bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regional anesthesia and cancer recurrence in patients with late-stage cancer: a systematic review and meta-analysis
Authors: Zhang Yue-Lun , Pei Li-Jian , Sun Chen , Zhao Meng-Yun , Che Lu , Huang Yu-Guang 
Published: October 2021

Abstract

Background:
Whether regional anesthesia may help to prevent disease recurrence in cancer patients is still controversial. The stage of cancer at the time of diagnosis is a key factor that defines prognosis and is one of the most important sources of heterogeneity for the treatment effect. We sought to update existing systematic reviews and clarify the effect of regional anesthesia on cancer recurrence in late-stage cancer patients.

Methods:
Medline, Embase, and Cochrane Library were searched from inception to September 2020 to identify randomized controlled trials (RCTs) and cohort studies that assessed the effect of regional anesthesia on cancer recurrence and overall survival (OS) compared with general anesthesia. Late-stage cancer patients were primarily assessed according to the American Joint Committee on Cancer Cancer Staging Manual (eighth edition), and the combined hazard ratio (HR) from random-effects models was used to evaluate the effect of regional anesthesia.

Results:
A total of three RCTs and 34 cohort studies (including 64,691 patients) were identified through the literature search for inclusion in the analysis. The risk of bias was low in the RCTs and was moderate in the observational studies. The pooled HR for recurrence-free survival (RFS) or OS did not favor regional anesthesia when data from RCTs in patients with late-stage cancer were combined (RFS, HR = 1.12, 95% confidence interval [CI]: 0.58–2.18, P = 0.729, I
2 = 76%; OS, HR = 0.86, 95% CI: 0.63–1.18, P = 0.345, I
2 = 48%). Findings from observational studies showed that regional anesthesia may help to prevent disease recurrence (HR = 0.87, 95% CI: 0.78–0.96, P = 0.008, I
2 = 71%) and improve OS (HR = 0.88, 95% CI: 0.79–0.98, P = 0.022, I
2 = 79%).

Conclusions:
RCTs reveal that OS and RFS were similar between regional and general anesthesia in late-stage cancers. The selection of anesthetic methods should still be based on clinical evaluation, and changes to current practice need more support from large, well-powered, and well-designed studies.
Bleomycin Electrosclerotherapy Treatment in the Management of Vascular Malformations
Authors: Kostusiak Milosz , Murugan Srinivasen , Muir Tobian 
Published: October 2021

BACKGROUND
Intralesional injection of a sclerosing agent is a standard treatment for vascular malformations, but many repeat treatments are often required to achieve a response. The temporary application of an electrical field to the treated area increases cellular membrane permeability and therefore augments drug delivery.

OBJECTIVE
To report a case series of patients with vascular malformations who received bleomycin electrosclerotherapy (EST).

MATERIALS AND METHODS
A prospective observational case series of patients with vascular malformations treated with bleomycin EST. Only patients who did not respond or had limited response to standard sclerotherapy were included. The response to the treatment was assessed using a global assessment score and patient-reported outcome measures.

RESULTS
Thirty patients were treated with EST. Most of the patients had venous malformations (57%). Complete response or significant improvement was observed in 17 (57%) and 7 (23%) patients, respectively. Most of the patients were satisfied or very much satisfied with the outcome of the treatment. Most commonly reported complications were swelling, pain, and bleeding.

CONCLUSION
Electrosclerotherapy is a promising method of augmenting the efficacy of intralesional bleomycin injections when treating vascular malformations. It can potentially lead to a reduction in the administered dose and number of treatment sessions needed.
Hutchinson Sign: Biopsy May Assist in Diagnosis of Subungual Melanoma in Situ
Authors: Oh Se Jin , Lee Jongeun , Park Sewon , Park Ji-Hye , Lee Dongyoun 
Published: October 2021

BACKGROUND
Early and accurate diagnosis of subungual melanoma (SUM) through histopathologic examination is critical, but lack of clinical suspicion leads to delays in diagnosis. Hutchinson sign (HS) can be one of the important clinical indicators for diagnosing SUM.

