bluuebunny/crossref_metadata_2025_split huggingface dataset:
Commercial Quinolone Ear Drops Cause Perforations in Intact Rat Tympanic Membranes
Authors: Dirain Carolyn O. , Karnani David N. , Antonelli Patrick J. 
Published: October 2019

Hypothesis:Commercial quinolone ear drops may promote the development of perforations (TMPs) in intact tympanic membrane (TMs).Background:Quinolone ear drops have been associated with TMPs after myringotomy +/- tube placement in a drug-specific manner and potentiation by steroids.Methods:Rats were randomized to six groups (10/group), with one ear receiving otic instillation of dexamethasone, ofloxacin, ciprofloxacin, ofloxacin + dexamethasone, ciprofloxacin + dexamethasone, or neomycin + polymyxin + hydrocortisone—all commercial formulations and at standard clinical concentrations—and the contralateral ear receiving saline, twice daily for 10 days. TMs were assessed over 42 days.Results:No TMPs were seen in ears treated with saline, dexamethasone, or neomycin. At day 10, TMPs were seen in one of 10 ofloxacin- and three of 10 ciprofloxacin + dexamethasone-treated ears (p = 0.038). At day 14, the ofloxacin TMP healed. In contrast, the three ciprofloxacin + dexamethasone TMPs remained and one new TMP developed in this group. A ciprofloxacin and an ofloxacin + dexamethasone-treated ears also had TMPs (p = 0.023). By day 21, the ofloxacin + dexamethasone TMP and two of four of the ciprofloxacin + dexamethasone TMPs healed but two new TMPs were seen in ciprofloxacin + dexamethasone ears (p = 0.0006). At day 28, 1 of 10 ciprofloxacin and 4 of 10 ciprofloxacin + dexamethasone-treated ears had TMPs (p = 0.0006). By day 35, only one ciprofloxacin + dexamethasone had TMP (p = 0.42). All TMPS were healed at day 42.Conclusions:Application of commercial quinolone ear drops can cause TMPs in intact TMs. This effect appears to be drug-specific and potentiated by steroids.
Pediatric hereditary angioedema: what the otolaryngologist should know
Authors: Bailey C. Eric , Carr Michele M. 
Published: October 2019

Purpose of review
To review pediatric hereditary angioedema for otolaryngologists, with emphasis on articles within the past 12–18 months.

Recent findings
Biologic therapies are accepted for adult hereditary angioedema (HAE), but have been studied less for pediatric HAE. Recent literature supports expanded use of biologic agents in pediatrics as acute treatment and prophylaxis. Available agents include plasma-derived C1 esterase inhibitors (C1-INH) (Berinert, Haegarda, Cinryze), recombinant C1-INH (Ruconest), bradykinin B2 receptor inhibitor (Icatibant), and kallikrein inhibitors (Ecallantide and lanadelumab). Of these, only Berinert is Food and Drug Administration (FDA) approved for acute therapy for children under 12 years of age. Ruconest is approved for treatment of acute attacks over age 13. Ecallantide also has FDA approval as acute treatment for age 12 and older, while lanadelumab and Haegarda are prophylactic agents for adolescents. Icatibant lacks FDA approval in patients under 18 years of age. Cinryze has FDA approval only for prophylaxis for children as young as 6 years old.

Summary
Pediatric HAE is a potentially life-threatening disease. Targeted biologic agents have gained acceptance in treatment of acute attacks, and their use as prophylactic agents is changing the focus of management from acute intervention to preventive management. While intubation or surgical airway management may still be necessary, early intervention or prophylaxis can decrease morbidity and improve quality of life.
Transfusion-Free Cranial Vault Remodeling: A Novel, Multifaceted Approach
Authors: Wood Robert J. , Stewart Christopher N. , Liljeberg Katie , Sylvanus Tonye S. , Lim Paul K. 
Published: October 2019

Background:
Approximately one in 2000 babies are born with craniosynostosis, and primary open repair is typically performed before 1 year of age. Historically, the procedure has been associated with nearly 100 percent transfusion rates. To decrease the rates of transfusion, the authors’ center has developed a novel multimodal blood conservation protocol.

