bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and Risk Factors for Cannula-Related Venous Thrombosis After Venovenous Extracorporeal Membrane Oxygenation in Adult Patients With Acute Respiratory Failure
Authors: Fisser Christoph , Reichenbächer Christoph , Müller Thomas , Schneckenpointner Roland , Malfertheiner Maximilian V. , Philipp Alois , Foltan Maik , Lunz Dirk , Zeman Florian , Lubnow Matthias 
Published: January 2019

Objectives:
Venovenous extracorporeal membrane oxygenation is indicated in patients with severe refractory acute respiratory failure. Venous thrombosis due to indwelling catheters is a frequent complication. The aim of this study was to analyze the incidence of cannula-related thrombosis and its risk factors after venovenous extracorporeal membrane oxygenation.

Design:
Retrospective observational study.

Setting:
A medical ICU at the University Hospital Regensburg.

Patients:
We analyzed consecutive patients with severe respiratory failure (Pao
2/Fio
2 < 85 mm Hg and/or respiratory acidosis with pH < 7.25) who were successfully treated with venovenous extracorporeal membrane oxygenation in a medical ICU between 2010 and 2017.

Intervention:
None.

Measurements and Main Results:
After extracorporeal membrane oxygenation weaning, duplex sonography or CT was conducted to detect cannula-related thrombosis. Thrombosis was classified as a large thrombosis by vein occlusion of greater than 50%. The incidence of thrombosis was correlated with risk factors such as coagulation variables (mean activated partial thromboplastin time ≤ 50 s, international normalized ratio antithrombin III, fibrinogen, plasma-free hemoglobin, platelets, and decline in D-dimer ≤ 50% the day after decannulation), cannula size, time on venovenous extracorporeal membrane oxygenation, renal failure, and underlying malignant disease. Data cut-off points were identified by receiver operating characteristic analysis. One-hundred seventy-two of 197 patients (87%) were screened. One-hundred six patients (62%) showed thrombosis that was considered large in 48 of 172 (28%). The incidence of thrombosis was higher in patients with a mean aPTT of less than or equal to 50 seconds (odds ratio, 1.02; p = 0.013) and in patients with a decline in D-dimer less than or equal to 50% (odds ratio, 2.76; p = 0.041) the day after decannulation following adjustment for risk factors.

Conclusions:
The incidence of cannula-related venous thrombosis after venovenous extracorporeal membrane oxygenation is high. Reduced systemic anticoagulation may enhance the risk of thrombosis. Sustained elevation of D-dimer after decannulation may indicate thrombosis. Patients should undergo routine duplex sonography after extracorporeal membrane oxygenation to detect thrombosis formation in the cannulated vessel.
Metformin Use and Kidney Cancer Survival Outcomes
Authors: Nayan Madhur , Punjani Nahid , Juurlink David N. , Finelli Antonio , Austin Peter C. , Kulkarni Girish S. , Uleryk Elizabeth , Hamilton Robert J. 
Published: January 2019

Objectives:
Metformin has been associated with improved survival outcomes in various malignancies. However, studies in kidney cancer are conflicting. We performed a systematic review and meta-analysis to evaluate the association between metformin and kidney cancer survival.

Materials and Methods:
We searched Medline and EMBASE databases from inception to June 2017 to identify studies evaluating the association between metformin use and kidney cancer survival outcomes. We evaluated risk of bias with the Newcastle-Ottawa scale. We pooled hazard ratios (HRs) for recurrence-free, progression-free, cancer-specific, and overall survival using random effects models, and explored heterogeneity with metaregression. We evaluated publication bias through Begg’s and Egger’s tests, and the trim and fill procedure.

Results:
We identified 9 studies meeting inclusion criteria, collectively involving 7426 patients. Five studies were at low risk of bias. The direction of association for metformin use was toward benefit for recurrence-free survival (HR, 0.99; 95% confidence interval [CI], 0.36-2.74), progression-free survival (pooled HR, 0.84; 95% CI, 0.66-1.07), cancer-specific (pooled HR, 0.72; 95% CI, 0.48-1.09), and overall survival (pooled HR, 0.73; 95% CI, 0.50-1.09), though none reached statistical significance. Metaregression found no study-level characteristic to be associated with the effect size, and there was no strong evidence of publication bias for any outcome.

