bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of the Intercostal Artery-based Latissimus Dorsi Muscle for Intrathoracic Reconstruction after Division of the Thoracodorsal Vessels and Latissimus Dorsi Muscle
Authors: Cherukuri Sai , Blackmon Shanda , Bakri Karim , Mardini Samir , Moran Steven L. , Gibreel Waleed 
Published: June 2023

Summary:
The latissimus dorsi muscle is the workhorse flap for intrathoracic reconstruction. Prior thoracotomy, which divides the latissimus dorsi muscle, limits the muscle’s intrathoracic reach. We present our experience using the distal portion of the muscle for intrathoracic reconstruction based off an intercostal vessel. We also demonstrate the ability of this intercostal perforator to allow for chimeric flap elevation with a separate skin paddle, depending on the branching pattern of the intercostal vessels. This study provides a case series of three consecutive patients, treated between September 2021 and June 2022. The intrathoracic pathology addressed in these patients are bronchopleural fistula, aortoesophageal fistula, and bronchoesophageal fistula. All patients had the resolution of symptoms related to intrathoracic fistulae and did not experience recurrence. This novel pedicled muscle flap can be an additional option for patients with prior thoracotomy and avoids the morbidity which can be seen with the serratus or rectus abdominis muscle flaps.
Serologic Evaluations in the Distinction Between Sinusitis-Related Orbital Cellulitis and Periorbital Necrotizing Fasciitis
Authors: Wladis Edward J. , Tomlinson Lauren A. , Moorjani Smriti , Rothschild Michael I. 
Published: June 2023

Purpose:
While sinusitis-related orbital cellulitis (SROC) and periorbital necrotizing fasciitis (PNF) share similar clinical presentations, they are managed differently, making rapid recognition of the appropriate clinical entity critical to optimal outcomes. This study was performed to assess whether serologic testing might help clinicians to distinguish between SROC and PNF.

Methods:
A retrospective review analysis was used to compare initial complete blood counts and comprehensive metabolic panels among adult patients with SROC and PNF. Statistical evaluations were used to determine the significance of differences between the groups.

Results:
Thirteen patients with PNF and 14 patients with SROC were identified. The 2 groups were similar in age, gender, and likelihood of immunosuppression (p > 0.05 for each metric). Mean leukocyte counts were 18.52 (standard deviation = 7.02) and 10.31 (standard deviation = 5.77) for PNF and SROC, respectively (p = 0.0057). White blood cell levels were above normal limits for 12 patients with PNF (92.3%) and 7 patients with SROC (50%) (p = 0.017). No other laboratory test was significantly different between the 2 groups.

Conclusions:
While the majority of serologic testing was quite similar in patients with either SROC or PNF, leukocyte levels may represent an important clue to distinguish between the two diseases. Clinical evaluation remains the gold standard to make the proper diagnosis, but markedly elevated white blood cell counts should prompt clinicians to at least consider a diagnosis of PNF.
Experiences of nurse practitioners with telehealth during the COVID-19 pandemic
Authors: Reilly Janet , Liphart Rhoads Jenna , Bettin Tina , Dennik-Champion Gina , Bansal Gaurav 
Published: June 2023

ABSTRACT

Background:
The COVID-19 pandemic brought many changes to the way nurse practitioners (NPs) provided care for patients, including the explosive and instantaneous use of telehealth in lieu of face-to-face services to maintain safe health care access and provision for patients and providers.

Purpose:
Although the literature abounds with patient perspectives and benefits of telehealth, little is found about the perceptions and experiences of NPs providing telehealth services during this time when telehealth was the primary care mode of providing nonacute care.

Methodology:
This mixed-methods, descriptive, exploratory study describes demographic and quantitative data about telehealth experiences collected from NPs across the nation early in the pandemic during fall 2020, and similar quantitative data collected later in spring 2021 from NPs in one state.

Results:
Significant findings between the 2020 national and 2021 state NP data include years of NP experience and the NP perceived barriers in the provision of telehealth services.

Conclusions:
Major patient-centric telehealth barriers were patient comfort with and accessibility to telehealth software. Major NP perceived telehealth barriers were regulatory laws, difficulty including telehealth visits into workflow when seeing patients in person, and comfort using telehealth software.

