bluuebunny/crossref_metadata_2025_split huggingface dataset:
Wrist Joint Skeletal Changes in Children With Transfusion-dependent Thalassemia
Authors: Dhawan Pawan , Kanojia Rajesh. K. , Chandra Jagdish , Kumar Ajay , Anand Rama , Gupta Sumit 
Published: February 2020

Background:
Arthropathies and bone deformities are well known to occur in patients with thalassemia major and have been attributed to the disease or to its therapy. Before the advent of chelation therapy, these children developed widened diploic space and “hair-on-end” pattern in skull, “cobweb” pattern in the pelvis, and the lack of the normal concave outline in the long bones because of extensive marrow proliferation. After the introduction of iron-chelation therapy, these patients were noted to develop metaphyseal abnormalities and vertebral changes resembling spondylo-metaphyseal dysplasia. Only one study has shown some association of deferiprone (chelating agent) use with distal ulnar changes in these children. Our study was done to describe the skeletal changes and deformities in wrist joints of children with transfusion-dependent thalassemia and correlate them with age, mean pretransfusion hemoglobin level, mean serum ferritin level, and type and duration of chelation therapy in these children.

Methods:
A total of 60 children with transfusion-dependent thalassemia from the thalassemia daycare center were examined. These children were divided into 3 groups on the basis of their age (group A: 2 to 6 y, group B: 6 to 10 y, and group C: 10 to 14 y). Detailed history, including treatment history, number of blood transfusions received over the last 1 year, clinical examination, and radiologic assessment of both forearm with wrists were done.

Results:
The clinical and radiologic differences in radial and ulnar lengths increased significantly with the increasing age of these patients, the ulna being short. There was some correlation between increasing negative ulnar variance and distal radial articular angle with deferiprone consumption.

Conclusion:
Chelation therapy, particularly with deferiprone, may cause distal ulnar growth arrest causing ulnar shortening and progressive radial bowing in these children.

Level of Evidence:
Level IV—case series.
Preoperative Mental Health Component Scoring Is Related to Patient Reported Outcomes Following Lumbar Fusion
Authors: Stull Justin D. , Divi Srikanth N. , Goyal Dhruv K.C. , Bowles Daniel R. , Reyes Ariana A. , Bechay Joseph , Sonnier John Hayden , Nachwalter Ryan N. , Zarowin Joseph J. , Galetta Matthew S. , Kaye Ian David , Woods Barrett I. , Kurd Mark F. , Radcliff Kris E. , Rihn Jeffrey A. , Anderson David Greg , Hilibrand Alan S. , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory D. 
Published: February 2020

Study Design.
Retrospective cohort review.

Objective.
The objective of this study was to identify depression using the Mental Component Score (MCS-12) of the Short Form-12 (SF-12) survey and to correlate with patient outcomes.

Summary of Background Data.
The impact of preexisting depressive symptoms on health-care related quality of life (HRQOL) outcomes following lumbar spine fusion is not well understood.

Methods.
Patients undergoing lumbar fusion between one to three levels at a single center, academic hospital were retrospectively identified. Patients under the age of 18 years and those undergoing surgery for infection, trauma, tumor, or revision, and less than 1-year follow-up were excluded. Patients with depressive symptoms were identified using an existing clinical diagnosis or a score of MCS-12 less than or equal to 45.6 on the preoperative SF-12 survey. Absolute HRQOL scores, the recovery ratio (RR) and the percent of patients achieving minimum clinically important difference (MCID) between groups were compared, and a multiple linear regression analysis was performed.

Results.
A total of 391 patients were included in the total cohort, with 123 (31.5%) patients reporting symptoms of depression based on MCS-12 and 268 (68.5%) without these symptoms. The low MCS-12 group was found to have significantly worse preoperative Oswestry disability index (ODI), visual analogue scale back pain (VAS Back) and visual analogue scale leg pain (VAS Leg) scores, and postoperative SF-12 physical component score (PCS-12), ODI, VAS Back, and VAS Leg pain scores (P < 0.05) than the non-depressed group. Finally, multiple linear regression analysis revealed preoperative depression to be a significant predictor of worse outcomes after lumbar fusion.

