bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Mathematics (and Metaphysics) of Identical Twins
Authors: Playford Richard 
Published: May 2020

The metaphysics of early embryos is a hotly debated topic in contemporary bioethics and metaphysics. Many contemporary Aristotelians believe that a human being is present from the moment of conception. At the same time, certain findings in modern embryology about the formation of identical twins challenge this belief. It becomes much harder when these theories are taken into account to understand the continued identity over time of the embryo(s) given the twinning process. In this article, I will consider the philosophical implications of two models of monozygotic twinning within an Aristotelian metaphysical schema one of which is the standard, or traditional, model. The other of which is a new model recently put forward by Herranz. For the sake of completeness, I will also consider the philosophical implications of chimeras for the Aristotelian position. I will explain how Aristotelians can understand the process of twinning while holding on to their belief that a human being is present from the moment of conception. Summary: I will argue that a human being is present from the moment of conception. I will argue for this on Aristotelian grounds, and I will then defend this claim from criticisms based on a number of findings in modern embryology.
Management Patterns in Pediatric Complicated Sinusitis
Authors: McDermott Sean M. , Onwuka Amanda , Elmaraghy Charles , Walz Patrick C. 
Published: May 2020

ObjectivesSinusitis is a common pediatric illness that can be complicated by periorbital or intracranial extension. Patients can be managed with antimicrobials alone or in conjunction with surgical intervention. This article examines management patterns and outcomes in pediatric patients presenting with complicated sinusitis.Study DesignCase series with chart review.SettingTertiary care pediatric hospital.Subjects and MethodsAn evaluation of 168 pediatric patients with complicated sinusitis with periorbital complications presenting at a single institution from 2008 to 2018 was performed. Demographics, disease characteristics, in‐hospital management, and outcomes were recorded and analyzed.ResultsThe most common complication was orbital cellulitis, seen in 49% of children. Surgical intervention occurred in 49% of patients, with 36% receiving medical therapy followed by surgery (MTS). Chandler I patients underwent surgical intervention 30% of the time, Chandler II patients 29%, and Chandler III patients 83%. Nineteen percent of initially nonoperative patients started on ampicillin‐sulbactam required MTS vs 57% of those started on other antibiotic regimens (P =. 01). Twelve percent of initially nonoperative Chandler I to II patients started on ampicillin‐sulbactam needed MTS vs 40% started on other antibiotic regimens. Hospital charges for operative patients were $45,056 vs $14,311 for nonoperative patients (P <. 01). Hospital charges for patients with surgery followed by medical therapy (SMT) were $45,563 vs $44,393 for MTS (P =. 92).ConclusionNonoperative early stage patients started on ampicillin‐sulbactam had a lower risk of MTS. MTS did not cost significantly more than SMT, and there were no significant outcome differences seen.
Subglottic Stenosis: Development of a Clinically Relevant Endoscopic Animal Model
Authors: Mady Leila J. , Criado Matthew , Park James , Baddour Khalil , Aral Ali Mubin , Roy Abhijit , Rigatti Lora Heather , Kumta Prashant N. , Chi David H. 
Published: May 2020

ObjectiveDevelop a clinically relevant and reproducible endoscopic animal model for subglottic stenosis amenable to testing of minimally invasive therapeutic modalities.Study DesignCohort study.SettingDivision of Laboratory Animals Research, University of Pittsburgh.Subjects and MethodsSubglottic stenosis was induced endoscopically via microsuspension laryngoscopy in 26 New Zealand white rabbits. A trimmed polypropylene brush connected to a novel electronic stenosis induction apparatus was used to create circumferential trauma to the subglottis. By using open source image analysis software, the cross‐sectional areas of the stenotic and native airways were compared to calculate the percentage of stenosis and the Myer‐Cotton classification grade.ResultsOf the 26 rabbits, 24 (92%) exhibited stenosis after the first attempt. The mean percentage of airway stenosis was 57% (range, 34%‐85%; SD, 15%). Five rabbits (19.2%) died on the day of stenosis induction from procedural complications. Of the 21 rabbits, 2 demonstrated no stenosis 7 days after initial injury and so underwent reinduction of airway injury, upon which they developed stenosis. Overall, 14 of the 21 rabbits (67%) exhibited moderate to severe stenosis (grade 2 or 3).ConclusionThe stenosis induction apparatus reliably induced stenosis with a low mortality rate as compared with that of other methods in the literature. The device could be improved to generate a predetermined potentially reproducible grade of stenosis as desired by the operator. This method sets the stage for a clinically relevant and reproducible subglottic stenosis disease model that is amenable to testing of minimally invasive treatment modalities.
Outpatient Otolaryngology in the Era of COVID‐19: A Data‐Driven Analysis of Practice Patterns
Authors: Kasle David A. , Torabi Sina J. , Savoca Emily L. , Judson Benjamin L. , Manes R. Peter 
Published: May 2020

