bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perioperative Outcomes After Preoperative Epidural Analgesia in Patients with Hip Fracture Undergoing Surgical Repair: A Systematic Review
Authors: Choi Jonathan V , Cheung Rachel M , Mozel Michelle R , Merchant Richard N , Lee Susan M 
Published: May 2021

Abstract

Objective
To examine the effectiveness and safety of epidural analgesia in the presurgical period in patients with hip fracture undergoing surgical repair.

Design
Systematic review.

Methods
The study protocol was registered with the PROSPERO systematic reviews registry with the (identifier CRD42019140396). Electronic databases were searched for randomized controlled trials comparing preoperative epidural analgesia with other forms of pain management in patients with a hip fracture. The primary outcomes included perioperative cardiac events and death. Pain, noncardiac complications, and adverse effects were also examined as secondary outcomes. The heterogeneity of the included studies was assessed with the I2 statistic, and a random-effects meta-analysis was conducted once sufficient homogeneity was demonstrated.

Results
Four studies, which included a total of 221 patients, met the inclusion criteria. Preoperative epidural analgesia resulted in fewer cardiac events, which was a reported outcome in two included studies (relative risk 0.30; 95% confidence interval 0.14–0.63; I2=0%). Preoperative epidural analgesia was also associated with a decreased perioperative mortality rate in a meta-analysis of two studies (relative risk 0.13; 95% confidence interval 0.02–0.98; I2 = 0%). Pain was not pooled because of variability in assessment methods, but preoperative epidural analgesia was associated with reduced pain in all four studies.

Conclusions
Preoperative epidural analgesia for hip fracture may reduce perioperative cardiac events and deaths, but the number of included studies in this systematic review was low. More research should be done to determine the benefit of early epidural analgesia for patients with hip fracture.
Efficacy and safety of switching from reference adalimumab to CT-P17 (100 mg/ml): 52-week randomized, double-blind study in rheumatoid arthritis
Authors: Furst Daniel E , Jaworski Janusz , Wojciechowski Rafal , Wiland Piotr , Dudek Anna , Krogulec Marek , Jeka Slawomir , Zielinska Agnieszka , Trefler Jakub , Bartnicka-Maslowska Katarzyna , Krajewska-Wlodarczyk Magdalena , Klimiuk Piotr A , Lee Sang Joon , Kim Sung Hyun , Bae Yun Ju , Yang Go Eun , Yoo Jae Kyoung , Kay Jonathan , Keystone Edward 
Published: May 2021

Abstract

Objective
To compare the safety and efficacy of switching from reference adalimumab to adalimumab biosimilar CT-P17 with continuing reference adalimumab/CT-P17 in active RA.

Methods
This double-blind, phase III study randomized (1:1) subjects with active RA to receive 40 mg (100 mg/ml) CT-P17 or European Union-sourced reference adalimumab subcutaneously every 2 weeks (Q2W) until week (W) 24 [treatment period (TP) 1]. Thereafter, subjects receiving reference adalimumab were randomized (1:1) to continue reference adalimumab or switch to CT-P17 from W26 (both Q2W until W48; TP2). Subjects receiving CT-P17 in TP1 continued CT-P17. W0–W24 results were previously reported; we present W26–W52 findings. End points were efficacy (including joint damage progression), pharmacokinetics, safety and immunogenicity.

Results
Of 607 subjects who initiated TP2 treatment, 303 continued CT-P17, 153 continued reference adalimumab and 151 switched to CT-P17. Efficacy improvements up to W24 were maintained during TP2; efficacy was comparable among groups. At W52, 20% improvement in ACR response rates were 80.5% (continued CT-P17), 77.8% (continued reference adalimumab) and 82.2% (switched to CT-P17). Joint damage progression was minimal. Mean trough serum adalimumab concentrations were similar among groups. CT-P17 and reference adalimumab safety profiles were numerically similar and switching did not affect immunogenicity. At W52, 28.4% (continued CT-P17), 27.0% (continued reference adalimumab) and 28.3% (switched to CT-P17) of subjects were anti-drug antibody-positive.

Conclusion
Efficacy, pharmacokinetics, safety and immunogenicity of CT-P17 and reference adalimumab were comparable after 1 year of treatment, including after switching from reference adalimumab to CT-P17.

