bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of normal range estimated glomerular filtration rate on mortality in selected patients undergoing coronary angiography – a long-term follow-up
Authors: Zornitzki Lior , Sadon Sapir , Wenkert Atalia , Steinvil Arie , Konigstein Maayan , Ben-Shoshan Jeremy , Kliuk-Ben Bassat Orit , Sirota Svetlana , Halkin Amir , Bazan Samuel , Finkelstein Ariel , Banai Shmuel , Arbel Yaron 
Published: November 2020

Background
Estimated glomerular filtration rate (eGFR) predicts mortality and adverse cardiovascular events in people with chronic kidney disease. The significance of eGFR within the normal range and its long-term effect on clinical adverse events is unknown. We examined the effect of normal range or mildly reduced eGFR on long-term mortality in a large prospective registry.

Methods
The study included consecutive patients undergoing clinically-driven coronary angiography who had an eGFR ≥60 ml/min/1.73 m2. Baseline clinical characteristics were assessed, and patients were followed-up for the occurrence of all-cause mortality. Cox regression analysis was used to evaluate the impact of eGFR.

Results
A total of 4186 patients were recruited. Median follow-up time was 2883 days (7.9 years). Mean age was 62.0 ± 11.3 years with 77.4% males. Clinical presentation included acute coronary syndrome and stable angina. In a multivariable model adjusted for possible confounding factors, decreasing eGFR within the normal and mildly reduced range was inversely associated with long-term all-cause mortality with a hazard ratio (HR) of 1.32 for every decrease of 10 ml/min/1.732 in eGFR. Compared to eGFR > 100 ml/min/1.732, there was a graded association between lower eGFR values and increased long term mortality with a HR of 1.16 (0.59–2.31) for eGFR 90–100 ml/min/1.732, HR 1.54 (0.81–2.91) for eGFR 80–90 ml/min/1.732, HR 2.62 (1.41–4.85) for eGFR 70–80 ml/min/1.732 and HR 2.93 (1.58–5.41) for eGFR 60–70 ml/min/1.732.

Conclusion
eGFR within the normal and mildly reduced range is an independent predictor of long-term all-cause mortality in selected patients undergoing clinically driven coronary angiography.
A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks
Authors: Gjeorgjievski Mihajlo , Imam Zaid , Cappell Mitchell S. , Jamil Laith H. , Kahaleh Michel 
Published: November 2020

Background:
Bariatric surgery leaks result in significant morbidity and mortality. Experts report variable therapeutic approaches, without uniform guidelines or consensus.

Objective:
To review the pathogenesis, risk factors, prevention, and treatment of gastric sleeve leaks, with a focus on endoscopic approaches. In addition, the efficacy and success rates of different treatment modalities are assessed.

Design:
A comprehensive review was conducted using a thorough literature search of 5 online electronic databases (PubMed, PubMed Central, Cochrane, EMBASE, and Web of Science) from the time of their inception through March 2020. Studies evaluating gastric sleeve leaks were included. MeSH terms related to “endoscopic,” “leak,” “sleeve,” “gastrectomy,” “anastomotic,” and “bariatric” were applied to a highly sensitive search strategy. The main outcomes were epidemiology, pathophysiology, diagnosis, treatment, and outcomes.

Results:
Literature search yielded 2418 studies of which 438 were incorporated into the review. Shock and peritonitis necessitate early surgical intervention for leaks. Endoscopic therapies in acute and early leaks involve modalities with a focus on one of: (i) defect closure, (ii) wall diversion, or (iii) wall exclusion. Surgical revision is required if endoscopic therapies fail to control leaks after 6 months. Chronic leaks require one or more endoscopic, radiologic, or surgical approaches for fluid collection drainage to facilitate adequate healing. Success rates depend on provider and center expertise.

Conclusion:
Endoscopic management of leaks post sleeve gastrectomy is a minimally invasive and effective alternative to surgery. Their effect may vary based on clinical presentation, timing or leak morphology, and should be tailored to the appropriate endoscopic modality of treatment.
High Rates of Mortality in Geriatric Patients Admitted for Inflammatory Bowel Disease Management
Authors: Schwartz Jeffrey , Stein Daniel J. , Lipcsey Megan , Li Brian , Feuerstein Joseph D. 
Published: November 2020

Goal:
The goal of this study was to evaluate the inpatient mortality risk among geriatric patients with inflammatory bowel disease (IBD).

