bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dynamic Cortical Connectivity during General Anesthesia in Surgical Patients
Authors: Vlisides Phillip E. , Li Duan , Zierau Mackenzie , Lapointe Andrew P. , Ip Ka I. , McKinney Amy M. , Mashour George A. 
Published: April 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Functional connectivity across the cortex has been posited to be important for consciousness and anesthesia, but functional connectivity patterns during the course of surgery and general anesthesia are unknown. The authors tested the hypothesis that disrupted cortical connectivity patterns would correlate with surgical anesthesia.

Methods
Surgical patients (n = 53) were recruited for study participation. Whole-scalp (16-channel) wireless electroencephalographic data were prospectively collected throughout the perioperative period. Functional connectivity was assessed using weighted phase lag index. During anesthetic maintenance, the temporal dynamics of connectivity states were characterized via Markov chain analysis, and state transition probabilities were quantified.

Results
Compared to baseline (weighted phase lag index, 0.163, ± 0.091), alpha frontal–parietal connectivity was not significantly different across the remaining anesthetic and perioperative epochs, ranging from 0.100 (± 0.041) to 0.218 (± 0.136) (P > 0.05 for all time periods). In contrast, there were significant increases in alpha prefrontal–frontal connectivity (peak = 0.201 [0.154, 0.248]; P < 0.001), theta prefrontal–frontal connectivity (peak = 0.137 [0.091, 0.182]; P < 0.001), and theta frontal–parietal connectivity (peak = 0.128 [0.084, 0.173]; P < 0.001) during anesthetic maintenance. Additionally, shifts occurred between states of high prefrontal–frontal connectivity (alpha, beta) with suppressed frontal–parietal connectivity, and high frontal–parietal connectivity (alpha, theta) with reduced prefrontal–frontal connectivity. These shifts occurred in a nonrandom manner (P < 0.05 compared to random transitions), suggesting structured transitions of connectivity during general anesthesia.

Conclusions
Functional connectivity patterns dynamically shift during surgery and general anesthesia but do so in a structured way. Thus, a single measure of functional connectivity will likely not be a reliable correlate of surgical anesthesia.
Case Report of Anemia Following Fetal–Maternal Hemorrhage
Authors: Coe Kristi L. 
Published: April 2019

Background:
Any maternal history of blood loss, ABO or Rh incompatibility, and hydrops fetalis often leads to suspicion of neonatal anemia postnatally. When maternal history consists only of decreased fetal movement, recognition of neonatal anemia can be problematic.

Clinical Findings:
This case was a transported late preterm neonate who presented initially with persistent hypoxia unresponsive to usual respiratory support. On examination, mild paleness was noted.

Primary Diagnosis:
Anemia caused by fetal–maternal hemorrhage was the ultimate diagnosis confirmed by a Kleihauer-Betke test on maternal serum examining fetal cells.

Interventions:
Neonatal resuscitation included positive pressure ventilation, oxygen, and intubation. However, oxygenation did not improve prompting consultation with the neonatologist. Sedation and a paralytic were given. A chest radiograph ruled out pneumothoraces and pleural effusions as causative. Initiation of inhaled nitric oxide produced a mild response. Eventually, the transport nurse obtained a complete blood count indicating severe anemia, which prompted an emergent blood transfusion. The accepting neonatology team consulted with the obstetrician and a Kleihauer-Betke test was performed on mother's blood confirming a large fetal–maternal hemorrhage.

Outcomes:
This neonate responded well to blood transfusions, a pressor, and respiratory support and was discharged home at 7 days of life.

Practice Recommendations:
Recognition of postnatal anemia is vital to sustaining life and this can occur in the transport environment. When maternal history is nonspecific and a neonate is hypoxic, uncommon causes of hypoxia can be identified with consultation and a complete blood count.
Total Breast Reconstruction with Fat Grafting Combined with Internal Tissue Expansion
Authors: Kolasinski Jerzy 
Published: April 2019

