bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unstable Proximal Femur Fractures Treated With Proximal Femoral Locking Plates: A Retrospective, Multicenter Study of 111 Cases
Authors: Collinge Cory A. , Hymes Robert , Archdeacon Michael , Streubel Phillip , Obremskey William , Weber Timothy , Watson J. Tracy , Lowenberg David ,   Members of the Proximal Femur Working Group of the Southeast Trauma Consortium
Published: May 2016

Objectives:
A few small case series have found that proximal femur fractures treated with a proximal femur locking plate (PFLP) have experienced more failures than expected. The purpose of this study was to review the clinical results of patients with acute, unstable proximal femur fractures treated with proximal femoral locking plates in a large, multicenter patient cohort.

Design:
This is a retrospective clinical study.

Setting:
The study included patients from 12 regional trauma centers and tertiary referral hospitals.

Patients:
One hundred eleven consecutive patients with unstable proximal femur fractures stabilized with a PFLP and having required clinical and radiographic follow-up at a minimum of 12 months after injury.

Intervention:
Surgical repair of an unstable proximal femur fracture with a PFLP.

Main outcome measurements:
Treatment failures (failure of fixation, nonunion, and malunion) and need for revision surgery.

Results:
Forty-six patients (41.4%) experienced a major treatment failure, including failed fixation with or without nonunion (39), surgical malalignment or malunion (18), deep infection (8), or a combination of these. Thirty-eight (34%) patients underwent secondary surgeries, including 30 for failed fixation, nonunion, or both. Treatment failure was found to occur at a significantly higher rate in patients with major comorbidities, in femurs repaired in varus malalignment, and using specific plate designs.

Conclusions:
Proximal femoral locking plates are associated with a high complication rate, frequently requiring revision or secondary surgeries in the treatment of unstable proximal femur fractures. Given the high complication rate with PFLPs, careful attention to reduction, use of a PFLP implant, and consideration should be given to alternative implants or fixation techniques when appropriate.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
A Novel Decision Aid for Surgical Patients with Ulcerative Colitis: Results of a Pilot Study
Authors: Cohan Jessica N. , Ozanne Elissa M. , Sewell Justin L. , Hofer Rebecca K. , Mahadevan Uma , Varma Madhulika G. , Finlayson Emily 
Published: May 2016

BACKGROUND:
Up to 30% of patients who have ulcerative colitis are faced with the complex decision between end ileostomy and IPAA. We developed a decision aid to encourage shared decision making between patients and surgeons.

OBJECTIVE:
The aim of this study is to determine whether a decision aid is effective and acceptable for surgical patients with ulcerative colitis and their treating surgeons.

DESIGN:
This was a prospective cohort study.

SETTINGS:
Patients and surgeons were enrolled from 3 colorectal surgery clinics.

PATIENTS:
Consecutive adult patients with ulcerative colitis who were candidates for IPAA and end ileostomy were selected.

INTERVENTIONS:
Patients used a multilingual decision aid before meeting with the surgeon.

MAIN OUTCOME MEASURES:
We measured changes in knowledge, treatment preference, and stage of decision making, as well as preparation for decision making, patient satisfaction, and surgeon satisfaction after using the decision aid.

RESULTS:
Twenty-five patients were enrolled; 5 had previously undergone subtotal colectomy. After using the decision aid, patients’ knowledge scores improved by 39% (p < 0.006), 6 patients changed their treatment preference, and 8 reported increased certainty in treatment preference. The median for preparation for decision making was 75 of 100. Patient satisfaction with the decision aid (median score, 37/41) and surgeon satisfaction with the clinical encounter (median score, 38/45) were high. Patients who previously underwent subtotal colectomy had lower preparation for decision-making scores (median score, 58 vs 78 for surgery-naïve patients, p = 0.06), and did not report increased certainty in treatment preference after using the decision aid.

LIMITATIONS:
The study included a small sample with no comparison group.

CONCLUSIONS:
A novel decision aid for surgical patients with ulcerative colitis appears to be effective and acceptable in patients and surgeons from diverse clinical settings. Patients who have not yet initiated surgical treatment seem to benefit most. Future studies to validate the knowledge questionnaire and test the decision aid in a randomized fashion are warranted.
Transverse Perineal Support: A Novel Surgical Treatment for Perineal Descent in Patients With Obstructed Defecation Syndrome
Authors: Renzi Adolfo , Brillantino Antonio , Di Sarno Giandomenico , d’Aniello Francesco , Bianco Pasquale , Iacobellis Francesca , Reginelli Alfonso , Grassi Roberto 
Published: May 2016

BACKGROUND:
We hypothesized that pathological perineal descent may be responsible for the failure of operations for obstructed defecation syndrome and that correcting excessive perineal descent may improve the outcome in this group of patients.

