bluuebunny/crossref_metadata_2025_split huggingface dataset:
Classification and Surgical Treatment of Developmental Spinal Canal Stenosis at Atlas Level
Authors: Wang Jianhua , Zhu Changrong , Li Hongji , Xiao Zhaoming , Ma Xiang yang , Wu Zenghui , Ai Fuzhi , Xia Hong 
Published: February 2020

Study Design.
A retrospective study.

Objective.
Investigate the diagnosis and surgery strategy for treatment of development spinal canal stenosis (DSSA) at atlas plane based on computerized tography (CT) image characters.

Summary of Background Data.
The occurrence of spinal canal stenosis in the atlas plane is relatively rare compared with lower cervical.

Methods.
Fifteen patients diagnosed with DSSA were included from 2014 to 2018. They are divided into four subgroups based on the character of CT images: group I (small size atlas), group II (hypertrophy of posterior arch of the atlas [PAA]), group III (incurved of PAA), and group IV (hypertrophy odontoid).

Results.
There are type I 7, type II 3, type III 2, and group IV 3 in the 15 cases. All the patients received different surgery procedures respectively: (1) posterior arch osteotomy were performed for group I/III//IV without atlantoaxial dislocation, (2) posterior arch resect and replantation were performed for group II, (3) occipital cervical fixation and fusion were added to the patients with associated atlantoaxial dislocation (AAD), (4) a new method of odontoid reduce and atlantoaxial fixation by transoral approach were performed for group IV with associated AAD. All cases underwent surgery successfully which included posterior occipitocervical fixation (OCF) + posterior arch resection (PAR) eight cases, PAR four cases, posterior arch remodeling and re-implantation (PARR) two cases, and Dens remodeling + trans-oral anterior reduction and plate fixation (DR+TARP) one case without severe complications. All patients show different improvement in the symptoms. Japanese orthopaedic association score improved from 9.2 to 14.7 in 1 year follow-up.

Conclusion.
DSSA could be easily diagnosed and divided into four subgroups according to the character of CT image, corresponding surgery strategy could receive a fine clinical result.

Level of Evidence: 4
Research progress on myocardial regeneration: what is new?
Authors: Du Chong , Fan Yi , Li Ya-Fei , Wei Tian-Wen , Wang Lian-Sheng 
Published: February 2020

Abstract
The regeneration capacity of cardiomyocytes (CMs) is retained in neonatal mouse hearts but is limited in adult mouse hearts. Myocardial infarction (MI) in adult hearts usually leads to the loss of large amounts of cardiac tissue, and then accelerates the process of cardiac remodeling and heart failure. Therefore, it is necessary to explore the potential mechanisms of CM regeneration in the neonates and develop potential therapies aimed at promoting CM regeneration and cardiac repair in adults. Currently, studies indicate that a number of mechanisms are involved in neonatal endogenous myocardial regeneration, including cell cycle regulators, transcription factors, non-coding RNA, signaling pathways, acute inflammation, hypoxia, protein kinases, and others. Understanding the mechanisms of regeneration in neonatal CMs after MI provides theoretical support for the studies related to the promotion of heart repair after MI in adult mammals. However, several difficulties in the study of CM regeneration still need to be overcome. This article reviews the potential mechanisms of endogenous CM regeneration in neonatal mouse hearts and discusses possible therapeutic targets and future research directions.
The Evolving Story of Laser Therapeutics for Basal Cell Carcinoma
Authors: Ahluwalia Jusleen , Avram Mathew M. , Ortiz Arisa E. 
Published: February 2020

BACKGROUND
The increasing burden from basal cell carcinoma (BCC) has stimulated the development of alternative treatments for these tumors.

OBJECTIVE
This review focuses on upcoming laser treatments for BCC and highlights the limitations of these therapies.

METHODS
A PUBMED search was conducted for articles on laser therapy of BCC. Key studies involving lasers to treat BCC were reviewed. Novel approaches to BCC are also described.

RESULTS
Vascular-specific laser therapy has increasingly been studied as an addition in the therapeutic armamentarium of BCC. Although these studies demonstrate efficacy for nonaggressive BCC, optimization of this technique is ongoing to minimize scarring. A more targeted approach to the treatment of BCC, such as immunized photothermal therapy or laser-assisted chemotherapeutic delivery, may result in less scarring, while maintaining efficacy similar to that of lasers targeting tumor vasculature.