OBJECTIVE
To evaluate the diagnostic value of small biopsies of HS for detecting SUM in situ.

METHODS
We retrospectively evaluated 12 patients who were diagnosed as SUM in situ and underwent punch biopsy at HS areas. Clinical features, dermoscopic findings, and histopathologic findings in HS regions were analyzed.

RESULTS
In most cases, HS was seen in hyponychium (11/12, 91.7%) with 1 case found in proximal nail fold, and 1 case in both the hyponychium and proximal nail fold. Dermoscopic features of HS showed irregular diffuse pigmentation (12/12, 100%) and parallel ridge pattern (7/12, 58.3%). Histopathologically, all cases showed irregularly scattered atypical melanocytes with hyperchromatic nuclei. Two cases showed subtle changes in melanocytes with little nuclear atypia, but additional section specimen showed more definitive findings of SUM in situ.

CONCLUSION
We present a supplementary biopsy technique for diagnosing SUM. Biopsy of HS may help in the diagnosis of SUM.
Merkel Cell Carcinoma: A Bibliometric Analysis of the Top 100 Cited Publications
Authors: Russomanno Kristen , Raiker Rahul , Pakhchanian Haig , Deng Min 
Published: October 2021

BACKGROUND
Bibliometric studies provide a quantitative statistical analysis of the published literature within a field of interest and allow for easy identification of the major contributing authors, funding sources, and publication trends within the field. To date, no bibliometric studies have been performed pertaining to Merkel cell carcinoma (MCC).

OBJECTIVE
To identify the 100 most frequently cited articles in MCC through a bibliometric analysis of the literature.

METHODS
Web of science was queried to determine the 100 most frequently cited MCC publications published between the years 1970 and 2019. Articles were listed by title, authors and their affiliated institutions, journal title and type, year of publication, country of origin, funding sources, and citation frequency.

RESULTS
Among the 100 most frequently cited MCC publications, articles were cited between 67 and 589 times with a mean of 136.3 times. Articles were cited between 2.0 and 98.2 times per year since publication with a mean of 11.3 times per year. 67% of the articles were published in oncology journals; 33% and 10% of the articles in dermatology and surgery journals, respectively. The most represented journal was Cancer (12%). Paul Nghiem was the most frequently identified author (18%). 36% of the top 100 articles were published out of the University of Washington. The most frequent funding agency was the National Institutes of Health (77%).

CONCLUSION
Through this bibliometric analysis, researchers can easily identify key publications pertaining to MCC, which may in turn enhance their approach to understanding and practicing evidence-based medicine regarding MCC.
OPHTHALMOMYIASIS INTERNA WITH INVASION OF THE OPTIC NERVE
Authors: Durrani Asad F. , Johnson Mark W. 
Published: October 2021

Purpose:
To report a case of ophthalmomyiasis interna with optic nerve invasion that was treated with oral ivermectin and prednisone.

Methods:
Case report with retrospective review of medical records and multimodal imaging studies.

Results:
A Christmas tree farmer in his sixties presented with expanding multicolored, spiraling photopsias in the left eye. The visual acuity measured 20/50, and examination and imaging findings showed subretinal tracks consistent with ophthalmomyiasis interna. After several weeks of spontaneous improvement, the visual acuity decreased to 20/150 and fundus examination showed new optic disc edema that was treated with ivermectin and prednisone. Despite the development of optic disc pallor, the visual acuity improved to 20/25.

