bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dexmedetomidine as an Alternative Anesthetic Agent for Flap Surgery: An Intravital Evaluation in the Cremaster Muscle Flap
Authors: Gencay Isin , Boybeyi Ozlem , Unlu Gulhan , Yazici Ilker , Aydin Gulcin , Buyukkocak Unase 
Published: August 2019

Introduction:
Flap surgery is one of the most commonly used techniques of reconstructive surgery for effective repair of damaged tissue. Optimal anesthetic technique and anesthetic agent plays an important role in flap perfusion. This study aimed to evaluate the effects of dexmedetomidine infusion on the microcirculation in the cremaster muscle flap by direct in vivo monitoring.

Materials and Methods:
We randomly divided 9 Wistar albino rats into 3 groups. The rats in the control group underwent the surgical procedure (isolation of the cremaster muscle) alone; the rats in the experimental groups 1 and 2 received an infusion of dexmedetomidine (10 and 30 min) after the surgical procedure.

Results:
The means of vessel diameters, number of functional capillaries, and movements of leukocytes in all groups were evaluated using intravital microscopic examination. The diameters of the arterioles and venules of the cremaster muscle significantly increased in the dexmedetomidine groups. The number of functional capillaries was higher in the dexmedetomidine groups than in the control group. No difference was observed in the movements of leukocytes between the control and experimental groups. Dexmedetomidine significantly increased the diameters of the arterioles and venules of the cremaster flap and the number of functional capillaries.

Conclusion:
On the basis of the effects of dexmedetomidine on microcirculation, we suggest that dexmedetomidine continue to be used as an anesthetic agent, and may be considered also for reconstructive procedures, particularly flap surgery.
Classification of Angulation Deformities of Lower Lateral Cartilages and Their Restoration
Authors: Çerçi Özkan Aret , Mete Fethi Sarper 
Published: August 2019

Background:
Shape of the tip is supplied by lower lateral cartilages (LLC) which are divided into 3 crura each composed of 2 segments divided by junction lines (JL). Tip restoration becomes more complicated with the presence of angulation deformities (AD) over LLC. It is aimed to classify AD based on their relationship to JL, to clarify their causes of the formation and to discuss restoration techniques for each of them.

Material and Methods:
Between 2016 and 2018, 375 primary rhinoplasties have been performed. All types of the AD have been retrospectively determined, renamed. Six different types of AD have been encountered in this series. Four of AD (types A, B, C, and D) have been located over JL and 2 of AD (types S and T) have not been located over JL.

Results:
Type-A AD diverging the footplates were observed in 9 patients, type-B AD resulting in a boxy-nose were observed in 18 cases, type-C AD resulting in acute angulation of the dome at the medial genu were observed in 4 patients, type-D AD resulting in a pinched tip and concave alar wings were observed in 6 patients, type-S AD resulting in a weak, and short columella were observed in 5 patients, type-T AD that creates a bulge over ala was observed just in 1 patient in our series. The total number of patients with AD was 39 (10.4% of all cases).

Conclusion:
Classification of AD over LLC based on their relationship to certain JL provides ease for recognition of these deformities and immediate per-operative planning for their restoration.
Sphenopalatine Foramen Computed Tomography Landmarks
Authors: El-Anwar Mohammad Waheed , Khazbak Alaa Omar , Hussein Atef , Saber Sameh , Bessar Ahmed Awad , Eldib Diaa Bakry 
Published: August 2019

Objective:
The aim of the study was to assess different radiologic bony landmarks for endoscopic localization of the sphenopalatine foramen (SPF).

Methods:
Paranasal computed tomography (CT) scans of adults without sinonasal pathology were included. On axial cuts, the anteroposterior distances from the SPF to maxillary line, anterior head of the middle turbinate, basal lamella of the middle turbinate, choanal arch, and posterior fontanel of the maxillary sinus ostium were measured. While on coronal cuts, the vertical distances from the SPF to the nasal floor was measured. The registered measurements were then studied and statistically analyzed.

