bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Orbital Preadipocyte Adipogenesis Between Pediatric and Adult Graves Ophthalmopathy
Authors: Choi Hee Young , Jung Jae Ho , Ahn Jung Hyo 
Published: October 2019

Abstract
To investigate the difference of adipogenesis in orbital preadipocytes between pediatric and adult Graves ophthalmopathy (GO) under lipopolysaccharide (LPS)-induced inflammation in vitro.
Orbital preadipocytes from pediatric and adult GO patients during eyelid or orbital surgery were cultured. The orbital preadipocytes in pediatric and adult GO were divided into group A and group B. In group A, pediatric and adult orbital preadipocytes were differentiated in adipogenesis media without LPS intervention, respectively. In group B, pediatric and adult orbital preadipocytes were incubated in culture medium containing 1 mg/L LPS for 48 hours before stimulation to differentiate into mature adipocytes in adipogenesis media. The expressions of adipogenic transcription factors, PPAR-γ and C/EBP-α, were determined by real-time polymerase chain reaction on day 7. On day 14, the cells were stained with oil red O to observe the intracellular lipid accumulation.
In group A without LPS intervention, the pediatric orbital preadipocytes showed increased expression of PPAR-γ, C/EBP-α, and intracellular lipids accumulation than the adult orbital preadipocytes. In a group B with LPS intervention, both pediatric and adult preadipocytes showed higher rates of adipogenesis than in group A. Additionally, the increase in adipogenesis was greater in the pediatric preadipocytes.
The pediatric orbital preadipocytes demonstrated increased adipogenesis than adult preadipocytes in GO without LPS-induced inflammation. Adipogenesis of the pediatric orbital preadipocytes was more affected and upregulated as compared to that of the adult preadipocytes by LPS-induced inflammation.
The Role of Transoral Robotic Surgery for Parapharyngeal Space: Experience of a Tertiary Center
Authors: Chu Francesco , De Berardinis Rita , Tagliabue Marta , Zorzi Stefano , Bandi Francesco , Ansarin Mohssen 
Published: October 2019

Abstract
The parapharyngeal space (PPS) is an anatomically and functionally complex region of the craniofacial district. Tumors that originate from this region are rare, and surgery is currently the best practice in the vast majority of cases with different surgical approaches being reported in the literature. Recently, mini-invasive robotic/endoscopic techniques have begun to emerge as effective alternatives in selected cases. In this work, we retrospectively analyzed 17 patients affected by PPS tumors, and managed by transoral robotic surgery (TORS) as a therapeutic or diagnostic procedure. TORS was used alone or combined with a transcervical approach for huge lesions of the PPS, at risk of fragmentation (curative intent). TORS also permitted biopsies of unknown lesions of the PPS to be conducted (diagnostic intent) otherwise unreachable without performing a mandibulotomy. All patients treated with curative intent benefited from radical surgery. No major complications were observed, and tumor fragmentation occurred only in 2 of 17 patients (11.8%). All patients receiving TORS with diagnostic intent were successfully referred to nonsurgical treatments based on the final histhopathological findings. This work also demonstrated TORS to be effective and safe on a larger group of patients compared to our preliminary study in 2016. TORS provides good oncological and functional outcomes when used with curative intent and is an effective diagnostic tool in cases of suspicious lesions of the PPS.
Langerhans Cell Histiocytosis in an Adult: A Discussion of Epidemiology and Treatment Options
Authors: El-Arab Kaley K. , Luedke Alexis Inge , Julian Bao-Quynh Thuy , Ferrauiola Julie , Miller Frank Raymond , Wang Howard Tz-ho 
Published: October 2019

Abstract
Langerhans cell histiocytosis (LCH) is a rare disorder defined by the abnormal proliferation of Langerhans cells. While LCH can present at any age, it is classically described as a pediatric condition, and is therefore overlooked in the adult patient. Additionally, depending on tumor burden and location, LCH can manifest with a host of oral and systemic symptoms which further confuses the clinical presentation and ultimate diagnosis.
The authors present a unique report of an elderly Hispanic male diagnosed with mandibular LCH who sought primary tumor excision after neoadjuvant chemotherapy. In this study, a fibula-free flap was used for subsequent reconstruction.
The purpose of the study is 2-fold: to highlight the variability of LCH in both patient symptomatology and demographics, as well as the role of plastic reconstructive surgery in definitive LCH management, particularly in the setting of single system unifocal disease.
The Possible Role of Color Doppler and Pulse Wave Doppler Ultrasound in the Diagnosis of Cutaneous Lymphangioma Circumscriptum
Authors: Sun Yang , Su Jing , Li Shan-Shan , Cui Li-Gang 
Published: October 2019