Background:
The challenges of caring for elderly patients with IBD will increase with the aging of the US population. Given the complications of hospitalization, we set to examine if elderly patients age older than 65 were at higher risk of mortality.

Materials and Methods:
All patients with ulcerative colitis (UC) or Crohn’s disease (CD) in the National Inpatient Sample (NIS) from 2016 and 2017 as the primary diagnosis or secondary diagnosis with an IBD-related cause of admission were included. Outcomes for patients aged above 65 were compared with below 65 using multivariable survey-adjusted regression. CD and UC were analyzed separately.

Results:
In 2016-2017, there were an estimated 162,800 admissions for CD and related complications compared with 96,450 for UC. In total, 30% of UC and 20% of CD admissions were geriatric. Geriatric status was associated with higher odds of mortality for CD [odds ratio (OR)=3.47, 95% confidence interval (CI): 2.72-4.44] and UC (OR=2.75, 95% CI: 2.16-3.49) after adjustment for comorbidities, admission type, hospital type, inpatient surgery, and IBD subtype. The cause of death was ∼80% infectious in both CD and UC in all groups. An average of 0.19 days (95% CI: 0.05-0.34) and $2467 (95% CI: 545-4388) increase was seen for geriatric CD patients. No significant change was seen for UC.

Conclusions:
Age over 65 was independently associated with higher odds of death in both UC and CD patients, even after appropriate adjustment. Further research is needed to optimize care for this growing patient population.
Lipoprotein (a) and diabetes mellitus: causes and consequences
Authors: Ward Natalie C. , Vickneswaran Shayimeera , Watts Gerald F. 
Published: November 2020

Purpose of review
This review provides an update on the role of lipoprotein (a) [Lp(a)] in diabetes, including its impact as a risk factor as well as its contribution to the development of cardiovascular disease.

Recent findings
Although a specific role for Lp(a) has not yet been conclusively established, it appears to have an inverse association with risk of diabetes. Several population-based studies have demonstrated associations between low levels of Lp(a) and increased risk of type 2 diabetes, but Mendelian randomization studies do not consistently support causality. Conversely, in patients with type 2 diabetes, elevated Lp(a) levels are associated with an increased risk of cardiovascular events.

Summary
Although Lp(a) contributes to the development of cardiovascular disease in patients with diabetes, few trials have investigated the benefits of reducing Lp(a) within this patient population. Furthermore, guidelines do not specifically address the risk associated with elevated Lp(a) levels. Despite this, Lp(a) should be measured in patients with diabetes and considered when evaluating their overall risk burden.
Usefulness of radiographic targeting on the evaluation of the location of a patency capsule using abdominal ultrasonography
Authors: Handa Osamu , Shiotani Akiko , Handa Yukiko , Fukushima Shinya , Osawa Motoyasu , Murao Takahisa , Matsumoto Hiroshi , Umegaki Eiji , Hata Jiro 
Published: November 2020

Background and aim
The usefulness of a radio-tag-free PillCam patency capsule (PatCap) has been reported to evaluate the patency of the small intestine. If the PatCap is not excreted within 33 h, the location of the failed PatCap must be confirmed. Although several methods for locating the failed PatCap have been reported, a universal method has not been established. In this study, we aimed to confirm the clinical feasibility of abdominal ultrasonography combined with abdominal X-ray in the determination of the location of a failed PatCap.

Patients and methods
Consecutive patients who were scheduled to undergo the capsule endoscopy and had received PatCap examination between July 2012 and September 2019 were retrospectively analyzed. Failed PatCap was assessed using ultrasonography combined with abdominal X-ray.

Results
Among the eligible 250 patients, 129 retrieved the PatCap in their stool within 33 h after ingestion. Among the remaining 121 patients, abdominal X-ray was performed and the PatCaps were suspected to be in the small bowel in 57 patients. Among these 57 patients, abdominal ultrasonography identified 17 PatCaps in the small bowel. Among the selected 250 patients, 233 patients (93.2%) were eligible for capsule endoscopy examination, while 17 patients (6.8%) were not eligible. Capsule endoscopy passed through the small intestine without any incident.

