bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of plastic surgeons in the trauma center: national level I trauma center startup experience in South Korea
Authors: Lee Il Jae , Cha Bohwan , Park Dong Ha , Hahn Hyung Min 
Published: February 2021

Abstract
Although it is well recognized that other surgical specialties perform various procedures related to trauma care, there is a lack of analyses focusing on the role of plastic surgical management in trauma centers. This retrospective study was designed to investigate the scope of plastic surgery services in acute trauma care, using clinical data obtained from a single, regional, level I trauma center.
This study included patients who presented to a single, regional, level I trauma center between March 1, 2016 and February 28, 2018. Patients with acute trauma to the facial soft tissue and skeleton, soft tissue of the upper and lower limbs, trunk and perineum, and other areas requiring plastic surgical procedures were included in the analysis. Cases requiring consultation for the correction of posttraumatic deformity or secondary deformity and trauma sequelae, such as scars, were excluded. Data on patients’ demographics and detailed surgical procedures were acquired from electronic medical records. The reviewed cases were categorized by the primary anatomical region requiring surgery and the primary procedure performed.
A total of 1544 patients underwent surgery, and 2217 procedures were recorded during the 2-year study period. In 2016, 1062 procedures on 690 patients, and, in 2017, 1155 procedures on 787 patients were registered. The average age of the patients who underwent plastic surgical procedure due to a trauma-related cause was 38.4 years (range, 2 days to 91 years), and 1148 patients (77.7%) were male. The head and neck region was the most commonly observed anatomical area that was operated on. The facial bone requiring the largest degree of surgical intervention was the mandible, followed by the zygomatic bone, nasal bones, orbital floor, and maxilla. Microsurgical procedures, such as flap surgery and microsurgery, were performed in 121 cases. The most commonly elevated free flap was the ALT flap (n = 69).
Plastic surgeons play various roles in level I trauma centers, such as in the management of facial injury, performing limb-saving free tissue transfers, and complex wound reconstruction with flaps or skin grafts. Thus, plastic surgeons are an essential part of trauma centers.
Evaluation of contrast-enhanced ultrasound for activity of rheumatoid arthritis
Authors: Zhu Yunpei , Sui Ping , Wang Cong , Wang Hui , Wen Zhihong 
Published: February 2021

Abstract

Background:
Contrast-enhanced ultrasound (CEUS) refers to a technique that uses contrast medium to strengthen the echo of backscatter, which can significantly improve the resolution, sensitivity and specificity of ultrasound diagnosis. As a quantitative imaging examination of blood flow signals, CEUS has allowed detection of synovial microvascularization in the joints of patients with rheumatoid arthritis (RA). However, the results of these studies have been contradictory. Therefore, the purpose of this study is to evaluate the value of CEUS in the activity of RA disease.

Methods:
We will search PubMed, Embase, Cochrane Library, and CNKI from their inception to the December 20, 2020, without restrictions of language and publication status. Two investigators will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. This study will only include high quality clinical cohort or case control studies. Statistical analysis was performed by using the Review Manager version 5.3 and the STATA version 14.0 (Stata Corp, College Station, TX, USA) softwares.

Results:
This systematic review will determine the value of CEUS in RA activity scores.

Conclusion:
The results of this study will provide a useful basis for high-quality CEUS to evaluate RA activity score.

Systematic review registration:
INPLASY2020120125.
Alarmingly high malnutrition in childhood and its associated factors
Authors: Al-zangabila Khaled , Poudel Adhikari Sasmita , Wang Qingzhi , Sunil Thankam S. , Rozelle Scott , Zhou Huan 
Published: February 2021

