bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic full-thickness resection using an endoluminal-suturing device: a proof-of-concept study
Authors: Huberty Vincent , Leclercq Loulia , Hiernaux Martin , Verset Laurine , Sandersen Charlotte , Beyna Thorsten , Neuhaus Horst , Deviere Jacques 
Published: October 2019

Abstract
Background and study aims Endoscopic full-thickness resection (EFTR) is used to achieve R0 resection in difficult situations and as a way to overcome the limitations of endoscopic submucosal dissection. Multiple techniques have been described but adequate tools are still under evaluation. In this study, we evaluated the safety and feasibility of non-exposed endoscopic full-thickness resection using a novel endoscopic suturing device.
Materials and methods Full-thickness resections of gastric predetermined lesions were performed on five pigs using the Endomina platform. After creating virtual lesion > 20 mm, sutures were placed around it using this triangulation platform. After tightening the knots, the bulging lesion, internalized into the gastric lumen, was cut with a needle knife.
Results R0 resections of large lesions (42 to 60 mm) were achieved in all cases. One perforation occurred and prompted us to improve the procedure by shortening the sutures for more maneuverability and reinforcing the suture line before section. Procedure duration dropped by 50 % between the first case and the fourth case. Histological analysis confirmed successful full-thickness resection of all resected specimens.
Conclusion EFTR using this triangulation platform seems feasible for lesions > 20 mm. Additional possible improvements were identified to simplify the procedure before moving to human trials.
Schwere Schocksymptomatik infolge anaphylaktoider Reaktion auf Ticagrelor
Authors: Schittek Gregor A. , Simonis Holger , Fischer Matthias , Soukup Jens 
Published: October 2019

ZusammenfassungDie Kasuistik beschreibt den ersten dokumentierten Fall mit einer klinisch gesicherten schweren Anaphylaxie nach Ticagrelor bei einem 76-jährigen männlichen Patienten mit ST-Hebungs-Myokardinfarkt (STEMI).
Endoscopic clipping prior to GVO vs. GVO in IGV1 bleeding: a multicenter retrospective clinical trial
Authors: Li Huixian , Ye Dong , Li Ping , Kong Derun 
Published: October 2019

Abstract
Background and study aims Bleeding from isolated gastric varices type I (IGV1) is more dangerous and fatal than other types of esophageal variceal hemorrhages. However, optimum treatment for bleeding from IGV1 remains undefined. This retrospective study compared the efficacy of endoscopic clipping prior to N-butyl-2-cyanoacrylate injection (GVO) and only GVO for treatment of IGV1.
Patients and methods Data were collected retrospectively at three medical centers. Ninety-six patients were enrolled between March 2015 and April 2017 and divided into two groups: group I (patients with endoscopic clipping prior to GVO, n = 46) and group II (patients with only GVO, n = 50). Computed tomography angiography (CTA) was performed to evaluate the status of gastrorenal shunts (GRS).
Results GRS was found in 59 of 66 patients (59/66). The groups did not differ in baseline characteristics. Initial hemostasis was successfully achieved in all patients. There was a significant difference in volume of N-butyl-2-cyanoacrylate administered (3.39 ± 1.20 mL in group I versus 2.53 ± 1.05 mL in group II (P = 0.03). Rebleeding occurred in 4.35% of patients in group I and 18.00 % in group II (P = 0.007). Variceal obliteration was achieved in all patients in group I and 72 % in group II (P < 0.001) with only one session. Rate of complications was similar in both the groups with the exception of one patient in group II who developed ectopic cerebral embolism.
Conclusions Endoscopic clipping prior to GVO may be an appropriate alternative to GVO as a treatment modality for IGV1 bleeding.
Role of EUS-FNA for gallbladder mass lesions with biliary obstruction: a large single-center experience
Authors: Singla Vikas , Agarwal Rachit , Anikhindi Shrihari Anil , Puri Pankaj , Kumar Mandhir , Ranjan Piyush , Kumar Ashish , Sharma Praveen , Bansal Naresh , Bakshi Pooja , Verma Kusum , Arora Anil 
Published: October 2019

