bluuebunny/crossref_metadata_2025_split huggingface dataset:
Visiting and observing: reflections on clinical observer visits to Neuropsychiatry, Royal Melbourne Hospital
Authors: Looi Jeffrey , Velakoulis Dennis 
Published: August 2020

Objectives: To describe and provide experiential reflections on a model of continuing professional development in psychiatry for development and maintenance of specialised skills. Conclusions: For clinical psychiatrists working in smaller population centres, clinical observer visits with peers may be a useful method to develop, improve and calibrate knowledge and skills. Such potential benefits may be even more marked for specialised fields of psychiatry, such as neuropsychiatry.
Assessment of the New L Pharyngeal Flap for Velopharyngeal Insufficiency
Authors: El-Anwar Mohammad Waheed , Elsheikh Ezzeddin , Alnemr Mohamed Abdelmohsen , Quriba Amal Saed , Hassan Elham , Bahgat Ahmed Yassin 
Published: August 2020

Objective: To assess the results of the new L pharyngeal flap for treatment of velopharyngeal insufficiency (VPI). Methods: This study included 60 patients who were diagnosed as persistent VPI (for > 1 year without response to speech therapy for 6 months at least). L-shaped superiorly based pharyngeal flap was tailored from oropharynx and inserted into the soft palate through a transverse full-thickness palatal incision 1 cm from the hard palate, then the distal horizontal part of the flap was spread 1 cm anteroposterior direction and 1 cm horizontally into the soft palate. Prior to and after surgery, patients were assessed by oral examination, video nasoendoscopy, and speech evaluation. Results: Postoperative speech assessment showed significant improvement in nasoendoscopic closure, speech assessment, and nasometric assessments. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in 59 (98.3%) patients at 6 months postoperatively. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea was reported. Conclusion: The newly designed L pharyngeal flap was proved to be highly effective, reliable, and safe in treating patients with persistent VPI with easy applicability and without significant complication.
Incidence and Hematological Biomarkers Associated With Preoperative Deep Venous Thrombosis Following Foot Fractures
Authors: Ma Jiangtao , Qin Jin , Hu Jinglve , Shang Meishuang , Zhou Yali , Liang Ningxi , Zhang Yingze , Zhu Yanbin 
Published: August 2020

Background: This study was designed to investigate the incidence and hematological biomarker levels that are associated with deep venous thrombosis (DVT) following closed foot fractures (except calcaneal fractures). Methods: A retrospective analysis of data on patients presenting with closed foot fractures (excluding the calcaneus) between October 2014 and December 2018 was conducted. Duplex ultrasonography was used to screen preoperative DVT of bilateral lower extremities. Data on demographics, comorbidities, types of fracture, and laboratory biomarkers at admission were collected. Univariate analyses and multivariate logistic regression analyses were carried out to determine the independent risk factors associated with DVT. Results: A total of 537 patients were included, among whom 28 patients had preoperative DVTs, indicating a crude incidence rate of 5.2%. In isolated closed foot fractures, DVT occurred in 12 (2.9%) out of 410 patients, while in patients with concurrent fracture in other locations, 16 (12.6%) out of 127 patients developed DVT. The average interval between fracture occurrence and diagnosis of DVT was 4.2 days (median, 2 days), ranging from 0 to 17 days. Twenty-four patients (85.7%) developed DVT in the injured extremity, 3 (10.7%) in the uninjured extremity, and 1 (3.5%) in bilateral extremities. Seven risk factors were identified to be associated with DVT, including alcohol consumption, concomitant other fractures, platelet distribution width (PDW) <12%, high-density lipoprotein cholesterol (HDL-C) <1.1mmol/L, serum alkaline phosphatase (ALP) >100 U/L, serum sodium concentration (Na+) <135 mmol/L, and D-dimer >0.5 mg/L. Conclusion: Being aware of the prevalence of DVT in closed foot fractures can help physicians to carry out the overall assessment, risk stratification, and individual prevention programs. Level of Evidence: Level III, a prospective cohort study.
Evaluation of intraoperative lagophthalmos formula for levator resection in congenital ptosis in Egyptian patients
Authors: Rakha Tarek M , El Saadani Abd El Khalik I , Awara Amr M , Mandour Sameh S 
Published: August 2020

