bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of short-term intensive insulin therapy on α-cell function in patients with newly diagnosed type 2 diabetes
Authors: Zheng Hai-Lan , Xing Yan , Li Fan , Ding Wei , Ye Shan-Dong 
Published: April 2020

Abstract
The effect of intensive insulin therapy on hyperglucagonemia in newly diagnosed type 2 diabetes (T2DM), and its associations with β-cell function, has not been elucidated. This study assessed the effect of 12 weeks of intensive insulin therapy on hyperglucagonemia in newly diagnosed T2DM and its associations with β-cell function, with reference to the effects of 12 weeks of oral hypoglycemic agents (OHAs).
One hundred eight patients with newly diagnosed T2DM were enrolled from January 2015 to December 2015. The patients were randomly divided to receive, for 12 weeks, either intensive insulin therapy or OHAs. Meal tolerance tests were conducted at baseline before treatment (0 week), at 12 weeks (end of treatment), and 12 months after the initiation of treatment. The levels of glucagon, proinsulin, C-peptide (CP), and blood glucose were measured at timepoints 0, 30, and 120 minutes during the meal tolerance test.
Intensive insulin treatment was associated with a decrease in glucagon levels (at 0, 30, and 120 minutes) and proinsulin/CP, and an increase in the insulin-secretion index ΔCP30/ΔG30 and ΔCP120/ΔG120, at 12 weeks and 12 months during the follow-up, compared with the corresponding effects of OHAs. Intensive insulin therapy could reduce but failed to normalize glucagon levels at 12 weeks. There were no correlations between the change of percentages in total area under the curve of glucagon and other glycemic parameters (proinsulin/CP; ΔCP30/ΔG30; or ΔCP120/ΔG120). Patients who received intensive insulin therapy were more likely to achieve their target glycemic goal and remission, compared with those who received OHAs.
Short-term intensive insulin therapy facilitates the improvement of both β-cell and α-cell function in newly diagnosed T2DM mellitus. Decline of β-cell secretion and concomitant α-cell dysfunction may both be involved in the pathogenesis of T2DM.
Is serum vitamin B12 decrease a necessity for the diagnosis of subacute combined degeneration?
Authors: Cao Jie , Xu Shabei , Liu Chenchen 
Published: April 2020

Abstract

Background:
To determine the prevalence of subacute combined degeneration (SCD) patients with normal or elevated serum vitamin B12 level and to identify clinical characteristics of these patients.

Methods:
We searched PubMed, EMBASE, and Cochrane library, without language restriction up to June 2019 and included studies with SCD patients who were diagnosed with normal or elevated serum vitamin B12 levels. Meta-analysis was performed to estimate the prevalence of SCD in patients with normal or elevated serum vitamin B12 levels and compare the differences of clinical data between patients with low and no-low serum vitamin B12 level.

Results:
Six studies were included in our analysis, with a total number of 181 patients involved. The pooled proportion in patients with no-low serum vitamin B12 level was 31.0% (95% confidence interval [CI]: 22.5–40.8). There was no significant difference in the level of hemoglobin (Mean difference (MD): –3.05, 95% CI: –12.42 to 6.33. P = 0.52) and erythrocyte mean corpuscular volume (MD: –2.37, 95% CI: –11.17 to 6.43, P = 0.60) between SCD patients with no-low and those with low serum vitamin B12 levels. The meta-analysis showed that the functional disability rating scale on admission in patients with low serum vitamin B12 level was no worse than that with normal or elevated serum vitamin B12 level (MD: 0.29, 95% CI: –0.58 to 1.16, P = 0.51).

