bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experience of Endoscopic Endonasal Approach for 803 Pituitary Tumors With Cavernous Sinus Invasion
Authors: Zhu Haibo , Li Chuzhong , Gui Songbai , Wang Xinsheng , Zong Xuyi , Zhao Peng , Bai Jiwei , Liu Chunhui , Cao Lei , Li Zhenye , Zhang Yazhuo 
Published: August 2021

Objective:
The aim of this study was to investigate the effectiveness, safety, complications, and prognosis of endoscopic endonasal surgery for pituitary adenomas with cavernous sinus invasion (CSI).

Methods:
The clinical data of 803 pituitary adenomas with CSI surgeries performed in our single ward between January 1, 2006 and December 31, 2018 were retrospectively reviewed. The resection degree, bone invasion, endocrine examination, complications, and outcome were retrospectively summarized.

Results:
Gross total resection was achieved in 394 patients (49.1%) subtotal resection in 171 patients (21.3%) and partial resection in 238 patients (29.6%). Clinically variable analyses showed that there was a significant correlation between CSI and female, older age, operation history, and non-gross total resection (NGTR). Among the pituitary adenomas with CSI, there was a significant correlation between bone invasive and NGTR, Knosp classification, recurrence. K-M curves showed that young age, larger tumors, bilateral invasion, Grade 4 of Knosp classification, NGTR, and bone invasion were associated with pituitary adenomas regrowth. Multivariate analysis revealed that bone invasion, NGTR, and Grade 4 of Knosp classification were independent risk factors for pituitary adenomas regrowth. There was a significant correlation between CSI and female, older age, operation history, and tumor resection degree.

Conclusions:
There was a significant correlation between CSI and female, older age, operation history, and tumor resection degree. The patients with CSI and bone invasion were likely to recurrent. Non-gross total resection, bone invasion, and Grade 4 of Knosp classification were independent risk factors for pituitary adenomas regrowth. Endoscopic endonasal surgery is an excellent choice for pituitary adenomas with CSI.
Establishment of Objective Clinical Parameters for Assessment of Trigonocephaly: Are Caliper-Derived Clinical Measures Adequate?
Authors: Yan Yufan , McGrath Jennifer L. , Janes Lindsay E. , Gosain Arun K. 
Published: August 2021

Objective:
Objective clinical parameters characterizing the severity of trigonocephaly are essential given the concern for computerized tomography (CT) scans and radiation in infants. The present study seeks to develop a clinical tool by which to characterize trigonocephaly.

Design:
Retrospective cohort study.

Setting:
Tertiary academically affiliated children's medical center.

Participants:
A retrospective review identified patients with trigonocephaly for whom surgery was recommended (group 1) and those with metopic ridging without significant trigonocephaly (group 2). Normal age-matched controls were also evaluated (group 3).

Interventions:
Cranial vault caliper measurements were compared across groups. Two ratios measuring anterior vault constriction were developed: (1) bitemporal width at the mid-forehead to the biparietal width, and (2) bitemporal width at the lateral brow to the biparietal width.

Main outcome measures:
Bitemporal width to biparietal width (ratio).

Results:
Caliper measures were obtained from 19 patients in group 1, 8 patients in group 2, and 19 patients in group 3 (controls). Cranial indices were not significantly different across groups. The bitemporal width at the mid-forehead to the biparietal width ratio was significantly lower in group 1, with no difference between groups 2 and 3. The bitemporal width at the lateral brow to the biparietal width ratio was significantly different between all 3 groups, with group 1 < group 2 < group 3, respectively.

Conclusions:
Bitemporal to biparietal ratios are a quantitative, objective clinical measure that can be used to differentiate patients with significant trigonocephaly from those with metopic ridging but no significant cranial deformity. These findings suggest that caliper-derived indices can assist in characterizing surgically relevant cranial vault deformities secondary to metopic synostosis and may circumvent CT-based analysis.
Inferolateral Transorbital Endoscopic Approach for Spheno-Orbital Meningiomas
Authors: Colombo Giovanni , Ferreli Fabio , Baram Ali , Mercante Giuseppe , Riva Marco , Di Maria Alessandra , Pessina Federico 
Published: August 2021

