bluuebunny/crossref_metadata_2025_split huggingface dataset:
State Variations in Public Payer Reimbursement for Common Plastic Surgery Procedures
Authors: Kaura Arminder S. , Berlin Nicholas L. , Momoh Adeyiza O. , Kozlow Jeffrey H. 
Published: September 2018

Background:
Existing data suggest decreased willingness of plastic surgeons to participate in Medicare and Medicaid. Significant disparities exist in Medicare and Medicaid reimbursement for various general surgical procedures. The aims of this study were to investigate variations in Medicare and Medicaid reimbursement across the nation for common plastic surgery procedures.

Methods:
Medicare and Medicaid reimbursement data for 2017 were obtained by means of the Centers for Medicare & Medicaid Services and publicly available fee schedules from each state, respectively, for eight common plastic surgery procedures. The difference in Medicare and Medicaid reimbursement was calculated across all states. The difference in value ascribed to each procedure was determined by comparing the payment from each payer to the work relative value units.

Results:
Medicaid reimbursement rates were significantly lower for the selected procedures, with a median national discount of −25 percent ($16.09 per work relative value unit) compared to Medicare. There were higher median rates of reimbursement per work relative value unit by Medicaid in only five states when compared to Medicare. Significant variations of more than 15 percent in the Medicaid-to-Medicare reimbursement ratios between our selected procedures were identified in 28 states.

Conclusions:
Variations exist between Medicare and Medicaid reimbursement for common plastic surgery procedures. The within-state variations in Medicaid reimbursement are likely reflective of important yet nontransparent differences in determining Medicaid reimbursement. These variations likely affect access to care for underserved populations. Professional societies should continue to convey the value of these important procedures and raise awareness regarding disparities in access to care.
The Stacked Hemiabdominal Extended Perforator Flap for Autologous Breast Reconstruction
Authors: Beugels Jop , Vasile Julie V. , Tuinder Stefania M. H. , Delatte Stephen J. , St-Hilaire Hugo , Allen Robert J. , Levine Joshua L. 
Published: September 2018

Background:
Options for bilateral autologous breast reconstruction in thin women are limited. The aim of this study was to introduce a novel approach to increase abdominal flap volume with the stacked hemiabdominal extended perforator (SHAEP) flap. The authors describe the surgical technique and analyze their results.

Methods:
A retrospective study was conducted of all SHAEP flap breast reconstructions performed since February of 2014. Patient demographics, operative details, complications, and flap reexplorations were recorded. The bipedicled hemiabdominal flap was designed as a combination of the deep inferior epigastric artery perforator (DIEP) and a second, more lateral pedicle: the deep or superficial circumflex iliac perforator vessels, the superficial inferior epigastric artery, or a lumbar artery or intercostal perforator.

Results:
A total of 90 SHAEP flap breast reconstructions were performed in 49 consecutive patients. Median operative time was 500 minutes (range, 405 to 797 minutes). Median hemiabdominal flap weight that was used for reconstruction was 598 g (range, 160 to 1389 g). No total flap losses were recorded. Recipient-site complications included partial flap loss (2.2 percent), hematoma (3.3 percent), fat necrosis (2.2 percent), and wound problems (4.4 percent). Minor donor-site complications occurred in five patients (10.2 percent). Most flaps were harvested on a combination of the DIEP and deep circumflex iliac artery vessels.

Conclusions:
This study demonstrated that the SHAEP flap is an excellent option for bilateral autologous breast reconstruction in women who require significant breast volume but have insufficient abdominal tissue for a bilateral DIEP flap. The bipedicled SHAEP flap allows for enhanced flap perfusion, increased volume, and abdominal contour improvement using a single abdominal donor site.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Developing a Rural, Community-Based Registry for Cardiovascular Quality Improvement
Authors: Langabeer James R. , Champagne-Langabeer Tiffany , Smith Derek 
Published: September 2018

Background:
Cardiovascular disease is one of the leading causes of death, yet most evidence is collected from small clinical trials or individual hospital providers. Achieving scalable data to enable quality improvements (QIs) remains a challenge. We investigate whether a registry that is shared by multiple providers and integrates data longitudinally could help drive QIs across a large rural geographic region.

Methods:
We describe a case study involving the development of an informatics infrastructure across the entire state of Wyoming. This rural, regional, community-based cardiovascular system of care involved all interventional hospitals in the state as well as all surrounding states. Data exchange was initiated between 36 hospitals, and 56 ambulance agencies, to a centralized registry for clinical analytics and QI for patients with acute myocardial infarction.

