bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combination therapy of obeticholic acid and ursodeoxycholic acid in patients with primary biliary cholangitis who respond incompletely to ursodeoxycholic acid: a systematic review
Authors: Li Xuan , Liao Min , Pan Qiong , Xie Qiaoling , Yang Hong , Peng Ying , Li Qiao , Qu Jiaquan , Chai Jin 
Published: July 2020

Background:
Although the efficacy of ursodeoxycholic acid (UDCA) and obeticholic acid (OCA) for primary biliary cholangitis (PBC) has been suggested by small trials, a meta-analysis to summarize the evidence has not yet been carried out. The aim of this study was to evaluate the clinical outcomes of the combination therapy of UDCA and OCA compared with UDCA monotherapy in patients with PBC.

Methods and materials:
We searched the PubMed, EMBASE, the web of science, and the Cochrane Library databases for English-language studies published before September 2018. Studies were included if they were randomized controlled trials (RCTs) and reported relative risk (RR) estimates with 95% confidence intervals (CIs) or related data for the clinical outcomes of different therapies in patients with PBC.

Results:
Of the 1169 titles identified, two studies meeting the inclusion criteria were included in the meta-analysis. Approximately 222 patients with PBC were included in this analysis. The results of this study indicated that combination therapy was significantly superior to monotherapy in reducing serum alanine transaminase (mean difference: –15.63 IU/L; 95% CI, –21.59 to –9.68), aspartate transaminase (mean difference: –6.63 IU/L; 95% CI, –11.03 to –2.24), gamma-glutamyl transpeptidase (mean difference: –131.30 IU/L; 95% CI, –177.52 to –85.08), and C-reactive protein (mean difference = –1.17 mg/L; 95% CI, –2.19 to –0.14), but NS in improving primary endpoints of alkaline phosphatase level with 15.0% reduction from baseline, and equal or higher than the upper limit of normal serum total bilirubin (RR = 2.75; 95% CI, 0.43–17.68), conjugated bilirubin (mean difference = –0.06 mg/dL; 95% CI, –0.28 to 0.15), IgM (mean difference = –41.18 mg/dL; 95% CI, –244.45 to 162.09), and adverse events (P > 0.05).

Conclusion:
This meta-analysis demonstrated that combination therapy with UDCA and OCA provided satisfactory clinical outcomes, which may be a promising alternative for patients with PBC who had an inadequate response to UDCA therapy. Therefore, high-quality RCTs on the safety and efficacy of the combination therapy of UDCA and OCA compared with UDCA monotherapy in patients with PBC should be performed in the future.
Risk of recurrent hepatic encephalopathy in patients with liver cirrhosis: a German registry study
Authors: Gabriel Maria M. , Kircheis Gerald , Hardtke Svenja , Markwardt Daniel , Buggisch Peter , Mix Heiko , Grüngreiff Kurt , Welzel Tanja M. , Kälsch Julia , Hartmann Heinz , Gerbes Alexander L. , Karpowitz Maria v. , Seeliger Benjamin , Wedemeyer Heiner , Weissenborn Karin 
Published: July 2020

Background and aims
Patients with hepatic encephalopathy (HE) show low quality of life, recurrent hospitalizations and an increased mortality. We aimed to assess the natural course of patients after a recent episode of overt HE and to identify risk factors for HE recurrence in Germany.

Methods
Fifteen sites took part in a prospective, observational study including patients with liver cirrhosis who had been hospitalized for HE within 3 months before recruitment. Clinical data, psychometric hepatic encephalopathy score (PHES) and critical flicker frequency were assessed quarterly for 1 year. Primary endpoint was HE recurrence requiring hospitalization, all-cause-mortality was treated as a competing risk factor.

Results
From January 2014 to March 2016, a total of 115 patients were recruited. Overall 14 premature deaths were documented. For 78 subjects follow-up data were available in accordance with the protocol. After a median of 118 days, more than half of the per-protocol cohort was readmitted to hospital due to HE (N = 34) or died (N = 11). The risk for hospitalization was significantly increased in patients who had been recruited by liver transplant centers (P = 0.003), had had frequent HE relapses prior to recruitment (P = <0.0001) or an abnormal PHES result of <−4 (P = 0.044). Abnormal PHES results barely missed level of significance as an independent risk factor for re-hospitalization in a multivariable competing risk model (P = 0.093).