Conclusion:
Decreased level of serum vitamin B12 may not be a necessity for the diagnosis of SCD. Approximately one third of the SCD patients have normal or elevated serum vitamin B12 level. No differences were found in clinical severity between patients with normal or elevated serum vitamin B12 level and those with low level of serum vitamin B12 on admission.
The efficacy and safety of cooled-radiofrequency neurotomy in the treatment of chronic thoracic facet (zygapophyseal) joint pain
Authors: Gungor Semih , Candan Burcu 
Published: April 2020

Abstract
Anatomic course of medial branches in the thoracic spine is significantly different. Cooled RFA (CRFA) is a newer technique that can create a larger spherical lesion with a potential to compensate for the anatomic variability of the medial branches in the thoracic spine. Our retrospective study aimed to investigate the efficacy and the adverse effects of the CRFA in the treatment of thoracic facet-related pain.
For this retrospective study, we evaluated 40 CRFA performed on 23 patients. The patients with diagnosis of thoracic facet joint-related pain underwent CRFA. Pain scores in numeric rating scale (NRS) were recorded at pretreatment and posttreatment at different time-points. The primary outcome measure was to report descriptive NRS score and average % improvement from baseline at each time point. A significant pain relief was determined by a decrease of ≥ 50% of mean NRS. Secondary outcome measure was the time to repeat treatment with subsequent CRFA. Adverse events were also recorded.
Improvement of average pain level was 20.72% in the 1st follow-up (FU) (4–8 weeks), 53% in the 2nd FU (2–6 months), and 37.58% in the 3rd FU (6–12 months). Subgroup analysis was done based on age cutoff (age in years ≤ 50 versus >50), and pretreatment NRS (≤7 versus >7). Patients with age ≤50 and NRS score >7 experienced the best pain relief in the 2nd FU period (2–6 months). The patients with age > 50 and NRS pain level ≤7 showed steadily increased benefit both in the 2nd FU (2–6 months) and 3rd FU (6–12 months).
This is the first clinical study to evaluate the efficacy and adverse effects of CRFA in the thoracic spine for facet joint-related pain. Our results suggest that CRFA procedure is an effective treatment modality for thoracic facet-related pain. Our subgroup analysis demonstrated that the pain relief and duration varies with the age and the pretreatment pain levels.
A case report of empty Sella syndrome secondary to Hantaan virus infection and review of the literature
Authors: Chen Haiying , Li Yuxiang , Zhang Peng , Wang Yang 
Published: April 2020

Abstract

Rationale:
Bleeding in the anterior pituitary lobe leading to tissue necrosis occurs in the acute stage of severe clinical forms of hemorrhagic fever with renal syndrome (HFRS), while atrophy of the anterior pituitary lobe with diminution of the gland function occurs after the recovery stage. The relationship between Hantaan virus infection and empty Sella syndrome (ESS) has rarely been reported.

Patient concerns:
This patient was a 54-year-old previously healthy Chinese male. He presented with fever, headache, and backache with dizziness and oliguria. Physical examination was notable for hypotension and the signs of conjunctival suffusion. His platelets decreased, and his urine protein was positive. Hantaan virus IgM and virus RNA were positive.

Diagnosis:
He was diagnosed as having HFRS. In his diuretic phase, his 24-hour urine volume was maintained at 10,000 mL, and his blood pressure was higher for a week. Then, he was diagnosed as having ESS after a series of examinations.

Interventions:
Hormone replacement therapy was given to this patient after the diagnosis “ESS” was made.

Outcomes:
The patient's symptoms improved, and he was discharged from the hospital soon after hormone replacement therapy.

Lessons:
Pituitary function examination and brain magnetic resonance imaging (MRI) need to be considered to scan for ESS and panhypopituitarism in the patients with HFRS accompanied by diabetes insipidus.
Reconstruction of bilateral inferomedial gluteal defects after resection of hidradenitis suppurativa with symmetrical keystone flaps designed parallel to relaxed skin-tension lines
Authors: Kim Hyo Bong , Lim Soo Yeon , Yoon Chi Sun , Kim Kyu Nam 
Published: April 2020

Abstract

Rationale:
Surgical treatment of hidradenitis suppurativa (HS) is challenging. Wide excision of affected lesions followed by skin graft or flap coverage has been recommended to achieve remission and prevent recurrence. Herein, we present our experience of bilateral inferomedial gluteal defects coverage using symmetrical keystone flaps (KFs) designed parallel to relaxed skin-tension lines (RSTLs).

Patient concerns:
An 18-year-old man was admitted for chronic inflammatory lesions in both inferomedial gluteal areas.

Diagnoses:
Physical examination revealed multiple sinuses with broad surrounding scars in both inferomedial gluteal areas, which led to a diagnosis of HS.

