bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of complex ventral hernias: results of an international survey
Authors: Knaapen L , Buyne O , Slater N , Matthews B , Goor H , Rosman C 
Published: February 2021

Abstract

Background
The surgical treatment of patients with complex ventral hernias is challenging. The aim of this study was to present an international overview of expert opinions on current practice.

Methods
A survey questionnaire was designed to investigate preoperative risk management, surgical approach and mesh choice in patients undergoing complex hernias repair, and treatment strategies for infected meshes. Geographical location of practice, experience and annual volumes of the surgeons were compared.

Results
Of 408 surgeons, 234 (57.4 per cent) were practising in the USA, 116 (28.4 per cent) in Europe, and 58 (14.2 per cent) in other countries. Some 412 of 418 surgeons (98.6 per cent) performed open repair and 322 of 416 (77.4 per cent) performed laparoscopic repair. Most recommended preoperative work-up/lifestyle changes such as smoking cessation (319 of 398, 80.2 per cent) and weight loss (254 of 399, 63.7 per cent), but the consequences of these strategies varied. American surgeons and less experienced surgeons were stricter. Antibiotics were given at least 1 h before surgery by 295 of 414 respondents (71.3 per cent). Synthetic and biological meshes were used equally in contaminated primary hernia repair, whereas for recurrent hernia repair synthetic mesh was used in a clean environment and biological or no mesh in a contaminated environment. American surgeons and surgeons with less experience preferred biological mesh in contaminated environments significantly more often. Percutaneous drainage and antibiotics were the first steps recommended in treating mesh infection. In the presence of sepsis, most surgeons favoured synthetic mesh explantation and further repair with biological mesh.

Conclusion
There remains a paucity of good-quality evidence in dealing with these hernias, leading to variations in management. Patient optimization and issues related to mesh choice and infections require well designed prospective studies.
Tetanus in a rural low-income intensive care unit setting
Authors: Olum Sam , Eyul Jacob , Lukwiya Daniel Ocen , Scolding Neil 
Published: February 2021

Abstract
Tetanus is a potentially severe but preventable infection. In resource-rich settings, vaccination programmes have reduced tetanus to a rare disease, though still carrying an overall mortality of some 13%. However, in low-income settings, tetanus remains common, and is a significant cause of mortality—though major World Health Organisation programmes are successfully targeting neonatal and maternal disease. Data concerning the frequency and outcomes of non-neonatal tetanus in low-income settings are very sparse. We aimed to utilize a unique intensive care unit-based dataset to elicit clinical and demographic features and mortality in a large cohort of tetanus patients admitted over an eleven-year period to a single hospital centre in a rural low-income setting in northern Uganda. A total of 268 patients with tetanus were admitted to the Intensive Care Unit at St Mary’s Hospital, Lacor between 2005 and 2015; the records of 190 were retrievable and had sufficient information to be assessed. 29 were neonates (median age 7 days, IQR 0), 52 children (1–16yrs; median age 11 years, IQR 4.5) and 109 were adults (median age 42 years, IQR 23). There was no seasonal pattern in the frequency of admissions. Of the 190 patients, 69 had endotracheal intubation with intermitent positive pressure ventilation, and 57 patients had central line placement. The overall mortality was 51.5–72.4% in neonatal disease, 25% in children and 57.8% in adults. The requirements for neither central line insertion, nor endotracheal intubation, nor intermittent positive pressure ventilation were independently linked to mortality rates. By contrast with neonatal and childhood disease, there was a marked male preponderance in adult tetanus—94 males and 15 females (gender difference P &lt; 0.001)—and although year-on-year breakdown suggested no obvious upward or downward trend over the span of our study in total numbers of tetanus admissions, a trend towards an increasing incidence of adult tetanus was apparent.These findings confirm that adult tetanus remains a major problem in rural low-income settings, particularly in males, and suggests that more resources should be devoted to vaccination programmes targeting men.
Toward a Theoretical Framework of Relational Maintenance in Computer-Mediated Communication
Authors: Mason Adam J , Carr Caleb T 
Published: February 2021

