bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of patient-related factors on successful autologous fat injection laryngoplasty in thyroid surgical treated related unilateral vocal fold paralysis- observational study
Authors: Lin Wen-Yang , Chang Wen-Dien , Ko Li-Wei , Tsou Yung-An , Chen Sheng-Hwa
Published: January 2020

The aim of this study was to compare major voice indicators in different sub-categories, the outcome of lipoinjection for patients might be refined and some voice prognostic factors could be more particularized in specific sub-groups. This is an observational study, and sub-grouped UVFP patients into 3 categories: male vs female, BMI ≥ 24 vs BMI < 24, Age ≥ 60 vs Age < 60 for more detailed exploring whether sub-categories affected voice diagnostic and prognostic parameters. Patients’ voice data is recorded before and after the autologous fat injection laryngoplasty by a multidimensional voice program. Overall, 73 patients’ voice performance were improved 12 months later by vocal fold lipoinjection. In the comparison of the male with female revealed female obtained better Jita than male by surgery (Female: 174.50 ± 100.58 Hz; Male: 294.82 ± 253.65 Hz; P < .05). BMI ≥ 24 vs BMI < 24 showed no statistical difference. Patients aged under 60 demonstrated better Highest F0, lowest F0, NHR and ShdB than elder ones 12 months after receiving vocal fold lipoinjection. Thus, Noise-to-harmonics ratio (NHR), voice turbulence index (VTI), and ShdB (Absolute shimmer, dB) may be the major post-operative evaluating markers of patients’ age under 60. Voice parameters showed no significant correlation with BMI. Female patients performed lower Jita (Absolute jitter, μsec) than male patients 1 year after receiving treatment. The experimental results in this study showed UVFP patients’ gender and age may stand as significant categories on analyzing clinical voice prognostic indicators, ShdB and Jita of autologous injection laryngoplasty.
Effects of electroacupuncture on patients with chronic urinary retention caused by a lower motor neuron lesion
Authors: Zhou Jing , Liu Sixing , Jiao Ruimin , Li Chunbin , Liu Zhishun
Published: January 2020

Chronic urinary retention (CUR) is defined as a non-painful bladder that remains palpable or percussible after the patient has passed urine. Acupuncture may decrease PVR and improve bladder function in patients with neurogenic CUR. The aim of this study was to preliminarily observe the effectiveness of electroacupuncture (EA) for patients with CUR caused by a lower motor neuron lesion and to provide some therapeutic data for further study.

This study was a pilot study of 30 patients with CUR caused by a lower motor neuron lesion. Patients were treated with EA for 12 weeks with 36 sessions of EA.

Responders were defined as participants with a decline in postvoid residual urine (PVR) volume after spontaneous urination of ≥50% from baseline. The proportion of responders, change in PVR volume from baseline after spontaneous urination, and the proportion of patients with severe difficulty with urination, who required assistance with bladder emptying and with stool retention, were measured at weeks 4, 8, and 12.

Thirty patients were included in this study, and 23 completed 12 weeks of treatment. The proportion of responders at weeks 4, 8, and 12 was 6.67%, 28%, and 43.48%, respectively. Decrease in PVR volume, compared with baseline, was significant at all asessment timepoints. The proportion of patients with severe difficulty with urination, who required assistance with bladder emptying and with stool retention, decreased after treatment.

EA is a potential treatment for improving bladder function in patients with CUR caused by a lower motor neuron lesion.
Reduced field-of-view diffusion-weighted imaging (DWI) in patients with gastric cancer
Authors: Cai Jin-Song , Chen Hai-Yan , Chen Jie-Yu , Lu Yuan-Fei , Sun Jian-Zhong , Zhou Ying , Yu Ri-Sheng
Published: January 2020

To evaluate the qualitative image quality and quantitative apparent diffusion coefficient (ADC) value of reduced field-of view (rFOV) and full field-of-view (fFOV) diffusion-weighted imaging (DWI) sequences at 3.0 T in patients with gastric cancer.

Fifty-three patients (37 males, 16 females; mean age, 63.3 ± 10.3 years) with 60 lesions with gastric cancer who underwent magnetic resonance (MR) scans, including both rFOV-DWI and fFOV-DWI, were retrospectively analyzed. Two observers subjectively evaluated image quality for both the fFOV-DWI and rFOV-DWI sequences regarding the anatomic details, distortion, lesion conspicuity, artifacts, and overall image quality. The mean ADC values of gastric cancer were calculated. The Wilcoxon test and paired samples t test were used. Interobserver agreement was assessed using kappa statistics.

The mean scores based on the 2 observers demonstrated significant differences in image quality in terms of anatomic details, distortion, lesion conspicuity, artifacts and overall image quality at both b values between rFOV-DWI and fFOV-DWI (P < .05) in the whole gastric area. rFOV-DWI yielded significantly better scores in image quality at b = 800 seconds/mm2 (P < .05) in patients with esophagogastric junction cancers, but there were no significant differences in the gastric corpus and gastric antrum region. The mean tumor ADC values of rFOV-DWI were significantly lower than those of fFOV-DWI (1.237 ± 0.228 × 10–3 mm2/second vs 1.683 ± 0.322 × 10–3 mm2/second, P < .001).

rFOV-DWI yielded significantly better image quality (anatomic details, distortion, lesion conspicuity, artifacts, overall image quality) and more accurate ADC measurements than fFOV-DWI did.
Ultrasound-guided percutaneous treatment of a calcific acromioclavicular joint
Authors: Iovane Angelo , Di Gesù Marco , Mantia Francesco , Thomas Ewan , Messina Giuseppe
Published: January 2020

Rationale:

Calcific tendinopathy is one of the most frequent causes of nontraumatic shoulder pain. However, intra-articular calcifications appear to be an infrequent condition. We herein report a rare case study of an intra-articular calcification of the acromioclavicular joint.

