bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of prognostic factors in patients receiving transarterial radioembolization for unresectable hepatocellular carcinoma
Authors: Soydal Cigdem , Araz Mine , Nak Demet , Akkus Pinar , Baltacioğlu Muhammet Halil , Bilgic Sadik , Kucuk Nuriye Ozlem 
Published: December 2019

Aim
This study aimed to analyze the prognostic factors of patients receiving transarterial radioembolization for unresectable hepatocellular carcinoma.

Material and method
Eighty-six (73 M and 13F; mean age: 64.3 ± 9.8 years) patients who received transarterial radioembolization for unresectable hepatocellular carcinoma were included. Relationship between serum alpha-fetoprotein and international normalization ratio level, albumin-bilirubin grade, neutrophil-lymphocyte ratio, presence of portal venous thrombosis and extrahepatic metastases, the dimension of index lesion and OS were analyzed.

Results
Neutrophil lymphocyte ratio was ≤ 5 in 76 (88%) and >5 in 10 (12%) of patients. Sixty-two (72%) patients died during a mean of 25.6± 9.7 months follow-up. Mean OS for all patients was calculated as 12.9 ± 14.6 months. In univariate analysis, albumin-bilirubin grade (22.3 ± 3.8 vs. 11.6 ± 4.2; P = 0.03), neutrophil-lymphocyte ratio (21.8 ± 3.6 vs. 7.3 ± 2.6; P =0.04), presence of extrahepatic metastases (30.1 ± 5.4 vs. 7.4 ± 2.0; P = 0.001) and portal venous thrombosis (26.5± 4.8 vs. 10.5 ± 2.1; P = 0.01) had significant effect on OS. In multivariate analysis, serum international normalization ratio (P = 0.005) and alpha-fetoprotein level (P = 0.004), albumin-bilirubin grade (P = 0.05), neutrophil-lymphocyte ratio (P = 0.007), Child-Pugh score (0.006) and presence of ascites (P = 0.005) were significantly correlated with OS.

Conclusion
Patients with low basal albumin-bilirubin grade and neutrophil-lymphocyte ratio survive longer after transarterial radioembolization for unresectable hepatocellular carcinoma. Presence of extrahepatic metastases and portal venous thrombosis seems to have a prognostic value.
Current Approach to the Evaluation and Management of Abdominal Compartment Syndrome in Pediatric Patients
Authors: Gottlieb Michael , Davenport Dayle V. , Adams Shayna , Chien Nicholas 
Published: December 2019

Abstract
Abdominal compartment syndrome is an emergent condition caused by increased pressure within the abdominal compartment. It can be caused by a number of etiologies, which are associated with decreased abdominal wall compliance, increased intraluminal or intraperitoneal contents, or edema from capillary leak or fluid resuscitation. The history and physical examination are of limited utility, and the criterion standard for diagnosis is intra-abdominal pressure measurement, which is typically performed via an intravesical catheter. Management includes increasing abdominal wall compliance, evacuating gastrointestinal or intraperitoneal contents, avoiding excessive fluid resuscitation, and decompressive laparotomy in select cases.
Breast Reconstruction Does Not Increase the Incidence of Postmastectomy Pain Syndrome
Authors: Reghunathan Meera , Rahgozar Paymon , Sbitany Hani , Srinivasa Dhivya R. 
Published: December 2019

BackgroundPostmastectomy pain syndrome (PMPS) is characterized by neuropathic pain from direct nerve injury during oncologic breast surgery causing chronic pain, often leading to chronic opioid dependence and long-term disability. To our knowledge, this study represents the first meta-analysis that defines the incidence of PMPS in patients undergoing mastectomy, with and without breast reconstruction.MethodsThe Cochrane, Embase, MEDLINE, and PubMed databases were queried. A total of 166 citations from 1991 to 2017 were reviewed to identify 22 unique manuscripts. Inclusion criteria required: (i) minimum 3-month follow-up, (ii) pain in breast, (iii) pain after mastectomy, (iv) documentation of any reconstruction, and (v) minimum of level three evidence.Comprehensive Meta- Analysis Softwareand Microsoft Excel were used for statistical calculations.ResultsSixteen manuscripts described the prevalence of postmastectomy pain and 11 described the prevalence of postreconstruction pain (5 had data for both). Study population size ranged from 32 to 1165 patients. All studies were classified as level 2 or level 3 evidence. The mean prevalence of pain after mastectomy alone using a random-effects model is 35.6% (30.3%–41.3%). Mean prevalence of pain after mastectomy with reconstruction using the random-effects model is 32.8% (24.4% - 42.5%). Analysis of variance analysis showed no significant difference between prevalence of chronic pain after mastectomy alone versus mastectomy and reconstruction (P= 0.88).ConclusionsOur meta-analysis establishes that postmastectomy reconstruction does not increase the incidence of PMPS. However, because this neuropathic pain often persists after reconstructive surgery, it is incumbent on the plastic surgeon to counsel patients on PMPS. Moving forward, prospective studies on the effects of reconstruction type and adjunct procedures are warranted.
Lymphovenous Anastomosis for the Treatment of Thoracic Duct Lesion
Authors: Lindenblatt Nicole , Puippe Gilbert , Broglie Martina A. , Giovanoli Pietro , Grünherz Lisanne 
Published: December 2019

