bluuebunny/crossref_metadata_2025_split huggingface dataset:
Liver transplantation for alcoholic hepatitis: update
Authors: Yanny Beshoy , Boutros Sandra , Saleh Fatima , Saab Sammy 
Published: February 2020

Purpose of review
Alcoholic liver disease continues to be a major public health concern in the United States and around the world. Alcoholic liver disease remains the third most common indication for liver transplantation in the United States. Mortality has been reported in up to 30–50% of patients with severe alcoholic hepatitis. Liver transplantation can be lifesaving for patients with alcoholic hepatitis. Liver transplantation for alcoholic liver disease was traditionally only considered in patients who have achieved 6 months of abstinence. The majority of patients with severe alcoholic hepatitis who fail medical therapy will not live long enough to meet this requirement. The purpose of this review is to provide an update from the most recent peer reviewed articles regarding early liver transplantation of alcoholic hepatitis.

Recent findings
This review shows that liver transplantation offers the best survival benefit to patients with alcoholic hepatitis. Selection criteria is a key component for a successful transplant. No change in 1-year graft survival between patients who have 6 months sobriety vs. those transplanted prior to 6 months abstinence. Liver transplantation is limited by very narrow selection criteria and limited long-term data.

Summary
Liver transplantation offers the best survival benefit to patients with alcoholic hepatitis. Selection criteria of patients has evolved and have become more permissive and the period of sobriety has become less important in the evaluation of process. However, long-term outcomes continue to lack in the literature. On the basis of previous studies, patients with longer pretransplant abstinence, disease process insight, older age at the time of transplant, the presence of social support that lives with the patient in the same dwelling place were noted to have lower rates of return to alcohol use after liver transplantation.
Mixed Langerhans Cell Histiocytosis and Erdheim-Chester Disease in a Girl: A Rare and Puzzling Diagnosis
Authors: Ocak Suheyla , Bayramoglu Zuhal , Tugcu Deniz , Karaman Serap , Unuvar Aysegul , Karakas Zeynep 
Published: February 2020

Objective:
The objective of this study was to report the case of a girl diagnosed as suffering from multisystem, BRAF V600E–positive refractory Langerhans cell histiocytosis (LCH) and coexistent Erdheim-Chester disease (ECD) with perirenal, intracranial involvement and the dramatic response to clofarabine treatment.

Observations:
Histiocytoses are rare diseases with a broad clinical spectrum. Recent evidence supports a molecular and clinical overlap between LCH and ECD, and mixed LCH/ECD is now a separate entity. However, only a few pediatric cases of mixed disease have been reported in the literature.

Conclusions:
In a child with refractory, multisystem histiocytosis and atypical presentations, mixed LCH/ECD should be suspected in the differential diagnosis.
Impact of an Immersive Virtual Reality Curriculum on Medical Students’ Clinical Assessment of Infants With Respiratory Distress*
Authors: Zackoff Matthew W. , Real Francis J. , Sahay Rashmi D. , Fei Lin , Guiot Amy , Lehmann Corinne , Tegtmeyer Ken , Klein Melissa 
Published: February 2020

Objective:
To determine whether exposure to an immersive virtual reality curriculum on pediatric respiratory distress improves medical students’ recognition of impending respiratory failure.

Design:
Randomized, controlled, prospective study conducted from July 2017 to June 2018. Evaluators blinded to student groupings.

Setting:
Academic, free-standing children’s hospital.

Participants:
All third-year medical students (n = 168) were eligible. The standard curriculum was delivered to all students during their pediatric rotation with optional inclusion of research data per Institutional Review Board review. A randomized selection of students was exposed to the virtual reality curriculum.

Intervention:
All students received standard training on respiratory distress through didactics and high-fidelity mannequin simulation. Intervention students underwent an additional 30-minute immersive virtual reality curriculum, experienced through an OculusRift headset, with three simulations of an infant with 1) no distress, 2) respiratory distress, and 3) impending respiratory failure.

