bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cervicovaginal lavage fluid zinc level as a marker of vaginal atrophy
Authors: Damjanovich Peter , Sipos Attila Gergely , Larson Kindra , Cunningham Tina D. , Takacs Peter , Kozma Bence 
Published: April 2020

Abstract

Objectives:
This study aimed to investigate the correlation between cervicovaginal fluid zinc levels and participants’ menopausal status and the presence of vulvovaginal symptoms of genitourinary syndrome of menopause.

Methods:
Women included in the study underwent a pelvic examination, collection of vaginal cytology, and cervicovaginal lavage was performed in a standardized fashion. The cervicovaginal lavage zinc content was determined. The vaginal health index was calculated, and the visual analog scale was obtained based on the participant's burning, itching, vaginal pain, dyspareunia, dryness, and dysuria.

Results:
One hundred twenty women participated in the study. Eighty-two participants were menopausal. The mean vaginal health index was 15 ± 6, while the total visual analog scale score was 14 ± 14. We found significant differences between cervicovaginal lavage zinc level and age group, menopausal status, presence of vaginal dryness, and vaginal atrophy. We also found a moderate positive correlation between Vaginal Maturation Value and cervicovaginal lavage zinc levels (r = 0.495, P value < 0.01) in the correlation analysis. However, in the multivariate regression model, including all significant factors, only vaginal atrophy remained significant.

Conclusions:
We found a significant association between vaginal atrophy (vaginal maturation value < 50) and cervicovaginal lavage zinc levels. Zinc levels of cervicovaginal lavage could be used as a new marker of vaginal atrophy.

Video Summary:
http://links.lww.com/MENO/A575.
Effect of Chinese herbal medicine on serum lipids in postmenopausal women with mild dyslipidemia: a randomized, placebo-controlled clinical trial
Authors: Nie Guangning , Yang Hongyan , Liu Jian , Cao Xiaojing , Cheng Fangping , Du Qiaolin , Wang Xiaoyun 
Published: April 2020

Abstract

Objective:
Previous studies have shown the association between menopause and dyslipidemia. This study was aimed to evaluate the effect of Chinese herbal medicine, tonifying kidney and descending turbidity (TKDT) granule, on serum lipid profiles in postmenopausal women with dyslipidemia.

Methods:
A double-blind randomized, placebo-controlled trial was conducted among 104 postmenopausal Chinese women with mild dyslipidemia. Participants were randomized into treatment group (n = 53) and control group (n = 51). The participants in the treatment group received TKDT granule once per day for 24 weeks, whereas the control group received placebo in the same manner. All participants were subjected to healthy lifestyle during the study. Serum lipid profiles, body weight, waist circumference, and safety indicators were measured both at baseline and 24 weeks after admission.

Results:
Compared with placebo, significant improvements in total cholesterol, low-density lipoprotein cholesterol, apolipoprotein-B (Apo-B), weight, and waist circumference in the TKDT group (P < 0.05) were observed after 24 weeks of treatment. Total cholesterol, low-density lipoprotein cholesterol, and Apo-B were decreased by 0.84 (0.77) mmol/L, 0.72 (0.77) mmol/L, and 0.12 (0.27) mmol/L, mean ± SD respectively. The weight, waist circumference, and body mass index were decreased by 4.07 (3.01) kg, 3.10 (2.95) cm, 1.60 (1.13), respectively. There were no significant differences in triglycerides, high-density lipoprotein cholesterol, and Apo-A between the two groups. Seven participants in the treatment group and six participants in the placebo group had mild or moderate adverse reactions.

Conclusion:
TKDT granule improved the lipid profile and reduced the related metabolic abnormalities in postmenopausal women with mild dyslipidemia based on lifestyle changes.
Diagnostic Performance of 68Ga-PSMA-11 Positron-emission-tomography/Computed-tomography in a Large Cohort of Patients with Biochemical Recurrence of Prostate Carcinoma
Authors: Hoffmann Manuela A. , Buchholz Hans-Georg , Wieler Helmut J. , Müller-Hübenthal Jonas , Trampert Ludwin , Richardsen Ines , Schreckenberger Mathias 
Published: April 2020

