bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reducing the Syndesmosis Under Direct Vision: Where Should I Look?
Authors: Tornetta Paul , Yakavonis Mark , Veltre David , Shah Anjan 
Published: June 2019

Objectives:
To compare the quality of syndesmotic reduction obtained using the incisura versus the ankle articular surface as the visual cue. Secondarily, we evaluated the difference in the anterior to posterior depth of the fibula to the tibia at the joint level and the fibula to the incisura 1 cm above the joint.

Methods:
Seven surgeons reduced disrupted syndesmoses of 10 cadaveric ankles using either the anterolateral articular surface of the distal tibia to the anteromedial fibular articular surface or the location of the fibula within the incisura as a visual reference. Malreductions in translation were measured in millimeter from the anatomical position of the fibula. The anterior to posterior distances of the tibia and fibula were also measured at both levels to determine the differences in their depths.

Results:
The translational reduction was within 2 mm in 93% (0.7 ± 0.7 mm) of reductions using the articular surface as a reference compared with 80% (1.2 ± 1.0 mm) using the incisura as a reference (P = 0.0001). All surgeons' reductions were better using the joint articular surface as the visual reference. The difference in the fibular and the tibial depth was smaller at the level of the articular surface versus the incisura (2.1 mm vs. 5.9 mm; P = 0.0002).

Conclusions:
The articular surface is a significantly more accurate visual landmark for translational reduction of the syndesmosis. This is potentially explained by the larger differences in the fibula and tibial depth at the incisura versus the articular surface.
External Radiation Dose, Obesity, and Risk of Childhood Thyroid Cancer After the Fukushima Daiichi Nuclear Power Plant Accident: The Fukushima Health Management Survey
Authors: Ohira Tetsuya , Ohtsuru Akira , Midorikawa Sanae , Takahashi Hideto , Yasumura Seiji , Suzuki Satoru , Matsuzuka Takashi , Shimura Hiroki , Ishikawa Tetsuo , Sakai Akira , Suzuki Shinichi , Yamashita Shunichi , Yokoya Susumu , Tanigawa Koichi , Ohto Hitoshi , Kamiya Kenji 
Published: June 2019

Background:
The 2011 Great East Japan Earthquake led to a nuclear accident at Fukushima Daiichi Nuclear Power Plant. This study examines the associations of radiation dose and lifestyle factors with incidence of thyroid cancer in Fukushima.

Methods:
We designed a prospective study with 300,473 participants aged 18 years or younger, who underwent thyroid examinations from October 2011. Follow-up surveys were conducted through June 2017, and 245,530 participants (123,480 men and 122,050 women, 82% follow-up) received follow-up examinations. Fukushima Prefecture was divided into five areas based on individual external radiation dose. We calculated relative risks and 95% confidence intervals (CIs) for thyroid cancer in each area, with area of lowest dose as reference, using age-adjusted Poisson regression models. We also calculated risks associated with overweight and obesity.

Results:
The incidence per 100,000 for Groups A (highest dose), B, C, D, and E (lowest dose) were 13.5, 19.2, 17.3, 9.0, and 8.3, respectively. Compared with Group E, the age-adjusted risks (95% CIs) were 1.62 (0.59, 4.47) for group A, 2.32 (0.86, 6.24) for group B, 2.21 (0.82, 5.94) for group C, and 1.02 (0.36, 2.86) for group D. Obesity was positively associated with thyroid cancer incidence; the multivariable-adjusted risk of thyroid cancer was 2.23 (1.01, 4.90) for obese individuals compared with nonobese individuals.

Conclusion:
Regional differences in radiation dose were not associated with increased risk of thyroid cancer among children in Fukushima within 4 to 6 years after the nuclear power plant accident. Obesity may be an important factor for further follow-up in Fukushima.
Artificial intelligence and augmented reality in gynecology
Authors: Moawad Gaby , Tyan Paul , Louie Michelle 
Published: June 2019

Purpose of review
Artificial intelligence and augmented reality have been progressively incorporated into our daily life. Technological advancements have resulted in the permeation of similar systems into medical practice.

Recent findings
Both artificial intelligence and augmented reality are being increasingly incorporated into the practice of modern medicine to optimize decision making and ultimately improve patient outcomes.

