bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postoperative Psychological Disorders Among Heart Transplant Recipients: A Meta-Analysis and Meta-Regression
Authors: Loh Alvona Z.H. , Tan Julia S.Y. , Tam John K.C. , Zhang Melvyn W. , Ho Cyrus S.H. , Ho Roger C. 
Published: June 2020

ABSTRACT

Objective
This meta-analysis evaluates the pooled prevalence of depression, anxiety, adjustment disorder, and posttraumatic stress disorder (PTSD) among heart transplant recipients globally and determines underlying moderators.

Methods
The authors searched PubMed, Embase, PsychINFO, BIOSIS, Science Direct, and Cochrane CENTRAL databases from inception to March 1, 2019, and 1321 records and 42 full-text articles were selected and reviewed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We calculated the pooled prevalence proportion of depression, anxiety, adjustment disorder, and PTSD using random-effects models. Meta-regression was performed to identify important moderators that contribute to heterogeneity.

Results
Twenty studies met the inclusion criteria and comprised 2169 patients. The pooled prevalence of depression was 21.6% (95% confidence interval [CI] = 16.8%–27.3%), anxiety 11.1% (95% CI = 3.8%–28.5%), adjustment disorder 11.0% (95% CI = 3.1%–32.1%), and PTSD 13.5% (95% CI = 8%–21.8%). There was significant heterogeneity. Meta-regression was conducted to account for the heterogeneity of the prevalence proportion. Predisposing factors, for example, New York Heart Association classes II and III/IV, steroid treatment, and acute rejection of transplant (<3 months), were associated with high prevalence of depression. Protective factors, for example, age and higher ejection fraction after transplant of patients, were associated with low prevalence of depression. Female sex, single status, and number of months since transplant were associated with high prevalence of anxiety. Single status was associated with high prevalence of both adjustment disorder and transplant-related PTSD.

Conclusions
The prevalence of psychiatric conditions, particularly depression, is high in heart transplant recipients. The identified protective and risk factors may guide psychological interventions in heart transplant recipients.
Perforator-Based Flaps for Defect Reconstruction of the Posterior Trunk
Authors: Hernekamp Jochen-Frederick , Cordts Tomke , Kremer Thomas , Kneser Ulrich 
Published: June 2020

Introduction
Full-thickness soft tissue defects of the back remain challenging clinical problems for reconstructive surgeons. Among a vast variety of local flap options, perforator-based local flaps gain increasing popularity lately. Because mostly heterogeneous patient cohort comparison of different perforator flaps is difficult and decision-making algorithms are lacking.

Methods
Patients, who received a local perforator-based soft tissue reconstruction between 2012 and 2019, were evaluated retrospectively. Patients' data were evaluated in terms of flap type and dimension, wound size and cause, surgery time, postoperative complications, and hospitalization. A focus was set on decision making concerning reconstructive techniques and flap choice for defect closure.

Results
Thirty-six patients (17 women, 19 men) were included, who received 40 perforator-based local flaps to reconstruct extended defects of the posterior trunk. Mean patient age was 56.3 years and mean hospitalization was 29 days. Average time of flap surgery was 179.7 minutes. Mean flap size was 160.8 cm2 and average defect size was 110 cm2. Defects occurred because of tumor resection (50%), orthopedic/trauma surgery (16.7%), or pressure sores (33.3%). Twenty-eight propeller flaps (PPFs, 70%) and 12 perforator-based VY-advancement flaps (P-VYF, 30%) were transferred. In 4 patients, a bilateral approach using more than one flap was necessary. Revision surgery was required in 9 patients (25%) because of postoperative hematoma (n = 3), postoperative wound infection (n = 3), partial flap necrosis (1× P-VYF) and 2 flap losses (2× PPFs).

Conclusions
Pedicled perforator flaps are a reliable option for soft tissue reconstruction of complex wounds of the posterior trunk. A flexible surgical strategy is mandatory, and the individual perforator anatomy has to be considered. In most cases, P-VYFs or PPFs are reliably possible and allow sufficient defect reconstruction. However, skin incisions should always be performed in a way that classic random pattern flaps are still possible. Even in large defects combined, local perforator flaps may lead to sustainable soft tissue reconstructions without functional donor site deficits.
The Protective Effect of Platelet Rich Plasma Against Cisplatin-Induced Ototoxicity
Authors: Yurtsever Kum Nurcan , Baklaci Deniz , Guler Ismail , Kuzucu Ihsan , Kum Rauf Oguzhan , Ozhamam Esra Ucaryilmaz , Ozcan Muge , Dere Huseyin 
Published: June 2020