IntroductionCoronavirus disease 2019 (COVID‐19) has induced a prioritization of acute care and telehealth, affecting the quantity of patients seen and the modality of their care.Study DesignRetrospective review.SettingSingle‐institution study conducted within the Division of Otolaryngology at the Yale School of Medicine.Subjects and MethodsData on all outpatient appointments within the Division of Otolaryngology were obtained from administrative records of billing and scheduling from March 16 to April 10, 2020. For comparison, a corresponding period from 2019 was also utilized.ResultsOf 5913 scheduled visits, 3665 (62.0%) were seen between March 18 and April 12, 2019, in comparison with 649 of 5044 (12.9%) during the corresponding COVID‐19–affected period. The majority of completed visits performed in weeks 1 and 2 were in person, while the majority in weeks 3 and 4 were via telehealth. Among subspecialties, a larger proportion of completed visits in 2020 were performed by pediatric and head and neck oncology otolaryngologists as compared with general/specialty otolaryngologists (P <. 001). Older adults (≥65 years) were less likely to have telehealth visits than younger adults (18‐64 years; 45.6% vs 59.6%, P =. 003).ConclusionsA major decrease in the completion rates of scheduled visits was seen in the COVID‐19–affected period, though this was not proportional among subspecialties. An associated increase in telehealth visits was observed. After COVID‐19–related hospital policy changes, approximately 2 weeks passed before telehealth visits surpassed in‐person visits, though this was not true among older adults.
Management of injuries near the innominate artery bifurcation using an accurate kissing Viabahn stent technique
Authors: Hu Shuang-Long , Wang Chun-Xin , Lu Hui-Jun , Yuan Ye 
Published: May 2020

Objective To evaluate the feasibility, safety, and efficacy of an accurate kissing Viabahn stent technique to manage injuries near the innominate artery bifurcation. Methods This retrospective study included patients with injuries near the innominate artery bifurcation who were treated with an accurate kissing Viabahn stent technique. Perioperative and follow-up data were extracted and analysed. Results A total of 10 patients were included (mean age, 52.8 years; six male and four female patients) with injuries at the following sites: the distal end of the innominate artery ( n = 2), the innominate artery bifurcation ( n = 5), the root of the right common carotid artery ( n = 2) and the origin of the right subclavian artery ( n = 1). All were successfully treated with the accurate kissing Viabahn stent technique. During follow-up (mean duration, 16.8 months), there were no complications, such as right upper limb ischaemia, neurological dysfunction, stent occlusion or migration. Conclusions The accurate kissing Viabahn stent technique to manage injuries near the bifurcation of the innominate artery was safe and effective, with good perioperative and long-term follow-up results.
Interval colorectal cancers after negative faecal immunochemical test in a 13-year screening programme
Authors: Zorzi Manuel , Hassan Cesare , Senore Carlo , Capodaglio Giulia , Turrin Anna , Narne Elena , Mussato Alessio , Rizzato Silvia , Chinellato Enrico , Zamberlan Sara , Repici Alessandro , Rugge Massimo 
Published: May 2020

