bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting factors related with uncured hypertension after retroperitoneal laparoscopic adrenalectomy for unilateral primary aldosteronism
Authors: BiLiGe WuYun , Wang Chaoqi , Bao JiRiGaLa , Yu Dahai , Min A , Hong Zhi , Chen Xiangbao , Wang Min , Wang Dongmei 
Published: July 2019

Abstract
Although unilateral primary aldosteronism (PA) is the most common surgically correctable cause of hypertension, the cure rate varies widely. The predicting factors related to uncured hypertension are not completely established. This study was designed to determine predicting factors associated with resolution of hypertension after adrenalectomy for PA.
The records of unilateral PA patients who had undergone retroperitoneal laparoscopic adrenalectomy were retrospectively reviewed from January 2010 to December 2017 in a single center. Patient demographics and preoperative factors were analyzed, including age, sex, smoking history, family history of hypertension, the presence of diabetes, body mass index (BMI), systolic blood pressure, diastolic blood pressure, biochemical results and tumor characteristics. Univariate and multivariate Logistic regression analysis were used for statistical assessment.
126 patients with unilateral PA were enrolled, and the mean age at the time of surgery was 54.2 years. Of these patients, 74 (58.7%) were women, and the mean BMI and duration of hypertension were 26 kg/m2 and 61 months, respectively. Hypertension was cured in 46% patients, of the patients with uncured hypertension, 91% had improved control of hypertension. In univariate analysis, age (P = .03), BMI (P = .01), duration of hypertension >5 years (P = .03), preoperative antihypertensive agents>2 (P = .02), contralateral abnormalities (P = .03) were the main factors related to uncured hypertension after adrenalectomy. In multivariate regression analysis, uncured hypertension was independently associated with obesity (25.00–29.99: odds ratio [OR], 2.97, P < .02; ≥30: OR, 6.42, P < .01), duration of hypertension >5 years (OR, 6.25, P < .01), preoperative antihypertensive agents >2 (OR, 5.30, P < .001), and contralateral adrenal abnormalities (OR, 8.38, P < .01).
The hypertension cure rate of unilateral adrenalectomy in PA is not high. Obesity, duration of hypertension >5 years, preoperative antihypertensive agents >2 and contralateral adrenal abnormalities were independently associated with uncured hypertension.
Molecular cytogenetic characterization of a mosaic small supernumerary marker chromosome derived from chromosome Y in an azoospermic male
Authors: Zhang Hongguo , Liu Xiangyin , Geng Dongfeng , Yue Fagui , Jiang Yuting , Liu Ruizhi , Wang Ruixue 
Published: July 2019

Abstract

Rationale:
Small supernumerary marker chromosomes (sSMCs) can be usually discovered in the patients with mental retardation, infertile couples, and prenatal fetus. We aim to characterize the sSMC and explore the correlation between with sSMC and male infertility.

Patient concerns:
A 26-year-old Chinese male was referred for infertility consultation in our center after 1 year of regular unprotected coitus and no pregnancy.

Diagnosis:
Cytogenetic G-banding analysis initially described a mosaic karyotype 47,X,Yqh-,+mar[28]/46,X,Yqh-[22] for the proband, while his father showed a normal karyotype. The chromosome microarray (CMA) analysis showed there existed a duplication of Yp11.32q11.221, a deletion of Yq11.222q12, a duplication of 20p11.1 for the patient. Azoospermia factor (AZF) microdeletion analysis for the patient showed that he presented a de novo AZFb+c deletion. Fluorescence in situ hybridization further confirmed the sSMC was an sSMC(Y) with SRY signal, Y centromere, and Yq deletion.

Interventions:
The patient would choose artificial reproductive technology to get his offspring according to the genetic counseling.

Outcomes:
The sSMC in our patient was proved to be an sSMC(Y), derived from Yq deletion. The spermatogenesis failure of the proband might be due to the synthetic action of sSMC(Y) mosaicism and AZFb+c microdeletion.