OBJECTIVE:
The purpose of this study was to report the short-term preliminary results of a novel surgical procedure, transverse perineal support, for the correction of pathological perineal descent.

DESIGN:
This was a prospective, uncontrolled, open-label study.

SETTINGS:
The study was conducted in a hospital and a university center.

PATIENTS:
Among 25 patients observed with failure of previous surgery for obstructed defecation syndrome, 12 with pathological perineal descent underwent transverse perineal support, were followed-up at 6 months, and constituted the object of analysis.

INTERVENTIONS:
The surgical procedure was performed positioning a porcine dermal implant just above the perineum superficial fascia sutured to the periosteum membrane of ischiatic tuberosities at the insertion of the superficial transverse perineal muscle.

MAIN OUTCOME MEASURES:
The main outcome measures were obstructed defecation syndrome score and x-ray and magnetic resonance defecographic imaging evaluation of perineal descent and anorectal manometric parameters.

RESULTS:
The postoperative median obstructed defecation syndrome score was 7.0 (range, 3–8), showing a statistically significant difference if compared with the preoperative score of 13.5 (range, 9–18; p = 0.0005). The mean postoperative maximum intrarectal pressure was 69.4 ± 11.1 mm Hg, significantly higher than the preoperative pressure of 45.9 ± 12.8 mm Hg (p < 0.0001). At postoperative x-ray and magnetic resonance imaging defecography, the mean fixed and dynamic perineal descents were significantly lower than the preoperative descents (p = 0.02 for fixed perineal descent and p = 0.0004 for dynamic perineal descent). Of the 4 patients (33.3%) with preoperative pathological dynamic perineal descent, only 1 showed a persistent pathological dynamic perineal descent. No early or late complication was observed.

LIMITATIONS:
The study was limited by its small size and short follow-up time.

CONCLUSIONS:
Transverse perineal support appears to be a promising, safe, and effective procedure in the treatment of obstructed defecation syndrome associated with pathological perineal descent (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A225).
The “Studded” Rectum: Phenotypic Evidence of MYH-Associated Polyposis
Authors: Church James , Kravochuck Sara 
Published: May 2016

BACKGROUND:

MYH-associated polyposis is a recessively inherited syndrome of colorectal cancer predisposition attributed to biallelic germline mutations in the base excision repair gene MYH. Clinically it overlaps with attenuated familial adenomatous polyposis, sporadic oligopolyposis, serrated polyposis, familial colorectal cancer type X, and Lynch syndrome. There is no specific phenotypic feature of MYH-associated polyposis. We have noticed that a proportion of patients with MYH-associated polyposis presenting for yearly colonoscopy surveillance have rectums that are studded with small hyperplastic polyps.

OBJECTIVE:
We report this as a possible unique phenotypic feature of the syndrome.

DESIGN:
This was a descriptive study.

SETTINGS:
The study was conducted at a department of colorectal surgery in a tertiary referral center.

PATIENTS:
Patients affected with oligopolyposis or MYH-associated polyposis presenting for endoscopic surveillance and polyp control were included.

INTERVENTIONS:
Interventions included colonoscopy or proctoscopy with excision or biopsy of mucosal lesions.

MAIN OUTCOME MEASURES:
The presence of rectal studding was measured.

RESULTS:
There were 49 patients, 16 with biallelic germline mutations of MYH; 10 of these had rectal studding. A sampling of rectal polyps was biopsied and all were hyperplastic. Five patients with biallelic MYH mutations had no studding, and 1 had not been prospectively examined. The studding was independent of the nature of the MYH mutation(s). The 33 patients other patients included 21 with serrated polyposis, 2 with a germline APC mutation, 1 with a PTEN mutation, 2 with mixed polyposis, 3 with oligoadenomatous polyposis and no germline mutation, and 4 patients with oligoadenomatous polyposis who had not been genetically tested. Only 1 of these (oligoadenomatous polyposis, not tested) had studding.

