bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complex Lower Extremity Wound in the Complex Host: Results From a Multicenter Registry
Authors: Kim Paul J. , Attinger Christopher E. , Orgill Dennis , Galiano Robert D. , Steinberg John S. , Evans Karen K. , Lavery Lawrence A. 
Published: April 2019

Background:
The complex diabetic lower extremity wound has not been well studied. There are a variety of new technologies now being applied with a paucity of evidence in evaluating their outcomes. The aim of this study is to describe clinical outcomes in the complex lower extremity wound in the comorbid host. We hypothesized that treatment choice would have minimal impact on healing outcomes in this compromised population.

Methods:
A multicenter retrospective registry of patients with diabetes and lower extremity wounds was created to compare treatment modalities of collagen–glycosaminoglycan scaffold, negative-pressure wound therapy, local tissue flap, and free tissue transfer. Statistical analyses included descriptive, proportional comparisons and Cox regression.

Results:
There were no statistical differences in age, hemoglobin A1c, or body mass index between groups. Study patients had a history of amputation (40.5%), peripheral vascular disease (54.6%), peripheral neuropathy (64.8%), end-stage renal disease (13.9%), renal/hepatic disease (40.4%), and hypertension (85%). The most common wound etiologies were surgical dehiscence (69%), diabetic neuropathic wounds (39%), and ischemic wounds (28%), most commonly located on the foot or at a prior amputation site (30%). Mean wound area was 57.9 cm2 and almost half with exposed bone. There were no statistical differences between treatment groups in proportion or time to healing, recurrence, or time to return to baseline function.

Conclusions:
Commonly used treatment modalities employed for this population of patients resulted in similar outcomes. This is the first study to describe the complex diabetic lower extremity wound in a complex host.
Retromuscular Mesh Repair Using Fibrin Glue: Early Outcomes and Cost-effectiveness of an Evolving Technique
Authors: Rhemtulla Irfan A. , Tecce Michael G. , Broach Robyn B. , Messa Charles A. , Mauch Jaclyn T. , Fischer John P. 
Published: April 2019

Background:
Retromuscular hernia repairs (RHRs) decrease hernia recurrence and surgical site infections but can cause significant pain. We aimed to determine if pain and postoperative outcomes differed when comparing suture fixation (SF) of mesh to fibrin glue fixation (FGF).

Methods:
Patients undergoing RHR (n = 87) between December 1, 2015 and December 31, 2017 were retrospectively identified. Patients received SF of mesh (n = 59, 67.8%) before the senior author changing his technique to FGF (n = 28, 32.2%). These 2 cohorts were matched (age, body mass index, number of prior repairs, mesh type, defect size, and wound class). Outcomes were analyzed using a matched pairs design with multivariable linear regression.

Results:
Two matched groups (21 FGF and 21 SF) were analyzed (45.2% female, average age 56 years, average body mass index 34.7 kg/m2, and average defect size 330 cm2). Statistical significance was observed for FGF compared with SF: length of stay (3.7 versus 7.1 days, P = 0.032), time with a drain (17.2 versus 27.5 days, P = 0.012), 30-day postoperative visits (2 versus 3, P = 0.003), pain scores (5.2 versus 3.1, P = 0.019) and activity within the first 24 hours (walking versus sitting, P = 0.002). Operative time decreased by 23.1 minutes (P = 0.352) and postoperative narcotic represcription (3 versus. 8 patients, p=0.147) also decreased. Average cost for patients receiving SF was $36,152 compared to $21,782 for FGF (P = 0.035).

Conclusions:
Sutureless RHR using FGF may result in decreased pain when compared with a matched cohort receiving SF, translating to enhanced recovery time, shortened hospital stay, and decreased costs.
Long-Term Descemetocele Management With Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) Treatment
Authors: Xu Mimi , Randleman James B. , Chiu Gloria B. 
Published: April 2019

Purpose:
To report a patient with chronic ocular graft versus host disease who achieved long-term stability of a descemetocele using prosthetic replacement of the ocular surface ecosystem (PROSE) treatment.

Methods:
Case report and literature review.

Results:
A 60-year-old white man, who underwent PROSE treatment 4 years earlier to address severe dry eyes secondary to ocular graft versus host disease, developed a central corneal ulcer that resulted in descemetocele formation. Because of the risks of surgical intervention in an immunocompromised patient with severe ocular surface disease, the descemetocele was monitored closely as the patient continued PROSE device wear. After 1 year with continued PROSE therapy, the patient's descemetocele remained stable without perforation and corrected visual acuity stabilized at 20/50 in the affected eye.

