bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Cost-efficiency in Bilateral Direct-to-Implant Reconstructions with Acellular Dermal Matrix
Authors: Buendía Javier , Olivas-Menayo Jesus 
Published: October 2019

Summary:
The use of acellular dermal matrix (ADM) for bilateral breast reconstruction has increased in recent years. Detection of BCRA mutation and therefore bilateral risk-reduction mastectomy is one of the main reasons for this increase. High cost of ADM is considered a major drawback for its use. The authors present a new technique which allows the use of only one unit of ADM for both breasts. After assessing the viability of the skin of mastectomy flaps, a musculofascial pocket formed superiorly by pectoralis major, laterally by serratus fascia and inferiorly by rectus fascia, is performed. Then, the ADM is divided in two halves. We propose two different ways to divide the matrix, cutting it vertically or diagonally in two. The way in which the matrix should be cut depends on the distensibility of the pocket. Afterwards, the implant is inserted and the exposed area of the implant is covered by the ADM sutured to the edges of the musculofascial pocket. Using only one ADM unit for bilateral reconstruction, the procedure becomes not only more cost-effective but also can reduce complications such as seroma, rippling, wrinkling, and visibility by means of a better coverage with lesser foreign body load. Furthermore, the lesser the matrix used, the faster the integration is achieved.
SUDDEN VISION LOSS FROM CENTRAL RETINAL ARTERY OCCLUSION AS A PRESENTING SYMPTOM OF MITRAL VALVE PAPILLARY FIBROELASTOMA
Authors: Henao Martha , Chamchikh Joud , Chalam Kakarla V. 
Published: October 2019

Purpose:
We describe a central retinal artery occlusion with cilioretinal sparing in a young male patient who was found to have mitral valve papillary fibroelastoma

Methods:
At the initial examination, a 33-year-old Hispanic man had visual acuity of 20/200 in his left eye, and 2 weeks later, visual acuity improved to 20/20. Diagnosis required transesophageal echocardiography to localize the lesion.

Results:
Mitral valve papillary fibroelastoma involving the mitral valve was successfully treated with tumor resection.

Conclusion:
Routine echocardiography should be performed in all patients presenting with central retinal artery occlusion as it may diagnose treatable cardiogenic etiologies and present further potentially life-threatening embolic events.
Interaction between eNOS gene polymorphism and current smoking on susceptibility to coronary heart disease in Chinese people
Authors: Yang Ping , Wu Peng , Liu Xing , Feng Jian , Zheng Shuzhan , Wang Yan , Fan Zhongcai 
Published: October 2019

Objective
This study aims to explore the relation between endothelial nitric oxide synthase (eNOS) single-nucleotide polymorphisms (SNPs) and the risk of coronary heart disease (CHD).

Methods
SNPstats (online software: http://bioinfo.iconcologia.net/SNPstats) was performed to test Hardy–Weinberg equilibrium in controls. Generalized multifactor dimensionality reduction (GMDR) was adopted to screen the preferable interaction between eNOS SNPs and smoking.

Results
The frequency for the rs1799983-T allele was 31.1% in CHD patients, which was significantly higher than that of 19.8% in controls (P < 0.05). The frequency for the rs891512-A allele was 28.8% in cases, which was also significantly higher than that of 20.1% in controls (P < 0.05). Logistic regression analysis showed that both rs1799983-T and rs891512-A alleles were related with increased risk of CHD, and the odds ratios (ORs) [95% confidence interval (CI)] were 1.71 (1.31–2.15) and 1.57 (1.14–2.07), respectively. High-order interactions were investigated among SNPs and environmental factors using the GMDR method. The data showed that a two-locus model (rs1799983 × smoking) had a testing accuracy of 0.60 (P = 0.001). We found that current smokers with rs1799983-GT or TT within eNOS gene have the highest CHD risk, compared to never smokers with rs1799983-GG genotype, OR (95% CI) = 2.74 (1.78–3.85), after covariates adjustment for age, gender, BMI, and alcohol drinking.

Conclusion
The rs1799983-T and rs891512-A alleles and interaction between rs1799983 and smoking were all risk factors of CHD.
Caring for the surgical patient with limited ICU resources
Authors: Ribeiro Marcelo A.F. , Fonseca Alexandre Z. , Santin Stephanie 
Published: October 2019

Purpose of review
The current review aims to discuss the management of surgical patients in an ICU in countries where resources are limited.

