bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reversible tactile hypoesthesia associated with myofascial trigger points: a pilot study on prevalence and clinical implications
Authors: Moriwaki Katsuyuki , Shiroyama Kazuhisa , Yasuda Masako , Uesugi Fumihiko 
Published: July 2019

Abstract

Introduction:
Tactile hypoesthesia observed in patients with myofascial pain syndrome (MPS) is sometimes reversible when pain is relieved by trigger point injections (TPIs). We aimed to investigate the prevalence of such reversible hypoesthesia during TPI therapy and topographical relations between areas of tactile hypoesthesia and myofascial trigger points (MTrP) in patients with MPS.

Methods:
Forty-six consecutive patients with MTrP were enrolled in this study. We closely observed changes in areas of tactile hypoesthesia in patients who had tactile hypoesthesia at the first visit, and throughout TPI therapy. Tactile stimulation was given using cotton swabs, and the areas of tactile hypoesthesia were delineated with an aqueous marker and recorded in photographs.

Results:
A reduction in the size of hypoesthetic area with TPI was observed in 27 (58.7%) patients. All the 27 patients experienced a reduction in pain intensity by more than 50% in a numerical rating scale score through TPI therapy. In 9 patients, the reduction in the sizes of hypoesthetic areas occurred 10 minutes after TPI. Complete disappearance of tactile hypoesthesia after TPI therapy was observed in 6 of the 27 patients. Myofascial trigger points were located in the muscles in the vicinity of ipsilateral cutaneous dermatomes to which the hypoesthetic areas belonged.

Conclusion:
Our results indicate a relatively high prevalence of reversible tactile hypoesthesia in patients with MPS. Mapping of tactile hypoesthetic areas seems clinically useful for detecting MTrP. In addition, treating MTrP with TPI may be important for distinguishing tactile hypoesthesia associated with MPS from that with neuropathic pain.
Timing of Microsurgical Reconstruction in Lower Extremity Trauma: An Update of the Godina Paradigm
Authors: Lee Z-Hye , Stranix John T. , Rifkin William J. , Daar David A. , Anzai Lavinia , Ceradini Daniel J. , Thanik Vishal , Saadeh Pierre B. , Levine Jamie P. 
Published: July 2019

Background:
Marko Godina, in his landmark paper in 1986, established the principle of early flap coverage for reconstruction of traumatic lower extremity injuries. The aim of this study was to determine how timing influences outcomes in lower extremity traumatic free flap reconstruction based on Godina’s original findings.

Methods:
A retrospective review identified 358 soft-tissue free flaps from 1979 to 2016 for below knee trauma performed within 1 year of injury. Patients were stratified based on timing of coverage: 3 days or less (early), 4 to 90 days (delayed), and more than 90 days (late). The delayed group was further divided into two groups: 4 to 9 days and 10 to 90 days. Flap outcomes were examined based on timing of reconstruction.

Results:
Flaps performed within 3 days after injury compared with between 4 to 90 days had decreased risk of major complications (OR, 0.40, p = 0.04). A receiver operating curve demonstrated day 10 to be the optimal day for predicting flap success. Flaps performed less than or equal to 3 days versus 4 to 9 days had no differences in any flap outcomes. In contrast, flaps performed within 4 to 9 days of injury compared to within 10 to 90 days were associated with significantly lower total flap failure rates (relative risk, 0.29, p = 0.025) and major complications (relative risk, 0.37, p = 0.002).

Conclusions:
Early free flap reconstruction performed within 3 days of injury had superior outcomes compared with the delayed (4 to 90 day) group, consistent with Godina’s original findings. However, as an update to his paradigm, this ideal early period of reconstruction can be safely extended to within 10 days of injury without an adverse effect on outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
The Impact of Cumulative Depression Along the HIV Care Continuum in Women Living With HIV During the Era of Universal Antiretroviral Treatment
Authors: Mills Jon C. , Pence Brian W. , Edmonds Andrew , Adedimeji Adebola , Schwartz Rebecca M. , Kassaye Seble , Cocohoba Jennifer , Cohen Mardge H. , Neigh Gretchen , Fischl Margaret A. , Kempf Mirjam-Colette , Adimora Adaora A. 
Published: July 2019

Background:
Data are limited on cumulative impacts of depression on engagement in care and HIV outcomes in women living with HIV (WLWH) during the era of universal antiretroviral therapy (ART). Understanding the relationship of accumulated depression with HIV disease management may help identify benefits of interventions to reduce severity and duration of depressive episodes.