Results:
After 3 years, the registry maintained all documented acute myocardial infarctions across Wyoming. Median total ischemic time (time from patient's symptom onset to definitive treatment) had a 36.7% improvement during the program. Changes in quality for the rural community included reduction in overall treatment times, as well as enhanced training, standardized protocols, and community awareness. We also share key lessons learned.

Conclusions:
Collaborative data registries for emergency cardiovascular care can help providers and communities measure and improve the quality of the care across regions.
68Ga–Prostate-Specific Membrane Antigen PET/CT and 18F-FDG PET/CT of Primary Signet Ring Cell Breast Adenocarcinoma
Authors: Parihar Ashwin Singh , Mittal Bhagwant Rai , Sood Apurva , Basher Rajender Kumar , Singh Gurpreet 
Published: September 2018

Abstract
Primary signet ring cell adenocarcinoma of the breast is a rare neoplasm. Similar to other mucinous neoplasms, it has low FDG avidity and poor prognosis compared with the traditional ductal/lobular carcinomas. We present a case of a 40-year-old woman with signet ring cell adenocarcinoma and skeletal fluorosis showing higher uptake of 68Ga–prostate-specific membrane antigen in the primary lesion and the metastatic sites compared with 18F-FDG on PET/CT imaging. Additionally, diffuse increased prostate-specific membrane antigen uptake was noticed in the entire skeleton, likely due to skeletal fluorosis.
Bone Flare to Androgen Deprivation Therapy in Metastatic, Hormone-Sensitive Prostate Cancer on 68Ga-Prostate-Specific Membrane Antigen PET/CT
Authors: Zacho Helle D. , Petersen Lars J. 
Published: September 2018

Abstract
A 69-year-old man with newly diagnosed prostate cancer PSA 274 ng/mL, Gleason 4+3, T-stage 3b) underwent 68Ga-PSMA PET/CT for staging with follow-up scans 6 and 13 weeks after androgen deprivation therapy (ADT) initiation. Six weeks after ADT initiation, lymph node metastases observed at staging showed metabolic and radiological regression, whereas the skeleton showed increased PSMA uptake in existing bone metastases and several new PSMA-avid lesions. Skeletal PSMA uptake decreased after 13 weeks of ADT, and prostate-specific antigen decreased to 16 ng/mL. These findings suggest the presence of the flare phenomenon to ADT in bone metastases seen on PSMA PET/CT.
FDG PET/CT Findings in TAFRO Syndrome
Authors: Hotta Masatoshi , Minamimoto Ryogo , Yashima Arisa , Nakano Masahiro , Yamashita Hiroyuki 
Published: September 2018

Abstract
A 67-year-old woman with prolonged fever, thrombocytopenia, and renal dysfunction underwent FDG PET/CT to evaluate underlying causes, including malignancy. PET/CT showed FDG uptake in ascites, subcutaneous edema, lymph nodes, spleen, and bone marrow. Subsequent bone marrow biopsy revealed myelofibrosis, and laboratory testing showed elevated concentrations of interleukin 6 in serum and ascites. These findings led to the diagnosis of TAFRO syndrome, a variant of multicentric Castleman disease, characterized by thrombocytopenia, anasarca, fever, reticulin myelofibrosis, and organomegaly. Because TAFRO syndrome is potentially fatal, accurate diagnosis is crucial. Characteristic FDG PET/CT findings facilitate the diagnosis of TAFRO syndrome, which is generally challenging.
A Case of Liver Injury Mimicking Metastasis After Gamma Knife Therapy for Lung Cancer
Authors: Tang Kun , Zheng Xiangwu , Lin Jie , Yin Weiwei 
Published: September 2018

Abstract
A 52-year-old man presented a mixed low-density lesion with high FDG uptake in hepatic segment VIII after gamma knife therapy for lung cancer, which was easily misdiagnosed as hepatic metastasis. Follow-up PET/CT assessment demonstrated that the hepatic lesion was barely observed and without FDG accumulation 5 months after radiotherapy. This case suggests that a new FDG-avid lesion at PET/CT after radiotherapy for lung cancer can be caused by radiation-induced liver injury. Knowledge of its imaging characteristics and nature course evaluated by follow-up PET/CT is critical to avoid misinterpretation of this lesion as metastases.
Botulinum Toxin Injection for Lower Face and Oral Cavity Raynaud Phenomenon After Mandibulectomy, Free Fibula Reconstruction, and Radiation Therapy
Authors: Boukovalas Stefanos , Mays Ashley C. , Selber Jesse C. 
Published: September 2018

