bluuebunny/crossref_metadata_2025_split huggingface dataset:
Novel Technique of Distal Roux-en-Y Gastric Bypass for Insufficient Weight Loss After Primary Procedure: Personal Experience and Primary Results at 12 Months
Authors: Thomopoulos Theodoros , Tomasi Vincent , Koliakos Evangelos , Thoma Maximilien , Navez Benoit 
Published: May 2018

Purpose:
In the literature, up to 20% of patients present a failure of weight loss after primary Roux-en-Y gastric bypass (RYGBP) or other restrictive procedures. Our aim is to describe the midterm results of our novel technique of distal Roux-en-Y gastric bypass (DRYGBP) as a revisional procedure.

Materials and Methods:
We performed our DRYGBP in 21 patients. The length of the common channel was 100 cm, whereas the lengths of the alimentary and the biliopancreatic limbs were 2/3 and 1/3 of the remaining bowel, respectively. We created 2 subgroups, a “revisional” group after failed restrictive procedures and a “distalization” group after failed RYGBP.

Results:
The mean excess weight loss at 12 months in the “revisional” group (10 patients) was 67.8% and in the “distalization” group (11 patients) 57.1%. We did not experience any mortality nor severe morbidity rates.

Conclusions:
In our experience, our DRYGBP differentiated procedure seems to be effective at 12 months.
Stabilization of Single-incision Laparoscopic Cholecystectomy by Needle Puncture and Bendable Retractor
Authors: Takahashi Kodai , Kanehira Eiji , Kamei Aya , Tanida Takashi , Sasaki Kazunori 
Published: May 2018

Background:
A recent meta-analysis and systematic review suggested that single-incision laparoscopic cholecystectomy (SILC) had a higher procedure failure rate with more blood loss and that it required a longer surgical time than conventional laparoscopic cholecystectomy. Herein, we introduce our experience with the needlescopic grasper-assisted and bendable retractor-assisted SILC technique and evaluate its safety and sustainability.

Methods:
The present retrospective cohort study included 407 Japanese patients who underwent needlescopic grasper-assisted and bendable retractor-assisted SILC between January 2012 and April 2017 at our institution.

Results:
In the present study, all patients successfully underwent needlescopic grasper-assisted and bendable retractor-assisted SILC without conversion to open surgery. Regarding surgical outcomes, mean surgical time was 58.2±23.2 minutes, and additional ports were required in 9 patients (2.2%). Postoperative morbidity developed in only 6 patients (1.4%).

Conclusions:
The surgical approaches defined herein were safe and sustainable with favorable surgical outcomes. Compared with conventional SILC, needlescopic grasper-assisted and bendable retractor-assisted SILC might become a mainstream procedure for minimally invasive surgery from the viewpoint of surgical difficulty.
A new weighted injury severity scoring system: Better predictive power for pediatric trauma mortality
Authors: Shi Junxin , Shen Jiabin , Caupp Sarah , Wang Angela , Nuss Kathryn E. , Kenney Brian , Wheeler Krista K. , Lu Bo , Xiang Henry 
Published: May 2018

BACKGROUND
An accurate injury severity measurement is essential for the evaluation of pediatric trauma care and outcome research. The traditional Injury Severity Score (ISS) does not consider the differential risks of the Abbreviated Injury Scale (AIS) from different body regions nor is it pediatric specific. The objective of this study was to develop a weighted ISS (wISS) system for pediatric blunt trauma patients with better predictive power than ISS.

METHODS
Based on the association between mortality and AIS from each of the six ISS body regions, we generated different weights for the component AIS scores used in the calculation of ISS. The weights and wISS were generated using the National Trauma Data Bank. The Nationwide Emergency Department Sample (NEDS) was used to validate our main results. Pediatric blunt trauma patients younger than 16 years were included, and mortality was the outcome. Discrimination (areas under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, negative predictive value, concordance) and calibration (Hosmer-Lemeshow statistic) were compared between the wISS and ISS.

