bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diversity in Plastic Surgery
Authors: Reghunathan Meera , Parmeshwar Nisha , Gallus Katerina M. , Gosman Amanda A. 
Published: January 2020

Background
Prior studies have shown that roadblocks exist for women to achieve higher career levels in plastic surgery. The authors evaluate female representation as lecturers, panelists, and moderators at national and regional plastic surgery meetings.

Methods
The annual meetings between January 2014 and January 2019 for 12 national and regional plastic surgery societies were included in this study. Data regarding sex of speakers were extracted from meeting programs. Binomial distribution analysis was used to compare female representation at meetings as compared with female representation among plastic surgeons. Analysis of variance with Tukey post hoc analysis was used to evaluate for differences in female representation among regions and subspecialties.

Results
Females comprised 14.8% of speakers, including instructors, moderators, and panelists, at all included plastic surgery meetings. There has not been a significant increase in the representation of females at plastic surgery meetings in the past 5 years (P = 0.08). Five of 12 societies had significantly lower female representation as speakers than expected by the proportion of female plastic surgeons (P < 0.05). American Society for Craniofacial Surgeons had significantly lower representation as compared with other subspecialty meetings (P < 0.01), and Texas Society of Plastic Surgeons had significantly lower representation among regional meetings (P < 0.05).

Conclusions
Female representation among plastic surgery residents and faculty has increased, yet women remain disproportionately underrepresented on the podium at educational meetings. Providing women the opportunity to serve as speakers, moderators, and panelists at meetings will ultimately enhance the diversity of our plastic surgical leadership.
Worse Than Death: Survey of Public Perceptions of Disability Outcomes After Hypothetical Traumatic Brain Injury
Authors: Wilson Jo Ellen , Shinall Myrick C. , Leath Taylor C. , Wang Li , Harrell Frank E. , Wilson Laura D. , Nordness Mina F. , Rakhit Shayan , de Riesthal Michael R. , Duff Melissa C. , Pandharipande Pratik P. , Patel Mayur B. 
Published: January 2020

Objective:
The aim of this study was to determine the health utility states of the most commonly used traumatic brain injury (TBI) clinical trial endpoint, the Extended Glasgow Outcome Scale (GOSE).

Summary Background Data:
Health utilities represent the strength of one's preferences under conditions of uncertainty. There are insufficient data to indicate how an individual would value levels of disability after a TBI.

Methods:
This was a cross-sectional web-based online convenience sampling adaptive survey. Using a standard gamble approach, participants evaluated their preferences for GOSE health states 1 year after a hypothetical TBI. The categorical GOSE was studied from vegetative state (GOSE2) to upper good recovery (GOSE8). Median (25th percentile, 75th percentile) health utility values for different GOSE states after TBI, ranging from −1 (worse than death) to 1 (full health), with 0 as reference (death).

Results:
Of 3508 eligible participants, 3235 (92.22%) completed the survey. Participants rated lower GOSE states as having lower utility, with some states rated as worse than death, though the relationship was nonlinear and intervals were unequal between health states. Over 75% of participants rated a vegetative state (GOSE2, absence of awareness and bedridden) and about 50% rated lower severe disability (GOSE3, housebound needing all-day assistance) as conditions worse than death.

Conclusions:
In the largest investigation of public perceptions about post-TBI disability, we demonstrate unequally rated health states, with some states perceived as worse than death. Although limited by selection bias, these results may guide future comparative-effectiveness research and shared medical decision-making after neurologic injury.
How to Handle Arterial Conduits in Liver Transplantation? Evidence From the First Multicenter Risk Analysis
Authors: Oberkofler Christian E. , Raptis Dimitri A. , DiNorcia Joseph , Kaldas Fady M. , Müller Philip C. , Pita Alejandro , Genyk Yuri , Schlegel Andrea , Muiesan Paolo , Tun Abraham Mauro E. , Dokus Katherine , Hernandez-Alejandro Roberto , Rayar Michel , Boudjema Karim , Mohkam Kayvan , Lesurtel Mickaël , Esser Hannah , Maglione Manuel , Vijayanand Dhakshina , Lodge J. Peter A. , Owen Timothy , Malagó Massimo , Mittler Jens , Lang Hauke , Khajeh Elias , Mehrabi Arianeb , Ravaioli Matteo , Pinna Antonio D. , Dutkowski Philipp , Clavien Pierre-Alain , Busuttil Ronald W. , Petrowsky Henrik 
Published: January 2020

