bluuebunny/crossref_metadata_2025_split huggingface dataset:
p-STAT3 expression in breast cancer correlates negatively with tumor size and HER2 status
Authors: Wang Yan , Wang Qian , Tang Chih-Hsin , Chen Hua-Dong , Hu Gui-Nv , Shao Jun-Kang , Dong Xiao-Fang , Jin Lu-Lu , Wang Chao-Qun 
Published: March 2021

Abstract
Although some studies have reported the expression and clinical significance of phosphorylated signal transducer and activator of transcription 3 (p-STAT3) in breast cancer tissues, it is still controversial whether p-STAT3 play a role in promoting or suppressing cancer. Here, we used immunohistochemistry analysis to explore expression of p-STAT3 in 407 cases of breast cancer, and analyzed the relationship between p-STAT3 expression and the clinicopathological characteristics and prognosis of breast cancer patients. Positive p-STAT3 expression was seen in 112 cases (27.5%) of breast cancer. p-STAT3 expression was negatively correlated with tumor size, tumor stage and human epidermal growth factor receptor 2 (HER2) status, and the positive rate of p-STAT3 was lowest in HER2-enriched subtype breast cancer (15.3%), while other subtypes were luminal B (23.0%), luminal A (30.2%), and triple-negative breast cancer (TNBC) (37.5%). Logistic regression model multivariate analysis showed that the independent correlation factor of p-STAT3 expression in breast cancer was tumor size (OR = 0.187, 95% CI = 0.042–0.839, P = .029) and HER2 status (OR = 0.392, 95% CI = 0.216–0.710, P = .002). In this study, no clear relationship was observed between patients’ prognosis and expression of p-STAT3. Therefore, we suggest that p-STAT3 expression in breast cancer is negatively correlated with tumor size and HER2 status, but appears to have no effect on survival.
Radiofrequency induced lesion characteristics according to force–time integral in experimental model
Authors: Hwang You Mi , Lee Woo Seok , Choi Kee-Joon , Kim Yoo Ri 
Published: March 2021

Abstract
Contact force (CF)-sensing technology has enabled accurate real-time CF measurement in tissue. Average CF, which is quantified by the force–time integral (FTI), correlates with lesion volume.
Little is known about which of the time and force factors that compose FTI plays a more important role and which is a better index for predicting lesion size, FTI, or force–power–time index (FPTI). Investigators sought to identify a better index for predicting radiofrequency ablation lesion formation with experimental model.
Radiofrequency current was delivered to the swine skeletal muscle at radiofrequency energy current was delivered at 4 fixed power settings (15, 25, 30, and 40 W) for 6 variable time durations (5, 10, 20, 30, 40, and 50 s) with 6 variable CF settings (5, 10, 20, 30, 40, and 50 g). At each setting, the following parameters were evaluated:
Between FTI factors, the time factor was more important than the force factor for lesion formation. The area under the curve was greater for FPTI (0.943) than for FTI (0.870). On univariate linear regression analysis, the explanatory power of the linear regression model was better explained by FPTI (56.4%) than FTI (32.1%).
Under the same FTI condition, the time factor had a greater effect on lesion formation. When power was included, the power factor had a greater effect on lesion formation and steam pop.
Short-term impact of the COVID-19 pandemic on patients with a chronic pain disorder
Authors: Lassen Christoph L. , Siam Laila , Degenhart Astrid , Klier Tobias W. , Bundscherer Anika , Lindenberg Nicole 
Published: March 2021

Abstract
The current Covid-19 pandemic has already had a definite impact on the daily life of many people worldwide. It has been proposed that people with preexisting medical conditions will be harder hit by the pandemic and the subsequent measures to contain the spread of the disease. In this questionnaire-based, observational study, we aimed to assess the impact of the pandemic on patients with a chronic pain disorder, who are treated at a tertiary multidisciplinary pain center.
Participants rated the impact of the pandemic on their chronic pain disorder using a self-designed questionnaire. Also, participants filled out the regular follow-up questionnaire to assess a chronic pain disorder measuring among other parameters pain intensity, symptoms of depression, anxiety, stress, and pain-related quality of life.
Of 136 eligible patients who presented to our pain center between May 5th and July 17th, 112 agreed to participate in the study (82.4%). Eighty two participants (73.2%) reported a deterioration of the pain disorder using the self-designed questionnaire. The more robust parameters of the regular follow-up questionnaire showed no relevant changes compared to data collected before the pandemic. We were not able to detect any demographic and medical parameters that were clinically relevantly associated with a higher impact of the pandemic.
We conclude that a chronic pain disorder is a relatively stable disease that does not change significantly due to external factors, like the Covid-19 pandemic, even if the subjective impact is perceived to be high.
Idiopathic hypereosinophilic syndrome in hemodialysis patients
Authors: Mutsuyoshi Yuko , Hirai Keiji , Morino Junki , Kaneko Shohei , Minato Saori , Yanai Katsunori , Ishii Hiroki , Matsuyama Momoko , Kitano Taisuke , Aomatsu Akinori , Miyazawa Haruhisa , Ito Kiyonori , Ueda Yuichiro , Ookawara Susumu , Morishita Yoshiyuki 
Published: March 2021