Conclusion:
Subretinal fly larvae can occasionally exit the eye by invading the optic nerve. Treatment of optic nerve involvement with ivermectin and prednisone can result in an excellent visual outcome.
The Pain Course: a randomised controlled trial and economic evaluation of an internet-delivered pain management program
Authors: Dear Blake F. , Karin Eyal , Fogliati Rhiannon , Dudeney Joanne , Nielssen Olav , Gandy Milena , Staples Lauren , Scott Amelia J. , Heriseanu Andreea I. , Bisby Madelyne A. , Hathway Taylor , Titov Nickolai , Schroeder Liz 
Published: October 2021

Abstract
There is interest in the potential of Internet-delivered programs to cost-effectively increase access to pain management for people with chronic pain. However, few large-scale clinical and economic evaluations have been undertaken. Using a randomised controlled trial design, the current study (n = 659) examined the clinical efficacy, cost-effectiveness, and cost utility of an Internet-delivered pain management program for people with mixed chronic pain conditions when delivered with optional clinician support. The treatment group reported significant improvements in disability, depression, anxiety, average pain intensity, and quality-adjusted life years (QALYs), compared with control, and exhibited relatively high levels of treatment engagement and satisfaction. Each additional clinical improvement (defined as ≥ 30% improvement) produced by the intervention, over control, was associated with a cost of $48, $27, $38, and $83 for disability, depression, anxiety, and average pain intensity, respectively. Gaining one QALY was associated with a cost of $152 or $11,910 per QALY when an 80% probability criterion for cost utility was applied. The program itself was associated a relatively small, fixed, cost per patient but was not cost saving over the brief intervention period. The findings support the clinical efficacy and cost-effectiveness of Internet-delivered programs with “on demand” clinician support as a way to increase access to pain management. Key limitations of the current study include the use of a waitlist-control group, a short follow-up period, and the focus on governmental healthcare costs. Further evaluation of these programs is necessary if they are scaled up and offered as routine care.
Exploring the Barriers Faced by Nephrology Nurses in Initiating Patients With Chronic Kidney Disease Into Advance Care Planning Using Focus-Group Interviews
Authors: CHEN Jui-O , LIN Chiu-Chu 
Published: October 2021

ABSTRACT

Background
The prevalence of end-stage renal disease in Taiwan is the highest in the world. The rate of signing advance directives in Taiwan is lower than in Western countries, and most of the barriers that have been identified relate to initiating advance care planning (ACP).

Purpose
This study was designed to explore the barriers to discussing ACP with patients with chronic kidney disease faced by nephrology nurses.

Methods
A descriptive qualitative study design was adopted. The Consolidated Criteria for Reporting Qualitative Research was used to report the findings of this study. Data were collected using purposive sampling. A total of 34 nephrology nurses were recruited from hospitals in northern (2 groups, 10 participants), central (1 group, 4 participants), and southern (5 groups, 20 participants) Taiwan. A qualitative content analysis was conducted to analyze the transcripts of the eight focus groups.

Results
Five themes were identified, including (a) lacking the confidence to discuss ACP, (b) difficulty in finding an appropriate opportunity to initiate ACP discussion, (c) personally lacking the characteristics to discuss ACP, (d) conflicting perspectives between doctors and nurses over ACP, and (e) culture and belief-based barriers to discussing ACP.

Conclusions/Implications for Practice
The findings obtained from the interviews revealed that nurses must enhance their ACP-related knowledge and communication skills and foster personal confidence in initiating ACP discussions. Furthermore, nurses must be empowered to work with other healthcare professionals. To implement the initial process of discussing ACP in clinical settings, clinical guidelines should be developed for healthcare professionals on initiating ACP. These measures may facilitate improved collaboration in healthcare settings and further encourage patients and their families to participate in shared decision-making that may help patients complete advance directives and thereby achieve better care quality at the end of life.
Peroral Endoscopic Myotomy for the Treatment of Esophageal Diverticula
Authors: Facciorusso Antonio , Ramai Daryl , Ichkhanian Yervant , Yadlapati Rena , Annese Vito , Wani Sachin , Khashab Mouen A. 
Published: October 2021

Background:
There is limited evidence on the efficacy of peroral endoscopic myotomy (POEM) in patients with esophageal diverticula.

Aims:
This meta-analysis aimed to assess the efficacy and safety profile of POEM in patients with Zenker (ZD) and epiphrenic diverticula.