RESULTS
The areas under the receiver operating characteristic curves from the wISS and ISS are 0.88 versus 0.86 in ISS of 1 to 74 and 0.77 versus 0.64 in ISS of 25 to 74 (p < 0.0001). The wISS showed higher specificity, positive predictive value, negative predictive value, and concordance when they were compared at similar levels of sensitivity. The wISS had better calibration (smaller Hosmer-Lemeshow statistic) than the ISS (11.6 vs. 19.7 for ISS = 1–74 and 10.9 vs. 12.6 for ISS = 25–74). The wISS showed even better discrimination with the Nationwide Emergency Department Sample.

CONCLUSION
By weighting the AIS from different body regions, the wISS had significantly better predictive power for mortality than the ISS, especially in critically injured children.

LEVEL OF EVIDENCE AND STUDY TYPE
Prognostic/epidemiological, level IV.
Validation of predictive equations to assess energy expenditure in acute spinal cord injury
Authors: Ramirez Christine L. , Pelekhaty Stacy , Massetti Jennifer M. , Galvagno Samuel , Harmon Laura , Botwinick Isadora , Scalea Thomas M. , Stein Deborah M. 
Published: May 2018

BACKGROUND
Acute spinal cord injury (SCI) is devastating with morbidities compounded by inadequate nutrition. The American Society for Parenteral and Enteral Nutrition recommends indirect calorimetry (IC) to evaluate energy needs in SCI because no predictive energy equations have been validated. We sought to determine the accuracy of predictive equations to predict measured energy expenditure (MEE).

METHODS
A retrospective review was performed over 2 years. Patients 18 years or older with cervical SCI who received IC were included. Height, weight, maximum temperature and minute ventilation on day of IC, plus MEE and VCO2 from IC were obtained. Predicted energy expenditure (PEE) was calculated using Harris–Benedict (HB), Penn State (PS), Mifflin St. Jeor (MSJ), Weir, Ireton–Jones (IJ), and 25 kcal/kg formulas. MEE was then compared to the PEE of each method.

RESULTS
Thirty-nine IC studies were completed for 20 patients. Weir had the strongest correlation to MEE (r = 0.98), followed by PS (r = 0.82). Correlations were similar among HB (r = 0.78), MSJ (r = 0.75), and IJ (r = 0.73), and weakest with 24 kcal/kg (r = 0.55). All had a p value <0.001. Deming regression confirmed strong correlations between Weir and PS to MEE, with coefficients of 1.03 and 1.515 (p < 0.001), respectively. Other formulas had comparatively higher coefficients and standard errors. Bland–Altman analysis confirmed Weir had the narrowest range of difference, with a mean difference of 25.5 kcal/day, followed by PS (−336.1 kcal/day).

CONCLUSIONS
Weir is the best predictive energy equation, with all statistical tests demonstrating a strong correlation between MEE and Weir. The second best predictive equation is the Penn State formula, which predicts actual MEE measured by IC with high accuracy.

LEVEL OF EVIDENCE
Diagnostic study, level III
A subset of five human mitochondrial formyl peptides mimics bacterial peptides and functionally deactivates human neutrophils
Authors: Kaczmarek Elzbieta , Hauser Carl J. , Kwon Woon Yong , Riça Ingred , Chen Li , Sandler Nicola , Otterbein Leo E. , Campbell Yan , Cook Charles H. , Yaffe Michael B. , Marusich Michael F. , Itagaki Kiyoshi 
Published: May 2018

BACKGROUND
Trauma causes inflammation by releasing mitochondria that act as Danger-Associated Molecular Patterns (DAMPs). Trauma also increases susceptibility to infection. Human mitochondria contain 13 N-formyl peptides (mtFPs). We studied whether mtFPs released into plasma by clinical injury induce neutrophil (PMN) inflammatory responses, whether their potency reflects their similarity to bacterial FPs and how their presence at clinically relevant concentration affects PMN function.

METHODS
N-terminal sequences of the 13 mtFPs were synthesized. Changes in human PMN cytosolic Ca2+ concentration ([Ca2+]i) and chemotactic responses to mtFPs were studied. Sequence similarity of mtFPs to the canonical bacterial peptide f-Met-Leu-Phe (fMLF/fMLP) was studied using the BLOcks SUbstitution Matrix 62 (BLOSUM 62) system. The presence of mtFPs in plasma of trauma patients was assayed by Enzyme-linked immunosorbent assay (ELISA). The effects of the most potent mtFP (ND6) on PMN signaling and function were then studied at ambient clinical concentrations by serial exposure of native PMN to ND6, chemokines and leukotrienes.

