bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tradeoffs in Implant Selection for Reconstructive Surgery and Adjuncts Utilized to Maximize Aesthetic Outcomes
Authors: Unger Jacob G. , Keller Patrick R. 
Published: July 2019

Background:
With many US Food and Drug Administration–approved cohesive gel implant styles currently available in the United States, surgeons and patients may feel overwhelmed by the implant-selection process. We discuss the relative merits of the most commonly used silicone cohesive gel implants and associated adjuncts, particularly in the reconstructive setting.

Methods:
A literature review was conducted in PubMed to identify articles that assessed the clinical impact of differing cohesive silicone gel implants and associated adjuncts on aesthetic outcomes and complications profile.

Results:
First, we review how the shape, cohesivity, and texture of cohesive gel implants impact breast aesthetics and complications after implant-based breast reconstruction (IBBR). Second, we review common adjuncts used in IBBR, including fat grafting and acellular dermal matrix (ADM), and we explore their roles in prepectoral IBBR. Finally, we review future directions in IBBR, including nanoscale implant surface modifications.

Conclusions:
In the absence of data showing that shaped implants are aesthetically preferable over round implants, we turn to a risk-benefit analysis of the complication profile of each type of implant. In selecting a smooth, round cohesive silicone implant that offers a variety of cohesivity levels, the patient can enjoy the benefits of smooth shells and avoid the drawbacks of textured shells, all without sacrificing clinically significant visual aesthetics. In the era of the bioengineered breast, this remains even more true.
Association of Statin Use With Kidney Damage and Function Among HIV-Infected Men
Authors: Ascher Simon B. , Scherzer Rebecca , Nishtala Arvind , Jotwani Vasantha , Grunfeld Carl , Parikh Chirag R. , Ng Derek , Wang Ruibin , Palella Frank J. , Shlipak Michael G. , Estrella Michelle M. 
Published: July 2019

Background:
Chronic kidney disease (CKD) occurs commonly among HIV-infected persons. Statins may delay CKD onset and progression through their cholesterol-lowering and pleiotropic effects.

Methods:
Among 850 HIV-infected men from the Multicenter AIDS Cohort Study with stored urine samples (2009–2011), we evaluated cross-sectional associations of statin use with urine biomarkers of kidney damage [albumin-to-creatinine ratio (ACR), alpha-1-microglobulin, interleukin-18, kidney injury molecule-1, and procollagen type III N-terminal propeptide] using multivariable linear regression. We evaluated the longitudinal associations of statin use with annual change in estimated glomerular filtration rate by creatinine (eGFR) using linear mixed models, and with incident proteinuria and incident CKD (eGFR <60 mL/min/1.73 m2) using Cox proportional hazards regression. We used inverse probability weighting to address potential confounding related to statin use.

Results:
Statin users comprised 30% of participants. In adjusted analyses, each year of cumulative statin use was associated with 4.0% higher baseline ACR levels (P = 0.05), but there was no association with baseline levels of other urine biomarkers. Statin use had no overall association with annual eGFR decline. Among participants with baseline proteinuria, statin use was modestly associated with slower annual eGFR decline compared to non-use (adjusted difference: 1.33 mL/min/1.73 m2 per year; 95% confidence interval: −0.07 to 2.70). Statin use was not associated with risk of incident proteinuria or incident CKD.

Conclusions:
Statin use was associated with higher baseline ACR, but not with biomarkers of tubulointerstitial injury. Statin use was associated with modestly slower eGFR decline only among participants with baseline proteinuria. Although these findings may be susceptible to confounding by indication, they suggest a limited effect of statins on CKD risk among HIV-infected men.
Pharmacologic Treatment of Psychiatric Disorders and Time With Unsuppressed HIV Viral Load in a Clinical HIV Cohort
Authors: Levy Matthew E. , Monroe Anne K. , Horberg Michael A. , Benator Debra A. , Molock Sherry , Doshi Rupali K. , Powers Happ Lindsey , Castel Amanda D. ,   on behalf of the DC Cohort Executive Committee
Published: July 2019

Objective:
To evaluate associations of mood, anxiety, stress-/trauma-related, and psychotic disorders, both treated and untreated, with duration of unsuppressed HIV viral load (VL) among persons living with HIV (PLWH).

Setting:
The DC Cohort, an observational clinical cohort of PLWH followed from 2011 to 2018 at 14 sites in Washington, DC.