Background
Chylous leak is an uncommon complication after head and neck surgery and typically results from a lesion of the thoracic duct (TD). Beside conservative treatment, different minimally invasive and surgical procedures exist, of which almost all lead to a total closure of the TD.

Methods
We report on a rare case of microsurgical lymphovenous anastomosis to treat a TD lesion. An additional systematic review on surgical procedures to treat TD lesions with special attention to lymphovenous anastomoses was performed according to the PRISMA guidelines.

Results
A 52-year-old patient with a chylous fistula after modified radical neck dissection was successfully treated by a lymphovenous anastomosis of the TD and external jugular vein with additional coverage by sternocleidomastoid muscle flap. The patient showed a complete resolution of chylous leak with an uneventful postoperative course.
The systematic search of literature yielded 684 articles with 4 case reports on lymphovenous anastomosis in chylous leak with a high success rate. Other surgical techniques include transcervical, thoracoscopic, or video-assisted thoracoscopic TD ligation, either alone or combined with a local muscle flap.

Conclusions
Lymphovenous anastomosis of the TD is a feasible and safe technique allowing for treatment of cervical TD lesions, especially if minimally invasive procedures fail. Compared with other techniques, lymphatic circulation can successfully be maintained.
Dickkopf 2–Expressing Adenovirus Increases the Survival of Random-Pattern Flaps and Promotes Vasculogenesis in a Rat Model
Authors: Choi Se Woon , Jeon Yeo Reum , Baek Wooyeol , Yun Chae-Ok , Roh Tai Suk , Lee Won Jai 
Published: December 2019

Background
Dickkopf 2 (DKK2) has important roles in vertebrate development; it inhibits Wnt signaling-related processes, such as axial patterning, limb development, somitogenesis, and eye formation. However, DKK2 also acts as a Wnt signaling agonist. Dickkopf 2, induced during endothelial cell morphogenesis, promotes angiogenesis in cultured human endothelial cells. In this study, we explored the effect of DKK2-expressing adenovirus on random-pattern flaps using a rodent model.

Methods
A DKK2-expressing (dE1-RGD/DKK2) adenovirus was generated and 20 Sprague-Dawley rats were randomly divided into 2 groups: a DKK2 group and a control group. Each group was intradermally injected with 1 × 107 plaque-forming units of DKK2-expressing adenovirus (DKK2 group) or control virus (control group) 48 hours before and immediately before surgery. Then, random-pattern dorsal cutaneous flaps of 3 × 9 cm were elevated. Flap survival rates and cutaneous blood flow were measured over time, and immunohistochemical staining was performed 10 days after surgery to detect CD31 and vascular endothelial growth factor (VEGF).

Results
Immunofluorescence staining confirmed the expression of DKK2 in the DKK2 group. The flap survival rate was higher in the DKK2 group (80.0 ± 4.49%) than in the control group (57.5 ± 4.21%; P < 0.05). Blood flow to the most distal compartment was higher in the DKK2 group than the control group during the early postoperative period. Although vascular density was greater in the DKK2 group, there was no difference in the VEGF concentration between groups.