Setting:
A cohort of WLWH (N = 1491) from the Women's Interagency HIV Study at 9 sites across the US.

Methods:
This longitudinal observational cohort study (2013–2017) followed WLWH for a maximum of 9 semiannual visits. Depression was quantified as a time-updated measure of percent of days depressed (PDD) created from repeated assessments using the Center for Epidemiologic Studies Depression scale. Marginal structural Poisson regression models were used to estimate the effects of PDD on the risks of missing an HIV care appointment, <95% ART adherence, and virological failure (≥200 copies/mL).

Results:
The risk of missing an HIV care appointment [risk ratio (RR) = 1.16, 95% confidence interval = 0.93 to 1.45; risk difference (RD) = 0.01, −0.01 to 0.03], being <95% ART adherent (RR = 1.27, 1.06–1.52; RD = 0.04, −0.01 to 0.07), and virological failure (RR = 1.09, 1.01–1.18; RD = 0.01, −0.01 to 0.03) increased monotonically with increasing PDD (comparing those with 25 to those with 0 PDD). The total effect of PDD on virological failure was fully (%100) mediated by being <95% ART adherent.

Conclusions:
Time spent depressed increases the risk of virological failure through ART adherence, even in the era of universal ART regimes forgiving of imperfect adherence.
Improved Liver Diffusion-Weighted Imaging at 3 T Using Respiratory Triggering in Combination With Simultaneous Multislice Acceleration
Authors: Tavakoli Andrej , Attenberger Ulrike I. , Budjan Johannes , Stemmer Alto , Nickel Dominik , Kannengiesser Stephan , Morelli John N. , Schoenberg Stefan O. , Riffel Philipp 
Published: July 2019

Objectives
The aim of this study was to retrospectively compare optimized respiratory-triggered diffusion-weighted imaging with simultaneous multislice acceleration (SMS-RT-DWI) of the liver with a standard free-breathing echo-planar DWI (s-DWI) protocol at 3 T with respect to the imaging artifacts inherent to DWI.

Materials and Methods
Fifty-two patients who underwent a magnetic resonance imaging study of the liver were included in this retrospective study. Examinations were performed on a 3 T whole-body magnetic resonance system (MAGNETOM Skyra; Siemens Healthcare, Erlangen, Germany). In all patients, both s-DWI and SMS-RT-DWI of the liver were obtained. Images were qualitatively evaluated by 2 independent radiologists with regard to overall image quality, liver edge sharpness, sequence-related artifacts, and overall scan preference. For quantitative evaluation, signal-to-noise ratio was measured from signal-to-noise ratio maps. The mean apparent diffusion coefficient (ADC) was measured in each liver quadrant. The Wilcoxon rank-sum test was used for analysis of the qualitative parameters and the paired Student t test for quantitative parameters.

Results
Overall image quality, liver edge sharpness, and sequence-related artifacts of SMS-RT-DWI received significantly better ratings compared with s-DWI (P < 0.05 for all). For 90.4% of the examinations, both readers overall preferred SMS-RT-DWI to s-DWI. Acquisition time for SMS-RT-DWI was 34% faster than s-DWI. Signal-to-noise ratio values were significantly higher for s-DWI at b50 but did not statistically differ at b800, and they were more homogenous for SMS-RT-DWI, with a significantly lower standard deviation at b50. Mean ADC values decreased from the left to right hepatic lobe as well as from cranial to caudal for s-DWI. With SMS-RT-DWI, mean ADC values were homogeneous throughout the liver.

Conclusions
Optimized, multislice, respiratory-triggered DWI of the liver at 3 T substantially improves image quality with a reduced scan acquisition time compared with s-DWI.
Acellular Dermal Matrix–sparing Direct-to-implant Prepectoral Breast Reconstruction
Authors: Viezel-Mathieu Alex , Alnaif Nayif , Aljerian Albaraa , Safran Tyler , Brabant Gordon , Boileau Jean-François , Dionisopoulos Tassos 
Published: July 2019

Introduction
Refined mastectomy techniques, the advent of new technologies and materials such as acellular dermal matrix (ADM), cohesive gel silicone implants, and intraoperative tissue perfusion analysis, have fueled a resurgence in prepectoral breast reconstruction. This article aims to compare an immediate direct-to-implant prepectoral ADM-sparing approach with the traditional subpectoral 2-stage immediate reconstruction. A cost analysis within a Canadian-run single-payer system is also presented.