Results:
In 70 patients (140 sides, 840 measurements), the mean distances from the SPF to nasal floor, choanal arch, maxillary line, anterior head of the middle turbinate, basal lamella, and posterior fontanel were 25.6 ± 2.4, 8.5 ± 1.38, 36.4 ± 2.6, 34.6 ± 4.26, 8.1 ± 1.27, and 13.7 ± 1.7 mm, respectively, without significant differences between right and left sides. Females showed significantly shorter mean distances between SPF and the nasal floor (P = 0.0011), choanal arch (P = 0.0459), and posterior fontanel (P < 0.0001) than males. While no significant differences were detected between both sexes as regard distances from SPF to maxillary line (P = 0.5579), anterior head of middle turbinate (P = 0.8581), and basal lamella (P = 0.0638).

Conclusion:
Preoperative CT can provide multiple easily detected, reliable, and simple bony landmarks that can help SPF endoscopic localization. Thus the authors recommend adding these measurements to the preoperative CT checklist for patients scheduled for sphenopalatine artery ligation and/or excision of vascular lesions.
The Value of Managing Severe Traumatic Brain Injury During the Perioperative Period Using Intracranial Pressure Monitoring
Authors: He Jianqing , Chen Junhui , Wu Ting , Zhang Chunlei , Yang Likun , Shi Zhong-Hua , Wang Yu-Hai 
Published: August 2019

Abstract
This study aimed to investigate the clinical efficacy of intracranial pressure (ICP) monitoring regarding the perioperative management of patients with severe traumatic brain injury (sTBI). This was a cohort study performed between Jan 2013 and Jan 2016 and included all patients with sTBI. All patients were split into ICP monitoring and non-ICP monitoring groups. The primary outcomes were in-hospital mortality and Glasgow Outcome Scale (GOS) scores 6 months after injury, whereas the secondary outcomes include rate of successful nonsurgical treatment, rate of decompression craniotomy (DC), the length of stay in the ICU, and the hospital and medical expenses. This retrospective analysis included 246 ICP monitoring sTBI patients and 695 without ICP monitoring sTBI patients. No significant difference between groups regarding patient demographics. All patients underwent a GOS assessment 6 months after surgery. Compared to the non-ICP monitoring group, a lower in-hospital mortality (20.3% vs 30.2%, P < 0.01) and better GOS scores after 6 months (3.3 ± 1.6 vs 2.9 ± 1.6, P < 0.05) with ICP monitoring. In addition, patients in the ICP monitoring group had a lower craniotomy rate (41.1% vs 50.9%, P < 0.01) and a lower DC rate (41.6% vs 55.9%, P < 0.05) than those in the non-ICP monitoring group. ICU length of stay (12.4 ± 4.0 days vs 10.2 ± 4.8 days, P < 0.01) was shorter in the non-ICP monitoring group, but it had no difference between 2 groups on total length of hospital stay (22.9 ± 13.6 days vs 24.6 ± 13.6 days, P = 0.108); Furthermore, the medical expenses were significantly higher in the non-ICP monitoring group than the ICP monitoring group (11.5 ± 7.2 vs 13.3 ± 9.1, P < 0.01). Intracranial pressure monitoring has beneficial effects for sTBI during the perioperative period. It can reduce the in-hospital mortality and DC rate and also can improve the 6-month outcomes. However, this was a single institution and observational study, well-designed, multicenter, randomized control trials are needed to evaluate the effects of ICP monitoring for perioperative sTBI patients.
A Study of the Effect of Platelet-Rich Plasma on Outcomes After Aspirated Human Fat Grafting With Experimental Design
Authors: Lei Hua , Xiao Ran 
Published: August 2019

Introduction:
Over the past decade, some studies have focused on whether platelet-rich plasma (PRP) can promote the survival of fat grafts after transplantation. However, the results of these studies have been controversial because of the variations in research methods and assessment methodologies.

Methods:
In this study, the authors aspirated fat particles from the abdomen of a healthy woman, mixed them with PRP, and injected them into the backs of nude mice subcutaneously, which simulates the clinical model. The control group was designed to mix aspired fat with normal saline. The fat grafts were removed 10 weeks after transplantation, stained with hematoxylin and eosin, and sliced into pathological sections, which were subsequently scanned and analyzed using the Digital Slide Scanning System (PRECICE, Beijing, China).

Results:
The total area of the graft section and the necrotic adipose tissue area in the control group were significantly larger than that in the PRP group. The fibrosis tissue area in the PRP group was significantly larger than that in the control group. There were no statistically significant differences in the viable adipocyte area, the cyst area, and the mature blood vessel number between the PRP and control groups.

