bluuebunny/crossref_metadata_2025_split huggingface dataset:
A method for exoskeletal assistance in squatting to standing movement: a feasibility study
Authors: Rosenberg Nahum , Edelstein Eliezer 
Published: October 2018

Background:
Impairment or fatigue of muscle groups in the trunk or lower limbs causes difficulty in rising from a seated position to standing. We hypothesized that a moment force generated externally on the knee axis might eliminate the need for the intrinsic force generation across the hip joint and provide external mechanical assistance for this movement, bypassing the trunk-hip force, which is otherwise essential. Since the force moment for this purpose acts on the knee axis, we evaluated a mechanical exoskeletal method based on a spring mechanism that passively extends the knee joint from almost full flexion in squatting to full extension in standing.

Methods:
Thirteen healthy volunteers (15-83 yr) were recruited for this study. Body movements from full squatting to upright standing, with and without application of an assisting exoskeletal device, were video recorded with reference to the femoral greater trochanter and the head of the humerus and expressed by torque across the knee and hip joints according to the measured vertical acceleration of the reference points.

Results:
We found that assisted knee extension up to 105 degrees from squatting is sufficient to passively proceed to full upright standing, with a significantly lower requirement for additional intrinsic muscle force of thigh and trunk (P<0.001 and P<0.01, respectively).

Conclusions:
This study demonstrated that the presented mechanical concept of assisted knee extension may provide improvement in the ability to rise from sitting or squatting to standing in individuals with muscle impairment, with possible improvement in quality of life.
Myelodysplastic syndromes in children
Authors: Galaverna Federica , Ruggeri Annalisa , Locatelli Franco 
Published: October 2018

Purpose of review
Myelodysplastic syndromes (MDSs) are rare disorders in children, showing peculiar clinical manifestations and biological features. This review will summarize biological, genetic and clinical features of childhood MDS and will provide an update of the algorithm of treatment of the different disease variants.

Recent findings
The most recent classification of MDS includes refractory cytopenia of childhood (RCC), advanced and therapy-related MDS. Importantly, in children, these clonal hematopoietic disorders may be often associated with inherited bone marrow failure syndromes, this representing a challenge for diagnostic work-up and treatment. Moreover, germline syndromes predisposing to develop MDS/acute myeloid leukemia have been recently identified, such as those caused by mutations in GATA2, ETV6, SRP72 and SAMD9/SAMD9-L.

Summary
Treatment of childhood MDS varies according to specific disease features; allogeneic hematopoietic stem cell transplantation (HSCT) using a Human Leukocyte antigen (HLA)-identical donor, whenever available, represents the treatment of choice for most of these children. HSCT is indicated in MDS with excess of blasts, or in therapy-related MDS. For RCC patients, HSCT is recommended for RCC associated with monosomy 7, or complex karyotype and for patients showing severe neutropenia or transfusion dependence. Novel approaches of HSCT from an HLA-haploidentical relative after selective graft manipulation allow reducing transplant-related complications.
“Extramammary-Type” Paget Disease of the Breast
Authors: Fernandez-Flores Angel , Eraña Itziar , Cuevas Jesus 
Published: October 2018

Background:
Mammary Paget disease and extramammary Paget disease (EMPD) have different prognoses. Because they are indistinguishable on histopathological grounds, they must be distinguished on a topographical basis.

Objective:
To study cases of Paget disease of the breast, which show similarities to EMPD.

Methods:
Cases were selected by 2 different approaches: (1) those with an exceptionally good evolution and no evidence of subjacent tumor and (2) those expressing MUC5AC.

Results:
Five cases were collected. All cases showed an indolent behavior with a known long clinical history in 2 cases (9 and 25 years, respectively) and a long follow-up in all cases but one (4–8 years). In all cases but one, surgery was performed, and no parenchymal tumor was found (either intraductal or infiltrating). All cases expressed cytokeratin 7 and MUC5AC without expression of MUC2, S100, or p40.

Limitations:
The short number of cases is a limitation of this study. In addition, case 5 is recent, so we have a very short follow-up.

