bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nutritional challenges in patients with gastroparesis
Authors: Aguilar Ariadna , Malagelada Carolina , Serra Jordi 
Published: July 2022

Purpose of review
Our purpose was to review the most recent publications on nutritional management in gastroparesis, and their relevance for global management of gastroparesis.

Recent findings
The last months, several reviews on gastroparesis have been published as well as excellent reviews on the nutritional management of patients suffering this condition. In these publications, the relevance of nutrition in management of gastroparesis has been highlighted. However, alarming studies have been published from several authors from Europe and the United States showing that a majority of patients did not follow any dietary advice from a specialist in nutrition, most patients start restrictive diets by their own, and that as much as 60% of patients have a caloric-deficient diet. In addition, recent studies show that some of the recommendations, like a radical exclusion of fibers from the diet, may be reconsidered taking into account the potential beneficial effects of fibers in global health.

Summary
Nutritional interventions are one of the cornerstones in management of gastroparesis. Consequently, an interdisciplinary approach, with managing teams composed by gastroenterologist and specialist in nutrition should be the correct strategy to achieve the best outcomes in symptom control and prevention of complications related to nutritional deficits.

Video abstract

http://links.lww.com/COCN/A17
Zinc Kinetics Correlate With Length-for-Age z Scores in Bangladeshi Infants
Authors: Wastney Meryl E. , Long Julie M. , McDonald Christine M. , Krebs Nancy F. , Islam M. Munirul , Ahmed Tahmeed , Khandaker Afsana Mim , Sthity Rahvia Alam , Westcott Jamie E. , King Janet C. 
Published: July 2022

Objectives:
Stunting [length-for-age z score (LAZ) <−2] has multiple causes and is prevalent in areas with low dietary zinc (Zn) intake. Zinc kinetics from non-stunted infants were used in a published model for predicting linear growth; here, we directly measure zinc kinetics in stunted infants.

Methods:
Zinc kinetics were determined in 9-month-old Bangladeshi infants (n = 10), who were non-wasted [weight-for-length z score (WLZ) >−2], ranging in LAZ from −2.9 to −0.43. Stable isotopes were administered 2 hours after a meal as oral (70Zn) and intravenous (67Zn) tracers. After isotope administration, blood was sampled within 5 hours and all urine and feces were collected for 24 hours. Urine was sampled twice-daily out to 9 days. Data were analyzed by compartmental modeling. Daily zinc intake was estimated by the model as the sum of zinc used for growth plus that lost via urine and feces. Zinc absorbed (the amount required to maintain steady state) was the sum of zinc used for growth plus urine and endogenous fecal excretions.

Results:
The LAZ score correlated with serum zinc concentration (R = 0.77, P = 0.001), urinary zinc excretion (R = 0.66, P = 0.010), and fractional zinc absorption from calculated daily intake (R = 0.58, P = 0.030). In stunted infants (n = 8), the amount of zinc absorbed did not increase with calculated zinc intake unlike published values for non-stunted infants.

Conclusions:
Zinc kinetics in Bangladeshi infants correlate with LAZ and show that malabsorption of supplemental sources of zinc may occur in stunted infants.
SPECT/CT Lymphoscintigraphy Guidance Simplifies and Improves Targeted Axillary Dissection of the Clipped Nodes After Neoadjuvant Chemotherapy in Initially Node-Positive Breast Cancer
Authors: Has Simsek Duygu , Emiroglu Selman , Yilmaz Ravza , Bayram Aysel , Isik Emine Goknur , Tukenmez Mustafa , Kuyumcu Serkan , Dursun Memduh , Muslumanoglu Mahmut , Cabioglu Neslihan 
Published: July 2022

Purpose
We assessed the feasibility of SPECT/CT lymphoscintigraphy (99m Tc-nanocolloid) method to simplify and improve targeted axillary dissection of clipped axillary lymph node (axLN) after neoadjuvant chemotherapy (NAC) in initially node-positive breast cancer.

Patients and Methods
Fifteen patients who had clip placement to biopsy-confirmed axLN metastasis due to clinically node-positive breast cancer before NAC and underwent SPECT/CT lymphoscintigraphy for surgery after NAC were included into the study. SPECT/CT lymphoscintigraphy was performed to localize the clipped node and to assess if the clipped lymph node (LN) had 99mTc-nanocolloid uptake or not. In case the clipped node had no uptake on SPECT/CT, the patient was referred to wire-guided localization procedure. Blue dye was also injected for dual mapping of sentinel LN biopsy.