Measurements and Main Results:
The impact of the virtual reality curriculum on recognition/interpretation of key examination findings, assignment of an appropriate respiratory status assessment, and recognition of the need for escalation of care for patients in impending respiratory failure was assessed via a free response clinical assessment of video vignettes at the end of the pediatric rotation. Responses were scored on standardized rubrics by physician experts. All eligible students participated (78 intervention and 90 control). Significant differences between intervention and control were demonstrated for consideration/interpretation of mental status (p < 0.01), assignment of the appropriate respiratory status assessment (p < 0.01), and recognition of a need for escalation of care (p = 0.0004).

Conclusions:
Exposure to an immersive virtual reality curriculum led to improvement in objective competence at the assessment of respiratory distress and recognition of the need for escalation of care for patients with signs of impending respiratory failure. This study represents a novel application of immersive virtual reality and suggests that it may be effective for clinical assessment training.
Carpal Tunnel Release without a Tourniquet: A Systematic Review and Meta-Analysis
Authors: Olaiya Oluwatobi R. , Alagabi Awwal M. , Mbuagbaw Lawrence , McRae Mark H. 
Published: February 2020

Background:
Open carpal tunnel release is commonly performed with the use of a tourniquet. The combination of local anesthetic and epinephrine with a pneumatic tourniquet helps provide clear visualization during decompression of the median nerve. There has been a rapid expansion of literature challenging the use of tourniquets in open carpal tunnel release. Consequently, the local anesthesia/no tourniquet approach has become increasingly popular. The authors evaluated the outcomes of awake open carpal tunnel release with and without a tourniquet.

Methods:
The authors attempted to identify all relevant studies, regardless of language or publication status. A systematic database search for relevant studies was conducted in MEDLINE, EMBASE, EBSCO, and CENTRAL. Included studies compared patients undergoing awake open carpal tunnel release with and without an arm or forearm tourniquet.

Results:
Eight studies evaluating 765 patients and 866 hands were included. Open carpal tunnel release with the wide awake, local anesthesia, no tourniquet approach resulted in a 2.14 point reduction on the visual analog scale (95% CI, 1.30 to 2.98; p < 0.001). The procedure was 1.82 minutes faster with the use of a tourniquet (95% CI, –3.26 to –0.39; p = 0.01). There were no significant differences between groups in intraoperative blood loss, surgeon perceived difficulty, and complications.

Conclusion:
This systematic review found that tourniquet use causes significantly more pain with no significant clinical benefit as compared with using a wide awake, no tourniquet approach in carpal tunnel decompression.
Recent Developments Are Changing Extensor Tendon Management
Authors: Merritt Wyndell H. , Wong Alison L. , Lalonde Donald H. 
Published: February 2020

Learning Objectives:
After reviewing this article, the participant should be able to: 1. Start early protected movement at 3 to 5 days after surgery with relative motion extension splinting for zone 5 extensor tendon lacerations over the hand. 2. Allow patients to resume regular activities much sooner than the conventional 3 to 4 weeks of splinting after extensor tendon repair. 3. Improve the rehabilitation of boutonniere deformities with relative motion splinting.

Summary:
This article focuses on surgery and rehabilitation of extensor tendon injuries from the proximal interphalangeal joint (boutonniere) to the wrist. Relative motion flexion and extension splinting and wide awake, local anesthesia, no tourniquet surgery have revolutionized the management of these lesions, with early protected movement, sooner return to regular activities, and improved rehabilitation. This article explains and illustrates these new advances in extensor tendon management.
Correction of the Topographic Relationship between the Depressor Septi Nasi and Incisivus Labii Superioris: Application to Cosmetic Surgery on the Lip and Nose
Authors: Kikuta Shogo , Iwanaga Joe , Watanabe Koichi , Kusukawa Jingo , Tubbs R. Shane 
Published: February 2020

Background:
The depressor septi nasi is a facial muscle with many different descriptions of its anatomy. Therefore, the aim of this study was to clarify the relationship of the depressor septi nasi, incisivus labii superioris, and surrounding structures.

Methods:
Twenty sides from 10 fresh-frozen cadaveric heads were used in this study. The depressor septi nasi and incisivus labii superioris were dissected intraorally and extraorally, and the relationship with surrounding structures was observed.