Abstract
Childhood malnutrition is a serious public health problem in Yemen. However, there is a limited information regarding association of malnutrition with different socio-economic factors. This study examines the correlates of socioeconomic and maternal behavioral factors on malnutrition in Yemeni children under 5 years of age.
Our study focuses on the nutritional status of children under 5 years of age, and uses the data provided by the cross-sectional study namely Yemen National Demographic and Health Survey. Three anthropometric indicators: stunting, wasting, and underweight were selected for the evaluation of malnutrition. Independent variables include personal and maternal characteristics, socioeconomic and behavioral factors, and illness conditions. The study used the Chi-Squared test to test the significant association between independent variables and logistic regression to estimate the odds of being malnourished.
A total of 13,624 Yemeni children under 5 years of age were included in the study. The results show the high malnutrition level – the prevalence of stunting was 47%, wasting was 16%, and underweight was 39%. There is a statistically significant association between socioeconomic status, behavioral factors, and child malnutrition. The odds of malnutrition decreased with the increase in the level of mother's education, economic status, and frequency of prenatal visits. The odds of malnutrition were least for children whose mothers had highest level of education (OR = 0.64; 95%CI = 0.55–0.76), who belonged to highest wealth index (OR = 0.41; 95%CI = 0.36–0.47). Moreover, the likelihood of malnutrition was less among the children whose mother had highest number of prenatal visits during the pregnancy (OR = 0.67; 95%CI = 0.59–0.76).
The high prevalence of stunting, wasting, and undernutrition were found in Yemeni children. Different factors such as regional variations, socio-economic disparities, and maternal education and health care utilization behavior are found to be associated with high malnutrition. These findings provide important policy implications to improving childhood malnutrition in Yemen.
Effectiveness comparisons of Chinese patent medicine on insomnia
Authors: Chao Ruoyu , Wu Chunli , An Hongqiang , Li Bing , Wu Jianlin 
Published: February 2021

Abstract

Background:
In recent years, the incidence of insomnia is increasing. However, the existing therapy methods for cannot fundamentally treat the disease. Meanwhile, Chinese patent medicine (CPM) plays an active role in the treatment of insomnia. However, there is no comparison and ranking of the efficacy of every CPM. Therefore, our study will use network meta-analysis to compare the efficacy of different CPM on insomnia, in order to provide evidence-based medical evidence for clinical treatment.

Methods:
We will search CNKI, Wanfang, VIP, CBM, Pubmed, Cochrane Library, Embase for the randomized controlled trials of CPM in the treatment of insomnia (up to December 31, 2020). We will use RevMan5.3, Stata15.1 and ADDIS software for statistical analysis. We will draw the surface under cumulative ranking area to predict the order of efficacy.

Results:
We aim to rank the efficacy and safety of different CPM for the treatment of insomnia.

Conclusion:
CPM plays a positive role in the treatment of insomnia and can provide evidence support for clinicians and patients

INPLASY registration number:
INPLASY2020120121
Long-term follow-up after rituximab plus bendamustine in a patient with relapsed or refractory hairy cell leukemia variant
Authors: Imoto Naoto , Koyama Daisuke , Sugiura Isamu , Kurahashi Shingo 
Published: February 2021

Abstract

Introduction:
Hairy cell leukemia variant (HCL-v) is a rare lymphoproliferative disorder regarded as a splenic B-cell lymphoma/leukemia, unclassifiable tumor in the 2017 World Health Organization classification of lymphoid tumors. The prognosis of HCL-v is much worse than that of classical hairy cell leukemia and there is no consensus regarding the optimal treatment strategy for HCL-v. For patients with indolent lymphoma, rituximab plus bendamustine (RB) has proven effective in several clinical trials. Thus, RB is expected to be a treatment option for patients with HCL-v, but there have been few reports of its use in these patients.

Patient concerns:
A 64-year-old man presented with leukocytosis and abnormal lymphocytes in peripheral blood in a medical examination. Computed tomography revealed mild splenomegaly, but no lymph node enlargement.

Diagnosis:
The patient was initially diagnosed with low-grade B-cell lymphoma. After he experienced a second relapse, his clinical data were reviewed again; subsequently, he was diagnosed with HCL-v on the basis of clinical presentation, flow cytometry findings, and cytogenetic abnormalities.

Interventions:
The patient was first treated with the cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) regimen. After the regimen was ineffective, he received six cycles of RB. After relapse, the patients received an additional six cycles of RB.

Outcomes:
The patients exhibited a slight reduction of the abnormal lymphocyte level but insufficient therapeutic efficacy during CHOP therapy. After the first cycle of RB, the patient exhibited an immediate response with the absence of minimal residual disease. He remained relapse-free for approximately 67 months. After a second relapse, complete response was again achieved with the absence of minimal residual disease following RB re-administration. He remained relapse-free for approximately 29 months after the second RB.

