bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defining Global Benchmarks for Laparoscopic Liver Resections
Authors: Goh Brian K.P. , Han Ho-Seong , Chen Kuo-Hsin , Chua Darren W. , Chan Chung-Yip , Cipriani Federica , Aghayan Davit L. , Fretland Asmund A. , Sijberden Jasper , D’Silva Mizelle , Siow Tiing Foong , Kato Yutaro , Lim Chetana , Nghia Phan Phuoc , Herman Paulo , Marino Marco V. , Mazzaferro Vincenzo , Chiow Adrian K.H. , Sucandy Iswanto , Ivanecz Arpad , Choi Sung Hoon , Lee Jae Hoon , Gastaca Mikel , Vivarelli Marco , Giuliante Felice , Ruzzenente Andrea , Yong Chee-Chien , Yin Mengqui , Chen Zewei , Fondevila Constantino , Efanov Mikhail , Rotellar Fernando , Choi Gi-Hong , Campos Ricardo R. , Wang Xiaoying , Sutcliffe Robert P. , Pratschke Johann , Lai Eric , Chong Charing C. , D’Hondt Mathieu , Monden Kazuteru , Lopez-Ben Santiago , Coelho Fabricio F. , Kingham Thomas Peter , Liu Rong , Long Tran Cong duy , Ferrero Alessandro , Sandri Giovanni B. Levi , Saleh Mansour , Cherqui Daniel , Scatton Olivier , Soubrane Olivier , Wakabayashi Go , Troisi Roberto I. , Cheung Tan-To , Sugioka Atsushi , Hilal Mohammad Abu , Fuks David , Edwin Bjørn , Aldrighetti Luca ,   International Robotic and Laparoscopic Liver Resection Study Group Investigators
Published: July 2022

Objective:
To establish global benchmark outcomes indicators after laparoscopic liver resections (L-LR).

Background:
There is limited published data to date on the best achievable outcomes after L-LR.

Methods:
This is a post hoc analysis of a multicenter database of 11,983 patients undergoing L-LR in 45 international centers in 4 continents between 2015 and 2020. Three specific procedures: left lateral sectionectomy (LLS), left hepatectomy (LH), and right hepatectomy (RH) were selected to represent the 3 difficulty levels of L-LR. Fifteen outcome indicators were selected to establish benchmark cutoffs.

Results:
There were 3519 L-LR (LLS, LH, RH) of which 1258 L-LR (40.6%) cases performed in 34 benchmark expert centers qualified as low-risk benchmark cases. These included 659 LLS (52.4%), 306 LH (24.3%), and 293 RH (23.3%). The benchmark outcomes established for operation time, open conversion rate, blood loss ≥500 mL, blood transfusion rate, postoperative morbidity, major morbidity, and 90-day mortality after LLS, LH, and RH were 209.5, 302, and 426 minutes; 2.1%, 13.4%, and 13.0%; 3.2%, 20%, and 47.1%; 0%, 7.1%, and 10.5%; 11.1%, 20%, and 50%; 0%, 7.1%, and 20%; and 0%, 0%, and 0%, respectively.

Conclusions:
This study established the first global benchmark outcomes for L-LR in a large-scale international patient cohort. It provides an up-to-date reference regarding the “best achievable” results for L-LR for which centers adopting L-LR can use as a comparison to enable an objective assessment of performance gaps and learning curves.
Socioeconomic Mediation of Racial Segregation in Pancreatic Cancer Treatment and Outcome Disparities
Authors: Poulson Michael R. , Papageorge Marianna V. , LaRaja Alexander S. , Kenzik Kelly M. , Sachs Teviah E. 
Published: July 2022

Objective:
To understand the mediating effect of socioeconomic factors on the association between residential segregation and racial disparities in pancreatic cancer (PC).

Background:
Black patients with PC present at a later stage and have worse mortality than White patients. These disparities have been explained by the level of residential segregation.

