bluuebunny/crossref_metadata_2025_split huggingface dataset:
To Assess the Technical Feasibility of Ultrasound Lumbar Sympathetic Block with Electrical Stimulation Needle in Out-of-Plane Needle Orientation: A Prospective Interventional Study
Authors: Marada Snehitha , Punj Jyotsna , Dhar Anita , Bhoi Debesh , Mohan Virender , Trikha Anjan , Pandey Ravindra Kumar , Darlong Vanlal 
Published: August 2021

Abstract

Objective
We describe the technical feasibility of a new technique of ultrasound lumbar sympathectomy validated by fluoroscopy.

Design
Prospective interventional study.

Setting
Pain block area.

Subjects
Thirty patients with peripheral arterial disease with pain at rest (numerical rating score [NRS] ≥3) were recruited.

Methods
In the lateral position, a curved probe (FUJIFILM SonoSite Edge, Bothell, WA, USA, 2–5 MHz) was placed transversely at the iliac crest. An electrical stimulation needle was inserted out of plane, below the lower pole of the kidneys, directed anterior to the vertebral body below. When the needle tip was not visualized, a current of 2.0 A was applied. Patients’ quadriceps contractions, ultrasound psoas contractions, and bone contact guided needle placement, which was confirmed on fluoroscopy. Other parameters noted were the number of needle insertions, vertebral level, pain NRS at baseline and at 4 hours, 24 hours, 1 week, and 2 weeks after block, temperature rise, and any other complications.

Results
In all patients, the needle tip was correctly placed in one to three attempts. In 73% of patients, the needle tip was at L3. Baseline pain NRS was 8 (interquartile range 7–8), which decreased to 2 (interquartile range 2–3) at 1 week after the procedure, and it was maintained in this range until 2 weeks later. A temperature rise of &gt;2ºC was noted in all patients.

Conclusion
Ultrasound lumbar sympathectomy can be performed safely in patients with peripheral arterial disease by an out-of-plane approach in the lateral patient position with an electrical stimulation needle. Before injection of the drug, aspiration of blood should be ruled out in view of the possibility of aortocaval injection.
Seizures in Iatrogenic Cerebral Arterial Gas Embolism
Authors: Muller Fenna F. , van Hulst Robert A. , Coutinho Jonathan M. , Weenink Robert P. 
Published: August 2021

Objectives:
Iatrogenic cerebral arterial gas embolism occurs when gas enters the cerebral arterial circulation during a medical procedure and is considered a severe complication. Seizures have been described in these patients, but information on clinical characteristics, treatment, and outcome is lacking in current literature. The aim of the study was to explore seizures in patients with iatrogenic cerebral arterial gas embolism and to evaluate management strategies.

Design:
Retrospective single-center observational study.

Setting:
The only university hospital in the Netherlands with a hyperbaric oxygen therapy facility.

Patients:
All patients presenting at or referred to our center with iatrogenic cerebral arterial gas embolism between May 2016 and December 2020.

Interventions:
Not applicable.

Measurements and Main Results:
Fifteen patients with iatrogenic cerebral arterial gas embolism were identified, of whom 11 (73%) developed seizures. Five patients developed their first seizure prior to hyperbaric oxygen therapy, three during hyperbaric oxygen therapy, and three after hyperbaric oxygen therapy. Of the 11 patients with seizures, all but one were treated with anti-epileptic drugs. With a median follow-up time of 5 months (range, 1–54 mo), five patients showed complete neurologic recovery, five had minor neurologic deficit, two had moderate to severe neurologic deficit, and three had died. Four patients still used anti-epileptic drugs at follow-up. No patients had recurrent seizures after hospital discharge.

Conclusions:
`Seizures are a common symptom in iatrogenic cerebral arterial gas embolism. They are often treated with anti-epileptic drugs and do not seem to lead to chronic epilepsy.
Amyloid and tau positive mild cognitive impairment: clinical and biomarker characteristics of dementia progression
Authors: Wei Hong-Chun , Li Bing , Ng Kok Pin , Fu Qing-Xi , Dong Sheng-Jie , Ba Mao-Wen , Kong Min 
Published: August 2021

Abstract

Background:
According to the amyloid, tau, neurodegeneration research framework classification, amyloid and tau positive (A+T+) mild cognitive impairment (MCI) individuals are defined as prodromal Alzheimer disease. This study was designed to compare the clinical and biomarker features between A+T+MCI individuals who progressed to progressive MCI (pMCI) and those who remained stable MCI (sMCI), and to identify relevant baseline clinical biomarker and features that could be used to predict progression to dementia within 2 years.

