bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combination of CAD/CAM and Augmented Reality in Free Fibula Bone Harvest
Authors: Battaglia Salvatore , Badiali Giovanni , Cercenelli Laura , Bortolani Barbara , Marcelli Emanuela , Cipriani Riccardo , Contedini Federico , Marchetti Claudio , Tarsitano Achille 
Published: November 2019

Summary:
The CAD/CAM technology for mandibular reconstruction has improved the results in terms of outcomes in restoring mandibular complex defects. Augmented reality (AR) represents an evolution of the navigation-assisted surgery. This technology merges the images of the virtual planning with the anatomy of the patient, representing in this way an enhanced scene for the surgeon’s eye. AR can also display in a single scene additional information for the surgeon. Despite of classical navigation, this scenario can be obtained with marker-less registration method, without using reference points or fiducial markers. This technologic evolution together with the large use in our experience of CAD/CAM protocol for mandibular reconstruction we developed this feasibility study to evaluate the possibility of using a marker-less image registration system. Moreover, we tried to evaluate the overlaying of the virtual planning and its reproducibility using AR. We performed a case series of 3 consecutive patients who underwent mandibular reconstruction using AR-assisted fibular free flap harvesting applying our digital workflow. Once launched, the mobile app installed on our tablet, the registration is performed according to a shape recognition system of the leg of the patient, rendering in real time a superimposition of the anatomy of the bony, vascular, and skin of the patient and also the surgical planning of the reconstruction. AR-assisted fibular free flap harvesting was performed. We believe that AR can be a prospective improving technology for mandibular complex reconstruction.
Magnetic Resonance Imaging Volumetry of Facial Muscles in a Face Transplant Recipient
Authors: Kantar Rami S. , Wake Nicole , Alfonso Allyson R. , Rifkin William J. , Ramly Elie P. , Diaz-Siso J. Rodrigo , Rodriguez Eduardo D. 
Published: November 2019

Summary:Face transplantation has evolved into a viable reconstructive option for patients with extensive facial disfigurement. Because the first face transplant procedure was described in 2005, the safety and feasibility of the procedure have been validated, and the focus of the field has shifted toward refining functional and esthetic outcomes. Recovery of muscle function following facial transplantation is critical to achieving optimal facial function and restoring facial expression. Assessment of facial muscle function in face transplant recipients has traditionally relied on clinical evaluation. In this study, we describe longitudinal changes in facial muscle volumes captured through quantitative magnetic resonance imaging in a face transplant recipient and compare these findings with functional outcomes evaluated through clinical assessment.
Assessment of Patient Radiation Dose during Conventional Diagnostic X-ray Examinations in Three Public Hospitals in Northern Jordan using TLDs
Authors: Ababneh Zaid Q. , Ababneh Anas M. , Bani Hani Majd S. , Ababneh Riad S. , Aljarrah Khaled M. 
Published: November 2019

Abstract
This study aims to measure entrance surface doses during routine chest and abdomen x-ray examinations of adult and child patients. Radiation dose measurements were performed using thermoluminescent dosimeters TLD-100s in three major public hospitals in northern Jordan on a total of 100 patients. Wide variations in entrance surface doses were observed within and between hospitals, which might be attributed to significant variations of the selected exposure parameters. For adult patients, the results have shown that the majority of entrance surface dose values from both chest and abdomen examinations were within recommended values of diagnostic reference levels. For child patients, the mean entrance surface dose from chest examinations in three age groups were 0.131 mGy (0–1 y), 0.136 mGy (1–5 y), and 0.191 mGy (5–10 y). These values were considered relatively high compared to the European reference levels and published results in the literature. However, for abdomen examinations, entrance surface dose values were relatively lower than European reference levels. Patient effective doses were estimated using a PCXMC 2.0 Monte Carlo program. The results for both adults and children were found to be relatively lower than the values reported by international publications. Due to the wide variations of entrance surface dose and the higher radiation doses delivered to child patients, this study recommends implementing a quality assurance program in such hospitals to achieve optimization between good image quality and minimum dose according to the as low as reasonably achievable principle. Moreover, the results of this work will provide a useful base for establishing local diagnostic reference levels for chest and abdomen examinations in Jordan.
Use of Reduced Activity Seeds in Breast Radioactive Seed Localization
Authors: Brost Eric , Prather Andrew , Naik Himani , Jafari Mary Ellen 
Published: November 2019

