bluuebunny/crossref_metadata_2025_split huggingface dataset:
An interdisciplinary approach for laparoscopic removal of a large retroperitoneal pelvic schwannoma attached to vital vessels
Authors: Macciò Antonio , Kotsonis Paraskevas , Aste Laura , Voicu Maria Andreea , Madeddu Clelia , Conti Carlo , Camparini Stefano 
Published: December 2019

Abstract

Rationale:
Retroperitoneal schwannomas are very rare and may grow very close to major abdominal vessels. Since the surgical approach to the retroperitoneal space may be complex due to surrounding vital organs, including major vessels, laparoscopic surgery is challenging and has only been recently adopted. Here, we report a case of laparoscopic resection of a large retroperitoneal schwannoma attached to large vital vessels.

Patient concerns:
A 62-year-old woman presented with a chief complaint of pain in the lower right limb with consequent claudication, which had lasted for approximately 1 year.

Diagnoses:
Magnetic resonance imaging revealed a solid oval mass measuring 45 × 32 × 39 mm, located medially to the right iliopsoas muscle at the level of the intersomatic space between the 5th lumbar vertebra and the 1st sacral vertebra. This mass was inhomogeneously hypointense in T2 due to the presence of cystic areas, with intense and inhomogeneous contrast enhancement, compatible with the diagnosis of a schwannoma. The mass compressed the inferior caval vein near its bifurcation and the right common iliac vein, anteriorly dislocating the ipsilateral iliac arterial axis.

Interventions:
A multidisciplinary team skilled in vascular and pelvic laparoscopy was involved. The patient underwent laparoscopic surgery via an anterior transperitoneal approach with right adnexectomy and radical excision of the tumor. The surgery lasted 120 minutes without intraoperative complications. Blood loss was less than 100 mL. The histologic diagnosis was a benign Schwannoma; grade I according to World Health Organization classification.

Outcomes:
The postoperative course was uneventful. At the 10-month follow-up, the patient had no recurrences and was asymptomatic.

Lessons:
Laparoscopic removal of large retroperitoneal schwannomas, even if attached to major vital vessels, is feasible and safe when performed by experienced surgeons.
Knowledge of and willingness to perform Hands-Only cardiopulmonary resuscitation among college students in Malaysia
Authors: Karuthan Sumitra Ropini , Firdaus Putri Jasmine Filza binti , Angampun Aloha Dee-Afryna George , Chai Xuan Jia , Sagan Chris Dom , Ramachandran Monishak , Perumal Sharmmathevan , Karuthan Mahendra , Manikam Rishya , Chinna Karuthan 
Published: December 2019

Abstract
Worldwide, millions of people die of sudden cardiac arrest every year. This is partly due to limited and sometimes ineffective bystander cardiopulmonary resuscitation (CPR). The need for mouth-to-mouth contact, fear of causing harm, litigation, and the complexity of delivering CPR are the main deterrents. In view of this, the basic life support algorithm has been simplified and lay rescuers are encouraged to perform Hands-Only CPR.
The objective of this study is to assess knowledge on and willingness to perform Hands-Only CPR among Malaysian college students and to determine the relationship between the two.
In an online self-administered survey, college students responded to a questionnaire on demographics, exposure to CPR, knowledge on Hands-Only CPR, and their willingness to perform Hands-Only CPR in 5 different scenarios (family members or relatives, strangers, trauma victims, children, and elderly people).
Data for 393 participants were analyzed. For knowledge, the mean score was 8.6 ± 3.2 and the median score was 9. In the sample, 27% of the respondents did not attend any CPR training before, citing that they were unsure where to attend the course. The knowledge score among those who attended CPR training (M = 3.6, S = 2.9) was significantly higher compared to those who did not (M = 6.7, S = 3.0). Out of the 393 participants, 67.7%, 55%, 37.4%, 45%, and 49.1% were willing to perform Hands-Only CPR on family members or relatives, strangers, trauma victims, children, and elderly people, respectively. There were significant associations (P < .001) between knowledge and willing to perform Hands-Only CPR on family members or relatives (OR = 1.32, 95% CI 1.43, 1.43), strangers (OR = 1.31, 95% CI 1.21, 1.42), trauma victims (OR = 1.21, 95% CI 1.12, 1.31), children (OR = 1.28, 95% CI 1.19, 1.39), and elderly people (OR = 1.36 95% CI 1.25, 1.48).
Based on this study, knowledge on Hands-Only CPR among local college students is not encouraging. Not many know where to attend such courses. There was significant association between knowledge and willingness to perform Hands-Only CPR.
Risk factors for the concomitant occurrence of alcoholic chronic pancreatitis and alcoholic liver cirrhosis: a 10-years cohort study at a tertiary hospital in China
Authors: Tan Jie-Hui , Jin Yang-Chen , Cao Rong-Chang , Zhou Lei , Zhang Guo-Wei 
Published: December 2019