CONCLUSION
Vascular-specific laser therapies show promise in treating low-risk BCC; however, scarring is not an uncommon adverse event. Although only animal studies have been performed to date, laser-activated gold nanoparticle therapy and laser-assisted drug delivery of vismodegib are potential therapies that theoretically confer a more selective approach. Laser modalities demonstrate promise in the treatment of nonaggressive BCC, although long-term studies have yet to be published.
Impact of Cooling on Lowering the Pain Threshold in Patients Undergoing Sclerotherapy
Authors: Coelho Neto Felipe , Souza Bianca R. , Belczak Sergio Q. , de Araujo Walter J.B. , Gomes de Oliveira Rodrigo 
Published: February 2020

BACKGROUND
Liquid sclerotherapy is the treatment of choice for telangiectasias. However, pain caused by the procedure is a barrier to treatment adherence by patients.

OBJECTIVE
To evaluate the use of skin cooling for the management of pain in patients undergoing liquid sclerotherapy.

METHODS AND MATERIALS
A total of 230 lower limbs from 115 patients with telangiectasias classified as C1 according to the Clinical-Etiological-Anatomical-Pathophysiological classification were included. Patients underwent liquid sclerotherapy with and without skin cooling during the procedure. Pain was assessed using a visual analog scale, applied immediately after the procedure, according to each lower limb area treated.

RESULTS
Visual analog scale pain scores were significantly lower for sclerotherapy with the use of cooling for pain management during the procedure than for sclerotherapy without cooling both in the thigh and leg (p < .0001).

CONCLUSION
The use of a cooling system is effective in reducing pain in patients undergoing liquid sclerotherapy of telangiectasias, providing more comfort to patients.
A Novel Correction Equation Avoids High-Magnitude Errors in Interpreting Therapeutic Drug Monitoring of Phenytoin Among Critically Ill Patients
Authors: Barra Megan E. , Phillips Kristy M. , Chung David Y. , Rosenthal Eric S. 
Published: February 2020

Background:
Phenytoin has a narrow therapeutic index and the potential of under-treatment or toxicity. Available equations are used to correct for the impact of hypoalbuminemia on unbound (free) phenytoin levels. The authors aimed to determine the accuracy of equations used to estimate free phenytoin in hospitalized patients and assess the impact of using additional clinical data.

Methods:
Concurrently measured total and free phenytoin levels in hospitalized patients (2014–2018) were retrospectively evaluated, excluding those from patients on renal replacement therapy and valproic acid. Differences between actual and estimated free phenytoin levels by the original (Original WTZ), Anderson-modified, and Kane-modified Winter–Tozer equations were assessed using Pearson correlations and Bland–Altman analysis. Thereafter, a population-derived formula was developed and validated in a testing cohort.

Results:
In the 4-year training cohort (n = 81), the Original WTZ equation had the smallest mean difference of all equations. A higher mean difference [−0.362 mcg/mL (95% CI −0.585 to −0.138) vs. −0.054 mcg/mL (95% CI −0.186 to 0.078)] was observed in intensive care unit (ICU) patients compared with non-ICU patients. A cross-validated multivariable model improved the accuracy of free phenytoin estimation in ICU and non-ICU patients, even in the separate testing cohort (n = 52) with respective mean differences of −0.322 mcg/mL (95% CI −0.545 to −0.098) and −0.025 mcg/mL (95% CI −0.379 to 0.329) and was superior to the Original WTZ [mean difference −0.858 mcg/mL (95% CI −1.069 to −0.647) vs. −0.106 mcg/mL (95% CI −0.362 to 0.151), respectively].

Conclusions:
Free phenytoin levels in hospitalized patients cannot be accurately determined using available estimation equations, particularly in critically ill patients. Combining ICU status and other available clinical data can improve therapeutic drug monitoring and prevent high-magnitude errors, particularly when free phenytoin assays are not readily available.
Efficacy and safety of ultra-low dose 0.005% estriol vaginal gel for the treatment of vulvovaginal atrophy in postmenopausal women with early breast cancer treated with nonsteroidal aromatase inhibitors: a phase II, randomized, double-blind, placebo-controlled trial
Authors: Hirschberg Angelica Lindén , Sánchez-Rovira Pedro , Presa-Lorite Jesús , Campos-Delgado Miriam , Gil-Gil Miguel , Lidbrink Elisabet , Suárez-Almarza Javier , Nieto-Magro Concepción 
Published: February 2020

Abstract

Objective:
To assess the efficacy and safety of ultra-low dose 0.005% estriol vaginal gel in women with breast cancer receiving nonsteroidal aromatase inhibitors (NSAIs) and experiencing treatment-related vulvovaginal symptoms and signs.