Conclusion.
Patients with depressive symptoms, identified with an MCS-12 cutoff below 45.6, were found to have significantly greater disability in a variety of HRQOL domains at baseline and postoperative measurement, and demonstrated less improvement in all outcome domains included in the analysis compared with patients without depression. However, while the improvement was less, even the low MCS-12 cohort demonstrated statistically significant improvement in all HRQOL outcome measures after surgery.

Level of Evidence: 3
First-Line Treatment With Atezolizumab Plus Nab-Paclitaxel for Advanced Triple-Negative Breast Cancer
Authors: Weng Xiuhua , Huang Xiaoting , Li Hongchao , Lin Shen , Rao Xin , Guo Xianzhong , Huang Pinfang 
Published: February 2020

Objective:
The authors conducted a cost-effectiveness analysis incorporating recent phase III clinical trial (IMpassion130) data to evaluate the cost-effectiveness of atezolizumab in combination with nab-paclitaxel (AnP) against nab-paclitaxel alone as the first-line treatment for advanced triple-negative breast cancer in developed and developing countries.

Materials and Methods:
A decision-analytic Markov model was developed using IMpassion130 data to evaluate the cost-effectiveness of AnP over a lifetime from the US health care payer and Chinese health care system perspective. Model inputs were derived from IMpassion130 and published literature. The primary outcomes of the model were quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). Uncertainty was addressed using univariate and probabilistic sensitivity analyses.

Results:
For the intention-to-treat (ITT) population, the projected mean outcome was better with AnP (1.41 QALYs) than with nab-paclitaxel alone (0.99 QALYs). Similar results were obtained for the programmed death ligand 1 (PD-L1)-positive population, with the obtained mean outcomes of 1.66 and 0.88 QALYs, respectively. For the Unites States, the ICER values comparing AnP with nab-paclitaxel were US$331,996.89 and US$229,359.88 per QALY gained for the ITT and PD-L1-positive populations, respectively. For China, the ICER values were US$106,339.26 and US$72,971.88 per QALY gained for the ITT and PD-L1-positive populations, respectively. The univariate sensitivity analysis indicated that the price of atezolizumab was the most influential factor in our study. AnP had 0% cost-effectiveness at the willingness-to-pay thresholds of US$150,000/QALY in the United States and US$29,383/QALY in China.

Conclusion:
AnP is not a cost-effective choice as the first-line treatment for advanced triple-negative breast cancer in the United States and China.
Determining Optimal Follow-up for Patients With Anal Cancer Following Chemoradiation
Authors: Frazer Marissa L. , Yang George , Felder Seth , McDonald Jordan , Sanchez Julian , Dessureault Sophie , Imanirad Iman , Carballido Estrella , Kim Richard D. , Hoffe Sarah E. , Frakes Jessica M. 
Published: February 2020

Background:
US health care is increasingly defined by over expenditure and inefficiency. Optimizing patient follow-up is critical, especially in cancers treated with high control rates. To optimize patient care, this study assessed time to disease recurrence or toxicity in patients with anal carcinoma.

Materials and Methods:
In total, 140 patients with biopsy-proven, nonmetastatic anal carcinoma, treated with chemoradiation utilizing intensity-modulated radiation therapy, were identified from our institutional database. This retrospective study evaluated local recurrence (LR), distant metastasis (DM), overall survival (OS), and late ≥grade 3 toxicity (LG3T). Patients were followed posttreatment every 3 months for 2 years, every 6 months in years 3 to 5, then yearly thereafter per NCCN recommendations.

Results:
The median age and follow-up was 58 years and 27 months, respectively. Patients were categorized into high (n=61; 44%) and low (n=77; 55%) risk groups based on stage. The 2-year LC, DMFS, and OS were 93%, 94%, and 89% and 5-year LC, DMFS, OS were 92%, 87%, and 85%, respectively. Overall, there were 29 events (9 LR, 11 DM, and 9 LG3T), with 62% of events occurring within year 1 and 79% within 2 years. Stratified by event type, at 2 years 89% of LR, 64% of DM, and 89% LG3T were identified. At the remaining follow-up points, the event incidence rate was 1.3%.

