bluuebunny/crossref_metadata_2025_split huggingface dataset:
Curative-dose Chemoradiotherapy Versus Total Laryngectomy For Stage T3-T4 Squamous Cell Carcinoma of the Larynx
Authors: Bates James E. , Amdur Robert J. , Morris Christopher M. , Hitchcock Kathryn E. , Dziegielewski Peter T. , Boyce Brian J. , Silver Natalie L. , Shaw Christiana , Mendenhall William M. 
Published: May 2019

Objective:Chemoradiotherapy (cRT) and total laryngectomy (TL) are acceptable treatments for locally advanced laryngeal squamous cell carcinoma (LSSC). We aimed to compare the outcomes in patients receiving full-dose treatment.Methods:We identified 11,237 patients in the National Cancer Database treated 2004 to 2015 for T3-4N0-3 LSCC with either TL (with 60 to 80 Gy of adjuvant RT) or cRT (70 to 80 Gy). We evaluated differences in overall survival (OS) using Kaplan-Meier and Cox proportional hazards modeling.Results:For patients with T3 disease, there was no difference in OS regardless of N stage (N0: hazard ratio [HR]=0.94,P=0.38; N+: HR=0.92,P=0.19). TL was associated with improved OS in patients with T4 disease (N0: HR=1.39,P<0.001; N+: HR=1.22,P=0.001).Conclusion:In patients who receive optimal therapy, both TL and cRT offer similar outcomes in T3 but not T4a disease.
Patient Advocacy in Plastic Surgery: An Underutilized Tool
Authors: Mullens Cody L. , Nathan Shelby L. , Kozak Geoffrey M. , Fischer John P. , Greco Gregory A. , Ueno Cristiane M. 
Published: May 2019

Summary:
Healthcare advocacy is an important tool in the plastic surgeon’s arsenal that stands the potential to improve both patient care and the profession. However, many physicians underestimate the importance and influence that healthcare advocacy has on the profession and feel that they lack the leverage and knowledge to advocate on behalf of themselves, their practices, their patients, and their profession, all of which are untrue. Plastic surgeons are uniquely positioned to advocate based on their clinical acumen, personal experiences with patient care, and their position in the healthcare ecosystem value chain. This article aims to equip plastic surgeons with a general framework of knowledge regarding policy and advocacy. Additionally, the article outlines and discusses recent advocacy efforts related to plastic surgery, and efforts that are on the horizon to provide some context to the relevance of advocacy related to plastic surgery. Finally, we aim to empower plastic surgeons to step into the policy advocacy arena for the betterment of our patients and the professional practice of plastic surgery.
Surgical Excision of Keloids Followed by In-office Superficial Radiation Therapy: Prospective Study Examining Clinical Outcomes
Authors: Jones Michael E. , Ganzer Christine A. , Bennett Deanne , Finizio Andrea 
Published: May 2019

Background:
Keloids are benign proliferative scars that often occur among individuals of color, and are thought to be the result of excessive collagen deposition that occurs after injury to the skin. The treatment of these scars is difficult with often poor outcomes. This study aimed to evaluate the effectiveness of surgical excision followed by in-office superficial radiation therapy (SRT) as a method to improve keloid remission.

Methods:
Participants for this study were recruited from June 2016 through February 2017 with 48 subjects enrolled and completed this study. All keloids were surgically resected and participants received 3 consecutive days of a customized dose of SRT, with a maximum cumulative dosage of 18 Gy. Patients were followed over the course of 12 months to monitor outcomes.

Results:
In this cohort, we found 39 (81%) to have achieved successful remission with 9 (19%) being classified as refractory. There were no adverse effects or medical complications reported as a part of this study.

Conclusion:
Study outcomes support the clinical benefits of surgical excision followed by SRT as a practical and efficient treatment for keloids.
Hyaluronic Acid Accelerates Re-epithelialization and Alters Protein Expression in a Human Wound Model
Authors: Nyman Erika , Henricson Joakim , Ghafouri Bijar , Anderson Chris D. , Kratz Gunnar 
Published: May 2019

Background:
Hyaluronic acid (HA), a large glycosaminoglycan involved in proliferation, migration, and tissue repair, is suggested to be an important factor for keratinocyte activation and re-epithelialization. The experimental hypothesis of this study was that HA accelerates re-epithelialization, and we aimed to investigate the effect of exogenous intradermal HA during deep dermal, incisional wound healing in vivo in humans, the primary endpoint being re-epithelialization.