Implications:
Specific strategies can help to overcome identified telehealth barriers.
The Prognostic Value of TTF-1/NKX2-1 in Lung Squamous Cell Carcinoma
Authors: Liao Yida , Yang Fan , Li Xiao , Chen Kezhong , Wang Jun 
Published: June 2023

Background:
TTF-1/NKX2-1 is a lineage-specific transcription factor that is expressed in the thyroid gland, lung, and forehead. It functions as a key component in regulating lung morphogenesis and differentiation. It is mainly expressed in lung adenocarcinoma, while its prognostic value in non-small-cell lung cancer remains controversial. This study evaluates the prognostic value of TTF-1 in different cellular locations in lung squamous cell carcinoma (SCC) and adenocarcinoma (ADC).

Materials and Methods:
The expression of TTF-1 was analyzed by immunohistochemistry in 492 patients (ADC 340 and SCC 152) who had undergone surgery between June 2004 and June 2012. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method.

Results:
Positive TTF-1 expression was 68.2% in ADC (located in the nucleus) and 29.6% in SCC (cytoplasm staining). The presence of TTF-1 was associated with better OS in SCC and ADC (P=0.000 and P=0.003, respectively). In SCC, an increased level of TTF-1 was associated with a longer disease-free survival (DFS). Positive TTF-1 expression was an independent favorable prognostic factor in SCC (P=0.020, HR: 2.789, 95%CI: 1.172–6.637) and ADC (P=0.025, HR: 1.680, 95%CI: 1.069–2.641).

Conclusions:
TTF-1 was largely located in the nucleus of ADC, while it always accumulated in the cytoplasm of SCC. The higher level of TTF-1 in the different subcellular locations of ADC and SCC was an independent, favorable prognostic factor, respectively. Increased TTF-1 in the cytoplasm of SCC was associated with a longer OS and DFS.
Online information on chronic pain in 3 countries: an assessment of readability, credibility, and accuracy
Authors: Basnet Ritu , Mendez David Ruiz , Lugo-González Isaías , O'Hagan Edel , O'Keeffe Mary , Sharma Saurab , Pate Joshua W. , Kennedy David S. 
Published: June 2023

Abstract

Objectives:
To assess the readability, credibility, and accuracy of online information on chronic pain in Australia, Mexico, and Nepal.

Methods:
We assessed Google-based websites and government health websites about chronic pain for readability (using the Flesch Kincaid Readability Ease tool), credibility (using the Journal of American Medical Association [JAMA] benchmark criteria and Health on the Net Code [HONcode]), and accuracy (using 3 core concepts of pain science education: (1) pain does not mean my body is damaged; (2) thoughts, emotions, and experiences affect pain; and (3) I can retrain my overactive pain system).

Results:
We assessed 71 Google-based websites and 15 government websites. There were no significant between-country differences in chronic pain information retrieved through Google for readability, credibility, or accuracy. Based on readability scores, the websites were “fairly difficult to read,” suitable for ages 15 to 17 years or grades 10 to 12 years. For credibility, less than 30% of all websites met the full JAMA criteria, and more than 60% were not HONcode certified. For accuracy, all 3 core concepts were present in less than 30% of websites. Moreover, we found that the Australian government websites have low readability but are credible, and the majority provided all 3 core concepts in pain science education. A single Mexican government website had low readability without any core concepts but was credible.

Conclusion:
The readability, credibility, and accuracy of online information on chronic pain should be improved internationally to support facilitating better management of chronic pain.
Therapeutic Options for Migraines in the Microsurgical Patient: A Scoping Review
Authors: Stearns Stephen A. , Xun Helen , Haddad Anthony , Rinkinen Jacob , Bustos Valeria P. , Lee Bernard T. 
Published: June 2023

Background:
There exists an increasing array of treatments proposed to prevent, alleviate, and abort symptoms of a migraine; however, for patients who undergo reconstructive microsurgery, caution must be taken to preserve vascular integrity. This study is the first-to-date scoping review of vascular and bleeding risk of current migraine therapies, with the purpose of identifying potential therapeutic agents for postoperative migraine management appropriate for microsurgical patients.

