bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors affecting labor duration in Chinese pregnant women
Authors: Chen Hongqin , Cao Liyuan , Cao Wen , Wang Hui , Zhu Cairong , Zhou Rong 
Published: December 2018

Abstract
The aim of the study was to explore the role of parity, maternal age, medical interventions, and birth weight with respect to labor duration and cervical dilation.
A total of 1601 pregnant women who had a singleton term gestation, spontaneous onset of labor, vertex presentation, vaginal delivery, and a normal perinatal outcome were reviewed. The retrospective study was conducted in patients from West China Second University Hospital of Sichuan University during June 2008 to June 2013.
There were 1367 nulliparous women and 234 multiparous women analyzed. The first stage (8.3 ± 3.8 vs 5.0 ± 2.6 hours), latent phase (5.1 ± 3.2 vs 3.5 ± 2.4 hours), active phase (3.2 ± 1.8 vs 1.5 ± 1.0 hours), second stage (44 ± 31 vs 18 ± 14 minutes), and total stage of labor (9.1 ± 3.9 vs 5.4 ± 2.6 hours) were all longer in nulliparous than in multipara women (all P < .05); but no significant difference in the third stage of labor (both 7 ± 4 minutes). In nulliparous women, the average time of first stage of labor increased by 58.257, 171.443, and 56.581 minutes due to artificial rupture of membranes, labor analgesia, and birth weight increased by 1 kg, respectively, but it decreased to 63.592 minutes by oxytocin usage, and the difference was significant. The average time of first stage of labor in nulliparous women aged from 26 to 30 years increased by 2.356 minutes compared to one in 20 to 26 years, but it increased by 1.802 minutes to the one in 30 to 39 years, compared to 20 to 26 years and the difference was not significant. The results were basically similar after multipara women were included.
Labor was significantly shorter in multiparous women than that in nulliparous women. Increased birth weight significantly increased in the length of the active phase and the second stage among nulliparous women. The increase of age, artificial rupture of membranes, labor analgesia, and the increase of birth weight tends to increase the time of first stage of labor and total labor duration, whereas oxytocin could shorten it.
1,25-dihydroxyvitamin-D3 promotes neutrophil apoptosis in periodontitis with type 2 diabetes mellitus patients via the p38/MAPK pathway
Authors: Tang Yaping , Liu Junyu , Yan Yanmei , Fang Hui , Guo Chengwei , Xie Ruidi , Liu Qi 
Published: December 2018

Abstract

Background
Abnormal neutrophils are involved in many chronic endocrine diseases, including type 2 diabetes mellitus (T2DM), and in periodontitis (PD), which is a chronic inflammatory disease in which neutrophils play a vital role. The p38 mitogen-activated protein kinase (MAPK) signaling pathway participates in the apoptosis of many inflammatory cells. Additionally, 1,25-dihydroxyvitamin-D3 (1,25VitD3) as a regulator can induce responses to infection and tumor cell apoptosis. However, the effect of 1,25VitD3 in the pathogenic relationship between T2DM and PD remains unclear. The aim of this study was to assess the effect of 1,25VitD3 on neutrophil apoptosis in patients with T2DM and PD and the p38-MAPK-relevant signaling pathway mechanism in this process in vitro.

Methods
Neutrophils were stained with Wright's stain, and apoptosis was detected by flow cytometry and Annexin V-fluorescein isothiocyanate (FITC)/propidium iodide (PI) staining. Apoptosis- and p38-related mRNAs and proteins were examined by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR), Western blotting and ELISA. The internal relationships were analyzed using a linear regression equation and Pearson's correlation coefficient.

Results
The highest rate of neutrophil apoptosis occurred in cultures treated with 10–8 mol/L 1,25VitD3 in the T2DM-PD group. The apoptosis rate in the T2DM-PD-p38 inhibitor group was higher than that in the healthy control group. Western blot, ELISA and qRT-PCR results showed that the mRNA and protein expression profiles of Caspase-3 and Bax were highly up-regulated and that Bcl-2 was down-regulated in the T2DM-PD-p38 inhibitor group. The expression levels of apoptotic mRNAs and proteins in the T2DM and T2DM-PD groups were significantly higher than those in the T2DM-p38 and T2DM-PD-p38 inhibitor groups. 1,25VitD3-induced neutrophil apoptosis and phosphorylated p38 (p-p38) expression were partially inhibited by the p38 inhibitor. Expression levels of apoptosis-related genes and p-p38 in neutrophils were positively associated with increasing concentrations of 1,25VitD3. p-p38 protein expression was positively associated with the level of serum 1,25VitD3.