Abstract
This article addresses the need for theoretical frameworks from which to advance the study of interpersonal relational maintenance in computer-mediated communication (CMC). We suggest one way to satisfy this need is to extend and adapt extant theories of offline relational maintenance to mediated interactions by addressing how CMC is likely integrated to sustain the underlying processes of human interaction in newer channels. Social penetration theory (SPT) is used to illustrate the process proposed. The building blocks of SPT—self-disclosure, reciprocal exchange, and the effect of environmental and situational contexts on interpersonal interactions—are still considered vital in sustaining relationships, even online. By considering how these components are affected by the idiosyncrasies of computer mediation, this work provides a path toward consistent, theoretically-driven research regarding the maintenance of relationships via CMC, and also exemplifies how scholars may forge additional avenues for such research.
Decrease of physical fitness during neoadjuvant chemoradiotherapy predicts the risk of pneumonia after esophagectomy
Authors: Bor P , Kingma B F , Kerst A , Steenhagen E , Ruurda J P , van Hillegersberg R , Valkenet K , Veenhof C 
Published: February 2021

SUMMARY
Although neoadjuvant chemoradiotherapy (nCRT) is frequently used in esophageal cancer patients undergoing treatment with curative intent, it can negatively impact patients’ physical fitness. A decline in physical fitness during chemoradiotherapy may be an indication of vulnerability. The aim of this study was to evaluate whether changes in physical fitness, weight, and fat-free mass index (FFMI) during nCRT can predict the risk of postoperative pneumonia. A retrospective longitudinal observational cohort study was performed in patients who received curative treatment for esophageal cancer between September 2016 and September 2018 in a high-volume center for esophageal cancer surgery. Physical fitness (handgrip strength, leg extension strength, and exercise capacity), weight, and FFMI were measured before and after chemoradiotherapy. To be included in the data analyses, pre- and post-nCRT data had to be available of at least one of the outcome measures. Logistic regression analyses were performed to evaluate the predictive value of changes in physical fitness, weight, and FFMI during nCRT on postoperative pneumonia, as defined by the Uniform Pneumonia Scale. In total, 91 patients were included in the data analyses. Significant associations were found between the changes in handgrip strength (odds ratio [OR] 0.880, 95% confidence interval [CI]: 0.813–0.952) and exercise capacity (OR 0.939, 95%CI: 0.887–0.993) and the occurrence of postoperative pneumonia. All pneumonias occurred in patients with declines in handgrip strength and exercise capacity after nCRT. A decrease of handgrip strength and exercise capacity during nCRT predicts the risk of pneumonia after esophagectomy for cancer. Measuring physical fitness before and after chemoradiotherapy seems an adequate method to identify patients at risk of postoperative pneumonia.
The 2020 ESC-ACVC quality indicators for the management of acute myocardial infarction applied to the FAST-MI registries
Authors: Schiele François , Gale Chris P , Simon Tabassome , Fox Keith A A , Bueno Hector , Lettino Maddalena , Tubaro Marco , Puymirat Etienne , Ferrières Jean , Ecarnot Fiona , Danchin Nicolas , Meneveau Nicolas 
Published: February 2021

Abstract

Aims
We estimated the 2020 European Society of Cardiology-Acute Cardio Vascular Care (ESC-ACVC) quality indicators (QI) for the management of acute myocardial infarction, from three existing registries to determine the feasibility of assessment, room for improvement, association with outcomes, and suitability for centre benchmarking.

Methods and results
Data were extracted from three French nationwide registries, namely FAST-MI 2005, 2010, and 2015. Feasibility of assessment and room for improvement were estimated by the denominator (patients in whom QI could be measured) and numerator (patients who satisfied the QI, among those eligible). Associations between composite QIs (CQIs) and mortality were assessed by multivariate analysis. Centre benchmarking was based on the centres mean CQI, vs. the national mean. The 2020 QIs were measured in 12 660/13 130 patients from FAST-MI. Measurement feasibility ranged from 15% to 100% with greater potential for implementation with the 2020 QI set. The mean (±SD) value of the opportunity-based CQI was 0.72 ± 0.01 and attainment of the all-or-none CQI 8.5%. Both CQIs were associated with adjusted 1-year mortality. Centre categorization into low, intermediate, and high quality was feasible, and distinguished centres with differing mortality.