Methods:
The authors administered their standard of care to children aged 1 year or younger undergoing primary repair of craniosynostosis between 2008 and 2014. In 2014, the authors implemented the following protocol: (1) preoperative erythropoietin and ferrous sulfate, (2) local anesthetic with epinephrine infiltration of the incision, (3) PlasmaBlade incision and subgaleal dissection, (4) hypervolemic hemodilution, and (5) intravenous tranexamic acid. Procedures performed before the protocol implementation served as controls. The authors performed classic fronto-orbital advancement with anterior cranial vault remodeling for coronal and metopic craniosynostosis. For lambdoid and sagittal craniosynostosis, barrel stave osteotomies, cranial base outfracture, and interposition bone grafting were performed.

Results:
A total of 279 children with a mean age of 6 months who had craniosynostosis repairs were included. One hundred forty-five underwent repair before the authors’ protocol, and 134 had repairs during the authors’ blood conservation protocol. Both groups were similar in demographics. Overall blood loss and operative times were significantly reduced by 73 percent and 11 percent, respectively. Blood transfusion rate decreased 92 percent (p < 0.001).

Conclusions:
These results show a strong association between the authors’ blood conservation protocol and significantly reduced transfusion rates. The authors believe this is a significant step forward and can be safely applied in the great majority of children undergoing craniosynostosis repairs.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Facial Recognition Neural Networks Confirm Success of Facial Feminization Surgery
Authors: Chen Kevin , Lu Stephen M. , Cheng Roger , Fisher Mark , Zhang Ben H. , Di Maggio Marcelo , Bradley James P. 
Published: October 2019

Background:
Male-to-female transgender patients desire to be identified, and treated, as female, in public and social settings. Facial feminization surgery entails a combination of highly visible changes in facial features. To study the effectiveness of facial feminization surgery, we investigated preoperative/postoperative gender-typing using facial recognition neural networks.

Methods:
In this study, standardized frontal and lateral view preoperative and postoperative images of 20 male-to-female patients who completed hard- and soft-tissue facial feminization surgery procedures were used, along with control images of unoperated cisgender men and women (n = 120 images). Four public neural networks trained to identify gender based on facial features analyzed the images. Correct gender-typing, improvement in gender-typing (preoperatively to postoperatively), and confidence in femininity were analyzed.

Results:
Cisgender male and female control frontal images were correctly identified 100 percent and 98 percent of the time, respectively. Preoperative facial feminization surgery images were misgendered 47 percent of the time (recognized as male) and only correctly identified as female 53 percent of the time. Postoperative facial feminization surgery images were gendered correctly 98 percent of the time; this was an improvement of 45 percent. Confidence in femininity also improved from a mean score of 0.27 before facial feminization surgery to 0.87 after facial feminization surgery.

Conclusions:
In the first study of its kind, facial recognition neural networks showed improved gender-typing of transgender women from preoperative facial feminization surgery to postoperative facial feminization surgery. This demonstrated the effectiveness of facial feminization surgery by artificial intelligence methods.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Demineralized Bone Matrix and Resorbable Mesh Bilaminate Cranioplasty Is Ineffective for Secondary Reconstruction of Large Pediatric Cranial Defects
Authors: Dvoracek Lucas A. , Lee Jonathan Y. , Ayyash Ali , Losee Joseph E. , Goldstein Jesse A. 
Published: October 2019

Summary:Replacement of the autologous bone flap after decompressive craniectomy can be complicated by significant osteolysis or infection with large defects over scarred dura. Demineralized bone matrix is an alternative to autologous reconstruction, effective when reconstructing large defects using a resorbable mesh bilaminate technique in primary cranioplasty, but this technique has not been studied for revision cranioplasty and the setting of scarred dura. Retrospective review was performed of patients receiving demineralized bone matrix and resorbable mesh bilaminate cranioplasty for postdecompressive craniectomy defects. Seven patients (mean age, 4.2 years) were identified with a mean follow-up of 4.0 years. Computed tomography before the demineralized bone matrix and resorbable mesh bilaminate cranioplasty and at least 1 year postoperatively were compared. Defects were characterized and need for revision was assessed. All patients had craniectomy with associated hemidural scarring. Five patients had autologous bone flap cranioplasty associated with nearly total osteolysis, and two patients had deferral of bone flap before demineralized bone matrix and resorbable mesh bilaminate cranioplasty. Demineralized bone matrix and resorbable mesh bilaminate cranioplasty demonstrated unpredictable and poor ossification, with bony coverage unchanged at postoperative follow-up. All patients required major revision cranioplasty at a mean time of 2.5 years. Porous polyethylene was successfully used in six of the revisions, whereas exchange cranioplasty was used in the remaining patient, with a mean follow-up of 1.4 years. Although demineralized bone matrix and resorbable mesh bilaminate is appropriate for primary cranioplasty, it should be avoided in the setting of scarred or infected dura in favor of synthetic materials or exchange cranioplasty.CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, IV.
Linking Daily-Life Interpersonal Stressors and Health Problems Via Affective Reactivity in Borderline Personality and Depressive Disorders
Authors: Hepp Johanna , Lane Sean P. , Carpenter Ryan W. , Trull Timothy J. 
Published: October 2019

