bluuebunny/crossref_metadata_2025_split huggingface dataset:
Malignant Transformation of Warthin Tumor in the Cervical Lymph Node
Authors: Park Soonchan , Lee Young Chan , Lim Sung-Jig , Kim Chanwoo 
Published: February 2023

Abstract
Warthin tumor is the second most common benign tumor of salivary glands. Here we present an interesting case of squamous cell carcinoma arising from the Warthin tumor in the cervical lymph node. The patient had another Warthin tumor in the parotid gland as well. Both the malignant transformation of Warthin tumor and the heterotopic occurrence of Warthin tumor in the cervical lymph node are rare. This exceptionally rare case demonstrates that the 2 rare clinical entities can occur simultaneously and affect clinical decisions.
The Virtual Surgical Management of Facial Fibrous Dysplasia
Authors: Khashaba Mohammed M. , Ibrahim Waleed H. , Shaker Shady M. , Shaheen Hamed A. 
Published: February 2023

Purpose:
Fibrous dysplasia (FD) is a benign condition, which is characterized by the replacement of normal bone with fibrous tissue and the deposition of woven bone in an irregular manner. Surgical resection, careful corrective osteotomies as debulking, and recontouring procedures are frequently performed, but can be complicated by postoperative regrowth of the lesion. The main aim of this study was to introduce a computer-guided technique for a predetermined technique of bone contouring of craniofacial FD involving the facial bones.

Methods:
This case report was conducted on an 18-year-old girl complaining of unilateral craniofacial dysplasia. Upon clinical examination and radiographic examination, a customized computer-generated bone contouring guide was designed using virtual surgical software for accurate contouring of excess bone in the cranial vault and frontal bone. This guide was virtually designed after importing the multislice computerized tomography scans into the virtual surgical planning software. It was generated based on the mirroring option of the unaffected normal side along the median sagittal plane. In the surgery, the guide was seated in place and 5 mm implant drills were inserted through the guide depth holes. Bone removal was made using surgical burs connecting the guiding depth holes.

Results:
At the end of the follow-up, the patient showed acceptance of her external appearance with no signs of infection or dehiscence.

Conclusion:
This patient-specific cutting guide shows a promising solution for preplanned bone removal in cases with unilateral craniofacial FD.
Does the Mutation Type Affect the Response to Cranial Vault Expansion in Children With Apert Syndrome?
Authors: Goodarzi Mohammad R. , Breakey William F. , van de Lande Lara S. , Borghi Alessandro , O’Hara Justine , Ong Juling , James Greg , Hayward Richard , Schievano Silvia , Dunaway David J. , Jeelani Nu Owase 
Published: February 2023

Most cases of Apert syndrome are caused by mutations in the FGFR2 gene, either Ser252Trp or Pro253Arg. In these patients, over the last decades, spring-assisted posterior vault expansion (SA-PVE) has been the technique of choice for cranial vault expansion in the Craniofacial Unit of Great Ormond Street Hospital for Children (GOSH), London. The aim of this study was to investigate if there is a difference in preoperative intracranial volume (ICV) in patients with Apert syndrome with Ser252Trp or Pro253Arg mutation and whether these mutations affect the change in ICV achieved by SA-PVE. The GOSH craniofacial SA-PVE database was used to select patients with complete genetic testing and preoperative and postoperative computed tomography scans. ICV was calculated using FSL (FMRIB Analysis Group, Oxford) and adjusted based on Apert-specific growth curves. Sixteen patients were included with 8 having Ser252Trp mutation and 8 having Pro253Arg mutation. The mean preoperative adjusted computed tomography volume for patients in the Ser252Trp group was 1137.7 cm3 and in the Pro253Arg group was 1115.8 cm3 (P=1.00). There was a significant increase in ICV following SA-PVE in all patients (P<0.001) with no difference in mean change in ICV between the groups (P=0.51). Four (50%) patients with Ser252Trp mutation and 3 (37.5%) with Pro253Arg mutations required a second operation after primary SA-PVE. The results demonstrate that regardless of the mutation present, SA-PVE was successful in increasing ICV in patients with Apert syndrome and that a repeat volume expanding procedure was required by a similar number of patients in the 2 groups.

