bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adipose Tissue-preserved Skin Grafts for Lower Extremity Defects: Recommendations to Optimize Outcomes
Authors: Van Kouwenberg Emily A. , Chiu David T. W. 
Published: March 2020

Background:
Adipose tissue-preserved skin grafts (ATPSGs) are full-thickness skin grafts with inclusion of a thin layer of adipose tissue. ATPSGs are recommended for reconstruction of anatomic areas that are cosmetically sensitive and for areas that functionally benefit from additional soft tissue thickness compared to traditional skin grafts. Careful intraoperative technique and postoperative care are mandatory for ATPSG success, given the expected higher metabolic demands compared to traditional grafts. A strict postoperative protocol is especially important after reconstruction of lower extremity defects.

Methods:
Detailed descriptions of intraoperative and postoperative care for ATPSG reconstructions are provided. A case is presented displaying lower extremity reconstruction with an ATPSG. The intraoperative technique includes meticulous hemostasis of the recipient site, atraumatic handling of recipient skin edges, anatomical epidermal-to-epidermal reapproximation, avoidance of tissue strangulation during inset, and careful bolster placement. The postoperative protocol after lower extremity reconstruction includes strict elevation, non-weight-bearing status, and eventual dangle protocol.

Results:
An 85-year-old woman was treated with an ATSG for a middle-third leg resection of squamous cell carcinoma resulting in a 9 × 5 cm defect. The strict postoperative protocol was initiated, but the patient was noncompliant with elevation and weight-bearing restrictions. She had postoperative congestion and epidermolysis that was treated with local wound care without need for additional surgery.

Conclusions:
There are many benefits to ATPSG reconstruction when chosen for the appropriate candidate. The meticulous technique and strict adherence to the postoperative protocol are crucial when these reconstructions are performed. Detailed descriptions of intraoperative and postoperative recommendations to optimize outcomes after ATPSG are presented.
Associations between ideal blood pressure based on different BMI categories and stroke incidence
Authors: Zheng Liqiang , Xie Yanxia , Zheng Jia , Guo Rongrong , Wang Yali , Dai Yue , Sun Zhaoqing , Xing Liying , Zhang Xingang , Sun Yingxian 
Published: March 2020

Objectives:
The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for high blood pressure (BP) in adults redefined hypertension as SBP at least 130 mmHg or DBP at least 80 mmHg. However, the optimal BP for different BMI population to reduce stroke incidence is uncertain.

Methods:
A prospective cohort study was designed by four examinations: baseline (2004–2006), 2008, 2010 and 2017 follow-up. The study group composed of 36 352 individuals, to determine the ideal BP range to reduce stroke incidence of two BMI level, adjusted Cox proportional hazards models were utilized to establish the associations between SBP/DBP and the risk of stroke incident. Then, the restricted cubic spline regression was applied to find the ideal range of SBP/DBP values for two kinds of BMI categories definitions.

Results:
During a median follow-up period of 12.5 years, 2548 (7.0%) nonstroke individuals at baseline developed incident stroke. After fully adjusting confounding factors, SBP (per 20 mmHg increase) and DBP (per 10 mmHg increase) are independently associated with the risk of stroke incidence [SBP, hazard ratio = 1.277, 95% confidence interval (95% CI), 1.217–1.340, P < 0.001; DBP, hazard ratio = 1.138, 95% CI, 1.090–1.189, P < 0.001].

Conclusion:
Our study revealed that the ideal BP for a population with BMI less than 24 kg/m2 was less than 130/80 mmHg, whereas the ideal BP for BMI at least 24 kg/m2 was less than 120/80 mmHg. The sensitivity analyses between BMI less than 25 kg/m2 and BMI at least 25 kg/m2 showed similar findings. This finding provides more accurate primary prevention strategies based on various BMI populations.
EPIRETINAL FIBROSIS REMOVAL IN AN ARGUS II–IMPLANTED EYE
Authors: Patelli Fabio , Falleni Monica , Colombo Leonardo , Martinelli Carla , Tosi Delfina , Bulfamante Gaetano , Rossetti Luca 
Published: March 2020

Purpose:
1) To investigate morphologic and histochemical characteristics of an epiretinal fibrosis removed in an Argus II–implanted eye; 2) to evaluate the Argus II function before and after the fibrosis removal, and 3) to compare morphologic and functional data.