Conclusion:
With the majority of recurrences/toxicities occurring within the first 2 years, a reduction in follow-up during years 3 to 5 may provide adequate surveillance. Revisions of the current recommendations could maximize resources while improving patient quality of life.
Treatment Timing in Small Cell Lung Cancer, a National Cancer Database Analysis
Authors: Bhandari Shruti , Kumar Rohit , Pham Danh , Gaskins Jeremy , Kloecker Goetz 
Published: February 2020

Objectives:
Small cell lung cancer (SCLC) is an aggressive disease treated as soon as possible given its rapid doubling time. Evidence for the appropriate time to chemotherapy initiation (TCI) for SCLC is lacking. This study evaluated TCI in SCLC on a national level.

Materials and Methods:
The National Cancer Database identified 64,491 SCLC patients treated with chemotherapy from 2010 to 2014. Factors associated with TCI were identified with multiple linear regression analyses. TCI was categorized into 4 groups using cutoff points of 7, 14, and 28 days. Using these categories, median overall survival and log-rank test was used for univariate analysis of the survival outcome and the Cox model was used for multivariate analysis.

Results:
Median TCI was 18 days with 21% treated ≤7 days, 21% in 8 to 14 days, 30% 15 to 28 days, and 28% >28 days from diagnosis. Younger age, white race, no insurance, more comorbidities, and higher stage were associated with shorter TCI. Median overall survival for TCI within 7 days was 8.2 months, 8 to 14 days was 9.2 months, 15 to 28 days was 10.3 months, and > 28 days was 10.8 months (P<0.001). In the multivariate analysis, increased TCI was associated with improved survival across all stages. Among stage IV patients, compared with TCI≤7 days, the hazard ratio (HR) is 0.92 (P<0.001) for 8 to 14 days, HR 0.82 (P<0.001) for 15 to 28 days, and HR 0.77 (P<0.001) for >28 days of TCI. Results were similar for stage III and for stages I+II.

Conclusions:
Our results show worse survival with shorter TCI. This provides evidence to inform a discussion regarding appropriate treatment timing and individualizing treatment.
A New Hydrocellular Wound Dressing Used After Dermatologic Surgery: Dermatologic Surgeons' and Patients' Perceptions
Authors: Orlandini Vincent , Peyrot Itzia , Magis Quentin , Lebas Damien , Tranchant Philippe , Bailly Jean-Yves , Wiart Thierry , Amici Jean-Michel 
Published: February 2020

BACKGROUND
Optimum postsurgical healing requires appropriate dressing use.

OBJECTIVE
This study assessed effectiveness and tolerance of a novel, hydrocellular dressing in dermatologic surgery using validated tools, describing its use in clinical practice, and comparing surgeons' and patients' perceptions of scar evolution.

METHODS
This study examined direct suture closures of surgical excisions of small- to medium-sized skin lesions on the extremities or trunk. Dressings were changed 3 times/week. The Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scales (POSAS) were used to assess outcomes. Data were collected at Day 0 (D0, FLC application), Day 15 to 21 (D15–21, suture removal), and Day 45 (D45) postprocedure by the surgeon and the patient.

RESULTS
There were 128 patients (mean age: 55.1 years, 56.1% women). Mean length and width of the excisions were 3.5 × 1.65 cm and the most common FLC applied was 8 × 8 cm (67.7%). Most scars had normal pigmentation, pliability, and height at D15 to 21 and D45, as reported by patients and surgeons using VSS. Patient scores on visual analog scale (VAS) were high (>8/10) and global satisfaction measured by POSAS was generally high (>7/10 at D15–21; >8/10 at D45).

CONCLUSION
These dressings were effective in managing surgical excisions, as assessed by VSS, VAS, and POSAS. Further controlled studies investigating various dressings in wound repair are needed.
Estrogen Plus Progestin Hormone Therapy and Ovarian Cancer
Authors: Lee Alice W. , Wu Anna H. , Wiensch Ashley , Mukherjee Bhramar , Terry Kathryn L. , Harris Holly R. , Carney Michael E. , Jensen Allan , Cramer Daniel W. , Berchuck Andrew , Doherty Jennifer Anne , Modugno Francesmary , Goodman Marc T. , Alimujiang Aliya , Rossing Mary Anne , Cushing-Haugen Kara L. , Bandera Elisa V. , Thompson Pamela J. , Kjaer Susanne K. , Hogdall Estrid , Webb Penelope M. , Huntsman David G. , Moysich Kirstin B. , Lurie Galina , Ness Roberta B. , Stram Daniel O. , Roman Lynda , Pike Malcolm C. , Pearce Celeste Leigh ,   for the Ovarian Cancer Association Consortium
Published: February 2020