Methods:
Currently available migraine therapeutics were compiled from UpToDate and the American Academy of Family Physicians. A PubMed literature review was performed for each therapeutic’s effect on bleeding or vascular involvement. Data were compiled into tables of abortive, symptom-controlling and prophylactic, and non-pharmacologic treatments. Expert microsurgeons reviewed the data to provide recommendations for optimized patient care.

Results:
Triptans and other ergot derivatives demonstrated strong evidence of vasoconstriction and were greatly advised against for immediate post-microsurgical use. Novel pharmaceutical therapies like Lasmiditan and CGRP antagonists have no literature indicating potential for vasoconstriction or hematoma and remain an investigational option for abortive medical treatment. For symptom control, acetaminophen appears the safest option, with clinical judgment and further research needed for use of NSAIDs. Alternative treatment techniques may include migraine prophylaxis with botulinum toxin injection or nutraceutical treatment via magnesium supplementation or Coenzyme Q10 administration, minimizing the need for additional medication in the postoperative setting.

Conclusions:
Patients undergoing reconstructive microsurgery have a unique medical profile limiting the therapeutic options available to treat migraines. This review provides preliminary evidence to be considered as a guide for prescribing therapeutics for migraine in the postoperative setting.
Comparing Combination Triamcinolone Acetonide and 5-Fluorouracil with Monotherapy Triamcinolone Acetonide or 5-Fluorouracil in the Treatment of Hypertrophic Scars: A Systematic Review and Meta-Analysis
Authors: Mavilakandy Akash K. , Vayalapra Sushanth , Minty Iona , Parekh Jvalant N. , Charles Walton N. , Khajuria Ankur 
Published: June 2023

Background:
Keloids and hypertrophic scars cause physical and psychosocial problems. A combination of 5-fluorouracil (5-FU) and triamcinolone acetonide (TAC) may enhance the treatment of pathologic scars, although the evidence base is limited. The authors compared the efficacy and complication rates of combination intralesional TAC and 5-FU with those of monotherapy intralesional TAC or 5-FU for the treatment of keloids and hypertrophic scars.

Methods:
Embase, MEDLINE, and CENTRAL were searched by two independent reviewers. The primary outcome was treatment efficacy (51% to 100% improvement). Study quality and risk of bias were assessed using the Cochrane risk of bias tool.

Results:
Of 277 articles screened, 13 studies were included, comprising 12 randomized control trials and one nonrandomized study. Six studies compared combination intralesional therapy versus monotherapy 5-FU, and nine studies compared combination intralesional therapy versus monotherapy TAC. The combined group demonstrated superior objective treatment efficacy compared with the monotherapy TAC group (OR, 3.45; 95% CI, 2.22 to 5.35; I2 = 0%; P < 0.00001) and monotherapy 5-FU group (OR, 4.17; 95% CI, 2.21 to 7.87; I2 = 0%; P < 0.0001). Telangiectasia was less frequent in combination therapy (OR, 0.24; 95% CI, 0.11 to 0.52; I2 = 0%; P = 0.0003) compared with monotherapy TAC.

Conclusions:
Combined intralesional TAC and 5-FU administration demonstrated superior treatment efficacy outcomes compared with monotherapy TAC or 5-FU. Patient-reported outcome measures should be incorporated in the design of future research to justify clinical recommendations.

Clinical Relevance Statement:
Combined TAC and 5-FU has demonstrated superior treatment efficacy outcomes compared to monotherapy TAC or 5-FU in the treatment of hypertrophic scars and keloids.
“Postoperative Outcomes Following Buried Penis Reconstruction: A Single-Institution Experience Using the Wisconsin Classification System”
Authors: Seitz Allison J. , Edalatpour Armin , Israel Jacqueline S. , Grimes Matthew D. , Williams Daniel H. , Poore Samuel O. 
Published: June 2023

Background:
Adult acquired buried penis (AABP) is a complex condition often necessitating surgical intervention. This study seeks to examine the validity of the Wisconsin Classification System (WCS) in guiding the surgical management of AABP. Additionally, we aimed to identify which factors contribute to postoperative complications and persistent symptoms following AABP repair.