LIMITATIONS:
The study was limited by its small number of biallelic MYH mutation carriers.

CONCLUSIONS:
Rectal studding may be a sign of MYH-associated polyposis and raises questions about the biology of abnormal base excision repair.
Risk of Surgical Site Infection Varies Based on Location of Disease and Segment of Colorectal Resection for Cancer
Authors: Murray Alice Charlotte Adelaide , Pasam Ravi , Estrada David , Kiran Ravi P. 
Published: May 2016

BACKGROUND:
Current quality-monitoring initiatives do not accurately evaluate surgical site infections based on type of surgical procedure.

OBJECTIVE:
This study aimed to characterize the effect of the anatomical site resected (right, left, rectal) on wound complications, including superficial, deep, and organ space surgical site infections, in patients who have cancer.

SETTINGS:
Data were retrieved from the American College of Surgeons National Surgical Quality Improvement Program database.

DESIGN:
This study was designed to determine the independent risk associated with the anatomical location of cancer resection for all subtypes of surgical site infection. Statistical methods included the Fisher exact test, the χ2 test, and univariable and multivariable analyses for each outcome of interest.

PATIENTS:
All colon and rectal resections for colorectal cancer between 2006 and 2012 were selected. Included were 45,956 patients: 17,993 (39.2%) underwent right colectomy, 11,538 (25.1%) underwent left colectomy, and 16,425 (35.7%) underwent rectal resections.

RESULTS:
The overall surgical site infection rate was 12.3%: 3.7% organ space, 1.4% deep, and 7.2% superficial. On multivariable analysis, rectal resection was associated with the greatest odds of overall surgical site infections in comparison with left- or right-sided resections (rectal OR, 1.51; 95% CI, 1.35–1.69 vs left OR, 1.09; 95% CI, 0.97–1.23 vs right OR, 1). Rectal resections were also associated with greater odds of developing a deep surgical site infection than either right (rectal OR, 1.45; 95% CI, 1.06–1.99) or left (OR, 0.89; 95% CI, 0.62–1.27). The likelihood of organ space surgical site infection followed a similar pattern (rectal OR, 1.83; 95% CI 1.49–2.25; left colon, OR, 0.95; 95% CI, 0.75–1.19). Rectal and left resections had increased odds of superficial surgical site infections compared with right resections (rectal OR, 1.31; 95% CI, 1.14–1.51; left OR, 1.19; 95% CI, 1.03–1.37).

LIMITATIONS:
This is a retrospective observational study.

CONCLUSIONS:
Rectal resections for cancer are independently associated with an increased likelihood of superficial, deep, and organ space infections. The policy on surgical site infections as a quality measure currently in place requires modification to adjust for the location of pathology and, hence, the anatomical segment resected when assessing the risk for type of surgical site infection.
Short-term Outcomes After Open and Laparoscopic Colostomy Creation
Authors: Ivatury Srinivas Joga , Bostock Rosenzweig Ian C. , Holubar Stefan D. 
Published: May 2016

BACKGROUND:
Colostomy creation is a common procedure performed in colon and rectal surgery. Outcomes by technique have not been well studied.

OBJECTIVE:
This study evaluated outcomes related to open versus laparoscopic colostomy creation.

DESIGN:
This was a retrospective review of patients undergoing colostomy creation using univariate and multivariate propensity score analyses.

SETTINGS:
Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program database were included.

PATIENTS:
Data on patients were obtained from the American College of Surgeons National Surgical Quality Improvement Program 2005–2011 Participant Use Data Files.

MAIN OUTCOME MEASURES:
We measured 30-day mortality, 30-day complications, and predictors of 30-day mortality.

RESULTS:
A total of 2179 subjects were in the open group and 1132 in the laparoscopic group. The open group had increased age (open, 64 years vs laparoscopic, 60 years), admission from facility (17.0% vs 14.9%), and disseminated cancer (26.1% vs 21.4%). All were statistically significant. The open group had a significantly higher percentage of emergency operations (24.9% vs 7.9%). Operative time was statistically different (81 vs 86 minutes). Thirty-day mortality was significantly higher in the open group (8.7% vs 3.5%), as was any 30-day complication (25.4% vs 17.0%). Propensity-matching analysis on elective patients only revealed that postoperative length of stay and rate of any wound complication were statistically higher in the open group. Multivariate analysis for mortality was performed on the full, elective, and propensity-matched cohorts; age >65 years and dependent functional status were associated with an increased risk of mortality in all of the models.