Abstract
Gallium-68 (68Ga) prostate-specific-membrane-antigen positron-emission-tomography/computed-tomography is a highly promising method for imaging primary and recurrent prostate cancer. These dual-modality imaging technologies enable whole-body functional and anatomical evaluation in a single session. This study investigated the performance of 68Ga-prostate-specific-membrane-antigen-11 positron-emission-tomography/computed-tomography for detecting prostate carcinoma in patients with rising prostate-specific-antigen after primary therapy. Six hundred sixty (660) patients with biochemical recurrence referred for positron-emission-tomography/computed-tomography with 68Ga-prostate-specific-membrane-antigen-11 were evaluated retrospectively. Prostate-specific-antigen-stratified cohorts of pathological scan results were analyzed, and relationships between prostate-specific-antigen kinetics and PSMA-positive tumor lesions were correlated. Gallium-68 prostate-specific-membrane-antigen-11 positron-emission-tomography/computed-tomography showed a pathological prostate-specific-membrane-antigen uptake in 76% (500 of 660 patients). Positive scans were positively associated with prostate-specific-antigen (p<0.001). For patients with prostate-specific-antigen <0.2 ng mL−1, the PSMA-positive tumor lesions rate was 41%. Patients with prostate-specific-antigen of 0.2–<0.5 ng mL−1, 0.5–<1.0 ng mL−1, 1.0–<2.0 ng mL−1, and 2.0–<5.0 ng mL−1 showed rates of 44.7%, 61.7%, 72.3%, 85.2%, respectively, and for prostate-specific-antigen of ≥5.0 ng mL−1 it increased to 94%. Prostate-specific-antigen velocity was also correlated with PSMA-positive tumor lesions (p<0.001). In contrast, no association was found for prostate-specific-antigen doubling time (p=0.74). PSMA-positive tumor lesions were significantly increased in patients with primary intermediate- (Gleason Score7) and high-risk (Gleason Score>7) vs. low-risk prostate cancer (Gleason Score<7) (p<0.001). Our data confirm the high performance of 68Ga-prostate-specific-membrane-antigen positron-emission-tomography/computed-tomography for the detection of recurrent prostate cancer. This may alter treatment planning and has been documented in other studies as well.
Corneal Biomechanical Changes After Uneventful Phacoemulsification in Patients With Type 2 Diabetes Mellitus and Patients Without Diabetes
Authors: Beato João N. , Esteves-Leandro João , Reis David , Falcão Manuel , Rosas Vítor , Carneiro Ângela , Falcão Reis Fernando 
Published: April 2020

Purpose:
To compare corneal biomechanical changes after uneventful phacoemulsification cataract surgery between type 2 diabetic (DM) and nondiabetic patients.

Methods:
Forty-four diabetic (44 eyes) and 44 (44 eyes) age and sex-matched non-DM controls with age-related cataract were enrolled in this prospective observational study. Corneal hysteresis (CH), corneal resistance factor (CRF), and corneal-compensated intraocular pressure (IOPcc) were evaluated by using the ocular response analyzer; central corneal thickness was recorded by using the Pentacam HR. Patients were evaluated preoperatively and 1 and 6 months after surgery.

Results:
In the DM group, CH was observed to be significantly lower than preoperative value (9.8 ± 1.5 mm Hg) at 1 month (9.4 ± 1.2 mm Hg, P = 0.040), but not at the 6-month follow-up (9.6 ± 1.6 mm Hg, P = 0.437),whereas it did not change significantly in the non-DM group (preoperative 9.8 ± 1.3 mm Hg vs. 1 month 9.6 ± 1.1 mm Hg vs. 6 months 10.1 ± 1.1 mm Hg, P > 0.05). CRF was significantly lower than the preoperative values at 1 and 6 months in both groups (P ≤ 0.001). Postoperative CH change was significantly associated with preoperative CH (P < 0.001), preoperative IOPcc (P = 0.004), and IOPcc change (P < 0.001), whereas CRF change was only correlated with preoperative CRF (P < 0.001). There was a significant postoperative IOPcc reduction 6 months after surgery (P < 0.001) in both DM and non-DM groups; however, central corneal thickness was not found to significantly change in the postoperative period (P > 0.05).