Interventions:
We performed wide excision on all affected lesions. The size of the final defects was 6 × 10 cm on the right side, and 5 × 9 cm on the left side. We covered the defects with KFs 9 × 15 cm (right) and 8 × 12 cm (left), which were based on the hotspots of the interior gluteal artery and internal pudendal artery perforators, and parallel to RSTLs.

Outcomes:
The flaps were inset without tension on each side, and the donor sites were closed primarily. All flaps fully survived and there were no postoperative complications. The patient was satisfied with the final outcome after 6 months of follow-up.

Lessons:
Successful reconstruction of bilateral inferomedial gluteal defects was achieved after resection of HS using symmetrical KFs designed parallel to RSTLs. The KF technique considering RSTLs could be a good reconstructive option for gluteal HS.
Successful treatment with matched unrelated donor peripheral blood stem cell transplantation for very severe aplastic anemia in presence of active infections
Authors: Huang Yu-Rong , Xie Cai-Qin , Tong Jie-Feng , Zhang Xiao-Hong , Xu Yang , Yuan Xiang-Gui 
Published: April 2020

Abstract

Rationale:
Very severe aplastic anemia (vSAA) with active infections is always fatal. Adequate infection control before hematopoietic stem cell transplantation is recommended.

Patient concerns:
A 38-year-old woman with vSAA suffered from acute perforated appendicitis and invasive pulmonary fungal infection, and she failed to respond to intense antimicrobial therapies.

Diagnosis:
She was diagnosed with refractory vSAA with stubborn acute perforated appendicitis and invasive pulmonary fungal infection.

Interventions:
We successfully completed an emergent reduced intensity conditioning-matched unrelated donor (MUD)-peripheral blood stem cell transplantation (PBSCT) as a salvage therapy in the presence of active infections. The conditioning regimens consisted of reduced cyclophosphamide 30 mg/kg/day from day-5 to day-3, fludarabine 30 mg/m2/day from day-5 to day-3 and porcine-antilymphocyte immunoglobulin 15 mg/kg/day from day-4 to day-2 without total body irradiation. Cyclosporin A, mycophenolate mofetil and short-term methotrexate were administered as graft-versus-host disease (GVHD) prophylaxis. Neutrophils and platelets were engrafted on day+15 and day+21. Appendiceal abscess and severe pneumonia developed after neutrophil engraftment, which were successfully managed with intense antimicrobial therapy and surgical intervention.

Outcomes:
Only limited cutaneous chronic GVHD was observed 5 months after transplantation. The patient still lives in a good quality of life 2 years after transplantation.

Lessons:
Active infections may be no longer a contraindication to hematopoietic stem cell transplantation for some patients with vSAA.
Standardized approach of albumin, midodrine and octreotide on hepatorenal syndrome treatment response rate
Authors: Hiruy Aklil , Nelson Joelle , Zori Andreas , Morelli Giuseppe , Cabrera Roniel , Kamel Amir 
Published: April 2020

Background:
Hepatorenal syndrome (HRS) remains a serious complication of cirrhosis with a high mortality rate. There is little information on the effect of standardizing albumin, midodrine and octreotide combination on treatment response in patients with HRS.

Objective:
The aim of the study was to determine the impact of a standardized HRS treatment regimen on renal function recovery. The primary outcome was full response rate. Secondary outcomes included partial and no response rates, 30-day all-cause mortality, ICU length of stay (LOS), hospital LOS, liver transplantation and total dose of albumin.

Methods:
This retrospective study evaluated the impact of using a standardized approach with albumin, midodrine and octreotide on treatment response rates compared to a historical group.

Results:
Of the patients with HRS, 28 received a standardized approach with albumin, midodrine and octreotide while 60 received a nonstandardized approach. Ten percent of patients achieved full response in the prestandardization group compared with 25% in the poststandardization group (P = 0.07). Renal replacement therapy was significantly more prevalent in the prestandardization group vs. poststandardization group (45% vs. 21.4%, P = 0.03). Liver transplantation was performed significantly more often in the prestandardization group compared the poststandardization group (23% vs. 3.6%, P = 0.02). Amount of albumin used was statistically lower in the poststandardization group (425 vs. 332 g, P = 0.05). No significant differences in days of HRS treatment, mortality rate, hospital and ICU LOS were observed.

