bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors for Kidney Dysfunction With the Use of Gentamicin in Open Fracture Antibiotic Treatment
Authors: Folse Jacob , Hill Charles E. , Graves Matthew L. , Russell George V. , Hydrick Josie , Jones LaRita C. , Replogle William H. , Bergin Patrick F. , Spitler Clay A. 
Published: August 2018

Objectives:
To evaluate all patients who received gentamicin for open fracture treatment and determine the incidence of, and risk factors for, kidney injury in this population.

Design:
Retrospective, case control.

Setting:
Single institution; Level 1 trauma center.

Patients/Participants:
A retrospective chart review identified patients who received gentamicin for open fracture antibiotic treatment from January 2008 to December 2012. Overall, 371 patients met the inclusion criteria and were categorized into 2 groups using risk, injury, failure, loss of kidney function, and end-stage kidney disease criteria: normal kidney function (74.9%) versus abnormal kidney function (25.1%).

Intervention:
Use of gentamicin in open fracture antibiotic treatment.

Main Outcome Measurements:
Kidney function; injury and treatment characteristics (eg, mechanism of injury; Gustilo-Anderson classification; number of surgical debridements, timing of definitive wound coverage, and type of wound coverage); and patient information (eg, age, height, weight, and body mass index, tobacco use, diabetes mellitus, human immunodeficiency virus, hepatitis, and current chemotherapy treatment).

Results:
Those with abnormal kidney function had lower baseline creatinine (P < 0.001) and higher injury severity scores (16.5 vs. 11.8, P < 0.001) and were more likely to require intensive care unit admission (P < 0.001) than the normal group. Female sex (P = 0.015), and higher weight (P = 0.004), ICU admission (P < 0.001), and use of CT contrasted imaging (P < 0.001) were independently associated with abnormal kidney function. Abnormal kidney function incidence also sharply increased with age.

Conclusions:
Females and heavier individuals are at-risk of kidney injury while receiving gentamicin. ICU admission and concurent CT contrasted imaging are strongly associated with kidney injury in patients receiving gentamicin for open fracture treatment, and gentamicin should be avoided in those >60 years of age.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Simulation of Supralevator Abscesses and Complex Fistulas in Cadavers: Pelvic Dissemination and Drainage Routes
Authors: García-Granero Alvaro , Sancho-Muriel Jorge , Sánchez-Guillén Luis , Alvarez Sarrado Eduardo , Fletcher-Sanfeliu Delfina , Frasson Matteo , A. Valverde-Navarro Alfonso , Martinez Soriano Francisco 
Published: August 2018

BACKGROUND:
Most perianal abscesses have a cryptoglandular origin, following the pathogenesis described by Parks in 1961. Supralevator abscesses have the most uncommon location. Nevertheless, such pathology results in a high morbidity because of their difficult diagnosis and treatment.

OBJECTIVE:
This study aimed to deepen the knowledge of the pathogenesis and management of supralevator abscesses, as well as the complications derived from incorrect treatment, by using simulation in cadavers.

DESIGN:
This study is an anatomosurgical description of pelvic and perianal zone and simulation of the different types of supralevator abscesses, their correct drainage routes, and secondary complex fistulas due to incorrect drainage.

SETTINGS:
This dynamic article is based on cadaveric simulation.

PATIENTS:
Three cadaveric pelvises (2 male and 1 female) were prepared in formalin and sagittally sectioned, and one perineal dissection was performed of a fresh male pelvis. This is an iconographic description of 3 patients treated for supralevator abscesses in our colorectal surgical unit.

MAIN OUTCOME MEASURES:
The virtual anatomical spaces map out a correct treatment.

RESULTS:
We reproduced the origin of the different types of supralevator abscesses, as well as their locations and possible drainage pathways, and we determined the definitive treatment of secondary fistulas and their morbidity due to their incorrect drainage.

LIMITATIONS:
The limitations of this study are inherent to anatomical studies without real case intervention.

CONCLUSIONS:
A proper anatomical knowledge of the supralevator abscesses and surgical training by using cadaveric simulations could improve the diagnostic criteria, facilitate the correct decision on surgical drainage pathways, and, thus, decrease postoperative morbidity in patients with this disease.
Impact of Tumor Deposits on Oncologic Outcomes in Stage III Colon Cancer
Authors: Wong-Chong Nathalie , Motl Jill , Hwang Grace , Nassif George J. , Albert Matthew R. , Monson John R.T. , Lee Lawrence 
Published: August 2018

BACKGROUND:
The prognosis of tumor deposits in stage III colon adenocarcinoma is poorly described.