Methods:
Women with hormone receptor-positive early breast cancer receiving NSAIs were randomized to either estriol vaginal gel or placebo for 12 weeks. Vaginal maturation, vaginal pH, and total and individual scores of symptoms and signs of vulvovaginal atrophy were assessed at baseline and at weeks 3 and 12; sexual functioning was also evaluated using the Female Sexual Functioning Index (FSFI) questionnaire, as well as circulating estrogens, follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

Results:
Sixty-one women with a mean age of 59 years were included: 50 received 0.005% estriol vaginal gel and 11 received placebo. Active treatment significantly improved maturation value and pH, vaginal dryness and global scores of symptoms and signs. Active treatment also increased the total FSFI score and all the FSFI domains, with the exception of pain. Small oscillations were observed in FSH and LH, which remained within the postmenopausal range. Estriol levels increased initially and normalized by week 12, and estradiol and estrone remained mostly undetectable throughout the study.

Conclusions:
Ultra-low dose 0.005% estriol vaginal gel showed efficacy in improving the symptoms and signs of vulvovaginal atrophy. These results, together with minimal oscillations in hormonal levels throughout the treatment, support the use of ultra-low dose 0.005% estriol vaginal gel as a treatment option for vulvovaginal atrophy in women with breast cancer receiving NSAIs with an indication for treatment with vaginal estrogens.

Video Summary:
http://links.lww.com/MENO/A531.
Association between hysterectomy and depression: a longitudinal follow-up study using a national sample cohort
Authors: Choi Hyo Geun , Rhim Chae Chun , Yoon Ji Young , Lee Suk Woo 
Published: February 2020

Abstract

Objectives:
This study investigated the influence of hysterectomy on depression using a national sample cohort from South Korea.

Methods:
We extracted data entered into the Korean Health Insurance data based form 2002 through 2013 and classified patients into a group of women who had undergone a hysterectomy (n = 9,971) and a 1:4 matched control group (n = 39,884). A Cox proportional hazards model was used to analyze the hazard ratios (HRs) and 95% confidence intervals (CIs) to assess the risk of depression in the hysterectomy group and the control group. The HR was calculated as the risk of depression in the hysterectomy group compared to that in the control group.

Results:
The incidence of depression in the hysterectomy group was 6.59 per 1,000 person-years and that in the control group was 5.70 per 1,000 person-years. The adjusted HR for depression was 1.15 in the hysterectomy group (95% CI = 1.03-1.29, P < 0.05). In a subgroup analysis, the adjusted HR for depression was 1.16 (95% CI; 1.03-1.31, P = 0.014) for patients who underwent hysterectomy without bilateral salpingo-oophorectomy. In an additional subgroup analysis, the adjusted HR for depression after hysterectomy was 1.18 (95% CI; 1.04-1.35, P = 0.012) in the younger than 50-year-old group.

Conclusion:
The incidence of depression was higher in women who underwent hysterectomy than in the matched control group.
INTRAOCULAR AND INTEROCULAR DIFFERENCES IN PARAFOVEAL VASCULAR DENSITY IN DIABETIC PATIENTS WITHOUT DIABETIC RETINOPATHY
Authors: Kim Yong-Kyu , An Yerim , Park Sung Pyo 
Published: February 2020

Purpose:
To evaluate the associations among optical coherence tomography angiography–measured vascular density (VD), intraocular and interocular VD differences, and clinical factors in diabetic patients without diabetic retinopathy.

Methods:
We retrospectively reviewed 94 Type 2 diabetic patients without diabetic retinopathy who had undergone optical coherence tomography angiography. Vascular density and vessel skeleton density were measured in a 3-mm central zone in the total capillary plexus, superficial capillary plexus, deep capillary plexus (DCP), and choriocapillaris layers. Intraocular VD difference was determined between the superior and inferior zones, while interocular VD difference was determined between both eyes of the patient. Associations between optical coherence tomography angiography parameters and clinical factors were evaluated.

Results:
Vascular density and intraocular and interocular VD differences were significantly associated with signal strength of the image, which was related with age and lens opacity. In multivariate analysis, diabetes duration was negatively associated with skeleton density in total capillary plexus and superficial capillary plexus layers, and positively associated with intraocular VD difference in superficial capillary plexus layer. Estimated glomerular filtration rate was negatively associated with intraocular skeleton density difference in total capillary plexus layer, interocular VD, and skeleton density differences in total capillary plexus layer.