Conclusions:
This study showed that phacoemulsification causes a significant and persistent decrease in intraocular pressure and CRF in both groups, whereas CH recovered to preoperative values, although more slowly in patients with diabetes.
Outcomes of Ipsilateral Simple Limbal Epithelial Transplantation, Tenonectomy, Mitomycin and Amniotic Membrane Transplantation for Treatment of Recurrent Pterygium
Authors: Trinh Tanya , Mimouni Michael , Mednick Zale , Einan-Lifshitz Adi , Cohen Eyal , Santaella Gisella , Sorkin Nir , Slomovic Allan 
Published: April 2020

Purpose:
To report on the outcomes of recurrent pterygium treated by ipsilateral simple limbal epithelial transplantation (SLET), mitomycin, tenonectomy, and amniotic membrane transplantation.

Methods:
A retrospective, interventional study was conducted including all patients with recurrent pterygium who underwent SLET surgery under a single surgeon using ipsilateral donor tissue with a minimum 6-month follow-up at Toronto Western Hospital, Canada. Outcome measures included the following: recurrence rates, best spectacle–corrected visual acuity, and postoperative complications.

Results:
Ten eyes of 10 patients, aged 60.7 ± 18.5 years (range 23–79) with a mean follow-up time of 15.2 ± 10.0 months of which 50% (n = 5) were men, were included. Eight eyes (80%) had a history of 2 or less pterygium operations. Two patients had 3 and 5 previous pterygium operations, respectively. Concurrent limbal stem cell disease was noted in 6 eyes (60%). Average number of pterygium recurrences per eye was 1.9 ± 1.3 (range 1–5). Mean pre-op best-corrected visual acuity was 0.5 LogMAR (Snellen equivalent 20/60, range 20/20 to counting fingers). Best-corrected visual acuity remained the same or improved in 6 eyes (60%). Recurrence was noted in 1 eye (10%) with a history of 5 previous pterygium excisions and remained stable at the last follow-up. No patients required a second operation.

Conclusions:
Ipsilateral SLET with mitomycin, tenonectomy, and amniotic membrane transplantation is a novel technique to address recurrent pterygium. Concurrent limbal stem cell diseases are often present. Initial results demonstrate low recurrence. Visual improvement is modest. Stabilization of the ocular surface to improve vision is possible.
Adverse Events Following Immunization Among Children With Epilepsy
Authors: Top Karina A. , Righolt Christiaan H. , Hawken Steven , Donelle Jessy , Pabla Gurpreet , Brna Paula , Deeks Shelley L. , Smith Bruce , Wilson Kumanan , Mahmud Salaheddin M. 
Published: April 2020

Background:
In children with epilepsy, fever and illness are known triggers for seizure; therefore, clinicians and parents could be concerned that immunization-induced inflammation and fever could also trigger seizures. We sought to estimate the risk of emergency department (ED) visit or hospitalization for epilepsy/seizure and all causes after immunization in children younger than 7 years of age with epilepsy.

Methods:
We conducted a self-controlled case series of children diagnosed with epilepsy before their 7th birthday and immunized from 2005 to 2015 in Ontario (population 14.2 million) and Manitoba (population 1.3 million), Canada, using administrative healthcare data. We estimated the age- and season-adjusted relative incidence (aRI) of epilepsy/seizure-related and all-cause ED visits/hospitalizations during various risk periods 0–28 days after inactivated and live immunizations versus a control period 35–83 days postimmunization. Estimates from each province were analyzed separately and then combined in a random-effects meta-analysis.

Results:
The combined risk of epilepsy/seizure-related hospitalization/ED visit was increased 0–2 days after inactivated vaccines (aRI = 1.5, 95% confidence interval: 1.1–1.9) and 7–10 days after live vaccines (aRI = 1.9, 1.4–2.7). For all-cause ED visit/hospitalization, the combined aRI estimate was 0.9 (0.8–1.2) 0–2 days after inactivated vaccines and 1.3 (1.1–1.5) 7–10 days after live vaccines.

Conclusions:
The risk of epilepsy/seizure-related ED visit/hospitalization was modestly increased among children with epilepsy during peak periods of fever and inflammation following inactivated and live vaccines. These risks must be balanced against the risk of complications from vaccine-preventable diseases.
Reduced Antibiotic Exposure by Serial Physical Examinations in Term Neonates at Risk of Early-onset Sepsis
Authors: Vatne Anlaug , Klingenberg Claus , Øymar Knut , Rønnestad Arild E , Manzoni Paolo , Rettedal Siren 
Published: April 2020

Background:
Suspected early-onset sepsis (EOS) results in antibiotic treatment of a substantial number of neonates who are uninfected. We evaluated if an approach using serial physical examinations (SPEs) can reduce antibiotic exposure for suspected EOS in term neonates during the first 3 days of life, without affecting safety.

