bluuebunny/crossref_metadata_2025_split huggingface dataset:
Integrated Plastic Surgery Match: Trends in Research Productivity of Successful Candidates
Authors: Ngaage Ledibabari M. , Elegbede Adekunle , McGlone Katie L. , Knighton Brooks J. , Cooney Carisa M. , Cooney Damon S. , Lifchez Scott D. , Slezak Sheri , Rasko Yvonne M. 
Published: April 2020

Background:
Plastic surgery continues to be one of the most competitive specialties in the residency match. Research productivity is a key component of the selection process. Nevertheless, potential applicants have a poor understanding of the strength of their research credentials in comparison to other applicants.

Methods:
The authors identified successful applicants from the 2012 to 2017 integrated plastic surgery residency application cycles. The authors performed a bibliometric analysis of these residents using Scopus, PubMed, and Google Scholar to identify published articles at the time of application. The authors then calculated the h-index of each applicant at the time of application.

Results:
The authors included 829 integrated residents. The median h-index was 0 (interquartile range, 0 to 3) and the median number of publications was 2 (interquartile range, 0 to 5) for all applicants. The proportion of applicants with at least one publication at the point of application increased significantly over time (60 percent in 2012 versus 76 percent in 2017; p = 0.0072). In addition, the number of publications per applicant increased over time (one in 2012 versus two in 2017; p = 0.0005), as did h-index (0 in 2012 versus 1 in 2017; p = 0.0015). Strikingly, the number and percentage of review articles among applicants increased significantly over this time frame (9 percent versus 14 percent; p = 0.0299).

Conclusions:
The increasing level of academic productivity among applicants may reflect the increasing competitiveness of the integrated plastic surgery residency application process. As the pressure to compete for a training position increases, students may seek faster-to-publish articles to gain an edge.
Surviving the COVID-19 Pandemic: Surge Capacity Planning for Nonemergent Surgery
Authors: Squitieri Lee , Chung Kevin C. 
Published: April 2020

Summary:
The coronavirus disease 2019 (COVID-19) pandemic has confronted the U.S. health care system with unprecedented challenges amidst a tenuous economic environment. As inpatient hospitals across the country prepare for an overwhelming influx of highly contagious COVID-19 cases, many nonemergent procedures have been cancelled or indefinitely postponed without guidance regarding eventual safe accommodation of these procedures in the future. Given the potentially prolonged impact of the COVID-19 pandemic on health care use, it is imperative for plastic surgeons to collaborate with other medical and surgical specialties to develop surge capacity protocols that allow continuation of safe, high-quality, nonemergent procedures. The purpose of this article is to provide necessary and timely public health information relevant to plastic surgery and also share a conceptual framework to guide surge capacity protocols for nonemergent surgery.
Central nervous system infections produced by varicella zoster virus
Authors: Nagel Maria A. , Niemeyer Christy S. , Bubak Andrew N. 
Published: April 2020

Purpose of review
Varicella zoster virus (VZV) causes varicella, establishes latency, then reactivates to produce herpes zoster. VZV reactivation can also cause central nervous system (CNS) disease with or without rash. Herein, we review these CNS diseases, pathogenesis, diagnosis, and treatment.

Recent findings
The most common CNS manifestation of VZV infection is vasculopathy that presents as headache, cognitive decline, and/or focal neurological deficits. VZV vasculopathy has also been associated with cerebral amyloid angiopathy and moyamoya syndrome. Rarely, VZV will produce a meningitis, encephalitis, cerebellitis, and myelopathy. Pathogenic mechanisms include direct VZV infection of affected tissue, persistent inflammation, and/or virus-induced hypercoagulability. Diagnosis is confirmed by the temporal association of rash to disease onset, intrathecal synthesis of anti-VZV antibodies, and/or the presence of VZV DNA in CSF. Most cases respond to intravenous acyclovir with corticosteroids.