Methods:
Data were obtained from Surveillance, Epidemiology, and End-Results (SEER) and included all Black and White patients who were diagnosed with PC between 2005 and 2015. The primary exposure variable was the Index of Dissimilarity, a validated measure of segregation. County-level socioeconomic variables from the US Census were assessed as mediators. The primary outcomes were advanced stage at diagnosis, surgical resection for localized disease, and overall mortality. Generalized structural equation modeling was used to assess the mediation of each of the socioeconomic variables.

Results:
Black patients in the highest levels of segregation saw a 12% increased risk [relative risk=1.12; 95% confidence interval (CI): 1.08, 1.15] of presenting at an advanced stage, 11% decreased likelihood of undergoing surgery (relative risk=0.89; 95% CI: 0.83, 0.94), and 8% increased hazards of death (hazard ratio=1.08; 95% CI: 1.03, 1.14) compared with White patients in the lowest levels. The Black share of the population, insurance status, and income inequality mediated 58% of the total effect on the advanced stage. Poverty and Black income immobility mediated 51% of the total effect on surgical resection. Poverty and Black income immobility mediated 50% of the total effect on overall survival.

Conclusions:
These socioeconomic factors serve as intervention points for legislators to address the social determinants inherent to the structural racism that mediate poor outcomes for Black patients.
Timing of a Major Operative Intervention After a Positive COVID-19 Test Affects Postoperative Mortality
Authors: Kougias Panos , Sharath Sherene E. , Zamani Nader , Brunicardi F. Charles , Berger David H. , Wilson Mark A. 
Published: July 2022

Background:
Studies indicate that coronavirus disease 2019 (COVID-19) infection before or soon after operations increases mortality, but they do not comment on the appropriate timing for interventions after diagnosis.

Objective:
We sought to determine what the safest time would be for COVID-19 diagnosed patients to undergo major operative interventions.

Methods:
High-risk operations, between January 2020 and May 2021, were identified from the Veterans Affairs COVID-19 Shared Data Resource. Current Procedural Terminology (CPT) codes were used to exact match COVID-19 positive cases (n=938) to negative controls (n=7235). Time effects were calculated as a continuous variable and then grouped into 2-week intervals. The primary outcome was 90-day, all-cause postoperative mortality.

Results:
Ninety-day mortality in cases and controls was similar when the operation was performed within 9 weeks or longer after a positive test; but significantly higher in cases versus controls when the operation was performed within 7 to 8 weeks (12.3% vs 4.9%), 5 to 6 weeks (10.3% vs 3.3%), 3 to 4 weeks (19.6% vs 6.7%), and 1 to 2 weeks (24.7% vs 7.4%) from diagnosis. Among patients who underwent surgery within 8 weeks from diagnosis, 90-day mortality was 16.6% for cases versus 5.8% for the controls (P<0.001). In this cohort, we assessed interaction between case status and any symptom (P=0.93), and case status and either respiratory symptoms or fever (P=0.29), neither of which were significant statistically.

Conclusions:
Patients undergoing major operations within 8 weeks after a positive test have substantially higher postoperative 90-day mortality than CPT-matched controls without a COVID-19 diagnosis, regardless of presenting symptoms.
A DNA Methylation-based Epigenetic Signature for the Identification of Lymph Node Metastasis in T1 Colorectal Cancer
Authors: Zhao Yinghui , Peng Fuduan , Wang Chuanxin , Murano Tatsuro , Baba Hideo , Ikematsu Hiroaki , Li Wei , Goel Ajay 
Published: July 2022

Objective:
This study aimed to unravel the lymph node metastasis (LNM)-related methylated DNA (mDNA) landscape and develop a mDNA signature to identify LNM in patients with T1 colorectal cancers (T1 CRC).

Background:
Considering the invasiveness of T1 CRC, current guidelines recommend endoscopic resection in patients with LNM-negative, and radical surgical resection only for high-risk LNM-positive patients. Unfortunately, the clinicopathological criteria for LNM risk stratification are imperfect, resulting in frequent misdiagnosis leading to unnecessary radical surgeries and postsurgical complications.

