bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac Arrests Associated With Tracheal Intubations in PICUs: A Multicenter Cohort Study*
Authors: Shiima Yuko , Berg Robert A. , Bogner Hillary R. , Morales Knashawn H. , Nadkarni Vinay M. , Nishisaki Akira 
Published: April 2016

Objectives:
To determine the incidence and epidemiologic characteristics of cardiac arrests among tracheal intubations in PICUs.

Design:
Retrospective cohort study of prospectively collected data.

Setting:
Twenty-five diverse PICUs.

Patients:
Critically ill children requiring tracheal intubation in PICUs.

Interventions:
Tracheal intubation quality improvement data were prospectively collected for all initial tracheal intubations in 25 PICUs from July 2010 to March 2014 using National Emergency Airway Registry for Children registry.

Measurements and Main Results:
Tracheal intubation–associated cardiac arrest was defined as chest compressions more than 1 minute occurring during tracheal intubation or within 20 minutes after tracheal intubation. A total of 5,232 pediatric tracheal intubations were evaluated. Tracheal intubation–associated cardiac arrest was reported in 87 (1.7%). Patient factors (demographics and indications for tracheal intubation), provider factors (discipline and training level), and practice factors (tracheal intubation method and use of neuromuscular blockade) were recorded. Hemodynamic instability and oxygenation failure as tracheal intubation indications were associated with cardiac arrests (adjusted odds ratio, 6.3; 95% CI, 3.9–10.3; and adjusted odds ratio, 4.3; 95% CI, 2.6–6.9, respectively). History of difficult airway and cardiac disease were also associated with cardiac arrests (adjusted odds ratio, 2.1; 95% CI, 1.2–3.5; and adjusted odds ratio, 2.1; 95% CI, 1.2–3.9, respectively). Provider and practice factors were not associated with cardiac arrests, and provider factors did not modify the effect of patient factors on cardiac arrests.

Conclusions:
Tracheal intubation–associated cardiac arrests occurred during 1.7% of PICU tracheal intubations. Tracheal intubation–associated cardiac arrests were much more common with tracheal intubations when the child had acute hemodynamic instability or oxygen failure and when the child had a history of difficult airway or cardiac disease.
Pediatric Triage in a Severe Pandemic: Maximizing Survival by Establishing Triage Thresholds*
Authors: Gall Christine , Wetzel Randall , Kolker Alexander , Kanter Robert K. , Toltzis Philip 
Published: April 2016

Objectives:
To develop and validate an algorithm to guide selection of patients for pediatric critical care admission during a severe pandemic when Crisis Standards of Care are implemented.

Design:
Retrospective observational study using secondary data.

Patients:
Children admitted to VPS-participating PICUs between 2009–2012.

Interventions:
A total of 111,174 randomly selected nonelective cases from the Virtual PICU Systems database were used to estimate each patient’s probability of death and duration of ventilation employing previously derived predictive equations. Using real and projected statistics for the State of Ohio as an example, triage thresholds were established for casualty volumes ranging from 5,000 to 10,000 for a modeled pandemic with peak duration of 6 weeks and 280 pediatric intensive care beds. The goal was to simultaneously maximize casualty survival and bed occupancy. Discrete Event Simulation was used to determine triage thresholds for probability of death and duration of ventilation as a function of casualty volume and the total number of available beds. Simulation was employed to compare survival between the proposed triage algorithm and a first come first served distribution of scarce resources.

Measurements and Main Results:
Population survival was greater using the triage thresholds compared with a first come first served strategy. In this model, for five, six, seven, eight, and 10 thousand casualties, the triage algorithm increased the number of lives saved by 284, 386, 547, 746, and 1,089, respectively, compared with first come first served (all p < 0.001).

Conclusions:
Use of triage thresholds based on probability of death and duration of mechanical ventilation determined from actual critically ill children’s data demonstrated superior population survival during a simulated overwhelming pandemic.
Insights into next developments in advanced gastric cancer
Authors: Obermannová Radka , Lordick Florian 
Published: April 2016

Purpose of review
The purpose of the review is to delineate novel approaches for biology-based treatment in advanced gastric cancer. We reviewed the latest translational and clinical research articles and congress presentations.

