bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adverse drug events observed with 150 mg versus 300 mg secukinumab for the treatment of moderate to severe plaque psoriasis
Authors: Zhang Li , Yang Hua , Chen Qihong , Zhao Jing 
Published: January 2019

Abstract

Background:
Secukinumab has been approved for the treatment of moderate to severe plaque psoriasis. However, safety measures concerning drug administration is vital during treatment. Understanding the right way to administer drugs is important to reduce any serious adverse drug event. In this analysis we aimed to systematically show the risk of adverse drug events which were observed with 150 mg versus (vs) 300 mg secukinumab for the treatment of moderate to severe plaque psoriasis.

Methods:
The major online databases: Cochrane Central, MEDLINE, www.ClinicalTrials.com and EMBASE were searched for relevant publications based on the comparison of secukinumab 150 mg vs 300 mg for the treatment of moderate to severe plaque psoriasis. Adverse drug events were considered as the clinical endpoints. Statistical analysis was carried out by the RevMan 5.3 software. Risk ratios (RR) and 95% confidence intervals (CIs) were generated to represent the data following statistical analysis.

Results:
Seven studies with a total number of 2361 participants were included. Results of this analysis showed that the risk of any adverse event (RR: 1.00, 95% CI: 0.96–1.05; P = .94), the risk of serious adverse events (RR: 1.04, 95% CI: 0.75–1.43; P = .82) and the risk of adverse events leading to drug discontinuation (RR: 0.98, 95% CI: 0.61–1.57; P = .92) were not significantly different between 150 mg vs 300 mg secukinumab for the treatment of moderate to severe plaque psoriasis. When the detailed adverse drug events were studied, the risks of infection or infestation (RR: 1.11, 95% CI: 0.98–1.25; P = .09), naso-pharyngitis (RR: 1.05, 95% CI: 0.90–1.23; P = .55), headache (RR: 0.92, 95% CI: 0.68–1.25; P = .60), diarrhea (RR: 1.14, 95% CI: 0.75–1.73; P = .55), pruritus (RR: 0.82, 95% CI: 0.56–1.22; P = .33), arthralgia (RR: 0.96, 95% CI: 0.67–1.38; P = .83), upper respiratory tract infection (RR: 0.98, 95% CI: 0.70–1.36; P = .89), hypertension (RR: 1.22, 95% CI: 0.83–1.81; P = .31), nausea (RR: 1.39, 95% CI: 0.63–3.04; P = .42), and cough (RR: 1.46, 95% CI: 0.67–3.19; P = .34) were still not significantly different between these 2 dosage regimens.

Conclusion:
Secukinumab 150 mg and 300 mg were both equally tolerable and might safely be used for the treatment of moderate to severe plaque psoriasis. No significant adverse drug events were observed with any of the dosage.
Use of the SYNTAX Score II to predict mortality in interventional cardiology
Authors: Yang Hua , Zhang Li , Xu Chen Hong 
Published: January 2019

Abstract

Background:
As the SYNTAX Score has limitations, it should be replaced by another better angiographic tool. By comparing mortality that was observed following percutaneous coronary intervention (PCI) in patients who were allotted a low versus a high score, we aimed to systematically investigate mortality prediction using the SYNTAX Score II in Interventional Cardiology.

Methods:
Electronic databases were searched for relevant publications using the terms “SYNTAX Score II and percutaneous coronary intervention.” The main outcome was all-cause mortality. This analysis was carried out by the RevMan 5.3 software [risk ratios (RRs) and 95% confidence intervals (95% CIs) were calculated].

Results:
A total number of 9443 participants were enrolled for this analysis. As different studies reported different range of SYNTAX Score II, we further classified these scores range into 4 different groups: 17 < SS > 17, 20 < SS > 20, 22 < SS > 22, and 26 < SS > 26 appropriately. Results of this analysis showed that the risk of mortality in patients with a high SYNTAX Score II (SS > 17) was significantly higher (RR: 2.65, 95% CI: 1.05–6.73; P = .04) than patients with a low SYNTAX Score II (SS < 17). Even when participants with a low SYNTAX Score II (SS < 20) were compared with patients who were assigned to a higher SYNTAX Score II (SS > 20), a significantly higher risk of mortality was associated with a high SYNTAX Score II (RR: 3.73, 95% CI: 1.99 – 6.96; P = .0001).

