A Systematic Review of Diagnoses with Rosettes Under Dermoscopy.

INTRODUCTION: Rosettes are a cluster of shiny white dots in the shape of a four-leaf clover seen under polarized dermoscopic light. Historically, rosettes were primarily reported in actinic keratoses and squamous cell carcinoma. However, rosettes have also been reported in other conditions. OBJECTIVES: The objective of this systematic review to elucidate the breadth of diagnoses exhibiting this unique dermoscopic phenomenon. METHODS: A review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Literature searches were performed in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science, as well as a manual search of the reference lists of screened articles. RESULTS: A total of 73 articles met the inclusion criteria. Out of these, 47 distinct diagnoses with rosette were identified. Among neoplastic conditions, keratinizing neoplasms had the highest number of articles reported (N = 19). Discoid lupus was the most commonly reported diagnosis within the inflammatory category (N = 6). Molluscum contagiosum was the predominant diagnosis among infectious entities (N = 3), while acroangiodermatitis was the sole diagnosis reported in the vascular category (N = 1). CONCLUSIONS: These findings confirm rosettes are not specific to keratinocytic growths and are observed in a wide range of conditions. Knowledge of the breadth of conditions with rosettes may aid clinicians when developing a differential diagnosis of a growth or an eruption with rosettes under dermoscopy.

Analysis of Conflicts of Interest in Studies Related to Robotics in Gastrointestinal and Abdominal Wall Surgery.

BACKGROUND: Industry payments to physicians represent a potential conflict of interest (COI) and can influence the study conclusions. This study aimed to evaluate the accuracy of the COIs reported in major surgical journals. STUDY DESIGN: Studies with at least one American author published between 2016 and 2021 that discussed observational and intervention studies assessing robotic surgery were included in the analysis. The Centers for Medicare & Medicaid Services' Open Payments database was used to collect the industry payments. A COI is defined as receiving funding from a robotics company while publishing research directly related to the company's products. A COI statement was defined as disclosed (or accurate) if the disclosure statement for the study in question acknowledged funding from the robotics companies. A COI was defined as undisclosed (or inaccurate) if the disclosure statement for the study in question did not acknowledge funding from the robotics companies. RESULTS: A total of 314 studies and 1978 authors were analyzed. Only 13.6% of the studies had accurate COI statements, whereas the majority (86.4%) had inaccurate COI disclosures. Additionally, 48.9% of the authors who received funding of $10,000 to $100,000 failed to report this amount in their disclosures, and 18% of the authors who received funding of $100,000 or more did not report it in their disclosures. CONCLUSIONS: There was a significant discordance between the self-reported COI in gastrointestinal and abdominal wall surgeries. This study calls for continued efforts to improve the definitions of what constitutes a relevant COI and encourages a standardized reporting process. It is imperative for investigators to make accurate disclosure statements.

Critical Appraisal of the Quality of Publications in Hepatobiliary and Pancreatic Surgery Research Using the American College of Surgeons NSQIP Database.

BACKGROUND: The use of the American College of Surgeons (ACS) NSQIP has increased in hepatobiliary and pancreatic surgery (HPB) research as it provides access to high-quality surgical outcome data on a national scale. Using the ACS NSQIP database, this study examined the methodologic reporting of HPB publications. STUDY DESIGN: Web of Science core collection (all editions) was queried for all HPB studies using the ACS NSQIP database published between 2004 and 2022. In addition, a critical appraisal was performed using the JAMA Surgery checklist, Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement, and Reporting of Studies Conducted Using Observational Routinely-Collected Health Data (RECORD) statement. RESULTS: In total, 276 studies were included in the analysis. The median scores for the JAMA Surgery checklist, RECORD statement, and STROBE statement were 4 of 7 (interquartile range [IQR] 3 to 5), 3 of 10 (IQR 2 to 4), and 15 of 21 (IQR 13 to 17), respectively. The criteria with the highest rates of nonadherence were discussing competing risks, clear definitions of inclusion and exclusion criteria, unadjusted and adjusted outcomes, provision of supplementary data, and performing subgroup analyses. Additionally, when examining checklist fulfillment of hepatobiliary studies and pancreatic studies separately, pancreatic studies demonstrated significantly greater fulfillment of the STROBE statement checklist items. CONCLUSIONS: Satisfactory reporting of methodology is present among HPB studies utilizing the ACS NSQIP database, with multiple opportunities for improvement. Areas for improved adherence include discussing competing risks, providing supplementary information, and performing appropriate subgroup analysis. Given the increasing role of large-scale databases in surgical research, enhanced commitment to reporting guidelines may advance HPB research and ensure quality reporting.