Methods:
Among PLWH ≥18 years old who received primary care at their HIV clinic, we determined in a time-updated manner whether participants had diagnoses and pharmacologic prescriptions for mood, anxiety, stress-/trauma-related, and/or psychotic disorders. Associations between psychiatric disorders/treatments and the proportion of subsequent days with VL ≥200 copies/mL were assessed using multivariable Poisson regression with generalized estimating equations.

Results:
Among 5904 participants (median age 51; 70% men; 82% Black), 45% had ≥1 psychiatric disorder, including 38% with mood disorders (50% treated), 18% with anxiety or stress-/trauma-related disorders (64% treated), and 4% with psychotic disorders (52% treated). Untreated major depressive disorder (adjusted rate ratio = 1.17; 95% confidence interval: 1.00 to 1.37), untreated other/unspecified depressive disorder (1.23; 1.01 to 1.49), untreated bipolar disorder (1.39; 1.15 to 1.69), and treated bipolar disorder (1.25; 1.02 to 1.53) (vs. no mood disorder) predicted more time with VL ≥200 copies/mL. Treated anxiety disorders (vs. no anxiety disorder) predicted less time (0.78; 0.62 to 0.99). Associations were weaker and nonsignificant for treated depressive disorders (vs. no mood disorder) and untreated anxiety disorders (vs. no anxiety disorder).

Conclusions:
PLWH with depressive and bipolar disorders, particularly when untreated, spent more time with unsuppressed VL than PLWH without a mood disorder. Treatment of mood disorders may be important for promoting sustained viral suppression.
Recent data on hepatitis E
Authors: Colson Philippe , Decoster Claire 
Published: July 2019

Purpose of review
Hepatitis E virus (HEV) has gained increased global recognition in recent years, particularly in developed countries. We summarized here a selection of the literature published since the 1st of June, 2017.

Recent findings
Longitudinal studies are increasingly conducted in Europe, to determine trends in HEV prevalence. The spectrum of mammals infected with HEV and potentially capable to transmit it to humans has widened. New virological data on HEV repCon and pathogenicity have been reported and clinical features of HEV infections have been precised or newly described. Finally, there are some new data on the therapeutic management of HEV infections in various clinical settings.

Summary
HEV emergence in developed countries appears to be based on improved diagnosis tools and increased awareness of clinicians that HEV transmission is essentially autochthonous and is a possible cause of life-threatening acute hepatitis, chronic hepatitis, cirrhosis, and extra-hepatic symptoms. In addition, the distribution of HEV strains evolves. Ribavirin remains to date the only specific treatment recommended for HEV infection, being efficient in the majority but not in all cases.
Development and Testing of a Visual Tool for Assessing Risk of Falls
Authors: Arihisa Katsuhiko , Yamamoto Akihiko , Hayashi Tatsuhiro , Hayashi Ayu , Ishizuki Chinami , Miyaguchi Hideki 
Published: July 2019

Background:
To develop a “Time Pressure-Kiken Yochi Training (TP-KYT) system” for measuring risk prediction ability of health care professionals.

Methods:
The TP-KYT was developed using responses from 51 experts with at least 5 years of clinical experience (8.7 ± 5.3 years). Participants extracted risk items by scoring 5 illustrations depicting fall-related medical accidents. With 77 “Experts” (34.0 ± 5.6 years old; clinical experience, 9.1 ± 4.8 years), 34 “Competents” (26.8 ± 5.5 years old; clinical experience, 1.1 ± 0.9 years), 34 “Advanced Beginners” (21.9 ± 0.7 years old), and 44 “Novices” (18.7 ± 1.9 years old), TP-KYT was validated using 1-way analysis of variance and Tukey's HSD (honestly significant difference) test. Risk prediction ability was evaluated using receiver operating characteristic curve analysis.

Results:
Experts scored significantly higher than others (Competents: P < .05; Advanced Beginners: P = 6.32E-10; and Novices: P = 4.53E-13). Area under the curve for Experts versus Competents was 0.73 and for Competents versus Advanced Beginners was 0.66. Sensitivity and specificity for Expert scores set at 212/213 were 54.5% and 82.4%, respectively, and for Competent scores set at 137/138 were 76.5% and 52.9%, respectively. The TP-KYT scores varied on the basis of the test taker's clinical experience.