Conclusion
1,25VitD3 could promote peripheral blood neutrophil apoptosis in patients with T2DM and PD through activation of the p38-MAPK signaling pathway in vitro.
Carpal tunnel syndrome caused by synovial osteochondromatosis of the finger flexor tendon
Authors: Kwon Dong Rak , Chae SeungBum , Moon Yong Suk , Woo In Ho 
Published: December 2018

Abstract

Rationale:
Carpal tunnel syndrome (CTS) is the most common peripheral nerve neuropathy resulting from compression of the median nerve as it traverses the carpal tunnel. The pathophysiology of this condition is multifactorial, and majority of cases of CTS are idiopathic. We report cases of CTS caused by synovial osteochondromatosis (SOC), which has rarely been reported.

Patient concerns:
A 45-year-old female was admitted to the clinic due to right hand tingling sensation for 4 months. On physical examination, the patient's symptoms and signs corresponded to the median nerve entrapment at wrist. However, there is mild swelling and tenderness around the second metacarpal bone. Pain was aggravated during wrist and finger flexion.

Diagnoses:
An electrodiagnostic study revealed CTS. She was advised to begin splinting the hand using a wrist brace and to undergo physiotherapy. After 2 weeks, the tingling sensation decreased slightly. However mild swelling and tenderness around the second metacarpal bone did not improve. Ultrasonography showed multiple echogenic foci. Magnetic resonance imaging (MRI) revealed a nodule at the proximal metacarpal level with synovial thickening, enhancement, and a calcified shadow close to the flexor tendon. After confirming the presence of an osseous nodule with synovial thickening, the patient underwent surgery

Interventions:
Carpal tunnel release and mass excision with synovectomy of the adjacent structures were performed. Histologically, the lesion was compatible with a diagnosis of SOC.

Outcome:
The symptoms have improved.

Lessons:
CTS due to SOC on finger flexor tendon is rare but should be considered for possible etiology. Appropriate clinical examination, plain radiography, ultrasonography, and MRI will help physicians to diagnose this condition. In this paper, we report the successful diagnosis and treatment of CTS caused by SOC within the finger flexor tendon.
Acetyl-l-Carnitine to Enhance Nerve Regeneration in Carpal Tunnel Syndrome: A Double-Blind, Randomized, Controlled Trial
Authors: Curran Matthew W. T. , Morhart Michael J. , Olson Jaret L. , Hachisuka Akiko , Chan K. Ming 
Published: December 2018

Background:
Carpal tunnel syndrome is very common. Although surgery is effective in mild and moderate cases, recovery is often incomplete in severe cases. Therefore, adjuvant therapy to improve nerve regeneration in those patients is much needed. Acetyl-l-carnitine has been shown to be effective in other neuropathies. The goal of this study is to test the hypothesis that acetyl-l-carnitine can promote nerve regeneration and improve function in patients with severe carpal tunnel syndrome.

Methods:
In this proof-of-principle, double-blind, randomized, placebo-controlled trial, adults with severe carpal tunnel syndrome were randomized to receive 3000 mg/day of acetyl-l-carnitine orally or placebo following carpal tunnel release surgery for 2 months. Outcomes were assessed at baseline and at 3, 6, and 12 months postoperatively. Symptom severity and functional outcomes were assessed using the Boston Carpal Tunnel Questionnaire and a wide range of physiologic and functional outcome measures. Patient safety was monitored by physical examination, blood work, and serum drug levels. The outcomes were analyzed using repeated measure two-way analysis of variance.