Objective:
The aims of the present study were to identify independent risk factors for conduit occlusion, compare outcomes of different AC placement sites, and investigate whether postoperative platelet antiaggregation is protective.

Background:
Arterial conduits (AC) in liver transplantation (LT) offer an effective rescue option when regular arterial graft revascularization is not feasible. However, the role of the conduit placement site and postoperative antiaggregation is insufficiently answered in the literature.

Study Design:
This is an international, multicenter cohort study of adult deceased donor LT requiring AC. The study included 14 LT centers and covered the period from January 2007 to December 2016. Primary endpoint was arterial occlusion/patency. Secondary endpoints included intra- and perioperative outcomes and graft and patient survival.

Results:
The cohort was composed of 565 LT. Infrarenal aortic placement was performed in 77% of ACs whereas supraceliac placement in 20%. Early occlusion (≤30 days) occurred in 8% of cases. Primary patency was equivalent for supraceliac, infrarenal, and iliac conduits. Multivariate analysis identified donor age >40 years, coronary artery bypass, and no aspirin after LT as independent risk factors for early occlusion. Postoperative antiaggregation regimen differed among centers and was given in 49% of cases. Graft survival was significantly superior for patients receiving aggregation inhibitors after LT.

Conclusion:
When AC is required for rescue graft revascularization, the conduit placement site seems to be negligible and should follow the surgeon's preference. In this high-risk group, the study supports the concept of postoperative antiaggregation in LT requiring AC.
Treatment for Infected Pancreatic Necrosis Should be Delayed, Possibly Avoiding an Open Surgical Approach
Authors: Ricci Claudio , Pagano Nico , Ingaldi Carlo , Frazzoni Leonardo , Migliori Marina , Alberici Laura , Minni Francesco , Casadei Riccardo 
Published: January 2020

Objective:
To evaluate all invasive treatments for suspected IPN.

Summary of Background Data:
The optimal invasive treatment for suspected IPN remains unclear.

Methods:
A systematic search of randomized clinical trials comparing at least 2 invasive strategies for the treatment of suspected IPN was carried out. A frequentist random-effects network meta-analysis was made reporting the surface under the cumulative ranking (SUCRA). The primary endpoint regarded both the in-hospital mortality and major morbidity rates. The secondary endpoints were mortality, length of stay, intensive care unit stay, the pancreatic fistula rate, and exocrine and endocrine insufficiency.

Results:
Seven studies were included, involving 400 patients clustered as following: 64 (16%) in early surgical debridement (ED); 27 (6.7%) in peritoneal lavage (PL); 45 (11.3%) in delayed surgical debridement (DD), 169 (42.3%) in the step-up approach with minimally invasive debridement (SUA-DD) and 95 (23.7%) with endoscopic debridement (SUA-EnD). The step-up approach with endoscopic debridement had the highest probability of being the safest approach (SUCRA 87.1%), followed by SUA-DD (SUCRA 59.5%); DD, ED, and PL had the lowest probability of being safe (SUCRA values 27.6%, 31.4%, and 44.4%, respectively). Analysis of the secondary endpoints confirmed the superiority of SUA-EnD regarding length of stay, intensive care unit stay, pancreatic fistula rate, and new-onset diabetes. The SUA approaches are similar regarding exocrine function. Mortality was reduced by any delayed approaches (DD, SUA-DD, or SUA-EnD).