Methods:
With a literature search through August 2020, we identified 12 studies (300 patients) assessing POEM in patients with esophageal diverticula. The primary outcome was treatment success. Results were expressed as pooled rates and 95% confidence intervals.

Results:
Pooled rate of technical success was 95.9% (93.4%-98.3%) in ZD patients and 95.1% (88.8%-100%) in patients with epiphrenic diverticula. Pooled rate of treatment success was similar for ZD (90.6%, 87.1%-94.1%) and epiphrenic diverticula (94.2%, 87.3%-100%). Rates of treatment success were maintained at 1 year (90%, 86.4%-97.4%) and 2 years (89.6%, 82.2%-96.9%) in ZD patients. Pooled rate of symptom recurrence was 2.6% (0.9%-4.4%) in ZD patients and 0% in patients with epiphrenic diverticula. Pooled rates of adverse events and severe adverse events were 10.6% (4.6%-16.6%) and 3.5% (0%-7.4%) in ZD and 8.4% (0%-16.8%) and 8.4% (0%-16.8%) in epiphrenic diverticula, respectively.

Conclusion:
POEM represents an effective and safe therapy for the treatment of esophageal diverticula.
Manipulation of the gut microbiome in gluten-intolerance
Authors: Olivares Marta , Flor-Duro Alejandra , Sanz Yolanda 
Published: October 2021

Purpose of review
Gluten is a complex mixture of highly immunogenic glutamine- and proline-rich proteins found in some cereals. In celiac disease (CeD), gluten triggers an autoimmune response due to its interaction with the human leukocyte antigen heterodimers that confer the genetic risk. The involvement of gluten in other disorders has also been investigated, but its role beyond CeD is still unclear. Here, we review the most recent evidence of the involvement of gluten in diseases and the opportunities of manipulating the gut microbiota to treat or prevent gluten-related conditions.

Recent findings
Most of the new studies have been conducted in the context of CeD, where important evidence has been gained on associations between the gut microbiota, genotype, and environmental factors such as breastfeeding and antibiotics. The role of the microbiota has been investigated in several prospective, observational and interventional studies with probiotics, which together showed that the gut microbiota could be targeted to ameliorate and aid in the prevention of CeD development.

Summary
Several studies have evidenced how genetic and environmental factors influence the gut microbiome with consequences in CeD. These findings could inspire the development of microbiota modulation strategies to support the prevention or treatment of CeD.
Aesthetics in Nursing Practice for Cancer Patients as Experienced by Nurses in Nepal
Authors: Dahal Pratiksha , Kongsuwan Waraporn 
Published: October 2021

BackgroundAesthetics in nursing practice address creating beautiful, meaningful, desirable, and satisfying experiences for both the nurse and the patient. However, little is known about aesthetics in nursing practice.ObjectiveThe aim of this study was to describe the lived experiences of nurses who provide aesthetically pleasant care in nursing practice for cancer patients.MethodsThe hermeneutic phenomenological approach grounded on Gadamer’s philosophy was used in this study. Sixteen Nepalese nurses who met the inclusion criteria were the participants. The data collection consisted of 2 methods of drawing graphic illustrations to reflect aesthetic nursing practices and in-depth interviews to explain them. The researchers analyzed and interpreted art-based graphic illustrations and interview transcriptions of 16 Nepalese nurses using van Manen’s approach.ResultsThe 5 thematic categories covering these meanings comprised (1) knowing persons as whole, (2) creating a pleasant healing environment, (3) creative use of palliative care resources, (4) nurturing hope, and (5) rewarding the self.ConclusionThis study provides the understanding of the nurses’ thoughts and actions of aesthetics in their nursing practice. The inductive knowledge from the experiences of the nurses informs the nursing discipline and profession to promote aesthetics in nursing.Implications for PracticeThese findings can be used to promote aesthetics in nursing practice to improve patients’ well-being holistically and increase nurses’ satisfaction from caring.
Stigma and Human Rights
Authors: Kelley Jennifer 
Published: October 2021

Purpose/Objectives:
Transgender patients encounter barriers to accessing medical treatment. Although the medical field has made strides to improve transgender patients' health care experiences, programs that provide support in navigating existing obstacles are lacking. As integrated care becomes more prevalent, primary care settings have the potential to become medical havens for vulnerable patient populations. Enlisting support of professional case managers to connect transgender patients to services to meet their physical and behavioral health needs could increase health care utilization and decrease disparities.

