bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metastatic breast cancer presenting as acute liver injury: diagnostic dilemma in the setting of suspected hemochromatosis
Authors: Chandradevan Raguraj , Takeda Hironobu , Hayes Benjamin , Faulkner Kalli , Darrow Matthew 
Published: May 2020

Abstract
A 70-year-old female with a history of lobular carcinoma of the breast, status post-mastectomy followed by adjuvant radio-chemotherapy in remission for 4 years was admitted with the features of acute liver failure (ALF). Iron studies revealed a hemochromatosis picture and the CT and MRI scans of the abdomen suggested cirrhosis. An extensive workup failed to identify an etiology. A trans-jugular liver biopsy was obtained and revealed poorly differentiated carcinoma consistent with the metastasis of breast primary. The patient’s condition deteriorated and died within a week following the onset of acute hepatic failure. DNA testing revealed that the patient was heterozygous for H63D mutation. In cases of ALF with the suspicion of malignancy, liver biopsy should be obtained to evaluate an infiltrative hepatic disease.
Serum levels of galectin-3 in idiopathic inflammatory myopathies: a potential biomarker of disease activity
Authors: Watanabe Eri , Kato Kazunori , Gono Takahisa , Chiba Emiko , Terai Chihiro , Kotake Shigeru 
Published: May 2020

Abstract

Objectives
Galectin-3 is involved in various biological activities, including immune activations and fibrosis. Idiopathic inflammatory myopathies (IIMs) are autoimmune diseases of unknown aetiology, often complicated by interstitial lung disease (ILD). The aim of this study was to evaluate the expression of galectin-3 in sera and tissues of patients with IIM and assess the associations of galectin-3 with patient characteristics and disease activity.

Results
Serum galectin-3 levels were significantly higher in IIM patients than in healthy controls. The serum galectin-3 levels positively correlated with serum levels of inflammatory markers and proinflammatory cytokines/chemokines and the Myositis Intention-to-Treat Activity Index. Stratification analysis revealed that patients with IIM-associated ILD (IIM-ILD) had significantly higher levels of serum galectin-3 than those without IIM-ILD. In addition, patients with acute/subacute interstitial pneumonia had significantly higher levels of serum galectin-3 than those with chronic interstitial pneumonia. Furthermore, serum galectin-3 levels in IIM-ILD patients correlated with the radiological assessments of parenchymal lung involvement and treatment response. Immunohistochemical analysis revealed that galectin-3 was expressed in inflammatory cells of myositis and dermatitis sections, whereas in ILD sections, galectin-3 was expressed in interstitial fibrosis and inflammatory cells.

Conclusion
Galectin-3 may be involved in the pathogenesis of inflammatory and fibrotic conditions in IIM and can serve as a potential biomarker of disease activity, especially in patients with IIM-ILD.
Perioperative anaphylaxis: diagnostic challenges and management
Authors: Savic Louise C. , Garvey Lene Heise 
Published: May 2020

Purpose of review
Perioperative hypersensitivity reactions can pose diagnostic and management challenges for the anaesthetist. Difficulties in diagnosing hypersensitivity reactions in the perioperative setting are highlighted and recommendations from recent guidelines on the acute management of life-threatening anaphylaxis are presented.

Recent findings
Anaesthetists play a key role in investigating perioperative hypersensitivity reactions. During a suspected perioperative hypersensitivity event, a serum tryptase level should be measured to help with subsequent allergy investigation. Moreover, anaesthetists can ensure that a high-quality referral is made to allergy clinics by providing thorough documentation of the events, detailing symptoms, treatments, and the chronology of drug administrations.

Summary
Perioperative hypersensitivity reactions are rare but can be life-threatening. A high index of suspicion should be maintained for their successful management. Whenever a perioperative hypersensitivity reaction is suspected, close collaboration between anaesthetist and the allergy team investigating the patient is paramount, in order for the patient to be appropriately investigated and have an uneventful anaesthetic in the future.
Simulation in obstetric anesthesia: an update
Authors: Marynen Frederik , Van Gerven Elke , Van de Velde Marc 
Published: May 2020

Purpose of review
Simulation training (crew resource management training and scenario training) has become an important tool in the education of anesthesiologists. This review summarizes recent research performed in this area, focusing more specifically on obstetric anesthesia.