Conclusions:
The first choice for suspected IPN seemed to be SUA-EnD. An alternative could be SUA-DD. PL, ED, and DD should be avoided.
Early Identification of Trauma-induced Coagulopathy
Authors: Perkins Zane B. , Yet Barbaros , Marsden Max , Glasgow Simon , Marsh William , Davenport Ross , Brohi Karim , Tai Nigel R. M. 
Published: January 2020

Objective:
The aim of this study was to develop and validate a risk prediction tool for trauma-induced coagulopathy (TIC), to support early therapeutic decision-making.

Background:
TIC exacerbates hemorrhage and is associated with higher morbidity and mortality. Early and aggressive treatment of TIC improves outcome. However, injured patients that develop TIC can be difficult to identify, which may compromise effective treatment.

Methods:
A Bayesian Network (BN) prediction model was developed using domain knowledge of the causal mechanisms of TIC, and trained using data from 600 patients recruited into the Activation of Coagulation and Inflammation in Trauma (ACIT) study. Performance (discrimination, calibration, and accuracy) was tested using 10-fold cross-validation and externally validated on data from new patients recruited at 3 trauma centers.

Results:
Rates of TIC in the derivation and validation cohorts were 11.8% and 11.0%, respectively. Patients who developed TIC were significantly more likely to die (54.0% vs 5.5%, P < 0.0001), require a massive blood transfusion (43.5% vs 1.1%, P < 0.0001), or require damage control surgery (55.8% vs 3.4%, P < 0.0001), than those with normal coagulation. In the development dataset, the 14-predictor BN accurately predicted this high-risk patient group: area under the receiver operating characteristic curve (AUROC) 0.93, calibration slope (CS) 0.96, brier score (BS) 0.06, and brier skill score (BSS) 0.40. The model maintained excellent performance in the validation population: AUROC 0.95, CS 1.22, BS 0.05, and BSS 0.46.

Conclusions:
A BN (http://www.traumamodels.com) can accurately predict the risk of TIC in an individual patient from standard admission clinical variables. This information may support early, accurate, and efficient activation of hemostatic resuscitation protocols.
The Effect of Postoperative Complications After Minimally Invasive Esophagectomy on Long-term Survival
Authors: Fransen Laura F. C. , Berkelmans Gijs H. K. , Asti Emanuele , van Berge Henegouwen Mark I. , Berlth Felix , Bonavina Luigi , Brown Andrew , Bruns Christiane , van Daele Elke , Gisbertz Suzanne S. , Grimminger Peter P. , Gutschow Christian A. , Hannink Gerjon , Hölscher Arnulf H. , Kauppi Juha , Lagarde Sjoerd M. , Mercer Stuart , Moons Johnny , Nafteux Philippe , Nilsson Magnus , Palazzo Francesco , Pattyn Piet , Raptis Dimitri A. , Räsanen Jari , Rosato Ernest L. , Rouvelas Ioannis , Schmidt Henner M. , Schneider Paul M. , Schröder Wolfgang , van der Sluis Pieter C. , Wijnhoven Bas P. L. , Nieuwenhuijzen Grard A. P. , Luyer Misha D. P. 
Published: January 2020

Background:
Esophagectomy is a technically challenging procedure, associated with significant morbidity. The introduction of minimally invasive esophagectomy (MIE) has reduced postoperative morbidity.

Objective:
Although the short-term effect on complications is increasingly being recognized, the impact on long-term survival remains unclear. This study aims to investigate the association between postoperative complications following MIE and long-term survival.

Methods:
Data were collected from the EsoBenchmark Collaborative composed by 13 high-volume, expert centers routinely performing MIE. Patients operated between June 1, 2011 and May 31, 2016 were included. Complications were graded using the Clavien-Dindo (CD) classification. To correct for short-term effects of postoperative complications on mortality, patients who died within 90 days postoperative were excluded. Primary endpoint was 5-year overall survival.

