bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Right Ventricular Systolic Dysfunction and Pulmonary Hypertension Are Associated With Worse Outcomes in Pediatric Acute Respiratory Distress Syndrome
Authors: Himebauch Adam S. , Yehya Nadir , Wang Yan , Conlon Thomas , Kilbaugh Todd J. , McGowan Francis X. , Mercer-Rosa Laura 
Published: August 2018

Objectives:
The prevalence and importance of early right ventricular dysfunction and pulmonary hypertension in pediatric acute respiratory distress syndrome are unknown. We aimed to describe the prevalence of right ventricular dysfunction and pulmonary hypertension within 24 hours of pediatric acute respiratory distress syndrome diagnosis and their associations with outcomes.

Design:
Retrospective, single-center cohort study.

Setting:
Tertiary care, university-affiliated PICU.

Patients:
Children who had echocardiograms performed within 24 hours of pediatric acute respiratory distress syndrome diagnosis.

Interventions:
None.

Measurements and Main Results:
Between July 1, 2012, and June 30, 2016, 103 children met inclusion criteria. Echocardiograms were analyzed using established indices of right ventricular and left ventricular systolic function and for evidence of pulmonary hypertension. Echocardiographic abnormalities were common: 26% had low right ventricular fractional area change, 65% had low tricuspid annular plane systolic excursion, 30% had low left ventricular fractional shortening, and 21% had evidence of pulmonary hypertension. Abnormal right ventricular global longitudinal strain and abnormal right ventricular free wall strain were present in 35% and 40% of patients, respectively. No echocardiographic variables differed between or across pediatric acute respiratory distress syndrome severity. In multivariable analyses, right ventricular global longitudinal strain was independently associated with PICU mortality (odds ratio, 3.57 [1.33–9.60]; p = 0.01), whereas right ventricular global longitudinal strain, right ventricular free wall strain, and the presence of pulmonary hypertension were independently associated with lower probability of extubation (subdistribution hazard ratio, 0.46 [0.26–0.83], p = 0.01; subdistribution hazard ratio, 0.58 [0.35–0.98], p = 0.04; and subdistribution hazard ratio, 0.49 [0.26–0.92], p = 0.03, respectively).

Conclusions:
Early ventricular dysfunction and pulmonary hypertension were detectable, prevalent, and independent of lung injury severity in children with pediatric acute respiratory distress syndrome. Right ventricular dysfunction was associated with PICU mortality, whereas right ventricular dysfunction and pulmonary hypertension were associated with lower probability of extubation.
Nutrition and the Plastic Surgeon: Possible Interventions and Practice Considerations
Authors: Roy Mélissa , Perry Julie A. , Cross Karen M. 
Published: August 2018

Summary:
The objective of this article is to convey the importance of nutrition in plastic surgery, to offer possible outpatient nutritional interventions within the surgical care setting, and to guide the plastic surgeon in integrating nutrition as a key practice enhancement strategy for the care of wound patients and beyond. The impact of nutritional status on surgical outcomes is well recognized. Malnutrition is very frequent among the hospitalized patient population and up to 1 in 4 plastic surgery outpatient is at risk for malnutrition. Micro- and macronutrients are both essential for optimal wound healing and although specific patient populations within the field of plastic surgery are more at risk of malnutrition, universal screening, and actions should be implemented. Outpatient interventions to promote adequate nutritional intake and address barriers to the access of fruits and vegetables have included both exposure and incentive interventions. In the clinical setting, universal screening using validated and rapid tools such as the Canadian Nutritional Screening Tool are encouraged. Such screening should be complemented by appropriate blood work, body mass index measurements, and prompt referral to a dietician when appropriate. The notion of prehabilitation has also emerged with impetus in surgery and encompasses the nutritional optimization of patients by promoting the enhancement of functional capacity preoperatively.
Local Cooling as a Step of Treatment for Tissue Ischemia Caused by Hyaluronic Acid Injection-induced Embolism—A Report of 9 Cases
Authors: Zhang Chen , Ge Chunying , Du Chunxiao , Li Jieqi 
Published: August 2018