Conclusion:
Following PCI, the risk of mortality was higher in those patients with a high SYNTAX Score II. The SYNTAX Score II might be considered as an important tool to predict mortality in Interventional Cardiology. Future research should further explore the benefits of this tool.
Malignant perivascular epithelioid cell tumor in the female genital tract
Authors: Liu Chia-Hao , Chao Wei-Ting , Lin Shih-Chieh , Lau Hei-Yu , Wu Hua-Hsi , Wang Peng-Hui 
Published: January 2019

Abstract

Background:
Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal tumor, located at various anatomic sites, including the female genital tract. This study aimed to evaluate the clinicopathological characteristics of patients with PEComa arising from the female genital tract.

Methods:
A retrospective study was conducted in Taipei Veterans General Hospital (Taipei VGH) between 2008 and 2018. All published English cases based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement were also included in the current review.

Results:
A total of 114 women from PRISMA and 3 women from Taipei VGH were identified. The uterus was the most commonly involved site (82/114, 71.9%), followed by the cervix (12/114, 10.5%). Immunohistochemical staining showed that nearly all gynecological PEComas were positive for human melanoma black 45 (113/114, 99.1%). More than half of the gynecological PEComas were immunoreactive for desmin (50/85, 58.8%). Multi-modality treatment, including surgery and mammalian target of rapamycin (mTOR) inhibitors as targeted therapy, provided long-term disease-free survival (cure rate ranging from 50% to 100%, based on the different anatomic sites of the female genital tract).

Conclusion:
Multi-modality treatment, including cytoreductive surgery and mTOR inhibitors with/without chemotherapy and/or radiation, should be considered for the management of women with PEComas in the genital tract.
Analgesic effect of trigger point injection and EMLA for shoulder pain in patients undergoing total laparoscopic hysterectomy
Authors: Kim Ji Eun , Kim Ji Young , Lee Hye Sun , Seok Suhyun , Kil Hae Keum 
Published: January 2019

Abstract

Backgroud:
The purpose of this study was to evaluate the effects of trigger point injection (TPI) and eutectic mixture local anesthetics (EMLA) cream on the postoperative shoulder pain in patients undergoing total laparoscopic hysterectomy.

Methods:
In this randomized, single-blinded, and controlled study, total 75 patients were randomly allocated to TPI group (n = 25), EMLA group (n = 25), and control group (n = 25). TPI group received TPIs with 2 mL of 0.2% ropivacaine, and EMLA group received an occlusive dressing with EMLA cream 2 g on both shoulders. Overall, abdominal, and shoulder pains were evaluated at rest and in motion on postoperative day 3.

Results:
The incidence of shoulder pain was significantly reduced in EMLA group (56%) compared to control (88%) or TPI (88%) groups (P = .025 in both); the severity of shoulder pain was mitigated in EMLA and TPI groups compared to control group (P < .001, each). Consequently, the overall pain decreased in EMLA group and TPI group (P = .023). The patients with exercise habit (n = 31) showed lower incidence of pain than patients without exercise habit (n = 26) (P = .002, P = .005, and P = .037 in overall, abdominal, and shoulder pain, respectively). TPI or EMLA treatments decreased shoulder pain irrespective of exercise habit (P = .001 and P < .001, respectively), but decreased overall pain only in patients without exercise habit (P = .019). Lastly, EMLA lowered overall pain score at the time of first analgesic request in ward compared to control group (P = .02).

Conclusions:
TPI and EMLA with occlusive dressing effectively reduced the shoulder pain after total laparoscopic hysterectomy.
Balance control, agility, eye–hand coordination, and sport performance of amateur badminton players
Authors: Wong Towel K.K. , Ma Ada W.W. , Liu Karen P.Y. , Chung Louisa M.Y. , Bae Young-Hyeon , Fong Shirley S.M. , Ganesan Balasankar , Wang Hsing-Kuo 
Published: January 2019

