bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mesh Repair of Rectus Diastasis for Abdominoplasty is Safer than Suture Plication
Authors: Sood Rachita , Janes Lindsay E. , Shah Nikita , Sasson Daniel C. , Ellis Marco F. , Dumanian Gregory A. 
Published: August 2021

Background:
Concerns regarding infection, extrusion, and pain have traditionally precluded the use of mesh to treat severe rectus diastasis during abdominoplasty in the United States. We describe a mesh abdominoplasty technique, and we hypothesize that the complication rate using mesh is greater than the complication rate of suture plication.

Methods:
Inclusion criteria for mesh abdominoplasty were patients who (1) had retrorectus planar mesh for repair of rectus diastasis, (2) did not have concurrent ventral hernia, and (3) underwent skin tailoring. Patients who underwent rectus plication with suture, and met criteria 2 and 3 above were included in a sample of consecutive standard abdominoplasty patients. The primary endpoint was surgical site occurrence at any time after surgery, as determined with review of their office and hospital medical records. Secondary endpoints included surgical site infection, revision rates, postoperative course, and aesthetics assessed with their last set of office photographs.

Results:
Surgical site occurrence rate was 0% of the 40 patients in the mesh group and 19% of the 37 patients in the standard group (P = 0.005); rates of soft-tissue revision were 23% in the mesh group and 27% in the standard group (P = 0.84). As to aesthetics, the mesh abdominoplasty patients had mean statistically lower preoperative scores in comparison with the standard plication group (65.8 ± 11.6 versus 70.3 ± 11.4, P = 0.0013). The mesh group had a statistical improvement to 75.9 ± 12.6 (P < 0.0001), whereas the standard plication group improved to 82.5 ± 11.4 (P < 0.0001).

Conclusions:
Retrorectus mesh placement in a cohort of patients with severe rectus diastasis had a complication rate lower than that seen in a cohort of patients with less severe rectus diastasis, therefore negating our original hypothesis. This was done without compromising aesthetic improvement.
Epidermal Inclusion Cysts following Dupuytren’s Percutaneous Needle Fasciotomy: A Case Report
Authors: Turner Jessica , Foroughi Forough , Jacob Jeeth 
Published: August 2021

Summary:
Percutaneous needle fasciotomy (PNF) is a favorable approach to Dupuytren’s contracture management, usually reserved for Tubiana stage 1–2, uncomplicated disease. It is growing in popularity globally. Epidermal inclusion cysts are benign, commonly encountered cavities usually found on acral skin, rarely glabrous skin, and often following trauma. We present a 43-year-old laborer with two incidentally found epidermal inclusion cysts in the open excision of painful, Tubiana 3 and 2 Dupuytren’s recurrence of his middle and ring fingers. He had undergone PNF to same 4 years prior. One cyst had ruptured. Both seemed to have migrated distally over time from the initial PNF site with progression of the Dupuytren’s disease. This may be the only case of multiple epidermal inclusion cysts post PNF for Dupuytren’s disease in the literature. The authors discuss factors contributing to epidermal inclusion cyst formation, and postulate whether needle choice may impact the risk of their development as a complication of PNF.
Negative Pressure Wound Therapy as a Salvage Procedure in Venous Congestion of Microsurgical Procedures
Authors: Quintero Jorge I. , Cárdenas Laura L. , Achury Adriana C. , Vega-Hoyos Daniela , Bermúdez Julio 
Published: August 2021

Summary:
Negative pressure wound therapy (NPWT) is widely used in skin defects, active infection, and surgical reconstruction; lately, it is being used after skin graft to improve the adhesion on the receptor area. During the last decade, another indication has been identified: the use of NPTW to avoid complications after free flaps such as venous congestion and the risk of necrosis. NPWT can be used in the initial complication of a free flap, and the venous congestions can be treated with this technique, with very good outcomes. NPWT can be established as a part of a postoperative protocol in microsurgical procedures to avoid major complications.
Percutaneous Tracheostomy in Respiratory Failure Due to COVID-19
Authors: Cohen Samuel E. , Lopez Angelena R. , Ng Philip K. , Friedman Oren A. , Chaux George E. 
Published: August 2021

Background:
Coronavirus disease 2019 (COVID-19) can lead to hypoxemic respiratory failure resulting in prolonged mechanical ventilation. Typically, tracheostomy is considered in patients who remain ventilator dependent beyond 2 weeks. However, in the setting of this novel respiratory virus, the safety and benefits of tracheostomy are not well-defined. Our aim is to describe our experience with percutaneous tracheostomy in patients with COVID-19.