Abstract
Cisplatin, a pharmacological agent widely used for treating many cancers, may cause serious side effects including ototoxicity, nephrotoxicity, and peripheral neuropathy. The present study aimed to investigate whether platelet-rich plasma (PRP) protects against cisplatin ototoxicity. Eight rats (16 ears) were divided into 2 groups: control group (4 rats, 8 ears) that received intratympanic saline and study group (4 rats, 8 ears) that received intratympanic PRP. Cisplatin (10 mg/day intraperitoneally) or vehicle was administered 2 times per day to the animals. Auditory brainstem responses were recorded preoperatively and postoperatively on day 4 and at week 3. The authors compared the morphological appearances of spiral ganglion cells and the organ of Corti and the density of spiral ganglion cells between treatment groups. The number of outer hair cells in the organ of Corti significantly decreased in the control group compared with that in the PRP group. Although no statistically significant difference was observed between the groups regarding ABR thresholds on day 4 (P = 0.083, a statistically significant difference was observed between groups at week 3 (P = 0.038). Our results suggest that PRP can prevent cisplatin-induced ototoxicity.
Reconstruction of Full Thickness Scalp Defects in Extremely Elderly Patients Using Dermal Regeneration Templates
Authors: Bernstein Jaime L. , Premaratne Ishani D. , Levy Adam S. , Kuhel William I. , Kutler David I. , Spector Jason A. 
Published: June 2020

Abstract
The reconstruction of full thickness scalp defects following oncologic resection poses a unique challenge that is further magnified in “extremely elderly” patients, defined as those in at least their ninth decade of life, who are often unsuitable candidates for complex reconstruction. A “simpler” option is two-stage reconstruction: placement of Integra dermal regenerative template (Integra Life Science, Plainsboro, NJ) followed by a split thickness skin graft (STSG). This case series illustrates the success of this technique in the extremely elderly. A retrospective analysis of patients > 80 years at the time of surgery who underwent full thickness scalp reconstruction following tumor extirpation in a two-stage approach under the care of single surgeon from January 2010 to June 2019 was conducted. Variables reviewed were medical history, surgical treatment response, time to split thickness skin graft, follow up, and success of wound coverage. Fourteen patients, with a mean age of 87 years (range: 80 to 101, median: 87), met inclusion criteria. Split thickness skin grafts were placed after an average of 18 days. Twelve patients had successful two-stage reconstruction with 100% take. One patient developed a hematoma under a portion of the template that neither required reoperation nor delayed split thickness skin graft placement. A second suffered from insufficient vascularization of the template with delay to split thickness skin graft and incomplete wound closure. This two-stage approach is a successful primary reconstructive option for definitive management of full thickness scalp defects following oncologic resection in extremely elderly patients.
Poor Clinical Outcomes and Immunoevasive Contexture in Intratumoral IL-10-Producing Macrophages Enriched Gastric Cancer Patients
Authors: Zhang Hongyu , Li Ruochen , Cao Yifan , Gu Yun , Lin Chao , Liu Xin , Lv Kunpeng , He Xudong , Fang Hanji , Jin Kaifeng , Fei Yuchao , Chen Yifan , Wang Jieti , Liu Hao , Li He , Zhang Heng , He Hongyong , Zhang Weijuan 
Published: June 2020

Objective:
To investigate the clinical significance of IL-10+ tumor-associated macrophages (TAMs) in gastric cancer.

Background:
Due to the plasticity and diversity of TAMs, it is necessary to phenotypically and functionally classify subsets of TAMs to better understand the critical role of TAMs in cancer progression. TAMs expressing interleukin-10 (IL-10) have been found to facilitate immune evasion in many malignancies, but the role of IL-10+ TAMs in gastric cancer remains obscure.

Methods:
Four hundred and sixty-eight tumor tissue microarray specimens, 52 fresh tumor tissue samples of gastric cancer patients from Zhongshan Hospital, and data of 298 gastric cancer patients from the Cancer Genome Atlas (TCGA) were analyzed. IL-10+ TAM level and immune contexture were examined by CIBERSORT, immunohistochemistry, and flow cytometry. Clinical outcomes were analyzed by Kaplan–Meier curves and Cox model.