OBJECTIVE:
The purpose of this study was to determine the impact of tumor deposits on oncologic outcomes in patients with stage III colon cancer.

DESIGN:
This was a multicenter retrospective cohort study.

SETTINGS:
The 2010 to 2014 National Cancer Database was queried for patients with resected stage III colon adenocarcinoma on final pathology.

PATIENTS:
Patients were divided into 3 groups: lymph nodes+tumor deposits–, lymph nodes+tumor deposits+, and lymph nodes–tumor deposits+.

MAIN OUTCOME MEASURES:
The main outcome was 5-year overall survival.

RESULTS:
Of 74,577 patients, there were 55,800 patients with lymph nodes+tumor deposits–, 13,740 patients with lymph nodes+tumor deposits+, and 5037 patients with lymph nodes–tumor deposits+. The groups had similar patient and facility characteristics, but patients with lymph nodes+tumor deposits+ had more advanced tumor characteristics. Patients with lymph nodes–tumor deposits+ were less likely to receive adjuvant systemic therapy (52% vs 74% lymph nodes+tumor deposits– and 75% lymph nodes+tumor deposits+, p < 0.001) and had a longer delay to initiation of adjuvant treatment (>8 weeks; 43% vs 33% lymph nodes+tumor deposits– and 33% lymph nodes+tumor deposits+, p < 0.001). Patients with lymph nodes+tumor deposits+ had the lowest 5-year overall survival (46.0% vs 63.4% lymph nodes+tumor deposits– vs 61.9% lymph nodes–tumor deposits+, p < 0.001). On multivariate analysis, patients with lymph nodes–tumor deposits+ had similar 5-year overall survival compared with patients with lymph nodes+tumor deposits– with ≤3 positive lymph nodes (HR, 0.93; 95% CI, 0.87–1.01). Patients with lymph nodes+tumor deposits+ had worse prognosis regardless of the number of involved lymph nodes (≤3 +lymph nodes: HR, 1.37; 95% CI, 1.28–1.47 and ≥4 +lymph nodes: HR, 1.30; 95% CI, 1.22–1.38). Of those not receiving adjuvant treatment, patients with lymph nodes–tumor deposits+ were younger and had more adverse tumor features than lymph node+ disease. Lymph nodes–tumor deposits+ was independently associated with less delivery of adjuvant systemic therapy (OR, 0.81; 95% CI, 0.80–0.82).

LIMITATIONS:
This study was limited by its retrospective analysis of a prospective database.

CONCLUSIONS:
The prognosis of patients with N1c disease is similar to nodal involvement without tumor deposits, yet these patients were less likely to receive adjuvant systemic therapy. Improvement in the delivery of appropriate care in these patients may increase survival and should be a target of future quality initiatives. See Video Abstract at http://links.lww.com/DCR/A666.
Nomogram Predicting Survival After Recurrence in Patients With Stage I to III Colon Cancer: A Nationwide Multicenter Study
Authors: Kawai Kazushige , Nozawa Hiroaki , Hata Keisuke , Kiyomatsu Tomomichi , Tanaka Toshiaki , Nishikawa Takeshi , Sugihara Kenichi , Watanabe Toshiaki 
Published: August 2018

BACKGROUND:
Although a number of studies have been conducted to investigate factors affecting colon cancer recurrence and patient overall survival after surgical treatment, no prognostic risk models have been proposed for predicting survival specifically after postsurgical recurrence.

OBJECTIVE:
We aimed to identify factors affecting the survival of the patients with recurrent colon cancer and to construct a nomogram for predicting their survival.

DESIGN:
This was a retrospective study.

SETTINGS:
This study used the Japanese Study Group for Postoperative Follow-Up of Colorectal Cancer database, which contains retrospectively collected data of all consecutive patients with stage I to III colorectal cancer who underwent surgical curative resection between 1997 and 2008 at 23 referral institutions.

PATIENTS:
A total of 2563 patients with stage I to III colon cancer who experienced recurrence after surgery were included in the present study.

MAIN OUTCOME MEASURES:
A nomogram predicting survival was constructed using a training cohort composed of patients from 15 hospitals (n = 1721) using a Cox regression hazard model analysis. The clinical applicability of this nomogram was validated in patients from the 8 remaining hospitals (the validation cohort; n = 842).

