bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraoperative Care Transitions Are Not Associated with Postoperative Adverse Outcomes
Authors: Terekhov Maxim A. , Ehrenfeld Jesse M. , Dutton Richard P. , Guillamondegui Oscar D. , Martin Barbara J. , Wanderer Jonathan P. 
Published: July 2016

AbstractBackgroundWhether anesthesia care transitions and provision of short breaks affect patient outcomes remains unclear.MethodsThe authors determined the number of anesthesia handovers and breaks during each case for adults admitted between 2005 and 2014, along with age, sex, race, American Society of Anesthesiologists physical status, start time and duration of surgery, and diagnosis and procedure codes. The authors defined a collapsed composite of in-hospital mortality and major morbidities based on primary and secondary diagnoses. The relationship between the total number of anesthesia handovers during a case and the collapsed composite outcome was assessed with a multivariable logistic regression. The relationship between the total number of anesthesia handovers during a case and the components of the composite outcome was assessed using multivariate generalized estimating equation methods. Additionally, the authors analyzed major complications and/or death within 30 days of surgery based on the American College of Surgeons National Surgical Quality Improvement Program–defined events.ResultsA total of 140,754 anesthetics were identified for the primary analysis. The number of anesthesia handovers was not found to be associated (P = 0.19) with increased odds of postoperative mortality and serious complications, as measured by the collapsed composite, with odds ratio for a one unit increase in handovers of 0.957; 95% CI, 0.895 to 1.022, when controlled for potential confounding variables. A total of 8,404 anesthetics were identified for the NSQIP analysis (collapsed composite odds ratio, 0.868; 95% CI, 0.718 to 1.049 for handovers).ConclusionsIn the analysis of intraoperative handovers, anesthesia care transitions were not associated with an increased risk of postoperative adverse outcomes.
Complications in Tibial Pilon Fractures: Avoiding Errors in Judgment
Authors: Watson John T. 
Published: July 2016

Pilon fracture surgery is fraught with many potential complications. Careful preoperative evaluation is required. Techniques for preoperative soft tissue management include compression dressings, stable ankle spanning external fixation, and compression foot pumps. Errors in judgment regarding the timing of surgery and over aggressive surgical exposure can lead to soft tissue complications. Postoperative wound management techniques include negative-pressure wound therapy to reduce incisional edema. Wound complications can be handled with a number of newer local pedicled rotational flaps, as well as biomaterials. These include acellular biomembranes to facilitate formation of a well-developed subcuticular tissue layer to serve as a substrate for local skin grafting. Mechanical instability occurs when the surgeon fails to neutralize deforming forces. This is accomplished by correct plate application, as well as treating areas of bone loss, that can all lead to late deformation, mechanical failure, and nonunion. This review covers crucial decision-making points regarding soft tissue and fixation strategies in an attempt to help avoid the frequency and severity of these complications.
Levels of Evidence: Diagnostic Level I, II, III, IV, and V. See Instructions for Authors for a complete description of levels of evidence.
Successful Treatment of Chronic Venous Ulcers With a 1,320-nm Endovenous Laser Combined With Other Minimally Invasive Venous Procedures
Authors: Wysong Ashley , Taylor Brent R. , Graves Michael , Mishra Vineet , Gilbertson Ryan , Greenway Hubert T. , Housman Leland 
Published: July 2016

BACKGROUND
Venous ulcers are very common with few curative treatment options.

OBJECTIVE
To report the closure rate and clinical characteristics of active venous ulcers in a vein clinic using endovenous laser ablation (EVLA) with a 1,320-nm laser.

METHODS AND MATERIALS
A prospective database was kept consisting of patients with an active venous ulcer at the time of consultation in a single-practitioner academic vein clinic from March 2007 to May 2014. A database was maintained and charts were reviewed with attention to the length of time the patient reported having the ulcer, procedures performed, and time to ulcer healing.

RESULTS
Thirty-one patients were identified at consultation with venous ulceration. One patient's ulcer was healed with conservative medical management before receiving treatment. The remaining 30 patients were treated with a combination of EVLA of the great and/or short saphenous veins, foam sclerotherapy of insufficient varicose and reticular veins, and phlebectomy as appropriate. Two patients were lost to follow up after partial treatment. Ulcer healing occurred in more than 93% (27/29) of patients with a median healing time of 55 days from the time of first treatment. The median follow-up time after treatment was 448 days.