Abstract
Cutaneous lymphangioma circumscriptum (CLC) is an uncommon congenital lymphatic malformation. Its dermoscopic features have been reported, however, if blood has infiltrated the lacunas, a pink hue overwhelms the lacunar structures, rendering dermoscopic features indistinguishable. In addition, dermoscopy cannot assess the subcutaneous extent of the lesion before surgery. The high-frequency array transducer Sonography with a high-frequency transducer is excellent in its resolution to evaluate skin lesions and is unaffected by infiltration of blood. Here, the authors report the use of ultrasound (color Doppler and pulse wave Doppler) for the diagnosis and management of CLC.
An 18-year-old man presented 10 years previously with an asymptomatic 0.5 × 0.7 cm cluster of dark reddish vesicular lesions on his buttock. The lesions had recently increased in size and number. There was associated pachyderma. The lesions were hyperechoic and well defined on grayscale ultrasound and hypervascular on color Doppler ultrasound. Cluster cystics of lymphatic spaces were found throughout the whole dermis, especially in the papillary dermis. The lymphatic channels extended downwards to the reticular dermis and the superficial layer of the subcutaneous tissue. The pathological findings revealed lymphangiomas invading the subcutaneous tissue. The flat endothelial cells were partly positive for D2-40, which is a marker of lymphatic endothelial cells. Ultrasound was able to delineate the margins of the lesions. Diagnosis of CLC using preoperative color Doppler and pulse wave Doppler could reduce unnecessary repeated pre- and postoperative biopsies.
Nasal Bone Osteoma Approach
Authors: Ono Maria Cecília Closs , D’Avanço de Morais André , Freitas Renato da Silva 
Published: October 2019

Abstract
Osteoma is a benign osteogenic lesion that arises most frequently in the craniomaxillofacial region. Rarely, it can appear on the outer side of nasal bone and cause aesthetic problems. The authors present an unusual case of outer side nasal bone osteoma with a brief review of its main clinical presentations, diagnostic studies, and treatment options.
Health Care Spending and New Persistent Opioid Use After Surgery
Authors: Lee Jay S. , Vu Joceline V. , Edelman Anthony L. , Gunaseelan Vidhya , Brummett Chad M. , Englesbe Michael J. , Waljee Jennifer F. 
Published: October 2019

Objective:
We sought to describe the differences in health care spending and utilization among patients who develop persistent postoperative opioid use.

Summary of Background Data:
Although persistent opioid use following surgery has garnered concern, its impact on health care costs and utilization remains unknown.

Methods:
We examined insurance claims among 133,439 opioid-naive adults undergoing surgery. Outcomes included 6-month postoperative health care spending; proportion of spending attributable to admission, readmission, ambulatory or emergency care; monthly spending 6 months before and following surgery. We defined persistent opioid use as continued opioid fills beyond 3 months postoperatively. We used linear regression to estimate outcomes adjusting for clinical covariates.

Results:
In this cohort, 8103 patients developed persistent opioid use. For patients who underwent inpatient procedures, new persistent opioid use was associated with health care spending (+$2700 per patient, P < 0.001) compared with patients who did not develop new persistent use. For patients who underwent outpatient procedures, new persistent opioid use was similarly correlated with higher health care spending (+$1500 per patient, P < 0.001) compared with patients who did not develop new persistent use. Patients without persistent opioid use returned to baseline health care spending within 6 months, regardless of other complications. However, patients with persistent opioid use had sustained increases in spending by approximately $200 per month.

Conclusion:
Unlike other postoperative complications, persistent opioid use is associated with sustained increases in spending due to greater readmissions and ambulatory care visits. Early identification of patients vulnerable to persistent use may enhance the value of surgical care.
Prediction Model of Long-term Survival After Esophageal Cancer Surgery
Authors: Xie Shao-Hua , Santoni Giola , Mälberg Kalle , Lagergren Pernilla , Lagergren Jesper 
Published: October 2019

Objective:
We aimed to develop prediction models for estimating the long-term survival in patients who have undergone surgery for esophageal cancer.

