bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exosomal miR-451 from human umbilical cord mesenchymal stem cells attenuates burn-induced acute lung injury
Authors: Liu Ji-Song , Du Juan , Cheng Xiu , Zhang Xiang-Zhou , Li Yong , Chen Xu-Lin 
Published: December 2019

Background:
The aim of this study was to investigate the molecular mechanism of human umbilical cord mesenchymal stem cells (MSCs)-derived exosomes (hUCMSC-Exos) in regulating burn-induced acute lung injury (ALI).

Methods:
In this study, we initially isolated exosomes from hUCMSCs and identified them by transmission electron microscopy. The expression of the protein markers CD9 and CD63 in the exosomes was determined by western blot analysis. The expression of miR-451 in the hUCMSC-Exos was determined by qRT-PCR. The levels of TNF-α, IL-1β, and IL-6 in lung tissues and serum as well as the levels of malondialdehyde, myeloperoxidase, superoxide dismutase in lung tissues were detected by ELISA. Hematoxylin–eosin stain was used to observe the morphological changes of lung tissues after burn. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assays were performed to detect apoptosis in lung tissues after burn. The expression of proteins related to the Toll-like receptor 4 (TLR4)/NF-κB signaling pathway in lung tissues after burn was analyzed by western blotting.

Results:
Our results showed that hUCMSC-Exos successfully decreased TNF-α, IL-1β, and IL-6 levels in rats after burn, and this reduction was reversed when the miR-451 expression in the hUCMSC-Exo group was inhibited. HUCMSC-Exo-derived miR-451 improves ALI via the TLR4/NF-κB pathway.

Conclusion:
We demonstrated that exosomes derived from hUCMSCs mediate miR-451 to attenuate burn-induced ALI.
Perioperative Homeopathic Arnica and Bromelain
Authors: Knackstedt Rebecca , Gatherwright James 
Published: December 2019

Introduction
Arnica and bromelain, two of the most widely recommended homeopathic medications to improve perioperative outcomes, have yet to be widely adopted by allopathic practitioners. A significant barrier to utilization of herbal medications by allopathic doctors is that the preparations and dosing regimens are not widely known or understood. The goal of this review was to critically analyze studies that have examined the perioperative efficacy of arnica and bromelain with a focus on treatment regimen and outcomes.

Methods
A triple database search was conducted with the keywords “arnica,” “bromelain,” and “surgery.” References for each identified article were analyzed for additional articles. Articles were analyzed for methodology, outcomes, and conclusion. Articles were excluded if they did not involve human subjects, were published before 1990, and if they were not available in English. Level of evidence was determined based on methodology.

Results
A total of 29 articles met inclusion criteria, with 20 and 9 in the arnica and bromelain treatment groups, respectively. There was marked heterogeneity with regard to surgical procedure, dosing regimen, outcomes measured, and results. Arnica seems to have a mitigating effect on ecchymosis, most notably following rhinoplasty and facelifts/facial procedures. Bromelain is well supported across numerous studies in reducing trismus, pain, and swelling following molar extractions. However, there was no effect demonstrated when evaluating topical arnica following blepharoplasty procedures.

Discussion
A systematic review of the literature demonstrates the potential for arnica and bromelain to improve perioperative outcomes including edema, ecchymosis, and pain control. Future studies are required to determine safety and efficacy of dosing and interactions with other medications. We hope this article stimulates surgeons to consider using these interventions to improve perioperative outcomes in the context of well-done studies with an objective analysis of results.
An Analysis of Specialty-Specific Microsurgical Head and Neck Reconstruction
Authors: Kozak Geoffrey M. , Katzel Evan B. , Rose Jessica F. , Nathan Shelby L. , Wu Liza C. 
Published: December 2019

Introduction
Head and neck free flap (HNFF) reconstructions have historically utilized a multidisciplinary approach between otolaryngology head and neck surgery (OHNS) and plastic surgery (PS). However, there seems to be a trend toward both the extirpative and reconstructive portions being performed by OHNS. We aimed to elucidate the volume trend in HNFF reconstruction over the last decade.

Methods
Data were collected by 3 modalities: electronic medical record search of patients who underwent HNFF surgery at our institution (2013–2018), survey data from microsurgery fellowship programs (2007–2017), and National Surgical Quality Improvement Program (NSQIP) query of cases receiving designated HNFF Current Procedural Terminology codes (2011–2016). Data were analyzed with trends in HNFF reconstruction as our primary outcome.