CONCLUSION
Endovenous laser ablation with a 1,320-nm laser in combination with foam sclerotherapy and phlebectomy as appropriate is effective treatment of chronic venous ulcers and should be considered as a treatment option for patients with C6 venous insufficiency. To the authors' knowledge, this is the largest, prospective series of chronic venous ulcers treated with EVLA. Further randomized controlled studies are needed to confirm these findings.
Penile Squamous Cell Carcinoma: Penis-Preserving Treatment With Mohs Micrographic Surgery
Authors: Machan Mac , Brodland David , Zitelli John 
Published: July 2016

BACKGROUND
There have been few published case series of penile squamous cell carcinoma (SCC) removed with Mohs micrographic surgery (MMS). Of these case series, the published cure rates are between 68% and 74%.

OBJECTIVE
To report 30 years of experience removing penile SCCs with MMS.

METHODS and Materials
Retrospective record review of 42 patients with 44 penile SCCs.

RESULTS
There was one recurrence of the 19 primary SCCs in situ, resulting in a cure rate of 94.7%. There were no recurrences among the 10 primary invasive SCC. Of the 6 recurrent invasive SCCs, 2 recurred, resulting in an initial cure rate of 66.7%. These 2 recurrences were re-treated with MMS with no evidence of recurrence at 5 years. There were 4 patients with SCC in situ of the glans with extension down the urethra. While all 4 patients required urethral dilation postoperatively secondary to urethral stricture, none of these tumors recurred and normal function was restored in each case.

CONCLUSION
In conclusion, MMS may be preferred for patients with penile carcinoma by providing a high cure rate and tissue conservative alternative to partial or total penectomy and does not need to be limited to low-grade, small, superficial tumors.
MiR-30s Family Inhibit the Proliferation and Apoptosis in Human Coronary Artery Endothelial Cells Through Targeting the 3′UTR Region of ITGA4 and PLCG1
Authors: Ma Feng , Li Tao , Zhang Huan , Wu GuanJi 
Published: July 2016

Abstract:
Atherosclerosis (As) is a common disease, which is serious hazard to human health. As the main pathological basis of ischemic cardiac and cerebral vascular disease, including coronary heart disease, cerebrovascular disease, and thromboembolic disease, it is a chronic inflammatory lesion of the arterial vessel wall. So far the pathogenesis of As has not been fully understood. Therefore, it is still lack of effective clinical prevention and treatment of drugs. More and more evidence indicate that miRNA plays an important role in the pathophysiology of many diseases, especially the occurrence and development of cardiovascular diseases. MiRNAs are widely detected in human coronary artery endothelial cells, which might participate in diverse biological functions through targeting different As associated genes. The aim of this study was to investigate the molecular mechanisms underlying miR-30s roles in As. Our study found the high expression of miR-30b and miR-30e in As clinical samples, identified the regulatory relationship of miR-30b and miR-30e to ITGA4 and PLCG1, respectively, and initially explored the effects of miR-30b and miR-30e on cell cycle and apoptosis through targeting ITGA4 and PLCG1. These data may provide a theoretical basis for clarifying the mechanism of miR-30s in As.
Does the uterus need to be removed to correct uterovaginal prolapse?
Authors: Gutman Robert E. 
Published: July 2016

Purpose of review
Owing to growing interest in uterine preservation, this evidence-based review compares hysteropexy with hysterectomy during surgery for uterovaginal prolapse.

Recent findings
LeFort colpocleisis is preferred over vaginal hysterectomy and total colpocleisis. The majority of studies show no differences in outcomes comparing sacrospinous hysteropexy with vaginal hysterectomy native tissue prolapse repair except for a single randomized controlled trial showing increased apical recurrences with advanced prolapse. Results comparing uterosacral hysteropexy and sacral hysteropexy with hysterectomy native tissue repairs are inconclusive. Potentially better outcomes are reported when laparoscopic hysterectomy (total or supracervical) is performed with sacral colpopexy compared with laparoscopic sacral hysteropexy, but mesh and morcellation risks should be considered. Data comparing vaginal mesh hysteropexy with currently available products with hysterectomy prolapse repairs are lacking but a high-quality study is underway.