Results:
Eighteen of 20 sides had a depressor septi nasi. When present, the depressor septi nasi originated from the orbicularis oris above the central incisor and the medial portion of the inferior part of the incisivus labii superioris and inserted into the base of the medial crus of the major alar cartilage and nasal septum. These three muscles were three-dimensionally fused at the insertion point of the depressor septi nasi. There was no specimen where the depressor septi nasi originated directly from the maxilla. The depressor septi nasi runs obliquely from the nasal septum and the base of the medial crus of the major alar cartilage to the orbicularis oris and inferior part of the incisivus labii superioris.

Conclusion:
A better understanding of the depressor septi nasi, incisivus labii superioris, and surrounding structures might be important during various surgical techniques, especially rhinoplasty.
Quantifying the Crisis: Opioid-Related Adverse Events in Outpatient Ambulatory Plastic Surgery
Authors: Crystal Dustin T. , Blankensteijn Louise L. , Ibrahim Ahmed M. S. , Brownstein Gary M. , Reed Lawrence S. , Watts David C. , Lin Samuel J. 
Published: February 2020

Background:
The United States is currently in the midst of an opioid epidemic precipitated, in part, by the excessive outpatient supply of opioid pain medications. Accordingly, this epidemic has necessitated evaluation of practice and prescription patterns among surgical specialties. The purpose of this study was to quantify opioid-related adverse events in ambulatory plastic surgery.

Methods:
A retrospective review of 43,074 patient profiles captured from 2001 to 2018 within an American Association for Accreditation of Ambulatory Surgery Facilities quality improvement database was conducted. Free-text search terms related to opioids and overdose were used to identify opioid-related adverse events. Extracted profiles included information submitted by accredited ambulatory surgery facilities and their respective surgeons. Descriptive statistics were used to quantify opioid-related adverse events.

Results:
Among our cohort, 28 plastic surgery patients were identified as having an opioid-related adverse event. Overall, there were three fatal and 12 nonfatal opioid-related overdoses, nine perioperative opioid-related adverse events, and four cases of opioid-related hypersensitivities or complications secondary to opioid tolerance. Of the nonfatal cases evaluated in the hospital (n = 17), 16 patients required admission, with an average 3.3 ± 1.7 days’ hospital length of stay.

Conclusions:
Opioid-related adverse events are notable occurrences in ambulatory plastic surgery. Several adverse events may have been prevented had different diligent medication prescription practices been performed. Currently, there is more advocacy supporting sparing opioid medications when possible through multimodal anesthetic techniques, education of patients on the risks and harms of opioid use and misuse, and the development of societal guidance regarding ambulatory surgery prescription practices.
Comparative Effectiveness Analysis of Complex Lower Extremity Reconstruction: Outcomes and Costs for Biologically Based, Local Tissue Rearrangement, and Free Flap Reconstruction
Authors: Kozak Geoffrey M. , Hsu Jesse Y. , Broach Robyn B. , Shakir Sameer , Calvert Catherine , Stranix John. T , Messa Charles , Levin L. Scott , Serletti Joseph M. , Kovach Stephen J. , Fischer John P. 
Published: February 2020