Methods:
Within a quality-improvement framework, SPEs for 24–48 hours for neonates with suspected EOS was implemented in the neonatal intensive care unit, Stavanger, Norway. The proportion of neonates ≥37 weeks gestation exposed to antibiotics, antibiotic therapy-days and the safety outcome time from birth to start antibiotics were compared between a baseline period (April 2014–February 2016), when a risk factor based approach was used, and a post-SPE-implementation period (January 2017–November 2018).

Results:
We included all term live born neonates (n = 17,242) in the 2 periods. There was a 57% relative reduction in neonates exposed to antibiotics; 2.9% in the baseline and 1.3% in the post-implementation period, P < 0.001. There was a 60% relative reduction in mean antibiotic therapy-days/1000 patient-days; from 320 to 129, P < 0.001, and a 50% relative reduction in time to initiate antibiotics in suspected EOS-cases, from median (interquartile range) 14 (5–28) to 7 (3–17) hours, P = 0.003. The incidence of culture-positive EOS remained unchanged. There were no infection-attributable deaths.

Conclusions:
Implementing SPE to guide empiric antibiotic therapy in term neonates with suspected EOS more than halved the burden of antibiotic exposure, without delay of antibiotic treatment of infected neonates or increased sepsis-related mortality.
Torsion in the Gravid and Nongravid Uterus: A Review of the Literature of an Uncommon Diagnosis
Authors: Ramseyer Abigail M. , Whittington Julie R. , Resendez Victoria A. , Whitcombe Dayna D. , Magann Everett F. 
Published: April 2020

Importance
Uterine torsion is an uncommon but life-threatening clinical situation that requires a high index of suspicion for diagnosis.

Objective
The aim of this study was to review literature and determine the etiology, presentation, diagnosis, and management of uterine torsion in the gravid and nongravid patients.

Evidence Acquisition
A literature search was undertaken by our research librarian using the search engines PubMed and CINAHL. The search terms used were “uterine torsion” OR (uterus and torsion). The search was limited to the English language, but the years searched were unlimited.

Results
The search identified 177 articles, 91 of which are the basis for this review. There have been 41 cases or gravid uterine torsion, their characteristics, and symptoms published since 2006. Torsion is rare in nongravid patients, but can still occur.

Conclusion and Relevance
Uterine torsion is rare, can affect all ages, and can have significant implications for women. Prompt recognition allows for timely intervention and can mitigate harm.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this activity, the learner should be better able to diagnose uterine torsion in the gravid and nongravid uteri and identify causative factors if present; ascertain differences in uterine torsion presentation in gravid and nongravid patients; identify severity of symptoms from asymptomatic to acute; and implement a treatment plan based on the reduction of morbidity and mortality while considering fertility preservation.
Intraoperative Assessment of DIEP Flap Breast Reconstruction Using Indocyanine Green Angiography: Reduction of Fat Necrosis, Resection Volumes, and Postoperative Surveillance
Authors: Hembd Austin S. , Yan Jingsheng , Zhu Hong , Haddock Nicholas T. , Teotia Sumeet S. 
Published: April 2020

Background:
This study aims to characterize the effect of laser-assisted indocyanine green fluorescence angiography on fat necrosis and flap failure in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction.

Methods:
A retrospective review was performed on 1000 free flaps for breast reconstruction at a single center from 2010 to 2017. Indocyanine green angiography was used after completion of recipient-site anastomoses to subjectively assess for areas of hypoperfusion. A multivariable logistical analysis was conducted with 24 demographic and surgical factors and their effects on fat necrosis and flap failure.

Results:
Five hundred six DIEP flaps were included in the statistical analyses. Thirteen percent of flaps had fat necrosis. Indocyanine green angiography was used for 200 flaps and was independently associated with a decrease in the odds of fat necrosis (OR, 0.38; p = 0.004). There was no reduction in flap failure rates when using indocyanine green angiography (OR, 1.15; p = 0.85). However, there was a decrease in flap loss with increasing venous coupler diameter (OR, 0.031 per 1-mm increase; p = 0.012). The 84.9-g higher weight of resected tissue before inset without indocyanine green angiography versus the weight of the tissue resected with indocyanine green angiography was statistically significant (p = 0.01). Per single incident of fat necrosis, our cohort underwent an additional 0.69 revision procedures, 1.22 imaging studies, 0.77 biopsies, and 1.7 additional oncologic office visits.

