bluuebunny/crossref_metadata_2025_split huggingface dataset:
Resection and Reconstruction of Giant Abdominoscrotal Arteriovenous Malformation
Authors: Danno Kanako , Narushima Mitsunaga , Iida Takuya , Banda Chihena , Todokoro Takeshi , Tashiro Kensuke , Ishiura Ryohei , Mitsui Kohei , Tone Shine , Mori Harushi 
Published: March 2020

Summary:
Genital arteriovenous malformations are rare and present unique surgical challenges in preserving urogenital function, abdominal wall integrity, and lower limb perfusion. A 32-year-old man with a giant abdominoscrotal arteriovenous malformation presented with recurrent heavy bleeding. Due to the high risk of rebleeding and fatal hemorrhage, surgery with curative intent was proposed and the patient was counseled on the risks of ischemia to the lower limb, testes, and penis. Preoperative embolization of the feeding vessels was performed. Three days later, surgical excision of the mass with the affected scrotum, left rectus muscle, sheath, and overlying abdominal skin followed. The testes were dissected from the malformation and preserved along with the right internal pudendal artery. The left thigh skin was advanced to the scrotal remnants and a neoscrotum created. The resulting large abdominal wall defect was reconstructed in layers with a pedicled anterolateral thigh flap, including innervated vastus lateralis muscle, to prevent herniation. Recovery was uneventful, and a 4-year follow-up revealed no significant clinical or radiological recurrence with recovery of flap sensation, retained erectile function, and no herniation. We report this case due to rarity of giant abdominoscrotal arteriovenous malformations and present preoperative embolization, surgical resection, and functional anterolateral thigh flap reconstruction as a valuable treatment option of this life-threatening illness.
Enhancing induced pluripotent stem cell toward differentiation into functional cardiomyocytes
Authors: Chien Chian-Shiu , Wang Chien-Ying , Leu Hsin-Bang , Chien Yueh , Yang Yi-Ping , Wang Chia-Lin , Tai Hsiao-Yun , Ko Yu-Ling , Tsai Fu-Ting , Chou Shih-Jie , Yu Wen-Chung , Yang Meng-Yin 
Published: March 2020

Background:
Heart diseases, especially myocardial ischemia, remain one of the leading causes of mortality worldwide and usually result in irreparable cardiomyocyte damage and severe heart failure. Recent advances in induced pluripotent stem cell (iPSC) technologies for applied regenerative medicine and stem cell research, especially for iPSC-derived cardiomyocytes have increased the hope for heart repair. However, the driver molecules of myocardial differentiation and the functional reconstruction capacity of iPSC-derived cardiomyocytes are still questionable.

Methods:
Herein, we established a rapid differentiated platform that is involved in cardiomyogenic differentiation and maturation from iPSCs in vitro. Functional analysis is performed in miR-181a-transfected iPSC-derived cardiomyocyte (iPSC-cardio/miR-181a) under a time-lapse microscope. In addition, we calculated the beating area and frequency of iPSC-cardio/miR-181a cells in the presence of HCN4 shRNA or miR-181a SPONGE.

Results:
miR-181a enhanced the beating area and maintained the beating frequency of iPSC-derived cardiomyocytes by enhancing HCN4 expression.

Conclusion:
miR-181a would play a key role on maintaining proper beating function in iPSC-derived cardiomyocytes.
Risk of hepatitis C virus infection in injecting and noninjecting drug users receiving opioid substitution therapy
Authors: Wang Chih-Wen , Chuang Hung-Yi , Chiang Hung-Che , Huang Po-Chin , Yu Ming-Lung , Dai Chia-Yen 
Published: March 2020

