BACKGROUND & AIMS: PURPOSE:Medication and nutrient administration considerations after bariatric surgery are discussed. SUMMARY:Bariatric surgery is categorized by surgical technique (i.e., restrictive procedure or a combination of restrictive and malabsorptive procedures). Roux-en-Y gastric bypass is the most frequently performed bariatric surgery in the United States. Patients who have undergone this surgery are at risk for nutrient deficiencies. Several factors, such as pH and absorption sites, should be considered when providing these patients with appropriate supplementation. Drug solubility and surface area for absorption are also affected by gastric bypass procedures. By bypassing major portions of the small intestine, Roux-en-Y procedures drastically reduce the surface area for absorption. These changes may warrant manipulation in drug route or dose to ensure adequate delivery. Drugs with long absorptive phases that remain in the intestine for extended periods are likely to exhibit decreased bioavailability in these patients. The reduced size of the stomach after surgery can place patients at risk for adverse events associated with some medications. Medications implicated in such adverse events include nonsteroidal antiinflammatory drugs, salicylates, and oral bisphosphonates. Drugs that are rapidly and primarily absorbed in the stomach or duodenum are likely to exhibit decreased absorption in patients who have had combination restrictive-malabsorptive procedures. Because reduced drug absorption may result in decreased efficacy rather than toxicity, increased patient monitoring for therapeutic effects can help detect potential absorption problems. CONCLUSION:Selection of appropriate nutrient salts can improve nutrient replacement in patients who have undergone bariatric surgery. Changes in dosage forms based on drug characteristics can improve bioavailability.

背景与目标： 目的：讨论减肥手术后的药物和营养管理注意事项。
摘要：B术手术按手术技术进行分类（即限制性手术或限制性与不良吸收手术的组合）。 Roux-en-Y胃旁路手术是美国最常进行的减肥手术。接受过此手术的患者有营养缺乏的风险。向这些患者提供适当的补充剂时，应考虑几个因素，例如pH值和吸收部位。胃旁路手术也会影响药物的溶解度和吸收表面积。通过绕开小肠的主要部分，Roux-en-Y程序可大大减少吸收的表面积。这些变化可能需要对药物途径或剂量进行控制，以确保充分递送。这些吸收期较长且长期保留在肠道中的药物可能会在这些患者中显示出较低的生物利用度。手术后胃的缩小可能使患者处于与某些药物相关的不良事件的风险中。与此类不良事件有关的药物包括非甾体类抗炎药，水杨酸酯和口服双膦酸酯。在具有限制性限制性吸收不良组合治疗的患者中，快速且主要在胃或十二指肠中吸收的药物很可能表现出吸收减少。由于减少的药物吸收可能会导致功效下降而不是毒性下降，因此增加对患者的治疗效果监测可以帮助发现潜在的吸收问题。
结论：选择合适的营养盐可以改善减肥手术患者的营养补充。根据药物特性改变剂型可以提高生物利用度。

BACKGROUND & AIMS: :The practice of duplicate publication has been condemned widely in the scientific community and several studies have been conducted to establish the level of the problem in various surgical fields. A retrospective review of original articles from the British Journal of Plastic Surgery and Plastic and Reconstructive Surgery during 2000 was conducted, using Medline (PubMed). A total of 431 abstracts were screened, from which 27 index articles related to 33 'suspected redundant' publications. Further evaluation was carried out by comparing the full text versions of these articles and assigning a grade of non-dual, dual, potentially dual and 'salami-slicing'. Only four suspect articles were confirmed as having some degree of redundancy, and these related to three index articles (3/431, <1%). The incidence of duplication in plastic surgery literature seems to be much lower compared to other surgical specialties, providing reassurance for reviewers, editors and readers of these journals.

背景与目标： ：重复出版的做法已在科学界受到广泛谴责，并已进行了多项研究来确定各个外科领域的问题水平。使用Medline（PubMed）对2000年《英国整形外科杂志》和《整形与重建外科杂志》上的原始文章进行了回顾性审查。共筛选了431篇摘要，其中27篇索引文章与33篇“可疑的冗余”出版物有关。通过比较这些文章的全文版本并指定非双重，双重，可能双重和“萨拉米切片”的等级，进行了进一步的评估。仅确认了四篇可疑文章具有一定程度的冗余度，这些文章与三篇索引文章有关（3/431，<1％）。与其他外科专业相比，整形外科文献中的重复发生率似乎要低得多，这为这些期刊的审稿人，编辑和读者提供了保证。

BACKGROUND & AIMS: BACKGROUND:Several case reports have raised serious concerns about the safety of shoulder surgery in the beach-chair position, related to global cerebral hypoperfusion. We summarize our experiences with 15,014 cases of shoulder arthroscopy over an 11-year period. Our primary aim was to evaluate the incidence of intraoperative or immediate postoperative neurologic events and secondarily to relate other perioperative complications. METHODS:We searched our online deidentified departmental quality improvement and patient safety database for adverse outcomes associated with arthroscopic shoulder surgery performed in the beach-chair position for the 11-year period between April 2001 and November 2011, as well as our hospital-system database and a statewide database. This was compared with the total number of such cases, available from our department billing database. RESULTS:The total rate of adverse events was 0.37%. Neurologic abnormalities suggestive of acute cerebral ischemia or hemorrhage did not occur in the immediate perioperative period. One new neurologic deficit was reported, secondary to ischemic stroke, which occurred 24 hours after the surgery. The most frequent complications detected were unplanned return to care (0.067%), local anesthetic systemic toxicity (0.053%), and airway compromise requiring unplanned intubation (0.033%). Complications were infrequent and did not vary in incidence over the course of the study. CONCLUSIONS:This retrospective study suggests that intraoperative or immediate postoperative stroke is rare when surgery is conducted in beach-chair position in conjunction with regional anesthesia, propofol sedation, and spontaneous respiration via natural airway.