Summary:
Breast reconstruction procedures are currently performed as standard practice and are an integral part of breast cancer treatment. The advantages and disadvantages of particular types of reconstruction are well known. Most of them require the woman to accept a different consistency of the reconstructed breast, as is the case with implants, or to have extra scarring in the donor site and a cutaneous island with a different texture in the recipient site, as is the case with TRAM, DIEP, and other flaps. This article presents the concept of breast reconstruction with fat grafting combined with internal tissue expansion. A 44-year-old woman after a right mastectomy for invasive carcinoma T1c, N0 (IIB) was presented. After unsatisfactory treatment with fat grafting supported by BRAVA system, she was qualified for breast reconstruction with fat grafting combined with tissue expansion. An anatomic 350 cm3 breast expander with an integrated port was implanted. It was filled with saline solution up to volume of 380 ml. Then, 7 fat grafting procedures combined with gradual emptying of the expander were performed. The 50/70 principle was used, that is, 50 ml of physiological saline was removed from the expander and 70 ml of fat was injected into the subcutaneous tissue over the expander. Finally, the expander was removed and a satisfactory volume and completely natural consistency of the breast was obtained. Breast reconstruction with fat grafting combined with tissue expansion is a promising method of total breast reconstruction after mastectomy.
Repeatability of Noninvasive Keratograph 5M Measurements Associated With Contact Lens Wear
Authors: García-Montero María , Rico-del-Viejo Laura , Lorente-Velázquez Amalia , Martínez-Alberquilla Irene , Hernández-Verdejo Jose Luis , Madrid-Costa David 
Published: April 2019

Objective:
To assess the intrarater repeatability of the measurements of tear meniscus height (TMH), noninvasive keratograph tear break-up time (NIKBUTs), and ocular redness measurements obtained with the Keratograph 5M (K5M) in a sample of soft silicone hydrogel contact lens (CL) wearers over 15 days.

Methods:
Prospective study over two consecutive weeks. Three measurements of TMH, NIKBUTs (NIKBUT first and NIKBUT average), and ocular redness were obtained in different sessions; the first day (baseline, at 8 hr of wear, and after lens removal) and the last day of wear—15th day (at 8 hr of wear and after lens removal). The repeatability of measurements were assessed by two intraclass correlation coefficient (ICC) forms; single measurement [ICC (2,1)] and multiple measurements (k=3) [ICC (2, k)].

Results:
Sixty-four eyes were analyzed. The repeatability of baseline TMH [ICC (2,1) greater than 0.90; coefficient of repeatability (CR)=0.06 mm] and after and during CL wear [ICC (2,k) greater than 0.90; CR≤0.07 mm] were excellent. The repeatability of baseline NIKBUT average [ICC (2,k)=0.89 (0.82–0.93); CR=6.07 sec] was maintained after CL removal but was poorer during CL wear. The repeatability of baseline NIKBUT first [ICC (2,k) =0.80 (0.69–0.87); CR=8.74 sec] was maintained after CL removal and during CL wear at moderate–good level.

Conclusions:
Intrarater repeatability of TMH, NIKBUTs, and ocular redness performed by K5M after CL wear remains stable when three measurements are performed. However, intrarater repeatability during CL wear decreased only for NIKBUT average and was not affected by time of use (15 days).
Zolpidem and Gender: Are Women Really At Risk?
Authors: Greenblatt David J. , Harmatz Jerold S. , Roth Thomas 
Published: April 2019

Abstract

Background
In 2013 the Food and Drug Administration (FDA) claimed the existence of new data showing women to be at risk for excessive daytime sedation and impaired driving proficiency following bedtime doses of zolpidem. The putative explanation was the reduced metabolic clearance of zolpidem and higher morning blood concentrations in women compared to men. The FDA acted to reduce the recommended dosage for women down to 50% of the dose for men. No other regulatory agency worldwide has taken similar action.

Methods
Gender effects on zolpidem pharmacokinetics, pharmacodynamics, adverse effects, clinical efficacy, and driving performance were evaluated through a further analysis of data from a previous study, together with a literature review.

Results
Women had on average 35% lower apparent clearance of zolpidem than men (236 vs 364 mL/min, P < 0.001). This difference was not explained by body weight. In some laboratory studies, women had greater functional impairment than men taking the same dose, but in all studies active drug was not distinguishable from placebo at 8 hours after oral dosage. On-the-road driving studies likewise showed no evidence of driving impairment in men or women at 8 hours after 10 mg of oral immediate-release zolpidem. No clinical trial demonstrated a gender-related difference in clinical efficacy or adverse reactions, and there was no evidence of a particular risk to women.