Level of Evidence:
III.
NUCLEAR FACTOR-ERYTHROID-2–RELATED FACTOR REGULATES SYSTEMIC AND PULMONARY BARRIER FUNCTION AND IMMUNE PROGRAMMING AFTER BURN AND INHALATION INJURY
Authors: Seim Roland F. , Mac Michelle , Sjeklocha Lucas M. , Kwiatkowski Alex J. , Keselowsky Ben G. , Wallet Shannon M. , Cairns Bruce A. , Maile Robert 
Published: February 2023

ABSTRACT
Major burn injury is associated with systemic hyperinflammatory and oxidative stresses that encompass the wound, vascular, and pulmonary systems that contribute to complications and poor outcomes. These stresses are exacerbated if there is a combined burn and inhalation (B+I) injury, which leads to increases in morbidity and mortality. Nuclear factor-erythroid-2–related factor (NRF2) is a transcription factor that functions to maintain homeostasis during stress, in part by modulating inflammation and oxidative injury. We hypothesized that the NRF2-mediated homeostasis after burn alone and combined B-I injury is insufficient, but that pharmacological activation of the NRF2 pathway has the potential to reduce/reverse acute hyper inflammatory responses. We found that, after burn and B+I injury, Nrf2−/−
mice have higher mortality and exhibit greater pulmonary edema, vascular permeability, and exacerbated pulmonary and systemic proinflammatory responses compared with injured wild-type (WT) controls. Transcriptome analysis of lung tissue revealed specific Nrf2-dependent dysregulated immune pathways after injury. In WT mice, we observed that B+I injury induces cytosolic, but not nuclear, accumulation of NRF2 protein in the lung microenvironment compared with sham-injured controls. Bardoxolone methyl (CDDO-Me)–containing microparticles (CDDO-MPs) were developed that allow for dilution in saline and stable release of CDDO-Me. When delivered intraperitoneally into mice 1 hour after B+I injury, CDDO-MPs significantly reduced mortality and cytokine dysfunction compared with untreated B-I animals. These data implicate the role of NRF2 regulation of pulmonary and systemic immune dysfunction after burn and B+I injury, and also a deficiency in controlling immune dysregulation. Selectively activating the NRF2 pathway may improve clinical outcomes in burn and B+I patients.
A Study of Surgical Residents' Self-Assessment of Open Surgery Skills Using Gap Analysis
Authors: Thinggaard Ebbe , Zetner Diana Bregner , Fabrin Anja , Christensen John Brochorst , Konge Lars 
Published: February 2023

Background
Surgical residents need structured and objective feedback to develop their skills and become capable of performing surgical procedures autonomously. A shortage of experienced surgical staff has prompted residents to seek feedback from self-assessment and peer assessments.

Objectives
We investigated whether surgical residents can reliably rate their own and their peers' basic surgical skills using the Global Rating Scale (GRS) from the Objective Structured Assessment of Technical Skills.

Methods
The study was a prospective and descriptive study conducted using gap analysis at the Copenhagen Academy for Medical Education and Simulation (Copenhagen, Denmark) from 2016 to 2017. Surgical residents were recruited during a course in basic open surgical skills. Among 102 course participants, 53 met the inclusion criteria and 22 participated in the study.

Results
We recruited surgical residents based in the Capital Region and Zealand Region of Demark, and 42% of eligible residents participated in the study. Surgical residents underestimated their own surgical performance (median, 17 [range, 15–18] vs. 20 [range, 19.75–22]; P < 0.001). They also rated their peers lower than an experienced rater did (median 10 [range, 8.75–14] vs. 15 and median 20.5 [range, 19–22] vs. 23; both P < 0.001). Gap analysis revealed residents had unrecognized strengths (ie, self-underappraisal) in most GRS domains.

Conclusions
Ratings are unreliable when surgical residents assess their own and their peers' performances using GRS. A gap analysis revealed unrecognized strengths in time and motion, instrument handling, knowledge of instruments and sutures, and knowledge of specific procedure as well as unrecognized weaknesses in flow of operation and forward planning.
Overuse and Misuse of Antibiotics and the Clinical Consequence in Necrotizing Pancreatitis
Authors: Timmerhuis Hester C. , van den Berg Fons F. , Noorda Paula C. , van Dijk Sven M. , van Grinsven Janneke , Sperna Weiland Christina J. , Umans Devica S. , Mohamed Yasmin A. , Curvers Wouter L. , Bouwense Stefan A.W. , Hadithi Muhammed , Inderson Akin , Issa Yama , Jansen Jeroen M. , de Jonge Pieter Jan F. , Quispel Rutger , Schwartz Matthijs P. , Stommel Martijn W.J. , Tan Adriaan C.I.T.L. , Venneman Niels G. , Besselink Marc G. , Bruno Marco J. , Bollen Thomas L. , Sieswerda Elske , Verdonk Robert C. , Voermans Rogier P. , van Santvoort Hjalmar C. ,   for the Dutch Pancreatitis Study Group
Published: February 2023

Objective:
The use and impact of antibiotics and the impact of causative pathogens on clinical outcomes in a large real-world cohort covering the entire clinical spectrum of necrotizing pancreatitis remain unknown.