背景与目标： 背景：几例病例报告引起了人们对与全脑低灌注相关的沙滩椅位置肩部手术安全性的严重关注。我们总结了我们在11年中共15014例肩关节镜检查的经验。我们的主要目的是评估术中或术后立即发生的神经系统事件的发生率，其次是与其他围手术期并发症相关。
方法：我们在2001年4月至2011年11月的11年期间，通过在线不确定的部门质量改善和患者安全性数据库搜索了在沙滩椅位置进行的关节镜肩部手术相关的不良结局，以及医院系统数据库和全州数据库。将其与此类案件的总数进行了比较，可从我们的部门账单数据库中获得该数目。
结果：不良反应总发生率为0.37％。围手术期未发生提示急性脑缺血或出血的神经系统异常。据报道，缺血性中风继发于术后24小时，出现了一种新的神经功能缺损。发现的最常见并发症是计划外恢复治疗（0.067％），局麻药全身毒性（0.053％）和需要计划外插管的气道损害（0.033％）。在研究过程中，并发症很少见，发生率也没有变化。
结论：这项回顾性研究表明，当在沙滩椅位置进行手术并伴有区域麻醉，异丙酚镇静和通过自然气道自发呼吸时，很少发生术中或术后中风。

BACKGROUND & AIMS: PURPOSE:To determine whether corneal topical application of mitomycin-C (MMC) results in measurable plasma levels of systemic absorption. SETTING:Madigan Army Medical Center, Refractive Surgery Center, Fort Lewis, Washington, and Micro-Constants Laboratory, San Diego, California, USA. DESIGN:Case-control study. METHODS:The study comprised male and female active-duty soldiers having excimer laser photorefractive keratectomy with MMC. Patients who met inclusion criteria were asked to provide a blood sample immediately after being treated with MMC 0.2 mg/mL (0.02%) for 30 seconds. Human plasma samples were evaluated by liquid chromatography mass spectrometry to determine whether MMC was present. RESULTS:Thirty samples were submitted for evaluation. There was zero detection of MMC in the submitted samples. The quantifiable limit was greater than 10.0 ng/mL. All samples were below this. CONCLUSIONS:In this study of 30 patients with topical application of MMC for refractive surgery, there was no measurable evidence of systemic absorption. Although systemic absorption has been found with use in larger quantities, it was not known whether MMC toxicity concerns could be extrapolated to the refractive surgery population. This information allows counseling of patients on the extremely low likelihood of systemic absorption or toxicity following current techniques for refractive surgery. FINANCIAL DISCLOSURE:No author has a financial or proprietary interest in any material or method mentioned.

背景与目标： 目的：确定局部应用丝裂霉素C（MMC）的角膜是否可测量血浆中的全身吸收水平。
地点：华盛顿州刘易斯堡的马迪根军医中心，屈光手术中心和美国加利福尼亚州圣地亚哥的微常数实验室。
设计：病例对照研究。
方法：该研究包括接受MMC准分子激光屈光性角膜切除术的现役士兵。接受入选标准的患者在接受0.2 mg / mL MMC（0.02％）的治疗30秒后，应立即提供血样。通过液相色谱质谱法评估人血浆样品，以确定是否存在MMC。
结果：提交了30个样品进行评估。在提交的样本中，MMC的检测为零。定量限大于10.0 ng / mL。所有样品均低于此值。
结论：在这项针对30例MMC局部应用屈光手术的患者的研究中，没有可测量的全身吸收证据。尽管已经发现全身吸收的使用量更大，但尚不清楚是否可以将MMC毒性问题推断到屈光手术人群中。该信息使患者可以根据当前屈光手术技术对全身吸收或毒性的可能性极低进行咨询。
财务披露：任何作者都不会对所提及的任何材料或方法具有财务或专有利益。

BACKGROUND & AIMS: :Twenty patients with strabismus and diplopia following surgery for retinal detachment were treated by botulinum toxin injection of the eye muscles. Twelve patients had regained fusion with elimination of diplopia in the primary position at the time of examination, 5 to 96 months after treatment (mean, 24 months). Three patients had partial diplopia elimination, and five patients continued to have diplopia.