Conclusions:
There is no evidence of a statistically significant association between metformin use and any survival outcome in kidney cancer. We discuss the potential for bias in chemoprevention studies and provide recommendations to reduce bias in future studies evaluating metformin in kidney cancer.
Treatment of Uncomplicated Acute Diverticulitis Without Antibiotics: A Systematic Review and Meta-analysis
Authors: Au Stephanie , Aly Emad H. 
Published: January 2019

BACKGROUND:
Despite low-quality and conflicting evidence, the Association of Coloproctology of Great Britain and Ireland recommends the routine use of antibiotics in the treatment of uncomplicated acute diverticulitis. Recent studies have shown that treatment without antibiotics did not prolong recovery. Some new guidelines currently recommend selective use of antibiotics.

OBJECTIVE:
The purpose of this study was to compare the safety, effectiveness, and outcomes in treating uncomplicated acute diverticulitis without antibiotics with treatment with antibiotics.

DATA SOURCES:
PubMed, Embase, Clinicaltrials.gov, and the Cochrane Library were searched with the key words antibiotics and diverticulitis.

STUDY SELECTION:
All studies published in English on treating uncomplicated acute diverticulitis without antibiotics and containing >20 individuals were included.

INTERVENTION:
Treatment without antibiotics versus treatment with antibiotics were compared.

MAIN OUTCOME MEASURES:
The primary outcome was the percentage of patients requiring additional treatment or intervention to settle during the initial episode. The secondary outcomes were duration of hospital stay, rate of readmission or deferred admission, need for surgical or radiological intervention, recurrence, and complication.

RESULTS:
Search yielded 1164 studies. Nine studies were eligible and included in the meta-analysis, composed of 2505 patients, including 1663 treated without antibiotics and 842 treated with an antibiotic. The no-antibiotics group had a significantly shorter hospital stay (mean difference = –0.68; p = 0.04). There was no significant difference in the percentage of patients requiring additional treatment or intervention to settle during the initial episode (5.3% vs 3.6%; risk ratio = 1.48; p = 0.28), rate of readmission or deferred admission (risk ratio = 1.17; p = 0.26), need for surgical or radiological intervention (risk ratio = 0.61; p = 0.34), recurrence (risk ratio = 0.83; p = 0.21), and complications (risk ratio = 0.70–1.18; p = 0.67–0.91).

LIMITATIONS:
Only a limited number of studies were available, and they were of variable qualities.

CONCLUSIONS:
Treatment of uncomplicated acute diverticulitis without antibiotics is associated with a significantly shorter hospital stay. There is no significant difference in the percentage of patients requiring additional treatment or intervention to settle in the initial episode, rate of readmission or deferred admission, need for surgical or radiological intervention, recurrence, or complications.
Combined Therapeutic Strategies for Keloid Treatment
Authors: Lee Young In , Kim Jihee , Yang Chae Eun , Hong Jong Won , Lee Won Jai , Lee Ju Hee 
Published: January 2019

BACKGROUND
Recent advances in keloid management favor the administration of combination therapy over monotherapy.

OBJECTIVE
The authors evaluated the safety and efficacy of combination therapy to treat keloids using fractional lasers, cryotherapy, and intralesional corticosteroids.

MATERIALS AND METHODS
The authors performed a retrospective study involving 35 Korean patients. Each patient underwent treatment using the 1,550 nm nonablative fractional erbium-glass laser, followed by the 10,600 nm ablative fractional carbon dioxide laser. Laser treatment was immediately followed by the administration of superficial cryotherapy and intralesional triamcinolone injection. Therapeutic efficacy was assessed using the Vancouver Scar Scale (VSS) score and the 7-point patient self-assessment score.

RESULTS
The mean total and subcategory VSS scores showed statistically significant improvements. The height and pliability scores showed the most significant and quickest responses to the combination therapy. The patients reported remarkable improvement in itching, pain, and limitations of motion after a single combination therapy session. Twenty patients were followed up for 1 year after the discontinuation of the combination treatment, and the recurrence was observed only in one patient. No significant adverse effects were observed throughout the follow-up period.