Results:
Gastric cancer patients with high IL-10+ TAM infiltration exhibited poor prognosis and inferior therapeutic responsiveness to fluorouracil-based adjuvant chemotherapy. IL-10+ TAM infiltration yielded an immunoevasive tumor microenvironment featured by regulatory T cell infiltration and CD8+ T cell dysfunction. The combinational analysis of IL-10+ TAM and CD8+ T cell infiltration stratified patients into distinct risk groups with different clinical outcomes. Moreover, IL-10+ TAM infiltration was correlated with tumor-intrinsic characteristics including EBV status, PD-L1 expression, and genome stability in gastric cancer.

Conclusions:
This study revealed that IL-10+ TAMs might drive an immunoevasive microenvironment and determine poor prognosis and inferior therapeutic responsiveness to fluorouracil-based adjuvant chemotherapy, indicating IL-10+ TAMs could be applied as a potential target for immunotherapeutic approach in gastric cancer.
Is Local Endoscopic Resection a Viable Therapeutic Option for Early Clinical Stage T1a and T1b Esophageal Adenocarcinoma?
Authors: Kamarajah Sivesh K. , Phillips Alexander W. , Hanna George B. , Low Donald E. , Markar Sheraz R. 
Published: June 2020

Objective:
The aim of this study was to evaluate the outcome of endoscopic resection (ER) versus esophagectomy in node-negative cT1a and cT1b esophageal adenocarcinoma.

Summary of Background Data:
The role of ER in the management of subsets of clinical T1N0 esophageal adenocarcinoma is controversial.

Methods:
Data from the National Cancer Database (2010–2015) were used to identify patients with clinical T1aN0 (n = 2545) and T1bN0 (n = 1281) esophageal adenocarcinoma that received either ER (cT1a, n = 1581; cT1b, n = 335) or esophagectomy (cT1a, n = 964; cT1b, n = 946). Propensity score matching and Cox analyses were used to account for treatment selection bias.

Results:
ER for cT1a and cT1b disease was performed more commonly over time. The rates of node-positive disease in patients with cT1a and cT1b esophageal adenocarcinoma were 4% and 15%, respectively. In the matched cohort for cT1a cancers, ER had similar survival to esophagectomy [hazard ratio (HR): 0.85, 95% confidence interval (CI): 0.70–1.04, P = 0.1]. The corresponding 5-year survival for ER and esophagectomy were 70% and 74% (P = 0.1), respectively. For cT1b cancers, there was no statistically significant difference in overall survival between the treatment groups (HR: 0.87, 95% CI: 0.66–1.14, P = 0.3). The corresponding 5-year survival for ER and esophagectomy were 53% versus 61% (P = 0.3), respectively.

Conclusions:
This study demonstrates ER has comparable long-term outcomes for clinical T1aN0 and T1bN0 esophageal adenocarcinoma. However, 15% of patients with cT1b esophageal cancer were found to have positive nodal disease. Future research should seek to identify the subset of T1b cancers at high risk of nodal metastasis and thus would benefit from esophagectomy with lymphadenectomy.
Comparison of Perioperative Outcomes in Heart Failure Patients With Reduced Versus Preserved Ejection Fraction After Noncardiac Surgery
Authors: Huang Yolanda Ya-Chin , Chen Ling , Wright Jason D. 
Published: June 2020

Objective:
To compare outcome after noncardiac surgery between HF patients with reduced versus preserved ejection fraction.

Summary of Background Data:
HF patients who undergo major noncardiac surgery have higher risks of morbidity and mortality compared to the general population. However, it is unclear whether HF subtypes confer different risk.

Methods:
This retrospective study included HF patients, 45 years or older, who underwent noncardiac surgery from January 1, 2010 to September 30, 2015 in the Nationwide Readmissions Database. Multivariable logistic regression models were used to provide adjusted rates of postoperative outcomes. Hospital-level clustering and Nationwide Readmissions Database sampling weights were applied to all models.

Results:
Of the weighted 296,057 HF patients [HF with reduced ejection fraction (HFrEF) 48.1%; HF with preserved ejection fraction (HFpEF) 51.9%] who underwent noncardiac surgery, 41.1% had cardiopulmonary complications, 55.7% had noncardiopulmonary complications and 5.4% died during hospitalization. Thirty-day readmission rates for the weighted 232,852 HF patients was 21.5%. The adjusted odds ratios of cardiopulmonary and noncardiopulmonary complications, in-hospital mortality and 30-day readmission for HFrEF compared to HFpEF patients were 1.01 [95% confidence interval (CI), 0.99–1.04], 1.05 (95% CI, 1.02–1.07), 1.27 (95% CI, 1.21–1.34), and 1.08 (95% CI, 1.05–1.12), respectively.

