bluuebunny/crossref_metadata_2025_split huggingface dataset:
Soy Isoflavones Inhibit Endothelial Cell Dysfunction and Prevent Cardiovascular Disease
Authors: Yamagata Kazuo 
Published: July 2019

Abstract:
Soybeans are among the most popular foods worldwide, and intake of soy-containing foods has been associated with many health benefits in part because of it structure similar to estrogen. Epidemiologic studies have demonstrated that soy consumption improves serum profiles of hypercholesterolemic patients. Several studies have also indicated an inverse relationship between the consumption of soy isoflavones and the incidence of cardiovascular diseases (CVD). Soy is a rich dietary source of isoflavones. The main soy isoflavones are daidzein and genistein; equol, another isoflavone and a major intestinal bacterial metabolite of daidzein, is generated by enterobacterial effects. Many isoflavones have antioxidative effects and anti-inflammatory actions, as well as induce nitric oxide production to maintain a healthy endothelium and prevent endothelial cell dysfunction. These effects may limit the development of atherosclerosis and CVD and restore healthy endothelial function in altered endothelia. Although the evidence supporting the benefits of soy isoflavones in CVD prevention continues to increase, the association between soy isoflavones and disease is not fully understood. This review summarized recent progress in identifying the preventive mechanisms of action of dietary soybean isoflavones on vascular endothelial cells. Furthermore, it describes the beneficial roles that these isoflavones may have on endothelial dysfunction-related atherosclerosis.
A Novel Mechanism of Sildenafil Improving the Excessive Proliferation and H2S Production in Pulmonary Arterial Smooth Muscle Cells
Authors: Yao Zhenya , Wang Cheng 
Published: July 2019

Abstract:
The dysregulation of pulmonary arterial vasoactive mediators or excessive proliferation of pulmonary arterial smooth muscle cells (PASMCs) might result in contraction or remodeling of pulmonary blood vessels, leading to related lung diseases. Recent studies suggest that hydrogen sulfide (H2S), a gaseous vasodilator generated in the blood vessels by the enzymes cystathionine γ-lyase (CSE) and cystathionine-β-synthase (CBS), could induce the vasodilation, thus improving contraction or remodeling-induced lung diseases. In this study, we hypothesized that PASMCs could produce H2S and relax the pulmonary artery, and its mechanism is related to CSE, CBS, and TRPV4 channels by affecting both the excessive proliferation and pulmonary vasoconstriction in PASMCs. We found that the sildenafil treatment could remarkably promote H2S production and control the proliferation in PASMCs; meanwhile, the protein levels of CSE and CBS and the intracellular concentration of calcium could also be increased by sildenafil. Moreover, the effects of sildenafil could be reversed by a CBS inhibitor or a CSE inhibitor, indicating that sildenafil could affect CSE and CBS to modulate the production of H2S and the proliferation in rat PASMCs. Together, we demonstrated a new mechanism for sildenafil to modulate the synthesis of H2S and cell proliferation in PASMCs by affecting CSE and CBS. TRPV4-dependent Ca2+ events and BMP4 may also be involved.
Reconstruction of Oncologic Sternectomy Defects: Lessons Learned from 60 Cases at a Single Institution
Authors: Banuelos Joseph , Abu-Ghname Amjed , Bite Uldis , Moran Steven L. , Bakri Karim , Blackmon Shanda H. , Shen Robert , Allen Mark S. , Pairolero Peter C. , Arnold Philip G. , Sharaf Basel 
Published: July 2019

Background:
Oncologic sternectomy results in complex defects where preoperative planning is paramount to achieve best reconstructive outcomes. Although pectoralis major muscle flap (PMF) is the workhorse for sternal soft tissue coverage, additional flaps can be required. Our purpose is to evaluate defects in which other flaps beside PMF were required to achieve optimal reconstruction.

Methods:
A retrospective review of consecutive patients at our institution who underwent reconstruction after sternal tumor resection was performed. Demographics, surgical characteristics, and outcomes were evaluated. Further analysis was performed to identify defect characteristics where additional flaps to PMF were needed to complete reconstruction.