Methods:
We stratified 197 A+T+MCI individuals into pMCI (n = 64) and sMCI (n = 133) over 2 years. Demographics and cognitive assessment scores, cerebrospinal fluid (CSF), and neuroimaging biomarkers (18F-florbetapir positron emission tomography mean standardized uptake value ratios [SUVR] and structural magnetic resonance imaging [MRI]) were compared between pMCI and sMCI at baseline, 12- and 24-month follow-up. Logistic regression models then were used to evaluate clinical baseline and biomarker features that predicted dementia progression in A+T+MCI.

Results:
pMCI individuals had higher mean 18F-florbetapir SUVR, CSF total-tau (t-tau), and p-tau181P than those in sMCI individuals. pMCI individuals performed poorer in cognitive assessments, both global and domain specific (memory, executive, language, attention, and visuospatial skills) than sMCI. At baseline, there were significant differences in regions of interest of structural MRI between the two groups, including bilateral amygdala, hippocampus and entorhinal, bilateral inferior lateral ventricle, left superior and middle temporal, left posterior and caudal anterior cingulate (P < 0.05). Baseline CSF t-tau levels and cognitive scores of Montreal cognitive assessment, functional assessment questionnaire, and everyday cognition by the patient's study partner language domain could predict progression to dementia in A+T+MCI within 2 years.

Conclusions:
In future clinical trials, specific CSF and cognitive measures that predict dementia progression in A+T+MCI might be useful risk factors for assessing the risk of dementia progression.
Infantile Hemangiomas Cleared by Combined Therapy With Pulsed Dye Laser and Propranolol
Authors: Sugimoto Atsuko , Aoki Ritsu , Toyohara Eri , Ogawa Rei 
Published: August 2021

BACKGROUND
Oral propranolol is the first-line therapy for infantile hemangioma. Combining it with pulse dye laser (PDL) (595nm-long PDL) could reduce treatment duration and sequelae incidence and severity.

OBJECTIVE
To determine the effect of PDL-propranolol treatment on duration to cure and sequelae.

METHODS
All consecutive patients with infantile hemangioma who were cured by PDL-propranolol treatment were identified.

RESULTS
In the 27 cases, average age at treatment start was 4.3 ± 3.8 months, mean tumor diameter was 11.1 ± 14.0 cm2, and tumor-type was most common (72.4% of lesions). The patients received 9.8 ± 10.5 PDL sessions. After ensuring patients had no physical contraindications, including heart disease, oral propranolol was started at 1 mg/kg/d, increased up to 3 mg/kg/d as a maintenance dose. Mean propranolol treatment duration was 11.1 ± 4.9 months. Total treatment duration was 15.3 ± 10.8 months.

CONCLUSION
Our data in the context of recent literature suggest combining propranolol with PDL may reduce propranolol duration without increasing harms.
Effect of De-epithelialization on Graft Survival Rate After Follicular Unit Extraction
Authors: Fan Zhe-Xiang , Liu Fang , Li Kai-Tao , Hu Zhi-Qi , Miao Yong 
Published: August 2021

BACKGROUND
To achieve a natural postoperative appearance, hair grafts are often de-epithelialized from the epidermis during follicular unit extraction (FUE). However, the effect of de-epithelialization on the survival rate of transplanted hair follicles (HFs) has not been investigated.

OBJECTIVE
To investigate the effect of de-epithelialization on the survival rate of transplanted HFs.

METHODS
A total of 64 male patients with androgenetic alopecia were included in this study. They were randomly divided into de-epithelialization and control groups. Organ culture was performed to assess the elongation of hair shaft and the percentage of anagen HFs in both groups. Patients were followed up postoperatively to evaluate complications, postoperative shedding, survival rates, and satisfaction.

RESULTS
No significant difference in hair shaft elongation and percentage of anagen HFs was observed between both groups. The immediate postoperative satisfaction in the control group was much lower than that in the de-epithelialization group (71.25% and 100%, respectively). No significant differences in shedding rate, graft survival rate, and complications were noticed between both groups.

