bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low-dose interleukin-2 therapy for the treatment of systemic lupus erythematosus
Authors: Humrich Jens Y. , Riemekasten Gabriela 
Published: December 2018

Purpose of review
To provide an overview behind the concept and recent advances of low-dose interleukin-2 (IL-2) therapy in systemic lupus erythematosus (SLE).

Recent findings
A disruption of regulatory T cell homeostasis caused by an acquired deficiency of IL-2 is a crucial event in the pathogenesis of SLE. Here, we highlight the key rationales for the clinical translation of low-dose IL-2 therapy in SLE and summarize the main findings from two independent, early phase uncontrolled clinical studies that investigated the immunological and clinical responses to low-dose IL-2 therapy in patients with active SLE. Important commonalities and differences between these studies with regard to study design and results are discussed.

Summary
Low-dose IL-2 therapy is capable to promote the selective expansion of a functionally competent regulatory T cell population in a well-tolerated way and may have the potential to influence the clinical course in patients with active SLE. Although a clearer proof for the clinical efficacy of low-dose IL-2 therapy in SLE is still outstanding, these early studies provide important rationales and the scientific basis for more comprehensive and placebo-controlled trials in the future.
The immune podocyte
Authors: Bhargava Rhea , Tsokos George C. 
Published: December 2018

Purpose of review
Lupus nephritis (LN) is a serious manifestation of systemic lupus erythematosus and is characterized by proteinuria and renal failure. Proteinuria is a marker of poor prognosis and is attributed to podocyte loss and dysfunction. It is often debated whether these cells are innocent bystanders or active participants in the pathogenesis of glomerulonephritis.

Recent findings
Podocytes share many elements of the innate and adaptive immune system. Specifically, they produce and express complement components and receptors which when dysregulated appear to contribute to podocyte damage and LN. In parallel, podocytes express major histocompatibility complex and co-stimulatory molecules which may be involved in local immune events. Podocyte-specific cytotoxic cells and possibly other immune cells contribute to glomerular damage. Autoantibodies present in lupus sera enter podocytes to upregulate calcium/calmodulin kinase which in turn compromises their structure and function.

Summary
More recent studies point to the restoration of podocyte function using cell targeted approaches to prevent and treat LN. These strategies along with podocyte involvement in the pathogenesis of LN will be addressed in this review.
Medial Plantar Artery Perforator Flap: Experience with Soft-tissue Coverage of Heel
Authors: Khan Fahad Hanif , Beg Mirza Shehab Afzal , Obaid-ur-Rahman  
Published: December 2018

Background:
Soft-tissue coverage is a challenge to the ankle and foot reconstructive surgeon due to its unique requirement of simultaneously withstanding body weight and to provide sensory feedback. We share our experience of medial plantar artery perforator (MPAP) flap, which provides a robust sensate coverage to heel defects.

Methods:
Three-year retrospective study, which included soft-tissue injury to heel. All patients underwent MPAP flap for the coverage of the defect. Patients' demographic, mode of injury, defect size, flap size and survival, time to start weight bearing, return of protective sensations, and comparative 2-point discrimination with opposite heel were studied.

Results:
We studied 16 cases with heel soft-tissue injuries. Fifteen had motor vehicle accident, and 1 had chronic diabetic wound. Mean surface area of flap was 4 × 5 cm. Except 1 flap, 15 flaps had complete survival and provided reliable wound coverage with comparable normal sensation as on other foot.

Conclusion:
We suggest that MPAP flap, when available, is a good local tissue for heel wounds coverage.
Versatility of the Extensor Digitorum Brevis Muscle Flap in Lower Limb Reconstruction
Authors: Abdelrahman Islam , Elmasry Moustafa , Steinvall Ingrid , Olofsson Pia , Nettelblad Hans , Zdolsek Johann 
Published: December 2018

Background:
Reconstruction of complex defects in the lower leg is a challenge. Although microvascular free tissue transfer is a popular technique, experience and available resources limit its use. Furthermore, free tissue transfer is not always required in the reconstruction of small lower leg defects, as many of them can be reconstructed with local alternatives such as an extensor digitorum brevis flap (EDB). Our aim was to describe our experience of the last 20 years with the EDB as a local muscle flap to cover small complex lower leg defects to establish its clinical feasibility and to document its associated complications.

Methods:
All adult patients who were operated with EDB flap reconstruction of the lower limb during 1997–2017 at the Department of Hand and Plastic Surgery, Linköping University Hospital, were included in this retrospective study.