Conclusions
The findings of the present study suggest that the DKK2-expressing adenovirus increases the survival of the random-pattern cutaneous flap independently of VEGF. The administration of the DKK2-expressing adenovirus into elevated skin flaps increased the number of capillaries and blood flow, thereby improving skin flap survival.
Surgical Decompression or Corticosteroid Treatment of Indirect Traumatic Optic Neuropathy
Authors: Chen Hsin-Hung , Lee Min-Chao , Tsai Chia-Hsuan , Pan Chun-Hao , Lin Yu-Te , Chen Chien-Tzung 
Published: December 2019

Background
Traumatic optic neuropathy (TON) is a rare cause of severe permanent visual impairment after injury. Traumatic optic neuropathy may occur due to sharp trauma (direct injury) that damages the optic nerve directly or due to damage from the transmitted forces after a concussive blow to the head or orbit (indirect injury). The management of indirect TON remains controversial. Either surgical decompression or mega dose corticosteroid is used for managing indirect TON. However, no consensus exists regarding the definitive treatment.

Materials and Methods
We designed a randomized controlled trial study to investigate this issue. Only patients with indirect TON and normal vision before the injury were enrolled. The patients' data were recorded, and fine cut facial computed tomography scan was performed to exclude those with retrobulbar hematoma. All the study subjects were randomly allocated to either the mega dose steroid (30 mg/kg stat and 15 mg/kg every 6 hours for 3 days) group or the surgical decompression group. The patients were followed up at 1 week, 1 month, 3 months, 6 months, and 9 months. During each follow-up, the Snellen visual acuity (VA), visual field, color change, fundus findings, and intraocular pressure were evaluated. These data were compared and analyzed using the Mann-Whitney U test and odds ratio. The short form questionnaire was used to analyze the lift quality difference between the two groups.

Results
Thirty patients were enrolled, 12 in the surgical group and 18 in the steroid treatment group. There were no significant differences in the improvement rate, improvement degree, and life quality between the groups. However, the odds ratios are 5, 10, 2.5, and nonavailable in the cutoff points of no light perception (NLP), light perception (LP), hand movement, and counting finger in surgery group. In steroid group, they are 1, 1, 1, 1.83 in each cutoff points. Patients with better VA than NLP had better life quality than those with NLP VA (P = 0.005). Other cutoff point groups had no significant difference.

Conclusions
Patients with worse initial VA (eg, NLP and LP) had a higher chance of benefiting from surgical treatment and experiencing improvements in the life quality.
Use of Extended Pedicled Transverse Rectus Abdominis Myocutaneous Flap for Extensive Chest Wall Defect Reconstruction After Mastectomy for Locally Advanced Breast Cancer
Authors: Lin Yun-Nan , Ou-Yang Fu , Hsieh Meng-Chien , Lee Su-Shin , Huang Shu-Hung , Chuang Chieh-Han , Chang Chih-Hau , Kuo Yur-Ren , Hou Ming-Feng , Lin Sin-Daw 
Published: December 2019

Background
The reconstruction of a large postmastectomy chest wall defect for patients with stage III/IV breast cancer is a challenge for plastic surgeons. In this study, we present the application of an extended transverse rectus abdominis myocutaneous (TRAM) flap to easily and safely reconstruct these defects.

Patients and Methods
A retrospective review from November 1997 to November 2016 revealed that 65 patients with stage III/IV breast cancer immediately underwent postmastectomy TRAM flap reconstruction. In total, 16 patients were enrolled in this study based on the inclusion criteria of a postmastectomy chest skin defect size of greater than or equal to 100 cm2 and a TRAM flap size of greater than or equal to 80% of the lower abdominal area for reconstruction.

Results
Eleven (68.9%) and 5 patients (31.3%) were diagnosed with stage III and stage IV breast cancer, respectively. The chest wall skin defects ranged from 135 to 440 cm2. All flap areas exceeded 80% of the lower abdominal area. Overall, 100% of the harvested flaps were used in 3 patients, and only 1 patient had marginal necrosis in zone IV. No total flap loss was observed. The average length of hospital stay was 5.8 days, and the mean follow-up duration was 46.6 months (range, 4.5–117.7 months). On a Likert scale, the mean follow-up satisfaction score of 10 patients was 4.7.

Conclusions
Even when the flap area exceeded 80% of the lower abdominal area, the extended TRAM flap proved an effective and viable method for the immediate reconstruction of extensive postmastectomy chest wall skin defects, resulting in few minor complications and high follow-up satisfaction scores.
Nonoperative Treatment Versus Appendectomy for Acute Nonperforated Appendicitis in Children
Authors: Patkova Barbora , Svenningsson Anna , Almström Markus , Eaton Simon , Wester Tomas , Svensson Jan F. 
Published: December 2019

Objective:
The aim of this study was to evaluate the safety and feasibility of nonoperative treatment of acute nonperforated appendicitis in children during 5 years of follow-up.

