bluuebunny/crossref_metadata_2025_split huggingface dataset:
Function-preserving Surgery for Femoral Sarcoma by “In Situ Preparation” Technique with a Free Flap
Authors: Uemura Kazuhisa , Kanno Seiji , Shimoe Takashi , Kojima Fumiyoshi , Murata Shinichi , Kusuhara Hirohisa , Wada Yoshitaka , Asamura Shinichi 
Published: February 2021

Summary:
Resection of soft-tissue sarcomas near important tissues (major blood vessels, nerves, bones) is challenging. “In situ preparation” (ISP) technique enables the function of the affected limb to be maintained by preserving the tissue as much as possible. The technique is based on evaluation of the margin of resection of important tissues near the tumor during surgery. Postoperative fractures are known to frequently occur, however, in cases where bones were preserved and periosteum has been resected by the ISP. We present the case of a 51-year-old woman who required treatment for soft-tissue sarcoma close to the femur. During surgery, femoral periosteum was included in the tumor side and the femur was preserved by the ISP. We covered the femur using a vascularized latissimus dorsi free flap instead of periosteum. The flap survived completely, and 5 years after surgery, there has been no recurrence or postoperative complications and the lower limb is functional. This is the first reported case of successful combined use of the bone ISP and the vascularized latissimus dorsi free flap to preserve the function of the limb affected by femoral sarcoma suspected of bone infiltration.
Reset Neurectomy for Cutaneous Nerve Injuries
Authors: Eberlin Kyle R. , Pickrell Brent B. , Hamaguchi Ryoko , Hagan Robert R. 
Published: February 2021

SummaryDiffuse cutaneous nerve injuries, often caused by a crush mechanism, are challenging for the nerve surgeon. Discrete nerve transections and focal neuromas are easier to identify and have a more distinct treatment algorithm. Following crush injury to a noncritical sensory nerve, a successful local anesthetic block proximal to the injury may help determine the possibility of surgical intervention. In these cases, we describe a technique of “reset neurectomy” whereby a neurectomy is performed proximal to the zone of injury, and immediate repair or reconstruction (with or without a nerve graft) is performed. This technique may be useful in cases of diffuse, nontransection nerve injuries in which neuropathic pain is the primary symptom.
Anterior Neck-scar Contracture Reconstruction Using a Long Skin-pedicled Flap
Authors: Kondo Akatsuki , Dohi Teruyuki , Izumi Nikki , Ochi Tomohiro , Ogawa Rei 
Published: February 2021

Summary:
We previously reported cases of anterior-neck reconstruction using super-thin and perforator-supercharged skin-pedicled flaps harvested from the pectoral area and back. Here, we reconstructed a neck-scar contracture with a long skin-pedicled flap from the pectoral area that survived without congestion despite not being supercharged with a perforator, as planned. The patient, a 67-year-old man, was admitted to our hospital due to neck-scar contracture after a chemical burn 3 years previously. During surgery, the scar was resected above the platysma. A large, 19 × 6-cm skin-pedicled flap was elevated from the left pectoral area. We planned to supercharge the flap by anastomosing the second intercostal perforator to the flap periphery but could not confirm the perforator intraoperatively. To promote flap survival, we did not elevate the flap pedicle more than absolutely necessary and then manipulated the flap very carefully. The flap survived fully and the contracture was effectively released. Thin flaps are useful for reconstructing exposed areas such as the face, neck, and dorsum of the hands that require good outcomes in terms of both function and aesthetics. However, if the flap is too large, ischemia/congestion could arise in the periphery unless the blood flow is stabilized by attaching a perforator. In our case, supercharging was not possible and we had to resort to careful intraoperative maneuvers to ensure flap survival. This approach was successful and suggests that although supercharging of thin and large flaps is preferred, unexpectedly unsuperchargeable flaps can be rescued by careful and finely tuned surgical judgment and techniques.
Two-way Revascularization to Manage Celiac Artery Stenosis during Pancreaticoduodenectomy: A Case Report
Authors: Takasu Hiroyuki , Kuramoto Yasuyo , Yokoyama Shigekazu , Ota Hideo , Yagi Sasagu , Hisamoto Sawa , Furukawa Soichi , Shimomura Yutaka 
Published: February 2021