Methods:
We conducted genome-wide methylation profiling of 39 T1 CRC specimens to identify differentially methylated CpGs between LNM-positive and LNM-negative, and performed quantitative pyrosequencing analysis in 235 specimens from 3 independent patient cohorts, including 195 resected tissues (training cohort: n=128, validation cohort: n=67) and 40 pretreatment biopsies.

Results:
Using logistic regression analysis, we developed a 9-CpG signature to distinguish LNM-positive versus LNM-negative surgical specimens in the training cohort [area under the curve (AUC)=0.831, 95% confidence interval (CI)=0.755–0.892; P<0.0001], which was subsequently validated in additional surgical specimens (AUC=0.825; 95% CI=0.696–0.955; P=0.003) and pretreatment biopsies (AUC=0.836; 95% CI=0.640–1.000, P=0.0036). This diagnostic power was further improved by combining the signature with conventional clinicopathological features.

Conclusions:
We established a novel epigenetic signature that can robustly identify LNM in surgical specimens and even pretreatment biopsies from patients with T1 CRC. Our signature has strong translational potential to improve the selection of high-risk patients who require radical surgery while sparing others from its complications and expense.
Inhibition of the JAK/STAT Pathway With Baricitinib Reduces the Multiple Organ Dysfunction Caused by Hemorrhagic Shock in Rats
Authors: Patel Nikita M. , Collotta Debora , Aimaretti Eleonora , Ferreira Alves Gustavo , Kröller Sarah , Coldewey Sina M. , Collino Massimo , Thiemermann Christoph 
Published: July 2022

Objective:
The aim of this study was to investigate (a) the effects of the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway inhibitor (baricitinib) on the multiple organ dysfunction syndrome (MODS) in a rat model of hemorrhagic shock (HS) and (b) whether treatment with baricitinib attenuates the activation of JAK/STAT, NF-κB, and NLRP3 caused by HS.

Background:
Posttraumatic MODS, which is in part due to excessive systemic inflammation, is associated with high morbidity and mortality. The JAK/STAT pathway is a regulator of numerous growth factor and cytokine receptors and, hence, is considered a potential master regulator of many inflammatory signaling processes. However, its role in trauma-hemorrhage is unknown.

Methods:
An acute HS rat model was performed to determine the effect of baricitinib on MODS. The activation of JAK/STAT, NF-κB, and NLRP3 pathways were analyzed by western blotting in the kidney and liver.

Results:
We demonstrate here for the first time that treatment with baricitinib (during resuscitation following severe hemorrhage) attenuates the organ injury and dysfunction and the activation of JAK/STAT, NF-κB, and NLRP3 pathways caused by HS in the rat.

Conclusions:
Our results point to a role of the JAK/STAT pathway in the pathophysiology of the organ injury and dysfunction caused by trauma/hemorrhage and indicate that JAK inhibitors, such as baricitinib, may be repurposed for the treatment of the MODS after trauma and/or hemorrhage.
Preoperative Computed Tomography Morphological Features Indicative of Incisional Hernia Formation After Abdominal Surgery
Authors: McAuliffe Phoebe B. , Desai Abhishek A. , Talwar Ankoor A. , Broach Robyn B. , Hsu Jesse Y. , Serletti Joseph M. , Liu Tiange , Tong Yubing , Udupa Jayaram K. , Torigian Drew A. , Fischer John P. 
Published: July 2022

Objective:
To investigate key morphometric features identifiable on routine preoperative computed tomography (CT) imaging indicative of incisional hernia (IH) formation following abdominal surgery.

Background:
IH is a pervasive surgical disease that impacts all surgical disciplines operating in the abdominopelvic region and affecting 13% of patients undergoing abdominal surgery. Despite the significant costs and disability associated with IH, there is an incomplete understanding of the pathophysiology of hernia.

