bluuebunny/crossref_metadata_2025_split huggingface dataset:
Different Risk Factors for Early and Late Colorectal Anastomotic Leakage in a Nationwide Audit
Authors: Sparreboom Cloë L. , van Groningen Julia T. , Lingsma Hester F. , Wouters Michel W.J.M. , Menon Anand G. , Kleinrensink Gert-Jan , Jeekel Johannes , Lange Johan F. 
Published: October 2018

BACKGROUND:
Anastomotic leakage remains a major complication after surgery for colorectal carcinoma, but its origin is still unknown. Our hypothesis was that early anastomotic leakage is mostly related to technical failure of the anastomosis, and that late anastomotic leakage is mostly related to healing deficiencies.

OBJECTIVE:
The aim of this study was to assess differences in risk factors for early and late anastomotic leakage.

DESIGN:
This was a retrospective cohort study.

Settings:
The Dutch ColoRectal Audit is a nationwide project that collects information on all Dutch patients undergoing surgery for colorectal cancer.

PATIENTS:
All patients undergoing surgical resection for colorectal cancer in the Netherlands between 2011 and 2015 were included.

MAIN OUTCOME MEASURES:
Late anastomotic leakage was defined as anastomotic leakage leading to reintervention later than 6 days postoperatively.

RESULTS:
In total, 36,929 patients were included; early anastomotic leakage occurred in 863 (2.3%) patients, and late anastomotic leakage occurred in 674 (1.8%) patients. From a multivariable multinomial logistic regression model, independent predictors of early anastomotic leakage relative to no anastomotic leakage and late anastomotic leakage relative to no anastomotic leakage included male sex (OR, 1.8; p < 0.001 and OR, 1.2; p = 0.013) and rectal cancer (OR, 2.1; p < 0.001 and OR, 1.6; p = 0.046). Additional independent predictors of early anastomotic leakage relative to no anastomotic leakage included BMI (OR, 1.1; p = 0.001), laparoscopy (OR, 1.2; p = 0.019), emergency surgery (OR, 1.8; p < 0.001), and no diverting ileostomy (OR, 0.3; p < 0.001). Independent predictors of late anastomotic leakage relative to no anastomotic leakage were Charlson Comorbidity Index of ≥II (OR, 1.3; p = 0.003), ASA score III to V (OR, 1.2; p = 0.030), preoperative tumor complications (OR, 1.1; p = 0.048), extensive additional resection because of tumor growth (OR, 1.7; p = 0.003), and preoperative radiation (OR, 2.0; p = 0.010).

LIMITATIONS:
This was an observational cohort study.

CONCLUSIONS:
Most risk factors for early anastomotic leakage were surgery-related factors, representing surgical difficulty, which might lead to technical failure of the anastomosis. Most risk factors for late anastomotic leakage were patient-related factors, representing the frailty of patients and tissues, which might imply healing deficiencies. See Video Abstract at http://links.lww.com/DCR/A730.
Pregnancy outcome in mothers over the age of 35
Authors: Heazell Alexander E.P. , Newman Lydia , Lean Samantha C. , Jones Rebecca L. 
Published: October 2018

Purpose of review
The proportion of pregnancies occurring in women of at least 35 years of age has increased from 6.2% in 1980 to 22.3% of births in 2016. This review summarizes recent epidemiological and basic scientific studies investigating the association between older maternal age and adverse pregnancy outcome(s), and clinical studies which investigate the effects of intervention to reduce adverse events.

Recent findings
Women of at least 35 years of age have increased risk of maternal and foetal complications in pregnancy including: stillbirth, a small for gestational age baby, preterm birth, preeclampsia and maternal death. These risks increase with increasing age. The reasons for this increased risk are incompletely understood, but likely involve ageing of the maternal cardiovascular and endocrine systems which impacts upon placental function. Intervention, by induction of labour (IOL) at 39-week gestation does not increase operative deliveries or short-term adverse maternal and neonatal outcomes and would reduce perinatal mortality.