Objective
Concomitant occurrence of alcoholic chronic pancreatitis (ACP) and alcoholic liver cirrhosis (ALC) is rare with few reported cases. The present study aimed to identify the potential risk factors of chronic pancreatitis (CP) and liver cirrhosis (LC) in ALC patients and ACP patients, respectively.

Methods
A retrospective analysis was performed on 536 patients with CP and 647 ALC patients without CP (Group A). Among the 536 CP patients, 213 ACP cases were divided into two groups: ACP with LC (Group B, n = 52) and ACP without LC (Group C, n = 161). A comparison between Group A and B was carried out to identify the potential risk factors of CP in ALC patients, while Group B and C were compared to determine the independent risk factors of LC in ACP patients.

Results
Concomitant occurrence of ACP and ALC accounted for 24.4% (52/213) in this cohort. Significant risk factors for CP in ALC patients included smoking [odds ratio (OR), 2.557; 95% confidence interval (CI): 1.531–5.489; P = 0.003] and multiple bouts of acute pancreatitis (OR, 4.813; 95% CI: 3.625–12.971; P < 0.001). Hepatitis B virus (HBV) infection (OR, 4.237; 95% CI: 1.742–7.629; P = 0.012) was the only independent risk factor associated with LC in ACP patients.

Conclusion
HBV infection exacerbated liver damage in ACP patients. Alcoholic patients who smoked and suffered from ongoing bouts of acute pancreatitis are prone to develop CP.
Prepectoral Breast Reconstruction in Nipple-Sparing Mastectomy With Immediate Mastopexy
Authors: Manrique Oscar J. , Arif Chaudhry , Banuelos Joseph , Abu-Ghname Amjed , Martinez-Jorge Jorys , Tran Nho V. 
Published: December 2019

Background
Nipple-areola preservation positively impacts quality of life of the patients and helps them to achieve a better psychological and sexual well-being, as well as higher satisfaction with their reconstruction. Patients with large or ptotic breasts, however, represent a technical challenge to surgeons, and nipple-areola preservation may be deferred in this clinical scenario. The aim of this study is to report our experience in patients with large or ptotic breasts who underwent nipple-sparing mastectomy (NSM) and prepectoral implant-based breast reconstruction with immediate mastopexy.

Methods
A single-institution retrospective chart review was performed in all consecutive patients who underwent NSM and prepectoral implant-based breast reconstruction, simultaneously with mastopexy. This procedure was offered preoperatively to patients who had ptotic or large breasts, which could benefit from mastopexy to obtain a better result. Aesthetic outcomes were evaluated using a modified 5-point Likert scale, and satisfaction and quality of life were evaluated using the reconstruction module of the BREAST-Q questionnaire.

Results
Seventeen NSMs with simultaneous mastopexy were performed on 9 patients. All completed reconstruction successfully, and there were no cases of nipple ischemia or necrosis. Global aesthetic evaluation score was 3.77 (±0.95). The Q-scores were as follows: satisfaction with breast was 90, psychosocial well-being was 95, sexual well-being was 80, and physical well-being with chest was 86.

Conclusions
In patients with large and/or ptotic breasts, NSM with prepectoral breast reconstruction and immediate mastopexy showed promising results. However, adequate preoperative planning and intraoperative flap assessment are necessary in order to minimize complications.
Prevalence of Musculoskeletal Symptoms and Ergonomics Among Plastic Surgery Residents
Authors: Kokosis George , Dellon Lee A. , Lidsky Michael E. , Hollenbeck Scott T. , Lee Bernard T. , Coon Devin 
Published: December 2019

Background
Musculoskeletal symptoms and injuries among surgeons are underestimated but are increasingly recognized to constitute a major problem. However, it has not been established when symptoms start and what factors contribute to the development of symptoms.