Results:
A total of 915 patients were included with a mean follow-up time of 30.8 months (standard deviation 17.9). Complications occurred in 542 patients (59.2%) of which 50.2% had a CD grade ≥III complication [ie, (re)intervention, organ dysfunction, or death]. The incidence of anastomotic leakage (AL) was 135 of 915 patients (14.8%) of which 84 patients were classified as a CD grade ≥III. Multivariable analysis showed a significantly deteriorated long-term survival in all patients with AL [hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.25–2.24]. This inverse relation was most distinct when AL was scored as a CD grade ≥III (HR 1.83, 95% CI 1.30–2.58). For all other complications, no significant association with long-term survival was found.

Conclusion:
The occurrence and severity of AL, but not overall complications, after MIE negatively affect long-term survival of esophageal cancer patients.
Quality of Life After Caustic Ingestion
Authors: Faron Matthieu , Corte Helene , Poghosyan Tigran , Bruzzi Matthieu , Voron Thibault , Sarfati Emile , Cattan Pierre , Chirica Mircea 
Published: January 2020

Objective:
The aim of the study was to evaluate long-term QOL after caustic ingestion.

Background:
Caustic ingestion strongly affects patient's QOL but data on the topic is scarce in the literature.

Methods:
QOL evaluation was conducted in survivors from a large cohort of patients with caustic injuries. QOL was assessed using the EORTC QLQ-OG25 module, the SF12v2 score, and the hospital anxiety and depression scale questionnaire. One hundred thirty-four patients (59 men, median age 43) completed the survey; 72 (54%) patients underwent emergency digestive resection and in 99 (74%) patients underwent esophageal reconstruction. Results of QOL questionnaires were compared to average values determined in healthy volunteers and in patients with esophageal cancers.

Results:
The median QLQ-OG25 score was 44 (34, 62) and values were significantly lower when compared to a normal population (P < 0.0001). SF12v2 scores were significantly inferior to those expected in a normal population on both the physical component summary (PCS) (43.3 ± 10.8; P < 0.0001) and the mental component summary (44 ± 9.7; P < 0.0001) scales. Emergency esophageal resection was significantly associated with higher QLQ-OG25 scores (P < 0.0001), but not with mental component summary (P = 0.3), PCS (P = 0.76), HAD anxiety (P = 0.95), and HAD depression scores (P = 0.59); results were similar after extended emergency resection. When compared to esophagocoloplasty alone, pharyngeal reconstruction had a significant negative impact on QLQ-OG25 (P < 0.0001), PCS (P = 0.01), and HAD depression (P = 0.0008) scores.

Conclusions:
QOL is significantly impaired after caustic ingestion. QOL issues should not influence the emergency surgical strategy but deserve discussion before esophageal reconstruction for caustic injuries.
Use and Misuse of Opioids After Endocrine Surgery Operations
Authors: Kuo Jennifer H. , Huang Yongmei , Kluger Michael D. , Hershman Dawn L. , Chabot John A. , Lee James A. , Wright Jason D. 
Published: January 2020

Objective:
To examine the rate of new and persistent opioid use after endocrine surgery operations

Summary of Background Data:
A global epidemic of opioid misuse and abuse has been evolving over the past 2 decades with opioid use among surgical patients being a particularly difficult problem. Minimal data exists regarding opioid misuse after endocrine surgical operations.

Methods:
A retrospective cohort study using the MarketScan identified adult patients who underwent thyroidectomy, parathyroidectomy, neck dissections for thyroid malignancy, and adrenalectomy from 2008 to 2017. Persistent opioid use was defined as receipt of ≥1 opioid prescription 90–180 days postop with no intervening procedures or anesthesia. Multivariable models were used to examine associations between clinical characteristics and any use and new persistent use of opioids.