CONCLUSION
Follicular de-epithelialization does not affect the survival rate of graft in FUE. Based on these data, de-epithelialization may improve immediate postoperative appearance and lead to a more pleasing cosmetic outcome.
Change of plasma amylin after bariatric surgery challenged by oral glucose is associated with remission of type 2 diabetes mellitus
Authors: Wang Jiunn-Wei , Chen Pei-Yu , Huang Hsien-Hao , Yeh Chun , Chen Shu-Chun , Lee Wei-Jei , Chen Chih-Yen 
Published: August 2021

Background:
Gastric bypass (GB) and sleeve gastrectomy (SG) were found to achieve different remission rates in the treatment of type 2 diabetes (T2DM). The alteration in several gut hormones after bariatric surgery has been demonstrated to play a key role for T2DM remission. Nevertheless, amylin, one of the diabetes-associated peptides, so far has an undetermined position on T2DM remission after bariatric surgery.

Methods:
Sixty eligible patients with T2DM (GB, 30; SG, 30) were initially enrolled in the hospital-based randomized trial. Twenty patients (GB, 10; SG, 10) who met the inclusion criteria and agreed to undergo 75-g oral glucose tolerance test (OGTT) were recruited. The recruited subjects underwent anthropometric measurements, routine laboratory tests, and 75-g OGTT before and 1 year after bariatric surgery. Enzyme immunoassays for plasma amylin were analyzed.

Results:
All subjects that underwent GB and half of those who underwent SG achieved T2DM remission. Plasma amylin levels significantly decreased 60–90 min after OGTT in the GB group (p < 0.05) and 30–60 minutes after OGTT in the SG group (p < 0.05). Significantly decreased plasma amylin levels were observed at 30–90 minutes after OGTT in the noncomplete remitters of the GB group (p < 0.05). Plasma amylin levels initially increased (p < 0.05) within 30 minutes after OGTT and then decreased (p < 0.05) in the next 30-minute interval in the nonremitters of the SG group.

Conclusion:
Postoral glucose challenge amylin levels could be as one of the parameters to evaluate T2DM remission after bariatric surgery, especially in those after SG.
What intensive care registries can teach us about outcomes
Authors: Beane Abi , Salluh Jorge I.F. , Haniffa Rashan 
Published: August 2021

Purpose of review
Critical care registries are synonymous with measurement of outcomes following critical illness. Their ability to provide longitudinal data to enable benchmarking of outcomes for comparison within units over time, and between units, both regionally and nationally is a key part of the evaluation of quality of care and ICU performance as well as a better understanding of case-mix. This review aims to summarize literature on outcome measures currently being reported in registries internationally, describe the current strengths and challenges with interpreting existing outcomes and highlight areas where registries may help improve implementation and interpretation of both existing and new outcome measures.

Recent findings
Outcomes being widely reported through ICU registries include measures of survival, events of interest, patient-reported outcomes and measures of resource utilization (including cost). Despite its increasing adoption, challenges with quality of reporting of outcomes measures remain. Measures of short-term survival are feasible but those requiring longer follow-ups are increasingly difficult to interpret given the evolving nature of critical care in the context of acute and chronic disease management. Furthermore, heterogeneity in patient populations and in healthcare organisations in different settings makes use of outcome measures for international benchmarking at best complex, requiring substantial advances in their definitions and implementation to support those seeking to improve patient care.

Summary
Digital registries could help overcome some of the current challenges with implementing and interpreting ICU outcome data through standardization of reporting and harmonization of data. In addition, ICU registries could be instrumental in enabling data for feedback as part of improvement in both patient-centred outcomes and in service outcomes; notably resource utilization and efficiency.
Prognostic value of SUVmax in breast cancer and comparative analyses of molecular subtypes
Authors: Lee Moon il , Jung Youn Joo , Kim Dong Il , Lee Seungju , Jung Chang Shin , Kang Seok Kyung , Pak Kyoungjune , Kim Seong Jang , Kim Hyun Yul 
Published: August 2021

Abstract

Background:
To assess the prognostic capability of the maximum standardized uptake values (SUVmax) measured in the primary tumor and axillary lymph nodes (ALNs) by pretreatment fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography and analyze outcomes according to the molecular breast cancer subtypes.

Methods:
The databases were systematically searched using keywords for breast cancer, positron emission tomography/computed tomography, and SUVmax; the extracted studies reported at least 1 form of survival data, event-free survival (EFS) and overall survival. Comparative analyses of the pooled hazard ratios (HRs) for EFS and overall survival were performed to assess their correlations with SUVmax. The pooled HR was estimated using random-effects model according to the results of heterogeneity.