Abstract
In this study, balance performance, agility, eye–hand coordination, and sports performance were compared between amateur badminton players and active controls.
Thirty young adult badminton players and 33 active controls participated in the study. Static single-leg standing balance (with eyes closed) was measured using a force platform, and dynamic balance was measured using the Y Balance Test (lower quarter). Agility was measured using a hexagon agility test, and eye–hand coordination was measured using a computerized finger-pointing task. Sports performance was quantified by the number of times a shuttlecock fell in a designated area following a badminton serve.
The badminton players had superior accuracy in badminton serving (P < .001) relative to the active controls. However, no significant between-group differences were noted in all other outcome variables (P > .05).
Amateur badminton players had more favorable sports performance, but not balance performance, agility, or eye–hand coordination, than controls.
Barriers in Neurogastroenterology and Motility Training Experience for Pediatric Gastroenterology Fellows
Authors: Graham Kahleb , Belkind‐Gerson Jaime , Darbari Anil , Boyle John T. 
Published: January 2019

ABSTRACTBackground:Neurogastroenterology and motility (NGM) disorders are common and have a high health care burden. Although pediatric gastroenterology fellows are expected to obtain comprehensive training in the diagnosis and management of NGM disorders, there is ongoing concern for unmet training needs and lack of exposure in treating patients who suffer from NGM problems.Methods:We conducted a cross‐section survey of trainees listed as pediatric gastroenterology fellows in North American training programs in 2018 via direct E‐mail and the pediatric gastroenterology listserv. Eighty‐one pediatric gastroenterology fellows responded to the anonymous survey.Results:A total of 53.1% of the fellows reported interest in NGM; however, 75.1% of the fellows believed they had not been adequately trained in NGM during their fellowship. Eighty percent of fellows with 2 weeks or less of dedicated motility training reported that they received inadequate NGM training, compared to 46.2% fellows who received 1 or more months of dedicated motility training (P = 0.0148). The majority of fellows reported not being comfortable in performing gastrointestinal (GI) motility studies. The majority of fellows also reported not being comfortable in interpreting GI motility studies.Conclusions:Although most pediatric gastroenterology fellows expressed interest in NGM, the lack of exposure and dedicated training in motility during fellowship were identified as barriers to pursuing motility‐focused careers. Furthermore, most fellows reported limited comfort with performing and/or interpreting motility studies. Changes are needed to encourage fellows to develop their interest and expertise in NGM.
From “Coordinated” to “Integrated” Residency Training: Evaluating Changes and the Current State of Plastic Surgery Programs
Authors: Rifkin William J. , Cammarata Michael J. , Kantar Rami S. , DeMitchell-Rodriguez Evellyn , Navarro Carla M. , Diaz-Siso J. Rodrigo , Ceradini Daniel J. , Stranix John T. , Saadeh Pierre B. 
Published: January 2019

Background:
Since the inception of the integrated model, educational leaders have predicted its ongoing evolution, as the optimal plastic surgery curriculum remains a source of debate. With the now complete elimination of the “coordinated” pathway, the total number of integrated programs has arguably reached a plateau. Accordingly, this study examines the current state of training in integrated residencies and reevaluates the variability in the first 3 years of training observed previously.

Methods:
Program information was obtained for all 68 integrated plastic surgery programs, and rotation schedules were available for 59. Plastic, general, and subspecialty surgery exposures were quantified and compared. Inclusion of rotations “strongly suggested” by the Residency Review Committee was also examined.

Results:
Plastic surgery exposure ranged from 3.5 to 25 months (mean, 13.9 ± 5.4 months). General surgery ranged from 5 to 22.5 months (mean, 12.8 ± 4.7 months). Subspecialty rotations ranged from 0 to 8 months (mean, 3.6 ± 1.8 months). There was no difference in mean plastic surgery exposure between programs based within departments versus divisions (15.4 months versus 13.3 months; p = 0.184). There remained significant variability in the inclusion of 18 non–plastic surgery rotations, including the “strongly suggested” rotations.