Abstract

Rationale:
Herein, we report 3 hemodialysis patients with idiopathic hypereosinophilic syndrome who were successfully treated using corticosteroid therapy.

Patient concerns:
Case 1 was a 63-year-old man who was undergoing hemodialysis because of bilateral nephrectomy and developed hypereosinophilia with digestive symptoms, myocardial injury, and intradialytic hypotension. Case 2 was an 83-year-old man who was undergoing hemodialysis because of nephrosclerosis and developed hypereosinophilia with pruritus, myocardial injury, and intradialytic hypotension. Case 3 was a 59-year-old man who was undergoing hemodialysis because of diabetic nephropathy and developed hypereosinophilia with pruritus, myocardial injury, and intradialytic hypotension.

Diagnoses:
All 3 patients presented with hypereosinophilia (eosinophil count ≥1500 /μL for more than 1 month) and multiple-organ involvement (intradialytic hypotension, cardiac injury, digestive symptoms, and allergic dermatitis). A specific cause for the hypereosinophilia was not identified by systemic computed tomography, electrocardiography, echocardiography, bone marrow examination, or blood tests. Furthermore, Case 2 and 3 had not recently started taking any new drugs and drug-induced lymphocyte stimulation tests were negative in Case 1. Therefore, they were diagnosed with idiopathic hypereosinophilic syndrome.

Interventions:
All 3 patients received corticosteroid therapy with prednisolone at a dose of 40 mg/d, 30 mg/d, and 60 mg/d in Case 1, 2, and 3, respectively.

Outcomes:
Their digestive symptoms, pruritus, intradialytic hypotension, and serum troponin I concentrations were immediately improved alongside reductions in their eosinophil counts.

Lessons:
There have been few case reports of idiopathic hypereosinophilic syndrome in patients undergoing hemodialysis. We believe that recording of the clinical findings and treatments of such patients is mandatory to establish the optimal management of idiopathic hypereosinophilic syndrome.
Goal-directed ultrasound protocol in patients with nontraumatic undifferentiated shock in the emergency department: prospective dual centre study
Authors: Leroux Pierre , Javaudin François , Le Bastard Quentin , Lebret Yannick , Pes Philippe , Arnaudet Idriss , Vignaud Frédéric , Montassier Emmanuel , Le Conte Philippe 
Published: March 2021

Background and Importance
Early identification of the cause of shock is associated with better prognosis.

Objective
The aim of this study was to explore the performances of an ultrasound protocol (echoSHOCK) to diagnose the cause of shock in the emergency department (ED).

Design, settings and participants
This was a prospective study performed in two EDs. Included patients were older than 18 years admitted with shock. After routine workup strategy, the suspected cause of shock and the planned treatment were reported. The echoSHOCK protocol, using only B mode, was then performed. After performing echoSHOCK, the investigator reported the same two items.

Intervention
echoSHOCK protocol that assessed: compressive pericardial effusion (tamponade), right ventricle dilatation and flattening of the septum, left ventricle dimension and systolic function, indices of hypovolemia.

Outcomes measure and analysis
We defined four different causes for shock (tamponade, acute cor pulmonale, cardiogenic and hypovolemia). The primary endpoint was the degree of agreement of the routine workup and echoSHOCK with an expert panel.

Main Results
85 patients [mean age of 73 (14) years] were included. Kappa coefficients between routine strategy and echoSHOCK for the cause of shock, with the expert panel were 0.33 (95% CI, 0.26-0.4) and 0.88 (95% CI, 0.83-0.93), respectively. Likewise, for the planned treatment, kappa were 0.21 (95% CI, 0.14-0.28) and 0.9 (95% CI, 0.85-0.94), respectively. The physician’s confidence increased from 3.9 (2.1) before echoSHOCK to 9.3 (1.1) after, (P < 0.001).