Conclusion
We confirmed that the abdominal ultrasonography with a radiographic targeting of the PatCap location is a reliable indicator to avoid the risk of capsule endoscopy retention or impaction and can be performed in most hospitals and clinics.
Comparing Mortality of Peritoneal and Hemodialysis Patients in an Era of Medicare Payment Reform
Authors: Wang Virginia , Coffman Cynthia J. , Sanders Linda L. , Hoffman Abby , Sloan Caroline E. , Lee Shoou-Yih D. , Hirth Richard A. , Maciejewski Matthew L. 
Published: November 2020

Background:
Prior studies have shown peritoneal dialysis (PD) patients to have lower or equivalent mortality to patients who receive in-center hemodialysis (HD). Medicare’s 2011 bundled dialysis prospective payment system encouraged expansion of home-based PD with unclear impacts on patient outcomes. This paper revisits the comparative risk of mortality between HD and PD among patients with incident end-stage kidney disease initiating dialysis in 2006–2013.

Research Design:
We conducted a retrospective cohort study comparing 2-year all-cause mortality among patients with incident end-stage kidney disease initiating dialysis via HD and PD in 2006–2013, using data from the US Renal Data System and Medicare. Analysis was conducted using Cox proportional hazards models fit with inverse probability of treatment weighting that adjusted for measured patient demographic and clinical characteristics and dialysis market characteristics.

Results:
Of the 449,652 patients starting dialysis between 2006 and 2013, the rate of PD use in the first 90 days increased from 9.3% of incident patients in 2006 to 14.2% in 2013. Crude 2-year mortality was 27.6% for patients dialyzing via HD and 16.7% for patients on PD. In adjusted models, there was no evidence of mortality differences between PD and HD before and after bundled payment (hazard ratio, 0.96; 95% confidence interval, 0.89–1.04; P=0.33).

Conclusions:
Overall mortality for HD and PD use was similar and mortality differences between modalities did not change before versus after the 2011 Medicare dialysis bundled payment, suggesting that increased use of home-based PD did not adversely impact patient outcomes.
Great nephrologists begin with great teachers: update on the nephrology curriculum
Authors: Raff Amanda C. 
Published: November 2020

Purpose of review
The purpose of this review is to highlight developments and opportunities in the nephrology curriculum from the basic science foundation years through teaching medical students, residents and fellows in the clinical realm.

Recent findings
Teaching skills are a vital tool for nephrologists both to promote excellent patient care and attract talented learners to the field. Exposure to dynamic and inspiring nephrologists is one of the main factors given by students and residents for selecting a career in nephrology. Nephrology teaching, including case discussions, problem-based learning, team-based learning and flipped classrooms, provides motivating active learning for medical students and is equally effective for didactics in graduate medical education. Avenues for teaching in the clinical realm include the microskills framework, bedside teaching and grounding in evidence-based medicine. Areas of growth include blended nephrology/subspecialty fields as well as social media applications.

Summary
Medical education is a satisfying and exciting area of growth in the field of nephrology. The recent literature provides a framework for best practices in active learning as well as providing numerous examples of educational interventions and innovations. In addition, this field is ripe for further development and scholarly activity.
Liver fat storage pathways: methodologies and dietary effects
Authors: Roumans Kay H.M. , Basset Sagarminaga Jeremy , Peters Harry P.F. , Schrauwen Patrick , Schrauwen-Hinderling Vera B. 
Published: November 2020

Purpose of review
Nonalcoholic fatty liver is the result of an imbalance between lipid storage [from meal, de novo lipogenesis (DNL) and fatty acid (FA) uptake] and disposal (oxidation and VLDL output). Knowledge on the contribution of each of these pathways to liver fat content in humans is essential to develop tailored strategies to prevent and treat nonalcoholic fatty liver. Here, we review the techniques available to study the different storage pathways and review dietary modulation of these pathways.

