bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of synbiotics on necrotizing enterocolitis and full enteral feeding in very low birth weight infants: A double-blind, randomized controlled trial
Authors: Mahboobipour Amir Ali , Bitaraf Ali , Mohammadi Pourang , Khosravifar Mina , Babaei Homa , Shahidolahi Amir 
Published: September 2024

Background:
Necrotizing enterocolitis (NEC) is a multifactorial disease primarily affecting infants with very low birth weight (VLBW). Research has shown that the pathogenesis of NEC is associated with abnormal bacterial colonization. Synbiotics, dietary supplements containing probiotics (beneficial bacteria) and prebiotics (non-digestible food), can alter the gut microbiome.

Methods:
A double-blind, randomized controlled trial was conducted to assess the efficacy of PediLact®, an oral drop multi-strain synbiotic containing Lactobacillus rhamnosus, Lactobacillus reuteri, and Bifidobacterium infantis, on nutritional parameters and the occurrence of NEC in VLBW neonates. In this study, 118 VLBW neonates from neonatal intensive care units were randomly allocated in a 1:1 ratio to receive either a synbiotic or a placebo. The synbiotic administration continued until the infant was fully fed. The primary outcomes were the occurrence of NEC and the number of days required to achieve full enteral feeding. Log-binomial regression and ANOVA/ANCOVA models were used for analysis.

Results:
In the group that received the synbiotic, the incidence of NEC decreased significantly (adjusted RR = 0.22, 95% CI: 0.07–0.72, P value = .01; adjusted RD = −0.22, 95% CI: −0.33 to −0.12, P value < .001; NNT = 5). Additionally, feeding intolerance was less frequent in this group (adjusted RR = 0.27, 95% CI: 0.14–0.51, P value < .001; NNT = 3). Furthermore, consumption of the synbiotic was associated with significant weight gain (approximately 40 g) in infants (adjusted SMD = 0.63; 95% CI: 0.26–1.00, P value < .001). The duration of hospitalization and the time required to reach full enteral feeding were also significantly shorter in the synbiotic group (by approximately 3 days). No serious side effects were reported.

Conclusion:
Prescribing multi-strain synbiotics reduces the incidence of NEC in VLBW infants and has beneficial effects on breastfeeding tolerance and weight gain velocity. Therefore, physicians may consider prescribing synbiotics to VLBW neonates.
Network pharmacological mechanism analysis and evidence-based medical validation of Dahuang Mudan Decoction in the treatment of acute pancreatitis
Authors: Chen Jinhan , Jiang Mengjie , Ying Yuou , Ji Yuan , Chi Yuying , Tao Linghui , Wu Fuping , Chen Mingxian 
Published: September 2024

Background:
Dahuang Mudan Decoction is commonly used in China for the treatment of acute pancreatitis. Nevertheless, the therapeutic efficacy of the drug remains a subject of debate, and its active ingredients and potential therapeutic targets remain to be determined. The present study used a network pharmacological approach to investigate the active ingredients and possible targets of the drug, and illustrated the clinical effectiveness of Dahuang Mudan Decoction in the treatment of acute pancreatitis by meta-analysis.

Methods:
The present study investigated the active ingredients of the constituent herbs of Dahuang Mudan Decoction using the TCMID database. In order to further identify molecular targets, Swiss Target Prediction, OMIM and Genecards databases was be used. The present study used metascape database for gene ontology function enrichment analysis and Kyoto Genome Encyclopedia pathway enrichment analysis. A gene interaction network diagram was established for predicting the main targets and mechanism of action to Dahuang Mudan Decoction for acute pancreatitis. To further illustrate the validity of the gene targets and the clinical efficacy of the drug, 13 relevant studies were included for meta-analysis and analyzed using the Cochrane Collaboration’s Review Manager 5.4 software.

Result:
After a thorough screening process, the present study identified three main components of Dahuang Mudan Decoction: kaempferol, quercetin and eupatin. These three major components have the potential to target 5 important proteins: AKT1, TNF-a, IL-6, TP53, HIF1A. In addition, pathway analyses by the Kyoto Genome Encyclopedia showed that Dahuang Mudan Decoction is active through the Pathways in cancer, AGE-RAGE signaling pathway in diabetic complications, PI3K-Akt signaling pathway, etc signaling pathway to act on acute pancreatitis. The results of meta-analysis showed that compared with the control group, the experimental group had superior performance in terms of overall treatment efficacy, reduction of hospital stays and inflammatory factor levels after treatment.

