bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Enteral Nutrition Reduces Mortality and Improves Other Key Outcomes in Patients With Major Burn Injury: A Meta-Analysis of Randomized Controlled Trials*
Authors: Pu Hong , Doig Gordon S. , Heighes Philippa T. , Allingstrup Matilde J. 
Published: October 2018

Objectives:
To identify, appraise, and synthesize current evidence to determine whether early enteral nutrition alters patient outcomes from major burn injury.

Data Sources:
Medline, Embase, and the China National Knowledge Infrastructure were searched. The close out date was May 1, 2018.

Study Selection:
Early enteral nutrition was defined as a standard formula commenced within 24 hours of injury or admission to ICU or burn unit. Comparators included any form of nutrition support “except” early enteral nutrition. Only randomized controlled trials reporting patient-centered outcomes were eligible for inclusion.

Data Extraction:
The primary outcome was mortality. Gastrointestinal hemorrhage, sepsis, pneumonia, renal failure, and hospital stay were evaluated as secondary outcomes.

Data Synthesis:
Nine-hundred fifty-eight full-text articles were retrieved and screened. Seven randomized controlled trials enrolling 527 participants with major burn injury were included. Compared with all other types of nutrition support, early enteral nutrition significantly reduced mortality (odds ratio, 0.36; 95% CI, 0.18–0.72; p = 0.003; I
2 = 0%). Early enteral nutrition also significantly reduced gastrointestinal hemorrhage (odds ratio, 0.21; 95% CI, 0.09–0.51; p = 0.0005; I
2 = 0%), sepsis (odds ratio, 0.23; 95% CI, 0.11–0.48; p < 0.0001; I
2 = 0%), pneumonia (odds ratio, 0.41; 95% CI, 0.21–0.81; p = 0.01; I
2 = 63%), renal failure (odds ratio, 0.27; 95% CI, 0.09–0.82; p = 0.02; I
2 = 32%), and duration of hospital stay (–15.31 d; 95% CI, –20.43 to –10.20; p < 0.00001; I
2 = 0%).

Conclusions:
The improvements in clinical outcomes demonstrated in this meta-analysis are consistent with the physiologic rationale cited to support clinical recommendations for early enteral nutrition made by major clinical practice guidelines: gut integrity is preserved leading to fewer gastrointestinal hemorrhages, less infectious complications, a reduction in consequent organ failures, and a reduction in the onset of sepsis. The cumulative benefit of these effects improves patient survival and reduces hospital length of stay.
Microablative fractional CO2 laser for the genitourinary syndrome of menopause: up to 12-month results
Authors: Athanasiou Stavros , Pitsouni Eleni , Grigoriadis Themos , Zacharakis Dimitris , Falagas Matthew E. , Salvatore Stefano , Protopapas Athanasios , Loutradis Dimitris 
Published: October 2018

Abstract

Objective:
The aim of this study is to assess the efficacy of microablative fractional CO2 laser therapy for genitourinary syndrome of menopause (GSM) management, when three, four, or five laser therapies were applied in a follow-up period of 12 months.

Methods:
Retrospective study evaluating GSM symptoms at baseline, and 1, 3, 6, and 12 months after last laser therapy. Visual analog scale, International Consultation on Incontinence Questionnaires- Female Urinary Tract Symptoms, International Consultation on Incontinence Questionnaires-Urinary Incontinence Short Form, Urogenital Distress Inventory-6, and Female Sexual Function Index were used for assessment of GSM symptoms’ intensity or bothering and parameters of sexual function.

Results:
Overall, 94 women were included (35, 35, and 24 received three, four, and five therapies, respectively). All GSM symptoms improved statistically significantly. Intensity of dyspareunia and dryness decreased from 9 (5-10) (median [minimum-maximum]) and 8 (0-10) at baseline to 0 (0-6) and 0 (0-8), 1 month after last laser therapy (all P < 0.001), respectively. FSFI and frequency of sexual intercourse increased from 10.8 (2-26.9) and 1 (0-8) at baseline to 27.8 (15.2-35.4) and 4 (2-8) 1 month after last laser therapy (all P < 0.001), respectively. The positive laser effect remained unchanged throughout the 12 months of follow-up. The same pattern was followed for symptom-free rates. Four or five laser therapies may be superior in lowering the intensity of GSM symptoms in comparison to three laser therapies, in short and long-term follow-up. Differences between four and five laser therapies were not found.

