
agent but has low oral bioavailability due to gut extrusion by
P-glycoprotein (P-gp). Oral paclitaxel could be more convenient, less
resource intensive, and more tolerable than intravenous administration.
Encequidar (HM30181A) is a novel, minimally absorbed gut specific P-gp
inhibitor. We tested whether administration of oral paclitaxel with
encequidar (oPac+E) achieved comparable AUC to intravenous paclitaxel
(IVP) 80mg/m2. Experimental approach: We conducted a multi-centre
randomised crossover study with two treatment periods. Patients (pts)
with advanced cancer received either oral paclitaxel 615mg/m2 divided
over three days and encequidar 15mg orally one-hour prior, followed by
IVP 80mg/m2, or the reverse sequence. PK blood samples were taken up to
day 9 for oPac+E and day 5 for IVP. Key Results: 42 pts were enrolled;
35 completed both treatment periods. AUC0-∞was 5033.5 +/- 1401.1 ng.h/mL
for oPac+E and 5595.9 +/- 1264.1 ng.h/mL with IVP. The geometric mean
ratio (GMR) for AUC was 89.5% (90% CI 83.9-95.5). Mean absolute
bioavailability of oPac+E was 12%. PK parameters did not change
meaningfully after 4 weeks administration of oPac+E in an extension
study. G3 treatment emergent adverse events occurred in 7 (18%) pts
with oPac+E and 2 (5%) with IVP. 75% of pts preferred oPac+E over IVP.
Conclusion and Implications: GMR for AUC was within the predefined
acceptable range of 80%-125% for demonstrating equivalence. oPac+E is
tolerable and there is no evidence of P-gp induction with repeat
administration. With further study, oPac+E is a candidate to replace
IVP.
OUTLET ROUX-Y-GASTRIC BYPASS POUCH REDUCTION USING ARGON PLASMA COAGULATION TO TREAT WEIGHT REGAIN: A Randomized Controlled Trial with SHAM Group
Authors: Ph.D Dr. Idiberto Jose Zotarelli Filho, MSc,
Published: January 2021

Aims: This study to evaluate the efficacy and complications of Argon
Plasma Coagulation (APC) therapy to treat post-RYGB weight regain
compared to a sham control group. Methods: 41 Patients with minimum
regain of 10 kg and minimal postoperative time of 36 months was
randomized into two groups. Results: In the APC group (n=21), the mean
initial weight 100.4 kg, and mean regained weight of 24.94 kg. In the
Sham group (n=20), the mean initial weight of 103.65 kg, and mean
regained weight of 25.18 kg. Only happened anastomosis stenosis after
the first APC session. The comparative results between the APC versus
the Sham were percentage recovered weight loss (63.95 x-2.65), weight
loss in kg (15.02 x-0.57), percentage total weight loss (14.46 x-0.62),
% excess weight loss (54.32 x-2.34), and BMI reduction (5.38 x-0.21),
with a p<0.0001 for all the comparisons. There was a
significant reduction in the APC group of HbA1c (5.66% to 4.96%) and
triglycerides (153.20mg/dL to 132.20mg/dL). Conclusion: This study
proves that APC outlet pouch reduction is much superior compared to sham
in promoting weight loss for patients that presented weight regain after
de RYGB.
Stability of Leadership as a Determinant in the Development of Budgetary Units in Poland
Authors: Gruziel Kinga
Published: January 2021

