bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mannitol in Critical Care and Surgery Over 50+ Years: A Systematic Review of Randomized Controlled Trials and Complications With Meta-Analysis
Authors: Zhang Weiliang , Neal Jonathan , Lin Liang , Dai Feng , Hersey Denise P. , McDonagh David L. , Su Fan , Meng Lingzhong 
Published: June 2018

Objective:
Despite clinical use spanning 50+ years, questions remain concerning the optimal use of mannitol. The published reviews with meta-analysis frequently focused on mannitol’s effects on a specific physiological aspect such as intracranial pressure (ICP) in sometimes heterogeneous patient populations. A comprehensive review of mannitol’s effects, as well as side effects, is needed.

Methods:
The databases Medline (OvidSP), Embase (OvidSP), and NLM PubMed were systematically searched for randomized controlled trials (RCTs) comparing mannitol to a control therapy in either the critical care or perioperative setting. Meta-analysis was performed when feasible to examine mannitol’s effects on outcomes, including ICP, cerebral perfusion pressure, mean arterial pressure (MAP), brain relaxation, fluid intake, urine output, and serum sodium. Systematic literature search was also performed to understand mannitol-related complications.

Results:
In total 55 RCTs were identified and 7 meta-analyses were performed. In traumatic brain injury, mannitol did not lead to significantly different MAP (SMD [95% confidence interval (CI)] =−3.3 [−7.9, 1.3] mm Hg; P=0.16) but caused significantly different serum sodium concentrations (SMD [95% CI]=−8.0 [−11.0, −4.9] mmol/L; P<0.00001) compared with hypertonic saline. In elective craniotomy, mannitol was less likely to lead to satisfactory brain relaxation (RR [95% CI]=0.89 [0.81, 0.98]; P=0.02), but was associated with increased fluid intake (SMD [95% CI]=0.67 [0.21, 1.13] L; P=0.004), increased urine output (SMD [95% CI]=485 [211, 759] mL; P=0.0005), decreased serum sodium concentration (SMD [95% CI]=−6.2 [−9.6, −2.9] mmol/L; P=0.0002), and a slightly higher MAP (SMD [95% CI]=3.3 [0.08, 6.5] mm Hg; P=0.04) compared with hypertonic saline. Mannitol could lead to complications in different organ systems, most often including hyponatremia, hyperkalemia, and acute kidney injury. These complications appeared dose dependent and had no long-term consequences.

Conclusions:
Mannitol is effective in accomplishing short-term clinical goals, although hypertonic saline is associated with improved brain relaxation during craniotomy. Mannitol has a favorable safety profile although it can cause electrolyte abnormality and renal impairment. More research is needed to determine its impacts on long-term outcomes.
Scoliosis Curvature Follows Thoracic Organ Orientation
Authors: Compton Jocelyn , Voort Wyatt Vander , Weinstein Stuart 
Published: June 2018

Study Design.
Retrospective cohort study, Level of Evidence III.

Objective.
To determine the relationship between internal organ orientation and adolescent idiopathic scoliosis (AIS) convexity directionality.

Summary of Background Data.
AIS affects 2% to 3% of the general population and demonstrations 80% to 99% right thoracic curve convexity. The mechanism of AIS as well as explanation for right-sided predominance is largely unknown.

Methods.
A retrospective chart review of all patients with dextrocardia from 2008 to 2018 was performed at a single institution. Upright chest x-rays and scoliosis x-rays were evaluated for scoliosis by measurement of Cobb angle. Chart review was performed to extract age, advanced imaging results, and surgical intervention.

Results.
Of 110 patients identified with dextrocardia, 19 patients exhibited radiographic features consistent with AIS (Cobb angle >10°). Fifteen (79%) of these patients demonstrated left-sided thoracic curvature. Six patients showed isolated dextrocardia with normal abdominal organ orientation; five patients (83%) showed left-sided thoracic curvature. There was not a statistical difference with regards to sex or curve severity. Magnetic resonance imaging (MRI) was performed on five patients with left-sided curvature without evidence of intra-spinal pathology.

Conclusion.
Dextrocardia shows increased incidence of AIS in both male and female patients. Left-sided thoracic curvature in cases with concurrent dextrocardia may not be associated with intra-spinal pathology as seen in the general population. These data suggest that thoracic organ orientation affects AIS convexity directionality.

Level of Evidence: 3
Factors Affecting Patient Decision-making on Surgery for Lumbar Disc Herniation
Authors: Andersen Stina Brogård , Birkelund Regner , Andersen Mikkel Ø. , Carreon Leah Y. , Coulter Angela , Steffensen Karina Dahl 
Published: June 2018

Study Design.
Qualitative research using semistructured interviews.