Background:
Few prediction models have been developed for the long-term survival in esophageal cancer patients.

Methods:
This nationwide Swedish population-based cohort study included 1542 patients who survived for ≥90 days after esophageal cancer surgery between 1987 and 2010, with follow-up until 2016. Risk prediction models for 1-, 3-, and 5-year all-cause mortality and 3- and 5-year disease-specific mortality were developed using logistic regression. Candidate predictors were established and readily identifiable prognostic factors. The performance of the models was assessed by the area under receiver-operating characteristic curve (AUC) with interquartile range (IQR) using bootstrap cross-validation and risk calibration.

Results:
Predictors included in all models were age, sex, pathological tumor stage, tumor histology, and resection margin status. The models also included various additional predictors depending on the outcome, that is, education level, neoadjuvant therapy, reoperation (within 30 d of primary surgery) and comorbidity (Charlson comorbidity index). The AUC statistics after cross-validation were 0.71 (IQR 0.69–0.74) for 1-year, 0.77 (IQR 0.75–0.80) for 3-year, and 0.78 (IQR 0.76–0.81) for 5-year all-cause mortality. The corresponding values were 0.76 (IQR 0.74–0.79) for 3-year and 0.77 (IQR 0.71–0.83) for 5-year disease-specific mortality. All models showed good agreement between the observed and predicted risks.

Conclusions:
These models showed good performance for predicting long-term survival after esophageal cancer surgery and may thus be useful for patients in planning their lives and to guide the postoperative treatment and follow-up.
Prophylactic Negative Pressure Wound Therapy for Closed Laparotomy Incisions
Authors: Kuper Tanya M. , Murphy Patrick B. , Kaur Bandeep , Ott Michael C. 
Published: October 2019

Objective:
The aim of this study was to determine whether negative pressure wound therapy (NPWT) applied to primarily closed incisions decreases surgical site infections (SSIs) following open abdominal surgery.

Background:
SSIs are a common cause of morbidity following open abdominal surgery. Prophylactic NPWT has shown promise for SSI reduction. However, the results of randomized controlled trials (RCTs) conducted among patients undergoing laparotomy have been inconsistent.

Methods:
We performed a meta-analysis of English language RCTs comparing the use of prophylactic NPWT to standard dressings on primarily closed laparotomy incisions following open abdominal surgery. Medline, EMBASE, Cochrane Library, and CINAHL databases were searched from inception to December 31st, 2018, for relevant studies. A random-effects model was used for statistical analysis.

Results:
Five RCTs totaling 792 patients were included in our meta-analysis after application of our exclusion and inclusion criteria. There was no significant difference in the risk of SSIs identified among those patients who had NPWT compared to standard dressings; relative risk (RR) 0.56 (95% confidence interval 0.30–1.03, P = 0.064). There was significant statistical heterogeneity across studies (I
2 = 67.4%; P = 0.015).

Conclusion:
The adoption of NPWT for routine SSI prophylaxis following laparotomy is currently not supported and should be used primarily in the context of a clinical trial.
Early Versus Delayed Surgical Repair and Referral for Patients With Bile Duct Injury
Authors: Wang Xiang , Yu Wen-Long , Fu Xiao-Hui , Zhu Bin , Zhao Teng , Zhang Yong-Jie 
Published: October 2019

Objective:
The aim of the study was to systematically review and meta-analyze the available evidence regarding the association between timing of repair or referral and clinical outcomes in bile duct injury (BDI).

Background:
Surgical repair is recommended for patients with complex BDI following laparoscopic cholecystectomy. However, consensus on the timing of surgery or referral to a specialist is lacking.

Methods:
We searched PubMed, Embase, Cochrane Library, and Scopus for eligible studies. The coprimary outcomes were repair failure in follow-up and postoperative complications. We pooled odds ratios (ORs) using random-effects models.

