bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correction of Lower Eyelid Retraction with En Glove Placement of Porcine Dermal Collagen Matrix Implant
Authors: Grumbine F. Lawson , Idowu Oulwatobi , Kersten Robert C. , Deparis Sarah W. , Vagefi M. Reza 
Published: February 2019

Summary:
The authors conducted a retrospective case series of patients undergoing a lateral tarsal strip procedure with “en glove” placement of an acellular porcine dermal collagen matrix for correction of mild to moderate lower eyelid retraction. A detailed description of this minimally invasive technique with retrospective analysis of outcomes is provided.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Wide-Awake Surgical Management of Hand Fractures: Technical Pearls and Advanced Rehabilitation
Authors: Hyatt Brad T. , Rhee Peter Charles 
Published: February 2019

Summary:
Most unstable metacarpal and phalangeal fractures for which operative treatment is indicated can be reduced and stabilized with either open or closed techniques using local anesthetic with epinephrine instead of intravenous sedation or general anesthesia. With the patient wide-awake during surgery, the hand can be taken through active range of motion to assess fracture stability. In this article, the authors review the rationale and technique for wide-awake, local anesthesia, no tourniquet surgery in the treatment of phalangeal and metacarpal fractures and impart pearls to optimize the patient experience and illustrate common fixation techniques using percutaneous Kirschner wires. The intraoperative assessment of fracture stability permits an accelerated, protected–range-of-motion protocol that minimizes postoperative stiffness and facilitates expedient recovery.
Is Chest Computed Tomography Always Necessary Following Nephrectomy for Renal Cell Carcinoma? A Pilot Study in Single Tertiary Institution
Authors: Lee Hong Seon , Kang Won Jun , Cho Nam Hoon , Park Sung Yoon 
Published: February 2019

Purpose
We evaluated patterns of thoracic recurrence from renal cell carcinoma (RCC) following nephrectomy as a pilot study.

Methods
Data of consecutive 39 patients who had recurrent RCC in the abdomen or thorax following curative nephrectomy were evaluated. Recurrence sites were analyzed with abdomen and chest computed tomography (CT), or positron emission tomography/CT. All patients had no metastasis before initial nephrectomy. Recurrence was classified into 3 types according to the site of initially detected recurrence: (a) abdomen-only type, (b) abdomen and thorax type, and (c) thorax-only type. Vertebral level of recurrence site in the thorax-only level was investigated. University of California Los Angeles–Integrated Staging System was utilized for risk stratification (eg, low, intermediate, and high-risk).

Results
Rate of intermediate or high risk was 89.7% (37/39). Rate of thoracic recurrence, regardless of concurrent abdominal recurrence, was 71.8% (28/39). Rate of thorax-only type was 53.8% (21/39). In thorax-only type, median vertebral level of recurrence site was T10 (range, T3–T12), and no patient with low risk had metastasis above the T10 level alone. In intermediate or high risk, 89.2% (33/37) had at least a recurrent lesion at the level of T7 or lower.

Conclusions
In low-risk patients, upper thoracic recurrence alone may be very rare after curative surgery. In majority of intermediate- or high-risk patients, initial recurrence may occur in the abdomen or lower thorax, which indicates abdomen CT covering T7 level may be an effective tool for postoperative follow-up in RCC.
Novel Hybrid Dextran-Gadolinium Nanoparticles as High-relaxivity T1 Magnetic Resonance Imaging Contrast Agent for Mapping the Sentinel Lymph Node
Authors: Lu Bolun , Wang Hao , Lu Qing , Tang Zhengya , Dou Hongjing , Dai Tingting , Li Shengli 
Published: February 2019

Objectives
To assess the applicability of a novel hybrid dextran-gadolinium nanoparticles (NPs) as high-relaxivity T1 magnetic resonance imaging (MRI) contrast agent for mapping the sentinel lymph node (SLN).

Methods
Dextran-bis-acrylamide-polyacrylic acid (Dex-MBA-PAA) NPs were synthesized through a self-assembly assisted approach and complexed with multiple chelated gadolinium (Gd) (III) ions. After their characterization was validated, they were used to mapping SLNs by MRI in Wistar rats, and their biosafety was evaluated.

Results
Dextran-MBA-polyacrylic acid-Gd NPs have suitable particle size and much higher longitudinal relaxivity (r
1) than that of commonly used clinical MRI contrast agents (eg, gadopentetic acid dimeglumine salt injection). The in vivo T1-weighted MRI results revealed their effectiveness at mapping SLNs. And their biological safety was also verified.

