bluuebunny/crossref_metadata_2025_split huggingface dataset:
Robotic Surgery: A Novel Approach for Breast Surgery and Reconstruction
Authors: Donnely Edward , Griffin Michelle F. , Butler Peter E. 
Published: January 2020

Background:
Breast cancer is the most prevalent cancer and second leading cause of cancer-related deaths in both the US and UK female population, a prominent cause of morbidity and cost to both health services. All surgically fit patients are offered breast reconstruction following the initial surgery, and this is traditionally an open approach: either implant-based or an autologous tissue flap. Both lead to scarring that is difficult to conceal. This paper aims to evaluate the novel minimally invasive technique of robotic-assisted surgery.

Methods:
A systematic review was conducted using Medline (OvidSP) and Embase (OvidSP) to evaluate the current application of robotic-assisted surgery in breast surgery and reconstruction.

Results:
Twenty-one articles were identified and discussed, composing of level 4 and 5 evidence comparing different surgeons' experiences, techniques, and outcomes. To date, the robotic system has been utilized to harvest the latissimus dorsi muscle for use as a tissue flap (total harvest time of 92 minutes), to perform nipple-sparing mastectomy with immediate breast reconstruction (total operation time 85 minutes) and lately to harvest a deep inferior epigastric perforator flap via an intraabdominal approach.

Conclusions:
Robotic-assisted surgery can successfully and reproducibly perform a nipple-sparing mastectomy with breast reconstruction. It can minimize the size of scarring and is superior to the laparoscopic technique, with improved 3-dimensional visualization, dexterity, and range of motion able to guide around the curvature of the breast. The main limiting factors are the lack of the US Food and Drug Administration approval, cost of the robot, and specialized skills required.
Facilitators and barriers to the Lean Enterprise Transformation program at the Veterans Health Administration
Authors: Azevedo Kathryn J. , Gray Caroline P. , Gale Randall C. , Urech Tracy H. , Ramirez Jeremy C. , Wong Emily P. , Lerner Barbara , Charns Martin P. , Vashi Anita A. 
Published: January 2020

Background
The Veterans Health Administration piloted a nationwide Lean Enterprise Transformation program to optimize delivery of services to patients for high value care.

Purpose
Barriers and facilitators to Lean implementation were evaluated.

Methods
Guided by the Lean Enterprise Transformation evaluation model, 268 interviews were conducted, with stakeholders across 10 Veterans Health Administration medical centers. Interview transcripts were analyzed using thematic analysis techniques.

Results
Supporting the utility of the model, facilitators and barriers to Lean implementation were found in each of the Lean Enterprise Transformation evaluation model domains: (a) impetus to transform, (b) leadership commitment to quality, (c) improvement initiatives, (d) alignment across the organization, (e) integration across internal boundaries, (f) communication, (g) capability development, (h) informed decision making, (i) patient engagement, and (j) organization culture. In addition, three emergent themes were identified: staff engagement, sufficient staffing, and use of Lean experts (senseis).

Conclusions
Effective implementation required staff engagement, strategic planning, proper scoping and pacing, deliberate coaching, and accountability structures. Visible, stable leadership drove Lean when leaders articulated a clear impetus to change, aligned goals within the facility, and supported middle management. Reliable data and metrics provided support for and evidence of successful change. Strategic early planning with continual reassessment translated into focused and sustained Lean implementation.

Practice Implications
Prominent best practices identified include (a) reward participants by broadcasting Lean successes; (b) provide time and resources for participation in Lean activities; (c) avoid overscoping projects; (d) select metrics that closely align with improvement processes; and (e) invest in coaches, informal champions, process improvement staff, and senior leadership to promote staff engagement and minimize turnover.
Celebrating 20 Years of IGHV Mutation Analysis in CLL
Authors: Chiorazzi Nicholas , Stevenson Freda K. 
Published: January 2020