Conclusion:
RB could be a treatment option for patients with relapsed or refractory HCL-v. Further research is needed to establish the optimal treatment regimen for patients of HCL-v.
Efficacy and safety of acupuncture for elderly patients with coronavirus disease 2019 (COVID-19)
Authors: Xia Qingchang , Gao Huawei , Xian Jin , Yan Xiao , Zhou Yue , Lu Yunping , Ma Yuxia 
Published: February 2021

Abstract

Background:
The study aims to evaluate the effectiveness and safety of acupuncture therapy for elderly patients with coronavirus disease 2019 (COVID-19).

Methods:
Relevant articles from December 2019 to December 2020 will be searched in the following electronic databases: Medline, PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), and China Scientific Journals Database. All published randomized controlled trials (RCTs) and credible clinical observations about this topic will be included. Two independent researchers will operate article retrieval, duplication removing, screening and data analysis by EndNote X9.0 and Stata 15.0. We will use the Cochrane risk of bias tool for randomized trials to assess the risk of bias of included studies. Meta-analysis, subgroup analysis, and/or descriptive analysis will be performed according to the data conditions included.

Results:
High-quality synthesis and/or descriptive analysis of current evidence will be provided from mortality rate, cure rate, C-reactive protein (CRP), creatine, troponin, aspartate aminotransferase, alanine aminotransferase, and improvements in chest CT scans, clinical symptoms (including fever, fatigue, cough, nausea, vomiting and diarrhea) and the side effects of acupuncture.

Conclusion:
This study will provide evidence of whether acupuncture is an effective and safe intervention for the elderly with COVID-19.

PROSPERO registration number:
CRD42020225245.
Biliary stent migration: why, how, and what?
Authors: Emara Mohamed H. , Ahmed Mohammed Hussien , Mohammed Ahmed S. , Radwan Mohamed I. , Mahros Aya M. 
Published: February 2021

Background and purpose
The frequency, risk factors as well as the sites of biliary stent migration are variable in the literature. This retrospective study investigated the frequency of biliary stent migration, why biliary stents migrated, how the migrated stents affected the patients, and what are the different techniques retrieved the migrated stents.

Patients and methods
Out of 876 stented patients, 74 patients (8.4%) had their stents migrated. Patients with and without migrated stents were compared regarding endoscopy and stent-related parameters. The sequels of stent migrations were reported. Furthermore, the methods used for stent retrieval were reviewed.

Results
Proximal and distal stent migration occurred at a rate of 3 and 5.5%, respectively. The independent predictors for stent migration were moderate to marked common bile duct (CBD) dilation, complete sphincterotomy, the use of balloon dilation, and stent insertion for more than 1 month. Cholangitis and stent obstruction was the most commonly reported adverse event (n = 18, 24.3%). Distal stent migration associated with two cases of bleeding due to duodenal wall injury, and two cases of duodenal perforation. All the retained migrated stents in the current study were retrieved by endoscopy using extraction balloon, Dormia basket, snares, and foreign body forceps.

Conclusion
Biliary stent migration occurs at a rate of 8.4%. Stents do migrate because of dilated CBD, wide sphincterotomy, and biliary balloon dilation. Furthermore, wide, straight stents inserted for more than 1 month easily migrate. The migrated stents migrated intraluminal in the CBD, duodenum or the colon. All the retained migrated stents were retrieved endoscopically.
Impact of endoscopist experience, patient age and comorbidities on dose of sedation and sedation-related complications by endoscopic ultrasound
Authors: Razpotnik Marcel , Bota Simona , Essler Gerolf , Weber-Eibel Jutta , Peck-Radosavljevic Markus 
Published: February 2021

Aim
The aim of the study is to investigate the influence of endosonographer experience and patient-related factors on the dose of sedation and sedation-related complications during endoscopic ultrasound (EUS).

Methods
Our retrospective analysis included EUS investigations performed between 2015 and 2018 at our institution. Sedation-related complications were defined as cardiorespiratory instability with oxygen saturation drop below 90% or prolonged low blood pressure or bradycardia.