Conclusion
Most of the 2020 QI can be measured from existing registries in all domains but not in the patient’s satisfaction domain. This assessment shows potential for implementation. Both CQIs were inversely associated with one-year mortality and centre benchmarking was feasible.
Sex differences in mortality and 90-day readmission rates after transcatheter aortic valve replacement: a nationwide analysis from the USA
Authors: Pajjuru Venkata S , Thandra Abhishek , Guddeti Raviteja R , Walters Ryan W , Jhand Aravdeep , Andukuri Venkata G , Alkhouli Mohamad , Spertus John A , Alla Venkata M 
Published: February 2021

Abstract

Aims
To assess gender differences in in-hospital mortality and 90-day readmission rates among patients undergoing transcatheter aortic valve replacement (TAVR) in the USA.

Methods and results
Hospitalizations for TAVR were retrospectively identified in the National readmissions database (NRD) from 2012 to 2017. Gender based differences in in-hospital mortality and 90-day readmissions were explored using multivariable logistic regression models. During the study period, an estimated 171 361 hospitalizations for TAVR were identified, including 79 722 (46.5%) procedures in women and 91 639 (53.5%) in men. Unadjusted in-hospital mortality and 90-day all-cause readmissions were significantly higher for women compared with men (2.7% vs. 2.3%, P = 0.002; 25.1% vs. 24.1%, P = 0.012, respectively). After adjusting for baseline characteristics, women had 13% greater adjusted odds of in-hospital mortality [adjusted odds ratio (aOR): 1.13, 95% confidence interval (CI): 1.02–1.26, P = 0.017], and 9% greater adjusted odds of 90-day readmission compared with men (aOR: 1.09, 95% CI: 1.05–1.14, P &lt; 0.001). During the study period, there was a steady decrease in-hospital mortality (5.3% in 2012 to 1.6% in 2017; Ptrend &lt; 0.001) and 90-day (29.9% in 2012 to 21.7% in 2017; Ptrend &lt; 0.001) readmission rate in both genders.

Conclusion
In-hospital mortality and readmission rates for TAVR hospitalizations have decreased over time across both genders. Despite these improvements, women undergoing TAVR continue to have a modestly higher in-hospital mortality, and 90-day readmission rates compared with men. Given the expanding indications and use of TAVR, further research is necessary to identify the reasons for this persistent gap and design appropriate interventions.
Atlantic ’45: Gaels, Indians and the Origins of Imperial Reform in the British Atlantic
Authors: Fisher Samuel K 
Published: February 2021

Abstract
This article offers a new explanation of the origins of imperial reform in the eighteenth-century British Atlantic. It does so by arguing that the efforts of Gaelic Jacobites in Ireland and Scotland, along with those of Native diplomats in North America, should be viewed as similar attempts to reshape the British empire by recourse to the French—and that in the period 1745–8 these attempts bore fruit. By comparing the efforts of imperial officials to cope with the Jacobite rising of 1745 and their failures in Indian diplomacy during the same period, the article posits the existence of an ‘Atlantic ’45’, a shared crisis of diversity that prompted calls for imperial reform and shaped the way it played out in Scotland, North America and Ireland. As they struggled to repress the rebellion and win over Indian allies, imperial officials found that they could not gain control of Gaelic and Indian peoples without also gaining more control over their provincial subjects, an insight that lay at the heart of reform thinking for the rest of the century and put the empire on a collision course with provincial subjects’ sense of what it meant to be British. By acknowledging the centrality of diversity and the important contributions of Gaelic and Indian peoples, the article offers a new way of understanding imperial reform and revolution, one that includes a richer and more complex cast and gives more purchase on the different trajectories of Ireland, Scotland, and North America both within and outside empire.
Long-term results of tricuspid annuloplasty with 3-dimensional-shaped rings: effective and durable!
Authors: Carino Davide , Zancanaro Edoardo , Lapenna Elisabetta , Ruggeri Stefania , Denti Paolo , Iaci Giuseppe , Buzzatti Nicola , Calabrese Maria Chiara , Nascimbene Simona , Sala Alessandra , Castiglioni Alessandro , Alfieri Ottavio , De Bonis Michele 
Published: February 2021

Abstract

OBJECTIVES
3-Dimensional (3D)-shaped rings are largely adopted for tricuspid annuloplasty, but evidence about their long-term results is scanty. The goal of this study was to analyse the long-term results of tricuspid annuloplasty with 3D-shaped rings.