Summary:
Celiac artery (CA) occlusion, or stenosis, is not uncommon, and most cases are asymptomatic. If the CA is occluded, collateral circulation from the superior mesenteric artery (SMA) is maintained through the pancreaticoduodenal arcade. However, the pancreaticoduodenal arcade is removed if pancreaticoduodenectomy (PD) is performed, which results in ischemia of the liver, stomach, and residual pancreas. Thus, these patients require CA revascularization, which can include antegrade endovascular reconstruction and retrograde reconstruction using vascular anastomosis from the SMA system to the CA system. Both methods carry risks of restenosis or anastomotic thrombosis. We report a technique that involves a combination of both revascularization methods in an 89-year-old man who underwent PD for lower bile duct cancer. Preoperative endovascular stent placement in the CA preserved antegrade blood flow to the liver, and intraoperative vascular anastomosis of the jejunal artery and right gastroepiploic artery achieved retrograde blood flow. Although we confirmed both stent and anastomosis patency and blood circulation in our case, obstruction of 1 of these revascularization pathways would not likely lead to ischemia of the liver. Thus, our 2-way revascularization technique for managing celiac artery stenosis during PD may reduce the risk of organ ischemia.
Minor Improvement in Activity and Participation and Decline in Physical Activity Motivation After Cardiac Rehabilitation Discharge
Authors: Kim Young Joo , Crane Patricia A. , Houmard Joseph A. , Swift Damon L. , Wu Qiang 
Published: February 2021

Purpose:
To investigate the changes in activities and participation, and mental and physical functions for 9 mo after cardiac rehabilitation (CR) among adults with chronic cardiac conditions.

Methods:
Twenty-five adults with chronic cardiac conditions scheduled for discharge from CR were assessed at four different times: within 2-wk window of CR discharge date, 1 mo, 3 mo, and 9 mo after CR discharge. Nine assessments according to the International Classification of Functioning, Disability and Health were used to track the changes post-CR.

Results:
Participants showed significant changes in the Cognitive Instrumental Activities of Daily Living adequacy of Performance Assessment of Self-Care Skills-Clinic (F = 8.10, P = .017) and improvements in the applied cognitive domain of the Activity Measure for Post-Acute Care Outpatient Short Form (F = 4.493, P = .016). Participants also showed significant decline in the CogState Detection test (F = 3.307, P = .045), the Physical Activity and Leisure Motivation Scale (PALMS) (F = 4.749, P = .005), and the affiliation subscale of the PALMS (F = 5.316, P = .002), and improvements in the 6-min walk test (F = 9.000, P = .011). Lastly, participants showed depressive symptoms for 3 mo post-CR. No other significant changes were detected among other outcome measures.

Conclusions:
Adults with chronic cardiac conditions discharged from site-based CR maintained their activity and participation level following discharge with little improvement. They also showed depressive symptoms and decreased motivation for physical activity post-CR.
Current Nutrition Practice in Cardiac Rehabilitation Programs
Authors: Kocanda Lucy , Schumacher Tracy L. , Kerr Jane , May Jennifer , Rollo Megan E. , Neubeck Lis , Brown Leanne J. 
Published: February 2021

Purpose:
This study sought to determine current practice regarding nutrition care within cardiac rehabilitation (CR) programs, including perceived barriers and facilitators to providing nutrition care in this setting.

Methods:
A cross-sectional survey was conducted in October and November 2019. Potential participants were program coordinators, identified through the Australian Cardiovascular Health and Rehabilitation Association program directory and invited to participate via e-mail.

Results:
Forty-nine respondents (response rate: 13%) are included in this analysis. Programs provided group (n = 42, 86%) and/or individual (n = 25, 51%) nutrition education, and most were supported by a dietitian (63%). However, the availability of dietitians and nutrition care provided at CR was variable. For example, individual education was consistently provided at 13 programs and usually by health professionals other than dietitians. Eight programs (16%) used a formal behavior change framework for nutrition care. Generally, respondents were positive about the role of nutrition; CR coordinators perceived nutrition as a valuable component of the program, and that they had good nutrition knowledge. An identified barrier was the financial resources available to support the provision of nutrition care.

Conclusions:
To ensure that patients receive the benefits of evidence-based nutrition care, program staff may require additional support, particularly regarding the use of evidence-based behavior change techniques. Key facilitators that may be leveraged to achieve this include the high value and priority that CR program coordinators place on nutrition care.
High Rates of SARS-CoV-2 Family Transmission in Children of Healthcare Workers During the First Pandemic Wave in Madrid, Spain
Authors: Méndez-Echevarría Ana , Sainz Talía , de Felipe Beatriz , Alcolea Sonia , Olbrich Peter , Goycochea-Valdivia Walter A. , Escosa-García Luis , Cobo Lorena , Calvo Cristina , Neth Olaf 
Published: February 2021

Background:
Data on SARS-CoV-2 transmission among children living with healthcare workers (HCWs) are scarce.