Conclusion:
In this study, PRP did not cause an increase in the number of viable adipocytes; however, it did increase the amount of inflammation, which promoted necrotic tissue absorption and the proliferation of granulation tissue. Further research, including research on normalization of fat preparation and grafting, unification of the PRP preparation and application scheme, and optimization of histological measurement and analysis methods, is needed to assess the effect of PRP on fat grafting.
Medicare's Hospital Acquired Condition Reduction Program Disproportionately Affects Minority-serving Hospitals
Authors: Zogg Cheryl K. , Thumma Jyothi R. , Ryan Andrew M. , Dimick Justin B. 
Published: August 2019

Objective:
To assess whether a hospital's percentage of Black patients associates with variations in FY2017 overall/domain-specific Hospital Acquired-Condition Reduction Program (HACRP) scores and penalty receipt. Differences in socioeconomic status and receipt of disproportionate share hospital payments (a marker of safety-net status) were also assessed.

Summary of Background Data:
In FY2015, Medicare began reducing payments to hospitals with high adverse event rates. Concern has been expressed that HACRP penalties could adversely affect minority-serving hospitals, leading to reductions in resources and exasperation of disparities among hospitals with the greatest need.

Methods:
100% Medicare FFS claims from 2013 to 2014 identified older adult inpatients, aged ≥65 years, presenting for 8 common surgical conditions. Multilevel mixed-effects regression determined differences in FY2017 HACRP scores/penalties among hospitals managing the highest decile of minority patients.

Results:
A total of 695,775 patients from 2923 hospitals were included. As a hospital's percentage of Black patients increased, climbing from 0.6% to 32.5% (lowest vs highest decile), average HACRP scores also increased, rising from 5.33 to 6.36 (higher values indicate worse scores). Increases in HACRP penalties did not follow the same stepwise increase, instead exhibiting a marked jump within the highest decile of racial minority-serving extent (45.7% vs 36.7%; OR [95% CI]: 1.45[1.42–1.47]). Similar patterns were observed for high disproportionate share hospital (OR [95% CI]: 1.44 [1.42–1.47]; absolute difference: +7.4 percentage-points) and low socioeconomic status-serving (1.38[1.35–1.40]; +7.3% percentage-points) hospitals. Restricted analyses accounting for the influence of teaching status and severity of patient case-mix both accentuated disparities in HACRP penalties when limiting hospitals to those at the highest known penalty-risk (more residents-to-beds, more severe), absolute differences +13.9, +20.5 percentage-points. Restriction to high operative volume, in contrast, reduced the penalty difference, +6.6 percentage-points.

Conclusions:
Minority-serving hospitals are being disproportionately penalized by the HACRP. As the program continues to develop, efforts are needed to identify and protect patients in vulnerable institutions to ensure that disparities do not increase.
Classifying dementia progression using microbial profiling of saliva
Authors: Bathini P. , Foucras S. , Perna A. , Berreux J.L. , Doucey M.A. , Annoni J.M. , Auber L. Alberi 
Published: August 2019

AbstractIntroductionThere is increasing evidence linking periodontal infections to Alzheimer’s disease. Saliva sampling can reveal information about the host and pathogen interactions that can inform about physiological and pathological brain states.MethodsA cross-sectional cohort of age-matched subjects (78) was segmented according to their chemosensory (University of Pennsylvania smell identification test; UPSIT) and cognitive scores (mini-mental score evaluation; MMSE and clinical dementia rating; CDR). Mid-morning saliva was sampled from each subject and processed for microbiome composition and cytokine analysis. Linear discriminant analysis (LDA) was used to unravel specific changes in microbial and immunological signatures and logistic regression analysis (LRA) was employed to identify taxa that varied in abundance among patients’ groups.ResultsUsing olfaction we distinguish in the cognitively normal population a segment with high chemosensory scores (CNh, 27) and another segment with chemosensory scores (CNr, 16) as low as MCI (21) but higher than the AD group (17). We could identify stage-specific microbial signatures changes but no clear distinct cytokine profiles. Periodontal pathogen species as F. villosus decline with increasing severity of AD while opportunistic oral bacteria as L. Wadei shows a significant enrichment MCI. Conclusions: The salivary microbiome indicates stage-dependent changes in oral bacteria favoring opportunistic bacteria at the expenses of periodontal bacteria, while the inflammatory profiles remain mainly unchanged in the sampled population.
Clinical benefits and adverse effects of genetically-elevated free testosterone levels: a Mendelian randomization analysis
Authors: Mohammadi-Shemirani Pedrum , Chong Michael , Pigeyre Marie , Morton Robert W. , Gerstein Hertzel C. , Paré Guillaume 
Published: August 2019