Conclusion
This study suggested that echoSHOCK significantly increased the ability to determine the cause of undifferentiated shock in the ED.
Assessment of diagnostic strategies based on risk stratification for aneurysmal subarachnoid hemorrhage: a retrospective chart review
Authors: Bianchi Christophe , Ageron François-Xavier , Carron Pierre-Nicolas 
Published: March 2021

Background and importance
Current guidelines recommend noncontrast computed tomography (NCCT) followed by lumbar puncture for the diagnosis of subarachnoid hemorrhage (SAH). Alternative strategies, including clinical risk stratification and CT angiography (CTA), are emerging.

Objective
To evaluate alternative strategies to current guidelines through clinical risk stratification.

Design, setting and participants
Single-site, retrospective observational study of patients with SAH suspicion, from 2011 to 2016. We combined results of each investigation (NCCT, CTA and lumbar puncture) with a clinical risk assessment, including Ottawa score.

Exposure
Comparing the current strategy (NCCT ± lumbar puncture if negative CT) to alternative strategies (NCCT + CTA ± lumbar puncture if high clinical risk or negative CT and onset of headache ≥12 h o dds ratio ≥24 h).

Outcome measure and analysis
Main outcome was diagnosis of SAH at hospital discharge. Secondary outcomes were death from all causes and need for invasive procedures at 28 days. We used sensitivity, specificity, positive predictive value and negative predictive value (NPV) to evaluate the diagnostic performance of three strategies.

Main results
310 patients were included. SAH was diagnosed in 8 cases (2.6%), none died and 7 (2.2%) had a surgical procedure. Performances of different strategies were not statistically different. NPVs were 99.7% [95% Confidence interval (CI), 98.2–100%] for strategy 1 and 100% (95% CI, 98.8–100%) for strategies 2 and 3. More than 4000 lumbar punctures are needed to diagnose one SAH when CTA is performed within 24 h of symptoms’ onset and absence of high-risk criteria.

Conclusion
Clinical risk stratification and CTA strategy are well-tolerated and effective for diagnosis of SAH, avoiding systematic use of lumbar puncture.
Emergency Medical Services response levels and subsequent emergency contacts among patients with a history of mental illness in Denmark: a nationwide study
Authors: Mackenhauer Julie , Valentin Jan Brink , Mikkelsen Søren , Steinmetz Jacob , Væggemose Ulla , Christensen Helle Collatz , Mainz Jan , Johnsen Søren Paaske , Christensen Erika Frischknecht 
Published: March 2021

Background and importance
People with mental illness have higher use of emergency services than the general population and may experience problems with navigating in complex healthcare systems. Poor physical health contributes to the excess mortality among the mentally ill.

Objective
To compare the level of Emergency Medical Services (EMS) response and subsequent contacts emergency between patients with and without a history of mental illness.

Design, setting, and participants
A nationwide cohort study was conducted in Denmark including medical 1-1-2 calls 2016 2017. The healthcare system is financed through taxation allowing free access to healthcare services including ambulance services.

Exposure
Exposed groups had a history of major, moderate, or minor mental illness.

Outcome measures and analysis
We studied seven national prehospital care Performance Indicators (PI 1–7). The selected PI concerned EMS response levels and subsequent contacts to prehospital and in-hospital services. Exposed groups were compared to nonexposed groups using regression analyses.

Results
We included 492 388 medical 1-1-2 calls: 8, 10, and 18% of calls concerned patients with a history of major, moderate, or minor mental illness, respectively.
There were no clinically relevant differences regarding response times (PI 1–2) or registration of symptoms (PI 3) between groups.
If only telephone advice was offered, patients with a history of major, moderate or minor mental illness were more likely to recall within 24 h (PI 4): adjusted risk ratio (RR) 2.11 (1.88–2.40), 1.96 (1.20–2.21), and 1.38 (1.20–1.60), but less or equally likely to have an unplanned hospital contact within 7 days (PI 6): adjusted RRs 1.05 (0.99–1.12), 1.04 (0.99–1.10), and 0.90 (0.85–0.94), respectively.
If released at the scene, the risk of recalling (PI 5) or having an unplanned hospital contact (PI 7) was higher among patients with a history of mental illness: adjusted RRs 2.86 (2.44–3.36), 2.41 (2.05–2.83), and 1.57 (1.35–1.84), and adjusted RRs 2.10 (1.94–2.28), 1.68 (1.55–1.81), and 1.25 (1.17–1.33), respectively.
Patients with a history of mental illness were more likely to receive telephone advice only adjusted RRs 1.61 (1.53–1.70), 1.30 (1.24–1.37), and 1.08 (1.04–1.13), and being released at scene adjusted RRs 1.11 (1.08–1.13), 1.03 (1.01–1.04), and 1.05 (1.03–1.07).