Trial registration
ClinicalTrials.gov, http://clinicaltrials.gov, NCT03789292.
Immunohistological Examination of AKT Isoforms in the Brain: Cell-Type Specificity That May Underlie AKT’s Role in Complex Brain Disorders and Neurological Disease
Authors: Levenga Josien , Wong Helen , Milstead Ryan , LaPlante Lauren , Hoeffer Charles A 
Published: May 2021

AbstractProtein kinase B (PKB/AKT) is a central kinase involved in many neurobiological processes. AKT is expressed in the brain as three isoforms, AKT1, AKT2, and AKT3. Previous studies suggest isoform-specific roles in neural function, but very few studies have examined AKT isoform expression at the cellular level. In this study, we use a combination of histology, immunostaining, and genetics to characterize cell-type-specific expression of AKT isoforms in human and mouse brains. In mice, we find that AKT1 is the most broadly expressed isoform, with expression in excitatory neurons and the sole detectable AKT isoform in gamma-aminobutyric acid ergic interneurons and microglia. By contrast, we find that AKT2 is the sole isoform expressed in astroglia and is not detected in other neural cell types. We find that AKT3 is expressed in excitatory neurons with AKT1 but shows greater expression levels in dendritic compartments than AKT1. We extend our analysis to human brain tissues and find similar results. Using genetic deletion approaches, we also find that the cellular determinants restricting AKT isoform expression to specific cell types remain intact under Akt deficiency conditions. Because AKT signaling is linked to numerous neurological disorders, a greater understanding of cell-specific isoform expression could improve treatment strategies involving AKT.
Optimal use of intranasal corticosteroids and intranasal saline, is there a clear answer?
Authors: Freeman Catherine M. , Rank Matthew A. 
Published: May 2021

Purpose of review
Chronic rhinosinusitis (CRS) is a prevalent condition that poses a significant burden on both quality of life and healthcare utilization. Notwithstanding the heterogenous nature of CRS endotypes and phenotypes, isotonic saline and corticosteroids are recommended as first line medical therapy by recent clinical guidelines. We provide an overview of recent studies of topical saline and corticosteroids for people with CRS and emphasize areas of unmet needs.

Recent findings
Recent trials suggest exhalation delivery systems of corticosteroid are effective and well tolerated but did not involve comparison with another active treatment. Recent comparative efficacy studies show no clear differences in doses of topical corticosteroid, method of topical corticosteroid delivery, advantage over macrolide antibiotic, or method or type of saline irrigation.

Summary
The preeminent formulation, dosage, and delivery of topical corticosteroid and saline for people with CRS represents an area of ongoing research need.
Readmissions After Guillain–Barre Syndrome: Nationally Representative Data
Authors: Roberts Mallory , Jin Peter , Shin Susan , Dhamoon Mandip 
Published: May 2021

Objectives:
We aimed to obtain nationally representative data on hospital readmission rates after Guillain–Barre syndrome (GBS).

Methods:

International Classification of Disease, Ninth Revision codes from the 2013 National Readmissions Database identified adult GBS admissions, comorbidities, and readmission diagnoses. Logistic regression estimated odds ratios (ORs) for readmission.

Results:
Of 2109 GBS admissions identified, 20.8% were readmitted within 1 year and 12.2% within 30 days. Age did not predict readmission. Plasmapheresis use showed a nonsignificant trend toward readmission versus intravenous immunoglobulin use [OR 1.43, 95% confidence interval (CI) 1.00–2.051, P = 0.050]. Respiratory failure (OR 1.70, 95% CI 1.23–2.35, P = 0.0014), heart failure (OR 2.14, 95% CI 1.25–3.66, P = 0.0057), and renal failure (OR 2.00, 95% CI 1.20–3.32, P = 0.0078) predicted readmission. Top readmission diagnoses included GBS or chronic inflammatory demyelinating polyneuropathy (42.0%) and sepsis (3.5%).

Conclusions:
One-fifth of GBS patients were readmitted within 1 year. Comorbid illnesses and respiratory complications increased a readmission risk but age did not.
I Want to Row Across the Atlantic. But You Have Amyotrophic Lateral Sclerosis!
Authors: Alderman Alan , Hayes Heather , Gibson Summer , Bromberg Mark B. 
Published: May 2021

Abstract
We describe an individual with slowly progressive amyotrophic lateral sclerosis who decided to enter the Talisker Whisky Atlantic Challenge, a rowing event across the Atlantic Ocean, and completes it in 51 days in a 5-man boat.
Psychosocial Adjustment in Emerging Adults With and Without Spina Bifida: A 14-Year Follow-up Study
Authors: Holmbeck Grayson N. , Kritikos Tessa K. 
Published: May 2021

ABSTRACT:

Objective:
A 14-year follow-up of youth with spina bifida (SB), as compared to a matched comparison sample without a chronic health condition, focused on psychosocial adjustment during emerging adulthood (ages 22–23).