Patient concerns:

A 46-year-old man presented with an acute pain in the anterior superior region of the left shoulder which also radiated to the left cervical region. The man during the physical evaluation also presented severe functional limitation of the shoulder movements in all planes of motion.

Diagnoses:

The diagnosis was carried out through a radiographic and an echotomographic examination, highlighting the intra-articular calcific formation associated to a reactive inflammatory reaction.

Interventions:

An ultrasound-guided percutaneous treatment following the guidelines for calcific tendinopathy of the shoulder was carried out.

Outcomes:

The posttreatment was satisfactory with the disappearance of the pain and the recovery of the shoulder movements in all planes of motion.

Lessons:

We can affirm that the ultrasound-guided percutaneous treatment in patients with calcification of the acromion-clavicular joint represents a valid and nonpainful therapeutic treatment.
Necrotizing tracheobronchitis causing airway obstruction complicated by pandemic 2009 H1N1 influenza
Authors: Chang Jinsun , Kim Tae-Ok , Yoon Joon-Young , Kho Bo-Gun , Shin Hong-Joon , Kwon Yong-Soo , Kim Yu-Il , Lim Sung-Chul
Published: January 2020

Rationale:

Influenza is an infection caused by the influenza virus, and its symptoms are mostly mild and self-limiting. However, influenza can cause severe or fatal complications in high-risk patients. Although tracheobronchitis is one of the common complications of influenza, necrotizing tracheobronchitis is very rare. Herein, we describe a case of necrotizing tracheobronchitis causing airway obstruction complicated by pandemic 2009 H1N1 influenza.

Patient concerns:

A 60-year-old man presented with fever and dyspnea. On arrival at the emergency room (ER), the patient received oxygen 4 L/minute via a nasal prolong owing to mild hypoxemia. And invasive mechanical ventilation was needed 5 hours after arrival at the ER due to progressive hypoxemia.

Diagnoses:

Fiberoptic bronchoscopy was performed owing to bloody secretion in the endotracheal tube and revealed diffuse tracheobronchitis with necrotic and hemorrhagic materials obstructing the trachea and bronchus. The pandemic 2009 H1N1 influenza virus was detected from the bronchial washing sample; no other microorganism was detected.

Intervention:

He received peramivir plus oseltamivir and broad-spectrum antibiotics.

Outcomes:

The bloody secretion continued. He developed cardiac arrest due to airway obstruction on the 6th day of admission. After cardiac arrest, his condition progressed to multi-organ failure, and the patient died on the 10th day of admission.

Lessons:

We suggest that necrotizing tracheobronchitis be considered in patients with influenza who present with unexplained hypoxemia.
Effect of serotonin-norepinephrine reuptake inhibitors for patients with chemotherapy-induced painful peripheral neuropathy
Authors: Song Soo Youn , Ko Young Bok , Kim Hyeun , Lee Geon Woo , Yang Jung Bo , Chang Ha Kyun , Kwak Sang Mi , Jung Jaeyun , Lee Siyeo , Lee Sun Yeul , Yoo Heon Jong
Published: January 2020

Background:

To compare the efficacy of serotonin-norepinephrine reuptake inhibitors (SNRIs) treatment for chemotherapy-induced peripheral neuropathy (CIPN)

Methods:

Two authors independently searched MEDLINE, Embase, Cochran Library, and Web of Science to identify and review articles published from January 1998 until December 2018 according to selection criteria. Outcomes were expressed as mean difference, the pooled odds ratio, or relative risk in a meta-analysis model.

Results:

A total of 10 studies were included in this meta-analysis: 6 randomized-controlled studies and 4 observational studies. Meta-analysis showed that CIPN was improved after treatment with SNRI (standardized mean difference = 2.20; 95% confidence interval, 0.90–3.49; I
2 = 93% in 3 randomized controlled studies). Somnolence and insomnia occurred in <15% of patients. Incidence of somnolence was lower than with pregabalin treatment, and insomnia was comparable to that in expectant management or pregabalin treatment. Incidence of nausea and vomiting was higher than in expectant management, but no significant difference was found when compared to expectant management.

Conclusion:

From the several available studies suitable for indirect comparison, SNRI shows excellent efficacy and tolerability to CIPN. SNRI could provide an important treatment option for CIPN.
Impact of nighttime and weekends on outcomes of emergency trauma patients
Authors: Hirose Tomoya , Kitamura Tetsuhisa , Katayama Yusuke , Sado Junya , Kiguchi Takeyuki , Matsuyama Tasuku , Kiyohara Kosuke , Takahashi Hiroki , Tachino Jotaro , Nakagawa Yuko , Mizushima Yasuaki , Shimazu Takeshi
Published: January 2020

The impact of time of day or day of week on the survival of emergency trauma patients is still controversial. The purpose of this study was to evaluate the outcomes of these patients according to time of day or day of week of emergency admission by using data from the nationwide Japan Trauma Data Bank (JTDB).

This study enrolled 236,698 patients registered in the JTDB database from 2004 to 2015, and defined daytime as 09:00 am to 16:59 pm and nighttime as 17:00 pm to 08:59 am, weekdays as Monday to Friday, and weekends as Saturday, Sunday, and national holidays. The outcome measures were death in the emergency room (ER) and discharge to death.