AbstractThe division of CLL into 2 broad subsets with highly significant differences in clinical behavior was reported in 2 landmark papers in Blood in 1999.1,2 The simple analysis of the mutational status of the IGV regions provided both a prognostic indicator and an insight into the cellular origins. Derivation from B cells with very low or no IGV mutations generally leads to a more aggressive disease course than derivation from B cells with higher levels. This finding focused attention on surface Ig (sIg), the major B‐cell receptor, and revealed dynamic antigen engagement in vivo as a tumor driver. It has also led to new drugs aimed at components of the intracellular activation cascades. After 20 years, the 2 senior authors of those papers have looked at the history of the observations and at the increasing understanding of the role of sIg in CLL that have emanated from them. As in the past, studies of CLL have provided a link between biology and the clinic, enabling more precise targeting which attacks critical pathways but minimizes side effects.
TWO-YEAR FOLLOW-UP OF A RETINAL ASTROCYTIC HAMARTOMA IMAGED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Amoroso Francesca , Souied Eric H. , Bruyère Elsa , Astroz Polina , Mouallem-Beziere Alexandra , Pedinielli Alexandre , Miere Alexandra 
Published: January 2020

Purpose:
To report a case of retinal astrocytic hamartoma imaged by optical coherence tomography angiography (OCTA), followed for 2 years.

Methods:
Observational case report.

Results:
A 25-year-old woman was referred for an incidental retinal lesion in the left eye (LE). At baseline, the best-corrected visual acuity in the LE was 20/32, and fundus examination showed the presence of a round, pigmented lesion in juxtafoveal region, corresponding, on spectral domain OCT, to a hyperreflective lesion within nerve fiber layer. Optical coherence tomography angiography revealed the presence of a high-flow lesion in the superficial capillary plexus segmentation. The patient was followed up for 2 years: best-corrected visual acuity remained stable and multimodal imaging, including OCTA, confirmed the benign and stable nature of the lesion. At baseline, the total lesion area on OCTA (superficial capillary plexus) was 0.181 mm2, whereas vascular density was 52.080%; the total area was 0.204 mm2, and vascular density was 53.740% at 2-year follow-up.

Conclusion:
Optical coherence tomography angiography is helpful not only for the diagnosis and follow-up of such rare tumors, but also it gives insights as to how these tumors develop and how they affect surrounding structures.
American Medical Society for Sports Medicine Position Statement: Mental Health Issues and Psychological Factors in Athletes: Detection, Management, Effect on Performance, and Prevention—Executive Summary
Authors: Chang Cindy J. , Putukian Margot , Aerni Giselle , Diamond Alex B. , Hong Eugene S. , Ingram Yvette M. , Reardon Claudia L. , Wolanin Andrew T. 
Published: January 2020

Abstract:
The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practice document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment, and prevention of mental health (MH) issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers, and MH providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact MH, including sexuality and gender issues, hazing, bullying, sexual misconduct, and transition from sport. Specific MH disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance, and prevention. This document uses the Strength of Recommendation Taxonomy to grade level of evidence.
Mental Health Issues and Psychological Factors in Athletes: Detection, Management, Effect on Performance, and Prevention: American Medical Society for Sports Medicine Position Statement
Authors: Chang Cindy J. , Putukian Margot , Aerni Giselle , Diamond Alex B. , Hong Eugene S. , Ingram Yvette M. , Reardon Claudia L. , Wolanin Andrew T. 
Published: January 2020

Abstract:
The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practices document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment, and prevention of mental health issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers, and mental health providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact mental health, including sexuality and gender issues, hazing, bullying, sexual misconduct, and transition from sport. Specific mental health disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders, and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance, and prevention. This document uses the Strength of Recommendation Taxonomy (SORT) to grade level of evidence.
Assessment and treatment of the withdrawal syndrome in paediatric intensive care units
Authors: Ávila-Alzate Jennihe Alejandra , Gómez-Salgado Juan , Romero-Martín Macarena , Martínez-Isasi Santiago , Navarro-Abal Yolanda , Fernández-García Daniel 
Published: January 2020

Abstract

Background:
Sedoanalgesia secondary iatrogenic withdrawal syndrome (IWS) in paediatric intensive units is frequent and its assessment is complex. Therapies are heterogeneous, and there is currently no gold standard method for diagnosis. In addition, the assessment scales validated in children are scarce. This paper aims to identify and describe both the paediatric diagnostic and assessment tools for the IWS and the treatments for the IWS in critically ill paediatric patients.