Background:
Menopausal estrogen-alone therapy is a risk factor for endometrial and ovarian cancers. When a progestin is included with the estrogen daily (continuous estrogen–progestin combined therapy), there is no increased risk of endometrial cancer. However, the effect of continuous estrogen–progestin combined therapy on risk of ovarian cancer is less clear.

Methods:
We pooled primary data from five population-based case–control studies in the Ovarian Cancer Association Consortium, including 1509 postmenopausal ovarian cancer cases and 2295 postmenopausal controls. Information on previous menopausal hormonal therapy use, as well as ovarian cancer risk factors, was collected using in-person interviews. Logistic regression was used to assess the association between use of continuous estrogen–progestin combined therapy and risk of ovarian cancer by duration and recency of use and disease histotype.

Results:
Ever postmenopausal use of continuous estrogen–progestin combined therapy was not associated with increased risk of ovarian cancer overall (OR = 0.85, 95% CI = 0.72, 1.0). A decreased risk was observed for mucinous ovarian cancer (OR = 0.40, 95% CI = 0.18, 0.91). The other main ovarian cancer histotypes did not show an association (endometrioid: OR = 0.86, 95% CI = 0.57, 1.3, clear cell: OR = 0.68, 95% CI = 0.40, 1.2; serous: OR = 0.98, 95% CI = 0.80, 1.2).

Conclusions:
Given that estrogen-alone therapy has been shown to be associated with increased risk of ovarian cancer, these findings are consistent with the hypothesis that adding a progestin each day ameliorates the carcinogenic effects of estrogen on the cells of origin for all histotypes of ovarian cancer.
Fetal surgery and stem cell therapy for meningomyelocele
Authors: Hii Ling-Yien , Sung Chen-Ai , Shaw Steven W. 
Published: February 2020

Purpose of review
To review the advance of maternal--fetal surgery, the research of stem cell transplantation and tissue engineering in prenatal management of fetal meningomyelocele (fMMC).

Recent findings
Advance in the imaging study provides more accurate assessment of fMMC in utero. Prenatal maternal--fetal surgery in fMMC demonstrates favourable postnatal outcome. Minimally invasive fetal surgery minimizes uterine wall disruption. Endoscopic fetal surgery is performed via laparotomy-assisted or entirely percutaneous approach. The postnatal outcome for open and endoscopic fetal surgery shares no difference. Single layer closure during repair of fMMC is preferred to reduce postnatal surgical intervention. All maternal--fetal surgeries impose anesthetic and obstetric risk to pregnant woman. Ruptured of membrane and preterm delivery are common complications. Trans-amniotic stem cell therapy (TRASCET) showed potential tissue regeneration in animal models. Fetal tissue engineering with growth factors and dura substitutes with biosynthetic materials promote spinal cord regeneration. This will overcome the challenge of closure in large fMMC. Planning of the maternal--fetal surgery should adhere to ethical framework to minimize morbidity to both fetus and mother.

Summary
Combination of endoscopic fetal surgery with TRASCET or tissue engineering will be a new vision to achieve to improve the outcome of prenatal intervention in fMMC.
Classification of Mouth Corners in Asian Women
Authors: Jeong Tae Kwang , Kim Young Min , Min Kyung Hee 
Published: February 2020

Background:
There is increasing interest in mouth corner lift (MCL), as well as lip augmentation. Procedures for lip corner lifting to create smiling lips include botulinum toxin, injectable filler, and surgery. However, there is no proper system to classify mouth corners, thereby causing difficulties in patient counseling, treatment planning, and communicating with medical staff. We developed a new classification system to analyze the shape of mouth corners in Asian women.