RESULTS
Five mtFPs (ND6, ND3, ND4, ND5, and Cox 1) induced [Ca2+]i flux and chemotaxis in descending order of potency. Evolutionary similarity to fMLF predicted [Ca2+]i flux and chemotactic potency linearly (R
2 = 0.97, R
2 = 0.95). Chemoattractant potency was also linearly related to [Ca2+]i flux induction (R2 = 0.92). Active mtFPs appear to circulate in significant amounts immediately after trauma and persist through the first week. The most active mtFP, ND6, suppresses responses to physiologic alveolar chemoattractants (CXCL-1, leukotriene B4) as well as to fMLF where CXCL-1 and leukotriene B4 do not suppress N-formyl peptide receptor (FPR)-1 responses to mtFPs. Prior FPR-1 inhibition rescues PMN from heterologous suppression of CXCR-1 and BLT-1 by mtFPs.

CONCLUSION
The data suggest mtFPs released by injured tissue may attract PMN to trauma sites while suppressing PMN responses to other chemoattractants. Inhibition of mtFP-FPR1 interactions might increase PMN recruitment to lung bacterial inoculation after trauma. These findings suggest new paradigms for preventing infections after trauma.

LEVEL OF EVIDENCE
Therapeutic, Level IV.
Implementation of a CT scan practice guideline for pediatric trauma patients reduces unnecessary scans without impacting outcomes
Authors: McGrew Patrick R. , Chestovich Paul J. , Fisher Jay D. , Kuhls Deborah A. , Fraser Douglas R. , Patel Purvi P. , Katona Chad W. , Saquib Syed , Fildes John J. 
Published: May 2018

INTRODUCTION
Computed tomography (CT) scans are useful in the evaluation of trauma patients, but are costly and pose risks from ionizing radiation in children. Recent literature has demonstrated the use of CT scan guidelines in the management of pediatric trauma. The study objective is to review our treatment of pediatric blunt trauma patients and evaluate CT use before and after CT-guideline implementation.

METHODS
Our Pediatric Level 2 Trauma Center (TC) implemented a CT scan practice guideline for pediatric trauma patients in March 2014. The guideline recommended for or against CT of the head and abdomen/pelvis using published criteria from the Pediatric Emergency Care and Research Network. There was no chest CT guideline. We reviewed all pediatric trauma patients for CT scans obtained during initial evaluation before and after guideline implementation, excluding inpatient scans. The Trauma Registry Database was queried to include all pediatric (age < 15) trauma patients seen in our TC from 2010 to 2016, excluding penetrating mechanism and deaths in the TC. Scans were considered positive if organ injury was detected. Primary outcome was the proportion of patients undergoing CT and percent positive CTs. Secondary outcomes were hospital length of stay, readmissions, and mortality. Categorical and continuous variables were analyzed with χ
2 and Wilcoxon rank-sum tests, respectively. p < 0.05 was considered significant.

RESULTS
We identified 1,934 patients: 1,106 pre- and 828 post-guideline. Absolute reductions in head, chest, and abdomen/pelvis CT scans were 17.7%, 11.5%, and 18.8%, respectively (p < 0.001). Percent positive head CTs were equivalent, but percent positive chest and abdomen CT increased after implementation. Secondary outcomes were unchanged.

CONCLUSIONS
Implementation of a pediatric CT guideline significantly decreases CT use, reducing the radiation exposure without a difference in outcome. Trauma centers treating pediatric patients should adopt similar guidelines to decrease unnecessary CT scans in children.

LEVEL OF EVIDENCE
Therapeutic study, level IV.
Can acute care surgeons perform while fatigued? An EAST multicenter study
Authors: Schuster Kevin M. , Hazelton Joshua P. , Rattigan Deviney , Nguyen Linh , Kim Dennis , Spence Lara H. , Turay David , Luo-Owen Xian , Perez Javier Martin , Dayal Saraswati , Blatt Melissa , Hill Casey , Bhattacharya Bishwajit 
Published: May 2018

BACKGROUND
Fatigued surgeon performance has only been assessed in simulated sessions or retrospectively after a night on call. We hypothesized that objectively assessed fatigue of acute care surgeons affects patient outcome.