Materials and Methods:
This is a single center retrospective descriptive study. We reviewed comorbidities and outcomes in patients with respiratory failure due to COVID-19 who underwent percutaneous tracheostomy at our institution from April 2020 to September 2020. In addition, we provide details of our attempt to minimize aerosolization by using a modified protocol with brief periods of planned apnea.

Results:
A total of 24 patients underwent percutaneous tracheostomy during the study. The average body mass index was 33.0±10.0. At 30 days posttracheostomy 17 (71%) patients still had the tracheostomy tube and 14 (58%) remained ventilator dependent. There were 3 (13%) who died within 30 days. At the time of data analysis in November 2020, 9 (38%) patients had died and 7 (29%) had been decannulated. None of the providers who participated in the procedure experienced signs or symptoms of COVID-19 infection.

Conclusion:
Percutaneous tracheostomy in prolonged respiratory failure due to COVID-19 appears to be safe to perform at the bedside for both the patient and health care providers in the appropriate clinical context. Morbid obesity did not limit the ability to perform percutaneous tracheostomy in COVID-19 patients.
Appropriate selection of candidates for outpatient thyroidectomy
Authors: Romero Arenas Minerva Angélica 
Published: August 2021

Purpose of review
Although traditionally an inpatient procedure, outpatient thyroidectomy has gained traction as a viable and well tolerated alternative for selected patients, with an added benefit of cost savings.

Recent findings
Research on outpatient thyroidectomy has focused on establishing its noninferiority in outcomes compared to the standard inpatient or overnight observation. Numerous studies have found comparable low rates of postoperative complications and no increase in readmission. Selection criteria have been well established by professional societies and research studies support the selection bias benefitting appropriately selected patients. The primary benefit of outpatient thyroidectomy reported is a decrease in cost, though additional theoretical benefits such as decreased exposure to nosocomial infections.

Summary
Outpatient thyroidectomy is a well tolerated approach in appropriately selected candidates, with cost reduction benefits. Adherence to societal guidelines for patient selection is paramount.
Gender disparities in transplantation
Authors: Sheikh Saulat S. , Locke Jayme E. 
Published: August 2021

Purpose of review
Transplantation is the life-saving therapy for patients suffering from end-organ failure, and as such, equitable access to transplantation (ATT) is of paramount importance. Unfortunately, gender/sex-based disparities exist, and despite the transplant community's awareness of this injustice, gender/sex-based disparities have persisted for more than two decades. Importantly, no legislation or allocation policy has addressed inequity in ATT that women disproportionately face. In fact, introduction of the model for end-stage liver disease-based liver allocation system in 2002 widened the gender disparity gap and it continues to be in effect today. Moreover, women suffering from kidney disease are consistently less likely to be referred for transplant evaluation and subsequently less likely to achieve a kidney transplant, yet they comprise the majority of living kidney donors.

Recent findings
Acknowledging gender/sex-based disparities in ATT is the first step toward interventions aimed at mitigating this long-standing injustice in healthcare.

Summary
This article provides a background of end-stage liver and kidney disease in women, summarizes the existing literature describing the issue of gender disparity in ATT, and identifies potential areas of intervention and future investigation.
The functioning and the complication rate of extreme long existing urinary diversions
Authors: Van Ginkel Charlotte J. , Cobussen-Boekhorst Hanny , Martens Frank , Feitz Wout F.J. , Heesakkers John P.F.A. 
Published: August 2021

Purpose of review
This review is timely and relevant because many patients live many years with urinary diversions. Knowledge about the long term outcome with respect to function and complications are important for patient counseling and for the manner to follow-up patients. This study was performed to investigate the functioning of urinary diversions constructed > 25 years earlier.

Recent findings
Most studies have a relatively shorter follow-up, mainly focussing on short term postoperative complications. Focussing on the long term, urinary tract infections (UTI) including pyelonephritis are common. Mild kidney function deterioration is described.

Summary
Retrospective study (2018–2019); 43 patients with regular follow-up at the Radboud University Medical Centre Nijmegen the Netherlands. Ileal conduit (n = 19) and ureterosigmoidostomy (n = 11) are the most common diversion types for reasons such as: bladder exstrophy (n = 15), urinary incontinence (n = 9) and malignancy (n = 8). This series with a median follow-up of 40 years, shows it is possible to live and cope with a urinary diversion for a very long time. Ureterosigmoidostomies give relatively good results. Ileal conduits are functioning properly with acceptable complication rates. 95% suffers from chronic UTI's. Kidney function deterioration was mild. Diversions for benign reasons have more complex complications compared to diversion constructed for malignant reasons.