Conclusion:
Intraocular and interocular VD difference may be an easy and sensitive way to detect subtle early microvascular changes in diabetic patients.
Distance of the fracture from the radiocarpal surface in childhood: does it determine surgical technique? A retrospective clinical study
Authors: Jozsa Gergo , Devecseri Gertrud , Vajda Peter , Juhasz Zsolt , Varga Marcell , Juhasz Tamas 
Published: February 2020

Abstract
Unstable distal metaphyseal and dia-metaphyseal fractures of the radius may have treated with a variety of operative techniques, Kirschner wires (K-wires), dorsally inserted titanium elastic stable intramedullary nailing (DESIN), and short titanium elastic stable intramedullary nailing (SESIN) in children.
The aim of this study was to evaluate the differences in clinical and radiographic outcomes between these methods.
Between January 2009 and December 2017 196 children were treated for forearm fractures in the distal third of the distal radius. Gender of the patients, different types of surgical techniques, number of postoperative X-rays, date of metal removal and degree of axis deviation after the metal removal were studied. Distance of the fracture line from the radiocarpal surface, the width of the distal epiphysis of the radius, and the cumulative width of the distal epiphysis of the ulna and radius were analyzed.
Out of the 196 children, stabilization of the fracture was achieved by K-wire in 139, by DESIN in 44, and by SESIN in 13 patients. The average time of metal removal was significantly shorter (3.8 months), following stabilization with K-wire. In children treated with K-wire, axial deviation of <5° was seen in 118 patients, 5° to 10° deviation in 15 patients, while deviation was above 10° in 6 children. In the DESIN group, <5° axial deviation was found in 37 patients and 5° to 10° in seven patients. In all 13 children treated with SESIN, axial deviation was measured to be <5°. The fracture distance from the radiocarpal surface was on average 23.7 and 45.6 mm in the children treated with K-wire and DESIN, respectively.
Fracture distance from the radiocarpal surface might determine the type of surgical technique required. If the distance of the fracture line is less than the width of the distal radius, osteosynthesis with a K-wire is recommended, while if the distance of the fracture is more than the cumulative width of the radius and the ulna, then DESIN may provide better results. The use of SESIN may be indicated when the area of the growth plate is injured.
Protective effect of rhubarb combined with ulinastatin for patients with sepsis
Authors: Meng Fulei , Du Chongbo , Zhang Yuxiao , Wang Shunyao , Zhou Qingming , Wu Liping , Wang Yanli , Yang Xiufen 
Published: February 2020

Abstract

Background:
Sepsis is the leading cause of death in critically ill patients. Ulinastatin (UTI), a protease inhibitor, and rhubarb, used as a traditional Chinese medication, are proved to be effective in treating sepsis, but the effect of the combination therapy of these two drugs on sepsis remains unclear. This study aimed to investigate the effect of the combination treatment of UTI and rhubarb on sepsis patients.

Methods:
A total of 75 septic patients were randomly divided into control group, UTI group, Rhubarb group, and UTI plus Rhubarb group. Clinical data and score of Acute Physiology and Chronic Health Evaluation II (APACHE II) were collected; lymphocyte subtypes in the peripheral blood were analyzed before and after the 5-day treatment in the Intensive Care Unit.

Results:
All the therapeutic interventions (UTI alone, rhubarb alone, or UTI plus rhubarb) significantly reduced the levels of C-Reactive protein, white blood cell density, lactic acid, and APACH II scores, and elevated the levels of CD4/CD8, but only UTI plus rhubarb treatment obviously decreased the level of procalcitonin.

Conclusion:
This study suggested that the combination of UTI and rhubarb may be a promising therapeutic scheme to ameliorate sepsis.
Skeletal muscle mass predicts the outcome of nivolumab treatment for non-small cell lung cancer
Authors: Tsukagoshi Mariko , Yokobori Takehiko , Yajima Toshiki , Maeno Toshitaka , Shimizu Kimihiro , Mogi Akira , Araki Kenichiro , Harimoto Norifumi , Shirabe Ken , Kaira Kyoichi 
Published: February 2020