Summary
Artificial intelligence has already been incorporated into many areas of medical practice but has been slow to catch on in clinical gynecology. However, several applications of augmented reality are currently in use in gynecologic surgery. We present an overview of artificial intelligence and augmented reality and current use in medical practice with a focus on gynecology.
Five-Year Outcomes of Ultrathin Descemet Stripping Automated Endothelial Keratoplasty
Authors: Madi Silvana , Leon Pia , Nahum Yoav , D'Angelo Sergio , Giannaccare Giuseppe , Beltz Jacqueline , Busin Massimo 
Published: June 2019

Purpose:
To report 5-year outcomes of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) with a central graft thickness intended to be <100 μm.

Methods:
This retrospective, consecutive, interventional case series included 354 eyes with endothelial decompensation due to various causes (Fuchs endothelial dystrophy, pseudophakic or aphakic bullous keratopathy, failed previous graft, herpetic endothelitis, or buphthalmos). Donor tissue was prepared using the microkeratome-assisted double-pass technique aiming at a graft thickness <100 μm. The Descemet membrane was stripped under air. The graft was delivered into the anterior chamber using the pull-through technique through a 3.2-mm clear corneal incision using a modified Busin glide. The best spectacle-corrected visual acuity (BSCVA), endothelial cell loss, graft survival rates, and immunologic rejection rates were evaluated.

Results:
Follow-up data at 1, 2, 3, and 5 years after UT-DSAEK were collected from 214, 172, 147, and 105 eyes, respectively. After excluding eyes with comorbidities, BSCVA better than or equal to  20/20 was recorded in 36.3%, 37.4%, 46.4%, and 53.4% of eyes, respectively, whereas BSCVA better than or equal to 20/40 was documented in 95.5%, 95.3%, 96.0%, and 96.6% of eyes, respectively. The mean endothelial cell loss was 35.4%, 42.3%, 43.3%, and 52.3%; Kaplan–Meier graft survival probability was 99.1%, 96.2%, 94.2%, and 94.2%, and Kaplan–Meier cumulative probability of a rejection episode was 3.4%, 4.3%, 5%, and 6.9% at 1, 2, 3, and 5 years, respectively.

Conclusions:
UT-DSAEK grafts allow excellent 5-year outcomes, including BSCVA, endothelial cell density, and survival rates comparable with those recorded post-Descemet membrane endothelial keratoplasty, but with a higher immunologic rejection rate.
Analysis of Intrasession Repeatability of Ocular Aberrometric Measurements and Validation of Keratometry Provided by a New Integrated System in Mild to Moderate Keratoconus
Authors: Piñero David P. , Soto-Negro Roberto , Ruiz-Fortes Pedro , Pérez-Cambrodí Rafael J. , Fukumitsu Hideki 
Published: June 2019

Purpose:
To evaluate the intrasession repeatability and validity of corneal curvature measurements provided by a new multifunctional device and to assess the intrasession repeatability of its ocular aberrometric measures.

Methods:
This prospective study comprises 37 mild to moderate keratoconus eyes of 37 patients. In all cases, 3 repeated measures of corneal topography and ocular aberrometry were performed with the iDesign 2 system (iD2; Johnson & Johnson Vision Care Inc, Jacksonville, FL) and one keratometric measurement was performed with the intraocular lens-(IOL) Master 500 (Carl Zeiss Meditec Inc, Dublin, CA) and Sirius (CSO) (SIR) systems.

Results:
The within-subject SD (Sw) was <0.50 D for all iD2 keratometric measurements, with intraclass correlation coefficient (ICC) >0.980. Sw and ICC for the keratometric axis were 2.60 degrees and 0.992, respectively. Concerning aberrations, all Sw values for high-order Zernike terms were ≤0.11 μm (ICC > 0.900), and all Sw values for refraction data were <0.75 D (ICC > 0.95), except for J45. No statistically significant differences were found between the devices in any keratometric parameter evaluated (P ≥ 0.222), but the limits of agreement between the devices were clinically relevant. The magnitude of K readings and astigmatism correlated significantly with the difference in these parameters between iD2 and SIR (0.432 ≤ r ≤ 0.489, P ≤ 0.041).

Conclusions:
The iD2 system provides consistent measures of keratometry and ocular aberrometry in eyes with mild to moderate keratoconus. Keratometric data obtained with this system in these eyes cannot be considered as interchangeable with data provided by intraocular lens-Master 500 and SIR.
Gonioscopy-assisted Transluminal Trabeculotomy (GATT) is An Effective Procedure for Steroid-induced Glaucoma
Authors: Boese Erin A. , Shah Manjool 
Published: June 2019

Precis:
Gonioscopy-assisted transluminal trabeculotomy (GATT) is a novel technique that lowers intraocular pressure (IOP) by fracturing the trabecular meshwork. In this retrospective chart review, GATT was found to be effective at lowering the intraocular pressure for steroid-induced glaucoma (SIG).

