bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparison of clinical outcomes between simultaneous integrated boost (SIB) versus sequential boost (SEQ) intensity modulated radiation therapy (IMRT) for head and neck cancer
Authors: Jiang Li , Zhang Yong , Yang Zhendong , Liang Feifei , Wu Jiangtao , Wang Rensheng 
Published: August 2019

Abstract

Background:
The optimal intensity modulated radiation therapy (IMRT) technique for head and neck cancer (HNC) has not been determined yet. The present study aimed to compare the clinical outcomes of the simultaneous integrated boost (SIB)-IMRT versus the sequential boost (SEQ)-IMRT in HNC.

Methods:
A meta-analysis of 7 studies involving a total of 1049 patients was carried out to compare the treatment outcomes together with severe acute adverse effects of the SIB-IMRT versus the SEQ-IMRT in HNC patients.

Results:
Comparison of the SIB-IMRT and SEQ-IMRT showed no significant difference in the measurement of overall survival (OS) (hazard ratio [HR] 0.94; 95% confidence inerval [CI], 0.70–1.27; P = .71), progression free survival (PFS) (HR 1.03; 95% CI, 0.82–1.30; P = .79), locoregional recurrence free survival (LRFS) (HR 0.98; 95% CI, 0.65–1.47; P = .91), and distance metastasis free survival (DMFS) (HR 0.87; 95% CI, 0.50–1.53; P = .63). Moreover, there were no significant differences in adverse effect occurrence between the SIB-IMRT and SEQ-IMRT groups.

Conclusion:
SIB-IMRT and SEQ-IMRT can provide comparable outcomes in the treatment of patients afflicted by HNC. Both IMRT techniques were found to carry a similar risk of severe acute adverse effect. SIB-IMRT may have advantages due to its convenience and short-course of treatment; however, the optimum fractionation and prescribed dose remained unclear. Furthermore, both IMRT techniques can be advocated as the technique of choice for HNC. Treatment plan should be individualized for patients.
Probiotics supplement for the prevention of eczema in children
Authors: Yang Wenhao , Tu Renyuan , Hu Yanan , He Tao , Zhang Weijian , Gu Li , Liu Hanmin 
Published: August 2019

Abstract

Background:
Atopic dermatitis (AD), also called eczema, is one of the most familiar chronic diseases in childhood. A possible pathological mechanism is immune dysfunction resulting in IgE sensitization to allergens. The recent studies demonstrated that the immune system can be affected by probiotics or prebiotics. However, the effectiveness and safety of probiotics or prebiotics on prevention of eczema are still unclear. To investigate this question, we conduct a systematic review and meta-analysis.

Methods:
The protocol followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Four main databases (PubMed, Embase, the Cochrane Library, and the web of science) will be searched dating until 15 July 2019 for randomized controlled trials investigating the effects and safety of probiotics or prebiotics on prevention of eczema in children with no language restrictions. In addition, a manual search of the references of relevant published studies will also be considered.
Studies selection, data extraction, and risk of bias assessment will be conducted by two independent reviewers. The primary outcome is the incidence of eczema. The second outcome is adverse events. The duration of intervention, the timing of intervention and intervention organism will be taken into consideration.

Results:
The results will provide useful information about the effect and safety of probiotics or prebiotics on reducing the incidence of eczema in children.

Conclusion:
The findings of this study will be published in a peer-reviewed journal.
PROSPERO registration number: CRD42019136528.
Surveillance of Opioid Prescribing as a Public Health Intervention: Washington State Bree Collaborative Opioid Metrics
Authors: Fulton-Kehoe Deborah , Von Korff Michael , Mai Jaymie , Weir Virginia , Lofy Kathryn H. , Sabel Jennifer , Tauben David , Franklin Gary 
Published: August 2019

Context:
To address risks associated with prescription opioid medications, guidelines recommend lower dose, shorter duration of use, and avoidance of concurrent sedatives. Monitoring opioid-prescribing practices is critical for assessing guideline impact, comparing populations, and targeting interventions to reduce risks.

Objective:
To describe development of Washington (WA) State opioid-prescribing metrics, provide purpose and definitions, and apply metrics to prescription data for WA health care organizations.

