bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reconstruction of Congenital Sternal Cleft
Authors: Hinchcliff Katharine M. , Xue Yunfeng , Wong Granger B. 
Published: January 2021

Introduction
Sternal cleft (SC) is a rare congenital deformity that results from failure of sternal bar fusion. Sternal cleft can be categorized as superior partial, inferior partial, or complete. Each form of SC can present as an isolated defect or in association with other congenital deformities, which presents a unique challenge for reconstructive surgeons. In our systematic review, we aim to summarize the published experience on repair of SCs and present a pragmatic approach to help guide reconstructive planning.

Methods
A systematic review was performed to identify all reported SC cases in literature that underwent sternal reconstruction.

Results
Seventy-one studies were identified from 1970 to 2019, which included a total of 115 patients. Superior partial SC was the most common SC variant, accounting for 65.2% (75/115) of all reported cases. There were 31 cases of complete SC (27.0%) and 9 cases (7.8%) of inferior partial SC; 49.6% of the patients (57/115) in our review had isolated SC without any other congenital deformities. Sixty-seven patients (60.3%) were treated with primary closure, with or without secondary maneuvers, such as chondrotomies, cartilage resection, or periosteal flaps. Alternative methods included interposition grafts, with autologous rib graft in 18 patients (15.8%), permanent mesh in 8 patients (7.0%), acellular dermal matrix in 5 patients (4.4%), sternal plate flap in 5 patients (4.4%), and nonthoracic autologous bone grafts in 4 patients (3.5%).

Conclusions
Our review supports that primary closure should be attempted regardless of patient age. For wider sternal gap, reconstruction with an autologous local graft or flap should be considered. When the patient does not have sufficient autologous tissue for a successful sternal reconstruction, alloplastic or allograft interposition options are a reasonable choice.
A 4-tier Protocolized Radiological Classification System for Leaks Following Sleeve Gastrectomy
Authors: Johari Yazmin , Catchlove William , Tse Madeleine , Shaw Kalai , Paul Eldho , Chen Richard , Loh Damien , Packiyanathan Andrew , Burton Paul , Nottle Peter , Ellis Samantha , Brown Wendy 
Published: January 2021

Objectives:
To develop and validate a classification of sleeve gastrectomy leaks able to reliably predict outcomes, from protocolized computed tomography (CT) findings and readily available variables.

Summary of Background Data:
Leaks post sleeve gastrectomy remain morbid and resource-consuming. Incidence, treatments, and outcomes are variable, representing heterogeneity of the problem. A predictive tool available at presentation would aid management and predict outcomes.

Methods:
From a prospective database (2009–2018) we reviewed patients with staple line leaks. A Delphi process was undertaken on candidate variables (80–20). Correlations were performed to stratify 4 groupings based on outcomes (salvage resection, length of stay, and complications) and predictor variables. Training and validation cohorts were established by block randomization.

Results:
A 4-tiered classification was developed based on CT appearance and duration postsurgery. Interobserver agreement was high (κ = 0.85, P < 0.001). There were 59 patients, (training: 30, validation: 29). Age 42.5 ± 10.8 versus 38.9 ± 10.0 years (P = 0.187); female 65.5% versus 80.0% (P = 0.211), weight 127.4 ± 31.3 versus 141.0 ± 47.9 kg, (P = 0.203). In the training group, there was a trend toward longer hospital stays as grading increased (I = 10.5 d; II = 24 d; III = 66.5 d; IV = 72 d; P = 0.005). Risk of salvage resection increased (risk ratio grade 4 = 9; P = 0.043) as did complication severity (P = 0.027).
Findings were reproduced in the validation group: risk of salvage resection (P = 0.007), hospital stay (P = 0.001), complications (P = 0.016).