In total, 170,622 patients were eligible for our analysis. In a multivariable logistic regression adjusted for confounding factors, both death in the ER and death at hospital discharge were significantly lower during the daytime than at nighttime (623/76,162 [0.82%] vs 954/94,460 [1.01%]; adjusted odds ratio [AOR] 0.79; 95% confidence interval [CI] 0.71–0.88 and 5765/76,162 [7.57%] vs 7270/94,460 [7.70%]; AOR 0.88; 95% CI 0.85–0.92). In contrast, the weekdays/weekends was not significantly related to either death in the ER (1058/114,357 [0.93%] vs 519/56,265 [0.92%]; AOR 0.95; 95% CI 0.85–1.06) or death at hospital discharge (8975/114,357 [7.85%] vs 4060/56,265 [7.22%]; AOR 1.02; 95% CI 0.97–1.06).

In this population of emergency trauma patients in Japan, both death in the ER and death at hospital discharge were significantly lower during the daytime than at night, but the weekdays/weekends was not associated with outcomes of these patients.
Early detection of hepatocellular carcinoma in patients with diabetes mellitus
Authors: Nouso Kazuhiro , Furubayashi Yoshie , Shiota Shohei , Miyake Nozomi , Oonishi Ayano , Wakuta Akiko , Kariyama Kazuya , Hiraoka Atsushi , Tsuji Kunihiko , Itobayashi Ei , Shimada Noritomo , Ishikawa Toru , Tada Toshifumi , Toyoda Hidenori , Kumada Takashi
Published: January 2020

Objectives

Diabetes mellitus is a risk factor for non-B, non-C hepatocellular carcinoma (NBNC-HCC); however, the number of diabetes mellitus patients is too large to examine tumor occurrence with periodic imaging modalities. Thus, the aim of this study was to develop a novel strategy for early detection of NBNC-HCC in diabetes mellitus patients.

Patients and methods

Ninety-three diabetes mellitus patients who had a single NBNC-HCC tumor less than 2 cm in diameter were selected from 6789 HCC patients. As controls, 172 tumor-free diabetes mellitus patients were enrolled. Characteristics were compared between groups. Furthermore, the efficacy of FIB4A, a new integrated score with FIB4 and alpha-fetoprotein, was analyzed as a marker for the early diagnosis of NBNC-HCC.

Results

Age, percentage of males, alcohol consumption, total bilirubin, transaminases, γ-glutamyl transpeptidase, FIB4 index, alpha-fetoprotein, and des-gamma-carboxy-prothrombin were higher in NBNC-HCC patients, whereas albumin and platelet counts were higher in the diabetes mellitus control group. Among these factors, the FIB4 index showed the highest odds ratio [OR: 20.0, 95% confidence interval (CI): 9.60–41.7] followed by alpha-fetoprotein (OR: 12.8, 95% CI: 6.53–25.4). A newly developed score, FIB4A, showed the highest area under the receiver operating characteristic curve (0.959) among the factors examined. The sensitivity was 86.2% at a Youden index cutoff (3.5) and it increased to 95.4%, while keeping high specificity (70.9%) when a cutoff of 2.5 was used.

Conclusion

FIB4A is a potential marker for early detection of NBNC-HCC in patients with diabetes mellitus. However, further studies are needed to confirm these findings.
Incidence rates and clinical characteristics of primary gastrointestinal non-Hodgkin lymphoma: a population study
Authors: Dizengof Vitaly , Levi Itai , Etzion Ohad , Fich Alexander , Blum Avital , Chertok Ilana R. Azulay , Ben-Yakov Gil , Rouvio Ory , Greenbaum Uri
Published: January 2020

Background & Aims:

After the rise of lymphoma incidence in the 1990’s, there is a paucity of epidemiologic studies describing the characteristics of primary gastrointestinal non-Hodgkin’s lymphoma (PGIL). This epidemiologic survey aims to identify recent trends in PGIL.

Methods:

A retrospective, population-based study describing adult patients with PGIL in the Israeli Negev region between 1998 and 2013.

Results:

131 patients were diagnosed with PGIL, representing an annual incidence rate of 22.42/100,000, compared to 35.87/100,000 in the overall Israeli population. Both incidence rates did not significantly change during the study period. The median age was 66 years, and the most common presentation was in the stomach (49.6%) and oral cavity (18.3%). Histologically, diffuse large B cell lymphoma (DLBCL) was predominant (55.0%). Most patients (66.4%) had early stage disease. Only T-cell lymphoma showed a male predominance (14.7% versus 5.4%,P=0.008). Fifty patients (44.2%) hadH. pyloritesting, and 35 (70.0%) were positive. Of these, 91.4% received eradication treatment, and 57.1% were negative thereafter.

Most patients received CHOP or RCHOP protocols (16.0% and 48.1%, respectively). Complete response was achieved in 53.4%. Median follow-up was 48 months, and 62 patients (47.3%) died during the study period. Liver involvement had a worse prognosis, (33.0% 5-year survival) compared to upper and lower GI disease(70.5% and 46.8% respectively,P=0.003 for the comparison between liver and other locations). T-cell lymphoma had worse survival (11 months vs. not reached,P=0.003).

Conclusions:

This study demonstrates the incidence, and clinical characteristics of PGIL in the Negev region. It is important to identify disease characteristics, thus facilitating better disease detection and prognostication.
Role of intensive dietary and lifestyle interventions in the treatment of lean nonalcoholic fatty liver disease patients
Authors: Hamurcu Varol Pinar , Kaya Eda , Alphan Emel , Yilmaz Yusuf
Published: January 2020

Background/aim

Although weight loss is recommended for the treatment of nonalcoholic fatty liver disease (NAFLD) in overweight and obese individuals, this treatment modality remains questionable in lean individuals. In this study, we investigated the effects of medical nutrition therapy (MNT) and intensive lifestyle interventions (ILIs) for NAFLD in lean versus obese patients.

