bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical analgesic efficacy of pectoral nerve block in patients undergoing breast cancer surgery
Authors: Sun Qianchuang , Liu Shuyan , Wu Huiying , Kang Wenyue , Dong Shanshan , Cui Yunfeng , Pan Zhenxiang , Liu Kexiang 
Published: April 2020

Abstract

Background:
Breast cancer is the most commonly diagnosed cancer in women, and more than half of breast surgery patients experience severe acute postoperative pain. This meta-analysis is designed to examine the clinical analgesic efficacy of Pecs block in patients undergoing breast cancer surgery.

Methods:
An electronic literature search of the Library of PubMed, EMBASE, Cochrane Library, and Web of Science databases was conducted to collect randomized controlled trials (RCTs) from inception to November 2018. These RCTs compared the effect of Pecs block in combination with general anesthesia (GA) to GA alone in mastectomy surgery. Pain scores, intraoperative and postoperative opioid consumption, time to first request for analgesia, and incidence of postoperative nausea and vomiting were analyzed.

Results:
Thirteen RCTs with 940 patients were included in our analysis. The use of Pecs block significantly reduced pain scores in the postanesthesia care unit (weighted mean difference [WMD] = −1.90; 95% confidence interval [CI], −2.90 to −0.91; P < .001) and at 24 hours after surgery (WMD = −1.01; 95% CI, −1.64 to −0.38; P < .001). Moreover, Pecs block decreased postoperative opioid consumption in the postanesthesia care unit (WMD = −1.93; 95% CI, −3.51 to −0.34; P = .017) and at 24 hours (WMD = −11.88; 95% CI, −15.50 to −8.26; P < .001). Pecs block also reduced intraoperative opioid consumption (WMD = −85.52; 95% CI, −121.47 to −49.56; P < .001) and prolonged the time to first analgesic request (WMD = 296.69; 95% CI, 139.91–453.48; P < .001). There were no statistically significant differences in postoperative nausea and vomiting and block-related complications.

Conclusions:
Adding Pecs block to GA procedure results in lower pain scores, less opioid consumption and longer time to first analgesic request in patients undergoing breast cancer surgery compared to GA procedure alone.
Optimization of serum thyroglobulin measured at different time points for prognostic evaluation in differentiated thyroid carcinoma patients
Authors: Mutsuddy Pupree , Jeon Subin , Yoo Su Woong , Zhang Yingjie , Chowdhury Md. Sunny Anam , Kim Jahae , Song Ho-Chun , Bom Hee-Seung , Min Jung-Joon , Kwon Seong Young 
Published: April 2020

Abstract
Although serum thyroglobulin (Tg) is a reliable differentiated thyroid carcinoma (DTC) prognostic marker, its cutoff values can be affected by TSH stimulation status. Serum Tg prognostic values measured at different time points before and after radioactive iodine (RAI) therapy prepared with recombinant human TSH (rhTSH) in DTC patients, were investigated.
This study included 160 DTC patients who underwent surgery followed by rhTSH-aided RAI therapy. Their serum Tg levels were measured 7 days before (D-7Tg), on the day of (D0Tg), and 2 days after (D2Tg) the RAI therapy. For response evaluation, the patients were classified into 2 groups: acceptable response and non-acceptable response (non-AR). Optimal Tg level cutoff values measured at different time points were evaluated for persistent or recurrent disease (PRD) prediction, as well as therapeutic response.
Multivariate analysis showed that D-7Tg, D0Tg, and D2Tg significantly predicted non-AR (P < .05, for all). Optimal Tg level cutoff values for non-AR prediction were 0.6, 2.6, and 3.7 ng/mL for D-7Tg, D0Tg, and D2Tg, respectively. Cox regression analysis showed that Tg levels were significantly associated with PRD free survival with D-7Tg, D0Tg, and D2Tg cutoff values of 0.8, 4.0, and 6.0 ng/mL, respectively (D-7Tg, P = .010; D0Tg, P = .005; D2Tg, P = .011).
Serum Tg levels measured at the different time points could predict PRD free survival as well as therapeutic response with different cutoff values in DTC patients who underwent rhTSH-aided RAI therapy.
Treatment for acute flares of gout
Authors: Tang Hongzhi , Xu Guixing , Zheng Qianhua , Cheng Ying , Zheng Hui , Li Juan , Yin Zihan , Liang Fanrong , Chen Jiao 
Published: April 2020

Abstract

Introduction:
The current evidence confirms the effectiveness and safety of several drug interventions in the treatment of acute flares of gout, however, the most preferred drugs are still unclear. We, therefore, seek to conduct a network meta-analysis that can systematically compare non-steroidal anti-inflammatory drugs (NSAIDs), COXIBs, colchicine, hormones, or IL-1 receptor antagonists, etc. for acute gout based on the latest evidence.