Summary
VZV produces a wide spectrum of CNS disorders that may be missed as some cases do not have an associated rash or a CSF pleocytosis. Clinicians must be vigilant in including VZV in their differential diagnosis of CNS infections as VZV is a ubiquitous pathogen; importantly, VZV CNS infections are treatable with intravenous acyclovir therapy and corticosteroids.
Pure Laparoscopic Versus Open Right Hepatectomy in Live Liver Donors
Authors: Hong Suk Kyun , Tan Ming Yuan , Worakitti Lapisatepun , Lee Jeong-Moo , Cho Jae-Hyung , Yi Nam-Joon , Lee Kwang-Woong , Suh Kyung-Suk 
Published: April 2020

Objective:The aim of the study was to present the safety and feasibility of pure laparoscopic donor right hepatectomy (PLDRH) in comparison with those of conventional donor right hepatectomy.Summary Background Data:Although the use of PLDRH is gradually spreading worldwide, its outcomes, including the long-term outcomes in both donors and recipients, have not yet been evaluated in a large comparative study.Methods:We retrospectively reviewed the medical records of 894 donors who underwent living donor liver transplantation between January 2010 and September 2018 at Seoul National University Hospital. We performed 1:1 propensity score matching between the PLDRH and conventional donor right hepatectomy groups. Subsequently, 198 donor-recipient pairs were included in each group.Results:The total operation time (P< 0.001), time to remove the liver (P< 0.001), and warm ischemic time (P< 0.001) were longer in the PLDRH group. None of the donors required intraoperative transfusion or experienced any irreversible disabilities or mortalities. The length of postoperative hospital stay was significantly shorter in the PLDRH group (P< 0.001). The rate of complications in donors was similar between the 2 groups. Although other complication rates in recipients were, however, similar, the rates of early (P= 0.019) and late (P< 0.001) biliary complications in recipients were higher in the PLDRH group. There was no significant difference in overall survival and graft survival between the 2 groups.Conclusions:PLDRH is feasible when performed at an experienced living donor liver transplantation center. Further studies on long-term recipient outcomes including biliary complications are needed to confirm the safety.
Gasless Laparoscopic Myomectomy Using A J-shaped Retractor and Suture Technique
Authors: Hwang Jong Ha , Kim Bo Wook 
Published: April 2020

Objective:
This study aimed to compare gasless single-port access (SPA) laparoscopic myomectomy using a J-shaped retractor and conventional SPA laparoscopic myomectomy.

Study Design:
The medical records of 60 patients who underwent laparoscopic myomectomy between January 2016 and August 2019 were reviewed. Thirty patients underwent gasless SPA laparoscopic myomectomy using a J-shaped retractor, and 30 patients underwent conventional SPA laparoscopic myomectomy. The 2 groups were compared in terms of surgical outcomes. In gasless laparoscopic myomectomy, closure of the uterine defect after myomectomy was performed using an extracorporeal suture technique with a Kelly clamp and knot pusher.

Results:
On comparing gasless SPA and conventional SPA laparoscopic myomectomy, no significant differences were observed in age, body mass index, parity, previous abdominal surgery, and size of the dominant uterine myoma. The median retraction setup time from skin incision was 8 minutes (range, 5 to 15 min) with gasless SPA laparoscopic myomectomy. The median total operation times were 105 minutes (range, 62 to 210 min) with gasless SPA myomectomy and 110 minutes (range, 60 to 270 min) with conventional SPA myomectomy, and there was no significant difference (P=0.251). There was no difference between the groups in terms of estimated blood loss. None of the patients experienced laparotomy conversion in both groups. No major complications, such as urologic, bowel, and vessel injuries, were found in both groups.

Conclusion:
Gasless SPA laparoscopic myomectomy using a J-shaped retractor is a safe and feasible approach, which allows for easy and convenient suturing of a uterine defect after myomectomy.
Cannabis and cannabinoids in cancer pain management
Authors: Meng Howard , Dai Tianyang , Hanlon John G. , Downar James , Alibhai Shabbir M.H. , Clarke Hance 
Published: April 2020

Purpose of review
An increasing number of patients are turning to cannabis and cannabinoids for management of their palliative and nonpalliative cancer pain and other cancer-related symptoms. Canadians have a legal framework for access to medical cannabis, which provides a unique perspective in a setting lacking robust clinical evidence. This review seeks to delineate the role of cannabis and cannabinoids in cancer pain management and offers insight into the Canadian practice.

Recent findings
A cohort study using nabiximols on advanced cancer pain in patients already optimized on opioids, over 3 weeks, demonstrated improved average pain score. A large observational study of cancer patients using cannabis over 6 months demonstrated a decreased number of patients with severe pain and decreased opioid use, whereas the number of patients reporting good quality of life increased.