Summary
The additional risks of pregnancy should be discussed with women of at least 35 years of age; additional foetal surveillance may be required in the antenatal period. The benefits and risks of IOL at 39-week gestation should be discussed with women at least 35 years of age.
Rationalizing the Vascular Anatomy for Oblique Osteotomy of the Metatarsal Head during Toe/Joint Transfers of the Metatarsophalangeal Joint
Authors: Lin Yu-Te , Chen Shih-Heng , Loh Charles Yuen Yung , Hsu Chung-Cheng , Lin Cheng-Hung 
Published: October 2018

Background:
The metatarsophalangeal joint (MTPJ) of the lessor toe has been used to reconstruct the metacarpophalangeal joint. When an oblique osteotomy of the metatarsal head is performed, the orientation of the vascular pedicle is crucial to preserve the blood supply to the MTPJ. This study was conducted to identify the path of the nutrient artery to the MTPJ.

Methods:
We reviewed our operative records in consecutive series of 45 patients during toe or joint harvest. Retrograde dissection of the vascular pedicle was performed starting from the distal communicating artery at the first webspace toward the first dorsal metatarsal and first plantar metatarsal arteries. All the vessels related to the MTPJ were explored and ligated if the MTPJ was not included in the flap.

Results:
The condylar branches to the proximal phalanx and the metaphyseal branches to the second metatarsus were barely identifiable during the dissections. The articular branch running perpendicularly from the plantar artery toward the plantar surface of MTPJ was verified in all cases. The articular branches originated either from the first plantar metatarsal artery (92.1%) or from the tibial plantar digital artery (7.9%). The external diameter of the articular branches was around 0.5–1 mm. When the articular branch was included and preserved, the metatarsal heads oozed immediately after the flap was reperfused.

Conclusions:
The study demonstrated the constant and sizable articular branch of the MTPJ that originates from the plantar artery system. The consistency of the vascular anatomy enables oblique osteotomies of the metatarsal head to be performed without fear of injury to the pedicle.
What Influences a Plastic Surgery Resident to Pursue an Academic Career?
Authors: Mandel Benjamin A. , Weber Sharon M. , Gutowski Karol A. , Salyapongse A. Neil , Bentz Michael L. 
Published: October 2018

Background:
A previous study demonstrated that independent model plastic surgery residents are less likely to pursue a career in academic surgery than those graduating from other surgical fellowships. This study was designed to evaluate whether a significant curriculum change emphasizing academic plastic surgery skills would be significant in influencing a plastic surgery resident’s decision to pursue a career in academic plastic surgery.

Methods:
A survey was sent to 30 consecutive graduates of a university plastic surgery residency program. This program had transitioned from a clinically focused independent residency-training model to an integrated model with a new and structured academic emphasis. Respondents who graduated after this transition (“ACADEMIC” n = 19) were compared with those who graduated before (“CLINICAL” n = 9). Results were analyzed using Fisher’s exact test and Wilcoxon rank sum test.

Results:
There were a total of 28 respondents (response rate = 93%). A higher percentage of the ACADEMIC group, in contrast to the CLINICAL group reported that they spent time during residency performing clinical research (84% versus 33%, P = 0.013), and that they are currently conducting clinical research in their practices (79% versus 0%, P < 0.001). These graduates were also more likely to have engaged their mentor both regarding professional issues (61% versus 0%, P = 0.016), and as a role model when choosing a career plan (72% versus 17%, P = 0.050). Finally, a higher percentage of the ACADEMIC exposed group entered an academic practice after training (44% versus 0%, P = 0.026).

Conclusion:
In a single plastic surgery residency program, the transition to strong academic mentorship with a structured academic educational program focus correlated with an increase in academic careers among program graduates. A proactive academically oriented educational and mentoring environment may help attract residents to careers in academic surgery.
Successful Use of Negative-pressure Wound Therapy and Dermal Substitute in the Treatment of Gluteal Ecthyma Gangrenosum in a 2-year-old Girl
Authors: Persano Giorgio , Pinzauti Enrico , Pancani Simone , Incerti Filippo 
Published: October 2018