Abstract
Background and study aims Although endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) is an established modality for pathological sampling of pancreatic and biliary lesions, limited data are available on the diagnostic value of EUS-FNA for evaluation of gallbladder mass lesions, a common cause of obstructive jaundice. We aimed to evaluate the usefulness of EUS-FNA for diagnosis of gallbladder mass lesions presenting with biliary obstruction.
Patients and methods This study was a retrospective analysis of data from patients who had undergone EUS-FNA for gallbladder mass lesions. FNA was performed on either a gallbladder mass, metastatic node or liver lesions. Outcome measures were diagnostic yield of EUS FNA and adverse events.
Results From April 2011 to August 2018, 101 patients with gallbladder mass lesions with biliary obstruction underwent EUS-FNA. The final diagnosis was malignancy in 98, benign disease in one, and two patients were lost to follow-up. EUS-FNA confirmed the diagnosis in 89 of 98 patients with malignancy (sensitivity 90.81 %); was false negative in nine of 98 cases with malignancy; and was truly negative in the solitary patient with benign disease (specificity 100 %). Positive predictive value, negative predictive value (NPV), and accuracy were 100 %, 10 %, and 90.90 %, respectively. Two patients had self-limiting pain.
Conclusion EUS-FNA is a sensitive tool for evaluation of gallbladder mass lesions presenting with obstructive jaundice. However, because of low NPV, lesions in which FNA is negative should be further evaluated.
EUS-guided biliary drainage is equivalent to ERCP for primary treatment of malignant distal biliary obstruction: a systematic review and meta-analysis
Authors: Hathorn Kelly E. , Bazarbashi Ahmad Najdat , Sack Jordan S. , McCarty Thomas R. , Wang Thomas J. , Chan Walter W. , Thompson Christopher C. , Ryou Marvin 
Published: October 2019

Abstract
Background and study aims Although endoscopic retrograde cholangiopancreatography (ERCP) is standard of care for malignant biliary obstruction, endoscopic ultrasound-guided biliary drainage (EUS-BD) as a primary treatment has become increasingly utilized. The aim of this study was to perform a systematic review and meta-analysis to evaluate the effectiveness and safety of EUS-BD for primary treatment of malignant biliary obstruction and comparison to traditional ERCP.
Methods Individualized search strategies were developed through November 2018 using PRISMA and MOOSE guidelines. A cumulative meta-analysis was performed by calculating pooled proportions. Subgroup analysis was performed for studies comparing EUS-BD versus ERCP. Heterogeneity was assessed with Cochran Q test or I
2 statistics, and publication bias by funnel plot and Egger’s tests.
Results Seven studies (n = 193 patients; 57.5 % males) evaluating primary EUS-BD for malignant biliary obstruction were included. Mean age was 67.4 years (2.3) followed an average of 5.4 months (1.0). For primary EUS-BD, pooled technical success, clinical success, and adverse event (AE) rates were 95 % (95 % CI 91 – 98), 97 % (95 % CI 93 – 100), and 19 % (95 % CI 11 – 29), respectively. Among EUS-BD and ERCP comparator studies, technical and clinical success, and total AEs were not different with lower rates of post-ERCP pancreatitis and reintervention among the EUS-BD group.
Conclusion Primary EUS-BD is an effective treatment with few AE. Comparing EUS-BD versus ERCP, EUS-BD has comparable efficacy and improved safety as a primary treatment for malignant biliary obstruction. Further randomized trials should be performed to identify patient populations and clinical scenarios in which primary EUS-BD would be most appropriate.
IMPlementing split Regimen OVEr Single dose using a Plan-Do-Study-Act approach (IMPROVES study)
Authors: Vanella Giuseppe , Hassan Cesare , De Bellis Mario , Giardini Maxemiliano , Grasso Enrico , Laterza Francesco , Tarantino Ottaviano , Di Giulio Emilio 
Published: October 2019