Conclusion:
We have developed and validated a classification system, based on protocolized CT imaging that predicts a step-wise increased risk of salvage resection, complication severity, and increased hospital stay. The system should aid patient management and facilitate comparisons of outcomes and efficacy of interventions.
Pancreatoduodenectomy at the Verona Pancreas Institute: the Evolution of Indications, Surgical Techniques, and Outcomes
Authors: Bassi Claudio , Marchegiani Giovanni , Giuliani Tommaso , Di Gioia Anthony , Andrianello Stefano , Zingaretti Caterina Costanza , Brentegani Giacomo , De Pastena Matteo , Fontana Martina , Pea Antonio , Paiella Salvatore , Malleo Giuseppe , Tuveri Massimiliano , Landoni Luca , Esposito Alessandro , Casetti Luca , Butturini Giovanni , Falconi Massimo , Salvia Roberto 
Published: January 2021

Objective:
The aim of the present study was to critically reappraise the experience at our high-volume institution to obtain new insights for future directions.

Summary Background Data:
The indications, surgical techniques, and perioperative management of pancreatoduodenectomy (PD) have profoundly evolved over the last 20 years.

Methods:
All consecutive PDs performed during the last 20 years at the Verona Pancreas Institute were divided into four 5-year timeframes and retrospectively analyzed in terms of indications, intraoperative features, and surgical outcomes. Significant milestones were provided to understand practice changes using a before-after analysis method.

Results:
The study population consisted of 3000 patients. The median age, ASA ≥ 3 and number of nonbenchmark cases significantly increased over time (P < 0.005). Pancreatic cancer was the leading indication, representing 60% of patients/year in the last timeframe, 40% of whom received neoadjuvant treatment. Conversely, after the development of International Guidelines, the proportion of resected cystic neoplasms progressively and thoroughly decreased. Given the increased complexity of surgery for pancreatic cancer, the evolution of technologies, surgical techniques, and postoperative management allowed the maintenance of favorable surgical outcomes over time, with a stable 20.0% of patients with a Clavien-Dindo grade ≥ 3, an 11.7% failure to rescue and a 2.3% in-hospital mortality rate. The incidence of postoperative pancreatic fistula, hemorrhage, and delayed gastric emptying was 22.4%, 13.4%, and 12.4%, respectively.

Conclusions:
PD significantly evolved in Verona over the past 2 decades. Surgeries of greater complexity are currently performed on increasingly frailer patients, mostly for pancreatic cancer and often after neoadjuvant chemotherapy. However, the progression of all fields of pancreatic surgery, including the expanding use of postoperative pancreatic fistula mitigation strategies, has allowed satisfactory outcomes to be maintained.
Peer-reviewing in Surgical Journals: Revolutionize or Perish?
Authors: Chloros George D. , Giannoudis Vasileios P. , Giannoudis Peter V. 
Published: January 2021

The gold standard of safe-guarding the quality of published science is peer review. However, this long-standing system has not evolved in today's digital world, where there has been an explosion in the number of publications and surgical journals. A journal's quality depends not only on the quality of papers submitted but is reflected upon the quality of its peer review process. Over the past decade journals are experiencing a rapidly escalating “peer review crisis” with editors struggling in recruiting reliable reviewers who will provide their skilled work for free with ever-diminishing incentives within today's restricted time-constraints. The problem is complex and difficult to solve, but more urgent than ever. Time is valuable and academicians, researchers and clinicians are overburdened and already extremely busy publishing their own research along with their ever growing clinical and administrative duties. Fewer and fewer individuals volunteer to provide their skilled work for free which is expected. The current incentives to review do not have a big impact on one's career and therefore are not realistic effective countermeasures.
As the limits of the system are constantly stretched, there will inevitably come a “point of no return” and Surgical Journals will be the ones to first take the hit as there is an overwhelming evidence of burnout in the surgical specialties and the Surgical community is almost 50% smaller than its Medical counterpart.
This review identifies the potential causes of the peer-review crisis, outlines the incentives and drawbacks of being a reviewer, summarizes the currently established common practices of rewarding reviewers and the existing and potential solutions to the problem. The magnitude of the problem and unsustainability that will make it perish are discussed along with its current flaws. Finally, recommendations are made to address many of the weaknesses of the system with the hope to revive it.
Multisystem outcomes and predictors of mortality in critically ill patients with COVID-19: Demographics and disease acuity matter more than comorbidities or treatment modalities
Authors: Alser Osaid , Mokhtari Ava , Naar Leon , Langeveld Kimberly , Breen Kerry A. , El Moheb Mohamad , Kapoen Carolijn , Gaitanidis Apostolos , Christensen Mathias A. , Maurer Lydia R. , Mashbari Hassan , Bankhead-Kendall Brittany , Parks Jonathan , Fawley Jason , Saillant Noelle , Mendoza April , Paranjape Charudutt , Fagenholz Peter , King David , Lee Jarone , Farhat Maha R. , Velmahos George C. , Kaafarani Haytham M.A. 
Published: January 2021

BACKGROUND
We sought to describe characteristics, multisystem outcomes, and predictors of mortality of the critically ill COVID-19 patients in the largest hospital in Massachusetts.