Results
All patients had only ipsilateral axLN metastasis. SPECT/CT lymphoscintigraphy showed that clipped LNs were radioavid in 12 of 15 patients (80%). Clipped LNs were not blue-stained in 5 patients (33.3%), and in 2 of them, clipped LNs were radioavid in SPECT/CT. Wire-guided localization was required in only 3 patients (20%) for nonradioavid/blue-stained clipped LNs. Removal of the clipped nodes was confirmed in all cases with a success rate of 100% by specimen graphy.

Conclusion
SPECT/CT lymphoscintigraphy seems feasible to determine the clipped LNs intraoperatively without requiring additional invasive methods in most of the patients. This technique simplifies and improves targeted axillary dissection of the clipped axLNs after NAC in initially node-positive breast cancer and can be adapted to clinical practice with further investigations.
Real-world Evaluation of the Efficacy of Neoadjuvant DCF Over CF in Esophageal Squamous Cell Carcinoma
Authors: Matsuda Satoru , Kitagawa Yuko , Takemura Ryo , Okui Jun , Okamura Akihiko , Kawakubo Hirofumi , Muto Manabu , Kakeji Yoshihiro , Takeuchi Hiroya , Watanabe Masayuki , Doki Yuichiro 
Published: July 2022

Objective:
We aimed to evaluate the efficacy of neoadjuvant docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy over cisplatin and 5-fluorouracil (CF) in patients with surgically resectable advanced esophageal squamous cell carcinoma (ESCC), using real-world data from 85 esophageal centers.

Background:
JCOG1109 trial, which assessed the superiority of DCF over CF, and the superiority of chemoradiotherapy with CF over CF alone demonstrated the significant survival advantage of neoadjuvant DCF in overall survival (OS) over CF for ESCC.

Methods:
The ESCC patients who received neoadjuvant CF or DCF at 85 Japanese esophageal centers certified by the Japan Esophageal Society were retrospectively reviewed. After propensity score (PS) matching, the OS and recurrence-free survival were compared between CF and DCF.

Results:
We initially enrolled 4781 patients. After data cleaning and PS matching using pretreatment variables, 1074 patients for each group were selected for subsequent analysis. There was no significant difference in the incidence of postoperative pneumonia and anastomotic leakage. In the survival analysis, OS was significantly longer in DCF group than CF group (hazard ratio, 0.868; 95% confidence interval, 0.770–0.978; P=0.02), as well as recurrence-free survival (hazard ratio, 0.850; 95% confidence interval, 0.761–0.949; P=0.004). The survival advantage of DCF was not observed in patients with 76 years old or older.

Conclusions:
Neoadjuvant DCF therapy showed a remarkable survival advantage in surgically resectable ESCC patients, especially in patients who were 75 years old or younger. The current real-world evidence will encourage recommendations for DCF as a standard regimen in neoadjuvant chemotherapy–based treatment strategy for ESCC.
Baseline Assessments of Psychomotor Aptitude Are Associated With the Future Operative Performance of Surgical Trainees
Authors: Toale Conor , Morris Marie , Ryan Donncha M. , Boland Fiona , Doherty Eva M. , Traynor Oscar J. , Kavanagh Dara O. 
Published: July 2022

Objective:
This study sought to investigate the association between validated psychomotor ability tests and future in-theater and simulated operative performance.

Background:
Assessments of visuospatial ability, perceptual ability, and manual dexterity correlate with simulated operative performance. Data showing the predictive value of such assessments in relation to future performance in the workplace is lacking.

Methods:
Core surgical residents in Ireland recruited from 2016 to 2019 participated in assessments of baseline perceptual, visuospatial, and psychomotor ability; Pictorial Surface Orientation (PicSOr) testing, digital visuospatial ability testing, and manual dexterity testing. Operative performance was prospectively assessed using the in-theater Supervised Structured Assessment of Operative Performance (SSAOP) tool, and simulation-based Operative Surgical Skill (OSS) assessments performed over a 2-year core training period. SSAOP assessments were scored using a 15-point checklist and a global 5-point operative performance score. OSS assessments were scored using procedure-specific checklists. Univariate correlations and multiple linear regression analyses were used to explore the association between fundamental ability measures and operative performance.

Results:
A total of 242 residents completed baseline psychomotor ability assessments. Aggregated fundamental ability scores were associated with performance in submitted workplace-based SSAOP assessments using the Total Checklist score (P=0.002) and Overall Performance scores (P=0.002), independent of operative experience, and undergraduate centile scores. Aggregated ability scores were also positively associated with simulation-based OSS assessment scores on multivariable analysis (P=0.03).

