Academic otolaryngology in the new millennium: Are we falling behind?

OBJECTIVE: To determine if differences in publication rates have evolved over the past 3 decades for academic otolaryngologists. METHODS: Three random samples with 50 academic otolaryngologists each were studied. These otolaryngologists completed training in 1 of the 3 time periods (1970-74, 1980-84, 1990-94) studied. Articles published within the first 5 years after graduation were tabulated and statistically analyzed. RESULTS: Academic otolaryngologists graduating in the 1970s, 1980s, and 1990s averaged 8.7, 8.9, and 6.4 publications during their first 5 years of academic practice, respectively. The first 2 cohorts averaged 5.4 and 5.7 publications in the 4 major otolaryngology journals, versus 3.3 for 1990s graduates. Basic science publications increased for 1990s graduates over those of the 1970s and 1980s graduates. The percentage of first author articles remained stable. Despite these trends, only the drop in case reports was statistically significant (P = 0.023, ANOVA). CONCLUSION: Trends may be developing that predict decreasing publication rates for newly trained otolaryngologists entering academic practice.     

A Meta‐Analysis of the Association Between Appraisals of Trauma and Posttraumatic Stress in Children and Adolescents

Cognitive models of posttraumatic stress disorder (PTSD) place an emphasis on the role of negative appraisals of traumatic events. It is suggested that the way in which the event is appraised determines the extent to which posttraumatic stress symptoms will be experienced. Therefore, a strong relationship between trauma appraisals and symptoms of PTSD might be expected. However, this relationship is not as firmly established in the child and adolescent literature. A systematic literature review of this relationship returned 467 publications, of which 11 met full eligibility criteria. A random effects meta‐analysis revealed a large effect size for the relationship between appraisals and PTSD symptoms in children and adolescents, r = .63, 95% CI [.58, .68], Z = 17.32, p < .001, with significant heterogeneity present. A sensitivity analysis suggested that this relationship was not contingent on 1 specific measure of appraisals. Results were consistent with the cognitive behavioral theory of PTSD, demonstrating that appraisals of trauma are strongly related to posttraumatic stress in children and adolescents. However, this relationship was not observed in a sample of 4‐ to 6‐year‐olds, indicating that further research is required to explicate cognitive processing of trauma in very young children.     

Improving survival in gastric cancer: review of operative mortality in English language publications from 1970

In this review of English language publications from 1970, operative mortality following surgery for gastric cancer has been analysed. Operative mortality has declined in series reporting operations in successive decades to 1970, 1980 and 1990. Series reporting patients having surgery for gastric cancer in the decade to 1990 show a mean operative mortality rate of 7.8 per cent (median 4.6 per cent). This improvement may have contributed to the declining mortality rates for gastric cancer in the face of unchanging surgical workload. Results of operations for gastric cancer should be reported in a standard manner.     

What to call spinal cord damage not due to trauma? Implications for literature searching

Abstract

Objectives

To illustrate the importance of multiple search terms and databases when searching publications on spinal cord damage not due to trauma. To develop comprehensive search filter for this subject, compare the results for 2000–2009 with the Medical Subject Headings (MeSH) and Emtree term ‘spinal cord diseases’ and determine changes in the number of articles over this period.

Design

Literature searches and search filter development.

Setting

Australia.

Interventions

Titles and abstracts searched in MEDLINE and EMBASE (2000–2009) for articles involving humans using search terms ‘non-traumatic spinal cord injury’ and ‘nontraumatic spinal cord injury’ (concise search). Develop comprehensive search filter for ‘spinal cord damage not due to trauma’ and compare the results with the MeSH term ‘spinal cord diseases.’

Outcome measures

Annual publications (2000–2009) identified in MEDLINE and EMBASE literature searches.