Purpose:
GATT is a novel microinvasive glaucoma surgery that builds on traditional trabeculotomy techniques to decrease the proximal resistance of conventional outflow, and it is proposed to be an effective surgical treatment for SIG. The purpose of this study is to evaluate the efficacy of GATT for lowering the IOP in SIG.

Methods and Patients:
A retrospective chart review was performed of all GATT procedures performed on patients with a predominant diagnosis of steroid-induced glaucoma between March 1, 2016 and March 30,2018 at the University of Michigan. Primary outcome measures include IOP, the number of IOP-lowering medications prescribed, and the topical steroid dosing over the duration of follow-up.

Results:
A total of 13 patients with steroid-induced glaucoma underwent the GATT procedure. There was a significant reduction in the mean IOP at all postoperative visits. The average IOP decreased by 16.4 (55%) to 19.5 mm Hg (63%) between 3 and 24 months postoperatively. By 24 months, all patients had a reduction in IOP of >20%. The number of glaucoma medications also decreased significantly from an average of 3.1 medications preoperatively to an average of 0.8 medications at last follow-up. The majority of patients (>67%) required continued use of steroids at all postoperative visits. The most common postoperative complication was a transient hyphema (38%). No patients required a repeat glaucoma surgery or anterior chamber washout.

Conclusions:
This small case series suggests that GATT is an effective and safe surgical technique to decrease IOP and decrease medication burden in patients with predominantly steroid-induced glaucoma. To our knowledge, this is the first study looking specifically at the efficacy of GATT for predominantly SIG.
A systematic review of questionnaires on itch by the Special Interest Group “Questionnaires” of the International Forum for the Study of Itch (IFSI)
Authors: Dominick Friederike , van Laarhoven Antoinette I.M. , Evers Andrea W.M. , Weisshaar Elke 
Published: June 2019

Introduction:
Itch can be perceived differently across patients and it can affect daily life in various ways. It is essential to assess those aspects that are relevant for the individual patient’s needs to improve treatment of patients suffering from acute or chronic itch. The International Forum for the Study on Itch (IFSI) Special Interest Group on “Questionnaires” aims to propose tools to assess different dimensions of itch and improve patient care. As a first step, this study aimed at a systematically reviewing existing patients’ self-report questionnaires on itch.

Materials and methods:
The databases PubMed, PsycINFO, and CINAHL were systematically searched for any scientific publication describing patients’ self-report questionnaires that assess itch-related information (≥2 items). Information about the publication was extracted by 2 experts as well as which of the 14 predefined dimensions of itch (by the IFSI Special Interest Group) were assessed within the questionnaire, for instance, duration of itch, itch aggravating or relieving factors, and effects on quality of life.

Results:
From a total of 5282 records, 58 articles were derived describing 62 questionnaires. Over half of the questionnaires were developed for dermatological conditions, and the vast majority targeted at adults. Most questionnaires address itch-related disability and itch intensity. Affective qualities of itch, coping with itch, response to current itch treatment, and the opinion on the origin of itch are infrequently asked for.

Discussion:
The number and content of the items within a dimension vary greatly. Measurement properties of the questionnaires were not systematically addressed, as these were often not reported in the original publication. Future research should focus on selecting adequate and reliable (sub)scales to develop a modular questionnaire system in order to uniformly assess the individual patient’s demands and improve care.
Efficacy of drug-eluting bead transarterial chemoembolization (DEB-TACE) combined with radiofrequency ablation versus DEB-TACE alone in Chinese hepatocellular carcinoma patients
Authors: Zhu Dedong , Yuan Denggao , Wang Zhe , Chen Sihan 
Published: June 2019