Conclusions
Dosage reduction in women is not supported by available scientific evidence, and may in fact lead to underdosing and the consequent hazard of inadequately treated insomnia.
Clinical application of high-resolution MRI in combination with digital subtraction angiography in the diagnosis of vertebrobasilar artery dissecting aneurysm
Authors: Zhang Meng , Ye Gengfan , Liu Yuandong , Wang Qian , Li Shuying , Wang Yunyan 
Published: April 2019

Abstract
Vertebrobasilar artery dissecting aneurysm (VBA-DA) is associated with serious complications and poor prognosis in patients. High-resolution magnetic resonance imaging (HR-MRI) is a noninvasive method for the diagnosis of VBA-DA.
VBA-DAs were classified according to the feature of HR-MRI in combination with digital subtraction angiography (DSA), and the clinical outcomes of different types of VBA-DAs were analyzed. Thirty-nine patients with 42 VBA-DAs were included and underwent HR-MRI, including three-dimensional T1 weighted image, three-dimensional T2 weighted image (3D-T2WI), three-dimensional time of flight MRA (3D-TOF-MRA), and three-dimensional fast imaging employing steady state acquisition (3D-FIESTA), and hematoma and flaps were compared. The follow-up was 3 to 25 months. The VBA-DAs were classified based on the images of HR-MRI and DSA, and the prognosis was analyzed.
VBA-DAs more frequently occurred on the vertebral artery, especially on the dominant vertebral artery. 3D-TOF-MRA showed high signal from hematoma, and 3D-FIESTA showed high signal from flaps. Based on HR-MRI images in combination with DSA, VBA-DAs were classified into 4 types: classical, stenosis, spiral, and hemorrhagic. The patients with the classical VBA-DAs had a higher improvement rate and a lower exacerbation rate. The patients with spiral and hemorrhagic VBA-DAs had poor clinical outcomes. The patients with stenosis VBA-DAs had poorer clinical outcomes than classical types and better clinical outcomes than spiral and hemorrhagic types.
The detection of intramural hematoma and dissection flap using HR-MRI provides basic information for the diagnosis of VBA-DA. Individualized therapeutic strategies can be designed for the treatment of VBA-DAs with different features of DSA and HR-MRI.
Crush versus Culotte stenting techniques for coronary bifurcation lesions
Authors: Chen En , Cai Wei , Chen Liang-long 
Published: April 2019

Abstract

Background:
In patients with complex true coronary bifurcation lesions (CBLs), Crush or Culotte stenting has been the commonest approaches of percutaneous coronary intervention (PCI). However, the optimal one remains in debate.

Methods:
A systematic review and meta-analysis of cohort studies searched from PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Chinese National Knowledge Infrastructure (CNKI), VIP information database, and WangFang Data Information Site, to compare the long-term safety and efficacy of PCI with Crush versus Culotte in patients with CBLs. The primary end point was target lesion revascularization (TLR) and secondary end points were a composite of major adverse cardiac events (MACE) including cardiac death (CD), myocardial infarction (MI), stent thrombosis (ST), and target vessel revascularization (TVR) by PCI or bypass surgery, and each individual component at long-term follow-up. Furthermore, omitting each study in turn was used to sensitivity analysis for high heterogeneity of studies.

Results:
A total of 7 studies were included to perform a meta-analysis, 3 randomized trials and 4 observational studies with 2211 patients, 1281 treated with Crush and 930 with Culotte. There was no significant difference in TLR and MACE between Crush and Culotte [RR 0.76, 95% CI (0.48–1.23), I2 = 57%; RR 0.78, 95% CI (0.47–1.29), I2 = 83%, respectively]. ST tended to be lower in patients treated with Crush [RR 0.61, 95% CI (0.37–1.01), I2 = 23%]. CD and MI were comparable between the 2 groups [RR 0.80, 95% CI (0.43–1.49), I2 = 0%; RR 0.74, 95% CI (0.49–1.13), I2 = 32%, respectively]. TVR was also associated with the similar risk [RR 0.76, 95% CI (0.49–1.16), I2 = 60%]. However, high heterogeneity was detected for TLR, MACE, and TVR, and the source of heterogeneity was DKCRUSH-III study by Chen, SL.

Conclusions:
In the treatment of coronary bifurcation lesions, TLR and MACE were not significant difference between the Crush and Culotte groups, but TLR and MACE were also regarded as high heterogeneity mainly due to better outcomes achieved by DK Crush and there was a trend toward lower ST in the Crush group. Crush, particularly DK Crush, may be superior to conventional Culotte for treatment of CBLs.

PROSPERO registration number:
CRD42018111868.
Magnetic resonance spectroscopy imaging in diagnosis of suspicious prostate cancer
Authors: Cai Weiguo , Zhu Dongyong , Byanju Sama , Chen Jie , Zhang Hanfei , Wang Yanfang , Liao Meiyan 
Published: April 2019

Abstract

Background:
This meta-analysis was conducted to assess the value of magnetic resonance spectroscopy imaging (MRSI) in the diagnosis of suspected prostate cancer (PC).