Conclusion
More than one-third of the study population had a history of mental illness. These patients received a significantly lighter EMS response than patients with no history of mental illness. They were significantly more likely to use the emergency care system again if released at scene. This risk increased with the increasing severity of the mental illness.
Thiamine combined with vitamin C in sepsis or septic shock: a systematic review and meta-analysis
Authors: Ge Zengzheng , Huang Jiewu , Liu Yawei , Xiang Jun , Gao Yanxia , Walline Joseph Harold , Lu Xin , Yu Shiyuan , Zhao Lina , Li Yi 
Published: March 2021

Background
Thiamine and vitamin C have been increasingly used in patients with sepsis or septic shock because of their potential for improving metabolism and reducing mortality.

Objective
We aim to determine if thiamine combined vitamin C can reduce mortality in patients with sepsis or septic shock.

Evidence sources and study selection
We comprehensively searched the PubMed, Embase, Cochrane Library, and Web of Science databases from their inception dates through 1 January 2021. Literature works evaluating the efficacy of thiamine combined vitamin C in patients with sepsis or septic shock were considered.

Data extraction and outcome measurements
Two reviewers extracted data and assessed study quality. A meta-analysis was performed to calculate an odds ratio (OR), 95% confidence intervals (CIs), and P values for in-hospital mortality (primary outcome). Secondary outcomes included duration of ICU stay, duration of hospital stay, duration of vasopressor use, and change in sequential organ failure assessment (SOFA) scores.

Results
Seven randomized controlled trials were identified, encompassing a total of 868 patients. There was no statistical difference between groups for in-hospital mortality (OR: 1.11; 95% CI [0.79–1.56]; P = 0.55). Other than improving SOFA score during the first 72 h after enrollment and duration of vasopressor use, we found no other significant associations.

Conclusions:
Despite widespread enthusiasm for thiamine combined with vitamin C for sepsis and septic shock, we only found an association with reduced SOFA score and time of vasopressor use. There was no association with in-hospital mortality.
Female Pattern Hair Loss: Why the Follicular Unit Transplantation Surgical Technique Remains a Good Option
Authors: Uebel Carlos O. , Piccinini Pedro S. , Spencer Leonardo S. B. , da Silveira Jorge A. M. 
Published: March 2021

Background:
Female pattern hair loss is a common nonscarring alopecia that can present with several patterns of decreased hair density. The condition is very bothersome to affected women, and although there are multiple nonsurgical options, surgical follicular unit transplantation remains one of the most effective options.

Methods:
A retrospective chart review was performed of the senior author’s (C.O.U.) experience and technique of follicular unit transplantation for treatment of female pattern hair loss.

Results:
A total of 751 patients with female pattern hair loss underwent follicular unit transplantation over the past 31 years. Average patient age was 48 years. Patients with small areas of hair loss made up 40 percent of the group (Ludwig stage I), those with medium-sized areas constituted 45 percent (Ludwig stage II), and those with large areas constituted 15 percent (Ludwig stage III). The average operative time was 3 hours 21 minutes. One hundred thirty-five patients (18 percent) underwent a second replacement, at an average period of 4 years after the procedure, because of the progressive nature of female pattern hair loss. Complications included donor-site scar widening in six patients and folliculitis in 17 patients.

