bluuebunny/crossref_metadata_2025_split huggingface dataset:
Occipitocervical fusion combined with 3-dimensional navigation and 3-dimensional printing technology for the treatment of atlantoaxial dislocation with basilar invagination
Authors: Yuan Tianyang , Jia Guoliang , Yang Lili , Xu Derui , Zhang Jun , Liu Qinyi 
Published: January 2020

Abstract

Introduction:
Basilar invagination (BI) is a common deformity in the occipitocervical region. The traditional surgical method of BI is direct transoral decompression followed by posterior decompression and fixation. Posterior-only decompression and fixation have achieved good efficacy in the treatment of BI in recent years, but complications are common due to the operation in the upper cervical vertebra and the medulla oblongata region. Moreover, posterior-only occipitocervical fusion combined with an intraoperative 3-dimensional (3D) navigation system is relatively rare, and reports of this procedure combined with 3D printing technology have not been published. We present a case of BI treated with posterior-only occipitocervical fusion combined with 3D printing technology and 3D navigation system to reduce the risk of surgical complications.

Patient Concerns:
A 55-year-old patient with a history of neck pain and numbness of the extremities for 6 years developed a walking disorder for 1 year.

Diagnoses:
Atlantoaxial dislocation with BI.

Interventions:
The patient underwent posterior-only occipitocervical fusion combined with intraoperative 3D navigation system and 3D printing technology.

Outcomes:
The patient's walking disorder was resolved and he was able to walk approximately 100 m by himself when he was allowed to get up and move around with the help of a neck brace. At 6 months postoperatively, the patient reported that the numbness of the limbs was reduced, and he could walk >500 m by himself.

Conclusion:
Occipitocervical fusion is one of the established techniques for the treatment of BI. The biggest advantage of the 2 technologies was that it ensured precise implant placement. The advantages of intraoperative 3D navigation systems are as follows: real-time intraoperative monitoring of the angle and depth of implant placement; the best nailing point can be determined at the time of implantation, rather than according to the operator's previous experience; and the extent of screw insertion is visible to the naked eye, rather than being dependent on the “hand feel” of the surgeon. At the same time, the 3D printing technology can be applied to clarify the relationship between blood vessels and bone around the implant to minimize injury to important structures during implantation.
Effects of lung protective ventilation on postoperative pulmonary outcomes for prolonged oral cancer combined with free flap surgery
Authors: Cheng Chia-Dan , Lin Wei-Lin , Chen Yuan-Wu , Cherng Chen-Hwan 
Published: January 2020

Abstract
The intraoperative lung protective ventilation with low tidal volume, positive end expiratory pressure (PEEP) and intermittent lungs recruitment was found to decrease postoperative pulmonary complications. In this retrospective medical records study, we investigated the effects of lung protective ventilation on postoperative pulmonary outcomes among the patients received prolonged oral cancer combined with free flap surgery.
We collected the medical records of the patients received oral cancer surgery with the operation time more than 12 hours from January 2011 to December 2015. We recorded
Fifty nine cases were included. Thirty cases received the lung protective ventilation and 29 cases received conventional ventilation. Compared to the patients received conventional ventilation, the patients received intraoperative lung protective ventilation showed
In conclusion, for the prolonged oral cancer combined with free flap surgery, the intraoperative lung protective ventilation improves postoperative pulmonary outcomes and decreases the duration of ICU stay.
Nondrug therapies for hypertensive patients complicated with cervical spondylosis
Authors: Wang Xinyi , Ju Jianqing , Xu Hao 
Published: January 2020

Abstract

Purpose:
The aim of this study was to systematically evaluate the efficacy and safety of nondrug therapies for hypertensive patients complicated with cervical spondylosis.

Methods:
Randomized controlled trials (RCTs) concerned with nondrug therapies for hypertensive patients complicated with cervical spondylosis were identified by searching 5 English and Chinese databases. Study selection, data extraction, and risk of bias assessment were conducted independently by 2 authors. RevMan 5.3 software was used for meta-analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval (CI).