Conclusion
Patients with a history of HE are at high risk for the development of recurrent overt HE demanding hospitalization. The PHES test may aid in detection, monitoring and risk stratification of recurrent HE.
The utility of 99mTc-mebrofenin hepatobiliary scintigraphy with SPECT/CT for selective internal radiation therapy in hepatocellular carcinoma
Authors: Labeur Tim A. , Cieslak Kasia P. , Van Gulik Thomas M. , Takkenberg R. Bart , van der Velden Sandra , Lam Marnix G.E.H. , Klümpen Heinz-Josef , Bennink Roel J. , van Delden Otto M. 
Published: July 2020

Background
Studies assessing the impact of selective internal radiation therapy (SIRT) on the regional liver function in patients with hepatocellular carcinoma (HCC) are sparse. This study assessed the changes in total and regional liver function using hepatobiliary scintigraphy (HBS) and investigated the utility of HBS to predict post-SIRT liver dysfunction.

Methods
Patients treated with SIRT for HCC between 2011 and 2019, underwent 99mTc-mebrofenin HBS with single-photon emission computed tomography/computed tomography (SPECT/CT) before and 6 weeks after SIRT. The corrected mebrofenin uptake rate (cMUR) and corresponding volume was measured in the total liver, and in treated and nontreated liver regions. Patients with and without post-SIRT liver dysfunction were compared.

Results
A total of 29 patients, all Child-Pugh-A and mostly intermediate (72%) stage HCC were included in this study. Due to SIRT, the cMURtotal declined from 5.8 to 4.5%/min/m2 (P < 0.001). Twenty-two patients underwent a lobar SIRT, which induced a decline in cMUR (2.9–1.7%/min/m2, P < 0.001) and volume (1228–1101, P = 0.002) of the treated liver region, without a change in cMUR (2.4–2.0%/min/m2, P = 0.808) or volume (632–644 mL, P = 0.661) of the contralateral nontreated lobe. There were no significant pre-SIRT differences in total or regional cMUR or volume between patients with and without post-SIRT liver dysfunction.

Conclusion
In patients treated with SIRT for HCC, HBS accurately identified changes in total and regional liver function and may have a complementary role to personalize lobar or selective SIRT. In this pilot study, there were no pre-SIRT differences in cMUR or volume to aid in predicting post-SIRT liver dysfunction.
Symptom Disclosure Process Among Iranian Women With Self-discovered Breast Cancer
Authors: Rafii Forough , Momeni Maryam , Taleghani Fariba 
Published: July 2020

Background
Breast cancer is the most common malignancy among Iranian women. Symptom disclosure plays an important role in help-seeking behavior among women with self-discovered breast cancer.

Objective
The aim of this study was to explain how symptoms are disclosed by Iranian women.

Methods
This study was conducted based on the grounded theory qualitative approach. Twenty-two Iranian women with breast cancer, who discovered the symptoms themselves and were referred to 2 teaching hospitals in Tehran and Qazvin, were included via purposive and theoretical sampling. The data were collected through semistructured interviews and were analyzed based on the Corbin and Strauss approach.

Results
The process of symptom disclosure had 5 stages including identifying the symptoms, evaluating and interpreting the symptoms, weighing the disclosure conditions, selecting the disclosure audience, and disclosing. The perceived threat was identified as the core category. On the basis of the level of threat perception and the seriousness of the symptoms, the 3 patterns of immediate disclosure, delayed disclosure, and nondisclosure were recognized.

Conclusion
Perceived threat is the main motivator for rapid disclosure in Iranian women with potential breast cancer symptoms and leads to a better follow-up of the symptoms. Therefore, increasing women's awareness about breast cancer symptoms, treatments, and non–follow-up consequences leads to a better perception of the threat level.

Implications for Practice
According to these findings, it is very important to increase Iranian women's awareness about the symptoms of breast cancer (especially the nonspecific ones). For this purpose, it is necessary to design educational interventions.
A Protocol to Examine Surgical Team Communication in a Large Military Medical Center
Authors: Stucky Christopher H. , De Jong Marla J. , Kabo Felichism W. , Huffman Sarah L. 
Published: July 2020

Background
Preventable clinician communication errors are the most frequent root cause of surgical adverse events. Effective communication among surgical team members is an important overall indicator of clinical nursing excellence and is crucial to promote patient safety and reduce healthcare risk.