Conclusion:
Follicular unit transplantation is an excellent option for treatment of female pattern hair loss patients, as there is no need to shave the recipient sites, operative times are shorter than for follicular unit excision techniques, and the incidence of complications is very low.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Craniofacial Microsurgery: An Integrated Approach to Management of Cleft and Craniofacial Syndromes, Surgical Experience, and Insights
Authors: Sachanandani Neil S. , Powers Jeremy M. , Issa Christopher J. , Oliver Lauren N. , Chaiyasate Kongkrit 
Published: March 2021

Abstract
Ian Jackson and Jack Fisher published one of the earliest reports on microsurgical applications for craniofacial patients in 1989. Since that time, applications of craniofacial surgery and microsurgery have significantly expanded and become more refined. However, there remain certain specific clinical problems in cleft and craniofacial surgery in which traditional craniofacial methods provide variable success or suboptimal outcomes. The purpose of the current study is to share our experience using an integrated approach of craniofacial and microsurgical methods to provide optimal surgical solutions to this complex patient population. The authors performed a retrospective review of 17 patients that utilized craniofacial microsurgery in setting of cleft and craniofacial syndromes performed by the senior author from July 2013 to July 2020. 22 free flaps were performed for 17 patients. The patient age at time of flap reconstruction ranged from 10 to 48 years (mean 21.4 years). There were 8 females and 9 males. There was one total flap loss. Based on our collective experience, the authors present a comprehensive algorithm for the role of microsurgical reconstruction in cleft and craniofacial patients. There are several situations in craniofacial surgery which traditional reconstructive methods require numerous operative interventions to achieve suitable outcomes. Craniofacial Microsurgery techniques can bring in new tissue and may prevent the need to manipulate scarred and multiply operated tissues. The craniofacial surgery team should not hesitate to apply microsurgical solutions to these situations for optimal results.
The Doctor Will “See” You Now – Unmet Expectations of Telemedicine in Plastic Surgery
Authors: Tam Anson K. , Kim Minji , Mathew Prakash J. , Thaller Seth R. 
Published: March 2021

Abstract
Social distancing protocols during the COVID-19 pandemic have resulted in a rapid expansion of telemedicine. It has allowed patients to save time and money on clinic visits, and physicians to communicate with patients who live remotely. Telemedicine has also been valuable in plastic surgery during initial consultations, transfers, and follow up visits. However, given the often-sensitive nature of plastic surgery, the professionalism and expectations of telemedicine have to be reviewed. A comprehensive literature search of the MEDLINE, PubMed, Google Scholar, EMBASE, and Cochrane Central Register of Controlled Trials was conducted for studies published through October 2020 with multiple search terms related to telemedicine and its use in plastic surgery. Data on the effectiveness, challenges, and professionalism of telemedicine were collected. Our review suggests that telemedicine can be an effective mode of communication in many realms of plastic surgery, including cleft care and craniofacial deformities. However, many plastic surgeons are unfamiliar with the existing platforms, and there are no clear guidelines on the most optimal platforms. Physicians have to recognize that patients might have low digital health literacy or may not even possess digital device for telemedicine. There also needs to be an overall improvement in patient education. Given that telemedicine use will continue to increase after the COVID-19 pandemic, regulations on Health Insurance Portability and Accountability Act-compliant platforms and specific guidelines on telemedicine visits, such as undressing, chaperones, privacy matters, need to be established while maintaining a professional relationship between the patient and the physician.
Temporal Artery and Temporal Region Supplied by the Middle Cerebral Artery: An Anatomical Study
Authors: Guler Tugba Morali , Guner Yahya Efe , Korkmaz Ali Can , Gungor Yigit , Sayaci Yagiz Emre , Kose Serdal Kenan , Comert Ayhan , Kahilogullari Gokmen 
Published: March 2021

Abstract
This study was conducted to describe in detail the branching patterns of cortical branches from the middle cerebral artery supplying the feeding of the temporal region, to define the arterial structure of temporal artery (TA) and to determine the effect of this arterial supply to the temporal region. The arteries of brains (n = 22; 44 hemispheres) were prepared for dissection after filling them with colored latex. TA was defined, and its classification was described, specifying its relationship with other cortical branches. A new classification was defined related to TA terminology. TA was found in 95% of cadavers, and it originated as an early branch in 75% and from the inferior trunk in 24% of cadavers. TA was classified as Type 0: No TA, Type I: single branch providing two cortical branches, Type II: single branch providing three or more cortical branches and Type III: double TA. Type I-TA (45%) was the most common, and Type II-TA arterial diameter was significantly larger than that of other types. All cadavers showed the cortical branches of temporal region from middle cerebral artery, anterior TA , middle TA, posterior TA and temporooccipital artery, except temporopolar artery (81%). Temporopolar artery, anterior TA, and middle TA primarily originated from TA, an early branch, but posterior TA and temporooccipital artery primarily originated from the inferior trunk. Detailed knowledge about cortical branches together with TA and also this region's blood supply would enable increased prediction of complications, especially in cases with these region-related pathologies, and would make interventions safer.