Results:
Twenty patients with similar baseline characteristics were assigned randomly to the treatment or placebo group in a 1:1 ratio. Sixty percent were women with a mean age ± SD of 59 ± 2. The treatment was safe with no major adverse events reported. Although patients in both groups showed improvements postoperatively, there was no significant difference in any of the outcome measures between the groups.

Conclusion:
Although acetyl-l-carnitine was well tolerated, it did not improve nerve regeneration or functional recovery in patients with severe carpal tunnel syndrome.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
A New Approach to an Old Flap: A Technique to Augment Venous Drainage from the Paramedian Forehead Flap
Authors: Wiener Martin , Karunanithy Narayan , Pease Natalie , Davies Andrew , Walker Nolan , Katsanos Konstantinos , Aldridge Ben , Healy Ciaran 
Published: December 2018

Summary:
The paramedian forehead flap is commonly used in nasal reconstruction, and survival of the distal part of the flap is usually essential for a good cosmetic outcome. Venous congestion leading to tissue necrosis is a recognized complication with this flap. The standard paramedian forehead flap is designed with a number of aims. These are to include the supratrochlear artery, to maximize mobility of the flap pedicle, to maximize the reach of the flap, and to minimize cosmetic implications at the donor site. The supratrochlear artery does not possess sizable venae comitantes; thus, the main pathway for venous drainage of the paramedian forehead flap is through superficial veins. The pattern and location of the superficial veins varies and therefore a standard skin pedicle design cannot be expected to always include sufficient veins to prevent venous congestion and subsequent flap necrosis. This article demonstrates the superficial venous anatomy of the forehead using computed tomographic venography, clinical demonstration, and cadaveric dissection, and describes a technique that can be carried out to augment flap venous drainage by performing careful dissection to identify additional superficial veins at the margins of the flap skin pedicle. One or more veins can then be mobilized and included with the flap pedicle to augment its venous drainage. Use of this technique should lead to a lower incidence of flap necrosis secondary to venous congestion.
Promotion of Primary Murine Breast Cancer Growth and Metastasis by Adipose-Derived Stem Cells Is Reduced in the Presence of Autologous Fat Graft
Authors: Gebremeskel Simon , Gencarelli John , Gareau Alison J. , Levatte Terry , Dugandzic, B.Sc. Anton , Johnston Brent , Bezuhly Michael 
Published: December 2018

Background:
Cell-assisted lipotransfer involves enrichment of autologous fat with supraphysiologic numbers of adipose-derived stem cells to improve graft take. Adipose-derived stem cells have been shown to promote cancer progression, raising concerns over the safety of adipose-derived stem cells and cell-assisted lipotransfer in postoncologic breast reconstruction. The authors compared the effect of adipose-derived stem cells alone, cell-assisted lipotransfer, and conventional fat grafting on breast cancer growth and metastasis.

Methods:
Proliferation and migration of murine 4T1 breast cancer cells cultured in control medium or mouse adipose-derived stem cell– or fat graft–conditioned medium were assessed by flow cytometry and scratch assay, respectively. Transcription levels of arginase-1, transforming growth factor-β, and vascular endothelial growth factor were assessed in adipose-derived stem cells and fat graft by quantitative reverse transcription polymerase chain reaction. An orthotopic mouse tumor model was used to evaluate breast cancer progression and metastasis. 4T1 cells were injected into the mammary pad of female BALB/c mice. Six days later, tumors were injected with saline, adipose-derived stem cells, fat graft, or cell-assisted lipotransfer (n = 7 per group). Two weeks later, primary tumors were examined by immunohistochemistry and lung metastasis was quantified.

Results:
Adipose-derived stem cell–conditioned medium increased cancer cell proliferation (p = 0.03); migration (p < 0.01); and transcription of arginase-1, transforming growth factor-β, and vascular endothelial growth factor compared to fat graft–conditioned or control medium (p < 0.02). Tumor-site injection with adipose-derived stem cells alone led to increased primary tumor growth and lung metastasis compared to control, fat graft, or cell-assisted lipotransfer groups (p < 0.05). Adipose-derived stem cell injection increased CD31+ vascular density in tumors (p < 0.01).