Methods:
A cross-sectional study was performed at a tertiary Hospital in Madrid, including children of HCW who suffered from SARS-CoV-2 infection between March and May 2020. Children underwent enzyme-linked immunosorbent serological study for detecting SARS-CoV-2 antibodies: VIRCELL IgG assay.

Results:
One hundred thirteen children from 69 HCWs with confirmed SARS-CoV-2 infection were recruited: 47 children had positive IgG (41.6%). Children secondary attack rate was 43.7% (25% if both parents have had asymptomatic infection; 39.5% if one parent was symptomatic; and 47% when both parents had symptoms). Having a positive sibling was associated with a positive IgG result (odds ratio = 12.2; 95% confidence interval: 4.4–33.7, P < 0.001). Median age was higher in IgG positive children (P = 0.022). Children who referred anosmia presented higher IgG titles (P < 0.04).

Conclusions:
We observed a very high SARS-CoV-2 transmission in children of HCW during the first pandemic wave, especially when both parents were symptomatic. Having a positive sibling was associated with seroconversion, supporting the important role of family clusters in the transmission of SARS-CoV-2.
Extension of Masses Involving the Lacrimal Sac to Above the Medial Canthal Tendon
Authors: Vahdani Kaveh , Gupta Tarang , Verity David H. , Rose Geoffrey E. 
Published: February 2021

Purpose:
Retention mucoceles of the lacrimal sac almost always expand below the medial canthal tendon (MCT), whereas the very much rarer malignancies involving the lacrimal sac may progress to form a mass above the tendon. In this study, the incidence of malignancy was determined for patients with a preoperative decision to undergo biopsy for a clinically suspect, hard lacrimal sac mass, together with the proportion having a tumor extending above the MCT.

Methods:
Patients thought—on the basis of having a firm, immobile mass centered on the lacrimal sac fossa—to possibly have lacrimal sac malignancy were identified from a database of biopsies between 1989 and 2020. A retrospective review of their clinical, radiologic, and pathologic records was undertaken.

Results:
Fifty-three patients (24 male; 45%) underwent biopsy of atypical masses of the lacrimal sac, of which 47 of 53 (89%) extended above the MCT. Seventy-seven percent (41/53) patients had malignancy—26 primary carcinomas and 15 secondary tumors (14 lymphomas or hematopoietic and 1 neuroendocrine)—and 12 had benign conditions (6 transitional cell papillomatosis, 5 chronic inflammation, and 1 solitary fibrous tumor); all the benign pathologies extended above the MCT. The age at presentation and duration of symptoms was similar in patients with benign or malignant pathology. One-fifth of malignant lesions had pain, whereas all the benign conditions were painless, and acute dacryocystitis was relatively uncommon—occurring in only 13% of patients.

Conclusions:
If a firm and immobile lacrimal sac mass extends above the MCT, it has about a 74% chance of being malignant and, if pain is present, the lesion is more likely to be so. Clinically suspicious masses in the lacrimal sac fossa, whether benign or malignant, appear to present at the same age and with a similar duration of symptoms.
Anterior Lamellar Repositioning in the Management of Meibomian Gland Inversion Secondary to Meibomian Gland Dysfunction
Authors: Samia-Aly Emma , Barua Ankur R. , Patel Radhika P. , Mehta Purnima 
Published: February 2021

Purpose:
To describe a simple alternative surgical approach to treat patients with Meibomian gland inversion (MGI; posterior migration of the Meibomian gland orifices) in the upper eyelid, secondary to cicatricial Meibomian gland dysfunction (MGD) not responding to maximal medical management.

Methods:
This was a retrospective, noncomparative, interventional case series of all patients with MGI not responding to conservative MGD treatment who underwent anterior lamellar repositioning through a skin crease incision with or without Blepharoplasty, between July 2017 and July 2019.

Results:
Eleven eyes of 7 patients were included in the study. All patients had a diagnosis of MGD with MGI and had been treated on average for 32 months with intensive medical therapy. Treatment included lubricants, topical ciclosporin 0.1%, topical steroids, and doxycycline. Despite intensive treatment, these patients remained symptomatic with persistent superior ocular surface staining. Following surgery, on average, the patients were followed for 23 months. Ten eyes (91%) had improvement of symptoms and superior ocular surface staining. All patients (100%) demonstrated improvement in the anatomical eversion of the eyelid margin and Meibomian gland orifice.