Results:
A total of 13 studies involving 929 patients were included. The majority of the included trials were assessed to be of high clinical heterogeneity and high risk of bias. The results of meta-analysis showed that there was a significant improvement in the effectiveness rate of cervical vertebra symptoms (RR = 1.67, 95% CI [1.33, 2.10], P < .0001), effectiveness rate of blood pressure lowering (RR = 1.35, 95% CI [1.06, 1.71], P = .02), systolic blood pressure reduction (MD = −11.05, 95% CI [−14.12, −7.98] mmHg, P < .0001), and diastolic blood pressure reduction (MD = −6.96, 95% CI [−8.89, −5.04] mmHg, P < .00001). Nondrug therapies had no significant difference compared with drugs in the effectiveness rate of overall improvement (RR = 1.3, 95% CI [0.93, 1.82], P = .12). There were no serious adverse effects related to nondrug therapies in the included trials.

Conclusion:
The results show sound advantages of nondrug therapies over conventional medicine or sham procedure in efficacy. However, the evidence remains weak because of the high clinical heterogeneity and high risk of the included trials. Therefore, further thorough investigation, large-scale, proper-designed, randomized trials of nondrug therapies for hypertension complicated with cervical spondylosis are warranted.

Prospero registration number:
CRD2019123175.
Prognostic value of 18F-FET PET/CT in newly diagnosed WHO 2016 high-grade glioma
Authors: Dissaux Gurvan , Basse Victor , Schick Ulrike , EL Kabbaj Osman , Auberger Benjamin , Magro Elsa , Kassoul Aboubakr , Abgral Ronan , Salaun Pierre-Yves , Bourhis David , Querellou Solène 
Published: January 2020

Abstract

O-(2-[18F]fluoroethyl)-l-tyrosine positron-emission tomography/computed tomography (18F-FET PET/CT) is well known in brain tumor management. Our study aimed to identify the prognostic value of 18F-FET PET/CT in high-grade gliomas (HGG) according the current 2016 World Health Organization (WHO) classification.
Patients with histologically proven WHO 2016 HGG were prospectively included. A dynamic 18F-FET PET/CT was performed allowing to obtain 2 static PET frames (static frame 1: 20–40 minutes and static frame 2: 2–22 minutes). We analyzed static parameters (standard uptake value [SUV]max, SUVmean, SUVpeak, TBRmax, TBRmean, tumoral lesion glycolysis, and metabolic tumoral volume) for various isocontours (from 10% to 90%). PET parameters, clinical features, and molecular biomarkers were compared with progression-free survival (PFS) and overall survival (OS) in univariate and multivariate analysis.
Twenty-nine patients were included (grade III n = 3, grade IV n = 26). Mean PFS and OS were, respectively, 8.8 and 13.9 months. According to univariate analysis, SUVmean, SUVpeak, TBRmax, and TBRmean were significantly correlated with OS. In static 1 analysis, TBRmax seemed to be the best OS prognostic parameter (P = .004). In static 2 analysis, TBRmean was the best parameter (P = .01). In static 1 analysis, only SUVpeak was significant (P = .05) for PFS. Good performance status (PS < 2; P < .0001) and extent of resection (P = .019) identified the subgroup of patients with the best OS. Only TBRmax (P = .026) and extent of resection (P = .025) remained significant parameters in multivariate analysis.
Our data suggested that high TBRmax seemed to be the most significant OS independent prognostic factor in patients with newly diagnosed HGG.
Shallow periorbital injection of triamcinolone acetonide in treatment of lower eyelid entropion related to thyroid-associated ophthalmopathy
Authors: Mo Fei , Xu Dongdong , Xu Haiyan , Li Gang , Gao Yizhuo , Li Hui 
Published: January 2020

Abstract

Introduction:
Entropion and secondary trichiasis can lead to irritative symptoms and essential damage of ocular surface. There is no literature reporting the lower eyelid entropion related to thyroid-associated ophthalmopathy (TAO), let alone the treatment. Treatment based on etiology may yield effective and sustained results. We report 3 case reports of lower eyelid entropion associated with TAO, and provide an effective and persistent alternative to cure this entropion via the administration of shallow periorbital injections of triamcinolone acetonide (TA).

Patient concerns:
Three patients presented irritative symptoms of ocular surface and diplopia.

Diagnosis:
According to thyroid dysfunction, physical examination, and imaging findings of extraocular muscle involvement, TAO and unilateral or bilateral lower eyelid entropion were diagnosed.

Interventions:
We administered shallow periorbital injections of TA to the affected eye at 3- to 4-week intervals depending on clinical response.