Objective
The purpose of this publication is to describe our research protocol, which will comprehensively investigate surgical team communication and surgical team structure. There are two overall study objectives: (a) to characterize the network factors that influence perioperative clinician communication and (b) to identify how team structure shapes communication effectiveness. Specifically, we will study the association among clinician relationships, surgical team familiarity, surgical team size, and communication effectiveness.

Methods
We will use an exploratory, prospective, cross-sectional, network-centric approach using social network analysis to determine how interdependent clinician relationships influence surgical communication patterns. Targeting an 80% response rate, we will use total population sampling to recruit all clinicians (nurses, surgeons, anesthetists, surgical technologists, students, residents) who directly provide surgical care in the operating room at a large military medical center. We will administer an electronic survey to surgical teams at the end of the surgical day to elicit clinician communication assessments and relational preferences. From the survey questions, we will develop six relational networks (interaction, close working relationship, socialization, advice seeking, advice giving, speaking up/voice) and three models that represent communication effectiveness for each participant and team. We will use various statistical methods to characterize the network factors that shape operating room clinician communication and identify how team structure shapes communication effectiveness.

Results
This study will start enrolling participants in 2020.

Discussion
We are among the first to comprehensively investigate operating room communication using social network analysis. The results of this study will provide valuable insight into nurse collaboration and communication in interprofessional teams, enable a thoughtful analysis of surgical staffing and perioperative team building, and inform future-targeted interventions to improve operating room communication weaknesses.
Radiology Education Amid COVID-19 Pandemic and Possible Solutions
Authors: Virarkar Mayur , Jensen Corey , Javadi Sanaz , Saleh Mohammed , Bhosale Priya R. 
Published: July 2020

Abstract
Along with the rest of the world, the United States is inundated by the COVID-19 pandemic. The medical services in the country have been severely affected. The pandemic poses extraordinary challenges to academic institutions including radiology residency and fellowship programs. Herein, we delineate major difficulties faced by our radiology training program and mitigating countermeasures. The primary objective is to discuss the changes in our radiology training programs due to COVID-19 to allow for continued radiology education.
Pyogenic Granuloma of the Hard Palate
Authors: Min Hyun Jin , Kim Kyung Soo 
Published: July 2020

Abstract
As the authors recently experienced a patient with pyogenic granuloma arising from the hard palate, they tried to review all the previously reported literatures with the emphasis on its clinical characteristics that can help the accurate diagnosis of this unusual lesion. Based on our experience and literatures review, clinicians should keep in mind that pyogenic granuloma should be taken into consideration in the differential diagnosis of the hard palatal mass despite its rarity. Although histopathological examination of the mass is the only way to arrive at a definitive diagnosis, the knowledge of the gross appearances of pyogenic granuloma with clinical features may be helpful for differential diagnosis.
Oral Mucosa Reconstruction With a Free Muscle Flap
Authors: Kurosawa Sayuri , Matsumoto Hiroshi , Kimata Yoshihiro 
Published: July 2020

Abstract
The use of cutaneous flaps for oral cavity reconstruction is common. However, physiologic reconstruction is not possible because of the presence of hair, and the thickness of cutaneous flaps causes difficulty when performing alveolar ridge augmentation. The authors found few published studies regarding the usefullness of oral reconstruction with free muscle flaps and no studies of histologic examination of reconstructed mucosa. Therefore, they performed a primary reconstruction of oral cavity defects with muscle flaps and allowed the raw surface to epithelialize in 5 patients who underwent oral cavity reconstruction. All flaps were successfully engrafted, and no complications occurred. Epithelialization occurred within approximately 3 months. The authors performed oral mucosal biopsy with the patient's consent and confirmed that the reconstructed oral mucosa appeared histologically normal. This method is more effective than the use of a cutaneous flap, and the physiologic reconstruction of the oral mucosa and alveolar ridge augmentation can be performed in a single operation. However, it is difficult to use in patients who require radiation therapy after the operation because of the requirement of 3 months for full epithelialization. Additionally, muscle contracture could lead to functional disabilities; thus, this procedure should be performed carefully in patients who exhibit large soft tissue defects or who have hard tissue intervention.
Le Fort I Down-Fracture for Management of Midface Tumors
Authors: Quirino Lilian Caldas , Carvalho Pedro Henrique de Azambuja , Santos José Cleveilton dos , Trento Guilherme dos Santos , Gabrielli Marisa Aparecida Cabrini , Pereira-Filho Valfrido Antonio 
Published: July 2020