Purpose: To evaluate the recent intraoperative lagophthalmos formula method for levator resection in determining postoperative lid height in congenital ptosis on Egyptian patients. Methods: This is a prospective case series which included 20 eyelids of 17 Egyptian children with congenital ptosis whose levator function is 4 mm or better. They underwent levator muscle resection guided by the recently presented intraoperative lagophthalmos formula. Preoperative Margin-to-Reflex Distance 1 (MRD1) and levator function were measured then intraoperative palpebral fissure opening was determined from formula: Intraoperative lagophthalmos = 9.08 − (0.48 × Preoperative MRD1) − (0.26 × Levator function). Success was defined as postoperative MRD1 ⩾ 3 mm and difference between both eyelid height ⩽1 mm at 6 months. Results: From 20 eyelids, there were five cases with mild (25%), 11 with moderate (55%), and four with severe (20%) ptosis. They showed success in four cases (80%), eight cases (73%), and three cases (75%) in each degree respectively with an overall success of 15 cases (75%). Conclusion: Proposed intraoperative lagophthalmos formula showed relatively good results in predicting postoperative eyelid level in Egyptian children with simple congenital ptosis with fair to good levator function.
Participatory Design, Project Clients, and Healthcare User Groups
Authors: Carthey Jane 
Published: August 2020

Aim: This study is the third in a series of investigations that explored the role of project user groups and how they impact on the design of a healthcare facility. Previous studies focused on a wide range of users, whereas this study sought the views of project clients. Background: The “project client” represents the organization responsible for the procurement of a healthcare facility. “Users” will work in or “use” that building. With the input of project clients, this research focused on the user group process required for Australian and New Zealand publicly funded healthcare projects. It sought lessons to improve the process for future projects. Methods: Previous research findings, and an expanded literature review examining participatory design, were used to develop questions for semistructured interviews with selected project clients. Responses were transcribed and analyzed in terms of themes and subthemes using reflexive thematic analysis to develop a narrative that reports and discusses the findings. Results: Although not all are recognized, many stakeholders influence design decisions. No history, rationale, terms of reference, or evaluations of the user group process were found, suggesting that although it is a “given,” the process could be enhanced. Useful suggestions for improving the user group process are offered. Conclusions: Evaluating the user group process, and learning from alternative approaches, may improve its outcomes. A project charter and terms of reference would support more effective decision making, while best practice guidelines and education for user group participants should be considered.
Rhinomanometry Versus Computational Fluid Dynamics: Correlated, but Different Techniques
Authors: Cherobin Giancarlo B. , Voegels Richard L. , Pinna Fábio R. , Gebrim Eloisa M. M. S. , Bailey Ryan S. , Garcia Guilherme J. M. 
Published: August 2020

Background Past studies reported a low correlation between rhinomanometry and computational fluid dynamics (CFD), but the source of the discrepancy was unclear. Low correlation or lack of correlation has also been reported between subjective and objective measures of nasal patency. Objective: This study investigates (1) the correlation and agreement between nasal resistance derived from CFD (RCFD) and rhinomanometry (RRMN), and (2) the correlation between objective and subjective measures of nasal patency. Methods Twenty-five patients with nasal obstruction underwent anterior rhinomanometry before and after mucosal decongestion with oxymetazoline. Subjective nasal patency was assessed with a 0-10 visual analog scale (VAS). CFD simulations were performed based on computed tomography scans obtained after mucosal decongestion. To validate the CFD methods, nasal resistance was measured in vitro (REXPERIMENT) by performing pressure-flow experiments in anatomically accurate plastic nasal replicas from 6 individuals. Results Mucosal decongestion was associated with a reduction in bilateral nasal resistance (0.34 ± 0.23 Pa.s/ml to 0.19 ± 0.24 Pa.s/ml, p = 0.003) and improved sensation of nasal airflow (bilateral VAS decreased from 5.2 ± 1.9 to 2.6 ± 1.9, p < 0.001). A statistically significant correlation was found between VAS in the most obstructed cavity and unilateral airflow before and after mucosal decongestion (r = −0.42, p = 0.003). Excellent correlation was found between RCFD and REXPERIMENT (r = 0.96, p < 0.001) with good agreement between the numerical and in vitro values (RCFD/REXPERIMENT = 0.93 ± 0.08). A weak correlation was found between RCFD and RRMN (r = 0.41, p = 0.003) with CFD underpredicting nasal resistance derived from rhinomanometry (RCFD/RRMN = 0.65 ± 0.63). A stronger correlation was found when unilateral airflow at a pressure drop of 75 Pa was used to compare CFD with rhinomanometry (r = 0.76, p < 0.001). Conclusion CFD and rhinomanometry are moderately correlated, but CFD underpredicts nasal resistance measured in vivo due in part to the assumption of rigid nasal walls. Our results confirm previous reports that subjective nasal patency correlates better with unilateral than with bilateral measurements and in the context of an intervention.
Lower Tibial Tunnel Placement in Isolated Posterior Cruciate Ligament Reconstruction: Clinical Outcomes and Quantitative Radiological Analysis of the Killer Turn
Authors: Lin Yipeng , Huang Zeyuan , Zhang Kaibo , Pan Xuelin , Huang Xihao , Li Jian , Li Qi 
Published: August 2020

