bluuebunny/crossref_metadata_2025_split huggingface dataset:
No-Touch Technique of Mesh Placement in Ventral Hernia Repair: Minimizing Postoperative Mesh Infections
Authors: Schneeberger Steven J. , Kraft Casey T. , Janis Jeffrey E. 
Published: April 2020

Summary:
Synthetic mesh is commonly used in ventral hernia repairs to reinforce the abdominal closure and minimize hernia recurrence rates. However, the use of synthetic mesh is associated with certain risks, most notably infection requiring explantation. This study sought to evaluate the use of a “no-touch” technique with antibiotic solution during synthetic mesh placement in ventral hernia repairs and its impact on complication/infection rates. The authors retrospectively reviewed a prospectively maintained database of patients undergoing abdominal wall reconstruction with synthetic mesh from 2013 to 2018 by a single surgeon with a minimum 1-year follow-up. Data collected included demographic data, medical comorbidities, hernia history, and the type of antibiotics used in the no-touch technique. Complications were stratified into short-term (<30 days), medium-term (30 to 90 days), and long-term (91 to 365 days) complications. Results were compared to previously published rates in the literature. Eighty-eight patients met inclusion criteria. Fourteen patients (15.9 percent) experienced postoperative complications (two patients had multiple complications); six of these patients (6.8 percent) were readmitted to the hospital for management. Subsequently, three of the readmitted patients (3.4 percent) required reoperations related to abdominal infection and required removal of the synthetic mesh. A total of 16 complication events occurred in the cohort: 13 short-term complications (81.3 percent), three medium-term complications (18.7 percent), and zero long-term complications. The authors conclude that the no-touch technique for mesh placement in ventral hernia repairs appears to be efficacious in minimizing infectious complications with mesh placement, although further prospective studies are required to further define this relationship.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Direct-to-Implant Breast Reconstruction with Simultaneous Nipple-Sparing Mastopexy Utilizing an Inferiorly Based Adipodermal Flap: Our Experience with Prepectoral and Subpectoral Techniques
Authors: Mosharrafa Ali M. , Mosharrafa Tamir M. , Zannis Victor J. 
Published: April 2020

Background:
Direct-to-implant breast reconstruction continues to grow in popularity among reconstructive breast surgeons and patients alike. Women with large breasts and ptosis are often thought not to be candidates for nipple sparing or direct-to-implant reconstruction. The authors utilized a single-stage, nipple-sparing, direct-to-implant reconstruction with simultaneous mastopexy, while the nipple-areolar complex was kept viable on an inferiorly based adipodermal flap in a single stage. They report their experience and outcomes using this approach in women with breast ptosis and/or macromastia.

Methods:
The authors reviewed all direct-to-implant reconstructions with simultaneous nipple-sparing mastopexies performed from June of 2015 to March of 2019. Sixty-five patients and 125 breast reconstructions were analyzed.

Results:
Among the 65 patients (125 breast reconstructions), 15 (23 percent) had implants placed in the prepectoral space, and 50 (77 percent) had them placed subpectorally. Forty-seven patients (72 percent) had acellular dermal matrix used. Partial nipple-areolar complex necrosis occurred in six patients (9 percent). Other complications included partial mastectomy flap necrosis (n = 8 patients, 12 percent), implant exposure (n = 3, 4 percent), infection (n = 1, 1 percent), capsular contracture (n = 4, 6 percent), and reoperation (n = 11, 16 percent). Mean follow-up was 17 months (range, 3 to 47 months). There have been no cancer recurrences reported in any participants to date.

Conclusions:
Nipple-sparing mastectomy with mastopexy and immediate direct-to-implant reconstruction dramatically improved the authors’ results for implant-based breast reconstruction patients. The higher than expected explantation rate of 7 percent early in the study has since improved. This approach provides an opportunity to expand indications for nipple-sparing mastectomy and direct-to-implant reconstruction to women with breast ptosis and/or macromastia.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Activation Status of NLRP3 Inflammasome in Peripheral Blood Mononuclear Cells From Patients With Gout Flare
Authors: Amezcua-Castillo Luis M. , Juárez-Vicuña Yaneli , Márquez-Velasco Ricardo , Amezcua-Guerra Luis M. 
Published: April 2020

Background/Objective
Although gout flares are featured by systemic signs of inflammation, cellular sources of inflammatory mediators are not yet properly characterized. Our objective was to evaluate serum levels and gene expression in peripheral blood mononuclear cells (PBMCs) of several molecules associated with the activation of NLRP3 inflammasome.