Conclusions:
This is the first case that reports stabilization of a descemetocele with a PROSE device. For patients at high risk for postsurgical complications, PROSE treatment could be considered as an alternative to corneal transplantation and as an adjunct to other ocular therapies in patients with descemetocele formation.
Two Soft Contact Lenses Retained in the Superior Fornix for 15 Years in a Patient With Unique Orbital Anatomy
Authors: Holicki Cameron , Sims Jake , Holicki Joseph 
Published: April 2019

Abstract:
A 70-year-old white woman presented to her ophthalmologist with bacterial conjunctivitis resistant to treatment. The relationship between the patient's globe and superior orbital rim prompted high clinical suspicion of an occult foreign body as the cause. The following article describes the office visits preceding the discovery of two adhered soft contact lenses lodged in the superior fornix of the right eye that had been hidden for 15 years. We discuss the role her unique orbital anatomy played in successfully concealing these foreign bodies for over a decade. In addition, we present an algorithm to practice when an occult foreign body is suspected, which includes effective clinical techniques.
A Successful Application of Intraventricular and Intravenous Colistin for Extensively Drug-Resistant Acinetobacter baumannii Ventriculitis in a Neurosurgical Patient Undergoing Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome
Authors: Lapinskienė Indrė , Linkaitė Gabrielė , Remeikaitė Donata , Balčiūnas Lukas , Kvaščevičius Robertas , Kšanas Ugnius , Šipylaitė Jūratė , Šerpytis Mindaugas 
Published: April 2019

Abstract
The prevalence of extensively drug-resistant Acinetobacter baumannii neuroinfection has markedly increased, and this infection is now a first-line medical emergency worldwide with a mortality rate of up to 50%. Its expanding resistance to most intravenous antibiotic treatments, as well as the severity of the initiated condition, obligates practitioners to concentrate on today's most effective therapy—the combination of intravenous and intraventricular/intrathecal colistin. The specific characteristics of the intraventricular/intrathecal route are promising for patients with supportive mechanical devices, such as extracorporeal membrane oxygenation or hemodiafiltration, which have significant impacts on drug pharmacokinetics in the blood. This influence is minimized when antibiotics are administered directly into cerebrospinal fluid. The case report represents a history of a 39-year-old man with nosocomial carbapenem-resistant A. baumannii ventriculitis and acute respiratory distress syndrome. His treatment with intravenous and intraventricular colistin, as well as extracorporeal membrane oxygenation therapy, managed to succeed in helping the patient's recovery.
Disseminated Leishmaniasis With Immune Reconstitution Inflammatory Syndrome–associated Pneumocystis Pneumonia in a Human Immunodeficiency Virus–infected Patient With First-line Antiretroviral Therapy Failure
Authors: Gupta Pulin Kumar , Mahto Subodh Kumar , Mittal Abhishek , Chawla Mahinder Pal S. , Kaushal Manju , Kumar Arvind 
Published: April 2019

Abstract
Disseminated atypical leishmaniasis is a stage IV defining illness in people with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome. Although visceral leishmaniasis is endemic in some regions of India, atypical disseminated leishmaniasis is not reported frequently. Patients of visceral leishmaniasis in HIV/acquired immunodeficiency syndrome present with atypical manifestations like involvement of upper or lower gastrointestinal tract, lungs, pleura, liver, kidney, skin, and peritoneum and have chronic progression with relapses irrespective of treatment given. We hereby report a case of atypical disseminated leishmaniasis in an HIV-positive patient, who also developed Pneumocystis pneumonia as a part of immune reconstitution syndrome after failure of first-line antiretroviral therapy. Our patient also had involvement of gastrointestinal tract and lymph nodes which has rarely been reported from Indian subcontinent.
Thyroid Incidentaloma on 18F-fluorocholine PET/CT and 68Ga-PSMA PET/CT Revealing a Medullary Thyroid Carcinoma
Authors: Ciappuccini Renaud , Edet-Sanson Agathe , Saguet-Rysanek Virginie , Gauthé Mathieu , Bardet Stéphane 
Published: April 2019