Methods and analysis:
Nine online databases are searched with inception to September 1, 2019; there will be no language restrictions on the included trials. Randomized controlled trials that include patients with acute flares of gout receiving drug therapy versus a control group will be included. The selection of studies, risk of bias assessment and data extraction will be conducted by 2 independent researchers. Bayesian network meta-analysis is applied using the Markov chain Monte Carlo method with Stata or R. The dichotomous data will be presented as risk ratios with 95% CIs and the continuous data will be presented as weighted mean differences or standardized mean differences with 95% CIs. Evidence quality will be evaluated using the GRADE system.

Ethics and dissemination:
This network meta-analysis will not involve private information from personal or imperil their rights, so, ethical approval is not required. The results of this network meta-analysis may be published in a journal or publicized in concerned conferences.
Effects of Cryopreservation and Replantation on Muscles
Authors: He Bo , Su Shouwen , Lu Yunxiang , Wen Xiaoyue , Duan Jiekui , Liu Xiangxia , Zhu Zhaowei , Liu Xiaolin 
Published: April 2020

Background
Wang successfully replanted the severed fingers of 2 patients after cryopreservation in 2002 and 2003, which has enabled us to share our own experience for the knowledge interests of our colleagues and to further develop this technology.

Methods
Fifteen healthy adult male Sprague-Dawley rats were selected and divided into 5 groups (group 1: normal control, group 2: cryopreservation with protectant, group 3: cryopreservation without protectant, group 4: 6-hour postoperative, and group 5: 72-hour postoperative). After harvesting the hind limbs, cryoprotectant was applied to 20 limbs, and the rest were cryopreserved without cryoprotectant for 15 days. After being thawed, the amputated limb was replanted in situ. Nerves, skins and gastrocnemius muscles were collected for hematoxylin and eosin staining, terminal deoxynucleotidyl transferase dUTP nick end labeling staining, and transmission electron microscopy observation.

Results
Muscle and skin tissues treated with cryoprotectant restored a better outline after being frozen than those not treated, whereas nerves were not significantly different between the 2 groups. After replantation, some of the myofibrils of the muscle were in disarray, but the sarcomere structure remained intact at approximately 6 hours postoperatively. At 72 hours, a transmission electron microscopy scan showed that the myofibrillar arrangement was disorderly, with segmental myofilament breakage, and the sarcomere structure was destroyed in some cases. In addition, the scan revealed increased apoptotic cells and collapse of basic structures in the skin and nerves.

Conclusions
Relative to that of skin and neuronal tissue, the replantation of muscle tissues through the cryopreservation method is more difficult.
A Prospective Comparative Study of Color Doppler Ultrasound and Infrared Thermography in the Detection of Perforators for Anterolateral Thigh Flaps
Authors: Xiao Wentian , Li Ke , Kiu-Huen NG Sally , Feng Shaoqing , Zhou Huihong , Nicoli Fabio , Blondeel Phillip , Zhang Yixin 
Published: April 2020

Background
Preoperative localization of the perforators allows precise planning of the flap design and improves surgical efficiency. Recently, infrared thermography is introduced as a reliable alternative, where the perforator corresponds to the “hot spot” on the thermogram. This study aims to compare the application of color Doppler ultrasound (CDU) and infrared thermography in preoperative perforator mapping of the anterolateral thigh (ALT) perforator flap.

Patients and Methods
From September 2017 to January 2019, CDU and infrared thermography were both applied on 20 patients to locate the perforators originated from lateral circumflex femoral artery preoperatively. The perforators identified using each modality were marked on the anterolateral thigh region. The accuracy of both mapping methods was analyzed according to the intraoperative findings. The relation between location bias and the thickness of subcutaneous tissue was analyzed.