Results:
A total of 259,115 patients were identified; 54.6% of opioid naïve patients received a perioperative opioid prescription. Fulfillment of this prescription was associated with malignant disease, greater extent of surgery, younger age, residence outside of the Northeast, and history of depression or substance abuse. The rate of new persistent opioid use was 7.4%. A lateral neck dissection conferred the highest risk for persistent opioid use (P < 0.01). Persistent opioid use was also associated with older age, Medicaid coverage, residency outside of the Northeast, increased medical co-morbidities, a history of depression, anxiety, substance use disorder, and chronic pain (all P < 0.01). Importantly, the risk for persistent opioid use increased with higher doses of total amount of opioids prescribed.

Conclusions:
The rate of new, persistent opioid use after endocrine surgery operations is substantial but may be mitigated by decreasing the number of postoperative opioids prescribed.
Subclassification of Microscopic Vascular Invasion in Hepatocellular Carcinoma
Authors: Kang Incheon , Jang Mi , Lee Jae Geun , Han Dai Hoon , Joo Dong Jin , Kim Kyung Sik , Kim Myoung Soo , Choi Jin Sub , Kim Soon Il , Park Young Nyun , Choi Gi Hong 
Published: January 2020

Objective:
To investigate whether subclassification of microscopic vascular invasion (MiVI) affects the long-term outcome after curative surgical resection or liver transplantation (LT) in patients with hepatocellular carcinoma (HCC).

Summary of Background Data:
The most important factor for TNM staging in HCC is MiVI, which includes all vascular invasions detected on microscopic examination. However, there is a broad spectrum of current definitions for MiVI.

Methods:
In total, 412 consecutive patients with HCC who underwent curative surgical resection without any preoperative treatment or gross vascular invasion were histologically evaluated for MiVI. Patients with MiVI were subclassified into 2 groups: microvessel invasion (MI; n = 164) only and microscopic portal vein invasion (MPVI; n = 36). Clinicopathologic features were compared between 2 groups (MI vs MPVI), whereas disease-free survival (DFS) and overall survival (OS) after resection were analyzed among 3 groups (no vascular invasion [NVI] vs MI vs MPVI). These subclassifications were validated in a cohort of 197 patients with HCC who underwent LT.

Results:
The MPVI group showed more aggressive tumor characteristics, such as higher tumor marker levels (alpha-fetoprotein, P = 0.006; protein induced by vitamin K absence-II, P = 0.001) and poorer differentiation (P = 0.011), than the MI group. In multivariate analysis, both MI and MPVI were independent prognostic factors for DFS (P = 0.001 and <0.001, respectively) and OS (P = 0.005 and <0.001, respectively). In the validation cohort, 5-year DFS was 89%, 67.9%, and 0% in the NVI, MI, and MPVI groups, respectively (P < 0.001), whereas 5-year OS was 79.1%, 55.0%, and 15.4%, respectively (P < 0.001).

Conclusions:
Based on subclassification of MiVI in HCC, MPVI was associated with more aggressive clinicopathologic characteristics and poorer survival than MI only. Therefore, the original MiVI classification should be divided into MI and MPVI.
Pancreatic Stone Protein Predicts Sepsis in Severely Burned Patients Irrespective of Trauma Severity
Authors: Klein Holger Jan , Niggemann Pia , Buehler Philipp Karl , Lehner Fabienne , Schweizer Riccardo , Rittirsch Daniel , Fuchs Nina , Waldner Matthias , Steiger Peter , Giovanoli Pietro , Reding Theresia , Graf Rolf , Plock Jan Alexander 
Published: January 2020

Objective:
The burn victim's inherent state of hyperinflammation frequently camouflages septic events delaying the initiation of targeted intensive care therapy. Accurate biomarkers are urgently needed to support sepsis detection before patients’ clinical deterioration.

Summary of Background Data:
Evidence on the usefulness of pancreatic stone protein (PSP) as a powerful diagnostic and prognostic marker in critically ill patients has recently accumulated.