Conclusions:
Plastic surgery exposure remains highly variable with a greater than 7-fold difference between programs. This suggests that programs are still sorting out the ideal curriculum. However, there is an overall trend toward earlier and increased plastic surgery exposure, which now exceeds the average time spent on general surgery rotations.
A Flow Dynamic Rationale for Accelerated Vascularized Composite Allotransplant Rejection
Authors: Robbins Nicholas L. , Wordsworth Matthew J. , Parida Bijaya K. , Kaplan Bruce , Gorantla Vijay S. , Weitzel Col Erik K. , Breidenbach Warren C. 
Published: January 2019

Background:
From 1996 to 2000, Diefenbeck et al. carried out six knee vascularized composite allotransplants. The allotransplants were composed of bone, soft tissue, and femoral vascular pedicle (25 to 40 cm). All rejected between 14 and 56 months. Failures were attributed to chronic rejection. In 2008, the Louisville team lost their fourth patient’s hand transplant at 8 months. During the rejection workup, intraoperative findings noted a thickened arterial pedicle attributed to intimal hyperplasia with significant fibrotic perivascular tissue and a near “no-flow phenomenon.” No cutaneous rejection was appreciated and failure was attributed to chronic rejection.

Methods:
Data were collected from two teams, one in Germany and the other in Louisville, Kentucky. The population under study consisted of the six knee and one hand transplants. The factor of interest was the long donor arterial pedicle. The outcome measurements were transplant survival time and histopathologic results.

Results:
There are only seven published vascularized composite allotransplant cases where a donor artery longer than 25 cm was used. This cohort represents a 100 percent accelerated failure rate. The cause of these losses remains unexplained. The donor arteries suffered from T-cell–mediated rejection and ischemia-induced media/adventitial necrosis.

Conclusions:
We hypothesize that the donor artery rejected at an accelerated rate because of ischemia caused by disruption of the external vasa vasorum in conjunction with intimal hyperplasia induced by T-cell–mediated rejection that led to disruption of the Windkessel effect. Loss of this effect presented as intimal hyperplasia accelerated by ischemia causing an expedited transplant failure.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Review of the Use of Stainless Wires in Craniosynostosis Surgery
Authors: Natghian Hamidreza , Song Marie , Wall Steven , Johnson David 
Published: January 2019

Background:
Controversy exists as to the ideal form of bone fixation in craniosynostosis surgery with the use of resorbable plates predominating in most craniofacial units. However, the use of stainless steel wires has been the preferred fixation method at the Oxford Craniofacial Unit (OCU) since its establishment. Wires have the advantage of being malleable, inexpensive, and quick and easy to use.

Methods:
A retrospective review of all patients who underwent craniosynostosis surgery at the OCU between February 1995 and February 2017 was undertaken. Average follow-up period was 141 months (11.7 years), with a minimum of 6 months.

Results:
A total number of 1226 craniosynostosis procedures were performed. A minimum of 16,160 wires were inserted. No complications were identified resulting from transdural migration of wires. One hundred fifty-six wires were removed in 92 patients during 109 general anesthetic day-care procedures. This was due to discomfort on palpation in the majority of cases. The average time from primary surgery to removal of wires was 37 months (3.1 years). The most common site for wire removal was in the supraorbital and lateral forehead regions, and occurred most frequently in children who had undergone fronto-orbital advancement and remodeling.

Conclusion:
The use of wires in craniofacial surgery is safe. One percent of all wires that were inserted had to be removed. Children undergoing primary craniosynostosis surgery have a 9% chance of needing a subsequent day-care procedure to have a wire removed. Taking into account the cost of this additional surgical procedure, the primary use of wires in craniosynostosis surgery is still significantly cheaper than the use of resorbable plates.
Efficacy of Single-incision Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair for Overweight or Obese Patients
Authors: Wakasugi Masaki , Nakahara Yujiro , Hirota Masaki , Matsumoto Takashi , Kusu Takashi , Takemoto Hiroyoshi , Takachi Ko , Oshima Satoshi 
Published: January 2019

Aim:
To evaluate the efficacy of single-incision laparoscopic surgery for totally extraperitoneal repair in overweight or obese patients.

Materials and Methods:
For outcome analyses, patients were subdivided by body mass index (BMI) as normal-weight (18.5≤BMI<25 kg/m2), overweight (25≤BMI<30 kg/m2) or obese (≥30 kg/m2) and compared.

Results:
In total, 201 patients were divided into a normal-weight group (n=152) and an overweight/obese group (n=49). Median operative time for unilateral hernia was 72 minutes in the normal-weight group and 95 minutes in the overweight/obese group (P<0.05). No significant differences in operative time for bilateral hernia, bleeding volume, peritoneal injury, conversion to a different procedure, postoperative hospital stay, follow-up duration, complications, or recurrence were identified.