This study investigates the concept of the stability of the state and the public finance sector (PFS) based on a review of current literature in the field. An attempt has been made to define the principles of public management and present the structures of public finance sector units (PFSU) in Poland. The study focuses on the public finance sector, units included in this sector, mechanisms influencing the functioning of public service organisations and their management. Part of the research is a case study analysis of a sample PFSU, which is a central administration body. The purpose of the study was to identify the measures used to assess the stability of a public finance sector unit and to interpret those measures in relation to the studied areas of the PFS in Poland. The paper explores the principles of managing the organisation of the public finance sector, the notion of public management and its genesis. The selected PFSU case was used to indicate the relationship between the functioning of a public finance sector unit and the stability of leadership in that unit. The study is descriptive and uses inference methods. The research material included the literature on public finance and management as well as internal materials of the studied public finance sector unit. The main objective of the study was to show how the destabilisation of leadership can affect the functioning of the state office. As a result of the analysis, measures most accurately describing the phenomenon of leadership stability have been constructed. They include: measures based on quantitative assessment, measures based on institutional behaviour assessment and measures based on the subjective opinions, behaviours and expectations of employees, stakeholders and associates of the PFSU. The existence of a relationship between the stability of leadership and the functioning of a public finance sector unit was confirmed. Changes were recorded in the functioning of the office during frequent personnel changes in senior civil service positions. (original abstract)
Poverty in Rural Areas : an Outline of the Problem
Authors: Kalinowski Sławomir
Published: January 2021

This article is an attempt to determine the level of poverty in rural areas in Poland. The author reviewed the most important publications on poverty and the indicators that determine its scale. Relative, objective and subjective poverty lines were used to present the range of rural poverty against the background of total poverty. Analyses showed that the at-risk-of-poverty rate for rural areas in Poland amounted to 21.2%. This means that almost every fifth rural resident is at risk of poverty, whereas every tenth resident is at risk of extreme poverty. The article also presents the rural areas in Poland which are at the highest risk of social exclusion. These areas were distinguished on the basis of the number of registered families receiving social benefits. Both Eurostat (EU-SILC) and Local Data Bank of the Statistics Poland (BDL GUS) were used. (original abstract)
Kidney Transplantation 2: Care of the Kidney Transplant Recipient
Authors: Azzi Jamil , Lee Belinda T. , Chandraker Anil , McGrath Martina M
Published: January 2021

Renal transplantation is the preferred therapy for patients with end-stage kidney disease, leading to increased life expectancy, improved quality of life, and reduced health care resource use. Owing to their preexisting burden of disease, caring for renal transplant recipients is complex. Patient management following successful renal transplantation involves a multifactorial approach to cardiovascular risk factor management, along with titration of immunosuppression, management of complications related to immunosuppression, and active monitoring of allograft function. Recent advances in immunosuppressive management hold promise for improved long-term allograft survival. Finally, immune monitoring of transplant recipients is an area of considerable research, with the ultimate aim of individualized management of immunosuppression and the ability to induce transplant-specific tolerance.
This review contains 7 figures, 11 tables, and 119 references.
Key words: cardiovascular disease, drug interactions, immunosuppression, infection, interstitial fibrosis and tubular atrophy, malignancy, rejection, tolerance
Heart Transplantation - Part I: General Considerations
Authors: Givertz Michael M.
Published: January 2021

Heart failure (HF) is a major public health problem with significant associated morbidity and mortality. In 2001, the American College of Cardiology/American Heart Association (ACC/AHA) guideline committee proposed a new approach to the classification of HF that emphasized both the development and progression of disease.  Stage A and B patients are at high risk for developing HF, and include those without structural heart disease (Stage A) and those with structural heart disease, but without signs or symptoms of HF (Stage B).  Stage C and D patients have structural heart disease with prior or current symptoms of HF (Stage C) or refractory HF requiring specialized interventions (Stage D).  Rregistries suggest that between 5% and 10% of patients with HF have advanced disease, which is associated with 1-year mortality in excess of 50% and a poor quality of life. The Heart Failure Society of America (HFSA) defines Stage D heart failure as “the presence of progressive and/or persistent severe signs and symptoms of heart failure despite optimized medical, surgical, and device therapy…generally accompanied by frequent hospitalization, severely limited exertional tolerance, and poor quality of life.”  In this two-part chapter, we focus on heart transplantation, which remains the standard-of-care for highly selected patients with end-stage HF and absence of contraindications to transplant.1-5
This review contains 7 figures, 8 tables, and 46 references.
Key words: heart failure, cardiomyopathy, heart transplant, mechanical circulatory support, prognosis, pulmonary hypertension, diabetes, HLA sensitization, donor
Bedside Procedures for General Surgeons
Authors: Cogbill Thomas H. , Jarman Benjamin T
Published: January 2021