Methods

In total, 35 patients (14 lean and 21 obese) were included in the study. All patients underwent transient elastography examinations, and controlled attenuation parameter (CAP) of >238 dB/m was indicative of hepatic steatosis. After 8 weeks of dietitian follow-up with MNT and ILI, the patients were compared with the baseline.

Results

Significant weight loss was recorded in both lean (5.4%) and obese patients (5.7%) with NAFLD. The mean BMI decreased from 23.9 (20.5–24.8) to 22.4 (19.5–24.2) kg/m2 (P = 0.001) in lean patients and from 34.0 (30.0–42.0) to 31.6 (26.9–42.5) kg/m2 (P < 0.001) in obese patients. The alanine aminotransferase level significantly decreased from 56 (15–163) to 28 (13–98) U/L (P = 0.010) in lean patients and from 27 (13–81) to 22 (13–46) U/L (P = 0.018) in obese patients. The median CAP decreased from 299 (246–360) to 236 (169–318) dB/m (P = 0.002) in lean patients and from 325 (258–400) to 253 (202–383) dB/m (P < 0.001) in obese patients. Moreover, remission of hepatic steatosis was detected in eight lean patients (57.1%) and eight obese patients (38.1%).

Conclusion

These results indicate that 5% body weight loss in effective in both obese and lean patients resulting in a similar NAFLD remission.
Combined use of rosuvastatin and ezetimibe improves hepatic steatosis in patients with dyslipidemia
Authors: Lee Won Dong , Kim Beom Kyung , Park Jun Yong , Kim Do Young , Ahn Sang Hoon , Han Kwang-Hyub , Kim Seung Up
Published: January 2020

Background and aims

Rosuvastatin plus ezetimibe are beneficial for the management of dyslipidemia. We investigated whether rosuvastatin plus ezetimibe improves hepatic steatosis in patients with dyslipidemia.

Methods

Between January and August 2018, 114 patients with dyslipidemia treated for 6 months with rosuvastatin plus ezetimibe were analyzed in this retrospective cohort study. The degree of hepatic steatosis was assessed using the hepatic steatosis index (HSI). Hepatic steatosis improvement and presence of fatty liver were defined as a ≥5% reduction in HSI score and HSI ≥36, respectively.

Results

The mean age of the study population (50 males and 64 females) was 57.4 years. At baseline, the mean BMI total cholesterol level, low-density lipoprotein cholesterol level, high-density lipoprotein cholesterol level, triglyceride level, and HSI were 25.1 kg/m2, 207.4 mg/dL, 126.1 mg/dL, 52.9 mg/dL, 146.4 mg/dL, and 36.1, respectively. During the 6-month treatment, hepatic steatosis burden was constant (mean HSI = 36.3 and 36.4 at 3 and 6 months, respectively). On multivariate analyses, ultrasonographic fatty liver and HSI ≥36 were selected as independent predictors of hepatic steatosis improvement. However, when 53 (46.5%) patients with fatty liver (HSI ≥ 36) were selected, hepatic steatosis burden was significantly improved (mean HSI = 40.8, 39.3, and 39.7 at baseline, 3 months, and 6 months, respectively).

Conclusions

The use of rosuvastatin plus ezetimibe for the management of dyslipidemia did not improve hepatic steatosis burden in all patients with dyslipidemia, but it improved hepatic steatosis burden in the subgroup with fatty liver.
Outcome of radioiodine therapy in thyroid cancer patients with recent contrasted computed tomography
Authors: Rodriguez Justin D. , Kirk Deepa , Benefield Thad , Maygarden Susan J. , Pou Karla , Kim Lawrence T. , Hackman Trevor G. , Khandani Amir H.
Published: January 2020

Objective

To document the outcome of radioiodine therapy (RIT) in differentiated thyroid cancer (DTC) patients with recent contrasted computed tomography (CCT).

Methods

Eighteen patients with DTC and recent thyroidectomy who underwent RIT within 90 days after a CCT were included. Disease status following RIT and whether the expected response to RIT was achieved were documented. Disease status was classified into one of three categories based on the patient’s thyroglobuline level, radioiodine scan (RIS), and other imaging modalities: no evidence of disease (NED), microscopic residual disease (MRD), or gross residual disease (GRD). Expected response to RIT was based on the overall interpretation of the referring physicians of follow up thyroglobuline values, RIS findings and clinical assessment as reflected in progress notes. Follow-up stimulated thyroglobuline and (or) RIS was performed on average 10.8 months after RIT (median 12 months). The last progress note reviewed was on average 33.3 months after RIT (median 31 months).

Results

There were 12 patients with NED, two with MRD and four with GRD. Expected response to RIT was achieved in 17 patients. In one patient, the effectiveness of RIT could not be determined.

Conclusion

RIT in postthyroidectomy setting can be successfully performed within 90 days after CCT. Further research is needed to confirm our findings.
Study of novel deformable image registration in myocardial perfusion single-photon emission computed tomography
Authors: Ito Toshimune , Onoguchi Masahisa , Okuda Koichi , Shibutani Takayuki
Published: January 2020

Objective

In the present study, deformable image registration (DIR) technology was applied to gated myocardial perfusion single-photon emission computed tomography (G-MPS) reconstructed images in distorting all image phases. We aimed to define a new method of end-diastole compatible image registration and verify the clinical usability for any cardiac volume.