Results
In total, 537 EUS examinations were analyzed (37.3% interventional). The median dose of propofol and midazolam were: 140 (30–570) and 3(1–7) mg, respectively. Sedation-related complications were documented in 1.8% of cases. All patients had transient, nonfatal respiratory insufficiency. Totally, 60% of the patients who developed complications were >75 years and 70% were male. The presence of cardiac and/or pulmonary comorbidities was associated with an OR = 8.77 [95% confidence interval (CI), 1.8–41.7] and American Society of Anesthesiologists class III with an OR = 7.64 (95% CI, 1.60–36.3) for the occurrence of sedation-related complications. Endosonographer experience did not influence the rate of sedation-related complications. In both diagnostic and interventional EUS, patients with comorbidities and older age received significantly less sedation. Experienced endosonographers used less sedation than trainees.

Conclusion
Endosonographer experience, patient age and the presence of comorbidities had a significant influence on sedation dose. Sedation-related complications occurred only in 1.8% of cases.
Understanding Regional Variation in the Cost of Breast Cancer Screening Among Privately Insured Women in the United States
Authors: Kunst Natalia , Long Jessica B. , Xu Xiao , Busch Susan H. , Kyanko Kelly A. , Lindau Stacy T. , Richman Ilana B. , Gross Cary P. 
Published: February 2021

Background:
Breast cancer screening for women aged 40–49 years is prevalent and costly, with costs varying substantially across US regions. Newer approaches to mammography may improve cancer detection but also increase screening costs. We assessed factors associated with regional variation in screening costs.

Methods:
We used Blue Cross Blue Shield Axis, a large US commercial claims database accessed through secure portal, to assess regional variation in screening utilization and costs. We included screening mammography±digital breast tomosynthesis (DBT), screening ultrasound, diagnostic mammography±DBT, diagnostic ultrasound, magnetic resonance imaging and biopsy, and evaluated their utilization and costs. We assessed regional variation in annual per-screened-beneficiary costs and examined potential savings from reducing regional variation.

Results:
Of the 2,257,393 privately insured women, 41.2% received screening mammography in 2017 (range: 26.6%–54.2% across regions). Wide regional variation was found in the DBT proportion (0.7%–91.1%) and mean costs of DBT ($299; range: $113–714) and 2-dimensional (D) mammograms ($213; range: $107–471). In one-fourth of the regions, the mean DBT cost was lower than the mean 2D mammography cost in the full sample. Regional variation in the per-screened-beneficiary cost (mean: $353; range: $151–751) was mainly attributable to variation in the cost of DBT (accounting for 23.4% of regional variation) and 2D mammography (23.0%). Reducing regional variation by decreasing the highest values to the national mean was projected to save $79–335 million annually.

Conclusions:
The mean mammogram cost for privately insured women ages 40–49 varies 7-fold across regions, driving substantial variation in breast cancer screening costs. Reducing this regional variation would substantially decrease the screening costs.
Evaluation of 68Ga-PSMA PET/CT with volumetric parameters for staging of prostate cancer patients
Authors: Aksu Ayşegül , Karahan Şen Nazli Pinar , Tuna Emine Burçin , Aslan Güven , Çapa Kaya Gamze 
Published: February 2021

Background
The aim of this study was to investigate the relationship between volumetric data obtained from staging 68Ga-prostate-specific membrane antigen (PSMA) PET computerized tomography (CT) images with prostate-specific antigen (PSA), risk groups, Gleason Grade (GG) groups and presence of metastasis.

Methods
We performed a retrospective analysis of 68Ga-PSMA PET-CT images from 88 patients undergoing initial staging of prostate adenocarcinoma between January 2015 and September 2018. Images were evaluated in LIFEx software; PSMA involvement above the background activity in prostate gland, lymph node and other distant metastases was plotted with 40% SUVmax threshold, SUVmax, PSMA tumor volume (PSMA-TV) and total lesion PSMA (TL-PSMA) values were obtained.