CONCLUSION
Combination keloid therapy using fractional lasers, superficial cryotherapy, and intralesional triamcinolone injection is safe and more effective than individual monotherapies.
Contemporary Mohs Micrographic Surgery Histologic Preparation Methods, Laboratory-Assistive Personnel Training, and Practice Setting—A Survey Study
Authors: Ishii Lisa , Arshanapalli Ashish , Surprenant David , Reserva Jeave , Moy Lauren , Martin Brendan , Krol Cindy , Cesario Linda , Alam Murad , Tung Rebecca 
Published: January 2019

BACKGROUND
The Mohs histotechnologist (MH) performs tissue preparation, sectioning, and staining, which are critical tasks in ensuring a successful Mohs micrographic surgery (MMS).

OBJECTIVE
To assess current norms in MH training, practice setting, and utilization of specific histologic techniques.

MATERIALS AND METHODS
A 16-question survey was created and distributed using Survey Monkey to all members of the American Society for Mohs Histotechnology.

RESULTS
Response rate was 30%. Most MHs received on-the-job training from other MHs or the Mohs surgeon. Mohs histotechnologists largely performed tasks related to tissue processing while Mohs surgeons generally illustrated the Mohs layer map. Automated routine staining was used in most laboratory tests, and laboratory tests used similar staining techniques. Most respondents worked in private offices verses academic centers. Total staining time was significantly longer at academic medical centers versus private offices (7 vs 5 minutes, p = .01).

CONCLUSION
These findings provide an updated profile of current laboratory training and tissue preparation techniques at MMS practices across the country. Understanding the roles of the MH in laboratory functioning may help laboratories adopt best practices.
Patient-Centered Outcomes for Skin Cancer Management: Utilization of a Patient Delphi Process to Identify Important Treatment Themes
Authors: Cartee Todd V. , Alam Murad , Armbrecht Eric S. , Behera Anit , Lawrence Naomi , Bordeaux Jeremy S. , Baum Christian L. , Rossi Anthony , Maher Ian A. 
Published: January 2019

BACKGROUND
Patient-reported outcomes are critical to research directed at maximizing patient benefit. The outcomes patients consider most relevant in the treatment of skin cancer have not been directly investigated.

OBJECTIVE
To develop a ranked list of outcomes deemed most important by patients with skin cancer through a proctored Delphi process.

METHODS
Twenty-one patients with a history of skin cancer volunteered to participate in the patient summit. The patient members participated in a guided discussion to generate a long list of potentially relevant outcomes. The list was then condensed and ranked through 2 rounds of a proctored Delphi process.

RESULTS
Patients were diverse in their skin cancer histories and complexities, ages, and states of residence. Twelve themes were rated as highly important by 70% or more of participants. Most of these themes related to patient education and the collaborative nature of the physician–patient relationship. Fear of recurrence and cosmetic outcome were also highly rated. Limitations include a preponderance of older patients and patients from the midwest and northeast.

CONCLUSION
Patients with skin cancer overwhelmingly prioritize a shared decision-making process, in which they are actively engaged and value detailed education regarding their disease. This should inform future research directed at skin cancer treatment and current physician–patient interactions.
A Randomized, Vehicle-Controlled Phase 3 Study of Aminolevulinic Acid Photodynamic Therapy for the Treatment of Actinic Keratoses on the Upper Extremities
Authors: Brian Jiang Shang I. , Kempers Steven , Rich Phoebe , Marcus Stuart , Houlihan Anna , Piacquadio Daniel , Pariser David 
Published: January 2019

BACKGROUND
Blue-light aminolevulinic acid photodynamic therapy (ALA-PDT) after broad-area application and 3-hour incubation is efficacious for actinic keratosis (AK) lesion clearance on upper extremities, with use of occlusive dressing significantly increasing efficacy.

OBJECTIVE
To prove the safety and efficacy of ALA-PDT versus vehicle (VEH-PDT) in the spot treatment of multiple AKs on upper extremities.

METHODS
Aminolevulinic acid or VEH was spot applied only to lesions on one upper extremity 3 hours before blue-light exposure. Treated extremity was covered with occlusive dressing during incubation. Identical treatment was repeated at Week 8 if AK lesions were present in the treated area.

RESULTS
Thirty-one percent (42/135) of subjects treated with ALA-PDT had complete clearance at Week 12, compared with 13% (17/134) of the subjects treated with VEH-PDT (p = .0001). The mean AK lesion clearance rate for ALA-treated subjects at Weeks 8 and 12 was 53% and 69%, respectively, compared with 26% and 30% for the VEH-treated group (p < .0001, linear mixed model). Safety profile observed in this study is consistent with previous studies/reports in the literature, and the therapy was well tolerated overall.