Outcomes:
All patients underwent complete correction of the lower eyelid entropion and no recurrence was found.

Conclusion:
The cause of lower eyelid entropion related to TAO might be the immunoinflammatory reaction of the lower eyelid retractors, enhancing the traction of pulling the lower eyelid inferoposteriorly. This condition can be treated with shallow periorbital injections of TA. Histopathological evidence and randomized controlled trials are expected to confirm our hypothesis.
Study of the rational dose of propofol in elderly patients under bispectral index monitoring during total intravenous anesthesia
Authors: Jia Lina , Hou Jiachen , Zheng Haibo , Sun Lihua , Fan Yingying , Wang Xu , Hao Mingyue , Li Yue , Yang Tongwei 
Published: January 2020

Abstract

Background:
Propofol has been used widely as an anesthetic for elderly patients; however, the drug instructions only indicate that the need for maintenance of general anesthesia in elderly patients is reduced, and not the extent of the reduction. This study has summarized the usage of propofol in total intravenous anesthesia under bispectral index (BIS) monitoring and determined the optimum dosage of propofol for elderly patients.

Methods:
The study comprised 156 patients undergoing elective surgery under general anesthesia divided into 2 groups according to their age: the elderly group (O group) and nonelderly group (Y group). BIS monitoring was used in both groups during the operation, and propofol and remifentanil were used to maintain anesthesia. The preoperative special conditions, intraoperative maintenance of propofol, remifentanil, fentanyl, cis-atracurium, vasoactive drug use, and hemodynamic changes were summarized.

Results:
Propofol maintenance in the O group was 3.372 ± 0.774 mg/(kg h), which was significantly lesser than that in Y group (P < 0.05). The incidence of cardiovascular and cerebrovascular diseases and the use rate of vasoactive drugs in the O group were significantly higher than in the Y group (P < 0.05).

Conclusion:
Propofol maintenance in the O group was significantly lower than that in the nonelderly group; this indicates that the anesthetic drug delivery rate for elderly patients should be reduced.
Normative values for Glazer Protocol in the evaluation of pelvic floor muscle bioelectrical activity
Authors: Oleksy Łukasz , Wojciechowska Małgorzata , Mika Anna , Antos Elżbieta , Bylina Dorota , Kielnar Renata , Pruszczyński Błażej , Stolarczyk Artur 
Published: January 2020

Abstract
The aim of the study was to evaluate pelvic floor muscle bioelectrical activity in healthy, young, and nulliparous women, and to present normative values for all phases and parameters measured with the Glazer Protocol.
In this study, 96 healthy, young, nulliparous women (age 22–27 years; 168.6 ± 5.1 cm; 57.1 ± 11.8 kg) were tested. The bioelectrical activity of the pelvic floor muscles was collected using an endovaginal electrode with the Glazer Protocol, which included the following series of muscles contractions and relaxations: pre-baseline rest, phasic contractions, tonic contractions, isometric contractions for muscle endurance evaluation, and post-baseline rest.
The following normative values of the bioelectrical signal for all phases of the Glazer Protocol were calculated: mean, minimal, and maximal values, 95% confidence interval, standard deviation, 95% standard deviation confidence interval, variance, coefficient of variation, and standard error of measurement. Average Mean Amplitude (μV) was as follows: pre-baseline rest (6.26 ± 3.33 μV), phasic contractions (49.76 ± 26.44 μV), tonic contractions (37.05 ± 25.99 μV), endurance contraction (16.10 ± 6.68 μV), and post-baseline rest (6.93 ± 3.99 μV).
This study was the first in which normative values for all phases of the Glazer Protocol were reported. This protocol is very often used in electromyography devices as a tool for pelvic floor muscle assessment. Due to the fact that the interpretation of the pelvic floor muscle evaluation is complex and difficult, the authors believe that the normative values proposed in this study allow for comprehensive interpretation of this test (both qualitatively and quantitatively) and provide a reference point for parameters measured in women with different pelvic floor dysfunctions.
Correlation between the caries status of the first permanent molars and the overall DMFT Index
Authors: Pontigo-Loyola América Patricia , Márquez-Corona María de Lourdes , Minaya-Sánchez Mirna , Lucas-Rincón Salvador Eduardo , Casanova-Rosado Juan Fernando , Robles-Minaya José Luis , Casanova-Sarmiento Juan Alejandro , Casanova-Rosado Alejandro José , Mendoza-Rodriguez Martha , Medina-Solís Carlo Eduardo 
Published: January 2020