RESULTS:
Eight factors (age, location of the primary tumor, histopathological type, positive lymph node status, presence of peritoneal metastasis, number of organs involved in the first recurrence, treatment for recurrence, and the interval between initial surgery and recurrence) were identified as nomogram variables. Our nomogram showed good calibration, with concordance indexes of 0.744 in the training cohort and 0.730 in the validation cohort. The survival curves stratified by the risk score calculated by the nomogram were almost identical for the training and validation cohorts.

LIMITATIONS:
The study was conducted using the data until 2008, and more advanced chemotherapeutic agents and multidisciplinary therapies that might have improved the outcomes predicted by our nomogram were not available. In addition, treatment strategies for recurrence might differ between countries.

CONCLUSIONS:
Our nomogram, which is based on a nationwide multicenter study, is the first statistical model predicting survival after recurrence in patients with stage I to III colon cancer. It promises to be of use in postoperative colon cancer surveillance. See Video Abstract at http://links.lww.com/DCR/A687.
Salvage Treatment of Failed Free Jejunal Flap Transfer: Our Experiences and Literature Review
Authors: Kubo Tateki , Seike Shien , Kiya Koichiro , Tomita Koichi , Hosokawa Ko 
Published: August 2018

Background:
Although there have been many reports on the success of free jejunal flap transfer for pharyngoesophageal reconstruction, reports on salvage procedures for failed transfers remain sparse. In this report, we retrospectively reviewed our salvage procedures for failed jejunal transfers and previous articles describing salvage treatment in failed jejunal flap cases.

Methods:
This report includes 6 cases of failed jejunal flap transfer, leading to necessary salvage surgery. We reviewed all cases to examine salvage procedures and early postoperative complications such as fistula formation. We also assessed postoperative late complications and swallowing function during long-term follow-up. A review of the literature was performed via PubMed.

Results:
Rejejunal transfer was performed successfully in 3 of 6 cases. Gastric pull-up reconstruction was adopted in 2 cases. In 1 case, an external stoma was created because of the patient’s poor medical condition. All 3 cases of rejejunal transfer and 1 gastric pull-up case recovered to resuming a normal diet. However, 1 gastric pull-up case required supplemental feeding with a jejunostomy tube. We reviewed 6 articles describing salvage treatment in failed jejunal flap cases.

Conclusion:
When free jejunal transfer fails, rejejunal transfer is optimal. However, in cases that lack suitable recipient vessels or have infection, a second jejunal transfer should not be considered. In such cases, gastric pull-up or colon interposition may be an alternative because they do not require vascular anastomosis. Pedicled pectoralis major flap is also an alternative, although the risk of salivary fistulas is very high.
The Use of Porcine Acellular Dermal Matrix in Single-stage, Implant-based Immediate Breast Reconstruction: A 2-center Retrospective Outcome Study
Authors: Loo Yew L. , Haider Sajjad 
Published: August 2018

Background:
There have been many reported benefits of the usage of acellular dermal matrices (ADMs) in breast reconstruction. ADM reduces the need for rectus abdominis muscle and serratus anterior coverage by providing an inferolateral coverage of the implant/tissue expander. ADM can provide patients with a 1-staged reconstruction. This study was designed to look at the complication rates of 2 major hospitals in the United Kingdom.

Methods:
A large, 2-center retrospective cohort review of patients, who underwent implant-based breast reconstruction using Strattice (LifeCell Corp., Branchburg, N.J.) between March 2009 and November 2017, was performed. One-way analysis of variance was done to compare outcome significance between groups. Independent t test was performed to compare outcomes of 2 cohorts and regression analysis to include confounding factors using SPSS Statistics for Windows (Version 22.0. Armonk, NY: IBM Corp.).

Results:
A total of 450 and 400 breast reconstructions were carried out in University Hospital of South Manchester (UHSM) and Royal Free London Hospital (RFH), respectively. We recorded a total complication of 37.8% in RFH cohort and 28% in UHSM cohort. The seroma rate was 11.25% and 13.33% in the UHSM and RFH cohort, respectively. Other complications reported were major and minor infections, implant loss, skin necrosis, hematomas, and implant exposure. Multiple linear regression analysis reported that confounding factors affected certain outcomes.

Conclusion:
Our 2-center complication rates were comparable to other articles. Results were comparable despite being in 2 different breast units in the United Kingdom.
Fluorescein Aqueous Angiography in Live Normal Human Eyes
Authors: Huang Alex S. , Penteado Rafaella C. , Saha Sajib K. , Do Jiun L. , Ngai Philip , Hu Zhihong , Weinreb Robert N. 
Published: August 2018

Purpose:
To evaluate aqueous humor outflow (AHO) in intact eyes of live human subjects during cataract surgery using fluorescein aqueous angiography.