Design:
We describe the development and testing of opioid-prescribing metrics by the WA State Bree Collaborative opioid work group.

Setting:
Washington State.

Participants:
Kaiser Permanente of Washington (KPW) Integrated Group Practice, KPW-contracted care providers, and WA Medicaid.

Main Outcome Measures:
Set of 6 strategic metrics tested across 3 different health systems adopted by WA State in 2017 for uniform tracking of opioid-prescribing guidelines and state policies. These metrics include (1) overall prevalence of any opioid use, (2) chronic use, (3) high-dose chronic use, (4) concurrent chronic sedative use, (5) days' supply of new prescriptions, and (6) transition from acute to chronic use.

Results:
In the first quarter of 2010, 10% to 12% of KPW and 14% of Medicaid patients received at least 1 opioid prescription. Among opioid users, 22% to 24% of KPW and 36% of Medicaid patients received chronic opioids. Among patients receiving chronic opioids, 16% to 22% of KPW and 32% of Medicaid patients received high doses (≥90 morphine-equivalent dose per day) and 20% to 23% of KPW and 33% of Medicaid patients received concurrent chronic sedatives. Five percent of Medicaid and 2% to 3% of KPW patients receiving new opioid prescriptions transitioned to chronic opioid use.

Conclusions:
The metrics are relatively easy to calculate from electronic health care data and yield meaningful comparisons between populations or health plans. These metrics can be used to display trends over time and to evaluate the impact of opioid-prescribing policy interventions.
Comparative Study of Meshed and Nonmeshed Acellular Dermal Matrix in Immediate Breast Reconstruction
Authors: Maisel Lotan Adi , Ben Yehuda Dafna , Allweis Tanir M. , Scheflan Michael 
Published: August 2019

Background:
Acellular dermal matrices are commonly used to support implant-based breast reconstruction. Meshing may enhance integration, reduce drain time and seroma, and decrease surgical costs.

Methods:
This was a retrospective, single-center analysis of 83 adult women (115 breasts) undergoing one-stage (84.3 percent) or two-stage (15.7 percent) immediate breast reconstruction with bovine-derived acellular dermal matrix (SurgiMend) meshed at a 2:1 ratio. Outcomes were compared with previously published data from a control group of 111 patients (147 breasts) undergoing the same procedure with nonmeshed (fenestrated) acellular dermal matrix.

Results:
The mean age of patients receiving meshed acellular dermal matrix was 48.3 years and the mean body mass index was 23.6 kg/m2. There were no significant differences in baseline characteristics versus controls, other than chemotherapy history (received by fewer patients in the meshed acellular dermal matrix group). Mean follow-up was 23.6 months. Overall rates of minor and major complications in the meshed acellular dermal matrix group were 16.5 percent and 13.0 percent, respectively—similar to controls (25.2 percent and 12.9 percent). However, with meshed acellular dermal matrix, there were significantly fewer major seromas (0 percent versus 8.2 percent; OR, ∞; 95 percent CI, 1.927 to ∞), fewer total hematomas (0 percent versus 4.8 percent; OR, ∞; 95 percent CI, 1.022 to ∞), and fewer total infections (10.4 percent versus 23.8 percent; OR, 2.682; 95 percent CI, 1.259 to 5.802) compared with controls. Time to drain removal was reduced. Rates of capsular contracture (5.2 percent versus 2.7 percent) and explantation (5.2 percent versus 2.7 percent) were similar in the meshed acellular dermal matrix and control groups.

Conclusion:
Acellular dermal matrix meshing reduces rates of postoperative seroma, hematoma, and infection and decreases drain removal time compared with nonmeshed acellular dermal matrix.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Can a Partially Injured Donor Nerve Restore Elbow Flexion in an Acute Brachial Plexus Injury in Rats?
Authors: Chang Tommy Nai-Jen , Shafarenko Mark , Dadouch Rachel , Tang Evelyn Ting-Hsuan , Zhang Jennifer , Gordon Tessa , Borschel Gregory H. 
Published: August 2019

Background:
Loss of elbow flexion commonly occurs following acute brachial plexus injury. The double fascicular transfer is often used in acute C5-C6 and C5-C7 root injuries, but is rarely applied in cases involving concomitant C8 or T1 root injury. The authors designed a rat model using varying severities of lower trunk injury to determine whether partial injury to the lower trunk affects nerve transfers for elbow flexion.