Abstract
A 66-year-old man with prostate cancer underwent 18F-fluorocholine PET/CT and thereafter 68Ga-labeled prostate-specific membrane antigen PET/CT to explore a rising prostate-specific antigen level. Both PET/CT studies showed a thyroid incidentaloma of the right lobe. Neck ultrasound confirmed the presence of a 16-mm right thyroid nodule. The serum calcitonin level was moderately increased at 25 ng/mL (<10). Cytology was non-diagnostic (Bethesda I). A right lobectomy was performed and pathology revealed a 15-mm medullary thyroid cancer. Two months after surgery, the calcitonin level returned to normal at 3.3 ng/mL.
68Ga DOTATATE PET/CT Versus 18F-FDG PET/CT for Detecting Intramedullary Hemangioblastoma in a Patient With Von Hippel-Lindau Disease
Authors: Banezhad Farnaz , Kiamanesh Zahra , Emami Farshad , Sadeghi Ramin 
Published: April 2019

Abstract
Von Hippel-Lindau disease is an inherited syndrome associated with several benign and malignant tumors such as central nervous system (CNS) hemangioblastoma. Herein, we report a known case of A Von Hippel-Lindau patient with a cerebral hemangioblastoma who was referred for further evaluation because of recent paraparesis. 18F-FDG PET/CT showed no focal uptake in the thoracic spine, which demonstrated increased 68Ga DOTATATE activity, owing to overexpression of somatostatin receptors, suggesting spinal cord hemangioblastoma. This case report indicates the significant role of 68Ga-labeled somatostatin receptor analogs in the diagnosis of hemangioblastoma.
Postchemotherapy Histiocyte-Rich Pseudotumor of the Spleen Simulating Residual Disease in a Patient With Non-Hodgkin Lymphoma on FDG PET/CT
Authors: Hod Nir , Lantsberg Sophie , Anconina Reut , Levin Daniel , Nalbandyan Karen , Levi Itai 
Published: April 2019

Abstract
A 64-year-old man was treated with multiagent chemotherapy owing to high-grade non-Hodgkin lymphoma presenting as a bulky disease involving the spleen. Interim and posttreatment sequential FDG PET/CT scans revealed a residual splenic mass showing markedly intense FDG uptake suspected of a residual viable lymphoma. To definitely decide about the appropriate treatment, a laparoscopic splenectomy was performed. Histopathologic specimen was compatible with the rare diagnosis of postchemotherapy histiocyte-rich pseudotumor of the spleen, a potential pitfall simulating viable disease on FDG PET/CT.
Avid 68Ga-PSMA Uptake in Accessory Submandibular Salivary Gland
Authors: Zhang Wei , Zhang Li , Zhao Yanhong , Chen Yue 
Published: April 2019

Abstract
Accessory submandibular salivary gland (ASSG) is an extremely rare variation of the submandibular salivary gland. We reported a 65-year-old man with prostate cancer underwent 68Ga-PSMA PET/CT for active surveillance. The images showed abnormal PSMA uptake adjacent to the submandibular salivary gland without abnormal activity distribution in the rest regions of the body. The lesion density was similar to that of the submandibular salivary gland. Pathological biopsy confirmed that it was an ASSG. Our case illustrates that ASSG is an addition benign cause of extraprostatic uptake of PSMA.
18F-FDG PET/CT in a Case of Metastatic Breast Cancer to the Vulva
Authors: Guglielmo Priscilla , Paderno Mariachiara , Elisei Federica , Guerra Luca , Landoni Claudio , Buda Alessandro , Crivellaro Cinzia 
Published: April 2019

Abstract
A 56-year-old woman, previously treated for breast cancer, presented to gynecologists with a lump of the left labium major of the vulva. The FDG pattern resembled as a cIV stage vulvar cancer, whereas biopsy indicated metastases from breast cancer. Metastatic disease to the vulva is particularly uncommon, representing 5% to 8% of all vulvar cancer lesions. However, gynecological uptakes, including vulvar site, have to be kept in mind as a possible site of metastatic lesions from breast cancer.
68Ga-NOTA-Evans Blue TOF PET/MR Lymphoscintigraphy Evaluation of the Severity of Lower Limb Lymphedema
Authors: Hou Guozhu , Hou Bo , Jiang Yuanyuan , Zhu Zhaohui , Long Xiao , Chen Xiaoyuan , Cheng Wuying 
Published: April 2019

Purpose
This study was designed to investigate the role of 68Ga-NOTA-Evans Blue (NEB) time-of-flight (TOF) PET/MR in evaluating lower limb lymphedema by visual analysis and novel parameters.