Conclusions
Dextran-MBA-polyacrylic acid-Gd NPs were synthesized and validated by in vitro and in vivo experiments for their ability to visualize SLNs by MRI with accurate positioning and excellent biosafety, and they have great potential for clinical SLN mapping.
Comparison of Cone-Beam Computed Tomography and Multislice Computed Tomography in the Assessment of Extremity Fractures
Authors: Dubreuil Thibaut , Mouly Jérôme , Ltaief-Boudrigua Aïcha , Martinon Amanda , Tilhet-Coartet Stéphane , Tazarourte Karim , Pialat Jean-Baptiste 
Published: February 2019

Objectives
The aims of this study were to evaluate the agreement between cone-beam computed tomography (CBCT) and multislice computed tomography for the characterization of extremity fractures and to compare image quality, radiation dose, and patient tolerance.

Methods
Thirty-six patients with suspected fracture affecting distal extremities or who required preoperative fracture assessment were enrolled prospectively. Each patient underwent CBCT and multislice computed tomography the same day. Both examinations were evaluated independently twice by 2 trained radiologists using the Müller AO classification for fracture characterization.

Results
Cohen κ coefficient for agreement between the imaging techniques was almost perfect for fracture characterization, κ = 0.94 [95% confidence interval, 0.91–0.98]. There was substantial to almost perfect agreement for secondary findings. Cone-beam computed tomography was well tolerated and significantly less irradiant and had better subjective image.

Conclusions
An excellent agreement between both imaging techniques was found. This confirms the ability of CBCT to assess fractures and its potential in the management of patients with distal limb trauma.
Circulatory Stasis or Thrombus in Left Atrial Appendage, An Easy Diagnostic Solution
Authors: Kantarci Mecit , Ogul Hayri , Sade Recep , Aksakal Enbiya , Colak Abdurrahim , Tanboga Ibrahim Halil 
Published: February 2019

Objective
The purpose of this study was to assess the diagnostic performance of prone position cardiac multidetector computed tomography (MDCT) in the detection of left atrial appendage (LAA) thrombi and to make differentiate between thrombus and circulatory stasis using transesophageal echocardiography (TEE) as the criterion-standard imaging modality.

Methods
From December 2014 to April 2016, 53 consecutive patients were admitted to the hospital because of circulatory stasis or/and thrombus. All patients underwent prone-position MDCT and TEE. Prone-position MDCT and TEE sensitivity, specificity, positive predictive value, and negative predictive value were calculated.

Results
For the MDCT scan in the prone position, the sensitivity, specificity, positive predictive value, and negative predictive value results were 100%, 100%, 100%, and 100%, respectively.

Conclusions
Multidetector computed tomography scanning in the prone position differentiates circulatory stasis and LAA thrombus, is clinically useful for detecting and ruling out LAA thrombus, and may be an alternative to TEE as a diagnostic tool.
Impact of the Myotomy Extent on Gastric Side on Surgical Outcome After Heller’s Cardiomotomy for Achalasia
Authors: El Nakeeb Ayman , Ezzat Helmy , Shehta Ahmed , El Gawad Mohamed A. , Abou El-Magd El-Sayed , El Sorogy Mohamed , Elrefei Mohamed , El-Geidi Ahmed A. , Gad El-Hak Nabil 
Published: February 2019

Background:
Laparoscopic Heller cardiomyotomy (LHM) with Dor fundoplication represents the most commonly accepted surgical management for achalasia. The ideal extent of myotomy on the gastric side remains a matter of continuous debate. The aim of this study was to compare the impact of the extent of myotomy on the gastric side on the outcome of LHM.

Patients and Methods:
Patients with achalasia who underwent LHM included in the study. The patients were classified according to the length of the gastric myotomy into 3 groups (group I: <1.5 cm, group II: 1.5 to 2.5 cm, and group III: >2.5 cm).

Results:
In total, 212 patients (94 males and 118 females) with achalasia treated by LHM and Dor fundoplication included in the study. No statistically significant differences were found among the 3 groups as regards preoperative data, intraoperative mucosal perforation, operative time, blood loss, and hospital stay. The incidence of persistent dysphagia was significantly higher in the group I. Postoperative GERD symptoms were significantly higher in group III (23.3%, P<0.0001). Recurrent achalasia was significantly higher in group I with 11 patients (15.9%), 8 patients in group II (7.1%), and nil in group III (P<0.02).