LIMITATIONS:
This study has the potential for selection bias and limited generalizability.

CONCLUSIONS:
Colostomy creation at American College of Surgeons National Surgical Quality Improvement Program hospitals is more commonly performed open rather than laparoscopically. Patient age >65 years and dependent functional status are associated with an increased risk of 30-day mortality.
LOCATING AND CHARACTERIZING ANGIOID STREAKS WITH EN FACE OPTICAL COHERENCE TOMOGRAPHY
Authors: Hanhart Joel , Greifner Hillel , Rozenman Yaakov 
Published: May 2016

Purpose:
To characterize angioid streaks (AS) with en face optical coherence tomography (OCT).

Methods:
Case report of a patient with myopia presenting with choroidal neovascularization secondary to AS. Swept-source en face OCT ability to image the streaks was compared with spectral-domain and swept-source B-scans as well as color and red-free pictures. A 48-year-old man with myopia presented with sudden central visual loss. Choroidal neovascularization secondary to AS was diagnosed and intraocular anti–vascular endothelial growth factor given with clinical and OCT features improvement.

Results:
Angioid streaks were visualized as less dark than the overlying retinal and the underlying choroidal vasculature. En face OCT located the changes at the level of Bruch membrane. An AS was found to be interrupted by the choroidal neovascularization, what was not captured by other modalities.

Conclusion:
En face OCT allows to assess the extent of changes in Bruch membrane and their spatial relationship to choroidal neovascularization.
Virtual Fitting, Selection, and Cutting of Preformed Anatomic Orbital Implants
Authors: Mahoney Nicholas R. , Peng Michelle Y. , Merbs Shannath L. , Grant Michael P. 
Published: May 2016

Purpose:
To evaluate the usage of preoperative digital anatomic implant evaluation in internal orbital fractures.

Methods:
An IRB-approved review of cases of orbital fracture repair was conducted and cases where digital implant modeling was performed were selected for comprehensive review. The surgical time of these cases was also compared with surgeon and implant matched controls.

Results:
A total of 25 patients and 26 orbits underwent preoperative virtual fitting and were reviewed. There were no complications or revision surgeries needed. Postoperative assessment demonstrated accuracy to the preoperative target with an average maximum deviation of 1.9 mm.

Conclusions:
Preoperative digital fracture assessment, implant manufacturer and size selection, and virtual cutting guide creation provides additional tools for orbital surgeons to achieve anatomic restoration without significant differences in operating time.
Periorbital Autologous Fat Grafting in Facial Nerve Palsy
Authors: Siah We Fong , Litwin Andre S. , Nduka Charles , Malhotra Raman 
Published: May 2016

Purpose:
To report outcomes and complications of periorbital autologous fat grafting (AFG) in improving volume loss-related symmetry and function in facial nerve palsy patients and to assess patient satisfaction.

Methods:
A retrospective, noncomparative review of all facial nerve palsy patients who underwent periorbital AFG at single center over a 4-year period. Two independent graders objectively assessed standard photographs for any change in volume loss and symmetry: pre- and postoperative periods (early, 0–2 months; intermediate, 3–9 months; and late, >10 months). Any adverse outcomes were recorded. Patient satisfaction was assessed by questionnaire survey.

Results:
A total of 18 facial nerve palsy patients (13 females) underwent periorbital AFG between February 2011 and 2015. Mean age was 51.9 ± 15.3 years (range, 26–76). Mean follow up was 6.8 ± 4.6 (range, 0.5–15) months. Photographs of 14 patients were eligible for evaluation. Tear trough visibility (p < 0.01), infraorbital rim visibility (p = 0.03), and lower eyelid-cheek junction symmetry (p < 0.01) improved in the early postoperative period with persistence of improvement in the latter parameter at intermediate postoperative period (p < 0.01). Lagophthalmos significantly improved (p = 0.03) in the early postoperative period. Two patients developed cheek cellulitis and 4 had persistent malar edema (3 had existing edema). Questionnaire survey showed a reduction in daytime ocular lubricants and an improvement in nocturnal-lagophthalmos symptoms.