This review is focused on 12 procedures that are commonly performed by general surgeons in the emergency department, critical care unit, operating room, and outpatient clinic. The review begins with eight critical care procedures: percutaneous tracheostomy, saphenous vein cutdown, percutaneous arterial cannulation, subclavian venous catheter placement by landmark technique, internal jugular venous catheter placement under ultrasound guidance, needle chest decompression, tube thoracostomy, and pericardiocentesis for trauma. Next, the diagnostic procedure of focused assessment with sonography for trauma (FAST) is described. The review finishes with three procedures that are frequently performed in the outpatient setting: temporal artery biopsy, simple abscess drainage, and muscle biopsy. Although considered basic procedures, each has its own set of key steps that must be learned, practiced, and mastered. Included in the description for each procedure are technical points that are intended to facilitate successful performance of the procedures as well as pitfalls to avoid. The most frequent complications for each procedure are briefly discussed in an effort to raise awareness so that they can be recognized and managed expeditiously. Common to all of these procedures is a need to understand the indications based on careful history, physical examination, and review of pertinent objective data. Whenever possible, informed consent should be obtained from the patient or family prior to the procedure and a complete surgical timeout performed. Sterile technique and personal protective gear/universal precautions should be employed whenever feasible. Finally, these patients should be followed postoperatively and appropriate follow-up studies and/or treatments arranged. The figures illustrate key steps used in a number of the procedures and typical ultrasound images of the internal jugular vein during central venous catheter placement and the four standard FAST views, along with photo insets depicting appropriate ultrasound probe positioning. The tables include the lists of equipment necessary to perform each procedure.
This review contains 17 figures, 14 tables, and 47 references
Acute and Chronic Radiation Injury to the Lower Gastrointestinal Tract
Authors: Beard Rachel E. , Nagle Deborah
Published: January 2021

Radiation is an integral part of therapy for many pelvic cancers, including rectal, prostate, cervical, and uterine cancers, and has been shown to decrease local recurrence and increase patient survival. Radiation injury is a sequela of treatment that manifests different symptoms depending on the organ affected. This review covers disease pathology, risk factors, disease prevention, clinical presentation, medical therapy, endoscopic therapy, and surgical therapy. Tables outline risk factors predisposing patients to the development of radiation injury, investigated prophylactic therapies to prevent radiation injury, reported frequencies of symptoms of chronic radiation proctitis, pharmacologic therapies that have demonstrated clinical benefit in randomized trials, and a scoring system for symptoms and endoscopic and histologic results. A management algorithm details evaluation and treatment of radiation-induced gastrointestinal injury. A microscopic section shows diffuse ulceration and granulation tissue formation. Photographs depict the rectal wall thickened by dense white tissue and severe perianal dermatitis.  Endoscopic views of radiation proctitis with ulceration, severe radiation proctitis, mild radiation proctitis, prominent telangiectasia, anal necrosis due to radiation, actively bleeding telangiectasia, and argon plasma coagulation are provided. Other figures include computed tomographic scans of an inflamed rectum and the rectal wall with thin mucosa, and magnetic resonance imaging of the pelvis.
This review contains 13 figures, 5 tables, and 89 references.
Oral Cavity Procedures
Authors: Prince Mark E.P. , Bradford Carol R. , Krause Charles J
Published: January 2021

The surgical management of lesions of the oral cavity is complex and requires the surgeon to consider multiple factors. Frequently a multidisciplinary team should be included in the decision-making process, particularly when a malignant lesion is being treated. Preoperative evaluation is critical in determining the optimal therapy and often will include radiologic evaluation and flexible endoscopy in addition to physical examination. Surgical decision making includes determining when a transoral approach is possible and appropriate versus a more extensive surgical approach such as a lip split and mandibulotomy. For small lesions, with a cooperative patient, local anesthesia might be adequate, but often, general anesthesia will be required. For malignant lesions, management of possible cervical node metastasis must be included in the treatment plan. Management of the airway during surgery and postoperatively must also be carefully considered. When there is concern for significant postoperative swelling or trismus, which might make reintubation difficult, tracheostomy should be considered. Primary closure can be effective for small defects. In some circumstances, a skin graft or local flaps can be successfully employed. When surgical excision results in larger defects, reconstruction must be included in the surgical plan.
 