Conclusions:
Validity and reliability of the TP-KYT were demonstrated. The TP-KYT can be a useful tool to quantify health professionals' ability to predict patients' fall risk under time pressure.
Manual and Fully Automated Segmentation to Determine the Ferromagnetic Status of Bullets Using Computed Tomography Dual-Energy Index: A Phantom Study
Authors: Ognard Julien , Dissaux Brieg , Diallo Idris , Attar Lakdar , Saccardy Claire , Ben Salem Douraied 
Published: July 2019

Objective
The aim was to determine if dual-energy computed tomography (DECT) can discriminate ferromagnetic bullets from nonferromagnetic ones.

Methods
The ferromagnetic properties of 29 bullets were determined. All bullets underwent a DECT evaluation, and a manual measurement of the dual-energy index was performed by 2 radiologists, followed by a fully automatic measurement, in 3 different positions in a phantom (air, water, and bone).

Results
Twenty-one bullets were found to be nonferromagnetic. There were significant differences between the mean of the dual-energy index measured in the core of ferromagnetic projectiles and those of nonferromagnetic ones in the lung position of the phantom (P = 0.007). Specificity was 86.36%, and negative predictive value was 90.48%. Among the 29 bullets, 24 were correctly classified.

Conclusions
Our study demonstrates that DECT can assess the ferromagnetic status of bullets and their magnetic resonance imaging compatibility using an extended computed tomography scale in an ex vivo phantom model.
Evaluation of Gall Bladder Stones Using Susceptibility Weighted Imaging
Authors: Gupta Rakesh Kumar , Neelavalli Jaladhar , Gupta Mamta , Ramaniharan Anandh K. , Sinha Bijendra Kumar , Kriplani Ajay Kumar , Saini Jitendra , Verma Radha Krishan , Verma Manoj Kumar , Bhattacharjee Rupsa , Saha Indrajit 
Published: July 2019

Objective
To evaluate the visualization of gallbladder stones on susceptibility-weighted imaging (SWI).

Materials and Methods
Imaging data from 47 patients who underwent clinically indicated cholecystectomy was reviewed. Breath-hold SWI was added to the magnetic resonance imaging protocol and magnitude and phase data was reviewed for gall-stones visualization. Phase signature, that is, diamagnetic, paramagnetic, or mixed, was also noted in the stones. Magnetic susceptibility value of surgically extracted gallstones were imaged ex vivo (n = 37).

Results
In 45 of 47 cases, gallstones were surgically confirmed. In 43 cases, gallstones were visualized in the SWI. In 1 case, although routine imaging failed, stones were visualized on SWI. In 29 diamagnetic, 7 paramagnetic and 9 cases mixed phase were seen. In an ex vivo study, magnetic susceptibility of stones was found ranging between −0.102 and −0.916 ppm for diamagnetic and 0.203 and 486 ppm for paramagnetic stones.

Conclusions
Gallbladder stones can be visualized with SWI and may be added to the routine magnetic resonance imaging protocol for its evaluation.
Modulating Diffusion-Weighted Magnetic Resonance Imaging for Screening in Oncologic Tertiary Prevention
Authors: Dreher Constantin , Kuder Tristan Anselm , König Franziska , Paech Daniel , Tavakoli Andrej , Laun Frederik Bernd , Flothow Florian , Gnirs Regula , Benkert Thomas , Nickel Dominik , Strecker Ralf , Schlemmer Heinz-Peter , Bickelhaupt Sebastian 
Published: July 2019

Introduction
Diffusion-weighted imaging (DWI) is an important part of oncological magnetic resonance imaging (MRI) examinations, especially for tertiary cancer prevention in terms of early detection of recurrent disease. However, abdominal studies can be challenged by motion artifacts, poor signal-to-noise ratios, and visibility of retroperitoneal structures, which necessitates sequence optimization depending on the investigated region. This study aims at prospectively evaluating an adapted DWI sequence ex vivo and in vivo in oncologic patients undergoing abdominal MRI.