Summary Background Data:
International guidelines recommend broad-spectrum antibiotics in patients with suspected infected necrotizing pancreatitis. This recommendation is not based on high-level evidence and clinical effects are unknown.

Materials and Methods:
This study is a post-hoc analysis of a nationwide prospective cohort of 401 patients with necrotizing pancreatitis in 15 Dutch centers (2010-2019). Across the patient population from the time of admission to 6 months postadmission, multivariable regression analyses were used to analyze (1) microbiological cultures and (2) antibiotic use.

Results:
Antibiotics were started in 321/401 patients (80%) administered at a median of 5 days (P25-P75: 1-13) after admission. The median duration of antibiotics was 27 days (P25-P75: 15-48). In 221/321 patients (69%) infection was not proven by cultures at the time of initiation of antibiotics. Empirical antibiotics for infected necrosis provided insufficient coverage in 64/128 patients (50%) with a pancreatic culture. Prolonged antibiotic therapy was associated with Enterococcus infection (OR 1.08 [95% CI 1.03-1.16], P=0.01). Enterococcus infection was associated with new/persistent organ failure (OR 3.08 [95% CI 1.35-7.29], P<0.01) and mortality (OR 5.78 [95% CI 1.46-38.73], P=0.03). Yeast was found in 30/147 cultures (20%).

Discussion:
In this nationwide study of patients with necrotizing pancreatitis, the vast majority received antibiotics, typically administered early in the disease course and without a proven infection. Empirical antibiotics were inappropriate based on pancreatic cultures in half the patients. Future clinical research and practice must consider antibiotic selective pressure due to prolonged therapy and coverage of Enterococcus and yeast. Improved guidelines on antimicrobial diagnostics and therapy could reduce inappropriate antibiotic use and improve clinical outcomes.
Transumbilical Reduced-port Laparoscopic Urachal Resection for Pediatric and Adolescent Patients
Authors: Aiyoshi Tsubasa , Jimbo Takahiro , Gotoh Chikashi , Masumoto Kouji 
Published: February 2023

Background:
Port placement in laparoscopic urachal resection has not yet been standardized. We herein report an approach for transumbilical reduced-port laparoscopic urachal resection for pediatric and adolescent patients.

Methods:
We retrospectively reviewed the outcomes of pediatric and adolescent patients for urachal remnant treated with reduced-port laparoscopic urachal resection from 2016 to 2020 in our department. Regarding our surgical procedure, a skin incision was made around the umbilicus, and the urachus was dissected partially under direct vision. Two transumbilical 5 mm ports and a 3.5 mm port in the right lateral abdomen were placed. In the laparoscopic view, the urachus was dissected from the abdominal wall and resected at the bladder dome. The defect of the peritoneum was closed by suturing.

Results:
Sixteen patients underwent the procedure. The median patient age was 12.5 years old. Surgery was performed by trainee surgeons in all patients without intraoperative complications or conversion to open surgery. The median postoperative hospital stay was 2 days.

Conclusions:
Our transumbilical reduced-port laparoscopic urachal resection technique has advantages in terms of safety, operability, and cosmetic appearance.
Impact of Perioperative Ketamine on Postoperative Bariatric Surgery Opioid Use and Length of Stay
Authors: Aghazarian Gary S. , Lind Romulo , Ardila Sara , Lastrapes Linda , Ghanem Muhammad , Teixeira Andre F. , Jawad Muhammad A. 
Published: February 2023

Settings:
Postoperative pain management is an ever-growing challenge with the rise of the opioid crisis. Ketamine is an NMDA channel blocker, considered an alternative to perioperative opioid use; small concentrations are safe. Objective: The primary objective of this study was to evaluate the impact of perioperative ketamine administration on postoperative opioid use and the length of hospital stay in bariatric patients.

Methods:
Four hundred (366) charts were retrospectively reviewed; of those, 187 received ketamine and were placed in the Ketamine group, 179 received standard-of-care pain management and were part of the No-Ketamine group. Data was collected using medical databases from July 2020 to January 2021.