ABSTRACTBACKGROUNDTestosterone products are increasingly being prescribed to males for a variety of possible health benefits but the causal relationship between testosterone and health-related outcomes is unclear. Evidence from well-powered randomized controlled trials are difficult to obtain, particularly regarding effects on long-term or adverse outcomes. We sought to determine the effects of genetically-predicted calculated free testosterone (CFT) on 23 health outcomes.METHODSGenetic variants associated with CFT were determined from 136,531 white British males in the UK Biobank. One-sample and two-sample Mendelian randomization (MR) analyses were performed to infer the effects of genetically-predicted CFT on 23 health outcomes selected based on relevance with known or suspected effects of testosterone therapy.FINDINGSIn males from the UK Biobank, 81 independent genetic variants were associated with CFT levels at genome-wide significance (p<5×10−8). Each 0.1 nmol/L increase in genetically-predicted CFT was associated with clinical benefits on increased heel bone mineral density (0.053 SD; 95% CI = 0.038 to 0.068; p=8.77×10−12) and decreased body fat percentage (−1.86%; 95% CI = −2.35 to −1.37; p=1.56×10−13), and adverse effects on increased risk of prostate cancer (OR=1.28; 95% CI=1.11 to 1.49; p=1.0×10−3), risk of androgenic alopecia (OR=1.82; 95% CI = 1.55 to 2.14; p=3.52×10−13), risk of benign prostate hyperplasia (BPH) (OR=1.81; 95% CI = 1.34 to 2.44; p=1.05×10−4) and hematocrit percentage (1.49%; 95% CI = 1.24 to 1.74; p=3.49×10−32).CONCLUSIONSLong-term elevated free testosterone levels cause prostate cancer, BPH, and hair loss while reducing body fat percentage and increasing bone density. It also has a neutral effect on type 2 diabetes, cardiovascular and cognitive outcomes. Well powered randomized trials are needed to address the effects of shorter term use of exogenous testosterone on these outcomes.
The consistent burden in published estimates of delirium occurrence in medical inpatients over four decades: a systematic review and meta-analysis study
Authors: Gibb Kate , Seeley Anna , Quinn Terry , Siddiqi Najma , Shenkin Susan , Rockwood Kenneth , Davis Daniel 
Published: August 2019

AbstractIntroductionDelirium is associated with a wide range of adverse patient safety outcomes. We sought to identify if trends in healthcare complexity were associated with changes in reported delirium in adult medical patients in the general hospital over the last four decades.MethodsWe used identical criteria to a previous systematic review, including studies using DSM and ICD-10 criteria for delirium diagnosis. Random effects meta-analysis pooled estimates across studies, meta-regression estimated temporal changes, funnel plots assessed publication bias.ResultsOverall delirium occurrence was 23% (95% CI 19%-26%) (33 studies). There was no change between 1980-2019, nor was case-mix (average age of sample, proportion with dementia) different. There was evidence of increasing publication bias over time.DiscussionThe incidence and prevalence of delirium in hospitals appears to be stable, though publication bias may mask true changes. Nonetheless, delirium remains a challenging and urgent priority for clinical diagnosis and care pathways.
Characteristics of Cardiac Memory in Patients with Implanted Cardioverter Defibrillator: the CAMI study
Authors: Haq Kazi T. , Cao Jian , Tereshchenko Larisa G. 
Published: August 2019