Conclusion:
In summary, network pharmacological studies have shown that Dahuang Mudan Decoction affects acute pancreatitis through different components, targets, and mechanisms. In addition, the meta-analysis study strongly supported the effectiveness of Dahuang Mudan Decoction in the treatment of acute pancreatitis.
Task-specific facial dystonia following COVID-19 infection: A case report
Authors: Lee Jong-Mok , Ko Pan-Woo 
Published: September 2024

Rationale:
During the coronavirus disease of 2019 (COVID-19) pandemic, various movement disorders associated with COVID-19 infection have been reported. However, the incidence of dystonia specifically associated with COVID-19 infection has been particularly rare.

Patient concerns:
A 43-year-old male patient presented to the movement disorders clinic with complaints of facial grimacing while chewing and experiencing spasms during nasal breathing. These symptoms appeared 2 weeks after he tested positive for COVID-19.

Diagnoses:
Based on normal diagnostic test results, including brain imaging and blood tests, it was concluded that task-specific facial dystonia following COVID-19 infection.

Interventions:
Despite treatment with clonazepam, trihexyphenidyl, and carbamazepine, his condition did not improve. Subsequently, botulinum toxin injections were administered to the affected facial muscles identified through video analysis.

Outcomes:
Botulinum toxin injections led to a significant improvement in the patient’s symptoms.

Lessons:
Task-specific dystonia affecting the facial muscles, particularly induced by specific actions such as chewing and nasal breathing, is rare and may represent an atypical post-infectious manifestation of COVID-19.
Effects of acupuncture on shoulder impingement syndrome: A systematic review and meta-analysis
Authors: An Sang-Joon , Shin Woo-Chul , Joo Sungjun , Cho Jae-Heung , Chung Won-Seok , Song Mi-Yeon , Kim Hyungsuk 
Published: September 2024

Background:
Shoulder impingement syndrome (SIS) is a common condition that causes chronic shoulder pain. The effectiveness of acupuncture in treating chronic shoulder pain has been documented in previous studies; however, existing systematic reviews and meta-analyses have often excluded Chinese databases and combined different types of acupuncture interventions, such as electroacupuncture, warm acupuncture, pharmacopuncture, and acupotomy. Thus, this study specifically examines the exclusive impact of manual acupuncture on SIS.

Methods:
Several databases, including PubMed, Cochrane Central, Embase, 1 Chinese database (China National Knowledge Infrastructure), and 5 Korean databases (ScienceON, Oriental Medicine Advanced Searching Integrated System, KoreaMed, Korean Studies Information Service System, and KMBASE), were systematically searched for relevant studies. The quality of the included studies was evaluated using the Cochrane Assessment Tool for Risk of Bias Version 2. Data collected from the selected studies were synthesized for meta-analysis. The primary outcome was a pain scale score, and the secondary outcomes were shoulder function and disability.

Results:
This study included 5 randomized controlled trials. The primary outcome assessment revealed significantly reduced pain (standardized mean difference [SMD] = −0.50, 95% confidence interval [CI] = −0.74 to −0.27) and improvements in shoulder function and disability (SMD = −0.57, 95% CI = −0.96 to −0.19). A subgroup analysis based on treatment duration indicated that short-term acupuncture treatment (≤4 weeks) exhibited a high level of confidence with low heterogeneity (SMD = −0.37, 95% CI = −0.73 to −0.02).

Conclusion:
Manual acupuncture is effective for relieving pain and improving shoulder function and disability in patients with SIS. However, further research is necessary to validate these findings owing to the limited number of patients and heterogeneity among the studies reviewed.
Diagnosis of a large cystic teratoma of accessory ovary complicated with torsion by ultrasound: A case report
Authors: He Yeping , Yan Xiaofang , Guo Jianfeng 
Published: September 2024

Rationale:
An accessory ovary complicated by cystic teratoma and torsion is extremely rare and requires prompt diagnosis and surgical treatment. However, evidence for effective preoperative imaging diagnosis has barely been reported. Our study presented a case in which preoperative ultrasound reasonably suspected ovarian tumor torsion and an accessory ovary, and laparoscopic surgery was strategically performed.