Results:
A greater length of stay was recorded in the No-Ketamine group (45.67±20.6 hours) when compared with the Ketamine group (40.6±14.3 hours); P<0.05. The Ketamine group had a mean MME of 17.5±16.5 whereas the No-Ketamine had a mean MME of 22.3±17.7, P<0.05.

Conclusions:
Ketamine may be a feasible alternative to reduce opioid use and hospital length of stay. We believe that ketamine can be an important contribution to ERABS pathways, being responsible for improved outcomes after bariatric/metabolic surgical procedures.
Small Bowel Refractory Bleeding
Authors: AL-Magedi Ahmed A. S. , Xv Yifan , Wang Zhi , Xu Wei , Wu Rong , Zhang Weiyu , Tao Qingsong 
Published: February 2023

Introduction:
Small bowel (SB) bleeding is one of the common gastrointestinal problems, particularly in elders. The study aimed to find the causes of refractory bleeding and overcome the challenges and difficulties of surgical treatment for SB refractory bleeding.

Methods:
All patients with SB refractory bleeding who underwent surgical treatment were included in this study. Patients’ characteristics, surgical finding, and follow-up assessments were reviewed and analyzed through Hospital Information System records from October 1, 2014, to November 30, 2020. All analyses were performed using SPSS v23.0.

Results:
The causes of SB bleeding include vascular lesions (angioectasia, arteriovenous malformations, and dieulafoy lesions) 29.6%, tumors (Polyps, gastrointestinal stromal tumor, Adenocarcinoma, and other) 24.5%, diverticular 18.4%, ulcers/erosion 15.3%, inflammatory bowel disease 7.1%, and other 5.1%. Patients (age below 60 y) were highly developed SB bleeding caused by diverticular 26.4% compared with patients (age 60 y or older) 8.9%, whereas bleeding caused by vascular lesions was significantly higher in patients (age 60 y or older) 37.8%. Other causes, such as tumors and inflammatory bowel disease, showed no significant difference related in age. Exploratory laparotomy was the standard method of bowel extrinsic examination. The intraoperative enteroscopy enterotomy (IOE-E) and IOE-combined were performed in 52 patients (1:1). IOE-E shows lower postoperative morbidity and shorter time of operation P<0.05 compared with the IOE-combined approach.

Conclusions:
Age and exhaustive patient history can assist in finding out the etiology. IOE-E is safe, and coordination between surgeon and endoscopist is necessary for IOE if an identifiable source cannot be found in endoscopy or exploratory laparotomy alone.
Anatomic Variation of Sacral Mesh Attachment During Minimally Invasive Sacrocolpopexy
Authors: Glass Clark Stephanie , Dang Rachel , Bonnet Sarah , Zyczynski Halina M. , Giugale Lauren 
Published: February 2023

Importance
Although anatomic level of mesh attachment to the sacrum varied during minimally invasive sacrocolpopexy with a large proportion above S1, this was not associated with pelvic organ prolapse recurrence.

Objective
This study aimed to describe the anatomic level of sacral mesh attachment and its association with prolapse recurrence after minimally invasive sacrocolpopexy.

Study Design
This study included a retrospective cohort of women who underwent minimally invasive sacrocolpopexy with subsequent abdominal and pelvic imaging (magnetic resonance imaging or computed tomography) between 2010 and 2019 at a single academic institution. Anatomic level of attachment was determined by a radiologist. Prolapse recurrence was defined as a composite of self-reported bulge symptoms, any prolapse measure beyond the hymen, and any retreatment with pessary or surgery. χ2 Tests were used for comparative outcomes.

Results
Analyses included 212 women. The mean ± SD age was 58.8 ± 9.9 years, the majority have preoperative stage III/IV prolapse (81.1%), and the median follow-up was 269 days (interquartile range, 57–825 days). Mesh was attached using titanium tacks (n = 136 [64.2%]) and suture (n = 76 [35.8%]) at the level of the L5-S1 intervertebral space (n = 113 [53.3%]) or overlying S1 (n = 89 [42.0%]).The surgical approach was significantly associated with attachment location with a greater proportion of laparoscopy cases demonstrating mesh attachment above S1 (85 [62.5%] vs robotically, 30 [39.5%]; P < 0.01). Dichotomized level of attachment was not associated with composite prolapse recurrence (above S1, n = 18 [22.2%] vs below S1, n = 24 [24.7%]; P = 0.69) or any compartment recurrence (P ≥ 0.36).