Conclusion:
Intraoperative indocyanine green fluorescence angiography decreases the odds of fat necrosis, saves volume when flap trimming at inset, and can significantly reduce the postoperative surveillance burden in DIEP-based breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Dipeptidyl Peptidase-4 Inhibitor Reduces the Risk of Developing Hypertrophic Scars and Keloids following Median Sternotomy in Diabetic Patients: A Nationwide Retrospective Cohort Study Using the National Database of Health Insurance Claims of Japan
Authors: Suwanai Hirotsugu , Watanabe Ryo , Sato Munemori , Odawara Masato , Matsumura Hajime 
Published: April 2020

Background:
Hypertrophic scars and keloids, which are abnormalities of fibrosis, often occur in surgical wounds; however, their exact cause and preventive measures are unknown. The administration of dipeptidyl peptidase-4 inhibitors to humans is expected to suppress fibrosis in wounds and minimize hypertrophic scar and keloid formation.

Methods:
This study aimed to verify the suppressive effect of dipeptidyl peptidase-4 inhibitors on the formation of hypertrophic scars or keloids using real world data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. It is a retrospective cohort study, and data were extracted from the National Database between April of 2013 and March of 2015. Patients who underwent median sternotomy were included in the study based on their claimed surgical codes. Subjects who were prescribed dipeptidyl peptidase-4 inhibitors constituted the treatment group; subjects who were not prescribed or administered dipeptidyl peptidase-4 inhibitors during that period constituted the nontreatment group.

Results:
Subjects included 5430 patients throughout Japan (3509 men and 1921 women). Of the 446 subjects who were treated with dipeptidyl peptidase-4 inhibitors within 1 year before the procedure, fewer than 10 (<2 percent) developed either hypertrophic scars or keloids. Of the 4984 subjects who were not treated, 152 (3.05 percent) were at significantly lower risk for hypertrophic scars and keloids (p = 0.04). A logistic regression analysis was performed to adjust for confounding factors, with history of hypertrophic scar formation as the explained variable.

Conclusion:
This study revealed that dipeptidyl peptidase-4 inhibitors suppress the onset of hypertrophic scars or keloids after surgery in humans.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Recurrence in Patients Achieving Pathological Complete Response After Neoadjuvant Treatment for Advanced Pancreatic Cancer
Authors: Blair Alex B. , Yin Ling-Di , Pu Ning , Yu Jun , Groot Vincent P. , Rozich Noah S. , Javed Ammar A. , Zheng Lei , Cameron John L. , Burkhart Richard A. , Weiss Matthew J. , Wolfgang Christopher L. , He Jin 
Published: April 2020

Objective:
The aim of this study was to characterize the patterns and treatment of disease recurrence in patients achieving a pathological complete response (pCR) following neoadjuvant chemoradiation for advanced pancreatic ductal adenocarcinoma (PDAC).

Summary of Background Data:
A pCR is an independent predictor for improved survival in PDAC. However, disease recurrence is still observed in these patients.

Methods:
Patients with advanced PDAC who were treated with neoadjuvant therapy and had a pCR were identified between 2009 and 2017. Overall survival (OS) was determined from the initiation of neoadjuvant, disease-free survival (DFS) from the date of surgery, and post-recurrence survival (PRS) from the date of recurrence. Factors associated with recurrence were analyzed using a Cox-regression model.

Results:
Of 331 patients with borderline resectable or locally advanced PDAC, 30 achieved a pCR following neoadjuvant treatment and pancreatectomy. The median DFS for pCR patients was 29 months and OS 76 months. Recurrence was observed in 14 patients. No clinicopathologic or treatment characteristics were associated with survival. The median PRS following recurrence was 25 months. Treatment following recurrence included chemotherapy, radiation or ablation, and surgical resection. Hepatectomy or completion pancreatectomy was accomplished in 2 patients that remain alive 13 and 62 months, respectively, following metastasectomy.

Conclusions:
A pCR following neoadjuvant therapy in patients with advanced PDAC is associated with remarkable survival, although recurrence occurs in about half of patients. Nevertheless, patients with pCR and recurrence respond well to treatment and survival remains encouraging. Advanced molecular characterization and longitudinal liquid biopsy may offer additional assistance with understanding tumor biologic behavior after achieving a pCR.