Methods:
A cohort of patients (n=21,501) that underwent colorectal surgery was identified, and clinical data and demographics were extracted, with a primary outcome of IH. Two datasets of case-control matched pairs were created for feature measurement, classification, and testing. Morphometric linear and volumetric measurements were extracted as features from anonymized preoperative abdominopelvic CT scans. Multivariate Pearson testing was performed to assess correlations among features. Each feature’s ability to discriminate between classes was evaluated using 2-sided paired t testing. A support vector machine was implemented to determine the predictive accuracy of the features individually and in combination.

Results:
Two hundred and twelve patients were analyzed (106 matched pairs). Of 117 features measured, 21 features were capable of discriminating between IH and non-IH patients. These features are categorized into three key pathophysiologic domains: 1) structural widening of the rectus complex, 2) increased visceral volume, 3) atrophy of abdominopelvic skeletal muscle. Individual prediction accuracy ranged from 0.69 to 0.78 for the top 3 features among 117.

Conclusions:
Three morphometric domains identifiable on routine preoperative CT imaging were associated with hernia: widening of the rectus complex, increased visceral volume, and body wall skeletal muscle atrophy. This work highlights an innovative pathophysiologic mechanism for IH formation hallmarked by increased intra-abdominal pressure and compromise of the rectus complex and abdominopelvic skeletal musculature.
Efficacy and Safety of Radiofrequency Ablation of Thyroid Nodules
Authors: Kandil Emad , Omar Mahmoud , Aboueisha Mohamed , Attia Abdallah S. , Ali Khalid M. , Abu Alhuda Ruba F. , Issa Peter P. , Wolfe Samantha , Omari Sara , Buti Yusef , Abozaid Omar , Toraih Eman , Shama Mohamed A. , Lee Grace , Tufano Ralph P. , Russell Jonathon O. 
Published: July 2022

Background:
Radiofrequency ablation (RFA) has been recently adopted into the practice of thyroidology in the United States, although its use as an alternative to traditional thyroid surgery in Asia and Europe came near the turn of the 21st century. In the United States, only a few studies with small sample sizes have been published to date. We examined outcomes of benign thyroid nodules treated with RFA from 2 North American institutions.

Methods:
We performed a prospective, multi-institutional cohort study of thyroid nodules treated with RFA between July 2019 and January 2022. Demographics, sonographic characteristics of thyroid nodules, thyroid function profiles, procedural details, complications, and nodule volume measurements at 1, 3, 6, and 12 months follow-up were evaluated. Adjusted multivariate logistic regression analysis was performed to identify sonographic features associated with treatment failure.

Results:
A total of 233 nodules were included. The median and interquartile range of volume reduction rate (VRR) at 1, 3, 6, and 12 months were 54% [interquartile range (IQR): 36%–73%], 58% (IQR: 37%–80%), 73% (IQR: 51%–90%), and 76% (IQR: 52%–90%), respectively (P<0.001). Four patients presented with toxic adenomas. All patients were confirmed euthyroid at 3-month postprocedure follow-up. Two patients developed temporary hoarseness of voice, but no hematoma or nodular rupture occurred postprocedure. Elastography was significantly associated with VRR. Compared with soft nodules, stiff nodules were more likely to have a lower VRR (odds ratio: 11.64, 95% confidence interval: 3.81–35.53, P<0.05), and mixed elasticity was also more likely to have a lower VRR (odds ratio: 4.9; 95% confidence interval: 1.62–14.85, P<0.05).

Conclusions:
This is the largest multi-institutional North American study examining thyroid nodule treatment response to RFA. RFA is a safe and effective treatment option that allows preservation of thyroid function with minimal risk of procedural complications.
Contemporary Management of Median Arcuate Ligament in Liver Transplantation
Authors: Babu Benoy I. , Oniscu Gabriel C. 
Published: July 2022

Background.
Median arcuate ligament (MAL) can impair arterial inflow during orthotopic liver transplantation (OLT). Furthermore, approaches to ensure optimal vascular inflow in the presence of MAL is not standardized.