Methods:
Analysis of biomarker kinetics (PSP, routine markers) was performed on 90 patients admitted to the Zurich Burn Center between May 2015 and October 2018 with burns ≥15% total body surface area with regard to infection and sepsis (Sepsis-3) over a 14-day time course.

Results:
PSP differentiated between sepsis, infection and sterile inflammation from day 3 onward with an area under the curve of up to 0.89 (P < 0.001), therefore, competing with procalcitonin (area under the curve = 0.86, P < 0.001). Compared to routine inflammatory biomarkers, only PSP demonstrated a significant interaction between time and presence of sepsis – signifying a steeper increase in PSP levels in septic patients as opposed to those exhibiting a nonseptic course (interaction P < 0.001). Event-related analysis demonstrated tripled PSP serum levels within 72 hours and doubled levels within 48 hours before a clinically apparent sepsis.

Conclusion:
PSP is able to differentiate between septic and nonseptic patients during acute burn care. Its steep rise up to 72 hours before clinically overt deterioration has the potential for physicians to timely initiate treatment with reduced mortality and costs.
Number and Station of Lymph Node Metastasis After Curative-intent Resection of Intrahepatic Cholangiocarcinoma Impact Prognosis
Authors: Zhang Xu-Feng , Xue Feng , Dong Ding-Hui , Weiss Matthew , Popescu Irinel , Marques Hugo P. , Aldrighetti Luca , Maithel Shishir K. , Pulitano Carlo , Bauer Todd W. , Shen Feng , Poultsides George A. , Soubrane Oliver , Martel Guillaume , Koerkamp Bas Groot , Itaru Endo , Lv Yi , Pawlik Timothy M. 
Published: January 2020

Objectives:
To determine the prognostic implication of the number and station of LNM, and the minimal number of LNs needed for evaluation to accurately stage patients with intrahepatic cholangiocarcinoma (ICC).

Background:
Impact of the number and station of LNM on long-term survival, and the minimal number of LNs needed for accurate staging of ICC patients remain poorly defined.

Methods:
Data on patients who underwent curative-intent resection for ICC was collected from 15 high-volume centers worldwide. External validation was performed using the SEER registry. Primary outcomes included overall (OS), disease-specific, and recurrence-free survival.

Results:
Among 603 patients who underwent curative-intent resection, median and 5-year OS were 30.6 months and 30.4%. Patients with 1 or 2 LNM had comparable worse OS versus patients with no nodal disease (median OS, 1 LNM 18.0, 2 LNM 20.0 vs no LNM 45.0 months, both P < 0.001), yet better OS versus patients with 3 or more LNM (median OS, 1–2 LNM 19.8 vs ≥3 LNM 16.0 months, P < 0.01). On multivariable analysis, a proposed new nodal staging with N1 (1–2 LNM) (Ref. N0, HR 2.40, P < 0.001) and N2 (≥3 LNM) [Ref. N0, hazard ratio (HR) 3.85, P < 0.001] categories were independently associated with incrementally worse OS. Patients with no nodal metastasis, 1–2 LNM and ≥3 LNM also had an increasingly worse disease-specific survival, and recurrence-free survival (both P < 0.05). Total number of LNs examined ≥6 had the greatest discriminatory power relative to OS among patients with 1–2 LNM, and patients with ≥3 LNM in both the multi-institutional (area under the curve 0.780) and SEER database (area under the curve 0.820) (n = 1036). Among patients who underwent an adequate regional lymphadenectomy (total number of LNs examined ≥6), LNM beyond the HDL was associated with worse OS versus LNM within the HDL only (median OS, 14.0 vs 24.0 months, HR 2.41, P = 0.003).

Conclusion:
Standard lymphadenectomy of at least 6 LNs is strongly recommended and should include examination beyond station 12 to have the greatest chance of accurate staging. The proposed new nodal staging of N0, N1, and N2 should be considered to stratify outcomes among patients after curative-intent resection of ICC.