Video abstract

http://links.lww.com/COU/A32.
Survival Outcomes Based on Sequence of Therapy Using FOLFIRINOX and Nab-Paclitaxel + Gemcitabine in Metastatic Pancreatic Ductal Adenocarcinoma
Authors: Baron Margaret Kelsey , Wang Xuechen , Nevala-Plagemann Christopher , Moser Justin C. , Haaland Benjamin , Garrido-Laguna Ignacio 
Published: August 2021

Objectives
Optimal sequence of therapy for patients with metastatic pancreatic ductal adenocarcinoma is unknown. Combination chemotherapy with fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) and nab-paclitaxel + gemcitabine (nab-p/gem) are standard first-line (1L) therapies. They have never been prospectively compared. We retrospectively compared overall survival (OS) of patients treated with 1L nab-p/gem and second-line (2L) FOLFIRINOX with those treated with the reverse sequence.

Methods
Patients with metastatic pancreatic ductal adenocarcinoma treated with 1L FOLFIRINOX and 2L nab-p/gem or vice versa were identified using an electronic health record–derived real-world database. Using an intent-to-treat analysis, we compared OS from initiation of 1L therapy. A Cox model, stratified by deciles of propensity score, estimated the effect of treatment sequence on OS.

Results
The study included 3027 patients. The median OS for 1L FOLFIRINOX versus nab-p/gem was 8.6 versus 6.1 months (hazard ratio, 0.77; 95% confidence interval, 0.70–0.84). The median OS for 1L FOLFIRINOX and 2L nab-p/gem versus 1L nab-p/gem and 2L FOLFIRINOX was 11.9 versus 11.5 months (hazard ratio, 0.97; 95% confidence interval, 0.79–1.18).

Conclusions
In this analysis of real-world data, 1L FOLFIRINOX was associated with increased OS in propensity analysis. For patients who received both FOLFIRINOX and nab-p/gem, median OS was similar regardless of sequence.
Use of Chromogranin A for Monitoring Patients With Pancreatic Neuroendocrine Neoplasms
Authors: Yu Fei , Fu Jingjing , Zhang Chuan , Wu Wenyu , Ai Shuyue , Yao Xiaochen , Meng Qingle , Huang Yue , Lu Guangming , Wang Feng , Qu Wei 
Published: August 2021

Objective
We aimed to assess the role of serum chromogranin A (CgA) in monitoring disease status and treatment response in patients with pancreatic neuroendocrine neoplasms (pNENs).

Methods
We included posttherapy pNENs patients with measured serum CgA levels who underwent 68Ga-labeled tetraazacyclododecanetetraacetic acid-peptide positron emission tomography (PET) imaging between April 2017 and January 2020. Serum CgA levels were determined by enzyme-linked immunosorbent assay. Tumor response was assessed according to the PET response evaluation criteria in solid tumors.

Results
Seventy-seven patients with 101 events were included in this study. Serum CgA levels were significantly higher in patients with active disease and metastasis. The optimal cutoff values for CgA for active and metastatic pNENs diagnosis after treatment were 52.39 (77.8% sensitivity, 80.7% specificity) and 60.18 ng/mL (73.9% sensitivity, 73.1% specificity), respectively. Based on 18 patients with serial CgA measurements and PET imaging, the optimal changes in CgA levels for predicting disease remission and progression were a 28.5% decrease (71.4% sensitivity, 88.2% specificity) and a 21.0% increase (100.0% sensitivity, 75.0% specificity), respectively.

Conclusions
We concluded that serum CgA levels are associated with disease status and treatment response and may thus provide a helpful biomarker for the monitoring and clinical management of patients with pNENs.
Incidence, Treatment, and Survival of Synchronous Peritoneal Metastases in Pancreatic Cancer
Authors: Rijken Anouk , Bakkers Checca , van Erning Felice N. , van der Geest Lydia G. , de Vos-Geelen Judith , Besselink Marc G. , Lemmens Valery E. , de Hingh Ignace H.J.T. ,   for the Dutch Pancreatic Cancer Group
Published: August 2021

Objective
The aim of the study was to gain insight in the incidence, treatment, and survival of patients with synchronous pancreatic peritoneal metastases.