METHODS
This is a prospective cohort study. All patients admitted to the intensive care unit (ICU) with reverse-transcriptase–polymerase chain reaction–confirmed severe acute respiratory syndrome coronavirus 2 infection between March 14, 2020, and April 28, 2020, were included; hospital and multisystem outcomes were evaluated. Data were collected from electronic records. Acute respiratory distress syndrome (ARDS) was defined as PaO2/FiO2 ratio of ≤300 during admission and bilateral radiographic pulmonary opacities. Multivariable logistic regression analyses adjusting for available confounders were performed to identify predictors of mortality.

RESULTS
A total of 235 patients were included. The median (interquartile range [IQR]) Sequential Organ Failure Assessment score was 5 (3–8), and the median (IQR) PaO2/FiO2 was 208 (146–300) with 86.4% of patients meeting criteria for ARDS. The median (IQR) follow-up was 92 (86–99) days, and the median ICU length of stay was 16 (8–25) days; 62.1% of patients were proned, 49.8% required neuromuscular blockade, and 3.4% required extracorporeal membrane oxygenation. The most common complications were shock (88.9%), acute kidney injury (AKI) (69.8%), secondary bacterial pneumonia (70.6%), and pressure ulcers (51.1%). As of July 8, 2020, 175 patients (74.5%) were discharged alive (61.7% to skilled nursing or rehabilitation facility), 58 (24.7%) died in the hospital, and only 2 patients were still hospitalized, but out of the ICU. Age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.04–1.12), higher median Sequential Organ Failure Assessment score at ICU admission (OR, 1.24; 95% CI, 1.06–1.43), elevated creatine kinase of ≥1,000 U/L at hospital admission (OR, 6.64; 95% CI, 1.51–29.17), and severe ARDS (OR, 5.24; 95% CI, 1.18–23.29) independently predicted hospital mortality.
Comorbidities, steroids, and hydroxychloroquine treatment did not predict mortality.

CONCLUSION
We present here the outcomes of critically ill patients with COVID-19. Age, acuity of disease, and severe ARDS predicted mortality rather than comorbidities.

LEVEL OF EVIDENCE
Prognostic, level III.
The Prevalence and Associated Factors of the Fear of Falling in Elderly Patients at the Primary Care Clinic of Songklanagarind Hospital
Authors: Chamroonkiadtikun Panya , Ananchaisarp Thareerat , Wajancomkul Panitan 
Published: January 2021

Objective:
The fear of falling (FOF) is defined as low perceived self-efficacy at avoiding falls during the nonhazardous activities of daily life. The FOF can lead to negative consequences including the physical change, and it might decrease the quality of life of the elderly. The aim of study was to assess the prevalence of FOF and identify the associated factors among Thai elderly patients.

Methods:
A cross-sectional study was performed. A total of 101 participants 60 years or older were recruited from October to November 2017. The data obtained through questionnaires, face-to-face interviews, and gait and balance tests that were measured by the researchers. The structured questionnaire included demographic data, history of falls, the Thai geriatric depression scale (TGDS), the Falls Efficacy Scale-International (FES-I), and the Thai mental state examination (TMSE). The balance and gait tests were conducted using the timed up and go (TUG) test and the Berg balance scale.

Results:
The prevalence of FOF was 70.3%. The logistic regression analysis showed a significant association between FOF and female gender (odds ratio [OR], 4.07; 95% confidence interval [CI], 1.63-10.46), whereas factors were not associated with FOF included age, living status, education, number of underlying disease, comorbidities, number of drugs used, history of fall, consequences of falls, visual acuity, TGDS, TMSE, TUG, and Berg balance test. In the multivariate model, the factors associated with the FOF were gender (OR, 4.28; 95% CI, 1.58-12.14) and hypertension (OR, 3.46; 95% CI, 1.11-11.72).