Methods:
A total of 8 standardized deep dermal incisional wounds (depth 1.6 mm, width 1.8 mm) per subject were induced in 10 healthy volunteers. Two of the wound sites per subject were pretreated with injections of HA and 2 with saline solution. At 2 time points (24 hours and 14 days), 2 biopsies for each treatment group (one for histology and one for proteomics) were taken. Skin erythema was measured at 24-hour intervals for 14 days as a surrogate measurement of inflammation.

Results:
At 24 hours, 8 of 9 wounds pretreated with HA showed complete re-epithelization, whereas none of the wounds pretreated with saline had re-epithelized. Wounds pretreated with HA also showed a 10-fold regulation of 8 identified proteins involved in wound healing compared to wounds treated with saline solution. No difference in inflammation, as measured as erythema, could be seen between any of the groups.

Conclusions:
We conclude that HA accelerates re-epithelialization and stimulates an altered protein expression in vivo in human deep dermal incisional skin wounds, but has no effect on the inflammation process as measured by erythema.
Cranial Suture Measurement by 2-point Method in Ultrasound Screening of Craniosynostosis
Authors: Okamoto Toyoko , Nuri Takashi , Harada Atsuko , Kyutoku Shigeo , Ueda Koichi 
Published: May 2019

Background:
Diagnostic imaging for craniosynostosis currently relies entirely on radiation images, but it has been estimated that a risk of cancer from diagnostic x-rays may exist. Use of ultrasound imaging has been reported, but very little has been written on normal findings of the cranial suture. Also, ultrasound diagnostic methods have not been established. To obtain images for the diagnosis of abnormal sutures in craniosynostosis, we investigated the normal ultrasonographic appearance of the suture. To establish screening methods for craniosynostosis, we prepared a 2-point method for simple evaluation and confirmed its usefulness.

Methods:
Ultrasonography was performed in infants with normal head, deformational plagiocephaly, and craniosynostosis. We focused on the measurement indices and decided on the order for making our observations. Furthermore, we developed an evaluation method (2-point method) and recorded our finding in a useful table.

Results:
We could clearly judge whether the cranial suture was patent or closed and were able to measure the suture width. Even for 2-year-old children, the width of the sutures at the points measured exceeded the echocardiographic resolution. By using the 2-point evaluation method, all the sutures could be inspected in about 2 minutes. Sensitivity was 100% and specificity was 95.1%.

Conclusions:
Our present studies showed that normal or abnormal suture can be clearly distinguished by ultrasound. By evaluating the fixed points instead of the whole line, it was possible to shorten the inspection time. Ultrasound screening by applying the 2-point method is very useful.
Hand Function in Apert Syndrome
Authors: Raposo-Amaral Cassio Eduardo , Denadai Rafael , do Monte Lameiro Thais Miguel , de Oliveira Yuri Moresco , Raposo-Amaral Cesar Augusto 
Published: May 2019

Background:
The Michigan Hand Questionnaire is widely used to assess hand outcomes in congenital hand deformities. The purpose of the present study is to compare Apert syndrome hand outcomes according to Upton hand type and age stratification with age-matched unaffected controls.

Methods:
The Brief Michigan Hand Questionnaire was administered to 39 Apert patients after completion of the digit separation surgical regimen, and 140 age-matched unaffected controls. Patients were divided into 3 groups according to age. In group 1 (from 4 months to 7 years of age), responses were provided by parents of Apert patients, and in group 2 (from 8 to 17 years of age), patients responded with assistance from their parents, and in group 3 (18 years of age or older), responses were provided by the patients themselves. Groups were substratified according to Upton hand type (type I, II, and III). Comparisons were made among groups, subgroups, and controls.

Results:
Comparisons of hand types for intragroups 1, 2, and 3, did not demonstrate any statistically significant differences (P > 0.05) between hand outcomes according to Upton hand type, regardless of patient age. Comparisons between Apert patients and their age-matched controls demonstrated statistically significant differences (P < 0.05), as the control group had higher outcome scores.