Methods.
We undertook a systematic review according to the Cochrane systematic review protocol and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We analyzed the incidence of MAL, investigations, treatment options, and potential complications associated with MAL intervention in patients undergoing OLT. After the exclusion criteria were implemented, the dataset from the final 21 manuscripts yielded 117 patients who underwent a liver transplant in the presence of MAL.

Results.
The incidence of MAL in patients undergoing OLT is between 1.6% and 12%. In 63.2% of cases, an open approach for MAL intervention was undertaken. Hepatic artery thrombosis developed in 17% (7) patients without MAL intervention versus 2.6% (2) after MAL intervention. Seven grafts (5.9%) were lost after OLT in patients with MAL. Three (3.9%) patients developed arterial stenosis post-MAL intervention.

Conclusions.
We propose an algorithm for intraoperative assessment and management of liver transplant arterial inflow in the presence of MAL based on the hepatic artery flow changes with respiration, following clamping of the recipient gastroduodenal artery. In the presence of a 30%–50% flow variation on respiration, the arterial inflow should be established preserving additional inflow from the recipient gastroduodenal artery. Consider an open MAL release if the flow remains insufficient. A poor arterial flow with no variation with respiration and lack of evidence of aortoiliac atherosclerosis indicates the need for arterial jump graft.
National Trends and Outcomes in Adolescents Undergoing Bariatric Surgery
Authors: Vuong Linh , Chang Su-Hsin , Wan Fei , Wu Ningying , Eagon J Chris , Eckhouse Shaina R , Dimou Francesca M 
Published: July 2022

BACKGROUND:
In the US, obesity continues to be a severe health issue now affecting adolescents. Bariatric surgery remains the most effective treatment for obesity, but use among adolescents remains low. The objective of this study was to identify current national trends in bariatric surgery among adolescents.

STUDY DESIGN:
Using the Nationwide Inpatient Sample database, adolescents aged 9 to 19 with a diagnosis of morbid obesity who underwent a laparoscopic gastric bypass (Roux-en-Y gastric bypass) or laparoscopic sleeve gastrectomy (SG) between 2015 and 2018 were identified. Demographics, comorbidities, and in-hospital complications were collected. National estimates were calculated. The trend of annual number of operations was determined by Kruskal–Wallis rank test.

RESULTS:
Between 2015 and 2018, 1,203 adolescents were identified, resulting in a nationwide estimate of 4,807 bariatric cases. The number of bariatric operations increased annually from 1,360 in 2015 to 1,740 operations in 2018 (p = 0.0771). The majority of patients were female (76%), 17 to 19 years old (84.1%), and White (47.9%). Most patients underwent SG (82.0%). Black and Hispanic patients comprised 40.2% of the cohort. Significant comorbidities included diabetes, dyslipidemia, nonalcoholic fatty liver disease, hypertension, and sleep apnea. The average length of stay decreased from 2.12 days to 1.64 days. There were no in-hospital mortalities, and complications were less than 1%.

CONCLUSIONS:
With the increasing prevalence of obesity among adolescents in the US, bariatric surgery increased over time but was performed less in patients younger than 16 years of age and racial minorities. Bariatric surgery among adolescents remains safe, with extremely low complication rates and zero in-hospital mortality.
One-Year Follow-Up of COVID-19 Impact on Surgical Education: Clinical Training Restored but Surgical Trainee Emotional Well-Being Still at Risk
Authors: Ellison E Christopher , Spanknebel Kathryn , Farmer Diana L , Matthews Jeffrey B , Stain Steven C , Shabahang Mohsen M , Gabler Blair Patrice , Nagler Alisa , Sloane Richard , Britt LD , Sachdeva Ajit K 
Published: July 2022

BACKGROUND:
A previous survey documented the severe disruption of the coronavirus disease 2019 pandemic on surgical education and trainee well-being during the initial surge and systemic lockdowns. Herein, we report the results of a follow-up survey inclusive of the 2020 to 2021 academic year.