Abstract
Background and aims A split-dose regimen for colonoscopy is recommended by international guidelines, but its adoption is still suboptimal. Our aim was to assess whether a Plan-Do-Study-Act approach (PDSA), a scientific method promoting quality improvement, would be able to improve adherence to a split-dose regimen, and to identify factors influencing its adoption.
Methods This study consisted of three phases: Cycle 1: a cross-sectional assessment of split-dose adherence in consecutive outpatients/inpatients undergoing colonoscopies in 74 Italian centers; Educational intervention: regional meetings with literature review, analysis of Cycle 1 data, and discussion on corrective measures; local diffusion of educational material and tools for improvement; Cycle 2: reassessment of split-dose adherence after spontaneous local interventions. Demographic, clinical, and procedural variables were systematically collected. Multivariate logistic regression was used to identify predictors of split-dose adoption.
Results In total, 8213 patients (mean age = 60.29 years (SD = 13.58), men = 54 %, outpatients = 88.4 %) were enrolled between 2013 and 2016 (Cycle 1 = 4189 patients and Cycle 2 = 4024 patients). Split-dose adoption rose from 29.1 % in Cycle 1 to 51.1 % in Cycle 2 (P < 0.0001), and being enrolled in Cycle 2 independently predicted split-dose adherence (OR = 2.9; 95 %CI 2.6 – 3.3). The adoption improved in all time slots, including colonoscopies scheduled before 0930. The main corrective measures were: rescheduling of colonoscopies after 0930 (between 0930 and 1130: OR = 2.6; 95 %CI 2.3 – 3.1; after 1130: OR = 7; 95 %CI 5.9 – 8.4); the cleansing regimen communicated by the Endoscopy unit (via form: OR = 1.6; 95 %CI 1.3 – 1.9; via visit: OR = 2.1; 95 %CI 1.7 – 2.5); a decrease in the use of deep sedation (OR = 2; 95 %CI 1.7 – 2.5).
Conclusions An educational intervention with observation-driven corrections through a PDSA approach was able to substantially increase the adoption of a split-dose regimen.
Update Breast Cancer 2019 Part 5 – Diagnostic and Therapeutic Challenges of New, Personalised Therapies in Patients with Advanced Breast Cancer
Authors: Welslau Manfred , Hartkopf Andreas D. , Müller Volkmar , Wöckel Achim , Lux Michael P. , Janni Wolfgang , Ettl Johannes , Lüftner Diana , Belleville Erik , Schütz Florian , Fasching Peter A. , Kolberg Hans-Christian , Nabieva Naiba , Overkamp Friedrich , Taran Florin-Andrei , Brucker Sara Y. , Wallwiener Markus , Tesch Hans , Schneeweiss Andreas , Fehm Tanja N. 
Published: October 2019

AbstractSignificant advancements have been made in recent years in advanced breast cancer and nearly all of them have been in the field of targeted therapy. Pertuzumab and trastuzumab-emtansine (T-DM1) have been able to be introduced in HER2-positive breast cancer. Now other anti-HER2 therapies are being developed (e.g. margetuximab, DS-8201a, pyrotinib) which can overcome other resistance mechanisms in the HER2 signalling pathway. In the field of hormone-receptor-positive breast cancer, an mTOR inhibitor and CDK4/6 inhibitors were introduced in the past. Now the introduction of the first PI3K inhibitor is forthcoming and this inhibitor will involve genetic testing of the tumour for a mutation in the PIK3CA gene. There are also significant advancements in triple-negative breast cancer: By combining chemotherapy and immunotherapy, an advantage for overall survival was able to be demonstrated in a subgroup (immune cells PD-L1-positive). The PARP inhibitor therapy for HER2-negative patients with a germ line mutation in BRCA1 or BRCA2 was also associated with an improved overall survival in a subgroup. These promising new study results are summarised in this review.
Freude an der Chirurgie – Einblicke gewähren, Begeisterung wecken
Authors: Kauffels-Sprenger Anne , Lehmann Wolfgang , Kutschka Ingo , Trojan Lutz , Ghadimi Michael 
Published: October 2019

ZusammenfassungDer „Göttinger Aufschneidertag“ wurde ins Leben gerufen, um im Rahmen eines Ganztagesprogramms mit praktischen Kursen und der Möglichkeit des direkten Austauschs zwischen Studierenden und Dozierenden die Begeisterung für die Chirurgie zu wecken. In Workshops aus insgesamt 4 chirurgischen Disziplinen werden den Teilnehmern Einblicke in das Handwerk der Chirurgie gewährt. Das Ziel ist es, in den Studierenden bereits zu einem frühen Zeitpunkt des Studiums Interesse für die Chirurgie zu wecken und ihnen die Freude am Beruf näherzubringen.
MiR-214 Attenuates the Osteogenic Effects of Mechanical Loading on Osteoblasts
Authors: Yuan Yu , Guo Jianmin , Zhang Lingli , Tong Xiaoyang , Zhang Shihua , Zhou Xuchang , Zhang Miao , Chen Xi , Lei Le , Li Hui , Liu Timon Cheng Yi , Xu Jiake , Zou Jun 
Published: October 2019