Methods:
We retrospectively reviewed all patients who underwent surgical repair of AABP from 2015-2021 by the senior author at our institution. Patients were categorized according to anatomic characteristics using the WCS. Preoperative symptoms, postoperative symptoms, and postoperative complications were evaluated.

Results:
Fifty-two patients underwent AABP repair. The mean age was 56.5±14.8 years, and the mean duration of follow-up was 350.0±517.4 days. The assigned preoperative WCS score was congruent with operative management in most patients (86.0%). Morbid obesity (BMI>40.0kg/m2) and postoperative complications were associated with persistent symptoms following AABP repair (p=0.026 and p=0.021, respectively). Increased WCS score was not associated with persistent postoperative symptoms (p=0.314). Morbid obesity (p=0.003), diabetes (p=0.029) and having a panniculectomy during AABP repair (p=0.046) increased the odds for developing postoperative complications. Patients with Type I AABP had significantly fewer complications than those with Type II, III, or IV (p=0.032).

Conclusions:
The Wisconsin Classification System serves as a preoperative guide, an educational tool for patients, and provides a framework for the discussion of intraoperative maneuvers and the likelihood of complications. It is imperative to counsel patients on the surgical management of AABP and the postoperative course, as this may permit realistic patient expectations and optimize outcomes.
Non-invasive cortical stimulation for drug-resistant pain
Authors: Garcia-Larrea Luis 
Published: June 2023

Purpose of review
Neuromodulation techniques are being increasingly used to alleviate pain and enhance quality of life. Non-invasive cortical stimulation was originally intended to predict the efficacy of invasive (neurosurgical) techniques, but has now gained a place as an analgesic procedure in its own right.

Recent findings
Repetitive transcranial magnetic stimulation (rTMS): Evidence from 14 randomised, placebo-controlled trials (~750 patients) supports a significant analgesic effect of high-frequency motor cortex rTMS in neuropathic pain. Dorsolateral frontal stimulation has not proven efficacious so far. The posterior operculo-insular cortex is an attractive target but evidence remains insufficient. Short-term efficacy can be achieved with NNT (numbers needed to treat) ~2–3, but long-lasting efficacy remains a challenge.
Like rTMS, transcranial direct-current stimulation (tDCS) induces activity changes in distributed brain networks and can influence various aspects of pain. Lower cost relative to rTMS, few safety issues and availability of home-based protocols are practical advantages. The limited quality of many published reports lowers the level of evidence, which will remain uncertain until more prospective controlled studies are available.

Summary
Both rTMS and tDCS act preferentially upon abnormal hyperexcitable states of pain, rather than acute or experimental pain. For both techniques, M1 appears to be the best target for chronic pain relief, and repeated sessions over relatively long periods of time may be required to obtain clinically significant benefits. Patients responsive to tDCS may differ from those improved by rTMS.
The utility of wearable headband electroencephalography and pulse photoplethysmography to assess cortical hyperarousal in individuals with stress-related mental disorders
Authors: Blaskovich Borbala , Bullón-Tarrasó Esteban , Pöhlchen Dorothee , Manafis Alexandros , Neumayer Hannah , Besedovsky Luciana , Brückl Tanja ,   BeCOME Working Group, Simor Peter , Binder Florian P. , Spoormaker Victor I. 
Published: June 2023