Methods
A retrospective 2-group comparative chart review study was performed (June 2015–January 2017) to identify all patients who underwent prepectoral direct-to-implant breast reconstruction using an ADM-sparing technique. The comparison group consisted of patients having undergone traditional 2-stage subpectoral reconstruction with ADM. All countable variables were included in the cost analysis, which was performed in Canadian dollars.

Results
A total of 77 patients (116 reconstructed breasts) were included. Both the prepectoral and subpectoral groups were comparable in size, demographics including age, diabetic and smoking status, and receiving neoadjuvant chemotherapy and postmastectomy radiotherapy. Patients having undergone direct-to-implant prepectoral reconstruction benefited from fewer follow-up visits (3.8 vs 5.4, respectively) and from less complications (24.7% vs 35.6%, respectively) including animation deformity. In addition, direct-to-implant prepectoral reconstruction costs 25% less than the 2-stage subpectoral reconstruction when all associated costs were considered.

Conclusion
Prepectoral implant placement avoids many of the disadvantages of the traditional 2 stage subpectoral reconstruction, including pectoralis muscle dissection, animation deformity, and multiple surgeries. As the first comparative cost analysis study on the subject, our ADM-sparing direct-to-implant prepectoral reconstruction method costs 25% less than the traditional 2-stage subpectoral reconstruction with a comparable complication profile.
Extensive Microsurgical Reconstruction of Chest Wall Defects for Locally Advanced Breast Cancer
Authors: Song Dajiang , Liu Dequan , Pafitanis Georgios , Liu Zeyang , Wang Xi , Zhou Xiao , Liu Jieqiong , Li Zan 
Published: July 2019

Background
Despite improvements in the early detection of breast cancer, locally advanced breast cancer (LABC) involving the chest wall exists in developing countries. Surgical resection remains a controversial management option. This study aims to demonstrate the value of chest wall reconstructive techniques for large LABC defects and report long-term outcomes.

Materials and Methods
We report a 10-years single-unit experience in the reconstruction of large defects (>300 cm2). From 2007 to 2017, all LABC cases managed with large surgical resection with immediate microsurgical chest wall reconstruction were included in this study. Herein, we present the demographics, comorbidities, clinicopathological LABC characteristics, surgical techniques (free flap choice, recipient vessels), and outcomes (survival, complication, cosmesis, and patient satisfaction).

Results
Of the 104 LABC cases, free deep inferior epigastric artery perforator flap was performed in 41 (39.4%) cases, free anterolateral thigh flap in 5 (4.8%), free deep inferior epigastric artery perforator combined with pedicled transverse rectus abdominis myocutaneous (TRAM) flap in 23 (22.1%), free muscle-sparing transverse rectus abdominis muscle flap in 30 (28.9%), and free transverse upper gracilis flap in 5 (4.8%). Complications were low. Over a median follow-up of 49.5 months, the 3-year local recurrence rate and distant metastasis–free survival were 13.9% and 84.9%, respectively. In addition, the 3-year disease-free survival and overall survival were 84.2% and 92.0%, respectively. The rate of excellent and good ratings by the esthetic assessment panel was 83.0%, and the patient satisfaction rate was 90.0%.

Conclusion
Wide resection and microvascular free tissue transfer is oncologically safe in LABC with huge tumors and provides versatile solutions for the reconstruction of extensive chest wall defects. With favorable long-term survival and cosmetic outcomes, surgical resection of LABC combined with flap reconstruction may offer a practical approach in difficult and complicated cases.

Implications for Practice
In this retrospective review, it was demonstrated that wide resection followed by distinct chest wall reconstructive free flaps transfer is oncologically safe in LABC with huge tumors and provides useful solutions for the reconstruction of extensive chest wall defects.
Updates in opioid and nonopioid treatment for chronic breathlessness
Authors: Abdallah Sara J. , Jensen Dennis , Lewthwaite Hayley 
Published: July 2019

Purpose of review
Chronic breathlessness is a troublesome symptom experienced by people with advanced malignant and nonmalignant disease. Disease-directed therapies are often insufficient in the management of chronic breathlessness. Therefore, pharmacological and nonpharmacological breathlessness-specific interventions should be considered for select patients.