Methods
This institutional review board–approved, prospective study included phantom measurements, volunteer examinations, and oncologic patient examinations of the abdomen. Fifty-seven MRI examinations in 54 patients (mean age, 58 years; range, 21–90 years) were included into the analysis. The MRI examination were performed at a 1.5 T MRI scanner (MAGNETOM Aera; Siemens Healthcare, Erlangen, Germany) and included both a standard EPI-DWI (s-DWI; b = 50, 900 s/mm2) and an adapted DWI (opt-DWI; EPI-DWI with b = 0, 50, 900, 1500 s/mm2, acquisition with higher spatial resolution and optimized processing for the abdomen including motion correction, adaptive image combination, and background suppression). For b = 900 s/mm2, the ratio of signal intensity in the normal tissue and the standard deviation of the noise in the surrounding air was quantitatively calculated; image quality and tissue differentiation parameters were rated by 2 independent, blinded readers using a 5-point Likert scale. Statistics included Wilcoxon signed-rank test and kappa statistic (P < 0.05/0.0125 after Bonferroni correction).

Results
The DWI phantom demonstrated an optimized contour sharpness and inlay differentiation for opt-DWI. The apparent ratio of normal tissue signal/standard deviation of background noise at b = 900 s/mm2 of the right/left hemiabdomen was significantly increased in opt-DWI (mean, 71.9 ± 23.5/86.0 ± 43.3) versus s-DWI (mean, 51.4 ± 15.4/63.4 ± 36.5; P < 0.001). Image quality parameters (contour sharpness and tissue differentiation of upper abdominal and retroperitoneal structures) were significantly increased in opt-DWI versus s-DWI (P < 0.001). Interreader reliability test showed good agreement (kappa = 0.768; P < 0.001).

Discussion
This study prospectively evaluated the potential of adapted DWI for screening in tertiary prevention of oncologic patients. An optimized DWI protocol with advanced processing achieved improved image quality in quantitative and qualitative analyses. Oncological optimization of DWI should be performed before its application in cancer patients to improve both screening and follow-up examinations, to better unleash the diagnostic potential of DWI.
Current Epidemiology of Surgical Sepsis
Authors: Brakenridge Scott C. , Efron Philip A. , Cox Michael C. , Stortz Julie A. , Hawkins Russell B. , Ghita Gabriela , Gardner Anna , Mohr Alicia M. , Anton Stephen D. , Moldawer Lyle L. , Moore Frederick A. 
Published: July 2019

Objective:
We sought to compare traditional inpatient outcomes to long-term functional outcomes and mortality of surgical intensive care unit (SICU) patients with sepsis.

Summary of Background Data:
As inpatient sepsis mortality declines, an increasing number of initial sepsis survivors now progress into a state of chronic critical illness (CCI) and their post-discharge outcomes are unclear.

Methods:
We performed a prospective, longitudinal cohort study of SICU patients with sepsis.

Results:
Among this recent cohort of 301 septic SICU patients, 30-day mortality was 9.6%. Only 13 (4%) patients died within 14 days, primarily of refractory multiple organ failure (62%). The majority (n = 189, 63%) exhibited a rapid recovery (RAP), whereas 99 (33%) developed CCI. CCI patients were older, with greater comorbidities, and more severe and persistent organ dysfunction than RAP patients (all P < 0.01). At 12 months, overall cohort performance status was persistently worse than presepsis baseline (WHO/Zubrod score 1.4 ± 0.08 vs 2.2 ± 0.23, P > 0.0001) and mortality was 20.9%. Of note at 12 months, the CCI cohort had persistent severely impaired performance status and a much higher mortality (41.4%) than those with RAP (4.8%) after controlling for age and comorbidity burden (Cox hazard ratio 1.27; 95% confidence interval, 1.14–1.41, P < 0.0001). Among CCI patients, independent risk factors for death by 12 months included severity of comorbidities and persistent organ dysfunction (sequential organ failure assessment ≥6) at day 14 after sepsis onset.

Conclusions:
There is discordance between low inpatient mortality and poor long-term outcomes after surgical sepsis, especially among older adults, increasing comorbidity burden and patients that develop CCI. This represents important information when discussing expected outcomes of surgical patients who experience a complicated clinical course owing to sepsis.
Sex Disparity in Outcomes of Ruptured Abdominal Aortic Aneurysm Repair Driven by In-hospital Treatment Delays
Authors: Wang Linda J. , Locham Satinderjit , Dakour-Aridi Hanaa , Lillemoe Keith D. , Clary Bryan , Malas Mahmoud B. 
Published: July 2019

Objective:
We sought to assess whether sex-related differences in timely repair of ruptured abdominal aortic aneurysm (rAAA) were associated with excess risk of early mortality in women.

Summary Background Data:
rAAA is a surgical emergency and timeliness of intervention affects outcomes. A door-to-intervention time of <90 minutes is recommended.

