bluuebunny/crossref_metadata_2025_split huggingface dataset:
An evaluation of the healthcare costs of metastatic breast cancer
Authors: Chen Hsuan-Ming , Chen Jin-Hua , Chiang Shao-Chin , Lin Yi-Chun , Ko Yu 
Published: October 2021

Abstract
To determine the economic burden of metastatic breast cancer (MBC) in Taiwan, we conducted a national retrospective claim database analysis to evaluate the incremental healthcare costs and utilization of MBC patients as compared to their breast cancer (BC) and breast cancer free (BCF) counterparts.
Data were obtained from the National Health Insurance Claim Database and the Taiwan Cancer Registry database between 2012 and 2015. All healthcare utilization and costs were calculated on a per-patient-per-month (PPPM) basis and were compared among groups using the generalized linear model adjusting for age group, residential area, and Charlson comorbidity index group.
A total of 1,606 MBC patients were matched to 6,424 BC patients and 6,424 BCF patients. The majority of overall MBC healthcare costs were attributed to outpatient costs (75.1%), followed by inpatient (23.2%) and emergency room costs (1.7%). The PPPM total healthcare costs of the MBC, BC, and BCF groups were TWD 7,422, 14,425, and 2,114, respectively. The adjusted PPPM total healthcare cost ratio of MBC to BCF was 4.1. Compared to BCF patients, the patients receiving both human epidermal growth factor receptor 2-targeted therapy and endocrine therapy incurred 28.1 times PPPM total costs. The adjusted PPPM total healthcare cost ratio of recurrent MBC to BCF was 2.3, while the ratio was 12.2 in the de novo MBC group.
Patients with MBC are associated with substantial economic burden, particularly in outpatient costs. The study findings could be useful for MBC-related economic evaluations and health resource allocation.
Observational study of an inpatient program for musculoskeletal disorders
Authors: Grote Vincent , Böttcher Elke , Unger Alexandra , Hofmann Peter , Moser Maximilian , Fischer Michael J. 
Published: October 2021

Abstract
A new inpatient secondary preventive program for patients with musculoskeletal health problems was introduced throughout Austria. The aim of the current work was to evaluate this “Health Prevention Active” program and its possible influences on the quality of medical results upon hospital discharge.
This observational study presents monocentric data for 7448 patients (48.99 ± 6.15 years; 53.7% women) with chronic musculoskeletal disorders who completed a 3-week health program. The focus was placed on measuring medical quality outcomes such as BMI, blood pressure, heart rate, pain, subjective ratings, and achieved power output in cycle ergometer exercise testing. We describe pre-post changes before and after the inpatient program and the results of a follow-up survey conducted after 1 year to identify moderating factors related to health outcomes.
The medical baseline showed obvious deficits regarding obesity, hypertension, and subjective symptoms. Of all patients, 36.5% were completely inactive. The patient's gender and physical activity had a high impact on the medical baseline status. In total, the majority of patients (86.2%; SMD = –0.78 ± 0.59) responded well to the health prevention program, independent of their ages and lifestyles.
Requirements for secondary prevention programs are high. The results of the study reflect the general problems presented by inactivity, obesity, and subjective symptoms like pain. Physical activity was specifically identified as a major factor for the observed medical baseline status.
Clinical efficacy and safety of traditional Chinese medicine Xiao Yao San in insomnia combined with anxiety
Authors: Hu Jing , Teng Jing , Wang Wanyu , Yang Ni , Tian Haoyu , Zhang Wei , Peng Xiangyu , Zhang Jingyu 
Published: October 2021

Abstract

Background:
Patients with long-term insomnia generally experience anxiety and depression. Traditional sleeping pills and anti-anxiety drugs have certain limitations. Xiao Yao San (XYS), a complementary and alternative therapy, has been widely used to treat insomnia combined with anxiety. This study aims to evaluate the efficacy and safety of XYS in the treatment of insomnia combined with anxiety.

Methods:
Related literature was retrieved from 8 electronic databases from the establishment time to March 2021. The subjects were diagnosed with insomnia combined with anxiety. We assessed the methodological quality of randomized controlled trials (RCTs) according to the Cochrane Handbook. Data analysis was conducted using RevMan 5.3 software.