Lessons:
It is nearly impossible to detect the chromosomal origin of sSMC through traditional banding techniques. The molecular cytogenetic characterization could be performed for identification of sSMC so that comprehensive genetic counseling would be offered.
Polyneuropathy in Critically Ill Mechanically Ventilated Children: Experience From a Tertiary Care Hospital in North India*
Authors: Shubham Shantanu , Dhochak Nitin , Singh Akanksha , Patel Sanjay Kumar , Chakrabarty Biswaroop , Sankar Jhuma , Gulati Sheffali , Kabra S. K. , Jaryal Ashok Kumar , Lodha Rakesh 
Published: July 2019

Objectives:
To determine the prevalence of critical illness polyneuropathy and its risk factors in critically ill children mechanically ventilated for 7 days or more.

Design:
Observational cohort study.

Setting:
PICU of a tertiary care hospital from North India.

Patients:
Children 1–15 years old admitted in PICU from June 2016 to September 2017, mechanically ventilated for 7 days or more, excluding those with diagnosed neuromuscular disease, stroke, or spinal pathology.

Intervention:
Demographic details, diagnosis, treatment details, and anthropometry at admission and enrolment were recorded. Nerve conduction studies were performed after enrolment and repeated a week later, if the child was still in PICU. Medical Research Council scoring for muscle strength was performed in survivors. Risk factors including Pediatric Index of Mortality-2 score, sepsis, multiple organ dysfunction, hypoalbuminemia, use of steroids, neuromuscular-blocking agents, and vasopressors were recorded. Samples for the level of micronutrients (copper, zinc, folate, and vitamin B12) were collected at the time of enrolling the child and at the time of discharge.

Measurements and Main Results:
Thirty-two children were enrolled, of whom 29 had features of critical illness polyneuropathy on evaluation at day 8 of mechanical ventilation (prevalence, 90.6% [95% CI, 80.5–100%]). The polyneuropathy was axonal in 26 (81.2%), mixed in one patient (3.1%), and uncharacterized in two (6.2%). Sepsis and multiple organ dysfunction were present in 31 subjects (96.9%). No risk factors for critical illness polyneuropathy could be identified although the study was not sufficiently powered to do so. The difference between serum micronutrient levels (copper, zinc, folate, and vitamin B12) between patients who developed polyneuropathy, and those who did not, was statistically insignificant.

Conclusions:
We observed a high prevalence of critical illness polyneuropathy in children in PICU, mechanically ventilated for 7 days or more; almost all of whom had underlying sepsis.
A Comparative Analysis of Telephone and In-Person Survey Administration for Public Health Surveillance in Rural American Indian Communities
Authors: English Kevin C. , Espinoza Judith , Pete Dornell , Tjemsland Amanda 
Published: July 2019

Objective:
Public health surveillance systems suffer from insufficient inclusion of American Indian/Alaska Native (AI/AN) populations. These health surveys have also gravitated to telephone administration because of the rising cost of face-to-face interviewing. Several studies have demonstrated that telephone surveys underrepresent people with low incomes, less educational attainment, and minorities. This study assessed the impact of administration mode upon survey participation in rural AI/AN tribes.

Design:
Using a modified Behavioral Risk Factor Surveillance System instrument, the Albuquerque Area Southwest Tribal Epidemiology Center partnered with 3 tribes to administer the survey to a target population of 900 AI/AN adults. Half of the sample was assigned to telephone survey administration and the other half was surveyed in-person by trained community interviewers. Significance testing was performed to assess differences in response rates, demographic characteristics, and costs by survey administration type.

Results:
Several notable differences between the survey administration modes were observed. In-person administration yielded a higher response rate (68.8%) than the telephone survey (35.7%). Likewise, in-person participants were, on average, younger and had lower household incomes and educational attainment than those who completed the survey via telephone. In-person survey administration was also slightly more cost-effective than telephone administration ($192 vs $211 per completed survey) due to the low response rate of telephone administration.

Conclusions:
The findings from this study have important implications for public health surveillance with rural AI/AN populations, where telephone survey administration is unlikely to yield sufficient coverage of this underserved population. This discovery is particularly disconcerting, given the fact that face-to-face interviewing has largely been replaced by telephone interviewing (and increasingly mobile phones) for public health surveillance in the United States. Without change and innovation, the AI/AN population will continue to lack meaningful health data, further challenging capacity to document and address persistent disparities and inequities witnessed among AI/ANs nationwide.
An Evaluation of Hepatitis C Virus Telehealth Services Serving Tribal Communities: Patterns of Usage, Evolving Needs, and Barriers
Authors: Stephens David , Leston Jessica , Terrault Norah A. , Gailloux Keri , Mera Jorge , Essex Whitney , Reilley Brigg 
Published: July 2019

Introduction:
American Indian/Alaska Native (AI/AN) populations are disproportionately affected by chronic hepatitis C virus (HCV) infection. Federal facilities of the Indian Health Service, in conjunction with Tribally operated and Urban Indian (I/T/U) health care facilities, serve an estimated 2.2 million AI/AN patients. The facilities are mainly rural and have few specialists. To fill the gap in specialists in I/T/U clinics, the Extension for Community Healthcare Outcomes (ECHO) telehealth model was used to support clinicians to treat HCV in primary care.