Conclusion:
A simple upper eyelid everting surgery with anterior lamellar repositioning can be effective in managing patients with MGI giving them symptomatic relief when all medical treatment fail. To the best of the authors’ knowledge, this is the first case series describing this simple surgical technique in the management of this subgroup of patients.
Risk Factors for New Onset Diplopia After Graduated Orbital Decompression
Authors: Stähr Kerstin , Eckstein Anja , Buschmeier Maren , Hussain Timon , Daser Anke , Oeverhaus Michael , Lang Stephan , Mattheis Stefan 
Published: February 2021

Purpose:
The aim of the study was to identify possible risk factors for new onset diplopia in 20° of primary position (NOD PP) after orbital decompression. A predisposition for NOD has been established for patients with pre-existing diplopia in secondary gaze; therefore, the authors focused on patients without preoperative diplopia.

Methods:
Retrospective chart review of patients who underwent balanced orbital decompression between 2012 and 2019 due to Graves orbitopathy at the authors’ institution. Exclusion criteria were incomplete clinical data set, revision surgery, and medial or lateral decompression only. The following clinical parameters were evaluated preoperatively and postoperatively: Hertel exophthalmometry, objective measurement of misalignment using the prism-cover-test, assessment of the field of binocular single vision, and measurement of monocular excursions. In addition, the diameter of the extraocular eye muscles was measured in all preoperative CT scans.

Results:
We included 327 patients (612 orbits), 126 patients (242 orbits) had no preoperative diplopia. In patients with NOD PP (34%, n = 43/126), enlargement of the medial rectus muscle and restriction of abduction and elevation were significantly more frequent than in patients with no NOD PP. The degree of exophthalmos decrease positively correlated with postoperative squint angle.

Conclusion:
We were able to identify the diameter of the medial rectus muscle, restriction of abduction, and elevation as well as an extensive reduction of exophthalmos as risk factors for NOD PP in patients with no preoperative diplopia.
Caregivers’ willingness to pay for Alzheimer’s disease medications in Taiwan
Authors: Huang Mao-Hsuan , Tsai Chia-Fen , Lee Wei-Ju , Wang Wen-Fu , Jhang Kai-Ming , Wang Shuu-Jiun , Fuh Jong-Ling 
Published: February 2021

Background:
Alzheimer’s disease (AD) exerts significant financial expenses on caregivers, and knowledge of caregivers’ support for out-of-pocket payment is of great importance for policymaking on the insurance coverage of future AD medication in Taiwan. We aimed to investigate caregivers’ willingness to pay (WTP) for a hypothetical curative AD medication and the effect of different factors on the amount of WTP.

Methods:
Informal caregivers of patients with AD and informants of patients with amnestic mild cognitive impairment (MCI) were included. An iterative bidding game technique, followed by a dichotomous choice question and a final open-ended question were used to elicit caregivers’ maximum WTP. The correlations between the WTP and characteristics of caregiver and patient were analyzed, including sex, educational level, severity of dementia, neuropsychiatric symptoms assessed by Neuropsychiatric Inventory, time needed to support patients assessed by Caregiver Activity Survey, and caregivers’ monthly income.

Results:
A total of 1134 informal caregivers of patients with AD or MCI were included. Caregivers of patients with AD were willing to pay for a curative AD medication, and their maximum WTP value was higher than informants of MCI patients. Among patients with AD and patients with MCI, caregivers’ monthly income was positively correlated with WTP. Apathy subsyndrome was the only factor correlated with percentage of WTP in caregiver’s income in the MCI group.

Conclusion:
Support for out-of-pocket WTP for a hypothetical curative AD medication was significantly related to caregiver’s income.
Iodine nutritional status of lactating women in northern Taiwan in 2019
Authors: Huang Chun-Jui , Cheng Cheng-Pin , Lee Lin-Hsuan , Chen Harn-Shen , Hwu Chii-Min , Tang Kam-Tsun , Shih Chiao-Wei , Yeh Chang-Ching , Yang Chen-Chang , Wang Fan-Fen 
Published: February 2021

Background:
Pregnant and lactating women are vulnerable to iodine deficiency. This study was conducted to evaluate the iodine nutritional status of lactating women in northern Taiwan.