Results:
Of 64 patients operated, only 7 had total flap failure, and the rate of complete success was 73% (47/64). Most of the skin defects were associated with fractures or complications thereof and were located in the ankle region, the dorsum of the foot, and the distal third of tibia or even the proximal tibia. Defects in the malleolar region and coexisting cardiovascular condition were factors associated with flap loss (either partial or total).

Conclusion:
The pedicled EDB-flap has, in our hands, proved to be a versatile and safe reconstructive option in the reconstruction of small defects in the lower leg and foot. Long-time follow-up is, however, recommended.
Malignant and Benign Phenotypes of Multimorbidity in Heart Failure
Authors: Chen Lei , Chan Yih-Kai , Busija Lucy , Norekval Tone M. , Riegel Barbara , Stewart Simon 
Published: December 2018

Background:
The impact of different patterns of multimorbidity in heart failure (HF) on health outcomes is unknown.

Objectives:
The aim of this study was to test the hypothesis that, independent of the extent of comorbidity, there are distinctive phenotypes of multimorbidity that convey an increased risk for premature mortality in patients hospitalized with HF.

Methods:
We analyzed the clinical profile and health outcomes of 787 patients hospitalized with HF participating in a multidisciplinary HF management program with a minimum 12-month follow-up. A Classification and Regression Tree model was applied to explore the distinctive combinations of 10 most prevalent concurrent conditions (other than coronary artery disease and hypertension) associated with 12-month all-cause mortality.

Results:
Mean (SD) age was 74 (12) years (59% men), and 65% had left ventricular systolic dysfunction. Most patients (88%) had 3 or more comorbid conditions, with a mean of 4.3 concurrent conditions in addition to HF. A total of 248 patients (32%) died (median, 663 [IQR, 492–910] days), including 142 deaths (18%) within 12 months. Patients with concurrent dysrhythmia, anemia, and respiratory disease experienced significantly higher 12-month all-cause mortality than those without these conditions (36.1% vs 3.6%, respectively; hazard ratio, 6.1 [95% confidence interval, 2.0–19.1]). Overall, this “malignant” phenotype of multimorbidity was associated with not only a markedly increased risk of all-cause mortality but also more unplanned readmissions, longer inpatient stays, and highest costs in the short (30-day) and longer terms when compared with more “benign” phenotypes of multimorbidity.

Conclusions:
We found a differential pattern of health outcomes according to pattern of comorbidity present in older patients hospitalized with HF and exposed to postdischarge, multidisciplinary management.
Risk factors for incidentally detected and symptomatic angiodysplasias: a case–control study with the general population as reference
Authors: Grooteman Katherina V. , Dalloyaux Shelley , van den Bemt Marjon C.P. , de Graaf Jacqueline , Verbeek André L.M. , Jackson Christian S. , van Geenen Erwin J.M. , Drenth Joost P.H. 
Published: December 2018

Background
There is no literature on risk factors for incidentally found angiodysplasias. In clinical practice, endoscopists may defer treatment owing to uncertainty about a causal role of any found angiodysplasia and overt or occult bleeding. The objective is to identify risk factors that distinguish incidental angiodysplasias from angiodysplasias that are the cause of symptomatic bleeding.

Participants and methods
A case–control study was conducted to compare angiodysplasia groups and a random sample from the general population. Patients with angiodysplasia were diagnosed between 2010 and 2015. Controls were from a 2005 population survey. Determinants were demographics, past medical history, lifestyle, medication and angiodysplasia characteristics. Multivariable logistic regression analyses were performed to identify independent risk factors.

Results
A total of 270 (59% men, mean age 65 years) patients with angiodysplasia and 5594 (46% men, mean age 58 years) controls were included in this study. Independent risk factors for incidental angiodysplasias are male sex [odds ratio (OR): 1.6; 95% confidence interval (CI): 1.02–2.6], thyroid dysfunction (OR: 4.1; 95% CI: 2.0–8.4), autoimmune disease (OR: 2.3; 95% CI: 1.2–4.1), chronic obstructive pulmonary disease (OR: 1.8; 95% CI: 1.0–3.2), and blood thinners (OR: 2.8; 95% CI: 1.6–4.8). Besides angiodysplasia characteristics, factors independently associated with symptomatic angiodysplasias are increased age (OR: 1.7/10 years age band; 95% CI: 1.3–2.5), valvular heart disease (OR: 10.4; 95% CI: 1.6–69.2), diabetes mellitus (OR: 2.6; 95% CI: 1.03–6.7) and hyperlipidemia (OR: 3.7; 95% CI: 1.1–12.1).