Conclusions:
Longer myotomy on the gastric side (>2.5 cm) ensures complete division of the LES with better outcomes in term of resolution of dysphagia but may be associated with higher postoperative GERD. Therefore, a myotomy length of 1.5 to 2.5 cm on the gastric side provides a balance between relieve of dysphagia and development of postoperative GERD.
Regulation of endothelial cell permeability by platelet-derived extracellular vesicles
Authors: Miyazawa Byron , Trivedi Alpa , Togarrati Padma Priya , Potter Daniel , Baimukanova Gyulnar , Vivona Lindsay , Lin Maximillian , Lopez Ernesto , Callcut Rachael , Srivastava Amit K. , Kornblith Lucy Z. , Fields Alexander T. , Schreiber Martin A. , Wade Charles E. , Holcomb John B. , Pati Shibani 
Published: February 2019

BACKGROUNDPlatelet (Plt)-derived extracellular vesicles (Plt-EVs) have hemostatic properties similar to Plts. In addition to hemostasis, Plts also function to stabilize the vasculature and maintain endothelial cell (EC) barrier integrity. We hypothesized that Plt-EVs would inhibit vascular EC permeability, similar to fresh Plts. To investigate this hypothesis, we used in vitro and in vivo models of vascular endothelial compromise and bleeding.METHODSIn the vitro model, Plt-EVs were isolated by ultracentrifugation and characterized for Plt markers and particle size distribution. Effects of Plts and Plt-EVs on endothelial barrier function were assessed by transendothelial electrical resistance measurements and histological analysis of endothelial junction proteins. Hemostatic potential of Plt-EVs and Plts was assessed by multiple electrode Plt aggregometry. Using an in vivo model, the effects of Plts and Plt-EVs on vascular permeability and bleeding were assessed in non-obese diabetic-severe combined immunodeficient (NOD-SCID) mice by an established Miles assay of vascular permeability and a tail snip bleeding assay.RESULTSIn the in vitro model, Plt-EVs displayed exosomal size distribution and expressed Plt-specific surface markers. Platelets and Plt-EVs decreased EC permeability and restored EC junctions after thrombin challenge. Multiplate aggregometry revealed that Plt-EVs enhanced thrombin receptor–activating peptide-mediated aggregation of whole blood, whereas Plts enhanced thrombin receptor–activating peptide–, arachidonic acid–, collagen-, and adenosine diphosphate–mediated aggregation. In the in vivo model, Plt-EVs are equivalent to Plts in attenuating vascular endothelial growth factor (VEGF)-A–induced vascular permeability and uncontrolled blood loss in a tail snip hemorrhage model.CONCLUSIONOur study is the first to report that Plt-EVs might provide a feasible product for transfusion in trauma patients to attenuate bleeding, inhibit vascular permeability, and mitigate the endotheliopathy of trauma.
Phase I/II Trial of Liver–derived Mesenchymal Stem Cells in Pediatric Liver–based Metabolic Disorders: A Prospective, Open Label, Multicenter, Partially Randomized, Safety Study of One Cycle of Heterologous Human Adult Liver–derived Progenitor Cells (HepaStem) in Urea Cycle Disorders and Crigler-Najjar Syndrome Patients
Authors: Smets Françoise , Dobbelaere Dries , McKiernan Patrick , Dionisi-Vici Carlo , Broué Pierre , Jacquemin Emmanuel , Lopes Ana Isabel , Gonçalves Isabel , Mandel Hanna , Pawlowska Joanna , Kamińska Diana , Shteyer Eyal , Torre Giuliano , Shapiro Riki , Eyskens François , Clapuyt Philippe , Gissen Paul , Pariente Danièle , Grunewald Stephanie , Yudkoff Marc , Binda Maria Mercedes , Najimi Mustapha , Belmonte Nathalie , de Vos Beatrice , Thonnard Joelle , Sokal Etienne 
Published: February 2019

Background.
Regenerative medicine using stem cell technology is an emerging field that is currently tested for inborn and acquired liver diseases.

Objective.
This phase I/II prospective, open label, multicenter, randomized trial aimed primarily at evaluating the safety of Heterologous Human Adult Liver–derived Progenitor Cells (HepaStem) in pediatric patients with urea cycle disorders (UCDs) or Crigler-Najjar (CN) syndrome 6 months posttransplantation. The secondary objective included the assessment of safety up to 12 months postinfusion and of preliminary efficacy.