Findings/Conclusions:
Because of their gender identities, transgender individuals experience high rates of discrimination within health care settings. There are also inequities that limit their access to quality treatment. These, combined with the fear of discrimination, contribute to an avoidance of medical care that negatively impacts the physical and mental health of transgender patients.

Implications for Case Management Practice:
Transgender discrimination in health care settings is pervasive and has detrimental effects on patients' well-being. Future research should foster collaboration between health care administrators, professional case managers, primary care providers, behavioral health consultants, and transgender patients to remove existing barriers and increase access to care. Until these changes occur, programs need to be designed for case managers to assist transgender patients in navigating the health care system and connecting to affirming providers.

Primary Practice Settings:
Health care systems and integrated primary care settings.
Defense Styles, Academic Procrastination, Psychological Wellbeing, and Approaches to Learning
Authors: Vlachopanou Patra , Karagiannopoulou Evangelia 
Published: October 2021

Abstract
This study investigates the relationships among defense styles, academic procrastination, psychological well-being, and approaches to learning. The questionnaires Defense Style Questionnaire-88, Procrastination Assessment Scale Questionnaire, Flourishing Scale, and HowULearn are used to measure the aforementioned variables, respectively. Social science students (N = 628) take part in the study. A hierarchical cluster analysis is used for clustering students into homogeneous groups. Three groups of students are identified: “psychologically stable and adaptive” (n = 285), “immature and unstable at risk” (n = 134), and “defensively dissonant” (n = 209) students. A decision tree model is used with the grade point average (GPA) score as an outcome variable to further examine interactions between the three clusters and the years of study on GPA. “Psychologically stable and adaptive” students report the highest GPA. Our findings bridge mental health variables with learning shedding light on our understanding of the use of defense styles when it comes to learning.
Robot-assisted fracture fixation in orthopaedic trauma surgery: a systematic review
Authors: Schuijt Henk Jan , Hundersmarck Dennis , Smeeing Diederik Pieter Johan , van der Velde Detlef , Weaver Michael John 
Published: October 2021

Objective:
To investigate the applications of robot-assisted surgery and its effect on surgical outcomes in orthopaedic trauma patients.

Data Sources:
A search was performed in PubMed and Embase for articles in English, Dutch, German, or French, without restrictions on follow-up times, study size, or year of publication.

Study Selection:
Studies were included if they investigated patients undergoing robot-assisted fracture fixation surgery for orthopaedic trauma.

Data Extraction:
Outcomes studied were operating time, fluoroscopy time/frequency, complications, functional outcomes, intraoperative blood loss, fracture healing, and screw placement accuracy. Critical appraisal was done by using the Methodological Index for Non-Randomized Studies.

Data Synthesis:
Narrative review.

Conclusions:
A total of 3832 hits were identified with the search and 8 studies were included with a combined total of 437 included patients, 3 retrospective cohort studies, 2 prospective cohort studies, 1 cohort study not otherwise specified, 1 case series, and 1 randomized controlled trial. Four studies investigated pelvic ring fractures, 3 studies investigated femur fractures, and 1 study investigated scaphoid fractures. Seven investigated percutaneous screw fixation and 1 studied intramedullary nail fixation. One robotic system was used across all studies, the TiRobot, and all procedures were performed in China. The limited evidence suggests that that robot-assisted orthopaedic trauma surgery may reduce operating time, use of fluoroscopy, intraoperative blood loss, and improve screw placement accuracy, but the overall quality of evidence was low with a high risk of bias. Robot-assisted fracture fixation does not appear to lead to better functional outcomes for the patient.

Level of evidence: III