Methods:
Women recruited from Taipei Veterans General Hospital (TVGH) in 2019 provided a spot urine sample and completed a Food Frequency Questionnaire. The urinary iodine concentration (UIC) was measured by inductively coupled plasma mass spectrometry.

Results:
The overall median UIC in 198 women was 120.4 μg/L, indicating a sufficient iodine status. Univariate analysis revealed a lower median UIC in women of younger age (p = 0.004), who were not taking multivitamins (p = 0.004), not on a postpartum nourishment diet (p = 0.04), and whose infant received more breast milk (p = 0.004). The median UIC was <100 μg/L in the group aged 20 to 29 years (UIC: 74.4 μg/L) and in women whose infants’ diet was composed of >50% breast milk (UIC: 86.1 μg/L). A postpartum nourishment diet was followed by 73.7% (n = 146) of the women. Nevertheless, a significant decrease in the intake frequency of iodine-containing foods, including seaweeds (p < 0.001), seafood (p < 0.001), dairy products (p = 0.009), and multivitamins (p < 0.001) was observed compared with the intake noted in a previous survey of pregnant women in TVGH. Following multivariate analysis, only younger age (20-29 vs ≥30 years; odds ratio [OR]: 3.38; 95% confidence interval [CI]: 1.49-7.65), no use of multivitamin (OR: 1.89; 95% CI: 1.03-3.48), and infant diet composition (>50% breast milk vs <50% breast milk; OR: 2.93; 95% CI: 1.37-6.25) were independently associated with UIC < 100 μg/L.

Conclusion:
The results suggest that the iodine status in lactating women in northern Taiwan is adequate. However, iodine deficiency may continue to be present in certain subgroups, such as women of younger age and those who do not take multivitamins.
Saliva Pooling Strategy for the Large-Scale Detection of SARS-CoV-2, Through Working-Groups Testing of Asymptomatic Subjects for Potential Applications in Different Workplaces
Authors: Girón-Pérez Daniel Alberto , Ruiz-Manzano Rocío Alejandra , Benitez-Trinidad Alma Betsaida , Ventura-Ramón Guadalupe Herminia , Covantes-Rosales Carlos Eduardo , Ojeda-Durán Ansonny Jhovanny , Mercado-Salgado Ulises , Toledo-Ibarra Gladys Alejandra , Díaz-Reséndiz Karina Janice , Girón-Pérez Manuel Iván 
Published: February 2021

Objective:
To perform an improved large-scale SARS-CoV-2 detection on pooled tests of asymptomatic workers.

Methods:
qRT-PCR validation of the SARS-CoV-2 detection in salivae samples and saliva pools and working-group saliva pooling and testing for SARS-CoV-2.

Results:
We found a high Cycle threshold correlation (r = 0.9099) between swabs and saliva samples. Then, through the pooling strategy, we detected that 18/360 (5%) of individual saliva samples were SARS-CoV-2 positive. Saliva-pooling efficiency (360 of test sample/30 individual PCR) was higher (5.45) than the reported for swabbing group-testing and we spared 82% of the PCR reagents as well as sampling and personal protection equipment.

Conclusion:
Through this simplified and less expensive procedure, we detected in a short time asymptomatic-infected SARS-CoV-2-carriers that were isolated from their co-workers, thus, this methodology can be implemented in different workplaces to ensure consumers that employees are not infectious.
Bilateral Cochlear Implantation in Children: Long-Term Outcome in the Adult Population With Special Emphasis on the Bilateral Benefit
Authors: Ehrmann-Müller Desiree , Shehata-Dieler Wafaa , Kurz Anja , Kühn Heike , Hagen Rudolf , Rak Kristen 
Published: February 2021

Objective:
To investigate the benefit of bilateral cochlear implantation in adults, who had been implanted being a child under the age of 10 years.

Study Design:
Retrospective data analysis.

Setting:
Tertiary referral center with a large cochlear implant program.

Main Outcome Measures:
Speech understanding in the Freiburg monosyllabic words in quiet and the HSM sentence test in quiet and in background noise.

Patients:
Seventy-seven bilaterally cochlear implantation implanted adults.

Results:
Bilateral cochlear implantation in children under the age of 10 years results in a significant benefit in speech comprehension in adulthood. In addition, a dependency regarding the time between the implantations and speech intelligibility was found.

Conclusion:
The results emphasize the benefit of bilateral cochlear implantation with a short interval between the operations in young children not only during formative years but also in adulthood.