Objective.
To explore, from a patient perspective, factors influencing a patient's decision-making process and the decision to have surgery for lumbar disc herniation.

Summary of Background Data.
Since strong evidence favoring surgical over nonsurgical treatment is lacking and firm guidelines regarding the optimal timing of surgery are not available, it is essential to involve patients in the decision-making process. Thus the elements that might affect the decision-making process and the decision to have surgery must be identified.

Methods.
Using a hermeneutic-phenomenological approach, 14 patients who were referred for primary surgery for lumbar disc herniation were interviewed. Interviews were transcribed and analyzed using a meaning-condensation method to identify themes influencing a patient's decision-making process and the decision to have surgery for lumbar disc herniation.

Results.
Four main themes that could directly or indirectly influence the patients’ decision-making process were identified: A) Patient information: patients’ conceptions about treatment were not always based on sufficient information; B) Accelerated workflows: some patients needed time to process the information given, which may be limited due to accelerated workflows; C) Power imbalance: patients can be reluctant to challenge the system, as they do not want to offend, which can be seen as a power imbalance between clinicians and patients; and D) Personal past experience: experience, about treatment options from, i.e., close relatives, can impact patients thoughts about possible treatments.

Conclusion.
Several factors can influence patients’ decision-making process and the decision itself: the amount and quality of information received as compared with their preconceived notions, the amount of time given to consider their decision, reluctance to challenge the system and offend the healthcare provider, and past personal experience. Understanding these complex factors will help clinicians to better support patients choosing between surgical and nonsurgical treatment for lumbar herniated disc.

Level of Evidence: 5
Validation of the Fusion Risk Score for Thoracic and Lumbar Spine Fusion Procedures
Authors: Deogaonkar Kedar , Mehbod Amir A. , Dawson John M. , Transfeldt Ensor E. 
Published: June 2018

Study Design:
This is a retrospective cohort study.

Objective:
This study aimed to determine whether the Fusion Risk Score (FRS) is valid for perioperative complications.

Summary of Background Data:
The FRS was previously formulated from a retrospective review of 364 fusion surgeries in patients over age 65. Patient demographics, comorbidities, surgical approach, levels, and osteotomies are incorporated in a weighted manner. This score correlated well with the risk of perioperative complications, operative time, estimated blood loss during surgery, and length of hospital stay.

Materials and Methods:
A new cohort of patients was studied. Subjects were 65 years old or older and had undergone routine elective thoracic or lumbar fusion surgery. The FRS was calculated for each subject to estimate risk (low, medium, or high) for perioperative complications. Actual incidences of major complications in the first 90 days after the surgery were noted and statistically compared with the predicted risk. The FRS was compared with intensive care unit admittance, estimated blood loss, operative time, and hospital length of stay to determine whether the score was predictive.

Results:
In total, 51% of our patients were at low risk (FRS, 1–3) for perioperative complications; 43% were at medium risk (FRS, 4–9); and 7% were at high risk (FRS, over 9). A total of 8% in the low-risk group, 23% in the medium-risk group, and 67% in the high-risk group actually developed significant perioperative complications. Medium-risk and high-risk patients experienced proportionally more perioperative complications than did low-risk patients; the difference was highly statistically significant.

Conclusions:
This study validated the association between the FRS and complications in the first 90 days after thoracolumbar spinal fusion surgery on the basis of patient and surgery characteristics. It also predicts the risk of intensive care unit admission, operative time, blood loss, and hospital length of stay.
Cutaneous Metastasis of Choriocarcinoma in 2 Male Patients: A Rare Presentation of an Aggressive Malignancy That Dermatopathologists Must Recognize
Authors: Marka Arthur , Hoyt Brian S. , LeBlanc Robert E. 
Published: June 2018

Abstract:
Testicular choriocarcinoma needs to be considered in the differential diagnosis of cutaneous metastases in young adult men because of its propensity for early hematogenous dissemination. Furthermore, the diagnosis may not be suspected in many cases in which there is clinically no testicular enlargement. This highly aggressive germ cell tumor typically metastasizes to the liver, lungs, and brain. Skin metastasis is exceedingly rare with only 22 cases previously reported in the world literature. We herein report 2 additional cases: a 25-year-old man and a 32-year-old man, both of whom were treated for mixed germ cell tumors and developed multiple cutaneous metastases to the head.
Patient Perceptions and Quality of Life After Colon and Rectal Surgery: What Do Patients Really Want?
Authors: Wrenn Sean M. , Cepeda-Benito Antonio , Ramos-Valadez Diego I. , Cataldo Peter A. 
Published: June 2018

BACKGROUND:
Colorectal surgery outcomes must be accurately assessed and aligned with patient priorities. No study to date has investigated the patient’s subjective assessment of outcomes most important to them during and following their surgical recovery. Although surgeons greatly value the benefits of laparoscopy, patient priorities remain understudied.