Methods:
There were four different rat groups in which 0, 25, 75, or 100 percent of the donor lower trunk remained intact. One-fourth of the cross-sectional area of the ulnar nerve was then transferred to the musculocutaneous nerve immediately. The authors assessed outcomes using a grooming test, muscle mass, retrograde labeling of sensory/motor neurons that regenerated axons, and immunohistochemical stain of regenerated axons.

Results:
Five months after nerve transfer, rats that underwent partial injury of the lower trunk fared significantly worse than the rats in whom the donor lower trunk remained 100 percent intact, but significantly better than the rats with 0 percent intact lower trunk. Rats with 25 or 75 percent of the lower trunk intact recovered equivalent function, at both the donor and recipient sites.

Conclusions:
Although relatively weak compared with the 100 percent intact donor lower trunk group, the partially injured donor nerve was still functional; even though the nerve sustained a partial injury, the residual axons reinnervated the target muscles. The power of the muscles following either 25 percent or 75 percent injuries was equal after the recovery. Resorting to this approach may be useful in cases in which no alternatives are available.
Immediate Reconstruction of Oncologic Spinal Wounds Is Cost-Effective Compared with Conventional Primary Wound Closure
Authors: Mericli Alexander F. , Rhines Laurence , Bird Justin , Liu Jun , Selber Jesse C. 
Published: August 2019

Background:
Several studies have demonstrated a reduced wound complication rate when immediate soft-tissue reconstruction is performed after complex spine instrumentations in high-risk patients; however, the cost-effectiveness of this technique is not known. The authors hypothesized that immediate soft-tissue reconstruction of oncologic spine wounds would be a cost-effective strategy compared with the standard of care (i.e., oncologic spine surgery with conventional primary wound closure).

Methods:
The authors used a decision tree model to evaluate the cost-utility, from the perspective of a hospital/insurer, of immediate reconstruction relative to the standard of care after oncologic spine surgery. A systematic review of the literature on oncologic spine surgery and immediate and delayed spinal wound reconstruction was performed to estimate health state probabilities. Overall expected cost and quality-adjusted life-years were assessed using a Monte Carlo simulation and sensitivity analyses.

Results:
Immediate soft-tissue reconstruction after oncologic spine surgery had an expected cost of $81,458.90 and an expected average of 24.19 quality-adjusted life-years, whereas primary wound closure (no reconstruction) had an expected cost of $83,434.34 and an expected average of 24.17 quality-adjusted life-years, making immediate reconstruction the dominant, most cost-effective strategy. Monte Carlo sensitivity analysis demonstrated that immediate reconstruction was the preferred and most cost-effective option in the majority of simulations. Even when the willingness-to-pay threshold varied from $0 to $100,000 per quality-adjusted life-year, immediate reconstruction remained the dominant strategy across all iterations.

Conclusion:
This cost-utility analysis suggests that immediate soft-tissue reconstruction after oncologic spine surgery is more cost-effective than primary closure alone.
The Supercharged Pedicled Jejunal Flap for Total Esophageal Reconstruction: A Retrospective Review of 100 Cases
Authors: Mays Ashley C. , Yu Peirong , Hofstetter Wayne , Liu Jun , Xue Amy , Klebuc Michael , Chevray Pierre , Selber Jesse 
Published: August 2019

Background:
When gastric pull-up is unsuccessful or unsuitable for total esophageal reconstruction, a supercharged pedicled jejunum can be used to reestablish gastrointestinal continuity. The authors reviewed their technique and outcomes of the supercharged pedicled jejunum for total esophageal reconstruction.

Methods:
A retrospective review of a prospectively maintained database was performed of 100 patients who underwent supercharged pedicled jejunum for total esophageal reconstruction between 2000 and 2017 at the Texas Medical Center. Patient characteristics, technical details, and outcomes were analyzed.