Conclusions:
Laser therapy may provide significant improvement and/or absence of GSM symptoms up to 12 months follow-up, irrespectively to the number of laser therapies applied. Symptoms intensity 1 month after last laser therapy may be indicative of GSM symptoms intensity at 12 months. One month after third laser therapy is the critical time to decide whether treatment extension should be offered.
Menopausal symptoms in different substages of perimenopause and their relationships with social support and resilience
Authors: Zhao Di , Liu Chunqin , Feng Xiujuan , Hou Fangyan , Xu Xiaofang , Li Ping 
Published: October 2018

Abstract

Objective:
This study is designed to measure the prevalence and severity of menopausal symptoms at different substages of perimenopause, as well as the relationships of these symptoms with social support and resilience in perimenopausal women.

Methods:
A convenience sample of 732 perimenopausal women was recruited from 3 communities of Jinan City, Shandong Province, China, between March 2015 and March 2017. The participants completed the Menopause Rating Scale, the 10-item Connor-Davidson Resilience Scale, the Perceived Social Support Scale, and a questionnaire regarding sociodemographic information.

Results:
Of all perimenopausal women surveyed, 76.4% reported menopausal symptoms. The prevalence and severity of menopausal symptoms differed significantly by different substages of perimenopause (all P < 0.001); the severity of menopausal symptoms was the least during the early menopausal transition substage and the most during the early postmenopausal substage. Multivariable-adjusted linear regression showed that family support (β = −0.169 to −0.240, P < 0.001) and resilience (β = −0.140 to −0.202, P < 0.001) were negatively associated with the total and subscale scores of the Menopause Rating Scale, and higher family support and resilience had fewer menopausal symptoms.

Conclusions:
The present findings suggest that menopausal symptoms vary across different substages of perimenopause. Furthermore, higher family support and resilience were significantly associated with fewer menopausal symptoms, which might be helpful for medical staff to identify these symptoms and seek appropriate preventive intervention.
Do Websites Provide What Applicants Need? Plastic Surgery Residency Program Websites Versus Applicant Self-reported Needs
Authors: Chen Vivi W. , Hoang Don , Garner Warren 
Published: October 2018

Background:
Plastic surgery residency program websites (PSRWs) remain a major resource for applicants to one of the most competitive specialties in medicine, yet it is unclear how the website content aligns with information applicants need.

Objective:
To evaluate PSRWs and whether they are meeting applicant needs.

Methods:
An anonymous online survey of 2016 plastic and reconstructive surgery applicants evaluated the use of PSRWs and information desired. Two researchers then independently analyzed all 93 PSRWs in the United States to determine whether the websites met the needs of applicants based on a quantitative scoring system.

Results:
Out of 369 total applicants to plastic surgery, the survey was sent to the 189 applicants to University of Southern California, and 87 responded (46% response rate). Ninety-eight percentage of respondents used websites during the application process. For 31%, websites served as the only source of information. Websites were moderately (60%) and only slightly useful (32%). For 22% and 34%, the quality of a website influenced their decision to apply or interview, respectively. Out of the 22 common components between the applicant survey and scoring assessment of websites, there was a significant difference in 17 components (77%) between those rated as “important” by applicants and availability of the corresponding component on websites (P < 0.05). Average (SD) score among websites was 18.7 (5.3) out of 49 maximum points (36.9%). Over 30% of websites displayed broken links or missing or outdated information. Only 19.6% displayed a link to provide website feedback.

Conclusions:
PSRWs commonly include pertinent information that is useful; however, most are lacking components valued by applicants. These findings can help guide the design, content, and improvement of PSRWs to be quality resources for applicants.
Pregnancy following Unilateral Immediate Breast Reconstruction with Titanized Polypropylene Mesh (TiLOOP(R) Bra) without Compromising the Result
Authors: Nolte Elke , Klein Evelyn , Paepke Stefan 
Published: October 2018