Results

Concise search identified 35 articles published during 2000–2009. More publications were identified using the term ‘nontraumatic spinal cord injury’ (n = 20) than ‘non-traumatic spinal cord injury’ (n = 16). Publications increased for both terms ‘spinal cord diseases’ (2000 = 279; 2009 = 415) and ‘spinal cord damage not due to trauma’ identified by the comprehensive search filter (2000 = 1251; 2009 = 1921).

Conclusions

Concise searches using terms ‘non-traumatic spinal cord injury’ and ‘nontraumatic spinal cord injury’ fail to identify relevant articles unless combinations of terms and databases are used. These are inadequate search terms for a comprehensive search. Further research is needed to validate our comprehensive search filter. An international consensus process is required to establish an agreed term for ‘spinal cord damage not due to trauma.’     

Improving survival in gastric cancer: review of 5-year survival rates in English language publications from 1970.

In this review of English language publications from 1970, 5-year survival rates after surgery for gastric cancer have been analysed. While the proportion of patients coming to operation has fallen from 92 per cent before 1970 to 71 per cent by 1990, the proportion of operated patients undergoing resection has increased from 37 per cent before 1970 to 48 per cent before 1990. This change suggests improved preoperative staging leading to better patient selection for operation. The 5-year survival rate following all resections has increased significantly from 20.7 per cent before 1970 to 28.4 per cent before 1990, an increase of 7.7 per cent (95 per cent confidence interval 7.1-8.3 per cent). The 5-year survival rate following curative or radical resection has risen from 37.6 to 55.4 per cent over the same period, an increase of 17.8 per cent (95 per cent confidence interval 17.1-18.5 per cent). It is likely that this improvement has contributed to the decrease in the mortality rate from gastric cancer. Comparison of Japanese series with others suggests that diagnosis and treatment of the disease at an earlier stage will result in an even greater increase in 5-year survival rates outside Japan. Of the papers studied, 56 per cent were excluded from analysis, the majority because the data provided about 5-year survival rates were insufficient or the survival calculations inappropriate. Results of survival after operations for gastric cancer should be calculated and presented in a standardized manner.     

Cost-Drivers in Acute Treatment of Severe Trauma in Europe: A Systematic Review of Literature

Abstract Introduction:   Throughout the world, trauma is a leading cause of morbidity and mortality in the young and most active group of society. While specialist trauma centers play a critical role in the survival after severe trauma, the assessment of trauma-related costs, budgeting for adequate trauma capacity, and determining the cost-effectiveness of interventions in critical care are fraught with difficulties. Through a systematic review of the European literature on severe trauma, we aimed to identify the key elements that drive the costs of acute trauma care. Methods:   A PubMed/MEDLINE search for articles relating the costs and economics of trauma was performed for the period January 1995 to July 2007. One hundred and seventy-three European publications were identified. Twelve publications were retrieved for complete review that provided original cost data, a breakdown of costs according to the different elements of trauma care, and focused on severe adult polytrauma. The identified publications presented studies from the UK (3), Germany (6), Italy (2), and Switzerland (1). Results:   In all publications reviewed, length of stay in the intensive care unit (ICU; 60%) and requirements for surgical interventions (≤ 25%) were the key drivers of hospital costs. The cost of transfusion during the initial rescue therapy can also be substantial, and in fact represented a significant portion of the overall cost of emergency and ICU care. Multiple injuries often require multiple surgical interventions, and prolonged ICU and hospital stay, and across all studies a clear relationship was observed between the severity of polytrauma injuries observed and overall treatment costs. While significant differences existed in the absolute costs of trauma care across countries, the key drivers of costs were remarkably similar. Conclusions:   Irrespective of the idiosyncrasies of the national healthcare systems in Europe, severity of injury, length of stay in ICU, surgical interventions and transfusion requirements represent the key drivers of acute trauma care for severe injury.     