Conclusions:
Similar hand outcomes scores were achieved by all Apert patients regardless of hand type. Following completion of the digit separation regimen, Apert patients presented hand outcome scores that were lower than those of the patients in the normative control group.
The Influence of Surgical Specialty on Oncoplastic Breast Reconstruction
Authors: Blankensteijn Louise L. , Crystal Dustin T. , Egeler Sabine A. , Varkevisser Rens R.B. , Ibrahim Ahmed M.S. , Sharma Ranjna , Lee Bernard T. , Lin Samuel J. 
Published: May 2019

Background:The integration of oncological surgery with reconstructive techniques has gained popularity in the treatment of breast cancer. oncoplastic reconstruction after partial mastectomy can be performed by the breast surgeon or in cooperation with a consulted plastic surgeon. This study aims to objectively assess the differences in outcomes for partial mastectomy and subsequent oncoplastic reconstruction performed by either general surgery alone or in combination with a plastic and reconstructive surgery team.Methods:Unilateral oncoplastic breast reconstruction cases were extracted from the National Surgical Quality Improvement Program databases from 2005 to 2017. Outcomes of cases performed by the general surgery team alone were compared with those in which the partial mastectomy was performed by the general surgeon with subsequent reconstruction performed by plastic surgeons. To account for cohort baseline differences, propensity score-matched analysis was performed.Results:In total, 4,350 patients were included in this study; 3,759 procedures were performed by general surgery alone versus 591 combined with plastic surgery. The analysis of propensity score-matched cohorts, comprising 490 patients each, showed no statistical difference in the risk for postoperative complications when surgery was performed by either of the 2 specialty services. A longer operative time and length of stay were found in the group reconstructed by plastic surgeons.Conclusions:This study found no significant differences in adverse postoperative outcomes for oncoplastic reconstructions after partial mastectomy between the 2 groups. The data may indicate collaboration between both surgical specialties in oncoplastic breast care was not associated with increased morbidity in these patients.
Inspiratory Muscle Training After Heart Valve Replacement Surgery Improves Inspiratory Muscle Strength, Lung Function, and Functional Capacity
Authors: Cargnin Camila , Karsten Marlus , Guaragna João Carlos Vieira da Costa , Dal Lago Pedro 
Published: May 2019

Purpose:
The aim of this study was to analyze the effects of inspiratory muscle training (IMT) as a therapeutic strategy after heart valve replacement surgery (HVRS).

Methods:
A double-blind, randomized, clinical trial that included patients undergoing elective HVRS, without post-operative complications, were allocated to 2 groups: IMT group (IMT-G) and IMT placebo group (IMT-PG). The IMT started 3 d after surgery and was performed twice daily for 4 wk. Lung function, maximum inspiratory pressure (MIP) as a measure of inspiratory muscle strength, functional capacity, and quality of life were assessed pre-operatively and at the end of training.

Results:
The IMT-G recovered pre-operative MIP and lung function values after 4 wk of training. This group also increased the distance walked during the 6-min walk test (6MWD). In the IMT-PG, the values of MIP were below those found pre-operatively, with impairment of lung function and lower 6MWD in the final evaluation. At the end of IMT, MIP was correlated with the 6MWD and with the spirometry variables.

Conclusions:
IMT performed for 4 wk after HVRS was effective in restoring the values of inspiratory muscle strength and lung function to the pre-operative level and increasing the functional capacity assessed by the 6MWD. Furthermore, an association between lung function and functional capacity was observed, demonstrating the clinical relevance of the use of IMT in the rehabilitation process of these patients.
Iris Posterior Synechiae After Descemet Membrane Endothelial Keratoplasty in Asian Eyes: Prevention and Management of Posterior Synechiae
Authors: Kobashigawa Yuji , Shimizu Toshiki , Hayashi Takahiko , Kobashigawa Hiroko , Yuda Kentaro , Mizuki Nobuhisa , Yamada Norihiro , Kato Naoko 
Published: May 2019

Objectives:
To evaluate the efficacy of a mydriatic agent for posterior synechiae after phacoemulsification and intraocular lens (IOL) implantation followed by Descemet membrane endothelial keratoplasty (staged DMEK).