Results
At our institution, HNFF reconstructions increased 4-fold (59–227). Percentage of cases by PS decreased from 18.6% to 6.0%, whereas that of OHNS increased 81.4% to 94.0% (P = 0.009). Survey data, completed by microsurgery fellowship program directors (23/81 [27.2%]), revealed the number of OHNS programs in 2007 performing 100 or more HNFF cases compared with PS was 40% (6/15) to 12.5% (1/8) (P = 0.172). By 2016, that number increased significantly for OHNS to 73.3% (11/15), whereas that of PS remained stagnant at 12.5% (1/8) (P = 0.005). According to NSQIP data, the percentage of cases performed by PS in 2011 was 52%, which was greater than OHNS's share of 43%. The other 5% was allotted to either orthopedic, oral and maxillofacial surgery, or general surgery. In 2013, those numbers reached a peak for PS at 55% and a nadir for OHNS at 36%. However, by 2016, the percentage of HNFF cases reversed. where 58% of cases were performed by OHNS and only 38% by PS. When comparing the 2011 data to the 2016 data, OHNS had a 134% increase, whereas PS had a 27% decrease (P = 0.003).

Conclusions
Head and neck free flap reconstruction has grown dramatically over the last 10 years. Plastic surgeons are performing fewer cases, whereas otolaryngology head and neck surgeons perform more as indicated by institutional, microsurgery fellowship program director survey, and NSQIP data.
Free Serratus Fascia Flap for Reconstruction of Soft Tissue Defects Involving the Distal Upper and Lower Extremity
Authors: Tuncer Serhan , Sezgin Billur , Sencan Ayse , Sari Alper 
Published: December 2019

Background
Free fascial flaps are widely used for the reconstruction of defects located on the distal extremities as they provide thin yet durable soft tissue coverage. The serratus anterior fascia flap stands out from other fascial flap alternatives as it has optimal anatomical properties that can provide ideal coverage in a wide range of reconstructive challenges. The purpose of this study was to present our experience with the serratus anterior fascia flap in a variety of complex soft tissue defects.

Methods
A retrospective review was conducted on patients who underwent reconstruction with the free serratus anterior fascia flap for complex soft tissue defects involving the distal extremities.

Results
Complex soft tissue defects of 13 patients were reconstructed using the free serratus fascia flap. No major postoperative complications such as flap loss, dehiscence, infection, or hematoma were encountered in any of the patients. All of the patients demonstrated durable and harmonious long-term flap coverage that facilitated movement without any signs of scar contractures and tendon adhesions at the site of reconstruction.

Conclusions
The serratus anterior fascia flap demonstrates versatility and stability for the closure of complex distal extremity defects. It creates thin yet durable coverage that facilitates underlying tendon gliding while providing harmony with the natural contours of these anatomic areas and has low donor site morbidity, making it a primary choice in the reconstruction complex soft tissue defects involving the hands and feet.
Rupture Rates Between 2-Strand and 4-Strand Flexor Tendon Repairs
Authors: Shaharan Shazrinizam , Bage Timothy , Ibrahim Nada , Diamantopoulos Antonios , Doswell Kirsty , Dheansa Baljit 
Published: December 2019

Abstract
The purpose of this study was to explore the difference in clinical outcome of 2-strand and 4-strand flexor tendon repairs in a single unit in adult population. A total of 109 complete divisions of a single flexor tendon were analyzed from 2016 to 2018 retrospectively. Thirty flexor tendons were repaired with 2-strand and 79 tendons were repaired with 4-strand technique. There was no significant difference in the complication rate including rupture, infection, and adhesions. These results support that 4-strand is not superior than 2-strand and that lower volume type of repair would be preferable.
A Study on Breast Reconstruction in a Developing Country
Authors: Kaviani Ahmad , Tabary Mohammadreza , Zand Sanaz , Araghi Farnaz , Nouraie Mehdi 
Published: December 2019

Background
Breast cancer, with an incidence of 33.2 per 100,000 in Iranian population, is considered as the most common cancer in Iranian women. Nowadays, with the increasing survival rates, breast reconstruction has been integrated into surgical techniques of breast cancer treatment. The aim of this study was to evaluate the current status of breast reconstruction in Iranian population.