Methods

Projection images were created using the Monte Carlo simulation. All image phases were shifted to fit the end-diastole phase by applying DIR to images that were reconstructed from projection images. Defect ratios were subsequently evaluated using the simulated images of the anterior wall simulated ischemia. Furthermore, receiver operating characteristic (ROC) analysis was performed for the clinical evaluation of DIR and nongated images. To this end, normal volume and small hearts of 33 patients without coronary artery disease and 55 with single vessel disease (coronary stenosis > 70%) were evaluated.

Results

Defect ratio analysis for voxel values of 25–100 were 75.7–21.3 for nongated and 74.7–15.6 for DIR images. For normal cardiac volume, the area under the ROC curve was 0.901 ± 0.088 for nongated and 0.925 ± 0.073 for DIR images (P = 0.078). Finally, for small cardiac volume, the area under the ROC curve was 0.651 ± 0.124 for nongated and 0.815 ± 0.119 for DIR (P < 0.01).

Conclusions

In the present study, we developed a new registration technique by applying DIR to G-MPS images. When optimal DIR conditions were applied, the resolution of G-MPS images was improved. Furthermore, the diagnostic ability was improved in cases of small cardiac volume.
Improving Self-Care Outcomes in Ostomy Patients via Education and Standardized Discharge Criteria
Authors: Millard Rachel , Cooper Denise , Boyle Mary Jo
Published: January 2020

Adjusting to life with a new ostomy is a daunting prospect for many patients. Without proper education, complications can occur, some requiring hospital readmission. Many home healthcare nurses also face the challenge of training new ostomy patients in self-care. The purpose of this quality improvement pilot study was to improve outcomes in a sample of new ostomy patients by implementing an intervention consisting of nurse and patient education. The study was conducted at a Southern California home healthcare agency with an average patient census of 270. The participants were 30 home healthcare nurses (6 licensed vocational nurses and 24 registered nurses). We followed the outcomes of four home healthcare patients with new ostomies. The nurse ostomy education session included both didactic and hands-on components to promote practice change. Patient education was guided by the use of an evidence-based ostomy skills checklist adapted from the Wound, Ostomy, and Continence Nurses Society's ostomy discharge criteria. Nurse's skills and competence were measured and compared via results from a 10-question pre- and postintervention nurse self-assessment survey. Patient outcomes were measured and compared via pre- and postintervention chart reviews examining three factors: number of weeks on service, number of visits to reach independence, and number of unscheduled visits. Statistical analysis of survey data showed a significant change in the scores for all questions, indicating the nurses felt more confident managing ostomies after the education session. After the intervention, the number of weeks patients were on service for a new ostomy diagnosis decreased by an average of 1.5 weeks; patients required 50% fewer visits to reach independence; and unscheduled visits decreased by 500%.
Identifying Targets to Improve Heart Failure Outcomes for Patients Receiving Home Healthcare Services
Authors: Kang Youjeong , Sheng Xiaoming , Stehlik Josef , Mooney Kathi
Published: January 2020

Heart failure (HF) is one of the leading causes of rehospitalization in the United States. Due to the complex nature of HF, the provision of Medicare-certified home healthcare services has increased. Medicare-certified home healthcare agencies measure and report patients' outcomes such as functional status, activities of daily living (ADL), and instrumental activities of daily living to the Centers for Medicare and Medicaid Services. These metrics are assessed using the Outcome and Assessment Information Set (OASIS). As a large data set, OASIS has been used to advance care quality in multiple ways including identifying risk factors for negative patient outcomes. However, there is a lack of OASIS analyses to assess the relationship between functional status and the role of other factors, such as pain, in impeding recovery after hospitalization among HF patients. Therefore, the purpose of this study is to identify the relationship between functional status and pain using the OASIS database. Among 489 HF patients admitted to home healthcare, 83% were White, 57% were female, and the median age was 80. Patients who reported daily but not constant activity-interfering pain at discharge demonstrated the least improvement in functional performance as measured by ADLs, whereas patients without activity-interfering pain demonstrated the greatest improvement in ADL performance (p value = 0.0284). Tracking individual patient ADL scores, particularly the frequency of activity-interfering pain, could be a key indicator for clinical focus for patients with HF in the home healthcare setting.
Analysis of the Curative Effect of the Anterior Approach to the Lower Cervical Spine for Cervicothoracic Spinal Tuberculosis
Authors: Li Zhaowei , Li Kunxiang , Tang Baoming , Ren Rong , Zhang Yuan , Li Zeqing , Wang Zengdong , Zhang Xuebin
Published: January 2020

Background:

The purpose of this study was to explore the clinical effect of the anterior approach to the lower cervical spine for cervicothoracic spinal tuberculosis (CTSTB).

Methods:

A total of 8 patients (6 males and 2 females) with CTSTB diagnosed by imaging examination and γ-interferon test, underwent the first stage lesion removal, bone grafting and internal fixation through the anterior approach to the lower cervical spine, were studied. Then, the clinical efficacy was evaluated using statistical analysis based on the materials about the Cobb angle of kyphosis, visual analog scale (VAS), Frankel grade, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).

Results:

All patients’ age ranged from 28 to 64 years (mean 46.2 ± 16.3). The mean operation time was 145 minutes (range 90–180 mins), intraoperative blood loss was 425 mL (range 200–1000 mL), and the average bone fusion time was 7.4 months. Postoperative neurological function of Frankel grading was significantly improved compared with that of preoperative. At final follow-up, the kyphosis angle was significantly decreased to 10 ± 2.1°, the mean VAS score was 1.6 ± 0.9 showing significant improvement, ESR and CRP returned to normal. The incidence of complications within 3 months after surgery was 25%, and the incidence of complications directly related to surgery was 12.5% (cerebrospinal fluid leakage).