Conclusion:
A trend towards improved treatment response rate was observed after standardizing the HRS treatment regimen. Standardized therapy led to significantly lower rates of renal replacement therapy and liver transplantation, suggesting patients in poststandardization were effectively managed medically without requiring further intervention.
Role of noninvasive tools for prediction of clinically evident portal hypertension in children
Authors: Kumar Aditi , Lal Sadhna B. , Bhatia Anmol , Das Ashim 
Published: April 2020

Background
Noninvasive tools (NITs) for predicting varices in children with portal hypertension (PHTN) are infrequently used.

Methods
Eighty-five consecutive, treatment-naïve children with PHTN and 97 controls were enrolled study from July 2017 to November 2018. Each case was evaluated by esophagogastroduodenoscopy (EGD) and various NITs: platelet spleen size Z (PSZ), clinical prediction rule (CPR), King’s variceal prediction rule (KVaPS), Splenic stiffness (SSM) and liver stiffness measurement (LSM) by point shear wave elastrography (pSWE).

Results
Had PHTN due to extra hepatic portal vein obstruction (EHPVO) and 70% due to cirrhosis [chronic liver disease (CLD)]. Sixty-five percent of PHTN cases had varices. Children with varices had lower platelet counts, lower albumin and larger spleens. SSM and LSM were significantly higher in cases as compared with controls. SSM was significantly higher in cases with varices than those without. SSM and LSM, at cutoffs of 3.8 and 3.2 kPa, respectively, discriminated PHTN cases from controls with an area under the curve (AUROC) of 0.67 (0.59–0.74). Both SSM and LSM predicted varices in CLD, but in EHPVO, only SSM predicted varices. SSM of 5.2 and 12.8 kPa, in CLD and EHPVO subgroups, respectively, had AUROC of 0.73 and 0.94 for variceal prediction. Blood-based NITs performed better in the CLD subgroup: aspartate aminotransferase platelet ratio index, CPR and KVPS predicted severity of PHTN with AUROC of 0.81, 0.92 and 0.93, respectively.

Conclusions
Blood-based NITs outperform elastography for prediction of PHTN/varices in children with CLD. SSM by pSWE is a better predictor of varices than LSM, especially in the EHPVO subgroup.
Radial Pronation Angle
Authors: Liu Lu , Liu Chang , Rong Yan-Bo , Bai Fan , Chen Shan-Lin 
Published: April 2020

Introduction
Congenital proximal radioulnar synostosis (CPRUS) is a relatively rare forearm deformity that is characterized by a fixed pronated forearm of varying severity. The osseous synostosis between the proximal part of the ulna and the radius can be seen on the X-ray images in most cases. Many researchers have attempted to identify methods to measure the disease severity to guide in the treatment of CPRUS. However, to describe the overall deformity, the use of multiple indicators is essential, and some of these measurements require special software or need to be conducted on cadavers.

Objective
The aim of the current study was to introduce the radius pronation angle (RPA), a novel radiological evaluation index of CPRUS, and analyze the relationship between the RPA and the severity of the deformity.

Methods
Three-dimensional models of 43 CPRUS forearms (19 left forearms and 24 right forearms) of 32 patients (23 males and 9 females; average age was 6 years 8 months; range, from 1.5 to 27 years) treated at Beijing Ji Shui Tan Hospital during 2016 to 2019 were reconstructed using a computer-assisted technique. The special flexed posterior-anterior views of the X-ray image (the f-PA view) of the forearms were obtained, and the forearm rotation angle and the ulnar inner rotation angle were measured on each forearm. The RPA was measured on the f-PA view, and the lengths of the osseous synostosis, ulna, and the radial head were measured on the computed tomography scan images using the multiplanar reconstruction function. The Pearson index was analyzed between the RPA and the other measurements.

Results
The RPAs were correlated with the forearm rotation angle, ulnar inner rotation angle, relative length of the osseous synostosis, and the relative length of the radial head (P < 0.05).