Abstract
Isolated lingual and lower face Raynaud phenomenon without primary Raynaud of the digits is a very rare condition associated with chemoradiation therapy (RT) in previous reports. The condition, which more commonly presents in patients with a history of Raynaud disease, is often self-limiting, but vasodilating agents and steroids have been suggested as possible treatment options. Spasmodic torticollis is a different, more common entity, also associated with history of RT or previous head and neck surgery. We present a rare case of a patient who developed Raynaud phenomenon of the lower face and tongue in the presence of spasmodic torticollis after mandibulectomy and free fibula reconstruction followed by RT to the oral cavity and neck. Possible causes, pathophysiologic mechanisms and treatment options are discussed. This is the first report of botulinum toxin treatment of isolated secondary Raynaud phenomenon of the lower face and tongue.
Provider Characteristics Associated With Outpatient Opioid Prescribing After Surgery
Authors: Cron David C. , Lee Jay S. , Dupree James M. , Syrjamaki John D. , Hu Hsou Mei , Palazzolo William C. , Englesbe Michael J. , Brummett Chad M. , Waljee Jennifer F. 
Published: September 2018

Objective:
To characterize differences in postoperative opioid prescribing across surgical, nonsurgical, and advanced practice providers.

Background:
There is a critical need to identify best practices around perioperative opioid prescribing. To date, differences in postoperative prescribing among providers are poorly understood.

Methods:
This is a retrospective multicenter analysis of commercial insurance claims from a statewide quality collaborative. We identified 15,657 opioid-naïve patients who underwent a range of surgical procedures between January 2012 and October 2015 and filled an opioid prescription within 30 days postoperatively. Our primary outcome was total amount of opioid filled per prescription within 30 days postoperatively [in oral morphine equivalents (OME)]. Hierarchical linear regression was used to determine the association between provider characteristics [specialty, advanced practice providers (nurse practitioners and physician assistants) vs. physician, and gender] and outcome while adjusting for patient factors.

Results:
Average postoperative opioid prescription amount was 326 ± 285 OME (equivalent: 65 tablets of 5 mg hydrocodone). Advanced practice providers accounted for 19% of all prescriptions, and amount per prescription was 18% larger in this group compared with physicians (315 vs. 268, P < 0.001). Primary care providers accounted for 13% of all prescriptions and prescribed on average 279 OME per prescription. The amount of opioid prescribed varied by surgical specialty and ranged from 178 OME (urology) to 454 OME (neurosurgery).

Conclusions:
Advanced practice providers account for 1-in-5 postoperative opioid prescriptions and prescribe larger amounts per prescription relative to surgeons. Engaging all providers involved in postoperative care is necessary to understand prescribing practices, identify barriers to reducing prescribing, and tailor interventions accordingly.
Surgical Outcomes of Hepatocellular Carcinoma With Bile Duct Tumor Thrombus
Authors: Kim Dong-Sik , Kim Bong-Wan , Hatano Etsuro , Hwang Shin , Hasegawa Kiyoshi , Kudo Atsushi , Ariizumi Shunichi , Kaibori Masaki , Fukumoto Takumi , Baba Hideo , Kim Seong Hoon , Kubo Shoji , Kim Jong Man , Ahn Keun Soo , Choi Sae Byeol , Jeong Chi-Young , Shima Yasuo , Nagano Hiroaki , Yamasaki Osamu , Yu Hee Chul , Han Dai Hoon , Seo Hyung-Il , Park Il-Young , Yang Kyung-Sook , Yamamoto Masakazu , Wang Hee-Jung 
Published: September 2018

Objective:
To identify optimal surgical methods and the risk factors for long-term survival in patients with hepatocellular carcinoma accompanied by macroscopic bile duct tumor thrombus (BDTT).

Summary Background Data:
Prognoses of patients with hepatocellular carcinoma accompanied by BDTT have been known to be poor. There have been significant controversies regarding optimal surgical approaches and risk factors because of the low incidence and small number of cases in previous reports.

Methods:
Records of 257 patients from 32 centers in Korea and Japan (1992-2014) were analyzed for overall survival and recurrence rate using the Cox proportional hazard model.

Results:
Curative surgery was performed in 244 (94.9%) patients with an operative mortality of 5.1%. Overall survival and recurrence rate at 5 years was 43.6% and 74.2%, respectively. TNM Stage (P < 0.001) and the presence of fibrosis/cirrhosis (P = 0.002) were independent predictors of long-term survival in the Cox proportional hazards regression model. Both performing liver resection equal to or greater than hemihepatectomy and combined bile duct resection significantly increased overall survival [hazard ratio, HR = 0.61 (0.38-0.99); P = 0.044 and HR = 0.51 (0.31-0.84); P = 0.008, respectively] and decreased recurrence rate [HR = 0.59 (0.38-0.91); P = 0.018 and HR = 0.61 (0.42-0.89); P = 0.009, respectively].