CONCLUSION
Aminolevulinic acid-PDT spot treatment using a 3-hour occluded incubation was superior to VEH-PDT for AK lesion clearance of the upper extremity.
Topical Aluminum Chloride and Monsel's Solution Block Toluidine Blue Staining in Mohs Frozen Sections: Mechanism and Solution
Authors: Chen Curtis L. , Wilson Steven , Afzalneia Reza , Chen Chih-Shan Jason 
Published: January 2019

BACKGROUND
A diminished-staining artifact is observed in some Mohs frozen sections that are stained in toluidine blue (T-blue). Such an artifact, not yet described in the literature, may interfere with a Mohs surgeon's accurate reading. The authors hypothesize that topical hemostatic agents, aluminum chloride, and Monsel's solution are the causative factors.

OBJECTIVE
To evaluate the aforementioned topical hemostatic agents as a potential cause of the nonstaining artifact, to propose the mechanism associated with this phenomenon, and to develop a method to prevent or rectify the problem.

MATERIALS AND METHODS
Leftover Mohs frozen sections and specimens were treated with aluminum chloride or Monsel's solution and processed with routine Mohs histology.

RESULTS
Nonstaining artifact is reproduced in aluminum chloride or Monsel's solution–treated ex vivo skin specimens. The authors found that ethylenediaminetetraacetic acid (EDTA), a chelating agent, can reverse the staining blockage. Such a finding suggests that aluminum or ferric cations bind to tissue and subsequently inhibit T-blue from interacting with the tissue. Direct binding of ferric cations to the tissue section is demonstrated with Prussian blue iron staining.

CONCLUSION
By rinsing Mohs frozen sections in an EDTA solution before T-blue staining, the authors could prevent hemostatic agent–induced nonstaining. Applying an EDTA wash and restaining the slides can correct the same artifact.
A Review and Update of Treatment Options Using the Acne Scar Classification System
Authors: Boen Monica , Jacob Carolyn 
Published: January 2019

BACKGROUNDAn unfortunate consequence of acne vulgaris is residual scarring that can negatively affect a patient's quality of life.OBJECTIVEJacob and colleagues have previously described an acne scar classification system based on acne scar pathology that divided atrophic acne scars into icepick, rolling, and boxcar scars, and this review will evaluate new and developing treatment options for acne scarring.METHODSA Medline search was performed on the various treatments for acne scars, and particular attention was placed on articles that used the acne scar classification system of icepick, rolling, and boxcar scars.RESULTSTherapies for acne scarring included surgical modalities, such as subcision, and punch excision and elevation, injectable fillers, chemical peels, dermabrasion, microneedling, and energy-based devices. In the past decade, there has been a trend toward using cosmetic fillers and energy-based devices to improve acne scarring.CONCLUSIONThere were few high-quality evidence-based studies evaluating the management of acne scarring. Many disparate acne severity scores were used in these studies, and the acne scar type was frequently undefined, making comparison between them difficult. Nonetheless, research into interventions for acne scarring has increased substantially in the past decade and has given patients more therapeutic strategies.
Facial Nerve Injury and Repair: A Practical Review for Cutaneous Surgery
Authors: Condie Daniel , Tolkachjov Stanislav N. 
Published: January 2019

BACKGROUNDThe facial nerve and its branches are at risk of injury during dermatologic surgery. Few publications in the dermatologic literature discuss facial nerve injury and management.OBJECTIVETo review facial nerve injury and management, including static and dynamic repair techniques, and to review outcomes in facial nerve reconstruction.METHODSTwo detailed literature reviews were performed using PubMed. First, articles reporting facial nerve injury and/or management in the dermatologic literature were identified. In addition, articles pertaining to outcomes in facial nerve reconstruction with a minimum of 20 patients were included.RESULTSFifty-three articles reporting outcomes in facial nerve reconstruction were identified and consist of retrospective reviews and case series. Most patients achieve improvement in facial symmetry and movement with nerve repair.CONCLUSIONTiming of facial nerve repair is an important consideration in management of facial nerve injury, with earlier repairs achieving better outcomes. Facial nerve repair does not result in normal facial movement, and improvements may require a year or more to be realized. Many options exist for facial nerve reconstruction, and patients with long-standing facial nerve injuries may still benefit from treatment.
Subcutaneous Injection of Tranexamic Acid to Reduce Bleeding During Dermatologic Surgery: A Double-Blind, Placebo-Controlled, Randomized Clinical Trial
Authors: Zilinsky Isaac , Barazani Tami Brutman , Visentin Denis , Ahuja Kiran , Martinowitz Uriel , Haik Josef 
Published: January 2019

BACKGROUND
Topical application, oral, and IV injection of tranexamic acid (TXA) have been used to reduce surgical bleeding.