AbstractObjectiveThe goal of this study was to determine factors associated with cardiac memory (CM) in patients with implantable cardioverter-defibrillators (ICD).MethodsPatients with structural heart disease (n=20; mean age 72.6±11.6 y; 80% male; mean left ventricular ejection fraction (LVEF) 31.7±7.6%; history of myocardial infarction (MI) in 75%, ventricular tachycardia (VT) in 85%) and preserved atrioventricular (AV) conduction received primary (80%) or secondary (20%) prevention dual-chamber ICD. Standard 12-lead ECG was recorded in AAI and DDD mode, before and after 7 days of right ventricular (RV) pacing in DDD mode with short AV delay. Direction (azimuth and elevation) and magnitude of spatial QRS, T, and ventricular gradient (SVG) vectors were measured before and after 7 days of RV pacing. CM was quantified as the degree of alignment between QRSDDD-7and TAAI-7vectors (QRSDDD-7-TAAI-7angle). Circular statistics and mixed models with a random slope and intercept were adjusted for days 1-7 change in cardiac activation, LVEF, known risk factors, and use of medications known to affect CM.ResultsQRSDDD-7-TAAI-7angle strongly correlated (circular r = - 0.972; P<0.0001) with TAAI-7-TDDD-7angle. In the mixed models, history of MI (−180°(95%CI −320° to −40°); P=0.011) and female sex (−162°(95%CI −268° to −55°); P=0.003) counteracted CM-T azimuth changes (+132°(95%CI 80°-184°); P<0.0001). History of VT (+27(95%CI 4-46) mV*ms; P=0.007) amplified CM-T area increase (+15(95%CI 6–24) mV*ms; P<0.0001).ConclusionsExisting cardiac remodeling affects CM in response to RV pacing. Women develop less CM than men. Activation memory is another manifestation of CM.
Modelling erythropoiesis in congenital dyserythropoietic anaemia type I (CDA-I)
Authors: Scott Caroline , Downes Damien J. , Brown Jill M. , Babbs Christian , Olijnik Aude-Anais , Gosden Matthew , Beagrie Robert , Schwessinger Ron , Fisher Christopher A. , Rose Anna , Ferguson David J.P , Johnson Errin , Hill Quentin. A , Okoli Steven , Renella Raffaele , Ryan Kate , Brand Marjorie , Hughes Jim , Roy Noemi , Higgs Douglas R. , Buckle Veronica J. 
Published: August 2019

AbstractWe employ and extensively characterise anex vivoculture system to study terminal erythroid maturation of CD34+progenitors from the peripheral blood of normal individuals and patients with Congenital Dyserythropoietic Anaemia type 1 (CDA-I). Using morphological analysis, FACS analysis and the proteomic approach CyTOF, we analysed patient-derived erythroblasts stage-matched with those from healthy donors during the expansion phase and into early differentiation. In patient cells, aspects of disordered erythropoiesis manifest midway through differentiation, including increased proliferation and changes in the DNA accessibility profile. We also show that cultured erythroblasts from CDA-I patients recapitulate the pathognomic feature of this erythroid disorder with up to 40% of the cells having abnormal ‘spongy’ chromatin morphology by electron microscopy, as well as upregulation of GDF15, a marker of ineffective erythropoiesis. In the tertiary phase of culture, patient cells show significantly less enucleation and there is persistence of earlier erythroid precursors. Furthermore, the enucleation defect appears to be more severe in patients with mutations inC15orf41, as compared to the other known causative geneCDAN1, indicating a genotype/phenotype correlation in CDA-I. Such erythroblasts are a valuable resource for investigating the pathogenesis of this disease and provide the opportunity for streamlining diagnosis for CDA-I patients and ultimately other forms of unexplained anaemia.
Ca2+signaling in astrocytes is sleep-wake state specific and modulates sleep
Authors: Bojarskaite Laura , Bjørnstad Daniel M. , Pettersen Klas H. , Cunen Céline , Hermansen Gudmund Horn , Åbjørsbråten Knut Sindre , Sprengel Rolf , Vervaeke Koen , Tang Wannan , Enger Rune , Nagelhus Erlend A. 
Published: August 2019

SummaryAstrocytic Ca2+signaling has been intensively studied in health and disease but remains uncharacterized in sleep. Here, we employed a novel activity-based algorithm to assess astrocytic Ca2+signals in the barrel cortex of awake and naturally sleeping mice while monitoring neuronal Ca2+activity, brain rhythms and behavior. We discovered that Ca2+signaling in astrocytes exhibits distinct features across the sleep-wake cycle and is reduced in sleep compared to wakefulness. Moreover, an increase in astrocytic Ca2+signaling precedes transitions from slow-wave sleep to wakefulness, with a peak upon awakening exceeding the levels during whisking and locomotion. Genetic ablation of a key astrocytic Ca2+signaling pathway resulted in fragmentation of slow-wave sleep, yet increased the frequency of sleep spindles. Our findings suggest a role for astrocytic Ca2+signaling in modulating sleep.