Abstract
To compare the efficacy of drug-eluting bead transarterial chemoembolization combined with radiofrequency ablation (DEB-TACE+RFA) versus DEB-TACE alone in Chinese hepatocellular carcinoma (HCC) patients.
The 28 patients receiving DEB-TACE+RFA and 74 HCC patients receiving DEB-TACE were recruited in this study. Treatment responses, progression-free survival (PFS), and overall survival (OS) were evaluated.
One to 3 months after treatments, the proportion of patients achieving complete response (CR) (78.6% vs 33.8%, P <.001) and objective response rate (ORR) (92.9% vs 78.4%, P =.010) were elevated in DEB-TACE+RFA group compared with DEB-TACE group. Multivariate logistic regression displayed that DEB-TACE+RFA was an independently predicting factor for better CR (P = .006). Subgroup analysis of CR achievement illuminated that DEB-TACE+RFA disclosed better CR achievement in patients with history of cirrhosis (P <.001), tumor located in right liver (P = .003), bilobar disease (P = .013), tumor size <3.3 cm (P = .001), no portal vein invasion (P = .001), no hepatic vein invasion (P <.001), Child-pugh stage A (P <.001), Barcelona Clinic Liver Cancer (BCLC) stage 0, A-B (P <.001), abnormal alpha-fetoprotein (AFP) (P = .001) and normal AFP (P = .016). The PFSs were similar between 2 groups (P = .112), however, the OS was more prolonged in DEB-TACE+RFA group (P = .025) compared with DEB-TACE group. And subgroup analysis displayed that PFS of patients with largest nodule size >3.3 cm (P = .025) was longer and patients with unilobar disease (P = .009), and patients with no hepatic invasion (P = .019) and Child-pugh stage A (P = .037) had more favorable OS in DEB-TACE+RFA group compared with DEB-TACE group.
DEB-TACE+RFA achieved better treatment responses and OS compared with DEB-TACE alone in Chinese HCC patients.
Cobra-PLA provides higher oropharyngeal leak pressure than LMA-Classic and LMA-Unique
Authors: Tan Yuan , Duan Guangyou , Chen Qin , Chen Feng , Li Hong 
Published: June 2019

Abstract
Cobra Perilaryngeal Airway (Cobra-PLA) is a relatively new single-use supraglottic device employed during general anesthesia. This meta-analysis includes randomized controlled trials (RCTs) yielding extensive comparison results among Cobra-PLA, Laryngeal Mask Airway (LMA)-Classic, and LMA-Unique.
Two authors performed searches in EMBASE, CENTRAL, PubMed, and ScienceDirect to identify RCTs that compared Cobra-PLA with LMA-Classic and with LMA-Unique in patients undergoing general anesthesia. Both random- and fixed-effects models were used. Begg's funnel plot was used to evaluate publication bias.
Twenty-two RCTs with a total of 1845 patients were included. Cobra-PLA offered significantly higher oropharyngeal leak pressure than LMA-Classic [mean difference (MD) = 3.56 (1.56, 5.55), P = .0005] and LMA-Unique [MD = 4.44 (2.12, 6.76), P = .0002]. First-insertion success rate, ease of insertion, insertion time, and reported complications among Cobra-PLA, LMA-Classic, and LMA-Unique were similar.
Compared with the commonly used LMA-Classic and LMA-Unique, Cobra-PLA provides superior airway sealing.
A chest tube may not necessary in children thoracoscopic lobectomy
Authors: Cheng Kaisheng , Yuan Miao , Xu Chang , Yang Gang , Liu Min 
Published: June 2019

Abstract
Drainage of the thorax postoperatively using chest tubes is a standard procedure in thoracic surgery. However, chest tubes can induce pain and immobilization, increase risk of infection, deteriorate the ventilation capacity, and increase difficulty of postoperative management, particularly in children. This study aimed to investigate the safety and effect of excluding chest tubes after performing thoracoscopic lobectomy in selected children.
A retrospective review of medical records was performed in West China Hospital of Sichuan University from January 2014 to June 2018. Patients who underwent thoracoscopic lobectomy without chest tubes were recorded. Patients with accompanying severe pulmonary infection, extensive thoracic adhesions, or undeveloped interlobar fissure were excluded.
In total, 246 patients underwent thoracoscopic lobectomy without a chest tube, and none required chest drain insertion or reintervention during hospitalization and follow-up at 90 days postoperatively. Among them, 2 (0.81%) patients developed a delayed pneumothorax which was found after being discharged, and resolved spontaneously in 2 weeks. No hemothorax, atelectasis, and bronchial fistula were found. Furthermore, 202 (82.1%) patients developed subcutaneous emphysema, which was asymptomatic and spontaneously resolved within 3 to 7 days. The length of postoperative hospital stay was 2 days; patients were discharged in the 3rd day postoperatively. Patients could recover to free mobilization and resume regular diet at 6 hours postoperatively. All patients were followed up for at least 3 months; no other complications were found, and all patients recovered well.
This study showed that chest tube placement in selected patients may be unnecessary in children undergoing thoracoscopic lobectomy. The minimally invasive procedure and meticulous resection have been the preconditions of this procedure, which may contribute to a rapid recovery and can avoid the chest tube-related complications effectively.
Long-term treatment with eteplirsen in nonambulatory patients with Duchenne muscular dystrophy
Authors: Alfano Lindsay N. , Charleston Jay S. , Connolly Anne M. , Cripe Linda , Donoghue Cas , Dracker Robert , Dworzak Johannes , Eliopoulos Helen , Frank Diane E. , Lewis Sarah , Lucas Karin , Lynch Jessie , Milici A. J. , Flynt Amy , Naughton Emily , Rodino-Klapac Louise R. , Sahenk Zarife , Schnell Frederick J. , Young G. David , Mendell Jerry R. , Lowes Linda P. 
Published: June 2019