This review contains 13 figures, 7 tables and 32 references
Key Words: glossectomy, lip split, oral cancer, mandibulectomy, mandibulotomy, maxillectomy, ranula, sialendoscopy
Parotidectomy
Authors: Ridge John A. , Si Wai Zih Francis
Published: January 2021

When a patient presents with a mass at the angle of the mandible, a neoplasm within the parotid gland is a strong consideration. The parotid is the largest of the salivary glands. Terminal branches of the facial nerve are found within the gland. Their functional preservation is an important goal of parotid surgery. Risks of facial nerve injury rise in reoperative procedures and resection of cancers. Surgical principles apply in parotidectomy. In addition to facial nerve injury, a numb earlobe, contour deficit, salivary fistula, and gustatory sweating should be discussed with the patient before an operation. Most lesions can be removed after identification of the main trunk of the facial nerve, but a retrograde approach after finding a peripheral branch may be required. No randomized trials support a benefit from nerve monitoring. An intact facial nerve will usually begin to function, but months of recovery time may be needed. Permanent paralysis is rare. Salivary fistulae are usually self-limited. Many methods to ameliorate the cosmetic changes after parotidectomy have been described. None has gained ascendency.

This review contains 6 figures and 61 references.
Key words: facial nerve, facial paralysis, Frey syndrome, gustatory sweating, nerve monitoring, parotid gland, parotid neoplasm, parotidectomy, salivary fistula
Lymphatic Mapping and Sentinel Node Biopsy
Authors: Ollila David W. , Stitzenberg Karyn B. , Gallagher Kristalyn
Published: January 2021

With an estimated 232,670 new cases in the United States in 2014, breast cancer is among the most common malignancies treated by US surgeons. Meanwhile, the incidence of melanoma is rising faster than for all other solid malignancies, with an estimated 76,100 new cases of invasive melanoma in the United States in 2014. Over the past 20 years, significant strides have been made in the management of these two diseases from the standpoint of both surgical and adjuvant therapy. For both diseases, the presence or absence of lymph node metastases is highly predictive of patient outcome and is the most important prognostic factor for disease recurrence and cancer-related mortality. This review covers lymphatic mapping and sentinel node biopsy for melanoma, special circumstances associated with sentinel node biopsy in melanoma, lymphatic mapping and sentinel node biopsy in breast cancer, and radiation exposure guidelines and policies. The figures show lymphatic mapping and sentinel lymph node biopsy for melanoma, lymphatic mapping and sentinel node biopsy for breast cancer, and touch-imprint cytology from lymphatic mapping and sentinel node biopsy for breast cancer.
 
This review contains 3 highly rendered figures and 89 references.
Open Esophageal Procedures
Authors: Wright Cameron D
Published: January 2021

The growing stature of minimally invasive approaches to esophageal diseases does not diminish the importance of the equivalent open approaches. This chapter describes common open operations performed to excise Zenker diverticulum, to manage complex gastroesophageal reflux disease, and to resect esophageal and proximal gastric tumors. For each of these open procedures, the preoperative evaluation, operative planning, steps of the operative techniques, postoperative care, complications, and outcome evaluation are described. Over two dozen figures show many of the operative steps for a cricopharyngeal myotomy and excision of Zenker diverticulum, a transthoracic hiatal hernia repair, a transhiatal esophagectomy, Ivor-Lewis esophagectomy, and a left thoracoabdominal esophagogastrectomy.