Methods
Fifteen patients with gout flare and 15 individuals with asymptomatic hyperuricemia were cross-sectionally studied. Serum levels of interleukin 1β (IL-1β), IL-18, monocyte chemoattractant protein 1/chemokine (C-C motif) ligand 2 (CCL2), and vascular cell adhesion molecule 1 were measured as a reflection of systemic inflammation, whereas the expression of NLRP3, CASP1, IL18, and CCL2 genes was measured to assess the inflammatory characteristics of PBMCs.

Results
Serum levels of IL-1β (1.27 [0.07–1.99] pg/mL vs. 0 [0–0.82] pg/mL, p = 0.032) and vascular cell adhesion molecule 1 (606 [435–748] pg/mL vs. 349 [305–422] pg/mL, p = 0.014) were significantly higher in patients with gout flare than in individuals with asymptomatic hyperuricemia, whereas differences in IL-18 and monocyte chemoattractant protein 1/CCL2 were not found. Notably, no differences were observed in the expression of NLRP3, CASP1, IL18, or CCL2 in PBMCs from individuals of one or another group.

Conclusions
Systemic inflammation during gout flares does not appear to be associated with NLRP3 inflammasome activation in PBMCs, suggesting that it may represent the systemic spread of local (synovial) inflammation to monosodium urate crystals, which provides a rationale for redirecting anti-inflammatory therapy from a systemic approach to one centered on the inflamed joint.
Pearls and Pitfalls in Interpretation of 68Ga-DOTATOC PET Imaging
Authors: Bashir Asma , Broholm Helle , Clasen-Linde Erik , Vestergaard Mark B. , Law Ian 
Published: April 2020

Abstract
DOTA-D-Phe1-Tyr3-octreotide labeled with 68Ga (68Ga-DOTATOC) is the commonly used PET tracer for imaging meningioma because of its high affinity to somatostatin receptor subtype 2 (SSTR2) and an established imaging modality for planning radiation and radionuclide therapy. However, SSTR2 is not an exclusive marker for meningioma, and not all meningiomas express high levels of SSTR2. The SSTR2 expression has been reported in other intracranial tumors, for example, glioma, pituitary adenoma, medullablastoma, primitive neuroectodermal tumors, and hemangioblastoma leading to a significant risk of misinterpretation of PET/CT findings. We present 2 cases with similar 68Ga-DOTATOC uptakes in 2 distinct etiologies, for example, cerebral lymphoma and meningioma.
Extrastriatal Peri-infarct Accumulation of 99mTc-TRODAT
Authors: ArunRaj S. T. , Tripathi Madhavi , Tripathi Manjari , Sachani Hemant , Singh Roma , Jaleel Jasim , Shaikh Raja Gulfam , Bal Chandrasekhar 
Published: April 2020

Abstract
We describe the extrastriatal accumulation of dopamine transporter imaging agent 99mTc-TRODAT in the peri-infarct area in a 75-year-old man referred for dopamine transporter SPECT imaging with a suspicion of idiopathic Parkinson disease.
Real-Time DMSA-SPECT/US Fusion Imaging Revealing Nonscarring Loss of Function After Pyelonephritis
Authors: Freesmeyer Martin , Weigel Friederike , John Ulrike , Mentzel Hans-Joachim , Gühne Falk 
Published: April 2020

Abstract
Using real-time SPECT/US fusion imaging, the localization of an uptake defect in DMSA scan could be identified unambiguously after being uncertain in ultrasound alone. Thereby, a localized functional loss, due to history of pyelonephritis, without scarring, but reduced cortical thickness could be verified. DMSA-SPECT/US primarily demonstrates its utility in depiction of renal pathologies and may be a descriptive tool in equivocal constellation of findings.
Colon Adenocarcinoma Associated With Clostridium Septicum Endophthalmitis Detected on 18F-FDG PET/CT
Authors: Plouznikoff Nicolas , Artigas Carlos , Woff Erwin , Ene Diana , Flamen Patrick 
Published: April 2020