Patient concerns:
An 18-year-old girl had persistent pain in the lower right abdomen for over 7 hours accompanied by nausea and vomiting, and she had a 14.1 × 10.1 × 9.0 cm hypo-echoic cystic lesion containing a 6.4 × 4.9 × 3.0 cm solid component accompanied by the whirlpool sign on the right side of the pelvis. Additionally, a hyper-echoic ovary with a size of 2.5 × 1.4 cm and a normal ovary appearance of 2.4 × 0.8 cm were detected on the right side of the adnexal area by ultrasound.

Diagnosis:
The cystic lesion was a large accessory ovarian cystic teratoma, complicated by torsion. The hyperechoic ovary appears as accessory ovarian stromal edema and the normal ovary appearance is eutopic.

Interventions:
Single-port laparoscopic resection of the ovarian lesion, release of the ovarian torsion, and oophoroplasty were performed.

Outcomes:
Postoperative recovery was unremarkable. Antral follicles were detected in both eutopic and accessory ovaries by ultrasound 20 days and 4 months after surgery. In addition, during the second postoperative ultrasound follow-up, the accessory ovary showed no difference in echo compared to the normal ovary, except for a slightly larger volume.

Lessons:
Clinical manifestations of accessory ovarian tumors combined with torsion are similar to those of eutopic ovarian torsion, and timely surgery is required.
A case of eosinophilic granulomatosis with polyangiitis combined with pulmonary tuberculosis: A case report
Authors: Lai Yuting , Xiao Shan , Shen Yan 
Published: September 2024

Rationale:
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare autoimmune disease that can affect multiple organ systems. The standard treatment mainly relies on glucocorticoids and immunosuppressive agents. In our study, we present an EGPA patient who had pulmonary tuberculous mycobacteria infection, such cases are rarely reported.

Patient concerns:
A 71-year-old male patient was diagnosed with EGPA (systemic type) and pulmonary tuberculosis simultaneously.

Diagnoses:
The Five-Factor score indicated that the patient required glucocorticoids combined with immunosuppressive agents for induction therapy, however, the use of immunosuppressive agents would significantly inhibit antituberculosis treatment. Nowadays, treating active autoimmune disease in patients with infections remains a clinical challenge.

Interventions:
Considering the patient did not show life-threatening or severe organ involvement and reduced the effect of antituberculosis immunity, we used glucocorticoids alone.

Outcomes:
Finally, the patient had no adverse events, the eosinophil counts were markedly decreased and symptoms of EGPA were relieved.

Lessons:
The patient of EGPA combined with pulmonary tuberculosis successfully treated with glucocorticoids alone may provide significant support in selecting the appropriate treatments for similar cases in the future.
Bladder transitional cell carcinoma anatomic primary site as a predictor of survival and mortality: a population-based retrospective cohort study
Authors: Hemade Ali , Hallit Souheil 
Published: September 2024

Background:
Bladder cancer is a heterogeneous disease with varying prognostic outcomes based on the primary tumor site within the bladder. This study aims to evaluate the impact of tumor location on overall survival and cancer-specific survival in bladder cancer patients.

Methods:
The authors conducted a retrospective cohort study using data from the Surveillance, Epidemiology, and End Results database. Patients with primary transitional cell carcinoma of the bladder were categorized based on their tumor locations. Survival outcomes were assessed using Kaplan–Meier analysis and Cox proportional hazards regression models, adjusted for age, sex, race, cancer stage, and treatment modalities. Additionally, binary logistic regression models were employed to predict overall mortality (OM) and cancer-specific mortality (CSM) at 1, 5, and 10 years.

Results:
The study included 107 909 patients diagnosed with primary bladder cancer between 2000 and 2021. Significant differences in survival outcomes were observed across different tumor sites. Bladder cancer originating in the urachus had the worst OS before 100 months and the worst CSS overall. Tumors in the anterior wall showed the worst OS after 100 months. In the Cox multivariable analysis, anterior wall tumors were associated with a 1.513-fold increased risk of death compared to lateral wall tumors. The binary logistic regression models showed that anterior wall tumors predicted the highest OM and CSM at 1-year, while urachal tumors had the worst outcomes at 5 and 10 years.