Conclusions:
Some cases of mammary Paget disease behave like EMPD with slow progression and with no underlying associated tumor. Immunoexpression of MUC5AC might be a clue to identify them.
Perineal Stapled Rectal Prolapse Resection in Elderly Patients: Long-term Follow-up
Authors: Ram Edward , Hoffman Aviad , Goldes Yuri , Rosin Danny , Horesh Nir , Gutman Mordechai , Edden Yair 
Published: October 2018

BACKGROUND:
Full-thickness rectal prolapse has a significant negative impact on quality of life. The therapeutic options, specifically in elderly patients, are imperfect. Perineal stapled rectal prolapse resection is a novel operation for treating external rectal prolapse. Long-term follow-up following this procedure is lacking. In our study, we report a long-term follow-up of 30 patients, analyzing the long-term recurrence rate, morbidity, and functional outcome.

OBJECTIVE:
This study aimed to examine the long-term results of perineal stapled rectal resection in a population unfit for prolonged general anesthesia.

DESIGN:
This was a cohort study with a prospective follow-up.

SETTINGS:
This study was conducted at a single tertiary referral center.

PATIENTS:
Patients undergoing perineal stapled rectal resection from January 2010 to June 2013 were included.

INTERVENTIONS:
Perineal stapled rectal prolapse resection was performed.

MAIN OUTCOME MEASURES:
The primary outcome measured was prolapse recurrence.

RESULTS:
A total of 30 patients underwent the surgical intervention. The median follow-up period was 61 months (range, 37–65). No intraoperative or postoperative complications occurred. Six patients (20%) had recurrent rectal prolapse, and continence was not achieved in any of the patients. Two patients who had recurrence underwent a redo perineal stapled rectal resection.

LIMITATIONS:
This study was limited by the small cohort of selected patients.

CONCLUSIONS:
Frail patients that can only endure a short procedure under regional anesthesia should be considered for perineal stapled rectal prolapse resection. The lack of mortality and morbidity, specifically in this population, along with the low long-term recurrence rates, make this a favorable surgical alternative. See Video Abstract at http://links.lww.com/DCR/A745.
Total Nose and Upper Lip Replantation: A Case Report and Literature Review
Authors: Elzinga Kate , Medina Abelardo , Guilfoyle Regan 
Published: October 2018

Summary:
The nose plays a critical role in olfaction, air filtration and humidification, and facial aesthetics. Most nasal amputations result from animal bites, human bites, and lacerations from glass. Successful replantation yields the best aesthetic and functional outcomes and is preferred compared with multistage nasal reconstruction. However, nasal replantation is technically challenging; establishing venous outflow can be particularly difficult. A 17-year-old male sustained a complete nose and upper lip amputation in a motor vehicle accident. The midface segment was emergently replanted. Two arteries (left dorsal nasal artery, left superior labial artery) and 1 vein (branch of the left supratrochlear artery) were anastomosed using microsurgical technique. A vein graft, systemic anticoagulation, and postoperative leeching were important adjuncts. Total operative time was 10 hours. Cold ischemia time was 2 hours and warm ischemia time was 1 hour. Two arteries were anastomosed to minimize the risk of ischemia of the nose and/or upper lip. Complete survival of the replanted segment was achieved. Eighteen months postoperatively, the patient has bilateral nasal patency, intact septal support, and an excellent aesthetic result. All efforts should be made to establish a venous anastomosis during nasal replantation to maximize functional and aesthetic outcomes. Partial necrosis is common following artery-only replantation, leading to tissue loss and contracture.
CRRT for sepsis-induced acute kidney injury
Authors: Romagnoli Stefano , Ricci Zaccaria , Ronco Claudio 
Published: October 2018

Purpose of review
Sepsis-induced acute kidney injury (SI-AKI) represents the first cause of AKI in ICUs, and renal replacement therapy (RRT) is frequently applied in advanced AKI stages. The debate between ‘rescue’ indications for RRT start in patients with severe AKI (acidosis, hyperkalemia, uremia, oliguria/anuria, volume overload) and a proactive RRT initiation is still ongoing. In addition, current SI-AKI pathophysiologic theory has identified the toxic effects of soluble middle-molecules released during sepsis and inflammation (pathogen and damaged associated molecular patterns).
The purpose of the present review is to summarize the recent literature on RRT for patients with SI-AKI. Supportive or replacement measures for severe stages of renal dysfunction and blood purification techniques for sepsis syndrome will be reviewed.