Conclusions:
Clinical outcomes were mostly influenced by tumor stage and underlying liver function, and the impact of BDTT to survival seemed less prominent than vascular invasion. Therefore, an aggressive surgical approach, including major liver resection combined with bile duct resection, to increase the chance of R0 resection is strongly recommended.
Disease-free Survival and Local Recurrence After Laparoscopic-assisted Resection or Open Resection for Rectal Cancer
Authors: Stevenson Andrew R. L. , Solomon Michael J. , Brown Christopher S. B. , Lumley John W. , Hewett Peter , Clouston Andrew D. , Gebski Val J. , Wilson Kate , Hague Wendy , Simes John 
Published: September 2018

Objective:
The aim of the study was to determine the efficacy of laparoscopic rectal resection (Lap) versus open laparotomy and rectal resection (Open) for rectal cancer on locoregional recurrence (LRR) and disease-free survival (DFS) at 2 years.

Summary background data:
Although a Lap approach to colon cancer surgery may offer similar oncological outcomes to Open with potentially less morbidity, this remains to be clearly established for the treatment of rectal cancer.

Methods:
A randomized, multicenter noninferiority phase 3 trial of 475 patients with T1 to T3 rectal adenocarcinoma <15 cm from anal verge, given Lap or Open and followed for a minimum 2 years to assess LRR, DFS, and overall survival (OS).

Results:
Secondary endpoint analyses included 450 patients (95%) without metastases at baseline (mean age 64; 34% women) who received Lap (n = 225) or Open (n = 225). Median follow-up was 3.2 years (range: 0.1–5.4 yrs). LRR cumulative incidence at 2 years: Lap 5.4%; Open 3.1% [difference, 2.3%; 95% confidence interval (CI), −1.5% to 6.1%; hazard ratio (HR) 1.7; 95% CI, 0.74–3.9]. DFS at 2 years: Lap 80%; Open 82% (difference, 2.0%; 95% CI, −9.3% to 5.4%; HR for recurrence or death, 1.17; 95% CI, 0.81–1.68; P = 0.41). After adjustment for baseline factors HR = 1.07 (95% CI, 0.7–1.6). OS at 2 years: Lap 94%; Open 93% (difference 0.9%; 95% CI, −3.6% to 5.4%).

Conclusions:
Laparoscopic surgery for rectal cancer did not differ significantly from open surgery in effects on 2-year recurrence or DFS and OS. Confidence intervals included potentially clinically important differences favoring open resection, so that the combination of primary and secondary study endpoints may not support laparoscopic resection of rectal cancer as a routine standard of care and further follow-up is required.
Workload, Recurrence, Quality of Life and Long-term Efficacy of Endoscopic Therapy for High-grade Dysplasia and Intramucosal Esophageal Adenocarcinoma
Authors: Schwameis Katrin , Zehetner Jörg , Green Kyle M. , DeMeester Steven R. 
Published: September 2018

Objective:
To review the workload, type and frequency of recurrence, long-term quality of life (QOL), and late oncologic outcomes with endoscopic therapy.

Background:
The short-term oncologic efficacy of endoscopic resection (ER) and ablation for patients with high-grade dysplasia (HGD) or intramucosal adenocarcinoma (IMC) is well-established in the literature.

Methods:
A retrospective chart review was performed of the initial 40 patients who had endoscopic therapy from 2001 to 2010 at 1 center by 1 physician.

Results:
Initial pathology was HGD in 22 and IMC in 18 patients, but 9 patients (41%) with HGD progressed to invasive cancer during endotherapy. The median follow-up was 82 months. Four patients had an esophagectomy, and in the remaining 36 patients, 70 ERs and 111 ablations were performed. The median number of endoscopic sessions was 4 in patients with short segment compared with 7 in patients with long-segment Barrett's. Complete resolution of intestinal metaplasia (CRIM) was achieved in 30 patients (83%) at a median of 21 months. In 18 patients (60%), CRIM was maintained, whereas 12 patients developed recurrence at a median of 14 months. Additional endotherapy (n = 11) led to CRIM again in 10 patients (83%). There were no cancer deaths when CRIM was achieved. Overall survival with endotherapy was 73% at 5 years and 67% at 10 years. Quality of life (QOL) was below population means in 4 of 8 areas, but alimentary satisfaction was good after endotherapy.