Conclusion
The risk factor profile for incidental angiodysplasias differs from symptomatic angiodysplasias and is more profound for the latter. This knowledge could help endoscopists in the decision-making process to treat an endoscopically detected angiodysplasia.
Breastfeeding Rates and Programs in Europe
Authors: Theurich Melissa A. , Davanzo Riccardo , Busck‐Rasmussen Marianne , Díaz‐Gómez N. Marta , Brennan Christine , Kylberg Elisabeth , Bærug Anne , McHugh Laura , Weikert Cornelia , Abraham Klaus , Koletzko Berthold 
Published: December 2018

ABSTRACTIntroduction:Among the world's regions, the WHO European Region has the lowest rates of exclusive breastfeeding at the age of 6 months with approximately 25%. Low rates and early cessation of breastfeeding have important adverse health consequences for women, infants, and young children. Protecting, promoting, and supporting breastfeeding are a public health priority.Objectives:National breastfeeding data and monitoring systems among selected European countries and the WHO European Region are compared. Mechanisms for the support, protection, and promotion of breastfeeding are reviewed and successes and challenges in implementation of national programs are presented.Methods:National representatives of national breastfeeding committees and initiatives in 11 European countries, including Belgium, Croatia, Denmark, Germany, Ireland, Italy, The Netherlands, Norway, Spain, Sweden, and Switzerland, participated in a standardized survey. Results are evaluated and compared in a narrative review.Results:Variation exists in Europe on breastfeeding rates; methodology for data collection; and mechanisms for support, protection, and promotion of breastfeeding. Directly after birth, between 56% and 98% of infants in all countries were reported to receive any human milk, and at 6 months 38% to 71% and 13% to 39% of infants to be breastfed or exclusively breastfed, respectively. National plans addressing breastfeeding promotion, protection, and support exist in 6 of the 11 countries.Conclusions:National governments should commit to evidence‐based breastfeeding monitoring and promotion activities, including financial and political support, to improve breastfeeding rates in the Europe. Renewed efforts for collaboration between countries in Europe, including a sustainable platform for information exchange, are needed.
Futile Recanalization With Poor Clinical Outcome Is Associated With Increased Edema Volume After Ischemic Stroke
Authors: Nawabi Jawed , Flottmann Fabian , Hanning Uta , Bechstein Matthias , Schön Gerhard , Kemmling Andre , Fiehler Jens , Broocks Gabriel 
Published: December 2018

Purpose
Futile recanalization with poor clinical outcome after endovascular treatment of acute ischemic stroke is poorly understood. Recently, vessel recanalization has been associated with reduced ischemic brain edema in patients with good clinical outcome. As edema volume (EV) may be quantified in computed tomography (CT), we hypothesized that higher EV after revascularization predicts futile recanalization with poor outcome.

Methods
In this observational study, 67 ischemic stroke patients with M1 middle cerebral artery occlusion fulfilled all inclusion criteria and were analyzed. All patients received successful endovascular recanalization (thrombolysis in cerebral infarction scale 2b/3) and subsequent follow-up CT 24 hours later. Edema volume within the infarct lesion was calculated in follow-up CT applying lesion water uptake quantification and was used to predict clinical outcome (Modified Rankin Scale [mRS] after 90 days) compared with infarct volume.

Results
The median EV after thrombectomy was 1.6 mL (interquartile range, 0.2–4.2 mL) in patients with mRS 0 to 4 and 8.6 mL (interquartile range, 2.0–49.8 mL) in patients with mRS 5 to 6 (P = 0.0008). In regression analysis, an EV increase of 1 mL was associated with an 8.0% increased likelihood of poor outcome (95% confidence interval, 2.8%–15.4%; P = 0.008). Based on univariate receiver operating characteristic curve analysis, absolute EV over 4.2 mL predicted poor outcome (mRS 5–6) with good discriminative power (area under curve, 0.74; 95% confidence interval, 0.62–0.84; specificity, 77%; sensitivity, 68%). In comparison, the area under curve for infarct volume was 0.68.

