bluuebunny/crossref_metadata_2025_split huggingface dataset:
Day-of–Free Tissue Transfer Qualitative Cultures Do Not Predict Limb Salvage Outcomes
Authors: Zolper Elizabeth G. , Bekeny Jenna C. , Ormiston Laurel D. , Walters Elliot T. , Fortman Emilie , Kotha Vikas S. , Fan Kenneth L. , Evans Karen K. 
Published: November 2020

Background:
Successful free tissue transfer is critical for lower extremity salvage in the chronic wound population. The rates of lower extremity free tissue transfer success lag behind those for other anatomical sites. The aim of this study was to evaluate whether positive qualitative day-of–free tissue transfer cultures or pathogen virulence negatively impacts short- and long-term outcomes of lower extremity free tissue transfer.

Methods:
Between April of 2011 and January of 2018, 105 lower extremity free tissue transfer procedures were performed. Growth level and speciation were identified from qualitative cultures taken during free tissue transfer. The relationship between demographics, comorbidities, culture data, postoperative infection, free tissue transfer survival, and long-term limb salvage was examined using logistic regression.

Results:
The median Charlson Comorbidity Index was 3. Intraoperative free tissue transfer cultures were positive in 39.1 percent. Flap survival was 93.3 percent. Postoperative infection developed in 12.4 percent. The limb salvage rate was 81.0 percent. Positive culture was not significant for flap survival, postoperative infection, or amputation. Cultures positive for Enterococcus species had a significant relationship with flap success (OR, 0.08; p = 0.01) and amputation (OR, 7.32; p = 0.04). Insufficient antimicrobial coverage had a significant relationship with postoperative infection (OR, 6.56; p = 0.01) despite the lack of pathogen concordance. On multivariate analysis, postoperative infection (OR, 12.85; p < 0.01) and Charlson Comorbidity Index were predictive of eventual amputation (OR, 1.44; p = 0.01).

Conclusions:
Positive day-of–free tissue transfer cultures, regardless of pathogen, had limited predictive value for short- and long-term outcomes of free tissue transfer in the authors’ cohort. These findings call for a broader multicenter prospective analysis and consideration of health care–associated infections and their impact on limb salvage outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Evidence-Based Performance Measures for Rhinoplasty: A Multidisciplinary Performance Measure Set
Authors: Manahan Michele A. , Fedok Fred , Davidson Caryn , Ahmad Jamil , Constantinides Minas , Davis Richard , Friedman Oren , Gilman Robert , Ishii Lisa , Keyes Geoffrey , Lin Samuel J. , Marcus Benjamin , Matarasso Alan , Most Sam P. , Quereshy Faisal , Sinno Sammy , Steinbacher Derek , Tollefson Travis , Rohrich Rod J. 
Published: November 2020

Summary:
The American Society of Plastic Surgeons, the American Academy of Otolaryngology–Head and Neck Surgery, and the American Academy of Facial Plastic and Reconstructive Surgery commissioned the multidisciplinary Rhinoplasty Performance Measure Development Work Group to identify and draft quality measures for the care of patients undergoing both functional and aesthetic rhinoplasty. One outcome measure and three process measures were identified. The outcome looked at patient satisfaction with rhinoplasty procedures. The process measures look at motivations and expectations of the procedure, airway assessment, and nonnarcotic shared decision-making strategies for pain management. All measures in this report were approved by the American Society of Plastic Surgeons Quality and Performance Measures Work Group and Executive Committee, and the American Academy of Otolaryngology–Head and Neck Surgery Foundation, the American Academy of Facial Plastic and Reconstructive Surgery, The Rhinoplasty Society, and the American Association of Oral and Maxillofacial Surgeons. The Work Group recommends the use of these measures for quality initiatives, Continuing Medical Education, Maintenance of Certification, Qualified Clinical Data Registry reporting, and national quality reporting programs.
Grafting a spherical hidradenitis-affected scrotal raw area using a sterile glove: a case report describing the Al Lahham technique
Authors: Al Lahham Salim , Aljassem Ghanem , Al-Basti Habib , Alyazji Zaki T.N. , Sada Ruba 
Published: November 2020

Introduction:
Hidradenitis suppurative (HS) is a chronic inflammatory skin condition that can be resistant to medical treatment, in which case the surgical option stands out as the only solution. In this paper, we present a case of severe hidradenitis treated surgically, and we introduce a simple way to secure a graft on a big circumferential area.