Methods:
Fibrosis, which developed between the Argus II prosthesis and the retina two years after implant, was surgically removed. Its morphologic and histochemical characteristics were evaluated both in light and transmission electron microscopy, with special stains and immunohistochemistry. The Argus II function was evaluated during the follow-up before surgical removal and 1 month later.

Results:
Fibrosis was successfully removed. It was composed of a fibrotic tissue with spindle cells arranged in nodular aggregates with a symmetric distribution, mixed with an inflammatory infiltrate. Extra- and intracellular, irregular, small iron particles were found and confirmed ultrastructural characterization with degenerative cellular changes. The repositioned Argus II restored, and its function was partially nearly to normal values 1 month after surgery.

Conclusion:
Fibrosis can develop between the Argus II and the retina with increasing reduced function. Morphologic characteristics of the removed fibrosis suggested a pathogenesis based on an inflammatory process involved in a foreign body reaction with progressing connective tissue deposition leading to sclerosis. Adequate clinical follow-up is critical to successful removal of the fibrosis with reactivation of the Argus II function.
Physical disuse contributes to widespread chronic mechanical hyperalgesia, tactile allodynia, and cold allodynia through neurogenic inflammation and spino-parabrachio-amygdaloid pathway activation
Authors: Ohmichi Yusuke , Ohmichi Mika , Tashima Ryoichi , Osuka Koji , Fukushige Kaori , Kanikowska Dominika , Fukazawa Yugo , Yawo Hiromu , Tsuda Makoto , Naito Munekazu , Nakano Takashi 
Published: March 2020

Abstract
Physical disuse could lead to a state of chronic pain typified by complex regional pain syndrome type I due to fear of pain through movement (kinesiophobia) or inappropriate resting procedures. However, the mechanisms by which physical disuse is associated with acute/chronic pain and other pathological signs remain unresolved. We have previously reported that inflammatory signs, contractures, disuse muscle atrophy, spontaneous pain-like behaviors, and chronic widespread mechanical hyperalgesia based on central plasticity occurred after 2 weeks of cast immobilization in chronic post-cast pain (CPCP) rat model. In this study, we also demonstrated dystrophy-like changes, both peripheral nociceptive signals and activation of the central pain pathway in CPCP rats. This was done by the following methods: (1) vascular permeability (Evans blue dye) and inflammatory- and oxidative stress-related messenger RNA changes (real-time quantitative polymerase chain reaction); (2) immunofluorescence of pERK and/or c-Fos expression in the spino-parabrachio-amygdaloid pathway; and (3) blockade of nociceptive-related signals using sciatic nerve block. Furthermore, we demonstrated tactile allodynia using an optogenetic method in a transgenic rat line (W-TChR2V4), cold allodynia using the acetone test, and activation of dorsal horn neurons in the chronic phase associated with chronic mechanical hyperalgesia using c-Fos immunofluorescence. In addition, we showed that nociceptive signals in the acute phase are involved in chronic pathological pain-like behaviors by studying the effects of sciatic nerve block. Thus, we conclude that physical disuse contributes to dystrophy-like changes, spontaneous pain-like behavior, and chronic widespread pathological pain-like behaviors in CPCP rats after 2 weeks of cast immobilization.
Increasing gender differences in the prevalence and chronification of orofacial pain in the population
Authors: Häggman-Henrikson Birgitta , Liv Per , Ilgunas Aurelia , Visscher Corine M. , Lobbezoo Frank , Durham Justin , Lövgren Anna 
Published: March 2020

Abstract
Although a fluctuating pattern of orofacial pain across the life span has been proposed, data on its natural course are lacking. The longitudinal course of orofacial pain in the general population was evaluated using data from routine dental check-ups at all Public Dental Health services in Västerbotten, Sweden. In a large population sample, 2 screening questions were used to identify individuals with pain once a week or more in the orofacial area. Incidence and longitudinal course of orofacial pain were evaluated using annual data for 2010 to 2017. To evaluate predictors for orofacial pain remaining over time, individuals who reported pain on at least 2 consecutive dental check-ups were considered persistent. A generalized estimating equation model was used to analyze the prevalence, accounting for repeated observations on the same individuals. In total, 180,308 individuals (equal gender distribution) were examined in 525,707 dental check-ups. More women than men reported orofacial pain (odds ratio 2.58, 95% confidence interval [CI] 2.48-2.68), and there was a significant increase in the prevalence of reported pain from 2010 to 2017 in both women and men. Longitudinal data for 135,800 individuals were available for incidence analysis. Women were at higher risk of both developing orofacial pain (incidence rate ratio 2.37; 95% CI 2.25-2.50) and reporting pain in consecutive check-ups (incidence rate ratio 2.56; 95% CI 2.29-2.87). In the northern Swedish population studied, the prevalence of orofacial pain increases over time and more so in women, thus indicating increasing differences in gender for orofacial pain.
Safety of Use of Clozapine in Patients With Schizophrenia With Comorbid Diabetes Mellitus
Authors: Grover Sandeep , Verma Meha , Chakrabarti Subho 
Published: March 2020