AbstractExercise is an effective way to prevent osteoporosis, but its mechanism remains unclear. MicroRNAs (miRNAs) play an essential role in bone metabolism. Recently, mechanical loading was reported to induce changes in miRNA expression in osteoblasts. However, the role of miRNAs in bone under exercise and its underlining mechanisms of action still remain unknown. MiR-214 was reported to regulate the process of osteogenesis and is considered a biomarker of osteoporosis. In this study, we aimed to investigate whether exercise could induce changes in miRNA expression in bone and to study the effects of miR-214 on mechanical loading-induced osteogenesis in osteoblasts. The results showed that miR-214 was down-regulated in both tibia from C57BL/6 mice after exercise in vivo and in osteoblasts after mechanical strain in vitro. Mechanical strain could enhance the ALP activity, promote matrix mineralization, up-regulate the expression of osteogenic factors such as ATF4, Osterix, ALP and β-catenin, and down-regulate RANKL and RANK expression. Over-expression of miR-214 not only inhibited the expression of these osteogenic factors but also attenuated mechanical strain-enhanced osteogenesis in osteoblasts. Collectively, our results indicated that miR-214 could attenuate the osteogenic effects of mechanical loading on osteoblasts, suggesting that inhibition of miR-214 may be one of the ways in which exercise prevents osteoporosis.
Healthcare Costs for Older Patients Before and After Inpatient
Rehabilitation: A Retrospective and Prospective Longitudinal Cohort
Study
Authors: Bachmann Stefan , Pfaundler Nubio , Oesch Peter , Kool Jan Pieter 
Published: October 2019

Abstract
Background Little is known about the costs incurred over the 12 months
before and after inpatient geriatric rehabilitation in Switzerland.
Objectives To compare direct healthcare costs for elderly patients over a
period of 12 months before and after inpatient rehabilitation and to determine
predictive factors for costs after discharge.
Design Retrospective and prospective cohort study.
Patients and Methods Elderly patients referred for inpatient
rehabilitation to the rehabilitation centre Walenstadtberg of Kliniken Valens,
Switzerland, were included. Cost data were collected from healthcare insurance
providers. Comparisons of costs before and after discharge from rehabilitation
were performed. The effect of patient characteristics (Multimorbidity,
Health-related quality of life, Age, Vulnerability, Independence in activities
of daily living, Sex, and Mobility) on costs 12 months before and after
rehabilitation was evaluated with regression analysis.
Results A total of 210 patients were enrolled, and 136 completed the
clinical follow-up. Seventy-five patients were included in the cost analysis.
Total mean healthcare costs per person in the 12-month period before discharge
were CHF 24 429, compared with CHF 18 154 in the 12-month period
after discharge. After rehabilitation lower costs were reported for hospital
admissions, while costs for drugs and therapy were significantly higher.
Multimorbidity and health-related quality of life were predictors of costs
before rehabilitation (adjusted R-square 0.183). Higher costs after
rehabilitation were predicted by higher multimorbidity (adjusted R-square 0.09),
lower independence in activities of daily living (adjusted R-square 0.04) and
lower health-related quality of life (adjusted R-square 0.03).
Conclusion The mean total costs before geriatric rehabilitation were
significantly higher compared with the mean costs after discharge from geriatric
rehabilitation. In particular, the mean costs for hospitalizations were lower
after rehabilitation. Multimorbidity and lower health-related quality of life
predicted higher costs before and after rehabilitation.
Chronic Inflammatory Demyelinating Polyradiculoneuropathy
Authors: Shije Jeffrey , Brannagan Thomas H. 
Published: October 2019

AbstractChronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a relatively common autoimmune disorder affecting the peripheral nerves and nerve roots, often causing progressive or recurrent weakness with diminished reflexes. Electrodiagnostic (EDx) studies, cerebral spinal fluid (CSF) analysis, and nerve biopsy may help provide supportive evidence for the diagnosis. Most cases have a favorable response to one of the three first-line treatments: corticosteroids, IV immunoglobulin (IVIG) and plasmapheresis. Responses to these treatments may vary among individual patients. There is evidence that a small percentage of CIDP patients with IgG class 4 (IgG4) autoantibodies to paranodal proteins have characteristic clinical features and poorer response to IVIG. Chemotherapy and other immunomodulatory agents, as well as hematopoietic stem cell transplantation, may be considered in refractory cases. The degree of disability varies, and most patients require ongoing treatment to maintain stable disease, although long-term remission or cure may be achieved in some patients.
Singing Style, Vocal Habits, and General Health of Professional Singers
Authors: Santos Sabrina Silva , Montagner Thaynara , Bastilha Gabriele Rodrigues , Frigo Letícia Fernandez , Cielo Carla Aparecida 
Published: October 2019