Methods:
Lip shapes were classified as types I (arched upper lip) and II (flat upper lip), each of which was further classified as subtypes a (upturned mouth corner) and b (flat or downturned mouth corner). Atypical cases were classified as type III. The anterior–posterior view of facial photographs were taken of female patients aged 20–40 years who visited HB Plastic Surgery Clinic between January 2017 and December 2018. Patients who visited for surgery other than lip plastic surgery (group A) and those who visited for MCL (group B) were compared. Changes in mouth corner type across age were examined.

Results:
The most common type was IIb in group A and Ib in group B. IIa and IIb were more common in group A, whereas Ib was more common in group B, at a statistically significant level. With increasing age, the proportions of IIb and III tended to increase, and Ia and IIa tended to decrease.

Conclusion:
This relatively simple classification system for mouth corners might be helpful in patient counseling and communication with medical staff during plastic surgery.
Excision and Primary Anastomosis for Isolated, Short, Anastomotic Strictures in Transmen
Authors: Verla Wesley , Hoebeke Piet , Spinoit Anne-Françoise , Waterloos Marjan , Monstrey Stan , Lumen Nicolaas 
Published: February 2020

Background:
Since the recommendation to perform excision and primary anastomosis (EPA) for isolated, short, anastomotic strictures in transmen, there have been no further reports about its results. This study aims to provide an updated and extended report about the results of EPA for the aforementioned indication.

Methods:
Since 2002, data of all transmen in whom an EPA urethroplasty has been performed at Ghent University Hospital were collected in a database. Exclusion criteria for this analysis were age <18 years old, nonanastomotic strictures, and stricture length >3.0 cm. Postoperative complications were analyzed with descriptive statistics. Failure-free survival (FFS) was analyzed with Kaplan–Meier statistics. Need for further urethral manipulation was used as definition for failure. Potential predictors for failure were entered in a univariate Cox regression analysis.

Results:
In total, 44 patients were included with a median (interquartile range) follow-up of 40 months (7–125 months). Complications after EPA urethroplasty were present in 12 (27%) of the patients and mainly involved low-grade complications (11/44, 25%). After 1, 2, and 5 years, the estimated FFS rate (SD) was 61% (7.8), 61% (7.8), and 47% (9.1). Stricture length (hazard ratio [HR], 2.11; P = 0.03), prior urethroplasty (HR, 3.53; P = 0.008), and extravasation at first voiding cystourethrography (HR, 3.00; P = 0.047) were identified as predictors for failure.

Conclusions:
EPA for an isolated, short, anastomotic stricture in transmen is associated with low complication rates, but high failure rates. After 5 years, the estimated FFS rate is 47%. Stricture length, prior urethroplasty, and extravasation at first voiding cystourethrography are predictors for failure.
Challenges and Solutions for the Implementation of Shared Decision-making in Breast Reconstruction
Authors: Myckatyn Terence M. , Parikh Rajiv P. , Lee Clara , Politi Mary C. 
Published: February 2020

Background:
Patient-centered care is a hallmark of quality in healthcare. It is defined as care that is respectful of, and responsive to, individual patient preferences, needs, and values, while ensuring patients are informed and engaged in the treatment decision-making process.

Methods:
We reviewed the literature and drew upon our own experiences to study the implementation of tools intended to facilitate shared decision-making in breast reconstruction.

Results:
For women with breast cancer, decision-making about breast reconstruction is often a challenging and perplexing process. The variety of choices available regarding timing and type of reconstruction and the unique individual patient and clinical treatment variables to consider can further complicate decisions. Accordingly, strategies to facilitate the decision-making process and enable patients and clinicians to make high-quality decisions about breast reconstruction are an essential component of comprehensive breast cancer care. Shared decision making is one proposed model to support informed and preference-sensitive decision-making in line with the principles of patient-centered care. Despite an emerging level of interest in shared decision making, there remains a lack of clarity regarding what the process involves and how to effectively implement it into clinical practice.

Conclusions:
Thus, widespread adoption of shared decision making remains lacking in clinical practice for women considering postmastectomy breast reconstruction. To address these gaps, this article reviews the principles of shared decision making, explores ways shared decision making can be utilized for patients who are candidates for breast reconstruction, and provides a practical overview to facilitate implementation of shared decision making into clinical practice.