Methods
All patients diagnosed with pancreatic cancer between 2008 and 2018 in the Netherlands Cancer Registry were evaluated. The patients were subcategorized as (1) synchronous peritoneal metastases, (2) synchronous systemic metastases, and (3) no metastases.

Results
In total, 25,334 patients with pancreatic cancer were included. Among them, 3524 (14%) presented with synchronous peritoneal metastases, 10,659 (42%) with systemic metastases, and 11,151 (44%) without metastases at the time of diagnosis. The proportion of the patients diagnosed with peritoneal metastases increased over time (11%, 2008; 16%, 2018; P < 0.001). Of these patients, 964 (27%) received cancer treatment and 2560 (73%) received best supportive care. The median overall survival in patients with peritoneal metastases, systemic metastases, and without metastases was 1.9, 2.4, and 8.0 months, respectively (P < 0.001). In the patients with peritoneal metastases, the median overall survival was 5.0 months when undergoing cancer treatment and 1.3 months with best supportive care (P < 0.001).

Conclusions
Patients with pancreatic cancer are increasingly diagnosed with synchronous peritoneal metastases. Given the current dismal prognosis, research to improve treatment is designated for this patient category.
Interrater Reliability in the American Board of Physical Medicine and Rehabilitation Part II Certification Examination
Authors: Kinney Carolyn L. , Raddatz Mikaela M. , Robinson Lawrence R. , Garrison Christopher J. , Sabharwal Sunil 
Published: August 2021

Objective
The design of medical board certification examinations continues to evolve with advances in testing innovations and psychometric analysis. The potential for subjectivity is inherent in the design of oral board examinations, making improvements in reliability and validity especially important. The purpose of this quality improvement study was to analyze the impact of using two examiners on the overall reliability of the oral certification examination in physical medicine and rehabilitation.

Design
This was a retrospective quality improvement study of 422 candidates for the American Board of Physical Medicine and Rehabilitation Part II Examination in 2020. Candidates were examined by examiner pairs, each of whom submitted independent scores. Training for all 116 examiners included examination case review, scoring guidelines, and bias mitigation. Examiner performance was analyzed for both internal consistency (intrarater reliability) and agreement with their paired examiner (interrater reliability).

Results
The reliability of the Part II Examination was high, ranging from 0.93 to 0.94 over three administrations. The analysis also demonstrated high interrater agreement and examiner internal consistency.

Conclusions
A high degree of interrater agreement was found using a new, two-examiner format. Comprehensive examiner training is likely the most significant factor for this finding. The two-examiner format improved the overall reliability and validity of the Part II Examination.
Policy and planning for large epidemics and pandemics – challenges and lessons learned from COVID-19
Authors: Sharp Ashley , Jain Vageesh , Alimi Yewande , Bausch Daniel G. 
Published: August 2021

Purpose of review
The COVID-19 pandemic is a global catastrophe that has led to untold suffering and death. Many previously identified policy challenges in planning for large epidemics and pandemics have been brought to the fore, and new ones have emerged. Here, we review key policy challenges and lessons learned from the COVID-19 pandemic in order to be better prepared for the future.

Recent findings
The most important challenges facing policymakers include financing outbreak preparedness and response in a complex political environment with limited resources, coordinating response efforts among a growing and diverse range of national and international actors, accurately assessing national outbreak preparedness, addressing the shortfall in the global health workforce, building surge capacity of both human and material resources, balancing investments in public health and curative services, building capacity for outbreak-related research and development, and reinforcing measures for infection prevention and control.

Summary
In recent years, numerous epidemics and pandemics have caused not only considerable loss of life, but billions of dollars of economic loss. The COVID-19 pandemic served as a wake-up call and led to the implementation of relevant policies and countermeasures. Nevertheless, many questions remain and much work to be done. Wise policies and approaches for outbreak control exist but will require the political will to implement them.
Evaluation of Computed Tomography Attenuation Value of Proximal Femoral Marrow to Diagnose and Differentiate Hematologic Malignancies, Myelofibrosis, and Aplastic Anemia
Authors: Ishii Shiro , Ohkawara Hiroshi , Endo Yoshiki , Hara Junko , Hotsumi Hirotoshi , Yamakuni Ryo , Sugawara Shigeyasu , Sekino Hirofumi , Ito Hiroshi 
Published: August 2021

Objective
The aim of this study was to diagnose hematologic diseases using computed tomography (CT) number of proximal femoral marrow.