Patients and Methods
This retrospective study was conducted in Imam Hospital between January 2008 and June 2018. All the patients underwent breast reconstruction surgery. The trend of reconstruction and complication rates were 2 major outcomes. Logistic regression model was used to predict complications. Student t test was used to compare means.

Results
Fifty-five patients underwent 60 autologous breast reconstruction surgeries and 152 patients underwent 193 prosthesis-based reconstruction surgeries. Most of cases were invasive ductal carcinoma ± ductal carcinoma in situ (126 cases, 68%). Among 253 surgeries in 207 patients, 98 cases (38.7%) were 2-stage implant, 91 (36.0%) were 1-stage implant, 3 (1.2%) were acellular dermal matrix + prosthesis, 31 (12.2%) were pedicled transverse rectus abdominis myocutaneous flap, 25 (9.8%) were latissimus dorsi flap ± prosthesis, and 4 (15.8%) were latissimus dorsi flap. Among prosthesis-based reconstructions, chemotherapy could predict the occurrence of complications (odds ratio, 2.87; 95% CI, 1.07–7.68), whereas none of these factors could predict the occurrence of complications in autologous reconstructions. The most prevalent complication was seroma formation (48.5% of all complications). Overall complication rates (including major and minor) were higher among autologous reconstructions compared with prosthesis-based reconstructions (45.8% and 21.1%, respectively, P < 0.001).

Conclusions
The trend of breast reconstruction is changing in Islamic Republic of Iran as a developing country. Implant-based reconstruction has surpassed autologous reconstructions in recent years. In terms of complications, we observed higher rates among autologous reconstructions.
Complications After Immediate 2-Stage Tissue Expander/Implant Breast Reconstruction
Authors: Park Jin-Woo , Jung Jae Hoon , Jeon Byung-Joon , Mun Goo-Hyun , Bang Sa Ik , Pyon Jai-Kyong 
Published: December 2019

Background
Complications after 2-stage tissue expander/implant breast reconstruction have been studied as outcomes of a single procedure. We separately evaluated complications after the second stage and assessed factors associated with the outcomes of the second stage of breast reconstruction.

Methods
Patients who underwent immediate 2-stage breast reconstruction between February 2010 and April 2017 were retrospectively reviewed. Patient demographics, surgical factors of the first stage of breast reconstruction, and complications and number of revision surgeries after the second stage were recorded. Factors associated with postoperative complications were analyzed, and a risk-scoring system was devised.

Results
We analyzed 619 patients who underwent 653 immediate 2-stage breast reconstructions. Multivariate analysis showed that complications were associated independently with smoking history, radiotherapy, and a final inflation volume of 450 mL or greater. Each factor contributed 1 point in the creation of a risk-scoring system. The overall complication rate was increased as the risk score increased (1.2%, 4.7%, and 16.0% for 0, 1, and 2 risk scores, respectively, P < 0.001). Revision operation rate was also significantly different across the 3 groups (0.2%, 1.6%, and 12.0% for 0, 1, and 2 risk scores, respectively, P < 0.001). The area under the receiver operating characteristic curve was 0.732 and 0.731 for the logistic regression model and risk-scoring system, respectively (P = 0.975).

Conclusions
In the second stage of immediate 2-stage tissue expander/implant breast reconstruction, the rate of complication and revision surgery can be predicted by a novel risk-scoring system. Greater attention and preventive measures for complications are needed for high-risk patients.
Primary Open Versus Closed Implantation Strategy for Totally Implantable Venous Access Ports
Authors: Hüttner Felix J. , Bruckner Tom , Hackbusch Matthes , Weitz Jürgen , Bork Ulrich , Kotschenreuther Peter , Heupel Oliver , Kümmel Sabine , Schlitt Hans J. , Mattulat Matthias , Pintér László , Seiler Christoph M. , Gutt Carsten N. , Nottberg Hubertus S. , Pohl Alexander , Ghanem Firas , Meyer Thomas , Imdahl Andreas , Neudecker Jens , Müller Verena A. , Gehrig Tobias , Reineke Mario , von Frankenberg Moritz , Schumacher Guido , Hennes Roland , Mihaljevic André L. , Rossion Inga , Klose Christina , Kieser Meinhard , Büchler Markus W. , Diener Markus K. , Knebel Phillip 
Published: December 2019

Objectives:
PORTAS-3 was designed to compare the frequency of pneumothorax or haemothorax in a primary open versus closed strategy for port implantation.