Results:
Thirteen eligible studies comprising 3040 patients with breast cancer were included. The pooled HRs of high SUVmax in the primary tumor and ALN were 3.01 (95% CI 1.83–4.97, P < .00001; I2 = 82%) and 3.72 (95% CI 1.15–12.01; I2 = 92%; P = .03), respectively. Patients with higher SUVmax demonstrated a poorer survival prognosis. Furthermore, comparative analyses according to the molecular subtypes demonstrated that the SUVmax in the primary tumor or ALN can be a predictive parameter in patients with the luminal subtype disease. Subtype analysis results indicated a significant association of the luminal group, with a HR of 2.65 (95% CI 1.31–5.37; I2 = 27%; P = .007).

Conclusions:
SUVmax from pretreatment is a significant prognostic factor for EFS in patients with breast cancer. Despite several limitations, correlation with molecular subtype (luminal type) was demonstrated. Further large-scale studies are required to investigate the precise prognostic capability of SUVmax.
Analysis and forecasting of confirmed, death, and recovered cases of COVID-19 infections in Nigeria
Authors: Chigbu Baptista C. , Edikpa Edith C. , Onu Eucharia A. , Nwabueze Akachukwu I. , Aneke Mary C. , Vita-Agundu Uche C. , Adepoju Esther B. 
Published: August 2021

Abstract
The coronavirus (COVID-19) disease outbreak was a public health emergency of international concern which eventually evolved into a pandemic. Nigeria was locked down in March, 2020 as the country battled to contain the spread of the disease. By August 2020, phase-by-phase easing of the lockdown was commenced and university students will soon return for academic activities. This study undertakes some epidemiological analysis of the Nigerian COVID-19 data to help the government and university administrators make informed decisions on the safety of personnel and students.
The COVID-19 data on confirmed cases, deaths, and recovered were obtained from the website of the Nigerian Centre for Disease Control (NCDC) from April 2, 2020 to August 24, 2020. The infection rate, prevalence, ratio, cause-specific death rate, and case recovery rate were used to evaluate the epidemiological characteristics of the pandemic in Nigeria. Exponential smoothing was adopted in modeling the time series data and forecasting the pandemic in Nigeria up to January 31, 2021.
The results indicated that the pandemic had infection rate of at most 3 infections per 1 million per day from April to August 2020. The death rate was 5 persons per 1 million during the period of study while recovery rate was 747 persons per 1000 infections. Analysis of forecast data showed steady but gradual decrease in the daily infection rate and death rate and substantial increase in the recovery rate, 975 recoveries per 1000 infections.
In general, the epidemiological attributes of the pandemic from the original data and the forecast data indicated optimism in the decrease in the rate of infection and death in the future. Moreover, the infection rate, prevalence and death rate in January 2021 coincided with the predictions based on the analysis. Therefore, the Nigerian government is encouraged to allow universities in the country to reopen while university administrators set up the necessary protocols for strict adherence to safety measures.
Efficacy and safety of HDACIs in the treatment of metastatic or unresectable renal cell carcinoma with a clear cell phenotype
Authors: Chen Juan , Ren Jia-Ju , Cai Jiangxia , Wang Xiaoli 
Published: August 2021

Abstract

Background:
In this study, we evaluated the efficacy and safety of histone deacetylase inhibitors (HDACIs) in the treatment of renal cell carcinoma (RCC).

Methods:
PubMed, EMBASE, the Cochrane Library, CNKI, and the Wanfang database were searched to retrieve studies describing the use of HDACIs for the treatment of RCC published between January 1, 2009, and January 1, 2021. Relevant studies were selected, and data were extracted. Then, a meta-analysis was performed using R 3.5.2 software.

Results:
The results showed that the objective response rate (ORR) of HDACIs used to treat RCC was 26% [95% confidence interval (95% CI): 0.19∼0.34] and that the 1-year progression-free survival (PFS) rate was 29% (95% CI: 0.14∼0.59). The ORR and PFS rate of the combination group were better than those of the monotherapy group, and the ORR and PFS rate of the selective HDACI group were better than those of the pan-HDACI group. The incidences of neutropenia and thrombocytopenia were higher and the incidence of fatigue was lower in the selective HDACI group than in the pan-HDACI group.