Recent findings
Simulation training is becoming more integrated in the modern education of anesthesiologists. Research regarding the most effective way to perform simulation training in terms of learning outcomes and long-term skill retention has started to appear. Scenarios which are played independently and that allow for simulated mortality, as well as relaxation techniques before debriefing might have positive effects in this regard. Furthermore, simulation has been investigated as a tool to improve patient safety in low-resource settings. In addition, simulation training in the domain of obstetrics has been rapidly expanding and has an important role in this field of medicine as well.

Summary
Simulation training has acquired a central role in modern education of anesthesiologists. Further research regarding elements to optimize simulation training in terms of learning outcomes and long-term skill retention is desirable. In addition, little data exist concerning the effect of simulation training on possible improvement of patient outcomes in anesthesia.
Hyper-Selective Posterior Fusion in Lenke 5C Adolescent Idiopathic Scoliosis
Authors: Shu Shibin , Zhang Tianyuan , Jing Wenting , Zhang Yuancheng , Gu Qi , Zhu Zezhang , Liu Zhen , Qiu Yong , Sun Xu , Wang Bin , Bao Hongda 
Published: May 2020

Study Design.
A prospective analysis.

Objective.
To investigate whether the hyper-selective posterior fusion (upper instrumented vertebra [UIV] as the vertebra one level below the upper end vertebra [UEV], lower instrumented vertebra [LIV] as the lower end vertebra [LEV]) was applicable in posterior fusion of Lenke 5C adolescent idiopathic scoliosis (AIS) patients and what could be the indication of hyper-selective fusion.

Summary of Background Data.
The improper UIV selection in selective fusion could lead to progressive thoracic compensatory curve, shoulder imbalance, and even coronal imbalance. However, few studies analyzed the clinical outcome of hyper-selective fusion.

Methods.
A prospective analysis of 80 patients with Lenke 5C AIS who underwent selective fusion was performed. According to the relationship between UEV and UIV, the patients were divided into UEV group (UIV = UEV) and UEV-1 group (UIV = UEV-1). Radiographic parameters and the incidence of postoperative proximal decompensation were compared. The Scoliosis Research Society (SRS)-22 scores were used to evaluate clinical outcomes between two groups.

Results.
Thirteen patients (27%) in UEV group and six (18.75%) in UEV-1 group showed proximal decompensation during follow-up, and the incidence was equivalent (P = 0.280). Within the UEV-1 group, the patients with proximal decompensation showed similar Risser grade, baseline thoracic Cobb angle, and main Cobb angle (P = 0.611, 0.435, 0.708, respectively). However, the baseline L-T apical vertebral translation (AVT) ratio was significantly larger in patients with proximal decompensation (P = 0.028). Meanwhile, patients with proximal decompensation in UEV group showed significantly smaller preoperative UIV translation and lumbar AVT but similar postoperative UIV tilt.

Conclusion.
Hyper-selective posterior fusion strategy could be performed in Lenke 5C patients with Risser more than grade 2 and with thoracic compensatory curve over 15°. The UIV in patients with small baseline thoracic curve, represented by larger baseline lumbar-thoracic AVT ratio, should be selected as UEV to prevent proximal decompensation.

Level of Evidence: 4
Use of granulocyte-colony stimulating factors in older patients: a review of recently published data
Authors: Klastersky Jean A. , Dal Lago Lissandra , Lalami Yassine 
Published: May 2020

Purpose of review
This review presents the analysis of recently published studies about the benefit from granulocyte-colony stimulating factors (G-CSF) in older cancer patients receiving chemotherapy.

Recent findings
During the last years, no major study aiming to confirm the clinical benefit of G-CSF prophylaxis in older patients treated with chemotherapy has been published. Nonetheless, all the data made recently available confirm that age, especially if other comorbid conditions are present as well, is a major risk factor for febrile neutropenia occurrence and that G-CSF prophylaxis can reduce significantly that risk.

Summary
New modalities of administering G-CSF prophylaxis might be considered in older people in the future. Among these approaches, the ‘same day’ administration of prophylaxis and chemotherapy and the development of less-expensive approaches for G-CSF prophylaxis, such as the use of biosimilars are studied.
Efficacy and Safety of the 532-nm KTP and Long-Pulsed 1064-nm Neodymium-doped Yttrium Aluminum Garnet Laser for Treatment of Vascular Malformations
Authors: Eichenfield Dawn Z. , Ortiz Arisa E. 
Published: May 2020

BACKGROUND
Pulsed dye lasers (PDLs) are well-established for treatment of capillary malformations but are unable to penetrate the depth needed to treat deeper vascular lesions. A combined approach using a deeper penetrating wavelength with a “superficial” wavelength could more comprehensively treat vascular malformations than PDL alone.