Summary
High satisfaction and low reoperation rates can be accomplished using a variety of hysteropexy techniques. The advantages and disadvantages of uterine conservation must be considered when planning uterovaginal prolapse surgery. The type of hysteropexy and possible graft configuration may impact reoperation rates for recurrent prolapse. Vaginal mesh risks must be considered and laparoscopic mesh risks must be balanced with potential difficulty of future hysterectomy if needed.
Reduced risk of breast cancer mortality in women using postmenopausal hormone therapy: a Finnish nationwide comparative study
Authors: Mikkola Tomi S. , Savolainen-Peltonen Hanna , Tuomikoski Pauliina , Hoti Fabian , Vattulainen Pia , Gissler Mika , Ylikorkala Olavi 
Published: July 2016

Abstract

Objective:
Data are controversial on the impact of postmenopausal hormone therapy (HT) on breast cancer mortality. We analyzed nationwide Finnish data on breast cancer mortality risk in women using HT consisting of estradiol-only therapy (ET) or estrogen-progestogen therapy (EPT).

Methods:
In total, 489,105 women using HT in 1994 to 2009, traced from the nationwide reimbursement register, were followed from the HT initiation (3.3 million cumulative exposure years) to breast cancer death (n = 1,578 women). The observed deaths were compared with those in the age-standardized background population.

Results:
The breast cancer mortality risk was reduced in all HT users with exposure for at most 5 years (standardized mortality ratio 0.56; CI 0.52-0.60), more than 5 to 10 years (0.46; 0.41-0.51), or more than 10 years (0.62; 0.56-0.68). A significantly larger risk reduction was detected in the 50 to 59 years age group (0.33; 0.29-0.37) compared with 60 to 69 (0.64; 0.59-0.70) or 70 to 79 (0.78; 0.69-0.87) years age groups. The death risk reductions in ET users tended to be larger in all age groups compared with EPT users, with a significant difference only in the 70 to 79 years age group (0.66; 0.57-0.76 vs 0.88; 0.77-1.00). The age at HT initiation, regardless whether ET or EPT, showed no association with breast cancer mortality.

Conclusions:
In the Finnish unselected population, breast cancer is fatal in 1 of 10 patients. Our data imply that this risk is prevalent in 1 of 20 patients with history of HT use. This is an important message for women considering or already using HT.
Leading on the edge
Authors: Mercer Danielle , Haddon Arlene , Loughlin Catherine 
Published: July 2016

Background:
Health care organizations are considered complex systems that represent both formal leadership as well as more informal and shared leadership models. Implementing these models is essential for optimizing care and patient outcomes. The paramedic profession specifically, although considered informally, leads out of hospital patient care.

Purpose:
To date, few empirical studies investigate shared leadership in health care settings. In paramedicine specifically, studies of leadership are scarce, despite paramedics' essential role in leading on the front lines of care. Using an exemplar of paramedics, we examine what it means to informally lead on the front lines of patient care with the emphasis on paramedics responding out of hospital.

Methodology:
We employed a qualitative, semistructured interview methodology with 29 paramedics from a group of companies in central/eastern Canada to explore the conditions and practices surrounding shared leadership.

Findings:
Paramedics argue that, despite their job title, they classify themselves as informal leaders who share the leadership role. More specifically, the paramedics discuss the precursors, practices, and structural conditions surrounding shared leadership within the realm of emergency medical services. They note that they often face out-of-hospital care without a formal manager, requiring them to collectively lead. The leader will shift in times of urgency, and this is contingent on their skills and competence. Furthermore, managers routinely called upon paramedics to lead in their absence.

Practice Implications:
It is shown here that, although informally enacted, paramedics view leadership as a necessary competency for clinical practice. We argue that leadership development of paramedics must begin during their formal education and training as part of the core curriculum. As well, direct managers can promote an environment of shared leadership and encourage paramedics to practice leadership with quality of patient service in mind.
A Novel Survey Tool to Quantify the Degree and Duration of STEMI Regionalization Across California
Authors: Rokos Ivan C. , Sporer Karl , Savino Paul B. , Mercer Mary P. , Shontz Selinda S. , Sabbagh Sarah , Hsia Renee Y. 
Published: July 2016

Introduction:
California has been a global leader in regionalization efforts for time-critical medical conditions. A total of 33 local emergency medical service agencies (LEMSAs) exist, providing an organized EMS framework across the state for almost 40 years. We sought to develop a survey tool to quantify the degree and duration of ST-elevation myocardial infarction (STEMI) regionalization over the last decade in California.