Methods.
Fourteen patients with UCDs and 6 with CN syndrome were divided into 3 cohorts by body weight and intraportally infused with 3 doses of HepaStem. Clinical status, portal vein hemodynamics, morphology of the liver, de novo detection of circulating anti–human leukocyte antigen antibodies, and clinically significant adverse events (AEs) and serious adverse events to infusion were evaluated by using an intent-to-treat analysis.

Results.
The overall safety of HepaStem was confirmed. For the entire study period, patient-month incidence rate was 1.76 for the AEs and 0.21 for the serious adverse events, of which 38% occurred within 1 month postinfusion. There was a trend of higher events in UCD as compared with CN patients. Segmental left portal vein thrombosis occurred in 1 patient and intraluminal local transient thrombus in a second patient. The other AEs were in line with expectations for catheter placement, cell infusion, concomitant medications, age, and underlying diseases.

Conclusions.
This study led to European clinical trial authorization for a phase II study in a homogeneous patient cohort, with repeated infusions and intermediate doses.
Coronary Artery Disease and Coronary Artery Bypass Grafting at the Time of Lung Transplantation Do Not Impact Overall Survival
Authors: Halloran Kieran , Hirji Alim , Li David , Jackson Kathy , Kapasi Ali , Meyer Steve , Mullen John , Lien Dale , Weinkauf Justin 
Published: February 2019

Background.
Coronary artery disease (CAD) is common in lung transplant candidates and may require revascularization before or at the time of their transplant. We reviewed the survival of lung transplant recipients with CAD requiring surgical intervention (CAD-coronary artery bypass grafting [CABG]) and those who did not (CAD-NoCABG) at the time of transplant, compared to a cohort with no CAD (NoCAD).

Methods.
We conducted a retrospective cohort study of adult patients transplanted in our program between 2004 and 2013. Our primary outcome was the association between 3-way CAD status (CAD-CABG, CAD-NoCABG, NoCAD) and overall retransplant-free survival via proportional hazards modeling, adjusting for age, gender, and transplant indication. Secondary endpoints included 1-year survival, survival by Kaplan-Meier analysis, duration of ventilation, intensive care unit stay, and hospitalization.

Results.
A total of 333 patients underwent transplant during the study timeframe. A total of 24 (7%) had CAD requiring CABG, 82 (25%) had CAD not requiring CABG, and the remaining 227 had no CAD. The 3-way CAD status was not associated with overall retransplant-free survival after adjustment for age, gender, and transplant indication. Duration of mechanical ventilation, intensive care unit stay and hospitalization were longer in both CAD groups compared with the NoCAD group.

Conclusions.
CAD status does not impact overall retransplant-free survival, despite greater perioperative complexity. Prospective studies comparing treatment strategies in these patient groups are warranted.
Safety of Everolimus With Reduced Calcineurin Inhibitor Exposure in De Novo Kidney Transplants: An Analysis From the Randomized TRANSFORM Study
Authors: Tedesco-Silva Helio , Pascual Julio , Viklicky Ondrej , Basic-Jukic Nikolina , Cassuto Elisabeth , Kim Dean Y. , Cruzado Josep M. , Sommerer Claudia , Adel Bakr Mohamed , Garcia Valter D. , Uyen Huynh-Do , Russ Graeme , Soo Kim Myoung , Kuypers Dirk , Buchler Matthias , Citterio Franco , Hernandez Gutierrez Maria Pilar , Bernhardt Peter , Chadban Steve 
Published: February 2019

Background.
The safety profiles of standard therapy versus everolimus with reduced-exposure calcineurin inhibitor (CNI) therapy using contemporary protocols in de novo kidney transplant recipients have not been compared in detail.

Methods.
TRANSFORM was a randomized, international trial in which de novo kidney transplant patients were randomized to everolimus with reduced-exposure CNI (N = 1014) or mycophenolic acid (MPA) with standard-exposure CNI (N = 1012), both with induction and corticosteroids.

Results.
Within the safety population (everolimus 1014, MPA 1012), adverse events with a suspected relation to study drug occurred in 62.9% versus 59.2% of patients given everolimus or MPA, respectively (P = 0.085). Hyperlipidemia, interstitial lung disease, peripheral edema, proteinuria, stomatitis/mouth ulceration, thrombocytopenia, and wound healing complications were more frequent with everolimus, whereas diarrhea, nausea, vomiting, leukopenia, tremor, and insomnia were more frequent in the MPA group. The incidence of viral infections (17.2% versus 29.2%; P < 0.001), cytomegalovirus (CMV) infections (8.1% versus 20.1%; P < 0.001), CMV syndrome (13.6% versus 23.0%, P = 0.044), and BK virus (BKV) infections (4.3% versus 8.0%, P < 0.001) were less frequent with everolimus. CMV infection was less common with everolimus versus MPA after adjusting for prophylaxis therapy in the D+/R− subgroup (P < 0.001). Study drug was discontinued more frequently due to rejection or impaired healing with everolimus, and more often due to BKV infection or BKV nephropathy with MPA.