Abstract
Nivolumab, a monoclonal antibody targeting programmed cell death-1, significantly prolongs survival for patients with advanced non-small-cell lung cancer (NSCLC). However, little is known about the value of predictive biomarkers. Hence, we investigated the impact of skeletal muscle (SM) mass loss on clinical outcomes in NSCLC patients undergoing nivolumab treatment. Thirty patients with histologically confirmed NSCLC treated with nivolumab were included in this study. Computed tomography was used to determine SM loss based on the SM index (SMI). The SMI is the cross-sectional area of the bilateral psoas muscles at the third lumbar vertebra, divided by height squared. The cut-off values were defined as 6.36 cm2/m2 for men and 3.92 cm2/m2 for women. Among the 30 patients, 13 (43%) had SM loss. There was no significant association between SM loss and immune-related adverse events. The SM loss group had undergone significantly more prior chemotherapy cycles (P = .04). SM loss was significantly associated with fewer nivolumab cycles (P = .01). No patients in the SM loss group achieved a partial response. Patients with SM loss had a significantly shorter progression-free survival period (P = .008) and median overall survival than those with normal SM mass (10 vs 25 months, respectively, P = .03). SM loss was an independent prognostic factor of poor survival. In conclusion, SM loss may be a predictive factor of poor outcomes in NSCLS patients undergoing nivolumab therapy.
Long non-coding RNA HANR as a biomarker for the diagnosis and prognosis of colorectal cancer
Authors: Xu Meng , Guo Xu , Wang Rong-Di , Zhang Zhi-Hang , Jia Yi-Mo , Sun Xu 
Published: February 2020

Abstract
Previous work suggests that the long noncoding RNA HCC associated long non-coding RNA (HANR) is associated with hepatocellular carcinoma (HCC) progression, but its significance in the context of colorectal cancer (CRC) remains to be determined. Therefore, in this study we assessed the prognostic and diagnostic value of HANR in patients suffering from CRC.
The HANR expression in 165 pairs of CRC cancer and adjacent non-cancerous prostate tissues was measured by quantitative reverse transcription polymerase chain reaction (qRT-PCR) analysis. Student t test was conducted for intergroup comparison. Pearson correlation test was used for correlation analysis. Survival curves were carried out by the Kaplan-Meier method and evaluated using the log-rank test. Multivariable Cox proportional hazard risk regression model was performed to screen the independent factor affected the prognosis of CRC patients.
In this study, levels of HANR were significantly higher in CRC tumor samples relative to adjacent normal tissue samples (P < .001). A ROC analysis suggested HANR expression could be reliably used to differentiate between normal and CRC tumor tissue. In addition, elevated HANR expression was positively correlated with more advanced and aggressive CRC features, such as a larger tumor size (P = .003), increased invasion depth (P = .012), and more advanced TNM stage (P = .011). Survival analyses revealed that elevated HANR expression was correlated with worse overall survival (P = .002) and disease-free survival (P = .003). A multivariate analysis further confirmed the relevance of HANR as an independent predictor of CRC patient outcomes.
In summary, these results indicate that the lncRNA HANR is a promising prognostic indicator in CRC patients.
Risk factors for the development of aspiration pneumonia in elderly patients with femoral neck and trochanteric fractures
Authors: Higashikawa Toshihiro , Shigemoto Kenji , Goshima Kenichi , Usuda Daisuke , Okuro Masashi , Moriyama Manabu , Inujima Hiromi , Hangyou Masahiro , Usuda Kimiko , Morimoto Shigeto , Matsumoto Tadami , Takashima Shigeki , Kanda Tsugiyasu , Sawaguchi Takeshi 
Published: February 2020

Abstract
Aspiration pneumonia (AP) has been recognized as one of the most common postoperative complications after hip surgery in elderly. The objective of the present study was to evaluate risk for postoperative complications of AP in elderly patients with femoral neck fractures.
We recruited 426 patients (age 84.9 ± 7.4 years) with a history of hip surgery carried out at Toyama Municipal Hospital. AP occurred in 18 out of 426 cases (4.23%). Statistical test has found significant differences in age, gender, serum albumin level, and cognitive impairment, between AP and non-AP groups. Subsequently multiple logistic regression analysis was conducted to investigate the risk factors for AP, including age, gender, serum albumin, cognitive impairment, and activities of daily living (ADL). Adjusted odds ratio showed significant differences in age, gender, and serum albumin, whereas no significant differences were found in cognitive impairment and ADL.
This study suggested that serum albumin seemed to be a risk factor for AP but were necessary to assess under adjustment of confounding factors, including age and gender. Monitoring serum albumin level seemed to be important for the postoperative management of AP, especially in elderly patients receiving surgery of femoral neck and trochanteric fractures.