Recent findings
There is some evidence to support the use of low-dose opioids (≤30 mg morphine equivalents per day) for the relief of breathlessness in the short term. However, additional studies are needed to understand the efficacy of opioids for chronic breathlessness in the long term.
Nonopioid therapies, including inspiratory muscle training, fan-to-face therapy, l-menthol and inhaled nebulized furosemide show some promise for the relief of breathlessness in advanced disease. There is insufficient evidence to support the use of anxiolytics and benzodiazepines and cannabis for chronic breathlessness.

Summary
More research is needed to identify therapies for the management of chronic breathlessness.
Impact of a National Private Health Insurer’s Prior Authorization Policy on Utilization of Vaginal Hysterectomy
Authors: Swenson Carolyn W. , Kamdar Neil S. , Seiler Kristian , Morgan Daniel M. 
Published: July 2019

Objectives
On April 6, 2015, the largest private health insurer in the United States implemented a policy requiring prior authorization for all hysterectomies except those done as outpatient vaginal. The purpose of this policy was to increase utilization of vaginal hysterectomy; however, it is unknown whether this policy had its intended effect. We sought to analyze trends in hysterectomy routes before and after implementation of the prior authorization policy to see if utilization of vaginal hysterectomy increased.

Methods
This was a retrospective study using the Optum Clinformatics Data Mart national claims database of women enrolled in a single national private health insurer who underwent hysterectomy for any indication between January 1, 2010, and June 30, 2016. Per-quarter utilization of hysterectomy routes (abdominal, laparoscopic, vaginal, and laparoscopic-assisted vaginal) was compared between the prepolicy and postpolicy periods using interrupted time series analyses.

Results
Data for 305,139 hysterectomies were available—248,821 in the prepolicy period and 56,318 in the postperiod. Outpatient vaginal hysterectomy had the greatest increase in utilization of all routes and types; the average utilization per quarter in the prepolicy period was −0.61%, and this increased to 0.21% in the postpolicy period (P < 0.0001). Outpatient laparoscopic hysterectomy had the greatest decrease in utilization, with an average decrease of −1.50% per quarter.

Conclusions
The prior authorization policy was associated with a short-term increase in utilization of vaginal hysterectomy.
Weight Gain After Simultaneous Kidney and Pancreas Transplantation
Authors: Knight Richard J. , Islam Ana K , Pham Christine , Graviss Edward A. , Nguyen Duc T. , Moore Linda W. , Kagan Anna , Sadhu Archana R. , Podder Hemangshu , Gaber A. Osama 
Published: July 2019

Background.
Excessive weight (EW) gain is common after solid organ transplantation, but there is little information concerning obesity after pancreas transplantation. The study goal was to characterize EW gain after kidney-pancreas (KP) transplantation.

Methods.
This was a retrospective single-center review of 100 KP recipients transplanted between September 2007 and June 2015.

Results.
The median percent weight gain for all recipients at 1 year posttransplant was 10% (interquartile range, 2.7%–19.3%) of baseline weight. EW gain, defined as greater than or equal to a 19% 1-year increase in weight, included all recipients (n = 26) above the upper limit of interquartile range for weight gain at 1 year. In multivariate analysis, recipient age <40 years, the use of tacrolimus/mammalian target of rapamycin immunosuppression, and an acute rejection event were independent risk factors for EW gain. At a mean follow-up of 43±23 months, there was no difference in patient or graft survival between the EW and non-EW cohorts. Although mean hemoglobin A1c levels between groups were equivalent, the EW versus non-EW cohort displayed a significant increase in mean insulin levels and a trend towards higher C-peptide levels. Criteria for posttransplant metabolic syndrome was met in 34.6% of EW versus 17.6% of non-EW cohorts (P = 0.07).

Conclusions.
At intermediate-term follow-up, EW gain after KP transplantation was not associated with an increased risk of death or graft loss, although there was a trend toward a greater risk of posttransplant metabolic syndrome. There may be a metabolic consequence of successful pancreas transplantation that results in EW gain in a proportion of recipients, leading to an increased risk of long-term cardiovascular complications.
A Comparison of Electronic and Paper Versions of the Montreal Cognitive Assessment
Authors: Wallace Sarah E. , Donoso Brown Elena V. , Simpson Richard C. , D’Acunto Kristin , Kranjec Alexander , Rodgers Mackenzie , Agostino Caroline 
Published: July 2019

Objective:
The objective of this study was to investigate older adults’ performance on the paper and electronic Montreal Cognitive Assessment (eMoCA).

Design:
Repeated measures and correlational design.

Participants:
A convenience sample of 40 adults over 65 years of age living in the community.