Methods:
In this prospective study, the outcomes of DMEK with or without mydriasis (0.5% tropicamide and 0.5% phenylephrine hydrochloride [Mydrin-P; Santen, Osaka, Japan]) after the DMEK procedure were analyzed. Patients underwent IOL implantation approximately 4 weeks before DMEK. Six months after DMEK, the iris posterior synechiae severity score was evaluated based on the extent of posterior synechiae affecting the eight areas (45° each) of the pupillary rim (posterior synechiae score; grades 0–8). Best spectacle-corrected visual acuity, central corneal thickness, endothelial cell density, axial length, and the amount of air at the end of the surgery were also evaluated.

Results:
Fifteen eyes of 15 patients (mydriatic: n=8, control: n=7) were eligible for inclusion. Iris posterior synechiae were detected in all seven eyes (100.0%) in the control group, whereas they were noted in two eyes in the mydriatic group (25%). The mean iris posterior synechiae score was 0.69±1.20 in the mydriatic group and was significantly lower than that in the control group (4.57±0.90; P<0.001). There was no significant difference in other clinical factors. Although the incidence and scores of posterior synechiae in the control group were higher, the incidence was significantly reduced with the use of a mydriatic agent (in the mydriatic group).

Conclusions:
Use of a mydriatic agent is an effective measure to prevent postoperative synechiae after DMEK.
Sex Differences in Heart Failure Symptoms and Factors Associated With Heart Failure Symptoms
Authors: Heo Seongkum , Shin Mi-Seung , Hwang Seon Young , An Minjeong , Park Jin-Kyu , Kim SunHwa , Shim Jae Lan , Kim JinShil 
Published: May 2019

Background:
A majority of patients with heart failure (HF) experience HF symptoms. Some literature suggests sex differences in the status of and also factors associated with HF symptoms. However, information on common HF symptom status and factors associated with HF symptoms in male and female patients is scarce.

Objectives:
The aim of this study was to examine HF symptom status and factors associated with HF symptoms in male and female patients with HF.

Methods:
Descriptive data on HF symptoms, psychological factors (depressive symptoms and perceived control), sociodemographic factors (age and sex), clinical factors (body mass index, comorbidities, medication, and left ventricular ejection fraction), and a behavioral factor (self-care) were collected in 70 male and 49 female patients with HF. Mann-Whitney U tests, χ2 tests, and stepwise regression models were used to address the objectives.

Results:
Fatigue was the most common HF symptom in both sexes, but male patients had less severe HF symptoms, including frequency, severity, and/or distress. In male patients, 2 psychological and 2 clinical factors (comorbidities and use of diuretics) were significantly associated with HF symptoms (adjusted R
2 = 0.669, P < .001), whereas in female patients, only depressive symptoms were significantly associated with HF symptoms (adjusted R
2 = 0.679, P < .001).

Discussion:
There were sex differences in HF symptoms and the factors associated with HF symptoms. Clinicians and researchers need to recognize and manage psychological factors in both sexes and clinical factors in male patients by using effective interventions to improve HF symptoms.
The Contribution of Living Arrangements, Social Support, and Self-efficacy to Self-management Behaviors Among Individuals With Heart Failure
Authors: Irani Elliane , Moore Scott Emory , Hickman Ronald L. , Dolansky Mary A. , Josephson Richard A. , Hughes Joel W. 
Published: May 2019

Background:
Living arrangements, social support, and self-efficacy have significant implications for self-management science. Despite the theoretical linkages among the 3 concepts, there is limited empirical evidence about their interplay and the subsequent influence on heart failure (HF) self-management.

Objective:
The aim of this study was to validate components of the Individual and Family Self-management Theory among individuals with HF.

Methods:
This is a secondary analysis of cross-sectional data generated from a sample of 370 individuals with HF. A path analysis was conducted to examine the indirect and direct associations among social environment (living arrangements), social facilitation (social support) and belief (self-efficacy) processes, and self-management behaviors (HF self-care maintenance) while accounting for individual and condition-specific factors (age, sex, race, and HF disease severity).