Background: The “killer turn” effect after posterior cruciate ligament (PCL) reconstruction is a problem that can lead to graft laxity or failure. Solutions for this situation are currently lacking. Purpose: To evaluate the clinical outcomes of a modified procedure for PCL reconstruction and quantify the killer turn using 3-dimensional (3D) computed tomography (CT). Study design: Case series; Level of evidence, 4. Methods: A total of 15 patients underwent modified PCL reconstruction with the tibial aperture below the center of the PCL footprint. Next, 2 virtual tibial tunnels with anatomic and proximal tibial apertures were created on 3D CT. All patients were assessed according to the Lysholm score, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Tegner score, side-to-side difference (SSD) in tibial posterior translation using stress radiography, and 3D gait analysis. Results: The modified tibial tunnel showed 2 significantly gentler turns (superior, 109.87° ± 10.12°; inferior, 151.25° ± 9.07°) compared with those reconstructed with anatomic (91.33° ± 7.28°; P < .001 for both comparisons) and proximal (99° ± 7.92°; P = .023 and P < .001, respectively) tibial apertures. The distance from the footprint to the tibial aperture was 16.49 ± 3.73 mm. All patient-reported outcome scores (mean ± SD) improved from pre- to postoperatively: Lysholm score, from 46.4 ± 18.87 to 83.47 ± 10.54 ( P < .001); Tegner score, from 2.47 ± 1.85 to 6.07 ± 1.58 ( P < .001); IKDC sports activities score, from 19 ± 9.90 to 33.07 ± 5.35 ( P < .001); and IKDC knee symptoms score, from 17.87 ± 6.31 to 25.67 ± 3.66 ( P < .001). The mean SSD improved from 9.15 ± 2.27 mm preoperatively to 4.20 ± 2.31 mm postoperatively ( P < .001). The reconstructed knee showed significantly more adduction (by 1.642°), less flexion (by 1.285°), and more lateral translation (by 0.279 mm) than that of the intact knee ( P < .001 for all). Conclusion: Lowering the tibial aperture during PCL reconstruction reduced the killer turn, and the clinical outcomes remained satisfactory. However, SSD and clinical outcomes were similar to those of previously described techniques using an anatomic tibial tunnel.
Olfaction in Primary Atrophic Rhinitis and Effect of Treatment
Authors: Mishra Anupam , Mishra Shukla Nimisha , Verma Veerendra , Mishra Subhash Chandra 
Published: August 2020

ObjectiveTo assess olfactory and clinical morbidity in primary (idiopathic)–type atrophic rhinitis and its course following treatment.Study DesignProspective nonrandomized controlled cohort study with follow‐up.SettingDepartment of Otorhinolaryngology and Head and Neck Surgery of a university hospital (tertiary heath care center).MethodsSixty‐one patients with atrophic rhinitis underwent assessment of clinical severity with baseline olfaction with the Brief Smell Identification test, while the improvement of their status following surgical versus nonsurgical treatment was further assessed.ResultsOlfaction was universally deranged with bimodal age presentation and female predominance (61%). Clinical improvement was significantly associated with surgical treatment but did not reveal any relation with up‐front severity of disease. A near‐significant association of age with severity did not reveal significance when stratified by age group. Baseline olfaction or its change following treatment did not reveal any significance with severity of disease or clinical improvement. Radiologic atrophy also did not reveal any significant relation with severity criteria.ConclusionsOlfactory functions as compared with clinical parameters provided better reflection of underlying (systemic) pathology with environmental interaction, while later it mainly signified localized condition. Accordingly, olfaction was affected early and recovered slowly (or not at all), independent of clinical morbidity, which in turn is affected rather late but recovers early. Olfactory dysfunction at the initial stage may be a surrogate marker of potential worsening clinical condition, since bacteria often superinfect underlying susceptible nasal environment. While surgery mainly improved clinical parameters without affecting olfaction directly, a true improvement would include recovery of both.
Anxiety and Depression in Patients With Retinitis Pigmentosa
Authors: Le Patrick , Nguyen Michelle , Vu Thoai , Dao Diem-Phuong , Olson Daniel , Zhang Alice Yang 
Published: August 2020