Recent findings
ICU beds in low-income and middle-income countries (LMICs) are limited and also have limited human and structural resources. The working force has been described to be the costliest factor. Nevertheless, costs for intensive care in LMICs are one third from the cost reported from high-income countries. Alternative options have been described, so intensive care can be delivered outside ICU. Examples are Rapid-Response Systems and Medical Emergency Teams.

Summary
The care of the surgical patients in an intensive care setting in countries with resource limitations should be optimized, protocols for standardized care implemented and Better research and resource allocation, as well as investment in healthcare training are essential for the development of intensive care in LMICs is necessary.
Prevalence of and risk factors for anxiety after coronary heart disease
Authors: Chen Ying-Ying , Xu Ping , Wang Yuan , Song Tian-Jiao , Luo Nan , Zhao Li-Jing 
Published: October 2019

Abstract

Background:
As the most important component of cardiovascular disease, coronary heart disease (CHD) is closely related to psychological factors such as anxiety. Anxiety, whether present before or after the onset of illness, can lead to many serious consequences. The aim of this systematic review and meta-analysis was to assess the prevalence of and potential risk factors for anxiety after coronary heart disease (post-CHD anxiety).

Method:
Systematic searches were performed in electronic databases including China National Knowledge Infrastructure (CNKI), Wanfang, Technology Journal database (VIP), PubMed, Web of Science, Embase and Medline.

Result:
Thirteen studies were included. With regard to cross-sectional studies, the prevalence of post-CHD anxiety was P = .37, 95% CI (0.26–0.49). The overall analysis among cohort studies revealed that the prevalence of post-CHD anxiety was P = .50, 95% CI (0.05–0.95). Among the 11 potential risk factors, low education level [OR = 1.46, 95% CI (1.05–2.02)] and long duration of disease [OR = 2.05, 95% CI (1.05–4.00)] were statistically significant.

Conclusion:
There is high heterogeneity between studies and many defects; thus, further research is required to support these results. Attention should be paid to post-CHD anxiety, and clinical caring should include psychological counselling and imparting disease-related knowledge to patients with a long disease duration and low educational background.
Treatment of varicocele with Fu's subcutaneous needling
Authors: Yu Xiaojiang , Li Ting , Zhuang Zhenjie , Li Yingxian , Xie Dongming , Li Zikang , Yuan Xueya , Yang Chaojie 
Published: October 2019

Abstract

Rationale:
Fu's subcutaneous needling (FSN) is an innovative therapy of traditional acupuncture. FSN has been widely applied for the treatment of pain symptoms by relieving local muscle tension and promoting local blood circulation. Varicocele (VCL) is a disease that commonly occurs in male adolescents. Patients with VCL can suffer from pain in the scrotum, inguinal area, or unilateral testis, which could be an indication for FSN. In this study, we present a unique case, in which a 30-year-old male patient with VCL benefitted from FSN.

Patient concerns:
A 30-year-old male complained of dull pain and swelling in the testicular area for 4 months. No significant abnormalities were identified in his genitalia by physical examination.

Diagnoses:
The patient was diagnosed with VCL, with his symptoms and signs of dull pain and swelling in the testicular area, and ultrasound also demonstrated the left-side VCL.

Interventions:
FSN was performed successfully twice a week on a different day without postoperative complications. The total course lasted 8 weeks.

Outcomes:
The patient experienced obvious relief of his testicular pain and swelling after each treatment course. All his symptoms resolved and disappeared after 4 treatment courses. After the 8-week treatment course, the color ultrasound after treatment demonstrated improved anastomotic blood flow rates in his left spermatic vein. No narrow or thrombotic parts were observed post-treatment compared to the color ultrasound before treatment. The patient was followed up at 1, 3, and 6 months after treatment. During the follow-up period, his previous symptoms disappeared without recurrence.

Lessons:
FSN significantly improved the patent's symptoms of testicular pain and abnormal dilatation and tortuosity of the spermatic veins. FSN might exert its therapeutic effect by improving the relaxation of muscle oppression and increasing the local blood reperfusion to resume blood stream. Due to the limitation of a single clinical observation case, a randomized clinical trial with a sufficient follow-up time is needed.
Papillary thyroid carcinoma with tracheal invasion
Authors: Zhang Jiateng , Fu Chao , Cui Kefei , Ma Xiao 
Published: October 2019

Abstract

Rationale:
Compared with most malignant tumors, papillary thyroid carcinoma (PTC) is usually associated with favorable survival and low recurrence rate. The prognostic factors of PTC include age, sex, tumor size, enlarged lymph nodes, and extrathyroidal extension. Among the extrathyroidal extension, upper aerodigestive tract (ADT) invasion by PTC is a marker of more aggressive tumor behavior, defining a subpopulation of patients at a greater risk of recurrence and death.