Abstract
To analyze whether a correlation exists between the caries status (Decayed, Missing and Filled Teeth, DMFT Index) of the first permanent molars (FPMs) and that of the full permanent dentition of Mexican adolescents, and to propose its use in large epidemiological studies of dental caries.
We conducted a cross-sectional study of 1538 adolescents from 12 to 15 years old. Based on a clinical oral examination, we determined the DMFT Indices of their FPMs (FPM-DMFT) and of their full permanent dentition (comprehensive DMFT Index). We explored each FPM to determine whether it was with or without caries, filled, missing or sealed. For our statistical analysis, we used Fisher exact test and Spearman correlation in Stata software.
After examining a total of 6157 FPMs, we found that 56.8% of our sample of adolescents had no caries in their 4 FPMs whereas 4.9% experienced caries in all 4. No significant differences emerged by sex (P > .05); however, by age, the older adolescents experienced greater FPM-DMFT (P < .05). Analysis yielded a correlation of r = 0.8693 between the FPM-DMFT and comprehensive DMFT scores (P < .0001) of participants. The underestimation of caries prevalence (DMFT > 0) was 5.4% (48.6% vs 43.2%), while the DMFT Index was underestimated at 0.34 (1.15 vs 0.81).
The strong correlation between the FPM-DMFT and comprehensive DMFT Indices suggests that overall caries status can be inferred on the basis of FPM caries status. This evidence is useful when conducting large epidemiological studies such as national surveys.
Medicaid Expansion Reduced Emergency Department Visits by Low-income Adults Due to Barriers to Outpatient Care
Authors: Chou Shih-Chuan , Gondi Suhas , Weiner Scott G. , Schuur Jeremiah D. , Sommers Benjamin D. 
Published: January 2020

Background:
Prior studies have found conflicting effects of Medicaid expansion on emergency department (ED) utilization but have not studied the reasons patients go to EDs.

Objectives:
Examine the changes in reasons for ED use associated with Medicaid expansion.

Research Design:
Difference-in-difference analysis.

Subjects:
We included sample adults from the 2012 to 2017 National Health Interview Survey who were US citizens and reported a total family income below 138% federal poverty level (n=30,259).

Measures:
We examined changes in the proportion of study subjects reporting: (1) any ED visits; (2) ED visits due to perceived illness severity; (3) office not open; and (4) barriers to outpatient care, comparing expansion and nonexpansion states.

Results:
Overall, 30.6% of low-income adults reported ED use in the past year, of which 74.1% reported illness acuity, 12.4% reported office not open, 9.5% reported access barriers, and 4.0% did not report any reason. Medicaid expansion was not associated with statistically significant changes in overall ED use [−2.2% (95% confidence interval—CI), −5.5% to 1.2%), P=0.21], ED visits due to perceived illness severity [0.5% (95% CI, −2.4% to 3.5%), P=0.73], or office not open [−0.9% (95% CI, −2.3% to 0.5%); P=0.22], but was associated with significant decrease in ED visits due to access barriers [−1.4% (95% CI, −2.6% to −0.2%), P=0.022].

Conclusions:
Medicaid expansion was associated with a decrease in low-income adults who reported outpatient care barriers as reasons for ED visits. There were no significant changes in overall ED utilization, likely because the majority of respondent reported ED use due to concerns with illness severity or outpatient office was closed.
Shared Decision-Making
Authors: Treiger Teresa M. 
Published: January 2020

Purpose/Objectives:
Despite improved access to information, many people are neither engaged in their health care nor in the decision-making process. As the hub of care coordination, case managers are perfectly positioned to participate in and support shared decision-making (SDM) efforts. This article addresses SDM from a case management perspective.
The objectives are to

Primary Practice Setting(s):
Applicable to all health care sectors where professional case management is practiced.

Findings/Conclusions:
Communication skill is an essential case management competency. Shared decision-making is a communication process in which a case manager and a client collaborate to make the best health care decisions based on what matters most to the client. Case managers must undertake education and training to become fluent in shared decision-making as a core feature of person-centered, professional practice.