This review contains 27 figures, 21 tables, 14 references
Keywords: Zenker diverticulum, esophageal cancer, gastroesophageal reflux disease, gastric tumor, cricopharyngeal myotomy, transthoracic hiatal hernia repair, transhiatal esophagectomy, Ivor-Lewis esophagectomy, left thoracoabdominal esophagogastrectomy
Fecal Incontinence
Authors: Madoff Robert D. , Vogler Sarah A.
Published: January 2021

Fecal incontinence, defined as the involuntary loss of gas, liquid, or solid stool through the anal canal, occurs in an estimated 18 million adults in the United States. Fecal incontinence causes social isolation and confines patients to their homes; additionally, it contributes to medical morbidity, including urinary tract infections, perianal skin breakdown, and decubitus ulcers. Causes for fecal incontinence can be broken down into three broad categories: neurologic disease; functional gastrointestinal diseases or abnormalities; and structural injuries or abnormalities in the pelvic floor, rectum, or anal sphincter. This review describes the clinical evaluation of, investigative studies related to, and management of fecal incontinence. Tables review common causes of sphincter injury, the Fecal Incontinence Severity Index, and daily life factors measured by the Fecal Incontinence Quality of Life questionnaire. Figures show an obstetric sphincter injury, an algorithm outlining the workup and management of fecal incontinence, ultrasonograms of a normal anal sphincter and a sphincter defect, the steps involved in sphincteroplasty, sacral nerve stimulation, and an artificial anal sphincter.
This review contains 6 figures, 3 tables, and 54 references.
The Impaired Surgeon
Authors: Kaups Krista L. , Hoyt David B.
Published: January 2021

Among the obligations and responsibilities of a surgeon is to practice in a competent manner. From a professional standpoint, competence is widely defined as the ability to practice with reasonable skill and safety, and a surgeon is impaired when she or he is not able to do so. There are a number of potential reasons leading to impairment, which may be temporary or a limitation throughout a surgeon’s professional career. Impairment may range from mild degradation of skills to complete incapacitation. The consequences of surgical practice with impairment are wide ranging and include patient-related harm and failure to provide exemplary care; personal consequences to the surgeon’s health and well-being; interpersonal issues with family, colleagues, and staff; and disciplinary and legal issues. This review covers substance abuse, personality issues (character impairment), medical school, residency, the practicing surgeon, the faculty member, boundary issues, aging, the individual surgeon, the department/hospital, burnout, prevention and recognition, individual/personal, organizational, the unprepared or "out-of-date" surgeon, prevention, and dealing with the unprepared surgeon. The figure shows an algorithm outlining the approach to the impaired surgeon. Tables list signs of substance abuse–related impairment, signs of character impairment, and signs of age-related impairment.
This review contains 1 highly rendered figure, 3 tables, and 123 references
Lower Extremity Amputation for Ischemia
Authors: Pevec William C.
Published: January 2021

Major amputations (proximal to the ankle) of the lower extremity are the manifestations of end-stage, nonreconstructable chronic arterial occlusive disease. A well-performed amputation provides the patient with the best prognosis for return to functional mobility. However, an amputation that fails to heal primarily may cause substantial physical and psychological harm to an already chronically ill patient. Minor amputations (at the toe or forefoot level) are not technically complex, but poor patient selection or technical imperfection can result in major amputation and loss of independent ambulation. In this chapter, selection of the level of amputation is reviewed; the methods to perform digital, forefoot, transtibial, and transfemoral amputations are presented; and postoperative management and potential complications are discussed.
 
Key Words: above-the-knee amputation, below-the-knee amputation, Guillotine amputation, ray amputation, transmetatarsal amputation, transphalangeal amputation
This review contains 10 figures, 1 table and 22 references
Substance Use Disorders in the Surgical Patient
Authors: Alarhayem Abdul Q , Keric Natasha , Dent Daniel L.
Published: January 2021