Methods:
We identified all the relevant papers from the EMBASE, PubMed, EBSCO, Web of Science, and Cochrane Library databases and screened the reference lists. The quality assessment of diagnostic accuracy studies-version 2 tool was used to assess the study quality. Publication bias was analyzed using Deeks’ funnel plot asymmetry test. We calculated the pooled sensitivities, specificities, positive likelihood ratios, negative likelihood ratios, diagnostic odds ratio (DOR), and 95% confidence intervals. The results were evaluated by summary receiver-operating characteristic curves (SROCs). Ultimately, a univariable meta-regression and subgroup analysis, Fagan plot, and likelihood matrix were used to analyze this review.

Results:
A total of 19 articles, which were based on patient-level analysis of PC, were included. These studies had a pooled sensitivity, specificity, DOR, and an area under the SROC of 0.86, 0.78, 22, and 0.89, respectively, by patient-level analysis. From the likelihood matrix, the summary negative likelihood ratio and positive likelihood ratio for MRSI diagnosis of PC were concentrated on the right lower quadrant, which neither confirmed nor excluded the diagnosis of cancer.

Conclusion:
MRSI has a relative application value in the diagnosis of cases of suspected PC. While MRSI is still required for diagnosis along with other clinical data and comprehensive analysis.
Prognostic impact of telomeric repeat-containing RNA expression on long-term oncologic outcomes in colorectal cancer
Authors: Bae Sung Uk , Park Won-Jin , Jeong Woon Kyung , Baek Seong Kyu , Lee Hye-Won , Lee Jae-Ho 
Published: April 2019

Abstract
Telomeres are transcribed into long, noncoding telomeric repeat-containing RNAs (TERRA) that have been implicated in the regulation of telomerase, the enzyme that lengthens telomeres, in heterochromatin formation at telomeres, and in telomere stability. This study aimed to evaluate the correlation between TERRA expression and long-term oncologic outcomes in colorectal cancer (CRC).
We evaluated 18p TERRA expression and telomere length using quantitative real-time PCR in 60 patients who underwent surgical resection for CRC between June 2008 and November 2010.
Patients were grouped according to 18p TERRA expression, with 29 (48.3%) and 31 (51.7%) patients in the low and high TERRA expression groups, respectively. The median follow-up period was 80 months (range 2–103). The 18p TERRA expression was marginally significantly associated with preoperative carcinoembryonic antigen (CEA; P = .082) and was significantly associated with telomere length (P < .05). Multivariate analysis revealed that preoperative CEA (hazard ratio [HR], 2.728; 95% confidence interval [CI], 0.832–8.944, P = .098) and 18p TERRA expression (HR, 0.113; 95% CI, 0.011–1.126, P = .071) were marginally significant independent prognostic factors for overall survival (OS), whereas preoperative CEA (HR, 4.254; 95% CI, 1.394–12.985, P = .011) and 18p TERRA expression (HR, 0.108; 95% CI, 0.011–1.037, P = .054) were significant independent prognostic factors for disease-free survival (DFS). According to our prognostic model with 2 prognostic factors, the OS and DFS rate increased to 76.2% and 80.63%, respectively, in patients with high 18p TERRA expression and CEA levels ≤5 (P = .178, P = .057, respectively).
18p TERRA expression was marginally significantly associated with preoperative CEA and significantly associated with telomere length, rendering it a potential prognostic factor for long-term oncologic outcomes in CRC.
Factors affecting bone age maturation during 3 years of growth hormone treatment in patients with idiopathic growth hormone deficiency and idiopathic short stature
Authors: Kang Min Jae , Kim Eun Young , Shim Young Suk , Jeong Hwal Rim , Lee Hye Jin , Yang Seung , Hwang Il Tae 
Published: April 2019