Conclusions
The RPA can be measured quickly and easily on the f-PA view of the X-ray image and can be used as a reliable indicator of the severity of CPRUS.
Comparative Effectiveness of Transversus Abdominis Plane Blocks in Abdominally Based Autologous Breast Reconstruction
Authors: Chi David , Chen Austin D. , Ha Austin Y. , Yaeger Lauren H. , Lee Bernard T. 
Published: April 2020

Background
The abdomen is the most common donor site in autologous microvascular free flap breast reconstruction and contributes significantly to postoperative pain, resulting in increased opioid use, length of stay, and hospital costs. Enhanced Recovery After Surgery (ERAS) protocols have demonstrated multiple clinical benefits, but these protocols are widely heterogeneous. Transversus abdominis plane (TAP) blocks have been reported to improve pain control and may be a key driver of the benefits seen with ERAS pathways.

Methods
A systematic review and meta-analysis of studies reporting TAP blocks for abdominally based breast reconstruction were performed. Studies were extracted from 6 public databases before February 2019 and pooled in accordance with the PROSPERO registry. Total opioid use, postoperative pain, length of stay, hospital cost, and complications were analyzed using a random effects model.

Results
The initial search yielded 420 studies, ultimately narrowed to 12 studies representing 1107 total patients. Total hospital length of stay (mean difference, −1.00 days; P < 0.00001; I
2 = 81%) and opioid requirement (mean difference, −133.80 mg of oral morphine equivalent; P < 0.00001; I
2 = 97%) were decreased for patients receiving TAP blocks. Transversus abdominis plane blocks were not associated with any significant differences in postoperative complications (P = 0.66), hospital cost (P = 0.22), and postoperative pain (P = 0.86).

Conclusions
Optimizing postoperative pain management after abdominally based microsurgical breast reconstruction is invaluable for patient recovery. Transversus abdominis plane blocks are associated with a reduction in length of stay and opioid use, representing a safe and reasonable strategy for decreasing postoperative pain.
Assessing Gaze Patterns in Common Cosmetic Procedures With Eye-Tracking Technology
Authors: Peterson Dylan J. , Azad Amee D. , Gkorila Aikaterina , Patel Ashraf A. , Boudreault Molly S. , Nazerali Rahim S. 
Published: April 2020

Background
Understanding the salient features that draw focus when assessing aesthetics is important for maximizing perceived outcomes. Eye-tracking technology provides an unbiased method for determining the features that draw attention when evaluating aesthetic plastic surgery. This study aimed to characterize viewing patterns of plastic surgery patients and laypeople when assessing facial cosmetic procedure images.

Methods
Twenty women who previously underwent cosmetic procedures and twenty women without a history of cosmetic procedures were shown sixteen pairs of preprocedure and postprocedure images of patients who underwent laser resurfacing or lip augmentation. Image pairs were randomized to whether preprocedural or postprocedural images came first. Participants viewed each image until they decided upon an aesthetic rating (scored 1–10), while an eye-tracking device recorded participants' gaze.

Results
The patient group's average ratings were 8.2% higher for preprocedural images and 13.3% higher for postprocedural images (P < 0.05 for both). The patient group spent 20.4% less time viewing images but spent proportionally more time evaluating the relevant features of each procedure (41.7% vs 23.3%, P < 0.01), such as the vermillion border of the upper lip, labial commissure, or periorbital region (P < 0.05 for each). For both groups, the most common site of first fixation was the nose for laser resurfacing images (26.6%) and the labial commissure for lip augmentation images (37.7%). Both groups spent more time fixated on nasolabial folds, marionette lines, and the periorbital region when viewing pre–laser resurfacing images than postprocedural images. Overall, each group had similar viewing patterns for time to first fixation on and frequency of fixations for a particular feature.

Conclusions
Women who previously underwent cosmetic procedures view postprocedural images more favorably and require less time to assess images, likely related to familiarity with aesthetic procedures. These women spend more time fixated on relevant features, such as the vermillion border of the upper lip, the labial commissure, and the periorbital region, than the control group. Notably, each group spent less time focused on regions associated with wrinkles, such as the marionette and periorbital areas in post–laser resurfacing images, suggesting that the procedure reduces attention-drawing features in these areas.