Methods:
A systematic review was conducted according to the PRISMA guidelines. This review included descriptive and observational studies published since 2000 that analyzed paediatric scales for the evaluation of the iatrogenic withdrawal syndrome and its treatments. The eligibility criteria included neonates, newborns, infants, pre-schoolers, and adolescents, up to age 18, who were admitted to the paediatric intensive care units with continuous infusion of hypnotics and/or opioid analgesics, and who presented signs or symptoms of deprivation related to withdrawal and prolonged infusion of sedoanalgesia.

Results:
Three assessment scales were identified: Withdrawal Assessment Tool-1, Sophia Observation Withdrawal Symptoms, and Opioid and Benzodiazepine Withdrawal Score. Dexmedetomidine, methadone and clonidine were revealed as options for the treatment and prevention of the iatrogenic withdrawal syndrome. Finally, the use of phenobarbital suppressed symptoms of deprivation that are resistant to other drugs.

Conclusions:
The reviewed scales facilitate the assessment of the iatrogenic withdrawal syndrome and have a high diagnostic quality. However, its clinical use is very rare. The treatments identified in this review prevent and effectively treat this syndrome. The use of validated iatrogenic withdrawal syndrome assessment scales in paediatrics clinical practice facilitates assessment, have a high diagnostic quality, and should be encouraged, also ensuring nurses’ training in their usage.
Safety and efficacy of outpatient follow-up for referred patients with undiagnosed fever
Authors: Harada Yukinori , Masuda Mikako , Hirosawa Takanobu , Takase Hiroshi , Morinaga Kohei , Nin Michihiro , Shimizu Taro 
Published: January 2020

Abstract
Fever is one of the most common symptoms seen in patients. The work-up and follow-up of fever in an outpatient-only setting is a reasonable option for stable patients referred for unexplained fever; however, the safety and efficacy of outpatient follow-up for those patients remain unclear. We conducted this study to evaluate the safety and efficacy of outpatient follow-up for referred patients with unexplained fever.
This study was a retrospective cohort study. We included patients referred to the outpatient department of the diagnostic medicine of our university hospital for unexplained fever between October 2016 and September 2017. Exclusion criteria were recurrent fever or admission for fever evaluation prior to referral. Main outcomes of interest were the rate of admission without diagnosis, rate of remission of fever, and the total duration of fever in undiagnosed patients.
Among 84 patients included in this study, 17 (20%) were diagnosed during outpatient follow-up, 6 (7%) were admitted due to worsened condition, 5 (6%) were lost to follow-up, and 56 (67%) were followed up as outpatients without a diagnosis. Among the 56 undiagnosed patients, fever resolved in 53 during outpatient follow-up with or without treatment (95%). The total duration of resolved fever in undiagnosed patients was within 8 weeks.
Follow-up of patients referred for unexplained fever in an outpatient setting is safe and effective.
Probiotics, prebiotics, and synbiotics for the treatment of dementia
Authors: Li Wenyuan , Guo Jing , Shen Yifeng , Huang Ling , Leng Bingshuang , Fan Dong , Shui Liyao , Chen Chongli 
Published: January 2020

Abstract

Background:
The number of dementia patients in the world is large, and the number of dementia patients will continue to rise in the future, which will bring a heavy social and economic burden. No interventions have been found to cure dementia. Medication can delay the progression of the disease and impose an economic burden. Some non-drug therapies often require the care of the caregiver. Probiotics, prebiotics, and synbiotics may intervene in dementia through microbiota-gut-brain axis (MGBA). However, their effectiveness and safety are still obscure and deserve further investigation. The purpose of this study is to assess the effect and safety of probiotics, prebiotics, and synbiotics in treating dementia.