Objective To assess faecal immunochemical test sensitivity for cancer in a very large population-based cohort followed up for six rounds with biennial faecal immunochemical test repetition. Methods This study is based on interval colorectal cancers diagnosed in a cohort of subjects aged 50–69 undergoing repeated faecal immunochemical test screening (six rounds) from 2002 to 2015. Test sensitivity was calculated using both the Proportional Interval Cancer Rate and the Interval Cancer Proportion method. Results Among 441,647 faecal immunochemical tests (123,347 individuals), 150 interval colorectal cancers were detected after a negative faecal immunochemical test. Interval colorectal cancer incidence rate was 1.87 per 10,000 person-years (95%CI: 1.60–2.20), and it was higher during the second interval year (rate ratio: 1.78; 95%CI: 1.28–2.47), for proximal locations (rate ratio: 3.00; 95%CI: 1.92–4.68), and among 60–71 year old subjects (rate ratio: 2.37; 95%CI: 1.61–3.50). The Proportional Interval Cancer Rate was 13.1%, with an overall faecal immunochemical test sensitivity of 86.9% (95%CI: 84.7–89.0). Sensitivity was lowest at the first round (81.5%; 95%CI: 75.6–86.2), and increased to 91.9% (95%CI: 83.9–96.5) for subsequent rounds. Applying the Interval Cancer Proportion method, sensitivity was 83.9% (95%CI: 81.3–86.2), and it was highest at the first round (89.0%; 95%CI: 85.7–91.6), ranging between 73% and 83.1% at subsequent rounds. Conclusions A faecal immunochemical test sensitivity for cancer higher than 80% resulted in a low incidence of interval colorectal cancers, representing an accurate estimate of one of the major limits of screening programmes. Due to intrinsic biases, the Proportional Interval Cancer Rate and the Interval Cancer Proportion methods generated different trends in faecal immunochemical test sensitivity by screening round.
Assessing Performance in Simulated Cleft Palate Repair Using a Novel Video Recording Setup
Authors: Podolsky Dale J. , Fisher David M. , Riff Karen W. Wong , Zuker Ronald M. , Drake James M. , Forrest Christopher R. 
Published: May 2020

Objective: To test the feasibility of implementing a high-fidelity cleft palate simulator during a workshop in Santiago, Chile, using a novel video endoscope to assess technical performance. Design: Sixteen cleft surgeons from South America participated in a 2-day cleft training workshop. All 16 participants performed a simulated repair, and 13 of them performed a second simulated repair. The repairs were recorded using a low-cost video camera and a newly designed camera mouth retractor attachment. Twenty-nine videos were assessed by 3 cleft surgeons using a previously developed cleft palate objective structured assessment of technical skill (CLOSATS with embedded overall score assessment) and global rating scale. The reliability of the ratings and technical performance in relation to minimum acceptable scores and previous experience was assessed. Results: The video setup provided acceptable recording quality for the purpose of assessment. Average intraclass correlation coefficient for the CLOSATS, global, and overall performance score was 0.69, 0.75, and 0.82, respectively. None of the novice surgeons passed the CLOSATS and global score for both sessions. One participant in the intermediate group, and 2 participants in the advanced group passed the CLOSATS and global score for both sessions. There were highly experienced participants who failed to pass the CLOSATS and global score for both sessions. Conclusions: The cleft palate simulator can be practically implemented with video-recording capability to assess performance in cleft palate repair. This technology may be of assistance in assessing surgical competence in cleft palate repair.
Costs and consequences of the Portuguese needle-exchange program in community pharmacies
Authors: Borges Margarida , Gouveia Miguel , Fiorentino Francesca , Jesus Gonçalo , Cary Maria , Guerreiro José Pedro , Costa Suzete , Carneiro António Vaz 
Published: May 2020

Background: Needle-exchange programs (NEPs) reduce infections in people who inject drugs. This study assesses the impact community pharmacies have had in the Needle-Exchange Program in Portugal since 2015. Methods: Health gains were measured by the number of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections averted, which were estimated, in each scenario, based on a standard model in the literature, calibrated to national data. The costs per infection were taken from national literature; costs of manufacturing, logistics and incineration of injection materials were also considered. The results were presented as net costs (i.e., incremental costs of the program with community pharmacies less the costs of additional infections avoided). Results: Considering a 5-year horizon, the Needle Exchange Program with community pharmacies would account for a 6.8% ( n = 25) and a 6.5% reduction ( n = 22) of HCV and HIV infections, respectively. The present value of net savings generated by the participation of community pharmacies in the program was estimated at €2,073,347. The average discounted net benefit per syringe exchanged is €3.01, already taking into account a payment to community pharmacies per needle exchanged. Interpretation: We estimate that the participation of community pharmacies in the Needle Exchange Program will lead to a reduction of HIV and HCV infections and will generate over €2 million in savings for the health system. Conclusions: The intervention is estimated to generate better health outcomes at lower costs, contributing to improving the efficiency of the public health system in Portugal.
Cytoplasmic levels of high mobility group A2 determine survival prognoses in breast cancer patients
Authors: Heilmann Thorsten , Vondung Florian , Borzikowsky Christoph , Krüger Sandra , Elessawy Mohamed , Alkatout Ibrahim , Wenners Antonia , Bauer Maret , Klapper Wolfram , Röcken Christoph , Maass Nicolai , Schem Christian , Trauzold Anna 
Published: May 2020