MATERIALS AND METHODS
A retrospective review of our prospectively maintained database was carried out to identify all patients who underwent tricuspid valve repair with 3D-shaped rings between January 2011 and December 2014. Kaplan–Meier methods were used to analyse long-term survival. Cumulative incidence function using death as the competitive outcome was used to estimate cardiac death.

RESULTS
A total of 168 patients were identified. The median age was 66 years. Eighty-two patients (49%) were in advanced New York Heart Association functional class III–IV. Atrial fibrillation (AF) was present in 101 (60%); the median ejection fraction was 60%. In 82 (49%) patients, a Medtronic 3D Contour annuloplasty ring was employed; in the remaining 86 (51%) patients, an Edwards MC3 ring was used. Cumulative incidence function of cardiac death, with non-cardiac death as a competing risk, was 1.9 ± 1.1%, 95% confidence interval (CI) (0.51–4.95) at 7 years. The cumulative incidence function of recurrence of tricuspid regurgitation (TR) ≥2+ at 7 years was 14 ± 3.17%, 95% CI (8.49–20.82). Recurrence of TR ≥2+ at 7 years was not significantly different between the Medtronic 3D Contour and the Edwards MC3 rings (P = 0.3). AF was identified as the only independent predictor of recurrence of TR ≥2+.

CONCLUSIONS
3D-shaped rings are effective and durable. TR recurrence was relatively low at 7 years and usually moderate (2+/4+) without a significant difference between the 2 types of rings. The role of AF as a predictor of TR recurrence was confirmed.
Secondary chordal resection with septal myectomy for treatment of symptomatic obstructive hypertrophic cardiomyopathy
Authors: Ram Eilon , Schwammenthal Ehud , Kuperstein Rafael , Jamal Tamer , Nahum Eyal , Sternik Leonid , Raanani Ehud 
Published: February 2021

Abstract

OBJECTIVES
Left ventricular outflow tract obstruction causes symptoms of heart failure in most patients with hypertrophic cardiomyopathy. Resection of the secondary mitral valve (MV) chordae has recently been shown to move the MV apparatus posteriorly, thereby eradicating the outflow gradient. The aim of this study was to evaluate whether secondary chordal resection concomitant to septal myectomy improves outcomes.

METHODS
Between 2005 and 2020, a total of 165 patients underwent septal myectomy without MV repair or replacement in our Medical Center. Secondary MV chordal resection was performed in 60 patients, and their outcomes were compared with those of the remaining 105 patients who did not undergo chordal resection (controls). Mean age was 61 ± 13 and 58 ± 16 years, respectively (P = 0.205).

RESULTS
There were no in-hospital deaths throughout the entire cohort. Of those patients who underwent secondary chordal resection, New York Heart Association functional class decreased from 3 (interquartile range 2–3) preoperatively to 1 (interquartile range 1–2) postoperatively (P &lt; 0.001), and resting outflow gradient decreased from 91 ± 39 mmHg to 13 ± 8 mmHg (86% change, P &lt; 0.001). Compared with controls, patients who underwent secondary chordal resection had a significant lower resting outflow gradient at follow-up (14 ± 7 mmHg vs 21 ± 15 mmHg, P = 0.002). The rate of moderate or more than moderate mitral regurgitation at 5 years was 2% in the secondary chordal resection group and 5% in the controls (hazard ratio 1.05, confidence interval 0.11–10.32; P = 0.965).

CONCLUSIONS
In this observational study, we report that secondary chordal resection concomitant to septal myectomy for left ventricular outflow tract obstruction is safe, relieves heart failure symptoms and reduces left ventricular outflow tract gradient in appropriately selected patients.
Complex transcatheter aortic valve replacement in aortic regurgitation and transcatheter mitral annuloplasty in severe dextrocardia
Authors: Rudziński Piotr Nikodem , Mach Markus , Gross Christoph , Andreas Martin 
Published: February 2021