Abstract

Purpose/Background
To evaluate the outcome of diabetes mellitus among patients of schizophrenia who had diabetes mellitus before starting clozapine.

Methods
Clozapine data were screened to detect the patients who had diabetes mellitus before starting clozapine. Those who had diabetes mellitus before starting clozapine were taken up for the study.

Results
Of the 468 records screened, 28 patients (5.6%) had diabetes mellitus before starting clozapine. Among the 28 patients, 15 (53.6%) were females, and 13 (46.4%) were male. In three-fourths (75%) of the patients, clozapine was started while these patients were admitted to the inpatient unit. Twenty-six patients had type 2 diabetes mellitus and 2 patients had type 1 diabetes mellitus at the time of starting clozapine. Most patients also had deranged blood glucose levels at the time of starting clozapine and required close monitoring of blood glucose levels and also starting/continuation of antidiabetic medications. None of the patients developed diabetic ketoacidosis during the initial part of the treatment. At the mean follow-up duration of 16 months, most patients were on regular follow-up for more than 1 year, and their blood glucose levels were maintained close to the reference range. Majority of these patients showed good response to clozapine.

Conclusions
The present study suggests that presence of diabetes mellitus should not stop the clinicians to use clozapine among patients with schizophrenia. However, close monitoring of blood glucose levels must be done.
Effectiveness and safety of acupuncture in post-stroke depression (PSD)
Authors: Chen Baishu , Zhao Minhong , Chen Bin , Yang Zhaojun , Yu Xiaojiang , Lin Xueying , Fan Chun 
Published: March 2020

Abstract

Background:
Post-stroke depression (PSD) is the most common emotional problem after stroke. It can lower the quality of life and increase the recurrence and mortality. Pharmacological agents have been shown to treat PSD. However, the benefits of pharmacotherapy are debatable and the side-effects are significant. More and more clinical trials suggest that acupuncture plays an important role in patients with PSD. The primary purposes of the study are to conduct a Bayesian analysis of randomized trials to determine the effect of acupuncture and investigate the effect of several acupuncture therapies on PSD.

Methods:
We will retrieve articles from 5 English databases [PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials, and WHO International Clinical Trials Registry (TCTRP)] and 4 Chinese databases [Chinese National Knowledge Infrastructure (CNKI), Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database (CBM)]. The publication period will be from inception to January 2019. All randomized controlled trials that evaluate the safety and efficacy of acupuncture on PSD will be included. The primary outcomes will be the change in the degree of depression as measured by the Hamilton Depression Scale and Beck Depression Inventory. Two reviewers will separately extract the data and assess the risk of bias by using the Cochrane Collaboration's risk of bias tool. Bayesian analysis will be conducted to pool the effects of several acupunctures. The ranking probabilities for several acupunctures (simple acupuncture, fire needle, warm acupuncture, auriculo-acupuncture, or electroacupuncture) will be estimated by the surface under the cumulative ranking curve.

Result:
This study will provide reliable evidence for acupuncture on PSD.

Conclusion:
The results of this review will introduce a safe and effective treatment and provide reliable evidence to evaluate the effectiveness of several acupuncture therapies on PSD.
Trial registration number: CRD42019132725
Relationship of ankle-brachial index, vibration perception threshold, and current perception threshold to glycemic variability in type 2 diabetes
Authors: Zhang Chuangbiao , Tang Meili , Lu Xiaohua , Zhou Yan , Zhao Wane , Liu Yu , Liu Yan , Guo Xiujie 
Published: March 2020