Results:
We included 32 studies. The rate of repair failure was significantly higher for early versus delayed repair [OR 1.65, 95% confidence interval (CI) 1.14–2.37, P
= 0.007], lower for early versus delayed referral (OR 0.28, 95% CI 0.17–0.45, P < 0.001), but did not differ substantially for on-table versus postcholecystectomy repair (OR 2.06, 95% CI 0.89–4.73, P = 0.09). Regarding postoperative complications, early referral outperformed delayed referral (OR 0.24, 95% CI 0.09–0.68, P
= 0.007); however, we found no significant differences between early and delayed repair (OR 1.34, 95% CI 0.96–1.87, P
= 0.08), or between on-table and postcholecystectomy repair (OR 1.13, 95% CI 0.42–3.07, P
= 0.81). At the cutoff time point of 6 weeks, early repair was associated with increased rates of repair failure (OR 4.03; P < 0.001), postoperative complications (OR 2.18; P < 0.001), and biliary stricture (OR 6.23; P < 0.001).

Conclusions:
Among patients with BDI, early referral and delayed repair appear to confer favorable outcomes.
Changes in Hospital-acquired Conditions and Mortality Associated With the Hospital-acquired Condition Reduction Program
Authors: Arntson Emily , Dimick Justin B. , Nuliyalu Ushapoorna , Errickson Josh , Engler Tedi A. , Ryan Andrew M. 
Published: October 2019

Importance:
To improve patient safety, the Centers for Medicare and Medicaid Services announced the Hospital-Acquired Condition Reduction Program (HACRP) in August 2013. The program reduces Medicare payments by 1% for hospitals in the lowest performance quartile related to hospital-acquired conditions. Performance measures are focused on perioperative care.

Objective:
To evaluate changes in HACs and 30-day mortality after the announcement of the HACRP.

Design:
Interrupted time-series design using Medicare Provider and Analysis Review (MEDPAR) claims data. We estimated models with linear splines to test for changes in HACs and 30-day mortality before the Affordable Care Act (ACA), after the ACA, and after the HACRP.

Setting:
Fee-for-service Medicare 2009–2015.

Participants:
Medicare beneficiaries undergoing surgery and discharged from an acute care hospital between January 2009 and August 2015 (N = 8,857,877).

Main Outcome and Measure:
Changes in HACs and 30-day mortality after the announcement of the HACRP.

Results:
Patients experienced HACs at a rate of 13.39 per 1000 discharges [95% confidence interval (CI), 13.10 to 13.68] in the pre-ACA period. This declined after the ACA was passed and declined further after the HACRP announcement [adjusted difference in annual slope, −1.34 (95% CI, −1.64 to −1.04)]. Adjusted 30-day mortality was 3.69 (95% CI, 3.64 to 3.74) in the pre-ACA period among patients receiving surgery. Thirty-day mortality continued to decline after the ACA [adjusted annual slope −0.04 (95% CI, −0.05 to −0.02)] but was flat after the HACRP [adjusted annual slope −0.01 (95% CI, −0.04 to 0.02)].

Conclusions and Relevance:
Although hospital-acquired conditions targeted under the HACRP declined at a greater rate after the program was announced, 30-day mortality was unchanged.
Frailty Factors and Outcomes in Vascular Surgery Patients
Authors: Houghton John S. M. , Nickinson Andrew T. O. , Morton Alastair J. , Nduwayo Sarah , Pepper Coral J. , Rayt Harjeet S. , Gray Laura J. , Conroy Simon P. , Haunton Victoria J. , Sayers Rob D. 
Published: October 2019

Objective:
To describe and critique tools used to assess frailty in vascular surgery patients, and investigate its associations with patient factors and outcomes.

Background:
Increasing evidence shows negative impacts of frailty on outcomes in surgical patients, but little investigation of its associations with patient factors has been undertaken.

Methods:
Systematic review and meta-analysis of studies reporting frailty in vascular surgery patients (PROSPERO registration: CRD42018116253) searching Medline, Embase, CINAHL, PsycINFO, and Scopus. Quality of studies was assessed using Newcastle–Ottawa scores (NOS) and quality of evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria. Associations of frailty with patient factors were investigated by difference in means (MD) or expressed as risk ratios (RRs), and associations with outcomes expressed as odds ratios (ORs) or hazard ratios (HRs). Data were pooled using random-effects models.