Abstract
A 70-year-old female with symptomatic severe native aortic regurgitation, acquired dextrocardia, moderate-to-severe secondary mitral regurgitation and prohibitive surgical risk was admitted for transcatheter aortic valve replacement. A balloon-expendable Sapien 3 Ultra valve was implanted successfully. After 6 months, the patient remained symptomatic due to the concomitant moderate-to-severe secondary mitral regurgitation. Transcatheter mitral valve repair using a Carillon Mitral Contour System was performed resulting in a significant reduction of mitral regurgitation and uneventful follow-up. Most importantly, other transcatheter repair techniques would not have been feasible due to the impossible transoesophageal echocardiography guidance. This is the first case of transcatheter aortic valve replacement in a patient with native aortic regurgitation, acquired dextrocardia and severe aortic annulus malrotation using a balloon-expendable valve. Moreover, it is the first transcatheter mitral valve repair procedure using Carillon device performed by a cardiac surgeon.
Does adding an aortic root replacement or sinus repair during arch repair increase postoperative mortality? Evidence from the Canadian Thoracic Aortic Collaborative
Authors: Hage Fadi , Hage Ali , Dagenais Francois , Cartier Andreanne , Ouzounian Maral , Chung Jennifer , El-Hamamsy Ismail , Chauvette Vincent , Peterson Mark D , Lachapelle Kevin , Ridwan Khalid , Boodhwani Munir , Guo Ming , Bozinovski John , Moon Michael C , White Abigail , Yamashita Michael , Lodewyks Carly , Atoui Rony , Payne Darrin , Chu Michael W A ,   the Canadian Thoracic Aortic Collaborative
Published: February 2021

Abstract

OBJECTIVES
The aim of this study was to examine the effect of the addition of an aortic root replacement or sinus repair on mortality and morbidity during aortic arch repair.

METHODS
A total of 2472 patients underwent proximal or total aortic arch repair with hypothermic circulatory arrest between 2002 and 2018 at 12 centres. Multivariable logistic regressions (MV) and propensity score (PS) with inverse probability of treatment weighting (IPTW) analyses were performed.

RESULTS
A total of 1099 (44.5%) patients had additional aortic root replacement (n = 934) or sinus repair (n = 165). Those with aortic root interventions were younger (61 ± 13 vs 64 ± 13 years, P &lt; 0.001) and had less females (23% vs 35%, P &lt; 0.001), less dissection (31% vs 36%, P = 0.004), less urgent cases (35% vs 39%, P = 0.047), more connective tissue disease (7% vs 3%, P &lt; 0.001) and less total arch replacements (14% vs 22%, P &lt; 0.001). On adjusted analyses, the addition of aortic root procedure was associated with increased mortality [MV: odds ratio (OR) 1.41, 95% confidence interval (CI) 1.03–1.92; PS-IPTW: risk increased by 3.7%, 95% CI 1.2–6.3%, P = 0.004]. Reoperation for bleeding was also increased with the addition of aortic root intervention (MV: OR 1.48, 95% 1.10–1.99; PS-IPTW: risk increased by 3.2%, 95% CI 0.8–5.6%, P = 0.009). The risks of stroke and dialysis-dependent renal failure were similar. When looking only at non-elective cases, the increased risk of mortality was more pronounced (MV: OR 1.60, 95% CI 1.11–2.32, P = 0.013; PS-IPTW: risk increased by 6.8%, 95 CI 1.7–11.8%, P = 0.008, and a number need to harm of 15 patients to cause 1 additional death).

CONCLUSIONS
The addition of aortic root replacement or sinus repair during proximal or total aortic arch repair seems to increase postoperative mortality only in non-elective cases.
Pre-primary teacher talk: L1 use across different activity references
Authors: Aull Bethany 
Published: February 2021

AbstractWhether and how instructor L1 use may enhance foreign language learning has been a topic of considerable discussion. Although numerous studies note the L1’s recurrence in teacher talk, research has tended either to quantify its overall use throughout whole class sessions or to outline specific functions. Consequently, little is known about teachers’ actual L1-versus-L2 distribution across different classroom activities. This article contemplates teacher references relating to two prominent activities: core references (focusing on target content) and logistical references (classroom management and organisation). Via word count, it contrasts L1 use in the core and logistical references of ten non-native EFL instructors of very young learners. The findings indicate significantly higher L1 quantities in logistical than core references, even in the case of comprehensible high-frequency logistical terms such as sit. This disparity raises questions about the role of activity-differential L1 use, and points to the particular value of logistics for focalized teacher-talk analysis and awareness.