Abstract
To explore the relationship of glycemic variability with lower extremity arterial disease (LEAD) and diabetic peripheral neuropathy (DPN).
Seventy-eight patients with type 2 diabetes were enrolled. All patients underwent 72-hour dynamic blood glucose monitoring and obtained mean amplitude of glycemic excursions (MAGE), mean of daily differences (MODD), standard deviation of blood glucose (SD), largest amplitude of glycemic excursion (LAGE), mean blood glucose (MBG), T≥10.0 (percentage of time for blood glucose levels ≥10.0 mmol/L), T≤3.9 (percentage of time for blood glucose levels ≤3.9 mmol/L), and other glycemic variability parameters. In the meanwhile, in order to explore the correlation of glycemic variability parameters with ankle-brachial index (ABI), vibration perception threshold (VPT), and current perception threshold (CPT), all patients underwent quantitative diabetic foot screening, including ABI for quantitative assessment of lower extremity arterial lesions and VPT and CPT for quantitative assessment of peripheral neuropathy.
Patients were divided into abnormal CPT group (n = 21) and normal CPT group (n = 57) according to the CPT values. Compared with the normal CPT group, abnormal CPT group showed significantly higher levels of HbA1c, longer duration of diabetes, and higher levels of T≤3.9 (P < .05). However, there was no significant difference of MAGE, SD, LAGE, MODD, and other glycemic variability parameters between abnormal CPT group and normal CPT group (P > .05). Pearson correlation analysis or Spearman correlation analysis showed that ABI negatively correlated with MBG, T≥10.0, SD, LAGE, and MAGE (P < .05), but no correlation of ABI with T≤3.9 and MODD (P > .05) was shown. VPT showed a positive correlation with T≥10.0 (P < .05), but no correlation with other glycemic variability parameters (P > .05). There was no correlation between the other CPT values and the glycemic variability parameters (P > .05), except that the left and right 250 Hz CPT values were positively correlated with T≤3.9 (P > .05).
The higher the blood glucose levels, the severer the degree of LEAD and DPN lesions; the higher the incidence of hypoglycemia, the severer the degree of DPN lesions; the greater the fluctuation of blood glucose, the severer the degree of LEAD lesions. However, the glycemic variability was not significantly correlated with DPN.
Elevated platelet distribution width predicts poor prognosis in hilar cholangiocarcinoma
Authors: Li Bei , Lu Jiong , Peng Ding-Zhong , Zhang Xin-Yi , You Zhen 
Published: March 2020

Abstract
Although the platelet distribution width (PDW) has been reported as a reliable predictor of prognosis in several types of cancer, to our knowledge the prognostic value of PDW in hilar cholangiocarcinoma (HC) has not been studied. The aim of the study was to investigate the prognostic value of PDW in HC patients. A retrospective analysis of 292 consecutively recruited HC patients undergoing radical resection with at least a 5-year follow-up. The optimal cutoff value of PDW was determined by receiver operating characteristic (ROC) curve. Survival analysis by the Kaplan–Meier method and the difference between the clinico-pathologic variables and survival was evaluated by log-rank analysis. Multivariate analysis identified independent prognostic risk factors of overall survival (OS). ROC curve analysis suggested that the optimal cutoff value for the PDW was 16.55. There were significant associations of high PDW with high white blood cell (P < .001) and high neutril-to-lymph ratio (P < .001). In a multivariate analysis, the PDW was an independent prognostic factor for overall survival (HR = 2.521, 95% CI 1.832–3.470, P < .001). In conclusions, our findings indicate that PDW may have clinical significance in predicting OS after surgery in HC patients.
Novice training
Authors: Wu Ching Feng , Paradela Marina , Wu Ching Yang , Mercedes de la Torre , Fernandez Ricardo , Delgado Maria , Fieira Eva , Hsieh Ming Ju , Chao Yin Kai , Yang Lan Yan , Pan Yu Bin , Gonzalez-Rivas Diego 
Published: March 2020