Purpose: Retinitis pigmentosa (RP) is a chronic progressive disease with no curative treatments. Understanding the variables involved with improving patients’ quality of life is important in managing this population. The literature investigating the relationship of anxiety and depression with RP relies on the analysis of smaller subset populations of patients with RP, and no study has quantified the effect size of the potential association. This study aims to elucidate and quantify the association between RP, anxiety, and depression. Methods: A retrospective case-control study was conducted of 6 093 833 medical records within the University of North Carolina Hospital and outpatient clinic system from July 1, 2004, to August 30, 2019. Patients with a diagnosis of RP, anxiety, and depression were identified within the Carolina Data Warehouse for Health by International Classification of Diseases, Ninth and Tenth Revision codes. Results: From the base population of 6 093 833 patients' medical records, 690 patients were diagnosed with RP, 253 065 with anxiety, and 232 541 with depression. Patients with RP have an odds ratio, adjusted for sex and age, of 4.915 (95% CI, 4.035-5.987) for having comorbid anxiety, 5.609 (95% CI, 4.622-6.807) for comorbid depression, and 4.130 (95% CI, 3.187-5.353) for comorbid anxiety and depression. Conclusions: Patients with RP have a higher prevalence of anxiety and depression, with increased odds of approximately 5 to 6 times for also carrying a diagnosis of anxiety or depression and about 4 times for carrying diagnoses of anxiety and depression compared with the general population.
Evaluation of an Expert Guided Integrative Therapy Concept in Patients With Breast or Gynecological Cancer During Systemic Therapy
Authors: Schmidt Georg , Mathes Sofia , Klein Evelyn , Kiechle Marion , Paepke Daniela 
Published: August 2020

Purpose.Breast and gynecological cancer patients undergoing systemic therapy frequently request integrative therapy concepts. The potential of integrative therapy (IM) lies in minimizing side effects of conventional cancer treatments and therefore decreasing treatment delays. IM can help to improve patients’ physical and emotional well-being, optimizing health and quality of life as IM involves patients in their own treatment. A counseling service for integrative medicine concepts as an outpatient program was implemented in our cancer center in 2013.Methods.In 2016 and 2017 144 breast and gynecological cancer patients were included into our specific IM program. The program comprises biological based complementary and alternative medicines (BB-CAM), a structured exercise therapy, manipulative and body-based practices, nutritional counseling, psycho-oncological and relaxing therapies. Therapists with additional specialization for IM, guide the treatment units. The program was evaluated via self-administered questionnaire.Results.78% of the participating patients noticed an improvement by using BB-CAMs. 86% stated to feel better through participation in the structured exercise program. 74% profited from nutritional counseling and 91% from manual therapy. 93% of the patients treated with body compresses considered the application as soothing. The Bio-Frequency Sound Color Bed led to a relaxation in 96%. Psychological therapy improved coping with the disease in 70% of the patients.Conclusion.Integrative oncology combines the best practices of conventional and complementary therapy, uniting them in a holistic concept. Data show that our integrative therapy concept is well accepted by the patients and that therapy- and disease-related side effects can be reduced.
Development of BIMSTEC Free Trade Area for Thailand in Indo-Pacific
Authors: Srisangnam Piti , Sabhasri Chayodom , Horachaikul Surat , Sinthuphan4and Jirayudh , Rudjanakanoknad Jittichai 
Published: August 2020