Summary:
Immediate breast reconstruction after mastectomy due to cancer or as a prophylactic treatment is widely preferred to avoid psychosocial distress, poor body image, and diminished sexual well-being. An increasing number of women undergoing breast reconstruction are in childbearing age; however, only limited data are available on the cosmetic outcome of patients undergoing implant-based breast reconstruction with a surgical mesh and subsequent pregnancy. This is a case report of a female patient who underwent unilateral implant-based breast reconstruction with a titanized surgical mesh implant (TiLOOP Bra). Twenty-two months after reconstruction, the woman delivered a healthy child. No adverse events occurred. The patient breastfed with the contralateral breast. The cosmetic result and patient-reported outcome was excellent. Pregnancy after breast reconstruction with a synthetic surgical mesh is not contradictory to an excellent cosmetic outcome.
Axillary Reconstruction with a Posterior Circumflex Humeral Artery Perforator Flap as a Salvage Surgery for Axillary Invasion of Advanced Breast Cancer
Authors: Otsuki Yuki , Nuri Takashi , Okada Masashi , Ueda Koichi , Fujioka Hiroya , Kimura Kosei , Iwamoto Mitsuhiko 
Published: October 2018

Summary:
A case of advanced breast carcinoma with large skin invasion that extended from the breast to the axilla and which was reconstructed with a meshed split skin graft for the chest defect and a posterior circumflex humeral artery perforator flap for the axillary area was described. When skin invasion of the breast cancer extends to the axillary area, reconstruction methods of the defect are probably complicated. The purpose of reconstruction is not only to close defects, but also to protect important tissues, such as axillary vessels and the brachial plexus. Moreover, thinner flaps are preferred to prevent a bulky contour. Many reconstruction methods can be used; however, if total mastectomy causes a large tissue defect from the breast to the axilla involving the subscapular artery, and only limited reconstruction is possible, a posterior circumflex humeral artery perforator flap can be an option to reconstruct the axilla.
Meta-analysis and Systematic Review of Skin Graft Donor-site Dressings with Future Guidelines
Authors: Serebrakian Arman T. , Pickrell Brent B. , Varon David E. , Mohamadi Amin , Grinstaff Mark W. , Rodriguez Edward K. , Nazarian Ara , Halvorson Eric G. , Sinha Indranil 
Published: October 2018

Background:
Many types of split-thickness skin graft (STSG) donor-site dressings are available with little consensus from the literature on the optimal dressing type. The purpose of this systematic review was to analyze the most recent outcomes regarding moist and nonmoist dressings for STSG donor sites.

Methods:
A comprehensive systematic review was conducted across PubMed/MEDLINE, EMBASE, and Cochrane Library databases to search for comparative studies evaluating different STSG donor-site dressings in adult subjects published between 2008 and 2017. The quality of randomized controlled trials was assessed using the Jadad scale. Data were collected on donor-site pain, rate of epithelialization, infection rate, cosmetic appearance, and cost. Meta-analysis was performed for reported pain scores.

Results:
A total of 41 articles were included comparing 44 dressings. Selected studies included analysis of donor-site pain (36 of 41 articles), rate of epithelialization (38 of 41), infection rate (25 of 41), cosmetic appearance (20 of 41), and cost (10 of 41). Meta-analysis revealed moist dressings result in lower pain (pooled effect size = 1.44). A majority of articles (73%) reported better reepithelialization rates with moist dressings.

Conclusion:
The literature on STSG donor-site dressings has not yet identified an ideal dressing. Although moist dressings provide superior outcomes with regard to pain control and wound healing, there continues to be a lack of standardization. The increasing commercial availability and marketing of novel dressings necessitates the development of standardized research protocols to design better comparison studies and assess true efficacy.
Skin Grafting on 3D Bioprinted Cartilage Constructs In Vivo
Authors: Apelgren Peter , Amoroso Matteo , Säljö Karin , Lindahl Anders , Brantsing Camilla , Stridh Orrhult Linnéa , Gatenholm Paul , Kölby Lars 
Published: October 2018

Background:
Three-dimensional (3D) bioprinting of cartilage is a promising new technique. To produce, for example, an auricle with good shape, the printed cartilage needs to be covered with skin that can grow on the surface of the construct. Our primary question was to analyze if an integrated 3D bioprinted cartilage structure is a tissue that can serve as a bed for a full-thickness skin graft.

Methods:
3D bioprinted constructs (10 × 10 × 1.2 mm) were printed using nanofibrillated cellulose/alginate bioink mixed with mesenchymal stem cells and adult chondrocytes and implanted subcutaneously in 21 nude mice.