Results:
The analysis includes 9 RCTs involving 681 patients. Meta-analysis supported that as an auxiliary drug for Western medicine (WM), XYS could enhance the clinical efficacy of insomnia calculated according to the traditional Chinese medicine (TCM) syndrome score scale (risk ratio [RR]: 1.26; 95% confidence interval [CI]: 1.13–1.43; P = .0002) and reduced the scores of Hamilton Anxiety Scale (mean difference [MD]: −5.19; 95% CI: −7.78 to −2.60; P < .001), Pittsburgh Sleep Quality Index (MD: −3.35; 95% CI: −4.86 to −1.84; P < .001), Self-rating Anxiety Scale (MD: −9.38; 95% CI: −10.20 to −8.75; P < .001), TCM syndrome score scale for insomnia (MD: −4.45; 95% CI: −6.65 to −2.24; P < .001), and TCM syndrome score scale for anxiety (MD: −5.54; 95% CI: −9.48 to −1.6; P = .006). The summary analysis also shows that the separate use of XYS was advantageous in reducing the scores of the Hamilton Anxiety Scale (MD: −3.70; 95% CI: −6.31 to −1.09; P = .005), Pittsburgh Sleep Quality Index (MD: −1.82; 95% CI: −2.39 to −1.24; P < .001), and Self-rating Anxiety Scale (MD: −10.79; 95% CI: −14.09 to −7.49; P < .001). The incidence of adverse events with XYS as an ancillary drug or used separately was lower than that in the WM.

Conclusion:
Our systematic evaluation and meta-analysis showed that XYS combined with WM or XYS alone was beneficial for improving sleep quality and relieving anxiety. Due to the low methodological quality, small sample size, and significant heterogeneity of RCTs, more rigorous and scientific clinical trials are required to further evaluate the efficacy and safety of XYS.

PROSPERO registration number:
CRD42020190613.
Characterization of PD-1/PD-L1 immune checkpoint expression in the pathogenesis of musculoskeletal Langerhans cell histiocytosis
Authors: Hashimoto Kazuhiko , Nishimura Shunji , Sakata Naoki , Inoue Masami , Sawada Akihisa , Akagi Masao 
Published: October 2021

Abstract
Recent data suggest that programmed cell death -1 (PD-1) and programmed cell death ligand-1 (PD-L1) are involved in the pathogenesis of Langerhans cell histiocytoma (LCH); however, their contributions are not well established. Also, the involvement of PD-1/PD-L1 molecules in musculoskeletal LCH remains particularly unclear. The current study aims to characterize the involvement of PD-1/PD-L1 immune checkpoint system in the pathogenesis of musculoskeletal LCH. PD-1/PD-L1 expression was evaluated in 6 patients, 3 men and 3 women with a mean age of 13.5 years, with musculoskeletal LCH who were treated at Kindai University Hospital and Osaka Women's and Children's Hospital between November 2005 and December 2020. The median follow-up period for all patients with musculoskeletal LCH was 41 months. We surveyed symptoms, number of lesions, treatment modality, and outcomes. Immunostaining for CD4, CD8, PD-1, and PD-L1 was also performed on pathological specimens obtained by biopsy. Multiple lesions were observed in 5 cases, and a single lesion was observed in 1 case. The chief complaint in 5 cases was pain. Four patients underwent spontaneous regression. The other 2 patients received chemotherapy. The outcomes included continuous disease-free (n = 5) and alive with the disease (n = 1). The CD4-, CD8-, PD-1-, and PD-L1-positive rates among all specimens were 100%, 100%, 16.6%, and 83.3%, respectively. The CD4/PD-L1, CD8/PD-L1, and PD-1/PD-L1 positive rates in all the specimens were 83.3%, 83.3%, and 16.6%, respectively. We believe that the PD-1/PD-L1 immune checkpoint molecules may play some role in the microenvironment of musculoskeletal LCH.
Acupuncture therapy for gastric ulcer
Authors: Wang Heran , Jiang Hailin , Zhao Jinying , Liu Xiaona , Li Tie , Chai Jiapeng , Meng Meng , Pan Ting , Xu Kaiyang , Wang Fuchun 
Published: October 2021

Abstract

Background:
Gastric ulcer (GU) is a clinically common disease of the digestive system that adversely affects patients’ quality of life and work ability. Although some articles have reported that acupuncture can improve the clinical symptoms of GU, the efficacy of acupuncture has not been scientifically or methodically evaluated. This study aimed to evaluate the effectiveness and safety of acupuncture for the treatment of patients with gastric ulcers.

Methods:
The following electronic databases will be searched from the respective dates of database inception to March 23, 2021: The Cochrane Library, Web of Science, EMBASE, MEDLINE, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wanfang database, the Chinese Scientific Journal Database, and other sources. Randomized controlled trials comparing acupuncture with other interventions or sham acupuncture were included. Two independent researchers will perform article retrieval, duplication removal, screening, quality evaluation, and data analyses by Review Manager (V.5.3.5). Meta-analyzes, subgroup analysis, and/or descriptive analyses will be performed based on the included data conditions.