Summary:
Ecthyma Gangrenosum is a manifestation of Pseudomonas Aeruginosa infection, usually occurring in immunocompromised patients, which can be associated with Pseudomonas Aeruginosa bacteremia with potentially lethal outcome. The clinical appearance is of an inflammatory cutaneous lesion with a central necrotic spot; the lesion then rapidly progresses to a gangrenous ulcer with a gray-black eschar extending in the deep soft tissues. Treatment of Ecthyma Gangrenosum includes both aggressive systemic antibiotic therapy and surgical procedures. A 2-year-old girl affected by B-cell precursor acute lymphoblastic leukemia was admitted to our hospital for suspected sepsis; the diagnosis was later confirmed by blood cultures positive for Pseudomonas Aeruginosa. In the days following the diagnosis, the patient developed a necrotic lesion of the right gluteal area consistent with Ecthyma Gangrenosum. Aggressive surgical debridement was then performed, followed by negative-pressure wound therapy and reconstruction with dermal substitute and autologous skin graft, which were successful. Ecthyma Gangrenosum is a potentially lethal condition affecting especially immunocompromised patients; aggressive medical treatment with combination antibiotic therapy is warranted and multiple surgical procedures, including extensive surgical debridement and diverting colostomy, are needed. Various reconstructive techniques have been reported in the literature, although no gold-standard can be established to date. Since Ecthyma Gangrenosum lesions are characterized by the presence of both high inflammatory activity due Pseudomonas infection and extensive tissue loss, the association of negative-pressure therapy and dermal substitutes implant seem to have a rationale in the surgical treatment of Ecthyma Gangrenosum and should therefore be considered.
An update on membranes and cartridges for extracorporeal blood purification in sepsis and septic shock
Authors: Honoré Patrick M. , De Bels David , Spapen Herbert D. 
Published: October 2018

Purpose of review
This review aims to summarize the most recent advances on different membranes and cartridges used for extracorporeal blood purification in critically ill patients with sepsis or septic shock.

Recent findings
Despite positive signals from experimental, cases and small clinical studies, blood purification showed no distinct morbidity and mortality benefit in large clinical trials.

Summary
None of the discussed specific membranes or cartridges can currently be recommended as sole adjunctive treatment in sepsis and septic shock. Any available technique should be timely initiated and adapted to the patient's status. Sickest patients seem to benefit more from blood purification. Patient selection is thus of crucial importance and may be optimized by focusing on disease severity and degree of organ failure. Measurement of endotoxin activity and plasma procalcitonin levels can support the selection process but ideal cutoff values need to be defined. Well-designed prospective randomized clinical trials assessing or comparing the various available membranes and cartridges are eagerly awaited.
Oxygen therapy in acute resuscitation
Authors: Frei Daniel R. , Young Paul J. 
Published: October 2018

Purpose of review
Avoidance and treatment of hypoxaemia is a cornerstone of acute resuscitation and yet the optimal approach to oxygen therapy in the acute care setting is uncertain. The aim of this review is to appraise recent evidence relating to the provision of supplemental oxygen to adult patients with acute illnesses with a focus on the resuscitation phase.

Recent findings
Recent findings generally support the notion that exposure to hyperoxaemia is associated with adverse outcomes in acutely ill adults with a range of diseases and raise the possibility that liberal provision of oxygen may cause harm. Several ongoing multicentre randomized trials aim to assess the effects of different oxygen therapy regimens on patient outcomes to provide a foundation for evidence-based recommendations regarding the use of supplemental oxygen in Intensive Care Unit patients.

Summary
At present, evidence is lacking to support routine liberal oxygen administration in acutely ill patients and, in most circumstances, a reasonable approach is to titrate supplemental oxygen to achieve an arterial oxygen saturation measured by pulse oximetry (SpO2) of 92–96% with the aim of avoiding both hypoxaemia and hyperoxaemia.
Corticosteroids administration to improve outcome in high-risk surgical patients
Authors: Asehnoune Karim , Vourc’h Mickael , Roquilly Antoine 
Published: October 2018

Purpose of review
Postoperative complications are major healthcare problems and are associated with a reduced short-term and long-term survival. Major surgery is associated with a predictable and usually transient systemic inflammatory response (SIRS), depending on the magnitude of the surgical trauma. An excessive SIRS syndrome participates to the development of postoperative organ dysfunction, infection and mortality. Corticosteroids may decrease the postsurgical SIRS. This review aims to discuss recent findings on the use of corticosteroids in major surgery.