背景与目标： ：20例视网膜脱离手术后的斜视和复视患者通过肉毒杆菌毒素注射治疗眼肌。在检查时，治疗后5至96个月（平均24个月），有12例患者恢复了融合，消除了原发性复视。 3例患者消除了部分复视，5例患者继续复视。

BACKGROUND & AIMS: :Hemorrhage is the most preventable cause of posttraumatic death. Many cases are potentially anatomically salvageable, yet remain lethal without logistics or trained personnel to deliver diagnosis or resuscitative surgery in austere environments. Revolutions in technology for remote mentoring of ultrasound and surgery may enhance capabilities to utilize the skill sets of non-physicians. Thus, our research collaborative explored remote mentoring to empower non-physicians to address junctional and torso hemorrhage control in austere environments. Major studies involved using remote-telementored ultrasound (RTMUS) to identify torso and junctional exsanguination, remotely mentoring resuscitative surgery for torso hemorrhage control, understanding and mitigating physiological stress during such tasks, and the technical practicalities of conducting damage control surgery (DCS) in austere environments. Iterative projects involved randomized guiding of firefighters to identify torso (RCT) and junctional (pilot) hemorrhage using RTMUS, randomized remote mentoring of MedTechs conducting resuscitative surgery for torso exsanguination in an anatomically realistic surgical trainer ("Cut Suit") including physiological monitoring, and trained surgeons conducting a comparative randomized study for torso hemorrhage control in normal (1g) versus weightlessness (0g). This work demonstrated that firefighters could be remotely mentored to perform just-in-time torso RTMUS on a simulator. Both firefighters and mentors were confident in their abilities, the ultrasounds being 97% accurate. An ultrasound-naive firefighter in Memphis could also be remotely mentored from Hawaii to identify and subsequently tamponade an arterial junctional hemorrhage using RTMUS in a live tissue model. Thereafter, both mentored and unmentored MedTechs and trained surgeons completed resuscitative surgery for hemorrhage control on the Cut-Suit, demonstrating practicality for all involved. While remote mentoring did not decrease blood loss among MedTechs, it increased procedural confidence and decreased physiologic stress. Therefore, remote mentoring may increase the feasibility of non-physicians conducting a psychologically daunting task. Finally, DCS in weightlessness was feasible without fundamental differences from 1g. Overall, the collective evidence suggests that remote mentoring supports diagnosis, noninvasive therapy, and ultimately resuscitative surgery to potentially rescue those exsanguinating in austere environments and should be more rigorously studied.

背景与目标： ：出血是创伤后死亡的最可预防原因。许多病例在解剖学上可能是可挽救的，但如果没有后勤人员或训练有素的人员在严酷的环境中进行诊断或复苏手术，则仍然致命。超声和手术的远程指导技术的革命可能会增强利用非医师技能的能力。因此，我们的研究合作探索了远程指导，以使非医师能够在严峻的环境中解决交界处和躯干出血的控制问题。重大研究涉及使用远程元素超声（RTMUS）识别躯干和关节血流失血，远程指导复苏手术以控制躯干出血，了解和缓解此类任务期间的生理压力以及在严格的条件下进行损伤控制手术（DCS）的技术实用性环境。迭代项目涉及使用RTMUS随机指导消防员以识别躯干（RCT）和交界处（飞行员）出血，在解剖学上现实的外科培训师（Cut Suit）中进行进行复苏性躯干放血手术的MedTechs的随机远程指导，包括生理监测，以及训练有素的外科医生，对正常（1g）和失重（0g）的躯体出血控制进行比较随机研究。这项工作表明，可以远程指导消防员在模拟器上执行即时躯干RTMUS。消防员和指导者都对自己的能力充满信心，超声波准确率达97％。孟菲斯市的一名初次使用超声的消防员也可以从夏威夷进行远程指导，以在活组织模型中使用RTMUS识别并随后压塞动脉结膜出血。此后，受指导和未受指导的MedTechs以及受过训练的外科医生都完成了复苏手术，以控制Cut-Suit上的出血，证明了所有参与者的实用性。尽管远程指导并没有减少MedTechs的失血量，但它增加了程序的置信度并降低了生理压力。因此，远程指导可能会增加非医师执行心理艰巨任务的可行性。最终，失重的DCS是可行的，与1g的差异不大。总体而言，集体证据表明，远程指导支持诊断，无创治疗以及最终的复苏手术，以挽救那些在严酷环境中放血的人，因此应进行更严格的研究。

BACKGROUND & AIMS: OBJECTIVES:The role of surgery in stage IV gallbladder (GB) cancer is not well established. This study analyses prognostic factors in patients with stage IV GB cancer following surgical resection with the aim of identifying a subgroup of patients who might benefit from surgical resection. METHODS:Clinicopathological details were analysed for 94 patients who were surgically treated for stage IV GB cancer at Seoul National University Hospital. RESULTS:Median survival was 8 months in patients with either stage IVa or IVb disease. Sixteen patients (17.0%) underwent resection with curative intent, which increased overall survival over that in patients undergoing palliative surgery (P < 0.001). No survival benefit was seen following surgery with curative intent in patients with stage IVa disease (P = 0.764). Surgery with curative intent resulted in a survival benefit in patients with stage IVb disease, patients with an isolated liver metastasis near the GB bed (median survival: 31 months vs. 9 months; P < 0.001) and patients with limited numbers of peritoneal implantations (median survival: 20 months vs. 6 months; P = 0.002). Preoperative serum carcinoembryonic antigen (CEA) (P = 0.018), surgery with curative intent (P = 0.045) and adjuvant chemotherapy (P = 0.002) were independent prognostic factors in patients with stage IV GB cancer. CONCLUSIONS:Surgery in combination with systemic chemotherapy may be beneficial in carefully selected patients with stage IVb GB cancer.