Conclusion:
Periorbital AFG is a useful adjunct in improving symmetry and lagophthalmos in facial nerve palsy patients where volume loss is a contributory factor but effects were not long lasting. Patient satisfaction is high. Those with preexisting malar bags are at higher risk of developing persistent malar edema following periorbital AFG.
Does Simulation Improve Recognition and Management of Pediatric Septic Shock, and If One Simulation Is Good, Is More Simulation Better?*
Authors: Dugan Mark C. , McCracken Courtney E. , Hebbar Kiran B. 
Published: May 2016

Objectives:
Determine whether serial simulation training sessions improve resident recognition and initial septic shock management in a critically ill simulated septic shock patient, and to determine whether serial simulations further improve resident task performance when compared with a single simulation session.

Design:
Prospective observational cohort study with a live expert review of trainee simulation performance. Expert reviewers blinded to prior trainee performance.

Setting:
A PICU room in a quaternary-care children’s hospital, featuring a hi-fidelity pediatric patient simulator.

Subjects:
Postgraduate year-2 and postgraduate year-3 pediatric residents who rotate through the PICU.

Interventions:
Postgraduate year-3 residents as the control cohort, completing one simulation near the start of their third residency year. Postgraduate year-2 residents as the intervention cohort, completing two simulations during their second residency year and one near the start of their third residency year.

Measurements and Main Results:
Resident objective performance was measured using a validated 27-item checklist (graded 0/1) related to monitoring, data gathering, and interventions in the diagnosis and management of pediatric septic shock. The intervention cohort had a higher mean performance percentage score during their third simulation than the control cohort completing their single simulation (87% vs 77%; p < 0.001). Septic shock was correctly diagnosed more often in the intervention cohort at the time of their third simulation (100% vs 78%; p < 0.001). Appropriate broad-spectrum antibiotics were administered correctly more often in the intervention cohort (83% vs 50%; p < 0.001).

Conclusions:
Simulations significantly improved resident performance scores in the management of septic shock with repetitive simulation showing significant ongoing improvements. Further studies are needed to determine long-term impact on knowledge and skill retention and whether results attained in a simulation environment are translatable into clinical practice in improving bedside care.
Generating an Executable Model of the Drosophila Central Complex
Authors: Givon Lev E. , Lazar Aurel A. 
Published: May 2016

AbstractThe central complex (CX) is a set of neuropils in the center of the fly brain that have been implicated as playing an important role in vision-mediated behavior and integration of spatial information for locomotor control. In contrast to currently available data regarding the neural circuitry of neuropils in the fly's vision and olfactory systems, comparable data for the CX neuropils is relatively incomplete; many categories of neurons remain only partly characterized, and the synaptic connectivity between CX neurons has yet to be experimentally determined. Successful modeling of the information processing functions of the CX neuropils therefore requires a means of easily constructing and testing a range of hypotheses regarding both the high-level structure of their neural circuitry and the properties of their constituent neurons and synapses. This document demonstrates how NeuroArch and Neurokernel may be used to algorithmically construct and evaluate executable neural circuit models of the CX neuropils and their interconnects based upon currently available information regarding the geometry and polarity of the arborizations of identified local and projection neurons in the CX.
Mutational signatures associated with tobacco smoking in human cancer
Authors: Alexandrov Ludmil B. , Ju Young Seok , Haase Kerstin , Van Loo Peter , Martincorena Iñigo , Nik-Zainal Serena , Totoki Yasushi , Fujimoto Akihiro , Nakagawa Hidewaki , Shibata Tatsuhiro , Campbell Peter J. , Vineis Paolo , Phillips David H. , Stratton Michael R. 
Published: May 2016

ABSTRACTTobacco smoking increases the risk of at least 15 classes of cancer. We analyzed somatic mutations and DNA methylation in 5,243 cancers of types for which tobacco smoking confers an elevated risk. Smoking is associated with increased mutation burdens of multiple distinct mutational signatures, which contribute to different extents in different cancers. One of these signatures, mainly found in cancers derived from tissues directly exposed to tobacco smoke, is attributable to misreplication of DNA damage caused by tobacco carcinogens. Others likely reflect indirect activation of DNA editing by APOBEC cytidine deaminases and of an endogenous clock-like mutational process. The results are consistent with the proposition that smoking increases cancer risk by increasing the somatic mutation load, although direct evidence for this mechanism is lacking in some smoking-related cancer types.ONE SENTENCE SUMMARYMultiple distinct mutational processes associate with tobacco smoking in cancer reflecting direct and indirect effects of tobacco smoke.