Conclusions:
HFrEF patients have increased risks of noncardiopulmonary complications, mortality, and readmission after noncardiac surgery. These findings suggest that targeted perioperative care for HF subtypes may be crucial for the growing population of HF patients undergoing noncardiac surgery. Despite cardiopulmonary complications not being statistically different between HF subtypes, given the high occurrence rate, any intervention to decrease the rate would be clinically meaningful.
The Fistula Risk Score Catalog
Authors: Trudeau Maxwell T. , Casciani Fabio , Ecker Brett L. , Maggino Laura , Seykora Thomas F. , Puri Priya , McMillan Matthew T. , Miller Benjamin , Pratt Wande B. , Asbun Horacio J. , Ball Chad G. , Bassi Claudio , Behrman Stephen W. , Berger Adam C. , Bloomston Mark P. , Callery Mark P. , Castillo Carlos Fernandez-del , Christein John D. , Dillhoff Mary E. , Dickson Euan J. , Dixon Elijah , Fisher William E. , House Michael G. , Hughes Steven J. , Kent Tara S. , Malleo Giuseppe , Salem Ronald R. , Wolfgang Christopher L. , Zureikat Amer H. , Vollmer Charles M. 
Published: June 2020

Objective:
This study aims to present a full spectrum of individual patient presentations of pancreatic fistula risk, and to define the utility of mitigation strategies amongst some of the most prevalent, and vulnerable scenarios surgeons encounter.

Background:
The FRS has been utilized to identify technical strategies associated with reduced CR-POPF incidence across various risk strata. However, risk-stratification using the FRS has never been investigated with greater granularity. By deriving all possible combinations of FRS elements, individualized risk assessment could be utilized for precision medicine purposes.

Methods:
FRS profiles and outcomes of 5533 PDs were accrued from 17 international institutions (2003–2019). The FRS was used to derive 80 unique combinations of patient “scenarios.” Risk-matched analyses were conducted using a Bonferroni adjustment to identify scenarios with increased vulnerability for CR-POPF occurrence. Subsequently, these scenarios were analyzed using multivariable regression to explore optimal mitigation approaches.

Results:
The overall CR-POPF rate was 13.6%. All 80 possible scenarios were encountered, with the most frequent being scenario #1 (8.1%) – the only negligible-risk scenario (CR-POPF rate = 0.7%). The moderate-risk zone had the most scenarios (50), patients (N = 3246), CR-POPFs (65.2%), and greatest non-zero discrepancy in CR-POPF rates between scenarios (18-fold). In the risk-matched analysis, 2 scenarios (#59 and 60) displayed increased vulnerability for CR-POPF relative to the moderate-risk zone (both P < 0.001). Multivariable analysis revealed factors associated with CR-POPF in these scenarios: pancreaticogastrostomy reconstruction [odds ratio (OR) 4.67], omission of drain placement (OR 5.51), and prophylactic octreotide (OR 3.09). When comparing the utilization of best practice strategies to patients who did not have these conjointly utilized, there was a significant decrease in CR-POPF (10.7% vs 35.5%, P < 0.001; OR 0.20, 95% confidence interval 0.12–0.33).

Conclusion:
Through this data, a comprehensive fistula risk catalog has been created and the most clinically-impactful scenarios have been discerned. Focusing on individual scenarios provides a practical way to approach precision medicine, allowing for more directed and efficient management of CR-POPF.
Skin Picking Successfully Treated With Atomoxetine in Comorbid Skin Picking and Attention-Deficit/Hyperactivity Disorder: A Case Report
Authors: Yurteri Nihal , Sarıgedik Enes 
Published: June 2020

Abstract
“Skin picking disorder” (SPD: also known as neurotic excoriation, psychogenic excoriation, or dermatillomania) is classified in the “obsessive-compulsive and related disorders” category in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and characterized by unintentional, repetitive skin picking behaviors. Atomoxetine is a selective noradrenaline reuptake inhibitor used in the treatment of attention-deficit/hyperactivity disorder (ADHD). In this case report, we present a 9-year-old girl with the comorbid diagnosis of ADHD and SPD treated successfully with atomoxetine. To our knowledge, this is the first report of skin picking treated with atomoxetine in a patient with ADHD. We discussed possible explanations of mechanisms. Further studies are required on the effectiveness of atomoxetine for the treatment of SPD in the presence and absence of comorbid ADHD.
Expanding Access to Continuous EEG Monitoring in Neonatal Intensive Care Units
Authors: Fitzgerald Mark P. , Massey Shavonne L. , Fung France W. , Puopolo Karen M. , Posencheg Michael , Allen-Napoli Linda , Malcolm Marissa , Abend Nicholas S. 
Published: June 2020