Abstract
Endogenous Clostridium septicum endophthalmitis is a rare and fulminant ocular infection, usually encountered in immunocompromised or diabetic patients. It is also highly associated with both gastrointestinal and hematologic malignancies. We describe herein the detection of an adenocarcinoma of the cecum on PET/CT with 18F-FDG in a patient with an active endogenous C. septicum endophthalmitis of the right eye. FDG PET/CT should be considered for all patients with endogenous endophthalmitis to exclude an occult malignancy, especially colorectal cancer.
99mTc-Besilesomab Scintigraphy in Soft Tissue Infections of the Lower Limbs
Authors: Barros Gouveia Patrícia , Valpaços Teixeira Ricardo Jorge , Alves de Sá Lemos Pinto Adriana , Amorim Maria Inês 
Published: April 2020

Abstract
Only a few studies and images of 99mTc-besilesomab scintigraphy are documented in the literature. We present a 99mTc-besilesomab image consistent with soft tissue infection of the lower limbs in a febrile 67-year-old man.
Hypoxia and Amino Acid Imaging of High-Grade Glioma
Authors: Mapelli Paola , Fallanca Federico , Scifo Paola , Barbera Maurizio , Castellano Antonella , Bettinardi Valentino , Incerti Elena , Gianolli Luigi , Anzalone Nicoletta , Picchio Maria 
Published: April 2020

Abstract
In the present case, we report the first experience of a patient with high-grade glioma who underwent dual 18F-FAZA PET/CT imaging for intratumoral hypoxia assessment, before treatment, and for therapy monitoring in the suspicious of recurrence, as part of a clinical research protocol. In addition, despite the diagnosis of glioblastoma, the patient at 3 years from diagnosis was alive and underwent 11C-methionine simultaneous PET/MRI for disease monitoring after treatment, showing stability of disease. The multitracer capability of PET in assessing different and complementary metabolic features along with the use of a last-generation scanner as PET/MRI in brain oncology are here enlighten.
Clinical Implications of 18F-FDG PET/CT in Malignant Glomus Tumors of the Esophagus
Authors: Seban Romain-David , Bozec Laurence , Champion Laurence 
Published: April 2020

Abstract
The majority of glomus tumors are localized to cutaneous sites and are benign. However, extracutaneous malignant glomus tumors have been reported and are aggressive. Here, we report a case of a 45-year-old man who presented severe dysphagia, diagnosed with malignant glomus tumor of the esophagus. 18F-FDG PET/CT played a decisive role in several phases of the patient management offering previously unknown accuracy. It was first performed in the initial staging of local tumor extent before surgery. A year and a half after, 18F-FDG PET/CT helped to detect recurrence and, finally, was performed for response evaluation of several systemic therapies.
Rib Plasmacytoma With Unusual Sunburst Periosteal Reaction
Authors: Singh Vijay , Suraj Ajay Kumar , Mishra Vineet , Ora Manish , Gambhir Sanjay 
Published: April 2020

Abstract
A 39-year-old man presented with progressive painful swelling on the left chest since 6 months. Examination revealed osseous consistency mass. CT of the thorax suggested mass arising from left fourth rib with intrathoracic and extrathoracic soft tissue components. It had extensive sunburst periosteal reaction consistent with primary malignant bone tumor. True cut biopsy revealed plasmacytoma. Routine hematological, biochemical, and bone marrow examinations were normal. Patient referred for whole-body 18F-FDG PET/CT to look for skeletal and bone marrow lesions. It revealed intensely metabolic left fourth rib lesion with periosteal reaction and no other lesion in the rest of the body.
18F-FDG PET/CT and Serial Chest CT Findings in a COVID-19 Patient With Dynamic Clinical Characteristics in Different Period
Authors: Liu Chunbao , Zhou Jun , Xia Liang , Cheng Xiaojie , Lu Diyu 
Published: April 2020

Abstract
Neurological symptoms and gastrointestinal symptoms were rare at onset in COVID-19. Here we report a 37-year-old man with vertigo, fever, and diarrhea symptoms as the first manifestation. 18F-FDG PET/CT spotted multiple ground glass opacity (GGO) lesions in the lungs, with increased tracer uptake in both lung GGOs and the whole colon. Serial CT examinations showed the emersion and dissipation of lung GGOs. We illustrate the symptoms initiation, the laboratory test results, the imaging examination, and the treatment strategy in the duration of COVID-19 with a timeline chart.
Outlook for Independent Plastic Surgery Training
Authors: Ovadia Steven A. , Thaller Seth R. 
Published: April 2020

Introduction
Traditionally, plastic surgery training occurs through the independent model after completion of another surgical residency. Training is a minimum of 3 years in duration. Integrated training in contrast commences upon completion of medical school and is a minimum of 6 years. Independent programs have increasingly been converting positions to integrated positions. Our survey was designed to evaluate possible plans for further conversion of independent positions to integrated positions.