Abstract
Spheno-orbital meningiomas (SOM) are slow growing tumors that often cause proptosis and visual deficits, due to direct compression of adjacent structures or hyperostosis of surrounding bones.
Traditionally, these lesions are approached via a lateral transcranial route. Recent interest in mini-invasive surgery and endoscopy brought many authors to study different trans-nasal or transorbital approaches.
The authors report a surgical case series with 3 patients with proptosis due to SOM who underwent surgery in our institution via an inferolateral trans-orbital endoscopic approach. The authors described our surgical technique and the authorsretrospectively reviewed the clinical and radiological outcomes of the patients.
All 3 patients had an effective orbital decompression with improvement of the proptosis and pain relief. Histological examination was possible and no intraoperative nor postoperative complications were observed.
Therefore, the authors consider inferolateral trans-orbital endoscopic approach as a feasible approach for lesions involving the lateral orbit compartment arising from middle cranial fossa or from orbit itself.
Half of Postoperative Deaths After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Could be Preventable
Authors: Houlzé-Laroye Constance , Glehen Olivier , Sgarbura Olivia , Gayat Etienne , Sourrouille Isabelle , Tuech Jean-Jacques , Delhorme Jean-Baptiste , Dumont Frédéric , Ceribelli Cécilia , Amroun Koceila , Arvieux Catherine , Moszkowicz David , Pirro Nicolas , Lefevre Jérémie H. , Courvosier-Clement Thomas , Paquette Brice , Mariani Pascale , Pezet Denis , Sabbagh Charles , Tessier Williams , Celerier Bertrand , Guilloit Jean-Marc , Taibi Abdelkader , Quenet François , Bakrin Naoual , Pocard Marc , Goéré Diane , Brigand Cécile , Piessen Guillaume , Eveno Clarisse 
Published: August 2021

Objective:
To perform a retrospective root-cause analysis of postoperative death after CRS and HIPEC procedures.

Background:
The combination of CRS and HIPEC is an effective therapeutic strategy to treat peritoneal surface malignancies, however it is associated with significant postoperative mortality.

Methods:
All patients treated with a combination of CRS and HIPEC between January 2009 and December 2018 in 22 French centers and died in the hospital, were retrospectively analyzed. Perioperative data of the 101 patients were collected by a local senior surgeon with a sole junior surgeon. Three independent experts investigated the typical root cause of death and provided conclusions on whether postoperative death was preventable (PREV group) or not (NON-PREV group). A typical root cause of preventable postoperative death was classified on a cause-and-effect diagram.

Results:
Of the 5562 CRS+HIPEC procedures performed, 101 in-hospital deaths (1.8%) were identified, of which a total of 18 patients of 70 years old and above and 20 patients with ASA score of 3. Etiology of peritoneal disease was mainly colorectal. A total of 54 patients (53%) were classified in the PREV group and 47 patients (47%) in the NON-PREV group. The results of the study show that in the PREV group, WHO performance status 1-2 was more frequent and the Median Peritoneal Cancer Index was higher compared with those of the NON-PREV group. The cause of death in the PREV group was classified as: (i) preoperatively for debatable indication (59%), (ii) intraoperatively (30%) and (iii) postoperatively in 17 patients (31%). A multifactorial cause of death was found in 11 patients (20%).

Conclusion:
More than half of the postoperative deaths after combined CRS and HIPEC may be preventable, mainly by following guidelines regarding preoperative selection of the patients and adequate intraoperative decisions.
Improving Surgical Research Capacity in Low- and Middle-Income Countries
Authors: Ullrich Sarah J. , Kisa Phyllis , Muzira Arlene , White Erin M. , Nabukenya Mary , Tumukunde Janat , Kakembo Nasser , Sekabira John , Chang David C. , Ozgediz Doruk 
Published: August 2021

Objective:
The aim of this study was to empirically determine the optimal sample size needed to reliably estimate perioperative mortality (POMR) in different contexts.

Summary Background Data:
POMR is a key metric for measuring the quality and safety of surgical systems and will need to be tracked as surgical care is scaled up globally. Continuous collection of outcomes for all surgical cases is not the standard in high-income countries and may not be necessary in low- and middle-income countries.

Methods:
We created simulated datasets to determine the sampling frame needed to reach a given precision. We validated our findings using data collected at Mulago National Referral Hospital in Kampala, Uganda. We used these data to create a tool that can be used to determine the optimal sampling frame for a population based on POMR rate and target POMR improvement goal.

Results:
Precision improved as the sampling frame increased. However, as POMR increased, lower sampling percentages were needed to achieve a given precision. A total of 357 eligible cases were identified in the Mulago database with an overall POMR rate of 14%. Precision of ±10% was achieved with 34% sampling, and precision of ±25% was obtained at 9% sampling. Using simulated datasets, a tool was created to determine the minimum sample percentage needed to detect a given mortality improvement goal.