Results:
The protocol of this study systematically assessed the effectiveness and safety of acupuncture for gastric ulcer patients. The primary outcome was the effective rate, and the secondary outcomes included negative conversing rate of Helicobacter pylori infection, untoward effect, recurrence rate, quality of life, and symptom scores.

Conclusion:
This study provides evidence of whether acupuncture is an effective and safe intervention for gastric ulcers.

PROSPERO registration number:
CRD42021251067
AFP-L3 for the diagnosis of early hepatocellular carcinoma
Authors: Zhou Jian-Ming , Wang Ting , Zhang Kun-He 
Published: October 2021

Abstract

Background:
The present study aimed to systematically evaluate the diagnostic value of an isoform of alpha-fetoprotein (AFP), AFP-L3, for early hepatocellular carcinoma (HCC) by a meta-analysis.

Methods:
Diagnostic reports of AFP-L3% in early HCC were searched in the PubMed, Web of Science, Cochrane Library, and Embase databases up to December 2019. The retrieved literature was reviewed, and eligible articles were selected. Data were extracted from the eligible articles, and the risk of bias was evaluated according to the Quality Assessment of Diagnostic Accuracy Studies scale. Statistical analyses were conducted by MetaDiSc1.4 and RevMan5.3 software. The sensitivities, specificities, and diagnostic odds ratios were pooled. The summary receiver operating characteristic curve was drawn, and the area under the curve was calculated.

Results:
Six studies with acceptable quality were included in the meta-analysis involving 2447 patients. No threshold effect was observed among the 6 studies, but there was obvious heterogeneity. The pooled sensitivity, specificity, and positive and negative likelihood ratios of AFP-L3% for the diagnosis of early HCC were 0.34 (95% CI 0.30–0.39, P < .0001), 0.92 (95% CI 0.91–0.93, P < .0001), 4.46 (95% CI 2.94–6.77, P = .0033), and 0.71 (95% CI 0.61–0.82, P = .0004), respectively. The diagnostic odds ratio was 6.78 (95% CI 4.02–11.44, P = .0074). The the area under the curve of the summary receiver operating characteristic was 0.755 (95% CI 0.57–0.94).

Conclusion:
AFP-L3% has high specificity but low sensitivity for diagnose early HCC, suggesting that AFP-L3% is more valuable for excluding HCC in conditions with elevated AFP than for diagnosing early HCC. In addition, a hypersensitive detection method can improve the diagnostic accuracy of AFP-L3% for early HCC.
Significance and Surgical Options for Nontranssexual Phalloplasty
Authors: Wu Qi , Liu Liqiang , Yang Zhe , Ma Ning , Wang Weixin , Li Yang-qun 
Published: October 2021

Objective
This study aimed to evaluate the long-term outcomes of phalloplasty and explore the clinical significance and selection of methods for penile reconstruction.

Methods
The same surgical team performed primary phalloplasty in 166 nontranssexual patients using different surgical approaches between September 2000 and September 2020. All patients had at least 6 months of follow-up. Surgical techniques, complications, and outcomes were retrospectively recorded.

Results
A total of 166 patients with indications such as penile trauma (n = 68 [41%]), amputation injury (n = 15 [9%]), iatrogenic (n = 13 [8%]), penile aplasia (n = 54 [32%]), genital ambiguity (n = 15 [9%]), and Peyronie disease (n = 1 [0.6%]) underwent different techniques of phalloplasty. Four patients (2.4%) had total flap necrosis, and 17 (10%) had partial flap necrosis. The total urethral complications rate was 32.5% (54 of 166); however, all the patients were able to void while standing after successful corrective surgery.

Conclusions
Individualized selection of appropriate penile reconstruction methods tailored to the cause of penile defect, patients' personal needs, thickness of donor site, and the blood supply of the flap are conducive to achieving satisfactory treatment results, reducing complications, and improving patient satisfaction. We believe that a scapular flap has certain advantages in nontranssexual patients, whereas other flaps also have their own indications.
Successful Treatment of a Patient With Breast Implant–Associated Anaplastic Large Cell Lymphoma With Local Residual Disease
Authors: Di Napoli Arianna , Firmani Guido , Sorotos Michail , Lopez Gianluca , Noccioli Niccolò , De Sanctis Vitaliana , Tafuri Agostino , Santanelli di Pompeo Fabio 
Published: October 2021

Background
Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is a hematological malignancy that may occur in patients undergoing breast implant placement. It more commonly behaves as a solid tumor, and the criterion standard treatment consists in an en bloc capsulectomy, which may not always be possible, according to the location of the implant. When local residual disease is present, BIA-ALCL must be treated with adjuvant therapies.