Objective:
To perform an integrative review associating current literature with a clinical series regarding the use of Le Fort I osteotomy for the removal of tumors located in the midface and central region of the skull base.

Methods:
A systematic review was performed through the PubMed, SCOPUS, and Cochrane databases. In addition, 4 different patients operated using the above-cited technique are described in this study.

Results:
Initially, 123 articles were found. After the removal of duplicates, and title and abstract reading, 27 articles were selected for data extraction. The Le Fort I surgical approach of tumors was performed in 183 patients.

Conclusion:
The Le Fort I surgical approach allows lesion exeresis with good visualization, low rates of recurrences and complications, and without aesthetic compromises for the patient.
Management of Intraoral Surgical Defects Using Sublingual Gland Flap
Authors: Jose Anson , Rawat Aditi , Singh Shagun , Nagori Shakil Ahmed , Roychoudhury Ajoy 
Published: July 2020

Abstract
The aim of the study was to evaluate the effectiveness of sublingual gland flap in the reconstruction of surgical defect following sequestrectomy in medication induced osteonecrosis of jaws (MRONJ), osteomyelitis (OML), and osteoradionecrosis (ORN) of mandible. A total of 6 patients with MRONJ (n = 4) osteomyelitis (n = 1) and ORN (n = 1) underwent sequestrectomy and reconstruction with sublingual gland flap. There were 03 males and 03 females. The age range was 45–71–70 years. All defects were present in the posterior mandible. All patients’ undergone sequestrectomy, debridement, and reconstruction with sublingual gland flap under local anesthesia. Postoperatively patients were followed up at 1, 3, and 6 months. Patients were monitored for complete epithelization of defect, infection, pain, and recurrence of the lesion. Complete epithelization with closure of the defect was achieved in all cases. None of the patients had residual pain or inflammation at the surgical site. None of our patients experienced any donor site morbidities. There was no case of postoperative infection. Reconstruction of intraoral defects using sublingual gland flap is an effective treatment modality to reconstruct small to medium sized defect of oral cavity.
Endoscopic Petrous Apex Surgery: The Utilization of Frontal Sinus Instrumentation
Authors: Zheng Zhong , Otten Marc L. , Bruce Jeffrey N. , Gudis David A. 
Published: July 2020

Background:
The petrous apex is a complex anatomic region for which each surgical approach each has distinct limitations. The authors describe the use of frontal sinus instrumentation for the endonasal endoscopic approach to petrous apex lesions

Objective:
To demonstrate that the angled design of frontal sinus instrumentation has pronounced clinical utility for the transsphenoidal transclival approach to the petrous apex.

Methods:
The authors present cases of expansile petrous apex lesions approached endoscopically via transsphenoid and transclival corridors, and highlight the technique of using curved frontal sinus instruments and angled endoscopes for posterolateral reach in the petrous apex dissection.

Results:
As demonstrated in the accompanying video, dissection with frontal sinus instrumentation allows the surgeon to navigate around the internal carotid artery.

Conclusions:
Significant technical and technological advances have been made in the field of expanded endoscopic endonasal skull base surgery in the past 3 decades. Increasing efforts are made to push the boundaries and access more laterally located lesions, such as those in the petrous apex. Surgical trajectory or vector is paramount to safely navigate around the internal carotid artery.
Is Tranexamic Acid Associated With Mortality or Multiple Organ Failure Following Severe Injury?
Authors: Richards Justin E. , Fedeles Benjamin T. , Chow Jonathan H. , Morrison Jonathan J. , Renner Corinne , Trinh Anthony T. , Schlee Caroline S. , Koerner Ken , Grissom Thomas E. , Betzold Richard D. , Scalea Thomas M. , Kozar Rosemary A. 
Published: July 2020

ABSTRACT

Background:
Tranexamic acid (TXA) administration is recommended in severely injured trauma patients. We examined TXA administration, admission fibrinolysis phenotypes, and clinical outcomes following traumatic injury and hypothesized that TXA was associated with increased multiple organ failure (MOF).