Conclusions:
Reliably tracking POMR does not require continuous data collection. Data driven sampling strategies can be used to decrease the burden of data collection to track POMR in resource-constrained settings.
Impact of the COVID-19 Pandemic on Long-term Recovery From Traumatic Injury
Authors: Herrera-Escobar Juan P. , Wang Joyce , Lamarre Taylor , Patel Nikita , Orlas Claudia P. , El Moheb Mohamad , Levy-Carrick Nomi C. , Sanchez Sabrina E. , Velmahos George , Kaafarani Haytham MA , Salim Ali , Nehra Deepika 
Published: August 2021

Objective:
Determine the proportion and characteristics of traumatic injury survivors who perceive a negative impact of the COVID-19 pandemic on their recovery and to define post-injury outcomes for this cohort.

Background:
The COVID-19 pandemic has precipitated physical, psychological, and social stressors that may create a uniquely difficult recovery and reintegration environment for injured patients.

Methods:
Adult (≥18 years) survivors of moderate-to-severe injury completed a survey 6 to 14 months post-injury during the COVID-19 pandemic. This survey queried individuals about the perceived impact of the COVID-19 pandemic on injury recovery and assessed post-injury functional and mental health outcomes. Regression models were built to identify factors associated with a perceived negative impact of the pandemic on injury recovery, and to define the relationship between these perceptions and long-term outcomes.

Results:
Of 597 eligible trauma survivors who were contacted, 403 (67.5%) completed the survey. Twenty-nine percent reported that the COVID-19 pandemic negatively impacted their recovery and 24% reported difficulty accessing needed healthcare. Younger age, lower perceived-socioeconomic status, extremity injury, and prior psychiatric illness were independently associated with negative perceived impact of the COVID-19 pandemic on injury recovery. In adjusted analyses, patients who reported a negative impact of the pandemic on their recovery were more likely to have new functional limitations, daily pain, lower physical and mental component scores of the Short-Form-12 and to screen positive for PTSD and depression.

Conclusions:
The COVID-19 pandemic is negatively impacting the recovery of trauma survivors. It is essential that we recognize the impact of the pandemic on injured patients while focusing on directed efforts to improve the long-term outcomes of this already at-risk population.
Defining Global Benchmarks in Elective Secondary Bariatric Surgery Comprising Conversional, Revisional, and Reversal Procedures
Authors: Gero Daniel , Vannijvel Marie , Okkema Sietske , Deleus Ellen , Lloyd Aaron , Lo Menzo Emanuele , Tadros George , Raguz Ivana , San Martin Andres , Kraljević Marko , Mantziari Styliani , Frey Sebastien , Gensthaler Lisa , Sammalkorpi Henna , Garcia-Galocha José Luis , Zapata Amalia , Tatarian Talar , Wiggins Tom , Bardisi Ekhlas , Goreux Jean-Philippe , Seki Yosuke , Vonlanthen René , Widmer Jeannette , Thalheimer Andreas , Kasama Kazunori , Himpens Jacques , Hollyman Marianne , Welbourn Richard , Aggarwal Rajesh , Beekley Alec , Sepulveda Matias , Torres Antonio , Juuti Anne , Salminen Paulina , Prager Gerhard , Iannelli Antonio , Suter Michel , Peterli Ralph , Boza Camilo , Rosenthal Raul , Higa Kelvin , Lannoo Matthias , Hazebroek Eric J. , Dillemans Bruno , Clavien Pierre-Alain , Puhan Milo , Raptis Dimitri A. , Bueter Marco 
Published: August 2021

Objective:
To define “best possible” outcomes for secondary bariatric surgery (BS).

Background:
Management of poor response and of long-term complications after BS is complex and under-investigated. Indications and types of reoperations vary widely and postoperative complication rates are higher compared to primary BS.

Methods:
Out of 44,884 BS performed in 18 high-volume centers from 4 continents between 06/2013-05/2019, 5,349 (12%) secondary BS cases were identified. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of centers. Benchmark cases had no previous laparotomy, diabetes, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, thromboembolic events, BMI> 50 kg/m2 or age> 65 years.