Background: High mobility group A proteins are involved in chromatin remodeling, thereby influencing multiple fundamental biological processes. HMGA2 has been linked to oncogenic traits among a variety of malignancies. Objective: To determine the prognostic implications of subcellular distribution patterns of HMGA2 in breast cancer. Methods: Nuclear and cytoplasmic HMGA2 was evaluated in 342 breast cancer specimens and matched with clinico-pathological parameters. Results: Overall and cytoplasmic, but not nuclear, levels of HMGA2 correlated with better survival prognoses in our collective (hazard ratio (HR) 0.34, P = 0.001 and HR 0.34, P < 0.001, respectively). The protective effect of cytoplasmic HMGA2 persisted in the Luminal A and triple negative breast cancer subgroups. Evaluating Luminal A and B subgroups jointly, only cytoplasmic, but not overall or nuclear HMGA2 levels were associated with better survival (HR 0.42, 95% confidence interval 0.21, 0.86, P = 0.017), irrespective of tumor size and node status. The addition of HMGA2 overall and cytoplasmic scores strengthened the prognostic selectivity in a model of conventional breast cancer risk factors. No predictive significance with regard to endocrine or chemoendocrine therapies was observed. Conclusion: Unexpectedly, we found a favorable survival probability upon overall levels of HMGA2 in our breast cancer collective, which was predominantly determined by the presence of HMGA2 in the cytoplasm.
HPV16 E6/E7 upregulate hTERC mRNA and gene amplification levels by relieving the effect of LKB1 on Sp1 phosphorylation in lung cancer cells
Authors: Yang Jing-Hua , Wu Ming-Zhe , Wang Xu-Bo , Wang Shiyu , Qiu Xue-Shan , Wang En-Hua , Wu Guang-Ping 
Published: May 2020

Background: There is an immediate need for research on the mechanism underlying telomerase activation and overexpression. Materials & Methods: A total of 174 patients with lung cancer ( n = 106) and benign lung disease ( n = 68) were recruited for the current study. The mRNA expression levels of E6, E7, LKB1, Sp1, and hTERC in brushing cells were detected by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR), and hTERC amplification was also detected by fluorescence in situ hybridization (FISH). To investigate the potential mechanism, bidirectional genetic manipulation was performed in well-established lung cancer cell lines. Results: Our results indicated that the mRNA expression levels of E6, E7, Sp1, and hTERC and the amplification level of hTERC were significantly increased in the malignant group compared with those of the benign group ( p < 0.01). Conversely, the mRNA expression level of LKB1 was significantly decreased in the malignant group ( p < 0.01). The correlation between E6, E7, Sp1, and hTERC expression was positive but was negative with LKB1 ( p < 0.01). Our results also showed that HPV16 E6/E7 downregulated the expression of LKB1 at both the protein and mRNA levels. The loss of LKB1 upregulated Sp1 expression, and also promoted Sp1 activity. Sp1 further upregulated hTERC at the mRNA and gene amplification levels. Thus, we proposed a HPV–LKB1–Sp1–hTERC axis of E6/E7 upregulation of hTERC expression. Conclusion: We demonstrated for the first time that E6 and E7 promoted hTERC mRNA expression and the amplification of hTERC by relieving the effect of LKB1 on the phosphorylation of Sp1. Sp1 further activated hTERC by directly binding to the promoter regions of hTERC.
Endoscopic ultrasound-guided drainage of difficult-to-access liver abscesses
Authors: Chin Yung Ka , Asokkumar Ravishankar 
Published: May 2020