Recent findings
In acute medicine, several lines of evidence have shown that moderate doses of corticosteroids decrease the excessive inflammatory response, without inducing immunosuppression. Evidences from several meta-analyses suggest that intraoperative administration of corticosteroids during major surgery decreases postoperative infectious complications, without significant risk of anastomotic leakage, or bleeding complications.

Summary
At present, no large randomized controlled trial has been performed in patients undergoing major noncardiac surgery. However, despite the widespread use of corticosteroids to improve analgesia and reduce postoperative nausea or vomiting, concerns continue to be raised about their safety. At present, the safety profile for using short course of moderate dose of corticosteroids is good, but glycaemic control and natremia should be carefully monitored during the postoperative period.
Enhanced triage for patients with suspected cardiac chest pain: the History and Electrocardiogram-only Manchester Acute Coronary Syndromes decision aid
Authors: Alghamdi Abdulrhman , Howard Laura , Reynard Charles , Moss Philip , Jarman Heather , Mackway-Jones Kevin , Carley Simon , Body Richard 
Published: October 2018

Objectives
Several decision aids can ‘rule in’ and ‘rule out’ acute coronary syndromes (ACS) in the Emergency Department (ED) but all require measurement of blood biomarkers. A decision aid that does not require biomarker measurement could enhance risk stratification at triage and could be used in the prehospital environment. We aimed to derive and validate the History and ECG-only Manchester ACS (HE-MACS) decision aid using only the history, physical examination and ECG.

Methods
We undertook secondary analyses in three prospective diagnostic accuracy studies that included patients presenting to the ED with suspected cardiac chest pain. Clinicians recorded clinical features at the time of arrival using a bespoke form. Patients underwent serial troponin sampling and 30-day follow-up for the primary outcome of ACS. The model was derived by logistic regression in one cohort and validated in two similar prospective studies.

Results
The HE-MACS model was derived in 796 patients and validated in cohorts of 474 and 659 patients. HE-MACS incorporated age, sex, systolic blood pressure plus five historical variables to stratify patients into four risk groups. On validation, 5.5 and 12.1% (pooled total 9.4%) patients were identified as ‘very low risk’ (potential immediate rule out) with a pooled sensitivity of 99.5% (95% confidence interval: 97.1–100.0%).

Conclusion
Using only the patient’s history and ECG, HE-MACS could ‘rule out’ ACS in 9.4% of patients while effectively risk stratifying remaining patients. This is a very promising tool for triage in both the prehospital environment and ED. Its impact should be prospectively evaluated in those settings.
Cervical osteophytosis and spine posture: contribution to swallow disorders and symptoms
Authors: Abdel-Aziz Mosaad , Azab Noha , El-Badrawy Amr 
Published: October 2018

Purpose of review
The article reviews the effects of cervical osteophytosis and spine posture on swallowing, and how they can cause dysphagia.

Recent findings
Cerivical osteophytosis which is a bony overgrowth of the cervical spines, it affects the swallowing through different mechanisms, including direct mechanical compression of the pharynx and esophagus, disturbances of normal epiglottic tilt over the inlet of the larynx by the osteophytes at C3–C4 level, inflammatory reactions in the tissues around the esophagus and cricopharyngeal spasm. Also, cervical spine posture in normal individuals could affect the swallowing mechanism by disturbance of the sphincteric action of the larynx and upper esophageal sphincter.

Summary
Cervical osteophytosis and abnormal cervical curvature may be overlooked by the Otolaryngologists as causes of swallowing disorders. The diagnosis is usually confirmed by radiologic study for the cervical spine. Cervical abnormality should be kept in mind while we are investigating patients with swallowing problem, and postural modification may help in treatment of such cases.
Distinct Patterns of Fiber Type Adaptation in Rat Hindlimb Muscles 4 Weeks After Hemorrhagic Stroke
Authors: Snow LeAnn M. , Low Walter C. , Thompson LaDora V. 
Published: October 2018

Objective
The aim of this study was to evaluate adaptations in soleus and tibialis anterior muscles in a rat model 4 wks after hemorrhagic stroke.