Presentation of case:
Our case is a severe form of HS involving both the axillary, the inguinal region and the scrotum that required multistaged surgery; the challenge was in the final stage, that is the grafting of the scrotum. To secure the graft on a big circumferential area we used our own technique that is simple and can be conducted in any hospital setting.

Discussion:
Surgical treatment of HS includes wide debridement and reconstruction with grafts or flaps. Using a piece of sterile glove to secure the graft is useful because of its stretchable properties that can compress the graft and the ability to maintain a moist environment that promotes healing, with making slits it can also help in draining excess fluids.

Conclusion:
We recommend testing this technique when grafting the scrotum or any circumferential area to secure the grafts.
Delivering high quality documentation on operative consent forms: a UK major trauma center Quality Improvement Project
Authors: Hobday Dorian , Chaudhry Zulfiqar , Popova Dardan , Welman Ted , Pahal Gurjinderpal S. , Stodell Matthew 
Published: November 2020

Background:
Royal College of Surgeons guidelines exist on the importance of full, accurate and legible completion of consent forms as a key part of the process of gaining informed consent. In addition to this, consent forms serve as an important medico-legal document to protect clinicians and patients should problems arise. It is therefore in all parties’ interests that they are correctly completed.
It was noted that consent forms within the Royal London Hospital Plastic Surgery department were often not correctly completed. A Quality Improvement Project was undertaken to improve the completion of consent forms within the department.

Materials and methods:
Common problem areas on consent forms were identified and Quality Improvement (QI) methodology was used to design the study including selection of appropriate outcome, process and balancing measures. Baseline information on completion of: (1) patient details, (2) consultant details, (3) legibility, (4) use of abbreviations in description of operation/complications, and (5) patient signatures was collected. Four weekly interventions were made which were accompanied by 4 further data collection cycles. A further reaudit took place 4 months following the completion of the project to establish whether improvements had been sustained.

Results:
Over the 5 QI data collection cycles the average completion of the 3 outcome measures rose from 59% to 93% and 4 months later was sustained at 91%. Outcome measure 1 (legibility of documentation) rose from 62% to 100%. Outcome measure 2 (omission of abbreviations) rose from 33% to 79%. Outcome measure 3 (patient signature) rose from 81% to 100%.

Conclusion:
This Quality Improvement Project led to a significant and sustained improvement in quality of completion of consent forms within the department with the most marked improvement in omission of abbreviations. This quality improvement methodology could easily be adapted for other surgical specialities.
Outcomes of Highly Selected Live Donors With a Future Liver Remnant Less Than or Equal to 30%: A Matched Cohort Study
Authors: Zuckerman Jesse , Gorgen Andre , Acuna Sergio A. , Abreu Phillipe , Goldaracena Nicolas , Galvin Zita , Cattral Mark S. , Ghanekar Anand , McGilvray Ian D. , Lilly Les B. , Selzner Nazia , Grant David R. , Sapisochin Gonzalo 
Published: November 2020

Background.
The main concern with live donor liver transplantation (LDLT) is the risk to the donor. Given the potential risk of liver insufficiency, most centers will only accept candidates with future liver remnants (FLR) >30%. We aimed to compare postoperative outcomes of donors who underwent LDLT with FLR ≤30% and >30%.

Methods.
Adults who underwent right hepatectomy for LDLT between 2000 and 2018 were analyzed. Remnant liver volumes were estimated using hepatic volumetry. To adjust for between-group differences, donors with FLR ≤30% and >30% were matched 1:2 based on baseline characteristics. Postoperative complications including liver dysfunction were compared between the groups.

Results.
A total of 604 live donors were identified, 28 (4.6%) of whom had a FLR ≤30%. Twenty-eight cases were successfully matched with 56 controls; the matched cohorts were mostly similar in terms of donor and graft characteristics. The calculated median FLR was 29.8 (range, 28.0–30.0) and 35.2 (range, 30.1–68.1) in each respective group. Median follow-up was 36.5 mo (interquartile range, 11.8–66.1). Postoperative outcomes were similar between groups. No difference was observed in overall complication rates (FLR ≤30%: 32.1% versus FLR >30%: 28.6%; odds ratio [OR], 1.22; 95% confidence interval [CI], 0.46-3.27) or major complication rates (FLR ≤30%: 14.3% versus FLR >30%: 14.3%; OR, 1.17; 95% CI, 0.33-4.10). Posthepatectomy liver failure was rare, and no difference was observed (FLR ≤30%: 3.6% versus FLR >30%: 3.6%; OR, 1.09; 95% CI, 0.11-11.1).