Results:
In 11 years, 60 consecutive patients were identified. Mean age was 58 (28–81) years old, with a mean follow-up of 40.6 (12–64) months. The majority were primary sternal tumors (67%) and the mean defect size was 148 cm2 (±81). Fourteen (23%) patients presented with postoperative complications, and the 30-day mortality rate was 1.6%. In 19 (32%) cases, additional flaps were required; the most common being the rectus abdominis muscle flaps. Larger thoracic defects (P = 0.011) and resections involving the inferior sternum (P = 0.021) or the skin (P = 0.011) were more likely to require additional flaps.

Conclusions:
Reconstruction of oncologic sternal defects requires a multidisciplinary team approach. Larger thoracic defects, particularly those that involve the skin and the inferior sternum, are more likely to require additional flaps for optimal reconstruction.
Clinical Characteristics and Outcomes of Ocular Cicatricial Pemphigoid: A Cohort Study and Literature Review
Authors: Fremont Félix , Pelissier-Suarez Cyrielle , Fournié Pierre , Porterie Marie , Thevenin Anaïs , Astudillo Léonardo , Paricaud Kim , Gualino Vincent , Soler Vincent , Pugnet Grégory 
Published: July 2019

Purpose:
Ocular cicatricial pemphigoid (OCP) is a rare systemic autoimmune disease and a potentially blinding subepithelial blistering disorder. The purpose of this study was to describe the clinical spectrum of the disease and to assess the efficacy and safety of immunosuppressive agents in a cohort of patients with OCP.

Methods:
We conducted a monocentric retrospective cross-sectional cohort study of all unselected consecutive patients diagnosed with progressive OCP. Ocular and extra ophthalmological involvement as well as histological findings were gathered. Other outcomes were exposures to immunosuppressive agents defined by the use of a particular treatment. For each exposure, success in controlling ocular inflammation was graded as a complete response, response, or failure. Relapses and adverse events (AE) were also recorded.

Results:
Seventeen patients (34 affected eyes), 35% of whom were women, were included, with an age at diagnosis of 75 ± 11 years. Corneal involvement was diagnosed in 30 of 34 eyes, and 22 of 34 eyes had progressive fibrosing conjunctival involvement. Sixty-two exposures to immunosuppressive agents or biologics were recorded: dapsone, n = 26; mycophenolate mofetil, n = 6; azathioprine, n = 4; cyclophosphamide, n = 10; rituximab, n = 14; and intravenous immunoglobulin, n = 2. Rates of response and of complete response achievement during the first 3 months were 84% and 45%, respectively. Response rates were 100%, 100%, 86%, 85%, and 80% for intravenous immunoglobulin, mycophenolate mofetil, rituximab, dapsone, and cyclophosphamide, respectively. Thirteen percent of those drugs were discontinued because of an adverse event in 4 patients.

Conclusions:
This study describes the efficacy of immunosuppressants or biologics with an acceptable safety profile for OCP.
Effect of the infusion rate of propofol on the onset time of rocuronium
Authors: Lin Chia-Shiang , Chen Chien-Chuan , Hsu Yung-Wei 
Published: July 2019

Background:
Administration of propofol, especially rapid administration, decreases patient cardiac output (CO) to various degrees. CO might influence the buildup of an effective drug level within the neuromuscular junction and affect the onset time of neuromuscular blockers. The present study aimed to investigate the effects of different infusion rates of propofol on patient CO and the onset time of rocuronium.

Methods:
A total of 90 patients were randomly assigned to receive propofol (2.5 mg/kg) at an infusion rate of 480 mg/min (group A), 240 mg/min (group B), or 120 mg/min (group C). After the administration of propofol, rocuronium (0.6 mg/kg) was administered to facilitate tracheal intubation. The Finometer monitor was used to obtain the cardiovascular profile during the induction of general anesthesia. Neuromuscular relaxation was monitored by acceleromyography using the ulnar nerve at the wrist surface and electrodes with repeated single twitches. Onset time was defined as the time from the beginning of rocuronium injection until 95% twitch depression. The onset time of rocuronium in the three groups was compared using analysis of variance with the post-hoc Tukey test. A p-value <0.05 was considered statistically significant.