Large bodies of evidence link alcohol consumption and substance use disorders (SUDs) with motor vehicle collisions, as well as life-threatening intentional injury.  According to the substance use and mental health estimates from the 2013 National Survey on Drug Use and Health, 24.6 million individuals age 12 or older were current illicit drug users in 2013, including 2.2 million adolescents age 12 to 17, and 60.1 million individuals age 12 or older were binge drinkers in the past month.  Many people with SUDs become patients; therefore, the surgeon must be able to recognize and manage many of the related issues that can ensue. This review details the definition of SUDs, basic principles of toxicology, acute management of the patient with suspected substance use intoxication or withdrawal, managing life-threatening syndromes in patients with SUDs, overdose and withdrawal syndromes of opioids, stimulants, and depressants, surgical complications of SUDs, perioperative and postoperative considerations in patients with SUDs, and consultation and referral to a toxicologist and poison control center. Figures show first- and zero-order kinetics;  pupillary examination, laboratory and radiographic findings in SUDs; polymorphic ventricular tachycardia; consciousness as an interplay between arousal and awareness, an algorithm for the management of seizures, sine, mechanism of cocaine’s cardiac toxicity and hemorrhagic stroke in a cocaine abuser, necrotizing soft tissue infection, digit necrosis associated with intra-arterial injection of cocaine, scars from skin popping, nonocclusive thrombus in the left internal jugular vein, needle fracture with soft tissue dislodgment, oral contrast-enhanced computed tomographic scan showing rounded foreign bodies in the stomach, and fecal impaction associated with heroin. Tables list criteria for substance use disorders according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V), frequently misused drugs, causes of death in SUD, cardiac, neurologic, and metabolic signs and symptoms caused by commonly abused substances , anion and osmolar gap equations, life-threatening manifestations of cocaine toxicity, and alcohol-related disorders.
This review contains 15 figures, 8 tables, and 85 references.
Trauma Imaging
Authors: Gross Joel A. , Gunn Martin L. , Fink Kathleen R.
Published: January 2021

Due to increased use of computed tomography (CT) and ultrasonography, technological advances in equipment design, and increased availability of imaging equipment in the emergency department, imaging studies have revolutionized the assessment of the trauma patient in the past three decades. This review examines commonly used imaging modalities in trauma evaluation, initial and additional imaging, brief introduction to CT, and an overview of CT image processing and reviewing a CT scan. Head imaging, spine imaging, chest imaging, and abdominal and pelvic imaging are presented, along with injury grading, solid-organ injury appearances and specific abdominal solid-organ injuries, urinary system injury, penetrating trauma, unexplained intraperitoneal fluid, vascular injury and musculoskeletal injury. Figures show lateral view of the cervical spine; volume rendering of the pelvis; CT windows; CT imaging of acute intracranial bleeding, herniation in acute subdural hemorrhage, post-traumatic pseudoaneurysm of descending thoracic aorta, subscapular hematoma of the liver, liver laceration, pseudoaneurysm of the liver, shattered kidney and the nonperfused right kidney attributable to a traumatic renal artery injury, tigroid spleen, a focus of gas and stranding adjacent to the lateral wall of the ascending colon, extravasated urinary contrast (white material) surrounding the proximal right indicating ureteral laceration or transection, intraperitoneal bladder rupture, and contrast extravasation in the liver; magnetic resonance imaging versus CT of shear injuries; and magnetic resonance imaging in the setting of cervical spine trauma. 
This review contains 18 highly rendered figures, 23 tables, and 83 references.
Keywords:Trauma, computed tomography, radiography, magnetic resonance imaging, ultrasonography, imaging study
Perioperative Management of Patients on Steroids Requiring Surgery
Authors: Reiher Alexandra , Sippel Rebecca S. , Elfenbein Dawn M.
Published: January 2021

Patients with chronic lung disease, inflammatory bowel disease, rheumatoid arthritis, and solid-organ transplantations are often on steroid supplementation either intermittently or chronically. Endogenous steroid use results in decreased adrenocorticotropic hormone secretion by the pituitary gland through negative feedback mechanisms. Over several weeks, this can result in adrenal gland atrophy, eventually leading to secondary adrenal insufficiency. Appropriate management of perioperative glucocorticoid replacement therapy can be challenging, but appropriate replacement is essential to optimize patient outcomes. Insufficient dosing of glucocorticoids during the perioperative period can result in hypotension and even death. Excessive treatment with glucocorticoids decreases wound healing, increases the risk of hyperglycemia, and increases susceptibility to infection. This review covers the historical perspective, the hypothalamic-pituitary-adrenal (HPA) axis, when to suspect an impaired HPA axis, an argument against supraphysiologic glucocorticoid treatment in the perioperative period, the rationale for treating patients with impaired renal function, guidelines for dosing glucocorticoids in the perioperative period, and consulting a specialist. Figures show a clinical algorithm for evaluation and treatment of adrenal insufficiency in the perioperative period and the HPA axis. Tables list steroid conversions and perioperative glucocorticoid treatment recommendations.
 