Abstract
This analysis aims to describe the outcomes of two nonambulatory patients with Duchenne muscular dystrophy (DMD) who participated in two clinical studies. The two consecutive trials of eteplirsen (studies 201 and 202) were conducted in patients with DMD (N = 12) and confirmed genetic mutations amenable to exon 51 skipping.
In study 201, 12 patients were randomized to receive once-weekly, double-blind intravenous infusions of eteplirsen 30 or 50 mg/kg or placebo for 24 weeks; patients then received open-label eteplirsen during weeks 25 through 28. All 12 patients continued onto open-label extension study 202 and received long-term treatment with eteplirsen. We compared cardiac, pulmonary, and upper limb function and dystrophin production in the nonambulatory twin patients versus the 10 ambulatory patients through 240 combined treatment weeks.
Ten study patients remained ambulatory through both studies, while the identical twin patients both experienced early, rapid loss of ambulation. The twin patients had greater disease severity at baseline (6-minute walk test [6MWT], 330 and 256 m) versus the other patients (n = 10; 6MWT range, 341–418 m). They maintained cardiac and upper limb function through combined week 240, with outcomes similar to those of the patients who remained ambulatory. Dystrophin production was confirmed following eteplirsen treatment.
Despite the loss of ambulation, other markers of disease progression remained relatively stable in the eteplirsen-treated twin patients and were similar to those of the ambulatory patients.
Single-cell RNA sequencing reveals novel gene expression signatures of trastuzumab treatment in HER2+ breast cancer
Authors: Wang Jun , Xu Rengen , Yuan Haiyan , Zhang Yunning , Cheng Sean 
Published: June 2019

Abstract
Human epidermal growth factor receptor 2-positive (HER2+) breast cancer accounts for ∼20% of invasive breast cancers and is associated with poor prognostics. The recent outcome of HER2+ breast cancer treatment has been vastly improved owing to the application of antibody-targeted therapies. Trastuzumab (Herceptin) is a monoclonal antibody designed to target HER2+ breast cancer cells. In addition to improved survival in the adjuvant treatment of HER2+ breast cancer, trastuzumab treatment has also been associated with cardiotoxicity side effect. However, the molecular mechanisms of trastuzumab action and trastuzumab-mediated cardiotoxicity are still not fully understood. Previous research utilized bulk transcriptomics analysis to study the underlining mechanisms, which relied on averaging molecular signals from bulk tumor samples and might have overlooked key expression features within breast cancer tumor. In contrast to previous research, we compared the single cancer cell level transcriptome profile between trastuzumab-treated and nontreated patients to reveal a more in-depth transcriptome profile. A total of 461 significantly differential expressed genes were identified, including previously defined and novel gene expression signatures. In addition, we found that trastuzumab-enhanced MGP gene expression could be used as prognostics marker for longer patient survival in breast invasive carcinoma patients, and validated our finding using TCGA (The Cancer Genome Atlas) breast cancer dataset. Moreover, our study revealed a 48-gene expression signature that is associated with cell death of cardiomyocytes, which could be used as early biomarkers for trastuzumab-mediated cardiotoxicity. This work is the first study to look at single cell level transcriptome profile of trastuzumab-treated patients, providing a new understanding of the molecular mechanism(s) of trastuzumab action and trastuzumab-induced cardiotoxicity side effects.