Recent findings
Anticipated RRT for SI-AKI does not seem to improve survival or renal recovery. There is no clinical advantage by delivering continuous RRT at high doses for blood purification purposes. Similarly, specific applications with dedicated devices and membranes have yielded no clinical benefit in these patients, so far.

Summary
In the present review, the recent insights and results from large randomized and nonrandomized trials in the area of RRT applied both as supportive measures for kidney failure and blood purification techniques are described.
Continuous renal replacement therapy: individualization of the prescription
Authors: Haines Ryan W. , Kirwan Christopher J. , Prowle John R. 
Published: October 2018

Purpose of reviewContinuous renal replacement therapy (CRRT) is now the mainstay of renal organ support in the critically ill. As our understanding of CRRT delivery and its impact on patient outcomes improves there is a focus on researching the potential benefits of tailored, patient-specific treatments to meet dynamic needs.Recent findingsThe most up-to-date studies investigating aspects of CRRT prescription that can be individualized: CRRT dose, timing, fluid management, membrane selection, anticoagulation and vascular access are reviewed. The use of different doses of CRRT lack conventional high-quality evidence and importantly studies reveal variation in assessment of dose delivery. Research reveals conflicting evidence for clinicians in distinguishing which patients will benefit from ‘watchful waiting’ vs. early initiation of CRRT. Both dynamic CRRT dosing and precision fluid management using CRRT are difficult to investigate and currently only observational data supports individualization of prescriptions. Similarly, individualization of membrane choice is largely experimental.SummaryClinicians have limited evidence to individualize the prescription of CRRT. To develop this, we need to understand the requirements for renal support for individual patients, such as electrolyte imbalance, fluid overload or clearance of systemic inflammatory mediators to allow us to target these abnormalities in appropriately designed randomized trials.
Regional citrate anticoagulation for continuous renal replacement therapy
Authors: Kindgen-Milles Detlef , Brandenburger Timo , Dimski Thomas 
Published: October 2018

Purpose of review
The delivery of an effective dialysis dose in continuous renal replacement therapy (CRRT) depends on adequate anticoagulation of the extracorporeal circuit. In most patients, either systemic heparin anticoagulation (SHA) or regional citrate anticoagulation (RCA) is used. This review will outline the basics and rationale of RCA and summarize data on safety and efficacy of both techniques.

Recent findings
The basic principle of RCA is to reduce the level of ionized calcium in the extracorporeal circuit via infusion of citrate. This way, effective anticoagulation restricted to the extracorporeal circuit is achieved. SHA and RCA were compared in a variety of studies. RCA significantly prolonged filter lifetime, reduced bleeding complications and provided excellent control of uremia and acid-base status. RCA was also safe in the majority of patients with impaired liver function, whereas caution must be exerted in those with severe multiorgan failure and persistent hyperlactatemia.

Summary
RCA per se is safe and effective for anticoagulation of CRRT. Compared to SHA, efficacy of anticoagulation is improved and adverse effects are reduced. RCA can be recommended as the anticoagulation mode of choice for CRRT in most ICU patients.
IgG4-related disease in the head and neck
Authors: Johnston James , Allen Jacqui E. 
Published: October 2018

Purpose of review
To summarize current evidence regarding the pathophysiology, diagnostic criteria, and management of IgG4 disease in the head and neck.

Recent findings
The anti-CD20 antibody, rituximab is being used increasingly as a primary treatment modality in cases with a definitive diagnosis. Despite the favorable prognosis, it is now recognized that the incidence of cancer development within 3 years of diagnosis is higher than that of the general population.