Results
A total of 20 ALT flaps were included. Fifty-three perforators were detected by CDU, and 51 “hot spots” were identified by infrared thermography, in which 50 “hot spots” corresponded to CDU, and the consistency test showed that the κ index was 0.712 (P < 0.05), representing high consistency. The infrared thermography has a sensitivity of 94.3% and a specificity of 85.7% compared with CDU. The deviation between thermal imaging and CDU was positively correlated with the thickness of the subcutaneous tissue. The Pearson correlation coefficient was 0.84 (R = 0.84). Forty-four perforators marked by CDU were selected for designing the flap. Anatomical findings showed that the accuracy rate of CDU and infrared thermal was 93.2% (41 of 44) and 86.3% (38 of 44), respectively. There was no statistical difference (P > 0.05).

Conclusions
Compared with CDU, infrared thermography can be used to locate perforators, in this case, the ALT perforators, with a high degree of consistency. It is portable, economical, noninvasive, and easy to operate. It has higher accuracy in patients with thinner subcutaneous tissue. We believe that infrared thermography can be a useful technique for perforator mapping, especially in patients where the subcutaneous tissue is thinner.
Free Medial Plantar Flap Versus Free Dorsal Myocutaneous Flap for the Reconstruction of Traumatic Foot Sole Defects
Authors: Han Yan , Han Yudi , Song Baoqiang , Guo Lingli , Tao Ran , Chai Mi 
Published: April 2020

Background
Trauma can cause large defects in the weight-bearing foot sole. The reconstruction of such defects poses a major challenge in providing a flap that is durable, sensate, and stable. The pedicled medial plantar flap has been commonly used for reconstructing heel and plantar forefoot defects; however, the ipsilateral instep region is usually compromised by trauma. The purpose of this article was to report the use of contralateral free medial plantar flaps for the coverage of weight-bearing plantar defects and to compare these with distant free flaps.

Methods
Between 2005 and 2019, 15 patients (10 men and 5 women) with weight-bearing foot plantar defects were treated with a contralateral medial plantar flap, 11 (7 men and 4 women) with either a latissimus dorsi flap or a scapular flap. The average age was 18.07 ± 10.14 years (range, 4–34 years) and 26.55 ± 13.05 years (range, 13–56 years), respectively. Surgery was performed as a primary or secondary reconstruction after a trauma by the same surgical team.

Results
The mean size of defects was 9.73 ± 3.55 × 6.43 ± 2.8 cm in the contralateral free medial plantar flap group and 17.14 ± 6.84 × 11.41 ± 4.29 cm in the free dorsal flap group. All flaps survived in both groups. In the instep flap group, the appearance was satisfactory, the flap was durable, and tactile sensation was preserved in all patients, and none required a revision procedure. Two patients experienced delayed union of the donor-site grafted skin. In the dorsal flap group, 5 patients complained of a partial necrosis or delayed union at the recipient site, and 9 developed recurrent ulcerations over the weight-\bearing area. Five patients achieved only partial sensation in the flap.

Conclusions
The contralateral medial plantar flap provides superior appearance, duration, and sensation over distant muscle flaps, without recurrent ulcerations. However, dorsal myocutaneous flaps may be used as a substitute when the defects are beyond the maximum boundaries of the instep area or are combined with bone loss.
Global Health Microsurgery Training With Cell Phones
Authors: Inchauste Suzanne M. , Deptula Peter L. , Zelones Justin T. , Nazerali Rahim S. , Nguyen Dung H. , Lee Gordon K. 
Published: April 2020

Background
Lack of surgical care for trauma, burns, congenital anomalies, and other surgical diseases is a growing portion of global disability and death accounting for 30% of the global disease burden. Global surgical and anesthesia care aim to achieve excellence and equality of clinical care through leadership, innovation, teaching, research, and advocacy. Stanford University Division of Plastic Surgery faculty partnered with ReSurge International to teach reconstructive microsurgery in low- and middle-income countries.

Challenge
Global surgery teaching and training are challenged by limited resources. Surgical loupes and operating microscopes used to perform complex microsurgery magnify the surgical field are very expensive. Our goal was to identify low-cost alternatives to teach and practice microsurgery suturing.

Innovation
Use cell phone camera with zoom capacity to teach and practice microsurgery suturing.

Results
Cell phones with zoom feature are widely available even in low- and middle-income countries. A cell phone was placed on a stand over a microsurgery practice station. The camera was used to zoom and focus on the suturing station to mimic a surgical field with loupes or microscope magnification. Nine attending surgeons and 7 residents practiced microsurgery with microsurgical instruments and 9-0 nylon suture under the magnification of a cell phone camera. The Stanford Microsurgery and Resident Training Scale was used to track their progress. A feedback survey was given to the participants to identify the usefulness of the cell phone setup for microsurgery suture practice.