背景与目标： 目的：手术在IV期胆囊癌中的作用尚不明确。这项研究分析了手术切除后Ⅳ期GB期癌症患者的预后因素，目的是确定可能从手术切除中受益的患者亚组。
方法：分析了首尔国立大学医院94例行IV型GB癌症手术治疗的患者的临床病理资料。
结果：IVa或IVb期患者的中位生存期为8个月。 16例（17.0％）接受根治性切除术的患者，与接受姑息手术的患者相比，总体生存率有所提高（P <0.001）。 IVa期疾病患者经根治性手术后未见生存获益（P = 0.764）。具有治愈意图的手术可为IVb期疾病患者，GB床附近发生单纯肝转移的患者（中位生存期：31个月对9个月； P <0.001）和腹膜植入次数有限的患者带来生存益处（中位生存期：20个月与6个月； P = 0.002）。 Ⅳ期GB期癌症患者的术前血清癌胚抗原（CEA）（P = 0.018），有根治性手术（P = 0.045）和辅助化疗（P = 0.002）是独立的预后因素。
结论：外科手术结合全身化学疗法可能对精心挑选的IVb GB期癌症患者有益。

BACKGROUND & AIMS: BACKGROUND:In 2013, the Declaration of Helsinki changed to mandate that all research studies involving human subjects, rather than just clinical trials alone, must have a protocol registered in a publicly accessible database prior to the enrolment of the first patient. The objective of this work was to assess the number of research studies involving human participants published in leading journals of plastic surgery that had either published a protocol or registered a protocol with a publicly accessible database. MATERIALS AND METHODS:This systematic review examined all research articles involving human participants published in Plastic and Reconstructive Surgery, The Journal of Plastic Reconstructive and Aesthetic Surgery and The Annals of Plastic Surgery from 1st April 2014-31st March 2015. The primary outcome measure was whether each study had either published or registered a protocol with any mainstream registry database. ClinicalTrials.gov, the International Standard Randomized Control Trial Number (ISRCTN) registry, the WHO (World Health Organisation) International Clinical Trials Registry Platform, The Cochrane Collaboration, the Research Registry, PROSPERO and PubMed were all reviewed. RESULTS:Of 595 included articles, the most common study designs were case series (n = 185, 31.1%). There were 24 randomized controlled trials (RCTs, 4.0%). A total of 24 studies had a protocol registered (4.0%). The most common database to register a protocol was with ClinicalTrials.gov (n = 17). The study design that most commonly had a registered protocol was the RCT (n = 8 of 24, 33.3% of RCTs). Three studies published a protocol in a journal (0.6%). CONCLUSION:Publication or registration of protocols for recent studies involving human participants in major plastic surgery journals is low. There is considerable scope to improve this and guidance is provided.

背景与目标： 背景：2013年，《赫尔辛基宣言》（Declaration of Helsinki Declaration）规定，所有涉及人类受试者的研究，而不仅仅是仅临床试验，都必须在第一个患者入组前在公共可访问的数据库中注册一个方案。这项工作的目的是评估在整形外科的主要期刊上发表的涉及人类参与者的研究数量，这些期刊已经发表了方案或在公共可访问的数据库中注册了方案。
材料与方法：本系统综述审查了2014年4月1日至2015年3月31日发表在《整形与重建外科》，《整形与美学外科杂志》和《整形外科年鉴》上的涉及人类参与者的所有研究文章。主要结果指标是是否每项研究均已在任何主流注册数据库中发布或注册了一项协议。 ClinicalTrials.gov，国际标准随机对照试验号码（ISRCTN）注册表，WHO（世界卫生组织）国际临床试验注册表平台，Cochrane合作组织，研究注册表，PROSPERO和PubMed均进行了审查。
结果：在595篇纳入文章中，最常见的研究设计是病例系列（n = 185，31.1％）。有24项随机对照试验（RCT，4.0％）。共有24项研究已注册方案（4.0％）。注册协议的最常见数据库是ClinicalTrials.gov（n = 17）。最常见的具有注册方案的研究设计是RCT（n = 24中的8，占RCT的33.3％）。三项研究在期刊上发表了实验方案（0.6％）。
结论：主要整形外科杂志中涉及人类参与者的最新研究的协议发表或注册很少。有很大的改进空间，并提供了指导。