The undisclosed disclosures: Conflicts of interest in studies related to robotics in hepatobiliary and pancreatic surgery.

BACKGROUND: The use of robotics in hepatobiliary and pancreatic surgery has increased. With this increased collaboration, there has also been a push toward improving the transparency of conflicts of interest in terms of funding provided by robotics companies. METHODS: Studies with ≥1 American author published between 2016 and 2020 discussing robotic hepatobiliary and pancreatic surgery were included in the analysis. The Centers for Medicare and Medicaid Services Open Payments Program was used to evaluate the accuracy of industry payment disclosures. Conflict of interest was defined as a lack of disclosure of ≥$100 funding from any robotics company in the United States. The primary outcome of this study was to determine the efficacy of the current standard conflict of interest reporting in surgery. RESULTS: A total of 355 studies (2,413 authors) were included. Of the studies that received robotics funding (n = 133), 20.3% did not disclose their conflicts of interest, whereas 79.7% had a conflict of interest disclosure. However, most of the disclosures (76.5%) were inaccurate. CONCLUSION: The findings of this study require an update in journal policies to ensure the accurate disclosure of conflicts of interest in robotic hepatobiliary and pancreatic surgery studies. Similarly, the investigators should ensure that their disclosures are accurate. Finally, surgeons must be more on top of their relationships with these companies and consider their vulnerability to bias.

Strategies to reduce limb ischemia in peripheral venoarterial extracorporeal membrane oxygenation: A systematic review and Meta-analysis.

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides cardiovascular and respiratory support for patients in cardiogenic shock; yet, complications are a frequent source of morbidity and mortality. Limb ischemia can be potentially mitigated by limp perfusion protection strategies (LPPS). We performed a systematic review and meta-analysis to evaluate the safety and efficacy of two LPPS in patients treated with peripheral VA-ECMO - prophylactic insertion of a distal perfusion catheter (DPC) and small bore (<17 Fr) arterial return cannula. Among 22 included studies, limb ischemia was reduced in patients receiving a small arterial cannula (OR 0.40, 95% CI 0.24-0.65; p < 0.001) and in patients receiving a prophylactic DPC (OR 0.31, 95% CI 0.21-0.47; p < 0.001). Mortality was not significantly reduced with either a small arterial cannula (OR 0.70, 95% CI 0.23-2.18; p = 0.54) or prophylactic DPC strategy (OR 0.89, 95% CI 0.67-1.17; p = 0.40). As such, prophylactic insertion of a DPC or smaller bore arterial return cannula appear to reduce the risk of lower limb ischemia in this analysis. Further data are needed to confirm these findings. Registration: Registered in PROSPERO Database (Registration CRD42020215677).

Lactate Clearance Is Associated With Improved Survival in Cardiogenic Shock: A Systematic Review and Meta-Analysis of Prognostic Factor Studies.

OBJECTIVE: Elevated blood lactate levels are strongly associated with mortality in patients with cardiogenic shock. Recent evidence suggests that the degree and rate at which blood lactate levels decrease after the initiation of treatment may be equally important in patient prognosis. We performed a systematic review and meta-analysis to evaluate the usefulness of lactate clearance as a prognostic factor in cardiogenic shock. METHODS AND RESULTS: We performed searches of Ovid MEDLINE, Elsevier EMBASE, EBM Reviews-Cochrane Central Register of Controlled Trials, and Web of Science to identify studies comparing lactate clearance between survivors and nonsurvivors at one or more timepoints. Both prospective and retrospective studies were eligible for inclusion. Two study investigators independently screened, extracted data, and assessed the quality of all included studies. Twelve studies were included in the meta-analysis. The median lactate clearance at 6-8 hours was 21.9% (interquartile range [IQR] 14.6%-42.1%) in survivors and 0.6% (IQR -3.7% to 14.6%) in nonsurvivors. At 24 hours, the median lactate clearance was 60.7% (IQR 58.1%-76.3%) and 40.3% (IQR 30.2%-55.8%) in survivors and nonsurvivors, respectively. Accordingly, the pooled mean difference in lactate clearance between survivors and nonsurvivors at 6-8 hours was 17.3% (95% CI 11.6%-23.1%, P < .001) at 6-8 hours and 27.9% (95% CI 14.1%-41.7%, P < .001) at 24 hours. CONCLUSIONS: Survivors had significantly greater lactate clearance at 6-8 hours and at 24 hours compared with nonsurvivors, suggesting that lactate clearance is an important prognostic marker in cardiogenic shock.