Methods
A 19-question survey approved by our institution's review board, and American Council of Academic Plastic Surgery was sent to all plastic surgery residents enrolled in Accreditation Council for Graduate Medical Education–accredited plastic surgery training programs in the United States. The presence of various musculoskeletal symptoms was calculated, and predictors of these symptoms were evaluated.

Results
We received 104 total responses. Ninety-four percent of residents had experienced musculoskeletal pain in the operating room. The neck was the most commonly affected area (54%) followed by the back (32%) and extremities (12%). Interestingly, 52% of responders developed these symptoms during the first 2 years of their residency. Furthermore, increasing postgraduate year level (P = 0.3) and independent versus integrated status (P = 0.6) had no correlation with pain, suggesting that symptoms began early in training.
Pain symptoms were frequent for 47%, whereas 5% reported experiencing symptoms during every case. The use of a headlight correlated with frequent pain (odds ratio, 2.5; P = 0.027). The use of microscope and loupes did not correlate with frequent pain. Eighty-nine percent of responders were aware of having bad surgical posture, but only 22% had received some form of ergonomics training at their institution. Sixty-four percent of responders believe that the operating room culture does not allow them to report the onset of symptoms and ask for adjustments. This was more common among residents reporting frequent pain (odds ratio, 3.12; P = 0.009).

Conclusions
Plastic surgeons are at high risk for occupational symptoms and injuries. Surprisingly, symptoms start early during residency. Because residents are aware of the problem and looking for solutions, this suggests an opportunity for educational intervention to improve the health and career longevity of the next generation of surgeons.
Morphometric Features of External Opening of the Carotid Canal and Relationship With Some Neighboring Formations on the Skull Base
Authors: Tuncel Çini Nilgün , Babacan Serdar , Ari Ilknur 
Published: December 2019

Abstract
The carotid canal must be taken into account during the surgical procedures since it contains the petrous segment of internal carotid artery. For this reason, we aimed to reveal the morphometric relationship of the carotid canal with related structures. The study was carried out with 11 parameters determined on a total of 52 sex unknown temporal bones belonging to the collection of Bursa Uludag University Faculty of Medicine, Anatomy Department. Measurements were taken by using mechanical sliding calipers and the findings were evaluated using the SPSS 22.0 program. Descriptive statistics of all variables were performed and correlation between the carotid canal and related structures were evaluated with the Spearman correlation analysis. Also, the correlation coefficient values were given. We developed the regression formulas to estimate the location of the carotid canal. There was a relationship between posterior and anterior point of external opening of carotid canal and mastoid process. The distance between the mastoid process-suprameatal spine and mastoid process-posterior root of zygomatic arch is highly correlated with each other.
Open Surgery Versus Closed Treatment of Unilateral Mandibular Condyle Fractures
Authors: Han Xiaodong , Shao Xiaojun , Lin Xiaozhen , Gui Weifu , Zhang Ming , Liang Limin 
Published: December 2019

Purpose:
The aim of this meta-analysis was to evaluate the efficacy of open surgery and closed treatment for unilateral moderately displaced mandibular condyle fractures.

Methods:
PubMed, Embase, and Cochrane Library databases were searched according to PRISMA guidelines from inception to October, 2018. Inclusion criteria were based on humans randomized controlled trials in the English literature. Pertinent data were collected and the incidence of the complications was calculated.

Results:
A total of 6 studies with 227 patients were included in the meta-analysis. The results showed that there were no significant differences in incidence of malocclusion (odds ratio [OR], 0.33; 95% confidence interval [CI]: 0.07–1.46; P = 0.14). However, open surgery group had a better maximal mouth opening (WMD = 3.82, 95% CI: 1.93–5.71, P < 0.01), protrusion (WMD = 1.16, 95% CI: 0.42–1.89, P < 0.01) and sum of both laterotrusions (WMD: 2.50, 95% CI: 1.77–3.22, P < 0.01). And the incidence of temporomandibular joint pain was lower than closed treatment group (OR: 0.15, 95% CI: 0.06–0.37, P < 0.01).