Conclusions:
The primary site of bladder cancer is a significant predictor of survival outcomes, with tumors in the urachus and anterior wall associated with a poorer prognosis. These findings underscore the importance of considering tumor location in the prognosis and management of bladder cancer. Future studies should aim to validate these findings in more diverse populations and explore the underlying biological mechanisms that drive these differences.
The Neo-Pitanguy Ligament: A Three-Flap Technique For Skin Tensioning
Authors: Ghavami Ashkan , Vranis Neil M. 
Published: September 2024

Background:
Creating a stable, long-lasting supratip break continues to be a challenge, particularly in patients with moderate to severe skin thickness. Multiple techniques have been previously described to address this, including Pitanguy’s ligament preservation, re-suturing, and cartilage frame alterations to increase the tip-to-septal angle differential. Each have noteworthy limitations.

Methods:
The senior author developed a novel technique which utilizes the native Pitanguy ligament augmented by two bilateral, medially-based superficial musculo-aponeurotic system (SMAS)/soft tissue flaps. This reduces supratip dead space, prevents tissue glide while controlling supratip/tip shape and position.

Results:
Twenty-six (n=26) primary rhinoplasties in which the supratip and tip skin sleeve was of appropriate thickness were selected and followed for 1-year post operatively. The tri-laminar neo-Pitanguy ligament (NPL) technique was employed in all patients. Every patient maintained a varied degree of supratip break at an average follow up time of 14 months (range: 12-16 months). There was one revision requiring local anesthesia. No patients requested or were indicated for a return to the operating room. No cases of post-operative pollybeak deformity were observed.

Conclusion:
The power of this novel supratip control technique is multidimensional. It allows the surgeon to precisely control the location of supratip break, creating a broad based, diamond-shaped supratip depression. Tri-lamination with the use of the two SMAS/soft tissue flaps provides added strength, control, and long-term stability compared to simple suturing. Soft tissue tensioning above, around, and below the new tip complex prevents dorsal skin tissue glide and further secures the infratip/columella in appropriate position.
Comparing Wise Pattern to Non–Wise Pattern Skin-Sparing Mastectomy: A Critical Evaluation of Patient Demographics and Surgical Outcomes
Authors: Brodsky Casey N. , Torres Sydney J. , Shabet Christina L. , Parker Naomi F. , Frecentese Grace I. , Myers Paige L. 
Published: September 2024

Background:
Multiple skin-sparing incisions are used in immediate postmastectomy breast reconstruction; however, the Wise pattern incision (WPI) may have superior cosmetic outcomes for large, ptotic breasts compared with the non–Wise pattern incision (NWPI). The authors evaluated patient demographics and surgical outcomes with WPI versus NWPI.

Methods:
An electronic medical record search was performed for patients at a single academic institution from 2019 to 2022 with International Classification of Diseases, 10th Revision, Clinical Modification diagnosis code Z42.1: “Encounter for breast reconstruction following mastectomy.” Retrospective chart review evaluated patient demographics, intraoperative factors, postoperative complications, and surgical cost.

Results:
A total of 288 patients were included: 58 underwent WPI and 230 underwent NWPI. Median body mass index (BMI) differed between WPI (30.5 kg/m2) and NWPI (26.4 kg/m2) (P < 0.001). Fifty-seven percent of WPI had preoperative grade 3 ptosis versus 23% of NWPI (P < 0.001). No difference was found in median operative times (WPI, 219 minutes; NWPI, 194 minutes; P = 0.38). Overall rates of postoperative complications differed between WPI (62%) and NWPI (45%) on univariate but not multivariate analysis. Median total surgery charge was higher for WPI (WPI, $36,223; NWPI, $31,185; P < 0.001), whereas implant cost was higher for NWPI (WPI, $2700; NPWI, $8040; P < 0.001).

Conclusions:
There was no significant difference in operative time, overall complication rate, or charge between incision types once adjusted for confounding factors. The higher complication rate in the WPI group was likely driven by higher BMI, a known risk factor for surgical complications regardless of approach. Surgeons can consider WPI as a noninferior option for patients with higher BMI and ptosis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
“Temporal MORE (Modified Orbicularis REpositioning): going beyond the limits of temporal lifting”.
Authors: Pascali Michele , Savani Luca , Gratteri Marco , Rega Umberto , Marchese Gloria , Persichetti Paolo 
Published: September 2024

Background:
Periorbital rejuvenation is often challenging and requires comprehensive evaluation of its various components to obtain satisfying results. Considering the crucial role of the orbicularis muscle in the periorbital aging process, the first author recently described his personal technique for temporal lifting through a subcutaneous approach in conjunction with an orbicularis muscle flap. In the current article, the authors present a modified and extended temporal lift approach, which allows for remarkable improvement not only in the temporal and brow region, but in the whole periorbital area up to the malar region, therefore named “Temporal MORE” (Modified Orbicularis REpositioning).