Vertebral artery injuries associated with cervical spine injuries: a review of the literature

STUDY DESIGN: Literature review. OBJECTIVE: To determine the incidence of vertebral artery injuries (VAIs) in association with cervical spine trauma and investigate the optimum diagnostic and treatment protocols. SUMMARY OF BACKGROUND DATA: VAIs may result from cervical spine trauma and have the potential to cause cerebral, brainstem, and even spinal cord ischemia. Screening and treatment for traumatic VAI are very controversial, with conflicting recommendations within the trauma and spine literature. METHODS: A literature review was performed to identify publications pertaining to VAIs associated with cervical spine trauma. These publications were evaluated to determine the incidence, radiographic evaluation, and treatment options of VAIs. RESULTS: Approximately 0.5% of all trauma patients will have a VAI, and 70% of all traumatic VAIs will have an associated cervical spine fracture. Cervical spine translation injuries and transverse foramen fractures are most commonly cited as having a significant association with VAIs. The incidence of neurologic deficits secondary to VAI ranges from 0% to 24% in published series that incorporate a screening protocol for asymptomatic patients. Catheter angiography has been the gold standard for the diagnosis of VAIs; however, new 16-slice computed tomography angiography seems to have sensitivity and specificity close to that of catheter angiography. Treatment options include observation, antiplatelet agents, anticoagulation, and endovascular treatments. Although some authors have advocated antithrombotic therapy for most asymptomatic VAIs, there is a lack of class I evidence to support any strong guidelines for treatment. CONCLUSIONS: VAIs can occur in association with cervical spine trauma and have the potential for neurological ischemic events. Screening for and treatment of asymptomatic VAIs may be considered, but it is unclear based on the current literature whether these strategies improve outcomes.     

International Publication Trends in the Traumatic Stress Literature

This analysis looked at international publication trends in the field of trauma by examining first author affiliations of over 13,000 trauma publications from 1987 to 2001. Searches were conducted using the Published International Literature on Traumatic Stress (PILOTS) database to determine frequency of international contributions. A similar search of the Journal of Traumatic Stress (JTS) was also conducted. Although the majority of trauma research comes from investigators in North America, examining publication trends over time revealed that trauma research is becoming increasingly international in its representation. Results suggest that of the overall trauma literature, 36% of contributions come from authors outside North America. Likewise, among JTS publications over the first 14 years of circulation, 27% came from authors outside North America. More recent publication years reflect higher levels of international contributions for both sources. The majority of trauma research published over the 15-year span was in English. Implications for the field of traumatic stress research are discussed.     

Cervical collars and braces in athletic brachial plexus injury and excessive cervical motion prevention: a review of the literature

A review of the literature was conducted to find publications relating to neck collars / rolls and prevention of sports injury, particularly burners and other cervical spine injuries, as well as in preventing excessive motion of the cervical spine. MEDLINE (1970-2005), Cinahl (1982-2005), Alt Health Watch (1990-2005), AMED (1995-2005), and the Index to Chiropractic Literature (1985-2005) databases were searched. To date there has been very little documented study into the ability of cervical collars/neck rolls to prevent excessive motion of the cervical spine or to prevent injury. Neck rolls/braces are capable of limiting cervical hyperextension under laboratory conditions, but the same can not be said for their ability to limit lateral flexion. Only one empirical study could be identified that looked at the ability of a collar to prevent burners and other neck injuries in athletes. Further laboratory and on-field studies are clearly needed.     

Association Between Shame and Posttraumatic Stress Disorder: A Meta‐Analysis

Posttraumatic stress disorder (PTSD) is a complex condition with affective components that extend beyond fear and anxiety. The emotion of shame has long been considered critical in the relation between trauma exposure and PTSD symptoms. Yet, to date, no meta‐analytic synthesis of the empirical association between shame and PTSD has been conducted. To address this gap, the current study summarized the magnitude of the association between shame and PTSD symptoms after trauma exposure. A systematic literature search yielded 624 publications, which were screened for inclusion criteria (individuals exposed to a Criterion A trauma, and PTSD and shame assessed using validated measures of each construct). In total, 25 studies employing 3,663 participants met full eligibility criteria. A random‐effects meta‐analysis revealed a significant moderate association between shame and posttraumatic stress symptoms, r = .49, 95% CI [0.43, 0.55], p < .001. Moderator analyses were not completed due to the absence of between‐study heterogeneity. Publication bias analyses revealed minimal bias, determined by small attenuation after the superimposition of weight functions. The results underscore that across a diverse set of populations, shame is characteristic for many individuals with PTSD and that it warrants a central role in understanding the affective structure of PTSD. Highlighting shame as an important clinical target may help improve the efficacy of established treatments. Future research examining shame's interaction with other negative emotions and PTSD symptomology is recommended.     