Summary:
Hyaluronic acid injection is 1 of the most popular procedures in facial rejuvenation and augmentation. It is widely popular in the cosmetic surgery due to several advantages, which include rapid effect, minimal injury, and a short postoperative recovery period. With continuous increase in hyaluronic acid injections, many cases of hyaluronic acid injection-induced embolism have been reported. At present, methods for early treatment of hyaluronic acid injection–induced embolism include local injection of hyaluronidase, topical application of nitroglycerin ointment, massage, hot compression, and intravenous injections of antibiotics and hormones. Although early warm massage may facilitate hyaluronic acid degradation by hyaluronidase, local application of heat will also increase metabolic rate in the tissue, thereby reducing the ischemic tolerance of the tissue. Therefore, in this study, warm massage was limited to the first 30 minutes after hyaluronidase injection and was followed by local cooling using a gauze pad soaked with antibiotic saline solution. Excellent therapeutic effects were achieved with this approach. The methods of treatment for tissue ischemia caused by hyaluronic acid injection–induced embolism and clinical cases are introduced in the article.
Prevalence of Burnout among Plastic Surgeons and Residents in Plastic Surgery: A Systematic Literature Review and Meta-analysis
Authors: Ribeiro Rafael V. E. , Martuscelli Osíris J. D. , Vieira Antônio C. , Vieira Christian F. 
Published: August 2018

Background:
Few studies have demonstrated the prevalence of burnout in the specialty of plastic surgery. Therefore, the objective of this systematic literature review and meta-analysis was to analyze the prevalence of burnout among plastic surgeons and residents in plastic surgery.

Methods:
The PRISMA statement for systematic reviews was followed, and the most relevant studies, published originally in any language until January 2018, were analyzed. The searches were conducted by 3 researchers in the following databases: the US National Library of Medicine (PubMed), Cochrane Central Register of Controlled Trials, Web of Science, and Scientific Electronic Library Online.

Results:
The final sample consisted of 6 publications, including 2,670 plastic surgeons and 90 residents in plastic surgery. There was a prevalence of male subjects, with mean ages of 47.2 years for plastic surgeons and 28.4 years for residents. The prevalence rates of burnout were 32.32% among plastic surgeons and 36.66% among residents in plastic surgery, and high emotional exhaustion, depersonalization, and low personal accomplishment scores were considerably higher among residents in plastic surgery (37.78%, 35.56%, and 42.22%, respectively) than among plastic surgeons (25.84%, 19.15%, and 7.50%, respectively).

Conclusion:
Given the high prevalence and fact that burnout syndrome correlates with the impairment of the professional and personal life of surgeons and residents in plastic surgery, and reduces quality in the care of patients, it is necessary to perform an early assessment and to regulate this phenomenon, with a focus on identifying, diagnosing, and providing appropriate treatment.
Burn in an Irradiated Prepectoral Breast Reconstruction: A Cautionary Tale
Authors: Nigro Lauren C. , Feldman Michael J. , Blanchet Nadia P. 
Published: August 2018

Summary:
Burns to breast reconstructions, both autologous and implant-based, are well described in the plastic surgery literature. The mechanism has often been contact; however, burns secondary to sun exposure have also been reported. With the increasing number of prepectoral breast reconstructions, including irradiated prepectoral reconstructions, we would like to highlight the increased susceptibility of these reconstructions to thermal and ultraviolet injury. We present the case of a patient who underwent prepectoral implant-based breast reconstruction years after irradiation, who subsequently developed full-thickness injury to her mastectomy flap after minor sun exposure. After weeks of daily wound care and hyperbaric oxygen treatments, the patient eventually reepithelialized over her exposed acellular dermal matrix tissue layer, allowing for implant salvage. Postmastectomy flaps overlying implants in the prepectoral plane are delicate; major burns can develop from minor thermal injury, even months after surgery. Irradiated prepectoral reconstruction patients should be educated about the susceptibility of their breast flaps to even minor burn injury and should maintain vigilance beyond the immediate postoperative period. It remains to be seen whether prepectoral reconstruction in an irradiated breast can be a viable, long-term option.
DIEAP Flap Patients Equally as Satisfied with the Abdomen as Abdominoplasty Patients
Authors: Ingvaldsen Christoffer Aam , Tindholdt Tyge Tind , Tønseth Kim Alexander 
Published: August 2018

Background:
The dermolipectomy of the deep inferior epigastric artery perforator (DIEAP) flap procedure is designed to give an end result as seen with abdominoplasty (AP). Several steps of an AP are, however, not routinely performed. This study compared the patient-reported outcomes between these 2 procedures with an emphasis on the abdomen.

Methods:
Thirty-four patients reconstructed with a DIEAP flap (DIEAP group), and 30 patients with an AP (AP group) were asked to complete 2 study-specific questionnaires. The first questionnaire covered abdominal outcomes, whereas the second was concerned with general outcomes.