Summary
Good preclinical animal data and a large body of observational evidence point to the potential efficacy of cannabinoids for cancer pain management. However, there are relatively weak data pointing to clinical efficacy from clinical trial data to date. In Canada, the burgeoning cannabis industry has driven the population to embrace a medicine before clinical evidence. There remains a need for high-quality randomized controlled trials to properly assess the effectiveness and safety of medical cannabis, compared with placebo and standard treatments for cancer-related symptoms.
Anatomical Distance From the Cervicovaginal Junction to the Uterovesical Peritoneal Reflection
Authors: Liu Xiaochun , Guo Zhuodan , Yu Bing , Wang Wenzhen , Hao Qian , Wang Wenyan , Wen Yaling 
Published: April 2020

Objective
The objective of this study was to measure the anatomical distance from the cervicovaginal junction to the uterovesical peritoneal reflection (CJ-PR).

Methods
A total of 120 hysterectomy patients were selected as study subjects. The uterus was removed, and the CJ-PR distance was immediately measured. For total vaginal hysterectomy, measurement was performed intraoperatively. The cervical length was also measured postoperatively.

Results
The median (interquartile) CJ-PR distance for all subjects was 3.3 (2.9–3.7) cm. Comparison of premenopausal and postmenopausal women without prolapse revealed median CJ-PR distances of 3.3 (3.0–3.6) cm and 3.0 (2.6–3.4) cm, respectively. The CJ-PR distance was longer in women with prolapse (4.6 [3.7–5.6] cm) than in those without prolapse (3.2 [2.8–3.6] cm). The median cervical lengths were 3.1 (2.7–3.6) cm for postmenopausal patients without prolapse and 4.4 (3.6–5.8) cm for postmenopausal patients with prolapse.

Conclusions
Knowledge of the CJ-PR distance may help gynecologists predict how far the uterovesical PR is from the anterior vaginal incision.
Actin is associated with tissue injury in trauma patients and produces a hypercoagulable profile in vitro
Authors: Coleman Julia R. , Moore Ernest E. , Freeman Kalev , Grubinger Nicholas D. , Hennig Grant W. , Cohen Mitchell J. , Samuels Jason M. , Hansen Kirk 
Published: April 2020

BACKGROUND
While tissue injury provokes fibrinolysis shutdown in trauma, the mechanism remains elusive. Cellular death causes release of structural proteins, including actin and myosin, which may interact with clot formation and structure. We hypothesized that tissue injury is associated with high circulating actin and that actin produces a hypercoagulable profile with decreased fibrinolysis in vitro.

METHODS
Blood was collected from trauma activation patients at a single Level I trauma center for thrombelastography and proteomics. Proteomic analyses were performed through targeted liquid chromatography coupled with mass spectrometry using isotope-labeled standards for quantification of actin and its endogenous inhibitor gelsolin. Based on the results, we added physiologic concentrations of cytoskeletal G-actin to whole blood from healthy volunteers and analyzed changes in thrombelastography, as well as to plasma and examined clot architecture using confocal microscopy of fluorescently labeled fibrinogen.

RESULTS
Overall, 108 trauma patients were included: majority (71%) men, median age of 32.7 years, 66% blunt mechanism, median New Injury Severity Score (NISS) of 41. Compared with patients without severe tissue injury (NISS < 15, n = 10), patients with severe tissue injury (NISS > 15, n = 98) had higher levels of circulating actin (0.0428 vs. 0.0301, p = 0.02). Further, there was a trend toward lower gelsolin levels in patients with fibrinolysis shutdown (0.1844 vs. 0.2052, p = 0.17) and tissue plasminogen activator resistance (0.1676 vs. 0.2188, p = 0.06).
Ten healthy volunteers were included in the in vitro experiments (50% male; median age, 31.3 years). Actin significantly increased angle (40.0° to 52.9°, p = 0.002) and decreased fibrinolysis (percent clot lysis 30 minutes after reaching maximum amplitude, 4.0% to 1.6%; p = 0.002), provoking fibrinolytic shutdown in three patients. The addition of actin to control plasma decreased fiber resolvability of fibrin clots, monitored by microscopy, and decreased plasmin-mediated fibrinolysis.

CONCLUSION
Actin increases clot propagation and provokes fibrinolysis shutdown in vitro, through a mechanism of plasmin inhibition. High circulating levels of actin are present in trauma patients with severe tissue injury, suggesting actin contributes to fibrinolysis shutdown in the setting of tissue injury.
Barriers to improving health care value in emergency general surgery: A nationwide analysis
Authors: Hanna Kamil , Haddadin Zaid , Sakran Joseph , Zeeshan Muhammad , Asmar Samer , Kulvatunyou Narong , Tang Andrew , Northcutt Ashley , Joseph Bellal 
Published: April 2020

INTRODUCTION
There is a growing need to improve the quality of care while decreasing health care costs in emergency general surgery (EGS). Health care value includes costs and quality and is a targeted metric by improvement programs. The aim of our study was to evaluate the trend of health care value in EGS over time and to identify barriers to high-value surgical care.