Methods:
We will summarize and meta-analyze randomized controlled trials (RCTs) of probiotics, prebiotics, and synbiotics for the treatment of dementia. RCTs comparing probiotics, prebiotics, and synbiotics with blank control, placebo or conventional therapies will be included. RCTs comparing probiotics, prebiotics, and synbiotics plus conventional therapies with conventional therapies alone will also be included. The following electronic databases will be searched: PubMed, Cochrane Library, EMBASE, CNKI, CBM, VIP, and WAN FANG DATA. The methodological quality of RCTs will be assessed using the Cochrane risk assessment tool. All trials included will be analyzed according to the criteria of the Cochrane Handbook. Review Manager 5.3, R-3.5.1 software will be used for publication bias analysis. Grading of Recommendations Assessment, Development and Evaluation (GRADE) pro-GDT web solution will be used for evidence evaluation.

Results:
This review will evaluate the effects of probiotics, prebiotics, and synbiotics on cognitive function, behavioral and psychological symptoms of dementia, quality of life (QOL), functional performance in activities of daily living, and compliance with the intervention and safety in patients with dementia.

Conclusions:
This review will provide clear evidence to assess the effectiveness and safety of probiotics, prebiotics, and synbiotics for dementia.

OSF registration number: DOI 10.17605/OSF.IO/2Q3AK.
A meta-analysis and systematic review of Leigh syndrome: clinical manifestations, respiratory chain enzyme complex deficiency, and gene mutations
Authors: Chang Xueli , Wu Yaxin , Zhou Jie , Meng Huaxing , Zhang Wei , Guo Junhong 
Published: January 2020

Abstract
Leigh syndrome (also called Leigh disease or subacute necrotizing encephalomyelopathy) is a rare inherited neurometabolic disorder, which affects the central nervous system. This meta-study systematically analyzed clinical manifestations, respiratory chain enzyme complex deficiency, and gene mutations.
Literature was searched for publications in MEDLINE, EMBASE, and the China National Knowledge Infrastructure database for meta-analyses of the incidence of clinical symptoms, laboratory assessments, imaging data, muscle biopsy histochemical staining, activity of the mitochondrial respiratory chain enzyme complex, gene mutations, and the association between age at disease onset and type of gene mutations.
This study included 5 studies with 385 Leigh syndrome patients. The most common clinical features of Leigh syndrome included elevated blood and/or cerebrospinal fluid (CSF) levels of lactate (72%), developmental retardation (57%), hypotonia (42%), followed by respiratory dysfunction (34%), epileptic seizures (33%), poor feeding (29%), and weakness (27%). Approximately 80% of the patients had deficiencies of the respiratory chain enzyme complex or isolated complex I deficiency (35%), 32% had mitochondrial DNA (mtDNA) mutations, and 38% had nuclear DNA (nDNA) mutations. Patients with nDNA mutations were younger than those with mtDNA mutations (8.82 ± 13.88 vs 26.20 ± 41.11 years, P = .007).
The data from the current meta-analysis demonstrated a variety of clinical and molecular manifestations of Leigh syndrome, with upregulated lactate levels in the blood or CSF being the most common feature. Diagnosis of Leigh syndrome could be confirmed using combined enzymatic and genetic analyses.
Low EIF2B5 expression predicts poor prognosis in ovarian cancer
Authors: Hou Lin , Jiao Yan , Li Yanqing , Luo Zhangping , Zhang Xueying , Pan Guoqiang , Zhao Yuechen , Yang Zhaoying , He Miao 
Published: January 2020