Methods:
The initial cohort at time 1 consisted of 68 families with an 8-year-old or 9-year-old child with SB and a matched comparison sample of 68 typically developing children and their families. At the final assessment (time 7), participants included 56 emerging adults with SB (82% of those who participated at time 1) and 62 comparison youth (91% of those who participated at time 1) who completed a set of self-report measures.

Results:
Emerging adults with SB continue to lag behind across several important developmental milestones, including decision-making responsibility, involvement in social and romantic relationships, sexual intimacy, educational and vocational achievement, financial independence, and engagement in health-related behaviors. However, from a resilience perspective, these individuals also exhibited a number of strengths across the following areas: identity development, quality of social supports, and fewer problem behaviors (e.g., alcohol and other substance use). Most findings were still significant after controlling for a verbal intelligence quotient proxy.

Conclusion:
This study highlighted vulnerabilities and strengths of individuals with SB as they enter emerging adulthood, with considerable continuity across childhood, adolescence, and emerging adulthood.
Assessing Ease of Delivering Emergency Care for Patients with Autism Spectrum Disorders
Authors: Kouo Theodore , Bharadwaj Neha , Kouo Jennifer , Tackett Sean , Ryan Leticia 
Published: May 2021

ABSTRACT:

Objective:
The aim of this study was to develop a method for objectively assessing the delivery of care to children with autism spectrum disorder (ASD) in the emergency department (ED).

Methods:
A case-control study of patients ages 2 to 18 years admitted to the hospital from January 2016 to January 2018. Cases were defined as patients with an International Classification of Diseases, Tenth Revision diagnosis of ASD or other pervasive developmental disorder (F84) in their medical record and were matched 1:1 with neurotypical controls. The primary outcome was ability to complete several core tasks clinically necessary within an ED visit and summarized into a Task Completion Index (TCI).

Results:
Overall, children with ASD had higher median TCIs of 0.25 (interquartile range [IQR] 0–0.45) versus 0 (IQR 0–0.25) when compared with children without ASD (p < 0.01). Children with ASD were 5 times more likely to have difficulty with triage vitals, 3 times more likely to require additional staff for peripheral intravenous placement, and 4 times more likely to experience delays or disruptions to their plan of care. The TCI was also associated with 8-fold increased odds of receiving pharmacologic or physical restraint.

Conclusions:
The TCI reflects difficulty accomplishing core tasks necessary to complete an ED visit. Children with ASD have higher TCIs than neurotypical controls, which puts them at higher risk for care disruptions. Evaluation of initiatives to improve quality of care for children with ASD should focus not only on metrics of overall experience and satisfaction but also how these initiatives affect the ability to effectively administer care.
Unraveling the Role of 12- and 20- HETE in Cardiac Pathophysiology: G-Protein–Coupled Receptors, Pharmacological Inhibitors, and Transgenic Approaches
Authors: Pascale Jonathan V. , Lucchesi Pamela A. , Garcia Victor 
Published: May 2021

Abstract:
Arachidonic acid–derived lipid mediators play crucial roles in the development and progression of cardiovascular diseases. Eicosanoid metabolites generated by lipoxygenases and cytochrome P450 enzymes produce several classes of molecules, including the epoxyeicosatrienoic acid (EET) and hydroxyeicosatetraenoic acids (HETE) family of bioactive lipids. In general, the cardioprotective effects of EETs have been documented across a number of cardiac diseases. In contrast, members of the HETE family have been shown to contribute to the pathogenesis of ischemic cardiac disease, maladaptive cardiac hypertrophy, and heart failure. The net effect of 12(S)- and 20-HETE depends upon the relative amounts generated, ratio of HETEs:EETs produced, timing of synthesis, as well as cellular and subcellular mechanisms activated by each respective metabolite. HETEs are synthesized by and affect multiple cell types within the myocardium. Moreover, cytochrome P450–derived and lipoxygenase- derived metabolites have been shown to directly influence cardiac myocyte growth and the regulation of cardiac fibroblasts. The mechanistic data uncovered thus far have employed the use of enzyme inhibitors, HETE antagonists, and the genetic manipulation of lipid-producing enzymes and their respective receptors, all of which influence a complex network of outcomes that complicate data interpretation. This review will summarize and integrate recent findings on the role of 12(S)-/20-HETE in cardiac diseases.
MiR-340 Promotes the Proliferation of Vascular Smooth Muscle Cells by Targeting von Hippel–Lindau Tumor Suppressor Gene
Authors: Chen Sheng , Zhao Wei , Min Hongye , Xu Yawei 
Published: May 2021