Conclusion:
This study indicates that visuospatial, psychomotor, and perceptual ability testing scores are associated with the future operative performance of surgical residents.
Parental Support Policies and Benefits: A Surgical Training Program Report Card of Transparency
Authors: Rangel Erika L. , Castillo-Angeles Manuel , Marincola Smith Paula , Terhune Kyla P. 
Published: July 2022

Objective:
This study aimed to investigate the transparency of parental benefits available to US surgical residency applicants.

Background:
Medical students prioritize work-family balance in specialty selection. Those applying to surgical residency programs also place a significant value on parental leave policies when deciding where to train. However, little is known about the amount of information that surgical training programs publicly offer to potential applicants regarding family support policies.

Methods:
Publicly available websites for 264 general surgery training programs were accessed to determine the availability of information on parental benefits. Twenty-six “items of transparency” included types of leave, contract flexibility, salary, lactation, and childcare support. Programs with fewer than the median items of transparency were contacted to inquire about additional public resources. Academic programs were stratified by their associated medical school rankings in the US News & World Report.

Results:
A total of 144 (54%) programs were academic and 214 (81.4%) had male program directors. The median number of items of transparency was 8 (29.6%). Of the 131 programs contacted, 33 (25.9%) replied, and 2 (6.1%) improved their transparency score. Academic programs associated with medical schools in the upper third of the rankings were more likely to have ≥8 items of transparency (70.8% vs. 45.6%; P=0.002). In the adjusted analysis, academic programs [odds ratio (OR): 3.44, 95% confidence interval (95% CI): 1.87–6.34], those with female program directors (OR: 2.09, 95% CI: 1.01–4.33), and those located in the Western (OR: 3.13, 95% CI: 1.31–7.45) and Southern (OR: 2.45, 95% CI: 1.21–4.98) regions of the country were more likely to have ≥8 items of transparency.

Conclusions:
There are significant deficits in publicly available information related to parental benefits for many surgical training programs, which may impact applicants’ decision making. Attracting the most talented candidates requires programs to create and share policies that support the integration of professional and personal success.
Conduits in Vascular Pancreatic Surgery
Authors: Kinny-Köster Benedict , Habib Joseph R. , van Oosten Floortje , Javed Ammar A. , Cameron John L. , Burkhart Richard A. , Burns William R. , He Jin , Wolfgang Christopher L. 
Published: July 2022

Objectives:
We analyze successes and failures of pushing the boundaries in vascular pancreatic surgery to establish safety of conduit reconstructions.

Background:
Improved systemic control from chemotherapy in pancreatic cancer is increasing the demand for surgical solutions of extensive local vessel involvement, but conduit-specific data are scarce.

Methods:
We identified 63 implanted conduits (41% autologous vessels, 37% allografts, 18% PTFE) in 56 pancreatic resections of highly selected cancer patients between October 2013 and July 2020 from our prospectively maintained database. Assessed parameters were survival, perioperative complications, operative techniques (anatomic and extra-anatomic routes), and conduit patency.

Results:
For vascular reconstruction, 25 arterial and 38 venous conduits were utilized during 39 pancreatoduodenectomies, 14 distal pancreatectomies, and 3 total pancreatectomies. The median postoperative survival was 2 years. A Clavien-Dindo grade ≥IIIa complication was apparent in 50% of the patients with a median Comprehensive Complication Index of 29.6. The 90-day mortality in this highly selected cohort was 9%. Causes of mortality were conduit related in 3 patients, late postpancreatectomy hemorrhage in 1 patient, and early liver metastasis in 1 patient. Image-based patency rates of conduits were 66% and 45% at postoperative days 30 and 90, respectively.

Conclusions:
Our perioperative mortality of vascular pancreatic surgery with conduits in the arterial or venous system is 9%. Reconstructions are technically feasible with different anatomic and extra-anatomic strategies, while identifying predictors of early conduit occlusion remains challenging. Optimizing reconstructed arterial and venous hemodynamics in the context of pancreatic malignancy will enable long-term survival in more patients responsive to chemotherapies.
European Multicentric Experience With Fenestrated-branched ENDOvascular Stent Grafting After Previous FAILed Infrarenal Aortic Repair
Authors: Budtz-Lilly Jacob , D’Oria Mario , Gallitto Enrico , Bertoglio Luca , Kölbel Tilo , Lindström David , Dias Nuno , Lundberg Goran , Böckler Dittmar , Parlani Gianbattista , Antonello Michele , Veraldi Gian F. , Tsilimparis Nikolaos , Kotelis Drosos , Dueppers Philip , Tinelli Giovanni , Ippoliti Arnaldo , Spath Paolo , Logiacco Antonino , Schurink Geert Willem H. , Chiesa Roberto , Grandi Alessandro , Panuccio Giuseppe , Rohlffs Fiona , Wanhainen Anders , Mani Kevin , Karelis Angelos , Sonesson Björn , Jonsson Magnus , Bresler Alina-Marilena , Simonte Gioele , Isernia Giacomo , Xodo Andrea , Mezzetto Luca , Mastrorilli Davide , Prendes Carlota F. , Chaikhouni Basel , Zimmermann Alexander , Lepidi Sandro , Gargiulo Mauro , Mees Barend , Unosson Jon 
Published: July 2022