Background Data:
The implantation strategy for totally implantable venous access ports with the optimal benefit/risk ratio remains unclear.

Methods:
PORTAS-3 was a multicentre, randomized, controlled, parallel-group superiority trial. Adult patients with oncological disease scheduled for elective port implantation were randomized to a primary open or closed strategy. Primary endpoint was the rate of pneumothorax or haemothorax. Assuming a difference of 2.5% between the 2 groups, a sample size of 1154 patients was needed to prove superiority of the open group. A logistic regression model after the intention-to-treat principle was applied for analysis of the primary endpoint.

Results:
Between November 9, 2014 and September 5, 2016, 1205 patients were randomized. Of these, 1159 (open n = 583; closed n = 576) were finally analyzed. The rate of pneumothorax or haemothorax was significantly reduced with the open strategy [odds ratio 0.27, 95% confidence interval (CI) 0.09–0.88; P = 0.029]. Operation time was shorter for the closed strategy. Primary success rates, tolerability, morbidity, dose rate of radiation, and 30-day mortality did not differ significantly between the groups.

Conclusion:
A primary open strategy by cut-down of the cephalic vein, if necessary enhanced by a modified Seldinger technique, reduces the frequency of pneumothorax or haemothorax after central venous port implantation significantly compared with a closed strategy by primary puncture of the subclavian vein without routine sonographic guidance. Therefore, open surgical cut-down should be the reference standard for port implantation in comparable cohorts.

Trial Registration:
German Clinical Trials Register DRKS 00004900.
Inflammation and Cognitive Function in Overweight and Obese Chinese Individuals
Authors: Fan Rong , Zhao Lei , Tong Chao , Qian Xiao-meng , Xiao Rong , Ma Wei-wei 
Published: December 2019

Background:
The role(s) of inflammation in obesity-associated cognitive decline in overweight or obese populations is not completely understood.

Objective:
To investigate the profile of plasma inflammatory cytokines in overweight and obese Chinese individuals and to assess the relationship between inflammation and cognitive function.

Methods:
We evaluated the cognitive domains of 282 Chinese adults, aged 35 to 64 years, using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The participants were classified into three groups according to their body mass index. Inflammatory cytokines were determined by immune turbidimetric analysis and enzyme-linked immunosorbent assay. Data were analyzed using covariance and partial correlation analyses after adjusting for gender, age, education level, hypertension, and hyperlipemia.

Results:
The total MoCA scores of the overweight and obese groups were significantly lower than that of the control group. The obese group displayed a significantly higher level of tumor necrosis factor-α than the overweight and control groups and a significantly higher level of transforming growth factor-β than the control group. The overweight group displayed a significantly higher interleukin-4 level than the control and obese groups. After adjusting for confounding factors, however, we found no significant correlation between the level of plasma inflammatory cytokines and MMSE or MoCA total score.

Conclusions:
Compared to normal-weight Chinese participants, overweight and obese Chinese participants revealed significant differences in their inflammatory cytokines profile; however, the inflammatory cytokine levels did not correlate with the significantly lower cognitive scores observed in the overweight and obese groups.
Emotion Recognition in Patients With Parkinson Disease
Authors: Wu Dong-Dong , Li Shu-Hua , He Jing , Su Wen , Chen Hai-Bo 
Published: December 2019

Background:
Individuals with Parkinson disease (PD) display cognitive dysfunction. However, few studies have investigated how facial and musical emotion recognition are affected in individuals with PD.

Objective:
To explore the relationship between facial and musical emotion recognition and executive functions in Chinese individuals with PD.

Methods:
We showed 40 Chinese individuals with PD and 40 Chinese healthy controls 24 black-and-white portraits and 24 musical excerpts that were designed to express happiness, sadness, fear, and anger. Then, we used four tests to assess the participants’ executive functions, including the Trail Making Test (TMT), Clock Drawing Test (CDT), semantic Verbal Fluency Test (VFT), and Digit Span Test (DST).