Results:
After 45 days, a full-thickness skin allograft was transplanted onto the constructs and the grafted construct again enclosed subcutaneously. Group 1 was sacrificed on day 60, whereas group 2, instead, had their skin-bearing construct uncovered on day 60 and were sacrificed on day 75 and the explants were analyzed morphologically. The skin transplants integrated well with the 3D bioprinted constructs. A tight connection between the fibrous, vascularized capsule surrounding the 3D bioprinted constructs and the skin graft were observed. The skin grafts survived the uncovering and exposure to the environment.

Conclusions:
A 3D bioprinted cartilage that has been allowed to integrate in vivo is a sufficient base for a full-thickness skin graft. This finding accentuates the clinical potential of 3D bioprinting for reconstructive purposes.
Prepectoral Hammock and Direct-to-implant Breast Reconstruction in 10 Minutes: A Focus on Technique
Authors: Gunnarsson Gudjon L. , Thomsen Jorn Bo 
Published: October 2018

Background:
Breast animation deformity has sparked a reappraisal of the prepectoral implant placement in breast reconstruction. Our approach for direct-to-implant breast reconstruction (DIR) has evolved from a dual plane muscle/mesh coverage to a simple prepectoral hammock covering just the inferolateral part of the implant without the muscle. The aim of this study was to test the procedure in a prospective case series with emphasis on reconstructive outcome.

Methods:
Twenty-seven patients undergoing nipple- or skin-sparing mastectomy without subsequent radiation therapy requesting a primary implant-based reconstruction were included from May 2016 to April 2017. Median age was 46 years (25–67). We registered comorbidities, complications, and long-term results of successful or failed reconstruction.

Results:
Forty-seven DIR in 27 women, 20 bilateral, 7 unilateral. The median body mass index was 24 (17–31). The median time for mastectomy and DIR was 103 minutes (60–150). The inferolateral hammock consisted of Meso Biomatrix (34), Strattice (11), and Vicryl (2). The median implant size was 260 cc (140–345). Four complications (14%), 2 hematomas, 1 seroma, and 1 infection with partial nipple necrosis were all salvaged and reconstruction completed successfully. The median follow-up was 11 months (7–17).

Conclusion:
The prepectoral inferolateral hammock, a swift one-stage procedure with a quick recovery, creates promising results in the presence of an adequate skin flap. The simplicity of the method has made it the authors first choice for DIR.
Role of the von Willebrand factor and the VITRO score as predictors for variceal bleeding in patients with hepatitis C-related cirrhosis
Authors: Ibrahim Elsaed H. , Marzouk Salah A. , Zeid Ahmed E. , Lashen Sameh A. , Taher Tarek M. 
Published: October 2018

Background
Noninvasive methods have been established to detect clinically significant portal hypertension in liver cirrhosis with variable limitations. The von Willebrand factor (vEF) has been found to increase in liver cirrhosis.

Aim
The aim of this study was to explore the vEF and VITRO (von Willebrand factor antigen/platelet ratio) score in the prediction of variceal bleeding in patients with portal hypertension.

Materials and methods
Fifty patients with hepatitis C-related liver cirrhosis (25 patients with variceal bleeding and 25 without variceal bleeding) as well as 80 healthy controls were included. Laboratory investigations and upper gastrointestinal endoscopy were performed in all patients. Serum vEF was measured in the patient and the control group. The VITRO score was calculated.

Results
The mean levels of the vEF antigen and the VITRO score were higher in patients with variceal bleeding compared with patients without variceal bleeding and controls (P<0.001). At levels of at least 100.1 ng/ml and at least 0.732, the vEF and the VITRO score could predict variceal bleeding with a sensitivity and a specificity of 92 and 99.9% for the vEF and 80 and 68% for the VITRO score (area under the curve=0.982 and 0.843), respectively. Levels of vEF were correlated positively with esophageal varices grade.

Conclusion
Serum vEF level and the VITRO score are potential noninvasive biomarkers for the prediction and risk stratification of variceal bleeding in hepatitis C-related liver cirrhosis.
The clinical impact of glucose-6-phosphate dehydrogenase deficiency in patients with sickle cell disease
Authors: Karafin Matthew S. , Fu Xiaoyun , D’Alessandro Angelo , Thomas Tiffany , Hod Eldad A. , Zimring James C. , Field Joshua J. , Francis Richard O. 
Published: October 2018

Purpose of review
Glucose-6-phosphate dehydrogenase (G6PD) deficiency and sickle cell disease (SCD) cause hemolysis, often occurring in individuals of African descent. These disorders co-occur frequently, and possibly interact, altering clinical outcomes in SCD. However, epidemiological investigations of SCD with G6PD deficiency have produced variable results. This contribution reviews the available data about the interaction of G6PD deficiency and SCD.