Summary
IgG4-related disease is a sclerosing, chronic inflammatory disease, that is benign, and usually occurs in middle-aged to elderly individuals. Definitive diagnosis of IgG4-related disease requires radiological confirmation of enlargement of the affected organ, elevated serum IgG4 levels, and characteristic histopathological findings. Treatment is primarily with systemic corticosteroids or the monoclonal anti-CD20 antibody rituximab, surgical excision, or a combination of treatment modalities. Prognosis is good with complete remission in up to 90% of patients.
Screening for Postpartum Depression by Hospital-Based Perinatal Nurses
Authors: Logsdon M. Cynthia , Vogt Krista , Davis Deborah Winders , Myers John , Hogan Felicia , Eckert Diane , Masterson Katlin 
Published: October 2018

Abstract

Purpose:
The primary purpose of this study was to evaluate acceptability by new mothers of postpartum depression (PPD) screening and education about community resources by hospital-based perinatal nurses. A secondary purpose was to determine further screening for PPD that women received by community providers in the first few weeks after birth.

Methods:
The study design was descriptive. As per standard practice on the unit, all new mothers were screened for depression the night before hospital discharge using the Edinburgh Postnatal Depression Scale (EPDS). New mothers identified as high risk for depression by EPDS scores greater than or equal to 10 (n = 75) and a comparison group of mothers at low risk for depression with EPDS scores less than 10 (n = 26) were recruited from an academic health sciences center. Participants were contacted by telephone 2 to 4 weeks later and asked about the acceptability of screening for depression and education about community resources by hospital-based perinatal nurses, as well as if they had received further screening for depression by community providers. Descriptive and correlational statistics were used to analyze data.

Results:
The majority of new mothers found it acceptable to be screened for depression and educated about community resources by hospital-based perinatal nurses. Many new mothers were not asked about depressive symptoms by community providers. There was no significant correlation between demographics and depression risk.

Clinical Implications:
New mothers viewed depression screening and receiving information on community resources as a positive part of their care. Communication between inpatient and community caregivers should be improved so that new mothers can benefit from seamless depression assessment, evaluation, and treatment.
Airway Clearance of the Term Newborn
Authors: Adams Ellise D. , O'Neal Pamela V. , Hanson Linda A. , Norris Casey , Ayers Angela , Harbin Brandi 
Published: October 2018

Abstract

Purpose:
This descriptive, observational study explored the practice of airway clearance of the term newborn at birth. The American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council have established guidelines for suctioning the well newborn.

Study Design and Methods:
Airway clearance practices of nurses, obstetricians, and respiratory therapists at 10 cesarean births and 10 vaginal births were observed. Data were analyzed using descriptive statistics and through content analysis of narratives.

Results:
All newborns observed experienced at least one airway clearance event and multiple airway clearance passes. Indications for suctioning were not consistent with professional guidelines. Airway clearance procedures and practices were inconsistent. Two suction devices used: the blue bulb syringe and orogastric catheter. If a newborn was suctioned three times, the orogastric catheter was the predominate device used.

Clinical Implications:
There was a lack of adherence to established clinical guidelines for newborn airway clearance. Further study is needed to identify education of airway clearance guidelines. Specific protocols such as safe suctioning methods, correct device use, and observation of complications associated with airway management need to be developed to support a newborn's healthy transition at birth.
Novel Biomarker Approaches in Classic Hodgkin Lymphoma
Authors: Aoki Tomohiro , Steidl Christian 
Published: October 2018

Abstract
Classic Hodgkin lymphoma (cHL) is one of the most common lymphomas in the Western world. Advances in the management of cHL have led to high cure rates exceeding 80%. Nevertheless, relapse or refractory disease in a subset of patients and treatment-related toxicity still represents unsolved clinical problems. The introduction of targeted treatments such as PD-1 blockade and the CD30 antibody drug conjugate, brentuximab vedotin, has broadened treatment options in cHL, emphasizing the critical need to identify biomarkers with the goal to provide rationales for treatment selection, increase effective drug utilization, and minimize toxicity. The unique biology of cHL featuring low abundant tumor cells and numerous nonmalignant immune cells in the tumor microenvironment can provide various types of promising biomarkers related to the tumor cells directly, tumor microenvironment cross-talk, and host immune response. Here, we comprehensively review novel biomarkers including circulating tumor DNA and gene expression–based prognostic models that might guide the ideal management of cHL in the future.
Current Use of Biological Scaffolds in Plastic Surgery
Authors: Panayi Adriana C. , Orgill Dennis P. 
Published: October 2018

Background:
Properly designed biodegradable scaffolds facilitate repair or regeneration of stromal tissues. Over the past 50 years, a variety of synthetic, semisynthetic, and decellularized scaffolds have been developed that provide surgeons with tools to reconstruct a wide array of structural defects.