Recent findings
A new molecular classification of gastric cancer based on histology, genetic and proteomic alterations has evolved. It provides a roadmap for development of new drugs and combinations and for patient stratification. Anti-HER2 treatment, which is an effective strategy in metastatic gastric cancer, is now also being studied in the perioperative setting. However, resistance mechanisms in advanced disease are poorly understood and optimal patient selection remains challenging. Targeting angiogenesis is an emerging concept in the management of advanced gastric cancer, and ramucirumab has prolonged survival in the second line either as a monotherapy or in combination with paclitaxel. Biomarkers for selecting patients who benefit from ramucirumab are still lacking. Immune checkpoint blockade and inhibition of cancer stemness targets are other emerging directions for the medical treatment of gastric cancer. Large-scale international studies are ongoing.

Summary
Promising biology-based treatment strategies are evolving. But tumor heterogeneity which is an inherent feature of gastric cancer challenges the development of molecularly targeted and personalized treatment strategies.
Topographic Anatomy of the Anal Sphincter Complex and Levator Ani Muscle as It Relates to Intersphincteric Resection for Very Low Rectal Disease
Authors: Tsukada Yuichiro , Ito Masaaki , Watanabe Kentaro , Yamaguchi Kumiko , Kojima Motohiro , Hayashi Ryuichi , Akita Keiichi , Saito Norio 
Published: April 2016

BACKGROUND:
Intersphincteric resection has become a widely used treatment for patients with rectal cancer. However, the detailed anatomy of the anal canal related to this procedure has remained unclear.

OBJECTIVE:
The purpose of this study was to clarify the detailed anatomy of the anal canal.

DESIGN:
This is a descriptive study.

SETTINGS:
Histologic evaluations of paraffin-embedded tissue specimens were conducted at a tertiary referral hospital.

PATIENTS:
Tissue specimens were obtained from cadavers of 5 adults and from 13 patients who underwent abdominoperineal resection for rectal cancer.

MAIN OUTCOME MEASURES:
Sagittal sections from 9 circumferential portions of the cadaveric anal canal (histologic staining) and 3 circumferential portions from patients were studied (immunohistochemistry for smooth and skeletal muscle fibers).

RESULTS:
Longitudinal fibers between the internal and external anal sphincters consisted primarily of smooth muscle fibers that continued from the longitudinal muscle of the rectum. The levator ani muscle attached directly to the lateral surface of the longitudinal smooth muscle of the rectum. The length of the attachment was longer in the anterolateral portion and shorter in the posterior portion of the anal canal. In the lateral and posterior portions, the levator ani muscle partially overlapped the external anal sphincter; however, there was less overlap in the anterolateral portion. In the posterior portion, thick smooth muscle was present on the surface of the levator ani muscle and it continued to the longitudinal muscle of the rectum.

LIMITATIONS:
We observed only limited portions in some surgical specimens because of obstruction by tumors.

CONCLUSIONS:
The levator ani muscle attaches directly to the longitudinal muscle of the rectum. The spatial relationship between the smooth and skeletal muscles differed in different portions of the anal canal. For intersphincteric resection, dissection must be performed between the longitudinal muscle of the rectum and the levator ani muscle/external anal sphincter, and the appropriate surgical lines must be selected based on the specific structural characteristics of each portion.
Tumor Budding Detection by Immunohistochemical Staining is Not Superior to Hematoxylin and Eosin Staining for Predicting Lymph Node Metastasis in pT1 Colorectal Cancer
Authors: Okamura Takuma , Shimada Yoshifumi , Nogami Hitoshi , Kameyama Hitoshi , Kobayashi Takashi , Kosugi Shin-ichi , Wakai Toshifumi , Ajioka Yoichi 
Published: April 2016

BACKGROUND:
Tumor budding is recognized as an important risk factor for lymph node metastasis in pT1 colorectal cancer. Immunohistochemical staining for cytokeratin has the potential to improve the objective diagnosis of tumor budding over detection based on hematoxylin and eosin staining. However, it remains unclear whether tumor budding detected by immunohistochemical staining is a significant predictor of lymph node metastasis in pT1 colorectal cancer.

OBJECTIVE:
The purpose of this study was to clarify the clinical significance of tumor budding detected by immunohistochemical staining in comparison with that detected by hematoxylin and eosin staining.

DESIGN:
This was a retrospective study.

SETTINGS:
The study was conducted at Niigata University Medical & Dental Hospital.

PATIENTS:
We enrolled 265 patients with pT1 colorectal cancer who underwent surgery with lymph node dissection.