Conclusion:

On the basis of familiarity with the anatomical structure and combining with the experience of the surgeon, the anterior approach to the lower cervical spine can be an effective treatment method for CTSTB.
Comparison of Different Intraarticular Injection Substances Followed by Temporomandibular Joint Arthroscopy
Authors: Sakalys Dovydas , Dvylys Dominykas , Simuntis Regimantas , Leketas Marijus
Published: January 2020

Nowadays, temporomandibular joint (TMJ) arthroscopies are often finished with intraarticular injections. There are a couple of different substances that can be injected into the articular cavity following arthroscopy; however, it is still unclear which one can help to reach the best clinical results.

The aim of this systematic review was to compare different substances that can be injected intraarticularly following TMJ arthroscopy to enhance clinical success.

A review protocol was registered in PROSPERO (Registration number: CRD42018114833). An electronic search was performed using PubMed, Cochrane Library, PlosOne, and Science Direct databases using a combination of the terms “temporomandibular” and “arthroscopy” to identify clinical trials published from 2009 until 2019. Mean differences of pain levels were evaluated in random-effect meta-analysis.

In total, 951 records were screened, of which only 3 fulfilled the inclusion criteria and were included into qualitative data synthesis, and only 2 articles were included into quantitative data analysis.

The results showed that subjects who received plasma rich in growth factors intraarticular injections had statistically significantly lower pain levels 18 months postoperatively than patients who received hyaluronic acid injections.

The results of the meta-analysis revealed that intraarticular injections followed by TMJ arthroscopy were more effective than arthroscopy alone in pain management (mean difference = −1.00, 95% confidence interval: −4.76 to 2.77, I
2 = 97% with significant heterogeneity).

The authors conclude that, although the sample is not extensive (only 3 studies), a tendency towards the superiority of plasma rich in growth factors over other treatments is seen in pain management of TMD.
Apert Syndrome Management: Changing Treatment Algorithm
Authors: Raposo-Amaral Cassio Eduardo , Denadai Rafael , Oliveira Yuri Moresco de , Ghizoni Enrico , Raposo-Amaral Cesar Augusto
Published: January 2020

Background:

The purpose of this study is to review 10 years of surgical experience in the management of Apert syndrome, focusing on an updated algorithm which includes hand reconstruction and posterior vault distraction osteogenesis (PVDO). Additionally, the authors compare PVDO, which is currently used, with fronto-orbital advancement (FOA), which was utilized in a previous algorithm.

Methods:

An observational retrospective study was performed on consecutive patients with Apert syndrome who underwent upper and lower limb reconstruction and craniofacial surgery between 2007 and 2017. A modified Clavien–Dindo surgical complication scale was used to stratify complications between PVDO and FOA. Demographic, surgical, and outcome data was also recorded. The blood transfusion rate between PVDO and FOA was also assessed and compared utilizing the Student t test.

Results:

The present study included 69 patients with Apert syndrome (34 males and 35 females). Craniofacial surgeries were performed on a total of 38 patients. A total of 210 operations were performed on the respective upper and lower limbs of patients included in this study. A total of 18 patients underwent PVDO (n = 9) and FOA (n = 9). Posterior vault distraction osteogenesis required significantly less transfused blood volume than FOA (P < 0.05). Complication rate and length of hospital stay were similar for each procedure.

Conclusion:

An updated algorithm to treat Apert patients was implemented. Posterior vault distraction osteogenesis incorporated into an updated algorithm results in a lower blood transfusion rate.
Relationship Between Primary Acquired Nasolacrimal Duct Obstruction, Paranasal Abnormalities and Nasal Septal Deviation
Authors: Dikici Oğuzhan , Ulutaş Hafize Gökben
Published: January 2020

Objectives:

This study aimed to investigate the relationship between nasal septal deviation and paranasal abnormalities in the etiology of primary acquired nasolacrimal duct obstruction (PANDO).

Methods:

A total of 37 (8 men, 29 women) patients (48 eyes with PANDO) between the ages 20 and 77 years (mean age, 52.8 ± 13.1 years) were included in the study. In the axial sections of paranasal sinus computed tomography, the transverse diameters at the most upper part and the most distal part of the nasolacrimal canal were separately measured. In addition, the relationships between PANDO and nasal septal deviation, inferior turbinate hypertrophy, agger nasi cells, paradoxical middle turbinate, concha bullosa, and the angle between the bony inferior turbinate and medial wall of the maxillary sinus were investigated.

Results:

A statistically significant relationship was found between PANDO and the axial location of septal deviation classification, axial angle of septal deviation classification, paradoxical middle turbinate, angle between the bony inferior turbinate and medial wall of the maxillary sinus and inferior meatus measure.