ABSTRACT

Objective
Borderline personality disorder (BPD) is associated with unstable interpersonal relationships, affective instability, and physical health problems. In individuals with BPD, intense affective reactions to interpersonal stressors may contribute to the increased prevalence of health problems.

Methods
BPD (n = 81) and depressed participants (DD; n = 50) completed six daily ambulatory assessment prompts for 28 days. At each prompt, participants reported interpersonal stressors (disagreements, rejections, feeling let down), negative affect, and health problems in four domains (gastrointestinal, respiratory, aches, depressive symptoms). In multilevel moderated mediation models, we examined the indirect effects of interpersonal stressors on health problems via negative affect, by group.

Results
Interpersonal stressors were positively associated with negative affect in both groups (β values > 0.12, p values < .001), but more so for participants with BPD (βDay = 0.05, p < .001). Negative affect was positively associated with health problems across all domains (βMoment/Day values > 0.01, p values < .046), but associations were larger at the day level for respiratory symptoms in BPD (β = 0.02, p = .025) and for depressive symptoms in DD (β = 0.04, p < .001). Negative affect mediated the association of interpersonal stressors and health problems in both groups, with larger effects for the DD group for depressive problems (β = 0.02, p = .092) and for the BPD group for the other three domains (β values > 0.02, p values < .090).

Conclusions
Interpersonal stressors may contribute to increased physical health problems via an inability to regulate affective responses to such events. This pathway may be stronger in several health domains for those with BPD and may contribute to an elevated risk of morbidity and mortality in this disorder, suggesting a target for intervention to reduce these risks.
Longer Sleep Duration and Endothelial Cell Health Among a Multiethnic Sample of Adolescents
Authors: Alcántara Carmela , Giorgio Cosenzo Luciana , Leigh Adam K.K. , Shimbo Daichi , Miller Gregory E. 
Published: October 2019

ABSTRACT

Objective
Adverse endothelial cell health, an early pathogenic process underlying atherosclerosis and cardiovascular disease, is evident in childhood and adolescence. Sleep duration, a modifiable cardiovascular health behavior, may be an important cardiovascular disease prevention target that may affect endothelial cell health. We examined the associations of longer sleep duration with endothelial cell injury among youth.

Methods
In a multiethnic sample of 235 children (63.0% female, mean age = 13.9 years), we conducted multivariable linear regressions to test the cross-sectional association of sleep duration and circulating levels of endothelial cell–derived microparticles (EMPs), phenotypic for endothelial cell activation and apoptosis (CD62E+ EMPs, CD31+/CD42b− EMPs, and CD31+/Annexin V+ EMPs). Sleep duration and EMPs were both treated as continuous variables. Models were adjusted for age, sex, race, pubertal status, household economic resources, and waist circumference.

Results
Overall, 69.2% had short sleep duration (<8 hours of sleep per night). Longer sleep duration was significantly associated with lower levels of CD62E+ EMPs and CD31+/CD42b− EMPs. A 60-minute increase in sleep duration was associated with an 8.40 (95% confidence interval = −205.20 to −1.80, p = .046) decrease in CD62E+ EMPs and a 9.00 (95% confidence interval = −153.60 to −9.60, p = .027) decrease in CD31+/CD42b− EMPs. Sleep duration was not associated with CD31+/Annexin V+ EMPs.