AbstractStudy ObjectivesSeveral stress-related mental disorders are characterized by disturbed sleep, but objective sleep biomarkers are not routinely examined in psychiatric patients. We examined the use of wearable-based sleep biomarkers in a psychiatric sample with headband electroencephalography (EEG) including pulse photoplethysmography (PPG), with an additional focus on microstructural elements as especially the shift from low to high frequencies appears relevant for several stress-related mental disorders (cortical hyperarousal).MethodsWe acquired 483 nights and could analyze 372 nights of sufficient quality from 83 healthy participants and those with a confirmed stress-related mental disorder (anxiety-affective spectrum). We analyzed the data with respect to macrostructural and microstructural characteristics according to the newly described spectral slope fitting over the whole frequency spectrum.ResultsThe headbands were accepted well by patients and the data quality was sufficient for most nights. The macrostructural analyses revealed trends for significance regarding sleep continuity but not sleep depth variables. The spectral analyses yielded no between-group differences except for a group × age interaction, with the normal age-related decline in the low versus high frequency power ratio flattening in the patient group. PPG analyses showed that the mean heart rate was higher in the patient group in pre-sleep epochs, a difference that reduced during sleep and dissipated at wakefulness.ConclusionsWearable devices that record EEG and/or PPG could be used over multiple nights to assess relevant markers such as sleep fragmentation, cortical hyperarousal, and sympathetic drive throughout the sleep–wake cycle in patients with stress-related mental disorders.
Atypical intrinsic neural timescale in the left angular gyrus in Alzheimer’s disease
Authors: Murai Shota A. , Mano Tatsuo , Sanes Jerome N. , Watanabe Takamitsu 
Published: June 2023

AbstractAlzheimer’s disease (AD) is characterised by cognitive impairment and progressive brain atrophy. Recent human neuroimaging studies showed that such AD symptoms are linked with anatomical and functional changes seen in the default mode network (DMN), but the key brain region whose atrophy disturbs the neural activity of the DMN and consequently contributes to the symptoms of AD remains unclear. Here, we examined the intrinsic neural timescales (INT) of the regions in the DMN aiming to identify such a crucial brain area. We investigated INT since prior work demonstrated its utility in quantifying local neural dynamics and bridging knowledge gaps between atypical local neuroanatomical features and symptoms in neuropsychiatric disorders. We used resting-state functional MRI data and compared INT between individuals diagnosed with AD and age-/sex-/handedness-matched cognitively normal individuals. To exclude the possibility that a region outside of the DMN has such a critical role, we first performed an exploratory whole-brain analysis and found that only the left angular gyrus, a region within the DMN, exhibited a shorter INT in the AD group compared to those with normal cognition. We also identified an AD-specific decrease in the grey matter volume in the left angular gyrus and revealed that such regional atrophy shortened the INT of the angular gyrus and consequently reduced the overall INT of the DMN. Moreover, we found that the overall shorter DMN INT led to the symptoms of AD, particularly, its impairments of attention control. Taken together, our findings indicate that the left angular gyrus serves as a key brain region whose structural atrophy and resultantly shorter INT destabilise DMN neural dynamics and contribute substantially to AD cognitive decline. Clinically, the outcome of this study indicates that INT of the left angular gyrus could serve as a convenient biomarker for the cognitive symptoms of AD.
Dietary nutrient balances and serum cholesterol: a new approach to an old question
Authors: Corrêa Leite Maria Léa 
Published: June 2023

AbstractThe continuing controversy concerning the relationships between diet and serum cholesterol levels highlights the need for innovative analytical approaches to the question. It is now acknowledged that dietary data are compositional in nature, but it is less widely recognised that the same is also true of any variable expressed in concentration units (mg/mL), such as serum cholesterol. Compositional data are parts of a whole and convey essentially relative information, which means they need to be interpreted in terms of the ratios between the individual components of the composition. The various formulations of log-ratio transformations proposed for compositional data analysis provide new variables that can be included in standard regression models as dependent and explanatory variables. Using data from an Italian population-based study, we describe the use of such methods to evaluate the relationships between a two-part composition (non-HDL and HDL cholesterol and their total) and three dietary nutrient compositions, and define multivariate linear regression equations that have one cholesterol log-ratio and the composition total as dependent variables and some macro- and micronutrient log-ratios as explanatory terms. Two alternative models are fitted: one containing the nutrient log-ratios in the form of their simplified expression as orthogonal balances; the other estimating the impact of nutrient pivot balances, which express the relative dominance of each of the parts of the dietary compositions. This approach to investigating the relationship between diet and serum cholesterol allows the simultaneous examination of the effects of non-redundant dietary components on both the quantitative and qualitative aspects of serum cholesterol profiles, and provides insights into some matters concerning public health.