Results:
The PD group showed significant impairment in recognizing anger from facial expressions, although their emotion recognition from musical excerpts was similar to that of the control group. Recognition of an angry face was significantly correlated to scores on the TMT and DST. Recognition of happy music was significantly correlated to the Hamilton Rating Scale for Depression score, whereas recognition of angry music was significantly correlated to musical knowledge background. Recognition of happy, sad, or angry music was significantly correlated to tests of executive function, whereas recognition of fearful music was not.

Conclusions:
The PD group showed impaired recognition of angry faces, which may be related to executive dysfunction. However, the PD group did not show any difficulties in recognizing emotions in music. This dissociation indicates that the mechanisms underlying the recognition of emotions in faces and music are partly independent.
Using a genetic risk score to estimate the earliest age of Alzheimer’s disease-related physiologic change in Body Mass Index
Authors: Brenowitz Willa D. , Zimmerman Scott C. , Filshtein Teresa J. , Yaffe Kristine , Walter Stefan , Hoffmann Thomas J. , Jorgenson Eric , Whitmer Rachel A. , Glymour M. Maria 
Published: December 2019

AbstractObjectivesWeight loss is common in the years before an Alzheimer’s disease (AD) diagnosis, likely due to changes in appetite and diet. The age at which this change in body mass index (BMI) emerges is unclear but may point to the earliest manifestations of AD, timing that may be important for identifying windows of intervention or risk reduction. We examined the association between AD genetic risk and cross-sectional BMI across adults in mid-to late-life as an innovative approach to determine the age at which BMI changes and may indicate preclinical AD.DesignObservational studySettingUK BiobankParticipants407,386 UK Biobank non-demented participants aged 39-70 with Caucasian genetic ancestry enrolled 2007-2010.Main Outcome MeasuresBMI (kg/m2) was constructed from height and weight measured during the initial visit. A genetic risk score for AD (AD-GRS) was calculated as a weighted sum of 23 genetic variants previously confirmed to be genome-wide significant predictors of AD (Z-scored). We evaluated whether the association of AD-GRS with BMI differed by age using linear regression with adjustment for sex and genetic ancestry, stratified by age grouping (40-60, 61+). We calculated the earliest age at which high AD-GRS predicted divergence in BMI compared to normal age-related BMI trends with linear and quadratic terms for age and interactions with AD-GRS.ResultsIn 39-49 year olds, AD-GRS was not significantly associated with lower BMI (0.00 kg/m2 per SD in AD-GRS; 95%CI: -0.03,0.03). In 50-59 year olds AD-GRS was associated with lower BMI (-0.03 kg/m2 per 1 SD in AD-GRS; 95%CI:-0.06,-0.01) and this association was stronger in 60-70 year olds (-0.09 kg/m2 per 1 SD in AD-GRS; 95%CI:-0.12,-0.07). Model-based BMI age-curves for people with high versus low AD-GRS scores began to diverge after age 47.InterpretationGenetic factors that increase AD risk begin to predict lower BMI in adults by age 50, with greater effect later in older ages. Weight loss may manifest as an early pathophysiologic change associated with AD.
Left frontal white matter links to rhythmic processing relevant to speech production
Authors: Bruffaerts Rose , Schaeverbeke Jolien , Grube Manon , Gabel Silvy , De Weer An-Sofie , Dries Eva , Van Bouwel Karen , Griffiths Timothy D , Sunaert Stefan , Vandenberghe Rik 
Published: December 2019

AbstractRecent evidence suggests that a shared neurocomputational mechanism tracks the temporal structure of auditory input and speech output. We investigate the link between speech production and rhythmic abilities in 24 healthy controls and 23 patients with primary progressive aphasia, including 12 non-fluent variant patients (NFV) with apraxia of speech. Seventy-five percent of NFV cases displayed poorer rhythmic abilities. Rhythmic abilities and speech rhythm were significantly correlated in both controls and patients. Deformation-based morphometry and diffusion tensor imaging were used to identify white matter atrophy related to impaired rhythmic abilities in NFV. Left frontal white matter volume adjacent to the supplementary motor area (SMA) correlated with rhythmic abilities. Metrics of the left Aslant tract, which is typically damaged in NFV cases, also correlated with rhythmic abilities. Our results support the existence of a common temporal scaffolding mechanism structuring perceptual input and speech output. This mechanism partly explains abnormal speech in NFV.