Abstract
The competency in video-assisted thoracoscopic (VATS) lobectomy is expected to be achieved after surgeons practiced 30 to 50 cases according to previous reports. Does single port video-assisted thoracoscopic (SPVATS) lobectomy have a steeper learning curve and being harder to perform correctly, leading to long development times and high defect rates?
From January, 2014 to February, 2017, 8 individual surgeons (3 were novices, 5 were pioneers in SPVATS surgery) submitted their cases chronologically to evaluate the learning curve of SPVATS lobectomy. Operating time (OT) was set as a surrogate marker for surgical competency. Postoperative outcomes and OT between the 2 groups were compared using propensity score matching (1:1 nearest neighbor). The learning curve for OT was evaluated using the cumulative sum (CUSUM) method.
In the entire study cohort, a total of 356 cases were included (93 in junior consultant group [group A], 263 in senior consultant group [group B]). There were no significant differences between the 2 groups in operative time, conversion rate, postoperative complication rate, 30 and 90 days mortality rate. After propensity-score matching (86 pairs), operative time was longer in group A (214.33 ± 62.18 vs 183.62 ± 61.25 minutes, P = .001). Two-year overall survival rate was similar among 2 groups (P = .409). Competency was reached after junior surgeon completed 30th case of SPVATS lobectomy.
SPVATS lobectomy is safe for the novice surgeon who wants to adopt this new surgical approach under well-developed training program. The learning curves for competence in SPVATS lobectomy are similar to VATS lobectomy in our series.
Evaluation of plasma D-dimer for the diagnosis in Chinese patients with hepatocellular carcinoma
Authors: Fang Ping , Du Lijun , Cai Decheng 
Published: March 2020

Abstract

Background:
To evaluate the value of plasma D-dimer levels for the diagnosis of hepatocellular carcinoma (HCC).

Methods:
The following databases were searched for relevant studies published from 1990 to 2018: Wanfang Data, SinoMed, VIP Chinese Science and Technology Periodicals Database, China National Knowledge Infrastructure, Superstar Journals Database, Cochrane library, and PubMed. The studies were selected according to the diagnosis of HCC by plasma D-dimer levels. Quality assessment of the diagnostic accuracy of the studied items was conducted for rigorous quality evaluation of the studies that met the inclusion criteria. After extracting the relevant data, Stata 15.0 software was adopted for the analysis of the diagnostic odds ratio (DOR), sensitivity, specificity, and positive and negative likelihood ratios. A summary receiver operating characteristic (SROC) curve was constructed to comprehensively evaluate the value of plasma D-dimer levels for the diagnosis of HCC.

Results:
A total of 6 studies conducted in China with 475 cases in the patient groups and 727 in the control groups were included. The confidence level was expressed as the 95% confidence interval (CI). The pooled sensitivity, specificity, positive and negative likelihood ratios, and DOR of plasma D-dimer levels for the diagnosis of HCC were 0.75 (95% CI = 0.66–0.82), 0.93 (95% CI = 0.86–0.97), 11.4 (95% CI = 5.3–24.5), 0.27 (95% CI = 0.20–0.36), and 42 (95% CI = 19–93), respectively. The area under the SROC curve was 0.88 (95% CI = 0.85–0.91).

Conclusions:
Plasma D-dimer has high sensitivity and specificity, and is expected to be an important plasma marker for the clinical diagnosis of HCC. Due to the limited quality and quantity of the included studies, the above results should be further validated.
Selective nerve root block combined with posterior percutaneous cervical endoscopic discectomy for cervical spondylotic radiculopathy with double nerve root variation
Authors: Yu Tong , Zhang Jun , Wu Jiu-Ping , Yu Hai-Chi , Tian Hai-Qing , Luo Su-Li , Liu Qin-Yi 
Published: March 2020

Abstract

Rationale:
The aim of this report is to present the technique of selective nerve root blockage combined with posterior percutaneous cervical endoscopic discectomy (PPECD) for cervical spondylotic radiculopathy (CSR).

Patient concerns:
A 49-year-old female has pain in the skin area of the left scapular, pain in left elbow and limitation of left upper limb movement for 1.5 years.

Diagnosis:
She was diagnosed with CSR and C6-7 double nerve root variation.

Interventions:
We used selective nerve root block to determine the lesion segment and applied PPECD to relieve pressure on the patient's nerve roots.

Outcomes:
The pain symptoms disappeared after the patient was treated with C6-7 nerve root block. Endoscopic displayed C6-7 double nerve root variation on the left side of the spinal cord intraoperative. The neurological function was intact postoperatively and no recurrence of cervical disc herniation during the 5 months’ follow-up period. The hospitalization time was 5 days, the operation time was 68.2 minutes and the bleeding volume was 52.6 ml. There was no change in cervical curvature and cervical disc height postoperatively. Japanese Orthopaedic Association score, SF-36 score and Visual Analogue Scale score improved significantly postoperatively.

Lessons:
The application of selective nerve root blockage combined with PPECD for CSR could achieve satisfactory effect of position and decompression of the injured nerve root. Besides, we recommend that surgery be performed under general anesthesia to minimize patients’ emotional stress and discomfort.