Methods:
Aqueous angiography was performed in 8 live human subjects (56 to 86 y old; 2 men and 6 women). After anesthesia, fluorescein (2%) was introduced into the eye [either alone or after indocyanine green (ICG; 0.4%)] from a sterile, gravity-driven constant-pressure reservoir. Aqueous angiographic images were obtained with a Spectralis HRA+OCT and FLEX module (Heidelberg Engineering). Using the same device, anterior-segment optical coherence tomography (OCT) and infrared images were also concurrently taken with aqueous angiography.

Results:
Fluorescein aqueous angiography in the live human eye showed segmental AHO patterns. Initial angiographic signal was seen on average by 14.0±3.0 seconds (mean±SE). Using multimodal imaging, angiographically positive signal colocalized with episcleral veins (infrared imaging) and intrascleral lumens (anterior-segment OCT). Sequential aqueous angiography with ICG followed by fluorescein showed similar segmental angiographic patterns.

Discussion:
Fluorescein aqueous angiography in live humans was similar to that reported in nonhuman primates and to ICG aqueous angiography in live humans. As segmental patterns with sequential angiography using ICG followed by fluorescein were similar, these tracers can now be used sequentially, before and after trabecular outflow interventions, to assess their effects on AHO in live human subjects.
Efficacy and Safety of the Ab-interno Xen Gel Stent After Failed Trabeculectomy
Authors: Karimi Ayesha , Hopes Marina , Martin Keith R. , Lindfield Dan 
Published: August 2018

Aims:
To assess the efficacy and safety of the Xen gel stent in reducing intraocular pressure (IOP) in eyes with prior failed trabeculectomy and to determine the frequency of complications and further intervention.

Methods:
Retrospective case note review of all patients with prior trabeculectomy undergoing Xen surgery across 5 centers from August 2015 to May 2017.

Results:
In total, 17 surgeries were reviewed. IOP reduced from 21.5 (±2.4) mm Hg preoperatively to 13.6 (±3.4) mm Hg at month 12 (P<0.05). Medication usage reduced from 2.8 (±0.6) preoperatively to 1.0 (±1.3) at month 12 (P<0.05). Adverse events included: numerical hypotony (IOP<6 mm Hg) in 4 cases (23.5%) that all resolved spontaneously, IOP spike of ≥30 mm Hg in 2 (11.8%) cases and transient occlusion of the implant by iris in 1 (5.9%) case. Secondary filtration surgery (Baerveldt tube implantation) was required in 2 (11.8%) cases. Postoperative bleb intervention was required in 9 cases (52.9%), usually in the first month after surgery.

Conclusions:
Xen reduces IOP and number of medications in eyes with failed trabeculectomy. Detailed preoperative conjunctival assessment and targeted stent placement is required. Prospective data and follow-up beyond 12 months are required but Xen seems a viable, effective, and safe option after failed trabeculectomy.
Neuroprotective effect of angiotensin II type 2 receptor stimulation in vincristine-induced mechanical allodynia
Authors: Bessaguet Flavien , Danigo Aurore , Bouchenaki Hichem , Duchesne Mathilde , Magy Laurent , Richard Laurence , Sturtz Franck , Desmoulière Alexis , Demiot Claire 
Published: August 2018

Abstract
Peripheral neuropathy is the major dose-limiting side effect of many currently used chemotherapies, such as vincristine (VCR). We recently demonstrated that candesartan, an angiotensin II type 1 receptor antagonist, was neuroprotective against resiniferatoxin-induced sensory neuropathy, and that this effect is mediated by stimulation of the angiotensin II type 2 receptor (AT2R). Thus, we evaluated the effect of preventive treatment with candesartan and a specific AT2R agonist, C21, on a mouse model of VCR-induced neuropathy. Vincristine was administered daily for 7 days to male Swiss mice. Treatment with candesartan and C21 was started on day 1, before VCR treatment, and continued until day 7. We evaluated the development of VCR-induced neuropathy and the effect of treatment by functional tests, immunohistochemical analyses of intraepidermal nerve fibers and dorsal root ganglia neurons, and ultrastructural analysis of the sciatic nerve. Mice treated with VCR showed high mechanical allodynia but no modifications of motor performance or mechanical/thermal nociception. Treatment with candesartan and C21 completely restored normal tactile sensitivity of VCR-treated mice. Both drugs prevented VCR-induced nonpeptidergic intraepidermal nerve fiber loss. Only C21 displayed neuroprotective effects against VCR-induced loss and enlargement of myelinated nerve fibers in the sciatic nerve. Our finding that candesartan and C21 are protective against VCR-induced neuropathic pain through AT2R stimulation favors evaluation of its therapeutic potential in patients receiving chemotherapy.
Development of a Novel Pathways Program for Pre-Health Students by a Private Four-Year University and a Private Health Professions University
Authors: Funk Phillip E. , Knott Patrick , Burdick Lindsey , Roberts Michael 
Published: August 2018