Methods:
A 4-year follow-up of a previous randomized controlled pilot trial, including 50 children with acute nonperforated appendicitis, was performed. The patients were initially randomized to nonoperative treatment with antibiotics or appendectomy with 1-year follow-up previously reported. Data were extracted from the computerized notes and telephone interviews.
The primary outcome was treatment failure, defined as need for a secondary intervention under general anesthesia, related to the previous diagnosis of acute nonperforated appendicitis.

Results:
The children were followed up for at least 5 years [median 5.3 (range 5.0–5.6)] after inclusion. There were no failures in the appendectomy group (0/26) and 11 failures in the nonoperative group (11/24). Nine failures had occurred during the first year after inclusion, 2 of whom had histologically confirmed appendicitis. There were 2 further patients with recurrent acute appendicitis 1 to 5 years after inclusion. Both these patients had uncomplicated laparoscopic appendectomies for histologically confirmed acute appendicitis. There were no losses to follow-up.

Conclusions:
At 5 years of follow-up 46% of children treated with antibiotics for acute nonperforated appendicitis had undergone an appendectomy, although acute appendicitis was only histologically confirmed in 4/24 (17%). Treatment with antibiotics seems to be safe in the intermediate-term; none of the children previously treated nonoperatively re-presented with complicated appendicitis.
Esophageal Adenocarcinoma After Antireflux Surgery in a Cohort Study From the 5 Nordic Countries
Authors: Maret-Ouda John , Santoni Giola , Wahlin Karl , Artama Miia , Brusselaers Nele , Färkkilä Martti , Lynge Elsebeth , Mattsson Fredrik , Pukkala Eero , Romundstad Pål , Tryggvadóttir Laufey , von Euler-Chelpin My , Lagergren Jesper 
Published: December 2019

Objective:
We aimed to clarify the long-term risk development of EAC after antireflux surgery.

Summary of Background Data:
Gastroesophageal reflux disease (GERD) increases EAC risk, but whether antireflux surgery prevents EAC is uncertain.

Methods:
Multinational, population-based cohort study including individuals with GERD from all 5 Nordic countries in 1964–2014. First, EAC risk after antireflux surgery in the cohort was compared with the corresponding background population by calculating standardized incidence ratios (SIRs) with 95% confidence intervals (95% CIs). Second, multivariable Cox proportional hazards regression, providing hazard ratios (HRs) with 95% CIs, compared EAC risk in GERD patients with antireflux surgery with those with nonsurgical treatment.

Results:
Among 942,071 GERD patients, 48,863 underwent surgery and 893,208 did not. Compared to the corresponding background population, EAC risk did not decrease after antireflux surgery [SIR 4.90 (95% CI 3.62–6.47) 1–<5 years and SIR 4.57 (95% CI 3.44–5.95) ≥15 years after surgery]. Similarly, no decrease was found for patients with severe GERD (esophagitis or Barrett esophagus) after surgery [SIR 6.09 (95% CI 4.39–8.23) 1–<5 years and SIR = 5.27 (95% CI 3.73–7.23) ≥15 years]. The HRs of EAC were stable comparing the surgery group with the nonsurgery group with GERD [HR 1.71 (95% CI 1.26–2.33) 1–<5 years and HR 1.69 (95% CI 1.24–2.30) ≥15 years after treatment], or for severe GERD [HR 1.56 (95% CI 1.11–2.20) 1–<5 years and HR 1.57 (95% CI 1.08–2.26) ≥15 years after treatment].

Conclusions:
Surgical treatment of GERD does not seem to reduce EAC risk.
Differential Effect of Demographics, Processing Speed, and Depression on Cognitive Function in 755 Non-demented Community-dwelling Elderly Individuals
Authors: Mougias Antonios , Christidi Foteini , Synetou Margarita , Kotrotsou Irene , Valkimadi Polena , Politis Antonios 
Published: December 2019

Background:
Several factors may account for inter- and intra-individual variability in cognitive functions, including age, gender, education level, information processing speed, and mood.

Objective:
To evaluate the combined contribution of demographic factors, information processing speed, and depressive symptoms to scores on several diagnostic cognitive measures that are commonly used in geriatric neuropsychological practice in Greece.