OBJECTIVE:
This study aimed to assess what aspects of patients’ perioperative care and recovery they value most when queried in the postoperative period.

DESIGN:
This study is an exploratory cross-sectional investigation of a defined retrospective patient population. Enrollees were stratified into subcategories and analyzed, with statistical analysis performed via χ2 test and unpaired t test.

SETTINGS:
This study was conducted at a single academic medical center in New England.

PATIENTS:
Patients who underwent a colorectal surgical resection between 2009 and 2015 were selected.

INTERVENTIONS:
Patients within a preidentified population were asked to voluntarily complete a 32-item questionnaire regarding their surgical care.

MAIN OUTCOME MEASURES:
The primary outcomes measured were patient perioperative and postoperative quality of life and satisfaction on selected areas of functioning.

RESULTS:
Of 167 queried respondents, 92.2% were satisfied with their recovery. Factors considered most important included being cured of colorectal cancer (76%), not having a permanent stoma (78%), and avoiding complications (74%). Least important included length of stay (13%), utilization of laparoscopy (14%), and incision appearance and length (2%, 4%).

LIMITATIONS:
The study had a relatively low response rate, the study is susceptible to responder’s bias, and there is temporal variability from surgery to questionnaire within the patient population.

CONCLUSIONS:
Overall, patients reported high satisfaction with their care. Most important priorities included being free of cancer, stoma, and surgical complications. In contrast, outcomes traditionally important to surgeons such as laparoscopy, incision appearance, and length of stay were deemed less important. This research helps elucidate the outcomes patients truly consider valuable, and surgeons should focus on these outcomes when making surgical decisions. See Video Abstract at http://links.lww.com/DCR/A596. See Visual Abstract at https://tinyurl.com/yb25xl66.
Histological Comparison of Cold versus Hot Snare Resections of the Colorectal Mucosa
Authors: Takayanagi Daisuke , Nemoto Daiki , Isohata Noriyuki , Endo Shungo , Aizawa Masato , Utano Kenichi , Kumamoto Kensuke , Hojo Hiroshi , Lefor Alan Kawarai , Togashi Kazutomo 
Published: June 2018

BACKGROUND:
Delayed postpolypectomy bleeding occurs more frequently after hot resection than after cold resection.

OBJECTIVE:
To elucidate the underlying mechanism, we performed a histological comparison of tissue after cold and hot snare resections.

DESIGN:
This is a prospective study, registered in the University Hospital Medical Information Network (UMIN000020104).

SETTING:
This study was conducted at Aizu Medical Center, Fukushima Medical University, Japan.

PATIENTS:
Fifteen patients scheduled to undergo resection of colorectal cancer were enrolled.

INTERVENTION:
On the day before surgery, 2 mucosal resections (hot and cold) of normal mucosa were performed on each patient using the same snare without saline injection. The difference was only the application of electrocautery or not. Resection sites were placed close to the cancer to be included in the surgical specimen.

MAIN OUTCOME MEASURES:
The primary outcome measure was the depth of destruction. Secondary outcome measures included the width of destruction, depth of the remaining submucosa, and number of vessels remaining at the resection sites. The number and diameter of vessels in undamaged submucosa were also evaluated.

RESULTS:
All cold resections were limited to the shallow submucosa, whereas 60% of hot resections advanced to the deep submucosa and 20% to the muscularis propria (p < 0.001). There was no significant difference in the width of destruction. The number of remaining large vessels after hot resections trended toward fewer (p = 0.15) with a decreased depth of remaining submucosa (p = 0.007). In the deep submucosa, the vessel diameter was larger (p < 0.001) and the number of large vessels was greater (p = 0.018).

LIMITATIONS:
Histological assessment was not blinded to the 2 reviewers. Normal mucosa was used instead of adenomatous tissue.