Methods:
The project started with the development of an 8-question survey tool via a multi-disciplinary expert consensus process. Next, the survey tool was distributed at the annual meeting of administrators and medical directors of California LEMSAs to get responses valid through December, 2014. The first scoring approach was the Total Regionalization Score (TRS) and used answers from all 8 questions. The second approach was called the Core Score, and it focused on only 4 survey questions by assuming that the designation of STEMI Receiving Centers must have occurred at the beginning of any LEMSA’s regionalization effort. Scores were ranked and grouped into tertiles.

Results:
All 33 LEMSAs in California participated in this survey. The TRS ranged from 15 to 162. The Core Score range was much narrower, from 2 to 30. In comparing TRS and Core Score rankings, the top-tertiles were quite similar. More rank variation occurred between mid- and low-tertiles.

Conclusion:
This study evaluated the degree and duration of STEMI network regionalization from 2004 to 2014 in California, and ranked 33 LEMSAs into tertiles based upon their TRS and their Core Score. Successful application of the 8-item survey and ranking strategies across California suggests that this approach can be used to assess regionalization in other states or countries around the world.
Severe Elevation of Liver Tests in Choledocholithiasis
Authors: Bangaru Saroja , Thiele Dwain , Sreenarasimhaiah Jayaprakash , Agrawal Deepak 
Published: July 2016

Background and Aims:
Choledocholithiasis is not commonly associated with dramatic elevations in aminotransferase or total serum bilirubin. Ours is the largest case series thus far studying the prevalence of dramatic elevations in liver tests associated with choledocholithiasis.

Materials and Methods:
We performed a retrospective chart review of all patients with choledocholithiasis diagnosed on endoscopic retrograde pancreatocholangiogram at a tertiary referral hospital over 7 years. We identified 740 patients with available liver tests and determined the prevalence of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) >1000 IU/L and of total serum bilirubin >10 mg/dL. We compared clinical characteristics of these 2 nonoverlapping groups.

Results:
Of 740 patients, AST and/or ALT values >1000 IU/L were present in 45 (6.1%) patients. On average AST and ALT decreased 79% and 56%, respectively, at discharge 1 to 8 days later. Total serum bilirubin levels >10 mg/dL were present in 35 (4.7%) patients and decreased by an average of 64% at discharge 1 to 8 days later. When compared with the group with total serum bilirubin >10 mg/dL, the group with elevated aminotransferases had significantly more females (93% vs. 43%, P<0.001), had smaller common bile duct diameter (8.5 vs. 10.6 mm, P=0.04), and were more likely to have had a prior cholecystectomy (40% vs. 14%, P=0.01). These 80 patients had higher utilization of health resources: half had additional laboratory studies and one fourth had additional imaging studies performed.

Conclusions:
In patients with high AST and/or ALT and serum total bilirubin levels with known choledocholithiasis, elaborate work up to look for another etiology is not required. As long as the values decrease significantly, they do not need to be followed until they normalize in the same hospitalization.
Randomized placebo-controlled study of baclofen in the treatment of muscle cramps in patients with liver cirrhosis
Authors: Elfert Asem A. , Abo Ali Lobna , Soliman Samah , Zakaria Sherin , Shehab El-Din Ibrahim , Elkhalawany Walaa , Abd-Elsalam Sherief 
Published: July 2016

Background and aims
Muscle cramps adversely influence the quality of life of patients with liver cirrhosis. Indeed, to date, a well-established therapy for this complication is still lacking. This is the first randomized placebo-controlled trial of baclofen in the treatment of muscle cramps in patients with liver cirrhosis.