Background:Various surgical techniques exist for lower extremity reconstruction, but limited high-quality data exist to inform treatment strategies. Using multi-institutional data and rigorous matching, the authors evaluated the effectiveness and cost of three common surgical reconstructive modalities.Methods:All adult subjects with lower extremity wounds who received bilayer wound matrix, local tissue rearrangement, or free flap reconstruction were retrospectively reviewed (from 2010 to 2017). Cohorts’ comorbidities and wound characteristics were balanced. Graft success at 180 days was the primary outcome; readmissions, reoperations, and costs were secondary outcomes.Results:Five hundred one subjects (166 matrix, 190 rearrangement, and 145 free flap patients) were evaluated. Matched subjects (n= 312; 104/group) were analyzed. Reconstruction success at 180 days for matrix, local tissue rearrangement, and free flaps was 69.2 percent, 91.3 percent, and 93.3 percent (p <0.001), and total costs per subject were $34,877, $35,220, and $53,492 (p <0.001), respectively. Median length of stay was at least 2 days longer for free flaps (p <0.0001). Readmissions and reoperations were greater for free flaps. Local tissue rearrangement, if achievable, provided success at low cost. Free flaps were effective with large, traumatic wounds but at higher costs and longer length of stay. Matrices successfully treated older, obese patients without exposed bone.Conclusions:Lower extremity reconstruction can be performed effectively using multiple modalities with varying degrees of success and costs. Local tissue rearrangement and free flaps demonstrate success rates greater than 90 percent. Bilayer wound matrix-based reconstruction effectively treats a distinct patient population.CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, III.
Effectiveness of Switching to Darunavir/Cobicistat in Virologically Suppressed HIV-Positive Patients Receiving Ritonavir-Boosted Protease Inhibitor–Based Regimen: The “STORE” Study
Authors: Gori Andrea , Antinori Andrea , Vergori Alessandra , Cossu Maria Vittoria , Menzaghi Barbara , Sterrantino Gaetana , Rusconi Stefano , Cattelan Anna Maria , Castelli Francesco , Gianotti Nicola , Orofino Giancarlo , Ripamonti Diego , Savinelli Stefano , Manzillo Elio , Santantonio Teresa Antonia , Celesia Benedetto Maurizio , Cauda Roberto , Maserati Renato , d'Arminio Monforte Antonella , Stingone Christof , Bonora Stefano , Uglietti Alessia , Termini Roberta , Rucci Francesco , Mancusi Daniela 
Published: February 2020

Objective:
This study investigates the effectiveness and tolerability of switching to a darunavir/cobicistat (DRV/c)-based antiretroviral regimen from a ritonavir-boosted protease inhibitor (PI/r)-based regimen in virologically suppressed HIV-positive patients. DRV trough values were also investigated.

Setting:
Prospective, multicenter, single-country, noninterventional cohort study.

Methods:
This study included patients on a PI/r-based ART for at least 12 months having plasma HIV-1 RNA <50 copies/mL since at least 6 months. The primary endpoint, defined as HIV-1 RNA <50 copies/mL, was measured at 48 ± 6 weeks from baseline. A secondary analysis was performed using the time to loss of virological response algorithm. Biochemical parameters, including DRV trough samples, were collected as per clinical practice and measured using high-performance liquid chromatography.

Results:
Of 336 patients enrolled, 282 completed the study: 70.8% had plasma HIV-1 RNA <50 copies/mL at 48 weeks; using the time to loss of virological response algorithm, 82.7% maintained virological suppression. Virological failure was observed in 6 patients (1.8%). Adverse event–related discontinuations were 4.5%. After 48 weeks, we found a significant improvement in both triglycerides (median, 130 to 113.5 mg/dL, P = 0.0254) and high-density lipoprotein cholesterol (48 to 49 mg/dL, P < 0.0001) but no change in other biomarkers. DRV trough concentrations in 56 subjects showed a median value of 2862.5 (1469.5–4439) ng/mL, higher in women than in men (4221 vs. 2634 ng/mL, P = 0.046).

Conclusions:
In stable HIV-1 positive virologically suppressed patients, the switch to DRV/c-based ART was beneficial in terms of low rates of virological failure and adverse events due to its high tolerability and improvement in triglycerides.
Acute Kidney Injury After Radiocontrast-Enhanced Computerized Tomography in Hospitalized Patients With Advanced Renal Failure
Authors: Gorelik Yuri , Bloch-Isenberg Natalie , Yaseen Hiba , Heyman Samuel N. , Khamaisi Mogher 
Published: February 2020

Background
The overall risk of postcontrast acute kidney injury (PC-AKI) after computerized tomography (CT) is negligible, likely because of the small volume of injected iodinated contrast media required. However, the safety of contrast media–enhanced CT in patients with advanced renal functional impairment, an established major risk factor for PC-AKI, is unknown.