Recent findings
The type of carbohydrate and fat could be of importance in modulating DNL, as complex carbohydrates and omega-3 FAs have been shown to reduce DNL. No effects were found on the other pathways, however studies investigating this are scarce.

Summary
Techniques used to assess storage pathways are predominantly stable isotope techniques, which require specific expertise and are costly. Validated biomarkers are often lacking. These methodological limitations also translate into a limited number of studies investigating to what extent storage pathways can be modulated by diet. Further research is needed to elucidate in more detail the impact that fat and carbohydrate type can have on liver fat storage pathways and content.
Robotic radical perineal prostatectomy: tradition and evolution in the robotic era
Authors: Minafra Paolo , Carbonara Umberto , Vitarelli Antonio , Lucarelli Giuseppe , Battaglia Michele , Ditonno Pasquale 
Published: November 2020

Purpose of review
To provide an updated review of robotic radical perineal prostatectomy (r-RPP) with emphasis on the recent advances in terms of surgical technique, outcomes, and new robotic platforms.

Recent finding
The technological innovations in the urological field have been applied to radical prostatectomy with the aim of preserving important anatomical structures and reduce patients’ morbidity and mortality. In recent years, robotic surgery contributed to resurge radical perineal prostatectomy. In 2014, the Cleveland Clinic group was the first to demonstrate the utility of a robotic approach in RPP. To date, the majority of the reported studies showed that r-RPP has noninferior perioperative, short-term oncological, and functional outcomes compared with the traditional robot-assisted radical prostatectomy (RARP). Given these benefits, r-RPP is a promising approach in selected patients, such as obese ones. Moreover, robotic perineal pelvic lymph node dissection performed through the same incision of r-RPP and the new Single-Port (SP) Robotic System represent further steps towards the overcoming of some intrinsic limitation of this surgical approach making this technique suitable for a larger number of patients with prostatic cancer.

Summary
Overall, r-RPP represents a reliable and effective novel surgical technique. However, more studies with long-term follow-up are needed to clarify the advantages over RARP.
Urethra-sparing minimally invasive simple prostatectomy: an old technique revisited
Authors: Cardoso Andreia , Lima Estevao 
Published: November 2020

Purpose of review
The aim of this study was to review recent development in urethra and ejaculation preserving laparoscopic and robotic simple prostatectomy.

Recent findings
Since Madigan prostatectomy original description in 1990, to recent reports of robotic-assisted surgery using this urethra-sparing technique, many studies have suggested the advantages of the preservation of urethra, bladder neck and ejaculatory ducts, when removing adenomatous tissue in benign prostatic obstruction (BPO) surgery. Allying anatomical preservation of this structure with the well known benefits of minimally invasive procedures seems to reduce postoperative haematuria, obviating the need for bladder irrigation, with shorter catheterization and hospitalization times, less risk of urethral stricture and, of utmost importance, reducing rates of retrograde ejaculation.

Summary
Urethra and bladder neck sparing techniques, especially in minimally invasive simple prostatectomy procedures, seem to provide real benefits, not only in the maintenance of preoperative potency and antegrade ejaculation but also accomplishing better perioperative outcomes, with faster patient recovery, and less complications. These techniques might well be the future standard techniques for sexually active men with large benign prostatic hyperplasia (BPH) requiring surgery.
Rethinking Upper Blepharoplasty: The Impact of Pretarsal Show
Authors: Alghoul Mohammed S. , Bricker Jonathan T. , Venkatesh Vishnu , Gupta Aakash R. , Vaca Elbert E. , Sinno Sammy , Ellis Marco F. , Mustoe Thomas A. 
Published: November 2020

Background:
Conventional upper blepharoplasty relies on skin, muscle, and fat excision to restore ideal pretarsal space–to–upper lid fold ratios. The purpose of this study was to identify presenting topographic features of upper blepharoplasty patients and their effect on cosmetic outcomes.

Methods:
This is a retrospective review of patients who underwent upper blepharoplasty at the authors’ institution from 1997 to 2017. Preoperative and postoperative photographs were standardized using Adobe Illustrator to an iris diameter of 11.5 mm. Pretarsal and upper lid fold heights were measured at five locations. Patients were classified into three groups based on preoperative pretarsal show: none, partial, or complete. Photographs were randomized in PowerPoint and given a cosmetic score of 0 to 5 by four independent reviewers.