Results:
Three contextual factors (living arrangements, age, and HF disease severity) had direct associations with perceived social support and self-efficacy, which in turn were positively associated with HF self-management behaviors. Living alone (β = −.164, P = .001) was associated with lower perceived social support, whereas being an older person (β = .145, P = .004) was associated with better support. Moderate to severe HF status (β = −.145, P = .004) or higher levels of perceived social support (β = .153, P = .003) were associated with self-efficacy.

Conclusions:
Our results support the Individual and Family Self-management Theory, highlighting the importance of social support and self-efficacy to foster self-management behaviors for individuals with HF. Future research is needed to further explore relationships among living arrangements, perceived and received social support, self-efficacy, and HF self-management.
Exploring the Mechanism of Effectiveness of a Psychoeducational Intervention in a Rehabilitation Program (CopenHeartRFA) for Patients Treated With Ablation for Atrial Fibrillation
Authors: Risom Signe Stelling , Lind Johanne , Dickson Victoria Vaughan , Berg Selina Kikkenborg 
Published: May 2019

Background
Patients treated for atrial fibrillation with an ablation can experience decreased mental health. Little is known about the effect of a psychoeducation intervention on this patient group.

Objectives
The aim of this study was to explore the effect of a psychoeducation intervention on patients' mental health after participating in a cardiac rehabilitation program, with a focus on elaborating on the lack of mental health improvements.

Method
Sequential explanatory mixed methods including secondary analysis of qualitative and quantitative data collected in a randomized rehabilitation trial was performed. Perceived health was measured by a questionnaire (n = 95), and qualitative interviews were performed (n = 10).

Results
Patients scoring high on perceived health experienced positive effects of the intervention. Patients scoring low appear to have either low physical capacity and severe atrial fibrillation symptoms, bigger life issues, or lack of social support.

Conclusion:
A more in-depth understanding of the effect of a psychoeducational intervention included in a cardiac rehabilitation program has been achieved.
Tobacco, Alcohol, Drug Use, and Intimate Partner Violence Among MSM Living With HIV
Authors: Chen Wei-Ti , Shiu Chengshi , Yang Joyce P. , Chuang Peing , Berg Kristin , Chen Li-Chen , Chi Pei-Chun 
Published: May 2019

Abstract
Men who have sex with men (MSM) and are living with HIV have reported high rates of intimate partner violence (IPV) and substance use. We examined relationships between accumulative IPV, incidents of IPV, and numbers of substances used. One hundred twenty Taiwanese MSM living with HIV completed a cross-sectional survey. Accumulative IPV was assessed by summing the number of 15 types of IPV experienced in the previous year; substance use was measured by any use of alcohol, tobacco, or other drugs during the previous week. In multivariate analysis, IPV was not associated with tobacco use but was positively associated with alcohol and other drug use and significantly associated with the probability of using multiple substances. MSM living with HIV who experienced greater IPV were more likely to use alcohol and other drugs and were more likely to use more than one substance. Health care providers screening for IPV should also screen for substance use.
Perceived Facilitators and Barriers regarding Partner Notification in People Living With HIV in Hunan, China: A Qualitative Study From the Patient Perspective
Authors: Zhang Kaili , Zhao Junshi , Li Xianhong , Chen Xi , Wang Honghong , Williams Ann Bartley , Fennie Kristopher 
Published: May 2019

Abstract
Consensus has been reached about the important role of partner notification (PN) for HIV prevention and control programs. We used a qualitative study to explore facilitators of and barriers to PN to understand reasons for disclosure and nondisclosure by people living with HIV in China. Our main goal was to identify information related to PN that may be unique to the Chinese cultural context. Of 41 participants who were interviewed, 33 had disclosed their HIV status to sexual partners. Facilitators for PN included preserving the integrity of the partnership, social support, and potential benefits of notification; barriers included perceived discrimination/stigma, possible negative consequences, and safety concerns. Participant physical health conditions, strength of the relationship, and concordant identification were found to be conditional factors of PN. Our findings provide information for a better understanding of PN in Chinese culture and offer a reference for developing more specific strategies to facilitate PN.