Materials and Methods
This is a retrospective study using large data analysis of hospitalized patients at a single center. Adults undergoing CT or magnetic resonance imaging were included in the study and were stratified by estimated glomerular filtration rate (eGFR) (≤30 or >30 mL/min/1.73 m2) and by either contrast-enhanced or nonenhanced imaging. Only patients with serial determination of creatinine before and after imaging were included. Demographic, clinical, and laboratory data between groups were analyzed and compared using univariate analysis, propensity score matching, and multivariate logistic regression analysis.

Results
A total of 22,319 imaging studies were included. Patients with an eGFR of 30 mL/min/1.73 m2 or lower undergoing contrast-enhanced CT (n = 403) had an increased risk to develop PC-AKI than did similar patients undergoing enhanced or nonenhanced magnetic resonance imaging (n = 96) or nonenhanced CT (n = 1576) or patients undergoing contrast-enhanced CT with a preprocedural eGFR higher than 30 mL/min/1.73 m2 (n = 9173). These findings remained robust after propensity matching for demographic, procedural, and clinical parameters. Multivariate regression analysis of all patients undergoing CT with preimaging eGFR of 30 mL/min or lower (n = 1979) revealed that iodine-based contrast enhancement increased the likelihood of post-CT AKI by 51% (confidence interval, 1.23–2.05).

Conclusion
Although radiocontrast-enhanced CT is considered safe in most hospitalized patients and in ambulatory settings, the risk of PC-AKI remains significant among inpatients with substantial preimaging renal functional impairment. Caution is warranted using iodine-based enhanced CT in hospitalized patients with an eGFR of 30 mL/min/1.73 m2 or lower.
Negative-Pressure Pulmonary Edema After Septoplasty
Authors: Erden Burak , AK Semih , Çiftçi Fatih 
Published: February 2020

Abstract
Negative-pressure pulmonary edema is a rare but life-threatening complication of septoplasty seen in the early-postoperative period. The main cause is laryngospasm; often with hypoxia and hemoptysis. In our case, a 36-year-old septoplasty recipient developed symptoms of hypotension, tachycardia and low oxygen saturation 3 hours after extubation. The patient was diagnosed with negative-pressure pulmonary edema. Treatment was applied with noninvasive positive pressure ventilation and diuretics. It should be noted that negative pressure pulmonary edema may vary in terms of presentation and may not be accompanied by laryngospasm.
Analysis of Severe Fever With Thrombocytopenia Syndrome in Critical Ill Patients in Central China
Authors: Nie Qi , Wang Dawei , Ning Zhijie , Li Tianmin , Tian Xinghan , Bian Pengfei , Ding Kun , Hu Chang , Peng Zhi-Yong 
Published: February 2020

ABSTRACT

Introduction:
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging zoonosis infected by virus (SFTSV) in central and eastern China, which is associated with high mortality. However, limited clinical data have been reported about this critical illness.

Patients and Methods:
Retrospective cohort study in intensive care unit (ICU) patients with SFTSV infection admitted in 2014 to 2019. Diagnosis was confirmed using reverse transcription polymerase chain reaction on serum samples.

Results:
One hundred sixteen patients with SFTSV infection were included (mean age 63 ± 9 years, 59 [51.3%] males). Non-survivors (43.1%) were older, and had lower Glasgow Coma Score, higher Acute Physiology and Chronic Health Evaluation II, and sequential organ failure assessment score at ICU admission. In addition, non-survivors had more severe respiratory failure (PaO2/FiO2: 208 ± 14 mm Hg vs. 297 ± 15 mm Hg), more frequent shock (25[50%] vs. 7[10.6%]), and required more frequently mechanical ventilation (78% vs. 19.7%; P < 0.001) and vasopressor support (56% vs. 9.1%; P < 0.001). Non-survivors experienced more obvious monocyte loss. After adjustment for potential confounding factors, older age, elevated lactate level, and elevated creatinine level were the independent risk factors for death.

Conclusion:
We provided knowledge about the clinical characteristics of SFTS admitted in ICU. Older age, elevated lactate level, and elevated creatinine level may be useful for identifying patients with poor outcome and intensive medical intervention can be provided for patients as soon as possible to reduce mortality.