BACKGROUND & AIMS: BACKGROUND:Early and late dumping are complications of gastric bypass surgery. Early dumping occurs within an hour after eating, when the emptying of food into the small intestine triggers rapid fluid shifts into the intestinal lumen and the release of gastrointestinal hormones, resulting in gastrointestinal and vasomotor symptoms. Late dumping occurs between 1 and 3 hours after carbohydrate ingestion and is caused by an exaggerated insulin release, resulting in hypoglycemia. Almost no data are currently available on the prevalence of early and late dumping or their impact on health-related quality of life (QoL). OBJECTIVES:To study the prevalence of early and late dumping in a large population of patients having undergone a primary Roux-en-Y gastric bypass (RYGB) and its effect on QoL. SETTING:Cross-sectional study at a single bariatric department in the Medical Center Leeuwarden, The Netherlands between 2008 and 2011. METHODS:In 2013, this descriptive cohort study approached by email or post all patients who underwent a primary RYGB in the setting between 2008 and 2011 in one hospital. These patients were asked to fill in standardized questionnaires measuring their QoL (RAND-36), anxiety and depression (HADS), fatigue (MFI-20) and any disease specific indicators of early and late dumping syndrome. RESULTS:The questionnaire was completed and returned by 351 of 613 patients (57.1%) and 121 nonobese volunteers. Participants were mostly female (80%), aged 42 (40-54 years), with an excess weight loss of 76.8% [IQR 61-95] after RYGB surgery 2.3 [ IQR 1.6-3.4] years earlier. Self-reported complaints of moderate to severe intensity suggestive of early and late dumping were present in 18.8% and 11.7% of patients, respectively. Patients with early and late dumping demonstrated significantly lower scores on the RAND-36 and HADS compared with patients without dumping. No differences were seen in the MFI-20 scores between patients with or without early and late dumping. CONCLUSION:In this descriptive cohort, self-reported complaints suggestive of early and late dumping of moderate-to-severe intensity were, respectively, 18.8% and 11.7% in a cohort after primary gastric bypass surgery. These complaints were associated with markedly reduced health-related QoL.

背景与目标： 背景：早期和晚期倾倒是胃搭桥手术的并发症。进食后一小时内会发生早期倾倒，这是因为食物排入小肠会触发液体快速进入肠腔并释放胃肠激素，从而导致胃肠道和血管舒缩症状。延迟进食发生在摄入碳水化合物后的1至3个小时之间，并且是由于胰岛素释放过大引起的，从而导致低血糖症。目前几乎没有关于早期和晚期倾倒的流行率及其对健康相关生活质量（QoL）的影响的数据。
目的：研究大量初次Roux-en-Y胃搭桥术（RYGB）患者的早期倾倒和晚期倾倒的患病率及其对生活质量的影响。
地点：2008年至2011年，在荷兰吕伐登医学中心的单个减肥科进行横断面研究。
方法：2013年，该描述性队列研究通过电子邮件或将所有在2008年至2011年之间在某医院接受原发性RYGB治疗的患者纳入研究。这些患者被要求填写标准化的问卷，以测量他们的生活质量（RAND-36），焦虑和抑郁（HADS），疲劳（MFI-20）以及早期和晚期倾倒综合征的任何疾病特异性指标。
结果：613例患者中的351例（占57.1％）和121例非肥胖志愿者完成了问卷调查并返回。参与者主要是女性（80％），42岁（40-54岁），RYGB手术2.3年[IQR 1.6-3.4]年后，体重减轻了76.8％[IQR 61-95]。自我报告的中度至重度暗示早期和晚期倾倒的投诉分别占患者的18.8％和11.7％。与没有倾倒的患者相比，早期和晚期倾倒的患者在RAND-36和HADS上的得分明显较低。在有或没有早期和晚期倾倒的患者之间，MFI-20评分均未见差异。
结论：在该描述性队列中，自我报告的关于初次胃旁路手术后队列中早期至中度至重度倾倒的投诉分别为18.8％和11.7％。这些投诉与健康相关的生活质量显着降低有关。

BACKGROUND & AIMS: BACKGROUND:Evidence-based guidelines recommend limited perioperative diagnostic imaging for new breast cancer diagnoses. For patients aged >65 years, conventional imaging use (mammography, plain radiographs, and ultrasound) has remained stable, whereas advanced imaging (computed tomography [CT], nuclear medicine scans [positron emission tomography/bone scans], and magnetic resonance imaging [MRI]) use has increased. In this study, the authors evaluated traditional and advanced imaging use among younger patients (aged ≤ 65 years) undergoing breast cancer surgery. METHODS:The MarketScan Commercial Claims and Encounters Research Database from 2005 through 2008 was analyzed to evaluate the use of conventional and advanced diagnostic imaging associated with surgery for ductal carcinoma in situ (DCIS) or stage I through III invasive breast cancer. RESULTS:The study cohort included 52,202 women (13% with DCIS and 87% with stage I-III breast cancer). The proportion of patients undergoing conventional imaging remained stable, whereas the average number of conventional imaging tests per patient increased from 4.21 tests in 2005 to 4.79 tests per patient in 2008 (P < .0001). For advanced imaging, the proportion of women who underwent imaging increased from 48.8% in 2005 to 68.8% in 2008 (P < .0001), as did the number of tests per patient (from 1.53 tests in 2005 to 1.98 tests in 2008; P < .0001). MRI examinations accounted for nearly all of the increase in advanced imaging. Patients who underwent MRI examinations received significantly more traditional imaging tests compared with to those who did not, indicating that these tests are additive and are not replacing traditional imaging. CONCLUSIONS:The current results demonstrate that the use of perioperative breast MRI has increased among women aged <65 years. Further study is indicated to determine whether the benefits of this procedure justify increased use.