Conclusion:

The authors concluded that the location and angle of the nasal septal deviation in the axial plane, width of the angle between the bony inferior turbinate and medial wall of the maxillary sinus, inferior meatus measure, and paradoxical middle turbinate may be effective factors in the etiology of PANDO.
Cervical Spine Injuries in Pediatric Maxillofacial Trauma: An Under-Recognized Problem
Authors: Goodenough Christopher J. , Moffitt Joseph K. , Wainwright D’Arcy J. , Cantor Andrew D. , Nguyen Phuong D. , Teichgraeber John F. , Greives Matthew R.
Published: January 2020

Pediatric cervical spine injuries (CSI) are uncommon events, but can be devastating injuries. Facial fractures have been associated with injuries to the cervical spine in children, but may be deemed isolated facial fractures and bypass the standard trauma pathway. The objective of this study is to describe the mechanisms, associated injuries and outcomes of pediatric cervical spine injuries in patients with known maxillofacial trauma at a level 1 trauma center. An analysis was performed of all patients under the age of 18 with maxillofacial trauma admissions to a single level 1 trauma center, from 2006 to 2015. Patients were stratified based on the presence or absence of a cervical spine injury. Data was abstracted to include demographic, mechanism and clinical outcomes data. There were 1274 patients who were admitted with maxillofacial trauma during the study period. Of these, 72 (5.7%) experienced a cervical spine injury. Factors associated with cervical spine injuries include older age and penetrating mechanism. Cervical spine injuries were associated with concomitant traumatic brain injuries and skull fractures. Patients with spine injuries were more like to experience a longer length of stay and death. On multivariate analysis, only increased age predicted CSI. Our database demonstrated a 5.7% incidence of pediatric cervical spine injuries in patients with maxillofacial trauma. This incidence is higher than previously published reports of smaller cohorts. Clinicians must take care to stabilize the cervical spine in any patient with facial fractures, especially during work up and diagnostic maneuvers performed before spinal injuries are ruled out.
Single-Stage Reconstruction of Full-Thickness Nasal Alar Defect Using Bilobed and Turnover Flaps
Authors: Habib Bedwani Nader , Rizkalla Maged
Published: January 2020

Skin cancer of the nose remains a common challenge for the reconstructive surgeon with full-thickness defects being particularly problematic. Reconstruction of the internal nasal lining poses the greatest difficulty with local tissue often having unsatisfactory vascularity or surface area. We describe the reconstruction of a full thickness nasal alar defect in a patient after failed full-thickness skin graft using a single stage procedure combining a bilobed flap with a turnover flap. The patient achieved excellent initial and long-term cosmesis and functionality and was very satisfied with the results. We demonstrate that selected full-thickness nasal alar defects may be reconstructed in a single procedure using a carefully placed turnover flap for the internal nasal lining and bilobed flap for outer skin cover.
Endoscopic Removal of Huge Cholesterol Granuloma in the Maxillary Sinus Confused With Odontogenic Keratocyst
Authors: Kim Dong-Jo , Kim Sung-Dong , Kim Sang-Hoon , Cho Kyu-Sup
Published: January 2020

Cholesterol granuloma is a foreign body reaction to the deposition of cholesterol crystals, usually found in association to chronic middle ear diseases, being highly uncommon in the paranasal sinuses. Furthermore, a huge and aggressive cholesterol granuloma involving the maxillary sinus, hard palate, buccal space, and maxillary alveolus is extremely rare and has not been reported previously. This article reports a case of huge cholesterol granuloma in the maxillary sinus confused with an expansile odontogenic keratocyst, which was treated successfully via transnasal endoscopic approach.
Temporal Trends and Outcomes in Liver Transplantation for Recipients With HIV Infection in Europe and United States
Authors: Campos-Varela Isabel , Dodge Jennifer L. , Berenguer Marina , Adam René , Samuel Didier , Di Benedetto Fabrizio , Karam Vincent , Belli Luca S. , Duvoux Christophe , Terrault Norah A.
Published: January 2020

Background.

We evaluated trends and outcomes of liver transplantation (LT) recipients with/without HIV infection.

Methods.

LT recipients between 2008 and 2015 from the United Network for Organ Sharing and Organ Procurement and Transplantation Network and European Liver Transplant Registry were included. Trends and characteristics related to survival among LT recipients with HIV infection were determined.

Results.

Among 73 206 LT patients, 658 (0.9%) were HIV-infected. The proportion of LT HIV-infected did not change over time (P-trend = 0.16). Hepatitis C virus (HCV) as indication for LT decreased significantly for HIV-infected and HIV-uninfected patients (P-trends = 0.008 and <0.001). Three-year cumulative graft survival in LT recipients with and without HIV infection was 64.4% and 77.3%, respectively (P < 0.001), with improvements over time for both, but with HIV-infected patients having greater improvements (P-trends = 0.02 and 0.03). Adjusted risk of graft loss was 41% higher in HIV-infected versus HIV-uninfected (adjusted hazard ratio [aHR], 1.41; P < 0.001). Among HIV-infected, model of end-stage liver disease (aHR, 1.04; P < 0.001), body mass index <21 kg/m2 (aHR, 1.61; P = 0.006), and HCV (aHR, 1.83; P < 0.001) were associated with graft loss, whereas more recent period of LT 2012–2015 (aHR, 0.58; P = 0.001) and donor with anoxic cause of death (aHR, 0.51; P = 0.007) were associated with lower risk of graft loss.

Conclusions.

Patients with HIV infection account for only 1% of LTs in United States and Europe, with fewer LT for HCV disease over time. A static rate of LT among HIV-infected patients may reflect improvements in cirrhosis management and/or persistent barriers to LT. Graft and patient survival among HIV-infected LT recipients have shown improvement over time.
The relationship between cortical thickness and language comprehension varies with sex in healthy young adults: a large sample analysis
Authors: Yang Guocheng , Li Dongfen , Rao Yunbo , Lu Fengmei
Published: January 2020