Background:Hepatitis C virus (HCV) is the most common viral infection among illicit drug users in the world. Although intervention of needle and syringe program and opioid substitution therapy had engaged to prevent HCV infection, the prevalence of HCV infection does not seem to decline. The aim of this study was to estimate the risk of HCV infection in injecting drug users (IDUs) and noninjecting drug users (NIDUs) receiving opioid substitution therapy.Methods:We recruited 1179 heroin-dependent patients (age: 20-66 years) under opioid substitution therapy from 2012 to 2015 in a Psychiatric Center, Southern Taiwan. The data of HCV, hepatitis B virus and HIV infection and liver biochemical examination were obtained. We used multivariate logistic regression analysis to predict the risk of HCV infection.Results:There were 93.1% of IDUs and 68.1% of NIDUs positive for HCV infection. In IDUs, HIV infection, age of heroin initiation, duration and dose of heroin use, frequency of detoxification, and number of criminal conviction were significantly associated with HCV infection. In NIDUs, snort/sniff heroin exhibited a significantly increased risk of HCV infection. Intravenous injecting (odds ratio [OR] = 23.10, 95% CI = 8.04-66.40,p< 0.001), intravenous injecting combined snort/sniff (OR = 12.95, 95% CI = 3.90-42.97,p< 0.001), and snort/sniff (OR = 4.14, 95% CI = 1.30-13.18,p= 0.016) were significantly associated with increased risk of HCV infection compared with smoking. The trend was significant (pfor trend <0.001).Conclusion:In Taiwan, IDUs had harmful characteristics compared with NIDUs and both had extremely high prevalence of HCV infection. We provided evidence that snort/sniff is a possible way of leak in HCV infection despite needle-syringes supplement program been provided. Opioid substitution therapy program should include HCV assessment and treatment in the new direct-acting antiviral therapy era.
Is the risk of idiopathic sudden sensorineural hearing loss higher in nasopharyngeal carcinoma than in hypopharyngeal cancer? A population-based study
Authors: Chang Hung , Tu Tzong-Yang , Wu Chuan-Song , Kuo Ting-Yu , Huang Chii-Yuan 
Published: March 2020

Background:
The aim of this study was to compare the risk of developing sudden sensorineural hearing loss (SSHL) in patients with hypopharyngeal cancer with that in patients with nasopharyngeal carcinoma (NPC).

Methods:
A population-based, retrospective cohort study was performed using the Taiwan National Health Research Database databank. Patients selected for this study were diagnosed with hypopharyngeal cancer or NPC and treated with radiotherapy in the period from 2001 to 2004. Routine follow-up was conducted for 8 years (2004–2012), and the incidence of SSHL was calculated at the final follow-up.

Results:
There was no significant difference in the risk of developing SSHL between the hypopharyngeal cancer group and its control group (p = 1.000). In hypopharyngeal cancer and NPC groups, the rates of SSHL were 0.12% and 1.00%, respectively (p < 0.001). The cumulative hazard of SSHL during the follow-up period was significantly higher in the NPC group than in the control group (p < 0.001).

Conclusion:
Radiotherapy in patients with hypopharyngeal cancer did not increase the risk of developing SSHL, but postirradiation NPC was significantly associated with an increased incidence of SSHL.
Prognostic factors and survival in conventional chondrosarcoma: A single institution review
Authors: Chen Yi-Chou , Wu Po-Kuei , Chen Chao-Ming , Tsai Shang-Wen , Chen Cheng-Fong , Chen Wei-Ming 
Published: March 2020

Background:
Chondrosarcoma is the second most common primary sarcoma of the bone. Surgery remains the gold standard for treatment due to chemotherapy and radiotherapy resistance in chondrosarcoma. The main aim of our study was to analyze patients with primary chondrosarcoma of the bone who were treated in a single tumor center. Our study team identified the prognostic factors for overall survival, metastasis-free survival, and recurrence-free survival.

Methods:
From 1998 to 2012, 55 consecutive patients were treated surgically. All patients were followed for local recurrence or distant metastasis. Uni- and multivariate analyses were performed for overall, metastasis-free, and recurrence-free survival.

Results:
Local recurrence developed in 29 of the 55 patients (52.7%). Recurrence-free survival in the multivariate analysis showed a significant association with the surgical margin, and high-grade lesions were an independent factor for local recurrence. In total, 11 patients died of the disease in the study, and the 5- and 10-year survival rates were 84.4% and 78.1%, respectively. The tumor grade and local recurrence were significant factors in the univariate analysis but were insignificant in the Cox regression with time-dependent covariates (p = 0.327 and p = 0.82, respectively). The development of distant metastasis was a significant poor prognostic factor in both the uni- and multivariate analyses.