Damage control surgery--a historical view

"Damage control surgery" is a surgical strategy to cope with the lethal triad of death, i.e., acidosis, hypothermia, and coagulopathy, often seen in severely injured patients. Perihepatic packing was attempted by some trauma surgeons during the 1970s as an alternative to hepatectomy for severe liver injury, with favorable results. The concept of bail-out surgery and reoperation was introduced during the 1980s as a treatment modality for severe abdominal trauma. This strategy of trauma care was named "damage control surgery" by Rotondo et al in 1993, which consists of initial laparotomy, secondary resuscitation, and definitive surgery. Angiography and TAE may be used during secondary resuscitation for hemostasis. The concept of damage control surgery is now applied not only to severely injured patients but also for other surgical patients in critical condition. Damage control surgery was introduced to Japan during the late 1990s. However, the Japanese experience has been limited because the volume of severe trauma cases is very small.     

Delayed traumatic intracerebral hematoma.

Although delayed traumatic intracerebral hematomas (DTICHs) have been frequently reported since 1970, the time interval from trauma to hemorrhage and diagnosis has not been well defined. Eight patients with DITCH were found among 1,320 head-injured patients admitted to the neurosurgical service through the emergency department from March 1989 to March 1990. The mean time interval between initial and follow-up CT scan was 22 h. The mean time interval between initial trauma and diagnosis of DITCH was 24 h. One patient was diagnosed incidentally by magnetic resonance imaging. Three patients underwent operation and five patients were managed conservatively. Three patients died, resulting in a case mortality rate of 37.5%. The time interval for DTICHs' development and pitfalls in its diagnosis were discussed.     

<Emphasis Type="Italic">Clostridium difficile</Emphasis> Infection: A Surgical Disease in Evolution

Introduction  Several recent publications suggest an increase in the incidence of Clostridium difficile colitis. However, such studies commonly lack denominators over which to index this rise. There is also concern in the literature that disease virulence is increasing. Methods  Billing, admission, operative, and infection databases at a single tertiary care center identified patients admitted from 1990 to 2006 with a diagnosis of C. difficile infection. Grouped by era, case numbers were indexed against overall hospital, operative, and laboratory volumes. C. difficile colectomy cases were individually examined and analyzed. Results  The number of hospitalized patients diagnosed with C. difficile colitis increased in a linear fashion during the study period (1990, 14 cases; 2006, 927 cases). The colectomy per C. difficile case ratio did not change over the study period (era 1, 0.17%; era 2, 0.20%; era 3, 0.16%). Thirteen patients underwent colectomy with 54% surviving. The increase in patients admitted with a diagnosis of C. difficile was significantly associated with hospital volume (p = 0.04), operative volume (p < 0.001), and lab testing volume (p = 0.008). Conclusion  The number of C. difficile patients admitted to our hospital is rising at an alarming rate. This reflects national trends and urgent action seems warranted to prevent a C. difficile epidemic. Originally Presented at: Digestive Disease Week, May 2007, Washington D.C.     