Conclusion.
A calculated FLR between 28% and 30% on its own should not represent a formal contraindication for live donation.
Latency of Multifocal Visual Evoked Potential in Multiple Sclerosis: A Visual Pathway Biomarker for Clinical Trials of Remyelinating Therapies
Authors: Klistorner Alexander , Triplett James D. , Barnett Michael H. , Yiannikas Con , Barton Joshua , Parratt John , You Yuyi , Graham Stuart L. 
Published: November 2020

Purpose:Acute focal demyelination is the characteristic feature of multiple sclerosis, with the majority of damaged axons undergoing limited remyelination and forming chronic lesions. Potential remyelinating agents are currently under development and there is therefore an urgent need for reliablein vivobiomarkers of remyelination. This study aimed to investigate potential changes in multifocal visual evoked potentials' (mfVEPs) latency in a cohort of relapsing–remitting multiple sclerosis (RRMS) patients. The potential sample size required for a remyelination-based clinical trial using different treatment effect sizes and the mfVEP latency as an outcome measure was also estimated.Methods:A total of 50 RRMS consecutive patients with no previous history of optic neuritis in at least one eye and 15 normal controls of similar age and gender composition were prospectively enrolled. Fifteen patients had a history of unilateral ON more than 12 months earlier, whereas 41 patients demonstrated optic radiations lesions on MRI at baseline. Most patients were on disease modifying therapy. A mfVEP was recorded at baseline and 12 months later.Results:At baseline, the mfVEP latency in RRMS patients was delayed compared with normal controls in both optic neuritis and nonoptic neuritis eyes. Latency delay was significantly correlated to optic radiation lesion volume (R2= 0.38,P< 0.001). There was no significant latency change in multiple sclerosis patients' eyes or optic neuritis and nonoptic neuritis eyes over the follow-up period with latency remaining remarkably constant. This was despite the fact that 46 of 50 patients were on disease-modifying therapies, implying current treatments do not affect myelination in chronic RRMS cases. Sample size calculations to evaluate an additional or alternative remyelinating agent, based on a 40% treatment effect, revealed that a relatively small sample size (78 patients) would be required to demonstrate efficacy in future trials of remyelination therapies.Conclusions:Given its known sensitivity for latency changes and the stability found in this RRMS population, the mfVEP represents an ideal biomarker to assess the degree of latency recovery that may be achieved by remyelination in multiple sclerosis.
How does level of personality functioning inform clinical management and treatment? Implications for ICD-11 classification of personality disorder severity
Authors: Bach Bo , Simonsen Sebastian 
Published: November 2020

Purpose of review
The International Classification of Diseases, 11th Edition (ICD-11) classifies personality disturbance according to levels of severity. This article reviews the literature on levels of personality functioning in relation to clinical management and treatment, and proposes how these findings apply to the ICD-11 classification of personality disorders.

Recent findings
Findings were primarily derived from studies using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) Level of Personality Functioning Scale (LPFS), Kernberg's Level of Personality Organization, and the general P-factor of personality disorder. Severity of personality dysfunction is related to treatment outcome, risk of dropout, therapeutic alliance, readiness for treatment, risk of harm to self or others, risk of dissociation and psychotic-like breaks, coherence in narrative identity, reflective functioning, and epistemic trust.