Methods:
All rAAA repairs in the Vascular Quality Initiative from 2003 to 2017 were reviewed. Patients were stratified by sex and time-delay cohorts. Univariate and multivariate analyses were performed.

Results:
There were 3719 rAAA repairs, of which 797 (21%) were performed in women. Sex did not affect repair type: open versus endovascular (21% females, each). Despite similar presentation delays [median 6 hours (inter quartile range, IQR: 3–16)], admission-to-intervention time was longer for women than men [median 1.5 hours (IQR 1–4] vs 1.2 hours (IQR 1–3), P=0.047]. Overall, 45% of patients had a >90-minute delay from admission to repair, with more women than men experiencing this delay (49% vs 44%, P=0.01). Neither were more likely to undergo transfer for treatment. After risk adjustment, female sex was associated with a 48% increase in 30-day mortality. Sex differences in mortality were no longer observed in patients with intervention delays of ≤90 minutes. In patients with >90-minute delays, a 77% increase in 30-day mortality of women over men was noted.

Conclusions:
Nearly half of rAAA patients have a door-to-intervention time longer than recommended societal guidelines. Sex differences in mortality after rAAA repair seem to be driven by in-hospital treatment delays.
The Effect of Perioperative Music on Medication Requirement and Hospital Length of Stay
Authors: Fu Victor X. , Oomens Pim , Klimek Markus , Verhofstad Michiel H. J. , Jeekel Johannes 
Published: July 2019

Objective:
To assess and quantify the effect of perioperative music on medication requirement, length of stay and costs in adult surgical patients.

Summary Background Data:
There is an increasing interest in nonpharmacological interventions to decrease opioid analgesics use, as they have significant adverse effects and opioid prescription rates have reached epidemic proportions. Previous studies have reported beneficial outcomes of perioperative music.

Methods:
A systematic literature search of 8 databases was performed from inception date to January 7, 2019. Randomized controlled trials investigating the effect of perioperative music on medication requirement, length of stay or costs in adult surgical patients were eligible. Meta-analysis was performed using random effect models, pooled standardized mean differences (SMD) were calculated with 95% confidence intervals (CI). This study was registered with PROSPERO (CRD42018093140) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines.

Results:
The literature search yielded 2414 articles, 55 studies (N = 4968 patients) were included. Perioperative music significantly reduced postoperative opioid requirement (pooled SMD −0.31 [95% CI −0.45 to −0.16], P < 0.001, I
2 = 44.3, N = 1398). Perioperative music also significantly reduced intraoperative propofol (pooled SMD −0.72 [95% CI −1.01 to −0.43], P < 0.00001, I
2 = 61.1, N = 554) and midazolam requirement (pooled SMD −1.07 [95% CI −1.70 to −0.44], P < 0.001, I
2 = 73.1, N = 184), while achieving the same sedation level. No significant reduction in length of stay (pooled SMD −0.18 [95% CI −0.43 to 0.067], P = 0.15, I
2 = 56.0, N = 600) was observed.

Conclusions:
Perioperative music can reduce opioid and sedative medication requirement, potentially improving patient outcome and reducing medical costs as higher opioid dosage is associated with an increased risk of adverse events and chronic opioid abuse.
Sarcopenia: looking to muscle mass to better manage pancreatic cancer patients
Authors: Basile Debora , Corvaja Carla , Caccialanza Riccardo , Aprile Giuseppe 
Published: July 2019

Purpose of review
Overall survival of patients with pancreatic cancer is strongly conditioned by tumor biology and the incidence of malnutrition and metabolic disorders. In this landscape, the assessment of body composition is crucial to properly manage the clinical implications of muscle wasting. The pathogenesis of this condition is the result of a complex interplay between cancer and the host. In particular, sarcopenia is induced by an inadequate nutritional intake, hormonal abnormalities, inflammation and imbalance between anabolic and catabolic pathways.

Recent findings
Recent evidences have highlighted the role of sarcopenia in cancer patients, revealing a prognostic impact on morbidity, mortality and survival.

Summary
The occurrence of sarcopenia could amplify chemotherapy-induced toxicities, prolong hospitalizations and reduce adherence to anticancer treatment, worsening quality of life and survival. Although considerable efforts have been made to develop treatment strategies, no effective interventions have been identified so far. Nevertheless, if promptly and adequately supported, pancreatic cancer might benefit from adopted dietary intervention to avoid further loss of lean mass.