Methods:
212 consecutive patients underwent Temporal MORE by the same surgeon between May 2021 and September 2022. Each patient filled a FACE-Q© questionnaire preoperatively and 12 months postoperatively. 5 independent surgeons were asked to score the results evaluating patients’ preoperative and postoperative pictures.

Results:
No major complications were recorded. The most satisfying aspect of this technique was dramatic periorbital rejuvenation noticeable in all patients.
FACE-Q pre-operative score was 34.29±5.872, while the post-operative was 80.11±6.796 (p<0.05); delta (post-pre) mean value was 45.82±8.925. Surgeons’ questionnaire mean value was 41.92±6.010. Statistical analysis showed a strong correlation between surgeons’ and patients’ satisfaction (“r” value 0.7488).

Conclusions:
Temporal MORE proved to achieve a comprehensive rejuvenation of the periorbital area in a straightforward and reproducible way, with a fast recovery and a low complication rate. In this cohort, patient satisfaction with the result was remarkable and comparable to the judgment of the surgeons interviewed.
Diagnosing Maxillary Occlusal Cant with average 3D Skeletofacial Model Template
Authors: Cheng Shun-Chien , Lin Hsiu-Hsia , Kuo Jyun-Cheng , Lo Lun-Jou , Ho Cheng-Ting 
Published: September 2024

Background:
Diagnosing maxillary occlusal cant involves varied methods, yet classification remains incomplete. This includes determining if the cant results from equal faults on both sides or if one side exhibits overdevelopment while the other underdevelops. This study introduces an innovative average 3D skull template for classifying maxillary occlusal cant instances.

Methods:
Sixty adult patients were divided into two groups: 30 with a mesoprosopic facial type and 30 with a leptoprosopic facial type. Using seven pairs of anatomical landmarks (N, Or (L, R), Lo (L, R), Zy (L, R)), the average skull models were aligned and superimposed onto the patients' skull models. Image resizing facilitated optimal registration area fitting. Vertical distances from the U6 mesial buccal cusp tip to the FH plane were measured to analyze occlusal cant, classified into three classes: overdevelopment (Class A), underdevelopment (Class B) and equal fault on both sides (Class C).

Results:
In the mesoprosopic group, Class B t was most common (40%), followed by Class A (27%) and Class C (33%). In the leptoprosopic facial type group, Class B remained prevalent (50%), followed by Class A (43%) and Class C (7%). Statistical analysis revealed a significant association between facial types and the three classes.

Conclusions:
Contrary to expectations, equal fault patterns were not predominant; instead, underdevelopment of the maxilla constituted the majority of occlusal cant cases. Utilizing average 3D skeletofacial models as templates emerges as an effective tool and alternative for diagnosing the instance of maxillary occlusal cant.

RISK STUDIES/LEVEL OF EVIDENCE:
Therapeutic, II.
Textbook Outcomes in Solid Transplantation: A Systematic Review
Authors: Martinino Alessandro , Ladowski Joseph Matthew , Schilirò Davide , Hartwig Matthew G. , Moris Dimitrios , Barbas Andrew S. 
Published: September 2024

Background.
The concept of TO is expanding across various surgical disciplines to establish a standardized, comprehensive quality benchmark. Traditional metrics such as 1-y patient and graft survival have been key for evaluating transplant program performance but are now deemed inadequate because of significant field advancements. This systematic review aims to provide a comprehensive understanding of the applicability and validity of textbook outcome (TO) in the setting of solid organ transplantation.

Methods.
A structured search, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was conducted across PubMed, Embase, and Scopus databases on March 10, 2024.

Results.
Fourteen articles were identified for inclusion in this review. Of these, 2 studies addressed TO in heart transplantation, 3 in lung transplantation, 2 in kidney transplantation, and 7 in liver transplantation. A subgroup analysis was conducted to categorize the different definitions of TOs and identify the most common reasons for TO failure.

Conclusions.
Our systematic review highlights the ongoing efforts in the field of solid organ transplantation to define TO and emphasizes the importance of developing a universally recognized set of TO criteria for each type of transplant. TO provides a valuable framework for transplant centers to benchmark their performance against similar institutions on a risk-adjusted basis and to pinpoint specific areas for enhancing patient outcomes. Even the most successful programs may discover aspects within the composite outcome with scope for improvement.