To develop a policy for creation of economic value and utilise the development of Bay of Bengal Initiative for Multi-Sectoral Technical and Economic Cooperation (BIMSTEC) free trade area for Thailand, two research tools are adopted in this article. The first one is based on the Global Trade Analysis Project (GTAP) model, adopted as a tool to explore quantitative impacts from the implementation of free trade area. Due to the limitations of the model, however, we have adopted a complementing qualitative analytical framework to ensure that the research must be as comprehensive as possible in every aspect. The qualitative analytical framework chosen in this article is called PEST analysis. Having completed field research, in-depth interviews, focus group meetings and model studies, this article concludes that BIMSTEC is a large-scale market with high purchasing power and growth rate as well as a great source of vast natural and human resources. It is situated not far from Thailand, and at the same time, its social and cultural conditions are very close to those of Thailand’s. It concludes that a stronger BIMSTEC is an essential foundation of Indo-Pacific. JEL Codes: F13, F 15
Prognostic impact of the ELN2017 risk classification in patients with AML receiving allogeneic transplantation
Authors: Grimm Juliane , Jentzsch Madlen , Bill Marius , Goldmann Karoline , Schulz Julia , Niederwieser Dietger , Platzbecker Uwe , Schwind Sebastian 
Published: August 2020

Abstract
In 2017, an updated European LeukemiaNet (ELN) risk classification was published allocating patients with acute myeloid leukemia (AML) to 3 risk groups on the basis of certain cytogenetic and molecular aberrations. To date, studies of the prognostic significance of the ELN2017 risk classification in the context of an allogeneic hematopoietic stem cell transplantation (HSCT) are lacking. We performed risk stratification according to the ELN2017 classification in 234 patients with AML who underwent allogeneic HSCT as a consolidation therapy. In our cohort, the risk of 39.7% of the patients was classified as favorable, that of 12.8% as intermediate, and that of 47.4% as adverse. In the context of allogeneic HSCT, the assignment to the 3 ELN2017 risk groups retained its prognostic significance, with patients with favorable risk having the best prognosis and those with adverse risk having the worst one. Subgroup analyses showed that patients with a monosomal karyotype or TP53 mutation had considerably increased relapse rates, even in the adverse-risk group. When we analyzed the impact of digital droplet PCR–based measurable residual disease (MRD) before allogeneic HSCT, MRD+ patients had impaired prognoses, with cumulative incidence of relapse and overall survival comparable to those of patients classified as having an ELN2017 adverse genetic risk. This study is the first to demonstrate that the ELN2017 classification distinguishes the 3 risk groups with significantly distinct prognoses, even after allogeneic HSCT, and emphasizes the dismal prognosis of patients with AML with TP53 mutations, monosomal karyotype, or MRD positivity after allogeneic HSCT.
Discovery of the possible mechanisms in kouyanqing granule for treatment of oral ulcers based on network pharmacology
Authors: Chen Pan , Yao Hongliang , Yuan Qing , Li Panlin , Wang Xinning , Su Weiwei , Wang Yonggang , Li Peibo 
Published: August 2020

Abstract
Background
Oral ulcer diseases are complex inflammatory diseases caused by multi-factors, which severely impact patient quality of life. Kouyanqing Granule (KYQG) has been used to treat inflammatory diseases of the mouth and throat, including recurrent aphthous stomatitis (RAS), traumatic ulcers, oral leukoplakia and so on. However, the underlying molecular mechanisms of KYQG in treating these diseases are still unclear. We aimed to explore the possible mechanisms in KYQG for the treatment of oral ulcers.

Methods
An innovative network pharmacology method was established by incorporating targets searching and fishing, network analysis, and silico validation to discover the pharmacological mechanisms of action of KYQG for the treatment of oral ulcers. Then, we verified the reliability of this method by an animal experiment.

Results
Our data indicated that a total of 47 key targets were screened, which mainly involved in three function modules including the inhibition of inflammation, the regulation of immunological response, and the suppression of oxidative stress. The implementation of these functions relies on the complex multi-pathways network, especially TNF signaling pathway and HIF-1 signaling pathway. The results of the experimental verification indicated that KYQG significantly inhibited the serum levels of cyclooxygenase-2 (COX2), matrix metalloproteinase 9 (MMP9) and tumor necrosis factor-alpha (TNF-α) in rats with oral ulcer.

Conclusion
KYQG exhibited the therapeutic effects on oral ulcers probably by inhibiting inflammation, regulating immunological response, and suppressing oxidative stress through a complex multi-pathways network. Particularly, TNF signaling pathway and HIF-1 signaling pathway may play crucial roles in the protection of KYQG against oral ulcers. This work not only offers a method for understanding the functional mechanisms of KYQG for treating oral ulcer diseases from a multi-scale perspective but also may provide an efficient way for research and development of complex composition formula.