Methods
Thirteen patients with unilateral lower limb lymphedema were divided into 3 groups according to the clinical severity: minimal (4 patients), moderate (5 patients), and severe (4 patients). All patients underwent 68Ga-NEB TOF PET/MR lymphoscintigraphy. The ratio of the standardized uptake value (SUV) of superficial lymphatic vessel (SLV) versus SUV of deep lymphatic vessel (DVL) (SUVslv/dlv) was designed to assess the level of lymphedema severity. The correlation between lymphedema severity and lymphoscintigraphy findings was determined using 1-way analysis of variance, the t test, and Pearson correlation analysis.

Results
There was a significant difference in the SUVslv between the affected limbs and normal limbs in all subjects (affected limbs: 0.57 ± 0.32, normal limbs: 1.86 ± 1.43; P < 0.05), which was not found in the SUVdlv (affected limbs: 0.64 ± 0.39, normal limbs: 0.63 ± 0.31; P > 0.1). The SUVslv/dlv of the affected limbs showed statistical differences within the 3 groups (P < 0.05) (minimal group: 1.91 ± 0.45; moderate group: 0.84 ± 0.16; severe group: 0.42 ± 0.11). The statistical analysis revealed a negative correlation between SUVslv/dlv and the severity of lymphedema (r = −0.899; P < 0.01).

Conclusions

68Ga-NEB TOF PET/MR lymphoscintigraphy can provide anatomical and functional information of lymphatic vessels to guide surgery plans. SUVslv/dlv was well correlated with clinical lymphedema severity and might be potential in evaluating bilateral lower limb lymphedema.
Cadaveric Bilateral Proximal Forearm Allotransplantation
Authors: Sivakumar Dinesh K. , Chavan Vinayak , Chittoria RaviKumar , Thiruvoth Friji M. , Mohapatra Devi Prasad , Subbarayan Elankumar , Reddy Konda Sireesha , Babu Preethitha , Kumaran Senthil , Aggarwal Abhinav , Guptha Saurabh 
Published: April 2019

Abstract
Until, sometime ago, microsurgery meant mainly covering a defect or replanting severed parts back to where they belong. Now, restoration of original function and aesthetic consideration is a must in planning reconstructive procedure. Hand transplant combines hand surgery and microsurgery with complex multidisciplinary care.
At the anniversary of our first cadaveric bilateral proximal forearm transplantation done in the country's government institute, we would like to share our experience in performing the surgery, outcomes so far, complications, and lessons learned, to contribute to the growing knowledge of vascularized composite allotransplant.
Better understanding the utilization of damage control laparotomy: A multi-institutional quality improvement project
Authors: Harvin John A. , Sharpe John P. , Croce Martin A. , Goodman Michael D. , Pritts Timothy A. , Dauer Elizabeth D. , Moran Benjamin J. , Rodriguez Rachel D. , Zarzaur Ben L. , Kreiner Laura A. , Claridge Jeffrey A. , Holcomb John B. 
Published: April 2019

BACKGROUND
Rates of damage control laparotomy (DCL) vary widely and consensus on appropriate indications does not exist. The purposes of this multicenter quality improvement (QI) project were to decrease the use of DCL and to identify indications where consensus exists.

METHODS
In 2016, six US Level I trauma centers performed a yearlong, QI project utilizing a single QI tool: audit and feedback. Each emergent trauma laparotomy was prospectively reviewed. Damage control laparotomy cases were adjudicated based on the majority vote of faculty members as being appropriate or potentially, in retrospect, safe for definitive laparotomy. The rate of DCL for 2 years prior (2014 and 2015) was retrospectively collected and used as a control. To account for secular trends of DCL, interrupted time series was used to effectiveness of the QI interventions.

RESULTS
Eight hundred seventy-two emergent laparotomies were performed: 73% definitive laparotomies, 24% DCLs, and 3% intraoperative deaths. Of the 209 DCLs, 162 (78%) were voted appropriate, and 47 (22%) were voted to have been potentially safe for definitive laparotomy. Rates of DCL ranged from 16% to 34%. Common indications for DCL for which consensus existed were packing (103/115 [90%] appropriate) and hemodynamic instability (33/40 [83%] appropriate). The only common indication for which primary closure at the initial laparotomy could have been safely performed was avoiding a planned second look (16/32 [50%] appropriate).

CONCLUSION
A single faceted QI intervention failed to decrease the rate of DCL at six US Level I trauma centers. However, opportunities for improvement in safely decreasing the rate of DCL were present. Second look laparotomy appears to lack consensus as an indication for DCL and may represent a target to decrease the rate of DCL after injury.