Summary
The overall level of personality disorder severity indicates risk of negative outcomes and may be used as decision tool for ‘personalized medicine’ and required treatment intensity (e.g., strength of alliance and the need for establishing epistemic trust). Beyond the ICD-11 guidelines for determining personality disorder severity, these implications also apply to practitioners using comparable frameworks such as the DSM-5 LPFS and Kernberg's Level of Personality Organization. Future research should focus on the interaction of severity with trait qualifiers in relation to clinical management.
Analytical and diagnostic performances of a high-throughput immunoassay for SARS-CoV-2 IgM and IgG
Authors: Padoan Andrea , Cosma Chiara , Zaupa Paolo , Plebani Mario 
Published: November 2020

BackgroundAbstractReliable SARS-CoV-2 serological assays are required for diagnosing infections, for the serosurveillance of past exposures and for assessing the response to future vaccines. In this study, the analytical and clinical performances of a chemiluminescent immunoassays for SARS-CoV-2 IgM and IgG detection (Mindray CL-1200i), targeting Nucleocapsid (N) and receptor binding domain (RBD) portion of the Spike protein, were evaluated.MethodsPrecision and linearity were evaluated using standardized procedures. A total of 157 leftover serum samples from 81 hospitalized confirmed COVID-19 patients (38 with moderate and 43 with severe disease) and 76 SARS-CoV-2 negative subjects (44 healthcare workers, 20 individuals with rheumatic disorders, 12 pregnant women) were included in the study. In an additional series of 44 SARS-CoV-2 positive, IgM and IgG time kinetics were also evaluated in a time-period of 38 days.ResultsPrecision was below or equal to 4% for both IgM and IgG, in all the studied levels, whilst a slightly significant deviation from linearity was observed for both assays in the range of values covering the manufacturer’s cut-off. Considering a time frame ≥ 12 days post symptom onset, sensitivity and specificity for IgM were 92.3% (95%CI:79.1%-98.4%) and 92.1% (95%CI:83.6%-97.0%). In the same time frame, sensitivity and specificity for IgG were 100% (95%CI:91.0%-100%) and 93.4% (95%CI:85.3%-97.8%). The assays agreement was 73.9% (Cohen’s kappa of 0.373). Time kinetics showed a substantial overlapping of IgM and IgG response, the latter values being elevated up to 38 days from symptoms onset.ConclusionsAnalytical imprecision is satisfactory as well as the linearity, particularly when taking into account the fact that both assays are claimed to be qualitative. Diagnostic sensitivity of IgG was excellent, especially considering specimens collected ≥12 days post symptom onset. Time kinetics suggest that IgM and IgG are detectable early in the course of infection, but the role of SARS-CoV-2 antibodies in clinical practice still requires further evaluations.
Impact of obstructive sleep apnoea on cardiometabolic health in an ageing population in rural South Africa: Building the case for the treatment of sleep disorders in deprived settings
Authors: Roche Johanna , Rae Dale , Redman Kirsten , Knutson Kristen L , Schantz Malcolm von , Gómez-Olivé F Xavier , Scheuermaier Karine 
Published: November 2020

AbstractObjectivesThe association between obstructive sleep apnoea (OSA) and increased cardiometabolic risk (CMR) has been well documented in higher-income countries. However, OSA and its association with CMR have not yet been investigated, based on objective measures, in Southern Africa. We measured polysomnography (PSG)-derived sleep characteristics, OSA prevalence and its association with cardiometabolic diseases in a rural, low-income, aging African-ancestry population in South Africa.MethodsSeventy-five participants were recruited. BMI, hypertension, diabetes, dyslipidaemia, and HIV status were determined. A continuous CMR score was calculated using waist circumference (WC), random glucose, HDL-cholesterol, triglycerides, and mean arterial blood pressure. Sleep architecture, arousal index, and apnoea-hypopnea index (AHI) for detection of OSA (AHI≥15) were assessed by home-based PSG. Associations between CMR score and age, sex, socio-economic status (SES), AHI and TST were investigated by multivariable analysis.ResultsIn our sample (53 women, 66.1±10.7y, 12 HIV+), 60.7% were overweight/obese, 61.3% hypertensive and 29.3% had undiagnosed OSA. Being older (p=0.02), having a greater BMI (p=0.02) and higher WC (p<0.01) were associated with OSA. AHI severity (ß=0.011p=0.01) and being a woman (ß=0.369, p=0.01) were independently associated with a greater CMR score in SES- and age-adjusted analyses.ConclusionsIn this ageing South African community with obesity and hypertension, OSA prevalence is alarming and associated with CMR. We demonstrate feasibility of detecting OSA in a rural setting using PSG. Our results highlight the necessity for actively promoting health education and systematic screening and treatment of OSA in this population, to prevent future cardiovascular morbidity, especially among women.
Mobile outreach testing for COVID-19 in twenty homeless shelters in Toronto, Canada
Authors: Kiran Tara , Craig-Neil Amy , Das Paul , Lockwood Joel , Wang Ri , Nathanielsz Nikki , Rosenthal Esther , Snider Carolyn , Hwang Stephen W. 
Published: November 2020