Abstract
Education in the health professions occurs at the graduate level, increasing the barriers to underrepresented and first-generation students. Some programs attempt to alleviate these barriers by streamlining passage from the undergraduate campus to the medical campus within a university or by accelerating entry to the professions by bypassing the bachelor's degree. These solutions each have their own limitations for students, including added pressure to maintain grades and a limited ability to explore multiple professions. The Alliance for Health Sciences, a partnership between DePaul University and Rosalind Franklin University of Medicine and Science (RFUMS), was formed to address these issues and has created the Pathways Honors program. Through this program, current DePaul students may apply for an early admission decision to one of 6 of RFUMS's programs and, if qualified, pursue an accelerated entry. They have the option to apply for early decision at any time during their undergraduate career to encourage exploration of career options and to allow students to adjust to college rigor with lower stakes. In addition, collaborative, innovative advising contributes to creating well-rounded students and admissions committee decisions not dictated solely by test metrics. The Pathways Honors program has continued to attract a diverse student pool to DePaul, and early indications are that many of these students are making a successful transition to professional programs. Currently, we have data on our first cohort of students. Continued development of this program will be necessary to ensure that it is preparing students for rigorous graduate programs and helping to diversify the health care workforce.
Integrating oral health curricula into nurse practitioner graduate programs: Results of a US survey
Authors: Dolce Maria C. , Haber Judith , Savageau Judith A. , Hartnett Erin , Riedy Christine A. 
Published: August 2018

ABSTRACT

Background and purpose:
Nurse practitioners (NPs) are a significant segment of the US primary care workforce and have a pivotal role in improving access to oral health (OH) care. The purpose of this research was to assess OH curricular integration in primary care NP programs and to examine factors that influence integration and satisfaction with graduates' level of OH competence.

Methods:
A cross-sectional, national survey of NP programs (N = 466) was conducted using an electronically distributed 19-item, self-administered questionnaire. Data analysis included univariate, bivariate, multivariate statistics, and logistic regression modeling.

Conclusions:
The large majority of pediatric, family, and adult–gerontology primary care programs are educating NP graduates about OH. Significant factors promoting integration and satisfaction with graduates' level of competence included the presence of a faculty champion and routine teaching by a dental professional or nondental OH expert.

Implications for practice:
With adequate OH education, NPs are ideally positioned to integrate OH and primary care services in practice, thereby, improving access to OH care.
Effectiveness of early identification and electronic interventions for teens with risk factors for the development of heart disease and diabetes: Phase II findings
Authors: Jung Lorena , Courts Elizabeth , Webber Pam , Zhou Qiuping Pearl 
Published: August 2018

ABSTRACT

Background and purpose:
Serum and physical risk factors for the development of heart disease and diabetes are detectable long before adulthood. The purpose of this two-part study was to assess the prevalence and associations of these risk factors in teens and determine the effectiveness of a customizable two-part electronic education program on minimizing identified risks.

Methods:
Data were collected from teens (n = 168) from two high schools (one urban and one rural) in the mid-Atlantic region. After baseline data were collected, the two-part electronic education program was initiated. Serum and physical risk factors were rechecked at 12-week intervals, and results were analyzed.

Conclusions:
Significant serum and physical risk factor associations were identified and remained present among teens over the course of the study. High-density lipoproteins showed significant, steady improvement. Low-density lipoproteins were positively associated with body mass index, diastolic blood pressure, and thyroid-stimulating hormone level.

Implications for practice:
Although serum and physical risk factors are identifiable in teens, routine screening of this age group and younger is not an established standard of care. Health care providers need effective, innovative methods to counteract these risks. Through increased awareness of the presence of risk factors in young patients, advanced nurse practitioners may implement earlier interventions to counteract these risks.