Methods:
Two-year, single-center, retrospective investigation. Inclusion criteria were age ≥ 18 years, Injury Severity Score (ISS) >16, admitted from scene of injury, thromboelastography within 30 min of arrival. Fibrinolysis was evaluated by lysis at 30 min (LY30) and fibrinolysis phenotypes were defined as: Shutdown: LY30 ≤ 0.8%, Physiologic: LY30 0.81–2.9%, Hyperfibrinolysis: LY30 ≥ 3.0%. Primary outcomes were 28-day mortality and MOF. The association of TXA with mortality and MOF was assessed among the entire study population and in each of the fibrinolysis phenotypes.

Results:
Four hundred twenty patients: 144/420 Shutdown (34.2%), 96/420 Physiologic (22.9%), and 180/410 Hyperfibrinolysis (42.9%). There was no difference in 28-day mortality by TXA administration among the entire study population (P = 0.52). However, there was a significant increase in MOF in patients who received TXA (11/46, 23.9% vs 16/374, 4.3%; P < 0.001). TXA was associated MOF (OR: 3.2, 95% CI 1.2–8.9), after adjusting for confounding variables. There was no difference in MOF in patients who received TXA in the Physiologic (1/5, 20.0% vs 7/91, 7.7%; P = 0.33) group. There was a significant increase in MOF among patients who received TXA in the Shutdown (3/11, 27.3% vs 5/133, 3.8%; P = 0.001) and Hyperfibrinolysis (7/30, 23.3% vs 5/150, 3.3%; P = 0.001) groups.

Conclusions:
Administration of TXA following traumatic injury was associated with MOF in the fibrinolysis shutdown and hyperfibrinolysis phenotypes and warrants continued evaluation.
Banded Versus Nonbanded Sleeve Gastrectomy
Authors: Fink Jodok M. , Hetzenecker Andrea , Seifert Gabriel , Runkel Mira , Laessle Claudia , Fichtner-Feigl Stefan , Marjanovic Goran 
Published: July 2020

Objective:
The aim of this study was to compare silicone-banded sleeve gastrectomy (BSG) to nonbanded sleeve gastrectomy (SG) regarding weight loss, obesity-related comorbidities, and complications.

Summary Background Data:
As a primary bariatric procedure, SG leads to excellent weight loss, yet weight regain is a relevant issue in mid- to long-term follow-up. Retrospective analyses suggest that banding a sleeve using a silicone ring may decrease weight regain and improve weight loss.

Methods:
The banded versus nonbanded sleeve gastrectomy single-center, randomized controlled trial was conducted from January 2015 to August 2019. The primary endpoint was defined as excess weight loss 3 years after surgery. Secondary endpoints included the surgery's impact on obesity-related comorbidities, quality of life, and complications. The study was registered under DRKS00007729.

Results:
Among 94 patients randomized, 97% completed 3-year follow-up. Mean initial body mass index was 50.9 kg/m2 [95% confidence interval (CI), 49.6–52.2]. Mean adjusted excess weight loss 3 years after SG amounted to 62.3% (95% CI, 56.2–68.5) and 73.9% ( 95% CI, 67.8–80.0) after BSG (difference 11.6%, P = 0.0073). Remission of type 2 diabetes occurred in 66.7% (4/6) after SG and in 91.0% (10/11) following BSG (P = 0.21). Three years after surgery, ring implantation correlated with decreased frequency of symptomatic reflux episodes (P = 0.01) but increased frequency of regurgitation (P = 0.03). The rate of major complications was not different between the study groups (BSG, n = 3; SG, n = 2; P = 0.63). Quality of life was better following BSG (P = 0.001).

Conclusions:
BSG provided better weight loss than nonbanded SG 3 years after surgery. Regurgitation was the main clinically relevant negative effect after BSG.