Conclusion:
The prevalence of FOF was high among Thai elderly patients. The present findings may help health care providers identify individuals who have FOF. These people could benefit from interventions, which focus on gender differences and hypertension aimed at reducing the FOF.
Current advances in plasma and cerebrospinal fluid biomarkers in Alzheimer's disease
Authors: Leuzy Antoine , Cullen Nicholas C. , Mattsson-Carlgren Niklas , Hansson Oskar 
Published: January 2021

Purpose of review
This review provides a concise overview of recent advances in cerebrospinal fluid (CSF) and blood-based biomarkers of Alzheimer's disease lesions.

Recent findings
Important recent advances for CSF Alzheimer's disease biomarkers include the introduction of fully automated assays, the development and implementation of certified reference materials for CSF Aβ42 and a unified protocol for handling of samples, which all support reliability and availability of CSF Alzheimer's disease biomarkers. Aβ deposition can be detected using Aβ42/Aβ40 ratio in both CSF and plasma, though a much more modest change is seen in plasma. Tau aggregation can be detected using phosphorylated tau (P-tau) at threonine 181 and 217 in CSF, with similar accuracy in plasma. Neurofilament light (NfL) be measured in CSF and shows similar diagnostic accuracy in plasma. Though total tau (T-tau) can also be measured in plasma, this measure is of limited clinical relevance for Alzheimer's disease in its current immunoassay format.

Summary
Alzheimer's disease biomarkers, including Aβ, P-tau and NfL can now be reliably measured in both CSF and blood. Plasma-based measures of P-tau show particular promise, with potential applications in both clinical practice and in clinical trials.
Visual field defects in temporal lobe epilepsy surgery
Authors: Vakharia Vejay N. , Diehl Beate , Tisdall Martin 
Published: January 2021

Purpose of review
Surgery can provide a robust long-standing seizure remission in drug-refractory mesial temporal lobe epilepsy (MTLE). Despite this, a significant proportion of postoperative patients are ineligible to gain a driving licence due to the size of the subsequent visual field defect (VFD). The amygdala and hippocampus are intimately related to several important white fibre association tracts and damage to the optic radiation results in a contralateral superior quadrantanopia. For this reason, several different modifications to established surgical approaches and novel techniques have recently been applied to mitigate or prevent damage to the optic radiation. There is still no consensus on which operative technique results in optimal outcomes regarding seizure remission, neuropsychological sequelae and VFD rates. We explore contemporary surgical approaches to the mesial temporal lobe and describe the intraoperative use of tractography and iMRI in preventing VFDs.

Recent findings
Established approaches for the surgical treatment of MTLE include standardized approaches in the form of anterior temporal lobectomies, selective approaches and various modifications thereof. Recent advancements in microsurgical techniques have seen numerous modifications to these approaches to spare the optic radiation as well as the introduction of minimally invasive alternatives such as laser interstitial thermal therapy (LITT) and stereotactic radiosurgery (SRS). The intraoperative use of optic radiation tractography through overlays in the operative microscope and interventional MRI suites to correct for brain shift have been shown to reduce VFDs.

Summary
VFDs following the surgical treatment of drug-refractory MTLE can have a significant impact on the quality of life. Each of the surgical techniques carries a risk to the visual pathways but the use of minimally invasive techniques as well as surgical adjuncts may reduce or prevent acquired VFDs.
Interictal autonomic dysfunction
Authors: Sivathamboo Shobi , Perucca Piero 
Published: January 2021

Purpose of review
Epilepsy is associated with autonomic dysfunction. Here, we provide an up-to-date review on measures of interictal autonomic function, focusing on heart rate variability (HRV), baroreflex sensitivity (BRS) and electrodermal activity (EDA).