Recent findings
Overall, G6PD deficiency contributes few, if any, effects to laboratory values and clinical outcomes in SCD patients, but may impact transfusion efficacy. This observation is most likely because of the relatively increased G6PD activity in the young red blood cell (RBC) population seen in SCD patients with or without G6PD deficiency. In addition, G6PD deficiency possibly interacts with other genetic modifiers, such as α thalassemia, hemoglobin F levels and SCD haplotype.

Summary
Although G6PD deficiency is relatively common, it does not appear to clinically impact patients with SCD. Nonetheless, it is important to evaluate G6PD status in patients with SCD to avoid the use of medications that may cause hemolysis. Future studies evaluating the clinical impact of transfusions from G6PD-deficient RBC donors would be of the greatest benefit to the current literature.
Chlamydia, Gonorrhea, and Human Immunodeficiency Virus Infection Among Transgender Women and Transgender Men Attending Clinics that Provide Sexually Transmitted Disease Services in Six US Cities: Results From the Sexually Transmitted Disease Surveillance Network
Authors: Pitasi Marc A. , Kerani Roxanne P. , Kohn Robert , Murphy Ryan D. , Pathela Preeti , Schumacher Christina M. , Tabidze Irina , Llata Eloisa 
Published: October 2018

Background
Transgender women and transgender men are disproportionately affected by human immunodeficiency virus (HIV) infection and may be vulnerable to other sexually transmitted diseases (STDs), but the lack of surveillance data inclusive of gender identity hinders prevention and intervention strategies.

Methods
We analyzed data from 506 transgender women (1045 total visits) and 120 transgender men (209 total visits) who attended 26 publicly funded clinics that provide STD services in 6 US cities during a 3.5-year observation period. We used clinical and laboratory data to examine the proportion of transgender women and transgender men who tested positive for urogenital and extragenital chlamydial or gonococcal infections and who self-reported or tested positive for HIV infection during the observation period.

Results
Of the transgender women tested, 13.1% tested positive for chlamydia and 12.6% tested positive for gonorrhea at 1 or more anatomic sites, and 14.2% were HIV-infected. Of transgender men tested, 7.7% and 10.5% tested positive for chlamydia and gonorrhea at 1 or more anatomic sites, and 8.3% were HIV-infected. Most transgender women (86.0% and 80.9%, respectively) and more than a quarter of transgender men (28.6% and 28.6%, respectively) with an extragenital chlamydial or gonococcal infection had a negative urogenital test at the same visit.

Conclusions
Publicly funded clinics providing STD services are likely an important source of STD care for transgender persons. More data are needed to understand the most effective screening approaches for urogenital, rectal, and pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae infections in transgender populations.
Delayed Death Due to Saddle Pulmonary Thromboembolus in Child With Nephrotic Syndrome Induced by Focal Segmental Glomerulosclerosis
Authors: Guenther Rory A. , Kemp Walter L. 
Published: October 2018

Abstract
While the characteristic features of nephrotic syndrome (ie, proteinuria, hypoalbuminemia, peripheral edema, and hyperlipidemia) are well known, the association of nephrotic syndrome and the risk of thromboembolic events is not as often appreciated and may be overlooked. This report describes a 10-year-old boy with focal segmental glomerulosclerosis who died following a saddle pulmonary thromboembolus, with near-complete occlusion of the left and right pulmonary arteries. The gross appearance of the thrombus suggested organization and histologic changes within the wall of the pulmonary artery indicated a period of at least 3 or more hours to a few days since the event occurred. Pulmonary thromboemboli in children are rare, and the number of cases in the medical literature discussing the occurrence of pulmonary thromboemboli in the background of renal disease in children is relatively small, and none apparently clearly describe saddle thromboemboli with a delay from time of occurrence until death. This case report serves as a good reminder for forensic pathologists to consider renal disease as an underlying etiology for pulmonary thromboembolus and how histologic features of the pulmonary artery may help determine a time frame for the event.