Conclusions.
De novo everolimus with reduced-exposure CNI yielded a comparable incidence, though a distinctly different pattern, of adverse events versus current standard of care. Both regimens are safe and effective, yet their distinct profiles may enable tailoring for individual kidney transplant recipients.
Geographic Disparity in Deceased Donor Liver Transplant Rates Following Share 35
Authors: Bowring Mary G. , Zhou Sheng , Chow Eric K.H. , Massie Allan B. , Segev Dorry L. , Gentry Sommer E. 
Published: February 2019

Background.
The Organ Procurement and Transplantation Network implemented Share 35 on June 18, 2013, to broaden deceased donor liver sharing within regional boundaries. We investigated whether increased sharing under Share 35 impacted geographic disparity in deceased donor liver transplantation (DDLT) across donation service areas (DSAs).

Methods.
Using Scientific Registry of Transplant Recipients June 2009 to June 2017, we identified 86 083 adult liver transplant candidates and retrospectively estimated Model for End-Stage Liver Disease (MELD)-adjusted DDLT rates using nested multilevel Poisson regression with random intercepts for DSA and transplant program. From the variance in DDLT rates across 49 DSAs and 102 programs, we derived the DSA-level median incidence rate ratio (MIRR) of DDLT rates. MIRR is a robust metric of heterogeneity across each hierarchical level; larger MIRR indicates greater disparity.

Results.
MIRR was 2.18 pre-Share 35 and 2.16 post-Share 35. Thus, 2 candidates with the same MELD in 2 different DSAs were expected to have a 2.2-fold difference in DDLT rate driven by geography alone. After accounting for program-level heterogeneity, MIRR was attenuated to 2.10 pre-Share 35 and 1.96 post-Share 35. For candidates with MELD 15–34, MIRR decreased from 2.51 pre- to 2.27 post-Share 35, and for candidates with MELD 35–40, MIRR increased from 1.46 pre- to 1.51 post-Share 35, independent of program-level heterogeneity in DDLT. DSA-level heterogeneity in DDLT rates was greater than program-level heterogeneity pre- and post-Share 35.

Conclusions.
Geographic disparity substantially impacted DDLT rates before and after Share 35, independent of program-level heterogeneity and particularly for candidates with MELD 35–40. Despite broader sharing, geography remains a major determinant of access to DDLT.
Transplant Suitability of Rejected Human Donor Lungs With Prolonged Cold Ischemia Time in Low-Flow Acellular and High-Flow Cellular Ex Vivo Lung Perfusion Systems
Authors: Okamoto Toshihiro , Wheeler David , Farver Carol F. , McCurry Kenneth R. 
Published: February 2019

Background.
Ex vivo lung perfusion (EVLP) has the potential to increase the number of donor lungs available for lung transplantation (LTx). While the current maximum cold ischemia time (CIT) for donor lungs in clinical LTx is around 8 hours, there are no data regarding the potential use of rejected donor lungs with CIT >8 hours before EVLP. The purpose of this study was to investigate the transplant suitability of lungs with a prolonged CIT in 2 EVLP systems.

Methods.
Following prolonged CIT of 13.8 hours (range 9.0–19.5 h), 16 rejected human donor lungs were randomly divided and perfused using either low-flow acellular or high-flow cellular EVLP systems (n = 8, each). Transplant suitability was evaluated according to the standard criteria of each EVLP system.

Results.
The high-flow cellular group was associated with a significantly lower transplant suitability (0% versus 37%, P = 0.027), significantly lower wet-to-dry ratio change (−0.71 ± 0.62 versus 0.43 ± 1.01, P = 0.035), and lower pathological score (1.62 ± 0.61 versus 3.00 ± 0.61, P = 0.163) than the low-flow acellular group. In both systems, inflammatory cytokines on perfusate (tumor necrosis factor-α, interleukin [IL]-1ß, IL-6, IL-8, and IL-10) increased in a time-dependent manner and were significantly higher than those of controls with CIT <8 hours (P < 0.05).

Conclusions.
The potential for reconditioning lungs with a CIT >8 hours is diminished compared with that for lungs having a shorter CIT due to severe ischemia reperfusion injury.