OBJECTIVE
To evaluate the safety and efficacy of TXA injected subcutaneously to reduce bleeding during dermatologic surgery.

METHODS
In this double-blinded, placebo-controlled, randomized prospective study, 131 patients were randomized to subcutaneous injection of lidocaine 2% diluted 1:1 with either saline (placebo) or TXA 100 mg/1 mL before surgery. Before the second stage or closure, size measurements of bloodstain impregnation on Telfa and surgical wound size were recorded and analyzed using mixed-effects linear regression. Subjective evaluation of hemostasis was performed using 4-point scale grading and analyzed using Fischer's exact test.

RESULTS
One hundred twenty-seven patients completed the study. The bloodstain to surgical wound size ratio was smaller in the TXA group (1.77) compared with the placebo group (2.49) (p < .001). An improved effect of TXA on bleeding was observed in the subgroup of patients receiving anticoagulants (mean difference; 95% confidence interval; −0.83; −1.20 to −0.46 p < .001). The subjective hemostasis assessment was significantly better in the TXA group overall (p = .043) and anticoagulant subgroup (p = .001) compared with the placebo group.

CONCLUSION
Subcutaneous injection of TXA was safe, reduced bleeding during dermatologic surgery, and particularly effective for patients receiving anticoagulation treatment.
A Clinical Review of Common Medications Used in Emergency Dermatological Situations
Authors: Mo Joshua H. , Chapman Lance W. , Cohen Joel L. 
Published: January 2019

BACKGROUND
Medical emergencies can occur in any environment, including dermatologic and procedural surgical settings. There are many options available to dermatologic surgeons, which they should consider having easily accessible in the office in case an emergency arises.

OBJECTIVE
To summarize the current understanding about major medications that should be on-hand during dermatological surgeries. To review their mechanism of action, examine their general use, and dermatological use during surgical emergencies.

METHODS AND MATERIALS
A comprehensive review using PubMed was performed, searching for studies using these various medications in relation to cutaneous surgeries.

RESULTS
Distinct items such as hyaluronidase, nitroglycerin paste, aspirin, injectable epinephrine, and defibrillators are potential options to address various emergencies and should be readily accessible to dermatologic surgeons.

CONCLUSION
Dermatologic surgeons' knowledge of key medications and options to have in the office allow for a proper response in the event an emergency arises.
ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY CAN IMPROVE DIABETIC RETINOPATHY SCORE WITHOUT CHANGE IN RETINAL PERFUSION
Authors: Bonnin Sophie , Dupas Bénédicte , Lavia Carlo , Erginay Ali , Dhundass Myriam , Couturier Aude , Gaudric Alain , Tadayoni Ramin 
Published: January 2019

Purpose:
To compare the changes in retinal perfusion on ultra–wide-field fluorescein angiography with the changes in diabetic retinopathy lesions observed on ultra–wide-field fundus color photographs after 3 monthly anti–vascular endothelial growth factor injections.

Methods:
Retrospective interventional cohort study analyzing the files of 14 patients with DR (18 eyes). UWF color photos and FA were analyzed at baseline (M0) and 1 month after the third anti-VEGF injection (M3). The main outcomes included the count of the number of red dots (microaneurysms, hemorrhages) and assessment of DR severity score (DRSS); the analysis of non-perfusion areas and disappearance or reappearance of arterioles or venules in the non-perfusion areas on FA.

Results:
Eighteen eyes of 14 diabetic patients, with mean age of 63 ± 5 years, were included. The DRSS score improved by at least one stage in 11/18 (61%) eyes. The mean number of red dots significantly decreased at M3 (n = 80 ± 85) compared with M0 (n = 139 ± 130) (P < 0.0001). No reperfusion of arterioles or venules was observed in or around nonperfusion areas.

Conclusion:
After anti–vascular endothelial growth factor injections, the improvement in the DRSS score based on color fundus photographs can occur without retinal reperfusion on ultra–wide-field fluorescein angiography.