Methods:
Participants in 3 regional HCV ECHO networks serving AI/AN patients were surveyed by e-mail and text message to determine patterns of ECHO usage, usefulness, and barriers to treating patients with HCV at their primary care clinics.

Results:
From a total of 44 respondents from 72 eligible health care facilities, a majority (61%) stated that they started treating patients with HCV subsequent to participating in the telehealth program. Participants with more telehealth experience sought increasing complexity in patient case presentations. In California, 7 of 8 clinicians who had attended more than 10 ECHO sessions expressed diminishing need for ECHO sessions to manage cases (<25% of patients). All elements of the ECHO sessions (presenting patient cases, listening to patient case presentations, teaching sessions, and sharing of programmatic insights) were considered “extremely useful” by the majority of respondents. The factors most cited as moderate or extensive barriers to providing HCV care were access to HCV direct acting antivirals (60%) and linking patients to care (50%).

Discussion:
Extension for Community Healthcare Outcomes may play a key role not only in increasing clinical capacity for HCV treatment but also in the inception of HCV services in this sample of I/T/U facilities. Participants with more telehealth experience demonstrated signs of increasing clinical capacity, where they were more likely to seek complex patient case presentations in ECHO sessions. A number of barriers continue to keep AI/ANs from being cured and stop clinicians from ending the epidemic, including access to HCV medications, time to provide HCV clinical services, and linking patients to HCV services.
Supersonic Transporter Deformity in Transgender Men following Phalloplasty
Authors: Salgado Christopher J. , Fein Lydia A. , Williams Eva A. , Sood Rachita 
Published: July 2019

Summary:
Phalloplasty is often the final stage of gender-affirmation surgery for transgender men. Obtaining penile rigidity is important for sexual function, but may also bring complications, including supersonic transporter deformity, in which the glans becomes ventrally displaced and flaccid. Two cases of supersonic transporter deformity are presented here, one with a hydraulic penile implant and one with an autologous bone transplant. Attempt at surgical correction was performed in both. Careful attention must be paid to the unique anatomy of the neophallus and type of penile prosthesis to prevent or correct supersonic transporter deformity in transgender men.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Virtual Reality Improves the Patient Experience during Wide-Awake Local Anesthesia No Tourniquet Hand Surgery: A Single-Blind, Randomized, Prospective Study
Authors: Hoxhallari Ediana , Behr Ian J. , Bradshaw Jonathan S. , Morkos Michael S. , Haan Pam S. , Schaefer Maureen C. , Clarkson James H. W. 
Published: July 2019

Summary:
Wide-awake local anesthesia no tourniquet surgery has been shown to decrease cost and hospital length of stay. The authors studied the use of virtual reality during wide-awake local anesthesia no tourniquet outpatient upper extremity surgery to assess its effect on patient pain, anxiety and fun. Patients undergoing wide-awake local anesthesia no tourniquet surgery were randomized to use (virtual reality) or not use (non–virtual reality) virtual reality during their procedures. Pain, fun, and anxiety were measured with a Likert scale at several time points, as were blood pressure and heart rate. A postoperative questionnaire was used to assess overall satisfaction. Virtual reality patients exhibited lower anxiety scores during injection, during the procedure, and at the end of the procedure. There were no differences in blood pressure, heart rate, or pain scores. Compared with non–virtual reality patients, virtual reality patients’ fun scores were higher. Virtual reality patients felt the experience helped them to relax, and they would recommend virtual reality–assisted wide-awake local anesthesia no tourniquet surgery. Among patients with self-reported preexisting anxiety, virtual reality patients had lower pain and anxiety scores during injection of local anesthesia compared with non–virtual reality patients. This study demonstrates that readily available virtual reality hardware and software can provide a virtual reality experience that reduces patient anxiety both during the injection of local anesthesia and during the surgical procedure. (Plast. Reconstr. Surg. 144: 408, 2019.)