Objective:
To report the mid-term outcomes of fenestrated-branched endovascular aneurysm repair (F-BEVAR) following a failed previous endovascular aneurysm repair (pEVAR) or previous open aneurysm repair (pOAR).

Methods:
Data from consecutive patients who underwent F-BEVAR for pEVAR or pOAR from 2006 to 2021 from 17 European vascular centers were analyzed. Endpoints included technical success, major adverse events, 30-day mortality, and 5-year estimates of survival, target vessel primary patency, freedom from reinterventions, type I/III endoleaks, and sac growth >5 mm.

Background:
Treatment of a failed previous abdominal aortic aneurysm repair is a complex undertaking. F-BEVAR is becoming an increasingly attractive option, although comparative data are limited regarding associated risk factors, indications for treatment, and various outcomes.

Results:
There were 526 patients included, 268 pOAR and 258 pEVAR. The median time from previous repair to F-BEVAR was 7 (interquartile range, 4–12) years, 5 (3–8) for pEVAR, and 10 (6–14) for pOAR, P<0.001. Predominant indication for treatment was type Ia endoleak for pEVAR and progression of the disease for pOAR. Technical success was 92.8%, pOAR (92.2%), and pEVAR (93.4%), P=0.58. The 30-day mortality was 6.5% overall, 6.7% for pOAR, and 6.2% for pEVAR, P=0.81. There were 1853 treated target vessels with 5-year estimates of primary patency of 94.4%, pEVAR (95.2%), and pOAR (94.4%), P=0.03. Five-year estimates for freedom from type I/III endoleaks were similar between groups; freedom from reintervention was lower for pEVAR (38.3%) than for pOAR (56.0%), P=0.004. The most common indication for reinterventions was for type I/III endoleaks (37.5%).

Conclusions:
Repair of a failed pEVAR or pOARis safe and feasible with comparable technical success and survival rates. While successful treatment can be achieved, significant rates of reintervention should be anticipated, particularly for issues related to instability of target vessels/bridging stents.
The Nissen-Hill Hybrid Repair
Authors: Aye Ralph W. , Baison George N. , Ahmed Hassan , Watkins Jeffery , DeMeester Steven R. , Bograd Adam J. , Farivar Alexander S. , Louie Brian E. 
Published: July 2022

Introduction:
A new repair for gastroesophageal reflux and hiatal hernia, the Nissen-Hill hybrid repair, was developed to combine the relative strengths of its component repairs with the aim of improved durability. In several small series, it has been shown to be safe, effective, and durable for paraesophageal hernia, Barrett esophagus, and gastroesophageal reflux disease. This study represents our experience with the first 500 consecutive repairs for all indications.

Methods:
Retrospective study of prospectively collected data for the first 500 consecutive Nissen-Hill hybrid repairs from March 2006 to December 2016, including all indications for surgery. Three quality of life metrics, manometry, radiographic imaging, and pH testing were administered before and at defined intervals after repair.

Results:
Five hundred patients were included, with a median follow-up of 6.1 years. Indications for surgery were gastroesophageal reflux disease in 231 (46.2%), paraesophageal hernia in 202 (40.4%), and reoperative repair in 67 (13.4%). The mean age was 59, with body mass index of 30 and 63% female. A minimally invasive approach was used in 492 (98%). Thirty-day operative mortality was 1 (0.2%), with a 4% major complication rate and a median length of stay of 2 days. Preoperative to postoperative pH testing was available for 390 patients at a median follow-up of 7.3 months, with the median DeMeester score improving from 45.9 to 2.7. At long-term follow-up (229 responses), all median quality of life scores improved: Quality Of Life in Reflux And Dyspepsia 4 to 6.9, Gastroesophageal Reflux Disease-Health Related Quality of Life 22 to 3, and Swallowing 37.5 to 45 and proton pump inhibitor use dropped from 460 (92%) to 50 (10%). Fourteen (2.8%) underwent reoperation for failure.