Abstract:
MiRNAs play key roles in the proliferation of vascular smooth muscle cells (VSMCs). However, the roles and underlying mechanism of miRNAs in VSMCs are not fully understood. The aim of this study was to evaluate the role of miR-340 in the proliferation of VSMCs. The expression levels of miR-340 and von Hippel–Lindau tumor suppressor (VHL) in VSMCs induced by platelet-derived growth factor-BB or fetal bovine serum were measured by q-polymerase chain reaction. The effects of miR-340 and VHL on cell proliferation and invasion were evaluated by CCK-8 assay. Target gene prediction and screening as well as luciferase reporter assay were performed to verify the downstream target genes of miR-340. Western blotting was used to detect the protein expression levels of vascular endothelial growth factor and VHL. Our results showed that the miR-340 was upregulated in platelet-derived growth factor-BBor fetal bovine serum–induced VSMCs. In addition, overexpression of miR-340 promoted VSMCs proliferation and invasion. Moreover, VHL was found to be a potential target for miR-340 and upregulation of VHL-inhibited VSMCs proliferation. MiR-340 plays a critical role in VSMC proliferation and neointimal hyperplasia in rats' carotid balloon injury model. Reduced expression levels of miR-340 promoted VHL-inhibited VSMCs proliferation. In conclusion, miR-340 may play a role in the regulation of proliferation of VSMCs by inhibition of VHL.
In Vivo Perforasome Perfusion in Hemi-DIEP Flaps Evaluated with Indocyanine-green Fluorescence Angiography and Infrared Thermography
Authors: Chaudhry Muiz A. , Mercer James B. , de Weerd Louis 
Published: May 2021

Background:
There are no in vivo studies that evaluate the effect of perforator dissection on the perfusion territory of a perforator (perforasome). In this study, indocyanine green fluorescence angiography (ICG-FA) and infrared thermography (IRT) were used intraoperatively to evaluate perforasome perfusion in hemi-DIEP flaps.

Methods:
Patients selected for DIEP breast reconstruction were prospectively included in the study. Preoperative perforator mapping was performed with CTA and handheld Doppler ultrasound. In general anesthesia, perforasome perfusion was evaluated with ICG-FA and IRT both before surgery and after flap dissection with preserved dominant perforators.

Results:
Thirty hemi-DIEP flaps were dissected in 15 patients (average BMI 26.6 kg/m2), of which 40% had been operated on in the lower abdomen. Fluorescence spots from ICG were associated with infrared radiation hotspots on IRT and these corresponded with the locations of the selected perforators. IRT and ICG-FA demonstrated similar patterns in perforasome perfusion before and after perforator dissection. Perforator dissection changed the perforasome perfusion. IRT made it possible to continuously monitor the perforator activity during surgery. ICG-FA easily identified areas with impaired flap perfusion due to previous surgery.

Conclusions:
Perforasome perfusion is a dynamic process that changes with perforator dissection. ICG-FA and IRT are reproducible techniques for in vivo evaluation of perforasome perfusion and produce comparable results.
Patient-reported Outcomes and 3-dimensional Surface Imaging after Risk-reducing Mastectomy and Immediate Breast Reconstruction
Authors: Bai Lucy , Sandelin Kerstin , Wickman Marie , Arver Brita , Lundström Ola , Johansson Hemming , Brandberg Yvonne 
Published: May 2021

Background:
The cosmetic results after risk-reducing mastectomy (RRM) and immediate breast reconstruction (IBR) are intended to be long-lasting. Long-term follow-up of the cosmetic outcome can be evaluated subjectively by the women themselves through patient-reported outcome measures such as questionnaires, or by using data from three-dimensional surface imaging (3D-SI) to calculate the volume, shape, and symmetry of the reconstructed breasts as a more objective cosmetic evaluation. The study aim was to evaluate the correspondence between patient-reported measures and 3D-SI measurements.

Methods:
Questionnaires (EORTC QLQ-BRECON23 and BIS) were sent to women on average 13 [7–20] years after RRM and IBR. Items were preselected for comparison with 3D measurements of women imaged using the VECTRA XT 3D-imaging system at the long-term follow-up.

Results:
Questionnaire responses and 3D images of 58 women, 36 without and 22 with previous breast cancer (where 15 also received radiotherapy) before RRM and IBR, were analyzed. Median age at follow-up was 57 [41–73] years. Patient-reported satisfaction with the cosmetic outcome was positive for both groups. 3D measurements indicated more symmetrical cosmetic results for women without previous breast cancer. No statistically significant associations between patient-reported satisfaction and 3D measurements were found.