胰腺癌免疫治疗研究热点的文献计量学可视化分析

背景与目的 胰腺癌是恶性程度较高的消化系统肿瘤之一，因其起病隐匿，早期常无典型症状，且肿瘤的侵袭性较强，故预后较差。随着对胰腺癌分子发病机制的深入研究，免疫治疗已成为胰腺癌治疗的新焦点。文献计量学是一种分析某一领域文献、直观地总结文献的趋势并预测研究热点的常用方法。本文旨在通过文献计量和知识图谱可视化分析胰腺癌免疫治疗的研究现状、热点和趋势，为后续的研究提供方向。方法 从Web of Science核心合集中提取相关出版物从开始到2022年5月发表的有关胰腺癌免疫治疗的文献，使用CtieSpace和VOSviewer等软件对该领域文献的国家、机构、作者、参考文献和关键词进行文献计量可视化分析。结果 共纳入2009—2022年发表与胰腺癌免疫治疗相关的英文文献2 230篇，自2016年文献数量每年都在稳定增长。这些文献的7 365位作者来自75个国家/地区的884个机构，共有7 943篇共被引参考文献。发文量最多的国家为美国（n=964），其次是中国（n=552）；发文量最多的机构为美国约翰霍普金斯大学（n=67）和德克萨斯大学MD安德森癌症中心（n=65）；发文量最多的作者为美国约翰霍普金斯大学的Elizabeth M Jaffee（n=41）和Lei Zheng（n=31）。共被引次数最多的文献为“Genomic analyses identify molecular subtypes of pancreatic cancer”（n=161），共被引参考文献时间线图显示，聚类“肿瘤微环境”是从2016年开始一直持续到现在的热点。关键词的突发检测揭示了胰腺癌免疫治疗领域的发展，最初的热点主要是“疫苗”，而近年来重点转移到“伊匹单抗”“检查点阻断”“上皮间质转化”“星状细胞”“巨噬细胞”“错配修复缺陷”和“肿瘤微环境”等。结论 与胰腺癌免疫治疗的相关研究呈持续上升趋势，是胰腺癌治疗的重要研究方向，目前美国在这一研究领域尚处于绝对领先地位。相关研究表明独特的肿瘤微环境可能是胰腺癌恶性程度较高且对放化疗不敏感的主要原因，深入研究胰腺癌肿瘤微环境（TME）的致病机理是目前研究的重点。除此之外，聚焦于“上皮间质转化”和“免疫检查点抑制”等的研究较为普遍，现有的研究表明单一的治疗手段对胰腺癌的治疗效果有限，免疫联合疗法或化疗联合免疫疗法可以进一步提高胰腺癌的临床疗效，是未来临床研究的趋势。     

How to Clear Polytrauma Patients for Fracture Fixation: Results of a systematic review of the literature

IntroductionEarly patient assessment is relevant for surgical decision making in severely injured patients and early definitive surgery is known to be beneficial in stable patients. The aim of this systematic review is to extract parameters indicative of risk factors for adverse outcome. Moreover, we aim to improve decision making and separate patients who would benefit from early versus staged definitive surgical fixation.MethodsFollowing the PRISMA guidelines, a systematic review of peer-reviewed articles in English or German language published between (2000 and 2022) was performed. The primary outcome was the pathophysiological response to polytrauma including coagulopathy, shock/haemorrhage, hypothermia and soft tissue injury (trauma, brain injury, thoracic and abdominal trauma, and musculoskeletal injury) to determine the treatment strategy associated with the least amount of complications. Articles that had used quantitative parameters to distinguish between stable and unstable patients were summarized. Two authors screened articles and discrepancies were resolved by consensus. Quantitative values for relevant parameters indicative of an unstable polytrauma patient were obtained.ResultsThe initial systematic search using MeSH criteria yielded 1550 publications deemed relevant to the following topics (coagulopathy (n = 37), haemorrhage/shock (n = 7), hypothermia (n = 11), soft tissue injury (n = 24)). Thresholds for stable, borderline, unstable and in extremis conditions were defined according to the existing literature as follows: Coagulopathy; International Normalized Ratio (INR) and viscoelastic methods (VEM)/Blood/shock; lactate, systolic blood pressure and haemoglobin, hypothermia; thresholds in degrees Celsius/Soft tissue trauma: traumatic brain injury, thoracic and abdominal trauma and musculoskeletal trauma.ConclusionIn this systematic literature review, we summarize publications by focusing on different pathways that stimulate pathophysiological cascades and remote organ damage. We propose that these parameters can be used for clinical decision making within the concept of safe definitive surgery (SDS) in the treatment of severely injured patients.     