Results:
Mean patient age was 59.5 ± 11.4 years. Forty-two patients (42 percent) had surgical complications (18 percent at the recipient site, 13 percent at the donor site, and 11 percent at both). Medical complications occurred in 28 patients (28 percent). A major surgical complication occurred in 20 patients (20 percent). The average length of stay was 15 days (range, 6 to 152 days). At last follow-up, 20 patients (20 percent) had metastatic disease and six (6 percent) had local recurrence. Fifty-four patients (54 percent) died during the follow-up period. Of 79 patients with follow-up longer than 6 months, 68 (86 percent) tolerated a solid or soft oral diet, with a 16 percent tube feed-dependence rate. Overall survival at 1, 3, and 5 years was 78.8, 53.7, and 33.1 percent, respectively. The median survival time was 38.7 months.

Conclusions:
The authors present their experience with 100 supercharged pedicled jejunums for total esophageal reconstruction. Functional outcomes are comparable to, or better than, other salvage modalities. With careful multidisciplinary planning and meticulous, well-orchestrated surgical technique, swallowing function can be restored to provide quality of life in patients with few remaining surgical options.
Statistical Process Control Charts for Monitoring Staphylococcus aureus Bloodstream Infections in Australian Health Care Facilities
Authors: Imam Nabeel , Spelman Tim , Johnson Sandra A. , Worth Leon J. 
Published: August 2019

Background:

Staphylococcus aureus bloodstream infection (SAB) in health care settings contributes significantly to mortality, and improved processes are associated with reduced burden of infection. In Australia, health care–associated SAB (HA-SAB) rates are reported as a health care performance indicator, but standardized methods for analyzing longitudinal data are not applied. Our objective was to evaluate the utility of statistical process control chart methodology for reporting HA-SAB and flagging higher than expected rates.

Methods:
A real-world test data set was defined as HA-SAB surveillance data collected by 155 Australian health care facilities between June 1, 2015, and June 30, 2017. This included 788 HA-SAB events, corresponding to an overall rate of 0.7 HA-SAB events per 10 000 occupied bed-days. The u-chart was selected as an appropriate tool, given the need for reporting natural units (HA-SAB rates) to a range of stakeholders. Facility-level data were plotted as u-charts, applying warning and control limits (2- and 3-SD thresholds, respectively).

Results:
Sixty-eight of the 155 participating facilities (43.9%) observed at least 1 HA-SAB event during the studied period. Using the traditional method of Poisson modeling, 56 of these 68 facilities demonstrated overdispersion with variance-to-mean ratio spanning 1.03 to 42.82. Modeling by negative binomial (NB) distribution was therefore applied to enhance functionality.

Conclusion:
The u-chart is an accessible method for monitoring HA-SAB, interpretable by a range of stakeholders. We demonstrate the benefit of NB modeling to account for overdispersion, providing an effective tool to avoid inappropriate flags while maintaining early detection of out-of-control systems throughout a wide range of health care settings.
The innovation of the final moult and the origin of insect metamorphosis
Authors: Belles Xavier 
Published: August 2019

The three modes of insect postembryonic development are ametaboly, hemimetaboly and holometaboly, the latter being considered the only significant metamorphosis mode. However, the emergence of hemimetaboly, with the genuine innovation of the final moult, represents the origin of insect metamorphosis and a necessary step in the evolution of holometaboly. Hemimetaboly derives from ametaboly and might have appeared as a consequence of wing emergence in Pterygota, in the early Devonian. In extant insects, the final moult is mainly achieved through the degeneration of the prothoracic gland (PG), after the formation of the winged and reproductively competent adult stage. Metamorphosis, including the formation of the mature wings and the degeneration of the PG, is regulated by the MEKRE93 pathway, through which juvenile hormone precludes the adult morphogenesis by repressing the expression of transcription factor E93, which triggers this change. The MEKRE93 pathway appears conserved in extant metamorphosing insects, which suggest that this pathway was operative in the Pterygota last common ancestor. We propose that the final moult, and the consequent hemimetabolan metamorphosis, is a monophyletic innovation and that the role of E93 as a promoter of wing formation and the degeneration of the PG was mechanistically crucial for their emergence.This article is part of the theme issue ‘The evolution of complete metamorphosis’.
Where did the pupa come from? The timing of juvenile hormone signalling supports homology between stages of hemimetabolous and holometabolous insects
Authors: Jindra Marek 
Published: August 2019