Patient concerns:
A 61-year-old woman had a cervical mass that was slowly growing for three years. Additionally, she had haemoptysis of 1-year duration. During the month prior to her visit, she had difficulty breathing.

Diagnosis:
Neck ultrasonography (US) and thyroid computed tomography (CT) images both showed a well-defined calcified mass on the left lobe of the thyroid gland. Additionally, the thyroid CT revealed that part of the mass protruded into the lumen which resulted in the thickening on the left side of the trachea. Accordingly, her diagnoses were as follows: firstly, a solid mass on the left lobe of the thyroid gland with tracheal compression; and finally, the space-occupying airway lesion.

Interventions:
She underwent a bronchoscopic examination, which revealed a mass blocking most of the upper endoluminal trachea. Thus, the mass was resected at the upper tracheal segment, followed by electrotome and argon plasma coagulation treatment. She was then transferred to the Thyroid Surgery Department. Thyroid surgeons took the surgical type of bilateral subtotal thyroidectomy + exploration of bilateral recurrent laryngeal nerve + dissection of the lymph node in neck central area + circumferential sleeve resection + end-to-end anastomosis + tracheotomy in the patient.

Outcomes:
After surgery, she recovered well without any local recurrence or distant metastasis.

Lessons:
When patients with PTC have haemoptysis, hoarseness, dyspnea, or any other symptoms, and the imaging examinations reveal a space-occupying lesion in the thyroid and airway, clinicians should focus on PTC with tracheal invasion, a bronchoscopic examination must be immediately performed because the subsequent surgical management depends on the degree of tracheal invasion.
Spleen-preserving distal pancreatectomy and lymphadenectomy for glucagonoma syndrome
Authors: Cao Xuefeng , Wang Xixiu , Lu Yanmin , Zhao Baolei , Shi Jian , Guan Qinghai , Zhang Xingyuan 
Published: October 2019

Abstract

Rationale:
Glucagonoma is a rare type of functional pancreatic neuroendocrine tumor that is characterized by distinctive clinical manifestations; among these, necrolytic migratory erythema represents the hallmark clinical sign of glucagonoma syndrome and is usually presented as the initial complaint of patients.

Patient concerns:
A 30-year-old male patient was admitted to our hospital with a complaint of diffuse erythematous ulcerating skin rash for more than 10 months. He also complained of hyperglycemia and a weight loss of 15 kg in those months.

Diagnosis:
This patient underwent a contrast-enhanced computed tomography scan which showed a pancreatic body mass measuring approximately 6 cm with low density accompanied by partial calcification in plain scanning images and uneven enhancement in strengthening periods. In addition, laboratory tests indicated elevated fasting blood glucagon (1109 pg/mL, normal range: 50–150 pg/mL) levels. Glucagonoma syndrome was ultimately diagnosed in clinical.

Intervention:
Spleen-preserving distal pancreatectomy was conducted and postoperative pathology revealed the presence of glucagonoma.

Outcomes:
The patient recovered uneventfully with the glucagonoma syndrome disappeared soon after surgery, and the postoperative plasma glucagon decreased to a normal level. Follow-up showed no recurrence for 5 years since the surgery.

Lessons:
The treatment of glucagonoma should be directed according to the stage at which the disease is diagnosed. Surgery is currently the only method available to cure the tumor, although medications are given to patients who present with advanced glucagonoma and who are not candidates for operation. Multidisciplinary therapy and multimodality treatment are advised, although these have been systematically evaluated to a lesser degree.
Efficacy and safety of high-dose tigecycline for the treatment of infectious diseases
Authors: Gong Jinhong , Su Dan , Shang Jingjing , Yu Hai , Du Guantao , Lin Ying , Sun Zhiqiang , Liu Guangjun 
Published: October 2019

Abstract

Background:
High-dose (HD) tigecycline regimen is increasingly used in infectious diseases, however its efficacy and safety versus low-dose (LD) is still unclear.