OBJECTIVE
To evaluate the safety and efficacy of the long-pulsed 1064-nm neodymium:yttrium–aluminum–garnet (LP 1064-nm Nd:YAG) in conjunction with the 532-nm potassium titanyl phosphate (532-nm KTP) laser wavelengths for treatment of capillary venous and venous malformations.

METHODS
In this retrospective single-center study, we queried patient records who underwent treatment with the 532-nm KTP and LP 1064-nm Nd:YAG laser wavelengths. A blinded panel of 3 physicians evaluated improvement in lesion color, elevation, texture, and overall architecture on a four-point scale: 0% to 25%; 26% to 50%, 51% to 75%, and 76% to 100%.

RESULTS
Our cohort consisted of 23 cases. Sixteen cases had sufficient information for clinical assessment. Treatment number and parameters varied depending on lesion, skin type, and end point. Clinical assessment of treatment effectiveness revealed average scores of 51% to 75% improvement for color, elevation, texture, and overall architecture.

CONCLUSION
This study illustrates that 2 wavelengths, 532-nm KTP to target superficial components and LP 1064-nm Nd:YAG for deeper components, can safely and effectively treat both capillary venous and venous malformations.
The effect of SLC6A3 variable number of tandem repeats and methylation levels on individual susceptibility to start tobacco smoking and on the ability of smokers to quit smoking
Authors: Tiili Emmi M. , Mitiushkina Natalia V , Sukhovskaya Olga A. , Imyanitov Evgeny N. , Hirvonen Ari P. 
Published: May 2020

Objective
Nicotine acts through the dopamine pathway in the brain affecting reward processing through cigarette consumption. Thus, both genetic and epigenetic factors related to dopamine metabolism may influence individual’s smoking behavior.

Materials and methods
We studied variations of two variable numbers of tandem repeats (VNTRs), 40 and 30 bp in length, in SLC6A3 gene together with six DNA methylation sites located in a first intron of the gene in relation to several smoking-related phenotypes in a study population consisting of 1230 Whites of Russian origin.

Results
Both the 5R allele of 30 bp VNTR and the 9R allele of 40 bp VNTR in SLC6A3 were associated with a reduced risk to tobacco smoking [odds ratio (OR) 0.53, 95% confidence interval (CI) 0.37–0.75; OR 0.62, 95% CI 0.43–0.88]. Although the carriers of 9R allele also had high Fagerström test for nicotine dependence scores (OR 1.65, 95% CI 1.04–2.60), they were still more likely to succeed in smoking cessation (OR 0.59, 95% CI 0.40–0.88). Also, current smokers had more than 2.5-fold likelihood to have increased SLC6A3 methylation levels than former smokers (OR 2.72, 95% CI 1.63–4.53).

Conclusion
The SLC6A3 5R of 30 bp and 9R of 40 bp VNTR variants may lead to a reduced risk to start smoking through decreased dopamine availability, and can also affect the success in subsequent smoking cessation attempts. Moreover, the elevated mean methylation values in the first intron of SLC6A3 may be related to nicotine dependence via a more active dopamine transporter.
Cost-effective minimally invasive gynecologic surgery: emphasizing surgical efficiency
Authors: Misal Meenal , Delara Ritchie , Wasson Megan N. 
Published: May 2020

Purpose of review
The United States has the highest healthcare costs among developed countries. This review evaluates surgical practices and equipment choices during endoscopic hysterectomy, highlighting opportunities for the gynecologic surgeon to reduce costs and maximize surgical efficiency.

Recent findings
There are opportunities to economize at every step of the endoscopic hysterectomy. When surgeons are provided education about instrumentation costs, the cost of hysterectomy has been shown to decrease. Colpotomy has been found to be the rate-limiting step in laparoscopic hysterectomy; use of a uterine manipulator likely saves time and money. When evaluating the economic impact of route of surgery, the cost differential between laparoscopic and robotic-assisted hysterectomy has decreased. Robotic-assisted hysterectomy may be more cost-effective in some cases, such as for larger uteri. From a systems-level perspective, dedicating a specific operating room team to the gynecology service can decrease operative time.