背景与目标： 背景：基于证据的指南建议对新的乳腺癌诊断进行有限的围手术期诊断成像。对于65岁以上的患者，传统的影像学检查（乳房X线照片，X线平片和超声检查）保持稳定，而高级影像学（计算机断层扫描[CT]，核医学扫描[正电子发射断层扫描/骨扫描]和磁共振成像[ MRI]）的使用有所增加。在这项研究中，作者评估了接受乳腺癌手术的年轻患者（≤65岁）的传统和高级成像使用情况。
方法：对2005年至2008年的MarketScan商业索赔和遭遇研究数据库进行了分析，以评估与导管原位癌（DCIS）或I至III期浸润性乳腺癌手术相关的常规和高级诊断成像的使用。
结果：该研究队列包括52,202名妇女（13％的DCIS患者和87％的I-III期乳腺癌患者）。接受常规影像学检查的患者比例保持稳定，而每名患者的常规影像学检查的平均次数从2005年的4.21次检查增加到2008年的每名患者4.79次检查（P <.0001）。对于高级影像学，接受影像学检查的女性比例从2005年的48.8％增加到2008年的68.8％（P <.0001），每位患者的检查次数也从2005年的1.53次增加到2008年的1.98次； P <.0001）。 MRI检查几乎占了高级影像学增长的全部。与未接受MRI检查的患者相比，接受过MRI检查的患者接受的传统成像检查要多得多，这表明这些检查是相加的，不能替代传统成像。
结论：目前的结果表明，<65岁的女性围手术期乳房MRI的使用有所增加。指示需要进一步研究以确定该程序的益处是否可证明增加使用量是合理的。

BACKGROUND & AIMS: BACKGROUND:Central venous oxygen saturation (ScvO2) remains the gold standard surrogate for tissue oxygen extraction in paediatric cardiac surgery. Near-infrared spectroscopy (NIRS) has been developed as a non-invasive diagnostic tool for regional oxygen saturation. The aim was to compare regional oxygen saturation measured by NIRS with ScvO2 in postoperative paediatric cardiac patients. METHODS:In this prospective study, we included newborns and infants younger than 45 days undergoing heart surgery. We recorded continuous ScvO2 and NIRS regional saturation placed on the forehead (B) and right flank (S) for 48 h postoperatively. A Bland-Altman's analysis was used to assess the agreement between these measurements. RESULTS:A total of 23 patients were included with a median age of 12 days (2-46) and median weight of 3.1 kg (2.3-4.47). The mean difference (MD) ScvO2- B NIRS was 10.45% with limits of agreement (LOA) -17.23 to 38.13% and ScvO2- S NIRS MD 7.16% with LOA: -25.51 to 39.84%. The single ventricle ScvO2- S NIRS subgroup had MD within ± 5%; however, wide LOA was observed. The remaining subgroups showed MD nearly above ± 5%, with wide LOA. CONCLUSIONS:The regional oxygen saturation of brain and kidney did not match ScvO2 as estimation of global tissue perfusion. Nevertheless, NIRS may still provide information regarding regional circulation that may help in the management of neonatal cardiac surgery patients.

背景与目标： 背景：中央静脉血氧饱和度（ScvO2）仍然是小儿心脏外科手术中组织氧提取的金标准。近红外光谱法（NIRS）已被开发为一种用于区域血氧饱和度的非侵入性诊断工具。目的是比较由NIRS和ScvO2测得的小儿心脏术后患者的局部血氧饱和度。
方法：在这项前瞻性研究中，我们纳入了进行心脏手术的45岁以下的新生儿和婴儿。我们记录了连续的ScvO2和NIRS区域饱和度放置在术后48 h的前额（B）和右胁（S）上。用布兰德-奥特曼（Bland-Altman）分析来评估这些测量之间的一致性。
结果：总共纳入23例患者，中位年龄为12天（2-46），中位体重为3.1 kg（2.3-4.47）。 ScvO2-B NIRS的平均差异（MD）为10.45％，协议限制（LOA）为-17.23至38.13％，Slovo2-S NIRS MD的平均值为7.16％，LOA为-25.51至39.84％。单心室ScvO2-S NIRS亚组的MD≤±5％。但是，观察到广泛的LOA。其余亚组的MD值接近±5％，LOA较宽。
结论：脑和肾脏的局部血氧饱和度与ScvO2不符，无法估计整体组织灌注。尽管如此，NIRS仍可能提供有关区域循环的信息，这可能有助于新生儿心脏外科手术患者的管理。

BACKGROUND & AIMS: BACKGROUND:Laparoscopic gastric bypass surgery (LGBS) has become the most widely used bariatric procedure due to its beneficial long-term outcomes for patients with morbid obesity. However, it is unclear whether racial differences in admission for LGBS have changed over time compared to racial differences in all other admissions. We aimed to investigate the trends and differences in the use of LGBS among white, African-American, and Hispanic patients from 2002 to 2008. METHODS:We performed a secondary analysis of data on obese adult patients operated between 2002 and 2008, using the Nationwide Inpatient Sample (NIS) database. The probability of being admitted for LGBS was estimated using logistic regression with race, year, and year by race interaction as predictors, controlling for numerous patient and hospital characteristics. RESULTS:Among 1,704,972 obese hospitalized patients captured through NIS from 2002 to 2008, 2.6 % underwent LGBS (2.8 % Whites, 1.7 % African-Americans, and 2.6 % Hispanics). In adjusted analysis, obese African-American (OR 0.48, p < 0.001) and Hispanic patients (OR 0.59, p < 0.001) were less likely to be admitted for LGBS than white patients in 2002. Race-year interactions showed that the odds of African-Americans undergoing LGBS significantly increased from 2002 to 2008 compared with Whites (annual OR 1.03, p < 0.001) while no such increase was detected for Hispanics (annual OR 1.02, p = 0.11). In 2008, African-American (OR 0.58, p < 0.001) and Hispanic patients (OR 0.65, p < 0.001) still had lower odds than white patients. CONCLUSIONS:This is the first study showing that the difference in the use of LGBS between obese African-American and white patients declined between 2002 and 2008. However, LGBS use still remained significantly lower for both African-American and Hispanic patients in 2008 compared with white patients.