METHODS
Five acute care surgery services prospectively identified emergency cases over 27 months. Emergency cases were defined by the surgeon identifying the patient as requiring immediate operation upon consultation or admission. Within 48 hours, surgeons reported sleep time accumulated before operation, if nonclinical delays to operation occurred, and patient volume during the shift. To maximize differences, fatigued surgeons were defined as performing a case after midnight without having slept in the prior 18 hours. Rested surgeons performed cases at or before 8 pm or after at least 3 hours of sleep before operation. A four-level ordinal scale was used to assign case complexity. Hierarchical logistic regression models were constructed to assess the impact of fatigue on mortality and major morbidity while controlling for center and patient level factors.

RESULTS
Of 882 cases collected, 611 met criteria for fatigue or rested. Of these cases, 370 were performed at night and 182 by a fatigued surgeon. Rested surgeons were more likely to be operating on an older or female patient; other characteristics were similar. Mortality and major morbidity were similar between fatigued and rested surgeons (12.1% vs 12.1% and 46.9% vs 48.9%), respectively. After controlling for center and patient factors, surgeon fatigue did not affect mortality or major morbidity. Mortality variance was 6.30% and morbidity variance was 7.02% among centers.

CONCLUSION
Acute care surgeons have similar outcomes in a fatigued or rested state. Work schedules for acute care surgeons should not be adjusted to shifts less than 24 hours for the sole purpose of improving patient outcomes.

LEVEL OF EVIDENCE
Prognostic study, level IV.
Trauma patients are safe to fly 72 hours after tube thoracostomy removal
Authors: Zonies David , Elterman Joel , Burns Christopher , Paul Vincent , Oh John , Cannon Jeremy 
Published: May 2018

BACKGROUND
Current recommendations for safe air travel following traumatic pneumothorax are 2 to 3 weeks after radiographic resolution. These recommendations are based on several small observational studies and expert consensus, which cite a theoretical risk of recurrence and hypoxia because of decreased oxygen tension at altitude. We sought to systematically study the timing of chest drain removal after traumatic pneumothorax and risk of recurrence in relation to air travel.

METHODS
A retrospective cohort study of consecutively admitted patients who sustained a traumatic chest injury treated with tube thoracostomy over a 5-year period was undertaken. Adult patients with a postremoval expiratory chest x-ray demonstrating absence of pneumothorax and at least a 24-hour observation period before flight were eligible for study. All patients were transferred to a participating medical center for continued care. In-flight medical monitoring was available for all patients. Baseline patient characteristics, interval period from drain removal to flight, in-flight medical records, and incidence of radiographic or clinical recurrence of pneumothorax at the destination facility were recorded.

RESULTS
Seventy-three patients who met the inclusion criteria were studied. All were male with a median age of 24 years (interquartile range [IQR], 22–26 years), injury severity score of 30 (IQR, 24–38), and chest abbreviated injury scale value of 3 (IQR, 2–4). The majority of patients sustained a penetrating injury (74%). The median duration of tube thoracostomy was 4 days (IQR, 3–6 days). The median period between thoracostomy tube removal and flight was 2.5 days (IQR, 1.5–4 days). Twenty-nine patients (40%) remained mechanically ventilated during transport. There were no reported in-flight medical emergencies for the entire cohort. There were no reported postflight radiographic or clinical recurrences during the subsequent 30 days.

CONCLUSIONS
After a 72-hour period of observation, air travel after tube thoracostomy removal appears safe for both mechanically ventilated and nonventilated patients.

LEVEL OF EVIDENCE
Therapeutic, level IV.
Blunt traumatic scapular fractures are associated with great vessel injuries in children
Authors: Abd el-shafy Ibrahim , Rosen Lisa M. , Prince Jose M. , Letton Robert W. , Rosen Nelson G. 
Published: May 2018

BACKGROUND
Patients with stable blunt great vessel injury (GVI) can have poor outcomes if the injury is not identified early. With current pediatric trauma radiation reduction efforts, these injuries may be missed. As a known association between scapular fracture and GVI exists in adult blunt trauma patients, we examined whether that same association existed in pediatric blunt trauma patients.