Results:
Fifty-three studies were included in the review and only 8 (15%) were both good quality (NOS ≥ 7) and used a well-validated frailty measure. Eighteen studies (62,976 patients) provided data for the meta-analysis. Frailty was associated with increased age [MD 4.05 years; 95% confidence interval (CI) 3.35, 4.75], female sex (RR 1.32; 95% CI 1.14, 1.54), and lower body mass index (MD −1.81; 95% CI −2.94, −0.68). Frailty was associated with 30-day mortality [adjusted OR (AOR) 2.77; 95% CI 2.01–3.81), postoperative complications (AOR 2.16; 95% CI 1.55, 3.02), and long-term mortality (HR 1.85; 95% CI 1.31, 2.62). Sarcopenia was not associated with any outcomes.

Conclusion:
Frailty, but not sarcopenia, is associated with worse outcomes in vascular surgery patients. Well-validated frailty assessment tools should be preferred clinically, and in future research.
Specific challenges in end-of-life care for patients with hematological malignancies
Authors: Gerlach Christina , Alt-Epping Bernd , Oechsle Karin 
Published: October 2019

Purpose of review
The disease-related burden of patients with hematological malignancies is comparable with patients suffering from solid tumors. Palliative care offers relief from suffering independent of type of disease and prognosis. The prevalence of hematological malignancies is expected to increase in the next 20 years because of better therapeutic options with longer survival and because of the aging population. However, patients with hematological malignancies are underrepresented in palliative care as these diseases are associated with special care needs and prognostic uncertainty, which differ from the unambiguity of terminally ill patients with solid tumors. This review describes the recent studies and guidelines addressing the problems in palliative care for patients with hematological malignancies.

Recent findings
Recent research covers prognostic uncertainty, challenges in terms of the acute death setting, and blood transfusions in the terminally ill as well as interdisciplinary collaboration. In addition to qualitative approaches exploring reasons for these challenges, criteria that indicate the approaching end of life in hematological malignancies were systematically developed and tested. Further, the effectiveness of palliative care addressing the hematopoietic stem cell transplantation setting was further analyzed.

Summary
The patients’ perspective needs to be involved in future research to examine whether the connotation of ‘palliative care’ is a barrier for patients, families or healthcare professionals. Communication culture and skills have already been identified as goals for medical training. Further studies should identify the effective elements of palliative care specific for hematological malignancies and develop feasible support models, including informal caregivers.
The Association Between Cytomegalovirus Infection and Cardiac Allograft Vasculopathy in the Era of Antiviral Valganciclovir Prophylaxis
Authors: Klimczak-Tomaniak Dominika , Roest Stefan , Brugts Jasper J. , Caliskan Kadir , Kardys Isabella , Zijlstra Felix , Constantinescu Alina A. , Voermans Jolanda J.C. , van Kampen Jeroen J.A. , Manintveld Olivier C. 
Published: October 2019

Background.
Previous studies on the association between cytomegalovirus (CMV) infection and cardiac allograft vasculopathy (CAV) were conducted on patients transplanted in the prevalganciclovir prophylaxis era. The aim of our study is to evaluate this relation in heart transplantation (HTx) recipients treated according to current prophylactic and immunosuppressive regimens.

Methods.
This single-center retrospective study included all consecutive adult patients that underwent HTx between January 1, 2000, and May 31, 2018. Clinically relevant CMV infection was defined as either plasma CMV DNAemia ≥ 1000 IU/mL with/without clinical symptoms or <1000 IU/mL with symptoms. The primary endpoint was first manifestation of CAV diagnosed by coronary angiography. For statistical analysis, the cause-specific hazard regression model was applied, with clinically relevant CMV infection and any CMV infection as time-dependent variables.

Results.
In total, 260 patients were included in the analysis. The median (interquartile range) follow-up was 7.88 (4.21–12.04) years. During the follow-up, clinically relevant CMV infection was diagnosed in 96 (37%) patients and CAV in 149 (57%) patients. In the multivariate regression analysis, independent predictors of CAV were: number of rejection episodes (cause-specific hazard ratio [95% confidence interval]: 1.18 [1.04-1.34], P = 0.01), hypertension (1.61 [1.11-2.34], P = 0.01), treatment with mycophenolate mofetil (0.68 [0.47-0.97], P = 0.03). No significant association was observed between CMV infection and CAV, except for patients who experienced a breakthrough CMV infection (n = 24) during prophylaxis (1.94 [1.11-3.40], P = 0.02).

Conclusions.
In the era of contemporary immunosuppression and valganciclovir prophylaxis, a significant effect of CMV infection on the risk of CAV was seen only among HTx recipients with CMV breakthrough infection.