Conclusions
Our results support the hypothesis that sleeping longer has beneficial effects on endothelial cell health during childhood. Primordial prevention efforts might incorporate sleep extension to offset cardiovascular risk in youth.
Defining Global Benchmarks in Bariatric Surgery
Authors: Gero Daniel , Raptis Dimitri A. , Vleeschouwers Wouter , van Veldhuisen Sophie L. , Martin Andres San , Xiao Yao , Galvao Manoela , Giorgi Marcoandrea , Benois Marine , Espinoza Felipe , Hollyman Marianne , Lloyd Aaron , Hosa Hanna , Schmidt Henner , Garcia-Galocha José Luis , van de Vrande Simon , Chiappetta Sonja , Menzo Emanuele Lo , Aboud Cristina Mamédio , Lüthy Sandra Gagliardo , Orchard Philippa , Rothe Steffi , Prager Gerhard , Pournaras Dimitri J. , Cohen Ricardo , Rosenthal Raul , Weiner Rudolf , Himpens Jacques , Torres Antonio , Higa Kelvin , Welbourn Richard , Berry Marcos , Boza Camilo , Iannelli Antonio , Vithiananthan Sivamainthan , Ramos Almino , Olbers Torsten , Sepúlveda Matias , Hazebroek Eric J. , Dillemans Bruno , Staiger Roxane D. , Puhan Milo A. , Peterli Ralph , Bueter Marco 
Published: October 2019

Objective:
To define “best possible” outcomes for bariatric surgery (BS)(Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy [SG]).

Background:
Reference values for optimal surgical outcomes in well-defined low-risk bariatric patients have not been established so far. Consequently, outcome comparison across centers and over time is impeded by heterogeneity in case-mix.

Methods:
Out of 39,424 elective BS performed in 19 high-volume academic centers from 3 continents between June 2012 and May 2017, we identified 4120 RYGB and 1457 SG low-risk cases defined by absence of previous abdominal surgery, concomitant procedures, diabetes mellitus, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, anticoagulation, BMI>50 kg/m2 and age>65 years. We chose clinically relevant endpoints covering the intra- and postoperative course. Complications were graded by severity using the comprehensive complication index. Benchmark values were defined as the 75th percentile of the participating centers’ median values for respective quality indicators.

Results:
Patients were mainly females (78%), aged 38±11 years, with a baseline BMI 40.8 ± 5.8 kg/m2. Over 90 days, 7.2% of RYGB and 6.2% of SG patients presented at least 1 complication and no patients died (mortality in nonbenchmark cases: 0.06%). The most frequent reasons for readmission after 90-days following both procedures were symptomatic cholelithiasis and abdominal pain of unknown origin. Benchmark values for both RYGB and SG at 90-days postoperatively were 5.5% Clavien-Dindo grade ≥IIIa complication rate, 5.5% readmission rate, and comprehensive complication index ≤33.73 in the subgroup of patients presenting at least 1 grade ≥II complication.

Conclusion:
Benchmark cutoffs targeting perioperative outcomes in BS offer a new tool in surgical quality-metrics and may be implemented in quality-improvement cycle.
ClinicalTrials.gov Identifier NCT03440138
Novel Real-time Prediction of Liver Graft Function During Hypothermic Oxygenated Machine Perfusion Before Liver Transplantation
Authors: Muller Xavier , Schlegel Andrea , Kron Philipp , Eshmuminov Dilmurodjon , Würdinger Michael , Meierhofer David , Clavien Pierre-Alain , Dutkowski Philipp 
Published: October 2019

Objective:
The aim of this study was to determine the predictive value of machine perfusate analysis on graft outcome.

Background:
Ex situ machine perfusion (MP) is gaining increasing interest to potentially repair injured organs and to assess organ function. In the field of liver transplantation, however, no studies exist on reliable prediction of graft function during MP.

Methods:
We have used hypothermic oxygenated perfusion (HOPE) for donation after circulatory death (DCD) or extended criteria donation after brain death (DBD) human liver grafts during the last 7 years. Our series includes 100 HOPE-treated liver-transplanted patients with an overall tumor-censored 5-year graft survival of 89%. We monitored 54 livers during HOPE in terms of fluorometric analysis of released mitochondrial flavin (flavin mononucleotide, FMN) in the machine perfusate.

Results:
Real-time optical measurement of mitochondrial FMN release in machine perfusates of livers disclosed a strong correlation with lactate clearance and coagulation factors at day 1 and 2 after transplantation. Receiver-operating characteristic curve analysis revealed an area under the curve (AUROC) of 0.79 [95% confidence interval (CI), 0.62–0.97] for severe allograft dysfunction and for early graft loss (AUROC 0.93, 95% CI, 0.84–1.0).