Conclusion:
Adipose-derived stem cells alone, but not conventional fat graft or cell-assisted lipotransfer, promote breast cancer cell proliferation and invasiveness in vitro and in vivo.
Nasal Dorsal Augmentation with Freeze-Dried Allograft Bone: 10-Year Comprehensive Review
Authors: Clark Richard P. , Pham Phuong M. , Ciminello Frank S. , Hagge Rosalie J. , Drobny Sarah , Wong Granger B. 
Published: December 2018

Background:
The aim of this study was to evaluate freeze-dried cortical allograft bone for nasal dorsal augmentation. The 42-month report on 18 patients was published in 2009 in Plastic and Reconstructive Surgery with 89 percent success at level II evidence, and this article is the 10-year comprehensive review of 62 patients.

Methods:
All grafts met standards recommended by the American Association of Tissue Banks, the U.S. Food and Drug Administration, and the Centers for Disease Control and Prevention. Objective evaluation of the persistence of graft volume was obtained by cephalometric radiography, cone beam volumetric computed tomography, and computed tomography at up to 10 years. Vascularization and incorporation of new bone elements within the grafts were demonstrated by fluorine-18 sodium fluoride positron emission tomography at up to 10 years. Subjective estimation of graft volume persisting up to 10 years was obtained by patient response to a query conducted by an independent surveyor.

Results:
The authors report objective proof of persistence of volume alone or combined with proof of neovascularization in 16 of 19 allografts. The authors report the patient’s subjective opinion of volume persistence in 37 of 43 grafts. The dorsal augmentation was assessed overall to be successful in 85 percent of 62 patients evaluated between 1 and 10 years, with a mean of 4.7 years.

Conclusions:
Freeze-dried allograft bone is a safe and equal alternative for dorsal augmentation without donor-site morbidity. Further studies are needed to (1) confirm these findings for young patients needing long-term reconstruction, and (2) partially demineralize allograft bone to allow carving with a scalpel.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
In Vivo Analysis of Urinary Stones With Dual-Energy Computed Tomography
Authors: Erdogan Hasan , Temizoz Osman , Koplay Mustafa , Ozturk Bahadir 
Published: December 2018

Objective
Formation mechanisms and treatment of the urinary stones are different, depending on their chemical structure. Therefore, determining the stone type plays a key role in planning treatment and preventive measures. Computed tomography (CT), with the use of dual-energy technology in recent years, has made it possible to do in vivo analysis of urinary stones. In this study, we aimed to evaluate the diagnostic efficacy of dual-energy CT (DECT) and compare its results with in vitro analysis, which is accepted as a gold standard for analysis of urinary stones.

Materials and Methods
The DECT examinations were performed on 373 patients using 128-slice dual-source CT scanner. Analysis of attenuation ratios in the high and low kilovoltage peak values of the stone was performed at workstation, and stones were classified as hydroxyapatite, calcium oxalate, cystine, and uric acid. On follow-up, the stone was obtained in 35 patients as a result of surgery or passed spontaneously. The DECT analysis and in vitro analysis results were compared and statistically evaluated.

Results
In all patients, 136 hydroxyapatite, 160 calcium oxalate, 57 uric acid, and 20 cystine stones were detected with DECT. In vitro analyses of the stones were performed in 35 patients, and 8 hydroxyapatite, 18 calcium oxalate, 6 uric acid, and 3 cystine stones were revealed. When DECT analysis results were compared with in vitro analysis results, stone types were detected correctly in 32 (91.4%) patients and incorrectly in 3 (8.6%) patients. Especially all uric acid and cystine stones were correctly detected with DECT.

Conclusions
With advanced postprocess analysis methods, DECT is able to analyze urinary stones. The DECT is found superior especially in detecting uric acid and cystine stones. Its success in detecting hydroxyapatite and calcium oxalate stones is also high. When in vivo analyses of the stones are performed with DECT, it will be possible to make a contribution to the personalization and optimization of the treatment.
Early Versus Late Conversion From Immediate to Prolonged-Release Tacrolimus After Renal Transplantation: Clinical Effects and Treatment Costs
Authors: Mendonça Luís , Diniz Hugo , Silvano José , Marques Sofia , Sampaio Susana , Pestana Manuel 
Published: December 2018

Introduction
Prolonged-release tacrolimus (PR-TAC) was associated with improved renal function after transplantation when compared to immediate-release tacrolimus (IR-TAC) although evidence is still scarce. This study aimed to compare clinical outcomes and treatment costs in patients who converted from IR-TAC to PR-TAC during the first year after renal transplantation (RT) (early converters [EC]) or after that period (late converters [LC]).