Conclusion:
Chondrosarcoma of the bone is a disease with surgery-dependent outcomes; but, however, patients often develop subsequent recurrence of the disease. The surgical margins were statistically associated with the risk of subsequent local recurrence but did not predict survival. The development of distant metastases was an independent prognostic factor for poor survival.
A Theoretical Framework and Process for Implementing a Spiral Integrated Curriculum in a Physical Therapist Education Program
Authors: Jette Diane U. , Macauley Kelly , Levangie Pamela K. 
Published: March 2020

Background and Purpose.
In 2016, faculty at the MGH Institute of Health Professions implemented a new physical therapist education curriculum based on contemporary theoretical models of learning to address shortcomings of the existing, traditional curriculum. Course content was siloed, students were spending too much time in class to the detriment of self-directed learning, and there was unwarranted repetition of content. Students seemed to emphasize superficial learning in an effort to pass numerous examinations across multiple courses, and they were learning factual knowledge in isolation. The purpose of this article is to describe a new curricular model framed within theoretical perspectives on learning, including cognitive load theory and constructivism. We also describe how we structured decisions about curriculum at the program, course, session, and assessment levels.

Method/Model Description and Evaluation.
We developed a curriculum that represents spiral integration, including integration of the foundational, clinical, and behavioral sciences at the program, course, session, and assessment levels. Courses employ increasingly complex patient narratives that present patients holistically. Course objectives focus on the higher levels of the learning taxonomies.

Outcomes.
The curriculum not only integrates content within and across courses but also uses constructivist learning theory by explicitly engaging students in iterative learning with emphasis on depth versus breadth of information.

Discussion and Conclusion.
The approach to teaching is focused on stimulating curiosity and motivating learning through patient narratives and early focus on clinical reasoning. Cognitive load is addressed by reducing in-class time and having students take only 1 course at a time. An ongoing process of critical study, review, and revision of the curriculum will continue to improve students’ learning experiences, environment, and outcomes.
Partnership Across Transitions to Improve Outcomes in the Lower Extremity Total Joint Population
Authors: Ketchum Amy 
Published: March 2020

BACKGROUND:
With the urgency related to improving quality and creating efficiency in healthcare, partnership is emerging as a critical concept related to transitions of care.

PURPOSE:
This quality improvement project included facilitation of hospital partnership with skilled nursing facilities to improve outcomes associated with the lower extremity total joint arthroplasty population.

METHODS:
The clinical nurse specialist (CNS) utilized a standardized framework to implement partnership strategies with multidisciplinary teams. Outcomes were monitored for the 2 quarters of partnership activities.

RESULTS:
All recommendations for developing a partnership model were facilitated within the project timeline. Patient experience and quality measures remained at, or improved, from baseline and met all strategic targets. Efficiency through episode payment demonstrated improvement at each interval during the study period. Analysis revealed a significant (p < .05) reduction in the mean hospital length of stay.

CONCLUSION:
The CNS practice outcomes suggest that the use of structured partnership strategies between agencies improves efficiency of care and accelerates rapid spread of innovation.
How 217 Pediatric Intensivists Manage Anemia at PICU Discharge: Online Responses to an International Survey*
Authors: Demaret Pierre , Karam Oliver , Labreuche, BST Julien , Chiusolo Fabrizio , Mayordomo Colunga Juan , Erickson Simon , Nellis Marianne E. , Perez Marie-Hélène , Ray Samiran , Tucci Marisa , Willems Ariane , Duhamel Alain , Lebrun Frédéric , Loeckx Isabelle , Mulder André , Leteurtre Stéphane 
Published: March 2020