Abstract
Ovarian cancer has the highest mortality among gynecological cancers. Although ovarian cancer usually responds well to chemotherapy, most patients still have a poor prognosis. EIF2B5 is a crucial molecule in posttranscriptional modifications involved in tumor progression, and here we investigated the prognostic role of EIF2B5 in ovarian cancer. We examined the differential expression of EIF2B5 mRNA in ovarian cancer by exploring The Cancer Genome Atlas (TCGA) database. The chi square test was used to identify a clinical correlation. Survival analysis and Cox regression model were performed to determine the association between EIF2B5 expression and overall survival (OS) in ovarian cancer patients. As a result, Low EIF2B5 expression was found in ovarian cancer tissues and correlated with survival status. Survival analysis showed that ovarian cancer patients with low EIF2B5 expression had a short OS. Moreover, Cox regression analysis indicated that low EIF2B5 expression was an independent risk factor for a poor prognosis in ovarian cancer. Additionally, according to gene set enrichment analysis, mesenchymal transition, angiogenesis, coagulation, and bile acid metabolism were differentially enriched in ovarian cancer with high EIF2B5 expression. In conclusion, Low EIF2B5 expression is an independent risk factor for a poor prognosis in ovarian cancer patients.
Primary radical hysterectomy vs chemoradiation for IB2-IIA cervical cancer
Authors: Yan Ruo-nan , Zeng Zhen , Liu Fang , Zeng Yuan-yuan , He Tao , Xiang Zhong-zheng , Zhang Bai-lu , Gong Han-lin , Liu Lei 
Published: January 2020

Abstract

Background:
To compare the clinical outcomes of radical hysterectomy (RH) with chemoradiotherapy (CRT) in women with stage IB2-IIA cervical cancer.

Methods:
Based on articles published up to December 2017, a literature search of PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and Chinese National Knowledge Infrastructure (CNKI) databases was conducted to identify eligible studies. Overall survival (OS), progression-free survival (PFS) with hazard ratios (HRs), and toxicities with odds ratios (ORs) were analyzed.

Results:
In total, 7 studies comprising 687 patients were identified for this meta-analysis. RH showed a significant trend toward improved survival outcomes compared with those of CRT, regardless of OS (HR = 0.49, 95% confidence interval [CI] 0.36–0.67, P < .001); or PFS (1.61, 95% CI 1.15–2.26, P = .005) for IB2-IIA cervical cancer. Subgroup analysis revealed that stage IB2 cervical cancer patients obtained better OS (HR = 0.36, 95% CI 0.23–0.56, P < .001; heterogeneity: P = .32, I
2 = 13%). However, a higher incidence of grade 3/4 genitourinary abnormalities was evident with RH (OR = 2.3, 95% CI 1.42–3.87, P = .021).

Conclusion:
Our study suggested that RH had distinct advantages over CRT for carcinoma of the uterine cervix with FIGO stage IB2-IIA, especially for IB2 cervical cancer.
Atypical myeloproliferative neoplasm with concurrent BCR-ABL1 fusion and CALR mutation
Authors: Liu Chunshui , Hu Ruiping , Du Zhonghua , Abecasis Manuel , Wang Cong 
Published: January 2020

Abstract

Rationale:
Concurrent calreticulin (CALR) mutation and BCR-ABL1 fusion are extremely rare in chronic myelogenous leukemia; to date, only 12 cases have been reported.

Patient concerns:
A 57-year-old male who had an 11-year history of essential thrombocytosis presented to our hospital with leukocytosis and marked splenomegaly for 3 months.

Diagnoses:
Chronic myelogenous leukemia with myeloid fibrosis arising on the background of essential thrombocytosis harboring both BCR-ABL1 fusion and type-1 like CALR mutation.

Interventions:
Imatinib was started at 300 mg daily and increased to 400 mg daily after 3 months; interferon was added after 12 months.

Outcomes:
Partial cytogenetic response was achieved after 3 months of imatinib therapy and complete cytogenetic response was achieved after 1 year of treatment. However, CALR mutation was still present with a stable mutational allele burden.

Lessons:
In this case report and review of additional 12 cases with simultaneous presence of CALR-mutation and BCR-ABL1 fusion, we highlighted the importance of integrating clinical, morphological, and molecular genetic data for classifying atypical myeloid neoplasms.