METHODS
Bluntly injured patients younger than 18 years old were identified from 2012 to 2014 in the National Trauma Data Bank. Great vessel injury included all major thoracic vessels and carotid/jugular. Demographics of patients with and without scapular fracture were compared with descriptive statistics. The χ2 test was used to examine this association using SAS Version 9.4 (SAS Institute, Inc, Cary, NC).

RESULTS
We found a significant association between pediatric scapular fracture and GVI. Of 291,632 children identified, 1,960 had scapular fractures. Children with scapular fracture were 10 times more likely to have GVI (1.2%) compared to those without (0.12%, p < 0.0001). Most common GVI seen were carotid artery, thoracic aorta, and brachiocephalic or subclavian artery or vein. Children with both scapular fracture and GVI were most commonly injured by motor vehicles (57% collision, 26% struck).

CONCLUSIONS
Injured children with blunt scapular fracture have a 10-fold greater risk of having a GVI when compared to children without scapular fracture. Presence of blunt traumatic scapular fracture should have appropriate index of suspicion for a significant GVI in pediatric trauma patients.

LEVEL OF EVIDENCE
Epidemiologic and prognostic study, level III; Therapeutic, level IV.
Survival and Metabolic Function of Syngeneic Mouse Islet Grafts Transplanted Into the Hepatic Sinus Tract
Authors: Li Feng , Jiao Ao , Li Xiaohang , Zhang Chengshuo , Sun Ning , Zhang Jialin 
Published: May 2018

Background
Islet grafts are transplanted into the liver via a portal vein in 90% of the clinical islet transplantations. However, the portal vein is far from being the ideal infusion site due to its unique drawbacks. These issues necessitated the exploration of an alternatively optimized site for clinical islet transplantation. With the widespread clinical application of percutaneous transhepatic puncture technique, we envisioned the possibility of islet transplantation into the hepatic sinus tract (HST).

Methods
The HST was created by temporarily placing a medically approved material into the hepatic parenchyma of C57BL/6 mice. The syngeneic islets were transplanted into the HST, after which, the nonfasting blood glucose, intraperitoneal glucose tolerance, and morphology were evaluated.

Results
A collagen-lined HST was formed by the 28-day implantation of a cylindrical nylon rod. Transplantation of ~300 syngeneic islets into the HST routinely reversed the hyperglycemia of the recipient mice and maintained normoglycemia for longer than 100 days until the graft was removed. The islet grafts within the HST stained positively for insulin, glucagon, and abundant microvessels and achieved comparable results to the islet grafts under the kidney capsule with respect to glycemic control and glucose tolerance.

Conclusions
These results suggested that an HST can be constructed for islet transplantation by temporarily placing a nylon material in the liver parenchyma. The HST is a promising site for clinical islet transplantation, thereby providing a satisfactory environment for the survival and metabolic function of islet grafts.
Acoustic Calibration in an Echoic Environment
Authors: Kazakov Alexander , Israel Nelken 
Published: May 2018

ABSTRACTBackground: The sound fed to a loudspeaker may significantly differ from that reaching the ear of the listener. The transformation from one to the other consists of spectral distortions with strong dependence on the relative locations of the speaker and the listener as well as on the geometry of the environment. With the increased importance of research in awake, freely-moving animals in large arenas, it becomes important to understand how animal location influences the corresponding spectral distortions.New Method: We describe a full calibration pipeline that includes spatial sampling and estimation of the spectral distortions. We estimated the impulse responses of the environment using Golay complementary sequences.Using those sequences, we also describe an acoustic 3D localization method for freely moving animals.Results: In our arena, the impulse responses are dominated by a small number of strong reflections. We use this understanding to provide guidelines for designing the geometry of the environment as well as the presented sounds, in order to provide more uniform sound levels throughout the environment. Our 3D localization method achieves a 1 cm precision through the utilization of sound cues only.Comparison with Existing Methods: To our knowledge, this is the first description of a large-scale acoustic calibration pipeline with acoustic localization for neuroscience studies.Conclusions: Principled sampling of large arena allows for better design and control of the acoustic information provided to freely-moving animals.