Recent findings
Resting HRV, BRS and EDA are altered in patients with epilepsy compared with healthy controls. A larger body of work is available for HRV compared with BRS and EDA, and points to interictal HRV derangements across a wide range of epilepsies, including focal, generalized, and combined generalized and focal epilepsies. HRV alterations are most pronounced in temporal lobe epilepsy, Dravet syndrome and drug-resistant and chronic epilepsies. There are conflicting data on the effect of antiseizure medications on measures of interictal autonomic function. However, carbamazepine has been associated with decreased HRV. Epilepsy surgery and vagus nerve stimulation do not appear to have substantial impact on measures of interictal autonomic function but well designed studies are lacking.

Summary
Patients with epilepsy, particularly those with longstanding uncontrolled seizures, have measurable alterations of resting autonomic function. These alterations may be relevant to the increased risk of premature mortality in epilepsy, including sudden unexpected death in epilepsy, which warrants investigation in future research.
Glutamine’s protection against brain damage in septic rats via increased protein oxygen-N-acetylglucosamine modification
Authors: Wang Jin , Lu Xinjian , Zheng Kang , Jing Liang 
Published: January 2021

Objective
This study aimed to observe the effect of glutamine (Gln) on brain damage in septic rats and explore its possible mechanism.

Methods
Ninety-three Sprague–Dawley rats were randomly divided into five groups: sham operation group, sepsis group, Gln-treated group, quercetin/Gln-treated group, and alloxan/Gln-treated group. The rats in each group were continuously monitored for mean arterial pressure (MAP) and heart rate changes for 16 h. Neuroreflex scores were measured 24 h after surgery. The water content of the brain tissue was measured. Plasma neuron enolase and cysteine protease-3 were measured using the ELISA. The expression levels of heat shock protein 70 (HSP70) and oxygen-N-acetylglucosamine (O-GlcNAc) were determined by western blot analysis. Finally, the brain tissue was observed via hematoxylin and eosin staining.

Results
The brain tissue water content, plasma neuron enolase content, brain tissue cysteine protease-3 content, and nerve reflex score were significantly lower in the Gln-treated group than in the sepsis group (P < 0.05). At the same time, the pathological brain tissue damage in the Gln-treated group was also significantly reduced. It is worth noting that the expression of HSP70 and the protein O-GlcNAc modification levels in the Gln-treated group were significantly elevated than the levels in the sepsis group (P < 0.05), and reversed by pretreatment with the HSP and O-GlcNAc inhibitors quercetion and alloxan.

Conclusions
Gln can attenuate brain damage in rats with sepsis, which may be associated with increased protein O-GlcNAc modification.
Effects of site, cerebral perfusion and degree of cerebral artery stenosis on cognitive function
Authors: Xie Binbin , Liu Yidan , Wu DongMei , Li Gongbo , Chen Taosong , Xiao Shufang , Yang Jing , Li Jiamin , Li Xiaofeng 
Published: January 2021

Objective
To investigate the effects of site, cerebral perfusion and degree of cerebral artery stenosis (CAS) on cognitive function.

Methods
A total of 57 patients with CAS and 53 controls from January 2019 to December 2019 were included. The former group was further divided into different subgroups according to the site, cerebral perfusion and degree of CAS. A series of neuropsychological tests were performed to evaluate the cognitive domains (such as memory, executive function, psychomotor speed, etc.). Rank sum test, t test, Chi-square test and analysis of variance were used for data analysis. Spearman correlation analysis was used to examine the relationship between the site, cerebral perfusion and degree of CAS and all tests’ scores.

Results
For patients with CAS who have decreased cerebral perfusion, their global cognitive function, memory, psychomotor speed, executive function and frontal lobe function were significantly impaired (all P < 0.05). There was a significant decrease in global cognitive function, psychomotor speed, memory, executive function and frontal lobe function in patients with anterior circulation stenosis (all P < 0.05). Moderate and severe CAS impaired subjects’ global cognitive function, memory, psychomotor speed, executive function and frontal lobe function (all P < 0.05). There was a correlation between the site, cerebral perfusion, the degree of CAS and cognitive function.

Conclusion
Global cognitive function, memory, psychomotor speed, frontal lobe function and executive function are impaired in patients with CAS, especially in those with anterior circulatory stenosis, moderate to severe stenosis and low cerebral perfusion.
See Video Abstract, http://links.lww.com/WNR/A613.