Implications for Professional Case Management Practice:
Professional case managers must understand the concept and principles of shared decision-making as applies in their practice as well as their responsibilities to support care team colleagues using shared decision-making concepts. Organizations should incorporate shared decision-making language in program descriptions, individual performance plans, satisfaction surveys, and department/organization goals.
Sclerotherapy With OK-432 for the Treatment of Symptomatic Lymphocele After Lymph Node Dissection
Authors: Uyulmaz Semra , Puippe Gilbert , Büyükakyüz Nilgün , Giovanoli Pietro , Pfammatter Thomas , Lindenblatt Nicole 
Published: January 2020

Objective
This study aimed to determine the benefits of sclerotherapy with OK-432 for the treatment of postoperative chronic lymphocele.

Background
Postoperative chronic lymphocele formation is common and accounts for a high postoperative morbidity. Nonsurgical strategies comprise repetitive percutaneous fluid aspiration or percutaneous sclerotherapy. OK-432 has been used to treat congenital lymphatic malformations with several reports of promising results. We hypothesized that it is more beneficial than repetitive percutaneous fluid aspiration for the treatment of symptomatic lymphocele.

Methods
Two cohorts of melanoma patients who developed recurrent lymphocele after lymph node dissection from January 2013 to August 2017 were compared. The first cohort was treated with repetitive percutaneous fluid aspiration (n = 20). The second cohort received OK-432 sclerotherapy (n = 20). Primary end points were overall treatment duration, number of treatment sessions, and the clinical success in both cohorts. Secondary end points were surgical site infection rate, need for additional antibiotic treatment, wound healing disorders, and the need for revision surgery.

Results
Mean overall duration of treatment with sclerotherapy was significantly shorter than with repetitive aspiration (9.4 ± 7.2 vs 47.5 ± 31.9 days, P < 0.01). Mean number of sclerotherapy treatment sessions were 2.5 ± 1.2. Clinical success with OK-432 was 19 of 20, and that with repeated aspiration was 7 of 20 (χ2 = 15.82, P < 0.001). No surgical site infection occurred in the sclerotherapy cohort, which was significantly lower than those treated with repetitive aspiration (P < 0.03). Surgical revision was mandatory in 12 of 20 patients who were treated with repetitive aspiration, and only 1 of 20 patients in the sclerotherapy cohort.

Conclusion
Sclerotherapy with OK-432 for the treatment of postoperative lymphocele is highly beneficial with a significant reduction of morbidity and the overall treatment time compared with repetitive aspiration.
The neoantigen landscape of mycosis fungoides
Authors: Sivanand A , Hennessey D , Iyer A , O’Keefe S , Surmanowicz P , Vaid G , Gniadecki R 
Published: January 2020

AbstractBackgroundMycosis fungoides (MF), the most common type of cutaneous T-cell lymphoma, has a dismal prognosis in advanced stages. Treatments for advanced disease are mostly palliative and MF remains incurable. Although MF is a known immunogenic neoplasm, immunotherapies such as interferons and the immune checkpoint inhibitors yield inconsistent results. Since the number, HLA-binding strength and subclonality of neoantigens are correlated with the therapeutic responses, we aimed here to characterize the landscape of neoantigens in MF.MethodsWe conducted whole exome and whole transcriptome sequencing of 24 MF samples (16 plaque, 8 tumour) from 13 patients. Bioinformatic pipelines (Mutect2, OptiType, MuPeXi) were used forin silicomutation calling, HLA typing, and neoantigen prediction. Phylogenetic analysis was used to subdivide the malignant cell population into stem and clades (subclones). Clonality of neaontigens was determined by matching neoantigens to the stem and clades of the phylogenetic tree of each MF sample.ResultsMF has a high mutational load (median 3217 non synonymous mutations), resulting in a significant number of total neoantigens (median 1309 per sample) and high-affinity neoantigens (median 328). In stage I disease most neoantigens were clonal but with progression to stage II, subclonal neoantigens comprised >50% of the total. There was very little overlap in neoantigens across patients or between different lesions on the same patient, indicating a high degree of genetic heterogeneity.ConclusionsAnalysis of the neoantigen landscape of MF revealed a very high neoantigen load and thus a significant immunogenic potential of this lymphoma. However, neoantigenic heterogeneity and significant subclonality might limit the efficacy of immunotherapy. We hypothesize that neoantigen number and subclonality might be useful biomarkers determining sensitivity to immunotherapeutic strategies.