Design
Young adult Sprague Dawley rats were randomly assigned to two groups: stroke and control, with eight soleus and eight tibialis anterior muscles per group. Hemorrhagic stroke was induced in the right caudoputamen of the stroke rats. Control rats had no intervention. Neurologic status was evaluated in both groups before stroke and 4 wks after stroke. Muscles were harvested after poststroke neurologic testing. Muscle fiber types and cross-sectional areas were determined in soleus and tibialis anterior using immunohistochemical labeling for myosin heavy chain.

Results
No generalized fiber atrophy was found in any of the muscles. Fiber types shifted from faster to slower in the tibialis anterior of the stroke group, but no fiber type shifts occurred in the soleus muscles of stroke animals.

Conclusions
Because slower myosin heavy chain fiber types are associated with weaker contractile force and slower contractile speed, this faster to slower fiber type shift in tibialis anterior muscles may contribute to weaker and slower muscle contraction in this muscle after stroke. This finding may indicate potential therapeutic benefit from treatments known to influence fiber type plasticity.
Reporting Adverse Events in Plastic Surgery: A Systematic Review of Randomized Controlled Trials
Authors: Morzycki Alexander D. , Hudson Alexandra S. , Samargandi Osama A. , Bezuhly Michael , Williams Jason G. 
Published: October 2018

Background:
Accurate knowledge of adverse events is critical for evaluation of the safety of interventions. Historically, adverse events in surgical trials have been poorly reported. The objective of this study was to systematically evaluate the reporting of adverse events in randomized controlled trials in the plastic surgery literature.

Methods:
Two independent reviewers conducted a systematic search using MEDLINE, Embase, and Scopus of the top seven plastic surgery journals with the highest impact factors. Randomized controlled trials describing a potentially invasive treatment, published between January of 2012 and December of 2016, were included.

Results:
One hundred forty-five randomized controlled trials involving 10,266 patients were included, of which 30 percent were registered. Anticipated adverse events were clearly defined in 15 percent of trials, and in 70 percent it was not clear who would be documenting adverse events. Furthermore, 72 percent of randomized controlled trials reported the occurrence of adverse events, of which 61 percent failed to report events occurring in the intrainterventional period. Binary logistic regression revealed that funded randomized controlled trials were 4.04 times more likely to report adverse events compared with nonfunded randomized controlled trials (95 percent CI, 1.41 to 10.83; p = 0.009).

Conclusions:
The authors’ findings suggest the need for reporting standards for adverse events in the plastic surgery literature, as such reporting remains heterogeneous and is lacking rigor. Improved quality and transparency are needed to strengthen evidence-based practice and permit a balanced intervention assessment. This study provides a set of recommendations aimed at improving adverse event reporting.
Assessing Quality of Life and Patient-Reported Satisfaction with Masculinizing Top Surgery: A Mixed-Methods Descriptive Survey Study
Authors: Poudrier Grace , Nolan Ian T. , Cook Tiffany E. , Saia Whitney , Motosko Catherine C. , Stranix John T. , Thomson Jennifer E. , Gothard M. David , Hazen Alexes 
Published: October 2018

Background:
Masculinizing top surgery (bilateral mastectomy with chest wall reconstruction) is an important gender-affirming procedure sought by many transmasculine and nonbinary individuals. Current literature is focused primarily on details of surgical technique and complication rates, with limited data available on how top surgery affects subjective quality-of-life measures.

Methods:
An anonymous online survey was distributed to 81 of the senior author’s former top-surgery patients. The survey response rate was 72 percent (58 respondents). Responses were analyzed to investigate quality of life, sexual confidence, mental health, satisfaction with top surgery, and patient attitudes toward top surgery’s role in gender affirmation.

Results:
Following top surgery, measures of quality of life and sexual confidence improved significantly (p < 0.001). In addition, 86 percent reported improvement in gender dysphoria–related mental health conditions. All but one respondent reported that top surgery had an overall positive impact on their life.

Conclusions:
Top surgery had major positive effects on all mental health and quality-of-life metrics. The authors’ findings contribute to a much-needed body of evidence that top surgery markedly improves the daily lives and functioning of transgender and nonbinary individuals who choose to undergo it.