Case Presentation
We describe the case of a 76-year-old woman who underwent unilateral placement of a breast implant after breast cancer surgery in 2004 and developed BIA-ALCL in 2019. A multidisciplinary team managed her case, and en bloc capsulectomy was indicated for the treatment of the malignancy. The histological report showed focal neoplastic infiltration of the posterolateral margin of resection, further supported by positron emission tomography/computed tomography scan, which showed a local uptake in the right anterolateral chest wall. Therefore, adjuvant radiotherapy treatment was indicated for the management of local residual disease, alongside a stringent follow-up protocol. More than 1 year later, imaging scans show no signs of BIA-ALCL recurrence.

Conclusions
Local residual disease in BIA-ALCL is bound to be a progressively more common occurrence, as awareness of BIA-ALCL increases and more cases are diagnosed worldwide. Currently, there is no established consensus on a standard approach for the treatment for patients with a higher risk of local recurrence. Our experience describes the protocol we used to successfully manage a case of BIA-ALCL with incomplete surgical margins, which hopefully can serve colleagues treating patients with similar cases.
Skin Reducing Mastectomy and Immediate Tissue Expander Reconstruction
Authors: Payne Samuel H. , Ballesteros Socorro , Brown Owen H. , Razavi Seyed Amirhossein , Carlson Grant W. 
Published: October 2021

Background
Complications of implant-based reconstruction have been shown to be related to increasing body mass index (BMI) and breast size. The impact of skin reducing mastectomy (SRM) with a dermal flap is examined.

Methods
A retrospective review of a single surgeon's experience with immediate submuscular tissue expander (TE) reconstruction from 2011 to 2019 was performed. The outcomes of SRM were compared with those of skin sparing mastectomy (SSM).

Results
A total of 162 patients (292 breasts) were identified. Mastectomy types were as follows: SRM, 73 (136 breasts) and SSM, 89 (156 breasts). Acellular dermal matrix (ADM) was used to supplement TE coverage in 65.4% of SRM cases. Mean BMI was 29.2 among SRM patients and 25.9 in SSM patients (P < 0.001). Obesity (BMI ≥ 30) was more prevalent in the SRM group (SRM, 38.4% vs SSM, 22.5%; P = 0.03). Mean mastectomy weight was higher in the SRM group (SRM, 833.6 g vs SSM, 425.6 g; P < 0.001). Mean BMI and mastectomy weight were lower in SRM patients who were reconstructed with ADM (ADM, 28.1 vs no ADM, 30.8; P = 0.01; ADM, 746.1 g vs no ADM, 1006.3 g; P < 0.001). Minor complications were more prevalent in the SRM group (SRM, 22.8% vs SSM, 4.5%; P < 0.001). Mastectomy skin flap necrosis (MSFN) was more common in the SRM group (SRM, 22.8% vs SSM, 7.7%; P < 0.001), but MSFN necessitating operative debridement was similarly low in both groups (SRM: 1.9% vs SSM: 4.5%). Major complication rates (SRM 11.0% vs SSM 10.9%) and reconstructive failure rates (SRM 5.9% vs SSM 5.1%) were similar between groups. Mastectomy weight 800 g or higher and BMI of 30 or higher were found to be risk factors for complications on analysis of the SRM cohort (P < 0.05).

Conclusions
Mastectomy weight and BMI were positive predictors of complications after immediate TE reconstruction. Mastectomy skin flap necrosis is more common after SRM than SSM. The use of SRM with a dermal flap has a similar major complication rate as SSM despite its use in obese, large-breasted women. The dermal flap provides soft tissue coverage, which prevents implant exposure and seroma. The use of ADM does not adversely affect the complication rate of SRM.
An Algorithmic Approach for the Reconstruction of Extended Upper-Third Auricular Soft Tissue Defects
Authors: Seretis Konstantinos , Bounas Nikolaos , Lykoudis Efstathios G. 
Published: October 2021

Abstract:
Auricular defects are demanding to reconstruct due to the complex anatomy and the three-dimensional shape of the ear. The functional perspective needs to be addressed without neglecting aesthetic outcomes though, given that it is a prominent facial landmark. In this report the reconstruction of a sizable soft tissue defect of the helical crus and upper third of the right auricle, following surgical excision of a skin tumor, is presented. A variety of treatment options is explored, and a relevant algorithm is proposed. This defect was reconstructed using a transposition flap from the postauricular area, accomplishing single-stage full defect coverage combined with optimal postoperative aesthetic results. High patient satisfaction levels were achieved, avoiding more complicated and prolonged procedures. This case exemplifies the proposed algorithmic approach of upper-third auricular defects, addressing these defects in a systematic and logical manner.
Correction of Severe Secondary Cleft Lip Nasal Deformity
Authors: Cho Byung Chae , Park Tae Hyun , Ryu Jeong Yeop , Lee Joon Seok , Choi Kang Young , Yang Jung Dug , Chung Ho Yun 
Published: October 2021