Conclusions:
Endotherapy is successful in most patients, but multiple sessions are usually required and disease progression can occur. Once CRIM is achieved, recurrence is common and mandates continued endoscopic follow-up. QOL is impaired with endotherapy, but alimentary satisfaction and oncologic outcomes support esophageal preservation with endotherapy for patients with HGD or IMC.
Variation in Surgical Treatment of Abdominal Aortic Aneurysms With Small Aortic Diameters in the Netherlands
Authors: Karthaus Eleonora G. , Vahl Anco , van der Werf Leonie R. , Elsman Bernard H. P. , Van Herwaarden Joost A. , Wouters Michel W. J. M. , Hamming Jaap F. 
Published: September 2018

Objective:
To evaluate reasons to deviate from aneurysm diameter thresholds, and focus on the difference in how Dutch vascular surgical units (VSUs) perceive their deviation and their actual deviation.

Background:
Guidelines recommend surgical treatment for asymptomatic abdominal aortic aneurysms (AAAs) with a diameter of at least 55 mm for men and 50 mm for women. We evaluate reasons to deviate from these guidelines, and focus on the difference in how Dutch vascular surgical units (VSUs) perceive their deviation and their actual deviation.

Methods:
All patients undergoing elective AAA repair between 2013 and 2016 registered in the Dutch Surgical Aneurysm Audit (DSAA) were included. Surgery at diameters of <55 mm for men and <50 mm for women were considered guideline deviations. National deviation and hospital variation in deviation were evaluated over time. Questionnaires were distributed among all Dutch VSUs, inquiring for acceptable reasons for guideline deviation. VSUs were asked to estimate the guideline deviation percentage in their hospital which was then compared with their DSAA percentage.

Results:
In all, 9039 patients were included. In 15%, we found guideline deviation, varying from 2% to 40% between VSUs. Over time, 21 VSUs were identified with a lower percentage of deviation than the national mean each year and 8 VSUs with a higher percentage. 44/60 VSUs completed the questionnaire. Most commonly reported reasons to deviate were concomitant large iliac diameter (91%) and saccular aneurysm (82%). The majority of the VSUs (77%) estimated their guideline deviation to be <5%. Eleven VSUs (25%) estimated their deviation concordant with their DSAA percentage, but 75% of VSUs underestimated their deviation.

Conclusions:
Dutch VSUs regularly deviate from the guidelines regarding aneurysm diameter, with variation between VSUs. Consensus exists amongst VSUs on acceptable reasons for guideline deviations; however, the majority underestimates their actual deviation percentage.
Somatostatin as Inflow Modulator in Liver-transplant Recipients With Severe Portal Hypertension
Authors: Troisi Roberto Ivan , Vanlander Aude , Giglio Mariano Cesare , Van Limmen Jurgen , Scudeller Luigia , Heyse Bjorn , De Baerdemaeker Luc , Croo Alexander , Voet Dirk , Praet Marleen , Hoorens Anne , Antoniali Giulia , Codarin Erika , Tell Gianluca , Reynaert Hendrik , Colle Isabelle , Sainz-Barriga Mauricio 
Published: September 2018

Objective:
To investigate the safety and efficacy of somatostatin as liver inflow modulator in patients with end-stage liver disease (ESLD) and clinically significant portal hypertension (CSPH) undergoing liver transplantation (LT) (ClinicalTrials.gov number,01290172).

Background:
In LT, portal hyperperfusion can severely impair graft function and survival, mainly in cases of partial LT.

Methods:
Thirty-three patients undergoing LT for ESLD and CSPH were randomized double-blindly to receive somatostatin or placebo (2:1). The study drug was administered intraoperatively as 5-mL bolus (somatostatin: 500 μg), followed by a 2.5 mL/h infusion (somatostatin: 250 μg/h) for 5 days. Hepatic and systemic hemodynamics were measured, along with liver function tests and clinical outcomes. The ischemia-reperfusion injury (IRI) was analyzed through histological and protein expression analysis.

Results:
Twenty-nine patients (18 receiving somatostatin, 11 placebo) were included in the final analysis. Ten patients responded to somatostatin bolus, with a significant decrease in hepatic venous portal gradient (HVPG) and portal flow of −28.3% and −29.1%, respectively. At graft reperfusion, HVPG was lower in patients receiving somatostatin (−81.7% vs −58.8%; P = 0.0084), whereas no difference was observed in the portal flow (P = 0.4185). Somatostatin infusion counteracted the decrease in arterial flow (−10% vs −45%; P = 0.0431). There was no difference between the groups in the severity of IRI, incidence of adverse events, long-term complications, graft, and patient survival.

Conclusions:
Somatostatin infusion during LT in patients with CSPH is safe, reduces the HVPG, and preserves the arterial inflow to the graft. This study establishes the efficacy of somatostatin as a liver inflow modulator.