Objective:To describe the management of anemia at PICU discharge by pediatric intensivists.Design:Self-administered, online, scenario-based survey.Setting:PICUs in Australia/New Zealand, Europe, and North America.Subjects:Pediatric intensivists.Interventions:None.Measurements and Main Results:Respondents were asked to report their decisions regarding RBC transfusions, iron, and erythropoietin prescription to children ready to be discharged from PICU, who had been admitted for hemorrhagic shock, cardiac surgery, craniofacial surgery, and polytrauma. Clinical and biological variables were altered separately in order to assess their effect on the management of anemia. Two-hundred seventeen responses were analyzed. They reported that the mean (±sem) transfusion threshold was a hemoglobin level of 6.9 ± 0.09 g/dL after hemorrhagic shock, 7.6 ± 0.10 g/dL after cardiac surgery, 7.0 ± 0.10 g/dL after craniofacial surgery, and 7.0 ± 0.10 g/dL after polytrauma (p< 0.001). The most important increase in transfusion threshold was observed in the presence of a cyanotic heart disease (mean increase ranging from 1.80 to 2.30 g/dL when compared with baseline scenario) or left ventricular dysfunction (mean increase, 1.41–2.15 g/dL). One third of respondents stated that they would not prescribe iron at PICU discharge, regardless of the hemoglobin level or the baseline scenario. Most respondents (69.4–75.0%, depending on the scenario) did not prescribe erythropoietin.Conclusions:Pediatric intensivists state that they use restrictive transfusion strategies at PICU discharge similar to those they use during the acute phase of critical illness. Supplemental iron is less frequently prescribed than RBCs, and prescription of erythropoietin is uncommon. Optimal management of post-PICU anemia is currently unknown. Further studies are required to highlight the consequences of this anemia and to determine appropriate management.
Motor Function in School-Aged Children With Positional Plagiocephaly or Brachycephaly
Authors: Collett Brent R. , Kartin Deborah , Wallace Erin R. , Cunningham Michael L. , Speltz Matthew L. 
Published: March 2020

Objective:
To determine whether children with a history of positional plagiocephaly/brachycephaly (PPB) show persistent deficits in motor development.

Methods:
In a longitudinal cohort study, we completed follow-up assessments with 187 school-aged children with PPB and 149 participants without PPB who were originally enrolled in infancy. Primary outcomes were the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition (BOT-2) composite scores.

Results:
Children with PPB scored lower than controls on the BOT-2. Stratified analyses indicated that differences were restricted to children who had moderate-severe PPB. No consistent differences were observed in children who had mild PPB.

Conclusion:
Children who had moderate-severe PPB in infancy show persistent differences in motor function. We suggest close developmental monitoring and early intervention to address motor deficits.
Management of Oronasal Fistulas in Patients With Cleft Lip and Palate
Authors: Miranda Bruna Lima , Júnior Júlio Leite de Araújo , Paiva Marcos Antônio Farias de , Lacerda Rosa Helena Wanderley , Vieira Alexandre Rezende 
Published: March 2020

Background:
The oronasal fistula in cleft patients is one of the complications that can be found after primary surgeries due to a failure of healing of the surgical repair that causes the communication between the oral and nasal cavities. A number of procedures can be implemented to correct the fistula and it is not clear if a particular technique is the best to be recommended.

Objective:
This study aims to systematically analyze the scientific evidence regarding the treatment of oronasal fistulas located in the lingual-alveolar and labial-alveolar regions in patients with cleft lip and palate who have undergone primary surgeries.

Material and Methods:
A bibliographic search of articles published until September 2018 without restricted year and language of publication, in PubMed (Medline), Scopus, Cochrane, Web of science, and BVS databases. The MeSHterms “Fistula,” “Oral Fistula,” and “Cleft Lip” were used, which were related to each other and with other keywords related to the subject of the review through the “OR” and “AND” operators. The quality of the publications was evaluated according to the guidelines of the Methodological Index for Nonrandomized Studies.

Results:
After applying the eligibility criteria, a total of 18 articles were selected for the extraction of data and qualitative analysis.