Results
In all patients, there was a moderate correlation between PSA and PSMA-tumor volume whole-body (PSMA-TVwb) (P < 0.001, r = 0.580) and a high correlation between total lesion-PSMAwb (TL-PSMAwb) (P < 0.001, r = 0.636). Prostate PSMA-TV (PSMA-TVp) and TL-PSMA (PSMA-TVp) values were different in local and locally advanced/metastatic patients (P = 0.020 and 0.006, respectively). PSMA-TVp and TL-PSMAp values were significantly different in low-moderate and high-risk patients (P = 0.003 and <0.001, respectively), and in patients with and without metastasis (P = 0.008 and <0.001, respectively). PSMA-TVp, PSMA-TVwb, TL-PSMAp and TL-PSMAwb values were significantly different in patients with GG ≤3 and >3 (P = 0.030, 0.002, <0.001 and <0.001, respectively).

Conclusion
Pretreatment 68Ga-PSMA PET/CT volumetric parameters provides unique data to use in the clinical decision-making process of patients with adenocarcinoma of the prostate.
Concept proposal for a six-tier integrated dual tracer PET-CT (68Ga-PSMA and FDG) image scoring system (‘Pro-PET’ score) and examining its potential implications in metastatic castration-resistant prostate carcinoma theranostics and prognosis
Authors: Adnan Aadil , Basu Sandip 
Published: February 2021

Objectives
To develop and examine a scoring system in metastatic castration-resistant prostate carcinoma (mCRPC) that integrates findings of both 68Ga-prostate-specific membrane antigen (PSMA) and flurodeoxyglucose (FDG) PET-CT imaging in a single combined parameter and referred to as the ‘Pro-PET’ score.

Methods
A six-tier integrated dual tracer PET-CT (68Ga-PSMA and FDG) Image Scoring System (‘Pro-PET’ score) was conceptualized, based on the findings of both 68Ga-PSMA-11 and FDG PET-CT in patients of mCRPC. This proposed integrated scoring was examined in a retrospective analytical study assessing mCRPC patients (n = 47) referred for 177Lu-PSMA-617 peptide receptor radioligand therapy (PRLT) and had both FDG and 68Ga-PSMA PET-CT undertaken within 15 days of each other without any interim treatment intervention. The ‘Pro-PET’ score grades and subgrades were assigned and compared with clinical data, such as histopathology, Gleason score, serum prostate-specific antigen (PSA), treatment response (symptomatic, biochemical, metabolic and anatomical) and survival [overall survival (OS) and progression-free survival (PFS)].

Results
The Pro-PET score significantly correlated with symptomatic (P = 0.05), biochemical (P = 0.05), metabolic (P = 0.001) and anatomical (P = 0.012) responses, PFS (P = 0.03) and OS (P = 0.027). On multivariate analysis, histopathology, Gleason score and PSA as individual parameters were not significantly associated with OS and PFS, whereas the Pro-PET score was found to have a significant association (P = 0.001 for PFS and 0.011 for OS).

Conclusion
The ‘Pro-PET’ scoring system integrating dual tracer PET-CT imaging findings in a single parameter appeared as a potentially promising prognostic marker that has the potential to enhance the objectivity and scientific basis of prostate carcinoma theranostics and prognostication.
Responding to Emotional Stress in Pediatric Hospitals
Authors: Huetsch Michael , Green Jeremy 
Published: February 2021

OBJECTIVE:
The aim of this study was to identify leadership awareness of emotional stress and employee support efforts in pediatric hospitals.

BACKGROUND:
The current pediatric environment has seen increases in treatment intensity, care duration, and acuity of patients resulting in increased likelihood of being exposed to emotional events.

METHODS:
Mail survey was sent to chief nursing officers at 87 pediatric hospitals.

RESULTS:
A total of 49 responses (56%) were received. Hospitals with less than 250 beds were significantly more likely to rate emotional stress as a large to very large problem, whereas ANCC Magnet® hospitals felt better about support efforts after patient deaths. Most commonly used support offerings focused on staff recovery after a traumatic event as opposed to training for prevention of emotional stress.

CONCLUSIONS:
Emotional stress is a well-recognized issue in pediatric hospitals with comparatively large resource commitment. Further focus on caregiver prevention training and unit leadership recognition of stress may be needed.