Methods:
The authors review the literature of biological degradable scaffolds in current clinical use in the United States and highlight their design principles and products in common use.

Results:
Host tissues populate scaffolds with inflammatory cells, fibroblasts, blood vessels, nerves, and lymphatics. Cells lay down extracellular matrix macromolecules, whereas enzymes degrade the scaffold. Over time, the scaffold can be totally replaced by host tissues.

Conclusions:
The greatest use of scaffolds in plastic surgery is in skin replacement, breast reconstruction, abdominal wall reconstruction, and peripheral nerve repair. Other areas of importance are cartilage and bone replacement and support for lining replacements such as bowel, bladder, mucosa, and dura. The wide range of research being performed in this field is likely to provide surgeons with more choices and improved materials to repair and regenerate stromal structures.
Tips for Making a Successful Online Microsurgery Educational Platform: The Experience of International Microsurgery Club
Authors: Kwon Soo-Ha , Goh Raymond , Wang Zeng-Tao , Ting-Hsuan Tang Evelyn , Chu Cheng-Feng , Chen Yen-Chou , Chuieng-Yi Lu Johnny , Wei Ching-Yueh , Ting-Wei Hsu Angela , Nai-Jen Chang Tommy 
Published: October 2018

Summary:
The presence of online learning resources has grown tremendously in recent years. They provide powerful and yet easily accessible means of learning and sharing knowledge. Online learning resources now encompass all aspects of medicine, and microsurgery is no exception. International Microsurgery Club is a closed, invitation-only group based on the Facebook social media platform. It was initiated on May 6, 2016, with the primary objectives of providing a convenient forum for discussing challenging cases, sharing valuable resources, and providing opportunities for research collaboration. The membership of International Microsurgery Club has grown to over 8700 at 2 years’ existence, and continues to expand. International Microsurgery Club has become one of the largest online platforms for global microsurgeons. Here, the authors share their experience on how to establish a successful online platform for medical education.
Is Reconstruction Preserving the First Ray or First Two Rays Better Than Full Transmetatarsal Amputation in Diabetic Foot?
Authors: Suh Young Chul , Kushida-Contreras Beatriz Hatsue , Suh HyunSuk Peter , Lee Ho Seung , Lee Woo Je , Lee Seung Hwan , Hong Joon Pio (Jp) 
Published: October 2018

Background:
The benefits of total transmetatarsal amputation over higher level amputation are well known. However, there are no studies evaluating the effects of first ray– or first two ray–sparing transmetatarsal amputation with flap coverage. The authors evaluated this approach with regard to functional outcome and to identify long-term complications.

Methods:
Retrospective data of 59 patients were evaluated according to their surgical method. Complete transmetatarsal amputation with free flap reconstruction was designated as the transmetatarsal amputation group with 27 patients and first ray– or first two ray–preserving transmetatarsal amputation with free flap reconstruction was designated as the ray group, with 32 patients. Demographics, flap outcomes, additional procedures after initial healing, and functional outcomes were measured and evaluated.

Results:
There was no statistically significant difference in demographic distribution and flap outcomes in either group, except for poor blood glucose control in the ray group. Additional procedures after initial healing showed no statistical difference, but the tendency of minor procedures was higher in the ray group. The maximum achieved ambulatory function was significantly better in the ray group, with an ambulatory function score of 4.4 compared with 3.7 in the transmetatarsal amputation group (p = 0.012).

Conclusions:
The preservation of the first ray or first two rays with free flap reconstruction may functionally benefit the patients despite the higher tendency toward minor procedures after initial healing. Furthermore, the progressive deformity of the preserved first and second toes will inevitably occur, requiring patients to undergo further surgery. Further studies are warranted to evaluate this approach.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.