This review contains 2 highly rendered figures, 2 tables, and 22 references.
Transplant Immunology: Basic Immunology and Clinical Practice
Authors: Foley David P , Lee Lung-Yi
Published: January 2021

Engraftment of a transplanted organ into an allogeneic host triggers a cascade of immunologic responses in the host that are designed to facilitate graft rejection. Modern donor-to-host matching techniques and immunosuppression protocols have successfully tempered this natural immune response so that graft survival has dramatically improved. However, optimizing graft survival by precisely downregulating the host response to graft rejection while preserving host immune defenses against pathologic and infectious agents remains poorly understood and elusive in current clinical practice. This review discusses transplant immunology with respect to host versus graft and the basis of allorecognition, as well as clinical management of the transplanted allograft. Figures show human leukocyte antigen (HLA), direct allorecognition, T cell receptor and CD3, T cell–associated second messenger signaling pathway, CD8 molecules directly ligating class I HLAs and CD4 molecules directly binding HLA class II, detection of alloantibodies by enzyme-linked immunosorbent assay or flow cytometry, recipient-donor crossmatch, histopathology of kidney allograft with antibody-mediated rejection, and an algorithm for assessment and management of renal allograft rejection. 
This review contains 9 figures, 6 tables and 61 references.
Keywords: Transplantation, immunology, human leukocyte antigen, crossmatch, donor, acute rejection, chronic rejection
The Diabetic Surgical Patient
Authors: Layba Cathline , Griffin Lance
Published: January 2021

Diabetes mellitus is the seventh leading cause of death in the United States; diabetic patients have a 50% chance of undergoing a surgical procedure during their lifetime, and operations in this patient population have been associated with a reported mortality of 4% to 13%. Careful planning of operative management and perioperative care must be taken into account when scheduling surgery for diabetic patients, especially patients taking insulin or oral hypoglycemic agents. Debate continues and inconsistencies remain regarding the management of both diabetes and hyperglycemia in the surgical setting. The review covers the evaluation of the diabetic patient, preoperative management, intraoperative management, postoperative management, total parenteral nutrition and blood glucose, cardiovascular and renal assessment, infection, and special populations. 
This review contains 2 figures, 5 tables, and 21 references
Keywords: Glucose, Hyperglycemia, perioperative period, surgery, diabetes mellitus, surgical site infection, preoperative management, postoperative management, wound healing
Nutritional Support
Authors: Uhlich Rindi , Hu Parker , Bosarge Patrick L
Published: January 2021

Nutritional optimization of the surgical patient remains a cornerstone of perioperative care. Significant effort and scrutiny are routinely directed to the field as it has the potential to improve outcomes, limit infectious complications, and decrease hospital length of stay and mortality. As such, previously identified cornerstones of care have been called into question. The timing, route, and intensity of nutritional supplementation remain the subject of controversy in an ever-evolving field. Previous methods of nutritional assessment, such as albumin and transthyretin, have proved unreliable, and their use is no longer recommended. In their place, new scoring systems are available to risk assess patients for malnutrition. We review the most pressing changes and assess the landscape of the field today.
Key words: critical illness, enteral, glutamine, malnutrition, nutrition, outcomes, parenteral, protein
Gallbladder and Biliary Tree
Authors: Gray Stephen
Published: January 2021

Understanding gallbladder and biliary anatomy is paramount to the surgeon. A comprehensive understanding of the gallbladder and biliary tree is necessary to properly treat a variety of surgical pathologies. Understanding the usual anatomy and the variations will help prevent iatrogenic biliary injuries. Moreover, anatomic consideration dictates oncologic therapies for gallbladder and biliary tract malignancies. 
Key words: bile duct, bile salts, biliary tree, cholecystectomy, gallbladder
The Esophagus
Authors: Wei Benjamin , Gleason Michael Frank
Published: January 2021