Patients and methods
A total of 100 patients with liver cirrhosis and muscle cramps signed an informed consent to participate in this study. They were recruited from the Department of Tropical Medicine-Tanta University Hospital. They were randomized to receive either baclofen or placebo for 3 months. Patients were followed monthly and 1 month after withdrawal. At each visit, the clinicoepidemiological data were recorded, the muscle cramp questionnaire was filled, and any drug-related side effects were reported.

Results
In the baclofen group, the frequency of muscle cramps decreased significantly after 1 and 3 months of treatment (P<0.005), with a significant relapse after withdrawal (P<0.001). Patients receiving baclofen showed a significant decrease in the severity and duration of muscle cramps (P<0.001). After 3 months of baclofen therapy at a dose of 30 mg/day, muscle cramps disappeared completely in 72%, reduced in 20%, and led to no change in 8% of patients. No significant changes in the frequency, severity, and duration of muscle cramps were noted in the placebo group. There were few but nonsignificant side effects in the baclofen group compared with the placebo group.

Conclusion
Baclofen was well tolerated, safe, and effective in the treatment of muscle cramps in patients with liver cirrhosis.
The Association Between Plasma Ferritin Level and Simple Febrile Seizures in Children
Authors: Köksal Ali O. , Özdemir Osman , Büyükkaragöz Bahar , Karaömerlioglu Merve , Bulus Ayse D. 
Published: July 2016

Introduction:
We conducted this study to determine the role of iron deficiency (ID) as a risk factor for simple febrile seizure (SFS) in 6- to 60-month-old children.

Materials and Methods:
In this case-control study 100 children aged 6 to 60 months with febrile seizure (FS) (study group) and 100 febrile children without seizures (control group) admitted to Pediatric Departments of Kecioren Training and Research Hospital in between June 2014 and March 2015 were evaluated. Complete blood count, serum iron, plasma ferritin, and total iron binding capacity analyses were performed in children with FS and were compared with controls.

Results:
Ferritin level was significantly lower in the study group than controls (P<0.05). Compared with the onset of the study (first day), ferritin levels of the study group significantly decreased at the 10th day (P<0.05). At the onset, we were not able to determine ID in 18% of children because of fever.

Conclusions:
There was a relationship between low plasma ferritin level and SFS. Low plasma ferritin level may be a risk factor for the development of SFS. For preventing the FS attacks, treatment of present ID and oral supplementary iron therapy should be initiated for children with SFS who have a low plasma ferritin.
Blue and Red Light-Evoked Pupil Responses in Photophobic Subjects with TBI
Authors: Yuhas Phillip T. , Shorter Patrick D. , McDaniel Catherine E. , Earley Michael J. , Hartwick Andrew T. E. 
Published: July 2016

ABSTRACT

Purpose
Photophobia is a common symptom in individuals suffering from traumatic brain injury (TBI). Recent evidence has implicated blue light-sensitive intrinsically photosensitive retinal ganglion cells (ipRGCs) in contributing to the neural circuitry mediating photophobia in migraine sufferers. The goal of this work is to test the hypothesis that ipRGC function is altered in TBI patients with photophobia by assessing pupillary responses to blue and red light.

Methods
Twenty-four case participants (mean age 43.3; 58% female), with mild TBI and self-reported photophobia, and 12 control participants (mean age 42.6; 58% female) were in this study. After 10 minutes of dark adaptation, blue (470 nm, 1 × 1013 phots/s/cm2) and red (625 nm, 7 × 1013 phots/s/cm2) flashing (0.1 Hz) light stimuli were delivered for 30 seconds to the dilated left eye while the right pupil was recorded. The amplitude of normalized pupil fluctuation (constriction and dilation) was quantified using Fourier fast transforms.

Results
In both case and control participants, the amplitude of pupil fluctuation was significantly less for the blue light stimuli as compared to the red light stimuli, consistent with a contribution of ipRGCs to these pupil responses. There was no significant difference in the mean pupil fluctuation amplitudes between the two participant groups, but case participants displayed greater variability in their pupil responses to the blue stimulus.

Conclusions
Case and control participants showed robust ipRGC-mediated components in their pupil responses to blue light. The results did not support the hypothesis that ipRGCs are “hypersensitive” to light in TBI participants with photophobia. However, greater pupil response variability in the case subjects suggests that ipRGC function may be more heterogeneous in this group.