Methods:
A systematic review and meta-analysis was performed; PubMed, Embase, Cochrane Library, ScienceDirect, Web of Science, clinicalTrials.gov, Wanfang, VIP, and China National Knowledge Infrastructure (CNKI), were searched using terms “tigecycline” AND “dose” up to October 31, 2018. Eligible studies were randomized trials or cohort studies comparing mortality, clinical response, microbiological eradication and safety of different tigecycline dose regimens for any bacterial infection. The primary outcome was mortality, and the secondary outcomes were clinical response rate, microbiological eradiation rate and adverse events (AEs). Meta-analysis was done with random-effects model, with risk ratios (RR) and 95% confidence intervals (CI) calculated for all outcomes.

Results:
Of 951 publications retrieved, 17 studies (n = 1041) were pooled in our meta-analysis. The primary outcome was available in 11 studies, and the RR for mortality was 0.67 (95% CI 0.53–0.84, P < .001). Clinical response (RR 1.46, 95% CI 1.30–1.65, P < .001) and microbiological eradication rate (RR 1.61, 95% CI 1.35–1.93, P < .001) were both higher in HD than in LD tigecycline regimen. However, non-Chinese study subgroup presented no statistical significance between HD and LD regimen, RR for mortality, clinical response and microbiological eradication were 0.79 (95% CI 0.56–1.14, P = .21), 1.35 (95% CI 0.96–1.92, P = .26), 1.00 (95% CI 0.22–4.43, P = 1.00), respectively. AEs did not differ between HD and LD tigecycline (RR 1.00, 95% CI 0.80–1.26, P = .97).

Conclusion:
HD tigecycline regimen reduced mortality meanwhile improved clinical efficacy and should be considered in serious infections caused by multidrug-resistant and extensively drug-resistant (MDR/XDR) bacteria.
Combined hepatocellular-cholangiocarcinoma
Authors: Zhang Hao , Yu Xiaojiong , Xu Jian , Li Juan , Zhou Yao 
Published: October 2019

Abstract
Combined hepatocellular-cholangiocarcinoma (CHCC) is a rare type of primary liver cancer (PLC). The aim of this study was to investigate the disease characteristics in CHCC patients and compare them with those in hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC).
The perioperative and follow-up data of CHCC patients (n = 15), HCC patients (n = 577), and ICC patients (n = 61) were retrospectively analyzed, and the clinicopathological characteristics were compared among these 3 groups.
In the CHCC group, the serum level of AFP was significantly higher than that of the ICC group (P = .002), and the CA19-9 level was higher than that of the HCC group (P = .011). The positive rates of CK7 and CK19 expression were higher in CHCC group than in HCC group (both P < .001), while the positive rates of Glypican–3 and Hepatocyte expression were higher in CHCC group than in ICC group (both P < .001). Meanwhile, the CHCC patients were likely to have undergone more MJH/LT than the HCC patients (P = .037) and the ICC patients (P = .011). Macrovascular invasion and lymph node metastasis in the CHCC group were significantly higher but satellite lesions were similar, compared to the HCC group. Both the 1-year disease-free survival (DFS) and the 1-year overall survival (OS) for the CHCC patients were worse than those for the HCC patients. AFP ≥ 400 ng/ml, tumor size ≥5 cm, tumor number ≥2, macro- and microvascular invasion, distant metastasis and positive margin were risk factors for both DFS and OS for the PLC patients. Multivariate analysis also confirmed that ICC and lymph node metastasis were risk factors for DFS and MJH/LT was risk factor for OS.
CHCC patients appear to have intermediate clinical characteristics in comparison with the HCC and ICC patients, and the 1-year DFS and OS for the CHCC patients was worse than the HCC patients, but similar to the ICC patients.
Epidemiological evaluation of traumatic lower limb fractures in children
Authors: Liu Huan , Wang Hongwei , Shao Bing , Lu Han , Zhang Song , Ou Lan , Chen Yu , Xiang Liangbi 
Published: October 2019