Results:
After induction, a significant decrease in CO was observed in group A (21.6% ± 4.6%) when compared with the findings in group B (11.6% ± 4.5%) and group C (9.8% ± 4.6%). The onset time of rocuronium was significantly longer in group A (177.7 ± 17.6 seconds) than in group B (121.3 ± 18.3 seconds) and group C (118.3 ± 12.3 seconds).

Conclusion:
Rapid administration of propofol significantly delays the onset time of rocuronium by altering CO as measured with the Finometer monitor.
Outcomes of Primary Pediatric Stapedotomy
Authors: Page Joshua Cody , Gau Victoria L. , Allsopp Tristan , King DeAnne , Jervis-Bardy Joshua , Dornhoffer John L. 
Published: July 2019

Objective:
To review a single institution experience with pediatric stapedotomy for juvenile otosclerosis (JO), congenital stapes footplate fixation (CSFF), or tympanosclerosis.

Study Design:
Retrospective chart review.

Setting:
Tertiary referral center.

Patients:
Pediatric patients undergoing surgery for stapes fixation from 2001 to 2017.

Main Outcome Measures:
Hearing result based on preoperative, first postoperative, and final postoperative pure-tone average air-bone gap (PTA-ABG). Age, sex, diagnosis, procedure performed, prosthesis, and ossicular anomalies were considered.

Results:
A total of 59 children (4–16 years of age) underwent surgery for stapes fixation (67 ears), with an average postoperative audiogram out to 2.88 years. Final postoperative ABG for tympanosclerosis (30.4 dB ± 10.9 dB) showed some improvement but the outcome was significantly worse than in CSFF (21.0 dB ± 11.4 dB) (p = 0.020) and JO (22.8 dB ± 14.9 dB).

Conclusion:
Our data suggest, that in our clinic, surgery for stapes fixation is safe to perform in children. While we achieved desirable results for JO and CSFF, patients with tympanosclerosis showed a statistically worse hearing outcome. Tympanosclerosis deserves special consideration and may be better served with a malleovestibulopexy, total ossicular replacement prosthesis (TORP), or amplification in lieu of traditional stapes surgery.
Organoids for replacement therapy: expectations, limitations and reality
Authors: Xinaris Christodoulos 
Published: July 2019

Purpose of review
To discuss existing expectations from organoids and how they can affect biomedical research and society, and to analyse the current limitations and how they can potentially be overcome.

Recent findings
Recent success with engineering human organoids has created great enthusiasm and expectations, especially for their potential as tissue substitutes. The most feasible applications for organoid technologies at the moment are: drug testing, disease modelling and studying of human development.

Summary
Being able to engineer transplantable tissues in a dish would fundamentally change the way we conduct biomedical research and clinical practice, and impact important aspects of science and society – from animal experimentation to personalized medicine, bioethics, transplantation and gene therapy. However, whether organoids will soon be able to fulfil these expectations is still unclear, because of significant existing limitations. By answering a set of questions, here I will examine the expectations on the future of organoids and how they can affect the field and the society, I will analyse the most important limitations that still prevent the production of transplantable human tissues in a dish, and discuss possible solution strategies.
Clinical Characteristics of Mycoplasma genitalium and the Usefulness of Syndromic Management Among Women Living With Human Immunodeficiency Virus
Authors: Ong Jason J. , Magooa Mahlape Precious , Chikandiwa Admire , Kelly Helen , Didelot Marie-Noelle , Muller Etienne E. , Maseko Venessa , Segondy Michel , Delany-Moretlwe Sinead , Kularatne Ranmini , Mayaud Philippe 
Published: July 2019

Abstract
We report the clinical symptoms and examination findings of Mycoplasma genitalium (MG) in women living with human immunodeficiency virus in South Africa. If we relied on syndromic management alone to treat MG, only 15 of 46 MG-infected women would have received. appropriate treatment: sensitivity of 32.6% (95% confidence interval, 19.5–48.0) and specificity of 67.4% (95% confidence interval, 63.4–71.2).
Death Related to Elective Nasal Polypectomy
Authors: Čurović Ivana , Savić Slobodan , Bogdanović Milenko , Durmić Tijana 
Published: July 2019