Methods
An electronic survey was prepared using the online survey platform Qualtrics. The survey questions were designed to solicit information regarding plans to convert independent positions to integrated positions. The survey was distributed by e-mail to program directors of the independent programs participating in the 2019 match. A reminder was sent 3.5 weeks after initial distribution, and results were collected for an additional 3 weeks.

Results
Sixteen program directors responded to our survey including 15 complete responses and 1 partial response representing a 40% response rate. Four respondents reported that they are considering decreasing their independent program by 1 position and converting the position to an integrated position. Three respondents reported that they are considering eliminating their independent program and converting to an integrated program. Each of these programs reported their independent program as having 1 position per year. With only a 40% response rate, 7 or more positions may be converted to integrated positions in the coming years.

Conclusions
Independent programs have been converting some or all positions to integrated positions. Although most plastic surgery positions were previously through the independent model, in 2019, 172 positions were offered through the integrated match compared with 63 for the independent match. Results of our study indicate that independent positions will continue to be converted to integrated positions for the next few years.
Management and outcomes of wartime cervical carotid artery injury
Authors: White Paul W. , Walker Patrick F. , Bozzay Joseph D. , Patel Jigarkumar A. , Rasmussen Todd E. , White Joseph M. 
Published: April 2020

BACKGROUND
Cervical carotid artery injuries entail high morbidity and mortality and are technically challenging to repair. This retrospective study describes the management and outcomes of cervical carotid injuries sustained during the recent wars in Iraq and Afghanistan.

METHODS
The Department of Defense Trauma Registry was queried to identify US military personnel who sustained battle-related cervical carotid injury between January 2002 and December 2015. Retrospective chart reviews of the military Electronic Health Record were performed on patients identified. Demographics, injury characteristics, surgical management, and outcomes were reviewed. Statistical analysis was performed to identify associations between injury and management factors, as well as stroke and mortality.

RESULTS
In total, 67 patients (100% male; age, 25 ± 7 years) were identified with cervical carotid artery injuries. Fifty-six patients (84%) sustained a common carotid artery (CCA) or internal carotid artery (ICA) injury, and 11 patients (16%) had an isolated external carotid artery (ECA) injury. The anatomic distribution of injury was as follows: CCA, 26 (38.8%); ICA, 24 (35.8%); CCA and ICA 2 (3%); ICA and ECA 3 (4.5%); and CCA, ICA, and ECA 1 (1.5%). Of the 56 CCA or ICA injuries, 39 underwent vascular repair, 9 (16%) were managed with ligation, 1 was treated with a temporary vascular shunt but succumbed to injuries before vascular repair, and 7 (13%) were treated nonoperatively. Seven (23%) of 30 ICA injuries were ligated compared with 2 (7.7%) of 26 injuries isolated to the CCA (p = 0.02). Compared with repair, ligation of the CCA/ICA was associated with a higher rate of stroke (89% vs. 33%, p = 0.003) and increased mortality without statistical significance (22% vs. 10%, p = 0.3). Every patient who underwent ICA ligation had a stroke (7/7). There was no difference in Injury Severity Score between the ligation and repair groups (23.8 ± 10.6 vs. 24.7 ± 13.4, p = 0.9). At a mean follow-up of 34.5 months, 10 of 17 stroke survivors had permanent neurologic deficits.

CONCLUSION
In modern combat, penetrating injuries involving the cervical carotid arteries are relatively infrequent. In this experience, isolated ICA injuries were three times more likely to be ligated than those involving the CCA. As a surgical maneuver, ICA ligation resulted in stroke in all cases.

LEVEL OF EVIDENCE
Retrospective cohort analysis, level III.
Competing Risk Analysis in Renal Allograft Survival: A New Perspective to an Old Problem
Authors: El Ters Mireille , Smith Byron H. , Cosio Fernando G. , Kremers Walter K. 
Published: April 2020

Background.
Graft survival after kidney transplant (KTX) is often estimated by the Kaplan-Meier (KM) method censoring for competing endpoints, primarily death. This method overestimates the incidence of graft loss.

Methods.
In 3157 adult KTX recipients followed for a mean of 79.2 months, we compared kidney and patient survival probabilities by KM versus competing risk analysis (CRA). These methods are extended to comparing different regression methods.