The esophagus is a tubular structure spanning from the posterior pharynx, through the thorax, and terminating in the stomach. It arises from endodermal foregut tissue. Its submucosal muscular layers are initially striated, transitioning to smooth muscle in more distal areas. Due to the distance in the body it traverses, the esophagus derives its blood and nerve supply from several structures. The role as a conduit from mouth to stomach necessitates secretory and barrier functions, as well as sphincters for protection from anterograde flow. Various modalities of esophageal test exist, ranging from fluoroscopy, to invasive endoscopy capable of obtaining tissue samples, to probes that detect pH and muscle tone, all of which play roles in identifying various pathologic processes.
Key words: abdomen, endoscopy, esophagography, esophagus, impedance, lower sphincter, manometry, upper sphincter
The Duodenum
Authors: Ronnekleiv-Kelly Sean , Burkhart Richard A
Published: January 2021

The duodenum is the first part of the small intestine that arises from the embryologic foregut and midgut. With maturation, it lies mostly retroperitoneal and is intimately associated with nearby structures such as the pancreas, hepatoduodenal ligament, and transverse colon mesentery. It is well vascularized with a rich lymphatic network and supports digestive, absorptive, immune, and endocrine functions. The duodenum receives food bolus from the stomach and releases various hormones important for regulating motility and gastric acid secretion. In the duodenum, food content mixes with bile and pancreatic enzymes to continue digestion of and initiate absorption for fats, carbohydrates, proteins, and vitamins and minerals. The duodenum experiences substantial exposure to the external environment and therefore contains an extensive immune barrier, including mucosa-associated lymphoid tissue. Additionally, there is a significant neuroendocrine network within the duodenum and small intestine that possesses a variety of endocrine functions, including regulation of acid secretion, motility, pancreatic function, bile flow, and mucosal cell growth. These enterochromaffin cells are the source duodenal neuroendocrine tumors (carcinoid) and can be classified according to subtype or grade. The duodenum is a diverse component of the small intestine that is uniquely suited to its numerous functions.    
Key words: absorption, acid secretion, anatomy, digestion, duodenum, intestinal immune system, microstructure, motility, mucosa-associated lymphoid tissue, neuroendocrine
Tumors of the Liver
Authors: Kim Alex C , Nathan Hari
Published: January 2021

Tumors in the liver arise from either the underlying hepatic parenchyma, resulting in benign or malignant lesions, or as metastatic deposit from extrahepatic malignancies. Treatment of these tumors is complex and requires a careful clinical evaluation. Recent improvement in diagnostic imaging techniques and reporting facilitates for appropriate characterization of hepatic tumors. In addition, utilization of genetics allows for careful classification of malignant potential in certain hepatic tumors. This chapter discusses several different types of hepatic tumors and examines the underlying etiologies, clinical presentation, diagnostic studies, staging, treatment, and prognosis. The staging of the malignant lesions is updated to reflect the American Joint Committee on Cancer’s eighth edition system.

This review contains 7 figures, 4 tables and 82 references.
Key Words: Barcelona Clinic Liver Cancer system, CAPOX, future liver remnant volume, FOLFOX, LI-RADS, stereotactic body radiation therapy, transarterial chemoembolization, transarterial radioembolization, β-catenin
Endovascular Procedures For Lower Extremity Vascular Disease: Specifics of Endovascular Treatment
Authors: Jayakumar Lalithapriya , Davies Mark
Published: January 2021

The application of endovascular procedures to lower-extremity vascular disease is well established for many common vascular diseases and has often supplanted conventional open surgical approaches. Endovascular therapy for arterial disease in the lower extremity encompasses treatment of acute ischemia, chronic ischemia, and aneurysmal disease. The fundamental skill set and techniques employed are common to all these processes. This chapter details the management of chronic ischemia, acute lower-extremity arterial ischemia, pseudoaneurysms and aneurysms, and arteriovenous malformations.
Key words: access closure, access complications, acute limb ischemia, aneurysm endovascular treatment, chronic limb ischemia, intravascular ultrasonography, lower-extremity angiogram, lower limb ischemia, percutaneous transluminal angioplasty, transcollateral access, transpopliteal access