Summary
The gynecologic surgeon is best equipped to control surgery-related costs by making choices that improve surgical efficiency and decrease operating room time. If a costlier piece of equipment leads to a more efficient case, the choice may be more cost-effective. There are multiple systems-level changes that can be implemented to decrease surgery-related costs.
Multifocal arterial disease: clinical implications and management
Authors: Paraskevas K.I. , Geroulakos G. , Veith F.J. , Mikhailidis D.P. 
Published: May 2020

Purpose of review
Vascular disease often affects more than one territory. Atherosclerosis is a global disease affecting multiple organs/systems. Cardiovascular risk factors are associated with an increased risk for the development of arterial disease in all vascular beds but differ in their individual impacts for each vascular bed. We discuss the various options to identify and manage multifocal arterial disease.

Recent findings
Coronary artery disease may coexist with carotid artery stenosis, abdominal aortic aneurysms, and/or peripheral artery disease (PAD). Atherosclerotic renal artery stenosis and renal function impairment may complicate PAD. Recent studies have confirmed that patients with multivascular bed disease have higher risk than patients with monovascular disease. In addition to the specific surgical/endovascular therapeutic options available, aggressive medical treatment and vascular disease prevention strategies should be rigorously implemented to best manage the overall atherosclerotic burden.

Summary
A holistic approach is essential to reduce the cardiovascular morbidity and mortality rates of vascular patients. Preventive measures should complement surgical/endovascular procedures so as to improve outcomes.
Additional prognostic value of electrocardiographic left ventricular hypertrophy in traditional cardiovascular risk assessments in chronic kidney disease
Authors: Tanaka Fumitaka , Komi Ryosuke , Nakamura Motoyuki , Tanno Kozo , Onoda Toshiyuki , Ohsawa Masaki , Sakata Kiyomi , Omama Shinichi , Ogasawara Kuniaki , Ishibashi Yasuhiro , Yonekura Yuki , Itai Kazuyoshi , Kuribayashi Toru , Kikuchi Yawara , Ishigaki Yasushi , Okayama Akira , Asahi Koichi 
Published: May 2020

Background:
Left ventricular hypertrophy (LVH) is a common predictor of the cardiovascular prognosis in chronic kidney disease (CKD). However, whether or not electrocardiography-derived LVH (ECG-LVH) has prognostic value in patients with various degrees of CKD and improves the cardiovascular risk stratification based on traditional risk factors remains unclear.

Methods:
A total of 7206 participants at least 40 years of age who were free from cardiovascular events in a general population were followed for the incidence of cardiovascular events. CKD was confirmed by either the presence of a reduced estimated glomerular filtration rate (eGFR) (<60 ml/min per 1.73 m2) or albuminuria, defined as a urinary albumin-to-creatinine ratio (UACR) of at least 30 mg/g Cr.

Results:
A total of 1886 (26.2%) had CKD, of which 1471 (78.0%) had a preserved eGFR (CKD stage 1–2). After an average 11.3 years of follow-up, the adjusted hazard ratio for the incidence of cardiovascular events significantly increased for ECG-LVH according to the Sokolow--Lyon voltage, Cornell voltage, or Cornell voltage product among participants with CKD (hazard ratio 1.47, P = 0.002), in contrast to those without CKD (hazard ratio 1.15, P = 0.210). The inclusion of any ECG-LVH parameters improved the accuracy of reclassification in any risk prediction model based on the eGFR, UACR, or Framingham 10-year risk score in the CKD participants (net reclassification improvement = 0.13–0.32, all P values <0.040).

Conclusion:
In patients with CKD stage 1–5, ECG-LVH is useful for predicting the risk of future cardiovascular events and adds prognostic information to traditional cardiovascular risk assessments.
Concomitant hypertension is associated with abnormal left ventricular geometry and lower systolic myocardial function in overweight participants: the FAT associated CardiOvasculaR dysfunction study
Authors: Herfindal Bertina , Gerdts Eva , Kringeland Ester Anne , Saeed Sahrai , Midtbø Helga , Halland Hilde 
Published: May 2020

Objective:
We studied the impact of concomitant hypertension on left ventricular (LV) systolic myocardial function and geometry in apparently healthy women and men with increased BMI.

Material and methods:
We performed a cross-sectional analysis of 535 participants (59% women) with BMI greater than 27 kg/m2 without known cardiovascular disease enrolled in the FAT associated CardiOvasculaR dysfunction (FATCOR) study. Hypertension was defined as use of antihypertensive treatment or elevated 24-h ambulatory blood pressure. Abnormal LV geometry was identified as increased relative wall thickness and/or LV mass index. Systolic myocardial function was assessed by midwall shortening (MWS) and speckle tracking peak global longitudinal strain (GLS).