Abstract
To investigate the age, gender, time, and etiology differences of traumatic lower limb fractures (TLLFs) in a population of children (≤18 years old), we retrospectively reviewed 936 children who had TLLFs and who came to our university-affiliated hospitals from 2001 to 2010. This study enrolled 657 males (70.2%) and 279 females (29.8%) aged (11.6 ± 4.9) years old. The most common etiologies and fracture sites were motor vehicle collisions (MVCs, 440, 47.0%) and tibias (376, 40.2%). A total of 126 (13.5%) patients suffered neurological deficits (NDs), 127 (13.6%) patients sustained associated injuries (ASOIs), and 78 (8.3%) patients sustained complications. During all periods the occurrence increased with increasing age group and a male preponderance was observed in all age groups. With increasing age, the proportion of injuries due to different etiologies increased and the proportion of femur fracture decreased from 65.2% to 34.5%. With increasing year of admission, the proportion of injuries due to MVCs decreased. The most common fracture sites were tibias in MVCs, femurs in low fall, high fall, and struck by object, feet in sprain. Male patients presented with significantly higher proportions of injuries due to struck by object and sprain, significantly lower proportions of pelvis fracture than the female patients. MVCs and tibias were the most common etiologies and fracture sites. Prevention and treatment should be taken according to the pattern of TLLFs which have specific annual, gender, and age characteristics.
Impact of ultrasound-guided fine needle aspiration cytology for diagnosis of thyroid nodules
Authors: Wang Jing , Liu Jing , Liu Zhe 
Published: October 2019

Abstract

Background:
Previous clinical studies have reported that ultrasound-guided fine needle aspiration cytology (UGFNAC) can be used for the diagnosis of thyroid nodules (TN) effectively. However, no study has systematically explored its diagnosis accuracy in patients with TN. Thus, this study will assess its diagnosis accuracy for TN.

Methods:
We will perform a comprehensive literature search from the following databases from their inceptions to the present without language restrictions: MEDILINE, EMBASE, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. We will consider all case-controlled studies investigating the impacts of UGFNAC diagnosis for patients with TN for inclusion. Two authors will independently carry out study selection, data collection, and methodological quality assessment. Quality Assessment of Diagnostic Accuracy Studies tool will be used for methodological quality evaluation. We will use RevMan V.5.3 and Stata V.12.0 software to perform statistical analysis.

Results:
We will apply sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio to judge the diagnostic accuracy of UGFNAC for TN.

Conclusion:
The results of this study will provide latest evidence for the diagnostic accuracy of UGFNAC for TN.

Systematic review registration:
PROSPERO CRD42019138805.
Efficacy of laser therapy for exercise-induced fatigue
Authors: Wang Dongmei , Wang Xingtong 
Published: October 2019

Abstract

Background:
Laser therapy is widely used for exercise-induced fatigue, while the effect among different studies remains controversial. The present study was to summary available randomized controlled trials (RCTs) to evaluate the effect of laser therapy in subjects with exercise-induced fatigue.

Methods:
PubMed, Embase, and Cochrane Library were searched to identify the potential RCTs from inception to October 2017. The weighted mean difference (WMD) with 95% confidence intervals (CIs) was calculated using a random-effects model.

Results:
Twenty RCTs involving a total of 394 individuals were included in final analysis. No significant differences were observed between the laser therapy and control for the outcomes of lactate (WMD: −0.19; 95%CI: −0.52 to 0.13; P = .244), repetitions (WMD: 4.44; 95%CI: −1.43 to 10.32; P = .138), work load (WMD: 3.38; 95%CI: −1.15 to 7.91; P = .144), time taken to perform the exercise tests (WMD: 4.42; 95%CI: −2.33 to 11.17; P = .199), creatine kinase (WMD: −41.80; 95%CI: −168.78 to 85.17; P = .519), maximum voluntary contraction (WMD: 23.83; 95%CI: −7.41 to 55.07; P = .135), mean peak forces (WMD: 2.87; 95%CI: −1.01 to 6.76; P = = .147), and visual analog scale (VAS) (WMD: −1.91; 95%CI: −42.89 to 39.08; P = = .927). The results of sensitivity analysis suggested that laser therapy might play an important role on the levels of lactate (WMD: −0.30; 95%CI: −0.59 to −0.01; P = = .040), maximum voluntary contraction (WMD: 33.54; 95%CI: 1.95 to 65.12; P = = .037), and VAS (WMD: −21.00; 95%CI: −40.78 to −1.22; P = = .037). The results of subgroup analyses indicated no significant differences between the laser therapy and placebo for lactate and repetitions when stratified by study design, mean age, gender, and study quality.

Conclusions:
The findings of this meta-analysis did not indicate any significant differences between the laser therapy and placebo.