Evidence based diagnostic procedures for the determination of suspected blunt cervical spine injuries. Development of an algorithm

BACKGROUND: The aim of this study was to present existing publications, describing various diagnostic procedures as well as considering the evidence supporting them, to develop a recommendation for diagnosis. MATERIAL AND METHODS: We reviewed relevant publications between 1966 and 2004 by a systemic literature search in MEDLINE, EMBASE, National Guideline Clearinghouse, Cochrane Library as well as a manual reference search. Keywords were cervical spine, cervical vertebrae, spinal, spinal cord, injury, trauma, fracture, dislocation, imaging, radiography, flexion, extension, fluoroscopy, computed tomography, computed scanning, and magnetic resonance imaging. The selected search results were then classified into levels of evidence. RESULTS: From among a total of 10,000 publications, 137 relevant publications were stringently reviewed. The level of evidence is on the whole limited due to deficit data; therefore, only class II-III recommendations are possible. We developed an algorithm for the diagnostic approach to suspected trauma of the cervical spine. This clinical algorithm displays the complex diagnosis of cervical spine injury in a clear and logically structured process. CONCLUSIONS: The diagnostic algorithm for cervical spine injury meets the presently required standards and maximizes care for the newly injured. The development, which can be followed using evidence-based medicine, is transparent and therefore aids the decision process when choosing an adequate diagnostic procedure.     

The management of penetrating rectal and anal trauma: A systematic review

IntroductionTraumatic injuries to the lower gastrointestinal tract (rectum and anus) have been largely reported in the military setting with sparse publications from the civilian setting. Additionally, there remains a lack of international consensus regarding definitive treatment pathways. This systematic review aimed to assess the current literature and propose a standardised treatment algorithm to aid management in the civilian setting.MethodsA systematic review of available literature from 1999 to 2016 that was performed. Primary endpoints were the assessment and surgical management of reported rectal and anal trauma.ResultsSeven studies were included in this review, reporting on 1255 patients. 96.3% had rectal trauma and 3.7% had anal trauma. Gunshot wounds are the most common mechanism of injury (46.9%). The overwhelming majority of injuries occurred in males (>85%) and were associated with other pelvic injuries. Surgical management has substantially evolved over the last five decades, with no clear consensus on best management strategies.ConclusionThere remains significant international discrepancy regarding the management of penetrating trauma to the rectum. Key management principals include the varying use of the direct primary closure, faecal diversion, pre-sacral drainage and/or distal rectal washout (rarely used). To date, there is sparse evidence regarding the management of penetrating anal trauma.     

1990—2021年阿片类药物对肿瘤预后影响相关文献的计量学分析

目的 系统评价和分析1990—2021年阿片类药物与肿瘤预后相关研究的发展趋势,探索该领域的发展方向和研究前沿,旨在为相关研究人员提供参考。

方法 2022年6月19日在Web of Science核心合集（WoSCC）数据库中检索并下载相关出版物及参数,并采用R语言、文献计量学在线分析平台和VOSviewer软件进行文献计量学及可视化分析。

结果 共纳入文献3 211篇,阿片类药物与肿瘤预后相关研究的发文量整体呈递增趋势,其中美国在该领域的发文量最多,中国和意大利分居第二、三位。该领域的主要出版期刊包括Journal of pain and symptom management、Supportive care in cancer和Pain medicine等。此外,阿片类药物对肿瘤发生发展影响的机制研究是该领域的热点方向。

结论 阿片类药物对肿瘤预后影响的相关研究处于持续稳定发展状态,机制研究及临床应用策略仍是该领域的热点方向。