Functional neuroimaging studies evaluating sex differences in language processing have been previously reported. However, it remains largely unclear whether there are structural bases for language comprehension and whether these are partially affected by sexual dimorphism in cortical thickness. To this end, we performed correlation analysis between cortical thickness and language comprehension in a large (N = 1017, 549 females, 468 males) young and healthy subjects from Human Connectome Project, with a specific focus on the impact of sex. We identified significant relationship between cortical thickness of the posterior cingulate cortex (PCC) and vocabulary comprehension in females (r = 0.318, r
2 = 10%), while the association was significantly reduced in males (P = 0.017, Cohen’s q = 0.154). Furthermore, thickness difference in the PCC was observed to be smaller in females (P < 0.0001, t = −7.12, Cohen’s d = 0.45); however, the difference disappeared when controlling for brain size (Cohen’s d = 0.002). Our findings indicated that variability in cortical thickness may affect cognitive function much more in females than in males, and highlighted the importance of brain size in explaining sex-specific cortical thickness.
Different changes in granulocyte-colony stimulating factor and its correlation with inflammatory biomarkers in patients after traumatic brain injury
Authors: Huang Xintao , Dai Yining , Ma Xiaodong , Wang Shizhou , Xu Xinjuan , Pei Xile , Li Ruilong , Wang Hongqin
Published: January 2020

Objective

This study analyzed changes in granulocyte-colony stimulating factor (G-CSF) and its correlation with leukocyte and neutrophil counts in patients after traumatic brain injury (TBI).

Methods

Sixty TBI patients were included retrospectively. The serum levels of G-CSF, tumor necrosis factor-α (TNF-α), and peripheral leukocyte and neutrophil counts at different time points were measured and analyzed, and the 6-month functional outcomes were monitored.

Results

The levels of G-CSF in mild and moderate TBI groups were higher than the control at the first three time points. G-CSF in the severe TBI group increased slowly and peaked at day 7, and was only significantly different from the control at day 7 and 14. The leukocyte and neutrophil counts of the mild group gradually decreased, but a second increase after day 4 was observed in the severe group. The cell counts were higher in the severe group compared to other groups. A positive correlation between G-CSF and leukocyte and neutrophil counts was observed in the severe group at day 1. G-CSF positively correlated with TNF-α in the severe group at day 4 and 7. In severe patients with a good outcome, G-CSF level at day 7 was significantly higher than those with a poor outcome.

Conclusion

The G-CSF levels in the severe TBI group exhibited a different pattern from those in the mild and moderate TBI groups, and these levels positively correlated with inflammatory biomarkers. Higher G-CSF levels in severe TBI at day 7 indicated a good outcome at 6 months.
Species-specific developmental timing is associated with global differences in protein stability in mouse and human
Authors: Rayon Teresa , Stamataki Despina , Perez-Carrasco Ruben , Garcia-Perez Lorena , Barrington Christopher , Melchionda Manuela , Exelby Katherine , Tybulewicz Victor , Fisher Elizabeth M. C. , Briscoe James
Published: January 2020

What determines the pace of embryonic development? Although many molecular mechanisms controlling developmental processes are evolutionarily conserved, the speed at which these operate can vary substantially between species. For example, the same genetic programme, comprising sequential changes in transcriptional states, governs the differentiation of motor neurons in mouse and human, but the tempo at which it operates differs between species. Using in vitro directed differentiation of embryonic stem cells to motor neurons, we show that the programme runs twice as fast in mouse as in human. We provide evidence that this is neither due to differences in signalling, nor the genomic sequence of genes or their regulatory elements. Instead, we find an approximately two-fold increase in protein stability and cell cycle duration in human cells compared to mouse. This can account for the slower pace of human development, indicating that global differences in key kinetic parameters play a major role in interspecies differences in developmental tempo.
Characterization of protein-ligand binding interactions of enoyl-ACP reductase (FabI) by native MS reveals allosteric effects of coenzymes and the inhibitor triclosan
Authors: Joyner P. Matthew , Tran Denise P. , Zenaidee Muhammad A. , Loo Joseph A.
Published: January 2020

The enzyme enoyl-ACP reductase (also called FabI in bacteria) is an essential member of the fatty acid synthase II pathway in plants and bacteria. This enzyme is the target of the antibacterial drug triclosan and has been the subject of extensive studies for the past 20 years. Despite the large number of reports describing the biochemistry of this enzyme, there have been no studies that provided direct observation of the protein and its various ligands. Here we describe the use of native MS to characterize the protein-ligand interactions of FabI with its coenzymes NAD+and NADH and with the inhibitor triclosan. Measurements of the gas-phase affinities of the enzyme for these ligands yielded values that are in close agreement with solution-phase affinity measurements. Additionally, FabI is a homotetramer and we were able to measure the affinity of each subunit for each coenzyme, which revealed that both coenzymes exhibit a positive homotropic allosteric effect. An allosteric effect was also observed in association with the inhibitor triclosan. These observations provide new insights into this well-studied enzyme and suggest that there may still be gaps in the existing mechanistic models that explain FabI inhibition.
Ancestral neural computations constrain the evolution of novel computations in simulated color vision networks
Authors: Buerkle Nathan P. , Palmer Stephanie E.
Published: January 2020

Efficient coding has been a successful organizational principle in neuroscience, but a more general theoretical framework needs to include the capacity for biological constraints to impede the realization of optimal circuit design. Here, we explore how evolution shapes the computational organization of a circuit using color vision as a model system. Taking a theoretical, machine learning approach allowed us to simulate the evolution of tetrachromatic color vision from a trichromatic ancestor both within and across distinct phylogenetic lineages. Analyzing network performance showed that trichromatic starting weights impose a significant constraint on learning rate, although the incremental increase in input layer complexity leads to better overall performance. Analyzing hidden layer computations showed that ancestry severely constrained evolution into a restricted and predictable portion of the theoretically available computational state space. Overall, our simulations of color vision evolution suggest that phylogenetic history is an important aspect of the functional organization of neural circuits.