Abstract
The investigation of deaths that are suspected to be related to medical therapy present several challenges for a forensic pathologist. We present a case of an otherwise healthy 58-year-old woman with multiple nasal polyps who underwent nasal polypectomy. The operation was initially considered successful. However, the patient had never recovered from general anesthesia and was declared deceased 24 hours after the surgery.
The autopsy revealed a basilar subarachnoid hemorrhage. The examination of the basilar skull showed a perforation of approximately 15 by 7 mm in the right cribriform plate. Above the bone perforation, there was a disruption of the dura and a 20-mm-long penetrating wound within the right frontal lobe parenchyma of the brain, with associated intraventricular hemorrhage. The subsequent sectioning of the formalin-fixed brain revealed extensive parenchymal destruction. The cause of death was certified as complications of nasal/sinus surgery, with a perforation of the skull base with hemorrhagic tissue destruction, whereas the manner of death was considered accidental.
Common nasal surgical procedures and known complications are discussed.
Differences in Opioid Prescribing Practices among Plastic Surgery Trainees in the United States and Canada
Authors: Grant David W. , Power Hollie A. , Vuong Linh N. , McInnes Colin W. , Santosa Katherine B. , Waljee Jennifer F. , Mackinnon Susan E. 
Published: July 2019

Background:
Overprescribing following surgery is a known contributor to the opioid epidemic, increasing the risk of opioid abuse and diversion. Trainees are the primary prescribers of these medications at academic institutions, and little is known about the factors that influence their prescribing. The authors hypothesized that differences in health care funding and delivery would lead to disparities in opioid prescribing. Therefore, the authors sought to compare the prescribing practices of plastic surgery trainees in the United States and Canada.

Methods:
A survey was administered to trainees at a sample of U.S. and Canadian institutions. The survey queried opioid-prescriber education, factors contributing to prescribing practices, and analgesic prescriptions written after eight procedures. Oral morphine equivalents were calculated for each procedure and compared between groups.

Results:
One hundred sixty-two trainees completed the survey, yielding a response rate of 32 percent. Opioid-prescriber education was received by 25 percent of U.S. and 53 percent of Canadian trainees (p < 0.0001). Preoperative counseling was performed routinely by only 11 percent of U.S. and 14 percent of Canadian trainees. U.S. trainees prescribed significantly more oral morphine equivalents than Canadians for seven of eight procedures (p < 0.05). Residency training in the United States and junior training level independently predicted higher oral morphine equivalents prescribed (p < 0.05).

Conclusions:
U.S. trainees prescribed significantly more opioids than their Canadian counterparts for seven of eight procedures surveyed. Many trainees are missing a valuable opportunity to provide opioid counseling to patients. Standardizing trainee education may represent an opportunity to reduce overprescribing.
Implant Surface Options and Biofilm Mitigation Strategies
Authors: Jewell Mark L. , Fickas Becky , Jewell Hillary , Jewell Mary Lind 
Published: July 2019

Summary:
Two important topics in breast augmentation and reconstruction relate to device surface texture and practices to mitigate biofilm contamination of implants. Breast augmentation can be considered a manufacturing process where planning concepts of process engineering and quality can be used to produce great outcomes. This article reviews the options available for surgeons with regards to device surface texture selection and practices to mitigate biofilm contamination of implants at the time of surgery.
Newer approaches in diagnosis of diarrhea in immunocompromised patients
Authors: Santoiemma Phillip P. , Ison Michael G. , Angarone Michael P. 
Published: July 2019

Purpose of review
This review will focus on the epidemiology and cause of diarrheal illness in solid organ transplant and stem-cell transplant population recipients with a specific focus on the role of advanced multiplex technology in the diagnosis of diarrhea within this patient population.

Recent findings
A wide range of infectious and noninfectious causes of diarrhea have been described in immunocompromised patients. The most common infections noted are Clostridioides difficile, norovirus, and cytomegalovirus, whereas immunosuppressive drugs and mucositis are the most common noninfectious causes of diarrhea. Historically, diagnostic evaluation has been limited to an array of single pathogen assays. Newer multiplex assays have become available that allow rapid, sensitive detection of a wide range of pathogens in a single assay. These assays have improved the number of patients with a diagnosed pathogen but may identify colonizing pathogens that are not pathogenic. Studies are needed to inform the discrimination and optimal use of these newer assays.