METHODS
The (2012–2015) National Readmission Database was queried for patients 18 years or older who underwent an EGS procedure (according to the American Association for the Surgery of Trauma definition). Health care value (V = quality metrics/cost) was calculated from the rates of freedom from readmission, major complications, reoperation, and failure to rescue (FTR) indexed over inflation-adjusted hospital costs. Outcomes were the trends in the quality metrics: 6-month readmission, major complications, reoperation, FTR, hospital costs, and health care value over the study period. Multivariable linear regression was performed to determine the predictors of lower health care value.

RESULTS
We identified 887,013 patients who underwent EGS. Mean ± SD age was 51 ± 20 years, and 53% were male. The rates of 6-month readmission, major complications, reoperation, and FTR increased significantly over the study period. The median hospital costs also increased over the study period (2012, US $9,600 to 2015, US $13,000; p < 0.01). However, the health care value has decreased over the study period (2012, 0.35; 2013, 0.30; 2014, 0.28; 2015, 0.25; p < 0.01). Predictors of decreased health care value in EGS are age 65 years or older (β = −0.568 [−0.689 to −0.418], more than three comorbidities (β = −0.292 [−0.359 to −0.21]), readmission to a different hospital (β = −0.755 [−0.914 to −0.558]), admission to low volume centers (β = −0.927 [−1.126 to −0.682]), lack of rehabilitation (β = −0.004 [−0.005 to −0.003]), and admission on a weekend (β = −0.318 [−0.366 to −0.254]).

CONCLUSION
Health care value in EGS appears to be declining over time. Some of the factors leading to decreased health care value in EGS are potentially modifiable. Health care value could potentially be improved by reducing fragmentation of care and promoting regionalization.

LEVEL OF EVIDENCE
Economic, level IV.
Effect of Shoes Reducing Varus Instability of the Knee on Gait Parameters, Knee Pain, and Health-Related Quality of Life in Females With Medial Knee Osteoarthritis
Authors: Nakano Hideki , Murata Shin , Kai Yoshihiro , Abiko Teppei , Matsuo Dai , Kawaguchi Michio , Matsumoto Takeshi , Yoshiura Yuji , Sumi Michihiro 
Published: April 2020

Observations:
The effects of shoes reducing varus instability of the knee on gait parameters, knee pain, and health-related quality of life (HRQOL) in patients with medial knee osteoarthritis were investigated.

Methods:
Twelve patients with medial knee osteoarthritis wore shoes reducing varus instability of the knee.

Results and Conclusions:
Gait velocity, stride length, step length, knee pain, and Japanese Knee Osteoarthritis Measure scores significantly improved in the postintervention period compared with the pre- and postcontrol periods. Therefore, shoes reducing varus instability of the knee can effectively improve gait parameters, knee pain, and HRQOL in patients with medial knee osteoarthritis.
Measuring outcomes that matter most to people with multiple sclerosis: the role of patient-reported outcomes
Authors: Brichetto Giampaolo , Zaratin Paola 
Published: April 2020

Purpose of review
Patient-reported outcome (PRO) represents a unique opportunity to measure the impact of health research, and care on outcomes that matter most to people with multiple sclerosis (PwMS).

Recent findings
How to incorporate PROs in MS clinical trials and, practice remains a matter of debate. The variety of measures available for use in MS has some benefits, but the lack of a set of standard measures has significant disadvantages. To help meeting the challenge, different PROs standard sets have been developed (PROMIS) for use across a broad range of chronic health conditions, and SymptoMScreen, specifically for MS. However, many of them were not co-created with PwMS and lacking understanding about what matters to patients. The newly proposed MS care unit model together with emerging initiatives such as iConquerMS and PROMOPROMS, are shaping new meaningful PROs. However, the uptake of PROMs in all settings can be effective only by a commonly held strategic agenda shared by all relevant stakeholders.