Conclusions
Elevated EV after endovascular thrombectomy was associated with poor clinical outcome and may indicate futile recanalization.
Focal Myositis of the Leg Presenting as Fever of Unknown Origin Detected by FDG PET/CT
Authors: Dong Aisheng , Bai Yushu , Wang Yang 
Published: December 2018

Abstract
Focal myositis is an uncommon inflammatory pseudotumor of the skeletal muscle that may mimic neoplastic and inflammatory diseases. We present one case of focal myositis involving the left proximal vastus lateralis and vastus intermedius, and left soleus showing intense FDG uptake on FDG PET/CT. This case indicates that focal myositis should be considered as a differential diagnosis in patients with focal hypermetabolic muscular lesions, including benign and malignant tumors, necrotizing autoimmune myopathy, nodular fasciitis, myositis ossificans, and muscular sarcoidosis.
Optimal Result of One-Stage Secondary Debulking Procedure After Flap Reconstruction of the Ankle
Authors: Jaramillo del Río Andrés Esteban , Hsieh Mu-han , Kuo Pao-Jen , Lin Tsan-Shiun 
Published: December 2018

Background
Skin and soft tissue defect of the ankle usually mandates flap reconstruction; however, bulky flap and difficulty ambulance have been the major disadvantages after flap reconstruction of this area. We used the concept of full-thickness skin graft as a 1-stage method of secondary debulking procedure to achieve both aesthetic and functional results.

Methods
Since January of 2004 to June of 2016, 22 one-stage secondary debulking procedures were performed on 22 patients who had received reconstruction with flaps for ankle defects. Nineteen cases were free myocutaneous flaps, 2 cases were free fasciocutaneous flaps, and 1 case was a distally based sural artery flap. In the operative technique, the full-thickness skin was harvested from the flap and regrafted on the defatted fascia with tie-over dressing. The functional and cosmetic outcomes as well as complications were reviewed.

Results
The overall mean follow-up time was 12 months. After the debulking procedure, all of the grafted skins took well. The patients were able to wear their own shoes without difficulty and regained ease of ambulation. The reconstructed area was found to decrease to an average of 28.92% as compared with predebulking area. The reconstructed ankles achieve good symmetry with regard to the contralateral side (P < 0.05). All of the patients were satisfied with the results of the reconstructed ankles.

Conclusions
The 1-stage secondary debulking procedure is a safe and reproducible technique that achieves good functional and aesthetic outcomes after flap reconstruction of the ankle.
The Medial Pillar Island Flap for Oncoplastic Breast Reconstruction of Upper Pole Defects
Authors: Akyurek Mustafa , Tomczyk Eleanor , Albert Mark , Quinlan Robert 
Published: December 2018

Background
Breast deformity is common following lumpectomy. Use of ptotic lower pole tissue for restoration of volume in the upper pole is quite appealing since it allows for a concomitant lift. This study presents the medial pillar island flap technique of oncoplastic breast reconstruction of upper pole defects.

Methods
Vascular anatomy of the lower pole of the breast was investigated with cadaver study. The medial pillar island flap was designed utilizing the territory of the inferior pole of the breast as an island flap pedicled medially by the internal mammary artery perforators surrounded by the soft tissue of the medial pillar. It was transposed to the upper pole lumpectomy defect as an independent flap from superomedial pedicle which was utilized for nipple transposition.

Results
The dominant internal mammary artery perforator supplying the medial pillar island flap was consistently found in the fourth interspace at a mean distance of 8.5 cm (range, 8 to 10) from the sternal midline. Thirty patients underwent the procedure, with a mean age of 61 years and mean body mass index of 28.9. The average size of the defect was 170 cm3 (range, 48 to 295 cm3). The majority of the patients (n = 28) underwent opposite breast symmetry surgery as well. The average follow up was 12 months. Complication rate was 23.3%. Reoperation rate was 16.7%. There was no evidence of flap compromise or nipple areola complex necrosis. Patient satisfaction was high, with a mean score of 4.1 (range, 2 to 5) out of 5.