Summary
Diarrhea is a common complication in immunocompromised patients and is associated with greater morbidity and rare mortality. New diagnostics facilitate detection of recognized pathogens and may allow for improved outcomes through the use of pathogen-targeted therapy.
Using Lean Six Sigma to Reduce Patient Cycle Time in a Nonprofit Community Clinic
Authors: Kovach Jamison V. , Ingle Dhanashri 
Published: July 2019

Background and Objectives:
The mission of nonprofit health care clinics is particularly challenging to fulfill given the large number of uninsured and underinsured people they serve. In addition, these clinics feel pressure to provide services in an efficient manner to prevent patient no-shows and encourage the continuation of medical care. These challenges tend to increase further when clinics feel they have exhausted their internal resourcefulness relative to their effort to improve patient care. Without additional guidance, it can be difficult for organizations to achieve additional performance improvements. To address this problem, a case example is presented that demonstrates how one nonprofit health care clinic used the Lean Six Sigma methodology to help them further improve the efficiency of their clinic visit process.

Methods:
This research focused specifically on the use of process analysis tools/methods to map the clinic visit process, collect and analyze process performance data, analyze the process to identify and prioritize causes of waste, and develop and implement solutions.

Results:
The clinic's use of this structured improvement approach contributed to reducing patient cycle time by more than 20% and increasing patient visit capacity.

Conclusions:
This research provides a rich example from which other health care facilities can learn to enhance their process improvement capabilities.
Combination of National Quality Assurance Data Collection With a Standard Operating Procedure in Community-Acquired Pneumonia: A Win-Win Strategy?
Authors: Schulte Falko C. , Bewig Burkhard , Petzina Rainer , Graf Demian , Balke Lorenz , Wehkamp Ulrike , Jahnke Iris , Wehkamp Kai 
Published: July 2019

Purpose:
The primary contact for German physicians with national quality assurance in community-acquired pneumonia (CAP) is frequently experienced as time-consuming obligatory documentation. Since the regular feedback loop stretches up to 18 months, the immediate impact on quality is perceived as rather low. Ultimately, a method leading to increase in the quality of data collection, clarification on expected clinical treatment standards, and improvement in the acceptance and feedback mechanism is needed.

Methods:
We developed a form merging data collection for quality indicators with a standard operating procedure (SOP) in CAP and implemented it in the daily routine of a university's department for internal medicine. Fulfillment of quality indicators before and after the implementation of the new form was measured.

Results:
Critical parameters such as the documentation of breathing rate and clinical parameters at discharge strongly improved after implementation of the intervention. Uncritical parameters showed slight improvement or stable results at a high level.

Conclusion:
The combination of collection of quality data with a clinical SOP and context information may improve the impact of quality measures by increasing acceptance, quality of data capture, short-loop feedback, and possibly quality of care.
Metal Artifact Reduction in Routine Chest and Abdominal Examinations Using Virtual Monoenergetic Images From Spectral Detector Computed Tomography
Authors: Van Hedent Steven , Kessner Rivka , Große Hokamp Nils , Baran Tomer Ziv , Kosmas Christos , Gupta Amit 
Published: July 2019

Objective
The objective of this study was to investigate the quantitative and qualitative effects of virtual monoenergetic images (VMIs) by spectral detector computed tomography (SDCT) on metal artifacts in routine examinations.

Methods
Fifty-nine patients with metal artifacts (caused by pacemakers, ports, screws, or prosthetic joints) affecting muscular tissue in the chest and/or abdomen were scanned using SDCT. Attenuation values around the metallic device were compared with contralateral unaffected values, for conventional images and 80 to 200 keV VMIs. In addition, general image quality and artifact intensity were rated by 2 readers.

Results
The VMIs significantly decreased metal artifact intensity in all patients (P < 0.05). In 39 patients (66.1%), the attenuation values of the artifact and the unaffected area on the optimal keV level were very similar (≤5 Hounsfield unit difference). Qualitative analysis showed that high VMIs significantly improved artifact intensity, with best scores at 140 keV.

Conclusions
High monoenergetic images of SDCT significantly reduce metal artifacts, with optimal assessment at 140 keV.