Abstract
To investigate the progression rate of bone age (BA) and associated factors during the first 3 years of growth hormone (GH) treatment in children with idiopathic GH deficiency (iGHD) and idiopathic short stature (ISS).
Data for prepubertal children with iGHD and ISS who were treated with recombinant human GH were obtained from the LG Growth Study Database and analyzed. Height, weight, BA, insulin-like growth factor-1 (IGF-1) level, and GH dose were recorded every 6 months. Differences between BA and chronological age (CA), BA-CA, were calculated at each measurement. This study included 92 (78 iGHD and 14 ISS) subjects.
After 3 years of GH treatment, the height z-score was −1.09 ± 0.71 (P < .001 compared to baseline), BA-CA was −1.21 ± 1.18 years (P < .001), and IGF-1 standard deviation score (SDS) was 0.43 ± 1.21 (P < .001) in the iGHD subjects; the change in BA over the 3 years was 3.68 ± 1.27 years. In the ISS subjects, the height z-score was −1.06 ± 0.59 (P < .001), BA-CA was −0.98 ± 1.23 years (P = .009), and IGF-1 SDS was 0.16 ± 0.76 (P = .648); the change in BA over the 3 years was 3.88 ± 1.36 years. The only significant factor associated with the BA progression was the BA-CA at 1 year of GH treatment (OR = 2.732, P = .001). The baseline BA-CA, IGF-1 SDS, and GH dose did not influence BA progression.
Prepubertal subjects with iGHD and ISS showed height improvement and mild BA acceleration over the first 3 years of GH treatment. However, because the BA progression rate was considered to be clinically acceptable, GH treatment may increase the predicted adult height during this period.
Relative tumor volume is a better independent prognostic factor in esophageal squamous cell carcinoma
Authors: Lv Jun , Gan Huimin , Zhang Wei , Pan Linjiang , Wang Rensheng , Qin Yutao 
Published: April 2019

Abstract
The present study is to evaluate the significance in prognosis of relative tumor volume (RTV) in patients with non-resectable esophageal squamous cell carcinoma (ESCC) treated by definitive radiotherapy alone or in combination with chemotherapy.
Fifty-eight consecutive patients with ESCC in UICC stage I to IV were retrospectively analyzed. Relative primary gross volume (RGTVp) was defined as primary gross volume (GTVp) divided by body volume. Relative primary gross volume for lymph nodes (RGTVnd) was defined as primary gross volume for lymph nodes (GTVnd) divided by body volume. The relationships were analyzed between overall survival (OS), disease free survival (DFS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and RGTVp (RGTVnd) in univariate and multivariate analyses.
The cut-off values of 0.947 and 0.007 were determined for RGTVp and RGTVnd, respectively. The 3-year OS, DFS, and LRFS for patients with RGTVp ≤ 0.947 vs RGTVp > 0.947 was 65.4% vs 25.0% (P = .001), 46.2% vs 12.5% (P = .002), and 90.1% vs 42.0% (P < .001). RGTVp was an independent risk factor for OS (P = .046), DFS (P = .015) and LRFS (P = .032), but showed no association with DMFS in univariate and multivariate analyses. The 3-year DFS and DMFS for patients with RGTVnd ≤ 0.007 vs RGTVnd > 0.007 was 44.4% vs 20.0% (P = .023), and 62.9% vs 24.6% (P < .004). RGTVnd was associated with DMFS (P = .012) in multivariate, but showed no associated with DFS.
The present study demonstrates that RTV was an independent factor relevant to prognosis for ESCC. It provides new clinical basis for personalized therapeutic regimens and might be included in the staging system.
Influenza A with hemorrhagic shock and encephalopathy syndrome in an adult
Authors: Fukuda Masafumi , Yoshida Tomohiro , Moroki Mariko , Hirayu Nobuhisa , Nabeta Masakazu , Nakamura Atsuo , Uzu Hideaki , Takasu Osamu 
Published: April 2019

Abstract

Introduction:
Hemorrhagic shock and encephalopathy syndrome (HSES) is a type of acute encephalopathy mainly seen in infants. It is a syndrome encompassing an onset of high fever, disturbance of consciousness, convulsion, and shock that rapidly progresses to watery diarrhea and liver and renal dysfunctions. It is extremely rare in adults, and the number of reports is limited worldwide. We report the case of an adult patient with HSES, which occurred after influenza A infection.

Patient concerns:
A 52-year-old man visited his family doctor 2 days after he noticed fever and was diagnosed with influenza A using an influenza rapid diagnosis kit; he underwent treatment on an outpatient basis. He was immediately hospitalized after developing fever, abdominal pain, malaise, and shock 16 hours after the commencement of the treatment. Abrupt acute brain swelling was noted 24 hours after hospitalization.

Diagnoses:
The antibody titer to influenza A (H3N2) was 1:40. Computed tomography obtained 24 hours after treatment initiation confirmed acute cerebral edema and cerebral herniation. Electroencephalogram at that time showed a flat line.

Interventions:
For the treatment of influenza A, laninamivir 150 mg was started immediately after the diagnosis by the family doctor, and 600 mg dose was given daily after hospitalization (or since 24 hours after the treatment initiation). For the management of shock, dobutamine 3 μg/kg/min and noradrenaline up to 0.2 μg/kg/min were used together with bolus infusion.

Outcomes:
The patient was declared brain dead on his 6th hospital day and he died on his 27th hospital day.

Conclusion:
Drastic courses such as that in our case with HSES can follow influenza infections even in adults.