Conclusions
Global surgery teaching and training face many challenges especially limited resources. Identifying low-cost alternative is crucial. Cell phone camera with zoom is a low-cost alternative to loupes or operating microscope for microsurgical teaching and training.
Investigating the potential for machine learning prediction of patient outcomes: a retrospective study of hospital acquired pressure injuries
Authors: Levy Joshua J. , Lima Jorge F. , Miller Megan W. , Freed Gary L. , O’Malley A. James , Emeny Rebecca T. 
Published: April 2020

AbstractBackgroundWhile recent research efforts to reduce pressure ulcers in the clinical context have focused on key retrospective characteristics, little work has focused on creating real-time predictive models to prevent this avoidable hospital-acquired injury. Furthermore, existing machine learning heuristics often fail to surpass traditional statistical models or provide individual-level risk assessments with explanations for each patient. Thus, we sought to compare the predictive performance of five machine learning and traditional statistical modeling techniques to predict the occurrence of Hospital Acquired Pressure Injuries (HAPI).MethodsElectronic Medical Record (EMR) information was collected from 57,227 hospitalizations, containing 241 positive HAPI cases, acquired from Dartmouth Hitchcock Medical Center from April 2011 to December 2016. The five classifiers were trained to predict HAPI incidence and performance was assessed using the C-statistic or Area Under the Receiver Operating Curve (AUC).ResultsLogistic Regression was the best modeling approach (AUC=0.91±0.034). We report discordance between predictors deemed important by the machine learning models compared to traditional statistical model. We provide means to visually assess factors important to every patient’s prediction, regardless of the modeling approach, through Shapley Additive Explanations.ConclusionsMachine learning models will continue to inform decision making processes but should be compared to traditional modeling approaches to ensure proper utilization. Disagreements between important predictors found by traditional and machine learning modeling approaches can potentially confuse clinicians and as such need to be reconciled. Future efforts to analyze time-stamped, prospective medical record data will be enhanced by patient-specific details. These developments represent important steps forward in developing real-time predictive models that can be integrated and readily deployed in electronic medical record systems to reduce unnecessary harm.
ACE2 and TMPRSS2 variants and expression as candidates to sex and country differences in COVID-19 severity in Italy
Authors: Asselta Rosanna , Paraboschi Elvezia Maria , Mantovani Alberto , Duga Stefano 
Published: April 2020

ABSTRACTBackgroundAs the outbreak of coronavirus disease 2019 (COVID-19) progresses, prognostic markers for early identification of high-risk individuals are an urgent medical need. Italy has the highest rate of SARS-CoV-2 infection, the highest number of deaths, and the highest mortality rate among large countries. Worldwide, a more severe course of COVID-19 is associated with older age, comorbidities, and male sex. Hence, we searched for possible genetic components of the peculiar severity of COVID-19 among Italians, by looking at expression levels and variants in ACE2 and TMPRSS2 genes, which are crucial for viral infection.MethodsExome and SNP array data from a large Italian cohort representative of the country’s population were used to compare the burden of rare variants and the frequency of polymorphisms with European and East Asian populations. Moreover, we looked into gene expression databases to check for sex-unbalanced expression.ResultsWhile we found no significant evidence that ACE2 is associated with disease severity/sex bias in the Italian population, TMPRSS2 levels and genetic variants proved to be possible candidate disease modulators, contributing to the observed epidemiological data among Italian patients.ConclusionsOur analysis suggests a role for TMPRSS2 variants and expression levels in modulating COVID-19 severity, a hypothesis that fosters a rapid experimental validation on large cohorts of patients with different clinical manifestations.
Wave Reflection: More Than A Round Trip
Authors: Afkhami Rashid , Johnson Sarah 
Published: April 2020

AbstractReflected pressure waves are key to the understanding of vascular ageing, a prominent factor in major cardiovascular events. Several different metrics have been proposed to index the effect of wave reflection on the pressure waveform and thereby serve as an indicator of vascular ageing. The extent to which these indices are influenced by factors other than vascular health remains a matter of concern. In this paper, we use transmission-line theory to derive a mathematical model for the reflection time (Trefl), and the augmentation index (AI), assuming a general extended model of the arterial system. Then, we test the proposed model against values reported in the literature. Finally, we discuss insights from the model to common observations in the literature such as age-related “shift” in the reflection site, the variation of AI with heart rate, and the flattening of Trefl in older participants.
SARS-CoV-2 receptor and entry genes are expressed by sustentacular cells in the human olfactory neuroepithelium
Authors: Fodoulian Leon , Tuberosa Joel , Rossier Daniel , Boillat Madlaina , Kan Chenda , Pauli Véronique , Egervari Kristof , Lobrinus Johannes A. , Landis Basile N. , Carleton Alan , Rodriguez Ivan 
Published: April 2020