Insect metamorphosis boasts spectacular cases of postembryonic development when juveniles undergo massive morphogenesis before attaining the adult form and function; in moths or flies the larvae do not even remotely resemble their adult parents. A selective advantage of complete metamorphosis (holometaboly) is that within one species the two forms with different lifestyles can exploit diverse habitats. It was the environmental adaptation and specialization of larvae, primarily the delay and internalization of wing development, that eventually required an intermediate stage that we call a pupa. It is a long-held and parsimonious hypothesis that the holometabolous pupa evolved through modification of a final juvenile stage of an ancestor developing through incomplete metamorphosis (hemimetaboly). Alternative hypotheses see the pupa as an equivalent of all hemimetabolous moulting cycles (instars) collapsed into one, and consider any preceding holometabolous larval instars free-living embryos stalled in development. Discoveries on juvenile hormone signalling that controls metamorphosis grant new support to the former hypothesis deriving the pupa from a final pre-adult stage. The timing of expression of genes that repress and promote adult development downstream of hormonal signals supports homology between postembryonic stages of hemimetabolous and holometabolous insects.This article is part of the theme issue ‘The evolution of complete metamorphosis’.
Links between metamorphosis and symbiosis in holometabolous insects
Authors: Hammer Tobin J. , Moran Nancy A. 
Published: August 2019

Many animals depend on microbial symbionts to provide nutrition, defence or other services. Holometabolous insects, as well as other animals that undergo metamorphosis, face unique constraints on symbiont maintenance. Microbes present in larvae encounter a radical transformation of their habitat and may also need to withstand chemical and immunological challenges. Metamorphosis also provides an opportunity, in that symbiotic associations can be decoupled over development. For example, some holometabolous insects maintain the same symbiont as larvae and adults, but house it in different tissues; in other species, larvae and adults may harbour entirely different types or numbers of microbes, in accordance with shifts in host diet or habitat. Such flexibility may provide an advantage over hemimetabolous insects, in which selection on adult-stage microbial associations may be constrained by its negative effects on immature stages, and vice versa. Additionally, metamorphosis itself can be directly influenced by symbionts. Across disparate insect taxa, microbes protect hosts from pathogen infection, supply nutrients essential for rebuilding the adult body and provide cues regulating pupation. However, microbial associations remain completely unstudied for many families and even orders of Holometabola, and future research will undoubtedly reveal more links between metamorphosis and microbiota, two widespread features of animal life.This article is part of the theme issue ‘The evolution of complete metamorphosis’.
Regulatory mechanisms underlying the specification of the pupal-homologous stage in a hemimetabolous insect
Authors: Ishimaru Yoshiyasu , Tomonari Sayuri , Watanabe Takahito , Noji Sumihare , Mito Taro 
Published: August 2019

Juvenile hormones and the genetic interaction between the transcription factorsKrüppel homologue 1(Kr-h1) andBroad(Br) regulate the transformation of insects from immature to adult forms in both types of metamorphosis (holometaboly with a pupal stage versus hemimetaboly with no pupal stage); however, knowledge about the exact instar in which this occurs is limited. Using the hemimetabolous cricketGryllus bimaculatus(Gb), we demonstrate that a genetic interaction occurs amongGb′Kr-h1,Gb′Brand the adult-specifier transcription factorGb′E93from the sixth to final (eighth) nymphal instar.Gb′Kr-h1andGb′BrmRNAs were strongly expressed in the abdominal tissues of sixth instar nymphs, with precocious adult moults being induced byGb′Kr-h1orGb′Brknockdown in the sixth instar. The depletion ofGb′Kr-h1orGb′BrupregulatesGb′E93in the sixth instar. By contrast,Gb′E93knockdown at the sixth instar prevents nymphs transitioning to adults, instead producing supernumerary nymphs.Gb′E93also repressesGb′Kr-h1andGb′Brexpression in the penultimate nymphal instar, demonstrating its important role in adult differentiation. Our results suggest that the regulatory mechanisms underlying the pupal transition in holometabolous insects are evolutionarily conserved in hemimetabolousG.bimaculatus, with the penultimate and final nymphal periods being equivalent to the pupal stage.This article is part of the theme issue ‘The evolution of complete metamorphosis’.