Conclusions:
Satisfaction with the long-term cosmetic outcome after RRM and IBR was, in general, positive when evaluated by the women. 3D-SI could be used as a more objective approach to assess the cosmetic outcome in terms of volume and shape-symmetry; however, it does not directly translate to the patient-reported satisfaction.
Chronic Nerve Injuries and Delays in Surgical Treatment Negatively Impact Patient-reported Quality of Life
Authors: Felder John M. , Ducic Ivica 
Published: May 2021

Background:
Little emphasis has been paid to characterize quality of life (QoL) burdens experienced by patients seeking surgical treatment for nerve injuries and neuropathic pain.

Methods:
A cross-sectional survey was distributed to all patients (N = 767) from a single nerve surgeon’s practice between 2014 and 2019. Data collected included demographics, specifics of the injury and symptoms, time to referral, and effects of the injury, surgery, and timing of surgery on QoL.

Results:
Of the 767 patients, 209 (27.2%) completed the survey. Average age was 48.8 years; 68.9% of patients were women and 31.1% men. At presentation, 68% had experienced symptoms for more than 1 year; 86.1% reported severity as being profound; 97.6% reported QoL was at least moderately negatively impacted by nerve injury; 70% felt they should have been referred earlier for surgical evaluation; 51.2% were not told that nerve surgery was an option for their problem; 83.1% felt that earlier referral would have improved their QoL. After surgery, symptoms were significantly mitigated in 55.5% of the patients, moderately mitigated in 21.5%. Patients reported QoL was significantly (59.8%) or at least moderately (76.6%) improved by nerve surgery.

Conclusions:
The majority of patients reported that nerve injuries imparted a moderate to severe impact on QoL, and that surgical treatment improved QoL. Most patients felt that earlier referral for surgical intervention would have led to better outcome and positively impacted QoL. Interdisciplinary treatment algorithms, including a role for surgical intervention, may be helpful in facilitating timely diagnosis, referral, and thus improved outcomes.
Facial Trauma 8 years after a Face Transplantation
Authors: Goutard Marion , Lellouch Alexandre G. , Dussol Bertrand , Lantieri Laurent A. 
Published: May 2021

Summary
Over the past 20 years, vascularized composite allografts (VCAs) have emerged as a realistic option in reconstructive surgery. Long-term follow-up reports indicate that face transplant patients have gained in quality of life and social integration. However, they require close monitoring of their immunosuppressive therapy because they are at high-risk for acute rejection episodes, leading eventually to chronic rejection and allograft loss. Reported acute rejection episodes in VCA recipients occur due to low immunosuppressive therapy (mainly due to lack of patient compliance or decreased doses of immunosuppressants to counter side-effects). Repeated mechanical traumas have recently been shown to trigger acute rejection episodes, especially in hand transplant patients. This article reports our experience of a 10-year follow-up of a 57-year-old face transplant patient and the management of his accidental facial trauma. To our knowledge, our patient is the first to undergo a major trauma on his VCA endangering his graft function and vitality. This report discusses the management of an acute surgical situation in those particular patients, and the challenges that arise to avoid acute rejection of the allograft. Ten years into his face transplant and at 18 months follow-up after his facial trauma, our patient shows great aesthetic and functional outcomes and remains rejection-free; a very encouraging result for all VCA candidates.
Severe Craniofacial Morbidity from a Bean Bag Projectile
Authors: Gonzalez Santiago R. , Loomba Vishalli , Obi-Osuagwu Osita , Al-Nowaylati Abdl-Rawf , Rahgozar Paymon 
Published: May 2021

Summary
Bean bag munitions, less-lethal weapons primarily used by law enforcement, can cause severe morbidity. Although bean bag munitions are less likely to cause severe injury when compared with regular gunshot rounds, it is crucial to understand that bean bag munitions may be life-threatening. In this case, we describe our experience with a patient who suffered a zygomaticomaxillary complex fracture, facial nerve injury, and retained munition round in his maxillary sinus from a bean bag projectile shot during an altercation with the police. The patient was urgently transferred to the operating room for extraction of the bean bag munition, and although fracture repair was successful, the patient sustained significant damage to facial nerves, leading to lagophthalmos. To our knowledge, this is the first case report describing a penetrating injury from a bean bag munition that was retained within a facial structure. We will discuss the surgical intervention used for this patient and the review of the current literature on these less-lethal munitions.