AbstractVarious reports indicate an association between COVID-19 and anosmia, suggesting an infection of the olfactory sensory epithelium, and thus a possible direct virus access to the brain. To test this hypothesis, we generated RNA-seq libraries from human olfactory neuroepithelia, in which we found substantial expression of the genes coding for the virus receptor angiotensin-converting enzyme-2 (ACE2), and for the virus internalization enhancer TMPRSS2. We analyzed a human olfactory single-cell RNA-seq dataset and determined that sustentacular cells, which maintain the integrity of olfactory sensory neurons, expressACE2andTMPRSS2. We then observed that the ACE2 protein was highly expressed in a subset of sustentacular cells in human and mouse olfactory tissues. Finally, we foundACE2transcripts in specific brain cell types, both in mice and humans. Sustentacular cells thus represent a potential entry door for SARS-CoV-2 in a neuronal sensory system that is in direct connection with the brain.
SPONTANEOUS ECHO CONTRAST IN MITRAL STENOSIS: WHY AND HOW?
Authors: Bilgel Ziya Gokalp , Gullu Ibrahim Hakan , Hamad Saif , Kasar Mutlu , Erol Tansel , Demircan Senol , MUderrisoglu Haldun 
Published: April 2020

ABSTRACTBackgroundSpontaneous echo contrast(SEC) is an echocardiographic finding particularly found in left atrium of patients with mitral stenosis and known as a risk factor for stroke. However, its pathophysiology is not fully understood.Material and MethodForty-eight patients with mitral stenosis scheluded for percutaneous mitral valvuloplasty were included in the study. SEC was graded from 0 to 4 according to its density. Blood samples were taken from the aorta and left atrium during the procedure. Whole blood viscosity, plasma viscosity(PV) and peripheral blood smears were obtained and analysed separately from these sites. Prior to the procedure, all participants also underwent transthoracic and transesophageal echocardiography.ResultsSevere SEC(grade 3-4) was found in 23 patients(48%), remaining 25 patients(52%) had mild to moderate SEC(grade 0-1-2). The patients with atrial fibrillation(AF) and hypertension(HT) had more significantly severe SEC compared to other patients. Compared to patients with mild to moderate SEC, patients with severe SEC had increased age, body mass index, left atrial diameter, left atrial area and left atrial PV. However, ejection fraction, left atrial appendage(LAA) filling and emptying velocities, LAA lateral wall late systolic velocity, LAA fractional area change and pulmonary vein(PVe) systolic velocity were found to be significantly reduced in patients with severe SEC compared to mild to moderate SEC. On multiple linear regression analysis, AF, left atrium PV and left atrial diameter were the strongly correlated with SEC grade.ConclusionWe have shown that AF, HT, systolic dysfunction of LAA, increased left atrial dimensions, reduced ejection fraction, decreased PVe flow velocity and increased left atrial PV were related with the development of SEC in patients with mitral stenosis.
STABILITY ANALYSIS OF DISEASE FREE EQUILIBRIUM STATE (E0) FOR AN ENDEMIC DETERMINISTIC MODEL FOR HIV/AIDS
Authors: Victor A. O. , Oduwole H. K. 
Published: April 2020

AbstractThis paper focused on determining the asymptotical stability of the new model which establishes that a disease-free equilibrium state exists and is locally asymptotically stable when the basic reproduction number 0 ≤ R0 < 1 and the following threshold conditions (0 ≤ R1 < 1, 0 ≤ R2 < 1, 0 ≤ R3 < 1, 0 ≤ R4 < 1 and 0 ≤ R5 < 1, 0 ≤ R6 < 1, 0 ≤ R7 < 1, 0 ≤ R8 < 1) are satisfied. Results from the model analysis shows that the proportion of infected juvenile and adult sub-population in the presence of High Active Anteritroviral Therapy (HAART) drastically reduce to a zero (R0 = 0) as compared to the infected age-structured population when treatment rate is low and the net transmission rate is near zero.