Results:
The DIEAP group was significantly older compared with the AP group. Eighty-five percentage of the DIEAP group and 66 % of the AP group answered the questionnaires. Postoperatively, the DIEAP group was significantly more satisfied with their bodies when dressed (P = 0.009), and there was a trend of DIEAP patients being more satisfied with the appearance of the abdomen (P = 0.085). No significant difference was found comparing outcomes concerning umbilicus, muscle function, pain, scarring, and contour. The DIEAP group was more worried about their health than the AP group postoperatively (P = 0.044). AP patients had a significantly more altered body image (P = 0.016) and increased sexual desire (P = 0.003) than DIEAP patients. There was no significant difference regarding changes in self-image, social relationships, being naked with partner, and overall satisfaction.

Conclusion:
DIEAP flap patients were equally as satisfied with the abdomen as AP patients.
Viability of Descemet Membrane Endothelial Keratoplasty Grafts Folded in the Eye Bank
Authors: Lohmeier John , Christy Jason , Chiang Eric , Barnes Kali , Cai Stephanie , Chen Conan , Subramanya Anshul , Chaurasia Akash , Rosen Allison , Vora Parth , Durr Nicholas J. , Allen Robert , Eghrari Allen Omid 
Published: August 2018

Purpose:
Preloaded, trifolded grafts in Descemet membrane endothelial keratoplasty require transfer of the trifolding process from the corneal transplant surgeon to the eye bank technician. We sought to assess whether trifolding may be safely conducted by an eye bank technician with cell loss comparable to standard peeling and lifting.

Methods:
A total of 10 grafts were stained, peeled, and transferred directly onto a bed of Calcein-AM and Amvisc Plus by an eye bank technician. Five grafts were removed and stained as a scroll, and 5 grafts were trifolded with the endothelium in before transfer. Photographs were acquired with an inverted fluorescence microscope, and image segmentation was performed. A t test was conducted to compare differences in endothelial cell loss across groups.

Results:
Mean cell loss in the scroll group was 18.5% [95% confidence interval (CI): 15.2%–21.9%] compared with 7.6% of the trifolded group (95% CI: 1.7%–13.5%). A 2-tailed t test indicated decreased cell loss in the trifolded group (P = 0.013).

Conclusions:
Despite additional manipulation of the graft, trifolding of Descemet membrane and endothelium may be performed by an eye bank technician without significantly increased cell loss relative to graft preparation as a scroll.
Evaluation of Cyclin D1 as a Discriminatory Immunohistochemical Biomarker for Idiopathic Pulmonary Fibrosis
Authors: Wei Christina H. , Baratelli Felicita E. , Xiao Guang-Qian , Koss Michael N. , Elatre Wafaa 
Published: August 2018

Background:
Distinction of idiopathic pulmonary fibrosis (IPF) from other chronic fibrosing interstitial pneumonitides, such as hypersensitivity pneumonitis (HP) and connective tissue diseases, is critical due to varied biological and clinical outcomes. However, their histologic overlaps often pose diagnostic challenges. A recent study suggested an association of herpesvirus saimiri infection with IPF. Productive viral infection is associated with coexpression of pirated mammalian protein cyclin D1, shown to be overexpressed by immunohistochemistry (IHC) in the regenerating alveolar epithelium in IPF but not in normal lungs. We evaluated the diagnostic utility of cyclin D1 to discriminate between IPF and other fibrosing interstitial lung diseases.

Materials and Methods:
A retrospective study of cyclin D1 IHC expression in 27 consecutive cases of chronic fibrosing interstitial lung diseases from 2011 to 2017: 12 usual interstitial pneumonia (UIP) pattern; 5 nonspecific interstitial pneumonia pattern; 3 HP pattern; 7 unclassifiable was performed. Five cases of normal lung obtained from lobectomy specimen for malignancy are included as control. Immunoreactivity was graded semiquantitatively on a scale of 0 to 3.

Results:
Cyclin D1 staining was uniformly strongly positive in all cases evaluated in the study, particularly in proliferating type II pneumocytes in the region of fibrosing areas. There was no statistical difference in the extent of cyclin D1 expression between UIP and non-UIP groups (2.7 vs. 2.5) and IPF versus non-IPF groups (2.7 vs. 2.4). Cyclin D1 expression is lower in control group compared with UIP groups (1.2 vs. 2.7).