Results:
Hypertensive participants were older (49 vs. 46 years), had higher BMI and waist circumference, higher prevalences of diabetes and abnormal LV geometry (29 vs. 16%), and lower GLS (−19 vs. −20%) and MWS (16.3 vs. 17.1%) compared with normotensive participants (all P < 0.01). In multivariable linear regression analyses, hypertension was associated with lower GLS (β=0.11, P = 0.035) and lower MWS (β=0.09, P = 0.029) independent of sex, diabetes, LV hypertrophy, ejection fraction, and waist circumference. Hypertension was also associated with presence of abnormal LV geometry [odds ratio 1.74 (95% confidence interval 1.04–2.89), P = 0.035) independent of the same confounders. When replacing waist circumference with BMI in the models, hypertension retained its association with lower myocardial function, whereas the association with abnormal LV geometry was attenuated.

Conclusion:
In participants with increased BMI without known clinical cardiovascular disease, concomitant hypertension was associated with lower systolic myocardial function and more abnormal LV geometry.
Clinical trial registration: URL: http://www.clinicaltrials.gov NCT02805478.
Obstructive sleep apnoea syndrome and left ventricular hypertrophy: a meta-analysis of echocardiographic studies
Authors: Cuspidi Cesare , Tadic Marijana , Sala Carla , Gherbesi Elisa , Grassi Guido , Mancia Giuseppe 
Published: May 2020

Aim:We investigated the association between obstructive sleep apnoea (OSA) and subclinical cardiac organ damage through a meta-analysis of echocardiographic studies that provided data on left ventricular hypertrophy (LVH), assessed as a categorical or continuous variable.Design:The PubMed, OVID-MEDLINE, and Cochrane library databases were systematically analyzed to search English-language articles published from 1 January 2000 to 15 August 2019. Studies were detected by using the following terms: ‘obstructive sleep apnea’, ‘sleep quality’, ‘sleep disordered breathing’, ‘cardiac damage’, ‘left ventricular mass’, ‘left ventricular hypertrophy’, and ‘echocardiography’.Results:Meta-analysis included 5550 patients with OSA and 2329 non-OSA controls from 39 studies. The prevalence of LVH in the pooled OSA population was 45% (CI 35--55%). Meta-analysis of studies comparing the prevalence of LVH in participants with OSA and controls showed that OSA was associated with an increased risk of LVH (OR = 1.70, CI 1.44–2.00,P < 0.001). LV mass was significantly increased in patients with severe OSA as compared with controls (SMD 0.46 ± 0.08, CI 0.29–0.62,P < 0.001) or with mild OSA. This was not the case for studies comparing patients with unselected or predominantly mild OSA and controls (0.33 ± 0.17, CI −0.01 to 0.67,P = 0.057).Conclusion:The present meta-analysis expands previous information on the relationship between OSA and echocardiographic LVH, so far based on individual studies. The overall evidence strongly suggests that the likelihood of LVH increases with the severity of OSA, thus exhibiting a continuous relationship.
Chronic effects and optimal dosage of strength training on SBP and DBP: a systematic review with meta-analysis
Authors: Oliver-Martínez Pedro A. , Ramos-Campo Domingo J. , Martínez-Aranda Luis M. , Martínez-Rodríguez Alejandro , Rubio-Arias Jacobo Á. 
Published: May 2020

Background and objectives:
Hypertension is a disease affecting a large part of the world's population that causes millions of deaths annually. Physical exercise is proposed as an alternative to pharmacologic therapies used to reduce blood pressure. The main objective was to compare the effect of different types of strength training in blood pressure, as well as to analyse several variables that can modify the effect of strength training not combined with medication in SBP and DBP (SBP-DBP).

Methods:
The search was carried out in two scientific databases: PubMed and Web of Science. Articles were included following three criteria: analysing the chronic effect of strength training in blood pressure; the studies were conducted at least during 4 weeks; and the articles were published in English.

Results:
The analysis showed a significant decrease of blood pressure for all types of training. The effect on SBP was greater when training without medication was carried out with isometric exercises than when training was performed with dynamic exercises. Moreover, the effects were no longer significant when the duration of the training programme exceeded 20 weeks as well as when training frequency was lower than three times per week were found.

Conclusion:
Strength training is effective in reducing both blood pressures (SBP-DBP). Training programmes, consisting of dynamic strength training without medication at a moderate intensity and with a frequency of three times per week, seem to be optimal in order to reduce blood pressure.
Prospective register of Systematic Reviews: CRD42019122421