MAIN OUTCOME MEASURES:
Tumor budding was evaluated by both hematoxylin and eosin and immunohistochemical staining with the use of CAM5.2 antibody. Receiver operating characteristic curve analyses were conducted to determine the optimal cutoff values for tumor budding detected by hematoxylin and eosin and CAM5.2 staining. Univariate and multivariate analyses were performed to identify the significant factors for predicting lymph node metastasis.

RESULTS:
Receiver operating characteristic curve analyses revealed that the cutoff values for tumor budding detected by hematoxylin and eosin and CAM5.2 staining for predicting lymph node metastases were 5 and 8. On multivariate analysis, histopathological differentiation (OR, 6.21; 95% CI, 1.16–33.33; p = 0.03) and tumor budding detected by hematoxylin and eosin staining (OR, 4.91; 95% CI, 1.64–14.66; p = 0.004) were significant predictors for lymph node metastasis; however, tumor budding detected by CAM5.2 staining was not a significant predictor.

LIMITATIONS:
This study was limited by potential selection bias because surgically resected specimens were collected instead of endoscopically resected specimens.

CONCLUSIONS:
Tumor budding detected by CAM5.2 staining was not superior to hematoxylin and eosin staining for predicting lymph node metastasis in pT1 colorectal cancer.
Systematic Review of Surgical Treatments for Fecal Incontinence
Authors: Forte Mary L. , Andrade Kate E. , Lowry Ann C. , Butler Mary , Bliss Donna Z. , Kane Robert L. 
Published: April 2016

BACKGROUND:
No systematic review has examined the collective randomized and nonrandomized evidence for fecal incontinence treatment effectiveness across the range of surgical treatments.

OBJECTIVE:
The purpose of this study was to assess the efficacy, comparative effectiveness, and harms of surgical treatments for fecal incontinence in adults.

DATA SOURCES:
Ovid MEDLINE, EMBASE, Physiotherapy Evidence Database, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine, and the Cochrane Central Register of Controlled Trials, as well as hand searches of systematic reviews, were used as data sources.

STUDY SELECTION:
Two investigators screened abstracts for eligibility (surgical treatment of fecal incontinence in adults, published 1980–2015, randomized controlled trial or observational study with comparator; case series were included for adverse effects). Full-text articles were reviewed for patient-reported outcomes. We extracted data, assessed study risk of bias, and evaluated strength of evidence for each treatment–outcome combination.

INTERVENTIONS:
Surgical treatments for fecal incontinence were included interventions.

MAIN OUTCOME MEASURES:
Fecal incontinence episodes/severity, quality of life, urgency, and pain were measured.

RESULTS:
Twenty-two studies met inclusion criteria (13 randomized trials and 9 observational trials); 53 case series were included for harms. Most patients were middle-aged women with mixed FI etiologies. Intervention and outcome heterogeneity precluded meta-analysis. Evidence was insufficient for all of the surgical comparisons. Few studies examined the same comparisons; no studies were high quality. Functional improvements varied; some authors excluded those patients with complications or lost to follow-up from analyses. Complications ranged from minor to major (infection, bowel obstruction, perforation, and fistula) and were most frequent after the artificial bowel sphincter (22%–100%). Major surgical complications often required reoperation; few required permanent colostomy.

LIMITATIONS:
Most evidence is intermediate term, with small patient samples and substantial methodologic limitations.

CONCLUSIONS:
Evidence was insufficient to support clinical or policy decisions for any surgical treatments for fecal incontinence in adults. More invasive surgical procedures had substantial complications. The lack of compliance with study reporting standards is a modifiable impediment in the field. Future studies should focus on longer-term outcomes and attempt to identify subgroups of adults who might benefit from specific procedures.
Comparative Impact of Hypoglycemic Agents on Severity and Extent of Myocardial Ischemia in Patients With Type 2 Diabetes Mellitus Undergoing Myocardial Perfusion Scintigraphy
Authors: Biondi-Zoccai Giuseppe , Pinto Annamaria , Versaci Francesco , Procaccini Enrica , Neri Giandomenico , Sesti Giorgio , Uccioli Luigi , Vetere Maurizio , Peruzzi Mariangela , Nudi Francesco 
Published: April 2016

Background:
Hypoglycemic agents differ in mechanism, efficacy, and profile. However, there is uncertainty on their impact on myocardial perfusion. We thus aimed to investigate whether individuals with type 2 diabetes mellitus treated with different drug classes exhibit different perfusion patterns at myocardial perfusion scintigraphy (MPS).