Conclusions:
Assessment of flavin, a marker of mitochondrial complex I injury, in the perfusate provides a fast prediction of liver graft function and loss during ex situ MP before implantation. This finding may have high clinical relevance, as liver grafts from extended DBD or DCD donors carry considerable risks for recipients. On-line estimation of outcome before implantation would therefore substantially increase safe utilization of liver grafts.
Intracorporeal or Extracorporeal Ileocolic Anastomosis After Laparoscopic Right Colectomy
Authors: Allaix Marco E. , Degiuli Maurizio , Bonino Marco A. , Arezzo Alberto , Mistrangelo Massimiliano , Passera Roberto , Morino Mario 
Published: October 2019

Objectives:
The aim of the study was to determine whether there are clinically relevant differences in outcomes between laparoscopic right colectomy (LRC) with intracorporeal ileocolic anastomosis (IIA) and LRC with extracorporeal IA (EIA).

Background:
IIA and EIA are 2 well-established techniques for restoration of bowel continuity after LRC. There are no high-quality studies demonstrating the superiority of one anastomotic technique over the other.

Methods:
This is a double-blinded randomized controlled trial comparing the outcomes of LRC with IIA and LRC with EIA in patients with a benign or malignant right-sided colon neoplasm. Primary endpoint was length of hospital stay (LOS). This trial was registered with ClinicalTrials.gov, number NCT03045107.

Results:
A total of 140 patients were randomized and analyzed. Median operative time was comparable in IIA versus EIA group {130 [interquartile range (IQR) 105–195] vs 130 (IQR 110–180) min; P = 0.770} and no intraoperative complications occurred. The quicker recovery of bowel function after IIA than EIA [gas: 2 (IQR 2–3) vs 3 (IQR 2–3) days, P = 0.003; stool: 4 (IQR 3–5) vs 4.5 (IQR 3–5) days, P = 0.032] was not reflected in any advantage in the primary endpoint: median LOS was similar in the 2 groups [6 (IQR 5–7) vs 6 (IQR 5–8) days; P = 0.839]. No significant differences were observed in the number of lymph nodes harvested, length of skin incision, 30-day morbidity (17.1% vs 15.7%, P = 0.823), reoperation rate, and readmission rate between the 2 groups.

Conclusions:
LRC with IIA is associated with earlier recovery of postoperative bowel function than LRC with EIA; however, it does not reflect into a shorter LOS.
Perioperative Interstitial Fluid Expansion Predicts Major Morbidity Following Pancreatic Surgery
Authors: Sandini Marta , Paiella Salvatore , Cereda Marco , Angrisani Marco , Capretti Giovanni , Casciani Fabio , Famularo Simone , Giani Alessandro , Roccamatisi Linda , Viviani Elena , Caccialanza Riccardo , Montorsi Marco , Zerbi Alessandro , Bassi Claudio , Gianotti Luca 
Published: October 2019

Objective:
To evaluate whether perioperative bioimpedance vector analysis (BIVA) predicts the occurrence of surgery-related morbidity.

Summary Background Data:
BIVA is a reliable tool to assess hydration status and compartimentalized fluid distribution.

Methods:
The BIVA of patients undergoing resection for pancreatic malignancies was prospectively measured on the day prior to surgery and on postoperative day (POD)1. Postoperative morbidity was scored per the Clavien-Dindo classification (CDC), and the Comprehensive Complication Index (CCI).

Results:
Out of 249 patients, the overall and major complication rates were 61% and 16.5% respectively. The median CCI was 24 (IQR 0.0–24.2), and 24 patients (9.6%) had a complication burden with CCI≥40. At baseline the impedance vectors of severe complicated patients were shorter compared to the vectors of uncomplicated patients only for the female subgroup (P=0.016). The preoperative extracellular water (ECW) was significantly higher in patients who experienced severe morbidity according to the CDC or not [19.4L (17.5–22.0) vs. 18.2L (15.6–20.6), P=0.009, respectively] and CCI≥40, or not [20.3L (18.5–22.7) vs. 18.3L (15.6–20.6), P=0.002, respectively]. The hydration index on POD1 was significantly higher in patients who experienced major complications than in uncomplicated patients (P=0.020 and P=0.025 for CDC and CCI, respectively).
At a linear regression model, age (β=0.14, P=0.035), sex female (β=0.40, P<0.001), BMI (β=0.30, P<0.001), and malnutrition (β=0.14, P=0.037) were independent predictors of postoperative ECW.

Conclusion:
The amount of extracellular fluid accumulation predicts major morbidity after pancreatic surgery. Female, obese and malnourished patients were at high risk of extracellular fluid accumulation.