Methods
We performed a retrospective study including 79 patients (EC, 39; LC, 41) which were followed up over 60 months. A mixed-effects approach was used to investigate the differences between both groups regarding renal and metabolic outcomes as well as treatment costs.

Results
The median time from RT to conversion was 3 months for EC and 25 months for LC. For both EC and LC, a significant increase in estimated glomerular filtration rate was observed after conversion (5.2 and 4.9 mL/min per 1.73 m2, respectively). During the first year after RT, EC presented a higher estimated glomerular filtration rate and inferior tacrolimus trough levels when compared to LC, with higher mean treatment costs associated. However, thereafter, these outcomes were similar between groups over the remaining time. At the end of follow-up, no significant differences were found regarding allograft acute rejection (2.6% and 2.4%), new-onset diabetes (15.7% vs 12.2%) or cardiovascular events (5.2% vs 7.3%).

Conclusions
There was a significant benefit on renal function after conversion from IR-TAC to PR-TAC. During the first year after RT, EC presented improved renal function, but higher treatment costs. None of these differences persisted at the end of follow-up.
Poly‐criminal Pirates and Ballooning Effects: Implications for International Counter‐piracy
Authors: Jacobsen Katja Lindskov 
Published: December 2018

AbstractIn view of continued international counter‐piracy efforts and these recent incidents, this article takes the five obstacles presented by Percy and Shortland (2013), as its point of departure for an analysis of key developments of importance for Somali piracy since 2013. Specifically, the article firsts offer an analysis and updated version of Percy and Shortland's five obstacles. Second, I argue, that a sixth obstacle should be added. This obstacle is the phenomenon that practitioners as well as academics working with organised crime refer to as ‘poly‐criminals’. Having elaborated on this additional obstacle – with reference to interviews conducted with key actors in Somalia – the third section explicates the policy impact of poly‐criminal pirates; it offers a discussion of what this alternative conception means for external actors’ counter‐piracy engagements, with particular attention to the risk of creating ‘balloon effects’ when addressing a challenge of this kind (poly‐criminals) through too narrowly defined counter‐piracy lenses, mandates and programmes.
Age‐related histomorphometric and immunohistochemical changes of the moderator band in Egyptian Baladi cattle
Authors: Emam Mahmoud Abdelghaffar , Abo‐Ahmed Ahmed I. 
Published: December 2018

AbstractThe moderator band (MB) is a common fibromuscular anatomical structure for the right ventricle of most animals. The histomorphometric and immunohistochemical analysis of the MBs of Egyptian Baladi cattle in relation to age was the aim of this study. Eighteen clinically healthy animals of both sexes were used for this study. The animals were divided into three groups depending on age, group I (N = 4, <1 year), group II (N = 8, 1–2 years) and group III (N = 6, 4–8 years). Cross sections of the MBs from all groups were stained with H&E, Masson's trichrome and anti‐connexin43 (Cx43) antibody for histological and immunohistochemical examinations. Also, measurements for the thickness of the endocardium of the MB as well as, the wall of its muscular artery were conducted. Bundles of Purkinje fibres (PFs) were identified peripherally in the endocardial layer and among the myocardial fibres in the core of each MB. The infiltration of endocardial adipocytes was the characteristic for MBs of old animals. All morphometric data showed a significant increase with the advancement of age. Immunohistochemical findings revealed the localization and distribution of Cx43 in the PFs and intercalated discs of all examined MBs. However, variation of Cx43 immunoreactivity was found among the groups depending on the age. On the basis of this study, this conclusion of different histomorphometry and Cx43 expression of the MBs in relation to age was drawn. These interesting findings provide further insight into age‐related physiological and pathological heart conditions.