Methods and Results:
We queried our administrative database for patients with diabetes mellitus without prior or recent myocardial infarction. The primary objective was to compare the severity and extent of ischemia at MPS, distinguishing patients according to management strategy. A total of 7592 patients were included [2336 (31%) on diet, 3611 (48%) on metformin, 749 (10%) on sulfonylureas, 449 (6%) on metformin plus sulfonylureas, 447 (6%) on metformin plus insulin]. Unadjusted analyses and analyses adjusting for baseline features suggested that sulfonylureas alone or in combination were associated with more severe ischemia than nonsulfonylurea regimens (P < 0.05), whereas combination regimens including metformin were associated with more extensive myocardial ischemia than the other regimens (P < 0.05 for both). However, no significant difference disfavoring either metformin or sulfonylurea regimens persisted after multivariable adjustment for baseline, stress, and angiographic characteristics (all P > 0.05).

Conclusion:
Several significant differences in baseline, stress, and scintigraphic features appear evident in patients with diabetes mellitus receiving different hypoglycemic agents or regimens.
Menopause status is associated with circadian- and sleep-related alterations
Authors: Gómez-Santos Cecilia , Saura Cristina Bandín , Lucas J.A. Ros , Castell Pedro , Madrid Juan A. , Garaulet Marta 
Published: April 2016

Abstract

Objective:
The aim of the study was to investigate whether postmenopausal women show differences in circadian-related variables and sleep characteristics compared with premenopausal women, and to analyze potential associations between these circadian-related variables and abdominal fat distribution or metabolic syndrome (MetS) components.

Methods:
A total of 177 women were studied (127 premenopausal, 50 postmenopausal). Sixty percent of the total population was overweight/obese, with no significant differences between premenopausal (60%) and postmenopausal women (62%) (P = 0.865). Wrist temperature (WT) and rest-activity cycles were measured during 8 consecutive days, and sleep and food diaries collected. MetS characteristics and daily patterns of saliva cortisol were analyzed. Sleep characteristics were assessed with domiciliary polysomnography.

Results:
Postmenopausal women showed a less robust rhythm in WT with lower amplitude (°C) (0.8 ± 0.4 vs 0.9 ± 0.5) (P < 0.05) and lower mean temperature values at the midpoint of sleep than premenopausal women. Postmenopausal women were also more morning-type than premenopausal women, showing a phase advance of approximately 1 hour in WT and rest-activity rhythms, and more morning-type habits (earlier sleep onset/offset and breakfast intake) (P < 0.05). Postmenopausal women showed higher levels of activity in the morning and lower in the evening compared with premenopausal women (P < 0.05). Daily variability in cortisol was significantly reduced in postmenopausal women compared with premenopausal women (P < 0.05). Postmenopausal women had increased frequency of sleep-related breathing abnormalities (P < 0.0001). In the women studied, abdominal fat and MetS were associated with an increase in circadian alterations (high fragmentation and low amplitude of the rhythm) (P < 0.05).

Conclusions:
Postmenopausal women exhibit loss of circadian robustness and an increase in sleep abnormalities compared with premenopausal women.
Unusual Vascular Supply to Extensor Digitorum Brevis
Authors: De Silva Dinuksha , Hsieh Frank , Gillies Rowan 
Published: April 2016

Summary:
Lower limb reconstruction after a traumatic event has always been a challenge for plastic surgeons. The reliability of vessel integrity postinjury often drives us away from a local reconstructive option. With the advancement of computed tomography angiogram, it can not only demonstrate the continuation of major vessels but also helps to map the vascular supply at a perforator level. We hereby report an incidentally identified anatomical variant with dual dominant blood supply to the extensor digitorum brevis muscle from an extra branch of anterior tibial artery originated at midtibial level. This variant was picked up preoperatively by computed tomography angiogram and confirmed intraoperatively to be one of the dominant supply. We took advantage of this unusual anatomy by basing our reconstruction on this branch and hence spared the need to terminalize distal dorsalis pedis artery.
30-year International Pediatric Craniofacial Surgery Partnership: Evolution from the “Third World” Forward
Authors: Swanson Jordan W. , Skirpan Jan , Stanek Beata , Kowalczyk Maciej , Bartlett Scott P. 
Published: April 2016

Background:
Craniofacial diseases constitute an important component of the surgical disease burden in low- and middle-income countries. The consideration to introduce craniofacial surgery into such settings poses different questions, risks, and challenges compared with cleft or other forms of plastic surgery. We report the evolution, innovations, and challenges of a 30-year international craniofacial surgery partnership.