Methods
The average CT number of marrow in hematologic diseases was measured on the caudal side of the greater trochanter.

Results
The CT numbers were −60.3 ± 16.8 in 12 patients with aplastic anemia, −53.2 ± 19.4 in 11 patients with monoclonal gammopathy of undetermined significance, −44.2 ± 21.1 in 10 normal controls, −30.9 ± 42.3 in 9 patients with chronic lymphatic leukemia, −29.8 ± 29.9 in 17 patients with benign anemia, −13.7 ± 40.9 in 33 patients with multiple myeloma, 0.32 ± 44.6 in 17 patients with myelodysplastic syndrome (MDS), 18.7 ± 40.0 in 44 patients with acute myeloid leukemia, 50.3 ± 27.4 in 13 patients with acute lymphatic leukemia, 51.5 ± 16.8 in 8 patients with myelofibrosis, and 56.4 ± 15.6 in 9 patients with chronic myeloid leukemia. Significant differences were observed between acute myeloid leukemia and MDS, between MDS and aplastic anemia, and between multiple myeloma and monoclonal gammopathy of undetermined significance (P < 0.01).

Conclusion
The marrow CT numbers may be indicators of hematologic diseases and can be used as a diagnostic tool.
Reader Performance as a Function of Patient Size for the Detection of Hepatic Metastases
Authors: Gong Hao , Yu Lifeng , Leng Shuai , Fletcher Joel G. , McCollough Cynthia H. 
Published: August 2021

Objective
To investigate reader performance as a function of patient size for the detection of hepatic metastases when an automatic exposure control (AEC) system is used, which varies image noise as a function of patient size.

Methods
Abdominal computed tomograhy examinations across 100, 120, 160, and 200 quality reference tube current-time product were collected, involving a cohort of 83 patients. Three radiologists identified hepatic metastases across all dose levels. Partial Spearman rank correlation and multivariate logistic regression were used to evaluate correlations between reader performance and patient size and lesion size/contrast while accounting for potential confounding effects. Analyses were repeated on an emulated less-variable noise AEC.

Results
No statistically significant correlation was observed between patient size and radiologist performance (for variable-noise AEC: range of partial Spearman ρ, −0.157 to −0.035]; range of adjusted odds ratios, 0.987, 1.006).

Conclusions
Reader performance was independent of patient size, suggesting that variable-noise AEC provides better modulation for larger patients than constant-noise AEC.
Application of Flat-Panel Volume Computed Tomography to Evaluate Cerebral Hemorrhage After Mechanical Thrombectomy of Acute Embolic Stroke of the Anterior Circulation
Authors: Yen Ho-Hsian , Chien Chun , Lee I-Hui , Chen Shih-Pin , Luo Chao-Bao , Lin Chung-Jung , Chen Shu-Ting , Yuan Wei-Hsin , Kuo Yu , Wu Chia-Hung , Chang Feng-Chi 
Published: August 2021

Objective
The aim of the study was to evaluate cerebral hemorrhage (CH) and contrast media leakage (CML or commonly synonymous with “contrast staining”) differentiation on flat-panel volume computed tomography (FPVCT) after intra-arterial mechanical thrombectomy.

Methods
We evaluated patients with hyperattenuation on FPVCT after intra-arterial mechanical thrombectomy between 2018 and 2021 by multiple parameters on CT angiography, FPVCT, CT, and/or magnetic resonance imaging.

Results
The CH (n = 43) versus CML (n = 24) groups revealed: (1) regional anatomical characteristics (preserved and distorted): 7 of 43 (9.6%) and 36 of 43 (83.7%) versus 22 of 24 (91.7%) and 2 of 24 (8.3%, P < 0.001); (2) thrombus in proximal two-thirds versus distal one-thirds M1 segment of middle cerebral artery (preserved and distorted): 17 of 21 (81.0%) and 4 of 21 (19.0%) versus 5 of 11 (45.5%) and 6 of 11 (54.5%, P = 0.040); and (3) average density ratio: 1.83 ± 0.65 versus 1.35 ± 0.13 (P = 0.004).

Conclusions
Contrast media leakage can be differentiated from CH by preserved regional anatomical characteristics and relatively low average density ratio on FPVCT. Patients with CML who have embolism in proximal two thirds of M1 segment are more likely to develop hyperattenuation with preserved regional anatomy.