Results.
Compared with CRA, the probabilities of death and graft loss (censored for the other outcome) were substantially higher by KM. These differences increased with increasing follow-up time. Importantly, differences in graft losses were magnified in subgroups with greater probabilities of death. Among recipients with diabetes, the probabilities of graft loss at 20 years were 57% by KM and 32% by CRA, while for non-diabetes mellitus corresponding values were 44% and 35%. Similar results are noted when comparing older versus younger recipients. Finally, we find that the Fine-Gray method assumptions are violated when using age and gender as covariates and that the alternative method of Aalen-Johansen may be more appropriate.

Conclusions.
CRA provides more accurate estimates of long-term graft survival and death, particularly in subgroups of recipients with higher rates of the competing event. Overestimation of risk by KM leads to both quantitative and qualitative misinterpretations of long-term KTX outcomes. When using regression analyses, care should be taken to check assumptions to guide the choice of appropriate method.
Alpha-synuclein Levels in the Differential Diagnosis of Lewy Bodies Dementia and Other Neurodegenerative Disorders
Authors: Mavroudis Ioannis , Petridis Foivos , Chatzikonstantinou Symela , Kazis Dimitrios 
Published: April 2020

Subjectives:
Lewy body dementia (LBD) is the second most common type of neurodegenerative dementia after Alzheimer disease (AD). It is characterized by the accumulation of Lewy bodies and Lewy neurites which are composed of aggregated phosphorylated alpha-synuclein, which is a presynaptic neuronal protein genetically and neuropathologically linked to Parkinson disease and to LBD. Alpha-synuclein is thought to contribute to LBD pathogenesis and to linked to disruption of cellular homeostasis and neuronal death, through effects on various intracellular targets, including synaptic function.

Methods:
In the present study, we did a meta-analysis on the reliability of alpha-synuclein levels in the cerebrospinal fluid (CSF) for the discrimination between LBD and other neurodegenerative disorders including AD, Parkinson disease (PD) dementia, progressive supranuclear palsy (PSP), multiple system atrophy (MSA) and frontotemporal dementia (FTD).

Results:
CSF alpha-synuclein levels were significantly different in LBD compared with AD, but no statistical difference was found between LBD, and dementia in PD, MSA, PSP, and FTD.

Conclusion:
Alpha-synuclein levels in the CSF can be used for the discrimination between LBD and AD, but not LBD and other neurodegenerative disorders such as dementia in PD, MSA, FTD, and PSP.
Chronic Constipation in the Community
Authors: Werth Barry L. , Fisher Murray J. , Williams Kylie A. , Pont Lisa G. 
Published: April 2020

PURPOSE:The aim of this study was to determine the prevalence of chronic constipation and identify factors associated with chronic constipation in community-dwelling adults.DESIGN:Cross-sectional study.METHODS:The target population was community-dwelling Australian adults; 1978 participants completed an online questionnaire exploring symptoms, management, and factors potentially associated with constipation. Chronic constipation was identified using Rome III criteria. Multivariate logistic regression model was used to identify factors associated with chronic constipation.RESULTS:The prevalence of chronic constipation was 23.9%. Factors significantly associated with chronic constipation in the multivariate model were female gender (odds ratio [OR] = 1.42, 95% confidence interval [CI], 1.12-1.81), current employment (OR = 1.45, 95% CI, 1.11-1.88), regular smoking (OR = 1.60, 95% CI, 1.19-2.14), poor self-rated health (OR = 2.57, 95% CI, 1.28-5.19), thyroid disease (OR = 1.77, 95% CI, 1.21-2.79), depression (OR = 1.49, 95% CI, 1.08-2.06), hemorrhoids (OR = 2.98, 95% CI, 1.84-4.83), irritable bowel syndrome (OR = 2.45, 95% CI, 1.73-3.46), and use of anti-inflammatory/antirheumatic medications (OR = 2.06, 95% CI, 1.15-3.68). In contrast to these factors, use of medications acting on the renin-angiotensin system was associated with a reduced likelihood of chronic constipation (OR = 0.47, 95% CI, 0.24-0.91).CONCLUSIONS:Chronic constipation is prevalent among community-dwelling adults. Various factors associated with chronic constipation have been identified, and knowledge of these factors may help health care professionals recognize individuals who are at high risk of chronic constipation.