LEVEL OF EVIDENCE
Epidemiological study with one negative criterion, level III.
Defining geographic emergency medical services coverage in trauma systems
Authors: Brown Joshua B. , Rosengart Matthew R. , Peitzman Andrew B. , Billiar Timothy R. , Sperry Jason L. 
Published: April 2019

BACKGROUND
Geographic distribution of trauma system resources including trauma centers and helicopter bases correlate with outcomes. However, ground emergency medical services (EMS) coverage is dynamic and more difficult to quantify. Our objective was to evaluate measures that describe ground EMS coverage in trauma systems and correlate with outcome.

METHODS
Trauma system resources in Pennsylvania were mapped. Primary outcome was county age-adjusted transportation injury fatality rate. Measures of county EMS coverage included average distance to the nearest trauma center, number of basic life support and advanced life support units/100 square miles, distance differential between the nearest trauma center and nearest helicopter base, and nearest neighbor ratio (dispersed or clustered geographic pattern of agencies). Spatial-lag regression determined association between fatality rates and these measures, adjusted for prehospital time, Injury Severity Score, and socioeconomic factors. Relative importance of these measures was determined by assessing the loss in R
2 value from the full model by removing each measure. A Geographic Emergency Medical Services Index (GEMSI) was created based on these measures for each county.

RESULTS
Median fatality rate was higher in counties with fewer trauma system resources. Decreasing distance to nearest trauma center, increasing advanced life support units/100 square miles, greater distance reduction due to helicopter bases, and dispersed geographic pattern of county EMS agencies were associated with lower fatality rates. The GEMSI ranged from −6.6 to 16.4 and accounted for 49% of variation in fatality rates. Adding an EMS agency to a single county that produced a dispersed pattern of EMS coverage reduced predicted fatality rate by 6%, while moving a helicopter base into the same county reduced predicted fatality rate by 22%.

CONCLUSION
The GEMSI uses several measures of ground EMS coverage and correlates with outcome. This tool may be used to describe and compare ground EMS coverage across trauma system geographies, as well as help optimize the geographic distribution of trauma system resources.

LEVEL OF EVIDENCE
Ecological study, level IV.
Rare variants contribute disproportionately to quantitative trait variation in yeast
Authors: Bloom Joshua S , Boocock James , Treusch Sebastian , Sadhu Meru J , Day Laura , Oates-Barker Holly , Kruglyak Leonid 
Published: April 2019

AbstractA detailed understanding of the sources of heritable variation is a central goal of modern genetics. Genome-wide association studies (GWAS) in humans1 have implicated tens of thousands of DNA sequence variants in disease risk and quantitative trait variation, but these variants fail to account for the entire heritability of diseases and traits. GWAS have by design focused on common DNA sequence variants; however, recent studies underscore the likely importance of the contribution of rare variants to heritable variation2. Further, finding the genes that underlie the GWAS signals remains a major challenge. Here, we use a unique model system to disentangle the contributions of common and rare variants to a large number of quantitative traits. We generated large crosses among 16 diverse yeast strains and identified thousands of quantitative trait loci (QTLs) that explain most of the heritable variation in 38 traits. We combined our results with sequencing data for 1,011 yeast isolates3 to decouple variant effect size estimation from allele frequency and showed that rare variants make a disproportionate contribution to trait variation as a consequence of their larger effect sizes. Evolutionary analyses revealed that this contribution is driven by rare variants that arose recently, that such variants are more likely to decrease fitness, and that negative selection has shaped the relationship between variant frequency and effect size. Finally, we leveraged the structure of the crosses to resolve hundreds of QTLs to single genes. These results refine our understanding of trait variation at the population level and suggest that studies of rare variants are a fertile ground for discovery of genetic effects.
Targeted expansion of Protected Areas to maximise the persistence of terrestrial mammals
Authors: Mogg Sarah , Fastre Constance , Jung Martin , Visconti Piero 
Published: April 2019

ABSTRACTOver a quarter of species assessed by the IUCN Red List are threatened with extinction. A global commitment to protect 17% of land and 10% of the oceans by 2020 is close to being achieved, but with limited ecological impacts due to its inadequacy and poor enforcement. Here, we reverse-engineer IUCN Red List criteria to generate area-based conservation targets and spatial conservation priorities to minimize the extinction risk of the world terrestrial mammals. We find that approximately 60% of the Earth’s non-Antarctic land surface would require some form of protection. Our results suggest that global conservation priority schemes, among which the Aichi targets, will be inadequate to secure the persistence of terrestrial mammals. To achieve this goal, international cooperation is required to implement a connected and comprehensive conservation area network, guided by high priority regions outlined in this study.