Interventions:
Participants completed the eMoCA and paper Montreal Cognitive Assessment (MoCA) in a randomized order during 1 session. Participants reported their touchscreen experience and comfort and indicated their modality preferences.

Main Outcome Measures:
The primary outcome measures were paper MoCA and eMoCA total and subscale scores. Secondary outcome measures included participants’ reported touchscreen experience and comfort, as well as post-administration preferences.

Results:
A moderate statistically significant correlation was found between eMoCA and paper MoCA performance across all participants. Analysis comparing first administration modality only (eMoCA vs. paper MoCA) found no statistically significant difference in total scores; however, there was a statistically significant difference for the visuospatial/executive subscale, which required physical interaction with paper or the tablet. For this subscale, participants scored lower on the eMoCA versus paper MoCA. There was a statistically significant correlation between experience with touchscreen devices and performance on the eMoCA, but not between modality preference and performance.

Conclusion:
Modality of administration can affect performance on cognitive assessments. Clinicians should consider individuals’ level of touchscreen experience before selecting administration modality.
Imaging in amyotrophic lateral sclerosis: MRI and PET
Authors: Kassubek Jan , Pagani Marco 
Published: July 2019

Purpose of review
Neuroimaging with MRI and PET has become a well-established technical tool for amyotrophic lateral sclerosis (ALS). This review summarizes current developments in the advanced neuroimaging assessment of ALS and explores their potential in a clinical and neuroscientific setting.

Recent findings
With a focus on diffusion-weighted imaging, MRI-based neuroimaging has shown to provide reliable measures for monitoring disease progression and should be included in the clinical workup of ALS. There have been efforts to improve the clinical utility of fluorodesoxyglucose (FDG)-PET, and multivariate analysis has made advances in discriminating patients from controls and for prognostic assessment. Beyond FDG-PET, promising investigations have been carried out implementing novel radiotracers.

Summary
MRI and PET studies in ALS have consistently shown patterns of functional and structural changes considered to be the pathological signature of the disease. The constant advance of neuroimaging techniques encourages to investigate the cascade of ALS neurodegeneration and symptoms at finer and more specific level. Multicenter studies and the implementation of novel methodologies might confer a pivotal role to neuroimaging in the clinical setting in the near future, accelerating ALS diagnosis and allowing a prompt prognosis about disease progression.
Relationship Between Cauda Equina Conduction Time and Type of Neurogenic Intermittent Claudication due to Lumbar Spinal Stenosis
Authors: Nagao Yuji , Imajo Yasuaki , Funaba Masahiro , Suzuki Hidenori , Nishida Norihiro , Kanchiku Tsukasa , Sakai Takashi , Taguchi Toshihiko 
Published: July 2019

Introduction:
This study investigated whether the prolongation of the cauda equina conduction time (CECT) was related to the type of neurogenic intermittent claudication due to lumbar spinal stenosis.

Methods:
In total, 149 patients who underwent surgery due to lumbar spinal stenosis with neurogenic intermittent claudication were classified into three groups as follows: cauda equina-type(n = 67), radicular-type(n = 29), and mixed-type(n = 53). Cauda equina conduction time was measured by placing disc electrodes on the abductor hallucis muscle, electrically stimulating the tibial nerve of the ankle and recording the compound muscle action potentials and F-waves. Motor evoked potentials from the abductor hallucis muscle were measured after magnetically stimulating the lumbosacral spine. Cauda equina conduction time was calculated from the latencies of compound muscle action potentials, F-waves, and motor evoked potentials. The measurement of the dural sac cross-sectional area were assessed using computed tomography myelography or MRI.

Results:
The values of CECT were as follows: cauda equina-type, 5.6 ± 1.1 ms; mixed-type, 5.1 ± 0.9 ms; and radicular-type, 4.0 ± 0.9 ms. The values of dural sac cross-sectional area were as follows: cauda equina-type, 42.8 ± 18.7 mm2; mixed-type, 49.6 ± 20.9 mm2; and radicular-type, 75.3 ± 19.1 mm2. In the cauda equina-type and mixed-type patients, CECT was significantly prolonged and there were negative correlations between CECT and dural sac cross-sectional area.

Conclusions:
Cauda equina conduction time differed according to the type of lumbar spinal stenosis. The prolongation of CECT may be caused by the demyelination of the CE. Cauda equina conduction time may be a useful measure for evaluating the dysfunction of the CE rather than radiculopathy for patients with lumbar spinal stenosis.