Results:
The benchmark cohort included 3143 cases, mainly females (85%), aged 43.8 ± 10 years, 8.4 ± 5.3 years after primary BS, with a BMI 35.2 ± 7 kg/m2. Main indications were insufficient weight loss (43%) and gastro-esophageal reflux disease/dysphagia (25%). 90-days postoperatively, 14.6% of benchmark patients presented ≥1 complication, mortality was 0.06% (n = 2). Significantly higher morbidity was observed in non-benchmark cases (OR 1.37) and after conversional/reversal or revisional procedures with gastrointestinal suture/stapling (OR 1.84). Benchmark cutoffs for conversional BS were ≤4.5% re-intervention, ≤8.3% re-operation 90-days postoperatively. At 2-years (IQR 1–3) 15.6% of benchmark patients required a reoperation.

Conclusion:
Secondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS.
Root-cause Analysis of Mortality After Pancreatic Resection (CARE Study)
Authors: Beugniez César , Sauvanet Alain , Sulpice Laurent , Gaujoux Sébastien , Turrini Olivier , Truant Stéphanie , Schwarz Lilian , Piessen Guillaume , Regimbeau Jean Marc , Muscari Fabrice , Adham Mustapha , Pattou François , Schneider Lucil , Clement Guillaume , Delpero Jean-Robert , Pruvot François-René , El Amrani Mehdi 
Published: August 2021

Objectives:
Analyze a multicenter cohort of deceased patients after pancreatectomy in high-volume centers in France by performing a root-cause analysis (RCA) to define the avoidable mortality rate.

Background:
Despite undeniable progress in pancreatic surgery for over a century, postoperative outcome remains particularly worse and could be further improved.

Methods:
All patients undergoing pancreatectomy between January 2015 and December 2018 and died postoperatively within 90 days after were included. RCA was performed in 2 stages: the first being the exhaustive collection of data concerning each patient from preoperative to death and the second being blind analysis of files by an independent expert committee. A typical root cause of death was defined with the identification of avoidable death.

Results:
Among the 3195 patients operated on in 9 participating centers, 140 (4.4%) died within 90 days after surgery. After the exclusion of 39 patients, 101 patients were analyzed. The cause of death was identified in 90% of cases. After RCA, mortality was preventable in 30% of cases, mostly consequently to a preoperative assessment (disease evaluation) or a deficient postoperative management (notably pancreatic fistula and hemorrhage). An inappropriate intraoperative decision was incriminated in 10% of cases. The comparative analysis showed that young age and arterial resection, especially unplanned, were often associated with avoidable mortality.

Conclusions:
One-third of postoperative mortality after pancreatectomy seems to be avoidable, even if the surgery is performed in high volume centers. These data suggest that improving postoperative pancreatectomy outcome requires a multidisciplinary, rigorous, and personalized management.
Incidence and Risk Factors for Diaphragmatic Herniation Following Esophagectomy for Cancer
Authors: Hertault Hugo , Gandon Anne , Behal Hélène , Legault Gaëtan , Degisors Sébastien , Martin Louis , Messier Marguerite , Noiret Barbara , Vermersch Mathilde , Nuytens Frederiek , Eveno Clarisse , Piessen Guillaume 
Published: August 2021

Objective:
To evaluate the incidence and risk factors of diaphragmatic herniation following esophagectomy for cancer (DHEC), and assess the results of surgical repair.

Summary Background data:
The current incidence of DHEC is discussed with conflicting data regarding its treatment and natural course.

Methods:
Monocentric retrospective cohort study (2009–2018). From 902 patients, 719 patients with a complete follow-up of CT scans after transthoracic esophagectomy for cancer were reexamined to identify the occurrence of a DHEC. The incidence of DHEC was estimated using Kalbfleisch and Prentice method and risk factors of DHEC were studied using the Fine and Gray competitive risk regression model by treating death as a competing event. Survival was analyzed.

Results:
Five-year DHEC incidence was 10.3% [95% CI, 7.8%–13.2%] (n = 59), asymptomatic in 54.2% of cases. In the multivariable analysis, the risk factors for DHEC were: presence of hiatal hernia on preoperative CT scan (HR = 1.72 [1.01–2.94], P = 0.046), previous hiatus surgery (HR = 3.68 [1.61–8.45], P = 0.002), gastroesophageal junction tumor location (HR = 3.51 [1.91–6.45], P < 0.001), neoadjuvant chemoradiotherapy (HR = 4.27 [1.70–10.76], P < 0.001), and minimally invasive abdominal phase (HR = 2.98 [1.60–5.55], P < 0.001). A cure for DHEC was achieved in 55.9%. The postoperative mortality rate was nil, the overall morbidity rate was 12.1%, and the DHEC recurrence rate was 30.3%. Occurrence of DHEC was significantly associated with a lower hazard rate of death in a time-varying Cox's regression analysis (HR = 0.43[0.23–0.81], P = 0.010).