Objectives: Antibiotic therapy and percutaneous drainage have been the first-line treatments for liver abscesses. However, percutaneous drainage of abscesses may be challenging in difficult-to-access locations such as the caudate lobe. The aim of this review was to determine the indications, technical feasibility and efficacy of endoscopic ultrasound-guided drainage of difficult-to-access liver abscesses. Methods: A literature review of original articles, abstracts, case series and case reports describing endoscopic ultrasound-guided liver abscess drainage was performed. The indications, techniques and complications associated with endoscopic ultrasound-guided drainage were reviewed. Results: A total of 15 studies were identified. The main indications were failed antibiotic therapy and difficulty in gaining percutaneous access. The technique involved identification and puncturing of an abscess under endoscopic ultrasound guidance followed by placement of a prosthesis via a guide wire. The technique was 97.5% successful with no major complications reported. Conclusion: Endoscopic ultrasound-guided drainage was feasible and safe and allowed complete drainage of liver abscesses not accessible by percutaneous drainage.
Morphometric analysis of medial and lateral tibia plateau and adaptability with Oxford partial knee replacement in a Japanese population
Authors: Kamenaga Tomoyuki , Hiranaka Takafumi , Hida Yuichi , Fujishiro Takaaki , Okamoto Koji 
Published: May 2020

Aims: In unicompartmental knee arthroplasty (UKA), tibial components must be correctly sized and positioned so that tibial cut surfaces are well covered without marked under- or overhang with impingement of the surrounding soft tissue. We used morphometric data of both medial and lateral tibial plateaus separately to plan UKA and evaluated the compatibility of the measurement data to the dimensions of six currently available tibial prostheses in a Japanese population. Materials and Methods: Using computed tomography, we preoperatively examined 60 patients (30 medial and 30 lateral osteoarthritis (OA)) scheduled for primary UKA at our hospital between 2013 and 2017. Each tibial cutting surface was measured in the transverse plane at 2 mm below the respective joint line. We used anteroposterior and mediolateral length to calculate the mediolateral length/anteroposterior ratio of both medial and lateral compartments. We then compared measurements across six current UKA systems: Oxford fixed tibia and fixed lateral tibia, Triathlon, TRIBRID, JOURNEY UNI, and HLS Uni Evolution. Results: We found no significant differences in morphometric data between the medial and the lateral OA. The cutting surface of lateral plateau, however, had smaller anteroposterior dimensions, greater mediolateral length, and higher mediolateral length/anteroposterior ratio than those of medial plateau. Therefore, in this Japanese population-based study, Oxford lateral tibia had good compatibility with the measurement data of lateral compartments. Conclusions: Lateral compartments had lower anteroposterior length, greater mediolateral length, and higher mediolateral length/anteroposterior ratio than those of medial compartments. We, therefore, strongly recommend using Oxford fixed lateral tibia for lateral OA over other current tibial prostheses because of superior coverage.
Direct oral anticoagulants for cancer-associated venous thromboembolism: a systematic review and meta-analysis
Authors: Mulder Frits I. , Bosch Floris T. M. , Young Annie M. , Marshall Andrea , McBane Robert D. , Zemla Tyler J. , Carrier Marc , Kamphuisen Pieter Willem , Bossuyt Patrick M. M. , Büller Harry R. , Weitz Jeffrey I. , Middeldorp Saskia , van Es Nick 
Published: May 2020

Abstract
Direct oral anticoagulants (DOACs) are an emerging treatment option for patients with cancer and acute venous thromboembolism (VTE), but studies have reported inconsistent results. This systematic review and meta-analysis compared the efficacy and safety of DOACs and low-molecular-weight heparins (LMWHs) in these patients. MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and conference proceedings were searched to identify relevant randomized controlled trials. Additional data were obtained from the original authors to homogenize definitions for all study outcomes. The primary efficacy and safety outcomes were recurrent VTE and major bleeding, respectively. Other outcomes included the composite of recurrent VTE and major bleeding, clinically relevant nonmajor bleeding (CRNMB), and all-cause mortality. Summary relative risks (RRs) were calculated in a random effects meta-analysis. In the primary analysis comprising 2607 patients, the risk of recurrent VTE was nonsignificantly lower with DOACs than with LMWHs (RR, 0.68; 95% CI, 0.39-1.17). Conversely, the risks of major bleeding (RR, 1.36; 95% CI, 0.55-3.35) and CRNMB (RR, 1.63; 95% CI, 0.73-3.64) were nonsignificantly higher. The risk of the composite of recurrent VTE or major bleeding was nonsignificantly lower with DOACs than with LMWHs (RR, 0.86; 95% CI, 0.60-1.23). Mortality was comparable in both groups (RR, 0.96; 95% CI, 0.68-1.36). Findings were consistent during the on-treatment period and in those with incidental VTE. In conclusion, DOACs are an effective treatment option for patients with cancer and acute VTE, although caution is needed in patients at high risk of bleeding.