Purpose:
Neonatal seizures are common and difficult to identify clinically because the majority are subclinical and correct identification of electroclinical seizures based on semiology is unreliable. Therefore, continuous EEG monitoring (CEEG) is critical for seizure identification in neonates and is recommended as the gold standard method in American Clinical Neurophysiology Society guidelines. Despite these recommendations, barriers to implementing widespread CEEG exist.

Methods:
To expand access to CEEG for at-risk neonates, a framework for providing remote CEEG was established at two network hospital neonatal intensive care units. Utilization and clinical impact were tracked as a quality improvement study.

Results:
In a 27-month period from June 2017 through September 2019, 76 neonates underwent CEEG between the two network neonatal intensive care units. Electrographic seizures occurred in about one quarter of records (18/76; 24%), though their incidence varied by CEEG indication. Care notes indicated that CEEG impacted clinical care in three quarters of cases (57/76; 75%). Continuous EEG impacted decisions to treat with anti-seizure medications in approximately one half of patients (impact: 28/57 [49%]; no impact 29/57 [51%]), and CEEG impacted prognostic discussions in approximately two thirds of patients (impact: 39/57 [68%]; no impact 18/57 [32%]).

Conclusions:
Establishment of a remote CEEG program for neonates is feasible, effective at identifying seizures, and improves the quality of care provided to neonates hospitalized at these network hospitals.
In silico multi-epitope vaccine against covid19 showing effective interaction with HLA-B*15:03
Authors: Faiza Muniba , Abdullah Tariq , Calderon-Tantalean Jose Franklin , Upadhyay Manish Ravindranath , Abdelmoneim Abdelrahman H. , Akram Fareeha , Thakur Bhupender Singh , Abdulaziz Ibrahim , Ononamadu Chimaobi James , Ghoraba Dina Abdelazim , Munawar Saba , Faruque MD Fakhrul Islam , Kigen Collins , Sharma Abhishek , Kumar Ashwani , Khalid Aqsa , Gharip Ali , Gupta Ankit , Manikumar Manne , Chaudhary Uma 
Published: June 2020

AbstractThe recent outbreak of severe acute respiratory syndrome (SARS) coronavirus (CoV)-2 (SARS-CoV-2) causing coronavirus disease (covid19) has posed a great threat to human health. Previous outbreaks of SARS-CoV and Middle East respiratory Syndrome CoV (MERS-CoV) from the same CoV family had posed similar threat to human health and economic growth. To date, not even a single drug specific to any of these CoVs has been developed nor any anti-viral vaccine is available for the treatment of diseases caused by CoVs. Subunits present in spike glycoproteins of SARS-CoV and SARS-CoV-2 are involved in binding to human ACE2 Receptor which is the primary method of viral invasion. As it has been observed in the previous studies that there are very minor differences in the spike glycoproteins of SARS-CoV and SARS-CoV-2. SARS-CoV-2 has an additional furin cleavage site that makes it different from SARS-CoV (Walls et al., 2020). In this study, we have analyzed spike glycoproteins of SARS-CoV-2 and SARS-CoV phylogenetically and subjected them to selection pressure analysis. Selection pressure analysis has revealed some important sites in SARS-CoV-2 and SARS-CoV spike glycoproteins that might be involved in their pathogenicity. Further, we have developed a potential multi-epitope vaccine candidate against SARS-CoV-2 by analyzing its interactions with HLA-B*15:03 subtype. This vaccine consists of multiple T-helper (TH) cells, B-cells, and Cytotoxic T-cells (CTL) epitopes joined by linkers and an adjuvant to increase its immunogenicity. Conservation of selected epitopes in SARS, MERS, and human hosts, suggests that the designed vaccine could provide cross-protection. The vaccine is designed in silico by following a reverse vaccinology method acknowledging its antigenicity, immunogenicity, toxicity, and allergenicity. The vaccine candidate that we have designed as a result of this work shows promising result indicating its potential capability of simulating an immune response.