Abstract
Radioactive seed localization procedures, using 125I seeds of typical activity 3.7 MBq and higher, are performed to localize nonpalpable lesions in the breast for surgical excision and pathology analysis. This study evaluated the use and dosimetry of 125I seeds of activity <3.7 MBq in radioactive seed localization procedures through retrospective health record review, Monte Carlo simulation, and experimental detection. An average seed strength at the time of specimen excision of 2.48 ± 0.629 MBq was used in 295 radioactive seed localization procedures at Gundersen Health System in La Crosse, Wisconsin, US. The average explanted seed activity served as a basis for Monte Carlo simulation of an 125I IsoAid Advantage seed embedded in soft tissue, which scored the dose deposited to soft tissue. Tabulated values of the dose to postsurgical residual tissue as a function of explanted tumor radius were shown and compared with previously published results. Use of seeds of activity from 1.44 to 3.7 MBq at the time of excision did not adversely affect seed detection and excision. The absorbed dose to residual tissue calculated using Monte Carlo was an average of 1.4 times larger than previously published results when scaled to identical seed strengths. This study demonstrates that seeds of activity <3.7 MBq can be used for radioactive seed localization procedures with no loss in efficacy and a benefit of reduced radiation dose to patients. This is important because the estimated radiation dose to residual tissue is approximately 1.4 times higher than previously indicated.
University of California Replacement of Cesium Irradiators with Alternative Technologies
Authors: MacKenzie Carolyn , Iwamoto Keisuke S. , Smith Kenneth 
Published: November 2019

Abstract
The University of California possesses a large number of 137Cs irradiators that are used in a wide variety of medical and research applications. The university president made a system-wide decision to reduce the potential threat of malevolent use of 137Cs by switching wherever feasible to x-ray irradiators over a 3-y period of time. A Radioactive Source Replacement Working Group of involved faculty was formed to study the topic and to make recommendations as to when alternative technologies could offer equivalency. The Working Group concluded that x-ray irradiators could replace 137Cs irradiators in most applications, with some likely exceptions. They found that the depth dose curve for the 320 kVp x-ray irradiator was found to be nearly identical to that of 137Cs down to a depth in tissue of 4 cm. It was concluded that x rays (energies ≤320 keV) are more biologically effective than 137Cs gamma rays, suggesting that lower doses of x rays will be required to achieve the same biological endpoint as 137Cs gamma rays. A simple conversion factor for equating x-ray effects to 137Cs effects was not recommended because relative biological effectiveness depends on multiple factors. They concluded that each experiment should be individually calibrated when converting from 137Cs irradiators to x-ray irradiators. The lessons learned from implementing the project to date have shown the importance of having senior management buy-in, involving the research community in the decision making process and allowing for exceptions where equivalency of 137Cs to x ray cannot be established.
Aspergillus flavus Left Ventricular Assist Device Driveline Exit Site Infection
Authors: Cunningham Hayley E. , Tessmann Paul B. , Lachiewicz Anne M. 
Published: November 2019

Abstract
Infection is a leading cause of death after left ventricular assist device implantation, but mold infections are rare. We present a unique case of localized Aspergillus left ventricular assist device driveline exit site infection successfully treated with debridement, antifungal therapy, and device retention, but the course was complicated by emergence of triazole resistance.
Regular dosing compared with as-needed dosing of opioids for management of chronic cancer pain: systematic review and meta-analysis
Authors: Edler-Buggy Sophie , Birtwistle Jacqueline , ElMokhallalati Yousuf , Kindl Korana , Good Phillip , Bennett Michael I. 
Published: November 2019

Abstract
Opioids are the recommended form of analgesia for patients with persistent cancer pain, and regular dosing “by the clock” is advocated in many international guidelines on cancer pain management. The development of sustained-release opioid preparations has made regular dosing easier for patients. However, patients report that the intensity and impact of their cancer pain varies considerably day to day, and many try to find a trade-off between acceptable pain control and impact of cognitive (and other) adverse effects on daily activities. In acute care settings, (eg, postoperative) as-needed dosing and other opioid-sparing approaches have resulted in better patient outcomes compared with regular dosing. The aim of this study was to determine whether regular dosing of opioids was superior to as-needed dosing for persistent cancer pain. We systematically searched for randomised controlled trials that directly compared pain outcomes from regular dosing of opioids with as-needed dosing in adult cancer patients. We identified 4347 records, 25 randomised controlled trials meet the inclusion criteria, 9 were included in the review, and 7 of these included in meta-analysis. We found no clear evidence demonstrating superiority of regular dosing of opioids compared with as-needed dosing in persistent cancer pain, and regular dosing was associated with significantly higher total opioid doses. There was, however, a paucity of trials directly answering this question, and low-quality evidence limits the conclusions that can be drawn. It is clear that further high-quality clinical trials are needed to answer this question and to guide clinical practice.
Impact of renin-angiotensin-aldosterone system activation and body weight change on N-terminal pro-B-type natriuretic peptide variation in 100-km ultramarathon runners
Authors: Li Li-Hua , Kao Wei-Fong , Chiu Yu-Hui , Hou Sen-Kuang , Meng Chen , How Chorng-Kuang 
Published: November 2019