背景与目标： 背景：腹腔镜胃旁路手术（LGBS）由于对病态肥胖患者有益的长期疗效，已成为减肥手术中使用最广泛的方法。但是，目前尚不清楚与所有其他录取中的种族差异相比，LGBS录取中的种族差异是否随时间变化。我们旨在调查2002年至2008年间白人，非裔美国人和西班牙裔患者使用LGBS的趋势和差异。
方法：我们使用全国住院患者样本（NIS）数据库对2002年至2008年间肥胖成人患者的数据进行了二次分析。使用种族，年份和年份（通过种族相互作用作为预测因素）进行逻辑回归，以控制众多患者和医院的特征为基础，估算了被纳入LGBS的可能性。
结果：从2002年到2008年，通过NIS捕获的1,704,972例肥胖住院患者中，有2.6％接受了LGBS治疗（2.8％的白人，1.7％的非裔美国人和2.6％的西班牙裔）。在校正后的分析中，2002年，肥胖的非洲裔美国人（OR 0.48，p <0.001）和西班牙裔患者（OR 0.59，p <0.001）与白人患者相比，LGBS入院的可能性较小。与白人相比，经历LGBS的非裔美国人在2002年至2008年间显着增加（年度OR 1.03，p <0.001），而西班牙裔未发现此类增加（年度OR 1.02，p = 0.11）。 2008年，非裔美国人（OR 0.58，p <0.001）和西班牙裔患者（OR 0.65，p <0.001）的患病几率仍低于白人患者。
结论：这是第一项研究，表明肥胖的非洲裔美国人和白人患者使用LGBS的差异在2002年至2008年之间有所下降。但是，与2008年相比，非洲裔美国人和西班牙裔患者的LGBS使用率仍然明显低于2008年。白人患者。

BACKGROUND & AIMS: INTRODUCTION:Significant malnutrition exists in a high percentage of patients with head and neck cancer. Malnutrition is associated with defects in immune function that may impair the host response to malignancy. Malnutrition and immunosupression make patients highly susceptible to postoperative infections and complications. OBJECTIVES:Some studies of patients receiving immuno-nutrition in the perioperative period in head and neck cancer have shown beneficial effects on clinical outcome and inmune status. The authors carried out a systematic review of randomised control trials to determine whether perioperative immunonutrition has a role in the treatment of head and neck cancer. METHODS:14 trials of polymeric nutritional supplementation with immunonutrition were identified. Two studies compared two types of immunonutrition. RESULTS:A reduction in the length of postoperative hospital stay was seen in some trials, but the reason for this reduction is not clear. Some studides showed statistical differences with less complications in arginine-enhanced group and also showed a significant decrease of fistula complications in patients treated with a high arginine dose enhanced formula, if compared with a medium dose of arginine. CONCLUSION:[corrected] Those planning future studies face challenges. A suitable powered clinical trial is required before firm recommendations can be made on the use of immunonutrition in head and neck cancer patients postoperatively.

背景与目标： 简介：大量的营养不良存在于头颈癌患者中。营养不良与免疫功能缺陷有关，可能损害宿主对恶性肿瘤的反应。营养不良和免疫抑制使患者对术后感染和并发症高度敏感。
目的：一些对头颈部癌患者围手术期接受免疫营养治疗的患者的研究表明，其对临床结局和免疫状况具有有益作用。作者对随机对照试验进行了系统评价，以确定围手术期免疫营养是否在头颈癌的治疗中起作用。
方法：鉴定了14项免疫营养性高分子营养补充试验。两项研究比较了两种类型的免疫营养。
结果：在某些试验中，术后住院时间减少了，但是减少的原因尚不清楚。与中等剂量的精氨酸相比，精氨酸增强组的某些研究结果显示统计学差异且并发症较少，并且用高精氨酸剂量增强配方治疗的患者的瘘管并发症也显着减少。
结论：[已纠正]那些计划未来研究的人面临挑战。在对头颈癌患者术后使用免疫营养提出确切建议之前，需要进行适当的临床试验。

BACKGROUND & AIMS: OBJECTIVE:Of pediatric patients with Crohn disease, 20% to 30% undergo surgery within 10 years. Although disease relapses and reoperations are common, long-term functional outcomes and quality of life (QoL) are unclear. METHODS:In 2010, we reviewed the hospital records of all pediatric patients with CD who had undergone intestinal resections during childhood in 2 major tertiary care hospitals between 1985 and 2008 and mailed out questionnaires that asked about health outcomes and QoL. We compared the QoL of the patients and a group of matched controls randomly chosen from the Population Register Centre. RESULTS:In total, 36 children had undergone bowel resection a median of 10 years earlier and had at least 2 years of follow-up. Disease activation (verified at endoscopy) requiring medical or surgical treatment occurred in 94% (median 1.8 years after primary resection). At least 1 surgical complication occurred in 77%, and 54% underwent re-resection. The patients reported a median stool frequency of 3 stools during the day and zero at night, with 33% being totally continent. Overall, 96% were completely or moderately satisfied with the outcome of the surgery. The QoL was comparable between the patients and controls, but school or work absences diminished the QoL of the patients. CONCLUSIONS:Surgery for pediatric-onset CD is risky even under expert care. Disease relapses and bowel re-resections are common during the first decade after primary surgery. In the long term, however, bowel function is acceptable and the QoL is comparable between patients and their peers.