Conclusions:
Cyclin D1 is not a specific marker of UIP pattern/IPF. The high expression of cyclin D1 in lung tissue of fibrosing interstitial pneumonitides regardless of etiology most likely correlates with proliferation in type II pneumocytes.
APOBEC3B High Expression in Gastroenteropancreatic Neuroendocrine Neoplasms and Association With Lymph Metastasis
Authors: Feng Changyin , Zheng Qiaoling , Yang Yinghong , Xu Meifang , Lian Yuane , Huang Jianping , Jiang Yiting 
Published: August 2018

Purpose:
Apolipoprotein B mRNA editing enzyme catalytic polypeptide-like 3B (APOBEC3B) is known as a source of mutations in multiple cancers. Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are a group of heterogeneous tumors. However, the expression and significance of APOBEC3B in GEP-NENs remains unclear.

Materials and Methods:
A total of 158 cases of GEP-NENs, including 78 cases of biopsy or endoscopic submucosal dissection resection specimens and 83 cases of surgical resection specimens were collected in this study. The cases were grouped according to tumor classification grade, including 42 cases of neuroendocrine tumors G1 (NET G1), 36 cases of NET G2, 36 cases of NET G3, 44 cases of neuroendocrine carcinoma (NEC). All of the 158 tumors were immunohistochemically studied using a polyclonal antibody against APOBEC3B. We evaluated APOBEC3B expression in GEP-NENs and investigated the relationships among the immunoreactivity of APOBEC3B, clinical and pathologic features, such as age, sex, tumor site, Ki67 cell proliferation index, and lymph metastasis.

Results:
A total of 33 cases (78.6%) of NET G1 showed high expression of APOBEC3B. A total of 28 cases (77.8%) of NET G2 demonstrated high expression of APOBEC3B. In NET G3 and NEC cases, the positive rates were 52.8% and 2.3%, respectively. The expression of APOBEC3B in NETs was significantly higher than that in NECs, NET G1 and NET G2 were higher than NET G3, and the difference was statistically significant. APOBEC3B high expression cases have lower lymph node metastasis rate, lower Ki67 cell proliferation index.

Conclusions:
In this study, APOBEC3B is highly expressed in GEP-NETs and is a predictor of lymph node metastasis in NET G3 and NEC cases. These findings might provide new insights into the biological mechanisms of GEP-NENs tumorigenesis and progression.
High Fidelity of Breast Biomarker Metrics: A 10-Year Experience in a Single, Large Academic Institution
Authors: Zhang Huina , Han Min , Varma Kavita R. , Clark Beth Z. , Bhargava Rohit , Dabbs David J. 
Published: August 2018

Purpose:
Recommendations for standardization of breast biomarkers including estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2) led to the creation of American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guidelines to provide continuous guidance. Included in these recommendations is the “ongoing assay assessment procedures.” We report these biomarker metrics as there is a dearth of published information on this topic.

Materials and Methods:
ER, PR, and HER2 positivity rates of all newly diagnosed, recurrent, and metastatic invasive breast cancers on core biopsies, and repeated testing on resection specimen by immunohistochemistry (IHC) and/or fluorescence in situ hybridization (FISH) were collected from April 1, 2008 to December 31, 2017.

Results:
The positivity rates of ER, PR, and HER2 over almost 10 years of monitoring showed high fidelity. Total ER-positive rate was 83.6% (81.4% to 86.8%), ER+/PR+ was 71.7% (68.6% to 75.5%), ER+/PR− was 17.6% (11.0% to 15.0%), ER−/PR− was 16.0% (13.5% to 18.2%), and ER−/PR+ was 0.6% (0.2% to 1.0%). The HER2-positive rate was 13.7% (10.2% to 17.4%) including 9.9% (7.3% to 11.9%) by IHC and 3.8% (1.9% to 5.9%) by FISH reflexed from IHC 2+ results. FISH amplification rate of HER2 IHC 2+ cases was 11.0% (5.8% to 19.2%). Annual quality-assurance check for HER2 IHC/FISH percent positive and percent negative agreement (as defined by Food and Drug Administration) was 96% to 100%.

Conclusions:
This longitudinal active assessment of 9564 breast biomarker cases shows the achievement of high fidelity of breast biomarker results when following the ASCO/CAP guidelines. Continuous monitoring of breast biomarkers may minimize assay analytical drift and assure quality clinically relevant results.
Energy Intake and Expenditure in Children With Heart Failure
Authors: Hoover John D. , Wong William W. , Adachi Iki , Brandt Paige , Jeewa Aamir 
Published: August 2018

Objectives:
Up to one third of children with heart failure exhibit growth failure. Limited data exists reporting energy requirements in this population. A study was designed to characterize the energy intake and total daily energy expenditure of children with heart failure using the doubly labeled water method.