Conclusions:
Compared with closed treatment, open surgery has significant advantages in improving mouth opening and mandibular movement, and reducing the incidence of temporomandibular joint pain, provided that open surgery was a promising application in treatment of unilateral moderately displaced mandibular condyle fractures.
Prognostic Impact of Postoperative Lymph Node Metastases After Neoadjuvant Chemoradiotherapy for Locally Advanced Squamous Cell Carcinoma of Esophagus
Authors: Leng Xuefeng , He Wenwu , Yang Hong , Chen Yuping , Zhu Chengchu , Fang Wentao , Yu Zhentao , Mao Weimin , Xiang Jiaqing , Chen Zhijian , Yang Haihua , Wang Jiaming , Pang Qingsong , Zheng Xiao , Liu Hui , Yang Huanjun , Li Tao , Zhang Xu , Li Qun , Wang Geng , Mao Teng , Guo Xufeng , Lin Ting , Liu Mengzhong , Fu Jianhua , Han Yongtao 
Published: December 2019

Objective:
To determine the prognostic impact of pathologic lymph node (LN) status and investigate risk factors of recurrence in esophageal squamous cell carcinoma (ESCC) patients with pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT).

Summary Background Data:
There are no large-scale prospective study data regarding ypN status and recurrence after pCR in ESCC patients receiving NCRT.

Methods:
The NEOCRTEC5010 trial was a prospective multicenter trial that compared the survival and safety of NCRT plus surgery (S) with S in patients with locally advanced ESCC. The relationships between survival and cN, pN, and ypN status were assessed. Potential prognostic factors in patients with ypN+ and pCR were identified.

Results:
A total of 389 ESCC patients (NCRT: 182; S: 207) were included. Patients with pN+ in the S group and ypN+ in the NCRT group had decreased overall survival (OS) and disease-free survival (DFS) compared with pN0 and ypN0 patients, respectively. Partial response at the primary site [hazard ratio (HR), 2.09] and stable disease in the LNs (HR, 3.26) were independent risk factors for lower DFS, but not OS. For patients with pCR, the recurrence rate was 13.9%. Patients with distant LN metastasis had a median OS and DFS of 16.1 months and 14.4 months, respectively. Failure to achieve the median total dose of chemotherapy was a significant risk factor of recurrence and metastasis after pCR (HR, 44.27).

Conclusions:
Persistent pathologic LN metastasis after NCRT is a strong poor prognostic factor in ESCC. Additionally, pCR does not guarantee a cure; patients with pCR should undergo an active strategy of surveillance and adjuvant therapy.
Long-term Impact of Bariatric Surgery on Venous Thromboembolic Risk
Authors: Moussa Osama , Ardissino Maddalena , Tang Alice , Lazzari Laura , Millar Ophelia , Ziprin Paul , Darzi Ara , Khan Omar , Collins Peter , Purkayastha Sanjay 
Published: December 2019

Objective:
The aim of this study is to evaluate the effect of bariatric surgery on long-term risk of VTEs in a large cohort of patients with obesity.

Background:
Obesity is a well-established risk factor for VTEs, such as pulmonary embolism and deep vein thrombosis. The rising prevalence of obesity and its associated co-morbidities, including VTE, represent a growing public health issue.

Methods:
A nested, retrospective matched cohort study was designed and conducted on prospectively collected national electronic healthcare records data from the Clinical Practice Research Datalink. Eight thousand, one hundred twelve patients were included in the study: the 4056 patients on the database who had undergone bariatric surgery, and equal numbers of age, sex, and body mass index matched controls. The primary endpoint was the occurrence of VTEs; secondary endpoints were the occurrence of deep vein thrombosis alone, pulmonary embolism alone.

Results:
Patients were followed up for a median of 10.7 years. The bariatric surgery cohort had a significantly lower occurrence of the primary outcome [hazard ratio (HR) 0.601; 95% confidence interval (CI) 0.430–0.841, P = 0.003]; mainly driven by a reduction in deep vein thrombosis (HR 0.523; 95% CI 0.349–0.783, P = 0·002) and not in pulmonary embolism (HR 0.882; 95% CI 0.511–1.521, P = 0.651).