Introduction For the singer, the voice is a medium used to express feelings that capture the listener. Every singing style has specific demands, and a vocal alteration may prevent the singer from meeting them.
Objective To compare the singing style, the vocal habits, and the general health data of professional singers.
Methods Cross-sectional, quantitative and retrospective study of a survey database. Data on the singing style, the vocal habits, and the health conditions and history of 57 professional singers, 31 female singers and 26 male singers, aged from 19 to 57 years old (average of 32 years old), from a mid-sized town were analyzed
Results There was a prevalence of female (54 ± 2%) popular singers (91 ± 2%), in the adult age (51 ± 2%), nonsmokers (89 ± 2%), nonusers of alcohol (77 ± 2%), with respiratory problems (53 ± 2%), mainly rhinitis (23 ± 2%), and without other health problems. There was a significant use of alcohol in males (p = 0.010); among the alcohol users, there was a significant presence of respiratory problems (p = 0.046), of pharyngitis/tonsillitis (p = 0.003), and of gastroesophageal reflux (GER) (p = 0.043); there was a significant presence of GER in subjects reporting endocrine problems (p = 0.023), of gastritis (p = 0.023), and of pharyngitis/tonsillitis (p = 0.030).
Conclusion There was a predominance of adult professional popular female singers, with complaints of respiratory issues (with a higher prevalence of rhinitis), without other general health issues, of nonsmokers, and of nonusers of alcohol.
The Influence of Dietary Salt on the Osseointegration of Implants in Aging Rats
Authors: Baldisserotto Julio , Padilha Dalva Maria Pereira , Amenábar José Miguel 
Published: October 2019

Introduction The bone-implant interface has been studied extensively, but only few papers focused on the nutritional aspects that may affect bone quality, especially salt intake.
Objective To study the osseointegration of implants in salt-loaded rats with low mineral bone content.
Methods A total of 60 4-month-old male rats were divided in 2 groups (n = 30), being these groups divided in 2 periods, (2 and 4 months). The control group received a normal diet, while the test group received a diet supplemented with 1% sodium chloride (NaCl). Implants were placed in the tibia of both groups. A total of 15 animals of each group were sacrificed at the 2nd month of the experiment, while the remaining animals were sacrificed at the 4th month.
Results No statistically significant difference was found in food intake between the groups on any experimental period, but a statistically significant difference was found in the liquid intake in the saline group in both periods. For all groups, osseointegration was observed in both groups. The mean percentage of osseointegration in the cortical bone, in the trabecular bone, and in the total osseointegrated surface between the control (46.38 ± 16.17%) and saline (49.13 ± 11.52%) groups at 2 months was not statistically different (p = 0.61). The total osseointegration areas of the control (53.98 ± 12.06%) and saline (51.40 ± 13.01%) groups at the 4th month of the study were not statistically (p = 0.61).
Conclusion Ingestion of salt did not affect directly the osseointegration process during the period of the experiment. The results suggest that mineral losses may not affect the achievement of good osseointegration in aging rats.
The Use of Osteotomies in Nasal Profileplasty
Authors: Berkhout Maaike Cornelia , Menger Dirk Jan 
Published: October 2019

AbstractIn rhinoplasty, osteotomies are performed to manipulate the bony nasal vault to improve the function and/or the aesthetics of the nose. This article provides an overview of the instruments used for osteotomies, as well as the indications and techniques for osteotomies in nasal profileplasty.
A Retrospective Analysis of Peroperative Risk Factors Associated with Posttonsillectomy Reactionary Hemorrhage in a Teaching Hospital
Authors: Manimaran Vinoth , Mohanty Sanjeev , Jayagandhi Satish Kumar , Umamaheshwaran Preethi , Jeyabalakrishnan Shivapriya 
Published: October 2019

Abstract
Introduction Tonsillectomy is one of the most common otolaryngology procedures performed worldwide. It is also one of the first procedures learnt by residents during their training period. Although tonsillectomy is viewed relatively as a low-risk procedure, it can be potentially harmful because of the chance of posttonsillectomy hemorrhage.
Objective The objective of the present study is to analyze the effects of peroperative factors and experience of the surgeon on the incidence and pattern of posttonsillectomy reactionary hemorrhage.
Methods A retrospective review of medical charts was performed from 2014 to 2017 in a tertiary care hospital. A total of 1,284 patients who underwent tonsillectomy and adenoidectomy were included in the study. The parameters assessed were experience of the surgeon, operating time, intraoperative blood loss, difference in mean arterial pressure (MAP) and pulse rate.
Results A total of 23 (1.79%) out of the 1,284 patients had reactionary hemorrhage. Out of those 23, 16 (69.5%) patients had been operated on by trainees, while 7 (30.5%) had been operated on by consultants (p = 0.033, odds ratio [OR] = 0.04). Operating time, intraoperative blood loss, difference in MAP and pulse rate were significantly higher in the reactionary hemorrhage group, and showed a positive association with risk of hemorrhage (p < 0.05; OR >1). Re-exploration to control the bleeding was required in 10 (76.9%) out of the 23 cases.
Conclusion The experience of the surgeon experience and peroperative factors have an association with posttonsillectomy hemorrhage. Close surveillance and monitoring of the aforementioned peroperative factors will help in the identification of patients at risk of hemorrhage.