Design:
Prospective study using doubly labeled water to measure total daily energy expenditure in children with heart failure. Doubly labeled water was administered orally and daily urine samples collected for 10 days. Total daily energy expenditure was compared with historic data from age- and gender-matched healthy population. Anthropometrics and 3-day calorie count were also done.

Setting:
The Cardiovascular Intensive Care Unit and Cardiology ward at Texas Children's Hospital.

Patients:
Children with new presentation of heart failure as defined by an ejection fraction less than 35% and requiring inotrope(s) at the time of enrollment.

Measurements and Main Results:
A total of five children with heart failure were enrolled from 2015 to 2016. All children showed weight-for-length less than mean-for-age. All had depressed myocardial function at enrollment, and all but one demonstrated improvement in ejection fraction at follow-up. Three had energy intake that met or surpassed their total daily energy expenditure, with total daily energy expenditure that measured below historic controls. One infant, despite supplementation, had an energy intake substantially below that of measured total daily energy expenditure and required cardiac transplantation.

Conclusions:
Growth failure in heart failure is likely multifactorial and may be related to suboptimal energy intake secondary to exercise intolerance, malabsorption, and/or end-organ dysfunction due to impaired cardiac output. Doubly labeled water is a feasible method to assess total daily energy expenditure in children with heart failure.
Three-Dimensional High-Resolution Black-Blood Magnetic Resonance Imaging for Detection of Arteritic Anterior Ischemic Optic Neuropathy in Patients With Giant Cell Arteritis
Authors: Sommer Nora N. , Treitl Karla M. , Coppenrath Eva , Kooijman Hendrik , Dechant Claudia , Czihal Michael , Kolben Theresa M. , Beyer Sebastian E. , Sommer Wieland H. , Saam Tobias 
Published: August 2018

ObjectivesArteritic anterior ischemic optic neuropathy (A-AION) caused by inflammatory occlusion of the posterior ciliary arteries is the most common reason for irreversible vision loss in patients with giant cell arteritis. Atypical clinical presentation and negative funduscopy can delay systemic high-dose corticosteroid therapy to prevent impending permanent blindness and involvement of the contralateral eye.The purpose of this study was to assess the diagnostic accuracy of 3-dimensional (3D) high-resolution T1-weighted black-blood magnetic resonance imaging (T1-BB-MRI) for the detection of posterior ciliary artery involvement in patients with giant cell arteritis and funduscopic A-AION.Materials and MethodsAfter institutional review board approval and informed consent, 27 patients with suspected giant cell arteritis and vision disturbances were included in this monocentric prospective cohort study. Giant cell arteritis was diagnosed in 18 patients according to the diagnostic reference standard (6 men, 73.8 [69.0–78.0] years); 14 of those were positive for A-AION. Precontrast and postcontrast 3D T1-BB-MRI was performed in all 27 patients. Two radiologists separately assessed image quality and local fat suppression (4-point scale), visual contrast enhancement (3-point scale), and diagnostic confidence (5-point scale) regarding arteritic posterior ciliary artery involvement. Magnetic resonance imaging findings were assessed in comparison to funduscopy. Statistical analysis included accuracy parameters and interrater agreement.ResultsSensitivity of 3D T1-BB-MRI was 92.9% (95% confidence interval, 66.1%–99.8%) and specificity was 92.3% (95% confidence interval, 64.0%–99.8%) for detection of A-AION–positive patients. Image quality and local fat suppression were assessed with 3.2 ± 0.8 (median 3) and 3.8 ± 0.5 (median 4). Visual contrast enhancement with 2.3 ± 0.8 (median 3) and diagnostic confidence was rated at 4.7 ± 0.5 (median 5). Interrater agreement was high (κ = 0.85,P< 0.001). Three-dimensional T1-BB-MRI displayed bilateral findings in 50% of the cases, whereas only unilateral A-AION was detected in funduscopy as a possible indication for the contralateral eye at risk.ConclusionsThree-dimensional T1-BB-MRI allows accurate detection of arteritic posterior ciliary artery involvement in patients with A-AION. Further, 3D T1-BB-MRI seems to display arteritic involvement of the posterior ciliary arteries earlier than funduscopy and might, therefore, display “vision-at-risk” in patients with visual impairment and suspected giant cell arteritis but unremarkable funduscopy.