Conclusion:
The combined Nissen-Hill hybrid repair is safe and effective in achieving excellent symptomatic and objective outcomes and low recurrence rates beyond 5 years.
Comparative Experience of Short-wavelength Versus Long-wavelength Fluorophores for Intraoperative Molecular Imaging of Lung Cancer
Authors: Kennedy Gregory T. , Azari Feredun S. , Chang Ashley , Nadeem Bilal , Bernstein Elizabeth , Segil Alix , Din Azra , Marfatia Isvita , Desphande Charuhas , Okusanya Olugbenga , Keating Jane , Predina Jarrod , Newton Andrew , Kucharczuk John C. , Singhal Sunil 
Published: July 2022

Background:
Intraoperative molecular imaging (IMI) using tumor-targeted optical contrast agents can improve cancer resections. The optimal wavelength of the IMI tracer fluorophore has never been studied in humans and has major implications for the field. To address this question, we investigated 2 spectroscopically distinct fluorophores conjugated to the same targeting ligand.

Methods:
Between December 2011 and November 2021, patients with primary lung cancer were preoperatively infused with 1 of 2 folate receptor-targeted contrast tracers: a short-wavelength folate-fluorescein (EC17; λem=520 nm) or a long-wavelength folate-S0456 (pafolacianine; λem=793 nm). During resection, IMI was utilized to identify pulmonary nodules and confirm margins. Demographic data, lesion diagnoses, and fluorescence data were collected prospectively.

Results:
Two hundred eighty-two patients underwent resection of primary lung cancers with either folate-fluorescein (n=71, 25.2%) or pafolacianine (n=211, 74.8%). Most tumors (n=208, 73.8%) were invasive adenocarcinomas. We identified 2 clinical applications of IMI: localization of nonpalpable lesions (n=39 lesions, 13.8%) and detection of positive margins (n=11, 3.9%). In each application, the long-wavelength tracer was superior to the short-wavelength tracer regarding depth of penetration, signal-to-background ratio, and frequency of event. Pafolacianine was more effective for detecting subpleural lesions (mean signal-to-background ratio=2.71 vs 1.73 for folate-fluorescein, P<0.0001). Limit of signal detection was 1.8 cm from the pleural surface for pafolacianine and 0.3 cm for folate-fluorescein.

Conclusions:
Long-wavelength near-infrared fluorophores are superior to short-wavelength IMI fluorophores in human tissues. Therefore, future efforts in all human cancers should likely focus on long-wavelength agents.
Performance of quick sequential organ failure assessment and modified age disease adjusted qadSOFA for the prediction of outcomes in emergency general surgery patients
Authors: Magyar Christian T. J. , Haltmeier Tobias , Dubuis Jean-Baptiste , Osterwalder Alice , Winterhalder Sebastian , Candinas Daniel , Schnüriger Beat 
Published: July 2022

BACKGROUND
Sepsis is a highly prevalent condition and is associated with a reported in-hospital mortality rate up to 40% in patients with abdominal sepsis requiring emergency general surgery (EGS). The quick sequential organ failure assessment score (qSOFA) has not been studied for EGS patients.

METHODS
Retrospective cohort study in adult patients undergoing abdominal EGS at a university tertiary care center from 2016 to 2018. The primary outcome was mortality. The effect of clinical variables on outcomes was assessed in univariable and multivariable logistic regression analyses. Based on these results, the qSOFA score was modified. The performance of scores was assessed using receiver operating characteristics.

RESULTS
Five hundred seventy-eight patients undergoing abdominal EGS were included. In-hospital mortality was 4.8% (28/578). Independent predictors for mortality were mesenteric ischemia (odds ratio [OR] 15.9; 95% confidence interval [CI] 5.2–48.6; p < 0.001), gastrointestinal tract perforation (OR 4.9; 95% CI 1.7–14.0; p = 0.003), 65 years or older (OR 4.1; 95% CI 1.5–11.4; p = 0.008), and increasing qSOFA (OR 1.8; 95% CI 1.2–2.8; p = 0.007). The modified qSOFA (qadSOFA) was developed. The area under the receiver operating characteristic curve of the qSOFA and qadSOFA for mortality was 0.715 and 0.859, respectively. Optimal cutoff value was identified as qadSOFA ≥ 3 (Youden Index 64.1%).

CONCLUSION
This is the first study investigating the qSOFA as a predictor for clinical outcomes in EGS. Compared with the qSOFA, the new qadSOFA revealed an excellent predictive power for clinical outcomes. Further validation of qadSOFA is warranted.

LEVEL OF EVIDENCE
Diagnostic test/criteria; Level II.