Background:
The change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels follows a paradox imposed by strenuous endurance exercise. Previous reports showed significant body weight (BW) loss was common in ultramarathon runners. This study investigated whether the BW change and renin–angiotensin–aldosterone system activation contribute to exercise-induced NT-proBNP release.

Methods:
A total of 26 participants who finished a 100 km ultramarathon in Taiwan were enrolled. For each participant, blood samples and spot urine samples were collected 1 week before the race, as well as immediately and 24 hours after the finish. BW change was recorded to monitor the hydration status.

Results:
Prolonged endurance exercise led to a substantial increase in NT-proBNP. Compared with prerace values, NT-proBNP levels significantly increased immediately after the race (24.3 ± 20.2 pg/mL to 402.9 ± 305.9 pg/mL, p < 0.05) and maintained high levels until 24 hours after the race (143.7 ± 126.1 pg/mL, p < 0.05). The fractional excretion of sodium values was below 1% in three different time points. The 100 km ultramarathon resulted in significant BW loss and elevated renin and aldosterone levels. However, only 24 hours after the race, a positive significant relationship was found between NT-proBNP and aldosterone levels (p = 0.007, r
2 = 0.267), but a negative significant relationship between NT-proBNP and BW increased during the recovery phase (p < 0.001, r
2 = 0.372).

Conclusion:
The mechanism of NT-proBNP release immediately following the race was multifaceted. During the recovery phase, rehydration might lead to the decrease of NT-proBNP. Our observations with regard to aldosterone and NT-proBNP might be in response to help the body maintains hydration state.
A CARE-compliant article
Authors: Miyazaki Kunihiko , Komatsubara Satoshi , Uno Koki , Fujihara Ryuji , Yamamoto Tetsuji 
Published: November 2019

Abstract

Rationale:
Multicentric carpotarsal osteolysis (MCTO) is a rare hereditary disease caused by mutations in MafB, a negative regulator of osteoclastogenesis.

Patient concerns:
A 20-year-old, Japanese woman with scoliosis visited our institute for treatment. Scoliosis was apparent since she was 12 years old, but she had not sought treatment until the age of 19. Medical examination showed a typical facial appearance associated with a small forehead and hypotelorism; shortening of the fingers of both hands and both upper limbs was observed, in addition to clubfoot. No café au lait spots or mental retardation were observed. On the other hand, the trunk showed evidence of an irregular waistline and a rib hump that obviously suggested scoliosis. Neurological deficit was not observed. Spirometry showed decreased forced vital capacity (FVC). Although proteinuria was observed, renal dysfunction and hypertension were not seen. The major curve of scoliosis was 82° (MC, Th7–L2; Th11 apical vertebra), and the upper curve was 77° (UC, Th1-6; Th3 apical vertebra). In a recumbent-traction position, the major curve was 54° and the upper curve was 56°. The pelvic incidence minus lumbar lordosis (PI–LL) angle was <10° and no mismatch was observed; thoracic kyphosis was decreased to 16°.

Diagnosis:
The patient was diagnosed with symptomatic scoliosis secondary to MCTO.

Interventions:
We decided to perform a correction and fusion from Th2 to L3 using a posterior spinal instrumentation.

Outcomes:
Postoperative x-ray demonstrated scoliosis angle correction from 77° to 38° at Th1–6 and 82° to 39° at Th7–L2. Postoperative x-ray demonstrated thoracic kyphosis angle correction from 16° to 21°. The patient's height increased from 155 to 161 cm.