Conclusions
The medial pillar island flap has reliable vascularity based on the internal mammary artery system. The flap carries lower pole breast tissue as confined by the medial and lateral pillars of a vertical mastopexy design, offering unrestricted arc of rotation for effective reconstruction of upper pole lumpectomy defects as it is completely dissected from the chest wall and the inframammary fold. The two flap design, along with superomedial pedicle, accomplishes versatility for flap inset. The technique was proven to result in safe outcomes without major complications.
Abnormal Presentation of Aggressive Fibromatosis After Radiotherapy for Keloids
Authors: Chen Yuan , Chen Yue , Liu Yong 
Published: December 2018

RationaleKeloids, dermal fibroproliferative lesions, often occur secondary to skin injury and extend beyond the margins of the original lesion. Aggressive fibromatosis (AF) is a rare condition arising from fibroblasts and is characterized clinically as a nonmetastasizing but locally invasive tumor. In this work, we present the case of a patient who developed AF in the chest 3 years after surgery and postoperative radiotherapy for keloids.Patient ConcernsA 15-year-old female patient who underwent surgery and postoperative radiotherapy for keloids presented with AF in the chest 3 years after intervention.Diagnoses and OutcomesPhysical examination revealed a fan-shaped scar on the manubrium sterni with a radius of 7 cm, as well as a 9 (L) × 2-cm (W) longitudinal reddish and irregularly surfaced scar arising from previous incisions. By comparing this case with similar cases reported previously, we infer that a history of exposure to radiation is the main factor that contributes to the development of AF in patients suffering from keloid scars. We also discussed the clinical characteristics of AF and treatment options and suggest factors that should be considered when using radiotherapy in patients with keloids.LessonsTo our knowledge, this is the first reported case of AF developing in a patient after radiotherapy for keloids. Radiotherapy may be a causal factor of AF.
Donor Site Morbidities of Iliac Crest Bone Graft in Craniofacial Surgery
Authors: Boehm Kaitlin S. , Al-Taha Mona , Morzycki Alexander , Samargandi Osama A. , Al-Youha Sarah , LeBlanc Martin R. 
Published: December 2018

Background
The iliac crest bone graft (ICBG) is criticized for high donor site morbidity. Recent research suggests this morbidity is related to the patient population for which the ICBG is harvested. This systematic review is the first to delineate the type and incidence of ICBG donor site complications in craniofacial surgery.

Methods
Two independent reviewers conducted a systematic review of multiple databases (MEDLINE, EMBASE, CINAHL, PEDRO, and Cochrane Central Register of Controlled Trials) from 1917 to 2017. All studies utilizing the ICBG for craniofacial indications were included. Donor site morbidities, including immediate and chronic pain, hematoma, seroma, infection, hypertrophic/painful scarring, nerve injury, muscle herniation, iliac crest fracture, and gait disturbance, were recorded. A weighted incidence for each morbidity, excluding immediate pain, was calculated. An average visual analog scale score was calculated for immediate pain.

Results
Forty-four studies, with 2801 patients, were included. Oral and maxillofacial (50%) and cleft reconstruction (40%) were the primary indications for surgery. Average immediate pain visual analog scale scores on postoperative days 1 and 14 were 6.3 and 1.3, respectively. The incidence of donor site morbidities was as follows: acute (45.7%) and chronic (1.5%) gait disturbance, acute (17.8%) and chronic nerve changes (1.4%), hypertrophic/painful scar (9.1%), chronic pain (3.1%), hematoma (2.2%), seroma (2.0%), infection (1.0%), iliac crest fracture (1.2%), and muscle herniation (0%).

Conclusions
Chronic morbidity was lower than previously documented. Rare chronic morbidity illustrates that the ICBG remains a viable surgical option. The authors hope this review will facilitate surgical planning and informed consent.
Surgical Technique for Nasal Cleft Repair
Authors: Chapchay Katya , Zaga Jonathan , Billig Allan , Adler Neta , Margulis Alexander 
Published: December 2018

Background
Congenital nasal cleft is a very rare yet challenging deformity to reconstruct. Atypical craniofacial clefts that involve the nasal ala are designated as number 1 and number 2 under the Tessier classification system. These clefts typically present as notches in the medial one-third of either nasal ala and may be accompanied by a malpositioned cartilaginous framework. Nasal clefts are smaller and far less common than familiar clefts of the lip and palate, but they pose equally challenging reconstructive planning.

Methods
Our described technique relies on usage of existing nasal tissue near the cleft. Local tissue rearrangement using a laterally based rotational alar flap, a medially based triangular flap, and a nasal wall advancement flap restores normal anatomy and provides an aesthetically pleasing result.

Results
Five children with isolated nasal cleft were treated by the senior author (A.M.) between 2010 and 2017. All patients presented with clefts of the soft tissue with no underlying cartilaginous involvement. There were no postoperative complications. Excellent aesthetic outcome was achieved in all patients.

Conclusion
Isolated nasal cleft can be properly corrected with the described procedure in a single stage and with optimal result.