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Customized Three-Dimensional Printing Spacers for Bone Positioning in Orthognathic Surgery for Correction and Prevention of Facial Asymmetry
Authors: Dumrongwongsiri Sarayuth , Lin Hsiu-Hsia , Niu Lien-Shin , Lo Lun-Jou 
Published: July 2019

Summary:
Orthognathic surgery is a powerful tool for correction of facial asymmetry and malocclusion. The goal is to achieve good dental function and facial aesthetics. Three-dimensional simulation is used for surgical planning, and bone gaps could be created to achieve facial balance. In this study, customized “spacers” were made using computer-aided design and three-dimensional printing for guides for use during surgery. With the final three-dimensional plan, the skull images were exported to 3-Matic software, where spacers were designed according to the bone gaps. Three-dimensionally–printed spacers were made and used to facilitate positioning and fixation. Consecutive patients with facial asymmetry were recruited in this prospective study. The postoperative outcome was assessed using a visual analogue scale and the three-dimensional facial surface area discrepancy index for subjective and objective evaluation. There were 12 patients and a total of 19 spacers for the Le Fort I and mandibular ramus segments. The spacers worked nicely during the bone fixation process. Mean preoperative and postoperative visual analogue scale scores were 4.83 and 7.14, with a statistically significant improvement for facial symmetry (p = 0.018). Mean preoperative and postoperative facial surface area discrepancy index was 0.95 and 0.98, and the correction of asymmetry was significant (p = 0.009). There were no related surgical complications. All patients were satisfied with the correction of facial asymmetry and malocclusion. The custom-made, three-dimensionally–printed spacers help to achieve surgical precision to correct and prevent facial asymmetry in orthognathic surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Appreciation of Postpartum Changes of the Rectus Muscles in Primary and Repeated Abdominoplasty
Authors: Janes Lindsay E. , Fracol Megan E. , Dumanian Gregory A. 
Published: July 2019

Background:
Abdominoplasty is one of the top five most commonly performed cosmetic procedures. Whereas widening of the linea alba is a well-accepted consequence of pregnancy, the changes to the rectus abdominis muscles are less well known and thus unappreciated and undertreated.

Methods:
After institutional review board approval, the Northwestern Enterprise Data Warehouse identified nulliparous and multiparous women, aged 18 to 45 years, who underwent abdominal computed tomography between 2000 and the present. Measurements included the width and cross-sectional area of each rectus muscle, width of the linea alba, and circumference of the abdominal cavity at the level of the L3 vertebra. In addition, two case reports addressing these anatomical changes with muscle modification and mesh reinforcement are presented.

Results:
Sixty women were identified that met our inclusion criteria: 15 nulliparous, 15 after one pregnancy (para 1), 15 after two pregnancies (para 2), and 15 after three or more pregnancies (para ≥ 3). The linea alba was significantly widened after one pregnancy from 1.14 cm to 2.29 cm, but did not significantly widen further with each subsequent pregnancy. The width of each rectus muscle was significantly widened from 6.00 ± 0.60 cm in nulliparous to 6.61 ± 0.58 cm in para 1, significantly widened again to 7.03 ± 0.46 cm in para 2, but not significantly widened after that (6.97 ± 1.00 cm in para 3).

Conclusions:
In addition to widening of the linea alba, pregnancy alters the shape of the rectus abdominis muscle. Correction of muscle width during abdominoplasty may be a necessary adjunct to achieve the proper tension in both primary and revision procedures.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Innovations in the Plastic Surgery Care Pathway: Using Telemedicine for Clinical Efficiency and Patient Satisfaction
Authors: Funderburk Christopher D. , Batulis Nicole S. , Zelones Justin T. , Fisher Alec H. , Prock Kimberly L. , Markov Nickolay P. , Evans Alison E. , Nigriny John F. 
Published: July 2019

Background:
Telemedicine delivers clinical information and permits discussion between providers and patients at a distance. Postoperative visits may be a burden to patients—many of whom travel long distances and miss work opportunities. By implementing a telehealth opportunity, the authors sought to develop a process that optimizes efficiency and provides optimal patient satisfaction.