Lessons:
It has been 24 months since the operation, and no exacerbation has been observed. To the best of our knowledge, this is the first report of surgical treatment of scoliosis secondary to MCTO.
A 9-day-old neonate with giant scalp abscess
Authors: Liu Hongyuan , Li Zongping , Yang Liling , Yang Xu , Zhang Yan , Chen Jia 
Published: November 2019

Abstract

Rationale:
Neonatal scalp mass is common in clinical practice. After birth canal compression and traction force, a cephalohematoma is usually found. However, cephalohematoma with abscess is extremely rare and dangerous. So far, there have been no reported cases of multidrug-resistant Escherichia coli infections in giant neonatal scalp hematoma.

Patient concerns:
We present a 9-day-old with a scalp abscess and a large scalp defect that remained after surgical drainage.

Diagnosis:
Physical examination showed a giant mass suggestive in the parietal region. B-mode ultrasound indicated the scalp mass was liquid. The early diagnosis was massive scalp hematoma. During conservative treatment, purulent fluid flowed from the mass region through a rupture in the scalp. MR examination showed the scalp had burst and no abnormalities were found in the medial side of the skull and skull.

Interventions:
The surgeon opened up the mass and removed necrotic tissue. The scalp was severely damaged; the aseptic auxiliary materials that we made in-house were used to gradually reduce the defect.

Outcomes:
The scalp was healed by anti-infection treatment and frequent changing of the dressings. The patient was successfully treated without two-stage surgery. There were no complications.

Lessons:
A scalp hematoma is a potential site of infection. Anti-infection treatment and surgery are necessary to correct infected scalp hematoma. This work offers a new way of treating other large scalp defects.
Association between interleukin-8 gene −251 A/T polymorphism and the risk of coronary artery disease
Authors: Zhang Quanfang , Lian Zhexun , Zhang Wenzhong , Cui Yan , Wang Wugang , Wu Jun , Chen Zuoyuan , Wang Wei 
Published: November 2019

Abstract

Background:
The association between interleukin-8 (IL-8) gene polymorphism −251 A>T and susceptibility to coronary artery disease (CAD) has been investigated previously; however, results remain controversial. Thus, a meta-analysis was conducted to reassess the effects of this polymorphism on CAD risks.

Methods:
The PubMed, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases were searched for relevant studies published up to December, 2018. The pooled odds ratios (OR) were calculated using STATA 13.0 software for allelic (A vs T) as well as homozygote (AA vs TT), heterozygote (AT vs TT), recessive (AA vs AT + TT), and dominant (AA + AT vs TT) genotype models, respectively.

Results:
Ten case-control studies (3744 cases and 3660 controls) were included. Overall, a significant association of IL-8 gene −251 A > T polymorphism with an increased risk of CAD was only observed in the dominant genotype model (OR = 1.48), but not others. In the subgroup analysis, significantly increased risks were also found for Chinese (OR = 1.64), polymerase chain reaction-restriction fragment length polymorphism genotyping (OR = 1.61), acute coronary syndrome (ACS) type (OR = 1.92 for 3 datasets; OR = 1.88 for 4 datasets), high quality (OR = 1.64), and age/gender matching status (OR = 1.55) under the dominant model. Furthermore, significantly increased risks were also found for ACS type under allelic (OR = 1.32 for 3 datasets; OR = 127 for 4 datasets), homozygote (OR = 1.64 for 3 datasets; OR = 1.50 for 4 datasets), heterozygote (OR = 1.32 for 3 datasets; OR = 1.30 for 4 datasets), and recessive (OR = 1.40 for 3 datasets; OR = 1.28 for 4 datasets) models.

Conclusion:
This meta-analysis suggests that Chinese patients carrying −251A allele of IL-8 may have an increased risk for the development of CAD, especially ACS.
Diastolic dysfunction is associated with an increased risk of postcontrast acute kidney injury
Authors: Lee Min-Jeong , Park Jin-Sun , Kim Hyuk-Hoon 
Published: November 2019

Abstract

Study objective:
Computed tomography (CT) is an important imaging modality in diagnosing a variety of disorders. Although systolic heart failure is a well-known risk factor for postcontrast acute kidney injury (PC-AKI), few studies have evaluated the association between diastolic dysfunction and PC-AKI. Therefore, the aim of our study was to investigate whether PC-AKI occurs more likely in patients with diastolic dysfuction.