Summary
The newly born PRO Initiative for MS (PROMS) aims to develop a strategic agenda shared by all relevant stakeholders to help meeting the challenge of developing PRO measures that correspond to the needs of all stakeholders.
From Community Acquired Pneumonia to COVID-19: A Deep Learning Based Method for Quantitative Analysis of COVID-19 on thick-section CT Scans
Authors: Li Zhang , Zhong Zheng , Li Yang , Zhang Tianyu , Gao Liangxin , Jin Dakai , Sun Yue , Ye Xianghua , Yu Li , Hu Zheyu , Xiao Jing , Huang Lingyun , Tang Yuling 
Published: April 2020

AbstractBackgroundThick-section CT scanners are more affordable for the developing countries. Considering the widely spread COVID-19, it is of great benefit to develop an automated and accurate system for quantification of COVID-19 associated lung abnormalities using thick-section chest CT images.PurposeTo develop a fully automated AI system to quantitatively assess the disease severity and disease progression using thick-section chest CT images.Materials and MethodsIn this retrospective study, a deep learning based system was developed to automatically segment and quantify the COVID-19 infected lung regions on thick-section chest CT images. 531 thick-section CT scans from 204 patients diagnosed with COVID-19 were collected from one appointed COVID-19 hospital from 23 January 2020 to 12 February 2020. The lung abnormalities were first segmented by a deep learning model. To assess the disease severity (non-severe or severe) and the progression, two imaging bio-markers were automatically computed, i.e., the portion of infection (POI) and the average infection HU (iHU). The performance of lung abnormality segmentation was examined using Dice coefficient, while the assessment of disease severity and the disease progression were evaluated using the area under the receiver operating characteristic curve (AUC) and the Cohen’s kappa statistic, respectively.ResultsDice coefficient between the segmentation of the AI system and the manual delineations of two experienced radiologists for the COVID-19 infected lung abnormalities were 0.74±0.28 and 0.76±0.29, respectively, which were close to the inter-observer agreement, i.e., 0.79±0.25. The computed two imaging bio-markers can distinguish between the severe and non-severe stages with an AUC of 0.9680 (p-value< 0.001). Very good agreement (κ = 0.8220) between the AI system and the radiologists were achieved on evaluating the changes of infection volumes.ConclusionsA deep learning based AI system built on the thick-section CT imaging can accurately quantify the COVID-19 associated lung abnormalities, assess the disease severity and its progressions.Key ResultsA deep learning based AI system was able to accurately segment the infected lung regions by COVID-19 using the thick-section CT scans (Dice coefficient ≥ 0.74).The computed imaging bio-markers were able to distinguish between the non-severe and severe COVID-19 stages (area under the receiver operating characteristic curve 0.968).The infection volume changes computed by the AI system was able to assess the COVID-19 progression (Cohen’s kappa 0.8220).Summary StatementA deep learning based AI system built on the thick-section CT imaging can accurately quantify the COVID-19 infected lung regions, assess patients disease severity and their disease progressions.
Clinical Characteristics of 20,662 Patients with COVID-19 in mainland China: A Systemic Review and Meta-analysis
Authors: Tang Chong , Zhang Keshi , Wang Wenlong , Pei Zheng , Liu Zheng , Yuan Ping , Guan Zhenpeng , Gu Jin 
Published: April 2020

AbstractCoronavirus disease 2019 (COVID-19) is a global pandemic and has been widely reported; however, a comprehensive systemic review and meta-analysis has not been conducted. We systematically investigated the clinical characteristics of COVID-19 in mainland China to guide diagnosis and treatment. We searched the PubMed, Embase, Scopus, Web of Science, Cochrane Library, bioRxiv, medRxiv, and SSRN databases for studies related to COVID-19 published or preprinted in English or Chinese from January 1 to March 15, 2020. Clinical studies on COVID-19 performed in mainland China were included. We collected primary outcomes including signs and symptoms, chest CT imaging, laboratory tests, and treatments. Study selection, data extraction, and risk of bias assessment were performed by two independent reviewers. Qualitative and quantitative synthesis was conducted, and random-effects models were applied to pooled estimates. This study is registered with PROSPERO (number CRD42020171606). Of the 3624 records identified, 147 studies (20,662 patients) were analyzed. The mean age of patients with COVID-19 was 49.40 years, 53.45% were male, and 38.52% had at least one comorbidity. Fever and cough were the most common symptoms, followed by fatigue, expectoration, and shortness of breath. Most patients with COVID-19 had abnormal chest CT findings with ground glass opacity (70.70%) or consolidation (29.91%). Laboratory findings shown lymphopenia, increased lactate dehydrogenase, increased infection-related indicators, and fibrinolytic hyperactivity. Antiviral therapy, antibiotic therapy, and corticosteroids were administered to 89.75%, 79.13%, and 35.64% of patients, respectively. Most clinical characteristics of COVID-19 are non-specific. Patients with suspected should be evaluated by virological assays and clinically treated.