CONCLUSIONS:
Hot resection caused damage to deeper layers involving more large vessels. This may explain the mechanism for the reduced incidence of hemorrhage after cold snare polypectomy. See Video Abstract at http://links.lww.com/DCR/A631.
Can Endorectal Ultrasound, MRI, and Mucosa Integrity Accurately Predict the Complete Response for Mid-Low Rectal Cancer After Preoperative Chemoradiation? A Prospective Observational Study from a Single Medical Center
Authors: Liu Sen , Zhong Guang-xi , Zhou Wei-xun , Xue Hua-dan , Pan Wei-dong , Xu Lai , Lu Jun-yang , Wu Bin , Lin Guo-le , Qiu Hui-zhong , Xiao Yi 
Published: June 2018

BACKGROUND:
Patients with locally advanced rectal cancer could be managed by a watch-and-wait approach if they achieve clinical complete response after preoperative chemoradiotherapy. Mucosal integrity, endorectal ultrasound, and rectal MRI are used to evaluate clinical complete response; however, the accuracy remains questionable. Clinical practice based on those assessment methods needs more data and discussion.

OBJECTIVE:
The aim of this prospective study was to evaluate the accuracy of mucosal integrity, endorectal ultrasound, and rectal MRI to predict clinical complete response after chemoradiotherapy.

DESIGN:
Endorectal ultrasound and rectal MRI were undertaken 6 to 7 weeks after preoperative chemoradiation therapy. Patients then received radical surgery based on the principles of total mesorectal excision. Preoperative tumor staging achieved by endorectal ultrasound and rectal MRI was compared with postoperative staging by pathologic examination. Sensitivity, specificity, and accuracy of each evaluation method were calculated.

SETTINGS:
The study was conducted at a single tertiary care center.

PATIENTS:
Patients diagnosed with mid-low rectal cancer by biopsy between May 2014 and December 2016 were enrolled in this study.

RESULTS:
A total of 124 patients were enrolled in this study, and postoperative pathology revealed that 20 patients (16.13%) achieved complete response (ypT0N0). The sensitivity of mucosal integrity, endorectal ultrasound, and MRI to predict clinical complete response was 25%. The specificity of mucosal integrity, endorectal ultrasound, and MRI was 94.23%, 93.90%, and 93.27%. The combination of each 2 or all 3 methods did not improve accuracy. Regression analysis showed that none of these methods could predict postoperative ypT0.

LIMITATIONS:
The sample size is small, and we did not focus on the follow-up data and cannot compare prognosis data with previous research studies.

CONCLUSIONS:
Both single-method and combined mucosal integrity, endorectal ultrasound, and rectal MRI have poor correlation with postoperative pathologic examination. A watch-and-wait approach based on these methods might not be a proper strategy compared with radical surgery after neoadjuvant therapy. See Video Abstract at http://links.lww.com/DCR/A693.
Safe and Effective Endoscopic Resection of Massive Colorectal Adenomas ≥8 cm in a Tertiary Referral Center
Authors: Emmanuel Andrew , Gulati Shraddha , Burt Margaret , Hayee Bu’Hussain , Haji Amyn 
Published: June 2018

BACKGROUND:
Endoscopic resection of large colorectal lesions is well reported and is the first line of treatment for all noninvasive colorectal neoplasms in many centers, but little is known about the outcomes of endoscopic resection of truly massive colorectal lesions ≥8 cm.

OBJECTIVE:
We report on the outcomes of endoscopic resection for massive (≥8 cm) colorectal adenomas and compare the outcomes with resection of large (2.0–7.9 cm) lesions.

DESIGN:
This was a retrospective study.

SETTINGS:
The study was conducted in a tertiary referral unit for interventional endoscopy.

PATIENTS:
A total of 435 endoscopic resections of large colorectal polyps (≥2 cm) were included, of which 96 were ≥8 cm.

MAIN OUTCOME MEASURES:
Outcomes included initial successful resection, complications, recurrence, surgery, and hospital admission.

RESULTS:
Endoscopic resection was successful for 91 of 96 massive lesions (≥8 cm). Mean size was 10.1 cm (range, 8–16 cm). A total of 75% had previous attempts at resection or heavy manipulation before referral. Thirty two were resected using endoscopic submucosal dissection or hybrid endoscopic submucosal dissection and the rest using piecemeal endoscopic mucosal resection. No patients required surgery for a perforation. Five patients had postprocedural bleeding. There were 25 recurrences: 2 were treated with transanal endoscopic microsurgery, 2 with right hemicolectomy, and the rest with endoscopic resection. Compared with patients with large lesions, more patients with massive adenomas had complications (19.8% versus 3.3%), required admission (39.6% versus 11.0%), developed recurrence (30.8% versus 9.9%), or required surgery for recurrence (5.0% versus 0.8%).

LIMITATIONS:
This was a retrospective study.