Methods:
This retrospective study was conducted by collecting the data of patients who visited an emergency medical center between January 2008 and December 2014. Patients who underwent contrast-enhanced CT (CECT) in the emergency department and had undergone echocardiography within 1 month of CECT were included. We defined PC-AKI as an elevation in the serum creatinine level of ≥0.5 mg/dL or ≥25% within 72 hours after CECT.

Results:
We included 327 patients, aged 18 years and older, who had a CECT scan and underwent an echocardiography within 1 month of the CECT scan at our institute over 20 years. The mean value of estimated glomerular filtration rate and E/E0 (early left ventricular filling velocity to early diastolic mitral annular velocity ratio) was 51.55 ± 7.66 mL·min1·1.73 m2 and 11.56 ± 5.33, respectively. A total of 32 patients (9.79%) developed PC-AKI. The prevalence of diabetes mellitus and chronic kidney disease was significantly higher in the PC-AKI group than in the non-PC-AKI group. Echocardiographic findings revealed that E/E0 was significantly increased in patients with PC-AKI. The logistic regression analysis showed that a higher E/E0 value (odds ratio [OR] 5.39, 95% confidence interval [CI] 1.51–25.23, P = .015) was a significant risk factor for PC-AKI.

Conclusion:
This study demonstrated that, among the echocardiographic variables, E/E0 was an independent predictor of PC- AKI. This, in turn, suggests that diastolic dysfunction may be a useful parameter in PC-AKI risk stratification.
Screening and identification of key biomarkers in nasopharyngeal carcinoma
Authors: Zhang Ji-Zhou , Wu Zeng-Hong , Cheng Qing 
Published: November 2019

Abstract
As for the lack of simple and effective diagnostic methods at the early of the nasopharyngeal carcinoma (NPC), the mortality rate of NPC still remains high. Therefore, it is meaningful to explore the precise molecular mechanisms involved in the proliferation, carcinogenesis, and recurrence of NPC and thus find an effective diagnostic way and make a better therapeutic strategy.
Three gene expression data sets (GSE64634, GSE53819, and GSE12452) were downloaded from Gene Expression Omnibus (GEO) and analyzed using the online tool GEO2R to identify differentially expressed genes (DEGs). Gene ontology functional analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis of the DEGs were performed in Database for Annotation, Visualization and Integrated Discovery. The Search Tool for the Retrieval of Interacting Genes database was used to evaluate the interactions of DEGs and to construct a protein–protein interaction network using Cytoscape software. Hub genes were validated with the cBioPortal database.
The overlap among the 3 data sets contained 306 genes were identified to be differentially expressed between NPC and non-NPC samples. A total of 13 genes (DNAAF1, PARPBP, TTC18, GSTA3, RCN1, MUC5AC, POU2AF1, FAM83B, SLC22A16, SPEF2, ERICH3, CCDC81, and IL33) were identified as hub genes with degrees ≥10.
The present study was attempted to identify and functionally analyze the DEGs that may be involved in the carcinogenesis or progression of NPC by using comprehensive bioinformatics analyses and unveiled a series of hub genes and pathways. A total of 306 DEGs and 13 hub genes were identified and may be regarded as diagnostic biomarkers for NPC. However, more experimental studies are needed to carried out elucidate the biologic function of these genes results for NPC.
Strumal carcinoid tumor of the ovary
Authors: Chai Wei , Zhang Wenlei , Zhou Li , Sun Xiaoyan , Jia Guifeng 
Published: November 2019

Abstract

Rationale:
Strumal carcinoid tumor of the ovary (SCTO) is a very rare kind of ovarian tumor. The symptoms of SCTO are often nonspecific and misleading. Therefore, a full understanding of the characteristics, diagnosis, and treatment methods of SCTO is important.

Patient concerns:
In this study, we report a 63-year-old woman with SCTO whose most obvious symptoms were abdominal distention and weight loss of 5 kg for about 1 month.

Diagnosis:
Her carbohydrate antigen 125 (CA125) levels were higher than normal. Gynecologic sonography showed an 8.8 × 7.5 cm mass with mixed density and an irregular shape behind the uterus. Pathologic and immunohistologic examinations confirmed SCTO of the right ovary.

Interventions:
The patient underwent complete surgical resection of the whole uterus, bilateral ovaries, and fallopian tubes.

Outcomes:
The patient recovered well with no obvious complications and was discharged on the 10th day postsurgery.

Lessons:
Complete surgical resection is vital to treat SCTO. Postsurgical pathologic and immunohistologic examinations can confirm a diagnosis of SCTO.