Conclusion:
This study initially confirmed the efficacy and safety of HDACIs for the treatment of RCC. Due to the limitations of the included studies, more high-quality studies are needed to validate the conclusions.
Adnexal Masses in Pregnancy
Authors: Montes de Oca Mary Katherine , Dotters-Katz Sarah K. , Kuller Jeffrey A. , Previs Rebecca A. 
Published: August 2021

ABSTRACT

Importance
Adnexal masses are identified in approximately 0.05% to 2.4% of pregnancies, and more recent data note a higher incidence due to widespread use of antenatal ultrasound. Whereas most adnexal masses are benign, approximately 1% to 6% are malignant. Proper diagnosis and management of adnexal masses in pregnancy are an important skill for obstetricians.

Objective
The aim of this study was to review imaging modalities for evaluating adnexal masses in pregnancy and imaging characteristics that differentiate benign and malignant masses, examine various types of adnexal masses, and understand complications of and explore management options for adnexal masses in pregnancy.

Evidence Acquisition
This was a literature review using primarily PubMed and Google Scholar.

Results
Ultrasound can distinguish between simple-appearing benign ovarian cysts and masses with more complex features that can be associated with malignancy. Radiologic information can help guide physicians toward recommending conservative management with observation or surgical removal during pregnancy to facilitate diagnosis and treatment. The risks of expectant management of an adnexal mass during pregnancy include rupture, torsion, need for emergent surgery, labor obstruction, and progression of malignancy. Historically, surgical removal was performed more routinely to avoid such complications in pregnancy; however, increasing knowledge has directed management toward conservative measures for benign masses. Surgical removal of adnexal masses is increasingly performed via minimally invasive techniques including laparoscopy and robotic surgery due to a decreased risk of surgical complications compared with laparotomy.

Conclusions and Relevance
Adnexal masses are increasingly identified in pregnancy because of the use of antenatal ultrasound. Clear and specific guidelines exist to help differentiate between benign and malignant masses. This is important for management as benign masses can usually be conservatively managed, whereas malignant masses require excision for diagnosis and treatment. A multidisciplinary approach, including referral to gynecologic oncology, should be used for masses with complex features associated with malignancy. Proper diagnosis and management of adnexal masses in pregnancy are an important skill for obstetricians.

Target Audience
Obstetricians and gynecologists, family physicians

Learning Objectives
After completing this activity, learners should be better able to compare different types of adnexal masses found in pregnancy, including incidence, clinical features, and imaging characteristics; evaluate an adnexal mass with imaging and laboratory tests; describe complications related to an adnexal mass in pregnancy; and determine management and/or surgical approaches for removal.
Vaginal Hysterectomy Rates Before and After Implementation of a Multiple-Tier Intervention
Authors: Crouss Tess , Sharma Shefali , Smith Devon , Hunter Krystal , Perry Robin , Lipetskaia Lioudmila 
Published: August 2021

(Abstracted from Obstet Gynecol 2021;137:641–647)
The American College of Obstetricians and Gynecologists recommend vaginal hysterectomy (VH) as the optimal route of hysterectomy when feasible. Compared with a laparoscopic route, the vaginal route is associated with lower overall costs, a decreased length of hospital stays, less postoperative pain, and quicker return to activity with no difference in adverse complications.
Fertility-Sparing Treatment for Early-Stage Cervical, Ovarian, and Endometrial Malignancies
Authors: Nitecki Roni , Woodard Terri , Rauh-Hain J. Alejandro 
Published: August 2021

(Abstracted from Obstet Gynecol 2020;136:1157–1169)
Approximately 21% of gynecologic malignancies are diagnosed in women younger than 40 years, raising the importance of future fertility in discussions of informed consent before cancer therapy. Fertility-preserving procedures in patients diagnosed with cancer remain relatively rare.
A Randomized Controlled Trial Assessing the Impact of Opioid-Specific Patient Counseling on Opioid Consumption and Disposal After Reconstructive Pelvic Surgery
Authors: Buono Kristen , Whitcomb Emily , Guaderrama Noelani , Lee Elizabeth , Ihara Jun , Sudol Neha , Lane Felicia , Lee Jennifer , Heliker Bhumy Davé , Brueseke Taylor 
Published: August 2021

(Abstracted from Female Pelvic Med Reconstr Surg 2021;27:151–158)
Inappropriate overprescription of opioids, an important risk factor for the development of opioid abuse, has been demonstrated after benign hysterectomy and reconstructive surgery for pelvic organ prolapse. Several landmark studies have found that surgeons can prescribe fewer opioids in the postoperative setting without affecting patient distress or refill requests.