Results:
Three hundred sixteen patients were included, 42 men (13 percent) and 274 women (87 percent). Group 1 included 101 eyes (16 percent), group 2 had 159 eyes (25 percent), and group 3 had 372 eyes (59 percent). Mean cosmetic score increased from 1.75 to 2.38 postoperatively (p < 0.001), with a significantly lower improvement in scores in group 3 compared to groups 2 and 1 for both sexes (p < 0.01). For group 3, those with midpupil pretarsal heights greater than 4 mm had a significantly lower postoperative aesthetic score (1.95) compared with those less than or equal to 4 mm (2.50) (p < 0.001).

Conclusions:
Many patients presenting for upper blepharoplasty have complete pretarsal show and are at risk for worse cosmetic outcomes using conventional skin excision techniques. Adjunctive procedures such as fat grafting and ptosis repair should be considered in this group.

Clinical Question/Level of Evidence:
Risk, II.
A Novel Approach in the Surgical Management of Nasal Tip Hemangiomas: A 26-Year Experience
Authors: Akinbiyi Takintope , Jackson Oksana A. , Nguyen Phuong D. , Low David W. 
Published: November 2020

Summary:
Infantile hemangiomas are common benign tumors of infancy with a predilection for the face. Nasal-tip hemangiomas, termed the “Cyrano deformity,” can have especially devastating psychological effects. The ideal surgical approach and timing for these patients is unclear, as numerous designs have been reported in the literature. The authors present a novel approach to nasal tip reconstruction involving an algorithmic approach to incision selection and leaving a thin rim of hemangioma tissue under the dermis after debulking to minimize skin envelope atrophy. Nineteen cases were treated with the senior author’s preferred method, with a mean age of 3.3 years and follow-up of 2.5 years. At follow-up, 10 patients were deemed by the senior author to have a very good aesthetic result, and the remaining nine patients were deemed to have an excellent one. The results of this study suggest that surgical intervention as early as 3 to 4 years of age is safe and provides good aesthetic outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Congestive Heart Failure Predicts Major Complications and Increased Length of Stay in Lower Extremity Pedicled Flap Reconstruction
Authors: Levy-Lambert Dina , Ramly Elie P. , Kantar Rami S. , Alfonso Allyson R. , Levine Jamie P. 
Published: November 2020

Background:
Congestive heart failure affects 6.2 million people in the United States. Patients have a decreased cardiopulmonary reserve and often suffer from peripheral edema, important considerations in lower extremity reconstructive surgery. In this study, the authors sought to determine the impact of congestive heart failure on postoperative outcomes following lower extremity pedicled flap reconstruction using a national multi-institutional database.

Methods:
The authors isolated all patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent lower extremity pedicled flap reconstruction from 2010 to 2016. Preoperative, intraoperative, and postoperative variables were compared between patients with and without congestive heart failure. Multivariable regressions were performed to determine the independent effect of congestive heart failure on postoperative outcomes.

Results:
The authors identified 1895 patients who underwent lower extremity pedicled flap reconstruction, of whom 34 suffered from congestive heart failure. No significant difference was observed between patients with versus without congestive heart failure in postoperative wound complications (superficial wound infection, deep wound infection, and wound dehiscence), renal failure, or readmission. On multivariable analysis, congestive heart failure was independently associated with increased cardiopulmonary complications (i.e., myocardial infarction, cardiac arrest, pneumonia, reintubation, and failed ventilator weaning) (OR, 3.92; 95 percent CI, 1.53 to 9.12), septic events (OR, 4.65; 95 percent CI, 2.05 to 10.02), and length of hospital stay (β, 0.37; 95 percent CI, 0.01 to 0.72).

Conclusions:
In patients undergoing lower extremity pedicled flap reconstruction, congestive heart failure independently predicts a four-fold increase in postoperative sepsis and cardiopulmonary complications and a significantly increased length of hospital stay. The authors’ findings highlight the need for heightened perioperative vigilance and medical optimization in this high-risk population.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.