Background:
The lower lateral cartilages (LLCs) are key elements for alar and tip support. Repositioning of both LLCs is an effective procedure for correcting a laterally spreading dome of LLCs and drooping nasal tip in cleft lip nasal deformity (CLND). The alar contour graft has become an essential component of rhinoplasty for correcting the concave or collapsed and retracted alar. Herein, onlay cartilage graft was combined with nasal tip plasty to correct hypoplastic cleft lateral crus or alar rim retraction, and with columella strut to obtain better aesthetic outcomes in patients with severe CLND.

Methods:
Seven patients with severe secondary unilateral CLND, including hypoplastic cleft lateral crus or alar rim retraction, underwent rhinoplasty from October 2013 to April 2020. Both LLCs were isolated and repositioned approximated medially using tip suture technique combined with columella strut. A septal cartilage onlay graft was applied on the hypoplastic cleft lateral crus. Cartilage graft on the nasal tip was performed to further project and enhance the nasal tip. Photogrammetric evaluation of the operated patients and statistical analysis of the obtained data were performed.

Results:
The average age at operation was 23.5 (range: 17–36) years. The follow-up period was 6–36 (mean, 14.3) months. All patients were enrolled by photogrammetric evaluation. Height of the medial nostril and short axis of the nostril on the cleft side were increased with a statistical significance of P < 0.05, indicating that depressed ala on the cleft side, which is a feature of CLND, was corrected similar to that of the noncleft side.

Conclusions:
The alar contour cartilage graft, as an effective adjunctive technique, improves the alar margin, prevents the alar rim from collapsing, and provides supports to the cleft-side alar rim. It can be a prophylactic measure to prevent postoperative retraction in patients with weakened LLCs. Lower lateral cartilage repositioning, columellar strut, and nasal tip plasty are useful for correcting severe secondary unilateral CLND
Anchored Suture Technique for the Reconstruction of Paranasal Skin Defects Secondary to Melanocytic Nevus Excision
Authors: Sun Di , Huang Xing , Lu Lin , Jin Rui , Zhou Xianyu , Huang Cheng , Luo Xusong 
Published: October 2021

Abstract:
To describe a modified anchored suture technique combined with varied flaps for the repair of paranasal skin defect secondary to melanocytic nevus excision. The feasibility and effectiveness of the technique were discussed. A total of 26 patients (10 male and 16 female) with an average age of 11.1 years were included in this retrospective study. All patients underwent the anchored suture technique. The subcutaneous tissue of the free margin of the cheek flap was sutured to the deep pyriform ligament. The local flaps were designed according to the size and shape of the defect. The diameter of the nevi ranged from 2.8 to 7.5 cm, with most being 3 to 5 cm (50%). Among the 26 patients, 17 patients underwent the anchored suture technique and nonadvancement flap, whereas the other 9 patients underwent the anchored suture technology and advancement flap with auxiliary incisions. Twenty-five patients had a symmetric nasal alar and unapparent scar and were satisfied with postoperative aesthetic outcomes. Thus, the anchored suture method combined with different flaps to repair paranasal defect is an effective and affordable technique to reconstruct paranasal tissue connections.
Rejection of Acellular Porcine Corneal Stroma Transplantation During Coronavirus Disease 2019 Pandemic
Authors: Chen Li-Na , Hao Ji-Long , Liu Xiu-Fen , Zhou Dan-Dan , Pant Om Prakash , Liu Xiang-Yu , Liu Hui-Feng , Liu Hong-Wei , Lu Cheng-Wei 
Published: October 2021

Abstract:
To report 2 successfully managed cases of graft rejection with acellular porcine corneal stroma (APCS) transplantation in patients with fungal corneal ulcer. Two patients were diagnosed with fungal corneal ulcer and received APCS transplantation. Graft rejection developed due to the lost follow-up during the period of coronavirus disease 2019 outbreak. Amniotic membranes transplantation and cauterization of neovascularization was performed, respectively. The graft failure resolved successfully after the procedure. To the best of our knowledge, amniotic membranes transplantation and cauterization of new vessels are the firstly reported in treating APCS graft failure. Amniotic membranes transplantation or cauterization of neovascularization appear to be a safe and costeffective method for treating graft failure.