Conclusions:
Single-incision laparoscopic surgery for totally extraperitoneal repair, which offers good cosmetic outcomes, seems feasible and safe for overweight or obese patients, although the operation takes longer.
Laparoscopy Versus Open Incarcerated Inguinal Hernia Repair in Octogenarians: Single-Center Experience With World Review
Authors: Payiziwula Jiangduosi , Zhao Pei-Ji , Aierken Amina , Yao Gang , Apaer Shadike , Li Tao , Tuxun Tuerhongjiang 
Published: January 2019

Objectives:
The clinical study is aiming to discuss the therapeutic benefit of laparoscopic hernia (LH) repair with comparing conventional open hernia (OH) repair in incarcerated hernia in octogenarians.

Materials and Methods:
The clinical data of 29 octogenarian incarcerated hernia patients who underwent hernia repair from November 2013 to March 2017 were retrospectively analyzed. The variables analyzed include baseline, operation characteristics, and clinical outcomes. The patients were divided into LH and OH according to the surgical approach and their clinical parameters were compared. Descriptive statistics were calculated, and outcomes were compared using the Fisher exact test and the student t test, a P≤0.05 was considered significant.

Results:
Of reported 18 octogenarian patients, 7 patients underwent LH, whereas the remaining 11 patients underwent OH. The median age of the patients was 86 (81 to 97). All patients in LH group and 3 patients in OH group underwent nonmesh repair. In total, 8 patients in OH group underwent mesh repair. Simultaneous intestinal resection was needed in 4 patients (2 in LH, 2 in OH) due to the necrotic bowel. No mortality was observed in all subjects. The results showed significantly shorter operation time (50±5 vs. 110±3 min; P=0.000), hospital stay (6±1 vs. 12±3 d; P=0.04). There were no noteworthy postoperative complications and during the follow-up period, no patient experienced recurrent hernia in both groups.

Conclusions:
LH nonmesh repair has not increased the morbidity and mortality but showed shorter hospital stay and fast recovery and no recurrence in octogenarian incarcerated hernia patients. Therefore, LH in octogenarian incarcerated hernia patients might be preferred approach in sophisticated hands with acceptable outcomes.
White matter regions with low microstructure in young adults are associated with white matter hyperintensities in late life
Authors: Lao Patrick J. , Vorburger Robert S. , Narkhede Atul , Gazes Yunglin , Igwe Kay C. , Guzman Vanessa A. , Last Briana , Habeck Christian , Stern Yaakov , Brickman Adam M. 
Published: January 2019

AbstractBackgroundWhite matter hyperintensities (WMH) are areas of increased signal observed on T2-weighted magnetic resonance imaging (MRI) that reflect macrostructural white matter damage frequently observed in aging. The extent to which diminished microstructure precedes or results from white matter damage is unknown. The aim of this study was to evaluate the hypothesis that white matter areas that show normatively lower microstructure are most susceptible to develop WMH.MethodsFive hundred fifty-seven older adults (age: 73.9±5.7yrs) underwent diffusion weighted imaging (DWI) and T2-weighted magnetic resonance imaging (MRI). Diffusion weighted imaging scans were processed into parametric maps of fractional anisotropy (FA) and T2-weighted MRI scans were segmented into WMH. All images were spatially normalized to standard space. A FA template was created to represent normative values from a separate, independent sample of young, healthy adults (N=49, age: 25.8±2.8yrs) and a WMH frequency template was created from the segmented WMH in the older adults. We compared FA values between areas defined as WMH with those defined as normal appearing white matter (NAWM) in the older participants. White matter hyperintensity frequency was binned (0-5%, 5-10%, 10-15%, 15-20%, >20%) and we determined whether WMH frequency bins were different by normative FA values defined in the younger group.ResultsFractional anisotropy values were lower (p<0.001) in WMH regions compared with NAWM regions in the older sample. Areas with higher WMH frequency in older adults had lower FA values in younger adults (5-10%>10-15%>15-20%; p<0.001).DiscussionLow FA values are observed in frank WMH, but FA is also normatively low in regions with high WMH frequency prior to damage. Regions with normatively lower microstructure are more susceptible to future damage from factors such as chronic hypoperfusion or pathology.