Methods:
Using quality improvement methods that have been highly effective in the business sector, we developed a testable workflow for patients in the postoperative telehealth setting. Seventy-two patients were enrolled and surveyed. A preoperative survey sought to determine travel distance, comfort with technology, access to the Internet and video-enabled devices, and the patient’s interest in telehealth. A postoperative survey focused on patient satisfaction with the experience.

Results:
Using the Lean Six Sigma methodology, the authors developed a telehealth workflow to optimize clinical efficiency. Preoperative surveys revealed that the majority (73 percent) of patients preferred in-person follow-up visits in the clinic. However, the postoperative survey distributed after the telehealth encounter found that nearly 100 percent of patients were satisfied with the telehealth experience. Ninety-six percent of patients said that their questions were answered, and 97 percent of patients stated that they would use telehealth again in the future.

Conclusions:
Telehealth encounters enable real-time clinical decision-making by providing patients and visiting nurses access to providers and decreasing patient transportation needs and wait times. Although initially hesitant to opt for a telehealth encounter in lieu of a traditional visit, the great majority of patients voiced satisfaction with the telehealth experience.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Emerging concepts in the diagnosis, treatment, and prevention of travelers’ diarrhea
Authors: Schweitzer Lorne , Singh Bhagteshwar , Rupali Priscilla , Libman Michael 
Published: July 2019

Purpose of review
Traveller's diarrhea, though not life-threatening. is often a vexing problem, which impacts overall function of the traveller while on holiday. Increasing data is available regarding molecular diagnostic techniques, which may help obtain an early etiologic diagnosis. Use of antibiotics for traveller's diarrhea is controversial in this era of multidrug resistance and microbiome disruption.

Recent findings
Travel to the tropics promotes gut colonization with drug-resistant bacteria and this risk increases after treatment with antibiotics, leading to potential ecological impacts in the country of residence.

Summary
Traveller's diarrhea is common and can impact a traveller's itinerary leading to significant inconvenience, and occasional longer term sequelae. Though bacterial causes predominate, recommended treatment is conservative in mild-to-moderate cases. Molecular techniques for early diagnosis of traveller's diarrhea may help with appropriate management. Treatment with antibiotics is sometimes required but is associated with gut colonization by multidrug-resistant bacteria.
Evidence of Prostate-Specific Membrane Antigen Expression in Hepatocellular Carcinoma Using 68Ga-PSMA PET/CT
Authors: Kuyumcu Serkan , Has-Simsek Duygu , Iliaz Raim , Sanli Yasemin , Buyukkaya Fikret , Akyuz Filiz , Turkmen Cuneyt 
Published: July 2019

Introduction
Prostate specific membrane antigen (PSMA) expression has been demonstrated in tumor neovasculature of many solid tumors, including hepatocellular carcinoma (HCC). The purpose of this study is to evaluate PSMA expression in patients with HCC.

Materials and Methods
Nineteen HCC patients who underwent 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) as part of restaging procedure also underwent 68Ga-PSMA PET. 18F-FDG PET and 68Ga-PSMA findings were compared visually as well as quantitatively using maximized standardized uptake values (SUVmax).

Results
FDG was positive in 15 patients while 16 patients demonstrated PSMA expression. The only extrahepatic finding was one metastatic lymph node detected by both tracers. Mean SUVmax of liver lesions on FDG PET/CT was 8.3 ± 2.3 and mean tumor to background ratio was 2.3 ± 1.5. Respective values for 68Ga-PSMA PET/CT were 17.4 ± 9 and 3.3 ± 2.2. On visual and quantitative evaluation uptake was higher with PSMA in nine patients and higher with FDG in four patients. PSMA and FDG activity were similar in three patients. One of the FDG positive patients was PSMA negative whereas two patients were PSMA positive but FDG negative. Heterogeneous uptake pattern was observed in three patients. Comparison of mean SUVmax and T/B values between PET studies revealed no statistically significant difference (P > 0.1). The mean survival was 25 months (range: 18–32 months) and SUVmax of PSMA (P = 0.05) and FDG (P = 0.012) showed medium strength of correlation with overall survival.

Conclusion
PSMA expression in advanced HCC can be demonstrated by 68Ga-PSMA PET but is not superior to FDG PET however it could be useful for identifying patients with limited therapeutic options.