AbstractBackgroundIt is unclear what the best strategy is for detecting COVID-19 among homeless shelter residents and what individual factors are associated with positivity.MethodsWe conducted a retrospective chart audit obtaining repeated cross-sectional data from outreach testing done at homeless shelters between April 1st and July 31st, 2020 in Toronto, Canada. We compared the positivity rate for shelters tested because of an outbreak (at least one known case) versus surveillance (no known cases). A patient-level analysis examined differences in demographic, health, and behavioural characteristics of residents who did and did not test positive for COVID-19.FindingsOne thousand nasopharyngeal swabs were done on 872 unique residents at 20 shelter locations. Among the 504 tests done in outbreak settings, 69 (14%) were positive and 1 (0.2%) was indeterminate. Among the 496 tests done for surveillance, 11 (2%) were positive and none were indeterminate. Shelter residents who tested positive were significantly less likely to have a health insurance card (54% vs 72%, p=0.03) or have visited another shelter in the last 14 days (0% vs 18%, p<0.01) compared to those who tested negative; There was no association between COVID-19 positivity and medical history (p=0.40) or symptoms (p=0.43).InterpretationOur findings support testing of asymptomatic shelter residents for COVID-19 when a positive case is identified at the same shelter but suggest limited utility of testing all shelter residents in the absence of a known case. Visiting another shelter in the last 14 days is associated with a decreased risk of COVID-19 positivity.
Inflammatory profile of induced sputum composition in systemic sclerosis: a comparison with healthy volunteers
Authors: Jacquerie P. , Henket M. , André B. , Moermans C. , de Seny D. , Gester F. , Louis R. , Malaise M. , Guiot J. 
Published: November 2020

AbstractBackgroundSystemic sclerosis (SSc) is a potentially serious and disabling connective tissue disease specially in case of interstitial lung disease (SSc-ILD). The aim of our study was to evaluate the potential utility of dosing in the induced sputum (IS) and to compare their levels in SSc-ILD and SSc-nonILD patients, as well as in healthy volunteers (HV). IS and sera values were also compared.MethodsIn a prospective cross-sectional analysis, we studied the IS and serum provided from 25 SSc patients, 15 SSc-nonILD and 10 SSc-ILD, compared to 25 HV. We analyzed sputum cell composition and quantified in the supernatant and corresponding serum by commercially available immunoassays: IGFBP-1, IGFBP-2, IGFBP-3, TGF-β, IL-8, TNF-α, YKL-40, MMP-7 and MMP-9. Lung function was studied by the determination of FEV-1 (%), FVC (%), DLCO (%) and KCO (%).ResultsThe IS of SSc patients had a lower weight than HV (p<0.01) without any significant difference with regard to the cellularity. IGFBP-1 (p<0.0001), TGF-β (p<0.05), IL-8 (p<0.05), YKL-40 (p<0.0001) and MMP-7 (p<0.01) levels were increased in the IS of SSc patients compared to HV. Only IL-8 serum levels (p<0.001) were increased in SSc patients compared to HV. Neither in IS nor in serum were observed differences between SSc-ILD and SSc-nonILD patients. Correlations were observed between IS IL-8 levels and FEV-1 (%)(r=-0.53, p<0.01), FVC (%) (r=-0.51, p<0.01) and annualized □KCO (%) (r=0.57, p<0.05), between IS TGF-□ levels and annualized □FEV-1 (%) (r=-0.57, p<0.05), between IS IGFBP-2 levels and annualized □KCO (%) (r=0.56, p<0.05).ConclusionOur study showed that SSc patients exhibit raised IS levels of IGFBP-1, TGF-β, IL-8, YKL-40 and MMP-7, molecules known to be involved in lung remodeling and fibrotic process, without any significant difference between SSc-ILD and SSc-nonILD patients. IL-8, TGF-□ and IGFBP-2 are correlated with lung function in SSc patients which emphasize clinical relevance. IS analysis represents a new approach to understand lung inflammatory process in SSc patients. A longitudinal study is needed to evaluate their pathophysiological relevance.