Conclusion:
All publications analyzed in this review reported the fistula treatment at the same surgical time as the bone graft, independently of the donor area, the type of cleft treated and the patient's age at operation. There was no consensus among the studies on the best treatment type for oronasal fistulas located in the alveolar region, and further comparative studies between the existing techniques will be necessary to address this question.
The Role of Staged Cryosurgery and Three-Dimensional Computed Tomography Integrated Navigation System in the Surgical Management of Severe Involvement of Craniofacial Polyostotic Fibrous Dysplasia
Authors: Yildiz Kemalettin , Dündar Tolga Turan , Abdallah Anas , Mehdizade Turan , Güneren Ethem , Canter Halil Ibrahim 
Published: March 2020

Abstract
Fibrous dysplasia (FD) is a developmental bone disorder caused by the hamartamatous proliferation of bone-forming cells. A 29-year-old male patient with diagnosis of FD was admitted to our clinic with the symptoms of severe craniomaxillofacial involvement of FD beginning from last year. Neurological examination revealed diplopia, horizontal nystagmus, conductive hearing loss, and partial vision loss. In his medical history, it was reported that he had undergone intramedullary nailing operation in his left femur due to a pathological fracture approximately 8 years ago in the orthopedics clinic of our institution. The patient underwent 3 consecutive surgeries by our plastic and neurosurgical team. The patient was followed-up in the neuro-intensive care unit between the surgical sessions and 1 week after the last operation. Afterwards, he was transferred to the neurosurgical department. No postoperative complication was detected. The preoperative signs were recovered. During his 6th month follow-up control-visit, all his preoperative symptoms were improved. In addition, the patient was satisfied with his postoperative cosmetic improvement. In conclusion, virtual surgical planning and intraoperative surgical navigation systems can make the challenging cases possible to operate with increasing the safety margin of the surgical procedures for polyostotic FD.
“Ready SIM Go”
Authors: Mednick Lauren , O'Connell Brianna , Graber Kelsey , Roussin Christopher , Weinstock Peter 
Published: March 2020

Summary Statement
Changing healthcare systems and efforts to decrease medical costs have resulted in many more patients and caregivers (PCs) needing to manage life-sustaining therapies on their own. Given the potential for underpreparedness to result in increased morbidity and mortality, developing safe and efficient homecare training methods for PCs is essential. Medical simulation with PCs is an underused tool, which has the potential to decrease anxiety and increase preparedness through opportunities for repeated practice of medical procedures within a safe, controlled environment. This article describes the development of a hospital-based simulation service line for PCs, leveraging lessons learned from training for 250 patients and 450 caregivers in 14 different departments and subspecialties, and explains adaptations of standard simulation methods necessary for safe and effective use of simulation with this unique population. Process blueprint, examples of specific programs, as well as feedback from participants and clinicians are included.
Association of Knowledge and Presence of Pelvic Floor Disorders and Participation in Pelvic Floor Exercises: A Cross-sectional Study
Authors: Goodridge Sophia Delpe , Chisholm Leah P. , Heft Jessica , Hartigan Siobhan , Kaufman Melissa , Dmochowski Roger R. , Stewart Thomas , Reynolds William Stuart 
Published: March 2020

Introduction
Women’s baseline knowledge of pelvic floor exercises (PFEs) and pelvic floor disorders (PFDs) is not well established, as is their knowledge regarding PFE and participation in such exercise. The aim of our study was to assess baseline PFD and PFE knowledge and to determine if knowledge in any way influenced participation in PFEs.

Methods
This was an institutional review board–approved, cross-sectional survey administered to women 18 years or older. We included all women who completed the survey, of which 3733 met the criteria. A survey-based questionnaire was used to query lower urinary tract symptoms, PFD, knowledge, and frequency of participation in PFEs.

Results
Of those who responded, the mean incontinence knowledge score was 9.2 ± 2.6, whereas the mean score for pelvic organ prolapse (POP) knowledge was 6.8 ± 3.6. Of the respondents, 92.5% reported being familiar with Kegel exercises. The majority of respondents reported that they did not participate in PFEs (57.4%). Those with POP were more likely to do daily PFEs than those without POP, 34.8% versus 16.4% (P < 0.001). Stress urinary incontinence did not influence frequency of performing PFEs.

Conclusions
Our study demonstrated that while baseline knowledge of POP and incontinence knowledge were high in this patient population, the majority of participants did not participate in PFE. Participants with POP were more likely to partake in daily PFE. A gap exists between knowledge and willingness to participate in PFE. Bridging this gap may be significantly impactful for women’s health.