Conclusions
Mesh was primarily attached to the anterior longitudinal ligament at the level of the L5-S1 intervertebral space or S1. Level of mesh attachment was not associated with composite prolapse recurrence.
The Impact of Facial Personal Protective Equipment on Speech Intensity
Authors: Krishnan Tara , Rudy Paul , Viswanathan Navin , Brommelsiek Margaret , Bachar Austin , Sutkin Gary 
Published: February 2023

Importance
Facial personal protective equipment (FPPE) filters small particles in the operating room (OR) but also affects speech production, diminishing the effective transfer of information among OR team members.

Objective
The aim of the study is to assess the attenuating effects of different combinations of layered FPPE on speech intensity, including potential differences in the effect of talkers with varying backgrounds and speaking volumes.

Study Design
We recruited 30 speakers from health and nonhealth occupations with English as either their first or second language. All participants spoke unmasked, at varying voice levels into a portable Zoom H4n device 12 inches from the microphone. These no-mask recordings were played from a Styrofoam head, fitted with 7 combinations of FPPE commonly worn in the COVID-19 era, with the attenuated signals assessed for digital average signal levels. We submitted these attenuation values to an omnibus mixed analysis of variance and performed a spectral analysis on signal attenuation stratified by typical speech frequency bands.

Results
Signal attenuation was strongly determined by FPPE combination, regardless of talker sex, first language, and occupation (P < 0.01, η2
p = 0.881). The effects of vocal output were also significant (P < 0.01, η2
p = 0.881). Soft talkers experienced particularly high attenuation at frequency bands higher than 2,000 Hz. The signal of the softest talkers, when asked to speak loudly, was similar to the loud talkers’ signal.

Conclusions
Layered FPPE in the OR protects the surgical team from small particle exposure but may increase communication failures. Our data can help OR staff choose FPPE and alter their vocal volume accordingly.
Time to early resuscitative intervention association with mortality in trauma patients at risk for hemorrhage
Authors: Deeb Andrew-Paul , Guyette Francis X. , Daley Brian J. , Miller Richard S. , Harbrecht Brian G. , Claridge Jeffrey A. , Phelan Herb A. , Eastridge Brian J. , Joseph Bellal , Nirula Raminder , Vercruysse Gary A. , Sperry Jason L. , Brown Joshua B. 
Published: February 2023

BACKGROUND
Hemorrhage is the leading cause of preventable death after injury. Others have shown that delays in massive transfusion cooler arrival increase mortality, while prehospital blood product resuscitation can reduce mortality. Our objective was to evaluate if time to resuscitation initiation impacts mortality.

METHODS
We combined data from the Prehospital Air Medical Plasma (PAMPer) trial in which patients received prehospital plasma or standard care and the Study of Tranexamic Acid during Air and ground Medical Prehospital transport (STAAMP) trial in which patients received prehospital tranexamic acid or placebo. We evaluated the time to early resuscitative intervention (TERI) as time from emergency medical services arrival to packed red blood cells, plasma, or tranexamic acid initiation in the field or within 90 minutes of trauma center arrival. For patients not receiving an early resuscitative intervention, the TERI was calculated based on trauma center arrival as earliest opportunity to receive a resuscitative intervention and were propensity matched to those that did to account for selection bias. Mixed-effects logistic regression assessed the association of 30-day and 24-hour mortality with TERI adjusting for confounders. We also evaluated a subgroup of only patients receiving an early resuscitative intervention as defined above.

RESULTS
Among the 1,504 propensity-matched patients, every 1-minute delay in TERI was associated with 2% increase in the odds of 30-day mortality (adjusted odds ratio [aOR], 1.020; 95% confidence interval [CI], 1.006–1.033; p < 0.01) and 1.5% increase in odds of 24-hour mortality (aOR, 1.015; 95% CI, 1.001–1.029; p = 0.03). Among the 799 patients receiving an early resuscitative intervention, every 1-minute increase in TERI was associated with a 2% increase in the odds of 30-day mortality (aOR, 1.021; 95% CI, 1.005–1.038; p = 0.01) and 24-hour mortality (aOR, 1.023; 95% CI, 1.005–1.042; p = 0.01).

CONCLUSION
Time to early resuscitative intervention is associated with morality in trauma patients with hemorrhagic shock. Bleeding patients need resuscitation initiated early, whether at the trauma center in systems with short prehospital times or in the field when prehospital time is prolonged.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.