Conclusions:
The 5-year incidence of DHEC is 10.3% and is associated with a favorable prognosis. Surgical repair of symptomatic or progressive DHEC is associated with an acceptable morbidity. However, the optimal surgical repair technique remains to be determined in view of the large number of recurrences.
The Impact of Cold Ischaemia Time on Outcomes of Living Donor Kidney Transplantation in the UK Living Kidney Sharing Scheme
Authors: van de Laar Stijn C. , Robb Matthew L. , Hogg Rachel , Burnapp Lisa , Papalois Vassilios E. , Dor Frank J. M. F. 
Published: August 2021

Objective:To assess the impact of CIT on living donor kidney transplantation (LDKT) outcomes in the UKLKSS versus outside the scheme.Background:LDKT provides the best treatment option for end-stage kidney disease patients. end-stage kidney disease patients with an incompatible living donor still have an opportunity to be transplanted through Kidney Exchange Programmes (KEP). In KEPs where kidneys travel rather than donors, cold ischaemia time (CIT) can be prolonged.Methods:Data from all UK adult LDKT between 2007 and 2018 were analysed.Results:9969 LDKT were performed during this period, of which 1396 (14%) were transplanted through the UKLKSS, which we refer to as KEP. Median CIT was significantly different for KEP versus non-KEP (339 versus 182 minutes,P< 0.001). KEP LDKT had a higher incidence of delayed graft function (DGF) (2.91% versus 5.73%,P< 0.0001), lower 1-year (estimated Glomerular Filtration Rate (eGFR) 57.90 versus 55.25 ml/min,P= 0.04) and 5-year graft function (eGFR 55.62 versus 53.09 ml/min,P= 0.01) compared to the non-KEP group, but 1- and 5-year graft survival were similar. Within KEP, a prolonged CIT was associated with more DGF (3.47% versus 1.95%,P= 0.03), and lower graft function at 1 and 5-years (eGFR = 55 vs 50 ml/min,P= 0.02), but had no impact on graft survival.Conclusion:Whilst CIT was longer in KEP, associated with more DGF and lower graft function, excellent 5-year graft survival similar to non-KEP was found.
Population-Based Evaluation of Indirect Signs of Increased Intracranial Pressure
Authors: Witsberger Emily M. , Huston John , Cutsforth-Gregory Jeremy K. , Johnson Patrick W. , Bhatti M. Tariq , Chen John J. 
Published: August 2021

Background:
The Mayo Clinic Study of Aging (MCSA) is a unique prospective study that systematically evaluates the normal aging population and includes many participants undergoing both MRI and lumbar puncture (LP). Using MCSA date, we aimed to determine the prevalence of indirect signs of raised intracranial pressure (ICP) on MRI and whether these correlate with LP opening pressure (OP). This is a large-scale study that evaluates how often indirect signs of increased ICP occur in a normal population.

Methods:
MCSA participants who had an MRI within 3 months of an LP with recorded OP were included in the study. MRIs were reviewed for indirect signs of raised ICP, including pituitary to sella (P/S) ratio, cerebellar tonsillar ectopia, and optic nerve sheath diameter (ONSD). These signs were evaluated for correlations with OP and influences from body mass index (BMI) and obstructive sleep apnea (OSA).

Results:
Five hundred ninety-seven MCSA patients were identified who underwent both LP and MRI. Two hundred sixty (43.6%) were women. The median age was 70.7 years (range 32.6–92.7). Median OP was 152 mm H2O (range 60–314 mm H2O), with 91 (15.2%) participants having an OP ≥ 200 mm H2O. Empty or partially empty sella was seen in 81 (12.8%) of the cohort. The P/S ratio decreased with increasing OP (r = −0.3, P < 0.001). There was a weak correlation between OP and average ONSD (r = 0.184, P = 0.01), which was no longer significant when accounting for age, gender, and BMI (partial r2 = 0.014, P = 0.097). There was no correlation between OP and cerebellar tonsillar ectopia. OSA was associated with increased ONSD (P = 0.004), but this did not remain statistically significant after accounting for age, gender, and BMI (P = 0.085).

Conclusion:
Smaller pituitary gland size correlated with increasing OP. This suggests that ICP is a continuum with some normal individuals demonstrating asymptomatic radiologic signs of raised ICP.