CONCLUSIONS:
Endoscopic resection of massive colorectal adenomas ≥8 cm is achievable with few significant complications, and the majority of patients avoid surgery. Systematic assessment is required to appropriately select patients for endoscopic resection, which should be performed in specialist units. See Video Abstract at http://links.lww.com/DCR/A653.
The naturally derived small compound Osthole inhibits osteoclastogenesis to prevent ovariectomy-induced bone loss in mice
Authors: Zhao Dongfeng , Wang Qiang , Zhao Yongjian , Zhang Hao , Sha Nannan , Tang Dezhi , Liu Shufen , Lu Sheng , Shi Qi , Zhang Yan , Dong Yufeng , Wang Yongjun , Shu Bing 
Published: June 2018

Abstract

Objective:
This study was to determine the bone protective effects and underlying mechanisms of Osthole (OT) in ovariectomized (OVX) mice. We found that the inhibitory effects of OT on receptor activator of nuclear factor kappa-B ligand (RANKL)-activated osteoclastogenesis are responsible for its bone protective effects in OVX mice.

Methods:
Eight-week-old mice were ovariectomized and OT (10 mg/kg/d) was intraperitoneally administrated to OVX mice 7 days after the surgery and were sacrificed at the end of the 3 months. Osteoclasts were generated from primary bone marrow macrophages (BMMs) to investigate the inhibitory effects of OT. The activity of RANKL-activated signaling was simultaneously analyzed in vitro and in vivo using immunohistochemistry, Western blot, and PCR assays.

Results:
OT dose dependently inhibited RANKL-mediated osteoclastogenesis in BMM cultures. OT administration attenuated bone loss (mg Ha/cm: 894.68 ± 33.56 vs 748.08 ± 19.51, P
< 0.05) in OVX mice. OT inhibits osteoclastogenesis (Oc.N/per view area: 72 ± 4.3 vs 0.8 ± 0.4, P
< 0.05) and bone resorption activity (bone resorbed percentages %, 48.56 ± 7.25 vs 3.25 ± 1.37, P
< 0.05) from BMMs. Mechanistically, OT inhibited the expressions of nuclear factor of activated T-cells c1 (NFATc1) and c-Fos. Moreover, OT suppressed the expression of RANKL-induced osteoclast marker genes, including matrix metalloproteinase 9 (MMP9), Cathepsin K (Ctsk), tartrate-resistant acid phosphatase (TRAP), and carbonic anhydrase II (Car2).

Conclusions:
OT inhibits RANKL-mediated osteoclastogenesis and prevents bone loss in OVX mice. Our findings revealed that OT is a potential new drug for treating postmenopausal osteoporosis.
Prognostic Value of the 6-Min Walk Test After Open-Heart Valve Surgery
Authors: Vitale Giuseppe , Sarullo Silvia , Vassallo Laura , Di Franco Antonino , Mandalà Giorgio , Marazia Stefania , Raffa Giuseppe M. , Giallauria Francesco , Sarullo Filippo M. 
Published: June 2018

Purpose:
This single-center retrospective analysis aimed to evaluate the prognostic relevance of 6-min walk test (6MWT) in patients admitted to an in-hospital cardiovascular rehabilitation program after open-heart valve surgery.

Methods:
One hundred one patients able to perform a 6MWT within the first week of admission (time after surgery: 16 ± 8 d) were included (age 68 ± 11 y; 55% female; median left ventricular ejection fraction 55% [interquartile range: 50-60]; 51% after aortic valve surgery). Study endpoints were cardiovascular death and the combined outcome of cardiovascular death/cardiac hospitalization. Univariate and multivariate analyses were performed to analyze predictive value of the 6MWT.

Results:
After a median follow-up of 27 mo, cardiovascular mortality was 9.9% while combined endpoint occurrence was 33%. Patients experiencing study endpoints had lower left ventricular ejection fraction, higher N-terminal prohormone of brain natriuretic peptide serum levels, and longer in-hospital stay (all P < .05). The 6MWT distance was a significant predictor of cardiovascular death (hazard ratio [HR] = 0.89, 95% CI: 0.81-0.97, P = .007) and cardiac hospitalizations (HR = 0.95, 95% CI: 0.90-0.99, P = .02). Even after adjusting for the relevant confounding variables of cardiovascular death and cardiac hospitalization, the adjusted HR = 0.88, 95% CI: 0.75-0.98, P = .028 and adjusted HR = 0.95, 95% CI: 0.90-0.99, P = .05, respectively.

Conclusions:
In patients admitted to an in-hospital cardiovascular rehabilitation program after open-heart valve surgery, 6MWT proved to be an independent prognostic tool, potentially allowing identification of high-risk patients for whom a more intensive and tailored in-hospital cardiovascular rehabilitation program should be designed and implemented in order to avoid unfavorable cardiovascular events.