Methods:
Using a cross-sectional study, we established a multivariate general linear model and analyzed the predictive role of age, gender, education, information processing speed (Trail Making Test—Part A), and depressive symptoms (Geriatric Depression Scale—15 Items) on measures of general cognitive status (Mini-Mental State Examination), verbal memory (Rey Auditory Verbal Learning Test), language (Confrontation Naming), and executive functions (Category and Phonemic Fluency, Trail Making Test—Part B) for a sample of 755 healthy, community-dwelling Greek individuals aged 50 to 90 years.

Results:
Participant factors significantly but differentially contributed to cognitive measures. Demographic factors and information processing speed emerged as the significant predictors for the majority of the cognitive measures (Mini-Mental State Examination; Rey Auditory Verbal Learning Test; Confrontation Naming; Category and Phonemic Fluency; Trail Making Test—Part B), whereas depressive symptoms significantly predicted verbal memory and semantic fluency measures (Rey Auditory Verbal Learning Test and Category Fluency).

Conclusions:
Clinicians should consider participant demographics, underlying slowing of processing speed, and depressive symptoms as potential confounding factors in cognitive measures. Our findings may explain the observed inter- and intra-individual variability in cognitive functions in the elderly population.
Validation and Clinical Experience With a Turkish Language Version of the Pittman Ostomy Complication and Severity Index
Authors: Sayar Serap , Vural Fatma 
Published: December 2019

PURPOSE:
The purpose of this study was to evaluate the content validity and interrater reliability of a Turkish language version of the Pittman Ostomy Complication and Severity Index (OCSI).

DESIGN:
Psychometric evaluation of instrument.

SUBJECTS AND SETTING:
The sample comprised 90 individuals living with an ostomy for 2 to 6 months. Their mean age was 59.48 years (SD 13.292); 52.2% were female. Almost two-thirds (73.3%, n = 66) had experienced at least 1 ostomy complication. The study was conducted in the Wound and Stoma Therapy Unit of the Dokuz Eylül University Hospital General Surgery Clinic and Polyclinic in Izmir, Turkey.

METHODS:
A Turkish language version of the OCSI was created using a translation, back-translation technique. The instrument's content validity was analyzed by 26 experts. Interrater reliability test was evaluated using Cohen's κ and intraclass correlation coefficients. Data were collected between January 15, 2017 and July 30, 2017 through face-to-face interviews conducted in our Wound and Stoma Therapy Unit.

RESULTS:
The overall content validity index was 0.95. Cohen's κ coefficient varied from 0.70 and 1.0 for all items. The Pearson correlation coefficient and intraclass correlation coefficient were 0.982 (P = .000) and 0.986 (P = .000), respectively, indicating good internal consistency. The most prevalent complications were leakage (41.1%), peristomal moisture-associated skin damage (42.2%), and stomal retraction (27.7%).

CONCLUSIONS:
Findings indicate that the Turkish language version of the Pittman OCSI is a reliable and valid instrument for assessment of presence and severity of early postoperative complications in individuals with an ostomy. We found the instrument parsimonious, easy-to-use, and clinically practical. It can be used to determine appropriate interventions to prevent or treat complications and evaluate the effects of nursing interventions designed to improve outcomes for patients with ostomies.
Anxiolytic effects of a galacto-oligosaccharides prebiotic in healthy female volunteers are associated with reduced negative bias and the gut bacterial composition
Authors: Johnstone Nicola , Milesi Chiara , Burn Olivia , van den Bogert Bartholomeus , Nauta Arjen , Hart Kathryn , Sowden Paul , Burnet Philip WJ , Kadosh Kathrin Cohen 
Published: December 2019

AbstractCurrent research implicates pre- and probiotic supplementation as potential mediators for improving symptomology in numerous physical and emotional ailments. The alteration of emotional states via nutrient intake is an attractive concept for clinicians and consumers alike and may be an efficient channel to improved well-being. Here we focus on the period of late adolescence, which is a time of emotional refinement via maturation that significantly influences emotional, social and physical well-being in later years. Effective interventions such as nutritional supplementation in this age group have the potential to offset health-related costs in later life. In this study we examined multiple indices of mood and well-being in 64 healthy females in late adolescence in a 4-week double blind, placebo controlled Galacto-oligosaccharide (GOS) prebiotic supplement intervention. We also obtained stool samples at baseline and follow-up for microbiome sequencing and analyses. We found effects of the GOS intervention on sub-clinical self-reported high trait anxiety, attentional bias, and bacterial abundance, suggesting that dietary supplementation with a GOS prebiotic may be influential in improving indices of pre-clinical anxiety.