STUDY DESIGN:
A survey was distributed to education leaders across all surgical specialties in summer 2021. We compared the proportion of participants reporting severe disruption in key areas with those of the spring 2020 survey. Aggregated differences by year were assessed using chi-square analysis.

RESULTS:
In 2021, severe disruption of education programs was reported by 14% compared with 32% in 2020 (p < 0.0001). Severe reductions in nonemergency surgery were reported by 38% compared with 87% of respondents in 2020. Severe disruption of expected progression of surgical trainee autonomy by rank also significantly decreased to 5% to 8% in 2021 from 15% to 23% in 2020 among respondent programs (p < 0.001). In 2021 clinical remediation was reported for postgraduate year 1 to 2 and postgraduate year 3 to 4, typically through revised rotations (19% and 26%) and additional use of simulation (20% and 19%) maintaining trainee promotion and job placement. In 2021, surgical trainees’ physical safety and health were reported as less severely impacted compared with 2020; however, negative effects of isolation (77%), burnout (75%), and the severe impact on emotional well-being (17%) were prevalent.

CONCLUSIONS:
One year after the initial coronavirus disease 2019 outbreak, clinical training and surgical trainee health were less negatively impacted. Disruption of emotional well-being remained high. Future needs include better objective measures of clinical competence beyond case numbers and the implementation of novel programs to promote surgical trainee health and well-being.
Homocysteine thiolactone contributes to a prognostic value of fibrin clot structure/function in coronary artery disease patients
Authors: Sikora Marta , Skrzydlewski Paweł , Perła-Kaján Joanna , Jakubowski Hieronim 
Published: July 2022

AbstractBackgroundFibrin clot structure/function contributes to cardiovascular disease. We examined sulfur-containing metabolites as determinants of fibrin clot lysis time (CLT) and maximum absorbance (Absmax) in relation to outcomes in coronary artery disease (CAD) patients. Effects of B-vitamin/folate therapy on CLT and Absmax were studied.Methods and FindingsPlasma samples were collected from 1,952 CAD patients randomized in a 2 × 2 factorial design to (i) folic acid, vitamins B12, B6; (ii) folic acid, vitamin B12; (iii) vitamin B6; (iv) placebo for 3.8 years in the Western Norway B-Vitamin Intervention Trial. Clot lysis time (CLT) and maximum absorbance (Absmax) were determined using a validated turbidimetric assay. Acute myocardial infarction (AMI) and mortality were assessed during a 7-year follow-up. Data were analyzed using bivariate and multiple regression. Survival free of events was studied using Kaplan Mayer plots. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards models. Baseline urinary (u)Hcy-thiolactone and plasma Cys were significantly associated with CLT while plasma Hcy was significantly associated with Absmax, independently of fibrinogen, triglycerides, vitamin E, glomerular filtration rate, body mass index, age, sex plasma creatinine, CRP, HDL-C, ApoA1. B-vitamins/folate did not affect CLT and Absmax. Kaplan-Meier analysis showed associations of increased baseline CLT and Absmax with worse outcomes. In Cox regression analysis, baseline CLT and Absmax (>cutoff) predicted AMI (CLT: HR 1.58, 95% CI 1.10-2.28; P = 0.013. Absmax: HR 3.22, CI 1.19-8.69; P = 0.021) and mortality (CLT: HR 2.54, 95% CI 1.40-4.63; P = 0.002. Absmax: 2.39, 95% CI 1.17-4.92; P = 0.017). After adjustments for other prognostic biomarkers these associations remained significant.ConclusionsuHcy-thiolactone and plasma Cys are novel determinants of CLT, an important predictor of adverse CAD outcomes. CLT and Absmax were not affected by B-vitamin/folate therapy, which could account for the lack of efficacy of such therapy in CAD.Trial RegistrationURL: http://clinicaltrials.gov. Identifier: NCT00354081