背景与目标： 目的：患有克罗恩病的小儿患者中，有20％至30％在10年内接受手术。尽管疾病复发和再次手术很普遍，但长期功能结局和生活质量（QoL）尚不清楚。
方法：2010年，我们回顾了1985年至2008年间两家主要三级医院的所有CD患儿在小儿时期接受过肠切除术的小儿CD的医院记录，并寄出了有关健康结局和QoL的问卷。我们比较了患者和从人口登记中心随机选择的一组配对对照的生活质量。
结果：总共36名儿童接受了肠切除术，中位值是10年前，并且至少接受了2年的随访。 94％（初次切除后中位数为1.8年）发生了需要药物或手术治疗的疾病激活（在内窥镜检查中验证）。 77％的患者至少发生了1例手术并发症，而54％的患者接受了再次切除。患者报告白天大便次数中位数为3次，晚上为零，其中33％完全为大洲。总体而言，有96％的人对手术的结果完全满意或中度满意。患者和对照组之间的QoL相当，但因学校缺勤或缺勤而降低了患者的QoL。
结论：即使在专家的护理下，小儿发作性CD的手术也是有风险的。在初次手术后的头十年，疾病复发和肠切除很常见。但是，从长期来看，肠功能是可以接受的，患者与同伴之间的QoL相当。

BACKGROUND & AIMS: STUDY DESIGN:Lung volumes and thoracic anatomy were measured from low-dose computed tomography (CT) scans preoperatively and 2 years following thoracoscopic anterior spinal fusion (TASF) for adolescent idiopathic scoliosis (AIS). OBJECTIVE:The aim of this study was to assess changes in lung volume after TASF surgical correction. SUMMARY OF BACKGROUND DATA:AIS patients are known to have decreased pulmonary function as a consequence of their spinal and ribcage deformity. Several studies have evaluated changes in pulmonary function clinically after scoliosis correction surgery showing varied results. To date, there have been no published studies using CT to evaluate lung volume changes following TASF. METHODS:Twenty-three female AIS patients with both pre- and 2 years postoperative low-dose CT scans were selected from an ethically approved, historical databank. Three-dimensional lung volumes were reconstructed to determine anatomical lung volumes. Right and left lung volumes, total lung volume, and right-to-left lung volume ratio were obtained as well as hemithoracic symmetry, to indicate the extent of thorax deformity. Cobb angle, rib hump, levels fused in surgery, and patient height were used for correlation analysis with the lung volume results. RESULTS:Left lung volume, total lung volume, and hemithoracic ratio all increased significantly 2 years after surgery. There was no significant change in right-to-left lung volume ratio (P = 0.36). Statistical regression found significant positive correlation between lung volume changes, reduction in Cobb angle, increase in height, and improvement in hemithoracic symmetry ratio. CONCLUSION:TASF resulted in a statistically significant increase in lung volume following surgery, as well as improvement in the symmetry of the thoracic architecture; however, the postoperative lung volumes remained in the lower 50th percentile relative to females without thoracic deformity. Furthermore, change in lung volume was significantly correlated with changes in Cobb angle, hemithoracic asymmetry, and increased patient height, which are important consequences of thoracic deformity correction surgery. LEVEL OF EVIDENCE:3.

背景与目标： 研究设计：在术前和胸腔镜前路脊柱融合术（TASF）治疗后的青少年特发性脊柱侧凸（AIS）进行低剂量计算机断层扫描（CT）扫描时，测量肺体积和胸腔解剖结构。
目的：本研究旨在评估TASF手术矫正后肺容量的变化。
背景数据摘要：已知由于脊柱和胸腔畸形，AIS患者的肺功能下降。多项研究评估了脊柱侧弯矫正手术后临床上肺功能的变化，结果各不相同。迄今为止，还没有发表使用CT评估TASF后肺容量变化的研究。
方法：从符合道德标准的历史数据库中选择了23例术前和术后2年均进行低剂量CT扫描的女性AIS患者。重建三维肺体积以确定解剖肺体积。获得左右肺体积，总肺体积和左右肺体积比以及半胸对称性，以指示胸廓畸形的程度。将Cobb角，肋骨隆起，手术中的融合水平以及患者身高用于与肺容量结果的相关性分析。
结果：术后2年，左肺容积，总肺容积和半胸腔比率均显着增加。左右肺容积比无明显变化（P = 0.36）。统计回归发现肺体积变化，Cobb角减小，身高增加和半胸对称性比率改善之间存在显着正相关。
结论：TASF导致手术后肺体积显着增加，并改善了胸腔结构的对称性。但是，相对于没有胸椎畸形的女性，术后肺活量仍处于较低的50％。此外，肺容量的变化与Cobb角的变化，半胸廓不对称以及患者身高的增加显着相关，这是胸畸形矫正手术的重要结果。
证据级别：3。