Conclusions:
The results of this nation-wide study set out to characterize the impact of bariatric surgery on long-term risk of thromboembolic events outline a significant reduction in thromboembolic events, driven by a reduction in deep vein thrombosis.
Identification of human tendon cell populations in healthy and diseased tissue using combined single cell transcriptomics and proteomics
Authors: Kendal AR , Layton T , Al-Mossawi H , Brown R , Loizou C , Rogers M , Sharp M , Dakin S , Appleton L , Carr A 
Published: December 2019

AbstractThe long-term morbidity of tendon disease in an increasingly active and ageing population represents a growing area of unmet clinical need. Tendon disorders commonly affect the lower limb, ranging from isolated tendon rupture to degenerative joint deformity. In the absence of valid animal models of chronic tendinopathy, traditional methods to isolate and identify crucial sub types involved in disease are limited by the heterogeneity of tendon cells, by their relative paucity in tissue and by the density of the surrounding collagen matrix. To overcome this, we have used next generation CITE-sequencing to combine surface proteomics with in-depth, unbiased gene expression analysis of single cells derived ex vivo from healthy and diseased tendon.For the first time we have been able to show that human tendon consists of at least eight sub-populations of cells. In addition to endothelial cells, Tc cells, and macrophages, there are five distinct tenocyte populations expressingCOL1Agenes. These consist of a population of resident cells expressing microfibril associated genes (FBN1, VCAN,DCN, EMILIN1,MFAP5), a group ofSCX+ cells co-expressing high levels of pro-inflammatory markers, a population ofAPOD+fibro-adipogenic progenitors (FAPs),TPPP3/PRG4+chondrogenic cells(COMP, CILP, PRG4)andITGA7+ Smooth Muscle-Mesenchymal Cells, recently described in mouse muscle but not, as yet, in human tendon. Surface proteomic analysis identified markers by which these sub-classes could be isolated and targeted in future.In comparison to healthy tendon, diseased tendon harboured a greater proportion ofSCX+tendon cells and these expressed high levels of pro-inflammatory markers includingCXCL1, CXCL6, CXCL8, PDPNand previously undescribedPTX3. We were also able to show that whereas disease associated genes such asCD248andPDPNwere expressed byCOL1+ tenocytes,IL33was restricted to endothelial cells of chronically diseased tendon.
Attractor dynamics gate cortical information flow during decision-making
Authors: Finkelstein Arseny , Fontolan Lorenzo , Economo Michael N. , Li Nuo , Romani Sandro , Svoboda Karel 
Published: December 2019

AbstractDecisions about future actions are held in memory until enacted, making them vulnerable to distractors. The neural mechanisms controlling decision robustness to distractors remain unknown. We trained mice to report optogenetic stimulation of somatosensory cortex, with a delay separating sensation and action. Distracting stimuli influenced behavior less when delivered later during delay – demonstrating temporal gating of sensory information flow. Gating occurred even though distractor-evoked activity percolated through the cortex without attenuation. Instead, choice-related dynamics in frontal cortex became progressively robust to distractors as time passed. Reverse-engineering of neural networks trained to reproduce frontal-cortex activity revealed that chosen actions were stabilized via attractor dynamics, which gated out distracting stimuli. Our results reveal a dynamic gating mechanism that operates by controlling the degree of commitment to a chosen course of action.One Sentence SummaryMechanisms controlling state-dependent communication between brain regions allow for robust action-selection.
Patterns of gene flow across multiple anthropogenic infrastructures: Insights from a multi-species approach
Authors: Remon Jonathan , Moulherat Sylvain , Cornuau Jérémie H. , Gendron Lucie , Richard Murielle , Baguette Michel , Prunier Jérôme G. 
Published: December 2019

1.ABSTRACTLarge-scale Transportation Infrastructures (LTIs) are among the main determinants of landscape fragmentation, with strong impacts on animal dispersal movements and metapopulation functioning. Although the detection of LTIs impacts is now facilitated by landscape genetic tools, studies are often conducted on a single species, although different species might react differently to the same obstacle. Multi-specific approaches are thus required to get a better overview of the impacts of human-induced fragmentation. We surveyed four species (a snake, an amphibian, a butterfly and a ground-beetle) in a landscape fragmented by six LTIs: a motorway, a railway, a country road, a gas pipeline, a power line and a secondary road network. We showed that half of the overall explained genetic variability across all species was due to LTIs. While the butterfly was seemingly not impacted by any LTI, the genetic structure of the three other species was mostly influenced by roads, motorway and railway. The power line did not affect any species and the gas pipeline only impacted gene flow in the ground-beetle through forest fragmentation, but other LTIs systematically affected at least two species. LTIs mostly acted as barriers but we showed that some LTIs could somehow promote gene flow, embankments probably providing favourable habitats for vertebrate species. Considering the high variability in species response to LTIs, we argue that drawing general conclusions on landscape connectivity from the study of a single species may lead to counterproductive mitigation measures and that multi-species approaches should be more systematically considered in conservation planning.