Methods:
We retrospectively report a partnership between surgeons at the Uniwersytecki Szpital Dzieciecy in Krakow, Poland, and a North American craniofacial surgeon. We studied patient conditions, treatment patterns, and associated complications, as well as program advancements and limitations as perceived by surgeons, patient families, and hospital administrators.

Results:
Since partnership inception in 1986, the complexity of cases performed increased gradually, with the first intracranial case performed in 1995. In the most recent 10-year period (2006–2015), 85 patients have been evaluated, with most common diagnoses of Apert syndrome, Crouzon syndrome, and single-suture craniosynostosis. In the same period, 55 major surgical procedures have been undertaken, with LeFort III midface distraction, posterior vault distraction, and frontoorbital advancement performed most frequently. Key innovations have been the employment of craniofacial distraction osteogenesis, the use of Internet communication and digital photography, and increased understanding of how craniofacial morphology may improve in the absence of surgical intervention. Ongoing challenges include prohibitive training pathways for pediatric plastic surgeons, difficulty in coordinating care with surgeons in other institutions, and limited medical and material resources.

Conclusion:
Safe craniofacial surgery can be introduced and sustained in a resource-limited setting through an international partnership.
Decompression–Avulsion of the Auriculotemporal Nerve for Treatment of Migraines and Chronic Headaches
Authors: Sanniec Kyle , Borsting Emily , Amirlak Bardia 
Published: April 2016

Summary:
Surgical decompression of peripheral branches of the trigeminal and occipital nerves has been shown to alleviate migraine symptoms. Site II surgery involves decompression of the zygomaticotemporal branch of the trigeminal nerve by the technique developed by Guyuron. Failure of site II surgery may occur secondary to an inability to recognize a second temporal trigger: site V, the auriculotemporal nerve. A direct approach for site V has been used with no clear description in the literature. Herein, we describe a safe and efficient method for auriculotemporal nerve decompression during the Guyuron endoscopic approach. Close attention to all temporal sites is necessary to avoid potential failure of migraine decompression surgery.
VITRECTOMY TO REMOVE POSTERIORLY RETAINED IRIS EXPANSION RING
Authors: Olson Jeffrey L. , Mackin Anna G. , Erlanger Michael S. 
Published: April 2016

Purpose:
To describe management of posteriorly retained iris expansion ring—a newly reported complication of phacoemulsification surgery in a patient with intact posterior capsule.

Methods:
Case report.

Patients:
A 64-year-old monocular patient with history of regressed proliferative diabetic retinopathy after pars plana vitrectomy, long-standing glaucoma, and cataract, undergoing phacoemulsification for cataract removal, complicated by posterior migration of the Malyugin ring through area of zonular dehiscence despite intact posterior capsule, which resulted in significant visual disturbance.

Results:
The intravitreal Malyugin ring was successfully removed by performing a standard 3-port 25-gauge vitrectomy and retrieving the mobilized ring into the barrel of the original injector device.

Conclusion:
A posteriorly retained iris expansion ring can be effectively extracted from the vitreous cavity with the original injector device, which allows for maximal control of the ring and minimal associated surgical trauma.
DOUBLE PSEUDOHYPOPYON FROM EMULSIFIED HEAVY SILICONE OIL
Authors: Ghasemi Falavarjani Khalil , Modarres Mehdi 
Published: April 2016

Purpose:
To report a patient with double pseudohypopyon from emulsification of heavy silicone oil.

Methods:
A 65-year-old woman with rhegmatogenous retinal detachment and a large inferior break underwent pars plana vitrectomy and heavy silicone oil (Oxane HD; Bausch and Lomb, Toulouse, France) tamponade. Eighteen months later, she returned for follow-up examination.

Results:
Slit-lamp examination revealed accumulation of emulsified silicone oil in both the inferior and superior portions of the anterior chamber leading to a “double pseudohypopyon” appearance.

Conclusion:
This case highlights the possibility of decomposition of the Oxane HD silicone oil with time creating an inverted pseudohypopyon from emulsification of light silicone oil in addition to a pseudohypopyon from heavy oil emulsification.